Expert assessment of practical approaches to optimize the participation of nurses in obtaining informed consent from the patient

INTRODUCTION: Nurses are an important resource to the health system and occupy a significant place in providing effective and quality healthcare. At the same time, obtaining informed consent is an important aspect in the nurses` work. Therefore, the opinion survey and the evaluation of experts on developing practical approaches aim to optimize the participation of nurses in the process of informed consent and have a great scientific and practical significance.AIM: To study the opinion and evaluation of experts on developing practical approaches to optimize the participation of nurses in the process of obtaining informed consent.MATERIALS AND METHODS: We have attached an analysis of the literature and used a documentary and an expert assessment method. An expert assessment of our own developed practical approaches was performed in the period March-September, 2015. It involved 50 experts - chief and senior nurses at the St. Marina University Hospital and used a questionnaire method of interviewing. Its aim was to optimize the participation of nurses in the process of informed consent of the patient.RESULTS: The majority of the experts approved the presented algorithm for obtaining informed consent from the patient and confirmed that the algorithm can be applied in the working process of the nurses. With regard to the presented data sheet for obtaining informed consent for intravenous injection (invasive nursing manipulation) the experts expressed concerns about the possible difficulties in putting it into practice, citing the shortage of nursing staff and time. A significant majority of experts, however, approved the technical sheet and evaluated it as applicable in nursing practice.CONCLUSIONS: The results of the expert assessment lead to the conclusion that the proposed practical approaches are applicable in nursing practice and will help to optimize the process of informed consent, respect the patient‘s right to informed consent, the professional comfort and safety of nurses

Ecological And Epidemiological Aspects Of The Listeria Infection In Bulgaria

Листериозата е рядко диагностицирана инфекция сред хората. Причинител на заболяването е Listeria monocytogenes, устойчив в околната среда грам-положителен микроорганизъм. Честотата на заболяването сред хората е 0,52 на 100 000 и нараства. В България се отбелязва трайна тенденция на нарастване броя на установените заболявания, леталитетът достига до 60%. Болестта протича с обща интоксикация и полиорганна симптоматика и се регистрира като менингит, сепсис, листериоза на новороденото. При бременните рядко се засяга ЦНС, но през плацентата инфекциозният агент уврежда мозъка, белите дробове и други органи на плода. Заболяемостта в България варира от 0,04 до 0,18 на 100 000 през 2017 г. През периода 2009-2017 г. са установени 62 болни от листериоза, като общо 29 или 46,77% от тях, са свързани с бременност. В последните години епидемичният процес се отдалечава значително от епизоотичния процес. Нараства делът на заболяванията, свързани с консумация на определени храни – съхранявани в хладилник и консумирани без термична обработка. Изследването на екологичните аспекти на епидемичния процес на листериозата има значение за подобряване диагностиката и лечението на болните, както и за профилактиката на заболяването чрез намаляване риска при производство и съхранение на храните.Listeriosis is a rarely diagnosed infection in humans. The cause of the disease is Listeria monocytogenes, an environmentally resistant gram-positive microorganism. The incidence of the disease among people is 0.52 per 100,000 and increases. In Bulgaria there is a steady trend of increasing the number of established cases with the lethality reaching 60%. The disease occurs with general intoxication and multiple organ symptoms and is often registered as meningitis, sepsis, listeriosis of the newborn. Pregnant women’s central nervous system (CNS) is rarely affected, but through the placenta the infectious agent damages the brain, lungs and other organs of the fetus. Morbidity in Bulgaria ranges from 0.04 to 0.18 per 100,000 in 2017. During the period 2009-2017, 62 patients were diagnosed with listeriosis, with a total of 29 or 46.77% associated with pregnancy. In the last few years, the epidemic process has receded significantly from the epizootic process. The number of diseases related to the consumption of certain foods - refrigerated and consumed without thermal treatment - is increasing. Examination of the environmental aspects of the listeriosis epidemic process is important for improving the diagnosis and treatment of patients as well as for disease prevention by reducing the risk in food production and storage

Manage epidemiological risk for HIV infection in the maritime transport and shipments

AIDS is a disease which is caused by the human immunodeficiency virus - HIV. Today HIV / AIDS is a global health, social and economic problem and a cause of high mortality. There are three main ways of HIV transmission: sexual transmission; blood and vertical. Lead is sexually transmitted - 87 percent in various forms of sexual intercourse without a condom. In particular, the use of services of prostitutes and nonuse of condom. Traveling abroad (mobile population) as economic migrants, on the occasion of trips, work, business trip, vacation is a vulnerable group for HIV / AIDS. Analyzing the spread of HIV / AIDS in the world and the country - 45% of new HIV infections occur in African Americans, 35% of whites and 17% for Hispanics. (10) our geographical location, the development of tourism, our status as a port city and describing the epidemiological risk for HIV among sailors and travelers have the need to study the epidemiology of HIV / AIDS in terms of shipping and transportation

Importans of the epidemiological control of insects and rodents for the navigation and limitation of infectious risk

The study of the characteristics of monitoring and control of epidemiologically significant insects and rodents in terms of navigation is a key to achieving effective ship‘s disinsection and deratisation (deratting). The success is a result of systematic and timely performed pest control. In international perspective ever closer the institutions work for the unification of these measures and the criteria for certification. In the contemporary conditions of globalization and intensive exchange of goods and passenger the vessels and vehicles can play an important role in the spread of infected rodents and insects in the world.Objective: To present to the medical and non-medical professionals related with navigation, the importance of bloodsucking insects and rodents for the spread of infectious diseases and to emphasize the importance of control measures against them to prevent „ship-associated infections`. Tasks: To present the targeted persons the specifics of control of insects and rodents in the vessels.Materials and Methods: The included teaching is consistent with the International Health Regulations (IHR 2005). They were studied historical materials, articles, epidemiological studies and analyzes of the WHO for the spread of communicable diseases. Manuals for anti-epidemic control and certification of vessels were used.Results and Discussion: Epidemiological significant rodents and insects can penetrate active or passive on vessels. They appear a risk factor for human health and the technical condition of the ship. It is essential the management, monitoring and actions related to pest control

Border health control in ports of the republic of Bulgaria and programmes for the management of infectious risk

According to the International Health Regulations as a risk for the public health are determined infectious diseases, radiation and chemical pollution. Urbanization and technological progress are a prerequisite for increasing the importance of these risks. The border crossing is facilitated, the area of spread of some infectious diseases expanded, they emerged new ones. We are witnesses of intensive migration of large groups of people without information about their health status. The system of medical control has as a basic order not to hinder the transport of goods and cargo, not to hinder people in their professional and personal trips. There remains the need to control the medical and health risk. Underway are several international projects and programs in this area. Inspectors carrying out border health control at the port of Varna actively participate in these activities. The trainings have aim to exchange experience, best practices and research for objectification of control. It must be optimization of administrative procedures, unification of issued international documents, a providing of ongoing training for border medical services, manning companies and ships` crews.Materials and methods: We used official documents of the WHO and the Republic of Bulgaria, working materials of international programs, official statistics RHI Varna for 2013 and 2014.Results and discussion: The border health control is essential for communicable disease surveillance - the preventing of import and spread of quarantine and especially dangerous infections, timely assessment and response to health risks for public health. It is done in accordance with the International Health Regulations (2005), Regulations on border crossings and border health control. Electronic systems are introduced for exchanging information, which requires good professional training of border medical services. The responsibility of seafarers increases because completing and bringing specific information into the electronic system. The importance of experience and communication between crews and medical services in order preparedness for rapid reaction grows. Realized are various education and training projects, optimized are health documents and protocols. It is necessary a development of target programs on particular problems of border health control to maintain the preparedness of seafarers and institutions for timely identification of health risks and adequate response

Sea epidemiology in teaching maritime medicine - prevention of infectious diseases, being subject to international health regulation and controlled by WHO

Naval Medicine is a scientific and practical direction with a complex interdisciplinary character and is a state policy in countries like Spain, Britain, Poland and the USA. Naval Medicine is defined as a system of scientific knowledge and practical activities, whose purpose is to protect and to gain in health of seafarers, life extension, prevent and treat diseases in humans. Sea epidemiology is a very important part of the medical disciplines. It is formed as a separate direction of epidemiology and as a section of maritime medicine in the 70s-90s of the twentieth century. During a trip the parasitic system, which interacts with the crew of the ships, operates completely differently than in conditions of residence on land, which requires specific approaches for the organization of prevention of infectious diseases during the journey and on land. The control of diseases, which are subject to the international health regulation, is an essential aspect of the marine epidemiology. In the directions for work on the implementation of the International Health Regulations (2005) in 2007 is said, that we should be ready for response in infectious diseases, which may arise as a result of sudden and rapid environmental and climatic changes as a result of industrial pollution and accidents that can put at risk millions of people in many countries and that is why they require measures of worldwide importance to be taken. The measures to protect public health are a significant section in the travel and the transport. Тhe management of infections by means of vaccine agents takes an important place in the system of actions. It finds systemic application in terms of maritime epidemiology as a tool for managing the infectious risk according to the number of vaccination avertible infections. Maritime training epidemiology should include the main sections of the general and private epidemiology in a constantly changing ecological and social environment of sea travel and transport

Preparation and characterization of a zinc oxide nanopowder supported onto inorganic clay.

Zinc oxide nanoparticles are obtained by a wet chemical method using zinc sulphate as a raw material. Doping sepiolite, micro-fibrous inorganic clay, with ZnO after precipitation under basic conditions and subsequent thermal treatment is investigated as both materials are abundant. They are used for the development of humidity and gas sensors of great environmental importance. The particle size distribution, the morphology and the composition of the powder samples are characterized by X-Ray diffraction accompanied by Field Emission Scanning Electron Microscopy and High Resolution-Transmission Electron Microscopy techniques. The data obtained confirm the formation of zinc oxide nanoparticles of a size of 10 nm on the modified sepiolite grains

Wave effects on coastal upwelling and water level

Traditional atmosphere, ocean and wave models are run independently of each other. This means that the energy and momentum fluxes do not fully account for the impact of the oceanic wave field at the air-sea interface. In this study, the Stokes drift impact on mass and tracer advection, the Stokes-Coriolis forcing, and the sea-state-dependent momentum and energy fluxes are introduced into an ocean circulation model and tested for a domain covering the Baltic Sea and the North Sea. Sensitivity experiments are designed to investigate the influence on the simulation of storms and Baltic Sea upwelling. Inclusion of wave effects improves the model performance compared with the stand-alone circulation model in terms of sea level height, temperature and circulation. The direct sea-state-dependent momentum and turbulent kinetic energy fluxes prove to be of higher importance than the Stokes drift related effects investigated in this study (i.e., Stokes-Coriolis forcing and Stokes drift advection on tracers and on mass). The latter affects the mass and tracer advection but largely balances the influence of the Stokes-Coriolis forcing. The upwelling frequency changes by >10% along the Swedish coast when wave effects are included. In general, the strong (weak) upwelling probability is reduced (increased) when adding the wave effects. From the results, we conclude that inclusion of wave effects can be important for regional, high-resolution ocean models even on short time scales, suggesting that they should be introduced in operational ocean circulation models. However, care should be taken when introducing the Stokes-Coriolis forcing as it should be balanced by the Stokes drift in mass and tracer advection

Long-term and large-scale multispecies dataset tracking population changes of common European breeding birds

Around fifteen thousand fieldworkers annually count breeding birds using standardized protocols in 28 European countries. The observations are collected by using country-specific and standardized protocols, validated, summarized and finally used for the production of continent-wide annual and long-term indices of population size changes of 170 species. Here, we present the database and provide a detailed summary of the methodology used for fieldwork and calculation of the relative population size change estimates. We also provide a brief overview of how the data are used in research, conservation and policy. We believe this unique database, based on decades of bird monitoring alongside the comprehensive summary of its methodology, will facilitate and encourage further use of the Pan-European Common Bird Monitoring Scheme results.publishedVersio

EuroGOOS roadmap for operational coastal downstream services

The EuroGOOS Coastal working group examines the entire coastal value chain from coastal observations to services for coastal users. The main objective of the working group is to review the status quo, identify gaps and future steps needed to secure and improve the sustainability of the European coastal service provision. Within this framework, our white paper defines a EuroGOOS roadmap for sustained “community coastal downstream service” provision, provided by a broad EuroGOOS community with focus on the national and local scale services. After defining the coastal services in this context, we describe the main components of coastal service provision and explore community benefits and requirements through sectoral examples (aquaculture, coastal tourism, renewable energy, port, cross-sectoral) together with the main challenges and barriers to user uptake. Technology integration challenges are outlined with respect to multiparameter observations, multi-platform observations, the land-coast-ocean continuum, and multidisciplinary data integration. Finally, the technological, financial, and institutional sustainability of coastal observing and coastal service provision are discussed. The paper gives special attention to the delineation of upstream and downstream services, public-private partnerships and the important role of Copernicus in better covering the coastal zone. Therefore, our white paper is a policy and practice review providing a comprehensive overview, in-depth discussion and actionable recommendations (according to key short-term or medium-term priorities) on the envisaged elements of a roadmap for sustained coastal service provision. EuroGOOS, as an entity that unites European national operational oceanography centres, research institutes and scientists across various domains within the broader field of operational oceanography, offers to be the engine and intermediary for the knowledge transfer and communication of experiences, best practices and information, not only amongst its members, but also amongst the different (research) infrastructures, institutes and agencies that have interests in coastal oceanography in Europe