Revising nursing documentation to meet patient outcomes

Often, complex documentation forms place unnecessary burdens on nurses. A change in one hospital's patient care forms contributes to positive outcomes. With the revised documentation, nurses spend more time caring for patients while still meeting the Joint Commission on Accreditation of Healthcare Organizations' requirements.     

GP documentation of obesity: what does it achieve?

BACKGROUND: Obesity is a major and increasing health problem in the United Kingdom, and, until recently, the government health promotion package for general practice reimbursed general practitioners for documenting obesity. Despite poor evidence for effectiveness of interventions in primary care, documentation of obesity could possibly improve patient awareness and knowledge, or provide public health information. AIM: To assess patient perception of obesity and its health risk, and the accuracy of estimating obesity using patient information. METHOD: Subjects were consecutive attenders to a general practitioner (GP) at a single urban practice in the South and West Region. Outcome measures were 'measured' body mass index (BMI) calculated from measured weight and height, 'estimated' BMI using patient information, and patient perception of obesity and the health risks of obesity. RESULTS: There is good correlation between 'estimated' and 'measured' BMI (intraclass correlation 0.91). Estimated BMI is lower than measured BMI (mean 0.77 lower), and the difference increases with age and level of BMI: for BMIs of < 20, 20-24.99, 25-29.99, and > or = 30 the mean differences (estimated-measured) were -0.06, -0.46, -0.98 and -1.72 respectively. Estimated obesity (BMI > 30) is reasonably sensitive (70%), specific (99%), and predictive (93% positive predictive value) of measured obesity (kappa 0.78). All obese subjects are aware that they are overweight, and most of them (78%, 95% confidence interval 66-88%) are aware that their weight is a health risk. CONCLUSION: Obese patients attending GPs' surgeries are likely to know if they are overweight, or could easily estimate from their knowledge of height and weight that they were overweight with reasonable accuracy. Obese subjects also know that their weight carries health risks. Thus, measurement of obesity in the general population is not likely to improve risk assessment or patient knowledge significantly. Without evidence for effective intervention or improved decision-making in primary care, reimbursement guidelines linked to the documentation of obesity in the population are probably an inefficient use of resources.     

Using nursing diagnoses to achieve desired outcomes for hemodialysis clients

OBJECTIVE: To identify impediments to the successful transfer and implementation of packaged information systems through large, divisionalized health services. DESIGN: A case analysis of the failure of an implementation of a critical application in the Public Health System of the State of New South Wales, Australia, was carried out. This application had been proven in the United States environment. MEASUREMENTS: Interviews involving over 60 staff at all levels of the service were undertaken by a team of three. The interviews were recorded and analyzed for key themes, and the results were shared and compared to enable a continuing critical assessment. RESULTS: Two components of the transfer of the system were considered: the transfer from a different environment, and the diffusion throughout a large, divisionalized organization. The analyses were based on the Scott-Morton organizational fit framework. In relation to the first, it was found that there was a lack of fit in the business environments and strategies, organizational structures and strategy-structure pairing as well as the management process-roles pairing. The diffusion process experienced problems because of the lack of fit in the strategy-structure, strategy-structure-management processes, and strategy-structure-role relationships. CONCLUSION: The large-scale developments of integrated health services present great challenges to the efficient and reliable implementation of information technology, especially in large, divisionalized organizations. There is a need to take a more sophisticated approach to understanding the complexities of organizational factors than has traditionally been the case.     

Head nurse and nursing expert--it is possible to achieve successful cooperation

Fourteen poor risk acute myeloid leukemia (AML) patients were treated with G-CSF prior (from day 0) and during chemotherapy with fludarabine and Ara-C from day 1 to day 5 (the FLAG regimen). Several biological parameters were monitored on the blast population: multidrug resistance (MDR) functional expression by rhodamine-123 efflux (Rhd-E), cell cycle changes, induction of apoptosis and leukemic clonogenic cell growth (CFU-L). The mean basal Rhd-E value was 14.4% (range 0-51.2), and 12/14 patients exhibited a dye efflux > 4%, efficiently blocked by the MDR-reversal agent cyclosporin A. After 24 h of G-CSF administration, cell cycle studies showed in bone marrow (BM) samples a significant mean increase in S phase (p = 0.04) and in RNA content of G1 cells (p = 0.01), coupled to a significant increase in apoptosis (p = 0.02). Clonogenic cell growth analysis showed a twofold increase in BM CFU-L in 6 of the 14 cases tested. When G-CSF activity was assessed without the addition of exogenous growth factors (autonomous proliferation), a significant increase (p = 0.02) in CFU-L was found only in patients who achieved a complete remission (CR); these patients were also characterized by lower S-phase values at diagnosis. Eight of the 14 patients treated achieved CR, but the median response duration was three months, and only two cases are still in CR. The FLAG regimen can thus induce remission in poor risk AML patients. The responses, however, are short, suggesting that resistant cells are not efficiently affected by either the use of agents not involved in the MDR-efflux mechanism or by the G-CSF priming strategy. Other post-induction therapies need to be considered in further approaches.     

Computerized documentation for a rural nursing intervention project

Complex traits are generally taken to be under the influence of multiple genes, which may interact with each other to confer susceptibility to disease. Statistical methods in current use for localizing such genes essentially work under single-gene models, either implicitly or explicitly. In genomic screens for complex disease genes, some of the marker loci must be in tight linkage with disease susceptibility genes. We developed a general multi-locus approach to identify sets of such marker loci. Our approach focuses on affected sib pair data and employs a nonparametric pattern recognition technique using artificial neural networks. This technique analyzes all markers simultaneously in order to detect patterns of locus interactions. When applied to previously published sib pair data on type I diabetes, our approach finds the same genes as in the published report in addition to some new loci. For a specific two-locus model of inheritance, the power of our approach is higher than that of the currently used analysis standard.     

The multifinality constraints effect: How goal multiplicity narrows the means set to a focal end.

In the presence of several objectives, goal conflict may be avoided via multifinal means, which advance all of the active goals at once. Because such means observe multiple constraints, they are fewer in number than the unconstrained means to a single goal. Five experimental studies investigated the process of choosing or generating such means for multiple goals. We found that the simultaneous activation of multiple goals restricted the set of acceptable means to ones that benefitted (or at least, did not harm) the entire set of active goals. Two moderators of this phenomenon were identified: (a) the feasibility of identifying multifinal means, which was dependent on the relations between the different active goals, and (b) the enhanced importance of the focal goal, which resulted in the inhibition of its alternatives and the consequent relaxation of multifinality constraints. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Performance incentives and means: how regulatory focus influences goal attainment

A study was performed to evaluate the effect of prolonged environmental hypobaric hypoxia on the ultrastructure of rat cornea. 60-day-old female Wistar rats were exposed to a simulated altitude of 5,500 m (350 mmHg) and pO2 of 76 mmHg for 30 days. Control rats were exposed to atmospheric sea level pressure (760 mmHg) and pO2 of 150 mmHg, for the same period. Ultrastructural analysis of the corneal epithelium did not reveal any relevant difference between control and treated rats. In contrast, the corneal stroma of rats subjected to hypoxia showed vascularization with advanced vessel differentiation and signs of active proliferation. The endothelium of hypoxic cornea showed swollen mitochondria and large empty cytoplasmic areas. The endothelial intercellular junctions could hardly be identified in the hypoxic condition. Nevertheless, the most evident change in hypoxic cornea was in Descemet's membrane, which was considerably thickened, to approximately twice that of the control specimen. These results suggest that environmental hypobaric hypoxia induces marked alterations in the corneal stroma and endothelium morphology, probably related to reduced oxygen tension in the aqueous humor, consequent to hypoxemia.     

Legal and medical nursing aspects of documentation, recording and reporting

This article deals with the importance of documentation, recording and reporting as a means of communication in daily medical and nursing practice. It points out the common deficiencies in this respect and describes the legal, clinical, medical and nursing implications of proper reporting. The medical staff is often not sufficiently aware of the importance of accurate reporting. The inadequate compiling and incorrect reading of medical records can jeopardize patients' rights to quality service.     

Effect of goal acceptance on the relationship of goal difficulty to performance.

Tested the hypotheses that goal acceptance moderates the relationship of goal difficulty to task performance as follows: (a) The relationship is positive and linear for accepted goals; (b) it is negative and linear if the goal is rejected; and thus, (c) slope reversal from positively to negatively linear relationships is associated with transition from positive to negative values of goal acceptance. The experiment was a within-S design, allowing for high variance in acceptance, with technicians and engineers (21–50 yrs of age) divided at random into a 2-phase experimental condition (n?=?104) with specific goal difficulty gradually increasing from Trial 1 to 7 and a control group (n?=?36) with the general instructions to "do your best." Instructions for Phase 2 differed from Phase 1 in that Ss were instructed to reassess their acceptance of difficult goals. The task consisted of determining, within 2-min trials, how many digits or letters in a row were the same as the circled one to the left of each row. Results support the hypotheses. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Steel based infiltration to achieve full density,high performance PM parts

Abstract

The current state of the art of iron base infi ltration is assessed. Recent efforts on development of the infi ltration process, its potential for improving mechanical properties and its dimensional change characteristics are reviewed and reported results summarised.     

Reliable cryptology as a means for confidentiality and safety in medical communication and documentation

The application of strong cryptography secures the integrity of medical data and their confidentiality during transmission. Encryption allows to use the Internet for the transmission of confidential medical data rendering an expensive specialised Internet like the DGN superfluous. By signing and timestamping medical records electronically their probative force is substantially improved in case of a law-suit.     

An analysis of nursing documentation as a reflection of actual nurse work

Nursing documentation is a fundamental nursing responsibility, yet it does not reflect the holistic nature of nurses' practice and work. This pilot study investigated nurses' perceptions of the function and value of documentation and barriers to the documentation process.     

Computer aided adjustment of the phrenic pacemaker: automatic functions, documentation, and quality control

Electrical stimulation of the phrenic nerves of patients with complete ventilatory insufficiency with the Vienna respiratory pacemaker has been in clinical use since 1983. During the adjustment of stimulation parameters with this device, the following problems have occurred: for some measurements like the recruitment curve, series of complete inspiration cycles have to be stimulated, which causes the danger of muscle fatigue for unconditioned patients. The documentation is completed predominantly by hand, taking time and increasing the possibility of error. As a first step to solve these problems, we developed a new stimulation and measurement system. It consists of a PC with data acquisition hardware, the necessary sensors, and amplifier circuitry. The implanted stimulator is controlled via the parallel interface. The new system offers some advantages: computer control shortens the time for measurement and documentation, and the stress on the patient and the risk of error is reduced; synchronized measurement makes it possible to use single stimulation pulses instead of bursts and ramps to reduce diaphragm fatigue; digital signal processing improves measurement results and reproducibility; and help functions and self tests are provided, together with a graphical user interface. We used sensors for air flow, diaphragm EMG, and acceleration, on up to 8 channels simultaneously. Combined sample rates of up to 100 kS/s were possible. The system could be adapted for other uses involving functional electrical stimulation with our implantable nerve stimulators. Using this equipment saves a lot of effort, and the adjustment process can be focused on improved stimulation results and better performance for the patient. Current research is studying implementation of automatic functions like acquisition of stimulation thresholds. This could result in a predominantly automated adjustment of the phrenic pacemaker and even in a closed-loop controlled system in the future.     

Bone rehabilitation to achieve optimal aesthetics

Treatment involving oral implants has established a high success rate, including implant survival on a long-term basis. The challenge facing the clinicians today is to achieve an optimal long-term aesthetic result. To address this challenge, the volume of the underlying hard and soft tissue must be restored either prior to or simultaneously with the implant placement. The learning objective of this article is to review the critical biologic and clinical criteria essential in achieving a predictable success in aesthetic enhancement of the implant site. The article discusses the five phases of ridge reconstruction, utilization of bone grafts (with or without membranes), and the use of membranes alone. Soft tissue management and augmentation in aesthetic and nonaesthetic regions are differentiated and presented. Surgical complications are recognized as a clinical reality, and exposure of the membranes is evaluated and discussed. Four cases are used to describe and illustrate the clinical procedure.     

创新企业文化 成就企业未来

企业文化自二十世纪八十代诞生以来,经过长时期的沉淀、孕育和提炼,越来越受到企业的重视,逐渐被企业及员工接受和认同,成为员工思想情感和意识的统率力量,成为增强企业职工凝聚力和推动企业发展进步的源动力。如何在21世纪发挥企业文化动力作用,保持企业的持续、快速、健康发展,使企业在剧烈的国际、国内市场竞争中顶住风浪的袭击,保持长盛不衰呢？本文就创新企业文化,最大化发挥企业文化作用进行了初步探讨。