Safe Visiting, March 20, 2103

For most of us a cold, or even the flu, poses nothing more than a minor inconvenience, some time at home in bed, and maybe a trip to see your physician. For residents and tenants in long-term care settings, however, coming down with the flu can be life threatening. Compromised immune systems and respiratory or cardiac issues can become more than just a challenge. Because of this, it is important to think about how a safe environment can be maintained while at the same time allowing for visitors and social activities.

Bacterial biofilms, antibiotic resistance and healthcare-associated infections: a dangerous connection

In 2012, were estimated 6.7 million cases of healthcare-associated infections (HAI) either in long-term care facilities or acute-care hospitals from which result 37,000 deaths configuring a serious public health problem. The etiological agents are diverse and often resistant to antimicrobial drugs. One of the mechanisms responsible for the emergence of drug resistance is biofilm assembly. Biofilms are defined as thin layers of microorganisms adhering to the surface of a structure, which may be organic or inorganic, together with the polymers that they secrete. They are dynamic structures which experience different stages of organization with the ageing and are linked to an increase in bacterial resistance to host defense mechanisms, antibiotics, sterilization procedures other than autoclaving, persistence in water distribution systems and other surfaces. The understanding of bacteria organization within the biofilm and the identification of differences between planktonic and sessile forms of bacteria will be a step forward to fight HAIs.

PCR-Internal Transcribed Spacer (ITS) genes sequencing and phylogenetic analysis of clinical and environmental Aspergillus species associated with HIV-TB co infected patients in a hospital in Abeokuta, southwestern Nigeria.

Background: Aspergillosis has been identified as one of the hospital acquired infections but the contribution of water and inhouse air as possible sources of Aspergillus infection in immunocompromised individuals like HIV-TB patients have not been studied in any hospital setting in Nigeria. Objective: To identify and investigate genetic relationship between clinical and environmental Aspergillus species associated with HIV-TB co infected patients. Methods: DNA extraction, purification, amplification and sequencing of Internal Transcribed Spacer (ITS) genes were performed using standard protocols. Similarity search using BLAST on NCBI was used for species identification and MEGA 5.0 was used for phylogenetic analysis. Results: Analyses of sequenced ITS genes of selected fourteen (14) Aspergillus isolates identified in the GenBank database revealed Aspergillus niger (28.57%), Aspergillus tubingensis (7.14%), Aspergillus flavus (7.14%) and Aspergillus fumigatus (57.14%). Aspergillus in sputum of HIV patients were Aspergillus niger, A. fumigatus, A. tubingensis and A. flavus. Also, A. niger and A. fumigatus were identified from water and open-air. Phylogenetic analysis of sequences yielded genetic relatedness between clinical and environmental isolates. Conclusion: Water and air in health care settings in Nigeria are important sources of Aspergillus sp. for HIV-TB patients.

Comportamiento de la patología biliar aguda y su manejo en el servicio de trauma y emergencia del Hospital "Vicente Corral Moscoso" Cuenca. Enero a junio de 2014

La patología biliar afecta a un gran porcentaje de la población adulta, motivo por el cual su tratamiento en la actualidad ha cambiado hacia un nuevo paradigma de cuidado bajo el concepto de “Acute Care Surgery” (ACS) 1 el cual se caracteriza por priorizar la valoración integral del paciente e intervención precoz de la patología. En el Hospital Vicente Corral Moscoso (HVCM) bajo este modelo ACS, y mediante la utilización de protocolos estandarizados se ha logrado dar un giro importante en el tratamiento oportuno de la patología biliar mediante la utilización de herramientas habituales como pruebas de laboratorio, imagenología y si es el caso, la resolución quirúrgica mediante técnica mínimamente invasiva o por vía convencional. OBJETIVO: Describir el comportamiento de la patología biliar y su manejo en el servicio de Trauma y Emergencias del Hospital “Vicente Corral Moscoso”, durante el período de enero a junio de 2014, bajo el modelo ACS. MÉTODOS: Estudio descriptivo transversal, que analizó los casos de colecistitis aguda litiásica (CAL), coledocolitiasis, pancreatitis aguda biliar (PAB) y su manejo, registrado en la base de datos digital del servicio de Emergencias del Hospital Vicente Corral Moscoso, bajo criterios clínicos, de laboratorio e imagenológicos, durante el periodo de enero a junio del 2014. RESULTADOS: El estudio contó con un total de 240 pacientes atendidos en el servicio de Trauma y Emergencia del HVCM, durante el periodo de enero a junio de 2014. La patología en orden de frecuencia fue: en un 47%, la Coledocolitiasis; 35% colecistitis aguda y, pancreatitis aguda biliar 18%. La prevalencia fue mayor en el sexo femenino en un 85%, 67%, y 81% respectivamente y el tratamiento se adaptó a cada patología. 1 Acute Care Surgery” (ACS): si bien no existe una definición literal hace referencia a una disciplina tripartita que engloba la cirugía de trauma, general en emergencias y cuidados críticos quirúrgicos, y que prioriza la identificación y manejo de las patologías potencialmente letales y de alta morbilidad. En nuestro medio lo más próximo a la definición seria Cirugía de Trauma y Emergencias. El manejo de la pancreatitis aguda biliar (PAB) bajo el concepto de cuidado agudo de pacientes quirúrgicos o “Acute Care Surgery” hace indispensable una intervención oportuna y temprana, utilizando todos los recursos disponibles para un manejo integral. CONCLUSIONES: La implementación del modelo de Cirugía de Trauma y Emergencias en nuestra institución ha logrado un manejo integral de colecistitis aguda litiásica, pancreatitis aguda biliar y coledocolitiasis, disminuyendo las complicaciones asociadas y evitando las recidivas de cuadros de mayor gravedad.

Professional partnerships in children's services: working together for children

Early childhood education and care services in Australia are moving towards an integrated approach to service delivery requiring educators to work in partnership with professionals from sectors such as health, education and community services for the benefit of young children and their families. This means that educators need to work in perhaps new and different ways in their everyday work.Professional partnerships in children’s services: Working together for children looks at ways educators can work effectively with other professionals in building and leading these partnerships in children’s services. It examines some of the issues surrounding working in partnership with others and the implications this has for understanding and enacting leadership. It explores topics such as:•working collaboratively in early childhood education and care settings•thinking about the knowledge base of others•transdisciplinarity—a new strategy to consider•examples of collaborative practice with otherprofessionals in early childhood education and care services are provided.Examples are given that have been implemented in early childhood education and care services to work collaboratively with other professionals. Professional partnerships in children’s services: Working together for children points to a way forward by encouraging the rethinking and reworking of practice by educators with the inclusion of reflective questions, scenarios from services and top tips for educators to consider.

People with dementia and the hospital environment: the view of patients and family carers

Background

A metropolitan geriatric evaluation and management (GEM) facility in Australia was undergoing expansion, and consideration for the needs of individuals with dementia and their family carers was identified as important in planning the new facility. Existing literature revealed that people in hospital value privacy, minimal noise, family amenities and homeliness, but these findings did not consider the perspectives of the person with dementia specifically.

Aim

The aim was to elicit the perspectives of current inpatients with dementia, and their family carers, about the environment/design features that they believe are necessary for people with dementia, and their family carers.

Method and design

This qualitative study utilised in-depth semi-structured interviews to obtain information from current inpatients with dementia and their family carers.

Results

Participants described how the care received was more important than the physical environment; however, participants also valued homeliness, privacy for the patient and for conversations, a shared space without a television and a connection to the outside. Participants described how accommodating carers, providing quiet spaces and appropriate amenities were also important.

Conclusions

While participants valued care over the physical surroundings, they also offered valuable information about their experience in the ward environment. Despite cognitive difficulties, people with dementia were able to provide useful information about the environment within which they were being cared.

Implications for practice

Consumer opinions about hospital design/environment should be considered as an important source of data. Privacy and personal space for people with dementia and their family carers, a connection with the outside environment , and the needs of carers and visitors are all important considerations when designing healthcare environments.

Sustainable population health : a pressing priority for community wellbeing

Recent developments in primary health care, preventive care, early intervention programs, population health constructs and coordinated care trials in Australia have explored the idea of changing our emphasis in health care from responsive acute care to more integrated, whole population community wellbeing management. This idea accepts that much illness and even trauma experienced by individuals in our communities can be prevented, mitigated or managed in a more constructive and positive manner than has previously been the case. Much disabling illness need not occur at all and can be avoided through better community based management models, education programs, and lifestyle changes that contribute to more healthy communities. As in the wider business world, we are becoming more cognisant of the fact that prevention is not only an appealing idea in terms of health outcomes and quality of life, but that it is good for business also. It can moderate demand for costly health care, assist consumers to understand how to live healthier and fulfilling lives and overall help to sustain a much more dynamic community. This article, based on work in a rural health service in South Australia, points to some elements of sustainable primary care that appear to have potential to take us where we need to go. It asks whether we have the capacity and the will to make the necessary investment in sustainability to ensure our future or whether we are to remain bound in a reactionary model of health care rather than considering the impact of wider social and physical environments as part of the overall community health equation.

Adaptation and validation of a survey instrument measuring perceived preparedness of nursing graduates

BACKGROUND: In Australia, a significant percentage of bachelor of nursing students are employed in the aged care sector, or in aged care settings, as assistants in nursing (AINs) or personal care assistants. However the value of aged care in nursing education is often overlooked. AIM: To outline the adaptation and validation of a survey, originally developed for medical graduates, for use with nursing graduates. DISCUSSION: Adaptation of the instrument was undertaken as part of a doctoral study that aimed to explore whether employment as an undergraduate assistant in nursing (AIN) in aged care prepares new graduates for clinical work. CONCLUSION: Outlining each step of the modification process can help nurse researchers who want to adapt existing instruments to meet their research objectives. IMPLICATIONS FOR PRACTICE: Undergraduate AIN employment has the potential to supplement clinical learning without the restrictions inherent in the student role. Furthermore, it has the potential to enhance recruitment and retention in the aged care sector.

Les représentations de l’infirmière chez les étudiantes nouvellement inscrites au baccalauréat en sciences infirmières

Certains chercheurs affirment que la principale raison qui pousserait une personne à devenir infirmière serait attribuable aux aspects vocationnels et non pas du désir d'exercer une profession qui requiert des connaissances et compétences inhérentes à la complexité des soins (Prater et McEwen, 2006; Price, McGillis Hall, Angus et Peter, 2013). Un des motifs principal d’attrition des étudiantes aux programmes de formation en sciences infirmières serait d’ailleurs la dissonance entre la représentation initiale qu’elles se font de l’infirmière et les exigences de la profession (AIIC, 2004). Une étude exploratoire a donc été réalisée auprès d’étudiantes nouvellement inscrites au baccalauréat en sciences infirmières (N=11), afin de mieux comprendre comment elles se représentent l’infirmière et quelles sont leurs attentes quant à la profession. Le cadre de référence de la théorie des représentations sociales de Moscovici (1961) soutient cette recherche. L’analyse qualitative de ces entretiens semi-dirigés nous renseigne à l’idée que les étudiantes québécoises se représentent le rôle de l’infirmière d’abord comme celui d’une personne qui aide, autant les bénéficiaires que les médecins. Les nouvelles étudiantes s’attendent à devoir faire face à des études exigeantes et à un travail difficile. Elles sont par contre prêtes à s’y engager par désir d’aider autrui et parce qu’elles se reconnaissent dans les qualités qu’elles jugent nécessaires à l’exercice de la profession infirmière, c’est-à-dire les habiletés relationnelles comme l’écoute, l’empathie et la patience. Ce constat laisse donc croire que le contexte historique dans lequel a évolué la profession infirmière au Québec, en plus des médias qui ne semblent pas actualiser l’image qu’ils projettent de l’infirmière, pourraient avoir une influence sur les représentations de l’infirmière de ces nouvelles étudiantes. Les résultats de cette étude pourraient permettre de circonscrire des angles de recherche future afin de comprendre davantage l’implication des représentations de l’infirmière dans le phénomène d’attrition des étudiantes, tout en ayant aussi des retombées pour la pratique infirmière au niveau des politiques et de la formation.

Les représentations de l’infirmière chez les étudiantes nouvellement inscrites au baccalauréat en sciences infirmières

Certains chercheurs affirment que la principale raison qui pousserait une personne à devenir infirmière serait attribuable aux aspects vocationnels et non pas du désir d'exercer une profession qui requiert des connaissances et compétences inhérentes à la complexité des soins (Prater et McEwen, 2006; Price, McGillis Hall, Angus et Peter, 2013). Un des motifs principal d’attrition des étudiantes aux programmes de formation en sciences infirmières serait d’ailleurs la dissonance entre la représentation initiale qu’elles se font de l’infirmière et les exigences de la profession (AIIC, 2004). Une étude exploratoire a donc été réalisée auprès d’étudiantes nouvellement inscrites au baccalauréat en sciences infirmières (N=11), afin de mieux comprendre comment elles se représentent l’infirmière et quelles sont leurs attentes quant à la profession. Le cadre de référence de la théorie des représentations sociales de Moscovici (1961) soutient cette recherche. L’analyse qualitative de ces entretiens semi-dirigés nous renseigne à l’idée que les étudiantes québécoises se représentent le rôle de l’infirmière d’abord comme celui d’une personne qui aide, autant les bénéficiaires que les médecins. Les nouvelles étudiantes s’attendent à devoir faire face à des études exigeantes et à un travail difficile. Elles sont par contre prêtes à s’y engager par désir d’aider autrui et parce qu’elles se reconnaissent dans les qualités qu’elles jugent nécessaires à l’exercice de la profession infirmière, c’est-à-dire les habiletés relationnelles comme l’écoute, l’empathie et la patience. Ce constat laisse donc croire que le contexte historique dans lequel a évolué la profession infirmière au Québec, en plus des médias qui ne semblent pas actualiser l’image qu’ils projettent de l’infirmière, pourraient avoir une influence sur les représentations de l’infirmière de ces nouvelles étudiantes. Les résultats de cette étude pourraient permettre de circonscrire des angles de recherche future afin de comprendre davantage l’implication des représentations de l’infirmière dans le phénomène d’attrition des étudiantes, tout en ayant aussi des retombées pour la pratique infirmière au niveau des politiques et de la formation.

Kommunala riktlinjer för anhöriganställningar : En kvalitativ innehållsanalys med feministisk teoriansats

Det övergripande syftet var att undersöka kommunala riktlinjer för anhöriganställningar tillgängliga på kommunernas hemsidor, dvs regeldokument gällande situationer där en anhörig anställs för att vårda en närstående. Det övergripande syftet har byggts upp utifrån följande tre frågeställningar angående hur kommunerna i Sverige beskriver: 1) vilka situationer som berättigar anhöriganställning, 2) hur det säkerställs att den äldre personen skall få sina behov tillgodosedda samt 3) hur säkerställs den anhöriganställdes rättigheter/välmående? Det saknas lagstöd för anhöriganställningar som rättighet, och det kommunala självstyret avgör om kommunen erbjuder denna omsorgsform. På senare tid har anhöriganställningar begränsats och förbjudits i flera svenska kommuner, och enligt uppgifter är det cirka 55–65 % av Sveriges kommuner som tillåter anhöriganställningar. Det är mestadels kvinnor med utländsk bakgrund som är anhöriganställda numera, och feministisk omsorgsforskning och media lyfter fram anhöriganställningar som en kvinnofälla och som en risk för integration av invandrare. I studien inkluderas riktlinjer från totalt 21 kommuner, vilka analyserades med kvalitativ innehållsanalys enligt Elo & Kyngäs (2007). De undersökta riktlinjerna hittades från hemsidorna för Sveriges 121 medelstora och stora kommuner (mer än 20 000 invånare). Resultatet har bearbetats med hjälp av feministisk teori (Hirdman 2012). Resultatet visar att det överlag finns få riktlinjer tillgängliga i Sveriges kommuner och att regelverken skiljer sig åt i de olika kommunerna.  I de riktlinjer som finns är ofta innehållet allmänna eller oklara beskrivningar. En slutsats är därför att många kommuner säkerställer sitt eget handlingsutrymme och ett tolkningsföreträde genom otydliga och allmänt hållna regler i sina riktlinjer. Utifrån ett feministiskt perspektiv kan dessa tolkningsföreträden skapa orättvisa strukturer och skillnader i förutsättningar och villkor för de äldre och för deras anhörigvårdare avseende anhöriganställningar. Slutligen visar resultatet på att de få detaljerade beskrivningarna prioriterar de äldres rättigheter framför de anhöriganställdas. Säkerställandet av de anhöriganställdas rättigheter beskrivs huvudsakligen att ske genom att kontrollera och styra de anhöriganställda. De anhöriganställda är ofta osynliga i riktlinjerna, betraktas som pseudoanställda och hamnar därför mellan stolarna vad gäller stödbehovet (Sand 2010).

Evaluación del desempeño de pruebas diagnósticas de tuberculosis en pacientes VIH positivo en dos hospitales públicos de Bogotá

La tuberculosis TB es una de las principales causas de muerte en el mundo en individuos con infección por VIH. En Colombia esta coinfección soporta una carga importante en la población general convirtiéndose en un problema de salud pública. En estos pacientes las pruebas diagnósticas tienen sensibilidad inferior y la enfermedad evoluciona con mayor frecuencia hacia formas diseminadas y rápidamente progresivas y su diagnóstico oportuno representa un reto en Salud. El objetivo de este proyecto es evaluar el desempeño de las pruebas diagnósticas convencionales y moleculares, para la detección de TB latente y activa pacientes con VIH, en dos hospitales públicos de Bogotá. Para TB latente se evaluó la concordancia entre las pruebas QuantiFERON-TB (QTF) y Tuberculina (PPD), sugiriendo superioridad del QTF sobre la PPD. Se evaluaron tres pruebas diagnósticas por su sensibilidad y especificidad, baciloscopia (BK), GenoType®MTBDR plus (Genotype) y PCR IS6110 teniendo como estándar de oro el cultivo. Los resultados de sensibilidad (S) y especificidad (E) de cada prueba con una prevalencia del 19,4 % de TB pulmonar y extrapulmonar en los pacientes que participaron del estudio fue: BK S: 64% E: 99,1%; Genotype S: 77,8% E: 94,5%; PCRIS6110 S: 73% E: 95,5%, de la misma forma se determinaron los valores predictivos positivos y negativos (VPP y VPN) BK: 88,9% y 94,8%, Genotype S: 77,8% E: 94,5%; PCRIS6110 S: 90% y 95,7%. Se concluyó bajo análisis de curva ROC que las pruebas muestran un rendimiento diagnóstico similar por separado en el diagnóstico de TB en pacientes con VIH, aumentando su rendimiento diagnostico cuando se combinan

Perfil epidemiológico y análisis de la formulación antibiótica en pacientes con infección urinaria nosocomial en la Fundación Cardioinfantil en el año 2014

Introducción: La IVU es muy frecuenten en la (FCI - IC), Alrededor el 60% de los pacientes con diagnóstico de IVU nosocomial corresponden a gérmenes resistente, Desde el año 2010 el CLSI disminuyó los puntos de corte de sensibilidad en las enterobacteriaceae y removió la necesidad de tamizaje y confirmación de (BLEE), en el presente trabajo se pretende determinar el perfil epidemiológico de la formulación antibiótica en pacientes con IVU nosocomial. Diseño: Se realizó un estudio observacional analítico de corte transversal. Métodos: Se realizó un análisis univariado, bivariado y multivariado. El análisis bivariado y multivariado se realizó para determinar la medida de asociación teniendo en cuenta la formulación de Carbapenemico la variable dependiente, evaluándose mediante chi cuadrado. Resultados: Se revisaron 131 urocultivos, se incluyeron 116. Los aislamientos microbiológicos más frecuentemente encontrados fueron E. Coli y K. Pneumoniae, el 43.4% de los aislamientos, presentaron expresión de BLEE, 90% de los aislamientos fueron sensibles a Cefepime. La mayoría de los modelos obtenidos mostraron una fuerte asociación entre el reporte de BLEE en antibiograma con la formulación de carbapenémicos como terapia final OR 33,12 IC 95% (2,90 – 337,4). Conclusión: La epidemiologia de la IVU nosocomial en la FCI-IC no difiere de las referencias internacionales, no hay adherencia a las guías de manejo intrahospitalario y el reporte de la palabra BLEE en el antibiograma predice la formulación de antibiótico carbapenémico por el médico que lee el urocultivo

A naturalistic inquiry of registered nurses' perspectives and expectations of psychodynamic therapeutic care in acute psychiatric inpatient facilities

Within contemporary inpatient mental health nursing practice, the psychodynamic model of care considered previously to be central to the nurse-patient relationship now seems a radical concept. It appears to exist only within primary care facilities and public health care practice settings. This naturalistic inquiry aimed to explicate mental health nurses' perspectives and expectations of providing psychodynamic therapeutic care in acute inpatient psychiatric facilities. Ten registered nurses working in acute inpatient mental health facilities were interviewed. Five themes emerged: a career for life, relating in a psychodynamic manner, swimming against the current, adopting a position of difference, and hopeful expectancy.

The education needs of caregivers of stroke survivors in acute and community settings

Stroke is a major cause of chronic illness in Australia, where it is estimated that between 200,000 and 250,000 people live with disabilities due to stroke. Given stroke's effect on survivors and the accompanying burden on caregivers, attention should be given to addressing the needs of caregivers of stroke survivors because they are central to supporting survivors living in the community. Research has shown that the information needs of caregivers are not being met across healthcare settings. Thus, some attention must be given to the development of educational materials that address caregiver needs. In this study we interviewed caregivers to determine their perspectives on support and educational needs at two different stages in the recovery of the stroke survivor: the acute hospital and the community. Despite a high level of uncertainty among caregivers in the acute and community settings, limited information was provided to assist them in their new role. A multifaceted approach would involve the development and implementation of specifically designed educational materials for caregivers, the use of a tool such as a patient-held record to assist in and improve the continuity and communication of care, and the provision of ongoing support from a stroke nurse practitioner who would follow stroke survivors from the acute setting to the community. This approach should be evaluated so that the important issue of addressing caregiver needs is given its due attention.