74 resultados para Biology, Microbiology|Agriculture, Fisheries and Aquaculture|Health Sciences, Immunology
Resumo:
Using a healthy settings framework, this study aims to compare and contrast how midwives working in either hospital or community settings are currently responding to the co-occurrence of domestic and child abuse; their perceived role and willingness to identify abuse; record keeping; reporting of suspected or definite cases of child abuse; and training received. Methods: A survey questionnaire was sent to 861 hospital and community midwives throughout Northern Ireland, which resulted in 488 midwives completing the questionnaire, a 57% response rate. Comparisons were made using descriptive statistics and cross-tabulation and the questionnaire was validated using exploratory factor analysis. Results: Community midwives reported receiving more training on domestic and child abuse. Although a high percentage of both hospital and community midwives acknowledged a link between domestic and child abuse, it was the community midwives who encountered more suspected and definite (p
Resumo:
For more than a decade the Peace Process has fundamentally changed Northern Irish society. However, although socioreligious integration and ethnic mixing are high on the political agenda in Northern Ireland, the Peace Process has so far failed to address the needs of some of the most vulnerable young people, for example, those who identify as gay, lesbian, or bisexual. Public debates in Northern Ireland remain hostile to same-sex-attracted people. Empirical evidence from the annual Young Life and Times (YLT) survey of 16-year-olds undertaken by ARK shows that same-sex-attracted young people report worse experiences in the education sector (e.g., sex education, school bullying), suffer from poorer mental health, experience higher social pressures to engage in health-adverse behavior, and are more likely to say that they will leave Northern Ireland and not return. Equality legislation and peace process have done little to address the heteronormativity in Northern Ireland.
Resumo:
In this piece, the authors suggest that the long term misinterpretation of the subtle and unique differences between the concepts of “counselling” and “nursing” has fuelled an uncertainty within mental health as to the true nature and essence of the role / scope of professional practice of the mental health nurse, which has important implications for practitioners, educators and patients alike.
Resumo:
Abstract
Background: Automated closed loop systems may improve adaptation of the mechanical support to a patient's ventilatory needs and
facilitate systematic and early recognition of their ability to breathe spontaneously and the potential for discontinuation of
ventilation.
Objectives: To compare the duration of weaning from mechanical ventilation for critically ill ventilated adults and children when managed
with automated closed loop systems versus non-automated strategies. Secondary objectives were to determine differences
in duration of ventilation, intensive care unit (ICU) and hospital length of stay (LOS), mortality, and adverse events.
Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2); MEDLINE (OvidSP) (1948 to August 2011); EMBASE (OvidSP) (1980 to August 2011); CINAHL (EBSCOhost) (1982 to August 2011); and the Latin American and Caribbean Health Sciences Literature (LILACS). In addition we received and reviewed auto-alerts for our search strategy in MEDLINE, EMBASE, and CINAHL up to August 2012. Relevant published reviews were sought using the Database of Abstracts of Reviews of Effects (DARE) and the Health Technology Assessment Database (HTA Database). We also searched the Web of Science Proceedings; conference proceedings; trial registration websites; and reference lists of relevant articles.
Selection criteria: We included randomized controlled trials comparing automated closed loop ventilator applications to non-automated weaning
strategies including non-protocolized usual care and protocolized weaning in patients over four weeks of age receiving invasive mechanical ventilation in an intensive care unit (ICU).
Data collection and analysis: Two authors independently extracted study data and assessed risk of bias. We combined data into forest plots using random-effects modelling. Subgroup and sensitivity analyses were conducted according to a priori criteria.
Main results: Pooled data from 15 eligible trials (14 adult, one paediatric) totalling 1173 participants (1143 adults, 30 children) indicated that automated closed loop systems reduced the geometric mean duration of weaning by 32% (95% CI 19% to 46%, P =0.002), however heterogeneity was substantial (I2 = 89%, P < 0.00001). Reduced weaning duration was found with mixed or
medical ICU populations (43%, 95% CI 8% to 65%, P = 0.02) and Smartcare/PS™ (31%, 95% CI 7% to 49%, P = 0.02) but not in surgical populations or using other systems. Automated closed loop systems reduced the duration of ventilation (17%, 95% CI 8% to 26%) and ICU length of stay (LOS) (11%, 95% CI 0% to 21%). There was no difference in mortality rates or hospital LOS. Overall the quality of evidence was high with the majority of trials rated as low risk.
Authors' conclusions: Automated closed loop systems may result in reduced duration of weaning, ventilation, and ICU stay. Reductions are more
likely to occur in mixed or medical ICU populations. Due to the lack of, or limited, evidence on automated systems other than Smartcare/PS™ and Adaptive Support Ventilation no conclusions can be drawn regarding their influence on these outcomes. Due to substantial heterogeneity in trials there is a need for an adequately powered, high quality, multi-centre randomized
controlled trial in adults that excludes 'simple to wean' patients. There is a pressing need for further technological development and research in the paediatric population.
Resumo:
Background: The purpose of this systematic literature review was to examine current empirical research on general and respiratory health outcomes in adult survivors of bronchopulmonary dysplasia (BPD).
Methods: We searched seven databases up to the end of November 2010 (MEDLINE, PubMed, EMBASE, PsycINFO, Maternity and Infant Care, Cumulative Index of Nursing and Allied Health Literature, and Web of Knowledge). We independently screened and included only those studies concerning the assessment of outcome measures in adult survivors of BPD. Data on methodologic design and findings were extracted from each included study; in addition, the methodologic quality of each study was assessed using the Critical Appraisal Skills Programme checklist.
Results: Fourteen cohort studies met the review criteria. Of those, a total of eight studies were considered to be of high quality (score 9-12), five of moderate quality (score 5-8), and only one was of low quality (score 0-4). In all studies of adult survivors of BPD, differences were found between the index and control groups, suggesting that many adults survivors of BPD who were born preterm or with very low birth weight had more respiratory symptoms and pulmonary function abnormalities compared with their peers. Five studies concerning radiologic findings reported structural changes persisting into adulthood. Findings from three studies suggested impairment in exercise capacity, although firm conclusions were limited by the small sample size in the studies reviewed.
Conclusions: Compared with adults born at term, adult survivors of BPD have more impairment in general and respiratory health, which does not seem to diminish over time.