Ward Areas Research Articles

AB0800 Bone Mineral Density in Postmenopausal Women with Hip Osteoarthritis

BackgroundOsteoporosis and osteoarthritis are the common diseases in women in postmenopausal period. The reason why osteoarthritis and osteoporosis do not affect all women during their postmenopausal period has not been...

AB0801 Implications of Vitamin D Deficiency for Patients with Ostearthritis

BackgroundThe existence of certain interdependencies between vitamin D status and osteoarthritis (OA) has been known for over 20 years. This issue needs closer investigation, however, as the VDD ramifications are...

A national survey of inpatient medication systems in English NHS hospitals

BackgroundSystems and processes for prescribing, supplying and administering inpatient medications can have substantial impact on medication administration errors (MAEs). However, little is known about the medication systems and processes currently used within the English National Health Service (NHS). This presents a challenge for developing NHS-wide interventions to increase medication safety. We therefore conducted a cross-sectional postal census of medication systems and processes in English NHS hospitals to address this knowledge gap.MethodsThe chief pharmacist at each of all 165 acute NHS trusts was invited to complete a questionnaire for medical and surgical wards in their main hospital (July 2011). We report here the findings relating to medication systems and processes, based on 18 closed questions plus one open question about local medication safety initiatives. Non-respondents were posted another questionnaire (August 2011), and then emailed (October 2011).ResultsOne hundred (61% of NHS trusts) questionnaires were returned. Most hospitals used paper-based prescribing on the majority of medical and surgical inpatient wards (87% of hospitals), patient bedside medication lockers (92%), patients’ own drugs (89%) and ‘one-stop dispensing’ medication labelled with administration instructions for use at discharge as well as during the inpatient stay (85%). Less prevalent were the use of ward pharmacy technicians (62% of hospitals) or pharmacists (58%) to order medications on the majority of wards. Only 65% of hospitals used drug trolleys; 50% used patient-specific inpatient supplies on the majority of wards. Only one hospital had a pharmacy open 24 hours, but all had access to an on-call pharmacist. None reported use of unit-dose dispensing; 7% used an electronic drug cabinet in some ward areas. Overall, 85% of hospitals had a double-checking policy for intravenous medication and 58% for other specified drugs. “Do not disturb” tabards/overalls were routinely used during nurses’ drug rounds on at least one ward in 59% of hospitals.ConclusionsInter- and intra-hospital variations in medication systems and processes exist, even within the English NHS; future research should focus on investigating their potential effects on nurses’ workflow and MAEs, and developing NHS-wide interventions to reduce MAEs.

Infrastructure and Contamination of the Physical Environment in Three Bangladeshi Hospitals: Putting Infection Control into Context

ObjectiveThis paper describes the physical structure and environmental contamination in selected hospital wards in three government hospitals in Bangladesh.MethodsThe qualitative research team conducted 48 hours of observation in six wards from three Bangladeshi tertiary hospitals in 2007. They recorded environmental contamination with body secretions and excretions and medical waste and observed ward occupant handwashing and use of personal protective equipment. They recorded number of persons, number of open doors and windows, and use of fans. They measured the ward area and informally observed waste disposal outside the wards. They conducted nine focus group discussions with doctors, nurses and support staff.ResultsA median of 3.7 persons were present per 10 m2 of floor space in the wards. A median of 4.9 uncovered coughs or sneezes were recorded per 10 m2 per hour per ward. Floors in the wards were soiled with saliva, spit, mucous, vomitus, feces and blood 125 times in 48 hours. Only two of the 12 patient handwashing stations had running water and none had soap. No disinfection was observed before or after using medical instruments. Used medical supplies were often discarded in open containers under the beds. Handwashing with soap was observed in only 32 of 3,373 handwashing opportunities noted during 48 hours. Mosquitoes and feral cats were commonly observed in the wards.ConclusionsThe physical structure and environment of our study hospitals are conducive to the spread of infection to people in the wards. Low-cost interventions on hand hygiene and cleaning procedures for rooms and medical equipment should be developed and evaluated for their practicality and effectiveness.

東京都区部・市部小中学校教室の事故データを用いた事故リスクに関する検討

The data of accidents in the junior high schools and the elementary schools in the ward areas and the urban districts of Tokyo were investigated with considering the meteorological data of relevant areas and the rate of air conditioners being placed in classrooms. The rate of air conditioners being placed in classrooms in the ward areas of Tokyo was four-six times higher than that in the urban districts of Tokyo. The data of accidents of the elementary / junior high schools were obtained from the NAASH (National Agency for the Advancement of Sports and Health), and the period of analysis was set as 3 years from 2005 to 2007. The data of accidents linked with meteorological data were classified for each level of the outside temperature at the time of occurrence of the accident. From this the relation of the outside temperature and the occurrence rate of accidents were determined. While the occurrence rate of accidents in classrooms in the ward areas during summer period was decreased with the years from 2005 to 2007, that in the urban districts was constant with the years. It was found that the difference in the rate of air conditioners being placed in classrooms might have an effect on the occurrence rate of accidents in the classrooms. The effect in the elementary schools could be greater than that in the junior high schools.

稠密観測データに基づく晴天弱風の冬季夜間における東京都区部を中心とした気温分布について

Tokyo—one of the largest cities in the world—exhibits intensive urban land use, urban sprawl, and high anthropogenic heat exhaustion, which produce characteristic urban temperature distributions. Typical features of the nocturnal temperature distribution from November to February under conditions of clear skies and weak winds were analyzed for the Tokyo metropolitan-ward area using data from spatially high-density observations from the Automated Meteorological Data Acquisition System (AMeDAS) of the Japan Meteorological Agency (JMA), municipal air pollution monitoring systems, and Extended-METROS from 2006/2007 to 2009/2010. To analyze the structure of temperature distributions in the Tokyo-ward area, hourly temperature data at 124 stations were interpolated into grid points with 1-km intervals. When high temperatures in central Tokyo were expressed as a difference in AMeDAS temperature between central Tokyo (Otemachi) and an average of four points outside the Tokyo-ward area, the weather conditions most strongly affecting this temperature difference at 06:00 Japan Standard Time (JST), prior to sunrise, were cloud amount followed by wind speed. The temperature difference at night under clear-sky and weak-wind conditions (average cloud amount of 2/10 or less and average wind speed of 3m/s or less) generally showed an abrupt increase during the several hours before and after sunset followed by a gradual increase, reaching maximum levels before sunrise (06:00 JST). When the temperature difference before sunrise was large, the difference would evidently increase even after midnight; however, if this difference was small, it would tend to decrease after midnight. The high temperatures in the metropolitan area were concentrated throughout the night near the southern area of Chuo ward. In particular, it is noted that several zones of steep horizontal temperature gradients were detected in the metropolitan-ward area. These zones (e.g. starting from the southern part of Saitama Prefecture, it appeared through the border between Nerima and Itabashi wards, Toshima, Shinjuku, and the area stretching from western Setagaya to the southwest) appeared during the period several hours before and after sunset, and gradually became more noticeable near sunrise. The distribution of temperature-decrease rate around sunset also showed steep horizontal gradient zones, which corresponded to regions exhibiting steep horizontal temperature gradient zones between the inner city and outer area.

The Subject and Future of the Undeveloped the Land Readjustment Project Required Area in the Fringe of Tokyo Wards Area

The Subject and Future of the Undeveloped the Land Readjustment Project Required Area in the Fringe of Tokyo Wards Area

Management of burns in intensive and acute care

Patients with major burns require specialist care in burn centres, taking into account the complex systemic response to a burn injury, avoidance of complications, specialist wound care and supportive multidisciplinary management. Occasionally, these patients may be managed in other settings, such as emergency departments or general intensive care units and ward areas, for example after an explosion or major disaster. Therefore, general nurses require an understanding of patients' complex needs, and should be aware of the latest developments in burn care and up-to-date evidence to ensure best practice.

Nutritional screening of elderly patients: a health improvement approach to practice

Almost 60% of elderly care in-patients are at risk of malnutrition. Malnourished patients have poorer clinical outcomes and this is a key factor with respect to prolonging the length of stay. Since 2003, the Malnutrition Universal Screening Tool (MUST) has been advocated as a method for identifying these at-risk patients. Screening should take place on admission; however, the Trust has set a stretch target of aiming to document the score accurately within 6h of admission. Three 'care of the elderly' wards participated in the project. Each month, the timeliness (within 6h of admission) and accuracy (compared to a dietician assessment) of the MUST scores on the wards were reviewed. Plan-Do-Study-Act cycles were used to rapidly test changes in the ward areas. Tests included a study day, one-to-one ward-based nutrition training, a focus on the use of alternative anthropometric measurements, the development of a training pack and the identification of the challenges for undertaking accurate and timely assessments. Baseline data identified that a MUST was documented in <60% of patients within 6h of admission and that only 70% were accurate. After implementation of the change package, all the wards achieved an improvement and documented MUST within 6h of admission; one ward achieved 90% accuracy in the scores. Ward teams receiving training and monthly feedback of their results creates ownership, momentum and maintains enthusiasm for striving to reach stretch targets. The team continues to work on improving accurate nutritional screening across the Trust by using quality improvement methodologies.

Cross-sectional study of prescribing errors in patients admitted to nine hospitals across North West England

ObjectiveTo evaluate the prevalence, type and severity of prescribing errors observed between grades of prescriber, ward area, admission or discharge and type of medication prescribed. DesignWard-based clinical pharmacists prospectively documented...

Long term trend of CT scans in eastern areas of special wards of Tokyo, Japan : analysis of the patient&apos;s age

Long term trend of CT scans in eastern areas of special wards of Tokyo, Japan : analysis of the patient&apos;s age

Age at death estimation using bone densitometry: Testing the Fernández Castillo and López Ruiz method in two documented skeletal samples from Portugal

This study aims to evaluate the accuracy, precision and bias of a method for age at death estimation based in bone mineral density values assessed by dual X-ray absorptiometry at Ward's area (proximal femur). Estimated age at death was contrasted with documented age at death in two Portuguese reference samples (Coimbra Identified Skeletal Collection – CISC, and Identified Skeletal Collection of the 21st Century – Santarém XXI). Mean absolute error (accuracy) varies between 10.5 years (females) and 11.6 years (males) in the CISC sample; and between 11.9 years (males) and 12.7 years (females) in the Santarém XXI study base. The precision of the method varies between 13.0 years (females) and 14.5 years (males), in the CISC sample, and between 8.4 years (females) and 9.5 years (males), in the Santarém XXI sample. Mean error values (bias) suggest that this method tends to overestimate age in younger individuals, and to underestimate it in older individuals, regardless of sex or sample. Nonetheless, the method seems to perform as well as, or better than, other widely tested age estimation techniques, making it a suitable option when more accurate tests are not feasible in any given situation.

Factors associated with delayed activation of medical emergency team and excess mortality: An Utstein-style analysis

AimWe used the Utstein template, with special reference to patients having automated patient monitoring, and studied the factors which are associated with delayed medical emergency team (MET) activation and increased hospital mortality. Design and settingA prospective observational study in a tertiary hospital with 45 of 769 general ward beds (5.9%) equipped with automated monitoring. Cohort569 MET reviews for 458 patients. ResultsBasic MET review characteristics were comparable to literature. We found that 41% of the reviews concerned monitored ward patients. These patients’ vitals had been more frequently documented during the 6h period preceding MET activation compared to patients in normal ward areas (96% vs. 74%, p<0.001), but even when adjusted to the documentation frequency of vitals, afferent limb failure (ALF) occurred more often among monitored ward patients (81% vs. 53%, p<0.001). In MET population, factors associated with increased hospital mortality were non-elective hospital admission (OR 6.25, 95% CI 2.77–14.11), not-for-resuscitation order (3.34, 1.78–6.35), ICD XIV genitourinary diseases (2.42, 1.16–5.06), ICD II neoplasms (2.80, 1.59–4.91), age (1.02, 1.00–1.04), preceding length of hospital stay (1.04, 1.01–1.07), ALF (1.67, 1.02–2.72) and transfer to intensive care (1.85, 1.05–3.27). ConclusionsDocumentation of vital signs before MET activation is suboptimal. Documentation frequency seems to increase if automated monitors are implemented, but our results suggest that benefits of intense monitoring are lost without appropriate and timely interventions, as afferent limb failure, delay to call MET when predefined criteria are fulfilled, was independently associated to increased hospital mortality.

Analyzing transition of urban facilities distribution and age structure of population in Central Tokyo

This paper aims to clarify the change of density of urban facilities in central Tokyo (ward area), and to analyze the change of density of urban facilities and its dependence on age structure of small district. We focus on age structure that have an influence on change of density of urban facility, and clarified its relationship. Day nursery, kindergarten, elementary school, junior high school, and hospital are taken up as urban facilities in this paper. We find out that the change in the density of each urban facility is partially explained by that in population density by using kernel density functions with appropriate radius.

Managing Acute Medical Admissions: The Plight of the Medical Boarder

In an ideal system, patients admitted acutely to hospital should have their care provided in an area with the most appropriate ward-based medical, nursing and allied professional staff profile. Frequently this does not happen due to the physical structure and organisation of our hospitals in Scotland. Acute medical admissions may be fitted in to the end of many different speciality ward areas while still under the care of a single internal medicine team - as 'medical boarders'. A survey of local medical and nursing staff revealed that a majority would not wish their relatives to be cared for in this way. It remains important to provide speciality beds for those patients who require them, but it is also necessary to develop a system that enables more patients to receive optimal care in the correct environment. In this article, we describe the issue, the problems created and some possible solutions.

Outcomes of in-hospital, out of intensive care and operation theatre cardiac arrests in a tertiary referral hospital

ObjectiveCardiac arrest in the hospital wards may not receive as much attention as it does in the operation theatre and intensive care unit (ICU). The experience and the qualifications of personnel in the ward may not be comparable to those in the other vital areas of the hospital. The outcome of cardiac arrest from the ward areas is a reasonable surrogate of training of the ward nurses and technicians in cardiopulmonary resuscitation. We conducted an audit to assess the issues surrounding the resuscitation of cardiac arrest in areas other than operation theatre and ICU in a tertiary referral hospital. Aims of the auditTo assess the outcomes of cardiac arrest in a tertiary referral hospital. Areas such as wards, dialysis room and emergency room were considered for the audit. MethodsThis is a retrospective observational audit of the case records of all the adult patients who were resuscitated from ‘code blue’. Data for 2 years from 2007 was analysed by a research fellow unconnected with the resuscitations. ResultsTwenty-two thousand three hundred and forty-four patients were admitted as in-patients to the hospital during the 2 years, starting May 2007 through May 2009. One hundred code blue calls were received during this time. Twenty-two of the total calls received were false. Among the 78 confirmed cardiac arrests 69 occurred in the wards, 2 in emergency room, 1 in cardiac catheterisation laboratory and 3 in dialysis room. Twenty-eight patients were declared dead after unsuccessful cardiopulmonary resuscitation. Among the 50 who were resuscitated with a return of spontaneous rhythm 26 died. Twenty-four patients were discharged (survival rate of 30%). The survival decreased significantly as the age progressed beyond 60. The resuscitation rates were better in day shifts in contrast to the night. Higher survival was noted in patients who received resuscitation in less than a minute. ConclusionA overall survival to discharge rate of 30% was noted in this audit. Higher survival rates might be attributable to high rate and degree of training at the time of their employment, which was repeated at yearly interval.

東京都練馬区石神井台地区における自然体験からみる緑地の利用と変遷

In this study, the objective has been determined to clarify the following two points with a case study of the Shakujiidai district in the Nerima Ward in Tokyo: 1) relationship between nature experiences and transition of open spaces since the Showa Era, and 2) current actual situation of open spaces and their usage among different generations. With regard to the current situation of nature experiences, elementary school students had sports and activities in relation to trees, grass and flowers, and water. Many responses from respondents in their 20’s and above indicated that they have activities related to trees. As for contents of nature experiences, respondents in their 20’s to 40’s enjoy collection and observation, and those in their 50’s and above mostly enjoy observation. Although details of nature experiences vary according to each generation, trees play an important part when people are exposed to nature. The results of locations indicate that Shakujii Park, which is a large scale “Municipal Park”, “Ward Park” and “Ikoi no Mori” are in use. The average area used for activities was 2,000 square meters and above. “Children’s park” and “ward green areas and green passages” have been found not much in use for nature experiences.

The Lichfield bone study: the skeletal response to exercise in healthy young men

The skeletal response to short-term exercise training remains poorly described. We thus studied the lower limb skeletal response of 723 Caucasian male army recruits to a 12-wk training regime. Femoral bone volume was assessed using magnetic resonance imaging, bone ultrastructure by quantitative ultrasound (QUS), and bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA) of the hip. Left hip BMD increased with training (mean ± SD: 0.85 ± 3.24, 2.93 ± 4.85, and 1.89 ± 2.85% for femoral neck, Ward's area, and total hip, respectively; all P < 0.001). Left calcaneal broadband ultrasound attenuation rose 3.57 ± 0.5% (P < 0.001), and left and right femoral cortical volume by 1.09 ± 4.05 and 0.71 ± 4.05%, respectively (P = 0.0001 and 0.003), largely through the rise in periosteal volume (0.78 ± 3.14 and 0.59 ± 2.58% for right and left, respectively, P < 0.001) with endosteal volumes unchanged. Before training, DXA and QUS measures were independent of limb dominance. However, the dominant femur had higher periosteal (25,991.49 vs. 2,5572 mm(3), P < 0.001), endosteal (6,063.33 vs. 5,983.12 mm(3), P = 0.001), and cortical volumes (19,928 vs. 19,589.56 mm(3), P = 0.001). Changes in DXA, QUS, and magnetic resonance imaging measures were independent of limb dominance. We show, for the first time, that short-term exercise training in young men is associated not only with a rise in human femoral BMD, but also in femoral bone volume, the latter largely through a periosteal response.

Developing a minimum data set for electronic nursing handover

This study presents a minimum data set designed for an electronic system to complement verbal nursing handover. Background. Poor communication of patient information at handover has been implicated in adverse events with changes to clinical handover being proposed as a solution. This study developed a minimum data set for an electronic patient summary tool. DESIGN; Using an observational design the scope of information being presented by nurses at handover was identified in relation to a generic Nursing Handover Minimum Data Set. Patient handovers (n = 195) were observed and digitally recorded across diverse specialties. Content analysis confirmed the frequent use of the Nursing Handover Minimum Data Set items across all specialties. The use of the items was affected by the patient context and the clinical setting. Aged care patients often had several clinical alerts reported (pressure areas, falls risk). Rapid changes in patient condition in emergency emphasised the need for a focus on observations and presenting problems. Mental health and maternity required further refinement of the items. The generic Nursing Handover Minimum Data Set can direct nurses to give a comprehensive account of their patient's condition and care. The data set needs to be flexible and adaptable to the patient context and setting and complements structured content verbal handover. This minimum data set provides an excellent framework for system development by clinicians, managers and information technologists. Educators can use this tool to teach student nurses, new graduates and experienced staff, about the patient information to be presented at handover. The Nursing Handover Minimum Data Set for electronic nursing handover complements verbal handover and provides a tool to give clinicians access to comprehensive information about all patients within the ward area.

Sharps including needlestick injuries in Australian nurses practising in New South Wales

ObjectivesTo determine nurse-reported period prevalence of Sharps Injuries including Needlesticks (SIN) in the past 12 months, factors associated with SIN in NSW and compare data across workplace categories and geographic...