99 research outputs found

    Validation of the Work Observation Method By Activity Timing (WOMBAT) method of conducting time-motion observations in critical care settings: an observational study

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    <p>Abstract</p> <p>Background</p> <p>Electronic documentation handling may facilitate information flows in health care settings to support better coordination of care among Health Care Providers (HCPs), but evidence is limited. Methods that accurately depict changes to the workflows of HCPs are needed to assess whether the introduction of a Critical Care clinical Information System (CCIS) to two Intensive Care Units (ICUs) represents a positive step for patient care. To evaluate a previously described method of quantifying amounts of time spent and interruptions encountered by HCPs working in two ICUs.</p> <p>Methods</p> <p>Observers used PDAs running the Work Observation Method By Activity Timing (WOMBAT) software to record the tasks performed by HCPs in advance of the introduction of a Critical Care clinical Information System (CCIS) to quantify amounts of time spent on tasks and interruptions encountered by HCPs in ICUs.</p> <p>Results</p> <p>We report the percentages of time spent on each task category, and the rates of interruptions observed for physicians, nurses, respiratory therapists, and unit clerks. Compared with previously published data from Australian hospital wards, interdisciplinary information sharing and communication in ICUs explain higher proportions of time spent on professional communication and documentation by nurses and physicians, as well as more frequent interruptions which are often followed by professional communication tasks.</p> <p>Conclusions</p> <p>Critical care workloads include requirements for timely information sharing and communication and explain the differences we observed between the two datasets. The data presented here further validate the WOMBAT method, and support plans to compare workflows before and after the introduction of electronic documentation methods in ICUs.</p

    AFe2As2 (A = Ca, Sr, Ba, Eu) and SrFe_(2-x)TM_(x)As2 (TM = Mn, Co, Ni): crystal structure, charge doping, magnetism and superconductivity

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    The electronic structure and physical properties of the pnictide compound families REREOFeAs (RERE = La, Ce, Pr, Nd, Sm), AAFe2_{2}As2_{2} (AA = Ca, Sr, Ba, Eu), LiFeAs and FeSe are quite similar. Here, we focus on the members of the AAFe2_{2}As2_{2} family whose sample composition, quality and single crystal growth are better controllable compared to the other systems. Using first principles band structure calculations we focus on understanding the relationship between the crystal structure, charge doping and magnetism in AAFe2_{2}As2_{2} systems. We will elaborate on the tetragonal to orthorhombic structural distortion along with the associated magnetic order and anisotropy, influence of doping on the AA site as well as on the Fe site, and the changes in the electronic structure as a function of pressure. Experimentally, we investigate the substitution of Fe in SrFe2xTMx_{2-x}TM_{x}As2_{2} by other 3dd transition metals, TMTM = Mn, Co, Ni. In contrast to a partial substitution of Fe by Co or Ni (electron doping) a corresponding Mn partial substitution does not lead to the supression of the antiferromagnetic order or the appearance of superconductivity. Most calculated properties agree well with the measured properties, but several of them are sensitive to the As zz position. For a microscopic understanding of the electronic structure of this new family of superconductors this structural feature related to the Fe-As interplay is crucial, but its correct ab initio treatment still remains an open question.Comment: 27 pages, single colum

    Quality of care assessment in geriatric evaluation and management units: construction of a chart review tool for a tracer condition

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    <p>Abstract</p> <p>Background</p> <p>The number of elderly people requiring hospital care is growing, so, quality and assessment of care for elders are emerging and complex areas of research. Very few validated and reliable instruments exist for the assessment of quality of acute care in this field. This study's objective was to create such a tool for Geriatric Evaluation and Management Units (GEMUs).</p> <p>Methods</p> <p>The methodology involved a reliability and feasibility study of a retrospective chart review on 934 older inpatients admitted in 49 GEMUs during the year 2002–2003 for fall-related trauma as a tracer condition. Pertinent indicators for a chart abstraction tool, the Geriatric Care Tool (GCT), were developed and validated according to five dimensions: access to care, comprehensiveness, continuity of care, patient-centred care and appropriateness. Consensus methods were used to develop the content. Participants were experts representing eight main health care professions involved in GEMUs from 19 different sites. Items associated with high quality of care at each step of the multidisciplinary management of patients admitted due to falls were identified. The GCT was tested for intra- and inter-rater reliability using 30 medical charts reviewed by each of three independent and blinded trained nurses. Kappa and agreement measures between pairs of chart reviewers were computed on an item-by-item basis.</p> <p>Results</p> <p>Three quarters of 169 items identifying the process of care, from the case history to discharge planning, demonstrated good agreement (kappa greater than 0.40 and agreement over 70%). Indicators for the appropriateness of care showed less reliability.</p> <p>Conclusion</p> <p>Content validity and reliability results, as well as the feasibility of the process, suggest that the chart abstraction tool can gather standardized and pertinent clinical information for further evaluating quality of care in GEMU using admission due to falls as a tracer condition. However, the GCT should be evaluated in other models of acute geriatric units and new strategies should be developed to improve reliability of peer assessments in characterizing the quality of care for elderly patients with complex conditions.</p

    Superconductivity in Co-doped SmFeAsO

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    Here we report the synthesis and basic characterization of SmFe1-xCoxAsO (x=0.10, 0.15). The parent compound SmFeAsO itself is not superconducting but shows an antiferromagnetic order near 150 K, which must be suppressed by doping before superconductivity emerges. With Co-doping in the FeAs planes, antiferromagnetic order is destroyed and superconductivity occurs at 15 K. Similar to LaFe1-xCoxAsO, the SmFe1-xCoxAsO system appears to tolerate considerable disorder in the FeAs planes. This result is important, which indicates difference between cuprare superconductors and the iron-based arsenide ones.Comment: 11 pages, 3 figure

    Elastic and anelastic relaxation behaviour of perovskite multiferroics I: PbZr0.53Ti0.47O3 (PZT)–PbFe0.5Nb0.5O3 (PFN)

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    Night nursing – staff's working experiences

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    <p>Abstract</p> <p>Background</p> <p>Although the duties and working conditions of registered, and enrolled nurses have previously been described from different perspectives, they have not been examined from the night nursing aspect. The aim of the study was to describe the night nursing staff's working experiences.</p> <p>Methods</p> <p>The design of the study is qualitative and descriptive. Interviews were conducted with 10 registered and 10 enrolled nurses working as night staff at a Swedish University Hospital. The interview guide was thematic and concerned the content of their tasks, as well as the working conditions that constitute night nursing. In addition, the interviews were transcribed verbatim and analyzed using content analysis.</p> <p>Results</p> <p>The night duties have to be performed under difficult conditions that include working silently in dimmed lighting, and making decisions when fatigue threatens. According to the night staff, its main goals are to provide the patients with rest and simultaneously ensure qualified care. Furthermore, the night nursing staff must prepare the ward for the daytime activities.</p> <p>Conclusion</p> <p>The most important point is the team work, which developed between the registered and enrolled nurses and how necessary this team work is when working at night. In order for nurses working at night to be fully appreciated, the communication between day and night staff in health care organizations needs to be developed. Furthermore, it is important to give the night staff opportunities to use its whole field of competence.</p
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