WorldWideScience

Sample records for anesthesia department hospital

  1. [Evaluation of muscle relaxant requirement for hospital anesthesia].

    Science.gov (United States)

    Shchegolev, A V; Levshankov, A I; Bogomolov, B N; Pereloma, V I; Dumnov, A G

    2013-03-01

    The rationale for cost-effectiveness of modern muscle relaxants (MR) administration in general anesthesia was evaluated. New MRs are more expensive than traditionally used pipecuronium and succinylcholine. However, the old MRs are often required as a block reversion with anticholinesterase medicines at the end of surgery, the longer artificial lung ventilation and observation in patients during recovery in intensive care unit. It was found that the district military hospital had done an annual average of about 900 general anesthesia assisted with artificial ventilation and muscle relaxation. About 2% of all anesthesias accrue to short-term anesthesia, the 27% to medium-term and 71% to long-term. 81% of the medium-term anesthesia accrue small hospitals. According to cost/effectiveness the most optimal muscle relaxants administration scheme for short-term (up to 30 min) anesthesia was mivacurium, for the operation of medium duration (30-120 min)--rocuronium, for long-term (120 min)--pipecuronium. An electronic form of annual report, which allows to obtain the necessary data for calculation of annual muscle relaxants demand and costs both in hospital and in the whole of the armed forces quickly, was developed.

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

    Directory of Open Access Journals (Sweden)

    LaQuia A. Vinson

    2016-08-01

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

  3. Managerial roles in contemporary hospital departments.

    Science.gov (United States)

    Longest, B B

    1997-01-01

    The emergence of managed care and more integrated healthcare delivery systems brings new challenges to managers in hospital departments. Managers can effectively respond to these challenges by assuming three roles--those of strategist, designer, and leader--described in the following article.

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

    Science.gov (United States)

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

    2016-01-01

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

  5. Local-regional anesthesia in the management of stingray stings: Experience of the Bouffard medical-surgical hospital in Djibouti.

    Science.gov (United States)

    Vanoye, C; Lacroix, G; Le Gonidec, E; Couret, A; Benois, A; Peigne, V

    2017-01-27

    Stingray injuries are very painful. Systemic analgesics are ineffective, and the use of local-regional anesthesia has been reported. This retrospective descriptive study reviewed all cases of stingray injuries seen at the emergency department of the Bouffard Hospital (Djbouti, Africa) between 2011 and 2014. The study included 35 patients. Most of the injuries (n= 31, 89%) concerned the lower limbs. Median pain intensity was 6 [5-8] on a visual analog scale of 0 (no pain) to 10. The following systemic medications were administered: acetaminophen to 13 (27%) patients, morphine to 8 (23%), and tramadol to 6 (17%). In all, 25 (71%) patients received local-regional anesthesia, 15 (60%) by injections at the ankle. All procedures were successful, and no adverse event was reported. This study reports clinical data about stingray injuries in the Red Sea area and highlights the interest of local-regional anesthesia in their management. Most of the procedures were distal and could be performed by trained emergency physicians.

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

    Science.gov (United States)

    Dexter, Franklin; Epstein, Richard H

    2015-12-01

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

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

    Science.gov (United States)

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

    2016-04-01

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

  8. Emergency inguinal hernia repair under local anesthesia: a 5-year experience in a teaching hospital

    OpenAIRE

    2016-01-01

    Background Local anesthesia (LA) has been reported to be the best choice for elective open inguinal hernia repair because it is cost efficient, with less post-operative pain and enables more rapid recovery. However, the role of LA in emergency inguinal hernia repair is still controversial. The aim of this study is to investigate the safety and effectiveness of LA in emergency inguinal hernia repair. Methods All patients underwent emergency inguinal hernia repair in our hospital between Januar...

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

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    Mercês Lobo

    2015-08-01

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

  10. A SURVEY OF ELECTIVE SURGICAL PATIENTS' ATTITUDES TOWARD ANESTHESIA IN PUMC HOSPITAL

    Institute of Scientific and Technical Information of China (English)

    黄宇光; 杨克勤; 任洪智; 罗爱伦

    2002-01-01

    Objective.To assess patients' knowledge,attitudes,and concerns regarding anesthetic management.Method.A survey of 55 items was developed and administered preoperatively to 500 patients including 190 men and 310 women in our hospital.Patients were interviewed on their knowledge of the role of anesthesiologists,their preferences regarding anesthetic management,and also their concern about potential anesthetic complications.Results.Patients' perceptions of anesthesiologists' training and role have reached a certain level.Most significant preoperative concerns regarding the anesthesiologists focused on experience,qualifications,and presence or absence during the anesthesia.Patients' concerns also included the possibility of not being waken up following anesthesia,experiencing postoperative pain,and becoming paralyzed.The variations of concerns depended partially on patients' sex,type of anesthesia,and proposed surgical procedure,partially on their education and living environments.Conclusion.It is suggested that anesthesiologists address significant patient concerns during the preoperative visit to enhance their effectiveness in patient care.Efforts to educate the public on the anesthesiologists' role in preoperative care would improve patients' confidence.

  11. Implementation of product-line management in a hospital pharmacy department.

    Science.gov (United States)

    Del Vecchio-Feinberg, G J; Sheinman, C H

    1990-09-01

    The development and implementation of product-line management (PLM) in a pharmacy department is reviewed. The PLM system of hospital organization shifts the emphasis from function to product. The pharmacy department at a 737-bed nonprofit hospital adopted PLM in an effort to reach more directly the physician and patient markets, enhance the image of pharmacy, and help meet requirements of the Joint Commission on Accreditation of Healthcare Organizations. The department surveyed physicians and administrators to identify their product and service needs and surveyed pharmacy staff members to identify the perceived benefits and risks of a PLM system. A strategic-planning session was held to decide how best to match the pharmacy department's product lines with market needs. The team leaders were renamed clinical supervisors and were no longer responsible for defined physical areas but rather for clinical matters relating to patients in the product line assigned. Pharmacy's chosen product lines were oncology services, neuropsychiatry, maternal and child care, cardiovascular, operating room-anesthesia-pain clinic, and general medical. The transition is being accomplished one product line at a time; interested team leaders transfer into clinical supervisor positions by achieving clinical expertise within the relevant product lines. Despite some initial confusion, PLM contributed to job satisfaction and morale and allowed the pharmacy department to provide increased clinical consultation and intervention services. PLM enhanced the clinical pharmacy program and focused clinical services on the physician and ultimately the patient.

  12. Focus on: Washington Hospital Center, Biomedical Engineering Department.

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    Hughes, J D

    1995-01-01

    The Biomedical Engineering Department of the Washington Hospital Center provides clinical engineering services to an urban 907-bed, tertiary care teaching hospital and a variety of associated healthcare facilities. With an annual budget of over $3,000,000, the 24-person department provides cradle-to-grave support for a host of sophisticated medical devices and imaging systems such as lasers, CT scanners, and linear accelerators as well as traditional patient care instrumentation. Hallmarks of the department include its commitment to customer service and patient care, close collaboration with clinicians and quality assurance teams throughout the hospital system, proactive involvement in all phases of the technology management process, and shared leadership in safety standards with the hospital's risk management group. Through this interactive process, the department has assisted the Center not only in the acquisition of 11,000 active devices with a value of more than $64 million, but also in becoming one of the leading providers of high technology healthcare in the Washington, DC metropolitan area.

  13. Evaluation of efficacy of restorative dental treatment provided under general anesthesia at hospitalized pediatric dental patients of Isfahan

    OpenAIRE

    Eshghi, Alireza; Samani, Mahdi Jafarzadeh; Najafi, Naghme Feyzi; Hajiahmadi, Maryam

    2012-01-01

    Background: General anesthesia (GA) allows dental treatment to be rendered under optimal conditions, theoretically ensuring ideal outcomes. The aim of this study was to determine the efficacy of restorative dental procedures performed under GA. Materials and Methods: In this cross-sectional retrospective study, 305 pediatric patients who had been treated under GA 6 to 24 months before our survey at Isfahan's hospitalized dentistry center were examined. The examination was performed on dental ...

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

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    Marco Bo

    2011-03-01

    Full Text Available The World Health Organization defines emergency contraception (EC as a means to prevent unwanted pregnancy. In countries where EC is dispensed behind the counter, emergency departments are a preferred point of care for its prescription and dispensing. In light of this situation and as no studies on emergency contraception in emergency departments in Italy have been conducted to date, this study was designed with a view to analyze the responses of emergency room physicians in relation to their prescribing habits and knowledge about the drug and in relation to frequency and profile of women arriving for care at hospital emergency departments in Piedmont and requesting prescription for the morning-after pill. This cross-sectional survey involved 29 hospital emergency departments in Piedmont where no gynecologists are on active duty. The survey instrument was a 24-item questionnaire. Analysis of responses revealed that in the physicians’ opinion the vast majority of requests came from Italian nationals (97% ranging in age from 18 to 30 years (76%, single and not cohabiting with a partner (60%, and nulliparous (64.0%. Women mostly request EC for first-time and the most common reasons were condom breakage or slippage. Just over half the physicians (52% stated that emergency contraception prescription was not an appropriate part of care provided at an emergency department and 72% stated they felt uneasy about prescribing emergency contraception. The survey also revealed gaps in physician knowledge about the pharmacokinetic and pharmacodynamic properties of emergency contraception pills.

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

    Directory of Open Access Journals (Sweden)

    Marco Bo

    2011-06-01

    Full Text Available The World Health Organization defines emergency contraception (EC as a means to prevent unwanted pregnancy. In countries where EC is dispensed behind the counter, emergency departments are a preferred point of care for its prescription and dispensing. In light of this situation and as no studies on emergency contraception in emergency departments in Italy have been conducted to date, this study was designed with a view to analyze the responses of emergency room physicians in relation to their prescribing habits and knowledge about the drug and in relation to frequency and profile of women arriving for care at hospital emergency departments in Piedmont and requesting prescription for the morning-after pill. This cross-sectional survey involved 29 hospital emergency departments in Piedmont where no gynecologists are on active duty. The survey instrument was a 24-item questionnaire. Analysis of responses revealed that in the physicians’ opinion the vast majority of requests came from Italian nationals (97% ranging in age from 18 to 30 years (76%, single and not cohabiting with a partner (60%, and nulliparous (64.0%. Women mostly request EC for first-time and the most common reasons were condom breakage or slippage. Just over half the physicians (52% stated that emergency contraception prescription was not an appropriate part of care provided at an emergency department and 72% stated they felt uneasy about prescribing emergency contraception. The survey also revealed gaps in physician knowledge about the pharmacokinetic and pharmacodynamic properties of emergency contraception pills.

  16. Human resources management for a hospital pharmacy department.

    Science.gov (United States)

    Chase, P A

    1989-06-01

    The concepts of human resources management (HRM) are presented, and the application of HRM concepts to a hospital pharmacy department is described. Low salaries and poor working conditions had precipitated a mass exodus of pharmacists from a 650-bed, tertiary-care medical center. The newly hired director of pharmacy sought to rebuild the department by developing a three-stage HRM model consisting of needs forecasting, performance management, and advanced management systems. In the needs-forecasting stage, the strengths and weaknesses of departmental programs were determined through analysis of existing standards of practice, situational analysis, and financial analyses; the strengths and weaknesses of departmental employees were determined through the use of talent inventories, turnover analysis, analysis of time and leave records, reevaluation of the department's job classifications, performance and productivity evaluations, and productivity evaluations, and development of a philosophy of practice and mission statement. Needs and problems were addressed by examining each existing program and developing new policies and procedures, performance standards, quality assurance mechanisms, and productivity expectations. Personnel needs and problems were addressed by designing a system of differentiated career ladders, contracting with pharmacists for career moves, developing the skills of currently employed pharmacists, and implementing a succession planning model. The model has been in place for approximately three years and is beginning to yield the desired results. Application of HRM concepts to a hospital pharmacy department appears to have been successful in improving employee morale and in helping the department to meet goals of expanded and improved services.

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

    Science.gov (United States)

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

    2015-12-01

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

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

    KAUST Repository

    Harrou, Fouzi

    2015-10-21

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

  19. Administration Medication Errors in Emergency Department in Level III Hospital

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    Silvia González Gómez

    2012-09-01

    Full Text Available • Objective: To determine the prevalence of medication errors associated with the administration in the emergency room of University Hospital Marques de Valdecilla. • Introduction: Adverse events related to health care, are increasingly common, it is estimated that between 44000 and 98000 people served in U.S. hospitals die from adverse events related to health care. In 7000 these deaths are caused by medication errors. In Spain the studies speak of similar figures. The emergency services are excluded usually in these studies because of its particular characteristics, but also are well known that these are characteristics (speed of decision-making, not having systems in unit dose dispensing ... what is expected that mistakes can be produced in larger numbers in emergency services in the areas of Spain hospitalization. • Method: This is a descriptive study in which cross-examine a sample of 627 administrations made in different areas of attention of the Emergency Department Valdecilla Hospital, in different time slots, months of the year and days a week. Between the months of January and December 2009.• Results: Have detected 119 errors in 627 observations, the most common error is log.• Conclusions: We have found a lower incidence of error 2.7%, comparing with other work (10%. While most of the studies reviewed speak of medication errors in general, including prescription, transcription, and administration.

  20. The interface of quality management and the hospital information department.

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    Spath, P L

    1993-02-01

    Hospital leadership, the Joint Commission, third-party payors, health care researchers, and others are repeatedly recognizing the essential role of information management in their quality improvement objectives. The health information department must become more proactive in its acknowledgment of these responsibilities by instituting the continuous quality improvement model. This model will prevent proactiveness from turning into mere reactiveness. As suggested by Peter Senge in The Fifth Discipline, "all too often, 'proactiveness' is reactiveness in disguise. If we simply become more aggressive fighting the 'enemy out there,' we are reacting--regardless of what we call it. True proactiveness comes from seeing how we contribute to our own problems."

  1. Laparoscopic total extraperitoneal repair under spinal anesthesia versus general anesthesia: a randomized prospective study

    OpenAIRE

    2016-01-01

    Turgut Donmez,1 Vuslat Muslu Erdem,2 Oguzhan Sunamak,3 Duygu Ayfer Erdem,2 Huseyin Imam Avaroglu1 1Department of General Surgery, 2Department of Anesthesiology and Reanimation, Lutfiye Nuri Burat State Hospital, 3Department of General Surgery, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey Background: Laparoscopic total extraperitoneal (TEP) inguinal hernia repair is a well-known approach to inguinal hernia repair that is usually performed under general anesthesia (GA). ...

  2. Intraoperative and anesthesia-related cardiac arrest and its mortality in older patients: a 15-year survey in a tertiary teaching hospital.

    Directory of Open Access Journals (Sweden)

    Juscimar C Nunes

    Full Text Available BACKGROUND: Little information is known about factors that influence perioperative and anesthesia-related cardiac arrest (CA in older patients. This study evaluated the incidence, causes and outcome of intraoperative and anesthesia-related CA in older patients in a Brazilian teaching hospital between 1996 and 2010. METHODS: During the study, older patients received 18,367 anesthetics. Data collected included patient characteristics, surgical procedures, American Society of Anesthesiologists (ASA physical status, anesthesia type, medical specialty team and outcome. All CAs were categorized by cause into one of four groups: patient's disease/condition-related, surgery-related, totally anesthesia-related or partially anesthesia-related. RESULTS: All intraoperative CAs and deaths rates are shown per 10,000 anesthetics. There were 100 CAs (54.44; 95% confidence intervals [CI]: 44.68-64.20 and 68 deaths (37.02; 95% CI: 27.56-46.48. The majority of CAs were patient's disease-/condition-related (43.5; 95% CI: 13.44-73.68. There were six anesthesia-related CAs (3.26; 95% CI: 0.65-5.87 - 1 totally and 5 partially anesthesia-related, and three deaths, all partially anesthesia-related (1.63; 95% CI: 0.0-3.47. ASA I-II physical status patients presented no anesthesia-related CA. Anesthesia-related CA, absent in the last five years of the study, was due to medication-/airway-related causes. ASA physical status was the most important predictor of CA (odds ratio: 14.52; 95% CI: 4.48-47.08; P<0.001 followed by emergency surgery (odds ratio: 8.07; 95% CI: 5.14-12.68; P<0.001. CONCLUSIONS: The study identified high incidence of intraoperative CAs with high mortality in older patients. The large majority of CAs were caused by factors not anesthesia-related. Anesthesia-related CA and mortality rates were 3.26 and 1.63 per 10,000 anesthetics, with no anesthesia-related CA in the last five years of the study. Major predictors of intraoperative CAs were poorer ASA

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

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    Youmbissi T

    2001-01-01

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

  4. 药师派驻麻醉科开展药品使用管理的实践%Practices of pharmacists stationed in anesthesia department to develop drug management

    Institute of Scientific and Technical Information of China (English)

    徐萍; 阮列敏; 戴微微; 黄长顺; 乐岚; 陈江飞

    2015-01-01

    Objectives: By dispatching professional pharmacists to anesthesia department to establish a new drug management mode, improve their efficiency and quality, and prevent narcotic converted into illegal channels. Methods: Two professional pharmacists are stationed in anesthesia department, some standard medicine kits, special anesthetic prescriptions and drug applications form were designed and the whole process of requisition, storage, use and recycle were regulated by professional pharmacists. Data before(July to December, 2012) and after(July to December, 2012) implementing professional pharmacists stationed in anesthesia department were collected to comparatively analyze drug consumption frequently used in operations, preparation time before anesthetic under different anesthesia, unqualified anesthetic prescriptions etc. Results: Under new management mode, the consumption of general drug in operation is going down, the preparation time before anesthetic is shorter and unqualified anesthetic prescriptions are reduced obviously, difference between two groups has statistical significance. Conclusions: A comprehensive and systematical drug management under pharmacists can not only guarantee the safety and rational use of drug, but also can improve the efficiency and quality in anesthesia department, it provides a useful method and experience for Drug Management in anesthesia department of general hospital and is worthy to be promoted.%目的:通过专职药师派驻麻醉科开展工作,建立麻醉科药品使用管理新模式,提高麻醉科工作效率和质量,防止麻醉药品流入非法渠道。方法:2名专职药师派驻麻醉科,设置标准配备的麻醉药箱,设计麻醉药品专用处方和各类药品使用登记表单,对所有药品的领用、储存、使用和回收等环节进行全程接管,同时采集2012年7月-12月和2013年同期数据,将手术麻醉使用频度较高药品的消耗数、不同麻醉方式、麻醉

  5. Contribution of the outpatient surgery unit ITO the general surgery department of a district hospital.

    Science.gov (United States)

    Carrasco; Flores; Aguayo; de Andres B; Moreno Egea A; Cartagena; De Vicente JP; Martin

    2000-07-01

    Introduction: The creation of Outpatient Surgery (OPS) units to combine the quality of medical attention and rationalize costs allows for greater efficiency in the use of resources. Aim: To report our series of patients undergoing surgery at the OPS units integrated into our Hospital (Type II): Patients and method: Between May 1994 and March 1998, 832 outpatients, of a total of 5230, underwent surgery at our General Surgery Unit. The criteria for exclusion from the programme depended on the patient and the enviroment or resulted from the operation itself. Results: Mean patient age was 47.5 years; there were 420 males and 412 females. Surgery was performed for 229 inguinofemoral hernias, 47 umbilical-epigastric hernias, nine incisional hernias, 193 pilonidal sinuses, 156 mammary nodules, 65 varicose veins, 64 arteriovenous fistulae and 69 proctology operations. The most common anesthesia techniques performed were rachianesthesia and local anesthesia. Eight point seven percent of the patients required admission (OPS failure), the most frequent causes being excessive pain, orthostatic-syncopal hypotension, nausea and vomiting and urine retention. There was no morbidity or mortality. Conclusion: OPS is a highly efficient procedure for resolving the most common pathologies in General Surgery. The anesthesia technique was an important factor in the rate of failure.

  6. Wait Time for Treatment in Hospital Emergency Departments: 2009

    Science.gov (United States)

    ... Health Aff 27(2):W84–95. 2008. American College of Emergency Physicians Crowding Resources Task Force. Responding to emergency department crowding: A guidebook for chapters. Dallas, TX. 2002. National Center for Health Statistics. NHAMCS Micro-data File Documentation. 2009. [PDF - 1. ...

  7. Integration of a psychoanalytic liaison department at a public hospital.

    Science.gov (United States)

    Neuburger, R P

    2000-08-01

    A general overview of liaison-psychoanalysis in a general hospital is presented. The team's trajectory is revisited, as generating a presence in the inpatient units: a demand which changes from a purely psychiatric, scarcely operative level to an acknowledgment of subjectivity. Generally, this appears disruptively in medical proceedings. Two case histories are presented: (i) 'the tenant' and (ii) 'the nail-polishing file'. With regard to the first case history, the transference in its double aspect, with the patient as well as with the unit's staff, is examined. The analyst's intervention seeks to untangle the impasse, which prevents the physicians from helping the patient. With regard to the second case history, in which the de-mystification aspects of liaison work are shown, the horror that the so-called 'mental illness' can produce in the medical institution is explored. The aim of narrating this experience is to preserve a psy-space in the hospital where the overwhelming technological developments menace with its disappearance.

  8. Intraoperative cardiac arrest during anesthesia:a retrospective study of 218 274 anesthetics undergoing non-cardiac surgery in a US teaching hospital

    Institute of Scientific and Technical Information of China (English)

    AN Jian-xiong; Li-Ming Zhang; Erin A.Sullivan; GUO Qu-lian; John P.Williams

    2011-01-01

    Background Patient safety has been gained much more attention in recent years.The authors reviewed patients who had cardiac arrest in the operating rooms undergoing noncardiac surgery between January 1989 and December 2001 at the University of Pittsburgh Medical Center,USA.The main objectives of the study were to determine the incidence of intraoperative cardiac arrest,to identify possible causes of cardiac arrest and to explore amenable modifications.Methods With approval by the University of Pittsburgh Institutional Review Board,patients experienced cardiac arrest during surgery were retrieved from medical records,surgical operation and anesthesia records and pathological reports by searching the Medical Archival Retrieval System (MARS),a hospital electronic searching system.Cases of cardiac arrest were collected over a period of thirteen years from the Pre byteria University Hospital (PUH),USA.Results We found 23 cases of intraoperative cardiac arrests occurred in 218 274 anesthesia cases (1.1 per 10 000).Fourteen patients (60.8%) died in the operating room,leading to a mortality rate from all causes of 0.64 per 10 000 anesthetics.Immediate overall survival rate after arrest was 39% (9/23).Half of the patients (12/23) were emergency cases with 41% survival rate (5/12).One fourth of the arrests were trauma patients (6/23).Most arrest patients (87%,20/23) were American Society of Anesthesiologists Physical Status (ASA PS) Ⅳ and Ⅴ,while only three patients were ASA PS-Ⅰ,Ⅱ and Ⅲ,respectively.One case was attributable to an anesthesia-related cardiac arrest and recovered after successful resuscitation.Conclusions Most intraoperative cardiac arrests were not due to anesthesia-related causes.Anesthesia-related cardiac arrests might have a higher survival rate when compared to other possible causes of cardiac arrest in the operating room.

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

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1999-02-01

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

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

    Directory of Open Access Journals (Sweden)

    Jing-Dong Ke

    2015-01-01

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

  11. Does type of hospital ownership influence physicians' daily work schedules? An observational real-time study in German hospital departments

    Directory of Open Access Journals (Sweden)

    Schöffel Norman

    2009-05-01

    Full Text Available Abstract Background During the last two decades the German hospital sector has been engaged in a constant process of transformation. One obvious sign of this is the growing amount of hospital privatization. To date, most research studies have focused on the effects of privatization regarding financial outcomes and quality of care, leaving important organizational issues unexplored. Yet little attention has been devoted to the effects of privatization on physicians' working routines. The aim of this observational real-time study is to deliver exact data about physicians' work at hospitals of different ownership. By analysing working hours, further impacts of hospital privatization can be assessed and areas of improvement identified. Methods Observations were made by shadowing 100 physicians working in private, for-profit or non-profit as well as public hospital departments individually during whole weekday shifts in urban German settings. A total of 300 days of observations were conducted. All working activities were recorded, accurate to the second, by using a mobile personal computer. Results Results have shown significant differences in physicians' working activities, depending on hospital ownership, concerning working hours and time spent on direct and indirect patient care. Conclusion This is the first real-time analysis on differences in work activities depending on hospital ownership. The study provides an objective insight into physicians' daily work routines at hospitals of different ownership, with additional information on effects of hospital privatization.

  12. Does type of hospital ownership influence physicians' daily work schedules? An observational real-time study in German hospital departments

    Science.gov (United States)

    Mache, Stefanie; Scutaru, Cristian; Vitzthum, Karin; Quarcoo, David; Schöffel, Norman; Welte, Tobias; Klapp, Burghard F; Groneberg, David A

    2009-01-01

    Background During the last two decades the German hospital sector has been engaged in a constant process of transformation. One obvious sign of this is the growing amount of hospital privatization. To date, most research studies have focused on the effects of privatization regarding financial outcomes and quality of care, leaving important organizational issues unexplored. Yet little attention has been devoted to the effects of privatization on physicians' working routines. The aim of this observational real-time study is to deliver exact data about physicians' work at hospitals of different ownership. By analysing working hours, further impacts of hospital privatization can be assessed and areas of improvement identified. Methods Observations were made by shadowing 100 physicians working in private, for-profit or non-profit as well as public hospital departments individually during whole weekday shifts in urban German settings. A total of 300 days of observations were conducted. All working activities were recorded, accurate to the second, by using a mobile personal computer. Results Results have shown significant differences in physicians' working activities, depending on hospital ownership, concerning working hours and time spent on direct and indirect patient care. Conclusion This is the first real-time analysis on differences in work activities depending on hospital ownership. The study provides an objective insight into physicians' daily work routines at hospitals of different ownership, with additional information on effects of hospital privatization. PMID:19473487

  13. Adolescent alcohol intoxication in the dutch hospital departments of pediatrics: A 2-year comparison study

    NARCIS (Netherlands)

    Hoof, J.J. van; Lely, N. van der; Bouthoorn, S.H.; Dalen, W.E. van; Pereira, R.R.

    2011-01-01

    Purpose: To monitor the prevalence of, and the circumstances leading to, adolescent alcohol intoxication admissions in Dutch hospital departments of pediatrics. Methods: Data were collected in 2007 and 2008, using the Dutch Pediatric Surveillance System, in which pediatricians received questionnaire

  14. Laparoscopic total extraperitoneal repair under spinal anesthesia versus general anesthesia: a randomized prospective study

    Directory of Open Access Journals (Sweden)

    Donmez T

    2016-10-01

    Full Text Available Turgut Donmez,1 Vuslat Muslu Erdem,2 Oguzhan Sunamak,3 Duygu Ayfer Erdem,2 Huseyin Imam Avaroglu1 1Department of General Surgery, 2Department of Anesthesiology and Reanimation, Lutfiye Nuri Burat State Hospital, 3Department of General Surgery, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey Background: Laparoscopic total extraperitoneal (TEP inguinal hernia repair is a well-known approach to inguinal hernia repair that is usually performed under general anesthesia (GA. To date, no reports compare the efficacy of spinal anesthesia (SA with that of GA for laparoscopic hernia repairs. The purpose of this study was to compare the surgical outcome of TEP inguinal hernia repair performed when the patient was treated under SA with that performed under GA. Materials and methods: Between July 2015 and July 2016, 50 patients were prospectively randomized to either the GA TEP group (Group I or the SA TEP group (Group II. Propofol, fentanyl, rocuronium, sevoflurane, and tracheal intubation were used for GA. Hyperbaric bupivacaine (15 mg and fentanyl (10 µg were used for SA to achieve a sensorial level of T3. Intraoperative events related to SA, operative and anesthesia times, postoperative complications, and pain scores were recorded. Each patient was asked to evaluate the anesthetic technique by using a direct questionnaire filled in 3 months after the operation. Results: All the procedures were completed by the allocated method of anesthesia as there were no conversions from SA to GA. Pain was significantly less for 1 h (P<0.0001 and 4 h (P=0.002 after the procedure for the SA and GA groups, respectively. There was no difference between the two groups regarding complications, hospital stay, recovery, or surgery time. Generally, patients were more satisfied with SA than GA (P<0.020. Conclusion: TEP inguinal hernia repair can be safely performed under SA, and SA was associated with less postoperative pain, better recovery, and better

  15. Using Lean Six Sigma Methodology to Improve Quality of the Anesthesia Supply Chain in a Pediatric Hospital.

    Science.gov (United States)

    Roberts, Renée J; Wilson, Ashley E; Quezado, Zenaide

    2017-03-01

    Six Sigma and Lean methodologies are effective quality improvement tools in many health care settings. We applied the DMAIC methodology (define, measure, analyze, improve, control) to address deficiencies in our pediatric anesthesia supply chain. We defined supply chain problems by mapping existing processes and soliciting comments from those involved. We used daily distance walked by anesthesia technicians and number of callouts for missing supplies as measurements that we analyzed before and after implementing improvements (anesthesia cart redesign). We showed improvement in the metrics after those interventions were implemented, and those improvements were sustained and thus controlled 1 year after implementation.

  16. Non-Opioid Analgesics Consumption At The Surgery Departments Of A Secondary Care Hospital In General Hospital In Kraljevo, Serbia

    OpenAIRE

    Aleksic Dejan; Bukonjic Andriana; Stefanovic Srdjan

    2015-01-01

    The aim of this study was to determine the amount of non-opioid analgesics consumed at the surgical departments of a secondary care hospital in Serbia, a developing country undergoing a socioeconomic transition that thus lacks sufficient funds to finance and invest in the healthcare system.

  17. Non-Opioid Analgesics Consumption At The Surgery Departments Of A Secondary Care Hospital In General Hospital In Kraljevo, Serbia

    Directory of Open Access Journals (Sweden)

    Aleksic Dejan

    2015-09-01

    Full Text Available The aim of this study was to determine the amount of non-opioid analgesics consumed at the surgical departments of a secondary care hospital in Serbia, a developing country undergoing a socioeconomic transition that thus lacks sufficient funds to finance and invest in the healthcare system.

  18. Does outsourcing paramedical departments of teaching hospitals affect educational status of the students?

    Science.gov (United States)

    Moslehi, Shandiz; Atefimanesh, Pezhman; Sarabi Asiabar, Ali; Ahmadzadeh, Nahal; Kafaeimehr, Mohamadhosein; Emamgholizadeh, Saeid

    2016-01-01

    Background: There is an increasing trend of outsourcing public departments. Teaching hospitals also outsourced some of their departments to private sectors. The aim of this study was to investigate and compare the educational status of students in public and outsourced departments of teaching hospitals affiliated to Iran University of Medical Sciences. Methods: This study was conducted in six teaching hospitals of Iran University of Medical Sciences, which had public and outsourced teaching departments in 2015. One hundred fifty students from the departments of radiology, physiotherapy and laboratory participated in this study and their perceptions about their educational status were assessed. A valid and reliable questionnaire was used; participation in the study was voluntary. Descriptive statistics such as mean (SD), t-test and Kolmogorov-Smirnov were used. Results: No difference was detected between the educational status of students in public and outsourced departments of radiology, physiotherapy and laboratory (p>0.05). Conclusion: Based on the students’ perception, the private sectors could maintain the educational level of the teaching departments similar to the public departments. It is recommended to involve all the stakeholders such as hospital administrators, academic staff and students in the decision- making process when changes in teaching environments are being considered. PMID:27683645

  19. Designing for Economies of Scale vs. Economies of Focus in Hospital Departments

    NARCIS (Netherlands)

    Vanberkel, Peter T.; Boucherie, Richard J.; Hans, Erwin W.; Hurink, Johann L.; Litvak, Nelly

    2010-01-01

    Subject/Research problem: Hospitals traditionally segregate resources into centralized functional departments such as diagnostic departments, ambulatory care centres, and nursing wards. In recent years this organizational model has been challenged by the idea that higher quality of care and efficien

  20. Waiting times before dental care under general anesthesia in children with special needs in the Children's Hospital of Casablanca

    OpenAIRE

    Badre, Bouchra; Serhier, Zineb; El Arabi, Samira

    2014-01-01

    Introduction Oral diseases may have an impact on quality of children's life. The presence of severe disability requires the use of care under general anesthesia (GA). However, because of the limited number of qualified health personnel, waiting time before intervention can be long. Aim: To evaluate the waiting time before dental care under general anesthesia for children with special needs in Morocco. Methods A retrospective cohort study was carried out in pediatric dentistry unit of the Univ...

  1. 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...

  2. [Anesthesia for ambulatory patients].

    Science.gov (United States)

    Landauer, B

    1975-11-13

    The specific problems of outpatient anesthesia are discussed with respect to the patient's condition, the anesthesist's qualification and pharmacological properties of anesthetics used. Methohexitone seems to be the best choice for induction. Problems may arise from the use of Propanidid, Ketamin and Diazepam. Nitrousoxide and Enflurane are a suitable completion. Endotracheal intubation, if needed, is facilitated by Suxamethonium, which is rapidly eliminated. Practical aspects of timing, premedication, induction, maintenance and ending of anesthesia are pointed out. After 1-2 hours the patient can be allowed to leave the hospital accompanied by a responsible person. Driving a car is not recommended before 24 hours have elapsed since anesthesia.

  3. Building areas of hospitals in Japan and distribution of areas by department--1980's.

    Science.gov (United States)

    Itoh, M; Nakayama, S; Liu, Y Y; Kawaguchi, Y

    1993-07-01

    (1) Areas of entire hospitals which have been continuously increasing in the past 30 years are finally showing signs for slowing down. The areas of the hospitals completed in the 1980's were generally 50 to 80 m2 per bed. (2) The distribution of the nursing department to the entire hospitals in area ratio ranges from 30 to slightly more than 40%, or higher than 35% in most cases. The actual areas of the nursing department has surpassed 20 m2 per bed in a considerably large number of hospitals. (3) The area ratio of the outpatient department tends to concentrate to about 12%. Of this percentage, in almost all hospitals, the proportion of the emergency division was less than 2%. (4) As in the 1970's, the diagnostic and treatment facilities were within the range of 18 to 22% in the majority of the hospitals. The distribution shifted to ratios higher than the previous survey. The distributions for the various sections are as follows: 1) Specimen test rooms 3 to 5% 2) Physiological examination rooms slightly below 1% to slightly above 2% 3) X-ray diagnosis rooms about 4% 4) Radiation therapy rooms about 1% 5) Nuclear medicine rooms about 1% 6) Operating department 3 to 5%, 2 to 3 m2/bed 7) Delivery suite less than 1% 8) Rehabilitation department 1 to 4% 9) Hemodialysis suite about 1% (5) The area ratios of the supply department dispersed substantially between 12 and 25%. About 70% of the hospitals remained in the range of 15 to 20%. The ratios of the various sections in the department are as follows: 1) Pharmacy: slightly less than 2% to slightly less than 3% 2) Central sterile and supply department: about 2% 3) Blood bank: installed in hospitals with more than 500 beds 4) Kitchen: slightly more than 2% to slightly more than 3%, 1.5 to 2.5 m2/bed 5) Laundry: less than 1% 6) Central storage and material hundling unit: about 1% 7) Mechanical plant: 5 to 13% (6) The administration department allocates 7 to 14% of its area to the management division and 2 to 6% to the

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

    OpenAIRE

    Soumya Nayak; Lloyd J. Taylor

    2012-01-01

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

  5. Monitoring compliance with transfusion guidelines in hospital departments by electronic data capture

    DEFF Research Database (Denmark)

    Norgaard, Astrid; De Lichtenberg, Trine Honnens; Nielsen, Jens

    2014-01-01

    and per hospital admission. Transfusion practice was more liberal in surgical and intensive care units than in medical departments. DISCUSSION: We described pre-transfusion haemoglobin levels, transfusion rates and volumes at hospital and departmental levels, and in surgical subpopulations. Initial data...... volumes. RESULTS: The model dataset include 33,587 admissions, of which 10% had received at least one unit of red blood cells. Haemoglobin measurements preceded 96.7% of the units transfused. The median pre-transfusion haemoglobin was 8.9 g/dL (interquartile range 8.2-9.7) at the hospital level. In only 6......-transfusion haemoglobin levels at the departmental level. In a tertiary care hospital, no such data were produced before this study. Our aim was to establish a Patient Blood Management database based on electronic data capture in order to monitor compliance with transfusion guidelines at departmental and hospital levels...

  6. Survey of international regional anesthesia fellowship directors

    Directory of Open Access Journals (Sweden)

    Lansdown AK

    2013-07-01

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

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

    Directory of Open Access Journals (Sweden)

    Kara H

    2013-12-01

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

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

    Directory of Open Access Journals (Sweden)

    Birva N Khara

    2013-08-01

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

  9. Patient safety in obstetrics and gynecology departments of two teaching hospitals in Delhi

    Directory of Open Access Journals (Sweden)

    Bindiya Gupta

    2016-01-01

    Full Text Available Background: A healthy safety culture is integral to positive health care. A sound safety climate is required in Obstetrics and Gynecology to prevent adverse outcomes. Objective: The objective of this study was to assess and compare patient safety culture in two departments of Obstetrics and Gynecology. Materials and Methods: Using a closed-ended standard version of Hospital Survey on Patient Safety Culture (HSOPS, respondents were asked to answer 42 survey items, grouped into 10 dimensions and two outcome variables in two tertiary care teaching hospitals in Delhi. Qualitative data were compared using Fisher's exact test and chi-square test wherever applicable. Mean values were calculated and compared using unpaired t-test. Results: The overall survey response rate was 55%. A positive response rate of 57% was seen in the overall perception of patient safety that ranged from very good to acceptable. Sixty-four percent showed positive teamwork across hospital departments and units, while 36% gave an affirmative opinion with respect to interdepartmental handoffs. However, few adverse events (0-10 were reported in the last 12 months and only 38% of mistakes by doctors were reported. Half of the respondents agreed that their mistakes were held against them. There was no statistical difference in the safety culture between the two hospitals. Conclusions: Although the perception of patient safety and standards of patient safety were high in both the hospitals' departments, there is plenty of scope for improvement with respect to event reporting, positive feedback, and nonpunitive error.

  10. Patient Safety in Obstetrics and Gynecology Departments of two Teaching Hospitals in Delhi

    Science.gov (United States)

    Gupta, Bindiya; Guleria, Kiran; Arora, Renu

    2016-01-01

    Background: A healthy safety culture is integral to positive health care. A sound safety climate is required in Obstetrics and Gynecology to prevent adverse outcomes. Objective: The objective of this study was to assess and compare patient safety culture in two departments of Obstetrics and Gynecology. Materials and Methods: Using a closed-ended standard version of Hospital Survey on Patient Safety Culture (HSOPS), respondents were asked to answer 42 survey items, grouped into 10 dimensions and two outcome variables in two tertiary care teaching hospitals in Delhi. Qualitative data were compared using Fisher's exact test and chi-square test wherever applicable. Mean values were calculated and compared using unpaired t-test. Results: The overall survey response rate was 55%. A positive response rate of 57% was seen in the overall perception of patient safety that ranged from very good to acceptable. Sixty-four percent showed positive teamwork across hospital departments and units, while 36% gave an affirmative opinion with respect to interdepartmental handoffs. However, few adverse events (0-10) were reported in the last 12 months and only 38% of mistakes by doctors were reported. Half of the respondents agreed that their mistakes were held against them. There was no statistical difference in the safety culture between the two hospitals. Conclusions: Although the perception of patient safety and standards of patient safety were high in both the hospitals' departments, there is plenty of scope for improvement with respect to event reporting, positive feedback, and nonpunitive error. PMID:27385879

  11. Relationship between commitment to hospital goals and job satisfaction: a case study of a nursing department.

    Science.gov (United States)

    Alpander, G G

    1990-01-01

    Why is it that people in the same occupation doing similar work in the same department experience different levels of intrinsic satisfaction? This article sheds light on this question and provides hospital administrators with guidelines for improving employee motivation through intrinsic job satisfaction.

  12. The role of regional and neuroaxial anesthesia in patients with systemic sclerosis

    Directory of Open Access Journals (Sweden)

    Dempsey Z

    2011-10-01

    Full Text Available Zoey Sarah Dempsey1, Simone Rowell2, Rose McRobert31Department of Anaesthesia, Southern General Hospital, Glasgow, Lanarkshire, 2Department of Anaesthesia, Western Infirmary, Glasgow, Lanarkshire, 3Department of Anaesthesia, The Ayr Hospital, Ayr, Aryshire, UKAbstract: Systemic sclerosis (SSc, previously known as progressive systemic sclerosis, is a form of scleroderma and a multisystem connective tissue disease which can impact on every aspect of anesthetic care, especially airway management. In this review we outline clinical manifestations and current medical treatment of the disease, and general principles of anesthetizing these patients. We focus on the role of regional anesthesia, including neuroaxial anesthesia, which may serve as a safe alternative to general anesthesia but can be technically challenging. We address concerns regarding abnormal responses to local anesthesia which have previously been reported in patients with SSc, and explore future developments in technology and pharmacology, which may enable regional anesthesia to be performed more successfully and with fewer complications.Keywords: systemic sclerosis, scleroderma, regional anesthesia, neuroaxial anesthesia

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

    DEFF Research Database (Denmark)

    Traberg, Andreas; Jacobsen, Peter

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

  14. Social Work in the Department of Defense Hospital: Impact of the Work

    Directory of Open Access Journals (Sweden)

    Joan C. Beder

    2012-03-01

    Full Text Available Social workers in the Department of Defense Hospital are faced with numerous challenges to best address the needs of the nation’s wounded. Social workers serve diverse roles on the multidisciplinary team and are integral to the hospital work environment. Sometimes, however, the work extracts a toll on the social worker that may be expressed in terms of burnout and compassion fatigue. The converse is also true, that social workers may have a strong sense of compassion satisfaction about what they do. This article details the experience of social workers in Department of Defense hospitals. It describes the impact of the work on the social workers noting levels of compassion satisfaction, compassion fatigue, and burnout. Findings suggest that generally the social workers find satisfaction in their work and degrees of compassion fatigue and burnout.

  15. Acinetobacter sp. isolates from emergency departments in two hospitals of South Korea.

    Science.gov (United States)

    Choi, Ji-Young; Ko, Eun Ah; Kwon, Ki Tae; Lee, Shinwon; Kang, Choel In; Chung, Doo-Ryeon; Peck, Kyong Ran; Song, Jae-Hoon; Ko, Kwan Soo

    2014-10-01

    A total of 114 Acinetobacter sp. isolates were collected from patients in the emergency departments (EDs) of two Korean hospitals. Most isolates belonged to the Acinetobacter baumannii complex (105 isolates, 92.1 %). Imipenem resistance was found in 39 isolates (34.2 %) of the Acinetobacter sp. isolates, and 6 colistin-resistant isolates were also identified. Species distribution and antimicrobial-resistance rates were different between the two hospitals. In addition, two main clones were identified in the imipenem-resistant A. baumannii isolates from hospital B, but very diverse and novel genotypes were found in those from hospital A. Many Acinetobacter sp. isolates, including the imipenem-resistant A. baumannii, are considered to be associated with the community. The evidence of high antimicrobial resistance and different features in these Acinetobacter sp. isolates between the two EDs suggests the need for continuous testing to monitor changes in epidemiology.

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

    Directory of Open Access Journals (Sweden)

    Soumya Nayak

    2012-10-01

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

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

    Data.gov (United States)

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

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

    Directory of Open Access Journals (Sweden)

    Fereshteh Farzianpour

    2011-01-01

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

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

    OpenAIRE

    2007-01-01

    Purpose : In order to profits to investigator who want to know acupuncture and moxbustion treatments are available to what symptoms today and how goes on the clinical lecture for oriental medical students, this research was carried out. Methods : The following conclusion were derived from 745 of patients who treated in acupunture & moxibustion department of Dongeui Oriental Medical hospital from the July in 2006 till January in 2007. Results : 1. There were 203(27.25%) persons of Lumbag...

  20. First Chinese public hospital wins Joint Commission International accreditation: the Health Information Department played a key role in the process.

    Science.gov (United States)

    Shaffer, Audrey; Jun, Cheng Li

    2008-07-01

    Sir Run Run Shaw Hospital in Hangzhou, China spent five years preparing for a Joint Commission International accreditation survey. In March 2007 it became the first public hospital on the Chinese mainland to attain international accreditation. The Health Information Department, managed according to Western standards, played an integral role in preparing the hospital for the survey.

  1. 38 CFR 17.51 - Emergency use of Department of Defense, Public Health Service or other Federal hospitals.

    Science.gov (United States)

    2010-07-01

    ... Health Service Or Other Federal Hospitals § 17.51 Emergency use of Department of Defense, Public Health... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Emergency use of Department of Defense, Public Health Service or other Federal hospitals. 17.51 Section 17.51...

  2. Anesthesia of the geriatric equine

    Directory of Open Access Journals (Sweden)

    Doherty TJ

    2012-08-01

    Full Text Available Reza Seddighi, Thomas J DohertyDepartment of Large Animal Clinical Sciences, College of Veterinary Medicine, Veterinary Medical Center, University of Tennessee, Knoxville, TN, USAAbstract: Advancements in veterinary medicine have resulted in an increased number of geriatric horses being presented for medical or surgical procedures that require general anesthesia. Due to the physiological changes associated with aging and the likelihood of concurrent disease conditions, the geriatric equine is at an increased risk during anesthesia. The main physiological changes associated with aging, and their impact on anesthesia, are discussed in this review.Keywords: geriatric, equine, anesthesia

  3. Radiation Protection in Radiology Departments of Ahvaz University of Medical Sciences Teaching Hospitals, Ahvaz, Iran, 2015

    Directory of Open Access Journals (Sweden)

    Fouladi Dehaghi

    2015-07-01

    Full Text Available Background Application of ionizing radiation in many fields especially in medicine is growing, and can cause adverse health effects. Objectives The current study aimed to evaluate the radiation protection principles in radiology departments, based on national standards. Materials and Methods The current study was conducted in all radiology departments of the teaching hospitals in Ahvaz, Iran, and their radiation protection status was investigated using Audit technique. For this purpose Audit checklist was prepared and essential information gathered by observation, interview with radiology department managers, and documentary surveying. At the end, standard situations were classified in three levels: poor (˂ 50%, medium (50 - 75%,s and good (75 - 100%. Results The mean of radiation protection in the studied radiology departments was 70.53%. The highest and lowest levels of radiation protection were in quality control and suitable ventilation, respectively. Radiation protection was evaluated as medium in 71.4% and good in 28.6% of the studied radiology departments. Conclusions The state of observed radiation protection principles was relatively in the weak level in the studied radiology departments especially in facilities such as ventilation system, radiography entrance, and darkroom situation. More important reason was usage changing of sections as radiology billet from related organizations.

  4. Hospital Factors Impact Variation in Emergency Department Length of Stay more than Physician Factors

    Science.gov (United States)

    Krall, Scott P.; Cornelius, Angela P.; Addison, J. Bruce

    2014-01-01

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

  5. The Application of Sufentanil Intravenous Anesthesia in Operations of Patients in Department of Neurosurgery%舒芬太尼静脉麻醉在神经外科手术中的应用

    Institute of Scientific and Technical Information of China (English)

    张梁

    2014-01-01

    Objective To compare the anesthesia effect of operations between fentanyl and sufentanil in patients in the Department of Neurosurgery.Methods 150 patients in Department of Neurosurgery, on the basis of different ways of anesthesia, were randomly divided into obser-vation group and control group with 75 cases in each group.The control group was treated with the intravenous anesthesia of fentanyl combined with propofol, but the observation group was treated with the sufentanil combined with propofol.The Hemodynamics changes and adverse reaction in the two groups were observed after anesthesia.Results The HR and MAP fluctuated in the observation group after anesthesia intubation and removing and the incidence rate of postoperative recovery time, postoperative vomiting, restlessness and respiratory depression were significantly lower than those in the control group ( P<0.05) .Conclusion The sufentanil an-esthesia has little influence on the oxygen metabolism and faster postoperative recovery.It has been the first choice of drug in the Department of Neurosurgery anesthesia.%目的:比较芬太尼与舒芬太尼在神经外科手术中的麻醉效果。方法选取150例神经外科手术患者为研究对象,依据麻醉方式不同,随机分为观察组和对照组各75例。对照组采用芬太尼联合丙泊酚静脉麻醉,观察组采用舒芬太尼联合丙泊酚静脉麻醉。观察围术期两组患者麻醉中血流动力学变化及术后不良反应。结果观察组麻醉插管后5 min、拔管时HR、MAP波动、术后苏醒时间、术后呕吐、烦躁、呼吸抑制等不良反应发生率均明显低于对照组( P<0.05)。结论舒芬太尼麻醉对血氧代谢影响小,术后苏醒快,可作为神经外科麻醉的首选药物。

  6. Patient satisfaction with triage nursing in a rural hospital emergency department.

    Science.gov (United States)

    Elder, Regina; Neal, Carolyn; Davis, Barbara A; Almes, Elizabeth; Whitledge, Lynn; Littlepage, Nancy

    2004-01-01

    This study examined what relationships or differences exist between patient and nurse characteristics, satisfaction with triage nurse caring behaviors, general satisfaction with the triage nurse, and intent to return to a rural hospital emergency department (ED). The ED, located at a 401-bed teaching hospital in a small southern city, averages 28,000 visits annually. Samples of ED nurses (N = 11) and ED patients (N = 65) were asked to respond to demographic forms and the Consumer Emergency Care Satisfaction Scale (CECSS) Adapted. Findings indicated that the nurse's acuity rating and the patient's perception of condition had a positive relationship. The patient's perception of condition, patient satisfaction, and caring satisfaction were predictors of intent to return. When patients perceived themselves as seriously ill or injured, they expressed less intent to return to that ED.

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

    Directory of Open Access Journals (Sweden)

    Tsoi Vincent F. K.

    2014-11-01

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

  8. Decreasing avoidable hospital admissions with the implementation of an emergency department case management program.

    Science.gov (United States)

    Sharieff, Ghazala Q; Cantonis, Matt; Tressler, Michelle; Whitehead, Mary; Russe, Jamie; Lovell, Eric

    2014-01-01

    With the passage of the Affordable Care Act, increased emphasis has been placed on optimizing quality and reducing expenditures. The use of an emergency department case manager (EDCM) is reemerging as an important initiative in the quest to provide high-quality care and decrease unnecessary hospital admissions. A pilot study of the use of EDCMs was conducted in one of the authors' EDs during a 6-month trial period. By using evidence-based criteria, the EDCM helped in real time to verify admission criteria, assisted with inpatient versus outpatient designation, found community alternatives to hospital admission, and initiated discharge planning for patients who required admission and were at high risk for readmission. EDCMs also worked with pharmacists to assist with medication management for patients who required assistance with obtaining prescriptions. Because of the pilot study's success, the authors' health care system will be implementing EDCMs throughout the organization.

  9. Disaster preparation and the functioning of a hospital social work department during the Gulf War.

    Science.gov (United States)

    Ben Shahar, I

    1993-01-01

    The nature of the Gulf War and its consequences for the public at the personal and community levels, called for considerable alterations in organization and management at the Chaim Sheba Medical Center, the largest government general hospital in Israel, with constant adaptation to the changing situation. The preparations and exercises preceding the state of emergency, combined with the knowledge and experience gained in similar situations in the past, equipped the staff of the Social Work Department to function adequately and to make appropriate decisions and changes in the face of moral and ethical dilemmas, as well as immediate physical threat. This article presents the rationale for the model of intervention that guided the hospital during the Gulf War in offering services to casualty victims and their families. Also discussed are the process of developing an organizational framework and its content that meets wartime demands, and the implications for social work practice in dealing with a war crisis.

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

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    Eshghyar N

    1999-12-01

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

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

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    Williams Eric W

    2008-10-01

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

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

    Directory of Open Access Journals (Sweden)

    Bora Koc

    2014-01-01

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

  13. Contrasting treatment and outcomes of septic shock: presentation on hospital floors versus emergency department

    Institute of Scientific and Technical Information of China (English)

    WANG Zhen; Chrism Schorr; Krystal Hunter; R. Phillip Dellinger

    2010-01-01

    Background Patients with septic shock have a high mortality. This study used the Surviving Sepsis Campaign (SSC)database to compare characteristics, treatments and outcomes of septic shock patients diagnosed in the emergency department (ED) to patients developing septic shock on hospital floors (HF).Methods The studied population included patients admitted to the intensive care unit (ICU) of an urban tertiary care medical center over an 18-month period. Acute physiology and chronic health evaluation (APACHE Ⅱ) scores, need for mechanical ventilation (MV), performance on four of the SSC resuscitation bundle indicators, ICU length of stay (LOS),hospital LOS and in-hospital mortality were ascertained.Results Sixty-six ED and 27 HF septic shock patients were included in this study. Urinary tract infections (UTI) and pneumonia were the two most common sites of infection in the ED patients. The sources of infection for HF septic shock patients were fairly well distributed across etiologies. The time to achieve superior vena cava oxygen saturation (ScvO2)> 70% in HF patients ((10.8±9.1) hours) was longer when compared to the ED patients ((6.6±-6.1) hours) (P <0.05).Hospital mortality for the ED and HF patients were 25.8% and 59.3%, respectively (P <0.05). Use of MV during the first 24 hours of shock was 44% in the ED patients and 70% in the HF patients (P <0.05) and was linked to mortality.Conclusions When compared to HF patients, ED septic shock patients have lower in-hospital mortality, there was less use of MV during the first 24 hours following onset of septic shock and the HF patients required a longer time to achieve target ScvO2. The need for mechanical ventilation is independently associated with increased mortality.

  14. [Simulation of a hospital emergency department and its potential use in management].

    Science.gov (United States)

    Barber Pérez, P; González López-Valcárcel, B

    1994-01-01

    We developed a computer simulation model of Emergency Department Operations of the Hospital Ntra. Sra. del Pino as a queue system. We designed and analyzed alternative functional structures of the Department and their implications on resources organization and reallocation. We programmed the operations, relations and flows between the components of the system with the simulation language SIMSCRIPT II.5. We have designed alternative configurations to assess how technical efficiency could be improved through the reallocation of human resources; how the system react would to interarrival time of patients changes; and what decisions must be taken about resources allocation in order to improve efficiency. Triage, Emergency Laboratory and radiology have the maximum average waiting times (11, 31 and 12 minutes, respectively). Some alternative organization patterns may improve this problem. Their social cost is also quantified in this work.

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

    Directory of Open Access Journals (Sweden)

    Kongsap P

    2012-11-01

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

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

    Science.gov (United States)

    Dodds, Peter

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

  17. Proposed ICD-10-CM Surveillance Case Definitions for Injury Hospitalizations and Emergency Department Visits.

    Science.gov (United States)

    Hedegaard, Holly B; Johnson, Renee L; Ballesteros, Michael F

    2017-01-01

    This report describes a collaboration between the National Center for Health Statistics and the National Center for Injury Prevention and Control to develop proposed surveillance case definitions for injury hospitalizations and emergency department (ED) visits for use with administrative data sets coded using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). The proposed ICD-10-CM surveillance case definitions were developed by applying General Equivalence Mappings to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) definitions. As with the ICD-9-CM definitions, there are slight differences between the proposed ICD-10-CM surveillance case definition for injury hospitalizations and the one for ED visits. The inclusion criteria for an injury hospitalization requires a case to have a principal diagnosis of one of the included nature-of-injury (injury diagnosis) codes. The inclusion criteria for an injury ED visit requires the case to have either a principal diagnosis of one of the included nature-of-injury codes or the presence of selected external-cause codes. The ICD-10-CM nature-of-injury and external-cause codes included in the proposed definitions are presented and caveats for use of the proposed definitions are described.

  18. Causality assessment of adverse drug reaction in Pulmonology Department of a Tertiary Care Hospital

    Science.gov (United States)

    Khan, Amer; Adil, Mir S.; Nematullah, K.; Ihtisham, S.; Aamer, K.; Aamir, Syed

    2015-01-01

    Background: Adverse drug reaction (ADR) is considered to be the sixth leading cause of death. The incidence rate estimates approximately 2% of hospital admissions are due to ADRs. Objective: To monitor ADRs in Pulmonology department of a tertiary care hospital patient with pulmonary diseases in an inpatient department of pulmonology. Materials and Methods: A prospective, single centered, observational and open labeled study was carried out in Princess Esra Hospital. The patient population was broadly divided into four categories based on diagnosis - chronic obstructive pulmonary disease, Infections, Asthma and Others. Suspected ADRs were reported, analyzed, and causality assessment was carried out using Naranjo's algorithm scale. Results: A total of 302 patients were observed, of which 98 patients experienced ADRs, which accounted for 32.23% of the incidence and totally 160 ADEs were observed. Adult Patients were found to have higher incidence (32.09%) while the incidence rate was slightly greater in geriatric patients (32.39%). The highest incidence of ADEs were found in others group (78.57%). Majority of ADRs were suspected to be due to theophylline (19.39%). Gastrointestinal system (38.75%) was the most common organ system affected due to ADRs. Drug was withdrawn in 12 patients, and specific treatment was administered to 32 patients in view of clinical status. Specific treatment for the management of suspected reaction was administered in 32.65% of ADR reports. Conclusion: A relatively high incidence of adverse drug events (32.2%) have been recorded which shows that not only Geriatric patients, but also adults are more susceptible to adverse drug effects. A number of drugs in combination were used, and ADEs often get multiplied. Careful therapeutic monitoring and dose individualization is necessary. PMID:26229344

  19. Hospital emergency department utilisation rates among the immigrant population in Barcelona, Spain

    Directory of Open Access Journals (Sweden)

    Garcia Oscar

    2008-03-01

    Full Text Available Abstract Background The recent increase in the number of immigrants of Barcelona represents a challenge for the public healthcare system, the emergency department being the most used healthcare service by this group. However, utilisation rates in our environment have not yet been studied. We aimed to compare emergency department utilisation rates between Spanish-born and foreign-born residents in a public hospital of Barcelona. Methods The study population included all adults residing in the area of study and visiting the emergency department of Hospital del Mar in 2004. The emergency care episodes were selected from the Emergency Department register, and the population figures from the Statistics Department of Barcelona. Emergency care episodes were classified into five large clinical categories. Adjusted rate ratios (RR of utilisation among foreign-born vs. Spanish-born residents were assessed through negative binomial regression. Results The overall utilisation rate was 382 emergency contacts per 1,000 persons-years. The RR for foreign-born versus Spanish-born residents was 0.62 (95% CI: 0.52; 0.74%. The RR was also significantly below one in surgery (0.51, 95% CI: 0.42; 0.63, traumatology (0.47, 95% CI: 0.38; 0.59, medicine (0.48, 95% CI: 0.38; 0.59 and psychiatry (0.42, 95% CI: 0.18; 0.97. No differences were found in utilisation of gynaecology and minor emergency services. Conclusion The overall lower utilisation rates obtained for foreign-born residents is consistent with previous studies and is probably due to the "healthy immigrant effect". Thus, the population increase due to immigration does not translate directly into a corresponding increase in the number of emergency contacts. The lack of differences in minor and gynaecological emergency care supports the hypothesis that immigrants overcome certain barriers by using the emergency department to access to health services. The issue of healthcare barriers should therefore be addressed

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

    OpenAIRE

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

    2013-01-01

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

  1. Predictive score for mortality in patients with COPD exacerbations attending hospital emergency departments

    Science.gov (United States)

    2014-01-01

    Background Limited information is available about predictors of short-term outcomes in patients with exacerbation of chronic obstructive pulmonary disease (eCOPD) attending an emergency department (ED). Such information could help stratify these patients and guide medical decision-making. The aim of this study was to develop a clinical prediction rule for short-term mortality during hospital admission or within a week after the index ED visit. Methods This was a prospective cohort study of patients with eCOPD attending the EDs of 16 participating hospitals. Recruitment started in June 2008 and ended in September 2010. Information on possible predictor variables was recorded during the time the patient was evaluated in the ED, at the time a decision was made to admit the patient to the hospital or discharge home, and during follow-up. Main short-term outcomes were death during hospital admission or within 1 week of discharge to home from the ED, as well as at death within 1 month of the index ED visit. Multivariate logistic regression models were developed in a derivation sample and validated in a validation sample. The score was compared with other published prediction rules for patients with stable COPD. Results In total, 2,487 patients were included in the study. Predictors of death during hospital admission, or within 1 week of discharge to home from the ED were patient age, baseline dyspnea, previous need for long-term home oxygen therapy or non-invasive mechanical ventilation, altered mental status, and use of inspiratory accessory muscles or paradoxical breathing upon ED arrival (area under the curve (AUC) = 0.85). Addition of arterial blood gas parameters (oxygen and carbon dioxide partial pressures (PO2 and PCO2)) and pH) did not improve the model. The same variables were predictors of death at 1 month (AUC = 0.85). Compared with other commonly used tools for predicting the severity of COPD in stable patients, our rule was significantly better

  2. Articaine: a review of its use for local and regional anesthesia

    Directory of Open Access Journals (Sweden)

    Snoeck M

    2012-06-01

    Full Text Available Marc SnoeckDepartment of Anaesthesia, Canisius-Wilhelmina Hospital, Nijmegen, The NetherlandsAbstract: Articaine is an intermediate-potency, short-acting amide local anesthetic with a fast metabolism due to an ester group in its structure. It is effective with local infiltration or peripheral nerve block in dentistry, when administered as a spinal, epidural, ocular, or regional nerve block, or when injected intravenously for regional anesthesia. In comparative trials, its clinical effects were not generally significantly different from those of other short-acting local anesthetics like lidocaine, prilocaine, and chloroprocaine, and there is no conclusive evidence demonstrating above-average neurotoxicity. Articaine proved to be suitable and safe for procedures requiring a short duration of action in which a fast onset of anesthesia is desired, eg, dental procedures and ambulatory spinal anesthesia, in normal and in special populations.Keywords: articaine, regional anesthesia, pharmacodynamics, pharmacokinetics, therapeutic use, tolerability, neurotoxicity

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

    Directory of Open Access Journals (Sweden)

    Meyer B

    2016-03-01

    Full Text Available Beau Meyer,1,2 Eric Adkins,3,4 Nathan M Finnerty,4 Fonda G Robinson5 1Division of Pediatric Dentistry, College of Dentistry, The Ohio State University, Columbus, OH, 2Department of Pediatric Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, 3The Ohio State University Wexner Medical Center Emergency Department, 4Department of Emergency Medicine, College of Medicine, 5Clinic Administration and Patient Care, College of Dentistry, The Ohio State University, Columbus, OH, USA Background: Emergency department (ED visits for dental reasons continue to impact EDs nationwide. This investigation determined the rate of follow-up in an emergency dental clinic (EDC after hospital ED visits for nontraumatic dental conditions. Methods: This prospective investigation reports the number of patients who presented to an ED for nontraumatic dental conditions and the rate of follow-up at an EDC. Upon ED discharge, patients were provided instructions to follow-up for low-cost care at the EDC. Telephone contact was attempted following failed referrals. Descriptive statistics were reported for comparing referral sources and demographic trends. Results: Two hundred and forty-seven referrals were made and 31% followed up for definitive treatment at the EDC. More referrals were made on weekends than on weekdays. Failed referrals were unreachable by telephone in 75% of cases. Tooth extraction was the most common treatment rendered in the EDC. Of the ED patients who accessed EDC care, 14% became comprehensive patients in the EDC's regular dental clinic. Conclusion: Less than one-third of ED referrals to the EDC followed up for definitive care when provided an opportunity to do so, and 75% of referrals were unreachable by telephone in the week following the ED dental visit. Keywords: emergencies, dental health services, health services accessibility, access to care, dental emergency treatment

  4. An audit of letters of referral to a prosthodontic department in a dental teaching hospital.

    Science.gov (United States)

    Fenlon, Michael R; Glick, Shiri; Sherriff, Martyn

    2008-09-01

    The purpose of this study was to investigate the quality and number of letters of referral for new patients received in the Prosthodontics Department of a Dental Teaching Hospital. Letters received during the month of May 2006 were included. Each letter of referral was tested against five criteria which might be expected in an appropriate letter of referral. These were information on the following: relevant dental history, relevant medical history, teeth present, diagnosis, and treatment plan. The results showed that only 8% of letters met all five criteria and 11% met none of them. Letters requesting better information were sent to referring practitioner as a result of this audit. However a re-audit in May 2007 showed that 9% of letters met all five criteria and 15% met none of them. A need has been identifiedfor better referral letters and ways of achieving this were discussed.

  5. Temporal and spatial organization of doctors' computer usage in a UK hospital department.

    Science.gov (United States)

    Martins, H M G; Nightingale, P; Jones, M R

    2005-06-01

    This paper describes the use of an application accessible via distributed desktop computing and wireless mobile devices in a specialist department of a UK acute hospital. Data (application logs, in-depth interviews, and ethnographic observation) were simultaneously collected to study doctors' work via this application, when and where they accessed different areas of it, and from what computing devices. These show that the application is widely used, but in significantly different ways over time and space. For example, physicians and surgeons differ in how they use the application and in their choice of mobile or desktop computing. Consultants and junior doctors in the same teams also seem to access different sources of patient information, at different times, and from different locations. Mobile technology was used almost exclusively during the morning by groups of clinicians, predominantly for ward rounds.

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

    Science.gov (United States)

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

    2015-12-01

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

  7. Assessing of Dialysis Adequacy in Patients under Hemodialysis in Dialysis Department of Ekbatan Hospital in Hamadan

    Directory of Open Access Journals (Sweden)

    E. Nadi

    2003-10-01

    Full Text Available Determining reduction proportion of blood urea in patients under hemodialysis in dialysis department of Ekbatan hospital and comparison between obtained results and standard scales. This study was descriptive, cross - Sectional. In this study the number of 100 patient under dialysis in were evaluated and their blood samples were accumitated before and after dialysis and were transferred to the laboratory. Results were calculated by BUN formula, meanwhile the other parameters as, the time of dialysis, speed of blood circulation, percentage of filter clearance, patient weight before and after dialysis, blood pressure before and after dialysis, also evaluated and registered. To consider the obtained results from BUN calculations we found out that 10% of individuals have URR 65%. In that the results are in accord with standard scales, and revealed adequate dialysis. About 34% were near accepted range (55%-64%. The rest of individuals about 56% were lower than accepted URR.

  8. DRUG UTILIZATION STUDY OF URINARY TRACT INFECTIONS IN MEDICINE DEPARTMENT IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Rajat

    2014-11-01

    Full Text Available : BACKGROUND: The WHO in 1977 provided the proper definition of Drug Utilization. It has been defined as the marketing, distribution, prescription and use of drugs in society with special emphasis on the resulting medical and social consequences. Urinary tract infection (UTI is caused by pathogenic invasion of the urinary tract which leads to an inflammatory response of the urothelium. Urinary tract infections are common burden in patients with diabetes mellitus. Cystitis, ascending infection leading to pyelonephritis, impaired leucocyte function, recurrent vaginitis, emphysematous complications and renal/perinephric abscesses are well recognized in this group of patients if glycemic control is poor. The present study was undertaken to identify the common pathogens and drug sensitivity pattern of the isolate among patients who attended the medicine outpatients department so as to guide empirical treatment. OBJECTIVES: To evaluate prescription pattern of antibiotics in UTI in medicine department in a tertiary care hospital. Study of type of patients along with type of UTI major symptoms, precipitating factors, evaluation of uropathogens. To analyze rationality among the prescriptions. METHODS AND MATERIALS: This prospective, observational and analytical study was done to assess the antibiotics prescribed in UTI in medicine department in a tertiary care hospital. Gender distribution, age wise distribution, type of patients (outpatients, inpatients, type of UTI (complicated, uncomplicated, presenting symptoms, lab investigations related to UTI, microorganisms isolated from urine culture, antibiotics prescribed for UTI, precipitating factors for UTI, route of drug administration, adjuvant drugs along with antibiotics for UTI and outcome of the treatment were evaluated. Patients receiving antibiotic therapy in UTI of either gender of age >18 years, visiting medicine department were included. Approval from the institutional ethics committee was

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

    Data.gov (United States)

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

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

    Directory of Open Access Journals (Sweden)

    S. A. Sridevi

    2013-06-01

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

  11. Factors influencing length of stay in the Emergency Department in a Private Hospital in North Jakarta

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    Irwan Juss

    2016-04-01

    Full Text Available Length of stay (LOS is a key measure of Emergency Department (ED throughput and a marker of quality objectives. Time studies that assess ED services may help to clarify the causes of prolonged ED service to patients. The objective of this study was to analyse factors influencing LOS in the ED of Private Hospital X. This study was conducted at the ED of Private Hospital X in North Jakarta. One hundred and seventy one adult patients were admitted via the over a period of three weeks in March 2008. Data recorded included characteristics of patients, service time of nurses, service time of physicians, and overall ED LOS. Anova and independent t-test were performed to determine factors associated with ED LOS. Elderly patients, patients in emergency status, patients with letters of referral, electrocardiogram (ECG training for physicians and advance cardiac life support (ACLS training for nurses were significantly associated with duration of service in the ED. Mean ED LOS was 50 ± 20.7 minutes. Patient category and characteristics of physicians and nurses are important independent variables that influence the ED’s duration of service. Future research is necessary to determine how these and other factors can be incorporated into a model for predicting ED LOS.

  12. A structured approach to transforming a large public hospital emergency department via lean methodologies.

    Science.gov (United States)

    Naik, Trushar; Duroseau, Yves; Zehtabchi, Shahriar; Rinnert, Stephan; Payne, Rosamond; McKenzie, Michele; Legome, Eric

    2012-01-01

    Emergency Departments (EDs) face significant challenges in providing efficient, quality, safe, cost-effective care. Lean methodologies are a proposed framework to redesign ED practices and processes to meet these challenges. We outline a systematic way that lean principles can be applied across the entire ED patient experience to transform a high volume ED in a safety net hospital. We review the change in ED performance metrics prior to and after lean implementation. We discuss critical insights and key lessons learned from our lean transformation to date. The steps to implementing lean principles across the patient's ED experience are described with specific attention to executive planning of rapid improvement experiments and the subsequent roll-out of lean transformation over an 18-month time frame. Basic ED performance data were compared to the year prior. Results of the exploratory analysis (using median and interquartile ranges and nonparametric tests for group comparisons) have shown improvement in several performance metrics after initiating lean transformation. The approach, lessons learned, and early data of our transformation can provide critical insights for EDs seeking to incorporate continuous improvement strategies. Key lessons and unique challenges encountered in safety net hospitals are discussed.

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

    Directory of Open Access Journals (Sweden)

    Wim Lammers

    2011-01-01

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

  14. After Medicaid Expansion In Kentucky, Use Of Hospital Emergency Departments For Dental Conditions Increased.

    Science.gov (United States)

    Chalmers, Natalia; Grover, Jane; Compton, Rob

    2016-12-01

    Access to oral health care is a critical need for the adult Medicaid population. Following the 2014 expansion of Medicaid eligibility in Kentucky, millions of adults became eligible to receive dental benefits. We examined the impact of the expansion on adult Medicaid enrollees' use of hospital emergency departments (EDs) for conditions related to dental or oral health in the period 2010-14. Based on our analysis of data for Kentucky from the State Emergency Department Databases, we found that the rate of discharges for these conditions from the ED increased significantly, from 1,833 per 100,000 population in 2013 to 5,635 in 2014. Adults covered by Medicaid who used the ED for treatment of oral health conditions in 2014 had high levels of chronic comorbidities and were more likely to be male and nonwhite than those in earlier years. To avoid costly and inappropriate use of the ED, states considering adding an adult Medicaid dental benefit should consider also making changes to assist beneficiaries in obtaining access to the dental health care delivery system.

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

    Directory of Open Access Journals (Sweden)

    Zynal Karaca

    2013-09-01

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

  16. [Enrichment of the functions of the psychiatric department in a general hospital and collaboration within the area].

    Science.gov (United States)

    Koishikawa, Hiraki; Ookami, Toshihiko

    2014-01-01

    Psychiatric disease has been included in the five main diseases, and a medical care plan is required. In it, there are many problems, for example, physical complications and which general hospital should chiefly deal with it. Here, we present a way to cope with these problems on the basis of achievements in the psychiatric department of Kameda General Hospital. Specifically, we would like to assert that creating a consultation-liaison team and enriching the section of clinical psychiatry are very important and effective. The activities of the consultation-liaison team, created to address various issues after establishing a psychiatric ward, have led to the possibility of a psychiatric department in a general hospital. Experience to date indicates that, in the context of a general hospital with a psychiatric inpatient unit, the existence of a multidisciplinary liaison team working across departmental boundaries is crucial to determining and managing the treatment of patients with psychiatric emergencies, as well as patients with psychiatric issues and physical complications. Additionally, in order to increase the effectiveness of the hospital liaison team, it is critical to realize seamless, prompt collaboration with facilities outside the hospital. In this respect, the role of a patient care coordinator is expected to become increasingly important. Additionally, enriching and guarding activities of clinical psychologists have contributed to the growth of psychiatric departments in general hospitals and proved to be effective in combination with activities of the consultation-liaison team.

  17. 日间门诊全麻下拔牙的临床应用及评价%Tooth Extraction Under General Anesthesia in Outpatient Department: A Retrospective Study with 18 Cases

    Institute of Scientific and Technical Information of China (English)

    张智勇; 张晓; 王德蕙; 高巍; 陈全; 刘文曙; 姜霞

    2012-01-01

    目的:回顾性分析日间门诊全麻下拔牙的病例资料,总结日间门诊全麻下拔牙的麻醉特点、诊疗规范、手术特点和安全性.方法:收集日间门诊全麻下拔牙病例,总结选择全麻的原因、拔除牙位、离院评价得分,分析日间门诊全麻下拔牙的麻醉特点、手术特点.根据术中情况和术后复查分析该方法的安全性.结果:共收集18个病例,男11例,女7例,年龄7~50岁.选择全麻的原因包括:无法配合手术的儿童、智障、癫痫、咽部敏感、局麻药物过敏和有紧张晕厥病史.拔除牙位主要是阻生智齿和埋伏多生牙,均采用气管内插管静吸复合麻醉.所有病例手术顺利并安全离院,离院标准评分均在13分以上.结论:严格遵从诊疗规范的情况下,日间门诊全麻下拔牙对因各种原因无法配合局麻下手术的患者是一种安全有效的治疗方法.%Objective: To evaluate the indication and security of tooth extraction under general anesthesia in outpatient department. Methods: The patients accepted tooth extractions under general anesthesia in outpatient department were included in this study. The following information were recorded and summed, including: the reason for choosing general anesthesia, the position of the teeth removed and the score of postanesthetic discharge scoring system. Results: 18 cases were collected in this study. There were 11 male and 7 females, and the range of the age was from 7 to 50 years. The reasons for choosing general anesthesia including: children cannot corporate, falling sickness, mentally challenged, pharynx sensitivity, allergenic to local anesthesia drug and patients have swoon history because of overmuch nervous in dentistry treatment. The major positions of the teeth extracted were impacted teeth and supernumerary teeth. All patients accepted endotracheal intubation intravenous -inhalation combined anesthesia. All the operations were performed successfully and all

  18. Services quality in emergency department of Nemazee Hospital: Using SERVQUAL model

    Directory of Open Access Journals (Sweden)

    Maryam Gholami

    2016-10-01

    Full Text Available Introduction: Patient satisfaction is crucial to the long-run success in health care center. With regard to the highest patients’ referral to the emergency department and the existing challenges due to the patient’s need to urgent care, we aimed to evaluate health care services quality in this unit to find out whether the patients have different expectations from health care providers and if they perceive some dimensions of care more important than others. Method: The SERVQUAL scale method was used in this cross-sectional study on 100 patients in June 2015. Patient satisfaction questionnaire based on SERVQUAL model was evaluated with high content validity and the reliability was 0.97 and 0.81. The data collected were analyzed using SPSS, version 20.0 (IBM, USA. Statistical analyses included descriptive statistics, paired and independence sample t-test and ANOVA at the significance level 0.05. Results:The results showed that the quality gap in all dimensions was significant (P<0.001. The largest quality gap was related to responsiveness (-1.08 and the lowest belonged to assurance (-0.8. Demographic characteristics were analyzed and the number of referrals was significant in tangibility and assurance dimensions (P = 0.04; also, in all cases the patients’ expectations (total Mean=4.35 were higher than their perception (total Mean = 3.295. Conclusion: In order to improve emergency services, it is recommended that the hospital management should provide appropriate facilities, reduce waiting time, increase in attention to ordering system based on the patients’ condition, and improve the behavior of health care personnel to patient is placed on the agenda of hospital management.

  19. Prevalence of Unrecognised Depression Among Outpatient Department Attendees of A Rural Hospital in Delhi, India

    Science.gov (United States)

    Kohli, Charu; Kishore, Jugal; Agarwal, Paras; Singh, Satya Vir

    2013-01-01

    Background: Depression is one of the most common mental disorders affecting 121 million people in the world and it frequently goes unrecognised among patients. This study was carried out to find out the prevalence of unrecognised depression among out patient attendees of a rural hospital in Delhi, India and its socio demographic correlates. Material and Methods: This is a rural hospital based cross sectional study among 395 patients attending different non-psychiatric outpatient departments. Data was collected by using predesigned & pretested questionnaire and prevalence of depression was determined by PRIME MD (PHQ-9) and analysed by using SPSS version 16. Data was analysed using chi-square test with “p” value < 0.05 considered as significant. Independent association of socio demographic variables were determined by multi–variate logistic regression analysis using WHO EPI INFO software. Results: The study included 67% females and 33% males with mean age 31.73 + 12 years. Most were Hindu (80%), married (75%), illiterate (47%) and were unemployed (65%). Out of 395 patients, 119 (30.1%) were diagnosed to be having depression. Out of 119 patients who were found depressed, 25 (21%) were already diagnosed case of depression and 94 (79%) were detected by using PRIME-MD, giving prevalence of unrecognised depression 23.8%. Among socio demographic factors, gender, religion, education status and being widow/separated were found to be statistically significantly associated with hidden depression among the patients. Conclusion: Unrecognized depression is a common in non-psychiatric OPDs. There is a need to screen patients presenting in such OPDs for depression. PMID:24179898

  20. How do patients come to the Accident and Emergency Department of RIPAS Hospital?

    Directory of Open Access Journals (Sweden)

    Po Thaw DA

    2012-06-01

    Full Text Available Introduction: The mode and speed of transportation to the Accident and Emergency Department (AED of hospitals is very important for critically ill patients. This study looked at the mode of transportation to the AED at the Raja Isteri Pengiran Anak Saleha (RIPAS Hospital. Materials and Methods: Three different time periods: Period A from 15th May to 31st May 2004, (17 days, n=2,170 without prioritising, Period B from 1st January 2004 to 31st July 2006 (31 months, n=235 dead on arrival and resuscitation cases, and Period C from 20th to 26th November 2006 (7 days, all Priority Cases 1 to 3 were reviewed. Data on mode of transportation and triage categories were extracted from the ambulance response sheets. Results: During Period A, the main mode of transportation to the AED was private vehicles (90.7% followed by ambulance (7.9%, and other transportation (1.4%. During study Period B, the main mode of transportation was also private transports (50.2% followed closely by ambulance (48.5% and other transportation (1.3%. During Period C, Priority 1 cases (life-threatening conditions, n=7, most were transported with private transport (71.4% followed by ambulance (28.6%; Priority 2 (n=232 cases, majority were transported with private transport (89.2%, followed by ambulance (10.3%, and one case used police transportation; and in Priority 3 cases (non-life threatening conditions, n=1,010, almost all were transported with private transport (98.7%, followed by police (0.9% and ambulance (0.4% respectively. Conclusion: Utilisation of designated emergency transportation is low especially for the moderate to seriously ill (Priority 1 and 2 patients when compared to other well developed countries. More needs to be done to improve the usage of emergency transportations especially for the seriously ill cases.

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

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    Kotsikoris Ioannis

    2011-11-01

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

  2. Beds Simulator 1.0: a software for the modelisation of the number of beds required for a hospital department.

    Science.gov (United States)

    Nguyen, Jean-Michel; Six, Patrick; Antonioli, Daniel; Lombrail, Pierre; Le Beux, Pierre

    2003-01-01

    The determination of the number of beds needed for a hospital department is a complex problem that try to take into account efficiency, forecasting of needs, appropriateness of stays. Health authority used methods based on ratios that do not take into account local specificities and use rather to support an economic decision. On the other side, the models developed are too specific to be applied to all type of hospital department. Moreover, all the solutions depend on the LoS (Length of Stay). We have developed a non parametric method to solve this problem. This modelisation was successfully tested in teaching and non teaching hospitals, for an Intensive Care Unit, two Internal Medicine and a surgical departments. A software easy to use was developed, working on Windows available on our website www.sante.univ-nantes.fr/med/stat/.

  3. [Children's department and child care institutions of the Central military, hospital of People's commissariat during the Great Patriotic War].

    Science.gov (United States)

    Simonenko, V B; Krainyukov, P E; Abashin, V G

    2016-01-01

    The article presents historical data about paediatric health care delivery and escort of children of the Command of the Red Army during their evacuation from Moscow in 1941. Data on foundation of kindergartens of People's commissariat in 1942-1943, their support and foundation of children's department in the hospital is given. Special subdivision governed by the head of child care institutions of the hospital was formed for managing child care institutions.

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

    Data.gov (United States)

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

  5. Parental Decisions regarding pre-hospital therapy and costing of the Emergency Department Visit

    LENUS (Irish Health Repository)

    McGovern, M

    2017-02-01

    Paediatric patients represent a large percentage of Emergency Department (ED) visits and there is often a perception that the acuity of these presentations is low. The decision-making process that results in parents attending the ED is poorly understood. We designed a cross-sectional cohort study to explore the reasons for attendance, the treatment initiated at home and to assess parental perception of the economic cost of attendance. Data was collected on 200 patients using a survey administered to parents in ED with a follow-up phone call 4-6 weeks later. Our results suggest that attendances are often prompted by parental anxiety rather than clinical deterioration and that prior ED usage is common among those presenting for assessment. Many parents had attempted community therapy with 128\\/200 patients (64%) having been referred by a healthcare professional and medical therapy at home having been employed by 114\\/200 (57%) parents before attendance. Parental knowledge of the safety of over-the-counter medications was variable the economic cost of an ED visit was poorly understood by participants. The results of our study suggest that parental desire for control over worrisome symptoms drives much of their management strategy prior to hospital attendance. Strategies in the ED may need to focus more on managing parental expectations than on managing the illness itself and management strategies employed should focus not only on medical therapy of the child’s illness but on educating and empowering the parent.

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

    Directory of Open Access Journals (Sweden)

    West LM

    2012-12-01

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

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

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    Su-Min Kim

    2007-12-01

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

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

    Directory of Open Access Journals (Sweden)

    J. Owusu-Banahene

    2014-10-01

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

  9. Frequency of medication errors in an emergency department of a large teaching hospital in southern Iran

    Directory of Open Access Journals (Sweden)

    Vazin A

    2014-12-01

    Full Text Available Afsaneh Vazin,1 Zahra Zamani,1 Nahid Hatam2 1Department of Clinical Pharmacy, Faculty of Pharmacy, 2School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran Abstract: This study was conducted with the purpose of determining the frequency of medication errors (MEs occurring in tertiary care emergency department (ED of a large academic hospital in Iran. The incidence of MEs was determined through the disguised direct observation method conducted by a trained observer. A total of 1,031 medication doses administered to 202 patients admitted to the tertiary care ED were observed over a course of 54 6-hour shifts. Following collection of the data and analysis of the errors with the assistance of a clinical pharmacist, frequency of errors in the different stages was reported and analyzed in SPSS-21 software. For the 202 patients and the 1,031 medication doses evaluated in the present study, 707 (68.5% MEs were recorded in total. In other words, 3.5 errors per patient and almost 0.69 errors per medication are reported to have occurred, with the highest frequency of errors pertaining to cardiovascular (27.2% and antimicrobial (23.6% medications. The highest rate of errors occurred during the administration phase of the medication use process with a share of 37.6%, followed by errors of prescription and transcription with a share of 21.1% and 10% of errors, respectively. Omission (7.6% and wrong time error (4.4% were the most frequent administration errors. The less-experienced nurses (P=0.04, higher patient-to-nurse ratio (P=0.017, and the morning shifts (P=0.035 were positively related to administration errors. Administration errors marked the highest share of MEs occurring in the different medication use processes. Increasing the number of nurses and employing the more experienced of them in EDs can help reduce nursing errors. Addressing the shortcomings with further research should result in reduction

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

    OpenAIRE

    Gaszynski T; Gaszynska E; Szewczyk T

    2014-01-01

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

  11. Internal quality audit and quality standards as a method of quality improvement at the Department of Ophthalmology, University Hospital.

    Science.gov (United States)

    Nasić, Mirjana; Pokupec, Rajko; Katusić, Damir; Miklić, Pavle; Suić, Ivan; Galić, Slobodan

    2005-01-01

    Quality assessment of clinical health care with the programme of quality standard is a method of health management, through which better efficiency and safety of health outcomes can be achieved. In the period from 2002 to 2004, a pilot program of quality has been carried out on the Department of Ophthalmology, University Hospital Center in Zagreb. Seven internal audit teams of hospital commission and teams of hospital departments were evaluating introducing practice for quality standards every three months. In the period of two years improvement in all standards of quality has been noticed (expressed in percent of progress towards the ideal result of 100%): personnel 20%, patient rights 15%, medical equipment 40%, quality of emergency service 60%, implementation of clinical guidelines and criteria for elective admission 55%, quality of risk prevention 70%, quality of medical records 60%. The two-years-improvement dynamics of about 46%, first year 24%.

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

    Science.gov (United States)

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

    2012-12-01

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

  13. DRUG UTILIZATION PATTERN IN OPTHALMOLOGY DEPARTMENT AT A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Pooja Prajwal

    2013-08-01

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

  14. Pattern of use of antibiotics in hospitalized patients in the medicine department of a tertiary care hospital

    OpenAIRE

    2015-01-01

    Background: (1) To assess pattern of antibiotic use among in-patients of medicine unit in a tertiary care hospital, (2) to determine the frequency of adverse drug reactions (ADR) among the inpatients receiving antibiotics in medicine unit. Methods: The study was prospective and based on the daily review of patient records for 2 months (June, July) of study period, including all the inpatients of medicine unit 1 receiving antimicrobials. The general information of the patients, infection, a...

  15. Spinal and epidural anesthesia

    Science.gov (United States)

    ... you epidural or spinal anesthesia is called an anesthesiologist. First, the area of your back where the ... Chan VWS. Spinal, epidural, and caudal anesthesia. In: Miller RD, ed. Miller's Anesthesia . 8th ed. Philadelphia, PA: ...

  16. Obesity and Anesthesia

    Science.gov (United States)

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

  17. Society for Ambulatory Anesthesia

    Science.gov (United States)

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

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

    Institute of Scientific and Technical Information of China (English)

    保志军

    2009-01-01

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

  19. The Mobile Modular Surgical Hospital: the Army Medical Department’s Future Unit of Action

    Science.gov (United States)

    2005-06-17

    4 Operational Terms and Definitions ...constrained by professional personnel shortages and the professional filler system will continue to be necessary. Operational Terms and Definitions ...or renal hemodialysis teams.10 Level (Echelon) IV: This level of care has traditionally been provided by large general hospitals and field hospitals

  20. Ambulatory anesthesia in plastic surgery: opportunities and challenges

    Directory of Open Access Journals (Sweden)

    Facque AR

    2015-10-01

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

  1. Patient satisfaction and positive patient outcomes in ambulatory anesthesia

    Directory of Open Access Journals (Sweden)

    Shah U

    2015-04-01

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

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

    Directory of Open Access Journals (Sweden)

    Valentina Antipova

    2016-03-01

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

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

    Science.gov (United States)

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

    2016-06-01

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

  4. Thoracic combined spinal epidural anesthesia for laparoscopic cholecystectomy in a geriatric patient with ischemic heart disease and renal insufficiency

    Directory of Open Access Journals (Sweden)

    Mehta N

    2015-12-01

    Full Text Available Nandita Mehta, Sunana Gupta, Atul Sharma, Mohd Reidwan Dar Department of Anesthesiology and Intensive Care, Acharya Shri Chander College of Medical Sciences and Hospital, Jammu, Jammu and Kashmir, India Abstract: Older people undergoing any surgery have a higher incidence of morbidity and mortality, resulting from a decline in physiological reserves, associated comorbidities, polypharmacy, cognitive dysfunction, and frailty. Most of the clinical trials comparing regional versus general anesthesia in elderly have failed to establish superiority of any single technique. However, the ideal approach in elderly is to be least invasive, thus minimizing alterations in homeostasis. The goal of anesthetic management in laparoscopic procedures includes management of pneumoperitoneum, achieving an adequate level of sensory blockade without any respiratory compromise, management of shoulder tip pain, provision of adequate postoperative pain relief, and early ambulation. Regional anesthesia fulfills all the aforementioned criteria and aids in quick recovery and thus has been suggested to be a suitable alternative to general anesthesia for laparoscopic surgeries, particularly in patients who are at high risk while under general anesthesia or for patients unwilling to undergo general anesthesia. In conclusion, we report results of successful management with thoracic combined spinal epidural for laparoscopic cholecystectomy of a geriatric patient with ischemic heart disease with chronic obstructive pulmonary disease and renal insufficiency. Keywords: geriatric anesthesia, bupivacaine, segmental anesthesia, laparoscopic surgery

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

    DEFF Research Database (Denmark)

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

    2010-01-01

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

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

    Directory of Open Access Journals (Sweden)

    M. Shashi Kumar

    2014-01-01

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

  7. Temporomandibular Joint Disorders Among Patients Treated in the Department of Oral and Maxillofacial Surgery at Muhimbili National Hospital

    OpenAIRE

    2010-01-01

    Temporomandibular joint disorders (TMJD) are the most common debilitating conditions of the stomatognathic system. Although they exist in the community they are not mentioned in the literature as an endemic health problem. Their prevalence does not seem to be clear enough for the health system in Tanzania to give them priority as other health problems. Study setting: The study was done in the department of Oral and Maxillofacial Surgery at Muhimbili National Hospital (MNH). To determine the o...

  8. The health of irregular and illegal immigrants: analysis of day-hospital admissions in a department of migration medicine.

    Science.gov (United States)

    Affronti, Mario; Affronti, Andrea; Pagano, Salvatore; Soresi, Maurizio; Giannitrapani, Lydia; Valenti, Miriam; La Spada, Emanuele; Montalto, Giuseppe

    2013-10-01

    It is difficult to trace full details of the path which irregular or illegal immigrants follow when seeking assistance in the network of the various hospital departments and health structures. The aim of this work was to analyze the health needs of immigrant people by reviewing the types of treatment given to them in the day-hospital of our Department of Migration Medicine. Our study analyzed day-hospital admissions between 2003 and 2009. The patient charts used for managing day-hospital activity were adopted in 2002 in conformity with the "OSI project". From these it is possible to draw up a scale picture of the distribution of each pathology in the immigrant population. The sample population consisted of 1,758 subjects, representing 7.4% of potential users. More than half came from Africa, followed by Asia, and then Europe. Gastroenterological diseases ranked first, with dyspeptic syndromes most frequently diagnosed. Infections and parasitic diseases ranked second, and the most frequent diagnoses were sexually transmitted diseases. Third were diseases of the genitourinary system. Metabolic disorders ranked fourth, among them, more than half of the cases were of diabetes mellitus, in patients from south-east Asia. Diseases of the circulatory system were sixth, with hypertension the most frequent pathology. Our data confirm a marked persistence of the phenomenon known as the "healthy immigrant effect" in these types of patients, as well as the prominent role played by "social determinants" in conditioning the health of immigrants, particularly in the case of some infectious diseases.

  9. Anesthesia for fetoscopic intervention

    Directory of Open Access Journals (Sweden)

    Jamil S Anwari

    2014-01-01

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

  10. Guidelines for safe handling of cytotoxic drugs in pharmacy departments and hospital wards.

    Science.gov (United States)

    1981-01-01

    The Specialty Practice Committee on Parenteral Services is one of a number of subcommittees of the Federal Council of The Society of Hospital Pharmacists of Australia (SHPA) having responsibility for development of professional practice in particular areas, such as drug distribution, drug information, clinical pharmacy, radiopharmaceuticals, and a number of others. Parenteral Services has been, perhaps, the major area of growth in Australian hospital pharmacy over the last three years. The pattern of growth of Australia has deviated somewhat from that which has emerged in the United States. Whereas the typical I.V. admixture service is relatively uncommon in Australian hospitals, the emphasis is towards specialization into Parenteral Nutrition and Oncology Support Services. Developments in Oncology Support have been particularly rapid, with many pharmacists becoming exclusively involved in this specialty. Concern is felt that operators intensively reconstituting and preparing cytotoxic drugs may be at risk from a variety of factors. Australian hospital pharmacists share the growing international opinion that this work is potentially hazardous and that safety guidelines governing every aspect of handling these substances are urgently required. The Specialty Practice Committee on Parenteral Services has conducted a study of safety aspects of this work as its major project for 1980 and has produced the document presented below. This is an official statement of the Society of Hospital Pharmacists of Australia.

  11. Spinal morphine anesthesia and urinary retention.

    Science.gov (United States)

    Mahan, K T; Wang, J

    1993-11-01

    Spinal anesthetic is a common form of surgical anesthetic used in foot and ankle surgery. Spinal morphine anesthetic is less common, but has the advantage of providing postoperative analgesia for 12 to 24 hr. A number of complications can occur with spinal anesthesia, including urinary retention that may be a source of severe and often prolonged discomfort and pain for the patient. Management of this problem may require repeated bladder catheterization, which may lead to urinary tract infections or impairment of urethrovesicular function. This study reviews the incidence of urinary retention in 80 patients (40 after general anesthesia and 40 after spinal anesthesia) who underwent foot and ankle surgery at Saint Joseph's Hospital, Philadelphia, PA. Twenty-five percent of the patients who had spinal anesthesia experienced urinary retention, while only 7 1/2% of the group who had general anesthesia had this complication. Predisposing factors, treatment regimen, and recommendations for the prevention and management of urinary retention are presented.

  12. Topical anesthesia

    Directory of Open Access Journals (Sweden)

    Mritunjay Kumar

    2015-01-01

    Full Text Available Topical anesthetics are being widely used in numerous medical and surgical sub-specialties such as anesthesia, ophthalmology, otorhinolaryngology, dentistry, urology, and aesthetic surgery. They cause superficial loss of pain sensation after direct application. Their delivery and effectiveness can be enhanced by using free bases; by increasing the drug concentration, lowering the melting point; by using physical and chemical permeation enhancers and lipid delivery vesicles. Various topical anesthetic agents available for use are eutectic mixture of local anesthetics, ELA-max, lidocaine, epinephrine, tetracaine, bupivanor, 4% tetracaine, benzocaine, proparacaine, Betacaine-LA, topicaine, lidoderm, S-caine patch™ and local anesthetic peel. While using them, careful attention must be paid to their pharmacology, area and duration of application, age and weight of the patients and possible side-effects.

  13. Construction of TCM Department in Military Hospital%刍议部队医院中医科建设

    Institute of Scientific and Technical Information of China (English)

    朱峪英

    2012-01-01

    In recent years, the traditional Chinese medicine departments are shrinking in all military hospitals, and most of TCM departments or hospitals in china are the same, even some of them are in tatters. However, 303 hospital sails in the head tide, by following the instructions of three generations of leaders, we focus on cultivation of talents, integration of traditional and western medicine, for promotion of traditional Chinese medicine, Based on the advantages of the traditional medicine, to find our distinguishing therapies with the combination western medicine , we won better both social and economic benefit. And our department also developed and strengthened by these characteristics medical treatment, service and cultivation.%部队医院的中医科,乃至全国的中医院、中医科大部分都呈萎缩状态,本院中医科注重人才培养,实行中西医结合,发展传统中医药学,立足于中医优势医疗,大力挖掘中医传统的特色医疗,找到与西医结合的切入点,既赢得了社会效益,也获得了良好的经济效益.

  14. PRESCRIPTION AUDIT OF ACNE VULGARIS IN SKIN OUTPATIENT DEPARTMENT OF A TERTIARY CARE TEACHING HOSPITAL

    Directory of Open Access Journals (Sweden)

    Vishal Prakash

    2014-10-01

    Full Text Available : OBJECTIVE: To evaluate prescribing pattern in acne vulgaris cases at a tertiary care teaching hospital in south India. METHODS: Prescriptions of 120 patients of acne vulgaris who attended Dermatology OPD of a tertiary care teaching hospital were selected for study and their drug data were analyzed. RESULTS: Topical Benzoyl peroxide, adapalene, ketoconazole were prescribed as monotherapy, while aloevera, liquid paraffin and white soft paraffin as polytherapy. Azithromycin, antibiotics, anti histaminics were prescribed as systemic monotherapy and polytherapy. Statistical analysis revealed p-value was > 0.05. CONCLUSIONS: Prescription patterns were in consensus with the general guidelines, with few changes, in the choice of established therapeutic agents.

  15. Evaluation of emergency medical technicians intermediate prediction about their transported patients final disposition in emergency department of Imam Khomeini Hospital.

    Science.gov (United States)

    Afzalimoghadam, Mohammad; Mozafari, Javad; Talebian, Mohammad Taghi; Mohammadnejad, Esmaeil; Kasaeian, Amir

    2013-08-07

    This was a prospective cross-sectional study of consecutive transported patients by emergency medical service (EMS) to a referral hospital. The goal of this study was the evaluation of emergency medical technician intermediate prediction about their transported patients disposition in Emergency Department of Imam Khomeini Hospital. 2950 patients were transported to this hospital, Questionnaires were submitted in 300 of consecutive patient transports and completed data were obtained and available upon arrival at hospital for 267 of these cases. Emergency medical technicians intermediate (EMT-I) were asked to predict whether the transported patient would require admission to the hospital, and if so, what will be their prediction of patient actual disposition. Their predictions were compared with emergency specialist physicians. EMT-I predicted that 208 (78%) transports would lead to admission to the hospital, after actual disposition, 232 (%87) patients became admitted. The sensitivity of predicting any admission was 65%, with positive predictive value (PPV) of 39% and specificity of 86% with negative predictive value (NPV) of 94%. The sensitivity of predicting trauma patients (56.2% of total patients) was 55% with PPV of 38%, specificity of 86% and for Non-trauma patients' sensitivity was 80% with PPV of 40% and specificity of 82%. EMT-I in our emergency medical system have very limited ability in prediction of admission and disposition in transported patients and their prediction were better in Non-trauma patients. So in our EMS, the pre-hospital diversion and necessity of transporting policies should not be based on EMS personnel disposition.

  16. Evaluation of emergency medical technicians intermediate prediction about their transported patients final disposition in emergency department of Imam Khomeini Hospital.

    Directory of Open Access Journals (Sweden)

    Mohammad Afzalimoghadam

    2013-07-01

    Full Text Available This was a prospective cross-sectional study of consecutive transported patients by emergency medical service (EMS to a referral hospital. The goal of this study was the evaluation of emergency medical technician intermediate prediction about their transported patients disposition in Emergency Department of Imam Khomeini Hospital. 2950 patients were transported to this hospital, Questionnaires were submitted in 300 of consecutive patient transports and completed data were obtained and available upon arrival at hospital for 267 of these cases. Emergency medical technicians intermediate (EMT-I were asked to predict whether the transported patient would require admission to the hospital, and if so, what will be their prediction of patient actual disposition. Their predictions were compared with emergency specialist physicians. EMT-I predicted that 208 (78% transports would lead to admission to the hospital, after actual disposition, 232 (%87 patients became admitted. The sensitivity of predicting any admission was 65%, with positive predictive value (PPV of 39% and specificity of 86% with negative predictive value (NPV of 94%. The sensitivity of predicting trauma patients (56.2% of total patients was 55% with PPV of 38%, specificity of 86% and for Non-trauma patients' sensitivity was 80% with PPV of 40% and specificity of 82%. EMT-I in our emergency medical system have very limited ability in prediction of admission and disposition in transported patients and their prediction were better in Non-trauma patients. So in our EMS, the pre-hospital diversion and necessity of transporting policies should not be based on EMS personnel disposition.

  17. Articaine: a review of its use for local and regional anesthesia

    OpenAIRE

    Snoeck M

    2012-01-01

    Marc SnoeckDepartment of Anaesthesia, Canisius-Wilhelmina Hospital, Nijmegen, The NetherlandsAbstract: Articaine is an intermediate-potency, short-acting amide local anesthetic with a fast metabolism due to an ester group in its structure. It is effective with local infiltration or peripheral nerve block in dentistry, when administered as a spinal, epidural, ocular, or regional nerve block, or when injected intravenously for regional anesthesia. In comparative trials, its clinical effects wer...

  18. Cognitive function correlations with apolipoprotein Eε4 single nucleotide polymorphism in 1 000 elderly patients following general anesthesia A randomized controlled study

    Institute of Scientific and Technical Information of China (English)

    Yingmin Cai; Haitao Hu; Rongliang Xue; Pengbin Liu; Gaifeng Feng; Weijiang Dong; Bin Yu; Minggang Zhao

    2009-01-01

    BACKGROUND: Cognitive dysfunction occurs in elderly patients following general anesthesia, and this might be associated with genetics. Studies have shown that theε4 allele gene is closely associated with senile dementia.OBJECTIVE: To compare and analyze the correlations between cognitive dysfunction and single nucleotide polymorphism of apolipoprotein E (ApoE) following inhaJation or intravenous anesthesia.DESIGN, TIME AND SETTING: A randomized, controlled study was performed. The patients were recruited from the Department of Anesthesia, Second Affiliated Hospital, Medical College, Xi'an Jiaotong University, China between May 2005 and December 2008. Genetic analyses were conducted at the Departments of Neuroanatomy and Forensic Medicine, Medical College, Xi'an Jiaotong University, China.PARTICIPANTS: A total of 1 000 patients of ASA Ⅰ-Ⅱ grade, without genetic connection, were enrolled in this study, comprising 520 males and 480 females, aged (70.1±4.6) years and weighing (57.3±7.5) kg. No patients suffered from cognitive dysfunction.METHODS: The patients were equally and randomly divided into intravenous anesthesia and gas anesthesia groups. Total intravenous anesthesia and inhaled anesthesia were used. Genomic DNA from whole blood was extracted. The ApoE gene was amplified by PCR. Restriction fragment length polymorphism of ApoE gene was analyzed. Cognitive function was evaluated by Mini-Mental State Examination (MMSE). Patients scoring 0.05).CONCLUSION: Results demonstrated a correlation between cognitive dysfunction and ApoE single nucleotide polymorphism in elderly patients after gas anesthesia. However, no relationship between cognitive dysfunction and ApoE single nucleotide polymorphism was determined in elderly patients following intravenous anesthesia. Therefore, elderly patients, especially those expressing the ApoEε4 gene, should be cautiously exposed to gas anesthesia.

  19. Ambulatory surgery with chloroprocaine spinal anesthesia: a review

    Directory of Open Access Journals (Sweden)

    Ghisi D

    2015-11-01

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

  20. [Perioperative mortality and morbidity in the year 2000 in 502 Japanese certified anesthesia-training hospitals: with a special reference to ASA-physical status--report of the Japan Society of Anesthesiologists Committee on Operating Room Safety].

    Science.gov (United States)

    Irita, Kazuo; Kawashima, Yasuo; Tsuzaki, Koichi; Iwao, Yasuhide; Kobayashi, Tsutomu; Seo, Norimasa; Goto, Yasuyuki; Morita, Kiyoshi; Shiraishi, Yoshito; Nakao, Yasuo; Tanaka, Yoshifumi; Tosaki, Youko; Dohi, Shuji; Obara, Hidefumi

    2002-01-01

    Perioperative mortality and morbidity in Japan from Jan. 1 to Dec. 31, 2000 were studied retrospectively. Committee on Operating Room Safety in Japanese Society of Anesthesiologists (JSA) sent confidential questionnaires to 794 certified training hospitals of JSA and received answers from 67.6% of the hospitals. We analyzed their answers with a special reference to ASA physical status (ASA-PS). The total number of anesthesia available for this analysis was 897,733. The percentages of patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E are 38.0, 40.3, 8.5, 0.4, 4.3, 5.3, 2.5, and 0.7%, respectively. Mortality and morbidity from all kinds of causes including anesthetic management, intraoperative events, co-existing diseases, and surgical problems were as follows. The incidences of cardiac arrest (per 10,000 cases of anesthesia) were 1.11, 3.26, 12.25, 54.60, 0.77, 4.46, 21.08 and 217.75 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The incidences of critical events including cardiac arrest, severe hypotension, and severe hypoxemia were 6.89, 20.22, 62.18, 148.21, 6.71, 20.38, 106.72 and 592.21 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The mortality rates (death during anesthesia and within 7 postoperative days) after cardiac arrest were 0.26, 0.77, 3.69, 41.60, 0.00, 1.06, 9.42 and 163.31 per 10,000 cases of anesthesia in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The overall mortality rates were 0.32, 1.38, 9.75, 70.20, 0.26, 2.12, 29.15 and 353.02 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. Overall mortality and morbidity were higher in emergency anesthesia than in elective anesthesia. ASA-PS correlated well with overall mortality and morbidity, regardless of etiology. The incidences of cardiac arrest totally attributable to anesthesia were 0.23, 0.50, 1.32, 0.00, 0.00, 0.85, 2.69 and 4

  1. Good Samaritan Hospital and its department of surgery: a historical perspective.

    Science.gov (United States)

    Kelley, Scott R; Welling, Richard E

    2010-05-01

    At the end of the Revolutionary War, the United States government acquired the Northwest Territory, including the city of Cincinnati. Given the city's position on the Ohio River, and the subsequent development and introduction of steamboats in the early 1800s, Cincinnati became a major center for commerce and trade. With a population of over 115,000 in 1850, Cincinnati was the sixth largest city in the United States--larger even than St. Louis and Chicago-the first major city west of the Allegheny Mountains, and the largest inland city in the nation. The city's growth and importance is mirrored by the history of one if its prized institutions, Good Samaritan Hospital--the oldest, largest, and busiest private teaching and specialty-care hospital in Greater Cincinnati and a national leader in many surgical fields.

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

    DEFF Research Database (Denmark)

    Carlé, Allan; Pedersen, Inge Bülow; Perrild, Hans

    2013-01-01

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

  3. [The department budget, in the context of the hospital global budget. Initial results in general medicine].

    Science.gov (United States)

    Besançon, F

    1984-02-23

    In a general hospital (Hôtel-Dieu, in the center of Paris), run with a global budget, budgets determined for each unit were introduced as an experiment in 1980. Physicians were in charge of certain expenses, mainly: linen, drugs, transportation of patients to and from other hospitals within Paris, and blood fractions. The whole does not exceed 4% of the turnover (FF 20 millions in 1980) of a 67 bed internal medicine unit. Other accounts deal with the stays, admissions, prescriptions of technical acts, laboratory analyses, and X-rays. In 1980, expenses were 11% more than budgeted, but the increase in stays and particularly in admissions was significantly greater. The resulting savings were 8.8% and 18.7% for stays and admissions respectively. Psychic reactions were variable. The subsequent budgets followed the fluctuations of recorded expenses, which were fairly important in both directions. The unit budget may be an advance or a regression, in a restrictive and past-perpetuating context. The coherence between the unit budget and the global hospital budget is questionable. Physicians were willing to take part in accounting and saving. They have good reason for not enlarging their financial responsibilities. Conversely, they may give more attention to diseases of public opinion.

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

    Directory of Open Access Journals (Sweden)

    Catherine L. Kothari

    2015-01-01

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

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

    Science.gov (United States)

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

    2016-09-01

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

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

    Directory of Open Access Journals (Sweden)

    Anxo Fernández-Ferreiro

    2016-12-01

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

  7. Analysis of ESBL- and AmpC-positive Enterobacteriaceae at the Department of Neonatology, University Hospital Olomouc.

    Science.gov (United States)

    Husičková, Vendula; Chromá, Magdaléna; Kolář, Milan; Hricová, Kristýna; Stosová, Taťána; Kantor, Lumír; Dubrava, Lubomír

    2011-06-01

    Bacterial infections are an important issue in current clinical medicine. The severity of infectious diseases has increased dramatically in recent years, which is also due to increasing numbers of resistant bacteria, including strains producing broad-spectrum beta-lactamases. The study aimed at determining the prevalence of ESBL- and AmpC-positive Enterobacteriaceae at the Department of Neonatology, University Hospital Olomouc. Enterobacteriaceae were isolated from clinical samples from infants hospitalized at the Department of Neonatology, University Hospital Olomouc over a period of 2 years. ESBL- and AmpC-positive isolates were subjected to basic genetic analysis. In the study period, a total of 1,526 isolates of the Enterobacteriaceae family were identified, including 55 (3.6%) cases of the ESBL phenotype and 17 (1.1%) AmpC-positive isolates. Genetic analysis of ESBL-positive isolates revealed a majority of CTX-M enzymes. Among AmpC beta-lactamases, the EBC, CIT, DHA, and MOX types were detected. An Escherichia coli strain was isolated with mutations in the promoter region of the ampC chromosomal gene that are associated with overproduction of the relevant enzyme.

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

    Science.gov (United States)

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

    2016-03-01

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

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

    Institute of Scientific and Technical Information of China (English)

    贺伟忠; 杨义; 范小丽; 李萌

    2014-01-01

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

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

    Science.gov (United States)

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

    2016-04-01

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

  11. Implementing "lean" principles to improve the efficiency of the endoscopy department of a community hospital: a case study.

    Science.gov (United States)

    Laing, Karen; Baumgartner, Katherine

    2005-01-01

    Many endoscopy units are looking for ways to improve their efficiency without increasing the number of staff, purchasing additional equipment, or making the patients feel as if they have been rushed through the care process. To accomplish this, a few hospitals have looked to other industries for help. Recently, "lean" methods and tools from the manufacturing industry, have been applied successfully in health care systems, and have proven to be an effective way to eliminate waste and redundancy in workplace processes. The "lean" method and tools in service organizations focuses on providing the most efficient and effective flow of service and products. This article will describe the journey of one endoscopy department within a community hospital to illustrate application of "lean" methods and tools and results.

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

    NARCIS (Netherlands)

    W.J. Lammers (Wim); E.M.M. van Lieshout (Esther); T.M. Mulligan (Terrence); J.C. Christiaanse (Jan); D. den Hartog (Dennis); Y. Lu (Yiming); P. Patka (Peter)

    2011-01-01

    textabstractEmergency medicine is an upcoming discipline that is still under development in many countries. Therefore, it is important to gain insight into the organization and patients presenting to the Emergency Department (ED). The aim of this cross-sectional study was to provide an epidemiologic

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

    Science.gov (United States)

    South Seattle Community Coll., Washington.

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

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

    Science.gov (United States)

    Kunisch, Joseph Martin

    2012-01-01

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

  15. [Testing the hemalog D in a hematology department of a general hospital in Paris (author's transl)].

    Science.gov (United States)

    Lortholary, P; Lejeune, F; Ganon, J P; Mathiot, C; Turpin, F

    1978-06-10

    Europe's firs Hemalog D was installed in the Hematology Laboratory of the Franco-Musulman Hospital at Bobigny, just outside Paris, in March 1975. The authors' experience with the apparatus since that date has enabled them to analyze the significance of "alarms", "high peroxidase", "large unstained cells", "remainder" and "low rate" in patients with and without hematologic disorders. On the basis of these results it has been possible to define the fate of the various blood cells in the Hemalog D, the role of the apparatus in the ivestigation of hematologic disorders and the type of "cooperation" between the hematologist and the Hemalog D.

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

    Directory of Open Access Journals (Sweden)

    Gaszynski T

    2014-07-01

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

  17. Chief complaint of patients attended in an ENT department of a secondary level hospital

    Directory of Open Access Journals (Sweden)

    Rafael TENOR-SERRANO

    2016-07-01

    Full Text Available Introduction and objective: Otolaryngology disorders can cause a wide variety of symptoms. In the present study, we describe the chief complaint and the epidemiological features of patients who attend a general ear, nose and throat consultation in a secondary level hospital. Method: This is a cross-sectional study that includes all patients who came for the first time to a general ENT consultation in the Hospital Costa del Sol (Marbella, Spain from November 2013 to December 2014. Chief complaint, age and sex were recorded. Results: One thousand three hundred and thirty-three patients were included, 54.4% were women and 45.6% were men. Mean age was 45.4 ± 23.9 years. A bimodal distribution with peaks in the group of age 40-60 years and in the first decade of life was observed. Out of the study subjects, 54% referred ear-related symptoms, 29% had pharyngolaryngeal or neck related symptoms, and 17.5% nose related symptoms. Globally, the most frequent symptom was hearing loss, followed by nasal obstruction and dizziness. Conclusions: We observe that the study population covers all range of age and consists mainly of women. Although the chief complain were diverse, 75% of the patients referred one of the ten most frequent symptoms. The most frequent symptoms were related to ear problems.

  18. Drug utilization review of ciprofloxacin in the outpatient department of Boru Meda Hospital, South Wollo Zone, Amhara Region, Ethiopia

    Directory of Open Access Journals (Sweden)

    Tessema Tsehay Biru

    2014-02-01

    Conclusions: Due From the retrospective Drug Use Evaluation (DUE study, it was identified that there was inappropriate ciprofloxacin use in the outpatient department of Boru Meda hospital even though the drug’s use regarding indications was a better performance and dosing practices were almost appropriate as per the criteria used for the study (assuming that there were no dose adjustments. There was a great problem concerning the duration of ciprofloxacin drug therapy. Ciprofloxacin use along with potentially interacting drugs and against contraindications was also another problem indicated in the study. [Int J Basic Clin Pharmacol 2014; 3(1.000: 171-178

  19. [Histrionic personality disorder in a psychiatry department at a general hospital].

    Science.gov (United States)

    Abril, A; Valle, J; Moreno, D; de Miguel, D; Molina, D

    1991-01-01

    The personality disturbances imply problem within the psychiatric assistance, both for its difficult delimitation and classification and for the limited results and bad use obtained from therapeutic resources. We studied 402 patients psychiatric service of a general hospital over a period approximately 2 years, 70 (17.5%) were diagnosed DSM-III with Personality disturbances: 44 females (62.9%) and 26 males (37.1%), of an age group between 18 and 67 years old. The most frequent diagnosis was of histrionic of the personality followed by unspecific and border-line. Within the histrionic disturbance of the personality there was a clear predominance of women, whereas in the others types, no significant differences were observed.

  20. [Estimating the grade of patient satisfaction at the bone marrow transplantation department in Florence hospitals].

    Science.gov (United States)

    Marsullo, M; Tozzi, S; Biagini, S; Rinaldi, L

    2000-01-01

    The satisfaction of the patients admitted to the bone marrow transplant unit of Careggi Hospital was evaluated by the nursing team. The aim of the evaluation was to measure the level of satisfaction for the nursing care and services and the areas of improvement. The questionnaire, with 23 questions referring to 5 areas (hotel care, Nurses' reliability, Ability to reassure, to answer to patients' needs and Empathy) derived from the conceptual model of Servqual. Ninety patients were given (or mailed) the questionnaire during a follow-up visit. Patients were asked to answer the questions evaluating each aspect on a scale from 1 (falls short of expectation) to 10 (exceeds all expectations). The answers show a very high satisfaction (> 8) for all the areas except for the food that reported a medium score of 5.2. Further analysis will allow a better understanding of the causes of dissatisfaction.

  1. Influence of atmospheric states in semi-arid areas on hospital admission in cardio-surgical department

    Science.gov (United States)

    Yackerson, Naomy S.; Zilberman, Arkadi; Aizenberg, Alexander

    2016-10-01

    The influence of the changes in atmospheric state, typical for areas close to big deserts, on acute myocardial infarction (AMI) was analyzed. Under test was the group of 3256 patients (77 % males, 23 % females), hospitalized in the Cardio-Surgical Department of Soroka Medical Center at Ben-Gurion University (BGU, Israel) during 2000-2008. To explore the relationship between atmospheric parameters and AMI, multivariate regression analysis has been performed. AMI was most frequent in winter to spring and least in summer. The highest number of cases was recorded in December and the lowest in September. Hospital admissions showed a higher prevalence in men than in women; the ratio is 3.3/1.0. About 60 % of males were aged between 45 and 65 years old with maximum ˜55 (21 %), whereas 60 % of women hospital admissions were aged between 65 and 80 years old with maximum ˜72 (24 %). The result suggested that the monthly mean relative humidity at daytime and its overall daily differences, wind speed, and respirable fraction of particulate concentration are associated with the admission for AMI. The results of the study confirm the importance of atmospheric state variability for cardiovascular diseases.

  2. Hospital-based inter-professional strategy to reduce in-patient admissions and emergency department visits for pediatric asthma.

    Science.gov (United States)

    Fleming, Karen; Kuzik, Brian; Chen, Chee

    2011-01-01

    Pediatric asthma is a common reason for emergency department (ED) visits and in-patient hospital admissions. Evidence demonstrates that asthma management initiated in the ED has limited benefit unless followed by ongoing coordinated inter-professional care (IPC). The Royal Victoria Hospital (RVH) of Barrie, Ontario, has developed a best practice model of care for pediatric asthma. Primary care providers and ED physicians are actively encouraged to refer children with any recurrent respiratory problems consistent with asthma to the Paediatric Asthma Clinic (PAC). Quarterly PAC visits with a certified asthma educator and a pediatrician include lung function measurement, written action plans and primary care provider communication. Ongoing outcome monitoring of patients receiving IPC has revealed that, compared with 12 months prior to enrolment in the PAC, patients show a two-thirds decrease in asthma-related ED visits and an 85% decrease in admissions. The PAC has contributed to an ongoing decline in the rates of pediatric asthma-related ED visits and admissions at RVH, which are currently less than half the rates seen at our peer hospitals. IPC for chronic diseases is best practice, and our model of care for pediatric asthma continues to provide critical data demonstrating and supporting the advantages of IPC in chronic disease management. RVH modifies practice and policy to meet best practices, optimizing the care provided to children with pediatric asthma.

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

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    Suzanne E Bentler

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

  4. The Organizational Valuation of Valuation Devices: Putting Lean whiteboard management to work in a hospital department

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    Amalie Martinus Hauge

    2016-12-01

    Full Text Available This paper is about the interplay between multiple modes of valuation. The paper engages with the question of how a valuation device intersects with the working values of an organization. While the many studies of valuation practices have drawn attention to the pervasive effects of valuation devices, only a few studies have taken into account the fact that many spaces, including organizations, are already filled with practices and ideas that constitute what is valuable. Revisiting classical organization theory, this paper shows that organizations comprise multiple, more - or less - integrated modes of valuation. Empirically, the paper draws on an ethnographic study of Lean management at a children's hospital, which is presented through analytical snapshots. The paper suggests that an organizational turn is relevant for valuation studies, as this fi rst allows an analytical expansion to include less 'deviced' valuations, contributes to the ongoing culture vs. device debate offering an alternative to the causal analysis of devices and effects without making the 'ineffable culture' what makes or breaks the causality.

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

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    Roberto Nardi

    2013-09-01

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

  6. Case study:-calender covers in a hospital laundry. Energy Efficiency Office, Department of Energy.

    Science.gov (United States)

    1992-01-01

    Whipps Cross Hospital laundry is typical of many laundries, both in the commercial sector and NHS, in that it uses old calenders which are substantially less efficient than more modern machines. Although calendering is a relatively efficient method of moisture removal, the quantity of flatwork processed by this laundry means that the calendering section uses a significant proportion of the total laundry energy consumption. In common with many other laundries, the four calenders were producing a great deal of airborne lint which required expensive cleaning at regular intervals, and made the working environment uncomfortable, reducing the performance and morale of the operators. In an effort to improve this situation, covers were fitted to all the calenders in early 1989. These were claimed to improve energy efficiency by reducing the heat losses from the calender's upper surfaces and to improve the local atmosphere by reducing the quantity of lint and moist air escaping into the laundry. This case study examines the savings (both energy savings and others) achieved by the installation of the covers, and assesses any drawbacks which may have become apparent after extended use.

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

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    Marami Baishya

    2016-01-01

    Full Text Available Background: Burnout in healthcare workers, especially among nurses, can have an impact on overall healthcare delivery system. For health in general and maternal health in particular, wellbeing of healthcare workers, including nurses, is of paramount importance. Material and methods: This study aimed to assess burnout among nurses working in the maternity department. One hundred nurses of a tertiary care centre, selected by non-purposive convenient sampling, were examined by a standardised questionnaire. Data were analysed by descriptive statistics. Results: Burnout in depersonalisation was moderate while that in emotional exhaustion and personal achievement were of low-levels. Conclusion: Understanding the nature of the problem of burnout can guide in better management.

  8. Assessment and Management of Work-Related Stress in Hospital Emergency Departments in Italy.

    Science.gov (United States)

    d'Ettorre, Gabriele; Greco, Maria Rita

    2016-01-01

    Recent changes in the organization of the healthcare system, triggered by the current economic crisis in Italy, require interventions aimed at minimizing the impact of work-related stress (WRS) on healthcare workers' health status and well-being. Emergency department (ED) personnel appear to be particularly vulnerable to WRS as a consequence of specific occupational risk factors. The aim of this retrospective observational study was to analyze the level of WRS after improvement interventions implemented by the management staff of the ED and focused on work context factors. The assessment of WRS showed that nurses and physicians of the ED are exposed to a medium level of risk; the improvement interventions aimed at reducing WRS were focused on: (1) function and organizational culture; (2) role within the occupational organization; and (3) relationships at work policy. These interventions were found to be significantly effective in reducing the risk of WRS.

  9. [Automated anesthesia record system].

    Science.gov (United States)

    Zhu, Tao; Liu, Jin

    2005-12-01

    Based on Client/Server architecture, a software of automated anesthesia record system running under Windows operation system and networks has been developed and programmed with Microsoft Visual C++ 6.0, Visual Basic 6.0 and SQL Server. The system can deal with patient's information throughout the anesthesia. It can collect and integrate the data from several kinds of medical equipment such as monitor, infusion pump and anesthesia machine automatically and real-time. After that, the system presents the anesthesia sheets automatically. The record system makes the anesthesia record more accurate and integral and can raise the anesthesiologist's working efficiency.

  10. Prescription audit of corticosteroid usage in the department of dermatology at a tertiary care teaching hospital

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    Mirshad PV

    2013-08-01

    Full Text Available Background: Corticosteroids are a group of commonly used drugs in dermatology practice whose non judicious use frequently results in undesirable and unwanted effects. Prescribing them rationally with care allows us to derive the maximum benefit out of them with minimal side effects. Methods: Retrospective analysis of 112 case files belonging to patients admitted in the department of dermatology over a period of one year was undertaken to ascertain the usage pattern of corticosteroids in relation to their potency, strength, frequency, duration, route, quantity to be applied. The data thus collected was expressed in terms of averages, ratios and proportions. Results: The total number of formulations prescribed were 929 out of which 10.8% were corticosteroids. The average number of formulations prescribed per patient was 8.29. About 78(70% patients admitted in dermatology received corticosteroids. Topical steroids were prescribed in 50 patients (44.7 % out of whom 36 (72% received only topical, the remaining 14(28% were prescribed both systemic and topical corticosteroids. Brand names were used in all cases. Highly potent corticosteroids like clobetasol, halobetasol and mometasone were prescribed to 39(50% of all cases who received topical corticosteroids. Conclusion: The study reveals the deficiencies which exist in the present prescribing pattern of corticosteroids. Educational interventions among the doctors as well as students should be carried out to in order to promote rational drug use. [Int J Basic Clin Pharmacol 2013; 2(4.000: 411-413

  11. Prevalence of unrecognized depression and associated factors among patients attending medical outpatient department in Adare Hospital, Hawassa, Ethiopia

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    Tilahune AB

    2016-10-01

    Full Text Available Asres Bedaso Tilahune,1 Gezahegn Bekele,1 Nibretie Mekonnen,2 Eyerusalem Tamiru2 1School of Nursing and Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia; 2Department of Medical Case Team, Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia Abstract: Depression is an illness that involves the body, mood, and thoughts and that affects the way a person eats, sleeps, feels about him or herself and thinks about things. Depression is one of the most common mental disorders affecting 121 million people in the world, and it frequently goes unrecognized among patients. It is estimated that 5%–10% of the population at any given time is suffering from identifiable depression needing psychiatric or psychosocial intervention. An institution-based cross-sectional study design was implemented to determine the magnitude and associated factors of unrecognized depression among patients attending the adult medical outpatient department in Adare Hospital, Hawassa, Southern Nations, Nationalities, and Peoples’ Region, Ethiopia, among 326 patients selected using systematic random sampling technique. Data were collected using the interviewer-administered technique. A structured questionnaire was used to collect data on sociodemographic characteristics and other independent variables. Depression was assessed using the Patient Health Questionnaire 9. Data were entered and analyzed using SPSS 20. The level of significance was determined at P<0.05. About 326 patients were interviewed, of whom 186 (57.1% were males. The mean age of participant was 34 with standard deviation of ±13.1 years. Current substance users accounted for 106 (32.5% of the total participants. Of 326 respondents, 80 (24.5% had significant depressive symptoms, while the detection rate of depression by the clinician was 0%. Depression was associated with female sex (adjusted odds ratio [AOR] =1.63 [1.14–2.34], age >60 years (AOR =4

  12. Hospital admissions for hypertensive crisis in the emergency departments: a large multicenter Italian study.

    Science.gov (United States)

    Pinna, Giuliano; Pascale, Claudio; Fornengo, Paolo; Arras, Sebastiana; Piras, Carmela; Panzarasa, Pietro; Carmosino, Gianpaolo; Franza, Orietta; Semeraro, Vincenzo; Lenti, Salvatore; Pietrelli, Susanna; Panzone, Sergio; Bracco, Christian; Fiorini, Roberto; Rastelli, Giovanni; Bergandi, Daniela; Zampaglione, Bruno; Musso, Roberto; Marengo, Claudio; Santoro, Giancarlo; Zamboni, Sergio; Traversa, Barbara; Barattini, Maddalena; Bruno, Graziella

    2014-01-01

    Epidemiological data on the impact of hypertensive crises (emergencies and urgencies) on referral to the Emergency Departments (EDs) are lacking, in spite of the evidence that they may be life-threatening conditions. We performed a multicenter study to identify all patients aged 18 years and over who were admitted to 10 Italian EDs during 2009 for hypertensive crises (systolic blood pressure ≥220 mmHg and/or diastolic blood pressure ≥120 mmHg). We classified patients as affected by either hypertensive emergencies or hypertensive urgencies depending on the presence or the absence of progressive target organ damage, respectively. Logistic regression analysis was then performed to assess variables independently associated with hypertensive emergencies with respect to hypertensive urgencies. Of 333,407 patients admitted to the EDs over the one-year period, 1,546 had hypertensive crises (4.6/1,000, 95% CI 4.4-4.9), and 23% of them had unknown hypertension. Hypertensive emergencies (n = 391, 25.3% of hypertensive crises) were acute pulmonary edema (30.9%), stroke (22.0%,), myocardial infarction (17.9%), acute aortic dissection (7.9%), acute renal failure (5.9%) and hypertensive encephalopathy (4.9%). Men had higher frequency than women of unknown hypertension (27.9% vs 18.5%, phypertensive patients, a larger proportion of men than women reported not taking anti-hypertensive drug (12.6% among men and 9.4% among women (phypertensive emergencies than urgencies (OR = 1.34, 95% CI 1.06-1.70), independently of presenting symptoms, creatinine, smoking habit and known hypertension. This study shows that hypertensive crises involved almost 5 out of 1,000 patients-year admitted to EDs. Sex differences in frequencies of unknown hypertension, compliance to treatment and risk of hypertensive emergencies might have implications for public health programs.

  13. Retrospective comparison of the effects of epidural anesthesia versus peripheral nerve block on postoperative outcomes in elderly Chinese patients with femoral neck fractures

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    Jin JW

    2015-08-01

    Full Text Available Jianwen Jin,1 Gang Wang,2 Maowei Gong,3 Hong Zhang,3 Junle Liu21Department of Clinical Medicine, Fujian Health College, Fuzhou, 2Department of Anesthesiology, Chinese People’s Liberation Army 105 Hospital, Hefei, 3Anesthesia and Operation Center, Chinese People’s Liberation Army General Hospital, Beijing, People’s Republic of ChinaBackground: Geriatric patients with femoral neck fracture (FNF have unacceptably high rates of postoperative complications and mortality. The purpose of this study was to compare the effects of epidural anesthesia versus peripheral nerve block (PNB on postoperative outcomes in elderly Chinese patients with FNF.Methods: This retrospective study explored mortality and postoperative complications in geriatric patients with FNF who underwent epidural anesthesia or PNB at the Chinese People’s Liberation Army General Hospital from January 2008 to December 2012. The electronic database at the Chinese People’s Liberation Army General Hospital includes discharge records for all patients treated in the hospital. Information on patient demographics, preoperative comorbidity, postoperative complications, type of anesthesia used, and in-hospital, 30-day, and 1-year mortality after surgery was obtained from this database.Results: Two hundred and fifty-eight patients were identified for analysis. The mean patient age was 79.7 years, and 71.7% of the patients were women. In-hospital, 30-day, and 1-year postoperative mortality was 4.3%, 12.4%, and 22.9%, respectively, and no differences in mortality or cardiovascular complications were found between patients who received epidural anesthesia and those who received PNB. More patients with dementia or delirium were given PNB. No statistically significant differences were found between groups for other comorbidities or intraoperative parameters. The most common complications were acute cardiovascular events (23.6%, electrolyte disturbances (20.9%, and hypoxemia (18.2%. Patients

  14. Hospital admissions for hypertensive crisis in the emergency departments: a large multicenter Italian study.

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    Giuliano Pinna

    Full Text Available Epidemiological data on the impact of hypertensive crises (emergencies and urgencies on referral to the Emergency Departments (EDs are lacking, in spite of the evidence that they may be life-threatening conditions. We performed a multicenter study to identify all patients aged 18 years and over who were admitted to 10 Italian EDs during 2009 for hypertensive crises (systolic blood pressure ≥220 mmHg and/or diastolic blood pressure ≥120 mmHg. We classified patients as affected by either hypertensive emergencies or hypertensive urgencies depending on the presence or the absence of progressive target organ damage, respectively. Logistic regression analysis was then performed to assess variables independently associated with hypertensive emergencies with respect to hypertensive urgencies. Of 333,407 patients admitted to the EDs over the one-year period, 1,546 had hypertensive crises (4.6/1,000, 95% CI 4.4-4.9, and 23% of them had unknown hypertension. Hypertensive emergencies (n = 391, 25.3% of hypertensive crises were acute pulmonary edema (30.9%, stroke (22.0%,, myocardial infarction (17.9%, acute aortic dissection (7.9%, acute renal failure (5.9% and hypertensive encephalopathy (4.9%. Men had higher frequency than women of unknown hypertension (27.9% vs 18.5%, p<0.001. Even among known hypertensive patients, a larger proportion of men than women reported not taking anti-hypertensive drug (12.6% among men and 9.4% among women (p<0.001. Compared to women of similar age, men had higher likelihood of having hypertensive emergencies than urgencies (OR = 1.34, 95% CI 1.06-1.70, independently of presenting symptoms, creatinine, smoking habit and known hypertension. This study shows that hypertensive crises involved almost 5 out of 1,000 patients-year admitted to EDs. Sex differences in frequencies of unknown hypertension, compliance to treatment and risk of hypertensive emergencies might have implications for public health programs.

  15. Hospital emergency department visits for carbon monoxide poisoning following an October 2006 snowstorm in western New York.

    Science.gov (United States)

    Muscatiello, Neil A; Babcock, Gwen; Jones, Rena; Horn, Edward; Hwang, Syni-An

    2010-01-01

    Following an October 2006 snowstorm that caused widespread power outages in western New York State, hospital emergency department (ED) visits for carbon monoxide (CO) poisoning increased. Overall, 264 people representing 155 households were diagnosed with CO poisoning during the power outages. Telephone interviews were conducted with a subset of these individuals. Respondents provided information about exposure sources, CO alarms, and awareness of CO warnings. In many households, portable generators were operated in an enclosed area. Awareness of CO warnings may have contributed to knowledge about locating portable generators outside. When operated outside, however, portable generators were generally located too close to the home. Gas kitchen ranges were used for heat by numerous households. In the short term, CO education and improved clarity of CO warning information is important for increasing awareness about power outage-related CO risks. Improvements in the combustion efficiency of portable generators should be a long-term goal.

  16. Topical negative pressure therapy Recent experience of the department of plastic surgery at Ibn Sina University Hospital, Rabat, Morocco

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    Abdelmoughit Echchaoui

    2014-12-01

    Full Text Available IntroductionThe topical negative pressure therapy (TNP is a non-invasive method to treat chronic and acute wounds locally, using a continuous or intermittent negative pressure.The objective of this study is to present the first experience of this type of treatment used in clinical cases in our department. By presenting these cases, we highlight indication and efficiency of this new technique applied in relatively complicated situations, at the same time it also allows a significant improvement in treating injuries and chronic wounds.Materials and methodsIn this study, we present the recent experience of the Department of Reconstructive and Plastic Surgery of the University Hospital Center of Avicenne in Rabat. This therapy was used for the first time this year (in 2014, in three young patients who presented with chronic wounds associated with local and general factors that are unfavorable for the healing process.ResultsIn all three of our cases we obtained highly satisfactory clinical results.TNP allows wounds to bud in a shorter time, as well as a fast healing by second intention due to controlled wound healing or split-skin graft without using flaps. This enables to decrease the margin of error, the time and the number of dressing replacements, and to reduce the length of hospital stay.ConclusionThis is an expensive and specific equipment. However, the cost-benefit ratio analysis shows that it is an essential method that should be part of our therapeutic strategies.Keywords: loss of substance, negative pressure, budding, healing.  

  17. Managing bioterrorism mass casualties in an emergency department: lessons learned from a rural community hospital disaster drill.

    Science.gov (United States)

    Vinson, Eric

    2007-01-01

    Bioterrorism represents a threat for which most emergency departments (EDs) are ill prepared. In order to develop an evidence-based plan for ED and hospital management of contaminated patients, a review was conducted of the most effective strategies developed during the severe acute respiratory syndrome (SARS) epidemic, as well as Centers for Disease Control and Prevention and military guidelines on biowarfare. Six basic steps were identified: 1) lock down the hospital and control access to the ED; 2) protect emergency care personnel with appropriate personal protective equipment; 3) decontaminate and triage patients; 4) isolate patients; 5) treat patients with appropriate medications or measures, including decontamination of wounds; and 6) use restrictive admission and transfer guidelines. By emphasizing these six basic concepts, a rural ED passed an annual state-run bioterrorism mass-casualty drill. The drill provided health care personnel with the knowledge and skills necessary to prepare for future bioterrorism casualties. These same concepts could also be used to manage highly virulent viral or bacterial outbreaks.

  18. RETROSPECTIVE STUDY OF RELAPAROTOMY IN DEPARTMENT OF OBSTRETRICS, GYNAECOLOGY AND FAMILY PLANNING IN, RURAL TERTIARY CARE HOSPITAL, ANDHRA PRADESH, INDIA

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    Uma Thombarapu, Prabha Devi Kodey, GangadharaRao Koneru

    2015-07-01

    Full Text Available Introduction: Relaparotomy is biggest dilemma to the surgeon and critical to the patient to undergo second surgery within short span of time .It is challenging both physically and mentally to the patient. Aim: Aim of the study was to determine incidence of relaparotomy and its indication, management and outcome in the department of Obstetrics, Gynaecology and Family Planning (OBGYN & FP in NRI Medical College & General Hospital at Guntur District. Materials and Methods: It is a retrospective observational study for the duration of 3 and ½ years. Total number of surgeries -7, 718. Total number of relaparotomy- 27 which include referral cases. Results: Incidence for relaparotomy was 0.34%. Most important cause for relaparotomy was haemorrhagic causes (44.4%, followed by burst abdomen (33.3%. Relaparotomy can increase morbidity, mortality (14.8% of patients with increased hospital stay on an average of 27 days including Intensive Care Unit, further increasing the financial burden to the patient. Conclusion: Emergency relaparotomy is a life saving procedure. Good expertise in selection of primary surgery and right surgical technique, intra operative hemostasis, control of post operative infection can avoid relaparatomy

  19. Anesthetic recovery and hemodynamic effects of continuous thiopental infusion versus halothane for maintenance anesthesia in patients undergoing ocular surgery

    NARCIS (Netherlands)

    Shoroghi, Mehrdad; Farahbakhsh, Farshid; Sheikhvatan, Mehrdad; Sheikhfathollahi, Mahmood; Abbasi, Ali; Talebi, Azam

    2011-01-01

    Purpose: To investigate anesthesia recovery and hemodynamic status in patients under thiopental infusion or halothane maintenance anesthesia undergoing ocular surgery. Methods: Fifty-nine voluntary patients undergoing ocular surgery in Farabi hospital were allocated to one of two maintenance anesthe

  20. PNEUMOTHORAX AFTER MODIFIED RADICAL MASTECTOMY UNDER GENERAL ANESTHESIA

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    Amminikutty

    2014-11-01

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

  1. The effects of work on the health of nurses who work in clinical surgery departments at university hospitals 1

    Science.gov (United States)

    da Silva, Rosângela Marion; Zeitoune, Regina Célia Gollner; Beck, Carmem Lúcia Colomé; de Martino, Milva Maria Figueiredo; Prestes, Francine Cassol

    2016-01-01

    ABSTRACT Objective: to analyze the effects of work on the health of nurses who work in clinical surgery departments at university hospitals in relation to physical, social and psychological suffering and pain. Methods: a quantitative transversal study was carried out between 2012 and 2013 in four institutions in a state located in the south of Brazil. We studied 65 nurses who responded to questions on their habits. We also obtained sociodemographical information on them as well as conducting an evaluation on work relational damage using an evaluation scale. Associations were checked through the use of the Chi-Sqaure and Fisher's exact test. Correlations were checked using the Spearmann test. Results: we found that physical ailments persisted and that there were connections between social and psychological pain/suffering and variable physical activities as well as connections with accidents in the work place and the option to work shifts. We noted correlations between social and psychological pain/suffering. Conclusion: nurses had their health compromised due to their work in clinical surgery departments. PMID:27508914

  2. Regional anesthesia for an upper extremity amputation for palliative care in a patient with end-stage osteosarcoma complicated by a large anterior mediastinal mass

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    Hakim M

    2015-09-01

    Full Text Available Mumin Hakim,1 Candice Burrier,1 Tarun Bhalla,1 Vidya T Raman,1 David P Martin,1,2 Olamide Dairo,1 Joel L Mayerson,3,4 Joseph D Tobias1,2 1Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, 2Department of Anesthesiology and Pain Medicine, The Ohio State University, 3Department of Orthopedic Surgery, Nationwide Children's Hospital, 4Department of Orthopedic Surgery, The Ohio State University, Columbus, OH, USA Abstract: Tumor progression during end-of-life care can lead to significant pain, which at times may be refractory to routine analgesic techniques. Although regional anesthesia is commonly used for postoperative pain care, there is limited experience with its use during home hospice care. We present a 24-year-old male with end-stage metastatic osteosarcoma who required anesthetic care for a right-sided above-the-elbow amputation. The anesthetic management was complicated by the presence of a large mediastinal mass, limited pulmonary reserve, and severe chronic pain with a high preoperative opioid requirement. Intraoperative anesthesia and postoperative pain management were provided by regional anesthesia using an interscalene catheter. He was discharged home with the interscalene catheter in place with a continuous local anesthetic infusion that allowed weaning of his chronic opioid medications and the provision of effective pain control. The perioperative applications of regional anesthesia in palliative and home hospice care are discussed. Keywords: osteosarcoma, peripheral nerve block, palliative care

  3. Epidural anesthesia in repeated cesarean section.

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    Rolando T. Espín González

    2003-04-01

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

  4. Anesthesia related Complications in Pediatric GI Endoscopy

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    A Sabzevari

    2014-04-01

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

  5. The effectiveness of the South African Triage Toll use in Mahalapye District Hospital – Emergency Department, Botswana

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    Stephane T. Tshitenge

    2016-03-01

    Full Text Available Background: The study aimed to determine the proportion of each priority level of patients, time of performance in each priority level, and the reliability of the South African Triage Scale (SATS tool at the Mahalapye District Hospital - Emergency Department (MDH-ED, a setting where the majority of the nurses were not formally trained on the use of the SATS.Methods: This was a cross-sectional study using case records in MDH-ED from 1 January 2014 to 31 December 2014. A panel of experts from the Mahalapye site of the Family Medicine Department, University of Botswana, reviewed and scored each selected case record that was compared with the scores previously attributed to the nurse triage.Results: From the 315 case records, both the nurse triage and the panel of expert triage assigned the majority of cases in the routine category (green, 146 (46% and 125 (40%, respectively, or in the urgent category (yellow, they assigned 140 (44% and 111 (35% cases, respectively.Overall, there was an adequate agreement between the nurse triage and the panel of expert triage (k = 0.4, 95% confidence interval: 0.3–0.5, although the level of agreement was satisfactory.Conclusion: Findings of the study reported that the profile of the priority-level categories in MDH-ED was made in the majority of routine and urgent patients, only the routine and the emergency patients were seen within the targeted time and they had a satisfactory level of reliability (between 0.4 and 0.6.

  6. Analysis of anesthesia practice and needs in Louisiana.

    Science.gov (United States)

    de Lanzac, K S; Miller, M K; Eyrich, J E

    2001-07-01

    The Louisiana State University Health Sciences Center Department of Anesthesiology performed an analysis of anesthesia practice and needs within the State of Louisiana. The State of Louisiana currently has approximately 300 practicing anesthesiologists (physicians), 700 certified registered nurse anesthetists (CRNAs), and does not currently utilize anesthesiologist assistants (AAs). Approximately 500,000 anesthesia encounters occur annually in Louisiana. Although there is a recognized critical shortage of anesthesiologists nationally, this document will focus mainly on the issue of mid-level providers of anesthesia services. The overwhelming majority of surgical and obstetric procedures is performed using the anesthesia care team approach both nationally and in the State of Louisiana. Within the anesthesia care team model, the practice of certified registered nurse anesthetists and anesthesiologist assistants are interchangeable, and both would meet the need for mid-level anesthesia providers in the State of Louisiana.

  7. 武汉同济医院开展癌痛规划化治疗示范病房建立管理规范培训暨麻醉处方权医师培训%Tongji Hospital launched the training programs for practices in wards with standard treatment of cancer pain and physicians'narcotic prescription right

    Institute of Scientific and Technical Information of China (English)

    Yi Cheng

    2011-01-01

    @@ On July 18th,2011,Academic Exchange Center of Tongji Hospital was packed with medical staff from Cancer Center,Department of Anesthesia,Department of Pharmacy,and Nursing Department.All of the people participated in the opening ceremony of "the training programs for practices in wards with standard treatment of cancer pain and physicians'narcotic prescription right".

  8. The effect of ozone associated with summertime photochemical smog on the frequency of asthma visits to hospital emergency departments

    Energy Technology Data Exchange (ETDEWEB)

    Cody, R.P. (Robert Wood Johnson Medical School, Piscataway, NJ (United States)); Weisel, C.P.; Lioy, P.J. (Robert Wood Johnson Medical School, Piscataway, NJ (United States) Environmental and Occupational Health Sciences Institute, Piscataway, NJ (United States)); Birnbaum, G. (Morristown Memorial Hospital, NJ (United States))

    1992-08-01

    A retrospective study using ambient ozone, temperature, and other environmental variables and their effect on the frequency of hospital visits for asthma was conducted in New Jersey, an area that often exceeds the allowable national standard for ozone. Data on emergency department visits for asthma, bronchitis, and finger wounds (a nonrespiratory control) were analyzed for the period May through August for 1988 and 1989. Asthma visits were correlated with temperature while the correlation between asthma visits and ozone concentration was nonsignificant. However, when temperature was controlled for in a multiple regression analysis, a highly significant relationship between asthma visits and ozone concentration was identified. Between 13 and 15% of the variability of the asthma visits and ozone concentration was identified. Between 13 and 15% of the variability of the asthma visits was explained in the regression model by temperature and ambient ozone levels. This association, when compared to similar studies in Canada, shows the contribution of ozone to asthma admissions to be stronger in areas with higher ozone concentrations. Thus, among regions with periodic accumulations of ozone in the ambient atmosphere, an exposure-response relationship may be discernible. This supports the need to attain air quality standards for ozone to protect individuals in the general population from the adverse health effects caused by ambient ozone exposure. 21 refs., 1 fig., 6 tabs.

  9. The Prevalence of Clubfoot in the Neonates who were Referred to the Emergency Department of Mofid Children Hospital

    Directory of Open Access Journals (Sweden)

    Hamid Reza Seyyed Hossein Zadeh Ardebili

    2011-05-01

    Full Text Available ObjectiveClub-foot is one of the most prevalent congenital anomalies of the lowerextremities. Since there is no epidemiologic study on the prevalence of thisdisease in Iran, we decided to assess it in a sample population in Tehran.Materials and MethodsWe assessed all neonates who were referred to the emergency department ofmofid children hospital between October 2007 and November 2008, due to apaediatric emergency problem. None of the patients had chief complaints oflower extremity deformity.ResultsDuring this time period (13 months, we could examine 682 neonates. Noneof the parents of these neonates had complaints regarding anomaly of lowerextremities of their neonates at the time of the emergency referral. Of them, 371(54% were female and 311 (46% were male. The age of the mother at the timeof pregnancy was 35 yr in 86 (13% neonates. There was a previous historyof clubfoot in the siblings of one of the neonates who was under orthopaedictreatment.Among all these neonates, we found two cases of clubfoot (0.3%, with bilateralinvolvement. In one of these cases, the older sibling also had clubfoot.ConclusionThe incidence of clubfoot has been reported between 0.39 and 6 cases in 1000live birth in the literature. In the present study, we found a prevalence of 0.3 forclubfoot in every 1000 neonates.

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

    Directory of Open Access Journals (Sweden)

    Alvaro Páez

    2011-10-01

    Full Text Available PURPOSE: To evaluate the performance of a 'one-stop' clinic in terms of proportion of discharges or inclusion in surgical waiting lists. MATERIALS AND METHODS: All patients were referred from primary care facilities (population 220.646 and from different departments in the hospital. Eight senior urologists, two registered nurses and two nurse attendants participated in the experience. Prior to the start of the project, referral protocols had been agreed with the primary care physicians involved. Compliance with the protocols was periodically tested. Eventually 5537 first visits (January-December 2009 where evaluable. RESULTS: Overall, the 'one-stop' format proved feasible in 74.2% of the patients (4108/5537. Patients, who successfully used the 'one-stop' format, were significantly younger than those who required additional consultations (43 vs 50 years old, respectively, Student's t test < 0.001. For obvious reasons the 'one-stop' format was universally possible in male sterilization and penile phimosis patients. Similarly, the 'one-stop' policy was applied in most consultations due to male sexual dysfunction (75% and urinary tract infection (73%. Other health problems, such as haematuria (62% and renal colic (46%, required more than one visit so that care of the patient reverted to the traditional, outpatient care model. CONCLUSION: A 'one-stop' philosophy is feasible for a number of procedures in a urological outpatient clinic. The costs to implement such an approach would be limited to managerial expenditure.

  11. Evaluation of prehospital and emergency department systolic blood pressure as a predictor of in-hospital mortality.

    Science.gov (United States)

    Lalezarzadeh, Fariborz; Wisniewski, Paul; Huynh, Katie; Loza, Maria; Gnanadev, Dev

    2009-10-01

    Hypotension is a trauma activation criterion validated by multiple studies. However, field systolic blood pressures (SBP) are still met with skepticism. How significant is the role of prehospital (PH) and emergency department (ED) SBP in the patient's overall condition? A review of the trauma registry over a 5-year period was conducted. PH SBPs were stratified into four categories: severe (SBP 80 mmHg or less), moderate (81-100 mmHg), mild hypotension (101-120 mmHg), and normotension (greater than 120 mmHg). These four groups were further subcategorized into the patients who were hypotensive, SBP 90 mmHg or less in the ED, versus those that were not (SBP greater than 90 mmHg). Data for 6964 patients were analyzed. Patients with PH SBP of 80 mmHg or less compared with patients who had PH SBP of greater than 80 mmHg had higher mortality (OR, 9; 95% CI, 6.45-12.84). Patients with both PH SBP 80 mmHg or less and ED SBP 90 mmHg or less had the highest risk of mortality (50%) and highest need for emergent operative intervention (54%). PH and ED hypotension is a strong predictor of in-hospital mortality and need for emergent surgical intervention in trauma patients. Field or ED blood pressures should serve as a significant marker of the patient's condition.

  12. Evaluation of Patients’ Exposure during Angiography and Angioplasty Procedures in the Angiography Department of Shahid Madani Hospital in Tabriz

    Directory of Open Access Journals (Sweden)

    Asghar Mesbahi

    2009-03-01

    Full Text Available Introduction: Coronary angiography and angioplasty procedures lead to significant radiation exposure of patients. In the current study, the average radiation dose to patients during angiography in the Angiography Department of Shahid-Madani Hospital was determined. Materials and Methods: An image intensifier based angiography unit (Philips BH 3000 was used for angiography procedures. The accuracy of the internal dosimeter was verified. Dose-area products (DAP of patients (236 cases during fluoroscopy and cine acquisition were recorded. Analyzing the data, the average radiation doses to patients for angiography and angioplasty and also for fluoroscopy and cine acquisition were determined. Additionally, the average fluoroscopy time for all patients was estimated. Results: The average DAPs of 23.7 and 91.5 Gycm2 were estimated for angiography and angioplasty respectively. Patient doses including fluoroscopy, cine acquisition and the total dose for angiography were 2, 7.7 and 3.8 times lower than angioplasty procedures respectively. Average fluoroscopy time was 1.9 times lower for angiography compared to angioplasty. Discussion and Conclusion: Fluoroscopy time and patient dose during fluoroscopy were in good agreement with other studies. However, the dose to patients during angioplasty was higher compared to other reports. To reduce patient dose in angioplasty procedures, the use of the lowest available frame rate, smallest field size and retraining of operators and technologists are recommended.

  13. [Perioperative mortality and morbidity for the year of 1999 in 466 Japanese Certified Anesthesia-training Hospitals: with special reference to ASA-physical status--report of Committee on Operating Room Safety of Japan Society of Anesthesiologists].

    Science.gov (United States)

    Irita, K; Kawashima, Y; Kobayashi, T; Goto, Y; Morita, K; Iwao, Y; Seo, N; Tsuzaki, K; Dohi, S

    2001-06-01

    Perioperative mortality and morbidity in Japan for the year 1999 were studied retrospectively. Committee on Operating Room Safety of the Japan Society of Anesthesiologists (JSA) sent confidential questionnaires to 774 Certified Training Hospitals of JSA and received answers from 60.2% of the hospitals. We analyzed their answers with special reference to ASA physical status (ASA-PS). The total number of anesthetics analyzed was 655, 644. Mortality and morbidity due to all kinds of causes including anesthetic management, intraoperative events, co-existing diseases, and operation were as follows. The incidence of cardiac arrest (per 10,000 anesthetics) was 0.68, 3.76, 14.37, 67.03, 0.36, 4.68, 27.96, 206.30 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The incidences of critical events including cardiac arrest, severe hypotension, and severe hypoxemia were 8.93, 26.99, 71.30, 188.52, 8.68, 31.27, 136.16, and 790.92 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The mortality rates (death during anesthesia and within 7th postoperative day) after cardiac arrest were 0.16, 0.94, 5.71, 33.51, 0.00, 1.46, 16.41 and 167.76 per 10,000 anesthetics in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The overall mortality rates were 0.24, 1.66, 12.16, 67.03, 0.00, 3.51, 34.65 and 417.14 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. Overall mortality and morbidity were higher in emergency anesthetics than in elective anesthetics. ASA-PS correlated well with overall mortality and with morbidity, regardless of etiology. The incidences of cardiac arrest totally attributable to anesthesia were 0.24, 0.45, 1.47, 8.38, 0.36, 1.75, 2.43 and 11.34 in patients with ASA-PS of I, II, III, IV, I E, II E, III E, and IV E, respectively. The incidences of all critical events totally attributable to anesthesia were 4.92, 8.81, 14.74, 20.95, 4

  14. Hospitals

    DEFF Research Database (Denmark)

    Mullins, Michael

    2013-01-01

    in the navigation experience and wasted time of medical staff in providing directions. Space in hospitals: space can be divided into personal, social and outdoor space. Personal space: single rooms have been well documented in: admission length, mortality rates, comfort levels, sense of privacy, all users...

  15. Adenotomy under general anesthesia.

    Science.gov (United States)

    Vokurka, J; Jakoubková, S; Vít, Z; Drahokoupilová, M

    1989-01-01

    Experience obtained from adenotomy (AT) under general anesthesia using Ketamin hydrochloride (Ketalar, Narkamon) in children are presented in this paper. The authors had used intramuscular premedication with Prothazin, Dolsin and Atropin at the first stage, then they shifted to oral administration of a combination of Diazepam, Theadryl and Atropin. Ketamin may be applied intravenously in the dosage of 1.0 to 1.5 mg/kg of body weight in most children. Where it is not possible, a triple dose into the muscle is used. A total of 2,266 AT were performed. About 70% of patients were calm during the operation, once a suspected aspiration was considered but it was not confirmed. The main contribution of the method is 100% amnesia of the surgery made. The procedure is a compromise between a requirement for minimal traumatization of the child's psyche by the intervention and the resources available, particularly the need of personnel at the majority of otorhinolaryngo-logical departments nowadays.

  16. [Kingella kingae ostemyelitis and septic arthritis in paediatric patients. Six cases from the Department of Pediatrics, National University Hospital of Iceland.].

    Science.gov (United States)

    Birgisson, H; Steingrímsson, O; Guðnason, T

    2000-01-01

    Kingella kingae (K. kingae) is a gram negative rod most often associated with septic arthritis and osteomyelitis in children. Infections caused by K. kingae had not been reported in Iceland when six cases were diagnosed at the Pediatric Department at the National University Hospital of Iceland. In this report we describe those cases and review the literature.

  17. Prescribing pattern of antipsychotic drugs in the outpatient department of psychiatry in Silchar Medical College and Hospital, Assam

    Directory of Open Access Journals (Sweden)

    Pinaki Chakravarty

    2016-01-01

    Full Text Available Objective: To study the prescribing pattern of antipsychotic drugs in the outpatient department of psychiatry in Silchar Medical College and Hospital (SMCH of Assam. Methods: It is a prospective cross-sectional study which was carried out for three months from August to November 2015 in the outpatient department of psychiatry. All patients irrespective of their ages and sexes were included in this study. Inpatients, referred patients, patients not willing to give consent, patients of epilepsy as well as those cases where diagnoses were not certain were excluded from the study. The prescription patterns of antipsychotic drugs and the occurrences of various psychiatric diseases on both the sexes were studied after taking permission from the Institutional Ethical Committee (SMCH. Results: A total of 112 prescriptions were analysed. The most common disease was found to be schizophrenia. Total drugs prescribed were 265 and average number of drugs per prescription was 2.36. It was seen that out of the 112 prescriptions, monotherapy was practiced in 19.64% (22 compared to polytherapy in 80.35% (90. Out of 265 prescribed drugs atypical antipsychotics were 112 (42.26%, typical antipsychotics 12 (4.52%, antiepileptics 57 (21.50%, antidepressants 29 (10.94%, antiparkinsonian 29 (10.94%, and others 26 (9.81%. Antipsychotics given orally were 122 of which olanzapine was 54 (44.26%, risperidone 40 (32.78%, chlorpromazine ten (8.19%, quetiapine eight (6.55%, aripiprazole five (4.09%, amisulpiride five (4.09% were seen. Injectable antipsychotics were two, of which only haloperidol two (100%. Antipsychotics in combination prescription with same groups were 14 (12.5%, with antidepressants, antipileptics, antiparkinsonian were 88 (78.57% and other agents were ten (8.92%, which included pantoprazole, multivitamins, and benfotiamine. Conclusion: This study shows that atypical antipsychotics are the most common drugs prescribed in patients with psychotic illness and

  18. A Description of the Management Characteristics of Anesthesia Care Delivery in Small, Medium, Large, Teaching and Non-Teaching Hospitals in the U.S. Navy

    Science.gov (United States)

    1998-10-01

    Cesarean sections . Navy CRNAs and anesthesiologist are assigned to cover the OB Department daily. Obstetrical services are offered in 18 of the 23...Program, reported in the Navy Nurse Corps Director’s Update that the United States is currently short 6,000 CRNAs and that the Navy Nurse Corps is short of...described in relation to the major research questions outlined in Chapter 1. The first section provides demographic and background data necessary to

  19. Elderly patients with lower extremity operation anesthesia department of orthopedics nursing observation%高龄骨科患者下肢手术麻醉护理配合观察

    Institute of Scientific and Technical Information of China (English)

    甘蔚明

    2014-01-01

    Objective Investigate the anesthesia nursing cooperation in the role of elderly orthopedics lower limbs.Methods To choose the ripe old age of orthopaedic surgery patients 150 cases as the research object,for the implementation of preoperative and intraoperative anesthetic care coordination,real time focus on the patient's condition changes.Results All patients with lower extremity surgery-orthopaedic surgery are completed smoothly,no patient anesthesia accident and the complications caused by anesthesia.Conclusion In the process of surgery anesthesia doctors and operating room nurses tacit cooperation,coordinated,conducive to the smooth completion of anesthesia and operation process of significantly ease the pain of patients and the psychological tension.%目的:探讨麻醉护理配合在高龄骨科下肢手术中的作用。方法:选择进行手术的高龄骨科患者150例作为研究对象,为其实施术前及术中麻醉护理配合,实时关注患者的病情变化情况。结果:所有下肢手术高龄骨科患者的手术均顺利完成,无一例患者发生麻醉意外及由麻醉引起的并发症。结论:手术过程中麻醉医生和手术室护士配合默契,协调一致,有利于顺利完成麻醉及手术过程,显著的减轻患者的疼痛及紧张的心理。

  20. 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...

  1. 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...

  2. CME Article: Perceptions of Acupuncture and Acupressure by Anesthesia Providers: A Quantitative Descriptive Study.

    Science.gov (United States)

    Faircloth, Amanda C; Dubovoy, Arkadiy; Biddle, Chuck; Dodd-McCue, Diane; Butterworth, John F

    2016-04-01

    Background: Randomized controlled trials show that acupuncture and acupressure support anesthesia management by decreasing anxiety, opioid requirements, and treating post-operative nausea and vomiting. Acupuncture and acupressure have demonstrated clinical usefulness but have not yet diffused into mainstream anesthesia practice. To determine why, this study assessed U.S. anesthesia provider's perceptions of acupuncture and acupressure. Methods: After institutional review board approval, 96 anesthesiology departments stratified by geographic region (Northeast, South, West, and Midwest) and institution type (university medical centers, community hospitals, children's hospitals, and veterans affairs hospitals) were selected for participation in an anonymous, pretested, online survey. The target sample was 1728 providers, of whom 292 (54% anesthesiologists, 44% certified registered nurse anesthetists, 2% anesthesiologist assistants) responded, yielding an overall 17% response rate. Results: Spearman correlation coefficient revealed a statistically significant correlation between acupuncture and geographic region, with the West having the highest predisposition toward acupuncture use (rs  = 0.159, p = 0.007). Women are more likely to use acupuncture than men (rs  = -0.188; p = 0.002). A strong effect size exists between acupuncture and country of pre-anesthesia training (rs  = 1.00; 95% CI = 1.08, 1.16). Some providers have used acupuncture (27%) and acupressure (18%) with positive outcomes; however, the majority have not used these modalities, but would consider using them (54%, SD = 1.44 ; acupressure: 60%, SD = 1.32). Seventy-six percent of respondents would like acupuncture education and 74% would like acupressure education (SDs of 0.43 and 0.44, respectively). Conclusions: While most of the U.S. anesthesia providers in this survey have not used these modalities, they nevertheless report a favorable perception of acupuncture

  3. 38 CFR 3.1605 - Death while traveling under prior authorization or while hospitalized by the Department of...

    Science.gov (United States)

    2010-07-01

    ... hospitalized under section 5 of Executive Order 10122 (15 FR 2173; 3 CFR 1950 Supp.) issued pursuant to Pub. L... funeral, burial, plot, or interment expenses of a person who dies while in a hospital, domiciliary, or... purpose of: (1) Examination; or (2) Treatment; or (3) Care dies enroute, burial, funeral, plot,...

  4. Anesthesia & Down Syndrome

    Science.gov (United States)

    ... tests used to verify existence and severity of valvular heart disease. Unfortunately, not all adults with Down syndrome will ... exams without sedation or anesthesia. Suspected existence of valvular heart disease must be communicated to the anesthesiologist prior to ...

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

    Directory of Open Access Journals (Sweden)

    Muhly WT

    2015-11-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-07-24

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

  7. Current options in local anesthesia for groin hernia repairs.

    Science.gov (United States)

    Kulacoglu, Hakan; Alptekin, Alp

    2011-01-01

    Inguinal hernia repair is one of the most common procedures in general surgery. All anesthetic methods can be used in inguinal hernia repairs. Local anesthesia for groin hernia repair had been introduced at the very beginning of the last century, and gained popularity following the success reports from the Shouldice Hospital, and the Lichtenstein Hernia Institute. Today, local anesthesia is routinely used in specialized hernia clinics, whereas its use is still not a common practice in general hospitals, in spite of its proven advantages and recommendations by current hernia repair guidelines. In this review, the technical options for local anaesthesia in groin hernia repairs, commonly used local anaesthetics and their doses, potential complications related to the technique are evaluated. A comparison of local, general and regional anesthesia methods is also presented. Local anaesthesia technique has a short learning curve requiring simple training. It is easy to learn and apply, and its use is in open anterior repairs a nice way for health care economics. Local anesthesia has been shown to have certain advantages over general and regional anesthesia in inguinal hernia repairs. It is more economic and requires a shorter time in the operating room and shorter stay in the institution. It causes less postoperative pain, requires less analgesic consumption; avoids nausea, vomiting, and urinary retention. Patients can mobilize and take oral liquids and solid foods much earlier. Most importantly, local anesthesia is the most suitable type of anesthesia in elder, fragile patients and patients with ASA II-IV scores.

  8. Anesthesia methods used by anesthetic specialists for circumcision cases

    Science.gov (United States)

    Altaş, Cafer; Küçükosman, Gamze; Yurtlu, Bülent S.; Okyay, Rahşan D.; Aydın, Bengü G.; Pişkin, Özcan; Çimencan, Murat; Ayoğlu, Hilal; Hancı, Volkan; Özkoçak-Turan, Işıl

    2017-01-01

    Objectives: To examine the anesthesiologist’s choice for anesthesia techniques and drugs in circumcision and determine the preoperative examination, intraoperative monitoring techniques, postoperative analgesia methods, and common complications among anesthesiologists working in Turkey. Methods: This cross-sectional study was conducted at Bulent Ecevit University Hospital, Zonguldak, Turkey, between May and July 2012. Survey data were obtained via survey forms through electronic data over the web. The questionnaire consists of 20 questions. These questions included demographic data, methods of anesthesia for circumcision, postoperative analgesia methods, and monitoring methods. Results: The data were obtained from 206 anesthesiologists who agreed to participate in the survey. Circumcision was performed most frequently in the age group of 3-6 years old. It was found that 47% of routine preoperative laboratory tests were coagulation parameters and complete blood count tests. The most common method of anesthesia was laryngeal mask. The frequency of administration of regional anesthesia was 37.4%, and caudal block was more preferable. Bupivacaine as a local anesthetic in regional anesthesia and midazolam and ketamine were the most preferred agents in sedoanalgesia. During regional anesthesia, ultrasound was most often used by anesthesiologists (31.6%). Conclusion: Ambulatory anesthesia protocols, which are also needed in circumcision, can be improved with international recommendation, and these protocols could be conformed as sociocultural structure in societies. This study should be regarded as a preliminary study to attract attention on anesthesia techniques in circumcision. PMID:28042634

  9. Evaluation of natural language processing from emergency department computerized medical records for intra-hospital syndromic surveillance

    Directory of Open Access Journals (Sweden)

    Pagliaroli Véronique

    2011-07-01

    Full Text Available Abstract Background The identification of patients who pose an epidemic hazard when they are admitted to a health facility plays a role in preventing the risk of hospital acquired infection. An automated clinical decision support system to detect suspected cases, based on the principle of syndromic surveillance, is being developed at the University of Lyon's Hôpital de la Croix-Rousse. This tool will analyse structured data and narrative reports from computerized emergency department (ED medical records. The first step consists of developing an application (UrgIndex which automatically extracts and encodes information found in narrative reports. The purpose of the present article is to describe and evaluate this natural language processing system. Methods Narrative reports have to be pre-processed before utilizing the French-language medical multi-terminology indexer (ECMT for standardized encoding. UrgIndex identifies and excludes syntagmas containing a negation and replaces non-standard terms (abbreviations, acronyms, spelling errors.... Then, the phrases are sent to the ECMT through an Internet connection. The indexer's reply, based on Extensible Markup Language, returns codes and literals corresponding to the concepts found in phrases. UrgIndex filters codes corresponding to suspected infections. Recall is defined as the number of relevant processed medical concepts divided by the number of concepts evaluated (coded manually by the medical epidemiologist. Precision is defined as the number of relevant processed concepts divided by the number of concepts proposed by UrgIndex. Recall and precision were assessed for respiratory and cutaneous syndromes. Results Evaluation of 1,674 processed medical concepts contained in 100 ED medical records (50 for respiratory syndromes and 50 for cutaneous syndromes showed an overall recall of 85.8% (95% CI: 84.1-87.3. Recall varied from 84.5% for respiratory syndromes to 87.0% for cutaneous syndromes. The

  10. Impact of oral diseases on quality of life in subjects attending out-patient department of a dental hospital, India

    Directory of Open Access Journals (Sweden)

    N Saimadhavi

    2013-01-01

    Full Text Available Context: Currently there is a growing interest in oral health outcomes in how oral health affects quality of life. When oral health related quality of life measures are used alongside traditional clinical methods of measuring oral health status, a more comprehensive assessment of the impact of oral diseases on the several dimensions of subjective wellbeing becomes possible. In this context, we attempted to study the impact of oral diseases on quality of life, so as to address the patient′s needs in an appropriate way and thereby improving one′s quality of life. Aims: To evaluate the impact of different oral diseases on quality of life using a modified OHIP-14 questionnaire, so as to address the patient′s needs in an appropriate way and thereby improving one′s quality of life. Settings and Design: The study was carried out among 302 subjects, attending the outpatient department a dental hospital, India, for check up and treatment of their oral condition. Subjects aged above 20 years, who gave their consent for the study were included. Materials and Methods: The study sample was categorized in to two groups based upon the duration of the affecting disease - group 1 consisted of subjects suffering with chronic diseases and group 2 of subjects suffering with acute diseases. All the subjects were asked to fill up their responses in the given OHIP-14 questionnaires. The completed questionnaires were then collected and statistically analyzed. Statistical Analysis Used: To evaluate the role of age on QOL, age was divided in to 2 groups using median split procedure. For inter and intragroup comparisions, independent sample t test, anova followed by post hoc test and Chi-square tests were employed. Results: Chi square test revealed a moderately impaired quality of life among all the diseases investigated. On comparing the mean domain and total OHIP score between the two groups, the domain of psychological discomfort and disability and the total

  11. Influence of local mucosal anesthesia combined with non tracheal intubation general anesthesia on EMR patients' intra-operative serum indexes

    Institute of Scientific and Technical Information of China (English)

    Sheng-Yong Liang

    2015-01-01

    Objective:To analyze the influence of local mucosal anesthesia combined with non tracheal intubation general anesthesia on EMR patients’ intra-operative serum indexes.Methods: 162 patients who received EMR from September 2013 to September 2014 in our hospital were enrolled and randomly divided into the observation group, including 81 cases, who received local mucosal anesthesia combined with non tracheal intubation general anesthesia, and the control group, including 81 cases, who received local mucosal anesthesia combined with routine tracheal intubation general anesthesia. Then inflammation index, stress index and immune index, etc were compared.Results:1) after general anesthesia, serum cytokine levels of IL-23, IL-32, PCT,β-EP and TNF-α, etc of the observation group were all significantly lower than those of the control group(P<0.05); 2) after general anesthesia, serum cytokine levels of COR, ET, TH and Ins, etc of the observation group were significantly lower than those of the control group(P<0.05); 3) after general anesthesia, serum levels of sICAM 1, CD11b, CD18 and CD20 of the observation group were lower than those of the control group; CD56 level was higher than that of the control group(P<0.05).Conclusion:Local mucosal anesthesia combined with non tracheal intubation general anesthesia provides sufficient anesthetic depth for EMR patients, and at the same time, can effectively reduce intra-operative systemic inflammatory response and stress response and contribute to the protection of body's immune function.

  12. Performance evaluation of medical records departments by analytical hierarchy process (AHP) approach in the selected hospitals in Isfahan : medical records dep. & AHP.

    Science.gov (United States)

    Ajami, Sima; Ketabi, Saeedeh

    2012-06-01

    Medical Records Department (MRD) is an important unit for evaluating and planning of care services. The goal of this study is evaluating the performance of the Medical Records Departments (MRDs) of the selected hospitals in Isfahan, Iran by using Analytical Hierarchy Process (AHP). This was an analytic of cross-sectional study that was done in spring 2008 in Isfahan, Iran. The statistical population consisted of MRDs of Alzahra, Kashani and Khorshid Hospitals in Isfahan. Data were collected by forms and through brainstorm technique. To analyze and perform AHP, Expert Choice software was used by researchers. Results were showed archiving unit has received the largest importance weight with respect to information management. However, on customer aspect admission unit has received the largest weight. Ordering weights of Medical Records Departments' Alzahra, Kashani and Khorshid Hospitals in Isfahan were with 0.394, 0.342 and 0.264 respectively. It is useful for managers to allocate and prioritize resources according to AHP technique for ranking at the Medical Records Departments.

  13. Development of a minimization instrument for allocation of a hospital-level performance improvement intervention to reduce waiting times in Ontario emergency departments

    Directory of Open Access Journals (Sweden)

    Anderson Geoff

    2009-06-01

    Full Text Available Abstract Background Rigorous evaluation of an intervention requires that its allocation be unbiased with respect to confounders; this is especially difficult in complex, system-wide healthcare interventions. We developed a short survey instrument to identify factors for a minimization algorithm for the allocation of a hospital-level intervention to reduce emergency department (ED waiting times in Ontario, Canada. Methods Potential confounders influencing the intervention's success were identified by literature review, and grouped by healthcare setting specific change stages. An international multi-disciplinary (clinical, administrative, decision maker, management panel evaluated these factors in a two-stage modified-delphi and nominal group process based on four domains: change readiness, evidence base, face validity, and clarity of definition. Results An original set of 33 factors were identified from the literature. The panel reduced the list to 12 in the first round survey. In the second survey, experts scored each factor according to the four domains; summary scores and consensus discussion resulted in the final selection and measurement of four hospital-level factors to be used in the minimization algorithm: improved patient flow as a hospital's leadership priority; physicians' receptiveness to organizational change; efficiency of bed management; and physician incentives supporting the change goal. Conclusion We developed a simple tool designed to gather data from senior hospital administrators on factors likely to affect the success of a hospital patient flow improvement intervention. A minimization algorithm will ensure balanced allocation of the intervention with respect to these factors in study hospitals.

  14. AWARENESS ABOUT ANESTHESIA AND ANESTHESIOLOGIST AM ONG THE PARAMEDICAL STAFFS OF S N MEDICAL COLLEGE, BAGALKOT (KARNATAKA

    Directory of Open Access Journals (Sweden)

    Hiremath

    2013-10-01

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

  15. Exploring the relationship between costs and quality. Does the joint evaluation of costs and quality alter the rankings of Danish hospital departments?

    DEFF Research Database (Denmark)

    Hvenegaard, Anne; Nielsen Arendt, Jacob; Street, Andrew

    2011-01-01

    vascular departments, we estimate fixed effect models for costs (linear) and quality (logistic). We consider two quality measures; mortality and wound complications. To assess whether the joint evaluation of costs and quality affects the ranking of departments, we construct joint confidence regions......OBJECTIVE: The purpose is to evaluate the relationship between costs and quality and to assess whether the joint evaluation of costs and quality affects the ranking of hospital departments relative to comparison based on costs alone. METHODS: Using patient level data for 3,754 patients in six...... for each pair of departmental effects for costs and quality using a bootstrap method and rank departments according to their cost-effectiveness ratio. The findings are used to evaluate a theory of a U-shaped cost/quality relationship. RESULTS: The association between cost and quality differs depending...

  16. Inclusive growth between mental department in general hospital and special mental hospital%综合医院精神科与精神病专科医院的包容性增长

    Institute of Scientific and Technical Information of China (English)

    陈育庆

    2011-01-01

    在综合医院就诊的患者中,不少患者同时伴有精神障碍.介绍了综合医院精神医学服务的现状,从社会偏见导致患者不愿到精神专科医院求治、对伴有躯体疾病精神患者的非精神疾病的综合救治能力和设施不足、资源有限导致无法满足不同层次需求等方面指出精神病专科医院的服务局限,从而提出综合医院开设精神科的必要性.认为在收治对象、人才培养、服务宗旨等方面,综合医院精神科与精神病专科医院是互为补充的,是可以通过合作竞争来达到和谐共存,实现包容性增长的局面的.%Some of patients visiting doctors in general hospital often accompany with mental disease. Status of mental service in general is introduced. Shortages in special mental hospital are discussed. First, social prejudice makes patient do not willing to see a doctor in special mental hospital. Second, lack of capacity and equipment to treat mental patients those who accompany with physiological disease. Third, limited resource makes special mental hospital not matching patient demands at all levels. So it is necessary to run mental department in general hospital. Special mental hospital and mental department in general hospital is complementary in parts of patient population, human resource training and service mission. Cooperative competition relation makes reconciliation between special mental hospital and mental department in general hospital and achieves inclusive growth.

  17. [Quality management according to the new SN EN ISO-Norm 9001:2000--experiences from initial certification of a hospital department].

    Science.gov (United States)

    Steffen, Th; Hochberger, G; Eisner, L

    2002-04-24

    Those who want to implement a quality-management system at a hospital these days cannot fall back on a broad-based system proven over the years. Though quality management as defined by ISO norm 9001 has been established as the central standard in many industrial areas, applicability of this ISO norm in the hospital sector has stirred up much controversy during recent years. Introduction of the new ISO norm 9001:2000 has changed the situation. The 2000 version of the new standard seeks to meet the demand for service operations--especially by establishing a clear procedural orientation. This report describes the new standard and its introduction in the Department of Surgery at the Cantonal Hospital in Olten, Canton Solothurn, Switzerland. It indicates the steps taken, for instance in the spheres of top management, quality management, procedural guidance, as well as customer and staff counselling. It also discusses the project's cost/benefit ratio for the organization.

  18. Prediction of Mobility Limitations after Hospitalization in Older Medical Patients by Simple Measures of Physical Performance Obtained at Admission to the Emergency Department

    DEFF Research Database (Denmark)

    Bodilsen, Ann Christine; Hedegaard Klausen, Henrik; Petersen, Janne

    2016-01-01

    .86–0.95), gait speed, OR 0.35 (0.26–0.46), chair-stand, OR 0.04 (0.02–0.08) and Cumulated Ambulation Score OR 0.49 (0.38–0.64). Adjustment for potential confounders did not change the results and the associations were not modified by any of the covariates: age, gender, cognitive status, the severity of the acute......Objective: Mobility limitations relate to dependency in older adults. Identification of older patients with mobility limitations after hospital discharge may help stratify treatment and could potentially counteract dependency seen in older adults after hospitalization. We investigated the ability...... of four physical performance measures administered at hospital admission to identify older medical patients who manifest mobility limitations 30 days after discharge. Design: Prospective cohort study of patients (≥65 years) admitted to the emergency department for acute medical illness. During the first...

  19. 医院职能部门绩效考核方法探索%Implementation of the Performance Appraisal in Hospital Functional Departments

    Institute of Scientific and Technical Information of China (English)

    殷晓红; 李萍; 沈正善; 高俊杰

    2012-01-01

    绩效考核是实现医院战略目标的有效手段.分析了三次考核指标的制定与实施情况,指出职能部门绩效考核难度较大,应持续改进并充分体现人性化.%The implementation of performance management is an effective mean to achieve hospital strategic goals. However, in reality, the performance appraisal in the hospital functional departments is difficult to implement. In practice, we carried out three times of the formulation and implementation of the performance indicators for functional departments, which was from the failure to come to comparative effective, but this method is not the most effective. The paper pointed out that the fully humanization is very importance in the performance appraisal.

  20. Factors Affecting Non-Adherence among Patients Diagnosed with Unipolar Depression in a Psychiatric Department of a Tertiary Hospital in Kolkata, India

    OpenAIRE

    Sohini Banerjee; Ravi Prasad Varma

    2013-01-01

    Non-adherence to depression treatment is a common clinical problem globally. However, limited research is available from India. This cross-sectional study aimed to assess non-adherence to prescribed treatment among patients with unipolar depression at a psychiatric out-patient department (OPD) of a tertiary hospital in Kolkata, India. The Morisky Medication Adherence Scale (MMAS) was used and a questionnaire designed by the Principal Investigator (PI) was administered. A total of 239 patients...

  1. An audit of the quality of referral letters received by the Department of Oral and Maxillofacial Surgery, Dublin Dental School and Hospital.

    LENUS (Irish Health Repository)

    Moloney, Justin

    2010-11-01

    One hundred consecutive referral letters, sent by dental practitioners to the Department of Oral and Maxillofacial Surgery, Dublin Dental School and Hospital, were audited in terms of quality. The audit was based on the Scottish Intercollegiate Guidelines Network (SIGN) recommendations of 1998. The audit demonstrated that in general referral letters required modification and did not give the clinician the required information. This paper sets out the results of the audit and suggests a template that should be used for future referrals.

  2. Assessment of prescribing, dispensing, and patient use pattern of antihypertensive drugs for patients attending outpatient department of Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia

    OpenAIRE

    Shukrala F; Gabriel T

    2015-01-01

    Fedila Shukrala,1 Tesfaye Gabriel2 1Dil Chora Referral Hospital, Dire Dawa, Ethiopia; 2Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia Background: Hypertension is a global concern and is one of the key preventable risk factors for cardiovascular events, resulting in unnecessary morbidity and mortality. The aim of this study was to assess the prescribing, dispensing and patient use pattern of antih...

  3. An audit of the quality of referral letters received by the Department of Oral and Maxillofacial Surgery, Dublin Dental School and Hospital.

    LENUS (Irish Health Repository)

    Moloney, Justin

    2010-10-01

    One hundred consecutive referral letters, sent by dental practitioners to the Department of Oral and Maxillofacial Surgery, Dublin Dental School and Hospital, were audited in terms of quality. The audit was based on the Scottish Intercollegiate Guidelines Network (SIGN) recommendations of 1998. The audit demonstrated that in general referral letters required modification and did not give the clinician the required information. This paper sets out the results of the audit and suggests a template that should be used for future referrals.

  4. Integration of the enterprise electronic health record and anesthesia information management systems.

    Science.gov (United States)

    Springman, Scott R

    2011-09-01

    Fewer than 5% of anesthesia departments use an electronic medical record (EMR) that is anesthesia specific. Many anesthesia information management systems (AIMS) have been developed with a focus only on the unique needs of anesthesia providers, without being fully integrated into other electronic health record components of the entire enterprise medical system. To understand why anesthesia providers should embrace health information technology (HIT) on a health system-wide basis, this article reviews recent HIT history and reviews HIT concepts. The author explores current developments in efforts to expand enterprise HIT, and the pros and cons of full enterprise integration with an AIMS.

  5. Risk management in anesthesia.

    Science.gov (United States)

    Cabrini, L; Levati, A

    2009-11-01

    Anesthesia is considered a leading discipline in the field of patient safety. Nevertheless, complications still occur and can be devastating. A substantial portion of anesthesia-related adverse events are preventable since risk factors can be detected and eliminated. Risk management (RM) in anesthesia includes preventive and remedial measures to minimize patient anesthesia-related morbidity and mortality. RM involves all aspects of anesthesia care. Classically, the following four steps are needed to prevent critical incidents or to learn from them: (1) detection of problems, (2) assessment, (3) implementation of solutions, and (4) verification of effectiveness. Problems and solutions can be identified into the fields of structures, processes and personnel. Authoritative agencies like the World Health Organization, the World Federation of Societies of Anesthesiologists, the Section and Board of Anesthesiology of the European Union of Medical Specialties and the Italian Scientific Society of Anesthesiologists (Società Italiana di Anestesia, Analgesia, Rianimazione e Terapia Intensiva SIAARTI) have proposed initiatives addressing safety in the operating room. The central role of a well-trained, constantly present anesthesiologist and the usefulness of checklists have been highlighted. Cost cutting and production pressure in medical care are potential threats to safety. A shared knowledge of the best standards of care and of the potential consequences of unscrupulous actions could make the daily management of conflicting interests easier. A correctly applied RM can be a powerful, highly beneficial aid to our practice.

  6. [Management and accounting solution required in clinical laboratory department in the hospital and the balanced scorecard (BSC)].

    Science.gov (United States)

    Takahashi, Toshiro

    2006-11-01

    This is to describe required accounting knowledge and the techniques for the clinical laboratory department management level people to operate their division from the viewpoint of management. Especially, the necessity and the efficacy of the BSC implementation in the clinical laboratory department are being explained.

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

    Science.gov (United States)

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

    2012-01-01

    Objectives Evaluate the validity of the International Classification of Diseases, 10th revision (ICD-10) code for hyperkalaemia (E87.5) in two settings: at presentation to an emergency department and at hospital admission. Design Population-based validation study. Setting 12 hospitals in Southwestern Ontario, Canada, from 2003 to 2010. Participants Elderly patients with serum potassium values at presentation to an emergency department (n=64 579) and at hospital admission (n=64 497). Primary outcome Sensitivity, specificity, positive-predictive value and negative-predictive value. Serum potassium values in patients with and without a hyperkalaemia code (code positive and code negative, respectively). Results The sensitivity of the best-performing ICD-10 coding algorithm for hyperkalaemia (defined by serum potassium >5.5 mmol/l) was 14.1% (95% CI 12.5% to 15.9%) at presentation to an emergency department and 14.6% (95% CI 13.3% to 16.1%) at hospital admission. Both specificities were greater than 99%. In the two settings, the positive-predictive values were 83.2% (95% CI 78.4% to 87.1%) and 62.0% (95% CI 57.9% to 66.0%), while the negative-predictive values were 97.8% (95% CI 97.6% to 97.9%) and 96.9% (95% CI 96.8% to 97.1%). In patients who were code positive for hyperkalaemia, median (IQR) serum potassium values were 6.1 (5.7 to 6.8) mmol/l at presentation to an emergency department and 6.0 (5.1 to 6.7) mmol/l at hospital admission. For code-negative patients median (IQR) serum potassium values were 4.0 (3.7 to 4.4) mmol/l and 4.1 (3.8 to 4.5) mmol/l in each of the two settings, respectively. Conclusions Patients with hospital encounters who were ICD-10 E87.5 hyperkalaemia code positive and negative had distinct higher and lower serum potassium values, respectively. However, due to very low sensitivity, the incidence of hyperkalaemia is underestimated. PMID:23274674

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

    Directory of Open Access Journals (Sweden)

    Lucía Vizcaíno-Martínez

    2014-01-01

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

  9. Outpatient varicocelectomy performed under local anesthesia

    Institute of Scientific and Technical Information of China (English)

    Geng-Long Hsu; Pei-Ying Ling; Cheng-Hsing Hsieh; Chii-Jye Wang; Cheng-Wen Chen; Hsien-Sheng Wen; Hsiu-Mei Huang; E. Ferdinand Einhorn; Guo-Fang Tseng

    2005-01-01

    Aim: To report a series of varicocelectomy performed under pure local anesthesia. Methods: From July 1988 to June 2003, a total of 575 patients, aged between 15 and 73 years, underwent high ligation of the internal spermatic vein for treatment of a varicocele testis under a regional block in which a precise injection of 0.8 % lidocaine solution was delivered to involved tissues after exact anatomical references were made. A 100-mm visual analog scale (VAS)was used to assess whether the pain level was acceptable. Results: The surgeries were bilateral in 52 cases, and unilateral in 523 cases. All were successfully performed on an outpatient basis except in the case of two patients, who were hospitalized because their surgeries required general anesthesia. Overall, 98.6 % (567/575) of men could go back to work by the end of the first post-operative week and only 8 (1.4 %) men reported feeling physical discomfort on the eighth day. The VAS scores varied from 11 mm to 41 mm with an average of (18.5 ± 11.3) mm that was regarded as tolerable. Conclusion: This study has shown varicocelectomy under local anesthesia to be possible,simple, effective, reliable and reproducible, and a safe method with minimal complications. It offers the advantages of more privacy, lower morbidity, with no notable adverse effects resulting from anesthesia, and a more rapid return to regular physical activity with minor complications.

  10. The Exploration and Practice of the Management of the Nutrition Depart-ment in the Hospital%医院营养科饮食保障管理探索与实践

    Institute of Scientific and Technical Information of China (English)

    陈珵

    2015-01-01

    in the dietetic social security under the background of, nutrition department according to the "food sanitation law, the No.85 Hospital of food hygiene and safety supervision and management regulations", the establishment of a food safety responsibility system, formulated the conforms to the actual hospital food safety management system, strengthen man-agement practitioners, and play the role of department experts, in practice continue to touch Suo Li practice, in terms of food security has been a qualitative leap. Hospital of food hygiene and safety to get effective protection, the completion of several of the major tasks of the categories of food security, food poisoning events did not occur, to ensure the food security of the officers and men of the hospital.%在后勤饮食保障社会化背景下,营养科根据《食品卫生法》《第八五医院食品卫生安全监督管理条例》,建立了食品安全责任体系,制定了符合医院实际的食品安全管理制度,加强从业人员管理,发挥科室专家作用,在实践中不断地摸索历练,在餐饮保障方面有了质的飞越。医院食品卫生安全得到有效保障,多次完成重大任务的大项餐饮保障,未发生一起食物中毒事件,保证了医院官兵的饮食安全。

  11. [Systemic Antimicrobials Consumption and Expenditures in Departments of Surgery of Multi-Profile Hospitals in the Russian Federation and the Republic of Belarus: Results of Multicentre Pharmacoepidemiological Study].

    Science.gov (United States)

    Belkova, Yu A; Rachina, S A; Kozlov, R S; Mishchenko, V M; Pavlukov, R A; Abubakirova, A I; Berezhanskiy, B V; Eliseeva, E V; Zubareva, N A; Karpov, I A; Kopylova, I A; Palyutin, Sh Kh; Portnyagina, U S; Pribytkova, O V; Samuylo, E K

    2016-01-01

    The results of the systemic antimicrobials (AM) consumption and expenditures assessment in the departments of surgery of multi-profile hospitals in different regions of the Russian Federation and the Republic of Belarus in 2009-2010 based on retrospective collection and analysis of the data from the hospital expenditure notes using ATC/DDD methodology are presented. The average AM consumption and expenditure rates in the above mentioned departments varied from 24.9 DDD/100 bed-days to 61.7 DDD/100 bed-days depending on the department profile, with beta-lactams (cephalosporins and penicillins) share in the consumption being as high as 70-90%, followed by fluoroquinolones and aminoglycosides. Only 55-70% of the consumed AM belonged to the drugs of choice, whereas the improper AM consumption and expenditure rates amounted up to 10-18%. The study outputs can be used for the budget allocation and AM distribution improvement in the departments of surgery, as well as for the development and efficacy control of the local antimicrobial stewardship programs.

  12. 医院门诊部健康管理实践的几点做法%Some methods of health management practice in hospital outpatient department

    Institute of Scientific and Technical Information of China (English)

    曹晶; 张海蕾; 李贤卓

    2014-01-01

    With the update of medical concept and the formation of new biological-psychological-social medical model,the goal of hospital service is constantly updating and upgrading.The outpatient department is the service window and forward position of the hospital.The health management work is an important part of hospital outpatient department work.The activity of health management practice in hospital outpatient department include strengthening the health management idea renewal, setting up and perfect the functions of the health management of science, optimizing the health management professional team, creating good environment and health management throughout the overall comprehensive health management services.Summarized as follows..%随着医学理念更新和新的生物-心理-社会医学模式的形成,医院服务的目标在不断更新和提升。门诊部是医院的服务窗口和前沿阵地。健康管理工作是医院门诊部工作的重要部分。本院门诊部健康管理实践活动包括强化健康管理理念更新,科学设置和完善健康管理职能部门,优化健康管理专业团队,创建良好的健康管理环境,提供全程全方位健康管理的整体服务。

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

    Data.gov (United States)

    U.S. Department of Health & Human Services — Overall rates of TBI climbed slowly from 2001 through 2007, then spiked sharply in 2008 and continued to climb through 2010. The increase in TBI rates in 2008 was...

  14. Perspectives on ambulatory anesthesia: the patient’s point of view

    Directory of Open Access Journals (Sweden)

    Sehmbi H

    2014-12-01

    Full Text Available Herman Sehmbi, Jean Wong, David T WongDepartment of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, CanadaAbstract: Recent advances in anesthetic and surgical techniques have led to tremendous growth of ambulatory surgery. With patients with many co-morbid conditions undergoing complex procedures in an ambulatory setting, the challenges in providing ambulatory surgery and anesthesia are immense. In recent years, the paradigm has shifted from a health-care provider focus involving process compliance and clinical outcomes, to a patient-centered strategy that includes patients’ perspectives of desired outcomes. Improving preoperative patient education while reducing unnecessary testing, improving postoperative pain management, and reducing postoperative nausea and vomiting may help enhance patient satisfaction. The functional status of most patients is reduced postoperatively, and thus the pattern of recovery is an area of ongoing research. Standardized and validated psychometric questionnaires such as Quality of Recovery-40 and Postoperative Quality of Recovery Scale are potential tools to assess this. Patient satisfaction has been identified as an important outcome measure and dedicated tools to assess this in various clinical settings are needed. Identification of key aspects of ambulatory surgery deemed important from patients’ perspectives, and implementation of validated outcome questionnaires, are important in improving patient centered care and patient satisfaction.Keywords: ambulatory, patient, satisfaction, anesthesia, outcomes, questionnaire, perspectives

  15. Evaluation of a Computerized Problem-Oriented Medical Record in a Hospital Department: Does it Support Daily Clinical Practice?

    DEFF Research Database (Denmark)

    Bossen, Claus

    2007-01-01

    led to more time spent documenting clinical work, fragmentation of patient situation into separate problems, and lack of overview.Conclusion: The problem-oriented method for structuring a computerized medical record may provide a description of how physicians think or ought to think, but does...... Purpose: Evaluation of a computerized problem-oriented medical record (CPOMR) for hospital work.Methods: A qualitative study of daily use of a CPOMR at an internal medicine hospital ward over a period of three months during which 66 patients were treated based on clinical information recorded...... in the CPOMR. The study is base on participant observation and interviews. Before and during the test period the author attended project planning meetings, a training workshop in the use of the CPOMR for nurses and physicians and local coordination meetings. After the test, 1 focus-group discussion...

  16. Application and evaluation of OSCE in assessment of clinical anesthesia minor students in anesthesiology department%OSCE在临床专业麻醉辅修班学生出科考核中的应用与评价

    Institute of Scientific and Technical Information of China (English)

    林舜艳; 尹正录; 高巨; 沈文瑞; 陈鑫; 周罗晶

    2015-01-01

    针对临床专业麻醉辅修班学生特点,制定出科考核客观结构化临床考试(objective structured clinical examination,OSCE)方案,对在麻醉科实习的辅修班学生进行出科考核,并设置问卷调查了解学生对OSCE考核方案的态度。结果显示,OSCE考核方案能客观、全面地反映学生对临床技能掌握和运用的情况;参加出科技能考核的学生对OSCE的设计与组织、质量和效能比较满意。%According to the characteristics of minor students majored in clinical anesthesia, an objective structured clinical examination (OSCE) program was established. This OSCE was applied to clinical anesthesia minor students for departmental rotation examination. Meanwhile, a questionnaire was set to collect students' attitude towards the OSCE assessment program. Results showed that OSCE assessment program could objectively and comprehensively reflect the students' clinical skills. Students participated in OSCE were quite satisfied with its design, organization, quality and effectiveness.

  17. Study of prescribing pattern of topical corticosteroids in dermatology out patients department in a tertiary care hospital in India

    OpenAIRE

    Nerurkar, Rajan P.; Manish R. Kokane; Manthan Nikesh Mehta

    2016-01-01

    Background: The selection of rational yet most effective treatment is an art to be learnt by most physicians. The advent of topical glucocorticoids has changed the way inflammatory dermatological conditions are managed. However, there is a constant need to keep a check on these prescriptions for their rationality. The present study was done to review the prescribing pattern of topical corticosteroids in dermatology outpatients at a tertiary care hospital. Methods: This was a prospective ob...

  18. Awareness Regarding Anemia, Gestational Diabetes and Pregnancy Induced Hypertension among Antenatal Women Attending Outpatient Department in a Rural Hospital

    OpenAIRE

    George M; George N; Ramesh N

    2016-01-01

    "Introduction: Antenatal mothers should not only be aware of normal antenatal care but also be aware about common morbidities like anemia, gestational diabetes mellitus (GDM), pregnancy induced hypertension (PIH), etc., which can have adverse pregnancy outcomes. This study was conducted to assess the awareness regarding anemia, GDM and PIH among antenatal women attending outpatient clinic in a rural hospital. Methods: This was a cross sectional study done during the period of October-Novem...

  19. Toward a sustainable and wise healthcare approach: potential contributions from hospital Internal Medicine Departments to reducing inappropriate medical spending

    Directory of Open Access Journals (Sweden)

    Roberto Nardi

    2013-04-01

    Full Text Available All countries are facing the question of how to maintain quality of care with shrinking health budgets, in the presence of a persistent increase in life expectancy, and with a significant growing demand for health care from aging populations and chronically ill patients. Current implementation of legislative measures is largely presented as a cost-cutting policy. With this political approach, there is a risk of services and the number of hospital beds being drastically reduced, mainly to detriment of the most vulnerable groups of the population and without considering the results obtained by each regional healthcare organization according to explicit evaluation markers. In our Scientific Society of Internal Medicine (the Federation of Associations of Hospital Doctors on Internal Medicine, FADOI, we want to support good medical practice because essential medicine is still a goal to be achieved throughout medical hospital care. We are looking for original ways to implement a sustainable and frugal hospital Internal Medicine policy by searching for wise and efficient clinical methodology to be applied in the care of patients admitted to internal medicine wards according to their real needs. We firmly believe that reinforcing a common agenda between medicine and public health, and sharing a common vision among professionals and decision makers in the planning of care, may be the greatest opportunity for any every health care reform. The future of the health care system cannot be restricted to mere cost reduction, but should aim to deliver better health care in relation to the money spent. Even in this period of austerity, new opportunities can still be found and doctors must lead efforts to meet this challenge.

  20. [The posturological department as clinical support for occupational medicine: clinical cases and results of a hospital unit].

    Science.gov (United States)

    Centemeri, R; D'Orso, M I; Latocca, R; Pagani, W; Cesana, G C

    2007-01-01

    The posturologic visit is a not widely known medical method for the evaluation and the therapy of low back pain. We describe the clinical and instrumental method followed in our posturological clinical unit organized jointly by hospital and university and the clinical cases evaluated in two years. An individual diagnostic evaluation and a personal therapy allowed an almost generalized complete remission of the symptoms and a very low number of reactivation of low back pain after a follow up of one years.

  1. Clinical feature analysis of hospital infections in department of urology based on 39 hospitalized patients%39例泌尿外科住院患者合并医院感染临床特征观察

    Institute of Scientific and Technical Information of China (English)

    肖玮琳; 甘艺平; 余强国; 宋小松

    2016-01-01

    Objective To explore the clinical features of hospital infections in hospitalized patients of urology department. Methods The clinical data of 39 patients suffered hospital infections and 40 patients without infections who were in the urology department of our hospital were compared and analyzed.ResultsThere were 52 pathogenic bacteria cultured from 39 patients with hospital infections, whose main infection sites were urinary tract infections and other infections. There was no relationship between patients’ gender and hospital infections,P>0.05, which was not statistically significant. For patients, the age, underlying disease, indwelling catheter, indwelling time, operation time, hospitalization time, and not using antibiotic drugs were the main reasons of hospital infections, P<0.05, which were statistically significant.ConclusionThere is a high hospital infection rate in the hospitalized patients of urology department, and the infections have complex clinical manifestations. The medical staff should probe into the infection causes and take effective measures to reduce the hospital infection rate.%目的:探讨泌尿科外科住院患者合并医院感染的临床特征。方法回顾性分析2012年10月~2015年10月来我院治疗的39例泌尿外科住院患者临床资料并选取同一时期来泌尿外科住院治疗未发生感染的40例患者对照分析,观察临床特征。结果39例院内感染患者共培养出52例病原菌。主要感染部位为泌尿道路感染及其他感染。患者性别与院内感染无关,无统计学意义(P>0.05)。年龄、基础疾病、留置尿管、留置时间、不使用抗生素、手术时间、住院时间均是导致院内感染的主要因素,有统计学意义(P<0.05)。结论泌尿外科住院患者发生感染机率较高并且临床表现复杂,要求医护人员要对感染原因深入分析并且采取有效措施预防,从而把医院感染机率降低。

  2. The Develoment of Anesthesia.

    Science.gov (United States)

    Davis, Audrey B.

    1982-01-01

    Until the eighteenth century, doctors were reluctant to use chemicals to alleviate pain because they accepted the religious/moral beliefs of their day, claiming that pain was beneficial for the body. Traces technical developments in the control of pain, discussing relationships of anesthesia to social, cultural, and scientific factors and…

  3. Local anesthesia: a review.

    Science.gov (United States)

    Malamed, S F; Sykes, P; Kubota, Y; Matsuura, H; Lipp, M

    1992-01-01

    Local anesthetics are the most widely administered drugs in dentistry. Significant advances have been made in past decades that have greatly increased both the safety and the efficacy of these important drugs. This paper reviews the history of local anesthesia, pharmacokinetics and clinical implications, techniques, complications, and future directions in the quest for more effective pain control in dentistry.

  4. Newer Anesthesia and Rehabilitation Protocols Enable Outpatient Hip Replacement in Selected Patients

    OpenAIRE

    Berger, Richard A; Sanders, Sheila A.; Thill, Elizabeth S.; Sporer, Scott M.; Della Valle, Craig

    2009-01-01

    Advancements in the surgical approach, anesthetic technique, and the initiation of rapid rehabilitation protocols have decreased the duration of hospitalization and subsequent length of recovery following elective total hip arthroplasty. We assessed the feasibility and safety of outpatient total hip arthroplasty in 150 consectutive patients. A comprehensive perioperative anesthesia and rehabilitation protocol including preoperative teaching, regional anesthesia, and preemptive oral analgesia ...

  5. Hospitals; hospitals13

    Data.gov (United States)

    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....

  6. 医院放射科空调系统及防辐射设计%Radiation protection and air conditioning system design for hospital radiology department

    Institute of Scientific and Technical Information of China (English)

    王松涛; 李欣; 赵艳波; 杜艳利

    2015-01-01

    Describes the features of the different radiology rooms in hospital including X-ray,CT, ECT,PET-CT,MRI and other radiology departments.According to the functional characteristics of the rooms and requirements of medical and health environment,presents the air conditioning system design of the radiology department.States the producing mechanism of radiation,and takes different radiation protection measures according to the different types of rays,which can provide reasonable suggestions for the air conditioning system and radiation protection design of the hospital radiology department.%简单描述了医院 X 线,CT,ECT,PET-CT,MRI 等放射科房间的功能特性,根据房间的功能特性及医疗卫生环境要求,详细阐述了放射科各房间的空调系统设计类型。介绍了医院放射科射线的产生机理,根据射线类型的不同采取相应的辐射防护措施,为医院放射科的空调系统及射线防护设计提供合理的建议。

  7. Effects of emergency department crowding on the delivery of timely care in an inner-city hospital in the Netherlands

    NARCIS (Netherlands)

    N. van der Linden (Naomi); M.C. van der Linden (M. Christien); J. Richards (John); R. Derlet (Robert); Grootendorst, D.C. (Diana C.); C.L. van den Brand (Crispijn)

    2016-01-01

    textabstractBackground The impact of delays in emergency department (ED) care has not been described in European countries where ED crowding is not universally recognized. The aim of this study was to determine the relationship of ED crowding with delays in triage and treatment, and 24-h mortality i

  8. An examination of emergency department nurses' attitudes towards deliberate self-harm in an Irish teaching hospital.

    LENUS (Irish Health Repository)

    McCarthy, Linda

    2010-01-01

    The purpose of this study was to examine emergency department (ED) nurses\\' attitudes towards individuals presenting with deliberate self-harm (DSH), including the relationship between attitudes and factors such as age, academic achievements, length of experience, and self-harm education.

  9. Treatment outcome for a sample of patients with Class II division 1 malocclusion treated at a regional hospital orthodontic department.

    LENUS (Irish Health Repository)

    Burden, D J

    1998-01-01

    This retrospective study assessed the outcome of orthodontic treatment of 264 patients with Class II division 1 malocclusion (overjet greater than 6 mm). The sample comprised patients who had completed their fixed appliance orthodontic treatment at a regional hospital orthodontic unit in the Republic of Ireland. The PAR Index (Peer Assessment Rating) was used to evaluate treatment outcome using before and after treatment study casts. The results revealed that treatment for this particular type of malocclusion was highly effective with a very few patients failing to benefit from their orthodontic treatment.

  10. Evaluation of trends of drug-prescribing patterns based on WHO prescribing indicators at outpatient departments of four hospitals in southern Ethiopia

    Directory of Open Access Journals (Sweden)

    Summoro TS

    2015-08-01

    Full Text Available Temesgen Sidamo Summoro,1 Kassa Daka Gidebo,2 Zewde Zemma Kanche,1 Eskinder Wolka Woticha2 1School of Medicine, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia; 2School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia Background: Rational prescribing is a primary step to ensure rational drug use. Often, half of the medicines are prescribed irrationally and half of these are even used incorrectly as the patients fail to take their medicines appropriately. The aim of this research was to evaluate drug-prescribing patterns of four hospitals in southern Ethiopia.Methods: A retrospective cross-sectional study was conducted between May 15 and June 25, 2014, to evaluate the drug-prescribing patterns based on the World health Organization (WHO prescribing indicators. The prescription papers, kept for the last 1 year in the outpatient departments of the four hospitals, were analyzed according to WHO guidelines. Also, prescriptions in the hospitals were analyzed to determine the most frequently prescribed drugs. All the statistical calculations were performed using SPSS® version 20.0 software.Results and discussion: The average number of drugs per prescription ranges from 1.82±0.90 to 2.28±0.90, whereas the percentage of use of antibiotics and injections ranged from 46.7 to 85 and 15 to 61.7, respectively. The average percentages of drugs prescribed by generic name and from the essential drugs list were 95.8 and 94.1, respectively. Anti-infective and analgesic drugs are found to be the most frequently prescribed medicines. In terms of polypharmacy, there was a slight deviation in prescribing patterns from what is acceptable according to the WHO criteria. Prescribing by generic name and from essential drug list was almost optimal. There was a significant deviation in the use of injectables in two of the four hospitals (50%, whereas their use in the other

  11. Assessment of prescribing, dispensing, and patient use pattern of antihypertensive drugs for patients attending outpatient department of Hiwot Fana Specialized University Hospital, Harar, Eastern Ethiopia

    Directory of Open Access Journals (Sweden)

    Shukrala F

    2015-01-01

    Full Text Available Fedila Shukrala,1 Tesfaye Gabriel2 1Dil Chora Referral Hospital, Dire Dawa, Ethiopia; 2Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia Background: Hypertension is a global concern and is one of the key preventable risk factors for cardiovascular events, resulting in unnecessary morbidity and mortality. The aim of this study was to assess the prescribing, dispensing and patient use pattern of antihypertensive drugs among patients attending Hiwot Fana Specialized University Hospital outpatient department.Methods: A hospital-based cross-sectional study was conducted in Hiwot Fana Specialized University Hospital on assessment of the prescribing, dispensing, and patient use pattern of antihypertensive drugs among patients who were above the age of 18 years and attending outpatient department from April 1–May 31, 2013. Data collection was conducted by reviewing the record of patients and direct observation of the dispensing process of randomly selected patients to measure average dispensing time, and direct interview with the patients. Results: A total of 400 patients met the inclusion criteria; out of the 400 patients studied, 63.5% were females. Most of the patients had Stage 1 hypertension (69%, followed by Stage 2 hypertension (31%. Out of the total number of patients, 264 were with different comorbid conditions: diabetes mellitus (64.3%, followed by congestive heart failure (15.1% and ischemic heart disease (2.3%. The most frequently prescribed class of antihypertensive drugs was diuretics, of which hydrochlorothiazide was the most frequently prescribed drug, both in single (55%, followed by enalapril (22.3%, methyl dopa (11.2%, atenolol (6.9%, and nifedipine (4.6%, and in combination with other antihypertensive drugs. The average dispensing time was 1.2 minutes, and 75% of the patients left the counter with inadequate information about the dosage

  12. 中国中医科学院西苑医院肿瘤科%Department of Oncology of Xiyuan Hospital of China Academy of Chinese Medical Sciences

    Institute of Scientific and Technical Information of China (English)

    中国中医科学院西苑医院肿瘤科

    2011-01-01

    This article introduced in detail on the Department of Oncology, Xiyuan Hospital of China Academy of Chinese Medical Sciences since it was established. The main direction of this department is TCM comprehensive therapy on colorectal cancer treatment. Development of department of oncology is through continuous exploration on specific treatment methods and systematic evaluation construction. The Department of Oncology of Xiyuan Hospital is the head unit of colorectal cancer treatment by the State Administration of Traditional Chinese Medicine in the "Eleventh Five-Year" Plan. The study, which is cooperated with 26 hospitals in China and National Research Cen-ter in Complementary and Alternative Medicine (NAFKAM) in Norway, is on the verification of TCM treatment of colorectal cancer diagnosis and treatment. The Integrative Medicine Diagnosis and Treatment Option on Colorectal Cancer was made. Exploration has been made on the three-level colorectal cancer prevention and control network with community hospitals. The completed tasks have been widely proved by the medical field both at home and abroad.%本文较详细地介绍了中国中医科学院西苑医院肿瘤科成立以来,确立了以中医综合治疗结、直肠癌为主攻方向,不断探索具体治疗方法和建立系统评价体系的成长历程.他们作为国家中医药管理局“十一五”结直肠癌专病建设组长单位,牵头联合全国26家医院以及挪威国家补充替代医学研究中心,进行的中医结直肠癌的诊疗方案的验证工作,牵头制定《结直肠癌中西医结合诊疗方案》,以及探索建立辐射社区医院的结直肠癌中医三级防治网络等工作,得到国内外医学界的广泛认可,具有典范借鉴意义.

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

    Directory of Open Access Journals (Sweden)

    Liu JL

    2014-05-01

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

  14. Pervasive Observation Medicine: The Application of RFID to Improve Patient Safety in Observation Unit of Hospital Emergency Department.

    Science.gov (United States)

    Chen, Chang-I; Liu, Cheng-Yaw; Li, Yu-Chuan; Chao, Chia-Cheng; Liu, Chien-Tsai; Chen, Chieh-Feng; Kuan, Ching-Feng

    2005-01-01

    Over the past decade, observation medicine has become an important component of emergency medicine. There are several settings in which observation medicine has been useful and valuable.(1) RFID as the patient identification, not only generates the on-line laboratory data and radiology report via hand-held wireless PDA, this RFID system help physician stream-line patient admission to acute bed or ICU in the emergency department more effectively.

  15. Trends of CT Use in the Pediatric Emergency Department in a Tertiary Academic Hospital of Korea during 2001-2010

    OpenAIRE

    2012-01-01

    Objective We wanted to assess the trends of computed tomography (CT) examinations in a pediatric emergency department (ED). Materials and Methods We searched the medical database to identify the pediatric patients who had visited the ED, and the number of CTs conducted from January 2001 to December 2010. We analyzed the types of CTs, according to the anatomic region, and the patients who underwent CT examinations for multiple regions. Data were stratified, according to the patient age (< 13 y...

  16. Incidência de parada cardíaca durante anestesia, em hospital universitário de atendimento terciário: estudo prospectivo entre 1996 e 2002 Incidencia de parada cardíaca durante anestesia, en hospital universitario de servicio terciario: estudio prospectivo entre 1996 y 2002 Cardiac arrest during anesthesia at a tertiary teaching hospital: prospective survey from 1996 to 2002

    Directory of Open Access Journals (Sweden)

    Leandro Gobbo Braz

    2004-12-01

    ,3%, aspiración pulmonar (18,2% e hidratación excesiva (9,1%. CONCLUSIONES: La incidencia de PC durante la anestesia aún continúa elevada. La mayoría de las PC y fallecimientos asociados a la anestesia fue relacionada al manoseo de las vías aéreas y a la administración de medicamentos y anestésicos.BACKGROUND AND OBJECTIVES: Cardiac arrest (CA incidence and causes during anesthesia are variable and difficult to be compared due design variations of major studies. This survey aimed at evaluating all intra and postoperative CA from 1996 to 2002 at a tertiary teaching hospital to determine CA incidence and causes. METHODS: The prospective incidence of CA during 40,941 anesthesias was identified from a database. All CA and deaths were reviewed by a Committee in order to determine triggering factors. CA cases were studied as to age, gender, ASA physical status, type of treatment, triggering factors, such as changes in patients physical status and surgical and anesthetic complications, type of anesthesia and evolution to death. RESULTS: There were 138 CA (33.7:10,000, being most of them neonates, children aged less than 1 year, elderly people, males (65.2%, physical status ASA III or poorer, in emergency surgeries and during general anesthesia. Physical status changes were the major CA factor (23.9:10,000 followed by surgical complications alone (4.64:10,000 or associated to physical status changes (2.44:10,000 and anesthetic complications alone (1.71:10,000 or associated to physical status changes (0.98:10,000. The risk of anesthesia-related death as major or contributing factor was similar for both (0.49:10,000. Major anesthesia-related death causes were ventilatory problems (45.4%, drug-related events (27.3%, pulmonary aspiration (18.2% and fluid overload (9.1%. CONCLUSIONS: CA incidence during anesthesia is still high. Most anesthesia-related cardiac arrests and deaths were related to airway management and drug and anesthetic administration.

  17. Acute Febrile Illness Surveillance in a Tertiary Hospital Emergency Department: Comparison of Influenza and Dengue Virus Infections

    Science.gov (United States)

    Lorenzi, Olga D.; Gregory, Christopher J.; Santiago, Luis Manuel; Acosta, Héctor; Galarza, Ivonne E.; Hunsperger, Elizabeth; Muñoz, Jorge; Bui, Duy M.; Oberste, M. Steven; Peñaranda, Silvia; García-Gubern, Carlos; Tomashek, Kay M.

    2013-01-01

    In 2009, an increased proportion of suspected dengue cases reported to the surveillance system in Puerto Rico were laboratory negative. As a result, enhanced acute febrile illness (AFI) surveillance was initiated in a tertiary care hospital. Patients with fever of unknown origin for 2–7 days duration were tested for Leptospira, enteroviruses, influenza, and dengue virus. Among the 284 enrolled patients, 31 dengue, 136 influenza, and 3 enterovirus cases were confirmed. Nearly half (48%) of the confirmed dengue cases met clinical criteria for influenza. Dengue patients were more likely than influenza patients to have hemorrhage (81% versus 26%), rash (39% versus 9%), and a positive tourniquet test (52% versus 18%). Mean platelet and white blood cell count were lower among dengue patients. Clinical diagnosis can be particularly difficult when outbreaks of other AFI occur during dengue season. A complete blood count and tourniquet test may be useful to differentiate dengue from other AFIs. PMID:23382160

  18. Use of pressurised aerosol inhalers among patients attending the Chest Clinic and Primary Care Department of University Hospital, Kuala Lumpur.

    Science.gov (United States)

    Liam, C K; Lo, Y L; Yap, B H; Low, S H; Ariwalagam, M

    1993-09-01

    Eighty consecutive patients who came to collect their prescriptions for pressurised aerosol inhalers at the Pharmacy of the University Hospital, Kuala Lumpur, were interviewed regarding their use of the pressurised inhaler. Their inhaler technique was also assessed. A significant proportion inhaled the steroid aerosol before the bronchodilator and 23.5% used the steroid inhaler for relief of acute dyspnoea. Only 28.8% of the 80 patients performed correctly all 6 steps necessary for the proper use of inhalers. The most common mistake was the failure to inhale slowly and deeply. Patients who had used the device for more than 5 years performed better, while correct inhaler technique was not dependent on the patient's sex, age or level of education.

  19. Erectile dysfunction among men attending surgical outpatients Department in a Tertiary Hospital in South-Western Nigeria

    Directory of Open Access Journals (Sweden)

    Augustine O Takure

    2016-01-01

    Full Text Available Background: Erectile dysfunction is becoming a public health issue with high incidences reported in community studies. Objective: To evaluate the characteristics and outcome of treatment in men with erectile dysfunction in a tertiary center in Ibadan southwestern Nigeria. Methods: Data of men with erectile dysfunction was retrieved between July 2004 and June 2014 and analyzed using SPSS version 16 statistical software. Results: Eighty-nine men with erectile dysfunction were managed which constituted 2% of all urological cases seen during the study period. Their median and mean ages were 39 years and 39.6 ± 1.2SD (range 19-76 years. The peak age incidence at 30-44 years was 41.6% and reduced with increasing age after 65 years to 4.5%. The etiologies were psychogenic in 55%, organic in 27%, idiopathic in 17% and 1% was familial. 67.5%, 31.5% and 3.4% were married, single and separated respectively. Seventy percent neither smoked cigarette nor drank alcohol, 21.3% drank alcohol and 9% took both alcohol and smoked cigarette. Seventy seven and half percent of men presented within 5 years of their symptom. The treatments offered were PDE type 5 inhibitors alone or in combination with psychotherapy or modification of medications. The outcome of these treatments ranged from 89% to 91% success rate. Conclusion: The number of men with erectile dysfunction managed in the tertiary hospital is very low though the outcome of treatment is within acceptable range. Increase public enlightenment may encourage increase hospital patronage and access to the available treatments for erectile dysfunction.

  20. 数字化医院中的检验科%Department of clinical laboratory in digital hospital

    Institute of Scientific and Technical Information of China (English)

    邹爱民; 朱文芳; 李伟

    2013-01-01

    Objective To establish virtual digital hospital and optimize the test flow, with the aid of the computer network platform. Methods Patients are required to first register in the medical area, recharge, and line up on the classified system. The system offers automatic billing. The prefabricated bar code scanning would bind information of the patients. The internal LIS system completes the inspection, audit reports. The reports were obtained through automatic single. Results The procedures offers convenience to patients, realizes crowd decentralization, ensures the accuracy of information, and turns "Three inspecting and nine checking" into "One inspecting and one checking". It also prevents cross pollution, protects patient privacy, and facilitates telemedicine. Conclusion The optimization of the inspection process benefit from the overall construction of digital hospital.%目的 借助计算机网络平台,建立虚拟数字化医院,优化检测检验流程.方法 患者来院先在自助医疗区挂号、充值;分检系统上排队;自动计费;预制条码扫描绑定信息;内部LIS 系统完成检验,审核报告;自动取单机取报告.结果 方便患者,分流人群,核对信息准确无误,"三查九对"变成"一查一对",防止交叉污染,保护病人隐私,便于远程医疗.结论 检验流程的优化得益于数字化医院的整体建设,缺一即为"飞不上天空的鹰".

  1. Anesthesia for thoracoscopic surgery

    OpenAIRE

    Conacher I

    2007-01-01

    Anesthesia for thoracoscopy is based on one lung ventilation. Lung separators in the airway are essential tools. An anatomical shunt as a result of the continued perfusion of a non-ventilated lung is the principal intraoperative concern. The combination of equipment, technique and process increase risks of hypoxia and dynamic hyperinflation, in turn, potential factors in the development of an unusual form of pulmonary edema. Analgesia management is modelled on that shown effective and therape...

  2. Awareness in cardiac anesthesia.

    LENUS (Irish Health Repository)

    Serfontein, Leon

    2010-02-01

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

  3. Characteristics and determinants of adult patients with acute poisoning attending the accident and emergency department of a teaching hospital in Qatar.

    Science.gov (United States)

    Khudair, I F; Jassim, Z; Hanssens, Y; Alsaad, W A

    2013-09-01

    Data about etiologic and demographic characteristics of acute poisoning in adults in Qatar are lacking. This prospective observational study was undertaken to analyze characteristics and possible determinants of acute poisoning in adults in Qatar. During 2010, 18,073 patients attended the emergency department of Hamad General Hospital, a teaching hospital in Qatar. Out of them, 599 (3.3%) patients were diagnosed as "poisoning case" with either chemical or pharmaceutical substances. The prevalence rate of poisoning incidence was 35.3/100,000 population. Seven patients died, corresponding with a case-fatality rate of 0.39/1000. The majority were male (65%) and the mean age was 34 years. The poisons involved were mainly chemicals (61.6%) and pharmaceuticals (38.4%). Female, mainly single, suffered more intentional poisoning compared to male. Of the patients aged 60 years and above (7.2%), the majority (95.3%) suffered unintentional poisoning with pharmaceuticals; 56% with warfarin, 12% with digoxin and 7% with insulin. Multivariate analysis shows that female gender, single status, younger than 35 years of age, being poisoned by pharmaceutical products, and the need for hospitalization are significant determinants for acute intentional poisoning after adjusting all other possible covariates. The findings of this study can be used to establish awareness and prophylactic campaigns in Qatar.

  4. Use of potentially inappropriate medicines in elderly: A prospective study in medicine out-patient department of a tertiary care teaching hospital

    Directory of Open Access Journals (Sweden)

    Zaveri H

    2010-01-01

    Full Text Available Objective: The present study was undertaken with the aim to detect extent of drug use in elderly at medicine outpatient department at tertiary care hospital and to evaluate inappropriate prescribing with the help of Beers′ criteria 2002. Materials and Methods: The study was carried out at medicine out patient department of our hospital. 407 geriatric patients were included during the study period of three and half months. The data was collected in a proforma which included the patients′ details and the prescriptions. Results: The results reveal that 7.42% of total drugs were prescribed in an inappropriate manner and 23.59% of total patients received at least one inappropriate drug prescription. Administration of a drug which is avoided in elderly forms a common category of inappropriate drug use. Antihistamines, anticholinergic, sedatives and hypnotics and cardiac glycosides are the most common drug groups prescribed in inappropriate manner. Conclusion: To conclude, this study shows high prevalence of inappropriate use of drugs in geriatric practice suggesting urgent need for sincere efforts to improve the situation.

  5. [Hernia repair and local anesthesia. Results of a controlled randomized clinical trial].

    Science.gov (United States)

    Milone, F; Salvatore, G; Leongito, M; Milone, M

    2010-01-01

    In the past, general and spinal anesthesia were used for hernia surgery, but nowadays local anesthesia has become the method of choice for hernia repair, especially in outpatient patients. The one-day surgery is sufficient in the management of this pathology. The advantages of local anesthesia are simplicity, safety, extended postoperative analgesia, early mobilization, lack post-anesthesia effects, and low costs. From January 2004 to December 2008 we observed 297 male patients with inguinal hernia. These patients were divided, with rigorous chronological order of hospital admission, in two study groups, different for anesthetic techniques used. Our controlled randomized clinical trial examines the effectiveness of local anesthesia to reduce the time of hospitalization, without alteration of results, and particularly the degree of satisfaction of patients surgical treated for inguinal hernia.

  6. 医院信息科绩效考核方案设计%Design of performance appraisal program in information department of hospitals

    Institute of Scientific and Technical Information of China (English)

    杨洪广; 吕晓娟; 张麟; 祝琦; 王晓勇

    2015-01-01

    医院信息科承担着医院信息系统建设、运营维护、日常监管等任务。随着医院信息系统的不断升级,医院信息科业务量也在不断增加,统筹科室资源、优化技术配置、强化管理手段,增强信息科的服务质量和保障效力成为医院信息主管重点关注的问题。本文介绍了第二炮兵总医院信息科绩效考评的设计原则和具体考核指标,以期为其他医院信息化管理提供参考。%Information department in hospitals shoulders the tasks of construction,operation,maintenance and super-vision of hospital information system ( HIS) . The work load increases with the update of HIS. The key issues con-cerned by the chief of HIS include the over planning of resources,optimizing the allocation of techniques,enforcing the means of management, improving the level of service and the efficiency of support. The principles for the design of performance appraisal program and the specific appraisal indicators in Information Department of Chinese PLA Second Artillery Forces were thus described in this paper in an attempt to provide reference for the information management in other hospitals.

  7. [Strategic planning: an important economic action for German hospitals].

    Science.gov (United States)

    Wiese, Christoph H R; Zink, Wolfgang; Russo, Sebastian G

    2011-11-01

    In medical systems, economic issues and means of action are in the course of dwindling human (physicians and nurses) and financial resources are more important. For this reason, physicians must understand basic economic principles. Only in this way, there may be medical autonomy from social systems and hospital administrators. The current work is an approach to present a model for strategic planning of an anesthesia department. For this, a "strengths", "weaknesses", "opportunities", and "threats" (SWOT) analysis is used. This display is an example of an exemplary anaesthetic department.

  8. Pattern of dental diseases among patients attending outpatient department of dental: a hospital based cross-sectional study

    Directory of Open Access Journals (Sweden)

    Pitamber Datt Garkoti

    2015-06-01

    Full Text Available Introduction: The public health problems associated with oral disease are a serious burden in India and other countries of the world. The causes of oral diseases are primarily rooted in poor socioeconomic and physical environment; unhealthy lifestyles and oral health related behaviour accordingly the action towards improvement of oral health should be directed towards modification of unhealthy environment and behaviours. Objective: To know the pattern of dental diseases among the patients attending Dental OPD. Materials and Methods: A hospital based cross sectional study among patients attending dental OPD in a tertiary care centre of Kumaun region during a period of one year i.e. from 1st January 2012 to 31st December 2012. Results: A total of 8928 patients attended dental OPD. Majority of the patients (25.3% were in the age group 30-39 years. Mostly were males (51.54%. Most common disease was dental caries (54.54%, followed by gingivitis (37.62%, abrasion (3.82%, malocclusion (3.05%, pericoronitis (0.53% and jaw fracture (0.44%. Conclusion: Dental Caries was the most common disease. Majority of the patients were in 30-39 years of age group. Health education and awareness at school level and in the community might prevent tooth loss in later life. [Natl J Med Res 2015; 5(2.000: 112-115

  9. Safe Anesthesia For Every Tot

    DEFF Research Database (Denmark)

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

    2015-01-01

    PURPOSE OF REVIEW: The term 'safe use of anesthesia in children is ill-defined and requires definition of and focus on the 'safe conduct of pediatric anesthesia'. RECENT FINDINGS: The Safe Anesthesia For Every Tot initiative (www.safetots.org) has been set up during the last year to focus...... on the safe conduct of pediatric anesthesia. This initiative aims to provide guidance on markers of quality anesthesia care. The introduction and implementation of national regulations of 'who, where, when and how' are required and will result in an improved perioperative outcome in vulnerable children....... The improvement of teaching, training, education and supervision of the safe conduct of pediatric anesthesia are the main goals of the safetots.org initiative. SUMMARY: This initiative addresses the well known perioperative risks in young children, perioperative causes for cerebral morbidity as well as gaps...

  10. Technology transfer from havana hospitals to primary care: yamila de armas, MD. Deputy director, provincial health department, havana city province.

    Science.gov (United States)

    Giraldo, Gloria

    2009-01-01

    Dr Yamila de Armas has occupied an array of posts since finishing her residency in family medicine in her home province of Cienfuegos in 1992. She has served as a family doctor; polyclinic, municipal and provincial health director; medical school dean; and twice vice minister of public health. But few would doubt her toughest job is the one she has now: deputy director of the Havana City Provincial Health Department, in charge of medical services for the 2.2 million people living in Cuba's complex, sprawling capital. It was here in 2002-2003 that the program was launched to repair, refurbish and expand the country's nearly 500 community polyclinics. Key to the effort was equipping these facilities with a broader range of new and upgraded medical technology. Dr de Armas offers MEDICC Review her reflections on the results five years later.

  11. The impact of a pre-hospital medical response unit on patient care and emergency department attendances.

    LENUS (Irish Health Repository)

    Deasy, C

    2012-02-03

    A rapid response team was instigated in Cork to improve prehospital care and reduce unnecessary Emergency Department (ED) visits. This consisted of a Specialist Registrar (SpR) in Emergency Medicine and a Paramedic who attended all "999" calls in a designated rapid response vehicle on the allotted study days. Two hundred and sixty-three patients were seen on designated days between Jan 2004 and March 2006. Presentations seen included; road traffic accident (23%) collapse (12%), fall (10%) and seizure (8%). The majority of calls were to houses (36%). The most common medical intervention was intravenous cannulation (25%). Intravenous medications were administered in 21% of these patients--morphine sulphate was the most common drug given. It was possible to safely discharge 31% of patients on scene. In our experience skilled Emergency Medicine doctors attending at scene could provide advanced care and reduce ambulance transportation and patient attendance.

  12. Three-level Prescription Review Pattern in Pharmacy Department of Our Hospital%我院药学部门三级处方点评模式

    Institute of Scientific and Technical Information of China (English)

    牟萍; 兰伯恩; 徐蜀远; 杨丽萍

    2013-01-01

    In order to improve the prescription quality, promote the rational drug use and ensure the medical safety, the establishment of prescription review pattern suitable for pharmacy department of hospital was explored. Under the guidance of the Prescription Administrative Policy and the Management Practice on Hospital Prescription Review (Tentative), the pharmacists in our hospital paid great attention to the prescription verification and participated in the prescription review. Clinical pharmacists put their emphasis on the prescription (doctor’s advice list) review and re-evaluation of pharmacy review. The prescription review working group reexamined the review results and put forward improvement proposals to the hospital. The prescription review system raised prescription review ability of pharmacists , guaranteed its fairness and rationality and showed benefits for the continuous improvement on prescription quality.%为提高处方质量,促进合理用药,保障医疗安全,探索建立适合我院药学部门的处方点评模式。在《处方管理办法》、《医院处方点评管理规范(试行)》的指导下,我院药房药师重在进行处方审核,参与处方点评;临床药师重在进行处方(医嘱单)点评及对药房药师点评进行再评价;处方点评工作小组复查点评结果,向医院提出改进措施。通过处方点评制度提高药房药师的审方能力,保证处方点评的公正合理,有利于处方的持续质量改进。

  13. 公立医院客户服务部建设的探索——华山医院东院客户服务部六年实践总结%An exploration of the construction of the customer service department in a public hospital: 6-year experience of Customer Service Department in East Branch, Huashan Hospital

    Institute of Scientific and Technical Information of China (English)

    蔡丽莉

    2012-01-01

    在医院内建立一个功能完整的客户服务部是目前公立医院的创新举措,它整合了医院内除医疗护理外所有的行政事务类服务和管理,树立了一个用对客服务的理念向医院客户传递服务信息建立良好的公共关系的形象.通过与院内外各部门的协调和合作完成部门各岗位的工作运转,在建立一个服务高端人群的医疗模式的同时为病人提供方便、及时、高效、温馨的人性化服务.六年来,华山东院在这方面进行了尝试探索,创建了医院的客户服务工作模式.%The establishment of a functional Customer Service Department is creative and integrated of current public hospitals. It doesn' t only integrate all the service and management in the hospital administration except for nursing, but also conveys a customer-oriented motto to the patients in order to establish a good characteristic of the public relationship. This department works by the coordination with internal and external departments of the hospital. While endeavoring to build a new medical pattern of high-end service, our department has sustained to provide the patients with convenient, prompt, efficient, considerate and personal service as well. We have been exploring in the past 6 years and established the pattern of customer service in the public hospital.

  14. [A retrospective study on the incidence of chronic renal failure in the Department of Internal Medicine and Nephrology at University Hospital of Antananarivo (the capital city of Madagascar)].

    Science.gov (United States)

    Ramilitiana, Benja; Ranivoharisoa, Eliane Mikkelsen; Dodo, Mihary; Razafimandimby, Evanirina; Randriamarotia, Willy Franck

    2016-01-01

    Chronic renal failure is a global public health problem. In developed countries, this disease occurs mainly in the elderly, but in Africa it rather affects active young subjects. This disease need for expensive treatments in a low income country, because of its costs. Our aim is to describe the epidemiology of new cases of chronic renal failure in Madagascar. This is a retrospective, descriptive study of 239 patients with chronic renal failure over a 3 year period, starting from 1 January 2007 to 31 December 2009, in the Department of Internal Medicine and Nephrology at University Hospital of Antananarivo. The incidence was 8.51% among patients hospitalized in the Department. The average age of patients was 45.4 years with extremes of 16 and 82 years and a sex ratio 1,46. The main antecedent was arterial hypertension (59.8%). Chronic renal failure was terminal in 75.31% of the cases (n=180). The causes of chronic renal failure were dominated by chronic glomerulonephritis (40.1%), nephroangiosclerosis (35.5%). Hemodialysis was performed in 3 patients (1.26%), no patient was scheduled for a renal transplantation. Mortality rate in the Department was 28.87%. Chronic renal failure is a debilitating disease with a dreadful prognosis which affects young patients in Madagascar. Its treatment remains inaccessible to the majority of patients. The focus must be mainly on prevention, especially on early effective management of infections, arterial hypertension and diabetes to reduce its negative impacts on the community and public health. The project on renal transplantation: living donor, effective and less expensive treatment compared to hemodialysis could also be a good solution for these Malagasy young subjects.

  15. Laparoscopic hernioplasty with epidural anesthesia; a report of 20 patients

    Directory of Open Access Journals (Sweden)

    Talebpour M

    2007-06-01

    Full Text Available Background: The incidence of inguinal hernia is 15 cases per 1,000 populations. The most common surgical methods of hernia repair are conventional open hernioplasty and laparoscopic hernioplasty. The advantages of laparoscopic hernioplasty are that the regional anatomy is observable, and bilateral herniorrhaphy can be performed at the same time. Since laparoscopic hernia is usually performed under general anesthesia, to shorten the length of hospital stay and to prevent complications, in this study, we evaluated the use of epidural anesthesia during hernioplasty. Methods: This study included 20 male patients treated by a single surgeon. We recorded the PCO2 levels before, during and after surgery, as well as the pain and intra-abdominal pressure. Results: Only one patient required conversion to general anesthesia. Three patients had hernia on the left side only, 14 patients on the right only and three patients had bilateral hernia. The PCO2 levels did not change (P=0.789. Fifty percent of patients had no postoperative pain. The median time to return to work or normal physical activity was 7 days. Conclusion: Laparoscopic inguinal herniorrhaphy is a feasible alternative to open surgical hernia repair. Employing epidural anesthesia prevents the complications of general anesthesia. This method achieves a shorter hospital stay and time to return to normal activity, as well as reduction in pain. Controlled trials comparing laparoscopic and tension-free open herniorrhaphy are needed to further assess the relative benefits of this procedure.

  16. Acute Paraplegia After General Anesthesia

    Directory of Open Access Journals (Sweden)

    Gholam Hossein Ghaedi

    2011-08-01

    Full Text Available Acute paraplegia is a rare but catastrophic complication of surgeries performed on aorta and corrective operations of vertebral column. Trauma to spinal cord after spinal anesthesia and ischemia of spinal cord also may lead to acute paraplegia. Acute paraplegia as a complication of general anesthesia in surgeries performed on sites other than aorta and vertebral column is very rare. Here we present a 56 year old woman with acute paraplegia due to spinal cord infarction after laparoscopic cholecystectomy under general anesthesia probably caused by atherosclerosis of feeding spinal arteries and ischemia of spinal cord after reduction of blood flow possibly due to hypotension during general anesthesia.

  17. Regional anesthesia as compared to general anesthesia for surgery in geriatric patients with hip fracture: Does it decrease morbidity, mortality and healthcare costs? Results of a single-centered study

    Science.gov (United States)

    Le-Wendling, Linda; Bihorac, Azra; Baslanti, Tezcan Ozrazgat; Lucas, Stephen; Sadasivan, Kalia; Heyman, James; Wendling, Adam; Heyman, H. James; Boezaart, Andre

    2013-01-01

    Introduction Hip fracture in geriatric patients has a substantial economic impact and represents a major cause of morbidity and mortality in this population. At our institution, a regional anesthesia program was instituted for patients undergoing surgery for hip fracture. This retrospective cohort review examines the effects of regional anesthesia (from mainly after July 2007) versus general anesthesia (mainly prior to July 2007) on morbidity, mortality and hospitalization costs. Methods This retrospective cohort study involved data collection from electronic and paper charts of 308 patients who underwent surgery for hip fracture from September 2006 to December 2008. Data on postoperative morbidity, in-patient mortality, and cost of hospitalization (as estimated from data on hospital charges) were collected and analyzed. Seventy-three patients received regional anesthesia and 235 patients received general anesthesia. During July 2007, approximately halfway through the study period, a regional anesthesia and analgesia program was introduced. Results The average cost of hospitalization in patients who receive surgery for hip fracture was no different between patients who receive regional or general anesthesia ($16,789 + 631 v. $16,815 + 643, respectively, p = 0.9557). Delay in surgery and intensive care unit admission resulted in significantly higher hospitalization costs. Age, male gender, African-American race and intensive care unit admission were associated with increased in-hospital mortality. In-hospital mortality and rates of readmission are not statistically different between the two anesthesia groups. Conclusions There is no difference in postoperative morbidity, rates of re-hospitalization, in-patient mortality or hospitalization costs in geriatric patients undergoing regional or general anesthesia for repair of hip fracture. Delay in surgery beyond 3 days and intensive care unit admission both increase cost of hospitalization. PMID:22758782

  18. 基于LINGO软件的医院科室布局优化方法探讨%Discussion on the Optimizing Method of the Hospital Department Layout Based on LINGO

    Institute of Scientific and Technical Information of China (English)

    刘晓华; 许锋

    2014-01-01

    目的:探讨医院科室合理布局的方法,重新调整各业务科室用房布局。方法将医院科室布局规划问题作为二次指派问题进行研究,使用LINGO软件进行科室布局优化求解并进行结果分析。结果按照优化求解进行布局重新分配后,医院科室配置效率得到提高。结论合理规划医院科室布局,有利于为患者提供更加便利和安全的服务,从整体上提高医院的运行效率。%Objective To discuss rational distribution methods of hospital departments, and re-adjust the layout of each department. Methods Studied on the hospital departments layout planning problem as the quadratic assignment problem, and analyzed the results for layout optimization using the LINGO software. Results After re-distribution of hospital departments, the hospital department allocation efficiency was improved. Conclusion Rational distribution of hospital departments is beneifcial to provide convenient and safe service to patients, and improve the operation efifciency of the hospital.

  19. Anatomy of an anesthesia information management system.

    Science.gov (United States)

    Shah, Nirav J; Tremper, Kevin K; Kheterpal, Sachin

    2011-09-01

    Anesthesia information management systems (AIMS) have become more prevalent as more sophisticated hardware and software have increased usability and reliability. National mandates and incentives have driven adoption as well. AIMS can be developed in one of several software models (Web based, client/server, or incorporated into a medical device). Irrespective of the development model, the best AIMS have a feature set that allows for comprehensive management of workflow for an anesthesiologist. Key features include preoperative, intraoperative, and postoperative documentation; quality assurance; billing; compliance and operational reporting; patient and operating room tracking; and integration with hospital electronic medical records.

  20. Anesthesia for Adults Having Eye Surgery

    Science.gov (United States)

    ... Condiciones Chinese Conditions Anesthesia for Adults Having Eye Surgery En Español What kinds of anesthesia are available for adults having eye surgery? A “general”, “local”, or “topical” anesthesia is necessary ...

  1. Re-attenders to the emergency department of a major urban hospital serving a population of 290,000.

    LENUS (Irish Health Repository)

    Ramasubbu, B

    2015-01-01

    The national Emergency Medicine Programme (EMP) in Ireland, defines a re-attender as any patient re-presenting to the Emergency Department (ED) within 28 days with the same chief complaint. A retrospective, electronic patient record audit was carried out on all re-attenders to Connolly ED during November 2012. There were 2919 attendances made up from 2530 patients; 230 patients re-attended a total of 389 times. The re-attendance rate was 13% (389\\/2919). 63 (27%) were frequent presenters. There was a significantly higher admission rate at second attendance than first (89 (39%) vs 39 (17%), p < 0.001). 25% (57\\/230) of patients \\'left before completion of treatment\\' (LBCT) at first attendance (significantly higher than the number at second attendance (p < 0.01)). 14\\/57 (25%) of those who LBCT at first attendance required admission at second attendance. 28\\/89 (31%) of second attendance admissions were failed discharges from first attendance. Reasons for re-attendance are multi-factorial and include both patient and departmental factors.

  2. Difficult airway management of children in ambulatory anesthesia: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Huang AS

    2016-11-01

    Full Text Available Andrea S Huang,1 Lindsey Rutland,2 John Hajduk,1 Narasimhan Jagannathan1,2 1Department of Pediatric Anesthesia, Ann and Robert H. Lurie Children’s Hospital of Chicago, 2Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Abstract: As the field of pediatric ambulatory anesthesia expands, anesthesiologists can anticipate encountering an increasing number of patients with expected and unexpected difficult airways. This unique setting and patient population both present challenges in making a decision whether and how to safely proceed in the case of a child with a difficult airway. A host of patient, provider, procedure, and facility-specific factors should be considered. Providers should understand the differences between the pediatric and adult airway, recognize common features and syndromes associated with difficult airways, and be comfortable with different airway equipment and techniques available in the ambulatory setting. Early anticipation, a comprehensive patient assessment, and a clear decision-making algorithm with multiple airway management plans are all critical in safely and effectively managing these patients. These issues and recommendations will be discussed in this comprehensive narrative review. Keywords: difficult airway, pediatrics, ambulatory surgery, airway devices, children

  3. Experimental valuation of specific hospital waste production in sanitary departments and surgeries; Valutazione sperimenatle della produzione specifica di rifiuti sanitari a rischio infettivo da reparti e gruppi operatori di una struttura ospedaliera

    Energy Technology Data Exchange (ETDEWEB)

    Serra, R.

    1999-10-01

    Experimental measures of hospital waste production in sanitary departments and surgeries at highly specialised hospital have been carried out. The salient differences in waste specific production in several departments explain relevantly the variability of hospital waste production reported in technical literature. [Italian] Sono state effettuate rilevazioni sperimentali della produzione di rifiuti speciali sanitari a rischio infettivo dai reparti digenza, di terapia intensiva e dalle sale operatorie di una struttura opsedaliera ad alta specializzazione. Le differenze significative riscontrate tra reparti o sale operatorie afferenti a unita' funzionali diverse, rendono conto della variabilita' dei valori di produzione di rifiuti speciali sanitari a rischio infettivo da strutture ospedaliere riscontrate nella letteratura.

  4. Abnormal vital signs are strong predictors for intensive care unit admission and in-hospital mortality in adults triaged in the emergency department - a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Barfod Charlotte

    2012-04-01

    Full Text Available Abstract Background Assessment and treatment of the acutely ill patient have improved by introducing systematic assessment and accelerated protocols for specific patient groups. Triage systems are widely used, but few studies have investigated the ability of the triage systems in predicting outcome in the unselected acute population. The aim of this study was to quantify the association between the main component of the Hillerød Acute Process Triage (HAPT system and the outcome measures; Admission to Intensive Care Unit (ICU and in-hospital mortality, and to identify the vital signs, scored and categorized at admission, that are most strongly associated with the outcome measures. Methods The HAPT system is a minor modification of the Swedish Adaptive Process Triage (ADAPT and ranks patients into five level colour-coded triage categories. Each patient is assigned a triage category for the two main descriptors; vital signs, Tvitals, and presenting complaint, Tcomplaint. The more urgent of the two determines the final triage category, Tfinal. We retrieved 6279 unique adult patients admitted through the Emergency Department (ED from the Acute Admission Database. We performed regression analysis to evaluate the association between the covariates and the outcome measures. Results The covariates, Tvitals, Tcomplaint and Tfinal were all significantly associated with ICU admission and in-hospital mortality, the odds increasing with the urgency of the triage category. The vital signs best predicting in-hospital mortality were saturation of peripheral oxygen (SpO2, respiratory rate (RR, systolic blood pressure (BP and Glasgow Coma Score (GCS. Not only the type, but also the number of abnormal vital signs, were predictive for adverse outcome. The presenting complaints associated with the highest in-hospital mortality were 'dyspnoea' (11.5% and 'altered level of consciousness' (10.6%. More than half of the patients had a Tcomplaint more urgent than Tvitals

  5. Polypharmacotherapy and drug-drug interactions in patients hospitalized in an Internal Medicine department: magnitude of the problem and clinical implications

    Directory of Open Access Journals (Sweden)

    Luigi Lusiani

    2013-04-01

    Full Text Available BACKGROUND The use of multiple drugs is a growing problem in elderly patients: it increases the risk of drug-drug interactions and reduces the compliance to cures. The magnitude and the clinical implications of this phenomenon in patients hospitalized in Internal Medicine departments (IM remain largely unknown. AIM OF THE STUDY To evaluate how frequently polypharmacotherapy occurs in IM patients, to what extent the hospitalization affects it, and to what extent potential drug-drug interactions have to do with the treated conditions. MATERIALS AND METHODS In this observational study, the clinical records of 232 consecutive patients (median age 80 years were reviewed, and the medical prescriptions on admission to and at discharge from the hospital were analysed, with special regard to potential drugdrug interactions, using the Micromedex® Healthcare Series system (www.thomsonhc.com; the interactions were classified in terms of severity and type (clinical relevance. RESULTS The total number of prescribed drugs per-patient on admission and at discharge were 4.73 ± 2.88 vs 5.69 ± 2.78 (p < 0.01; the number of potentially harmful interactions were 0.91 ± 1.17 vs 1.39 ± 1.59 (p < 0.01; the percentage of patients at risk for any interactions (mostly moderate or severe, as a matter of fact were 53% vs 66% (p < 0.01. As for clinical relevance, most interactions were of the pharmacodymanic type (67 vs 93, p n.s., and very few patients (5 vs 5 had interactions potentially interfering with their disease status. The risk of interactions progressively increased with the number of prescribed drugs, reaching a plateau of 60% with the combination of 4 drugs. CONCLUSIONS Our data confirm that drug-drug interactions due to polypharmacotherapy are a relevant problem in patients hospitalized in IM, and that hospitalization per se adds to its magnitude. Although few patients seem to be directly threatened in their disease status, most of them are exposed to the

  6. 神经内科医院感染分析及防控干预%Department of neurology at hospital infection causes and prevention intervention

    Institute of Scientific and Technical Information of China (English)

    印夏微

    2013-01-01

    目的:调查神经内科医院感染的发病率、发病部位及原因,制订预防和控制医院感染的措施。方法采用前瞻性和回顾性相结合的方法调查2007年7月-2013年6月我院神经内科住院患者的医院感染情况。结果本次共调查住院患者45112例,发生医院感染1038例次,医院感染率为2.3%。医院感染以内科患者多发,内科患者又以神经内科的患者多发。医院感染部位依次为呼吸道、泌尿道、胃肠道及其他。结论预防呼吸道感染,加强通风,及时清除呼吸道分泌物;预防泌尿道感染,严格遵守无菌操作原则,掌握导尿管拔除时机;注意保暖,增强抵抗力,合理使用抗生素;提高护理人员手卫生依从性,积极治疗原发病是预防医院感染的有效措施。%Objective To investigate the neurological hospital incidence of nosocomial infection and pathogenic site as well as the relative reasons. Discuss the measurements of prevention and control of hospital infection. Method Conduct a survey on all of the inpatients in the department of Neurology hospital during the period from July 2007 to June 2013.Results 45,112 cases of inpatients were involved in this investigation and 1039 cases among them were exam to have nosocomial infection. The rate of hospital infection of this sample is 2.3%. It is reflected from the statistical data that the hospital infection happened most among the medical patients, especially the neurology patients. The apartments that were suffered from the hospital infection in a less serious condition were the respiratory tract,urinary tract and gastrointestinal tract. Conclusions The solution to this hospital infection condition can be:first,prevent the respiratory tract infections of both hospital stuffs and patients by strengthening the ventilation of indoor environment and cleaning the respiratory secretions in time. Secondly,prevent the urinary tract infections by strictly

  7. Delayed emergence after anesthesia.

    Science.gov (United States)

    Tzabazis, Alexander; Miller, Christopher; Dobrow, Marc F; Zheng, Karl; Brock-Utne, John G

    2015-06-01

    In most instances, delayed emergence from anesthesia is attributed to residual anesthetic or analgesic medications. However, delayed emergence can be secondary to unusual causes and present diagnostic dilemmas. Data from clinical studies is scarce and most available published material is comprised of case reports. In this review, we summarize and discuss less common and difficult to diagnose reasons for delayed emergence and present cases from our own experience or reference published case reports/case series. The goal is to draw attention to less common reasons for delayed emergence, identify patient populations that are potentially at risk and to help anesthesiologists identifying a possible cause why their patient is slow to wake up.

  8. Nurse anesthesia and multiculturalism.

    Science.gov (United States)

    Horton, B J; Waugaman, W R

    1996-01-01

    Program directors from 90 accredited nurse anesthesia programs in the United States and Puerto Rico were surveyed concerning multicultural issues. This article summarizes the identified needs of clients and student nurse anesthetists from culturally diverse backgrounds. Noteworthy findings include the perception that clients were more disadvantaged than students because of differences in socioeconomic status; the fact that about half of the programs provided students with instruction on cultural differences; and the observation that specific units of instruction within courses were the most frequent way of giving instruction in this subject area.

  9. Anesthesia for thoracoscopic surgery

    Directory of Open Access Journals (Sweden)

    Conacher I

    2007-01-01

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

  10. Anesthesia and pulmonary hypertension.

    Science.gov (United States)

    McGlothlin, Dana; Ivascu, Natalia; Heerdt, Paul M

    2012-01-01

    Anesthesia and surgery are associated with significantly increased morbidity and mortality in patients with pulmonary hypertension due mainly to right ventricular failure, arrhythmias, postoperative hypoxemia, and myocardial ischemia. Preoperative risk assessment and successful management of patients with pulmonary hypertension undergoing cardiac surgery involve an understanding of the pathophysiology of the disease, screening of patients at-risk for pulmonary arterial hypertension, analysis of preoperative and operative risk factors, thorough multidisciplinary planning, careful intraoperative management, and early recognition and treatment of postoperative complications. This article will cover each of these aspects with particular focus on the anesthetic approach for non-cardiothoracic surgeries.

  11. Anesthesia for geriatric patients.

    Science.gov (United States)

    Deiner, S; Silverstein, J H

    2011-02-01

    The number of elderly surgical patients will be increasing in Italy. Slowly, anesthesiologists are developing the expertise to care for these patients. The information available to apply to these cases is now the topic of a number of anesthesia textbooks dedicated to the elderly. In this article, we review some of the more recent findings and provide some tips to help guide the care of elderly patients. It is hoped that practitioners will use this information to improve the care of these patients and conduct additional research to further improve care in the future.

  12. [Anesthesia and bodybuilding].

    Science.gov (United States)

    Hokema, Frank; Pietsch, Uta-Carolin; Führer, Dagmar; Kaisers, Udo

    2008-05-01

    A strong tendency toward body enhancement and body forming in western industrial societies makes it more likely for each anesthesiologist to get involved in the care of bodybuilders. These patients quite frequently consume androgenic anabolic steroids, human growth hormone and other drugs or substances which are believed to accelerate muscle gain. Cardiovascular, hepatic, psychiatric, hormonal and infectious side effects or complications are common and rarely monitored by health care professionals. The anesthesia risk is not exactly known but seems to be determined mainly by cardiovascular events like myocardial ischemia and dysrhythmias.

  13. Abnormal vital signs are strong predictors for Intensive Care Unit admission and in-hospital mortality in adults triaged in the Emergency Department - A prospective cohort study

    DEFF Research Database (Denmark)

    Barfod, Charlotte; Laurtizen, Marlene Mp; Danker, Jakob K

    2012-01-01

    outcome in the unselected acute population. The aim of this study was to quantify the association between the main component of the Hillerod Acute Process Triage (HAPT) system and the outcome measures; Admission to Intensive Care Unit (ICU) and in-hospital mortality, and to identify the vital signs......, scored and categorized at admission, that are most strongly associated with the outcome measures. METHODS: The HAPT system is a minor modification of the Swedish Adaptive Process Triage (ADAPT) and ranks patients into five level colour-coded triage categories. Each patient is assigned a triage category...... for the two main descriptors; vital signs, Tvitals, and presenting complaint, Tcomplaint. The more urgent of the two determines the final triage category, Tfinal. We retrieved 6279 unique adult patients admitted through the Emergency Department (ED) from the Acute Admission Database. We performed regression...

  14. STUDY OF DERMATOLOGICAL QUALITY OF LIFE IN PATIENTS WITH VITILIGO ATTENDING THE OUT PATIENT DEPARTMENT OF DERMATOLOGY IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Ashiq

    2015-11-01

    Full Text Available : BACKGROUND: Vitiligo is an autoimmune, chronic pigmentary disorder causing considerable amount of social stigma leading to low self-esteem. AIM: To assess the quality of life in patients with vitiligo who are attending the outpatient department in Sri Ramachandra Hospital. The study was done over a period of 2 years. Parameters that were studied included gender distribution, occupation, type of Vitiligo. METHODS: 200 vitiligo patients answered a ten point questionnaire designed by Cardiff to assess the quality of life. RESULTS: Out of the 200 patients, 66 were male & 134 female, 158 were married and 42 unmarried, vitiligo vulgaris being the commonest type. Mean DLQI was higher in housewife (Occupation-13.5, vitiligo vulgaris (Type of vitiligo-16.34, diabetes mellitus (Association with vitiligo-27. CONCLUSION: The results demonstrate that vitiligo has a very large to extremely large effect on the quality of life.

  15. FACTORS ASSOCIATED WITH EXTENDED SPECTRUM β-LACTAMASE PRODUCING ESCHERICHIA COLI IN COMMUNITY-ACQUIRED URINARY TRACT INFECTION AT HOSPITAL EMERGENCY DEPARTMENT, BANGKOK, THAILAND.

    Science.gov (United States)

    Savatmorigkorngul, Sorravit; Poowarattanawiwit, Pongsuree; Sawanyawisuth, Kittisak; Sittichanbuncha, Yuwares

    2016-03-01

    Urinary tract infection or UTI is most commonly caused by Escherichia coli. This study investigated the prevalence of and risk factors for extended spectrum β-lactamase-producing (ESBL) E. coli in community-acquired UTI presenting at the Emergency Department, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. A retrospective review was conducted over a one-year period (2014) of case histories of patients over 15 years of age diagnosed with (n = 159) and without culture-positive (n = 249) ESBL E. coli. Backward stepwise multivariate logistic regression analysis revealed four independent risk factors for UTI caused by ESBL E. coli, namely, urinary catheter use, previous UTI in which ESBL E. coli was present, and previous use of antibiotics cephalosporin and penicillin. This information should be useful in devising future public health prevention and control programs for ESBL E. coli-associated community-acquired UTI.

  16. The emerging trend in the epidemiology of gunshot injuries in the emergency department of a Nigerian tertiary hospital in a State without formal prehospital emergency medical services

    Directory of Open Access Journals (Sweden)

    Gabriel Uche Pascal Iloh

    2013-01-01

    Full Text Available Background : Gunshot injuries (GSIs though a rarity in Nigeria before the Nigerian civil war have now become rampant with variable epidemiology. It is emerging as a common cause of trauma-related emergency hospitalizations. Aim: The study was aimed at reviewing the epidemiology of gunshot injuries in the emergency department (ED of a Nigerian tertiary hospital over a 5-year period. Materials and Methods: This was a retrospective study of GSIs seen at the ED of Federal Medical Centre, Umuahia, Nigeria using data from medical records, patients′ case notes, ED admission registers, and nurses′ report books. The data collected included age, sex, place of the incidence, time of the incidence, time of presentation to the hospital, anatomic sites, and etiology of the injury. Results : The age ranged from 14 years to 80 years with mean age of 47 ± 8.1 years. There were 95 males and 22 females with a male to female ratio of 4.3:1. The three most common causes were armed robbery (31.6%, kidnapping (21.3%, and police brutality (17.9%. The incident predominantly affected the middle age group (57.3%, occurred mostly during the day time (72.6%, affecting mainly the lower limbs (65.8% and majority (84.6% of the victims presented 1 hour after the injury. None of the victims received prehospital care. Conclusion: There was variability in the epidemiology of GSIs with kidnapping and police brutality emerging among preeminent contributors and downward trend of armed robbery-related GSIs. The incident occurred predominantly during the day time and most victims presented late to the ED. Interventional strategies including the responsible security apparatus system are advocated.

  17. [The Health Department of Sicily "Regional recommendations for hospital discharge and communication with patients after admission due to a cardiologic event" decree].

    Science.gov (United States)

    Abrignani, Maurizio Giuseppe; De Luca, Giovanni; Gabriele, Michele; Tourkmani, Nidal

    2014-06-01

    Mortality and rehospitalizations still remain high after discharge for an acute cardiologic event. In this context, hospital discharge represents a potential pitfall for heart disease patients. In the setting of care transitions, the discharge letter is the main instrument of communication between hospital and primary care. Communication, besides, is an integral part of high-quality, patient-centered interventions aimed at improving the discharge process. Inadequate information at discharge significantly affects the quality of treatment compliance and the adoption of lifestyle modifications for an effective secondary prevention. The Health Department of Sicily, in 2013, established a task force with the aim to elaborate "Regional recommendations for hospital discharge and communication with patients after admission due to a cardiologic event", inviting to participate GICR-IACPR and many other scientific societies of cardiology and primary care, as discharge letter and communication are fundamental junctions of care transitions in cardiology. These recommendations have been published as a specific decree and contain: a structured model of discharge letter, which includes all of the parameters characterizing patients at high clinical risk, high thrombotic risk and low risk according to the Consensus document ANMCO/GICR-IACPR/GISE; is thus possible to identify these patients, choosing consequently the most appropriate follow-up pathways. A particular attention has been given to the "Medication Reconciliation" and to the identification of therapeutic targets; an educational Kit, with different forms on cardiac diseases, risk factors, drugs and lifestyle; a check-list about information given to the patient and caregivers. The "Recommendations" represent, in conclusion, the practical realization of the fruitful cooperation between scientific societies and political-administrative institutions that has been realized in Sicily in the last years.

  18. Accounting and comparing of expenditure on the medical services given at neuro-surgery department of Imam Khomeyni Hospital in the year of 1994 (1373

    Directory of Open Access Journals (Sweden)

    Abasi Moghadam M

    1998-09-01

    Full Text Available This study was focused on analysis of expenditure on all the medical services given at Neuro-Surgery Department of Imam-Khomeini Hospital in the year of 1994 (1373. In this study, all the information on descriptive method and the techniques of cost analysis and cost per unit of service provided accountancy, were analysed. 573 patients were considered in this study. 522 of them underwent 13 different types of neuro-surgery operations. 92.6% of them total departmental costs were related to current expenditures and 7.4% of that was related to the capial expenditures. The personnel costs with 49% was the highest portion of the total costs. Percentage wise, the costs were as follows: Medicine, materials and equipment 22%, food 17.6%, depreciation 7.4%, fuel, water, electricity and telephone 3.5%. The mean duration of stay was 16.3 days for every in-patient. The percentage of occupied bed was 58% if the percentage of desired bed occupancy was supposed 80%, therefore, 22% of the bed, plus 3512 bed-day were gone wasted. The real cost of med-care policy need to be more rational for the operation and hospitalization. It should be mentioned that the wasted time was 886 hours and wasted cost was 71, 708, 410 Rials in operation room.

  19. Qualitative Inquiry into Challenges Experienced by Registered General Nurses in the Emergency Department: A Study of Selected Hospitals in the Volta Region of Ghana

    Science.gov (United States)

    Adatara, Peter

    2016-01-01

    Registered General Nurses (RGNs) play crucial roles in emergency departments (EDs). EDs in Ghana are primarily staffed by RGNs who have had no additional formal education in emergency care. Additionally, basic, master's, or doctoral level nursing education programs provide limited content on the complexities of emergency nursing. Nurses in EDs are affected by many challenges such as growing patient population, financial pressures, physical violence, verbal abuse, operational inefficiencies, overcrowding, and work overload. There is a paucity of research on challenges experienced by RGNs in EDs in the Volta Region of Ghana. In this qualitative study, twenty RGNs in EDs from three selected hospitals in the Volta Region of Ghana were interviewed. All recorded interviews were transcribed, reviewed several times by researchers and supervisors, and analyzed using content analysis. Five thematic categories were identified. These thematic categories of challenges were lack of preparation for ED role, verbal abuse from patients relatives, lack of resources in ED, stressful and time consuming nature of ED, and overcrowding in ED. Formal education of RGNs in the advanced role of emergency care, adequate supply of resources, increased hospital management support, and motivations for RGNs working in ED are necessary to improve the practice of emergency care. PMID:27885343

  20. EVALUATION OF ANXIETY & DEPRESSIVE SYMPTOMS IN PATIENTS WITH 1 ST EPISODE OF CHEST PAIN ATTENDING MEDICINE OUT PATIENT DEPARTMENT OF TERTIARY CARE TEACHING HOSPITAL

    Directory of Open Access Journals (Sweden)

    Bhavik S.

    2015-06-01

    Full Text Available INTRODUCTION: As chest pain is an important symptom of coronary artery disease (CAD and other non - cardiac diseases , the presentation of the symptom often prompts referral to physicians for further investigation. Previous studies h ad shown significant as sociation between chest pain and D e pr e ssive and anxiety symptoms. AIMS AND OBJECTIVES: Evaluate and screen depressive symptoms , anxiety symptoms and somatic symptoms in patients with 1 st episode of chest pain attending medicine out - patient department of tertiary care teaching hospital. METHODOLGY : Cross - sectional observational study. Prior permission from institutional ethics committee of ‘SUMANDEEP VIDYAPEETH’ had been taken. 100 patients having first episosde of chest pain coming to M edicine opd of DHIRAJ HOSPITAL are recruited randomly after 1st December 2014. Each patient is given case r eport form containing sociodemographic data , patients medical history , depression and somatic symptoms scale and Hamilton’s anxiety scale (HAM - A. All data are entered in spss 16 and analysed with different ( S tatistical tests. Differences on categorical m easures will be reported as P value. The result is significant if P <0.05. RESULT: 38% & 49% patients have clinically significant depression and anxiety respectively. DSSS score is positively correlated with duration of chest pain. CONCLUSION : significant level of depression and anxiety found in 1 st episode of chest pain patients.

  1. Anesthesia and cor triatriatum

    Directory of Open Access Journals (Sweden)

    Federica Scavonetto

    2014-01-01

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

  2. Analysis of bias in measurements of potassium, sodium and hemoglobin by an emergency department-based blood gas analyzer relative to hospital laboratory autoanalyzer results.

    Directory of Open Access Journals (Sweden)

    Jian Bo Zhang

    Full Text Available The emergency departments (EDs of Chinese hospitals are gradually being equipped with blood gas machines. These machines, along with the measurement of biochemical markers by the hospital laboratory, facilitate the care of patients with severe conditions who present to the ED. However, discrepancies have been noted between the Arterial Blood Gas (ABG analyzers in the ED and the hospital laboratory autoanalyzer in relation to electrolyte and hemoglobin measurements. The present study was performed to determine whether the ABG and laboratory measurements of potassium, sodium, and hemoglobin levels are equivalent, and whether ABG analyzer results can be used to guide clinical care before the laboratory results become available.Study power analyses revealed that 200 consecutive patients who presented to our ED would allow this prospective single-center cohort study to detect significant differences between ABG- and laboratory-measured potassium, sodium, and hemoglobin levels. Paired arterial and venous blood samples were collected within 30 minutes. Arterial blood samples were measured in the ED by an ABL 90 FLEX blood gas analyzer. The biochemistry and blood cell counts of the venous samples were measured in the hospital laboratory. The potassium, sodium, and hemoglobin concentrations obtained by both methods were compared by using paired Student's t-test, Spearman's correlation, Bland-Altman plots, and Deming regression.The mean ABG and laboratory potassium values were 3.77±0.44 and 4.2±0.55, respectively (P<0.0001. The mean ABG and laboratory sodium values were 137.89±5.44 and 140.93±5.50, respectively (P<0.0001. The mean ABG and laboratory Hemoglobin values were 12.28±2.62 and 12.35±2.60, respectively (P = 0.24.Although there are the statistical difference and acceptable biases between ABG- and laboratory-measured potassium and sodium, the biases do not exceed USCLIA-determined limits. In parallel, there are no statistical differences and

  3. Demographic and clinical characteristics of red tag patients and their one-week mortality rate from the emergency department of the Hospital Universiti Sains Malaysia.

    Science.gov (United States)

    Ahmad, Rashidi; Rahmat, Rashdan; Hisamudin, Nik; Rahman, Nik Abdul; Noh, Abu Yazid Mohd; Mohammad, Nasir; Wahab, Sheik Farid Abdul; Zaini, Ida Zarina

    2009-11-01

    Early identification and rapid treatment of red tag patients may decrease morbidity and mortality. We examined the clinical characteristics, etiologies and one week mortality rate of red tag (life threatening and potentially life threatening illness) patients at the Hospital Universiti Sains Malaysai (HUSM). A cross-sectional study was conducted at the Emergency Department of the HUSM from 1 August 2006 to 31 January 2007; 440 eligible patients were analyzed. The group had a mean age of 47.2 +/- 22 years, with 67.3% of the patients being male. Twenty-three percent were trauma cases with motor vehicle accident being the major mechanism of injury. Fifty-four percent of the cases had cardiac related illnesses. The mean duration of stay in the Emergency Department (ED) was 3.9 +/- 1.5 hours. The survival rate at one week was 76.6%. The non-trauma group comprised 74.0% of death cases. Acute coronary syndrome and road traffic accidents comprised 22.0% of total death cases at one week. Red tag patients constitute a large proportion of ED cases and may remain in the ED for significant periods of time.

  4. Survey of patients with acute poisoning seen in the Emergency Department of the University Hospital of Gent between 1983 and 1990.

    Science.gov (United States)

    Verstraete, A G; Buylaert, W A

    1995-12-01

    In a prospective study of 4234 patients with acute poisoning in the Emergency Department of the University Hospital of Gent in Belgium between 1983 and 1990, we observed a decline in the number of poisonings from 665 in 1983 to 424 in 1990. This was due to a decrease in the number of deliberate self-poisonings. Fifty-six per cent of patients were female and the most prevalent age group was 20 to 24 years. There was no seasonal variation. The substances most frequently taken were benzodiazepines (55% of the deliberate self-poisonings), ethanol in combination with other substances (35.8%), barbiturates and older hypnotics (18.6%), non-narcotic analgesics (13.3%) and tricyclic antidepressants (11.6%). Carbon monoxide accounted for 65.1% of all the accidental poisonings. With regard to treatment, a reduction in gastric lavage was observed. The patients were transferred to the intensive care unit (29.2%), the psychiatry ward (23.6%) or discharged home (27.8%). Only 0.3% of the patients died in the Emergency Department.

  5. 医院药剂科文化的构建与实践%Cultural Construction and Practice of the Pharmacy Department in Hospital

    Institute of Scientific and Technical Information of China (English)

    杜淑娴; 程红勤; 王育琴

    2013-01-01

    OBJECTIVE:To explore the influence of the cultural construction on the management of the pharmacy department and the level of pharmaceutical care.METHODS:The experience of the construction of department culture in our hospital was introduced,i.g.establishing same values of pharmacy department by building up the service concept of "patient-centered" and the contents of "quality,learning,team,sharing and performance".RESULTS & CONCLUSIONS:The cultural construction of pharmacy department is developed by insisting quality management,building up learning organization,enhancing team construction and learning and communication,carrying out performance management.All pharmacist's enthusiasm and initiative are mobilized,cohesion of sections is enhanced,which contribute to the sustainable development of the department of pharmacy and the level of pharmaceutical care.%目的:探讨文化建设对药剂科管理和药学服务水平的影响.方法:介绍该院科室文化建设的经验,内容包括通过树立“以患者为中心”的服务理念,结合“质量、学习、团队、分享、绩效”等具体内容,确立了药剂科的共同价值观.结果与结论:通过坚持质量管理、构建学习型组织、加强团队建设、加强学习交流、实施绩效管理等进行药剂科的文化建设,调动了全体药师工作的积极性和主动性,科室的凝聚力得以加强,从而促进了药剂科的持续发展和药学服务水平的提升.

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

    DEFF Research Database (Denmark)

    Rosenberg, J; Oturai, P; Erichsen, C J;

    1994-01-01

    STUDY OBJECTIVE: To evaluate the relative contribution of general anesthesia alone and in combination with the surgical procedure to the pathogenesis of late postoperative hypoxemia. DESIGN: Open, controlled study. SETTING: University hospital. PATIENTS: 60 patients undergoing major abdominal...... surgery and 16 patients undergoing middle ear surgery, both with comparable general anesthesia. MEASUREMENTS AND MAIN RESULTS: Patients were monitored with continuous pulse oximetry on one preoperative night and the second postoperative night. Significant episodic or constant hypoxemia did not occur...... on the second postoperative night following middle ear surgery and general anesthesia, but severe episodic and constant hypoxemia did occur on the second postoperative after major abdominal surgery and general anesthesia. CONCLUSIONS: General anesthesia in itself is not an important factor in the development...

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

    Directory of Open Access Journals (Sweden)

    M. Baalbaki

    2003-07-01

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

  8. Features and influencing factors of hospital infection in hematology department%血液科医院感染特点及影响因素

    Institute of Scientific and Technical Information of China (English)

    田国燕; 章亮; 封爱英

    2014-01-01

    OBJECTIVE To investigate the infection rate in hematology wards and analyze risk factors for hospital infection so as to provide reference for prevention or decrease of hospital infections .METHODS The clinical data of 562 inpatients in the hematology department during Jan .2011 to Mar .2012 were collected and systematically ana-lyzed .The self-made questionnaire was used to investigate the general information of infected and uninfected patients ,the main infected site ,the distribution of pathogens and potential influencing factors .Data were pro-cessed and analyzed using the statistical software SPSS 17 .0 .RESULTS Fifty-two patients had infections among the 562 inpatients in the hematology department ,the incidence of every 1000 days was 5 .9‰ .The main site of in-fection was respiratory tract (53 .7% ) .Gram-negative bacteria were the main pathogen (43 .2% ) ,followed by gram-positive bacteria (37 .8% ) and fungus (18 .9% ) .CONCLUSION Patients with hematologic malignancies are more likely to have hospital infection .On base of strengthening disinfection of the air and the equipment in the ward ,it has important clinical significance to carefully choose prophylactic antibiotics ,reduce invasive operation , and shorten hospitalization time for reducing the occurrence of infection in hematology wards .%目的:了解血液科住院患者医院感染的发生率,分析医院感染的主要病原菌,为预防或减少医院感染的发生提供参考依据。方法对血液科2011年1月-2012年3月的562例住院患者临床资料进行收集并系统分析,采用自行设计问卷调查医院感染患者的基本情况、医院感染部位、病原菌的分布,采用SPSS17.0进行数据的统计分析与处理。结果血液科562例住院患者发生感染52例,千日感染率5.9‰;感染部位主要为呼吸道,占53.7%;检出病原菌中以革兰阴性菌为主占43.2%,其次为革兰阳性菌占37.9%,真菌占18.9%

  9. 肝胆外科住院患者抗菌药物应用分析%Use of antibiotics among hospitalized patients of hepatobiliary surgery department

    Institute of Scientific and Technical Information of China (English)

    张洪卫; 李晓娜; 张天伟

    2015-01-01

    OBJECTIVE To investigate the rationality of use of antibiotics among the hospitalized patients of hepato‐biliary surgery department so as to provide guidance for the reasonable clinical use of antibiotics .METHODS The clinical data of 260 patients who were hospitalized the hepatobiliary surgery department from Jan 2010 to Oct 2013 were retrospectively analyzed ,and the rationality of use of antibiotics was observed .RESULTS Of the 260 pa‐tients ,242 cases used antibiotics ,with the utilization rate of antibiotics of 93 .08% .Among the 242 patients who used antibiotics ,about 8 categories ,22 types of antibiotics ,were involved ;the cephalosporins ,penicillins ,quino‐lones ,and imidazole nitrates were the most frequently used antibiotics ;the combination use of antibiotics was widespread ,there were 78 (32 .23% ) patients receiving two‐drug therapy ,67 (27 .69% ) patients receiving three‐drug therapy ,and 53 (21 .90% ) patients receiving more than three‐drug therapy ;the metronidazole plus cephalo‐sporins plus quinolones or aminoglycosides was the most frequently used three‐drug therapy .Only 43 of 260 pa‐tients underwent the detection of pathogens ,with the submission rate of 16 .54% .CONCLUSION The use of anti‐biotics among the hospitalized patients of hepatobiliary surgery department basically conforms to the principle of effectiveness and safety ,however ,unreasonable use of antibiotics remains among the minority of the patients , which should be paid high attention to .%目的:了解肝胆外科住院患者的抗菌药物应用及其合理性,为临床合理使用抗菌药物提供参考依据。方法回顾性分析医院2010年1月-2013年10月收治的260例肝胆外科住院患者临床资料,调查其抗菌药物的应用并分析其用药合理性。结果260例患者中有242例使用了抗菌药物,抗菌药物的使用率达93.08%;242例用药患者中所涉及的抗菌药物约8大类、22个品种;使用最多

  10. ASSESSMENT OF KNOWLEDGE ABOUT IMMUNIZATION OF UNDER FIVE CHILDREN AMONG MOTHERS ATTENDING OUTPATIENT DEPARTMENT OF PEDIATRICS IN A TERTIARY CARE HOSPITAL IN KOLLAM, KERALA

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    Ahmad Nadeem

    2015-07-01

    Full Text Available BACKGROUND : Immunization is the most cost effective public health intervention to reduce childhood morbidity and mortality. Thousands of children can be saved from vaccine preventable diseases each year by immunization. The knowledge of mothers’ is an important factor for better immunization coverage. Less knowledge affects decision making regarding immunization. OBJECTIVES: To assess the knowledge about immunization of under five children among mothers a ttending outpatient department of paediatrics in a tertiary care hospital in Kollam, Kerala and to find out the association of the knowledge level of mothers with some selected variables. MATERIAL AND METHODS : A Cross sectional study was done among mothers of under five children attending the OPD of pediatrics in a tertiary care hospital in Kollam, Kerala from 1 st to 30 th May, 2014. The sample size was 210 and simple random sampling was used. Statistical analysis was done and chi - square test & percentages w ere calculated. RESULT: 93.8% of mothers knew that vaccines are beneficial for their child. 58% were aware about the side effects of few vaccines. 50% of mothers believed that as polio is eradicated from India, there is no need to give polio vaccine. 35% o f mothers acquired knowledge regarding immunization through health workers. All of them had knowledge about polio vaccine but only half of them knew about rotavirus vaccine. 60% mothers believed that multiple vaccines are beneficial although 26% hold their view that it has no benefit at all. 39.5% of mothers’ had adequate knowledge about immunization. It was positively associated with education, working class and high socio - economic status of mothers. CONCLUSION: There are several loopholes in the mother’s knowledge regarding immunization. Many of them had no knowledge about optional vaccines. There is a need to improve knowledge regarding immunization among general population. Adequate information about completin g the

  11. Prescribing pattern and pharmacoeconomics of antibiotic use in the department of pediatrics of a tertiary care medical college hospital in northern India

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    Ravika Kanish

    2015-01-01

    Full Text Available Background: Systemic antibiotics account for more than one third of all prescriptions for children; hence, antibiotic prescriptions for children lead to major public health concerns. Moreover, data regarding rational antibiotic use in children are very limited. Hence, it is essential that the antibiotic prescribing pattern be evaluated periodically to determine the rationality of its use and cost. Objectives: The aim of our study is to identify the prescribing pattern and to carry out the cost-identification analysis of antibiotic use in the patients admitted in the pediatrics department of a tertiary care hospital in North India. Materials and Methods: The study was conducted for 2 months in the pediatric ward and intensive care unit (ICU. The data regarding patient demographics and antibiotic use were collected daily in a structured pro forma. A descriptive analysis of the data was done. Results: A total of 191 patients were enrolled, most of them belonging to the age group of 2-14 years. Majority of the patients were males (75.9%. On an average, 1.9 antimicrobial agents (AMAs were prescribed per patient. The most common AMAs prescribed were cephalosporins followed by aminoglycosides. The preferred route of administration was parenteral (92%. The average cost of treatment per patient was estimated to be `3,338. The percentage of drugs prescribed by generic name was 58%. Conclusions: Since our hospital is a major referral center of the state, newer generation of antibiotics are more commonly prescribed here. Hence, the cost of therapy is high. This baseline study will help in formulating an antibiotic policy and the standard treatment guidelines (STG for appropriate use of antibiotics.

  12. A study evaluating knowledge, attitude and practices of practitioners in the medicine department of tertiary care teaching rural hospital with respect to antihypertensives

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    Jatin Patel

    2015-06-01

    Full Text Available Background: The aim of this study was to evaluate knowledge, attitude and practices of practitioners in the medicine department of tertiary care teaching rural hospital with respect to antihypertensives and find out the disparity between the recommended and actual practices for pharmacological management. Methods: It was survey type of study, carried out using feedback questionnaire related to use of antihypertensives. Total 25 consultants were included in the study. Results: It was found that in mild hypertension single drug and two drugs in combination were preferred by 15 and 10 practitioners respectively. In moderate hypertension single drug, two drugs in combination, and greater than two drugs were preferred by 3, 13, and 7 practitioners respectively. In severe hypertension two drugs in combination and greater than two drugs were preferred by 16 and 9 practitioners respectively; none preferred single drug. Angiotensin converting enzyme inhibitors /angiotensin receptor blockers, beta blockers, Calcium channel blockers, diuretics were preferred as first line drug by 7, 4, 8, and 16 practitioners respectively. Most commonly preferred combination was Losartan and amlodipine by 16 practitioners. In pregnancy nifedipine was preferred as the first line drug while in elderly diuretics were preferred. In hypertensive patients with age less than 40 years all practitioners preferred ACEIs/ARBs. In diabetics ACEIs/ARBs was preferred by all practitioners. Each practitioner claimed to follow Joint National Committee (JNC 7 criteria. Cost of drug was an important consideration in all their prescribing patterns. Conclusion: The knowledge, attitudes and practices followed by the practitioners of Dhiraj hospital were satisfactory and guidelines oriented. [Int J Res Med Sci 2015; 3(3.000: 715-717

  13. Hypoglycaemic complications with diabetes mellitus management: the predominant adverse drug reaction presenting to the Accident and Emergency Department of The University Hospital of the West Indies.

    Science.gov (United States)

    Gossell-Williams, M; Williams-Johnson, J; Francis, L

    2010-10-01

    Evaluation of adverse drug reactions (ADRs) is important to the assessment of risk factors in an aim to ensure maximum benefits of drug therapy. This study was done to assess the types of ADRs presenting to the Accident and Emergency department (A&E) of the University Hospital of the West Indies. Admissions to the A&E associated with drugs were followed on a weekly basis for 19 weeks from October 2007 to February 2008 using the patient logbook. Medical records of patients with suspected ADRs were collected and evaluated by an Emergency Medicine Consultant of A & E to confirm the occurrence of ADRs and the suspected drug. Of the 8170 admissions to A&E, 48 (0.6%) were related to ADRs, with most occurring in females and the mean age (+/- standard error) was 58.9 (+/- 3.4) years. Drug induced hypoglycaemia accounted for 28 (56.3%) cases of ADRs and included mainly patients on insulin, with or without a sulphonylurea therapy. Most of these diabetic patients also had co-morbidities and were on multi-drug therapy (18). Allergic reactions accounted for 10 (21%) of the ADR outcomes. Other drugs accounting for ADRs included cardiovascular drugs (10.4%), analgesic/anti-inflammatory medications (8.3%), drugs acting on the central nervous system (8.3%) and anti-infectives (8.3%). It is concluded that drug-induced hypoglycaemia is the major ADR presenting to the A&E of the University Hospital of the West Indies; it is a preventable ADR and therefore further investigation should evaluate possible factors attributed to the occurrences.

  14. A comparative study of extradural anesthesia using 0.75% ropivacaine, 0.75% ropivacaine with fentanyl, and 0.75% ropivacaine with buprenorphine for cesarean section from a rural teaching hospital in India

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    Grace Maria George

    2014-01-01

    Full Text Available Context: The study was to compare the analgesic efficacy of three different epidural solutions - ropivacaine, ropivacaine fentanyl mixture, and ropivacaine buprenorphine mixture - for cesarean section. Materials and Methods: This was a prospective, randomized, controlled, double blind study carried out in primi parturients undergoing elective cesarean section with singleton fetus. A total of 102 parturients in the age group of 20-35 years, American Society of Anesthesiologists (ASA I or II scheduled for elective cesarean under continuous epidural anesthesia were divided into three groups using a computer-generated random number list. The test dose (3 ml 2% lignocaine with 15 μg adrenaline and 0.75% ropivacaine 12 ml were given to all parturients. In addition, normal saline 1 ml, fentanyl 50 μg, and buprenorphine 300 μg were given to Group I, II, and III respectively. Sensory block, motor block, analgesia, maternal effects, fetal outcome, and surgeons′ and parturients′ satisfaction were evaluated. Results: Onset of sensory block was faster in the fentanyl and buprenorphine groups compared to ropivacaine group (9.94 ± 0.48, 10.72 ± 0.26 versus 14.59 ± 0.34. Duration of sensory block was prolonged in buprenorphine group as compared to fentanyl and ropivacaine groups (120.41 ± 4.31 versus (95.68 ± 3.28, 98.28 ± 3.42. Duration of analgesia was prolonged in buprenorphine group compared to fentanyl and ropivacaine groups (516.38 ± 29.14 versus 327.06 ± 12.41, 285.78 ± 10.10. It proved to be safe for mother and fetus. The surgeon and the parturients were satisfied with the mode of anesthesia. Conclusion: Ropivacaine 0.75%, ropivacaine 0.75% with fentanyl 50 mg, or buprenorphine 300 mg provided safe anesthesia when given extradurally for cesarean section. Addition of both fentanyl and buprenorphine to ropivacaine hastened the onset of sensory block, while addition of buprenorphine provided prolonged excellent postoperative analgesia.

  15. Establishment and Application of the Performance Appraisal System for Departments in the Hospital%我院科室绩效考核系统的建立与应用

    Institute of Scientific and Technical Information of China (English)

    曹莉; 樊俊芝; 李婧

    2014-01-01

    Performance appraisal was of great significance to improve the management level for the hospital and the departments. In view of the deifciencies in the present performance appraisal indicator system, this paper exempliifed Guang’anmen Hospital for its successful establishment of a performance appraisal system through the network information platform to meet the needs of management and departments appraisal for hospital leaders and relevant departments.%绩效考核对于提高医院及科室的管理水平具有重要作用。本文针对目前绩效考核指标体系存在的不足,我院在医院网络信息平台上建立绩效考核系统,以满足医院领导、考核部门及业务科室的管理需要。

  16. The Ryder Cognitive Aid Checklist for Trauma Anesthesia.

    Science.gov (United States)

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

    2016-05-01

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

  17. Evaluation of Bacterial Contamination in Anesthesia Breathing Circuits

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    F Farnia

    2007-07-01

    Full Text Available Introduction : Hospital infections are one of the important reasons of mortality and incurred expenses. Therefore, we must control these infections by identifying contamination sources. The aim of this study was the determination of bacterial pollution of corrugated anesthesia sets in surgical rooms. Methods: This study was an analytic-description one performed in training hospitals of Yazd city. Research sample was 440 cases provided from different parts of corrugate after completing the anesthesia period by wet sterile swabs and transferred to culture media. On Thursday, each week, a sample from different parts of tube after sterilizing with cetrimide solution was obtained. Finally, after 24 hours, culture medias were studied for colony growth. Results: Obtained results indicated that of 440 cases taken samples, 343 cases were without bacterial pollution, 71 cases (19.29% had bacterial pollution of samples before sterilizing and 26 cases (36.1% were polluted after tube sterilizing. Conclusion: Sampling and culturing from used equipment and tools in hospital is one of the important actions for identifying and controlling hospital infections. Obtained results from this study indicated that of 440 cases, there were 97 cases of pollution. Therefore, it is suggested that anti bacterial filters should be installed before Y form piece of tubes in anesthesia machines and disposable corrugated tubes should replace traditional tubes. In addition, it seems necessary that wider investigations should be done.

  18. Frequent Users of Hospital Emergency Departments in Korea Characterized by Claims Data from the National Health Insurance: A Cross Sectional Study.

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    Jung Hoon Woo

    Full Text Available The Korean National Health Insurance, which provides universal coverage for the entire Korean population, is now facing financial instability. Frequent emergency department (ED users may represent a medically vulnerable population who could benefit from interventions that both improve care and lower costs. To understand the nature of frequent ED users in Korea, we analyzed claims data from a population-based national representative sample. We performed both bivariate and multivariable analyses to investigate the association between patient characteristics and frequent ED use (4+ ED visits in a year using claims data of a 1% random sample of the Korean population, collected in 2009. Among 156,246 total ED users, 4,835 (3.1% were frequent ED users. These patients accounted for 14% of 209,326 total ED visits and 17.2% of $76,253,784 total medical expenses generated from all ED visits in the 1% data sample. Frequent ED users tended to be older, male, and of lower socio-economic status compared with occasional ED users (p < 0.001 for each. Moreover, frequent ED users had longer stays in the hospital when admitted, higher probability of undergoing an operative procedure, and increased mortality. Among 8,425 primary diagnoses, alcohol-related complaints and schizophrenia showed the strongest positive correlation with the number of ED visits. Among the frequent ED users, mortality and annual outpatient department visits were significantly lower in the alcohol-related patient subgroup compared with other frequent ED users; furthermore, the rate was even lower than that for non-frequent ED users. Our findings suggest that expanding mental health and alcohol treatment programs may be a reasonable strategy to decrease the dependence of these patients on the ED.

  19. [Regional anesthesia and cancer immunology].

    Science.gov (United States)

    Igarashi, Toru; Mori, Katsuya; Inoue, Kei; Suzuki, Takeshi; Morisaki, Hiroshi

    2013-09-01

    Regional anesthesia has been widely applied as an excellent method for perioperative analgesia. Recent studies suggested that regional anesthesia is a promising approach to minimize the risk of surgical site infection and postoperative cancer recurrence, subsequently providing the benefits to the long-term outcome. In particular, it is of great interest that regional anesthesia might be able to reduce cancer recurrence. In cancer patients, innate immunity against cancer could be depressed, resulting in the predisposition to evoke metastasis. Besides, during the perioperative periods, tumor immunity is significantly depressed due to surgical pain, activation of sympathetic nervous system, inflammatory responses, and others. In this review article, we discuss the tumor immunity during the perioperative period, with focus on the alterations of tumor immunity and regional anesthesia.

  20. Transverse myelitis following spinal anesthesia

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    Jha Sanjeev

    2006-01-01

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

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

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    Munevera Hadžimešić

    2013-12-01

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

  2. Sleep Apnea and Total Joint Arthroplasty under Various Types of Anesthesia

    Science.gov (United States)

    Memtsoudis, Stavros G.; Stundner, Ottokar; Rasul, Rehana; Sun, Xuming; Chiu, Ya-Lin; Fleischut, Peter; Danninger, Thomas; Mazumdar, Madhu

    2014-01-01

    Background and Objectives The presence of sleep apnea (SA) among surgical patients has been associated with significantly increased risk of perioperative complications. Although regional anesthesia has been suggested as a means to reduce complication rates among SA patients undergoing surgery, no data are available to support this association. We studied the association of the type of anesthesia and perioperative outcomes in patients with SA undergoing joint arthroplasty. Methods Drawing on a large administrative database (Premier Inc), we analyzed data from approximately 400 hospitals in the United States. Patients with a diagnosis of SA who underwent primary hip or knee arthroplasty between 2006 and 2010 were identified. Perioperative outcomes were compared between patients receiving general, neuraxial, or combined neuraxial-general anesthesia. Results We identified 40,316 entries for unique patients with a diagnosis for SA undergoing primary hip or knee arthroplasty. Of those, 30,024 (74%) had anesthesia-type information available. Approximately 11% of cases were performed under neuraxial, 15% under combined neuraxial and general, and 74% under general anesthesia. Patients undergoing their procedure under neuraxial anesthesia had significantly lower rates of major complications than did patients who received combined neuraxial and general or general anesthesia (16.0%, 17.2%, and 18.1%, respectively; P = 0.0177). Adjusted risk of major complications for those undergoing surgery under neuraxial or combined neuraxial-general anesthesia compared with general anesthesia was also lower (odds ratio, 0.83 [95% confidence interval, 0.74–0.93; P = 0.001] vs odds ratio, 0.90 [95% confidence interval, 0.82–0.99; P = 0.03]). Conclusions Barring contraindications, neuraxial anesthesia may convey benefits in the perioperative outcome of SA patients undergoing joint arthroplasty. Further research is needed to enhance an understanding of the mechanisms by which neuraxial

  3. 综合性医院急诊科292例院内抢救病例临床分析%Clinical Analysis of Cases of emergency department of general hospital treatment of 292 cases of hospital

    Institute of Scientific and Technical Information of China (English)

    熊杰

    2013-01-01

    Objective to analyze the comprehensive hospital emergency department in the rescue of clinical pathology data. Methods:in our hospital emergency department in the rescue of the clinical data of 292 patients were analyzed. Results :the emergency hospital treatment cases, cases of 60~80 years old, male more than female cases. Rescue type mainly: poisoning and physical damage; Circulatory system diseases; The digestive tract diseases; Respiratory disease. Rescue of your top three diseases: upper gastrointestinal hemorrhage, gastrointestinal bleeding;Pulmonary infection, pneumonia, etc.;Chronic obstructive pulmonary diseases acute exacerbation. And other diseases, poisoning, or physical damage; Severe asthma; Pleural ef usion; Acute myocardial infarction; Cerebral hemorrhage, cerebral infarction; Diabetic ketoacidosis, etc. Life-threatening acute symptoms of main diseases is: syncope; Chest tightness; Chest pain; Hemoptysis; Breathing, cardiac arrest; Dif iculty breathing; In a coma. Conclusion:emergency rescue is the regularity of the distribution of cases, to indicate in the emergency department, provides favorable conditions for the emergency work.%目的分析综合性医院急诊科院内抢救病理的临床资料。方法对我院急诊科院内抢救的292例患者的临床资料进行分析。结果急诊科院内抢救病例中,60~80岁的病例居多,男性病例比女性病例多。抢救类型主要是:中毒和物理因素损害;循环系统疾病;消化道疾病;呼吸道疾病。抢救的病种居前3名的是:上消化道出血、消化道出血;肺部感染,肺炎等;慢性阻塞性肺疾病急性加重。还有其余病种:中毒或物理损害;重症哮喘;胸腔积液;急性心肌梗死;脑出血、脑梗死;糖尿病酮症酸中毒等。危及生命的急性症状主要病种为:晕厥;胸闷;胸痛;咯血;呼吸心搏骤停;呼吸困难;昏迷。结论急诊抢救病例是规律性分布的,能够

  4. Clinical relevance in anesthesia journals

    DEFF Research Database (Denmark)

    Lauritsen, Jakob; Møller, Ann M

    2006-01-01

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

  5. Is there any benefit in associating neuraxial anesthesia to general anesthesia for coronary artery bypass graft surgery?

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    Fabiano Timbó Barbosa

    2016-06-01

    Full Text Available ABSTRACT BACKGROUND AND OBJECTIVES: The use of neuraxial anesthesia in cardiac surgery is recent, but the hemodynamic effects of local anesthetics and anticoagulation can result in risk to patients. OBJECTIVE: To review the benefits of neuraxial anesthesia in cardiac surgery for CABG through a systematic review of systematic reviews. CONTENT: The search was performed in Pubmed (January 1966 to December 2012, Embase (1974 to December 2012, The Cochrane Library (volume 10, 2012 and Lilacs (1982 to December 2012 databases, in search of articles of systematic reviews. The following variables: mortality, myocardial infarction, stroke, in-hospital length of stay, arrhythmias and epidural hematoma were analyzed. CONCLUSIONS: The use of neuraxial anesthesia in cardiac surgery remains controversial. The greatest benefit found by this review was the possibility of reducing postoperative arrhythmias, but this result was contradictory among the identified findings. The results of findings regarding mortality, myocardial infarction, stroke and in-hospital length of stay did not show greater efficacy of neuraxial anesthesia.

  6. To ventilate or not after minimally invasive direct coronary artery bypass surgery : The role of epidural anesthesia

    NARCIS (Netherlands)

    de Vries, AJ; Mariani, MA; van der Maaten, JMAA; Loef, BG; Lip, H

    2002-01-01

    Objective: To evaluate the effect of immediate postoperative extubation and postoperative ventilation after minimally invasive direct coronary artery bypass (MIDCAB) surgery and to assess the role of epidural anesthesia. Design: Randomized prospective study. Setting: University hospital, single inst

  7. GENERAL ANESTHESIA: IS IT SAFE FOR NEWBORNS, INFANTS AND YOUNG CHILDREN ?

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    Nancheva Jasminka

    2016-07-01

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

  8. ANALYSIS OF COST STRUCTURE FOR PHARMACOTHERAPY OF PATIENTS WITH STABLE ANGINA (THE CASE OF CARDIOLOGY DEPARTMENT OF TVER REGIONAL CLINICAL HOSPITAL

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    M. A. Demidova

    2012-01-01

    Full Text Available Aim. To analyze the cost structure for pharmacotherapy of patients with stable angina (SA, in particular, to compare the cost of pharmacotherapy with drugs, both included and not included into the official Standard of care (SC. Material and methods. Medical records of patients with SA (n=100 admitted to the cardiology department of Tver Regional Clinical Hospital in January-July 2010 were studied retrospectivelly. Costs of treatment with drugs specified in SC for patients with SA as well as drugs not included in SC were considered. Costs of pharmacotherapy and cost structure were determined. Pharmacoeconomical methods, especially ABC analysis, were partially used.  Results. Totally 65502.39 ruble was spent for pharmacotherapy of 100 patients with SA. Cost structure was the following: 32679.34 ruble was spent for drugs recommended by SC, 23698.18 ruble — for drugs not included in SC, and 9124.87 ruble — for drugs to treat concomitant diseases which are not taken into account by SC for patients with SA. Conclusion. SA pharmacotherapy counts 50% of the total cost for drugs recommended by SC, 36% — for drugs not included in SC but belonged to pharmacological class presented in SC, and 14% — drugs from pharmacological class not included in SC. In the process of new SC elaboration for SA patients it is necessary to take into account treatment costs of concomitant diseases especially diabetes mellitus which can account up to 9.5% of total treatment cost of SA patients.

  9. Health-hazard-evaluation determination report No. HHE-78-6-503, Cumberland Outpatient Department of Beth Israel Hospital, Brooklyn, New York

    Energy Technology Data Exchange (ETDEWEB)

    Messite, J.; Fannick, N.L.

    1978-07-01

    In response to a request from a representative of the nursing staff, an investigation was made of possible methadone exposures at the Cumberland Outpatient Department of Beth Israel Hospital, Brooklyn, New York, a methadone-dispensing clinic. The distribution room measured 12 feet in all dimensions and was enclosed on three sides. Methadone had previously been received in prepackaged doses, but more recently the nurses had to count the contents of each 100-count bottle of methadone hydrochloride and separate tablets or diskets into individual doses. Nurses involved in dispensing the medication reported intermittent sleepiness, itching of the face, nose, and eyes, and dryness of skin on the hands and face. Urine studies indicated no detectable methadone or methadone metabolites at a limit of 1 microgram per milliliter. There is no evidence of methadone absorption; however, they recommend that skin contact with the tablets and diskets be kept to a minimum by use of instruments for moving the pills on the counting tray, frequent clean up of dust, and periodic hand washing.

  10. Application of Structural Equation Model to Evaluate the Perception of Service Quality of Medical Staffs of infectious Disease Department in Chinese Hospitals

    Institute of Scientific and Technical Information of China (English)

    2014-01-01

    Objective To enhance the quality of medical service for Chinese patients through research of service quality from Chinese medical personnel. Methods ServQual scale was used for infection medical staffs randomly by sampling questionnaire in Beijing, Shanghai, Chengdu, Chongqing, Guangzhou and Nanning. The data collected were entered and analyzed using SPSS 20.0. Statistical methods included frequency, factor analysis, reliability analysis, correlation analysis, independent samples t test, one-way analyses of variance, simultaneous regression analysis and structural equation model analysis. Results The Kaiser-Meyer-Olkin value for the factor analysis of the scale was 0.970. The Cronbach’sαfor the reliability analysis was 0.975. The Pearson correlation coefficients were 0.624-0.874 and statistically significant. Undergraduates felt good, PhD students felt bad;the doctors felt bad;managers felt good. Standard 5 dimensions of the regression coefficients were positive, including empathy (β = 0.288), reliability (β =0.241) impacting on perceived service quality mostly. The control ability and stability of the standard error of perceived service quality directly effected value were 0.646 and 0.382, respectively. Conclusions Medical staffs of infectious disease department have poor perception of service quality. Hospitals should improve awareness and of clinicians and deepen the reform of the medical care system.

  11. Advances in the use of intravenous techniques in ambulatory anesthesia

    Directory of Open Access Journals (Sweden)

    Eng MR

    2015-07-01

    Full Text Available Matthew R Eng,1 Paul F White1,2 1Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; 2White Mountain Institute, The Sea Ranch, CA, USA Summary statement: Advances in the use of intravenous techniques in ambulatory anesthesia has become important for the anesthesiologist as the key perioperative physician in outpatient surgery. Key techniques and choices of anesthetics are important in accomplishing fast track goals of ambulatory surgery. Purpose of review: The anesthesiologist in the outpatient environment must focus on improving perioperative efficiency and reducing recovery times while accounting for patients' well-being and safety. This review article focuses on recent intravenous anesthetic techniques to accomplish these goals. Recent findings: This review is an overview of techniques in intravenous anesthesia for ambulatory anesthesia. Intravenous techniques may be tailored to accomplish outpatient surgery goals for the type of surgical procedure and individual patient needs. Careful anesthetic planning and the application of the plans are critical to an anesthesiologist's success with fast-track ambulatory surgery. Conclusion: Careful planning and application of intravenous techniques are critical to an anesthesiologist's success with fast-track ambulatory surgery. Keywords: intravenous anesthesia, outpatient anesthesia, fast-track surgery

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

    Directory of Open Access Journals (Sweden)

    Guilherme de Castro Santos

    2011-10-01

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

  13. Anesthesia for outpatient female sterilization.

    Science.gov (United States)

    Fishburne, J I

    1983-04-01

    This issue of the Bulletin deals with the principles of anesthesia for outpatient female sterilization with emphasis on techniques for laparoscopy and minilaparotomy. General anesthesia techniques provide analgesia, amnesia, and muscle relaxation and are particularly useful for managing the anxious patient. Disadvantages include increased expense, need for specialized equipment, and highly trained personnel, and delayed recovery. Complications, though relatively rare, can be life-threatening and include aspiration of stomach contents, hypoxia, hypercarbia, hypotension, hypertension, cardiac arrhythmias, cardiorespiratory arrest, and death. There is no single preferred technique of general anesthesia, athough most anesthetists employ methods that allow rapid recovery of faculties, enabling the patient to be discharged soon after surgery. To accomplish this end, light anesthesia with sodium thiopental induction and nitrous oxide maintenance is often used. Short duration muscle relaxation with an agent such as succinylcholine supplements this technique. Other techniques include light anesthesia with inhalational anesthetic agents and the use of intravenous ketamine. Local anesthesia augmented by systemic and/or inhalational analgesia is supplanting general anesthesia techniques for laparoscopy in many locales. This approach is also particularly well-suited for minilaparotomy in developing countries, where it has achieved its greatest popularity. The local technique carries with it reduced morbidity and mortality but may not entirely relieve discomfort. The primary danger of local anesthesia is respiratory depression due to excessive narcosis and sedation. The operator must be alert to the action of the drugs and should always use the minimal effective dose. Although toxicity due to overdosage with local anesthetic drugs is occasionally experienced, allergic reactions to the amide-linkage drugs such as lidocaine or bupivacaine are exceedingly rare. For outpatient

  14. Leroy D Vandam, MD: an anesthesia journey.

    Science.gov (United States)

    Ortega, Rafael A

    2005-08-01

    Leroy D Vandam, MD was a remarkable man--an intricate amalgamation of an artist, scientist, and physician. He was a bastion of medical historical knowledge. Dr Vandam became a most influential anesthesiologist, some say, a giant. He was an example of someone who, with resolve, overcame adversity. His artwork is displayed in countless places, and several of his paintings form part of the Wood Library Museum Heritage Series. Dr Vandam was first a surgeon, but he abandoned surgery and pursued a career in anesthesiology under the leadership of Robert Dripps. He completed his residency training at the University of Pennsylvania and joined its staff in 1949. When he arrived at Brigham and Women's Hospital in the 1950s as director of anesthesia, he embarked on one of the most illustrious careers in American anesthesiology. Dr Vandam published more than 250 original articles, chapters, abstracts, and other reports on a wide variety of subjects including history, art, and pharmacology. His classic article on the complications of neuroaxial blocks is a seminal work in anesthesiology. This article describes how an anesthesiologist who shared an interest with Dr Vandam in the history of anesthesiology came to produce a movie based on his career, the evolution of anesthesia equipment, and the transformation of our specialty.

  15. Structural Measures - Hospital

    Data.gov (United States)

    U.S. Department of Health & Human Services — A list of hospitals and the availability of structural measures at that hospital. A structural measure reflects the environment in which hospitals care for patients....

  16. Patient survey (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...

  17. A matched-pair cluster design study protocol to evaluate implementation of the Canadian C-spine rule in hospital emergency departments: Phase III

    Directory of Open Access Journals (Sweden)

    Rowe Brian H

    2007-02-01

    Full Text Available Abstract Background Physicians in Canadian emergency departments (EDs annually treat 185,000 alert and stable trauma victims who are at risk for cervical spine (C-spine injury. However, only 0.9% of these patients have suffered a cervical spine fracture. Current use of radiography is not efficient. The Canadian C-Spine Rule is designed to allow physicians to be more selective and accurate in ordering C-spine radiography, and to rapidly clear the C-spine without the need for radiography in many patients. The goal of this phase III study is to evaluate the effectiveness of an active strategy to implement the Canadian C-Spine Rule into physician practice. Specific objectives are to: 1 determine clinical impact, 2 determine sustainability, 3 evaluate performance, and 4 conduct an economic evaluation. Methods We propose a matched-pair cluster design study that compares outcomes during three consecutive 12-months "before," "after," and "decay" periods at six pairs of "intervention" and "control" sites. These 12 hospital ED sites will be stratified as "teaching" or "community" hospitals, matched according to baseline C-spine radiography ordering rates, and then allocated within each pair to either intervention or control groups. During the "after" period at the intervention sites, simple and inexpensive strategies will be employed to actively implement the Canadian C-Spine Rule. The following outcomes will be assessed: 1 measures of clinical impact, 2 performance of the Canadian C-Spine Rule, and 3 economic measures. During the 12-month "decay" period, implementation strategies will continue, allowing us to evaluate the sustainability of the effect. We estimate a sample size of 4,800 patients in each period in order to have adequate power to evaluate the main outcomes. Discussion Phase I successfully derived the Canadian C-Spine Rule and phase II confirmed the accuracy and safety of the rule, hence, the potential for physicians to improve care. What

  18. Hospital Inspections

    Data.gov (United States)

    U.S. Department of Health & Human Services — Welcome to hospitalinspections.org, a website run by the Association of Health Care Journalists (AHCJ) that aims to make federal hospital inspection reports easier...

  19. Spinal anesthesia for laparoscopic cholecystectomy: Thoracic vs. Lumbar Technique

    Directory of Open Access Journals (Sweden)

    Luiz Eduardo Imbelloni

    2014-01-01

    Full Text Available Aims: In our group, after a study showing that spinal anesthesia is safe when compared with general anesthesia, spinal anesthesia has been the technique of choice for this procedure. This is a prospective study with all patients undergoing LC under spinal anesthesia in our department since 2007. Settings and Design: Prospective observational. Materials and Methods: From 2007 to 2011, 369 patients with symptoms of colelithiasis, laparoscopic cholecystectomy were operated under spinal anesthesia with pneumoperitoneum and low pressure CO 2. We compared 15 mg of hyperbaric bupivacaine and lumbar puncture with 10 or 7.5 mg of hyperbaric bupivacaine thoracic puncture, all with 25 μg fentanyl until the sensory level reached T 3 . Intraoperative parameters, post-operative pain, complications, recovery, patient satisfaction, and cost were compared between both groups. Statistical Analysis Used: Means were compared by ANOVA or Kruskal-Wallis test, the percentages of the Chi-square test or Fisher′s exact test when appropriate. Time of motor and sensory block in spinal anesthesia group was compared by paired t test or Mann-Whitney test. Differences were considered significant when P ≤ 0.05, and for comparisons of mean pain visual scale, we employed the Bonferroni correction applied to be considered significant only with P ≤ 0.0125 Results: All procedures were completed under spinal anesthesia. The use of lidocaine 1% was successful in the prevention of shoulder pain in 329 (89% patients. There were significant differences in time to reach T 3 , obtaining 15 mg > 10 mg = 7.5 mg. There is a positive correlation between the dose and the incidence of hypotension. The lowest doses gave a decrease of 52.2% in the incidence of hypotension. There was a positive correlation between the dose and duration of sensory and motor block. Sensory block was almost twice the motor block at all doses. With low doses, 60% of patients went from table to stretcher

  20. Accounting and management of aseptic materials at the central sterile supply department of hospital%医院消毒供应中心无菌物品的核算与管理

    Institute of Scientific and Technical Information of China (English)

    周彬; 王亚娟

    2015-01-01

    文章结合原国家卫生部2009年颁布的《消毒供应中心三项标准》和2012年颁布的《医院财务制度》和《医院会计制度》中的相关条款,探讨医院消毒供应中心无菌物品的核算与管理工作。%In the paper, the accounting and management of aseptic materials at the Center Sterile Supply Department of hospital is discussed in accordance with relevant provisions in the Three Standards for Central Sterile Supply Departments promulgated by the former Ministry of Health of China in 2009, as well as the Hospital Financial System and Hospital Accounting System issued in 2012.

  1. A prospective study on prevalence of adverse drug reactions due to antibiotics usage in otolaryngology department of a tertiary care hospital in North India

    Directory of Open Access Journals (Sweden)

    Farhan Ahmad Khan

    2013-10-01

    Full Text Available Background: Polypharmacy, advancing age and longer duration of hospital stay are the factors responsible for adverse drug reactions (ADRs. This study has attempted to analyze the pattern of antimicrobial prescription in OPD & IPD of the Otolaryngology department and to detect, document, assess and report the suspected ADRs due to antibiotic use and preparation of guidelines to minimize the incidence of ADRs. Methods: A prospective study conducted at the TMMC&RC on patients aged >40 years, who visited the Otolaryngology department over a period of 5 months. Suspected ADRs were assessed for causality and severity using Naranjo’s probability scale and modified Hartwig’s criteria, respectively. Results: Out of 1200, 925 prescriptions were analyzed. Most patients were from 41-60 age (59.45% followed by 61-80 age (37.29% and least from >80 yr (3.24%. But the incidence of ADRs were found to be higher in patients of >80 yr age group n=8 (26.66%. The most commonly prescribed antibacterials were β-Lactams (64.61%. Out of 925 prescriptions studied, only 94 were found to have 154 ADRs. The most commonly identified ADRs were Gastrointestinal 47.40%, followed by Neurotoxicity 24.67%, cutaneous reactions 20.12%, Hepatic 4.54% and Kidney 3.24%. 74.67% of the ADRs were probable and 20.77% were possible type and only 4.54% were definite. 74.67% ADRs were found to be type A, and 25.32% type B. Conclusions: Our study showed that prevalence of ADRs was highest in elder age group and diarrhea was the most common ADR found. Therefore elderly patients should be given special attention when prescribing medications to avoid clinically significant harmful consequences. Minimizing unnecessary antibiotic use by even a small percentage could significantly reduce the immediate and direct risks of drug-related adverse events in individual patients. [Int J Basic Clin Pharmacol 2013; 2(5.000: 548-553

  2. Breast augmentation under general anesthesia versus monitored anesthesia care: a retrospective comparative study.

    Science.gov (United States)

    Eldor, Liron; Weissman, Avi; Fodor, Lucian; Carmi, Nurit; Ullmann, Yehuda

    2008-09-01

    Breast augmentation is one of the leading esthetic surgeries, enjoying high satisfaction rates. Pain, nausea, and vomiting are frequent shortcomings of the immediate postoperative period. The aim of this study was to compare breast augmentation from the anesthetic point of view: general anesthesia (GA) versus monitored anesthesia care (MAC). The charts of 115 patients were reviewed in this retrospective study performed over a period of 2 years. Sixty-nine women chose to have the surgery done under MAC, and 46 under GA. Statistically significant differences were noted in both postoperative hospital stay (16.1 +/- 6.78 hours vs. 11.7 +/- 6.10 hours) and frequency of vomiting (mean, 0.5 vs. 0.22 times per patient) after GA and MAC, respectively (Mann-Whitney, P < 0.01). Postoperative pain, assessed using the visual analog scale, was significantly higher (mean visual analog scale, 5 vs. 3.27) when the prosthesis was placed in the submuscular plane compared with the subglandular plane (Mann-Whitney, P = 0.043). When offered a choice, more women preferred MAC over GA for their breast augmentation procedure. Less vomiting and shorter postoperative hospitalization were prominent in the MAC group.

  3. Brief discussion of crisis management system of department of pharmacy in hospital%浅谈医院药学部的危机管理体系

    Institute of Scientific and Technical Information of China (English)

    蔡晓华; 朱轶红

    2015-01-01

    Objective:Through investigation of crisis management system of department of pharmacy in hospital, to improve related crisis awareness and response capacity of pharmacy worker to security event and change crisis into opportunity. Methods: An Analysis from the aspects of policy crisis, management crisis, quality crisis, quality crisis, technology crisis, security and emergency crisis, public relations crisis, and occupation pressure crisis was done. Results: The crisis management system can find problems, solve the problem, and avoid unsafe events to further expand and develop. Conclusions:The establishment of crisis management sys-tem can ensure the public physical and mental health, and medical and health services to the greatest extent.%目的::通过探讨医院药学部的危机管理体系,提高药学工作者对安全事件相关的危机意识和反应能力,从危机变为转机。方法:从政策危机、管理危机、质量危机、素质危机、技术危机、安全与突发事件危机、公共关系危机、职业压力危机等方面分析。结果:危机管理体系能够及早发现问题,解决问题,杜绝不安全事件的进一步发扩大、发展。结论:危机管理体系的建立能够最大地保障公众的身心健康与卫生健康事业。

  4. Ill-lighting syndrome: prevalence in shift-work personnel in the anaesthesiology and intensive care department of three Italian hospitals

    Directory of Open Access Journals (Sweden)

    Zanatta Paolo

    2009-03-01

    Full Text Available Abstract Background Light is one of the most important factors in our interaction with the environment; it is indispensable to visual function and neuroendocrine regulation, and is essential to our emotional perception and evaluation of the environment. Previous studies have focussed on the effects of prolonged anomalous exposure to artificial light and, in the field of work-related illness. Studies have been carried out on shift-work personnel, who are obliged to experience alterations in the physiological alternation of day and night, with anomalous exposure to light stimuli in hours normally reserved for sleep. In order to identify any signs and symptoms of the so-called ill-lighting syndrome, we carried out a study on a sample of anaesthesiologists and nurses employed in the operating theatres and Intensive Care Departments of three Italian hospitals. We measured the subjective emotional discomfort (stress experienced by these subjects, and its correlation with environmental discomfort factors, in particular the level of lighting, in their workplace. Methods We used a questionnaire developed by the Scandinavian teams who investigated Sick-Building Syndrome, that was self-administered on one day in the environments where the degree of illumination was measured according to UNIEN12464-1 regulations. Results Upon comparison of the types of exposure with the horizontal luminance values (lux measured ( 1500 lux and the degree of stress reported, (Intensive Care: mean stress = 55.8%, high stress = 34.6%; Operating Theatres: mean stress = 51.5%, high stress = 33.8%, it can be observed that the percentage of high stress was reduced as the exposure to luminance was increased, although this finding was not statistically significant. Conclusion We cannot share other authors' enthusiasm regarding the effects on workers well-being correlated to the use of fluorescent lighting. The stress level of our workers was found to be more heavily influenced by

  5. Use of intravenous immunoglobulin in the Department of Neurology at Ninewells Hospital, 2008-2009: Indications for utilization and cost-effectiveness

    Directory of Open Access Journals (Sweden)

    O′ Riordan Jonathan

    2010-01-01

    Full Text Available This study was designed to identify the indications for prescription of intravenous immunoglobulin (IVIg in neurology and the cost effectiveness of this therapy. Objectives: IVIg is a relatively costly therapy and the annual budget spent on providing this therapy for various indications at Ninewells Hospital was close to £1.5 million. In today′s economic times, a cost-benefit analysis of all therapies is prudent. This is of relevance to countries in the developing world as well where perhaps not everybody could afford such cost-intensive therapy. Materials and Methods: We audited 2 time periods over 12 months each in 2004-2005 and 2008-2009 to look at the patterns of utilization of IVIg over these periods. We searched the literature for alternative and cost-effective therapies for the most common indications for use of IVIg. Results: Fiscal costs on prescription of IVIg have rocketed up by almost 300% in this Neurology Department comparing data from 2004-2005 vs 2008-2009 and this is disproportionate to the increase in the annual admission rate (bed usage, partly because of the soaring costs of the drug available in the market and also because of the increased prescription of IVIg for numerous indications where clinical trials data are yet not so robust. Conclusion: We have looked at the cost of alternative therapies and offer some proposals that if implemented could potentially save £330,000 annually from the health budget at this NHS Trust. Perhaps similar models could evolve for better cost-effective utilization of IVIg in countries in the developing world where health budgeting is more acutely relevant.

  6. Chilhood leprosy: Clinical and epidemiological study in the Department of Dermatology, Clinicas Hospital, Faculty of Medical Sciences, National University of Asuncion-Paraguay, 2005-2014

    Directory of Open Access Journals (Sweden)

    Beatriz Di Martino Ortiz

    2016-01-01

    Full Text Available Introduction: Leprosy in childhood is not a common finding. The risk of a child to develop the disease is 4 times greater in contact with close people and 9 times higher among household contacts. The maximum risk observed is when the contact is Multibacillary (MB and intradomicilliary. Leprosy in childhood reflects the clinical characteristics of adult, with some peculiar aspects. Non-contagious forms (IL and TT are common during childhood. The contagious forms (BB, LB and LL are less frequent due to higher required incubation period. Aim: To describe the clinical and epidemiological characteristics of childhood leprosy in the Department of Dermatology, Clinicas Hospital from January 2005 to July 2014. Methods: Retrospective, observational cross-sectional study with an analytical component. Results: The total number of leprosy patients was 369, and of these 11 were pediatric patients (2.98% with a predominance of males (8/11 from 3 to 16 years. The BI ranged from negative to 3+. 6/11 were MB. The evolution was good in all cases and two patients developed leprorreactions. The lesions were predominant in facial location. 6/11 patients had family contacts. Conclusions: Leprosy in children is more common than is reported, especially in endemic areas. In <5 years, the disease is very rare. More than half of the cases of children with leprosy have a positive contact. It is considered that in <5 years the spread is always intradomiciliary; this shows the importance of monitoring contacts, which will be possible with the determination of all stakeholders in order to banish the undetected cases and prevent damage.

  7. ESTRATEGIA ANESTÉSICA PARA LA CIRUGÍA CON EL CORAZÓN LATIENDO. CINCO AÑOS DE EXPERIENCIA EN EL CARDIOCENTRO ERNESTO CHE GUEVARA / Anesthesia strategy for surgery with beating heart. Five years of experience at the “Ernesto Che Guevara” Cardiology Hospital

    Directory of Open Access Journals (Sweden)

    Ignacio R. Fajardo Egozcue

    2009-06-01

    Full Text Available Introduction and Objectives: The anesthesia in coronary surgery, using high sustained doses of fentanyl, leads to protracted postoperative extubation and stay. The assessment of an anesthesiastrategy for coronary surgery without extracorporeal circulation, in order to reduce the use of opioids and make possible an early extubation and a shorter post-surgical stay, was the objective of thiswork. Methods: 732 patients who underwent surgical myocardial revascularization without heartlung machine, from February 2003 to December 2007, using general anesthesia with intermittent boluses of fentanyl, with or without associated epidural anesthesia, were studied. Results: 625 surgical operations with general anesthesia in boluses and 107 adding peridural anesthesia were carried out. The average amount of fentanyl was 34.7 ml per patient in the first group and 24.9 ml when adding peridural anesthesia. Twenty seven patients were extubated in the operating room. The total average time was 8.6 hours (8.8 hours in the group where the anesthesia in boluses wasused and 6.7 hours for those with peridural anesthesia associated. The total average stay at the Intensive Care Unit was 40.1 hours. Conclusions: The intermittent anesthesia reduced the amount of fentanyl used in 86.6 percent when compared to the high sustained doses reported in a previous study. This made possible the early extubation of the patients, which increased due to the use of peridural anesthesia, and a decrease in average stay of the patient at the Intensive Care Unit.

  8. Unintentional carbon monoxide poisoning hospitalization and emergency department counts and rates by county, year, and fire-relatedness among California residents,2000-2007

    Data.gov (United States)

    California Environmental Health Tracking Program — This dataset contains case counts, rates, and confidence intervals of unintentional carbon monoxide poisoning (CO) inpatient hospitalizations and emergency...

  9. 关于公立医院行政后勤科室绩效分配实践与思考%On Public Hospital Administrative Department Performance Distribution Practice and Thinking

    Institute of Scientific and Technical Information of China (English)

    周琳; 汤金霞

    2015-01-01

    公立医院行政后勤科室绩效分配是一项重大改革,是现代医院发展的新思路. 绩效工资实施得好可以提高职工作积极性和工作效率,从而提高医院的总体管理水平,加速公立医院的改革步伐.%Public hospital administrative department performance distribution is a major reform, is a new train of thought on the development of modern hospital. Performance-based pay implementation well can improve employee motivation and work efficiency, so as to improve the overall management level of hospital, accelerating the pace of reform of public hospital

  10. Stabilizing membrane domains antagonizes anesthesia

    CERN Document Server

    Machta, Benjamin B; Nouri, Mariam; McCarthy, Nicola L C; Gray, Erin M; Miller, Ann L; Brooks, Nicholas J; Veatch, Sarah L

    2016-01-01

    Diverse molecules induce general anesthesia with potency strongly correlated both with their hydrophobicity and their effects on certain ion channels. We recently observed that several anesthetics inhibit heterogeneity in plasma membrane derived vesicles by lowering the critical temperature ($T_c$) for phase separation. Here we exploit conditions that stabilize membrane heterogeneity to test the correlation between the anesthetic potency of n-alcohols and effects on $T_c$. First we show that hexadecanol acts oppositely to anesthetics on membrane mixing and antagonizes ethanol induced anesthesia in a tadpole behavioral assay. Second, we show that two previously described `intoxication reversers' raise $T_c$ in vesicles and counter ethanol's effects in vesicles, mimicking the findings of previous electrophysiological measurements. Third, we find that hydrostatic pressure, long known to reverse anesthesia, also raises $T_c$ in vesicles with a magnitude that counters the effect of an anesthetic at relevant concen...

  11. Marsupial, insectivore, and chiropteran anesthesia.

    Science.gov (United States)

    Pye, G W

    2001-01-01

    This article covers the manual restraint and anesthesia of marsupials, insectivores, and chiroptera. Marsupials commonly kept as pets in the U.S. [e.g., eastern gray kangaroos (Macropus giganteus), Bennett's wallabies (Macropus rufogriseus), and sugar gliders (Petaurus breviceps)] are covered in detail. Marsupial species kept in zoological parks [e.g., Tasmanian devils, koalas (Phascolarctos cinereus), and common wombats (Vombatus ursinus)] are covered in less detail. Of the insectivores, only the African hedgehog (Atelerix albiventris) and the European hedgehog (Erinaceus europaeus) are commonly kept as pets and, consequently, the insectivore section concentrates on discussing these two species. The section on chiropteran anesthesia is divided into two broad categories: the megachiropterans (flying foxes and fruit bats) and the microchiropterans (insectivorous bats). Most of the information on the species covered in this article is anecdotal, and this should be kept in mind when using the anesthesia protocols described.

  12. EEG entropy measures in anesthesia

    Directory of Open Access Journals (Sweden)

    Zhenhu eLiang

    2015-02-01

    Full Text Available Objective: Entropy algorithms have been widely used in analyzing EEG signals during anesthesia. However, a systematic comparison of these entropy algorithms in assessing anesthesia drugs’ effect is lacking. In this study, we compare the capability of twelve entropy indices for monitoring depth of anesthesia (DoA and detecting the burst suppression pattern (BSP, in anesthesia induced by GA-BAergic agents.Methods: Twelve indices were investigated, namely Response Entropy (RE and State entropy (SE, three wavelet entropy (WE measures (Shannon WE (SWE, Tsallis WE (TWE and Renyi WE (RWE, Hilbert-Huang spectral entropy (HHSE, approximate entropy (ApEn, sample entropy (SampEn, Fuzzy entropy, and three permutation entropy (PE measures (Shannon PE (SPE, Tsallis PE (TPE and Renyi PE (RPE. Two EEG data sets from sevoflurane-induced and isoflu-rane-induced anesthesia respectively were selected to assess the capability of each entropy index in DoA monitoring and BSP detection. To validate the effectiveness of these entropy algorithms, phar-macokinetic / pharmacodynamic (PK/PD modeling and prediction probability analysis were applied. The multifractal detrended fluctuation analysis (MDFA as a non-entropy measure was compared.Results: All the entropy and MDFA indices could track the changes in EEG pattern during different anesthesia states. Three PE measures outperformed the other entropy indices, with less baseline vari-ability, higher coefficient of determination and prediction probability, and RPE performed best; ApEn and SampEn discriminated BSP best. Additionally, these entropy measures showed an ad-vantage in computation efficiency compared with MDFA.Conclusion: Each entropy index has its advantages and disadvantages in estimating DoA. Overall, it is suggested that the RPE index was a superior measure.Significance: Investigating the advantages and disadvantages of these entropy indices could help improve current clinical indices for monitoring DoA.

  13. Double balloon enteroscopy examinations in general anesthesia

    Institute of Scientific and Technical Information of China (English)

    Laszlo; Zubek; Lena; Szabo; Peter; Laszlo; Lakatos; Janos; Papp; Janos; Gal; Gabor; Elo

    2010-01-01

    AIM:To demonstrate that the double balloon enteroscopy(DBE) can be safely performed in general anesthesia with intubation.METHODS:We performed a retrospective examination between August 2005 and November 2008 amongpatients receiving intubation narcosis due to DBE examination.The patients were grouped based on sex,age and physical status.Anesthesia records includedduration of anesthesia,quantity of medication usedand anesthesia-related complications.We determinedthe frequency of complications in the differen...

  14. 西藏左贡县医院妇科门诊疾病谱分析%Spectrum of disease at gynecology outpatient department in Zuogong county hospital

    Institute of Scientific and Technical Information of China (English)

    王玢; 洛松次登; 万荣; 冯正勇; 扎西松姆; 德尕

    2015-01-01

    目的:通过分析西藏左贡县医院妇科门诊妇科疾病谱,探讨当地妇女妇科疾病的发病特点,为制定预防和治疗措施提供依据。方法:回顾性分析2010年7月至2010年9月期间左贡县医院妇科门诊就诊病例1183例。结果:妇科疾病发病率前5位顺次为:慢性宫颈炎(41.50%)、阴道炎(36.01%)、盆腔炎(14.62%)、子宫肌瘤(3.63%)、功能性子宫出血(2.87%)。同时患有2种以上炎症性疾病的占33.13%,妇科炎症性疾病总发病率92.13%,明显高于国内报道;子宫肌瘤及功能性子宫出血发病率均低于国内报道。结论:西藏左贡县受特殊地理环境及特殊民族风俗影响,女性性生活开始较早、分娩次数较多、卫生经济状况较差,妇科炎症性疾病发病率较高,特别是两种以上炎症同时发病较多。做好计划生育的宣教、降低人工流产率、减少分娩次数、加强流产后及产后妇女的保健、加大对于基层妇产科专业人员的帮扶等,对于降低妇科炎症性疾病发病率、提高当地妇女生殖健康水平很有必要。%Objectives:To discuss the characteristics of female diseases by means of analyzing the women diseases spectrum at gynecology outpatient department of Zuogong county hospital,so as to provide evidence for making precautionary and therapeutic measures.Methods:1 1 83 patients at gynecology department of Zuogong county hospital were retrospectively analyzed From July to September in 201 0.Results:The top five female diseases with the highest morbidity were chronic cervicitis (41 .5%),vaginitis (36.01 %),pelvic infection (1 4.62%), myoma of uterus (3.63%)and dysfunctional uterus bleeding (2.87%).About 33.1 3% objects suffered from two kinds of inflammatory gynecologic diseases.The total morbidity of female inflammatory diseases was 92.1 3%,which was superior to that reported domestically,otherwise the

  15. The thermodynamics of general anesthesia

    CERN Document Server

    Heimburg, T; Heimburg, Thomas; Jackson, Andrew D.

    2006-01-01

    It is known that the action of general anesthetics is proportional to their partition coefficient in lipid membranes (Meyer-Overton rule). This solubility is, however, directly related to the depression of the temperature of the melting transition found close to body temperature in biomembranes. We propose a thermodynamic extension of the Meyer-Overton rule which is based on free energy changes in the system and thus automatically incorporates the effects of melting point depression. This model provides a quantitative explanation of the pressure reversal of anesthesia. Further, it explains why inflammation and the addition of divalent cations reduce the effectiveness of anesthesia.

  16. The Comparison Of Total Intravenous Anesthesia (Propofol, Alfentanyl Plus Midazolam, Alfentanyl With General Anesthesia In D&C Patients

    Directory of Open Access Journals (Sweden)

    Shoeibi G

    2004-07-01

    Full Text Available Background: Total Intravenous Anesthesia (TIVA compared to general anesthesia has some pits and falls. Many drugs have been employed for this anesthesia. Propofol is accounted as the last advent anesthetic drug. It belongs to alkyl phenol families and has been accounted one of the best choices for the continuous infusion. Invention of midazolam as the first water soluble benzodiazepine was also an important event in anesthesia and it can be used as continuous infusion for the anesthesia. Materials and Methods: In this randomized controlled clinical trial, alfentanyl plus propofol or midazolam were used for TIVA anesthesia in 60 female patients undergoing Dilatation and Curettage (D&C in Dr.Shariati hospital in March 2002 till March 2003. They were allocated reandomly in two group of alfentanyl plus propofol (propofol group or alfentanyl plus midazolam (midazolam group Results: There was no significant difference in mean of age between propofol group and midazolam group (P>0.05, also There was no significant difference in preanesthesia condition such as blood pressure and heart rate between propofol group and midazolam group (p>0.05. After induction of anesthesia there was a gross blood pressure decrease in both group that it was greater in midazolam group (85 mmHg versus 73 mmHg, P0.05 also there was just one naloxane injection in midazolam group that have no significant difference between groups (P>0.05. Recovery room stay was significantly lower in propofol group (25 minutes versus 39 minutes, P<0.05. Conclusion: The results of this study was similar to Vuyk et.al.In their study there was a significant lower recovery time estimated by psychomotor reflexes and there was significant lower drowsiness, place and time orientation time compared to midazolam group. Finally according to the results of this study it can be resulted that TIVA with propofol is more suitable than midazolam and it can lower hospitalization time and cost. In future studies

  17. Characteristics of Anxiety Disorder in General Hospitals' Outpatient Department%综合医院门诊焦虑障碍患者的特点分析

    Institute of Scientific and Technical Information of China (English)

    鲁文兴; 陈星; 姜荣环; 马弘; 娄英男; 何燕玲; 杨蕾

    2014-01-01

    Objective To explore the characteristics of anxiety disorder in outpatient of general hospitals. Methods The outpatients in Neurology,Gastroenterology,Cardiology,and Gynecology department were screened using general information questionnaire,Hospital Anxiety and Depression Scale( HADS),Patient Health Questionnaire somatic symptom severity scale (PHQ - 15). All the patients who's HADS score were 8 or above were examined by psychiatrists using the Mini International Neuropsychiatry Interview(MINI)and were determined the psychiatric diagnosis. Results All in all 2 074 outpatients completed the investigation:110 with anxiety disorder(anxiety disorder group)among which 57(51. 8% )with comorbid anxiety depres-sion,1 538 cases without anxiety disorder(normal group)(915 cases' HADS were under 8,623 cases were determined by MINI). The depression group was younger than the normal control〔(45. 3 ± 14. 1)vs. (49. 7 ± 16. 8),t = 2. 667,P 0. 05).The total score in PHQ - 15 of anxiety patient were higher than those of normal controls〔(12. 5 ± 5. 7)vs. (7. 1 ± 4. 3),t =12. 371,P 0.05)。焦虑障碍组的 PHQ -15总分为(12.5±5.7)分,正常组为(7.1±4.3)分,两组间比较差异有统计学意义(t =12.371,P <0.01)。焦虑障碍组患者 PHQ -15中出现频率前三位的条目为:感到疲劳37.3%(41例);睡眠问题37.3%(41例);虚弱感30.0%(33例)。正常组和焦虑障碍组的误工天数、目前疾病造成的功能损害(对家庭生活和家庭责任的影响、对工作和学习的影响、对社交生活的影响)间差异有统计学意义(P <0.05)。焦虑障碍组患者有自杀倾向者占32.7%(36例),只有22例患者(20.0%)被建议转诊到精神科(16例,14.5%)或予以精神类药物(6例,5.5%)。结论综合医院门诊的焦虑障碍患者共病抑郁障碍的比例高、躯体主诉多、生活质量差、自杀倾向高,但被识别的比例较低。

  18. Testicular torsion based on material from the Department of Paediatric Surgery, Urology and Traumatology at Wladyslaw Buszkowski Children’s Hospital in Kielce during 2008–2013

    Directory of Open Access Journals (Sweden)

    Roman Sławek

    2014-06-01

    Full Text Available Introduction: Among the causes of acute scrotum syndrome, testicular torsion undoubtedly causes the most serious consequences. The remaining aetiological factors are torsion of the testicular appendages and of the epididymis, epididymo-orchitis, testicular injury, incarcerated inguinal hernia, acute testicular hydrocele and idiopathic scrotal oedema. Torsion of the testis occurs as a result of a twisting of the testis around the vertical axis. This leads to venous occlusion and subsequently to arterial occlusion with ischaemia and necrosis of the gonad. Aim of the research: Determination of the possibilities of saving the testicle after torsion of the gonad. Material and methods: S ixty-eight cases of testicular torsion were analysed in boys aged 0–18 years who were treated during the period 2008–2013 in the Department of Paediatric Surgery, Urology and Traumatology in Kielce. The evaluation determined whether or not the gonad could be saved. The degree of macroscopically evident testicular necrosis was determined and the decision made concerning the saving or resecting the gonad. Further development of the saved testicle was monitored ambulatorily. Results: In 39 patients the testicle was removed due to necrosis, while in the remaining cases the gonad was saved. Torsion of the left testicle was more frequently observed. The symptoms of the torsion were: testicle pain, nausea and vomiting and, more rarely, abdominal pain. The symptoms occurred from 2 h to several days before reporting to hospital. Emergency surgery was performed. After the surgery ultrasonographic control covered the assessment of blood flow, echostructure and dimensions of the saved gonad (due to the possibility of atrophy after torsion. Conclusions: A patient who reports pain in the scrotal region should be approached as an emergency case, requiring immediate diagnostics and, very often, emergency surgical management. USG examination with the assessment of

  19. Pain management trend of vaso-occulsive crisis (VOC) at a community hospital emergency department (ED) for patients with sickle cell disease.

    Science.gov (United States)

    Inoue, Susumu; Khan, Isra'a; Mushtaq, Rao; Sanikommu, Srinivasa Reddy; Mbeumo, Carline; LaChance, Jenny; Roebuck, Michael

    2016-01-01

    Pain management at the emergency department (ED) for vaso-occulsive crisis (VOC) for patients with sickle cell disease has not been optimum, with a long delay in giving the initial analgesic. We conducted a retrospective survey over a 7-year period to determine our ED's timing in giving pain medication to patients with VOC as a quality improvement project. We compared different periods, children vs adults, and the influence of gender in the analgesic administration timing. This is a retrospective chart review of three different periods: (1) years 2007-2008, (2) years 2011-2012, and (3) year 2013. We extracted relevant information from ED records. Data were analyzed using Student t test, chi-square analysis, and the Kruskal-Wallis test. There was a progressive improvement in the time interval to the 1st analgesic over these three periods. Children received analgesics more quickly than adults in all periods. Male adult patients received pain medication faster than female adult patients, although initial pain scores were higher in female than in male patients. Progressively fewer pediatric patients utilized ED over these three periods, but no difference for adult patients was observed. The proportion of pediatric patients admitted to the hospital increased with each period. The progressive decrease in both the number of patients and the number of visits to the ED by children suggested that the collective number of VOC in children has decreased, possibly secondary to the dissemination of hydroxyurea use. We failed to observe the same trend in adult patients. The need for IV access, and ordering laboratory tests or imaging studies tends to delay analgesic administration. Delay in administration of the first analgesic was more pronounced for female adult patients than male adult patients in spite of their higher pain score. Health care providers working in ED should make conscious efforts to respect pain in women as well as pain in men. Though not proven from this study

  20. Exploration of patients’ and doctors’ perceptions of the role of anesthesiologist and anesthesia

    Directory of Open Access Journals (Sweden)

    Panagiota Ntouma

    2015-04-01

    Full Text Available Introduction: Anesthesiology is a medical specialty with rapid development in the recent decades. The work of anesthetists, however, is not recognized in the medical circles and research reports that patients have incomplete knowledge about anesthesia and the anesthesiologist. Purpose: The purpose of the present research was to assess the views of patients and doctors of other specialties in Greece, for the role of the anesthesiologist and anesthesia. Material and Methods: The study was conducted at the General Hospital of Thessaloniki, Papageorgiou, with the use of questionnaires, during January-March 2014, and data were analyzed with SPSS 15. The study included 100 participants from the surgical clinics and 50 doctors from other specialties. Results: The vast majority of patients (> 90%, who took part in the research, are aware that the anesthesiologist is a physician but are not aware of the specific tasks undertaken in the peri-operative period. Also, they have knowledge for several of their out of surgery activities, except from their involvement in the radiology department (16%, the pain clinic (23% and the psychiatric clinic (20%. The same lack of knowledge is evident for the latter by the other physicians too (only 22% was aware as well as for the necessary preoperative withhold of food and drink (34%, and the involvement of anesthesiologist in cardiology (44%, psychiatric (22% clinics and radiology department (42%. However, they are generally aware of most of anesthesiologist’s tasks and anesthesia’s complications. Conclusions: The research shows the need to intensify efforts from anesthesiologists to inform patients about issues related to anesthesiology. Doctors of other specialties lack expertise in specific issues of anesthesiology; therefore they need additional training in order to contribute in informing patients.

  1. 军队医院经济管理信息平台科级核算应把握的要点%The Key Points of Department Level Cost Accounting of Military Hospital Economic Management Information Platform

    Institute of Scientific and Technical Information of China (English)

    薛运友; 王崇才; 杜佳原; 高社

    2014-01-01

    目的:明确岗位责任制,结合军队医院实际,探讨科级医疗成本核算方法。方法:创新管理理念,明确核算方法,实现管理效果。结果:构建科级核算模式,实现科级核算系统化规范化。结论:创建科级核算系统平台,对于促进军队医院全成本核算管理和提升医院运营管理水平将起到十分重要的支撑作用。%Objective: To discuss department-level cost account method by clarifying system of post responsibility and combining fact of military hospital. Method: Innovating management concept, clarifying accounting method, realizing management effect. Results: Formed department-level accounting system, realized department-level accounting effect. Conclusion: It is a powerful support to military hospital whole cost accounting that to construct department-level accounting platform and to enhance hospital management level.

  2. Hospital Outpatient PPS Partial Hospitalization Program LDS

    Data.gov (United States)

    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...

  3. PREDICTORS OF ATTITUDE OF PARTURIENTS SELECTED FOR CESAREAN SECTION TOWARD SPINAL ANESTHESIA

    Directory of Open Access Journals (Sweden)

    M.R. Afhami

    2004-11-01

    Full Text Available There are many factors contributing to success of regional anesthesia. Patients’ attitude toward spinal anesthesia is one of the most important of these factors. This is a descriptive study performed on 100 healthy parturient selected for elective cesarean section in Alzahra Obstetric Hospital,Tabriz, Iran. The aim of this study was to evaluate patients’ attitude and their knowledge about spinal anesthesia. Patients were selected randomly. Data collection was performed using a questionnaire. Statistical programs used were Student’s t test and Chi square for demographic characteristics. The most important factors which influenced patients’ attitude were nausea and vomiting (27%, fear of pain (34%, fear of needle puncture (15% and discomfort during return of sensory and motor functions (6%. Being awake during surgery and witnessing birth of neonate were the most pleasant stages of anesthesia (19%. It seems that providing enough and appropriate information about the procedure at preoperative visit can increase acceptance of this regional anesthetic technique.

  4. Comparison of remifentanil and low-dose fentanyl for fast-track cardiac anesthesia

    DEFF Research Database (Denmark)

    Khanykin, Boris; Siddiqi, Rizwan; Jensen, Per F

    2013-01-01

    BACKGROUND: Different anesthetic techniques have been used for fast tracking in cardiac anesthesia. Remifentanil, with its unique pharmacokinetic profile, could be an ideal drug for fast tracking. Possible limitations of remifentanil are rapid onset of postoperative pain after discontinuation...... of the drug infusion, which may increase the risk of an ischemic event. We conducted this randomized study to compare the efficacy of remifentanil versus low doses of fentanyl in fast-track cardiac anesthesia. It has been hypothesized that remifentanil would provide a safe anesthesia with no impact...... anesthesia. The study was designed as a prospective randomized study. The primary outcomes were changes in the cardiac index and creatine kinase MB fraction (CKMB), extubation times, mobilization times, and lengths of stay in the intensive care unit (ICU) and the hospital. Frequency of myocardial infarction...

  5. Intestinal circulation during inhalation anesthesia

    Energy Technology Data Exchange (ETDEWEB)

    Tverskoy, M.; Gelman, S.; Fowler, K.C.; Bradley, E.L.

    1985-04-01

    This study was designed to evaluate the influence of inhalational agents on the intestinal circulation in an isolated loop preparation. Sixty dogs were studied, using three intestinal segments from each dog. Selected intestinal segments were pumped with aortic blood at a constant pressure of 100 mmHg. A mixture of /sub 86/Rb and 9-microns spheres labeled with /sup 141/Ce was injected into the arterial cannula supplying the intestinal loop, while mesenteric venous blood was collected for activity counting. A very strong and significant correlation was found between rubidium clearance and microsphere entrapment (r = 0.97, P less than 0.0001). Nitrous oxide anesthesia was accompanied by a higher vascular resistance (VR), lower flow (F), rubidium clearance (Cl-Rb), and microspheres entrapment (Cl-Sph) than pentobarbital anesthesia, indicating that the vascular bed in the intestinal segment was constricted and flow (total and nutritive) decreased. Halothane, enflurane, and isoflurane anesthesia were accompanied by a much lower arteriovenous oxygen content difference (AVDO/sub 2/) and oxygen uptake than pentobarbital or nitrous oxide. Compared with pentobarbital, enflurane anesthesia was not accompanied by marked differences in VR, F, Cl-Rb, and Cl-Sph; halothane at 2 MAC decreased VR and increased F and Cl-Rb while isoflurane increased VR and decreased F. alpha-Adrenoceptor blockade with phentolamine (1 mg . kg-1) abolished isoflurane-induced vasoconstriction, suggesting that the increase in VR was mediated via circulating catecholamines.

  6. Specialist training in pediatric anesthesia

    DEFF Research Database (Denmark)

    Hansen, Tom G

    2009-01-01

    There has been a great deal of focus on specialist training in pediatric anesthesia in the last decade or so. Internationally, however, there is still no uniform agreement as to how such a training program should be arranged and organized. Since September 2003, the Scandinavian Society of Anaesth......There has been a great deal of focus on specialist training in pediatric anesthesia in the last decade or so. Internationally, however, there is still no uniform agreement as to how such a training program should be arranged and organized. Since September 2003, the Scandinavian Society...... of Anaesthesiology and Intensive Care Medicine has coordinated an advanced Inter-Nordic educational program in pediatric anesthesia and intensive care. The training program is managed by a Steering Committee. This program is intended for physicians who recently have received their specialist degree in anesthesiology...... and intensive care. The training period is 12 months of which 9 months are dedicated to pediatric anesthesia and 3 months to pediatric intensive care. During the 1-year training period, the candidates are designated a Scandinavian host clinic (at a tertiary pediatric center in Scandinavia approved...

  7. Anesthesia and the developing brain

    DEFF Research Database (Denmark)

    Davidson, Andrew J; Becke, Karin; de Graaff, Jurgen

    2015-01-01

    It is now well established that many general anesthetics have a variety of effects on the developing brain in animal models. In contrast, human cohort studies show mixed evidence for any association between neurobehavioural outcome and anesthesia exposure in early childhood. In spite of large...

  8. Management of neutropenic patients in the intensive care unit (NEWBORNS EXCLUDED) recommendations from an expert panel from the French Intensive Care Society (SRLF) with the French Group for Pediatric Intensive Care Emergencies (GFRUP), the French Society of Anesthesia and Intensive Care (SFAR), the French Society of Hematology (SFH), the French Society for Hospital Hygiene (SF2H), and the French Infectious Diseases Society (SPILF).

    Science.gov (United States)

    Schnell, David; Azoulay, Elie; Benoit, Dominique; Clouzeau, Benjamin; Demaret, Pierre; Ducassou, Stéphane; Frange, Pierre; Lafaurie, Matthieu; Legrand, Matthieu; Meert, Anne-Pascale; Mokart, Djamel; Naudin, Jérôme; Pene, Frédéric; Rabbat, Antoine; Raffoux, Emmanuel; Ribaud, Patricia; Richard, Jean-Christophe; Vincent, François; Zahar, Jean-Ralph; Darmon, Michael

    2016-12-01

    Neutropenia is defined by either an absolute or functional defect (acute myeloid leukemia or myelodysplastic syndrome) of polymorphonuclear neutrophils and is associated with high risk of specific complications that may require intensive care unit (ICU) admission. Specificities in the management of critically ill neutropenic patients prompted the establishment of guidelines dedicated to intensivists. These recommendations were drawn up by a panel of experts brought together by the French Intensive Care Society in collaboration with the French Group for Pediatric Intensive Care Emergencies, the French Society of Anesthesia and Intensive Care, the French Society of Hematology, the French Society for Hospital Hygiene, and the French Infectious Diseases Society. Literature review and formulation of recommendations were performed using the Grading of Recommendations Assessment, Development and Evaluation system. Each recommendation was then evaluated and rated by each expert using a methodology derived from the RAND/UCLA Appropriateness Method. Six fields are covered by the provided recommendations: (1) ICU admission and prognosis, (2) protective isolation and prophylaxis, (3) management of acute respiratory failure, (4) organ failure and organ support, (5) antibiotic management and source control, and (6) hematological management. Most of the provided recommendations are obtained from low levels of evidence, however, suggesting a need for additional studies. Seven recommendations were, however, associated with high level of evidences and are related to protective isolation, diagnostic workup of acute respiratory failure, medical management, and timing surgery in patients with typhlitis.

  9. 医院科室预算编制方法的创新%Innovation on hospital department budgeting methods CHEN Shimin, SUN Tiehong, CHEN Jiangang,GUO Hangyuan

    Institute of Scientific and Technical Information of China (English)

    陈士敏; 孙铁红; 陈剑刚; 郭航远

    2013-01-01

      通过对科室预算的编制形式、编制流程的探讨,明确科室预算的编制标准和操作细则。提出编制医院科室预算的具体方案,辅助医院年度经营计划的顺利实施,提高科室的工作绩效。%By discussing hospital department budgeting form and process, the details of standard and operation in department budgeting are defined. With the implementing of yearly operation plan, the department budgeting plan is presented to improve department's performance.

  10. Influence of anesthesia techniques of caesarean section on memory, perception and speech

    Directory of Open Access Journals (Sweden)

    Volkov O.O.

    2014-06-01

    Full Text Available In obstetrics postoperative cognitive dysfunctions may take place after caesarean section and vaginal delivery with poor results both for mother and child. The goal was to study influence of anesthesia techniques following caesarian section on memory, perception and speech. Having agreed with local ethics committee and obtained informed consent depending on anesthesia method, pregnant women were divided into 2 groups: 1st group (n=31 had spinal anesthesia, 2nd group (n=34 – total intravenous anesthesia. Spinal anesthesia: 1.8-2.2 mLs of hyperbaric 0.5% bupivacaine. ТIVА: Thiopental sodium (4 mgs kg-1, succinylcholine (1-1.5 mgs kg-1. Phentanyl (10-5-3 µgs kg-1 hour and Diazepam (10 mgs were used after newborn extraction. We used Luria’s test for memory assessment, perception was studied by test “recognition of time”. Speech was studied by test "name of fingers". Control points: 1 - before the surgery, 2 - in 24h after the caesarian section, 3 - on day 3 after surgery, 4 - at discharge from hospital (5-7th day. The study showed that initially decreased memory level in expectant mothers regressed along with the time after caesarean section. Memory is restored in 3 days after surgery regardless of anesthesia techniques. In spinal anesthesia on 5-7th postoperative day memory level exceeds that of used in total intravenous anesthesia. The perception and speech do not depend on the term of postoperative period. Anesthesia technique does not influence perception and speech restoration after caesarean sections.

  11. [Risk management in anesthesia and critical care medicine].

    Science.gov (United States)

    Eisold, C; Heller, A R

    2017-02-16

    Throughout its history, anesthesia and critical care medicine has experienced vast improvements to increase patient safety. Consequently, anesthesia has never been performed on such a high level as it is being performed today. As a result, we do not always fully perceive the risks involved in our daily activity. A survey performed in Swiss hospitals identified a total of 169 hot spots which endanger patient safety. It turned out that there is a complex variety of possible errors that can only be tackled through consistent implementation of a safety culture. The key elements to reduce complications are continuing staff education, algorithms and standard operating procedures (SOP), working according to the principles of crisis resource management (CRM) and last but not least the continuous work-up of mistakes identified by critical incident reporting systems.

  12. The Kleine-Levin Syndrome: A Rare Disease with Often Delayed Diagnosis—A Report of Two Cases in the Department of Neurology of the University Hospital of Cocody (Côte d'Ivoire)

    Science.gov (United States)

    Assi, Berthe; Yapo-Ehounoud, Constance; Baby, Mohamed Ben Allaoui; Aka-Diarra, Evelyne; Amon-Tanoh, Muriel; Tanoh, Christian

    2016-01-01

    The Kleine-Levin syndrome is a rare pathology characterized by recurrent episodes of hypersomnia associated with behavioral and cognitive disorders with, among others, hyperphagia and hypersexuality. The disease mainly affects young males. A few studies mention cases that occurred in Africa, especially in Côte d'Ivoire. In this paper, we report the very first two cases observed in the Neurology Department of the University Hospital of Cocody. The diagnosis was clinical, based on the recurrence of hypersomnia, cognitive and behavioral disorders during the periods of hypersomnia, and the return of patients to normal state between episodes. This diagnosis was delayed due to failure to understand the pathology, thereby leading patients to wandering. In fact, the two patients were consulted, respectively, 3 years and 6 years after the hypersomnia began. The objective was to report the very first cases observed in the Neurology Department of the University Hospital of Cocody, Côte d'Ivoire. PMID:26989535

  13. The Kleine-Levin Syndrome: A Rare Disease with Often Delayed Diagnosis—A Report of Two Cases in the Department of Neurology of the University Hospital of Cocody (Côte d’Ivoire

    Directory of Open Access Journals (Sweden)

    Berthe Assi

    2016-01-01

    Full Text Available The Kleine-Levin syndrome is a rare pathology characterized by recurrent episodes of hypersomnia associated with behavioral and cognitive disorders with, among others, hyperphagia and hypersexuality. The disease mainly affects young males. A few studies mention cases that occurred in Africa, especially in Côte d’Ivoire. In this paper, we report the very first two cases observed in the Neurology Department of the University Hospital of Cocody. The diagnosis was clinical, based on the recurrence of hypersomnia, cognitive and behavioral disorders during the periods of hypersomnia, and the return of patients to normal state between episodes. This diagnosis was delayed due to failure to understand the pathology, thereby leading patients to wandering. In fact, the two patients were consulted, respectively, 3 years and 6 years after the hypersomnia began. The objective was to report the very first cases observed in the Neurology Department of the University Hospital of Cocody, Côte d’Ivoire.

  14. 某院病案科室建设中的问题与改进措施%Problems Existing in the Construction of Medical Record Department in a Hospital and Relevant Improvement Measures

    Institute of Scientific and Technical Information of China (English)

    顾琳; 刘明; 郝新一

    2015-01-01

    The medical records management exposed many problems in the review of the hospital,such as weak management of the department,shortages existing in the knowledge structure of the staff and work responsibility,which influenced the construction of the department and brought many adverse effects to the informatization construction as well as electronic medical records of the hospital.Focused on the problems existing in the factual work of the hospital,we had made relevant rectification in the self-inspection before the review of the hospital.Through conducting measures such as strengthen the organization construction of the department,adjust the structure of leaders and put emphasis on the cultivation of professional quality of the staff,could we promote the construction of medical record department,as well as improve the management quality of medical records and service ability at the same time.%某院的病案管理在医院评审中暴露出诸多问题,如科室管理薄弱,人员知识结构以及工作职能等方面存在不足,影响了科室建设,对医院的电子病历及信息化建设带来不利影响。在医院评审前,自查医院实际工作中存在的问题,进行相应的整改。通过加强科室组织建设,调整科室领导结构,注重员工专业素质培养等措施,全面促进病案科建设,使医院病案管理质量和服务能力得以提升。

  15. Introduction of virtual patients onto a final year anesthesia course: Hong Kong experience

    Directory of Open Access Journals (Sweden)

    Joseph YC Leung

    2011-02-01

    Full Text Available Joseph YC Leung1, Lester AH Critchley1, Alex LK Yung2, Shekhar M Kumta21Department of Anaesthesia and Intensive Care, 2Department of Traumatology and Orthopaedics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong KongAbstract: e-Learning has revolutionized the way in which undergraduate medical education is delivered. One e-learning tool of note is the virtual patient (VP, a type of computer software that simulates real-life clinical scenarios, in which the learner emulates the role of health care provider to obtain the history, conduct examination, and make diagnoses and management decisions. VPs have been in use since 1993. Early designs were based on serial screen-cards of patient history, examination, investigations, diagnoses, treatment, and outcome, which the learner explored. With the development of web technology, VPs can now be accessed via the Internet and are more versatile, supporting different structural designs to suit a variety of learning objectives, and they can branch via different routes through a case. Using VPs has a number of advantages: 1 VPs improve access to learning material, 2 VPs help learners to acquire higher order cognitive skills like strategic thinking and decision making, 3 VPs provide a safe environment to practice, 4 VPs help to teach interdisciplinary care, and 5 VPs can be used instead of patients for examination. A number of well-known VP player systems are in use today: CASUS, CAMPUS, web-based Simulation of Patients, OpenLabyrinth, and vpSim. At the Chinese University of Hong Kong, we have also developed a web-based VP authoring and player system called Formative Assessment Case Studies (FACS, which is run by our Teaching and Learning Resources Centre. FACS has been integrated into Year-5 Anesthesia teaching since 2006. Three VP products have been developed: Anaesthesia FACS (six cases that teaches preoperative assessment, Acute Pain Management FACS, and an

  16. Postoperative rhabdomyolysis following pars-plana vitrectomy under general anesthesia

    Directory of Open Access Journals (Sweden)

    Campbell JP

    2013-08-01

    Full Text Available John P Campbell,1 Cobin Soelberg,2 Andreas K Lauer11Retina Division, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA; 2Division of Anesthesiology, Oregon Health and Science University, Portland, OR, USAImportance: Rhabdomyolysis is a known, but rare, complication of general anesthesia. To the authors' knowledge, it has never before been reported following an ocular surgery, and we could find no similar cases in the surgical literature following any brief surgical procedure. We believe this case to be unique in those regards and aim to raise awareness among ophthalmologists of this postoperative complication, as timely intervention can prevent renal failure and death.Observations: We report the case of a 58-year-old male who developed rhabdomyolysis following vitrectomy for retinal detachment repair under general anesthesia. The patient had several risk factors for this complication including morbid obesity, type II diabetes mellitus, and American Society of Anesthesia class III risk profile. His postoperative course was notable for significant myalgias in the postoperative recovery area, followed several hours later by oliguria, "root beer" colored urine, and a markedly elevated creatinine kinase level. He was hospitalized for two days for intravenous hydration and monitoring of his renal function and has fully recovered.Relevance: As the prevalence of obesity and type II diabetes mellitus increase worldwide, ophthalmologists need to be aware of the signs and symptoms of postoperative rhabdomyolysis. Treatment often requires inpatient hospitalization to prevent the associated morbidity and mortality.Keywords: rhabdomyolysis, general anesthesia, vitrectomy, retinal detachment, obesity, diabetes

  17. 我院门诊2007-2011年中成药应用分析%Analysis of the Utilization of Chinese Patent Medicines in Outpatient Department in Our Hospital during 2007-2011

    Institute of Scientific and Technical Information of China (English)

    张碧华; 穆林; 金鹏飞; 蔡小兵

    2012-01-01

    目的:为临床合理用药提供参考.方法:对我院门诊中成药的销售金额及构成比、用药频度和科室用药分布情况进行统计分析.结果:我院门诊中成药的种类连续性较好,各类药销售金额及构成比相对固定,同时在临床各科室的用药集中度相对较低.结论:我院在用药品种的选择上基本能够满足临床需求,同时也兼顾了患者的经济承受能力,注重合理用药,保障了临床用药的安全、有效和经济.%OBJECTIVE: To analyze clinical utilization of Chinese patent medicines in outpatient department of our hospital during 2007-2011,and to provide reference for clinical rational drug use. METHODS: The utilization of Chinese patent medicines in outpatient department of our hospital was analyzed statistically in respect of consumption sum, constituent ratio, DDDs and departments distribution of drug use. RESULTS: The category continuity of Chinese patent medicines in outpatient department was fairly good. The consumption sum and constituent ratio for various drugs were relatively fixed, the concentration ratio of drug use were lower in clinical departments. CONCLUSIONS: The type selection of Chinese patent medicines in hospital meet the requirement of clinical treatments, and also need to consider the afford ability of patients and rational drug use so as to guarantee safe, effective and economical drug in the clinic.

  18. 我院临床科室药品管理与针对性药学服务实践%Practice of Drug Management and Targeting Pharmaceutical Care in Clinical Department of Our Hospital

    Institute of Scientific and Technical Information of China (English)

    彭其胜; 易晓玲; 王柏桉; 陈昆陵

    2013-01-01

    OBJECTIVE:To promote the standardization of drug management in clinical department of our hospital,and to guarantee the safety of clinical drug use.METHODS:The situation of drug management in clinical department of our hospital was investigated by on-site inspection.Pharmacy department provided various pharmaceutical care for nurses according to the existing problem.RESULTS & CONCLUSIONS:The drug management is standard relatively in clinical departments of our hospital.There is hidden trouble for drug storage.Pharmacy department intervenes in drug management by developing knowledge training,on-site explanation and demonstration,etc.Related pharmacological knowledge and drug safety consciousness of nurses are also improved,and the risk factors of drug use are reduced.%目的:促进我院临床科室药品管理规范,保障临床用药安全.方法:以现场检查方式了解我院临床科室药品管理现状,对发现的问题,药剂科开展针对护理人员的多方面的药学服务.结果与结论:我院临床各科室药品管理较为规范,但在存放药品上存在安全隐患.药剂科通过对护理人员开展知识培训、现场讲解及演示等药学服务进行了干预,增加了护理人员的相关药学知识及药品安全意识,减少了药品使用的不安全因素.

  19. A Narrative Review of Meaningful Use and Anesthesia Information Management Systems.

    Science.gov (United States)

    Gálvez, Jorge A; Rothman, Brian S; Doyle, Christine A; Morgan, Sherry; Simpao, Allan F; Rehman, Mohamed A

    2015-09-01

    The US federal government has enacted legislation for a federal incentive program for health care providers and hospitals to implement electronic health records. The primary goal of the Meaningful Use (MU) program is to drive adoption of electronic health records nationwide and set the stage to monitor and guide efforts to improve population health and outcomes. The MU program provides incentives for the adoption and use of electronic health record technology and, in some cases, penalties for hospitals or providers not using the technology. The MU program is administrated by the Department of Health and Human Services and is divided into 3 stages that include specific reporting and compliance metrics. The rationale is that increased use of electronic health records will improve the process of delivering care at the individual level by improving the communication and allow for tracking population health and quality improvement metrics at a national level in the long run. The goal of this narrative review is to describe the MU program as it applies to anesthesiologists in the United States. This narrative review will discuss how anesthesiologists can meet the eligible provider reporting criteria of MU by applying anesthesia information management systems (AIMS) in various contexts in the United States. Subsequently, AIMS will be described in the context of MU criteria. This narrative literature review also will evaluate the evidence supporting the electronic health record technology in the operating room, including AIMS, independent of certification requirements for the electronic health record technology under MU in the United States.

  20. Construction of Intelligent Paging Queue System in Hospital Outpatient Department%医院门诊智能寻呼排队系统的构建

    Institute of Scientific and Technical Information of China (English)

    朱莉

    2012-01-01

    To create a fair, reasonable and effective outpatient environment, to establish accurate waiting for medical treatment channel, through the China Mobile Group paging feature, combined with the hospital information system (HIS), hospital outpatient intelligent paging queuing system. The system uses treatment business processes to achieve real-time hospital outpatient management, fast and smooth, improve service efficiency, improve the hospital window image.%为营造公平、合理、有效的门诊就诊环境,建立精确候诊就医通道,通过中国移动集团寻呼功能,结合医院信息系统(HIS),建立了医院门诊智能寻呼排队系统.该系统利用就诊业务流程实现了医院门诊管理的实时、快捷和通畅,提高了服务效率,提升了医院良好的窗口服务形象.

  1. The elderly and general anesthesia

    DEFF Research Database (Denmark)

    Steinmetz, J; Rasmussen, L S

    2010-01-01

    Due to the aging population, the number of elderly patients taking advantage of healthcare services is increasing. A general physical decline of all organ systems and a high frequency of chronic disease accompanying aging.Comorbidity and polypharmacy are therefore common in the elderly. Hence, th......, the administration of general anesthesia to the elderly can be a very challenging task. This paper aims to highlight some of the important issues presented to the elderly undergoing surgery and to suggest some strategies for management....

  2. [Emergencies evolving from local anesthesia].

    Science.gov (United States)

    Kaufman, E; Garfunkel, A; Findler, M; Elad, S; Zusman, S P; Malamed, S F; Galili, D

    2002-01-01

    Local anesthesia is without doubt the most frequently used drug in dentistry and in medicine. In spite of records of safety set by using these drugs, there is evidence to adverse reactions ranging from 2.5%-11%. Most of the reactions originate from the autonomic system. A recent, well-planned study indicates that adverse reactions are highly correlated to the medical status of the patient: the higher the medical risk, the greater the chance to experience an adverse reaction. This study also found that adverse reactions highly correlated to the concentration of adrenalin. Another recent study found a direct relationship between adverse reactions and the level of anxiety experienced by the patient and to the dental procedure. Most of the reactions in this study occurred either immediately at injection time and within 2 hours following the injection. Since the beginning of last century, vasoconstrictors have been added to local anesthesia solutions in order to reduce toxicity and prologue activity of the LA. However, today it is commonly agreed that this addition to local anesthesia should not be administered to cardiac patients especially those suffering from refractory dysrhythmias, angina pectoris, post myocardial infarction (6 months) and uncontrolled hypertension. Other contraindications to vasoconstrictors are endocrine disorders such as hyperthyroidism, hyperfunction of the medullary adrenal (pheochromocytoma) and uncontrolled diabetes mellitus. Cross reactivity of local anesthetic solutions can occur with MAO inhibitors, non specific beta adrenergic blockers, tricyclic antidepressants, phenothiazides and cocaine abusers. Noradrenaline added to local anesthetics as a vasoconstrictor has been described as a trigger to a great increase in blood pressure and therefore has been forbidden for use in many countries. This paper describes 4 cases of severe complications following the injections of local anesthesia of which three ended in fatality.

  3. Acupuncture in ambulatory anesthesia: a review

    Directory of Open Access Journals (Sweden)

    Norheim AJ

    2015-09-01

    Full Text Available Arne Johan Norheim,1 Ingrid Liodden,1 Terje Alræk1,2 1National Research Center in Complementary and Alternative Medicine (NAFKAM, Department of Community Medicine, Faculty of Health Sciences, University of Tromsø – The Arctic University of Norway, Tromsø, 2The Norwegian School of Health Sciences, Institute of Acupuncture, Kristiania University College, Oslo, NorwayBackground: Post-anesthetic morbidities remain challenging in our daily practice of anesthesia. Meta-analyses and reviews of acupuncture and related techniques for postoperative nausea and vomiting (POVN and postoperative vomiting (POV show promising results while many clinicians remain skeptical of the value of acupuncture. Given the interest in finding safe non-pharmacological approaches toward postoperative care, this body of knowledge needs to be considered. This review critically appraises and summarizes the research on acupuncture and acupressure in ambulatory anesthesia during the last 15 years.Methods: Articles were identified through searches of Medline, PubMed, and Embase using the search terms “acupuncture” or “acupuncture therapy” in combination with “ambulatory anesthesia” or “ambulatory surgery” or “day surgery” or “postoperative”. A corresponding search was done using “acupressure” and “wristbands”. The searches generated a total of 104, 118, and 122 references, respectively.Results: Sixteen studies were included; eight studies reported on acupuncture and eight on acupressure. Nine studies found acupuncture or acupressure effective on primary endpoints including postoperative nausea and vomiting, postoperative pain, sore throat, and emergence agitation. Four studies found acupuncture had a similar effect to antiemetic medication.Conclusion: Overall, the studies were of fairly good quality. A large proportion of the reviewed papers highlights an effect of acupuncture or acupressure on postoperative morbidities in an ambulatory setting

  4. [Anesthesia in ophthalmology (author's transl)].

    Science.gov (United States)

    Gemperlé, M

    1977-02-01

    General anesthesia in ophthalmological surgery has become a great fashion. However there are still many problems especially in intraocular surgery. The eye with normal intraocular pressure generally needs no special technique. Most of the usual anesthesia produce a slight hypotonia with the exception of Succinylcholine, whose effect is contrary. Unfortunately this is not the case in eyes with pathologically increased intraocular pressure as in the different forms of glaucoma. Eye surgeons and anesthesists therefore look for solutions to this problem which in principle consist in the application of medicaments, which not seldom are rather agressive. The controlled hypotension by ganglion blockers, the curarisation in the state of being awake, the rapid perfusion of solutions with high osmotique effect (isolated or associated) represent such measures. The one has the disadvantage to be applied during so-called subvigile anesthesias where the security that the patient is asleep is rather doubtful; the other has the disadvantage that it requires a rapid perfusion of solutions with highly osmotic effect. It goes without saying that these conditions represent risks especially if one considers that the candidates for this type of intervention very often are senile persons with prearious cardiovascular equilibrium, with insufficient renal function and with insufficient arterial cerebral circulation. These are some of the problems which are to be discussed.

  5. Neuropathological research at the "Deutsche Forschungsanstalt fuer Psychiatrie" (German Institute for Psychiatric Research) in Munich (Kaiser-Wilhelm-Institute). Scientific utilization of children's organs from the "Kinderfachabteilungen" (Children's Special Departments) at Bavarian State Hospitals.

    Science.gov (United States)

    Steger, Florian

    2006-09-01

    During National Socialism, the politically motivated interest in psychiatric genetic research lead to the founding of research departments specialized in pathological-anatomical brain research, the two Kaiser Wilhelm-Institutes (KWI) in Berlin and Munich. The latter was indirectly provided with brain material by Bavarian State Hospitals, to three of which "Kinderfachabteilungen" (Special Pediatric Units) were affiliated. As children became victims of the systematically conducted child "euthanasia" in these Special Pediatric Units, this paper will address the question whether and to which extent the organs from victims of child "euthanasia" were used for (neuro-) pathological research at the KWI in Munich. By means of case studies and medical histories (with focus on the situation in Kaufbeuren-Irsee), I will argue that pediatric departments on a regular base delivered slide preparations, that the child "euthanasia" conduced in these departments systematically contributed to neuropathological research and that slide preparations from victims of child "euthanasia" were used in scientific publications after 1945.

  6. Laryngeal mask airway and endotracheal tube: odynophagia and dysfhonia incidence under general anesthesia at the University Hospital San Vicente de Paúl, Medellín, 2000 Máscara laríngea y tubo endotraqueal: incidencia de odinogagia y disfonía por su uso en anestesia general en el Hospital Universitario San Vicente de Paúl, Medellín, 2000

    Directory of Open Access Journals (Sweden)

    Mónica del Rosario Guzmán Carazo

    2001-03-01

    Full Text Available We describe the odynophagia and dysphonia incidence after the use of either laryngeal mask (LM or endotracheal tube (ETT in adult patients submitted to elective surgery, under general anesthesia, at the University Hospital San Vicente of Paul, Medellín, Colombia, between February 14 and March 16 of 2000. A descriptive and prospective study was carried out in 63 patients, in which the global incidence of odynophagia was 15.9% and that of dysphonia 12.5%; there was a higher odynophagia incidence with the use of ETT, 37.5%, than with LM, 2.6%. The dysphonia incidence was also higher with the use of the TET (25% than with LM (5.1%. The odynophagia incidence was higher in women (19.1% than in men (6.2%. Dysphonia was also more frequent in women (14.8% than in men (6.2%. Accordingly, we can conclude that odynophagia and dysphonia incidences are lower in men, when the time of anesthesia is two hours or less and when LM is used. More studies are necessary to carry out a comparative analysis of the complications with the use of LM and ETT, in order to offer the safest and more effective technique for insuring the airway. Se describe la incidencia de odinofagia y disfonía después del uso de la máscara laríngea (ML o del tubo endotraqueal (TET en pacientes adultos sometidos a cirugía electiva, bajo anestesia general, en el Hospital Universitario San Vicente de Paúl, de Medellín, entre febrero y marzo de 2000. Se hizo un estudio descriptivo, prospectivo, de corte transversal, en 63 pacientes, en los cuales se encontró una incidencia global de odinofagia del 15.9% y de disfonía del 12.5%. Hubo una mayor incidencia de odinofagia con el uso del TET, 37.5%, que con la ML, 2.6%. La incidencia de disfonía también fue mayor con el uso del TET (25% que con la ML (5.1%. La incidencia de odinofagia fue mayor en las mujeres (19.1% que en los hombres (6.2%. La disfonía también fue más frecuente en mujeres (14.8% que en hombres (6.2%. De acuerdo con los

  7. SPLIT SKIN GRAFT HARVESTING UNDER LOCAL ANESTHESIA INFILTRATION VERSUS TOPICAL LOCAL ANESTHESIA

    Directory of Open Access Journals (Sweden)

    Shahi

    2014-04-01

    Full Text Available OBJECTIVE: To compare the effectiveness of topical local anesthesia using PRILOX cream versus local anesthesia infiltration using lignocaine and adrenaline in harvesting split skin graft. METHODS: A prospective study of 58 patients requiring split skin graft was carried. One group comprising 29 patients underwent harvesting of split skin graft under topical local anesthesia using PRILOX cream while the other group had local anesthesia infiltration using lignocaine and adrenaline. RESULTS: There were no significant differences between the 2 groups in terms of operating time, per operative pain, post-operative pain and post-operative requirement of analgesia. There was significant difference in time and pain during administration of local anesthesia and patient’s acceptability/ satisfaction with method of anesthesia. CONCLUSION: Topical local anesthesia using PRILOX cream can be used effectively for harvesting of split skin graft and is good alternative to local anesthesia infiltration.

  8. Sedation in hypoalbuminemic geriatric patients under spinal anesthesia in hip surgery

    Science.gov (United States)

    Ersoy, Ayşın; Kara, Deniz; Ervatan, Zekeriya; Çakırgöz, Mensure; Kıran, Özlem

    2015-01-01

    Objectives: To compare midazolam and propofol sedation in hypoalbuminemic geriatric patients under spinal anesthesia in hip surgery with bispectral index monitoring. Methods: This prospective and randomized study was completed in the Department of Anesthesiology, Okmeydani Training and Research Hospital, Istanbul, Turkey between February 2013 and December 2014. Sixty patients undergoing elective hip surgery under spinal anesthesia in the geriatric age group with albumin levels below 3 g/dl were randomly divided into Group I and Group II. After administration of spinal block, Group I were given 0.05 mg/kg bolus midazolam, and then 0.02-0.1 mg/kg/hr dose infusion was begun. In Group II, 1 mg/kg bolus propofol was given within 10 minutes, and then 1-3 mg/kg/hr infusion was begun. The systolic arterial pressure, diastolic arterial pressure, mean arterial pressure, heart rate, peripheral oxygen saturation values, respiratory rate, and Wilson’s 5-stage sedation score were recorded at 15-minute intervals. At the end of the operation, the recovery time and surgeon satisfaction were recorded. Results: The recovery times for patients in Group I were found to be longer than in Group II (p<0.05). The respiration rate in patients in Group I at the start of surgery, 15th minute of surgery, and after surgery were lower than in Group II (p<0.05). Conclusion: We conclude that propofol is more reliable in terms of hemodynamic stability than midazolam, as it causes less respiratory depression and faster recovery in the propofol group. PMID:26446330

  9. Analysis of 207 Cases of Medication Errors in Outpatient Department of Our Hospital%我院门诊207例用药错误分析

    Institute of Scientific and Technical Information of China (English)

    王璐; 董艳; 李彤; 周庆梅; 杜广清

    2016-01-01

    目的:为临床合理用药提供参考。方法:对我院2014年10月-2015年9月门诊药房报告的用药错误(ME)案例进行分析,包括ME分级、分类、发生原因、发生和发现ME的人员情况及构成比。结果:207例报告中无A级错误,B级错误199例,C级错误8例,无D~I级错误。其中,医师处方错误162例(78.26%),药师调剂错误45例(21.74%),排名前3位的医师处方错误依次为用法用量不当(42.59%)、给药途径不当(40.74%)和溶剂不适宜(5.56%);排名前3位的药师调剂错误依次为品种错误(40.00%)、规格错误(28.89%)和数量错误(24.44%)。医师处方错误的原因主要是信息系统不完善(56.17%)和医师不了解药物信息(43.83%);药师调剂错误的主要原因是药品一品多规(35.56%)、名称相似(28.89%)和人员疲劳(26.67%)。发现ME的人员中,药师、护士和患者或家属占比分别为97.58%、1.45%和0.97%。结论:进一步加强医院信息化建设,同时加强医师和药师的在岗培训,可以在一定程度上减少ME的发生。%OBJECTIVE:To provide reference for clinical rational drug use. METHODS:Medication error(ME)cases report-ed from outpatient department from Oct. 2014 to Sept. 2015 in our hospital were analyzed,including ME category,classification, cause and proportion of persons who triggered or detected ME. RESULTS:Among 207 reports,there was no case of category A, 199 cases of category B,8 cases of category C,no of categories D-I. Among them,162 cases occurred in the links of prescrip-tions by doctors (78.26%),45 cases (21.74%) occurred in the links of dispensing prescriptions by pharmacists,the top 3 ME were improper usage(42.59%),improper administration route(40.74%)and inappropriate solvent(5.56%);the top 3 dispensing errors were variety error(40.00%),specification error(28.89%)and number errors(24.44%). The main

  10. Medical evaluation abnormalities in acute psychotic patients seen at the emergency department of Muhimbili national hospital in Dar es Salaam, Tanzania

    OpenAIRE

    S.G. Yusuf*; M.S. Runyon; V. Mwafongo; T.A. Reynolds

    2013-01-01

    Prior studies have shown varied rates of medical pathology in patients presenting to acute care settings with psychotic symptoms, and there is almost no literature from the sub-Saharan Africa region. We investigated the yield of physical examination and laboratory testing among patients presenting with acute psychosis to an urban ED in Dar es Salaam. Methods: This was a prospective observational study of patients presenting to the ED at Muhimbili National Hospital with acute psychosis. A s...

  11. 局麻与硬膜外麻醉腹股沟疝修补术的临床对比研究%Local anesthesia and epidural anesthesia clinical comparative study of inguinal hernia repair

    Institute of Scientific and Technical Information of China (English)

    郑欣; 王宝

    2014-01-01

    目的:探讨局麻和硬膜外麻醉下行无张力疝修补术的疗效。方法:选择海盐县人民医院2010年12月到2011年12月所实施的无张力疝修补术患者60例,其中局麻组30例,硬膜外麻醉组30例。结果:局麻组患者在术后疼痛程度,术后住院天数以及平均住院费用都优于硬膜外麻醉组,而平均手术时间及术后并发症无显著差异。结论:局麻下无张力疝修补术简便易行,疗效肯定,术后疼痛轻,住院费用低,值得在临床上推广,尤其在基层医院。%Objective:to study the anesthesia and epidural anesthesia downlink without tension hernia repair effect.Methods:choice of haiyan county peo-ple's hospital in December 2010 to December 2011,the implementation of 60 patients with without tension hernia repair,30 cases with local anesthesia group,epidural anesthesia group 30 cases.Results:local anesthesia group of patients in postoperative pain,postoperative hospitalization days and average hospitalization expenses were better than epidural anesthesia group,while the average operation time and postoperative complications had no significant difference.Conclusion:easy without tension hernia repair under local anesthesia,curative effect,light postoperative pain,hospitalization expense is low,is worth popularizing in clinic,especially in basic-level hospitals.

  12. 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...

  13. HCAHPS Hospital Survey

    Data.gov (United States)

    U.S. Department of Health & Human Services — Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Hospital Survey The intent of the HCAHPS initiative is to provide a standardized survey...

  14. Articaine and lidocaine for maxillary infiltration anesthesia.

    Science.gov (United States)

    Vähätalo, K.; Antila, H.; Lehtinen, R.

    1993-01-01

    This study was undertaken to compare the anesthetic properties of articaine hydrochloride with 1:200,000 epinephrine (Ultracain DS) and lidocaine with 1:80,000 epinephrine (Xylocain-Adrenalin) for maxillary infiltration anesthesia. Twenty healthy dental student volunteers were included in this double-blind study. Each subject received 0.6 mL of each test solution at different times. Infiltration anesthesia was performed on the upper lateral incisor. The onset and duration of anesthesia were monitored using an electric pulp tester. No statistically significant differences were seen in the onset and duration of anesthesia between the articaine and lidocaine solutions. PMID:7943919

  15. Fully Automated Anesthesia, Analgesia and Fluid Management

    Science.gov (United States)

    2016-09-05

    General Anesthetic Drug Overdose; Adverse Effect of Intravenous Anesthetics, Sequela; Complication of Anesthesia; Drug Delivery System Malfunction; Hemodynamic Instability; Underdosing of Other General Anesthetics

  16. Paperless anesthesia: uses and abuses of these data.

    Science.gov (United States)

    Anderson, Brian J; Merry, Alan F

    2015-12-01

    Demonstrably accurate records facilitate clinical decision making, improve patient safety, provide better defense against frivolous lawsuits, and enable better medical policy decisions. Anesthesia Information Management Systems (AIMS) have the potential to improve on the accuracy and reliability of handwritten records. Interfaces with electronic recording systems within the hospital or wider community allow correlation of anesthesia relevant data with biochemistry laboratory results, billing sections, radiological units, pharmacy, earlier patient records, and other systems. Electronic storage of large and accurate datasets has lent itself to quality assurance, enhancement of patient safety, research, cost containment, scheduling, anesthesia training initiatives, and has even stimulated organizational change. The time for record making may be increased by AIMS, but in some cases has been reduced. The question of impact on vigilance is not entirely settled, but substantial negative effects seem to be unlikely. The usefulness of these large databases depends on the accuracy of data and they may be incorrect or incomplete. Consequent biases are threats to the validity of research results. Data mining of biomedical databases makes it easier for individuals with political, social, or economic agendas to generate misleading research findings for the purpose of manipulating public opinion and swaying policymakers. There remains a fear that accessibility of data may have undesirable regulatory or legal consequences. Increasing regulation of treatment options during the perioperative period through regulated policies could reduce autonomy for clinicians. These fears are as yet unsubstantiated.

  17. Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Organ Procurement Organization Reporting and Communication; Transplant Outcome Measures and Documentation Requirements; Electronic Health Record (EHR) Incentive Programs; Payment to Nonexcepted Off-Campus Provider-Based Department of a Hospital; Hospital Value-Based Purchasing (VBP) Program; Establishment of Payment Rates Under the Medicare Physician Fee Schedule for Nonexcepted Items and Services Furnished by an Off-Campus Provider-Based Department of a Hospital. Final rule with comment period and interim final rule with comment period.

    Science.gov (United States)

    2016-11-14

    This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2017 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program. Further, in this final rule with comment period, we are making changes to tolerance thresholds for clinical outcomes for solid organ transplant programs; to Organ Procurement Organizations (OPOs) definitions, outcome measures, and organ transport documentation; and to the Medicare and Medicaid Electronic Health Record Incentive Programs. We also are removing the HCAHPS Pain Management dimension from the Hospital Value-Based Purchasing (VBP) Program. In addition, we are implementing section 603 of the Bipartisan Budget Act of 2015 relating to payment for certain items and services furnished by certain off-campus provider-based departments of a provider. In this document, we also are issuing an interim final rule with comment period to establish the Medicare Physician Fee Schedule payment rates for the nonexcepted items and services billed by a nonexcepted off-campus provider-based department of a hospital in accordance with the provisions of section 603.

  18. [Use of general anesthesia during fiber colonoscopy in cancer patients].

    Science.gov (United States)

    Zamiralova, O Ia; Shcherbakov, A M; Evtiukhin, A I

    2002-01-01

    The evidence on the attitude of 60 cancer out-patients to fibrocolonoscopy carried out under general anesthesia was evaluated versus different procedures of intravenous injection. Most patients were scared prior to examination; 83.3% felt sleepy during the procedure while 85% of those anesthetized wouldn't mind receiving narcosis for repeat examination. Propofol (diprivan) alone showed an advantage over midazolam (dormicum) in being more tolerable and cutting stay at hospital by a third. Ketamin proved undesirable due to psychomimetic effects and delayed regaining of consciousness.

  19. General anesthesia for the heaviest man in the world

    Directory of Open Access Journals (Sweden)

    Abdullah S Terkawi

    2014-01-01

    Full Text Available The prevalence of obesity has increased greatly over the last 20 years, resulting in an increase in the number of bariatric and nonbariatric surgeries in this population. We present the case of a 20-year-old male, weighing 610 kg (1345 lb, and believed to be the heaviest living man in the world. After 4 months of rigorous in-hospital weight reduction, now weighing 510 kg (1125 lb, he underwent a laparoscopic gastric sleeve procedure under general anesthesia. This report describes the management of his anesthetic and exemplifies the challenges associated with this patient population.

  20. 硬膜外腔小剂量罗哌卡因用于高龄高危患者骨科下肢手术麻醉分析%Effect of small dose of epidural anesthesia with ropivacaine on high-risk elderly patients with operation of lower limb in department of orthopedics

    Institute of Scientific and Technical Information of China (English)

    张继晨

    2016-01-01

    Objective TO investiGate tHe effect Of smaLL dOse Of epiduraL anestHesia WitH rOpivacaine On HiGH-risK eLderLy patients WitH OperatiOn Of LOWer Limb in department Of OrtHOpedics. Methods FrOm September 2012 tO NOvember 2014,tHe cLinicaL data Of 210 HiGH-risK eLderLy patients WitH OperatiOn Of LOWer Limb Were retrOspectiveLy anaLyzed. Results THe anestHesia effect Of LOWer Limb surGery in HiGH-risK eLderLy patients Of 0. 75% rOpivacaine Were better tHan tHat Of 0. 894% rOpivacaine and 0. 6% rOpivacaine,incLudinG tHe LenGtH Of time Of Onset Of anestHesia,tHe resistance mOvement LaG time,sensOry bLOcK time,BrOmaGe scOre,tHere Were siGnificant differences(P﹤0. 05). 0. 75% rOpivacaine GrOup Of LOWer Limb OrtHOpedic surGery Was superiOr tO 0. 894% rOpivacaine GrOup and 0. 6% rOpivacaine GrOup in DBP, HR,SPO2 ,SBP durinG anestHesia,tHere Were siGnificant differences( P﹤0. 05). Conclusions EpiduraL 0. 75% rOpiva-caine Has siGnificant effect On HiGH-risK eLderLy patients WitH OperatiOn Of LOWer Limb in department Of OrtHOpedics,and pLays a cruciaL rOLe On tHe deveLOpment Of epiduraL anestHesia,WitH far-reacHinG cLinicaL siGnificance,sO it is WOrtHy Of cLinicaL triaLs and prOmOtiOn.%目的:探讨硬膜外腔小剂量罗哌卡因用于高龄高危患者骨科下肢手术麻醉的临床效果。方法选取2012年9月至2014年11月收治的210例高龄高危下肢手术患者,对其临床资料进行系统的回顾分析。结果0.75%罗哌卡因组的高龄高危患者骨科下肢手术麻醉效果在多方面均优于0.894%罗哌卡因组和0.6%罗哌卡因组,包括麻醉起效时长、运动阻滞时间、感觉阻滞时间、BrOmaGe评分,组间比较差异有统计学意义(P﹤0.05)。0.75%罗哌卡因组骨科下肢手术麻醉的舒张压(DBP)、心率(HR)、脉搏血氧饱和度( SPO2)、收缩压( SBP)、BrOmaGe评分与0.894%罗哌卡因、0.6%罗哌卡因组相比具有明显的优势,组间比较差异有统计学意义( P﹤0

  1. The Role and Function of Department Director in the Private Hospital Management%科主任在民营医院管理中的地位和作用

    Institute of Scientific and Technical Information of China (English)

    唐伟; 管伟立

    2014-01-01

    This article discusses the role and function of director in Department of Psychiatry in private hospitals and how they could do to coordinate the relationship between hospital and their ward, ensure medical wards security, coordinate all kinds of personnel in the department, increase revenue as well as cut down cost in the competitive medical market so as to make the department operate efficiently within the existing health care system.%本文论述了在医疗市场竞争条件下,民营精神病院科主任的地位、作用,以及如何协调好医院和病区的关系,如何做好病区医疗安全防范。协调好科室各类人员,做好增收节支,使一个科室能够在现有的医疗体制下高速并有效地运转。

  2. 精神专科医院外科住院患者精神病共病现状分析%Status analysis on psychiatric comorbidity of inpatients from surgery department of psychiatric hospitals

    Institute of Scientific and Technical Information of China (English)

    沈萍; 沈仲夏; 徐美英; 陈海勤; 金莉; 陈海支

    2012-01-01

    目的 分析精神专科医院外科住院患者精神病共病的流行病学情况及特征.方法外科住院患者791例,对其中共患精神病者进行统计学分析.结果 791例患者中共患精神病59例,精神病前3位分别为精神分裂症、抑郁症、神经症;外科疾病前3位分别为骨折、脑外伤、肠梗阻.结论 精神专科医院外科住院患者精神病共病比例高,共患疾病有相关性.%Objective To study the cpidcmiological status and characteristics on psychiatric comorbidity of inpatients from surgery department of psychiatric hospitals. Method Take statistic analysis on patients with psychiatric comorbidity from 791 inpatients from surgery department. Result There arc 59 psychiatric comorbidity patients from 791 patients. The first three of psychosis arc schizophrenia, depression and neurosis and the first three surgical diseases arc fracture, brain injury and intestinal obstruction. Conclusion There is a high level of psychiatric comorbidity among inpatients from surgery department of psychiatric hospitals. There is correlation between comorbidity diseases.

  3. A STUDY OF PRESCRIBING PATTERN OF NON STEROIDAL ANTI INFLAMMATORY DRUGS IN ORTHOPEDIC OUT PATIENT DEPARTMENT AT A TERTIARY CARE HOSPITAL

    OpenAIRE

    Asha Latha; Srinivasu; Ananda Babu Naik; Jaya Chandra

    2015-01-01

    AIM: To determine the pattern of NON STEROIDAL ANTI INFLAMMATORY DRUGS prescribing for arthritic and non - arthritic conditions in orthopedic outpatient department . METHODOLOGY: 100 prescription duplicate collected and analyzed prospectively for the pattern of NSAID prescription for arthritic and non - arthritic conditions; the drug formulation , route , frequency, duration of adm issio n and concomitant medications results. NSAID were...

  4. Development and Evaluation of Educational Materials for Pre-Hospital and Emergency Department Personnel on the Care of Patients with Autism Spectrum Disorder

    Science.gov (United States)

    McGonigle, John J.; Migyanka, Joann M.; Glor-Scheib, Susan J.; Cramer, Ryan; Fratangeli, Jeffrey J.; Hegde, Gajanan G.; Shang, Jennifer; Venkat, Arvind

    2014-01-01

    With the rising prevalence of patients with autism spectrum disorder (ASD), there has been an increase in the acute presentation of these individuals to the general health care system. Emergency medical services and emergency department personnel commonly address the health care needs of patients with ASD at times of crisis. Unfortunately, there…

  5. Apnea after Awake Regional and General Anesthesia in Infants : The General Anesthesia Compared to Spinal Anesthesia Study-Comparing Apnea and Neurodevelopmental Outcomes, a Randomized Controlled Trial

    NARCIS (Netherlands)

    Davidson, Andrew J.; Morton, Neil S.; Arnup, Sarah J.; De Graaff, Jurgen C.; Disma, Nicola; Withington, Davinia E.; Frawley, Geoff; Hunt, Rodney W.; Hardy, Pollyanna; Khotcholava, Magda; Von Ungern Sternberg, Britta S.; Wilton, Niall; Tuo, Pietro; Salvo, Ida; Ormond, Gillian; Stargatt, Robyn; Locatelli, Bruno Guido; McCann, Mary Ellen; Lee, Katherine; Sheppard, Suzette; Hartmann, Penelope; Ragg, Philip; Backstrom, Marie; Costi, David; Von Ungern-Sternberg, Britta S.; Knottenbelt, Graham; Montobbio, Giovanni; Mameli, Leila; Giribaldi, Gaia; Prato, Alessio Pini; Mattioli, Girolamo; Wolfler, Andrea; Izzo, Francesca; Sonzogni, Valter; Van Gool, Jose T D G; Numan, Sandra C.; Kalkman, Cor J.; Hagenaars, J. H M; Absalom, Anthony R.; Hoekstra, Frouckje M.; Volkers, Martin J.; Furue, Koto; Gaudreault, Josee; Berde, Charles; Soriano, Sulpicio; Young, Vanessa; Sethna, Navil; Kovatsis, Pete; Cravero, Joseph P.; Bellinger, David; Marmor, Jacki; Lynn, Anne; Ivanova, Iskra; Hunyady, Agnes; Verma, Shilpa; Polaner, David; Thomas, Joss; Meuller, Martin; Haret, Denisa; Szmuk, Peter; Steiner, Jeffery; Kravitz, Brian; Suresh, Santhanam; Hays, Stephen R.; Taenzer, Andreas H.; Maxwell, Lynne G.; Williams, Robert K.; Bell, Graham T.; Dorris, Liam; Adey, Claire; Bagshaw, Oliver; Chisakuta, Anthony; Eissa, Ayman; Stoddart, Peter; Davis, Annette; Myles, Paul; Wolf, Andy; McIntosh, Neil; Carlin, John; Leslie, Kate; De Lima, Jonathan; Hammer, Greg; Field, David; Gebski, Val; Tibboel, Dick

    2015-01-01

    Background: Postoperative apnea is a complication in young infants. Awake regional anesthesia (RA) may reduce the risk; however, the evidence is weak. The General Anesthesia compared to Spinal anesthesia study is a randomized, controlled trial designed to assess the influence of general anesthesia (

  6. Apnea after Awake Regional and General Anesthesia in Infants : The General Anesthesia Compared to Spinal Anesthesia Study-Comparing Apnea and Neurodevelopmental Outcomes, a Randomized Controlled Trial

    NARCIS (Netherlands)

    Davidson, Andrew J; Morton, Neil S; Arnup, Sarah J; de Graaff, Jurgen C; Disma, Nicola; Withington, Davinia E; Frawley, Geoff; Hunt, Rodney W; Hardy, Pollyanna; Khotcholava, Magda; von Ungern Sternberg, Britta S; Wilton, Niall; Tuo, Pietro; Salvo, Ida; Ormond, Gillian; Stargatt, Robyn; Locatelli, Bruno Guido; McCann, Mary Ellen; Absalom, Anthony

    2015-01-01

    BACKGROUND: Postoperative apnea is a complication in young infants. Awake regional anesthesia (RA) may reduce the risk; however, the evidence is weak. The General Anesthesia compared to Spinal anesthesia study is a randomized, controlled trial designed to assess the influence of general anesthesia (

  7. Papel de la dirección médica en el encaje de urgencias en el hospital The role of medical management in the involvement of the emergency department in the hospital

    Directory of Open Access Journals (Sweden)

    A. Salazar

    2010-01-01

    Full Text Available La reordenación funcional y estructural del servicio de urgencias es un objetivo prioritario de los órganos directivos de cualquier centro. La reordenación verdadera de la atención urgente debe basarse en tres líneas argumentales: 1. La demanda de atención urgente es previsible. 2. La gestión interna que el hospital ofrece es mejorable. 3. La responsabilidad de poner en marcha dispositivos de drenaje alternativos al ingreso convencional. Es fundamental el papel de la admisión del centro como verdadera unidad de gestión de pacientes, definiendo la normativa funcional y el manual de procedimientos de la unidad de admisiones e instaurando una reunión decisoria diaria de planificación con la participación activa de la dirección, admisiones y urgencias y elaborando el mapa diario de necesidades de hospitalización. Otras políticas facilitarán el más eficiente circuito de los pacientes desde su acceso al hospital hasta su ingreso: - Creación de la unidad de preingreso de urgencias de 24 horas. - Ejecución del sistema de priorización en la asignación de camas. - Adecuación de los ingresos urgentes y de los ingresos programados para estudios diagnósticos mediante la potenciación de circuitos de diagnóstico rápido ambulatorios y el uso de las alternativas a la hospitalización convencional como son las unidades de corta estancia, la hospitalización domiciliaria, unidades de convalecencia. - Ejecución de la política del centro hospitalario sobre circulación interna de pacientes desde su ingreso a su alta (traslados internos, prioridades de ubicación de pacientes, movimiento de altas, etc..The functional and structural reordering of the accident and emergency services is a priority for hospital management staffs. A true reordering must be based on the following questions: 1. Demand for accident and emergency care is predictable. 2. The way the hospital deals with this can be improved. 3. Hospitals have the responsibility of

  8. Dexmedetomidine: Expanding role in anesthesia

    Directory of Open Access Journals (Sweden)

    Jyotsna S Paranjpe

    2013-01-01

    Full Text Available The potential uses of dexmedetomidine (DEX, a highly selective α2 - adrenoceptor agonist are very diverse. DEX appears to mimic many of the actions of mythical ′ideal′ sedative/analgesic agent. Although not orally active, DEX shows good bioavailability when administered via various other routes like intranasal, buccal, IM than intra-venous. DEX has similar pharmacokinetics in all age groups. Its side effects are predictable and easily treatable, hence it has found place as a part of fast-tracking anesthesia regimens in children. DEX is the sedative of choice for peri-operative use in high risk patients, since it is cardioprotective, neuroprotective and renoprotective. Premedication with DEX obtunds the autonomic pressor responses due to laryngoscopy and endotracheal intubation when used as an adjuvant to general anesthesia. DEX in high doses offers another approach to managing morbidly obese patients and patients with a compromised airway; without causing any cardio-respiratory depression. It is near ideal hypotensive agent used for controlled hypotension. Its value as a primary sedative and analgesic is becoming more accepted and evident in critically ill patients; in adult and paediatric intensive care units. Besides use in locoregional anesthesia, it is also used as an opioid substitute, for treatment of substance withdrawal, as an anti-shivering agent, for treatment of delirium and as an end of life medication. Availability of an antidote (Atipamezole with similar elimination half life is taking the drug into new frontiers. However, use of DEX is contraindicated in patients with hepatic failure, hypovolemic shock, advanced heart block or ventricular dysfunction.

  9. Risk factor analysis on hospital infection of lateral episiotomy patients in the department of obstetrics and gynaecology%会阴侧切伤口医院感染的相关危险因素分析

    Institute of Scientific and Technical Information of China (English)

    邱莉芳; 刘凤仁; 梁享生; 董建; 王文玲; 张起文

    2012-01-01

    Objectives During August 2009 and October 2009,a hospital infection event occurred in a hospital in Shenzhen. The object of this study is to understand the main cause of the hospital infection among lateral episiolomy patients in the department of obstetrics and gynaecology, so as to prevent and reduce the occurrence of hospital infection. Method Descriptive analysis and case control study were adopted for analysis of the occurrence of hospital infections and its risk factors. Results During August 2009 and October 2009, total 8 patients were diagnosed as hospital infection after their obstetric surgery, with a hospital infection rate of 2.94%. Epidemiologies) survey found that postoperative hospital stay ≥3 days and hospitalized complications were risk factors for hospital infection among lateral episiotomy patients, and serious bacteria pollution existed on the object surface and ward air of the maternity ward may be the direct cause for hospital infection. Conclusion The important measures to prevent the occurrence of hospital infection among patients after perineal operation are to put much emphasis on the disinfection, postpartum nursing and surgery quality.%目的 为调查2009年8-10月深圳某医院妇产科产妇会阴侧切伤口发生医院感染事件的原因和预防相关院内感染的发生.方法 采用描述性分析和病例对照的方法,了解某医院产科医院感染发生情况并对医院感染发生相关因素进行探讨.结果 272例侧切术病人中8例发生医院感染,术后感染率为2.94%.经调查,会阴侧切缝合术后住院天数≥3 d(X2=0.01,P=0.01)、住院时有合并症(Fisher's Exect Test,P=0.04)是产科会阴侧切术产妇医院感染发生的危险因素,而产房物品表面(>5 cfu/m2)及病房空气(>200 cfu/m3)细菌污染严重可能为该次医院感染发生的直接原因.结论 提高手术质量,做好产后护理及产房与病房的消毒工作是预防产妇会阴侧切伤口发生医院感染的重要措施.

  10. [Carotid endarterectomy under local anesthesia].

    Science.gov (United States)

    Kuz'min, A L; Belov, Iu V

    2001-01-01

    Results of carotid endarterectomy (CEAE) in 193 patients with different degree of cerebrovascular insufficiency were analyzed. All the patients were men with carotid atherosclerosis (age from 39 to 68 years, mean age 53.6 +/- 0.4). A total of 253 CEAEs were performed under local anesthesia (60 patients underwent consecutive bilateral operations). In early postoperative period 3 patients died, one of them--of ischemic stroke due to thrombosis of internal carotid artery on the side of the operation. Non-fatal stroke was in 1 patient. There were no intraoperative cerebral complications. This testifies to reliability of cerebral circulation control through direct contact with patient.

  11. Presbycusis: reversible with anesthesia drugs?

    Science.gov (United States)

    Kocher, Carl A

    2009-02-01

    Age-related hearing impairment, or presbycusis, is a degenerative condition not currently treatable by medication. It is therefore significant that the author, as a patient, experienced a reversal of high-frequency hearing loss during a 2-day period following abdominal surgery with general anesthesia. This report documents the surgery and the subsequent restoration of hearing, which was bilateral and is estimated to have exceeded 50dB at 4kHz. A possible role is noted for anesthetic agents such as lidocaine, propofol, or fentanyl. This experience may hold a clue for research toward the development of medical treatments for presbycusis.

  12. 北京朝阳医院2013年急诊科曲马多临床使用情况分析%Analysis of the application of tramadol in emergency department of Beijing Chaoyang Hospital in 2013

    Institute of Scientific and Technical Information of China (English)

    蔡乐; 张征; 苏晔; 史红

    2015-01-01

    Objective:To analyze the application of tramadol in emergency department of Beijing Chaoyang Hospital,and to provide reference for rational drug use in the clinic.Methods:597 prescriptions of tramadol in emergency department of our hospital during 2013 were randomly selected. Using the defined daily dose(DDD) method and drug utilization index(DUI)evaluation , the data analysis of prescriptions of tramadol extended release tablets and injection was performed.Results:In the randomly selected prescriptions of hospital emergency department, tramadol was mainly used in acute pain. The DUI of tramadol extended release tablets and tramadol injection was both less than 1.Conclusion:The utilization of tramadol was on the whole rational in emergency department of the hospital,but tramodol should be strictly controlled and avoided to be abused in the clinic. On the other hand,it's necessary to strengthen the propaganda of rational usage of tramadol .%目的:了解北京朝阳医院急诊患者使用曲马多的情况及合理性,为临床合理用药提供参考。方法:随机抽取2013年该院急诊科医生开具的包含曲马多的处方597张,采用限定日剂量法(DDD)和药物利用指数(DUI)进行评价与分析,对该院曲马多缓释片和曲马多注射液在急诊中的临床使用进行相关数据分析。结果:在本次随机抽取的该院急诊科医生开具的包含曲马多处方中,该品种主要应用于急性疼痛,曲马多缓释片DUI<1,曲马多注射液DUI<1。结论:该院急诊曲马多使用基本合理,但仍有不足,需加强对医生合理用药的宣传。

  13. Assessment of safety culture within the radiotherapy department of the Bordeaux University Hospital Centre; Evaluation de la culture de securite au sein du service de radiotherapie du centre hospitalier universitaire de Bordeaux

    Energy Technology Data Exchange (ETDEWEB)

    Leysalle, A.; Vendrely, V.; Sarrade, C.; Boutolleau, J.B.; Vitry, E.; Trouette, R.; Maire, J.P. [Hopital Saint-Andre, 33 - Bordeaux (France)

    2010-10-15

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

  14. Causes Analysis of Medical Disputes in Department of Gynecology and Obstetrics in a Military Hospital%军队医院妇产科医疗纠纷成因分析

    Institute of Scientific and Technical Information of China (English)

    李红薇; 金玉明

    2013-01-01

    The causes of medical dispute were ananlyzed in department of gynecology and obstetrics in a military hospital,and the preventive measures,principle of management were raised in order to ensure "zero defect" of the obstetrics and gynecology services.%通过对本院妇产科2008-2011年发生的医疗纠纷进行分析,找出医疗纠纷的发生的原因及发展过程,提出预防措施及处理原则和方案,以期达到妇产科质量的“零缺陷”.

  15. The anesthesia information management system for electronic documentation: what are we waiting for?

    Science.gov (United States)

    Bloomfield, Eric L; Feinglass, Neil G

    2008-01-01

    The anesthesia information management system (AIMS) will be part of the future of healthcare. An electronic medical records system or AIMS will provide clear and concise information and have the potential to integrate information across the entire hospital system, improve quality of care, reduce errors, decrease risks, and improve revenue capture. The practice of anesthesia requires a medical record system that can capture data in real time. In this article, we describe challenges that must be overcome to establish an efficient electronic medical record system for anesthesiology.

  16. Partial intravenous anesthesia in cats and dogs.

    Science.gov (United States)

    Duke, Tanya

    2013-03-01

    The partial intravenous anesthesia technique (PIVA) is used to lower the inspired concentration of an inhalational anesthetic by concurrent use of injectable drugs. This technique reduces the incidence of undesirable side-effects and provides superior quality of anesthesia and analgesia. Drugs commonly used for PIVA include opioids, alpha-2 adrenergic agonists, injectable anesthetic agents, and lidocaine. Most are administered by intravenous infusion.

  17. Papel de la dirección médica en el encaje de urgencias en el hospital The role of medical management in the involvement of the emergency department in the hospital

    OpenAIRE

    2010-01-01

    La reordenación funcional y estructural del servicio de urgencias es un objetivo prioritario de los órganos directivos de cualquier centro. La reordenación verdadera de la atención urgente debe basarse en tres líneas argumentales: 1. La demanda de atención urgente es previsible. 2. La gestión interna que el hospital ofrece es mejorable. 3. La responsabilidad de poner en marcha dispositivos de drenaje alternativos al ingreso convencional. Es fundamental el papel de la admisión del centro como ...

  18. [Drug monitoring in hospitals of Cordoba City (Argentina). 2-year-experience of the Pharmacological Department as a peripheric effect of ANMAT].

    Science.gov (United States)

    Segura, Aída E del V; Mutal, Víctor; Lizzio, Salvador; Montrull, Hilda L

    2005-01-01

    There were designed Monitorings study (FVG), centred on three Public Hospitals of C6rdoba, seeking to detect Adverse Reactions for medicines. To such purpose there were realized forming courses of human resources in FVG. FVG's cards were distributed, of own design, recovered then. For statistical calculation there was applied the INFO 4. 84 informed cards were recovered. The groups of involved medicines: they were: Antibiotics (22%), cardiovascular (16%), antiulcerous (10%), anxiolytics (8.75%), nonsteroidal anti-inflammatory (8%), onchologics (6%), anticonvulsants (3.75%), hypolypemics (3.5%), sexual hormones (2.5%), hypoglycemics (2.5%), plasmatic expansors (2.5%). The organs affected by RAM were: Central Nervous System (25%), skin (25%), gastrointestinal (17.5%), Bleeds (7.5%), cardiovascular (7.5%), respiratory (7%), immune (6%), renal (4%). The analysis of imputability indicated: Definite RAM: 10 % Probable RAM: 90%.

  19. The Effect of Time-to-Provider, Left-without-Treatment and Length-of-Stay on Patient Satisfaction in Training Hospitals' Emer¬gency Department, Iran

    Directory of Open Access Journals (Sweden)

    Mohammad ARAB

    2015-10-01

    Full Text Available Background: It is necessary to consider into hospital emergency services' quantity and quality in different aspects such as time-to-provider, left-without-treatment and length-of-stay. The aimof this research was to identify the effect of these factors on patient satisfaction in training hospitals.Methods: In this descriptive-analytical and cross-sectional study, the sample size was calculated 768. The instrument included 54 questions and 8 sections. Three questions were in the field of following factors: 1 Time to provider was defined as the time from initial triage to initial provider evaluation. 2 Left-without-Treatment patients were defined as those who were initially triaged but were unable to be evaluated by a provider because they had left the ED. 3 Length-of-Stay was defined as time from initial triage to the time of final ED disposition, either discharge or admission. It was analyzed by descriptive statistics, simple logistic regression, multiple logistic regressions, simple linear regression and multiple linear regression.Results: The time-to-provider lower than 15 minutes, LWOT and LOS lower than 6 hours were 92.8%, 3.9% and 90.3%, respectively. The mean of time-to-provider and the mean of LOS were 18.1 minutes and 202 minutes. Time-to-Provider affected satisfaction of admission, guardians, nursing care and managing proceedings (P<0.001. LOS affected satisfaction of admission, guardians and diagnosis proceedings (P<0.01. LWOT did not affect satisfaction and its domains (P>0.05.Conclusion: Decreasing time-to-provider and LOS has the effect on patient satisfaction in some domains. Furthermore, left-without-treatment rate is not a good proxy of patient satisfaction. Keywords: Time-to-Provider, Left-without-Treatment, Length-of-Stay, Satisfaction

  20. As ‘Ouvidorias’ virtuais em Hospitais Universitários Brasileiros e Espanhóis / Online “Complaint" Departments in Brazilian and Spanish University Hospitals

    Directory of Open Access Journals (Sweden)

    Cleusa Maria Andrade Scroferneke

    2013-12-01

    Full Text Available O artigo propõe, a partir da análise comparativa dos resultados da pesquisa realizada junto a Hospitais Universitários Brasileiros e Espanhóis, discutir sobre a relevância das ‘ouvidorias’ virtuais como espaço de interlocução, como lugar de comunicação,tendo o Paradigma da Complexidade (Morin, 2005, 2001 como opção de Método. Os procedimentos metodológicos envolvem levantamento bibliográfico, acompanhamento e análise mensal dos sites/portais dos Hospitais em relação à nomenclatura de ‘ouvidorias’ virtuais, acessibilidade, formas de contato, presença [ou não] de mídias sociais. Trata-se de um recorte de uma pesquisa mais ampla que conta com o apoio do Conselho Nacional de Desenvolvimento Científico e Tecnológico/ CNPq e da Universidade. / Based on the comparative analysis of results of research conducted in Brazilian and Spanish University Hospitals, this article aims to discuss the relevance of online “complaints departments” as a space for dialogue and communication using the paradigm of Complexity (Morin, 2005, 2001 as a method option. The methodological procedures adopted included a literature review, questionnaires, monthly monitoring and analysis of Hospital websites/portals in relation to the nomenclature of online “complaint departments”, accessibility, points of contact, and presence (or not of social media. It forms part of a broader study supported by the National Council of Scientific and Technological Development /CNPq and the University.

  1. [Prevalence of sensitization to inhalant allergens in the immunology department from Hospital de Especialidades Pediátricas María, Honduras, 2016].

    Science.gov (United States)

    Gonzales-González, Victoria Alejandra; Díaz-Flores, Adolfo Martín; Fernández-Zelaya, Karla Zobeyda; Rivera-Reyes, María Félix

    2017-01-01

    Antecedentes: Las enfermedades alérgicas constituyen un problema de salud pública; se estima que entre 30 y 40 % de la población mundial se encuentra afectada por alguna. Conocer la prevalencia de sensibilización a alérgenos permite ofrecer diagnósticos y tratamientos adecuados. En Honduras no se cuenta con estudios en pacientes pediátricos. Objetivos: El objetivo de esta investigación fue identificar el tipo de sensibilización más frecuente en los niños y su correlación con las enfermedades alérgicas más frecuentes en los pacientes en inmunoterapia del Hospital María de Especialidades Pediátricas. Métodos: Estudio retrospectivo transversal descriptivo en el cual se revisaron los expedientes y base de datos de los pacientes en inmunoterapia alérgica del Hospital de Especialidades Pediátricas María entre enero de 2015 y junio de 2016. Resultados: Se evaluaron 215 niños en inmunoterapia, las edades oscilaron entre 3 y 18 años, con una media de 10.8 años. Se identificó que 73.02 % tenía pruebas epicutáneas positivas a aeroalérgenos. Los aeroalérgenos más frecuentes fueron Dermatophagoides farinae y Dermatophagoides psterossynium mix (96.74 %), cucaracha americana (37.21 %) y Aspergillus fumigatus y Homdonderum cladosporioides (16.28 %). Conclusiones: Los ácaros domésticos y la cucaracha americana constituyeron la mayor causa de sensibilización en pacientes en inmunoterapia.

  2. Neurology department hospitalized patients with sleep disorders related factors of the survey and analysis%神经内科住院患者睡眠障碍的相关因素调查及护理对策

    Institute of Scientific and Technical Information of China (English)

    王淑芳

    2012-01-01

    目的 探讨神经内科住院患者睡眠障碍的相关因素,为其临床治疗提供参考依据,并提供护理对策.方法 共纳入120例神经内科住院患者,所有患者均进行匹兹堡睡眠质量指数(PSQI)评估睡眠质量,按PSQI总分≥5或PSQI总分<5分为A、B两组.采用多因素回归分析方法进行多因素分析.结果 120例神经内科住院患者中有20例患者出现睡眠障碍的影响,睡眠障碍发生率为16.7%;神经内科住院患者发生睡眠障碍与年龄≥60岁、情绪障碍、咳嗽、心衰病史、头痛、对疾病的担忧存在相关性,两组比较差异有统计学意义(P<0.05).情绪障碍、咳嗽、心衰病史及头痛均是神经内科住院患者发生睡眠障碍的独立危险因素(P<0.05).结论 神经内科住院患者发生睡眠障碍与情绪障碍的存在,咳嗽、头痛症状的发生,心衰病史的影响有密切的相关性,是其发生的独立危险因素,在临床工作中,对上述可干预因素进行必要的干预有重要的意义,可能改善该类患者的睡眠质量.%Objective To explore neurology department hospilalized patients with sleep disorders related factors,for the clinical therapy provide a reference basis, and provide nursing counlermeasures. Methods Participants included 120 cases of neurology department in hospital patients, all patients were in Pittsburgh sleep quality index (PSQ1) sleep quality evaluation, according to the PSQ1 score 5 or PSQ1 score was < 5 is divided into A, B two groups. Using multiple factors regression analysis method with factor analysis. Results 120 cases of neurology department in hospital patients with 20 cases (the influence of sleep disorder,sleep disorder rate is 16. 7% ;neurology department in hospital in patients with sleep disorders and age was 60 years old, mood disorders, cough, heart failure, history, headache, to disease worries there is a correlation between the two groups (P < 0. 05). Emotional disturbance

  3. Desenvolvimento da especialidade saúde e trabalho, no departamento de enfermagem do Hospital Virtual Brasileiro Desarrollo de la especialidad de trabajo y salud del departamento de enfermería en el Hospital Virtual Brasileño Development of the health and work speciality at the nursing department of a Brazilian Virtual Hospital

    Directory of Open Access Journals (Sweden)

    Regina Helena do Nascimento

    2003-03-01

    Full Text Available O objetivo deste estudo é criar uma página na internet, sobre a especialidade Saúde e Trabalho, no Departamento de Enfermagem do Hospital Virtual Brasileiro. A estrutura da página está dividida nos seguintes temas: Sistema Único de Saúde (SUS; SUS x Norma Operacional de Saúde do Trabalhador (NOST; Breve histórico da organização do trabalho; Qualidade de vida; Eventos e links sobre o tema. Foi utilizada a metodologia de navegação e programação HTML (hyper text markup language para o desenvolvimento das páginas WWW, revisão bibliográfica dos últimos anos, através de bibliotecas e da própria internet; além da revisão por especialistas na área de Saúde e Trabalho.El objetivo de este es crear una página en la internet sobre la especialidad de Trabajo y Salud, en la sección del Departamento de Enfermería del Hospital Virtual Brasileño, permitiéndole al internauta obtener informaciones sobre el tema; contactar sites sobre el asunto; y ver la relación de eventos científicos en esa área. La diagramación de la página incluye los siguientes temas: Sistema Único de Salud (SUS, SUS vs. Norma Operacional de Salud del Trabajador (NOST, un resumen histórico sobre la organización del trabajo, Calidad de Vida, Eventos, y En laces sobre el tema. Las páginas WWW fueron realizadas con programación HTML (hiper text markup language. La metodologia incluyó la revisión de la bibliografía actualizada sobre el tema y la revisión del texto por especialistas del área.The goal of this study is to create a page on internet about the Health and Work speciality, at the Nursing Department of a Brazilian Virtual Hospital. The page structure is divided in these subjects: Unified Health System, Unified Health System and the Operational Occupational Health Norm, a small history about work organization, life quality and courses and links about this subject. The authors utilized the navigation and programming methodology of hyper text

  4. Efficacy and safety of 0.5% levobupivacaine versus 0.5% bupivacaine for peribulbar anesthesia

    Directory of Open Access Journals (Sweden)

    Pacella E

    2013-05-01

    Full Text Available Elena Pacella,1 Fernanda Pacella,1 Fabiana Troisi,2 Domenico Dell'Edera,3 Paolo Tuchetti,4 Tommaso Lenzi,1 Saul Collini21Department of Sense Organs, Faculty of Medicine and Dentistry, Rome, 2Department of Medical Surgical Sciences and Translational Medicine Sapienza, Faculty of Medicine and Psychology, Roma, University of Rome, Rome, 3Unit of Cytogenetic and Molecular Genetics, Madonna delle Grazie Hospital, Matera, 4National Institute for Health, Migration and Poverty, Rome, ItalyBackground: This randomized double-blind study examined the use of a new anesthetic agent, levobupivacaine 0.5%, which is the S(−-enantiomer of a racemic mixture of bupivacaine, for peribulbar anesthesia and compared it with racemic bupivacaine 0.5% alone or in combination with hyaluronidase 10 IU/mL.Methods: A total of 160 patients undergoing ophthalmic surgery were randomized into four groups (n = 40 each to receive inferotemporal peribulbar injection of levobupivacaine 0.5% (group L, racemic bupivacaine 0.5% (group B, levobupivacaine + hyaluronidase 10 IU/mL (group LH, or racemic bupivacaine + hyaluronidase 10 IU/mL (group BH by two anesthetists and two ophthalmologists in a ratio of 25% each. Ocular akinesia and orbicularis oculi function were evaluated using a three-point scale; a value < 5 points was considered as requiring surgery, and movements were re-evaluated the day following surgery to confirm regression of the block.Results: The time to onset (12 ± 2.6 minutes versus 13 ± 2.8 minutes and duration of anesthesia (185 ± 33.2 minutes versus 188 ± 35.7 minutes were similar between groups L and B. Complete akinesia (score 0 was obtained more frequently when hyaluronidase was used in addition to the anesthetic, with occurrences of 72.5% versus 57.5% in group LH versus L, respectively, and 67.5% versus 45% in group BH versus B. Moderate hypotension (<30% of baseline was observed in four patients (10% in group L, two (5.0% in group B, one (2.5% in group LH

  5. 平衡记分卡在临床科室绩效考核指标体系中的应用%Application of the Balanced Score Card in Performance Assessment Index System for Clinical Departments of Hospital

    Institute of Scientific and Technical Information of China (English)

    刘瑞敏; 贺延平; 徐劲松; 呼子涵

    2012-01-01

    目的 建立科学合理的临床科室绩效评价指标体系.方法 参考文献,利用德尔菲法确定医院临床科室绩效评价的三级指标体系及权重.结果 构建了一套较为科学实用的临床科室平衡计分卡绩效评价指标体系.该体系包括4个一级指标,10个二级指标,26个三级指标.结论 平衡计分卡从多个维度评价科室,有利于发现科室的不足,并持续改进.%Objective To establish scientific and rational performance assessment index system for clinical departments. Method Using the Delphi method to determine the tertiary index system and its weight for performance assessment of clinical departments in hospital. Result A more scientific and practical performance assessment index system with the Balanced Score Card was built, which included four primary indexes, ten secondary indexes and twenty - six third grade indexes. Conclusion The Balanced Score Card can evaluate medical work and development of clinical department in several aspects. It is beneficial to discover inadequacies of the clinical departments and can improve.

  6. The Current Development Status Analysis of Medical Record Department of 50 Hospitals in Jilin Province%吉林省50家医院病案科建设现状分析

    Institute of Scientific and Technical Information of China (English)

    赵佳; 马洪喜; 王海峰; 徐长妍

    2013-01-01

    Objective To investigate the current development status of medical record department ,then provide basis for the im -proving of the development of medical record department in 50 Hospitals in Jilin Province .Method To issue questionnaires to medical record department of 50 hospitals in Jilin Province by means of random sampling method .The questionnaires are sent in electronic mail way ,and the leaders of the departments are invited to fill in them .Results The configuration structure of Jilin Province medical record departments employees is irrational ,females are accounted for 83 .19% ,age focus on above 30 years old take a percent of 85 . 43% with relatively low education background .In aspects of professional background ,the ratio of employees who are majored in clin -ical medicine and nursing is 54 .88% .The proportion of the hospital preparation bed spaces and medical record administrative staff in 92% is over 50 :1 .In addition ,the relationship of administrative subordination in medical record department is unreasonable and job function is not comprehensive .Conclusion We suggest the leaders of hospital pay enough attention to the development of medical record department ,issue encouragement policies to absorb better professional young people ,attach importance to the training and con -tinuing education of employees ,thus to improve the hospitals’ general standard of the management of medical records .%  目的了解目前吉林省内医院病案科建设现状,为改善我省医院病案科建设提供依据.方法采用随机抽样的方法对吉林省内50家医院病案科发放调查问卷,调查问卷以电子邮件的方式发给各医院病案科,并请科室负责人填写.结果吉林省病案科从业人员配置结构不合理,女性占83.19%、85.43%的人员在30岁以上,且学历层次偏低;在专业背景方面,临床医学和护理学专业的占54.88%;92%的医院编制床位数与病案管理人员比例在50:1

  7. Epidemiologic and Bacteriologic Study of the Burned Patients from the Plastic Surgery Department of the County Emergency Hospital of Ploieşti, over a 4 Years Period (2010-2013).

    Science.gov (United States)

    Zbuchea, A; Racasan, O; Falca, V; Mitache, C; Vladescu, C

    2015-01-01

    This study analyses the epidemiologic data and the bacteriologic results of a total number of 759 burned patients, which were treated and discharged from the Plastic Surgery Department of the County Emergency Hospital of Ploiesti, between 01 01 2010 and 31 12 2013. The investigated parameter shave been: age and gender distribution, rural or urban population, burn etiology, total burn surface area (TBSA),TBSA, location and depth of lesions, therapeutic management,length of hospital stay, types of bacteria isolated from the infected wounds and their sensitivity to antibiotics, patients' mortality. The statistical analysis revealed the following results: mean age 51.33 ± 18.44 years, male/female ratio 1.35/1, rural/urban ratio 1.34/1, most common etiologies were scalds (44.8%) and flames (37.6%), mean TBSA 7.7 ± 8.4%, main locations were the extremities, splitthickness skin grafting in 15% of the patients, hospital stay 15.57 ± 13.84 days, main bacteria isolated were Pseudomonas aeruginosa (26.3%) and Staphylococcus aureus (22.9%), mortality rate 0.13%. The best methods to decrease the burn morbidity are the burn and infection prevention, for which several measures are discussed.

  8. The Application Based on BSC in Performance Evaluation of the Clinical Departments of Public Hospitals%基于BSC 的公立医院临床科室绩效考核指标应用研究

    Institute of Scientific and Technical Information of China (English)

    方孝梅; 罗杰; 涂自良; 明星辰; 张毅; 杨婷

    2013-01-01

    To build a public hospital clinical departments indicators of performance appraisal based on the BSC concept .Compar-ing the changes before and after the application of relevant indicators ,we can see it can promote the continuous improvement of the quality of medical care .We can provide guidance for the hospital to develop clinical indicators of performance appraisal ,ensure a bal-anced development of hospital quality and efficiency by exploring four dimensions indicators of the financial ,customers ,internal oper-ational processes ,and learning and growth indicators .%  探讨公立医院以BSC的理念构建临床科室绩效考核指标,通过对比应用前后的相关指标,以及临床绩效考核指标的应用,达到促进医疗质量的持续改善。通过财务、客户、内部运营流程以及学习与成长4个维度指标的应用效果的分析,为医院制定临床绩效考核指标提出指导意见,确保医院质量和效益均衡发展。

  9. Hospital infection in Department of Urology nursing intervention%泌尿外科医院感染的护理干预

    Institute of Scientific and Technical Information of China (English)

    冯培芳; 吴南红

    2012-01-01

    Objective To study the postoperative care of patients with urological problems, reduce the probability of the occurrence of postoperative infection in patients with. Methods In our hospital from 2011 March to 2012 March a total of 100 patients with urological operation therapy for the patients with infection were analyzed and studied, discussed the hospital of Urology operation nursing of patients with. Results Urology patients with postoperative infection occurred mainly in the respiratory tract.urinary junctions.operation incision positions, and Escherichia coli, Candida albicans, S. aureus is lead to patients with urine road infection strains. Kleber spawn and Staphylococcus aureus is the cause of the main species in patients with bloodstream infections. Conclusion Through the research on the science of nursing method can effectively reduce the urological patients after operation infection, effectively improve the urological patient outcomes, has very important clinical significance.%目的:探讨泌尿科患者术后护理问题,降低患者术后感染发生的几率.方法:将我院2011年3月到2012年3月收治的100例经泌尿科手术治疗的患者的感染情况进行了分析和研究,探讨了医院对泌尿科手术患者的护理方法.结果:泌尿科患者术后感染主要发生在尿路口、呼吸道、手术切口等位置,而大肠杆菌、白色念球菌、球菌是导致患者出现尿路口感染的主要菌种.克雷伯菌种和球菌则是导致患者血液感染的主要菌种.结论:通过研究可知科学的护理方法可以有效的降低泌尿科患者手术后感染的几率,有效的提高泌尿科患者的治疗效果,具有非常重要的临床意义.

  10. 医院科室空气中汞和甲醛的检测与分析%Detection and Analysis of Mercury and Formaldehyde in Hospital Departments

    Institute of Scientific and Technical Information of China (English)

    李斯

    2011-01-01

    [Objective]To detect the mercury and formaldehyde levels in dental office and pathology room of 6 hospitals. [Methods]The air samples were collected by the large bubbling absorber, and hydride generation atomic fluorescence spectrometry (HG-AFS )was applied to determine the mercury in air, formaldehyde detection by Phenol reagent spectrophotometry. [Results]The mercury levels in the air of dental rooms of 6 hospitals ranged between 0.0013 μg/m3 and 0.0054 μg/m3 which did not exceed national standard, while the formaldehyde levels of pathology room air was 0.02 ~ 1.90 mg/m3, 2 of them exceeded the national standard. [ Conclusion]The protection against mercury and formaldehyde should be enhanced to reduce the chance of exposure to mercury and formaldehyde and protect the health of medical workers.%目的 对6家医院牙科诊室和病理室空气中汞和甲醛进行检测.方法 用大型气泡吸收管采集空气样品,氢化物原子荧光光谱法测定空气中汞的含量,酚试剂分光光度法测定甲醛含量.结果 6所医院牙科诊室空气中汞浓度为:0.0013~0.0054 μg/m3,均未超出国家标准;6家医院病理室空气中甲醛浓度为0.02~1.90 mg/m3,有2家医院病理室空气中甲醛浓度超出了国家卫生标准.结论 应加强对汞和甲醛这两种污染物的防护,减少摄入汞和甲醛的机会,保护医务工作者的健康.

  11. A study of factors delaying hospital arrival and predictors of mortality in patients presenting to emergency department with Stroke: A developing state scenario

    Directory of Open Access Journals (Sweden)

    Vinayak Nagaraja

    2010-10-01

    Full Text Available Background: Thrombolytic therapy for acute ischemic stroke has recently become available in India but its success depends on initiating the treatment in the narrow therapeutic time window. There is commonly a delay of several hours before patients with acute stroke seek medical attention. Materials and Methods: A prospective study was conducted to assess the factors influencing this delay in admission of acute stroke cases. 134cases (101 males, 33 females of acute stroke that arrived within 72 hours at our hospital casualty were recruited. A standardized structured questionnaire was given to patients or their attendants. Results: The median time to casualty arrival was 9 hours with 13.4% cases arriving within 3 hours and 36.5 % cases within 6 hours. Distances from hospital, referral, belief in myths and alternate medicine and low threat perception of symptoms of stroke were independent factors associated with delay in arrival. Living in city, day time onset, urgency shown by attendant, availability of transport and presence of family history were associated with early arrival. There was no correlation with patients' or attendants' sex, educational status, history of previous stroke or transient ischemic attack, subtype or severity of stroke, time of stroke and availability of transport. 134 patients (65.7% were from rural population, 55.22%-smokers, 46.76%-alcoholics with mean (SD age of 53.83+/-18.02years [significantly lower in females (mean difference=9.73years p=0.002], were admitted and diagnosed to have stroke. 87.3% had first episode of stroke and 12.7 had more than one episode of stroke. ICF rate was 26.1%. ICF rate has no relation with age (p=0.516, sex (p=0.460, number of episodes (0.795, underlying hypertension (p=0.905. Odds of diabetics dying were 12 times higher than non-diabetics. Inpatient mortality was also significantly higher in smokers compared with non-smokers (p=0.004, in patients with right-sided compared with left

  12. The formation and design of the TRIAGE study--baseline data on 6005 consecutive patients admitted to hospital from the emergency department

    DEFF Research Database (Denmark)

    Plesner, Louis Lind; Iversen, Anne Kristine Servais; Langkjær, Sandra

    2015-01-01

    categorized as green, 2386 (39.7 %) yellow, 1616 (26.9 %) orange and 25 (0.4 %) red. Median age was 62 years (IQR 46-76), 49.8 % were male and median length of stay was 1 day (IQR 0-4). No events were found in 2658 (44.2 %) and 158 (2.6 %) were admitted to intensive or intermediate-intensive care unit and 219...... the Danish Emergency Proces Triage (DEPT) which categorizes patients as green (not urgent), yellow (urgent), orange (emergent) or red (rescusitation). Presenting complaints, admission diagnoses, comorbidities, length of stay, and 'events' during admission (any of 20 predefined definitive treatments...... that necessitates in-hospital care), vital signs and routine laboratory tests taken in the ED were aslo included in the database. RESULTS: Between September 5(th) 2013 and December 6(th) 2013, 6005 patients were included in the database and the biobank (94.1 % of all admissions). Of these, 1978 (32.9 %) were...

  13. 虚拟化平台在医院放射科的应用%Application of the Virtualization Platform in the Radiology Department in the Hospital

    Institute of Scientific and Technical Information of China (English)

    周毅

    2016-01-01

    In 2015, the radiology information system in our hospital was upgraded. Meanwhile, the virtualization platform was introduced. This paper describes the construction of hardware and software environment of the virtualization platform, deployment of virtual machine, features of the virtualization platform and its effect in the practical application, as well as comparing with the before modification system and summarizing the advantages of the virtualization platform in increasing resource utilization rate, maintaining the consistency of performance, increasing capacity in disaster recovery, and others.%我院于2015年对放射科信息系统进行了升级改造,引入了虚拟化平台。本文对虚拟化平台硬件和软件环境的搭建、虚拟机的布署、平台特点及实际应用效果进行了阐述,并与改造前的系统进行了比较,总结了其在提高资源利用率、保持业务连续性、容灾等方面的优点。

  14. Bone bank service in Odense, Denmark. Audit of the first ten years with bone banking at the Department of Orthopaedics, Odense University Hospital.

    Science.gov (United States)

    Nielsen, H T; Larsen, S; Andersen, M; Ovesen, O

    2001-01-01

    There has been an increase in the demand for allograft bone in recent years. The Odense University Hospital bone bank has been in function since 1990, and this paper outlines our results during the 10 year period 1990-1999. Potential donors were screened by contemporary banking techniques which include a social history, donor serum tests for HIV, hepatitis B and C, and graft microbiology. The bones were stored at -80 degrees C. No type of secondary sterilisation was made. 423 femoral heads were approved and donated to 300 patients,1-6 heads/operation. The allografts have been used mainly to reconstruct defects at revision hip arthroplasty (34%), and for fracture surgery (24%). 7 % of all transplanted patients were reoperated because of infection. In the hip revision group the infection rate was 4 %. There were no cases of disease transmission. During the 10 year period there was a change in the clinical use of the allografts. In the first years the allografts were mainly used for spinal fusion surgery, but today the majority are used in hip revision and fracture surgery. The clinical results correspond to those reported in larger international series.

  15. ٍEffective factors on the Incidence of medication errors from the nursing staff perspective in various department of Fasa Hospital

    Directory of Open Access Journals (Sweden)

    Mostafa Bizhani

    2013-06-01

    Full Text Available  Background and Objective: The incidence of medical errors is deemed one of the unavoidable cases of serious threats to the health and safety of patients. This study aimed to determine the factors influencing medication errors from the perspective of the nursing staff. Materials and Methods: This descriptive -analytic study recruited 80 nurses working in various wards in Fasa Hospital. The nurses were selected via the availability sampling method, and their perspective on factors affecting medication errors was gathered using a questionnaire designed for this study. The data were analyzed with SPSS-15 software.   Results: The most important causes of medication errors were work fatigue, low nurse-to-patient ratio, long working hours, high density of work in units, and doing other tasks. Other variables such as age and gender as well as factors effective on the incidence of medication errors are mentioned in the full text. Conclusion: From the nurses’ standpoint, workload and the patient-to-nurse ratio were the most significant factors leading to medication errors.

  16. A study on the standard of documentation of lumbar puncture in neurology department of a major Irish Teaching Hospital in Ireland

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    Shakya Bhattacharjee

    2013-01-01

    Full Text Available Objective: Poor documentation following lumbar puncture (LP had always been a matter of concern. This study aimed to investigate the documentation pattern of neurology house officers, registrars (Regs, and specialist Regs following LP in a major teaching hospital. Materials and Methods: Total hundred patient records were examined in the light of a carefully designed proforma containing 15 important indicators of good-quality LP documentation. Result: Mean number of indicators overall documented by doctors was found to be 6.24 ± 3.0037. The mean number of indicators recorded by house officers was 5.11 ± 3.01 and Regs was 7.56 ± 3.28. A total of 33% LPs were performed without a documented consent. Only 36% performers documented the type and size of needle they used during the procedure. Only 46% documents revealed the strength and name of the local anesthetic used. Statistically significant difference between senior house officers and Regs in terms of numbers of indicators documented was noted. Conclusion : The documentation standard among neurology junior doctors remained poor.

  17. A study on the standard of documentation of lumbar puncture in neurology department of a major Irish Teaching Hospital in Ireland

    Science.gov (United States)

    Bhattacharjee, Shakya; Kaur, Gurpreet

    2013-01-01

    Objective: Poor documentation following lumbar puncture (LP) had always been a matter of concern. This study aimed to investigate the documentation pattern of neurology house officers, registrars (Regs), and specialist Regs following LP in a major teaching hospital. Materials and Methods: Total hundred patient records were examined in the light of a carefully designed proforma containing 15 important indicators of good-quality LP documentation. Result: Mean number of indicators overall documented by doctors was found to be 6.24 ± 3.0037. The mean number of indicators recorded by house officers was 5.11 ± 3.01 and Regs was 7.56 ± 3.28. A total of 33% LPs were performed without a documented consent. Only 36% performers documented the type and size of needle they used during the procedure. Only 46% documents revealed the strength and name of the local anesthetic used. Statistically significant difference between senior house officers and Regs in terms of numbers of indicators documented was noted. Conclusion: The documentation standard among neurology junior doctors remained poor. PMID:24339594

  18. A three-year follow-up on injuries sustained by cruise ship passengers and crew treated at the Orthopaedic and Traumatology Department at Dubrovnik County Hospital.

    Science.gov (United States)

    Bekic, Marijo; Mikolaucic, Michele; Golubovic, Marko; Kojic, Niksa; Lenz, Rikard; Lojpur, Jakisa; Bekic, Marijana

    2015-11-01

    Dubrovnik is one of the most popular destinations in the world for cruise ships. Several cruise ship passengers and crew members who have suffered different injuries have been treated at our department. This was a retrospective study to analyse injuries that occurred to crew members and passengers on cruise ships that docked in Dubrovnik over a three-year period from December 2010 to December 2013. During this period, a total of 370 patients suffered trauma that needed medical treatment. A total of 119 of these patients required hospitalisation and received medical help based on the nature of the trauma they suffered. The remaining 251 patients were treated at our outpatient clinic. Female patients in this study were exposed to osteoporotic trauma. Male patients presented mostly with injuries sustained during physical activities or because of the nature of their job on board. The leading cause of trauma accidents in the present study was falls on the same level.

  19. Comparison on the influence of different anesthesia methods for oxygen metabolism and hemodynamics of patients with infective shock

    Institute of Scientific and Technical Information of China (English)

    Ma Jie

    2016-01-01

    Objective:To observe and compare the influence state of general anesthesia and general anesthesia combined with epidural anesthesia for the oxygen metabolism and hemodynamics of patients with infective shock, in order to provide evidence for the selection of anesthesia methods of the patients with infective shock.Methods:A total of 42 patients with infective shock in hospital from April 2013 to December 2015 were randomly divided into control group and observation group by the principle of random allocation, 21 cases in control group were with general anesthesia, 21 cases in observation group were with general anesthesia integrated with epidural anesthesia, then the oxygen metabolism and hemodynamics indexes of two groups before the anesthesia and at 20min during the operation, at 10min after the operation were compared.Results: The oxygen metabolism parameters including SvO2, CjvO2 and VO2 were respectively (64.81±5.99)%, (94.24±5.32) mL/L, (136.16±8.32) mL/min•m2 and (67.20±6.08)%, (95.10±5.40) mL/L, (133.15±8.17) mL/min•m2, and they were all better than (60.11±5.81)%, (90.11±5.04) mL/L, (145.15±9.38) mL/min•m2 and (63.24±5.95)%, (92.23±5.18) mL/L, (142.24±9.11) mL/min•m2 of control group, the hemodynamics indexes were all better than those of control group.Conclusion: The influence state of general anesthesia integrated with epidural anesthesia or the oxygen metabolism and hemodynamics of patients with infective shock are better than those of general anesthesia, so the application value of general anesthesia integrated with epidural anesthesia in the patients are relatively higher.

  20. Nurse Staffing Calculation in the Emergency Department - Performance-Oriented Calculation Based on the Manchester Triage System at the University Hospital Bonn.

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    Ingo Gräff

    Full Text Available To date, there are no valid statistics regarding the number of full time staff necessary for nursing care in emergency departments in Europe.Staff requirement calculations were performed using state-of-the art procedures which take both fluctuating patient volume and individual staff shortfall rates into consideration. In a longitudinal observational study, the average nursing staff engagement time per patient was assessed for 503 patients. For this purpose, a full-time staffing calculation was estimated based on the five priority levels of the Manchester Triage System (MTS, taking into account specific workload fluctuations (50th-95th percentiles.Patients classified to the MTS category red (n = 35 required the most engagement time with an average of 97.93 min per patient. On weighted average, for orange MTS category patients (n = 118, nursing staff were required for 85.07 min, for patients in the yellow MTS category (n = 181, 40.95 min, while the two MTS categories with the least acute patients, green (n = 129 and blue (n = 40 required 23.18 min and 14.99 min engagement time per patient, respectively. Individual staff shortfall due to sick days and vacation time was 20.87% of the total working hours. When extrapolating this to 21,899 (2010 emergency patients, 67-123 emergency patients (50-95% percentile per month can be seen by one nurse. The calculated full time staffing requirement depending on the percentiles was 14.8 to 27.1.Performance-oriented staff planning offers an objective instrument for calculation of the full-time nursing staff required in emergency departments.

  1. Prescribing pattern and WHO core prescribing indicators in post-operative patients of Gynaecology department of a tertiary care teaching hospital

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    Bhanu P. Kolasani

    2016-12-01

    Full Text Available Background: Prescription pattern analysis is an essential tool to provide an insight regarding the existing drug usage and to ensure rational drug therapy. Even though drugs used for gynecological disorders are one of the commonly used, they are least studied in terms of prescribing patterns. Hence the present study was planned to analyze the prescribing pattern and WHO core prescribing indicators among post-operative patients of Gynaecology department in our institute. Methods: A prospective observational study was conducted in 76 post-operative patients of Gynaecology department for a period of six months. Each prescription was analyzed for demographic data, total number and various categories of drugs prescribed, the percentage of individual drugs prescribed in each category, the dosage forms and the percentage of drugs prescribed by generic name, and from essential drug list were also analyzed. Results: A total of 990 medications were prescribed among which anti-microbial agents (32.52% were the most commonly prescribed category followed by analgesics (19.60% and Intravenous fluids (13.53%. Metronidazole (27.02% was the most commonly prescribed antimicrobial, Diclofenac (68.04% was the commonly prescribed analgesics and Ringer lactate (38.81% was the commonly prescribed Intravenous fluid. Most commonly prescribed antiulcer drug was ranitidine (75.0%, antiemetic was Ondansetron (76.39%. Majority of drugs (72.54% were prescribed by generic name. Average number of drugs per prescription was 13.03. Percentages of encounters with antibiotics were 32.52%. The percentage of drugs prescribed from the National List of Essential Medicines (NLEM was 82.16%. Injection (57.78% was the most common drug formulation. Conclusions: Antimicrobial agents and analgesics were the most commonly prescribed drugs. Prescription by generic name was high, usage of antibiotics and injections were also high and Poly-pharmacy was common, especially among antimicrobial

  2. Síndrome de Burnout em trabalhadores de enfermagem de um pronto socorro de hospital universitário Síndrome de Burnout en trabajadores de enfermería del servicio de emergencia de un hospital universitario Burnout Syndrome among nursing staff from an emergency department of a hniversity hospital

    Directory of Open Access Journals (Sweden)

    Denise Albieri Jodas

    2009-01-01

    necesario desarrollar estrategias de reorganización del proceso de trabajo disminuyendo fuentes de estrés.OBJECTIVE: To identify the factors associated with the signs and symptoms of burnout among nursing staff from an emergency department of a university hospital. METHODS: The study used a quantitative descriptive design. The sample comprised of 61 nursing staff. A self-administered structured questionnaire and the Maslach Burnout Inventory were used to collect the data. Data were analyzed with EpiInfo 2004. RESULTS: Among the sample of the study, 8.2% of female participants had burnout. However, a great number (54.1% had high risk for burnout. Only 37.7% of participants had a low risk for burnout. Factors associated with burnout include the lack of knowledge and motivation for professional development. CONCLUSION: The organization and work dynamics of the emergency department led to workload and tension, which suggested the need to develop strategies for the re-organization of the work dynamics to decrease the sources of stress.

  3. 椎管神经阻滞麻醉分娩镇痛对分娩结局的影响%Effect of labor anesthesia with intravertebral anesthesia on delivery outcome

    Institute of Scientific and Technical Information of China (English)

    于芳; 牛秀敏; 韩凌霄; 孔祥玲

    2012-01-01

    ObjectiveTo explore the effect of labor anesthesia with intravertebral anesthesia and its impact on delivery outcome. Methods: A total of 80 primiparous women who were awaiting delivery in obstetrical department of general hospital of Tianjin medical university and affiliated hospital of medical college of armed police from July 2010 to September 2011 were selected and divided into two groups. Forty primiparous women in observation group were treated with intravertebral anesthesia; while forty primiparous women in control group were not trealed with intravertebral anesthesia; the progression of stages of labor in the two groups .were observed closely, and corresponding treatments were performed. Results; There was no statistically significant difference in maternal age, gestational weeks, body height, head basin score, body mass index (BMI) , the grade of pain during latent period, blood pressure, maternal heart rate, and fetal heart rate between the two groups ( P > 0. 05 ) . The grade of pain, blood pressure, heart rate, and cesarean section rate in observation group were statistically significantly lower than those in control group ( P < 0. 05 ) . There was no statistically significant difference in the rate of instrumental delivery, the incidence of postpartum hemorrhage, and the incidence of neonatal asphyxia between the two groups. Conclusion; Intravertebral anesthesia can relieve the pain of parturient women during the stages of labor safely and effectively, reduce the cesarean section rate significantly, which has no adverse impact on the stages of labor and delivery outcome, the method is worthy to be popularized and applied in clinic.%目的:探讨应用椎管神经阻滞麻醉的分娩镇痛效果及对分娩结局的影响.方法:选择2010年7月~ 2011年9月天津医科大学总医院及武警医学院附属医院产科住院待分娩的初产妇80例.其中观察组40例,临产后行椎管神经阻滞麻醉;非分娩镇痛组(对照组)40例,

  4. 河北省45家三级医院病案室现状调查研究%Investigation on status quo of medical record management department in 45 tertiary hospitals in Hebei province

    Institute of Scientific and Technical Information of China (English)

    吕建波; 吕璐

    2014-01-01

    Objectives:To learn the status quo of medical record management department and give evidence of policy making by investigating 45 tertiary hospitals in Hebei Province. Methods:Unified questionnaires were used by well training investigators to carry out the survey in the selected hospitals. Results:71.11%of hospitals has set up individual medical record management department and also 71.11%of hospitals have reading room. Furthermore, 62.22%of hospitals have electronic reading room. 93.33%of hospitals use specialized network and 53.33%of which use internet. There are 15.66%of hospitals has no medical record management software and 11.11%of hospitals analyze medical quality index by hand. There are also 22.22%of hospitals tracking medical record by hand. On average, there are 11.5 staffs in medical record management department per hospital and 0.58 medical record management staff per 50 beds. There are 1.7 qualified coding staff and 2.7 coding staff in practice per hospital. The average 7 days, 3 days and 2 days of medical record archive rate are 97.30%、78.66%and 52.20%respectively. Conclusions:The common problems of medical record management can be summarized as lack of staff and low quality of staff, irrational title and major structure and low degree of informatization and archive rate, which has seriously constraint hospital medical record information accuracy and efficient utilization and also constraint clinical pathway management and DRGs promotion as well.%目的:通过对河北省45家三级医院病案室进行调查,了解病案室的基本情况,为制定有关政策提供依据。方法:制定统一调查表并进行相关培训,派专门人员深入医院进行调查。结果:有71.11%的医院独立设置了病案室,有阅览室的占71.11%,电子阅览室的占62.22%;93.33%的医院拥有内网、53.33%的使用外网;有15.66%的医院无病案管理软件,11.11%的医院不能使用计算机进行医疗质量统计指标

  5. Clinical and microbiological features of community-acquired and nosocomial bloodstream infections in the surgical department of a tertiary-care hospital in Beijing

    Institute of Scientific and Technical Information of China (English)

    L(U) You; GUO Peng; YE Ying-jiang; WANG Hui; SHEN Zhan-long; WANG Qi; ZHAO Chun-jiang

    2013-01-01

    Background Bloodstream infections (BSls) remain a major cause of morbidity and mortality in patients undergoing surgery.This study aimed at elucidating the clinical characteristics of community-acquired BSls (CABs) and nosocomial BSls (nBSls) in patients admitted to the surgical wards of a teaching hospital in Beijing,China.Methods This cross-sectional study compared 191 episodes of BSls in 4074 patients admitted to the surgical wards between January 2008 and December 2011.Cases of BSls were classified as CABs or nBSls,and the characteristics,relevant treatments,and outcomes of CABs and nBSls were compared.Results Of the 191 BSls,52 (27.2%) and 139 (72.8%) were CABs and nBSls,respectively.Eschedchia coli,coagulasenegative staphylococci,and Klebsiella spp,were the most frequently isolated microorganisms.There were significant differences between CABs and nBSls with respect to the use of hormonal drugs,ventilation,acute physiology and chronic health evaluation (APACHE) Ⅱ and American Society of Anesthesiologists scores,and prevalence of cancer (P <0.05).Empirical antibacterial therapy did not decrease the crude mortality,but multivariate analysis showed that high APACHE Ⅱ was independently associated with a risk of mortality (odds ratio =0.97,95% confidence interval:0.93-1.02 for APACHE Ⅱ).Conclusions We found significant differences in the clinical characteristics of surgical patients with CABs and nBSls.The outcome of patients seems to be related to high APACHE Ⅱ scores.

  6. Epidemiological profile of 277 patients with facial fractures treated at the emergency room at the ENT Department of Hospital do Trabalhador in Curitiba/PR, in 2010

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    Ykeda, Ronnie Barreto Arrais

    2012-01-01

    Full Text Available Introduction: Epidemiological studies that focus on facial injuries are of great interest for the knowledge of occurrence and severity of presentation. Aim: To study the epidemiological profile of 277 patients who suffered facial fractures at the Hospital do Trabalhador (HT, with an emphasis on variables such as sex, age, cause, and anatomical sites of fractures, comparing the clinical findings with other studies. Method: Retrospective nonrandomized chart review of 277 patients who were treated at HT by the ENT service during the full year 2010, victims of facial fractures. Results: Of 277 patients, 74.72% were male and 25.27% female (ratio 3:1. According to age, the fractures were distributed as follows: 0-9 years: 4.69%, 10-19 years: 17.32%, 20-29 years: 23.82%, 30-39 years: 20.21%, 40-49 years: 16.24%, 50-59 years: 10.83%, 60-69 years: 3.97%, and 60-79 years: 2.88%. The cause of trauma was most frequently interpersonal violence, 36.45%, followed by falls, 23.09%, and motor vehicle crashes with 17.32%. Regarding location, nasal fracture was the most common, with 44.75%, followed by the mandible, 14.32%, orbit, 12.78%, maxillary, 12.02%, zygomatic, 9.97%, 3.32% and front Le Fort 2.88%. Conclusion: The patients were mostly males, aged 21-30 years, victims of aggression with the most commonly fractured bone being the nose. The adoption of personal and public strategies and measures may prevent facial fractures.

  7. Fetomaternal Outcome in Severe Preeclamptic Women Undergoing Emergency Cesarean Section under Either General Or Spinal Anesthesia

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    Suman Chattopadhyay

    2014-01-01

    Full Text Available This prospective observational study compared the effects of general and spinal anesthesia in 173 severe preeclamptic women undergoing emergency cesarean section. 146 (84.5% patients underwent spinal anesthesia (SA and 27 (15.5% patients had general anesthesia (GA. Most of the patients were primigravid and nulliparous. Intraoperatively SA group required more intravenous fluid and vasopressor support, while GA group required more preoperative labetalol injection for blood pressure control. Overall 13.3% of patients required critical care, particularly GA group (44.4% versus 7.5%; P<0.001. Patients receiving GA had a higher mortality (25.9% versus 1.4%; P<0.001. The length of hospital stay was comparable. Significantly more neonates of patients receiving GA were found to be preterm (77.8% versus 44.5%; P<0.01 and required advanced resuscitation. GA group also had higher neonatal mortality (29.6% versus 11%; P<0.05. To conclude, severe preeclamptic mothers receiving general anesthesia and their babies required more critical care support. Maternal as well as neonatal mortality was significantly higher with general anesthesia.

  8. Exacerbation of preexisting neurological deficits by neuraxial anesthesia: report of 7 cases.

    Science.gov (United States)

    Aldrete, J Antonio; Reza-Medina, Marisela; Daud, Olga; Lalin-Iglesias, Silvia; Chiodetti, Gustavo; Guevara, Uriah; Wikinski, Jaime A; Torrieri, Alberto

    2005-06-01

    We undertook this case series to determine if preexisting neurological disease is exacerbated by either spinal or epidural anesthesia. In the website of the Arachnoiditis Foundation, we posted an offer to advise anesthesiologists in cases of neurological problems after either of these techniques was used. Contacts were made first by way of the Internet, confirmed by telephone, and maintained by fax, e-mail, or by special mail. Patients here described were cared for and observed by one of the authors, in a hospital, in Argentina or in Mexico. A total of 7 adult, ASA physical status I and II patients, including 3 men and 4 women, with subtle symptoms of neurological disease before anesthesia, are described. Two patients had continuous lumbar epidural anesthesia, 3 had spinals; in 2 more, attempted epidural blocks led to accidental dural puncture and were converted to subarachnoid anesthetics. All patients accepted neuraxial anesthesia without informing the anesthesiologists that they had mild neurological symptoms before surgery. Because anesthesiologists did not specifically inquire about subclinical neurological symptoms or prior neurological disease, anesthesiologists are advised to carefully inquire about prior neurological disease whether neuraxial anesthesia techniques are considered.

  9. Effect of general anesthesia and orthopedic surgery on serum tryptase

    DEFF Research Database (Denmark)

    Garvey, Lene H; Bech, Birgitte Louise; Mosbech, Holger

    2010-01-01

    Mast cell tryptase is used clinically in the evaluation of anaphylaxis during anesthesia, because symptoms and signs of anaphylaxis are often masked by the effect of anesthesia. No larger studies have examined whether surgery and anesthesia affect serum tryptase. The aim of this study...... was to investigate the effect of anesthesia and surgery on serum tryptase in the absence of anaphylaxis....

  10. Perfil epidemiológico do trauma de face dos pacientes atendidos no pronto socorro de um hospital público Epidemiology of facial trauma of patients admitted to a public hospital emergency department

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    Jefferson Lessa Soares de Macedo

    2008-02-01

    Full Text Available OBJETIVO: Avaliar os dados epidemiológicos e a localização dos traumas de face de pacientes atendidos no Hospital Regional da Asa Norte (HRAN, Brasília, Distrito Federal. MÉTODO: Trata-se de um estudo retrospectivo, realizado no pronto socorro do HRAN-DF, visando avaliar o perfil epidemiológico dos pacientes atendidos pela equipe da Unidade de Cirurgia Plástica vítimas de trauma de face no período de 1 de janeiro a 31 dezembro de 2004. RESULTADOS: O estudo compreendeu 711 pacientes, destacando-se o sexo masculino (72,8%. Quanto à causa, predominou a agressão física, seguida por acidente com veículos/motos. As quedas foram a causa predominante das lesões em crianças, mas verificou-se a participação cada vez maior da agressão física como mecanismo de trauma facial com o aumento da idade. A relação de homem:mulher foi de 3:1. A faixa etária mais atingida foi de 21 a 30 anos, representando 35,3% dos pacientes. As fraturas foram encontradas em 24,9% das lesões faciais. O nariz foi o local mais acometido nas fraturas de face (76,8%. CONCLUSÃO: A violência interpessoal foi a principal causa de trauma de face. A queda da própria altura mostrou-se como importante mecanismo de trauma nos extremos de idade.BACKGROUND: To evaluate the etiology, age, gender and location of the lesions of facial trauma in patients arriving at our hospital. METHODS: The data were evaluated through retrospective analysis of patient charts from January 1st to December 31st, 2004. RESULTS: The group comprised 711 patients with facial trauma. Blunt assault was the most common cause, followed by motor vehicle crashes. Falls were, by far, the predominant cause of injury in children, but with increasing age, assaults became more common. It was observed a male:female ratio of 3:1. The most frequent age group was the 21-30 years one, with 52%. Facial fractures were found in 24.9% of facial injuries. The most frequent fracture was nasal (76.8%. CONCLUSION

  11. Mortality in anesthesia: a systematic review

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    Leandro Gobbo Braz

    2009-01-01

    Full Text Available This systematic review of the Brazilian and worldwide literature aims to evaluate the incidence and causes of perioperative and anesthesia-related mortality. Studies were identified by searching the Medline and Scielo databases, followed by a manual search for relevant articles. Our review includes studies published between 1954 and 2007. Each publication was reviewed to identify author(s, study period, data source, perioperative mortality rates, and anesthesia-related mortality rates. Thirty-three trials were assessed. Brazilian and worldwide studies demonstrated a similar decline in anesthesia-related mortality rates, which amounted to fewer than 1 death per 10,000 anesthetics in the past two decades. Perioperative mortality rates also decreased during this period, with fewer than 20 deaths per 10,000 anesthetics in developed countries. Brazilian studies showed higher perioperative mortality rates, from 19 to 51 deaths per 10,000 anesthetics. The majority of perioperative deaths occurred in neonates, children under one year, elderly patients, males, patients of ASA III physical status or poorer, emergency surgeries, during general anesthesia, and cardiac surgery followed by thoracic, vascular, gastroenterologic, pediatric and orthopedic surgeries. The main causes of anesthesia-related mortality were problems with airway management and cardiocirculatory events related to anesthesia and drug administration. Our systematic review of the literature shows that perioperative mortality rates are higher in Brazil than in developed countries, while anesthesia-related mortality rates are similar in Brazil and in developed countries. Most cases of anesthesia-related mortality are associated with cardiocirculatory and airway events. These data may be useful in developing strategies to prevent anesthesia-related deaths.

  12. Comparison of maternal and fetal outcomes among patients undergoing cesarean section under general and spinal anesthesia: a randomized clinical trial

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    Anıl İçel Saygı

    Full Text Available CONTEXT AND OBJECTIVE: As the rates of cesarean births have increased, the type of cesarean anesthesia has gained importance. Here, we aimed to compare the effects of general and spinal anesthesia on maternal and fetal outcomes in term singleton cases undergoing elective cesarean section.DESIGN AND SETTING: Prospective randomized controlled clinical trial in a tertiary-level public hospital.METHODS: Our study was conducted on 100 patients who underwent cesarean section due to elective indications. The patients were randomly divided into general anesthesia (n = 50 and spinal anesthesia (n = 50 groups. The maternal pre and postoperative hematological results, intra and postoperative hemodynamic parameters and perinatal results were compared between the groups.RESULTS: Mean bowel sounds (P = 0.036 and gas discharge time (P = 0.049 were significantly greater and 24th hour hemoglobin difference values (P = 0.001 were higher in the general anesthesia group. The mean hematocrit and hemoglobin values at the 24th hour (P = 0.004 and P < 0.001, respectively, urine volume at the first postoperative hour (P < 0.001 and median Apgar score at the first minute (P < 0.0005 were significantly higher, and the time that elapsed until the first requirement for analgesia was significantly longer (P = 0.042, in the spinal anesthesia group.CONCLUSION: In elective cases, spinal anesthesia is superior to general anesthesia in terms of postoperative comfort. In pregnancies with a risk of fetal distress, it would be appropriate to prefer spinal anesthesia by taking the first minute Apgar score into account.

  13. Elevation of a patient's trunk and legs does not influence length of stay in the post-anesthesia care unit

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    Otávio Omati

    Full Text Available CONTEXT: Patient recovery time after anesthesia depends on problem-oriented monitoring and individual assessment. OBJECTIVE: To investigate the influence of patient positioning on post-anesthesia recovery time. TYPE OF STUDY: Retrospective. SETTING: Post-anesthesia care unit, Hospital das Clínicas, São Paulo. METHODS: Data were obtained from patients recovering from anesthesia in a supine horizontal position or with their trunk and legs elevated at 30 degrees. Data were recorded every 30 minutes. The start time was considered to be the admission to the unit, and the final measurement was taken when the patient reached an Aldrete-Kroulik index of 10. The length of time until discharge was recorded. RESULTS: 442 patients recovering after general (n = 274 or regional anesthesia (n = 168 were assigned to be kept in a supine position or with their trunk and legs elevated. There was no difference in the medians for non-parametric results, between supine position (75 min, n = 229 and trunk and legs elevated (70 min, n = 213; p = 0.729. Patients recovered faster from regional anesthesia with trunk and legs elevated (70 min than in the supine position (84.5 min, although not significantly (p = 0.097. There was no difference between patients recovering from general anesthesia, no matter the positioning (70 min; p = 0.493. DISCUSSION: Elevated legs may supposedly improve venous return and cardiac output since spinal anesthesia blocks sympathetic system and considering leg-raising has been shown to improve cardiac output from hipovolemia. Our findings did not support this hypothesis. Some limitations included a retrospective collection of data that did not allow randomization for recovery position and the unregistered duration of the exposure to the anesthetic drugs. CONCLUSIONS: There was no difference in anesthesia recovery time in relation to positioning patients supinely or with trunk and legs elevated.

  14. Applying Lean Six Sigma for innovative change to the post-anesthesia care unit.

    Science.gov (United States)

    Haenke, Roger; Stichler, Jaynelle F

    2015-04-01

    Many healthcare organizations are building or renovating patient care facilities. Using Lean Six Sigma methods, nurse leaders can eliminate unnecessary waste and improve work and patient care environments. Starting with a key department like the post-anesthesia care unit is a good way to expose staff and leaders to the potential of Lean.

  15. 42 CFR 414.61 - Payment for anesthesia services furnished by a teaching CRNA.

    Science.gov (United States)

    2010-10-01

    ... teaching CRNA. 414.61 Section 414.61 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF... teaching CRNA. (a) Basis for payment. Beginning January 1, 2010, anesthesia services furnished by a teaching CRNA may be paid under one of the following conditions: (1) The teaching CRNA, who is not...

  16. Alzheimer’s disease and anesthesia

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    Marie-Amélie ePapon

    2011-01-01

    Full Text Available Cognitive disorders such as post-operative cognitive dysfunction, confusion, and delirium, are common following anesthesia in the elderly, with symptoms persisting for months or years in some patients. Alzheimer's disease (AD patients appear to be particularly at risk of cognitive deterioration following anesthesia, and some studies suggest that exposure to anesthetics may increase the risk of AD. Here, we review the literature linking anesthesia to AD, with a focus on the biochemical consequences of anesthetic exposure on AD pathogenic pathways.

  17. A STUDY OF PRESCRIBING PATTERN OF NON STEROIDAL ANTI INFLAMMATORY DRUGS IN ORTHOPEDIC OUT PATIENT DEPARTMENT AT A TERTIARY CARE HOSPITAL

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    Asha Latha

    2015-01-01

    Full Text Available AIM: To determine the pattern of NON STEROIDAL ANTI INFLAMMATORY DRUGS prescribing for arthritic and non - arthritic conditions in orthopedic outpatient department . METHODOLOGY: 100 prescription duplicate collected and analyzed prospectively for the pattern of NSAID prescription for arthritic and non - arthritic conditions; the drug formulation , route , frequency, duration of adm issio n and concomitant medications results. NSAID were prescribed for non - traumatic musculo skeletal 35% pain, 25% post traumatic pain, 20% osteoarthritis, 10% post - operative pain, 3% ankylosing spondylitis, 6% degenerativ e disease of spine, 1% neuralgia. The NSAIDs commonly prescribed were Aceclofenac 45%, Etodolac 20%, Diclofenac 24%, and Ibuprofen 11%. Fixed dose combination of NSAIDs with adjuvante was prescribed in. The adjuvants, included are paracetamol 55.6%, serrat opeptidase 32.8%, chlorzoxazone 9.1%, Thiocolchichoside 2.5%. oral formulations of NSAIDs were prescribed in all patients, supplemented by Topical formulations as gel/cream in 15% of subjects. The dosing frequency was BID (65%, OD (25%, TID (2%, SOS (8% . Duration of administration ranged from 5 - 15 days . other classes of drugs used concomitantly were proton pump inhibitors , calcium supplements, Multivitamins, Anti microbials, Immuno suppressants, and Glucosamine. CONCLUSION: NSAIDs were prescribed empiric all y for various arthritic and Non - arthritic conditions, frequently as fixed dose combinations [FDC]s with various adjuvants as per the standard guide lines. However patient information was inadequate in most of the prescriptions. Proper patient Assessment deemed necessary for individualizing NSAIDs.

  18. Study on management of medical-technical departments in hospitals by the lean observation%精细化视角下的医院医技科室的管理

    Institute of Scientific and Technical Information of China (English)

    黄培

    2012-01-01

    本文阐述了现代医院医技科室定义及分类,剖析了当前医技科室管理中存在的不精细,最后提出构建精细化医技科室管理体系,包括推行质量全过程管理、提高服务水平、提升技术内涵、严格规范,确保医技科室可持续发展.%This article expounded the definition and classification of medical-technical departments in hospitals by the lean observation, analyzed the question in medical-technical departments management. At last the author proposed the establishment of medical-technical departments management mechanism based on lean, which included carrying out quality management from the whole course, improving the level of service and elevicateing the implication of technology, excuting the standard strictly to ensure the sustainable development.

  19. Department of Cardiology of Seep Quality of Patients with Hospital and Nursing Interventions%心内科住院患者睡眠质量分析与护理干预

    Institute of Scientific and Technical Information of China (English)

    范文静; 杨静; 金雁; 宋淑平; 郭晓霞; 李明波

    2012-01-01

    目的:了解心内科住院患者睡眠质量,分析睡眠障碍的原因,探讨改善患者睡眠障碍的有效护理对策.方法:对我院2010年5月-2010年12月心内科109例住院睡眠障碍患者采取问卷调查及深入访谈相结合的方法进行调查,找出心内科患者睡眠障碍的原因;随后,将109例患者随机分为两组,对照组实行组常规护理,干预组实行有针对性的护理,7d后对对两组患者睡眠障碍进行测评.结果:心内科患者睡眠障碍症状为:入眠时间长,早醒,觉醒次数多,醒后再入眠难;睡眠障碍原因为:患者自身疾病、心理、环境、其他及综合因素所致.通过有针对性的护理干预后,两组有较大差距(P<0.05),干预组患者睡眠障碍改善明显,干预组好于对照组,表明护理干预可有效改善患者的睡眠质量.结论:疾病因素、心理因素以及生活习惯是影响心内科住院患者睡眠质量的主要因素,通过科学有效的护理干预措施,可以改善心内科患者的睡眠质量,提高患者的身心健康.%Objective: Understanding of sleep quality of patients with hospitalized Department of Cardiology, analyzing the causes of sleep disorders, sleep disorders patients with of an effective improvement of nursing. Methods:Our hospital in May 2010-2010 Department of Cardiology 109 cases in December hospitalized patients with sleep disorders questionnaire and in-depth interview to a combination of methods of investigation, Department of Cardiology to find out the reasons for patients with sleep disorders; then the 109 patients randomized Divided into two groups, the implementation of routine care group, the intervention group and targeted nursing practice, 7d after the two groups were carried out evaluation of sleep disorders. Results: Department of Cardiology patients with symptoms of sleep disorders: sleep for a long time, early awakening, awakening more often, difficult to sleep after awake; sleep disorders due to

  20. Local Anesthesia Combined With Sedation Compared With General Anesthesia for Ambulatory Operative Hysteroscopy

    DEFF Research Database (Denmark)

    Brix, Lone Dragnes; Thillemann, Theis Muncholm; Nikolajsen, Lone

    2016-01-01

    anesthesia combined with sedation (group LA + S; n = 76) or general anesthesia (group GA; n = 77). Primary outcome was the worst pain intensity score in the postanesthesia care unit (PACU) rated by the patients on a numerical rating scale. FINDING: Data from 144 patients were available for analysis (LA + S...... was shorter (P anesthesia with sedation can be recommended as a first choice anesthetic technique for operative ambulatory hysteroscopy....

  1. Resistance of Acinetobacter Baumannii Infection in Hospitalized Patients of Department of Respiratory in A Hospital%某院呼吸科住院患者感染鲍曼不动杆菌的耐药性分析

    Institute of Scientific and Technical Information of China (English)

    刘永新

    2013-01-01

    Objective Analysis of our hospital respiratory and drug resistance of acinetobacter baumannii infection in hospitalized patients, provide the basis for clinical rational use of antimicrobial agents. Methods Makes the conventional cultivation, separation and identification of all kinds of specimens. The 32 strains of acinetobacter baumannii isolated from the drug susceptibility results are analyzed. Results Acinetobacter baumannii detection rate was 15.4%, the l6 kinds of antimicrobial agents of sensitive rate, high sensitivity of the first five kinds of antimicrobial agents, respectively of ampicillin/shu ba jotham, ofloxacin, piperacillin/he azole, cefepime and tobramycin, their sensitive rate were higher than 20%, the rest of the 11 kinds of antimicrobial drug sensitive rate is below 20%, have higher percentages. With cefazolin, ampicillin, cefotetan, because with nitrofurantoin and ammonia QuNa all performance for the resistance. Conclusions To strengthen the drug resistance of acinetobacter baumannii monitoring and analysis, specification of antimicrobial agents application, to maintain sensitive antimicrobial agents of antimicrobial activity is of great significance.%目的:分析我院呼吸科住院患者感染鲍曼不动杆菌的耐药性,为临床合理使用抗菌药物提供依据。方法对按常规送检的各类标本进行培养、分离和鉴定。对分离出的32株鲍曼不动杆菌的药敏结果进行分析。结果鲍曼不动杆菌检出率为15.4%,其对16种抗菌药物所呈现的敏感率存在差异,其中敏感性较高的前5种抗菌药物分别为氨苄西林/舒巴坦、左旋氧氟沙星、哌拉西林/他唑巴坦、头孢吡肟和妥布霉素,它们的敏感率均高于20%,其余11种抗菌药物敏感率均低于20%,有较高的耐药率。其中头孢唑啉、氨苄西林、头孢替坦、呋喃妥因和氨曲南均表现为全耐药。结论加强对鲍曼不动杆菌的耐药性监测和分析,规范

  2. Radiological Protection Situation Analysis of Nuclear Medicine Department in A Hospital%某医院核医学科放射卫生防护分析

    Institute of Scientific and Technical Information of China (English)

    李宁; 肖国有; 廖光星; 杨鸿宇; 王洪良; 杨志; 邓李燕; 陆静佳

    2015-01-01

    目的:根据国家规定的有关标准,对某核医学科的放射防护情况进行分析与评价,并依据辐射防护最优化原则,给出更为合理的防护建议。方法通过现场监测,使用 BH3103 X-γ便携式巡测仪进行空气比释动能率的测量,X-γ剂量率仪进行辐射剂量率的测量,并估算出工作人员得附加年剂量、患者剂量及通风橱内1 h 换气次数。结果该核医学科科室内外的环境辐射水平在0.10~0.35μGy/h,工作人员的年附加剂量为:分装人员全身为0.11 mSv ;手为2.12 mSv。注射人员全身为0.89 mSv ;手为5.12 mSv。摆位人员全身为0.82 mSv。患者剂量在4.5~5.9 mSv。通风橱检测结果符合防护要求。结论该核医学科的辐射防护监测结果符合国家规定的相关标准要求,放射防护管理较完善。%Objective To analyze and evaluate the radiological protection situation of nuclear medicine department according to national standards on the basis of radiation protection optimization principle,then more reasonable protective suggestions are given. Methods Using BH3103X-γ portable survey instrument to measure the air kerma rate and X-γ dose rate to measure radiation dose rate in the case of field monitoring,then using the data to estimate the workers’additional dose、patients’radiation dose and air change times in a hour. Results The environmental radiation level of the nuclear medicine department’s indoor and outdoor were between 0.10 to 0.35 μGy/h,the workers’additional dose in a year as fol ows :the whole body of repackaging worker was 0.11 mSv and hands were 2.12 mSv,the whole body of injection worker is 0.89 mSv and hands were 5.12 mSv,the whole body of placement worker was 0.89 mSv,the patients’radiation dose were between 4.5 to 5.9 mSv. The test results conform to the protection requirements of the fume hood. Conclusion The radiation protection test results of the nuclear medicine department are

  3. Celiac Disease in Patients Fulfilling the Rome III Criteria for Irritable Bowel Syndrome Attending Gastroenterology Department of A Tertiary Care Hospital in Bangladesh.

    Science.gov (United States)

    Chowdhury, M K; Chakraborty, R; Gope, S; Rahman, M A; Miah, A R; Raihan, A S; Sarkar, S; Paul, B K; Ferdousi, K R

    2016-01-01

    Irritable bowel syndrome (IBS) is a chronic gastrointestinal disorder that substantially affects patients' quality of life and is associated with a considerable drain of health-care resources and economic burden. But some IBS patients may have celiac disease that could be treated by gluten-free diet which will subsequently improve their quality of life. This study was done to see the prevalence of celiac disease among the IBS patients fulfilling Rome III criteria. The present cross-sectional study was conducted in the Department of Gastroenterology at BSMMU, Dhaka from July 2010 to September 2011. A total of 107 patients aged ranging between 16-60 years clinically labeled as IBS and fulfilled Rome III criteria were included as study sample. The test statistics used to analyze the data were descriptive statistics. The mean age of the patients was 31.5±10.3 years and male to female ratio was roughly 6:1. The mean duration of IBS was 32.0±2.1 months. All of the patients had abdominal discomfort or pain in the preceding 6 months and had a history of loose (mushy) or watery stool, 99.1% had pain or discomfort relieved with defaecation. The prevalence of diarrhoea was found in 78.5% and mixed 21.5% of the patients. About 5% of the patients had raised ESR and majority (86.9%) of the patients had normal level of hemoglobin. Ten (9%) of 107 patients were found positive for anti-t TG (IgA). These findings suggest that an around one-tenth of IBS especially diarrhoea predominant patients may have celiac disease who will respond to simple gluten-free diet thus minimizing the morbidity and mortality. So, all clinically diagnosed IBS patients especially diarrhoea predominant cases should be suggested for the screening for celiac disease.

  4. Study of patients of road traffic accidents a rriving in emergency department [ED] of V.S hospital at Ahmedabad city, single centre pilot study.

    Directory of Open Access Journals (Sweden)

    Aharnish Shah

    2014-07-01

    Full Text Available Objectives of the study According to the latest world status report on road safety released by WHO, we are now the world leaders in road traffic accident rate & related mortality. Our study intends to find out the epidemiological factors, risk factors, use of safety measures, compliance with traffic laws, presenting injuries & ED intervention required, in patients with road traffic accidents. Materials & methods Our study is a cross sectional observational study in which data was obtained from 150 patients of road traffic accidents arriving at any time to emergency department. Collected data included information about basic details, basic crash characteristics, risk factors, use of safety measures, injuries sustained, ED intervention required & disposition. Results Approximately 77% of the patients belong to 11-50 yr age group. The most common time of RTA is between 6 am to 12 noon [36.67%]. However accidents requiring admission were more during night time [62.74%]. Innocent passengers & pedestrians contributed to 41% of the accident cases. Non compliance with traffic laws & safety measures like driving without license [20%], using mobile phones while driving [10%], not using headlights at night [26%], not using seatbelts [80%], not using helmets [91%], etc were found in a substantial number of cases. Intracranial bleed & skull fractures were significantly (31.2% v/s 0% more in drivers without helmets than those with helmets. ED intervention required in decreasing order were dressing ( 38%, laceration repair (27.33%, splinting (24%, crash intubation (10%, ICD (2.66%. Conclusion: Well equipped secondary & tertiary level trauma centres, specially dedicated to management of trauma patients, with a proper triage plan, are necessary for proper management of trauma patients & better utilisation of resources. Our study shows that an ER physician should be trained in l aceration repair, dressing, splint/slab application, fracture/dislocation reduction

  5. A prospective, non-interventional study of assessment and treatment adequacy of pain in the emergency department of a tertiary care cancer hospital

    Directory of Open Access Journals (Sweden)

    P N Jain

    2013-01-01

    Full Text Available Introduction: Pain is the most common reason for emergency department (ED visits by the cancer patients. Treatment inconsistency and inadequacy are reported worldwide in the management of ED pain. We conducted a non-interventional observational study of 100 patients visiting ED with moderate to severe pain in a tertiary care cancer center. Aims: The goal of this study was to describe the characteristics of pain and its treatment by oncologists in ED. Materials and Methods: Management of 100 adult patients with complaints of moderate to severe pain was observed by the investigator in ED. Treatment was provided by the doctors of respective oncological services. Later, patients were interviewed by the investigator to collect data about the details of their pain and treatment adequacy. Results: On arrival to ED, about 65% patients reported severe pain, however no formal pain assessment was performed and no patient received strong opioids. Poor compliance for prescribed analgesic medications was noted in a large number of patients (31%, primarily due to suboptimal pain relief and lack of awareness. Protocol based analgesic treatment was non-existent in ED. Majority of patients remained in significant pain after 30 min of analgesic administration and 24% patients could never achieve more than 50% pain relief at the time of discharge. Conclusion: Due to lack of formal pain assessment and laid down protocols, suboptimal pain management is commonly prevalent in ED. Use of strong opioids continues to be scarce in management of severe pain. There is a need to formulate pain management protocols for ED pain.

  6. An automated, broad-based, near real-time public health surveillance system using presentations to hospital Emergency Departments in New South Wales, Australia

    Directory of Open Access Journals (Sweden)

    Chiu Clayton

    2005-12-01

    Full Text Available Abstract Background In a climate of concern over bioterrorism threats and emergent diseases, public health authorities are trialling more timely surveillance systems. The 2003 Rugby World Cup (RWC provided an opportunity to test the viability of a near real-time syndromic surveillance system in metropolitan Sydney, Australia. We describe the development and early results of this largely automated system that used data routinely collected in Emergency Departments (EDs. Methods Twelve of 49 EDs in the Sydney metropolitan area automatically transmitted surveillance data from their existing information systems to a central database in near real-time. Information captured for each ED visit included patient demographic details, presenting problem and nursing assessment entered as free-text at triage time, physician-assigned provisional diagnosis codes, and status at departure from the ED. Both diagnoses from the EDs and triage text were used to assign syndrome categories. The text information was automatically classified into one or more of 26 syndrome categories using automated "naïve Bayes" text categorisation techniques. Automated processes were used to analyse both diagnosis and free text-based syndrome data and to produce web-based statistical summaries for daily review. An adjusted cumulative sum (cusum was used to assess the statistical significance of trends. Results During the RWC the system did not identify any major public health threats associated with the tournament, mass gatherings or the influx of visitors. This was consistent with evidence from other sources, although two known outbreaks were already in progress before the tournament. Limited baseline in early monitoring prevented the system from automatically identifying these ongoing outbreaks. Data capture was invisible to clinical staff in EDs and did not add to their workload. Conclusion We have demonstrated the feasibility and potential utility of syndromic surveillance using

  7. [The choice of a pediatric anesthesia ventilator].

    Science.gov (United States)

    Kern, D; Larcher, C; Cottron, N; Ait Aissa, D; Fesseau, R; Alacoque, X; Delort, F; Masquère, P; Agnès, E; Visnadi, G; Fourcade, O

    2013-12-01

    The technology of anesthesia ventilators has substantially progressed during last years. The choice of a pediatric anesthesia ventilator needs to be led by multiple parameters: requirement, technical (pneumatic performance, velocity of halogenated or oxygen delivery), cost (purchase, in operation, preventive and curative maintenance), reliability, ergonomy, upgradability, and compatibility. The demonstration of the interest of pressure support mode during maintenance of spontaneous ventilation anesthesia makes this mode essential in pediatrics. In contrast, the financial impact of target controlled inhalation of halogenated has not be studied in pediatrics. Paradoxically, complex and various available technologies had not been much prospectively studied. Anesthesia ventilators performances in pediatrics need to be clarified in further clinical and bench test studies.

  8. Anesthesia in a Baird's tapir (Tapirus bairdii).

    Science.gov (United States)

    Trim, C M; Lamberski, N; Kissel, D I; Quandt, J E

    1998-06-01

    A Baird's tapir (Tapirus bairdii) was satisfactorily immobilized on two occasions with i.m. detomidine (0.065-0.13 mg/kg) and butorphanol (0.13-0.2 mg/kg). On the second occasion, anesthesia was induced by i.v. administration of ketamine (2.2 mg/kg). Twenty minutes later, endotracheal intubation was performed after an additional i.v. injection of ketamine (1.5 mg/kg). Anesthesia was maintained with isoflurane, which provided excellent conditions for radiology and surgery. Anesthesia was associated with hypoxemia when the tapir was allowed to breathe air and with hypoventilation. Mean arterial pressure remained satisfactory. No antagonist drugs were administered, and recovery from anesthesia was rapid and smooth.

  9. Anesthesia: What to Expect (For Parents)

    Science.gov (United States)

    ... a wide variety of modern medicines and monitoring technology to make sure that kids are stable and as comfortable as possible before, during, and after their ... Parents MORE ON THIS TOPIC Anesthesia Basics Types of ...

  10. Investigations Regarding Anesthesia during Hypovolemic Conditions.

    Science.gov (United States)

    1983-09-25

    supplier (J.G. Boswell Co.) artificially inseminates all swine, thus breeding is exactly controlled, and genetic make-up known and reproducible. Their...the facility is not required thus eliminating unproductive quarantine time and diminishing housing costs. Since our supplier artificially insem...this .ouiu be beneficial % hen iniucing anesthesia during . hypovole.iia. I.en used tor induction of anesthesia ouring hypovolemia, ketamine incrcases

  11. Single-lung ventilation in pediatric anesthesia.

    Science.gov (United States)

    Choudhry, Dinesh K

    2005-12-01

    Single-lung ventilation is requested for an increasing spectrum of surgical procedures in infants and children. A clear understanding of the physiology of single-lung ventilation, the techniques of lung separation, and the technical skill necessary to apply these techniques are essential for an anesthesiologist practicing thoracic anesthesia. This article focuses on various devices available for single-lung ventilation in the pediatric age group, the relevant respiratory physiology, and the strategies that optimize oxygenation during one-lung anesthesia.

  12. Mobile anesthesia: Ready, set, pack, and go

    OpenAIRE

    Khayata, Issam; Bourque, Jesse

    2012-01-01

    Introduction: Although we get into the habit of thinking that anesthesia cannot be safely delivered without the availability of all equipments available in a state of the art Operating room, we find ourselves faced with situations where the availability and mobility of all this equipment is limited ; this results in the impetus to start a thought process of how we can perform mobile anesthesia with less technology. Disaster situations, such as earthquakes, floods, or armed conflicts, might ha...

  13. Advances in local anesthesia in dentistry.

    Science.gov (United States)

    Ogle, Orrett E; Mahjoubi, Ghazal

    2011-07-01

    Local pain management is the most critical aspect of patient care in dentistry. The improvements in agents and techniques for local anesthesia are probably the most significant advances that have occurred in dental science. This article provides an update on the most recently introduced local anesthetic agents along with new technologies used to deliver local anesthetics. Safety devices are also discussed, along with an innovative method for reducing the annoying numbness of the lip and tongue following local anesthesia.

  14. Anesthesia and analgesia for geriatric veterinary patients.

    Science.gov (United States)

    Baetge, Courtney L; Matthews, Nora S

    2012-07-01

    The number of geriatric veterinary patients presented for anesthesia appears to be increasing. This article summarizes physiologic changes that occur in geriatric patients that are relevant to anesthesia. Proper patient preparation and vigilant monitoring are the best defense against anesthetic problems in the geriatric animal. The authors also discuss particular anesthetic problems as they relate to geriatric patients and seek to present solutions to these problems.

  15. About Forum of Anesthesia and Monitoring

    Institute of Scientific and Technical Information of China (English)

    2003-01-01

    Forum of Anesthesia and Monitoring is one of the leading publications for the specialties of Anesthesia,Intensive Care and Pain in China, sponsored by Beijing Committee of Anesthesiologists of Chinese Medical Association and Medical Information Limited. Published since 1993, it is widely regarded as the popular scientific journal in the specialty. This is evidenced not just by its circulation, but by its influences to the young anesthetists in China.

  16. About Forum of Anesthesia and Monitoring

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    Forum of Anesthesia and Monitoring is one of the leading publications for the specialties of Anesthesia.Intensive Care and Pain in China. sponsored by Beijing Committee of Anesthesiologists of Chinese Medical Association and Medical Information Limited. Published since 1993, it is widely regarded as the popular scientific journal in the specialty. This is evidenced not just by its circulation, but by its influences to the.young anesthetists in China.

  17. Anesthesia Approach in Endovascular Aortic Reconstruction

    Directory of Open Access Journals (Sweden)

    Ayşin Alagöl

    2013-03-01

    Full Text Available Introduction: We have analyzed our initial results of our anesthesia techniques in our new-onset endovascular aortic reconstruction cases.Patients and Methods: The perioperative data of 15 elective and emergent endovascular aortic reconstruction cases that were operated in 2010-2011 were collected in a database. The choice of anesthesia was made by the risk factors, surgical team’s preferences, type and location of the aortic pathology and by the predicted operation duration. The data of local and general anesthesia cases were compared.Results: Thirteen (86.7% cases were male and 2 (13.3% female. Eleven patients were in ASA Class III. The demographic parameters, ASA classifications, concurrent diseases were similar in both groups. Thirteen (86.7% cases had infrarenal abdominal aortic aneurysm and 2 (13.3% had Type III aortic dissection. The diastolic arterial pressures were lower in general anesthesia group in 20th and 40th minutes’ measurements just like the mean arterial pressure measurements at the 40th, 100th minutes and during the deployment of the graft. Postoperative mortality occurred in 3 (20.0% patients and they all had general anesthesia and they were operated on emergency basis. Postoperative morbidity occurred in four patients that had general anesthesia (acute renal failure, multi-organ failure and pneumonia. The other patient had atrial fibrillation on the 1st postoperative day and was converted to sinus rhythm with amiodarone infusion.Conclusion: Edovascular aortic reconstruction procedures can safely be performed with both general and local anesthesia less invasively compared to open surgery. General anesthesia may be preferred for the better hemodynamic control.

  18. [Pneumocystis Pneumonia in 107 HIV Infected Patients Admitted to the Department of Infectious Diseases at Santa Maria Hospital, Lisbon (2002 - 2013)].

    Science.gov (United States)

    Grilo, Vilma; Pereira, Aida

    2016-10-01

    Introdução: A pneumonia por Pneumocystis jirovecii é das doenças infecciosas oportunistas mais comuns em infectados por vírus da imunodeficiência humana, sendo, actualmente, em Portugal a infecção definidora de sida mais reportada. Os objectivos deste estudo foram, analisar as características de uma população co-infectada por vírus da imunodeficiência humana e pneumonia por Pneumocystis jirovecii, comparando-a com as referências disponíveis, e avaliar comparativamente subpopulações de doentes, consoante o conhecimento prévio da infecção por vírus da imunodeficiência humana, o método de diagnóstico de pneumonia por Pneumocystis jirovecii e o resultado na alta. Material e Métodos: Realizámos um estudo restrospectivo pela análise dos registos clínicos de 107 doentes internados no Serviço de Doenças Infecciosas do Hospital de Santa Maria, entre 1 de janeiro de 2002 e 31 de dezembro de 2013, com o diagnóstico de pneumonia por Pneumocystis jirovecii e vírus da imunodeficiência humana. As características epidemiológicas e clínicas foram avaliadas, incluindo o estado imunitário, a carga vírica e a terapêutica instituída e foi realizado um estudo estatístico das variáveis.Resultados: Nesta população, os resultados demonstraram predomínio do sexo masculino (81,3%), idade entre 20 - 39 anos (59,2%), transmissão de vírus da imunodeficiência humana por via heterossexual (48,6%), e que 24,3% eram imigrantes. Apesar do conhecimento da infecção por vírus da imunodeficiência humana (62,6%), 76,2% destes doentes não apresentava seguimento médico sustentado. A contagem de linfócitos TCD4+ ≤ 200 células/mm3 (96,3%), carga vírica elevada e candidose orofaríngea (72%) foram os principais factores de risco para o desenvolvimento de pneumonia por Pneumocystis jirovecii, e os marcadores de gravidade, como a hipoxemia (78,5%) e a elevação da LDH (82,2%) não traduziram pior prognóstico. Apenas foi possível isolar

  19. 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...

  20. Potential anesthesia protocols for space exploration missions.

    Science.gov (United States)

    Komorowski, Matthieu; Watkins, Sharmila D; Lebuffe, Gilles; Clark, Jonathan B

    2013-03-01

    In spaceflight beyond low Earth's orbit, medical conditions requiring surgery are of a high level of concern because of their potential impact on crew health and mission success. Whereas surgical techniques have been thoroughly studied in spaceflight analogues, the research focusing on anesthesia is limited. To provide safe anesthesia during an exploration mission will be a highly challenging task. The research objective is thus to describe specific anesthesia procedures enabling treatment of pre-identified surgical conditions. Among the medical conditions considered by the NASA Human Research Program Exploration Medical Capability element, those potentially necessitating anesthesia techniques have been identified. The most appropriate procedure for each condition is thoroughly discussed. The substantial cost of training time necessary to implement regional anesthesia is pointed out. Within general anesthetics, ketamine combines the unique advantages of preservation of cardiovascular stability, the protective airway reflexes, and spontaneous ventilation. Ketamine side effects have for decades tempered enthusiasm for its use, but recent developments in mitigation means broadened its indications. The extensive experience gathered in remote environments, with minimal equipment and occasionally by insufficiently trained care providers, confirms its high degree of safety. Two ketamine-based anesthesia protocols are described with their corresponding indications. They have been designed taking into account the physiological changes occurring in microgravity and the specific constraints of exploration missions. This investigation could not only improve surgical care during long-duration spaceflights, but may find a number of terrestrial applications in isolated or austere environments.

  1. 北京天坛医院神经科护士满意度相关因素研究%Potential Factors of Job Satisfactory among Nurses in Department of Neurology in ;Beijing Tiantan Hospital

    Institute of Scientific and Technical Information of China (English)

    张华; 王忠; 王彩云; 贾金秀; 王晨

    2015-01-01

    Objective To investigate the potential factors associated to job satisfactory of nurses in department of Neurology in Beijing Tiantan Hospital, improve the job satisfactory and quality of care, and consolidate nursing team that contribute to the harmonious and stable development. Methods An advanced assessment system was used to perform the investigation of job satisfactory among 393 nurses in department of Neurology in Beijing Tiantan Hospital. Results Family/job (P Conclusion Individual and humanized working time arrangements were beneifcial for resolution of conlficts between family and work;improvement of working environment and safety equipment, scientific and reasonable evaluation of the value of nursing work to achieve rational income distribution, strengthening communication between managers and nurses, and timely improvement of management methods would improve the job satisfactory.%目的了解影响神经科护士工作满意度的因素。  方法借鉴国外成熟的测评体系对393名神经科护士满意度进行调查。  结果家庭/工作(P  结论实现人性化安排工作时间,积极落实并妥善处理工作和家庭间冲突,改善工作环境及安全设施,科学合理评估护理的工作价值,进行合理分配收入,切实完善管理机制,以提高护士工作满意度。

  2. Predictors of Failure of Awake Regional Anesthesia for Neonatal Hernia Repair : Data from the General Anesthesia Compared to Spinal Anesthesia Study-Comparing Apnea and Neurodevelopmental Outcomes

    NARCIS (Netherlands)

    Frawley, Geoff; Bell, Graham; Disma, Nicola; Withington, Davinia E; de Graaff, Jurgen C; Morton, Neil S; McCann, Mary Ellen; Arnup, Sarah J; Bagshaw, Oliver; Wolfler, Andrea; Bellinger, David; Davidson, Andrew J; Absalom, Anthony

    2015-01-01

    BACKGROUND: Awake regional anesthesia (RA) is a viable alternative to general anesthesia (GA) for infants undergoing lower abdominal surgery. Benefits include lower incidence of postoperative apnea and avoidance of anesthetic agents that may increase neuroapoptosis and worsen neurocognitive outcomes

  3. Predictors of Failure of Awake Regional Anesthesia for Neonatal Hernia Repair : Data from the General Anesthesia Compared to Spinal Anesthesia Study--Comparing Apnea and Neurodevelopmental Outcomes

    NARCIS (Netherlands)

    Frawley, Geoff; Bell, Graham; Disma, Nicola; Withington, Davinia E; de Graaff, Jurgen C; Morton, Neil S; McCann, Mary Ellen; Arnup, Sarah J; Bagshaw, Oliver; Wolfler, Andrea; Bellinger, David; Davidson, Andrew J

    2015-01-01

    BACKGROUND: Awake regional anesthesia (RA) is a viable alternative to general anesthesia (GA) for infants undergoing lower abdominal surgery. Benefits include lower incidence of postoperative apnea and avoidance of anesthetic agents that may increase neuroapoptosis and worsen neurocognitive outcomes

  4. [Application of Non-intubated Anesthesia in VATS].

    Science.gov (United States)

    Dai, Xiaotan; Song, Pingping; Zhang, Baijiang

    2016-05-20

    Tracheal intubation general anesthesia technique is widely used in video-assisted thoracic surgery (VATS) because it can improve the safety of VATS, but the complications of tracheal intubation can not be avoided. How to develop a "minimally invasive" surgery (including micro anesthesia) has become a hot topic in the field of minimally invasive surgery. Along with the progress of the anesthesia management technology and the risk management in the operation, the technology of non-intubated anesthesia was successfully applied to VATS, namely using local anesthesia to maintain patients intraoperative independent ventilation and intraoperative only mild sedation or fully conscious state of implementation of thoracoscope surgery, therefore is also called awake VATS. The anesthesia method not only reduces the anesthesia injury of tracheal intubation, but also conforms to the idea of rapid rehabilitation surgery. Based on non-intubated anesthesia in VATS in the brief history of development, the anesthesia selection, operation advantages and risks are reviewed in this paper.

  5. Problems and Countermeasures of the Daily Management of the Grass-Roots Hospital Pharmacy Department%基层医院药剂科日常管理存在的问题及对策

    Institute of Scientific and Technical Information of China (English)

    祝国强

    2015-01-01

    随着现代医药研究的进步,有新的医药产品被不断研发出来,并在临床上得到广泛的应用,这就要求强化医药产品的日常管理。医院药剂科就是管理临床医药产品的重要性部门,其职责就是向各科室提供临床用药,并进行监督和管理,以保证患者安全,药剂管理是医院管理中不可或缺的部分。但是,目前在我国基层医院的药剂管理存在一些问题,影响到药物临床应用的安全性和有效性,本文全面剖析存在的问题,并提出了相应的对策和建议,以期实现科学、合理的药剂日常管理。%With the development of modern medical research progress, there have been new pharmaceutical products have been developed, and is widely used in clinic, this requires strengthening the daily management of pharmaceutical products. The hospital pharmacy management of clinical medicine is the importance of the product department, whose duty is to all departments to provide clinical medication, and supervise and management, to ensure the effective drug to patient safety, therefore said, pharmacy management is an integral part of the management of the hospital. However, there are some prob-lems in the pharmacy management of grass roots hospitals in our country, the influence to the safety and effectiveness of clinical drug application, in this paper, a comprehensive analysis of the existing problems, and puts forward the correspond-ing countermeasures and suggestions, in order to realize the scientific, reasonable drug daily management.

  6. The Application of Topical Anesthesia Combined with Subconjunctival Anesthesia for Glaucoma Surgery

    Institute of Scientific and Technical Information of China (English)

    Shengsong Huang; Minbin Yu; Jie Lian; Min Fan; Changyu Qiu

    2003-01-01

    Purpose: To evaluate the feasibility, reliability and analgesia effect of topical anesthesia combined with subconjunctival anesthesia in anti-glaucomatous surgery.Methods: Two hundred and four cases (357 eyes) underwent anti-glaucomatous surgeries under topical anesthesia with 0.5% Alcaine eye drops combined with subconjunctival anesthesia with 2% Lidocaine. The analgesic effect was analysed with visual analogue pain scale.Results: Among all of 357 eyes, 62 eyes underwent peripheral iridectomy, 67 eyes underwent simple trabeculectomy, 167 eyes underwent compound brabeculectomy and 12 eyes nonpenetrating trabecular surgery. The effects of anesthesia were as follows: 304 eyes(85.2%) were painless (Grade I ), 50 eyes (14.0%) were slight painful (Grade Ⅱ ), and 3 eyes (0.8%) were more painful (Grade Ⅲ ) during surgery. And no severe complications were observed in all the cases during surgery and postoperatively. Amaurosis fugax was not observed in the glaucoma patients at the late stage with narrow visual fields and poor visual ability.Conclusion: Topical anesthesia combined with subconjunctival anesthesia is effective,safe and simple anesthesia alternative in routine anti-glaucomatous surgery, especially for the glaucoma patients at the late stage with narrow visual fields and poor visual ability. It is worthy of being applied widely.

  7. Los factores psicosociales determinan la aceptación de la hospitalización a domicilio directamente desde el servicio de urgencias Psychosocial factors determine patients' acceptance of emergency department discharge directly to hospital-at-home care

    Directory of Open Access Journals (Sweden)

    Sònia Jiménez

    2010-08-01

    ' acceptance of emergency department discharge directly to hospital-at-home care. Patients and methods: We performed a prospective observational cohort study of patients seen at the emergency department who met the following inclusion criteria: need for hospital admission, ability to be interviewed, and availability of an informal caregiver. The dependent variable was defined as the predisposition to accept or refuse hospital-at-home care. For each patient, the following independent variables were recorded: demographic characteristics, health-related factors, comorbidities, current illness and psychosocial perceptions related to hospital-at-home care. The associations among the variables were tested by means of logistic regression analysis. Results: We included 129 patients. Seventy-one percent would have accepted hospital-at-home care. Acceptance of hospital-at-home care was associated with psychosocial perceptions only, independently of demographic characteristics, current illness severity and comorbidities. These psychosocial perceptions included adequate conditions at home (OR: 4.31; 95% CI: 1.18-15.78, not being afraid of oxygen manipulation (OR: 5.99; 95% CI: 2.05-17.52, lack of fear of a poor outcome (OR: 6.07; 95% CI: 1.94-18.96 and the possibility of enjoying a more flexible schedule (OR: 12.61; 95% CI: 3.31-48.01. Conclusions: Hospital-at-home care would be well accepted by patients if offered in the emergency department as an alternative to conventional hospitalization. Acceptance depends on patients' psychosocial perceptions, which should be assessed before this mode of care is proposed.

  8. The formation and design of the 'Acute Admission Database'- a database including a prospective, observational cohort of 6279 patients triaged in the emergency department in a larger Danish hospital

    Directory of Open Access Journals (Sweden)

    Barfod Charlotte

    2012-04-01

    Full Text Available Abstract Background Management and care of the acutely ill patient has improved over the last years due to introduction of systematic assessment and accelerated treatment protocols. We have, however, sparse knowledge of the association between patient status at admission to hospital and patient outcome. A likely explanation is the difficulty in retrieving all relevant information from one database. The objective of this article was 1 to describe the formation and design of the 'Acute Admission Database', and 2 to characterize the cohort included. Methods All adult patients triaged at the Emergency Department at Hillerød Hospital and admitted either to the observationary unit or to a general ward in-hospital were prospectively included during a period of 22 weeks. The triage system used was a Danish adaptation of the Swedish triage system, ADAPT. Data from 3 different data sources was merged using a unique identifier, the Central Personal Registry number; 1 Data from patient admission; time and date, vital signs, presenting complaint and triage category, 2 Blood sample results taken at admission, including a venous acid-base status, and 3 Outcome measures, e.g. length of stay, admission to Intensive Care Unit, and mortality within 7 and 28 days after admission. Results In primary triage, patients were categorized as red (4.4%, orange (25.2%, yellow (38.7% and green (31.7%. Abnormal vital signs were present at admission in 25% of the patients, most often temperature (10.5%, saturation of peripheral oxygen (9.2%, Glasgow Coma Score (6.6% and respiratory rate (4.8%. A venous acid-base status was obtained in 43% of all patients. The majority (78% had a pH within the normal range (7.35-7.45, 15% had acidosis (pH 7.45. Median length of stay was 2 days (range 1-123. The proportion of patients admitted to Intensive Care Unit was 1.6% (95% CI 1.2-2.0, 1.8% (95% CI 1.5-2.2 died within 7 days, and 4.2% (95% CI 3.7-4.7 died within 28 days after admission

  9. 合理用药软件系统在我院门诊处方调配中的应用%Application of Rational Drug Use Software System in the Drug Dispensing in Outpatient Department of Our Hospital

    Institute of Scientific and Technical Information of China (English)

    陈蓉; 顾宝晨; 龚银华; 虞勋; 包健安

    2016-01-01

    目的:探讨合理用药软件系统在我院门诊处方调配中的应用。方法:介绍合理用药软件系统(包括临床用药决策支持软件、发药软件、药品管理软件)在我院门诊处方开具(事前预警)、处方调配(事中干预)、处方点评(事后监管)中的应用情况。通过收集我院使用合理用药软件系统后门诊处方审查及干预等情况评价其应用效果。结果与结论:借助合理用药软件系统,实现了对处方用药的事前、事中及事后科学、方便、快捷的监控与管理;我院2015年1-5月共监测门诊处方721507份,系统警示拦截的处方占0.17‰,系统审核提示药师审核的处方占23.25%,处方合格率均在99.96%以上;经药师干预后,各种不合理类型处方数均有明显下降(P<0.01)。建议药师在充分应用信息化系统的同时,在实践中积极探索以对其不断优化改进,从而促进医院合理用药水平的提高。%OBJECTIVE:To discuss the application of rational drug use software system in drug dispensing in outpatient depart-ment of our hospital. METHODS:The application of rational drug use software system (included clinical decision support soft-ware,drug dispensing software and drug management software) in prescribing (warning in advance),dispensing (intervention in the event)and the prescription review(the post review)in outpatient department of our hospital were all introduced. Outpatient pre-scription checking and intervention were collected from our hospital after the application of rational drug use software system to evaluate the effect of the software system. RESULTS & CONCLUSIONS:Rational drug use software system is adopted to realize scientific,convenient and express monitoring and management of prescription drug use in advance,in the course and afterwards. A total of 721 507 outpatient prescriptions were checked in our hospital from Jan. to May in 2015;0.17

  10. 呼吸内科住院患者口腔感染调查及危险因素分析%Risk factors for oral infections in hospitalized patients of department of respiratory medicine

    Institute of Scientific and Technical Information of China (English)

    谢云; 诸兰艳; 范杜

    2014-01-01

    目的:了解呼吸内科住院患者口腔感染的感染率、病原菌分布及其相关危险因素,为防治呼吸内科住院患者口腔感染提供科学依据。方法回顾性调查医院呼吸内科2010年1月-2011年12月收治的2908例住院患者临床资料,对口腔感染危险因素进行单因素分析,并对差异有统计学意