This study prospectively evaluates the recall of one hundred patients following admission to an Intensive Care Unit (ICU) at Groote Schuur Hospital. It was prompted by criticism (by members of staff and visitors to the ICU) of our practice of wardrounds, arterial blood gas sampling, and light sedation of patients. In addition, staff preconceptions about patients' reactions to the ICU needed evaluation. The patients analyzed included a wide spectrum of race, religion, occupation, and educational levels. The more common diagnoses included asthma (22%), pneumonia (14%), trauma (13%), and Adult Respiratory Distress Syndrome (ARDS) (13%). The average APACHE II score (a scoring system widely used to evaluate severity of illness) was 12.27 and 68% of the patients were mechanically ventilated. Objective data collected while the patients were in the ICU included demographic information, diagnosis, APACHE II score, sedation, level of consciousness, and procedures. Within 48 hours of discharge from the ICU, patients were interviewed and asked to quantify their recall of procedures and events which had occurred while they were in the ICU. Data was entered into a microcomputer database for analysis and, where appropriate, statistical tests were performed. Seventy-one patients recalled being admitted to hospital but only 50 remembered being admitted to ICU. Eighty-four patients described the ICU atmosphere as friendly or relaxed. Seventy-three patients felt that they had sufficient sleep while in the ICU. The most frequently reported unpleasant experiences were arterial blood gas sampling (48 patients), tracheal suctioning (30 of 68 ventilated patients), pain (22 patients), and noise (20 patients). Only 6 patients disliked wardrounds and discussion around the bedside. Conclusions include the suggestions that arterial catheters or pulse oximetry should be used when frequent arterial blood gas analyses are needed, and that tracheal suctioning should be performed with more care.

The purpose of this investigation is to identify various economic, societal, and institutional variables that can be associated with enrollment trends of the Research Universities I and II. These variables will then be used to formulate disaggregated enrollment forecasts by enrollment-change categories and by institutional classification, using Carnegie Commission and Office of Education taxonomies. These disaggregated trends along with appropriate variables and forecasted variables will be used to construct prediction models by category and institution. The results indicate that the research universities have not experienced declining enrollments and that their growth was slower but more stable than the national norm. They have not experienced the growth of part-time students that occurred nationally. Instead, the increased enrollment was caused by a growth in the female student population. The enrollments of research universities can be predicted by the one variable of time with an error of less than 3.0 percent. The predictors based upon individual institutions produce an error of 0.993 percent for the Research Universities I and 1.650 percent for the Research Universities II. The predictions based upon trend groups produced an error of 4.32 percent and 2.29 percent for the respective research universities. The enrollment of the research universities can be predicted with an accuracy of 13.54 percent for the Research Universities I and 8.134 percent for group II.

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No description available.

It has consistently been documented in many countries and sectors that there are difficulties in implementing public policy effectively. A priori, the Australian health care system is no exception to this general proposition. While governments issue directives with particular goals in mind these goals are not always met, because of the modifications, interpretations or lack of uptake by targeted populations. However it is not clear the extent to which these difficulties occur in the public hospital sector, and we lack clear empirical data on this phenomenon. This thesis investigates the effects of a state government directive on the development and implementation of elective admission policies in New South Wales public hospitals. It did this by three separate but related studies that examined the impact of the directive at the hospitals??? management and staff levels. The first two studies were quantitative and qualitative surveys of hospital managers and admission staff. The management survey aimed to ascertain the extent to which managers responded to the directive in terms of developing and implementing hospital policies. The staff survey sought to investigate staff awareness and knowledge of the developed policies. The third study was a qualitative analysis of the policy contents to determine the extent to which they reflected the aims and objectives of the government directive guidelines. All three studies found a general lack of relevance and applicability of the government directive and its guidelines to individual hospital organisations. The manager survey showed a disconnection between the central government office responsible for implementing the directive and hospital managers??? perspectives. This was apparent by the lack of response to the directive by many hospitals and the fact that managers often passed on the task of implementing the directive and its guidelines to other hospital staff. The findings of the qualitative analysis of policies showed evidence of hospital strategies to manage pressures created by the directive. These difficulties were corroborated by the surveyed staff that reported difficulties in translating the directive???s requirements (as reflected by the hospital policy), into the reality of their daily work; a lack of organisational commitment to policy enforcement; and a suspicion regarding the directive???s political motives. The findings of this thesis show that, as with other public service sectors effective policy implementation in the public hospital arena is problematic, with government agendas frequently not aligned with the requirements of stakeholders, and inadequate understanding of implementation barriers. Recommendations are made regarding methods to improve the synchronicity of political directives with organisational realties in the public hospital sector.

With the maturity of wireless network technologies, more and more real-time data and applications, such as video on demand, video teleconferencing, are being transmitted on the wireless environment. In the next generation high-speed wireless networks, the important issue is how to provide quality-of-service (QoS) guarantees as they are expected to support multimedia applications. Although the QoS provisioning problem arises in wireline network as well, scarcity of bandwidth, mobility of hosts, high bit error rate, etc., provisioning a challenging task in wireless network. It is important to reduce the dropping rate caused by lack of available bandwidth in the handoff target cell. Call admission control is a key component for real-time, continuous media connections to guarantee QoS for these applications. In this thesis, we proposed a new call admission control scheme in wireless network. The scheme is integration bandwidth reservation and reallocation strategy and more effective to reach that decrease the handoff call dropping probability (CDP), new call blocking probability (CBP) and increase the bandwidth utilization (BU). Furthermore, our scheme also considered aspects of multi-class and fairness when the system allocated resource to calls. Extensive simulation results show that our scheme outperforms the best previously known schemes to provide QoS guarantees for multimedia traffic.

Proefschrift--Nijmegen--Katholieke universiteit, 1995. / Bibliogr. p. [239]-246. Index.

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Background: The efficacy of interventions to prevent in-hospital transmission of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) is poorly defined, particularly for admission screening. Methods: Variability in ESBL-E infection control practices was evaluated with a survey of 15 hospitals. All ESBL-E positive clinical and screening specimens at 12 hospitals (6 screening and 6 non-screening) from 2005-2009 were included and defined as hospital-onset or community-onset using standard definitions. ESBL-E incidence and susceptibility were studied. Screening efficacy was evaluated with a negative binomial model, adjusting for study year and incidence of community-onset cases. Results: Diverse practices in infection control for ESBL-E were found with 53.3% of hospitals utilizing admission screening. Overall incidence and hospital-onset cases increased 4-fold and 2-fold, respectively. Fluoroquinolone susceptibility for E. coli (12.8%) and K. pneumoniae (9.0%) was low. Hospital-onset cases were 49.1% lower in screening compared to non-screening hospitals (p<0.001). Conclusion: Admission screening can reduce the incidence of hospital-onset ESBL-E cases.