Sample records for anesthesia department hospital

  1. Repetitive Pediatric Anesthesia in a Non-Hospital Setting

    Purpose: Repetitive sedation/anesthesia (S/A) for children receiving fractionated radiation therapy requires induction and recovery daily for several weeks. In the vast majority of cases, this is accomplished in an academic center with direct access to pediatric faculty and facilities in case of an emergency. Proton radiation therapy centers are more frequently free-standing facilities at some distance from specialized pediatric care. This poses a potential dilemma in the case of children requiring anesthesia. Methods and Materials: The records of the Indiana University Health Proton Therapy Center were reviewed for patients requiring anesthesia during proton beam therapy (PBT) between June 1, 2008, and April 12, 2012. Results: A total of 138 children received daily anesthesia during this period. A median of 30 fractions (range, 1-49) was delivered over a median of 43 days (range, 1-74) for a total of 4045 sedation/anesthesia procedures. Three events (0.0074%) occurred, 1 fall from a gurney during anesthesia recovery and 2 aspiration events requiring emergency department evaluation. All 3 children did well. One aspiration patient needed admission to the hospital and mechanical ventilation support. The other patient returned the next day for treatment without issue. The patient who fell was not injured. No patient required cessation of therapy. Conclusions: This is the largest reported series of repetitive pediatric anesthesia in radiation therapy, and the only available data from the proton environment. Strict adherence to rigorous protocols and a well-trained team can safely deliver daily sedation/anesthesia in free-standing proton centers

  2. Anesthesia

    ... arm or leg. A common type is epidural anesthesia, which is often used during childbirth. General - makes ... afterwards. Sedation can be used with or without anesthesia. The type of anesthesia or sedation you get ...

  3. Behavior Assessment in Children Following Hospital-Based General Anesthesia versus Office-Based General Anesthesia

    LaQuia A. Vinson


    Full Text Available The purpose of this study was to determine if differences in behavior exist following dental treatment under hospital-based general anesthesia (HBGA or office-based general anesthesia (OBGA in the percentage of patients exhibiting positive behavior and in the mean Frankl scores at recall visits. This retrospective study examined records of a pediatric dental office over a 4 year period. Patients presenting before 48 months of age for an initial exam who were diagnosed with early childhood caries were included in the study. Following an initial exam, patients were treated under HBGA or OBGA. Patients were followed to determine their behavior at 6-, 12- and 18-month recall appointments. Fifty-four patients received treatment under HBGA and 26 were treated under OBGA. OBGA patients were significantly more likely to exhibit positive behavior at the 6- and 12-month recall visits p = 0.038 & p = 0.029. Clinicians should consider future behavior when determining general anesthesia treatment modalities in children with early childhood caries presenting to their office.

  4. Quantifying the Diversity and Similarity of Surgical Procedures Among Hospitals and Anesthesia Providers.

    Dexter, Franklin; Ledolter, Johannes; Hindman, Bradley J


    In this Statistical Grand Rounds, we review methods for the analysis of the diversity of procedures among hospitals, the activities among anesthesia providers, etc. We apply multiple methods and consider their relative reliability and usefulness for perioperative applications, including calculations of SEs. We also review methods for comparing the similarity of procedures among hospitals, activities among anesthesia providers, etc. We again apply multiple methods and consider their relative reliability and usefulness for perioperative applications. The applications include strategic analyses (e.g., hospital marketing) and human resource analytics (e.g., comparisons among providers). Measures of diversity of procedures and activities (e.g., Herfindahl and Gini-Simpson index) are used for quantification of each facility (hospital) or anesthesia provider, one at a time. Diversity can be thought of as a summary measure. Thus, if the diversity of procedures for 48 hospitals is studied, the diversity (and its SE) is being calculated for each hospital. Likewise, the effective numbers of common procedures at each hospital can be calculated (e.g., by using the exponential of the Shannon index). Measures of similarity are pairwise assessments. Thus, if quantifying the similarity of procedures among cases with a break or handoff versus cases without a break or handoff, a similarity index represents a correlation coefficient. There are several different measures of similarity, and we compare their features and applicability for perioperative data. We rely extensively on sensitivity analyses to interpret observed values of the similarity index. PMID:26678472

  5. Associated Roles of Perioperative Medical Directors and Anesthesia: Hospital Agreements for Operating Room Management.

    Dexter, Franklin; Epstein, Richard H


    As reviewed previously, decision making can be made systematically shortly before the day of surgery based on reducing the hours of overutilized operating room (OR) time and tardiness of case starts (i.e., patient waiting). We subsequently considered in 2008 that such decision making depends on rational anesthesia-hospital agreements specifying anesthesia staffing. Since that prior study, there has been a substantial increase in understanding of the timing of decision making to reduce overutilized OR time. Most decisions substantively influencing overutilized OR time are those made within 1 workday before the day of surgery and on the day of surgery, because only then are ORs sufficiently full that case scheduling and staff assignment decisions affect overutilized OR time. Consequently, anesthesiologists can easily be engaged in such decisions, because generally they must be involved to ensure that the corresponding anesthesia staff assignments are appropriate. Despite this, at hospitals with >8 hours of OR time used daily in each OR, computerized recommendations are superior to intuition because of cognitive biases. Decisions need to be made by a Perioperative Medical Director who has knowledge of the principles of perioperative managerial decision making published in the scientific literature rather than by a committee lacking this competency. Education in the scientific literature, and when different analytical methods should be used, is important. The addition that we make in this article is to show that an agreement between an anesthesia group and a hospital can both reduce overutilized OR time and patient waiting: The anesthesia group and hospital will ensure, hourly, that, when there are case(s) waiting to start, the number of ORs in use for each service will be at least the number that maximizes the efficiency of use of OR time. Neither the anesthesia group nor the hospital will be expected to run more than that number of ORs without mutual agreement

  6. Anesthesiologists Are Affiliated with Many Hospitals Only Reporting Anesthesia Claims Using Modifier QZ for Medicare Claims in 2013.

    Miller, Thomas R; Abouleish, Amr; Halzack, Nicholas M


    We examined hospitals that exclusively used the billing modifier QZ in anesthesia claims for a 5% sample of Medicare beneficiaries in 2013. We used a national Medicare provider file to identify physician anesthesiologists and nurse anesthetists affiliated with these hospitals. Among the 538 hospitals that exclusively reported the modifier QZ, 47.5% had affiliated physician anesthesiologists. These hospitals accounted for 60.4% of the cases. Our results illustrate the challenges of using modifier QZ to describe anesthesia practice arrangements in hospitals. The modifier QZ does not seem to be a valid surrogate for no anesthesiologist being involved in the care provided. PMID:26491838

  7. Carotid endarterectomy: review of 10 years of practice of general and locoregional anesthesia in a tertiary care hospital in Portugal

    Mercês Lobo


    Full Text Available BACKGROUND: Retrospective and prospective randomized studies have compared general and locoregional anesthesia for carotid endarterectomy, but without definitive results.OBJECTIVES: Evaluate the incidence of complications (medical, surgical, neurological, and hospital mortality in a tertiary center in Portugal and review the literature.METHODS: Retrospective analysis of patients undergoing endarterectomy between 2000 and 2011, using a software for hospital consultation.RESULTS: A total of 750 patients were identified, and locoregional anesthesia had to be converted to general anesthesia in 13 patients. Thus, a total of 737 patients were included in this analysis: 74% underwent locoregional anesthesia and 26% underwent general anesthesia. There was no statistically significant difference between the two groups regarding per operative variables. The use of shunt was more common in patients undergoing general anesthesia, a statistically significant difference. The difference between groups of strokes and mortality was not statistically significant. The average length of stay was shorter in patients undergoing locoregional anesthesia with a statistically significant difference.CONCLUSIONS: We found that our data are overlaid with the literature data. After reviewing the literature, we found that the number of studies comparing locoregional and general anesthesia and its impact on delirium, cognitive impairment, and decreased quality of life after surgery is still very small and can provide important data to compare the two techniques. Thus, some questions remain open, which indicates the need for randomized studies with larger number of patients and in new centers.

  8. 麻醉护士的工作范畴及在麻醉科的作用研究%Anesthesia Nurses Job Category and Research in the Department of Anesthesiology Effect



    In the process of anesthesia in today's medical is very common, and the implementation of anesthesia is anesthesia nurses. Anesthesia nurses as a special medical staff has been widely used in the hospital, this paper will detail the anesthesia nurse’s job category and function in the department of anesthesiology, the training content of nurse anesthesia, and goals.%麻醉在现今的医疗过程中十分常见,而实施麻醉的就是麻醉护士。麻醉护士作为特殊的医务人员在医院中得到广泛的运用,本文将详述麻醉护士的工作范畴及在麻醉科的作用、麻醉护士的培训内容和目标。

  9. Survey of international regional anesthesia fellowship directors

    Lansdown AK; McHardy PG; Patel SC; Nix CM; McCartney CJL


    Andrew K Lansdown,1,2 Paul G McHardy,1 Sanjiv C Patel,1,3 Catherine M Nix,1 Colin JL McCartney1 1Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; 2University of Sydney, Sydney, NSW, Australia; 3University College Hospital, London, UK Background: The scope of regional anesthesia fellowship programs has not been analyzed but may provide insights that could improve fellowship training and standards. Methods: Regional anesthesia fellowship ...

  10. The Frederic Joliot hospital department

    The Service Hospitalier Frederic Joliot (SHFJ) of the CEA, has got a scientific and a medical mission: to develop techniques allowing the functional study of human organs. The paper presents the main activities of this department: the positron emission tomography to visualize in real time markers in the organism in neurology and cardiology, researches on epilepsy to localize the epileptic centre, the nuclear medicine in cardiology with the use of the gamma photon emission tomography and the radiopharmacology to visualize the drugs effects in the organism. (A.L.B.)

  11. [The Eppendorf University Hospital, Hamburg--a cradle of German- speaking anesthesia?].

    Goerig, M


    "The time will come when German medicine, too, will have to concern itself with the issue of a professional narcotiseur. Until then it will be our duty to keep the interest in narcosis, which has increased satisfactorily in the past years, alive." With this statement the editors of the journal "Der Schmerz" substantiated the publication og a German-speaking anestesiological journal in 1928. Ernst von der Porten, a professional anesthesist working in Hamburg was the chief initiator for the appearance of the new journal. Possible he was incited by his former teacher, the Eppendorf surgeon Paul Sudeck, to delve deeper into our special field. Very early Sudeck himself began to concern himself with anesthesiological questions and he found an ardent supporter of the idea of specialisation in anesthesiology (quite unheard of in Germany at that time) in Helmut Schmidt, a staff member. Schmidt habilitated on an anesthesiological theme and that again was reason enough for the editors to write an editorial about. Schmidt who one of the chief organizers of the "90. Tagung Deutscher Naturforscher und Arzte" in the late summer of 1928 was hindered by the surgeons on founding the Deutsche Narkosege-sellschaft (German Narcosis Society) with colleagues. After World War II German surgeons rethought their position, mainly influenced by Anglo-American narcosis specialists. After the foundation of the Deutsche Gesellschaft für Anaesthesiein the year 1953, the first professorate for the special field of anesthesiology was given to Karl Horatz--one of the founding members--10 years later. Not surprisingly the professorate was instituted at the university hospital in Eppendorf which could be called the cradle of German-speaking anesthesia. The following concerns itself with some of the impulses that were given by the "Neues Allgemeines Krankenhaus Eppendorf" and became important stepping stones in our special field through the decades. PMID:10548957

  12. An organizational metamodel for hospital emergency departments.

    Kaptan, Kubilay


    I introduce an organizational model describing the response of the hospital emergency department. The hybrid simulation/analytical model (called a "metamodel") can estimate a hospital's capacity and dynamic response in real time and incorporate the influence of damage to structural and nonstructural components on the organizational ones. The waiting time is the main parameter of response and is used to evaluate the disaster resilience of health care facilities. Waiting time behavior is described by using a double exponential function and its parameters are calibrated based on simulated data. The metamodel covers a large range of hospital configurations and takes into account hospital resources in terms of staff and infrastructures, operational efficiency, and the possible existence of an emergency plan; maximum capacity; and behavior both in saturated and overcapacitated conditions. The sensitivity of the model to different arrival rates, hospital configurations, and capacities and the technical and organizational policies applied during and before a disaster were investigated. This model becomes an important tool in the decision process either for the engineering profession or for policy makers. PMID:25397658

  13. 50th Year Anniversary of Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University.

    Lertakyamanee, Jariya


    Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, has started to be a formal anesthesia division, divided from division of Surgery in 1965; hence our 50th year anniversary in 2015. Research is now a priority and mandatory mission, according to the vision of Mahidol University. Second mission is to teach and train, and we produce the highest number of states-of-the-art anesthesiologists and anesthetic nurses each year Curriculum and training are being continuously improved. From a small unit, now it is one of the largest departments and extends the service, our third mission, to more than only in the operating theaters. We look after pre-anesthesia assessment, inside and outside operating room anesthesia, post-operative pain relief Intensive Care Unit, and chronic pain management. The number of patients and their diseases increase; so do the complexities of surgeries. There are tremendous changes in drugs and equipment. There is the fourth mission on administration, IT and resource management. And the fifth mission which is corporate social responsibility. However, we still believe that compassion, responsibility and integrity are most important. We have taught and tried to live by the teaching of HRH the King's Father. And these will contribute to our progress and shine in the next 50 years. PMID:27501620

  14. Simplified Surgical Placement of Tenckhoff Catheter under Local Anesthesia: The Dammam Central Hospital Experience

    Youmbissi T


    Full Text Available Many methods are used for the placement of Tenckhoff catheters. Eighteen consecutive Tenckhoff catheters were placed under local anesthesia through a mini laparotomy with a reduced operating team. There were only three total catheter failures. Complications were infrequent and operating time was less than one hour on average. This simple procedure should be a part of the training program of all junior surgeons and nephrologists.

  15. Safe Anesthesia for Radiotherapy in Pediatric Oncology: St. Jude Children's Research Hospital Experience, 2004-2006

    Purpose: To determine the incidence of anesthesia-related complications in children undergoing radiotherapy and the associated risk factors. Methods and Materials: We retrospectively investigated the incidence and types of anesthesia-related complications and examined their association with age, weight, oncology diagnosis, type of anesthetic (propofol vs. propofol and adjuncts), total propofol dose, anesthetic duration, type of radiotherapy procedure (simulation vs. radiotherapy) and patient position (prone vs. supine). Results: Between July 2004 and June 2006, propofol was used in 3,833 procedures (3,611 radiotherapy sessions and 222 simulations) in 177 patients. Complications occurred during 49 anesthetic sessions (1.3%). On univariate analysis, four factors were significantly associated with the risk of complications: procedure duration (p <0.001), total propofol dose (p <0.001), use of adjunct agents (vs. propofol alone; p = 0.029), and simulation (vs. radiotherapy; p = 0.014). Patient position (prone vs. supine) was not significantly associated with the frequency of complications (odds ratio, 0.71; 95% confidence interval, 0.33-1.53; p = 0.38). On multivariate analysis, the procedure duration (p <0.0001) and total propofol dose (p ≤0.03) were the most significant risk factors after adjustment for age, weight, anesthetic type, and procedure type. We found no evidence of the development of tolerance to propofol. Conclusion: The rate of anesthesia-related complications was low (1.3%) in our study. The significant risk factors were procedure duration, total propofol dose, the use of adjunct agents with propofol, and simulation (vs. radiotherapy)

  16. Anesthesia Awareness

    ... and Anesthesia Smoking and Anesthesia Outpatient Surgery Anesthesia Awareness Very rarely – in only one or two out ... become aware or conscious. The condition – called anesthesia awareness – means the patient can recall the surroundings or ...

  17. Use of an accident and emergency department by hospital staff.

    Mann, C J


    OBJECTIVE: To assess the number of attendances by hospital staff at an accident and emergency (A&E) department, and reasons for their attendance. METHODS: A&E attendances by hospital staff were studied for a 12 month period. Comparison was made with attendances by non-hospital staff in full or part time employment. Differences between the observed and expected numbers of attendances were analysed using chi 2 analysis. RESULTS: 560 staff attendances were recorded out of 78,103 total attendance...

  18. Hospitality and tourism department members receive national awards

    Ho, Sookhan


    Faculty members, graduate students, and an alumnus of the hospitality and tourism management department at Virginia Tech's Pamplin College of Business received national honors for their research at the 14th annual Graduate Student Research Conference in Hospitality and Tourism, held recently in Las Vegas, Nev.

  19. Department head appointed for Hospitality and Tourism Management

    Ho, Sookhan


    James R. Lang, of Blacksburg, professor of management and Strickler Professor of Entrepreneurial Studies at Virginia Tech•À_ó»s Pamplin College of Business, has been appointed interim head of the Department of Hospitality and Tourism Management.

  20. Quality Management in Hospital Departments : Empirical Studies of Organisational Models

    Kunkel, Stefan


    The general aim of this thesis was to empirically explore the organisational characteristics of quality systems of hospital departments, to develop and empirically test models for the organisation and implementation of quality systems, and to discuss the clinical implications of the findings. Data were collected from hospital departments through interviews (n=19) and a nation-wide survey (n=386). The interviews were analysed thematically and organisational models were developed. Relationships...

  1. The comparison of anesthesia effect of lung surgery through video-assisted thoracic surgery: A meta-analysis

    Jing-Dong Ke


    Conclusion: These results indicated that epidural anesthesia can save operating time and postoperative hospital stay time. But epidural anesthesia and general anesthesia have the same effect on complications.

  2. Regional Anesthesia in Trauma Medicine

    Loreto Lollo; Wu, Janice J.; Andreas Grabinsky


    Regional anesthesia is an established method to provide analgesia for patients in the operating room and during the postoperative phase. While regional anesthesia offers unique advantages, as shown by the recent military experience, it is not commonly utilized in the prehospital or emergency department setting. Most often, regional anesthesia techniques for traumatized patients are first utilized in the operating room for procedural anesthesia or for postoperative pain control. While infiltra...

  3. Patient refusal for regional anesthesia in elderly orthopedic population: A cross-sectional survey at a tertiary care hospital

    Asma Abdus Salam; Gauhar Afshan


    Background and Aims: Improvements in pain management techniques in the last decade have had a major impact on the practice of orthopedic surgeries, for example, total hip arthroplasty and total knee arthroplasty. Although there are a number of treatment options for postoperative pain, a gold standard has not been established. In our institution, both general anesthesia and regional anesthesia (RA), are being offered to the elderly orthopedic population but RA is not frequently accepted by eld...

  4. Emergency Department of a Rural Hospital in Ecuador

    Tara Johnson, MD, MPH; David Gaus, MD, MPH/TM; Diego Herrera, MD


    Introduction: There is a paucity of data studying patients and complaints presenting to emergency departments (EDs) in low- and middle-income countries. The town of Pedro Vicente Maldonado (PVM) is located in the northwestern highlands of Ecuador. Hospital PVM (HPVM) is a rural teaching hospital providing family medicine residency training. These physicians provide around-the-clock acute medical care in HPVM’s ED. This study provides a first look at a functioning ED in rural Latin America by ...

  5. Hospitals

    Department of Homeland Security — This database contains locations of Hospitals for 50 states and Washington D.C. , Puerto Rico and US territories. The dataset only includes hospital facilities and...

  6. Networks in the radiology department and the hospital

    Data networks are a basic technology with regard to an appropriate design of the information technology (IT) infrastructure for the hospital. Due to the distributed workflow within the hospital, an integrated Hospital Information System (HIS) is based mostly on a set of network applications facing specific items. Medical communication standards, i. e., HL 7, DICOM, and in the near future the migration towards XML, support the interoperability between the IT subsystems and pave the way to patient information systems with access to unified and complete electronic medical records (EMR). Furthermore, with standardized communication techniques, such as CORBAmed, an object-oriented design of Healthcare applications will be possible in the near future. The intent of this paper is to give an overview of which basic technologies are suitable for building comprehensive, flexible, and reliable hospital networks and which also meet the special demands of the radiology department. (orig.)

  7. General anesthesia

    General anesthesia is treatment with certain medicines that puts you into a deep sleep so you do not feel ... doctor called an anesthesiologist will give you the anesthesia. Sometimes, a certified and registered nurse anesthetist will ...

  8. Survey of international regional anesthesia fellowship directors

    Lansdown AK


    Full Text Available Andrew K Lansdown,1,2 Paul G McHardy,1 Sanjiv C Patel,1,3 Catherine M Nix,1 Colin JL McCartney1 1Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada; 2University of Sydney, Sydney, NSW, Australia; 3University College Hospital, London, UK Background: The scope of regional anesthesia fellowship programs has not been analyzed but may provide insights that could improve fellowship training and standards. Methods: Regional anesthesia fellowship directors across the world were asked to complete a comprehensive survey that detailed the range of educational and practical experience and attitudes as well as assessment procedures offered in their programs. Results: The survey response rate was 66% (45/68. Overall, the range of activities and the time and resources committed to education during fellowships is encouraging. A wide range of nerve block experience is reported with most programs also offering acute pain management, research, and teaching opportunities. Only two-thirds of fellowships provide formal feedback. This feedback is typically a formative assessment. Conclusion: This is the first survey of regional anesthesia fellowship directors, and it illustrates the international scope and continuing expansion of education and training in the field. The results should be of interest to program directors seeking to benchmark and improve their educational programs and to faculty involved in further curriculum development. Keywords: anesthesia, regional, fellowship, education

  9. Knowledge about Anesthesia and Perception about Anesthesiologists among Patients at a Rural Tertiary Care Hospital: A Cross Sectional Survey

    Birva N Khara


    Conclusion: The available data suggest that specialty of anesthesia has not done all that it can to educate the patients in particular and the public at large about the role of anesthesiologist. [Natl J Med Res 2013; 3(4.000: 371-373

  10. Group therapy in mental hospital department. Challenges, capabilities, hopes.

    Łukasz Mateusz Majchrzak


    Group psychotherapy is common and useful disorder treatment process, especially using in outpatient system. The situation in stationary system such as mental hospitals and their acute departments is quite different, because it is more exacting work environment for group and therapists. The clinical observations shows that for great part of stationary system patients the psychodynamic group therapy is new experience. Hence it is very important to prepare therapeutic program which is well thoug...

  11. [Hospitality for elderly patients in the emergency department].

    Boulet, Marie-Claude; Dami, Fabrice; Hugli, Olivier; Renard, Delphine; Foucault, Eliane; Carron, Pierre-Nicolas


    Demographic evolution results in a growing use of emergency department by elderly patients. They require special care to avoid any further degradation of cognitive and functional abilities already compromised by the disease or injury that led them to hospital in the first place. Through a clinical case, we list the risks related to the care of these particular patients in the emergency department. Early recognition of those risks and careful management of these patients' specific needs can significantly contribute to reduce lengths of stay, an important outcome from both the individual patient's and society's perspective. PMID:26790241

  12. Group therapy in mental hospital department. Challenges, capabilities, hopes.

    Łukasz Mateusz Majchrzak


    Full Text Available Group psychotherapy is common and useful disorder treatment process, especially using in outpatient system. The situation in stationary system such as mental hospitals and their acute departments is quite different, because it is more exacting work environment for group and therapists. The clinical observations shows that for great part of stationary system patients the psychodynamic group therapy is new experience. Hence it is very important to prepare therapeutic program which is well thought out and contains realistic goals. As the research shows, patients suffering for deeper pathology needs more safety and more compact therapeutic environment. Then they can make some substantial changes. Presented statistics of patients which was participating in this therapy (n 53 shows that although they have different diagnosis, more of them (64,2% accomplished this process. Providing group psychotherapy in mental hospital department is exacting but possible task. Furthermore it is practicable and efficient method. Benefits both are strong for patients and for hospital (better realization of government schedule.

  13. Early detection of abnormal patient arrivals at hospital emergency department

    Harrou, Fouzi


    Overcrowding is one of the most crucial issues confronting emergency departments (EDs) throughout the world. Efficient management of patient flows for ED services has become an urgent issue for most hospital administrations. Handling and detection of abnormal situations is a key challenge in EDs. Thus, the early detection of abnormal patient arrivals at EDs plays an important role from the point of view of improving management of the inspected EDs. It allows the EDs mangers to prepare for high levels of care activities, to optimize the internal resources and to predict enough hospitalization capacity in downstream care services. This study reports the development of statistical method for enhancing detection of abnormal daily patient arrivals at the ED, which able to provide early alert mechanisms in the event of abnormal situations. The autoregressive moving average (ARMA)-based exponentially weighted moving average (EWMA) anomaly detection scheme proposed was successfully applied to the practical data collected from the database of the pediatric emergency department (PED) at Lille regional hospital center, France.

  14. Spinal and epidural anesthesia

    Intraspinal anesthesia; Subarachnoid anesthesia; Epidural; Peridural anesthesia ... Spinal and epidural anesthesia have fewer side effects and risks than general anesthesia (asleep and pain-free). Patients usually recover their senses ...

  15. Patient refusal for regional anesthesia in elderly orthopedic population: A cross-sectional survey at a tertiary care hospital

    Salam, Asma Abdus; Afshan, Gauhar


    Background and Aims: Improvements in pain management techniques in the last decade have had a major impact on the practice of orthopedic surgeries, for example, total hip arthroplasty and total knee arthroplasty. Although there are a number of treatment options for postoperative pain, a gold standard has not been established. In our institution, both general anesthesia and regional anesthesia (RA), are being offered to the elderly orthopedic population but RA is not frequently accepted by elderly population. The objective of this study was to determine the frequency of various reasons for refusal of RA in elderly patients undergoing orthopedic surgeries. Material and Methods: A prospective study conducted over a period of 1 year, had 549 patients with ages above 60 years who underwent different types of elective orthopedic procedures 182 patients who refused RA were interviewed according to a structured questionnaire designed to assess the reasons of refusal. Results: Most common reason for the refusal of RA was surgeon's choice (38.5%), whereas 20.3% of the patients were unaware about the RA. There was a significant association between female gender and refusing RA due to backache (17.2%) and fear of being awake during the operation (24.1%) respectively. Conclusion: This survey showed that the main reasons among elderly female population were the fear of remaining awake and backache. However, overall it was the surgeon's choice which made patients refuse RA, and the anesthesiologists were the main source of information. PMID:27006550

  16. Prevalence and causes of hospitalization in victims admitted to emergency department of Imam Hossein hospital in Shahroud

    Mohammadreza Khatibi; Hosein Bagheri; Malehe Khakpash; Zahra Movahhed-Khalilabadi


    Introduction: Accidents are second cause of disabilities and could lead to physical and psycological disorders and even death. The aims of this study were to evaluate the prevalence and causes of hospitalization in victims that admitted to emergency department of Imam Hossein hospital in Shahroud. Methods: This study is a descriptive analytic and cross-sectional research that has been done on 3027 victims of different accidents referred to emergency department of Imam Hossein hospital in Shah...

  17. Medical information system in hospital emergency departments' organizational perspectives.

    Dumont, V; Rousseau, A


    The study reported in this article examines the implementation of the same software in 3 emergency departments from different Belgian hospitals. It was experienced and perceived very differently as a failure or a success by the units' staff. The software integrates different functionalities, which can be chosen and customized by some members of the units themselves. We will look at the three processes of implementation to find out different plausible explanation for their 'failure or success'. Our approach is developed through the qualitative methodology of case studies. The translation theory is presented as a renewal way of thinking the perceived 'successful or failed' implementation of a new information system and a guide for new project in emergency department. PMID:15058415

  18. Seniors and Anesthesia

    ... Media Anesthesia 101 Patient Safety Stories Resources About Home » Patients » Preparing For Surgery » Seniors and Anesthesia Share this Page Preparing For Surgery Effects of Anesthesia Children and Anesthesia Pregnancy, Childbirth and Anesthesia Seniors and Anesthesia Surgery Risks Anesthesia ...

  19. Anesthesia Basics

    ... giving you anesthesia. CRNAs may work under the supervision of a anesthesiologist or on their own — it ... lot over the years, thanks to advances in technology and the extensive training anesthesiologists receive. The more ...

  20. Radioprotection in nuclear medicine department of 'Porto Alegre Clinical Hospital'

    The use of ionizing radiation in medicine allows great benefits. Nuclear Medicine uses ionizing radiation for medical diagnostic, such as: tumor, cancer, and dysfunctions location. However the use of ionizing radiation must be controlled in order to avoid likely biological effects in human beings. In order to extremely minimize that these effects appear, the Medical Physics Department of the Porto Alegre Clinical Hospital has implemented some procedures to assure that handling and use of radioactive material are in a safe way. This preoccupation is considered in all the places of nuclear medicine sector since the moment when the radioactive material is brought into including its manipulation and retirement, the exam process being accompanied. (authors). 4 refs

  1. Superior subconjunctival anesthesia versus retrobulbar anesthesia for manual small-incision cataract surgery in a residency training program: a randomized controlled trial

    Kongsap P


    Full Text Available Pipat KongsapDepartment of Ophthalmology, Prapokklao Hospital, Chanthaburi, Thailand; Faculty of Medicine, Chulalongkorn University, Bangkok, ThailandPurpose: To evaluate the effectiveness of subconjunctival anesthesia as compared to retrobulbar anesthesia for pain control during manual small-incision cataract surgery (MSICS performed by third-year residents.Design: A randomized, controlled trial.Patients and methods: A total of 150 patients undergoing routine cataract surgery were randomly assigned to receive either subconjunctival anesthesia (group 1, n = 75 or retrobulbar anesthesia (group 2, n = 75. Third-year residents performed MSICS using the modified Blumenthal technique. Subconjunctival anesthesia was administered by injecting 2% xylocaine with adrenalin into the superior conjunctiva, and retrobulbar anesthesia by injecting 2 mL of 2% xylocaine with adrenalin into the retrobulbar space. We studied the following variables: intraoperative pain score rated on a 100-point visual analog scale (VAS, operative time, and injection and operative complications.Results: A mean age of 69 vs 70 years, an operative time of 47.1 (SD, 9.9 min vs 47.7 (10.9 min, and a median (interquartile range pain score of 40 (range, 20–70 vs 40 (range, 20–50 were observed in the subconjunctival and the retrobulbar groups, respectively. The injection complication of subconjunctival hemorrhage was significantly higher in the subconjunctival group (25.3% compared to the retrobulbar group (1.3%. The operative complication rate between groups was not different (P > 0.05.Conclusion: Both, superior subconjunctival anesthesia and retrobulbar anesthesia were effective during MSICS when used in a residency training program.Keywords: subconjunctival anesthesia, retrobulbar anesthesia, cataract surgery, small-incision cataract surgery, visual analog scale, pain score

  2. Symptomatic Urinary Lithiasis: Epidemiology and Management at Urology Department of University Hospital of Cotonou

    Prince Pascal Hounnasso; Josué Dejinnin Georges Avakoudjo; Abdoul Karim Paré; Kirakoya Brahima; Adama Ouattara; Michel Michael Agounkpé; Gilles Natchagandé; Sanni Rafiou Toré; Abubakar Babagana Mustapha; Alexandre Vodounou


    Purpose: To study the epidemiology and treatment modalities of urolithiasis at Urology Department of University Hospital of Cotonou. Materials and Methods: It was a retrospective and descriptive study over a 10 years period ranging from January 1st, 2004 to December 31st, 2013. One hundred and two patients who were hospitalized for symptomatic urolithiasis at the Urology Department of University Hospital of Cotonou were enrolled. Results: Hospital incidence of urolithiasis w...

  3. Patient satisfaction and positive patient outcomes in ambulatory anesthesia

    Wong, Jean; Shah, Ushma; Wong, David


    Ushma Shah, David T Wong, Jean Wong Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada Abstract: Most surgeries in North America are performed on an ambulatory basis, reducing health care costs and increasing patient comfort. Patient satisfaction is an important outcome indicator of the quality of health care services incorporated by the American Society of Anesthesiologists (ASA). Patient satisfaction is a complex concep...

  4. Outcomes after same-day oral surgery: a review of 1,180 cases at a major teaching hospital.

    Chye, E P; Young, I G; Osborne, G A; Rudkin, G E


    Outcome was measured from data collected on 1,180 consecutive ambulatory oral surgery patients, two thirds of whom were treated under general anesthesia and the remainder who were treated under local anesthesia supplemented with intravenous sedation. Three patients (0.25%) required admission on the day of surgery; all had undergone general anesthesia. The surgery-related complication rate in the general anesthesia group (1:132) was similar to that for local anesthesia and sedation (1:128). However, anesthesia-related complications had an incidence of 1:99 in the general anesthesia group, but were absent in those receiving local anesthesia and sedation. Eight patients (0.7%) required hospital readmission after being discharged, mostly because of complications of surgery. The incidence of postoperative nausea and vomiting in the recovery room after local anesthesia and sedation (6%) was less than after general anesthesia (14%) (P bed and being ready for discharge were less after local anesthesia and sedation (38 +/- 15 minutes and 120 +/- 39 minutes, respectively) than after general anesthesia (61 +/- 50 minutes and 141 +/- 62 minutes). At the time of follow-up during the first few postoperative days, 7% of patients had gone to a family doctor and 4% to hospital accident and emergency departments, usually for minor problems. Paracetamol 500 mg plus codeine phosphate 30 mg was effective in 97% of cases when provided as a take-home analgesic. Ninety-nine percent of patients were satisfied with their management. PMID:8336221

  5. L市三级医院麻醉风险管理现状及对策研究%Research on the Present Situation and Countermeasures of Anesthesia Risk Management in Tertiary Hospital of L City

    郑碧鑫; 郑欢; 姜鲜


    为了解三级医院麻醉风险管理的现状,以便提出有效控制麻醉风险的建议,课题组对L市三级医院医务人员展开问卷调查,并在此基础上进行统计分析.结果显示,麻醉风险与医师职称、年龄、文化程度、从业时间、麻醉安全意识、医师风险教育、麻醉准备情况等因素密切相关.因此,需要从完善制度建设、强化工作协同性、加大行政执法力度等方面着手建设,方能有效控制麻醉风险的发生.%To understand the present situation of anesthesia risk management present situation in tertiary hospitals, and put forward suggestions on effective control of anesthesia risks, the research team conducted ques-tionnaire on medical personnel in tertiary risks hospital of L city, and analyzed the results statistically. Results showed that anesthesia risks are closely related with physicians' title, age, educational degree, working time, anesthesia risk awareness, risk education, and narcotic preparation, etc.. Therefore, we can effectively control anesthesia risks by perfecting the system construction, strengthening the collaborative work, and enhancing ad-ministrative law enforcement, etc..

  6. Inhalation anesthesia in experimental radiotherapy: a reliable and time-saving system for multifractionation studies in a clinical department

    An inhalation anesthesia system has been employed to overcome several of the limitations associated wih the use of sodium pentobarbital and other i.p. administered anesthetics in experimental radiotherapy. The described method is reliable and time-saving. The depth and duration of anesthesia are easily controllable. Only 4 deaths have occurred with more than 6000 animal exposures. The use of polystyrene jigs is shown to provide adequate thermal isolation. Oxygen as a carrier of the anesthetic agent is expected to prevent a reduced tissue oxygenation and its radiobiologial consequences. The whole system is constructed as a mobile unit in which up to 16 mice or rats can be anesthetized simultaneously and irradiated in a single field with clinical treatment equipment during short time intervals between patient irradiations. The described advantages of this method make it specially suited for experiments with protracted fractionation schedules

  7. Emergency Department of a Rural Hospital in Ecuador

    Tara Johnson, MD, MPH


    Full Text Available Introduction: There is a paucity of data studying patients and complaints presenting to emergency departments (EDs in low- and middle-income countries. The town of Pedro Vicente Maldonado (PVM is located in the northwestern highlands of Ecuador. Hospital PVM (HPVM is a rural teaching hospital providing family medicine residency training. These physicians provide around-the-clock acute medical care in HPVM’s ED. This study provides a first look at a functioning ED in rural Latin America by reviewing one year of ED visits to HPVM. Methods: All ED visits between April 14, 2013, and April 13, 2014, were included and analyzed, totaling 1,239 patient visits. Data were collected from their electronic medical record and exported into a de-identified Excel® database where it was sorted and categorized. Variables included age, gender, mode of arrival, insurance type, month and day of the week of the service, chief complaint, laboratory and imaging requests, and disposition. We performed descriptive statistics, and where possible, comparisons using Student’s T or chi-square, as appropriate. Results: Of the 1239 total ED visits, 48% were males and 52% females; 93% of the visits were ambulatory, and 7% came by ambulance. Sixty-three percent of the patients had social security insurance. The top three chief complaints were abdominal pain (25.5%, fever (15.1% and trauma (10.8%. Healthcare providers requested labs on 71.3% of patients and imaging on 43.2%. The most frequently requested imaging studies were chest radiograph (14.9%, upper extremity radiograph (9.4%, and electrocardiogram (9.0%. There was no seasonal or day-of-week variability to number of ED patients. The chief complaint of human or animal bite made it more likely the patient would be admitted, and the chief complaint of traumatic injury made it more likely the patient would be transferred. Conclusion: Analysis of patients presenting to a rural ED in Ecuador contributes to the global study

  8. Operation of a support service team in the emergency department of a general hospital.

    Condra, M; Groll, L; Walker, D M; Abrams, M O; Sims, P.


    We describe the development and operation of an emergency support service team in the Emergency Department of the Kingston General Hospital, Kingston, Ont. The team, composed of professionals from other departments of the hospital, provides emotional and practical support to family members or survivors in medical emergencies. We discuss the roles of the team members and their procedures for dealing with distress and grief.

  9. Prescribing Pattern in Outpatient Departments of Two Tertiary Care Teaching Hospitals in Dhaka

    Halima Begum


    Full Text Available Background: Medically inappropriate, ineffective and economically inefficient use of drugs is very common in our country. About 40% or more drugs expenditure may be wasted through irrational prescribing and dispensing. The need for promoting rational use of drugs is not only because of economic considerations; also it is an essential element for achieving quality of the health and medical care for patients and the community. For this purpose a cross sectional study was carried out among the individuals attending the outpatient departments (OPD of Medicine, Surgery, Gynecology & Obstetrics, Pediatrics, Orthopedics, Dermatology & Venereology, Ophthalmology and Otolaryngology of two tertiary care teaching hospitals of Dhaka, Bangladesh. Objective: To observe the prescribing pattern in outpatient departments of two tertiary care teaching hospitals (Dhaka by using World Health Organization (WHO core prescribing indicators. Materials and Methods: Six hundred prescriptions of patients attending the OPD of Medicine, Surgery, Gynecology & Obstetrics, Pediatrics, Orthopedics, Dermatology & Venereology, Ophthalmology and Otolaryngology of Enam Medical College Hospital (private hospital and Sir Salimullah Medical College Hospital (public hospital were collected randomly on working days from April to September 2014. Then the prescriptions were analyzed by following the “Prescribing indicators form” as recommended by the International Organization of Rational Use of Drugs (INRUD/WHO. Results: Average number of drugs per prescription was significantly high (3.07 in public hospital and 3.00 in private hospital. Generic prescribing was significantly lower in private hospital (4.00% than that in public hospital (21.00%. Antibiotic prescription was higher in private hospital (42.35%. Injection prescribed in public hospital was 5.74% whereas 5.66% in private hospital. Drugs prescribed from Essential Drug List of Bangladesh were less in both the hospitals (42

  10. Managerial competencies of head and department nurses in facultative hospital Brno Bohunice

    Tomáš Kotrba


    Head and department nurses were the target groups of this research in the Faculty Hospital, Brno. This paper deals with their managerial competencies. 846 respondents participated in a questionnaire research covering 724 nurses, 99 department nurses and 23 head nurses. This research shows that informal relationships predominate in the Hospital and it is based on the democratic managerial style of department and head nurses. Nurses in management positions are quite satisfied with their manager...

  11. Hospitals, Published in Not Provided, Indiana State Department of Health.

    NSGIC GIS Inventory (aka Ramona) — This Hospitals dataset as of Not Provided. Data by this publisher are often provided in UTM coordinate system; in a Transverse Mercator projection; The extent of...

  12. Hospital Based Emergency Department Visits Attributed to Child Physical Abuse in United States: Predictors of In-Hospital Mortality

    Veerajalandhar Allareddy; Rahimullah Asad; Min Kyeong Lee; Romesh P Nalliah; Sankeerth Rampa; Speicher, David G; Rotta, Alexandre T; Veerasathpurush Allareddy


    OBJECTIVES: To describe nationally representative outcomes of physical abuse injuries in children necessitating Emergency Department (ED) visits in United States. The impact of various injuries on mortality is examined. We hypothesize that physical abuse resulting in intracranial injuries are associated with worse outcome. MATERIALS AND METHODS: We performed a retrospective analysis of the Nationwide Emergency Department Sample (NEDS), the largest all payer hospital based ED database, for the...

  13. Hospital Based Emergency Department Visits Attributed to Child Physical Abuse in United States: Predictors of In-Hospital Mortality

    Allareddy, Veerajalandhar; Asad, Rahimullah; Lee, Min Kyeong; Romesh P Nalliah; Rampa, Sankeerth; Speicher, David G; Rotta, Alexandre T; Allareddy, Veerasathpurush


    Objectives: To describe nationally representative outcomes of physical abuse injuries in children necessitating Emergency Department (ED) visits in United States. The impact of various injuries on mortality is examined. We hypothesize that physical abuse resulting in intracranial injuries are associated with worse outcome. Materials and Methods We performed a retrospective analysis of the Nationwide Emergency Department Sample (NEDS), the largest all payer hospital based ED database, for the ...

  14. Application of Lean Six Sigma techniques to optimize hospital laboratory Emergency Department Turnaround time across a multi-hospital system

    Hagg, Heather (Woodward); Scachitti, Susan; Mapa, Lash; Brandford, Lillie; Vanni, Chris; Cox, Catherine


    In January 2005, Indiana University, Purdue University at Indianapolis (IUPUI) and Purdue- Calumet were invited to partner with the Alverno Clinical Labs in adapting Lean Six Sigma methodologies for use within healthcare. Our initial project focused on optimization of lab services for the emergency department at the Saint Margaret Mercy Hospitals in Hammond, IN. This project resulted in reduction of lab test report time to the emergency department from 75 minutes to less than 35 minutes. Thes...

  15. Society for Ambulatory Anesthesia

    ... We Represent Ambulatory and Office-Based Anesthesia The Society for Ambulatory Anesthesia provides educational opportunities, encourages research ... 6620 | E-mail: Copyright | 2016 Society for Ambulatory Anesthesia Home | Search | Terms | Privacy Policy | ...

  16. Obesity and Anesthesia

    ... Apnea and Anesthesia Smoking and Anesthesia Outpatient Surgery Obesity and Anesthesia More than one-third of Americans ... Sleep Apnea, a chronic medical problem common with obesity, can present with serious breathing problems before, during, ...

  17. Practical radiation protection in hospitals. A view at the nuclear medicine departement of the University Hospital of Cologne

    Radiation protection plays a predominant role in nuclear medicine departments as they are installations dealing with open radioactive substances. Many experts in radiation protection who are not directly involved in nuclear medicine may only have a vague insight into the daily routine of such installations. This contribution would like to give an impression by making a virtual tour through the nuclear medicine department of the University Hospital of Cologne - a department that covers a large part of the ability spectrum of this discipline. This tour will show some specialities concerning radiation protection in diagnostic and therapeutic procedures. (orig.)

  18. A limited-service rural hospital model: the freestanding emergency department.

    Avery, S


    A rural hospital that has been downsized to a freestanding emergency department is an important model in that it offers a possible solution to a community's need to have emergency-care services locally available. This model could include other important local services, such as skilled-nursing and outpatient services. This study looks at the financial feasibility of a rural hospital shutting down acute-care services and maintaining emergency services. Expenses were determined, and changes to revenue and expenses were estimated. Reimbursement was assumed static. Medicare cost reports and hospital financial disclosure reports were used in investigating three model categories: an urgent-care clinic with emergency services; a hospital-based emergency department with an outpatient clinic; a hospital-based emergency department with an outpatient clinic and a hospital-based skilled-nursing facility. Even with best-case assumptions regarding continued reimbursement, results show only a small increase in net income and, in two cases, large losses compared with the size of the hospital operations. A subsidy would be required from the community or an affiliated hospital or network for the model to remain financially stable. The regulatory barriers to implementation are noted, as well as the potential problems with the human aspects of implementation--staffing, recruitment and retention, professional education and quality. If the model rural hospital is an affiliate or partner with one or more health care facility, which could assist with financial and staffing needs, it may be feasible. PMID:10511753

  19. Dexmedetomidine for awake intubation and an opioid-free general anesthesia in a superobese patient with suspected difficult intubation

    Gaszynski T; Gaszynska E; Szewczyk T


    Tomasz Gaszynski,1 Ewelina Gaszynska,2 Tomasz Szewczyk31Department of Anesthesiology and Intensive Therapy, 2Department of Hygiene and Health Promotion, 3Department of Gastroenterology, Oncology, and General Surgery, Barlicki University Hospital, Medical University of Lodz, PolandAbstract: Super-obese patients (body mass index [BMI] >50 kg/m2) are at a particularly high risk of anesthesia-related complications during postoperative period, eg, critical respiratory events including respirato...

  20. Dexmedetomidine for awake intubation and an opioid-free general anesthesia in a superobese patient with suspected difficult intubation

    Gaszynski, Tomasz


    Tomasz Gaszynski,1 Ewelina Gaszynska,2 Tomasz Szewczyk31Department of Anesthesiology and Intensive Therapy, 2Department of Hygiene and Health Promotion, 3Department of Gastroenterology, Oncology, and General Surgery, Barlicki University Hospital, Medical University of Lodz, PolandAbstract: Super-obese patients (body mass index [BMI] >50 kg/m2) are at a particularly high risk of anesthesia-related complications during postoperative period, eg, critical respiratory events including respi...

  1. Ambulatory anesthesia in plastic surgery: opportunities and challenges

    Facque AR


    Full Text Available Alexander R Facque, Peter J Taub Division of Plastic and Reconstructive Surgery, Department of Surgery, Mount Sinai Medical Center, New York, NY, USA Abstract: In 2013, there were 17 million procedures performed by plastic and reconstructive surgeons in the United States in the private office or ambulatory “surgicenter” setting, as well as additional operations performed in hospitals on an outpatient basis. As interest in performing increasingly complex surgical procedures on an outpatient basis continues to grow, the surgeon and anesthesiologist alike must be prepared to offer safe and reliable anesthesia and analgesia in the ambulatory setting. Surgeons must be aware of the possible techniques that will be employed in their surgeries in order to anticipate and prepare patients for possible postoperative side effects, and anesthesiologists must be prepared to offer such techniques in order to ensure a relatively rapid return to normal activity despite potentially having undergone major surgery. The following is a review of the specific considerations that should be given to ambulatory plastic surgery patients with comments on recent developments in the techniques used to safely administer agreeable and effective anesthesia. Keywords: ambulatory surgery, cosmetic anesthesia, outpatient, ambulatory anesthesia

  2. Patient satisfaction and positive patient outcomes in ambulatory anesthesia

    Shah U


    Full Text Available Ushma Shah, David T Wong, Jean Wong Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada Abstract: Most surgeries in North America are performed on an ambulatory basis, reducing health care costs and increasing patient comfort. Patient satisfaction is an important outcome indicator of the quality of health care services incorporated by the American Society of Anesthesiologists (ASA. Patient satisfaction is a complex concept that is influenced by multiple factors. A patient's viewpoint and knowledge plays an influential role in patient satisfaction with ambulatory surgery. Medical optimization and psychological preparation of the patient plays a pivotal role in the success of ambulatory surgery. Postoperative pain, nausea, and vomiting are the most important symptoms for the patient and can be addressed by multimodal drug regimens. Shared decision making, patient–provider relationship, communication, and continuity of care form the main pillars of patient satisfaction. Various psychometrically developed instruments are available to measure patient satisfaction, such as the Iowa Satisfaction with Anesthesia Scale and Evaluation du Vecu de I'Anesthesie Generale, but none have been developed specifically for ambulatory surgery. The ASA has made recommendations for data collection for patient satisfaction surveys and emphasized the importance of reporting the data to the Anesthesia Quality Institute. Future research is warranted to develop a validated tool to measure patient satisfaction in ambulatory surgery. Keywords: patient, satisfaction, anesthesia, outcomes, questionnaire, perspectives

  3. A Comparison of Satisfaction; Spinal versus General Anesthesia for Cesarean Section

    Objective: To compare the patients satisfaction with spinal and general anesthesia after cesarean section at CMH Lahore. Study Design: Randomized controlled trials. Study Setting: The study was conducted at the department of Obstetrics and Gynaecology combined military Hospital, Lahore, for 6 months from July to Dec 2011. Patients and Methods: Total 70 patients were included in the study and randomly divided into two groups of 35 each using random numbers table. All patients between ages of 20-40 years admitted for elective cesarean section and presented for following up at day 5-7 who never had any type of anesthesia in the past. There included in the study patients with complaints of migraine, low backaches, positive history or any other medical disorder were excluded from the study. Results: A total number of patients included were 70. Out of these selected patients, 35 procedures were carried out under spinal anesthesia and 35 under general anesthesia. Insignificant difference was found in satisfaction level of both the groups (p=0.220). There is significant difference for the future choice between two groups (p<0.001). Conclusion: Spinal anesthesia provides equal satisfaction for patients of cesarean section than general anesthesia. (author)

  4. The impact of anesthesia providers on major morbidity following screening colonoscopies

    Lubarsky DA


    Full Text Available David A Lubarsky,1 Jason R Guercio,2 John W Hanna,3,4 Maria T Abreu,5 Qianli Ma,3 Claudia Uribe,3 David J Birnbach,1,6 David R Sinclair,1 Keith A Candiotti1 1Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami – Miller School of Medicine, Miami, FL, USA; 2Department of Anesthesiology, Duke University, Durham, NC, USA; 3Humana, Comprehensive Health Insights, Miami, FL, USA; 4University of Miami – Miller School of Medicine, Miami, FL, USA; 5Department of Medicine, Division of Gastroenterology, University of Miami – Miller School of Medicine, Miami, FL, USA; 6Department of Public Health Sciences, University of Miami – Miller School of Medicine, Miami, FL, USA Background and aims: Few studies evaluate the impact of anesthesia providers during procedures, such as colonoscopy, on low-risk patients. The objective of this study was to compare the effect of anesthesia providers on several outcome variables, including major morbidity, following screening colonoscopies. Methods: A propensity-matched cohort study of 14,006 patients who enrolled with a national insurer offering health maintenance organization (HMO, preferred provider organization (PPO, and Medicare Advantage plans for a screening colonoscopy between July 1, 2005 and June 30, 2007 were studied. Records were evaluated for completion of the colonoscopy, new cancer diagnosis (colon, anal, rectal within 6 months of the colonoscopy, new primary diagnosis of myocardial infarction (MI, new primary diagnosis of stroke, hospital admission within 7 days of the colonoscopy, and adherence to guidelines for use of anesthesia providers. Results: The presence of an anesthesia provider did not affect major morbidity or the percent of completed exams. Overall morbidity within 7 days was very low. When an anesthesia provider was present, a nonsignificant trend toward greater cancer detection within 6 months of the procedure was observed. Adherence to national

  5. Emergency Contraception: a survey of Hospital Emergency Departments Staffs

    Marco Bo; Ivo Casagranda; Mario Galzerano; Lorena Charrier; Maria Michela Gianino


    The World Health Organization defines emergency contraception (EC) as a means to prevent unwanted pregnancy. In countries where EC is dispensed behind the counter, emergency departments are a preferred point of care for its prescription and dispensing. In light of this situation and as no studies on emergency contraception in emergency departments in Italy have been conducted to date, this study was designed with a view to analyze the responses of emergency room physicians in relation to thei...


    李井柱; 王明山; 时飞; 赵圣钧; 李晓征; 冯伟


    Objective To understand the status quo of anesthesia management for cesarean section (CS) in Three A hospitals of Qingdao, and analyze its imperfection and provide basis for clinical intervention. Methods A survey of anesthetic records of November 2011, in Qingdao Three A hospitals, was done. The modalities of anesthesia and anesthetic selection for bellyful emergency CS, preoperative sedative measures, management of hypotension at surgery were analyzed. Results In November of 2011, a total of 956 CSs were performed in Three A hospitals of Qingdao, in which, intraspinal anesthesia was done in 948 (99. 2%) cases. Combined spinal and epidural anesthesia or local anesthesia was applied for most bellyful emergency CS. No preoperative sedative measures were adopted. Intraoperative hypotension was controlled with ephedrine and fast intravenous infusion of crystalline or colloidal. Uterine inertia was managed with large dose(10 —40 U) of oxytocin. Argument remained for prevention and cure of nausea and vomitting at surgery, and yet effective measures were unavailable. Conclusion [ntraspinal anesthesia is mainly used for cesarean section in Qingdao Three A hospitals. Now, there are still no effective measures for preoperative sedation, and for nausea and vomitting at surgery. The anesthetic selection for emergency bellyful lying-in women, the application of oxytocin and vasoactive agent are to be further improved.%目的 了解青岛市三级甲等医院剖宫产术麻醉管理现状,分析其不足之处,为临床干预提供依据.方法 调查青岛市三级甲等医院2011年11月麻醉记录单,分析麻醉方式及急症饱胃剖宫产术麻醉选择,术前镇静措施,处理术中低血压、宫缩乏力及恶心呕吐的措施等.结果 2011年11月,青岛市三级甲等医院共实施剖宫产术麻醉956例,其中椎管内麻醉948例(99.2%);急症饱胃剖宫产术多选择腰硬联合麻醉或局部浸润麻醉;均未采用术前镇静措施;均采

  7. Anesthesia for fetoscopic intervention

    Jamil S Anwari


    Full Text Available This is the first case report on anesthesia for fetoscopy performed in Saudi Arabia. Epidural anesthesia was given to the mother in her late second trimester for the fetoscopic intervention. The anesthesia related issues such as physiological and anatomical changes in pregnancy, tocolytic medications and their interactions with anesthesia, anesthetizing/sedating the primary patient are discussed.

  8. 21 CFR 884.5100 - Obstetric anesthesia set.


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Obstetric anesthesia set. 884.5100 Section 884.5100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... § 884.5100 Obstetric anesthesia set. (a) Identification. An obstetric anesthesia set is an assembly...

  9. [The neurology department of the Lankwitz Hospital. A contribution to the history of emigration, psychotherapy and the Berlin hospital].

    Müller, Thomas


    At Lankwitz near Berlin the Jewish physicians James Fraenkel and Albert Oliven founded a private hospital in 1890. This hospital, which integrated seven departments, became one of the biggest private asylums in the Reich during the first decade of the 20th century. Parts of the hospital served the military during WWI. As most of the physicians at Lankwitz were Jewish, the year 1933 meant an immense moral and scientific decline, since these physicians were forced to leave and later threatened. We know of one physician killed in a concentration camp. Hardly any research about this hospital had been published until the 1990's. This contribution is the first portraying one department--that of neurology. From the early years of the hospital, therapists involved with psycho-dynamic psychiatry and psychoanalysis were attracted to it. Lankwitz was a major experience for a number of later famous psychiatrists and psychoanalysts. This continued to be the case during the years of the Weimar Republic, after the hospital had been leased [verpachtet] to the insurance companies [gesetzliche Krankenkassen] of Greater Berlin. Revealing more about the history of Berlin's private clinics, this article also contributes to the city's history of neurology, psychiatry and psychotherapy. For the example of Lankwitz, the myth of a 'marginalized psychoanalysis', rejected by the contemorary medicine, cannot be corroborated. On the contrary, the Lankwitz physicians portrayed here seemed to have combined and integrated clinical work with psychoanalytic theory and practice. Germany's turn towards National Socialism however meant an immediate end for the Lankwitz clinic and the mode of therapy described. PMID:15291149

  10. Prevalence and causes of hospitalization in victims admitted to emergency department of Imam Hossein hospital in Shahroud

    Mohammadreza Khatibi


    Full Text Available Introduction: Accidents are second cause of disabilities and could lead to physical and psycological disorders and even death. The aims of this study were to evaluate the prevalence and causes of hospitalization in victims that admitted to emergency department of Imam Hossein hospital in Shahroud. Methods: This study is a descriptive analytic and cross-sectional research that has been done on 3027 victims of different accidents referred to emergency department of Imam Hossein hospital in Shahroud. Necessary data were obtained through questionnaire and archived file during one year in hospital.The data was analyzed by using descriptive and analytic statistic methods. Results: Upon to results, from all 3027 victims, 73.7% were male and 26.3% were female. Also, the majority of victims had 15-20 years old and the most of them were married. 42% of accidents were included traffic accidents and from 51.3% of accidents that their placed were determined, 83.4% of them were happened in street and in summer and in September and also in evenfall. In this study, significant correlation have seen between accident type and age, sex, accident place, season and month and accident time (P0.05. Conclusion: Accidents are preventable and require improving knowledge of people about importance of safety principles during driving and also increasing the safety factor in roads and streets. Effective heath and therapeutic planning in medical and emergency centers is essential for decreasing the rate of mortality from accidents.

  11. History of anesthesia in Germany.

    Wawersik, J


    The first ether anesthetic was administered in Germany by J.F. Heyfelder (1798-1869) at the Erlangen University Hospital on January 24, 1847. Thereafter, famous discoveries occurred in the field of pharmacology. Albert Niemann isolated cocaine from the coca shrub in 1860; Emil Fischer synthesized the first barbiturate, Veronal, in 1902; and Helmut Weese promoted the first ultra-short-acting barbiturate, hexobarbital (Evipan), in 1932. The local anesthetic effect of cocaine was reported by Koller at the Congress of the German Society for Ophthalmology on September 15, 1884, in Heidelberg. Many new techniques were tried first in German hospitals. Friedrich Trendelenburg carried out, by tracheotomy, the first operation with endotracheal intubation in 1869, and Franz Kuhn promoted and clinically practiced endotracheal intubation in Heidelberg beginning in 1900. August Bier performed the first operation under spinal anesthesia at the Kiel University Hospital on August 16, 1898. Carl Ludwig Schleich (1859-1922) standardized the methods of infiltration anesthesia by using a cocaine solution in sufficient dilution. The development of anesthesia machines was greatly influenced by Heinrich Dräger (1847-1917) and his son Bernhard Dräger (1870-1928). The Dräger Company in Lübeck built the first anesthesia machine with a carbon dioxide (CO2) absorber and circle system in 1925. Paul Sudeck and Helmut Schmidt worked with this system at the Hamburg University Hospital and reported their results in 1926. The first Dräger anesthesia machine was produced in 1902 and introduced into clinical use by Otto Roth (1863-1944) in Lübeck. Before the Second World War, three universities in Germany carried out research in the field of anesthesia: the University of Freiburg with H. Killian, the University of Hamburg with P. Sudeck and H. Schmidt, and the University of Würzburg with C.G. Gauss. Killian and Gauss established the first journals, Der Schmerz and Narkose und Anaesthesie, in

  12. Geriatric Patients Presenting to the Emergency Department of a Japanese University Hospital

    EZAKI, TAKAHIRO; YAMADA, Tomomi; Yasuda, Mitsuhiro; Setoguchi, Hidekazu; Noda, Eiichiro; Kannna, Tomoo; Shiraishi, Kiminori; Zaitshu, Akinori; Hashizume, Makoto


    To evaluate the trend of elderly patients visiting the emergency department of a Japanese University Hospital, out patient-based records were reviewed of the emergency department of Kyushu University Hospital from 2000 to 2004. A total number of 7610 emergency patients visited the department during the five year period. The median(25%, 75%)of age was 32(22, 56). Patients aged 65 years and over accounted for 16% of all attendances. All the patients were classified into 6 groups according to t...

  13. The Frederic Joliot hospital department; Le service hospitalier Frederic Joliot



    The Service Hospitalier Frederic Joliot (SHFJ) of the CEA, has got a scientific and a medical mission: to develop techniques allowing the functional study of human organs. The paper presents the main activities of this department: the positron emission tomography to visualize in real time markers in the organism in neurology and cardiology, researches on epilepsy to localize the epileptic centre, the nuclear medicine in cardiology with the use of the gamma photon emission tomography and the radiopharmacology to visualize the drugs effects in the organism. (A.L.B.)

  14. The role of the human resources department in hospital reengineering.

    Freed, D H


    The ¿people part¿ of reengineering is the most difficult to implement or even predict. In this context, active involvement by the Human Resources (HR) Department is a necessity, not an option, for the success of reengineering initiatives. Reengineering requires a changed environment and methods that HR must facilitate; creates extraordinary demands for leadership and communication, which HR is uniquely qualified to support; and represents an extraordinary opportunity for HR to reinvent its own processes and create a sustained competitive advantage for the organization. Exploiting these opportunities will require HR to proactively engage the organization. PMID:10154919

  15. Hospital based emergency department visits attributed to child physical abuse in United States: predictors of in-hospital mortality.

    Veerajalandhar Allareddy

    Full Text Available OBJECTIVES: To describe nationally representative outcomes of physical abuse injuries in children necessitating Emergency Department (ED visits in United States. The impact of various injuries on mortality is examined. We hypothesize that physical abuse resulting in intracranial injuries are associated with worse outcome. MATERIALS AND METHODS: We performed a retrospective analysis of the Nationwide Emergency Department Sample (NEDS, the largest all payer hospital based ED database, for the years 2008-2010. All ED visits and subsequent hospitalizations with a diagnosis of "Child physical abuse" (Battered baby or child syndrome due to various injuries were identified using ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification codes. In addition, we also examined the prevalence of sexual abuse in this cohort. A multivariable logistic regression model was used to examine the association between mortality and types of injuries after adjusting for a multitude of patient and hospital level factors. RESULTS: Of the 16897 ED visits that were attributed to child physical abuse, 5182 (30.7% required hospitalization. Hospitalized children were younger than those released treated and released from the ED (1.9 years vs. 6.4 years. Male or female partner of the child's parent/guardian accounted for >45% of perpetrators. Common injuries in hospitalized children include- any fractures (63.5%, intracranial injuries (32.3% and crushing/internal injuries (9.1%. Death occurred in 246 patients (13 in ED and 233 following hospitalization. Amongst the 16897 ED visits, 1.3% also had sexual abuse. Multivariable analyses revealed each 1 year increase in age was associated with a lower odds of mortality (OR = 0.88, 95% CI = 0.81-0.96, p < 0.0001. Females (OR = 2.39, 1.07-5.34, p = 0.03, those with intracranial injuries (OR = 65.24, 27.57-154.41, p<0.0001, or crushing/internal injury (OR = 4.98, 2.24-11.07, p<0.0001 had higher odds of

  16. Prescribing pattern of non-steroidal anti-inflammatory drugs at outpatient departments of teaching hospitals

    Md. Shamsur Rahman, Zinnat Ara Begum; and Md. Khoshroz Samad


    The prescribing pattern of non-steroidal anti-inflammatory drugs (NSAIDs) in prescriptions prescribed by the qualified medical personnel in the outpatient departments of three selected teaching hospitals in Dhaka city were studied. A total of 600 prescriptions containing NSAIDs were collected. The clinical conditions for which NSAIDs prescribed were identical in all the three hospitals, although there were wide variations in the prescribing pattern with respect to pharmacological sub-classes ...

  17. Oral Cancer Knowledge: A Survey Administered to Patients in Dental Departments at Large Italian Hospitals

    Villa, Alessandro; Kreimer, Aimee R.; Pasi, Massimo; Polimeni, Antonella; Cicciù, Domenico; Strohmenger, Laura; Gherlone, Enrico; Abati, Silvio


    We assessed the oral cancer (OC) knowledge, including risk factors and clinical symptoms, among patients attending dental departments within Italian university hospitals. Two thousand and two hundred questionnaires were sent to four hospitals in order to assess patients’ knowledge regarding clinical and epidemiological aspects of OC; OC knowledge was evaluated overall and stratified by oral cancer family history. Participants frequently identified cigarette smoking (87.8%) and heavy alcohol c...

  18. Resilience-based design of a hospital Emergency Department considering human behavior

    Piqué Saboya, Marta


    The paper presents a hospital testbed which aims to help the earthquake engineering community moving another step toward th e realization and implementation of resilience(based design strategie s for health care facilities. An organizational model describing the response of the Hospital Emergency Department (ED) has been implemented using a discre te events simulation model (DES). The waiting time is the main response parame ter used to evaluate the resilie...

  19. Goldratt’s Theory Applied to the Problems Associated with an Emergency Department at a Hospital

    Soumya Nayak; Lloyd J. Taylor


    Healthcare costs continue to increase dramatically, while quality remains a significant problem. Reform measures initiated by the government will drive expansion of these costs, further stressing taxpayers and employers, and forcing hospitals to adopt fundamental changes as they try to adjust to increased demands for services and to lessening reimbursements from all payers. This struggle is best seen at the point of entry for many at a hospital: the emergency department (ED). It is at the eme...

  20. Time and department distribution of hypoglycemia occurrences in hospitalized diabetic patients

    Cun-mei Yang; Yan-lan Ma; Jun Kang; Zhe Jia; Yan-yan Wang; Hong-ying Ma; Jie Wang


    Hypoglycemia occurred on hospitalized patients would result in severe complications. So we monitored the blood glucose of hospitalized patients with diabetes in 14 clinical departments from January to December 2013. Totally 105728 cases of blood glucose were monitored and 1374 cases of hypoglycemia were detected. The incidence of hypoglycemia was 1.29%. Among which, 317 cases of severe hypoglycemia were detected and the incidence of severe hypoglycemia was 0.29%. The peak periods of hypoglyce...

  1. Ambulatory surgery with chloroprocaine spinal anesthesia: a review

    Ghisi D


    Full Text Available Daniela Ghisi, Stefano Bonarelli Department of Anaesthesia and Postoperative Intensive Care, Istituto Ortopedico Rizzoli, Bologna, Italy Abstract: Spinal anesthesia is a reliable and safe technique for procedures of the lower extremities. Nevertheless, some of its characteristics may limit its use for ambulatory surgery, including delayed ambulation, risk of urinary retention, and pain after block regression. The current availability of short-acting local anesthetics has renewed interest for this technique also in the context of short- and ultra-short procedures. Chloroprocaine (CP is an amino-ester local anesthetic with a very short half-life. It was introduced and has been successfully used for spinal anesthesia since 1952. Sodium bisulfite was then added as a preservative after 1956. The drug was then abandoned in the 1980s for several reports of neurological deficits in patients receiving accidentally high doses of intrathecal CP during epidural labor analgesia. Animal studies have proven the safety of the preservative-free formulation, which has been extensively evaluated in volunteer studies as well as in clinical practice with a favorable profile in terms of both safety and efficacy. In comparison with bupivacaine, 2-chloroprocaine (2-CP showed faster offset times to end of anesthesia, unassisted ambulation, and discharge from hospital. These findings suggests that 2-CP may be a suitable alternative to low doses of long-acting local anesthetics in ambulatory surgery. Its safety profile also suggests that 2-CP could be a valid substitute for intrathecal short- and intermediate-acting local anesthetics, such as lidocaine and mepivacaine – often causes of transient neurological symptoms. In this context, literature suggests a dose ranging between 30 and 60 mg of 2-CP for procedures lasting 60 minutes or less, while 10 mg is considered the no-effect dose. The present review describes recent evidence about 2-CP as an anesthetic agent for

  2. Cutaneous adverse drug reactions seen at a university hospital department of dermatology

    Borch, Jakob E; Andersen, Klaus E; Bindslev-Jensen, Carsten


    Patients with suspected cutaneous adverse drug reactions are often referred to allergy clinics or departments of dermatology for evaluation. These patients are selected compared with patients identified in prospective and cross-sectional studies of hospital populations. This explains the observed...... variation in prevalence of specific reactions and of eliciting drugs. This study investigated the prevalence of cutaneous adverse drug reactions in a university hospital department of dermatology that is specially focused on allergy. An 8-month survey was carried out during the period April-December 2003...

  3. Trauma in elderly patients evaluated in a hospital emergency department in Konya, Turkey: a retrospective study

    Kara H


    Full Text Available Hasan Kara,1 Aysegul Bayir,1 Ahmet Ak,1 Murat Akinci,1 Necmettin Tufekci,1 Selim Degirmenci,1 Melih Azap21Department of Emergency Medicine, Selçuk University, Konya, Turkey; 2Department of Emergency Medicine, Konya Numune Hospital, Konya, TurkeyPurpose: Trauma is a common cause of admission to the hospital emergency department. The purpose of this study was to evaluate the cause of admission, clinical characteristics, and outcomes of patients aged ≥65 years admitted to an emergency department in Turkey because of blunt trauma.Materials and methods: Medical records were retrospectively reviewed for 568 patients (314 women and 254 men aged ≥65 years who were admitted to an emergency department of a tertiary care hospital.Results: Trauma was caused by low-energy fall in 379 patients (67%, traffic accident in 79 patients (14%, high-energy fall in 69 patients (12%, and other causes in 41 patients (7%. The most frequent sites of injury were the lower extremity, thorax, upper extremity, and head. The femur was the most frequent fracture site. After evaluation in the emergency department, 377 patients (66% were hospitalized. There were 31 patients (5% who died. Risk of hospitalization after trauma was significantly associated with trauma to the lower extremity, thorax, and spine; fractures of the femur and rib; and intracranial injury.Conclusion: Emergency department admission after trauma in patients aged $65 years is common after low-energy falls, and most injuries occur to the extremities. It is important to focus on prevention of falls to decrease the frequency of trauma in the elderly.Keywords: fall, femur, fracture, injury

  4. Hand Surgery: Anesthesia

    ... Therapist? Media Find a Hand Surgeon Hand Surgery Anesthesia Email to a friend * required fields From * To * ... in to name and customize your collection. DESCRIPTION Anesthesia is a way to control pain during a ...

  5. Topical anesthesia in phacoemulsification

    Saad Waheeb


    Conclusion : Topical anesthesia is a satisfactory and safe alternative to retrobulbar and peribulbar anesthesia for clear corneal phacoemulsification and intraocular lens implantation in selected cataract patients in the hands of experienced cataract surgeon.

  6. A Computerized Record System for Anesthesia Services

    Chase, Christopher R.; Merz, Barbara A.


    We have developed a computerized record system, the CAPE system, which supports patient management, administrative and research applications for anesthesia services in our hospital, the Medical Center Hospital of Vermont. In this paper we briefly describe the CAPE system and, as an example of its use in our hospital, we describe the development and implementation of a preoperative screening program used to identify patients at high risk to postoperative respiratory complications.

  7. Performance measurement in a radiology department at a Danish non-profit hospital

    Traberg, Andreas; Jacobsen, Peter

    The purpose of this article is to describe a Lean and dynamic model to measure the performance in the health care area. The empiric work has been done at an X-ray department with 85 employees and daily treatment of about 145 patients. The present case is based on a Master Thesis where the goal was...... to develop a set of Key Performance Indicators (KPI), which could portray the X-ray department of Hospital of Southern Jutland in Denmark, performance relation to patients, employees and the government The upper management has created a vision for the year 2010 and a strategic plan for the hospital...... 14 strategic goals. The way the performance is presented is through a web based interactive version, where employees will have access to through the hospitals internal IT system. By displaying all KPI´s in an interactive environment, the individuals have the option of choosing exactly those...

  8. Caudal epidural anesthesia during intracavitary brachytherapy for cervical cancer

    It has been suggested that pain control during intracavitary brachytherapy for cervical cancer is insufficient in most hospitals in Japan. Our hospital began using caudal epidural anesthesia during high-dose-rate (HDR) intracavitary brachytherapy in 2011. The purpose of the present study was to retrospectively investigate the effects of caudal epidural anesthesia during HDR intracavitary brachytherapy for cervical cancer patients. Caudal epidural anesthesia for 34 cervical cancer patients was performed during HDR intracavitary brachytherapy between October 2011 and August 2013. We used the patients' self-reported Numeric Rating Scale (NRS) score at the first session of HDR intracavitary brachytherapy as a subjective evaluation of pain. We compared NRS scores of the patients with anesthesia with those of 30 patients who underwent HDR intracavitary brachytherapy without sacral epidural anesthesia at our hospital between May 2010 and August 2011. Caudal epidural anesthesia succeeded in 33 patients (97%), and the NRS score was recorded in 30 patients. The mean NRS score of the anesthesia group was 5.17 ± 2.97, significantly lower than that of the control group's 6.80 ± 2.59 (P = 0.035). The caudal epidural block resulted in no side-effects. Caudal epidural anesthesia is an effective and safe anesthesia option during HDR intracavitary brachytherapy for cervical cancer. (author)

  9. Dexmedetomidine for awake intubation and an opioid-free general anesthesia in a superobese patient with suspected difficult intubation

    Gaszynski T


    Full Text Available Tomasz Gaszynski,1 Ewelina Gaszynska,2 Tomasz Szewczyk31Department of Anesthesiology and Intensive Therapy, 2Department of Hygiene and Health Promotion, 3Department of Gastroenterology, Oncology, and General Surgery, Barlicki University Hospital, Medical University of Lodz, PolandAbstract: Super-obese patients (body mass index [BMI] >50 kg/m2 are at a particularly high risk of anesthesia-related complications during postoperative period, eg, critical respiratory events including respiratory arrest, and over-sedation leading to problems with maintaining airway open, hypoxia and hypercapnia. In this paper authors present a case of a 39-year-old super-obese (BMI 62.3 kg/m2 female patient who was admitted for surgical treatment of obesity. Preanesthesia evaluation revealed hypertension and type 2 diabetes mellitus (DM as comorbidities as well as potential for a difficult intubation– neck circumference of 46 cm, reduced neck mobility and DM type 2. Patient was intubated using "awake intubation" method using topical anesthesia and dexmedetomidine infusion. General anesthesia was maintained with sevoflurane and dexmedetomidine infusion instead of opioid administration in "opioid-free anesthesia method".Keywords: morbid obesity, non-opioid anesthesia, dexmedetomidine

  10. Rates of TBI-related Emergency Department Visits, Hospitalizations, and Deaths — United States, 2001–2010

    U.S. Department of Health & Human Services — In general, total combined rates for traumatic brain injury (TBI)-related emergency department (ED) visits, hospitalizations and deaths have increased over the past...

  11. Psychological aspects of pediatric anesthesia

    Drašković Biljana


    Full Text Available Surgery and anesthesia cause a significant emotional stress in both parents and children. Since the consequences of this stress develop immediately after surgery and can last even when the hospital treatment is over, the role of the anesthesiologist is to ensure psychological as well as physiological well-being of the patient. In order to reduce emotional stress induced by anesthesia and operation, the anesthesiologist has to understand certain developmental phases that children go through and to identify situations which a child could potentially see as a danger or a threat. This can usually be achieved by careful preoperative assessment and by administering preoperative sedation. During the preoperative visit to the patient, the anesthesiologist can evaluate the levels of anxiety of both parents and children as well as assess the child’s medical condition.

  12. Emergency department visits and hospitalizations for respiratory disease on the island of Hawaii, 1981 to 1991.

    Mannino, D M; Ruben, S; Holschuh, F C; Holschuh, T C; Wilson, M D; Holschuh, T


    This study examined trends in and patterns of emergency department visits and hospitalizations for respiratory disease on the island of Hawaii from 1981 to 1991. We found that emergency department visit rates and hospitalization rates for both asthma and COPD for 1987 to 1991 increased in all regions of the island in comparison with such rates for 1981 to 1986. Rates of emergency department visits and hospitalizations for chronic obstructive pulmonary disease or COPD, but not asthma, were significantly higher in the high-exposure Kona side of the island than in the intermittent-exposure Hilo side of the island during 1983 and 1988 to 1990. We also found that during the weeks that winds were from the west, blowing volcanic air pollution toward Hilo, emergency department visits for asthma increased 15%. Some of the results of our study support the hypothesis that volcanic air pollution affects respiratory health on the island of Hawaii, while other results do not. Any future studies should include measurements of air pollutant levels. PMID:8882554

  13. Goldratt’s Theory Applied to the Problems Associated with an Emergency Department at a Hospital

    Soumya Nayak


    Full Text Available Healthcare costs continue to increase dramatically, while quality remains a significant problem. Reform measures initiated by the government will drive expansion of these costs, further stressing taxpayers and employers, and forcing hospitals to adopt fundamental changes as they try to adjust to increased demands for services and to lessening reimbursements from all payers. This struggle is best seen at the point of entry for many at a hospital: the emergency department (ED. It is at the emergency department that patients’ expectations regarding staff communication with patients, wait times, the triage process, capacity and payment will determine a significant part of a hospital’s revenue. Using Dr. Eliyahu M. Goldratt’s Thinking Process, we will determine what core problem(s are causing a 362-bed regional West Texas hospital emergency department to lose revenue. Evaluation of the current emergency department will determine the Undesirable Effects (UDE. Using that information will lead to the construction of the Current Reality Tree (CRT, which will bring focus to the core problem(s. To break the constraints, which are the core problem(s, an Evaporative Cloud (EC is generated. And, the end result will be to construct a Future Reality Tree (FRT, which will validate the idea(s generated in the EC. It was determined that there are ten major UDE’s that affected this hospital’s emergency department. They were focused around staff communication, wait times, triage process, information management, service provided and bill collections. A conclusion was made that the core problem dealt with triaging patients and utilization of the services provided by the hospital. Since the reimbursement rate is affected by the patient’s satisfaction, the areas to focus on would be: triage, education, communication and retention. Although it may be neither feasible nor desirable to meet all the patient’s expectations, increased focus on those areas may




    Full Text Available A 67 yrs old lady who underwent modified Radical mastectomy under General Anesthesia developed pneumothorax in the immediate post-operative period. She was treated with chest tube insertion and was discharged from hospital 8 days later

  15. Causes of poisoning in patients evaluated in a hospital emergency department in Konya, Turkey

    Objectives: To evaluate demographic and clinical characteristics of patients with poisoning at a community hospital. Methods: The retrospective study comprised records of patients who were admitted to the emergency department of Konya Numune Hospital, Turkey, because of poisoning between January 1, 2009, and December 31, 2011. Data was evaluated for age, gender, educational status, occupation, arrival time, mechanism of intoxication , body temperature, pulse, respiratory rate, Glasgow Coma Scale score, treatment applied, duration of hospital stay, duration of follow-up, test results, final diagnosis, clinical disposition, and outcome. Agents causing the poisoning were also determined. Results: Records of 1036 patients were evaluated. Of them, 764(74%) were female and 272(26%) were male. The predominant age range was 15-24 years in 617(60%) patients. The median time from substance exposure to admission to the emergency department was 2 hours. The most common cause of poisoning was attempted suicide in 955 (92%) patients and drug intoxication was the agent involved in 932 (90%). In the 15-24 year age range, there were 469(76%) female patients. Of the total female population in the study, 716(94%) attempted suicide. The median hospital stay was 24 hours. There were 908(88%) patients who were advised to seek further evaluation at the psychiatry clinic, and 9 (0.9%) patients were admitted to the psychiatry inpatient units after medical treatment. In patients who were hospitalized and followed up, 1 (0.1%) died because of multiple drug poisoning. Conclusion: Most admissions to the emergency department for poisoning related to young women had used drugs during a suicide attempt. (author)

  16. Anesthesia for cesarean section in pregnancies complicated by placenta previa

    Objective was to evaluate the factors affecting the choice of anesthetic technique for cesarean section in women with placenta previa. In this retrospective study, the records of the labor Ward Theatre of the University of Benin Teaching Hospital, Benin City, Nigeria were examined from January 2000 to December 2004 to identify all the women who had cesarean section for placenta previa. The patient's socio-demographic characteristics, type of placenta previa, anesthesia technique, estimated blood loss, maternal and fetal outcomes were recorded. One hundred and twenty-six patients had cesarean section for placenta previa, however, only 81 patients 64.3% were available for analysis. General anesthesia was administered to 52/81 patients 64.2% and 29/81 patients 35.8% received spinal anesthesia. A history of antepartum bleeding was recorded in 61.7% n=50. Of 31 patients without antepartum hemorrhage APH, 15/31 had general anesthesia and 16/31 had spinal anesthesia. The patients who had APH, 37/50 had general anesthesia and 1/50 had spinal anesthesia. There was an increased chance of using general anesthesia and if APH were present p=0.03, odds ratio=3.1, 95% confidence interval=1.2-7.7. Spinal anesthesia may useful in patients with placenta previa. The presence of APH may encourage the use of general anesthesia for cesarean delivery. (author)

  17. Staff Report to the Senior Department Official on Recognition Compliance Issues. Recommendation Page: Council on Accreditation of Nurse Anesthesia Educational Programs

    US Department of Education, 2010


    The Council on Accreditation of Nurse Anesthesia Educational Programs (COA) accredits institutions and programs that prepare nurses to become practicing nurse anesthetists. Currently the agency accredits 105 programs located in 35 states, the District of Columbia and Puerto Rico, including three single purpose freestanding institutions. The…

  18. Factors associated with hospital admissions and repeat emergency department visits for adults with asthma

    Adams, R; B. Smith; Ruffin, R


    BACKGROUND—A small proportion of patients with asthma account for a disproportionate number of acute health service events. To identify whether factors other than severity and low socioeconomic status were associated with this disproportionate use, a prospective study was undertaken to examine management and psychosocial factors associated with increased risk for admission to hospital with asthma and repeat visits to the emergency department over a 12month period.

  19. Prescription pattern of fixed dose drug combination in cardiology department in a tertiary care hospital

    Pramod Kumar Manjhi; Lalit Mohan; Manish Kumar; Harihar Dikshit; Singh, B. P.; Anuj Kumar Pathak; Sanjeev Kumar


    Background: A cardiovascular disease (CVD) is one of the most common causes of mortality and morbidity globally. The drastic change in the lifestyle of population during 21st century has had a great impact on health especially cardiovascular diseases. Objective of this study was to assess the prescription pattern of fixed dose drug combinations (FDCs) in the department of cardiology in a tertiary care hospital. Methods: The prescriptions of 210 patients suffered by cardiovascular disorders...


    Pooja Prajwal; Mohandas Rai; Sharath Kumar K; Srinivas Bhat U; Floyd Vernon Dsouza


    The objective of the study is to assess the average number of drugs per prescription, formulations being prescribed, various categories of drugs being prescribed and the category most often used in ophthalmology. This is a retrospective hospital based study carried out in the department of ophthalmology at A.J institute of medical sciences, Mangalore, India. The study period was from July 2012 to July 2013. Total number of prescriptions analyzed were 3543, in which total of 15,324 drugs were ...

  1. Clinical pharmacist evaluation of medication inappropriateness in the emergency department of a teaching hospital in Malta

    West LM; Cordina M; Cunningham S


    Appropriate prescribing remains an important priority in all medical areas of practice. Objective The objective of this study was to apply a Medication Appropriateness Index (MAI) to identify issues of inappropriate prescribing amongst patients admitted from the Emergency Department (ED). Methods This study was carried out at Malta's general hospital on 125 patients following a two-week pilot period on 10 patients. Patients aged 18 years and over and on medication therapy were included. Medic...

  2. Increased HIV testing among hospitalized patients who declined testing in the emergency department.

    Felsen, Uriel R; Cunningham, Chinazo O; Zingman, Barry S


    Health-care systems have serial encounters with many of the same patients across care settings; however, few studies have examined the role of reoffering HIV testing after a patient declines. We assessed whether an intervention to increase HIV testing among hospitalized patients was associated with increased testing among those who declined a test while in the Emergency Department (ED). We studied 8-week periods pre- and post-implementation of an electronic medical record (EMR)-based intervention to increase HIV testing among hospitalized patients. We included all patients 21-64 years old who had no prior HIV test, declined HIV testing in the ED, and were subsequently hospitalized. We used logistic regression to test for an association between time of hospital admission (pre- vs. post-intervention) and whether an HIV test was performed prior to discharge. Pre- and post-implementation, 220 and 218 patients who declined HIV testing in the ED were hospitalized, respectively. There were no significant demographic or clinical differences among patients pre- and post-implementation. Pre- and post-implementation, the median proportion of patients tested weekly was 6.7% (IQR 6.5%, 10.0%) and 41.4% (IQR 33.3%, 41.9%), respectively (aOR 6.2: 95%CI: 3.6, 10.6). HIV testing increased among hospitalized patients who declined a test in the ED after implementation of an EMR-based intervention. Almost half of the patients who declined testing in the ED ultimately underwent testing after it was reoffered during hospitalization, suggesting that the decision to undergo HIV testing is a dynamic process. Leveraging EMR resources may be an effective tool for expanding HIV testing, and testing should be reoffered to patients who previously declined. PMID:26654431

  3. Epidural anesthesia in repeated cesarean section.

    Rolando T. Espín González


    Full Text Available Background: A spectacular development has been experimented in the Anesthesiology branch in the last few years in the different areas of its competence in which the attendance activity on obstetric patients as well as every aspect related with its adequate practice is of a great importance. Objective: to evaluate the efficacy of epidural anesthesia in repetitive cesarean. Methods: a descriptive retrospective study of a series of cases (112in which epidural anesthesia in repetitive cesarean was applied from January 2001 to December 2001 in the surgical unit of the Gynecological obstetric service at the University Hospital ¨Dr. Gustavo Aldereguía Lima¨ in Cienfuegos city, Cuba. Some variables such as fixation time of the anesthesia, its duration, transurgical and postsurgical hemodynamic behavior, complications related with the anesthesia, evaluation of the new born baby and, the level of satisfaction of the patients were analyzed. Results: The immediate transurgical and postsurgical hemodynamic behavior was stable predominating normotension and the normal cardiac frequency. The complications related to anesthesia were minimal. The level of satisfaction of the patients was elevated. No alterations in new born babies were presented. As a conclusion, it may be stated that epidural anesthesia in repetitive cesarean is a safety and reliable anesthetic method.

  4. Accreditation of Emergency Department at a Teaching Hospital in Tehran University of Medical Sciences in 2010

    Fereshteh Farzianpour


    Full Text Available Problem statement: Considering the importance of emergency departments in healthcare system and the high mortality rate of patients referred to these departments, it is crucial to provide quality services in emergency departments. Accreditation is a systematic process for improving quality of care and it enables managers to assess and evaluate the healthcare system. Accreditation of an organization provides an obvious commitment for improving quality of safety, quality of patient care, ensuring safety surveillance and continuous activities for reducing dangers which threaten patients and staff. Therefore, given the vital role as well as and the perpetual and indispensable service provided by the emergency departments, it is necessary to re-evaluate the manner of service provision in these departments according to the standards and criteria of accreditation, so that an observance of these criteria will lead to improvement of emergency medicine in Iran. Thus, the present study was undertaken with the purpose of accreditation of emergency department of a teaching hospital of Tehran University of Medical Sciences according to the standards of Iranian Deputy of Health and the JCI. Approach: This is a descriptive-analytic study with a cross-sectional structure. Our study population consisted of 50 individuals of the healthcare staff (physicians and nurses working in morning and evening work shifts of the emergency department in the teaching hospital. Data collection tools consisted of standard questionnaires of the Deputy of Health (9 series and questionnaires developed by authors based on the standards of the Joint Commission International (JCI regarding patient satisfaction with services provided in emergency departments. In order to determine the reliability and validity of the data collection tools, professors and experts reviewed the questionnaire of quality and patient safety in accordance with standards of quality patient safety from the

  5. Hospitals - HOSPITALS_CLINICS_ISDH_IN: Hospitals and Rural Health Clinics in Indiana in 2007 (Indiana State Department of Health, Point Shapefile)

    NSGIC GIS Inventory (aka Ramona) — HOSPITALS_CLINICS_ISDH_IN is a point shapefile showing the locations of 160 hospitals included in a "Hospital Directory" that appears on a Web page of the Indiana...

  6. The 500-bed hospital that isn't there: the Victorian Department of Health review of the Hospital in the Home program.

    Montalto, Michael


    The Victorian Department of Health reviewed its Hospital in the Home (HIH) program in 2009, for the first time in a decade. Annual reimbursements to all Victorian hospitals for HIH care had reached $110 million. Nearly all Victorian hospitals have an HIH program. Collectively, these units recorded 32,462 inpatient admissions in 2008-09, representing 2.5% of all inpatient admissions, 5.3% of multiday admissions and 5% of all bed-days in Victoria. If HIH were a single entity, it would be a 500-bed hospital. Treatment of many patients with acute community- and hospital-acquired infections or venous thromboembolism has moved into HIH. There is still capacity for growth in clinical conditions that can be appropriately managed at home. The review found evidence of gaming by hospitals through deliberate blurring of boundaries between acute HIH care and postacute care. The Victorian HIH program is a remarkable success that has significantly expanded the overall capacity of the hospital system, with lower capital resources. It suggests HIH with access to equivalent hospital remuneration is necessary for a successful HIH policy. Hospitals should invest in HIH medical leadership and supervision to expand their HIH services, including teaching. HIH is a challenge to the traditional vision of a hospital. Greater community awareness of HIH could assist in its continued growth. PMID:21077817

  7. [Rapid opiate detoxification under anesthesia (RODA)].

    Dubols, N; Hallet, C; Luppens, D; Ansseau, M; Charlier, C


    Rapid Opiate Detoxification under Anesthesia (RODA) involves the use of opiate antagonists combined with anesthesia and pharmacotherapy to reduce withdrawal symptoms. The aim of our study was to measure the plasma concentrations of heroin metabolites and methadone during anesthesia and patient stay at the hospital in order to assess the amount of active substances at each protocol step. Plasma concentrations of antagonists were also quantified and compared to the recommended target values. Blood samples were drawn in 10 patients undergoing RODA at different times of the procedure (during anesthesia, in post-anesthesia care unit and in psychiatry unit). The plasma concentrations of heroin metabolites, methadone and antagonists were measured using a previously described method. Heroin active metabolites were no longer detected in the patient blood when helshe left the hospital; by contrast, methadone was still present at significant concentrations 3 days after the beginning of the detoxification procedure. Naltrexone analysis allowed us to adjust doses to insure opiate receptor blockade during acute withdrawal, which is a critical period. PMID:23888580

  8. Anesthesia related Complications in Pediatric GI Endoscopy

    A Sabzevari


    Full Text Available Introduction: Elective upper and lower GI endoscopy is usually performed in children on an outpatient basis with the child under sedation or general anesthesia (GA. The objective of this study was to describe Anesthesia related complications in   children undergoing elective GI endoscopy.   Materials and Methods: The study design was descriptive on 1388 patients undergoing elective GI endoscopy in Sheikh Hospital from 2009 to 2013. All patient received propofol or standard inhalational anesthesia. We examined patients’ demographic data  ,  location of GI endoscopy ,  perioperative vital singe ,  recovery time , respiratory and cardiac complications , post operative nausea and vomiting , agitation , diagnosis and outcome   Results: Pediatric patients aged 2 to 17 years. 29 % of elective GI endoscopy was upper GI endoscopy and 70.3 % was lower GI endoscopy and 0.7 was both of them. 47.7 % of Pediatric patients were female and 52.3 % was male. We haven’t significant or fatal anesthesia related respiratory and cardiac complications (no apnea, no cardiac arrest. 8 patients (0.5% have transient bradicardia in post operative care Unit. 83 patients (5.9% have post operative nausea and vomiting controlled by medication.  6 patients (0.4% have post operative agitation controlled by medication.   Conclusions: General anesthesia and deep sedation in children undergoing elective GI endoscopy haven’t significant or fatal anesthesia related complications. We suggest Anesthesia for infants, young children, children with neurologic impairment, and some anxious older children undergoing elective GI endoscopy. Keyword: Anesthesia, Complication, Endoscopy, Pediatric.

  9. A quest to increase safety of anesthetics by advancements in anesthesia monitoring: scientometric analysis

    Vlassakov KV


    Full Text Available Kamen V Vlassakov, Igor Kissin Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA Abstract: The aim of this study was to assess progress in the field of anesthesia monitoring over the past 40 years using scientometric analysis. The following scientometric indexes were used: popularity indexes (general and specific, representing the proportion of articles on either a topic relative to all articles in the field of anesthetics (general popularity index, GPI or the subfield of anesthesia monitoring (specific popularity index, SPI; index of change (IC, representing the degree of growth in publications on a topic from one period to the next; and index of expectations (IE, representing the ratio of the number of articles on a topic in the top 20 journals relative to the number of articles in all (>5,000 biomedical journals covered by PubMed. Publications on 33 anesthesia-monitoring topics were assessed. Our analysis showed that over the past 40 years, the rate of rise in the number of articles on anesthesia monitoring was exponential, with an increase of more than eleven-fold, from 296 articles over the 5-year period 1974–1978 to 3,394 articles for 2009–2013. This rise profoundly exceeded the rate of rise of the number of articles on general anesthetics. The difference was especially evident with the comparison of the related GPIs: stable growth of the GPI for anesthesia monitoring vs constant decline in the GPI for general anesthetics. By the 2009–2013 period, among specific monitoring topics introduced after 1980, the SPI index had a meaningful magnitude (≥1.5 in 9 of 24 topics: Bispectral Index (7.8, Transesophageal Echocardiography (4.2, Electromyo­graphy (2.8, Pulse Oximetry (2.4, Entropy (2.3, Train-of-four (2.3, Capnography (1.9, Pulse Contour (1.9, and Electrical Nerve Stimulation for neuromuscular monitoring (1.6. Only one of these topics (Pulse

  10. Antibiotics prescribing pattern in the in-patient departments of a tertiary care hospital

    Ambili Remesh


    Settings and Design: A cross-sectional prospective study was carried out in six inpatients departments (Surgery, Orthopedics, ENT, Ophthalmology, Medicine, and Pediatrics of a 550-bed tertiary care hospital in Trivandrum, India for two months (July-August 2012. Institutional Research and Ethics Committee clearance were obtained prior to the study. Materials and Methods: The data were collected in a predesigned performa from the medical case sheets, drug charts, and laboratory investigations of 100 in-patients. The enrolled patients were observed from admission till discharge. Descriptive statistics were applied to the collected data and analyzed using Microsoft Excel software. Results: The mean duration of hospitalization among the study population was 5.48 (±4.28 days. Of the 410 medicines prescribed, antibiotics contributed 151 (36.8%. They were mostly indicated for respiratory infections, and the most common antibiotic was Beta-lactams (91 (60.2%. Interestingly, 89 antibiotics (60% were administered as injections. About 70 (46% of the antibiotics were prescribed without any combinations. The adherences to World Health Organization′s essential medicines list were 122 (81%. A total of seven adverse drug reactions were reported in the current study. Of which, none were serious, and five (70% were cutaneous reactions. Conclusions: Of the 100 patients analyzed from six in-patient departments, it was observed that the hospital physicians prescribed antibiotics more rationally with no banned drugs and less newer drugs. Rational prescribing of antibiotics would help avoid polypharmacy and prevent drug resistances.

  11. Temporal dynamics of emergency department and hospital admissions of pediatric asthmatics

    Kimes, Daniel; Levine, Elissa; Timmins, Sidey; Weiss, Sheila R.; Bollinger, Mary E.; Blaisdell, Carol


    Asthma is a chronic disease that can result in exacerbations leading to urgent care in emergency departments (EDs) and hospitals. We examined seasonal and temporal trends in pediatric asthma ED (1997-1999) and hospital (1986-1999) admission data so as to identify periods of increased risk of urgent care by age group, gender, and race. All pediatric ED and hospital admission data for Maryland residents occurring within the state of Maryland were evaluated. Distinct peaks in pediatric ED and hospital asthma admissions occurred each year during the winter-spring and autumn seasons. Although the number and timing of these peaks were consistent across age and racial groups, the magnitude of the peaks differed by age and race. The same number, timing, and relative magnitude of the major peaks in asthma admissions occurred statewide, implying that the variables affecting these seasonal patterns of acute asthma exacerbations occur statewide. Similar gross seasonal trends are observed worldwide. Although several environmental, infectious, and psychosocial factors have been linked with increases in asthma exacerbations among children, thus far they have not explained these seasonal patterns of admissions. The striking temporal patterns of pediatric asthma admissions within Maryland, as described here, provide valuable information in the search for causes.

  12. From the emergency department to the general hospital: hospital ownership and market factors in the admission of the seriously mentally ill.

    Shen, Jay J; Cochran, Christopher R; Moseley, Charles B


    General hospitals are becoming the safety net provider for the seriously mentally ill (SMI) in the United States, but these patients are faced with a number of potential barriers when accessing these hospitals. Hospital ownership and market forces are two potential organizational and healthcare system barriers that may affect the SMI patient's access, because the psychiatric and medical services they need are unprofitable services. This study examines the relationship among hospital ownership, market forces, and admission of the SMI patient from the emergency department into the general hospital. This was a cross-sectional study of a large sample of SMI patients from the 2002 State Inpatient Datasets for five states. Multiple logistic regression was applied in the multivariable analysis. After controlling for patient, hospital, and county covariates and when compared with not-for-profit hospitals, public hospitals were more likely to admit while investor-owned hospitals were less likely to admit SMI patients. Hospitals in competitive markets were less likely to admit while hospitals with capitation revenues were slightly less likely to admit these patients. Policy options that can address this "market failure" include strengthening the public psychiatric inpatient care system, making private health insurance coverage of the SMI more equitable, revising Medicare prospective payment system to better reimburse the treatment of the SMI, and allowing not-for-profit hospitals to count care of the SMI as a community benefit. Results of this study will be useful to healthcare managers searching for ways to reduce unnecessary administrative costs while continuing to maintain the level of administrative activities required for the provision of safe, effective, and high-quality care. PMID:18720688

  13. Are Anesthesia Providers Ready for Hypnosis? Anesthesia Providers' Attitudes Toward Hypnotherapy.

    Stone, Alexander B; Sheinberg, Rosanne; Bertram, Amanda; Seymour, Anastasia Rowland


    This study sought to measure current attitudes toward hypnosis among anesthesia providers using an in-person survey distributed at a single grand rounds at a single academic teaching hospital. One hundred twenty-six anesthesia providers (anesthesiologists and nurse anesthetists) were included in this study. A 10-question Institutional Review Board (IRB)-approved questionnaire was developed. One hundred twenty-six (73% of providers at the meeting) anesthesia providers completed the survey. Of the respondents, 54 (43%) were anesthesiologists, 42 (33%) were trainees (interns/residents/fellows) in anesthesia, and 30 (24%) were nurse anesthetists. Over 70% of providers, at each level of training, rated their knowledge of hypnosis as either below average or having no knowledge. Fifty-two (42%) providers agreed or strongly agreed that hypnotherapy has a place in the clinical practice of anesthesia, while 103 (83%) believed that positive suggestion has a place in the clinical practice of anesthesia (p hypnosis were that it is too time consuming (41%) and requires special training (34%). Only three respondents (2%) believed that there were no reasons for using hypnosis in their practice. These data suggest that there is a self-reported lack of knowledge about hypnosis among anesthesia providers, although many anesthesia providers are open to the use of hypnosis in their clinical practice. Anesthesia providers are more likely to support the use of positive suggestion in their practice than hypnosis. Practical concerns should be addressed if hypnosis and therapeutic verbal techniques are to gain more widespread use. PMID:27003489

  14. Effects of Anesthesia

    ... Regional Anesthesia The potential side effects of regional anesthesia (such as an epidural or spinal block, in which an anesthetic is injected in ... days after the procedure if some of the spinal fluid leaks out. Minor back ... was injected. Serious but rare complications include: Pneumothorax – ...

  15. A system model of work flow in the patient room of hospital emergency department.

    Wang, Junwen; Li, Jingshan; Howard, Patricia K


    Modeling and analysis of patient flow in hospital emergency department (ED) is of significant importance. In a hospital ED, the patients spend most of their time in the patient room and most of the care delivery services are carried out during this time period. In this paper, we propose a system model to study patient (or work) flow in the patient room of an ED when the resources are partially available. A closed and re-entrant process model is developed to characterize the care service activities in the patient room with limited resources of doctors, nurses, and diagnosis tests. Analytical calculation of patient's length of stay in the patient room is derived, and monotonic properties with respect to care service parameters are investigated. PMID:23589322

  16. Achieve Sustainable Hospital Excellence Through 5-S in an Emergency Department in Hong Kong

    Tsoi Vincent F. K.


    Full Text Available 5-S is the first step towards TQM. Over the last century, the Japanese have formalised the technique and named it as 5-S Practice. Since 1993, Sam Ho has improved and defined its terms in English/Chinese and developed the world's first 5-S Audit Checklist. In the article, an emergency department of a Hong Kong hospital was examined against 5-S 50-point Checklist for the improvement of their quality assurance systems towards its accreditation process with Australian standards. The findings evidently reveal that the impact of 5-S on hospital quality assurance in the unit are positive. Riding on the above scenario, the research aim is to identify whether the 5-S practice is a suitable and effective tool for healthcare quality assurance in an emergency setting which is led towards its accreditation process set by other mechanisms.

  17. The preliminary experience in the emergency department of a newly opened penitentiary institution hospital in Turkey

    Bora Koc


    Full Text Available Background: Emergency cases become a widespread problem in prisons across Turkey. The opening of a new prison hospital in January 2012 within the catchment of Silivri Penitentiary Institution gave a unique opportunity to treat the inmates quickly. Aims: The study was to conduct an extensive review for documentation of prisoners′ healthcare problems leading to emergency admission following the first year after the opening of Penitentiary Institution Hospital and point to decrease redundant hospital transfers of this individual cohort. Materials and Methods: A cross-sectional study was carried out where 12,325 visits to the Silivri Penitentiary Institution Hospital for emergency visits from the period of 1 st January 2012 to the 31 st December 2012 were identified from electronic medical records. After obtaining consent from the local IRB, data including details of the type, cause and nature of the complaints of the illnesses were processed. Results: In the 12-month period, there were 12,325 visits to the emergency department, of which 4328 for surgical conditions (35.1%, 2684 for medical disorders (21.8%, 1867 for sports injuries (15.2%, 1327 for Ear Nose Throat (ENT problems (10.8%, 827 for psychiatric disorders (6.70%, 396 for violence injury (3.2%, 169 for self harm (1.4%, and 727 for miscellaneous (5.8%. The most common cause of emergency visits was sports injuries, followed by non-specific abdominal pain and ENT problems. Eighteen prisoners re-attended 243 times, ranging from 8 visits to a maximum of 56 visits. Conclusion: Inmates in prison have a wide range of complaints, and sometimes these complaints do not suggest an illness. Prison population exhibited substantially higher prevalence rates of diseases than the civilian population. We conclude that this new healthcare system in prisons will prevent redundant hospital transfers and guarantee detainees have access to the same health care that is offered to non-detained population.

  18. Emergency department physician training in Jamaica: a national public hospital survey

    Williams Eric W


    Full Text Available Abstract Background Emergency Department (ED medical officers are often the first medical responders to emergencies in Jamaica because pre-hospital emergency response services are not universally available. Over the past decade, several new ED training opportunities have been introduced locally. Their precise impact on the health care system in Jamaica has not yet been evaluated. We sought to determine the level of training, qualifications and experience of medical officers employed in public hospital EDs across the nation. Methods A database of all medical officers employed in public hospital EDs was created from records maintained by the Ministry of Health in Jamaica. A specially designed questionnaire was administered to all medical officers in this database. Data was analyzed using SPSS Version 10.0. Results There were 160 ED medical officers across Jamaica, of which 47.5% were males and the mean age was 32.3 years (SD +/- 7.1; Range 23–57. These physicians were employed in the EDs for a mean of 2.2 years (SD +/- 2.5; Range 0–15; Median 2.5 and were recent graduates of medical schools (Mean 5.1; SD +/- 5.9; Median 3 years. Only 5.5% of the medical officers had specialist qualifications (grade III/IV, 12.8% were grade II medical officers and 80.5% were grade I house officers or interns. The majority of medical officers had no additional training qualifications: 20.9% were exposed to post-graduate training, 27.9% had current ACLS certification and 10.3% had current ATLS certification. Conclusion The majority of medical officers in public hospital EDs across Jamaica are relatively inexperienced and inadequately trained. Consultant supervision is not available in most public hospital EDs. With the injury epidemic that exists in Jamaica, it is logical that increased training opportunities and resources are required to meet the needs of the population.

  19. Ultrasound-guided epidural anesthesia for a parturient with severe malformations of the skeletal system undergoing cesarean delivery: a case report

    Luo LL


    Full Text Available LinLi Luo,* Juan Ni,* Lan Wu, Dong Luo Department of Anesthesiology, West China Second Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China  *These authors contributed equally to this work and should be considered co-first authors Abstract: Anesthetic management of patients with preexisting diseases is challenging and individualized approaches need to be determined based on patients' complications. We report here a case of ultrasound-guided epidural anesthesia in combination with low-dose ketamine during cesarean delivery on a parturient with severe malformations of the skeletal system and airway problems. The ultrasound-guided epidural anesthesia was performed in the L1–L2 space, followed by an intravenous administration of ketamine (0.5 mg/kg for sedation and analgesia. Satisfactory anesthesia was provided to the patient and spontaneous ventilation was maintained during the surgery. The mother and the baby were discharged 5 days after surgery, no complications were reported for either of them. Our work demonstrated that an ultrasound-guided epidural anesthesia combined with low-dose ketamine can be used to successfully maintain spontaneous ventilation and provide effective analgesia during surgery and reduce the risk of postoperative anesthesia-related pulmonary infection. Keywords: anesthesia, regional, cesarean delivery, ketamine, ultrasound-guided

  20. Patients’ receptiveness for Medical students during consultation in Out patient department of a teaching hospital in Karachi Pakistan

    Laiq-uz-Zaman Khan, Muhammad; Jawaid, Masood; Hafeez, Kamran


    Objective: Patients’ attitude towards medical students’ presence during treatment depends on the cultural values of the society. This study was conducted to find out the patients’ receptiveness in our society to be involved in teaching process for medical students during consultation in out patient department of a teaching hospital in Karachi Pakistan. Methodology: This cross sectional study was conducted in the surgical Out Patient Department (OPD) at Dow University Hospital from May 2012 to...

  1. 2012~2014年某医院麻醉用药合理性分析%Reasonable analysis of anesthesia drugs in certain large hospital from 2012 to 2014

    姜佳希; 李静; 曲海军


    Objective To analyze whether the use of anesthesia drugs was reasonable at a hospital and raise rationali-zation suggestions. Methods To find out two kinds of anesthetic drugs according to the sales amount. The content included the amount of medication,defined daily dose(DDD),medication frequency(DDDs),defined daily cost(DDC). Results There was an upward trend of the sales amount at a hospital. Intravenous anesthetics and analgesics located in the fore-front of the sales amount line. Conclusion Most clinical applications of intravenous anesthetics and analgesics were reason-able. A few unreasonable applications needed to intervene,in order to promote clinical rational drug use.%目的:分析某医院麻醉用药是否合理,提出合理用药建议。方法根据总金额排序找出销售金额位于前两位的麻醉用药,再对其限定日剂量 DDD、用药频度 DDDs、日均费用 DDC 进行分析。结果某院麻醉用药的总金额呈逐年上升的趋势。静脉麻醉药和镇痛药位于麻醉用药金额排序的前2位。结论静脉麻醉药和镇痛药的临床应用基本合理,部分用药尚存在不合理之处,亟待干预,以促进临床合理用药。

  2. Assessment of safety culture within the radiotherapy department of the Bordeaux University Hospital Centre

    The assessment of the safety culture within a radiotherapy department has been performed by using a Safety Attitudes Questionnaire (SAQ). It assesses the safety environment, the team cooperation quality, the satisfaction related to professional activity, the approval of management actions, the perception of the work environment quality and of logistic support, and the acknowledgment of the influence of stress on performance. The survey has been performed before and after the support intervention of a hospital audit and expertise mission in relationship with the National cancer Institute (Inca). The comparison of results before and after this support intervention shows a general score improvement for the SAQ. Short communication

  3. The Prevalence of Pemphigus (Razi Hospital and Department of Oral Pathology, Tehran University of Medical Sciences

    Eshghyar N


    Full Text Available The aim of this retrospective statistical study was to determine the prevalcence and frequency of"nage and sex distributions of pemphigus disease. Pemphigus disease classified as autoimmune bullous"ndermatoses which is a chronic mucocutaneous disease."nThis study was performed in Razi Hospital and department of oral pathology of dental school, Tehran"nUniversity of Medical Sciences. The most frequently effected area was buccal moucosa of oral cavity. The"nmost rate of recurrence was found in oral cavity which being more common in middle age females (25-44"nyears.

  4. Hospitals - HOSPITALS_HSIP_IDHS_IN: Hospitals in Indiana as Developed for the Homeland Security Infrastructure Program (Indiana Department of Homeland Security, Point Shapefile)

    NSGIC GIS Inventory (aka Ramona) — HOSPITALS_HSIP_IDHS_IN is a point shapefile that contains hospital locations, as developed for the Homeland Security Infrastructure Program (HSIP). The data were...

  5. Consumer satisfaction with nursing care in a rural community hospital emergency department.

    Clark, C A; Pokorny, M E; Brown, S T


    The article describes a study undertaken to assess patient satisfaction with nursing care in a rural hospital emergency department with respect to psychological safety, discharge teaching, information giving, and technical competence. This descriptive research utilized Davis' Consumer Emergency Care Satisfaction Scale to determine the degree to which 52 patients perceived overall satisfaction with nursing care. Findings indicated that patients were satisfied with nursing care. No statistically significant effect of gender or education level on consumer satisfaction or on any subscale was detected, but African American consumers were less satisfied with discharge teaching, which may suggest that discharge teaching should reflect the cultural diversity of consumers presenting to the emergency department. Nursing staff may need to spend more time with rural African American consumers. Staff may need to be inserviced to meet the cultural and educational needs of African Americans. PMID:8562989

  6. The effects of noise on the cognitive performance of physicians in a hospital emergency department

    Dodds, Peter

    In this research, the acoustic environment of a contemporary urban hospital emergency department has been characterized. Perceptive and cognitive tests relating to the acoustic environment were conducted on both medical professionals and lay people and a methodology for developing augmentable acoustic simulations from field recordings was developed. While research of healthcare environments remains a popular area of investigation for the acoustics community, a lack of communication between medical and acoustics researchers as well as a lack of sophistication in the methods implemented to evaluate hospital environments and their occupants has led to stagnation. This research attempted to replicate traditional methods for the evaluation of hospital acoustic environments including impulse response based room acoustics measurements as well as psychoacoustic evaluations. This thesis also demonstrates some of the issues associated with conducting such research and provides an outline and implementation for alternative advanced methods of re- search. Advancements include the use of the n-Back test to evaluate the effects of the acoustic environment on cognitive function as well as the outline of a new methodology for implementing realistic immersive simulations for cognitive and perceptual testing using field recordings and signal processing techniques. Additionally, this research utilizes feedback from working emergency medicine physicians to determine the subjective degree of distraction subjects felt in response to a simulated acoustic environment. Results of the room acoustics measurements and all experiments will be presented and analyzed and possible directions for future research will be presented.

  7. Situation of the radiological protection in hospitals of the Department the Freedom - Peru

    The present work is first one in this gener that it is made in the Department of the Freedom - Peru. The intention was to do a diagnose of the radiation protection in the sanitary scope taking into account some main parameters like the level of qualification of the worker occupational exposed, the design of environment and the quality of the equipment in aspects like: collimation, filtration, kV and time. In this study were taken into account the Hospitals of the Department of the Freedom that belong to the Ministry of Health, Social Security and Private Centers of Health. From each hospital a random sample of the radiology worker was taken and it was applied a survey with related questions to radiological safety. The gather of the information became by means of direct survey. The obtained results are very useful, because besides to make a real diagnose of the radiation protection, evaluating the human and technical factor, they serve to improve the aspects of quality in radiological diagnosis, since the conclusions allow to establish if it is counted on a suitable level of radiation protection on the part of the workers and if the equipment fulfills the quality necessary to reach an efficient use of x-rays

  8. Glass injuries seen in the emergency department of a South African district hospital

    Doudou Nzaumvila


    Full Text Available Background: The emergency department of Embhuleni Hospital frequently manages patients with glass-related injuries. This study assessed these injuries and the glass that caused them in more detail.Aim: The objectives of our study included determining the type of glass causing these injuries and describing the circumstances associated with different types of glass injuries.Setting: The emergency department of Embhuleni Hospital in Elukwatini, Mpumalanga province, South Africa.Methods: This was a cross-sectional study with a sample size of 104 patients. Descriptive statistics were used to assess the characteristics of the glass injuries.Results: Five different types of glass were reported to have caused the injuries, namely car glass (7.69%, glass ampoules (3.85%, glass bottles (82.69%, glass windows (3.85% and street glass shards (1.92%. Glass bottle injuries were mainly caused by assaults (90.47% and most victims were mostly young males (80.23%. The assaults occurred at alcohol-licensed premises in 65.11% of cases. These injuries occurred mostly over weekends (83.72%, between 18:00 and 04:00. The face (34.23% and the scalp (26.84% were the sites that were injured most often.Conclusion: Assault is the most common cause of glass injuries, usually involving young men at alcohol-licensed premises. Glass injuries generally resulted in minor lacerations, with few complications (2.68%.

  9. Racial Disparity in Duration of Patient Visits to the Emergency Department: Teaching Versus Non-teaching Hospitals

    Zynal Karaca


    Full Text Available Introduction: The sources of racial disparity in duration of patients’ visits to emergency departments (EDs have not been documented well enough for policymakers to distinguish patient-related factors from hospital- or area-related factors. This study explores the racial disparity in duration of routine visits to EDs at teaching and non-teaching hospitals.Methods: We performed retrospective data analyses and multivariate regression analyses to investigate the racial disparity in duration of routine ED visits at teaching and non-teaching hospitals. The Healthcare Cost and Utilization Project (HCUP State Emergency Department Databases (SEDD were used in the analyses. The data include 4.3 million routine ED visits encountered in Arizona, Massachusetts, and Utah during 2008. We computed duration for each visit by taking the difference between admission and discharge times.Results: The mean duration for a routine ED visit was 238 minutes at teaching hospitals and 175 minutes at non-teaching hospitals. There were significant variations in duration of routine ED visits across race groups at teaching and non-teaching hospitals. The risk-adjusted results show that the mean duration of routine ED visits for Black/African American and Asian patients when compared to visits for white patients was shorter by 10.0 and 3.4%, respectively, at teaching hospitals; and longer by 3.6 and 13.8%, respectively, at non-teaching hospitals. Hispanic patients, on average, experienced 8.7% longer ED stays when compared to white patients at non-teaching hospitals.Conclusion: There is significant racial disparity in the duration of routine ED visits, especially in non-teaching hospitals where non-White patients experience longer ED stays compared to white patients. The variation in duration of routine ED visits at teaching hospitals when compared to non-teaching hospitals was smaller across race groups. [West J Emerg Med. 2013;14(5:529–541.

  10. Orthopedic Anesthesia in Haiti

    Osteen, Kristie D.


    Healthcare practitioners from around the world responded almost immediately in the aftermath of the 2010 earthquake in Haiti. This article reports on the efforts of an orthopedic trauma team in Haiti and its efforts in providing surgery without general anesthesia.


    Şahin, Aynur; Doğru, Hatice Yılmaz


    Obesity is one of the serious condition that commonly effects health in modern age. It was reported that obesity was three-fold increased in the last three decades. According to the statement by World Health Organisation in 2005, 700 million people will be estimated obese in 2015. While neuraxial anesthesia is a commonly used technique in the worldwide, the process may have difficulties in obese patients. In this review, the pathophysiological changes and challenges in neuraxial anesthesia ...

  12. Hospital Factors Impact Variation in Emergency Department Length of Stay More Than Physician Factors

    Scott P. Krall


    Full Text Available Introduction: To analyze the correlation between the many different emergency department (ED treatment metric intervals and determine if the metrics directly impacted by the physician correlate to the “door to room” interval in an ED (interval determined by ED bed availability. Our null hypothesis was that the cause of the variation in delay to receiving a room was multifactorial and does not correlate to any one metric interval.Methods: We collected daily interval averages from the ED information system, Meditech©. Patient flow metrics were collected on a 24-hour basis. We analyzed the relationship between the time intervals that make up an ED visit and the “arrival to room” interval using simple correlation (Pearson Correlation coefficients. Summary statistics of industry standard metrics were also done by dividing the intervals into 2 groups, based on the average ED length of stay (LOS from the National Hospital Ambulatory Medical Care Survey: 2008 Emergency Department Summary.Results: Simple correlation analysis showed that the doctor-to-discharge time interval had no correlation to the interval of “door to room (waiting room time”, correlation coefficient (CC (CC=0.000, p=0.96. “Room to doctor” had a low correlation to “door to room” CC=0.143, while “decision to admitted patients departing the ED time” had a moderate correlation of 0.29 (p <0.001. “New arrivals” (daily patient census had a strong correlation to longer “door to room” times, 0.657, p<0.001. The “door to discharge” times had a very strong correlation CC=0.804 (p<0.001, to the extended “door to room” time. Conclusion: Physician-dependent intervals had minimal correlation to the variation in arrival to room time. The “door to room” interval was a significant component to the variation in “door to discharge” i.e. LOS. The hospital-influenced “admit decision to hospital bed” i.e. hospital inpatient capacity, interval had a

  13. Hospitals

    Mullins, Michael


    is to minimize the negative effects of stress inducing environments based on research results. Which stress inducing factors? We can look around at some old hospitals and see they are noisy, confusing, ugly, monotonous, hard, cold, artificial, and dark; qualitative terms which can indicate what we shouldn...... in the navigation experience and wasted time of medical staff in providing directions. Space in hospitals: space can be divided into personal, social and outdoor space. Personal space: single rooms have been well documented in: admission length, mortality rates, comfort levels, sense of privacy, all users......’ satisfaction. Social space: attention to spatial qualities, volume and interior design in terms of encouraging physical contact between users in wards, waiting areas and semi-private rooms. Outdoor space: Landscape and gardens are not enough in themselves; they should be visible, centrally or strategically...

  14. 42 CFR 415.178 - Anesthesia services.



  15. A survey of user acceptance of electronic patient anesthesia records

    Jin, Hyun Seung; Kim, Myung Hee; Lee, Suk Young; Jeong, Hui Yeon; Choi, Soo Joo; Lee, Hye Won


    Background An anesthesia information management system (AIMS), although not widely used in Korea, will eventually replace handwritten records. This hospital began using AIMS in April 2010. The purpose of this study was to evaluate users' attitudes concerning AIMS and to compare them with manual documentation in the operating room (OR). Methods A structured questionnaire focused on satisfaction with electronic anesthetic records and comparison with handwritten anesthesia records was administer...

  16. A Simple Clinical Score “TOPRS” to Predict Outcome in Pediatric Emergency Department in a Teaching Hospital in India

    Ravinder Kumar Soni; Bains, Harmesh S.


    Objective: To develop a simple clinical scoring system for severity of illness to help prioritize care and predict outcome in emergency department.Methods: Prospective hospital based observational study. Out of a total of 874 children who attended emergency department in one year, 777 were included in the study. Data was collected at the time of admission in emergency department. The baseline information like age, gender, etc and variables of ‘toprs’ score viz temperature, oxygen saturation, ...

  17. Usefulness of Intravenous Anesthesia Using a Target-controlled Infusion System with Local Anesthesia in Submuscular Breast Augmentation Surgery

    Kyu-Jin Chung; Kyu-Ho Cha; Jun-Ho Lee; Yong-Ha Kim; Tae-Gon Kim; Il-Guk Kim


    Background Patients have anxiety and fear of complications due to general anesthesia. Through new instruments and local anesthetic drugs, a variety of anesthetic methods have been introduced. These methods keep hospital costs down and save time for patients. In particular, the target-controlled infusion (TCI) system maintains a relatively accurate level of plasma concentration, so the depth of anesthesia can be adjusted more easily. We conducted this study to examine whether intravenous anest...

  18. Regional anesthesia for pediatric knee surgery: a review of the indications, procedures, outcomes, safety, and challenges

    Muhly WT


    Full Text Available Wallis T Muhly, Harshad G Gurnaney, Arjunan GaneshDepartment of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Pennsylvania, PA, USAAbstract: The indications for surgery on the knee in children and adolescents share some similarity to adult practice in that there are an increasing number of sports-related injuries requiring surgical repair. In addition, there are some unique age-related conditions or congenital abnormalities that may present as indications for orthopedic intervention at the level of the knee. The efficacy and safety of peripheral nerve blocks (PNBs for postoperative analgesia following orthopedic surgery has been well established in adults. Recent studies have also demonstrated earlier functional recovery after surgery in patients who received PNBs. In children, PNB is gaining popularity, and increasing data are emerging to demonstrate the feasibility, efficacy, and safety in this population. In this paper, we will review some of the most common indications for surgery involving the knee in children and the anatomy of knee, associated dermatomal and osteotomal innervation, and the PNBs most commonly used to produce analgesia at the level of the knee. We will review the evidence in support of regional anesthesia in children in terms of both the quality conferred to the immediate postoperative care and the role of continuous PNBs in maintaining effective analgesia following discharge. Also we will discuss some of the subtle challenges in utilizing regional anesthesia in the pediatric patient including the use of general anesthesia when performing regional anesthesia and the issue of monitoring for compartment syndrome. Finally, we will offer some thoughts about areas of practice that are in need of further investigation.Keywords: pediatric surgery, regional anesthesia, analgesia, knee surgery

  19. Factors impacting same-day cancellation of outpatient pediatric magnetic resonance imaging under anesthesia

    Studies of elective surgical procedures indicate that cancellation is common and preventable. Little is known about cancellation of anesthesia-supported elective diagnostic imaging. To describe the reasons for same-day cancellation of MRI studies performed under sedation or anesthesia and identify patient characteristics associated with cancellations. This case-control study was carried out in a university-affiliated tertiary care children's hospital. Cases were defined as elective outpatient MRI studies booked under anesthesia that were cancelled after the patient had arrived in the radiology department in 2009. Matched controls were identified by selecting the same day and time 1 week before or after the cancelled case. Main outcome measures included demographics, MRI study characteristics, and social and medical factors. There were 111 outpatient anesthesia-supported MRI studies cancelled on the same day as the assessment (cancellation rate: 4.5%), of which 74.6% were related to family and patient factors, while 22% were related to system factors. Cancelled cases involved patients who lived in lower median income quintile neighborhoods compared to controls (2 vs. 3; P = 0.0007; odds ratio [OR] 3.81; 95% confidence interval [CI] 1.18-12.34). Those who traveled a greater median distance (in kilometers) were less likely to be cancelled (18.8 vs. 27.1, P = 0.0035). Although cancelled patients had a lower mean number of total medical services (2.5 vs. 3.0; P = 0.03; OR = 0.78; 95% CI 0.62-0.98), current medical factors (past 12 months) did not impact cancellations. Same-day cancellations of anesthesia-supported MRI studies are not uncommon, and the main predictor of cancellation seems to be socioeconomic rather than medical. (orig.)

  20. Factors impacting same-day cancellation of outpatient pediatric magnetic resonance imaging under anesthesia

    Hoffman, Andrea S. [University of Toronto, Department of Paediatrics, Division of Developmental Paediatrics, Holland Bloorview Kids Rehabilitation Hospital, Toronto (Canada); Matlow, Anne [University of Toronto, Strategic Initiatives, Postgraduate Medical Education, Toronto (Canada); Shroff, Manohar [University of Toronto, Department of Diagnostic Imaging, Division of Neuroradiology, Hospital for Sick Children, Toronto (Canada); Cohen, Eyal [University of Toronto, Division of Paediatric Medicine and Child Health Evaluative Sciences, Hospital for Sick Children, Department of Paediatrics and Institute of Health Policy, Management and Evaluation, Toronto (Canada)


    Studies of elective surgical procedures indicate that cancellation is common and preventable. Little is known about cancellation of anesthesia-supported elective diagnostic imaging. To describe the reasons for same-day cancellation of MRI studies performed under sedation or anesthesia and identify patient characteristics associated with cancellations. This case-control study was carried out in a university-affiliated tertiary care children's hospital. Cases were defined as elective outpatient MRI studies booked under anesthesia that were cancelled after the patient had arrived in the radiology department in 2009. Matched controls were identified by selecting the same day and time 1 week before or after the cancelled case. Main outcome measures included demographics, MRI study characteristics, and social and medical factors. There were 111 outpatient anesthesia-supported MRI studies cancelled on the same day as the assessment (cancellation rate: 4.5%), of which 74.6% were related to family and patient factors, while 22% were related to system factors. Cancelled cases involved patients who lived in lower median income quintile neighborhoods compared to controls (2 vs. 3; P = 0.0007; odds ratio [OR] 3.81; 95% confidence interval [CI] 1.18-12.34). Those who traveled a greater median distance (in kilometers) were less likely to be cancelled (18.8 vs. 27.1, P = 0.0035). Although cancelled patients had a lower mean number of total medical services (2.5 vs. 3.0; P = 0.03; OR = 0.78; 95% CI 0.62-0.98), current medical factors (past 12 months) did not impact cancellations. Same-day cancellations of anesthesia-supported MRI studies are not uncommon, and the main predictor of cancellation seems to be socioeconomic rather than medical. (orig.)

  1. Hospital Compare

    U.S. Department of Health & Human Services — Hospital Compare has information about the quality of care at over 4,000 Medicare-certified hospitals across the country. You can use Hospital Compare to find...

  2. HCAHPS - Hospital

    U.S. Department of Health & Human Services — A list of hospital ratings for the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). HCAHPS is a national, standardized survey of hospital...

  3. Demographic Analysis of Emergency Department Patients at the Ruijin Hospital, Shanghai

    Wim Lammers


    Full Text Available Emergency medicine is an upcoming discipline that is still under development in many countries. Therefore, it is important to gain insight into the organization and patients presenting to the Emergency Department (ED. The aim of this cross-sectional study was to provide an epidemiological description of complaints and referrals of the patients visiting the ED of the Ruijin Hospital in Shanghai, China. A questionnaire was developed and completed for a convenience sample of all patients presenting to the Triage Desk of the ED. The study was performed in June 2008. A total of 2183 questionnaires were completed. The most common complaints were fever (15%, stomach/abdominal pain (15%, vertigo/dizziness (11%, and cough (10%. Following triage, patients were predominantly referred to an internist (41%, neurologist (14%, pulmonologist (11%, or general surgeon (9%. This study provides a better understanding of the reason for the ED visit and the triage system at the ED of the Ruijin Hospital. The results can be used in order to improve facilities appropriate for the specific population in the ED.

  4. Needlestick injury among medical personnel in Accident and Emergency Department of two teaching hospitals.

    Ng, Y W; Hassim, I Noor


    Needlestick injury has been recognized as one of the occupational hazards which results in transmission of bloodborne pathogens. A cross-sectional study was carried out among 136 health care workers in the Accident and Emergency Department of two teaching hospitals from August to November 2003 to determine the prevalence of cases and episodes of needlestick injury. In addition, this study also assessed the level of knowledge of blood-borne diseases and Universal Precautions, risk perception on the practice of Universal Precautions and to find out factors contributing to needlestick injury. Prevalence of needlestick injury among the health care workers in the two hospitals were found to be 31.6% (N = 43) and 52.9% (N = 87) respectively. Among different job categories, medical assistants appeared to face the highest risk of needlestick injury. Factors associated with needlestick injury included shorter tenure in one's job (p risk of needlestick injury while performing procedures on patients. Therefore, comprehensive infection control strategies should be applied to effectively reduce the risk of needlestick injury. PMID:17682562

  5. Depression and anxiety in cancer patients in outpatient department of a tertiary care hospital in Pakistan

    Objective: To examine the prevalence of depression and anxiety in patients with cancer in an outpatient department of a tertiary care hospital in Pakistan. Methodology: This study was conducted between May 2006 and January 2007. The sample consisted of 60 diagnosed cancer patients (30 males/30 females). DSM- IV criteria and Hospital Anxiety and Depression Scale (HADS) were used to diagnose and assess anxiety and depression. Results: Fifty two percent (31 patients, 10 males/21 females) of the subjects reported having symptoms of anxiety, depression or both according to DSM IV Criteria, (anxiety =14, males six / females eight, depression = 6, males two / females four , and depression + anxiety both = 11, males two / females nine). A total of 70% (21/30) of the entire female sample met the criteria for depression, anxiety or both. A total of 33% (10/30) of the entire male sample met the criteria for depression, anxiety or both. Conclusion: This study shows high prevalence rates of depression and anxiety in cancer patients in Pakistan. The oncologists and internists treating cancer patients should screen their patients for symptoms of depression and anxiety. (author)

  6. A proposed simulation optimization model framework for emergency department problems in public hospital

    Ibrahim, Ireen Munira; Liong, Choong-Yeun; Bakar, Sakhinah Abu; Ahmad, Norazura; Najmuddin, Ahmad Farid


    The Emergency Department (ED) is a very complex system with limited resources to support increase in demand. ED services are considered as good quality if they can meet the patient's expectation. Long waiting times and length of stay is always the main problem faced by the management. The management of ED should give greater emphasis on their capacity of resources in order to increase the quality of services, which conforms to patient satisfaction. This paper is a review of work in progress of a study being conducted in a government hospital in Selangor, Malaysia. This paper proposed a simulation optimization model framework which is used to study ED operations and problems as well as to find an optimal solution to the problems. The integration of simulation and optimization is hoped can assist management in decision making process regarding their resource capacity planning in order to improve current and future ED operations.

  7. Local anesthesia for prostate brachytherapy

    patients treated so far, and no unplanned admissions to the hospital or need to reschedule a patient to be implanted under general or spinal anesthesia. Conclusions: The substitution of local anesthesia has facilitated rapid introduction of a high-volume brachytherapy program at an institution that previously had none, without requiring the allocation of significant operating room time. Although the patients reported here were implanted without conscious sedation, we are starting to try various sedatives and analgesics for patients who we anticipate will have substantial anxiety with the procedure

  8. Drug utilization study in the otorhinolaryngology department in a tertiary care hospital

    S. A. Sridevi


    Full Text Available Background: Drug utilization is defined by the World Health Organization (WHO as the marketing, distribution, prescription, and use of drugs in society, with special emphasis on the resulting medical, social, and economic consequences. The aim of this study was to evaluate the pattern of prescription and then drug utilization in outpatient (OPD of the Department of Otolaryngology in a tertiary care teaching hospital. Methods: This was a retrospective study conducted at the A.C.S. medical college and hospital, Chennai for a period of 7 months. All the patients who attended the Ear Nose and Throat (ENT OPD were included. The total number who attended the OPD was 10,249 which include 6,956 new cases and 3313 old cases. Results: The antibacterials commonly used were β Lactams (56%, macrolides (14%, fluoroquinolones (12%, aminoglycosides (8%. Among the penicillin group, the commonest drug prescribed was a combination of amoxicillin and clavulanic acid (27%, in cephalosporins was cefixime + clavulanic acid (19%. Aminoglycosides include gentamycin in refractory cases. Fluoroquinolones include ciprofloxacin and levofloxacin. Others Drugs like antihistamines and mucolytics were prescribed in 27%, anti- ulcer drugs in 36% cases, analgesics in 33% cases and herbal medicines in 4%. The average number of drugs used in each prescription was 3.20. All the drugs were prescribed with brand names. The average cost per prescription per day for OPD patients is 37 Rupees. Conclusions: β Lactams were commonly used antibacterials in the otorhinolaryngology department. [Int J Basic Clin Pharmacol 2013; 2(3.000: 306-310

  9. Characteristics of patients presenting to the vascular emergency department of a tertiary care hospital: a 2-year study

    Kotsikoris Ioannis


    Full Text Available Abstract Background The structure of health care in Greece is receiving increased attention to improve its cost-effectiveness. We sought to examine the epidemiological characteristics of patients presenting to the vascular emergency department of a Greek tertiary care hospital during a 2-year period. We studied all patients presenting to the emergency department of vascular surgery at Red Cross Hospital, Athens, Greece between 1st January 2009 and 31st December 2010. Results Overall, 2452 (49.4% out of 4961 patients suffered from pathologies that should have been treated in primary health care. Only 2509 (50.6% needed vascular surgical intervention. Conclusions The emergency department of vascular surgery in a Greek tertiary care hospital has to treat a remarkably high percentage of patients suitable for the primary health care level. These results suggest that an improvement in the structure of health care is needed in Greece.




    Full Text Available ABSTRACT: BACKGROUND : The more advancing and life saving specialty and specialist i.e ., anesthesia and ane sthesiologists, both have been kept behind the screen, more so in developing countries. Though the role of anesthesiologist is crucial, the public knowledge of anesthetic practice is limited. The present day anesthesiologist is based on the use of newer a nd safer drugs, better patient monitoring, pain management, labour analgesia and critical care. OBJECTIVES : This study was designed to assess the knowledge about the role of anesthesia and anesthesiologist among the paramedical staff at S.N medical college , Bagalkot. METHODOLOGY : This prospective questionnaire based study was done at S.N medical college and hospital among paramedical staffs working in different departments after taking the consent and approval of the ethical committee. Data was collected by pretested and predesigned questionnaire from 105 study participants. A majority of 90.28% of respondents felt that anesthesia was necessary for surgery. 40.80% knew that it was given by anesthesiologists. 18.38% of respondents knew that besides anaestheti zing, anesthesiologists monitor the vital signs till the completion of surgery. 5.60%, 9.11% & 3.8% of respondents were aware of their role in ICU, labor analgesia and pain clinic respectively. Only 22.81% patients had knowledge about anesthesia risks give n in consent form. The statistical association between past exposure to anesthesia and knowledge about anesthesia was not significant (p <0.1 . CONCLUSION : Anesthesiologist work mainly in the operation theatre and to some extent monitor the patient in the post operative ward for pain management and nausea vomiting, headache, etc. The role inside the theater & expanding role outside the theater poorly known. The awareness about the role of anesthesiologist in operation theater intensive care unit labor analg esia acute and chronic pain management and emergency care areas and

  11. Quality control programme established in the Nuclear Medicine Department of the Vancouver Coastal Health Authority Hospitals

    The Vancouver Coastal Health Authority (VCH) covers a large area of Southern British Columbia that includes 14 hospitals. Five of them have Nuclear Medicine (NM) departments with a total of 18 cameras of different ages and produced by different manufacturers. A flawless operation of these cameras is of paramount importance for the accuracy of diagnostic studies. Consequently, a comprehensive quality control (QC) programme has been designed to detect changes in their performance that might degrade the accuracy of clinical images. The most extensive testing is done at acceptance of the new equipment, simpler tests continue regularly throughout the whole period of camera operation. The tests are based on the National Electrical Manufacturers Association (NEMA) recommendations on how to perform QC experiments and how to analyse the results. The QC programme in all five NM departments follows the same principles. It is supervised by a 'regional' physicist. Initially, however, problems were encountered. At first, analysis of the QC data coming from these different cameras was seriously hindered by the lack or rigidity of the proprietary manufacturers' software. In particular, it was very difficult, if not impossible, to reliably compare the performance of different systems. An additional problem was caused by the large distances between hospital departments which made regular consultations by the physicist and test supervision difficult. In this paper, we present a practical solution to these problems and discuss our particular implementation of a QC programme that covers 18 cameras and unites five busy NM departments. To address the first problem and make the analysis of test results reliable and camera independent, we have developed a software application 'Nuclear Medicine QC' (NMQC) which implements the basic scintillation camera QC analyses and follows exactly the most recent NEMA standard. Our software allows multiple types of QC tests to be analysed within a single

  12. Peripheral nerve blocks versus general anesthesia for total knee replacement in elderly patients on the postoperative quality of recovery

    Liu JL


    Full Text Available JunLe Liu,1,* WeiXiu Yuan,1,* XiaoLin Wang,1,* Colin F Royse,2,3 MaoWei Gong,1 Ying Zhao,1 Hong Zhang1 1Anesthesia and Operation Center, Chinese People's Liberation Army General Hospital and Medical School of Chinese People's Liberation Army, Beijing, People's Republic of China; 2Anesthesia and Pain Management Unit, Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia; 3Department of Anesthesia and Pain Management, The Royal Melbourne Hospital, Melbourne, Victoria, Australia *These authors contributed equally to this work Background: Both peripheral nerve blocks with sedation or general anesthesia can be used for total knee replacement surgery. Objectives: We compared these anesthetic techniques on the postoperative quality of recovery early in elderly patients. Materials and methods: In our study, 213 patients who were ≥65 years old and undergoing total knee replacement were randomized to peripheral nerve blocks (PNBs – lumbar plexus and sciatic – with propofol sedation, or general anesthesia with combined propofol and remifentanil. Blocks were performed using nerve stimulation and 0.35% ropivacaine. All patients received postoperative multimodal analgesia. Postoperative recovery was assessed at 15 minutes, 40 minutes, 1 day, 3 days, and 7 days after surgery, with the Postoperative Quality of Recovery Scale, in physiological, nociceptive, emotive, modified activities of daily living, modified cognitive, and overall patient perspective domains. Results: Intraoperative blood pressure and heart rate were more stable with PNBs (P<0.001. The recovery was better with PNBs in physiological (P<0.001, emotive (depression and anxiety (P<0.001, nociceptive (pain and nausea (P<0.001, modified cognitive (P<0.001, and all domains recovery (P<0.001, but not in activities of daily living (P=0.181. Intraoperative drugs and the postoperative sulfentanil requirement of the PNBs group were lower (all P<0.001. Differences were


    M.R. Afhami; P. Hassanzadeh Salmasi J. Rahimi Panahea


    There are many factors contributing to success of regional anesthesia. Patients’ attitude toward spinal anesthesia is one of the most important of these factors. This is a descriptive study performed on 100 healthy parturient selected for elective cesarean section in Alzahra Obstetric Hospital,Tabriz, Iran. The aim of this study was to evaluate patients’ attitude and their knowledge about spinal anesthesia. Patients were selected randomly. Data collection was performed using a questionnaire. ...

  14. General anesthesia plus ilioinguinal nerve block versus spinal anesthesia for ambulatory inguinal herniorrhapy

    Lucía Vizcaíno-Martínez


    Full Text Available Objective: The aim was to evaluate general anesthesia (GA plus ilioinguinal nerve block (IIB versus spinal anesthesia (SA in patients scheduled for ambulatory inguinal hernia repair regarding pain management, anesthesia recovery and reducing potential complications. Materials and Methods: A double-blind, prospective, randomized, controlled study in patients American Society of Anesthesiologists I-III randomized into two groups: GA plus IIB group, induction of anesthesia with propofol, maintenance with sevoflurane, airway management with laryngeal mask allowing spontaneous ventilation and ultrasound-guided IIB; SA group, patients who underwent spinal block with 2% mepivacaine. The study variables were pain intensity, assessed by visual analog scale, analgesic requirements until hospital discharge, time to ambulation and discharge, postoperative complications-related to both techniques and satisfaction experienced. Results: Thirty-two patients were enrolled; 16 patients in each group. The differences regarding pain were statistically significant at 2 h of admission (P < 0.001 and at discharge (P < 0.001 in favor of the GA plus ilioinguinal block group. In addition in this group, analgesic requirements were lower than SA group (P < 0.001, with times of ambulation and discharge significantly shorter. The SA group had a higher tendency to develop complications and less satisfaction. Conclusion: General anesthesia plus IIB is better than SA regarding postoperative analgesia, time to mobilization and discharge, side-effect profile and satisfaction experienced by the patients.

  15. Update on complications in pediatric anesthesia

    Giovanni de Francisci


    Full Text Available Complications in pediatric anesthesia can happen, even in our modern hospitals with the most advanced equipment and skilled anesthesiologists. It is important, albeit in a tranquil and reassuring way, to inform parents of the possibility of complications and, in general, of the anesthetic risks. This is especially imperative when speaking to the parents of children who will be operated on for minor procedures: in our experience, they tend to think that the anesthesia will be a light anesthesia without risks. Often the surgeons tell them that the operation is very simple without stressing the fact that it will be done under general anesthesia which is identical to the one we give for major operations. Different is the scenario for the parents of children who are affected by malignant neoplasms: in these cases they already know that the illness is serious. They have this tremendous burden and we choose not to add another one by discussing anesthetic risks, so we usually go along with the examination of the child without bringing up the possibility of complications, unless there is some specific problem such as a mediastinal mass.

  16. Anesthesia for radiologic procedures

    Anesthetic techniques for neurodiagnostic studies and radiation therapy have been recently reviewed, but anesthetic involvement in thoracic and abdominal radiology has received little attention. Patient reactions to radiologic contrast media may be of concern to the anesthesiologist, who is often responsible for injecting these agents during diagnostic procedures, and thus is included in this discussion. Finally, the difficulties of administering anesthesia for magnetic resonance imaging (MRI) scans are outlined, in an effort to help anesthesiologist to anticipate problems with this new technologic development. Although there are very few indications for the use of general anesthesia for diagnostic radiologic studies in adults, most procedures performed with children, the mentally retarded, or the combative adult require either heavy sedation or general anesthesia. In selecting an anesthetic technique for a specific procedure, both the patient's disease process and the requirements of the radiologist must be carefully balanced

  17. 喉罩联合无肌松全麻在小儿眼科手术中的应用%The application of LMA combined with general anesthesia without muscle relaxants in the pediatric department of ophthalmology operation

    贺伟忠; 杨义; 范小丽; 李萌


    目的:研究无肌松全麻联合喉罩置入对小儿眼科手术围术期应激反应的影响。方法选择全身麻醉下小儿眼科手术患者90例,随机分为A、B两组,每组各45例。 A组使用肌松药插入气管导管,B组采用无肌松药全麻并置入喉罩。对比手术中各时间点的平均动脉压(MAP)、心率(P)、心率收缩压乘积(RPP)、血氧饱和度(SpO2)。观察两组拔管期呛咳、躁动等拔管反应,并记录拔管(喉罩)时间、麻醉药总量。结果A组麻醉诱导及拔管期血流动力学波动高于B组;A组严重呛咳、躁动例数高于B组;A组拔管时间长于B组;A组麻醉药物总量多于B组。结论喉罩联合无肌松全麻应用于小儿眼科手术安全可靠,相较气管插管围术期应激反应更低。%Objective To study without muscle relaxants combined general effect of laryngeal mask insertion on the pe-diatric department of ophthalmology operation perioperative stress responses. Methods Ninety patients with pediatric eye surgery were randomly divided into group A and group B, 45 cases in each group. Group A treated with muscle re-laxants insert the tracheal tube, group B treated with without anesthesia and muscle relaxants into the LMA. Contrast surgery mean arterial pressure at each time point (MAP), heart rate (P), rate pressure product (RPP), oxygen saturation (SpO2). Extubation were observed choking, restlessness, etc. extubation reaction, record extubation (LMA) time, total quantity of using drug. Results A induction of anesthesia and extubation hemodynamic fluctuations was higher than that of group B; Severe cough, agitation of group A were higher than that in B group; The extubation time was longer than that of group B; Drug amount was higher than that of group B. Conclusion LMA Joint no muscle relaxant used in pe-diatric anesthesia eye surgery is safe and reliable, with lower stress response.

  18. Anesthesia for interventional radiology

    We recognized that the complexity and surgical nature of many interventional radiology procedures dictate essential radiologic involvement into traditional anesthesiologic areas. They reviewed our experience with a variety of interventional procedures to document complications and problems related to anesthetic use (or misuse) and compile recommendations for rational monitoring and control for these procedures. In particular, the authors have studied complications of drug therapies and the treatment of these complications; use of complex anesthesia procedures (e.g., epidural anesthesia, succinylcholine blockage); reasons for choice of drugs (e.g., fentanyl vs meperidine vs morphine); and medico-legal aspects of radiologist performing traditional anesthesiology-type procedures

  19. Evaluation of preventable trauma death in emergency department of Imam Reza hospital

    Gholipour, Changiz; Rad, Bahram Samadi; Vahdati, Samad Shams; Ghaffarzad, Amir; Masoud, Armita


    BACKGROUND: Trauma is considered as a worldwide problem despite socio-economic development. Motor vehicle accidents (MVAs) are the most important cause of trauma. Trauma related deaths are mostly preventable. This study aimed to investigate the causes and prevention of death in trauma patients. METHODS: This retrospective, descriptive-analytic study assessed 100 trauma patients referred to our emergency department (ED) from January 2013 to Januanry 2015. The included patients were those with trauma died after arrival at our ED. Age, sex, cause of trauma, clinical causes of death, causes of death defined by autopsy, way of transfer to the ED, time of ambulance arrival at the scene of trauma, and time elapsed to enter the ED from the scene of trauma were studied. RESULTS: In the 100 patients, 21 (21%) patients were female and 79 (79%) male. Forty-three patients were older than 60 years. Trauma was largely due to pedestrian accidents in 31% of the patients, and 33% had a hypo-volemic shock. About 80% of deaths were due to intra-cranial hemorrhage (ICH) or intra-ventricular hemorrhage (IVH), and spinal injuries were not preventable. Autopsy revealed that 28% of the patients suffered from internal injuries. Autopsy revealed that 19% of the deaths were not preventable and 81% were considered preventable. In our patients, 76 were transferred to the hospital by emergency medicine services (EMS). Analysis of time for ambulance arrival to the scene and frequency of death revealed that 52.2% of the deaths occurred between 11 and 15 minutes. Analysis of time for admission to the ED from the scene of trauma showed that 74.6% deaths occurred between 6 and 10 minutes. CONCLUSIONS: The rate of hospital preventable deaths is about 80%, a high mortality rate, which denotes a lack of proper diagnosis and treatment. The time for arrival of EMS at the scene of trauma is longer than that in other countries. PMID:27313809

  20. Epidemiology of Suicide and Associated Socio-Demographic Factors in Emergency Department Patients in 7 General Hospitals in Northwestern China

    Zhao, Cheng-jin; Dang, Xing-bo; Su, Xiao-Li; Bai, Jia; Ma, Long-yang


    Background This study aimed to illustrate the characteristics of suicide attempters treated in the Emergency Departments of 7 general hospitals in Xi’an and to provide relevant data for early psychological treatment. Material/Methods Between October 2010 and September 2014, 155 suicide attempters were treated in the Emergency Departments. Data were collected using a semi-structured questionnaire. Descriptive statistics, chi-square tests, and multivariate analyses were used to identify the fac...

  1. Physician Assistant and Advance Practice Nurse Care in Hospital Outpatient Departments: United States, 2008-2009

    ... Index, Updated July 15, 2006" and "Hospital Market Profiling Solution, Second Quarter, 2006." The OPD visit response ... by year, hospital size, and location. About the authors Esther Hing and Sayeedha Uddin are with CDC's ...

  2. 76 FR 15349 - Fiscal Year 2011 Cost of Hospital and Medical Care Treatment Furnished by the Department of...


    ... From the Federal Register Online via the Government Publishing Office OFFICE OF MANAGEMENT AND BUDGET Fiscal Year 2011 Cost of Hospital and Medical Care Treatment Furnished by the Department of... this notice in the Federal Register and will remain in effect until further notice. Pharmacy rates...

  3. 78 FR 21631 - Fiscal Year 2013 Cost of Hospital and Medical Care Treatment Furnished by the Department of...


    ... From the Federal Register Online via the Government Publishing Office OFFICE OF MANAGEMENT AND BUDGET Fiscal Year 2013 Cost of Hospital and Medical Care Treatment Furnished by the Department of... surgery rates remain in effect until further notice. Pharmacy rates are updated periodically. A...

  4. Determining the rate of follow-up after hospital emergency department visits for dental conditions

    Meyer, Beau; Adkins, Eric; Finnerty, Nathan M; Robinson, Fonda G


    Background Emergency department (ED) visits for dental reasons continue to impact EDs nationwide. This investigation determined the rate of follow-up in an emergency dental clinic (EDC) after hospital ED visits for nontraumatic dental conditions. Methods This prospective investigation reports the number of patients who presented to an ED for nontraumatic dental conditions and the rate of follow-up at an EDC. Upon ED discharge, patients were provided instructions to follow-up for low-cost care at the EDC. Telephone contact was attempted following failed referrals. Descriptive statistics were reported for comparing referral sources and demographic trends. Results Two hundred and forty-seven referrals were made and 31% followed up for definitive treatment at the EDC. More referrals were made on weekends than on weekdays. Failed referrals were unreachable by telephone in 75% of cases. Tooth extraction was the most common treatment rendered in the EDC. Of the ED patients who accessed EDC care, 14% became comprehensive patients in the EDC’s regular dental clinic. Conclusion Less than one-third of ED referrals to the EDC followed up for definitive care when provided an opportunity to do so, and 75% of referrals were unreachable by telephone in the week following the ED dental visit. PMID:27099530

  5. Study of the New Patients of Acupuncture and Moxibustion Department in Dongeui Oriental Medical Hospital

    Su-Min Kim


    Full Text Available Purpose : In order to profits to investigator who want to know acupuncture and moxbustion treatments are available to what symptoms today and how goes on the clinical lecture for oriental medical students, this research was carried out. Methods : The following conclusion were derived from 745 of patients who treated in acupunture & moxibustion department of Dongeui Oriental Medical hospital from the July in 2006 till January in 2007. Results : 1. There were 203(27.25% persons of Lumbago, 101(13.56% persons of Bell's palsy, 94(12.62% persons of Omalgia, 80(10.74% persons of paralysis of limb, 74(9.94% persons of disordinary sense of limb and etc. 2. There were 395 females(53.02% and 350 males(46.98%. 3. The patients over 60th were 26.72%, the 50th were 23.08%, the 40th were 22.14%, the 30th were 15.44%, 20th were 8.45%. So the older the more patients. Conclusion : In accordance with the above results, acupuncture & moxibustion teatments are good to use degenerative musculoskeletal disease, pain, paralysis and etc.

  6. Fertility status of males working in radiology departments of teaching hospitals

    All the 33 male doctors and para-medical staff employed in the radiology departments of two teaching hospitals have been studied for their fertility status. Their mean age was 32.5 years and they had been doing radiological work for 8.6 years on an average. Out of the 33 males, all of whom were married, one had primary infertility with severe oligospermia. He was successfully treated with oral vitamin A and E along with a 3-month off from handling x-ray machines; the child born was healthy and normal. Another 5 subjects had been married for only less than two years and their seminograms were essentially normal. They were classified as 'Unproven fertility'. The remaining 27 persons had fathered 61 children-16 born before the father had started working in radiology and 45 conceived later. There was 1 case of still-birth and 1 of microcephaly. However, the overall incidence of infertility and congenital defects was not significantly different than in the general population. (author)

  7. An evaluation of hospital emergency department (HED) adherence to universal precautions.

    Rydman, R J; Tannebaum, R D; Zalenski, R J


    A longitudinal cross sectional study of Hospital Emergency Department (HED) procedures over a nine month period was conducted. A total of 1,541 procedures were observed on 56 randomly selected 8-h work shifts. Shifts were distributed: 34% day shift; 34% evening shift; and 32% on the night shift. Observations on the evening shift were oversampled to capture an adequate number of trauma patients. Observations were distributed: 33% day shift; 39% evening shift; and 28% on the night shift. Measurements included: type of procedure; adherence to specific barrier technique, i.e., use of gloves, gowns, masks, and eye protection; and occurrence of adverse exposure. Ten types of HED procedures were documented and analyzed. Computerized tracking of study observations established periodic rates of HED health care worker (HCW) adherence to universal precautions. These data are important for internal quality control/assurance programs and rate comparisons within and across institutions over time. The longitudinal evaluation of the database revealed that glove compliance increased over the period of the study and adverse exposure decreased. Conducting ongoing or periodic observational studies of this kind are important and necessary in order to gauge HED response to the epidemiologic challenges of urban society. PMID:7829982

  8. Monitoring of patients in the Oncology department of the Clinical Hospital

    An important number of patients that visit the Oncology department o the Clinicas Hospital lost sight at some stage of their evolution. Our objective was to quantify the proportion of patients who are lost and describe the time spent in the service and its relationship with variables such as age, sex, origin of the patient and progress of the disease, for which we performed a descriptive observational study with an analytical component of 435 stories clinics patients with confirmed diagnosis of cancer, treated from January 2001 to December 2004, in order to have a minimum of 5 years of follow-up potential. Data were processed with Excel 2003. Patients had between 15-85 years old with a mean and median of 52 ± 14 years DS. Two hundred Seventy women and 165 were men, 232 were from the metropolitan area. The time of length of service was 0-114 months with a median of 8 and an average DS 21 months ± 27 months. As of December 2009 31 117 patients had died 36 remained in control and 282 were lost from sight. We found no relationship between age (p = 0.1) nor the state of progress of the disease at diagnosis (p = 0.21) If there were significant differences with greater probability of loss tracking men (p = 0.009) and from sites outside the metropolitan area (p = 0.04). The number of patients who are lost is very large and we must develop strategies more effective monitoring

  9. Radiological zoning of a nuclear medicine department: Example of the military hospital Sainte-Anne

    According to the ministerial order of May 15, 2006 (transposition of the EURATOM directive 96/29 from May 13, 1996), each person in charge of a medical institution is compelled to classify the working areas dealing with sources of ionizing radiation. The approach to the delineation of radiological areas should appear in an internal document combining the analysis of heath risks. Without waiting for the publication of the official guidelines as announced in the notice DGT/ASN no. 1 of January 18, 2008 and in accordance with the above mentioned order, we have already formalized the different steps towards a zoning in the new nuclear medicine department in the Military Hospital Ste Anne of Toulon by using a detailed methodology to measure exposition and contamination levels. The methodology is largely based on measurements and consideration of normal envelopes. Analysis of integrated doses over an hour in a room can ultimately determine radiological areas. We apply the new recommended values to define the different classified zones according to their specificity and discuss this new way of assessment of exposure risks as well as the consequences on the different staff categories concerned. (authors)

  10. Film reject analysis and image quality in diagnostic Radiology Department of a Teaching hospital in Ghana

    J. Owusu-Banahene


    Full Text Available Patients usually undergo repeated X-ray examinations after their initial X-ray radiographs are rejected due to poor image quality. This subjects the patients to an excess radiation exposure and extra cost and necessitates the need to investigate the causes of reject. The use of reject analysis as part of the overall quality assurance programs in clinical radiography and radiology services is vital in the evaluation of image quality of a well-established practice. It is shown that, in spite of good quality control maintained by the Radiology Department of a Teaching hospital in Ghana, reject analysis performed on a number of radiographic films developed indicated 14.1% reject rate against 85.9% accepted films. The highest reject rate was 57.1 ± 0.7% which occurs in cervical spine and the lowest was7.7 ± 0.5% for lumbar spine. The major factors contributing to film rejection were found to be over exposure and patient positioning in cervical spine examinations. The most frequent examination was chest X-ray which accounts for about 42.2% of the total examinations. The results show low reject rates by considering the factors for radiographic rejection analysis in relation to both equipment functionality and film development in the facility.

  11. Clinical pharmacist evaluation of medication inappropriateness in the emergency department of a teaching hospital in Malta

    West LM


    Full Text Available Appropriate prescribing remains an important priority in all medical areas of practice. Objective: The objective of this study was to apply a Medication Appropriateness Index (MAI to identify issues of inappropriate prescribing amongst patients admitted from the Emergency Department (ED.Method: This study was carried out at Malta’s general hospital on 125 patients following a two-week pilot period on 10 patients. Patients aged 18 years and over and on medication therapy were included. Medication treatment for inappropriateness was assessed by using the MAI. Under-prescribing was also screened for. Results: Treatment charts of 125 patients, including 697 medications, were assessed using a MAI. Overall, 115 (92% patients had one or more medications with one or more MAI criteria rated as inappropriate, giving a total of 384 (55.1% medications prescribed inappropriately. The mean SD MAI score per drug was 1.78 (SD=2.19. The most common medication classes with appropriateness problems were supplements (20.1%, antibiotics (20.0% and steroids (19.8%. The most common problems involved incorrect directions (26% and incorrect dosages (18.5%. There were 36 omitted medications with untreated indications. Conclusion: There is considerable inappropriate prescribing which could have significant negative effects regarding patient care.

  12. 科主任的能力培养探讨%Study on Ability Improvement of Department Director in Hospital



    Hospital management was based on the department management. The competenees of department director influ-enced the branch directly, even overall hospital construction. Therefore, it was very important to enhance department director's competence. The department directors in hospital should firmly grasp the direction of academic subject. It was described in detail as following: strategizing the academic subject development plans for a long-term, training talented people for department, culti-vating a sense of competition, and having ability of acquisition of information, foreign languages and technological innovation.%科室是医院组织管理的基础,科主任的能力直接影响医院的建设.提高科主任的能力水平对医院的发展至关重要.科主任应具备长远目光、培养人才的意识及竞争意识和良好的心态,同时具备信息获取、技术创新等能力,从而把握学科发展方向,推动科室与医院的可持续发展.

  13. Effect of general anesthesia and major versus minor surgery on late postoperative episodic and constant hypoxemia

    Rosenberg, J; Oturai, P; Erichsen, C J; Pedersen, M H; Kehlet, H


    STUDY OBJECTIVE: To evaluate the relative contribution of general anesthesia alone and in combination with the surgical procedure to the pathogenesis of late postoperative hypoxemia. DESIGN: Open, controlled study. SETTING: University hospital. PATIENTS: 60 patients undergoing major abdominal...... the second postoperative night following middle ear surgery and general anesthesia, but severe episodic and constant hypoxemia did occur on the second postoperative after major abdominal surgery and general anesthesia. CONCLUSIONS: General anesthesia in itself is not an important factor in the...... development of late postoperative constant and episodic hypoxemia, which instead may be related to the magnitude of trauma and/or opioid administration....

  14. Consultations by Asylum Seekers: Recent Trends in the Emergency Department of a Swiss University Hospital

    Srivastava, David; Exadaktylos, Aristomenis K.


    Background Large-scale war-related migration to Switzerland and other European countries is currently challenging European health systems. Little is known about recent patterns and trends in Emergency Department (ED) consultations by Asylum Seekers (AS). Methods A retrospective single-centre analysis was performed of the data from all adult patients with the official status of “Asylum Seeker” or “Refugee” who consulted the ED of Bern University Hospital, Switzerland, between June 2012 and June 2015. Patient characteristics and clinical information, such as triage category, type of referral and discharge, violence-related injury and diagnostic group on discharge, were extracted from the computerised database or determined from the medical reports. Changes in categorical variables between the three studied years were described. Results A total of 1,653 eligible adult patients were identified in the 3-year period. Between the first (06/12–06/13) and third periods (06/14–06/15), the number of presentations per year increased by about 45%. The AS came from 62 different nations, the most common countries being Eritrea (13%), Somalia (13%) and Syria (11%). The mean age was 33.3 years (SD 12.3) and two thirds (65.7%) were male. The proportion of women increased over time. Moreover the relative proportions shifted from patients between 20 and 50 years to patients of under 20 or over 60 years. Nearly two thirds of the patients were walk-in emergencies and this proportion increased over time. The mean triage score was 2.9 (SD 0.7), with more than 90% presenting as “urgent consultation”. About half of the patients were treated for trauma (17.2%), infections (16.8%) or psychiatric problems (14.2%). Trauma was seen in a higher proportion of male than female patients. About 25% of the patients were admitted for in-hospital treatment. Conclusions The recent rise in AS in the population has lead to an increase in AS presenting to EDs. This changes the composition of

  15. The role of leader behaviors in hospital-based emergency departments' unit performance and employee work satisfaction.

    Lin, Blossom Yen-Ju; Hsu, Chung-Ping C; Juan, Chi-Wen; Lin, Cheng-Chieh; Lin, Hung-Jung; Chen, Jih-Chang


    The role of the leader of a medical unit has evolved over time to expand from simply a medical role to a more managerial one. This study aimed to explore how the behavior of a hospital-based emergency department's (ED's) leader might be related to ED unit performance and ED employees' work satisfaction. One hundred and twelve hospital-based EDs in Taiwan were studied: 10 in medical centers, 32 in regional hospitals, and 70 in district hospitals. Three instruments were designed to assess leader behaviors, unit performance and employee satisfaction in these hospital-based EDs. A mail survey revealed that task-oriented leader behavior was positively related to ED unit performance. Both task- and employee-oriented leader behaviors were found to be positively related to ED nurses' work satisfaction. However, leader behaviors were not shown to be related to ED physicians' work satisfaction at a statistically significant level. Some ED organizational characteristics, however, namely departmentalization and hospital accreditation level, were found to be related to ED physicians' work satisfaction. PMID:21159414

  16. The Attitudes of Undergraduate Tourism and Hospitality Students Towards the Food and Beverage Department in the Hospitality Industry

    ÖZDEMİR, Bahattin; Aktaş, Aylin; Volkan ALTINTAŞ


    This paper is aimed to measure the attitudes of the undergraduate students at Akdeniz University School of Tourism and Hotel Management towards food and beverage departments in hotels. A literature review that consists of studies focusing on the meas¬urement of attitudes towards tourism industry, of people who either study tourism or completed their tourism education, has been conducted. A questionnaire that has been developed through the literature review was used as a survey instrument that...

  17. Validity of the International Classification of Diseases 10th revision code for hyperkalaemia in elderly patients at presentation to an emergency department and at hospital admission

    Fleet, Jamie L; Shariff, Salimah Z; Gandhi, Sonja; Matthew A Weir; Jain, Arsh K; Garg, Amit X.


    Objectives Evaluate the validity of the International Classification of Diseases, 10th revision (ICD-10) code for hyperkalaemia (E87.5) in two settings: at presentation to an emergency department and at hospital admission. Design Population-based validation study. Setting 12 hospitals in Southwestern Ontario, Canada, from 2003 to 2010. Participants Elderly patients with serum potassium values at presentation to an emergency department (n=64 579) and at hospital admission (n=64 497). Primary o...

  18. Acupuncture in ambulatory anesthesia: a review

    Norheim AJ; Liodden I; Alræk T


    Arne Johan Norheim,1 Ingrid Liodden,1 Terje Alræk1,2 1National Research Center in Complementary and Alternative Medicine (NAFKAM), Department of Community Medicine, Faculty of Health Sciences, University of Tromsø – The Arctic University of Norway, Tromsø, 2The Norwegian School of Health Sciences, Institute of Acupuncture, Kristiania University College, Oslo, NorwayBackground: Post-anesthetic morbidities remain challenging in our daily practice of anesthesia. Meta-an...

  19. Comparative outcomes of peripheral nerve blocks versus general anesthesia for hip fractures in geriatric Chinese patients

    Liu JL


    Full Text Available Jun Le Liu,1,* Xiao Lin Wang,1,* Mao Wei Gong,1,* Hai Xing Mai,2 Shu Jun Pei,1 Wei Xiu Yuan,1 Hong Zhang11Anesthesia and Operation Center, Chinese People’s Liberation Army General Hospital and Medical School of Chinese People’s Liberation Army, Beijing, People’s Republic of China; 2Department of Urology, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, People’s Republic of China*These authors contributed equally to this workBackground: Geriatric patients undergoing hemiarthroplasty for hip fractures have unacceptably high rates of postoperative complications and mortality. Whether anesthesia type can affect the outcomes has still been inconclusive.Objectives: We compared general anesthesia (GA and peripheral nerve blocks (PNBs on postoperative complications and mortality in elderly patients with femoral neck fractures (FNF undergoing hemiarthroplasty.Materials and methods: This retrospective study involved data collection from an electronic database. Two hundred and seventeen patients underwent hemiarthroplasty for FNF between January 2008 and December 2012 at the Chinese People’s Liberation Army General Hospital. Data on mortality within in-hospital, 30-day, and 1-year, complications, comorbidities, blood loss and transfusion, operative time, postoperative hospital length of stay, intensive care unit admission, and hospital charge were collected and analyzed. Univariate and multivariate Cox regression analyses of all variables were used for 30-day and 1-year mortality.Results: Seventy-two patients receiving GA and 145 receiving PNBs were eventually submitted and analyzed. Mortality was 6.9%, 14.7%, and 23.5% at in-hospital, 30-day, and 1-year, respectively postoperatively, while mortality and cardiovascular complications did not differ between the two anesthetic techniques. Preoperative comorbidities and intraoperative parameters were not statistically different except that patients receiving GA were more likely

  20. Benefit or burden? A sociotechnical analysis of diagnostic computer kiosks in four California hospital emergency departments.

    Ackerman, Sara L; Tebb, Kathleen; Stein, John C; Frazee, Bradley W; Hendey, Gregory W; Schmidt, Laura A; Gonzales, Ralph


    High expectations for new technologies coexist with wide variability in the actual adoption and impact of information technology (IT) projects in clinical settings, and the frequent failure to incorporate otherwise "successful" projects into routine practice. This paper draws on actor-network theory to present an in-depth, sociotechnical analysis of one such project--a computer kiosk designed to diagnose and expedite treatment of urinary tract infections (UTI) in adult women. Research at a hospital urgent care clinic demonstrated the kiosk program's effectiveness at diagnosing UTI and reducing patient wait times, and the kiosk was subsequently adopted by the clinic for routine patient care. However, a study promoting the adoption of the device at emergency departments (ED) was characterized by persistent staff resistance and lower-than-expected patient eligibility for kiosk-assisted care. The device was ultimately abandoned at all but one of the new sites. Observations and interviews with ED staff and the design/research team were conducted at four California EDs between April and July 2011 and point to conflicting understandings of evidence for the device's usefulness and reasons for its (non)adoption. The kiosk program's designers had attempted to "rationalize" medical work by embedding a formal representation of triage practices in the kiosk's software. However, the kiosk's "network" failed to stabilize as it encountered different patient populations, institutional politics, and the complex, pragmatic aspects of ED work at each site. The results of this evaluation challenge the persistent myth that a priori qualities and meanings inhere in technology regardless of context. The design and deployment of new IT projects in complex medical settings would benefit from empirically informed understandings of, and responses to, the contingent properties of human-technology relations. PMID:23063214


    Pooja Prajwal


    Full Text Available The objective of the study is to assess the average number of drugs per prescription, formulations being prescribed, various categories of drugs being prescribed and the category most often used in ophthalmology. This is a retrospective hospital based study carried out in the department of ophthalmology at A.J institute of medical sciences, Mangalore, India. The study period was from July 2012 to July 2013. Total number of prescriptions analyzed were 3543, in which total of 15,324 drugs were prescribed. Analysis of the prescriptions showed that average number of drugs per prescription was 4.325. The maximum number of drugs prescribed were in the form of eye drops (67.65 %, followed by ointments (11.66 %, tablet (7.8 %, capsules (7.23 %, syrup (3.54 % and injection (2.12 %. The dosage form was indicated for 91 %, frequency of drug administration for 97 % drugs and duration of treatment for only 69 % of the drugs prescribed. Around 56.44 % of diagnosis accounted for senile immature cataract. Rest 15.33 % and 9.81 % acconting for pseudophakia and senile mature cataract respectively. The number of antibiotics prescribed was 8,955 (58.43 %, out of these 5,981 (66.79 % antibiotics were prescribed in the form of drops, 2,782 (31.06 % as ointment and 191 (2.13 % orally. Number of encounters with anti-inflammatory and anti allergic drugs was 1,547 (10.1 %, mydriatics and cycloplegics 1,317 (8.6 %, miotics 474 (3.1 %, lubricant and miscellaneous eye drops 2,869 (18.72 % and multivitamins 161 (1.05 %. Prescription writing errors were at its minimum thereby avoiding irrational prescriptions. Duration of treatment and prescribing by generic name were very low.

  2. Cough Variant Asthma in Medical Outpatient Department of a Tertiary Care Hospital in Bangladesh

    Rukhsana Parvin


    Full Text Available Background: Cough variant asthma (CVA is a subset of asthma where the only symptom is chronic persistent cough. Many cases go unrecognized due to lack of proper evaluation. Response to asthma medication with features supportive of airway hypersensitivity helps in management of this disease. Objective: To find out the proportion of cough variant asthma among the patients attending medicine outpatient department of Enam Medical College, Savar, Dhaka. Materials and Methods: This cross sectional study was conducted in Enam Medical College Hospital, Savar, Dhaka over a period of two years from July 2009 to July 2011. Cough variant asthma was diagnosed mainly on clinical ground as chronic cough without wheezing, fever, weight loss, shortness of breath or sputum or any other apparent cause that persisted for more than eight weeks with absolutely normal physical examination of chest, normal chest radiography and blood count except raised eosinophil count and IgE level. Patients who met these criteria were given 2 weeks course of inhaler beclomethasone propionate and were assessed for improvement. Those who improved after steroid inhalation were categorised as having cough variant asthma. Results: Out of purposively selected 148 patients complaining only of chronic dry cough for more than eight weeks, 92 patients met the primary selection criteria for cough variant asthma. These 92 patients were given 2 weeks trial of 250 ìgm beclomethasone inhalation twice daily. Seventy nine patients reported almost complete recovery from chronic cough after 2 weeks and were categorized as having CVA. Thirteen patients did not improve and were not categorized as CVA. Conclusion: These findings suggest that cough variant asthma is the most common among the patients with chronic cough not due to any apparent cause. The efficacy of inhaled corticosteroid suggests that early intervention is effective in the treatment of this disease.

  3. Designing and evaluating a balanced scorecard for a health information management department in a Canadian urban non-teaching hospital.

    Nippak, Pria Md; Veracion, Julius Isidro; Muia, Maria; Ikeda-Douglas, Candace J; Isaac, Winston W


    This report is a description of a balanced scorecard design and evaluation process conducted for the health information management department at an urban non-teaching hospital in Canada. The creation of the health information management balanced scorecard involved planning, development, implementation, and evaluation of the indicators within the balanced scorecard by the health information management department and required 6 months to complete. Following the evaluation, the majority of members of the health information management department agreed that the balanced scorecard is a useful tool in reporting key performance indicators. These findings support the success of the balanced scorecard development within this setting and will help the department to better align with the hospital's corporate strategy that is linked to the provision of efficient management through the evaluation of key performance indicators. Thus, it appears that the planning and selection process used to determine the key indicators within the study can aid in the development of a balanced scorecard for a health information management department. In addition, it is important to include the health information management department staff in all stages of the balanced scorecard development, implementation, and evaluation phases. PMID:24948412

  4. Anesthesia and cor triatriatum

    Federica Scavonetto; Tze Yeng Yeoh; Tasha L Welch; Weingarten, Toby N.; Juraj Sprung


    Aims and Objectives: Cor triatriatum sinistrum (CTS) and cor triatriatum dextrum (CTD) are rare congenital anomalies characterized by the presence of a perforated septum which divides the respective atrium into a proximal and distal chamber. This report reviews the perioperative course of patients with uncorrected cor triatriatum (CT) undergoing procedures requiring anesthesia. In addition, we performed a literature search that examines the experience of others regarding the peri-operative co...

  5. Awareness in cardiac anesthesia.

    Serfontein, Leon


    Cardiac surgery represents a sub-group of patients at significantly increased risk of intraoperative awareness. Relatively few recent publications have targeted the topic of awareness in this group. The aim of this review is to identify areas of awareness research that may equally be extrapolated to cardiac anesthesia in the attempt to increase understanding of the nature and significance of this scenario and how to reduce it.

  6. Incidence and prevalence of hospital-acquired infections in a cohort of patients admitted to medical departments

    Petersen, Martin Haubro; Holm, Morten Olskjær; Pedersen, Svend Stenvang;


    INTRODUCTION: Hospital-acquired infections (HAI) are a significant cause of morbidity and mortality. Only point prevalence analyses of HAI have been recorded in Denmark. The aim of this study was to investigate the incidence and prevalence of HAI in patients admitted to departments of internal.......7-10.6). Exposure to bladder catheter was associated with an increased risk of urinary tract infection, incidence rate ratio 4.9; (95% CI 1.8-11.5). For the initial 14 days of hospitalization, the incidence of HAI was independent, while the prevalence increased linearly with duration of admittance. CONCLUSION: The...... incidence of HAI was relatively constant during the initial 14-day-period of hospitalization, suggesting that shortening the period will have no major impact on the incidence of HAI. The prevalence was 9.7%, which is in line with results from prior studies....

  7. Intracameral anesthesia for cataract surgery: a population-based study on patient satisfaction and outcome

    Westborg I


    Full Text Available Inger Westborg,1,2 Eva Mönestam1 1Department of Clinical Sciences/Ophthalmology, Umeå University, Umeå, Sweden; 2Eye Clinic, Sunderby Hospital, Luleå, Sweden Purpose: To evaluate if the standard anesthetic regimen – topical combined with intracameral anesthesia without sedation – in a population-based cohort of unselected cataract surgery cases is adequate, optimal, and good practice, or if improvements are necessary. Methods: We conducted a prospective, observational study on all cases of cataract surgery during a 1-year period at one institution (n=1249. Data were collected from the patients’ records. Outcome measures were use of preoperative sedation, type of anesthesia, complications, and adverse events. In a subgroup of patients (n=124 satisfaction with the anesthetic regimen was evaluated using a short questionnaire. Results: Most cases (90%, 1125/1249 had combined topical and intracameral anesthesia without sedation. Patients who chose preoperative sedation (midazolam hydrochloride sublingually were significantly younger and more often female (P=0.0001 and P=0.011, respectively. In the questionnaire subgroup, the median pain score after surgery was 0.7 (visual analog scale, 0–10. A pain score of 1.9 or less was reported by 76% of the patients. Patients reporting a pain score of 2 or more had sedation and additional anesthetics more often. No significant difference was found regarding age, sex, pulse rate, oxygen saturation, first or second eye surgery, or adverse intraoperative events for patients with pain scores of 1.9 or less and 2 or more. Conclusion: This large population-based series of small-incision phacoemulsification surgery shows that combined topical and intracameral anesthesia without sedatives is well tolerated for most phacoemulsification patients. It is also effective in cases when complications or adverse events occur. It is important to be responsive to the individual patient’s needs and adjust operating

  8. Hospitals; hospitals13

    University of Rhode Island Geospatial Extension Program — Hospital Facilities information was compiled from several various sources. Main source was the RI Department of Health Facilities Regulation database, License 2000....

  9. The one-stop clinic as the standard of out-patient care in a hospital urology department

    Alvaro Páez; Enrique Redondo; Javier Sáenz; Mercedes Marín; Nuria Juárez; Manuel Durán


    PURPOSE: To evaluate the performance of a 'one-stop' clinic in terms of proportion of discharges or inclusion in surgical waiting lists. MATERIALS AND METHODS: All patients were referred from primary care facilities (population 220.646) and from different departments in the hospital. Eight senior urologists, two registered nurses and two nurse attendants participated in the experience. Prior to the start of the project, referral protocols had been agreed with the primary care physicians invol...

  10. Evaluating the Quality of Multiple Trauma Patient Records in the Emergency Department of Imam Khomeini Hospital in Urmia

    Gholamreza Faridaalaee; Behzad Boushehri; Neda Mohammadi; Omid Safari


    Introduction: Medical profile is an important source of data regarding the patient, the illness, the doctor’s performance and leads to adequate diagnosis and treatment. Filling out medical profiles correctly, greatly decreases medical errors and leads to accurate diagnosis and proper treatment of the patients. This study aims to evaluate the quality of the patient records of trauma patients admitted to the emergency department of Emam Khomeini Hospital, Urmia, Iran. Methods: In a cross-sectio...

  11. A study conducted on the demographic factors of victims of violence in support and administrative departments of hospital in 2013

    Keyvanara, Mahmoud; Maracy, Mohammad Reza; Ziari, Najmeh Bahman


    Background: Violence is now regarded as a serious problem and its complication causes heavy costs on the healthcare systems. The present study aimed to investigate the correlation between some demographic characteristics and confrontation with violence. Since there is no study on the prevalence of violence among the support and administration staff of hospitals in Iran, this study was conducted to investigate violence in these departments. Materials and Methods: This descriptive–analytical an...

  12. Parallel Quality Assessment of Emergency Departments by European Foundation for Quality Management Model and Iranian National Program for Hospital Evaluation

    Mohammad Hasan Imani Nasab; Bahram Mohaghegh; Nader Khalesi; Ebrahim Jaafaripooyan


    Background European Foundation for Quality Management (EFQM) model is a widely used quality management system (QMS) worldwide, including Iran. Current study aims to verify the quality assessment results of Iranian National Program for Hospital Evaluation (INPHE) based on those of EFQM. Methods: This cross-sectional study was conducted in 2012 on a sample of emergency departments (EDs) affiliated with Tehran University of Medical Sciences (TUMS), Iran. The standard questionnaire of EFQM (V-201...

  13. General practice based physiotherapy: its use and effect on referrals to hospital orthopaedics and rheumatology outpatient departments.

    O Cathain, A.; Froggett, M; Taylor, M. P.


    BACKGROUND. In November 1992, a pilot scheme was established in Doncaster to provide an on-site physiotherapy service in six non-fundholding general practices covering a population of approximately 44,000 people. AIM. The aim of the pilot scheme was to transfer a hospital-based physiotherapy service, to which general practitioners had direct access, to a primary care setting and to reduce referrals to an orthopaedics outpatient department. METHOD. Use of physiotherapy services and referrals t...

  14. Effect of Full Correction Versus Partial Correction of Elevated Blood Glucose in the Emergency Department on Hospital Length of Stay.

    Johnson-Clague, Michaela; DiLeo, Jessica; Katz, Michael D; Patanwala, Asad E


    There is limited information to guide the extent to which asymptomatic hyperglycemia needs to be corrected in patients presenting to the emergency department (ED) with unrelated complaints. The objective of this study was to compare full correction (FC) versus partial correction (PC) of elevated blood glucose in the ED on hospital length of stay. This was a retrospective cohort study conducted in an academic ED in the United States. Adult diabetic patients with hyperglycemia (blood glucose >200 mg/dL) in the ED who were treated with subcutaneous insulin were included. Patients were categorized based on the level of blood glucose control achieved within the first 24 hours from triage: (1) FC group for whom blood glucose hospital length of stay between groups. A total of 161 patients were included in this study (FC = 81, PC = 80). There was no significant difference between hospital length of stay in the FC [3 days (interquartile range, 1-5 days)] and PC [3 days (interquartile range, 2-6 days)] groups (P = 0.159). In the multivariate analysis, after adjusting for potential confounders, there was no significant association between level of correction and hospital length of stay (log-transformed) (coefficient 0.238; 95% confidence interval, -0.062 to 0.537; P = 0.119; R = 13%). The extent of glucose correction was not associated with a decrease in hospital length of stay in diabetic patients with hyperglycemia in the ED. PMID:25187094

  15. A study of occupational health and safety measures in the Laundry Department of a private tertiary care teaching hospital, Bengaluru

    M. Shashi Kumar


    Full Text Available Introduction: The Laundry Department plays an important role in preventing the spread of infection and continuously supplying clean linen to various departments in any hospital. Objectives of the Study: To identify existing practices and occupational safety and health (OSH measures in the Laundry Department and to assess the use of personal protective equipments (PPEs among health care workers. Materials and Methods: A cross-sectional study was carried out in a private tertiary care teaching hospital. An observation checklist was developed, which was partially based on occupational hazard checklist of OSHA for Laundry Department. This was field tested and validated for applicability for this study. Results: The potential biological hazards are infections through exposure to aerosols, spills and splashes during various activities, fungal infection due to wet clothes and environment and infections through fomites. The potential physical hazards are injuries due to slips and falls, exposure to heat, humidity, dust, noise, and vibration. The potential chemical hazards are contact dermatitis and allergic asthma due to exposure to detergents, phenyl solution, bleaching powder, and soap oil solution. The potential ergonomic hazards are musculoskeletal diseases and repetitive stress injuries at the shoulder, elbow, and small joints of the hands. PPEs were not used consistently in most areas of the department.

  16. Safe Anesthesia For Every Tot

    Weiss, Markus; Vutskits, Laszlo; Hansen, Tom G;


    PURPOSE OF REVIEW: The term 'safe use of anesthesia in children is ill-defined and requires definition of and focus on the 'safe conduct of pediatric anesthesia'. RECENT FINDINGS: The Safe Anesthesia For Every Tot initiative ( has been set up during the last year to focus on the...... improvement of teaching, training, education and supervision of the safe conduct of pediatric anesthesia are the main goals of the initiative. SUMMARY: This initiative addresses the well known perioperative risks in young children, perioperative causes for cerebral morbidity as well as gaps in...

  17. Hospitals, Published in 2004, 1:24000 (1in=2000ft) scale, Sawyer County Surveyors Department.

    NSGIC GIS Inventory (aka Ramona) — This Hospitals dataset, published at 1:24000 (1in=2000ft) scale, was produced all or in part from Field Observation information as of 2004. Data by this publisher...

  18. Anesthesia - what to ask your doctor - adult

    ... that I am having? General anesthesia Spinal or epidural anesthesia Conscious sedation When do I need to stop ... to my stomach? If I have spinal or epidural anesthesia, will I have a headache afterwards? What if ...

  19. Anesthesia - what to ask your doctor - child

    ... my child is having? General anesthesia Spinal or epidural anesthesia Conscious sedation When does my child need to ... upset stomach? If my child had spinal or epidural anesthesia, will my child have a headache afterwards? What ...

  20. SEXUAL DIMORPHISM OF GOUT CLINIC (adapted from the materials of the rheumatology departments of Saransk hospitals

    Valentina Antipova


    Full Text Available Over the past decades the incidence of gout has increased in the world. Despite the well studied mechanisms of development and characteristics of the clinical picture of the di-sease, gout is diagnosed late. Gout is believed to occur in 1 - 3% of the population of the developed countries, predominantly in men over 45, but in modern literature there is information about the age reduction for the gout onset and the incidence of gout in women. An ever-increasing incidence, an early disability, impaired quality of life, and a high risk of death make the gout problem highly relevant one and require the improvement of the detection methods, early gout detection and optimization of tactics for managing patients with gout. The object of the present research is the identification of sexual dimorphism of gout clinic (adapted from the materials of rheumatology departments of Saransk hospitals. Materials and Methods The study included 195 patients with gout (169 men and 26 women surveyed in 2011– 2015 in reumatology сlinices GBUZ “MRCB” and GBUZ “RCH № 5” of Saransk. The average age of women was 52,3 ± 12,3, of men – to 54,3 ± 13,2, median disease du-ration was 5,2 (2,6–7,8 years for women and 9 (3,5–14,5 years for men. Results Chronic arthritis was detected in 58,8 % of women and 67,5 % of men. The formation of tophi in women was observed earlier and in greater numbers than in men: the average duration of the disease before the formation of tophi in women was 3,1 years, and for men 5,7 years. In the group of women the average duration of the first artrit bout was 13 days, in the group of men – 10 days. The metobolic syndrome components such as arte¬rial hypertension, diabetes mellitus of the 2nd type, dyslipidemia were observed more often in women than in men Discussion and Conclusions Clinical course of women’s gout has its features. Since gout in women is more severe, the chronic tophy gout develops earlier than in men. Women

  1. Team building with information system departments: a hospital librarian's experience in coexisting, collaborating, and cooperating.

    Grosman, J; Larson, B.


    Hospital librarians and information systems (IS) staff regard themselves as information professionals and have coexisted in the same institutions for many years. While hospital librarians have increased their computer literacy, IS staff have begun to recognize the value of knowledge-based information as an IS resource. Parallel growth and mutual interest have resulted in increased opportunities for information professionals to share skills and network for mutual advantage. Creating positive r...

  2. Evaluation of Radiation Protection in Nuclear Medicine Department in Namazi Hospital According to Global Accepted Standards

    Mohammad Mehdi Movahedi; Alireza Mehdizadeh


    Background & Objective: In the recent years, nuclear medicine has enjoyed remarkable growth thanks to such novel technologies as SPECT-CT and PET, which are utilized for the recognition of new detectable molecules and radiopharmaceutical medicines. Therefore, the current regulations on radiation protection require revision. Namazi Hospital of Shiraz is one of the first nuclear medicine centers in Iran. Many patients visit this hospital every year; consequently, radiation protection must b...

  3. Implementing Lean Six Sigma Methodologies in the Radiology Department of a Hospital Healthcare System

    Workman-Germann, Jamie; Hagg, Heather (Woodward)


    Increased focus is being placed on the quality of care provided by Hospitals and Healthcare Systems around the country. Caught in the middle between tightening govenment standards, stricter compliance guidelines for insurance companies, and the basic mission to serve those in need with quality and compassion, hospitals are searching for ways to improve their processes and services for the benefit of all. CT (Computed Tomography - CAT Scan) and MRI (Magnetic Resonance Imaging) services in the ...

  4. Anesthesia for bronchoscopy.

    Abdelmalak, Basem B; Gildea, Thomas R; Doyle, D John


    Bronchoscopic procedures are at times intricate and the patients often very ill. These factors and an airway shared with the pulmonologist present a clear challenge to anesthesiologists. The key to success lies in the understanding of both the underlying pathology and procedure being performed combined with frequent two-way communication between the anesthesiologist and the pulmonologist. Above all, vigilance and preparedness are paramount. Topics discussed in this review include anesthesia for advanced diagnostic procedures as well as for interventional/ therapeutic procedures. The latter includes bronchoscopic tracheal balloon dilation, tracheobronchial stenting, endobronchial electrocautery, bronchoscopic cryotherapy and other techniques. Special situations, such as tracheoesophageal fistula and mediastinal masses, are also considered. PMID:22762465

  5. Anesthesia for thoracoscopic surgery

    Conacher I


    Full Text Available Anesthesia for thoracoscopy is based on one lung ventilation. Lung separators in the airway are essential tools. An anatomical shunt as a result of the continued perfusion of a non-ventilated lung is the principal intraoperative concern. The combination of equipment, technique and process increase risks of hypoxia and dynamic hyperinflation, in turn, potential factors in the development of an unusual form of pulmonary edema. Analgesia management is modelled on that shown effective and therapeutic for thoracotomy. Perioperative management needs to reflect the concern for these complex, and complicating, processes to the morbidity of thoracoscopic surgery.

  6. Paediatric Spinal Anesthesia

    Rakhee Goyal


    Full Text Available Paediatric spinal anesthesia is not only a safe alternative to general anaesthesia but often the anaesthesia technique of choice in many lower abdominal and lower limb surgeries in children. The misconception regarding its safety and feasibility is broken and is now found to be even more cost-effective. It is a much preferred technique especially for the common daycase surgeries generally performed in the paediatric age group. There is no require-ment of any additional expensive equipment either and this procedure can be easily performed in peripheral centers. However, greater acceptance and experience is yet desired for this technique to become popular.

  7. Emergency Department Visits and Injury Hospitalizations for Female and Male Victims and Perpetrators of Intimate Partner Violence

    Catherine L. Kothari


    Full Text Available Introduction. The potential for hospital-based interventions for male victims of intimate partner violence (IPV as well as adult perpetrators of both genders has been largely unexplored despite early evidence of acute-care utilization that may be as high as female victims. The current investigation compared the emergency department (ED and injury-related-hospitalization rates of IPV-involved individuals against standardized national norms, assessing differences by gender and victim/perpetrator-status. Methods. This cross-sectional study collected one-year ED and in-patient visit data from hospital records for individuals listed as victim or perpetrator in an IPV criminal charging request in a Midwestern county (N=2,937. Expected rates were calculated based upon age-adjusted national norms. Results. The IPV-involved population generated ED rates 4.1 times higher than expected and injury-related-hospitalization rates that were 4.0 times higher than expected. Bi-directionally-violent individuals (both victim and perpetrator in IPV charges consistently had the highest utilization rates (ED 8.4 RR, injury-hospitalization 22.5 RR. Victims, primarily female, had higher ED-visits than perpetrators, primarily male (victims = 4.6 RR, perpetrator = 3.1 RR. Perpetrators, though, had higher injury hospitalizations (victims = 0.8RR, perpetrators = 5.5 RR. Conclusions. Substantial opportunities exist within acute-care medical settings to intervene with IPV-involved women, men, victims, and perpetrators, although the magnitude of the opportunity varied by setting, gender and victim/perpetrator-status.

  8. Evidence-based management assessment of return on investment from anesthesia information management systems.

    O'Sullivan, Cormac T; Dexter, Franklin; Lubarsky, David A; Vigoda, Michael M


    A systematic and comprehensive review of the scientific literature revealed 4 evidence-based methods that contribute to a positive return on investment from anesthesia information management systems (AIMS): reducing anesthetic-related drug costs, improving staff scheduling and reducing staffing costs, increasing anesthesia billing and capture of anesthesia-related charges, and increased hospital reimbursement through improved hospital coding. There were common features to these interventions. Whereas an AIMS may be the ideal choice to achieve these cost reductions and revenue increases, alternative existing systems may be satisfactory for the studied applications (i.e., the incremental advantage to the AIMS may be less than predicted from applying each study to each facility). Savings are likely heterogeneous among institutions, making an internal survey using standard accounting methods necessary to perform a valid return on investment analysis. Financial advantages can be marked for the anesthesia providers, although hospitals are more likely to purchase the AIMS. PMID:17304783

  9. Trends in maternal mortality at the University of Calabar Teaching Hospital, Nigeria, 1999–2009

    TU Agan; EI Archibong; JE Ekabua; et al


    TU Agan1, EI Archibong1, JE Ekabua1, EI Ekanem1, S E Abeshi1, TA Edentekhe2, EE Bassey21Department of Obstetrics and Gynecology and 2Department of Anesthesia, College of Medical Sciences, University of Calabar Teaching Hospital, NigeriaBackground: Maternal mortality remains a major public health challenge, not only at the University of Calabar Teaching Hospital, but in the developing world in general.Objective: The objective of this study was to assess trends in maternal mortality in a tertia...

  10. Comparing policies for children of parents attending hospital emergency departments after intimate partner violence, substance abuse or suicide attempt.

    Hoytema van Konijnenburg, Eva M M; Diderich, Hester M; Teeuw, Arianne H; Klein Velderman, Mariska; Oudesluys-Murphy, Anne Marie; van der Lee, Johanna H


    To improve identification of child maltreatment, a new policy ('Hague protocol') was implemented in hospitals in The Netherlands, stating that adults attending the hospital emergency department after intimate partner violence, substance abuse or a suicide attempt should be asked whether they care for children. If so, these children are referred to the Reporting Center for Child Abuse and Neglect (RCCAN), for assessment and referrals to support services. An adapted, hospital-based version of this protocol ('Amsterdam protocol') was implemented in another region. Children are identified in the same manner, but, instead of a RCCAN referral, they are referred to the pediatric outpatient department for an assessment, including a physical examination, and referrals to services. We compared results of both protocols to assess how differences between the protocols affect the outcomes on implementation, detection of child maltreatment and referrals to services. Furthermore, we assessed social validity and results of a screening physical examination. We included 212 families from the Amsterdam protocol (cohort study with reports by pediatric staff and parents) and 565 families from the Hague protocol (study of RCCAN records and telephone interviews with parents). We found that the RCCAN identified more maltreatment than pediatric staff (98% versus at least 51%), but referrals to services were similar (82% versus 80% of the total sample) and parents were positive about both interventions. Physical examination revealed signs of maltreatment in 5%. We conclude that, despite the differences, both procedures can serve as suitable methods to identify and refer children at risk for maltreatment. PMID:26718263

  11. Evaluation of the in vitro ocular toxicity of the fortified antibiotic eye drops prepared at the Hospital Pharmacy Departments.

    Fernández-Ferreiro, Anxo; González-Barcia, Miguel; Gil-Martínez, María; Santiago Varela, María; Pardo, María; Blanco-Méndez, José; Piñeiro-Ces, Antonio; Lamas Díaz, María Jesús; Otero-Espinar, Francisco J


    The use of parenteral antibiotic eye drop formulations with non-marketed compositions or concentrations, commonly called fortified antibiotic eye drops, is a common practice in Ophthalmology in the hospital setting. The aim of this study was to evaluate the in vitro ocular toxicity of the main fortified antibiotic eye drops prepared in the Hospital Pharmacy Departments. We have conducted an in vitro experimental study in order to test the toxicity of gentamicin, amikacin, cefazolin, ceftazidime, vancomycin, colistimethate sodium and imipenem-cilastatin eye drops; their cytotoxicity and acute tissue irritation have been evaluated. Cell-based assays were performed on human stromal keratocytes, using a cell-based impedance biosensor system [xCELLigence Real-Time System Cell Analyzer (RTCA)], and the Hen's Egg Test for the ocular irritation tests. All the eye drops, except for vancomycin and imipenem, have shown a cytotoxic effect dependent on concentration and time; higher concentrations and longer exposure times will cause a steeper decline in the population of stromal keratocytes. Vancomycin showed a major initial cytotoxic effect, which was reverted over time; and imipenem appeared as a non-toxic compound for stromal cells. The eye drops with the highest irritating effect on the ocular surface were gentamicin and vancomycin. Those antibiotic eye drops prepared at the Hospital Pharmacy Departments included in this study were considered as compounds potentially cytotoxic for the ocular surface; this toxicity was dependent on the concentration used. PMID:27570987

  12. Admissions for drug-related problems at the Emergency Department of a University Hospital in the Kingdom of Saudi Arabia

    Mastour S Alghamdy


    Full Text Available Background and Aim: Medication Errors can result in drug-related problems (DRPs. Insight into the frequency, type, and severity of DRPs could help reduce their incidence. The aim of the present study was to estimate the prevalence of admissions as a result of DRPs at the Emergency Department (ED of a university hospital in the Kingdom of Saudi Arabia. Materials and Methods: Files of suspected cases of DRPs reporting to ED in the year 2012 were scrutinized. Suspicion arose from the hospital record system based on Diagnosis Code Numbers (ICD-9-CM, Professional 2010 and from triggers, such as some drugs, laboratory tests, and signs and symptoms pointing to DRPs. Results: Of 5574 admissions, 253 (4.5% were DRPs and were categorized as: Overdose toxicity and side effects of drugs 50 (19.8%, drug-interactions 29 (11.5%, accidental and suicidal drug ingestions 26 (10.3%, drug abuse 18 (7.1%, drug allergy 10 (4%, super-infections 8 (3.2%, and noncompliance to treatment 112 (44.3%. About 70% of DRPs were preventable; 67 (26.5% required hospital admission for 7-102 days and 10 (4% died. Conclusions: Noncompliance to treatment, overdose toxicity, drug interactions, and drug abuse are important causes of hospital admissions as a result of DRPs. Awareness of prescribers to the problem and their education would help to prevent them and improve patient care.

  13. Does regional anesthesia influence early outcome of upper arm arteriovenous fistula?

    To assess the effect of regional anesthesia on the outcome of elbow arteriovenous fistula (AVF), prospectively studied consecutive patients with end-stage renal disease referred for permanent vascular access to the Vascular Unit of King Fahd University Hospital between September 2004 and September 2007. The patients were divided into 2 groups: Group 1: patients who underwent the construction of the AVF under regional anesthesia and Group 2: patients who were operated under general anesthesia, indicated by their preferences or failure of regional anesthesia. Data including patient characteristics and type of AVF were recorded. The internal diameter of the vein and the artery and intra-operative blood flow were measured. The complications of both types of anesthesia were recorded. The patients were followed up for three months. Eighty four cases were recruited in this study. Complete brachial plexus block was achieved in 57 (68%) patients. Seven patients were converted to general anesthesia and 20 patients had AVF under general anesthesia from the start. There were no significant differences between the 2 groups with regard to basic characteristics or operative data. There were no instances of systemic toxicity, hematomas, or nerve injury from the regional block. No major complications were reported from the general anesthesia. There was no significant difference between both groups regarding early failure of AVF (Group 1, 14% vs. Group2; 11%. P= 0.80). No significant advantage of regional over general anesthesia in terms of early outcome of AVF was seen in this study (Author).

  14. Anesthesia and cor triatriatum

    Federica Scavonetto


    Full Text Available Aims and Objectives: Cor triatriatum sinistrum (CTS and cor triatriatum dextrum (CTD are rare congenital anomalies characterized by the presence of a perforated septum which divides the respective atrium into a proximal and distal chamber. This report reviews the perioperative course of patients with uncorrected cor triatriatum (CT undergoing procedures requiring anesthesia. In addition, we performed a literature search that examines the experience of others regarding the peri-operative course of patients with CT. Materials and Methods: A computerized search of a medical record database was conducted to identify patients with a clinical diagnosis of uncorrected CTD and CTS undergoing surgical procedures. Descriptive statistics were used. Results: We identified 12 adult patients with asymptomatic CTS (n = 7 and CTD (n = 5 who underwent 23 anesthetics. There were no perioperative complications which could be attributed directly to the anatomy of CT. Conclusions: Our observation and review of the literature suggest that patients with asymptomatic CT typically tolerate anesthesia and surgical procedures well.

  15. Department of Health and Human Services Changes: Implications for Hospital Social Workers

    Conlon, Annemarie; Aldredge, Patti A.


    In April 2010, President Obama issued a directive to the Secretary of Health and Human Services (HHS) regarding patient visitation, advance directives, and other initiatives to improve the lives of lesbian, gay, bisexual, and transgender people and their families. The HHS response to this directive has implications for hospital social workers. The…

  16. Accreditation of Emergency Department at a Teaching Hospital in Tehran University of Medical Sciences in 2010

    Fereshteh Farzianpour; Roholah Askari; Amin T. Hamedani; Gholamosien Khorshidi; Sanaz Amirifar; Shadi Hosseini


    Problem statement: Considering the importance of emergency departments in healthcare system and the high mortality rate of patients referred to these departments, it is crucial to provide quality services in emergency departments. Accreditation is a systematic process for improving quality of care and it enables managers to assess and evaluate the healthcare system. Accreditation of an organization provides an obvious commitment for improving quality of safety, quality of patient care, ensuri...

  17. Suicide Assessment in Hospital Emergency Departments: Implications for Patient Satisfaction and Compliance

    Mitchell, Ann M; Garand, Linda; Dean, Diane; Panzak, George; Taylor, Melissa


    Suicide is a complex, multidimensional event with a host of contributing factors. Suicidal emergencies are among other behavioral and psychiatric emergencies that provide the basis for emergency department visits. Therefore, emergency departments are ideal clinical environments for the assessment of suicidal patients. A case example from an emergency department visit is provided as a basis of discussion as we describe subpopulations at high risk for suicide and review critical assessment para...

  18. Oral hygiene awareness and practice amongst patients visiting the Department of Periodontology at a Dental College and Hospital in North India

    Kapoor, Daljit; Gill, Sanjeet; Singh, Arshdeep; Kaur, Inderpreet; Kapoor, Pooja


    Objective: This study was carried out to assess the oral hygiene awareness and practices amongst patients visiting the Department of Periodontology at Gian Sagar Dental College and Hospital, Ramnagar (Patiala). Methods: A cross-sectional study was carried out amongst the patients visiting the Department of Periodontology of Gian Sagar Dental College and Hospital, Ramnagar, Patiala. This proposed study was reviewed by the Institutional ethical committee and their clearance was obtained. A tota...

  19. Audit of high energy therapy beams in hospital oncology departments by the National Radiation Laboratory

    In 1993 the output of every high energy radiotherapy beam used clinically in New Zealand was measured by National Radiation Laboratory (NRL) staff using independent dosimetry equipment. The purpose of this was to audit the dosimetry that is used by hospital physicists for the basis of patient treatments, and to uncover any errors that may be clinically significant. This report analyses the uncertainties involved in comparing the NRL and hospital measurements, and presents the results of the 1993 audit. The overall uncertainty turns out to be about 1.5%. The results for linear accelerator photon beams are consistent with a purely random variation within this uncertainty. Electron beams show some small errors beyond the expected uncertainty. Gamma beams have the potential to be the most accurately measured, but in practice are less accurately measured than linear accelerator beams. None of the disagreements indicated an error of clinical significance. 8 refs., 3 figs., 2 tabs

  20. High Age Predicts Low Referral of Hyperthyroid Patients to Specialized Hospital Departments

    Carlé, Allan; Pedersen, Inge Bülow; Perrild, Hans; Ovesen, Lars; Jørgensen, Torben; Laurberg, Peter Marsvin


    Background: Hospital-based studies may be hampered by referral bias. We investigated how the phenomenon may influence studies of hyperthyroid patients. Methods: By means of a computer-based linkage to the laboratory database and subsequent detailed evaluation of subjects with abnormal test results......, we prospectively identified all 1,148 patients diagnosed with overt hyperthyroidism in a four-year period in and around Aalborg City, Denmark. Each patient was classified according to nosological type of hyperthyroidism. We studied the referral pattern of patients to local hospital units, and...... analyzed how referral depended on subtype of disease, sex, age, and degree of biochemical hyperthyroidism. Results: In a 4-year period, 1,032 hyperthyroid patients were diagnosed at primary care offices, and 435 of these (42.2%) were referred to specialized units, 92 patients had hyperthyroidism diagnosed...

  1. Usefulness of Intravenous Anesthesia Using a Target-controlled Infusion System with Local Anesthesia in Submuscular Breast Augmentation Surgery

    Kyu-Jin Chung


    Full Text Available Background Patients have anxiety and fear of complications due to general anesthesia.Through new instruments and local anesthetic drugs, a variety of anesthetic methods havebeen introduced. These methods keep hospital costs down and save time for patients. Inparticular, the target-controlled infusion (TCI system maintains a relatively accurate level ofplasma concentration, so the depth of anesthesia can be adjusted more easily. We conductedthis study to examine whether intravenous anesthesia using the TCI system with propofol andremifentanil would be an effective method of anesthesia in breast augmentation.Methods This study recruited 100 patients who underwent breast augmentation surgeryfrom February to August 2011. Intravenous anesthesia was performed with 10 mg/mLpropofol and 50 μg/mL remifentanil simultaneously administered using two separate modulesof a continuous computer-assisted TCI system. The average target concentration was set at2 μg/mL and 2 ng/mL for propofol and remifentanil, respectively, and titrated against clinicaleffect and vital signs. Oxygen saturation, electrocardiography, and respiratory status werecontinuously measured during surgery. Blood pressure was measured at 5-minute intervals.Information collected includes total duration of surgery, dose of drugs administered duringsurgery, memory about surgery, and side effects.Results Intraoperatively, there was transient hypotension in two cases and hypoxia in threecases. However, there were no serious complications due to anesthesia such as respiratorydifficulty, deep vein thrombosis, or malignant hypertension, for which an endotrachealintubation or reversal agent would have been needed. All the patients were discharged on theday of surgery and able to ambulate normally.Conclusions Our results indicate that anesthetic methods, where the TCI of propofol andremifentanil is used, might replace general anesthesia with endotracheal intubation in breastaugmentation surgery.

  2. Propofol-Based Sedation Versus General Anesthesia for Endoscopic Submucosal Dissection.

    Yurtlu, Derya Arslan; Aslan, Fatih; Ayvat, Pinar; Isik, Yasemin; Karakus, Nesli; Ünsal, Belkis; Kizilkaya, Mehmet


    The main objective of this study is to evaluate general anesthesia or propofol-based sedation methods at gastric endoscopic submucosal dissection (ESD) procedures.The anesthetic method administered to cases undergoing upper gastrointestinal ESD between 2013 and 2015 was retrospectively investigated. Procedure time, lesion size, dissection speed, anesthesia time, adverse effects such as gag reflex, nausea, vomiting, cough, number of desaturation episodes (SpO2 fentanyl were significantly higher (P < 0.05). Anesthesia time, postoperative anesthesia care unit, and hospital stay durations were not significantly different between the groups.General anesthesia increased dissection speed and enhanced endoscopist performance when compared with propofol-based sedation technique. PMID:27196474

  3. The Study of Oral Clonidine Effect in Duration of Spinal Anesthesia with Lidocaine and Its Complications

    M. Baalbaki


    Full Text Available There are many kinds of intervention to prolong the duration of spinal anesthesia which one of them is preoperation oral drugs. The purpose of this study was determination of clonidine effects in duration of spinal anesthesia and its complications. This study was a double - blinded randomized controlled clinical trial in 40-60 years old males of Mobasher and Ekbatan hospitals in Hamadan. In this study there were 40 cases candidated for spinal anesthesia and we divided them to 2 groups i.e. test and control then the results were recorded on questionnaire sheets. The test cases were prescribed 0.2 mg clonidine P.O. preoperatively and their duration of spinal anesthesia prolonged 11 minutes averagely and decreased its complications related to control prescribed placebo. Hence , the result showed preparation oral clonidine prolongs the duration of spinal anesthesia and decreases its complications like hypotention , nausea and vomiting.

  4. The Ryder Cognitive Aid Checklist for Trauma Anesthesia.

    Behrens, Vicente; Dudaryk, Roman; Nedeff, Nicholas; Tobin, Joshua M; Varon, Albert J


    Despite mixed results regarding the clinical utility of checklists, the anesthesia community is increasingly interested in advancing research around this important topic. Although several checklists have been developed to address routine perioperative care, few checklists in the anesthesia literature specifically target the management of trauma patients. We adapted a recently published "trauma and emergency checklist" for the initial phase of resuscitation and anesthesia of critically ill trauma patients into an applicable perioperative cognitive aid in the form of a pictogram that can be downloaded by the medical community. The Ryder Cognitive Aid Checklist for Trauma Anesthesia is a letter-sized, full-color document consisting of 2 pages and 5 sections. This cognitive aid describes the essential steps to be performed: before patient arrival to the hospital, on patient arrival to the hospital, during the initial assessment and management, during the resuscitation phase, and for postoperative care. A brief online survey is also presented to obtain feedback for improvement of this tool. The variability in utility of cognitive aids may be because of the specific clinical task being performed, the skill level of the individuals using the cognitive aid, overall quality of the cognitive aid, or organizational challenges. Once optimized, future research should be focused at ensuring successful implementation and customization of this tool. PMID:27101496

  5. The association of longitudinal and interpersonal continuity of care with emergency department use, hospitalization, and mortality among Medicare beneficiaries.

    Suzanne E Bentler

    Full Text Available BACKGROUND: Continuity of medical care is widely believed to lead to better health outcomes and service utilization patterns for patients. Most continuity studies, however, have only used administrative claims to assess longitudinal continuity with a provider. As a result, little is known about how interpersonal continuity (the patient's experience at the visit relates to improved health outcomes and service use. METHODS: We linked claims-based longitudinal continuity and survey-based self-reported interpersonal continuity indicators for 1,219 Medicare beneficiaries who completed the National Health and Health Services Use Questionnaire. With these linked data, we prospectively evaluated the effect of both types of continuity of care indicators on emergency department use, hospitalization, and mortality over a five-year period. RESULTS: Patient-reported continuity was associated with reduced emergency department use, preventable hospitalization, and mortality. Most of the claims-based measures, including those most frequently used to assess continuity, were not associated with reduced utilization or mortality. CONCLUSION: Our results indicate that the patient- and claims-based indicators of continuity have very different effects on these important health outcomes, suggesting that reform efforts must include the patient-provider experience when evaluating health care quality.

  6. Pattern of Dermatological Cases Attending Skin-VD Outpatient Department in a Medical College Hospital of Bangladesh

    Abu Baker


    Full Text Available Background: The pattern of skin diseases varies from one country to another and even from region to region of the same country. We are geographically placed in the tropical region with natural outcome of communicable diseases. We conducted this cross sectional study in a tertiary hospital of Bangladesh keeping the proposition in mind that infectious diseases occupy maximum percentage among skin and venereal diseases in outpatients in Bangladesh. Objectives: To classify the diseases attending the Skin & VD outpatient department of Enam Medical College Hospital (EMCH and to draw comments and recommendations on the basis of findings. Materials and Methods: All patients irrespective of age and sex attending the OPD of Skin-VD Department of Enam Medical College Hospital during a 2-year time-period (from January 2009 to December 2010 were included in the study. Structured questionnaire, check-list and face-to-face interview (whenever necessary were used as tools of data collection. Statistical analyses were done by SPSS version Windows 11.1. Results: Total number of patients was 12100. Most of the patients were aged (>18 years; 64.28%, dominated by male (61.63%, married (56.1%, literate (71.11%, coming from far (>5 km; 63.5% and of middle class origin (59.73%. Out of the total cases, maximum (23.42% were diagnosed as eczema, followed by infectious diseases (17%, acne (8.69% and psoriasis (6.36%. Conclusion: In this study we found infectious diseases to occupy the second position next to eczema and our findings nullify the proposition that infectious diseases occupy maximum percentage among skin and venereal diseases in outpatients in Bangladesh.

  7. Transverse myelitis following spinal anesthesia

    Jha Sanjeev


    Full Text Available Spinal anesthesia is widely used during surgical procedures. It is generally safe and the frequency of severe, permanent neurological complications associated with it has been reported to be extremely low. We report a patient, who developed paraplegia following spinal anesthesia. A 29-year-old male was referred with acute, flaccid, sensory motor paraplegia, with bladder and bowel involvement. He developed this immediately after an operation for inguinal hernia under spinal anesthesia. Spinal magnetic resonance imaging revealed hemorrhagic myelitis in the conus at D12. He was referred after he did not respond to intravenous methylprednisolone for 10 days. This case brings up the difficulty encountered in determination of the interspace used for spinal anesthesia and the potential for traumatic injury to the spinal cord. It also demonstrates the tragic outcome after a clinician violates some important, standard and established guidelines.

  8. Post anesthesia recovery rate evaluated by using White fast tracking scoring system

    Munevera Hadžimešić


    Full Text Available Introduction: Postponed recuperation from anesthesia can lead to different complications such as apnoea, aspiration of gastric content whit consequent development of aspiration pneumonia, laryngospasm, bradycardia, and hypoxia. Aim of this research was to determine infl uence of propofol, sevoflurane and isoflurane anesthesia on post anesthesia recovery rate.Methods: This was a prospective study; it included 90 patients hospitalized in period form October 2011 to may 2012 year, all patients included in the study underwent lumbar microdiscectomy surgery. Patients were randomly allocated to one of three groups: group 1: propofol maintained anesthesia, group 2: sevoflurane and group 3: isofl urane maintained anesthesia. Assessments of recovery rate were done 1, 5 and 10 minutes post extubation using White fast tracking scoring system.Results: Significant difference was observed only 1 minute after extubation (p=0,025 finding recovery rate to be superior in propofol group. Propofol group compared to inhaled anesthesia with sevoflurane group, shows significantly faster recovery from anesthesia only one minute after extubation (p=0,046. In comparison of propofol group and isofl urane anesthesia group, statistical significance was noticed one minute following extubation (p=0,008. Comparison of propofol group and inhaled anesthesia groups recovery rates were not significantly different at all times measured. When we were comparing sevoflurane and isoflurane anesthesia, recovery rates shoved no signifi cant statistical difference.Conclusions: Recovery rate evaluated by using White fast tracking scoring system was superior and with fewer complications in propofol maintained in comparison to sevoflurane and isoflurane maintained anesthesia only one minute post extubation, while after fifth and tenth minute difference was lost.

  9. Clinical relevance in anesthesia journals

    Lauritsen, Jakob; Møller, Ann M


    The purpose of this review is to present the latest knowledge and research on the definition and distribution of clinically relevant articles in anesthesia journals. It will also discuss the importance of the chosen methodology and outcome of articles.......The purpose of this review is to present the latest knowledge and research on the definition and distribution of clinically relevant articles in anesthesia journals. It will also discuss the importance of the chosen methodology and outcome of articles....

  10. Incidence of and factors associated with perioperative cardiac arrest within 24 hours of anesthesia for emergency surgery

    Siriphuwanun V


    Full Text Available Visith Siriphuwanun,1 Yodying Punjasawadwong,1 Worawut Lapisatepun,1 Somrat Charuluxananan,2 Ketchada Uerpairojkit2 1Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Mueang District, Chiang Mai, Thailand; 2Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand Purpose: To determine the incidence of and factors associated with perioperative cardiac arrest within 24 hours of receiving anesthesia for emergency surgery. Patients and methods: This retrospective cohort study was approved by the ethical committee of Maharaj Nakorn Chiang Mai Hospital, Thailand. We reviewed the data of 44,339 patients receiving anesthesia for emergency surgery during the period from January 1, 2003 to March 31, 2011. The data included patient characteristics, surgical procedures, American Society of Anesthesiologists (ASA physical status classification, anesthesia information, location of anesthesia performed, and outcomes. Data of patients who had received topical anesthesia or monitoring anesthesia care were excluded. Factors associated with cardiac arrest were identified by univariate analyses. Multiple regressions for the risk ratio (RR and 95% confidence intervals (CI were used to determine the strength of factors associated with cardiac arrest. A forward stepwise algorithm was chosen at a P-value <0.05. Results: The incidence (within 24 hours of perioperative cardiac arrest in patients receiving anesthesia for emergency surgery was 163 per 10,000. Factors associated with 24-hour perioperative cardiac arrest in emergency surgery were age of 2 years or younger (RR =1.46, CI =1.03–2.08, P=0.036, ASA physical status classification of 3–4 (RR =5.84, CI =4.20–8.12, P<0.001 and 5–6 (RR =33.98, CI =23.09–49.98, P<0.001, the anatomic site of surgery (upper intra-abdominal, RR =2.67, CI =2.14–3.33, P<0.001; intracranial, RR =1.74, CI =1.35–2.25, P<0.001; intrathoracic, RR =2.35, CI =1.70–3


    Jasminka Nancheva


    Full Text Available The exposure of neonates, infants and small children to general anesthesia is becoming a common occurrence. Accumulating preclinical data indicate that exposure to commonly used general anesthetic agents during key periods of brain development in this population(between late gestation and 3 to 4 years of age, can lead to apoptotic neurodegeneration, synapse loss, and cognitive and neurobehavioral deficits that persist as the organism matures. New work suggests that infants and small children undergoing some types of surgery could have better recovery if they receive regional anesthesia rather than general anesthesia. In response to this concerns, the Food and drug administration (FDA and the International Research Society in anesthesia (IARS started an initiative called Smart Tots (Strategies for Mitigating Anesthesia- related neuro Toxicity in Tots which examine the effects of anesthesia on brain development. Also another two major prospective studies are ongoing in children : PANDA (Pediatric Anesthesia Neurodevelopment assessment Study project is a large, multi-center study based at the Morgan Stanley Children’s Hospital of New York at Columbia University, and another one is GAS study which is a multisite randomized controlled trial comparing neurodevelopment outcomes in infant receiving general anesthesia compared to spinal and other regional anesthetics to the stress response to surgery. The findings from these studies will help researches to design the safest anesthetic regimens and to develop the new and safer anesthetic drugs for use in pediatric medicine.

  12. Consciousness fluctuation during general anesthesia: a theoretical approach to anesthesia awareness and memory modulation.

    Cascella, Marco; Schiavone, Vincenzo; Muzio, Maria Rosaria; Cuomo, Arturo


    With anesthesia awareness as a model of study we debate the both fascinating and dangerous phenomenon called consciousness fluctuation that takes place during surgical anesthesia. In accordance with current scientific knowledge this paradox is the consequence of our limits in both precise knowledge of anesthesia mechanisms and our inability to accurately assess the level of anesthesia with brain monitoring. We also focus on the relationships between memory and anesthesia, as well as the possibility of interfering with memory during general anesthesia. PMID:27046232

  13. Preload versus coload and vasopressor requirement for the prevention of spinal anesthesia induced hypotension in non-obstetric patients

    To compare the effectiveness of preload and coload for the prevention of Spinal Induced Hypotension (SIH) and vasopressor requirements. Study Design: Randomized trial. Place and Duration of Study: Department of Anesthesia, The Aga Khan University Hospital, Karachi, Pakistan, from June 2007 - June 2010. Methodology: Sixty patients were randomly divided into preload and coload group of 30 each. Patients with ASA1 - 3, aged 20 - 60 years were included. Patients with history of IHD, COPD, BMI > 30 and surgical procedure TURP were excluded. All patients received crystalloid 10 ml/kg before induction of spinal anesthesia in preload group and at the time of spinal anesthesia in coload group. Blood pressure and heart rate were recorded at different time intervals till 45 minutes. Patients received ephedrine 5 mg when systolic blood pressure dropped below 90 mmHg and heart rate was less than 60 beats/minute and/or phenylephrine 50 micrograms when systolic blood pressure dropped below 90 mmHg and heart rate was more than 60 beats/minute. Results: There was no statistically significant difference at different time intervals in heart rate, systolic and mean arterial pressure between the groups. Diastolic blood pressure was significantly different in both groups at 6 - 15 minutes after spinal anesthesia. SIH occurred (21) 70% and (15) 50% in preload and coload groups, respectively (p=0.187). Ephedrine requirement for SIH was significantly high in preload group (p=0.017). Phenylephrine requirement for SIH was high in preload group which was statistically non-significant (p=0.285). Conclusion: Coload group has lower incidence of spinal induced hypotension and significantly less vasopressor requirement than the preload group. (author)

  14. Process mapping of PTA and stent placement in a university hospital interventional radiology department

    de Bucourt, Maximilian; Busse, Reinhard; Güttler, Felix; Reinhold, Thomas; Vollnberg, Bernd; Kentenich, Max; Hamm, Bernd; Teichgräber, Ulf K


    Objective To apply the process mapping technique in an interdisciplinary approach in order to visualize, better understand, and efficiently organize percutaneous transluminal angioplasty (PTA) and stent placement procedures in a university hospital’s interventional radiology department. Methods After providing an overview of seven established mapping techniques for medical professionals, the process mapping technique was chosen and applied in an interdisciplinary approach including referrers ...

  15. Improving Emergency Department Triage Classification with Computerized Clinical Decision Support at a Pediatric Hospital

    Kunisch, Joseph Martin


    Background: The Emergency Severity Index (ESI) is an emergency department (ED) triage classification system based on estimated patient-specific resource utilization. Rules for a computerized clinical decision support (CDS) system based on a patient's chief complaint were developed and tested using a stochastic model for predicting ESI scores.…

  16. Institutional Effectiveness Assessment Process, 1993-94. Executive Summary. Hospitality and Service Occupations Division, Cosmetology Department.

    South Seattle Community Coll., Washington.

    A study was conducted to evaluate student and student employer satisfaction with the services provided by the South Seattle Community College (SSCC) Cosmetology Department. Specifically, the study gathered data related to four outcomes: that students receive an educational experience allowing them to meet their goals; that former and current…

  17. Natural orifice transluminal endoscopic surgery (NOTES): implications for anesthesia.

    Schaefer, Michael


    Natural orifice transluminal endoscopic surgery (NOTES) has recently evolved as a novel approach for abdominal surgery with great potential to further improve the advantages of laparoscopy over laparotomy. The first patients undergoing NOTES cholecystectomy or appendectomy reported no or only minimal pain, required no narcotic analgesics, and were discharged early from the hospital and immediately resumed daily activities. If this is confirmed by randomized controlled clinical trials, what are the potential implications for anesthesia? PMID:20948698

  18. Avaliação da dor pós-operatória e alta hospitalar com bloqueio dos nervos ilioinguinal e ílio-hipogástrico durante herniorrafia inguinal realizada com raquianestesia: estudo prospectivo Assessment of postoperative pain and hospital discharge after inguinal and iliohypogastric nerve block for inguinal hernia repair under spinal anesthesia: a prospective study

    Guilherme de Castro Santos


    with II and IH nerve block (10 mL of 0.75% ropivacaine and surgical wound infiltration (10 mL of 0.75% ropivacaine. The following data were analyzed: demographic data, pain intensity according to the visual analog scale (VAS, and number of doses of analgesics (dipyrone, ketorolac and nalbuphine in the immediate postoperative period, as well as at the time of hospital discharge. RESULTS: The VAS at rest was significantly lower in Group B compared with Group C (p < 0.05, three hours after the procedure, with no differences on VAS during movement in all postoperative periods. The number of doses of analgesics during the postoperative period was similar in both groups, but patients in Group B were discharged earlier than in Group C. CONCLUSION: II and IH nerve block associated with surgical wound infiltration with 0.75% ropivacaine provides better postoperative analgesia and early hospital discharge in patients undergoing inguinal hernia repair under spinal anesthesia.

  19. Does increased medication use among seniors increase risk of hospitalization and emergency department visits?

    Sara Allin; David Rudoler; Audrey Laporte


    Objective: to examine the extent of the health risks of consuming multiple medications among the older population. Data sources/study setting: Secondary data from the period 2004-2006. The study setting was the province of Ontario, Canada, and the sample consisted of individuals aged 65 years or older who responded to a national health survey. Study design: We estimated a system of equations for inpatient and emergency department (ED) services to test the marginal effect of medication use on ...

  20. A study to assess burnout among nurses of maternity department in Gauhati Medical College Hospital, Assam

    Marami Baishya; Bivarani Goswami


    Background: Burnout in healthcare workers, especially among nurses, can have an impact on overall healthcare delivery system. For health in general and maternal health in particular, wellbeing of healthcare workers, including nurses, is of paramount importance. Material and methods: This study aimed to assess burnout among nurses working in the maternity department. One hundred nurses of a tertiary care centre, selected by non-purposive convenient sampling, were examined by a standardised...

  1. Ten years of replantation surgery at the Department of Plastic Surgery, Charles University Hospital, Prague.

    Kletenský, J; Nejedlý, A; Pros, Z; Svoboda, S; Tvrdek, M


    The authors present results of the ten years replantation surgery centre at the department of plastic surgery in Prague. The presented series of patients includes 393 persons operated on because of amputation or ischaemic injury to the region of the upper extremity. The number of replantations and revascularisations in the individual years is analysed, as well as the age of the patients, type of injury, mechanism of injury and operation results. PMID:7618394

  2. A Simple Clinical Score “TOPRS” to Predict Outcome in Pediatric Emergency Department in a Teaching Hospital in India


    Full Text Available Objective: To develop a simple clinical scoring system for severity of illness to help prioritize care and predict outcome in emergency department.Methods: Prospective hospital based observational study. Out of a total of 874 children who attended emergency department in one year, 777 were included in the study. Data was collected at the time ofadmission in emergency department. The baseline information like age, gender, etc and variables of ‘toprs’score viz temperature, oxygen saturation, pulse rate, respiratory rate, sensorium and seizures were recorded.Variables were categorized as normal (score zero or abnormal (score 1 based on systemic inflammatory response syndrome (SIRS criteria and criteria mentioned in advanced pediatric life support (APLS and the total scores were computed for each child. The outcome (death/discharge was correlated with the studyvariables and total score. The predictive ability of score was calculated using receiver operating characteristic (ROC curve analysis.Findings: Of the six variables, temperature, oxygen saturation and respiratory rate were found to be significantly associated with mortality. Mortality increased with the increase in the number of abnormal variables. Based on the regression coefficients, maximum possible score was 6.68. The predictive ability of score was 81.7 calculated using ROC curve. Maximum discrimination was observed at a score of 2.5.Conclusion: For triage in emergency, any patient with 2 or more abnormal variables should be closely monitored and evaluated. These patients require admission as they have a potential risk of death.

  3. Simulation in teaching regional anesthesia: current perspectives

    Udani AD


    Full Text Available Ankeet D Udani,1 T Edward Kim,2,3 Steven K Howard,2,3 Edward R Mariano2,3On behalf of the ADAPT (Anesthesiology-Directed Advanced Procedural Training Research Group1Department of Anesthesiology, Duke University School of Medicine, Durham, NC, USA; 2Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA; 3Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USAAbstract: The emerging subspecialty of regional anesthesiology and acute pain medicine represents an opportunity to evaluate critically the current methods of teaching regional anesthesia techniques and the practice of acute pain medicine. To date, there have been a wide variety of simulation applications in this field, and efficacy has largely been assumed. However, a thorough review of the literature reveals that effective teaching strategies, including simulation, in regional anesthesiology and acute pain medicine are not established completely yet. Future research should be directed toward comparative-effectiveness of simulation versus other accepted teaching methods, exploring the combination of procedural training with realistic clinical scenarios, and the application of simulation-based teaching curricula to a wider range of learner, from the student to the practicing physician.Keywords: regional anesthesia, simulation, medical education, ultrasound, nerve block, simulator

  4. Drug utilization pattern in outpatient department of Government Medical College and C.P.R. Hospital, Kolhapur

    Rama R. Bhosale


    Full Text Available Background: Drug utilization studies are used to analyze different aspects of the use of drugs and to implement methods of improving therapeutic quality. This study was conducted to study drug prescription pattern in outpatient department of Government Medical College and C.P.R. Hospital, Kolhapur which is one of the important medical college in western Maharashtra. Methods: One thousand prescriptions were screened & analyzed as per the study parameters from OPD of Government Medical College & C.P.R. Hospital, Kolhapur. Study parameters like demographic profile of the patient like age, sex and diagnosis were recorded. Also groups of drugs commonly prescribed, number of drugs per patient, drug profile and drawbacks of prescription if any were recorded and analyzed. Results: Most common group of drugs prescribed by physicians was Analgesics (32.83%, followed by Antimicrobials (22.82%, Multivitamins (16.42% and Antacids (9.14%. The average number of drugs prescribed per patient was four; the average number of analgesic was one. The incidence of polypharmacy was common occurrence and some prescriptions had small drawbacks like absence of diagnosis, absence of doctor’s signature, etc. Conclusions: We conclude that most of the prescriptions which were analyzed at R.C.S.M. Government Medical College and C.P.R. Hospital, Kolhapur, were according to the standard norms of WHO prescriptions and also most of the drugs prescribed were from the list of essential drug list. But still there is scope for improvement in prescription pattern. [Int J Basic Clin Pharmacol 2013; 2(4.000: 403-406

  5. Complexity in hospital internal medicine departments: what are we talking about?

    Roberto Nardi


    Full Text Available Internal medicine (IM patients are mostly elderly, with multiple complex co-morbidities, usually chronic. The complexity of these patients involves the intricate entanglement of two or more systems (e.g. body and disease, family-socio-economic and environmental status, coordination of care and therapies and this requires comprehensive, multi-dimensional assessment (MDA. Despite attempts to improve management of chronic conditions, and the availability of several MDA tools, defining the complex patient is still problematic. The complex profile of our patients can only be described through the best assessment tools designed to identify their characteristics. In order to do this, the Federation of Associations of Hospital Doctors on Internal Medicine FADOI has created its own vision of IM. This involves understanding the different needs of the patient, and analyzing diseases clusters and the possible relationships between them. By exploring the real complexity of our patients and selecting their real needs, we can exercise holistic, anthropological and appropriate choices for their treatment and care. A simpler assessment approach must be adopted for our complex patients, and alternative tools should be used to improve clinical evaluation and prognostic stratification in a hierarchical selection of priorities. Further investigation of complex patients admitted to IM wards is needed.

  6. Trial of a small image network system in a radiology department of an university hospital

    This paper describes the construction of an image network system in Shinshu University Hospital, and some of its current issues and advantages. Our discussion is based on our experience with a PACS system. SAIPACS, which was installed in 1990 for use in clinical conferencing and pre- and post-graduate education, and with a new CT and MRI network, which was subsequently introduced in 1993. The SAIPACS interconnects eight digital imaging modalities, including CT, MRI, XTV-DR (including digital tomosynthesis), FCR, nuclear medicine (RI), DSA, US, and a film digitizer (FD), with a workstation. Transmission time from the magnetic disk of each imaging modality to the SAIPACS image disk is not rapid enough. Therefore, we need to select image for transfer that are pertinent to our specific purpose, to complete image transmission within a practically acceptable period of time. The new CT/MRI network is composed of two CT units, two MRI systems, an image processing unit and a Universal Gateway. It provides faster image transmission than the SAIPACS system, because there is no need to reform image data to send them in a reversible compressed form. A versatile network system connected to the SAIPACS and CT/MRI network enables digital image data to be processed and edited and images to be transferred back to SAIPACS for clinical or educational use. (author)

  7. Impact of clinical pharmacy services in a short stay unit of a hospital emergency department in Qatar.

    Abdelaziz, Hani; Al Anany, Rasha; Elmalik, Ashraf; Saad, Mohammad; Prabhu, Kirti; Al-Tamimi, Haleema; Salah, Salem Abu; Cameron, Peter


    Background The presence of a clinical pharmacist in a hospital's Emergency Department (ED) is important to decrease the potential for medication errors. To our knowledge, no previous studies have been conducted to evaluate the impact of implementing clinical pharmacy services in the ED in Qatar. Objective To characterize the contributions of clinical pharmacists in a short stay unit of ED in order to implement and scale-up the service to all ED areas in the future. Methods A retrospective study conducted for 7 months in the ED of Hamad General Hospital, Qatar. The intervention recommendations were made by clinical pharmacists to the physician in charge during medical rounds. Results A total of 824 documented pharmacist recommendations were analyzed. The interventions included the following: Providing information to the physician (24.4 %) and recommending medication discontinuation (22.0 %), dose adjustment (19.3 %), medication addition (16.0 %), changes in frequency of medications (7.6 %), medication resumption (5.7 %), and patient education (5.0 %). Conclusion Clinical pharmacists in the ED studied play an important role in patient care. PMID:27033505

  8. Characteristics of Older Adults Admitted to Hospital versus Those Discharged Home, in Emergency Department Patients Referred to Internal Medicine

    Hominick, Kathryn; McLeod, Victoria; Rockwood, Kenneth


    Background Frail older adults present to the Emergency Department (ED) with complex medical, functional, and social needs. When these needs can be addressed promptly, discharge is possible, and when they cannot, hospital admission is required. We evaluated the care needs of frail older adults in the ED who were consulted to internal medicine and seen by a geriatrician to determine, under current practices, which factors were associated with hospitalization and which allowed discharge. Methods We preformed a chart-based, exploratory study. Data were abstracted from consultation records and ED charts. All cases had a standard Comprehensive Geriatric Assessment (CGA which records a Clinical Frailty Scale (CFA) and allows calculation of a Frailty Index (FI). Results Of 100 consecutive patients, 2 died in the ED, 75 were admitted, and 23 were discharged, including one urgent placement. Compared with discharged patients (0.39 ± SD 0.16), those admitted had a higher mean FI-CGA (0.48 ± 0.13; p < .01). Greater mobility dependence (2% in discharged vs. 32% in admitted; p < .05) was notable. Conclusions Discharge decisions require assessment of medical, functional, and social problems. Ill, frail patients often can be discharged home when social and nursing support can be provided. The degree of frailty, impaired mobility, and likely delirium must be taken into account when planning for their care. PMID:27076860

  9. Survival of male patients with spinal cord injury after cardiac arrest in Department of Veterans Affairs hospital: Pilot study

    Deborah Caruso, MD


    Full Text Available Survivability characteristics after cardiopulmonary resuscitation in the population with spinal cord injury (SCI are unclear but may be useful for advanced care planning discussions with patients. Retrospective evaluation from records of all SCI patients over 10 yr at a Department of Veterans Affairs medical center who experienced in-hospital cardiac arrest was performed. Demographic data and other common measurements were recorded. Thirty-six male subjects were identified, and only two patients survived to discharge (5.5% survival rate, both of whom were admitted for nonacute issues and were asymptomatic shortly before the cardiac arrest. The mean age at the time of cardiopulmonary arrest was 62.4 yr, with a mean time from cardiac arrest to death of 3.02 d. No significant demographic parameters were identified. Overall, SCI likely portends worse outcome for acutely ill patients in the situation of a cardiac arrest. Conclusions are limited by sample size.

  10. Experience of the Oncological Radiotherapy Department of the Asturias General Hospital on the treatment of testicular seminoma

    In this paper the limited experience of the Oncological Radiotherapy Department of the Asturia's General Hospital in the treatment of testicular seminoma is presented. This comprises 23 cases: 17 stage I cases and 6 stage II cases. No failure in the treatment of stage I cases was recorded, these patients exhibiting a 100% actual survival. In stage II patients, a regional failure attributable to an initial error in therapy planning which was rescued by a combination of chemotherapy and radiotherapy, and a case with lung metastases, were observed. Actual survival for this group was 83.33%. For all patients, actual survival was 95.65% (standard error: 4.25%). (Author). 6 refs