54 resultados para Operating Room Nursing


Relevância:

90.00% 90.00%

Publicador:

Resumo:

This paper investigates the environmental conditions inside a highly-glazed cross-ventilated meeting room. A 3D computational fluid dynamics (CFD) model of an indoor environment is developed with the support of the field measurements performed in a normally operating room. The work presented here follows the steps of the formal calibration methodology for the development of CFD models of naturally ventilated environments. This paper utilises the calibration methodology in order to predict environmental conditions within the highly-glazed cross-ventilated room occupied by people. The CFD model is verified and validated with field measurements performed in an operating building. Moreover, parametric analysis determines the most influential boundary conditions on indoor air temperatures and air speeds

Relevância:

80.00% 80.00%

Publicador:

Resumo:

Purpose: To identify factors associated prospectively with increased cataract surgical rate (CSR) in rural Chinese hospitals.

Methods: Annual cataract surgical output was obtained at baseline and 24 months later from operating room records at 42 rural, county-level hospitals. Total local CSR (cases/million population/y), and proportion of CSR from hospital and local competitors were calculated from government records. Hospital administrators completed questionnaires providing demographic and professional information, and annual clinic and outreach screening volume. Independent cataract surgeons provided clinical information and videotapes of cases for grading by two masked experts using the Ophthalmology Surgical Competency Assessment Rubric (OSCAR). Uncorrected vision was recorded for 10 consecutive cataract cases at each facility, and 10 randomly-identified patients completed hospital satisfaction questionnaires. Total value of international nongovernmental development organization (INGDO) investment in the previous three years and demographic information on hospital catchment areas were obtained. Main outcome was 2-year percentage change in hospital CSR.

Results: Among the 42 hospitals (median catchment population 530,000, median hospital CSR 643), 78.6% (33/42) were receiving INGDO support. Median change in hospital CSR (interquartile range) was 33.3% (-6.25%, 72.3%). Predictors of greater increase in CSR included higher INGDO investment (P = 0.02, simple model), reducing patient dissatisfaction (P = 0.03, simple model), and more outreach patient screening (P = 0.002, simple and multiple model).

Conclusions: Outreach cataract screening was the strongest predictor of increased surgical output. Government and INGDO investment in screening may be most likely to enhance output of county hospitals, a major goal of China's Blindness Prevention Plan.

Relevância:

80.00% 80.00%

Publicador:

Resumo:

Key content
- Trainees face many challenges in learning the skill set required to perform laparoscopic surgery.
- The time spent in the operating room has been detrimentally impacted upon since the implementation of the European Working Time Directive. In order to address the deficit, surgical educators have looked to the benefits enjoyed in the aviation and sports industries in using simulation training.

Learning objectives
- To summarise the current understanding of the neuropsychological basis of learning a psychomotor skill.
- To clarify factors that influence the acquisition of these skills.
- To summarise how this information can be used in teaching and assessment of laparoscopic skills.

Ethical issues
- The use of virtual reality simulators may be able to form a part of the aptitude assessment in the selection process, in order to identify trainees with the desired attributes to progress into the training programmes. However, as skill improves with practice, is it ethical to exclude novices with poor initial performance assessment before allowing them the opportunities to improve?

Relevância:

30.00% 30.00%

Publicador:

Resumo:

The attainable steady-state limiting currents and time responses of membrane-covered and membrane-independent gas sensors incorporating different electrode and electrolyte materials have been compared. A new design comprising a membrane-free microelectrode modified with a thin layer of a room temperature ionic liquid is considered. While the use of ionic liquid as electrolyte eliminates the need for a membrane and added supporting electrolyte, the slower diffusion of analyte within the more viscous medium results in slower time responses. Such sensors do, however, have potential application in more extreme operating conditions, such as high temperature and pressure, where traditional solvents would volatise.

Relevância:

30.00% 30.00%

Publicador:

Resumo:

Natural ventilation is a sustainable solution to maintaining healthy and comfortable environmental conditions in buildings. However, the effective design, construction and operation of naturally ventilated buildings require a good understanding of complex airflow patterns caused by the buoyancy and wind effects.The work presented in this article employed a 3D computational fluid dynamics (CFD) analysis in order to investigate environmental conditions and thermal comfort of the occupants of a highly-glazed naturally ventilated meeting room. This analysis was facilitated by the real-time field measurements performed in an operating building, and previously developed formal calibration methodology for reliable CFD models of indoor environments. Since, creating an accurate CFD model of an occupied space in a real-life scenario requires a high level of CFD expertise, trusted experimental data and an ability to interpret model input parameters; the calibration methodology guided towards a robust and reliable CFD model of the indoor environment. This calibrated CFD model was then used to investigate indoor environmental conditions and to evaluate thermal comfort indices for the occupants of the room. Thermal comfort expresses occupants' satisfaction with thermal environment in buildings by defining the range of indoor thermal environmental conditions acceptable to a majority of occupants. In this study, the thermal comfort analysis, supported by both field measurements and CFD simulation results, confirmed a satisfactory and optimal room operation in terms of thermal environment for the investigated real-life scenario. © 2013 Elsevier Ltd.

Relevância:

20.00% 20.00%

Publicador:

Resumo:

Objectives: To determine the impact of the prospective payment system (PPS) for skilled nursing facilities on the pharmacologic treatment of depression.

Methods: We used a quasi-experimental study comparing the pharmacological treatment rates for depression in the pre-PPS period (1997) to the post-PPS period (2000) in 8149 residents with documented depression living in over 500 nursing facilities in Ohio. Logistic regression models adjusting for clustering effects of residents residing in homes using generalized estimating equations provided estimates of the PPS effect on use of any antidepressant and the use of selective serotonin reuptake inhibitors (SSRIs). We evaluated the extent to which the PPS effect was modified by organizational characteristics, including structural characteristics, resource characteristics, and staff resources available in the homes.

Results: Overall, there was no difference in the likelihood of any antidepressant [odds ratio (OR), 1.05; 95% confidence interval (CI), 0.93 to 1.18, resident-adjusted model] or an SSRI being used (OR, 0.98; 95% CI, 0.86 to 1.12, resident-adjusted model) after the introduction of PPS compared with 1997 when this reimbursement system was not in place (referent group). These trends did not appear to be modified substantially by organizational characteristics.

Conclusion: Although PPS did not appear to have influenced the treatment of depression in nursing homes, systems that provide checks and balances in relation to PPS are warranted.

Relevância:

20.00% 20.00%

Publicador:

Resumo:

Background:
Internationally, nurse-directed protocolised-weaning has been evaluated by measuring its impact on patient outcomes. The impact on nurses’ views and perceptions has been largely ignored.

Aim:
To determine the change in intensive care nurses’ perceptions, satisfaction, knowledge and attitudes following the introduction of nurse-directed weaning. Additionally, views were obtained on how useful protocolised-weaning was to practice.

Methods:
The sample comprised nurses working in general intensive care units in three university-affiliated hospitals. Nurse-directed protocolised-weaning was implemented in one unit (intervention group); two ICUs continued with usual doctor-led practice (control group). Nurses’ perceptions, satisfaction, knowledge and attitudes were measured by self-completed questionnaires before (Phase I) and after the implementation of nurse-directed weaning (Phase II) in all units.

Results:
Response rates were 79% (n=140n=140) for Phase 1 and 62% (n=132n=132) for Phase II. Regression-based analyses showed that changes from Phase I to Phase II were not significantly different between the intervention and control groups. Sixty-nine nurses responded to both Phase I and II questionnaires. In the intervention group, these nurses scored their mean perceived level of knowledge higher in Phase II (6.39 vs 7.17, p=0.01p=0.01). In the control group, role perception (4.41 vs 4.22, p=0.01p=0.01) was lower and, perceived knowledge (6.03 vs 6.63, p=0.04p=0.04), awareness of weaning plans (6.09 vs 7.06, p=0.01p=0.01) and satisfaction with communication (5.28 vs 6.19, p=0.01p=0.01) were higher in Phase II. The intervention group found protocolised weaning useful in their practice (75%): this was scored significantly higher by junior and senior nurses than middle grade nurses (p=0.02p=0.02).

Conclusion

We conclude that nurse-directed protocolised-weaning had no effect on nurses’ views and perceptions due to the high level of satisfaction which encouraged nurses’ participation in weaning throughout. Control group changes are attributed to a ‘reactive effect’ from being study participants. Weaning protocols provide a uniform method of weaning practice and are particularly beneficial in providing safe guidance for junior staff.

Relevância:

20.00% 20.00%

Publicador:

Resumo:

The influence of manufacturing tolerance on direct operating cost (DOC) is extrapolated from an engine nacelle to be representative of an entire aircraft body. Initial manufacturing tolerance data was obtained from the shop floor at Bombardier Aerospace Shorts, Belfast while the corresponding costs were calculated according to various recurring elements such as basic labour and overtime labour, rework, concessions, and redeployment; along with the non-recurrent costs due to tooling and machinery, etc. The relation of tolerance to cost was modelled statistically so that the cost impact of tolerance change could be ascertained. It was shown that a relatively small relaxation in the assembly and fabrication tolerances of the wetted surfaces resulted in reduced costs of production that lowered aircraft DOC, as the incurred drag penalty was predicted and taken into account during the optimisation process.