Improving Bedside Swallow Screening in Acute Stroke Patients: An Evaluation Plan

A stroke is a life-changing event for a patient and his or her family. The acute stroke patient is at risk for developing aspiration pneumonia, whether silent or overt. Prevention of pneumonia in this population requires timely completion and documentation of the bedside swallow screen to identify those patients at risk for aspiration pneumonia; however, anecdotal data from the emergency department at the site of this project suggested that completion and documentation of the screening were inconsistent. Guided by the quality caring model adopted by the project site as well as the logic model, the aim of this project was to evaluate emergency room nurses\u27 compliance with documentation after completing a modified bedside swallow screening. To facilitate documentation compliance, the current bedside screening tool was modified to make it user friendly. Electronic records of stroke patients (n = 104) admitted to the emergency room were monitored for a period of 6 months after implementing the modified bedside swallow screening tool. The findings indicate that implementing the modified bedside swallow screening tool achieved 93% documentation compliance in the electronic records and 100% documentation in patient charts over this 6-month period and clearly identified patients at risk for developing aspiration pneumonia. Further study is recommended to determine the relationship between the results of the modified bedside swallow screening and the development of hospital-acquired pneumonia. Implementation of this modified bedside swallow screening tool can initiate therapeutic measures to reduce the incidence of aspiration pneumonia in the acute stroke patient, resulting in shorter length of hospitalization and reduced health care costs

Arts as a Catalyst for Adult Learning

Using collaborative inquiry, the researchers wished to explore the relationship between art and learning. Themes of individual and collective learning emerged. In general, the arts provide a useful tool for provoking reflective dialog and a platform for viewing and assuming different perspectives

Breast feeding promotion in an urban and a rural Jamaican hospital

Breast feeding promotion has been a national priority in Jamaica since the mid-1970s. Despite this effort, breast feeding rates have continued to decline there, especially in urban areas. Studies of the role of health professionals in promoting breast feeding have shown that specific practices encourage breast feeding, while others discourage it. In the context of declining breast feeding in a nation committed to promoting it, the goal of this study was to explore the relationship between specific health professional practices, mothers' breast feeding, and mothers' knowledge of breast feeding in rural and urban Jamaica. To accomplish this goal, a structured interview was administered to 113 mothers of infants age 0-6 months at one urban (n=62) and one rural (n=51) hospital, regarding (1) physician and nurse practices known to affect breast feeding, (2) mothers' own breast feeding practices, and (3) mothers knowledge of breast feeding issues. Physician and nurse visits were also directly observed to confirm responses given to the questionnaire and to assess the resources devoted to teaching mothers about breast feeding. While extensive lectures, posters and pamphlets promoting breast feeding were provided for mothers at the urban hospital, far fewer educational resources were available for mothers at the rural hospital. Overall, however, health professional practices discouraging breast feeding were observed more frequently at the urban hospital than at the rural hospital, whereas practices promoting breast feeding were more common at the rural hospital. At the rural hospital, mothers' breast feeding practices more closely approximated recommendations than at the urban hospital. Moreover, there was no difference between urban and rural mothers' knowledge about breast feeding, despite the input of far greater educational resources to mothers at the urban hospital. This study suggests that merely educating mothers about breast feeding is insufficient. Efforts to promote breast feeding must emphasize specific health professional practices that support early initiation of breast feeding. The health policy implications of these findings are discussed.breast feeding infant feeding hospitals Jamaica

The Roles and Responsibilities of Physicians in Pre-Hospital Emergency Medical Services: A Caribbean Perspective

A Pre-hospital Emergency Medical Service (PHEMS) is a vital component of a country’s health service because it provides early medical care to critically ill and injured persons in the field. There is evidence to show that early care reduces mortality and morbidity and offers the patient the best chance of survival and improved quality of life. Caribbean territories have been developing their PHEMS as part of a programme of health sector reform. In a study of PHEMS in 12 Caribbean countries, the Pan American Health Organization reported that there were no clear guidelines with respect to the roles and responsibilities of the physician in PHEMS in the majority of countries. In fact, a few countries had services where there was no direct physician involvement. We present a brief review of the internationally recognized roles and responsibilities of physicians in PHEMS, and make recommendations with particular reference to the Caribbean. We suggest that there is a need for direct and active involvement of physicians in the development of PHEMS because the Emergency Medical Technician is recognized as an extension of the physician in the field and is supposed to be protected by the physician’s licence to deliver medical care. "Funciones y Responsabilidades de los Médicos en los Servicios Médicos de Emergencia pre-hospitalaria: Una Perspectiva Caribeña" RESUMEN El servicio médico de emergencia pre-hospitalaria (SMEPH) es un componente vital del servicio de salud de un país, porque provee atención médica temprana y sobre el terreno a personas accidentadas o enfermas en estado crítico. Las evidencias indican que la atención temprana reduce la mortalidad y la morbosidad, a la vez que ofrece al paciente la mejor oportunidad posible de sobrevivir y mejorar la calidad de vida. Los territorios caribeños han estado desarrollando su SMEPH como parte de un programa de reforma del sector de la salud. En un estudio del SMEPH en 12 países caribeños, la Organización Panamericana de la Salud informó que no había directrices claras con respecto a las funciones y responsabilidades del médico en el SMEPH en la mayoría de países. De hecho, unos países tenían servicios en los que no había participación directa del médico. Presentamos aquí una revisión breve de las funciones y responsabilidades reconocidas internacionalmente para los médicos en el SMEPH, y hacemos recomendaciones con referencia particular al Caribe. Sugerimos que hay necesidad de que los médicos participen de manera activa y directa en el desarrollo del SMEPH, porque el técnico médico de emergencia es reconocido como una extensión del médico sobre el terreno, y se supone que esté amparado por una licencia para impartir atención médica

Risk Factors for Clinical Leptospirosis from Western Jamaica

A retrospective, matched case-control study was conducted in Jamaica's Western Regional Health Authority (WRHA). Forty-three individuals developing clinical leptospirosis between January 2005 and December 2007 (i.e., cases) were age and neighborhood matched to 89 controls. Odds ratios (OR) and associated 95% confidence intervals (CIs) and the relative excess risk due to interaction (RERI) were calculated. Cases had increased odds of contact with rodents OR 3.52, goats OR 3.38, and being engaged in outdoor labor OR 5.30. Knowledge of leptospirosis and indoor work was protective, OR 0.39 and OR 0.16, respectively. Positive RERI values were noted for joint exposure to rodents and goats (RERI 5.54), outdoor labor and goats (RERI 6.97), and outdoor labor and rodents (RERI 30.59). Our results suggest a synergistic effect of occupational and environmental exposures on clinical human leptospirosis from the WRHA. Knowledge of the disease and its risk factors allows for protection from the disease