Proceeding: 3rd Java International Nursing Conference 2015 “Harmony of Caring and Healing Inquiry for Holistic Nursing Practice; Enhancing Quality of Care”, Semarang, 20-21 August 2015

This is the proceeding of the 3rd Java International Nursing Conference 2015 organized by School of Nursing, Faculty of Medicine, Diponegoro University, in collaboration with STIKES Kendal. The conference was held on 20-21 August 2015 in Semarang, Indonesia. The conference aims to enable educators, students, practitioners and researchers from nursing, medicine, midwifery and other health sciences to disseminate and discuss evidence of nursing education, research, and practices to improve the quality of care. This conference also provides participants opportunities to develop their professional networks, learn from other colleagues and meet leading personalities in nursing and health sciences. The 3rd JINC 2015 was comprised of keynote lectures and concurrent submitted oral presentations and poster sessions. The following themes have been chosen to be the focus of the conference: (a) Multicenter Science: Physiology, Biology, Chemistry, etc. in Holistic Nursing Practice, (b) Complementary Therapy in Nursing and Complementary, Alternative Medicine: Alternative Medicine (Herbal Medicine), Complementary Therapy (Cupping, Acupuncture, Yoga, Aromatherapy, Music Therapy, etc.), (c) Application of Inter-professional Collaboration and Education: Education Development in Holistic Nursing, Competencies of Holistic Nursing, Learning Methods and Assessments, and (d) Application of Holistic Nursing: Leadership & Management, Entrepreneurship in Holistic Nursing, Application of Holistic Nursing in Clinical and Community Settings

Improving empirical antibiotic treatment:The role of diagnostic accuracy and surveillance

Antimicrobial Resistance (AMR) is a global health and development threat quickly worsening, especially in low-middle and middle-income countries. Overuse of antibiotics and inappropriate antibiotic treatment are the main drivers of AMR. The thesis describes the use of the urinary dipstick and the adherence to clinical guidelines as ways to improve the diagnostic process of urinary tract infection (UTI) and sepsis, respectively. An improved diagnostic process steers the prescription of the right antibiotic at the right time. Empirical antibiotic treatment requires insight into the prevailing prevalence of AMR, which population-based surveillance provides, in general, more accurate data compared to laboratory-based surveillance. In Southeast Asian countries where the prevalence of AMR is high, there are limited surveillance activities precluding guidance to empirical antibiotic treatment. The thesis discusses findings from current AMR surveillance in Indonesia, showing an extremely high prevalence of AMR in bacterial isolates from urine samples of patients suspected of UTI, threatening rational choices for empirical treatment. The thesis introduces the technique of Lots Quality Assurance Sampling as a way to make AMR surveillance more efficient while obtaining relevant local data to facilitate the choice of an appropriate antibiotic treatment strategy and steer empirical treatment guidelines and antimicrobial stewardship efforts

Medical tourism

Provides an outline of the current research around medical tourism, especially its impact on Australians. Background Medical tourism is a burgeoning industry in our region. It involves patients traveling outside of their home country for medical treatment. Objective This article provides an outline of the current research around medical tourism, especially its impact on Australians. Discussion Patients are increasingly seeking a variety of medical treatments abroad, particularly those involving cosmetic surgery and dental treatment, often in countries in South-East Asia. Adverse events may occur during medical treatment abroad, which raises medico-legal and insurance issues, as well as concerns regarding follow-up of patients. General practitioners need to be prepared to offer advice, including travel health advice, to patients seeking medical treatment abroad. &nbsp

Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations

Abstract Health care-associated infections (HAI) are a major public health problem with a significant impact on morbidity, mortality and quality of life. They represent also an important economic burden to health systems worldwide. However, a large proportion of HAI are preventable through effective infection prevention and control (IPC) measures. Improvements in IPC at the national and facility level are critical for the successful containment of antimicrobial resistance and the prevention of HAI, including outbreaks of highly transmissible diseases through high quality care within the context of universal health coverage. Given the limited availability of IPC evidence-based guidance and standards, the World Health Organization (WHO) decided to prioritize the development of global recommendations on the core components of effective IPC programmes both at the national and acute health care facility level, based on systematic literature reviews and expert consensus. The aim of the guideline development process was to identify the evidence and evaluate its quality, consider patient values and preferences, resource implications, and the feasibility and acceptability of the recommendations. As a result, 11 recommendations and three good practice statements are presented here, including a summary of the supporting evidence, and form the substance of a new WHO IPC guideline

Independent risk factors for the development of incontinence-associated dermatitis (category 2) in critically ill patients with fecal incontinence : a cross-sectional observational study in 48 ICU units

Background: Critically ill patients suffering from fecal incontinence have a major risk of developing incontinence-associated dermatitis (IAD). The presence of moisture and digestive enzymes (lipase, protease) negatively influences skin barrier function. Additional risk factors will make some patients even more vulnerable than others. In order to provide (cost) effective prevention, this specific patient population should be identified timely. Objectives: To identify independent risk factors for the development of IAD category 2 (skin loss) in critically ill patients with fecal incontinence. Design: A cross-sectional observational study. Setting and participants: The study was performed in 48 ICU wards from 27 Belgian hospitals. Patients of 18 years or older, with fecal incontinence at the moment of data collection, were eligible to participate. Patients with persistent skin redness due to incontinence (IAD category 1) were excluded. Methods: Potential risk factors were carefully determined based on literature and expert consultations. Data were collected over a period of eight months by trained researchers using patient records and observation of skin care practices. At the time a patient was included in the study, all relevant data from the past six days, or since admission at the ICU, were recorded. Simultaneously, direct skin observations were performed and high definition photographs were ratified by an expert IAD researcher. A multiple binary logistic regression model was composed to identify independent risk factors. Variables with P < .25 in single binary logistic regression analyses were added to the multiple model using a forward procedure. A cut-off value of P < .1 was established to retain variables in the final model. Nagelkerke's R 2 and Hosmer-Lemeshow statistic were calculated as measures of model fit. Results: The sample comprised of 206 patients, of which 95 presented with IAD category 2, and 111 were free of IAD. Seven independent risk factors were identified: liquid stool [odds ratio (OR) 4.69; 95% confidence interval (CI) 2.28-9.62], diabetes (OR 2.89; 95% CI 1.34-6.27), age (OR 1.05; 95% CI 1.02-1.08), smoking (OR 2.67; 95% CI 1.21-5.91), non-use of diapers (OR 2.97; 95% CI 1.39-6.33), fever (OR 2.60; 95% CI 1.23-5.53), and low oxygen saturation (OR 2.15; 95% CI 1.03-4.48). Nagelkerke's R 2 was 0.377. The Hosmer-Lemeshow statistic indicated no significant difference between the observed and expected values (p = .301). Conclusions: Liquid stool, diabetes, age, smoking, non-use of diapers, fever, and low oxygen saturation were independently associated with IAD category 2 in critically ill patients with fecal incontinence

PATTERN OF COMPLEMENTARY THERAPY USED BY PATIENTS IN DIABETES CARE REGIMENT

Background: Diabetes is chronic health problem which couldnt be cured. Use of medical therapy in a long term need huge budget and increase risk of adverse effect. Complementary/ alternative medicine CAM) is a choice for patient in diabetes care management beside conventional medical therapy. Some of CAM were’nt have enough evidence based support respect to its benefit and adverse effect. Objective: Aim of the study was to explore pattern of use of CAM by diabetic patient. Methods: The study used qualitative descriptive phenomenology method and data collected by in-depth interview. Participants were 4 diabetic patient and 2 of diabetic patient family member who used CAM. Result: Diabetes patients perceive complementary therapy as an effort to manage disease, complement to other diabetes care regiments, and substitutes or complements of medical drugs therapy. Reasons of use of complementary therapy were low cost, practical, and effective therapeutic impact. CAMs used by diabetes patient were herbs, animal, supplement diet, pray, and massage. Sources of information of CAM were families, friends, and traditional healer. Herbs ingredients were boiled, applied with hot water, made like a coffee, or cooked like salads/ vedgetables. Impact of complementary therapy used faced by diabetic patient were both beneficial and detrimental. Discussion: Study findings congruent with other studies. Diabetes patient manage CAM administration by themself and no consultation with health professionals that may harmfull for them eventhough they only experience minor side effect. Its need further study to find conclusive CAM effectivity and safety. Conclutions: The study findings consist of diabetes patient perception about CAM, reasons of CAM uses, how to uses CAM, and impact felt after CAM uses. Use of complementary therapy need to be consulted with health professionals to help diabetic patient consider its adverse effects and beneficials. Keywords : Diabetes, Complementary/ Alternative Medicine (CAM

Vibration therapy reduces CPAP need in a prospective randomised controlled trial

Background: Increased mucus production is a common phenomena following ventilatory support, which might increase morbidity. In order to reduce airway obstruction we tested the effect of vibration therapy on the duration of ventilatory support. Methodology: We conducted a randomised control study in a level IIIC NICU (28 beds) of a university hospital. Compared were nonactive techniques to vibration therapy in preterm infants with a gestational age of 26 - 33 weeks. All infants were ventilated or receive respiratory support by nasal CPAP. Results: 104 infants were enrolled, 49 in the vibration group and 55 in the control group. Demographic characters were in the vibration group compared to control group mean birth weight 1274 (± 335) gram vs. 1240 (± 351) gram and mean gestational age 29.8 (± 1.3) weeks vs. 29.9 (± 1.4) weeks. Vibration therapy did not reduce ventilation time (100 vs. 80 hours, p = 0.88) however duration of CPAP decreases significant (57 vs 157 hours, p < 0.018). Conclusion: Vibration therapy reduced Mean Airway Pressure, oxygen requirements and CPAP need in preterm infants, but did not reduce the duration of mechanical ventilation

National inventory of emergency departments in Singapore

Background: Emergency departments (EDs) are the basic units of emergency care. We performed a national inventory of all Singapore EDs and describe their characteristics and capabilities. Methods: Singapore EDs accessible to the general public 24/7 were surveyed using the National ED Inventories instrument ( http://www.emnet-nedi.org). ED staff members were asked about ED characteristics with reference to calendar year 2007. Results: Fourteen EDs participated (100% response). All EDs were located in hospitals, and most (92%) were independent departments. One was a psychiatric ED; the rest were general EDs. Among general EDs, all had a contiguous layout, with medical and surgical care provided in one area. All but two EDs saw both adults and children; one ED was adult-only, and the other saw only children. Six were in the public sector and seven in private health-care institutions, with public EDs seeing the majority (78%) of ED patients. Each private ED had an annual patient census of 60,000. They received 98% of ambulances and had an inpatient admission rate of 30%. Two public EDs reported being overcapacity; no private EDs did. For both public and private EDs, availability of consultant resources in EDs was high, while technological resources varied. Conclusion: Characteristics and capabilities of Singapore EDs varied and were largely dependent on whether they are in public or private hospitals. This initial inventory establishes a benchmark to further monitor the development of emergency care in Singapore

Patterns of injury and violence in Yaoundé Cameroon: an analysis of hospital data.

BackgroundInjuries are quickly becoming a leading cause of death globally, disproportionately affecting sub-Saharan Africa, where reports on the epidemiology of injuries are extremely limited. Reports on the patterns and frequency of injuries are available from Cameroon are also scarce. This study explores the patterns of trauma seen at the emergency ward of the busiest trauma center in Cameroon's capital city.Materials and methodsAdministrative records from January 1, 2007, through December 31, 2007, were retrospectively reviewed; information on age, gender, mechanism of injury, and outcome was abstracted for all trauma patients presenting to the emergency ward. Univariate analysis was performed to assess patterns of injuries in terms of mechanism, date, age, and gender. Bivariate analysis was used to explore potential relationships between demographic variables and mechanism of injury.ResultsA total of 6,234 injured people were seen at the Central Hospital of Yaoundé's emergency ward during the year 2007. Males comprised 71% of those injured, and the mean age of injured patients was 29 years (SD = 14.9). Nearly 60% of the injuries were due to road traffic accidents, 46% of which involved a pedestrian. Intentional injuries were the second most common mechanism of injury (22.5%), 55% of which involved unarmed assault. Patients injured in falls were more likely to be admitted to the hospital (p &lt; 0.001), whereas patients suffering intentional injuries and bites were less likely to be hospitalized (p &lt; 0.001). Males were significantly more likely to be admitted than females (p &lt; 0.001)DiscussionPatterns in terms of age, gender, and mechanism of injury are similar to reports from other countries from the same geographic region, but the magnitude of cases reported is high for a single institution in an African city the size of Yaoundé. As the burden of disease is predicted to increase dramatically in sub-Saharan Africa, immediate efforts in prevention and treatment in Cameroon are strongly warranted

BARRIERS OF FALL RISK ASSESSMENT AND PREVENTION IMPLEMENTATION IN HOSPITAL SETTING

Falls are the most worrying incidence of patient safety concern that have an impact on injury and death. 1.9 to 3 percent of patients fall in the hospital, with injuries in 6 to 44 percent. Hospitals are making efforts to reduce those fall rates, but its implementation are hindered by a variety of barriers. This study aims to identify the barriers of fall risk assessment and prevention in the hospital. The research method is systematic review using PRISMA, with 15 included studies. Identified barriers includes insufficient knowledge, lack of motivation, absence of champion, lack of resources, inadequate communication, unsustainable program, and support and access shortage. To successfully implement fall prevention programs in hospitals requires a multifaceted, planned approach that includes: regular education and training for staff and patients; provision of equipment; audit, reminders and feedback; leadership and champions; simple programs; and a framework and time for adaptation in the hospital. Keywords: barriers, fall risk assessment, fall prevention, hospita