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The purpose of this research was to determine the relationship of the slime layer antigen(s) to the "101" or LPS antigens and to attempt to evaluate the role of antibodies against the latter in protection against experimental infections in mice with the homologous strain of Pseudomonas aeruginosa. Results from agglutination tests, chromatographic separations, passive protection tests, and characterizations of the antigens by gel double diffusion do not support the concept that LPS is a necessary portion of the immunogenic material. The immunogenicity of LPS can be attributed to co-purification of residual amounts of slime layer antigens on the washed cells from which LPS was extracted.

This research study examines the influence of two major forces, competition and regulation, on the strategic orientation of hospitals. This is a particularly relevant subject, as the effectiveness of competition versus the effectiveness of regulation in the health care market has been called one of the Bellwether issues in health care policy, and the most controversial and far reaching philosophical battle facing the health care industry. Even after three decades of research and debate, there is still no consensus on how the hospital industry responds to either a competitive environment or a regulated environment. There continues to be significant variation across the country on which model provides the environmental context for hospitals, and there is no resolution of the issue on the horizon. It is clear that the dichotomy of a competitive environment or a regulated environment and the wide variation from market to market will continue to be significant factors influencing the development of hospital strategies. Developing strategies that provide an appropriate fit with the particular environmental context is a critical aspect of the success of an organization.This study provides a unique perspective on the subject, with an examination of the relationship between the level of competition in the market and the level of regulation in the market, and whether these dimensions influence hospital strategic orientation. Porter's strategic orientation typology is used as the model for hospital strategy, and the theoretical framework combines the legitimacy seeking elements of institutional theory and the resource and cost control elements of resource dependency theory.The findings of this study indicate an association between a competitive environment and a differentiation orientation. As competition decreases, there is a greater likelihood of association with cost inefficiency. The results also indicate that in the absence of CON or as CON decreases, there is a greater likelihood of cost inefficiency. Although this study provides a timely analysis of a very controversial topic, it is clear that additional research efforts are needed on this critical issue that impacts every hospital in the country.

The formation of multi-hospital systems represents one of the largest structural changes in the hospital industry. As of 2008, system affiliated hospitals outnumbered stand alone hospitals 2511 to 2167 and the percentage of system affiliated rural hospitals has increased dramatically from 24.8% in 1983 to 42.2% in 2008 (based on AHA data for non-federal acute care general hospitals). The effects of system membership on hospital performance have been of great interest to health care researchers, but the majority of research on multi-hospital systems has either focused exclusively on urban facilities or pooled urban and rural facilities in the same sample, and thus failed to allow for potential differences in membership effects between urban and rural hospitals. The result is that the effect of system membership on rural hospital performance has remained largely unexplored, creating a gap in the body of health services research. The objectives of this study are both theoretical and empirical. Theoretically, this study is intended to be a deliberate empirical application of contingency theory, which is the one major organizational theory that seeks to explain variations in organizational performance as its fundamental purpose. Empirically, this study seeks to explore the relationship between rural hospital system membership and rural hospital performance, taking into account the environment of the rural hospital and the structure of the multi-hospital system to which it belongs. The study sample consists of 1010 non-federal, short-term, acute care general rural hospitals with consistent system membership and critical access hospital (CAH) status from 2004 to 2008. Hospital economic performance is represented by the dependent variables of hospital total margin and a productive efficiency score calculated using Data Envelopment Analysis (DEA). Four contingent pairs containing measures for environmental munificence, system membership, the presence of local system partners, the presence of hierarchical system partners, and CAH status, were used to measure a hospital’s fit between environment and structure. Regression analysis was used to determine the relationship between hospital performance and the fit between a hospital’s environment and its organizational/system structure. Results of the analysis indicate that hospitals with a better fit have significantly higher total margins, but results for productive efficiency were largely insignificant.

Uncontrolled pain has proven effects on both physiological and psychological responses of hospitalized patients. These incapacitating sequelae most often negatively impact patient outcomes resulting in unnecessary suffering and prolong hospitalizations. First line nurses often have preconceived notions about a patient's pain without developing an individualized patient context that considers appropriate pain management knowledge translated from best practice standards. Guided by Bandura's social learning theory and Lippitt's change theory, the purpose of this quality improvement project was to determine if use of the Curriculum Outline on Pain for Nursing from the International Association for the Study of Pain (IASP) improved nursing knowledge of pain management for hospitalized patients. The Knowledge and Attitude Survey Regarding Pain was given as a pretest and posttest to assess the knowledge of 100 registered nurses from an acute care hospital, before and after an education intervention was provided. The results of the paired pretests and posttests indicated a statistically significant difference t(99) = 0.03, (p < 0.05) following use of the IASP Curriculum. Use of the IASP Outline Curriculum, coupled with sustainability strategies, has a strong probability of impacting nurses' knowledge and subsequently contributing to positive social change for the community of patients expecting optimal clinical outcomes from their nurses.

Children are the cornerstone of the community as well as the future of society. Child abuse and suicide among the young population is a serious and prevalent problem. Through a number of survey studies undertaken in other countries including Canada, United States, and Australia, researchers demonstrated that child abuse was related to suicidal behavior. However, this association had not been examined in Hong Kong. However, the number of hospital admissions for child abuse in Hong Kong had increased from 15.6 to 61.9 per 100,000 between 1995 and 2015 and 3.7% of child abuse cases had previously recorded suicide attempts. This study aimed to identify the association between child abuse and suicide attempts compared with influenza infection using electronic hospital admission records. From January 1, 1995 to July 31, 2016, patients with admission age < 18 years with the diagnosis of child abuse or influenza infection were included in this study (n = 54,256). The study also retrieved data on suicide attempt hospital admissions after the first hospital admission from the database. The study results demonstrate that the adjusted hazard ratio indicated that at any given point of time, child abuse subjects had 4.79 times higher risk (95% CI 3.88 to 5.92) of attempting suicide compared with influenza infected subjects. The hazard ratio for sexual abuse and physical abuse compared with the influenza infected group was 6.48 (95% CI 4.56 to 9.19) and 4.83 (95% CI 3.67 to 6.34). Study results indicated that there was a significant association between child abuse and suicide attempts in Hong Kong. If confirmed, the study results may inform policy and interventions to reduce child abuse and consequently child suicide attempts.

Exposure to noise in hospital intensive care units (ICUs) can disrupt patients’ sleep and delay their recovery. In this intervention study, noise levels were measured in eight patient rooms of a medical ICU (MICU) every minute with sound level meters for eight weeks before and after an intervention. Implemented over six weeks, the intervention was designed to educate nurses and other staff members to reduce noise levels through behavior modification, including instituting a “quiet time” in the afternoons, encouraging patients to keep televisions off or at lower volumes, and speaking more quietly during conversations. Sound equivalent levels (Leq) were calculated from one-minute measurements for each hour in each room. These hourly Leq (Leq-H) values were compared by pod (group of rooms within the MICU), room position (in proximity to a central nurses’ station), occupancy status, and time of day. Days with more than ten hours of one-minute noise levels above 60 dBA were flagged as the loudest time periods and compared to MICU activity logs. The intervention was ineffective with Leq-H values always above World Health Organization guidelines for ICUs (35 dBA in day; 30 dBA at night) before and after the intervention. Leq-H values frequently exceeded more modest project goals during the day regardless of the intervention (50% of Leq-H > 55 dBA both pre- and post-intervention) and at night (68% and 62% of Leq-H > 50 dBA pre- and post-intervention). Statistical analysis of the Leq-H suggests a general source is contributing to the high baseline noise in the MICU, most likely the heating, ventilation, and air-conditioning (HVAC) system. Our analysis of one-minute data indicated that high noise was often associated with high-volume respiratory-support devices. We concluded that our intervention focusing on administrative controls (e.g., education and training) was not enough to reduce noise in the MICU but that an intervention designed with engineering controls (e.g., shielding, substitution) would be more effective.

A study of women's views of maternity services in the Northern Sydney Area Health Service was conducted as a result of the changing patterns of use of the Area's 7 obstetric hospitals. 340 primiparous women living in the Northern Sydney Area who had given birth in the previous six months were approached in Early Childhood Health Centres and asked to complete a survey exploring the factors influencing their choice of obstetric hospital, postnatal length of stay in hospital, and overall satisfaction with their choice of hospital. Of the 315 eligible women, 312 (99%) consented to participate and 297 (94%) completed the survey. Overall, reputation of the hospital and quality of nursing care were the most frequent reasons given for choice of hospital and there was some evidence that women selected different hospitals for distinct reasons. Women's postnatal length of stay ranged from less than 1 day to 11 days with an average of 5.3 days. Private patients stayed an average of 1 day longer than public patients, after adjusting for delivery type and pregnancy induced hypertension. There was little evidence that women in the Northern Sydney Area Health Service desire a shorter postnatal stay with the majority of women reporting they were satisfied with their length of stay. Overall, women displayed high levels of satisfaction with their choice of hospital; at least 90% of women attending all hospitals except one reported that they would choose the same hospital for the birth of another baby. This study provides valuable information, based on the experiences of the service users, to help guide the Northern Sydney Area Health Service in the provision of its maternity services to ensure they meet the changing needs of women and their families.

This inquiry investigated the phenomenon of 'staying' as a feature of the turnover, recruitment and retention of social workers in hospital settings. In the absence of specific literature on the subject, the study made a significant and original contribution to knowledge about social work staff turnover, including the meaning attached to work, the relationship of social workers to the hospital organisation, and to job satisfaction. Using qualitative methodology, data were collected from multiple sources including in-depth interviews at two large Sydney Teaching Hospitals, a period of engagement in each Social Work Department, a comprehensive review of primary data from archival records of the Directors of Social Work Services in Teaching Hospitals (NSW) between 1981-1999, and secondary source materials of federal and state health policy documents. Two core categories emerged from the study which were social workers 'tolerance' of the hospital environment and their qualities of 'selfactualisation'. Of central importance to the inquiry was the discovery of grounded theory which explained the relationship of these categories to the phenomenon of 'staying'. The intersection of 'tolerance' and 'self- actualisation' qualified 'staying' as either a positive or negative experience for the social worker and the hospital. This theory was presented as an original model which with further refinement, could be used as a predictive tool in studies of turnover of social workers in hospital settings. The findings challenged existing theories that staff retention was preferable to staff turnover in hospital organisations and identified qualities in hospital social workers which would ensure the continuing relevance of social work to the changing hospital environment. The model has implications for hospitals, Social Work Departments and for social work education in the preparation and training of social workers to join the hospital workforce. Specific activities that supported the 'self-actualisation' of social workers, and aspects of 'tolerance' were identified which worked for the benefit of both social workers and hospitals.

<p>Falls and fallinjuries are very common in peoples own homes in various institutions. Hospital inpatients often fall during daytime in connection with their visit to the toilet. Visual impairment such as cataract, glaucoma, macular degeneration and diabetic retinopathy can cause falls. The purpose of this study was to examine patient´s records where falls and fallinjuries were documented at an emergency clinic and to examine if they were registered to visual impairment. The records from 68 hospital inpatients from the age of 65 years and older who did fall during the year of 2004, were examined. In spite of different preventive actions that were taken, falls and fallinjuries often happened when the patients were on the move and left on their own. The number of patients who have any visual impairment and a record at an eye clinic, were 41. Thirtytwo of the patients who have any visual impairment did fall between 18:00 - 06:00. In the emergency clinics records, there were no records about how the patients experienced their visual ability. Objective and subjective visual impairment were only registered in the eye clinics records. When risk assessments are made, visual impairment should be considered as a riskfactor for falling. It should be considered as an independent riskfactor as well as in addition with other riskfactors. When the patient gets to the ward, the nurse should ask the patient and register if he or she has any visual impairment. The nurse can therefore use strategies to plan the caring and prevent falls and fallinjuries during the patients stay at the emergency clinic. Visual impairment as well as the natural ageing affects the visual ability and therefore the wards environment should contain sharp colours and bright lightening.</p>