THE EFFECT OF TASK ORIENTED FUNCTIONAL TRAINING PROGRAMME IN ELDERLY WITH HEMORRHAGIC STROKE- A CASE STUDY

2021 ◽  
pp. 63-65
Author(s):  
Anuradha Pai ◽  
Shiksha Yadav
Keyword(s):  
Daily Living ◽  
Tertiary Care ◽  
Training Programme ◽  
Stair Climbing ◽  
Care Hospital ◽  
Post Intervention ◽  
Functional Training ◽  
Activity Promotion ◽  
Task Oriented ◽  
Bed Mobility

BACKGROUND- A 70 year old unknown male patient was found unconscious on road and was brought to tertiary care hospital. On investigations and clinical correlation, patient was diagnosed as a case of left hemiparesis secondary to acute middle cerebral artery infarct. Patient regained consciousness on next day and was in state of complete dependence for bed mobility and daily living activities. He was managed conservatively and was referred to occupational therapy department for further management. METHOD- Patient was evaluated by using uniform terminology. Modied Barthel index, Modied Rankin Scale, Basic MOCA scale and Stroke Specic QOL scales were administered. Patient was given intervention for 5 weeks. Enabling activities with self-care functional activities were practised. Accident prevention, activity promotion, Compensatory strategies and environmental modications were done. Scales were administered post intervention and comparative data was obtained. RESULT- Change of pre-intervention and post- intervention score indicates improvements in performing activities of daily living, reduced disability, improved cognition and quality of living. There were signicant improvement in activities like eating, drinking milk, in bed mobility dressing and coming to sit. Minimum to moderate improvement was seen in activities like toileting, walking, stair climbing and use of wheelchair. Despite his age and lack of family support, signicant functional improvements were documented in this elderly stroke patient, and he was discharged to old age home. CONCLUSION- Supplementing enabling activities with task oriented functional training is feasible and effective in improving independence for activity of daily living in elderly stroke

scholarly journals 600. Decreased Hospital Readmission After Programmatic Strengthening of an Outpatient Parenteral Antimicrobial Therapy (OPAT) Program

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S362-S363
Author(s):  
Gaurav Agnihotri ◽  
Alan E Gross ◽  
Minji Seok ◽  
Cheng Yu Yen ◽  
Farah Khan ◽  
...  
Keyword(s):  
Hospital Readmission ◽  
Multinomial Logistic Regression ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Intervention Group ◽  
Care Hospital ◽  
Full Time ◽  
Post Intervention ◽  
Before And After ◽  
The Impact

Abstract Background Although it is recommended that an OPAT program should be managed by a formal OPAT team that supports the treating physician, many OPAT programs face challenges in obtaining necessary program staff (i.e nurses or pharmacists) due to limited data examining the impact of a dedicated OPAT team on patient outcomes. Our objective was to compare OPAT-related readmission rates among patients receiving OPAT before and after the implementation of a strengthened OPAT program. Methods This retrospective quasi-experiment compared adult patients discharged on intravenous (IV) antibiotics from the University of Illinois Hospital before and after implementation of programmatic changes to strengthen the OPAT program. Data from our previous study were used as the pre-intervention group (1/1/2012 to 8/1/2013), where only individual infectious disease (ID) physicians coordinated OPAT. Post-intervention (10/1/2017 to 1/1/2019), a dedicated OPAT nurse provided full time support to the treating ID physicians through care coordination, utilization of protocols for lab monitoring and management, and enhanced documentation. Factors associated with readmission for OPAT-related problems at a significance level of p< 0.1 in univariate analysis were eligible for testing in a forward stepwise multinomial logistic regression to identify independent predictors of readmission. Results Demographics, antimicrobial indications, and OPAT administration location of the 428 patients pre- and post-intervention are listed in Table 1. After implementation of the strengthened OPAT program, the readmission rate due to OPAT-related complications decreased from 17.8% (13/73) to 6.5% (23/355) (p=0.001). OPAT-related readmission reasons included: infection recurrence/progression (56%), adverse drug reaction (28%), or line-associated issues (17%). Independent predictors of hospital readmission due to OPAT-related problems are listed in Table 2. Table 1. OPAT Patient Demographics and Factors Pre- and Post-intervention Table 2. Factors independently associated with hospital readmission in OPAT patients Conclusion An OPAT program with dedicated staff at a large academic tertiary care hospital was independently associated with decreased risk for readmission, which provides critical evidence to substantiate additional resources being dedicated to OPAT by health systems in the future. Disclosures All Authors: No reported disclosures

Impact of targeted bundles to reduce the nebulization time gap from prescription to administration among red triaged patients in emergency department: An quality improvement initiative

2021 ◽  
Author(s):  
Seema Sachdeva seema sachdeva ◽  
Akshay Kumar Akshay Kumar ◽  
Parveen Aggarwal Parveen Aggarwal
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Signs And Symptoms ◽  
Fish Bone ◽  
Quality Improvement Initiative ◽  
Care Hospital ◽  
Analysis Model ◽  
Post Intervention ◽  
Targeted Interventions ◽  
Administration Time

Abstract BackgroundSevere exacerbation of asthma are potentially life-threatening and therefore require prompt care and frequent management. Important elements of early treatment includes recognition of early signs and symptoms of breathing difficulty and timely prescription and administration of therapeutic agents. A subsequent delay in receiving nebulization during an acute exacerbation of asthma can leads to cardiac arrest and even death. AimTo reduce the gap in administration of nebulization from its prescription time among red triaged patients by 50% from its baseline. Setting and designThis interventional study was conducted among red triaged patients in emergency department of tertiary care hospital, India . Material and MethodsBaseline information was collected during first 4 weeks to find gap in administration of nebulization from its prescription time. Fish bone analysis and process map were laid down to analyse the situation. The intervention using targeted bundles was done via 3 PDSA (PDSA1: indenting the nebulizers, PDSA 2: training of doctors and nurses, PDSA 3; introducing equipment checklist) to reduce the gap . A run chart using time series analysis model was used to compare the pre and post intervention nebulization gap. ResultsTotal 74 patients (30 in pre- intervention, 44 in post intervention) admitted in red triaged area were observed for nebulization gap from prescription to administration. Median time for nebulization gap before intervention was 46.5 minutes which reduced to 15 minutes in post intervention phase. ConclusionThis bundles of targeted interventions was successful to reduce the nebulization gap. Key words: nebulization gap, prescription time, administration time

scholarly journals 1225. How Frequently Should Sink Drains Be Disinfected?

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S440-S440
Author(s):  
Jorge A Ramos-Castaneda ◽  
Matthew L Faron ◽  
Joshua Hyke ◽  
Blake W Buchan ◽  
Rahul Nanchal ◽  
...  
Keyword(s):  
Hydrogen Peroxide ◽  
Horizontal Transmission ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Control Group ◽  
Care Hospital ◽  
Bacterial Reduction ◽  
Post Intervention ◽  
Bacterial Colony ◽  
Healthcare Facilities

Abstract Background New evidence shows the relevance of sink drains in the horizontal transmission of multidrug-resistant organisms. We recently demonstrated that a peroxide-based disinfectant (product B) was better than bleach at disinfecting sink drains; however, we did not determine the duration of this effect. In this study, we evaluate the duration of bacterial reduction in sink drains treated with product B and compared it to an enhanced hydrogen peroxide agent (product A). Methods Testing was performed in a 26-bed medical intensive care unit at a 566-bed tertiary care hospital in Milwaukee, WI. Two disinfectants were compared: product A (hydrogen peroxide, octanoic acid, and peroxyacetic acid; Virasept, Ecolab) and product B (hydrogen peroxide-based disinfectant; Peroxide Multi Surface Cleaner and Disinfectant, Ecolab). Sinks were randomly assigned to product A, product B, and control (no disinfection). On day 0, baseline cultures were obtained and disinfectant agents were applied. On post-intervention days 1, 3, 5, and, 7, samples from each drain were collected using E-swabs (Copan, Italy). Quantitation of Gram-negative burden was determined by serial dilution in saline plated to MacConkey agar and dilutions that contained 20–200 colonies were used for bacterial colony-forming units (CFU). Multivariate multiple linear regression and analysis of variance were used to compare mean Ln(1+CFU) between groups using R v3.5.0. Environmental sampling, cultures, and statistical analyses were performed blinded to the disinfected used. Results All three groups had similar CFU counts at baseline (P > 0.05). On day 1, a statistically significant reduction in bacterial CFUs was observed in the group treated with product A compared with sinks treated with product B (P = 0.04) or the control group (P < 0.01). The same differences were observed on day 3 post-intervention. There were no significant reductions on days 5 and 7. Conclusion Product A was the most effective product at disinfecting sink drains but its effect disappeared at 5 days post-disinfection. These results suggest that treating sink drains every 5 days with a hydrogen peroxide mixture would be ideal for healthcare facilities dealing with sink drain contamination. Disclosures All authors: No reported disclosures.

scholarly journals IMPACT OF CERTAIN EDUCATIONAL INTERVENTIONS ON ADVERSE DRUG REACTION REPORTING BY NURSING HEALTH PROFESSIONALS AT A TERTIARY CARE HOSPITAL

2020 ◽  
pp. 175-180
Author(s):  
SUPRIYA SONOWAL ◽  
CHETNA K DESAI ◽  
JIGAR R PANCHAL
Keyword(s):  
Adverse Drug Reaction ◽  
Drug Reaction ◽  
Health Professionals ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Educational Interventions ◽  
Care Hospital ◽  
Post Intervention ◽  
Adr Reporting ◽  
Nursing Health

Objectives: The objectives of the study were to evaluate the impact of certain educational interventions on adverse drug reaction (ADR) reporting by nursing health professionals at a tertiary care hospital. Methods: Knowledge, attitude, and practice (KAP) of the nurses regarding ADR reporting were evaluated before and after interventions using a KAP questionnaire. Educational interventions carried out among the nurses were workshops, booklets, SMSes, personal briefings, and posters. Number and quality of ADR reported by nurses in pre-intervention (3 months), intervention (10 months), and post-intervention (3 months) phase were compared. Results: There was a significant increase in response rate to questionnaires in the post-intervention phase (post-IP) (97.74%) as compared to pre-intervention (91.28%) phase (pre-IP). The knowledge score of the nurses increased significantly in post-IP (11.65 ± 2.14) as compared to the pre-intervention (6.98 ± 2.46) phase. No ADR was reported by nurses in pre-IP. Thirty nurses reported 30 ADRs in the intervention phase and six nurses reported six ADRs in the post-IP. The mean score of completeness of ADR notification forms decreased significantly in post-IP. Maximum ADRs (10) were reported after the workshops. Conclusion: Educational interventions improved the KAP of ADR reporting by nurses, albeit temporary. This suggests the need of continuous educational interventions.

scholarly journals Outcome of intra-articular hyaluronic acid in treatment of osteoarthritis of knee at a tertiary care hospital in Kathmandu, Nepal

2019 ◽  
Vol 7 (1) ◽  
pp. 36-40
Author(s):  
Deepak Kumar Dutta
Keyword(s):  
Hyaluronic Acid ◽  
Knee Osteoarthritis ◽  
Functional Outcome ◽  
Tertiary Care ◽  
Oxford Knee Score ◽  
Functional Improvement ◽  
Care Hospital ◽  
Post Intervention ◽  
Viscous Solution

Background and Objectives: Intra-articular hyaluronic acid is widely used in the treatment of knee osteoarthritis. This study aimed to assess the efficacy of hyaluronic acid in moderate severity knee osteoarthritis. Material and Methods: Patients of knee osteoarthritis were administered single intra-articular injection of Hyaluronic Acid 25 mg (2.5 ml viscous solution) and were followed up at 4, 12, and 24 weeks. Functional improvement was assessed using Oxford Knee Score (OKS). Comparisons of pre- and post-intervention mean OKS scores were done by paired t test. Results: Total 50 patients (mean age 58.62±12.62 years) were studied. In the six months follow up, patients showed marked improvement in functional outcome from a mean OKS of 27 before injection to 39 at 4 weeks and remained constant up to 6months of follow up. Conclusion: Intra-articular hyaluronic acid injectionas a treatment modality for moderate grade knee osteoarthritis provides good functional outcome and pain control for up to six months.

scholarly journals P048: Brief online educational intervention improves emergency physicians’ and general surgeon's ability to interpret focused gallbladder ultrasound

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S81-S81
Author(s):  
S. Peng ◽  
M. Woo ◽  
P. Glen ◽  
B. Ritcey ◽  
W. Cheung ◽  
...  
Keyword(s):  
Gallstone Disease ◽  
Tertiary Care ◽  
Emergency Department Visits ◽  
Biliary Colic ◽  
Care Hospital ◽  
Emergency Physicians ◽  
Post Intervention ◽  
Significant Difference ◽  
Post Assessment ◽  
Gallbladder Ultrasound

Introduction: Biliary colic is a frequent cause for emergency department visits. Ultrasound is the initial test of choice for gallstone disease. We evaluated the effectiveness of a brief online educational module aimed to improve Emergency Physicians’ (EP) and General Surgeons’ (GS) accuracy in interpreting gallbladder ultrasound. Methods: EPs and GSs (resident/fellow and attending) from a single academic tertiary care hospital were invited to participate in a pre- and post- assessment of the interpretation of gallbladder ultrasound. Demographic information was obtained in a standardized survey. All questions developed for the pre- and post- assessment were reviewed for content and clarity by 3 EP and GS experts. Participants were asked 22 multiple-choice questions and then directed to a 7-minute video-tutorial on gallbladder ultrasound interpretation. After a 3-week period, participants then completed a post-intervention assessment. Following pre- and post- assessment, participants were surveyed on their confidence in gallbladder ultrasound interpretation. Data was analyzed using descriptive statistics and paired t-test. Results: The overall response rate of the pre-intervention was 50.9% (116/228) and 40.8% (93/228) for the post-intervention. In pre-intervention assessment, 27.7% of participants reported they were “not at all confident” in interpreting gallbladder ultrasound. This contrasted with post-intervention confidence level, where only minority (7.8%) reported “not at all confident”. There was a significant increase from the pre- to post- intervention (75.7% to 85.4%; p < 0.01) in correct interpretations. The greatest improvement was seen in those with previous experience interpreting gallbladder ultrasound (from 79.6% to 91.1%; p < 0.01). EPs scored significantly higher than GSs in the pre-intervention (EPs 78.2% compared to GSs 71.0%; p < 0.01). This trend was also observed in post-intervention, although the difference was no longer significant (EPs 88.9% compared to GSs 82.8%; p = 0.05). There was no significant difference in performance between residents/fellows compared to attendings. Conclusion: This brief, online intervention improved the accuracy of EPs’ and GSs’ interpretation of gallbladder ultrasound. This is an easily accessible tutorial that can be used as part of a comprehensive ultrasound educational program. Further studies are required to determine if EPs’ and GSs’ interpretations of gallbladder ultrasound impacts patient-oriented outcomes.

scholarly journals Role of Informed Consent in Reducing Pre-Operative Anxiety

2018 ◽  
Vol 3 (1) ◽  
Keyword(s):  
Informed Consent ◽  
Tertiary Care ◽  
Sampling Technique ◽  
Preoperative Anxiety ◽  
Care Hospital ◽  
Post Intervention ◽  
Public And Private ◽  
Surgical Units ◽  
Quasi Experimental

Background: Preoperative anxiety is challenging concept in preoperative patients. It could reduce by various methods; one of them is informed consent in which information is provided to patients regarding anesthesia and surgical procedure, it also helps patients to make autonomous decision. Objective: The aim this study was to identify the role of informed consent in preoperative anxiety, in surgical patients of both public and private tertiary care hospital Peshawar. Method: A quasi experimental study design was carried out among preoperative patients of surgical units. The sample of 65 participants was selected through convenient sampling technique. First, the preoperative anxiety was measured with valid adopted questionnaire APAIS. Second, the informed consent was explained to patients and after this again preoperative anxiety was measured to see the effect of informed consent on preoperative anxiety. Results: Among 65 participants 41 (63.1%) were males and 24 (36.9%) were females. 58 (89.2%) were married and 7 (10.8%) were unmarried. The mean age of participants was 49.92 +16.76 years. 24 (36.9%) of the participants were uneducated, 17 (26.2%) primary, 13 (20.0%) secondary, 6 (9.2%) bachelor, and 5 (7.7%) had higher education. The participants were graded for preoperative anxiety, 3 (4.6%) had somewhat, 9 (13.8%) moderate, 27 (41.5%) moderately high, and 26 (40.0%) had extremely high anxiety. while the post-intervention anxiety grades were identified as 20 (30.8%) somewhat, 18 (27.7%) moderate, 17 (26.2%) moderately high, and 10 (15.4%) extremely high. The study shows that well explained informed consent reduced the patient pre-operative anxiety. Conclusion: Preoperative anxiety is common phenomena experienced by patient undergoing through surgical procedures, informed consent is a tool that ensure the respect of patient autonomy and reduce their preoperative anxiety.

scholarly journals The effect of ladder approach on development of preterm low birth weight infants with HIE-2

2020 ◽  
Vol 7 (3) ◽  
pp. 520
Author(s):  
Tushar R. Jadhav ◽  
Shailaja S. Jaywant
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Premature Infants ◽  
Tertiary Care ◽  
Control Group ◽  
Care Hospital ◽  
Post Intervention ◽  
Low Birth Weight Infants ◽  
Significant Difference

Background: Premature infants with Peri-natal asphyxia leading to a hypoxic-ischemic encephalopathy (HIE) are at greater risk for cerebral palsy. HIE grade II infants have long term neurological complications due to maladaptive brain wiring during NICU stay. Ladder approach, with graded stimulation program is administered by Occupational therapist, plays a vital role to minimize the maladaptive responses to environment. Objective of this study was to effect of Ladder Approach on preterm low birth weight Infants with HIE-2 as compared to conventional treatment. Design of this study was to Prospective Block Randomized Convenient Sampling Control Trial, Experimental design study. The study was carried out in the NICU and PU ward of Tertiary care hospital in metropolitan city from April 2015 to October 2016. The study subjects included a convenient sample of 30 preterm Low birth weight HIE-2 infants randomly selected into study or control groups. Neonatal behavioural Assessment scale (NBAS), Infant Neurological International Battery (INFANIB).Methods: The preterm infants from study group who received Ladder Approach and control group who received routine conventional care only. Outcome measures NBAS was at baseline and first follow up. INFANIB was administered at second follow up to assess neurodevelopment.Results: Showed that the premature infants of the study had significant difference in neuro behavioral status with mean for all subcomponents from to post intervention mean 39.6 in experimental group and from baseline mean of 24.3 to post intervention mean score of 33.2 in control group on neurobehavioral scale. Further neurodevelopmental status showed similar results on INFANIB in experimental group.Conclusions: The premature Infants with HIE grade 2, receiving ladder approach have shown more mature responses resulting into well-organized Neurobehavioral status, and resulted in improved brain wiring as evident in INFANIB.

scholarly journals Assessment of Utilization of Rehabilitation Services among Stroke Survivors

2018 ◽  
Vol 09 (04) ◽  
pp. 461-467 ◽  
Author(s):  
Chandel Mahak ◽  
Nagi Manisha ◽  
Ghai Sandhya ◽  
Khurana Dheeraj ◽  
Manju Dhandapani ◽  
...  
Keyword(s):  
Daily Living ◽  
Health Workers ◽  
Tertiary Care ◽  
Rehabilitation Services ◽  
Stroke Survivors ◽  
Care Hospital ◽  
Exclusion Criteria ◽  
Factors Affecting ◽  
Stroke Population ◽  
Common Problems

ABSTRACT Background: Rehabilitation is probably one of the most important phases of recovery for many stroke survivors. The current study was conducted with the objective to assess the utilization of rehabilitation services and factors affecting nonutilization of rehabilitation services among the stroke survivors. Materials and Methods: The current study was carried out in the Neuro Outpatient Department of a tertiary care hospital in India. It was a descriptive study. Consecutive 55 stroke survivors who had met the inclusion and exclusion criteria were recruited in this study. Self-structured rehabilitation tool was used to collect the data. Results: Data were analyzed using the descriptive and inferential statistics. Majority of the patients comprised 70.9% of males and 29.1% of females. Among participants, 70.90% were aware about rehabilitation, 67% were utilizing rehabilitation services, whereas 33% were not utilizing rehabilitation services. In the current study, certain reasons were found behind not utilizing rehabilitation services. There were 83.3% of participants who had lack of awareness about rehabilitation services and 61.1% of participants who had no availability of rehabilitation services. Only 45.5% of rural inhabitants were utilizing rehabilitation services as compared to 81.2% of urban inhabitants and 83.23% of suburban inhabitants. Conclusion: Rehabilitation is of utmost importance. Hemiparesis, difficulty in performing activity of daily living, difficulty in performing social activities, and difficulty in reasoning were the most common problems faced by people suffering stroke after discharge from the hospital. There was lack of awareness and utilization of rehabilitation services by patients among Indian stroke population. Hence, health workers have an immense role in educating, motivating, and ensuring that rehabilitation services in rural inhabitants.

scholarly journals Referrals to a pediatric emergency room of a tertiary care teaching hospital before and after introduction of a referral education module- a qualitative study 

2020 ◽  
Author(s):  
Gopalakrishnan Ezhumalai ◽  
Jayashree Muralidharan ◽  
Arun Bansal ◽  
Karthi Nallasamy ◽  
Bhavneet Bharti
Keyword(s):  
Emergency Room ◽  
Tertiary Care ◽  
Geographical Area ◽  
Pediatric Emergency ◽  
Critically Ill Children ◽  
Care Hospital ◽  
Care Providers ◽  
Post Intervention ◽  
Intervention Phase

Abstract Background: Provision of timely care to critically ill children is essential for good outcome. With development of specialized pediatric critical care units, referral from community and smaller peripheral hospitals has received greater impetus. Our tertiary care hospital caters to referrals from a wide geographical area. Since there is no standard referral and feedback system in India, we decided to evaluate the quality of referrals coming to our Emergency Room (ER) with respect to their demography, association with severity of illness and mortality. We plan to use this data to establish a standard referral and feedback process to streamline our ER referrals. Methods: Our study was completed in three phases in Pediatric ER;Pre-intervention, Intervention and Post intervention phases. Quality of referrals was graded by granting one score to presence of each item when matched with a quality checklist performa. A referral was graded ‘good’, ‘fair’ and ‘poor’ if it scored >7, 5 –7 and < 5 points respectively. Case studies, expert opinions, and lacunae observed in first phase were taken into consideration while preparing the referral education module, that was administered to health care providers of referring hospitals. Quality of referrals was compared between pre and post intervention phases. Results: Majority of inpatient admissions were ‘referred’ patients (99.3%). Most referrals belonged to the neighboring states of Punjab (48.2%) and Haryana (22.4%). Major referrals were from public sector hospitals (80.9%) of which the teaching hospitals topped the list (53.6%). Most common mode of transport was government run ambulance services(85.5%) and the common reason for referral was need for PICU bed and/or mechanical ventilation (50.4%). The post intervention phase saw a significant decline in the proportion of poor referrals (93.2 vs.78.2%;p=0.001) and a significant increase in the proportion of fair(6.1 vs 18%; p=0.001)and good referrals (0.7 vs 18%;p=0.001) Proportion of children presenting to triage with physiological decompensation with respect to poor referrals had significantly decreased in post intervention phase [580(79.8%) vs 1025(93.7%); p=0.0001]. Conclusion:Referral education had significantly improved the quality of referrals coming to our ER. Continuing education will be required for sustained and increased benefits. Key words: Quality of referral, Pediatric emergency, Triage

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