An insight to nurse workload: predicting activities in the next shift and analyzing bedside alarms influence

The effects of nursing shortage and the increasing nursing workload have been emphasized in recent years. Hospitals and healthcare organizations have actively implemented initiatives to combat the workforce shortage and mitigate the effects of high workload among their nurses. In cooperation with a Dutch hospital, this project seeks to understand the workload of nurses by understanding what will happen in the next shift and by measuring the alarm workload of their nurses, particularly the bedside alarms that send signals to wifi phones of nurses, to obtain a partial workload of nurses that may reflect the intensity level of the total nurse workload. The project also investigates the effects of the alarm workload, patient, working condition and staff individuality on nurse performance. Finally, the project seeks to discover possible contributing factors to the alarm occurrence, therefore finding a mitigation to reduce the bedside alarm workload

Shoulder complaints : the occurence, course and diagnosis

Shoulder complaints are expressed in a variety of symptoms. In many cases, the prominent symptom is pain. In some cases, pain is present most of the day and frequently also at night. In other cases, it is provoked primarily by physical activities. Often it is accompanied by restricted range in shoulder movement. This inhibit people in their daily lives by reducing their ability to use their arm in activities such as dressing, personal hygiene, work, household activities, hobbies and sports. These shoulder symptoms may also lead to sick leave, bringing costs to the workers themselves, as well as to employers and society. Although these are a common musculoskeletal complaint, the estimated prevalence of shoulder complaints varies considerably

Importancia del aprestamiento en Educación Inicial para el desarrollo del pensamiento lógico matemático de los niños y niñas de multinivel, turno matutino de la Escuela Adic-Venancia del departamento de Matagalpa, durante el segundo semestre del año 2016

Mediante la presente investigación se estudió: El aprestamiento en educación inicial para la adquisición del aprendizaje. Se aborda además la importancia del aprestamiento en educación inicial para el desarrollo del pensamiento lógico matemático de los niños y niñas de multinivel, turno matutino de la Escuela Adic-Venancia del departamento de Matagalpa, durante el segundo semestre del 2016, con el objetivo de analizar la importancia del aprestamiento en educación inicial para el desarrollo del pensamiento lógico matemático de los niños y niñas. Esta temática es importante debido a que las actividades lúdicas son poco apreciadas como una herramienta básica para lograr el desarrollo del pensamiento lógico matemático de los educandos. Por eso mediante esta investigación se pretende identificar las actividades que se implementan para el aprestamiento del pensamiento lógico. Además de describir la importancia del aprestamiento en el pensamiento lógico matemático de los niños y niñas de multinivel de educación inicial. El aprestamiento para el desarrollo del pensamiento lógico matemático es importante, porque a través de él se estimula la evolución de las capacidades innatas del niño y la niña de educación inicial sin embargo, en los salones de clase no se están implementando estrategias metodológicas que le ayuden al niño en dicho desarrollo es por ello que se proponen actividades para favorecer el desarrollo del pensamiento lógico matemático tales como: ejercicios de ubicación espacial, clasificación, seriación, bloques lógicos, rompecabezas, domino de diferencias, cantos, otro

Doctors' preferences in de-escalating DMARDs in rheumatoid arthritis: A discrete choice experiment

Background: Current guidelines suggest reduction of DMARDs can be considered in RA patients in remission. Objectives were (1) to estimate the relative importance of patient characteristics rheumatologists consider in their decision to de-escalate (2) to assess whether heterogeneity exists among rheumatologists with respect to de-escalation and (3) to identify the preferred de-escalation strategy. Methods: A discrete choice experiment (DCE) was conducted. All rheumatologists and trainees in The Netherlands were invited to participate. A conditional logit model was estimated to assess overall preference for de-escalation and its determinants. Heterogeneity was estimated by latent class analysis. Results: The DCE questionnaire was completed by 156 doctors. This questionnaire was constructed using the results of semi-structured interviews with 12 rheumatologists that identified five patient characteristics relevant for de-escalation: number of swollen joints (SJC), presence of DAS remission/low disease activity (LDA), patient history, duration of remission/LDA and patient willingness to de-escalate DMARDs. Overall SJC and patient history were most important. Latent class analysis revealed five subgroups of doctors, showing differences regarding willingness to de-escalate and relative importance of patient characteristics. De-escalation of the TNF inhibitor rather than methotrexate first was the most preferred strategy. Conclusions: Rheumatologists are not uniform in their decision on whom to de-escalate. Differences emerged in which characteristics they traded off resulting in five subgroups: those that taper (1) always, (2) in absence of swollen joints, (3) in absence of swollen joints and presence of favorable patient history, (4) in DAS remission and favorable patient history, and (5) taking into account all factors

Focus group interviews reveal reasons for differences in the perception of disease activity in rheumatoid arthritis

Objective: Doctors frequently see patients who have difficulties coping with their disease and rate their disease activity high, despite the fact that according to the doctors, the disease activity is low. This study explored the patients’ perspectives on this discordance that may help to understand why for some patients, usual care seems to be insufficient. Methods: In our qualitative study we conducted focus group interviews where questions were used as a guideline. Transcripts were analyzed using inductive thematic analysis. Findings: Twenty-nine patients participated in four focus groups. Participants could not put their finger exactly on why doctors estimated that their disease activity was low, while they experienced high levels of disease activity. During the in-depth focus interviews, seven themes emerged that appeared related to high experienced disease activity: (1) perceived stress, (2) balancing activities and rest, (3) medication intake, (4) social stress, (5) relationship with professionals, (6) comorbidity, and (7) physical fitness. Conclusion: When patients were asked why their view of their disease activity was different from that of their physician, seven themes emerged. The way participants coped with these themes seemed to be the predominant concept. Specific interventions that focus on one or more of the reported themes and on coping may improve not only the quality of life of these patients but also the satisfaction with the patient–doctor relationship for both parties

How to study determinants related to medication adherence in newly diagnosed polyarthritis patients for the development of a prediction instrument

Introduction: For patients with a chronic disease, the appropriate use of medication is the key to manage their illness

A five-year model to assess the early cost-effectiveness of new diagnostic tests in the early diagnosis of rheumatoid arthritis

__Background:__ There is a lack of information about the sensitivity, specificity and costs new diagnostic tests should have to improve early diagnosis of rheumatoid arthritis (RA). Our objective was to explore the early cost-effectiveness of various new diagnostic test strategies in the workup of patients with inflammatory arthritis (IA) at risk of having RA. __Methods:__ A decision tree followed by a patient-level state transition model, using data from published literature, cohorts and trials, was used to evaluate diagnostic test strategies. Alternative tests were assessed as add-on to or replacement of the ACR/EULAR 2010 RA classification criteria for all patients and for intermediate-risk patients. Tests included B-cell gene expression (sensitivity 0.60, specificity 0.90, costs €150), MRI (sensitivity 0.90, specificity 0.60, costs €756), IL-6 serum level (sensitivity 0.70, specificity 0.53, costs €50) and genetic assay (sensitivity 0.40, specificity 0.85, costs €750). Patients with IA at risk of RA were followed for 5 years using a societal perspective. Guideline treatment was assumed using tight controlled treatment based on DAS28; if patients had a DAS28 >3.2 at 12 months or later patients could be eligible for starting biological drugs. The outcome was expressed in incremental cost-effectiveness ratios (€2014 per quality-adjusted life year (QALY) gained) and headroom. __Results:__ The B-cell test was the least expensive strategy when used as an add-on and as replacement in intermediate-risk patients, making it the dominant strategy, as it has better health outcomes and lower costs. As add-on for all patients, the B-cell test was also the most cost-effective test strategy. When using a willingness-to-pay threshold of €20,000 per QALY gained, the IL-6 and MRI

Methods for identifying surgical wound infection after discharge from hospital: a systematic review.

Background: Wound infections are a common complication of surgery that add significantly to the morbidity of patients and costs of treatment. The global trend towards reducing length of hospital stay post-surgery and the increase in day case surgery means that surgical site infections (SSI) will increasingly occur after hospital discharge. Surveillance of SSIs is important because rates of SSI are viewed as a measure of hospital performance, however accurate detection of SSIs post-hospital discharge is not straightforward. Methods: We conducted a systematic review of methods of post discharge surveillance for surgical wound infection and undertook a national audit of methods of post-discharge surveillance for surgical site infection currently used within United Kingdom NHS Trusts. Results: Seven reports of six comparative studies which examined the validity of post-discharge surveillance methods were located; these involved different comparisons and some had methodological limitations, making it difficult to identify an optimal method. Several studies evaluated automated screening of electronic records and found this to be a useful strategy for the identification of SSIs that occurred post discharge. The audit identified a wide range of relevant post-discharge surveillance programmes in England, Scotland and Wales and Northern Ireland; however, these programmes used varying approaches for which there is little supporting evidence of validity and/or reliability. Conclusion: In order to establish robust methods of surveillance for those surgical site infections that occur post discharge, there is a need to develop a method of case ascertainment that is valid and reliable post discharge. Existing research has not identified a valid and reliable method. A standardised definition of wound infection ( e. g. that of the Centres for Disease Control) should be used as a basis for developing a feasible, valid and reliable approach to defining post discharge SSI. At a local level, the method used to ascertain post discharge SSI will depend upon the purpose of the surveillance, the nature of available routine data and the resources available