16 research outputs found

    Irastis.com : website instrucional sobre prevenção de infecção relacionada à assistência à saúde

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    Orientadora: Profa. Letícia PontesDissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Programa de Pós-Graduação em Prática do Cuidado em Saúde. Defesa : Curitiba, 17/08/2020Inclui referências: p. 66-70Resumo: Trata-se do desenvolvimento de um website instrucional, fundamentado na prática baseada em evidência, sobre bundles na prevenção de Infecção Relacionada à Assistência à Saúde, em Unidades de Terapia Intensiva. Como método, seguiram-se os moldes da pesquisa metodológica de produção tecnológica, desenvolvida em quatro fases: (I) levantamento bibliográfico e revisão da literatura pertinente ao tema proposto; (II) produção de conteúdos em textos, imagens e vídeos baseados na revisão realizada; (III) desenvolvimento de um website instrucional, na plataforma WordPress; (IV) elaboração do design da interface do website e inserção dos conteúdos criados, sobre as principais infecções relacionadas à assistência à saúde, em unidades de terapia intensiva, e os respectivos bundles utilizados como medidas de prevenção destas infecções. Como resultado, desenvolveu-se website instrucional para ser acessado por computadores, tablets e smarthphones, denominado "Iras Tis", cujo endereço eletrônico é irasti.com, que contém compêndio sintético de conteúdos inerentes ao tema proposto. Conclusão: O desenvolvimento deste website se mostrou eficaz e compatível com as inovações e novas tecnologias relacionadas à pesquisa e educação. Tem potencial para corroborar com a diminuição das infecções nas Unidades de Terapia Intensiva, por meio da implementação de medidas de prevenção nele divulgadas.Abstract: This is the development of an instructional website, based on evidence-based practice, on bundles in the prevention of Infection Related to Health Care, in Intensive Care Units. As a method, we followed the molds of the methodological research of technological production, developed in four phases: (I) bibliographic survey and review of the literature relevant to the proposed theme; (II) production of content in texts, images and videos based on the review carried out; (III) development of an instructional website, on the WordPress platform; (IV) elaboration of the website interface design and insertion of the contents created, about the main infections related to health care, in intensive care units, and the respective bundles used as measures to prevent these infections. As a result, an instructional website was developed to be accessed by computers, tablets and smartphones, called "Iras Tis", whose electronic address is irasti.com, which contains a synthetic compendium of contents inherent to the proposed theme. Conclusion: The development of this website proved to be effective and compatible with the innovations and new technologies related to research and education. It has the potential to corroborate the decrease in infections in Intensive Care Units, through the implementation of prevention measures disclosed therein

    Sustainable use of marine biodiversity as source of novel anti-biofilm agents in industrial and clinical settings

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    Amongst marine bacteria, cold-adapted microorganisms represent an untapped reservoir of biodiversity endowed with an interesting chemical repertoire able to synthesize a broad range of potentially valuable bioactive compounds, including antimicrobial activity. The rapid emergence of resistant bacteria is occurring worldwide, endangering the efficacy of antibiotics. One of the main causes of antibiotic resistance is the capability of microorganisms to associate into communities of cells called biofilms. These complex structures provide protection from potential stressors, including the lack of water, high or low pH, or the presence of substances toxic to microorganisms such as antibiotics, antimicrobials or heavy metals. Therefore, coordinated efforts to implement the arsenal of novel anti-infective treatments are greatly needed. In this contest, my PhD project aimed to the sustainable exploitation of Polar marine biodiversity in an attempt to find viable sources of novel anti-biofilm agents, in particular acting against Staphylococcus epidermidis, one of the most common causes of infections associated with medical devices. In detail, during the first part of my project, I focused on the study of the Antarctic marine bacterium Pseudoalteromonas haloplanktis TAC125 and of its ability to produce anti-biofilm molecules, then, on the purification, identification and characterization of the active molecule produced. By setting up of a strategy for the large scale biofilm cultivation of the Antarctic bacterium, the production yield of P. haloplanktis TAC125 anti-biofilm agent was improved, so as to allow the purification and the identification of the active molecule, the pentadecanal. However, as the pentadecanal is a chemically reactive agent, it could easily undergo oxidation reactions, therefore it could not be suitable for all possible anti-biofilm strategies. Therefore, some chemical analogues were synthesized and characterized for their anti-biofilm activity and their possible use in combination with antibiotics were investigated. Then, as a possible clinical application, an anti-biofilm coating system, active against S. epidermidis, was developed, by physical adsorption of pentadecanal and its analogues on polydimethylsiloxane (PDMS), a silicon-based material commonly used for the manufacturing of medical devices. Finally, some physiological studies were dedicated to P. haloplanktis TAC125 biofilm formation in relation with environmental adaptations, with the purpose to explore the potentiality of P. haloplanktis TAC125 in biotechnological field. In the second part of my PhD project, given their only partially explored potential, I have also studied other Polar bacteria belonging to different genera, looking for novel anti-biofilm agents against S. epidermidis. Through the screening of small metabolites and proteins/peptides libraries designed starting from planktonic cultures of Polar bacteria, some promising producer strains were identified and their anti-biofilm activities were characterized. Preliminary purification protocols were set up for each kind of molecules, according to their physico-chemical characteristics. Further studies are still ongoing to identify the structure of the active molecules

    Full Issue: Volume 3, Number 1

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    Interventions to improve antibiotic prescribing practices for hospital inpatients

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    Background Antibiotic resistance is a major public health problem. Infections caused by multidrug-resistant bacteria are associated with prolonged hospital stay and death compared with infections caused by susceptible bacteria. Appropriate antibiotic use in hospitals should ensure effective treatment of patients with infection and reduce unnecessary prescriptions. We updated this systematic review to evaluate the impact of interventions to improve antibiotic prescribing to hospital inpatients. Objectives To estimate the effectiveness and safety of interventions to improve antibiotic prescribing to hospital inpatients and to investigate the effect of two intervention functions: restriction and enablement. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library), MEDLINE, and Embase. We searched for additional studies using the bibliographies of included articles and personal files. The last search from which records were evaluated and any studies identified incorporated into the review was January 2015. Selection criteria We included randomised controlled trials (RCTs) and non-randomised studies (NRS). We included three non-randomised study designs to measure behavioural and clinical outcomes and analyse variation in the effects: non- randomised trials (NRT), controlled before-after (CBA) studies and interrupted time series (ITS) studies. For this update we also included three additional NRS designs (case control, cohort, and qualitative studies) to identify unintended consequences. Interventions included any professional or structural interventions as defined by the Cochrane Effective Practice and Organisation of Care Group. We defined restriction as 'using rules to reduce the opportunity to engage in the target behaviour (or increase the target behaviour by reducing the opportunity to engage in competing behaviours)'. We defined enablement as 'increasing means/reducing barriers to increase capability or opportunity'. The main comparison was between intervention and no intervention. Data collection and analysis Two review authors extracted data and assessed study risk of bias. We performed meta-analysis and meta-regression of RCTs and meta-regression of ITS studies. We classified behaviour change functions for all interventions in the review, including those studies in the previously published versions. We analysed dichotomous data with a risk difference (RD). We assessed certainty of evidence with GRADE criteria. Main results This review includes 221 studies (58 RCTs, and 163 NRS). Most studies were from North America (96) or Europe (87). The remaining studies were from Asia (19), South America (8), Australia (8), and the East Asia (3). Although 62% of RCTs were at a high risk of bias, the results for the main review outcomes were similar when we restricted the analysis to studies at low risk of bias. More hospital inpatients were treated according to antibiotic prescribing policy with the intervention compared with no intervention based on 29 RCTs of predominantly enablement interventions (RD 15%, 95% confidence interval (CI) 14% to 16%; 23,394 participants; high-certainty evidence). This represents an increase from 43% to 58% .There were high levels of heterogeneity of effect size but the direction consistently favoured intervention. The duration of antibiotic treatment decreased by 1.95 days (95% CI 2.22 to 1.67; 14 RCTs; 3318 participants; high-certainty evidence) from 11.0 days. Information from non-randomised studies showed interventions to be associated with improvement in prescribing according to antibiotic policy in routine clinical practice, with 70% of interventions being hospital-wide compared with 31% for RCTs. The risk of death was similar between intervention and control groups (11% in both arms), indicating that antibiotic use can likely be reduced without adversely affecting mortality (RD 0%, 95% CI -1% to 0%; 28 RCTs; 15,827 participants; moderate-certainty evidence). Antibiotic stewardship interventions probably reduce length of stay by 1.12 days (95% CI 0.7 to 1.54 days; 15 RCTs; 3834 participants; moderate-certainty evidence). One RCT and six NRS raised concerns that restrictive interventions may lead to delay in treatment and negative professional culture because of breakdown in communication and trust between infection specialists and clinical teams (low-certainty evidence). Both enablement and restriction were independently associated with increased compliance with antibiotic policies, and enablement enhanced the effect of restrictive interventions (high-certainty evidence). Enabling interventions that included feedback were probably more effective than those that did not (moderate-certainty evidence). There was very low-certainty evidence about the effect of the interventions on reducing Clostridium difficile infections (median -48.6%, interquartile range -80.7% to -19.2%; 7 studies). This was also the case for resistant gram-negative bacteria (median -12.9%, interquartile range -35.3% to 25.2%; 11 studies) and resistant gram-positive bacteria (median -19.3%, interquartile range -50.1% to +23.1%; 9 studies). There was too much variance in microbial outcomes to reliably assess the effect of change in antibiotic use. Heterogeneity of intervention effect on prescribing outcomes We analysed effect modifiers in 29 RCTs and 91 ITS studies. Enablement and restriction were independently associated with a larger effect size (high-certainty evidence). Feedback was included in 4 (17%) of 23 RCTs and 20 (47%) of 43 ITS studies of enabling interventions and was associated with greater intervention effect. Enablement was included in 13 (45%) of 29 ITS studies with restrictive interventions and enhanced intervention effect. Authors' conclusions We found high-certainty evidence that interventions are effective in increasing compliance with antibiotic policy and reducing duration of antibiotic treatment. Lower use of antibiotics probably does not increase mortality and likely reduces length of stay. Additional trials comparing antibiotic stewardship with no intervention are unlikely to change our conclusions. Enablement consistently increased the effect of interventions, including those with a restrictive component. Although feedback further increased intervention effect, it was used in only a minority of enabling interventions. Interventions were successful in safely reducing unnecessary antibiotic use in hospitals, despite the fact that the majority did not use the most effective behaviour change techniques. Consequently, effective dissemination of our findings could have considerable health service and policy impact. Future research should instead focus on targeting treatment and assessing other measures of patient safety, assess different stewardship interventions, and explore the barriers and facilitators to implementation. More research is required on unintended consequences of restrictive interventions

    Examining antibiotic resistance in the feedlot cattle industry using real-time, quantitative PCR (qPCR) and enterococci as an indicator bacterium

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    Antibiotics are administered to livestock at subtherapeutic levels to maintain animal health. Many of the antibiotics used are analogues or the same as those used in human medicine, raising the possibility that genes conferring resistance arise within agricultural production systems. This thesis examined antibiotic resistance in the Canadian beef feedlot industry. Real-time, quantitative PCR was used to examine differences in the relative abundance of eighteen resistance genes across five antibiotic families from feedlot cattle faeces and urban environments. The effect of infeed administration and withdrawal of tylosin phosphate on macrolide resistance was examined using enterococci as an indicator bacterium. Resistant enterococci (n=21) were selected for whole-genome sequencing and comparative genomics. Results presented here show that the relative abundance of resistance genes differs between cattle feedlots and urban environments, likely a reflection of differences in antibiotic use. Sulfonamide, fluoroquinolone and β-lactam resistance genes predominated in urban wastewater, whilst tetracycline resistance genes were more prevalent in cattle faeces. Macrolide use in cattle production increased the proportion of erythromycinand tylosin-resistant enterococci. However, withdrawal of tylosin from the diet appeared to contribute to reduced macrolide resistance in enterococci. Comparative genomics revealed resistance to macrolides was present on mobile genetic elements, specifically the Tn917 transposon harbouring erm(B). This transposon was identified in both Enterococcus hirae and Enterococcus faecium suggesting inter-species transfer of resistance genes may occur in the bovine gastrointestinal tract. Furthermore, the integrative conjugative elements (ICEs) Tn916 and Tn5801, both conferring tetracycline resistance, were identified in E. faecium. As the cost of genomic sequencing continues to decrease, further investigation of ICEs using whole genome sequencing will help determine if there are linkages between enterococci isolates from bovine environmental and human clinical sources and whether bovine enterococci represent a source to the dissemination and spread of antibiotic resistance

    Disponibilidade, desempenho e confiança em sistemas de bases de dados hospitalares - Suporte à decisão inteligente para prevenção de falhas

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    Tese de Doutoramento em Engenharia BiomédicaNos ambientes hospitalares, as tecnologias e os sistemas de informação suportam a atividade dos profissionais que atuam na prestação de cuidados de saúde, devendo proporcionar um acesso seguro e consistente, confidencialidade, eficiência e disponibilidade permanente. Por outro lado, devem mimetizar os processos de registo e difusão da informação mantendo um elevado grau de desempenho. Nestes contextos, os Sistemas de Gestão Bases de Dados (SGBD) assumem-se como sistemas críticos consumindo grandes quantidades de recursos de armazenamento, de processamento e de comunicação e não podendo estar sujeitos a falhas. Apesar da existência de ferramentas tecnológicas para a monitorização e a afinação das configurações dos SGDBs e do avanço tecnológico, com versões mais estáveis, mais seguras e com maior desempenho constata-se que os problemas e dificuldades continuam a surgir. Estes aspectos constituem uma oportunidade de investigação no sentido de se procurar definir modelos para a previsão de eventos, situações e formas de atuação, com alguma antecedência, tais como: • Prever a taxa de utilização de um sistema e do volume de armazenamento necessário; • Prever a ocorrência de um evento crítico que implique a paragem do SGDB; • Prever com antecedência os recursos necessários para resolver um problema. A investigação na área clínica há muito que tem produzido modelos de intervenção em situações críticas permitindo alocar recursos e atuar em conformidade (e.g. MEWS). Seguindo de perto estes avanços, este trabalho visa o estudo, modelação e implementação de um modelo de antecipação e de intervenção em SGBDs e a sua materialização no contexto de um sistema de suporte à decisão inteligente.In healthcare environments, technologies and information systems support the activities of professionals working in health care and must provide a safe and consistent access, confidentiality, efficiency and continuous availability. On the other hand, should reduce the registration process and dissemination of information while maintaining a high performance degree. In these contexts, the Database Management Systems (DMS) are assumed to be critical systems consuming large amounts of storage resources, processing and communication and can not be subject to failures. Despite the existence of technological tools for monitoring and tuning the settings of DMS and technological advances, more stable versions, safer and higher performance notes that the problems and difficulties continue to arise. These constitute a research opportunity in order to seek to define models for the prediction of events, situations and ways of action, such as: • Predict the utilization rate of a system and the required storage volume; • Provide for the occurrence of a critical event that causes the stop of DMS; • Plan in advance the resources needed to solve a problem. Research in the clinical area has long produced models of intervention in critical situations allowing allocate resources and act accordingly (e.g. MEWS). Following these developments, this work aims to study, modeling and implementation of a model of anticipation and intervention in DBMS and its materialization in the context of a support system for intelligent decision

    Evidence-Based Design in Nederlandse ziekenhuizen:

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    Subject Evidence-Based Design in hospitals. Problem What role can Evidence-Based Design have in the design of better hospitals? Purpose To determine spatial (or: concrete) qualities, scientifically proven to have a positive influence on the health and well being of patients and staff, in order to offer the architect a helping hand for designing better hospitals. These measures are drawn from research that has been done in the framework of Evidence-Based Design (EBD), which can be perceived as the scientific variant of the healing environment. Relevance In the Dutch media the term healing environment is often used by architects, representatives of hospitals and researchers. Everyone provides their own content (colour, nature, treatment, hospitality, etc.) to this collective concept. The determination of concrete design elements, with a proven positive effect for patients, can contribute to the design of better care environments. Method and approach Literature research and case studies. EBD → elements → checklist → case studies in field research ↑ ---------- analysis ---------- ↑ Spatial measures were selected from scientific articles from Evidence-Based Design research that are applicable for an architect. Only those measures were selected for which the effect has been proven sufficiently. The selection was based on scientific articles that have been validated by EBD expert teams. The measures in this study cover waiting rooms, consultation rooms, nursing departments, patient rooms and day treatment areas. The measures have an effect on: A positive contribution to the health of patients (chapter 3); A positive contribution to the well being (less anxiety, stress) of patients (chapter 4); A positive contribution to the efficiency and effectiveness of staff (chapter 5).  The literature research gives information on how physical environmental interventions can contribute to the problems of the patient (such as lack of sleep). The selected measures are gathered in a checklist. This checklist gives an overview of all the validated spatial measures (from chapters 3, 4, 5). In the checklist it becomes clear which spatial measure can contribrute to which positive effects.  Some aspects are more significant than others because they contribute to many problems (such as the one-person patient room); others appear just once and contribute to just one aspect. The application of EBD in recently built Dutch Hospitals has been studied using this checklist in the case studies. In the field research (chapter 7) nine recently built Dutch hospitals (Orbis Medisch Centrum Sittard, Isala Klinieken Zwolle, Meander Medisch Centrum Amersfoort, Jeroen Bosch Ziekenhuis Den Bosch, Flevoziekenhuis Almere, Maasziekenhuis Boxmeer, Deventer Ziekenhuis Deventer, Bright Sites VUMC Amsterdam, Alexander Monro Kliniek Bilthoven) were visited. Using the checklist the analysis is carried out as to whether EBD elements are used and if so how they are applied. The goals of the case studies are to gain understanding of: The degree to which, and the way in which, the selected measures are applied; The consequences for the architectonical quality. The case studies want to answer the following questions: Does the frequent use of terms such as healing environment indeed reflect the application of design elements that have been scientifically proven? If certain aspects derived from EBD are applied, in which way is this done? This study has disregarded the extent to which the aimed effects of the measures, as attributed in the literature, are evident when these measures are applied in reality in the hospitals. A characteristic of this study is the fact that it has been done from the field of architecture. Design qualities are studied. For each case study the design drawings from the architect were retrieved and studied, and the hospital was visited. Also for every case study an interview was held with a staff member of the hospital and with the architect. The media was searched for each hospital from the field research to determine whether the hospital or architect mentions the healing environment. In chapter 8 all the gathered data from the cases are compared. The question about architectural quality is relevant from the perspective of the architect. EBD gives little information about the quality of the architecture for the architect. EBD states that there are too few research studies about design. Most starting points are found in the paragraph ‘interior’ (such as variation and differentiation). Roger Ulrich writes in a few articles about an aesthetically pleasant environment, a hotel-like interior and being well decorated. In this he understates the importance of the quality of the design. Just sometimes he remarks about the use of colour, avoiding cheap furniture and the use of adequate lighting. For the architect design is important. For this reason, during the field research the design of the spaces was also observed: the analysis is not limited to the aspects derived from Evidence-Based Design. Therefore a professional analysis of architectural quality is possible. In chapter 9 the most significant aspects of architectural quality are described. In this part of the case studies vocabulary familiar in architecture and common architectural analytical methods are used. This part of the study gives information about the relationship between Evidence-Based Design and architectural quality. In chapter 8 the conclusion is drawn if and how EBD is applied in recently built Dutch hospitals and the most significant results using the checklist are described. Results a checklist with all the physical measures together; the findings of the case studies based on this checklist; conclusions and recommendations. The field research shows that EBD is sparely used in many spaces in hospitals: Daylight and view. It was remarkable that in most hospitals many rooms are walled in, especially consulting rooms in outpatient areas. It also happens frequently that patients in rooms (for example day treatment), due to the interior design or the placement of furniture, cannot look outside. Nature. In almost none of the case studies was there an easy accessible (patio) garden that staff and patients can use. Patient room. More than half of the cases have the majority of patient bedrooms with shared bathrooms. Day treatment areas and multi occupancy patient bedrooms have, in almost all cases no design solutions that contribute to privacy, control, positive distraction or social support. Interior. Many spaces in the hospitals from the field research where patients and staff stay a long time have an institutional character. Rooms with an institutional character do not offer the possibility for control or positive distraction to the patient due to a lack of variation and differentiation in colours, materials, lighting and furniture. Also there is in none of the hospitals any art in rooms where patients stay a long time and need positive distraction. It is frequently the case that equipment and necessities do not have an obvious location or that no possibility is offered for putting equipment etc. in a cupboard. This contributes to the fact that many rooms are chaotic and unattractive. From the field research we can learn that EBD gives few concrete measures for design. A few EBD measures are important for architecture but they do not give actual rules for the design. The architect designs the totality of functional, programmatic and esthetic aspects of the brief of requirements. This study shows that the quality of the design is indeed important. EBD stands not in the way of architectural quality and architectural quality is no obstruction for the use of EBD. Commentary and recommendations The functional and programmatical measures from EBD provide the architect with information to design better hospitals. The recommendations that EBD provides for design are also valuable. The field research showed that still many measures from EBD are not applied in hospitals. It is recommended that hospitals and architects take note of EBD in order to realise the positive effects for patients. In the field research an often-heard complaint was that the scientific basis of hospital design is insufficient: more EBD is needed. It is recommended that during the design and building process of a hospital attention is given to research (for example Post Occupancy Evaluation) in order to contribute to the body of knowledge of the positive effects of the 3. The field research showed that the quality of architecture is important in the experience of users and patients. It is recommended that more attention be given to architectural quality in the hospital environment. I also advise that the client gives more attention and is more involved in the design. The client can play a strong role in creating architectonical quality and making a better hospital environment

    Evidence-Based Design in Nederlandse ziekenhuizen

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    Subject Evidence-Based Design in hospitals.   Problem What role can Evidence-Based Design have in the design of better hospitals?   Purpose To determine spatial (or: concrete) qualities, scientifically proven to have a positive influence on the health and well being of patients and staff, in order to offer the architect a helping hand for designing better hospitals. These measures are drawn from research that has been done in the framework of Evidence-Based Design (EBD), which can be perceived as the scientific variant of the healing environment.   Relevance In the Dutch media the term healing environment is often used by architects, representatives of hospitals and researchers. Everyone provides their own content (colour, nature, treatment, hospitality, etc.) to this collective concept. The determination of concrete design elements, with a proven positive effect for patients, can contribute to the design of better care environments.   Method and approach Literature research and case studies. EBD → elements → checklist → case studies in field research ↑ ---------- analysis ---------- ↑ Spatial measures were selected from scientific articles from Evidence-Based Design research that are applicable for an architect. Only those measures were selected for which the effect has been proven sufficiently. The selection was based on scientific articles that have been validated by EBD expert teams. The measures in this study cover waiting rooms, consultation rooms, nursing departments, patient rooms and day treatment areas. The measures have an effect on: A positive contribution to the health of patients (chapter 3); A positive contribution to the well being (less anxiety, stress) of patients (chapter 4); A positive contribution to the efficiency and effectiveness of staff (chapter 5).  The literature research gives information on how physical environmental interventions can contribute to the problems of the patient (such as lack of sleep). The selected measures are gathered in a checklist. This checklist gives an overview of all the validated spatial measures (from chapters 3, 4, 5). In the checklist it becomes clear which spatial measure can contribrute to which positive effects.  Some aspects are more significant than others because they contribute to many problems (such as the one-person patient room); others appear just once and contribute to just one aspect. The application of EBD in recently built Dutch Hospitals has been studied using this checklist in the case studies. In the field research (chapter 7) nine recently built Dutch hospitals (Orbis Medisch Centrum Sittard, Isala Klinieken Zwolle, Meander Medisch Centrum Amersfoort, Jeroen Bosch Ziekenhuis Den Bosch, Flevoziekenhuis Almere, Maasziekenhuis Boxmeer, Deventer Ziekenhuis Deventer, Bright Sites VUMC Amsterdam, Alexander Monro Kliniek Bilthoven) were visited. Using the checklist the analysis is carried out as to whether EBD elements are used and if so how they are applied. The goals of the case studies are to gain understanding of: The degree to which, and the way in which, the selected measures are applied; The consequences for the architectonical quality. The case studies want to answer the following questions: Does the frequent use of terms such as healing environment indeed reflect the application of design elements that have been scientifically proven? If certain aspects derived from EBD are applied, in which way is this done? This study has disregarded the extent to which the aimed effects of the measures, as attributed in the literature, are evident when these measures are applied in reality in the hospitals. A characteristic of this study is the fact that it has been done from the field of architecture. Design qualities are studied. For each case study the design drawings from the architect were retrieved and studied, and the hospital was visited. Also for every case study an interview was held with a staff member of the hospital and with the architect. The media was searched for each hospital from the field research to determine whether the hospital or architect mentions the healing environment. In chapter 8 all the gathered data from the cases are compared. The question about architectural quality is relevant from the perspective of the architect. EBD gives little information about the quality of the architecture for the architect. EBD states that there are too few research studies about design. Most starting points are found in the paragraph ‘interior’ (such as variation and differentiation). Roger Ulrich writes in a few articles about an aesthetically pleasant environment, a hotel-like interior and being well decorated. In this he understates the importance of the quality of the design. Just sometimes he remarks about the use of colour, avoiding cheap furniture and the use of adequate lighting. For the architect design is important. For this reason, during the field research the design of the spaces was also observed: the analysis is not limited to the aspects derived from Evidence-Based Design. Therefore a professional analysis of architectural quality is possible. In chapter 9 the most significant aspects of architectural quality are described. In this part of the case studies vocabulary familiar in architecture and common architectural analytical methods are used. This part of the study gives information about the relationship between Evidence-Based Design and architectural quality. In chapter 8 the conclusion is drawn if and how EBD is applied in recently built Dutch hospitals and the most significant results using the checklist are described.   Results a checklist with all the physical measures together; the findings of the case studies based on this checklist; conclusions and recommendations. The field research shows that EBD is sparely used in many spaces in hospitals: Daylight and view. It was remarkable that in most hospitals many rooms are walled in, especially consulting rooms in outpatient areas. It also happens frequently that patients in rooms (for example day treatment), due to the interior design or the placement of furniture, cannot look outside. Nature. In almost none of the case studies was there an easy accessible (patio) garden that staff and patients can use. Patient room. More than half of the cases have the majority of patient bedrooms with shared bathrooms. Day treatment areas and multi occupancy patient bedrooms have, in almost all cases no design solutions that contribute to privacy, control, positive distraction or social support. Interior. Many spaces in the hospitals from the field research where patients and staff stay a long time have an institutional character. Rooms with an institutional character do not offer the possibility for control or positive distraction to the patient due to a lack of variation and differentiation in colours, materials, lighting and furniture. Also there is in none of the hospitals any art in rooms where patients stay a long time and need positive distraction. It is frequently the case that equipment and necessities do not have an obvious location or that no possibility is offered for putting equipment etc. in a cupboard. This contributes to the fact that many rooms are chaotic and unattractive. From the field research we can learn that EBD gives few concrete measures for design. A few EBD measures are important for architecture but they do not give actual rules for the design. The architect designs the totality of functional, programmatic and esthetic aspects of the brief of requirements. This study shows that the quality of the design is indeed important. EBD stands not in the way of architectural quality and architectural quality is no obstruction for the use of EBD.   Commentary and recommendations The functional and programmatical measures from EBD provide the architect with information to design better hospitals. The recommendations that EBD provides for design are also valuable. The field research showed that still many measures from EBD are not applied in hospitals. It is recommended that hospitals and architects take note of EBD in order to realise the positive effects for patients. In the field research an often-heard complaint was that the scientific basis of hospital design is insufficient: more EBD is needed. It is recommended that during the design and building process of a hospital attention is given to research (for example Post Occupancy Evaluation) in order to contribute to the body of knowledge of the positive effects of the 3. The field research showed that the quality of architecture is important in the experience of users and patients. It is recommended that more attention be given to architectural quality in the hospital environment. I also advise that the client gives more attention and is more involved in the design. The client can play a strong role in creating architectonical quality and making a better hospital environment

    Human Rights in Patient Care: A Practitioner Guide - Macedonia

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    Health systems can too often be places of punishment, coercion, and violations of basic rights—rather than places of treatment and care. In many cases, existing laws and tools that provide remedies are not adequately used to protect rights.This Practitioner Guide series presents practical how-to manuals for lawyers interested in taking cases around human rights in patient care. The manuals examine patient and provider rights and responsibilities, as well as procedures for protection through both the formal court system and alternative mechanisms in 10 countries.Each Practitioner Guide is country-specific, supplementing coverage of the international and regional framework with national standards and procedures in the following:ArmeniaGeorgiaKazakhstanKyrgyzstanMacedoniaMoldova (forthcoming)RomaniaRussia (forthcoming)SerbiaUkraineThis series is the first to systematically examine the application of constitutional, civil, and criminal laws; categorize them by right; and provide examples and practical tips. As such, the guides are useful for medical professionals, public health mangers, Ministries of Health and Justice personnel, patient advocacy groups, and patients themselves.Advancing Human Rights in Patient Care: The Law in Seven Transitional Countries is a compendium that supplements the practitioner guides. It provides the first comparative overview of legal norms, practice cannons, and procedures for addressing rights in health care in Armenia, Georgia, Kazakhstan, Kyrgyzstan, Macedonia, Russia, and Ukraine.A Legal Fellow in Human Rights in each country is undertaking the updating of each guide and building the field of human rights in patient care through trainings and the development of materials, networks, and jurisprudence. Fellows are recent law graduates based at a local organization with expertise and an interest in expanding work in law, human rights, and patient care. To learn more about the fellowships, please visit health-rights.org

    Pengaruh Cold Compression Therapy terhadap Proses Penyembuhan Pasien Pasca Open Reduction Internal Fixation (ORIF) Ekstremitas

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    Permasalahan pasca pembedahan ortopedi berkaitan dengan nyeri, perfusi jaringan, promosi kesehatan, mobilitas fisik, dan konsep diri. Perawatan fase pasca operasi ortopedi merupakan upaya untuk menanggulangi efek operasi dan meningkatkan penyembuhan. Manajemen trauma jaringan lunak meliputi proteksi, istirahat, dingin, kompresi, dan elevasi. Hasil analisa penerapan EBN menunjukan bahwa nyeri menurun dari rata-rata 6,6 menjadi 3,2; edema menurun dari rata-rata 49,3 cm menjadi 48 cm; dan rentang gerak sendi lutut dari rata-rata 250 meningkat menjadi 440. Cold compression therapy merupakan terapi modalitas yang digunakan pada berbagai manajemen operasi dengan berbagai variasi prosedur ortopedi dengan kerusakan jaringan berperan dapat meningkatkan proses penyembuhan dengan indikator penurunan nyeri dan edema, serta peningkatan rentang gerak sendi. Cold compression therapy dapat digunakan sebagai standar operasional prosedur untuk memberikan asuhan keperawatan saat 24 – 48 jam pasca ORIF. Kata kunci : cold compression therapy, proses penyembuhan, pasca ORI
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