Current Issue : April - June Volume : 2020 Issue Number : 2 Articles : 6 Articles
Introduction: Poisoning is a major health problem worldwide, and it causes significant morbidity and mortality. It\nis estimated that 350,000 people died worldwide from unintentional poisoning. The purpose of this study is to\nassess nursesâ?? knowledge and practice on the initial management of acute poisoning among nurses in Dessie\nreferral hospital, Amhara region, Ethiopia.\nMethods: Hospital based cross sectional study was conducted from January 2018 to June 2018. Simple Random\nsampling technique was used to select the samples. Data was collected by using self-administered structured\nquestioners. Data were cleansed, checked for completeness and entered into SPSS version 20 for analyses. Statistical\nmeasures of Central tendency, T-test and ANOVA were used in determining the association between independent\nand dependent variables.\nResults: Based on the given 13 items to assess the general knowledge of nurses on poisoning, the score ranges\nfrom 2 to 9 with the range of 7 with the mean score of 7.48(SD-0. 0.839) for the entire respondents that was 57.5%\nfor the given items that was less than 75% which was unsatisfactory level of knowledge. The mean score of general\nknowledge on poisoning was high among nurses who had training on initial management of poisoning than those\nnurses who had not the training.\nConclusion and recommendation: All Dessie referral nurses that participated in this study had unsatisfactory\ngeneral knowledge on poisoning, knowledge on initial management of acute poisoning and self-reported practice.\nThe major implication of these study findings on the health system is the importance of ensuring support to\nnursesâ?? health care services for early detection and management of poisoning....
Background: Nurses and midwives are central to the implementation and delivery of\nquality care through evidence-based practice (EBP). However, implementation of EBP in nursing and\nmidwifery is under-researched with few examples of systematic and sustained change. The Registered\nNurses Association of Ontarioâ??s Best-Practice Spotlight Organization (BPSO) Program was adopted\nin South Australia as a framework to systematically implement EBP in two diverse and complex\nhealthcare settings. Methods: The study was a post-implementation, mixed-method evaluation\nconducted at two healthcare settings in Adelaide, South Australia utilizing qualitative and quantitative\ndata. Proctorâ??s implementation evaluation framework guided the evaluation design. Information\nsources included; interviews, focus groups, questionnaires, and document review. Results: Clinical\nand executive staff (n = 109 participants) from a broad range of stakeholder groups participated in\nthe interviews, focus groups, and returned questionnaires. A number of facilitators directly affecting\nprogram implementation were identified; these pertained to embedding continuity into the programâ??s\nimplementation and delivery, a robust governance structure, and executive sponsorship. Barriers\nto implementation were also identified. These barriers pertained to organizational or workforce\nchallenges; staff turnover and movement (e.g., secondment), insufficient staff to allow people to attend\ntraining, and a lack of organizational commitment to the program, especially at an executive level.\nAs a result of successful implementation, it was observed that over three years, the BPSO program\npositively influenced the uptake and implementation of EBP by clinicians and the organizations into\nwhich they were introduced. Conclusions: The BPSO model can be translocated to new healthcare\nsystems and has the potential to act as a mechanism for establishing and sustaining EBP change.\nThis study was the first to apply an implementation evaluation framework to the BPSO program,\nwhich allowed for structured analysis of facilitating or impeding factors that affected implementation\nsuccess. The findings have important implications for other health systems looking to translocate\nthe same or similar EBP programs, as well as contributing to the growing body of implementation\nevaluation literature....
Aim: Review of presentation, management and outcome of patients admitted\nwith Diabetic Ketoacidosis (DKA) to an emergency department short stay\nunit with expedited discharge. Methods: All admitted patients with a discharge\ndiagnosis of â??Diabetic Ketoacidosisâ?, were identified by the file auditing\nsection in the Emergency Department. Data obtained from the medical\nrecords were collected using an explicit chart review from January 2012 to\nJune 2013. Data included clinical monitoring, investigations performed, the\ntype and amount of intravenous fluids given, the insulin regime, potassium\nsupplementation and outcome. Results: Out of a total of 120 patients labelled\nas DKA or hyperglycaemia on arrival, hundred patients fulfilled the criteria\nfor DKA. In the population studied the mean age was 25 years with a male\npredominance. Eighty-two patients suffered from Type 1 Diabetes Mellitus\n(T1DM) whilst eighteen patients had Type 2 Diabetes Mellitus (T2DM). Sixteen\npatients were newly diagnosed during the present admission. Seventy-six\n(76%) patients were on insulin. The insulin regimen and potassium supplementation\nwere followed as per protocol in all patients. All the patients except\none were given intravenous fluid according to protocol. Parameters were monitored\nadequately except fluid input and output monitoring. The median\nlength of stay in the short stay unit was 1.5833 days. There was no return visit\nwithin one week of discharge. Conclusion: The median length of stay was\nshort and there were no documented complications or deaths during the\nstay. There was poor compliance with documentation of fluid input and output.\nIn this population, the short stay model of care appeared to be safe and\nefficient....
Background: The inappropriate use of antibiotics in hospitals increases resistance, morbidity, and mortality. Little is\ncurrently known about appropriate antibiotic use among hospitals in Lahore, the capital city of Pakistan.\nMethods: Longitudinal surveillance was conducted over a period of 2 months among hospitals in Lahore, Pakistan.\nAntibiotic treatment was considered inappropriate on the basis of a wrong dosage regimen, wrong indication, or\nboth based on the British National Formulary.\nResults: A total of 2022 antibiotics were given to 1185 patients. Out of the total prescribed, approximately twothirds\nof the study population (70.3%) had at least one inappropriate antimicrobial. Overall, 27.2% of patients had\nrespiratory tract infections, and out of these, 62.8% were considered as having inappropriate therapy.\nCephalosporins were extensively prescribed among patients, and in many cases, this was inappropriate (67.2%).\nPenicillins were given to 283 patients, out of which 201 (71.0%) were prescribed for either the wrong indication or\ndosage or both. Significant variations were also observed regarding inappropriate prescribing for several\nantimicrobials including the carbapenems (70.9%), aminoglycosides (35.8%), fluoroquinolones (64.2%), macrolides\n(74.6%) and other antibacterials (73.1%).\nConclusion: Educational interventions, institutional guidelines, and antimicrobial stewardship programs need to be\ndeveloped to enhance future appropriate antimicrobial use in hospitals in Pakistan. Policies by healthcare and\nGovernment officials are also needed to minimize inappropriate antibiotic use....
Background: Despite the almost universal adoption of Integrated Management of Childhood Illness (IMCI)\nguidelines for the diagnosis and treatment of sick children under the age of five in low- and middle-income\ncountries, child mortality remains high in many settings. One possible explanation of the continued high mortality\nburden is lack of compliance with diagnostic and treatment protocols. We test this hypothesis in a sample of\nchildren with severe illness in the Democratic Republic of the Congo (DRC).\nMethods: One thousand one hundred eighty under-five clinical visits were observed across a regionally\nrepresentative sample of 321 facilities in the DRC. Based on a detailed list of disease symptoms observed, patients\nwith severe febrile disease (including malaria), severe pneumonia, and severe dehydration were identified. For all\nthree disease categories, treatments were then compared to recommended case management following IMCI\nguidelines.\nResults: Out of 1180 under-five consultations observed, 332 patients (28%) had signs of severe febrile disease, 189\npatients (16%) had signs of severe pneumonia, and 19 patients (2%) had signs of severe dehydration. Overall,\nproviders gave the IMCI-recommended treatment in 42% of cases of these three severe diseases. Less than 15% of\nchildren with severe disease were recommended to receive in-patient care either in the facility they visited or in a\nhigher-level facility.\nConclusions: These results suggest that adherence to IMCI protocols for severe disease remains remarkably low in\nthe DRC. There is a critical need to identify and implement effective approaches for improving the quality of care\nfor severely ill children in settings with high child mortality....
A two-tiered ambulance system, consisting of advanced and basic life support for emergency and nonemergency patient care,\nrespectively, can provide a cost-efficient emergency medical service. However, such a system requires accurate classification of\npatient severity to avoid complications. Thus, this study considers a two-tiered ambulance dispatch and redeployment problem in\nwhich the average patient severity classification errors are known. This study builds on previous research into the ambulance\ndispatch and redeployment problem by additionally considering multiple types of patients and ambulances, and patient classification\nerrors. We formulate this dynamic decision-making problem as a semi-Markov decision process and propose a minibatch\nmonotone-approximate dynamic programming (ADP) algorithm to solve the problem within a reasonable computation\ntime. Computational experiments using realistic system dynamics based on historical data from Seoul reveal that the proposed\napproach and algorithm reduce the risk level index (RLI) for all patients by an average of 11.2% compared to the greedy policy. In\nthis numerical study, we identify the influence of certain system parameters such as the percentage of advanced-life support units\namong all ambulances and patient classification errors. A key finding is that an increase in undertriage rates has a greater negative\neffect on patient RLI than an increase in overtriage rates. The proposed algorithm delivers an efficient two-tiered ambulance\nmanagement strategy. Furthermore, our findings could provide useful guidelines for practitioners, enabling them to classify\npatient severity in order to minimize undertriage rates....
Loading....