Therapeutic hypothermia after cardiac arrest : Studies on neurological and cardiological outcome and prediction of outcome in hypothermia-treated patients resuscitated from out-of-hospital cardiac arrest

The outcome of the successfully resuscitated patient is mainly determined by the extent of hypoxic-ischemic cerebral injury, and hypothermia has multiple mechanisms of action in mitigating such injury. The present study was undertaken from 1997 to 2001 in Helsinki as a part of the European multicenter study Hypothermia after cardiac arrest (HACA) to test the neuroprotective effect of therapeutic hypothermia in patients resuscitated from out-of-hospital ventricular fibrillation (VF) cardiac arrest (CA). The aim of this substudy was to examine the neurological and cardiological outcome of these patients, and especially to study and develop methods for prediction of outcome in the hypothermia-treated patients. A total of 275 patients were randomized to the HACA trial in Europe. In Helsinki, 70 patients were enrolled in the study according to the inclusion criteria. Those randomized to hypothermia were actively cooled externally to a core temperature 33 ± 1ºC for 24 hours with a cooling device. Serum markers of ischemic neuronal injury, NSE and S-100B, were sampled at 24, 36, and 48 hours after CA. Somatosensory and brain stem auditory evoked potentials (SEPs and BAEPs) were recorded 24 to 28 hours after CA; 24-hour ambulatory electrocardiography recordings were performed three times during the first two weeks and arrhythmias and heart rate variability (HRV) were analyzed from the tapes. The clinical outcome was assessed 3 and 6 months after CA. Neuropsychological examinations were performed on the conscious survivors 3 months after the CA. Quantitative electroencephalography (Q-EEG) and auditory P300 event-related potentials were studied at the same time-point. Therapeutic hypothermia of 33ºC for 24 hours led to an increased chance of good neurological outcome and survival after out-of-hospital VF CA. In the HACA study, 55% of hypothermia-treated patients and 39% of normothermia-treated patients reached a good neurological outcome (p=0.009) at 6 months after CA. Use of therapeutic hypothermia was not associated with any increase in clinically significant arrhythmias. The levels of serum NSE, but not the levels of S-100B, were lower in hypothermia- than in normothermia-treated patients. A decrease in NSE values between 24 and 48 hours was associated with good outcome at 6 months after CA. Decreasing levels of serum NSE but not of S-100B over time may indicate selective attenuation of delayed neuronal death by therapeutic hypothermia, and the time-course of serum NSE between 24 and 48 hours after CA may help in clinical decision-making. In SEP recordings bilaterally absent N20 responses predicted permanent coma with a specificity of 100% in both treatment arms. Recording of BAEPs provided no additional benefit in outcome prediction. Preserved 24- to 48-hour HRV may be a predictor of favorable outcome in CA patients treated with hypothermia. At 3 months after CA, no differences appeared in any cognitive functions between the two groups: 67% of patients in the hypothermia and 44% patients in the normothermia group were cognitively intact or had only very mild impairment. No significant differences emerged in any of the Q-EEG parameters between the two groups. The amplitude of P300 potential was significantly higher in the hypothermia-treated group. These results give further support to the use of therapeutic hypothermia in patients with sudden out-of-hospital CA.

Healing gardens in the Lady Cilento Children’s Hospital: Reflections on benefits, preferences and design from bench diaries

Background Interest in the use of healing gardens in healthcare settings to provide therapeutic benefits is increasing, however insight is needed to determine whether patients, patient families and friends, and staff who spend time in these gardens use these in the manner for which they were designed, and experience the benefits suggested by broader research in this field. Objective(s) Visitors to four of the LCCH gardens have left comments in ‘bench diaries’ (visitors books). Analysis of these comments yields valuable insights into the use of the gardens, enabling reflection on the design intent and outcomes and guidance regarding how the gardens might be better utilised, as well as a basis for further investigation into the use and value of the gardens. Method(s) Comments have been coded and analysed using a thematic analysis approach to identify patterns relating to the reasons for which people appear to come to the healing gardens; benefits they appear to receive from spending time there; and features and aspects of the gardens that they appear to appreciate in particular. Only comments related to the gardens have been used in this analysis, with all comments being deidentified. Outcome/Conclusion Comments left in the Adventure Garden and Secret Garden bench diaries were used for the analysis, as Staff Garden and Babies Garden bench diary comments did not relate to the garden. There were no negative comments relating to the gardens, other than one comment requesting additional benches. The vast majority of comments expressed gratitude for the space. The four most frequently observed themes from the comments left in the Secret Garden Bench Diary indicated that they were seeking ‘time out’ from their experiences of being at the hospital, a desire for a ‘dose of nature’ (greenery, beautiful garden, etc), and fresh air, and that the garden space provided a restorative experience to them in some manner. Comments in the Adventure Garden Bench Diary related predominately to the view. Analysis of the comments emphasises the importance of gardens providing multi-sensory experiences that significantly differentiate the space from the hospital ward and provide visitors with a sense of being away, of peacefulness, and of familiarity with the outside world. Positioning gardens with prospect, and solar aspect, appears important in these regards, as does the presence of visible greenery. Adequate seating in locations that provide pleasing views appears particularly important for staff and adult visitors. Whilst comments in the Bench Diaries did not indicate direct awareness of the stress and anxiety-reducing effects that research elsewhere has found from viewing plants and nature, however these effects may underpin many of these experiences that visitors did share.

Social work in a hospital emergency department

This paper describes how a Hospital Social Work Department's Emergency Team has attempted to provide a crisis and out-of-hours service to its Emergency Department. Through a staffing commitment to extensive evening and weekend cover, the Emergency Team's social worker is able to provide an immediate intervention and assessment service to problems. This has resulted in early detection and treatment of the non-medical aspects of a patient's problem and appropriate referral to other agencies for longer-term follow-up.

Hospital social work in Australia: Emerging trends or more of the same?

Social work in health care has been established for more than 100 years and is one of the largest areas of practice for social workers. Over time, demographic changes and growth in the aging population, increased longevity rates, an explosion in rates of chronic illness together with rapidly increasing cost of health care have created serious challenges for acute hospitals and health social workers. This article reviews the Australian health care system and policies with particular emphasis on the public hospital system. It then examines current hospital social work roles, including the continued role in discharge planning and expanding responsibility for emerging client problems, such as patient complexity, legal, and carer issues. The article concludes with a discussion of evolving issues and challenges facing health social work to ensure that social work remain relevant within this practice context.

Pain measurement and management in elderly patients : Clinical studies in long term hospital care and after cardiac surgery

The proportion of patients over 75 years of age, receiving all different types of healthcare, is constantly increasing. The elderly undergo surgery and anaesthetic procedures more often than middle-aged patients. Poor pain management in the elderly is still an issue. Although the elderly consumes the greatest proportion of prescribed medicines in Western Europe, most clinical pharmacological studies have been performed in healthy volunteers or middle-aged patients. The aim of this study was to investigate pain measurement and management in cognitively impaired patients in long term hospital care and in cognitively normal elderly patients after cardiac surgery. This thesis incorporated 366 patients, including 86 home-dwelling or hospitalized elderly with chronic pain and 280 patients undergoing cardiac surgery with acute pain. The mean age of patients was 77 (SD ± 8) years and approximately 8400 pain measurements were performed with four pain scales: Verbal Rating Scale (VRS), the Visual Analogue Scale (VAS), the Red Wedge Scale (RWS), and the Facial Pain Scale (FPS). Cognitive function, depression, functional ability in daily life, postoperative sedation and postoperative confusion were assessed with MMSE, GDS, Barthel Index, RASS, and CAM-ICU, respectively. The effects and plasma concentrations of fentanyl and oxycodone were measured in elderly (≥ 75 years) and middle-aged patients (≤ 60 years) and the opioid-sparing effect of pregabalin was studied after cardiac surgery. The VRS pain scores after movement correlated with the Barthel Index. The VRS was most successful in the groups of demented patients (MMSE 17-23, 11-16 and ≤ 10) and in elderly patients on the first day after cardiac surgery. The elderly had a higher plasma concentration of fentanyl at the end of surgery than younger patients. The plasma concentrations of oxycodone were comparable between the groups. Pain intensity on the VRS was lower and the sedation scores were higher in the elderly. Total oxycodone consumption during five postoperative days was reduced by 48% and the CAM-ICU scores were higher on the first postoperative day in the pregabalin group. The incidence of postoperative pain during movement was lower in the pregabalin group three months after surgery. This investigation demonstrates that chronic pain did not seem to impair daily activities in home-dwelling Finnish elderly. The VRS appeared to be applicable for elderly patients with clear cognitive dysfunction (MMSE ≤17) and it was the most feasible pain scale for the early postoperative period after cardiac surgery. After cardiac surgery, plasma concentrations of fentanyl in elderly were elevated, although oxycodone concentrations were at similar level compared to middle-aged patients. The elderly had less pain and were more sedated after doses of oxycodone. Therefore, particular attention must be given to individual dosing of the opioids in elderly surgical patients, who often need a smaller amount for adequate analgesia than middle-aged patients. The administration of pregabalin reduced postoperative oxycodone consumption after cardiac surgery. Pregabalin-treated patients had less confusion, and additionally to less postoperative pain on the first postoperative day and during movement at three months post-surgery. Pregabalin might be a new alternative as analgesic for acute postoperative and chronic pain management in the elderly. Its clinical role and safety remains to be verified in large-scale randomized and controlled studies. In the future, many clinical trials in the older category of patients will be needed to facilitate improvements in health care methods.

Determinacion de frecuencia de politraumatismo oseo (ptos) en mascotas caninas en el hospital animal El Dorado

Ante la falta de información acerca de la frecuencia, diagnóstico, tratamiento y primeros auxilios de la mascota canina politraumatizada en nuestro país, y la falta de medios para la praxis ortopédica, se propuso este estudio de tesis; cuyo titulo es: Determinación de frecuencia de politraumatismo óseo con diagnostico radiológico en mascotas caninas en el Hospital Animal El Dorado. Para lo cual se procedió a establecer los siguientes objetivos: la evaluación de la frecuencia de politraumatismos óseos (PTO) atendidos en la clínica veterinaria El Dorado con diagnostico radiológico, para esto se realizó dicho estudio en un periodo de 3 meses, en el cual se estudiaron expedientes y recopilación de datos, con este estudio de tesis se logró comprobar que la mayor afectación por fracturas la sufren los canes de raza criolla, seguidos por los Pastores Alemanes, así mismo se determinó que el manejo de las mascotas es determinante y predisponente a que una mascota sufra una fractura. Se identificó que los animales menores de 2 años sufren mayormente fracturas. Se concluyó que debido a los altos costos de la praxis, muchos veterinarios no atienden a sus pacientes y también debido a la misma razón muchos dueños de mascotas optan por la eutanasia o simplemente dejan que el tiempo repare las fracturas. Este estudio pretende ser una herramienta que permita al estudiante de Medicina Veterinaria tener un mayor entendimiento acerca de los politraumatismos. Para el profesional una referencia. Se concluyó que la raza y edad de las mascotas, así mismo, como la época del año (invierno) son factores determinantes en el surgimiento de Politraumatismo óseo, los cuales se localizan con mayor frecuencia en mascotas a nivel cubito/radio, fémur, tibia y peroné, la terapia mayormente utilizada fue la conservadora mediante el uso de férulas seguida de la quirúrgica con el uso de cerclaje.

La Facultad de Teología en una Iglesia llamada a ser “hospital de campaña”

En el mes de octubre del año pasado se realizó en la Facultad una Reunión de Claustro en la que participamos unos cuarenta profesores, reunidos para conversar e intercambiar ideas acerca de la entrevista que el P. Antonio Spadaro S.J. le hiciera al papa Francisco. Como los temas abordados allí fueron muchos, nos pareció oportuno señalar los que podían interesar de manera más directa a nuestra Facultad. En el diálogo tuvimos presente esa perspectiva, la de la posible recepción o incidencia entre nosotros de algunas de las afirmaciones hechas en esa entrevista. La conversación giró en torno a cuatro grandes campos temáticos: Eclesiológico; Pastoral-Moral; Espiritualidad; Diálogo fe-cultura. Haciéndome eco de esa rica experiencia, que seguramente se prolongará en el presente año académico, quisiera retener un párrafo de dicha entrevista, a partir del cual intentaré reflexionar manteniendo la misma perspectiva, a saber, la de su posible incidencia en la vida de nuestra Facultad...

Un modelo de programación por metas para la elaboración del contrato-programa de un hospital público

[ES] Proponemos un modelo de programación por metas para la estimación del plan de producción (case-mix) que debe reflejarse en el Contrato–Programa que suscriben anualmente los Hospitales Públicos y la Administración. Las variables de decisión son los volúmenes de actividad de cada servicio médico del hospital y los atributos son los indicadores básicos que se manejan al elaborar el Contrato-Programa: fi nanciación, número de altas, estancia media y peso de complejidad. Para resolver nuestro modelo empleamos la herramienta SOLVER de la hoja de cálculo EXCEL. La utilización de esta herramienta permite simular varios escenarios de una manera ágil, lo que es de gran ayuda para el estudio y discusión de las cantidades a contratar entre el Hospital y la Administración. El artículo finaliza con una breve presentación de los resultados obtenidos al aplicar nuestro modelo a un hospital de tamaño medio (118 camas) del Servicio Vasco de Salud.

Las aportaciones del Condado de Treviño a las instituciones de Vitoria en la Edad Moderna: La Colegial de Santa María y el Hospital de Santiago

Ponencia presentada en I Congreso de Estudios Históricos del Condado de Treviño: 850 aniversario de la fundación de la Villa de Treviño, celebrado los días 1,2 y 3 de junio de 2011 en Treviño (Condado de Treviño)

Process management in healthcare.Sant Camil Hospital case study

Nowadays due to the crisis, some government measures are aimed at reducing healthcare spending, affecting in some level or another the quality offered. Process management is said to be a useful tool for reducing healthcare costs by improving management without any additional economic investment. That is doing more with the same resources and without reducing the quality offered. In this study an empirical case of a Catalan hospital is presented. Overall, the usefulness of process management in the healthcare sector is shown and some tips are provided for those managers that want to implement this management system in their hospitals. This work is also interesting for those managers responsible for the National Healthcare System due to a big question is stated: what would happen if process management was implemented in the whole healthcare system?

Fatores de risco no ambiente do trabalho de enfermagem em um hospital universitário

Pesquisa realizada em um Hospital Universitário do Estado do Rio de Janeiro, através de uma abordagem quantitativa descritiva, com objetivo de identificar os fatores de riscos ambientais presentes nas situações de trabalho dos profissionais de enfermagem, a partir da observação sistemática dos locais de trabalho pelos profissionais de saúde e segurança do trabalho e dos chefes de enfermagem de clínicas de um Hospital Universitário, visando gerar resultados que possam trazer a discussão, os riscos ocupacionais aos quais estão expostos os profissionais de enfermagem, seu conhecimento a respeito destes riscos e sua atuação na identificação e ação sobre os mesmos. A população foi composta por treis profissionais de saúde e segurança no trabalho e trinta enfermeiros chefes de unidade de internação. Para a coleta de dados foi utilizado um questionário fechado proposto no Guia de Avaliação de Riscos nos Locais de Trabalho de Boix e Vogel (1997) e adaptado para aplicação em estabelecimentos de saúde por Mauro (2001). Os dados foram analisados através do software Statical Package for the Social Sciences (SPSS) versão 15.0. Os resultados evidenciaram que os fatores de riscos ocupacionais de maior relevância do estudo foram: os sistemas inadequados de prevenção de incêndio, de saída de emergência e dispositivos e instruções de segurança e manutenção preventiva inadequada, exposição à riscos biológicos, desenho arquitetônico dos locais de trabalho inadequado, distribuição inadequada de pessoal e conhecimento ergonômico insuficiente do trabalhador. Estes fatores atuam de forma direta ou indireta nos locais de trabalho, propiciando aos profissionais um ambiente desfavorável para a realização das atividades, o que pode comprometer a sua saúde e vida profissional. Concluiu-se que os profissionais enfermeiros no cargo de gestores, em sua maioria, não possuem a visibilidade sobre os fatores de riscos aos quais eles próprios e a equipe sob sua gerência encontram-se expostos, mesmo porque desempenham suas tarefas quase em sua integralidade com alto risco de acidentes e doenças. O estudo proporcionou melhor compreensão dos fatores de risco presentes no ambiente, suas repercussões no processo de trabalho de enfermagem e na saúde dos profissionais, da importância da inserção e comprometimento dos gestores sobre os fatores de risco no ambiente de trabalho e da ergonomia participativa na análise e prevenção de riscos ocupacionais.

Design of an oxygen flow meter for hospital application

A general description of the need for hospital flow meters is given along with an analysis of some common flow measurement methods.

The design criteria, establishment of the basic configuration of the instrument, and the evolution of the final design are presented in detail. The ability of the magnetic crossover mechanism to extract the square root of an input is explained, and design curves are presented. The action of the flow totalizer is described in relation to the rest of the instrument. A complete set of manufacturing drawings for the instrument and its tooling is included in the thesis.

In conclusion, an evaluation of the completed instrument is made, and improvements and modifications are indicated. Mention is made of the adaptability of the magnetic crossover mechanism to other instrumentation.