Type Of Healthcare Setting Research Articles

Recommendations and requirements for soap and hand rub dispensers in healthcare facilities.

Hand hygiene is one of the most important measures to prevent transmission of infectious agents and plays a major role in prevention of infection in any type of healthcare setting. While requirements for the efficacy of hand disinfectants are defined in European testing norms such as the EN 1500 for hygienic hand disinfection or EN 12791 for surgical hand preparation, no specific recommendations for hand rub dispensers and liquid soap dispensers have been given yet. Therefore, the intention of the present recommendation on soap and hand rub dispensers in healthcare facilities is to close this gap and to enhance future improvement of dispenser functionality and design. Regardless of manufacture and design of a hand rub or liquid soap dispensers the following requirements shall be met in healthcare facilities:Triggering the dispenser must be possible without using hands. Sensor- or elbow-operated dispensers both fulfill this requirement. Dispensers must be only refillable in a modality where the content, be it a hand rub or liquid soap, cannot be contaminated. This is achieved best by using replaceable cartridge systems. Refilling through “top-up” must not be possible. The disperser should allow usage of different types of cartridges made by different manufacturers. Dispensers must be operated and maintained such that a microbial contamination of the pump nozzle may easily be avoided. It must be possible to identify the products used in a dispenser easily and without any manipulation. Identifying the type of product, be it a hand rub or a liquid soap, as well as reading the product's name and critical manufacturers' warnings must be possible at any time. The disperser must allow identification of the level of the used product without any further manipulation at any time. The design of the dispenser must allow easy cleaning and disinfection the outside and inside of the dispenser. The manufacturer of the dispenser must provide the user with information on applicable chemicals and cleaning products. It must be possible to reprocess the dispenser and all of its permanent parts by applying machine based thermal disinfection at an A0-value of minimum 60 (e.g. 80°C/1 minute). Automatically portioning dispensers shall not fail during 200 hubs. The maximal allowed failure rate shall not exceed 1% (2 out of 200 consecutive hubs). A dispenser used for alcohol based hand rubs must allow keeping the alcohol concentration constant over a time period of 3 months. The maximum acceptable decrease in the concentration of the alcohol shall not exceed 5%. Liquid soap and hand rub dispensers with single-use pumps, ideally already mounted on the cartridge and to be discharged with the empty cartridge, are preferable. If pumps are used on the next consecutive cartridge, the manufacturer must provide the user with a detailed introduction for cleansing and reprocessing before further use. Because of forensic reasons it is recommended to place a good readable sign on the dispenser indicating e.g. “Apply alcohol based hand rubs only on the hand! Do not drink, avoid spraying into the eye or application on mucous membranes”. It is regarded as an additional benefit, if the dispenser is able to document the consumption of hand rub or the frequency of hubs either mechanically or electronically.

Trends in the Use of Bone Morphogenetic Protein as a Substitute to Autologous Iliac Crest Bone Grafting for Spinal Fusion Procedures in the United States

Analysis of Nationwide Inpatient Sample (NIS) database for data related to spinal fusion procedures. To identify trends in the use of bone morphogenetic protein (BMP) versus iliac crest bone grafts in various spinal fusion procedures performed in the United States, explore stratification by patient demographics, and analyze the impact on treatment cost. BMP has been shown to achieve better clinical outcomes in anterior lumbar interbody fusions procedures, which led to its Food and Drug Administration approval for this indication in 2002. Since then, significant off-label use has occurred, without a full description of the results. We searched the NIS for data relating to BMP administration or iliac crest bone grafting in a variety of spinal fusion procedures performed from 1993 to 2006, based on International Classification of Diseases, Ninth Revision classification. The NIS is the largest all-payer inpatient care database, with demographic, outcome, and cost data from approximately eight million annual patient discharges throughout the United States. Demographics among patients treated with BMP versus iliac crest bone graft were compared to reduce the likelihood of bias in the analysis. BMP became applied more frequently in each type of spinal fusion procedure examined over our study period, with the exception of anterior lumbar interbody fusions. Patients receiving iliac crest bone grafts versus BMP exhibited very similar demographic characteristics, including age, socioeconomic status, and type of health care setting. Although BMP typically increased the cost of the procedure itself, it improved outcomes and shorter hospital stays often provided a net benefit. BMP is increasingly being used in spinal fusion procedures, including ones for which it is not officially approved, because of the surgical and postsurgical benefits it provides. Given the morbidity that this may entail, monitoring outcomes trends will help to inform guidelines for BMP use and ensure that its benefits continue to outweigh its costs.

The uptake of research evidence: a systematic review of nurses' experiences of using research evidence in their practice.

Review question/objective The objective of this systematic review is to critically appraise and synthesise the best available evidence regarding the uptake of research evidence in clinical practice as experienced by nurses. This review seeks to answer the following questions: 1. What are the experiences of nurses in relation to the uptake of research into clinical practice? 2. What factors do nurses report as helpful in the uptake of research evidence into clinical practice? 3. What factors do nurses report as limiting the uptake of research evidence into clinical practice? Inclusion criteria Types of participants This review will consider qualitative studies that include all nurses working in any type of health care setting, including acute (hospitals), primary (community health), mental health and aged care. For the purpose of this review, the generic term ‘nurses’ will include registered nurses, enrolled nurses and assistants in nursing. The aim is to be as inclusive as possible and allow for global variations of nurse positions. Types of intervention(s)/phenomena of interest This review will consider studies that investigate the experience of nurses regarding the uptake of research evidence into clinical practice, including clinical decision making or clinical judgement. The term ‘clinical decision making’ for this review will describe any organisational aspects that influence decision making. The term ‘clinical judgement’ will describe the ‘different grounds for making judgements’. 20 (p. 1506) Additionally, for this review the terms research uptake or utilisations and evidence-based practice will be used interchangeably as they all represent the aspect of incorporating research evidence into clinical practice. Types of outcomes This review will consider any subjective accounts by nurses describing their experiences, either positive or negative, in relation to the uptake of research evidence into clinical practice.

The uptake of research evidence: a systematic review of nursesʼ experiences of using research evidence in their practice

Review question/objective The objective of this systematic review is to critically appraise and synthesise the best available evidence regarding the uptake of research evidence in clinical practice as experienced by nurses. This review seeks to answer the following questions: 1. What are the experiences of nurses in relation to the uptake of research into clinical practice? 2. What factors do nurses report as helpful in the uptake of research evidence into clinical practice? 3. What factors do nurses report as limiting the uptake of research evidence into clinical practice? Inclusion criteria Types of participants This review will consider qualitative studies that include all nurses working in any type of health care setting, including acute (hospitals), primary (community health), mental health and aged care. For the purpose of this review, the generic term ‘nurses’ will include registered nurses, enrolled nurses and assistants in nursing. The aim is to be as inclusive as possible and allow for global variations of nurse positions. Types of intervention(s)/phenomena of interest This review will consider studies that investigate the experience of nurses regarding the uptake of research evidence into clinical practice, including clinical decision making or clinical judgement. The term ‘clinical decision making’ for this review will describe any organisational aspects that influence decision making. The term ‘clinical judgement’ will describe the ‘different grounds for making judgements’. 20 (p. 1506) Additionally, for this review the terms research uptake or utilisations and evidence-based practice will be used interchangeably as they all represent the aspect of incorporating research evidence into clinical practice. Types of outcomes This review will consider any subjective accounts by nurses describing their experiences, either positive or negative, in relation to the uptake of research evidence into clinical practice.

An Update on Assessing Development in the Pediatric Office: Has Anything Changed After Two Policy Statements?

Objective The aim of this study was to examine parental reports of receiving a child developmental assessment (DA), and the child, family, and type of health care setting characteristics and well-child care processes associated with receiving this aspect of preventive developmental care. Methods The 2007 National Survey of Children’s Health was used to study 16 223 children, aged 10 months to 4 years, who received a DA with a structured questionnaire from their primary care provider in the previous 12 months. Data were adjusted for child characteristics, family socioeconomic factors, type of health care setting, and processes of care. Results Few children were assessed for developmental delays by using developmental questionnaires (28%). A greater percentage of parents of children with public insurance reported receiving a developmental questionnaire compared with parents of children who were uninsured or privately insured (32% vs 26% and 25%, respectively; P = .02). The adjusted odds of receiving a developmental questionnaire were higher for children with public insurance than private insurance (odds ratio [OR] 1.35, 95% confidence interval [CI], 1.05–1.73), higher for children whose usual place of care was a clinic or health center than a doctor’s office (OR 1.36, 95% CI, 1.07–1.74), and higher for children reporting adequate family-centered care (OR 1.41, 95% CI, 1.14–1.74). Conclusions Parental receipt of developmental questionnaires is low and varies by type of insurance, type of place for usual source of care, and adequacy of family-centered care. There is room for improvement in the provision of developmental questionnaires and, our results suggest, areas for continuing research to understand variations in DA practices.

Time to listen: a review of methods to solicit patient reports of adverse events

BackgroundPatients have been shown to report accurate observations of medical errors and adverse events. Various methods of introducing patient reporting into patient safety systems have been published with little consensus...

What Do Chaplains Really Do? I. Visitation in the New York Chaplaincy Study

ABSTRACT The current study presents findings from the New York Chaplaincy Study about chaplain visits with patients and their families in 13 healthcare institutions in the Greater New York City area during 1994–1996. It documents the distribution of 34,279 clinical visits by religious affiliation, population served (patients, family and friends), and type of healthcare setting (acute care and non-acute care), and analyzes the number and duration of visits with patients by their medical status. Chaplains in acute settings tended to make less frequent but longer visits with patients than chaplains in non-acute settings. On average, chaplains spent less time with patients who were alone than they did during visits with patients whose family was present during the visit or visits with only family members. Average visit duration was positively related to the percentage of visits in each of the 13 facilities that were made in response to referrals (r = .65, p < .05), and the average duration of referred visits was significantly longer (p < .001) than that of non-referred visits (p < .001). The findings are intended to provide a general picture of what these particular chaplains did in these particular institutions over this particular time-period and are not intended to represent a standard of what chaplains should be doing.

Burnout Among Occupational Therapists

Objectives. Using Maslach's Burnout Inventory (MBI), this study examined burnout among full-time staff occupational therapists including the extent of their burnout; how occupational therapists' burnout compared to four health care professions, and if type of health care setting impacts their level of burnout.Method. The MBI was mailed to each subject in the random sample (n = 3000) of occupational therapists who were American Occupational Therapy Association (AOTA) members.Results. Occupational therapists displayed a higher level of emotional exhaustion, and lower levels of depersonalization and personal accomplishment. Differences were found in the levels of occupational therapists' burnout when compared to four health care professions. Occupational therapists working in chronic care health care settings demonstrated higher levels of burnout than those working in other health care settings.Conclusion. The occupational therapist should strive to match their skills, interests, life style, and experience to the appropriate health care setting to promote a good person-environment fit to decrease burnout and promote quality patient care and personal health.

Are healthcare providers talking to HIV-seropositive patients about safer sex?

HIV-seropositive men (n = 250) from San Francisco and New York city completed a self-administered survey assessing health care providers delivery of safer-sex messages. 1 out of 4 men had never received safer-sex counseling from their healthcare provider. Men at highest risk for transmitting HIV were no more likely to have been counseled than men at lower risk. Physicians should regularly provide tailored safer-sex messages to all HIV-seropositive patients who have entrusted them with their care. (authors)

Epilepsias en el ámbito extrahospitalario. Estudio en 150 casos

In this paper we present epidemiological data from a register of cases of epilepsy attended in the Centro de Especialidades of the Alboraya street in Valencia. The sample corresponds to a particular type of healthcare setting, halfway between the family doctor and the specialist hospital department, which has recently begun to be developed in Spain in the field of neurology. The sample consisted of 150 patients who completed a questionnaire-type protocol. The average age of the patients was 39.66 +/- 19.60 years, slightly more in the men than in the women. There were slightly more women than men included in the study. The epilepsy was either long-term or of recent onset. The average age of onset was 25.42 +/- 21.35 years. More than two thirds of the sample, that is 108 patients (72%) had partly controlled disease. However, a considerable number of them were irregularly controlled and another group of 23 (15.3%) were on polytherapy with three or more antiepileptic drugs. The data from this series of 150 cases is, in general, similar to that of other epidemiological studies done in Spain. However, it is noticeable that there is a high proportion of patients with problems of control, although this may be due simply to a bias in the selection. We hope that the publication of this new data will stimulate new studies to analyse the attention give to patients with epilepsy in this healthcare setting.