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Large Teaching Hospital (large + teaching_hospital)
Selected AbstractsPractices and views on fetal heart monitoring: a structured observation and interview studyBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 4 2006S Altaf Objective, To assess and explain deviations from recommended practice in National Institute for Clinical Excellence (NICE) guidelines in relation to fetal heart monitoring. Design, Qualitative study. Setting, Large teaching hospital in the UK. Sample, Sixty-six hours of observation of 25 labours and interviews with 20 midwives of varying grades. Methods, Structured observations of labour and semistructured interviews with midwives. Interviews were undertaken using a prompt guide, audiotaped, and transcribed verbatim. Analysis was based on the constant comparative method, assisted by QSR N5 software. Main outcome measures, Deviations from recommended practice in relation to fetal monitoring and insights into why these occur. Results, All babies involved in the study were safely delivered, but 243 deviations from recommended practice in relation to NICE guidelines on fetal monitoring were identified, with the majority (80%) of these occurring in relation to documentation. Other deviations from recommended practice included indications for use of electronic fetal heart monitoring and conduct of fetal heart monitoring. There is evidence of difficulties with availability and maintenance of equipment, and some deficits in staff knowledge and skill. Differing orientations towards fetal monitoring were reported by midwives, which were likely to have impacts on practice. The initiation, management, and interpretation of fetal heart monitoring is complex and distributed across time, space, and professional boundaries, and practices in relation to fetal heart monitoring need to be understood within an organisational and social context. Conclusion, Some deviations from best practice guidelines may be rectified through straightforward interventions including improved systems for managing equipment and training. Other deviations from recommended practice need to be understood as the outcomes of complex processes that are likely to defy easy resolution. [source] Perinatal mortality: clinical value of postmortem magnetic resonance imaging compared with autopsy in routine obstetric practiceBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 4 2003Marianne E. Alderliesten Objective To compare postmortem magnetic resonance imaging (MRI) with autopsy in perinatal deaths. To determine the acceptance and feasibility of postmortem perinatal MRI. Design Cohort study. Setting Large teaching hospital. Population Fetuses and neonates from 16 weeks gestational age until 28 days after birth, stillbirths as well as intrapartum and neonatal deaths. Methods MRI was performed prior to autopsy in a consecutive cohort of perinatal deaths after full parental consent. Agreement between MRI and autopsy was calculated. The consent rate for both examinations was recorded separately, as well as the time between the perinatal death and the MRI. Main outcome measure Full agreement between MRI and autopsy. Results Of 58 cases, 26 parents consented to both examinations (45%). Autopsy showed 18 major malformations, of which 10 were detected with MRI. The positive predictive value of MRI was 80% (4/5) and the negative predictive value was 65% (13/20). Additional consent for MRI was given in eight cases (14%). In 84%, the MRI could be performed within 48 hours. Conclusions MRI is of value if autopsy is refused, but diagnostic accuracy is insufficient to recommend substitution of full autopsy. The acceptance rate of MRI only is better than that of autopsy. [source] Biopsy site selection for endobronchial ultrasound guide-sheath transbronchial biopsy of peripheral lung lesionsINTERNAL MEDICINE JOURNAL, Issue 2 2008D. I. K. Fielding Abstract Background: Choice of biopsy method for peripheral lung lesions is usually between CT-guided fine-needle aspiration biopsy (CT FNA) and bronchoscopy. Endobronchial ultrasound guide-sheath biopsy (EBUS GS) is a new method to improve the yield of bronchoscopy. Guidance on which lesions would be appropriate for either method is needed. The aim of the study was to compare the diagnostic yields and pneumothorax rate of EBUS GS and CT FNA in terms of the location of the lesion needing biopsy, in particular, whether the lesion is touching the pleura. Methods: Prospective series of EBUS GS were compared to retrospective review of CT FNA carried out simultaneously in a large teaching hospital. Results: For EBUS GS 140 cases were carried out with mean lesion size 29 mm. Overall diagnostic sensitivity was 66%. For lesions not touching visceral pleura it was 74% compared with 35% where it was on the pleura (P < 0.01). For CT FNA 121 cases were carried out with mean lesion size 37 mm. The overall diagnostic sensitivity was 64%. Rate of pneumothorax and ICC placement in EBUS GS was 1 and 0% and in CTFNA was 28 and 6%, with P < 0.001 for both. Conclusion: Lesion location, in particular, connection to the visceral pleura, can improve decision-making in referral for either CT FNA or EBUS GS to maximize diagnostic yield and minimize pneumothorax rate. [source] Evaluation of the off-label usage of rituximab in a large teaching hospital in New South WalesINTERNAL MEDICINE JOURNAL, Issue 8 2007R. Sharma Abstract A retrospective review of patients receiving rituximab off label in a large teaching hospital was conducted between July 2002 and January 2006. The indication, dosing regimen, efficacy and cost of rituximab were evaluated. Rituximab was prescribed for three clinical indications; acute organ transplant rejection, post-transplant lymphoproliferative disease and autoimmune disease. On average, 600 mg of rituximab was prescribed weekly for 4 weeks, costing the hospital $108 739.37. We suggest an initial approval for a limited number of doses with subsequent approval dependent on improvement in predefined clinical or biochemical end-points. Furthermore, we suggest an Australia-wide central database be established to enable delineation of the optimal dosing schedule, as well as monitoring of clinical outcome. [source] Nursing Diagnosis Extension and Classification: Ongoing PhaseINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2003Martha Craft-Rosenberg BACKGROUND The Nursing Diagnosis Extension and Classification Project (NDEC) has been active for almost a decade. The team began with the formation of a team of investigators at The University of Iowa College of Nursing. From 1994 until 2000 the research team consisted of 16 investigators who were experts in nursing care across the lifespan. They also represented expertise in both qualitative and quantitative research. The aims of the NDEC research are to evaluate and revise NANDA diagnoses, to validate the diagnoses using a clinical information system, and to develop candidate diagnoses. MAIN CONTENT POINTS Phase 1 of the NDEC research has yielded 116 refined and developed nursing diagnoses that have been submitted to NANDA. Of these, 65 have been approved and 54 appeared in Nursing Diagnoses: Definitions and Classification, 1999,2000 along with 39 NDEC products. In the 2000,2001 edition, 7 diagnoses refined by NDEC and 7 new diagnoses submitted by NDEC are included. As only about half the NDEC products have appeared in NANDA publications, the three-level review process (Diagnosis Review Committee, membership, and Board) has been discussed with the NANDA board. This request is currently being honored by the Diagnosis Review Committee; however, review by the membership and review by the NANDA board is just beginning to move in this direction. Phase 2, clinical validation of the NDEC work, is being conducted at a long-term care facility. It will also be conducted at a large teaching hospital. All the NDEC refinement and development work has been submitted for clinical validation. Currently validation is planned at the label level only. Phase 3 involves identification of candidate diagnoses. Many of the candidate diagnoses were developed during the concept analysis phase, when NDEC team members identified the need for additional diagnoses. Nurses in practice have submitted other candidate diagnoses. In total 195 candidate diagnoses have been identified and placed into a database. In order for the NDEC team to make decisions regarding priorities for diagnosis development, the diagnoses in the candidate database are compared to diagnoses in other classifications that have already been developed. Several classifications are used for comparison including the Omaha System and the Home Health Care Classification. A large table is used to compare candidate label to other labels. Candidate diagnosis included in other classifications will be given lower priority for development by NDEC. CONCLUSIONS The NDEC work plan includes work on diagnoses to be resubmitted to the NANDA Diagnosis Review Committee. It is hoped that the Web site for NLINKS will facilitate the work of diagnosis refinement and development. NDEC will continue to work with any investigator who is seeking assistance. The last part of the work plan is resource acquisition and recruitment of investigators to continue the refinement and development of diagnoses. [source] Insights into creation and use of prescribing documentation in the hospital medical recordJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 5 2005Mary P. Tully PhD MRPharmS Abstract Rationale, aims and objectives, Extraction of prescribing data from medical records is a common, albeit flawed, research method. Yet little is known about the processes that result in those data. This study explores the creation and use of prescribing documentation in the medical record, from the perspective of the hospital doctors who both create and use it. Methods, Thirty-six hospital doctors were purposively selected for qualitative interviews, giving a maximum variability sample of grades of doctors across the range of major medical specialty areas and medical teams at a large teaching hospital in England. Results, The findings suggest a number of reasons why hospital doctors fail to record prescribing decisions in the medical record. There was no set standard, record keeping was not formally taught and the hurried environment of the ward gave little time for documentation. The doctors also acknowledged that there was no need for completeness, as colleagues would be able to ,fill in the gaps' via an inferential process. ,Assumptions ,were ,made ,and ,although ,this ,was ,not ,seen ,as ,ideal, it was recognized as necessary if work was to be done efficiently. Conclusion, These results reinforce the suggestion that, despite the large number of potential users, the medical record is created for those with the right privileged knowledge. This has profound implications for those without that insider knowledge who are using medical records for research purposes. Funding, This work was funded by a North West Regional National Health Service Postdoctoral Fellowship. [source] An appraisal of the use of secondment within a large teaching hospitalJOURNAL OF NURSING MANAGEMENT, Issue 6 2001BA(HONS), J. Hamilton RGN, M MED SCI Introduction, This study was undertaken in a large teaching hospital in Sheffield. It explores the use of secondment as a vehicle for practice, service and career development. Aim, To provide us with an understanding of the ways in which we utilize secondment opportunities, with a view to developing good practice guidelines that will help both the individual and the organization to maximize the potential in each secondment post. Method, A survey of nursing staff who had been on secondment during the previous year. Questionnaires were used to gather data from the senior nurse in each specialty directorate to develop an organizational (seconder) perspective and 20 secondees to provide an individual (secondee) perspective. Results, Nurses tended to be seconded from clinical roles into specialist clinical roles or non-clinical roles, predominantly in areas of research, audit, practice development and teaching. Seconded posts were new roles for individuals and the majority were relocated to new work environments. Secondment was overwhelmingly seen as an opportunity, allowing individuals to develop new skills and knowledge, progress their career and gain a broader strategic perspective. However, there were a number of barriers to progress: lack of role definition for the organization and the individual; uncertainty about the future; falsely raised hopes that secondments would be extended; uncertainty about status; and difficulties adjusting to a new environment and culture within unrealistically short timeframes. Conclusions, Secondment use has become widespread throughout the National Health Service (NHS) and is a very positive and popular vehicle for staff and service development. The potential benefits are high but must be offset against the risks. This paper introduces an organizational risk assessment matrix which can be used to inform the development of effective secondment ventures. [source] Opportunistic immunisation of infants admitted to hospital: Are we doing enough?JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 6 2008Kelly-Anne Ressler Aim: To determine the accuracy and effectiveness of opportunistic immunisation of children admitted to the paediatric unit of a large teaching hospital using retrospectively collected data. Methods: Immunisation status, documented using clinical indicator (CI) forms, of all admissions over a 1-year period was compared with that recorded by the Australian Childhood Immunisation Register. In order to determine the effectiveness of providing catch-up plans, we analysed the difference in catch-up times of the children with and without a catch-up plan on their CI form. Results: The details of 614 admissions in the study period were included. Comparing the Australian Childhood Immunisation Register with the CI for assessing immunisation status, we found that 83 of the 573 (14.5%) were incorrectly recorded, and only 25 of the 82 admissions in which the infant was overdue were identified on the ward. Children were more likely to be vaccinated within 30 days and 90 days of admission if they had been given a catch-up plan. Of the children who had not been given a catch-up plan, almost half were still overdue at 90 days. Conclusions: Admission to hospital provides opportunities for both routine and catch-up immunisation; however, for opportunistic immunisation to be effective, health service screening and immunisation documentation must be accurate. [source] Pedagogy, power and service user involvementJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 1 2004A. FELTON mn rn (mental health) This paper explores mental health nurse educators' perceptions of the involvement of service users in preregistration nurse education. The idea for the study was developed from a local group of people including service users, lecturers and students committed to finding ways to develop service user involvement in education. This qualitative study uses semi-structured interviews to explore participants' perceptions in depth. Five lecturers who teach on the diploma programme based at a large teaching hospital were interviewed. The results suggest that the current situation of involving service users at the research site was ineffective. The concepts of ,role' and power relationships were used to explore the reasons for this. The development of service user involvement in education is complex and requires further research. [source] Patient priorities of care in rheumatology outpatient clinics: a qualitative studyMUSCULOSKELETAL CARE, Issue 4 2007Vicky Ward PhD Abstract Objective:,To provide more understanding of what rheumatoid arthritis (RA) patients want and need from an outpatient visit. Methods:,25 patients who experienced care in a nurse practitioner clinic (n = 10), junior doctor clinic (n = 9) or consultant clinic (n = 6) in a large teaching hospital in West Yorkshire were interviewed about their perceptions and experiences of care. Interviews were approximately 11/2 hours in duration and were carried out in a neutral environment by a research nurse. Interview data were subjected to atheoretical content analysis, which resulted in the identification of emergent themes. Results:,Five main themes emerged from the analysis of interview data: 1) patients want to be communicated to clearly and effectively and value positive relationships with practitioners. These help to give patients confidence in the care they are receiving; 2) patients want to feel in control of their condition and tend to refuse interventions as a way of gaining control; 3) patients want to be given clear explanations during consultations, and want information in oral and written forms; 4) patients want to be able to access practitioners between scheduled appointments as a way of gaining reassurance; and 5) patients want to feel valued by society through having their difficulties appreciated and understood by others. Conclusion:,This research adds to the body of evidence on what patients want from their rheumatology care, and each theme has clear implications for future practice. Copyright © 2007 John Wiley & Sons, Ltd. [source] Influences that drive clinical decision making among junior rheumatology nurses: A qualitative studyMUSCULOSKELETAL CARE, Issue 4 2006Domini Jayne Bryer MA BSc(Hons) RN Abstract This paper presents a qualitative study exploring the influences that drive clinical decision making among a small group of junior rheumatology nurses. A qualitative, descriptive design was chosen. Semi-structured interviews were used with a purposive sample of six junior staff nurses from two inpatient rheumatology wards in a large teaching hospital in the North of England. The interviews were audiotaped and transcribed using Burnard's (1991) thematic content analysis. The findings demonstrate four distinct themes which influence clinical decision making including professional development, patient-focused care, working in a specialty and rheumatology nursing. Development of experiential knowledge alongside access to specialized information and expert practitioners was also influential in informing decisions. Copyright © 2006 John Wiley & Sons, Ltd. [source] Meeting patient needs in the hospital setting, are written nutrition education resources too hard to understand?NUTRITION & DIETETICS, Issue 3 2008Louise PERKINS Abstract Aims:, To determine the readability of written nutrition education resources currently used in the Nutrition and Dietetics Department in a large teaching hospital and assess whether these resources are of an appropriate readability level for the target population. Methods:, Dietitians in the department (n = 17) were interviewed to identify resources in use. Readability analysis of current resources (n = 235) followed, using the Simplified Measure of Gobbledegook (SMOG). The SMOG scores were compared with census data for the average reading ability of the target population based on the number of school years completed. Results:, The readability level for the resources ranged from 6 to 15. The mean was 10.4 ± 1.89 (n = 235). This compared with a reading ability in the target population of between years 6 and 8. This discrepancy suggests that the resources may be too complex and are unlikely to be well understood by the target population. Conclusions:, In the time-poor clinical environment where there is reliance on written nutrition resources to support and reinforce education messages, it is pertinent to pay more attention to readability level. Written resources are unlikely to be effective if they are too complex. It is therefore suggested that dietitians consider the readability when developing and reviewing written nutrition education resources to ensure best-quality patient care. The results of this project suggest that the SMOG index is a useful method to use for this purpose as it is widely available, easy to use and expedient in implementation. [source] Risk factors predisposing to fetal loss following a second trimester amniocentesisBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 10 2001Nikolaos E. Papantoniou Objective To examine the influence of possible risk factors on fetal loss rate following amniocentesis. Design Retrospective analysis of case records between 1993 and 1998. Setting Fetal medicine unit of a large teaching hospital. Population One thousand and six women with singleton pregnancies formed the study group. Seven hundred and eight of them had bleeding during the current pregnancy before the procedure, while 298 had a history of three or more first trimester abortions and/or a second trimester miscarriage or termination of pregnancy. Four thousand and twenty-four women who had amniocentesis and had no risk factors served as controls. Both groups were also classified according to maternal age. Group 1: 1610 women aged 20,34 years; Group 2: 2850 women aged 35,39 years; Group 3; 570 women > 40 years. Methods Women of both groups underwent a second trimester amniocentesis between 16 and 21 weeks of gestation. Fetal losses following amniocentesis were examined in three time intervals: 1. in the first two weeks after the procedure; 2. up to the 28th week; 3. from the 28th week to term. Results There was a statistically significant difference in the fetal loss rate between women aged 20,34 years (2.54%) and those > 40 years (5.1%). Women with a history of vaginal bleeding during the current pregnancy had a higher fetal loss rate compared with controls (6.5%vs 2.8%), which corresponds to an odds ratio of 2.4 (95% CI 1.69,3.42). A similar difference was found between the group of women with a history of previous abortions/terminations and the controls (8%vs 2.8%): OR 3.03 (95% CI 1.92,4.79). Conclusions There is a higher risk of fetal loss following amniocentesis in women > 40 years of age compared with those aged 20,34 years. Bleeding in the current pregnancy, a history of three or more first trimester abortions, a second trimester miscarriage or termination of pregnancy seem to be significant predisposing factors for fetal loss after an amniocentesis. [source] Outcomes in 2748 patients referred to a colorectal two-week rule clinicCOLORECTAL DISEASE, Issue 4 2007R. A. Smith Abstract Objective, To assess the 3-year outcomes of a nurse-led, one-stop, 2-week rule (TWR) clinic for suspected colorectal cancer (CRC) in a large teaching hospital. Method, Data were collected prospectively from January 2002 to December 2004. In total, 2748 patients were seen over the 3-year period. The ratio of male:female subjects was 1190:1558 (43%:57%). Median age at presentation was 66 years (range 17,96). Results, A total of 1363 (49.6%) nonconforming referrals were made; 1300 patients (47.3%) underwent flexible sigmoidoscopy during their initial assessment in clinic; 1439 patients (52.4%) underwent a barium enema during the course of their investigation; 2503 patients (91.1%) were seen within 14 working days. The median overall wait for the initial clinic appointment was 10 days. The annual number of patients seen was similar over the 3-year period. A total of 174 cancers (6.3%) were identified which accounted for 36.4% of all CRCs diagnosed during the study period. Nineteen cancers presented in the nonconforming group (1.6% of all non-conforming patients). Rectal tumours accounted for 59.8% (n = 104) of all cancers diagnosed while right-sided tumours accounted for only 10.9% (n = 19). Advanced tumours accounted for 73.0% (n = 127) of the total; 133 (76.4%) cancer patients underwent some form of surgical intervention. Conclusion, A specialist nurse-led, one-stop TWR clinic for suspected colorectal cancer is sustainable and can be run successfully with over 90% of referrals seen within the targeted time period. The proportion of non-conforming referrals was high and a large number of advanced and unstaged tumours was observed. Low numbers of proximal tumours were detected. [source] Therapeutic drug monitoring in a developing country: an overviewBRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue S1 2001N. J. Gogtay Therapeutic Drug Monitoring (TDM) was introduced in India in the mid and late 1980s and the last 10 years have seen it grow, together with the growth of separate Clinical Pharmacology departments. The TDM service in the country is broadly of two types: in large teaching hospitals where the service is available through departments of Clinical Pharmacology, and in the private sector, where drug estimations are done by clinical biochemistry departments with minimal interpretation. This article is based on literature review and our own experiences over a 10 year period in a department of Clinical Pharmacology. It focuses on the evolution of TDM, its problems such as lack of funding, special aspects such as the impact of ethnic diff;erences, nutritional defi;ciencies, quality of medicines and availability of generic products; its utility as a research tool and its future. [source] | ||||||||||||||||||||||