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At least 235 records · Page 13Linked to original sources
PubMed1986

Effects of proprietary management in general hospital psychiatric units.

The rapid increase in the number of proprietary psychiatric hospitals during the last 15 years has drawn criticism from those concerned about the impact of the profit motive on the quality of patient care. This study assessed changes in the structure and quality of care on 13 acute care psychiatric units before and after a single outside proprietary firm was hired to manage the units. The study found significant improvements in many areas after the change; they included higher occupancy rates, higher staffing levels, more hours of staff inservice training, higher collections-to-billings ratios, and improved program structure and process as measured by Joint Commission on Accreditation of Hospitals criteria. No changes were found in the length of stay or diagnostic mix of patients. The findings indicate that program quality and profit are not necessarily incompatible, but the author cautions against making generalizations to other situations based on the small study sample.

Bed Occupancy↗
PubMed1989

The role of fantasies, countertransference, and psychological defenses in patient violence.

Over the past decade the management of aggression on psychiatric units has generally focused on pharmacologic and physical interventions rather than on psychodynamic concerns. The author reviews the dynamics of violence and discusses how clinical staff's fantasies, countertransferences, and psychological defenses may interact to trigger patient aggression. Interventions that address these issues with staff include developing a cohesive treatment team in which clinical staff can express their feelings without the need to explore the psychodynamic underpinnings, having clinical leaders maintain a strong presence on the unit to serve as role models, and providing regular inservice training.

Conflict, Psychological↗
PubMedDate not supplied

Microbial contamination of enteral feeding solutions in a community hospital.

Seven related studies were done to estimate the type and amount of contamination that occurred in nutrient feeding solution when administered according to procedure in a community hospital. The initial study was done in a simulated nonclinical setting with select technicians monitoring for gavage systems delivering a commercially prepared nutrient feeding solution. The solution remained sterile over 48 hr. In the second study, various nurses maintained the enteral feeding simulations unaware of the objective of study. Significant contamination was found, but a decrease occurred when the study was duplicated and the nurses were made aware that contamination was the issue being studied. The subsequent study had all gavage equipment in clinical use in the hospital on a given day cultured for microbial contamination. Significant contamination was present and did not decrease when the study was duplicated following inservice training. Suggestions for standards of care are made.

Enteral Nutrition↗
PubMed1993

Inadvertent intravenous administration of an elemental enteral nutrition formula.

OBJECTIVE: To report a case of intravenous infusion of an elemental enteral nutrition formula. CASE SUMMARY: A 65-year-old woman with a high-output jejunostomy required fluid and electrolyte replacement via a central line and enteral nutrition support via a gastrostomy tube. She inadvertently received 160 mL of half-strength elemental enteral nutrition formula (Vivonex TEN) via her central venous catheter. After four hours of the infusion, the patient felt ill and was found to by hypotensive and pyrexic. Over the next 24 hours she developed severe back pain and diffuse muscle tenderness. Her creatine kinase concentration was mildly elevated and there were no electrocardiographic changes. There was no rise in serum amylase concentration. Her renal function deteriorated markedly over the following three hours but responded to hydration and diuretic therapy. Liver enzymes, slightly elevated prior to this event, remained unchanged. Blood cultures were negative, but prophylactic therapy with vancomycin and ceftazidime was instituted. The patient recovered and was discharged eight days later. DISCUSSION: Previous reports of inadvertent intravenous administration of enteral feedings have described such complications as osmolarity, microembolism, hypersensitivity, and septicemia. This patient's nonfatal outcome may have been related to the infusion of the enteral formula via the central rather than the peripheral route, the infusion of an elemental rather than a whole protein formula, and the use of sterile water to reconstitute the formula. CONCLUSIONS: Particular care should be taken when a patient has more than one catheter implanted on the chest or abdomen (e.g., central venous or peritoneal dialysis catheter). It is important that inservice training is provided and written protocols are available for the safe infusion of enteral formulas.

Aged↗
PubMed2006

Using resident input to identify and integrate essential components of a foot and ankle rotation.

BACKGROUND: Foot and ankle surgery is one of the orthopaedic subspecialties to which residents not uncommonly receive limited exposure. Therefore, it is important to identify what both faculty and residents regard as fundamental to a foot and ankle rotation. The purposes of this study were to identify the essential components of a foot and ankle rotation and to correlate these with the American Orthopaedic Foot and Society (AOFAS) core curriculum, and to discuss how to integrate resident input and AOFAS guidelines into a valued foot and ankle rotation. METHODS: Over a 5-year period, each orthopaedic resident beginning a 10-week postgraduate year (PGY) 3 foot and ankle rotation was asked to choose topics to be covered during weekly 45-minute discussion conferences. Each resident also identified personal goals for the rotation. Data were collected in this prospective nature, and the responses of the 24 PGY 3 residents from our program who completed the rotation between February, 2000, and April, 2005, were analyzed. The discussion conference topics were compared to the AOFAS guidelines, and the top 10 personal goals were determined. Prerotation and postrotation Orthopaedic Inservice Training Examination (OITE) foot and ankle scores for the residents also were analyzed. RESULTS: Among the nine AOFAS core curriculum categories, residents most frequently chose chronic soft-tissue foot and ankle problems, followed in frequency by foot and ankle arthritis, foot and ankle trauma, and diabetic foot. Individually, posterior tibial tendon insufficiency, hallux valgus, diabetic foot, and calcaneal fracture were the most frequently chosen discussion conference topics. In regards to personal goals for the rotation, residents most commonly wanted to improve their physical examination skills (88%) and increase their orthotic knowledge (71%). The OITE scores improved by a mean of 12% after the rotation. CONCLUSIONS: This study provides new and detailed information about resident expectations for a valued foot and ankle rotation. These results should be integrated with existing AOFAS guidelines to further refine the essential components of a core foot and ankle curriculum.

Ankle↗
PubMed2003

Predict Resident Exam Performance (PREP) study.

Predictive relationships between Resident Inservice Training Examination (RITE) performance and first-attempt success on American Board of Psychiatry and Neurology (ABPN) neurology examinations were assessed in board-eligible residents at the University of Virginia from 1988 to 1998. Third-year RITE results were predictive of success on the written ABPN examination, but they did not adequately predict success on the oral or on combined examinations. Residency programs should consider developing training tools that predict outcome on the oral ABPN examination.

Adult↗
PubMed2002

RITE performance predicts outcome on the ABPN Part I examination.

OBJECTIVE: This study examined the performance correlation the American Academy of Neurology Resident Inservice Training Examination (RITE) and Part I of the American Board of Psychiatry and Neurology (ABPN) examination. METHODS: Candidates who took the RITE in the last year of training were tracked and their subsequent performance on the ABPN Part I examination was compared with their performance on the RITE. RESULTS: Performance on the RITE is predictive of performance on the ABPN Part I examination. CONCLUSIONS: The RITE can be used to assess a resident's readiness to take the ABPN Part I examination.

Internship and Residency↗
PubMed1990

[Profile of the nurse in the outpatient units of INAMPS in Brazil. O Instituto Nacional de Assistência Médica da Previdência Social].

The objective of this study was to outline a profile of the nurses working within the INAMPS (National Health Service) outpatients centers in Brasil. Its purpose was to offer some assistance on the understanding of the subject, to the nursing educational system, to the employers of the product of that system, to the nurses' associations and to the nurses themselves. In the pursue of the objective, the author depicted: personal and professional traits of the nurses; job satisfaction and perceived support from the administration; the most frequent nurses activities performed. It also established the relations between nurses traits, job satisfaction, perceived support, and activities performed. Data was collected from March to December 1984. The questionnaires were sent to the universe of working nurses in the outpatient centers--1158 nurses. 927 (80.1%) answers were obtained. The population studied represented: 94.3% female, majority married; 30 to 40 years old, year of graduation and year of admission in the INAMPS in the 70's. Gross results were: job satisfaction 83.6%, perception of support from administration 75.2%, prepared as specialists 71.3%, and frequence to continuing educational programs 84.1%. Mains activities performed by nurses in decreasing order: supervision of nursing personnel 39.3%, direct nursing care 36.7%, teaching of patients and families 21.7%, administrative--functions 17.9%, and inservice training of personnel 3.6%. No relation was demonstrated between graduate preparation and job satisfaction nor perceived support from administration. Positive relation was found between educative activities and job satisfaction, and between supervision of nursing personnel or performance of administrative functions and perception of support from the administration.

Adult↗
PubMed1993

Methods of minimising the cost of aminoglycoside therapy to hospitals.

Aminoglycoside agents are used for a wide variety of systemic infections and can profoundly affect hospital expenditures depending upon the amounts used, acquisition costs, and costs incurred during therapy. Significant cost advantages can be gained through selection and proper use of the appropriate aminoglycoside. Institutions can improve the selections by using inservice training and other educational methods, drug-use audits, and therapeutic substitution. Institutions may also restrict or delete certain aminoglycosides from the drug formularies to help minimise costs. Therapeutic drug monitoring can reduce the incidence of aminoglycoside adverse effects. However, some methods of monitoring, such as certain clinical pharmacokinetic services, can be time consuming and require additional manpower. These measures can be shown to be cost effective if they can decrease the length of therapy, minimise toxicity, decrease the length of hospitalisation, or affect mortality. Experimental data and preliminary clinical evidence suggest that once-daily regimens of aminoglycoside agents have some possible advantages over the standard regimens. If this regimen can be widely used, cost savings secondary to decreased use of aminoglycosides can be realised in the future. Potent, broad spectrum beta-lactam monotherapy has threatened to replace conventional combination therapies that include aminoglycosides in some infectious processes and a few studies have found certain single-drug therapies to be cost effective.

Aminoglycosides↗
PubMed1998

An audit tool for health visitors and SLTs working with the pre-school population.

This paper will present the preliminary findings of a national Royal College of Speech and Language Therapists audit of speech and language therapy and health visiting services to the pre-school population. The audit was carried out in six districts of the United Kingdom, representing a broad range of locations and models of service delivery. The purpose of the audit was to evaluate specific aspects of the management of children with speech and language difficulties. Audit tools were applied to referral and selection procedures, inservice training and parent programmes. Preliminary findings and their implications are discussed.

Child, Preschool↗
PubMed1991

Functional and mental status outcomes of clients discharged from acute gerontological versus medical/surgical units.

The goal of a specialized geriatric unit in an acute care hospital setting is to minimize losses and have the patient maintain or achieve an optimal level of functioning and cognition. This study showed that more acute clients on a geriatric unit maintained or improved functioning capacity at a significant level in fewer days and at a lowered cost. Nursing implications include inservice training specific to caring for geriatric clients and providing early assessment and identification of strengths. Interventions such as reality orientation and early proactive measures can be used to maintain or achieve optimal cognitive functional capacity.

Activities of Daily Living↗
PubMed1995

A marketing strategy for a nursing college.

The objective of this study is to explore and describe a marketing strategy for a nursing college. An explorative and descriptive research design, within the context of a nursing college and affiliated hospitals, was followed. A literature study of marketing models was undertaken and the Delphi-method was utilised to determine the contribution of marketing staff and the possible content of a marketing strategy for a nursing college. The results were utilised to describe guidelines for such a strategy, consisting of marketers/marketing agents, target market, product, price, promotional activities, place and market research. Recommendations include the planning, implementation and evaluation of strategy, inservice training for potential marketing agents, inclusion of marketing as part of the formal education of tutors and nurse managers, as well as an impact study of the scholar as the main consumer.

Advertising↗
PubMed1993

Handwashing practices among occupational therapy personnel.

Handwashing is the most effective method of preventing the spread of nosocomial infection. Despite its simplicity, handwashing is frequently omitted by health care personnel. To date there have been no studies of the handwashing practices of occupational therapists. A telephone survey of 50 occupational therapy personnel indicated that the majority (60%) washed their hands with a liquid antimicrobial soap 9 or more times during the work day with a wash duration of 10 seconds or less. Analyses revealed no statistically significant differences between handwashing frequency and duration and age, years in practice, position, academic degree, or work setting. Overall, handwashing technique was found to be lacking. All respondents stated that handwashing was important to occupational therapy practice and most agreed that it was just as important for therapists as it was for physicians and nurses. Most agreed that hands should be washed both before and after each patient contact. However, few respondents actually did so regularly. Most respondents indicated that they received their knowledge of handwashing from inservice training at their place of employment. Their occupational therapy educational programs did not provide basic information on handwashing techniques.

Adult↗
PubMed1991

ALERT-India 1981-89: nine years' experience of leprosy control in the slums of Bombay.

Bombay has a population of about 8 million people, one-half of whom live in slums. In 1981, ALERT-India started its first leprosy control project in N, S and T Wards of Greater Bombay Municipal Corporation covering an area of 122 sq km in the north-eastern suburbs of Vidhyavihar, Ghatkopar, Vikhroli, Kanjurmarg, Bhandup and Mulund, with a total population of 1,100,000 according to the 1981 census. In the 9 years of operation, over 12,000 patients have been registered and treated and of these 7425 have been released from treatment, having satisfactorily completed courses of chemotherapy. However, over 1000 cases are still identified every year by house-to-house or school surveys, or by self-reporting, including a considerable percentage in children. The origin, development, staff structure, operational procedure, administration and recording system of ALERT-India are described in detail, with emphasis on what has been accomplished with purely outpatient facilities, using paramedical workers, all of whom have received inservice training from Government recognized training centres for their specific tasks. The account includes a brief description of an expansion of the organization's work into townships in New Bombay, where preliminary surveys in 1988 confirmed the presence of leprosy cases and the need for treatment facilities. The discussion addresses: 1, the better use of the large volume of statistical information which has been collected by ALERT-India during the past 9 years, with emphasis on its value in assessing the impact on the control programme and modifying future policy; 2, the need to radically examine the present policy of survey, versus an 'education campaign approach' with regard to increasing early case-detection and self-reporting; 3, the establishment of a central coordinating body for leprosy control in Bombay to exchange information, coordinate efforts and formulate a future plan of action, the latter in association with the National Leprosy Eradication Programme; and 4, the development of a health education resource centre in association with the Bombay Municipal Corporation.

Health Services↗
PubMed1991

IT training. Through the training maze.

With information technology affecting every area of the health service, increasing numbers of staff are looking for training to help them keep up. John Hepworth offers some guidelines for choosing the right course.

Computer User Training↗
PubMedDate not supplied

Multidisciplinary approach used to improve infant care.

Many of the implemented changes have required the rewriting of standards of care and policies, as well as the education of staff. Staff education was addressed through a variety of approaches, including one-hour inservice training sessions and eight-hour courses. In the final analysis, the multidisciplinary QA committee has had a significant impact on improving the processes involved in caring for infants with RDS. Because of this success, committee members have acknowledged that all aspects of patient care may be examined and changes implemented when caregivers keep an open mind and are willing to change the way "things have always been done." This commitment to examine all aspects of care and to implement change has been, for Presbyterian Hospital, the key to genuine quality improvement. As a result of these and other efforts, Presbyterian Hospital has improved the care given to all of its patients. In March 1992, the hospital received accreditation with commendation.

Ancillary Services, Hospital↗
PubMed1995

Special report on patient care. The new federal patient-dumping regulations: some commonly asked questions and answers.

Until both providers and government surveyors become more familiar with the new EMTALA regulations, there will be an uncomfortable period of adjustment, and perhaps some turmoil as well, particularly regarding the new requirement that facilities who receive suspicious transfers report those transfers to HCFA. Providers should carefully examine their internal policies on discharge and transfer of emergency patients to assure that those policies are consistent with the new regulations. Particular attention should be given to inservice training for medical and support personnel in the emergency department, because they must precisely comply with the law and their errors can subject the hospital to costly investigations and potential fines of $50,000 for each violation.

Centers for Medicare and Medicaid Services, U.S.↗