Contents
Academic literature on the topic 'United Oxford Hospitals'
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the lists of relevant articles, books, theses, conference reports, and other scholarly sources on the topic 'United Oxford Hospitals.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Journal articles on the topic "United Oxford Hospitals"
1
Enright, Mark C., Nicholas P. J. Day, Catrin E. Davies, Sharon J. Peacock, and Brian G. Spratt. "Multilocus Sequence Typing for Characterization of Methicillin-Resistant and Methicillin-Susceptible Clones ofStaphylococcus aureus." Journal of Clinical Microbiology 38, no. 3 (2000): 1008–15. http://dx.doi.org/10.1128/jcm.38.3.1008-1015.2000.
Full textAbstract:
A multilocus sequence typing (MLST) scheme has been developed forStaphylococcus aureus. The sequences of internal fragments of seven housekeeping genes were obtained for 155 S. aureusisolates from patients with community-acquired and hospital-acquired invasive disease in the Oxford, United Kingdom, area. Fifty-three different allelic profiles were identified, and 17 of these were represented by at least two isolates. The MLST scheme was highly discriminatory and was validated by showing that pairs of isolates with the same allelic profile produced very similar SmaI restriction fragment patterns by pulsed-field gel electrophoresis. All 22 isolates with the most prevalent allelic profile were methicillin-resistant S. aureus (MRSA) isolates and had allelic profiles identical to that of a reference strain of the epidemic MRSA clone 16 (EMRSA-16). Four MRSA isolates that were identical in allelic profile to the other major epidemic MRSA clone prevalent in British hospitals (clone EMRSA-15) were also identified. The majority of isolates (81%) were methicillin-susceptible S. aureus (MSSA) isolates, and seven MSSA clones included five or more isolates. Three of the MSSA clones included at least five isolates from patients with community-acquired invasive disease and may represent virulent clones with an increased ability to cause disease in otherwise healthy individuals. The most prevalent MSSA clone (17 isolates) was very closely related to EMRSA-16, and the success of the latter clone at causing disease in hospitals may be due to its emergence from a virulent MSSA clone that was already a major cause of invasive disease in both the community and hospital settings. MLST provides an unambiguous method for assigning MRSA and MSSA isolates to known clones or assigning them as novel clones via the Internet.
2
Norman, John G., Stephen Brealey, Ada Keding, David Torgerson, and Amar Rangan. "Does time to surgery affect patient-reported outcome in proximal humeral fractures? A subanalysis of the PROFHER randomized clinical trial." Bone & Joint Journal 102-B, no. 1 (January 2020): 33–41. http://dx.doi.org/10.1302/0301-620x.102b1.bjj-2020-0546.r1.
Full textAbstract:
Aims The aim of this study was to explore whether time to surgery affects functional outcome in displaced proximal humeral fractures Methods A total of 250 patients presenting within three weeks of sustaining a displaced proximal humeral fracture involving the surgical neck were recruited at 32 acute NHS hospitals in the United Kingdom between September 2008 and April 2011. Of the 125 participants, 109 received surgery (fracture fixation or humeral head replacement) as per randomization. Data were included for 101 and 67 participants at six-month and five-year follow-up, respectively. Oxford Shoulder Scores (OSS) collected at six, 12, and 24 months and at three, four, and five years following randomization was plotted against time to surgery. Long-term recovery was explored by plotting six-month scores against five-year scores and agreement was illustrated with a Bland-Altman plot. Results The mean time from initial trauma to surgery was 10.5 days (1 to 33). Earlier surgical intervention did not improve OSS throughout follow-up, nor when stratified by participant age (< 65 years vs ≥ 65 years) and fracture severity (one- and two-part vs three- and four-part fractures). Participants managed later than reported international averages (three days in the United States and Germany, eight days in the United Kingdom) did not have worse outcomes. At five-year follow-up, 50 participants (76%) had the same or improved OSS compared with six months (six-month mean OSS 35.8 (SD 10.0); five-year mean OSS 40.1 (SD 9.1); r = 0.613). A Bland-Altman plot demonstrated a positive mean difference (3.3 OSS points (SD 7.92)) with wide 95% limits of agreement (-12.2 and 18.8 points). Conclusion Timing of surgery did not affect OSS at any stage of follow-up, irrespective of age or fracture type. Most participants had maximum functional outcome at six months that was maintained at five years. These findings may help guide providers of trauma services on surgical prioritization. Cite this article: Bone Joint J 2020;102-B(1):33–41
3
Willems, Rob J. L., Janetta Top, Nicole van den Braak, Alex van Belkum, Dik J. Mevius, Giel Hendriks, Marga van Santen-Verheuvel, and Jan D. A. van Embden. "Molecular Diversity and Evolutionary Relationships of Tn1546-Like Elements in Enterococci from Humans and Animals." Antimicrobial Agents and Chemotherapy 43, no. 3 (March 1, 1999): 483–91. http://dx.doi.org/10.1128/aac.43.3.483.
Full textAbstract:
ABSTRACT We report on a detailed study on the molecular diversity and evolutionary relationships of Tn1546-like elements in vancomycin-resistant enterococci (VRE) from humans and animals. Restriction fragment length polymorphism (RFLP) analysis of the VanA transposon of 97 VRE revealed seven different Tn1546 types. Subsequent sequencing of the complete VanA transposons of 13 VRE isolates representing the seven RFLP types followed by sequencing of the identified polymorphic regions in 84 other VanA transposons resulted in the identification of 22 different Tn1546derivatives. Differences between the Tn1546 types included point mutations in orf1, vanS,vanA, vanX, and vanY. Moreover, insertions of an IS1216V-IS3-like element inorf1, of IS1251 in the vanS-vanHintergenic region, and of IS1216V in thevanX-vanY intergenic region were found. The presence of insertion sequence elements was often associated with deletions in Tn1546. Identical Tn1546 types were found among isolates from humans and farm animals in The Netherlands, suggesting the sharing of a common vancomycin resistance gene pool. Application of the genetic analysis of Tn1546 to VRE isolates causing infections in hospitals in Oxford, United Kingdom, and Chicago, Ill., suggested the possibility of the horizontal transmission of the vancomycin resistance transposon. The genetic diversity in Tn1546 combined with epidemiological data suggest that the DNA polymorphism among Tn1546 variants can successfully be exploited for the tracing of the routes of transmission of vancomycin resistance genes.
4
Singer, Donald. "1 Osler and the fellowship of postgraduate medicine." Postgraduate Medical Journal 95, no. 1130 (November 21, 2019): 685.1–685. http://dx.doi.org/10.1136/postgradmedj-2019-fpm.1.
Full textAbstract:
Sir William Osler’s legacy lives on through the Fellowship of Postgraduate Medicine (FPM). Osler was in 1911 founding President both of the Postgraduate Medical Association and on 1981 of the Inter-allied Fellowship of Medicine. These societies merged later in 1919, with Osler as President until his death at the end of that year. This joint organization was initially called the Fellowship of Medicine and Post-Graduate Medical Association and continues to this day as the Fellowship of Postgraduate Medicine. In the 1880s, in his role as medical leader in North America, Osler pioneered hospital residency programmes for junior trainee doctors. As Regius Professor of medicine in Oxford from 1905, Osler wished early postgraduate teaching in the UK, and in London in particular, to include access to ‘the wealth of material at all the hospitals’. He also saw medical societies as important for providing reliable continuous medical develop for senior doctors.Under Osler’s leadership, the Fellowship of Medicine responded to demand for postgraduate civilian medical training after the First World War, supported by a general committee of 73 senior medical figures, with representatives from the British Army Medical Service, Medical Services of the Dominions of the United Kingdom, of America and of the British Colleges and major medical Schools. Some fifty general and specialist hospitals were initially affiliated with the Fellowship, which provided sustained support of postgraduate training well into the 1920s, including publication of a weekly bulletin of clinics, ward rounds, special lectures and organized training courses for men and women of all nationalities. In 1925, in response to expanding interest in postgraduate education, the Fellowship developed the bulletin into the Postgraduate Medical Journal, which continues as a monthly international publication. Stimulated by discussions at meetings of the FPM, through its Fellows, the FPM was influential in encouraging London and regional teaching hospitals to develop and maintain postgraduate training courses. The FPM and its Fellows also were important in supporting the creation of a purely postgraduate medical school, which was eventually founded at the Hammersmith Hospital in West London as the British, then Royal Postgraduate Medical School.At the end of the Second World War, there was a major development in provision of postgraduate medical education with the founding in 1945 of the British Postgraduate Medical Federation, which was supported by government, the University Grants Committee and the universities. There was also a marked post-war increase in general provision of postgraduate training at individual hospitals and within the medical Royal Colleges. Postgraduate Centres were established at many hospitals.Nonetheless the FPM continued some involvement in postgraduate courses until 1975. Since then the FPM has maintained a national and international role in postgraduate education through its journals, the Postgraduate Medical Journal and Health Policy and Technology (founded in 2012) and by affiliations with other organisations and institutes.Osler was an avid supporter of engagement between medicine and the humanities, chiding humanists for ignorance of modern science and fellow scientists for neglecting the humanities. The FPM has over much of the past decade supported this theme of Osler by being a major patron of the Hippocrates Prize for Poetry and Medicine, which has achieved significant international interest, with over 10,000 entries from over 70 countries.
5
Alwan, Nada A. S., David Kerr, Dhafir Al-Okati, Fransesco Pezella, and Furat N. Tawfeeq. "Comparative Study on the Clinicopathological Profiles of Breast Cancer Among Iraqi and British Patients." Open Public Health Journal 11, no. 1 (May 25, 2018): 177–91. http://dx.doi.org/10.2174/1874944501811010177.
Full textAbstract:
Background:Breast cancer is the most common cancer in Iraq and the United Kingdom. While the disease is frequently diagnosed among middle-aged Iraqi women at advanced stages accounting for the second cause of cancer-related deaths, breast cancer often affects elderly British women yielding the highest survival of all registered malignancies in the UK.Objective:To compare the clinical and pathological profiles of breast cancer among Iraqi and British women; correlating age at diagnosis with the tumor characteristics, receptor-defined biomarkers and phenotype patterns.Methods:This comparative retrospective study included the clinical and pathological characteristics of (1,940) consecutive female patients who were diagnosed with invasive breast cancer from 2014 to 2016 in Iraq (Medical City Teaching Hospital, Baghdad: 635 cases) and UK (John Radcliffe, Oxford and Queen's, BHR University Hospitals: 1,305 cases). The studied parameters in both groups comprised the age of the patient at the time of diagnosis, breast cancer histologic type, grade, tumor size, lymph node status, clinical stage at presentation, Estrogen Receptor (ER), Progesterone Receptor (PR) and HER2 positive tumor contents and the receptor-defined breast cancer surrogate subtypes.Results:The Iraqi patients were significantly younger than their British counterparts and exhibited higher trend to present at advanced stages; reflected by larger size tumors and frequent lymph node involvement compared to the British (p<0.00001). They also had worse receptor-defined breast cancer subtypes manifested by higher rates of hormone receptor (ER/PR) negative, HER2 positive tumor contents, Triple Positive and Triple Negative phenotypes (p<0.00001). Excluding HER2 status, the significant differences in the clinical and tumor characteristics between the two populations persisted after adjusting for age among patients younger than 50 years.Conclusion:The remarkable differences in the clinical and tumor characteristics of breast cancer between the Iraqi and British patients suggest heterogeneity in the underlying biology of the tumor which is exacerbated in Iraq by the dilemma of delayed diagnosis. The significant ethnic disparities in breast cancer profiles recommend the prompt strengthening of the national cancer control plan in Iraq as a principal approach to the management of the disease.
6
Marlow, Lucy L., Angeline H. Y. Lee, Emma Hedley, Michael P. Grocott, Michael C. Steiner, J. Duncan Young, Najib M. Rahman, Christopher P. Snowden, and Kyle T. S. Pattinson. "Findings of a feasibility study of pre-operative pulmonary rehabilitation to reduce post-operative pulmonary complications in people with chronic obstructive pulmonary disease scheduled for major abdominal surgery." F1000Research 9 (March 9, 2020): 172. http://dx.doi.org/10.12688/f1000research.22040.1.
Full textAbstract:
Background: Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of complications and death following surgery. Pulmonary complications are particularly prominent. Pulmonary rehabilitation is a course of physical exercise and education that helps people with COPD manage their condition. Although proven to improve health outcomes in patients with stable COPD, it has never been formally tested as a pre-surgical intervention in patients scheduled for non-cardiothoracic surgery. If a beneficial effect were to be demonstrated, pulmonary rehabilitation for pre-surgical patients with COPD might be rapidly implemented across the National Health Service, as pulmonary rehabilitation courses are already well established across much of the United Kingdom (UK). Methods: We performed a feasibility study to test study procedures and barriers to identification and recruitment to a randomised controlled trial testing whether pulmonary rehabilitation, delivered before major abdominal surgery in a population of people with COPD, would reduce the incidence of post-operative pulmonary complications. This study was run in two UK centres (Oxford and Newcastle upon Tyne). Results: We determined that a full randomised controlled trial would not be feasible, due to failure to identify and recruit participants. We identified an unmet need to identify more effectively patients with COPD earlier in the surgical pathway. Service evaluations suggested that barriers to identification and recruitment would likely be the same across other UK hospitals. Conclusions: Although pulmonary rehabilitation is a potentially beneficial intervention to prevent post-operative pulmonary complications, a randomised controlled trial is unlikely to recruit sufficient participants to answer our study question conclusively at the present time, when spirometry is not automatically conducted in all patients planned for surgery. As pulmonary rehabilitation is a recommended treatment for all people with COPD, alternative study methods combined with earlier identification of candidate patients in the surgical pathway should be considered. Trial registration: ISRCTN29696295, 31/08/2017
7
Silveira, Douglas R. A., Lynn Quek, Itamar S. Santos, Anna Corby, Juan L. Coelho-Silva, Diego A. Pereira-Martins, Grant Vallance, et al. "Integrating clinical features with genetic factors enhances survival prediction for adults with acute myeloid leukemia." Blood Advances 4, no. 10 (May 26, 2020): 2339–50. http://dx.doi.org/10.1182/bloodadvances.2019001419.
Full textAbstract:
Abstract The 2017 European LeukemiaNet 2017 acute myeloid leukemia (AML) risk stratification (ELN2017) is widely used for risk-stratifying patients with AML. However, its applicability in low- and middle-income countries is limited because of a lack of full cytogenetic and molecular information at diagnosis. Here, we propose an alternative for risk stratification (the Adapted Genetic Risk [AGR]), which permits cytogenetic or molecular missing data while retaining prognostic power. We first analyzed 167 intensively treated patients with nonacute promyelocytic leukemia AML enrolled in São Paulo, Brazil (Faculdade de Medicina da Universidade de São Paulo), as our training data set, using ELN2017 as the standard for comparison with our AGR. Next, we combined our AGR with clinical prognostic parameters found in a Cox proportional hazards model to create a novel scoring system (survival AML score, SAMLS) that stratifies patients with newly diagnosed AML. Finally, we have used 2 independent test cohorts, Faculdade de Medicina de Ribeirão Preto (FMRP; Brazil, n = 145) and Oxford University Hospitals (OUH; United Kingdom, n = 157) for validating our findings. AGR was statistically significant for overall survival (OS) in both test cohorts (FMRP, P = .037; OUH, P = .012) and disease-free survival in FMRP (P = .04). The clinical prognostic features in SAMLS were age (>45 years), white blood cell count (<1.5 or >30.0 × 103/μL), and low albumin levels (<3.8 g/dL), which were associated with worse OS in all 3 cohorts. SAMLS showed a significant difference in OS in the training cohort (P < .001) and test cohorts (FMRP, P = .0018; OUH, P < .001). Therefore, SAMLS, which incorporates the novel AGR evaluation with clinical parameters, is an accurate tool for AML risk assessment.
8
Patel, Vikram. "A view from the road: experiences in four continents." Psychiatric Bulletin 18, no. 8 (August 1994): 500–502. http://dx.doi.org/10.1192/pb.18.8.500.
Full textAbstract:
Since graduating from medical school eight years ago, I have had the chance of experiencing clinical psychiatry in four countries on four continents; Bombay and Goa, India, my home, where I trained in medicine and began my psychiatric training; Oxford and London, United Kingdom, where I acquired a taste for academic psychiatry and completed my clinical training; Sydney, Australia, where I worked in a liaison unit in a large general hospital and a community mental health centre; and now, Harare, Zimbabwe, where I am conducting a two year study on traditional concepts of mental illness and the role of traditional healers and other care providers in primary mental health care.
9
Sadideen, Hazim, Karim Hamaoui, Munir Saadeddin, Lucy Cogswell, Tim Goodacre, and Tony Jefferis. "Handover practice amongst core surgical trainees at the Oxford School of Surgery." Journal of Educational Evaluation for Health Professions 11 (February 28, 2014): 3. http://dx.doi.org/10.3352/jeehp.2014.11.3.
Full textAbstract:
Purpose: To date there are no United Kingdom (UK) studies specifically evaluating handovers amongst core surgical trainees (CSTs). The Oxford School of Surgery examined regional handover practice, aiming to assess and improve trainee perception of handover, its quality, and ultimately patient care. Methods: Based on two guidance documents ('Safe handover, safe patients' by the British Medical Association and 'Safe Surgical Practice' by the Royal College of Surgeons'), a 5-point Likert style questionnaire was designed, exploring handover practice, educational value, and satisfaction. This was given to 50 CSTs in 2010.Results: There were responses from 40 CSTs (80.0 %). The most striking findings revolved around perceived educational value, formal training, and auditing practice with regards to handover, which were all remarkably lower than expected. CST handover was thus targeted in the Department of Plastic Surgery at the University Hospital, with the suggestion and implementation of targeted changes to improve practice. Conclusion: In the EWTD era with many missed educational opportunities, daily handover represents an underused educational tool for CSTs, especially in light of competency-based and time-limited training. We recommend modifications based on our results and the literature and hope schools of surgery follow suit nationally by assessing and addressing handover practice.
10
Reeve, William JE, Paul Dearden, Benjamin Drake, Rajeshkumar Kakwani, Murty N. Aradhyula, Nicholas Talbot, Adrian M. Hughes, David Townshend, and Ian T. Sharpe. "Minimum 2 Year Outcomes of a Fixed Bearing Total Ankle Replacement in the United Kingdom." Foot & Ankle Orthopaedics 4, no. 4 (October 1, 2019): 2473011419S0035. http://dx.doi.org/10.1177/2473011419s00354.
Full textAbstract:
Category: Ankle, Ankle Arthritis Introduction/Purpose: The Infinity (Wright medical) total ankle replacement (TAR) has become the most implanted ankle replacement in the UK with a 30.1% share in the most recent 2016 England and Wales NJR 14th report. It is a fixed bearing implant utilising an anterior approach and radiological guidance to aid alignment, and is approved for use in the UK as an uncemented implant. Methods: Since introducing the Infinity TAR in June 2014, all implants from two centres in the UK; The Royal Devon and Exeter Hospital NHS Foundation Trust and Northumbria NHS Healthcare Trust, have been followed up prospectively. 113 implants are included with 2 year minimum follow-up, average follow-up being 33 months (24-52). Pre- and post-operative demographic, radiographic and functional outcomes were collected including Visual Analogue Score (VAS), Manchester Oxford foot questionnaire (MOxFQ, UK validated patient reported outcome score) EQ5D (validated quality of life score). Complexity was assessed using COFAS pre-operative grade. Results: Implant survivorship was 93.8% at 2 years minimum. Median age was 68 (42-92), male: female 72:41. Mean MOxFQ improved by 28, mean EQ5D by 1.4 and mean VAS by 7. 16 cases had planned additional procedures, 5 required intra-operative medial malleolar fixation. There have been 2 revisions for deep infection, 2 for implant subsidence, 1 for instability and 2 for unexplained pain (6.2%). 5 patients have required further surgery to the ankle and hindfoot with implant retention (4.4%). 3 patients have asymptomatic tibial cysts (3.4%) and 1 patient has an asymptomatic talar cyst (0.9%) - there is no evidence of progression or loosening. Conclusion: We report favourable early functional, radiographic and survivorship outcomes of this implant in the UK population.
Books on the topic "United Oxford Hospitals"
1
The professor and the madman: A tale of murder, insanity, and the making of the Oxford English dictionary. New York: HarperPerennial, 1999.
Find full text
2
The professor and the madman: A tale of murder, insanity, and the making of the Oxford English dictionary. New York: HarperCollins Publishers, 1998.
Find full text
3
The professor and the madman: A tale of murder, insanity, and the making of the Oxford English dictionary. Thorndike, Me: G.K. Hall, 1999.
Find full text
4
Simon, Winchester. The professor and the madman: A tale of murder, insanity, and the making of the Oxford English dictionary. New York: HarperCollins Publishers, 1998.
Find full text
5
Simon, Winchester. The surgeon of Crowthorne: A tale of murder, madness and the love of words. London: Viking, 1998.
Find full text
6
The surgeon of Crowthorne: A tale of murder, madness and the love of words. London: Viking, 1998.
Find full text
9
Boyd, E. Andrew. Health Care Pricing in the United States: The Case of Hospitals. Oxford University Press, 2012. http://dx.doi.org/10.1093/oxfordhb/9780199543175.013.0005.
Full text
10
Jennings, Kevin. Acute Cardiac Care: Community and Hospital Management of Myocardial Infarction (Oxford Medical Publications). Oxford University Press, USA, 1994.
Find full textBook chapters on the topic "United Oxford Hospitals"
1
Reynard, John, Simon Brewster, and Suzanne Biers. "Urological eponyms." In Oxford Handbook of Urology, 815–19. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199696130.003.0019.
Full textAbstract:
Alcock’s canal: canal for the internal pudendal vessels and nerve in the ischiorectal fossa. Benjamin Alcock (b 1801). Professor of Anatomy, Physiology, and Pathology (1837) at the Apothecaries Hall in Dublin. Anderson–Hynes pyeloplasty: dismembered pyeloplasty for PUJO. James Anderson and Wilfred Hynes. Surgeons, Sheffield United Hospitals....
2
Gournay, Kevin. "Psychiatric nursing techniques." In New Oxford Textbook of Psychiatry, 1403–8. Oxford University Press, 2012. http://dx.doi.org/10.1093/med/9780199696758.003.0177.
Full textAbstract:
Psychiatric nursing as an entity has really only evolved since the Second World War. Psychiatric nurses (now often referred to as mental health nurses in the United Kingdom and Australasia) can now be found in most countries of the developed world, although in the developing world, psychiatric nursing is still not defined as a specific discipline. In many countries, psychiatric hospitals are still staffed by untrained ‘Attendants’ who may have some supervision from general trained nurses. Nevertheless, a number of initiatives, notably those of the Geneva Initiative in Psychiatry in Eastern Europe and the former Soviet Union and the World Health Organization in African countries, have provided specific training in psychiatric nursing techniques. The development of psychiatric nursing across the world needs to be seen in the context of changing and evolving patterns of mental health care. De-institutionalization, with the attendant setting up of community mental health teams, has prompted a range of innovations in psychiatric nursing and the psychiatric nurse of today, who in the United States and Europe is likely to be a university graduate, is a very different person to that of the nurse working in the post-Second World War asylums of 40 years ago. In this chapter, we examine the development of psychiatric nursing in some detail and particularly emphasize the role of psychiatric nurses working in the community. Community psychiatric nursing first developed in the United Kingdom nearly 50 years ago and this model has been followed in countries such as Australia and New Zealand. However, this community role has not developed to any great extent in the United States, where the main presence of psychiatric nursing remains in hospital-based care. Furthermore, in the United Kingdom and Australasia, the development of community initiatives has seen the role of the psychiatric nurse blurring with that of other mental health professionals. Chapters such as this cannot really do justice to the whole range of techniques used by psychiatric nurses; neither can it examine in any detail the differences between psychiatric nursing practices across the world. However, a description of psychiatric nursing in six important areas will provide the reader with an appreciation of the range and diversity of psychiatric nursing skills:♦ Inpatient care ♦ Psychosocial interventions in the community ♦ Prescribing and medication management ♦ Cognitive behaviour therapy ♦ Primary care ♦ Psychiatric nursing in the developing world.
3
Bookbinder, Marilyn, Romina Arceo, and James T. McDaniel. "Improving the Quality of Care across All Settings." In Oxford Textbook of Palliative Nursing, edited by Betty Rolling Ferrell and Judith A. Paice, 573–605. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780190862374.003.0048.
Full textAbstract:
This chapter provides perspectives on quality-based initiatives in the United States across healthcare settings and populations and describes their impact on patient, professional, and system outcomes. The authors discuss the need for quality improvement (QI) at end of life, QI principles, and the models, methods, and tools most frequently used. Also described are areas of national priority for improving end-of-life (EOL) care. A care-path for the end of life is used to illustrate a QI effort and the FOCUS_PDSA method and to encourage use of specific tools for improving EOL care, including respiratory distress, and a clinician assessment of EOL care using The Joint Commission (TJC) tracer methodology. The authors review the linkages between QI and practice changes in hospitals and hospices that ultimately lead to improved EOL care and close with examples of how nurses are providing leadership in the field of quality hospice and palliative care.
4
Burns, Tom. "Planning and providing mental health services for a community." In New Oxford Textbook of Psychiatry, 1452–63. Oxford University Press, 2012. http://dx.doi.org/10.1093/med/9780199696758.003.0185.
Full textAbstract:
The aim of this chapter is to assist clinicians and managers review and plan services effectively for their local population. Severe psychiatric disorders manifest themselves in social relations and often disrupt social structures; they have wide-ranging consequences and services need to be comprehensive. Health and social care have been intertwined in psychiatry from its origins—it is neither feasible nor sensible to ignore the wider context of their management. The last 30 years have seen an explosion of Mental Health Services Research alongside the shrinking and closure of mental hospitals (see Chapter 7.6). Policy considerations, particularly cost containment and public safety, have influenced the research agenda which is disproportionately Anglophone (from the United States, United Kingdom, and Australasia) and focused on new services developed as alternatives to institutional care with staffing and motivation that are not easily generalizable. More routine practices, crucial for safe and effective care, have been relatively neglected by researchers. This chapter is mainly devoted to describing the essential components of a mental health service—its ‘building blocks’. It will then consider how they relate to one another, how they can be prioritized, and how integrated into an effective local service linking into other essential services. Lastly it will stress how their inevitable evolution should be monitored. Services for adults (increasingly referred to as ‘adults of working age’ indicating 18–65 years) will be used as the template. In many settings these may be the only services, stretching to accommodate all comers. In better resourced health care systems a range of specialized services have evolved from this basic model and are described elsewhere in this section (refugees 7.10.1, homeless 7.10.2, and ethnic minorities 7.10.3).
5
Jones, David P. H. "Child abuse and neglect." In New Oxford Textbook of Psychiatry, 1731–40. Oxford University Press, 2012. http://dx.doi.org/10.1093/med/9780199696758.003.0226.
Full textAbstract:
Child abuse and neglect (child maltreatment) is a combination of a consensus about what comprises unacceptable child rearing/care, together with what children have a right to be free from. This is made explicit in the United Nations Convention on the Rights of the Child, which sets out basic rights and standards for judging children's welfare, including, but not limited to, maltreatment. It incorporates both maltreatment of children within families and that arising from wider social influences, including child labour and sexual exploitation, and children in war zones. Maltreatment affects the healthy and normal course of development. It causes deviation from an expected trajectory, preventing the developing child's negotiation of sequential tasks and disrupting normal transaction between different facets of development. Therefore maltreatment is the very antithesis of adequate child care and rearing, posing a major public health threat. Adequate rearing of the young is such a fundamental activity that the state must be concerned with the overall welfare of children within its society; in family settings where they are normally brought up, and in schools, hospitals, and residential settings. While the Convention provides a framework, several states have developed a children's ombudsman, with wide-ranging powers to oversee the status of children's welfare and to tackle obstacles to it. There are laws within each society to regulate the care and welfare of children, specifying the consequences if children are maltreated. In England and Wales, the Children Acts 1989, and 2004 address the overall welfare of children, including those deemed in need of extra help and support, and provide a legislative structure for those children who are at risk of, or are actually being, significantly harmed (child maltreatment). Countries vary in their response to child maltreatment. In the United States, any professional who has reason to suspect that a child is being maltreated is legally required to inform the local child welfare agency (mandatory reporting). Some countries in Europe (e.g. Belgium and Holland) have a system whereby child-maltreatment concerns are dealt with confidentially, through health and social care supportive systems, rather than through primarily legal methods. The United Kingdom lies between these extremes, but relatively closer to the United States model than to the ‘confidential doctor’ system. Whatever system is in place, it is clear from the scope of the problem of child maltreatment that multidisciplinary working is a core requirement. A developmental-ecological model is the most useful conceptual framework, which draws together the various factors known to contribute or be associated with the predisposition, occurrence, course and effects of child maltreatment. It incorporates individual and interpersonal factors, family influences, immediate neighbourhood ones, together with broader social influences on child rearing and care. However, these layers of increasing social complexity, which surround the individual child, are not static. In addition to transactions between factors, there are important influences historically, and subsequent to any maltreatment, which have an impact on outcome. This inclusive conceptual framework enables genetic and environmental factors to be integrated in a manner that can inform clinical assessment and intervention.
6
Taylor, Pamela J., and Emma Dunn. "Management of offenders with mental disorder in specialist forensic mental health services." In New Oxford Textbook of Psychiatry, 2015–21. Oxford University Press, 2012. http://dx.doi.org/10.1093/med/9780199696758.003.0270.
Full textAbstract:
Specialist forensic mental health (fmh) services are for people with serious mental disorders and grave offending behaviour who tend to be rejected from mainstream services. Although often triggered by single high profile cases, these specialist services are among the best planned and commissioned services in psychiatry, founded in evidence of need, risk and efficacy of interventions. They are grounded in a multidisciplinary clinical perspective and often have integrated academic units. They interface both with other clinical services and with the criminal justice service. Good relationships with the local community are vital for establishment and growth. Secure psychiatric hospitals have two overarching aims: improving health and delivering safety for patients and others. In secure hospitals, patients’ autonomy is limited in a number of important ways: they may not be allowed to leave the hospital at all, may be confined to a particular area within the hospital, and/or treatment may be enforced. Although these restrictions are undoubtedly at least partly in the interests of the patients themselves, they are commonly also in the interests of others. This chapter looks at service structure, including planning principles, principles of assessment, admission criteria, the pathway to treatment, and finally assessing outcomes.
7
Wong, Roger Y. M. "Older people presenting to acute care hospitals." In Oxford Textbook of Geriatric Medicine, 247–54. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198701590.003.0034.
Full textAbstract:
Older people presenting to acute care hospitals are at risk of developing adverse events. Comprehensive geriatric assessment (CGA) in acute care provides standardized assessment and management of geriatric problems. The emergency department is a common point of entry, and strategies that focus on enhancing expertise, equipment, policies, and protocols are helpful. The geriatric consultation service model is commonly deployed, and the geriatric evaluation and management unit (GEMU) is a common ward-based model. The acute care for elders (ACE) unit model is associated with fewer adverse events, less functional decline, shorter hospital length of stay, lower institutionalization risk, and lower cost. The senior friendly hospital (SFH) model requires further studies to confirm its effectiveness. A number of geriatric post-discharge liaison services can smooth the transition of older people returning to the community. Overall these models of care are not mutually exclusive, but together they comprise the best practice for older people.
8
Chen, Liang-Kung. "Post-acute care and intermediate care." In Oxford Textbook of Geriatric Medicine, 255–60. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198701590.003.0035.
Full textAbstract:
Post-acute care (PAC), interchangeable with intermediate care, is the key to the success of healthcare services for older people. Due to the need for longer periods of recovery from acute insults, PAC provides the opportunities for these patients to regain functional independence, as well as reduction in hospital readmission and premature long-term care placement. Moreover, the functional recovery obtained from PAC services is associated with the reduction in one-year mortality by 62%. Different models of PAC services have been developed internationally, including home care models, community hospitals, day hospitals, nurse-led units, and community rehabilitation teams. The success of PAC depends on person-centred care with a multidisciplinary approach and comprehensive geriatric assessment, which is consistent in different PAC models. Some specific clinical conditions occurring in PAC possess unique characteristics and impact on PAC outcomes. These conditions are not exclusive to PAC, but their presence may strongly influence quality of care.
9
Furmedge, Dan. "Geriatric Medicine." In Oxford Assess and Progress: Clinical Medicine. Oxford University Press, 2019. http://dx.doi.org/10.1093/oso/9780198812968.003.0023.
Full textAbstract:
Geriatric medicine is the largest ‘medical’ specialty in the United Kingdom, with the number of geriatricians expanding at a huge rate with significant demand. Pragmatic specialists in frailty and complex co- morbidity, the work of geriatricians reaches across geriatric medicine wards, the acute medical unit, emergency departments and acute frailty units, surgical wards, and tertiary medical wards and in the community from inner city London to rural Scotland. They can be found in residential and nursing care homes, rehabilitation teams, and hospital at home teams. Frailty, falls, delirium, dementia, continence, immobility, rehabilitation, polypharmacy, nutrition, end- of- life care, advanced care planning, community medicine, and legal and ethical medicine are all core features of a geriatrician’s day. In this chapter, the questions give a taste of some of these concepts and will also demonstrate how geriatric medicine crosses almost every specialty.
10
"Hospital liaison palliative care." In Oxford Handbook of Palliative Care, edited by Max Watson, Rachel Campbell, Nandini Vallath, Stephen Ward, and Jo Wells, 763–76. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780198745655.003.0027.
Full textAbstract:
This chapter outlines the opportunities and challenges of providing a palliative care service within the acute hospital setting. It has been suggested that between one-third and two-thirds of people in developed world countries will die in hospital. The hospital, probably more than any other healthcare setting, is a challenging environment in which to support the human dimension in patient care. The focus is on investigation, treatment, and cure; priorities, such as quality-of-life issues, can get overshadowed. The chapter covers the particular issues associated with delivering palliative care in the intensive care unit and casualty department and the need to develop an understanding of the principles of palliative care across the many departments in an acute hospital involved in the care of dying patients. The chapter also looks at the difficulties in arranging urgent discharge for patients who wish to die at home.