PubMed Health⌕ Search

Biomedical subjects

R K Shukla

Publications and source records attributed to R K Shukla.

At least 19 recordsLinked to original sources
PubMed1985

Admissions monitoring and scheduling to improve work flow in hospitals.

As part of a five-year effort to evaluate alternative methods of improving nurse productivity, this study was undertaken to better understand work flow monitoring as a technique for stabilizing staffing patterns and to improve productivity in hospitals. Two admissions scheduling and monitoring systems were studied and compared with an admissions system without an explicit monitoring function in three medical-surgical units of a 641-bed community hospital. The admissions system based on monitoring case mix was found to be more effective than the system based on monitoring census. Both were significantly more effective than the admissions system without an explicit monitoring function.

Admitting Department, Hospital↗
PubMed1985

A longitudinal approach for measuring integration and continuity of nursing care.

Munson and Clinton developed an instrument to measure cross-sectional variation in integration and continuity of nursing care in team, modular, and primary nursing units in a hospital. In this study I show that when the instrument is adapted for longitudinal studies of nursing care, it provides more reliable and sensitive measurements. My results also indicate that the primary nursing care structure provides higher integration and continuity of care and care management than the team and the modular structures, and that the modular structure scores higher than the team structure.

Continuity of Patient Care↗
PubMed1984

Patients perception of care under primary and team nursing.

The relationship between the structure of nursing care and patient satisfaction is examined after equalizing the quantity and quality of nursing staff. An all-registered-nurse model of primary nursing is compared to team nursing. The nursing competency scores of registered nurses (as measured by the Slater scale) on two patient care units were equalized through 6 months of continuing education and staff development programs. A patient checklist was used to determine satisfaction with care and perceived omissions in care. No significant differences in satisfaction with care were found between the two units. The unit with primary nursing was perceived as having significantly higher omissions in care in three categories: dietary needs, reaction to therapy, and contact with nurses. The results suggest that the effect of nursing care structures on patient perception of care may be contingent upon the efficiency of the support systems and the competency of the nursing staff.

Clinical Competence↗
PubMed1983

Utilization of physical therapy personnel in one hospital. A work sampling study.

The purpose of this study was to illustrate the adaptability and use of work sampling, an industrial engineering technique, as a dependable method for collecting personnel utilization data in the physical therapy department of a general hospital and to demonstrate the concept of work sampling to physical therapy supervisors and personnel unfamiliar with this approach. Over a six-week period, a total of 5,824 observations were made at randomly selected 15-minute intervals during the 40-hour work week. Percentages of total time used in observed activities for all physical therapy personnel were divided as follows: 1) direct care, 20.38 percent; 2) indirect care, 11.18 percent; 3) administration, 2.27 percent; 4) communication, 3.28 percent; 5) clerical, 9.56 percent; 6) personal time, 24.60 percent; and 7) out-of-department, 28.72 percent. Physical therapists were most likely to be involved in personal duties from 8 AM to 9 AM (35%) and from 4 PM to 4:30 PM (41%). They showed greatest productivity from 9 AM to 10 AM (59%) and spent time in out-of-department activities rather consistently throughout the day. A conclusion of this study was that work sampling may be used successfully to collect personnel utilization data in a physical therapy department.

Humans↗
PubMed1983

All-RN model of nursing care delivery: a cost-benefit evaluation.

The proponents of the primary model of nursing, in which a single nurse bears direct and indirect responsibility for a given number of patients during their hospital stay, suggest that both nurse and patient stand to gain from this system of service delivery. In this study, an all-RN model of delivery was compared with a team model and a modular model. The study was carefully designed to control for the quantity and quality of nurses in all three models. The study found no appreciable differences among the three models in the quality of care delivered. The all-RN model, however, was found to be more costly than the other two models.

Attitude of Health Personnel↗
PubMed1983

Technical and structural support systems and nurse utilization: systems model.

There are two major components to nursing support systems: technical support systems, for the distribution of supplies and medicines to patients and for communication among hospital personnel, and structural support systems, for the organization of nursing staff-RNs, LPNs, and aides-into a systematic, working assignment pattern. Four hospital studies that used different combinations of technical and structural support systems were compared for the amount of time registered nurses were able to spend on direct patient care activities. It was found that a structural support system based on the primary nursing model, coupled with a decentralized technical support system, maximized direct patient care time.

Hospital Communication Systems↗
PubMed1982

Primary or team nursing? Two conditions determine the choice.

The cost-benefit analysis of the primary nursing structure is contingent on the factors that affect the proper use of nursing skills. By reducing the problems of coordinating the work, primary nursing has the potential of greater professional nurse involvement with patients. However, in a unit with inefficient support systems, inappropriate use of professional skills in primary nursing render the primary nursing structure less cost-beneficial than the team nursing structure. We may postulate here that primary nursing will be more cost-beneficial than team nursing when the nursing support system requires very little of the RNs' time and the patients require highly skilled care. In a hospital that has inefficient nursing support systems and on nursing units that have mostly self-care to intermediate care patients, primary nursing will only diminish proper use of nursing skills without significant potential to improve the quality of care. On the contrary, with highly efficient nursing support systems and on nursing units that have mostly intermediate use to extensive care patients, primary nursing will have great potential to improve quality and to use nursing skills properly.

Continuity of Patient Care↗
PubMed1980

Reactivity of trachea, bronchi, and lung strips to histamine and carbachol in rhesus monkeys.

Responses of isolated airway smooth muscles of a subhuman primate to carbachol and histamine were investigated. Isolated lung parenchymal strips of rhesus monkeys (RM) exhibited approximately equal sensitivity (i.e., ED50) and contractility (i.e., maximum tension) to carbachol and histamine. Tracheal chains and bronchial strips responded with concentration-dependent contractions to carbachol. Trachea did not exhibit any contractile responses to histamine. Bronchial strips responded with weak contractile responses to histamine when compared with those elicited ay carbachol. Histamine-induced contractions on bronchi and lung strips were easily antagonized by pyrilamine (H1-receptor antagonist) (10(-6) to 5 X 10(-6) M). Carbachol-contracted trachea and bronchi responded with relaxations to histamine and dimaprit (H2-receptor agonist) that were antagonized by metiamide (H2-receptor antagonist) (5 X 10(-5) M). The present findings indicate 1) a differential reactivity of central and peripheral airway smooth muscles of RM to histamine and carbachol; 2) lung strips of RM appear to possess only H1 types of histamine receptors; 3) bronchial smooth muscles of RM have a small population of H1-receptors mediating bronchoconstriction; and 4) a preponderance of inhibitory H2-receptors in the tracheobronchial smooth muscles of rhesus monkeys. If these subhuman primate findings apply to the airways of man, they could aid considerably in furthering our understanding of the pathophysiology of the respiratory tract.

Animals↗
PubMed1978

True macrodactyly of the hand.

A case of true progressive macrodactyly was treated by cosmetic amputation of the middle and ring fingers with defatting of the palm and dorsum of the hand. Three months later the result was satisfactory.

Amputation, Surgical↗
PubMed1976

Modified Zancolli's operation in claw hand in leprosy.

The operative technique of the Modified Zancolli's operation in claw hand is easy. Re-education is easier in Zancolli's capsulorrhaphy than any other operations. Results of this operation are encouraging. It is particularly required when quick turnover of cases is needed and when adequate facilities for physiotherapy is not available. In cases operated by Zancolli's capsulorrhaphy active flexion of metacarpophalangeal joint is possible. Complications are few e.g. pulling of capsulorrhaphy and development of flexion contracture.

Hand Deformities, Acquired↗
PubMed1976

Fatigue fracture of the femoral neck.

Fatigue fractures in the necks of femurs removed from fresh cadavers were produced experimentally by applying repeated compression and rotational stresses. We found that a load applied once in a physiological direction may be within the ultimate strength of the bone, but may produce a fracture if applied repeatedly. With increased age, chances of fatigue failure increased age, chances of fatigue failure increased and loads of even physiological magnitude produced fatigue fractures. This may also happen during life. The subcapital fractures produced in these specimens were similar to those seen in patients in a clinical practice. This has been reported many times in new young military recruits. In individuals undergoing unusually strenuous exercises, the stress concentrations can be unusually high.

Adult↗
PubMed1972

The role of creatinine and histidine in Benedict's qualitative test for reducing sugar in urine.

The statement made in some standard textbooks that Benedict's qualitative test gives a green, yellow, or orange-red precipitate with pure solutions of glucose of varying strength has been shown to be incorrect. Pure solutions of glucose give only a bright red precipitate at all concentrations. These changes in the colour of the suspensions are observed with urinary glucose only. The difference in the action of glucose in water and in urine has been shown to be mostly due to creatinine and to a small extent to the histidine content of urine. The colour of the precipitate depends not only on the concentration of glucose but also on that of creatinine. An increase in concentration of creatinine tends to make the precipitate more yellow. Histidine has a similar though much smaller effect. Attention has been drawn to possible errors in the semi-quantitative assay of urinary glucose by Benedict's test arising out of variation in concentration of creatinine and histidine.

Chemical Precipitation↗