Many older adults experience complications related to hospitalization. The most prevalent of complications is delirium which often goes undetected and untreated and results in increased morbidity and mortality. Nurses are in an ideal position to detect and manage delirium because of their close patient contact, however delirium remains underrecognized even when using a valid screening tool. This study adopts a qualitative descriptive approach to identify the barriers to nurse detection of delirium. Ten frontline surgical nurses participated in semi-structured interviews from which five major themes emerged through an inductive thematic analysis. Nurses have a knowledge deficit of the features of delirium and find it difficult to access information regarding their patients’ baseline cognitive function. Nurses reported inadequate time with patients that led to a self-perpetuating delirium cycle and furthermore, nurses stated that hyperactive delirium symptoms prevented adequate assessment and care. Nurse-physician communication plays an important role in delirium detection and treatment with both psychological and feminist perspectives offered. Recommendations include improvements in nursing knowledge, management of time and enhancements to current written and verbal communication about delirium. / Graduate

PURPOSE: The objective was to determine if particular magnetic resonance, clinical and demographic findings were associated with functional status prior to surgery and predictive of functional outcomes at follow-up. RESULTS: The study included 65 consecutive CSM patients. The modified Japanese Orthopaedic Association Scale (mJOA) was used as the primary outcome measure. Higher baseline mJOA scores were associated with younger age, shorter duration of symptoms, fewer compressed segments and less severe cord compression. Better post-operative mJOA scores were associated with younger age, shorter duration of symptoms and higher baseline scores. Using multivariate analysis, baseline and follow-up mJOA scores adjusted for baseline mjOA score were best predicted by age. CONCLUSION: Age and clinical severity scores at admission can both provide valuable information. However, MR imaging features of the spinal cord before surgery cannot accurately predict the functional prognosis for patients with CSM and hence alternative imaging approaches may be required.

PURPOSE: The objective was to determine if particular magnetic resonance, clinical and demographic findings were associated with functional status prior to surgery and predictive of functional outcomes at follow-up. RESULTS: The study included 65 consecutive CSM patients. The modified Japanese Orthopaedic Association Scale (mJOA) was used as the primary outcome measure. Higher baseline mJOA scores were associated with younger age, shorter duration of symptoms, fewer compressed segments and less severe cord compression. Better post-operative mJOA scores were associated with younger age, shorter duration of symptoms and higher baseline scores. Using multivariate analysis, baseline and follow-up mJOA scores adjusted for baseline mjOA score were best predicted by age. CONCLUSION: Age and clinical severity scores at admission can both provide valuable information. However, MR imaging features of the spinal cord before surgery cannot accurately predict the functional prognosis for patients with CSM and hence alternative imaging approaches may be required.

Objective. The objective of this study is to test the efficacy of the biodegradable mesh as an alternative fixation device to the titanium mesh for support of onlay particulate, bone and cancellous, marrow (PBCM) grafts. Two parameters were evaluated: (1) Bone graft volume maintenance; and (2) Calcified tissue surface area and distribution. Methods. 12 New Zealand white rabbits were used and divided equally into two groups. In both groups, endochondral, cancellous bone graft was harvested from the anterior ilium. The bone graft was then compressed and placed as an onlay onto the lateral aspect of the mandible using two chambers for each animal. In the control group, the chambers were made of titanium, however in the test group the chambers were made of poly L-lactide, polyglycolide and trimethylene carbonate mesh (Inion GTR(TM) Finland), and thereafter the chambers were fixed to the mandible. The animals were then sacrificed after eight weeks postoperatively, and then Micro-CT imaging was performed for the entire sample in order to determine the total volume of calcified tissue present under each chamber. In addition, Histologic sections were obtained from each chamber, and thereafter stained using Toluidine blue and Von Kossa for the purpose of histomorphometric analysis in order to determine the calcified tissue surface area. Results. When comparing the data from both the titanium (Ti) and the biodegradable mesh (PLA) groups, Micro CT analysis showed no significant statistical difference (P-value = 0.546) with regard to the percentage of bone found under the chambers (Ti 15.0% and PLA 13.83%). Interestingly, neither did the histomorphometric analysis show any significant statistical deference (P-value = 0.8272) with regard to the percentage of calcified tissue surface area (Ti 16.86% and PLA 16.17%). Moreover, this calcified tissue was also found to be evenly distributed in both groups. Conclusion. Biodegradable mesh made of poly L-lactic and polyglycolic acid copolymers appears to be an appropriate alternative to the Ti mesh for support of PBCM bone grafts. However, further clinical trails should be conducted to confirm these findings.

This research project investigated the impact of an action research intervention implemented to reducing surgical wound infection in one of the acute care hospitals in India. The study aimed to develop and implement a clinical practice improvement program in reducing surgical wound infection by improving the hand washing and wound dressing practices of nurses. The study also aimed to identify the important contributing factors to a model that predicts surgical wound infection. Pre-post evaluation measures were taken to compare the results of surgical wound infection rate before and after the implementation of the intervention. Surgical wounds of two thousand patients (one thousand before the intervention and another one thousand after) were assessed to determine the wound infection rate and severity of wound infection. The hand washing and wound dressing practices of forty nurses were observed. These same nurses were involved in the intervention using a participatory action research process. The results of the study suggest that there was a marked, significant reduction in the rate and severity of wound infection following the implementation of the intervention. By increasing the hand washing facilities in the ward, educating nurses on the importance of better hygiene, pre-operative shaving and post-operative wound care, the hand washing and wound dressing practices of nurses improved considerably. These improvements resulted in a reduction in the number and severity of patients' surgical wound infections. The study also examined the contribution of different factors to surgical wound infection in a Indian hospital. Significant predictive factors were the patients' age, longer pre-operative hospital stay, extended pre-operative shaving time before surgery, wound class, and co-morbidity of the patient. The identification of risk factors that contributed to increased surgical wound infection for example pre-operative skin preparation, pre-operative hospital stay of the patient would help in taking appropriate measures at the ward level and organisation as a whole. Nosocomial infections extends to an unnecessary lengthy hospital stay, additional treatment increased mortality and morbidity, and increased cost to the patients and the nation as a whole. This project proved that educational mentoring, data surveillance processes and involving the nurses in an action research process were effective in enabling participants to improve their clinical practice and thereby reduce the incidence of patients' surgical wound infections. Establishing infection control teams, ongoing surveillance and feedback to staff of nosocomial infection rates is an urgent need in all Indian hospitals. Organisational management, as a priority, need to provide funding and staff dedicated to undertaking this essential work. Health care professionals can no longer plead ignorance of a situation for which all have a moral and professional responsibility.

There are a number of factors recognised as significant for nursing staff retention. These include, a lack of organisational care, bullying (commonly referred to as horizontal violence), and high workload acuity. However, there does not appear to be any indication that these factors influence the retention of nurses within the speciality of acute perioperative nursing. A descriptive study using postpositivist methodology and triangulation of methods was designed to answer the question: What are the critical factors that influence staff retention in an acute perioperative environment? Forty-eight (n = 48) perioperative nurses answered a questionnaire in relation to individual needs, provision of nursing care and administration and management. Four (n = 4) nurses subsequently participated in a focus group interview that explored in more depth, the survey data related to the following characteristics: Educational opportunities; Level of workload acuity; Rostering flexibility; Management; Established policies/Quality assurance; Graduate orientation programs and Professional relationships in an acute perioperative setting. Data analysis revealed that > 90% of respondents agreed that these characteristics are important for job satisfaction and influence staff retention in an acute perioperative environment. A sense of belonging appears to be the most important theme that emerged from the qualitative data. Job satisfaction and staff retention are attained when nurses have a sense of belonging in the workplace. To achieve these, nurses need to identify barriers, develop their communication and leadership skills and determine the ideal professional practice model. The themes (Figure 5), "Finding time" and increased "sick leave", in relation to workload acuity are new findings that provide a platform for future research.

MPhilPH / Female tubal sterilisation, often referred to as "tubal ligation" but more often performed these days using laparoscopically-applied metal clips, remains a popular form of contraception in women who have completed their families. A review of the literature on the incidence of failure of tubal sterilisation found many reports of case-series and small clinic-based studies, but only a few larger studies with good epidemiological designs, most recently the US CREST study conducted during the 1980s and early 1990s. The CREST study reported a conditional (life-table) cumulative incidence of failure of 0.55, 0.84, 1.18 and 1.85 per 100 women at 1, 2, 4 and 10 years of follow-up respectively. The study described here estimated a lower bound for the incidence of tubal sterilisation failure in NSW by probabilistically linking routinely-collected hospital admission records for women undergoing sterilisation surgery to hospital admission records for the same women which were indicative of subsequent conception or which represented censoring events such as hysterectomy or death in hospital. Data for the period July 1992 to June 2000 were used. Kaplan-Meier and proportional-hazards survival analyses were performed on the resulting linked data set. The conditional cumulative incidence per 100 women at 1, 2 4 and 8 years of follow-up was estimated to be 0.74 (95% CI 0.68-0.81), 1.05 (0.97-1.13), 1.33 (1.23-1.42) and 1.51 (1.39-1.62) respectively. Forty percent of failures ended in abortion and 14% presented as ectopic pregnancies. Age, private health insurance status and sterilisation in a smaller hospital were all found to be associated with lower rates of failure. Strong evidence of time-limited excess numbers of failures in women undergoing surgery in particular hospitals was also found. The study demonstrates the feasibility of using linked, routinely-collected health data to evaluate relatively rare, long-term outcomes such as sterilisation failure on a population-wide basis.

Thesis (M.A.)--Northern Kentucky University, 2007. / Made available through ProQuest. Publication number: AAT 1445115. ProQuest document ID: 1342744201. Includes bibliographical references (p. 35-36)

Thesis (Ph. D.)--West Virginia University, 2008. / Title from document title page. Document formatted into pages; contains ix, 137 p. : ill. Includes abstract. Includes bibliographical references (p. 127-137).

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.