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Metropolitan Teaching Hospital (metropolitan + teaching_hospital)
Selected AbstractsThe utility of FDG-PET in the preoperative staging of esophageal cancerDISEASES OF THE ESOPHAGUS, Issue 5 2008S. Gananadha SUMMARY., Accurate staging of esophageal cancer is important when determining which patients will potentially benefit from curative surgery. The aim of this study was to evaluate the incremental effect of 2-fluoro-2-deoxyglucose positron emission tomography (FDG-PET) when used in addition to standard staging modalities. Patients referred to two surgeons in an Australian metropolitan teaching hospital with esophageal or esophago-gastric junction malignancy between May 2002 and December 2006 were included. Patients who had undergone prereferral treatment with chemotherapy or radiotherapy were excluded. Patients undergoing resection for gastrointestinal stromal tumors or high-grade dysplasia within Barrett's esophagus were also excluded. Clinical and non-clinical data were recorded prospectively. Pretreatment staging included routine CT scan and selective endoscopic ultrasound (EUS). FDG-PET was performed in patients judged to have curable disease on CT scanning and EUS. From a total of 130 eligible patients, 76 were judged to have curable disease on the basis of CT and EUS findings. Of these 76 patients, 19 (25%) were excluded from surgery due to additional information obtained from FDG-PET. The addition of FDG-PET to routine preoperative staging resulted in the exclusion from surgery of 19 (25%) patients who prior to the introduction of FDG-PET would have undergone attempted resection. FDG-PET should be performed in all patients under consideration for esophagogastric resection in order to avoid resection in patients with disseminated disease. [source] Nurses' knowledge of error in blood pressure measurement techniqueINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 3 2002BHScArticle first published online: 27 MAY 200, DipAppSci(NsgEdn), Robin S Armstrong RN Errors in measuring blood pressure may have significant impact on the investigation and treatment of patients. Errors arise from faults in measurement technique or the equipment used. In Australia, blood pressure measurement technique is taught to nurses during their undergraduate education and may not be reviewed again. This observational, descriptive study surveyed clinical nurses at a metropolitan teaching hospital at shift hand-over time. Participation was voluntary and anonymous by 78 nurses who answered a questionnaire to determine the need and focus for updating blood pressure measurement technique. Sixty-one per cent of participants conformed to currently accepted practice in identifying systolic blood pressure, and 71% diastolic blood pressure; 54% correctly interpreted a description of blood pressure sounds containing an auscultatory gap. Correct answers for assessment of faulty equipment were given by 58%, assessing cuff size by 57%, arm position for seated measurement by 14%, determination of inflation pressure by 29% and deflation rate 62%. Incidence of terminal digit preference was 32%. These findings indicate that knowledge of participants was inadequate to perform blood pressure measurement in a standardized manner, and prevent introduced error. [source] Anxiety as a factor influencing satisfaction with emergency department care: perspectives of accompanying personsJOURNAL OF CLINICAL NURSING, Issue 24 2009Anna Ekwall Aim., To measure levels of anxiety among people accompanying consumers to the emergency department and to explore how anxiety influences satisfaction with care. Background., When people seek treatment in an emergency department they are often accompanied by a next-of-kin, family member or friend. While the accompanying person plays a vital role in providing psycho-social support to consumers, little is known about how they perceive the quality of care. Learning more about how accompanying persons perceive care may inform the development of strategies to enhance communication processes between staff, consumers and accompanying persons. Design., A prospective cross-sectional survey design. Methods., Data were collected from a consecutive sample of accompanying persons at one Australian metropolitan teaching hospital. Of all eligible individuals approached, 128/153 (83·7%) returned completed questionnaires. The questionnaire comprised a series of open- and close-ended questions about perceptions of medical need, urgency and satisfaction with the overall visit. Anxiety was assessed using the Visual Analogue Scale for Anxiety (VAS-A). Results., There was a significant association between the accompanying person's levels of anxiety and satisfaction at point of discharge. In the satisfied group, mean VAS-A scores were 17·4 (SD 17·5) compared to 42·9 (SD 26·6) in the not satisfied group (p = 0·011). Moreover, those participants who were not satisfied with the visit did not show a significant reduction in VAS-A scores from triage to point of discharge. Conclusion., The lower the level of anxiety reported by accompanying persons when leaving the emergency department, the more satisfied they are likely to be with their emergency department visit. Ultimately, well informed and confident accompanying persons are beneficial for ensuring quality patient support. Relevance to clinical practice., Asking accompanying persons about their anxiety level before discharge gives them the opportunity to pose clarifying questions and is, therefore, an effective way of improving their satisfaction with the emergency department visit. [source] The influence of patient acuity on satisfaction with emergency care: perspectives of family, friends and carersJOURNAL OF CLINICAL NURSING, Issue 6 2008Anna Ekwall PhD Aims and objectives., To investigate the factors that influence satisfaction with emergency care among individuals accompanying patients to the emergency department and explore agreement between the triage nurse and accompanying person regarding urgency. Background., Many patients seeking treatment in hospital are escorted by an accompanying person, who may be a friend, family member or carer. Several factors influence patient satisfaction with emergency care, including waiting time and time to treatment. It is also influenced by provision of information and interpersonal relations between staff and patients. Research on satisfaction has focused on the patient perspective; however, individuals who accompany patients are potential consumers. Knowledge about the ways accompanying persons perceive the patient's medical condition and level of urgency will identify areas for improved patient outcomes. Design and methods., A prospective cross-sectional survey with a consecutive sample (n = 128 response rate 83·7%) was undertaken. Data were collected in an Australian metropolitan teaching hospital with about 32,000 visits to the emergency department each year. The Consumer Emergency Satisfaction Scale was used to measure satisfaction with nursing care. Results., Significant differences in perceptions of patient urgency between accompanying persons and nurses were found. Those people accompanying patients of a higher urgency were significantly more satisfied than those accompanying patients of a lower urgency. These results were independent of real waiting time or the accompanying person's knowledge of the patients' triage status. In addition, older accompanying persons were more satisfied with emergency care than younger accompanying persons. Discussion., Little attention has been paid to the social interactions that occur between nurses and patients at triage and the ways in which these interactions might impact satisfaction with emergency care. Relevance to clinical practice., Good interpersonal relationships can positively influence satisfaction with the emergency visit. This relationship can contribute to improved patient care and health outcomes. [source] Prediction of intern attendance at a seminar-based training programme: a behavioural intention modelMEDICAL EDUCATION, Issue 7 2000Rob J Boots Context The factors determining intern attendance at ,resident rounds' training programmes are not known. Aims This study aimed to use a behavioural model (the Triandis theory of social behaviour) to predict intern attendance at the resident round programme at a metropolitan teaching hospital. Subjects These included 109 interns in a large metropolitan teaching hospital, in the 1996 and 1997 cohorts. Methods Tabulated responses from a structured interview administered to 10 randomly selected interns were used to develop survey items related to the Triandis variables. Attendance was monitored using a sessional logbook and by self-report. Item analysis was conducted for each variable scale. Stepwise multiple regression models were constructed to predict attendance and intention. Results The average proportion of resident rounds attended was 43% (95% confidence intervals (CI) 40,47%) from logbook attendance, and 63% (95% CI 61,65%) by self-report. Cronbach's alpha for the subscales ranged from 0·62 to 0·91. Intern attendance was predicted by the habit of attendance and negatively predicted by facilitating conditions (AdjR2=0·26, P < 0·0001). The intention to attend was only independently predicted by perceived consequences (AdjR2= 0·19, P < 0·0001). Conclusions The establishment of resident education programmes within teaching hospitals requires attention to and modification of facilitating conditions that may allow improvements in attendance and in quality of the programme. [source] Prosthesis related sepsis following laparoscopic adjustable gastric bandingANZ JOURNAL OF SURGERY, Issue 7-8 2010Michael Facek Abstract Background:, Laparoscopic adjustable gastric banding (LAGB) is well-recognized as a superior method to achieving durable weight loss in the medium term when compared with non-surgical methods of weight loss. In this paper, we described the clinical presentation and outcomes of patients presenting with band or band-adjustment reservoir sepsis from our series from a single institution. Methods:, We conducted a retrospective review of prospectively collected clinical, anthropometric and biochemical data from patients who underwent LAGB placement over a five-year period at a metropolitan teaching hospital. Those patients requiring surgical intervention for prosthesis-related sepsis were included in the review. Results:, Of the 445 patients in this series, 10 (2.2%) developed prosthesis sepsis and required operative intervention. Three (0.7%) presented with reservoir sepsis requiring removal of the reservoir. One had band erosion identified and the entire prosthesis removed. In seven (1.5%) of the patients, infections occurred at the gastric band. Two patients presented with purulent peritonitis and underwent immediate band removal. The remainder presented with band abscesses and either had their band removed (three patients) or left in position and the sepsis treated with drainage and antibiotics (two patients). Conclusions:, In our current series, a small proportion of LAGB patients developed prosthesis-related infection that typically required port or band removal and usually occurred early in the post-operative course. We have modified our prophylactic antibiotic regime and surgical technique as a result of this review. In selected cases of band infection, bands were salvaged with subsequent acceptable weight loss, suggesting that LAGB salvage in the presence of sepsis may be achievable in some patients. [source] Factors associated with return-to-work and health outcomes among survivors of road crashes in VictoriaAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2 2010Michael Fitzharris Abstract Objective: To explore the relationships between injury, disability, work role and return-to-work outcomes following admission to hospital as a consequence of injury sustained in a road crash. Design and setting: Prospective cohort study of patients admitted to an adult trauma centre and two metropolitan teaching hospitals in Victoria, Australia. Participants were interviewed in hospital, 2.5 and eight months post-discharge. Participants: Participants were 60 employed and healthy adults aged 18 to 59 years admitted to hospital in the period February 2004 to March 2005. Results: Despite differences in health between the lower extremity fracture and non-fracture groups eight months post-crash the proportions having returned to work was approximately 90%. Of those returning to work, 44% did so in a different role. After adjustment for baseline parameters, lower extremity injuries were associated with a slower rate of return to work (HR: 0.31; 95%CI: 0.16,0.58) as was holding a manual occupation (HR: 0.16; 95%CI: 0.09,0.57). There were marked differences in physical health between and within the injury groups at both follow-up periods. Conclusions: These results demonstrate that both injury type and severity and the nature of ones occupation have a considerable influence on the rate and pattern of return to work following injury. Further, persisting disability has a direct influence on the likelihood of returning to work. The implications of these findings and the types of data required to measure outcome post-injury are discussed. [source] Student attitudes to surgical teaching in provincial hospitalsAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 3 2003Martin H. Bruening ABSTRACT Objective:The ever-increasing pressure on metropolitan teaching hospitals to rationalise budgets and increase productivity has resulted in a dwindling amount of teaching opportunity for the medical student population. One solution to the problem was to utilise a largely untapped resource in South Australia, namely the provincial hospitals, however, student opinion regarding such a radical change had yet to be determined. Design:A questionnaire was circulated among an entire year group of medical students who would be undertaking the revised surgical curriculum with rural attachments. Setting:In October 1997, a decision was made by the Department of Surgery at the University of Adelaide to proceed with optional rural surgical attachments in 1998. Subjects:The survey was distributed to the 125 members of the 1997 fifth year medical student group. Results:A total of 92 questionnaires were returned giving a response rate of 75%. Thirty-nine students ranked a rural term in their top half of preferences, while a further 18 indicated that they would go to a rural centre if they had to. Conclusion:Despite having little warning of the impending changes to their surgical curriculum, the majority of students who responded to the questionnaire stated that they would be willing to venture to the country locations. Before planning significant changes to an established curriculum, the student group should be consulted to gauge their opinion. What is already known:Within the medical literature, studies have been performed with regard to student opinions regarding postgraduate internships in rural locations, but to our knowledge, this survey represents the first study into student opinion with particular reference to rural surgical attachments prior to their commencement within a medical school curriculum. What this study adds:As a result of this study, it can now be concluded that a considerable amount of interest exists within the student population to undertake rural surgical rotations. [source] | ||||||||||