• Title/Summary/Keyword: Patient care team

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Establishment of an intravenous conscious sedation service at a University Dental Clinic in Tanzania

  • Karpal Singh Sohal;Frank Bald;Samwel Mwalutambi;Paulo J Laizer;David K Deoglas;Jeremiah Robert Moshy;Baraka Kileo;Noah Joshua;Sospeter Sewangi
    • Journal of Dental Anesthesia and Pain Medicine
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    • v.23 no.2
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    • pp.83-89
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    • 2023
  • Background: With advances in safety measures for anesthesia, conscious sedation has gained popularity in the field of dentistry and has become essential in dental practice worldwide. However, in Tanzania, intravenous (IV) sedation is rarely practiced in the dental field. Therefore, we report the establishment of sustainable IV conscious sedation in dental practices and subsequently train local OMS residents in Tanzania. Methods: In 2019, intravenous conscious sedation was initiated at the University Dental Clinic of the Muhimbili University of Health and Allied Science (MUHAS), Tanzania. During the preparatory phase of the program, local oral and maxillofacial surgeons (OMSs) were given a series of lecture notes that concentrated on different aspects of IV conscious sedation in dentistry. During the on-site training phase, an oral surgeon from the United States joined the OMSs for case selection, IV-conscious sedation procedures, and patient follow-up. Patients were recruited from existing patient records at the MUHAS Dental Clinic. Results: The first conscious IV sedation program in dentistry was successfully launched at the University Dental Clinic in Tanzania. The local team of OMSs was trained on the safe administration of sedative agents (midazolam or ketamine) to perform various minor surgical procedures in a dental office. Nine patients with different ages, body masses, and medical conditions benefited from the training. No complications were associated with IV conscious sedation in the dental office. Conclusion: This was the first successful "hands-on" training on IV conscious sedation provided to OMSs in Tanzania. It laid the foundation for the sustainable care of patients with special needs requiring oral health-related care in the country.

Exploratory Study of Person Centered Care Practice in Korean Long-term Care Facilities using DCM(Dementia Care Mapping) as a tool (DCM(Dementia Care Mapping)을 활용한 한국 요양시설에서의 사람중심케어 실천의 탐색적 연구)

  • Kim, Dongseon
    • 한국노년학
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    • v.41 no.2
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    • pp.197-215
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    • 2021
  • This study aims to evaluate Person Centered Care practice and characteristics of care services in Korean long-term care facilities using Dementia Care Mapping as a tool. DCM, systematic observational evaluation tool for measuring dementia patients' QOL, was transformed into self-report rating scale. The process of transforming DCM into a scale of 34 items involves operationalization of DCM concepts and it's adaptation into Korean long-term care practices. Review by research team of Bradford university was added to maintain DCM concept and meaning in this scale. The scale with Cronbach alpha of .88 was surveyed on 343 care workers. Survey result shows PCC value practiced by them is 3.77(of 5 likert scale) and values on each categories of PCC reveal the characteristics of care in Korean facilities; attachment(4.02), comfort(3.95), inclusion(3.89), identity(3.67) and occupation(3.41). Dementia care in Korean facilities focuses on recipients'safety, comfort but lacks individualistic care and the meaningful and fulfilling occupation for patients. Looking at the organizational and individual factors influencing DCM values, the small facilities showed higher PCC values and there are no significant difference in PCC values between public and private facilities. Managers and care workers with career of 1~2 years showed higher PCC values compared to other career ranks and lengthes. This study suggests care practice should be centered on personhood of patients in long-term care facilities, for which introduction of unit care and education of PCC for service providers including support personnel are needed. DCM and Korean DCM scale developed in this study are suggested for the PCC-based assessment on care quality.

Role of Dedicated Subspecialized Radiologists in Multidisciplinary Team Discussions on Lower Gastrointestinal Tract Cancers

  • Sun Kyung Jeon;Se Hyung Kim;Cheong-il Shin;Jeongin Yoo;Kyu Joo Park;Seung-Bum Ryoo;Ji Won Park;Tae-You Kim;Sae-Won Han;Dae-Won Lee;Eui Kyu Chie;Hyun-Cheol Kang
    • Korean Journal of Radiology
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    • v.23 no.7
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    • pp.732-741
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    • 2022
  • Objective: To determine the impact of dedicated subspecialized radiologists in multidisciplinary team (MDT) discussions on the management of lower gastrointestinal (GI) tract malignancies. Materials and Methods: We retrospectively analyzed the data of 244 patients (mean age ± standard deviation, 61.7 ± 11.9 years) referred to MDT discussions 249 times (i.e., 249 cases, as five patients were discussed twice for different issues) for lower GI tract malignancy including colorectal cancer, small bowel cancer, GI stromal tumor, and GI neuroendocrine tumor between April 2018 and June 2021 in a prospective database. Before the MDT discussions, dedicated GI radiologists reviewed all imaging studies again besides routine clinical reading. The referring clinician's initial diagnosis, initial treatment plan, change in radiologic interpretation compared with the initial radiology report, and the MDT's consensus recommendations for treatment were collected and compared. Factors associated with changes in treatment plans and the implementation of MDT decisions were analyzed. Results: Of the 249 cases, radiologic interpretation was changed in 73 cases (29.3%) after a review by dedicated GI radiologists, with 78.1% (57/73) resulting in changes in the treatment plan. The treatment plan was changed in 92 cases (36.9%), and the rate of change in the treatment plan was significantly higher in cases with changes in radiologic interpretation than in those without (78.1% [57/73] vs. 19.9% [35/176], p < 0.001). Follow-up records of patients showed that 91.2% (227/249) of MDT recommendations for treatment were implemented. Multiple logistic regression analysis revealed that the nonsurgical approach (vs. surgical approach) decided through MDT discussion was a significant factor for patients being managed differently than the MDT recommendations (odds ratio, 4.48; p = 0.017). Conclusion: MDT discussion involving additional review of radiology examinations by dedicated GI radiologists resulted in a change in the treatment plan in 36.9% of cases. Changes in treatment plans were significantly associated with changes in radiologic interpretation.

Study on Value Conceptions in fundamentals of Nursing (임상간호 가치관에 관한 일 조사연구)

  • 한윤복;김영매
    • Journal of Korean Academy of Nursing
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    • v.3 no.1
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    • pp.97-104
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    • 1972
  • This study was designed to investigate differences in some aspects of value conceptions in fundamentals of nursing functions between nursing service personnel and nurse-educators. The purpose of the study was to identify the difference of value conceptions between the hospital nurses and school instructors, to contribute as a reference in strengthening the educational program in establishing nay hinder professional growth. The questionaries of this study were focused in the following aspects: 1) establishment of nursing service management system, 2) strengthening of the professionalization of nursing service, 3) hindrance in accomplishment of independent nursing functions, 4) communication skills in nurse-patient relationship, 5) activities directly related to nursing care planning, 6) communication skills in nurse-doctor relationship, 7) attitude towards taking responsibilities for patient- centered nursing approach, and 8) nursing educational approach towards preparation of professional competence in practicing independent nursing functions. 265 graduate nurses from 14 general hospitals and 88 nursing instructors from 18 schools, collegiate and diploma, were sampled. The main findings of the study were as follows; 1. Both groups responded highly in the lack of public recognition of nursing profession and hospital administrators support in establishment of nursing service management system. Further investigation is needed to define some relationship between the intrinsic and extrinsic factors which might give influence to the professional development. 2. while hospital nursing personnel responded on environmental pressure such as a heavy nursing load as the factor giving hindrance to independent nursing functions, the nurse educators responded highly on lack of nursing competence of individual nurses. An emphasis should be placed on the development of nursing interaction through professional education. If the professional model is not well established, nursing function will be limited to medical assistance. 3. 3. The patient-centered approach for nurse-patient communication had given positive respond for both group, tut lacks in team concept in problem solving process. There exist a social distance between nurses and other professional co-workers in the hospital hierarchy. 4. It was indicated that, as an intrinsic factor in the development of nursing service and nursing education, building up a philosophical basis is an utmost importance. This question is opened for further and extensive study to clarify whether existence of philosophical absence or philosophical stasis in nursing profession hinders the development.

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Verification of Reliability and Validity of KPCS-1 and Estimation of Nursing Time Conversion Index (한국형 환자분류도구-1(KPCS-1)의 신뢰도와 타당도 검증 및 간호시간 환산지수 산출)

  • Song, Kyung Ja;Kim, Eun Hye;Yoo, Cheong Suk;Park, Hyeoun Ae;Song, Mal Soon;Park, Kwang Ok
    • Journal of Korean Clinical Nursing Research
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    • v.16 no.2
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    • pp.127-140
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    • 2010
  • Purpose: This study was performed to verify reliability and validity of Korean Patient Classification System for nurses(KPCS-1), to estimate nursing time conversion index, and to classify patients into groups according to KPCS-1 scores. Methods: KPCS-1 was revised from KPCS by a professional review team. Interrater reliability and construct validity of KPCS-1 were verified by data from 433 patients. Direct and indirect nursing time of 204 patients were measured by stopwatch observation and self reports for 24 hours. Nursing time conversion index was calculated. Results: KPCS-1 consisted of 12 area, 50 nursing activities, and 73 items. The interrater reliability was tested between two nurse group (r=.88, p<.001) and construct validity was verified according to medical department (F=10.97, p<.001) and patient pattern (F=5.54, p=.001). The correlation of nursing time and classification score was also statistically significant (r=.56, p<.001). The nursing time conversion index was 9.03 minutes per 1 classification score. The patients were classified into 4 groups by the classification scores. Conclusion: KPCS-1 can be a useful factor type patient classification system for general ward. Further study is needed to evaluate validity and reliability for refining KPCS-1 and to develop ways connecting the scores with nursing outcomes.

Risk Factors of Predicting Intensive Care unit Transfer in Deteriorating Ward Patients (병동 급성악화 환자의 중환자실 전동 위험요인 분석)

  • Lee, Ju-Ry
    • Journal of Digital Convergence
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    • v.19 no.4
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    • pp.467-475
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    • 2021
  • Purpose: When a patient with acute deterioration occurs in a ward, the decision to transfer to intensive care unit (ICU) is critical to improve the patient's outcomes. However, when available ICU resources limited, it is difficult to determine which of the deteriorating ward patients to transfer to the ICU. Therefore the purpose of this study was to identify risk factors in predicting deteriorating ward patients transferred to intensive care unit (ICU). Methods: We reviewed retrospectively clinical data of 2,945 deteriorating ward patients who referred medical emergency team. Data were analyzed with multivariate logistic regression. Results: The solid cancer that diagnosed at hospitalization (odds ratio[OR] 0.39; 95% confidence interval [CI] 0.32-0.47), when the cause of deterioration was respiratory problem (1.51; 95% CI 1.17-1.95), high MEWS (1.22; 1.17-1.28) and SpO2/FiO2 score (2.41; 2.23-2.60) were predictive of ICU transfer. Conclusion: These findings suggest that early prediction and treatment of patients with high risk of ICU transfer may improve the prognosis of patients.

The Attitude of the Bereaved Family Attending a Bereavement Memorial Service (사별가족모임과 관련된 사별가족 태도 연구)

  • Jung, In-Soon;Shim, Byoung-Yong;Kim, Young-Seon;Lee, Ok-Kyung;Han, Sun-Ae;Shin, Ju-Hyun;Lee, Jong-Ku;Hwang, Su-Hyun;Ok, Jong-Sun;Kim, Hoon-Kyo
    • Journal of Hospice and Palliative Care
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    • v.8 no.2
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    • pp.143-151
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    • 2005
  • Purpose: Bereavement Memorial Service has been held every year by the hospice team at St. Vincent's Hospital for the purpose of supporting the bereaved family who feel grief and mourning. The purpose of this study is to find out the attitude of the bereaved attending at bereavement memorial service (BMS) and to find out the areas needing improvements to set up better memorial service. Methods: Hospice team sent invitation card to 180 families of patients who admitted and passed away at hospice ward Nov., 2003${\sim}$Oct., 2004. Among them 22 families attended the BMS meeting, which was held on 26th Nov., 2004. The researcher collected data from 22 families with 'Questionnaire' survey. Except identifying data and 2 dichotomy questions, we used open-ended questionnaire. 1 researcher conducted a telephone interview survey in 18 families who couldn't attend at BMS meeting. Results: The median age was 56 (range $16{\sim}19$) and there were 37 females and 3 males. They were patient's wife (22), mother (4), husband (5), daughter (4), mother-in-law (1), siblings (1), brothers wife (1). Duration after bereavement, $1{\sim}3$ months (17) was the highest frequency. 36 families agreed 'the dead experienced the death with dignity'. The reason of agreement to the death with dignity was 'the patient died in preparation' (16). 'the patient died in well-being condition spiritually' (9), 'the patient died in comfort physically (7). 4. persons thought the dead died with indignity. The bereaved defined 'the death with dignity' as follows: 'acceptance of death & death in spiritual well-being' (9), 'death in physical comfort condition' (7), 'the death in psycho-social well-being' (3), non-respondents (10). Most families (21) were still in difficulty to overcome bereavement grief. The answer regarding the method to overcome the difficulty was 'with spiritual sublimation' (13), 'with devotion of oneself in daily life' (10), 'with devotion to mourning as it is' (3). With regard to their attitude to invitation, 'having joy and thanks from hospice team' (21), 'grief' (4), 'suffering' (4). Toward the existence of hesitation about attendance at BMS meeting, the result as follows. Nonexistence of hesitation respondent (34), existence respondent (6), the reason for hesitation was various; 'the meeting reminds me of the suffering times', 'the meeting makes me to recall, and it will be likely to cry', and so on. The needs and feelings to memorial service meeting were various; 'it was meaningful time', 'it was good to recall about the dead', 'more meeting annually' and so on. In respect of the most difficulty after bereavement, in attendant family, 'depression' (10) was the highest frequency, whereas, in non-attendant family, the most difficult thing was 'financial problem/role difficulty (6). Conclusion: This study shows the rate of attendance was high in bereaved whose bereavement duration $1{\sim}3$ month. Most of bereaved were still suffering from bereavement grief within 1 year. Although most families didn't hesitate and felt positive mood to invitation, the rate of attendance was low. Comparing with two groups between attendant family and non-attendant, the latter felt more difficulty in 'financial problem/role difficulty, on the other hand, the former felt difficulty in 'depression'. Hereafter, the additional study about the factor relating to these attitude and needs of the bereaved relating to memorial service will be necessary.

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A Model of Activation in Physical Therapy of Public Health Center (보건소 중심의 물리치료 활성화 모델)

  • Bae Sung-Soo;Kim Chung-Sun;Lee Han-Suk
    • The Journal of Korean Physical Therapy
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    • v.11 no.3
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    • pp.123-131
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    • 1999
  • The purpose of is study deals with the physical therapy and the delivery system of public health center, as a center, in community based rehabilitation and delivery system. We hope that the system of physical therapy of public health center in community based rehabilitation spreads all over the country and contributes to the promotion of national health and social welfare. There are many public health center in the country because it can serve inhabitants with the medical benefits in the Erst line. public health center continuously provides poor inhabitants who cant pay medical expenses care of health. It has the public health center branches that take care of inhabitants who live a remote village and hiterland. Additionally, many people want to receive physical therapy. Therefore, the physical therapy of public health center becomes the central paint in community based rehabilitation so that we supply the inhabitants with superior rehabilitation service. We can approach them as a team that be constituted with physical therapist speech therapist, psychologist, nurse, social work. Also the role of physical therapist is divided into two parts, which are home visiting part that individually takes can of patients nod public health part that takes care of patient, family, home, community. We connect with both self-governing body and the government so that we may receive government subsidies. Also, we must prepare regular school education for community based rehabilitation

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Effects of Simulation-based Practice using Standardized Patients for the Care of Women with Postpartum Hemorrhage on Nursing Student's Clinical Performance Competence and Critical thinking Deposition (표준화 환자를 활용한 산후출혈 산모 간호 시뮬레이션 실습이 간호학생의 임상수행능력과 비판적 사고 성향에 미치는 효과)

  • Kim, Sun-Hee
    • Korean Parent-Child Health Journal
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    • v.15 no.2
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    • pp.71-79
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    • 2012
  • Purpose: This study was conducted to examine the effects of simulation-based practice using standardized patients for the care of woman with postpartum hemorrhage as related to clinical performance competence and critical thinking deposition of nursing students. Methods: A nonequivalent control group pre-post test experimental design was used. Fifty four third year students were recruited, 29 students for the experimental group and 25 students for the control group. The simulation-based practice about nursing care related to postpartum hemorrhage included skill training, team-based practice, and debriefing. It was implemented with the experimental group for about 30 minutes in October 6, 2011. Data were analyzed using frequency, ratio, chi-square, Fisher's exact probability, and t-test using the SPSS/WIN program. Results: The experimental group who had the simulation-based practice showed significantly higher knowledge and skills of clinical performance competence than the control group (t=2.19, p=.003). But the experimental group who had the simulation-based practice did not show significantly higher critical thinking deposition than the control group (t=-0.32, p=.748). Conclusion: The results indicate that a simulation-based practice is an effective teaching method to improve knowledge and skills for clinical performance competence of nursing students. Further study is needed to identify the effect of a simulation-based practice on nursing attitudes.

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Association between Weekend Admission and In-hospital Mortality among Cardiovascular Patients in Korea

  • Lee, Sang Ah;Park, Eun-Cheol;Shin, Jaeyong;Ju, Yeong Jun;Lee, Hoo-Yeon
    • Health Policy and Management
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    • v.29 no.2
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    • pp.237-244
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    • 2019
  • Background: Weekend admission is known for having association with increased mortality attributed by poor quality of care and severe patients. We investigated the association between hospital admission on weekends and the in-hospital mortality rates of patients with cardiovascular disease. Furthermore, we examined this association stratified by admission via emergency room or not. Methods: We analyzed claim data provided by the Health Insurance Review & Assessment in 2013. In total, 80,817 cardiovascular patients were included in this study, which treated in-hospital mortality (early and during total length of stay) as a dependent variable. A generalized linear mixed effects model was used. We conducted subgroup analyses stratified by admission via emergency room or not. Results: Patients who admitted on weekend showed higher in-hospital mortality both early (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.23-1.78) and during total length of stay (OR, 1.17; 95% CI, 1.02-1.33) compared to those admitted on weekdays. Patients who were admitted to the hospital on a weekend by emergency room were more likely to experience early in-hospital mortality compared to those admitted on weekdays. Furthermore, we found that patients not admitted to the hospital through the emergency department were more likely to experience both early and total length of stay in-hospital mortality. Conclusion: Our study shows higher in-hospital mortality rates for cardiovascular patients admitted on weekends. Efforts to improve the quality of care on weekend are important to mitigate the 'weekend effect' and improve patient outcomes.