Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) is a valid screening tool in chemotherapy outpatients

Purpose In the oncology population where malnutrition prevalence is high, more descriptive screening tools can provide further information to assist triaging and capture acute change. The Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) is a component of a nutritional assessment tool which could be used for descriptive nutrition screening. The purpose of this study was to conduct a secondary analysis of nutrition screening and assessment data to identify the most relevant information contributing to the PG-SGA SF to identify malnutrition risk with high sensitivity and specificity. Methods This was an observational, cross-sectional study of 300 consecutive adult patients receiving ambulatory anti-cancer treatment at an Australian tertiary hospital. Anthropometric and patient descriptive data were collected. The scored PG-SGA generated a score for nutritional risk (PG-SGA SF) and a global rating for nutrition status. Receiver operating characteristic curves (ROC) were generated to determine optimal cut-off scores for combinations of the PG-SGA SF boxes with the greatest sensitivity and specificity for predicting malnutrition according to scored PG-SGA global rating. Results The additive scores of boxes 1–3 had the highest sensitivity (90.2 %) while maintaining satisfactory specificity (67.5 %) and demonstrating high diagnostic value (AUC = 0.85, 95 % CI = 0.81–0.89). The inclusion of box 4 (PG-SGA SF) did not add further value as a screening tool (AUC = 0.85, 95 % CI = 0.80–0.89; sensitivity 80.4 %; specificity 72.3 %). Conclusions The validity of the PG-SGA SF in chemotherapy outpatients was confirmed. The present study however demonstrated that the functional capacity question (box 4) does not improve the overall discriminatory value of the PG-SGA SF.

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.

Early protein malnutrition disrupts cerebellar development and impairs motor coordination

Maternal malnutrition affects every aspect of fetal development. The present study asked the question whether a low-protein diet of the mother could result in motor deficits in the offspring. Further, to examine whether cerebellar pathology was correlated with motor deficits, several parameters of the postnatal development of the cerebellum were assayed. This is especially important because the development of the cerebellum is unique in that the time scale of development is protracted compared with that of the cortex or hippocampus. The most important result of the study is that animals born to protein-deficient mothers showed significant delays in motor development as assessed by rotarod and gait analysis. These animals also showed reduced cell proliferation and reduced thickness in the external granular layer. There was a reduction in the number of calbindin-positive Purkinje cells (PC) and granular cells in the internal granular layer. However, glial fibrillary acidic protein-positive population including Bergmann glia remained unaffected. We therefore conclude that the development of the granular cell layer and the PC is specifically prone to the effects of protein malnutrition potentially due to their protracted developmental period from approximately embryonic day 11 to 13 until about the third postnatal week.

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?

Improved utilization and increased availability of fishery products as an effective control of aggravated animal protein deficiency - induced malnutrition in Nigeria

The estimated potential of Nigerian fish resources is 1,830,994 tonnes(t) whereas the demand based on per capita consumption of 12.0kg and a population of 88.5 million is 1.085 million tonnes. Supply is presently less than 500,000 tons. The gap between demand and supply have to be met through improved utilization and increased availability of fish and fishery products. The role of fish in nutrition is recognized, since it supplies a good balance of protein, vitamins and minerals and a relatively low caloric content. This paper appraises the consumption and utilisation pattern of fish in Nigeria, the spoilage of fish and prevention of losses as a means of increasing the availability of fish for human consumption and consequent control of aggravated animal protein deficiency - induced malnutrition. The paper further highlights the point that without increased landings, increased supply of fish can be achieved through reduction of postharvest loss of what is presently caught. The use of newly designed smoke - drying equipment to achieve such goal is highlighted. The paper also emphasises the need to put into human food chain those non-conventional fishery resources and by-catch of shrimp and demersal trawl fishes by conversion into high value protein products like fish cakes, fish pies and salted dried cakes