Kelling Hospital

OBJECTIVE: To assess whether home-based medication review by a pharmacist for at-risk older patients in a primary care setting can reduce hospital admissions. DESIGN: Randomised controlled trial comparing home-based medication review with standard care. SETTING: Home-based medication review of 136 patients registered with one general practice. METHOD: Study participants were over 80 years of age, living at home, taking four or more medicines, and had at least one additional medicines-related risk factor. The intervention comprised two home visits by a community pharmacist who educated the patient/carer about their medicines, noted any pharmaceutical care issues, assessed need for an adherence aid, and subsequently met with the lead GP to agree on actions. MAIN OUTCOME MEASURE: Total non-elective hospital admissions within 6 months. Secondary outcomes included number of deaths, care home admissions and quality of life (EQ-5d). Impact on number of medicines prescribed was also assessed. RESULTS: At 6 months, no difference in hospital admissions (21 intervention versus 20 control P = 0.80), and no difference in care home admissions or deaths were detected between groups. There was a small (non-significant) decrease in quality of life in the intervention group. There was a statistically significant reduction in the mean number of medicines prescribed ( -0.87 items in favour of the intervention group, 95% confidence interval -1.66 to -0.08, P = 0.03). CONCLUSIONS: No positive impact on clinical outcomes or quality of life was demonstrated, however, this intervention did appear to reduce prescribing. This is in line with other evidence and suggests that this form of intervention may not have a clear health gain, but may lead to modest savings in terms of reduced prescribing. Future research should focus on whether such a prescribing effect would make this type of intervention cost effective.

Construction continues to have the largest number of fatal and major injuries among UK industry groups and the general rates have shown only a small amount of change over the last few years. Safety processes can (and do) fail, resulting in injuries and incidents. Behavioural science uses data and analysis to come to conclusions about what is actually happening. Therefore, objectivity is at the core of behavioural science. This science of behaviour can help us produce more effective implementations of safety solutions. Behaviour-based safety (BBS) processes most typically involve careful observation of behaviour, feedback, and reinforcement designed to change behaviour in strategic ways. BBS processes recognise the workplace environment as the dominant factor in the creation of safe working. This focus on behaviour needs to be coordinated with the elimination of work hazards. The authors’ basic premise is that workplace injuries are reduced when their causes are understood. This paper will discuss the history, successes, and failures of BBS, and suggest fertile areas for improving traditional safety practices.

Recently we presented our concept of "videography with the slit lamp," which provides an imaging solution for nearly every pathological finding in ophthalmology. This paper deals with the changes that must be made to prepare the slit lamp for documenting squint. To achieve this goal we propose: 1. Changes in the observation system: minus lenses in front of the objective of the slit lamp to achieve a sharp image of both eyes (eg, -8 diopters [dpt] if the patient sits at a distance of 50 cm). 2. Changes in the illumination system: minimizing the narrowed angle between illumination and observation axis by holding a "recentration" prism of 14 dpt horizontally in front of the slit light. This procedure creates equally sufficient illumination of the patient's face and central corneal reflexes. 3. Recording clinical findings with a digital recorder. This enables us to identify binocular eye positions, which sometimes last only part of a second, eg, in latent or intermittent strabism. 4. Visualizing clinical findings by using Microsoft PowerPoint® to build up 9-gaze composites or adjust corneal reflexes on subsequent foils. Changes in binocular eye positions (eg, after surgery, but also during diagnostic covering) can be made visible by flickering between the foils to compare.

We present a simple test doable on any slit lamp by which, relying on the positions of the Purkinje reflexes to one another (Tscherning 1898; Gullstrand 1909), keratoconus can be diagnosed. The beam of a small light source is directed onto an eye at about 30 cm distance from an 40°–20° oblique horizontal position temporally and nasally (see Fig. 1, Gellrich 2018). On video still images taken with a slit lamp biomicroscope (Gellrich & Kandzia 2016), we measured the deviation of the second Purkinje image (P2) from the horizontal connecting line between the first (P1) and fourth Purkinje image (P4) in a group of 14 patients affected by keratoconus and 14 normal persons (‘P2-deviation’). P2 deviations exceeding 0.2 mm were associated with a characteristic ‘tick shape’ for the connecting line P1 – P2 – P4 (see Fig. 1). One keratoconus patient's eye had to be excluded due to keratoplasty surgery leaving a total of 24 eyes with keratoconus for our investigation. Classic biomicroscopic signs of keratoconus (Munson's sign, Vogt’ s striae and iron lines) were also documented (Gellrich 2014). Mean P2 deviation was much larger in the keratoconus group than in the normal group (0.29 versus 0.04 mm – p < 0.001, t-test) (Table 1). Among the keratoconus patients, I observed a marked lateral difference in the severity of the disease in nine individuals. The side more seriously affected always exhibited a higher mean P2 displacement in each individual. Those more severely affected eyes had a mean P2 displacement of 0.34 ± 0.10 mm, whereas the less affected eyes’ mean was 0.15 ± 0.08 mm. P2 deviation was larger in eyes with Amsler stage 2 than in those with Amsler stage 1 (0.35 versus 0.23 mm – p < 0.05, t-test). Contralateral eyes clinically not affected by keratoconus had larger mean P2 deviation (0.11 mm) than a normal control group (0.04 mm). These data indicate that the tick test can not only serve as a quick test for keratoconus, but that this method has the potential for documenting severity and possibly even the course of the disease. Furthermore, we were interested in a comparison between the tick sign and the classic biomicroscopic changes associated with keratoconus. All 14 keratoconus patients exhibited at least one positive tick test. From 54 Purkinje patterns in the keratoconus group, 32 revealed a positive tick sign while it was always negative in the control group. On the other hand, only 7 of the 14 keratoconus patients presented biomicroscopic indications of keratoconus in 11 eyes: 10 eyes with Vogt's striae and/or iron lines, one eye with haze. Munson's sign was never present. P2 deviation in our setting for the tick test can be explained by backwards tilt of the posterior in relation to the anterior corneal surface which should be accompanied by higher pachymetric values above than below the corneal equator. For this correlation between corneal dimensions and the tick sign, we analysed topographic data available with the Galilei system from 19 eyes with keratoconus in 11 patients (Steinberg et al. 2015). In the affected eyes, the tick sign was present for 26/38 Purkinje patterns. For topographic correlation with our Purkinje patterns, we determined 1 mm temporally and nasally from the pupil centre the difference in corneal thickness between corresponding locations 0.5 mm above and below the horizontal meridian. We found that if this difference exceeded 20 μm (corresponding to 1.15° angle of tilt between anterior and posterior surface), the tick sign was always positive (20 patterns) and where the tick sign was missing, the pachymetric difference was always <20 μm.

AIMS AND OBJECTIVES: To produce a model for advanced nurse practitioners (ANPs) to follow in the assessment and management of patients with a reduced or low urine output. BACKGROUND: Reduced urine output can be caused by a multitude of factors, some of which signify serious disease or may lead to serious morbidity. Assessment of reduced urine output is essential to ensure that patient safety is maintained at all times. Advanced nurse practitioners can add to patient safety by undertaking assessments of these patients at appropriate times and managing appropriately. DESIGN: This paper presents a new model for immediate triage, assessment and treatment for reduced urine output, using history, early warning score, accuracy and laboratory results, or HEAL, with clear points for referral where appropriate. CONCLUSION: This model can be used by advanced nurse practitioners to guide assessments and ensure that patients are appropriately managed in response, with minimal additional training. RELEVANCE TO CLINICAL PRACTICE: This can aid advanced nurse practitioners in assessment, increasing patient safety and expatiating management. This shows how ANPs can be used to safely blur traditional professional boundaries with the aid of protocols.

In the food processing business it is known that the use of preservatives to maintain the durability of a food ingredient, but in practice there are still many producers who use dangerous preservatives such as formalin in food products, one of which is in the salted long jawed mackerel (Rastrelliger sp.) and salted Asian Snakehead (Channa striata). The purpose of this study was to determine the differences in formalin content in the salted long jawed mackerel and salted Asian Snakehead fish This study used an analytical survey with a cross sectional design. The samples were then examined using the Formaldehyde Test method. The results of this study indicate that from 162 samples of the fishes examined, 19 salted mackerels (23.5%) and 39 salted snakeheads (48.1%) were free of formalin and fulfilled the health requirements with a formalin content of 0 mg / l. The conclusion of this study is that there are differences in formalin content in the salted mackerels and salted snakeheads sold in the traditional market in Denpasar in 2019.

Journal Article SOURCE WANTED Get access L. SHADBOLT L. SHADBOLT Birkfield House, High Kelling, Norfolk Search for other works by this author on: Oxford Academic Google Scholar Notes and Queries, Volume 16, Issue 2, February 1969, Pages 74-d–74, https://doi.org/10.1093/nq/16-2-74d Published: 01 February 1969

Ikan kembung memiliki kandungan protein yang tinggi, karena banyaknya protein dan kandungan vitamin membuat daya tahan kesegaran ikan kembung tidak bertahan lama. Oleh karena itu sering dilakukan pengawetan pada ikan kembung agar bisa disimpan lebih lama. Berdasarkan hasil penelitian didapat bahwa perendaman Kunyit rata-rata daya awet Ikan Kembung pada pada perlakuan 10% berlangsung selama 16,6 jam, rata- rata pada perlakuan 15% berlangsung 22 jam, rata- rata pada perlakuan 20% berlangsung 27 jam, rata- rata pada perlakuan 25% bertahan 31,8 jam, dan rata- rata pada 30% bertahan 35 jam. Sedangkan perendaman Lengkuas rata-rata daya awet Ikan Kembung pada pada perlakuan 10% bertahan 14,4 jam, rata-rata pada perlakuan 15% bertahan 19 jam, rata-rata pada perlakuan 20% bertahan 21,8 jam, rata-rata pada perlakuan 25% bertahan 26,4 jam, dan rata-rata pada perlakuan 30% bertahan 32,4 jam. Kunyit yang paling efektif jika dilihat dari sifat fisik ikan kembung pada konsentrasi 30% dengan rata-rata daya simpan sebesar 35 jam. Sedangkan Lengkuas yang paling efektif jika dilihat dari sifat fisik ikan kembung pada konsentrasi 30% dengan rata-rata daya simpan sebesar 32,4 jam.

The paper discusses the method to separate oil/ water mixture by gravity automatically.In this article,the method is to separate oilwater mixture generated in diesel engine with the equipment together with cooling water circuit system.