PurposeHalf of the patients experience pain during their ICU stay which is known to influence their outcomes. Nurses and physicians encounter organizational barriers towards pain assessment and treatment. We aimed to evaluate the association between adequate pain management and nurse to patient ratio, bed occupancy rate, and fulltime presence of an intensivist.Materials and methodsWe performed unadjusted and case-mix adjusted mixed-effect logistic regression modeling on data from thirteen Dutch ICUs to investigate the association between ICU organizational characteristics and adequate pain management, i.e. patient-shift observations in which patients' pain was measured and acceptable, or unacceptable and normalized within 1 h.All ICU patients admitted between December 2017 and June 2018 were included, excluding patients who were delirious, comatose or had a Glasgow coma score < 8 at the first day of ICU admission.ResultsCase-mix adjusted nurse to patient ratios of 0.70 to 0.80 and over 0.80 were significantly associated with adequate pain management (OR [95% confidence interval] of respectively 1.14 [1.07–1.21] and 1.16 [1.08–1.24]). Bed occupancy rate and intensivist presence showed no association.ConclusionHigher nurse to patient ratios increase the percentage of patients with adequate pain management especially in medical and mechanically ventilated patients.
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This report investigates prior experiences and impacts of the European Capital of Culture (ECoC) with the aim of informing preparation plans for Leeuwarden and Fryslân to organize the event in 2018. The longterm benefits that the ECoC tend to be both tangible through improvements in facilities, and intangible as self-confidence and pride increase as the result of celebrating the destination, its culture and history.
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In recent years, the effects of the physical environment on the healing process and well-being have proved to be increasingly relevant for patients and their families (PF) as well as for healthcare staff. The discussions focus on traditional and institutionally designed healthcare facilities (HCF) relative to the actual well-being of patients as an indicator of their health and recovery. This review investigates and structures the scientific research on an evidence-based healthcare design for PF and staff outcomes. Evidence-based design has become the theoretical concept for what are called healing environments. The results show the effects on PF and staff from the perspective of various aspects and dimensions of the physical environmental factors of HFC. A total of 798 papers were identified that fitted the inclusion criteria for this study. Of these, 65 articles were selected for review: fewer than 50% of these papers were classified with a high level of evidence, and 86% were included in the group of PF outcomes. This study demonstrates that evidence of staff outcomes is scarce and insufficiently substantiated. With the development of a more customer-oriented management approach to HCF, the implications of this review are relevant to the design and construction of HCF. Some design features to consider in future design and construction of HCF are single-patient rooms, identical rooms, and lighting. For future research, the main challenge will be to explore and specify staff needs and to integrate those needs into the built environment of HCF.
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To understand how transition across different thermal zones in a building impacts the thermal perception of occupants, the current work examines occupant feedback in two work environments — nursing staff in hospital wards and the workers in an office. Both studies used a mix of subjective surveys and objective measurements. A total of 96 responses were collected from the hospital wards while 142 were collected from the office. The thermal environment in the hospital wards was perceived as slightly warm on the ASHRAE thermal sensation scale (mean TSV = 1.2), while the office workers rated their environment on the cool side (mean TSV = 0.15). The results also show that when the transitions were across temperature differences within 2 °C, the thermal perception was not impacted by the magnitude of the temperature difference — as reflected in occupant thermal sensation and thermal comfort/thermal acceptability vote. This would imply that the effect of temperature steps on thermal perception, if any, within these boundaries, was extremely short lived. These findings go towards establishing the feasibility of heterogeneous indoor thermal environments and thermal zoning of workspaces for human comfort.
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Objective. To study the prevalence, nature and determinants of aggression among inpatients with acquired brain injury. Background. Patients with acquired brain injury often have difficulty in controlling their aggressive impulses. Design. A prospective observational study design. Methods. By means of the Staff Observation Aggression Scale-Revised, the prevalence, nature and severity of aggressive behaviour of inpatients with acquired brain injury was assessed on a neuropsychiatric treatment ward with 45 beds. Additional data on patient-related variables were gathered from the patients’ files. Results. In total, 388 aggressive incidents were recorded over 17 weeks. Of a total of 57 patients included, 24 (42%) patients had engaged in aggressive behaviour on one or more occasions. A relatively small proportion of patients (n = 8; 14%) was found to be responsible for the majority of incidents (n = 332; 86%). The vast majority of aggression incidents (n = 270; 70%) were directly preceded by interactions between patients and nursing staff. In line with this, most incidents occurred at times of high contact intensity. Aggressive behaviour was associated with male gender, length of stay at the ward, legal status and hypoxia as the cause of brain injury. Conclusion. Aggression was found to be highly prevalent among inpatients with acquired brain injury. The results suggest that for the prevention of aggression on the ward, it may be highly effective to develop individually tailored interventions for the subgroup with serious aggression problems. Relevance to clinical practice. Insight into the frequency, nature and determinants of aggressive behaviour in inpatients with acquired brain injury provides nurses with tools for the prevention and treatment of aggressive behaviour.
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An important consideration for future age-friendly cities is that older people are able to live in housing appropriate for their needs. While thermal comfort in the home is vital for the health and well-being of older people, there are currently few guidelines about how to achieve this. This study is part of a research project that aims to improve the thermal environment of housing for older Australians by investigating the thermal comfort of older people living independently in South Australia and developing thermal comfort guidelines for people ageing-in-place. This paper describes the approach fundamental for developing the guidelines, using data from the study participants’ and the concept of personas to develop a number of discrete “thermal personalities”. Hierarchical Cluster Analysis (HCA) was implemented to analyse the features of research participants, resulting in six distinct clusters. Quantitative and qualitative data from earlier stages of the project were then used to develop the thermal personalities of each cluster. The thermal personalities represent di erent approaches to achieving thermal comfort, taking into account a wide range of factors including personal characteristics, ideas, beliefs and knowledge, house type, and location. Basing the guidelines on thermal personalities highlights the heterogeneity of older people and the context-dependent nature of thermal comfort in the home and will make the guidelines more user-friendly and useful. Original publication at MDPI: https://doi.org/10.3390/ijerph17228402 © 2020 by the authors. Licensee MDPI.
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Discussions about the importance of the built environment for healthcare delivery extend at least as far back as Hippocrates 1 (400 BC). The iconic Florence Nightingale (1859) also strongly believed in the influence the indoor environment has on the progress of disease and recovery. Today, the role of the built environment in the healing process is of growing interest to healthcare providers, environmental psychologists, consultants, and architects. Although there is a mounting evidence 1 linking healthcare environments to health outcomes, because of the varying quality of that evidence, there has also been a lack of clarity around what can and cannot be achieved through design. Given the ageing of society and the ever increasing numbers of persons with dementia in the Western World, the need for detailed knowledge about aged care environments has also become increasingly important. The mental and physical health state of these persons is extremely fragile and their needs demand careful consideration. Although environmental interventions constitute only a fraction of what is needed for people with dementia to remain as independent as possible, there is now sufficient evidence (2, 3) to argue they can be used as a first-line treatment, rather than beginning with farmalogical interventions.
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As people age, physiological changes affect their thermal perception, sensitivity and regulation. The ability to respond effectively to temperature fluctuations is compromised with physiological ageing, upsetting the homeostatic balance of health in some. As a result, older people can become vulnerable at extremes of thermal conditions in their environment. With population ageing worldwide, it is an imperative that there is a better understanding of older people’s thermal needs and preferences so that their comfort and wellbeing in their living environment can be optimised and healthy ageing achieved. However, the complex changes affecting the physiological layers of the individual during the ageing process, although largely inevitable, cannot be considered linear. They can happen in different stages, speeds and intensities throughout the ageing process, resulting in an older population with a great level of heterogeneity and risk. Therefore, predicting older people’s thermal requirements in an accurate way requires an in-depth investigation of their individual intrinsic differences. This paper discusses an exploratory study that collected data from 71 participants, aged 65 or above, from 57 households in South Australia, over a period of 9 months in 2019. The paper includes a preliminary evaluation of the effects of individual intrinsic characteristics such as sex, body composition, frailty and other factors, on thermal comfort. It is expected that understanding older people’s thermal comfort from the lens of these diversity-causing parameters could lead to the development of individualised thermal comfort models that fully capture the heterogeneity observed and respond directly to older people’s needs in an effective way. (article starts at page 13)
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Older people are often over-represented in morbidity and mortality statistics associated with hot and cold weather, despite remaining mostly indoors. The study “Improving thermal environment of housing for older Australians” focused on assessing the relationships between the indoor environment, building characteristics, thermal comfort and perceived health/wellbeing of older South Australians over a study period that included the warmest summer on record. Our findings showed that indoor temperatures in some of the houses reached above 35 °C. With concerns about energy costs, occupants often use adaptive behaviours to achieve thermal comfort instead of using cooling (or heating), although feeling less satisfied with the thermal environment and perceiving health/wellbeing to worsen at above 28 °C (and below 15 °C). Symptoms experienced during hot weather included tiredness, shortness of breath, sleeplessness and dizziness, with coughs and colds, painful joints, shortness of breath and influenza experienced during cold weather. To express the influence of temperature and humidity on perceived health/wellbeing, a Temperature Humidity Health Index (THHI) was developed for this cohort. A health/wellbeing perception of “very good” is achieved between an 18.4 °C and 24.3 °C indoor operative temperature and a 55% relative humidity. The evidence from this research is used to inform guidelines about maintaining home environments to be conducive to the health/wellbeing of older people. Original publication at MDPI: https://doi.org/10.3390/atmos13010096 © 2022 by the authors. Licensee MDPI.
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Talloze studies tonen aan dat een fysiek actieve leefstijl bloeddruk, cholesterol en gewicht verlaagt, botten en spieren versterkt en het risico van hart- en vaatziekten, darmkanker en diabetes type II vermindert. Bewegen kan dus worden gezien als een medicijn wat voor iedereen toegankelijk is.
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