scholarly journals A closed loop two cycle audit investigating the availability and accessibility of physical healthcare equipment on forensic inpatient wards within mersey care's secure division

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S74-S74
Author(s):  
Thomas Davies ◽  
Stephen Owens ◽  
Tonia Forjoe
Keyword(s):  
Physical Health ◽  
Closed Loop ◽  
Psychiatric Inpatient ◽  
Control Sample ◽  
Care Quality ◽  
Percentage Increase ◽  
Acute Setting ◽  
Equipment Availability ◽  
The Mean ◽  
Forensic Inpatient

AimsTo evaluate the provision of recommended medical equipment on forensic psychiatric inpatient wards in Mersey Care's secure division, as outlined by the Care Quality Commission (CQC) in their 2019 guidance “Brief Guide: Physical Healthcare In Mental Health Settings”. It has been documented that people with severe and enduring mental illness are at risk of dying on average 15 to 20 years earlier than people without, two thirds of which are due to avoidable physical illnesses. It was our aim to use these data to improve the provision of physical healthcare equipment on the wards of Mersey Care's secure division, in turn allowing for the safe assessment of patients in the acute setting, and the monitoring their chronic health conditions.MethodWe conducted a closed loop, two cycle audit of all forensic inpatient wards in Mersey Care's secure division measuring the provision of physical health equipment against the CQC's 2019 guidance. The intervention was to present our findings and implement physical health equipment boxes in the clinic rooms on the wards. Low, medium, high, and secure learning disability (LD) wards were audited, with a control sample of non-secure wards (addiction, old age, general adult, and LD non-secure) in the initial cycle for comparison.ResultOn initial audit, the mean availability of equipment across the secure division was 66% (range 50.9%-88.9%), and 75% across our sample of wards in the non-secure divisions (range 61.1%-88.9%). Following the intervention in the secure units, the mean availability increased to 73.5% (range 72.2%-77.8%). The mean percentage increase in equipment availability following intervention was 12.5% (range -12.5% to 41.8%).ConclusionFollowing the intervention, the re-audit conducted found an overall improvement with 73.5% of recommended equipment available. Despite this improvement in equipment availability in the secure unit wards, the equipment is still less available than on the non-secure control wards. Due to this, further intervention and another re-audit have been planned. In the second cycle, significant items such as disposable gloves, pulse oximeters, sphygmomanometers, thermometers and stethoscopes were available across all wards. This was an improvement from the initial audit and allows for the safe assessment of patients in the acute setting.

Creation of physiologic rhythm by closed loop stimulation in heart failure patients with severe chronotropic incompetence: worldwide first results of a pilot study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Proff ◽  
B Merkely ◽  
R Papp ◽  
C Lenz ◽  
P.J Nordbeck ◽  
...  
Keyword(s):  
Heart Rate ◽  
Closed Loop ◽  
Funding Source ◽  
Chronotropic Incompetence ◽  
First Results ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Abstract Background The prevalence of chronotropic incompetence (CI) in heart failure (HF) population is high and negatively impacts prognosis. In HF patients with an implanted cardiac resynchronisation therapy (CRT) device and severe CI, the effect of rate adaptive pacing on patient outcomes is unclear. Closed loop stimulation (CLS) based on cardiac impedance measurement may be an optimal method of heart rate adaptation according to metabolic need in HF patients with severe CI. Purpose This is the first study evaluating the effect of CLS on the established prognostic parameters assessed by the cardio-pulmonary exercise (CPX) testing and on quality of life (QoL) of the patients. Methods A randomised, controlled, double-blind and crossover pilot study has been performed in CRT patients with severe CI defined as the inability to achieve 70% of the age-predicted maximum heart rate (APMHR). After baseline assessment, patients were randomised to either DDD-CLS pacing (group 1) or DDD pacing at 40 bpm (group 2) for a 1-month period, followed by crossover for another month. At baseline and at 1- and 2-month follow-ups, a CPX was performed and QoL was assessed using the EQ-5D-5L questionnaire. The main endpoints were the effect of CLS on ventilatory efficiency (VE) slope (evaluated by an independent CPX expert), the responder rate defined as an improvement (decrease) of the VE slope by at least 5%, percentage of maximal predicted heart rate reserve (HRR) achieved, and QoL. Results Of the 36 patients enrolled in the study, 20 fulfilled the criterion for severe CI and entered the study follow-up (mean age 68.9±7.4 years, 70% men, LVEF=41.8±9.3%, 40%/60% NYHA class II/III). Full baseline and follow-up datasets were obtained in 17 patients. The mean VE slope and HRR at baseline were 34.4±4.4 and 49.6±23.8%, respectively, in group 1 (n=7) and 34.5±12.2 and 54.2±16.1% in group 2 (n=10). After completing the 2-month CPX, the mean difference between DDD-CLS and DDD-40 modes was −2.4±8.3 (group 1) and −1.2±3.5 (group 2) for VE slope, and 17.1±15.5% (group 1) and 8.7±18.8% (group 2) for HRR. Altogether, VE slope improved by −1.8±2.95 (p=0.31) in DDD-CLS versus DDD-40, and HRR improved by 12.9±8.8% (p=0.01). The VE slope decreased by ≥5% in 47% of patients (“responders to CLS”). The mean difference in the QoL between DDD-CLS and DDD-40 was 0.16±0.25 in group 1 and −0.01±0.05 in group 2, resulting in an overall increase by 0.08±0.08 in the DDD-CLS mode (p=0.13). Conclusion First results of the evaluation of the effectiveness of CLS in CRT patients with severe CI revealed that CLS generated an overall positive effect on well-established surrogate parameters for prognosis. About one half of the patients showed CLS response in terms of improved VE slope. In addition, CLS improved quality of life. Further clinical research is needed to identify predictors that can increase the responder rate and to confirm improvement in clinical outcomes. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Biotronik SE & Co. KG

Critical Care Nurses’ Physical and Mental Health, Worksite Wellness Support, and Medical Errors

2021 ◽  
Vol 30 (3) ◽  
pp. 176-184
Author(s):  
Bernadette Mazurek Melnyk ◽  
Alai Tan ◽  
Andreanna Pavan Hsieh ◽  
Kate Gawlik ◽  
Cynthia Arslanian-Engoren ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Critical Care ◽  
Physical Health ◽  
Medical Errors ◽  
Odds Ratio ◽  
Care Quality ◽  
Critical Care Nurses ◽  
Worksite Wellness ◽  
Physical And Mental Health

Background Critical care nurses experience higher rates of mental distress and poor health than other nurses, adversely affecting health care quality and safety. It is not known, however, how critical care nurses’ overall health affects the occurrence of medical errors. Objective To examine the associations among critical care nurses’ physical and mental health, perception of workplace wellness support, and self-reported medical errors. Methods This survey-based study used a cross-sectional, descriptive correlational design. A random sample of 2500 members of the American Association of Critical-Care Nurses was recruited to participate in the study. The outcomes of interest were level of overall health, symptoms of depression and anxiety, stress, burnout, perceived worksite wellness support, and medical errors. Results A total of 771 critical care nurses participated in the study. Nurses in poor physical and mental health reported significantly more medical errors than nurses in better health (odds ratio [95% CI]: 1.31 [0.96-1.78] for physical health, 1.62 [1.17-2.29] for depressive symptoms). Nurses who perceived that their worksite was very supportive of their well-being were twice as likely to have better physical health (odds ratio [95% CI], 2.16 [1.33-3.52]; 55.8%). Conclusion Hospital leaders and health care systems need to prioritize the health of their nurses by resolving system issues, building wellness cultures, and providing evidence-based wellness support and programming, which will ultimately increase the quality of patient care and reduce the incidence of preventable medical errors.

Speaking Fundamental Frequency Characteristics of Five- and Six-Year-Old Children with Mongolism

1970 ◽  
Vol 13 (2) ◽  
pp. 418-425 ◽  
Author(s):  
Bernd Weinberg ◽  
Marsha Zlatin
Keyword(s):  
Fundamental Frequency ◽  
Trisomy 21 ◽  
Clinical Observation ◽  
Control Sample ◽  
Frequency Standard ◽  
Normal Children ◽  
The Subject ◽  
The Mean ◽  
Voice Fundamental Frequency ◽  
Speaking Fundamental Frequency

Spontaneous speech samples of 27 children with trisomy-21 type Down’s syndrome and 66 normal children were tape-recorded and analyzed for mean fundamental frequency, standard deviation, and range. Results indicate that the mean speaking fundamental frequency (SFF) level for the sample of children with mongolism was significantly higher than the mean SFF level for the control sample. Approximately 50% of the children with mongolism had mean SFF levels exceeding the highest mean SFF level of their matched controls. In only two cases did the mean SFF for a child with mongolism fall below the mean SFF level for control children of the same age and sex. No child with mongolism exhibited a mean SFF level below the lowest mean SFF for any control subject. The subject in question is the clinical observation that children with mongolism typically have low voice fundamental frequency levels.

Analysis of Operation of AVC System in Fuzhou Power Grid

2014 ◽  
Vol 1061-1062 ◽  
pp. 1013-1016
Author(s):  
Jun Jie Xiong ◽  
Wei He ◽  
Hao He
Keyword(s):  
Success Rate ◽  
Closed Loop ◽  
Power Grid ◽  
Value Management ◽  
Operation And Maintenance ◽  
Equipment Availability

Through the statistics of AVC system equipment availability, closed loop rate, action number and success rate, analyses the operation of AVC system in Fuzhou power grid, there are still many problems, such as closed loop rate is not high, some AVC substation remote low success rate.In order to effectively improve the pertinent measures from the design, operation and maintenance, fixed value management etc..

scholarly journals Interleukin-5 (IL-5) increases spontaneous apoptosis of B-cell chronic lymphocytic leukemia cells in vitro independently of bcl-2 expression and is inhibited by IL-4

Blood ◽  
1994 ◽  
Vol 84 (7) ◽  
pp. 2297-2304 ◽  
Author(s):  
T Mainou-Fowler ◽  
VA Craig ◽  
JA Copplestone ◽  
MD Hamon ◽  
AG Prentice
Keyword(s):  
Lymphocytic Leukemia ◽  
Leukemia Cells ◽  
Percentage Increase ◽  
Spontaneous Apoptosis ◽  
Interleukin 5 ◽  
The Third ◽  
The Mean ◽  
Induced Apoptosis ◽  
Cell Chronic Lymphocytic Leukemia

Abstract During hematopoiesis, viability factors that suppress apoptosis are required throughout the differentiation process. Some of these factors may also function as growth factors. Interleukin-5 (IL-5) is recognized as a growth factor in hematopoiesis. We examined the involvement of IL- 5 as a viability factor of B-CLL in vitro. In 13 B-CLL cases studied, IL-5 at 20 U/mL increased spontaneous apoptosis by a mean percentage of 53% (range, 20% to 129%) (P < .05) after 2 days in culture. On the third day, the mean percentage increase was 37% (range, 18% to 50%). In all cases, IL-4 protected B-CLL cells against IL-5-induced apoptosis by a mean percentage of 47% (range, 18% to 81%) (P < .001). This protection was specific to IL-4 and it was reduced with anti-IL-4 antibody. In addition, expression of bcl-2 protein in untreated cultures was not significantly different from that of the IL-5-treated cells; mean equivalent of soluble fluorochrome (MESF) was 5.2 (range, 3.0 to 6.8) and 4.9 (range, 3.0 to 6.3), respectively (P > .2). In freshly isolated B-CLL cells, the MESF was 4.5 (range, 2.4 to 6.6). These results show that IL-5 induced apoptosis in B-CLL cells by a pathway that is independent of bcl-2 expression. IL-4 partially protects against this effect.

scholarly journals A Multi-Pollutant Air Quality Health Index (AQHI) Based on Short-Term Respiratory Effects in Stockholm, Sweden

2019 ◽  
Vol 16 (1) ◽  
pp. 105 ◽  
Author(s):  
Henrik Olstrup ◽  
Christer Johansson ◽  
Bertil Forsberg ◽  
Andreas Tornevi ◽  
Agneta Ekebom ◽  
...  
Keyword(s):  
Air Quality ◽  
Birch Pollen ◽  
Mean Value ◽  
Emergency Department Visits ◽  
Percentage Increase ◽  
Health Index ◽  
Mean Values ◽  
Quality Health ◽  
The Mean ◽  
Air Quality Health Index

In this study, an Air Quality Health Index (AQHI) for Stockholm is introduced as a tool to capture the combined effects associated with multi-pollutant exposure. Public information regarding the expected health risks associated with current or forecasted concentrations of pollutants and pollen can be very useful for sensitive persons when planning their outdoor activities. For interventions, it can also be important to know the contribution from pollen and the specific air pollutants, judged to cause the risk. The AQHI is based on an epidemiological analysis of asthma emergency department visits (AEDV) and urban background concentrations of NOx, O3, PM10 and birch pollen in Stockholm during 2001–2005. This analysis showed per 10 µg·m–3 increase in the mean of same day and yesterday an increase in AEDV of 0.5% (95% CI: −1.2–2.2), 0.3% (95% CI: −1.4–2.0) and 2.5% (95% CI: 0.3–4.8) for NOx, O3 and PM10, respectively. For birch pollen, the AEDV increased with 0.26% (95% CI: 0.18–0.34) for 10 pollen grains·m–3. In comparison with the coefficients in a meta-analysis, the mean values of the coefficients obtained in Stockholm are smaller. The mean value of the risk increase associated with PM10 is somewhat smaller than the mean value of the meta-coefficient, while for O3, it is less than one fifth of the meta-coefficient. We have not found any meta-coefficient using NOx as an indicator of AEDV, but compared to the mean value associated with NO2, our value of NOx is less than half as large. The AQHI is expressed as the predicted percentage increase in AEDV without any threshold level. When comparing the relative contribution of each pollutant to the total AQHI, based on monthly averages concentrations during the period 2015–2017, there is a tangible pattern. The AQHI increase associated with NOx exhibits a relatively even distribution throughout the year, but with a clear decrease during the summer months due to less traffic. O3 contributes to an increase in AQHI during the spring. For PM10, there is a significant increase during early spring associated with increased suspension of road dust. For birch pollen, there is a remarkable peak during the late spring and early summer during the flowering period. Based on monthly averages, the total AQHI during 2015–2017 varies between 4 and 9%, but with a peak value of almost 16% during the birch pollen season in the spring 2016. Based on daily mean values, the most important risk contribution during the study period is from PM10 with 3.1%, followed by O3 with 2.0%.

scholarly journals Do care plans and annual reviews of physical health influence unplanned hospital utilisation for people with serious mental illness? Analysis of linked longitudinal primary and secondary healthcare records in England

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e023135 ◽  
Author(s):  
Jemimah Ride ◽  
Panagiotis Kasteridis ◽  
Nils Gutacker ◽  
Christoph Kronenberg ◽  
Tim Doran ◽  
...  
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Physical Health ◽  
Serious Mental Illness ◽  
Care Quality ◽  
Care Plan ◽  
Care Plans ◽  
Primary Care Quality ◽  
Hospital Utilisation ◽  
Reduced Risk

ObjectiveTo investigate whether two primary care activities that are framed as indicators of primary care quality (comprehensive care plans and annual reviews of physical health) influence unplanned utilisation of hospital services for people with serious mental illness (SMI).Design, setting, participantsRetrospective observational cohort study using linked primary care and hospital records (Hospital Episode Statistics) for 5158 patients diagnosed with SMI between April 2006 and March 2014, who attended 213 primary care practices in England that contribute to the Clinical Practice Research Datalink GOLD database.Outcomes and analysisCox survival models were used to estimate the associations between two primary care quality indicators (care plans and annual reviews of physical health) and the hazards of three types of unplanned hospital utilisation: presentation to accident and emergency departments (A&E), admission for SMI and admission for ambulatory care sensitive conditions (ACSC).ResultsRisk of A&E presentation was 13% lower (HR 0.87, 95% CI 0.77 to 0.98) and risk of admission to hospital for ACSC was 23% lower (HR 0.77, 95% CI 0.60 to 0.99) for patients with a care plan documented in the previous year compared with those without a care plan. Risk of A&E presentation was 19% lower for those who had a care plan documented earlier but not updated in the previous year (HR: 0.81, 95% CI 0.67 to 0.97) compared with those without a care plan. Risks of hospital admission for SMI were not associated with care plans, and none of the outcomes were associated with annual reviews.ConclusionsCare plans documented in primary care for people with SMI are associated with reduced risk of A&E attendance and reduced risk of unplanned admission to hospital for physical health problems, but not with risk of admission for mental health problems. Annual reviews of physical health are not associated with risk of unplanned hospital utilisation.

Wool prices and sheep breeding objectives - a historical perspective

1994 ◽  
Vol 45 (8) ◽  
pp. 1671 ◽  
Author(s):  
DJ Cottle
Keyword(s):  
Important Determinant ◽  
Moving Average ◽  
Fibre Diameter ◽  
Percentage Increase ◽  
Sire Evaluation ◽  
Selection Indices ◽  
Breeding Objectives ◽  
Fibre Fineness ◽  
The Mean ◽  
Fleece Weight

An analysis of weekly wool prices for different fibre diameter market indicators from 1950 to 1993 was conducted to determine appropriate economic values for the calculation of sheep selection indices. An important determinant of breeding objectives and selection indices is the percentage increase in the value of wool for each 1 8m reduction in fibre diameter, termed index percentage (IP). From 1950 to 1981 the appropriate IP value for fine (20 8m), medium (21 8m) and strong (23 8m) wool Merinos was 5%. From 1981 to 1993 the mean weekly IP values for fine, medium and strong wool Merinos were about 20, 15 and 8% respectively. The 5 year moving average IP values in 1993 for fine, medium and strong wool Merinos were 25, 20 and 8% respectively. The distributions of weekly wool prices and IP values are not normal and are positively skewed. Therefore, a safer, more conservative approach is to calculate the median weekly IP values for any period or to use median weekly wool prices to calculate IP values. The median weekly IP values for 1981-1993 were 20, 11 and 8% for fine, medium and strong Merino wools respectively. Thus recently there has been a larger relative premium for fibre fineness which could be a permanent trend. Selection efficiencies for clean fleece weight and fibre diameter in fine and strong wool Merinos are predicted to be at least 90% when 10% and 5% indices are used respectively. Selection efficiency in medium wool Merinos when a 5% index is used is only 79% if the 'true' IP is 15%, or 90% if the 'true' IP is 10%. The 10% and 5% indices are currently calculated and made available to the ram owners who participate respectively in the N.S.W. Merino fine and medium wool sire evaluation schemes. It is suggested that there is a case for using indices with higher fibre diameter premiums (i.e. 20% and 10% respectively), than those currently provided in the fine and medium wool schemes.

scholarly journals Non-Linear Dynamic Feature Analysis of a Multiple-Stage Closed-Loop Gear Transmission System for 3D Circular Braiding Machine

Symmetry ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 1788
Author(s):  
Lingling Yao ◽  
Zhuo Meng ◽  
Jianqiu Bu ◽  
Yize Sun
Keyword(s):  
Closed Loop ◽  
Transmission Error ◽  
Mean Value ◽  
Transmission System ◽  
Gear Transmission ◽  
Random Disturbance ◽  
Symmetrical Structure ◽  
Linear Dynamic ◽  
Gear Transmission System ◽  
The Mean

Aiming at the particularity of a multiple-stage closed-loop gear transmission system for 3D circular braiding machine, the model of gear transmission system in radial braiding machine was simplified. The non-linear dynamic equations of a n-elements closed-loop gear transmission system with symmetrical structure including static transmission error, the random disturbance of meshing damping and backlash were considered. For convenience of calculation n = 3, the equations were solved numerically by using Runge-Kutta. The dynamic transmission error(DTE) with different backlash, dynamic meshing forces with and without the random disturbance of meshing damping, the amplitude of dynamic transmission error at n = 1000 r/min and b = 2.65 × 10−5 m, root mean square(RMS) of DTE and the mean value of DTE of the first pair of gears were analyzed. The simulation results show that different backlash and the random disturbance of meshing damping have a great influence on the dynamic displacement error and meshing force of the gear pair, and RMS and the mean value of DTE changes at different rotational speeds. The results will provide a reference for realizing the smoothness of the closed-loop gear transmission system with symmetrical structure for 3D braiding machine and have great practical significance for improving the braiding quality.

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