Specialist Departments Research Articles

On the development of higher shipbuilding education in Bulgaria

The current paper provides a detailed historical overview of the emergence and development of the higher shipbuilding education in Bulgaria since the middle of the 20th century. The author has searched and used authentic documentary sources, as well as recollections of former students from that period, while adhering to the maximum when using and quoting the used sources. At the beginning of the paper are mentioned the first vessels and the shipbuilders who have completed their education abroad and laid the foundations of shipbuilding and the higher shipbuilding education in our country. The first lecturers at the newly established Shipbuilding Department at the State University-Varna are briefly listed and 2 photographs of the first students at this department are added, identifying the individuals. Attached is also a list of graduates from the first class and a photo taken at the 50th anniversary of their graduation. The paper notes that, after the closure of the Shipbuilding specialty at the Higher Institute of National Economy-Varna (then) in 1957/58, the same specialty was established in 1959 at the Higher Naval Academy N.Y. Vaptsarov, where after the graduation of 4 classes it was discontinued again. The third establishment of the Shipbuilding Department was in 1962 with the establishing of the Higher Mechanical and Electrical Engineering Institute-Varna. The paper provides a brief analysis of the achievements of the two specialist departments – Shipbuilding and Naval Machines and Mechanisms – in the educational, research and international fields.

Palliative care made visible: Developing a rural model for the Western Cape Province, South Africa.

IntroductionCaring for people with life-threatening illnesses is a key part of working in health care. While South Africa launched the National Policy Framework and Strategy for Palliative Care 2017–2022, integrating palliative care into existing public health care is in its infancy. Most patients in the Western Cape have poor access to palliative care, an inequality felt hardest by those living in rural areas.Building the modelIn 2018, with district wide institutional managerial support, a palliative care model for rural areas was initiated in the Western Cape. The process involved setting up hospital- and community-based multi-professional palliative care teams, initiating weekly palliative care ward rounds, training champions in palliative care and raising awareness of palliative care and its principles.DiscussionEstablishing regular ward rounds has changed the way patients needing palliative care are managed, particularly in challenging the mindsets of specialist departments. The emergence of the multi-professional team listening and planning together at the patient’s bedside has restored some of the dignity and ethos of patient-centred care, which is a core principle of the provincial Health Care 2030 vision.ConclusionIn a short time period, we have managed to build a service that aims to improve care for palliative patients in rural areas. Its strength lies in a multi-professional patient-centred approach and improved communication between different components of the health system, providing a more seamless service that supports patients when they need it most.

Prevalence, clinical profiles, and prognosis of POEMS syndrome in Japanese nationwide survey.

To elucidate current epidemiological, clinical profiles, and treatment of polyneuropathy, organomegaly, endocrinopathy, M-protein, and skin changes (POEMS) syndrome. We conducted a nationwide survey in 2015 using an established epidemiologic method. Data processing sheets were sent to all neurology and hematology specialist departments throughout Japan to identify patients with POEMS who were seen between April 2012 and March 2015. The estimated number of patients with POEMS was 392 (95% confidence interval [CI] 320-464), and the prevalence was 0.3 per 100,000. Detailed clinical profiles were available for 167 patients. Median age at onset was 54 years (range, 21-84 years), and the ratio of male to female was 1.5. All patients showed polyneuropathy; 89% had monoclonal plasma cell proliferation; and 84% had elevated vascular endothelial growth factor level in whom pretreatment serum or plasma was available (n = 87). Other common features were skin changes (84%), edema/effusion (81%), and organomegaly (76%). A total of 160 patients were treated with any of the following: radiation, corticosteroids, melphalan, thalidomide, lenalidomide, bortezomib, or autologous stem cell transplantation. Primary therapeutic options were thalidomide (n = 86) and autologous stem cell transplantation (n = 71). Thirty-nine patients (24%) were initially treated with corticosteroid alone. The 10-year overall survival was 93% (95% CI 86%-96%). This study showed current epidemiologic and clinical status of POEMS syndrome in Japan. A quarter of patients were still inadequately treated with corticosteroid alone, whereas either autologous stem cell transplantation or immunomodulatory drugs improved the prognosis.

Medicine and Economy: Measures for a Science Based, Patient-Centred and Resource Conscious Care. The Association of Scientific Medical Societies' (AWMF) Strategy Paper

The AWMF and its medical societies perceive an increasing dominance of economic targets in the hospital health care sector, leading to impairment of patient care. While resource use in health care should be appropriate, efficient and fairly allocated, "economization" creates a burdensome situation for physicians, nurses and other health care professionals.The AMWF and the medical societies studied causes and developed measures for a scientific, patient-centred and resource-conscious medical care. Disincentives due to the remuneration system, number and equipment of hospitals resp. specialist departments and their basic funding need to be overcome. Proposed actions relate to the patient-doctor-level, the management level of hospitals and the level of planning and financing hospitals including compensation of hospital care. To place patients and their health in the forefront again, joint efforts of all stakeholders in health care are needed.

Staffing level: Survey among psychosomatic-psychotherapeutic institutions in Germany

Using a standardized written hospital survey from the Deutsches Krankenhausinstitut (DKI), we invited a total of 218 psychosomatic-psychotherapeutic hospitals and specialist departments to participate. The participation rate of the institutions was 35%. In the overall sample, one psychotherapist (physician/clinical psychologist) was responsible for treating a median of 3.9 beds/patients (interquartile range 3.1-5.1) and one nurse a median of 2.9 beds/patients (interquartile range 2.3-3.9). There were significant differences for the nurse-patient ratio depending on the organizational size of the institution. To ensure quality treatment, professional experts saw increased staffing needs of about 12-17% across both professions. For the professional groups of specialist therapists and social workers, broad variances were observed for the therapist-patient ratio in the overall sample. The study provides an important and relevant data basis for the further discussion to determine mandatory minimal staffing levels in German psychosomatic-psychotherapeutic institutions.

The SAS grade: underused and under recognised?

The speciality and associate specialist grade doctor is an important part of many specialist departments in both medicine and dentistry. In this article we highlight their vital (and often forgotten) contribution in providing and delivering excellent patient care within the dental specialties. We suggest that more should be done to address the needs of this important section of our workforce. Encouraging a programme of continued professional development together with a more structured path for career progression should be considered.

Developing nursing leadership and specialist skills: the Burdett scholarship

Evidence-based post-registration education can greatly benefit nursing careers. The cost of continuing professional development can be prohibitive, but grants, bursaries and scholarships are available to support nurses. The Burdett Trust for Nursing established a specialist scholarship for gastrointestinal nurses. Each cohort of two scholars rotates through the specialist departments at St Mark's Hospital, London, a tertiary referral centre for intestinal and colorectal care. They also complete a residential degree-level course in stoma care, as well as specialist master classes and study days. Leadership skills and professional clinical competencies are central to the curriculum. Two previous Burdett scholars give their personal perspective on how the programme has improved their skills, confidence and career trajectories.

Does Intradisciplinary Conflict Influence to Outcomes of Emergency Medicine Residency Program? A Mixed Methods Study.

To explore impact of emergency medicine residency program on patient waiting times in emergency department (ED) and determine the associated factors. A two-phased sequential exploratory mixed-methods approach was used. The first phase was comprised of retrospective before-after design of ED encounters for a 3-month period, six months before and six months after the introduction of an emergency medicine residency program in an Iranian teaching hospital. The second phase included semi-structured interviews with five individuals which purposively selected to participate in qualitative design. Quantitative data were analysed descriptively and qualitative data were analysed using an iterative framework approach. The most patients were admitted to the hospital in night shift, both before and after the resident EMS. No statistically significant differences were found among all of the waiting times during the two time periods except for the average time interval between admission and physician start time (p<0.0001), which increased (instead of reducing), and the average time interval between physician start time and first treatment measure (p<0.0001), which decreased during the year the residents began. The interviewees revealed the intradisciplinary conflicts and interferences existing between ED and other specialist departments, are main important factor to delayed processing of patients visits. This study has shown that intradisciplinary conflict would affect the outcomes of emergency medicine residency program and ED process. These new findings enhance the understanding of the nature of conflicts and will persuade policy makers that design a set of clinical practice guidelines to clarify the duties and responsibilities of parties involved in ED.

Does Intradisciplinary Conflict Influence to Outcomes of Emergency Medicine Residency Program? A Mixed Methods Study

To explore impact of emergency medicine residency program on patient waiting times in emergency department (ED) and determine the associated factors.A two-phased sequential exploratory mixed-methods approach was used. The first phase was comprised of retrospective before-after design of ED encounters for a 3-month period, six months before and six months after the introduction of an emergency medicine residency program in an Iranian teaching hospital. The second phase included semi-structured interviews with five individuals which purposively selected to participate in qualitative design. Quantitative data were analysed descriptively and qualitative data were analysed using an iterative framework approach.The most patients were admitted to the hospital in night shift, both before and after the resident EMS. No statistically significant differences were found among all of the waiting times during the two time periods except for the average time interval between admission and physician start time (p<0.0001), which increased (instead of reducing), and the average time interval between physician start time and first treatment measure (p<0.0001), which decreased during the year the residents began. The interviewees revealed the intradisciplinary conflicts and interferences existing between ED and other specialist departments, are main important factor to delayed processing of patients visits.This study has shown that intradisciplinary conflict would affect the outcomes of emergency medicine residency program and ED process. These new findings enhance the understanding of the nature of conflicts and will persuade policy makers that design a set of clinical practice guidelines to clarify the duties and responsibilities of parties involved in ED.

Assessment of Health Literacy and validation of single-item literacy screener (SILS) in a sample of Italian people.

Health literacy (HL) is a complex concept with multiple components; it involves the ability to effectively use and interpret texts, documents, and numbers. to measure HL levels among a sample of adult Italian patients; to develop and validate the Italian version of the single-item literacy screener (SILS); to assess the diagnostic accuracy of the SILS as an indicator of limited reading ability regarding health documents, compared to the newest vital sign (NVS). The subjects were enrolled in emergency departments, primary care settings, and specialist departments. The Italian versions of the NVS and of the SILS were administered to the patients, as well as a questionnaire aimed in collected socio-demographic information. Overall, 174 patients completed the interview (compliance: 87%). Considering the NVS, 24.1% of the subjects presented high likelihood of limited HL, 13.2% a possibility of limited HL, and 62.6% adequate HL. SILS has shown a good concurrent validity compared to NVS (Spearman's rho r = -0.679; p < 0.001). The diagnostic accuracy of the SILS was high. The best performance parameters in assessing the diagnostic accuracy of SILS are found to be for threshold value of 2 in in identifying subjects with high likelihood of limited HL at the NVS (sensitivity: 83.3%; specificity: 82.6%; accuracy: 82.8%; positive predicted value: 60.3%; negative predicted value: 94%; Cohen's kappa: 0.6). The Italian version of SILS - as an indicator of limited reading and understanding ability regarding health information - is a good tool to measure HL in comparison to more complex measurement instruments of functional HL, like NVS.

Disease profile of inpatients in general practice department of a Grade A tertiary hospital

Objective To analyze the disease profile of inpatients from general practice department in a Grade A tertiary hospital. Methods Information of 3 963 inpatients admitted in general practice department of the Second Hospital of Hebei Medical University from November 2013 to March 2016 was retrospectively analyzed. Results Inpatients were admitted from emergency department(10.8%), specialist departments(2.9%) or general practice department(80.3%). The most frequent diagnosis was headache, dizziness or syncope of unknown origin (29.3%), followed by fever of unknown origin (22.4%), cerebrovascular diseases (7.5%). Undifferentiated diseases accounted for 84.2% of all conditions; the diagnostic categories included common diseases, multiple diseases and chronic diseases of all systems. In the discharged patients, 10.9% had one single diagnosis, 23.6% had one comorbidity of chronic diseases, the remaining had two and more comorbidities of chronic diseases. Most inpatients of general practice department were discharged with improvement or cure; the other outcomes included transferred to specialist departments(6.1%), referred to higher level hospitals(2.8%), auto-discharge (0.9%) and death (0.1%). Conclusions The disease profile of inpatients in department of general practice in Grade A hospital includes undifferentiated disease, common diseases, frequently encountered diseases and chronic diseases of all systems, multiple diseases are common, which is similar with the disease profile of community health service center. It's suggesting that general practice department in Grade A tertiary hospital can make up for the shortage of specialist departments and meet the basic medical needs of patients. Key words: Hospitals, general; Inpatients; General practice; Disease spectrum

Are future business professionals ready for multicultural marketing? An empirical investigation

As more companies establish specialist departments and tailor their activities to meet the growing multicultural market, there is a need for multicultural expertise within organisations. Marketing professionals however, are often guilty of using stereotypes and relying on generalisations that not only are inaccurate, but are also likely to turn off the very people a company wants to reach. There is a dearth of knowledge about the multicultural competencies that shape professional choices and behaviours. This paper uses survey data to examine undergraduate students’ ideologies related to multicultural issues. Results suggest business students, more than many other types of student, are less culturally competent. Implications for diversity training and education are considered.

Exhibition: Making Beauty: Elpida Hadzi-Vasileva: Gut Feeling.

Making Beauty: Elpida Hadzi-Vasileva Djanogly Gallery, Nottingham 20 August 2016 – 30 October 2016 Making Beauty is a site-specific installation at Djanogly Gallery in Nottingham by the artist Elpida Hadzi-Vasileva. She is a highly-respected artist from Macedonia who has exhibited at the Venice Biennale representing her country, and the Vatican. The exhibition contains reconfigurations of two previous major works of Hadzi-Vasileva; Fragility, previously in the Fabrica gallery in Brighton, and Haruspex , commissioned by the Vatican in 2015 for display in its Pavilion at the Venice Biennale. Supported by Wellcome Trust funding, the artist collaborated with three digestive-disease specialist departments at University College Hospital …

Managing anaemia in the outpatient setting

Anaemia is not a disease but the result of a variety of causes, and globally, the commonest cause is iron deficiency. Anaemic patients have an increased risk of morbidity and mortality and are more likely to require hospitalization. In addition, anaemic patients are more likely to receive blood transfusion even though this may be avoidable with timely management. It is important to elucidate the reason for the anaemia so that appropriate treatment can be offered, for the anaemia and the underlying cause. Many patients with anaemia can be managed in the outpatient setting. The diagnostic approach should be to elicit the patient's clinical history, carry out an examination and undertake some simple investigations. The mean red blood cell volume can be used to classify anaemia into microcytic, normocytic or macrocytic, which helps to guide additional investigations. The article gives an overview of the investigation of anaemia together with treatment recommendations. The development of algorithms for anaemia allows for the preliminary management of such patients to be undertaken in primary care or by specialist nurses who can then triage the patients to the appropriate specialist departments. Timely coordination of care can result in the avoidance of emergency admissions, correction of anaemia prior to surgery and reduction in unnecessary transfusions. The management of patients with anaemia is an important facet of Patient Blood Management. International initiatives are being developed to support best practice in anaemia management.

Emergency Department Interfaces

Emergency Departments ED may be an exceptionally good example of an interface within a hospital. EDs have no patients of their own but pass them over to other institutions, either to specialist departments within the hospital or to primary care providers. Moreover, many doctors, nurses, attendants and institutions take part in the care of emergency department patients, and thus the number of its interfaces is very high. The characteristics of working in an ED, for example shortage of time, high work load, taking care of several patients at the same time and frequently crowding, may compromise the transfer of information via interfaces, sometimes including even vital data. The best way to secure handoff of information may be the formalization and standardization of this process, assuring patient safety and quality of care. Further study is required.

Acute Hospital Admissions Because of Health Care–Related Adverse Events: A Retrospective Study of 5 Specialist Departments

BackgroundHealth care–related adverse events (HCRAEs), which should not be confused with (blameworthy) medical errors, are common; they can lead to hospital admissions and can have grave consequences. Although they are sometimes potentially preventable, information is lacking on HCRAEs leading to admission to different departments. AimThis study aimed to gain insight into the incidence, type, severity, and preventability of HCRAEs (including adverse drug events) leading to hospitalization to the departments of internal medicine, surgery, orthopedics, neurology, and neurosurgery. Further, we explore if there are differences regarding these HCRAEs between these departments. MethodsWe retrospectively evaluated the medical records of all patients admitted through the emergency department (ED) in a 6-month period to the departments of internal medicine, surgery, orthopedics, neurology, and neurosurgery. All patients admitted because of HCRAEs were included. ResultsMore than one-fifth (21.8%; range 12.0%–47.8%) of all admissions to the 5 departments were due to a HCRAE. Half (49.9%) of these HCRAEs were medication-related and 30.5% were procedure-related. In 6.5% of patients, the HCRAE led to permanent disability and another 4.4% of patients died during hospitalization. HCRAEs treated by internists and neurologists were usually medication-related, whereas HCRAEs treated by surgeons, orthopedic surgeons, and neurosurgeons were usually procedure-related. ConclusionHospital admissions to different departments are often caused by HCRAEs, which sometimes lead to permanent disability or even death. Gaining insight into similarities and differences in HCRAEs occurring in different specialties is a starting point for improving clinical outcomes.

Centralization of Risk Management in Business Companies: A Case Study on the Role of Specialist Departments

As part of his Ph.D. studies, the author researches risk management in project business and focuses on the construction industry. This paper deals with the intra-company organization of risk management. In particular, it examines advantages and disadvantages of centralization and decentralization of risk management. First, the paper deals with various aspects of risk management on theoretical level, ways of organizing risk management structures and relating decision criteria as well as the relevant tasks of specialist departments. Methodology of further research is based on a case study that explores details of centralization and decentralization in business practice. In the center of the case study is the company Bilfinger Berger Civil, a large, international construction company, which is an active player in the project business and has already carried out a variety of construction projects successfully. On the one hand, the company units and persons involved in Bilfinger’s risk management are introduced; on the other hand the tasks of the Group’s centralized departments are illuminated in detail. This includes the Corporate Legal, Internal Auditing, Corporate Treasury, Group Controlling and Project Controlling departments. The risk management of Bilfinger Berger Civil is finally assessed in form of a summary. As a main result the reader gains information about theories on structuring risk management within business companies and numerous impressions on the practical application in a real construction company.

Apathy and impaired recognition of emotion: are they related in Parkinson’s disease?

Apathy is one of the most disabling behavioural disorders in Parkinson's disease (PD). It corresponds to a set of behavioural, emotional and cognitive features, such as reduced interest and participation in the main activities of daily living, a lack of initiative, a trend towards early withdrawal from initiated activities, indifference and flattening of affect. Its prevalence in PD ranges from 17% to 70%.1 This broad variability is related to heterogeneous population characteristics (the general population, patients in specialist departments, institutionalised patients, etc), different assessment procedures (clinical assessments, scores on non-specific or specific scales, etc) and the overlap between the clinical manifestations of apathy and those of other disorders (such as depression, anhedonia, cognitive decline and even some personality traits). The mechanisms that …

Communication about symptoms of eating disorders in the general practitioner surgery.

An eating disorder is a complex disease in which the patient subjects his or her body to the various eating disorder symptoms in the absence of other ways of dealing with everyday life. There are seven symptoms of an eating disorder that generally appear in different combinations from one period to another in one and the same patient. Feelings of shame may cause information on symptoms to be withheld. Patients aged 18 and above with serious eating disorders responded anonymously to a questionnaire before entering treatment in two specialist departments. The main focus was on whether the patient had talked with a general practitioner (GP) about relevant eating disorder symptoms and ailments that could be related to the eating disorder. Altogether 114 patients participated (of which three were men). A total of 91 (80%) had discussed the eating disorder with their GP during the past year. Of these, 67% of those who had reduced their food intake over the past year had discussed this with their GP. Altogether 68% of those who had vomited and 33% of those who had over-exercised had communicated this. None of the respondents had revealed their use of diuretic or weight-loss drugs to their GP. 85% of respondents stated that the GP must ask specifically about each symptom of an eating disorder in order to reveal these. At least half had discussed the association between current ailments and the eating disorder. A total of 49% had been weighed. In order to be able to establish the best possible basis for a medical assessment, the GP should ask specifically about each symptom of an eating disorder.

Stationary geriatric early rehabilitation is well known and well organized in many countries. But is it sufficiently in outcome for patients from all assigning specialist departments? A randomized outcome trail of 1,295 patients

Stationary geriatric early rehabilitation is well known and well organized in many countries. But is it sufficiently in outcome for patients from all assigning specialist departments? A randomized outcome trail of 1,295 patients