Computerized Medical Care: The HELP System at LDS Hospital

journal articleBiomedical Informatic

“I don't eat when I'm sick”: Older people's food and mealtime experiences in hospital

Background Inadequate dietary intake is a common problem amongst older acute-care patients and has been identified as an independent risk factor for in-hospital mortality. This study aimed to explore whether food and mealtime experiences contribute to inadequate dietary intake in older people during hospitalisation. Methods This was a qualitative phenomenological study, data for which were collected using semi-structured interviews over a three-week period. During this time, 26 patients aged 65 years or more, admitted to medical and surgical wards in a tertiary acute-care hospital, were asked to participate if they were observed to eat less than half of the meal offered at lunch. Participants provided their perspectives on food and mealtimes in hospital. Responses were recorded as hand-written notes, which were agreed with the interviewee, and analysed thematically using the framework method. Results Twenty-five older people were interviewed across six wards. Two main themes, ‘validating circumstances’ and ‘hospital systems’, were identified. Each theme had several sub-themes. The sub-themes within validating circumstances included ‘expectations in hospital’, ‘prioritising medical treatment’, ‘being inactive’, and ‘feeling down’. Those within ‘hospital systems’ were ‘accommodating inconvenience’, ‘inflexible systems’, and ‘motivating encouragement’. Conclusion Inadequate dietary intake by older hospital patients is complex and influenced by a range of barriers. Multilevel and multidisciplinary interventions based on a shared understanding of food and nutrition as an important component of hospital care are essential to improve dietary intake and reduce the risk of adverse clinical outcomes. Improving awareness of the importance of food for recovery amongst hospitalised older people and healthcare staff is a priority

Systematic Literature Review of the Evidence for Effective National Immunisation Schedule Promotional Communications

Introduction: A systematic literature review examined the published evidence on the effectiveness of European promotional communications for national immunisation schedule (NIS) vaccinations. The review was commissioned by the European Centre for Disease Prevention and Control (ECDC) and conducted by the Institute for Social Marketing at the University of Stirling.The purpose of the review: ‘Immunisation hesitancy' has negatively impacted population uptake of routine immunisation. A substantial body of evaluated communication activity promoting nationally indicated routine immunisation has been published. This systematic review of the evidence aims to: collate and map the types of promotional communication that have been used; assess the quality of the evaluative research reporting on these promotional communications; and assess the applicability of this evidence to immunisation policy, strategy and practice priorities. The analysis and findings are intended to provide a current status report on the evidence, and evidence gaps for good practice in national immunisation promotional communications, thus supporting countries in their communication activities for the prevention and control of communicable diseases.Objectives of the review: The review aimed to answer the following research questions: Which audiences have been targeted by NIS promotional communications? Which communication methods and approaches have been used to promote or reinforce NIS vaccination uptake? What theoretical underpinnings are used to inform communication methods and approaches? Which settings and communication channels have been used to promote or reinforce NIS vaccination uptake? What is the evidence for effectiveness of communication initiatives in changing or reinforcing knowledge, attitudes or behaviour towards NIS? What is the evidence for impact of NIS communication initiatives to control communicable disease? What impact have campaign communications promoting NIS had on public acceptance and vaccine uptake rates

Evaluation of the Nimbin Integrated Services Project

This report is an evaluation of a Nurse Practitioner-led integrated service for mental health and drug and alcohol clients, in a small town in rural NSW.Dept of Premier and Cabinet, NS

Neuraminidase inhibitors for preventing and treating influenza in healthy adults and children

BACKGROUND: Neuraminidase inhibitors (NIs) are stockpiled and recommended by public health agencies for treating and preventing seasonal and pandemic influenza. They are used clinically worldwide. OBJECTIVES: To describe the potential benefits and harms of NIs for influenza in all age groups by reviewing all clinical study reports of published and unpublished randomised, placebo-controlled trials and regulatory comments. SEARCH METHODS: We searched trial registries, electronic databases (to 22 July 2013) and regulatory archives, and corresponded with manufacturers to identify all trials. We also requested clinical study reports. We focused on the primary data sources of manufacturers but we checked that there were no published randomised controlled trials (RCTs) from non-manufacturer sources by running electronic searches in the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE (Ovid), EMBASE, Embase.com, PubMed (not MEDLINE), the Database of Reviews of Effects, the NHS Economic Evaluation Database and the Health Economic Evaluations Database. SELECTION CRITERIA: Randomised, placebo-controlled trials on adults and children with confirmed or suspected exposure to naturally occurring influenza. DATA COLLECTION AND ANALYSIS: We extracted clinical study reports and assessed risk of bias using purpose-built instruments. We analysed the effects of zanamivir and oseltamivir on time to first alleviation of symptoms, influenza outcomes, complications, hospitalisations and adverse events in the intention-to-treat (ITT) population. All trials were sponsored by the manufacturers. MAIN RESULTS: We obtained 107 clinical study reports from the European Medicines Agency (EMA), GlaxoSmithKline and Roche. We accessed comments by the US Food and Drug Administration (FDA), EMA and Japanese regulator. We included 53 trials in Stage 1 (a judgement of appropriate study design) and 46 in Stage 2 (formal analysis), including 20 oseltamivir (9623 participants) and 26 zanamivir trials (14,628 participants). Inadequate reporting put most of the zanamivir studies and half of the oseltamivir studies at a high risk of selection bias. There were inadequate measures in place to protect 11 studies of oseltamivir from performance bias due to non-identical presentation of placebo. Attrition bias was high across the oseltamivir studies and there was also evidence of selective reporting for both the zanamivir and oseltamivir studies. The placebo interventions in both sets of trials may have contained active substances. Time to first symptom alleviation. For the treatment of adults, oseltamivir reduced the time to first alleviation of symptoms by 16.8 hours (95% confidence interval (CI) 8.4 to 25.1 hours, P 1000) and nausea whilst on treatment (RD 4.15%, 95% CI 0.86 to 9.51); NNTH = 25 (95% CI 11 to 116). AUTHORS' CONCLUSIONS: Oseltamivir and zanamivir have small, non-specific effects on reducing the time to alleviation of influenza symptoms in adults, but not in asthmatic children. Using either drug as prophylaxis reduces the risk of developing symptomatic influenza. Treatment trials with oseltamivir or zanamivir do not settle the question of whether the complications of influenza (such as pneumonia) are reduced, because of a lack of diagnostic definitions. The use of oseltamivir increases the risk of adverse effects, such as nausea, vomiting, psychiatric effects and renal events in adults and vomiting in children. The lower bioavailability may explain the lower toxicity of zanamivir compared to oseltamivir. The balance between benefits and harms should be considered when making decisions about use of both NIs for either the prophylaxis or treatment of influenza. The influenza virus-specific mechanism of action proposed by the producers does not fit the clinical evidence

Family adjustment after brain injury : understanding and intervening

This portfolio is made up of three sections:Part one is a systematic literature review, in which the empirical literature relating to family-based interventions after brain injury –delivered both face-to-face by therapists and utilising new telehealth delivery methods –is reviewed and critically contrasted. It aims to explore the effectiveness of these delivery methods.Part two is an empirical paper exploring the shared relationship of mothers and non-injured siblings of young adults who have incurred severe traumatic brain injury. This was implemented using semi-structured interviews and analysed using Interpretative Phenomenological Analysis, with consequent themes discussed in the context of established empirical and theoretical literature.Part three comprises the appendices, including further information for parts one and two, as well as reflective and epistemological statements

Horizontal Violence Effect on Nurse Retention

Horizontal violence is known by a variety of terms such as lateral violence, bullying, and incivility. Christie and Jones (2014) describe lateral violence as a problem in nursing where a behavior is demonstrated through harmful actions that occur between nurses. Studies have revealed how horizontal violence affects nurse retention. Horizontal violence is a relevant issue in the healthcare community, yet often goes undiscussed. Walrafen (2012) explains that an outcome of horizontal violence in nursing is directly proportional to a decrease in retention of nurses. Sherman (2012) proclaimed that nurses who are subjected to horizontal violence have low self-esteem, depression, excessive sick leave, and poor morale. As Wilson (2011) identified nurses, who witness or experience horizontal violence have an increased desire to leave the organization where the bullying takes place. Horizontal violence is a pervasive source of occupational stress with physical, psychological, and organizational consequences (Hauge, et al, 2010). Roy (2007) describes this as an unkind, discourteous manner in which nurses relate to their colleagues. As nurses seek to perform their daily tasks, other co-workers may embarrass them for their lack of knowledge, tease them as they participate in informal cliques, or demean them for their technique (Bakker, 2012). Creating excuses, taunting, and refusing to share information, nursing education or knowledge are examples of horizontal violence (Ball, 1996)

The Influence Of Social And Economic Factors On Breastfeeding And Rural Mothers

Little is known or understood about rural mothers and their experience with breastfeeding. The literature demonstrates a sound understanding of the factors that influence mothers and breastfeeding; however, it is unclear what factors influence breastfeeding among rural mothers. A search of the literature offered thousands of articles related to urban mothers and their breastfeeding experience, but few describe the rural mother’s breastfeeding experience. Therefore, the purpose of this study is to investigate the basic process that characterizes breastfeeding among mothers in the rural setting and to develop a theory based on the investigation of factors that influence breastfeeding among rural mothers. Because little is known, a grounded theory approach provides the best avenue to investigate the interactions between mother and baby. This study attempts to address the current information gap related to rural mothers and their breastfeeding experience. Health care providers in rural areas face many challenges to providing breastfeeding support and services to mothers. Both rural hospitals and rural communities have breastfeeding gaps. Rural mothers experience access barriers to breastfeeding support; however, some can overcome breastfeeding barriers. Hospital nurses and lactation consultants who demonstrate specific support characteristics can provide rural mothers with breastfeeding support that could significantly impact rural health outcomes. KEYWORDS: Breastfeeding, Rural Mothers, Mothers Breastfeeding, Breastfeeding Barrier

Existential Sustainability: An investigation of Loneliness and Belonging in Relation to Sustainable Housing

The strive to create sustainable societies is often addressed through the lens of social, economic-, or environmental sustainability. However, this division fails to acknowledge existential dimensions of sustainability, i.e., the fundamental concern to sustain a good and meaningful life. This paper expands the notion of Existential Sustainability in relation to socio-material dimensions and built environments. The paper responds to a double crisis in Sweden with growing loneliness and a severe housing crisis. 40% of Sweden’s households are single households and the production of new homes is characterized by small apartments. At the same time mental health problems among young adults haveincreased, as well as the experienced loneliness among elderly. This paper explores the rich relation between housing and existential sustainability through earlier research, statistics, and data from an ongoing project with Uppsala municipality. By doing so this paper aim to further expand and deepen the discussion on existential dimensions of housing in relation to UN’s SDG