- Healthcare Management | Nursing Education| Pediatric Nursing and Care | Pediatric and hospital medicine specialties | Hospitalists: Categorization| Pediatric Nosocomial infections | Pediatric Infectious Diseases: diagnosis and treatments
Location: Boston,USA
Chair
Vinit Wankhede
Government Medical College and Hospital, India
Session Introduction
Karan Pahuja
Nelson’s Mother and Child Care Center and Research Institute, India
Title: Electro-clinical worsening in children treated with Carbamazepine/ Oxcarbamazepine: Concern for use of CBZ/OXC as an initial AED for focal epilepsy in children.
Time : 13:50-14:20
Biography:
Carbamazepine (CBZ) and its derivative Oxcarbamazepine (OXC) are antiepileptic drugs (AEDs) effective in mainly focal and few generalized epilepsies. However, CBZ/OXC is not only known to exacerbate epileptic seizures in generalized epilepsies but also sometimes even in focal epilepsies and known to have EEG worsening as an adverse effect. Literature review describes several cases of seizure exacerbation and /or EEG worsening due to CBZ/OXC with a high incidence in children. We report 30 new cases of such worsening.
Methodology: Out of 262children, who were put on CBZ/OXC, we retrospectively analyzed 30 patients who developed clinical and/or electrographic worsening after initiation of drug. We noted detailed seizure profile, serial EEG tracings, cognitive functions or behavior before and after CBZ/OXC treatment and after withdrawal of CBZ/OXC. 27 patients had focal epilepsy and 3 had generalized epilepsy who presented initially with focal seizures. Clinically, seizure frequency increased in 14 patients(46.6%) and 12(40%) had onset of new seizures types like isolated myoclonus in 5, isolated absences in 5 and GTC, atonia with myoclonus in 1, myoclonus with absences in 1 and in rest 4(13.3%)deteriorating scholastic performance and/or appearance of behavioral issues were the sole indicators of worsening. Electrographically, deterioration was in the form CSWS pattern in 6 patients, 3 Hz SWD in 2 and increase in discharge frequency in rest 22. The cognitive/ psychosocial issues were noted in 25 patients in the form of ADHD/hyperactivity/inattentiveness/aggressiveness. After discontinuation of CBZ/OXC and change of AED, reduction in seizure frequency, disappearance of new seizure types, behavior improvement and improving scholastic performance was noted. EEG abnormalities reduced in 22 cases (73.33%) and disappeared in 8 patients (26.66%).
Conclusion: Children on CBZ/OXC must be followed up for clinical and psychosocial parameters. Increase in seizure frequency, appearance of new seizure types or behavioral issues and progressive scholastic deterioration warrants timely EEG to look for possible worsening. However, this also raises concern for use of CBZ/OXC as an initial AED for focal epilepsy in children.
Abstract:
Karan Pahuja is a final year medical (MBBS) student at Government Medical College and Hospital, Nagpur, Maharashtra, India. He is also a research trainee under Dr. Vinit Wankhede at Nelson Child and Mother Care Hospital and Research Institute located in Nagpur. He is interested in evolving as a clinical researcher and improve doctor patient communication skills. Being able to communicate in 5 languages, he has been working hard on his knowledge and abilities to become a fine clinician and scientist.
Mojdeh Habibi Zoham
Tehran University of Medical Sciences, Iran
Title: Afebrile benign convulsion associated with mild gastroenteritis
Time : 14:20-14:50
Biography:
Mojdeh Habibi Zohan is a pediatric critical care fellowship who is working as an assistant professor in Tehran University of Medical Sciences, Tehran, Iran. She has certified pediatric critical care specialist and has five years of experience in the field of critical care of pediatrics. She is first aid and PALS certified. She is interested in all fields of pediatrics including pediatric neurology thus this research was established. The entity of this investigation is a novel and useful issue for practicing pediatricians.
Abstract:
Background: Benign convulsion with mild gastroenteritis is a new clinical entity that occurs in children who are otherwise healthy.
Method: This cohort study held among patients with afebrile convulsion and accompanying gastroenteritis in a tertiary children hospital during a 2-year period. Demographic and clinical data were analyzed. Neurodevelopmental milestones were observed during a follow-up period of 12 to 24 months.
Results: Twenty-five patients aged 3 to 48 months with female predominance were enrolled. Ninety-three percent of cases experienced generalized tonic-clonic seizures. One-third of seizures occurred in clusters. Primary laboratory findings and electroencephalography were normal except for 3 with few epileptic waves. During the follow-up period, no seizure recurrence happened. Long-term antiepileptic treatment was unnecessary.
Conclusion: Afebrile convulsion accompanying mild gastroenteritis is a convulsive disorder with reassuring prognosis. Due to its benign course, comprehensive neurodiagnostic evaluation and long-term antiepileptic drugs are usually avoidable.
Brittney R. Dahlen, Samantha Lambert & Kristen M. Haack
Mayo Clinic Rochester, USA
Title: Safe patient handling: Implementing staff education to reduce exertion injuries
Biography:
Brittney R. Dahlen is a staff registered nurse on a general surgery and plastic surgery in-patient nursing unit a Mayo Clinic Rochester. Brittney obtained a Bachelor of Science in Nursing degree from University of Minnesota in 2014. Brittney has worked at Mayo Clinic for over 3 years and has been very active in department and unit committees. She is involved with the NDNQI Pressure Injury and Restraint Survey, Skin Savers, Francis 2C Safety Committee Co-Chair, and Francis 2C Patient Experience Committee Co-Chair. Brittney holds a Certified Medical Surgical Registered Nursing and Bronze Quality Fellow specialty certifications. Brittney enjoys working with her nursing and multidisciplinary colleagues on quality improvement projects and is excited to pursue a Doctorate of Nursing Practice in Nursing Leadership
Abstract:
Statement of the Problem: In 2016, Francis 2C, a general and plastic surgery in-patient unit, had an increased number of staff exertion injuries. After review of injury incident reports, it can be concluded all exertion injuries in 2016 could have been prevented by utilizing available lift equipment. According to an ANA survey, “…almost 60% of nurses list disabling back injuries as one of the top three health safety issues” (Stenger, Montgomery, & Briesemeister, 2007). Utilization of lift equipment was found to decrease injury rates, but a change in nursing culture is also necessary to promote maximum safety (Zadvinskis & Salsbury, 2010). The purpose of this study was to determine if staff education (including leadership and culture education) as well as unit safety advocates would decrease exertion injuries through increased safe patient handling equipment use. Methodology & Theoretical Orientation: This quality improvement project was conducted by obtaining pre- and post-survey data of staff knowledge and cultural perceptions of safe patient handling equipment. Safe patient handling education using ceiling lifts and slings was developed and presented to staff in four hour sessions, during which staff had the opportunity to practice working with the sling and lift equipment. Staff committed to changing five behaviors in their daily practice to increase ceiling lift utilization and overall reduce exertion injuries. Findings: To date, Francis 2C has seen an 80% decrease in exertion injuries since 2016. Post-implementation surveys have been sent out to staff and further results are expected in December 2017. Conclusion & Significance: This project is ongoing with expected completion date of February 2018. Conclusions and significance will then be determined. Recommendations: Although this project is ongoing, it has been noted that staff education, buy-in, and culture change are integral factors to success in reducing exertion injuries, not just available safe patient handling equipment.
Biography:
Dr Fizza Hassan is a Final Year Student at Karachi Medical and Dental College, affiliated with Karachi University. She has been a keen researcher since High School and took part in many scientific projects at the city level. She has attended several national and international seminars and conferences. She has taken part in many types of research successfully published in international journals and many are ongoing. She is looking forward to a bright future in a medical career.
Abstract:
Background: Osteogenesis imperfecta is a group of genetic bone disorder of significant clinical variability secondary to mutations in the genes that code for type I pro-collagen. Major clinical characteristics of OI are bone fragility, osteopenia, variable degrees of short stature, and progressive skeletal deformities. The severity of the disease influences the ability to walk. Therefore it is important for physicians, patients, and the patients’ parents to gain insight into the severity and classification of the disease and the influence of disease-related characteristics on the prognosis for walking.
Objectives: Intramedullary strengthening of the fragile bones of Osteogenesis imperfecta by rodding results in great benefit on the affected individual.
Search Method: The following electronic databases were searched up to October 2017: CENTRAL (in the Cochrane Library), PubMed, and Science Direct, Scopus. In addition, we searched conference proceedings and reference lists of included studies. No language restrictions were applied.
Selection criteria: Case reports, interventional trials, Quasi-RCT, systemic review archives, and other studies that included a clearly defined comparator group were included. The studies investigated the surgical intervention of femoral intramedullary rodding, and improvement in functional ability and quality of life from the year 2000 to 2017.
Data analysis and Collection: Screening of citations, data extraction and validation, and assessment of the risk of bias was combined efforts of both authors.
Conclusion: Rodding is a sign of disease severity. In general, intramedullary rodding in the lower extremities is primarily indicated in the most severe types to stabilize the bone and to correct deformities. Early closed rodding has improved the early management of the disease without causing any ill effects. Because no randomized clinical trials have been performed for ethical reasons, the improvement of possibilities for ambulation after intramedullary rodding of the lower extremities remain questionable. Several authors state that intramedullary rodding of the legs improved the possibility for ambulation and expanding intramedullary rods reduce incidence of deformity, fractures, and increase walking capability, whereas others found no differences in patients who did and did not receive intramedullary rodding in the age of first achieving motor milestones and the ability for walking in later life. After intramedullary rodding of the legs was performed, functional ability, especially in the preexisting milestones, improved in patients with type III and IV, whereas in patients with type I, walking ability improved. It has been reported that in type IV, even when ambulation is achieved, walking is frequently lost in the second decade of life because of progressive spinal deformity, decreased motivation in physical therapy and the increasing use of a wheelchair.
Laila Khymani
Aga Khan University Hospital, Pakistan
Title: Re-engineering of homehealth service delivery model at Aga Khan University Hospital Karachi – Pakistan
Biography:
Laila Khymani has her expertise in health systems development in improving the health care quality. Her passion to provide quality healthcare to the doorsteps of the underserved population has encouraged her to come up with the innovation in service delivery model. This innovative service delivery model has created cost-effective and efficient ways of providing home health services to people in a country where they have to pay the cost of health care out of their pockets. This business approach is beneficial for all stakeholders; the organization in terms of financial sustainability, health care workers in terms of job satisfaction and remuneration and above all for patients in terms of access and availability of quality healthcare at their doorstep.
Abstract:
Introduction: Home is the place where every individual wants to be. However, literature has started to reveal that home is also the best setting for providing health care to patients where it is applicable. Considering the raising concerns regarding 1) increasing numbers of patients in hospitals, 2) throughput of discharges, 3) traveling to health care settings, 4) time spend by patient and attendants, and 5) cost associated with hospitalization, home care is the answer today and more so in future as all these concerns are on a rising trend.
Objective: Project objective was to an increase access to care for patients who required medical care at home, as evidenced by increasing number of patients of home care leading to increase in throughput at the hospital.
Method: Using Deming’s Plan-Do-Study-Act (PDSA) model for continuous quality improvement methodology, a project was initiated to identify ways to increase patient volume for home care within the available resources. The team reviewed current operational processes, the workload for home health workers along with costs incurred to deliver the services including staff salary, overtime, and transportation. Data related to current operational model was analyzed in depth to identify root cause of inefficiency. Process reengineering was performed to develop an improved design of service delivery. Two major interventions done; 1) development of hub and spoke model and 2) introduction of variable payment model for Registered Nurses (RN). Both these models were piloted at one spoke and upon success, replicated and standardized for home health services at Aga Khan University Hospital.
Results: Volume and revenue comparison of pre and post intervention revealed an increase in annual volume by 28% over the preceding year exceeding budgeted volume and revenue target by 14% and 11% respectively. Reduction in transportation cost, time efficiency, increase in nurses’ remuneration and an increase in staff and patient satisfaction were extra gains from the utilization of this new service delivery model of home health care.
Conclusion: The success of this project has provided a sustainable service delivery model of home health service to the organization and access to quality health care to the patients.
David Stanley
University of New England, Australia
Title: Exploring clinical leadership myths and legends; florence nightingale and mary seacole
Biography:
David has contributed significantly to nursing and midwifery education since he began teaching Enrolled Nurses in South Australia, in 1987. Since then, David has developed into a consummate professional educator who is student focused and driven to maintaining high quality, supportive, clinically relevant and up-to-date learning experiences in a range of presentation/learning formats.
Abstract:
Aim: To identify who the clinical leaders are and to explore and critically analyze the experience of being a clinical leader.
Background: Results from 6 studies will be presented. These started in 2001 and comprise data gathered in 2 countries over the following 17 years. Limited literature and fewer studies pointed to insight only from the management paradigm. These 6 studies explain another leadership theory that point toward a new way to understand clinical leadership.
Research Design: Each of the 6 studies employed a qualitative methodology (either Grounded Theory or Phenomenology). Each study secured a Human Research Ethics Committee approval. Studies involved a wide range of healthcare professionals (predominantly nurses), involved both male and female respondents, and took place in either, the UK and Australia between 2001 and 2015.
Questionnaire data were analyzed with the aid of the SPSS program and the in-depth qualitative data used NVivo data analysis software.
Results: Results offer a wide range of data. The data points to an understanding of the common characteristics of clinical leaders. These are approachability, clinical competence, values and beliefs have driven, supportive, motivator, inspiring confidence, effective communicator, visible in practice and a role model. The attribute most commonly not identified as a clinical leader characteristic is that of ‘controlling’. The results from the studies outlined above have also led to the development of a new leadership theory: Congruent Leadership (Stanley, 2008, & 2016). This theory suggests that leaders demonstrate a match (congruence) between the leader’s values and beliefs, and their actions.
- Nursing Education | Pediatric Hospitalist responsibilities
Location: Boston,USA
Chair
Tochi O. Ubani,
NursesDrCommunication, USA
