Moreover, only a small amount of time was spent on contact to parents. Parental involvement is an important factor to mediate between educational institution and family structures. It is seen as a basic support of peda- gogical work in the day care centre [17-19]. A successful exchange between nursery school teacher and parents could be beneficial for educational process of all relevant children. Former studies showed that family-supportive measures are particularly successful if parents and edu- cators cooperate . The use of manifold experiences of pedagogical staff and parents is meaningful for child’s development. Furthermore a positive relationship between educator and parents is essential for a valuable child care. A parent should have the possibility to talk about any possible concern with the nursery school tea- cher, even more because educator are those - adjacent to physicians - who call parents ’ attention most fre- quently to developmental disorders of their children . In this connection contact to parents is important with regard to preventive measures.
In our study , haemophilia patients admitted to the day care centre of Tirunelveli medical college hospital are analysed. It was found that haemophilia is a rare inherited X-linked recessive bleeding disorder. The bleeding manifestation in these patients varies from lethal CNS hemorrhagic episodes to superficial ecchymosis. Performing a complete physical examination, gathering the entire past medical history of the cases and the family plays an important role in the study of the disease.
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The designated centre was mainly staffed by two core staff members who worked alternate duties as only one was required on duty at any one time and did sleep over duties in the centre. This ensured a continuity of care for residents. They had suitable qualifications for the posts. The resident’s assessment confirmed that they did not require fulltime nursing care. However, where clinical support was required this was available within the organisation. There was a clinical nurse on call system operated each evening and night.
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Residents spoken with by the inspector talked of their day-to-day activities as well as of their ambitions in terms of personal achievement and education. It was clear from these discussions that positive relationships with family, where achievable, were actively fostered by staff and management at the centre. Residents also spoke of regular and frequent excursions into the local community for the purpose of both recreation and in order to achieve outcomes related to independent living such as banking or shopping for provisions and personal items. Care plans documented records of past contact with friends and relatives and also an agenda of upcoming arrangements, for example outings planned over the festive period. Communication with family around healthcare and wellbeing was also recorded.
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actively involved in the day-to-day running of the unit and readily available and accessible to both residents and staff. There was evidence of individual residents' needs being met and the staff supported residents encouraging them to achieve or maintain their independence where possible, including training and education. Inspectors noted that community and family involvement was also encouraged. In general the inspectors observed evidence of good practice during the course of the inspection and were satisfied that residents received an appropriate standard of care with access as required to a general practitioner (GP), dentist and other allied healthcare professionals. There was a range of social activities available to residents. The inspectors found that whilst the service was generally of a good standard, it did not meet all of the requirements of the Health Care Act 2007 (Care and Support of Residents in Designated Centres for Persons (Children and Adults) with Disabilities) Regulations 2013. Areas identified for improvement included the following:
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Each resident's wellbeing and welfare is maintained by a high standard of evidence- based care and support. Each resident has opportunities to participate in meaningful activities, appropriate to his or her interests and preferences. The arrangements to meet each resident's assessed needs are set out in an individualised personal plan that reflects his /her needs, interests and capacities. Personal plans are drawn up with the maximum participation of each resident. Residents are supported in transition between services and between childhood and adulthood.
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Under Regulation 23 (2) (a) you are required to: Carry out an unannounced visit to the designated centre at least once every six months or more frequently as determined by the chief inspector and prepare a written report on the safety and quality of care and support provided in the centre and put a plan in place to address any concerns regarding the standard of care and support.
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There had been no incidents or allegations of abuse but both the person in charge and the staff who met with inspectors demonstrated some understanding of what to do should this arise. However, the contact details for the local social work duty offices were not available for staff and the person in charge was not aware that a report could be made to the Garda Síochána at weekends in the event of a concern or allegation of abuse arising then. There were no standard report forms available at the centre. These issues needed to be addressed to ensure any concerns can be reported in a timely way and to ensure the robustness of the centres safeguarding practices.
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The data were analysed using SPSS (Statistical Package for the Social Sciences) software 16. Multivariable Pois- son regression with robust variance estimation was used to assess the association of study site (PCCs of Kaunas, Klaipeda, Panevezys vs Vilnius ED and PCC), season (spring, autumn, winter vs summer), age (24–47 and 48–71 vs 0–23 months), sex (male vs female) and attendance of day care centre (DCC; non-attending vs attending) with SPn non-susceptibility. Univariable Pois- son regression with robust parameter estimates was used to analyse the associations of pneumococcal non- susceptibility to separate antibiotics with sex, study site, and treatment with antimicrobials (between one and six months prior the study). Cross tabulation with chi- squared test was used to test statistical significance for differences between two groups. Statistical significance was defined by p < 0.05.
The study was limited as the sample size was not representative of the elderly population in South Africa, and was confined to elderly individuals attending a day care centre in Sharpeville. Accordingly, the results cannot be generalised. In addition, different participants and very few men were involved in the biennial study.
From the seventh month onwards complementary foods are to be introduced to children, along with continued breastfeeding for two years or beyond. Children can eat ‘normal home’ food (in mashed or semi-solid form), however children at this age can eat only small quantities at a time and therefore need to be fed many (about five) times a day and need to be given food that has adequate calories, proteins and micronutrients. Some of the interventions required for this age group are: Ensuring that frequent meals in adequate quantity are given to the children. This food has to have adequate nutrients in the form of animal proteins (milk, eggs, meat, fish), adequate in fats, fruit and vegetables. Nutritious and carefully designed take-home rations (THR) based on locally procured food, delivered every week, should be provided as ‘supplementary nutrition’ for children in this age group. Crèches must be provided, with trained workers, to ensure that these children are provided with adequate care and development opportunities, especially if there are no adult carers at home due to increased female work participation. Further services children in this age group require are regular immunization and growth monitoring, treatment for anaemia and worms, prompt care for fever, diarrhoea, coughs and colds and referral services for the sick and severely malnourished child. Most of the above can be provided by the Accredited Social Health Activist (ASHA) and the Anganwadi workers (AWW).
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of preventive measures, which translates into insufficient dog vaccination, an uncontrolled canine population, poor knowledge of proper post-exposure prophylaxis on the part of many medical professionals, and an irregular supply of anti- rabies vaccine and immunoglobulin, particularly in primary- health-care facilities (Alakes Kumar et al., 2014). Conclusions- Ultimate goal of this study was to document statistics of prevalence of vector borne, vaccine preventable, communicable, food and water borne diseases in a population attending a tertiary care centre of north Maharashtra. Inspite of the advancement in science and technology the population is still suffering from vaccine preventable and vector borne diseases. Diptheria, tetanus, rabies, hepatitis B like vaccine preventable diseases still remain a cause of concern as many of times there is shortage of anti diphtheriaserum, antitetanusantirabies serum. Also these are much more costlier than the vaccines.
The idea of a universal public system that combines childcare and early learning was formulated in the 1930s by the policy expert Alva Myrdal. But it was not until after WWII that formal ECEC provision began to increase. During the 1960s, labour shortage, women’s increased entry into the labour market, and demands for more gender equality brought ECEC onto the political agenda. In the 1970s the Swedish government began to actively promote women’s employment and a dual earner family model; and the number of places in day care centres (today called preschools) increased. Between 1975 and 1990 attendance rates of children age one to six increased from 17% to 52%, 139 but demand for places rose even faster.
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Falls are a common and serious problem facing elderly people and are associated with considerable mortality and morbidity . Forty to sixty percent of falls cause injuries with an estimated 5% of incident falls resulting in frac- tures[2,3]. Falls result in institutionalisation, hospitali- sation and injury-related death. Over the age of 65 years a third of the population fall at least once a year  rising to over a half by 85 years . Previous studies have identified a number of potentially modifiable fall risk fac- tors. Intervention studies in the USA and New Zealand have shown that a combined multidisciplinary assess- ment and treatment programme and an individualised home based targeted exercise programme respectively can reduce falls by 30%-46% [8-10]. The UK PROFET study showed that in patients presenting to an Accident and Emergency department with a fall, the number of subse- quent falls were reduced by half in those who had received the intervention, which constituted a thorough medical assessment and an occupational therapy home visit. In 1999 there were 647,721 A&E attendances and 204,424 admissions to hospitals in the UK as a result of injuries sustained in unintentional falls by the over 60's. It was cal- culated that these falls cost the UK Government a total of £981 million, £581 million of which was met by the NHS. The main cost components were inpatient admissions (making up 49.4% of total costs) and long term care costs (accounting for 41%). The costs incurred as the result of a fall increased with age.
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The use of terminology in this review is also misleading in and of itself. The title of the review is ’Day care for preschool children’. The background clearly sets the stage for a review which will address the debate about ’where and by whom young children should be looked after’, and cites figures from Meltzer’s 1994 review of day care services in this country to show that 2% of under threes in Britain and 48% in Denmark use this sort of service. The objectives then go on to state that ’a systematic review was conducted to assess the effects of day- are on children and families’. The inclusion criteria then state that the type of intervention which was considered for inclusion in the review was ’non parental day-care for pre-school education’. In the abstract it states that the selection criteria were ’non-parental day-care for children under 5 years of age’ with no mention of it being provided for the purpose of preschool education. The authors then go on in the discussion to switch between the terms ’day-care’ and ’pre-school education’, and to conclude that ’Day-care has a beneficial effect on children’s development, school success, and adult life patterns’. Similarly, in the abstract it states that ’Day care increases children’s IQ, and has beneficial effects on behavioural development and school achievement’. This review would be more accurate if it used the term early intervention projects, to describe the programmes, and not day-care or preschool education. Day are services for children are typically divided into two main groups (excluding play groups) (i) day care which generally refers to children under three, and children receiving full-time care in nurseries or with child minders and relatives and; (ii) preschool education which typically refers to children over three in nursery education or kindergartens (Hennessy, Martin, Moss and Melhuish, 1992). This division has had serious implications in terms of the type of care children and parents have received (ibid.). Furthermore, while the research on preschool education has tended to show that ’preschool programmes can bring about beneficial outcomes, especially in children from disadvantaged backgrounds (Education Select Committee, 1989, in ibid., p. 19), the findings from day care has been much more ambivalent and nuanced (ibid). For example, the Hennessy and Melhuish 1991 non-systematic review of early day-care pointed to the way in which age at entry can be a confounding factor because the earlier the child enters a nursery, the more likely they are to be there for increased periods of time, and the greater the number of changes in day-care provision they are likely to have experienced by the time they enter school. Gender differences in outcome have also been reported.
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O’Brien -Pallas et al. investigated the association of NPRs with nurse sensitive patient outcomes. 34 Their outcomes included: deep vein thrombosis, pressure ulcers, falls with injury, medical errors with consequences, pneumonia, catheter associated urinary tract infection and wound infections. O’Brien -Pallas et al. analysed an administrative dataset of 1,230 patients from 24 cardiac and cardiovascular units from six hospitals. 34 They calculated the NPR as the average number of patients cared for daily by a nurse on day shift during the data collection period. They found that for every additional patient per nurse, patients were 22% les s likely to experience ‘excellent or good quality care ’ and 35% more likely to experience a longer than expected length of stay. 34
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In consequence, nosocomial pneumonia is a common and a life threatening problem among seriously ill patients who are mechanically ventilated. The incidence varies from 9% to 68% with a high fatality rate ranging from 50% to 80%, especially when it is caused by antibiotic-resistant bacteria (Khosravi et al., 2012). Routine endotracheal aspirate cultures of critically ill patients in ICU may be predictive of patients who are at high risk of invasive disease, and may guide the selection of appropriate empirical therapy based on the predominant pathogen identified in the cultures in the development of VAP (Joseph et al., 2010). However, in adult patients the cause of respiratory exacerbations is usually related to the acquisition of new strains of bacteria, rather than an increase in the number of bacteria present when clinically stable (Cline et al., 2012). Failure to treat the potential pathogen increases the morbidity and mortality, while overenthusiastic treatment of colonizing organisms results in unnecessary exposure to broad spectrum antibiotics and predisposes to infection with multidrug resistant (MDR) pathogens (Joseph et al., 2010). The objective of this study was to determine prevalence and antibiotic susceptibility profile of bacteria colonizing tracheal tubes to different antibiotics in the intensive care unit of a tertiary care center, New Delhi, India.
The idea of the DDC is described in the policy of Wymenga (2018). The DDC could be set up as an additional process within the current organization of geriatric care in MST. As shown in figure 4, different processes can currently be distinguished (Wymenga, 2018). When MST takes a DDC into use, primary care professionals could refer vulnerable elderly patients with a targeted (somatic) care need to this centre for a one-off consultation. In addition, primary care professionals can consult the geriatrician without referring the patient through electronic consultation and telephone consultation (respectively: ECMS and TCMS). These consultation options can be used to support the diagnosis made and in case of doubt if a referral is necessary (MST, 2016). Figure 5 gives a representation of the process as intended by the vulnerable elderly policy of Wymenga (2018). The goal of the DDC is to assess the care needs of vulnerable elderly (70+), by carrying out additional diagnostic tests to that the primary care provide. The controlling and monitoring function on the patient’s care path remain with the primary care professional. By performing the necessary tests in one day, the number of hospital visits of the patients could be limited. In addition, early clarification of the care needs of vulnerable elderly (70+) could potentially reduce the high pressure on the ED, and thereby the healthcare expenses. This way the DDC could contribute to an integral approach of geriatric care (Verlee, 2017).
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Information was available to relatives on the death of a loved one. The inspector noted that the information available was centre specific and there was written information given further to family meetings. For example, the inspector reviewed a file which confirmed a leaflet 'Understanding the changes which occur before death' to a family as a support to read following the meeting. Staff informed residents’ about the funeral arrangements and those who wished to attend the funeral were facilitated. The policy confirmed a sympathy card was sent to relatives when a resident died and an annual memorial service was held in November each year to remember all residents who had died in the past year.
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Drinks and snacks including plates of sandwiches and soup were available throughout the day and night if required. Homemade scones were also available for residents. One resident informed the inspector that she did baking within the designated centre as an activity and they would eat whatever was baked. The inspector noted the chef kept a record of resident's birthdays and special requests. For example, the chef told the inspector that a fresh cake would be prepared to celebrate resident's birthdays. Residents with diabetes and/or specific dietary needs, wishes and preferences were carefully recorded and communicated with the chef. The inspector found good staff attention to detail in terms of resident individual wishes and preferences. The inspector noted tea and coffee making facilities were available in the designated centre and residents and families were supported with same if required. The inspector saw that a summer barbeque for residents and families was taking place within the designated centre the day following inspection and the inspector saw preparation for same. A lot of the residents highlighted they were looking forward to this event to the inspector stating they enjoyed the food, music and dancing.