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Copeptin as a possible Sign associated with Hemodynamic Derangement and Diagnosis throughout Liver organ Cirrhosis.
Implementation of a Neonatal Pain Assessment Instrument at a Neonatal Intensive Care Unit - A Quality Improvement Project Abstract.Background Optimal pain management is necessary in order to not jeopardize the development of preterm neonates. Aim Implementation and evaluation of systematic and best possible pain assessment with the Bernese Pain Scale for Neonates for all preterm and sick neonates of a neonatal intensive care unit by nursing staff. Methods The educational concept is based on three key strategies knowledge translation (group- and one-on-one training), reflection (case conferences) and clinical training. The frequency of the use of the Pain Score was recorded before (T0) and after implementation (T1) and six months after completion of the project (T2). Results Before the implementation (T0) the use of the Bernese Pain Scale was regulated by an internal guideline but its application could not be verified during the baseline period (fulfillment rate of 0 %). After implementation (T1) at least one assessment per shift per neonate could be achieved in 99.1 % of the cases. Nurses conducted 210 assessments on 38 neonates in T1. In follow-up (T2) six months after implementation fulfillment rate of 100 % in 34 neonates was achieved with 188 pain assessments. Conclusions This implementation strategy was successful in establishing the assessment instrument in clinical practice.Everyday life of adolescents with sickle cell disease - A qualitative, explorative and participative photovoice study Abstract.Background Sickle cell disease (SCD) is a chronic, inherited haematological condition that occurs rarely in Switzerland. The disease is characterized by recurring attacks of pain and serious infections that require frequent hospitalisation. Due to its rarity, little is known about the disease's impact on the daily lives of afflicted adolescents. Aim The study investigated how the disease impacts on the lives of adolescents with SCD and identified the most pertinent challenges they face in their daily activities. Knowledge gained serves to improve support offered by the Paediatric Haematological Centre. Method Qualitative data was collected using the participative method Photovoice. This involved an integrated group discussion of photographs taken by the participants, and was followed by reconstructive analysis. Results Issues voiced covered living environment (e. g. family), coping strategy (e. g. peers) and health literacy (e. g. understanding their condition). These issues were perceived as challenges as well as a resource. Self-management and Shaping of health management emerged as key issues for a support and care concept in nursing and health counselling of SCD. Conclusions Adolescents with SCD exhibited health literacy in various areas of their lives that can be fostered by the health care system. A most promising approach is genuine participation and inclusion of peers in both councelling and research.The spirit of sport, which encompasses intrinsic values associated with sport participation, is core to the World Anti-Doping Agency's (WADA) strategy for doping prevention. The contribution of these values to clean sport has yet to be established. In this study, athletes rated the importance of spirit of sport values (WADA, 2015) and sport values (Lee et al., 2000, 2008) and indicated their clean sport likelihood in a hypothetical scenario. ALLN ic50 Clean sport likelihood was positively predicted by the five spirit of sport values (ethics/fair play/honesty, respect for rules/laws, dedication/commitment, teamwork, community/solidarity), two sport value domains (morality, competence), and 11 sport values (contract maintenance, being fair, conscientiousness, sportspersonship, show skills, health/fitness, caring/compassion, team cohesion, achievement, tolerance, obedience). Clean sport likelihood was best predicted by moral values.We present a case of a 53-year-old male living with well-controlled HIV who, as part of routine monitoring, was noted to have an unexpected decline in renal function. His antiretrovirals were switched accordingly. It subsequently transpired that he had recently started taking creatine supplements in order to build muscle mass. He underwent specialist renal review and further investigation with a chromium-labelled scan which revealed his renal function was, in fact, stable. He continues under renal and HIV follow-up. It is now more widely recognised that creatine can affect renal function, and result in difficulty in interpretation of traditional renal blood tests. However, the further investigations that may be undertaken in such settings and HIV treatment considerations are not as widely reported. This case serves as a reminder to ensure over-the-counter and herbal supplements are part of routine questioning in HIV clinics, and outlines the specialist investigations that may be undertaken in cases of apparent renal decline.
Despite evidence on the positive impact of trust in a doctor-patient relationship on health outcomes, there are limited studies conducted in Pacific Island Countries including Fiji. This study was conducted to assess the current level of patient trust in doctors and investigate its determinants in Fiji. Method A random sample of 410 participants attending the outpatient services completed the self-administered structured questionnaire. The response rate was 91% (N=375) and data was analyzed using descriptive statistics and analytic analysis using logistic regression. Result Mean age of participants was 38years (±15yrs). The majority of patients had partial trust in their doctors compared to full trust (61.6% vs 38.4%). More than half of the participants perceived doctor's communication behavior as fair rather than good (53.6% vs 45.6%). Those over 50 years (OR 1.96; p=0.007, 95% CI 1.198-3.226) and those who perceived doctors' communication behavior as good (OR 8.48; p=0.0001, 95% CI 5.257-13.709) were sign age of participants was 38years (±15yrs). The majority of patients had partial trust in their doctors compared to full trust (61.6% vs 38.4%). More than half of the participants perceived doctor's communication behavior as fair rather than good (53.6% vs 45.6%). Those over 50 years (OR 1.96; p=0.007, 95% CI 1.198-3.226) and those who perceived doctors' communication behavior as good (OR 8.48; p=0.0001, 95% CI 5.257-13.709) were significantly more likely to have full trust in the doctors. Conclusion This study reveals that age and communication are determinants of trust in Fiji. In view of the current perception of the doctors' communication behavior, Fiji's Ministry of Health and Medical Services should implement policies to give equal importance to the communication skills of the doctors together with their clinical skills and enforce it in the medical schools.
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