Injury and frequency of use of playground equipment in public schools and parks in Brisbane, Australia

Objective: The purpose of this study was to determine the frequency of use of play equipment in public schools and parks in Brisbane, Australia, and to estimate an annual rate of injury per use of equipment, overall and for particular types of equipment. Methods: Injury data on all children injured from playground equipment and seeking medical attention at the emergency department of either of the two children's hospitals in the City of Brisbane were obtained for the years 1996 and 1997. Children were observed at play on five different pieces of play equipment in a random sample of 16 parks and 16 schools in the City of Brisbane. Children injured in the 16 parks and schools were counted, and rates of injury and use were calculated. Results: The ranked order for equipment use in the 16 schools was climbing equipment (3762 uses), horizontal ladders (2309 uses), and slides (856 uses). Each horizontal ladder was used 2.6 times more often than each piece of climbing equipment. Each horizontal ladder was used 7.8 times more than each piece of climbing equipment in the sample of public parks. Slides were used 4.6 times more than climbing equipment in parks and 1.2 times more in public schools. The annual injury rate for the 16 schools and 16 parks under observation was 0.59/100000 and 0.26/100000 uses of equipment, respectively. Conclusions: This study shows that annual number of injuries per standardized number of uses could be used to determine the relative risk of particular pieces of playground equipment. The low overall rate of injuries/100000 uses of equipment in this study suggests that the benefit of further reduction of injury in this community may be marginal and outweigh the economic costs in addition to reducing challenging play opportunities.

The use of cusum analysis in the early detection and management of hospital bed occupancy crises

Objective: To assess the value of cusum analysis in hospital bed management. Design: Comparative analysis of medical patient flows, bed occupancy, and emergency department admission rates and access block over 2 years. Setting: Internal Medicine Services and Emergency Department in a teaching hospital. Interventions: Improvements in bed use and changes in the level of available beds. Main outcome measures: Average length of stay; percentage occupancy of available beds; number of patients waiting more than 8 hours for admission (access block); number of medical patients occupying beds in non-medical wards; and number of elective surgical admissions. Results: Cusum analysis provided a simple means of revealing important trends in patient flows that were not obvious in conventional time-series data. This prompted improvements in bed use that resulted in a decrease of 9500 occupied bed-days over a year. Unfortunately and unexpectedly, after some initial improvement, the levels of access block, medical ward congestion and elective surgical admissions all then deteriorated significantly. This was probably caused by excessive bed closures in response to the initial improvement in bed use. Conclusion: Cusum analysis is a useful technique for the early detection of significant changes in patient flows and bed use, and in determining the appropriate number of beds required for a given rate of patient flow.

Evaluation of a pilot telemedicine network for accident and emergency work

A pilot accident and emergency. teleconsulting service was established in Scotland. It was based at the accident and emergency department of the main hospital in Aberdeen. There were three peripheral sites in rural Grampian (Peterhead, Turriff and Huntly) and one in the Shetland Isles. The videoconferencing equipment used was connected by ISDN at 384 kbit/s. During the 15 months of the study, 1998 videoconference calls were made, of which 402 (20%) calls were made to the accident and emergency department for clinical consultations. The majority of the clinical calls (95%) were made between 09:00 and 17:00, and more than 90% were completed within 20 min. During the majority of calls (87%) one or more X-ray images were transmitted. The majority of patients (89%) received treatment without transportation to the main centre in Aberdeen. The present study demonstrated that accident and emergency teleconsultations can be technically reliable, effective in reducing the number of patient transfers and acceptable to the referring clinicians. As a result, approximately pound1.5 million has been made available by the government to develop a national system for Scotland.

Clinical decision support system for point of care use: ontology driven design and software implementation

OBJECTIVES: The objective of this research was to design a clinical decision support system (CDSS) that supports heterogeneous clinical decision problems and runs on multiple computing platforms. Meeting this objective required a novel design to create an extendable and easy to maintain clinical CDSS for point of care support. The proposed solution was evaluated in a proof of concept implementation. METHODS: Based on our earlier research with the design of a mobile CDSS for emergency triage we used ontology-driven design to represent essential components of a CDSS. Models of clinical decision problems were derived from the ontology and they were processed into executable applications during runtime. This allowed scaling applications' functionality to the capabilities of computing platforms. A prototype of the system was implemented using the extended client-server architecture and Web services to distribute the functions of the system and to make it operational in limited connectivity conditions. RESULTS: The proposed design provided a common framework that facilitated development of diversified clinical applications running seamlessly on a variety of computing platforms. It was prototyped for two clinical decision problems and settings (triage of acute pain in the emergency department and postoperative management of radical prostatectomy on the hospital ward) and implemented on two computing platforms-desktop and handheld computers. CONCLUSIONS: The requirement of the CDSS heterogeneity was satisfied with ontology-driven design. Processing of application models described with the help of ontological models allowed having a complex system running on multiple computing platforms with different capabilities. Finally, separation of models and runtime components contributed to improved extensibility and maintainability of the system.

The potential for pharmacists to manage children attending emergency departments

AIM: There have been concerns about maintaining appropriate clinical staff levels in Emergency Departments in England.1 The aim of this study was to determine if Emergency Department attendees aged from 0-16 years could be managed by community pharmacists or hospital independent prescriber pharmacists with or without further advanced clinical practice training. METHOD: A prospective, 48 site, cross-sectional, observational study of patients attending Emergency Departments (ED) in England, UK was conducted. Pharmacists at each site collected up to 400 admissions and paediatric patients were included in the data collection. The pharmacist independent prescribers (one for each site) were asked to identify patient attendance at their Emergency Department, record anonymised details of the cases-age, weight, presenting complaint, clinical grouping (e.g. medicine, orthopaedics), and categorise each presentation into one of four possible categories: CP, Community Pharmacist, cases which could be managed by a community pharmacist outside an ED setting; IP-cases that could be managed at ED by a hospital pharmacist with independent prescriber status; IPT, Independent Prescriber Pharmacist with additional training-cases which could be managed at ED by a hospital pharmacist independent prescriber with additional clinical training; and MT, Medical Team only-cases that were unsuitable for the pharmacist to manage. An Impact Index was calculated for the two most frequent clinical groupings using the formula: Impact index=percentage of the total workload of the clinical grouping multiplied by the percentage ability of pharmacists to manage that clinical group. RESULTS: 1623 out of 18,229 (9%) attendees, from 45 of the 48 sites, were children aged from 0 to 16 years of age (median 8 yrs, range 0-16), 749 were female and 874 were male. Of the 1623 admissions, 9% of the cases were judged to be suitable for clinical management by a community pharmacist (CP), 4% suitable for a hospital pharmacist independent prescriber (IP), 32% suitable for a hospital independent pharmacist prescriber with additional training (IPT); and the remaining 55% were only suitable for the Medical Team (MT). The most frequent clinical groups and impact index for the attendees were General Medicine=10.78 and orthopaedics=10.60. CONCLUSION: Paediatric patients attending Emergency Departments were judged by pharmacists to be suitable for management outside a hospital setting in approximately 1 in 11 cases, and by hospital independent prescriber pharmacists in 4 in 10 cases. With further training, it was found that the total proportion of cases that could be managed by a pharmacist was 45%. The greatest impact for pharmacist management occurs in general medicine and orthopaedics.

Systematic Molecular Phenotyping: A Path Toward Precision Emergency Medicine?

Precision medicine is an emerging approach to disease treatment and prevention that considers variability in patient genes, environment, and lifestyle. However, little has been written about how such research impacts emergency care. Recent advances in analytical techniques have made it possible to characterize patients in a more comprehensive and sophisticated fashion at the molecular level, promising highly individualized diagnosis and treatment. Among these techniques are various systematic molecular phenotyping analyses (e.g., genomics, transcriptomics, proteomics, and metabolomics). Although a number of emergency physicians use such techniques in their research, widespread discussion of these approaches has been lacking in the emergency care literature and many emergency physicians may be unfamiliar with them. In this article, we briefly review the underpinnings of such studies, note how they already impact acute care, discuss areas in which they might soon be applied, and identify challenges in translation to the emergency department (ED). While such techniques hold much promise, it is unclear whether the obstacles to translating their findings to the ED will be overcome in the near future. Such obstacles include validation, cost, turnaround time, user interface, decision support, standardization, and adoption by end-users.

Benefits and resource implications of family meetings for hospitalized palliative care patients: research protocol.

BACKGROUND:
Palliative care focuses on supporting patients diagnosed with advanced, incurable disease; it is 'family centered', with the patient and their family (the unit of care) being core to all its endeavours. However, approximately 30-50% of carers experience psychological distress which is typically under recognised and consequently not addressed. Family meetings (FM) are recommended as a means whereby health professionals, together with family carers and patients discuss psychosocial issues and plan care; however there is minimal empirical research to determine the net effect of these meetings and the resources required to implement them systematically. The aims of this study were to evaluate: (1) if family carers of hospitalised patients with advanced disease (referred to a specialist palliative care in-patient setting or palliative care consultancy service) who receive a FM report significantly lower psychological distress (primary outcome), fewer unmet needs, increased quality of life and feel more prepared for the caregiving role; (2) if patients who receive the FM experience appropriate quality of end-of-life care, as demonstrated by fewer hospital admissions, fewer emergency department presentations, fewer intensive care unit hours, less chemotherapy treatment (in last 30 days of life), and higher likelihood of death in the place of their choice and access to supportive care services; (3) the optimal time point to deliver FM and; (4) to determine the cost-benefit and resource implications of implementing FM meetings into routine practice.
METHODS:
Cluster type trial design with two way randomization for aims 1-3 and health economic modeling and qualitative interviews with health for professionals for aim 4.
DISCUSSION:
The research will determine whether FMs have positive practical and psychological impacts on the family, impacts on health service usage, and financial benefits to the health care sector. This study will also provide clear guidance on appropriate timing in the disease/care trajectory to provide a family meeting.

Iowa Immunization Program Annual Report 2013, April 30, 2014

The Bureau of Immunization is part of the Division of Acute Disease Prevention and Emergency Response (ADPER) at the Iowa Department of Public Health (IDPH). The ADPER division provides support, technical assistance and consultation to local hospitals, public health agencies, community health centers, emergency medical service programs and local health care providers regarding infectious diseases, disease prevention and control, injury prevention and public health and health care emergency preparedness and response. The division encompasses the Center for Acute Disease Epidemiology (CADE), the Bureau of Immunization and Tuberculosis (ITB), the Bureau of Emergency Medical Services (EMS), the Bureau of Communication and Planning (CAP), the Office of Health Information Technology (HIT), and the Center for Disaster Operations and Response (CDOR). The Bureau of Immunization and Tuberculosis includes the Immunization Program, the Tuberculosis Control Program, and the Refugee Health Program. The mission of the Immunization Program is to decrease vaccine‐preventable diseases through education, advocacy and partnership. While there has been major advancement in expanding immunizations to many parts of Iowa’s population, work must continue with public and private health care providers to promote the program’s vision of healthy Iowans living in communities free of vaccine‐preventable diseases. Accomplishing this goal will require achieving and maintaining high vaccination coverage levels, improving vaccination strategies among under‐vaccinated populations, prompt reporting and thorough investigation of suspected disease cases, and rapid institution of control measures. The Immunization Program is comprised of multiple programs that provide immunization services throughout the state: Adolescent Immunization Program, Adult Immunization Program, Immunization Registry Information System (IRIS), Vaccines for Children Program (VFC), Perinatal Hepatitis B Program, and Immunization Assessment Program.

Continuity of care in older adults with multiple chronic conditions

Thesis (Ph.D.)--University of Washington, 2016-08

Role of emergency thoracic ultrasonography in spontaneous pneumomediastinum. Two case report

Early identification of spontaneous pneumomediastinum in an Emergency Department is possible with thoracic ultrasound. We report two cases of spontaneous pneumomediastinum, diagnosed in a 26-year old man with chronic asthma and a 19-year old athlete, and discuss the role of thoracic US alongside conventional X-ray and thoracic CT in emergency medicine. The patients were transferred to an Emergency Department, where conservative treatment produced a good outcome. The greater sensitivity and specificity of thoracic US over conventional supine X-ray in the detection of occult pneumothorax is ever more appreciated. However, training in the diagnosis of pneumomediastinum is required.

Satisfação/motivação dos enfermeiros profissão, serviço e hierarquia

Apesar de décadas de estudos, as opiniões são controversas. Não existe uma opinião comum entre os pesquisadores sobre o que é e como ocorre a motivação, a satisfação e a insatisfação no trabalho. As condições físicas dos serviços são um factor primordial para a motivação, satisfação ou insatisfação do trabalhador, assim como o tipo de liderança existente no mesmo. Ao longo da nossa história tem-se assistido a muitos exemplos de liderança, uns mais, outros menos eficazes. A satisfação no trabalho é um estado afectivo resultante da apreciação das características percebidas do trabalho e da organização. Neste contexto de mudanças na administração pública em geral e na área da saúde em particular, surge este estudo em contexto hospitalar, motivado pela necessidade de conhecer a satisfação dos enfermeiros de um Centro Hospitalar de Lisboa e a relação com algumas variáveis sócio demográficas. Optou-se pelo paradigma quantitativo, numa amostra de 122 inquiridos pertencentes a um grupo de profissionais de enfermagem de um Hospital Central de Lisboa. Para a elaboração da parte empírica utilizou-se o método por questionário de escolha múltipla. Os objectivos definidos: Objectivo Geral: perceber o nível de motivação/ satisfação dos enfermeiros relativamente à profissão ao serviço e à hierarquia. Objectivos específicos: Identificar o nível de satisfação/motivação dos enfermeiros dos serviços estudados relativamente à profissão, em função das variáveis sociodemográficas. - Caracterizar os aspectos com os quais os enfermeiros têm maior e menor satisfação relacionados com a profissão, serviço e hierarquia. - Identificar se existe relação entre o nível de motivação/satisfação e os sintomas físicos sentidos. Os participantes da amostra são, maioritariamente do sexo feminino, a média de idades é de 32 anos, grande percentagem já tem como habilitações profissionais a licenciatura, têm entre 1 e 28 anos de profissão e 1 e 28 anos no serviço actual, 17,2% exercem funções de chefia. Grande percentagem da amostra tem como horário semanal de trabalho 35 horas e trabalham em horário rotativo. Os enfermeiros são profissionais que mostram insatisfação relativamente à profissão e hierarquia e moderada satisfação relativamente aos serviços. A satisfação dos enfermeiros quanto à profissão altera-se de acordo com o horário de trabalho, vínculo à instituição e os sentimentos que os mesmos têm relativamente ao trabalho. A satisfação dos enfermeiros relativamente ao serviço altera-se consoante o tempo de profissão e com os sentimentos que os profissionais apresentam relativamente ao trabalho. Quanto à satisfação dos enfermeiros relativamente à hierarquia altera-se dependendo da idade dos profissionais, do tempo de profissão e do serviço onde desempenham. Relativamente à satisfação geral com o trabalho, esta pode alterar dependendo da idade, do tempo de profissão, do serviço onde desempenham funções e dos sentimentos dos profissionais relativamente ao trabalho. De salientar que ao analisarmos os serviços estudados separadamente concluímos que os enfermeiros do serviço de urgência são profissionais muito insatisfeitos com a hierarquia e os enfermeiros da Unidade de Urgência Médica são profissionais pouco satisfeitos, mas apesar de tudo satisfeitos com a hierarquia. ABSTRACT; Behind decades of studies, the opinions are controversial. There is a common opinion among researchers about what is and how is the motivation, satisfaction and dissatisfaction at work. The physical conditions of services are a major factor in motivation, satisfaction or dissatisfaction of the worker and the type of leadership exists in it. Throughout our history have seen many examples of leadership, some more, some less effective. Job satisfaction is an affective state resulting from the assessment of the perceived characteristics of work and organization. ln this context of changes in public administration in general and in health in particular, this study appears in the hospital setting, motivated by the need to know the satisfaction of nurses in a Hospital in Lisbon and the relationship with sociodemographic variables. We chose the quantitative paradigm in a sample of 122 respondents belonging to a group of nursing professionals in a central hospital in Lisbon. ln developing the empirical part we used the method for multiple-choice test. The objectives: General Objective: To understand the level of motivation I satisfaction of nurses for the profession and the service hierarchy. Specific objectives: To identify the level of satisfaction I motivation of nursing service studied for the profession, according to the socio-demographic variables. - Characterize the points with which nurses have the highest and lowest satisfaction related to the profession, service and hierarchy. - To identify if there is a relationship between the level of motivation I satisfaction and physical symptoms felt. The sample participants are mostly female, average age is 32 years, a large percentage already has the professional qualifications of the degree, are between and 28 years of occupation and 1 and 28 in the current service, 17.2 % hold positions of leadership. A great percentage of the sample has the working week and working 35 hours on rotating schedule. Nurses are professionals who show dissatisfaction with the profession and the hierarchy and moderately satisfied for the services, the latter fact can be justified by what is possible when the organization professionals are available and perform functions in service to their liking and they like to work. The satisfaction of nurses as the profession changes according to working hours, commitment to the institution and the feelings they have for the work. The satisfaction of nurses for the service changes depending on the length of service and with the feelings that professionals are on the job. The satisfaction of nurses from the hierarchy will change depending on the age of professionals, time and professional service where they play. For the overall satisfaction with the work, this may change depending on age, length of employment, where the service functions and the feelings of the professionals for the job. Note that when analyzing the services studied separately concluded that the nurses in the emergency department professionals are very unhappy with the hierarchy and the nurses of the Unit of Emergency Medical professionals are somewhat satisfied but still happy

Na especificidade, a evidência do impacto das intervenções do enfermeiro especialista em enfermagem de reabilitação no doente com patologia respiratória crónica, no serviço de urgência

O presente estudo decorreu no serviço de urgência do Hospital do Espírito Santo de Évora – EPE, de Setembro de 2015 a Janeiro de 2016 e enquadra-se na área da prestação de cuidados especializados em enfermagem de reabilitação. É um estudo de caso, em que objeto de estudo é “A Intervenção do Enfermeiro Especialista em Enfermagem de Reabilitação no doente com Patologia Respiratória Crónica”. A abordagem metodológica é mista pois trata-se de um caso de estudo que não é puramente qualitativo. A utilização de metodologia quantitativa com indicadores quantitativos permitirá uma melhor compreensão e visão global do caso apresentado. Trata-se de um estudo de natureza descritiva, transversal e não experimental pois tem como objetivo a recolha de dados observáveis e quantificáveis, num determinado período de tempo e não o controlo de fenómenos. População alvo: todos os utentes com Patologia Respiratória Crónica internados no Serviço de Observação no período de tempo referido anteriormente. Amostra: 4 utentes com média de idades de 78,0 anos dos quais 75% eram do sexo masculino e 25% do sexo feminino. Foram implementadas intervenções de enfermagem de reabilitação, nomeadamente, reabilitação funcional respiratória e motora, que demonstraram ser eficazes tendo-se obtido saturações periféricas de O2 de 96%, em média. Estes resultados traduzem-se em ganhos ao nível da capacidade respiratória permitindo o desenvolvimento de atividades de vida diária normais. Também foi possível a manutenção e potenciação das capacidades de mobilidade nestes utentes com uma média etária elevada e com algumas limitações físicas e/ou cognitivas o que, só por si, também traduz ganhos em saúde no que concerne à sua independência e melhoria da qualidade de vida. O Enfermeiro Especialista em Enfermagem de Reabilitação é claramente uma mais-valia no serviço de urgência pois ao colocar em prática uma dinâmica de desempenho voltado para os conhecimentos especializados adquiridos, criando ferramentas que permitam um desempenho estruturado dos cuidados, a promoção da sua continuidade, a sua avaliação e a produção de conhecimento científico baseado na evidência contribui para a redução do tempo de internamento o que se repercute na maior eficácia na Gestão de Unidades de Saúde.

A dotação de Enfermeiros no serviço de Urgência Geral do CHCB: A segurança dos cuidados na sazonalidade

Com a realização deste estágio pretende-se fazer um levantamento do número de pessoas que recorrem ao Serviço de Urgência Geral do centro Hospitalar Cova da Beira, fazendo uma análise da sazonalidade dessa procura e posteriormente projetar possíveis adaptações à dotação de enfermeiros. Pretende-se também contribuir para a segurança dos cuidados de Enfermagem, prestados no Serviço de Urgência do Centro Hospitalar Cova da Beira e calcular a dotação de Enfermeiros necessária baseada na necessidade de cuidados de Enfermagem por atendimento. Vamos fazer referência aos métodos de cálculo de dotação de Enfermagem nos serviços de Urgência e a legislação existente. Caracterizar o referido serviço e proceder ao levantamento, apresentação e análise do número de atendimentos no ano de 2010.

Ultrasonido a la cabecera del paciente, una herramienta diagnóstica de disección aórtica en el departamento de emergencias

El síndrome aórtico agudo puede presentarse como un cuadro clínico característico de una emergencia vascular, o por el contrario de una forma completamente atípica, donde el diagnóstico reta al médico de emergencias, llevando a errores fatales al pasar por alto el diagnóstico de esta entidad. Con el objetivo de mostrar la utilidad del ultrasonido realizado a la cabecera del paciente en el diagnóstico de disección aórtica, se describen 9 casos de pacientes que ingresaron al departamento de emergencias y que fueron diagnosticados con síndrome aórtico agudo, gracias a la valoración ultrasonográfica inicial realizada por residentes y Especialistas en Medicina de Emergencias en un hospital de Bogotá D.C., Colombia. Este reporte de casos muestra que el ultrasonido a la cabecera del paciente, es un método diagnóstico no invasivo, accesible y útil para la detección temprana de esta patología en los servicios de emergencias.

Descripción de la prevalencia del boarding en la fundación santa fe de bogotá.

Introducción: El boarding es el fenómeno que ocurre cuando existen pacientes hospitalizados en urgencias sin una cama de hospitalización a la cual trasladarse, en la literatura mundial se ha identificado como un factor que repercute en la calidad y seguridad de la atención en urgencias. Este trabajo busca describir la prevalencia de dicho fenómeno en el servicio de urgencias de la Fundación Santa fe de Bogotá Metodología: Estudio observacional de prevalencia. Se incluyeron pacientes del mes de octubre de 2015 atendidos por especialistas en medicina de emergencias de la Fundación Santa fe de Bogotá. Se tomaron datos del turno realizado (mañana, tarde y noche), y datos del servicio de urgencias para su descripción. Resultados: La mediana de ocupación por boarding en urgencias fue del 68% con un rango intercuartil de 54-75%; en términos de tiempo en minutos, la mediana fue de 1054 minutos, con un rango intercuartil de 621-1490. Existen diferencias numéricas del tiempo en minutos de acuerdo el turno (mañana: 992,77 DE 519, tarde:1584,13 DE 1000,27 noche:1304,13 DE 2126,43). Discusión: El tiempo de boarding reportado para urgencias de la Fundación Santa fe de Bogotá es comparativamente mayor al descrito en la literatura mundial, se deben explorar en estudios analíticos posteriores los factores o variables que se asocien a la presencia de este fenómeno.