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Selected AbstractsBeliefs on Mandatory Influenza Vaccination of Health Care Workers in Nursing Homes: A Questionnaire Study from the NetherlandsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2009Ingrid Looijmans-van den Akker MD OBJECTIVES: To assess whether nursing homes (NHs) made organizational improvements to increase influenza vaccination rates in healthcare workers (HCWs) and to quantify the beliefs of NH administrators on the arguments used in favor of implementation of mandatory influenza vaccination of HCWs. DESIGN: Anonymous questionnaire study. SETTING: Dutch NHs. PARTICIPANTS: Dutch NH administrators. MEASUREMENTS: Influenza vaccination rates in NH residents and NH HCWs, organizational aspects of influenza vaccination of HCWs, and agreement of respondents with arguments in favor of implementation of mandatory influenza vaccination in HCWs. RESULTS: Of the 310 distributed questionnaires, 185 were returned (response rate 59.7%). The average vaccination rate in NH HCWs was 18.8% and in NH residents was 91.6%. In all, 126 (68.1%) NHs had a written policy, 161 (87.0%) actively requested that their employees be immunized, and 161 (87.0%) offered information to HCWs in any way. Despite the fact that the majority of NH administrators (>69%) agreed with all arguments in favor of implementation of mandatory influenza vaccination, only a minority (24.3%) agreed that mandatory vaccination should be implemented if voluntary vaccination fails to reach sufficient vaccination rates. CONCLUSION: Despite the low vaccination rate of NH HCWs, most NH administrators did not support mandatory influenza vaccination of NH HCWs. [source] Health care workers and tuberculosisINTERNAL MEDICINE JOURNAL, Issue 3 2000R. L. Stuart First page of article [source] The meaning of self-care for people with chronic illnessJOURNAL OF NURSING AND HEALTHCARE OF CHRONIC ILLNE SS: AN INTERNATIONAL INTERDISCIPLINARY JOURNAL, Issue 3 2010Debbie Kralik RN kralik d, price k & telford k (2010) Journal of Nursing and Healthcare of Chronic Illness2, 197,204 The meaning of self-care for people with chronic illness Aim., To reveal the meaning of self-care as described by men and women living with chronic conditions. Background., Chronic illness self-care and self-management are terms that have been used interchangeably in the literature. Self-care in the context of chronic illness has received some research attention, but remains an under-explored concept. Methods., Conversation data were gathered using longitudinal email groups facilitated by the first author over a 21-month period between 2003,2005, with 42 men and women living with chronic illness. Results., Self-care is a process of adaptation in response to learning about oneself and about ways to live well with illness. Developing capacity to self care impacted significantly on the way participants experienced illness, their view of themselves and of their future. Conclusions., People living with chronic illness describe the process of self-care as transformational in terms of feelings about their selves and reclaiming a sense of order. It enables them to move forward with a sense of the future. The primary health care principle of holistic assessment, taking account of the wider context of people's lives, is of heightened importance when educating about self-care. Relevance to clinical practice., Health care workers can assist people by acknowledging that chronic illness self-care is a process that gradually evolves and is borne out of listening to the person's priorities and finding ways for strategies to fit harmoniously alongside those priorities. [source] Verbal and Physical Abuse and Neglect as Manifestations of HIV/AIDS Stigma in Five African CountriesPUBLIC HEALTH NURSING, Issue 5 2007Priscilla S. Dlamini ABSTRACT Objective: To explore the experience of HIV/AIDS-related stigma for people living with HIV/AIDS (PLWA) in Lesotho, Malawi, South Africa, Swaziland, and Tanzania. Design and sample: Descriptive study using 43 focus groups (n=251 participants), which included male and female PLWA from both rural and urban areas and nurses working with PLWA. Methods: Participants were asked to relate incidents of HIV/AIDS-related stigma that they had experienced or observed. Focus group discussions were taped, and data were content analyzed to identify examples of abuse (verbal and physical abuse and neglect) related to HIV/AIDS stigma. Data analysis also explored targets of abuse, abusers, and consequences of abuse. Results: Participant reports documented extensive verbal and physical abuse and neglect or negating (disallowing of access to services and opportunities) experienced by PLWA and observed by nurses caring for them, and identified negative consequences experienced by PLWA whose HIV-positive status was disclosed to family, friends, or community members. Conclusions: Health care workers who encourage PLWA to disclose their HIV status must carefully consider the implications of encouraging disclosure in an environment with high levels of stigma, and must recognize the real possibility that PLWA may experience serious verbal and physical abuse as a consequence of disclosure. [source] Prevention of occupational skin disease: a workplace intervention study in geriatric nursesBRITISH JOURNAL OF DERMATOLOGY, Issue 2 2009M. Dulon Summary Background, Health care workers have an increased risk of occupational dermatosis. Objectives To determine whether a skin care programme reduces skin disease on the hands of geriatric nurses and increases protective behaviour and the provision of skin care products at the workplace. The intervention was based on a 2-h skin care training session and an occupational advisory service. Methods, The study design was a randomized intervention study with a control group. Three hundred and eighty-eight geriatric nurses were included in the intervention group exposed to a skin care programme (IG; n = 146) and in the control group (CG; n = 242). Both groups completed questionnaires on exposure and underwent clinical examinations of their hands at the beginning and after a 12-month period. Preventive measures initiated by the employer at the workplace were documented at baseline and at 3 months after the intervention. Results, At baseline, no difference between the IG and the CG was found with respect to skin changes or work-related behaviour. At follow-up, the frequency of skin disease was significantly reduced in the IG, from 26% at baseline to 17% at follow-up, whereas the frequency remained almost unchanged in the CG. Effects on behaviour in the IG included significant increases in the use of moisturizers and hand disinfection instead of hand washing. The provision of cotton gloves and barrier cream products increased at intervention workplaces. Conclusions, Effective implementation of an occupational skin care programme for geriatric nurses should include both the training of the nurses and an occupational advisory service for management. [source] Factors Related to Missed Diagnosis of Incidental Scabies Infestations in Patients Admitted Through the Emergency Department to Inpatient ServicesACADEMIC EMERGENCY MEDICINE, Issue 9 2010Ming-Yuan Hong MD ACADEMIC EMERGENCY MEDICINE 2010; 17:958,964 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives:, Scabies is highly contagious and requires prompt diagnosis and implementation of infection control measures to prevent transmission and outbreaks. This study investigated the clinical and administrative correlates associated with missed diagnosis of scabies in an emergency department (ED). Methods:, This was a retrospective study of patients with incidental scabies infestations who were admitted to a university hospital via the ED during a 4-year period. Results:, A total of 135 inpatients were identified as having scabies; among them, 111 patients (82%) had visited the ED. Scabies were diagnosed during the ED stay in 39 of 111 patients (35%), while the diagnosis was missed in the ED in 72 patients (65%). Although no geographic clusters suggestive of nosocomial scabies transmission were registered, 160 medical workers and one hospitalized patient received prophylactic treatment due to direct skin-to-skin contact with inpatient scabies cases during the study period. Overcrowding (odds ratio [OR] = 8.4; 95% confidence interval [CI] = 1.9 to 38.0) and time constraints (OR = 8.2; 95% CI = 1.9 to 34.7) in the ED were associated with a missed diagnosis of scabies during ED stay. Patients with lower illness severity scores were at higher risk for failure to diagnose and to treat scabies prior to hospital admission (OR = 5.7; 95% CI = 1.6 to 20.9). Conclusions:, Missed diagnoses of scabies during ED stay may result in nosocomial spread and increase the unnecessary use of prophylactic treatments. ED overcrowding, time constraints, and less severe illness compromise ED recognition of scabies. Health care workers should be especially alert for signs of scabies infestations under these conditions. [source] Haemodynamic crisis and reversible multiorgan failure caused by HIV post-exposure prophylaxis after needle-stick injury in a health care workerHIV MEDICINE, Issue 2 2004T Feldt We report the case of a 59-year-old nurse from our HIV ward who developed a severe haemodynamic crisis with concomitant acute multiorgan failure after initiation of a post-exposure prophylaxis (PEP) with zidovudine/lamivudine (CombivirTM) and lopinavir/ritonavir (KaletraTM) after a needle-stick injury with an HIV-contaminated needle. Although serious and life-threatening adverse effects of post-exposure prophylaxis have been documented in several cases, this is the first report of a severe acute cardiovascular incident following PEP initiation. [source] Post-exposure prophylaxis with a maraviroc-containing regimen after occupational exposure to a multi-resistant HIV-infected source personJOURNAL OF MEDICAL VIROLOGY, Issue 1 2008Frédéric Méchai Abstract We report the case of a health care worker who received a post-exposure prophylaxis including an investigational drug, maraviroc, after a needle stick percutaneous injury to an HIV-infected patient with late-stage disease and harboring a multi-drug resistant virus. Post-exposure prophylaxis including maraviroc was pursued for a total of 28 days, with a weekly clinical and biological evaluation. Post-exposure prophylaxis was well tolerated, with no increase in liver function tests. The health care worker remained HIV-negative after a 6-month follow-up. J. Med. Virol. 80:9,10, 2008. © 2007 Wiley-Liss, Inc. [source] The role of the senior health care worker in critical careNURSING IN CRITICAL CARE, Issue 4 2004Paula Ormandy Summary ,,This article identifies that the introduction of the support worker role in the critical care team facilitates flexibility when organizing and managing patient care ,,Qualified nurses' time can be used more effectively, enhancing the quality of the patient care delivered ,,Aspects of the qualified nurses' workload in critical care can be shared and delegated successfully to unqualified staff ,,It is our view that staffing levels in critical care environments need to be reviewed with more flexible working practices to meet the current and future demands of critical care ,,There is a need for national consensus amongst qualified nurses to clarify and define the role of the support worker and develop a critical care competency framework to standardize training ,,To ensure proficiency, adequate training and appropriate accountability, support workers require regulation by a nationally recognized body [source] Immunisation Rates in Older Veterans and War WidowsAUSTRALASIAN JOURNAL ON AGEING, Issue 3 2000Balakrishnan Nair Aim: To study the immunisation rates of veterans and war widows aged 70 years and above in New South Wales and Queensland, as part of the Preventive Care Trial. Method: A trained health care worker assessed subjects at home regarding health, illness and immunisation status. Results: Suboptimal immunisation rate for influenza (72%) and poor rates for pneumococcus (14%) and tetanus (43%) were detected. Conclusion: Subjects in this study were not immunised according to recommended guidelines. Further education campaigns are warranted to improve immunisation rates in older people. [source] FS07.2 Occupational contact dermatitis and workers' compensationCONTACT DERMATITIS, Issue 3 2004Kathryn Frowen Statistics for occupational contact dermatitis (OCD) in Australia are gathered from workers' compensation (WC) data and research has indicated that occurrence is underestimated by as much as 400%. This study investigated reasons which might influence decisions whether to claim WC or not. A questionnaire was posted to 168 individuals diagnosed with significantly work related OCD at a specialised occupational dermatology clinic, therefore fulfilling valid claim criteria under the WC scheme operating in the state of Victoria. 70 completed responses were analysed. Ages ranged from 18,65 and only 40% had claimed workers' compensation, with those under 45 y less likely to claim. Females were significantly (P < 0.05) less likely to claim, as were respondents who had dermatitis present for less than 6 months. At the time of diagnosis, 37% of respondents were health care workers, 10% hairdressers, 7% food handlers, and 29% worked in hospitals, 24% manufacturing, 10% hairdressing salons, and 7% each vehicle maintenance, food service and trades. 31% no longer worked for the same employer, however 90% of respondents were still employed. Those who did not claim WC lost less time from work than those who claimed, but more non-claimants still had skin problems quite often or constantly than did claimants. 28.6% of non-claimants had all or some of their medical and/or lost time costs paid by their employer, and only 18% of claimants had all of their costs paid by their employer or WC insurer. Although the sample size was small, interesting data was also obtained from the qualitative responses. [source] FC03.1 Experience from joint occupational health/dermatology clinicsCONTACT DERMATITIS, Issue 3 2004Yat Wing Wong Background:, A monthly consultant led occupational health/dermatology clinic was started in 1999 providing rapid access to staff with suspected occupational skin disease including natural rubber latex (NRL) allergy and teaching for the occupational health staff. Objectives:, To evaluate the characteristics and outcome of staff attending this clinic and to assess patient satisfaction. Methods:, A retrospective case note survey was performed from staff attending the clinic from 1999 to 2002. A questionnaire was sent to them >3 months following consultation. Results:, A total of 116 patients were identified (12 male, 104 female), and 85 (73%) were nurses. 77 (66%) patients were referred with hand eczema (HE). Of the 45 patients referred with adverse reactions or exacerbation of hand dermatitis following the use of latex gloves, only 4 had positive prick tests and were considered to have NRL allergy. Patients with significant HE or occupational exacerbation of HE were referred for patch testing (n = 36). Of the remainder, most could be discharged after a single visit. 49/95 (52%) questionnaires were returned, 34/45 (76%) patients found the consultation useful. As a separate study, the data recorded within the patch test clinic looking at health care workers (HCW) referred both from this clinic and from other sources was analysed. This showed relevant positive patch tests in 16/49 (33%) patients. In 55/99 (56%), an occupational cause was likely. Conclusion:, Occupational skin disease in HCW is common, attendance at the clinic was beneficial and a single visit was sufficient in most cases. [source] Latex allergy: diagnosis and managementDERMATOLOGIC THERAPY, Issue 4 2004James S. Taylor ABSTRACT:, Latex allergy is an IgE-mediated immediate hypersensitivity response to natural rubber latex (NRL) protein with a variety of clinical signs ranging from contact urticaria, angioedema, asthma, and anaphylaxis. Major allergens include dipped latex products such as gloves and balloons. In highest risk for NRL allergy are patients with spina bifida, but health care workers and others who wear latex gloves are also at risk. NRL allergic patients may also react to fruits/foods, especially banana, kiwi, and avocado. Diagnosis is made by a positive latex RAST and/or skin prick test or challenge test to NRL. Allergen avoidance and substitution and the use of latex-safe devices including synthetic gloves (vinyl, synthetic polyisoprene, neoprene, nitrile, block polymers, or polyurethane) are essential for the affected patient. Accommodation in the workplace may include the use of powder-free, low-allergen NRL gloves or synthetic gloves. These preventive measures have significantly reduced the prevalence of reported reactions to NRL. Hyposensitization is not yet feasible. [source] New and experimental approaches to treatment of diabetic foot ulcers: a comprehensive review of emerging treatment strategiesDIABETIC MEDICINE, Issue 11 2004R. Eldor Abstract Diabetic foot ulcers occur in up to 15% of all diabetic patients and are a leading cause of nontraumatic amputation worldwide. Neuropathy, abnormal foot biomechanics, peripheral vascular disease and external trauma are the major contributors to the development of a foot ulcer in the diabetic patient. Therapy today includes repeated debridement, offloading, and dressings, for lower grade ulcers, and broad spectrum antibiotics and occasionally limited or complete amputation for higher grades, requiring a team effort of health care workers from various specialties. The large population affected by diabetic foot ulcers and the high rates of failure ending with amputation even with the best therapeutic regimens, have resulted in the development of new therapies and are the focus of this review. These include new off loading techniques, dressings from various materials, methods to promote wound closure using artificial skin grafts, different growth factors or wound bed modulators and methods of debridement. These new techniques are promising but still mostly unproven and traditional approaches cannot be replaced. New and generally more expensive therapies should be seen as adding to traditional approaches. [source] Preparedness for anthrax attack: the effect of knowledge on the willingness to treat patientsDISASTERS, Issue 3 2010Ariel Rokach Little is known about the factors that may impact on the willingness of physicians and nurses to treat patients during a bioterrorism attack. This survey was conducted among 76 randomly selected nurses and physicians in the emergency rooms of three public hospitals in order to analyse the relationship between knowledge, profession and the willingness to treat anthrax. The study finds that the willingness of physicians and nurses to come to work is 50% greater among the group with the highest knowledge about anthrax (P < 0.0001). Within that group, the willingness to treat patients suspected of being infected with anthrax was 37% greater (P < 0.0001) and the willingness to treat patients diagnosed with anthrax was 28% greater (P = 0.004) than in the other groups. These results imply that enhancement of knowledge among health care workers may improve their willingness to come to work and treat patients infected with anthrax during a bioterrorism attack. [source] Amphetamine-induced movement disorderEMERGENCY MEDICINE AUSTRALASIA, Issue 3 2005Michael A Downes Abstract Recreational use of amphetamines is common in Australia and New Zealand when compared with other developed nations. The clinical effects are variable because of the potential of these drugs to increase the proportion of different biogenic amines in the central nervous system (CNS). The substances affected are adrenaline, noradrenaline, serotonin and dopamine. Movement disorders represent one of the less common presentations of amphetamine toxicity but one that health care workers should be aware of nonetheless. [source] Smallpox Vaccination for Emergency Physicians,ACADEMIC EMERGENCY MEDICINE, Issue 6 2003AAEM/SAEM Smallpox Vaccination Working Group Abstract On December 13, 2002, President Bush formally announced the national smallpox vaccination program. The plan involves vaccinating health care workers who would respond to possible smallpox cases, including emergency physicians. Although not all aspects of the program are clearly established, it appears that vaccination of health care workers will occur in the near future. This joint statement has been used by the American Academy of Emergency Medicine and the Society for Academic Emergency Medicine regarding smallpox vaccination for emergency physicians. [source] Chemotherapy-related nausea and vomiting , past reflections, present practice and future managementEUROPEAN JOURNAL OF CANCER CARE, Issue 1 2004M. MILLER ba (hons), msc (cancer nursing), rgn research fellow Although much progress has occurred in the last decade regarding the management of chemotherapy-induced nausea and vomiting, these remain among the most intolerable side-effects of treatment and patients continue to report the negative impact such symptoms have on their ability to enjoy life. Inadequate control of nausea and vomiting reduces patients' quality of life and functional status and jeopardizes the delivery of optimal treatment, so making its management a priority for oncology health care workers. This article will reflect on past and present evidence regarding the management of chemotherapy-induced nausea and vomiting while highlighting some of the most recent scientific advances before drawing conclusions about the future management of this troublesome symptom for patients receiving chemotherapy. [source] Acute cardiorespiratory collapse from heparin: a consequence of heparin-induced thrombocytopeniaEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 5 2004Martha P. Mims Abstract: Background:, Heparin has rarely been reported to cause acute cardiorespiratory reactions or collapse. Some reports relate this to underlying heparin-induced thrombocytopenia. Objective:, To confirm and increase awareness of acute life-threatening cardiopulmonary events when patients with heparin-induced thrombocytopenia are re-exposed to heparin. Design:, Retrospective observational case series. Patients/setting:, Four cardiovascular surgery patients were identified in two adjacent large urban hospitals over a 2-yr-period who experienced eight episodes of cardiorespiratory collapse immediately following heparin administration. All had underlying heparin-induced thrombocytopenia. Results:, Intravenous boluses of unfractionated heparin were given to four patients with known or previously unrecognized heparin-induced thrombocytopenia. Two patients experienced severe respiratory distress within 15 min for which they required endotracheal intubation. Two other patients experienced cardiac arrest or a lethal arrhythmia within minutes of receiving intravenous heparin. Serologic tests for heparin-induced antibodies were positive in all patients. In three cases, the platelet count was normal or near normal but fell dramatically (71%) immediately following the heparin bolus. Three cases had prior diagnoses of heparin-induced thrombocytopenia, but health care workers administered heparin either unaware of the diagnosis or ignorant of its significance. No patients died, but all required some form of cardiopulmonary resuscitation and subsequent intensive care. Conclusions:, Heparin administration to patients with heparin-induced antibodies can result in life-threatening pulmonary or cardiac events. Appreciation of this phenomenon can unmask cases of heparin-induced thrombocytopenia and strengthens the mandate to avoid any heparin exposure in affected patients. Recognition is crucial to avoiding disastrous outcomes. [source] Oral hygiene of elderly people in long-term care institutions , a cross-sectional studyGERODONTOLOGY, Issue 4 2006Luc M. De Visschere Objective:, The aim of this cross-sectional study was to assess the level of oral hygiene in elderly people living in long-term care institutions and to investigate the relationship between institutional and individual characteristics, and the observed oral cleanliness. Materials and methods:, Clinical outcome variables, denture plaque and dental plaque were gathered from 359 older people (14%) living in 19 nursing homes. Additional data were collected by a questionnaire filled out by all health care workers employed in the nursing homes. Results:, Only 128 (36%) residents had teeth present in one or both dental arches. About half of the residents (47%) wore complete dentures. The mean dental plaque score was 2.17 (maximum possible score = 3) and the mean denture plaque score was 2.13 (maximum possible score = 4). Significantly more plaque was observed on the mucosal surface of the denture with a mean plaque score of 2.33 vs. 1.93 on the buccal surface (p < 0.001). In the multiple analyses only the degree of dependency on an individual level was found to be significantly correlated with the outcome dental plaque (odds ratio: 3.09) and only the management of the institution with denture plaque (odds ratio: 0.43). Conclusion:, Oral hygiene was poor, both for dentures and remaining teeth in residents in long-term care institutions and only the degree of dependency of the residents and the management of the institutions was associated with the presence of dental plaque and denture plaque respectively. [source] Co-morbidity in the ageing haemophilia patient: the down side of increased life expectancyHAEMOPHILIA, Issue 4 2009E. P. MAUSER-BUNSCHOTEN Summary., Because of an increased life expectancy, (age-related) co-morbidity is becoming a common occurrence in haemophilia patients. In this review, haemophilia-related and non-haemophilia-related medical problems, treatment recommendations and psychosocial consequences in ageing haemophilia patients are discussed. Haemophilic arthropathy is an important cause of pain and disability, and a frequent indication for surgery in haemophilia patients. In addition, many adult patients are infected with hepatitis C or HIV, the consequences and treatment of which can add to physical and mental discomfort. Moreover, inhibitors against factor VIII can also develop in adulthood, especially in patients with mild haemophilia. Hypertension is reported to occur more often in haemophilia patients than in the general population. Other internal problems, like renal abnormalities, overweight, diabetes mellitus and hypercholesterolemia are discussed. Haemophilia seems to protect against cardiovascular disease, although the incidence is increasing. Recommendations are given on dealing with tooth extractions, surgical interventions and sexuality problems in patients with haemophilia. In addition to haemophilia in itself, co-morbidity has a major psychological impact, and an important effect on quality of life. It can also result in complex treatment regimens, in which coordination between health care workers is essential. [source] The European Early Promotion Project: A new primary health care service to promote children's mental healthINFANT MENTAL HEALTH JOURNAL, Issue 6 2002Kaija Puura The number of children in Europe with significant psychologic and social problems is large and increasing. This article describes an innovative crosscultural method of working with families to promote the psychosocial well being of children and prevent the development of psychologic and social problems. A study designed to evaluate the effects of the service is also presented. Primary health care workers in five European countries have been trained to conduct promotional interviews with all prospective mothers in their area one month before and one month after birth. They have also been taught to work with mothers identified as in need of support as a parent by using a specific counselling model to try to prevent the onset of child mental health difficulties. Effects of the intervention on children's psychologic development and family adaptation are being evaluated at two years in comparison with matched groups not receiving the intervention. ©2002 Michigan Association for Infant Mental Health. [source] The health status of family caregivers in Taiwan: an analysis of gender differencesINTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 9 2005Chii-Jun Chiou Abstract Background Many studies have assessed the impact of caregivers' work activities on the caregiver. There is growing concern about the ever-increasing problems, both physical and physiological, faced by health care workers who provide care for the ill and incapacitated. Aim The aim of the study was to examine what, if any, differences exist between male and female caregivers. This study primarily focused on caregivers who were taking care of a family member. Method Three hundred and eighty-eight caregivers (280 females and 108 males) were recruited from 16 randomly selected home-care agencies in Southern Taiwan. The participants completed the Chinese Health Questionnaire-12 and the Self-Rated Health Scale. They also completed questionnaires drawn up specifically for the purpose of this study. Results Compared to the male caregivers, the female caregivers more often reported they suffered from symptoms of lack of well being, a decrease in psychosocial health and overall self-rated health. Conclusion The results reiterate the importance of considering gender differentiation in the caregiving role. Major differences were found in the extent to which negative health consequences were experienced by the male and female caregivers. The results suggest that caregivers, especially female caregivers, urgently require adequate professional health care assistance in order to reduce the negative physical and physiological effects of caregiving on the health caregiver. Copyright © 2005 John Wiley & Sons, Ltd. [source] A systematic review on the effectiveness of alcohol-based solutions for hand hygieneINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 1 2004Wilawan Picheansathian RN MS MPH The use of alcohol has been proposed as an option for hand hygiene. A systematic review was conducted to evaluate the clinical evidence supporting the use of alcohol-based solutions in hospitals as an option for hand hygiene. Studies published between January 1992 and April 2002 in English and Thai, related to the effectiveness of alcohol-based solutions, were reviewed. The databases searched included Medline, DARE, CINAHL and Dissertation Abstracts International. All studies were assessed as having adequate methodological quality. Results of this systematic review supported that alcohol-based hand rubbing removes microorganisms effectively, requires less time and irritates hands less often than does handwashing with soap or other antiseptic agents and water. Furthermore, the availability of bedside alcohol-based solutions increases compliance with hand hygiene among health care workers. [source] A 7-step consultation plan for health care workers and hairdressersJOURNAL DER DEUTSCHEN DERMATOLOGISCHEN GESELLSCHAFT, Issue 9 2007Stephanie Soost Summary Background: Skin diseases are among the most common occupational disor-ders in health care workers and hairdressers. Optimal prevention methods make it possible for more individuals to remain active in their profession. We devised a 7-step consultation plan which was employed in a standard fashion and then evaluated. Patients and Methods: 264 employes were evaluated in the Education and Support Center of the German Accident Prevention and Insurance Association in the Health and Welfare Services (BGW schu.ber.z Berlin) from 2003 to 2005 in a standardized manner. Included were detailed history, physical examination, skin physiology measurements (transepidermal water loss, corneometry, sebumetry) and then making a diagnosis and therapeutic recommendations. Results: Within the study group of 264 employes the most frequent diagnosis were toxic-irritant hand eczema (28.4%), allergic contact eczema (19.7%), atopic eczema (15.5%) and irritant contact eczema with atopic diathesis (13.6%). The frequency of contact sensitivity was high in the study group (80.7%). The skin physiological parameters were not remarkably altered and did not differ between individuals with an atopic diathesis versus without an atopic diathesis. Conclusion: This standardized protocol for a "7-step consultation plan"when applied in a standardized manner offers quality-controlled but also individually-adapted support considering dermatological, educational and occupational aspects. Skin physiology parameters did not provide any further information indicating the need of the development of novel techniques to measure skin barrier function. [source] Hospital discharge planning for frail older people and their family.JOURNAL OF CLINICAL NURSING, Issue 18 2009Are we delivering best practice? Aims and objectives., This paper examined the available evidence concerning hospital discharge practices for frail older people and their family caregivers and what practices were most beneficial for this group. Background., Hospital discharge practices are placing an increasing burden of care on the family caregiver. Discharge planning and execution is significant for older patients where inadequate practices can be linked to adverse outcomes and an increased risk of readmission. Design., Literature review. Methods., A review of English language literature published after 1995 on hospital discharge of frail older people and family carer's experiences. Results., Numerous factors impact on the hospital discharge planning of the frail older person and their family carer's that when categorised focus on the role that discharge planning plays in bridging the gap between the care provided in hospital and the care needed in the community, its potential to reduce the length of hospital stay, the impact of the discharge process on family carer's and the need for a coordinated health professional approach that includes dissemination of information, clear communication and active support. Conclusion., The current evidence indicates that hospital discharge planning for frail older people can be improved if interventions address family inclusion and education, communication between health care workers and family, interdisciplinary communication and ongoing support after discharge. Interventions should commence well before discharge. Relevance to clinical practice., An awareness of how the execution of the hospital discharge plan is perceived by the principal family carer of a frail older person, will allow nurses and others involved with the discharge process to better reconcile the family caregivers' needs and expectations with the discharge process offered by their facility. The research shows there is a direct correlation between the quality of discharge planning and readmission to hospital. [source] Hepatitis E in Qatar imported by expatriate workers from Nepal: Epidemiological characteristics and clinical manifestationsJOURNAL OF MEDICAL VIROLOGY, Issue 6 2009Abdulsalam Saif Ibrahim Abstract Prompted by cases of acute hepatitis in expatriate workers presenting at Alkhor Hospital, Qatar, a limited prospective observational study was conducted from July 2005 to June 2006 to determine the epidemiological and clinical features of patients (predominantly Nepalese) presenting with acute hepatitis. Countrywide during that period samples from 86 Nepalese presenting at different centers were found to be anti-HEV IgG positive and 50 of these were also positive for anti-HEV IgM. Fifty-eight of those Nepalese were seen and treated at Alkhor Hospital and of them 43 were confirmed as cases of acute HEV, being positive for both anti-HEV IgM and IgG. The remaining 15 were diagnosed as probable cases of acute HEV on the basis of clinical and epidemiological similarity. It seems likely that transit in Kathmandu in reportedly unsanitary conditions was the focus of infection. In some of those examined at Alkhor, ultrasound detected a thickened gallbladder wall in 30 of 39 (76.9%) with two cases having clinical acalcular cholecystitis. Higher levels of alanine aminotransferase and aspartate aminotransferase were associated with severe disease and derangement in coagulation. On the available evidence hepatitis E was imported by expatriate workers and it is clear that medical screening of these workers pre- and post-arrival must be improved to prevent further outbreaks. It is also essential that health care workers in Qatar are made aware of this ongoing problem of imported HEV and understand the variable presentation of the condition. J. Med. Virol. 81:1047,1051, 2009. © 2009 Wiley-Liss, Inc. [source] Genetic characterization of hepatitis C virus strains in Estonia: Fluctuations in the predominating subtype with timeJOURNAL OF MEDICAL VIROLOGY, Issue 4 2007Tatjana Tallo Abstract During the last decade, there has been a dramatic increase in intravenous drug use in young adults in Estonia with an increased incidence of both hepatitis B and C as a consequence. Since genetic data are limited regarding hepatitis C virus (HCV) strains in Estonia, the aim of the study was to characterize HCV strains in different risk groups to determine their relatedness to strains from other geographical regions. Three hundred fifty-three anti-HCV positive sera collected during 1994,2004 from hospitalized patients, blood donors and health care workers were used as source of HCV RNA. Two hundred nine (59%) of the sera were positive for HCV RNA by PCR directed to the 5,-UTR region. For 174 strains the HCV subtype was determined by analyses of the NS5B and/or the 5,UTR-core regions. 1b (71%) was the most common subtype followed by 3a (24%), 2c (2%), 1a (1%), and 2a (1%). The 1b and 3a strains were similar to strains from other regions of the former USSR. Within genotype 1b there were several HCV lineages. However, for 3a there seemed to be two separate introductions into Estonia. There was a relative shift from subtype 1b to 3a in 1999,2000 with a further replacement of 3a with 1b in intravenous drug users in 2001 and onwards (P,<,0.05). However, both subtypes were found to co-circulate in the community independent of risk factors. One patient was infected with the 2k/1b recombinant presumed to originate from St. Petersburg being the first isolate of this recombinant recovered outside Russia. J. Med. Virol. 79:374,382, 2007. © 2007 Wiley-Liss, Inc. [source] Staff attitudes towards aggression in health care: a review of the literatureJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 1 2005G. J. JANSEN rn mnsc The aim of this literature review was to explore the attitudes of health care workers towards inpatient aggression and to analyse the extent to which attitudes, as defined from a theoretical point of view, were addressed in the selected studies. Databases from 1980 up to the present were searched, and a content analysis was done on the items of the selected studies. The concepts ,cognition' and ,attitude' from the framework of ,The Theory of Reasoned Action' served as categories. The self-report questionnaire was the most common instrument used and three instruments specifically designed to measure attitudes were found. These instruments lacked profound validity testing. From a total of 74 items, two thirds focussed on cognitions and only a quarter really addressed attitudes towards aggression. Research was particularly concerned with the cognitions that nurses had about aggression, and attitudes were studied only to a limited extent. Researchers used different instruments, which makes it difficult to compare results across settings. [source] A Metric of Maternal Prenatal Risk Drinking Predicts Neurobehavioral Outcomes in Preschool ChildrenALCOHOLISM, Issue 4 2009Lisa M. Chiodo Background:, Fetal Alcohol Spectrum Disorders (FASDs), including Fetal Alcohol Syndrome, continue to be high-incidence developmental disorders. Detection of patterns of maternal drinking that place fetuses at risk for these disorders is critical to diagnosis, treatment, and prevention, but is challenging and often insufficient during pregnancy. Various screens and measures have been used to identify maternal risk drinking but their ability to predict child outcome has been inconsistent. This study hypothesized that a metric of fetal "at-risk" alcohol exposure (ARAE) derived from several indicators of maternal self-reported drinking would predict alcohol-related neurobehavioral dysfunctions in children better than individual measures of maternal alcohol consumption alone. Methods:, Self-reported peri-conceptional and repeated maternal drinking during pregnancy were assessed with semi-structured interviews and standard screens, i.e., the CAGE, T-ACE, and MAST, in a prospective sample of 75 African-American mothers. Drinking volumes per beverage type were converted to standard quantity and frequency measures. From these individual measures and screening instruments, a simple dichotomous index of prenatal ARAE was defined and used to predict neurobehavioral outcomes in the 4- to 5-year-old offspring of these women. Study outcomes included IQ, attention, memory, visual-motor integration, fine motor skill, and behavior. Statistical analyses controlled for demographic and other potential confounders. Results:, The current "at-risk" drinking metric identified over 62% of the mothers as drinking at risk levels,23% more than the selection criterion identified,and outperformed all individual quantity and frequency consumption measures, including averages of weekly alcohol use and "binge" alcohol exposures (assessed as intake per drinking occasion), as well as an estimate of the Maternal Substance Abuse Checklist (Coles et al., 2000), in predicting prenatal alcohol-related cognitive and behavioral dysfunction in 4- to 5-year-old children. Conclusions:, A metric reflecting multiple indices of "at-risk" maternal alcohol drinking in pregnancy had greater utility in predicting various prenatal alcohol-related neurobehavioral dysfunction and deficits in children compared to individual measures of maternal self-reported alcohol consumption or a previous maternal substance abuse index. Assessing fetal risk drinking in pregnant women was improved by including multiple indicators of both alcohol consumption and alcohol-related consequences and, if appropriate practical applications are devised, may facilitate intervention by health care workers during pregnancy and potentially reduce the incidence or severity of FASDs. [source] | ||||||||||||||||||||||||||||||||||