Les deux journaux de José Santos Vargas (1814-1825. 1: Problèmes d'édition

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1995-01-01

Full Text Available La découverte du journal de guerre tenu par le guérillero José Santos Vargas a renouvelé nos connaissances sur l’histoire de la guerre d’indépendance dans le Haut Pérou. Cependant, le fait qu’il existe deux manuscrits différents de ce document, publiés tous deux par les soins de don Gunnar Mendoza, l’un en 1952 en Bolivie, l’autre en 1982 au Mexique, pose aux historiens des problèmes que les choix effectués par l’éditeur ont obscurcis. Cette première livraison d’un article qui devrait en comprendre deux remet en question la valeur scientifique de l’édition de 1982. LOS DOS DIARIOS DE JOSÉ SANTOS VARGAS. 1: PROBLEMAS EDITORIALES. El descubrimiento del diario de guerra redactado por el guerrillero José Santos Vargas ha renovado el conocimiento de la guerra de independencia en el Alto Perú. Pero el hecho de que existen dos manuscritos distintos de este documento, ambos publicados por don Gunnar Mendoza, uno en Bolivia en 1952 y otro en México en 1982, plantea a los historiadores problemas que las decisiones del editor han obscurecido. Esta primera entrega de un artículo que constará de dos, pone en tela de juicio el valor científico de la edición de 1982. THE TWO DIARIES OF JOSÉ SANTOS VARGAS. 1: PROBLEMS OF EDITION. The discovery of the diary of the guerillero leader José Santos Vargas add to our knowledge of the history of the independence war in the Alto Peru. However, the existence of two different manuscripts, both published by don Gunnar Mendoza, the first in Bolivia, 1952, the second in Mexico, 1982, present historians with problems that have been obscured by the editor’s choices. In this first part of the two parts article, we question the scientific value of the edition of 1982.

La fiesta del Chivo, de Mario Vargas Llosa: perspectivas de recepción de una novela de éxito

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Frauke Gewecke

2014-06-01

Full Text Available Cuando a comienzos de marzo de 2000 la editorial Alfaguara lanzó al mercado español la nueva novela de Mario Vargas Llosa, anunciada desde hacía meses como evento editorial del año, la acogida por parte de la crítica fue unánimemente entusiasta, calificada la novela de “magistral” y “espléndida” o, para citar a Miguel García-Posada de El País (11-3-2000, de “narración poderosa”, escrita por Vargas Llosa “con su instinto de novelista nato”. Siguió una apretada campaña de promoción, con la presencia constante de Vargas Llosa en la prensa española y con una gira emprendida por el autor que lo llevó a Santo Domingo, Buenos Aires, Lima, México y hasta Miami.

El periodismo en la literatura. Impresiones de la realidad en la narrativa de Vargas Llosa

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Juana Martínez Gómez

2011-07-01

Full Text Available El periodismo y la literatura son prácticas escriturales que interesan a Vargas Llosa desde muy temprana edad y que cultiva de forma simultánea durante toda su vida. Desde su concepción realista de la literatura, el autor no puede soslayar la presencia del ámbito periodístico en algunasde sus novelas como una faceta relevante del conglomerado social ficcionalizado. Este trabajo aborda las diferentes formas que el periodismo adopta en sus novelas empezando brevemente por Conversación en la Catedral, para repasar después otras novelas y detenerse con mayorprofundidad en la última, El sueño del celta, en la que el periodismo aparece como soporte narrativo de gran envergadura.Palabras claves: Mario Vargas Llosa, literatura, periodismo, narrativa peruana.

Infarto agudo del miocardio en los centros diagnósticos integrales de Vargas, Venezuela Myocardial acute infarction in integral diagnosis centers of Vargas, Venezuela

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Ana Rosa Jorna Calixto

2010-12-01

2006 without evidence of decrease in mortality despite the technological improvement of emergences services. OBJECTIVE: to characterize its behavior in the integral diagnostic centers of the Vargas State from June, 2006 to June, 2009. METHODS: a retrospective and descriptive study was conducted to characterize the behavior of myocardial acute infarction in urgency and emergency services of integral diagnostic centers using the Barrio Adentro's Statistics. RESULTS: a total of 186 patients were seen due to myocardial acute infarction with predominance of intensive therapy admissions (2,4 % on the hospitalization services. Those deceased from this cause included 35 persons the 17,1 % of total of deceased. The 39,2 % was thrombolized where the higher figure was achieved in 2008 with a 51,2 %. The mortality from myocardial acute infarction fluctuated between rates of 17,3 and 20 by each 100 patients treated. The crude mortality rate was of 9,58 by 100 000 inhabitants. CONCLUSIONS: the figure of cases seen due to infarction had a stable increasing behavior, accounting for the 0,7 % of total of admissions in these centers with predominance of intensive therapy admissions over the hospitalization services. Thrombolytic treatment was applied using recombinant streptokinase in a significant percentage of patients. In the hospitalization services mortality from this cause was higher. The death risk not decreased for patients presenting with this disease and the general mortality during the study period was of 35 patients for a rate of 9,58 x 100 000 inhabitants.

Avidity of IgG for rubella: an evaluation of the need for implementation at the Materno-Infantil Presidente Vargas Hospital in Porto Alegre, Rio Grande do Sul, Brazil

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M.M. Reis

Full Text Available Rubella serum assays performed in the laboratory of the Materno-Infantil Presidente Vargas Hospital (HMIPV from 1998 to 2002 were reviewed to determine if IgG avidity assays should be implemented. IgG was determined using the Enzyme Linked Fluorescent Assay, ELFA, VIDAS® system, bioMérieux or the Microparticle Enzyme Immunoassay, MEIA, Axsym® system, Abbott, and IgM was determined using the ELFA, VIDAS® system, bioMérieux, a capture format assay. Specific IgG was assayed in 2,863 samples, with positive results for 84% of the patients, for the most part with high levels of antibodies. IgM was assayed in 2,851 samples, being positive in 14 (0.49% and inconclusive in 25 (0.88%. Serology for toxoplasmosis was also positive or inconclusive in 5 patients. After a cost-effectiveness analysis, it was decided not to implement avidity assays, considering that the HMIPV is a public institution, with limited funding. Difficulties concerning the integration of the Clinical Pathology Service with the Clinical Staff of the institution were also considered.

Un documento desconocido de Pedro Fermín de Vargas

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Alberto Corradine Angulo

1967-11-01

Full Text Available Varios autores se han detenido a estudiar la vida singularísima de don Pedro Fermín de Vargas, quien bien podría llevar con sobrados méritos el título de Precursor; testimonio de este aserto son sus escritos y su vida misma, llenas de la profundidad de sus observaciones, que presentaba a las autoridades virreinales con gran sencillez y naturalidad, aún cuando pretendía ocultar el verdadero alcance de sus planteamientos

El arte de hoy : Germán Vargas se llevó la risa

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Ana María Escallón

1991-01-01

Full Text Available Dijo la prensa que Germán Vargas, murió en Barranquilla el 21 de mayo de 1991. A quienes no aceptamos la evidencia del hecho, resulta imposible referirnos a él con nuestras propias palabras. Por esto, el Boletin Cultural y Bibliográfico transcribe lo que otros dijeron. D.J.A.

Dispersiones acuosas de poliuretano bloqueado: una alternativa como agente curtiente Aqueous dispersions of blocked polyurethane: an alternative as tanning agents

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José Luis Mata-Mata

2008-06-01

Full Text Available Se sintetizaron y se evaluaron como agentes curtientes de pieles vacunas dos tipos de agentes de reticulación base poliuretano bloqueado. Se presentan los resultados de la síntesis de dispersiones acuosas de poliuretano bloqueado (DPU’s, basadas en prepolímeros a partir de la reacción de los diisocianatos alifáticos H12MDI (4,4’ metilenbis-ciclohexilisocianato y HDI (hexametilendiisocianato con polioles base poliéter óxido de etileno de peso molecular 1 y 2 KDa, en una relación molar isocianato/oxhidrilo (NCO/OH de 4:1 y 6:1 a 100 °C por 2 y 4 horas. En una segunda reacción, los grupos isocianato (NCO libres del prepolímero se bloquearon con una solución acuosa de NaHSO3 ó Na2S2O5 al 40%p/p. Los prepolímeros se caracterizaron mediante espectroscopia IR y RMN de ¹H. El tanto por ciento de isocianato libre en el prepolímero, así como el bloqueo de dichos grupos, se determinaron por espectroscopía IR. La evaluación de la capacidad curtiente de las DPU’s se determinó de acuerdo a la estabilidad térmica de la piel (temperatura de desnaturalización, mediante Calorimetría Diferencial de Barrido (DSC y a la determinación del índice de reticulación de las DPU’s con la colágena de la piel mediante un ensayo con ninhidrina.Two types of crosslinking agents blocked polyurethanes were synthesized and evaluated as tanning agents of bovine skins. The results of the synthesis of aqueous dispersions of blocked polyurethane (DPU’s are presented. They were based on prepolymers from the reaction of the aliphatic diisocyanates H12MDI 4,4’-methylenebis(cyclohexyl isocyanate and HDI (hexamethylene diisocyanate with HO-polyols such as polyethylene oxide of molecular weight 1 and 2 kDa. The molar NCO/OH ratio was fixed in 4:1 or 6:1, at 100 °C and 2 or 4 hours for the reaction time. In a second reaction, the prepolymer containing terminal NCO groups were blocked by reaction with an aqueous NaHSO3 or Na2S2O5 solution to 40% w/w. The

Hombres. Don Tomás Rueda Vargas

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Boletin Cultural y Bibliográfico Banco de la República

1958-07-01

Full Text Available Quince años hizo el 25 de julio que desapareció de entre nosotros don Tomás Rueda Vargas. Su nombre, ejemplar por muchos conceptos, viene siempre nimbado de las virtudes cardinales que conformaron su tarea y su vida. Escritor nato,  sabía manejar el idioma con singular pericia sin caer en  rebuscamientos  ni  en  gongorismos. Su  pensamiento era diáfano por  lo cual no se  perdía en  el laberinto de  las palabras.   Apenas éstas eran  el dócil  instrumento para su dialéctica, para ese  generoso razo­  namiento intelectual que constituía el  Alfa  y el Omega   de  su diario batallar.

Natural hazards on alluvial fans: the debris flow and flash flood disaster of December 1999, Vargas state, Venezuela

Science.gov (United States)

Larsen, Matthew C.; Wieczorek, Gerald F.; Eaton, L.S.; Torres-Sierra, Heriberto; Sylva, Walter F.

2001-01-01

Large populations live on or near alluvial fans in locations such as Los Angeles, California, Salt Lake City, Utah, Denver, Colorado, and lesser known areas such as Sarno, Italy, and Vargas, Venezuela. Debris flows and flash floods occur episodically in these alluvial fan environments, and place many communities at high risk during intense and prolonged rainfall. In December 1999, rainstorms induced thousands of landslides along the Cordillera de la Costa, Vargas, Venezuela. Rainfall accumulation of 293 mm during the first 2 weeks of December was followed by an additional 911 mm of rainfall on December 14 through 16. Debris flows and floods inundated coastal communities resulting in a catastrophic death toll of as many as 30,000 people. Flash floods and debris flows caused severe property destruction on alluvial fans at the mouths of the coastal mountain drainage network. In time scales spanning thousands of years, the alluvial fans along this Caribbean coastline are dynamic zones of high geomorphic activity. Because most of the coastal zone in Vargas consists of steep mountain fronts that rise abruptly from the Caribbean Sea, the alluvial fans provide practically the only flat areas upon which to build. Rebuilding and reoccupation of these areas requires careful determination of hazard zones to avoid future loss of life and property. KEY TERMS: Debris flows, flash floods, alluvial fans, natural hazards, landslides, Venezuela

Esport e propaganda política: um estudo comparado dos governos de Vargas (1930-1945 e Perón (1946-1955 Deporte y propaganda política: un estudio comparado de los gobiernos de Vargas (1930-1945 Y Perón (1946-1955 = Sports and political propagand:a comparative study of the Vargas Government (1930-1945 and Peron (1946-1955

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Victor Andrade de Melo

2013-03-01

Full Text Available Este artigo tem por objetivo analisar a utilização do esporte como instrumento político durante e primeira Era Vargas, no Brasil, e durante os dois primeiros mandatos de Juan Domingo Perón, na Argentina. Tanto Vargas como Perón buscavam identificar o regime político com as vitórias obtidas no campo esportivo. Desta forma, o controle estatal sobre o esporte e sua utilização pelos meios de propaganda política visavam criar um elo de identificação nacional entre o esporte e os governos, ressaltando os novos modelos de nação e cidadãos engendrados pelo varguismo e pelo peronismo. Pretendeuse também analisar as diferenças na abordagem de cada governo sobre o esporte e seus modelos de intervenção na estrutura política interna do esporte. Esperase que este trabalho possa trazer contribuições significativas para o debate sobre a produção de um ideário político através do esporte, assim como sobre o processo de formação de identidades nacionais na América Latina, mais especificamente no Brasil e na Argentina.Este artículo tiene por objetivo analizarla utilización del deporte como instrumento político durante la primera etapa Vargas, en Brasil, y durante los dos primeros mandatos de Juan Domingo Perón, en Argentina. Tanto Vargas como Perón buscaban identificar su régimen político con las victorias obtenidas en los campos de deporte. De esta forma, el control estatal sobre el deporte y su utilización por los medios de propaganda política reafirmaban la identificación nacional entre el deporte y los gobiernos, resaltando los nuevos modelos de nación y ciudadanos creados por el varguismo y el peronismo. Se pretende también analizar las diferencias en la forma en que cada gobierno abordó el deporte y sus modelos de intervención en la estructura política interna del mismo. Se espera que este trabajo aporte contribuciones significativas para el debate sobre la producción de un ideario político a través del deporte

AISTHESIS EN EL REALISMO CRÍTICO DE LA CIUDAD Y LOS PERROS DE MARIO VARGAS LLOSA

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José Morales Saravia

2011-11-01

Full Text Available Lo nuevo de la "nueva novela hispanoamericana", que La ciudad y los perros (1962 de Mario Vargas Llosa representa, se halla en el re-trabajo de las categorías suministradas por la tradición realista bajo premisas que buscan despertar en el lector vivencias directas de lo feo. Este artículo analiza ambas estéticas implicadas en ello: aquella que construye lo feo en toda su amplitud y aquella del efecto que hace vivenciar lo feo directamente por el lector.The new aspect of the "nueva novela hispanoamericana", represented by Vargas Llosa's 1962 The Time of Hero, lies in the rework of categories from the realistic tradition under premises that seek to awaken in readers direct experiences of ugliness. This article analyses the two aesthetics involved in this process: one that constructs a vast fiction world of ugliness (KarlRosenkranz's Asthetik des Hasslichen, and another that enables readers to experience ugliness directly (Wirkungsasthetik.

Pesquisa de Micobactérias Ambientais em água de torneira, luvas e soluções utilizadas em procedimentos cirúrgicos no Hospital Universitário Getúlio Vargas - Manaus/AM Investigation of Environmental Mycobacteria in tap water, surgical gloves and antiseptic solutions used in surgical procedures at the Getúlio Vargas University Hospital, Manaus-AM/Brazil

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Adriana Vallejo Restrepo

2009-01-01

Full Text Available Investigou-se por métodos bacteriológicos (cultivo e moleculares (PCR - Restriction Enzyme Analysis, PRA, a presença de micobactérias ambientais em águas de torneira, soluções e luvas cirúrgicas, utilizadas nas etapas dos procedimentos cirúrgicos executados no centro cirúrgico do Hospital Universitário Getulio Vargas (HUGV, na cidade de Manaus-Amazonas/Brasil. Foram colhidas e analisadas 105 amostras sendo: 24 de águas (colhidas das 2 torneiras existentes no centro cirúrgico, 8 de solução de Povidine e 7 de solução de Clorhexidina, que servem para a higienização das mãos dos cirurgiões; 39 de luvas cirúrgicas (superfícies internas e externas; e 27 de soluções que foram efetivamente utilizadas durante o ato cirúrgico. Por método bacteriológico obteve-se 41 isolados micobacterianos apenas de águas das torneiras. Pelo PRA obteve-se a detecção de DNA micobacteriano somente na amostra de água que forneceu acima de 100 colônias de micobactérias por tubo semeado. Os isolados foram identificados como sendo Mycobacterium celatum perfil 2, M. gordonae perfil 3, M. gordonae perfil 6, M. intracellulare perfil 1, M. lentiflavum perfil 3 e M. mucogenicum perfil 1. O encontro de M. mucogenicum, espécie já incriminada em surtos pós-cirúrgicos, indica que devem ser efetuados procedimentos de limpeza e monitoramento em todos os pontos de distribuição de águas, visando à prevenção de surtos de micobacterioses nosocomiais induzidos pelo uso das águas nas diferentes atividades de manuseio ou higienização dos pacientes submetidos a procedimentos invasivos.Using bacteriological (culture and molecular (PCR - Restriction Enzyme Analysis, PRA methods, we investigated the presence of environmental mycobacteria in tap water, antiseptic solutions and surgical gloves, used in carrying out surgical procedures at the Getúlio Vargas University Hospital Surgical Center, in Manaus -Amazonas/Brazil. Samples (105 were collected and

Arquetipos femeninos en las obras de Francisco Umbral y Mario Vargas Llosa

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Godoy Cossío, Ana

2016-01-01

Sin duda, investigar a dos escritores como Francisco Umbral y Mario Vargas Llosa ambos situados en el Olimpo de los grandes escritores del siglo XX, no ha sido tarea fácil, pero sí verdaderamente fascinante. Poseedores de talento, creatividad y de genio literario son portadores de una marca propia e indeleble en el periodismo, en el ensayo crítico y en la narrativa. Dos columnas equidistantes y equivalentes con voz propia que se han coronado por igual gracias a sus productivas vidas. En suma,...

Acceleration of bioremediation of soil polluted with oil derivatives by using lad farming microorganisms from President Getulio Vargas refinery - REPAR/PETROBRAS, PR, Brazil; Aceleracao da biorremediacao de solo contaminado com derivados de petroleo com o uso de microorganismos do landfarming da Refinaria Presidente Getulio Vargas - PETROBRAS/REPAR

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Krenczynski, Michele Cristine; Carvalho, Francisco Jose Pereira de Campos [Parana Univ., Curitiba, PR (Brazil). Curso de Pos-Graduacao em Ciencia do Solo]. E-mail: fjcampos@cce.ufpr.br

1998-07-01

This work is part of the studies on bioremediation criteria of the oil wastes contaminated soil, which are being performed by the Presidente Getulio Vargas refinery - REPAR - PETROBRAS, Brazil. (author)

Dos precursores: D. Pedro Fermín de Vargas y D. Antonio Nariño

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Roberto Tisnés

1962-02-01

Full Text Available Se cumple en el presente año –el 3 de julio exactamente-el bicentenario del nacimiento del notable Precursor de la Independencia D. Pedro Fermín de Vargas. Como anticipo de la biografía que para esa fecha verá la luz pública, nos permitimos publicar uno de los capítulos de la primera parte.

Écrire dans la variante de l’autre : le cas de Sous les vents de Neptune de Fred Vargas

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Nadine Vincent

2014-04-01

Full Text Available Pour tout auteur, choisir d’écrire dans une langue ou dans la variante d’une langue qui n’est pas la sienne représente un défi de taille. Nous nous intéresserons au roman Sous les vents de Neptune, de l’écrivaine française Fred Vargas, qui a situé une partie de son intrigue au Québec, sans maîtriser la notion de variation linguistique. En analysant les réactions des lecteurs européens et québécois, de même que les caractéristiques de la langue québécoise de Vargas, nous aborderons la question de l’impérialisme linguistique et de son anachronisme au xxie siècle.

MARIO VARGAS LLOSA: LA FICCIONALIZACIÓN DE LA HISTORIA EN LA GUERRA DEL FIN DEL MUNDO

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Horst Nitschack

2011-11-01

Full Text Available En la novela La Guerra del fin del mundo Mario Vargas Llosa presenta una reescritura y ficcionalización del texto fundacional Os Sertdes de Euclides da Cunha. El presente artículo sitúa esta novela en el momento de un cambio radical de las convicciones ideológicas y políticas de Mario Vargas Llosa en la década de los 70 y se propone analizar de qué manera las nuevas posiciones neoliberales asumidas por el autor se reflejan en la poética de la novela. Como argumento central se sostiene que en el proceso de ficcionalización del texto referencial de Euclides da Cunha se dejan descubrir dos estrategias: la primera es la individualización de la Historia, es decir, la narración privilegia las experiencias subjetivas de los protagonistas para explicar sus disposiciones a la violencia; en la segunda, la ficcionalización asume una paradoja: finge representar lo irrepresentable advirtiendo al mismo tiempo al lector que se trata solamente de ficción, es decir, ella responsabiliza al propio lector en qué medida él está dispuesto a identificar la narración con la 'verdad' histórica. En los dos casos nos encontramos frente a una poética que valoriza la responsabilidad individual y lo subjetivo en vez de la dependencia individual de lo colectivo y del compromiso de la narración con la historia objetiva.In the novel The War of the End of the World (La guerra del fin del mundo Mario Vargas Llosa presents a rewriting and fictionalization of Euclides da Cunha's foundational text Os Sertdes. The article relates this novel to the radical change in Mario Vargas Llosa's ideological and political convictions in the 1970s and intends to analyze how the author's neo-liberal positions are reflected in the poetics of this novel. The central argument is that in this process of fictionalization of Euclides da Cunha's text, two strategies can be discovered: the first being the individualization of History, that is, the narrative privileges the subjective

José María Vargas (1786-1854): Reformer of anatomical studies in Venezuela.

Science.gov (United States)

Reverón, Rafael Romero

2014-03-01

José María Vargas (1786-1854): Venezuelan medical doctor, surgeon, optician, anatomist, chemist, botanist, professor, geologist, mineralogist, and mathematician. Second President of Venezuela (1835-1836), First republican dean, he reformed medicine studies in 1827 establishing human anatomical dissection in the Universidad Central de Venezuela where he taught human anatomy between 1827 and 1853 along with surgery and chemistry. In 1838, he wrote Curso de Lecciones y demostraciones Anatómicas, the first book on the subject printed in Venezuela for the teaching of human anatomy. Copyright © 2013 Wiley Periodicals, Inc.

EL CAPÍTULO PCP-SL EN LA NARRATIVA DE MARIO VARGAS LLOSA

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Lucero de Vivanco

2011-11-01

Full Text Available Este artículo aborda cuatro textos narrativos del escritor peruano Mario Vargas Llosa relacionados con la violencia que se vivió en Perú en el contexto de la guerra entre Sendero Luminoso y el Estado: las novelas Historia de Mayta y Lituma en los Andes y los documentos Informe de Uchuraccay e Historia de una matanza. La lectura que hago parte problematizando los supuestos teóricos planteados por el escritor en La verdad de las mentiras en relación con la "verdad" de la literatura y su independencia con respecto a la realidad. Desde este lugar crítico, propongo que sus teorías no solo son problemáticas en sí mismas cuando se trata de narrar la violencia, sino que no son coincidentes con las prácticas culturales de sus lectores, razón por la cual los debates se encienden en la escena ideológica y la cuestión de la referencialidad se vuelve lucha política.The present article focuses on four narrative texts by Peruvian writer Mario Vargas Llosa that deal with the war between Shining Path and the Peruvian state: the novels Historia de Mayta and Lituma en los Andes, and the documents Informe de Uchuraccay and Historia de una matanza. My reading begins by discussing the writer's theories about "truth" in literature and its independence from reality as shown in La verdad de las mentiras. From this critical position, I propose that these theories are not only problematic in themselves when narrating violence, but also that they do not match with his readers' cultural practices. This point has led to incensed discussions in ideological debates, turning the question of referentiality into a problem of political struggle.

Survey of the University "Luis Vargas Torres" through Econometric Techniques. Comprehensive Income

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Ramón Rodríguez-Betancourt

2015-12-01

Full Text Available Government Programme 2013-2017 defines in higher education, the principles of the curriculum proposals of much public interest careers. In this regard the authorities of the Technical University "Luis Vargas Torres" of Esmeraldas, have taken the decision to evaluate its management and action against the development of the province and the country. Therefore, the objective of this research is the application of a survey of students of different specialties, Faculty of Engineering and Technology to explore their views on the educational process, research, outreach, culture and sport, stratified random sampling with results showing that key processes are completed by 66% on average is applied, indicating that the authority still has to set goals to overcome the short comings that have an emphasis on research.

A Holocene pollen record of vegetation change and human impact from Pantano de Vargas, an intra-Andean basin of Duitama, Colombia

NARCIS (Netherlands)

Gomez, A.; Berrio, J.C.; Hooghiemstra, H.; Becerra, M.; Marchant, R.

2007-01-01

Holocene environments in the intra-Andean basin of Duitama (Eastern Cordillera of Colombia, 2510 m altitude) are presented based on the 620 cm long Vargas pollen and sediment record. Seven AMS radiocarbon dates show these lake and swamp sediments represent the period from 8800 to 2610 14C yr BP. We

La niña-mujer en el huerto narrativo de Francisco Umbral y Mario Vargas Llosa

OpenAIRE

Godoy Cossío, Ana

2017-01-01

El artículo aborda la preeminencia de la niña-mujer como uno de los arquetipos femeninos predominantes en las narrativas de Francisco Umbral y Mario Vargas Llosa. Desde la perspectiva espacio-temporal, el estudio proyecta el doble microcosmos ficcional/no ficcional de la infancia/niñez, en cuyas etapas imperan los episodios obsesivos como marcas indelebles de la memoria individual y colectiva, restauradas por el narrador/protagonista/testigo. En sus textos, las niñas son el núcleo del paraíso...

Teoría política posfundacional en La guerra del fin del mundo de Mario Vargas Llosa: ¿Canudos postestructuralista?

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Martín Retamozo

2011-11-01

Full Text Available It can be said that the relation between literature and political theory is not as prolific as that established by other disciplines such as philosophy, history and psychology. Although politics has held a central role in literature it is difficult to assert the prominence of political theory. A remarkable exception to this can be found in the novel La guerra del fin del mundo by Mario Vargas Llosa, not because the author dedicates himself to political theory but because of the complicity the plot shares with some contemporary theoretical perspectives. Within this horizon, the article proposes a reading of La guerra del fin del mundo in the light of its relation with key categories from post foundational political thought such as Heterogeneity, Antagonism, constitutive outside, empty signifier, discourse and hegemony. The article thus aims to contribute to the discussion of theoretical categories whose abstraction has often turned them difficult to assimilate. It also offers some reading clues to approach Vargas Llosa?s novel in the light of present political theory

Libros adquiridos por don Pedro Fermín de Vargas en sus viajes por las Antillas

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Sergio Elías Ortíz

1962-04-01

Full Text Available Entre los papeles relacionados con la vida de Don Pedro Fermín de Vargas, que pueden consultarse en el Archivo General de Indias de Sevilla, hay una carta de él y una lista de libros que envía al Administrador de Correos de la Habana, Don José Fuertes, antiguo amigo suyo, luego su corresponsal y a la  vez espía de sus pasos para aprisionarlo, con el objeto de que se los guardase “en algún rincón de sus casa”.

Re-appraisal and extension of the Gratton-Vargas two-dimensional analytical snowplow model of plasma focus evolution in the context of contemporary research

International Nuclear Information System (INIS)

Auluck, S. K. H.

2013-01-01

Recent resurgence of interest in applications of dense plasma focus and doubts about the conventional view of dense plasma focus as a purely irrotational compressive flow have re-opened questions concerning device optimization. In this context, this paper re-appraises and extends the analytical snowplow model of plasma focus sheath evolution developed by F. Gratton and J. M. Vargas [Energy Storage, Compression and Switching, edited by V. Nardi, H. Sahlin, and W. H. Bostick (Plenum, New York, 1983), Vol. 2, p. 353)] and shows its relevance to contemporary research. The Gratton-Vargas (GV) model enables construction of a special orthogonal coordinate system in which the plasma flow problem can be simplified and a model of sheath structure can be formulated. The Lawrenceville Plasma Physics (LPP) plasma focus facility, which reports neutron yield better than global scaling law, is shown to be operating closer to an optimum operating point of the GV model as compared with PF-1000

Evaluation of prescription indicators established by the WHO in Getúlio Vargas - RS

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Andressa Tanise Vooss

2011-06-01

Full Text Available To evaluate the conditions of the services offered to the community regarding medications, the World Health Organization (WHO has developed the Medication Use Indicators, among them Prescription indicators. The objective of this study was to evaluate drug prescriptions in a Basic Health Care Center in Getúlio Vargas - RS, according to the Prescription Indicators recommended by the WHO. The data collection was performed with the use of a form and the prescriptions for June / July and November / December 2008 were evaluated. The average number of drugs prescribed was 2.03, and 72.8% of the drugs were prescribed by generic name, 80.3% were on the list of essential drugs, 21.7% were antibiotics and 2.4% were injectable drugs. The results were in accordance with WHO recommendations and were similar to those reported by other studies.Para avaliar as condições dos serviços prestados à população no que se refere aos medicamentos, a Organização Mundial da Saúde (OMS desenvolveu Indicadores do uso de Medicamentos, entre eles os de Prescrição. O objetivo da pesquisa foi avaliar prescrições medicamentosas de usuários de uma Unidade Básica de Saúde do município de Getúlio Vargas - RS conforme os Indicadores de Prescrição preconizados pela OMS. A coleta de dados foi realizada com uma ficha. Para isso houve acesso as prescrições atendidas no período de junho/julho e de novembro/dezembro de 2008. A média de medicamentos prescritos foi de 2,03, 72,8% dos medicamentos foram prescritos pelo nome genérico, 80,3% constavam na lista dos medicamentos essenciais, 21,7% eram antibióticos e 2,4% injetáveis. Observou-se que os resultados obtidos estão de acordo com os recomendados pela OMS e que foram similares a outros estudos.

The Outreach Process in the Technical University Luis Vargas Torres, Esmeraldas, Ecuador

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Harold Oyarvide-Ramirez

2016-06-01

Full Text Available As part of the transformative process that takes place in the ecuadorian university is research that aims to improve the outreach model at the Technical University Luis Vargas Torres Esmeraldas developed. The need of jobs forces people to venture into small businesses, however, this process is done in an empirical way, without sufficient technical and administrative knowledge that will enable the company to manage efficiently and obtain funding sources. Hence the relevance of the study, which allows guide and train the business sector in order to conduct an efficient management and create new businesses that operate as a means for the transformation of the productive matrix. The research results are: the structure and function of outreach model, the key elements that support the creation of the Center for Business Development and Entrepreneurship Support and the socioeconomic impact achieved from the development of relations among universities, businesses and government.

Revisión de la escala de asertividad de Rathus adaptada por León y Vargas (2009)

OpenAIRE

León Madrigal, Marcela

2014-01-01

Se retomó el estudio desarrollado por León y Vargas (2009) para adaptar la escala Rathus a una muestra de estudiantes de educación superior costarricense. Se utilizaron los mismos datos con el fin de someter a prueba la estructura multidimensional del constructo, propuesta por dichos autores en el estudio original. También, se aporta nueva evidencia, basado en el análisis de estructuras de covarianza, de la validez convergente y divergente de las puntuaciones de la escala. Se enfatiza la impo...

LA PALABRA, LA IMAGEN Y EL MUNDO: LAS NOVELAS DE VARGAS LLOSA EN EL CINE

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Matías Rebolledo

2011-11-01

Full Text Available Uno de los medidores más concretos para dimensionar el impacto cultural y artístico de un autor en estos días es la cantidad de relecturas que generan sus obras (reescrituras, obras de teatro, películas, etc.. Cada una de estas reinterpretaciones genera nuevas perspectivas y lecturas sobre los textos originales, en un diálogo permanente. Al ser Mario Vargas Llosa uno de los autores latinoamericanos más adaptados en cine, se hace importante revisar críticamente las propuestas cinematográficas a partir de su obra. De este modo, este artículo revisa las tres principales adaptaciones de sus novelas, a saber, La ciudad y los perros, Pantaleón y las Visitadoras y La Fiesta del Chivo, analizando algunos aspectos centrales de cada una de éstas, ya sean estructurales o temáticos, para así iluminar algunas dimensiones no solo de cada adaptación en particular, sino de este intercambio discursivo en general.Nowadays, one of the most concrete ways to measure an author's cultural and artistic impact is the amount of reinterpretations over his works (in literature, theatre, cinema, etc.. Each one of these versions produces new interpretations and perspectives over the original texts, in a constant dialogue. One of the most adapted Latin-American authors to cinema is Mario Vargas Llosa, which reveals the importance of a critical study of the film versions of his works. Thus, this article reviews the three main adaptations of his novels (The Time of the Hero, Captain Pantoja and the Special Service, and The Feast of the Goat by analyzing central aspects pertaining either to structures or themes in order to elucidate certain dimensions relevant not only to each particular adaptation, but also to this discursive interchange in general.

In vitro use characterization of the microorganism from land farming of the Presidente Getulio Vargas Refinery, Brazil, for soils decontamination; Caracterizacao in vitro do uso de microorganismos do landfarming da Refinaria Presidente Getulio Vargas - PETROBRAS-REPAR para a descontaminacao de solos

Energy Technology Data Exchange (ETDEWEB)

Krenczynski, Michele Cristine; Goncalves, Claudia Martins; Castro, Rodrigo Azevedo; Nascimento Neto, Durval [Parana Univ., Curitiba (Brazil). Pos-graduacao em Ciencia do Solo; Carvalho, Francisco Jose Pereira de Campos [Parana Univ., Curitiba (Brazil); Grube, Karl; Coelho, Ibirajara Jorge Evangelista [PETROBRAS, Rio de Janeiro, RJ (Brazil)

1998-07-01

In the present work, a set of experiments are reported from the evaluation of commercial use of the microorganisms of the Refinaria Presidente Getulio Vargas PETROBRAS land farming as inoculants for accelerating the bioremediation of contaminated soil with petroleum sludge, light naphtha, shale naphtha, toluene, heavy refinery oily waste, solp oil, sludge from the oily swage treatment plant, oily swage sludge and mixed oily wastes. These results are presented and discussed comparatively, and the characterization of the biodegradation activity of the land farming microorganisms for use in acceleration of bioremediation is discussed. (author)

Sonhos americanos, realidades autoritárias: encontros entre a sociedade democrática de John Dewey e a era Vargas

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Jerry Dávila

2005-12-01

como o paradoxo do governo Vargas que, depois da perseguição a Teixeira, adotou silenciosamente muitos dos projetos defendidos por Teixeira. Em particular, este artigo sugere que as visões progressistas e autoritárias do papel do Estado nas reformas sociais, em última instância, dividem a mesma visão pós-modernista e a mesma limitação desta visão.

The health services wastes management of a sample of brazilian hospitals

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Claude Machline

2006-07-01

Full Text Available This paper focuses the Health Services wastes management of 70 Brazilian hospitals. As the outcome of a distance course, in 2003, each hospital was required to describe its existing Health Services wastes system and its Plan for improvement.The project was administered by an association of two leading Brazilian educational entities, the Fundação Getulio Vargas and the Universidade Federal de Santa Catarina. Data concerning collection, disposal and final treatment of infectious, hazardous, chemical, radioactive and common wastes were tabulated and analysed. Water supply, liquid effluents and gaseous emissions were also investigated..Their technical and economical aspects were appraised. The research indicates that the sampled hospitals are still in an incipient stage of wastes management. An extensive gap exists between the present situation and the legal and acceptable requirements they should comply with, both on health care and on environmental standpoints.

Escritores comprometidos, campo literario y novela total en los años sesenta. Mario Vargas Llosa, lector de Cien años de soledad

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Jorge Valenzuela Garcés

2011-07-01

Full Text Available El proyecto de “novela total” que concibieron y llevaron a la práctica connotados integrantes del “boom” de la novela hispanoamericana tuvo extraordinarias muestras en textos como Cien años de soledad o La casa verde. En este estudio nos ocupamos de describir el campo literario delos años sesenta y el modo en que este influye, a través de la figura del compromiso, en las demandas al escritor-intelectual de izquierda sobre la necesidad de proyectar, en los textos literarios, una imagen integral del proceso histórico y social del continente. El análisis se centra en la forma en que Vargas Llosa construye, a partir del análisis de una novela como Cien años de soledad, el proyecto de la novela total y el modo en que la novela del escritor colombiano representó esta totalidad respondiendoa las demandas del campo literario en un contexto marcado porun discurso que entonces explicaba la situación de retraso de nuestro continente debido a la dependencia del imperialismo.Palabras claves: Mario Vargas Llosa, novela total, campo intelectual, campo literario.

Periodization of the urban interventions: a review of ratings from “Vargas & Castilho”, “Boyer” and “Simões Jr.”

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Geise Brizotti Pasquotto

2010-09-01

Full Text Available The present paper aims to compare the periods proposed by three authors “Vargas e Castilho” (2006, “Boyer” (1998 and “Simões Jr.” (1994. They did it to identify four significant moments of intervention in urban space from the period of modernity. It is noteworthy that, in this comparison, the most important thing is not to define a concept, but understanding the process and the paradigms that underpin each of these interventions.

Mutante espontâneo de Bacillus licheniformis bloqueado no estágio I da esporogênese, possuidor de metabolismo respiratório aumentado A spontaneous mutant of Bacillus licheniformis with increased respiratory metabolism, blocked in stage I of sporogenesis

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Leon Rabinovitch

1976-01-01

Full Text Available Um mutante espontâneo de Bacillus licheniformis, derivado da amostra esporogênica 2390, foi estudado com vistas ao reconhecimento do estágio da evolução para esporo em que o mesmo se encontrava bloqueado. Eletronmicrografias sugeriram que as células desse mutante, colhidas durante a fase estacionária da curva de crescimento, não ultrapassaram o estágio I da esporogênese (i.e., permaneceram com o nucleóide disposto como filamento axial, enquanto a produção de antibiótico (bacitracina e a atividade proteolítica foram francamente detectadas. A linhagem mutante, designada Spolp-72, nas condições experimentais empregadas não biossintetizou esporos por estarvação em solução de sais inorgãnicos, mas evidenciou uma frequência de esporulação menor que 10*-7, após crescimento vegetativo em meio de cultura favorável á esporogênese. A amostra Spolp-72 externa um crescimento vegetativo inicial restringido, quando comparada com a amostra 2390, enquanto que, inversamente, sua atividade respiratória é significativamente mais elevada. Este último comportamento foi confirmado no presente trabalho, contrastando, nesse particular, com outros tipos de mutantes de esporulação já descritos, os quais se encontram bloqueados nos primeiros estágios da via esporogenética.A spontaneous mutant strain derived from the sporogenic B. licheniformis 2390 was studied with a view to determining at what developmental stage toward sporulation it was blocked. Electronmicrographs suggested that the mutant cells harvested during the stationary phase of the growth curve were unable to go beyond stage I of sporogenesis (i. e., their nucleoid remained as an axial filament. On the other hand, antibiotic production (bacitracin and proteolytic activity were easily detected. Under the present experimental conditions the mutant strain, named Spolp-72, did not synthesize spores by starvation in a solution of inorganic salts, in contrast with the parental

Entrevista a Consuelo Triviño: reivindica la obra del semiolvidado Vargas Vila, negando similitudes con la de Fernando Vallejo

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Fernando Díaz Ruiz

2014-06-01

Full Text Available En el año del sesquicentenario del nacimiento del escritor modernista más leído de su época, exiliado a Europa debido a sus ataques a los líderes de la Regeneración colombiana, la autora de La semilla de la ira (2008, novela sobre la vida de Vargas Vila, señala que sería importante elegir tres o cuatro libros suyos, los de mayor valor, y colocarlos en el lugar que les corresponde en nuestro sistema literario.

Repair procedure used in removing corroded pits in the distillation towers of the Getulio Vargas Refinery Unit 2100

Energy Technology Data Exchange (ETDEWEB)

Lordelos, H.M.; Santin, J.L.

1977-07-01

A description is given of the corrosion pits on ASTM A240, Type 405 steel cladded to carbon steel plates used in Petroleo Brasileiro S.A.'s Getulio Vargas Refinery Unit 2100 distillation towers; the repair procedure used, including sand blasting of the corroded surfaces, grinding of the pits, and welding of those pits whose depth was above a maximum limit, and the use of liquid penetrant to check the repairs made; and hydrostatic testing of the T2201 catalytic cracking unit, which used also cladded metals and on which the pits were much smaller in size and number than those on the distillation units.

El capítulo PCP-SL en la narrativa de Mario Vargas Llosa

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Lucero de Vivanco

2011-01-01

Full Text Available Este artículo aborda cuatro textos narrativos del escritor peruano Mario Vargas Llosa relacionados con la violencia que se vivió en Perú en el contexto de la guerra entre Sendero Luminoso y el Estado: las novelas Historia de Mayta y Lituma en los Andes y los documentos Informe de Uchuraccay e Historia de una matanza. La lectura que hago parte problematizando los supuestos teóricos planteados por el escritor en La verdad de las mentiras en relación con la "verdad" de la literatura y su independencia con respecto a la realidad. Desde este lugar crítico, propongo que sus teorías no solo son problemáticas en sí mismas cuando se trata de narrar la violencia, sino que no son coincidentes con las prácticas culturales de sus lectores, razón por la cual los debates se encienden en la escena ideológica y la cuestión de la referencialidad se vuelve lucha política.

La fisura irremediable: indígenas, regiones y nación en tres novelas de Mario Vargas Llosa

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María de las Mercedes Ortiz Rodríguez

2012-12-01

Full Text Available In his novels The Green House (1966, The Storyteller (1989 and Death in the Andes (1996, Mario Vargas Llosa reinforces the dominant visions in which the Peruvian Andes and jungle are portrayed as the realms of barbarism and savagery respectively—as opposed to the Coast, which is considered the civilized center of the nation. I discuss how he resuscitates topics like cannibalism and the extirpation of idolatries in colonial times, clearly employing the linear evolutionism of the nineteenth century. He uses these familiar tropes and images to characterize, as did his predecessors, indigenous people as savages, cannibals and pagans who constitute an obstacle for the development of Peru in a neoliberal and global world.

Tres lecturas de las novelas de Mario Vargas Llosa : interpretación psicoanalítica de la producción novelesca de un autor

OpenAIRE

Jonsson, Petter

2009-01-01

This doctoral thesis is a psychoanalytic interpretation of the novels of the Peruvian author Mario Vargas Llosa, and it explores these novels from three different perspectives, here called readings. The first perspective focuses on the literary techniques and the importance these may have for the interpretation of the content of the novels. This first reading includes a summary of the reception of the works and reveals many aspects that have not been discovered in earlier studies. The second ...

Venezuela : Vargas : Centrale thermo-électrique de Tacoa dans les années 1980 : littoral caraïbe de Catia La Mar

OpenAIRE

Pouyllau , Michel

1981-01-01

La Centrale thermo-électrique de Tacoa (connue actuellement comme Complejo Generador Josefina Joaquina Sánchez de Tacoa) a été construite en plusieurs étapes sur le littoral caraïbe de Catia La Mar (quartier Arrecife). Elle participe à l'approvisionnement électrique du Littoral de l'Etat de Vargas (villes de La Guaira, Maiquetia) ainsi que, pour partie, de la capitale Caracas. L'image correspond à une extension réalisée à la fin des années 1970 par Electricidad de Caracas et la compagnie belg...

Las dictaduras de Vargas y Franco: implicaciones de la consagración de la maternidad para la enfermería

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Tânia Cristina Franco Santos; Ieda de Alencar Barreira; Antonio José de Almeida Filho; Alexandre Barbosa de Oliveira

2010-01-01

Este estudio tuvo como objetivo describir las características históricas y sociales de Brasil y España en el contexto de los regímenes dictatoriales instaurados por Vargas y Franco, y analizar las representaciones sobre la maternidad en el contexto de esos regímenes y sus implicaciones para la enfermería. Es un estudio histórico y social cuyo método consideró como fuentes: documentos escritos brasileños y españoles. La recolección de los datos se hizó en el período de 13 de mayo a 29 de agost...

The intimidated bodies: The somatic consequences of state terrorism in Mario Vargas Llosa’s novel The Feast of the Goat

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Wojciech Sawala

2015-01-01

Full Text Available This paper argues that Mario Vargas Llosa’s novel The Feast of the Goat (2000 uses the images of the bodies of three of its characters (Urania Cabral, Trujillo and Agustín Cabral to represent the mechanisms of state terrorism at the time of Trujillo’s dictatorship in the Dominican Republic. It is a traumatizing system, which leaves somatic marks in all the actors involved. We analyze the manners in which the Peruvian author uses the images of protagonists’ organic processes to sketch the psychical, emotional and ideological processes and states, linked to or generated by the policies of intimidation.

Vargas Jiménez, Dolores: Picasso: iconografías del baile.

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José Jiménez Guerrero

2016-01-01

Full Text Available Fue en el año 1967. Bajo el mecenazgo de una institución ya desaparecida, el Liceo de Málaga, se convocó la primera edición del «Premio Málaga de Investigación». Esta loable iniciativa tuvo una continuidad temporal ininterrumpida hasta 1999. Tras ocho años de silencio, y gracias al respaldo de la Real Academia de Bellas Artes de San Telmo y de la Academia Malagueña de Ciencias, y al patrocinio de la entidad Cajamar, este prestigioso premio fue de nuevo convocado. A ello se sumó en el año 2012 la decisión adoptada por la Diputación de Málaga de publicar los trabajos premia dos en las dos modalidades del referido premio: Humanidades y Ciencias. Los libros editados forman parte de la colección que lleva por título «Premios Málaga de Investigación». En la convocatoria del año 2013, el premio de la sección humanística recayó en el trabajo presentado por Dolores Vargas Jiménez, doctora en Historia del Arte, bajo el título de Picasso: iconografías del baile. Y siguiendo lo preestablecido, su obra fue editada por la entidad supramunicipal.

Un modello italiano per l’economia nel Brasile di Getúlio Vargas: la «Carta del Lavoro» del 1927

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Mario G. Losano

2012-01-01

Full Text Available Il corporativismo fu uno degli elementi caratterizzanti dello Stato fascista, che con esso intendeva ricollegarsi alla tradizione medievale italiana. Oscillando tra storia e «invented tradition», con esso il governo fascista proponeva una soluzione alla crisi economica degli anni Trenta e un’alternativa allo Stato tanto liberale quanto comunista, cioè una «terza via». Del corporativismo italiano vengono sinteticamente esaminate le origini, l’evoluzione e la struttura, dedicando particolare attenzione alla Carta del Carnaro del 1920, il documento che lo preparò durante l’avventura di Fiume di Gabriele d’Annunzio. Il corporativismo, come modello di gestione economica che negava la lotta di classe, si diffuse in Europa e fuori di essa nell’epoca delle dittature. L’attenzione si concentra sul Brasile, nella sua transizione dalla República Velha alla dittatura di Getúlio Vargas, iniziata nel 1930 e durata fino al 1954, anche se in modo istituzionalmente non unitario. All’interno del movimento che l’accompagnò, l’«Integralismo», il filosofo Miguel Reale (1910–2006 propugnò un corporativismo democratico. Il modello corporativo italiano si riflette in alcune parti della vasta «Consolidação das Leis do Trabalho», emanata da Vargas nel 1943. Essa costituisce un chiaro esempio della legislazione sociale che accompagnò molte dittature del XX secolo e che, nel caso del Brasile, ebbe effetti anche dopo la caduta del regime. La «Consolidação» riguardava però soltanto i lavoratori urbani, mentre il Brasile era una società prevalentemente agraria. Per questo vengono passare in rassegna le misure a favore dei diritti sociali dei lavoratori urbani e agrari prese dai governi di Juscelino Kubitschek (1902–1976 e di João Goulart (1919–1976, nonché, infine, la tutela accordata nel 1964 ai lavoratori agrari dallo Statuto della Terra.

BRAZILIAN ADMINISTRATION, ADMINISTRATIVE REFORM AND THE NEW STATE: THE ROLE OF ADMINISTRATIVE APPARATUS IN VARGAS ADMINISTRATION

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Emerson Moura

2016-07-01

Full Text Available The role played by the administrative apparatus through the Department of Administrative Services in the Government policy Vargas is the object put in debate. Analyzes the theme from the the investigation of patrimonial, authoritarian and inefficient context which marks the formation and development of administrative bureaucracy, the tenders of professionalization and efficiency brought by the administrative reforms of the 1930s and 1940s with the contrast of the limitations of the import of the Weberian model in the Brazilian context and analysis of the establishment of the New State DASP and their assignments. Search the work demonstrate the control position he held directly and through the State Departments in the Brazilian Public Administration ensuring centralized and developmental policy of the government. For this is adopted as the research method of approach structuralism in order to identify the deconstruction of the phenomenon - of administrative reforms - in the superficial perception - the proposed impersonality and efficiency as the best way of achieving the public interest - its invariant structure - the search for the adequacy of the administrative apparatus and bureaucracy for pursuit of political ends pursued by the Government.

Apocalipsis y literatura en Cien años de soledad de Gabriel García Márquez, La guerra del fin del mundo de Mario Vargas Llosa y Estrella distante de Roberto Bolaño

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Laura Luche

2013-07-01

Full Text Available The study examines three novels of apocalyptic character, Cien años de soledad by Gabriel García Márquez, La guerra del fin del mundo by Mario Vargas Llosa and Estrella distante by Roberto Bolaño. Both in Cien años de soledad and in La guerra del fin del mundo apocalypse is related to the sudden and forced graft of modernity in a backward society and to the inability of the ruling class to understand the disturbing and devastating aspects of such a graft and, more generally, to understand themselves, their own development, their own history. Through the metaliterary component that characterizes them, Garcia Marquez’s and Vargas Llosa’ novels represent literature as an instrument that as memory, as a form of processing and understanding of history, can help to prevent the repetition of the apocalypse they narrate. In Bolaño’s novel, on the contrary, writers seem not to have any cognitive power anymore and their literature not only doesn’t play any salvific role, but rather becomes one of the elements that contributes to the historical catastrophe.

[The Vargas Dictatorship in Brazil (1937-1945) and the Primer Franquismo in Spain (1939-1945): power and counter-power of nurses].

Science.gov (United States)

Santos, Tânia Cristina Franco; Gomes, Maria da Luz Barbosa; Oliveira, Alexandre Barbosa de; Almeida Filho, Antonio José de

2012-01-01

This is a historical and social study, which aimed to describe the main characteristics of the Vargas and Franco dictatorships, and to analyze the implications of these to the institutionalization of nursing in Brazil and Spain. As fonts, it was used written documents located in the historical Brazilian and Spanish archives, in addition to the literature on the subject. Data analysis, supported by concepts of Pierre Bourdieu's World Social Theory, showed that, in Brazil and Spain, in referring to the social division of labor, the meeting point between Church and the State was the seclusion of women in private space. It is concluded that the feminine qualities were capitalized by the nurses to legitimize their actions in public space, even to reproduce in that space, consented to by the State and Church, occupations appropriate to femininity.

First record of folivory on a newly documented host plant for the little known geometrid moth Eupithecia yubitzae Vargas & Parra (Lepidoptera, Geometridae in northern Chile

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Héctor A. Vargas

2015-06-01

Full Text Available The native tree Schinus molle (Anacardiacae is reported for the first time as a host plant for larvae of the little known geometrid moth Eupithecia yubitzae Vargas & Parra (Lepidoptera, Geometridae in the Atacama Desert of northern Chile, based on morphology and DNA barcodes. This discovery importantly expands the host range of E. yubitzae, as previous records were restricted to Fabaceae trees. Larvae were previously known as florivorous, while these were found to be folivorous on S. molle. Furthermore, host-associated cryptic larval polychromatism was detected, as larvae collected on S. molle were found to be mostly pale green, contrasting with the dark yellow ground color of the larvae typically collected on fabaceous host plants.

Análisis de la comunicación persuasiva: la entrega del Nobel a Vargas Llosa

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Santiago Martínez

2012-04-01

Full Text Available Desde los tiempos de su candidatura a la presidencia de Perú, el Premio Nobel de Literatura Mario Vargas Llosa nunca renunció a su faceta política así como tampoco a la de observador de la sociedad. Algo que le ha procura- do numerosos detractores pero que no ha mermado sus dotes narrativas. Esta controversia provocó interpretaciones frontalmente encontradas a su discurso en la ceremonia de entrega de los galardones, celebrada en diciembre de 2010. Cuando observamos la interpretación que de aquel acontecimiento realizaron dos medios de comunicación escritos, queda reflejada, al aplicar en el más amplio sentido del término, el uso de las técnicas de comunicación periodística persuasiva. Se realiza así en este trabajo un análisis de diversos aspectos que influyen en esta forma de comunicación, desde la elección de la persona que ha de redactar la información o el comentario de fondo, hasta la selección de los textos originales, completos o fragmentados, que apoyan las opiniones vertidas en la información, pasando por el análisis formal, incluso, del tipo de imágenes elegidas para ilustrar la información y su apoyo en forma de texto de pie de foto.

De Los ríos profundos a Lituma en los andes: La respuesta de Mario Vargas Llosa a José María Arguedas

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Marie-Madeleine Gladieu

2011-05-01

Full Text Available La novela de Mario Vargas Llosa Lituma en los Andes1 poco tiene que ver, aparentemente, con el mundo narrativo de José María Arguedas: las nuevas aventuras de un personaje ficticio bien conocido de los lectores, presente en varias obras anteriores de aquel autor, en nada se asemejan a las del niño Ernesto ni a las de otro protagonista arguediano. Los Andes sirven de decorado para los dos relatos, pero entre la naturaleza y los pueblos que se suceden en Los ríos profundos2en toda su diversidad, y los paisajes hoscos y siempre peligrosos por los que cruza Lituma, apenas reconoce el lector aquella parte del sur peruano. Algunos detalles, sin embargo, al examinar bien el texto y el contexto de Lituma en los Andes, llaman la atención.

Apocalipsis y literatura en Cien años de soledad de Gabriel García Márquez, La guerra del fin del mundo de Mario Vargas Llosa y Estrella distante de Roberto Bolaño

OpenAIRE

Laura Luche

2013-01-01

The study examines three novels of apocalyptic character, Cien años de soledad by Gabriel García Márquez, La guerra del fin del mundo by Mario Vargas Llosa and Estrella distante by Roberto Bolaño. Both in Cien años de soledad and in La guerra del fin del mundo apocalypse is related to the sudden and forced graft of modernity in a backward society and to the inability of the ruling class to understand the disturbing and devastating aspects of such a graft and, more generally, to understand...

Global parameter optimization of a Mather-type plasma focus in the framework of the Gratton–Vargas two-dimensional snowplow model

International Nuclear Information System (INIS)

Auluck, S K H

2014-01-01

Dense plasma focus (DPF) is known to produce highly energetic ions, electrons and plasma environment which can be used for breeding short-lived isotopes, plasma nanotechnology and other material processing applications. Commercial utilization of DPF in such areas would need a design tool that can be deployed in an automatic search for the best possible device configuration for a given application. The recently revisited (Auluck 2013 Phys. Plasmas 20 112501) Gratton–Vargas (GV) two-dimensional analytical snowplow model of plasma focus provides a numerical formula for dynamic inductance of a Mather-type plasma focus fitted to thousands of automated computations, which enables the construction of such a design tool. This inductance formula is utilized in the present work to explore global optimization, based on first-principles optimality criteria, in a four-dimensional parameter-subspace of the zero-resistance GV model. The optimization process is shown to reproduce the empirically observed constancy of the drive parameter over eight decades in capacitor bank energy. The optimized geometry of plasma focus normalized to the anode radius is shown to be independent of voltage, while the optimized anode radius is shown to be related to capacitor bank inductance. (paper)

Perception Modelling of Visitors in Vargas Museum Using Agent-Based Simulation and Visibility Analysis

Science.gov (United States)

Carcellar, B. G., III

2017-10-01

Museum exhibit management is one of the usual undertakings of museum facilitators. Art works must be strategically placed to achieve maximum viewing from the visitors. The positioning of the artworks also highly influences the quality of experience of the visitors. One solution in such problems is to utilize GIS and Agent-Based Modelling (ABM). In ABM, persistent interacting objects are modelled as agents. These agents are given attributes and behaviors that describe their properties as well as their motion. In this study, ABM approach that incorporates GIS is utilized to perform analyticcal assessment on the placement of the artworks in the Vargas Museum. GIS serves as the backbone for the spatial aspect of the simulation such as the placement of the artwork exhibits, as well as possible obstructions to perception such as the columns, walls, and panel boards. Visibility Analysis is also done to the model in GIS to assess the overall visibility of the artworks. The ABM is done using the initial GIS outputs and GAMA, an open source ABM software. Visitors are modelled as agents, moving inside the museum following a specific decision tree. The simulation is done in three use cases: the 10 %, 20 %, and 30 % chance of having a visitor in the next minute. For the case of the said museum, the 10 % chance is determined to be the closest simulation case to the actual and the recommended minimum time to achieve a maximum artwork perception is 1 hour and 40 minutes. Initial assessment of the results shows that even after 3 hours of simulation, small parts of the exhibit show lack of viewers, due to its distance from the entrance. A more detailed decision tree for the visitor agents can be incorporated to have a more realistic simulation.

First record of the genus Spinaethorax Papáč & Palacios-Vargas, 2016 (Collembola, Neelipleona, Neelidae in Asia, with a new species from a Vietnamese cave.

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Clément Schneider

2017-10-01

Full Text Available A new species of the genus Spinaethorax Papáč & Palacios-Vargas, 2016, recently erected for two cave species of Mexico, is described from a Vietnamese cave. It differs from the Mexican species most noticeably by the dorsal chaetotaxy of the head (number and morphology of chaetae, the shape of S-chaetae on the third antennomere, the dorsal chaetotaxy of the abdomen and the chaetotaxy of the dens. The pattern of special τ-chaetae is described for the first time in the genus. The affinities between Spinaethorax and the other genera of Neelipleona are discussed. Spinaethorax is probably closely related to Neelus Folsom, 1896. A table of the differential characters is provided for the three known species of Spinaethorax. Spinaethorax appears to be restricted to caves, but its presence in Vietnam indicates that this genus has a much larger distribution than previously recognized.

O prelúdio das campanhas de alfabetização na era Vargas: a Cruzada Nacional de Educação - The prelude of literacy campaigns in the Vargas Era: the crusade National Education

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Alessandro Carvalho Bica

2011-05-01

Full Text Available As primeiras décadas da chamada era Vargas podem ser caracterizadas por suas mudanças políticas, culturais, sociais ou pedagógicas. No que tange às transformações ou alterações no campo da escolarização, muitos pesquisadores tem se dedicado a pesquisas acerca dessa temática. Ademais, afirma-se que a preocupação com os rumos educacionais e os altos índices de analfabetismo da população brasileira, inflamou os discursos políticos no limiar da década de 1930. Nesta ótica, o Manifesto dos Pioneiros da Educação Nova consolidou a visão de um segmento da intelectualidade que, embora com diferentes posições, vislumbrava a possibilidade de interferir na organização da sociedade brasileira do ponto de vista da educação. Neste sentido, pelo decreto n. 21.731, de 15 de agosto de 1932, a Cruzada Nacional de Educação foi declarada de utilidade pública. Considerava-se que a alfabetização se constituía no elemento básico para a solução de todos os problemas políticos e sociais do Brasil. Em seus principais artigos, o decreto instituía anualmente a Semana da Alfabetização no Brasil, durante o mês de outubro. Esta campanha mobilizou vários setores da sociedade na possibilidade de abrir mais de 10.000 escolas primárias em todo o Brasil. No documento que segue, pode-se observar um discurso permeado de intenções cívicas e patrióticas.

“Antonio Vargas Reyes y la Medicina del Siglo XIX”. Del Académico Roberto de Zubiría

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Efraim Otero Ruiz

2004-03-01

Full Text Available

La Segunda Edición de un Libro Admirable (Comentario a la 2ª Edición del libro “Antonio Vargas Reyes-La Medicina del Siglo XIX en Colombia” por el Académico Roberto de Zubiría C.-Febrero 2003

Circunstancias ajenas a la voluntad de los protagonistas hicieron que la presentación de este libro ante la Academia Nacional de Medicina tuviera que ser postergada hasta la fecha actual. De todas maneras, persiste mi vivo agradecimiento ante las directivas de la Academia y ante el mismo autor por haberme distinguido con el honor de ser yo quien presente ante ustedes esta obra, en el momento ya con varios meses de haber sido publicada por Editorial Kimpres, en un elegante volumen de 212 páginas y que marca un hito entre los libros de historia médica publicados en el país en el año 2002.

Efectivamente, en sus 20 capítulos, seguidos de un apéndice y del testamento del personaje aquí biografiado, además de una extensa bibliografía curiosamente referida con números romanos, Roberto de Zubiría nos entrega una visión panorámica de lo que fue, como reza el subtítulo, la medicina del siglo XIX en Colombia. Medicina que estuvo rubricada y marcada por los sucesos de la independencia, en su segunda década, a la que se siguió el cambio intelectual necesario y obligatorio que nos trocaba de un pensamiento de colonos y súbditos al de seres independientes, que debían crear o transformar las nuevas instituciones de la patria. Como lo ha dicho el historiador médico español García-Valdés a propósito de Europa, podría decirse que el siglo XIX sólo llega a la medicina colombiana a partir de 1820. Por eso el primer capítulo hace un inventario de lo que era el ambiente y las escuelas iniciales de la primera mitad de ese siglo, con los primeros intentos de establecer una cátedra por José Celestino Mutis y Miguel de Isla, a quienes el autor señala justamente como los verdaderos precursores

Las dictaduras de Vargas y Franco: implicaciones de la consagración de la maternidad para la enfermería

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Tânia Cristina Franco Santos

2010-01-01

Full Text Available Este estudio tuvo como objetivo describir las características históricas y sociales de Brasil y España en el contexto de los regímenes dictatoriales instaurados por Vargas y Franco, y analizar las representaciones sobre la maternidad en el contexto de esos regímenes y sus implicaciones para la enfermería. Es un estudio histórico y social cuyo método consideró como fuentes: documentos escritos brasileños y españoles. La recolección de los datos se hizó en el período de 13 de mayo a 29 de agosto de 2008. Para el análisis se realizaron las etapas de organización y clasificación de las fuentes elegidas. Como resultado, se evidencio que la glorificación de la mujer por sus virtudes físicas como la maternidad y por sus atributos morales legitimó su inserción honorable en el espacio público, para reproducir en ese espacio, como enfermeras, las cualidades femeninas necesarias al cuidado. Se concluye que la consagración de la maternidad ha determinado posibilidades y límites para la enfermera.

Cult of the Sexless Casement with Special Reference to the Novel The Dream of the Celt by Mario Vargas Llosa (Nobel Prize Winner for Literature 2010

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Jeffrey Dudgeon

2014-01-01

Full Text Available The Irish revolutionary Roger Casement, executed in 1916, has spawned an army of books, articles, and news stories, more about his diaries and the authenticity controversy that still surrounds them than about his seminal work encouraging and arming Irish separatism or his humanitarian investigations in the Congo and the Peruvian Amazon. His aura and image in life, and more so in death, was Christ-like. A cult developed that required him to be sexless. The more he was said to be an active homosexual, as graphically revealed in his journals, ironically, the more he was revered as an icon by his Catholic nationalist supporters. The entry of Nobel prizewinning novelist Mario Vargas Llosa to the field and his adoption of a mixed, even contradictory, view of Casement’s sexuality in his Dream of the Celt (2010 has sparked a new round of disputation particularly from Angus Mitchell, the foremost proponent of the diary forgery theory. This emerges in his extensive Field Day Review articles, one of which provides a full history of the controversy. 

Rute e Alberto resolveram ser turistas a leitura literária para crianças no período Vargas

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CELDON FRITZEN

2014-01-01

Full Text Available Tratando del estudio de la lectura de obras literarias para niños en el período de Vargas, este artículo examina el trabajo de la Comisión Nacional de Literatura Infantil (CNLI y su comprensión de este tipo de lectura. El análisis muestra cómo la perspectiva de aquelllos intelectuales fue determinada por la tensión entre lo lúdico y lo pedagógico. A continuación, el artículo discute la renovación pedagógica propuesta por la Escuela Nueva y sus conexiones con el concepto de la lectura de obras literarias propuestas por la CNLI. Por fin, el texto analiza la obra didáctica de Cecilia Meireles Rute e Alberto resolveram ser turistas (1938. Se há verificado que em esa obra de carácter eminentemente didáctico, la autora dejó clara su relación con los valores consagrados por la Escuela Nueva. Cecilia, en essa obra, intento utilizar recursos literarios, tales como la creación de personajes, espacios de ficción, el uso de diálogos y narraciones, sin obtener el equilibrio en la compleja dinámica entre la enseñanza y lo lúdico. El resultado es una obra que, en comparación con otras de la misma autora, no está a la altura de sus logros literarios.

POLÍTICAS PÚBLICAS DE EMPREGO NO BRASIL: apontamentos entre a Era Vargas e o Neoliberalismo

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Leonardo de Araujo e Mota

2016-01-01

Full Text Available No Brasil, a partir dos anos 1930, com a criação do Ministério do Trabalho, Indústria e Comércio e a elaboração da legislação trabalhista, o mercado de trabalho brasileiro regulamentou-se com a criação das leis de proteção ao trabalhador, conferindo ao Estado o objetivo de inserção do trabalhador na organização das políticas de emprego. A partir dos anos 1990, porém, evidenciou-se a redução da intervenção do Estado nas relações capital-trabalho, explicação possível para a limitação de políticas públicas de geração de emprego e renda. Este artigo tem como objetivo efetuar uma síntese sócio-histórica das políticas de emprego no Brasil comparando a Era Vargas ao Neoliberalismo, considerando as relações capital-trabalho na perspectiva da intervenção do Estado, das mudanças tecnológicas, dos cenários macroeconômicos e da organização da produção no mundo do trabalho contemporâneo. A pesquisa bibliográfica foi o método de pesquisa utilizado, tendo como referências livros, artigos e publicações em meio digital. Concluiu-se que, embora políticas de emprego ainda existam e tenham como finalidade criar condições favoráveis de acesso ao mercado de trabalho para os trabalhadores, o Estado neoliberal tornou-se refém de conjunturas macroeconômicas cada vez mais competitivas em nível global para a criação de novos postos de trabalho, fato que precipita os trabalhadores em empregos cada vez mais precários, flexíveis e de baixa remuneração.

Teoría política posfundacional en La guerra del fin del mundo de Mario Vargas Llosa: ¿Canudos postestructuralista?

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Martín Retamozo

2012-11-01

Full Text Available La relación entre teoría política y literatura quizás no pueda contarse entre las más fecundas si se la compara con el vínculo que han establecido disciplinas como la filosofía, la historia y la psicología. Si bien la política ha ocupado un lugar central en la literatura es difícil sostener que la teoría política haya obtenido un sitio destacado. Una notable excepción encontramos en la novela La guerra del fin del mundo de Mario Vargas Llosa, no porque el autor se dedique a la teoría política, sino por la complicidad de la trama de la novela con ciertas perspectivas teóricas contemporáneas. En este horizonte, el artículo tiene como objetivo realizar una lectura de La guerra del fin del mundo y sugerir su relación con categorías centrales de la teoría política de inspiración posfundacional como Heterogeneidad, Antagonismo, exterior constitutivo, significante vacío, discurso y hegemonía. El trabajo que presentamos, de este modo, pretende aportar a la discusión de ciertas categorías teórico políticas que muchas veces por su grado de abstracción han suscitado dificultades pero también ofrecer claves de lectura de esta novela desde la teoría política actual

Use of bioremediation and treatment of wetland for remediation of the accidental crude-oil spill of July 16, 2000 at the Petrobras Refinery Refinaria Presidente Getulio Vargas (REPAR), Araucaria, PR, Brazil

Energy Technology Data Exchange (ETDEWEB)

Millette, D. [Hydrogeo Plus Inc., Montreal, PQ (Canada); Falkiewicz, F.; Zamberlan, E. [Petrobras-REPAR, Araucaria (Brazil); Campos Carvalho, F.J.P. de [Universidade Federal do Parana, Curifiba (Brazil). Dept. de Solos; Neto, A.C.B.; Caicedo, N.O.L.; Motta Marques, D. [Universidad Federal do Rio Grande do Sul, Porto Alegre (Brazil). Instituto de pesquisas hidraulicas; Linhares, M. [Petrobras, Rio de Janeiro (Brazil)

2003-07-01

On July 16, 2000, a pipeline supplying oil to the PETROBRAS refinery Refinaria Presidente Getulio Vargas-REPAR, located in Araucaria, Brazil, ruptured. The resulting oil spill involved approximately 4 million litres of crude oil. Workers managed to retain a vast quantity of oil within a two-kilometre area called Ponto O. The banks and floodplain of a small stream, the Arroio Saldanha, were contaminated, as well as the soil of four small wetlands. The authors presented an overview of the remediation program implemented. They focused on the soil bioremediation and treatment of wetland programs. Some of the remediation technologies used were: in situ bioremediation, injection and recovery trenches, and treatment of wetland in the vicinity of the discharge. Most of the free product from the sector adjacent to the spill site seems to have been removed by the recovery trenches. The preliminary data obtained from soil monitoring points to the efficiency of in situ bioremediation. Wetland vegetation was successfully restored and hydrocarbons appear to have been removed from the groundwater. 2 figs.

VIH e infecciones oportunistas: un tema de actualidad y motivo de interés en nuestra familia FELSOCEM.

Directory of Open Access Journals (Sweden)

Pedro Felipe Parra Velasco

2010-08-01

Full Text Available Me complace observar, la forma en que los estudiantes de medicina se concientizan de problemas grandes de nuestra sociedad, que impactan la salud en términos de mortalidad. Es el caso del VIH; referenciado en un artículo de la edición anterior; denominado “Infecciones oportunistas en individuos VIH hospitalizados. Hospital Vargas de Caracas. 2005 - 2006”, poniendo en manifiesto las infecciones oportunistas como factor determinante en la sobrevida de los pacientes que padecen esta enfermedad (...

Eimeria atlapetesi nom. nov., a replacement name for Eimeria pileata Soriano-Vargas et al., 2015 (Apicomplexa: Eimeriidae), preoccupied by Eimeria pileata Straneva and Kelley, 1979 (Apicomplexa: Eimeriidae), with observations on histopathology and phylogenetic analysis.

Science.gov (United States)

Soriano-Vargas, Edgardo; Salgado-Miranda, Celene; Zepeda-Velázquez, Andrea Paloma; Medina, Juan Pablo; Janczur, Mariusz Krzysztof; González-Gómez, Maricruz; Flores-Valle, Izanami Tereira; Berto, Bruno Pereira; Lopes, Carlos Wilson Gomes

2017-01-31

Eimeria pileata Soriano-Vargas, Medina, Salgado-Miranda, García-Conejo, Galindo-Sánchez, Janczur, Berto and Lopes, 2015 is a junior homonym of Eimeria pileata Straneva and Kelley, 1979 and needs to be replaced. This coccidium was described from a rufous-capped brush finch Atlapetes pileatus Wagler in the Nevado de Toluca Natural Protected Area, Mexico. Thus, to maintain the original intent of the specific epithet derived from the scientific name of the type-host, the name Eimeria atlapetesi nom. nov. is proposed as a replacement name. Additionally, the current work reports another rufous-capped brush finch A. pileatus parasitized by E. atlapetesi in co-infection with an Isospora sp., providing observations of histopathology and phylogenetic analysis of 18S ribosomal RNA (rRNA) gene from E. atlapetesi. Endogenous forms of E. atlapetesi and Isospora sp. were observed in intestinal sections. Few oocysts of Isospora sp. were observed; therefore they were not morphologically or molecularly identified. In return, E. atlapetesi was identified and it was phylogenetically close to Eimeria dispersa Tyzzer, 1929 from the domestic turkey Meleagris gallopavo Linnaeus.

Surface composition of Ru containing duplex stainless steel after passivation in non-oxidizing media

CSIR Research Space (South Africa)

Myburg, G

1998-10-01

Full Text Available . Skinner, J. Appl. Elec- .7112. wx .471 or 971. wx .301. wxN.D. Tomashov, G.P. Chernova, E.N. Ustinsky, Corrosion .134. wxN.D. Tamashov, G.P. Chermava, L.A. Chigirinskaya, E.A. .704. wxK. Varga, P. Baradlai, W.O. Barnard, G. Myburg, P. Halmas, .25. wx...J.H. Potgieter, W. Skinner, A.M. Heyns, in: Proceedings of the 1st International Chromium Steel and Alloys Congress, 2, 1992, p. 235. wxJ.H. Potgieter, W.O. Barnard, G. Myburg, K. Varga, P. .? 1103. wxK. Varga, P. Baradlai, W.O. Barnard, J.H. Potgieter, P. .143...

Latitudes, el ancho mundo de la investigación social: Bolivianos, paraguayos y argentinos en la obra : Una investigación de la antropóloga Patricia Vargas sobre la relación entre la migración de países limítrofes y el mercado de trabajo en la construcción en el área metropolitana

OpenAIRE

Mendivil, Adrián; Vargas, Patricia

2005-01-01

Latitudes es un ciclo de programas especiales, idea y conducción del periodista Adrián Mendivil, basado en la investigación en ciencias sociales. En esta entrega, se entrevista a la antropóloga Patricia Vargas sobre el impacto de inmigración de países limítrofes en el mercado de trabajo en la construcción en el área metropolitana argentina. Explica el concepto de "etnografía" y su aplicación para comprender la temática: la llegada de bolivianos y paraguayos y su relación con los trabajadores ...

Principais indicadores e ferramentas utilizados pelos gestores: uma análise estatística da percepção dos alunos de MBA da Fundação Getúlio Vargas Management indicators and tools: perceptions of MBA students

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Marcelo Cauduro de Castro

2007-09-01

Full Text Available O objetivo deste estudo foi identificar a relevância de indicadores e ferramentas de gestão na percepção dos alunos de MBA da Fundação Getúlio Vargas (FGV. Para isso, utilizou-se um questionário com 26 quesitos definidos a partir de pesquisas anteriores e uma escala de variação de importância do tipo Likert. A amostra foi composta de um total de 425 alunos. Desses, 97 entrevistados não selecionaram nenhum indicador ou ferramenta de gestão. Assim, 328 respostas foram analisadas e interpretadas. Os resultados demonstraram que o Fluxo de Caixa Projetado é o indicador de gestão mais relevante, seguido da Margem Líquida de Vendas. Os dados também apontaram, entre as cinco primeiras posições, indicadores considerados mais sofisticados, como, por exemplo, o Balanced Scorcard (BSC, o Earnings before Interest Taxes Depreciation and Amortization (EBITDA e o Economic Value Added (EVA®. Verificou-se também que as exigências relativas à informação contábil variavam de acordo com o perfil dos respondentes. Os resultados demonstram também que não existe um indicador ou ferramenta de gestão que seja considerado ótimo. Finalmente, há indícios apontados pela pesquisa de que, apesar de a contabilidade gerencial ser considerada uma disciplina global, suas especificidades e características podem ser locais ou regionais.The relevance of management indicators and tools, according to perception of 425 MBA students of the Fundação Getulio Vargas, was identified using a questionnaire with 26 queries based on previous surveys. Results from only 328 respondents were analyzed because 97 did not select any management indicator or tool. Project Cash Flow was the most relevant indicator followed by Net Revenues. In addition the three more sophisticated indicators of Balanced Scorecard (BSC, Earnings before Interest Taxes Depreciation and Amortization (EBITDA and Economic Value Added (EVA® were among the first five ranked. Since it was noted

Quantitative analysis of the relief in watersheds of the “El Ávila” massif northern hillside (Vargas State, Venezuela and its hydrogeomorphological meaning

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Williams José Méndez Mata

2016-11-01

Full Text Available The morphological features of the relief and its quantitative morphometric quantification are essential elements in interpreting its influence on the hydrogeomorphological dynamics of watersheds in mountainous environments. This is particularly important when studying small spatial units (micro watersheds and torrential regimes, as this influences the sudden and aggressive hydrological responses of these systems and the likelihood of activation of mass removal processes. In the study region (Vargas State, Venezuela the most important debris flow recorded in Venezuela’s history occurred on December 14, 15 and 16, 1999, as a consequence of extremely heavy rainfall in those dates associated with a very particular weather. For the above reasons, this research conducted a quantitative analysis of the relief features in watersheds of “El Ávila” massive northern hillside and their impact on the local hydrogeomorphological dynamics, aimed at identifying the main attributes influencing these dynamics. The study area is located in the northern-central region of Venezuela, in the central part of Vargas state, delimited by 10º32’25”-10º37’35”N and 66º40’08”- 66º59’12”W, and comprises thirteen micro watersheds of mountainous environment. The methodology consisted of (a the geomorphological characterization of the area, from the review and interpretation of digitized base maps at scales 1:5 000 and 1:25 000, the digital elevation model (DEM, aerial photographs at scale 1:5 000, orthophotomaps at scale 1:25 000, satellite images, Google Earth and Google Maps images, and geomorphological maps (landforms and geomorphological processes at scale 1:25 000; (b measurements and calculations of basic morphometric parameters of watershed relief on digital mapping using the ArcGIS 9.2 and their Spatial Analysis and ArcHydro modules, and the mathematical equations that define the other parameters using MS Excel; (c descriptive statistical

El Boom y el fracaso de los intelectuales. Sobre Conversación en la Catedral (1969 de Vargas Llosa y Cien años de soledad (1967 de García Márquez

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Mercedes Alonso

2015-01-01

Full Text Available El debate en torno al papel de los intelectuales tiene un lugar central en el Boom de la Literatura Latinoamericana. Por un lado,  porque es un momento en que los escritores saltan a la esfera pública e intervienen en ámbitos que exceden o literario. Por otro, porque ha sido uno de los temas que ha ocupado a la crítica en su afán de adscribir el fenómeno al mercado o a las circunstancias políticas de América Latina. Bajo el supuesto de esa centralidad, el presente artículo busca desentrañar las representaciones del intelectual que aparecen en dos novelas del período: Conversación en la Catedral (1969 de Mario Vargas Llosa y Cien años de soledad (1967 de Gabriel García Márquez. En ellas aparecen elementos y problemáticas presentes en los debates que les son contemporáneos con una mirada más amplia que la que opone al escritor y el político (o al intelectual y el revolucionario. Las tareas propias del letrado y la relación con la esfera pública y con las masas definen a los dos personajes principales a partir de los que se puede reconstruir una definición del intelectual.

Aragarças: a cidade encantada no sertão de Goiás

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Manuel Ferreira Lima Filho

2000-06-01

Full Text Available Analiso aqui o espaço social da cidade de Aragarças que foi construída pela Expedição Roncador-Xingu (1942-1943 e Fundação Brasil Central, (1943-1967, contextualizadas no movimento Marcha para o Oeste, iniciada pelo governo de Getúlio Vargas. A parte Alta da cidade é a materialização no espaço das representações sociais da comunidade de memória que se formou, de modo especial, representada pelos pioneiros servidores que viveram na cidade o apogeu da Fundação Brasil Central, nas décadas de 1940 e 1950, quando foram construídas suas principais obras como o hospital, o hotel Getúlio Vargas, a olaria, o aeroporto e as pontes sobre os rios Garças e Araguaia que uniram a cidade com Barra do Garças (MT. No período, constitui-se uma grande malha área regional, militarizando o espaço aéreo do Brasil Central e Amazônia. Em oposição, existe a parte Baixa da cidade, situada às margens do rio Araguaia, que a Expedição Roncador Xingu já encontrara ocupada pelos garimpeiros e sertanejos. Compreender a fusão cidade/pioneiro é primordial para se ter acesso à cadeia de signos que produzem uma comunicação da cultura do pioneiro do médio Araguaia e suas relações sociais.I analyze here the social space of the city of Aragarças. Built by the Roncador-Xingu Expedition (1942-1943 and Fundação Brasil Central [(1943-1967, both contextualized in the movement March to the West, begun by Getúlio Vargas's government. The high part of the city, begun in the space named by the pioneers of the 'Old Base' is the materialization in the space of the social representations from community memory that was formed, in a special way, represented by the pioneer workers that lived in the city the acme of the Brazil Central Foundation, in the decades of 1940 and 1950. Its main works were the building of the hospital, Getúlio Vargas Hotel, the pottery , the airport and the bridges on the rivers Garças and Araguaia that united the city with

Interaction of science and diplomacy: Latin American, the United States and nuclear energy, 1945-1955

International Nuclear Information System (INIS)

Cabral, R.

1986-01-01

Nuclear programs in Argentina and Brazil can be traced to August 1945 when their scientific communities articulated responses to the atomic bombings of Japan. They culminated in attempts to develop independent nuclear programs, sharply opposed by the United States, during the nationalist governments of Juan Peron and Getulio Vargas. This dissertation, based on primary sources from the three nations, analyzes these programs and the American responses. Latin America entered the nuclear age attempting to control natural resources, to improve scientific establishments, and to appraise Latin American-United States relations. Despite some clear warnings about nuclear dangers, the new form of energy was seen as the solution to industrial problems, poverty, and outside political interference. International opposition, which may have included nuclear threats from the United States, blocked Argentina's first attempt in 1947. After 1948, Peron wanted a nuclear program for cheap energy and prestige. The qualifications of the Brazilian scientists gave more substance to their program. The program originated in August, 1945, but assumed national proportion with the government of Vargas in 1951. Lack of American cooperation forced Vargas to establish a secret program with Germany. American troops intervened taking over the German equipment already completed. The final collapse came about with Vargas' suicide in August, 1954

Magnetic Nanostructures Patterned by Self-Organized Materials

Science.gov (United States)

2016-01-05

Palma , J. Escrig, J. C. Denardin Angular dependence of the coercivity and remanence of ordered arrays of Co nanowires Journal of...J. L. Palma , C. Gallardo, L. Spinu, J. M. Vargas, L. S. Dorneles, J. C. Denardin, J. Escrig, Magnetic properties of Fe20 Ni80 antidots: Pore size and...array disorder, Journal of Magnetism and Magnetic Materials., 344, 2013, 8-13 7. E. Vargas, P. Toro, J.L. Palma , J. Escrig, C. Chaneac,

Determination of elemental impurities and U and O isotopic compositions with a view to identify the geographical and industrial origins of uranium ore concentrates

Science.gov (United States)

Salaun, A.; Hubert, A.; Pointurier, F.; Aupiais, J.; Pili, E.; Richon, P.; Fauré, A.; Diallo, S.

2012-12-01

First events of illicit trafficking of nuclear and radiological materials occurred 50 years ago. Nuclear forensics expertise are aiming at determining the use of seized material, its industrial history and provenance (geographical area, place of production or processing), at assisting in the identification and dismantling of illicit trafficking networks. This information is also valuable in the context of inspections of declared facilities to verify the consistency of operator's declaration. Several characteristics can be used to determine the origin of uranium ore concentrates such as trace elemental impurity patterns (Keegan et al., 2008 ; Varga et al., 2010a, 2010b) or uranium, oxygen and lead isotopic compositions (Tamborini et al., 2002a, 2002b ; Wallenius et al., 2006; Varga et al., 2009). We developed analytical procedures for measuring the isotopic compositions of uranium (234U/238U and 235U/238U) and oxygen (18O/16O) and levels of elemental impurities (e.g. REE, Th) from very small amounts of uranium ore concentrates (or yellow cakes). Micrometer particles and few milligrams of material are used for oxygen isotope measurements and REE determination, respectively. Reference materials were analyzed by mass spectrometry (TIMS, SF-ICP-MS and SIMS) to validate testing protocols. Finally, materials of unknown origin were analyzed to highlight significant differences and determine whether these differences allow identifying the origin of these ore concentrates. References: Keegan, E., et al. (2008). Applied Geochemistry 23, 765-777. Tamborini, G., et al. (2002a). Analytical Chemistry 74, 6098-6101. Tamborini, G., et al. (2002b). Microchimica Acta 139, 185-188. Varga, Z., et al. (2009). Analytical Chemistry 81, 8327-8334. Varga, Z., et al. (2010a). Talanta 80, 1744-1749. Varga, Z., et al. (2010b). Radiochimica Acta 98, 771-778 Wallenius, M., et al. (2006). Forensic Science International 156, 55-62.

Re-appraisal and extension of the Gratton-Vargas two-dimensional analytical snowplow model of plasma focus. III. Scaling theory for high pressure operation and its implications

Science.gov (United States)

Auluck, S. K. H.

2016-12-01

Recent work on the revised Gratton-Vargas model (Auluck, Phys. Plasmas 20, 112501 (2013); 22, 112509 (2015) and references therein) has demonstrated that there are some aspects of Dense Plasma Focus (DPF), which are not sensitive to details of plasma dynamics and are well captured in an oversimplified model assumption, which contains very little plasma physics. A hyperbolic conservation law formulation of DPF physics reveals the existence of a velocity threshold related to specific energy of dissociation and ionization, above which, the work done during shock propagation is adequate to ensure dissociation and ionization of the gas being ingested. These developments are utilized to formulate an algorithmic definition of DPF optimization that is valid in a wide range of applications, not limited to neutron emission. This involves determination of a set of DPF parameters, without performing iterative model calculations, that lead to transfer of all the energy from the capacitor bank to the plasma at the time of current derivative singularity and conversion of a preset fraction of this energy into magnetic energy, while ensuring that electromagnetic work done during propagation of the plasma remains adequate for dissociation and ionization of neutral gas being ingested. Such a universal optimization criterion is expected to facilitate progress in new areas of DPF research that include production of short lived radioisotopes of possible use in medical diagnostics, generation of fusion energy from aneutronic fuels, and applications in nanotechnology, radiation biology, and materials science. These phenomena are expected to be optimized for fill gases of different kinds and in different ranges of mass density compared to the devices constructed for neutron production using empirical thumb rules. A universal scaling theory of DPF design optimization is proposed and illustrated for designing devices working at one or two orders higher pressure of deuterium than the current

Doença de Castleman associada a sarcoma de células dendríticas foliculares e miastenia gravis Castleman's disease associated with follicular dendritic cell sarcoma and myasthenia gravis

Directory of Open Access Journals (Sweden)

Fernando Luiz Westphal

2010-12-01

Full Text Available A doença de Castleman é um distúrbio linfoproliferativo atípico, de etiologia desconhecida, que pode estar associada a uma série de condições clínicas, inclusive doenças de caráter autoimune e neoplasias malignas. No presente relato, uma paciente de 72 anos foi encaminhada ao serviço de cirurgia torácica do Hospital Universitário Getúlio Vargas, localizado na cidade de Manaus (AM para a ressecção de um tumor de mediastino posterior. Três meses antes, havia sido internada em UTI com um quadro de dispneia intensa, ocasião na qual foi diagnosticada miastenia gravis. Após a ressecção da massa mediastinal, a análise histopatológica revelou doença de Castleman hialino-vascular complicada por sarcoma de células dendríticas foliculares. Até o momento da redação deste estudo, a paciente utilizava um anticolinesterásico e corticoides para o controle da miastenia gravis.Castleman's disease is an atypical lymphoproliferative disorder of unknown etiology, which might be associated with various clinical conditions, including autoimmune diseases and malignant neoplasms. We report the case of a 72-year-old female patient who was referred to the thoracic surgery department of Getúlio Vargas University Hospital, in the city of Manaus, Brazil, for the resection of a posterior mediastinal tumor. Three months prior, the patient had been admitted to the ICU with signs of severe dyspnea, at which time she was diagnosed with myasthenia gravis. After the resection of the mediastinal tumor, the histopathological examination revealed hyaline vascular-type Castleman's disease, complicated by follicular dendritic cell sarcoma. At this writing, the patient was being treated with an anticholinesterase agent and corticosteroids for the control of myasthenia gravis.

La construcción de la entomología agrícola en Venezuela y la facultad de agronomía de la UCV: una visión histórica.

OpenAIRE

Pacheco Troconis, Germán

2007-01-01

Presentación. Freites, Yajaira Viejas concepciones y nuevos términos. Old conceptions and new terms. Strozzi, Susana Núcleo ecotecnológico para el desarrollo local sostenible de Camurí grande, estado Vargas. Nucleo ecotecnologico for the sustainable local development of great Camurí, state Vargas. Da Silva, María de Fátima; Libretti, Gianfranco y Ramos, Niurka Villafañe y la estadística del Táchira en 1877. Una herramienta de racionalización de la actividad urbana. ...

2020 Focus briefs on the world's poor and hungry people:

OpenAIRE

IFPRI

2007-01-01

Contents: 1.The Changing Profile of Poverty in the World/Shaohua Chen and Martin Ravallion. 2.Characteristics and Causes of Severe Poverty and Hunger/Akhter U. Ahmed, Ruth Vargas Hill, Lisa C. Smith, and Tim Frankenberger. 3.The Poorest and Hungry: Looking Below the Line/Akhter U. Ahmed, Ruth Vargas Hill, and Doris M. Wiesmann. 4.Mapping Where the Poor Live/Todd Benson, Michael Epprecht, and Nicholas Minot 5.Child Malnutrition in India and China/Peter Svedberg. 6.Poverty and the Globalization...

Hospital staffing and hospital costs.

Science.gov (United States)

Andrew, R R

1976-08-07

A comparative study of costs per bed per day in teaching hospitals affiliated with Monash University compared with large non-teaching metropolitan hospitals (1964 to 1974) shows they are much higher in teaching hospitals. There is no evidence that this is due to the additional costs arising from the clinical schools. Research in the teaching hospitals and the accompanying high professional standards and demands on services are major factors accounting for the difference. Over the decade studied, the resident staff have increased by 77% and other salaried staff by 24%. The index of expenditure for the three teaching hospitals in the decade has increased by 386%.

An iterative method for the solution of nonlinear systems using the Faber polynomials for annular sectors

Energy Technology Data Exchange (ETDEWEB)

Myers, N.J. [Univ. of Durham (United Kingdom)

1994-12-31

The author gives a hybrid method for the iterative solution of linear systems of equations Ax = b, where the matrix (A) is nonsingular, sparse and nonsymmetric. As in a method developed by Starke and Varga the method begins with a number of steps of the Arnoldi method to produce some information on the location of the spectrum of A. This method then switches to an iterative method based on the Faber polynomials for an annular sector placed around these eigenvalue estimates. The Faber polynomials for an annular sector are used because, firstly an annular sector can easily be placed around any eigenvalue estimates bounded away from zero, and secondly the Faber polynomials are known analytically for an annular sector. Finally the author gives three numerical examples, two of which allow comparison with Starke and Varga`s results. The third is an example of a matrix for which many iterative methods would fall, but this method converges.

Hospitality within hospital meals—Socio-material assemblages

DEFF Research Database (Denmark)

Justesen, Lise; Gyimóthy, Szilvia; Mikkelsen, Bent E.

2016-01-01

Hospital meals and their role in nutritional care have been studied primarily from a life and natural science perspective. This article takes a different approach and explores the idea of hospitality inspired by Jacques Derrida’s work on the ontology of hospitality. By drawing on ethnographic fie...... and management involved in hospital food service and in nutritional care to work more systematically with the environment for improved hospital meal experiences in the future......Hospital meals and their role in nutritional care have been studied primarily from a life and natural science perspective. This article takes a different approach and explores the idea of hospitality inspired by Jacques Derrida’s work on the ontology of hospitality. By drawing on ethnographic...

Hospital Prices Increase in California, Especially Among Hospitals in the Largest Multi-hospital Systems

Directory of Open Access Journals (Sweden)

Glenn A. Melnick PhD

2016-06-01

Full Text Available A surge in hospital consolidation is fueling formation of ever larger multi-hospital systems throughout the United States. This article examines hospital prices in California over time with a focus on hospitals in the largest multi-hospital systems. Our data show that hospital prices in California grew substantially (+76% per hospital admission across all hospitals and all services between 2004 and 2013 and that prices at hospitals that are members of the largest, multi-hospital systems grew substantially more (113% than prices paid to all other California hospitals (70%. Prices were similar in both groups at the start of the period (approximately $9200 per admission. By the end of the period, prices at hospitals in the largest systems exceeded prices at other California hospitals by almost $4000 per patient admission. Our study findings are potentially useful to policy makers across the country for several reasons. Our data measure actual prices for a large sample of hospitals over a long period of time in California. California experienced its wave of consolidation much earlier than the rest of the country and as such our findings may provide some insights into what may happen across the United States from hospital consolidation including growth of large, multi-hospital systems now forming in the rest of the rest of the country.

Exploração do acervo da RAE-Revista de Administração de Empresas (1961 a 2016) à luz da bibliometria, text mining, rede social e geoanálise

OpenAIRE

José Eduardo Ricciardi Favaretto; Eduardo de Rezende Francisco

2017-01-01

This article examined more than five decades of the Revista de Administração de Empresas (Journal of Business Administration [RAE]), between 1961 and 2016, through accessing documents made available on the internet in the electronic repository of periodicals and magazines of the Biblioteca Digital da Fundação Getulio Vargas-Escola de Administração de Empresas de São Paulo (Digital Library of the Getulio Vargas Foundation-School of Business Administration of São Paulo), which follows the Open ...

Can hospitals compete on quality? Hospital competition.

Science.gov (United States)

Sadat, Somayeh; Abouee-Mehrizi, Hossein; Carter, Michael W

2015-09-01

In this paper, we consider two hospitals with different perceived quality of care competing to capture a fraction of the total market demand. Patients select the hospital that provides the highest utility, which is a function of price and the patient's perceived quality of life during their life expectancy. We consider a market with a single class of patients and show that depending on the market demand and perceived quality of care of the hospitals, patients may enjoy a positive utility. Moreover, hospitals share the market demand based on their perceived quality of care and capacity. We also show that in a monopoly market (a market with a single hospital) the optimal demand captured by the hospital is independent of the perceived quality of care. We investigate the effects of different parameters including the market demand, hospitals' capacities, and perceived quality of care on the fraction of the demand that each hospital captures using some numerical examples.

A orgia perpétua: Flaubert e Madame Bovary. Translated by José Rubens Siqueira

Directory of Open Access Journals (Sweden)

Matheus Silva Vieira

2017-05-01

A presente resenha visa analisar a nova tradução de La orgía perpetua, realizada por José Rubens Siqueira, e publicada em 2015. Publicado originalmente em 1975, La Orgía perpetua é o terceiro livro de crítica de Vargas Llosa; antes ele já havia escrito Bases para una interpretación de Ruben Darío (1958 e García Márquez: historia de un deicídio (1971. É comum a crítica afirmar que La Orgía perpetua é uma das portas de entrada para os estudos flaubertianos, o que não deixa de ser uma verdade, mas essa obra também pode ser lida como um “confessionário crítico”, já que Llosa assume nesse livro a influência recebida de Flaubert. Assim, La orgía perpetua pode interessar tanto aos estudiosos da obra de Gustave Flaubert, quanto aos estudiosos de Vargas Llosa.  Por A orgia perpétua se tratar de um livro de crítica literária e não de ficção, encontramos um texto em que Vargas Llosa não explora tanto os recursos estilísticos da língua espanhola, mais especificamente do espanhol “callejero” peruano, como o faz em livros como As cidades e os cachorros. Desse modo, ao analisarmos a tradução de Siqueira, percebemos que esse tradutor se ateve ao estilo claro e direto da prosa ensaística de Vargas Llosa.

Hospital waste management in nonteaching hospitals of Lucknow City, India

Directory of Open Access Journals (Sweden)

Manish Kumar Manar

2014-01-01

Full Text Available Objective: To assess hospital waste management in nonteaching hospitals of Lucknow city. Materials and Methods: A cross-sectional, descriptive study was conducted on the staffs of nonteaching hospitals of Lucknow from September 2012 to March 2013. A total of eight hospitals were chosen as the study sample size. Simple random sampling technique was used for the selection of the nonteaching hospitals. A pre-structured and pre-tested interview questionnaire was used to collect necessary information regarding the hospitals and biomedical waste (BMW management of the hospitals. The general information about the selected hospitals/employees of the hospitals was collected. Results: Mean hospital waste generated in the eight nonteaching hospitals of Lucknow was 0.56 kg/bed/day. About 50.5% of the hospitals did not have BMW department and colored dustbins. In 37.5% of the hospitals, there were no BMW records and segregation at source. Incinerator was used only by hospital A for treatment of BMW. Hospital G and hospital H had no facilities for BMW treatment. Conclusion: There is a need for appropriate training of staffs, strict implementation of rules, and continuous surveillance of the hospitals of Lucknow to improve the BMW management and handling practices.

Desaparecidos

Directory of Open Access Journals (Sweden)

Mario Benedetti

2012-08-01

Full Text Available Están en algún sitio / concertados desconcertados / sordos buscándose / buscándonos bloqueados por los signos y las dudas contemplando las verjas de las plazas los timbres de las puertas / las viejas azoteas ordenando sus sueños sus olvidos quizá convalecientes de su muerte privada nadie les ha explicado con certeza si ya se fueron o si no si son pancartas o temblores sobrevivientes o responsos ven pasar árboles y pájaros e ignoran a qué sombra pertenecen cuando empezaron a desaparecer hace t...

A intensidade dos algoritmos nas séries iniciais: uma imposição sócio-histórico-estrutural ou opção valiosa? p.55-76

OpenAIRE

Mendonça, Maria do Carmo Domite

2009-01-01

Como nós professores podemos reconhecer/valorizar ou não o quadro que aí está em Educação Matemática? Como os professores-pesquisadores podemos compreender a ansiedade existente em treinar os algoritmos convencionais, quando o assunto é o cálculo das operações aritméticas básicas? Um caminho para a mudança seria focalizar/discutir o que, naturalmente, tem bloqueado atitudes de maior autonomia frente a esse fato matemático, imobilizando-os mesmo para qualquer inovação. Então, usando argumentos...

Estudio sobre la percepción de calidad de vida que presentan pacientes que han sufrido un accidente cerebrovascular a través de la ECVI-38

OpenAIRE

Rodríguez Álvarez, Sandra

2016-01-01

Trabajo fin de Grado, curso 2015/2016 [ES] Introducción. La OMS define el accidente cerebrovascular como la interrupción del suministro de sangre al cerebro, por lo general debido a que un vaso sanguíneo se rompe o es bloqueado por un coágulo. Esto corta el suministro de oxígeno y nutrientes, causando daños en el tejido cerebral. El Ictus representa la tercera causa de muerte y la primera de invalidez en los adultos de los países occidentales, con una incidencia de 200 casos por cada 10...

The application of hospitality elements in hospitals.

Science.gov (United States)

Wu, Ziqi; Robson, Stephani; Hollis, Brooke

2013-01-01

In the last decade, many hospital designs have taken inspiration from hotels, spurred by factors such as increased patient and family expectations and regulatory or financial incentives. Increasingly, research evidence suggests the value of enhancing the physical environment to foster healing and drive consumer decisions and perceptions of service quality. Although interest is increasing in the broader applicability of numerous hospitality concepts to the healthcare field, the focus of this article is design innovations, and the services that such innovations support, from the hospitality industry. To identify physical hotel design elements and associated operational features that have been used in the healthcare arena, a series of interviews with hospital and hotel design experts were conducted. Current examples and suggestions for future hospitality elements were also sought from the experts, academic journals, and news articles. Hospitality elements applied in existing hospitals that are addressed in this article include hotel-like rooms and decor; actual hotels incorporated into medical centers; hotel-quality food, room service, and dining facilities for families; welcoming lobbies and common spaces; hospitality-oriented customer service training; enhanced service offerings, including concierges; spas or therapy centers; hotel-style signage and way-finding tools; and entertainment features. Selected elements that have potential for future incorporation include executive lounges and/or communal lobbies with complimentary wireless Internet and refreshments, centralized controls for patients, and flexible furniture. Although the findings from this study underscore the need for more hospitality-like environments in hospitals, the investment decisions made by healthcare executives must be balanced with cost-effectiveness and the assurance that clinical excellence remains the top priority.

From Chavela to Frida: loving from the margins.

Science.gov (United States)

Ruiz-Alfaro, Sofía

2012-01-01

This article analyzes the portrayal of lesbian desire in the case of two of the most renowned icons of contemporary Mexican and Latino popular culture: singer Chavela Vargas (1919-2012) and painter Frida Kahlo (1910-1954). This article explores the intertextual dialogue between two texts that deal with the construction of Kahlo's persona and sexuality: Chavela's memoir, titled Y si quieres saber de mi pasado (2002), and the film Frida (2001), directed by Julie Taymor. Fundamental to this study is Chavela Vargas' lesbian subject position in both texts and the consequences and implications her location has in representing lesbian homoerotics and desire.

The Impact of Hospital Size on CMS Hospital Profiling.

Science.gov (United States)

Sosunov, Eugene A; Egorova, Natalia N; Lin, Hung-Mo; McCardle, Ken; Sharma, Vansh; Gelijns, Annetine C; Moskowitz, Alan J

2016-04-01

The Centers for Medicare & Medicaid Services (CMS) profile hospitals using a set of 30-day risk-standardized mortality and readmission rates as a basis for public reporting. These measures are affected by hospital patient volume, raising concerns about uniformity of standards applied to providers with different volumes. To quantitatively determine whether CMS uniformly profile hospitals that have equal performance levels but different volumes. Retrospective analysis of patient-level and hospital-level data using hierarchical logistic regression models with hospital random effects. Simulation of samples including a subset of hospitals with different volumes but equal poor performance (hospital effects=+3 SD in random-effect logistic model). A total of 1,085,568 Medicare fee-for-service patients undergoing 1,494,993 heart failure admissions in 4930 hospitals between July 1, 2005 and June 30, 2008. CMS methodology was used to determine the rank and proportion (by volume) of hospitals reported to perform "Worse than US National Rate." Percent of hospitals performing "Worse than US National Rate" was ∼40 times higher in the largest (fifth quintile by volume) compared with the smallest hospitals (first quintile). A similar gradient was seen in a cohort of 100 hospitals with simulated equal poor performance (0%, 0%, 5%, 20%, and 85% in quintiles 1 to 5) effectively leaving 78% of poor performers undetected. Our results illustrate the disparity of impact that the current CMS method of hospital profiling has on hospitals with higher volumes, translating into lower thresholds for detection and reporting of poor performance.

Steering patients to safer hospitals? The effect of a tiered hospital network on hospital admissions.

Science.gov (United States)

Scanlon, Dennis P; Lindrooth, Richard C; Christianson, Jon B

2008-10-01

To determine if a tiered hospital benefit and safety incentive shifted the distribution of admissions toward safer hospitals. A large manufacturing company instituted the hospital safety incentive (HSI) for union employees. The HSI gave union patients a financial incentive to choose hospitals that met the Leapfrog Group's three patient safety "leaps." The analysis merges data from four sources: claims and enrollment data from the company, the American Hospital Association, the AHRQ HCUP-SID, and a state Office of the Insurance Commissioner. Changes in hospital admissions' patterns for union and nonunion employees using a difference-in-difference design. We estimate the probability of choosing a specific hospital from a set of available alternatives using conditional logistic regression. Patients affiliated with the engineers' union and admitted for a medical diagnosis were 2.92 times more likely to select a hospital designated as safer in the postperiod than in the preperiod, while salaried nonunion (SNU) patients (not subject to the financial incentive) were 0.64 times as likely to choose a compliant hospital in the post- versus preperiod. The difference-in-difference estimate, which is based on the predictions of the conditional logit model, is 0.20. However, the machinists' union was also exposed to the incentive and they were no more likely to choose a safer hospital than the SNU patients. The incentive did not have an effect on patients admitted for a surgical diagnosis, regardless of union status. All patients were averse to travel time, but those union patients selecting an incentive hospital were less averse to travel time. Patient price incentives and quality/safety information may influence hospital selection decisions, particularly for medical admissions, though the optimal incentive level for financial return to the plan sponsor is not clear.

Nursing magnet hospitals have better CMS hospital compare ratings

Directory of Open Access Journals (Sweden)

Robbins RA

2017-11-01

Full Text Available Background: There has been conflicting data on whether Nursing Magnet Hospitals (NMH provide better care. Methods: NMH in the Southwest USA (Arizona, California, Colorado, Hawaii, Nevada, and New Mexico were compared to hospitals not designated as NMH using the Centers for Medicare and Medicaid (CMS hospital compare star designation. Results: NMH had higher star ratings than non-NMH hospitals (3.34 + 0.78 vs. 2.86 + 0.83, p<0.001. The hospitals were mostly large, urban non-critical access hospitals. Academic medical centers made up a disproportionately large portion of the NMH. Conclusions: Although NMH had higher hospital ratings, the data may favor non-critical access academic medical centers which are known to have better outcomes.

A orgia perpétua: Flaubert e Madame Bovary. Translated by José Rubens Siqueira

Directory of Open Access Journals (Sweden)

Matheus Silva Vieira

2017-05-01

Full Text Available A presente resenha visa analisar a nova tradução de La orgía perpetua, realizada por José Rubens Siqueira, e publicada em 2015. Publicado originalmente em 1975, La Orgía perpetua é o terceiro livro de crítica de Vargas Llosa; antes ele já havia escrito Bases para una interpretación de Ruben Darío (1958 e García Márquez: historia de un deicídio (1971. É comum a crítica afirmar que La Orgía perpetua é uma das portas de entrada para os estudos flaubertianos, o que não deixa de ser uma verdade, mas essa obra também pode ser lida como um “confessionário crítico”, já que Llosa assume nesse livro a influência recebida de Flaubert. Assim, La orgía perpetua pode interessar tanto aos estudiosos da obra de Gustave Flaubert, quanto aos estudiosos de Vargas Llosa. Por A orgia perpétua se tratar de um livro de crítica literária e não de ficção, encontramos um texto em que Vargas Llosa não explora tanto os recursos estilísticos da língua espanhola, mais especificamente do espanhol “callejero” peruano, como o faz em livros como As cidades e os cachorros. Desse modo, ao analisarmos a tradução de Siqueira, percebemos que esse tradutor se ateve ao estilo claro e direto da prosa ensaística de Vargas Llosa.

Letter to the editor

Directory of Open Access Journals (Sweden)

Linde A

2016-08-01

Full Text Available Annika Linde, Amelie Plymoth Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden It was with great interest that we noticed that other researchers are also interested in participant-collected nasal swabs to detect pathogens in acute respiratory infections, and we welcome the findings presented in the study by Vargas et al.1        Of importance is that already in the beginning of 2015, we showed in our research work that nasal self-sampling is feasible in large-scale surveillance of respiratory infections.2  View the original paper by Vargas and colleagues. 

HCAHPS - Hospital

Data.gov (United States)

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...

Hospital Compare

Data.gov (United States)

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...

Japanese hospitals--culture and competition: a study of ten hospitals.

Science.gov (United States)

Anbäcken, O

1994-01-01

Japanese health care is characterized by a pluralistic system with a high degree of private producers. Central government regulates the prices and the financing system. All citizens are covered by a mandatory employment-based health insurance operating on a non-profit basis. The consumer has a free choice of physician and hospital. A comparison between Japan, Sweden and some other countries shows significant dissimilarities in the length of stay, number of treatments per hospital bed and year and the staffing of hospitals. About 80 per cent of the hospitals and 94 per cent of the clinics are privately owned. The typical private hospital owned by a physician has less than 100 beds. In this paper, data collected (1992/93) in an empirical study of Japanese hospitals and their leadership is presented. Also discussed are the hospitals' style of management, tools and strategies for competition and competences--personal and formal skills required of the leadership in the hospital. There follows a study of ten hospitals, among which hospital directors and chief physicians were interviewed. Interviews are also made with key persons in the Ministry of Health and Welfare and other organizations in the health care field. The result is also analysed from a cultural perspective--'what kind of impact does the Japanese culture have on the health care organization?' and/or 'what kind of sub-culture is developed in the Japanese hospitals'. Some comparisons are made with Sweden, USA, Canada and Germany. The different roles of the professions in the hospital are included in the study as well as the incentives for different kinds of strategies--specialization, growing in size, investments in new equipment, different kind of ownership and hospitals. Another issue discussed is the attempt to uncover whether there is an implicit distribution of specialties--silent agreements between hospitals, etc.

The management of hospital waste products in hospitals of Bushehr Province

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kamran Mirzaie

2008-02-01

Full Text Available Background: Hospital waste contains a large quantity of dangerous pathogenic agents, which are hazardous to the health of man, animal, plant and the environment. In Iran, like many other developing countries, not enough attention is paid to this matter and available information regarding the generation and disposal of medical wastes are low. The existing information about production and disposal of wastes in our hospitals is little and incomplete. In this study, a survey on hospital waste management system in Bushehr province hospitals was conducted. Methods: In this cross-sectional study, 8 hospitals in Bushehr province were investigated during a period of 6 months using a questionnaire, interviews and direct observations. The questionnaire had 93 questions (open and closed about general information on the hospitals and about various systems of managing hospital waste according to the World Health Organization suggested survey questionnaire for hospital waste management in developing countries. Results: In hospitals of bushehr province, waste generation rate was 2615 kg/day, including domestic waste (51.7%, infectious waste (20.8%, sharps (15.2% and chemical and drugs wastes (12.3%. In almost all hospitals, segregation of infectious waste from domestic waste at the place of origin and putting them in special containers had been done but this segregation wasn’t complete and sometimes some hazardous waste were disposed of in domestic waste containers. All hospitals used a color coding system for waste containers, 75 % of hospitals had incinerators. In others, waste was carried out by municipal service daily. In all hospitals, all workers were trained about hospital waste management. In none of the surveyed hospitals, there was an obvious policy and plan for purchasing equipment and necessary facilities in order to dispose hospital waste correctly and also no clear budget was allocated for hospital waste management. In none of these hospitals

Hospitals

Data.gov (United States)

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...

Hospitals - HOSPITALS_HAZUS_IN: Hospitals and Clinics in Indiana, Derived from HAZUS (Federal Emergency Management Agency, Point Shapefile)

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NSGIC State | GIS Inventory — HOSPITALS_HAZUS_IN is a point shapefile that shows locations of hospitals and clinics in Indiana. HOSPITALS_HAZUS_IN was derived from the shapefile named "HOSPITAL."...

Patient Survey (PCH - HCAHPS) PPS-exempt Cancer Hospital - Hospital

Data.gov (United States)

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...

Patients' perceptions of interactions with hospital staff are associated with hospital readmissions: a national survey of 4535 hospitals.

Science.gov (United States)

Yang, Lianping; Liu, Chaojie; Huang, Cunrui; Mukamel, Dana B

2018-01-29

Reducing 30-day hospital readmissions has become a focus of the current national payment policies. Medicare requires that hospitals collect and report patients' experience with their care as a condition of payment. However, the extent to which patients' experience with hospital care is related to hospital readmission is unknown. We established multivariate regression models in which 30-day risk-adjusted readmission rates were the dependent variables and patients' perceptions of the responsiveness of the hospital staff and communication (as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores) were the independent variables of interest. We selected six different clinical conditions for analyses, including acute myocardial infarction (AMI), chronic obstructive pulmonary disease (COPD), heart failure, hip/knee surgery, pneumonia, and stroke. Data included all acute care hospitals reporting in Hospital Compare in 2014. The number of hospitals with reported readmissions ranged from 2234 hospitals for AMI to 3758 hospitals for pneumonia. The average 30-day readmission rates ranged from 5.19% for knee/hip surgery to 22.7% for COPD. Patient experience of hospital-staff responsiveness as "top-box" ranged from 64% to 67% across the six clinical conditions, communication with nurses ranged from 77% to 79% and communication with doctors ranged from 80% to 81% (higher numbers are better). Our finding suggests that hospitals with better staff responsiveness were significantly more likely to have lower 30-day readmissions for all conditions. The effect size depended on the baseline readmission rates, with the largest effect on hospitals in the upper 75th quartile. A ten-percentage-point increase in staff responsiveness led to a 0.03-0.18 percentage point decrease in readmission rates. We found that neither communication with physicians nor communication with nurses was significantly associated with hospital readmissions. Our findings

Performance of in-hospital mortality prediction models for acute hospitalization: Hospital Standardized Mortality Ratio in Japan

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Motomura Noboru

2008-11-01

Full Text Available Abstract Objective In-hospital mortality is an important performance measure for quality improvement, although it requires proper risk adjustment. We set out to develop in-hospital mortality prediction models for acute hospitalization using a nation-wide electronic administrative record system in Japan. Methods Administrative records of 224,207 patients (patients discharged from 82 hospitals in Japan between July 1, 2002 and October 31, 2002 were randomly split into preliminary (179,156 records and test (45,051 records groups. Study variables included Major Diagnostic Category, age, gender, ambulance use, admission status, length of hospital stay, comorbidity, and in-hospital mortality. ICD-10 codes were converted to calculate comorbidity scores based on Quan's methodology. Multivariate logistic regression analysis was then performed using in-hospital mortality as a dependent variable. C-indexes were calculated across risk groups in order to evaluate model performances. Results In-hospital mortality rates were 2.68% and 2.76% for the preliminary and test datasets, respectively. C-index values were 0.869 for the model that excluded length of stay and 0.841 for the model that included length of stay. Conclusion Risk models developed in this study included a set of variables easily accessible from administrative data, and still successfully exhibited a high degree of prediction accuracy. These models can be used to estimate in-hospital mortality rates of various diagnoses and procedures.

Virginia gutierrez de pineda: ve lo que todos han visto pero piensa lo Que otros no han pensado

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Ligia Echeverri Ángel

1997-04-01

Full Text Available Este ensayo pretende hilvanar las cualidades innatas con las condiciones ambientales y educativas que afianzaron y respaldaron el surgimiento de una personalidad científica de las ciencias sociales y humanas, en una época cuando las mujeres tenían bloqueado el acceso a la formación en este campo.Por cuestión de espacio, apenas sí se menciona lo más destacado de la creación científica y literaria de Virginia Gutiérrez de Pineda, privilegiando aquellas contribuciones que han producido mayor impacto en las comunidades académicas nacional e internacional.

Developing IT Infrastructure for Rural Hospitals: A Case Study of Benefits and Challenges of Hospital-to-Hospital Partnerships.

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Reddy, Madhu C; Purao, Sandeep; Kelly, Mary

2008-01-01

This article presents a study identifying benefits and challenges of a novel hospital-to-hospital information technology (IT) outsourcing partnership (HHP). The partnership is an innovative response to the problem that many smaller, rural hospitals face: to modernize their IT infrastructure in spite of a severe shortage of resources. The investigators studied three rural hospitals that outsourced their IT infrastructure, through an HHP, to a larger, more technologically advanced hospital in the region. The study design was based on purposive sampling and interviews of senior managers from the four hospitals. The results highlight the HHP's benefits and challenges from both the rural hospitals' and vendor hospital's perspectives. The HHP was considered a success: a key outcome was that it has improved the rural hospitals' IT infrastructure at an affordable cost. The investigators discuss key elements for creating a successful HHP and offer preliminary answers to the question of what it takes for an HHP to be successful.

Hospital Outpatient PPS Partial Hospitalization Program LDS

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U.S. Department of Health & Human Services — Hospital Outpatient Prospective Payment System (OPPS) Partial Hospitalization Program LDS This file contains select claim level data and is derived from 2010 claims...

Hospitals look to hospitality service firms to meet TQM goals.

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Hard, R

1992-05-20

Hospitals that hire contract service firms to manage one or all aspects of their hospitality service departments increasingly expect those firms to help meet total quality management goals as well as offer the more traditional cost reduction, quality improvement and specialized expertise, finds the 1992 Hospital Contract Services Survey conducted by Hospitals.

Além do Estado e da ideologia: imigração judaica, Estado-Novo e Segunda Guerra Mundial

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Roney Cytrynowicz

2002-01-01

Full Text Available A partir de uma pesquisa em fontes primárias das instituições centrais associadas à imigração judaica em São Paulo e Rio de Janeiro, este artigo mostra como, durante o Estado-Novo e a Segunda Guerra Mundial, as entidades judaicas funcionaram de forma corriqueira, adaptaram-se às restrições nacionalistas do governo Getúlio Vargas e, muitas vezes, engendraram estratégias sofisticadas para enfrentar a lei e a ideologia. Esta perspectiva de história social e do cotidiano evidencia, portanto, uma leitura distinta daquela que - analisando exclusivamente a lei, a ideologia e o preconceito do regime Vargas - considera que havia um clima de medo e perseguição generalizado entre os imigrantes judeus residentes no País. Este artigo mostra, complementarmente, que 1937-1945 foram anos decisivos para a implantação de uma comunidade etnicamente ativa e para a sedimentação de uma identidade judaico-brasileira.This article shows that, during the Estado Novo and World War II, Jewish institutions adapted themselves to Vargas and nationalist restrictions, and created sophisticated strategies to undermine both law and national ideology. This social history perspective, based on primary documents from major institutions associated with Jewish immigrants in Sao Paulo and Rio de Janeiro, provides an important corrective to the historiography that focuses on law, elite ideology and prejudice during the Vargas regime, giving the erroneous impression that Jews lived in a climate of fear and generalized persecution in Brazil. This article also shows that the years 1937- 1945 were decisive in for formation of an ethnically active community that created a clear Jewish-Brazilian identity.

Do HMO penetration and hospital competition impact quality of hospital care?

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Rivers, P A; Fottler, M D

2004-11-01

This study examines the impact of HMO penetration and competition on hospital markets. A modified structure-conduct-performance paradigm was applied to the health care industry in order to investigate the impact of HMO penetration and competition on risk-adjusted hospital mortality rates (i.e. quality of hospital care). Secondary data for 1957 acute care hospitals in the USA from the 1991 American Hospital Association's Annual Survey of Hospitals were used. The outcome variables were risk-adjusted mortality rates in 1991. Predictor variables were market characteristics (i.e. managed care penetration and hospital competition). Control variables were environmental, patient, and institutional characteristics. Associations between predictor and outcome variables were investigated using statistical regression techniques. Hospital competition had a negative relationship with risk-adjusted mortality rates (a negative indicator of quality of care). HMO penetration, hospital competition, and an interaction effect of HMO penetration and competition were not found to have significant effects on risk-adjusted mortality rates. These findings suggest that when faced with intense competition, hospitals may respond in ways associated with reducing their mortality rates.

The Hospital Information Planning Study at Groote Schuur Hospital ...

African Journals Online (AJOL)

Information is an increasingly important resource in an academic hospital. Effective planning and control of this resource are essential in order to maximize its usefulness. Tile HOspital Information Planning Study (HIPS) undertaken at Groote Schuur Hospital, and based on. the Business Systems Planning (BSP) ...

Exploring hospitality within hospital meals by means of visual methodologies

DEFF Research Database (Denmark)

Justesen, Lise

2016-01-01

ABSTRACT This paper reflects the application of visual methodologies adapted in an explorative study on hospitality and hospital meals. It takes point of departure in a multi-sited ethnographic fieldwork placed at a general hospital in 2012. Visual methodologies were applied in multiple ways....... This includes visual methodologies as part of observation and interview strategies. The paper presents and discusses how the application of different visual methodologies can contribute to the construction of ethnographical knowledge on hospitality and hospital meals. Finally ethical considerations as well...

On Hospital Design – Identifying Building Attributes of Hospital Design

DEFF Research Database (Denmark)

Holst, Malene Kirstine; Kirkegaard, Poul Henning; Christoffersen, Lars D.

The present paper surveys the input parameters in hospital design and describes them formally as building attributes in preparation for facilitating planning and designing of hospitals with the aim of a more optimal design process. The overview of the hospital functionalities, bonds, logistics...... and needs is based on an approach of understanding the complexity of the hospital functionalities based on capacities, qualities and times beforehand specific department or units are described. This approach attempts to create an overview of the hospital functionalities respecting capacities, qualities...

Hospital prices and market structure in the hospital and insurance industries.

Science.gov (United States)

Moriya, Asako S; Vogt, William B; Gaynor, Martin

2010-10-01

There has been substantial consolidation among health insurers and hospitals, recently, raising questions about the effects of this consolidation on the exercise of market power. We analyze the relationship between insurer and hospital market concentration and the prices of hospital services. We use a national US dataset containing transaction prices for health care services for over 11 million privately insured Americans. Using three years of panel data, we estimate how insurer and hospital market concentration are related to hospital prices, while controlling for unobserved market effects. We find that increases in insurance market concentration are significantly associated with decreases in hospital prices, whereas increases in hospital concentration are non-significantly associated with increases in prices. A hypothetical merger between two of five equally sized insurers is estimated to decrease hospital prices by 6.7%.

Los hijos del pecado. Ilegitimidad y vida familiar en la Santafé de Bogotá Colonial. 1750-1810

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Ann Twinam

1999-01-01

Full Text Available Guiomar Dueñas Vargas. Los hijos del pecado. Ilegitimidad y vida familiar en la Santafé de Bogotá Colonial. 1750-1810. Bogotá: Editorial Universidad Nacional. 1997. 282 p. Esta edición española de la disertación doctoral que Guiomar Dueñas Vargas presentó en 1995 en la Universidad de Texas es una muy importante contribución a la germinante literatura sobre sexualidad, ilegitimidad, estructura familiar y movilidad social durante las postrimerías de la Colonia en la América española. Es particularmente bienvenida debido a su interés por los sectores populares en la poco investigada Santafé de bogotá.

Performance evaluation of nonhomogeneous hospitals: the case of Hong Kong hospitals.

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Li, Yongjun; Lei, Xiyang; Morton, Alec

2018-02-14

Throughout the world, hospitals are under increasing pressure to become more efficient. Efficiency analysis tools can play a role in giving policymakers insight into which units are less efficient and why. Many researchers have studied efficiencies of hospitals using data envelopment analysis (DEA) as an efficiency analysis tool. However, in the existing literature on DEA-based performance evaluation, a standard assumption of the constant returns to scale (CRS) or the variable returns to scale (VRS) DEA models is that decision-making units (DMUs) use a similar mix of inputs to produce a similar set of outputs. In fact, hospitals with different primary goals supply different services and provide different outputs. That is, hospitals are nonhomogeneous and the standard assumption of the DEA model is not applicable to the performance evaluation of nonhomogeneous hospitals. This paper considers the nonhomogeneity among hospitals in the performance evaluation and takes hospitals in Hong Kong as a case study. An extension of Cook et al. (2013) [1] based on the VRS assumption is developed to evaluated nonhomogeneous hospitals' efficiencies since inputs of hospitals vary greatly. Following the philosophy of Cook et al. (2013) [1], hospitals are divided into homogeneous groups and the product process of each hospital is divided into subunits. The performance of hospitals is measured on the basis of subunits. The proposed approach can be applied to measure the performance of other nonhomogeneous entities that exhibit variable return to scale.

Pediatric out-of-hospital deaths following hospital discharge: a ...

African Journals Online (AJOL)

Background: Out-of-hospital death among children living in resource poor settings occurs frequently. Little is known about the location and circumstances of child death following a hospital discharge. Objectives: This study aimed to understand the context surrounding out-of-hospital deaths and the barriers to accessing ...

Hospital diversification strategy.

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Eastaugh, Steven R

2014-01-01

To determine the impact of health system restructuring on the levels of hospital diversification and operating ratio this article analyzed 94 teaching hospitals and 94 community hospitals during the period 2008-2013. The 47 teaching hospitals are matched with 47 other teaching hospitals experiencing the same financial market position in 2008, but with different levels of preference for risk and diversification in their strategic plan. Covariates in the analysis included levels of hospital competition and the degree of local government planning (for example, highly regulated in New York, in contrast to Texas). Moreover, 47 nonteaching community hospitals are matched with 47 other community hospitals in 2008, having varying manager preferences for service-line diversification and risk. Diversification and operating ratio are modeled in a two-stage least squares (TSLS) framework as jointly dependent. Institutional diversification is found to yield better financial position, and the better operating profits provide the firm the wherewithal to diversify. Some services are in a growth phase, like bariatric weight-loss surgery and sleep disorder clinics. Hospital managers' preferences for risk/return potential were considered. An institution life cycle hypothesis is advanced to explain hospital behavior: boom and bust, diversification, and divestiture, occasionally leading to closure or merger.

Hospital Web site 'tops' in Louisiana. Hospital PR, marketing group cites East Jefferson General Hospital.

Science.gov (United States)

Rees, Tom

2002-01-01

East Jefferson General Hospital in Metairie, La., launched a new Web site in October 2001. Its user-friendly home page offers links to hospital services, medical staff, and employer information. Its jobline is a powerful tool for recruitment. The site was awarded the 2002 Pelican Award for Best Consumer Web site by the Louisiana Society for Hospital Public Relations & Marketing.

Hospital 360°.

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Giraldo Valencia, Juan Carlos; Delgado, Liliana Claudia

2015-01-01

There are forces that are greater than the individual performance of each hospital institution and of the health system structural of each country. The world is changing and to face up to the future in the best possible way, we need to understand how contexts and emerging trends link up and how they affect the hospital sector. The Columbian Association of Hospitals and Clinics, ACHC, has thus come up with the Hospital 360° concept which uses hospitals capable of anticipating changing contexts by means of the transition between present and future and takes on board the experience of global, socio-economic, demographic, political, environmental and technological fields as its model. Hospital 360° is an invitation to reinvent processes and institution themselves allowing them to adapt and incorporate a high degree of functional flexibility. Hospital 360° purses goals of efficiency, effectiveness and relevance, but also of impact and sustainability, and is coherent with the internal needs of hospital institutions and society for long-term benefits.

Hospital networks and the dispersal of hospital-acquired pathogens by patient transfer.

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Tjibbe Donker

Full Text Available Hospital-acquired infections (HAI are often seen as preventable incidents that result from unsafe practices or poor hospital hygiene. This however ignores the fact that transmissibility is not only a property of the causative organisms but also of the hosts who can translocate bacteria when moving between hospitals. In an epidemiological sense, hospitals become connected through the patients they share. We here postulate that the degree of hospital connectedness crucially influences the rates of infections caused by hospital-acquired bacteria. To test this hypothesis, we mapped the movement of patients based on the UK-NHS Hospital Episode Statistics and observed that the proportion of patients admitted to a hospital after a recent episode in another hospital correlates with the hospital-specific incidence rate of MRSA bacteraemia as recorded by mandatory reporting. We observed a positive correlation between hospital connectedness and MRSA bacteraemia incidence rate that is significant for all financial years since 2001 except for 2008-09. All years combined, this correlation is positive and significantly different from zero (partial correlation coefficient r = 0.33 (0.28 to 0.38. When comparing the referral pattern for English hospitals with referral patterns observed in the Netherlands, we predict that English hospitals more likely see a swifter and more sustained spread of HAIs. Our results indicate that hospitals cannot be viewed as individual units but rather should be viewed as connected elements of larger modular networks. Our findings stress the importance of cooperative effects that will have a bearing on the planning of health care systems, patient management and hospital infection control.

Hospital turnaround strategies.

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Langabeer, James

2008-01-01

Despite reports of higher profitability in recent years, hospitals are failing at a faster rate than ever before. Although many hospitals leave decisions regarding revenues and costs to chief financial officers and their staff, this is a recipe for disaster. From research conducted over the last 4 years on hospital bankruptcies and turnarounds, the author found that a common series of actions will help organizations evade collapse. The author explored these turnaround strategies through research and analysis of a variety of hospitals and health systems that had a high probability of immediate financial crisis or collapse. His continued observation and analysis of these hospitals in subsequent years showed that most hospitals never emerge from their bleak financial conditions. However, a few hospital administrations have successfully turned around their organizations.

Medicare's Hospital Readmissions Reduction Program in Surgery May Disproportionately Affect Minority-serving Hospitals.

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Shih, Terry; Ryan, Andrew M; Gonzalez, Andrew A; Dimick, Justin B

2015-06-01

To project readmission penalties for hospitals performing cardiac surgery and examine how these penalties will affect minority-serving hospitals. The Hospital Readmissions Reduction Program will potentially expand penalties for higher-than-predicted readmission rates to cardiac procedures in the near future. The impact of these penalties on minority-serving hospitals is unknown. We examined national Medicare beneficiaries undergoing coronary artery bypass grafting in 2008 to 2010 (N = 255,250 patients, 1186 hospitals). Using hierarchical logistic regression, we calculated hospital observed-to-expected readmission ratios. Hospital penalties were projected according to the Hospital Readmissions Reduction Program formula using only coronary artery bypass grafting readmissions with a 3% maximum penalty of total Medicare revenue. Hospitals were classified into quintiles according to proportion of black patients treated. Minority-serving hospitals were defined as hospitals in the top quintile whereas non-minority-serving hospitals were those in the bottom quintile. Projected readmission penalties were compared across quintiles. Forty-seven percent of hospitals (559 of 1186) were projected to be assessed a penalty. Twenty-eight percent of hospitals (330 of 1186) would be penalized less than 1% of total Medicare revenue whereas 5% of hospitals (55 of 1186) would receive the maximum 3% penalty. Minority-serving hospitals were almost twice as likely to be penalized than non-minority-serving hospitals (61% vs 32%) and were projected almost triple the reductions in reimbursement ($112 million vs $41 million). Minority-serving hospitals would disproportionately bear the burden of readmission penalties if expanded to include cardiac surgery. Given these hospitals' narrow profit margins, readmission penalties may have a profound impact on these hospitals' ability to care for disadvantaged patients.

Hospitals; hospitals13

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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....

[Satisfaction of hospitalized patients in a hospital in Apurimac, Peru].

Science.gov (United States)

Sihuin-Tapia, Elsa Yudy; Gómez-Quispe, Oscar Elisban; Ibáñez-Quispe, Vladimiro

2015-01-01

In order to determine the satisfaction of hospitalized patients in the Sub-regional Hospital of Andahuaylas, 175 patients were surveyed using the Servqual multidimensional model. The estimate of variables associated with the satisfaction of the hospitalized patients was performed by using bivariate and multivariate logistic regression analysis. We found 25.0% satisfaction. Lower levels of satisfaction were associated with having a secondary level education (aOR: 0.05; 95% CI: 0.01 to 0.64) and with having been hospitalized in the surgery department (aOR 0.14, CI: 95%: 0.04 to 0.53). It was concluded that there was a low level of satisfaction with the quality of care received by hospitalized patients and this was associated with the level of education and type of hospital department.

Hospital Library Administration.

Science.gov (United States)

Cramer, Anne

The objectives of a hospital are to improve patient care, while the objectives of a hospital library are to improve services to the staff which will support their efforts. This handbook dealing with hospital administration is designed to aid the librarian in either implementing a hospital library, or improving services in an existing medical…

Hospital marketing revisited.

Science.gov (United States)

Costello, M M

1987-05-01

With more hospitals embracing the marketing function in their organizational management over the past decade, hospital marketing can no longer be considered a fad. However, a review of hospital marketing efforts as reported in the professional literature indicates that hospitals must pay greater attention to the marketing mix elements of service, price and distribution channels as their programs mature.

Trends in hospital librarianship and hospital library services: 1989 to 2006.

Science.gov (United States)

Thibodeau, Patricia L; Funk, Carla J

2009-10-01

The research studied the status of hospital librarians and library services to better inform the Medical Library Association's advocacy activities. The Vital Pathways Survey Subcommittee of the Task Force on Vital Pathways for Hospital Librarians distributed a web-based survey to hospital librarians and academic health sciences library directors. The survey results were compared to data collected in a 1989 survey of hospital libraries by the American Hospital Association in order to identify any trends in hospital libraries, roles of librarians, and library services. A web-based hospital library report form based on the survey questions was also developed to more quickly identify changes in the status of hospital libraries on an ongoing basis. The greatest change in library services between 1989 and 2005/06 was in the area of access to information, with 40% more of the respondents providing access to commercial online services, 100% more providing access to Internet resources, and 28% more providing training in database searching and use of information resources. Twenty-nine percent (n = 587) of the 2005/06 respondents reported a decrease in staff over the last 5 years. Survey data support reported trends of consolidation of hospitals and hospital libraries and additions of new services. These services have likely required librarians to acquire new skills. It is hoped that future surveys will be undertaken to continue to study these trends.

Hospitable Classrooms: Biblical Hospitality and Inclusive Education

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Anderson, David W.

2011-01-01

This paper contributes to a Christian hermeneutic of special education by suggesting the biblical concept of hospitality as a necessary characteristic of classroom and school environments in which students with disabilities and other marginalized students can be effectively incorporated into the body of the classroom. Christian hospitality, seen…

The impact of HMO and hospital competition on hospital costs.

Science.gov (United States)

Younis, Mustafa Z; Rivers, Patrick A; Fottler, Myron D

2005-01-01

This study examines the impact of HMO penetration and competition on health system performance, as measured by hospital cost per adjusted admissions. The study population consisted of acute-care hospitals in the United States. The findings of this study suggest that there is no relationship between HMO competition and hospital cost per adjusted admission. Governmental efforts to stimulate competition in the hospital market, if focused on promoting HMOs, are not likely to produce cost-containing results quickly.

Effects of competition on hospital quality: an examination using hospital administrative data.

Science.gov (United States)

Palangkaraya, Alfons; Yong, Jongsay

2013-06-01

This paper investigates the effects of competition on hospital quality using hospital administration data from the State of Victoria, Australia. Hospital quality is measured by 30-day mortality rates and 30-day unplanned readmission rates. Competition is measured by Herfindahl-Hirschman index and the numbers of competing public and private hospitals. The paper finds that hospitals facing higher competition have lower unplanned admission rates. However, competition is related negatively to hospital quality when measured by mortality, albeit the effects are weak and barely statistically significant. The paper also finds that the positive effect of competition on quality as measured by unplanned readmission differs greatly depending on whether the hospital is publicly or privately owned.

Prey identification in nests of the potter wasp Hypodynerus andeus (Packard (Hymenoptera, Vespidae, Eumeninae using DNA barcodes

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Héctor A. Vargas

2014-06-01

Full Text Available Prey identification in nests of the potter wasp Hypodynerus andeus (Packard (Hymenoptera, Vespidae, Eumeninae using DNA barcodes. Geometrid larvae are the only prey known for larvae of the Neotropical potter wasp Hypodynerus andeus (Packard, 1869 (Hymenoptera, Vespidae, Eumeninae in the coastal valleys of the northern Chilean Atacama Desert. A fragment of the mitochondrial gene cytochrome oxidase c subunit 1 was amplified from geometrid larvae collected from cells of H. andeus in the Azapa Valley, Arica Province, and used to provide taxonomic identifications. Two species, Iridopsis hausmanni Vargas, 2007 and Macaria mirthae Vargas, Parra & Hausmann, 2005 were identified, while three others could be identified only at higher taxonomic levels, because the barcode reference library of geometrid moths is still incomplete for northern Chile.

Enlightened state versus millenarian vision: A comparison between two historical novels

Directory of Open Access Journals (Sweden)

Z. Roelofse-Campbell

1997-04-01

Full Text Available Two millenarian events, one in Brazil (Canudos Rebellion, 1897 and the other in South Africa (Bulhoek Massacre, 1921 have inspired two works of narrative fiction: Mario Vargas Llosa's The War of the End of the World (1981 and Mike Nicol’s This Day and Age (1992. In both novels the events are presented from the perspectives of both the oppressed landless peasants and the oppressors, who were the ruling élites. In both instances, governments which purported to be models of enlightenment and modernity resorted to violence and repression in order to uphold their authority. Vargas Llosa's novel was written in the Latin American tradition where truth and fiction mingle indistinguishably while in the South African novel fictional elements override historical truth.

Financial Performance of Hospitals in the Mississippi Delta Region Under the Hospital Readmissions Reduction Program and Hospital Value-based Purchasing Program.

Science.gov (United States)

Chen, Hsueh-Fen; Karim, Saleema; Wan, Fei; Nevola, Adrienne; Morris, Michael E; Bird, T Mac; Tilford, J Mick

2017-11-01

Previous studies showed that the Hospital Readmissions Reduction Program (HRRP) and the Hospital Value-based Purchasing Program (HVBP) disproportionately penalized hospitals caring for the poor. The Mississippi Delta Region (Delta Region) is among the most socioeconomically disadvantaged areas in the United States. The financial performance of hospitals in the Delta Region under both HRRP and HVBP remains unclear. To compare the differences in financial performance under both HRRP and HVBP between hospitals in the Delta Region (Delta hospitals) and others in the nation (non-Delta hospitals). We used a 7-year panel dataset and applied difference-in-difference models to examine operating and total margin between Delta and non-Delta hospitals in 3 time periods: preperiod (2008-2010); postperiod 1 (2011-2012); and postperiod 2 (2013-2014). The Delta hospitals had a 0.89% and 4.24% reduction in operating margin in postperiods 1 and 2, respectively, whereas the non-Delta hospitals had 1.13% and 1% increases in operating margin in postperiods 1 and 2, respectively. The disparity in total margins also widened as Delta hospitals had a 1.98% increase in postperiod 1, but a 0.30% reduction in postperiod 2, whereas non-Delta hospitals had 1.27% and 2.28% increases in postperiods 1 and 2, respectively. The gap in financial performance between Delta and non-Delta hospitals widened following the implementation of HRRP and HVBP. Policy makers should modify these 2 programs to ensure that resources are not moved from the communities that need them most.

Practices regarding hospital waste management at public and private sector hospitals of Lahore

International Nuclear Information System (INIS)

Mahmood, S.; Din, N.U.; Mohsin, J.

2011-01-01

Health care (Biomedical) waste is a term used for all waste arising from health care establishments. In most of health care centers of Pakistan, including Lahore, hospital wastes are simply mixed with the municipal waste in collecting bins at road-sides and disposed off similarly. Proper Management of biomedical waste, especially the hazardous one, being produced in hospital settings is important in terms of their ability to cause harm to the related per-sons and the environment as well. To Observe and compare the practices regarding Hospital Waste management of the public sector hospital with private sector hospital. Descriptive, Cross sectional. Methodology: Standardized checklist was used to assess the practices of nursing and sanitary staff. Practices regarding waste segregation were same at both hospitals. While practices regarding waste collection and transportation were better at The Children's Hospital. Public sector hospital has, paradoxically, better practices regarding hospital waste management in comparison to private sector hospital. (author)

Determinants of Hospital Pharmacists’ Job Satisfaction in Romanian Hospitals

Directory of Open Access Journals (Sweden)

Magdalena Iorga

2017-12-01

Full Text Available Aim: The purpose of this study is to identify the level of job satisfaction among hospital pharmacists in Romania in relation to environmental, socio-demographic, and individual factors. Material and Methods: Seventy-eight hospital pharmacists were included in the research. The Job Satisfaction Scale was used to measure the level of satisfaction with their current jobs, and the TAS-20 was used to evaluate emotional experience and awareness. Additionally, 12 items were formulated in order to identify the reasons for dissatisfaction with jobs, such as budget, number of working hours, legislation, relationships with colleagues, hospital departments, or stakeholders. Data were analyzed using IBM SPSS Statistics version 23. Results: The analyses of the data revealed a low level of satisfaction regarding the pay–promotion subscale, a high level of satisfaction with the management–interpersonal relationship dimension, and a high level of satisfaction regarding the organization–communication subscale. Seventy-four percent of subjects are dissatisfied about the annual budget, and 86.3% are not at all satisfied with present legislation. Conclusions: These results are important for hospital pharmacists and hospital management in order to focus on health policies, management, and environmental issues, with the purpose of increasing the level of satisfaction among hospital pharmacists.

Determinants of Hospital Pharmacists' Job Satisfaction in Romanian Hospitals.

Science.gov (United States)

Iorga, Magdalena; Dondaș, Corina; Soponaru, Camelia; Antofie, Ioan

2017-12-11

Aim : The purpose of this study is to identify the level of job satisfaction among hospital pharmacists in Romania in relation to environmental, socio-demographic, and individual factors. Material and Methods : Seventy-eight hospital pharmacists were included in the research. The Job Satisfaction Scale was used to measure the level of satisfaction with their current jobs, and the TAS-20 was used to evaluate emotional experience and awareness. Additionally, 12 items were formulated in order to identify the reasons for dissatisfaction with jobs, such as budget, number of working hours, legislation, relationships with colleagues, hospital departments, or stakeholders. Data were analyzed using IBM SPSS Statistics version 23. Results : The analyses of the data revealed a low level of satisfaction regarding the pay-promotion subscale, a high level of satisfaction with the management-interpersonal relationship dimension, and a high level of satisfaction regarding the organization-communication subscale. Seventy-four percent of subjects are dissatisfied about the annual budget, and 86.3% are not at all satisfied with present legislation. Conclusions : These results are important for hospital pharmacists and hospital management in order to focus on health policies, management, and environmental issues, with the purpose of increasing the level of satisfaction among hospital pharmacists.

[Long-term psychiatric hospitalizations].

Science.gov (United States)

Plancke, L; Amariei, A

2017-02-01

Long-term hospitalizations in psychiatry raise the question of desocialisation of the patients and the inherent costs. Individual indicators were extracted from a medical administrative database containing full-time psychiatric hospitalizations for the period 2011-2013 of people over 16 years old living in the French region of Nord-Pas-de-Calais. We calculated the proportion of people who had experienced a hospitalization with a duration of 292 days or more during the study period. A bivariate analysis was conducted, then ecological data (level of health-care offer, the deprivation index and the size of the municipalities of residence) were included into a multilevel regression model in order to identify the factors significantly related to variability of long-term hospitalization rates. Among hospitalized individuals in psychiatry, 2.6% had had at least one hospitalization of 292 days or more during the observation period; the number of days in long-term hospitalization represented 22.5% of the total of days of full-time hospitalization in psychiatry. The bivariate analysis revealed that seniority in the psychiatric system was strongly correlated with long hospitalization rates. In the multivariate analysis, the individual indicators the most related to an increased risk of long-term hospitalization were: total lack of autonomy (OR=9.0; 95% CI: 6.7-12.2; P<001); diagnoses of psychological development disorders (OR=9.7; CI95%: 4.5-20.6; P<.001); mental retardation (OR=4.5; CI95%: 2.5-8.2; P<.001): schizophrenia (OR=3.0; CI95%: 1.7-5.2; P<.001); compulsory hospitalization (OR=1.7; CI95%: 1.4-2.1; P<.001); having experienced therapeutic isolation (OR=1.8; CI95%: 1.5-2.1; P<.001). Variations of long-term hospitalization rates depending on the type of establishment were very high, but the density of hospital beds or intensity of ambulatory activity services were not significantly linked to long-term hospitalization. The inhabitants of small urban units had

Rotas Críticas: Desatar nós para fazer laços Critical Paths: Untied Ourselves to Bond Rotas Críticas: Desatar nós para fazer laços

Directory of Open Access Journals (Sweden)

Marta Conte

2012-11-01

Full Text Available

Este artigo baseia-se na experiência desenvolvida em oficinas de escrita com a equipe do Ambulatório de Atenção às Situações de Violência do Hospital Materno Infantil Presidente Vargas, de Porto Alegre/RS. Esta atividade fez parte da pesquisa A construção identitária na adolescência em contextos violentos na perspectiva da Clínica em Saúde Mental. Relatamos o trabalho que precisa ser operado para fazer frente aos desafios no atendimento em saúde coletiva, diante da realidade da violência em um contexto de vulnerabilidades sociais. Analisamos através dos diários de bordo e discussões de casos as rotas críticas no atendimento à problemática da violência, na perspectiva da integralidade e da intersetorialidade. Ressaltamos a importância de associar a escuta implicada à análise institucional em um trabalho que precisa ser construído como desejo e pactuado entre instituição, equipes e rede de serviços que acolhem pessoas que vivem em contextos violentos.

This article is based on the experience developed in writing workshops with the staff of the Attention to Violent Situations Ambulatory in the Presidente Vargas Children Hospital, in Porto Alegre / RS. This activity was part of the research called, “Adolescent Identity Construction in violent contexts in view of the Mental Health Clinic”. Among the themes covered are the institutional demands, the critical paths of care, the problem of violence and involvement with acceptance in the perspective of integral and intersectional approach. We analyzed “The Observing Diaries” of the authors and the case discussions. We point out the difference between what is required to be undertaken and what is possible in practice, highlighting the importance of linkiang listening implied to the institutional analysis in a project that needs to be built as desired agreement between institution, staff and service network that welcome people who live in

Candiduria in hospitalized patients in teaching hospitals of Ahvaz.

Science.gov (United States)

Zarei-Mahmoudabadi, A; Zarrin, M; Ghanatir, F; Vazirianzadeh, B

2012-12-01

Nosocomial infections are usually acquired during hospitalization. Fungal infection of the urinary tract is increasing due to predisposing factors such as; antibacterial agents, indwelling urinary catheters, diabetes mellitus, long hospitalization, immunosuppressive agents, use of IV catheters, radiation therapy, malignancy. The aim of our study was to determine the prevalence of candiduria and urinary tract infection in patients admitted in Golestan and Emam Khomeini hospitals of Ahvaz, Iran. During 14 months, a total of 744 urine samples were collected and transferred to medical mycology laboratory immediately. Ten µl of uncentrifuged sample was cultured on CHROM agar Candida plates and incubated at 37°C for 24-48h aerobically. Candida species were identified based on colony morphology on CHROM agar Candida, germ tube production and micro-morphology on corn meal agar including 1% Tween 80. In the present study, 744 hospitalized patients were sampled (49.5%, female; 50.5%, male). The prevalence of candiduria in subjects was 16.5% that included 65.1% female and 34.9% male. The most common isolates were C. albicans (53.3%), followed by C. glabrata (24.4%), C. tropicalis (3.7%), C. krusei (2.2%), and Geotrichum spp. (0.7%) Urine cultures yielded more than 10,000 yeast colonies in 34.1% of cases, and the major predisposing factor associated with candiduria was antibiotic therapy (69.1%). Candiduria is relatively common in hospitalized patients in educational hospitals of Ahvaz. In addition, there is a strong correlation between the incidence of candiduria in hospitalized patients and broad-spectrum antibiotics therapy.

The Relationship between Place of Residence and Hospitalization Rate in the Biggest Referral Hospital of the Northwest according to Hospitalization Wards

Directory of Open Access Journals (Sweden)

Amin Talebpour

2016-06-01

Full Text Available ​ Background and objectives: In accordance with the global pattern, the urban population in Iran is higher than the rural population. But, are the statistics of using hospitalization services in public hospitals in these two categories similar to this pattern? This study seeks to determine the effect of place of residence on hospitalization rate by examining annual hospitalization statistics of the country’s biggest referral hospital in the northwest. Material and Methods: The method used in this study is cross-sectional and all cases of hospitalization in Imam Reza Hospital as the northwest’s biggest referral hospital were picked by available sampling method. The cases of 30260 hospitalized patients were examined through direct observation and items extracted from their files were recorded in the checklist. In order to determine the relations between the variables, K2 test was applied and the P-value was considered less than 0.05 The obtained data were analyzed by SPSS.16 software. Results: Results indicated that the frequency distribution of patients in terms of their urban or rural residence did not yield any significant difference (P>0/05. Results also showed that the highest hospitalization rate for urban patients was 16.1% (3305 individuals in surgery ward while it was 14.2% (1384 individuals for rural patients in orthopedic ward. The least significant statistical difference between urban and rural hospitalization rates was observed in renal ward with 72.9% (1162 individual urban patients and 27.1% (432 individuals rural patients of total patients hospitalized in this ward. The most significant statistical difference between urban and rural hospitalization rates was observed in ICU with 44.9% (297 individuals urban patients and 55.1% (365 individuals rural patients of the total patients hospitalized in this ward. Conclusion: A relative comparison among illnesses in urban and rural populations, aside from illnesses caused by trauma

Mobile Technology in Hospital Schools: What Are Hospital Teachers' Professional Learning Needs?

Science.gov (United States)

McCarthy, Aidan; Maor, Dorit; McConney, Andrew

2017-01-01

The aim of this study was to identify hospital teachers' professional learning needs to enable effective use of mobile technology in hospital schools. Hospitalized students cannot attend their regular schools and as a result their educational progress and development can suffer. In an attempt to address this, hospital schools provide learning…

Marginal Hospital Cost of Surgery-related Hospital-acquired Pressure Ulcers.

Science.gov (United States)

Spector, William D; Limcangco, Rhona; Owens, Pamela L; Steiner, Claudia A

2016-09-01

Patients who develop hospital-acquired pressure ulcers (HAPUs) are more likely to die, have longer hospital stays, and are at greater risk of infections. Patients undergoing surgery are prone to developing pressure ulcers (PUs). To estimate the hospital marginal cost of a HAPU for adults patients who were hospitalized for major surgeries, adjusted for patient characteristics, comorbidities, procedures, and hospital characteristics. Data are from the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases and the Medicare Patient Safety Monitoring System for 2011 and 2012. PU information was obtained using retrospective structured record review from trained MPMS data abstractors. Costs are derived using HCUP hospital-specific cost-to-charge ratios. Marginal cost estimates were made using Extended Estimating Equations. We estimated the marginal cost at the 25th, 50th, and 75th percentiles of the cost distribution using Simultaneous Quantile Regression. We find that 3.5% of major surgical patients developed HAPUs and that the HAPUs added ∼$8200 to the cost of a surgical stay after adjusting for comorbidities, patient characteristics, procedures, and hospital characteristics. This is an ∼44% addition to the cost of a major surgical stay but less than half of the unadjusted cost difference. In addition, we find that for high-cost stays (75th percentile) HAPUs added ∼$12,100, whereas for low-cost stays (25th percentile) HAPUs added ∼$3900. This paper suggests that HAPUs add ∼44% to the cost of major surgical hospital stays, but the amount varies depending on the total cost of the visit.

Hospitality and hostility in hospitals

DEFF Research Database (Denmark)

Jensen, Tina Blegind; Aanestad, Margunn

2007-01-01

The purpose of this paper is to discuss the adoption of healthcare information systems (HIS) from a user perspective. Our case study concerns how a group of orthopaedic surgeons experienced and reacted to the adoption and mandatory use of an Electronic Patient Record system in a Danish hospital. We...... propose to use the concepts of hospitality and hostility to turn our attention to the interaction between the host (the surgeons) and the guest (the information system) and consider how the boundaries between them evolved in the everyday work practices. As an alternative to previous studies on technology...

Organizational culture and its relationship with hospital performance in public hospitals in China.

Science.gov (United States)

Zhou, Ping; Bundorf, Kate; Le Chang, Ji; Huang, Jin Xin; Xue, Di

2011-12-01

To measure perceptions of organizational culture among employees of public hospitals in China and to determine whether perceptions are associated with hospital performance. Hospital, employee, and patient surveys from 87 Chinese public hospitals conducted during 2009. Developed and administered a tool to assess organizational culture in Chinese public hospitals. Used factor analysis to create measures of organizational culture. Analyzed the relationships between employee type and perceptions of culture and between perceptions of culture and hospital performance using multivariate models. Employees perceived the culture of Chinese public hospitals as stronger in internal rules and regulations, and weaker in empowerment. Hospitals in which employees perceived that the culture emphasized cost control were more profitable and had higher rates of outpatient visits and bed days per physician per day but also had lower levels of patient satisfaction. Hospitals with cultures perceived as customer-focused had longer length of stay but lower patient satisfaction. Managers in Chinese public hospitals should consider whether the culture of their organization will enable them to respond effectively to their changing environment. © Health Research and Educational Trust.

The effects of health information technology adoption and hospital-physician integration on hospital efficiency.

Science.gov (United States)

Cho, Na-Eun; Chang, Jongwha; Atems, Bebonchu

2014-11-01

To determine the impact of health information technology (HIT) adoption and hospital-physician integration on hospital efficiency. Using 2010 data from the American Hospital Association's (AHA) annual survey, the AHA IT survey, supplemented by the CMS Case Mix Index, and the US Census Bureau's small area income and poverty estimates, we examined how the adoption of HIT and employment of physicians affected hospital efficiency and whether they were substitutes or complements. The sample included 2173 hospitals. We employed a 2-stage approach. In the first stage, data envelopment analysis was used to estimate technical efficiency of hospitals. In the second stage, we used instrumental variable approaches, notably 2-stage least squares and the generalized method of moments, to examine the effects of IT adoption and integration on hospital efficiency. We found that HIT adoption and hospital-physician integration, when considered separately, each have statistically significant positive impacts on hospital efficiency. Also, we found that hospitals that adopted HIT with employed physicians will achieve less efficiency compared with hospitals that adopted HIT without employed physicians. Although HIT adoption and hospital-physician integration both seem to be key parts of improving hospital efficiency when one or the other is utilized individually, they can hurt hospital efficiency when utilized together.

PENi kirjandusauhinnad selgunud : [sõnum

Index Scriptorium Estoniae

2002-01-01

Nabokovi-preemia Mario Vargas Llosale; Laura Pelsi auhind Tony Kushnerile ja Maria Irene Fornesile; uudsena noortele kirjanike määratava Robert Binghami auhinna saavad Carolyn Cooke, Matthew Klam ja Manil Suri

The Hospitable Meal Model

DEFF Research Database (Denmark)

Justesen, Lise; Overgaard, Svend Skafte

2017-01-01

This article presents an analytical model that aims to conceptualize how meal experiences are framed when taking into account a dynamic understanding of hospitality: the meal model is named The Hospitable Meal Model. The idea behind The Hospitable Meal Model is to present a conceptual model...... that can serve as a frame for developing hospitable meal competencies among professionals working within the area of institutional foodservices as well as a conceptual model for analysing meal experiences. The Hospitable Meal Model transcends and transforms existing meal models by presenting a more open......-ended approach towards meal experiences. The underlying purpose of The Hospitable Meal Model is to provide the basis for creating value for the individuals involved in institutional meal services. The Hospitable Meal Model was developed on the basis of an empirical study on hospital meal experiences explored...

ELEMENTAL FORMS OF HOSPITALITY

Directory of Open Access Journals (Sweden)

Maximiliano Emanuel Korstanje

2010-11-01

Full Text Available Modern studies emphasized on the needs of researching the hospitality as relevant aspects of tourism and hospitality fields. Anyway, these approaches are inextricably intertwined to the industry of tourism and do not take seriously the anthropological and sociological roots of hospitality. In fact, the hotel seems to be a partial sphere of hospitality at all. Under this context, the present paper explores the issue of hospitality enrooted in the political and economic indo-European principle of free-transit which is associated to a much broader origin.  Starting from the premise etymologically hostel and hospital share similar origins, we follow the contributions of J Derrida to determine the elements that formed the hospitality up to date.

Fraud in Hospitals

OpenAIRE

Musau, Steve; Vian, Taryn

2008-01-01

Hospitals are vulnerable to corruption. In the U.S., health care fraud has been stimated to cost $60 billion per year, or 3% of total health care expenditures - much of it in the hospital sector. Hospitals account for 50% or more of health care pending in many countries. Fraud and corruption in hospitals negatively affect access and quality, as public servants make off with resources which could have been used to reduce out-of-pocket expenditures for patients, or improve needed services. This...

Adherence to hospital drug formularies and cost of drugs in hospitals in Denmark

DEFF Research Database (Denmark)

Plet, H. T.; Hallas, J.; Kjeldsen, L. J.

2013-01-01

PURPOSE: To investigate adherence rates to hospital drug formularies (HDFs) and cost of drugs in hospitals. METHODS: Data on drugs used during 2010 were analyzed for ten hospitals (two hospitals from each of the five regions), constituting 30 % of hospitals and 45 % of hospital beds in Denmark....... Drug use data from individual hospitals were retrieved from the hospital pharmacies. Adherence to the HDFs was analyzed for selected substances characterised by extensive use both in primary and secondary sectors (ATC codes A10, B03, C03, C07, C08, C09, C10, J01, N02, N05 and R03). Within each group......, we also identified the drugs constituting 90 % of the volume (= DU90%) and the adherence to the HDF in this segment (Index of Adherence). RESULTS: Substances used by hospitals varied between 598 and 1,093. The proportion of used substances that were on the HDF varied between 14 % and 44 %. University...

Substantial shifts in ranking of California hospitals by hospital-associated methicillin-resistant Staphylococcus aureus infection following adjustment for hospital characteristics and case mix.

Science.gov (United States)

Tehrani, David M; Phelan, Michael J; Cao, Chenghua; Billimek, John; Datta, Rupak; Nguyen, Hoanglong; Kwark, Homin; Huang, Susan S

2014-10-01

States have established public reporting of hospital-associated (HA) infections-including those of methicillin-resistant Staphylococcus aureus (MRSA)-but do not account for hospital case mix or postdischarge events. Identify facility-level characteristics associated with HA-MRSA infection admissions and create adjusted hospital rankings. A retrospective cohort study of 2009-2010 California acute care hospitals. We defined HA-MRSA admissions as involving MRSA pneumonia or septicemia events arising during hospitalization or within 30 days after discharge. We used mandatory hospitalization and US Census data sets to generate hospital population characteristics by summarizing across admissions. Facility-level factors associated with hospitals' proportions of HA-MRSA infection admissions were identified using generalized linear models. Using state methodology, hospitals were categorized into 3 tiers of HA-MRSA infection prevention performance, using raw and adjusted values. Among 323 hospitals, a median of 16 HA-MRSA infections (range, 0-102) per 10,000 admissions was found. Hospitals serving a greater proportion of patients who had serious comorbidities, were from low-education zip codes, and were discharged to locations other than home were associated with higher HA-MRSA infection risk. Total concordance between all raw and adjusted hospital rankings was 0.45 (95% confidence interval, 0.40-0.51). Among 53 community hospitals in the poor-performance category, more than 20% moved into the average-performance category after adjustment. Similarly, among 71 hospitals in the superior-performance category, half moved into the average-performance category after adjustment. When adjusting for nonmodifiable facility characteristics and case mix, hospital rankings based on HA-MRSA infections substantially changed. Quality indicators for hospitals require adequate adjustment for patient population characteristics for valid interhospital performance comparisons.

Hospital board effectiveness: relationships between board training and hospital financial viability.

Science.gov (United States)

Molinari, C; Morlock, L; Alexander, J; Lyles, C A

1992-01-01

This study examined whether hospital governing boards that invest in board education and training are more informed and effective decision-making bodies. Measures of hospital financial viability (i.e., selected financial ratios and outcomes) are used as indicators of hospital board effectiveness. Board participation in educational programs was significantly associated with improved profitability, liquidity, and occupancy levels, suggesting that investment in the education of directors is likely to enhance hospital viability and thus increase board effectiveness.

Experiencing hospitality : an exploratory study on the experiential dimensions of hospitality

NARCIS (Netherlands)

Pijls-Hoekstra, Ruth; Groen, Brenda H.; Galetzka, Mirjam; Pruyn, Ad T.H.

2015-01-01

What is hospitality? Only few academic articles tap into the meaning of the concept of hospitality. Especially academic investigation of hospitality from a guest perspective is scarce; the combination of ‘hospitality’ and ‘experience’ has received hardly any attention. The present paper describes a

Planning Study Hospital, Cape Town The Hospital Information at ...

African Journals Online (AJOL)

Tile HOspital Information Plan- ning Study ... Hospital, and based on. the Business Systems Plan- ... technology can be of considerable benefit in dealing with these issues. .... coherenr, flexible information systems with a minimum of data.

Using the Hospital Nutrition Environment Scan to Evaluate Health Initiative in Hospital Cafeterias.

Science.gov (United States)

Derrick, Jennifer Willahan; Bellini, Sarah Gunnell; Spelman, Julie

2015-11-01

Health-promoting environments advance health and prevent chronic disease. Hospitals have been charged to promote health and wellness to patients, communities, and 5.3 million adults employed in United States health care environments. In this cross-sectional observational study, the Hospital Nutrition Environment Scan (HNES) was used to measure the nutrition environment of hospital cafeterias and evaluate the influence of the LiVe Well Plate health initiative. Twenty-one hospitals in the Intermountain West region were surveyed between October 2013 and May 2014. Six hospitals participated in the LiVe Well Plate health initiative and were compared with 15 hospitals not participating. The LiVe Well Plate health initiative identified and promoted a healthy meal defined as health initiative branding were also posted at point of purchase. Hospital cafeterias were scored on four subcategories: facilitators and barriers, grab-and-go items, menu offerings, and selection options at point of purchase. Overall, hospitals scored 35.3±13.7 (range=7 to 63) points of 86 total possible points. Cafeterias in health initiative hospitals had significantly higher mean nutrition composite scores compared with non-health initiative hospitals (49.2 vs 29.7; Penvironment of hospital cafeterias. Additional research is needed to quantify and strategize ways to improve nutrition environments within hospital cafeterias and assess the influence on healthy lifestyle behaviors. Copyright © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

Hospital enterprise Architecture Framework (Study of Iranian University Hospital Organization).

Science.gov (United States)

Haghighathoseini, Atefehsadat; Bobarshad, Hossein; Saghafi, Fatehmeh; Rezaei, Mohammad Sadegh; Bagherzadeh, Nader

2018-06-01

Nowadays developing smart and fast services for patients and transforming hospitals to modern hospitals is considered a necessity. Living in the world inundated with information systems, designing services based on information technology entails a suitable architecture framework. This paper aims to present a localized enterprise architecture framework for the Iranian university hospital. Using two dimensions of implementation and having appropriate characteristics, the best 17 enterprises frameworks were chosen. As part of this effort, five criteria were selected according to experts' inputs. According to these criteria, five frameworks which had the highest rank were chosen. Then 44 general characteristics were extracted from the existing 17 frameworks after careful studying. Then a questionnaire was written accordingly to distinguish the necessity of those characteristics using expert's opinions and Delphi method. The result showed eight important criteria. In the next step, using AHP method, TOGAF was chosen regarding having appropriate characteristics and the ability to be implemented among reference formats. In the next step, enterprise architecture framework was designed by TOGAF in a conceptual model and its layers. For determining architecture framework parts, a questionnaire with 145 questions was written based on literature review and expert's opinions. The results showed during localization of TOGAF for Iran, 111 of 145 parts were chosen and certified to be used in the hospital. The results showed that TOGAF could be suitable for use in the hospital. So, a localized Hospital Enterprise Architecture Modelling is developed by customizing TOGAF for an Iranian hospital at eight levels and 11 parts. This new model could be used to be performed in other Iranian hospitals. Copyright © 2018 Elsevier B.V. All rights reserved.

Appropriateness of pediatric hospitalization in a general hospital in Kuwait.

Science.gov (United States)

Shafik, Magdy H; Seoudi, Tarek M M; Raway, Tarek S; Al Harbash, Nowair Z; Ahmad, Meshal M A; Al Mutairi, Hanan F

2012-01-01

To determine the rate of inappropriate pediatric admissions using the Pediatric Appropriateness Evaluation Protocol (PAEP) and to examine variables associated with inappropriateness of admissions. A prospective study was conducted in the Department of Pediatrics, Farwania General Hospital, Kuwait, to examine successive admissions for appropriateness of admission as well as several sociodemographic characteristics over a 5-month period (August 2010 to December 2010). A total of 1,022 admissions were included. Of the 1,022 admissions, 416 (40.7%) were considered inappropriate. Factors associated with a higher rate of inappropriate admission included older age of patients and self-referral. The rate of inappropriate hospitalization of children was high in Farwania Hospital, Kuwait, probably due to the relatively free health care services, parental preference for hospital care, easy access to hospital services, and insufficient education about the child's condition. Copyright © 2012 S. Karger AG, Basel.

Association of Changing Hospital Readmission Rates With Mortality Rates After Hospital Discharge

Science.gov (United States)

Wang, Yongfei; Lin, Zhenqiu; Normand, Sharon-Lise T.; Ross, Joseph S.; Horwitz, Leora I.; Desai, Nihar R.; Suter, Lisa G.; Drye, Elizabeth E.; Bernheim, Susannah M.; Krumholz, Harlan M.

2017-01-01

Importance The Affordable Care Act has led to US national reductions in hospital 30-day readmission rates for heart failure (HF), acute myocardial infarction (AMI), and pneumonia. Whether readmission reductions have had the unintended consequence of increasing mortality after hospitalization is unknown. Objective To examine the correlation of paired trends in hospital 30-day readmission rates and hospital 30-day mortality rates after discharge. Design, Setting, and Participants Retrospective study of Medicare fee-for-service beneficiaries aged 65 years or older hospitalized with HF, AMI, or pneumonia from January 1, 2008, through December 31, 2014. Exposure Thirty-day risk-adjusted readmission rate (RARR). Main Outcomes and Measures Thirty-day RARRs and 30-day risk-adjusted mortality rates (RAMRs) after discharge were calculated for each condition in each month at each hospital in 2008 through 2014. Monthly trends in each hospital’s 30-day RARRs and 30-day RAMRs after discharge were examined for each condition. The weighted Pearson correlation coefficient was calculated for hospitals’ paired monthly trends in 30-day RARRs and 30-day RAMRs after discharge for each condition. Results In 2008 through 2014, 2 962 554 hospitalizations for HF, 1 229 939 for AMI, and 2 544 530 for pneumonia were identified at 5016, 4772, and 5057 hospitals, respectively. In January 2008, mean hospital 30-day RARRs and 30-day RAMRs after discharge were 24.6% and 8.4% for HF, 19.3% and 7.6% for AMI, and 18.3% and 8.5% for pneumonia. Hospital 30-day RARRs declined in the aggregate across hospitals from 2008 through 2014; monthly changes in RARRs were −0.053% (95% CI, −0.055% to −0.051%) for HF, −0.044% (95% CI, −0.047% to −0.041%) for AMI, and −0.033% (95% CI, −0.035% to −0.031%) for pneumonia. In contrast, monthly aggregate changes across hospitals in hospital 30-day RAMRs after discharge varied by condition: HF, 0.008% (95% CI, 0.007% to 0.010%); AMI, −0

42 CFR 424.13 - Requirements for inpatient services of hospitals other than psychiatric hospitals.

Science.gov (United States)

2010-10-01

... other than psychiatric hospitals. 424.13 Section 424.13 Public Health CENTERS FOR MEDICARE & MEDICAID... other than psychiatric hospitals. (a) Content of certification and recertification. Medicare Part A pays for inpatient hospital services of hospitals other than psychiatric hospitals only if a physician...

2281-IJBCS-Article-Clement Balogoun

African Journals Online (AJOL)

hp

la production des charbons actifs à partir de résidus ligno-cellulosiques ...... as affected by ozone and alkaline treatment. Chemosphere .... Modeling. Butterworth-Heinemannseries in Chemical Engineering: Boston. Vargas AMM, Cazetta AL, ...

ELEMENTAL FORMS OF HOSPITALITY

OpenAIRE

Maximiliano Emanuel Korstanje

2010-01-01

Modern studies emphasized on the needs of researching the hospitality as relevant aspects of tourism and hospitality fields. Anyway, these approaches are inextricably intertwined to the industry of tourism and do not take seriously the anthropological and sociological roots of hospitality. In fact, the hotel seems to be a partial sphere of hospitality at all. Under this context, the present paper explores the issue of hospitality enrooted in the political and economic indo-European principle ...

Medical Student Education in State Psychiatric Hospitals: A Survey of US State Hospitals.

Science.gov (United States)

Nurenberg, Jeffry R; Schleifer, Steven J; Kennedy, Cheryl; Walker, Mary O; Mayerhoff, David

2016-04-01

State hospitals may be underutilized in medical education. US state psychiatric hospitals were surveyed on current and potential psychiatry medical student education. A 10-item questionnaire, with multiple response formats, was sent to identified hospitals in late 2012. Ninety-seven of 221 hospitals contacted responded. Fifty-three (55%) reported current medical student education programs, including 27 clinical clerkship rotations. Education and training in other disciplines was prevalent in hospitals both with and without medical students. The large majority of responders expressed enthusiasm about medical education. The most frequent reported barrier to new programs was geographic distance from the school. Limited resources were limiting factors for hospitals with and without current programs. Only a minority of US state hospitals may be involved in medical student education. While barriers such as geographic distance may be difficult to overcome, responses suggest opportunities for expanding medical education in the state psychiatric hospitals.

Hospitality and Institutional Meals

DEFF Research Database (Denmark)

Justesen, Lise; Strøjer, Anna-Lise

2017-01-01

Abstract: There is a growing interest in articulating institutional meal serving practices as a hospitality activity involving host and guest interactions. This study aims to qualify institutional hospitality and meal activities by exploring private hospitality events. The study is based......-structured interview, students reflected on their hospitality experiences. The interviews were transcribed and analyzed using a thematic analysis method. The emerging themes on hospitality activities were identified. It was found that hospitality activities could be characterized as a process where the individual...... was transformed into a guest. Information on purpose of the event and other information given in the invitation were part of this process. Furthermore, hospitality activities could be characterized by blurred host-guest relations and by being able to embrace unexpected events as well. The activities were...

Severe Maternal Morbidity and Hospital Cost among Hospitalized Deliveries in the United States.

Science.gov (United States)

Chen, Han-Yang; Chauhan, Suneet P; Blackwell, Sean C

2018-05-03

 The objective of this study was to estimate the contemporary national rate of severe maternal morbidity (SMM) and its associated hospital cost during delivery hospitalization.  We conducted a retrospective study identifying all delivery hospitalizations in the United States between 2011 and 2012. We used data from the National (Nationwide) Inpatient sample of the Healthcare Cost and Utilization Project. The delivery hospitalizations with SMM were identified by having at least one of the 25 previously established list of diagnosis and procedure codes. Aggregate and mean hospital costs were estimated. A generalized linear regression model was used to examine the association between SMM and hospital costs.  Of 7,438,946 delivery hospitalizations identified, the rate of SMM was 154 per 10,000 delivery hospitalizations. Without any SMM, the mean hospital cost was $4,300 and with any SMM, the mean hospital cost was $11,000. After adjustment, comparing to those without any SMM, the mean cost of delivery hospitalizations with any SMM was 2.1 (95% confidence interval: 2.1-2.2) times higher, and this ratio increases from 1.7-fold in those with only one SMM to 10.3-fold in those with five or more concurrent SMM.  The hospital cost with any SMM was 2.1 times higher than those without any SMM. Our findings highlight the need to identify interventions and guide research efforts to mitigate the rate of SMM and its economic burden. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Variations in hospitalization rates among nursing home residents: the role of discretionary hospitalizations.

Science.gov (United States)

Carter, Mary W

2003-08-01

To examine variations in hospitalization rates among nursing home residents associated with discretionary hospitalization practices. Quarterly Medicaid case-mix reimbursement data from the state of Massachusetts served as the core data source for this study, which was linked with data from the Medicare Provider Analysis and Review file (MEDPAR) to specify hospitalization status, nursing facility attribute data from the state of Massachusetts to specify facility-level organizational and structural attributes, and data from the Area Resource File (ARF) to specify area market-level attributes. Data spans three years (1991-1993) to produce a longitudinal analytical file containing 72,319 person-quarter-level observations. Two-step, multivariate logistic regression models were estimated for highly discretionary hospitalizations versus those containing less discretion, and low discretionary hospitalizations versus those containing greater amounts of physician discretion. Findings indicate that facility case-mix levels and area hospital bed supply levels contribute to variations in hospitalization rates among nursing home residents. Highly discretionary hospitalizations appear to be most sensitive to patient diagnoses best described as chronic, ambulatory care sensitive conditions. Findings suggest that defining hospitalizations simply in terms of whether an event occurs versus otherwise may obscure valuable information regarding the contribution of various risk factors to highly discretionary versus low discretionary hospitalization rates.

Reseña libro

Directory of Open Access Journals (Sweden)

Mario Humberto Ruz Sosa

2016-06-01

Full Text Available Gabriela Vargas-Cetina (ed.. Anthropology and the Politics of Representation.  Identity Strategies, Decentered Selves and Crucial Places.  Tuscaloosa: University of Alabama Press, 2014. ISBN 978-0-8173-5717-7

Competition among Turkish hospitals and its effect on hospital efficiency and service quality.

Science.gov (United States)

Torun, Nazan; Celik, Yusuf; Younis, Mustafa Z

2013-01-01

The level of competition among hospitals in Turkey was analyzed for the years 1990 through 2006 using the Herfindahl-Hirschman Index (HHI). Multiple and simple regression analyses were run to observe the development of competition among hospitals over this period of time, to examine likely determinants of competition, and to calculate the effects of competition on efficiency and quality in individual hospitals. This study found that the level of competition among hospitals in Turkey has increased throughout the years. Also, competition has had a positive effect on the efficiency of hospitals; however, it did not have a significant positive effect on their quality. Moreover, there are important differences in the level of competition among hospitals that vary according to the geographical region, the type of ownership, and the type of hospital. This study is one of the first to evaluate the effects of health policies on competition as well as the effects of increasing competition on hospital quality and efficiency in Turkey.

Hospital benchmarking: are U.S. eye hospitals ready?

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de Korne, Dirk F; van Wijngaarden, Jeroen D H; Sol, Kees J C A; Betz, Robert; Thomas, Richard C; Schein, Oliver D; Klazinga, Niek S

2012-01-01

Benchmarking is increasingly considered a useful management instrument to improve quality in health care, but little is known about its applicability in hospital settings. The aims of this study were to assess the applicability of a benchmarking project in U.S. eye hospitals and compare the results with an international initiative. We evaluated multiple cases by applying an evaluation frame abstracted from the literature to five U.S. eye hospitals that used a set of 10 indicators for efficiency benchmarking. Qualitative analysis entailed 46 semistructured face-to-face interviews with stakeholders, document analyses, and questionnaires. The case studies only partially met the conditions of the evaluation frame. Although learning and quality improvement were stated as overall purposes, the benchmarking initiative was at first focused on efficiency only. No ophthalmic outcomes were included, and clinicians were skeptical about their reporting relevance and disclosure. However, in contrast with earlier findings in international eye hospitals, all U.S. hospitals worked with internal indicators that were integrated in their performance management systems and supported benchmarking. Benchmarking can support performance management in individual hospitals. Having a certain number of comparable institutes provide similar services in a noncompetitive milieu seems to lay fertile ground for benchmarking. International benchmarking is useful only when these conditions are not met nationally. Although the literature focuses on static conditions for effective benchmarking, our case studies show that it is a highly iterative and learning process. The journey of benchmarking seems to be more important than the destination. Improving patient value (health outcomes per unit of cost) requires, however, an integrative perspective where clinicians and administrators closely cooperate on both quality and efficiency issues. If these worlds do not share such a relationship, the added

El mundo del libro: septiembre de 1964

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Agustín Rodríguez Garavito

1964-09-01

Full Text Available El documento presenta las reseñas de los siguientes títulos: Los pasos en la sombra -Por Helcías Martán Góngora -Poesía- Ediciones Medusa. Colombia. Diccionario Biográfico de Artistas delNuevo Reino de Granada - Edición: Instituto Colombiano de Cultura Hispánica. Bogotá. Artículos y Ensayos -Por José Joaquín Vargas Valdés -Introducción y Selección de Aníbal Vargas Barón -Universidad de Oregón. U.S.A. De lo celeste y tenebroso -Gabriel Uliosa -Poemas- Editorial Iqueima. San Andrés y Providencia -James J. Parsons. -Talleres Gráficos del Banco de la República -Bogotá-Colombia

[Crisis unit at the general hospital: Determinants of further hospitalization].

Science.gov (United States)

Norotte, C; Omnès, C; Crozier, C; Verlyck, C; Romanos, M

2017-10-01

The availability of short-stay beds for brief admission (less than 72hours) of crisis patients presenting to the emergency room is a model that has gained a growing interest because it allows time for developing alternatives to psychiatric hospitalization and favors a maintained functioning in the community. Still, the determinants influencing the disposition decision at discharge after crisis intervention remain largely unexplored. The primary objective of this study was to determine the factors predicting aftercare dispositions at crisis unit discharge: transfer for further hospitalization or return to the community. Secondary objectives included the description of clinical and socio-demographic characteristics of patients admitted to the crisis unit upon presentation to the emergency room. All patients (n=255) admitted to the short-stay unit of the emergency department of Rambouillet General Hospital during a one-year period were included in the study. Patient characteristics were collected in a retrospective manner from medical records: patterns of referral, acute stressors, presenting symptoms, initial patient demand, Diagnostic and Statistical Manual, 5th edition (DSM-5) disorders, psychiatric history, and socio-demographic characteristics were inferred. Logistic regression analysis was used to determine the factors associated with hospitalization decision upon crisis intervention at discharge. Following crisis intervention at the short-stay unit, 100 patients (39.2%) required further hospitalization and were transferred. Statistically significant factors associated with a higher probability of hospitalization (P<0.05) included the patient's initial wish to be hospitalized (OR=4.28), the presence of a comorbid disorder (OR=3.43), a referral by family or friends (OR=2.89), a history of psychiatric hospitalization (OR=2.71) and suicidal ideation on arrival in the emergency room (OR=2.26). Conversely, significant factors associated with a lower probability of

Hospitals

DEFF Research Database (Denmark)

Mullins, Michael

2013-01-01

The challenge could be briefly seen in these terms: hospitals as places for treatment where there’s a technology focus and hospitals for healing where there’s a human focus. In the 60s - 70s wave of new hospital building, an emphasis on technology can be seen. It’s time to move from the technology...... focus. It is not enough to consider only the factors of function within architecture, hygiene, economy and logistics. We also need to look at aspects of aesthetics, bringing nature into the building, art, color, acoustics, volume and space as we perceive them. Contemporary methods and advances...... placed, accessible, provided with plenty of greenery, and maximize sensory impressions, providing sounds, smells, sight and the possibility to be touched. This is a very well documented area I can say. Hygiene, in terms of architecture can give attention to hand wash facilities and their positioning...

[Smoking prevalence in hospital workers: meta-analysis in 45 Catalan hospitals].

Science.gov (United States)

Martínez, Cristina; Martínez-Sánchez, Jose M; Antón, Laura; Riccobene, Anna; Fu, Marcela; Quirós, Nuria; Saltó, Esteve; Fernández, Esteve

2016-01-01

To estimate the prevalence of smoking in workers from hospitals within the Catalan Network for Smoke-free hospitals from 2009 to 2012 according to workers' sociodemographic characteristics and the type of hospital. A meta-analysis was performed of prevalence surveys from representative samples of workers from 45 hospitals. The combined prevalence for all hospitals was calculated using a regression model with a random effects model weighted by sample size. The overall prevalence of smoking was 28.1% (95%CI: 26.1 to 30.0%) with a maximum and minimum of 40.3% and 19.1%, respectively. The health professionals with the lowest prevalence of smoking were physicians (16.4%; 95%CI: 12.9 to 19.9) and nurses (25.4%; 95%CI 21.6 to 29.2). The prevalence of smoking in hospital health workers was lower than in the general population of working age. Physicians were the group with the lowest smoking prevalence. Smoking cessation should be promoted among other professional groups. Copyright © 2015 SESPAS. Published by Elsevier Espana. All rights reserved.

[Screening for malnutrition among hospitalized patients in a Colombian University Hospital].

Science.gov (United States)

Cruz, Viviana; Bernal, Laura; Buitrago, Giancarlo; Ruiz, Álvaro J

2017-04-01

On admission, 30 to 50% of hospitalized patients have some degree of malnutrition, which is associated with longer length of stay, higher rates of complications, mortality and greater costs. To determine the frequency of screening for risk of malnutrition in medical records and assess the usefulness of the Malnutrition Screening Tool (MST). In a cross-sectional study, we searched for malnutrition screening in medical records, and we applied the MST tool to hospitalized patients at the Internal Medicine Wards of San Ignacio University Hospital. Of 295 patients included, none had been screened for malnutrition since hospital admission. Sixty one percent were at nutritional risk, with a higher prevalence among patients with HIV (85.7%), cancer (77.5%) and pneumonia. A positive MST result was associated with a 3.2 days increase in length of hospital stay (p = 0.024). The prevalence of malnutrition risk in hospitalized patients is high, but its screening is inadequate and it is underdiagnosed. The MST tool is simple, fast, low-cost, and has a good diagnostic performance.

Hospital pharmacy workforce in Brazil.

Science.gov (United States)

Santos, Thiago R; Penm, Jonathan; Baldoni, André O; Ayres, Lorena Rocha; Moles, Rebekah; Sanches, Cristina

2018-01-04

This study aims to describe the distribution of the hospital pharmacy workforce in Brazil. Data were acquired, during 2016, through the Brazilian National Database of Healthcare Facilities (CNES). The following variables were extracted: hospital name, registry number, telephone, e-mail, state, type of institution, subtype, management nature, ownership, presence of research/teaching activities, complexity level, number of hospital beds, presence of pharmacists, number of pharmacists, pharmacist specialization. All statistical analyses were performed by IBM SPSS v.19. The number of hospitals with a complete registry in the national database was 4790. The majority were general hospitals (77.9%), managed by municipalities (66.1%), under public administration (44.0%), had no research/teaching activities (90.5%), classified as medium complexity (71.6%), and had no pharmacist in their team (50.6%). Furthermore, almost 60.0% of hospitals did not comply with the minimum recommendations of having a pharmacist per 50 hospital beds. The Southeast region had the highest prevalence of pharmacists, with 64.4% of hospitals having a pharmaceutical professional. This may have occurred as this region had the highest population to hospital ratio. Non-profit hospitals were more likely to have pharmacists compared to those under public administration and private hospitals. This study mapped the hospital pharmacy workforce in Brazil, showing a higher prevalence of hospital pharmacists in the Southeast region, and in non-profit specialized hospitals.

Service Robots for Hospitals

DEFF Research Database (Denmark)

Özkil, Ali Gürcan

services to maintain the quality of healthcare provided. This thesis and the Industrial PhD project aim to address logistics, which is the most resource demanding service in a hospital. The scale of the transportation tasks is huge and the material flow in a hospital is comparable to that of a factory. We......Hospitals are complex and dynamic organisms that are vital to the well-being of societies. Providing good quality healthcare is the ultimate goal of a hospital, and it is what most of us are only concerned with. A hospital, on the other hand, has to orchestrate a great deal of supplementary...... believe that these transportation tasks, to a great extent, can be and will be automated using mobile robots. This thesis consequently addresses the key technical issues of implementing service robots in hospitals. In simple terms, a robotic system for automating hospital logistics has to be reliable...

Muusikamaailm : Festival "Ultima" Oslos. Kaks juubilari šveitsist. Honeckil juba kaks orkestrit / Priit Kuusk

Index Scriptorium Estoniae

Kuusk, Priit, 1938-

2001-01-01

Nüüdismuusikafestivalist "Ultima" Oslos. šveitsi muusikategelased Tibor Varga ja Rudolf Kelterborn tähistasid juubelit. Noorel austria dirigendi Manfred Honeck'i juhatada on kaks orkestrit- Rootsi Raadio Sümfooniaorkester ja Oslo Filharmoonia Orkester

Determinants of the direct cost of heart failure hospitalization in a public tertiary hospital.

Science.gov (United States)

Parissis, John; Athanasakis, Kostas; Farmakis, Dimitrios; Boubouchairopoulou, Nadia; Mareti, Christina; Bistola, Vasiliki; Ikonomidis, Ignatios; Kyriopoulos, John; Filippatos, Gerasimos; Lekakis, John

2015-02-01

Heart failure (HF) is the first reason for hospital admission in the elderly and represents a major financial burden, the greatest part of which results from hospitalization costs. We sought to analyze current HF hospitalization-related expenditure and identify predictors of cost in a public tertiary hospital in Europe. We performed a retrospective chart review of 197 consecutive patients, aged 56±16years, 80% male, with left ventricular ejection fraction (LVEF) of 30±10%, hospitalized for HF in a major university hospital in Athens, Greece. The survey involved the number of hospitalization days, laboratory investigations and medical therapies. Patients who were hospitalized in CCU/ICU or underwent interventional procedures or device implantations were excluded from analysis. Costs were estimated based on the Greek healthcare system perspective in 2013. Patients were hospitalized for a median of 7 days with a total direct cost of €3198±3260/patient. The largest part of the expenses (79%) was attributed to hospitalization (ward), while laboratory investigations and medical treatment accounted for 17% and 4%, respectively. In multivariate analysis, pre-admission New York Heart Association NYHA class (p=0.001), serum creatinine (p=0.003) and NT-proBNP (p=0.004) were significant independent predictors of hospitalization cost. Direct cost of HF hospitalization is high particularly in patients with more severe symptoms, profound neurohormonal activation and renal dysfunction. Strategies to lower hospitalization rates are warranted in the current setting of financial constraints faced by many European countries. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Evaluation of Collection and Disposal of Hospital Waste in Hospitals and Healthcare Centers

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Saeid Nazemi

2012-08-01

Full Text Available Currently, one of the environmental issues is waste of hospitals and healthcare facilities which due to hazardous, toxic, and disease-causing agents such as pharmaceutical, chemical and infectious disease, is of particular sensitivity. According to a 2002 survey by WHO, it was determined that 22 million people worldwide suffer from infectious diseases annually, because of contacting hospital wastes. Also based on a research conducted in 22 countries, 18 to 64 percent of hospitals wastes are not disposed properly [1]. The purpose f the study is to appraise collection and disposal of hospital wastes in hospitals and healthcare centers of Shahroud.In this sectional study, 3 university hospitals (580 beds and 10 healthcare facilities were investigated for six months (mehr-azar 89 at Shahroud. In order to determine the amount of waste, produced waste of an entire day was weighted in hospitals and health centers. In this research, proposed questionnaires of WHO for developing countries was used to evaluate collection and disposal system of hospitals waste. Collected data was coded and analyzed by SPSS ver.15.

What happens in hospitals does not stay in hospitals: antibiotic-resistant bacteria in hospital wastewater systems.

Science.gov (United States)

Hocquet, D; Muller, A; Bertrand, X

2016-08-01

Hospitals are hotspots for antimicrobial-resistant bacteria (ARB) and play a major role in both their emergence and spread. Large numbers of these ARB will be ejected from hospitals via wastewater systems. In this review, we present quantitative and qualitative data of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli, vancomycin-resistant enterococci and Pseudomonas aeruginosa in hospital wastewaters compared to community wastewaters. We also discuss the fate of these ARB in wastewater treatment plants and in the downstream environment. Published studies have shown that hospital effluents contain ARB, the burden of these bacteria being dependent on their local prevalence. The large amounts of antimicrobials rejected in wastewater exert a continuous selective pressure. Only a few countries recommend the primary treatment of hospital effluents before their discharge into the main wastewater flow for treatment in municipal wastewater treatment plants. Despite the lack of conclusive data, some studies suggest that treatment could favour the ARB, notably ESBL-producing E. coli. Moreover, treatment plants are described as hotspots for the transfer of antibiotic resistance genes between bacterial species. Consequently, large amounts of ARB are released in the environment, but it is unclear whether this release contributes to the global epidemiology of these pathogens. It is reasonable, nevertheless, to postulate that it plays a role in the worldwide progression of antibiotic resistance. Antimicrobial resistance should now be seen as an 'environmental pollutant', and new wastewater treatment processes must be assessed for their capability in eliminating ARB, especially from hospital effluents. Copyright © 2016. Published by Elsevier Ltd.

Hospital network performance: a survey of hospital stakeholders' perspectives.

Science.gov (United States)

Bravi, F; Gibertoni, D; Marcon, A; Sicotte, C; Minvielle, E; Rucci, P; Angelastro, A; Carradori, T; Fantini, M P

2013-02-01

Hospital networks are an emerging organizational form designed to face the new challenges of public health systems. Although the benefits introduced by network models in terms of rationalization of resources are known, evidence about stakeholders' perspectives on hospital network performance from the literature is scanty. Using the Competing Values Framework of organizational effectiveness and its subsequent adaptation by Minvielle et al., we conducted in 2009 a survey in five hospitals of an Italian network for oncological care to examine and compare the views on hospital network performance of internal stakeholders (physicians, nurses and the administrative staff). 329 questionnaires exploring stakeholders' perspectives were completed, with a response rate of 65.8%. Using exploratory factor analysis of the 66 items of the questionnaire, we identified 4 factors, i.e. Centrality of relationships, Quality of care, Attractiveness/Reputation and Staff empowerment and Protection of workers' rights. 42 items were retained in the analysis. Factor scores proved to be high (mean score>8 on a 10-item scale), except for Attractiveness/Reputation (mean score 6.79), indicating that stakeholders attach a higher importance to relational and health care aspects. Comparison of factor scores among stakeholders did not reveal significant differences, suggesting a broadly shared view on hospital network performance. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Trinta e sete dias em Nova York com Adalzira Bittencourt Thirty - seven days in New York with Adalzira Bittencourt

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Peggy Sharpe

2008-12-01

Full Text Available A viagem de Adalzira Bittencourt para os Estados Unidos durante 1939 gerou a publicação de uma narrativa de viagem que conta os detalhes de sua visita a inúmeras escolas, hospitais, orfanatos de Nova York e à Feira Mundial de 1939 na mesma cidade. Suas impressões sobre as reformas eugênicas, que estavam sendo implementadas nos Estados Unidos nessa época, revelam sua aliança aos projetos de renovação cultural patrocinados pelo regime de Getúlio Vargas que visavam melhorar as condições sociais da população não privilegiada da sociedade brasileira. Os comentários de Bittencourt também expõem o preconceito racial prevalente nos Estados Unidos e sua própria atitude racista com o setor da população brasileira pelo qual advogava como educadora, ativista social, escritora e advogada.Adalzira Bittencourt's visit to the US during 1939 resulted in a travel narrative that recounts the details of her visits to numerous schools, hospitals and orphanages in the city of New York and to the 1939 World's Fair held in the same city. Her general impressions of the eugenic reforms underway in the US during this time period reveal her support for the project of cultural renewal sponsored by the Vargas regime that targeted the disadvantaged in Brazilian society. In addition, Bittencourt's commentary exposes the racial prejudice prevalent in American society at the time and outlines the hues and tones of her own brand of racism vis a vis the very sector of the Brazilian population she advocated for throughout her career as a lawyer, educator, social activist and writer.

The founding of Zemun Hospital

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Milanović Jasmina

2014-01-01

Full Text Available This year Zemun Hospital - Clinical Hospital Center Zemun celebrates 230th anniversary of continuous work, thus becoming the oldest medical facility in Serbia. The exact date of the hospital founding has been often questioned in history. Various dates appeared in the literature, but the most frequent one was 25th of February 1784. Until now, the document which confirms this has never been published. This article represents the first official publication of the document which confirms that Zemun Hospital was indeed founded on this date. The first hospitals started emerging in Zemun when the town became a part of the Habsburg Monarchy. The first sanitary facility ever formed was the “Kontumac” - a quarantine established in 1730. Soon after, two more confessional hospitals were opened. The Serbian (Orthodox Hospital was founded before 1769, whereas the German (Catholic Hospital started working in 1758. Both hospitals were financed, amongst others, by the Town Hall - the Magistrate. In order to improve efficiency of these hospitals, a decision was made to merge them into a single City Hospital. It was founded on 25th February 1784, when the General Command ordered the Magistrate of Zemun to merge the financess of all existing hospitals and initiate the construction of a new building. Although financially united, the hospitals continued working in separate buildings over a certain period of time. The final, physical merging of these hospitals was completed in 1795. [Projekat Ministarstva nauke Republike Srbije, br. 47030

Radiopharmaceuticals and hospital radiopharmacy practices: course manual for accreditation/certification of hospital radiopharmacists

International Nuclear Information System (INIS)

Ramamoorthy, N.; Shivarudrappa, V.; Bhelose, Amita A.

2000-02-01

This manual on hospital radiopharmaceuticals and hospital radiopharmacy practices contains information and recommendations that could be of use to hospital radiopharmacists while the main focus of the book is to impart adequate exposure to basics of radiopharmaceuticals and purity and safety aspects of formulations to be made in hospital radiopharmacy. Papers relevant to INIS are indexed separately

Hospital Dermatology, Introduction.

Science.gov (United States)

Fox, Lindy P

2017-03-01

Inpatient dermatology is emerging as a distinct dermatology subspecialty where dermatologists specialize in caring for patients hospitalized with skin disease. While the main focus of inpatient dermatology is the delivery of top-quality and timely dermatologic care to patients in the hospital setting, the practice of hospital-based dermatology has many additional components that are critical to its success. ©2017 Frontline Medical Communications.

A multicenter qualitative study on preventing hospital-acquired urinary tract infection in US hospitals.

Science.gov (United States)

Saint, Sanjay; Kowalski, Christine P; Forman, Jane; Damschroder, Laura; Hofer, Timothy P; Kaufman, Samuel R; Creswell, John W; Krein, Sarah L

2008-04-01

Although urinary tract infection (UTI) is the most common hospital-acquired infection, there is little information about why hospitals use or do not use a range of available preventive practices. We thus conducted a multicenter study to understand better how US hospitals approach the prevention of hospital-acquired UTI. This research is part of a larger study employing both quantitative and qualitative methods. The qualitative phase consisted of 38 semistructured phone interviews with key personnel at 14 purposefully sampled US hospitals and 39 in-person interviews at 5 of those 14 hospitals, to identify recurrent and unifying themes that characterize how hospitals have addressed hospital-acquired UTI. Four recurrent themes emerged from our study data. First, although preventing hospital-acquired UTI was a low priority for most hospitals, there was substantial recognition of the value of early removal of a urinary catheter for patients. Second, those hospitals that made UTI prevention a high priority also focused on noninfectious complications and had committed advocates, or "champions," who facilitated prevention activities. Third, hospital-specific pilot studies were important in deciding whether or not to use devices such as antimicrobial-impregnated catheters. Finally, external forces, such as public reporting, influenced UTI surveillance and infection prevention activities. Clinicians and policy makers can use our findings to develop initiatives that, for example, use a champion to promote the removal of unnecessary urinary catheters or exploit external forces, such public reporting, to enhance patient safety.

The Medicare Hospital Readmissions Reduction Program: potential unintended consequences for hospitals serving vulnerable populations.

Science.gov (United States)

Gu, Qian; Koenig, Lane; Faerberg, Jennifer; Steinberg, Caroline Rossi; Vaz, Christopher; Wheatley, Mary P

2014-06-01

To explore the impact of the Hospital Readmissions Reduction Program (HRRP) on hospitals serving vulnerable populations. Medicare inpatient claims to calculate condition-specific readmission rates. Medicare cost reports and other sources to determine a hospital's share of duals, profit margin, and characteristics. Regression analyses and projections were used to estimate risk-adjusted readmission rates and financial penalties under the HRRP. Findings were compared across groups of hospitals, determined based on their share of duals, to assess differential impacts of the HRRP. Both patient dual-eligible status and a hospital's dual-eligible share of Medicare discharges have a positive impact on risk-adjusted hospital readmission rates. Under current Centers for Medicare and Medicaid Service methodology, which does not adjust for socioeconomic status, high-dual hospitals are more likely to have excess readmissions than low-dual hospitals. As a result, HRRP penalties will disproportionately fall on high-dual hospitals, which are more likely to have negative all-payer margins, raising concerns of unintended consequences of the program for vulnerable populations. Policies to reduce hospital readmissions must balance the need to ensure continued access to quality care for vulnerable populations. © Health Research and Educational Trust.

Children's Hospitals' Solutions for Patient Safety Collaborative Impact on Hospital-Acquired Harm.

Science.gov (United States)

Lyren, Anne; Brilli, Richard J; Zieker, Karen; Marino, Miguel; Muething, Stephen; Sharek, Paul J

2017-09-01

To determine if an improvement collaborative of 33 children's hospitals focused on reliable best practice implementation and culture of safety improvements can reduce hospital-acquired conditions (HACs) and serious safety events (SSEs). A 3-year prospective cohort study design with a 12-month historical control population was completed by the Children's Hospitals' Solutions for Patient Safety collaborative. Identification and dissemination of best practices related to 9 HACs and SSE reduction focused on key process and culture of safety improvements. Individual hospital improvement teams leveraged the resources of a large, structured children's hospital collaborative using electronic, virtual, and in-person interactions. Thirty-three children's hospitals from across the United States volunteered to be part of the Children's Hospitals' Solutions for Patient Safety collaborative. Thirty-two met all the data submission eligibility requirements for the HAC improvement objective of this study, and 21 participated in the high-reliability culture work aimed at reducing SSEs. Significant harm reduction occurred in 8 of 9 common HACs (range 9%-71%; P collaborative dedicated to implementing HAC-related best-practice prevention bundles and culture of safety interventions designed to increase the use of high-reliability organization practices resulted in significant HAC and SSE reductions. Structured collaboration and rapid sharing of evidence-based practices and tools are effective approaches to decreasing hospital-acquired harm. Copyright © 2017 by the American Academy of Pediatrics.

Determining Disturbing Factors of Sleep Quality among Hospitalized Elderly Patients in Kashan Hospitals, Iran 2009

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M Kafaei

2013-03-01

Full Text Available Introduction: Sleep is an effective factor in the recovery processes. Many variables affect on the sleep quality of hospitalized elderly people. This study was conducted to determine the factors disturbing sleep quality among hospitalized older adult patients in Kashan hospitals. Methods: A cross-sectional study was carried out on a sample of 390 elderly hospitalized patients in Kashan hospitals. The study data was gathered via Pittsburgh Sleep Quality Index (PSQI Questionnaire. A global total score of 5 or greater indicated a “poor" quality of sleep. The data were analyzed using Chi square, t- test and binary logistic regression at multivariate model. Results: The total quality of sleep was poor in hospitalized elderly patients (7/2±4/8. Sex, marital status, level of education, type of ward, previous hospitalization experience, use of hypnotics at home and hospital, and previous sleep disorders were statistically associated with quality of sleep; however, there was not significant relationship between quality of sleep and age, length of hospitalization, and daytime napping. In the final regression model, marital status (OR=4.6, level of education (OR=1.9, length of hospitalization (OR=1.1, Previous hospitalization experience (OR=0.4, use of hypnotics in hospital (OR=0.27 and previous sleep disorder (OR=0.01 were the most important determinants of sleep quality. Conclusion: Quality of sleep was poor in hospitalized elderly due to a wide range of sleep disturbing factors. The most important factors involved marital status, level of education, previous hospitalization experience, previous sleep disorder and use of hypnotics in hospital.

Impact of hyperglycemia on morbidity and mortality, length of hospitalization and rates of re-hospitalization in a general hospital setting in Brazil

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Leite Silmara AO

2010-07-01

Full Text Available Abstract Background Hyperglycemia in hospitalized patients is known to be related to a higher incidence of clinical and surgical complications and poorer outcomes. Adequate glycemic control and earlier diagnosis of type 2 diabetes during hospitalization are cost-effective measures. Methods This prospective cohort study was designed to determine the impact of hyperglycemia on morbidity and mortality in a general hospital setting during a 3-month period by reviewing patients' records. The primary purposes of this trial were to verify that hyperglycemia was diagnosed properly and sufficiently early and that it was managed during the hospital stay; we also aimed to evaluate the relationship between in-hospital hyperglycemia control and outcomes such as complications during the hospital stay, extent of hospitalization, frequency of re-hospitalization, death rates and number of days in the ICU (Intensive Care Unit after admission. Statistical analyses utilized the Kruskall-Wallis complemented by the "a posteriori" d.m.s. test, Spearman correlation and Chi-squared test, with a level of significance of 5% (p Results We reviewed 779 patient records that fulfilled inclusion criteria. The patients were divided into 5 groups: group (1 diabetic with normal glycemic levels according to American Diabetes Association criteria for in-hospital patients (n = 123; group (2 diabetics with hyperglycemia (n = 76; group (3 non-diabetics with hyperglycemia (n = 225; group (4diabetics and non-diabetics with persistent hyperglycemia during 3 consecutive days (n = 57 and group (5 those with normal glucose control (n = 298. Compared to patients in groups 1 and 5, patients in groups 2, 3 and 4 had significantly higher mortality rates (17.7% vs. 2.8% and Intensive Care Unit admissions with complications (23.3% vs. 4.5%. Patients in group 4 had the longest hospitalizations (mean 15.5 days, and group 5 had the lowest re-hospitalization rate (mean of 1.28 hospitalizations. Only

In a niche of time: do specialty hospitals outperform general services hospitals?

Science.gov (United States)

Poole, LeJon; Davis, Jullet A; Gunby, Norris W

2013-01-01

Niche hospitals represent a growing segment in the health care industry. Niche facilities are primarily engaged in the treatment of cardiac or orthopedic conditions. The effectiveness of this strategy is of interest because niche hospitals focus on only the most profitable services. The purpose of this research was to assess the financial effectiveness of the niche strategy. We theorize that firm and market-level factors concomitantly with the strategy of the hospital-niche versus traditional-are associated with financial performance. This research used 2 data sources, the 2003 Medicare Cost Report and the 2003 Area Resource File. The sample was limited to only for-profit, urban, nongovernmental hospitals (n = 995). The data were analyzed using hierarchical least squares regression. Financial performance was operationalized using the hospital's return on assets. The principal finding of this project is that niche hospitals had significantly higher performance than traditional facilities. From the organizational perspective, the niche strategy leads to better financial performance. From a societal perspective, the niche strategy provides increased focus and efficiencies through repetition. Despite the limited focus of this strategy, patients who can access these providers may experience better outcomes than patients in more traditional hospitals.

Mental hospital reform in Asia: the case of Yuli Veterans Hospital, Taiwan

OpenAIRE

Lin, Chih-Yuan; Huang, Ai-Ling; Minas, Harry; Cohen, Alex

2009-01-01

Abstract Background Yuli Veterans Hospital (YVH) has been the largest mental hospital for the patients with chronic and severe mental illness in Taiwan for the past 50 years. While this hospital used to be a symbol of hopelessness among patients and their families and an unspoken shame among Taiwan psychiatry and mental health circles it now represents an example of how an old, custodial hospital can be transformed into a very different institution. In this case study we will describe the fea...

Additional funding mechanisms for Public Hospitals in Greece: the case of Chania Mental Health Hospital.

Science.gov (United States)

Rentoumis, Anastasios; Mantzoufas, Nikolaos; Kouris, Gavriil; Golna, Christina; Souliotis, Kyriakos

2010-11-10

To investigate whether the long term lease of public hospital owned land could be an additional financing mechanism for Greek public (mental) health hospitals. We performed a financial analysis of the official 2008 data of a case - study hospital (Mental Health Hospital of Chania). We used a capital budgeting approach to investigate whether value is created for the public hospital by engaging its assets in a project for the development of a private renal dialysis Unit. The development of the private unit in hospital owned land is a good investment decision, as it generates high project Net Present Value and Internal Rate of Return. When the project commences generating operating cash flows, nearly €400.000 will be paid annually to the Mental Health Hospital of Chania as rent, thereby gradually decreasing the annual deficit of the hospital. Revenue generated from the long term lease of public hospital land is crucial to gradually eliminate hospital deficit. The Ministry of Health should encourage similar forms of Public Private Partnerships in order to ensure the sustainability of public (mental) hospitals.

Help prevent hospital errors

Science.gov (United States)

... this page: //medlineplus.gov/ency/patientinstructions/000618.htm Help prevent hospital errors To use the sharing features ... in the hospital. If You Are Having Surgery, Help Keep Yourself Safe Go to a hospital you ...

Risk of malnutrition of hospitalized children in a university public hospital.

Science.gov (United States)

Muñoz-Esparza, Nelly Carolina; Vásquez-Garibay, Edgar Manuel; Romero-Velarde, Enrique; Troyo-Sanromán, Rogelio

2017-02-01

The study aimed to demonstrate that the duration of hospitalization has a significant effect on the nutritional status of children treated in a university hospital. A longitudinal study was conducted during 2014, with a non-random sampling site concentration in children from birth to 19 years who were admitted to the hospital in the past 24 hours and who met the inclusion criteria and had signed informed consent. Upon entering, at 7 days, and at discharge, anthropometric indices, including weight/age, height/age, weight/height, BMI/age, head circumference/age, triceps and subscapular skin folds, and fat percentage, were obtained. Student's t-test, U Mann-Whitney, ANOVA, chi square, Wilcoxon, and odds ratios were used to analyze the data. In total, 206 patients were included: 40% infants, 25% preschoolers, 15% schoolchildren, and 20% teenagers. Infants had a significant improvement from admission to discharge in the indices weight/length (p = 0.042) and BMI (p = 0.002); adolescents showed decreased BMI from admission to discharge from the hospital (p = 0.05). Patients with longer hospitalization (more than 10 days) had an increased deficit in anthropometric indices at admission (p malnutrition and require greater monitoring of nutritional status during hospitalization.

Hospital Medicine (Part 1): what is wrong with acute hospital care?

LENUS (Irish Health Repository)

Kellett, John

2009-09-01

Modern hospitals are facing several challenges and, over the last decade in particular, many of these institutions have become dysfunctional. Paradoxically as medicine has become more successful the demand for acute hospital care has increased, yet there is no consensus on what conditions or complaints require hospital admission and there is wide variation in the mortality rates, length of stay and possibly standards of care between different units. Most acutely ill patients are elderly and instead of one straightforward diagnosis are more likely to have a complex combination of multiple co-morbid conditions. Any elderly patient admitted to hospital is at considerable risk which must be balanced against the possible benefits. Although most of the patients in hospital die from only approximately ten diagnoses, obvious life saving treatment is often delayed by a junior doctor in-training first performing an exhaustive complete history and physical, and then ordering a number of investigations before consulting a senior colleague. Following this traditional hierarchy delays care with several "futile cycles" of clinical activity thoughtlessly directed at the patient without any benefit being delivered. If acute hospital medicine is to be improved changes in traditional assumptions, attitudes, beliefs and practices are needed.

Medicare Payment Penalties and Safety Net Hospital Profitability: Minimal Impact on These Vulnerable Hospitals.

Science.gov (United States)

Bazzoli, Gloria J; Thompson, Michael P; Waters, Teresa M

2018-02-08

To examine relationships between penalties assessed by Medicare's Hospital Readmission Reduction Program and Value-Based Purchasing Program and hospital financial condition. Centers for Medicare and Medicaid Services, American Hospital Association, and Area Health Resource File data for 4,824 hospital-year observations. Bivariate and multivariate analysis of pooled cross-sectional data. Safety net hospitals have significantly higher HRRP/VBP penalties, but, unlike nonsafety net hospitals, increases in their penalty rate did not significantly affect their total margins. Safety net hospitals appear to rely on nonpatient care revenues to offset higher penalties for the years studied. While reassuring, these funding streams are volatile and may not be able to compensate for cumulative losses over time. © Health Research and Educational Trust.

78 FR 15882 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Science.gov (United States)

2013-03-13

... Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and... Register entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals...

Results of a hospital waste survey in private hospitals in Fars province, Iran

International Nuclear Information System (INIS)

Askarian, Mehrdad; Vakili, Mahmood; Kabir, Gholamhosein

2004-01-01

Hospital waste is considered dangerous because it may possess pathogenic agents and can cause undesirable effects on human health and the environment. In Iran, neither rules have been compiled nor does exact information exist regarding hospital waste management. The survey presented in this article was carried out in all 15 private hospitals of Fars province (Iran) from the total numbers of 50 governmental and private hospitals located in this province, in order to determine the amount of different kinds of waste produced and the present situation of waste management. The results indicated that the waste generation rate is 4.45 kg/bed/day, which includes 1830 kg (71.44%) of domestic waste, 712 kg (27.8%) of infectious waste, and 19.6 kg (0.76%) of sharps. Segregation of the different types of waste is not carried out perfectly. Two (13.3%) of the hospitals use containers without lids for on-site transport of wastes. Nine (60%) of the hospitals are equipped with an incinerator and six of them (40%) have operational problems with the incinerators. In all hospitals municipal workers transport waste outside the hospital premises daily or at the most on alternative days. In the hospitals under study, there aren't any training courses about hospital waste management and the hazards associated with them. The training courses that are provided are either ineffective or unsuitable. Performing extensive studies all over the country, compiling and enacting rules, establishing standards and providing effective personnel training are the main challenges for the concerned authorities and specialists in this field

Preventing hospital malnutrition: a survey on nutritional policies in an Italian University Hospital.

Science.gov (United States)

Annetta, M G; Pittiruti, M; De Rosa, S; Franchi, P; Pintaudi, G; Caricato, A; Antonelli, M

2015-11-01

A proper strategy for fighting hospital malnutrition should include nutritional screening of all hospitalized patients, adequate utilization of the Hospital facilities - such as Clinical Nutrition Services or Nutrition Teams - and an adequate algorithm for the adoption of proper nutrition support (oral, enteral or parenteral) with proper timing. The main aim of the present study was to investigate the current policies of different non-intensive wards of our institution (a 1100 beds University Hospital) in terms of prevention of hospital malnutrition. We conducted a one-day survey to verify the current policies of nutritional screening and the indication to nutritional support in adult patients, interviewing nurses and physicians of our non-intensive hospital wards. A total of 29 wards were considered, which sum up to 755 hospitalized patients. We found that nutritional screening at admission is routinely assessed only in 41% of wards and that oral nutrient intake is controlled regularly only in 72%. Indication to clinical nutrition support and specifically to artificial nutrition is not consistent with the current international guidelines. Only 14% of patients were receiving artificial nutrition at the moment of the survey and the majority of them were given parenteral nutrition rather than enteral feeding. Our survey confirmed that in large hospitals the main barriers to the fight against hospital malnutrition are the lack of knowledge and/or commitment by nurses and physicians as well as the lack of well-defined hospital policies on early nutritional screening, surveillance of nutritional status and indication to nutrition support.

Service Robots for Hospitals: A Case Study of Transportation Tasks in a Hospital

DEFF Research Database (Denmark)

Özkil, Ali Gürcan; Fan, Zhun; Dawids, Steen

2009-01-01

In this paper, the need for automated transportation systems for hospitals is investigated. Among other alternatives, mobile robots stand out as the most prominent means of automation of transportation tasks in hospitals. Existing transportation routines of a hospital are analyzed in order...... to verify the need for automation and identify possible areas of improvement. The analysis shows that most of the existing transportation is carried out manually, and hospitals can greatly benefit from automated transportation. Based on the results of the analysis, three alternatives are derived...... for implementing mobile service robots for transportation tasks in hospitals....

NOTAS BIBLIOGRÁFICAS

Directory of Open Access Journals (Sweden)

Eugenio Rivas

2017-04-01

Full Text Available O sacerdote jesuíta espanhol Gerardo R. Vargas recolhe nesta obra sua experiência de mais de 30 anos como professor de Filosofia da Religião na Pontifícia Universidade Javeriana.

Additional funding mechanisms for Public Hospitals in Greece: the case of Chania Mental Health Hospital

Directory of Open Access Journals (Sweden)

Golna Christina

2010-11-01

Full Text Available Abstract Objectives To investigate whether the long term lease of public hospital owned land could be an additional financing mechanism for Greek public (mental health hospitals. Methods We performed a financial analysis of the official 2008 data of a case - study hospital (Mental Health Hospital of Chania. We used a capital budgeting approach to investigate whether value is created for the public hospital by engaging its assets in a project for the development of a private renal dialysis Unit. Results The development of the private unit in hospital owned land is a good investment decision, as it generates high project Net Present Value and Internal Rate of Return. When the project commences generating operating cash flows, nearly €400.000 will be paid annually to the Mental Health Hospital of Chania as rent, thereby gradually decreasing the annual deficit of the hospital. Conclusions Revenue generated from the long term lease of public hospital land is crucial to gradually eliminate hospital deficit. The Ministry of Health should encourage similar forms of Public Private Partnerships in order to ensure the sustainability of public (mental hospitals.

The Influence of Employee Ability, Hospital???s Ethic and Leadership to Satisfaction through the Employee Commitment: A Study on Indonesian Type A Government Hospital

OpenAIRE

Mardiana, Ria; Djabir Hamzah; Syamsul Bahri

2013-01-01

Aims: The aims of this study is to confirm the direct and indirect influence of employee ability, perceived of hospital???s ethic and leadership to the satisfaction of customer through employee commitment. Sample are hospital???s stakeholders that consist of paramedics (frontliners, doctors, and nurses) and inpatient of healthcare insurance. Study design: A survey instrument comprising a construct of employee ability, perceived hospital ethic, lead...

Hospital-acquired listeriosis.

Science.gov (United States)

Graham, J C; Lanser, S; Bignardi, G; Pedler, S; Hollyoak, V

2002-06-01

We report four cases of listeriosis that occurred over a two-month period in north east England. Due to the apparent nosocomial acquisition of infection and the clustering of cases in time and place, extended epidemiological investigation was performed and the outbreak was traced to a caterer who was providing sandwiches for hospital shops. We discuss the difficulties in preventing food-borne listeriosis in the hospital setting. Copyright 2002 The Hospital Infection Society.

Logistics in hospitals: a case study of some Singapore hospitals.

Science.gov (United States)

Pan, Zhi Xiong; Pokharel, Shaligram

2007-01-01

The purpose of this paper is to investigate logistics activities in Singapore hospitals. It defines various types of activities handled by a logistics division. Inventory management policy and the use of information and communication technologies (ICT) for logistics purposes are also discussed. The study identifies the nature of strategic alliances in Singapore's health care industry. This study was conducted by utilizing a framework for data collection, pre-testing the questionnaire and conducting interviews. Various relevant literature was reviewed to design the questionnaire. This study finds that logistics division carry out many related activities and some of them also provide engineering services. The hospitals make use of ICT. The hospitals are clustered under various groups to minimize the cost of operation, including the logistics related costs. However, hospitals do not see alliances with suppliers as a strategic option; rather they focus on outsourcing of logistics services. The findings also show that Singapore hospitals have a good stocking policy for both medical and non-medical items so that changes in patient mix can be easily handled. Singapore is continuously improving its health care industry and therefore, the findings will help hospitals in other regions to adopt some of the practices, like concentrating on local vendors, outsourcing, clustering, and maximum use of information technology as competitive factors that can improve the service and reduce the cost of operation. The paper suggests motivators and barriers to the use of ICT in logistics in the health care industry.

Hospital medicine (Part 2): what would improve acute hospital care?

LENUS (Irish Health Repository)

Kellett, John

2009-09-01

There are so many obvious delays and inefficiencies in our traditional system of acute hospital care; it is clear that if outcomes are to be improved prompt accurate assessment immediately followed by competent and efficient treatment is essential. Early warning scores (EWS) help detect acutely ill patients who are seriously ill and likely to deteriorate. However, it is not known if any EWS has universal applicability to all patient populations. The benefit of Rapid Response Systems (RRS) such as Medical Emergency Teams has yet to be proven, possibly because doctors and nurses are reluctant to call the RRS for help. Reconfiguration of care delivery in an Acute Medical Assessment Unit has been suggested as a "proactive" alternative to the "reactive" approach of RRS. This method ensures every patient is in an appropriate and safe environment from the moment of first contact with the hospital. Further research is needed into what interventions are most effective in preventing the deterioration and\\/or resuscitating seriously ill patients. Although physicians expert in hospital care decrease the cost and length of hospitalization without compromising outcomes hospital care will continue to be both expensive and potentially dangerous.

Estudo comparativo das indicações de cesariana entre um hospital público-universitário e um hospital privado Comparative study of cesarean section indications between a public university hospital and a private hospital

Directory of Open Access Journals (Sweden)

Renato Humberto Fabri

2002-04-01

Full Text Available OBJETIVOS: analisar a incidência e as indicações de cesariana realizadas no Hospital Escola da Falculdade de Medicina do Triângulo Mineiro e um hospital privado, ambos localizados em Uberaba, Minas Gerais, Brasil. MÉTODOS: trata-se de estudo transversal desenvolvido a partir da coleta nos prontuários dos hospitais, consistindo da idade, procedência, situação conjugal, escolaridade, paridade e indicações de cesariana. RESULTADOS: a incidência de cesariana foi de 24,3% no Hospital Escola contra 89,2% no hospital privado. As indicações mais freqüentes de cesariana no Hospital Escola foram a cesárea iterativa (26,7%, distócia (22,4% e o sofrimento fetal agudo (18,2%, e no hospital privado foram cesárea iterativa (36% e distócia (36%. As pacientes do hospital privado tinham maior escolaridade. CONCLUSÕES: os dados sugerem que o aumento de cesarianas no hospital privado foi decorrente de iteratividade, distócia e a escolaridade mais elevada das pacientes.OBJECTIVES: to analyse the incidence and the indications of cesarean section performed in the University Hospital of the "Triângulo Mineiro Faculty of Medicine " and a private hospital in Uberaba, Minas Gerais, Brazil. METHODS: a cross sectional study was carried out by using the data source of the medical files from both hospitals consisting of patient age, place of origin, marital status, education level, parity and cesarean sections indications. RESULTS: the cesarean sections rate was 24,3 % (325 of 1.441 births at the university hospital against 89,2% (100 of 112 births of the private hospital. The most frequent indications in the University Hospital were previous cesarean sections (26,7%, dystocia (22,4% and acute fetal distress (18,2%. In the private hospital, indications were previous cesarean section (36% and dystocia (36%. The private hospital's patients had higher education levels. CONCLUSIONS: the higher rate of cesarean sections observed in the private hospital

Hospital boards and hospital strategic focus: the impact of board involvement in strategic decision making.

Science.gov (United States)

Ford-Eickhoff, Karen; Plowman, Donde Ashmos; McDaniel, Reuben R

2011-01-01

Despite pressures to change the role of hospital boards, hospitals have made few changes in board composition or director selection criteria. Hospital boards have often continued to operate in their traditional roles as either "monitors" or "advisors." More attention to the direct involvement of hospital boards in the strategic decision-making process of the organizations they serve, the timing and circumstances under which board involvement occurs, and the board composition that enhances their abilities to participate fully is needed. We investigated the relationship between broader expertise among hospital board members, board involvement in the stages of strategic decision making, and the hospital's strategic focus. We surveyed top management team members of 72 nonacademic hospitals to explore the participation of critical stakeholder groups such as the board of directors in the strategic decision-making process. We used hierarchical regression analysis to explore our hypotheses that there is a relationship between both the nature and involvement of the board and the hospital's strategic orientation. Hospitals with broader expertise on their boards reported an external focus. For some of their externally-oriented goals, hospitals also reported that their boards were involved earlier in the stages of decision making. In light of the complex and dynamic environment of hospitals today, those charged with developing hospital boards should match the variety in the external issues that the hospital faces with more variety in board makeup. By developing a board with greater breadth of expertise, the hospital responds to its complex environment by absorbing that complexity, enabling a greater potential for sensemaking and learning. Rather than acting only as monitors and advisors, boards impact their hospitals' strategic focus through their participation in the strategic decision-making process.

Sociodemographic profile and hospitalization process of elderly assisted at a emergency hospital

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Maria Luciene Nobre Coutinho

2015-12-01

Full Text Available Objectives: to investigate the sociodemographic profile and the process of hospitalization of elderly assisted in an emergency hospital. Methods: descriptive epidemiological study conducted at an emergency hospital with 300 elderly patients using a form with hospitalization process and sociodemographic variables. Results: there was a predominance of females (56.0%, between 80 and 89 years old (45.4%, illiterate or with elementary education (86.7%, married or living in stable union (42.6%, with non-communicable chronic disease (54.7% and regular use of medications. The main reason for hospitalization was fall (54.7% at home and in the morning hours (42.4%, with admission in the afternoon, transported by ambulance. Conclusion: the findings contribute to the development of strategies directed to assist and care of the healthy elderly and in vulnerable situations.

Hospital-acquired malnutrition in children at a tertiary care hospital

African Journals Online (AJOL)

Del-Rossi Sean Quadros

As such, there is a need for hospitals to monitor its occurrence using cost- effective but accurate tools. Table 1: General .... Malades Hospital, France.2. Our study ... daily weight loss, which is the critical threshold for an adverse clinical outcome ...

Hospital Acquisitions Before Healthcare Reform.

Science.gov (United States)

McCue, Michael J; Thompson, Jon M; Kim, Tae Hyun

2015-01-01

The hospital industry has experienced increased consolidation in the past 20 years. Since 2010, in particular, there has been a large rise in the number of hospital acquisitions, and observers have suggested this is due in part to the expected impact of federal healthcare reform legislation. This article reports on a study undertaken to identify the market, management, and financial factors affecting acute care, community hospitals acquired between 2010 and 2012. We identified 77 such hospitals and compared them to other acute care facilities. To assess how different factors were associated with acquisitions, the study used multiple logistic regressions whereby market factors were included first, followed by management and financial factors. Study findings show that acquired hospitals were located in markets with lower rates of preferred provider organization (PPO) penetration compared with nonacquired hospitals. Occupancy rate was found to be inversely related to acquisition rate; however, case-mix index was significantly and positively related to a hospital's being acquired. Financial factors negatively associated with a hospital's being acquired included age of plant and cash flow margin. In contrast to the findings from earlier studies of hospital acquisitions, our results showed that acquired hospitals possessed newer assets. However, similar to the findings of other studies, the cash flow margin of acquired hospitals was lower than that of nonacquired facilities.

Structural Measures - Hospital

Data.gov (United States)

U.S. Department of Health & Human Services — A list of hospitals and the structural measures they report. A structural measure reflects the environment in which hospitals care for patients, for example, whether...

Hospital staff education on severe sepsis/septic shock and hospital mortality: an original hypothesis

Directory of Open Access Journals (Sweden)

Capuzzo Maurizia

2012-11-01

Full Text Available Abstract Background Signs of serious clinical events overlap with those of sepsis. We hypothesised that any education on severe sepsis/septic shock may affect the outcome of all hospital patients. We designed this study to assess the trend of the mortality rate of adults admitted to hospital for at least one night in relationship with a hospital staff educational program dedicated to severe sepsis/septic shock. Methods This study was performed in six Italian hospitals in the same region. Multidisciplinary Sepsis Teams members were selected by each hospital management among senior staff. The education included the following steps: i the Teams were taught about adult learning, problem based learning, and Surviving Sepsis guidelines, and provided with educational material (literature, electronic presentations, scenarios of clinical cases for training and booklets; ii they started delivering courses and seminars each to their own hospital staff in the last quarter of 2007. To analyse mortality, we selected adult patients, admitted for at least one night to the wards or units present in all the study hospitals and responsible for 80% of hospital deaths. We fitted a Poisson model with monthly hospital mortality rates from December 2003 to August 2009 as dependent variable. The effect of the educational program on hospital mortality was measured as two dummy variables identifying a first (November 2007 to December 2008 and a second (January to August 2009 education period. The analysis was adjusted for a linear time trend, seasonality and monthly average values of age, Charlson score, length of stay in hospital and urgent/non-urgent admission. Results The hospital staff educated reached 30.6% at the end of June 2009. In comparison with the pre-education period, the Relative Risk of death of the patient population considered was 0.93 (95% confidence interval [CI] 0.87-0.99; p 0.025 for in-patients in the first, and 0.89 (95% CI 0.81-0.98; p 0.012 for

Surveillance for hospital-acquired infections on surgical wards in a Dutch university hospital

NARCIS (Netherlands)

Kamp-Hopmans, Titia E. M.; Blok, Hetty E. M.; Troelstra, Annet; Gigengack-Baars, Ada C. M.; Weersink, Annemarie J. L.; Vandenbroucke-Grauls, Christina M. J. E.; Verhoef, Jan; Mascini, Ellen M.

2003-01-01

OBJECTIVES: To determine incidence rates of hospital-acquired infections and to develop preventive measures to reduce the risk of hospital-acquired infections. METHODS: Prospective surveillance for hospital-acquired infections was performed during a 5-year period in the wards housing general and

42 CFR 419.20 - Hospitals subject to the hospital outpatient prospective payment system.

Science.gov (United States)

2010-10-01

... prospective payment system. 419.20 Section 419.20 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEM FOR HOSPITAL... Outpatient Prospective Payment System § 419.20 Hospitals subject to the hospital outpatient prospective...

Using In-Hospital Mortality as an Indicator of Quality Care and Hospital Performance

Directory of Open Access Journals (Sweden)

Badia BISBIS

2016-06-01

Full Text Available The in-hospital mortality (MIH is used as a performance indicator and quality healthcare in hospital. However, the majority of deaths resulted from an inevitable disease process (severity of cases and / or co-morbidity, and not medical errors or changes in the quality of care. This work aims to make a distribution of deaths in the Regional Hospital of Eastern, Al Farabi hospital and to highlight that more studies on the MIH are required consistently with detailed clinical data at the admission. The MIH showed its limitation as a health care  indicator. The overall rate of in-hospital deaths within the Al Farabi hospital has averaged 2.4%, with 8.4% in the emergency unit, 28% in intensive care unit, 22% Neonatology unit, 1.6% in pediatric unit. The MIH may depend, firstly, on the condition of patients before hospitalization and secondly, on the conditions of their transfer from one institution to another that supports them as a last resort. Al Farabi hospital supports patients transferred from the provinces of the eastern region. Thus, 6% of patients who died in 2014 come from Berkane, 2% from  Nador, 2% from Bouarfa, 4% from  Taourirt and 2% from Jerrada. One might question about  the procedures and the conditions of such transfers. In conclusion, the overall MIH measured from routine data do not allow proper comparison between hospitals or the assessment of the quality of care and patient safety in the hospital. To do so, we should ideally have detailed clinical data on admission (e.g. type of admission, age of patient, sex, comorbidity, .... The MIH is however an important indicator to consider as a tool to detect potential  problems related to admission procedures and to suspect an area of "non-quality" in healthcare . The MIH is interesting for the patient and for the hospital because it serves the improvement of quality healthcare.

How to govern physician-hospital exchanges: contractual and relational issues in Belgian hospitals.

Science.gov (United States)

Trybou, Jeroen; Gemmel, Paul; Annemans, Lieven

2014-07-01

Our aim was to investigate contractual mechanisms in physician-hospital exchanges. The concepts of risk-sharing and the nature of physician-hospital exchanges - transactional versus relational - were studied. Two qualitative case studies were performed in Belgium. Hospital executives and physicians were interviewed to develop an in-depth understanding of contractual and relational issues that shape physician-hospital contracting in acute care hospitals. The underlying theoretical concepts of agency theory and social exchange theory were used to analyse the data. Our study found that physician-hospital contracting is highly complex. The contract is far more than an economic instrument governing financial aspects. The effect of the contract on the nature of exchange - whether transactional or relational - also needs to be considered. While it can be argued that contractual governance methods are increasingly necessary to overcome the difficulties that arise from the fragmented payment framework by aligning incentives and sharing financial risk, they undermine the necessary relational governance. Relational qualities such as mutual trust and an integrative view on physician-hospital exchanges are threatened, and may be difficult to sustain, given the current fragmentary payment framework. Since health care policy makers are increasing the financial risk borne by health care providers, it can be argued that this also increases the need to share financial risk and to align incentives between physician and hospital. However, our study demonstrates that while economic alignment is important in determining physician-hospital contracts, the corresponding impact on working relationships should also be considered. Moreover, it is important to avoid a relationship between hospital and physician predominantly characterized by transactional exchanges thereby fostering an unhealthy us-and-them divide and mentality. Relational exchange is a valuable alternative to contractual

The impact of non-IPA HMOs on the number of hospitals and hospital capacity.

Science.gov (United States)

Chernew, M

1995-01-01

Concentration in the hospital market could limit the success of health care reform strategies that rely on managed care to constrain costs. Hospital market capacity also is important because capacity affects both costs and the degree of price competition. Because managed care plans, particularly non-individual practice association (non-IPA) model HMOs, practice a less hospital-intensive style of care, consolidation and downsizing in the hospital market potentially will accompany managed care growth, influencing the long-run effectiveness of managed care cost-containment strategies. Using Standard Metropolitan Statistical Area (SMSA) data from 1982 and 1987, a 10-percentage point increase in non-IPA HMO market share is estimated to reduce the number of hospitals by about 4%, causing an approximate 5% reduction in the number of hospital beds. No statistically significant relationship is found between non-IPA HMO penetration rates and hospital occupancy rates.

Improvement of hospital performance through innovation: toward the value of hospital care.

Science.gov (United States)

Dias, Casimiro; Escoval, Ana

2013-01-01

The perspective of innovation as the strategic lever of organizational performance has been widespread in the hospital sector. While public value of innovation can be significant, it is not evident that innovation always ends up in higher levels of performance. Within this context, the purpose of the article was to critically analyze the relationship between innovation and performance,taking into account the specificities of the hospital sector. This article pulls together primary data on organizational flexibility, innovation, and performance from 95 hospitals in Portugal,collected through a survey, data from interviews to hospital administration boards, and a panel of 15 experts. The diversity of data sources allowed for triangulation. The article uses mixed methods to explore the relationship between innovation and performance in the hospital sector in Portugal. The relationship between innovation and performance is analyzed through cluster analysis, supplemented with content analysis of interviews and the technical nominal group. The main findings reveal that the cluster of efficient innovators has twice the level of performance than other clusters. Organizational flexibility and external cooperation are the 2 major factors explaining these differences. The article identifies various organizational strategies to use innovation in order to enhance hospital performance. Overall, it proposes the alignment of perspectives of different stakeholders on the value proposition of hospital services, the embeddedness of information loops, and continuous adjustments toward high-value services.

Nutritional Assessment in Elderly Hospitalized Patients in Qazvin Teaching Hospitals in 2011

Directory of Open Access Journals (Sweden)

Azam Ghorbani

2013-04-01

Full Text Available Objectives: Nutritional status in the elderly is an important issue in developing countries has been little attention to it. It results from complex interaction between personal and environmental factors that have a considerable effect on mortality, morbidity and quality of life of elderly people especially the hospitalized ones. The aim of this study was to investigate nutritional status in elderly hospitalized patients in Qazvin Teaching Hospitals and know Influential factors to plan appropriate programs for improving their health. Methods & Materials: In this cross-sectional study 233 elderly (151 women and 171 men aging more than 60 years, hospitalized in two hospitals in Qazvin city were studied. Nutritional status were evaluated using Mini Nutritional Assessment, The nutritional status was classified into: malnourished, risk of malnutrition and without malnutrition (adequate. Results: Among the assessed elderly 29.8% were well nourish, 13.4% malnourished and 42.95 at risk of malnutrition. There was more malnutrition in females compared to males (25.8% vs 7.2 P=23(62.5% vs. 12.6% P<0.001, Statistical analysis of the studied variables showed that nutritional status were significantly associated with Age, BMI, WC and WHR Conclusion: This study confirms a high prevalence of malnutrition risk in hospitalized elderly patients. The assessment of nutritional status with MNA that can facilitate evaluation of the nutritional status of elderly individuals in hospitals

Differences in hospital casemix, and the relationship between casemix and hospital costs.

Science.gov (United States)

Söderlund, N; Milne, R; Gray, A; Raftery, J

1995-03-01

The aim of the study was to examine the relationship between hospital costs and casemix, and after adjustment for casemix differences, between cost and institutional size, number of specialties, occupancy and teaching status. A retrospective analysis of all admissions to nine acute-care NHS hospitals in the Oxford region during the 1991-1992 financial year was undertaken. All episodes were assigned to a diagnosis-related group (DRG) and a cost weight assigned accordingly. Costs per finished consultant episode, before and after adjustment for casemix differences, were analysed at the hospital and specialty level. Casemix differences were significant, and accounted for approximately 77 per cent of the difference in costs between providers. Costs per casemix-adjusted episode were not significantly associated with differences in hospital size, scope, occupancy levels or teaching status, but sample size was insufficient to investigate these relationships adequately. Specialty costs were poorly correlated with specialty casemix. This was probably due to poor apportionment of specialty costs in hospital accounting returns. Casemix differences need to be taken into account when comparing providers for the purposes of contracting, as unadjusted unit costs may be misleading. Although the methods used may currently be applied to most NHS hospitals, widespread use would be greatly facilitated by the development of indigenous cost weights and better routine hospital data coding and collection.

Pre-hospitalization, hospitalization, and post-hospitalization costs of patients with neurocysticercosis treated at the Instituto Nacional de Neurologia y Neurocirugia (INNN in Mexico City, Mexico

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Rachana Bhattarai

2018-05-01

Full Text Available ABSTRACT The objective of this study was to estimate the direct costs associated with the diagnosis and treatment of neurocysticercosis (NCC during pre-hospitalization, hospitalization, and post-hospitalization periods for 108 NCC patients treated at the Instituto Nacional de Neurologia y Neurocirugia (INNN in Mexico City, Mexico. Information on clinical manifestations, diagnostic tests, hospitalizations, surgical procedures, prescription medication, and other treatments was collected via medical chart reviews. Uncertain values for costs and frequency of treatments were imputed using bootstrap techniques. The average per-patient pre-hospitalization and hospitalization costs were US$ 257 (95% CI: 185 – 329 and US$ 2,576 (95% CI: 2,244 – 2,908, respectively. Post-hospitalization costs tended to decrease over time, with estimates for the first five years post-hospitalization of US$ 475 (95% CI: 423 – 527, US$ 228 (95% CI: 167 – 288, US$ 157 (95% CI: 111 – 202, US$ 150 (95% CI: 106 – 204, and US$ 91 (95% CI: 27 – 154, respectively. NCC results in a significant economic burden for patients requiring hospitalization, with this burden continuing years post-hospitalization.

The impact of medical tourism on Thai private hospital management: informing hospital policy.

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James, Paul T J

2012-01-01

The purpose of this paper is to help consolidate and understand management perceptions and experiences of a targeted group (n=7) of Vice-Presidents of international Private Thai hospitals in Bangkok regarding medical tourism impacts. The method adopted uses a small-scale qualitative inquiry. Examines the on-going development and service management factors which contribute to the establishment and strengthening of relationships between international patients and hospital medical services provision. Develops a qualitative model that attempts to conceptualize the findings from a diverse range of management views into a framework of main (8) - Hospital Management; Hospital Processes; Hospital Technology; Quality Related; Communications; Personnel; Financial; and Patients; and consequent sub-themes (22). Outcomes from small-scale qualitative inquiries cannot by design be taken outside of its topical arena. This inevitably indicates that more research of this kind needs to be carried out to understand this field more effectively. The evidence suggests that Private Thai hospital management have established views about what constitutes the impact of medical tourism on hospital policies and practices when hospital staff interact with international patients. As the private health service sector in Thailand continues to grow, future research is needed to help hospitals provide appropriate service patterns and appropriate medical products/services that meet international patient needs and aspirations. Highlights the increasing importance of the international consumer in Thailand's health industry. This study provides insights of private health service providers in Bangkok by helping to understand more effectively health service quality environments, subsequent service provision, and the integrated development and impacts of new medical technology.

75 FR 60640 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

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2010-10-01

...; RIN 0938-AP33 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Changes and FY 2011 Rates; Provider... Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective...

77 FR 4908 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

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2012-02-01

... Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal... the final rule entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates...

77 FR 65495 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

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2012-10-29

... Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and... Federal Register entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates...

Risks predicting prolonged hospital discharge boarding in a regional acute care hospital.

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Shaikh, Sajid A; Robinson, Richard D; Cheeti, Radhika; Rath, Shyamanand; Cowden, Chad D; Rosinia, Frank; Zenarosa, Nestor R; Wang, Hao

2018-01-30

Prolonged hospital discharge boarding can impact patient flow resulting in upstream Emergency Department crowding. We aim to determine the risks predicting prolonged hospital discharge boarding and their direct and indirect effects on patient flow. Retrospective review of a single hospital discharge database was conducted. Variables including type of disposition, disposition boarding time, case management consultation, discharge medications prescriptions, severity of illness, and patient homeless status were analyzed in a multivariate logistic regression model. Hospital charges, potential savings of hospital bed hours, and whether detailed discharge instructions provided adequate explanations to patients were also analyzed. A total of 11,527 admissions was entered into final analysis. The median discharge boarding time was approximately 2 h. Adjusted Odds Ratio (AOR) of patients transferring to other hospitals was 7.45 (95% CI 5.35-10.37), to court or law enforcement custody was 2.51 (95% CI 1.84-3.42), and to a skilled nursing facility was 2.48 (95% CI 2.10-2.93). AOR was 0.57 (95% CI 0.47-0.71) if the disposition order was placed during normal office hours (0800-1700). AOR of early case management consultation was 1.52 (95% CI 1.37-1.68) versus 1.73 (95% CI 1.03-2.89) for late consultation. Eighty-eight percent of patients experiencing discharge boarding times within 2 h of disposition expressed positive responses when questioned about the quality of explanations of discharge instructions and follow-up plans based on satisfaction surveys. Similar results (86% positive response) were noted among patients whose discharge boarding times were prolonged (> 2 h, p = 0.44). An average charge of $6/bed/h was noted in all hospital discharges. Maximizing early discharge boarding (≤ 2 h) would have resulted in 16,376 hospital bed hours saved thereby averting $98,256.00 in unnecessary dwell time charges in this study population alone. Type of disposition, case

The performance of Hospital Corporation of America and Healthtrust hospitals after leveraged buyouts.

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Clement, J P; McCue, M J

1996-07-01

The authors examine performance changes after two leveraged buyouts (LBOs) in the hospital industry, one an employee stock ownership plan (ESOP) and the other a managed buyout (MBO). The findings show that hospitals owned by HCA, the MBO firm, and Health Trust, the ESOP firm, did not increase revenues, decrease operating expenses, or improve profitability after the LBOs, relative to other hospitals in their local markets. Nor were the numbers or salaries of employees at these facilities decreased. Although performance incentives associated with LBOs did not change performance at the hospital level, incentives to meet debt payments did result in corporate changes. More specifically, the LBOs led to corporate downsizing through the sale of hospitals and subsidiaries.

Does a hospital's quality depend on the quality of other hospitals? A spatial econometrics approach.

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Gravelle, Hugh; Santos, Rita; Siciliani, Luigi

2014-11-01

We examine whether a hospital's quality is affected by the quality provided by other hospitals in the same market. We first sketch a theoretical model with regulated prices and derive conditions on demand and cost functions which determine whether a hospital will increase its quality if its rivals increase their quality. We then apply spatial econometric methods to a sample of English hospitals in 2009-10 and a set of 16 quality measures including mortality rates, readmission, revision and redo rates, and three patient reported indicators, to examine the relationship between the quality of hospitals. We find that a hospital's quality is positively associated with the quality of its rivals for seven out of the sixteen quality measures. There are no statistically significant negative associations. In those cases where there is a significant positive association, an increase in rivals' quality by 10% increases a hospital's quality by 1.7% to 2.9%. The finding suggests that for some quality measures a policy which improves the quality in one hospital will have positive spillover effects on the quality in other hospitals.

Do More Hospital Beds Lead to Higher Hospitalization Rates? A Spatial Examination of Roemer’s Law

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Delamater, Paul L.; Messina, Joseph P.; Grady, Sue C.; WinklerPrins, Vince; Shortridge, Ashton M.

2013-01-01

Background Roemer’s Law, a widely cited principle in health care policy, states that hospital beds that are built tend to be used. This simple but powerful expression has been invoked to justify Certificate of Need regulation of hospital beds in an effort to contain health care costs. Despite its influence, a surprisingly small body of empirical evidence supports its content. Furthermore, known geographic factors influencing health services use and the spatial structure of the relationship between hospital bed availability and hospitalization rates have not been sufficiently explored in past examinations of Roemer’s Law. We pose the question, “Accounting for space in health care access and use, is there an observable association between the availability of hospital beds and hospital utilization?” Methods We employ an ecological research design based upon the Anderson behavioral model of health care utilization. This conceptual model is implemented in an explicitly spatial context. The effect of hospital bed availability on the utilization of hospital services is evaluated, accounting for spatial structure and controlling for other known determinants of hospital utilization. The stability of this relationship is explored by testing across numerous geographic scales of analysis. The case study comprises an entire state system of hospitals and population, evaluating over one million inpatient admissions. Results We find compelling evidence that a positive, statistically significant relationship exists between hospital bed availability and inpatient hospitalization rates. Additionally, the observed relationship is invariant with changes in the geographic scale of analysis. Conclusions This study provides evidence for the effects of Roemer’s Law, thus suggesting that variations in hospitalization rates have origins in the availability of hospital beds. This relationship is found to be robust across geographic scales of analysis. These findings suggest

Mental hospital reform in Asia: the case of Yuli Veterans Hospital, Taiwan.

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Lin, Chih-Yuan; Huang, Ai-Ling; Minas, Harry; Cohen, Alex

2009-01-02

Yuli Veterans Hospital (YVH) has been the largest mental hospital for the patients with chronic and severe mental illness in Taiwan for the past 50 years. While this hospital used to be a symbol of hopelessness among patients and their families and an unspoken shame among Taiwan psychiatry and mental health circles it now represents an example of how an old, custodial hospital can be transformed into a very different institution. In this case study we will describe the features of this transformation, which, over the past 20 years, has aimed to help extended stay inpatients with severe mental illness to integrate into the local community of Yuli even though it is not their original home. Using historical documents and oral narratives from Yuli inhabitants, workers and patients of YVH, we will offer a case study of the Yuli model. There are four main components of the Yuli model: holistic medical support, vocational rehabilitation, case management, and the residential program. The four components help patients recover two essential features of their lives: vocational life and ordinary daily routines. As the process of recovery evolves, patients gradually regain inner stability, dignity, self-confidence, and a sense of control. The four components are critical to rebuild the structure and order of life of the patients and are indispensable and interdependent parts of one service package. They operate simultaneously to benefit the patients to the greatest degree possible. There are many challenges to the further development and financial viability of the model of services developed at YVH. There are also important questions concerning the replicability of the Yuli model in other sociocultural and service system contexts. This case study reveals the possibility of transforming a custodial mental hospital into a hospital providing high quality care. Hospital and community are not in opposition. They are part of a continuum of care for the patients. We reinterpret and

Demographic factors and hospital size predict patient satisfaction variance--implications for hospital value-based purchasing.

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McFarland, Daniel C; Ornstein, Katherine A; Holcombe, Randall F

2015-08-01

Hospital Value-Based Purchasing (HVBP) incentivizes quality performance-based healthcare by linking payments directly to patient satisfaction scores obtained from Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Lower HCAHPS scores appear to cluster in heterogeneous population-dense areas and could bias Centers for Medicare & Medicaid Services (CMS) reimbursement. Assess nonrandom variation in patient satisfaction as determined by HCAHPS. Multivariate regression modeling was performed for individual dimensions of HCAHPS and aggregate scores. Standardized partial regression coefficients assessed strengths of predictors. Weighted Individual (hospital) Patient Satisfaction Adjusted Score (WIPSAS) utilized 4 highly predictive variables, and hospitals were reranked accordingly. A total of 3907 HVBP-participating hospitals. There were 934,800 patient surveys by the most conservative estimate. A total of 3144 county demographics (US Census) and HCAHPS surveys. Hospital size and primary language (non-English speaking) most strongly predicted unfavorable HCAHPS scores, whereas education and white ethnicity most strongly predicted favorable HCAHPS scores. The average adjusted patient satisfaction scores calculated by WIPSAS approximated the national average of HCAHPS scores. However, WIPSAS changed hospital rankings by variable amounts depending on the strength of the predictive variables in the hospitals' locations. Structural and demographic characteristics that predict lower scores were accounted for by WIPSAS that also improved rankings of many safety-net hospitals and academic medical centers in diverse areas. Demographic and structural factors (eg, hospital beds) predict patient satisfaction scores even after CMS adjustments. CMS should consider WIPSAS or a similar adjustment to account for the severity of patient satisfaction inequities that hospitals could strive to correct. © 2015 Society of Hospital Medicine.

Legitimacy of hospital reconfiguration: the controversial downsizing of Kidderminster hospital.

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Oborn, Eivor

2008-04-01

This paper examines the contested organizational legitimacy of hospital reconfiguration, which continues to be a central issue in health care management. A qualitative study which focuses on the controversial downsizing of Kidderminster Hospital, a highly publicized landmark case of district general hospital closure. Rhetorical strategies are analysed to examine how legitimacy was constructed by stakeholder groups and how these strategies were used to support or resist change. Stakeholders promoting change legitimized re-organization pragmatically and morally arguing the need for centralization as a rational necessity. Stakeholders resisting change argued for cognitive and moral legitimacy in current service arrangements, contrasting local versus regionalized aspects of safety and provision. Groups managed to talk past each other, failing to establish a dialogue, which led to significant conflict and political upheaval. Stakeholders value hospitals in different ways and argue for diverse accounts of legitimacy. Broader discourses of medical science and democratic participation were drawn into rhetorical texts concerning regionalization to render them more powerful.

Lower Mortality in Magnet Hospitals

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McHugh, Matthew D.; Kelly, Lesly A.; Smith, Herbert L.; Wu, Evan S.; Vanak, Jill M.; Aiken, Linda H.

2014-01-01

Background Although there is evidence that hospitals recognized for nursing excellence—Magnet hospitals—are successful in attracting and retaining nurses, it is uncertain whether Magnet recognition is associated with better patient outcomes than non-Magnets, and if so why. Objectives To determine whether Magnet hospitals have lower risk-adjusted mortality and failure-to-rescue compared with non-Magnet hospitals, and to determine the most likely explanations. Method and Study Design Analysis of linked patient, nurse, and hospital data on 56 Magnet and 508 non-Magnet hospitals. Logistic regression models were used to estimate differences in the odds of mortality and failure-to-rescue for surgical patients treated in Magnet versus non-Magnet hospitals, and to determine the extent to which differences in outcomes can be explained by nursing after accounting for patient and hospital differences. Results Magnet hospitals had significantly better work environments and higher proportions of nurses with bachelor's degrees and specialty certification. These nursing factors explained much of the Magnet hospital effect on patient outcomes. However, patients treated in Magnet hospitals had 14% lower odds of mortality (odds ratio 0.86; 95% confidence interval, 0.76–0.98; P = 0.02) and 12% lower odds of failure-to-rescue (odds ratio 0.88; 95% confidence interval, 0.77–1.01; P = 0.07) while controlling for nursing factors as well as hospital and patient differences. Conclusions The lower mortality we find in Magnet hospitals is largely attributable to measured nursing characteristics but there is a mortality advantage above and beyond what we could measure. Magnet recognition identifies existing quality and stimulates further positive organizational behavior that improves patient outcomes. PMID:24022082

Hospital information system institutionalization processes in indonesian public, government-owned and privately owned hospitals.

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Handayani, P W; Hidayanto, A N; Ayuningtyas, Dumilah; Budi, Indra

2016-11-01

The Hospital Information System (HIS) could help hospitals as a public entity to provide optimal health services. One of the main challenges of HIS implementation is an institutional change. Using institutional theory as the analytical lens, this study aims to explain the institutionalization of HIS as an instance of e-health initiatives in Indonesia. Furthermore, this paper aims for hospital management and researchers to improve the understanding of the social forces that influence hospital personnel's HIS acceptance within an organizational context. We use case studies from four public, government-owned hospitals and four privately owned (public and specialty) hospitals to explain the HIS institutionalization process by exploring the three concepts of institutional theory: institutional isomorphism, institutional logic, and institutional entrepreneurship. This study reveals that differences exist between public, government-owned and private hospitals with regard to the institutionalization process: public, government-owned hospitals' management is more motivated to implement HIS to comply with the regulations, while private hospitals' management views HIS as an urgent requirement that must be achieved. The study findings also reveal that various institutional isomorphism mechanisms and forms of institutional logic emerge during the process. Finally, three factors-self-efficacy, social influence, and management support-have a significant influence on the individual acceptance of HIS. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Hospitality Healthscapes: The New Standard for Making Hospitals More Hospitable

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Courtney Suess Raeisinafchi

2017-06-01

Full Text Available What comes to mind when you think of a hospital room? Stark. Sterile. Bare. Clinical. What might it mean for patients if the association with the environment shifted to something like: Comforting. Bright. Elegant. Personal?

Virtual Pediatric Hospital

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... Thoracopaedia - An Imaging Encyclopedia of Pediatric Thoracic Disease Virtual Pediatric Hospital is the Apprentice's Assistant™ Last revised ... pediatric resources: GeneralPediatrics.com | PediatricEducation.org | SearchingPediatrics.com Virtual Pediatric Hospital is curated by Donna M. D' ...

Statin Use and Hospital Length of Stay Among Adults Hospitalized With Community-acquired Pneumonia.

Science.gov (United States)

Havers, Fiona; Bramley, Anna M; Finelli, Lyn; Reed, Carrie; Self, Wesley H; Trabue, Christopher; Fakhran, Sherene; Balk, Robert; Courtney, D Mark; Girard, Timothy D; Anderson, Evan J; Grijalva, Carlos G; Edwards, Kathryn M; Wunderink, Richard G; Jain, Seema

2016-06-15

Prior retrospective studies suggest that statins may benefit patients with community-acquired pneumonia (CAP) due to antiinflammatory and immunomodulatory effects. However, prospective studies of the impact of statins on CAP outcomes are needed. We determined whether statin use was associated with improved outcomes in adults hospitalized with CAP. Adults aged ≥18 years hospitalized with CAP were prospectively enrolled at 3 hospitals in Chicago, Illinois, and 2 hospitals in Nashville, Tennessee, from January 2010-June 2012. Adults receiving statins before and throughout hospitalization (statin users) were compared with those who did not receive statins (nonusers). Proportional subdistribution hazards models were used to examine the association between statin use and hospital length of stay (LOS). In-hospital mortality was a secondary outcome. We also compared groups matched on propensity score. Of 2016 adults enrolled, 483 (24%) were statin users; 1533 (76%) were nonusers. Statin users were significantly older, had more comorbidities, had more years of education, and were more likely to have health insurance than nonusers. Multivariable regression demonstrated that statin users and nonusers had similar LOS (adjusted hazard ratio [HR], 0.99; 95% confidence interval [CI], .88-1.12), as did those in the propensity-matched groups (HR, 1.03; 95% CI, .88-1.21). No significant associations were found between statin use and LOS or in-hospital mortality, even when stratified by pneumonia severity. In a large prospective study of adults hospitalized with CAP, we found no evidence to suggest that statin use before and during hospitalization improved LOS or in-hospital mortality. Published by Oxford University Press for the Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Electronic Cigarettes on Hospital Campuses

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Clare Meernik

2015-12-01

Full Text Available Smoke and tobacco-free policies on hospital campuses have become more prevalent across the U.S. and Europe, de-normalizing smoking and reducing secondhand smoke exposure on hospital grounds. Concerns about the increasing use of electronic cigarettes (e-cigarettes and the impact of such use on smoke and tobacco-free policies have arisen, but to date, no systematic data describes e-cigarette policies on hospital campuses. The study surveyed all hospitals in North Carolina (n = 121 to assess what proportion of hospitals have developed e-cigarette policies, how policies have been implemented and communicated, and what motivators and barriers have influenced the development of e-cigarette regulations. Seventy-five hospitals (62% completed the survey. Over 80% of hospitals reported the existence of a policy regulating the use of e-cigarettes on campus and roughly half of the hospitals without a current e-cigarette policy are likely to develop one within the next year. Most e-cigarette policies have been incorporated into existing tobacco-free policies with few reported barriers, though effective communication of e-cigarette policies is lacking. The majority of hospitals strongly agree that e-cigarette use on campus should be prohibited for staff, patients, and visitors. Widespread incorporation of e-cigarette policies into existing hospital smoke and tobacco-free campus policies is feasible but needs communication to staff, patients, and visitors.

Electronic Cigarettes on Hospital Campuses.

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Meernik, Clare; Baker, Hannah M; Paci, Karina; Fischer-Brown, Isaiah; Dunlap, Daniel; Goldstein, Adam O

2015-12-29

Smoke and tobacco-free policies on hospital campuses have become more prevalent across the U.S. and Europe, de-normalizing smoking and reducing secondhand smoke exposure on hospital grounds. Concerns about the increasing use of electronic cigarettes (e-cigarettes) and the impact of such use on smoke and tobacco-free policies have arisen, but to date, no systematic data describes e-cigarette policies on hospital campuses. The study surveyed all hospitals in North Carolina (n = 121) to assess what proportion of hospitals have developed e-cigarette policies, how policies have been implemented and communicated, and what motivators and barriers have influenced the development of e-cigarette regulations. Seventy-five hospitals (62%) completed the survey. Over 80% of hospitals reported the existence of a policy regulating the use of e-cigarettes on campus and roughly half of the hospitals without a current e-cigarette policy are likely to develop one within the next year. Most e-cigarette policies have been incorporated into existing tobacco-free policies with few reported barriers, though effective communication of e-cigarette policies is lacking. The majority of hospitals strongly agree that e-cigarette use on campus should be prohibited for staff, patients, and visitors. Widespread incorporation of e-cigarette policies into existing hospital smoke and tobacco-free campus policies is feasible but needs communication to staff, patients, and visitors.

Hidden Costs of Hospital Based Delivery from Two Tertiary Hospitals in Western Nepal.

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Jeevan Acharya

Full Text Available Hospital based delivery has been an expensive experience for poor households because of hidden costs which are usually unaccounted in hospital costs. The main aim of this study was to estimate the hidden costs of hospital based delivery and determine the factors associated with the hidden costs.A hospital based cross-sectional study was conducted among 384 post-partum mothers with their husbands/house heads during the discharge time in Manipal Teaching Hospital and Western Regional Hospital, Pokhara, Nepal. A face to face interview with each respondent was conducted using a structured questionnaire. Hidden costs were calculated based on the price rate of the market during the time of the study.The total hidden costs for normal delivery and C-section delivery were 243.4 USD (US Dollar and 321.6 USD respectively. Of the total maternity care expenditures; higher mean expenditures were found for food & drinking (53.07%, clothes (9.8% and transport (7.3%. For postpartum women with their husband or house head, the total mean opportunity cost of "days of work loss" were 84.1 USD and 81.9 USD for normal delivery and C-section respectively. Factors such as literate mother (p = 0.007, employed house head (p = 0.011, monthly family income more than 25,000 NRs (Nepalese Rupees (p = 0.014, private hospital as a place of delivery (p = 0.0001, C-section as a mode of delivery (p = 0.0001, longer duration (>5days of stay in hospital (p = 0.0001, longer distance (>15km from house to hospital (p = 0.0001 and longer travel time (>240 minutes from house to hospital (p = 0.007 showed a significant association with the higher hidden costs (>25000 NRs.Experiences of hidden costs on hospital based delivery and opportunity costs of days of work loss were found high. Several socio-demographic factors, delivery related factors (place and mode of delivery, length of stay, distance from hospital and travel time were associated with hidden costs. Hidden costs can be a

Hidden Costs of Hospital Based Delivery from Two Tertiary Hospitals in Western Nepal.

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Acharya, Jeevan; Kaehler, Nils; Marahatta, Sujan Babu; Mishra, Shiva Raj; Subedi, Sudarshan; Adhikari, Bipin

2016-01-01

Hospital based delivery has been an expensive experience for poor households because of hidden costs which are usually unaccounted in hospital costs. The main aim of this study was to estimate the hidden costs of hospital based delivery and determine the factors associated with the hidden costs. A hospital based cross-sectional study was conducted among 384 post-partum mothers with their husbands/house heads during the discharge time in Manipal Teaching Hospital and Western Regional Hospital, Pokhara, Nepal. A face to face interview with each respondent was conducted using a structured questionnaire. Hidden costs were calculated based on the price rate of the market during the time of the study. The total hidden costs for normal delivery and C-section delivery were 243.4 USD (US Dollar) and 321.6 USD respectively. Of the total maternity care expenditures; higher mean expenditures were found for food & drinking (53.07%), clothes (9.8%) and transport (7.3%). For postpartum women with their husband or house head, the total mean opportunity cost of "days of work loss" were 84.1 USD and 81.9 USD for normal delivery and C-section respectively. Factors such as literate mother (p = 0.007), employed house head (p = 0.011), monthly family income more than 25,000 NRs (Nepalese Rupees) (p = 0.014), private hospital as a place of delivery (p = 0.0001), C-section as a mode of delivery (p = 0.0001), longer duration (>5days) of stay in hospital (p = 0.0001), longer distance (>15km) from house to hospital (p = 0.0001) and longer travel time (>240 minutes) from house to hospital (p = 0.007) showed a significant association with the higher hidden costs (>25000 NRs). Experiences of hidden costs on hospital based delivery and opportunity costs of days of work loss were found high. Several socio-demographic factors, delivery related factors (place and mode of delivery, length of stay, distance from hospital and travel time) were associated with hidden costs. Hidden costs can be a

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Attitudes and expectations regarding exercise in the hospital of hospitalized older adults: a qualitative study.

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So, Cynthia; Pierluissi, Edgar

2012-04-01

To describe expectations of, and perceived motivators and barriers to, in-hospital exercise of hospitalized older adults. Qualitative study using the framework theory. Public hospital general medical wards. Twenty-eight English- or Spanish-speaking inpatients aged 65 to 103. Semistructured interviews were conducted at the bedside. Questions explored attitudes and expectations regarding in-hospital exercise. Interviews were tape recorded and transcribed, and content analysis was performed to identify major themes. For most participants (71%), exercise in the hospital meant walking. Only 29% of participants expected to be exercising in the hospital, although three-quarters perceived it to be appropriate. Major themes included motivating factors and barriers to in-hospital exercise. Motivating factors included avoiding the negative effects of prolonged bed rest, promoting a sense of well-being, promoting functional recovery, and being asked to exercise. Barriers included symptoms related to one's illness, institutional barriers, and fear of injury. Most respondents (85%) felt that if the physician suggested exercise, it would influence their decision to do so, yet few (27%) reported that they had spoken to their physician about exercise. Hospitalized older adults have positive perceptions about in-hospital exercise, although they must overcome significant barriers to do so. Medical professionals have a strong influence over the exercise behavior of elderly adults in the hospital yet infrequently address the issue. Incorporating motivating factors and removing barriers may increase the effectiveness of in-hospital exercise programs. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

Towards the collaborative hospital

DEFF Research Database (Denmark)

Prætorius, Thim; Hasle, Peter; Edwards, Kasper

2015-01-01

Hospitals are increasingly faced with conflicting demands as they have to respond to increasing patient demands as well as financial, clinical and quality challenges. To handle these demands the hospital need to reconfigure its organization, and we propose to build on a concept for the collaborat......Hospitals are increasingly faced with conflicting demands as they have to respond to increasing patient demands as well as financial, clinical and quality challenges. To handle these demands the hospital need to reconfigure its organization, and we propose to build on a concept...... of the collaborative hospital concern the creation of an appropriate balance between standardization and local autonomy, shared purpose centred around providing the best possible care, and use of enabling structures that sustain the new ways of collaborative work. The chapter builds on the theoretical framework...

The effects of hospital reforms on the management of public hospitals in Tanzania: Challenges and lessons learnt.

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Shwekerela, Byera

2014-01-01

Although hospital reforms are being advocated internationally as part of a solution to hospital management problems in developing countries, studies have shown that they do give rise to some challenges. A study was undertaken that used in-depth interviews, focus group discussion and document review to examine hospital reforms. The article examines the effects of reforms on the management of Level II public hospitals in Tanzania and documents the related challenges and lessons Learnt. It is shown that hospital reforms have mixed effects in resource-strained hospitals, and that hospital reform actions may have replaced the bureaucratic inefficiencies associated with hospitals being managed from the central level (MoHSW) with the equally bureaucratic inefficiencies that characterize the management of these hospitals from a supposedly local level, the office of the Regional Administrative Secretary (RAS). Managing hospitals from this level seems to cause many hospital management problems to be left unattended.

HOSPITAL IMAGE AS A MODERATING VARIABLE ON THE EFFECT OF HOSPITAL SERVICE QUALITY ON THE CUSTOMER PERCEIVED VALUE, CUSTOMER TRUST AND CUSTOMER LOYALTY IN HOSPITAL SERVICES

Directory of Open Access Journals (Sweden)

Indrianawati Usman

2017-12-01

Full Text Available This is an explanatory research, analyzing the hospital image as a moderating variable on the effect of hospital service quality on customer perceived value and trust. Research was conducted at several hospitals in Surabaya Indonesia, especially to outpatients. Data was collected by survey to the outpatients of the hospitals. The purpose of this research was empirically examining the effects of hospital service quality on customer perceived value and customer trust, examine effects of customer perceived value and customer trust on customer loyalty. Moreover This research also examined the variable of hospital image as a moderating variable in the effects of hospital service quality on customer perceived value and customer trust. The result of this research gave a perspective to hospital management about the importance of building patient trust, since trust is very important, even more important than satisfaction level. Further studies with more emphasis on identifying the factors building patient trust to the hospital in order to raise customer loyalty should be conducted.

75 FR 34614 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and...

Science.gov (United States)

2010-06-17

... Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and Fiscal Year 2010 Rates and to the Long- Term Care Hospital Prospective Payment System and Rate Year 2010 Rates... Prospective Payment Systems for Acute Care Hospitals and Fiscal Year 2010 Rates and to the Long-Term Care...

Evaluation of the frequency of Candida spp. in hospitalized and non-hospitalized subjects

Directory of Open Access Journals (Sweden)

J. N. Vieira

2018-02-01

Full Text Available Abstract The aim of this study was to evaluate the frequency of Candida species between a non-hospitalized and a hospitalized population. For this purpose, samples of saliva were sampled through sterile swabs, moistened in peptone water and rubbed in the oral cavity of 140 individuals, from which, 70 were hospitalized patients from the Medical Clinic of a Teaching Hospital and the other 70 were non-hospitalized subjects. All saliva samples were plated in Sabouraud Dextrose agar added with Chloramphenicol and incubated at 36 °C for 48 hours. The morphology identification was performed through macroscopic and microscopic characterization, the CHROMagar Candida medium and the VITEK® system Yeast Biochemical Card (bio Mérieux SA, France. The results showed a colonization of Candida spp. in 85.7% the hospitalized individuals, where the species found were C. albicans (60%, C. tropicalis (23.4%, C. krusei (3.3% and Candida spp. (13.3%. In the non-hospitalized individuals the colonization by Candida spp was 47.1%, and the species found were: C. albicans (45.5%, C.krusei (9.1%, C. guilliermondii (9.1% %, C. tropicalis (3.0%, C. famata (3.0% and Candida spp. (30.3%. In spite of their presence in oral cavity in both groups, Candida spp. was more frequently isolated in hospitalized individuals, who were 6.73 times more likely to have this fungus in the oral cavity and were 3.88 times more likely to have Candida albicans.

Segmentation in local hospital markets.

Science.gov (United States)

Dranove, D; White, W D; Wu, L

1993-01-01

This study examines evidence of market segmentation on the basis of patients' insurance status, demographic characteristics, and medical condition in selected local markets in California in the years 1983 and 1989. Substantial differences exist in the probability patients may be admitted to particular hospitals based on insurance coverage, particularly Medicaid, and race. Segmentation based on insurance and race is related to hospital characteristics, but not the characteristics of the hospital's community. Medicaid patients are more likely to go to hospitals with lower costs and fewer service offerings. Privately insured patients go to hospitals offering more services, although cost concerns are increasing. Hispanic patients also go to low-cost hospitals, ceteris paribus. Results indicate little evidence of segmentation based on medical condition in either 1983 or 1989, suggesting that "centers of excellence" have yet to play an important role in patient choice of hospital. The authors found that distance matters, and that patients prefer nearby hospitals, moreso for some medical conditions than others, in ways consistent with economic theories of consumer choice.

Mobile Robots for Hospital Logistics

OpenAIRE

Özkil, Ali Gürcan

2012-01-01

Hospitals are complex and dynamic organisms that are vital to the well-being of societies. Providing good quality healthcare is the ultimate goal of a hospital, and it is what most of us are only concerned with. A hospital, on the other hand, has to orchestrate a great deal of supplementary services to maintain the quality of healthcare provided. Logistics is the most resource demanding service in a hospital. The scale of the transportation tasks is huge and the material flow in a hospital is...

Association of Hospitalization for Neurosurgical Operations in Magnet Hospitals With Mortality and Length of Stay.

Science.gov (United States)

Missios, Symeon; Bekelis, Kimon

2018-03-01

The association of Magnet hospital status with improved surgical outcomes remains an issue of debate. To investigate whether hospitalization in a Magnet hospital is associated with improved outcomes for patients undergoing neurosurgical operations. A cohort study was executed using all patients undergoing neurosurgical operations in New York registered in the Statewide Planning and Research Cooperative System database from 2009 to 2013. We examined the association of Magnet status hospitalization after neurosurgical operations with inpatient case fatality and length of stay (LOS). We employed an instrumental variable analysis to simulate a randomized trial. Overall, 190 787 patients underwent neurosurgical operations. Of these, 68 046 (35.7%) were hospitalized in Magnet hospitals, and 122 741 (64.3%) in non-Magnet institutions. Instrumental variable analysis demonstrated that hospitalization in Magnet hospitals was associated with decreased case fatality (adjusted difference, -0.8%; -95% confidence interval, -0.7% to -0.6%), and LOS (adjusted difference, -1.9; 95% confidence interval, -2.2 to -1.5) in comparison to non-Magnet hospitals. These associations were also observed in propensity score adjusted mixed effects models. These associations persisted in prespecified subgroups of patients undergoing spine surgery, craniotomy for tumor resection, or neurovascular interventions. We identified an association of Magnet hospitals with lower case fatality, and shorter LOS in a comprehensive New York State patient cohort undergoing neurosurgical procedures. Copyright © 2017 by the Congress of Neurological Surgeons

Hospital waste management in Lebanon

International Nuclear Information System (INIS)

Chaker, Alissar

1999-01-01

Hospital wastes comprises approximately 80% domestic waste components, also known as non-risk waste and 20% hazardous or risk waste. The 20% of the hospital waste stream or the risk waste (also known as infectious, medical, clinical wastes) comprises components which could be potentially contaminated with infections, chemical or radioactive agents. Therefore, it should be handled and disposed of in such a manner as to minimize potential human exposure and cross-contamination. Hospital risk waste and be subdivided into seven general categories as follows: infections, anatomical/pathological, chemical, pharmaceutical, radioactive waste, sharps and pressurised containers. These waste categories are generated by many types of health care establishments, including hospitals, clinics, infirmaries.... The document presents also tables of number of hospitals and estimated bed number in different regions in Lebanon; estimated hospital risk and non-risk waste generation per tonnes per day for the years 1998 until 2010 and finally sensitivity analysis of estimated generation of hospital risk waste in Lebanon per tonnes per day for the years 1998 until 2010. The management, treatment and disposal of hospital risk waste constitute important environmental and public safety issues. It is recognised that there is alack of infrastructure for the safe and environmentally acceptable disposal of hospital waste in Lebanon

The impact of managed care penetration and hospital quality on efficiency in hospital staffing.

Science.gov (United States)

Mobley, Lee R; Magnussen, Jon

2002-01-01

The state of California has recently mandated minimum nurse-staffing ratios, raising concerns about possible affects on hospital efficiency. In this study, we examine how market factors and quality were related to staffing levels in California hospitals in 1995 (prior to implementation of the new law). We are particularly interested in the affect of managed care penetration on this aspect of hospital efficiency because the call to legislative action was predicated on fears that hospitals were reducing staffing below optimal levels in response to managed care pressures. We derive a unique measure of excess staffing in hospitals based on a data envelopment analysis (DEA) production function model, which explicitly includes ancillary care among the inputs and outputs. This careful specification of production is important because ancillary care use has risen relative to daily hospital services, with the spread of managed care and advances in medical technology. We find that market share (adjusted for size) and market concentration are the major determinants of excess staffing while managed care penetration is insignificant. We also find that poor quality (outcomes worse than expected) is associated with less efficient staffing. These findings suggest that the larger, more efficient urban hospitals will be penalized more heavily under binding staffing ratios than smaller, less-urban hospitals.

On spaces of hospitality

DEFF Research Database (Denmark)

Greve, Anni

Although specialists in hospitality have worked extensively on hospitality with respect to relations between different nations or between nations and individuals of a different nationality, for instance when they seek asylum, Jacques Derrida preferred to focus instead upon the relationship between...... the guest and the host. This has provided a much-needed rethinking of how to understand hospitality as a way of relating, as an ethics and as a politics. Within this work, there have often appeared discussions of ‘spaces of hospitality’, but these spaces have remained largely abstract. This is where...... this paper comes in: It will re open discussions of spaces of hospitality with an introduction into an on-going research project that studies the performative, structural and social dynamics of cultural encounters focusing on forms of hospitality that are related to particular sites in the city, namely...

Hjertestop uden for hospital

DEFF Research Database (Denmark)

Frandsen, F; Nielsen, J R; Gram, L

1989-01-01

During the period 1.10.1986-30.9.1987, all patients with cardiac arrest outside hospital brought to the casualty department in Odense Hospital were registered. Out of 160 patients, 133 (83%) could be primarily resuscitated, 19 (12%) were resuscitated but died later in hospital and eight patients (5......%) were resuscitated and could be discharged alive from hospital. Out of the eight patients who were discharged alive, only two (1%) had retained reasonable cerebral function as assessed by dementia testing. Treatment of the cardiac arrest prior to the arrival of the ambulance, duration of the cardiac...... arrest for less than six minutes and staffing of the ambulance with three first-aid men were factors of decisive importance for survival of the patients. The results of this investigation demonstrate that treatment of cardiac arrest outside hospital is unsatisfactory. Proposals for improvement...

Population versus hospital controls for case-control studies on cancers in Chinese hospitals.

Science.gov (United States)

Li, Lin; Zhang, Min; Holman, D'Arcy

2011-12-15

Correct control selection is crucial to the internal validity of case-control studies. Little information exists on differences between population and hospital controls in case-control studies on cancers in Chinese hospital setting. We conducted three parallel case-control studies on leukemia, breast and colorectal cancers in China between 2009 and 2010, using population and hospital controls to separately match 540 incident cases by age, gender and residency at a 1:1 ratio. Demographic and lifestyle factors were measured using a validated questionnaire in face-to-face interview. Odds ratios (ORs) and 95% confidence intervals (CIs) were obtained using conditional logistic regression analyses. The two control groups had closely similar exposure distributions of 15 out of 16 factors, with the only exception being that hospital controls were less likely to have a BMI ≥ 25 (OR = 0.71, 95% CI: 0.54, 0.93). For exposure of green tea drinking, the adjusted ORs (95% CIs) comparing green tealeaves intake ≥ 1000 grams annually with non-drinkers were 0.51 (0.31, 0.83) and 0.21 (0.27, 0.74) for three cancers combined, 0.06 (0.01, 0.61) and 0.07 (0.01, 0.47) for breast cancer, 0.52 (0.29, 0.94) and 0.45 (0.25, 0.82) for colorectal cancer, 0.65 (0.08, 5.63) and 0.57 (0.07, 4.79) for leukemia using hospital and population controls respectively. The study found that hospital controls were comparable with population controls for most demographic characteristics and lifestyle factors measured, but there was a slight difference between the two control groups. Hospital outpatients provide a satisfactory control group in hospital-based case-control study in the Chinese hospital setting.

Population versus hospital controls for case-control studies on cancers in Chinese hospitals

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Li Lin

2011-12-01

Full Text Available Abstract Background Correct control selection is crucial to the internal validity of case-control studies. Little information exists on differences between population and hospital controls in case-control studies on cancers in Chinese hospital setting. Methods We conducted three parallel case-control studies on leukemia, breast and colorectal cancers in China between 2009 and 2010, using population and hospital controls to separately match 540 incident cases by age, gender and residency at a 1:1 ratio. Demographic and lifestyle factors were measured using a validated questionnaire in face-to-face interview. Odds ratios (ORs and 95% confidence intervals (CIs were obtained using conditional logistic regression analyses. Results The two control groups had closely similar exposure distributions of 15 out of 16 factors, with the only exception being that hospital controls were less likely to have a BMI ≥ 25 (OR = 0.71, 95% CI: 0.54, 0.93. For exposure of green tea drinking, the adjusted ORs (95% CIs comparing green tealeaves intake ≥ 1000 grams annually with non-drinkers were 0.51 (0.31, 0.83 and 0.21 (0.27, 0.74 for three cancers combined, 0.06 (0.01, 0.61 and 0.07 (0.01, 0.47 for breast cancer, 0.52 (0.29, 0.94 and 0.45 (0.25, 0.82 for colorectal cancer, 0.65 (0.08, 5.63 and 0.57 (0.07, 4.79 for leukemia using hospital and population controls respectively. Conclusions The study found that hospital controls were comparable with population controls for most demographic characteristics and lifestyle factors measured, but there was a slight difference between the two control groups. Hospital outpatients provide a satisfactory control group in hospital-based case-control study in the Chinese hospital setting.

Medicare Hospital Spending Per Patient - Hospital

Data.gov (United States)

U.S. Department of Health & Human Services — The "Medicare hospital spending per patient (Medicare Spending per Beneficiary)" measure shows whether Medicare spends more, less or about the same per Medicare...

Mental hospital reform in Asia: the case of Yuli Veterans Hospital, Taiwan

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Minas Harry

2009-01-01

Full Text Available Abstract Background Yuli Veterans Hospital (YVH has been the largest mental hospital for the patients with chronic and severe mental illness in Taiwan for the past 50 years. While this hospital used to be a symbol of hopelessness among patients and their families and an unspoken shame among Taiwan psychiatry and mental health circles it now represents an example of how an old, custodial hospital can be transformed into a very different institution. In this case study we will describe the features of this transformation, which, over the past 20 years, has aimed to help extended stay inpatients with severe mental illness to integrate into the local community of Yuli even though it is not their original home. Methods Using historical documents and oral narratives from Yuli inhabitants, workers and patients of YVH, we will offer a case study of the Yuli model. Results There are four main components of the Yuli model: holistic medical support, vocational rehabilitation, case management, and the residential program. The four components help patients recover two essential features of their lives: vocational life and ordinary daily routines. As the process of recovery evolves, patients gradually regain inner stability, dignity, self-confidence, and a sense of control. The four components are critical to rebuild the structure and order of life of the patients and are indispensable and interdependent parts of one service package. They operate simultaneously to benefit the patients to the greatest degree possible. Discussion There are many challenges to the further development and financial viability of the model of services developed at YVH. There are also important questions concerning the replicability of the Yuli model in other sociocultural and service system contexts. Conclusion This case study reveals the possibility of transforming a custodial mental hospital into a hospital providing high quality care. Hospital and community are not in opposition

Early discharge hospital at home.

Science.gov (United States)

Gonçalves-Bradley, Daniela C; Iliffe, Steve; Doll, Helen A; Broad, Joanna; Gladman, John; Langhorne, Peter; Richards, Suzanne H; Shepperd, Sasha

2017-06-26

Early discharge hospital at home is a service that provides active treatment by healthcare professionals in the patient's home for a condition that otherwise would require acute hospital inpatient care. This is an update of a Cochrane review. To determine the effectiveness and cost of managing patients with early discharge hospital at home compared with inpatient hospital care. We searched the following databases to 9 January 2017: the Cochrane Effective Practice and Organisation of Care Group (EPOC) register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, and EconLit. We searched clinical trials registries. Randomised trials comparing early discharge hospital at home with acute hospital inpatient care for adults. We excluded obstetric, paediatric and mental health hospital at home schemes.   DATA COLLECTION AND ANALYSIS: We followed the standard methodological procedures expected by Cochrane and EPOC. We used the GRADE approach to assess the certainty of the body of evidence for the most important outcomes. We included 32 trials (N = 4746), six of them new for this update, mainly conducted in high-income countries. We judged most of the studies to have a low or unclear risk of bias. The intervention was delivered by hospital outreach services (17 trials), community-based services (11 trials), and was co-ordinated by a hospital-based stroke team or physician in conjunction with community-based services in four trials.Studies recruiting people recovering from strokeEarly discharge hospital at home probably makes little or no difference to mortality at three to six months (risk ratio (RR) 0.92, 95% confidence interval (CI) 0.57 to 1.48, N = 1114, 11 trials, moderate-certainty evidence) and may make little or no difference to the risk of hospital readmission (RR 1.09, 95% CI 0.71 to 1.66, N = 345, 5 trials, low-certainty evidence). Hospital at home may lower the risk of living in institutional setting at six months (RR 0.63, 96% CI

Analysis of hospital logistics and costs of the Clinical Engineering Sector in a Philanthropic Hospital

Directory of Open Access Journals (Sweden)

Antônio Artur de Souza

2014-12-01

Full Text Available Hospitals are considered complex organizations mainly due to the high cost of the health care structure employed for care. Reducing operating costs is a challenge for hospital managers. Particularly in the clinical engineering sector, adequate hospital logistics can reduce costs. In this context, the aim of the research was to analyze the activities of hospital logistics of the Clinical Engineering department at a charity hospital, focusing on cost reduction. The paper presents a case study in a large charity hospital located in the metropolitan region of Belo Horizonte, MG. The analysis focuses on the activities of hospital logistics at this hospital clinical engineering sector. The work in this sector is concentrated in the realization and implementation of equipment maintenance, to the detriment of efforts to reduce costs and increase safety for all streams managed by the sector. It was also found that there are risks of increased costs with inadequate routines: (i acquisition of new and large equipment; (ii maintenance and release schedule for use; and (iii the theft of equipment.

Early examples of art in Scottish hospitals, 2: Crichton Royal Hospital, Dumfries.

Science.gov (United States)

Park, Maureen

2003-12-01

Fine art has been used in hospitals for centuries. However, Crichton Royal Hospital in Dumfries pioneered the use of art activity in the treatment of its patients. This article is the second of two which look at examples of art created for, and in, Scottish hospitals in the 19th century. It is suggested that the importance of Scotland's contribution to this movement is unrecognized by many of its modern-day practitioners.

Baldrige Award cites two hospitals. Baptist, Saint Luke's hospitals honored for quality, performance.

Science.gov (United States)

Rees, Tom

2004-01-01

Baptist Hospital Inc., Pensacola, Fla.; and Saint Luke's Hospital, Kansas City, Mo., have received the prestigious Malcolm Baldrige National Quality Award in the category of healthcare. Named for a former secretary of commerce, the award recognizes efficiency, effectiveness and excellence. The two hospitals are among only seven companies in the U.S. to be so recognized this year.

Does outsourcing affect hospital profitability?

Science.gov (United States)

Danvers, Kreag; Nikolov, Pavel

2010-01-01

Organizations outsource non-core service functions to achieve cost reductions and strategic benefits, both of which can impact profitability performance. This article examines relations between managerial outsourcing decisions and profitability for a multi-state sample of non-profit hospitals, across 16 states and four regions of the United States. Overall regression results indicate that outsourcing does not necessarily improve hospital profitability. In addition, we identify no profitability impact from outsourcing for urban hospitals, but somewhat positive effects for teaching hospitals. Our regional analysis suggests that hospitals located in the Midwest maintain positive profitability effects with outsourcing, but those located in the South realize negative effects. These findings have implications for cost reduction efforts and the financial viability of non-profit hospitals.

[Continuity of hospital identifiers in hospital discharge data - Analysis of the nationwide German DRG Statistics from 2005 to 2013].

Science.gov (United States)

Nimptsch, Ulrike; Wengler, Annelene; Mansky, Thomas

2016-11-01

In Germany, nationwide hospital discharge data (DRG statistics provided by the research data centers of the Federal Statistical Office and the Statistical Offices of the 'Länder') are increasingly used as data source for health services research. Within this data hospitals can be separated via their hospital identifier ([Institutionskennzeichen] IK). However, this hospital identifier primarily designates the invoicing unit and is not necessarily equivalent to one hospital location. Aiming to investigate direction and extent of possible bias in hospital-level analyses this study examines the continuity of the hospital identifier within a cross-sectional and longitudinal approach and compares the results to official hospital census statistics. Within the DRG statistics from 2005 to 2013 the annual number of hospitals as classified by hospital identifiers was counted for each year of observation. The annual number of hospitals derived from DRG statistics was compared to the number of hospitals in the official census statistics 'Grunddaten der Krankenhäuser'. Subsequently, the temporal continuity of hospital identifiers in the DRG statistics was analyzed within cohorts of hospitals. Until 2013, the annual number of hospital identifiers in the DRG statistics fell by 175 (from 1,725 to 1,550). This decline affected only providers with small or medium case volume. The number of hospitals identified in the DRG statistics was lower than the number given in the census statistics (e.g., in 2013 1,550 IK vs. 1,668 hospitals in the census statistics). The longitudinal analyses revealed that the majority of hospital identifiers persisted in the years of observation, while one fifth of hospital identifiers changed. In cross-sectional studies of German hospital discharge data the separation of hospitals via the hospital identifier might lead to underestimating the number of hospitals and consequential overestimation of caseload per hospital. Discontinuities of hospital

The diffusion of Magnet hospital recognition.

Science.gov (United States)

Abraham, Jean; Jerome-D'Emilia, Bonnie; Begun, James W

2011-01-01

Magnet recognition is promoted by many in the practice community as the gold standard of nursing care quality. The Magnet hospital population has exploded in recent years, with about 8% of U.S. general hospitals now recognized. The purpose of this study was to identify the characteristics that distinguish Magnet-recognized hospitals from other hospitals within the framework of diffusion theory. We conceptualize Magnet recognition as an organizational innovation and Magnet-recognized hospitals as adopters of the innovation. We hypothesize that adoption is associated with selected characteristics of hospitals and their markets. The study population consists of the 3,657 general hospitals in the United States in 2008 located in metropolitan or micropolitan areas. We used logistic regression analysis to estimate the association of Magnet recognition with organizational and market characteristics. Empirical results support hypotheses that adoption is positively associated with hospital complexity and specialization, as measured by teaching affiliation, and with hospital size, slack resources, and not-for-profit or public ownership (vs. for-profit). Adopters also are more likely to be located in markets that are experiencing population growth and are more likely to have competitor hospitals within the market that also have adopted Magnet status. A positive association of adoption with baccalaureate nursing school supply is contrary to the hypothesized relationship. Because of its rapid recent growth, consideration of Magnet program recognition should be on the strategic planning agenda of hospitals and hospital systems. Hospital administrators, particularly in smaller, for-profit hospitals, may expect more of their larger not-for-profit competitors, particularly teaching hospitals, to adopt Magnet recognition, increasing competition for baccalaureate-prepared registered nurses in the labor market.

Trends in diarrhea hospitalizations among infants at three hospitals in Tanzania before and after rotavirus vaccine introduction.

Science.gov (United States)

Lyamuya, Faraja; Michael, Fausta; Jani, Bhavin; Fungo, Yohana; Chambo, Alfred; Chami, Inviolatha; Bulali, Regina; Mpamba, Amina; Cholobi, Happy; Kallovya, Dotto; Kamugisha, Christopher; Mwenda, Jason M; Cortese, Margaret M

2018-04-11

The Tanzania Ministry of Health introduced monovalent human rotavirus vaccine in January 2013, to be administered at ages 6 and 10 weeks. Data suggest there was high vaccine uptake. We used hospital ward registers from 3 hospitals to examine trends in diarrhea hospitalizations among infants before and after vaccine introduction. Ward registers from Dodoma Regional Referral Hospital (Central Tanzania), and two hospitals in Mbeya (Southwest area), Mbeya Zonal Referral Hospital and Mbalizi Hospital, were used to tally admissions for diarrhea among children by age group, month and year. Rotavirus surveillance had started at these hospitals in early 2013; the proportion of infants enrolled and rotavirus-EIA positive were examined by month to determine peak periods of rotavirus disease post-vaccine introduction. Registers were available for 2-4 prevaccine years and 2-3 post introduction years. At Dodoma Regional Referral Hospital, compared with the mean of 2011 and 2012, diarrhea hospitalizations among infants were 26% lower in 2015 and 58% lower in 2016. The diarrhea peak shifted later in the year first by 1 and then by 2-3 months from prevaccine. At the Mbeya hospitals, the number of diarrhea admissions in prevaccine period varied substantially by year. At Mbeya Referral Hospital, diarrhea hospitalizations among infants were lower by 25-37% in 2014 and 11-26% in 2015, while at Mbalizi Hospital, these hospitalizations were 4% lower in 2014 and 14% higher in 2015. Rotavirus testing data demonstrated a lowering of the prevaccine peak, a shift in timing of the peak months and indicated that other diarrheal peaks in post-introduction years were not due to rotavirus. In this ecological evaluation, total diarrhea hospitalizations among infants were lower (≥25% lower in ≥1 year) following introduction in 2 of 3 hospitals. There are challenges in using ward registers to ascertain possible impact of rotavirus vaccine introduction on trends in hospitalizations for

Strategic management for university hospitals

Directory of Open Access Journals (Sweden)

Martha Isabel Riaño-Casallas

2016-10-01

Full Text Available Introduction: There are several approaches and schools that support strategic management processes. University hospitals require the implementation of a strategic approach to their management, since they are a particular type of organization with the triple mission of providing health care, education and research. Objective: To propose a strategic profile for a university hospital. Materials and methods: The theoretical framework of strategic management was analyzed and some particular components of hospital management were studied; based on these criteria, the strategic management process in three high complexity hospitals of Bogotá, D.C. was examined and a profile of both the objectives and the functional strategies for the hospital was proposed. Results: The main strategic thinking schools are presented; the processes and components of strategic management are described, and a strategic management profile for a university hospital is proposed. Conclusion: The strategic orientation of management for an institution with the characteristics of a university hospital facilitates achieving organizational objectives.

Health promoting hospitals: a study on educational hospitals of Isfahan, Iran

Directory of Open Access Journals (Sweden)

Atefeh Afshari

2016-03-01

Conclusion: It seems that some of the health promoting hospitals (HPS duties carried out by hospitals. So, to improve the quality of health services, it seems useful to encourage policymakers and health service managers to create coherent policies and guidelines in HPS.

How a hospital must face a massive emergency: the case of Martini Hospital, Turin

Directory of Open Access Journals (Sweden)

Antonio Morra

2008-09-01

Full Text Available The terms “disaster” or “surge capability”, referred to hospitals, are often used to define a massive casualty admission. This may be a misleading concept, because emergency may as well arise from inside hospitals, and the last years high figures related to fires in the about 2,000 italian hospitals should suggest a different point of view. In this article the authors describe their experience in hospital preparedness at Ospedale Martini in Turin. Hospital operators regularly attend basic (GOM and advanced (HDM© courses about disaster response and organization, and a specific course is dedicated to operators involved in internal safety (fire emergency. In this courses, computer simulations are widely used, associated with conventional didactic. If education is one of the two cornerstones of disaster preparedness at Ospedale Martini, well designed emergency plans and an effective disaster management are the other one. The Internal Emergency Plan (Fire and Evacuation is aimed to give a proper response to fires and other events arising from inside the hospital and potentially requiring its partial or total evacuation. The Massive Casualties Admission Emergency Plan increases the surge capability of the hospital allowing to take care of a great number of injured people, and at the same time avoiding a dramatic fall in the treatment quality. The “Hospital Disaster Management©” system, created by the authors, is an organizational scheme based on team work. Its aim is to “put order in chaos” when hospitals are facing a disaster. Properly trained physicians and nurses, assigned to key positions, act in this system as Hospital Disaster Managers: their tasks are to coordinate the teams, to manage critical resources and to use the emergency plans as powerful instruments.

All projects related to Nigéria | Page 4 | IDRC - International ...

International Development Research Centre (IDRC) Digital Library (Canada)

Promoting Implementation of Tobacco Control Laws and Policies in Nigeria ... Although birth and death rates are still relatively high in Africa, African ... for Technology and Society) is part of the Fundação Getulio Vargas Law School in Rio de ...

HOSPITAL IMAGE AS A MODERATING VARIABLE ON THE EFFECT OF HOSPITAL SERVICE QUALITY ON THE CUSTOMER PERCEIVED VALUE, CUSTOMER TRUST AND CUSTOMER LOYALTY IN HOSPITAL SERVICES

OpenAIRE

Indrianawati Usman

2017-01-01

This is an explanatory research, analyzing the hospital image as a moderating variable on the effect of hospital service quality on customer perceived value and trust. Research was conducted at several hospitals in Surabaya Indonesia, especially to outpatients. Data was collected by survey to the outpatients of the hospitals. The purpose of this research was empirically examining the effects of hospital service quality on customer perceived value and customer trust, examine eff...

Distinguishing in-hospital and out-of-hospital status epilepticus: clinical implications from a 10-year cohort study.

Science.gov (United States)

Sutter, R; Semmlack, S; Spiegel, R; Tisljar, K; Rüegg, S; Marsch, S

2017-09-01

The aim was to determine differences of clinical, treatment and outcome characteristics between patients with in-hospital and out-of-hospital status epilepticus (SE). From 2005 to 2014, clinical data were assessed in adults with SE treated in an academic medical care centre. Clinical characteristics, treatment and outcomes were compared between patients with in-hospital and out-of-hospital SE. Amongst 352 patients, 213 were admitted with SE and 139 developed in-hospital SE. Patients with in-hospital SE had more acute/fatal aetiologies (60% vs. 35%, P Status Epilepticus Severity Score (STESS) was an independent predictor for death in both groups, increased Charlson Comorbidity Index and treatment refractory SE were associated with death only in patients with in-hospital SE. Continuous anaesthesia for refractory SE was associated with increased mortality only in patients with out-of-hospital SE. The area under the receiver operating curve was 0.717 for prediction of death by STESS in patients with in-hospital SE and 0.811 in patients with out-of-hospital SE. Patients with in-hospital SE had more fatal aetiologies and comorbidities, refractory SE, less return to functional baseline, and increased mortality compared to patients with out-of-hospital SE. Whilst the STESS was a robust predictor for death in both groups, the association between continuous anaesthesia and death was limited to out-of-hospital SE. © 2017 EAN.

Severe maternal morbidity in Zanzibar's referral hospital: Measuring the impact of in-hospital care

NARCIS (Netherlands)

Herklots, T.; Acht, L. van; Meguid, T.; Franx, A.; Jacod, B.C.

2017-01-01

OBJECTIVE: to analyse the impact of in-hospital care on severe maternal morbidity using WHO's near-miss approach in the low-resource, high mortality setting of Zanzibar's referral hospital. SETTING: Mnazi Mmoja Hospital, a tertiary care facility, in Zanzibar, Tanzania. METHODS: We identified all

Multiple sclerosis and alcohol use disorders: In-hospital mortality, extended hospital stays, and overexpenditures.

Science.gov (United States)

Gili-Miner, M; López-Méndez, J; Vilches-Arenas, A; Ramírez-Ramírez, G; Franco-Fernández, D; Sala-Turrens, J; Béjar-Prado, L

2016-10-22

The objective of this study was to analyse the impact of alcohol use disorders (AUD) in patients with multiple sclerosis (MS) in terms of in-hospital mortality, extended hospital stays, and overexpenditures. We conducted a retrospective observational study in a sample of MS patients obtained from minimal basic data sets from 87 Spanish hospitals recorded between 2008 and 2010. Mortality, length of hospital stays, and overexpenditures attributable to AUD were calculated. We used a multivariate analysis of covariance to control for such variables as age and sex, type of hospital, type of admission, other addictions, and comorbidities. The 10,249 patients admitted for MS and aged 18-74 years included 215 patients with AUD. Patients with both MS and AUD were predominantly male, with more emergency admissions, a higher prevalence of tobacco or substance use disorders, and higher scores on the Charlson comorbidity index. Patients with MS and AUD had a very high in-hospital mortality rate (94.1%) and unusually lengthy stays (2.4 days), and they generated overexpenditures (1,116.9euros per patient). According to the results of this study, AUD in patients with MS results in significant increases in-hospital mortality and the length of the hospital stay and results in overexpenditures. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

[Current status of "hospital-clinic" and "hospital-pharmacy" cooperation for inhalation therapy -based on hospital surveys throughout Japan].

Science.gov (United States)

Yoshimura, Chie; Momose, Yasuyuki; Horie, Takeo; Komase, Yuko; Niimi, Akio; Dobashi, Kunio; Fujimoto, Keisaku; Tohda, Yuuji; Ohta, Ken; Adachi, Mitsuru

2014-02-01

The "zero death from asthma strategy" in the medical treatment for bronchial asthma has been promoted by the Ministry of Health, Labour, and Welfare from 2006, and it indicates that medical and non-medical specialists, as well as pharmacists, should cooperate, and strives to build cooperation which is suited the actual conditions of an area. It is also important for COPD. Although hospitals in some areas cooperate with clinics and pharmacies, the overall concept of cooperation appears to be absent in most Japanese hospitals. A questionnaire was administered in early March, 2012 to 477 allergology institutions, and was authorized by an educational establishment. Among 246 replies from the institutions, cooperation between hospitals and clinics was carried out by 98 institutions (39.8%) specializing in bronchial asthma, and in 64 institutions (37.2%) specializing in COPD. However, cooperation tools were used in only 37 of these institutions (15.0%). The ability to fill prescriptions outside the hospital was available in 209 institutions (85.0%). One-hundred and seventeen institutions (47.6%) replied that they have no tools for hospital-pharmacy cooperation. Direct indications were written in prescriptions by 82 institutions (33.3). In order to build inter-regional association and to equalize medical treatment, we suggest that developing tools and organization for cooperation between health professionals who treat patients with bronchial asthma and COPD is necessary.

Sociotechnical factors influencing unsafe use of hospital information systems: A qualitative study in Malaysian government hospitals.

Science.gov (United States)

Salahuddin, Lizawati; Ismail, Zuraini; Hashim, Ummi Rabaah; Raja Ikram, Raja Rina; Ismail, Nor Haslinda; Naim Mohayat, Mohd Hariz

2018-03-01

The objective of this study is to identify factors influencing unsafe use of hospital information systems in Malaysian government hospitals. Semi-structured interviews with 31 medical doctors in three Malaysian government hospitals implementing total hospital information systems were conducted between March and May 2015. A thematic qualitative analysis was performed on the resultant data to deduce the relevant themes. A total of five themes emerged as the factors influencing unsafe use of a hospital information system: (1) knowledge, (2) system quality, (3) task stressor, (4) organization resources, and (5) teamwork. These qualitative findings highlight that factors influencing unsafe use of a hospital information system originate from multidimensional sociotechnical aspects. Unsafe use of a hospital information system could possibly lead to the incidence of errors and thus raises safety risks to the patients. Hence, multiple interventions (e.g. technology systems and teamwork) are required in shaping high-quality hospital information system use.

Strategic management process in hospitals.

Science.gov (United States)

Zovko, V

2001-01-01

Strategic management is concerned with strategic choices and strategic implementation; it provides the means by which organizations meet their objectives. In the case of hospitals it helps executives and all employees to understand the real purpose and long term goals of the hospital. Also, it helps the hospital find its place in the health care service provision chain, and enables the hospital to coordinate its activities with other organizations in the health care system. Strategic management is a tool, rather than a solution, that helps executives to identify root causes of major problems in the hospital.

Hospital marketing.

Science.gov (United States)

Carter, Tony

2003-01-01

This article looks at a prescribed academic framework for various criteria that serve as a checklist for marketing performance that can be applied to hospital marketing organizations. These guidelines are drawn from some of Dr. Noel Capon of Columbia University's book Marketing Management in the 21st Century and applied to actual practices of hospital marketing organizations. In many ways this checklist can act as a "marketing" balanced scorecard to verify performance effectiveness and develop opportunities for innovation.

Hospital management structures in Maltese hospital through the ages

OpenAIRE

Savona-Ventura, Charles

2001-01-01

The spreading cult of Christ the Healer during the Medieval period led to sick-nursing being viewed as a Christian duty. This encouraged royal dignitaries and philantrophic individuals to donate funds towards the institution and maintenance of a hospital or hospice, the management of these institutions being often shared with religious authorities. The Maltese Islands have been serviced by a series of hospitals, the earliest dating to the fourteenth century. In line with the ch...

77 FR 63751 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Science.gov (United States)

2012-10-17

... [CMS-1588-F2] RIN 0938-AR12 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates..., 2012 Federal Register entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for...

Moving Towards the Age-friendly Hospital: A Paradigm Shift for the Hospital-based Care of the Elderly.

Science.gov (United States)

Huang, Allen R; Larente, Nadine; Morais, Jose A

2011-12-01

Care of the older adult in the acute care hospital is becoming more challenging. Patients 65 years and older account for 35% of hospital discharges and 45% of hospital days. Up to one-third of the hospitalized frail elderly loses independent functioning in one or more activities of daily living as a result of the 'hostile environment' that is present in the acute hospitals. A critical deficit of health care workers with expertise and experience in the care of the elderly also jeopardizes successful care delivery in the acute hospital setting. We propose a paradigm shift in the culture and practice of event-driven acute hospital-based care of the elderly which we call the Age-friendly Hospital concept. Guiding principles include: a favourable physical environment; zero tolerance for ageism throughout the organization; an integrated process to develop comprehensive services using the geriatric approach; assistance with appropriateness decision-making and fostering links between the hospital and the community. Our current proposed strategy is to focus on delirium management as a hospital-wide condition that both requires and highlights the Geriatric Medicine specialist as an expert of content, for program development and of evaluation. The Age-friendly Hospital concept we propose may lead the way to enable hospitals in the fast-moving health care system to deliver high-quality care without jeopardizing risk-benefit, function, and quality of life balances for the frail elderly. Recruitment and retention of skilled health care professionals would benefit from this positive 'branding' of an institution. Convincing hospital management and managing change are significant challenges, especially with competing priorities in a fiscal environment with limited funding. The implementation of a hospital-wide delirium management program is an example of an intervention that embodies many of the principles in the Age-friendly Hospital concept. It is important to change the way

Estimating inpatient hospital prices from state administrative data and hospital financial reports.

Science.gov (United States)

Levit, Katharine R; Friedman, Bernard; Wong, Herbert S

2013-10-01

To develop a tool for estimating hospital-specific inpatient prices for major payers. AHRQ Healthcare Cost and Utilization Project State Inpatient Databases and complete hospital financial reporting of revenues mandated in 10 states for 2006. Hospital discharge records and hospital financial information were merged to estimate revenue per stay by payer. Estimated prices were validated against other data sources. Hospital prices can be reasonably estimated for 10 geographically diverse states. All-payer price-to-charge ratios, an intermediate step in estimating prices, compare favorably to cost-to-charge ratios. Estimated prices also compare well with Medicare, MarketScan private insurance, and the Medical Expenditure Panel Survey prices for major payers, given limitations of each dataset. Public reporting of prices is a consumer resource in making decisions about health care treatment; for self-pay patients, they can provide leverage in negotiating discounts off of charges. Researchers can also use prices to increase understanding of the level and causes of price differentials among geographic areas. Prices by payer expand investigational tools available to study the interaction of inpatient hospital price setting among public and private payers--an important asset as the payer mix changes with the implementation of the Affordable Care Act. © Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

Pseudomonas aeruginosa from hospital environment

Directory of Open Access Journals (Sweden)

Milind Davane

2014-03-01

Full Text Available Hospital acquired infection is an additional affliction to the patient admitted to the hospital for some serious illness and is caused by pathogens which are prevalent in hospital environment. In the hospital, microbes are ubiquitous; and can reach the sick patient through various sources, such as air, water, food, contaminated equipments, linen, catheters, scopes, ventilators, contaminated disinfectants and other preparations used for treatment, visitors, infected patients, etc.

Predictors of Hospitalization in Patients with Syncope Assisted in Specialized Cardiology Hospital

Energy Technology Data Exchange (ETDEWEB)

Fischer, Leonardo Marques; Dutra, João Pedro Passos [Instituto de Cardiologia, Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre, RS (Brazil); Mantovani, Augusto [UFCSPA - Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS (Brazil); Lima, Gustavo Glotz de [Instituto de Cardiologia, Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre, RS (Brazil); UFCSPA - Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS (Brazil); Leiria, Tiago Luiz Luz, E-mail: drleiria@cardiol.br [Instituto de Cardiologia, Fundação Universitária de Cardiologia do Rio Grande do Sul, Porto Alegre, RS (Brazil)

2013-12-15

Risk stratification of a syncopal episode is necessary to better differentiate patients needing hospitalization of those who can be safely sent home from the emergency department. Currently there are no strict guidelines from our Brazilian medical societies to guide the cardiologist that evaluate patients in an emergency setting. To analyze the criteria adopted for defining the need for hospitalization and compare them with the predictors of high risk for adverse outcome defined by the OESIL score that is already validated in the medical literature for assessing syncope. A cross-sectional study of patients diagnosed with syncope during emergency department evaluation at our institution in the year 2011. Of the 46,476 emergency visits made in that year, 216 were due to syncope. Of the 216 patients analyzed, 39% were hospitalized. The variables associated with the need of hospital admission were - having health care insurance, previous known cardiovascular disease, no history of prior stroke, previous syncope and abnormal electrocardiograms during the presentation. Patients classified in OESIL scores of 0-1 had a greater chance of emergency discharge; 2-3 scores showed greater association with the need of hospitalization. A score ≥ 2 OESIL provided an odds ratio 7.8 times higher for hospitalization compared to score 0 (p <0.001, 95% CI:4,03-15,11). In approximately 39% no etiological cause for syncope was found and in 18% cardiac cause was identified. Factors such as cardiovascular disease, prior history of syncope, health insurance, no previous stroke and abnormal electrocardiograms, were the criteria used by doctors to indicate hospital admission. There was a good correlation between the clinical judgment and the OESIL criteria for high risk described in literature.

Predictors of Hospitalization in Patients with Syncope Assisted in Specialized Cardiology Hospital

International Nuclear Information System (INIS)

Fischer, Leonardo Marques; Dutra, João Pedro Passos; Mantovani, Augusto; Lima, Gustavo Glotz de; Leiria, Tiago Luiz Luz

2013-01-01

Risk stratification of a syncopal episode is necessary to better differentiate patients needing hospitalization of those who can be safely sent home from the emergency department. Currently there are no strict guidelines from our Brazilian medical societies to guide the cardiologist that evaluate patients in an emergency setting. To analyze the criteria adopted for defining the need for hospitalization and compare them with the predictors of high risk for adverse outcome defined by the OESIL score that is already validated in the medical literature for assessing syncope. A cross-sectional study of patients diagnosed with syncope during emergency department evaluation at our institution in the year 2011. Of the 46,476 emergency visits made in that year, 216 were due to syncope. Of the 216 patients analyzed, 39% were hospitalized. The variables associated with the need of hospital admission were - having health care insurance, previous known cardiovascular disease, no history of prior stroke, previous syncope and abnormal electrocardiograms during the presentation. Patients classified in OESIL scores of 0-1 had a greater chance of emergency discharge; 2-3 scores showed greater association with the need of hospitalization. A score ≥ 2 OESIL provided an odds ratio 7.8 times higher for hospitalization compared to score 0 (p <0.001, 95% CI:4,03-15,11). In approximately 39% no etiological cause for syncope was found and in 18% cardiac cause was identified. Factors such as cardiovascular disease, prior history of syncope, health insurance, no previous stroke and abnormal electrocardiograms, were the criteria used by doctors to indicate hospital admission. There was a good correlation between the clinical judgment and the OESIL criteria for high risk described in literature

Demographic Factors and Hospital Size Predict Patient Satisfaction Variance- Implications for Hospital Value-Based Purchasing

Science.gov (United States)

McFarland, Daniel C.; Ornstein, Katherine; Holcombe, Randall F.

2016-01-01

Background Hospital Value-Based Purchasing (HVBP) incentivizes quality performance based healthcare by linking payments directly to patient satisfaction scores obtained from Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Lower HCAHPS scores appear to cluster in heterogeneous population dense areas and could bias CMS reimbursement. Objective Assess nonrandom variation in patient satisfaction as determined by HCAHPS. Design Multivariate regression modeling was performed for individual dimensions of HCAHPS and aggregate scores. Standardized partial regression coefficients assessed strengths of predictors. Weighted Individual (hospital) Patient Satisfaction Adjusted Score (WIPSAS) utilized four highly predictive variables and hospitals were re-ranked accordingly. Setting 3,907 HVBP-participating hospitals. Patients 934,800 patient surveys, by most conservative estimate. Measurements 3,144 county demographics (U.S. Census), and HCAHPS. Results Hospital size and primary language (‘non-English speaking’) most strongly predicted unfavorable HCAHPS scores while education and white ethnicity most strongly predicted favorable HCAHPS scores. The average adjusted patient satisfaction scores calculated by WIPSAS approximated the national average of HCAHPS scores. However, WIPSAS changed hospital rankings by variable amounts depending on the strength of the predictive variables in the hospitals’ locations. Structural and demographic characteristics that predict lower scores were accounted for by WIPSAS that also improved rankings of many safety-net hospitals and academic medical centers in diverse areas. Conclusions Demographic and structural factors (e.g., hospital beds) predict patient satisfaction scores even after CMS adjustments. CMS should consider WIPSAS or a similar adjustment to account for the severity of patient satisfaction inequities that hospitals could strive to correct. PMID:25940305

Hospitals with higher nurse staffing had lower odds of readmissions penalties than hospitals with lower staffing.

Science.gov (United States)

McHugh, Matthew D; Berez, Julie; Small, Dylan S

2013-10-01

The Affordable Care Act's Hospital Readmissions Reduction Program (HRRP) penalizes hospitals based on excess readmission rates among Medicare beneficiaries. The aim of the program is to reduce readmissions while aligning hospitals' financial incentives with payers' and patients' quality goals. Many evidence-based interventions that reduce readmissions, such as discharge preparation, care coordination, and patient education, are grounded in the fundamentals of basic nursing care. Yet inadequate staffing can hinder nurses' efforts to carry out these processes of care. We estimated the effect that nurse staffing had on the likelihood that a hospital was penalized under the HRRP. Hospitals with higher nurse staffing had 25 percent lower odds of being penalized compared to otherwise similar hospitals with lower staffing. Investment in nursing is a potential system-level intervention to reduce readmissions that policy makers and hospital administrators should consider in the new regulatory environment as they examine the quality of care delivered to US hospital patients.

The financial performance of rural hospitals and implications for elimination of the Critical Access Hospital program.

Science.gov (United States)

Holmes, George M; Pink, George H; Friedman, Sarah A

2013-01-01

To compare the financial performance of rural hospitals with Medicare payment provisions to those paid under prospective payment and to estimate the financial consequences of elimination of the Critical Access Hospital (CAH) program. Financial data for 2004-2010 were collected from the Healthcare Cost Reporting Information System (HCRIS) for rural hospitals. HCRIS data were used to calculate measures of the profitability, liquidity, capital structure, and financial strength of rural hospitals. Linear mixed models accounted for the method of Medicare reimbursement, time trends, hospital, and market characteristics. Simulations were used to estimate profitability of CAHs if they reverted to prospective payment. CAHs generally had lower unadjusted financial performance than other types of rural hospitals, but after adjustment for hospital characteristics, CAHs had generally higher financial performance. Special payment provisions by Medicare to rural hospitals are important determinants of financial performance. In particular, the financial condition of CAHs would be worse if they were paid under prospective payment. © 2012 National Rural Health Association.

[Psychopathology of anxiety-phobic disorders that led to hospitalization in a psychiatric hospital].

Science.gov (United States)

Chugunov, D A; Schmilovitch, A A

To study the psychopathology of anxiety-phobic disorders and motives of hospitalization of patients in a psychiatric hospital. One hundred and thirty-two patients were examined, 72 patients of the main group were admitted to general psychiatric departments, 60 patients of the control group in the sanatorium psychiatric departments. Clinical-psychopathological, follow-up, psychometric and statistical methods were used. Patients with hospital anxiety-phobic disorders had agoraphobia with panic disorder, social phobias, hypochondriacal phobias, specific phobias and multiple phobias. The main reasons for hospitalization were: the intensity of anxiety-phobic disorders, contrast content of phobias, multiplicity of anxiety-phobic disorders, ambulance calls, personality accentuations and rental aims.

Incidences and variations of hospital acquired venous thromboembolism in Australian hospitals: a population-based study.

Science.gov (United States)

Assareh, Hassan; Chen, Jack; Ou, Lixin; Hillman, Ken; Flabouris, Arthas

2016-09-22

Data on hospital-acquired venous thromboembolism (HA-VTE) incidence, case fatality rate and variation amongst patient groups and health providers is lacking. We aim to explore HA-VTE incidences, associated mortality, trends and variations across all acute hospitals in New South Wales (NSW)-Australia. A population-based study using all admitted patients (aged 18-90 with a length of stay of at least two days and not transferred to another acute care facility) in 104 NSW acute public and private hospitals during 2002-2009. Poisson mixed models were used to derive adjusted rate ratios (IRR) in presence of patient and hospital characteristics. Amongst, 3,331,677 patients, the incidence of HA-VTE was 11.45 per 1000 patients and one in ten who developed HA-VTE died in hospital. HA-VTE incidence, initially rose, but subsequently declined, whereas case fatality rate consistently declined by 22 % over the study period. Surgical patients were 128 % (IRR = 2.28, 95 % CI: 2.19-2.38) more likely to develop HA-VTE, but had similar case fatality rates compared to medical patients. Private hospitals, in comparison to public hospitals had a higher incidence of HA-VTE (IRR = 1.76; 95 % CI: 1.42-2.18) for medical patients. However, they had a similar incidence (IRR = 0.91; 95 % CI: 0.75-1.11), but a lower mortality (IRR = 0.59; 95 % CI: 0.47-0.75) amongst surgical patients. Smaller public hospitals had a lower HA-VTE incidence rate compared to larger hospitals (IRR  1.71). Hospitals with a lower reported HA-VTE incidence tended to have a higher HA-VTE case fatality rate. Despite the decline in HA-VTE incidence and case fatality, there were large variations in incidents between medical and surgical patients, public and private hospitals, and different hospital groups. The causes of such differences warrant further investigation and may provide potential for targeted interventions and quality improvement initiatives.

78 FR 38679 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Science.gov (United States)

2013-06-27

... Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Proposed... Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and... regarding MS-DRG classifications and new technology add-on payments. Eva Fung (410) 786-7539, for...

[Communication between the primary care physician, hospital staff and the patient during hospitalization].

Science.gov (United States)

Menahem, Sasson; Roitgarz, Ina; Shvartzman, Pesach

2011-04-01

HospitaL admission is a crisis for the patient and his family and can interfere with the continuity of care. It may lead to mistakes due to communication problems between the primary care physician and the hospital medical staff. To explore the communication between the primary care physician, the hospital medical staff, the patient and his family during hospitalization. A total of 269 questionnaires were sent to all Clalit Health Services-South District, primary care physicians; 119 of these questionnaires (44.2%) were completed. Half of the primary care physicians thought that they should, always or almost always, have contact with the admitting ward in cases of internal medicine, oncology, surgery or pediatric admissions. However, the actual contact rate, according to their report, was only in a third of the cases. A telephone contact was more common than an actual visit of the patient in the ward. Computer communication between the hospital physicians and the primary care physicians is still insufficiently developed, although 96.6% of the primary care physicians check, with the aid of computer software, for information on their hospitalized patients. The main reasons to visit the hospitalized patient were severe medical conditions or uncertainty about the diagnosis; 79% of the physicians thought that visiting their patients strengthened the level of trust between them and their patients. There are sometimes communication difficulties and barriers between the primary care physicians and the ward's physicians due to partial information delivery and rejection from the hospital physicians. The main barriers for visiting admitted patients were workload and lack of pre-allocated time on the work schedule. No statistically significant differences were found between communication variables and primary care physician's personal and demographic characteristics. The communication between the primary care physician and the hospital physicians should be improved through

Hospital-Level Variation in Practice Patterns and Patient Outcomes for Pediatric Patients Hospitalized With Functional Constipation.

Science.gov (United States)

Librizzi, Jamie; Flores, Samuel; Morse, Keith; Kelleher, Kelly; Carter, Jodi; Bode, Ryan

2017-06-01

Constipation is a common pediatric condition with a prevalence of 3% to 5% in children aged 4 to 17 years. Currently, there are no evidence-based guidelines for the management of pediatric patients hospitalized with constipation. The primary objective was to evaluate practice patterns and patient outcomes for the hospital management of functional constipation in US children's hospitals. We conducted a multicenter, retrospective cohort study of children aged 0 to 18 years hospitalized for functional constipation from 2012 to 2014 by using the Pediatric Health Information System. Patients were included by using constipation and other related diagnoses as classified by International Classification of Diseases, Ninth Revision . Patients with complex chronic conditions were excluded. Outcome measures included percentage of hospitalizations due to functional constipation, therapies used, length of stay, and 90-day readmission rates. Statistical analysis included means with 95% confidence intervals for individual hospital outcomes. A total of 14 243 hospitalizations were included, representing 12 804 unique patients. The overall percentage of hospitalizations due to functional constipation was 0.65% (range: 0.19%-1.41%, P hospitalization included: electrolyte laxatives: 40% to 96%; sodium phosphate enema: 0% to 64%; mineral oil enema: 0% to 61%; glycerin suppository: 0% to 37%; bisacodyl 0% to 47%; senna: 0% to 23%; and docusate 0% to 11%. Mean length of stay was 1.97 days (range: 1.31-2.73 days, P hospitalized with functional constipation across US children's hospitals. Collaborative initiatives to adopt evidence-based best practices guidelines could help standardize the hospital management of pediatric functional constipation. Copyright © 2017 by the American Academy of Pediatrics.

Parametric Optimization of Hospital Design

DEFF Research Database (Denmark)

Holst, Malene Kirstine; Kirkegaard, Poul Henning; Christoffersen, L.D.

2013-01-01

Present paper presents a parametric performancebased design model for optimizing hospital design. The design model operates with geometric input parameters defining the functional requirements of the hospital and input parameters in terms of performance objectives defining the design requirements...... and preferences of the hospital with respect to performances. The design model takes point of departure in the hospital functionalities as a set of defined parameters and rules describing the design requirements and preferences....

Hospitality and Collegial Community: An Essay.

Science.gov (United States)

Bennett, John B.

2000-01-01

Explains a collegial ethic of hospitality as a cardinal academic virtue and suggests a way of building a "collegium," the covenantal community of academe. Discusses how academicians can develop hospitable teaching, hospitable scholarship, and hospitable service. (Author/SLD)

Community Hospital Telehealth Consortium

National Research Council Canada - National Science Library

Williams, Elton

2004-01-01

The Community Hospital Telehealth Consortium is a unique, forward-thinking, community-based healthcare service project organized around 5 not-for-profit community hospitals located throughout Louisiana and Mississippi...

Community Hospital Telehealth Consortium

National Research Council Canada - National Science Library

Williams, Elton

2003-01-01

The Community Hospital Telehealth Consortium is a unique, forward-thinking, community-based healthcare service project organized around 5 not-for-profit community hospitals located throughout Louisiana and Mississippi...

Community Hospital Telehealth Consortium

National Research Council Canada - National Science Library

Williams, Jr, Elton L

2007-01-01

The Community Hospital Telehealth Consortium is a unique, forward-thinking, community-based healthcare service project organized around 5 not-for-profit community hospitals located throughout Louisiana and Mississippi...

Measuring cost efficiency in the Nordic hospitals--a cross-sectional comparison of public hospitals in 2002.

Science.gov (United States)

Linna, Miika; Häkkinen, Unto; Peltola, Mikko; Magnussen, Jon; Anthun, Kjartan S; Kittelsen, Sverre; Roed, Annette; Olsen, Kim; Medin, Emma; Rehnberg, Clas

2010-12-01

The aim of this study was to compare the performance of hospital care in four Nordic countries: Norway, Finland, Sweden and Denmark. Using national discharge registries and cost data from hospitals, cost efficiency in the production of somatic hospital care was calculated for public hospitals. Data were collected using harmonized definitions of inputs and outputs for 184 hospitals and data envelopment analysis was used to calculate Farrell efficiency estimates for the year 2002. Results suggest that there were marked differences in the average hospital efficiency between Nordic countries. In 2002, average efficiency was markedly higher in Finland compared to Norway and Sweden. This study found differences in cost efficiency that cannot be explained by input prices or differences in coding practices. More analysis is needed to reveal the causes of large efficiency disparities between Nordic hospitals.

A Decomposition of Hospital Profitability

Directory of Open Access Journals (Sweden)

Jason Turner

2015-06-01

Full Text Available Objectives: This paper evaluates the drivers of profitability for a large sample of U.S. hospitals. Following a methodology frequently used by financial analysts, we use a DuPont analysis as a framework to evaluate the quality of earnings. By decomposing returns on equity (ROE into profit margin, total asset turnover, and capital structure, the DuPont analysis reveals what drives overall profitability. Methods: Profit margin, the efficiency with which services are rendered (total asset turnover, and capital structure is calculated for 3,255 U.S. hospitals between 2007 and 2012 using data from the Centers for Medicare & Medicaid Services’ Healthcare Cost Report Information System (CMS Form 2552. The sample is then stratified by ownership, size, system affiliation, teaching status, critical access designation, and urban or non-urban location. Those hospital characteristics and interaction terms are then regressed (OLS against the ROE and the respective DuPont components. Sensitivity to regression methodology is also investigated using a seemingly unrelated regression. Results: When the sample is stratified by hospital characteristics, the results indicate investor-owned hospitals have higher profit margins, higher efficiency, and are substantially more leveraged. Hospitals in systems are found to have higher ROE, margins, and efficiency but are associated with less leverage. In addition, a number of important and significant interactions between teaching status, ownership, location, critical access designation, and inclusion in a system are documented. Many of the significant relationships, most notably not-for-profit ownership, lose significance or are predominately associated with one interaction effect when interaction terms are introduced as explanatory variables. Results are not sensitive to the alternative methodology. Conclusion: The results of the DuPont analysis suggest that although there appears to be convergence in the behavior of

A Decomposition of Hospital Profitability

Science.gov (United States)

Broom, Kevin; Elliott, Michael; Lee, Jen-Fu

2015-01-01

Objectives: This paper evaluates the drivers of profitability for a large sample of U.S. hospitals. Following a methodology frequently used by financial analysts, we use a DuPont analysis as a framework to evaluate the quality of earnings. By decomposing returns on equity (ROE) into profit margin, total asset turnover, and capital structure, the DuPont analysis reveals what drives overall profitability. Methods: Profit margin, the efficiency with which services are rendered (total asset turnover), and capital structure is calculated for 3,255 U.S. hospitals between 2007 and 2012 using data from the Centers for Medicare & Medicaid Services’ Healthcare Cost Report Information System (CMS Form 2552). The sample is then stratified by ownership, size, system affiliation, teaching status, critical access designation, and urban or non-urban location. Those hospital characteristics and interaction terms are then regressed (OLS) against the ROE and the respective DuPont components. Sensitivity to regression methodology is also investigated using a seemingly unrelated regression. Results: When the sample is stratified by hospital characteristics, the results indicate investor-owned hospitals have higher profit margins, higher efficiency, and are substantially more leveraged. Hospitals in systems are found to have higher ROE, margins, and efficiency but are associated with less leverage. In addition, a number of important and significant interactions between teaching status, ownership, location, critical access designation, and inclusion in a system are documented. Many of the significant relationships, most notably not-for-profit ownership, lose significance or are predominately associated with one interaction effect when interaction terms are introduced as explanatory variables. Results are not sensitive to the alternative methodology. Conclusion: The results of the DuPont analysis suggest that although there appears to be convergence in the behavior of NFP and IO

Status of hospital infection control measures at seven major tertiary care hospitals of northern Punjab

International Nuclear Information System (INIS)

Ikram, A.; Shah, S.I.H.; Naseem, S.; Absar, S.A.; Safi-Ullah; Ambreen, T.

2010-01-01

To determine the availability and implementation of various hospital infection control measures at tertiary care hospitals. Study Design: Survey. Place and Duration of Study: National Institute of Science and Technology, Islamabad, from June through August 2008. Methodology: Seven tertiary care very busy hospitals were selected; one from Islamabad, 5 from Rawalpindi, and one from Lahore. A detailed proforma was designed addressing all the issues pertaining to hospital infection control measures. Air sampling was done and growth yielded was identified by standard methods. Results: Analyses revealed that all of the hospitals had an Infection Control Committee. Microbiological diagnostic facilities were adequate at all the hospitals and overall microorganism yield was very high. Antibiotic policy was claimed by most, not available on ground. Majority of the operation theatres were without proper air flow system and autoclaves were not being regularly monitored. There was no proper disposal for sharps and needles. Incineration was not the usual mode for infectious waste. Conclusion: The results of the present study imply availability of proper hospital infection control policies with need of strict implementation of such measures. (author)

Income smoothing by Dutch hospitals

NARCIS (Netherlands)

Boterenbrood, D.R.

2014-01-01

Research indicates that hospitals manage their earnings. However, these findings might be influenced by methodological issues. In this study, I exploit specific features of Dutch hospitals to study income smoothing while limiting these methodological issues. The managers of Dutch hospitals have the

Psychiatric referrals in two general hospitals.

Directory of Open Access Journals (Sweden)

Doongaji D

1989-07-01

Full Text Available A prospective study was undertaken to compare the patterns of psychiatric referrals in two general hospitals in Bombay viz. the King Edward Memorial Hospital (64 cases and the Jaslok Hospital and Research Centre (62 cases. It was observed that depressive symptoms were the most common presenting symptoms in these patients attending either of the hospitals. Similarly, the commonest diagnoses were depression and organic mental disorder. Attempted suicide with organophosphorous compounds was the commonest reason for hospitalization at K.E.M. Hospital (p less than 0.001. A significant number of these patients were females (p less than 0.05. The psychiatric referrals at Jaslok had been hospitalized mainly for suspected medical or neurological illness (p less than 0.001. These patients belonged to higher economic strata and hence had a better paying capacity compared to patients at KEM hospital, a significant number of whom were unemployed (p less than 0.001. The duration of pre-referred illness of patients and their stay at Jaslok hospital were longer as compared to those at KEM Hospital (p less than 0.01. The number of non-relevant special investigations carried out on patients in Jaslok was more (p less than 0.01. Further analysis of diagnoses revealed that a significant number of patients at KEM Hospital were admitted as primary psychiatric illness (p less than 0.05.

Electronic Cigarettes on Hospital Campuses

OpenAIRE

Meernik, Clare; Baker, Hannah M.; Paci, Karina; Fischer-Brown, Isaiah; Dunlap, Daniel; Goldstein, Adam O.

2015-01-01

Smoke and tobacco-free policies on hospital campuses have become more prevalent across the U.S. and Europe, de-normalizing smoking and reducing secondhand smoke exposure on hospital grounds. Concerns about the increasing use of electronic cigarettes (e-cigarettes) and the impact of such use on smoke and tobacco-free policies have arisen, but to date, no systematic data describes e-cigarette policies on hospital campuses. The study surveyed all hospitals in North Carolina (n = 121) to assess w...

Transfer of the Subgenus Davismyia from Wyeomyia to Sabethes and Description of the Type Species, Miamyia Petrocchiae (Diptera: Culicidae)

Science.gov (United States)

1990-12-01

Ponte 1928) gave the following information about these specimens but did not indicate where they were deposited: “Localidad del tipo : Tucuman (Race...Balderama and R. Vargas. 1984. Associations of arbovirus vectors with gallery forests and domestic environments in south- eastern Bolivia. PAHO Bull . 18

Gender Differences in Hospital CEO Compensation: A National Investigation of Not-for-Profit Hospitals.

Science.gov (United States)

Song, Paula H; Lee, Shoou-Yih Daniel; Toth, Matthew; Singh, Simone R; Young, Gary J

2018-01-01

Gender pay equity is a desirable social value and an important strategy to fill every organizational stratum with gender-diverse talent to fulfill an organization's goals and mission. This study used national, large-sample data to examine gender difference in CEO compensation among not-for-profit hospitals. Results showed the average unadjusted annual compensation for female CEOs in 2009 was $425,085 compared with $581,121 for male CEOs. With few exceptions, the difference existed across all types of not-for-profit hospitals. After controlling for hospital- and area-level characteristics, female CEOs of not-for-profit hospitals earned 22.6% less than male CEOs of not-for-profit hospitals. This translates into an earnings differential of $132,652 associated with gender. Explanations and implications of the results are discussed.

Admission of people with dementia to psychiatric hospitals in Japan: factors that can shorten their hospitalizations.

Science.gov (United States)

Morikawa, Takako; Maeda, Kiyoshi; Osaki, Tohmi; Kajita, Hiroyuki; Yotsumoto, Kayano; Kawamata, Toshio

2017-11-01

People exhibiting serious behavioural and psychological symptoms of dementia are usually voluntarily or involuntarily committed to psychiatric hospitals for treatment. In Japan, the average hospital stay for individuals with dementia is about 2 years. Ideally, individuals should be discharged once their symptoms have subsided. However, we see cases in Japan where individuals remain institutionalized long after behavioural and psychological symptoms of dementia are no longer apparent. This study will attempt to identify factors contributing to shorter stays in psychiatric hospitals for dementia patients. Questionnaires consisting of 17 items were mailed to 121 psychiatric hospitals with dementia treatment wards in western Japan. Out of 121 hospitals that received the questionnaires, 45 hospitals returned them. The total number of new patient admissions at all 45 hospitals during the month of August 2014 was 1428, including 384 dementia patients (26.9%). The average length of stay in the dementia wards in August 2014 was 482.7 days. Our findings revealed that the rate of discharge after 2 months was 35.4% for the dementia wards. In addition, we found that the average stay in hospitals charging or planning to charge the rehabilitation fee to dementia patients was significantly shorter than in hospitals not charging the rehabilitation fee. In Japan, dementia patients account for over 25% of new admissions to psychiatric hospitals with dementia wards. The average length of stay in a psychiatric hospital dementia ward is more than 1 year. A discharge after fewer than 2 months is exceedingly rare for those in a dementia ward compared with dementia patients in other wards. If institutions focus on rehabilitation, it may be possible to shorten the stay of dementia patients in psychiatric hospitals. © 2017 Japanese Psychogeriatric Society.

State of malnutrition in hospitals of Ecuador

OpenAIRE

Sylvia Gallegos Espinosa; Marcelo Nicolalde Cifuentes; Sergio Santana Porbén

2014-01-01

Rationale: Hospital malnutrition is a global health problem affecting 30-50% of hospitalized patients. There are no estimates of the size of this problem in Ecuadorian hospitals. Hospital malnutrition might influence the quality of medical assistance provided to hospitalized populations. Objectives: To estimate the current frequency of malnutrition among patients admitted to Ecuadorian public hospitals. Materials and methods: The Ecuadorian Hospital Malnutrition Study was conducted between No...

CMS penalizes 758 hospitals for safety incidents

Directory of Open Access Journals (Sweden)

Robbins RA

2015-12-01

Full Text Available No abstract available. Article truncated after 150 words. The Centers for Medicare and Medicaid Services (CMS is penalizing 758 hospitals with higher rates of patient safety incidents, and more than half of those were also fined last year, as reported by Kaiser Health News (1. Among the hospitals being financially punished are some well-known institutions, including Yale New Haven Hospital, Medstar Washington Hospital Center in DC, Grady Memorial Hospital, Northwestern Memorial Hospital in Chicago, Indiana University Health, Brigham and Womens Hospital, Tufts Medical Center, University of North Carolina Hospital, the Cleveland Clinic, Hospital of the University of Pennsylvania, Parkland Health and Hospital, and the University of Virginia Medical Center (Complete List of Hospitals Penalized 2016. In the Southwest the list includes Banner University Medical Center in Tucson, Ronald Reagan UCLA Medical Center, Stanford Health Care, Denver Health Medical Center and the University of New Mexico Medical Center (for list of Southwest hospitals see Appendix 1. In total, CMS ...

Assessing the efficiency of hospital pharmacy services in Thai public district hospitals.

Science.gov (United States)

Rattanachotphanit, Thananan; Limwattananon, Chulaporn; Limwattananon, Supon; Johns, Jeff R; Schommer, Jon C; Brown, Lawrence M

2008-07-01

The purpose of this study was to assess the efficiency of hospital pharmacy services and to determine the environmental factors affecting pharmacy service efficiency. The technical efficiency of a hospital pharmacy was assessed to evaluate the hospital's ability to use pharmacy manpower in order to produce the maximum output of the pharmacy service. Data Envelopment Analysis (DEA) was used as an efficiency measurement. The two labor inputs were pharmacists and support personnel and the ten outputs were from four pharmacy activities: drug dispensing, drug purchasing and inventory control, patient-oriented activities, and health consumer protection services. This was used to estimate technical efficiency. A Tobit regression model was used to determine the effect of the hospital size, location, input mix of pharmacy staff, working experience of pharmacists at the study hospitals, and use of technology on the pharmacy service efficiency. Data for pharmacy service input and output quantities were obtained from 155 respondents. Nineteen percent were found to have full efficiency with a technical efficiency score of 1.00. Thirty-six percent had a technical efficiency score of 0.80 or above and 27% had a low technical efficiency score (location were significantly associated with pharmacy service efficiency.

Salmonellosis Hospitalizations in the United States: Associated Chronic Conditions, Costs, and Hospital Outcomes, 2011, Trends 2000-2011.

Science.gov (United States)

Cummings, Patricia L; Kuo, Tony; Javanbakht, Marjan; Shafir, Shira; Wang, May; Sorvillo, Frank

2016-01-01

Hospitalized salmonellosis patients with concurrent chronic conditions may be at increased risk for adverse outcomes, increasing the costs associated with hospitalization. Identifying important modifiable risk factors for this predominantly foodborne illness may assist hospitals, physicians, and public health authorities to improve management of these patients. The objectives of this study were to (1) quantify the burden of salmonellosis hospitalizations in the United States, (2) describe hospitalization characteristics among salmonellosis patients with concurrent chronic conditions, and (3) examine the relationships between salmonellosis and comorbidities by four hospital-related outcomes. A retrospective analysis of salmonellosis discharges was conducted using the Agency for Healthcare Research and Quality's Nationwide Inpatient Sample for 2011. A supplemental trend analysis was performed for the period 2000-2011. Hospitalization characteristics were examined using multivariable regression modeling, with a focus on four outcome measures: in-hospital death, total amount billed by hospitals for services, length of stay, and disease severity. In 2011, there were 11,032 total salmonellosis diagnoses; 7496 were listed as the primary diagnosis, with 86 deaths (case-fatality rate = 1.2%). Multivariable regression analyses revealed a greater number of chronic conditions (≥4) among salmonellosis patients was associated with higher mean total amount billed by hospitals for services, longer length of stay, and greater disease severity (p ≤ 0.05). From 2000 to 2011, hospital discharges for salmonellosis increased by 27.2%, and the mean total amount billed by hospitals increased nearly threefold: $9,777 (2000) to $29,690 (2011). Observed increases in hospitalizations indicate the burden of salmonellosis remains substantial in the United States. The positive association between increased number of chronic conditions and the four hospital-related outcomes affirms

[Hospitals' evolution through the ages].

Science.gov (United States)

de Micheli, Alfredo

2005-01-01

The predecessor institutions of modern hospitals--Byzantine nosocómeion, European hospitale and Islamic maristan--were dissimilar both in their patients and their aims. The first charitable organizations in West Europe (Rome) and in the East (Cesarea in Cappadocia) were rather hospices. After the collapse of the Western Roman Empire (476 A.D.), some monastic centers were prepared to provide medical assistance to religious and secular patients. Since the XI and XII Centuries in all of Christian Europe the charitable institutions, designated as hospitale, multiplied. Among the Italian ones, the Roman Santo Spirito (Holy Ghost) Hospital, built in the 1201-1204 period, reached a preeminet position. This one soon became the most important of the entire Christendom (archihospital), with a lot of affiliated hospitals in Europe and later in America. The first American hospital, Saint Nicholas Hospital, opened on December 29, 1503 in Santo Domingo, obtained in 1541 its affiliation to the Santo Spirito archihospital. Regarding continental America, the first health centers were established in Mexico: the Immaculate Conception Hospital and the Saint Lazarus Hospital, both established by Hernán Cortés. For its part, clinical teaching was systematized at the Saint Francis Hospital in Padua and by there moved to Leyden. In Mexico, the chair of medical clinics or practical medicine was established in 1806 at the Saint Andrew Hospital. During the XX century, Dr. Ignacio Chávez was the driving force behind the creation of the modern Mexican Health Institutes. These ones are dedicated to the treatment of poor patients, as well as to medical teaching and research.

Maternity and parental leave policies at COTH hospitals: an update. Council of Teaching Hospitals.

Science.gov (United States)

Philibert, I; Bickel, J

1995-11-01

Because residents' demands for parental leave are increasing, updated information about maternity and paternity leave policies was solicited from hospitals that are members of the Council of Teaching Hospitals (COTH) of the AAMC. A 20-item questionnaire, combining forced-choice categories and open-ended questions, was faxed to 405 COTH hospitals in October 1994; 45% responded. A total of 77% of the respondents reported having written policies for maternity and/or parental leave; in 1989, only 52% of COTH hospitals had reported having such policies. Forty-one percent of the 1994 responding hospitals offered dedicated paid maternity leave, with a mean of 42 days allowed. Twenty-five percent of the respondents offered paternity leave, and 15% offered adoption leave. It is encouraging that the majority of the teaching hospitals that responded to the survey had adopted written policies, but the 23% without written policies remain a source of concern. Well-defined policies for maternity, paternity, and adoption leave can reduce stress and foster equity both for trainees requiring leave and for their colleagues.

Hospital transformation and organisational learning.

Science.gov (United States)

Ho, W

1999-12-01

Kwong Wah Hospital was founded by the charity organisation Tung Wah Group of Hospitals some 88 years ago, with management transfer to the Hong Kong Hospital Authority in 1991. Capitalizing both from the traditional caring culture of its founder, as well as opportunities in the new management environment, the hospital has scored remarkable successes in service quality, community partnership, organisational effectiveness, and staff development. Underpinning these transformations were Structure, Process, People, and Culture strategies. The learning imperative is heavily mandated or the success of each of these strands of development. Indeed, the embodiment of a learning organisation culture provides the impetus in sustaining the change momentum, towards achieving the Vision of becoming a 'Most Preferred Hospital' in Hong Kong.

Research in Hospitality Management

African Journals Online (AJOL)

Research in Hospitality Management (RHM) is a peer-reviewed journal ... to the quintessential managerial areas of Finance, Human Resources, Operations, ... competency and career development of hospitality management students · EMAIL ...

Quality indicators for the hospital transfusion chain : A national survey conducted in 100 dutch hospitals

NARCIS (Netherlands)

Zijlker-Jansen, Pauline Y.; Janssen, M. P.; van Tilborgh-de Jong, A. J W; Schipperus, M. R.; Wiersum-Osselton, J. C.

2015-01-01

Background: The 2011 Dutch Blood Transfusion Guideline for hospitals incorporates seven internal quality indicators for evaluation of the hospital transfusion chain. The indicators aim to measure guideline compliance as shown by the instatement of a hospital transfusion committee and transfusion

[Ryazan hospital--80 years].

Science.gov (United States)

Klimov, A S; Gromov, M F

2012-02-01

In December 2011 marked 80 years of the founding of the Ryazan garrison hospital, originally housed in two buildings: "Redut housed"--a monument of architecture of the XVIII century and the former almshouses room "for the maimed in the war", was built in 1884 now Ryazan garrison hospital (from 2010--Branch No 6 FSI "in 1586 the district military hospital in the Western Military District", the Defense Ministry of Russia)--a multi-field medical preventive institution on the basis of which soldiers, military retirees, family members and military retirees from Ryazan, Moscow, Tambov regions are treated. Every year more than 7 thousand patients get treatment here. During the counterterrorism operations in Chechnya over 800 wounded were brought to the hospital from the battle area.

Hospital Management Software Development

OpenAIRE

sobogunGod, olawale

2012-01-01

The purpose of this thesis was to implement a hospital management software which is suitable for small private hospitals in Nigeria, especially for the ones that use a file based system for storing information rather than having it stored in a more efficient and safer environment like databases or excel programming software. The software developed within this thesis project was specifically designed for the Rainbow specialist hospital which is based in Lagos, the commercial neurological cente...

Pre-hospital and hospital delay in patients with non-ST elevation acute coronary syndromes in tertiary care

Directory of Open Access Journals (Sweden)

G.S. Youssef

2017-09-01

Conclusion: Pre-hospital delay was mainly patient-related. Hospital delay was mainly related to healthcare resources. Governmental measures to promote ambulance emergency services may reduce the pre-hospital delay, while improving the utilization of healthcare resources may reduce hospital delay.

EARNINGS MANAGEMENT IN U.S. HOSPITALS.

Science.gov (United States)

Dong, Gang Nathan

2016-01-01

This paper examines the hospital management practices of manipulating financial earnings within the bounds of generally accepted accounting principles (GAAP). We conduct regression analyses that relate earnings management to hospital characteristics to assess the economic determinants of hospital earnings management behavior. From the CMS Cost Reports we collected hospital financial data of all U.S. hospitals that request reimbursement from the federal government for treating Medicare patients, and regress discretionary accruals on hospital size, profitability, asset liquidity, operating efficiency, labor cost, and ownership. Hospitals with higher profit margin, current ratio, working capital, days of patient receivables outstanding and total wage are associated with more earnings management, whereas those with larger size and higher debt level, asset turnover, days cash on hand, fixed asset age are associated with lower level of earnings manipulation. Additionally, managers of non-profit hospitals are more likely to undertake some form of window-dressing by manipulating accounting accruals without changing business models or pricing strategies than their public hospital counterparts. We provide direct evidence of the use of discretionary accruals to manage financial earnings among U.S. hospitals and the finding has profound policy implications in terms of assessing the pervasiveness of accounting manipulation and the overall integrity of financial reporting in this very special public and quasi-public service sector.

Pre-hospital critical care by anaesthesiologist-staffed pre-hospital services in Scandinavia

DEFF Research Database (Denmark)

Krüger, A J; Lossius, H M; Mikkelsen, S

2013-01-01

All Scandinavian countries provide anaesthesiologist-staffed pre-hospital services. Little is known of the incidence of critical illness or injury attended by these services. We aimed to investigate anaesthesiologist-staffed pre-hospital services in Scandinavia with special emphasis on incidence...

In-hospital Mortality due to Respiratory Diseases in the Provincial Hospital of Cienfuegos. 2010-2014

OpenAIRE

Liuva Leyva Rodríguez; Orlando Morera Álvarez; Daylin Madruga Jiménez; Heidy Caridad Cordero Cabrera; Reinaldo José Pino Blanco

2016-01-01

Background: in-hospital mortality is a health indicator commonly used as a measure of quality of care. Respiratory diseases are a major cause of deaths in hospitals. Objective: to describe mortality from respiratory diseases at the Dr. Gustavo Aldereguía Lima University General Hospital in Cienfuegos. Methods: a descriptive study of all patients over 18 years old who died from respiratory diseases in the hospital of Cienfuegos from 2010 to 2014 was conducted. The variables analyzed were: age,...

Perceptions of the hospital ethical environment among hospital social workers in the United States.

Science.gov (United States)

Pugh, Greg L

2015-01-01

Hospital social workers are in a unique context of practice, and one where the ethical environment has a profound influence on the ethical behavior. This study determined the ratings of ethical environment by hospital social workers in large nationwide sample. Correlates suggest by and compared to studies of ethical environment with nurses are explored. Positive ratings of the ethical environment are primarily associated with job satisfaction, as well as working in a centralized social work department and for a non-profit hospital. Religiosity and MSW education were not predictive. Implications and suggestions for managing the hospital ethical environment are provided.

Hospital Compare - Archived Data

Data.gov (United States)

U.S. Department of Health & Human Services — Hospital Compare is a consumer-oriented website that provides information on how well hospitals provide recommended care to their patients. This information can help...

Collaboration between Hospital and Community Pharmacists to Improve Medication Management from Hospital to Home

Directory of Open Access Journals (Sweden)

Judith Kristeller

2017-05-01

Full Text Available Objective: The objective of this study is to determine if a model for patient-centered care that integrates medication management between hospital and community pharmacists is feasible and can improve medication adherence. Design: This was a randomized, non-blinded, interventional study of 69 patients discharged from a hospital to home. Process measures include the number and type of medication-related discrepancies or problems identified, patient willingness to participate, the quality and quantity of interactions with community pharmacists, hospital readmissions, and medication adherence. Setting: A 214-bed acute care hospital in Northeastern Pennsylvania and seventeen regional community pharmacies. Patients: Enrolled patients were hospitalized with a primary or secondary diagnosis of heart failure or COPD, had a planned discharge to home, and agreed to speak to one of seventeen community pharmacists within the study network (i.e., a network community pharmacist following hospital discharge. Intervention: Information about a comprehensive medication review completed by the hospital pharmacist was communicated with the network community pharmacist to assist with providing medication therapy management following hospital discharge. Results: Of 180 patients eligible for the study, 111 declined to participate. Many patients were reluctant to talk to an additional pharmacist, however if the patient’s pharmacist was already within the network of 17 pharmacies, they usually agreed to participate. The study enrolled 35 patients in the intervention group and 34 in the control group. An average of 6 medication-related problems per patient were communicated to the patient’s network community pharmacist after discharge. In the treatment group, 44% of patients had at least one conversation with the network community pharmacist following hospital discharge. There was no difference in post-discharge adherence between the groups (Proportion of Days

Constructing Episodes of Inpatient Care: How to Define Hospital Transfer in Hospital Administrative Health Data?

Science.gov (United States)

Peng, Mingkai; Li, Bing; Southern, Danielle A; Eastwood, Cathy A; Quan, Hude

2017-01-01

Hospital administrative health data create separate records for each hospital stay of patients. Treating a hospital transfer as a readmission could lead to biased results in health service research. This is a cross-sectional study. We used the hospital discharge abstract database in 2013 from Alberta, Canada. Transfer cases were defined by transfer institution code and were used as the reference standard. Four time gaps between 2 hospitalizations (6, 9, 12, and 24 h) and 2 day gaps between hospitalizations [same day (up to 24 h), ≤1 d (up to 48 h)] were used to identify transfer cases. We compared the sensitivity and positive predictive value (PPV) of 6 definitions across different categories of sex, age, and location of residence. Readmission rates within 30 days were compared after episodes of care were defined at the different time gaps. Among the 6 definitions, sensitivity ranged from 93.3% to 98.7% and PPV ranged from 86.4% to 96%. The time gap of 9 hours had the optimal balance of sensitivity and PPV. The time gaps of same day (up to 24 h) and 9 hours had comparable 30-day readmission rates as the transfer indicator after defining episode of care. We recommend the use of a time gap of 9 hours between 2 hospitalizations to define hospital transfer in inpatient databases. When admission or discharge time is not available in the database, a time gap of same day (up to 24 h) can be used to define hospital transfer.

Hospital development plans: a new tool to break ground for strategic thinking in Tanzanian hospitals.

Science.gov (United States)

Flessa, Steffen

2005-12-01

Tanzanian hospitals suffer from underfunding and poor management. In particular, planning and strategic thinking need improvement. Cultural values such as subordination, risk aversion, and high time preference, together with a long history of socialist government, result in lack of responsibility, accountability, and planning. This has been addressed by the health sector reform with its focus on decentralization, strengthened by the introduction of basket funding facilitated by the Comprehensive Council Health Plans. As a consequence of this the next logical step is to improve the authority of regional and district hospitals in the use of their resources by introducing hospital development plans. These strategic plans were introduced as tools of strategic planning in 2001 by the Kreditanstalt für Wiederaufbau in close collaboration with the Tanzanian Ministry of Health, binding the release of rehabilitation funds to presentation of a strategic hospital plan. This study examines the rationale and content of hospital development plans. Initial experiences are discussed. The quality of presented plans has steadily improved, but there is a tendency for hospitals with a close connection to development partners to present well prepared reports while other hospitals have severe problems fulfilling the requirements. For many hospitals it is in fact the first time that they have had to define their functions and future role, thus breaking ground for strategic thinking.

[Evaluation of the efficiency and quality of hospitals publicly owned with private management and hospitals of the public sector].

Science.gov (United States)

Giraldes, Maria Do Rosário

2007-01-01

The main aim of this article is to evaluate the hospital expenditure by user in an efficiency perspective and to evaluate the quality of the health system using process indicators and outcome indicators. In an efficiency perspective the concept of technical efficiency has been chosen, and a correction has been made, as well, in what concerns a case-mix index (CMI). The indicators have been calculated by user in what concerns the main hospital activities (the expenditure in inpatient care by treated patient, in day hospital by treated patient, in outpatient care by consultation, etc), and as well the auxiliary sections of clinic support and the hotel support services. All the indicators have been corrected according to the case-mix index, in 2004, and have been weighted according to the relevance of its expenditure in total expenditure. In a quality perspective two types of indicators have been considered: process indicators and outcome indicators. Process indicators, as the percentage of surgeries in ambulatory care, the percentage of caesareans in total deliveries and the rate of autopsy. The outcome indicator number of episodes of inpatient care due to surgery infection in total days of inpatient care The composite indicator of efficiency, weighted by the inverse of the case-mix index presents the lower values in Tondela, Seia, and Fafe, while the Hospital of the Litoral Alentejano is, in this group, the most inefficient. The Agueda Hospital presents the better Composite Efficiency Indicator, in Group II, followed by the Barcelos and S. João da Madeira Hospitals, while the Figueira da Foz Hospital presents the worst situation. In hospitals from Group III the Hospitals of Vale de Sousa, EPE, and the Vila Franca de Xira Hospital present the better Composite Efficiency Indicator followed by the Barreiro Hospital, EPE. In Group IV it is the Hospital of S. Sebastião, EPE, that presents the lowest Composite Efficiency Indicator, followed by the Cascais Hospital, SPA

Hospitality Services. Student Activity Book.

Science.gov (United States)

Texas Tech Univ., Lubbock. Home Economics Curriculum Center.

This student activity book contains pencil-and-paper activities for use in a hospitality services course focusing on the food and lodging segments of the hospitality and tourism industry. The activities are organized into 29 chapters on the following topics: hospitality services industry; professional ethics; organization/management structures in…

Hospitality in College Composition Courses

Science.gov (United States)

Haswell, Janis; Haswell, Richard; Blalock, Glenn

2009-01-01

There has been little discussion of hospitality as a practice in college writing courses. Possible misuses of hospitality as an educational and ethical practice are explored, and three traditional and still tenable modes of hospitality are described and historicized: Homeric, Judeo-Christian, and nomadic. Application of these modes to…

Hospitality Studies: Escaping the Tyranny?

Science.gov (United States)

Lashley, Conrad

2015-01-01

Purpose: The purpose of this paper is to explore current strands in hospitality management education and research, and suggest that future programs should reflect a more social science informed content. Design/methodology/approach: The paper reviews current research in hospitality management education and in the study of hospitality and…

Post-Hospital Medical Respite Care and Hospital Readmission of Homeless Persons

Science.gov (United States)

Kertesz, Stefan G.; Posner, Michael A.; O’Connell, James J.; Swain, Stacy; Mullins, Ashley N.; Michael, Shwartz; Ash, Arlene S.

2009-01-01

Medical respite programs offer medical, nursing, and other care as well as accommodation for homeless persons discharged from acute hospital stays. They represent a community-based adaptation of urban health systems to the specific needs of homeless persons. This paper examines whether post-hospital discharge to a homeless medical respite program was associated with a reduced chance of 90-day readmission compared to other disposition options. Adjusting for imbalances in patient characteristics using propensity scores, Respite patients were the only group that was significantly less likely to be readmitted within 90 days compared to those released to Own Care. Respite programs merit attention as a potentially efficacious service for homeless persons leaving the hospital. PMID:19363773

Assessing knowledge, performance, and efficiency for hospital waste management-a comparison of government and private hospitals in Pakistan.

Science.gov (United States)

Ali, Mustafa; Wang, Wenping; Chaudhry, Nawaz; Geng, Yong; Ashraf, Uzma

2017-04-01

Proper management of healthcare waste is a critical concern in many countries of the world. Rapid urbanization and population growth rates pose serious challenges to healthcare waste management infrastructure in such countries. This study was aimed at assessing the situation of hospital waste management in a major city of Pakistan. Simple random sampling was used to select 12 government and private hospitals in the city. Field visits, physical measurements, and questionnaire survey method were used for data collection. Information was obtained regarding hospital waste generation, segregation, collection, storage, transportation, and disposal. Data envelopment analysis (DEA) was used to classify the hospitals on the basis of their relative waste management efficiencies. The weighted average total waste generation at the surveyed hospitals was discovered to be 1.53 kg/patient/day of which 75.15% consisted of general waste and the remaining consisted of biomedical waste. Of the total waste, 24.54% came from the public hospital and the remaining came from the private hospitals. DEA showed that seven of the surveyed hospitals had scale or pure technical inefficiencies in their waste management activities. The public hospital was relatively less efficient than most of the private hospitals in these activities. Results of the questionnaire survey showed that none of the surveyed hospitals was carrying out waste management in strict compliance with government regulations. Moreover, hospital staff at all the surveyed hospitals had low level of knowledge regarding safe hospital waste management practices. The current situation should be rectified in order to avoid environmental and epidemiological risks.

Costs of hospital malnutrition.

Science.gov (United States)

Curtis, Lori Jane; Bernier, Paule; Jeejeebhoy, Khursheed; Allard, Johane; Duerksen, Donald; Gramlich, Leah; Laporte, Manon; Keller, Heather H

2017-10-01

Hospital malnutrition has been established as a critical, prevalent, and costly problem in many countries. Many cost studies are limited due to study population or cost data used. The aims of this study were to determine: the relationship between malnutrition and hospital costs; the influence of confounders on, and the drivers (medical or surgical patients or degree of malnutrition) of the relationship; and whether hospital reported cost data provide similar information to administrative data. To our knowledge, the last two goals have not been studied elsewhere. Univariate and multivariate analyses were performed on data from the Canadian Malnutrition Task Force prospective cohort study combined with administrative data from the Canadian Institute for Health Information. Subjective Global Assessment was used to assess the relationship between nutritional status and length of stay and hospital costs, controlling for health and demographic characteristics, for 956 patients admitted to medical and surgical wards in 18 hospitals across Canada. After controlling for patient and hospital characteristics, moderately malnourished patients' (34% of surveyed patients) hospital stays were 18% (p = 0.014) longer on average than well-nourished patients. Medical stays increased by 23% (p = 0.014), and surgical stays by 32% (p = 0.015). Costs were, on average, between 31% and 34% (p-values < 0.05) higher than for well-nourished patients with similar characteristics. Severely malnourished patients (11% of surveyed patients) stayed 34% (p = 0.000) longer and had 38% (p = 0.003) higher total costs than well-nourished patients. They stayed 53% (p = 0.001) longer in medical beds and had 55% (p = 0.003) higher medical costs, on average. Trends were similar no matter the type of costing data used. Over 40% of patients were found to be malnourished (1/3 moderately and 1/10 severely). Malnourished patients had longer hospital stays and as a result cost more than well

Unplanned Hospital Visits - National

Data.gov (United States)

U.S. Department of Health & Human Services — Unplanned Hospital Visits – national data. This data set includes national-level data for the hospital return days (or excess days in acute care) measures, the...

The impact of stakeholder involvement in hospital policy decision-making: a study of the hospital's business processes.

Science.gov (United States)

Malfait, Simon; Van Hecke, Ann; Hellings, Johan; De Bodt, Griet; Eeckloo, Kristof

2017-02-01

In many health care systems, strategies are currently deployed to engage patients and other stakeholders in decisions affecting hospital services. In this paper, a model for stakeholder involvement is presented and evaluated in three Flemish hospitals. In the model, a stakeholder committee advises the hospital's board of directors on themes of strategic importance. To study the internal hospital's decision processes in order to identify the impact of a stakeholder involvement committee on strategic themes in the hospital decision processes. A retrospective analysis of the decision processes was conducted in three hospitals that implemented a stakeholder committee. The analysis consisted of process and outcome evaluation. Fifteen themes were discussed in the stakeholder committees, whereof 11 resulted in a considerable change. None of these were on a strategic level. The theoretical model was not applied as initially developed, but was altered by each hospital. Consequentially, the decision processes differed between the hospitals. Despite alternation of the model, the stakeholder committee showed a meaningful impact in all hospitals on the operational level. As a result of the differences in decision processes, three factors could be identified as facilitators for success: (1) a close interaction with the board of executives, (2) the inclusion of themes with a more practical and patient-oriented nature, and (3) the elaboration of decisions on lower echelons of the organization. To effectively influence the organization's public accountability, hospitals should involve stakeholders in the decision-making process of the organization. The model of a stakeholder committee was not applied as initially developed and did not affect the strategic decision-making processes in the involved hospitals. Results show only impact at the operational level in the participating hospitals. More research is needed connecting stakeholder involvement with hospital governance.

The potential of hospital Website marketing.

Science.gov (United States)

Sanchez, P M

2000-01-01

In recent years, hospital website marketing has witnessed explosive growth. Industry experts cite an almost 100% growth in hospital website marketing over the last several years. At one time lagging in the adoption of Internet technology, hospitals have now begun making significant strides in catching up with other industries. In spite of the general proliferation of hospital websites, however, the full potential of the Internet with its unique characteristics has yet to be realized. In this paper, current trends fueling the growth of hospital website marketing are first explored. Secondly, barriers to realizing the potential of website marketing are investigated. Finally, recommendations for improving hospital website marketing are developed.

Severe maternal morbidity in Zanzibar’s referral hospital : Measuring the impact of in-hospital care

NARCIS (Netherlands)

Herklots, Tanneke; Van Acht, Lieke; Meguid, Tarek; Franx, Arie; Jacod, Benoit

2017-01-01

Objective: to analyse the impact of in-hospital care on severe maternal morbidity using WHO’s near-miss approach in the low-resource, high mortality setting of Zanzibar’s referral hospital. Setting: Mnazi Mmoja Hospital, a tertiary care facility, in Zanzibar, Tanzania. Methods: We identified all

Record of hospitalizations for ambulatory care sensitive conditions: validation of the hospital information system.

Science.gov (United States)

Rehem, Tania Cristina Morais Santa Barbara; de Oliveira, Maria Regina Fernandes; Ciosak, Suely Itsuko; Egry, Emiko Yoshikawa

2013-01-01

To estimate the sensitivity, specificity and positive and negative predictive values of the Unified Health System's Hospital Information System for the appropriate recording of hospitalizations for ambulatory care-sensitive conditions. The hospital information system records for conditions which are sensitive to ambulatory care, and for those which are not, were considered for analysis, taking the medical records as the gold standard. Through simple random sampling, a sample of 816 medical records was defined and selected by means of a list of random numbers using the Statistical Package for Social Sciences. The sensitivity was 81.89%, specificity was 95.19%, the positive predictive value was 77.61% and the negative predictive value was 96.27%. In the study setting, the Hospital Information System (SIH) was more specific than sensitive, with nearly 20% of care sensitive conditions not detected. There are no validation studies in Brazil of the Hospital Information System records for the hospitalizations which are sensitive to primary health care. These results are relevant when one considers that this system is one of the bases for assessment of the effectiveness of primary health care.

[Hospital clinical engineer orientation and function in the maintenance system of hospital medical equipment].

Science.gov (United States)

Li, Bin; Zheng, Yunxin; He, Dehua; Jiang, Ruiyao; Chen, Ying; Jing, Wei

2012-03-01

The quantity of medical equipment in hospital rise quickly recent year. It provides the comprehensive support to the clinical service. The maintenance of medical equipment becomes more important than before. It is necessary to study on the orientation and function of clinical engineer in medical equipment maintenance system. Refer to three grade health care system, the community doctors which is called General practitioner, play an important role as the gatekeeper of health care system to triage and cost control. The paper suggests that hospital clinical engineer should play similar role as the gatekeeper of medical equipment maintenance system which composed by hospital clinical engineer, manufacture engineer and third party engineer. The hospital clinical engineer should be responsible of guard a pass of medical equipment maintenance quality and cost control. As the gatekeeper, hospital clinical engineer should take the responsibility of "General engineer" and pay more attention to safety and health of medical equipment. The responsibility description and future transition? development of clinical engineer as "General Engineer" is discussed. More attention should be recommended to the team building of hospital clinical engineer as "General Engineer".

Record of hospitalizations for ambulatory care sensitive conditions: validation of the hospital information system

Directory of Open Access Journals (Sweden)

Tania Cristina Morais Santa Barbara Rehem

2013-09-01

Full Text Available OBJECTIVE: to estimate the sensitivity, specificity and positive and negative predictive values of the Unified Health System's Hospital Information System for the appropriate recording of hospitalizations for ambulatory care-sensitive conditions. METHOD: the hospital information system records for conditions which are sensitive to ambulatory care, and for those which are not, were considered for analysis, taking the medical records as the gold standard. Through simple random sampling, a sample of 816 medical records was defined and selected by means of a list of random numbers using the Statistical Package for Social Sciences. RESULT: the sensitivity was 81.89%, specificity was 95.19%, the positive predictive value was 77.61% and the negative predictive value was 96.27%. In the study setting, the Hospital Information System (SIH was more specific than sensitive, with nearly 20% of care sensitive conditions not detected. CONCLUSION: there are no validation studies in Brazil of the Hospital Information System records for the hospitalizations which are sensitive to primary health care. These results are relevant when one considers that this system is one of the bases for assessment of the effectiveness of primary health care.

Survey of the Information-Seeking Behaviour of Hospital Professionals at a Public Cancer Hospital in Greece Proves the Value of Hospital Libraries. A Review of: Kostagiolas, P. A., Ziavrou, K., Alexias, G., & Niakas, D. (2012. Studying the information-seeking behavior of hospital professionals: The case of METAXA Cancer Hospital in Greece. Journal of Hospital Librarianship, 12(1, 33-45.

Directory of Open Access Journals (Sweden)

Antonio DeRosa

2013-06-01

Full Text Available Objective – To study the information-seeking practices of hospital staff and weigh the impact of hospital libraries on effective information-seeking.Design – Survey questionnaire.Setting – Large public cancer hospital in Greece.Subjects – The authors surveyed 49 physicians, 43 nursing staff members, 25 administrative staff members, 23 paramedical staff members, and 5 technical staff members, totaling 145 health professionals.Methods – Participants were given a questionnaire comprised of five parts: general information (including gender, age, education, position, and professional experience; questions on computer and Internet accessibility; questions regarding individual information needs; questions on information-seeking obstacles; and a question regarding the satisfaction with the current degree of information availability in the hospital. The last question was ranked using a 5-point Likert scale. Each questionnaire was distributed with a cover letter explaining the anonymity and consent of the respondent. Hospital members were randomly selected using a number generator and respondents returned completed surveys to the hospital personnel office in a sealed envelope within a specified time frame. The sampled group was representative of the overall population of the hospital.Main Results – The authors discuss demographic data of respondents: 65.7% were women; 56.7% were over 40 years old; 29.0% were graduates of higher technological institutes; 28.3% were university graduates; 9.7% held a postgraduate degree; 8.3% had a PhD; and 1.4% had only secondary education. As for the remainder of the survey questions: 64% of respondents had access to the Internet both at home and at work, while only 8.2% had no access to the Internet at all; most respondents noted using the Internet for seeking scientific information (83.0% and e-mail communication (65.3%; the main obstacle respondents noted experiencing when seeking information was the lack of

Cultural Humility and Hospital Safety Culture.

Science.gov (United States)

Hook, Joshua N; Boan, David; Davis, Don E; Aten, Jamie D; Ruiz, John M; Maryon, Thomas

2016-12-01

Hospital safety culture is an integral part of providing high quality care for patients, as well as promoting a safe and healthy environment for healthcare workers. In this article, we explore the extent to which cultural humility, which involves openness to cultural diverse individuals and groups, is related to hospital safety culture. A sample of 2011 hospital employees from four hospitals completed measures of organizational cultural humility and hospital safety culture. Higher perceptions of organizational cultural humility were associated with higher levels of general perceptions of hospital safety, as well as more positive ratings on non-punitive response to error (i.e., mistakes of staff are not held against them), handoffs and transitions, and organizational learning. The cultural humility of one's organization may be an important factor to help improve hospital safety culture. We conclude by discussing potential directions for future research.

Hospital clinical pharmacy services in Vietnam.

Science.gov (United States)

Trinh, Hieu T; Nguyen, Huong T L; Pham, Van T T; Ba, Hai L; Dong, Phuong T X; Cao, Thao T B; Nguyen, Hanh T H; Brien, Jo-Anne

2018-04-07

Background Clinical pharmacy is key to the quality use of medicines. While there are different approaches in different countries, international perspectives may inform health service development. The Vietnamese Ministry of Health introduced a legal regulation of clinical pharmacy services in December 2012. Objective To describe the services, and to explore reported barriers and facilitators in implementing clinical pharmacy activities in Vietnamese hospitals after the introduction of Vietnamese Ministry of Health legal regulation. Setting Thirty-nine hospitals in Hanoi, Vietnam, including 22 provincial and 17 district hospitals. Method A mixed methods study was utilized. An online questionnaire was sent to the hospitals. In-depth interviews were conducted with pairs of nominated pharmacists at ten of these hospitals. The questionnaire focused on four areas: facilities, workforce, policies and clinical pharmacy activities. Main outcome measure Proportion of clinical pharmacy activities in hospitals. Themes in clinical pharmacy practice. Results 34/39 (87%) hospitals had established clinical pharmacy teams. Most activities were non-patient-specific (87%) while the preliminary patient-specific clinical pharmacy services were available in only 8/39 hospitals (21%). The most common non-patient-specific activities were providing medicines information (97%), reporting adverse drug reactions (97%), monitoring medication usage (97%). The patient specific activities varied widely between hospitals and were ad hoc. The main challenges reported were: lack of workforce and qualified clinical pharmacists. Conclusion While most hospitals had hospital-based pharmacy activities, the direct patient care was limited. Training, education and an expanded work forces are needed to improve clinical pharmacy services.

Production of a lipolytic enzyme originating from Bacillus halodurans LBB2 in the methylogrophic yeast Pichia pastoria

CSIR Research Space (South Africa)

Ramchuran, SO

2006-07-01

Full Text Available of Biotechnology, Center for Chemistry and Chemical Engineering, Lund University, P.O. Box 124, 22100 Lund, Sweden e-mail: eva.nordberg_karlsson@biotek.lu.se V. A. Vargas Centro de Biotecnología, Facultad de Ciencias y Tecnología, Universidad Mayor de San...

Aragonian stratigraphy reconsidered, and a re-evaluation of the middle Miocene mammal biochronology in Europe

NARCIS (Netherlands)

Daams, R.; Meulen, A.J. van der; Alvarez Sierra, M.A.; Peláez-Campomanes, P.; Krijgsman, W.

1998-01-01

The recently collected fauna of Armantes 1A in Chron C5Br of the Armantes section necessitates reinterpretation of the previous bio- and magnetostratigraphical correlations between the Armantes and Vargas sections (Calatayud-Daroca Basin, Central Spain) [W. Krijgsman, M. Garcés, C.G. Langereis, R.

The Use of Ferroelectric Ceramics to Charge Small Capacitor Banks

Science.gov (United States)

2017-09-01

CENTER D BLANKENBILLER 106 DIR US ARL (PDF) RDRL DP RC BECKER TW BJERKE RDRL WMM JH BEATTY RDRL WMM A JJ LA SCALA...KORNECKI SM WALSH RDRL WMM E VL BLAIR SM KILCZEWSKI JC LASALVIA PJ PATEL JJ SWAB LR VARGAS-GONZALEZ RDRL WML B

Characterization of Anopheles Pseudopunctipennis Larval Habitats

Science.gov (United States)

1996-01-01

conditions for growth in the small, slow-mov- ing streams and side pools of receding rivers con- taining a rich growth of green algae (Shannon and...Sanchez, J. L. Cespedes, R. Vargas- Sagarnaga and R. Rodriguez. 1992. Evidencia genetica 626 JOURNAL OF THE AMERICAN MOSQUITO CONTROL ASSOCIATION

77 FR 36958 - Proposed Requirements-Race to the Top-Early Learning Challenge; Phase 2

Science.gov (United States)

2012-06-20

..., social-emotional, and cognitive outcomes; enhance school readiness; and help close the school readiness... kindergarten. 3 4 \\1\\ Camilli, G., Vargas, S., Ryan, S., & Barnett, W. S. (2010). Meta-analysis of the effects... notice in the Federal Register. Executive Orders 12866 and 13563 Regulatory Impact Analysis Under...

El papel de los sistemas de relevo de fosfatos en la respuesta al estrés y la diferenciación celular en Aspergillus nidulans /

OpenAIRE

Vargas Pérez, Itzel Aidé sustentante.

2009-01-01

 tesis que para obtener el grado de Doctor en Ciencias Bioquímicas, presenta Itzel Aidé Vargas Pérez ; asesor Dimitris Georgellis. VIII, 66 páginas : ilustraciones. Doctorado en Ciencias Bioquímicas UNAM, Instituto de Fisiología Celular, 2009

The German hospital malnutrition study.

Science.gov (United States)

Pirlich, Matthias; Schütz, Tatjana; Norman, Kristina; Gastell, Sylvia; Lübke, Heinrich Josef; Bischoff, Stephan C; Bolder, Ulrich; Frieling, Thomas; Güldenzoph, Helge; Hahn, Kristian; Jauch, Karl-Walter; Schindler, Karin; Stein, Jürgen; Volkert, Dorothee; Weimann, Arved; Werner, Hansjörg; Wolf, Christiane; Zürcher, Gudrun; Bauer, Peter; Lochs, Herbert

2006-08-01

Malnutrition is frequently observed in chronic and severe diseases and associated with impaired outcome. In Germany general data on prevalence and impact of hospital malnutrition are missing. Nutritional state was assessed by subjective global assessment (SGA) and by anthropometric measurements in 1,886 consecutively admitted patients in 13 hospitals (n=1,073, university hospitals; n=813, community or teaching hospitals). Risk factors for malnutrition and the impact of nutritional status on length of hospital stay were analyzed. Malnutrition was diagnosed in 27.4% of patients according to SGA. A low arm muscle area and arm fat area were observed in 11.3% and 17.1%, respectively. Forty-three % of patients 70 years old were malnourished compared to only 7.8% of patients malnutrition was observed in geriatric (56.2%), oncology (37.6%), and gastroenterology (32.6%) departments. Multivariate analysis revealed three independent risk factors: higher age, polypharmacy, and malignant disease (all PMalnutrition was associated with an 43% increase of hospital stay (PMalnutrition is associated with increased length of hospital stay. Higher age, malignant disease and major comorbidity were found to be the main contributors to malnutrition. Adequate nutritional support should be initiated in order to optimize the clinical outcome of these patients.

Library Hospitality: Some Preliminary Considerations

Science.gov (United States)

Johnson, Eric D. M.; Kazmer, Michelle M.

2011-01-01

Library scholars and practitioners have frequently reflected on the various factors that in combination make up a hospitable library, but there has been little theoretical synthesis of the notion of the library as a place of hospitality. The hospitality industry provides a rich vein of theoretical material from which to draw definitions of…

The Impact of Medicaid Disproportionate Share Hospital Payment on Provision of Hospital Uncompensated Care

Science.gov (United States)

Hsieh, Hui-Min; Bazzoli, Gloria J.

2012-01-01

This study examines the association between hospital uncompensated care (UC) and reductions in Medicaid Disproportionate Share Hospital (DSH) payments resulting from the 1997 Balanced Budget Act. Data on California hospitals from 1996 to 2003 were examined using two-stage least squares with a first-differencing model to control for potential feedback effects. Our findings suggest that not-for-profit hospitals did reduce UC provision in response to reductions in Medicaid DSH, but the response was inelastic in value. Policy makers need to continue to monitor how UC changes as sources of support for indigent care change with the Patient Protection and Affordable Care Act (PPACA). PMID:23230705

Hospital marketing: characterization of marketing actions in private hospitals in the city of São Paulo - Brazil.

Science.gov (United States)

Leiderman, Eduardo Blay; Padovan, Jorge Luis; Zucchi, Paola

2010-01-01

Characterize the marketing actions in private hospitals in the city of São Paulo, the organizational structure of the marketing area, the target public of marketing actions and the media used. Exploratory cross-sectional study, carried out by a survey made with hospital administrators. The hospitals studied were clearly divided in two groups whose differentials are statistically significant: 1. good infrastructure and equipment, with a well-defined investment policy in marketing; 2. worse infrastructure and less equipment, with lower proportional investment in marketing. 1. The actions most used are the evaluation of patients/caregivers satisfaction, web site and dissemination of the hospital services. 2. The hospital administrators attribute a level of significant importance to the application of hospital marketing concepts. 3. There is a marketing structure in most of the hospitals studied. 4. The hospitals consider as extremely or very important publics: patients and relatives, doctors, collaborators, health plans and community. 5. The media most used are the most simple and of lower cost. 6. There is a statistically significant correlation between the higher investment in marketing and the best infrastructure. 7. The studied hospitals apply the concept of marketing in a restricted way.

Hospital law: the changing scene.

Science.gov (United States)

Hirsh, H L

1978-01-01

The liability of hospitals in tort law has been a fairly recent development. Formerly, hospitals were protected from liability under the doctrine of charitable immunity. Legal "immunity" avoids liability in tort essentially under all circumstances. It is conferred not because of the particular facts of the situation but because of the status or position of the favored defendant. It does not deny the tort, merely the resulting liability. Such immunity does not mean that conduct that would amount to a tort on the part of other defendants is not still equally tortious in character, but merely that for the protection of the particular defendant, or of the interests which he represents, he is given absolution from liability. Similarly, the "captain-of-the-ship" and the attendant "borrowed or lent servant" doctrine is being abandoned. As medical technology continues to advance, the modern hospital will undoubtedly assume a greater responsibility toward its patients--with amplified medical-legal implications. The hospital is no longer a hotel where patients stay, awaiting treatment by their private physicians. The theory that the hospital does not act through its employees--physicians, nurses, and others--no longer reflects the trend in judicial philosophy. The decisions cited reflect the current trend in judicial analysis and thinking. Medical science has provided numerous benefits to humankind, but along with those benefits, numerous risks have accrued. Whether hospitals should have to bear the responsibilities inherent in such risks is a much-argued matter. However, hospital liability, in fact, is the trend of our judicial determination. The ramifications of this trend have been many. Hospitals and physicians will closely scrutinize surgical operations and other hospitals procedures and practices. The fact remains clear that responsibility for every patient is now shared by both the physicians and the hospital--share and share alike. The present thinking is that the

Hospitals: Soft Target for Terrorism?

Science.gov (United States)

De Cauwer, Harald; Somville, Francis; Sabbe, Marc; Mortelmans, Luc J

2017-02-01

In recent years, the world has been rocked repeatedly by terrorist attacks. Arguably, the most remarkable were: the series of four coordinated suicide plane attacks on September 11, 2001 on buildings in New York, Virginia, and Pennsylvania, USA; and the recent series of two coordinated attacks in Brussels (Belgium), on March 22, 2016, involving two bombings at the departure hall of Brussels International Airport and a bombing at Maalbeek Metro Station located near the European Commission headquarters in the center of Brussels. This statement paper deals with different aspects of hospital policy and disaster response planning that interface with terrorism. Research shows that the availability of necessary equipment and facilities (eg, personal protective clothing, decontamination rooms, antidotes, and anti-viral drugs) in hospitals clearly is insufficient. Emergency teams are insufficiently prepared: adequate and repetitive training remain necessary. Unfortunately, there are many examples of health care workers and physicians or hospitals being targeted in both political or religious conflicts and wars. Many health workers were kidnapped and/or killed by insurgents of various ideology. Attacks on hospitals also could cause long-term effects: hospital units could be unavailable for a long time and replacing staff could take several months, further compounding hospital operations. Both physical and psychological (eg, posttraumatic stress disorder [PTSD]) after-effects of a terrorist attack can be detrimental to health care services. On the other hand, physicians and other hospital employees have shown to be involved in terrorism. As data show that some offenders had a previous history with the location of the terror incident, the possibility of hospitals or other health care services being targeted by insiders is discussed. The purpose of this report was to consider how past terrorist incidents can inform current hospital preparedness and disaster response planning

Præhospital ultralyd

DEFF Research Database (Denmark)

Rognås, Leif Kåre; Christensen, Erika Frischknecht; Sloth, Erik

2009-01-01

Danish anaesthesiologists use ultrasound (US) to examine and treat acutely ill or traumatized patients in the emergency room, operating theatre and intensive care unit. They are also involved in pre-hospital care where US may theoretically be beneficial for both diagnostic and therapeutic purpose....... The literature concerning the potential use of emergency US in the pre-hospital setting is evaluated. Evidence from both Europe and the USA indicates that pre-hospital US improves diagnosis and visitation of acutely ill or traumatized patients. Udgivelsesdato: 2009-Aug-31...

'The hospital was just like a home': self, service and the 'McCord Hospital Family'.

Science.gov (United States)

Noble, Vanessa; Parle, Julie

2014-04-01

For more than a century, McCord Hospital, a partly private and partly state-subsidised mission hospital has provided affordable health-care services, as well as work and professional training opportunities for thousands of people in Durban, a city on the east coast of South Africa. This article focuses on one important aspect of the hospital's longevity and particular character, or 'organisational culture': the ethos of a 'McCord Family', integral to which were faith and a commitment to service. While recognising that families - including 'hospital families' like that at McCord - are contentious social constructs, with deeply embedded hierarchies and inequalities based on race, class and gender, we also consider however how the notion of 'a McCord family' was experienced and shared in complex ways. Indeed, during the twentieth century, this ethos was avidly promoted by the hospital's founders and managers and by a wide variety of employees and trainees. It also extended to people at a far geographical remove from Durban. Moreover, this ethos became so powerful that many patients felt that it shaped their convalescence experience positively. This article considers how this 'family ethos' was constructed and what made it so attractive to this hospital's staff, trainees and patients. Furthermore, we consider what 'work' it did for this mission hospital, especially in promoting bonds of multi-racial unity in the contexts of segregation and apartheid society. More broadly, it suggests that critical histories of the ways in which individuals, hospitals, faith and 'families' intersect may be of value for the future of hospitals as well as of interest in their past.

Evaluation of paediatric injury hospitalization incidence at Hospital Ward in Grudziądz

Directory of Open Access Journals (Sweden)

Ewa Barczykowska

2016-05-01

4Correction Unit No. 2 in Grudziadz     Mailing address: Marta Lewicka, Collegium Medicum im. L. Rydygiera w Bydgoszczy, UMK w Toruniu, ul. Techników 3, 85-801 Bydgoszcz, Poland; Phone 52 585 21 93, e-mail: marta_grabinska@hotmail.com   Abstract Introduction. Children's and adolescents' injuries are a serious medical problem, as they lead to substantial medical and socio-economic effects. Aim of the paper. The aim of the conducted research was to analyze incidence and causes of hospitalizing children between birth and 18 years of age on the grounds of injuries. Material and methods. Medical histories of 2 832 children between birth and 18 years of age treated for injuries in 2006-2010 in Wladyslaw Bieganski Regional Specialist Hospital in Grudziadz were analyzed. Results. Correlations between treatment method and subsequent years of research (p<0,05, between children's age group and type of injury, and between type of injury and season of the year and hospitalization time, were shown to be statistically significant. No correlation was found in the studied population between subsequent years of research and injury types or residence of the injured. Conclusions. 1. The most frequent causes for placing children in the hospital were cranioencephalic injuries, injuries to the osteoarticular system, and burns. 2. The children's age determined the type of injury inflicted. Children in the youngest age group were most frequently hospitalized for burns, children in the age of 3-6 years for foreign bodies, and in the group of 7-18 years of age for injuries to the chest and to the osteoarticular system. 3. Boys were more frequently injured in a manner requiring hospital treatment than girls were. 4. A decisive majority of injured children required only conservative treatment and a stay in the hospital for no more than 3 days. 5. A constant tendency of higher occurence of injuries in children during spring and summer, was observed. Keywords: children, injuries

THE FACTORS AFFECTING SATISFACTION LEVELS IN HOSPITALIZED PATIENTS: AN APPLICATION IN PUBLIC HOSPITAL

Directory of Open Access Journals (Sweden)

Neşe ACAR

2017-09-01

Full Text Available This study was conducted to determine the factors that affect the level of satisfaction of services provided by public hospitals. Patients' satisfaction levels were measured by interviewing 156 patients in a public hospital. Factor analysis of the data obtained from the research resulted in five factors called nurses 'behaviors, physical conditions, doctors' behavior, technical staff behaviors, food and beverage. MANOVA analysis was conducted to determine the differences in the perception of factors with respect to the demographic characteristics of the patients and differences were found in terms of profession. It has been seen that it is important that public hospitals have specialist doctors and modern equipment and that they have qualities such as the quality of the health personnel in preferring patients to public hospitals.

Parameter calibration for synthesizing realistic-looking variability in offline handwriting

Science.gov (United States)

Cheng, Wen; Lopresti, Dan

2011-01-01

Motivated by the widely accepted principle that the more training data, the better a recognition system performs, we conducted experiments asking human subjects to do evaluate a mixture of real English handwritten text lines and text lines altered from existing handwriting with various distortion degrees. The idea of generating synthetic handwriting is based on a perturbation method by T. Varga and H. Bunke that distorts an entire text line. There are two purposes of our experiments. First, we want to calibrate distortion parameter settings for Varga and Bunke's perturbation model. Second, we intend to compare the effects of parameter settings on different writing styles: block, cursive and mixed. From the preliminary experimental results, we determined appropriate ranges for parameter amplitude, and found that parameter settings should be altered for different handwriting styles. With the proper parameter settings, it should be possible to generate large amount of training and testing data for building better off-line handwriting recognition systems.

Are comparisons of patient experiences across hospitals fair? A study in Veterans Health Administration hospitals.

Science.gov (United States)

Cleary, Paul D; Meterko, Mark; Wright, Steven M; Zaslavsky, Alan M

2014-07-01

Surveys are increasingly used to assess patient experiences with health care. Comparisons of hospital scores based on patient experience surveys should be adjusted for patient characteristics that might affect survey results. Such characteristics are commonly drawn from patient surveys that collect little, if any, clinical information. Consequently some hospitals, especially those treating particularly complex patients, have been concerned that standard adjustment methods do not adequately reflect the challenges of treating their patients. To compare scores for different types of hospitals after making adjustments using only survey-reported patient characteristics and using more complete clinical and hospital information. We used clinical and survey data from a national sample of 1858 veterans hospitalized for an initial acute myocardial infarction (AMI) in a Department of Veterans Affairs (VA) medical center during fiscal years 2003 and 2004. We used VA administrative data to characterize hospitals. The survey asked patients about their experiences with hospital care. The clinical data included 14 measures abstracted from medical records that are predictive of survival after an AMI. Comparisons of scores across hospitals adjusted only for patient-reported health status and sociodemographic characteristics were similar to those that also adjusted for patient clinical characteristics; the Spearman rank-order correlations between the 2 sets of adjusted scores were >0.97 across 9 dimensions of inpatient experience. This study did not support concerns that measures of patient care experiences are unfair because commonly used models do not adjust adequately for potentially confounding patient clinical characteristics.

The Impact of Hospital Closures and Hospital and Population Characteristics on Increasing Emergency Department Volume: A Geographic Analysis.

Science.gov (United States)

Lee, David C; Carr, Brendan G; Smith, Tony E; Tran, Van C; Polsky, Daniel; Branas, Charles C

2015-12-01

Emergency visits are rising nationally, whereas the number of emergency departments is shrinking. However, volume has not increased uniformly at all emergency departments. It is unclear what factors account for this variability in emergency volume growth rates. The objective of this study was to test the association of hospital and population characteristics and the effect of hospital closures with increases in emergency department volume. The study team analyzed emergency department volume at New York State hospitals from 2004 to 2010 using data from cost reports and administrative databases. Multivariate regression was used to evaluate characteristics associated with emergency volume growth. Spatial analytics and distances between hospitals were used in calculating the predicted impact of hospital closures on emergency department use. Among the 192 New York hospitals open from 2004 to 2010, the mean annual increase in emergency department visits was 2.7%, but the range was wide (-5.5% to 11.3%). Emergency volume increased nearly twice as fast at tertiary referral centers (4.8%) and nonurban hospitals (3.7% versus urban at 2.1%) after adjusting for other characteristics. The effect of hospital closures also strongly predicted variation in growth. Emergency volume is increasing faster at specific hospitals: tertiary referral centers, nonurban hospitals, and those near hospital closures. This study provides an understanding of how emergency volume varies among hospitals and predicts the effect of hospital closures in a statewide region. Understanding the impact of these factors on emergency department use is essential to ensure that these populations have access to critical emergency services.

The interstices of hospitality

African Journals Online (AJOL)

jane.b

School of Hospitality and Tourism, Anhembi Morumbi University, São Paulo, Brazil ... aspects of hospitality, and the approach of the social sciences, which study the dynamics of ..... in the virtual media, the ritual always begins with an invitation.

HMO penetration: has it hurt public hospitals?

Science.gov (United States)

Clement, J P; Grazier, K L

2001-01-01

The purpose of this study is to determine the extent to which health maintenance organization (HMO) penetration within the public hospitals' market area affects the financial performance and viability of these institutions, relative to private hospitals. Hospital- and market-specific measures are examined in a fully interacted model of over 2,300 hospitals in 321 metropolitan statistical areas (MSAs) in 1995. Although hospitals located in markets with higher HMO penetration have lower financial performance as reflected in revenues, expenses and operating margin, public hospitals are not more disadvantaged than other hospitals by managed care.

Trick questions: cosmopolitan hospitality

Directory of Open Access Journals (Sweden)

Eleanor Byrne

2013-08-01

Full Text Available Byrne’s paper consists of two parallel texts. The first explores the limits of cosmopolitanism in practice, taking as its subject the Life in the UK Citizenship Test, inaugurated under the Labour Government in 2005. It argues that the test exemplifies the predicament of all attempts at cosmopolitan hospitality as unconditional welcoming, through a discussion of the relation between questioning and welcoming the stranger. Establishing the relationship between cosmopolitanism and hospitality as envisaged in Derrida’s reading of Kant it asks what kind of cosmopolitan hospitality is either possible or desirable by exploring what Derrida calls the ‘perversions’ inherent in the structures of hospitality. It focuses on the concept of the ‘trick questions’ that the state asks the foreigner observed by Derrida in his reading of The Apology of Socrates; questions that seem to invite answers but foreclose the possibilities of a free response. The second text asks how this logic that Derrida identifies can be pushed or coaxed into new ways of addressing the perceived threats of ‘unconditional’ hospitality through a reading of ‘unconditional hospitality’ as queer in the work of Tove Jansson.

Coccidioidomycosis-associated hospitalizations, California, USA, 2000-2011.

Science.gov (United States)

Sondermeyer, Gail; Lee, Lauren; Gilliss, Debra; Tabnak, Farzaneh; Vugia, Duc

2013-10-01

In the past decade, state-specific increases in the number of reported cases of coccidioidomycosis have been observed in areas of California and Arizona where the disease is endemic. Although most coccidioidomycosis is asymptomatic or mild, infection can lead to severe pulmonary or disseminated disease requiring hospitalization and costly disease management. To determine the epidemiology of cases and toll of coccidioidomycosis-associated hospitalizations in California, we reviewed hospital discharge data for 2000-2011. During this period, there were 25,217 coccidioidomycosis-associated hospitalizations for 15,747 patients and >$2 billion US in total hospital charges. Annual initial hospitalization rates increased from 2.3 initial hospitalizations/100,000 population in 2000 to 5.0 initial hospitalizations/100,000 population in 2011. During this period, initial hospitalization rates were higher for men than women, African Americans and Hispanics than Whites, and older persons than younger persons. In California, the increasing health- and cost-related effects of coccidioidomycosis-associated hospitalizations are a major public health challenge.

Características clínicas e história familiar em pacientes ambulatoriais com transtorno obsessivo-compulsivo Características clínicas e historia familiar en pacientes ambulatoriales con trastorno obsesivo-compulsivo Clinical features and family history in obsessive-compulsive outpatients

Directory of Open Access Journals (Sweden)

Ygor Arzeno Ferrão

2004-12-01

Full Text Available INTRODUÇÃO: A ocorrência familiar do transtorno obsessivo-compulsivo permite-nos especular sobre diferenças clínicas entre indivíduos com história familiar de TOC (HF+ e sem história familiar de TOC (HF-. Este estudo investigou a associação entre história familiar de TOC e algumas características clínicas. MATERIAL E MÉTODOS: Foram estudados retrospectivamente 111 pacientes através de revisão de prontuários de atendimento no Hospital Materno-Infantil Presidente Vargas de Porto Alegre, no período de julho de 1994 até julho de 2002. RESULTADOS: A idade média de início dos sintomas foi menor no grupo HF+ (17,8 anos ± 8,69 versus 20,8 anos ± 9,65; p = 0,000963. A intensidade dos sintomas obsessivo-compulsivos medidos pela YBOCS foi mais grave no grupo HF+ (22,5 ± 4,16 versus 17,93 ± 9,95; p INTRODUCCÍON: La ocurrencia familiar del trastorno obsesivo-compulsivo nos permite conjeturar sobre diferencias clínicas entre individuos con historia familiar de TOC (HF+ y sin historia familiar de TOC (HF-. Este estudio investigó la asociación entre historia familiar de TOC y algunas características clínicas. MATERIAL Y MÉTODOS: Se estudió retrospectivamente a 111 pacientes a través de revisión de prontuarios de atención en el Hospital Materno-Infantil Presidente Vargas, de Porto Alegre, en el periodo de julio de 1994 hasta julio de 2002. RESULTADOS: La edad media de inicio de los síntomas fue menor en el grupo HF+ (17,8 años ± 8,69 versus 20,8 años ± 9,65; p = 0,000963. La intensidad de los síntomas obsesivo-compulsivos medidos por Y-BOCS fue más grave en el grupo HF+ (22,5 ± 4,16 versus 17,93 ± 9,95; p INTRODUCTION: The occurrence of obsessive-compulsive disorder (OCD in families suggests the existence of clinical differences between patients with (FH+ and without (FH- a family history of OCD. This study aims at assessing the association between family history of OCD and some clinical features. MATERIAL AND METHODS

A violência contra a mulher atendida em unidade de urgência: uma contribuição da enfermagem La violencia contra la mujer atendida en unidad de urgencia: una contribuición de la enfermería The violence against woman who is attended in an unit of urgency: a nursing contribution

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Claudete Ferreira de Souza Monteiro

2006-08-01

Full Text Available INTRODUÇÃO: A violência na atualidade tem se comportado como um sério problema de saúde pública, e os serviços de urgência têm se constituído em porta de entrada para mulheres agredidas. Por essa razão, objetivou-se, com o presente trabalho, levantar os casos de violência contra a mulher atendidos em uma unidade de urgência no ano de 2004. MÉTODO: Estudo quantitativo, descritivo, retrospectivo, realizado em Teresina (PI, no Serviço de Pronto-Socorro do Hospital Getúlio Vargas, com amostra populacional de 100 casos selecionados por amostragem sistemática, tendo por instrumento um formulário com perguntas fechadas. RESULTADOS: A violência apresentou alta magnitude entre as mulheres usuárias dos serviços de pronto-atendimento, mas com elevada taxa de subnotificação quanto ao tipo de agressor (89% e causas da violência sem registro (80% CONCLUSÕES: Concluiu-se que os registros de violência foram maiores nos casos em que as mulheres apresentaram marcas físicas; foi expressivo o número de subnotificação de agressores. Finalmente, é conveniente que os profissionais que atendem mulheres vítimas da violência doméstica sejam treinados para identificar, acolher e registrar corretamente os casos de violência.INTRODUCCIÓN: La violencia en la actualidad se ha comportado como un serio problema de salud pública, y los servicios de urgencia se han constituido como puerta de entrada para las mujeres agredidas. Por lo tanto, fue objetivado, con el actual trabajo, levantar los casos de violencia contra la mujer, atendidos en una unidad de urgencia en el año de 2004. MÉTODO: Estudio cuantitativo, descriptivo, retrospectivo, realizado en Teresina (Piauí - Brasil, en el Servicio Médico de Urgencia del hospital de Getúlio Vargas, con muestra poblacional de 100 casos seleccionadas por el muestreo sistemático, teniendo por instrumento un formulario con preguntas cerradas. RESULTADOS: La violencia presentó alta magnitud entre

Hospital management practices and availability of surgery in sub-Saharan Africa: a pilot study of three hospitals.

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Funk, Luke M; Conley, Dante M; Berry, William R; Gawande, Atul A

2013-11-01

Sub-Saharan Africa has a high surgical burden of disease but performs a disproportionately low volume of surgery. Closing this surgical gap will require increased surgical productivity of existing systems. We examined specific hospital management practices in three sub-Saharan African hospitals that are associated with surgical productivity and quality. We conducted 54 face-to-face, structured interviews with administrators, clinicians, and technicians at a teaching hospital, district hospital, and religious mission hospital across two countries in sub-Saharan Africa. Questions focused on recommended general management practices within five domains: goal setting, operations management, talent management, quality monitoring, and financial oversight. Records from each interview were analyzed in a qualitative fashion. Each hospital's management practices were scored according to the degree of implementation of the management practices (1 = none; 3 = some; 5 = systematic). The mission hospital had the highest number of employees per 100 beds (226), surgeons per operating room (3), and annual number of operations per operating room (1,800). None of the three hospitals had achieved systematic implementation of management practices in all 14 measures. The mission hospital had the highest total management score (44/70 points; average = 3.1 for each of the 14 measures). The teaching and district hospitals had statistically significantly lower management scores (average 1.3 and 1.1, respectively; p management practices in low resource settings. We observed substantial variation in implementation of basic management practices at the three hospitals. Future research should focus on whether enhancing management practices can improve surgical capacity and outcomes.

Hip fracture in hospitalized medical patients

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Zapatero Antonio

2013-01-01

Full Text Available Abstract Background The aim of the present study is to analyze the incidence of hip fracture as a complication of admissions to internal medicine units in Spain. Methods We analyzed the clinical data of 2,134,363 adults who had been admitted to internal medicine wards. The main outcome was a diagnosis of hip fracture during hospitalization. Outcome measures included rates of in-hospital fractures, length of stay and cost. Results A total of 1127 (0.057% admittances were coded with an in-hospital hip fracture. In hospital mortality rate was 27.9% vs 9.4%; p  Conclusions In-hospital hip fracture notably increased mortality during hospitalization, doubling the mean length of stay and mean cost of admission. These are reasons enough to stress the importance of designing and applying multidisciplinary plans focused on reducing the incidence of hip fractures in hospitalized patients.

Association of Admission to Veterans Affairs Hospitals vs Non-Veterans Affairs Hospitals With Mortality and Readmission Rates Among Older Men Hospitalized With Acute Myocardial Infarction, Heart Failure, or Pneumonia.

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Nuti, Sudhakar V; Qin, Li; Rumsfeld, John S; Ross, Joseph S; Masoudi, Frederick A; Normand, Sharon-Lise T; Murugiah, Karthik; Bernheim, Susannah M; Suter, Lisa G; Krumholz, Harlan M

2016-02-09

Little contemporary information is available about comparative performance between Veterans Affairs (VA) and non-VA hospitals, particularly related to mortality and readmission rates, 2 important outcomes of care. To assess and compare mortality and readmission rates among men in VA and non-VA hospitals. Cross-sectional analysis involving male Medicare fee-for-service beneficiaries aged 65 years or older hospitalized between 2010 and 2013 in VA and non-VA acute care hospitals for acute myocardial infarction (AMI), heart failure (HF), or pneumonia using the Medicare Standard Analytic Files and Enrollment Database together with VA administrative claims data. To avoid confounding geographic effects with health care system effects, we studied VA and non-VA hospitals within the same metropolitan statistical area (MSA). Hospitalization in a VA or non-VA hospital in MSAs that contained at least 1 VA and non-VA hospital. For each condition, 30-day risk-standardized mortality rates and risk-standardized readmission rates for VA and non-VA hospitals. Mean aggregated within-MSA differences in mortality and readmission rates were also assessed. We studied 104 VA and 1513 non-VA hospitals, with each condition-outcome analysis cohort for VA and non-VA hospitals containing at least 7900 patients (men; ≥65 years), in 92 MSAs. Mortality rates were lower in VA hospitals than non-VA hospitals for AMI (13.5% vs 13.7%, P = .02; -0.2 percentage-point difference) and HF (11.4% vs 11.9%, P = .008; -0.5 percentage-point difference), but higher for pneumonia (12.6% vs 12.2%, P = .045; 0.4 percentage-point difference). In contrast, readmission rates were higher in VA hospitals for all 3 conditions (AMI, 17.8% vs 17.2%, 0.6 percentage-point difference; HF, 24.7% vs 23.5%, 1.2 percentage-point difference; pneumonia, 19.4% vs 18.7%, 0.7 percentage-point difference, all P percentage-point difference, -0.22; 95% CI, -0.40 to -0.04) and HF (-0.63; 95% CI, -0.95 to -0.31), and

Hospital burden of road traffic injury: major concern in primary and secondary level hospitals in Bangladesh.

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Mashreky, S R; Rahman, A; Khan, T F; Faruque, M; Svanström, L; Rahman, F

2010-04-01

To assess the burden of road traffic injury (RTI) in primary and secondary level hospitals in Bangladesh, and its economic impact on affected families. Cross-sectional study. The study was carried out in February and March 2001. To estimate the burden of RTI patients and the length of stay in hospital, the discharge records of primary and secondary level hospitals were used as data sources. Records from 16 district hospitals and 45 Upazila health complexes (subdistrict level hospitals), selected at random, were included in this study. A direct interview method was adopted to estimate the patient costs of RTI; this involved interviewing patients or their attendants. In this study, patient costs included money spent by the patient for medicine, transport, food and lodging (including attendants). Approximately 33% of the beds in primary and secondary level hospitals in Bangladesh were occupied by injury-related patients, and more than 19% of the injury patients had been injured in a road traffic accident. People aged 18-45 years were the major victims of RTI, and constituted 70% of the total RTI-related admissions in primary and secondary level hospitals. More than two-thirds of RTI patients were male. The average duration of hospital stay was 5.7 days, and the average patient cost for each RTI patient was US$86 (5834 BDT). RTI is a major cause of hospital admission in Bangladesh, and represents an economic and social burden for the family and the nation. A national strategy and road safety programme need to be developed to reduce the hospital burden and minimize the economic and social impact. 2010 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Pre-hospital physical activity status affects in-hospital course of elderly patients with acute myocardial infarction.

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Miyamoto, Takamichi; Obayashi, Tohru; Hattori, Eijirou; Yamauchi, Yasuteru; Niwa, Akihiro; Isobe, Mitsuaki

2010-03-01

The clinical course of elderly patients with acute myocardial infarction (AMI) can sometimes unexpectedly result in an adverse outcome even when therapy appears to be successful. We suspect that specific factors may characterize this worsening of status during hospitalization. This study examines whether the pre-hospital physical activity status of the elderly treated with percutaneous coronary intervention (PCI) for AMI affects their in-hospital course. We studied 110 consecutive patients, aged 80 or older, who had undergone emergent PCI for AMI. Patients were divided into two groups based on clinical presentation: Better Killip class (Killip classes I and II) and Worse Killip class (Killip classes III and IV). Patients were also divided into two groups based on pre-hospital physical activity status, determined retrospectively by review of medical records: Good physical activity (n=57) comprising those able to go out alone independently and Poor physical activity comprising those mainly confined to home (n=53). The overall in-hospital mortality rate was 9.1% for the study population. The Worse Killip class group had a higher in-hospital mortality rate than the Better Killip class group (27.8% vs 5.4%, respectively; p=0.0102). In addition, the Poor physical activity group had a higher in-hospital mortality rate than the Good physical activity group (15.1% vs. 3.5%, respectively; p=0.047). These data suggest that pre-hospital physical activity status in elderly patients with AMI may affect in-hospital mortality as well as Killip class.

Rural Hospital Mergers and Acquisitions: Which Hospitals Are Being Acquired and How Are They Performing Afterward?.

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Noles, Marissa J; Reiter, Kristin L; Boortz-Marx, Jonathan; Pink, George

2015-01-01

The number of stand-alone rural hospitals has been shrinking as larger health systems target these hospitals for mergers and acquisitions (M and As). However, little research has focused specifically on rural hospital M and A transactions. Using data from Irving Levin Associates' Healthcare M and A Report and Medicare Cost Reports from 2005 to 2012, we examined two research questions: (1) What were the characteristics of rural hospitals that merged or were acquired, and (2) were there changes in rural hospital financial performance, staffing, or services after an M and A transaction? We used logistic regression to identify factors predictive of merger, and we used multiple regression to examine various hospital measures after an M or A. Study results showed that hospitals with weaker financial performance but lower staffing levels and staffing costs were more likely to merge or be acquired. Statistically weak evidence suggested that operating margins declined after the merger; stronger evidence suggested reductions in salary expense. There was no statistically significant evidence of changes to the number of full-time equivalent (FTE) employees, the service lines that were included in the study, capital expenditures, or the amount of debt financing among the hospitals that merged or were acquired. M and A may not result in a rapid influx of capital, a relief of debt burden, or an improvement in bottom-line profitability. However, M and A may be a viable option for maintaining the hospital and the access to care it provides.

Food production and service in UK hospitals.

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Ahmed, Mohamed; Jones, Eleri; Redmond, Elizabeth; Hewedi, Mahmoud; Wingert, Andreas; Gad El Rab, Mohamed

2015-01-01

The purpose of this paper is to apply value stream mapping holistically to hospital food production/service systems focused on high-quality food. Multiple embedded case study of three (two private-sector and one public-sector) hospitals in the UK. The results indicated various issues affecting hospital food production including: the menu and nutritional considerations; food procurement; food production; foodservice; patient perceptions/expectations. Value stream mapping is a new approach for food production systems in UK hospitals whether private or public hospitals. The paper identifies opportunities for enhancing hospital food production systems. The paper provides a theoretical basis for process enhancement of hospital food production and the provision of high-quality hospital food.

Brincar no hospital: estratégia de enfrentamento da hospitalização infantil Playing in the hospital: coping strategy in child hospitalization

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Alessandra Brunoro Motta

2004-04-01

Full Text Available Estudos indicam que a hospitalização pode afetar o desenvolvimento da criança, interferindo na qualidade de vida. Para lidar com essa situação, o brincar tem funcionado como estratégia de enfrentamento. Procurando-se avaliar a importância dada ao brincar pela criança e caracterizar atividades lúdicas possíveis no hospital, 28 crianças hospitalizadas com câncer (6-12 anos, em Vitória/ES, foram entrevistadas e responderam a um instrumento especialmente elaborado (AEH - Avaliação das Estratégias de Enfrentamento da Hospitalização - Conjunto B: Brincar no hospital, contendo 20 desenhos de brinquedos e brincadeiras, classificados em jogos de Exercícios, Simbólicos, de Acoplagem, de Regras e Atividades Diversas. 78,6% das crianças relataram que gostariam de brincar no hospital, o que é justificado principalmente pela sua função lúdica, na companhia de outras crianças internadas. Não houve diferenças significativas nas escolhas entre as categorias de brincadeiras. O instrumento mostrou que o brincar pode ser um recurso adequado para a adaptação da criança hospitalizada, permitindo personalizar a intervenção.Studies have shown that the hospitalization can affect a child development interfering with his/her quality of life. In order to deal with this situation, the act of playing has worked as a coping strategy. With the purpose to assess of the importance children give to play and to characterize possible playful activities in the hospital, 28 children hospitalized with cancer (6-12 years in Vitória, ES, were interviewed and took part on an instrument specially developed (AEH Evaluation of the Coping Strategies of the Hospitalization - group B: Playing in the hospital, consisting of 20 drawings of toys and games classified in games of Exercises, Symbolic Game, Game of Connection, Game of Rules and a variety of Activities. 78,6% of the children said that they would like playing in the hospital, which is justified mainly

Failure to Thrive Hospitalizations and Risk Factors for Readmission to Children's Hospitals.

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Puls, Henry T; Hall, Matthew; Bettenhausen, Jessica; Johnson, Matthew B; Peacock, Christina; Raphael, Jean L; Newland, Jason G; Colvin, Jeffrey D

2016-08-01

Risk factors for failure to thrive (FTT) readmissions, including medical complexity, have not been described. We sought to characterize children hospitalized for FTT and identify risk factors associated with FTT-specific readmissions during the current era of increasing medical complexity among hospitalized children. This retrospective cohort study used the Pediatric Health Information System database of 43 freestanding children's hospitals across the United States. The cohort included children <2 years of age with index hospitalizations for FTT between 2006 and 2010. The main outcome was FTT-specific readmission within 3 years. Using Cox proportional hazards models, we assessed the association of demographic, clinical, diagnostic, and treatment characteristics with FTT-specific readmission. There were 10 499 FTT hospitalizations, with 14.1% being readmitted for FTT within 3 years and 4.8% within 30 days. Median time to readmission was 66 days (interquartile range, 19-194 days). Nearly one-half of children (40.8%) had at least 1 complex chronic condition (CCC), with 16.4% having ≥2 CCCs. After multivariable modeling, increasing age at admission, median household income in the lowest quartile (adjusted hazard ratio, 1.23 [95% confidence interval, 1.05-1.44]), and prematurity-related CCC (adjusted hazard ratio, 1.46 [95% confidence interval, 1.16-1.86]) remained significantly associated with readmission. Nearly one-half of children hospitalized for FTT had a CCC, and a majority of FTT-specific readmissions occurred after the traditional 30-day window. Children with prematurity-related conditions and low median household income represent unique populations at risk for FTT readmissions. Copyright © 2016 by the American Academy of Pediatrics.

Hospital-affiliated and hospital-owned retail clinics: strategic opportunities and operational challenges.

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Kaissi, Amer

2010-01-01

Retail clinics have experienced an exponential growth in the last few years. While the majority of retail clinics are freestanding, venture-backed companies affiliated with retail hosts, an increasing number of hospital systems have decided to develop their own retail clinics or partner with existing national companies. Using a stakeholder approach, the purpose of this article is to assess the strategic considerations behind these decisions and the operational challenges associated with them and to use the results to develop a questionnaire that can be applied in future research in a national sample of healthcare executives. We conducted eight in-depth interviews with administrative and clinical leaders in seven hospital systems across the United States that have or had a relationship with retail clinics in the last three years. Our findings show that the hospital systems' association with retail clinics involves two main models: an affiliation with retail chains that operate the clinics and ownership of the clinics with an arms-length relationship with the retail chain. Hospital systems are engaging in these relationships for several strategic reasons: to increase market share through enhanced referrals to physician offices and hospitals, to become closer to consumers, and to experiment with nontraditional ways of delivering health care. Operational challenges included physician resistance and skepticism, poor financial performance, people's perception of retail clinics, staffing issues, and the newness of the business model. Six out of eight respondents thought that hospital affiliation with/ownership of retail clinics is a trend that is here to stay, although many provided caveats and stipulations. Further research is needed to provide more evidence about this emerging way of healthcare delivery.

[Hospital admissions due to varicella in a tertiary hospital].

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Guzmán Laura, K P; Periañez Vasco, A; Falcón Neyra, M D; Croche Santander, B

2014-06-01

Varicella (chickenpox) can cause serious complications and admission to hospital. Several countries included the varicella vaccine in their immunization schedules. A descriptive and retrospective study of hospitalizations due to varicella and its complications was conducted in a referral center from 2005 to 2011. A total of 1192 children with varicella were seen in the emergency room, of which 99 (8.5%) required admission. The annual incidence of admissions due to varicella and varicella complications was, 19.4 and 15.3 cases per 100,000 children under 14 years, respectively. Complications were more common in children under 5 years (79.5%), and with no underlying disease (78.2%). Infection of skin and soft tissue was the most common complication (62%). The mean hospital stay was 4.5 days (SD 4). Varicella causes high morbidity, and is more frequent in absolute terms in healthy children under 5 years of age. Therefore, routine vaccination recommended by the Immunization Advisory Committee should be mandatory. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

Does Hospitalization Predict the Disease Course in Ulcerative Colitis? Prevalence and Predictors of Hospitalization and Re-Hospitalization in Ulcerative Colitis in a Population-based Inception Cohort (2000-2012).

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Golovics, Petra A; Lakatos, Laszlo; Mandel, Michael D; Lovasz, Barbara D; Vegh, Zsuzsanna; Kurti, Zsuzsanna; Szita, Istvan; Kiss, Lajos S; Balogh, Mihaly; Pandur, Tunde; Lakatos, Peter L

2015-09-01

Limited data are available on the hospitalization rates in population-based studies. Since this is a very important outcome measure, the aim of this study was to analyze prospectively if early hospitalization is associated with the later disease course as well as to determine the prevalence and predictors of hospitalization and re-hospitalization in the population-based ulcerative colitis (UC) inception cohort in the Veszprem province database between 2000 and 2012. Data of 347 incident UC patients diagnosed between January 1, 2000 and December 31, 2010 were analyzed (M/F: 200/147, median age at diagnosis: 36, IQR: 26-50 years, follow-up duration: 7, IQR 4-10 years). Both in- and outpatient records were collected and comprehensively reviewed. Probabilities of first UC-related hospitalization were 28.6%, 53.7% and 66.2% and of first re-hospitalization were 23.7%, 55.8% and 74.6% after 1-, 5- and 10- years of follow-up, respectively. Main UC-related causes for first hospitalization were diagnostic procedures (26.7%), disease activity (22.4%) or UC-related surgery (4.8%), but a significant percentage was unrelated to IBD (44.8%). In Kaplan-Meier and Cox-regression analysis disease extent at diagnosis (HR extensive: 1.79, p=0.02) or at last follow-up (HR: 1.56, p=0.001), need for steroids (HR: 1.98, p<0.001), azathioprine (HR: 1.55, p=0.038) and anti-TNF (HR: 2.28, p<0.001) were associated with the risk of UC-related hospitalization. Early hospitalization was not associated with a specific disease phenotype or outcome; however, 46.2% of all colectomies were performed in the year of diagnosis. Hospitalization and re-hospitalization rates were relatively high in this population-based UC cohort. Early hospitalization was not predictive for the later disease course.

[Historical exploration of Acapulco hospitals, Guerrero, Mexico].

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Fajardo-Ortiz, Guillermo; Salcedo-Alvarez, Rey Arturo

2006-01-01

This study attempts to recount the history of the main hospitals of the port of Acapulco from colonial times until the end of the 20th century. The Augustine friars began hospital care at the end of the first part of the 16th century. Later, Bernardino Alvarez (1514?-1584), with the support of the Spanish crown, founded the first formal hospital in Acapulco called Hospital de Nuestra Señora de la Consolación (Our Lady of Consolation Hospital). During the 16th and 17th centuries, the sick were attended by friars, and by the end of the 19th century there were physicians and surgeons. From the end of the Independence War until the end of the 19th century, the port did not have any true hospital. The first degreed physicians and surgeons arrived and resided in Acapulco in 1920. In 1938, the Hospital Civil Morelos (Morelos Civil Hospital) began providing services. It was replaced by the Hospital General de Acapulco (General Hospital of Acapulco). At the fourth decade of the past century the Cruz Roja (Red Cross) was created. In 1957 the hospital services of the Instituto Mexicano del Seguro Social (IMSS, Mexican Institute of Social Security), which was founded in 1963, was inaugurated with the Unidad Medico/Social (Medical and Social Unit) of the IMSS in Acapulco. This began the journey of modernity in Acapulco. In 1992, Hospital Regional Vicente Guerrero (Regional Hospital Vicente Guerrero) of the IMSS, initiated its services. In 1960, medical services for civil workers and their families were housed in the Hospital Civil Morelos (Morelos Civil Hospital). Shortly afterwards, the Instituto de Seguridad y Servicios Sociales para los Trabajadores del Estado (ISSSTE, Security and Social Services Institute for State Employees) had their own hospital. During the 20th century, Acapulco has added other hospital services to care for members of the navy and armed forces, as well as for those persons with financial resources for private care.

Hospital-based expert model for health technology procurement planning in hospitals.

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Miniati, R; Cecconi, G; Frosini, F; Dori, F; Regolini, J; Iadanza, E; Biffi Gentili, G

2014-01-01

Although in the last years technology innovation in healthcare brought big improvements in care level and patient quality of life, hospital complexity and management cost became higher. For this reason, necessity of planning for medical equipment procurement within hospitals is getting more and more important in order to sustainable provide appropriate technology for both routine activity and innovative procedures. In order to support hospital decision makers for technology procurement planning, an expert model was designed as reported in the following paper. It combines the most widely used approaches for technology evaluation by taking into consideration Health Technology Assessment (HTA) and Medical Equipment Replacement Model (MERM). The designing phases include a first definition of prioritization algorithms, then the weighting process through experts' interviews and a final step for the model validation that included both statistical testing and comparison with real decisions. In conclusion, the designed model was able to provide a semi-automated tool that through the use of multidisciplinary information is able to prioritize different requests of technology acquisition in hospitals. Validation outcomes improved the model accuracy and created different "user profiles" according to the specific needs of decision makers.

Functional textiles in hospital interiors

DEFF Research Database (Denmark)

Mogensen, Jeppe

This PhD thesis explores the possibilities and design qualities of using functional textiles in the interior of hospital environments, and is the result of a three years collaboration between Aalborg University, Department of Civil Engineering, and VIA University College, VIA Design. The project...... that the physical environments affect the patients’ level of stress and influence their process of recovery and healing. However, although research in this field of hospital design has increased substantially in recent years, knowledge on the use of new materials and textiles in hospital interiors is still rather...... limited. Concerned with the design potentials of using textiles in hospital interiors, the purpose of the PhD project has been to explore the possibilities and design qualities of using these materials in hospital design. Relating to both technical and aesthetic aspects of using functional textiles...

Financial analysis of diabetic patients hospitalizations submitted to lower limb amputation in a public hospital

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Renata Santos Silva

2015-03-01

Full Text Available This study is a documental descriptive analysis which aimed to verify the cost established in 2006, in relation to the hospitalization of 21 diabetic patients submitted to the lower limb amputation in a public hospital and the value transferred by the Unified Health System (SUS regarding this procedure. Among the studied patients, 57.14% were female and 42.86% male, aged 40 to 90 years. The time of diagnosis varied from 5 to 25 years. The average of hospitalization was 14 days per patient. The cost to the hospital was R$ 99,455.74, average cost per patient was R$ 4,735.98. The total amount transferred by SUS to the hospital was R$ 27,740.15, a cost 3.6 times lower than the hospital costs. The SUS transferring is in accordance with the predetermined values for its table of procedure. Prevention is the only alternative to reduce the rate of amputation and improve survival of diabetes patients. It is necessary an early diagnosis and better control of diabetes mellitus with appropriate government and institutional policies.

An Evaluation of the Management Information System and Technology in Hospitals (GESITI/Hospitals

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Antonio José Balloni

2017-02-01

Full Text Available The research project "Management of System and Information Technology in Hospitals" (GESITI/Hospitals has the purpose of mapping out the management of Information Systems (IS and Information Technology (IT in hospitals. By applying a multifocal prospective questionnaire in hospitals, the research aims to identify the hospitals need and demand, prospecting for unfolding, and generate a public integrated research report for supporting public and/or private decisions-makings. The ultimate result from this GESITI/Health research project should be a significant improvement on the hospital management and on the decisions-makings, which must reflect on peoples more satisfied regarding a better health care. Therefore, this paper aims to publish the main ideas of the GESITI/Health project i.e., its "Methodology & original Prospective Questionnaire (PQ". The methodology used is the Interpretative (or Introspective. About the PQ, we do not known, up to this date, who have developed a multifocal broad field tool -the PQ-, aiming wide hospitals management-. From 2010-16 the "methodology and PQ" have been implemented by about forty -40- universities -and increasing-, from Brazil and Abroad and, forty local research reports were generated. A book, published by the Brazilian Minister of Health [1], presents the results of a pilot project carried out by nineteen -19- out of these forty -40- universities, to know: sixteen Brazilian, one Mexican, one Argentina, one from Slovakia and one from Portugal. The chapter 25 of this book [1.A] presents an integrated research from all nineteen chapters -an integrated research report-. Finally, in the oral presentation, we will briefly present the "Methodology and the PQ" presented in this paper and, also, we will present an integrated comparative analyzes -main results got with the field application of the PQ- regarding the case studies accomplished by the universities from Brazil and Abroad.

Hospital responses to pay-for-performance incentives.

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Reiter, Kristin L; Nahra, Tammie A; Alexander, Jeffrey A; Wheeler, John R C

2006-05-01

Not-for-profit hospitals are complex organizations and, therefore, may face unique challenges in responding to financial incentives for quality. In this research, we explore the types of behavioural changes made by not-for-profit Michigan hospitals in response to a pay-for-performance system for quality. We also identify factors that motivate or facilitate changes in effort. We apply a conceptual framework based on agency theory to motivate our research questions. Using data derived from structured interviews and surveys administered to 86 hospitals participating in a pay-for-performance system, we compare hospitals reporting and not reporting behavioural changes. Separate analyses are performed for hospitals reporting structure-related changes and hospitals reporting process-related changes. Our findings confirm that hospitals respond to incentive payments; however, our findings also reveal that hospital responses are not universal. Rather, involvement by boards of trustees, willingness to exert leverage with physicians, and financial and competitive motivations are all associated with hospitals' behavioural responses to incentives. Results of this research will help inform payers and hospital managers considering the use of incentives about the nature of hospitals' responses.

The importance of working capital management for hospital profitability: evidence from bond-issuing, not-for-profit U.S. hospitals.

Science.gov (United States)

Rauscher, Simone; Wheeler, John R C

2012-01-01

Increased financial pressures on hospitals have elevated the importance of working capital management, that is, the management of current assets and current liabilities, for hospitals' profitability. Efficient working capital management allows hospitals to reduce their holdings of current assets, such as inventory and accounts receivable, which earn no interest income and require financing with short-term debt. The resulting cash inflows can be reinvested in interest-bearing financial instruments or used to reduce short-term borrowing, thus improving the profitability of the organization. This study examines the relationship between hospitals' profitability and their performance at managing two components of working capital: accounts receivable, measured in terms of hospitals' average collection periods, and accounts payable, measured in terms of hospitals' average payment periods. Panel data derived from audited financial statements for 1,397 bond-issuing, not-for-profit U.S. hospitals for 2000-2007 were analyzed using hospital-level fixed-effects regression analysis. The results show a negative relationship between hospitals' average collection period and profitability. That is, hospitals that collected on their patient revenue faster reported higher profit margins than did hospitals that have larger balances of accounts receivable outstanding. We also found a negative relationship between hospitals' average payment period and their profitability. Hospital managers did not appear to delay paying their vendors. Rather, the findings indicated that more profitable hospitals paid their suppliers faster, possibly to avoid high effective interest rates on outstanding accounts payable, whereas less profitable hospitals waited longer to pay their bills. The findings of this study suggest that working capital management indeed matters for hospitals' profitability. Efforts aimed at reducing large balances in both accounts receivable and accounts payable may frequently be

Outpatient admissions and hospital costs of Syrian refugees in a Turkish university hospital.

Science.gov (United States)

Tahirbegolli, Bernard; Çavdar, Sabanur; Çetinkaya Sümer, Esin; Akdeniz, Sıdıka I; Vehid, Suphi

2016-07-01

To examine the most frequent admitted polyclinics, diagnoses, and the costs of Syrian refugee patient in a Turkish university hospital in the metropolitan city of Istanbul, Western part of Turkey.  Research methodology consist of analyzing outpatient admissions to the Hospital Polyclinics of Faculty of Medicine, Istanbul University, Cerrahpasa, Istanbul, Turkey from January-June 2014. We carried out diagnosis groups as classified in the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification, and analyzed the hospital cost of first admission through records based in the hospital information system.  Median age of 251 Syrian refugee patients is 19 years, inter quartile rate 7-34 years. Patients aged 65 and older compared with those until 18 years and 19 to 64 years aged groups have made statistically significant (p less than 0.001) less hospital admissions. The Most frequented clinic was the emergency clinic. On June there have been significantly (p less than 0.001) more admissions compared with other months. The most common diagnoses were diseases of the respiratory system. The costs of per admission was estimated nearly 48 US Dollar/per patient and the total amount of hospital admissions was 12,031.93 US Dollar.  On the specified dates, the clinics were mostly frequented from Syrian refugees until 18 years group. The most common presenting symptoms are respiratory diseases and most frequented clinic is emergency.

Effect of Regional Hospital Competition and Hospital Financial Status on the Use of Robotic-Assisted Surgery.

Science.gov (United States)

Wright, Jason D; Tergas, Ana I; Hou, June Y; Burke, William M; Chen, Ling; Hu, Jim C; Neugut, Alfred I; Ananth, Cande V; Hershman, Dawn L

2016-07-01

Despite the lack of efficacy data, robotic-assisted surgery has diffused rapidly into practice. Marketing to physicians, hospitals, and patients has been widespread, but how this marketing has contributed to the diffusion of the technology remains unknown. To examine the effect of regional hospital competition and hospital financial status on the use of robotic-assisted surgery for 5 commonly performed procedures. A cohort study of 221 637 patients who underwent radical prostatectomy, total nephrectomy, partial nephrectomy, hysterectomy, or oophorectomy at 1370 hospitals in the United States from January 1, 2010, to December 31, 2011, was conducted. The association between hospital competition, hospital financial status, and performance of robotic-assisted surgery was examined. The association between hospital competition was measured with the Herfindahl-Hirschman Index (HHI), hospital financial status was estimated as operating margin, and performance of robotic-assisted surgery was examined using multivariate mixed-effects regression models. We identified 221 637 patients who underwent one of the procedures of interest. The cohort included 30 345 patients who underwent radical prostatectomy; 20 802, total nephrectomy; 8060, partial nephrectomy; 134 985, hysterectomy; and 27 445, oophorectomy. Robotic-assisted operations were performed for 20 500 (67.6%) radical prostatectomies, 1405 (6.8%) total nephrectomies, 2759 (34.2%) partial nephrectomies, 14 047 (10.4%) hysterectomies, and 1782 (6.5%) oophorectomies. Use of robotic-assisted surgery increased for each procedure from January 2010 through December 2011. For all 5 operations, increased market competition (as measured by the HHI) was associated with increased use of robotic-assisted surgery. For prostatectomy, the risk ratios (95% CIs) for undergoing a robotic-assisted procedure were 2.20 (1.50-3.24) at hospitals in moderately competitive markets and 2.64 (1.84-3.78) for highly competitive markets

Hospital information systems: experience at the fully digitized Seoul National University Bundang Hospital.

Science.gov (United States)

Yoo, Sooyoung; Hwang, Hee; Jheon, Sanghoon

2016-08-01

The different levels of health information technology (IT) adoption and its integration into hospital workflow can affect the maximization of the benefits of using of health IT. We aimed at sharing our experiences and the journey to the successful adoption of health IT over 13 years at a tertiary university hospital in South Korea. The integrated system of comprehensive applications for direct care, support care, and smart care has been implemented with the latest IT and a rich user information platform, achieving the fully digitized hospital. The users experience design methodology, barcode and radio-frequency identification (RFID) technologies, smartphone and mobile technologies, and data analytics were integrated into hospital workflow. Applications for user-centered electronic medical record (EMR) and clinical decision support (CDS), closed loop medication administration (CLMA), mobile EMR and dashboard system for care coordination, clinical data warehouse (CDW) system, and patient engagement solutions were designed and developed to improve quality of care, work efficiency, and patient safety. We believe that comprehensive electronic health record systems and patient-centered smart hospital applications will go a long way in ensuring seamless patient care and experience.

Organizational culture in Qazvin hospitals (2013

Directory of Open Access Journals (Sweden)

AM. Mosadeghrad

2017-12-01

Full Text Available Background: Organizational culture influences employees’ job satisfaction, commitment and performance. A strong corporate culture enhances organizational performance. Objective: The aim of this study was to determine the type of organizational culture in Qazvin hospitals. Methods: A descriptive and cross-sectional study was conducted by a survey questionnaire in Qazvin (2013 that was distributed among 800 hospital employees and managers based on stratified random sampling. Findings: The mean of hospitals’ organizational culture was 2.95 out of 5 score. Hospitals' organizational cultures were evaluated as strong in attention to details and stability dimensions and moderate in creativity, risk taking, team working and power distance dimensions. Attention to details in public hospitals was higher than private and social security hospitals. Conclusion: Organizational culture of Qazvin hospitals was evaluated as moderate. Managers for improving hospitals' performance and enhancing employees' and patients' satisfaction should create a culture of higher creativity, innovation, team working and risk taking and lower power distance.

Hospital waste management status in Lebanon

International Nuclear Information System (INIS)

Karam, R.; Oueida, F.; Tissot-Guerraz, F.; Trepo, D.; Collombel, C.

2000-01-01

author.The existing management of hospital waste in Lebanon currently poses both an environmental hazard as well as a public health risk. This is due mainly to lack of legislation, information and modern treatment and disposal facilities designed for this purpose. A nation-wide questionnaire survey was conducted to asses the status of hospital waste management. The study started from October 1997 till August 1998. We found that 75% of the surveyed hospitals completely ignore their total waste quantity: 73% of hospitals surveyed practice segregation at source of infectious, pathological, sharps and pharmaceuticals; more than 40% dispose of their hospital risk wastes through the municipality waste disposal, 24% by burning in open fires, 14% by on-site hospital incinerators, 11% in on-site dumping, 8% handled by a private contractor and 1% in uncontrolled landfill. We conclude that with some exceptions, the hospital waste management situation in Lebanon is very far from being satisfactory and therefore needs to be reconsidered. 1 Fig., 6 tabs., 18 refs

Payment of hospital cardiac services.

Science.gov (United States)

Unger, W J

1991-01-01

This report describes how acute-care community hospitals in the United States get paid for services when their patients either are entitled to Medicare or Medicaid benefits or subscribe to a Blue Cross or Blue Shield plan, a commercial insurance plan, a health maintenance organization, a preferred provider organization, or some other third-party payment mechanism. The focus of this report is on cardiac services, which are the most common type of inpatient services provided by acute-care community hospitals. Over the past three decades, extraordinary advances in medical and surgical technologies as well as healthier life-styles have cut the annual death rate for coronary heart disease in half. Despite this progress, cardiovascular disease remains the number one cause of hospitalization. On average nationwide, diseases and disorders of the circulatory system are the primary reason for 17 percent of all patient admissions, and among the nation's 35 million Medicare beneficiaries they are the primary reason for 25 percent of all admissions. In the United States heart disease is the leading cause of death and a major cause of morbidity. Its diagnosis and treatment are often complex and costly, often requiring multiple hospitalizations and years of medical management. To focus management attention and resources on the immense cardiology marketplace, many hospitals have hired individuals with strong clinical backgrounds to manage their cardiology programs. These "front-line" managers play a key role in coordinating a hospital's services for patients with cardiovascular disease. Increasingly, these managers are being asked to become active participants in the reimbursement process. This report was designed to meet their needs. Because this report describes common reimbursement principles and practices applicable to all areas of hospital management and because it provides a "tool kit" of analytical, planning, and forecasting techniques, it could also be useful to hospital

Stage implementation of RFID in hospitals.

Science.gov (United States)

Kumar, Sameer; Livermont, Gregory; McKewan, Gregory

2010-01-01

The use of radio frequency identification device (RFID) technology within the healthcare industry was researched and specific instances of implementation of this technology in the hospital environment were examined. The study primarily makes use of ideas from operations and supply chain management, such as work flow diagrams, value stream mapping, and poka-yokes (mistake proofing measures) for investigations of processes, failures, and solutions. This study presents a step-by-step approach of how to implement the use of RFID tracking systems within the entire hospital. A number of poka-yokes were also devised for improving the safety of the patient and cost effectiveness of the hospital to insure the success of the hospital health care delivery system. Many players in the hospital environment may be impacted. This includes patients, doctors, nurses, technicians, administrators, and other hospital personnel. Insurance and government agencies may be impacted as well. Different levels of training of hospital personnel will be required based on the degree of interaction with the RFID system. References to costs, Return On Investment, change management, ethical and legal considerations are also made to help the reader understand the benefits and implications of the technology in the hospital environment.

[Hospital information system performance for road traffic accidents analysis in a hospital recruitment based area].

Science.gov (United States)

Jannot, A-S; Fauconnier, J

2013-06-01

Road traffic accidents in France are mainly analyzed through reports completed by the security forces (police and gendarmerie). But the hospital information systems can also identify road traffic accidents via specific documentary codes of the International Classification of Diseases (ICD-10). The aim of this study was therefore to determine whether hospital stays consecutive to road traffic accident were truly identified by these documentary codes in a facility that collects data routinely and to study the consistency of results from hospital information systems and from security forces during the 2002-2008 period. We retrieved all patients for whom a documentary code for road traffic accident was entered in 2002-2008. We manually checked the concordance of documentary code for road traffic accident and trauma origin in 350 patient files. The number of accidents in the Grenoble area was then inferred by combining with hospitalization regional data and compared to the number of persons injured by traffic accidents declared by the security force. These hospital information systems successfully report road traffic accidents with 96% sensitivity (95%CI: [92%, 100%]) and 97% specificity (95%CI: [95%, 99%]). The decrease in road traffic accidents observed was significantly less than that observed was significantly lower than that observed in the data from the security force (45% for security force data against 27% for hospital data). Overall, this study shows that hospital information systems are a powerful tool for studying road traffic accidents morbidity in hospital and are complementary to security force data. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

78 FR 50495 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Science.gov (United States)

2013-08-19

... Connective Tissue) a. Reverse Shoulder Procedures b. Total Ankle Replacement Procedures 6. MDC 15 (Newborns... specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric... Issues. James Poyer, (410) 786-2261, PPS-Exempt Cancer Hospital Quality Reporting Issues. Allison Lee...

Hospitals in the state of Louisiana, Geographic NAD83, LDHH (2007) [hospitals_06_07_pub_LDHH_2007

Data.gov (United States)

Louisiana Geographic Information Center — Hospitals in the state of Louisiana. This database contains the responses provided by the hospitals to the "Emergency Response Hospital Data Verification Form" that...

[Labor law issues in hospitals by structural changes and changes in hospital ownership].

Science.gov (United States)

Meyer, Peter

2003-11-01

The present article deals with the potential impact of structural changes and changes in hospital control or ownership on the employment contracts of the physicians concerned. While taking the applicable jurisdiction into consideration, the author examines the options of assigning new responsibilities or decreasing compensation opportunities, amending or even terminating employment contracts, outsourcing hospital-related services, or allowing physicians in the future to provide these services at their own risk. Furthermore, the article outlines the change in employer in various "change of control" scenarios such as in the case of hospital privatisation.

Hospitality services generate revenue.

Science.gov (United States)

Bizouati, S

1993-01-01

An increasing number of hospitals are undertaking external revenue-generating activities to supplement their shrinking budgets. Written at the request of Leadership, this article outlines an example of a successful catering service -- a money-generating business that more Canadian hospitals could profitably consider.

Hospitality Services Reference Book.

Science.gov (United States)

Texas Tech Univ., Lubbock. Home Economics Curriculum Center.

This reference book provides information needed by employees in hospitality services occupations. It includes 29 chapters that cover the following topics: the hospitality services industry; professional ethics; organization and management structures; safety practices and emergency procedures; technology; property maintenance and repair; purchasing…

The changing power equation in hospitals.

Science.gov (United States)

Rayburn, J M; Rayburn, L G

1997-01-01

This research traces the origins, development, and reasons for change in the power equation in the U.S. hospitals between physicians, administrators and accountants. The paper contains three major sections: a review of the literature concerning authority, power, influence, and institutional theory; a review of the development of the power of professions, especially physicians, accounting and healthcare administrators, and the power equilibrium of a hospital; and, a discussion of the social policy implications of the power struggle. The basis for physicians' power derives from their legal ability to act on which others are dependent, such as choosing which hospital to admit patients, order tests and procedures for their patients. The Federal Government's prospective payment system and the hospitals' related case-mix accounting systems appear to influence the power structure in hospitals by redistributing that power. The basis of the accountants' power base is control of financial information. Accountants have a definite potential for influencing which departments receive financial resources and for what purpose. This moves hospital accountants into the power equation. The basis of the hospital administrators' power is their formal authority in the organization. Regardless of what actions federal government agencies, hospital accountants, or hospital administrators take, physicians are expected to remain the dominant factor in the power equation. Without major environmental changes to gain control of physician services, only insignificant results in cost containment will occur.

Admission rates in a general practitioner-based versus a hospital specialist based, hospital-at-home model

DEFF Research Database (Denmark)

Mogensen, Christian Backer; Ankersen, Ejnar Skytte; Lindberg, Mats J

2018-01-01

. CONCLUSIONS: The GP based HaH model was more effective than the hospital specialist model in avoiding hospital admissions within 7 days among elderly patients with an acute medical condition with no differences in mental or physical recovery rates or deaths between the two models. REGISTRATION: No. NCT......BACKGROUND: Hospital at home (HaH) is an alternative to acute admission for elderly patients. It is unclear if should be cared for a primarily by a hospital intern specialist or by the patient's own general practitioner (GP). The study assessed whether a GP based model was more effective than...... Denmark, including + 65 years old patients with an acute medical condition that required acute hospital in-patient care. The patients were randomly assigned to hospital specialist based model or GP model of HaH care. Five physical and cognitive performance tests were performed at inclusion and after 7...

Hospitality and prosumption | Ritzer | Research in Hospitality ...

African Journals Online (AJOL)

Research in Hospitality Management. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 5, No 1 (2015) >. Log in or Register to get access to full text downloads.

Internet Hospitals in China: Cross-Sectional Survey.

Science.gov (United States)

Xie, Xiaoxu; Zhou, Weimin; Lin, Lingyan; Fan, Si; Lin, Fen; Wang, Long; Guo, Tongjun; Ma, Chuyang; Zhang, Jingkun; He, Yuan; Chen, Yixin

2017-07-04

The Internet hospital, an innovative approach to providing health care, is rapidly developing in China because it has the potential to provide widely accessible outpatient service delivery via Internet technologies. To date, China's Internet hospitals have not been systematically investigated. The aim of this study was to describe the characteristics of China's Internet hospitals, and to assess their health service capacity. We searched Baidu, the popular Chinese search engine, to identify Internet hospitals, using search terms such as "Internet hospital," "web hospital," or "cloud hospital." All Internet hospitals in mainland China were eligible for inclusion if they were officially registered. Our search was carried out until March 31, 2017. We identified 68 Internet hospitals, of which 43 have been put into use and 25 were under construction. Of the 43 established Internet hospitals, 13 (30%) were in the hospital informatization stage, 24 (56%) were in the Web ward stage, and 6 (14%) were in full Internet hospital stage. Patients accessed outpatient service delivery via website (74%, 32/43), app (42%, 18/43), or offline medical consultation facility (37%, 16/43) from the Internet hospital. Furthermore, 25 (58%) of the Internet hospitals asked doctors to deliver health services at a specific Web clinic, whereas 18 (42%) did not. The consulting methods included video chat (60%, 26/43), telephone (19%, 8/43), and graphic message (28%, 12/43); 13 (30%) Internet hospitals cannot be consulted online any more. Only 6 Internet hospitals were included in the coverage of health insurance. The median number of doctors available online was zero (interquartile range [IQR] 0 to 5; max 16,492). The median consultation fee per time was ¥20 (approximately US $2.90, IQR ¥0 to ¥200). Internet hospitals provide convenient outpatient service delivery. However, many of the Internet hospitals are not yet mature and are faced with various issues such as online doctor scarcity and

State of malnutrition in hospitals of Ecuador.

Science.gov (United States)

Gallegos Espinosa, Sylvia; Nicolalde Cifuentes, Marcelo; Santana Porbén, Sergio

2014-08-01

Hospital malnutrition is a global health problem affecting 30-50% of hospitalized patients. There are no estimates of the size of this problem in Ecuadorian hospitals. Hospital malnutrition might influence the quality of medical assistance provided to hospitalized populations. To estimate the current frequency of malnutrition among patients admitted to Ecuadorian public hospitals. The Ecuadorian Hospital Malnutrition Study was conducted between November 2011 and June 2012 with 5,355 patients (Women: 37.5%; Ages ≥ 60 years: 35.1%; Length of stay ≤ 15 days: 91.2%) admitted to 36 public hospitals located in the prominent cities of 22 out of the 24 provinces of the country. Malnutrition frequency was estimated by means of the Subjective Global Assessment survey. Malnutrition affected 37.1% of the surveyed patients. Malnutrition was dependent upon patient's age and education level; as well as the presence of cancer, sepsis, and chronic organic failure. Hospital areas showed different frequencies of hospital malnutrition. Health condition leading to hospital admission influenced negatively upon nutritional status. Malnutrition frequency increased as length of stay prolonged. Malnutrition currently affects an important proportion of patients hospitalized in public health institutions of Ecuador. Policies and actions are urgently required in order to successfully deal with this health problem and thus to ameliorate its negative impact upon quality of medical care. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Genetics Home Reference: Rothmund-Thomson syndrome

Science.gov (United States)

... Daire V, Crandall B, Hannula-Jouppi K, Hennekam R, Herzog D, Keymolen K, Lipsanen-Nyman M, Miny P, Plon SE, Riedl S, Sarkar A, Vargas FR, Verloes A, ... Levy ML, Lewis RA, Chintagumpala MM, Ruiz-Maldanado R, Contreras-Ruiz J, ... Plon SE. Association between osteosarcoma and deleterious mutations in ...

75 FR 9645 - Additional Designations of Individuals and Entities Pursuant to Section 804(b) of the Foreign...

Science.gov (United States)

2010-03-03

... worldwide basis. It provides a statutory framework for the President to impose sanctions against significant... identified by the President. In addition, the Secretary of the Treasury consults with the Attorney General...; a.k.a. MENDEZ VARGAS, Jesus; a.k.a. MENDEZ, Jesus), Tazumbos, Jalisco, Mexico; Calle Dr. Lose Luis...

Highlights in the History of U.S. Army Dentistry

Science.gov (United States)

2012-01-01

Rodríguez Vargas, DDS is given credit for ground breaking microbiology research on cariogenic bacteria . 23 October 1941 The War Manpower...oriented care for Soldiers over twenty-five. The emphasis in this age group was prevention of periodontal disease. In October 1974 the two phases of the

78 FR 27485 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Science.gov (United States)

2013-05-10

... Readmission 5. MDC 8 (Diseases and Disorders of the Musculoskeletal System and Connective Tissue) a. Reverse... hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are..., (410) 786-2261, PPS-Exempt Cancer Hospital Quality Reporting Issues. Allison Lee, (410) 786-8691 and...

[Hospital legislation in the Federal Republic of Germany and its effects on psychiatric hospitals (author's transl)].

Science.gov (United States)

Zumpe, V

1978-02-01

The article discusses the hospital laws of several land governments enacted subsequent to the hospital financing law of the Federal Government, in respect of the influence exercised by these laws on the internal structure of the hospital. The fact that the laws apply to all kinds of hospitals, and hence also to big psychiatric hospitals, is considered a disadvantage for psychiatric care. Such care is obviously hampered, on the one hand, by the legislative demand for departmentalization of the individual fields according to specialist subjects, representing a setup which is opposed to the realization of patient care in accordance with the requirements of the communities and citizens who expect to be cared for on an individual and not on a schematic basis, whereas, on the other hand, the new structures of management stipulated by the law do not provide for the inclusion of representatives of the new groups of professions now engaged in psychiatric activities. The model of regrouping the hospital structure into sectors instead of medical specialist departments, is presented and contrasted with the proposed model. It is recommended to arrange for representation of the non-medical and non-nursing professions in the managing boards, as well as to take into account the sociotherapeutico-rehabilitative interests as forming part of the conceptual approach to care in psychiatric hospitals, via special hospital committees.

Medical Professionals Designing Hospital Management Models