743 resultados para Patient Experiences in ED


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"June 14, 1990."

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Mode of access: Internet.

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Background and Objectives: Improved ultrasound and needle technology make popliteal sciatic nerve blockade a popular anesthetic technique and imaging to localize the branch point of the common peroneal and posterior tibial components is important because successful blockade techniques vary with respect to injection of the common trunk proximally or separate injections distally. Nerve stimulation, ultrasound, cadaveric and magnetic resonance studies demonstrate variability in distance and discordance between imaging and anatomic examination of the branch point. The popliteal crease and imprecise, inaccessible landmarks render measurement of the branch point variable and inaccurate. The purpose of this study was to use the tibial tuberosity, a fixed bony reference, to measure the distance of the branch point. Method: During popliteal sciatic nerve blockade in the supine position the branch point was identified by ultrasound and the block needle was inserted. The vertical distance from the tibial tuberosity prominence and needle insertion point was measured. Results: In 92 patients the branch point is a mean distance of 12.91 cm proximal to the tibial tuberosity and more proximal in male (13.74 cm) than female patients (12.08 cm). Body height is related to the branch point distance and is more proximal in taller patients. Separation into two nerve branches during local anesthetic injection supports notions of more proximal neural anatomic division. Limitations: Imaging of the sciatic nerve division may not equal its true anatomic separation. Conclusion: Refinements in identification and resolution of the anatomic division of the nerve branch point will determine if more accurate localization is of any clinical significance for successful nerve blockade.

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Aims To determine the cost savings of pharmacist initiated changes to hospitalized patients' drug therapy or management in eight major acute care government funded teaching hospitals in Australia. Methods This was a prospective study performed in eight hospitals examining resource implications of pharmacists' interventions assessed by an independent clinical panel. Pharmacists providing clinical services to inpatients recorded details of interventions, defined as any action that directly resulted in a change to patient management or therapy. An independent clinical review panel, convened at each participating centre, confirmed or rejected the clinical pharmacist's assessment of the impact on length of stay (LOS), readmission probability, medical procedures and laboratory monitoring and quantified the resultant changes, which were then costed. Results A total of 1399 interventions were documented. Eight hundred and thirty-five interventions impacted on drug costs alone. Five hundred and eleven interventions were evaluated by the independent panels with three quarters of these confirmed as having an impact on one or more of: length of stay, readmission probability, medical procedures or laboratory monitoring. There were 96 interventions deemed by the independent panels to have reduced LOS and 156 reduced the potential for readmission. The calculated savings was $263 221 for the eight hospitals during the period of the study. This included $150 307 for length of stay reduction, $111 848 for readmission reduction. Conclusions The annualized cost savings relating to length of stay, readmission, drugs, medical procedures and laboratory monitoring as a result of clinical pharmacist initiated changes to hospitalized patient management or therapy was $4 444 794 for eight major acute care government funded teaching hospitals in Australia.

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In an age of globalisation and internationalisation, how women learn to represent themselves in terms of their cultural, social and gender identities in the wider world is significant. A group of 17 Japanese women studying in postgraduate courses in three Australian universities were interviewed for part of this longitudinal project, and their case studies are presented in this paper to portray the women's lived experiences and interpret how higher education overseas affects their reconstruction of their 'selves' and traditional Japanese femininity. I set my analytic framework through a discussion of the forceful globalisation of higher education and discourses of identity and 'self', and then analyse the present status of Japanese women in contemporary Japan. I then provide excerpts of the women's narratives which indicate ambivalent 'selves' in transition. Two possibilities have arisen from their narratives to illuminate this ambivalence - one possibility is that women's positive experiences in Australia and their increased and diverse exposure to and experience of other cultures may influence cultural change such as the transformation of constructs of women at home, and challenge existing identity and femininity discourses in Japan. The second possibility is that negative aspects of their 'diasporic experiences' can also articulate other complex identity politics, such as Japanese women's 'double marginalisation' which means being both a woman and a member of an ethnic minority group, conflicts between the homogenisation of 'Asian women' and representations of 'new Japanese women', and their sense of belongingness to their original culture. These contradictory phenomena of identity formations within Japanese women have the potential to shift the debate and challenge current essentialist views of hegemonic homogenisation of regional identities.