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Special Care Unit (special + care_unit)
Kinds of Special Care Unit Selected AbstractsAssessing levels of contaminants in breast milk: methodological issues and a framework for future researchPAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 1 2008Mary J. Renfrew Summary To assess the scale of the possible exposure by the breast-fed infant to potentially harmful substances in breast milk, methodologically robust studies are essential. Many studies in this field, however, do not report details of crucial issues such as recruitment and milk sampling. The aims of the study reported here were to develop robust methods for the study of contaminants in breast milk, and to develop a framework for future research and population monitoring. Three cohorts of women and babies were recruited by midwives from five sites in northern England. Cohort 1 (cross-sectional, n = 322) were asked to provide two milk samples, one at one week following birth and one at a subsequent time point. Cohort 2 (longitudinal, n = 54) were asked to provide five samples at specified time points over the first 12,16 weeks after birth. Cohort 3 (convenience, n = 18), mothers of babies in the Special Care Unit, were asked to donate surplus breast milk. A novel method of analysing fat concentration in small volumes was developed and tested. A randomly selected set of samples from different donors and stages of lactation was screened for organochlorine pesticide residues, polychlorinated biphenyls, dioxins/furans, phthalates and heavy metals. A total of 453 samples were donated. Cohort 3 was the least successful route of recruitment. Cohorts 1 and 2 combined were most representative of the population. Sample collection, transport and storage procedures, and the collection of data on life style and diet, were robust and acceptable to women. Midwifery involvement in recruitment was an essential component. This study offers a framework both for the conduct of future research studies, and for the establishment of regional and national monitoring mechanisms for contaminants in breast milk. Similar work on contaminants in formula as fed to babies is needed to inform risk assessment methods. [source] Environmental approach to reducing agitation in older persons with dementia in a nursing homeAUSTRALASIAN JOURNAL ON AGEING, Issue 3 2005Lesley Wilkes Objective:,This paper reports the effects on challenging (agitated) behaviours, such as aggression, noisiness and wandering, when persons with dementia were relocated to a special unit. Methods:,The study was a simple interrupted time series quasi-experimental design. The dependent variable was agitated behaviour and the independent variables were residing in an old unit and in a Special Care Unit (SCU). Twenty-two persons with dementia from a nursing home were involved in this study. Subjects were assessed weekly for 1 month prior to the move to the SCU and weekly for 1 month at 3 and 6 months after the move. Data were entered into SPSS software and analysed. Results:,The most significant results from the study were that the verbally agitated behaviour of the subjects was reduced and sustained throughout the 6 months of the study after their move into a SCU. Conclusions:,This study has shown that environmental design does impact positively in the care of persons with dementia. [source] Dental nomograms for benchmarking based on the study of health in Pomerania data setJOURNAL OF CLINICAL PERIODONTOLOGY, Issue 12 2004C. Schwahn Abstract Aim: Benchmarking is a means of setting goals or targets. On an oral health level, it denotes retaining more teeth and/or improving the quality of life. The goal of this pilot investigation was to assess whether the data generated by a population-based study (SHIP 0) can be used as a benchmark data set to characterize different practice profiles. Material and Methods: The data collected in the population-based study SHIP (n=4310) in eastern Germany were used to generate nomograms of tooth loss, attachment loss, and probing depth. The nomograms included twelve 5-year age strata (20,79 years) presented as quartiles, and additional percentiles of the dental parameters for each age group. Cross-sectional data from a conventional dental office (n=186) and from a periodontology unit (n=130, Greifswald) in the study region as well as longitudinal data set of a another periodontology unit (n=135, Kiel) were utilized in order to verify whether the given practice profile was accurately reflected by the nomogram. Results: In terms of tooth loss, the data from the conventional dental office agree with the median from the nomogram. For attachment loss and probing depth, some age groups yielded slight but not uniform deviations from the median. Cross-sectional data from the periodontology unit Greifswald showed attachment loss higher than the median in younger but not in older age groups. The probing depth was uniformly less than the median and tended toward the 25th percentile with increasing age. The longitudinal data of the Unit of Periodontology in Kiel showed a pronounced trend towards higher percentiles of residual teeth, meaning that the patients retained more teeth. Conclusion: The profile of the Pomeranian dental office does not deviate noticeably from the population-based nomograms. The higher attachment loss of the Unit of Periodontology in Greifswald in younger age strata clearly reflects their selection because of periodontal disease; the combination of higher attachment loss and decreased probing depth may reflect the success of the treatment. The tendency of attachment loss towards the median with increasing age may indicate that the Unit of Periodontology in Greifswald does not fulfill its function as a special care unit in the older subjects. The longitudinal data set of the Unit of Periodontology in Kiel impressively reflects the potential of population-based data sets as a means for benchmarking. Thus, nomograms can help to determine the practice profile, potentially yielding benefits for the dentist, health insurance company, or , as in the case of the special care unit , public health research. [source] Evidenced-based clinical practice guideline for management of newborn painJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 4 2010Kaye Spence Aim: To facilitate the uptake of evidence and to reduce the evidence practice gap for management of newborn pain through the development of a clinical practice guideline. Method: An audit of practice and an appraisal of clinical practice guidelines were undertaken to establish current practices and guideline availability for the management of newborn pain in 23 hospitals in Australia. Guidelines were appraised using the Appraisal of Guidelines for Research and Evaluation instrument. A literature search was undertaken to acquire the evidence for best practice for management of newborn pain. Results: Neonatal units in 17 hospitals had clinical practice guidelines. Each was peer reviewed and assessed according to the domains of the Appraisal of Guidelines for Research and Evaluation instrument. There was lack of consistency across the guidelines. As a result, a best practice guideline was developed based on current best evidence and the Royal Australian College of Physicians recommendations. To facilitate an ongoing compliance with the guideline, an audit tool was included together with algorithms for procedural pain and pain assessment. Conclusion: The clinical practice guideline can be used by clinicians in varying settings such as the neonatal intensive care and special care unit. The document can be used to support existing practices or challenge clinicians to close the evidence practice gap for the management of newborn pain. [source] Practice variation in initial management and transfer thresholds for infants with respiratory distress in Australian hospitals.JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 6 2007Who should write the guidelines? Aim: In Australian hospitals: (i) to identify current practices in the initial oxygen management of infants with respiratory distress; (ii) to identify factors important in deciding to transfer an infant; and (iii) to identify thresholds for transfer. Methods: All Australian hospitals with: >200 registered deliveries, a special care unit (SCU) or neonatal intensive care unit (NICU), and at least one paediatrician were surveyed in 2004 (n = 176). The questionnaire sought information on the initial oxygen management and factors important in deciding to transfer. Three scenarios were also used to identify thresholds for pH, carbon dioxide and oxygen levels at which transfer should occur. Responses from SCU were compared with those from NICU. Results: 15/19 (79%) NICUs and 118/157 (75%) SCUs responded. Initial oxygen management varies widely among SCUs and NICUs. NICUs set significantly lower saturation (SaO2) targets in two of the three scenarios. NICUs are statistically significantly more likely to regard ,Medical Staff Experience' and ,Time to Nearest NICU' as important compared with SCUs (P < 0.05). NICUs would ,Probably' and ,Definitely Transfer' infants at significantly lower oxygen levels in all three cases (P < 0.05). SCUs are significantly less likely to transfer babies with pH of <7.25 compared with NICUs. There was no difference between the centres for CO2 level. Conclusion: The wide variation that exists between nurseries in the initial management of infants with respiratory distress and in the thresholds for transfer strongly suggests the need for the development of practice guidelines. [source] Thematic analysis of the experience of making a decision to place a family member with Alzheimer's disease in a special care unit,RESEARCH IN NURSING & HEALTH, Issue 6 2001Howard Karl Butcher Abstract The purpose of this study was to provide an in-depth description of the experience of making the decision to place a family member in a special care unit among a diverse sample of family caregivers. To achieve purposive maximum variation of the sample, the sample of 30 family caregivers was chosen from an original study of 256 family caregivers. The sample was randomly stratified according to ethnicity, gender, and relationship to the care receiver. Three independent researchers used Luborsky's method of thematic analysis to analyze the interviews. After mutual consensus, 1565 themes (descriptive statements) were identified and synthesized into 21 topics. The topics were then synthesized into four patterns describing the decision-making experience: moving toward the unavoidable decision, struggling with the decision, seeking reassurance, and remaining connected. © 2001 John Wiley & Sons, Inc. Res Nurs Health 24:470,480, 2001 [source] Diabetic mothers and their newborn infants , rooming-in and neonatal morbidityACTA PAEDIATRICA, Issue 7 2010E Stage Abstract Aim:, As a result of increased neonatal morbidity, the infants of diabetic mothers have routinely been admitted to a neonatal special care unit (NSCU). We therefore investigated whether the offer of rooming-in diabetic mothers and their newborn infants has an effect on neonatal morbidity. Methods:, The records of an old cohort of 103 infants routinely admitted to the NSCU, and a new cohort (N = 102), offered rooming-in were assessed for neonatal morbidity. Results:, Eighty-four (82%) of the new cohort infants followed their mothers to the maternity ward; whereas 19 (18%) were transferred to the NSCU chiefly because of prematurity. Ten infants were later transferred to the NSCU for minor problems. Neonatal morbidity and neonatal hypoglycaemia were significantly less common in the new cohort than in the old cohort [27 (26%) vs. 55 (54%), p < 0.001 and 42 (41%) vs. 64 (63%), p = 0.0027 respectively]. Maternal HbA1c in late pregnancy was significantly lower in the new cohort, but the only independent predictors of neonatal morbidity were belonging to the old cohort and preterm delivery. Conclusion:, Neonatal care with rooming-in mothers with type 1 diabetes and their newborn infants seems safe and is associated with reduced neonatal morbidity, when compared with routine separation of infants from their mothers. [source] Infants with HIV-infected mothers in a universal newborn hearing screening programme in Lagos, NigeriaACTA PAEDIATRICA, Issue 8 2009Bolajoko O Olusanya Abstract Aim:, To establish the characteristics of infants with human immunodeficiency virus (HIV)-infected mothers enrolled under a two-stage universal newborn hearing screening programme in Lagos, Nigeria. Methods:, A matched case-control study from May 2005 to December 2007 in which factors associated with maternal HIV status were determined by conditional multivariable logistic regression analysis. Results:, Some 266 newborns had HIV-infected mothers and were matched with 1330 controls by age and sex. Factors independently associated with increased risk of maternal HIV status were ethnicity, religion, housing sanitation facilities and prematurity while prior or current caesarean section, admission into special care unit and hyperbilirubinaemia were associated with lower risk of maternal HIV. Maternal HIV status was not significantly associated (p = 0.082) with the risk of sensorineural hearing loss although newborns with HIV-infected mothers had more than two-fold risk (p = 0.030) of not completing the hearing tests compared with controls. Conclusion:, HIV-infected mothers are likely to live in poor housing conditions but their newborns are not at an increased risk of sensorineural hearing loss in this setting barring the potential effect of significantly increased drop-out rate in this group. [source] Factors associated with sclerema in infants with diarrhoeal disease: a matched case-control studyACTA PAEDIATRICA, Issue 5 2009Mohammod Jobayer Chisti Abstract Aim: To identify clinical and biochemical factors associated with sclerema in infants with diarrhoeal illness, and their outcome. Methods: In this case-control study, we enrolled 30 infants with clinical sepsis with sclerema (cases) and another 60, age- and sex-matched infants with clinical sepsis but without sclerema (controls) from among those admitted to the special care unit (SCU) and longer stay unit (LSU) of the Dhaka Hospital of International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) for their diarrhoeal illness from May 2005 through April 2006. Sclerema as the dependant variable while hypoxia, hypothermia, C-reactive protein (CRP) level, serum total protein and prealbumin level were the major independent variables compared in the analysis. Differences in proportions were compared by the chi-square test and differences of mean were compared by Student's t -test or Mann,Whitney test, as appropriate. Results: The case-fatality was significantly higher among the cases than the controls (30% vs. 2%, CI 2.9,565.5). After adjusting for confounders, infants with sclerema were more likely to be hypothermic (OR 11.6, 95% CI 1.1,126.5), and have lower serum total protein (OR 1.12, 95% CI 1.04,1.21) and prealbumin (OR 1.5, 95% CI 1.1,2.3). Conclusion: Diarrhoeal infants having clinical sepsis presenting with hypothermia, lower serum protein and prealbumin are prone to be associated with sclerema. [source] Using spaced retrieval and Montessori-based activities in improving eating ability for residents with dementia,INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 10 2010Li-Chan Lin Abstract Objectives To construct a training protocol for spaced retrieval (SR) and to investigate the effectiveness of SR and Montessori-based activities in decreasing eating difficulty in older residents with dementia. Methods A single evaluator, blind, and randomized control trial was used. Eighty-five residents with dementia were chosen from three special care units for residents with dementia in long-term care facilities in Taiwan. To avoid any confounding of subjects, the three institutions were randomized into three groups: spaced retrieval, Montessori-based activities, and a control group. The invention consisted of three 30,40,min sessions per week, for 8 weeks. Results After receiving the intervention, the Edinburgh Feeding Evaluation in Dementia (EdFED) scores and assisted feeding scores for the SR and Montessori-based activity groups were significantly lower than that of the control group. However, the frequencies of physical assistance and verbal assistance for the Montessori-based activity group after intervention were significantly higher than that of the control group, which suggests that residents who received Montessori-based activity need more physical and verbal assistance during mealtimes. In terms of the effects of nutritional status after intervention, Mini-Nutritional Assessment (MNA) in the SR group was significantly higher than that of the control group. Conclusion This study confirms the efficacy of SR and Montessori-based activities for eating difficulty and eating ability. A longitudinal study to follow the long-term effects of SR and Montessori-based activities on eating ability and nutritional status is recommended. Copyright © 2010 John Wiley & Sons, Ltd. [source] Neuropsychiatric symptoms and quality of life in patients in the final phase of dementiaINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 1 2009Raymond T.C.M. Koopmans Abstract Objectives To assess neuropsychiatric symptoms and quality of life in a group of patients in the final phase of dementia. Methods All patients with dementia (n,=,216) residing on dementia special care units of two Dutch nursing homes were included in the study provided they met the criteria for the final phase of dementia. Neuropsychiatric symptoms were assessed with the Neuropsychiatric Inventory Nursing Home version (NPI-NH) and the Cohen Mansfield Agitation Inventory (CMAI). Quality of life was assessed with the QUALIDEM Results Of the 216 dementia patients 39 met the criteria for the final phase of dementia. The patients showed a specific pattern of behaviours with a high prevalence of apathy, agitation and behaviours that were mainly observed during morning care such as making strange noises, grabbing, performing repetitious mannerism, spitting, hitting, screaming and pushing. Overall quality of life of these patients in the final phase of dementia was moderate. Conclusion In this small sample, patients in the final phase of dementia show specific behavioural problems, that mainly should be addressed with psychosocial interventions. Copyright © 2008 John Wiley & Sons, Ltd. [source] Prevalence of neuropsychiatric symptoms in a large sample of Dutch nursing home patients with dementiaINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 7 2007Sytse U. Zuidema Abstract Objective To estimate the prevalence of neuropsychiatric symptoms of dementia patients in Dutch nursing homes. Methods Cross-sectional study in a large sample of 1322 demented patients living in 59 dementia special care units (SCUs) in The Netherlands. Symptoms were observed by licensed vocational nurses during regular care-giving in a 2-week observational period prior to assessment. Neuropsychiatric symptoms were assessed using the Neuropsychiatric Inventory- Nursing home version (NPI-NH; frequency X severity score , 4) and the Cohen-Mansfield Agitation Inventory (CMAI; symptoms occurring at least once a week). Results More than 80% of these patients suffered from at least one clinically significant symptom, as defined with the NPI-NH frequency X severity score , 4. Measured with the NPH-NH agitation/aggression, apathy and irritability were the most frequently observed behaviors, with prevalences of 30,35%. Using the CMAI, 85% of the patients showed at least one symptom of agitation, of which general restlessness was observed most frequently (44%). Other frequently observed symptoms with prevalence rates of 30% were cursing or verbal aggression, constant request for attention, negativism, repetitious sentences, mannerisms, pacing, and complaining. Physically aggressive symptoms such as hitting, kicking, biting occurred less often (less than 13%). Conclusions Prevalence rates of neuropsychiatric symptoms in Dutch nursing home patients with dementia residing in SCUs are high, especially agitation and apathy. Insight into the prevalence rates of individual symptoms in patients with dementia has important practical consequences for the accurate planning of staff allotment and stresses the need for patient oriented care. Copyright © 2006 John Wiley & Sons, Ltd. [source] Use of constraints and surveillance in Norwegian wards for the elderlyINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 6 2003Øyvind Kirkevold Abstract Objective To describe the use of constraints and surveillance and their correlates in a nationwide sample of wards in institutions for the elderly in Norway. Methods Questionnaires were sent to 975 institutions and returned by 623 (64%) with 1398 wards. The wards' head nurses were asked whether any patient was currently subjected to physical restraints, electronic surveillance, force or pressure in medical examination or treatment, and force or pressure in ADL. The reporting of constraints was found reliable. Results In all, 79% of the head nurses reported daily or occasional use of constraints in their wards. Most frequently reported were force or pressure in the performing of activities of daily living (reported by 61%, 95% Confidence Intervals (CI) 59,64), use of force or pressure in medical treatment or examination (49%, 95% CI 47,53) and use of physical restraints (38%, 95% CI 36,41). Electronic surveillance was used less frequently (14%, 95% CI 13,16). All classes of constraints, except physical constraints, were used significantly more frequently in special care units for persons with dementia than in ordinary nursing home units. The methodology does not allow conclusions to be drawn regarding the role of ward size and person characteristics. The staffing was unrelated to the use of constraints which varied significantly across the counties. Conclusion Constraints are widely used in Norwegian institutions for the elderly. A different pattern in use of constraints was found between special care units for demented patients and ordinary units in nursing homes. Copyright © 2003 John Wiley & Sons, Ltd. [source] Is Dementia Special Care Really Special?JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 2 2008A New Look at an Old Question OBJECTIVES: To quantify differences in care provided to nursing home (NH) residents with dementia living on and off dementia special care units (SCUs). DESIGN: Cross-sectional study using propensity score adjustment for resident and NH characteristics. SETTING: Free-standing NHs in nonrural U.S. counties that had an SCU in 2004 (N=1,896). PARTICIPANTS: Long-stay (,90 days) NH residents with a diagnosis of Alzheimer's disease or dementia and at least moderate cognitive impairment (N=69,131). MEASUREMENTS: Resident-level NH care processes such as physical restraints, bed rails, feeding tubes, psychotropic medications, and incontinence care. RESULTS: There was no difference in the use of physical restraints (adjusted odds ratio (AOR)=0.94, 95% confidence interval (CI)=0.79,1.11), but SCU residents were less likely to have had bed rails (AOR=0.55, 95% CI=0.46,0.64) and to have been tube fed (AOR=0.36, 95% CI=0.30,0.43). SCU residents were more likely to be on toileting plans (AOR=1.23, 95% CI=1.08,1.39) and less likely to use pads or briefs in the absence of a toileting plan (AOR=0.73, 95% CI=0.61,0.88). SCU residents were more likely to have received psychotropic medications (AOR=1.23, 95% CI=1.05,1.44), primarily antipsychotics (SCU=44.9% vs non-SCU=30.0%). CONCLUSION: SCU residents received different care than comparable non-SCU residents. Most strikingly, SCU residents had greater use of antipsychotic medications. [source] Prevalence and associated factors of pneumonia in patients with vegetative state in TaiwanJOURNAL OF CLINICAL NURSING, Issue 7 2008Li-Chan Lin PhD Aims., The aim of this study was to investigate the prevalence rate and influencing factors of pneumonia associated with long-term tube feeding in special care units for patients with persistent vegetative states (PVS) in Taiwan. Background., Pneumonia is a significant cause of morbidity, hospitalization and mortality in the nursing home population. Tube feeding has been found as a risk factor for the occurrence of pneumonia. Methods., Two hundred sixty subjects were chosen from three hospital-based special care units for patients with PVS and 10 nursing facilities for persons in PVS in Taiwan. All subjects, who were diagnosed with PVS, received either financial aid for institutional care or were means-tested from The Bureau of Social Welfare of cities and counties in Taiwan. Data were collected through chart review and observations. Results., The prevalence rate of pneumonia in nursing facilities for patients with PVS was 14·2%. The prevalence rate of tube-feeding in nursing facilities for PVS was 91·2%. The mean duration of tube-feeding was 73·21 SD 55·33 months. A total of 90·4% was fed with a nasogastric (NG) tube. Having a lower intake of food and fluids daily and having been institutionalized for a shorter period were three dominant factors associated with the occurrence of pneumonia. Conclusion., Research findings reveal that the incidence of pneumonia is higher in patients who do not receive adequate food and water. Continuing in-service training to improve caregivers' knowledge and skill in providing care to patients in PVS and monitoring their skills in feeding is needed to decrease the occurrence of pneumonia in this population. Relevance to clinical practice., Staff needs to be taught to monitor laboratory data and signs and symptoms of malnutrition and hydration deficit, and also be alert to early indicators of pneumonia in patients with PVS. [source] Work stress and physical assault of nursing aides in rural nursing homes with and without dementia special care unitsJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 3 2005D. G. MORGAN phd rn Purpose:, This study compared nursing aides (NAs) employed in rural nursing homes with and without dementia special care units (SCUs) on (1) exposure to and distress from disruptive behaviours exhibited by residents, (2) job strain and (3) physical assault. Design and methods:, The data were drawn from a larger study conducted in Saskatchewan, Canada, in which all rural nursing homes of ,,100 beds that had an SCU were matched to same-sized rural facilities with no SCU. Nursing aides (n = 355) completed a mailed survey questionnaire. Results:, Nursing aides employed in nursing homes with an SCU reported significantly less frequent exposure to disruptive behaviours (including aggressive and aversive behaviours) than NAs in non-SCU facilities, less distress when these behaviours were directed toward them, less exposure to aggressive behaviour during caregiving, lower job demands and lower job strain. There was a trend toward increased risk of being assaulted in the last year associated with being in a non-SCU facility. Having a permanent position, increased job strain, and feeling inadequately prepared for dementia care were significantly associated with higher risk of being assaulted. In the SCU facilities, NAs who worked more time on the SCU reported more assaults but less distress from disruptive behaviour, lower psychological job demands, lower job strain and greater work autonomy. Implications:, Providing more dementia care training and reducing job demands and job strain may help to reduce work-related stress and physical assault of nursing aides employed in nursing homes. [source] | ||||||||||||||||||||||