10-year pattern of admissions in psychiatric unit at a tertiary care hospital in pakistan.

To identify the pattern of psychiatric morbidity in hospitalized patients of a tertiary care unit.Design; Details of patient’s admissions from the case register of psychiatric unit were recorded retrospectively.The study was conducted in Dept. of Psychiatry Jinnah Postgraduate Medical Centre JPMC Karachi and included data of ten years. RESULTS;- TA total of 5527 patients were hospitalized during period of ten years (1995 – 2004). Among them 62.612% (n = 3461) were males and 37.38 (n = 2066) were females. The majority of patients were in the age range of 15 – 44 years. On the basis of ICD classification, mood disorders (F 30 – F 39) (42.42%) were most frequent diagnosis made, followed by schizophrenia, schizotypal and delusional disorders (F20-F29) (26.50%), mental and behavioural disorders due to psychoactive substance use (9.5%).CONCLUSION; Pattern of inpatients psychiatric disorders is slightly different from outpatient population and comprised of mostly patients with un-manageable acute psychiatric disorder. This measure of assessment of needs will help in allocation of resources

Intertemporal Welfare Dynamics

human development, technology

An Exploratory Study of Patient Falls

Debate continues between the contribution of education level and clinical expertise in the nursing practice environment. Research suggests a link between Baccalaureate of Science in Nursing (BSN) nurses and positive patient outcomes such as lower mortality, decreased falls, and fewer medication errors. Purpose: To examine if there a negative correlation between patient falls and the level of nurse education at an urban hospital located in Midwest Illinois during the years 2010-2014? Methods: A retrospective crosssectional cohort analysis was conducted using data from the National Database of Nursing Quality Indicators (NDNQI) from the years 2010-2014. Sample: Inpatients aged ≥ 18 years who experienced a unintentional sudden descent, with or without injury that resulted in the patient striking the floor or object and occurred on inpatient nursing units. Results: The regression model was constructed with annual patient falls as the dependent variable and formal education and a log transformed variable for percentage of certified nurses as the independent variables. The model overall is a good fit, F (2,22) = 9.014, p = .001, adj. R2 = .40. Conclusion: Annual patient falls will decrease by increasing the number of nurses with baccalaureate degrees and/or certifications from a professional nursing board-governing body

Time from adenosine di-phosphate receptor antagonist discontinuation to coronary bypass surgery in patients with acute coronary syndrome: meta-analysis and meta-regression

BACKGROUND: Adenosine di-phosphate receptor antagonists (ADPRAs) blunt hemostasis for several days after administration. This effect, aimed at preventing cardiac ischemic complications particularly in patients with acute coronary syndromes (ACS), may increase perioperative bleeding in the case of cardiac surgery. Practice Guidelines recommend withholding ADPRAs for at least 5days prior to surgery, though with a weak base of evidence. The purpose of this study was to systematically review observational and experimental studies of early or late preoperative discontinuation of ADPRAs prior to coronary artery bypass grafting (CABG) for patients with ACS. METHODS: MEDLINE, EMBASE, the Cochrane Library databases up to December 2011; and reference lists. Observational and experimental studies that compared early ADPRA discontinuation with late discontinuation, or no discontinuation, in patients with ACS undergoing CABG. RESULTS: There were 19 studies, including 14,046 participants, 395 deaths and 309 reoperations due to bleeding. ADPRA late discontinuation up to CABG was associated with an increased risk of postoperative mortality (OR 1.46, 95% confidence interval (CI) 1.10 to 1.93) and reoperations due to bleeding (OR 2.18; 95% CI 1.47 to 2.62). Between-study heterogeneity was low. Meta-analysis limited to high quality or prospective studies gave consistent results. In most instances, the 95% prediction intervals for summary risk estimates confirmed the risk across study groups. CONCLUSIONS: ADPRA late discontinuation prior to CABG is associated with an increased risk of death and reoperations due to bleeding in patients with ACS. The confidence in the estimates of risk for late discontinuation is moderate to high

Indigenous agency in global systems

The article addresses expanding of global economic systems by studying Sámi strategies addressing Norwegian High Northern Policies (NHNP) launched by the Norwegian Ministry of Foreign Affairs from 2005. NHNP attracted global economy, labour and knowledge to the Arctic region. The Sámi responding are analysed by using agency theories in economic geography, and contributes to expand the content of agencies e.g. by understanding its embedding in specific historical shaped structures as well as in debates on new opportunity spaces in the wake of globalism. The study demonstrates three strategies debated and launched by the Sámi Parliament: (i) In grounding its resistance the Sámi Parliament argued that the entry of international industries into areas with Sámi population threaten the fundamental conditions for Sámi livelihood. (ii) By entering global governance the parliament emphasized the importance of Sámi negotiation with multinational companies in global governance frameworks. (iii) And by changing the historical understanding of Sámi territories in order to include research and higher education milieus outside remote rural districts

Real-World Evidence in Healthcare Decision Making : Global trends and case studies from Latin America

Objectives: Real-world evidence (RWE) is increasingly used to inform health technology assessments (HTAs) for resource allocation, which are valuable tools for emerging economies such as in America. However, the characteristics and uses in South America are unknown. This study aims to identify sources, characteristics and uses of RWE in Argentina, Brazil, Colombia and Chile, and evaluate the context-specific challenges. The implications for future regulation and responsible management of RWE in the region are also considered. Methods: A systematic literature review, database mapping, and targeted grey literature search were conducted to identify the sources and characteristics of RWE. Findings were validated by key opinion leaders attending workshops in four South American countries. Results: A database mapping exercise revealed 407 unique databases. Geographic scope, database type, population and outcomes captured were reported. Characteristics of National Health Information Systems show efforts to collect interoperable data from service providers, insurers and government agencies, but that initiatives are hampered by fragmentation, lack of stewardship and resources. RWE is mainly used in South America for pharmacovigilance and as pure academic research, but less so for HTA decision-making or pricing negotiations and not at all to inform early access schemes. Conclusions: The quality of data collected in real-world in the case-study countries varies and RWE is not consistently used in healthcare decision-making. Authors recommend that future studies monitor the impact of digitalisation, and the potential effects of access to RWE on the quality of patient care

Assessing the effectiveness of if-then plans to facilitate increased fruit and vegetable intake in adults

Non-communicable diseases (NCDs) are prevalent, causing high rates of morbidity and mortality. A diet rich in fruit and vegetables are important in the prevention and management of NCDs. If-then plans is a planning strategy that could facilitate eating behaviour change by creating a mental link between a cue and a response in an “If…, then…”-structure. The aim was to investigate the effectiveness of if-then plans to facilitate increased fruit and vegetable intake in adults. The second objective was to investigate if the effectiveness of if-then plans is related to differences in sample population or planning factors. A systematic review and random-effects meta-analysis (REML) were conducted and reported (PRISMA 2020). Three databases were searched (Nov. 2022). Included studies were RCTs, testing the effect of if-then plans on fruit and/or vegetable intake in adults. Quality of the evidence was assessed with RoB 2 and GRADE. Ten studies were included. If-then plans had a small statistically significant effect (SMD(d) = 0.23, 95% CI: 0.09, 0.37) on fruit and vegetable intake. There was not a statistically significant difference between subgroups (both ps > .05). The confidence in the evidence was graded to be of moderate quality

Understanding construction delay analysis and the role of pre-construction programming

Copyright © 2013, American Society of Civil Engineers. This is the author's accepted manuscript. The final published article is available from the link below.Modern construction projects commonly suffer from delay in their completions. The resolution of time and cost claims consequently flowing from such delays continues to remain a difficult undertaking for all project parties. A common approach often relied on by contractors and their employers (or their representatives) to resolve this matter involves applying various delay analysis techniques, which are all based on construction programs originally developed for managing the project. However, evidence from literature suggests that the reliability of these techniques in ensuring successful claims resolution are often undermined by the nature and quality of the underlying program used. As part of a wider research carried out on delay and disruption analysis in practice, this paper reports on an aspect of the study aimed at exploring preconstruction stage programming issues that affect delay claims resolutions. This aspect is based on an in-depth interview with experienced construction planning engineers in the United Kingdom, conducted after an initial large-scale survey on delay and disruption techniques usage. Summary of key findings and conclusions include: (1) most contractors prefer to use linked bar chart format for their baseline programs over conventional critical path method (CPM) networks; (2) baseline programs are developed using planning software packages. Some of these pose difficulties when employed for most delay analysis techniques, except for simpler ones; (3) manpower loading graphs are not commonly developed as part of the main deliverables during preconstruction stage planning. As a result, most programs are not subjected to resource loading and leveling for them to accurately reflect planned resource usage on site. This practice has detrimental effects on the reliability of baseline programs in their use for resolving delay claims; and (4) baseline program development involves many different experts within construction organizations as expected, but with very little involvement of the employer or its representative. Active client involvement is however quite important as it would facilitate quick program approval/acceptance before construction, a necessary requirement for early delay claims settlement, which otherwise are often left unresolved long after the delaying events with the potential of generating into expensive disputes. The study results provide a better understanding of the key issues that need attention if improvements are to be made in delay claim resolutions. Additional research focusing on the testing of these results using a much larger sample and rigorous statistical analysis for generalization purposes would be helpful in advancing the limited knowledge of this subject matter