Plos One
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In 2009, the Western Australian (WA) Government introduced the Four-Hour Rule (FHR) program. The policy stated that most patients presenting to Emergency Departments (EDs) were to be seen and either admitted, transferred, or discharged within 4 hours. This study utilised de-identified data from five participating hospitals, before and after FHR implementation, to assess the impact of the FHR on several areas of ED functioning. ⋯ The FHR had a consistent effect on 'flow' measures: significantly reducing ED overcrowding and access block and enhancing ED efficiency. Time-based outcome measures mostly improved with the FHR. There is some evidence of increased ED attendance, but no evidence of increased ED re-attendance. Effects on patient disposition status were mixed. Overall, this reflects the value of investing resources into the ED/hospital system to improve efficiency and patient experience. Further research is required to illuminate the exact mechanisms of the effects of FHR on the ED and hospital functioning across Australia.
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Clinical Trial
The impact of being bullied at school on psychological distress and work engagement in a community sample of adult workers in Japan.
The aim of this study was to investigate the long-term impact of being bullied at school on current psychological distress and work engagement in adulthood among Japanese workers. We hypothesized that workers who had been bullied at school could have higher psychological distress and lower work engagement compared to those who had not been bullied. ⋯ Being bullied at school was positively associated with both psychological distress and work engagement in a sample of workers. Being bullied at school may be a predisposing factor for psychological distress, as previously reported. The higher levels of work engagement among people who experienced being bullied at school may be because some of them might have overcome the experience to gain more psychological resilience.
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The aim of the present study was to evaluate the ability of the ratios of central venous to arterial carbon dioxide content and tension to arteriovenous oxygen content to predict an increase in oxygen consumption (VO2) upon fluid challenge (FC). ⋯ Our results showed that the ratios of central venous to arterial carbon dioxide content and tension to arteriovenous oxygen content were not predictive of VO2 changes following fluid challenge in postoperative cardiac surgery patients.
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Observational Study
Mid regional pro-adrenomedullin for the prediction of organ failure in infection. Results from a single centre study.
Biomarkers are widely used to confirm the presence of infection. However, it would be of the greatest importance to predict in advance the occurrence or worsening of organ dysfunction in infected patients allowing timely antibiotic escalation. This study investigates the ability of procalcitonin (PCT) and MR-proADM to predict the transition to sepsis in infected patients. ⋯ This was a pivotal study conducted in a single neurointensive centre on a limited number of patients, and as such it does not provide definitive conclusions. PR-proADM predicted occurrence and worsening of organ failure in critically ill patients with and without infection. The combination with infection diagnostic biomarkers such as PCT would allow predicting evolution to sepsis in infected patients.
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Nurses play an important role in maintaining patients' dignity. How to measure patients' dignity and dignity-related distress is an important issue in nursing care. Use of a reliable and valid tool assessing dignity-related distress in patients is necessary. ⋯ As a result of the factor analysis, four factors, including existential distress, loss of support and sense of meaning, symptom distress, and loss of autonomy. Concurrent validity showed that the PDI-MV was significantly correlated with the PHQ-9 (r = 0.25-0.54), DS-MV (r = 0.30-0.58) and the RSES (r = - 0.08 to-0.30), Cronbach's alpha coefficients for the PDI-MV and four factors were 0.95, 0.95, 0.84, 0.83, and 0.89 respectively. The PDI-MV is a psychometrically sound instrument assessing a broad range of dignity-related distress issues in cancer patients.