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Biomedical subjects

S Gardner

Publications and source records attributed to S Gardner.

87 records · Page 5Linked to original sources
PubMedDate not supplied

A nosocomial common source outbreak caused by Pseudomonas pickettii.

Pseudomonas pickettii, a Gram-negative bacillus which has been recovered rarely from clinical specimens, was isolated from the respiratory tracts of 9 of 29 (31%) pediatric intensive care unit patients. The reservoir of the organism was intrinsically contaminated single dose vials of tracheal irrigant solution. Four additional hospitals in three other states have notified the Centers for Disease Control of respiratory colonization with aerobic nonfermentative Gram-negative organisms and have associated this colonization with the use of the same tracheal irrigant solution. Because of the potential for intrinsic contamination, single dose vials must be added to the list of potentially hazardous environmental agents.

Adolescent↗
PubMedDate not supplied

Septicemia and septic shock in pediatric patients: 140 consecutive cases on a pediatric hematology-oncology service.

PURPOSE: This report describes the incidence of septic shock in pediatric hematology-oncology patients with positive blood cultures and investigates parameters of potential use in early diagnosis of gram-negative (GN) bacteremia and septic shock. PATIENTS: In a 12-month period, 140 consecutive episodes of septicemia (135 bacterial and 5 fungal) were seen in 100 patients. The absolute neutrophil count (ANC) was > 500/microl in 89 episodes (65%). RESULTS: Septic shock developed in patients with positive blood cultures with an overall incidence of approximately 19%. Of the 12 bacteremic patients who required transfer to the intensive care unit, 83% had a GN isolate recovered. The incidence of septic shock was not significantly lower in the group of patients with ANC > 500/microl. Low serum bicarbonate correlated with GN infection in patients with bacteremia. CONCLUSIONS: GN organisms were the major cause of septic shock in a group of pediatric hematology-oncology patients with positive blood cultures although they were recovered less frequently than gram-positive organisms. In our study, non-neutropenic patients with indwelling catheters were at approximately the same risk for GN shock as neutropenic patients. Monitoring blood carbon dioxide content may be useful in the early diagnosis of GN infection.

Adolescent↗
PubMedDate not supplied

A home advisory service for pre-school children with developmental delays.

This paper describes the development of a home advisory service for families of children with developmental difficulties. It demonstrates the transition from a research phase to routine service provision, and indicates that the expansion in numbers of families receiving the service has been achieved whilst maintaining or improving the actual quality of the service. Information is provided on the placement of children who have left the service, and on the plans for future research within the service.

Child Development↗
PubMedDate not supplied

The progress of developmentally delayed pre-school children in a home-training scheme.

The present study compared the rates of development of a group of 35 pre-school children in a home-training scheme. The children entered the service at different ages and suffered from different disabilities. The families received weekly visiting from a home advisor, who was specially trained to develop skills in the parents to help their children. Those who developed most rapidly were the group of environmentally deprived children. The non-specific developmentally delayed and Down's syndrome children progressed well during the study period. The children who suffered from cerebral palsy and those with visual handicaps developed at a very slow rate, despite the training that they were receiving. This finding may reflect the severity of their handicaps but also it suggests that the needs of these particular groups should be further examined. The age of entry to the scheme did not seem to be an important variable. The individual variability within each specified group was wide.

Child Development↗
PubMedDate not supplied

Sleep clinics with health visitors: a 2-year evaluation.

This study was undertaken to evaluate a service for sleep clinics over a time span of 2 years. The service was operated jointly by health visitors and clinical psychologists and based on a previous model run by the same team of psychologists and child development advisors. The outcome was not supportive of this type of service in terms of referral rates over a period of time, improvement rate, continued existence or cost-effectiveness of such a service. The reasons for the difficulties of such clinics are discussed.

Ambulatory Care Facilities↗
PubMedDate not supplied

The mother as incubator-after delivery.

Decreases in body temperature of 10 nude babies who were held next to their mothers' bodies were compared with the decreases in temperature of 9 babies who were kept in heated beds. After 15 minutes both groups of babies had identical temperatures of 98.1 degrees F, which is well above the acceptable minimum of 96.9 degrees F. It appears that mothers who desire to hold their babies immediately after delivery can be permitted to do so without concern by the staff that the babies will become chilled.

Body Temperature Regulation↗
PubMedDate not supplied

An integrated approach to hospital strategic planning, quality assurance, and continuous quality improvement.

Like many other healthcare organizations today, the authors' facility, a 306-bed acute care community hospital in Michigan, strives to visualize and make a transition from traditional quality assurance to continuous quality improvement. The Juran Trilogy provided the insight that strategic planning, measurement, and continuous improvement must exist side by side. At the authors' facility, this realization resulted in the hospital quality plan, which treats each of these components as part of the foundation for quality. The authors explain this model and the reporting and communication mechanisms that support it.

Communication↗
PubMedDate not supplied

Tracking the use and impact of a community social report: where does the information go?

The purpose of this paper is to report on a study evaluating the extent to which a social report (entitled "Hamilton-Wentworth Profile on Children and Youth") was read and used by recipients. Subjects were divided into two groups: an Active Group which had worked on producing the Profile and/or requested copies of it once it had been released, and a Passive Group which had received copies of the Profile through a general mailing list used for other research reports. Approximately one year later, 90% of the Active Group recalled the Profile compared to 21% of the Passive Group. Similarly, 83% of Active Group respondents had read the Profile compared to 8% of Passive Group subjects. 80% of Active Group respondents and 5% of Passive Group respondents used the Profile. The results suggest that if social reports are read by local community agencies and individuals, they will be used to help improve conditions for children and youth. Social reports at the local level are more likely to be read if potential users are engaged in the process of report production and if the reports are disseminated to the appropriate target audience.

Attitude of Health Personnel↗
PubMedDate not supplied

Assessing progress against the size of the problem.

To summarize articles with the depth and range of the nine in this collection is difficult. What the articles demonstrate as a whole is that a great deal of activity is under way in the arena of connecting child welfare and substance abuse services, with a growing body of documentation accompanying it. The articles bode good news in that they indicate a broadening awareness of the interconnectedness of these issues, and they highlight a number of creative and effective programs that have been established to mitigate the problems. Tremendous challenges-from funding to outcomes research-however, are also made evident in this body of work.

Adult↗
PubMedDate not supplied

Looking for Dr. Jekyll but hiring Mr. Hyde.

As healthcare facilities are expected to provide a safe environment for employees and the public, proactive steps must be taken to screen, supervise, and train employees. This article discusses human resource management procedures to avoid liability for negligent hiring, supervision, retention, and training.

Crime↗
PubMedDate not supplied

Integration of pressure ulcer treatment protocol into practice: clinical outcomes and care environment attributes.

The purpose of this study was to determine if a research-based protocol for pressure ulcer treatment that had been successfully implemented in a long-term care facility was sustained over time. A secondary aim was to describe the attributes of the care environment that may have contributed to or impeded the maintenance of this protocol. A retrospective chart review was conducted of all patients who developed incident stage II, III, or IV pressure ulcers in the facility over a one-year period five years after initial implementation of a pressure ulcer treatment protocol. Data regarding ulcer characteristics and type, frequency, and duration of treatments were collected. Subjects were followed until the ulcer healed, the subject died or was discharged, or the 1-year study period ended. Care environment attributes, including patient care hours, turnover and stability rates, salaries, decision-making structures, and facility mission were obtained from the facility's Human Resource Department and existing databases in the Nursing Services Department. Outcomes of protocol implementation were defined as ulcer healing and costs associated with treatment. Costs were calculated from the provider perspective and included cost of supplies and labor consumed in providing direct pressure ulcer care. Of the 46 incident ulcers treated during the one-year study period, 40 (87%) healed and five (11%) were unhealed when the subject died. One ulcer remained unhealed at the end of the study. The total cost for treatment of these incident ulcers was $18,688, with nursing labor comprising 80% of the total expenditures. Adherence to the protocol, which contained predominantly inexpensive moist wound healing treatment options, resulted in complete healing of most pressure ulcers at a relatively low cost to the facility. The organizational environment of the facility, which maintains staffing levels and salaries at higher than national averages and promotes staff nurse accountability and decision making, may have provided the necessary climate to overcome barriers to clinical integration and sustain the desired care practices.

Aged↗