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Appropriate Setting (appropriate + setting)
Selected AbstractsProviders' Beliefs, Attitudes, and Behaviors before Implementing a Computerized Pneumococcal Vaccination ReminderACADEMIC EMERGENCY MEDICINE, Issue 12 2006Judith W. Dexheimer MS Abstract Background The emergency department (ED) has been recommended as a suitable setting for offering pneumococcal vaccination; however, implementations of ED vaccination programs remain scarce. Objectives To understand beliefs, attitudes, and behaviors of ED providers before implementing a computerized reminder system. Methods An anonymous, five-point Likert-scale, 46-item survey was administered to emergency physicians and nurses at an academic medical center. The survey included aspects of ordering patterns, implementation strategies, barriers, and factors considered important for an ED-based vaccination initiative as well as aspects of implementing a computerized vaccine-reminder system. Results Among 160 eligible ED providers, the survey was returned by 64 of 67 physicians (96%), and all 93 nurses (100%). The vaccine was considered to be cost effective by 71% of physicians, but only 2% recommended it to their patients. Although 98% of physicians accessed the computerized problem list before examining the patient, only 28% reviewed the patient's health-maintenance section. Physicians and nurses preferred a computerized vaccination-reminder system in 93% and 82%, respectively. Physicians' preferred implementation approach included a nurse standing order, combined with physician notification; nurses, however, favored a physician order. Factors for improving vaccination rates included improved computerized documentation, whereas increasing the number of ED staff was less important. Relevant implementation barriers for physicians were not remembering to offer vaccination, time constraints, and insufficient time to counsel patients. The ED was believed to be an appropriate setting in which to offer vaccination. Conclusions Emergency department staff had favorable attitudes toward an ED-based pneumococcal vaccination program; however, considerable barriers inherent to the ED setting may challenge such a program. Applying information technology may overcome some barriers and facilitate an ED-based vaccination initiative. [source] Surveillance of Infectious Disease Occurrences in the Community: An Analysis of Symptom Presentation in the Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 7 2003Joe Suyama MD Objectives: To determine the effectiveness of a simulated emergency department (ED)-based surveillance system to detect infectious disease (ID) occurrences in the community. Methods: Medical records of patients presenting to an urban ED between January 1, 1999, and December 31, 2000, were retrospectively reviewed for ICD-9 codes related to ID symptomatology. ICD-9 codes, categorized into viral, gastrointestinal, skin, fever, central nervous system (CNS), or pulmonary symptom clusters, were correlated with reportable infectious diseases identified by the local health department (HD). These reportable infectious diseases are designated class A diseases (CADs) by the Ohio Department of Health. Cross-correlation functions (CCFs) tested the temporal relationship between ED symptom presentation and HD identification of CADs. The 95% confidence interval for lack of trend correlation was 0.0 ± 0.074; thus CCFs > 0.074 were considered significant for trend correlation. Further cross-correlation analysis was performed after chronic and non-community-acquirable infectious diseases were removed from the HD database as a model for bioterrorism surveillance. Results: Fifteen thousand five hundred sixty-nine ED patients and 6,489 HD patients were identified. Six thousand two hundred eight occurrences of true CADs were identified. Only 87 (1.33%) HD cases were processed on weekends. During the study period, increased ED symptom presentation preceded increased HD identification of respective CADs by 24 hours for all symptom clusters combined (CCF = 0.112), gastrointestinal symptoms (CCF = 0.084), pulmonary symptoms (CCF = 0.110), and CNS symptoms (CCF = 0.125). The bioterrorism surveillance model revealed increased ED symptom presentation continued to precede increased HD identification of the respective CADs by 24 hours for all symptom clusters combined (CCF = 0.080), pulmonary symptoms (CCF = 0.100), and CNS symptoms (CCF = 0.120). Conclusions: Surveillance of ED symptom presentation has the potential to identify clinically important ID occurrences in the community 24 hours prior to HD identification. Lack of weekend HD data collection suggests that the ED is a more appropriate setting for real-time ID surveillance. [source] Explaining employee turnover in an Asian contextHUMAN RESOURCE MANAGEMENT JOURNAL, Issue 1 2001Naresh Khatri Employee turnover is giving sleepless nights to HR managers in many countries in Asia. A widely-held belief in these countries is that employees have developed ,bad' attitudes due to the labour shortage. Employees are believed to job-hop for no reason, or even for fun. Unfortunately, despite employee turnover being such a serious problem in Asia, there is a dearth of studies investigating it; in particular studies using a comprehensive set of variables are rare. This study examines three sets of antecedents of turnover intention in companies in Singapore: demographic, controllable and uncontrollable. Singapore companies provide an appropriate setting as their turnover rates are among the highest in Asia. Findings of the study suggest that organisational commitment, procedural justice and a job-hopping attitude were three main factors associated with turnover intention in Singapore companies. [source] Genetic Testing, Genetic Information, and the Role of Maternal-Child Health Nurses in IsraelJOURNAL OF NURSING SCHOLARSHIP, Issue 3 2006Sivia Barnoy Purpose: To examine the rate of genetic testing, the characteristics of those who had these tests, and to examine the public's openness to the possibility of expanding nurses' roles in maternal-child health (MCH) clinics to include providing genetic information. Design: The study was conducted in nine MCH clinics in the central district of Israel. All women attending the clinics during 1 week were requested to complete the questionnaire. The sample consisted of 361 participants. Findings: A high rate of genetic testing (80.4%) was shown. Higher education, being secular, and native-born Israeli predicted testing performance. Half of the tested participants reported that they did not understand the test results and were interested in receiving explanations regarding these results. Forty-four percent of respondents were interested in receiving genetic information from an MCH nurse. Conclusions: A high rate of genetic testing performance was reported. The public reported lack of information regarding genetic tests and their results. An appropriate setting for providing this information is the maternal-child health clinics. [source] Teaching and learning in the clinical setting: a qualitative study of the perceptions of students and teachersMEDICAL EDUCATION, Issue 11 2003Patsy Stark Objective, To describe the perceptions of medical students and clinical teachers of teaching and learning in the clinical setting. Design, Qualitative study of focus groups with undergraduate medical students and semistructured interviews with hospital consultant clinical teachers. Setting, The School of Medicine, University of Leeds and the Leeds Teaching Hospitals Trust, UK. Participants, Fourth year medical students and consultant clinical teachers. Main outcome measures, Analysis of narratives to identify students' perceptions of clinical teaching and consultants' views of their delivery of undergraduate clinical teaching. Results, Students believed in the importance of consultant teaching and saw consultants as role models. However, they perceived variability in the quality and reliability of teaching between physicians and surgeons. Some traditional teaching venues, especially theatre, are believed to be of little clinical importance. Generally, consultants enjoyed teaching but felt under severe pressure from other commitments. They taught in a range of settings and used various teaching strategies, not all of which were perceived to be ,teaching' by students. Conclusions, While students and teachers are educational partners, they are not always in agreement about the quality, quantity, style or appropriate setting of clinical teaching. To enable teachers to provide more high quality teaching, there needs to be support, opportunities and incentives to understand curricular developments and acquire teaching skills. [source] Factors determining the performance of triple quadrupole, quadrupole ion trap and sector field mass spectrometer in electrospray ionization mass spectrometry.RAPID COMMUNICATIONS IN MASS SPECTROMETRY, Issue 13 2001The sequence coverage by fragment ions resulting from collision-induced dissociation in a triple stage quadrupole (TSQ) and a quadrupole ion trap (QIT) mass spectrometer of 10,20-mer oligonucleotides was investigated. While (a-B) and w ion series were the most abundant on both instruments, additional ion series of sequence relevance were preferably formed in the TSQ. Thus, a total number of 83 fragment ions were used to deduce the complete sequence of a 10-mer oligonucleotide of mixed sequence from a tandem mass spectrum recorded on the TSQ. The complete sequence was also encoded in the 28 fragments that were obtained from the QIT under comparable fragmentation conditions. Spectrum complexity increased considerably at the cost of signal-to-noise ratio upon fragmentation of a 20-mer oligonucleotide in the TSQ, whereas spectrum interpretation with longer oligonucleotides was significantly more straightforward in spectra recorded on the QIT. The extent of fragmentation had to be optimized by appropriate setting of collision energy and choice of precursor ion charge state in order to obtain full sequence coverage by fragments for de novo sequencing. Moreover, full sequence information was also dependent on base sequence because of the low tendency of backbone cleavage at thymidines. Tandem mass spectrometry on the QIT yielded redundant information that was successfully utilized to deduce the complete sequence of 20-mer oligonucleotides with high confidence. Copyright © 2001 John Wiley & Sons, Ltd. [source] Routine Screening for Asymptomatic Abdominal Aortic Aneurysm in High-risk Patients Is Not Recommended in Emergency Departments That Are Frequently CrowdedACADEMIC EMERGENCY MEDICINE, Issue 11 2009Beatrice Hoffmann MD Abstract Objectives:, The objectives were to examine the feasibility of offering abdominal aortic aneurysm (AAA) screening to consecutive, asymptomatic high-risk patients in a busy emergency department (ED) and to compare the prevalence of undetected AAA among ED patients to the prevalence among similarly aged men from the general population. Methods:, A prospective cohort study was conducted at an academic community ED with an annual census of 58,000 patients. Dedicated study coordinators attempted to approach all consecutive male ED patients >50 years who presented in June,August 2007 during hours of high patient volume. To be eligible, older males had to have a smoking history or a family history of AAA. Patients were excluded if they presented with AAA symptoms, had a previous history of AAA screening or repair, had hemodynamic instability, or had an altered mental status. Study coordinators completed a brief interview with all enrolled subjects to obtain demographic and health information. A credentialed ED provider performed the ultrasound (US) screening exam and documented all findings. The US director reviewed representative images of the sonographic exam for correct visualization and measurement during quality assurance. The ED sonographers also completed a survey regarding their attitudes toward AAA screening in the ED. The primary study outcomes were the feasibility of AAA screening in the ED (screening rate, enrollment rate, US success rate, and providers' opinions) and the prevalence of AAA (aortic diameter of ,3.0 cm) in the study sample. Results:, During the 12-week study period, the study coordinators successfully approached 96% (700/729) of males > 50 years who were in the ED during study enrollment hours. Of those approached, 278 were eligible (40%), 25% were ineligible, 20% were not at high risk, and for 15% we could not determine risk factor status because of altered mental status. Of the 278 eligible, 196 (70%) underwent an US exam; 10% were not scanned because the providers were too busy, and 20% declined participation. Of those scanned, the ED sonographer was able to completely visualize and correctly measure the abdominal aortas of 71% of subjects. The prevalence rate of AAA in the study sample was 5.7% (95% confidence interval [CI] = 1.9% to 9.6%), similar to reported rates of 6 or 7% in other studies. More than half of the ED sonographers reported that US screening for AAA improved the quality of ED care (58%) and patient satisfaction (63%). However, 47% reported that AAA screening reduced ED efficiency, and 74% felt that the ED was not an appropriate setting for routine AAA screening. Conclusions:, Routine screening for asymptomatic AAA required substantial ED resources for a relatively low success rate of completed screens. The prevalence rate of AAA in our ED sample was not significantly different than prevalence estimates obtained from older men in the general population. ED sonographers reported benefits of screening in terms of improving the quality of emergency care and patient satisfaction, but also reported that it reduced operational efficiency. For EDs that have problems with crowding, we do not recommend implementing a routine screening program for AAA, even among high-risk patients. [source] Preliminary soil micromorphology studies of landscape and occupation history at Tabon Cave, Palawan, PhilippinesGEOARCHAEOLOGY: AN INTERNATIONAL JOURNAL, Issue 7 2007Helen Lewis Preliminary soil micromorphology study of cultural sediments at Tabon Cave, Philippines, supports interpretations of sporadic occupation in the Paleolithic. The presence in some deposits of authigenic minerals potentially related to altered cultural materials, such as ash, needs further investigation. Later in the sequence there is a marked change in local depositional processes, with the onset of significant quartz sand deposition in layers dating from the Middle to Late Holocene. This could relate to beach development in the area. Future sedimentological study and dating would confirm this interpretation, which suggests that in appropriate settings, stratified cave sediments could be useful for the study of regional sea level rise. © 2007 Wiley Periodicals, Inc. [source] Patients' experiences of hip fractureJOURNAL OF ADVANCED NURSING, Issue 4 2003Graeme Archibald BA MSc RN Background., Hip fracture is a major cause of mortality and morbidity, particularly among older people, but there is little information on how individuals experience this. Aims., This study was conducted to explore the experiences of individuals who had suffered a hip fracture. The aim was not to produce generalizable findings but, rather, to generate a rich description of the experience of incurring and recovering from a hip fracture, to inform nursing practice. Method., Phenomenological methodology was used. A purposeful sample of five older patients was interviewed, following a stay in a community hospital for rehabilitation after surgical repair of a hip fracture. The unstructured interviews were tape-recorded, transcribed verbatim and analysed for significant statements and meanings. Findings., Four major themes emerged: the injury experience, the pain experience, the recovery experience and the disability experience. The injury experience consisted of storytelling, recalling the experience of the injury itself. The pain experience consisted of coping with the pain. The recovery experience involved the operation, beginning the struggle of recovery, and regaining independence. The disability experience consisted of the disability itself, depending on others, and being housebound. Conclusions., Pain management, meeting psychological and physical needs for nursing care, planning for discharge, and ensuring a reasonable quality of life are areas for nursing care development. Consideration of appropriate settings for rehabilitation is needed and there should be further investigation into improving quality of life after discharge. [source] Contributions of Anopheles larval control to malaria suppression in tropical Africa: review of achievements and potentialMEDICAL AND VETERINARY ENTOMOLOGY, Issue 1 2007K. WALKER Abstract Malaria vector control targeting the larval stages of mosquitoes was applied successfully against many species of Anopheles (Diptera: Culicidae) in malarious countries until the mid-20th Century. Since the introduction of DDT in the 1940s and the associated development of indoor residual spraying (IRS), which usually has a more powerful impact than larval control on vectorial capacity, the focus of malaria prevention programmes has shifted to the control of adult vectors. In the Afrotropical Region, where malaria is transmitted mainly by Anopheles funestus Giles and members of the Anopheles gambiae Giles complex, gaps in information on larval ecology and the ability of An. gambiae sensu lato to exploit a wide variety of larval habitats have discouraged efforts to develop and implement larval control strategies. Opportunities to complement adulticiding with other components of integrated vector management, along with concerns about insecticide resistance, environmental impacts, rising costs of IRS and logistical constraints, have stimulated renewed interest in larval control of malaria vectors. Techniques include environmental management, involving the temporary or permanent removal of anopheline larval habitats, as well as larviciding with chemical or biological agents. This present review covers large-scale trials of anopheline larval control methods, focusing on field studies in Africa conducted within the past 15 years. Although such studies are limited in number and scope, their results suggest that targeting larvae, particularly in human-made habitats, can significantly reduce malaria transmission in appropriate settings. These approaches are especially suitable for urban areas, where larval habitats are limited, particularly when applied in conjunction with IRS and other adulticidal measures, such as the use of insecticide treated bednets. [source] | ||||||||||