Academic literature on the topic 'Hospital care. [from old catalog]'
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Journal articles on the topic "Hospital care. [from old catalog]"
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Chandra, Ronald, Jose M. Mandei, Jeanette I. Ch Manoppo, Rocky Wilar, Ari L. Runtunuwu, and Phey Liana. "Serum nitric oxide and pediatric sepsis outcomes." Paediatrica Indonesiana 54, no. 4 (August 31, 2014): 213. http://dx.doi.org/10.14238/pi54.4.2014.213-8.
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Background Sepsis is the complex pathophysiologic responsesof the host against systemic infection. Sepsis can cause severeconditions such as septic shock and multiple organ failure.Although we have a better understanding of the molecular basisof sepsis as well as aggressive therapy, the mortality rate remainshigh, between 20-80%. Nitric oxide (NO) is one of the mediatorsassociated with cardiovascular failure, apoptosis and organdysfunction in sepsis.Objective To evaluate for a possible correlation between NOlevels and outcomes in pediatric sepsis.Methods A prospective cohort study was conducted at thepediatric intensive care unit (PICU) of Prof. Dr. R.D. KandouGeneral Hospital in Manado, from June to November 2012. Fortychildren aged one month to five year old, fulfilled the InternationalPediatrics Sepsis Consensus Conference 2 005 criteria were recruited.Nitrite oxide metabolites (nitrite and nitrate) levels were measuredusing a calorimetric assay kit (Cayman®, Catalog No.780001)from venous blood specimens collected at admission. All patientsreceived antibiotics empirically within an hour of the diagnosis.Outcomes of patients recorded were survivor or died, and lengthof stay in PICU.Results Mann-Whitney U test revealed a significant differencebetween median serum NO levels ins urvivors and those who died(18.60 vs. 36.50 fLM/L, respectively; P= 0.016).Conclusion Serum NO concentration is higher in those whodied than in survivors of pediatric sepsis. Specific NO inhibitionmay be beneficial in decreasing morbidity and mortality in thiscondition.
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Draper, Brian, and Lee-Fay Low. "Psychiatric services for the “old” old." International Psychogeriatrics 22, no. 4 (March 15, 2010): 582–88. http://dx.doi.org/10.1017/s1041610210000293.
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ABSTRACTBackground: Few studies have specifically examined mental health service delivery to persons aged over 84 years, often described as the “old” old. Our aim was to compare mental health service provision in Australia to persons aged 85 years and over with the “young” old and other age groups. We hypothesized that the “old” old would differ from the “young” old (65–84 years) by diagnostic category, rates of specialist psychiatric hospital admission, and use of Medicare funded psychiatric consultations in the community.Methods: Mental health service delivery data for 2001–02 to 2005–06 was obtained from Medicare Australia on consultant psychiatrist office-based, home visit and private hospital services subsidized by the national healthcare program and the National Hospital Morbidity database for separations (admitted episodes of patient care) from all public and most private hospitals in Australia on measures of age, gender, psychiatric diagnosis, location and type of psychiatric care.Results: Use of specialist psychiatric services in the community per annum per 1000 persons declined with age in men and women from 137.28 and 191.87 respectively in those aged 20–64 years to 11.84 and 14.76 respectively in those over 84 years. However, men and women over 84 years received psychiatric home visits at 377% and 472% respectively of the rates of persons under 65. The annual hospital separation rate per 1000 persons for specialist psychiatric care was lowest in those aged over 84 (3.98) but for inpatient non-specialized psychiatric care was highest in those over 84 (21.20). Depression was the most common diagnosis in specialized psychiatric hospitalization in those aged over 84 while organic disorders predominated in non-specialized care in each age group over 64 years with the highest rates in those aged over 84.Conclusion: Mental health service delivery to persons aged over 84 is distinctly different to that provided to other aged groups being largely provided in non-specialist hospital and residential settings.
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Jeyamurugan, Kokila, and Ratna B. Basak. "Child Life Specialists in Pediatric Hospital Care." OBM Integrative and Complementary Medicine 05, no. 03 (May 12, 2020): 1. http://dx.doi.org/10.21926/obm.icm.2003034.
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Child life specialists (CLS) are trained providers who form part of a pediatric multidisciplinary and pediatric palliative care team. Their role is invaluable to mitigate the stress and anxiety of children during hospitalization. They may use various strategies in children like play, art and music therapy and pet therapy, to help self-express and cope with painful procedures.We present a brief narrative on CLS with a case of a 10- year- old Hispanic boy who had metastatic osteosarcoma.The case illustration is from a prior institute that one of the coauthors was associated with.
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Gadhade, Jyoti B., Rajesh S. Hiray, and Balasaheb B. Ghongane. "Carbamazepine induced Stevens Johnson Syndrome: a case report from a tertiary care hospital." International Journal of Basic & Clinical Pharmacology 7, no. 8 (July 23, 2018): 1654. http://dx.doi.org/10.18203/2319-2003.ijbcp20183039.
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Stevens Johnson Syndrome is a rare but life-threatening skin disease and Carbamazepine is considered as one of the most common cause. The reported frequency of serious Carbamazepine hypersensitivity reaction is between 1/1000 and 1/10000 new exposures to the drug. Here, we report a case of a 40 year old female patient, who developed multiple ulcerative lesions all over the body three days after starting treatment with Carbamazepine for Trigeminal Neuralgia. (Worldwide Unique Number- 2017-58502 and AMC Report Number- BJGMC-Pune/Nov-2017/BBG-1860) Stevens Johnson Syndrome was diagnosed. Carbamazepine was withdrawn, and the patient was treated with topical and intravenous antibiotics. A biopsy was done which confirmed the diagnosis of Stevens Johnson Syndrome.
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Nechowska, Aoife, Theophilus Samuels, and Sameer Ranjan. "Overdose admissions to a district general hospital intensive care unit." BJPsych Open 7, S1 (June 2021): S95. http://dx.doi.org/10.1192/bjo.2021.285.
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AimsThis audit aimed to analyse the patient population coming into East Surrey Hospital's Intensive Care Unit from 1993 to 2019.BackgroundThe Office for National Statistics (ONS) published a report in August 2019 on ages most likely to die by suicide and drug poisoning. Their data showed that Generation X were dying by this method in greater numbers than other age groups. This is in contrast with data from 1990s for England and Wales which showed people in their 20s were most likely to die by suicide or poisoning. This audit set out to look at admission data from an intensive care unit (ICU) in a district general hospital in Surrey over a similar period of time.MethodPatient records from 1993 to September 2019 were accessed using the WardWatcher database. To access the maxim number of admissions qualifying under the aims, the database was accessed by searching under “admission comments” for: overdose, self-harm, poison, suicide. These reports were downloaded and the lists were checked against each other to delete duplicates. This gave a total of 331 patients. The data were analysed by year, according to age, gender, season, psychiatric diagnoses and previous overdose attempts. Their outcomes were checked against recorded deaths. There was not enough information to investigate method of overdose.ResultA total of 331 patient records were accessed. The youngest patient was 15 years old, the oldest was 84 years old. The age dataset was non-parametrically distributed with the median age of 43 years (IQR 33-51 years). The age distributions for each year appeared symmetrical but total numbers for each year were small. The population was split as 191 female (58%) and 141 male (42%). 16 patients died on the ICU on admission with an overdose, 5% of total numbers, of which 19% had a previous overdose attempts and 44% had a psychiatric diagnosis. The youngest death was 22 and the oldest was 81 years old. The average age was 47 years, with the spread consistent in the 2000s and 2010s.ConclusionThe results from East Surrey Hospital's ICU do not reflect the analysis from the ONS. The mean age for each year has remained similar. Numbers for the audit were small and admission criteria to the ICU prescribe that the patient be critically unwell and may not be indicative of the total admissions to a district general hospital.
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Poudel, Arjun, Nancye M. Peel, Lisa Nissen, Charles Mitchell, Len C. Gray, and Ruth E. Hubbard. "Potentially Inappropriate Prescribing in Older Patients Discharged From Acute Care Hospitals to Residential Aged Care Facilities." Annals of Pharmacotherapy 48, no. 11 (August 26, 2014): 1425–33. http://dx.doi.org/10.1177/1060028014548568.
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Background: The frequency of prescribing potentially inappropriate medications (PIMs) in older patients remains high despite evidence of adverse outcomes from their use. Little is known about whether admission to hospital has any effect on appropriateness of prescribing. Objectives: This study aimed to identify the prevalence and nature of PIMs and explore the association of risk factors for receiving a PIM. Methods: This was a prospective study of 206 patients discharged to residential aged care facilities from acute care. All patients were at least 70 years old and were admitted between July 2005 and May 2010; their admission and discharge medications were evaluated. Results: Mean patient age was 84.8 ± 6.7 years; the majority (57%) were older than 85 years, and mean (SD) Frailty Index was 0.42 (0.15). At least 1 PIM was identified in 112 (54.4%) patients on admission and 102 (49.5%) patients on discharge. Of all medications prescribed at admission (1728), 10.8% were PIMs, and at discharge, of 1759 medications, 9.6% were PIMs. Of the total 187 PIMs on admission, 56 (30%) were stopped and 131 were continued; 32 new PIMs were introduced. Of the potential risk factors considered, in-hospital cognitive decline and frailty status were the only significant predictors of PIMs. Conclusions: Although admission to hospital is an opportunity to review the indications for specific medications, a high prevalence of inappropriate drug use was observed. The only associations with PIM use were the frailty status and in-hospital cognitive decline. Additional studies are needed to further evaluate this association.
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Mishra, Ipsita, Rukma Narkar, Vaibhav Pathak, Arun Kumar Choudhury, and Anoj Kumar Baliarsinha. "Classic CAH Presenting in Adulthood: Experience From a Tertiary Care Hospital in Eastern India." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A124. http://dx.doi.org/10.1210/jendso/bvab048.249.
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Abstract Classic CAH presenting in adulthood: Experience from a tertiary care hospital in Eastern India: Congenital adrenal hyperplasia(CAH) is one of the most common genetic disorders transmitted as an autosomal recessive trait. Of the various forms CAH due to 21-hydroxylase deficiency is most common. Based on the clinical phenotype CAH can be classified as classic and non-classic form. It is very rare for classic CAH to present in adulthood. We describe 3 patients with classic CAH presenting in adulthood. Case 1: 21 year old female presented with complaint of not attaining menarche. She had features of virilisation t with a modified Ferriman Gallwey(FG) score of 18/36, pubic hair stage 4 and atrophied breasts. Genital examination revealed clitoromegaly (CI-100 mm2) with Prader stage 2. Biochemical evaluation revealed elevated levels of serum testosterone (257.2 ng/dl), 17-hydroxy progesterone(332 ng/ml), DHEAS(417 µg/dl) and PRA of 34ng/ml/hr. Case 2: 30 year old female presented with complaint of primary infertility for 5 years. She had history of delayed menarche at 20 years and oligomenorrheic cycles since last 10 years. On examination there was hirsutism with a modified FG score of 15/36, pubic hair stage 5 with atrophied breasts. Genital examination revealed symmetrical genitalia with nonpalpable gonads, clitiromegaly(CI=135mm2) and a single urogenital opening (Prader stage 3). Biochemical evaluation revealed elevated levels of serum testosterone (812ng/dl), 17-hydroxy progesterone (164.8 ng/ml), DHEAS (503 µg/dl) and PRA of 42ng/ml/hr. Case 3: 26 year old female presented with complaint of noticing excessive hair growth in androgen dependent areas. On examination there was short stature,modified FG score 16/36, pubic hair stage 5 with atrophied breasts. Genital examination revealed clitoromegaly (CI=75mm2) with Prader stage 2. Biochemical evaluation revealed elevated levels of serum testosterone (254.2 ng/dl), 17-hydroxy progesterone (351.8 ng/ml), DHEAS (296.2 µg/dl) and PRA of 30ng/ml/hr. Karyotype in all the three patients was 46,XX. All our patients had serum testosterone values in tumorous range, however imaging studies didnot reveal any evidence of malignancy in the adrenals except for occurrence of a single right adrenal nodule of size 2×2.1cm with precontrast HU of <10 and absolute contrast washout of >60% in case 2. Based on clinical and biochemical findings a diagnosis of classic CAH was made. They were started on corticosteroid and mineralocorticoid replacement. In all of the above three patients none of them had been evaluated for the presenting complaints prior to visiting our centre. Failure of implementation of neonatal screening for CAH in many centres in India and the social stigma associated with genital ambiguity are contributory to the delay in diagnosis of CAH.
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Rosenvinge, H. P. "The role of the psychogeriatric day hospital." Psychiatric Bulletin 18, no. 12 (December 1994): 733–36. http://dx.doi.org/10.1192/pb.18.12.733.
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In the currant climate of the implications of the Community Care Act and health service reforms, defining the role and function of the psychogeriatric day hospital is crucial, particularly its distinction from day centre care. This paper describes this role and key issues in day hospital planning. It was presented to the Wessex Specialists in Old Age Psychiatry and accepted by them as a consensus document.
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Brennan, Sarah, and Rajdeep Routh. "Hospital Anticipatory Care Planning for Inpatients of Organic Old Age Psychiatry Wards (NHS Lanarkshire)." BJPsych Open 7, S1 (June 2021): S176—S177. http://dx.doi.org/10.1192/bjo.2021.480.
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AimsTo improve practice of Hospital Anticipatory Care Planning for inpatients of Organic Old Age Psychiatry wards in NHS Lanarkshire.BackgroundHospital Anticipatory Care Plans (HACPs) are important components of care for inpatients with progressive and life-limiting conditions. HACPs provide guidance on treatment escalation and limitation for individual patients, in the event that they become acutely unwell. In the Old Age Psychiatry Department at NHS Lanarkshire, HACP standards are as follows: HACP forms should be completed within 2 weeks of admissionHACP information leaflets should be provided to relatives/carersHACPs should be discussed with relatives/carersIf a patient without an HACP becomes acutely unwell, an HACP should be made, and the responsible Consultant informedHACP should be discussed within the multi-disciplinary team (MDT)HACPs should be regularly reviewedHACP and DNACPR forms should be kept at the front of the notesSuperseded HACPs should be marked as obsoleteMethodInpatient notes were reviewed in October 2019 and compared against the above standards.The findings were presented at the Clinical Governance Meeting and Old Age Psychiatry Teaching Group in December 2019.An ‘HACP Checklist’ was also created to prompt good practice.Inpatient notes were reviewed again in July 2020.Data from both time periods were compared.ResultThere was an improvement in:The proportion of patients who had an HACP - from 59% to 96%The proportion of patients who had an HACP made within 2 weeks of admission - from 35% to 78%Documentation of HACP discussions with relatives/carers - documented for 77% of patients (from 47%)Timing of HACP discussions with relatives/carers - took place within 2 weeks for 52% of patients (from 29%)Documentation of HACP discussion by MDT - documented for 73% of patients (from 29%)HACP Information Leaflets were only distributed to one patient's relatives/carers across both time pointsMedical emergencies for patients with no HACP were infrequent and so comparison could not be madeHACPs were reviewed less frequently in July 2020 than in October 2019HACP forms and DNACPR forms were always filed appropriatelySuperseded HACP forms were always appropriately marked as obsoleteConclusionHACP practice mostly improved from October 2019 to July 2020. This may have been due to increased awareness of HACP Standards, following the presentation of initial data to inpatient teams.A much larger influence, however, was likely to be the COVID-19 pandemic and associated efforts to improve HACP practice throughout the Health Board.
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Babamahmoodi, Farhang, and Abdolreza Babamhmoodi. "Recovery from Intracranial Hemorrhage Due to Leptospirosis." Case Reports in Medicine 2011 (2011): 1–3. http://dx.doi.org/10.1155/2011/504308.
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Intracranial hemorrhage is a rare and fatal presentation of leptospirosis. In this paper we present the case of a 51-year-old male farmer who lives in northern Iran. He came to our hospital with a severe headache. A paraclinical evaluation showed clear signs of thrombocytopenia, and a brain MRI revealed left temporoparietal hemorrhage. Our preliminary diagnosis was Leptospirosis, and after 26 days of hospital care the patient was discharged in good condition. This paper will educationally help physicians in better diagnosis and treatment of leptospirosis.
Books on the topic "Hospital care. [from old catalog]"
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Fuller, Andrew S. The Forest Tree Culturist: A Treatise On The Cultivation Of American Forest Trees, With Notes On The Most Valuable Foreign Species. Kessinger Publishing, LLC, 2007.
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Fuller, Andrew S. The Forest Tree Culturist: A Treatise On The Cultivation Of American Forest Trees, With Notes On The Most Valuable Foreign Species. Kessinger Publishing, LLC, 2007.
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Hardwick, Julie. Sex in an Old Regime City. Oxford University Press, 2020. http://dx.doi.org/10.1093/oso/9780190945183.001.0001.
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Based on extensive archival research, the extraordinary stories of ordinary people’s lives in this book explore many facets of young people’s intimacy from meeting to courtship to the many occasions when untimely pregnancies necessitated a range of strategies. These might include marriage but could also be efforts to induce abortions, arrangements for out-of-wedlock delivery, charging the father with custody, leaving the baby with a foundling hospital, or infanticide. Clergy, lawyers, social welfare officials, employers, midwives, wet-nurses, neighbors, family, and friends supported young women and held young men responsible for the reproductive consequences of their sexual activity. These practices of intimacy reframe our understanding of multiple aspects of the Old Regime. Young people’s intimate experiences challenge the belief that disciplining female sexuality was a critical early modern goal of state formation and religious reformation. They suggest rethinking the history of a sexual double standard in local and long contexts, the history of marriage, and the role of law in the politics of communities and institutions. The lives of young people also reshape many more specific debates, for instance, about the history of emotions, infanticide, attitudes to illegitimacy, pre-modern workplaces, and the body. The book reveals the important role of the young people’s working communities, where the norm was local management of intimacy with a heavy emphasis on pastoral care and pragmatic acceptance of the inevitability of out-of-wedlock pregnancy.
Book chapters on the topic "Hospital care. [from old catalog]"
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Gillick, Muriel R. "From the Outside In." In Old and Sick in America. University of North Carolina Press, 2017. http://dx.doi.org/10.5149/northcarolina/9781469635248.003.0003.
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The interests of various groups--physicians, hospital administrators, drug companies, device manufacturers, and Medicare—affect the older patient’s experience in the office. Physicians avoid home visits in the interest of achieving work/life balance; hospitals buy medical practices to maximize admissions; drug companies use point-of-care marketing to sell pharmaceuticals; device manufacturers lobby physicians to order tests; and Medicare mandates medication reviews and after-visit summaries.
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Whitfield, Denise. "Extremity Swelling and Altered Mental Status." In Acute Care Casebook, edited by Leslie V. Simon, 346–50. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190865412.003.0070.
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Snake envenomation is a significant global health problem, particularly in tropical and subtropical locations. In this case, a 38-year-old performing military field operations in South America develops systemic symptoms consistent with snake envenomation after falling into brush. His symptoms were recognized by his unit medic who initiated appropriate field care and immediate resuscitation with intravenous fluids. He was rapidly transported to a local hospital. The hospital administered polyvalent snake antivenom given his systemic symptoms while providing continued supportive care. Field care for snake bites includes removal of the patient from the snake’s striking range, immobilization of the affected extremity, and supportive care. Immediate transport to a facility with snake envenomation management capability is crucial for definitive management.
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Gillick, Muriel R. "Now and Then." In Old and Sick in America. University of North Carolina Press, 2017. http://dx.doi.org/10.5149/northcarolina/9781469635248.003.0012.
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The Skilled Nursing Facility (SNF) is largely a creation of Medicare: the institution of prospective payment for hospital care in 1983 led to early discharge of patients from the hospital. For frail, old people who were not ready to go home so quickly, the SNF evolved as an intermediate site of care. Social trends and scientific developments also affected the development of the SNF over the past fifty years. Changes in family structure as well as unprecedented geographic mobility weakened the ability of families to take care of older people after a hospital stay. The growth of mega-corporations and of mergers and acquisitions led to the development of SNF chains. In medical science, the development of hip and knee joint replacement surgery, along with the aging of the population, led to the rise in popularity of these procedures, with a concomitant need for post-surgical rehabilitation. The development of the intensive care unit and advances in anaesthesia resulted in a steady rise in the age of patients undergoing complex surgery, further stimulating the need for skilled nursing facility care.
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Smith, Andrew F., and Allan M. Cyna. "Perioperative care." In Handbook of Communication in Anaesthesia & Critical Care. Oxford University Press, 2010. http://dx.doi.org/10.1093/oso/9780199577286.003.0015.
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The perioperative period can be a life-changing event for many patients, the effects of which can be lifelong for better or worse. The anaesthetist’s communication at this time can have a profound impact on the care of their patients in the matter of both short-term cooperation and long-term perceptions of their hospital experience. Induction of anaesthesia is a stressful time for many patients, young and old. There is an inevitable loss of control when the patient hands this over temporarily to the anaesthetist. In order to enhance cooperation, anaesthetists will reap unexpected benefits by avoiding the use of negative language. Well-meaning staff may, however, sabotage an otherwise smooth induction by telling patients, ‘There is nothing to worry about’ with the implicit suggestion that there is ‘something to worry about’. Unfortunately such well-meaning statements, even when directed at children, tend to yield the opposite effect of what is intended. Patient stress at this time increases suggestibility such that comments frequently function as inadvertent suggestions—be they positive or negative. This can be utilized to enhance the anaesthetist’s ability to provide a smooth, safe and stress-free induction. A typical series of pre-induction communications may go something like, … ‘Don’t worry we won’t drop you’. As the patient is transferred from a trolley to the operating table. ‘The blood pressure cuff gets really tight and may hurt and try not to move while it’s pumping up’. ‘That noise over there is just the nurse checking the drill!’… Explaining what is happening in simple straightforward non-technical language, and at the same time communicating in a positive way, is invariably the more useful approach. For example, …‘Welcome to the operating room Mr P ’. ‘You can relax as we move you to this other bed—you are quite safe’. ‘We will place some monitoring leads on so we can keep you safe and comfortable. A pulse monitor gently placed on your finger, an ECG on your chest and a blood pressure cuff on your arm. As the blood pressure cuff tightens and we take its reading this often allows patients to relax knowing how closely we are looking after them’. …
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Nethercott, Daniel, and Maire Shelly. "Critical care." In Handbook of Communication in Anaesthesia & Critical Care. Oxford University Press, 2010. http://dx.doi.org/10.1093/oso/9780199577286.003.0019.
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It is well recognized that errors of communication are associated with causing harm to patients on the Intensive Care Unit (ICU). By means of presenting a patient-based narrative, this chapter looks at communication in intensive care medicine focusing attention on styles of communication that are useful in different areas of common practice. It must be accepted that communication needs to convey a message that sits within its own context. For instance, the way that proxy decisions are made for patients who lack capacity varies with both culture and region. Resources are variable, and this includes the time that can be allocated to communication. It is clearly beyond the scope of this chapter to offer guidance on exactly what information should be given to patients and their relatives, but we aim to highlight useful ways of making the communication of that information more effective. 03:00 in a District General Hospital Emergency department. The on-call intensive care doctor is fast-bleeped to the resuscitation bay to see a 35-year-old man called Stephen who has been brought in by ambulance from a roadside accident. He is conscious but distressed, with significant injuries to both legs and thorax. A ‘trauma team’ of doctors is assembled, plus the delivering paramedics, accident and emergency-qualified nurses and healthcare assistants. Communicating with teams in time-critical situations presents a clear challenge. Team members can be unknown to each other with an unknown skill mix, the clinical problems are undefined, different personnel have different—sometimes conflicting—motives, and goals, and clinical priorities can shift over time. The anaesthetist must be confident to communicate with authority in these circumstances. Under stress, most team members will respond well to someone else taking the lead. They will usually do what they are asked if they understand the instruction, are competent to undertake the task, and are not overloaded with other tasks. Closed-loop communication is a good way to keep communication efficient: ‘Someone get me a tube!’ can be misunderstood or ignored by most of the team. ‘Sarah, I want you to get a size 8 endotracheal tube from the trolley and test the cuff for me. Do you know how to do that?’ is specific, directed to a named individual and asks for confirmation of understanding and competence to complete the task.
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Rothstein, William G. "Training in Primary Care." In American Medical Schools and the Practice of Medicine. Oxford University Press, 1987. http://dx.doi.org/10.1093/oso/9780195041866.003.0028.
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Training in primary care has received limited attention in medical schools despite state and federal funding to increase its emphasis. Departments of internal medicine, which have been responsible for most training in primary care, have shifted their interests to the medical subspecialties. Departments of family practice, which have been established by most medical schools in response to government pressure, have had a limited role in the undergraduate curriculum. Residency programs in family practice have become widespread and popular with medical students. Primary care has been defined as that type of medicine practiced by the first physician whom the patient contacts. Most primary care has involved well-patient care, the treatment of a wide variety of functional, acute, self-limited, chronic, and emotional disorders in ambulatory patients, and routine hospital care. Primary care physicians have provided continuing care and coordinated the treatment of their patients by specialists. The major specialties providing primary care have been family practice, general internal medicine, and pediatrics. General and family physicians in particular have been major providers of ambulatory care. This was shown in a study of diaries kept in 1977–1978 by office-based physicians in a number of specialties. General and family physicians treated 33 percent or more of the patients in every age group from childhood to old age. They delivered at least 50 percent of the care for 6 of the 15 most common diagnostic clusters and over 20 percent of the care for the remainder. The 15 clusters, which accounted for 50 percent of all outpatient visits to office-based physicians, included activities related to many specialties, including pre- and postnatal care, ischemic heart disease, depression/anxiety, dermatitis/eczema, and fractures and dislocations. According to the study, ambulatory primary care was also provided by many specialists who have not been considered providers of primary care. A substantial part of the total ambulatory workload of general surgeons involved general medical examinations, upper respiratory ailments, and hypertension. Obstetricians/ gynecologists performed many general medical examinations. The work activities of these and other specialists have demonstrated that training in primary care has been essential for every physician who provides patient care, not just those who plan to become family physicians, general internists, or pediatricians.
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Kopp, Vincent J. "The pre-anaesthetic visit." In Handbook of Communication in Anaesthesia & Critical Care. Oxford University Press, 2010. http://dx.doi.org/10.1093/oso/9780199577286.003.0013.
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This chapter addresses deficiencies in pre-anaesthesia communication. Here, the use of medical narrative illustrates communication-enhancing techniques and attitudes that may help anaesthetists anticipate and respond to the biopsychosocial content, extant in the pre-anaesthesia assessment setting. By any measure, the pre-anaesthesia evaluation sets anaesthesia care in motion. Until now, little has been written about the development of a learnable framework for effective communication, in this or any other anaesthesia care setting. With respect to pre-anaesthesia communication, the need for heuristics or ‘rules of thumb’ is ever acute to improve rapport, elicit and respond to questions, manage ambiguity, as well as to obtain valid consent. Furthermore, anaesthetists have to communicate effectively with patients about conflicting advice, prior negative anaesthetic experiences and fears about awareness and intraoperative death. A 56-year-old man scheduled for an elective left inguinal herniorrhaphy meets his anaesthetist minutes before surgery is to begin. Three days before, the patient presented to hospital with his hernia incarcerated. It was easily reduced. A follow-up office visit with his surgeon preceded the surgery. The patient’s sole co-morbidity is benign prostatic hypertrophy. On the morning of surgery this otherwise healthy-appearing man, accompanied by his wife, meets the anaesthetist for the first time. After record review the patient is told three anaesthetic options exist—local anaesthesia with intravenous sedation, general anaesthesia and spinal anaesthesia — and that ‘spinal is the way to go’. Unquestioningly, the patient agrees to spinal anaesthesia. The spinal block is easy to place. The surgery is uneventful. Post-operatively, the patient cannot urinate. His discharge from the day-surgery unit is delayed by hours. He is told it is because of ‘the spinal’. Bladder catheterization ensues. The rest of his recuperation is uneventful, except for lingering feelings of betrayal, distrust and disappointment. He wonders why he was not told spinal anaesthesia might cause urinary retention. He becomes angry. He resolves never to use that anaesthetist’s or hospital’s services again. His wife even urges him to sue them both for pain and suffering. What could have been done to effect a more positive outcome for the patient, the anaesthetist and the hospital? The answer lies, at least in part, in improved communication.
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de Rond, Mark. "A Reason to Live." In Doctors at War. Cornell University Press, 2017. http://dx.doi.org/10.7591/cornell/9781501705489.003.0004.
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The author, having been in Camp Bastion for more than a week, talks about the casualties of war that doctors and nurses at the field hospital had to attend to on a daily basis. Two of the casualties had been dropped off by helicopter, the elder of whom was badly inebriated. Another casualty was a thirteen-year-old who had sustained shrapnel wounds from an improvised explosive. The author also reflects on the key principles that medical professionals expect to enact, such as “making the care of your patients your first concern” and “providing a good standard of practice and care.” Pre-deployment training for surgeons and anesthetists was predominantly technical in nature. This general technical focus is designed in part to desensitize doctors to emotions that may interfere with their ability to provide the best possible patient care.
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Murdoch, Claire. "Change and Continuity in Psychiatry: One Woman’s Reflections." In Women's Voices in Psychiatry, 219–28. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198785484.003.0023.
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This chapter offers a recollection of training and working as a nurse in Friern Barnet Hospital during the 1980s. As the era of the Victorian asylum drew to a close, the possibility of new and improved approaches to mental health provision loomed. Murdoch offers a personal account of working within and challenging the status quo. She describes prevailing policy and practice and a sense of the struggle to usher in the new while respecting and learning from the old. She offers insights into the contradictory permissiveness of the day, and the tolerance and celebration of eccentric and endearing aspects of life in the asylum. Murdoch conveys how much has changed and points to constant features in the search for effective, humane treatments over the three decades. Stigma, funding, freedom, responsibility, and structures to support care in the community all remain constants.
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Coyne, Imelda, and Joan Livesley. "Introduction to core principles in children’s nursing." In Clinical Skills in Children's Nursing. Oxford University Press, 2010. http://dx.doi.org/10.1093/oso/9780199559039.003.0009.
Full textAbstract:
The aim of this chapter is to discuss the core principles in children’s nursing and the application of these principles in everyday practice for nurses working with children and families. These essential principles are fundamental in the delivery of high quality care and as such will be evident throughout this textbook. This chapter will explain these principles in the context of community and hospital care and illustrate how nurses can use this knowledge in their clinical practice. There is no doubt that clinical skills are an essential component of high quality healthcare, but they are on their own insufficient to ensure that the needs of children and their families are met. Clinical skills need to be embedded in children’s services that are child centred and clearly focused around the needs of children and their families; but how is this possible? To ensure high quality care for children in hospital and the community you need to incorporate the core principles of family centred care into your everyday nursing practice and interventions. It is essential to understand the principles of family centred care and the importance of partnership and negotiation in the delivery of clinical skills. Knowing where to begin can be difficult, but we think that you can start with the concept of attachment and loss. Understanding this in relation to children’s separation from their family and home will help you to understand the impact of hospitalization on children, particularly those younger than five years old. The adverse aspects of hospitalization have been a substantial driving force in delivering more nursing services to children at home. However, it is also important to remain aware of the ongoing impact of lifelong illness on children and their families and why it is essential to use effective communication skills, maintain safe environments, and incorporate play into your practice. Together with evidence-based clinical skills, these facets of practice will enable you to maintain and promote children’s and families’ health and well-being. Specific learning outcomes are as follows. At the end of this chapter you will: ● Understand the basic elements of attachment and loss theory.
Conference papers on the topic "Hospital care. [from old catalog]"
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Blejan, Emilian Ionuţ, Gabriela Ciupitu, and Andreea Arsene. "Connecting the Customer Experience Concept with Pharmaceutical Care for Improving the Healthcare Status of Patients." In International Conference Innovative Business Management & Global Entrepreneurship. LUMEN Publishing, 2020. http://dx.doi.org/10.18662/lumproc/ibmage2020/19.
Full textAbstract:
Healthcare costs are rising worldwide, due to a series of factors related to increased spending on medication, aging, medication errors, adverse drug events and hospital admissions. Aging phenomenon is closely followed by an increasing burden of chronic diseases. New therapies used to treat chronic diseases have intensified the economic pressure on healthcare organizations. Pharmacists play an important role in lowering costs by reviewing the pharmacotherapy of patients. Pharmacists are also the link between the physician and the patient, providing free medical advice without the need for an appointment. Lowering the number of inappropriately prescribed drugs reduces the risk of adverse drug events that frequently contribute to prolonged and expensive hospital admissions. In the near future, a new approach is needed for long term results. Pharmacists will have to reshape the old concept of patient care, moving out of the negative feelings area derived from sickness and start to protect health instead of managing disease. It will result a shift from sick care to proactive healthcare experiences. Pharmacists will anticipate and solve patient’s problems before they can produce a displeasure. For maintaining a well-being state of patients is now necessarily to adopt or implement a patient centred strategy based on customer experience pillars. In Romania integrity matters most in customer experience, closely followed by personalization. In the new Era of pharmaceutical care, pharmacists will have to focus on patient experience and patient journey.
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Киреева, Виктория, Viktoriya Kireeva, Г. Лифшиц, G. Lifshic, Н. Кох, N. Koh, Ю. Усольцев, Yu Usolcev, Константин Апарцин, and Konstantin Apartsin. "Advantages of a personalized approach to the prevention and treatment of cardiovascular diseases in the staff of the INC Of the SBRAS." In Topical issues of translational medicine: a collection of articles dedicated to the 5th anniversary of the day The creation of a department for biomedical research and technology of the Irkutsk Scientific Center Siberian Branch of RAS. Москва: INFRA-M Academic Publishing LLC., 2017. http://dx.doi.org/10.12737/conferencearticle_58be81ec9ed47.
Full textAbstract:
Purpose of the study. To test the functional associations of polymorphic variants of genes in the regulation of blood pressure and vascular tone in employees of the ISC SB RAS. Materials and methods. The study involved patients, employees of the ISC SB RAS, being under care of the outpatient clinic of the Hospital of the ISC SB RAS. During routine laboratory testing the patients were taken 2 ml of blood for genetic analysis and further molecular genetic study on “Hypertension”, “Endothelial dysfunction”, “Pharmacogenetics”, “Inflammatory response” panels. Results. In the analysis of 12 genes coding for key proteins of hormonal enzyme blood pressure regulation systems, polymorphism of CYP11B2 showed statistically significant correlation with the presence of arterial hypertension, which makes its further study promising. The presence of allele C showed protective significance in relation to the development of hypertension with OR = 0,247. When checking associations of functional polymorphic variants of genes, the products of which are involved in the regulation of vascular tone, with hypertension in patients younger than 50 years old we found association of T/T rs5443GNB3 genotype with the debut of hypertensive disease under the age of 50. The data obtained allow the doctor to choose the most personalized and effective safe drug from certain groups, as well as its dose for employees having passed molecular genetic testing. These data can reveal predisposition to the most widespread and socially significant diseases in the surveyed subjects and provide specific personalized recommendations for the prevention of these diseases.