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Sample records for army community hospital

  1. Strategic Analysis and Associated Management Products Supporting the Reengineering of Bayne-Jones Army Community Hospital: Consultative Products and Findings

    National Research Council Canada - National Science Library

    Fulton, Larry

    1998-01-01

    .... ̂Product 2 - "Bayne-Jones Army Community Hospital Web Site," a strategic Internet web site for marketing health and wellness, the TRICARE medical network, the Joint Readiness Training Center Surgeon's...

  2. Staying Prepared for the Joint Commission: Restructuring for Continuous Accreditation, Reynolds Army Community Hospital

    National Research Council Canada - National Science Library

    Lindsay, Richard

    2001-01-01

    .... The Joint Commission on the Accreditation of Healthcare Organizations and consequently, the U.S. Army Medical Department are measuring a great deal of a hospitals effectiveness and quality of services based on Performance Improvement...

  3. Strategic Planning for Irwin Army Community Hospital: The Assessment and Implementation of Services, in Order to Meet Fort Riley's Increasing Population

    National Research Council Canada - National Science Library

    Besser, Christopher S

    2008-01-01

    ... that is significantly increasing in size yet with the same physical support structure. The purpose of this research is to develop a strategic plan to determine an optimal "mix" of services for Irwin Army Community Hospital (IACH...

  4. Alternatives to Address Role Clarification at the U.S. Army Community Hospital, Fort Polk

    Science.gov (United States)

    1981-06-01

    Study on Conflict in Two Hospitals," Health Services Manager, 11 (December 1978): 1-9. 2 Richard Beckhard , Explorations on the Teaching and Learning of...ward to seeing you on the 21st of March. RICHARD B. STUART, M.D. COL, m Commanding 78 APPENDIX E AFTER ACTION REPORT ON ROLE CLARIFICATION WORKSHOP 79

  5. Defining the Role and Functions of the Utilization Management Nurse Consultant at Keller Army Community Hospital

    Science.gov (United States)

    1993-08-01

    encephalitis, quadriplegio and paraplegia. Cardiovascular Conditions Myocardial infarction, cardiac bypass surgery, cardiac valvular disease , intractable...moving patients from an inpatient acute care hospital setting to less costly alternative setting such as their homes. Case managers often have...that 40% of patients admitted to acute care beds could have been cared for at less acute and expensive levels. In a time of reduced resources, the VA

  6. A Study of the Civilian-Military Contingency Hospital System at Keeler Army Community Hospital, West Point, New York

    Science.gov (United States)

    1983-04-01

    Rochelle Hospital Medical Center 16 Guion Place, Box 321 New Rochelle, New York 10802 Edward C. Ackerman 231 (914) 631-5100 Executive Director Phelps...Hospital New Rochelle Medical Center DoD Executive Agent 16 Guion Place New Rochelle, N.Y. Date:_____________ Date: ,//_ _ FOR THE VETERANS...3) Make maximum use of locally available communication system to include EMS and Hospital Emergency Administrative Radio (HEAR). d. Transportation

  7. A Study to Identify the Determinants of Patient Satisfaction at Martin Army Community Hospital Using Quantitative and Qualitative Methods

    Science.gov (United States)

    1990-06-01

    1988). Psychographic segmentation for marketing success, Healthcare Executive, March/April, 26-29. Oliver 87 Friedman, John (1989). Applied marketing ...the statistical calculations presented in this paper. X The Marketing Committee of MACH for their 0 involvement in determining the questions to be...services available at the Oliver 14 hospital--capitalizing on one of the best consumer marketing opportunities available in hospitals today. However

  8. An Analysis of High Frequency Users of the Martin Army Community Hospital Emergency Room: Factors Contributing to Heightened Utilization

    Science.gov (United States)

    1997-06-01

    Frequency of Use By Stability of Location 40 Frequency of Use By Tobacco Use 41 Frequency of Use By Overweight Individuals 42 Frequency of Use By...38 Table 17. Insurance by Group 39 Table 18. Location Stability by Group 40 Table 19. Tobacco Use by Group 41 Table 20. Overweight...topics for this Graduate Management Project ( GMP ), outpatient utilization was identified as an area of perceived weakness for the hospital. In order

  9. Community Hospital Telehealth Consortium

    National Research Council Canada - National Science Library

    Williams, Elton

    2003-01-01

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

  10. Community Hospital Telehealth Consortium

    National Research Council Canada - National Science Library

    Williams, Jr, Elton L

    2007-01-01

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

  11. Factors predicting health behaviors among Army Reserve, active duty Army, and civilian hospital employees.

    Science.gov (United States)

    Wynd, Christine A; Ryan-Wenger, Nancy A

    2004-12-01

    This study identified health-risk and health-promoting behaviors in military and civilian personnel employed in hospitals. Intrinsic self-motivation and extrinsic organizational workplace factors were examined as predictors of health behaviors. Because reservists represent a blend of military and civilian lifestyles, descriptive analyses focused on comparing Army Reserve personnel (n = 199) with active duty Army (n = 218) and civilian employees (n = 193), for a total sample of 610. Self-motivation and social support were significant factors contributing to the adoption of health-promoting behaviors; however, organizational workplace cultures were inconsistent predictors of health among the three groups. Only the active Army subgroup identified a hierarchical culture as having an influence on health promotion, possibly because of the Army's mandatory physical fitness and weight control standards. Social support and self-motivation are essential to promoting health among employees, thus hospital commanders and chief executive officers should encourage strategies that enhance and reward these behaviors.

  12. Multistage Deployment of the Army Theater Hospital

    Science.gov (United States)

    2013-12-01

    2. Analysis ...............................................................................................43 E. COMMANDER’S RISK ASSESMENT EFFECTS...environments that traverse mountainous ranges to city streets, for a plethora of casualties to include women, children , and the elderly. The ideal hospital...includes women soldiers and civilian contractors, local national civilian women, children , and elderly, and larger quantities of detainees. This study

  13. A Study to Determine the Feasibility of Establishing a Same-Day Surgery Program at General Leonard Wood Army Community Hospital, Fort Leonard Wood, Missouri

    Science.gov (United States)

    1989-05-23

    ancient Egypt (Schneck 1S98, 2q8). Prior to the advent of M IZ,z general anesthesia and modern hospital construction, most m patients with financial means...PROCEDURE 1 7 378 ECTOPIC PREGNANCY 3 7 z 379 THREATENED ABORTION 1 6 rn 380 ABORTION W/O D&C 1 4 v 381 ABORTION WITH D&C ASPIRATION CURETTAGE, OR...MALIGNANCY AGE ា W/O CC 1 360 VAGINA, CERVIX & VULVA PROCEDURES 2 361 LAPAROSCOPY & INCISIONAL TUBAL INTERRUPTION 48 378 ECTOPIC PREGNANCY 4 379

  14. Predicting U.S. Army suicides after hospitalizations with psychiatric diagnoses in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

    Science.gov (United States)

    Kessler, Ronald C.; Warner, LTC Christopher H.; Ivany, LTC Christopher; Petukhova, Maria V.; Rose, Sherri; Bromet, Evelyn J.; Brown, LTC Millard; Cai, Tianxi; Colpe, Lisa J.; Cox, Kenneth L.; Fullerton, Carol S.; Gilman, Stephen E.; Gruber, Michael J.; Heeringa, Steven G.; Lewandowski-Romps, Lisa; Li, Junlong; Millikan-Bell, Amy M.; Naifeh, James A.; Nock, Matthew K.; Rosellini, Anthony J.; Sampson, Nancy A.; Schoenbaum, Michael; Stein, Murray B.; Wessely, Simon; Zaslavsky, Alan M.; Ursano, Robert J.

    2014-01-01

    IMPORTANCE The U.S. Army experienced a sharp rise in suicides beginning in 2004. Administrative data show that among those at highest risk are soldiers in the 12 months after inpatient treatment of a psychiatric disorder. OBJECTIVE To develop an actuarial risk algorithm predicting suicide in the 12 months after US Army soldier inpatient treatment of a psychiatric disorder to target expanded post-hospital care. DESIGN, SETTING, AND PARTICIPANTS There were 53,769 hospitalizations of active duty soldiers in 2004–2009 with ICD-9-CM psychiatric admission diagnoses. Administrative data available prior to hospital discharge abstracted from a wide range of data systems (socio81 demographic, Army career, criminal justice, medical/pharmacy) were used to predict suicides in the subsequent 12 months using machine learning methods (regression trees, penalized regressions) designed to evaluate cross-validated linear, nonlinear, and interactive predictive associations. MAIN OUTCOME Suicides of soldiers hospitalized with psychiatric disorders in the 12 months after hospital discharge. RESULTS 68 soldiers died by suicide within 12 months of hospital discharge (12.0% of all Army suicides), equivalent to 263.9 suicides/100,000 person-years compared to 18.5 suicides/100,000 person-years in the total Army. Strongest predictors included socio-demographics (male, late age of enlistment), criminal offenses (verbal violence, weapons possession), prior suicidality, aspects of prior psychiatric inpatient and outpatient treatment, and disorders diagnosed during the focal hospitalizations. 52.9% of post-hospital suicides occurred after the 5% of hospitalizations with highest predicted suicide risk (3,824.1 suicides/100,000 person years). These highest-risk hospitalizations also accounted for significantly elevated proportions of several other adverse post-hospital outcomes (unintentional injury deaths, suicide attempts, re-hospitalizations). CONCLUSIONS AND RELEVANCE The high concentration

  15. Community Hospital Telehealth Consortium (CHTC)

    Science.gov (United States)

    2003-12-30

    technology to improve and expand the opportunity for rural and urban underserved populations to receive quality, affordable health care....The Community Hospital Telehealth Consortium (CHTC) is a unique, forward-thinking, community-based healthcare service project organized around 6 not

  16. Predicting suicides after psychiatric hospitalization in US Army soldiers: the Army Study To Assess Risk and rEsilience in Servicemembers (Army STARRS).

    Science.gov (United States)

    Kessler, Ronald C; Warner, Christopher H; Ivany, Christopher; Petukhova, Maria V; Rose, Sherri; Bromet, Evelyn J; Brown, Millard; Cai, Tianxi; Colpe, Lisa J; Cox, Kenneth L; Fullerton, Carol S; Gilman, Stephen E; Gruber, Michael J; Heeringa, Steven G; Lewandowski-Romps, Lisa; Li, Junlong; Millikan-Bell, Amy M; Naifeh, James A; Nock, Matthew K; Rosellini, Anthony J; Sampson, Nancy A; Schoenbaum, Michael; Stein, Murray B; Wessely, Simon; Zaslavsky, Alan M; Ursano, Robert J

    2015-01-01

    The US Army experienced a sharp increase in soldier suicides beginning in 2004. Administrative data reveal that among those at highest risk are soldiers in the 12 months after inpatient treatment of a psychiatric disorder. To develop an actuarial risk algorithm predicting suicide in the 12 months after US Army soldier inpatient treatment of a psychiatric disorder to target expanded posthospitalization care. There were 53,769 hospitalizations of active duty soldiers from January 1, 2004, through December 31, 2009, with International Classification of Diseases, Ninth Revision, Clinical Modification psychiatric admission diagnoses. Administrative data available before hospital discharge abstracted from a wide range of data systems (sociodemographic, US Army career, criminal justice, and medical or pharmacy) were used to predict suicides in the subsequent 12 months using machine learning methods (regression trees and penalized regressions) designed to evaluate cross-validated linear, nonlinear, and interactive predictive associations. Suicides of soldiers hospitalized with psychiatric disorders in the 12 months after hospital discharge. Sixty-eight soldiers died by suicide within 12 months of hospital discharge (12.0% of all US Army suicides), equivalent to 263.9 suicides per 100,000 person-years compared with 18.5 suicides per 100,000 person-years in the total US Army. The strongest predictors included sociodemographics (male sex [odds ratio (OR), 7.9; 95% CI, 1.9-32.6] and late age of enlistment [OR, 1.9; 95% CI, 1.0-3.5]), criminal offenses (verbal violence [OR, 2.2; 95% CI, 1.2-4.0] and weapons possession [OR, 5.6; 95% CI, 1.7-18.3]), prior suicidality [OR, 2.9; 95% CI, 1.7-4.9], aspects of prior psychiatric inpatient and outpatient treatment (eg, number of antidepressant prescriptions filled in the past 12 months [OR, 1.3; 95% CI, 1.1-1.7]), and disorders diagnosed during the focal hospitalizations (eg, nonaffective psychosis [OR, 2.9; 95% CI, 1.2-7.0]). A total

  17. Hospitality and Collegial Community: An Essay.

    Science.gov (United States)

    Bennett, John B.

    2000-01-01

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

  18. Walking in the Woods: A Phenomenological Study of Online Communities of Practice and Army Mentoring

    Science.gov (United States)

    2015-04-01

    current state of Army leader development. The Army Advanced Civil Schooling program funded my tuition and living expenses during my studies at...January 2009): Taught multiple courses in World History, History of Western Civilization , and Russian History. Developed, implemented and supervised...and learning in social systems. Social Innovation, Sociedade e Trabalho. Lisbon, Portugal. Wenger, E. (2010). Communities of practice and social

  19. Hospital outreach to support faith community nursing.

    Science.gov (United States)

    Messerly, Sally; King, Michalene A; Hughes, Suzanne

    2012-01-01

    A Faith Community Nurse (FCN) Program was initiated by a Magnet hospital and developed through collaboration between hospital departments and a university nurse educator. This article describes the program's development and activities that offer FCNs networking, free continuing education, and are an extension of the hospital's mission and values.

  20. Work Environment and Health Status of the Nurses in Social Security (ESSALUD), Army and Private Hospitals in Lima - 1996

    OpenAIRE

    Loli Ponce, Amalia; Departamento de Enfermería Facultad de Medicina Universidad Nacional Mayor de San Marcos Lima, Perú

    2014-01-01

    OBJECTIVES: To know and compare the main characteristics of work environment (WE) and health status (HS) through nurses opinions in the three classes of health care centers (HCC). MATERIAL AND METHODS: Descriptive, comparative, cross-sectional study. 3259 nurses frorri social security, private entities and army hospitals were selected randomly and interviewed. RESULTS: Laboral regimens of nurses working at army hospitals or social security, consist of about 30 to 40 hours/week in which they h...

  1. PACS and its hospital-wide implementation: A case study at the Madigan Army Medical Center

    International Nuclear Information System (INIS)

    Choi, Hyung Sik; Kim, Yong Min; Smith, Donald V.; Bender, Gregory N.

    1993-01-01

    PACS represents the future of radiology in modern hospitals. Workstations and databases can be developed to substantially increase clinician's productivity, improve diagnostic accuracy, and make a large amount of knowledge and patient information available on-line to the physician. Currently, there are several hospitals in the process of implementing a total PACS system. They include Madigan Army Medical Center (Tacoma, Washington), VA Hospital in Baltimore, and Hammersmith Hospital in London (1). In order to provide the radiologist, the clinicians, and other health personnel in Korea with the general concept of PACS and its up-to-date status report, we describe the MDIS system being implemented in MAMC (Madigan Army Medical Center) which is the first hospital-wide large-scale PACS in the world. The major PACS components in MAMC have been installed since March 1992 and the full system implementation will be completed by summer 1993. The goal of the MDIS system in MAMC is to increase to more than 90% filmless by the end of 1993. In this paper, we discuss the introduction and background of PACS and its potential benefits, the current status of PACS installation in MAMC and the future plan, and the flow of image data and text information in MAMC

  2. The mobile Army surgical hospital (MASH): a military and surgical legacy.

    Science.gov (United States)

    King, Booker; Jatoi, Ismalil

    2005-01-01

    Operation Iraqi Freedom was perhaps the last military campaign that will ever utilize the services of a mobile Army surgical hospital (MASH). The Army has now essentially replaced the MASH with combat surgical hospitals (CSH) and forward surgical teams (FST). MASH units were designed as mobile, flexible, forward-deployed military hospitals, providing care for the wounded near the frontlines of the battlefield. These hospitals not only saved thousands of lives during war but also greatly influenced the delivery of trauma and critical care in civilian hospitals. The MASH was made popular by the television series of the 1970s, depicting the 4077th during the Korean War. Although a comical series, these television episodes provided viewers with a glimpse of life in a MASH during time of war. This article chronicles the history of the MASH from its inception during World War II to recent experiences in Operation Iraqi Freedom. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 p656-a PMID:15926641

  3. Army Library Institute V: Product/Marketing/Service - Volume 2, Supplementary Data

    Science.gov (United States)

    1981-11-01

    28307 US Army Community Hospital, Fort Campbell, KY 42223 US Army Community Hospital, Fort Carson, CO 80913 US Array Conununity Hospital, Coco Solo...46. gj la Doal w/üniönT JB. a. Uadership lech Svc ± M- £. TOBLIC SEPTICES 13. Onaa/Taa/PR 24. SOI/Uaer Feedback Z5. General Reference 16

  4. Policy Analysis of Surgical Utilization at Blanchfield Army Community Hospital

    Science.gov (United States)

    2009-04-09

    Utilization 12 anterior /posterior cruciate ligament (ACL/PCL) reconstruction surgery may take 2-3 hours and a cataract surgery may only take 10-20 minutes...equipment, or secondary services like an ICU or physical therapy . Larger, more in depth cases could be performed at Gateway, thus allowing for an...Fort Campbell’s Post Office is on the Kentucky side which, ultimately, provides the post with a Kentucky mailing address. The physical facility of BACH

  5. Effects of Army Training Activities on Bird Communities at the Pinon Canyon Maneuver Site, Colorado

    Science.gov (United States)

    1991-09-01

    the course of the study. They are brood parasites that lay their eggs in the nests of other species, sometimes substantially reducing the nesting...of Biological Sciences, Northern Arizona University, 1979). 42. May, R.M., and SK. Robinson, "Population Dynamics of Brood Parasitism ," American...Effects of Army Training Activities on Bird Communities at the Piflon Canyon Maneuver Site, Colorado by David J. Tazik This report describes a study

  6. Midtrimester Abortion Experience in a Community Hospital

    Science.gov (United States)

    West, George A.

    1981-01-01

    The midtrimester abortion experience in a community hospital serving a population of approximately 250,000 people was reviewed over a four-year period. During the 48-month study period, 744 patients were aborted, utilizing intra-amniotic infusion of hypertonic saline and/or prostaglandins F2A augmented by a weak pitocin infusion. The combination of 20 percent saline, prostaglandins F2A preoperative placement of intracervical laminaria, and pitocin augmentation was found to be most efficacious, resulting in an average injection to abortion time of 10.5 hours and reduction of hospital stay from three to two days. The established protocol is reviewed. PMID:7310923

  7. Minimally invasive parathyroidectomy: a community hospital experience.

    Science.gov (United States)

    Vaid, Sachin; Pandelidis, Steve

    2011-07-01

    Minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism can be successfully performed using preoperative sestamibi scan and intraoperative radioguidance without the need of measurement of intraoperative parathyroid hormone (PTH) levels. The purpose of our study was to review the outcomes of MIPs performed in a community hospital without measuring PTH levels intraoperatively and to demonstrate that this is an effective therapeutic modality with comparable success rates. We performed a retrospective medical record review of patients undergoing MIPs from April 1, 1998, through May 31, 2005, in a 500-bed community hospital. A total of 188 parathyroidectomies for primary hyperparathyroidism were performed by a single surgeon during the study period, 111 of which were MIPs. In this series of 111 patients, we found 2 recurrences, achieving a success rate of 98.2%. Higher preoperative PTH levels and gland weight had a direct correlation with the successful performance of MIP.

  8. Childhood poisoning: a community hospital experience.

    Science.gov (United States)

    Gehlbach, S H; Wall, J B

    1977-06-01

    We reviewed medical records of 53 children who ingested poison and were treated as inpatients and 107 who were treated as outpatients in a Southeastern community hospital. Findings included a much higher incidence of petroleum distillate poisoning than is found nationally, and a low frequency of aspirin ingestions. Data on packaging of the poisons indicate that one third was stored in food containers. Of the products encountered, 33% currently require safety packaging but were found in obsolete containers.

  9. Energy Surveys of Army Hospitals, Energy Engineering Analysis Program, Darnall Army Community Hospital, Fort Hood, Texas. Executive Summary

    Science.gov (United States)

    1987-12-01

    Association of ?rofessinnal tnergy Managers I Market Plats, Suite 3001 %&I Tranni-co. CA 94105 (415) 3S*-8055 xegbetship in national organiationas typically...441Ling with 4MergY MGWeoy "IitG. 20. l ed-jet aIlled valter circulated duft *. light tooling loeds.CIL . Insca~l lsinuia sIved motor to seat loads. 22

  10. Education in geriatric medicine for community hospital staff.

    LENUS (Irish Health Repository)

    O'Hanlon, Shane

    2010-12-01

    Community hospitals provide many services for older people. They are mainly managed by nursing staff, with some specialist input. Little is known about education provided in these facilities. Most education in geriatric medicine is provided in hospitals, despite most elderly care being provided in the community. The authors surveyed senior nursing staff in Irish community hospitals to examine this area in more detail. Staff in all 18hospitals in the Health Service Executive (South) area were invited to participate. The response rate was 100%. Sixteen of the 18 respondents (89%) felt staff did not have enough education in geriatric medicine. Just over half of hospitals had regular staff education sessions in the area, with a minority of sessions led by a geriatrician, and none by GPs. Geriatrician visits were valued, but were requested only every 1-3 months. Staff identified challenging behaviour and dementia care as the areas that posed most difficulty.

  11. Co-morbidities in children hospitalized for community acquired ...

    African Journals Online (AJOL)

    -morbidities in children admitted for community acquired pneumonia (CAP) in ... It is recommended that the presence of comorbidity be actively looked for in children hospitalized for pneumonia, so as to effect holistic treatment, and improve the ...

  12. Weekend Physiotherapy Practice in Community Hospitals in Canada

    OpenAIRE

    Ottensmeyer, C. Andrea; Chattha, Sanmeet; Jayawardena, Shemayi; McBoyle, Kelly; Wrong, Christine; Ellerton, Cindy; Mathur, Sunita; Brooks, Dina

    2012-01-01

    Purpose: To analyze weekend physiotherapy services in acute-care community hospitals across Canada. Method: Questionnaires were mailed to acute-care community hospitals (institutions with >100 inpatient beds, excluding psychiatric, mental health, paediatric, rehabilitation, tertiary, and long-term care facilities) across Canada from January to April 2010. The questionnaire collected information on patient referral criteria, staffing, workload, and compensation for weekend physiotherapy servic...

  13. COORDINATING HOSPITAL AND COMMUNITY WORK ADJUSTMENT SERVICES. FINAL REPORT.

    Science.gov (United States)

    GOERTZEL, VICTOR; AND OTHERS

    THE GOALS OF THIS STUDY WERE TO USE WORK TO HELP PATIENTS LEAVE THE CAMARILLO STATE HOSPITAL SOONER, BECOME A PART OF THE COMMUNITY, AND BECOME SELF-SUPPORTING. THE PROJECT SELECTED 146 SCHIZOPHRENIC MALES WHO HAD A HISTORY OF POOR WORK ADJUSTMENT. AS PART OF THE TREATMENT, THE MEN WERE PLACED IN THE HOSPITAL BAKERY. AFTER ADJUSTMENT TO THE WORK…

  14. Community hospital and medical school cooperation in continuing medical education.

    Science.gov (United States)

    Jay, S J; Casebeer, L; Woods, J R; Nyhuis, A W; O'Toole, J B

    1995-02-01

    To determine the extent and trends of cooperation in continuing medical education (CME) between community teaching hospitals and medical schools in the United States. A questionnaire was sent in September 1992 to the directors of CME at 276 teaching hospital members of the Association for Hospital Medical Education (AHME). The survey was designed to answer two questions: (1) What is the extent of cooperation between hospital CME providers and medical schools? (2) In the next three years will community hospitals seek competitive or collaborative relationships in CME with medical schools? By late April 1993, 216 (78%) of the questionnaires had been returned. Of these, 177 (64% of the sample) were analyzed. Of the responding hospitals, 91 (52%) cooperated with 92 medical schools in CME; 75 (45%) of the hospitals planned to increase cooperation. Only ten (11%) of the hospitals described their current CME relationship with a medical school as "competitive in most areas"; 23 (14%) expected to increase competition in the next three years. Forty-one (24%) of the respondents were part of a community hospital CME consortium; only 20 (16%) of the other institutions expected to participate in a consortium in the next three years. Hospital size and membership in the Association of American Medical Colleges' Council of Teaching Hospitals were generally correlated with current and future competition in CME with a medical school and likely participation in a community CME consortium. The majority of teaching hospital members of the AHME perceived that they would have cooperative relationships in CME with affiliated medical schools in the three years following the survey. These collaborative relationships should provide an important basis for the further planning and development of medical education consortia.

  15. Supporting communication for children with cerebral palsy in hospital: Views of community and hospital staff

    Science.gov (United States)

    Hemsley, Bronwyn; Lee, Sabrena; Munro, Kathleen; Seedat, Nadeera; Bastock, Kaely; Davidson, Bronwyn

    2014-01-01

    Objective We aimed to investigate the views of allied health and nursing staff on supporting the communication of children with cerebral palsy (CP) and complex communication needs (CCN) in hospital. Method We conducted 12 focus groups with 49 community- and hospital-based allied health professionals and hospital nurses. Results Participants reported having active roles in supporting children’s seating, mobility, equipment, mealtime management and psychosocial needs, but not in supporting the children’s communication in hospital. Participants described several environmental barriers to supporting children’s augmentative and alternative communication (AAC) in hospital, and suggested a range of strategies to ease communication difficulties at the bedside. Conclusion Results indicate a potential new role for community- and hospital-based health professionals in supporting nurses to implement AAC strategies at the bedside. Supporting nursing staff to remove environmental barriers and use communication technologies might create a more communicatively accessible hospital ward for children with CP and CCN. PMID:24102353

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

    Directory of Open Access Journals (Sweden)

    Judith Kristeller

    2017-05-01

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

  17. ORIGINAL ARTICLES Hospital and community isolates of ...

    African Journals Online (AJOL)

    2009-08-01

    Aug 1, 2009 ... exceeding that of chronic renal failure even when dialysis and renal transplantation are included.1 The ... uropathogens isolated from patients attending Dr George. Mukhari (DGM) Hospital in Ga-Rankuwa, ... not be used for the empiric treatment of urinary tract infections. S Afr Med J 2009; 99: 584-587. 584 ...

  18. Martin Luther King, Jr., General Hospital and community involvement.

    Science.gov (United States)

    Humphrey, M M

    1973-07-01

    Community involvement is not just one facet of the new Martin Luther King, Jr., General Hospital's existence. It is the mainstream from which all other activities flow. In addition to meeting the conventional needs of a conventional hospital staff with the core collection of texts and journals, this library goes one step further. It acts as a resource for its community health workers, dietitians, and nurses in their various outreach programs. It serves as a stimulus for the high school or community college student who may be curious about a health career. It also finds time to provide reading material for its patients.

  19. Hospitality: transformative service to children, families, and communities.

    Science.gov (United States)

    Melton, Gary B

    2014-11-01

    Hospitality is an ancient moral practice that was deeply embedded in early Judaism, Christianity, and Islam. Hospitality requires acceptance of, service to, and respect for people who lack a place in the community. The contemporary importance of this practice reflects the social disconnection and economic disadvantage of many young parents and the high frequency of separation of young people, including many young parents, from their communities. Such social deterioration substantially increases the risk of child maltreatment. Building on the proposals of the U.S. Advisory Board on Child Abuse and Neglect, Strong Communities for Children demonstrated the effectiveness of community building in reducing such risk. It further suggested the importance of both relying on and learning from hospitable people in strengthening support for children and their parents. PsycINFO Database Record (c) 2014 APA, all rights reserved.

  20. Identifying key hospital service quality factors in online health communities.

    Science.gov (United States)

    Jung, Yuchul; Hur, Cinyoung; Jung, Dain; Kim, Minki

    2015-04-07

    The volume of health-related user-created content, especially hospital-related questions and answers in online health communities, has rapidly increased. Patients and caregivers participate in online community activities to share their experiences, exchange information, and ask about recommended or discredited hospitals. However, there is little research on how to identify hospital service quality automatically from the online communities. In the past, in-depth analysis of hospitals has used random sampling surveys. However, such surveys are becoming impractical owing to the rapidly increasing volume of online data and the diverse analysis requirements of related stakeholders. As a solution for utilizing large-scale health-related information, we propose a novel approach to identify hospital service quality factors and overtime trends automatically from online health communities, especially hospital-related questions and answers. We defined social media-based key quality factors for hospitals. In addition, we developed text mining techniques to detect such factors that frequently occur in online health communities. After detecting these factors that represent qualitative aspects of hospitals, we applied a sentiment analysis to recognize the types of recommendations in messages posted within online health communities. Korea's two biggest online portals were used to test the effectiveness of detection of social media-based key quality factors for hospitals. To evaluate the proposed text mining techniques, we performed manual evaluations on the extraction and classification results, such as hospital name, service quality factors, and recommendation types using a random sample of messages (ie, 5.44% (9450/173,748) of the total messages). Service quality factor detection and hospital name extraction achieved average F1 scores of 91% and 78%, respectively. In terms of recommendation classification, performance (ie, precision) is 78% on average. Extraction and

  1. Ramelton Community Hospital, Ramelton, Letterkenny, Donegal.

    LENUS (Irish Health Repository)

    McLoughlin, Kathleen

    2015-11-24

    For most people, home is the preferred place of care and death. Despite the development of specialist palliative care and primary care models of community based service delivery, people who are dying, and their families\\/carers, can experience isolation, feel excluded from social circles and distanced from their communities. Loneliness and social isolation can have a detrimental impact on both health and quality of life. Internationally, models of social and practical support at the end of life are gaining momentum as a result of the Compassionate Communities movement. These models have not yet been subjected to rigorous evaluation. The aims of the study described in this protocol are: (1) to evaluate the feasibility, acceptability and potential effectiveness of The Good Neighbour Partnership (GNP), a new volunteer-led model of social and practical care\\/support for community dwelling adults in Ireland who are living with advanced life-limiting illness; and (2) to pilot the method for a Phase III Randomised Controlled Trial (RCT).

  2. Weekend physiotherapy practice in community hospitals in Canada.

    Science.gov (United States)

    Ottensmeyer, C Andrea; Chattha, Sanmeet; Jayawardena, Shemayi; McBoyle, Kelly; Wrong, Christine; Ellerton, Cindy; Mathur, Sunita; Brooks, Dina

    2012-01-01

    To analyze weekend physiotherapy services in acute-care community hospitals across Canada. Questionnaires were mailed to acute-care community hospitals (institutions with >100 inpatient beds, excluding psychiatric, mental health, paediatric, rehabilitation, tertiary, and long-term care facilities) across Canada from January to April 2010. The questionnaire collected information on patient referral criteria, staffing, workload, and compensation for weekend physiotherapy services and on the availability of other rehabilitation health professionals. Of 146 community hospitals deemed eligible, 104 (71%) responded. Weekend physiotherapy was offered at 69% of hospitals across Canada, but this rate varied: ≥75% in all regions except Quebec (30%). Hospitals with a high proportion of acute-care beds were more likely to offer weekend physiotherapy services (logistic regression, p=0.021). Services differed among Saturdays, Sundays, and holidays in terms of the numbers of both physiotherapists and physiotherapy assistants working (Kruskal-Wallis, pCanada. Method: Questionnaires were mailed to acute-care community hospitals (institutions with >100 inpatient beds, excluding psychiatric, mental health, paediatric, rehabilitation, tertiary, and long-term care facilities) across Canada from January to April 2010. The questionnaire collected information on patient referral criteria, staffing, workload, and compensation for weekend physiotherapy services and on the availability of other rehabilitation health professionals. Results: Of 146 community hospitals deemed eligible, 104 (71%) responded. Weekend physiotherapy was offered at 69% of hospitals across Canada, but this rate varied: ≥75% in all regions except Quebec (30%). Hospitals with a high proportion of acute-care beds were more likely to offer weekend physiotherapy services (logistic regression, p =0.021). Services differed among Saturdays, Sundays, and holidays in terms of the numbers of both physiotherapists and

  3. Community representation in hospital decision making: a literature review.

    Science.gov (United States)

    Murray, Zoë

    2015-06-01

    Advancing quality in health services requires structures and processes that are informed by consumer input. Although this agenda is well recognised, few researchers have focussed on the establishment and maintenance of customer input throughout the structures and processes used to produce high-quality, safe care. We present an analysis of literature outlining the barriers and enablers involved in community representation in hospital governance. The review aimed to explore how community representation in hospital governance is achieved. Studies spanning 1997-2012 were analysed using Donabedian' s model of quality systems as a guide for categories of interest: structure, in relation to administration of quality; process, which is particularly concerned with cooperation and culture; and outcome, considered, in this case, to be the achievement of effective community representation on quality of care. There are limited published studies on community representation in hospital governance in Australia. What can be gleaned from the literature is: 1) quality subcommittees set up to assist Hospital Boards are a key structure for involving community representation in decision making around quality of care, and 2) there are a number of challenges to effectively developing the process of community representation in hospital governance: ambiguity and the potential for escalated indecision; inadequate value and consideration given to it by decision makers resulting in a lack of time and resources needed to support the community engagement strategy (time, facilitation, budgets); poor support and attitude amongst staff; and consumer issues, such as feeling isolated and intimidated by expert opinion. The analysis indicates that: quality subcommittees set up to assist boards are a key structure for involving community representation in decision making around quality of care. There are clearly a number of challenges to effectively developing the process of community representation in

  4. Community Hospital of the Assumption, Thurles, Tipperary.

    LENUS (Irish Health Repository)

    French-O’Carroll, F

    2017-01-01

    Hip fractures are a major cause of morbidity and mortality1. Surgery performed on the day of or after admission is associated with improved outcome2,3. An audit cycle was performed examining time to surgery for hip fracture patients. Our initial audit identified lack of theatre space as one factor delaying surgery. A dedicated daytime emergency theatre was subsequently opened and a re-audit was performed to assess its impact on time to surgery. Following the opening of the theatre, the proportion of patients with a delay to hip fracture surgery greater than 36 hours was reduced from 49% to 26% with lack of theatre space accounting for 23% (3 of 13) of delayed cases versus 28.6% (9 of 32) previously. 44% of hip fracture surgeries were performed in the emergency theatre during daytime hours, whilst in-hospital mortality rose from 4.6% to 6%. We conclude that access to an emergency theatre during daytime hours reduced inappropriate delays to hip fracture surgery.

  5. Evaluating Michigan's community hospital access: spatial methods for decision support

    Directory of Open Access Journals (Sweden)

    Varnakovida Pariwate

    2006-09-01

    Full Text Available Abstract Background Community hospital placement is dictated by a diverse set of geographical factors and historical contingency. In the summer of 2004, a multi-organizational committee headed by the State of Michigan's Department of Community Health approached the authors of this paper with questions about how spatial analyses might be employed to develop a revised community hospital approval procedure. Three objectives were set. First, the committee needed visualizations of both the spatial pattern of Michigan's population and its 139 community hospitals. Second, the committee required a clear, defensible assessment methodology to quantify access to existing hospitals statewide, taking into account factors such as distance to nearest hospital and road network density to estimate travel time. Third, the committee wanted to contrast the spatial distribution of existing community hospitals with a theoretical configuration that best met statewide demand. This paper presents our efforts to first describe the distribution of Michigan's current community hospital pattern and its people, and second, develop two models, access-based and demand-based, to identify areas with inadequate access to existing hospitals. Results Using the product from the access-based model and contiguity and population criteria, two areas were identified as being "under-served." The lower area, located north/northeast of Detroit, contained the greater total land area and population of the two areas. The upper area was centered north of Grand Rapids. A demand-based model was applied to evaluate the existing facility arrangement by allocating daily bed demand in each ZIP code to the closest facility. We found 1,887 beds per day were demanded by ZIP centroids more than 16.1 kilometers from the nearest existing hospital. This represented 12.7% of the average statewide daily bed demand. If a 32.3 kilometer radius was employed, unmet demand dropped to 160 beds per day (1

  6. Home hospitalization in the spectrum of community geriatric care.

    Science.gov (United States)

    Stessman, J; Hammerman-Rozenberg, R; Cohen, A

    1997-04-01

    The Home Hospitalization Programme was initiated in Jerusalem in 1991 to provide intensive medical care at home in order to prevent or shorten hospitalizations. The programme was based upon regular home visits by physicians, and nursing assessment to determine the need for regular nursing care. Primary-care physicians and nurses were renumerated by a global monthly fee, and were on 24-h call in addition to their periodic visits. Patients were recruited by senior geriatric physicians from acute hospital wards, as well as from the community, at the family doctor's request. Ancillary services available to the home hospitalization team included laboratory and electrocardiographic testing, specialty consultations, physical occupational or speech therapy, social work and home help up to 3 h daily. Monthly visits by a senior physician provided oversight and further consultation. Home hospitalization grew out of the continuing care division of the Clalit Sick Fund, a health maintenance organization providing umbrella medical insurance and ambulatory care. The programme grew synergistically with the other facilities of continuing care to encompass a network of comprehensive services to acute, subacute and chronic patients both at home and in institutional settings. In 4 years this network succeeded in establishing the focus of subacute intensive care in the community, achieving high levels of patient and family satisfaction, as well as striking economic advantages. In its first 2 years of operation home hospitalization saved S4 million due to reduced hospital utilization, and preliminary data for the subsequent 2 years indicated that this trend continued. Home hospitalization became the hub of a far-reaching system of supportive, intensive and humane care in the community.

  7. The changing roles of pharmacists in hospital and community ...

    African Journals Online (AJOL)

    Dr Patrick O Erah

    Available online at http://www.tjpr.freehosting.net. Editorial. The changing roles of pharmacists in hospital and community pharmacy practice in Nigeria. The profession and practice of pharmacy did not start in Nigeria as a well defined health care area of specialization as it is today. Rather, pharmaceutical training was borne.

  8. Ciprofloxacin : Use and resistance in Community, Nursing Home and Hospital

    NARCIS (Netherlands)

    van Hees, B.C.

    2011-01-01

    The aim of the studies described in this thesis was to analyze some aspects of ciprofloxacin use and clinical and (molecular) epidemiology of ciprofloxacin resistance in different settings, both within hospitals (chapter 3,4 and 6), community and nursing homes (chapter 2 and 5). With its broad

  9. Community-acquired Pneumonia in Hospitalized Urban Young ...

    African Journals Online (AJOL)

    As part of a comprehensive hospital-based study of acute lower respiratory infections (ALRI) in under-five urban Nigerian children, we sought to identify the possible clinical and investigative correlates of lobar versus bronchopneumonia, and the possible determinants of mortality in community-acquired pneumonia. Over a ...

  10. St. Joseph's Community Hospital, Millstreet, Cork.

    LENUS (Irish Health Repository)

    Barker, Maja

    2007-01-01

    BACKGROUND: Self-perceptions of aging have been implicated as independent predictors of functional disability and mortality in older adults. In spite of this, research on self-perceptions of aging is limited. One reason for this is the absence of adequate measures. Specifically, there is a need to develop a measure that is theoretically-derived, has good psychometric properties, and is multidimensional in nature. The present research seeks to address this need by adopting the Self-Regulation Model as a framework and using it to develop a comprehensive, multi-dimensional instrument for assessing self-perceptions of aging. This study describes the validation of this newly-developed instrument, the Aging Perceptions Questionnaire (APQ). METHODS: Participants were 2,033 randomly selected community-dwelling older (+65 yrs) Irish adults who completed the APQ alongside measures of physical and psychological health. The APQ assesses self-perceptions of aging along eight distinct domains or subscales; seven of these examine views about own aging, these are: timeline chronic, timeline cyclical, consequences positive, consequences negative, control positive, control negative, and emotional representations; the eighth domain is the identity domain and this examines the experience of health-related changes. RESULTS: Mokken scale analysis showed that the majority of items within the views about aging subscales were strongly scalable. Confirmatory factor analysis also indicated that the model provided a good fit for the data. Overall, subscales had good internal reliabilities. Hierarchical linear regression was conducted to investigate the independent contribution of APQ subscales to physical and psychological health and in doing so determine the construct validity of the APQ. Results showed that self-perceptions of aging were independently related to physical and psychological health. Mediation testing also supported a role for self-perceptions of aging as partial mediators in

  11. Etiology and severity of various forms of ocular war injuries in patients presenting at an Army Hospital in Pakistan

    Science.gov (United States)

    Hassan Naqvi, Syed Abid; Malik, Sidra; Zulfiqaruddin, Syed; Anwar, Syeda Birjees; Nayyar, Shahzad

    2016-01-01

    Objective: To determine the etiology and severity of various forms of ocular war injuries in patients presenting at an Army Hospital in Pakistan. Methods: This cross sectional study was conducted at the Department of Ophthalmology, Combined Military Hospital, Peshawar over four years period from June 2012 through March 2016, Two hundred ten consecutive soldiers who presented with ocular war injuries were included for analysis after taking written informed consent. A predesigned proforma was used to record patient’s demographic details along with the cause, side, type and severity of injury, ocular trauma score was also recorded at presentation. Results: The mean age of the patients was 29.34±5.35 years. All of them were males. Left side was more frequently involved (n=126, 60.0%) and the most frequent underlying cause was IED blast injury (n=114, 54.3%). Closed globe injuries were more frequent and were recorded in 120 (57.1%) patients. Upon assigning Ocular Trauma Score, Grade-V (28.6%) injuries were the most frequent followed by Grade-I (25.7%), Grade III (25.7%), Grade II (11.4%) and Grade IV (8.6%). When stratified for the type of injury, OTS Grade I injuries were highest (60.0%) among patients with open globe injuries, hence poorer prognosis, while OTS Grade V injuries were highest (50.0%) among patients with closed globe injuries (p=0.000). Conclusion: IED blast injuries are most frequently encountered ocular war injuries often involving soldiers in the age group 20-30 years. These open globe injuries had worst clinical presentation to begin with and poorer prognosis than closed globe injuries. PMID:28083061

  12. U.S. Army Recruiting: Improving Advertising, Community Outreach, and Social Media

    Science.gov (United States)

    2010-03-01

    environments in order to persuade the next generation of prospects to enlist. 14. ABSTRACT Generation Y and I, All Volunteer Army, Cyber Recruiting 15...Social Media FORMAT: Strategy Research Project DATE: 22 March 2010 WORD COUNT: 7,200 PAGES: 34 KEY TERMS: Generation Y and I, All Volunteer...within its overall recruiting strategy. To enable success, the Informational LOO focus is addressing generation Y and I norms with the specific ways

  13. Community Hospitals Indianapolis creates breast cancer awareness. The hospital joins a partnership with local ABC affiliate.

    Science.gov (United States)

    Herreria, J

    1999-01-01

    Community Hospitals Indianapolis raises the public's awareness of the importance of breast self-examination and mammography as the best tools for early detection of breast cancer. The health system has designed a program called Buddy Check 6 to partner with a local television station.

  14. [A Questionnaire Survey on Cooperation between Community Pharmacies and Hospitals in Outpatient Chemotherapy-Comparison of Roles of Pharmacists in Community Pharmacy and Hospitals].

    Science.gov (United States)

    Ishibashi, Masaaki; Ishii, Masakazu; Nagano, Miku; Kiuchi, Yuji; Iwamoto, Sanju

    2018-01-01

     Previous reports suggested that sharing outpatient information during chemotherapy is very important for managing pharmaceutical usage between community pharmacies and hospitals. We herein examined using a questionnaire survey whether pharmaceutical management for outpatient chemotherapy is desired by community and hospital pharmacists. The response rates were 44.3% (133/300) for pharmacists in community pharmacies and 53.7% (161/300) for pharmacists in hospitals. Prescriptions for outpatients during chemotherapy were issued at 88.2% of the hospitals. Currently, 28.9% of hospital pharmacists rarely provide pharmaceutical care, such as patient guidance and adverse effect monitoring, for outpatients receiving oral chemotherapy. Furthermore, whereas 93.7% of hospital pharmacists conducted prescription audits based on the chemotherapy regimen, audits were only performed by 14.8% of community pharmacists. Thus, outpatients, particularly those on oral regimens, were unable to receive safe pharmaceutical care during chemotherapy. Community pharmacists suggested that hospital pharmacists should use "medication notebooks" and disclose prescription information when providing clinical information to community pharmacists. They also suggested sending clinical information to hospital pharmacists by fax. On the other hand, hospital pharmacists suggested the use of "medication notebooks" and electronic medical records when providing clinical information to community pharmacists. In addition, they suggested for community pharmacists to use electronic medical records when providing clinical information to hospital pharmacists. As there may be differences in opinion between community and hospital pharmacists, mutual preliminary communication is important for successful outpatient chemotherapy.

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

    Science.gov (United States)

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

    2016-06-15

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

  16. Urological Emergency Admissions to a Community Hospital: A Review

    Science.gov (United States)

    Atkins, Sam O.

    1983-01-01

    A one-year study was conducted on the impact of emergency admissions to the 125-bed Southwest Community Hospital in Atlanta, Georgia. During the study in 1979, 70 urological emergency room admissions were made, of which 44 (62.8 percent) were males and 26 (37.2 percent) were females. In comparison, 93 admissions were made directly from the private office. The study considered the timeliness of diagnosis and treatment, surgical procedures performed, impact on urological emergency room nursing and medical personnel, physician response to notification, cost containment, and implied legal ramifications and organization structure. Thus, an immediate close scrutiny of urological emergency admission at the nonuniversity affiliated Southwest Community Hospital was permitted. PMID:6876189

  17. First 101 Robotic General Surgery Cases in a Community Hospital.

    Science.gov (United States)

    Oviedo, Rodolfo J; Robertson, Jarrod C; Alrajhi, Sharifah

    2016-01-01

    The general surgeon's robotic learning curve may improve if the experience is classified into categories based on the complexity of the procedures in a small community hospital. The intraoperative time should decrease and the incidence of complications should be comparable to conventional laparoscopy. The learning curve of a single robotic general surgeon in a small community hospital using the da Vinci S platform was analyzed. Measured parameters were operative time, console time, conversion rates, complications, surgical site infections (SSIs), surgical site occurrences (SSOs), length of stay, and patient demographics. Between March 2014 and August 2015, 101 robotic general surgery cases were performed by a single surgeon in a 266-bed community hospital, including laparoscopic cholecystectomies, inguinal hernia repairs; ventral, incisional, and umbilical hernia repairs; and colorectal, foregut, bariatric, and miscellaneous procedures. Ninety-nine of the cases were completed robotically. Seven patients were readmitted within 30 days. There were 8 complications (7.92%). There were no mortalities and all complications were resolved with good outcomes. The mean operative time was 233.0 minutes. The mean console operative time was 117.6 minutes. A robotic general surgery program can be safely implemented in a small community hospital with extensive training of the surgical team through basic robotic skills courses as well as supplemental educational experiences. Although the use of the robotic platform in general surgery could be limited to complex procedures such as foregut and colorectal surgery, it can also be safely used in a large variety of operations with results similar to those of conventional laparoscopy.

  18. Radiological incident preparedness for community hospitals: a demonstration project.

    Science.gov (United States)

    Jafari, Mary Ellen

    2010-08-01

    In November 2007, the Wisconsin Division of Public Health Hospital Disaster Preparedness Program State Expert Panel on Radiation Emergencies issued a report titled The Management of Patients in a Radiological Incident. Gundersen Lutheran Health System was selected to conduct a demonstration project to implement the recommendations in that report. A comprehensive radiological incident response plan was developed and implemented in the hospital's Trauma and Emergency Center, including the purchase and installation of radiation detection and identification equipment, staff education and training, a tabletop exercise, and three mock incident test exercises. The project demonstrated that the State Expert Panel report provides a flexible template that can be implemented at community hospitals using existing staff for an approximate cost of $25,000.

  19. Hospital Resource Utilisation by Patients with Community-Acquired Pneumonia

    LENUS (Irish Health Repository)

    McCarthy, S

    2017-09-01

    Little data is available on the resource utilisation of patients admitted with Community-Acquired Pneumonia (CAP) in Ireland. A retrospective review of 50 randomly-selected patients admitted to Beaumont Hospital with CAP was undertaken. The mean length of stay of patients with CAP was 12 days (+\\/- 16 days). All patients were emergency admissions, all had a chest x-ray, a C-reactive protein blood test, and occupied a public bed at some point during admission. Common antimicrobial therapies were intravenous (IV) amoxicillin\\/clavulanic acid and oral clarithromycin; 60% received physiotherapy. The estimated mean cost of CAP per patient was €14,802.17. Costs arising from admission to hospital with CAP are substantial, but efforts can be undertaken to ensure that resources are used efficiently to improve patient care such as discharge planning and fewer in-hospital ward transfers

  20. The future of community nursing: Hospital in the Home.

    Science.gov (United States)

    Lee, Gerry; Pickstone, Nicola; Facultad, Jose; Titchener, Karen

    2017-04-02

    With an increasing ageing population who often have multiple long-term conditions, there is a growing need to provide an alternative type of care to the traditional hospital-based model. 'Hospital in the Home' is a model that provides integrated care for patients in their home. The @home service was established in 2013 by Guy's and St Thomas' NHS Foundation Trust. The service provides health care in patients' home, supporting early discharge from hospital as well as preventing avoidable admissions and readmissions saving valuable hospital bed days and reducing length of stay. This article describes the service available with the use of a case study of a 78-year-old lady who was referred by the London Ambulance Service with exacerbation of chronic obstructive pulmonary disease (COPD). This case study highlights the ability to assess, treat and manage an acutely unwell patient with newly diagnosed heart failure in the community without the need for hospitalisation. This type of integrated care model with a multidisciplinary team is a feasible alternative to the traditional models of care in both the acute and community settings.

  1. Situational leadership styles, staff nurse job characteristics related to job satisfaction and organizational commitment of head nurses working in hospitals under the jurisdiction of the Royal Thai Army.

    Science.gov (United States)

    Intaraprasong, Bhusita; Potjanasitt, Sureporn; Pattaraarchachai, Junya; Meennuch, Chavalit

    2012-06-01

    To analyze the relationships between the situational leadership styles, staff nurse job characteristic with job satisfaction and organizational commitment of head nurses working in hospitals under the jurisdiction of the Royal Thai Army The cross-sectional analytical study was conducted in 128 head nurses working in hospitals under the jurisdiction of the Royal Thai Army. Data were collected by mailed questionnaires. A total of 117 completed questionnaires (91.4%) were received for analysis. Statistical analysis was done using Pearson's Product Moment Correlation Coefficient. It was found that situational leadership styles were not correlated with job satisfaction and organizational commitment of head nurses. Staff nurse job characteristics had a low level of positive correlation with job satisfaction and organizational commitment of head nurses at 0.05 level of significance (r = 0.202 and 0.189 respectively). The hospital administrators should formulate policy to improve working system, human resource management and formulate policies and strategies based on situational leadership. In addition, they should improve the characteristics of staff nurse job by using surveys to obtain job satisfaction and organizational commitment.

  2. Antibiotic use among medical specialties in a community hospital.

    Science.gov (United States)

    Jogerst, G J; Dippe, S E

    1981-02-27

    Antibiotic use in a community hospital was evaluated to demonstrate specialty variations. A chart review was performed using the Veterans Administration's "Guidelines for Peer Review" to determine appropriate antibiotic use. Of the 1,054 patients discharged in August 1977, three hundred ten (29.4%) received 479 courses of antibiotics of which two hundred eighty-seven (60%) were considered appropriate. Seventy-two percent of the therapeutic courses and 36% of the prophylactic courses were appropriate. Prophylactic antibiotics were used in 12% of the hospitalized patients and accounted for 33% of the total antibiotics. No notable difference in appropriate antibiotic use was found among general surgeons (73%), internists (72%), orthopedists (71%), and family practitioners (67%). Substantially lower levels were found among urologists (54%), otolaryngologists (44%), and obstetricians (36%). Continued education in proper antibiotic use is needed especially for prophylaxis. Educational programs directed at specific specialties may be the most fruitful way to effect improved overall antibiotic use.

  3. Understanding the Models of Community Hospital rehabilitation Activity (MoCHA): a mixed-methods study.

    Science.gov (United States)

    Gladman, John; Buckell, John; Young, John; Smith, Andrew; Hulme, Clare; Saggu, Satti; Godfrey, Mary; Enderby, Pam; Teale, Elizabeth; Longo, Roberto; Gannon, Brenda; Holditch, Claire; Eardley, Heather; Tucker, Helen

    2017-02-27

    To understand the variation in performance between community hospitals, our objectives are: to measure the relative performance (cost efficiency) of rehabilitation services in community hospitals; to identify the characteristics of community hospital rehabilitation that optimise performance; to investigate the current impact of community hospital inpatient rehabilitation for older people on secondary care and the potential impact if community hospital rehabilitation was optimised to best practice nationally; to examine the relationship between the configuration of intermediate care and secondary care bed use; and to develop toolkits for commissioners and community hospital providers to optimise performance. 4 linked studies will be performed. Study 1: cost efficiency modelling will apply econometric techniques to data sets from the National Health Service (NHS) Benchmarking Network surveys of community hospital and intermediate care. This will identify community hospitals' performance and estimate the gap between high and low performers. Analyses will determine the potential impact if the performance of all community hospitals nationally was optimised to best performance, and examine the association between community hospital configuration and secondary care bed use. Study 2: a national community hospital survey gathering detailed cost data and efficiency variables will be performed. Study 3: in-depth case studies of 3 community hospitals, 2 high and 1 low performing, will be undertaken. Case studies will gather routine hospital and local health economy data. Ward culture will be surveyed. Content and delivery of treatment will be observed. Patients and staff will be interviewed. Study 4: co-designed web-based quality improvement toolkits for commissioners and providers will be developed, including indicators of performance and the gap between local and best community hospitals performance. Publications will be in peer-reviewed journals, reports will be distributed

  4. Community services' involvement in the discharge of older adults from hospital into the community

    Directory of Open Access Journals (Sweden)

    Michelle Guerin

    2013-09-01

    Full Text Available Background: Community services are playing an increasing role in supporting older adults who are discharged from hospital with ongoing non-acute care needs.  However, there is a paucity of information regarding how community services are involved in the discharge process of older individuals from hospital into the community.  Methods: 29 databases were searched from 1980 to 2012 (inclusive for relevant primary published research, of any study design, as well as relevant unpublished work (e.g. clinical guidelines which investigated community services’ involvement in the discharge of older individuals from hospital into the community. Data analysis and quality appraisal (using McMaster critical appraisal tools was undertaken predominately by the lead author.  Data was synthesised qualitatively. Results: 12 papers were eligible for inclusion (five randomised controlled trials, four before and after studies and three controlled trials, involving a total of 8440 older adults (> 65 years.  These papers reported on a range of interventions.  During data synthesis, descriptors were assigned to four emergent discharge methods: Virtual Interface Model, In-reach Interface Model, Out-reach Interface Model, and Independent Interface Model.   In each model, the findings were mixed in terms of healthcare and patient and carer outcomes.  Conclusions: It is plausible that each model identified in this systematic review has a role to play in successfully discharging different cohorts of older adults from hospital.  Further research is required to identify appropriate population groups for various discharge models, and to select suitable outcomes measures to determine the effectiveness of these models, considering all stakeholders' involved.

  5. Community-Acquired Pneumonia Hospitalization among Children with Neurologic Disorders

    Science.gov (United States)

    Millman, Alexander J.; Finelli, Lyn; Bramley, Anna M.; Peacock, Georgina; Williams, Derek J.; Arnold, Sandra R.; Grijalva, Carlos G.; Anderson, Evan J.; McCullers, Jonathan A.; Ampofo, Krow; Pavia, Andrew T.; Edwards, Kathryn M.; Jain, Seema

    2016-01-01

    Objective To describe and compare the clinical characteristics, outcomes, and etiology of pneumonia among children hospitalized with community-acquired pneumonia (CAP) with neurologic disorders, non-neurologic underlying conditions, and no underlying conditions. Study design Children <18 years old hospitalized with clinical and radiographic CAP were enrolled at 3 US children’s hospitals. Neurologic disorders included cerebral palsy, developmental delay, Down syndrome, epilepsy, non-Down syndrome chromosomal abnormalities, and spinal cord abnormalities. We compared the epidemiology, etiology, and clinical outcomes of CAP in children with neurologic disorders with those with non-neurologic underlying conditions, and those with no underlying conditions using bivariate, age-stratified, and multivariate logistic regression analyses. Results From January 2010–June 2012, 2358 children with radiographically confirmed CAP were enrolled; 280 (11.9%) had a neurologic disorder (52.1% of these individuals also had non-neurologic underlying conditions), 934 (39.6%) had non-neurologic underlying conditions only, and 1144 (48.5%) had no underlying conditions. Children with neurologic disorders were older and more likely to require intensive care unit (ICU) admission than children with non-neurologic underlying conditions and children with no underlying conditions; similar proportions were mechanically ventilated. In age-stratified analysis, children with neurologic disorders were less likely to have a pathogen detected than children with non-neurologic underlying conditions. In multivariate analysis, having a neurologic disorder was associated with ICU admission for children ≥2 years of age. Conclusions Children with neurologic disorders hospitalized with CAP were less likely to have a pathogen detected and more likely to be admitted to the ICU than children without neurologic disorders. PMID:27017483

  6. Impact of pulsed xenon ultraviolet light on hospital-acquired infection rates in a community hospital.

    Science.gov (United States)

    Vianna, Pedro G; Dale, Charles R; Simmons, Sarah; Stibich, Mark; Licitra, Carmelo M

    2016-03-01

    The role of contaminated environments in the spread of hospital-associated infections has been well documented. This study reports the impact of a pulsed xenon ultraviolet no-touch disinfection system on infection rates in a community care facility. This study was conducted in a community hospital in Southern Florida. Beginning November 2012, a pulsed xenon ultraviolet disinfection system was implemented as an adjunct to traditional cleaning methods on discharge of select rooms. The technology uses a xenon flashlamp to generate germicidal light that damages the DNA of organisms in the hospital environment. The device was implemented in the intensive care unit (ICU), with a goal of using the pulsed xenon ultraviolet system for disinfecting all discharges and transfers after standard cleaning and prior to occupation of the room by the next patient. For all non-ICU discharges and transfers, the pulsed xenon ultraviolet system was only used for Clostridium difficile rooms. Infection data were collected for methicillin-resistant Staphylococcus aureus, C difficile, and vancomycin-resistant Enterococci (VRE). The intervention period was compared with baseline using a 2-sample Wilcoxon rank-sum test. In non-ICU areas, a significant reduction was found for C difficile. There was a nonsignificant decrease in VRE and a significant increase in methicillin-resistant S aureus. In the ICU, all infections were reduced, but only VRE was significant. This may be because of the increased role that environment plays in the transmission of this pathogen. Overall, there were 36 fewer infections in the whole facility and 16 fewer infections in the ICU during the intervention period than would have been expected based on baseline data. Implementation of pulsed xenon ultraviolet disinfection is associated with significant decreases in facility-wide and ICU infection rates. These outcomes suggest that enhanced environmental disinfection plays a role in the risk mitigation of hospital

  7. Determinants for hospitalization in " low-risk" community acquired pneumonia

    Directory of Open Access Journals (Sweden)

    Aliyu Muktar H

    2003-06-01

    Full Text Available Abstract Background A variable decision in managing community acquired pneumonia (CAP is the initial site of care; in-patient versus outpatient. These variations persist despite comprehensive practice guidelines. Patients with a Pneumonia Severity Index (PSI score lower than seventy have low risk for complications and outpatient antibiotic management is recommended in this group. These patients are generally below the age of fifty years, non-nursing home residents, HIV negative and have no major cardiac, hepatic, renal or malignant diseases. Methods A retrospective analysis of 296 low-risk CAP patients evaluated within a year one period at St. Agnes Hospital, Baltimore, Maryland was undertaken. All patients were assigned a PSI score. 208 (70% were evaluated and discharged from the emergency department (E.D. to complete outpatient antibiotic therapy, while 88 (30% were hospitalized. Patients were sub-stratified into classes I-V according to PSI. A comparison of demographic, clinical, social and financial parameters was made between the E.D. discharged and hospitalized groups. Results Statistically significant differences in favor of the hospitalized group were noted for female gender (CI: 1.46-5.89, p= 0.0018, African Americans (CI: 0.31-0.73, p= 0.004, insurance coverage (CI: 0.19-0.63, p= 0.0034, temperature (CI: 0.04-0.09, p= 0.0001 and pulse rate (CI: 0.03-0.14, p= 0.0001. No statistically significant differences were observed between the two groups for altered mental status, hypotension, tachypnea, laboratory/radiological parameters and social indicators (p>0.05. The average length of stay for in-patients was 3.5 days at about eight time's higher cost than outpatient management. There was no difference in mortality or treatment failures between the two groups. The documentation rate and justifications for hospitalizing low risk CAP patients by admitting physicians was less than optimal. Conclusions High fever, tachycardia, female gender

  8. Emergency Preparedness Plan. DeWitt Army Community Hospital, Fort Belvoir, Virginia,

    Science.gov (United States)

    1997-12-31

    emergency situation. 5. DENT AC will respond to DACH’s requests for oral surgeons, a dental forensic team, and other manpower requirements as...Department of Psychology & Neurology Chief, Department of Radiology Chief, Department of Obstetrics & Gynecology Chief, Department of Dentistry

  9. A Descriptive Survey of Weight Control Participants at a U.S. Army Community Hospital.

    Science.gov (United States)

    1983-08-01

    the failure group exercised, their caloric intake did not decrease so that only minimal benefit was obtained from the exercise. The last contributing...number for each type of activity) C Calisthenics 1 Never 2 Occasionally 3 Frequently 4 Routinely D Running 1 Never 2 Occasionally 3 Frequently 4

  10. A Case Study: Business Process Reengineering at Raymond W. Bliss Army Community Hospital

    Science.gov (United States)

    1997-05-01

    other Nerve Syst. Proc. w/o CC :.0963 $6,263 1 1.0963 $6,:33 SD 041 Extraocular Procedures except Orbit 0.7171 $4,097 1 0.7171 $4,097 SD 047 Other...ulcer or cellulitis 1.1838 $6,763 3 3.5514 $20,290 SD 267 Perianal & Pilonidal Proc. ’ 0.8368 $4.781 8...0.4845 $2,768 1 0.4845 $2,768 SD 276 Nonmaiignant Breast Disord. 0.5028 $2.873 1 0.5028 $2,873 OBS 278 Cellulitis age > 17 W/O CC 0.5712 $3.263 3 1.7136

  11. Demand Management: The Primary Care Role at Ireland Army Community Hospital (IACH)

    National Research Council Canada - National Science Library

    Hall, Bonnie J

    2005-01-01

    .... Several factors contributing to this concern are the variability of primary care managers, deficiencies in the continuity of care, the lack of internal policies governing primary care practices...

  12. Analysis of Patient Cycle Times at the Urgent Care Clinic at Moncrief Army Community Hospital

    National Research Council Canada - National Science Library

    Chavez, Jose L

    2004-01-01

    ...), no significant improvement in overall satisfaction was found between the two time intervals. Written patient comments indicated a greater concern for personal treatment experienced rather than access time to receive care...

  13. A Study to Determine the Most Efficient Provision of Surgical Care at Darnall Army Community Hospital

    Science.gov (United States)

    1987-09-01

    windows 5 Oral Surgery 1. Complicated exodontia 7 Orthoped ic 1. Closed reduction of simple fractures 2 3. Carpal tunnel release 17 9. Pin and wire...Cheiloplasty 8. Dermabrasion 9. Blepharoplasty 82 69 Oral Surgery 1. Complicated exodontia (adult and pediatric) 2. Surgical removal of adontogenic and...nonodontogenic lesions 3. Closed reduction of facial fractures Orthopedic 1. Closed reduction of simple fractures 2. Percutaneous pin fixation of

  14. An Analysis of Operating Room Performance Metrics at Reynolds Army Community Hospital

    Science.gov (United States)

    2009-06-28

    OTHER OTHER OTHER OTHER OTHER OTHER OTHER BCA BCB BCD BBD BHC BEA BEB BEC BED BEE BEF BEZ BLA BLB BAI BAR BAX BAZ BB BBL BBM...Management Clinic 23.11 23.11 BUN Burn 3.7* 3.74 HCU C3YN Ueneral 22.02 22.02 BCC Obslelrics BCB BCB BCD Bre’asl care S.8J 5.5J BDA Pediatrics

  15. An Effective Outpatient Appointment System for General Leonard Wood Army Community Hospital

    Science.gov (United States)

    1990-07-13

    Programming Schedules Hooten GMP 19 Purpose of the Study W. Edwards Deming , a noted industrialist and proponent of Total Quality Management (Walton... Willian . (1987, Suamer). Effects of problem based scheduling on patient waiting and staff utilization of time in a pediatric clinic. Journal of Aplied...satisfaction. The Journal of Family_ Practice. 24 (2), 200-202. Walton, Mary (1986). The Deming _alnaggeent method. New York. The Putnam Publishing Group. 94

  16. Inpatient Behavioral Health Recapture A Busiess Case Analysis at Evans Army Community Hospital Fort Carson, Colorado

    Science.gov (United States)

    2009-07-20

    100 Clean Linen 60 60 Clean Supply 120 120 Equipment Storage 100 100 Patient Property Storage 40 40 Stretcher and Wheelchair Storage 80 80 Crash...D account/ancillary services). According to the medical expense and performance reporting system for fixed military medical and dental treatment...reporting system for fixed military medical and dental treatment facilities manual (2008), this account captures costs associated with depreciation

  17. Provision of community benefits by tax-exempt U.S. hospitals.

    Science.gov (United States)

    Young, Gary J; Chou, Chia-Hung; Alexander, Jeffrey; Lee, Shoou-Yih Daniel; Raver, Eli

    2013-04-18

    The Patient Protection and Affordable Care Act (ACA) requires tax-exempt hospitals to conduct assessments of community needs and address identified needs. Most tax-exempt hospitals will need to meet this requirement by the end of 2013. We conducted a national study of the level and pattern of community benefits that tax-exempt hospitals provide. The study comprised more than 1800 tax-exempt hospitals, approximately two thirds of all such institutions. We used reports that hospitals filed with the Internal Revenue Service for fiscal year 2009 that provide expenditures for seven types of community benefits. We combined these reports with other data to examine whether institutional, community, and market characteristics are associated with the provision of community benefits by hospitals. Tax-exempt hospitals spent 7.5% of their operating expenses on community benefits during fiscal year 2009. More than 85% of these expenditures were devoted to charity care and other patient care services. Of the remaining community-benefit expenditures, approximately 5% were devoted to community health improvements that hospitals undertook directly. The rest went to education in health professions, research, and contributions to community groups. The level of benefits provided varied widely among the hospitals (hospitals in the top decile devoted approximately 20% of operating expenses to community benefits; hospitals in the bottom decile devoted approximately 1%). This variation was not accounted for by indicators of community need. In 2009, tax-exempt hospitals varied markedly in the level of community benefits provided, with most of their benefit-related expenditures allocated to patient care services. Little was spent on community health improvement.

  18. Creating a Business Plan and Projecting Revenue for a Cosmetic Laser Center in a Community Hospital

    National Research Council Canada - National Science Library

    McDevitt, Matthew

    2000-01-01

    ... this. In early 1999, the hospital chief executive officer at Sound Shore Medical Center, a not- for-profit community hospital located in southern Westchester County, New York, began gathering information...

  19. Percutaneous cholecystostomy at the community hospital: value evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jeong Min; Lee, Mi Suk; Lee, Jin Hee; Ym, Seong Hee; Yoon, Young Gun [Namwon Medical Center, Namwon (Korea, Republic of); Sohn, Myung Hee; Kim, Chong Soo; Han, Young Min; Choi, Ki Chul [Chonbuk National Univ., Chonju (Korea, Republic of)

    1997-10-01

    To assess the role of percutaneous cholecystostomy as a therapeutic maneuver in patients critically ill with acute cholecystitis in community hospitals. Eighteen patients, 11 with suspected acute calculous cholecystits and seven with acute acalulous cholecystitis underwent emergency percutaneous cholecystostomy. All demonstrated a variety of high risk factors for cholecystectomy:liver cirrhosis(n=3D2), diabetes mellitus(n=3D3), cardiac disease(n=3D3), underlying malignancy(n=3D2), pulmonary dysfunction(n=3D1), septic cholangitis(n=3D5), and old age(n=3D2). All percutaneous cholecystostomies were performed with ultrasound guidance and preferably using the transhepatic route. All procedures but one were successful, and most cholecystostomies were performed within 5-20 minutes. Technical problems were as follows: guide-wire buckling during catheter insertion(n=3D2) and procedure failure(n=3D1). The only major problem was a case of localized bile peritonitis due to procedural failure, but a few minor complications were encountered:catheter dislodgment(n=3D3), and significant abdominal pain during the procedure(2). After successful cholecystostomy, a dramatic improvement in clinical condition was observed in 16 of 17 patients(94%) within 48 hours. Ten of 16 patients who responded to percutaneous cholecystostomy underwent elective cholecystectomy after the improvement of clinical symptoms, and the remaining six patients improved without other gallbladder interventions. Percutaneous cholecystostomy is not only an effective procedure for acute cholecystitis, but also has a definite role in the management of these high-risk patients in community hospitals.=20.

  20. Rhinovirus Viremia in Patients Hospitalized With Community-Acquired Pneumonia.

    Science.gov (United States)

    Lu, Xiaoyan; Schneider, Eileen; Jain, Seema; Bramley, Anna M; Hymas, Weston; Stockmann, Chris; Ampofo, Krow; Arnold, Sandra R; Williams, Derek J; Self, Wesley H; Patel, Anami; Chappell, James D; Grijalva, Carlos G; Anderson, Evan J; Wunderink, Richard G; McCullers, Jonathan A; Edwards, Kathryn M; Pavia, Andrew T; Erdman, Dean D

    2017-11-27

    Rhinoviruses (RVs) are ubiquitous respiratory pathogens that often cause mild or subclinical infections. Molecular detection of RVs from the upper respiratory tract can be prolonged, complicating etiologic association in persons with severe lower respiratory tract infections. Little is known about RV viremia and its value as a diagnostic indicator in persons hospitalized with community-acquired pneumonia (CAP). Sera from RV-positive children and adults hospitalized with CAP were tested for RV by real-time reverse-transcription polymerase chain reaction. Rhinovirus species and type were determined by partial genome sequencing. Overall, 57 of 570 (10%) RV-positive patients were viremic, and all were children aged <10 years (n = 57/375; 15.2%). Although RV-A was the most common RV species detected from respiratory specimens (48.8%), almost all viremias were RV-C (98.2%). Viremic patients had fewer codetected pathogens and were more likely to have chest retractions, wheezing, and a history of underlying asthma/reactive airway disease than patients without viremia. More than 1 out of 7 RV-infected children aged <10 years hospitalized with CAP were viremic. In contrast with other RV species, RV-C infections were highly associated with viremia and were usually the only respiratory pathogen identified, suggesting that RV-C viremia may be an important diagnostic indicator in pediatric pneumonia. Published by Oxford University Press for the Infectious Diseases Society of America 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  1. Evaluating hospitals' provision of community benefit: an argument for an outcome-based approach to nonprofit hospital tax exemption.

    Science.gov (United States)

    Rubin, Daniel B; Singh, Simone Rauscher; Jacobson, Peter D

    2013-04-01

    Nonprofit hospitals are exempt from federal income taxation if they pass organizational and operational tests, including satisfying the community-benefit standard. Policymakers, however, have questioned the adequacy of the community benefits that nonprofit hospitals provide in exchange for these exemptions. The Internal Revenue Service recently responded to these concerns by redesigning its tax forms for nonprofit hospitals. The new Form 990 Schedule H requires nonprofit hospitals to provide additional information about their community-benefit activities. This new reporting requirement, however, places an undue focus on input-based community-benefit indicators, in particular expenditures. We argue that expanding the current input-based reporting requirement to include not only monetary inputs but also population health outcomes would achieve greater benefit for society.

  2. Nature's Swiss Army knives: ovipositor structure mirrors ecology in a multitrophic fig wasp community.

    Directory of Open Access Journals (Sweden)

    Mahua Ghara

    Full Text Available Resource partitioning is facilitated by adaptations along niche dimensions that range from morphology to behaviour. The exploitation of hidden resources may require specially adapted morphological or sensory tools for resource location and utilisation. Differences in tool diversity and complexity can determine not only how many species can utilize these hidden resources but also how they do so.The sclerotisation, gross morphology and ultrastructure of the ovipositors of a seven-member community of parasitic wasps comprising of gallers and parasitoids developing within the globular syconia (closed inflorescences of Ficus racemosa (Moraceae was investigated. These wasps also differ in their parasitism mode (external versus internal oviposition and their timing of oviposition into the expanding syconium during its development. The number and diversity of sensilla, as well as ovipositor teeth, increased from internally ovipositing to externally ovipositing species and from gallers to parasitoids. The extent of sclerotisation of the ovipositor tip matched the force required to penetrate the syconium at the time of oviposition of each species. The internally ovipositing pollinator had only one type of sensillum and a single notch on the ovipositor tip. Externally ovipositing species had multiple sensilla types and teeth on their ovipositors. Chemosensilla were most concentrated at ovipositor tips while mechanoreceptors were more widely distributed, facilitating the precise location of hidden hosts in these wasps which lack larval host-seeking behaviour. Ovipositor traits of one parasitoid differed from those of its syntopic galler congeners and clustered with those of parasitoids within a different wasp subfamily. Thus ovipositor tools can show lability based on adaptive necessity, and are not constrained by phylogeny.Ovipositor structure mirrored the increasingly complex trophic ecology and requirements for host accessibility in this parasite

  3. Validating Performance of a Hospital Discharge Planning Decision Tool in Community Hospitals.

    Science.gov (United States)

    Holland, Diane E; Brandt, Cheryl; Targonski, Paul V; Bowles, Kathryn H

    The Early Screen for Discharge Planning (ESDP) is a decision support tool developed in an urban academic medical center. High ESDP scores identify patients with nonroutine discharge plans who would benefit from early discharge planning intervention. We aimed to determine the predictive performance of the ESDP in a different practice setting. Rural regional community hospital. We designed a comparative, descriptive survey study and enrolled a convenience sample of 222 patients (identified at admission) who provided informed consent. Sample characteristics and ESDP scores were collected during enrollment. The Problems After Discharge Questionnaire, EuroQoL-5Dimensions quality-of-life measure, length of stay, and use of post-acute care services were recorded after discharge. We compared outcomes between patients with low and high ESDP scores. More than half of the sample (51.8%) had a high ESDP score. Patients with high ESDP scores reported more problems after discharge (p = .02), reported lower quality of life (p < .001), had longer length of stays (p = .04), and used post-acute care services (p = .006) more than patients with low ESDP scores. The difference in the average percentage of unmet needs was not statistically significant (p = .12), but patients with high ESDP scores reported more unmet needs than patients with low ESDP scores. The value of systematically proactive approaches to discharge planning is increasingly recognized, but establishing the performance capacity of support tools is critical for optimizing benefit. These study findings support use of the ESDP in regional community hospitals, making it a useful, open-source decision support tool for various health care delivery systems.

  4. Tuberculosis screening for hospital employees. A five-year experience in a large community hospital.

    Science.gov (United States)

    Vogeler, D M; Burke, J P

    1978-02-01

    A 5-year experience in developing an annual tuberculosis screening program for employees of a 570-bed community hospital in a state with a low endemic rate of tuberculosis is described. Using a computerized payroll system to notify employees and the incentive of free lunch tickets, the program reached more than 95 per cent of the eligible employees. No active cases and only 7 skin test conversions (0.11 per cent) were found during the 5-year period; only 3 of the 7 converters worked in patient care. Three other converters (1.03 per cent) were found among the 291 employee contracts of 20 patients who were initially undiagnosed. The costs for comprehensive screening were high in relation to the low conversion rates found, and more selective screening may be justified in similar hospitals where the risk of acquiring tuberculosis is low. Nonetheless, because the problem of poor compliance was managed successfully, the program has provided an effective measure of protection for both patients and personnel.

  5. Community Benefit Spending By Tax-Exempt Hospitals Changed Little After ACA.

    Science.gov (United States)

    Young, Gary J; Flaherty, Stephen; Zepeda, E David; Singh, Simone Rauscher; Rosen Cramer, Geri

    2018-01-01

    Provisions of the Affordable Care Act (ACA) encouraged tax-exempt hospitals to invest broadly in community health benefits. Four years after the ACA's enactment, hospitals had increased their average spending for all community benefits by 0.5 percentage point, from 7.6 percent of their operating expenses in 2010 to 8.1 percent in 2014.

  6. Deinstitutionalisation for long-term mental illness: cost differences in hospital and community care.

    Science.gov (United States)

    Lapsley, H M; Tribe, K; Tennant, C; Rosen, A; Hobbs, C; Newton, L

    2000-06-01

    This project studied the cost analysis of psychiatric hospital and then community care for long-stay patients with chronic mental illness discharged during the closure of a psychiatric hospital in Sydney. Expenditure and income data in both settings were collected. Costs were analysed on an occupied bed-day basis. The hospital setting cost more per patient per day compared with the various community costs which were one-third to one-half of the comparable hospital costs. The analysis demonstrated overall that hospital care was nearly twice as expensive as care in the community setting. The factors which may have influenced, although not necessarily altered, the substance of the findings largely related to 'organisational efficiency'. The mental hospital as an older, more rigid system was likely to be less efficient than the newer community service provision which was under intensive scrutiny both clinically and financially by all interested parties.

  7. Persisting high hospital and community childhood mortality in an urban setting in Guinea-Bissau

    DEFF Research Database (Denmark)

    Veirum, Jens Erik; Biai, Sidu; Jakobsen, Marianne

    2007-01-01

    AIM: To describe paediatric hospitalization in a West African capital in relation to overall childhood mortality in the community and to evaluate the potential impact of improved management at the hospital. METHODS: Hospital data on child admissions in a 6-year period were linked to information i...... be free of charge, in order to minimize the impact of social inequality. Udgivelsesdato: 2007-Oct...

  8. Army Sustainability Report 2010

    Science.gov (United States)

    2011-09-01

    Antonio. The buffer objectives are to protect endangered species, primarily the Golden Cheeked Warbler , through off-site mitigation, and to acquire...water projects, including solar powered and standalone water filtration systems. In 2009, the Army worked with East African Community partner nations

  9. "Know your audience": A hospital community engagement programme in a non-profit paediatric hospital in Cambodia.

    Directory of Open Access Journals (Sweden)

    Sreymom Pol

    Full Text Available The purpose of this evaluation is to explore the impact of the new hospital community engagement programme (comprised of a Young Persons Advisory Group and a Science Café on community members and other stakeholders, with regard to their attitudes, skills and degree of engagement in a paediatric hospital in Cambodia.Data collection included feedback questionnaires and reflections produced after each YPAG and Science Café event. Further questionnaires and reflective interviews were conducted to gather the views of key stakeholders. Data were analysed by thematic content analysis and numerical data were expressed using descriptive statistics.The vast majority of participants expressed their enjoyment and satisfaction of the hospital community engagement programme. Delivering the programme in the right manner for the target audiences, by prioritising their needs was key to this. Participants valued the programmes in terms of the knowledge delivered around good health practices, the skills developed such as confidence and responsibility for their health, and the provision of opportunities to voice their opinions. All stakeholders recognised the importance of the programme in improving the quality of the healthcare service provided at the hospital.In order to have a successful hospital community engagement programme, understanding the target audience is essential. The engagement programme must be delivered in the right way to meet the needs of community members, including right communication, right setting, right people and right timing. This will ultimately result in a meaningful programme that is able to empower community members, potentially resulting in lasting change in healthcare practices. In conclusion, the gap between hospitals and the community could narrow, allowing everyone to interact and learn from each other.

  10. “Know your audience”: A hospital community engagement programme in a non-profit paediatric hospital in Cambodia

    Science.gov (United States)

    Fox-Lewis, Shivani; Cheah, Phaik Yeong; Turner, Claudia

    2017-01-01

    Objective The purpose of this evaluation is to explore the impact of the new hospital community engagement programme (comprised of a Young Persons Advisory Group and a Science Café) on community members and other stakeholders, with regard to their attitudes, skills and degree of engagement in a paediatric hospital in Cambodia. Design Data collection included feedback questionnaires and reflections produced after each YPAG and Science Café event. Further questionnaires and reflective interviews were conducted to gather the views of key stakeholders. Data were analysed by thematic content analysis and numerical data were expressed using descriptive statistics. Results The vast majority of participants expressed their enjoyment and satisfaction of the hospital community engagement programme. Delivering the programme in the right manner for the target audiences, by prioritising their needs was key to this. Participants valued the programmes in terms of the knowledge delivered around good health practices, the skills developed such as confidence and responsibility for their health, and the provision of opportunities to voice their opinions. All stakeholders recognised the importance of the programme in improving the quality of the healthcare service provided at the hospital. Conclusions In order to have a successful hospital community engagement programme, understanding the target audience is essential. The engagement programme must be delivered in the right way to meet the needs of community members, including right communication, right setting, right people and right timing. This will ultimately result in a meaningful programme that is able to empower community members, potentially resulting in lasting change in healthcare practices. In conclusion, the gap between hospitals and the community could narrow, allowing everyone to interact and learn from each other. PMID:28771631

  11. Community Hospitals in Selected High Income Countries: A Scoping Review of Approaches and Models

    Directory of Open Access Journals (Sweden)

    Eleanor M Winpenny

    2016-11-01

    Full Text Available Background: There is no single definition of a community hospital in the UK, despite its long history. We sought to understand the nature and scope of service provision in community hospitals, within the UK and other high-income countries. Methods: We undertook a scoping review of literature on community hospitals published from 2005 to 2014. Data were extracted on features of the hospital model and the services provided, with results presented as a narrative synthesis. Results: 75 studies were included from ten countries. Community hospitals provide a wide range of services, with wide diversity of provision appearing to reflect local needs. Community hospitals are staffed by a mixture of general practitioners (GPs, nurses, allied health professionals and healthcare assistants. We found many examples of collaborative working arrangements between community hospitals and other health care organisations, including colocation of services, shared workforce with primary care and close collaboration with acute specialists. Conclusions: Community hospitals are able to provide a diverse range of services, responding to geographical and health system contexts. Their collaborative nature may be particularly important in the design of future models of care delivery, where emphasis is placed on integration of care with a key focus on patient-centred care.

  12. Tax-Exempt Hospitals' Investments in Community Health and Local Public Health Spending: Patterns and Relationships.

    Science.gov (United States)

    Singh, Simone R; Young, Gary J

    2017-12-01

    To investigate whether tax-exempt hospitals' investments in community health are associated with patterns of governmental public health spending focusing specifically on the relationship between hospitals' community benefit expenditures and the spending patterns of local health departments (LHDs). We combined data on tax-exempt hospitals' community benefit spending with data on spending by the corresponding LHD that served the county in which a hospital was located. Data were available for 2 years, 2009 and 2013. Generalized linear regressions were estimated with indicators of hospital community benefit spending as the dependent variable and LHD spending as the key independent variable. Hospital community benefit spending was unrelated to how much local public health agencies spent, per capita, on public health in their communities. Patterns of local public health spending do not appear to impact the investments of tax-exempt hospitals in community health activities. Opportunities may, however, exist for a more active engagement between the public and private sector to ensure that the expenditures of all stakeholders involved in community health improvement efforts complement one another. © Health Research and Educational Trust.

  13. The Journey to Meet Emerging Community Benefit Requirements in a Rural Hospital: A Case Study

    Science.gov (United States)

    Sabin, Allison V; Levin, Pamela F

    2015-10-22

    The Affordable Care Act requires nonprofit hospitals to collaborate with public health agencies and community stakeholders to identify and address community health needs. As a rural organization, Wabash County (Indiana) Hospital pursued new approaches to achieve these revised requirements of the community benefit mandate. Using a case study approach, the authors provide a historical review of governmental relationships with nonprofit community hospitals, offer a case study application for implementing legislative mandates and community benefit requirements, share the insights they garnered on their journey to meet the mandates, and conclude that drawing upon the existing resources in the community and using current community assets in novel ways can help conserve time, and also financial, material, and human resources in meeting legislative mandates.

  14. Lack of effective communication between communities and hospitals in Uganda: a qualitative exploration of missing links

    Directory of Open Access Journals (Sweden)

    Mutebi Aloysius

    2009-08-01

    Full Text Available Abstract Background Community members are stakeholders in hospitals and have a right to participate in the improvement of quality of services rendered to them. Their views are important because they reflect the perspectives of the general public. This study explored how communities that live around hospitals pass on their views to and receive feedback from the hospitals' management and administration. Methods The study was conducted in eight hospitals and the communities around them. Four of the hospitals were from three districts from eastern Uganda and another four from two districts from western Uganda. Eight key informant interviews (KIIs were conducted with medical superintendents of the hospitals. A member from each of three hospital management boards was also interviewed. Eight focus group discussions (FGDs were conducted with health workers from the hospitals. Another eight FGDs (four with men and four with women were conducted with communities within a five km radius around the hospitals. Four of the FGDs (two with men and two with women were done in western Uganda and the other four in eastern Uganda. The focus of the KIIs and FGDs was exploring how hospitals communicated with the communities around them. Analysis was by manifest content analysis. Results Whereas health unit management committees were supposed to have community representatives, the representatives never received views from the community nor gave them any feed back from the hospitals. Messages through the mass media like radio were seen to be non specific for action. Views sent through suggestion boxes were seen as individual needs rather than community concerns. Some community members perceived they would be harassed if they complained and had reached a state of resignation preferring instead to endure the problems quietly. Conclusion There is still lack of effective communication between the communities and the hospitals that serve them in Uganda. This deprives the

  15. Alcohol Use Disorders and Community-Acquired Pneumococcal Pneumonia: Associated Mortality, Prolonged Hospital Stay and Increased Hospital Spending.

    Science.gov (United States)

    Gili-Miner, Miguel; López-Méndez, Julio; Béjar-Prado, Luis; Ramírez-Ramírez, Gloria; Vilches-Arenas, Ángel; Sala-Turrens, José

    2015-11-01

    The aim of this study was to investigate the impact of alcohol use disorders (AUD) on community-acquired pneumococcal pneumonia (CAPP) admissions, in terms of in-hospital mortality, prolonged stay and increased hospital spending. Retrospective observational study of a sample of CAPP patients from the minimum basic datasets of 87 Spanish hospitals during 2008-2010. Mortality, length of hospital stay and additional spending attributable to AUD were calculated after multivariate covariance analysis for variables such as age and sex, type of hospital, addictions and comorbidities. Among 16,202 non-elective admissions for CAPP in patients aged 18-74years, 2,685 had AUD. Patients admitted with CAPP and AUD were predominantly men with a higher prevalence of tobacco or drug use disorders and higher Charlson comorbidity index. Patients with CAPP and AUD had notably higher in-hospital mortality (50.8%; CI95%: 44.3-54.3%), prolonged length of stay (2.3days; CI95%: 2.0-2.7days) and increased costs (1,869.2€; CI95%: 1,498.6-2,239.8€). According to the results of this study, AUD in CAPP patients was associated with increased in-hospital mortality, length of hospital stay and hospital spending. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  16. The Army Family Team Building Program: Facilitating a Transformative Learning Process--An Intrinsic Case Study

    Science.gov (United States)

    Gall, Joseph A.

    2009-01-01

    This study sought to understand how the Army Family Team Building program influences self-reliance and self-sufficiency in Army spouses as they integrate into the Army community. The purpose of the Army Family Team Building program is to empower Army spouses with knowledge and skills, which foster well-being and improve quality of life. The…

  17. Paediatric utilisation of a teaching hospital and a community health ...

    African Journals Online (AJOL)

    promotive services, a Cape Provincial Administration (CPA) day hospital and a maternity obstetric unit (MQU) run by the. Peninsula Neonatal and Maternity Services (PNMS). The day hospital provid,es a 24-hour curative service and has a basic laboratory and X-ray facility, as well as a functioning rehydration unit. Despite ...

  18. Community-acquired pneumonia (CAP) hospitalizations and deaths: is there a role for quality improvement through inter-hospital comparisons?

    Science.gov (United States)

    Aelvoet, W; Terryn, N; Blommaert, A; Molenberghs, G; Hens, N; De Smet, F; Callens, M; Beutels, P

    2016-02-01

    To assess between-hospital variations in standardized in-hospital mortality ratios of community-acquired pneumonia (CAP), and identify possible leads for quality improvement. We used an administrative database to estimate standardized in-hospital mortality ratios for 111 Belgian hospitals, by carrying out a set of hierarchical logistic regression models, intended to disentangle therapeutic attitudes and biases. To facilitate the detection of false-negative/positive results, we added an inconclusive zone to the funnel plots, derived from the results of the study. Data quality was validated by comparison with (i) alternative data from the largest Belgian Sickness Fund, (ii) published German hospital data and (iii) the results of an on-site audit. All Belgian hospital discharge records from 2004 to 2007. A total of 111 776 adult patients were admitted for CAP. Risk-adjusted standardized in-hospital mortality ratios. Out of the 111 hospitals, we identified five and six outlying hospitals, with standardized mortality ratios of CAP consistently on the extremes of the distribution, as providing possibly better or worse care, respectively, and 18 other hospitals as having possible quality weaknesses/strengths. At the individuals' level of the analysis, adjusted odds ratios showed the paramount importance of old age, comorbidity and mechanical ventilation. The data compared well with the different validation sources. Despite the limitations inherent to administrative data, it seemed possible to establish inter-hospital differences in standardized in-hospital mortality ratios of CAP and to identify leads for quality improvement. Monitoring is needed to assess progress in quality. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  19. Economic and safety benefits of pharmaceutical interventions by community and hospital pharmacists in Japan.

    Science.gov (United States)

    Tasaka, Yuichi; Yasunaga, Daiki; Tanaka, Mamoru; Tanaka, Akihiro; Asakawa, Takashige; Horio, Ikuo; Miyauchi, Yoshiro; Araki, Hiroaki

    2016-04-01

    Pharmaceutical interventions by community and hospital pharmacists can improve medication safety and result in financial savings. Their effect has not been fully explored in Japan. To evaluate the economic and safety contributions of various pharmaceutical interventions by community and hospital pharmacists in Japan. Two hospitals and eight community pharmacies in Ehime Prefecture, Japan, in 2014-2015. Pharmacists entered data about pharmaceutical interventions via the internet, and the data were divided into 11 types of interventions. The economic impact was estimated based on the rate of avoidance of serious adverse drug reactions and the monetary cost of these reactions in the Japanese compensation system. The cost saving from adjusting prescriptions to take account of unused prescription drugs was calculated using drug prices from the national health insurance scheme. Main The number of pharmaceutical interventions and their economic impact. RESULTS The total cost savings from 500 to 509 pharmaceutical interventions by community and hospital pharmacists were US$207,126.6 and US$592,840, respectively. Community pharmacists mainly intervened to correct prescription errors. They also adjusted 135 prescriptions to take account of unused prescription drugs. This potentially improved patients' adherence and contributed to effective use of medication. Pharmaceutical interventions by hospital pharmacists facilitated avoidance of 10 serious adverse drug reactions, and included 42 transvenous antimicrobial therapy interventions, 88 interventions in cancer chemotherapy, and 47 monitoring recommendations. Hospital pharmacists helped improve patients' quality of life using more aggressive interventions besides correcting prescription errors. Over half of pharmaceutical interventions by community and hospital pharmacists contributed to avoidance of adverse drug reactions. These results suggest the importance of pharmaceutical interventions by both community and hospital

  20. After the Spring: Reforming Arab Armies

    Science.gov (United States)

    2014-09-01

    Arab region, and intercultural communication . She was previously assigned to the North Atlantic Treaty Organization (NATO) Defence College and the...and provides solutions to strategic Army issues affecting the national security community . The Peacekeeping and Stability Operations Institute...concern topics having strategic implications for the Army, the Department of Defense, and the larger national security community . In addition to its

  1. Hospital and Community Pharmacists’ Perceptions of Which Competences Are Important for Their Practice

    Directory of Open Access Journals (Sweden)

    Jeffrey Atkinson

    2016-06-01

    Full Text Available The objective of the PHAR-QA (Quality assurance in European pharmacy education and training project was to investigate how competence-based learning could be applied to a healthcare, sectoral profession such as pharmacy. This is the first study on evaluation of competences from the pharmacists’ perspective using an improved Delphi method with a large number of respondents from all over Europe. This paper looks at the way in which hospital pharmacists rank the fundamental competences for pharmacy practice. European hospital pharmacists (n = 152 ranked 68 competences for pharmacy practice of two types (personal and patient care, arranged into 13 clusters. Results were compared to those obtained from community pharmacists (n = 258. Generally, hospital and community pharmacists rank competences in a similar way. Nevertheless, differences can be detected. The higher focus of hospital pharmacists on knowledge of the different areas of science as well as on laboratory tests reflects the idea of a hospital pharmacy specialisation. The difference is also visible in the field of drug production. This is a necessary competence in hospitals with requests for drugs for rare diseases, as well as paediatric and oncologic drugs. Hospital pharmacists give entrepreneurship a lower score, but cost-effectiveness a higher one than community pharmacists. This reflects the reality of pharmacy practice where community pharmacists have to act as entrepreneurs, and hospital pharmacists are managers staying within drug budgets. The results are discussed in the light of a “hospital pharmacy” specialisation.

  2. Hospital and Community Pharmacists’ Perceptions of Which Competences Are Important for Their Practice

    Science.gov (United States)

    Atkinson, Jeffrey; Sánchez Pozo, Antonio; Rekkas, Dimitrios; Volmer, Daisy; Hirvonen, Jouni; Bozic, Borut; Skowron, Agnieska; Mircioiu, Constantin; Sandulovici, Roxana; Marcincal, Annie; Koster, Andries; Wilson, Keith A.; van Schravendijk, Chris; Frontini, Roberto; Price, Richard; Bates, Ian; De Paepe, Kristien

    2016-01-01

    The objective of the PHAR-QA (Quality assurance in European pharmacy education and training) project was to investigate how competence-based learning could be applied to a healthcare, sectoral profession such as pharmacy. This is the first study on evaluation of competences from the pharmacists’ perspective using an improved Delphi method with a large number of respondents from all over Europe. This paper looks at the way in which hospital pharmacists rank the fundamental competences for pharmacy practice. European hospital pharmacists (n = 152) ranked 68 competences for pharmacy practice of two types (personal and patient care), arranged into 13 clusters. Results were compared to those obtained from community pharmacists (n = 258). Generally, hospital and community pharmacists rank competences in a similar way. Nevertheless, differences can be detected. The higher focus of hospital pharmacists on knowledge of the different areas of science as well as on laboratory tests reflects the idea of a hospital pharmacy specialisation. The difference is also visible in the field of drug production. This is a necessary competence in hospitals with requests for drugs for rare diseases, as well as paediatric and oncologic drugs. Hospital pharmacists give entrepreneurship a lower score, but cost-effectiveness a higher one than community pharmacists. This reflects the reality of pharmacy practice where community pharmacists have to act as entrepreneurs, and hospital pharmacists are managers staying within drug budgets. The results are discussed in the light of a “hospital pharmacy” specialisation. PMID:28970394

  3. Explaining turnover intention in Korean public community hospitals: occupational differences.

    Science.gov (United States)

    Hwang, Jee-In; Chang, Hyejung

    2008-01-01

    Personnel in public hospitals had relatively low job satisfaction despite of tenure employment. High turnover rates degrade hospital image and incur additional costs related to recruitment and training. The purposes of this study were to describe the occupational differences and to identify factors affecting turnover intention among public hospital personnel. A questionnaire survey was conducted as part of Administrative Services Quality Evaluation Program by Seoul metropolitan municipality from 1 November to 1 December in 2003. The subjects were 1251 entire hospital personnel in four hospitals. The questionnaire was designed to measure job satisfaction, organizational commitment, turnover intention, and demographic characteristics. Logistic regression analysis was performed to determine factors influencing turnover intention. There were significant differences in job satisfaction, organizational commitment, and turnover intention according to the occupations. The turnover intention rates were highest among physicians, followed by paramedicals and nursing staffs and then administrators. The significant factors affecting turnover intention were involvement and loyalty among physicians, hospital type, satisfaction with systems and loyalty among nursing staffs, satisfaction with relationship and loyalty among administrators, and loyalty among paramedicals. There were different moderators that influence turnover intentions of hospital personnel. Loyalty had the most important effect upon turnover intention in all occupations. 2007 John Wiley & Sons, Ltd

  4. Linking up with the community: a fertile strategy for a university hospital?

    NARCIS (Netherlands)

    Plochg, Thomas; Delnoij, Diana M. J.; Klazinga, Niek S.

    2006-01-01

    PURPOSE: To systematically identify, describe and characterise the collaborative initiatives, which have been established between the Academic Medical Centre/University of Amsterdam and local health care providers in the adjacent community. BACKGROUND: The viability of university hospitals is

  5. Community perceptions of the effects of rural hospital closure on access to care.

    Science.gov (United States)

    Reif, S S; DesHarnais, S; Bernard, S

    1999-01-01

    The purpose of this case study was to ascertain the perceptions of health professionals who were located in six rural communities where hospital closure occurred, regarding the impact of closure on community residents. These health professionals were asked to respond to questions about effects of hospital closures on the availability of medical services such as emergency care, physician services, hospital services and nursing home care. To control for trends in medical services utilization that were unrelated to hospital closure, the study design included comparison areas where similar hospitals remained open. A standardized questionnaire was administered to three health professionals in each of the areas that experienced a hospital closure and also in the matched comparison areas. Interviews of the health professionals in closure areas provide evidence suggestive of some perceived negative effects of hospital closure on these communities. These negative effects include difficulty recruiting and retaining physicians, concern of residents about the loss of their local emergency room, and increased travel times to receive hospital services. The perceived effects of closure appeared to be mediated by the distance required for travel to the nearest hospital. Respondents perceived increased travel times to most significantly affect vulnerable populations, such as the elderly, the disabled and the economically disadvantaged. Respondents in the majority of comparison areas also reported access barriers for vulnerable populations. These barriers primarily center on problems of obtaining transportation and enduring the rigors of travel. Improvements in the availability of transportation to medical care may offer some stabilization to communities where hospitals closed; however, it also is the case that transportation improvements are needed to increase access to care in rural communities where hospitals remained open.

  6. Costs of day hospital and community residential chemical dependency treatment.

    Science.gov (United States)

    Kaskutas, Lee Ann; Zavala, Silvana K; Parthasarathy, Sujaya; Witbrodt, Jane

    2008-03-01

    Patient placement criteria developed by the American Society of Addiction Medicine (ASAM) have identified a need for low-intensity residential treatment as an alternative to day hospital for patients with higher levels of severity. A recent clinical trial found similar outcomes at social model residential treatment and clinically-oriented day hospital programs, but did not report on costs. This paper addresses whether the similar outcomes in the recent trial were delivered with comparable costs, overall and within gender and ethnicity stratum. This paper reports on clients not at environmental risk who participated in a randomized trial conducted in three metropolitan areas served by a large pre-paid health plan. Cost data were collected using the Drug Abuse Treatment Cost Analysis Program (DATCAP). Costs per episode were calculated by multiplying DATCAP-derived program-specific costs by each client's length of stay. Differences in length of stay, and in per-episode costs, were compared between residential and day hospital subjects. Lengths of stay at residential treatment were significantly longer than at day hospital, in the sample overall and in disaggregated analyses. This difference was especially marked among non-Whites. The average cost per week was USD 575 per week at day hospital, versus USD 370 per week at the residential programs. However, because of the longer stays in residential, per-episode costs were significantly higher in the sample overall and among non-Whites (and marginally higher for men). These cost results must be considered in light of the null findings comparing outcomes between subjects randomized to residential versus day hospital programs. The longer stays in the sample overall and for non-White clients at residential programs came at higher costs but did not lead to better rates of abstinence. The short stays in day hospital among non-Whites call into question the attractiveness of day hospital for minority clients. Outcomes and costs

  7. 75 FR 52960 - Medicare Program; Rural Community Hospital Demonstration Program: Solicitation of Additional...

    Science.gov (United States)

    2010-08-30

    ... subsequent cost reporting period, the lesser of their reasonable costs or a target amount. The target amount.... The target amount in subsequent cost ] reporting periods is defined as the preceding cost reporting... establishing cost-based reimbursement for ``rural community hospitals'' to furnish covered inpatient hospital...

  8. The Treatment of Eating Disorder Clients in a Community-Based Partial Hospitalization Program.

    Science.gov (United States)

    Levitt, John L.; Sansone, Randy A.

    2003-01-01

    Outlines a multi-faceted treatment approach to eating disorders within a partial hospital program that is affiliated with a community mental health hospital. Although empirical confirmation is not currently available, initial clinical impressions indicate that the program is facilitating the recovery of these difficult-to-treat individuals.…

  9. Saint Anthony Hospital: Infusing Developmental and Family Support Services in Community-Based Medical Practice

    Science.gov (United States)

    Casas, Paula; Isarowong, Nucha

    2015-01-01

    Physicians affiliated with small community hospitals face numerous barriers to using developmentally oriented best practices in primary care with young children. Saint Anthony Hospital's Developmental Support Project model promotes improved developmental outcomes for children through two complementary strands of services: (a) training and…

  10. From Pergamon to Army Base Hospital No. 5: the history and significance of the galea aponeurotica in the evolution of neurosurgery.

    Science.gov (United States)

    Connor, David E; Chittiboina, Prashant; Nanda, Anil

    2014-08-01

    The authors trace the etymology and historical significance of galea or epicranial aponeurosis. In ancient Greece, galea referred to a helmet worn by soldiers, typically made of animal hide or leather. Throughout antiquity, physicians referred to all soft tissue between the skin and the skull as panniculus, a standard established by Galen of Pergamon. A manual of surgery in the Middle Ages referred to the entire scalp as a "great panicle that is called pericranium." During the early Renaissance, Leonardo da Vinci famously and stylistically analogized the dissection of the cranium with the peeling of an onion. Not until 1724 would the tendinous sheath connecting the frontalis and occipitalis muscles be defined as "Galea tendinosa cranii." By 1741, the convention of referring to the galea as an aponeurosis was well established. Harvey Cushing's wartime experiences at Army Base Hospital No. 5 reinforced the surgical significance of the galea. Operative mortality was significantly diminished due to "closure of the wounds with buried sutures in the galea." This operative nuance was then passed from teacher to pupil and has now become one of the tenets of modern neurosurgical practice.

  11. Perceived quality of an alternative to acute hospitalization: an analytical study at a community hospital in Hallingdal, Norway.

    Science.gov (United States)

    Lappegard, Øystein; Hjortdahl, Per

    2014-10-01

    There is growing international interest in the geography of health care provision, with health care providers searching for alternatives to acute hospitalization. In Norway, the government has recently legislated for municipal authorities to develop local health services for a selected group of patients, with a quality equal to or better than that provided by hospitals for emergency admissions. General practitioners in Hallingdal, a rural district in southern Norway, have for several years referred acutely somatically ill patients to a community hospital, Hallingdal sjukestugu (HSS). This article analyzes patients' perceived quality of HSS to demonstrate factors applicable nationally and internationally to aid in the development of local alternatives to general hospitals. We used a mixed-methods approach with questionnaires, individual interviews and a focus group interview. Sixty patients who were taking part in a randomized, controlled study of acute admissions at HSS answered the questionnaire. Selected patients were interviewed about their experiences and a focus group interview was conducted with representatives of local authorities, administrative personnel and health professionals. Patients admitted to HSS reported statistically significant greater satisfaction with several care aspects than those admitted to the general hospital. Factors highlighted by the patients were the quiet and homelike atmosphere; a small facility which allowed them a good overall view of the unit; close ties to the local community and continuity in the patient-staff relationship. The focus group members identified some overarching factors: an interdisciplinary and holistic approach, local ownership, proximity to local general practices and close cooperation with the specialist health services at the hospital. Most of these factors can be viewed as general elements relevant to the development of local alternatives to acute hospitalization both nationally and internationally. This

  12. Getting more for your money: designing community needs assessments to build collaboration and capacity in hospital system community benefit work.

    Science.gov (United States)

    Ainsworth, Dale; Diaz, Heather; Schmidtlein, Mathew C

    2013-11-01

    Most community health needs assessments (CHNAs) are unilateral in nature and fail to include a community-based participatory research (CBPR) approach, limiting them in their scope. Nonprofit hospitals are required to conduct CHNAs every 3 years to determine where community prevention dollars should be spent. In 2010, a CBPR CHNA approach was conducted with four hospital systems in Northern California. Merging concepts from organization development, the approach included (a) goal determination, (b) use of a guiding framework, (c) creation of a container in which to interact, (d) established feedback loops, and (e) intentional trust-building exercises. The approach was to build lasting relationships between hospital systems that would extend beyond the CHNA. Results using this approach revealed that members representing all four hospital systems (a) began to meet regularly after the CHNA was completed, (b) increased collaboration with other community organizations, (c) expanded their level of intraorganization partnerships, (d) enjoyed the process, (e) felt that their professional knowledge expanded, and (f) felt connected professionally and personally with other hospital representatives. As a result, other joint projects are underway. The results of this study indicate that using CBPR to design a CHNA can build sustained collaborative relationships between study participants that continue.

  13. Community Sampling and Integrative Taxonomy Reveal New Species and Host Specificity in the Army Ant-Associated Beetle Genus Tetradonia (Coleoptera, Staphylinidae, Aleocharinae)

    Science.gov (United States)

    von Beeren, Christoph; Maruyama, Munetoshi; Kronauer, Daniel J. C.

    2016-01-01

    Army ant colonies host a diverse community of arthropod symbionts. Among the best-studied symbiont communities are those of Neotropical army ants of the genus Eciton. It is clear, however, that even in these comparatively well studied systems, a large proportion of symbiont biodiversity remains unknown. Even more striking is our lack of knowledge regarding the nature and specificity of these host-symbiont interactions. Here we surveyed the diversity and host specificity of rove beetles of the genus Tetradonia Wasmann, 1894 (Staphylinidae: Aleocharinae). Systematic community sampling of 58 colonies of the six local Eciton species at La Selva Biological Station, Costa Rica, combined with an integrative taxonomic approach, allowed us to uncover species diversity, host specificity, and co-occurrence patterns of symbionts in unprecedented detail. We used an integrative taxonomic approach combining morphological and genetic analyses, to delineate species boundaries. Mitochondrial DNA barcodes were analyzed for 362 Tetradonia specimens, and additional nuclear markers for a subset of 88 specimens. All analyses supported the presence of five Tetradonia species, including two species new to science. Host specificity is highly variable across species, ranging from generalists such as T. laticeps, which parasitizes all six local Eciton species, to specialists such as T. lizonae, which primarily parasitizes a single species, E. hamatum. Here we provide a dichotomous key along with diagnostic molecular characters for identification of Tetradonia species at La Selva Biological Station. By reliably assessing biodiversity and providing tools for species identification, we hope to set the baseline for future studies of the ecological and evolutionary dynamics in these species-rich host-symbiont networks. PMID:27829037

  14. Educational Hospital Units of Valencia community: a case study

    Directory of Open Access Journals (Sweden)

    Cristina PORTOLÉS SOLER

    2018-01-01

    Full Text Available The functioning and organization of an educational hospital unit of Valencia is described, through observation, field diary and documental analysis (during February to May 2016. Also, it is designed and implemented an educational project through the story The zebra Camila for students of early childhood education hospitalized in the Pediatric Oncology Service. In the project LOMCE objectives are followed, in addition to the Hospital Pedagogy objectives themselves; 12 educational units are proposed, covering all curricular areas of early childhood education, with a variety of activities and resources that can be adapted to the different educational needs of students who are included. Teachers, the kind of students, the areas of activity, methodology and teaching resources are very diverse and are based on health services.

  15. Joint Community Health Needs Assessments as a Path for Coordinating Community-Wide Health Improvement Efforts Between Hospitals and Local Health Departments.

    Science.gov (United States)

    Carlton, Erik L; Singh, Simone Rauscher

    2018-05-01

    To examine the association between hospital-local health department (LHD) collaboration around community health needs assessments (CHNAs) and hospital investment in community health. We combined 2015 National Association of County and City Health Officials (NACCHO) Forces of Change, 2013 NACCHO Profile, and 2014-2015 Area Health Resource File data to identify a sample of LHDs (n = 439) across the United States. We included data on hospitals' community benefit from their 2014 tax filings (Internal Revenue Service Form 990, Schedule H). We used bivariate and multivariate regression analyses to examine LHDs' involvement in hospitals' CHNAs and implementation strategies and the relationship with hospital investment in community health. The LHDs that collaborated with hospitals around CHNAs were significantly more likely to be involved in joint implementation planning activities than were those that did not. Importantly, LHD involvement in hospitals' implementation strategies was associated with greater hospital investment in community health improvement initiatives. Joint CHNAs may improve coordination of community-wide health improvement efforts between hospitals and LHDs and encourage hospital investment in community health improvement activities. Public Health Implications. Policies that strengthen LHD-hospital collaboration around the CHNA may enhance hospital investments in community health.

  16. Rural-Urban Differences in Preventable Hospitalizations among Community-Dwelling Veterans with Dementia

    Science.gov (United States)

    Thorpe, Joshua M.; Van Houtven, Courtney H.; Sleath, Betsy L.; Thorpe, Carolyn T.

    2010-01-01

    Context: Alzheimer's patients living in rural communities may face significant barriers to effective outpatient medical care. Purpose: We sought to examine rural-urban differences in risk for ambulatory care sensitive hospitalizations (ACSH), an indicator of access to outpatient care, in community-dwelling veterans with dementia. Methods: Medicare…

  17. Hospital-community interactions foster coexistence between methicillin-resistant strains of Staphylococcus aureus.

    Directory of Open Access Journals (Sweden)

    Roger Kouyos

    2013-02-01

    Full Text Available Methicillin-resistant Staphylococcus aureus (MRSA is an important cause of morbidity and mortality in both hospitals and the community. Traditionally, MRSA was mainly hospital-associated (HA-MRSA, but in the past decade community-associated strains (CA-MRSA have spread widely. CA-MRSA strains seem to have significantly lower biological costs of resistance, and hence it has been speculated that they may replace HA-MRSA strains in the hospital. Such a replacement could potentially have major consequences for public health, as there are differences in the resistance spectra of the two strains as well as possible differences in their clinical effects. Here we assess the impact of competition between HA- and CA-MRSA using epidemiological models which integrate realistic data on drug-usage frequencies, resistance profiles, contact, and age structures. By explicitly accounting for the differing antibiotic usage frequencies in the hospital and the community, we find that coexistence between the strains is a possible outcome, as selection favors CA-MRSA in the community, because of its lower cost of resistance, while it favors HA-MRSA in the hospital, because of its broader resistance spectrum. Incorporating realistic degrees of age- and treatment-structure into the model significantly increases the parameter ranges over which coexistence is possible. Thus, our results indicate that the large heterogeneities existing in human populations make coexistence between hospital- and community-associated strains of MRSA a likely outcome.

  18. Hospital-Community Interactions Foster Coexistence between Methicillin-Resistant Strains of Staphylococcus aureus

    Science.gov (United States)

    Kouyos, Roger; Klein, Eili; Grenfell, Bryan

    2013-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of morbidity and mortality in both hospitals and the community. Traditionally, MRSA was mainly hospital-associated (HA-MRSA), but in the past decade community-associated strains (CA-MRSA) have spread widely. CA-MRSA strains seem to have significantly lower biological costs of resistance, and hence it has been speculated that they may replace HA-MRSA strains in the hospital. Such a replacement could potentially have major consequences for public health, as there are differences in the resistance spectra of the two strains as well as possible differences in their clinical effects. Here we assess the impact of competition between HA- and CA-MRSA using epidemiological models which integrate realistic data on drug-usage frequencies, resistance profiles, contact, and age structures. By explicitly accounting for the differing antibiotic usage frequencies in the hospital and the community, we find that coexistence between the strains is a possible outcome, as selection favors CA-MRSA in the community, because of its lower cost of resistance, while it favors HA-MRSA in the hospital, because of its broader resistance spectrum. Incorporating realistic degrees of age- and treatment-structure into the model significantly increases the parameter ranges over which coexistence is possible. Thus, our results indicate that the large heterogeneities existing in human populations make coexistence between hospital- and community-associated strains of MRSA a likely outcome. PMID:23468619

  19. Teaching hospital performance: towards a community of shared values?

    Science.gov (United States)

    Mauro, Marianna; Cardamone, Emma; Cavallaro, Giusy; Minvielle, Etienne; Rania, Francesco; Sicotte, Claude; Trotta, Annarita

    2014-01-01

    This paper explores the performance dimensions of Italian teaching hospitals (THs) by considering the multiple constituent model approach, using measures that are subjective and based on individual ideals and preferences. Our research replicates a study of a French TH and deepens it by adjusting it to the context of an Italian TH. The purposes of this research were as follows: to identify emerging views on the performance of teaching hospitals and to analyze how these views vary among hospital stakeholders. We conducted an in-depth case study of a TH using a quantitative survey method. The survey uses a questionnaire based on Parsons' social system action theory, which embraces the major models of organizational performance and covers three groups of internal stakeholders: physicians, caregivers and administrative staff. The questionnaires were distributed between April and September 2011. The results confirm that hospital performance is multifaceted and includes the dimensions of efficiency, effectiveness and quality of care, as well as organizational and human features. There is a high degree of consensus among all observed stakeholder groups about these values, and a shared view of performance is emerging. Our research provides useful information for defining management priorities to improve the performance of THs. Copyright © 2013 Elsevier Ltd. All rights reserved.

  20. Community-oriented services in a psychiatric hospital. Effort to ...

    African Journals Online (AJOL)

    “Yaba apa osi” (Yaba to the left side). Consequently, in the year 2000 the hospital stepped up its efforts on destigmatization through public enlightenment programmes and provision of commercial /social as well as general health care services in the institution that would bring or attract the citizenry to its facilities. We carried ...

  1. 78 FR 20523 - Community Health Needs Assessments for Charitable Hospitals

    Science.gov (United States)

    2013-04-05

    ... of an organization the financial statements of which are included in consolidated financial statements with other organizations, its consolidated financial statements). Notice 2010-39 In May 2010, the... audited financial statements. The expected recordkeepers are hospital organizations described in sections...

  2. Value congruence, control, sense of community and demands as determinants of burnout syndrome among hospitality workers.

    Science.gov (United States)

    Asensio-Martínez, Ángela; Leiter, Michael P; Gascón, Santiago; Gumuchian, Stephanie; Masluk, Bárbara; Herrera-Mercadal, Paola; Albesa, Agustín; García-Campayo, Javier

    2017-09-07

    Employees working in the hospitality industry are constantly exposed to occupational stressors that may lead employees into experiencing burnout syndrome. Research addressing the interactive effects of control, community and value congruence to alleviate the impact of workplace demands on experiencing burnout is relatively limited. The present study examined relationships among control, community and value congruence, workplace demands and the three components of burnout. A sample of 418 employees working in a variety of hospitality associations including restaurants and hotels in Spain were recruited. Moderation analyses and linear regressions analyzed the predictive power of control, community and value congruence as moderating variables. Results indicate that control, community and value congruence were successful buffers in the relationships between workplace demands and the burnout dimensions. The present findings offer suggestions for future research on potential moderating variables, as well as implications for reducing burnout among hospitality employees.

  3. Clinical features and the role of atypical pathogens in nursing and healthcare-associated pneumonia (NHCAP): differences between a teaching university hospital and a community hospital.

    Science.gov (United States)

    Miyashita, Naoyuki; Kawai, Yasuhiro; Akaike, Hiroto; Ouchi, Kazunobu; Hayashi, Toshikiyo; Kurihara, Takeyuki; Okimoto, Niro

    2012-01-01

    The Japan Respiratory Society documented a new category of guidelines for nursing and healthcare-associated pneumonia (NHCAP), which is distinct from community acquired pneumonia (CAP). The objective of this study was to determine the epidemiological differences between NHCAP patients in a teaching university hospital and a community hospital. In addition, to clarify the strategy for treatment of NHCAP, we investigated the role of atypical pathogens. We analyzed 250 NHCAP and 421 CAP cases in a university hospital and 349 NHCAP and 374 CAP cases in a community hospital. Patient age and the incidences of poor general condition were significantly higher in the community hospital compared with those in the university hospital. The distribution and frequency of pathogens, especially multidrug-resistant (MDR) pathogens, were significantly different between the two hospitals. Central nervous system disorders, dementia and poor performance status, which was possibility related to aspiration pneumonia, were significantly more frequent in patients with NHCAP compared with those with CAP in both hospitals. Atypical pathogens were detected in a few cases in patients with NHCAP. There were many differences in the clinical characteristics between NHCAP patients in a university hospital and a community hospital even for hospitals located in the same area. Aspiration pneumonia was thought to be the main characteristic of NHCAP in both hospitals. Thus, all NHCAP patients did not need the same empiric therapy with a multidrug regimen directed against MDR pathogens. In addition, physicians rarely need to consider atypical pathogens in NHCAP treatment.

  4. The political correctness of a physician hospital organization may precipitate its demise in a community hospital.

    Science.gov (United States)

    Hoffman, J S

    1995-01-01

    Health maintenance organizations are placing an increased pressure on physicians and hospitals to assume the risk of providing health care services under capitated agreements. They believe that if the providers' profits are based upon their cost-efficient provision of medical services, they will control their use of medical resources and reduce health care spending. Managing the risks of a capitated contract necessitates the integration of the hospital's and the physician's incentives. However, is the most appropriate legal structure that will enable physicians and hospitals to form risk-sharing contracts with managed care entities and manage these contracts profitably a physician-hospital organization? It is estimated that over 50 percent of the physician-hospital organizations that are created each year fail within the first two years of their operation because of political and financial reasons. A multispecialty group composed of select physicians, who are willing to integrate their practices and who have a low length of stay in the hospital, may be in a better position to manage the risks imposed by capitated contracts.

  5. Community decision-making about critical access hospitals: lessons learned from Montana's Medical Assistance Facility Program.

    Science.gov (United States)

    Shreffler, M J; Capalbo, S M; Flaherty, R J; Heggem, C

    1999-01-01

    Limited-service hospitals have been used as a means of maintaining health care services in rural communities with full-service hospitals at risk of closure. The Medical Assistance Facility (MAF) limited-service hospital model has been implemented in 12 communities in Montana and has been evaluated by the Health Care Financing Administration as a viable alternative to a full-service hospital in frontier communities. The 1997 federal Critical Access Hospital (CAH) legislation is the most recent nationwide alternative for maintaining health care in rural communities, and it incorporates many of the features of the MAF model. The purpose of this study was to examine rural community decision making regarding MAF conversion from the perspectives of key informants who were involved in the decision-making process. A descriptive multiple case study design was used. Data were obtained through interviews with community members during site visits. The research focused on identification of local issues that were influential in the decision to convert to or reopen as an MAF, features of the MAF model that made it a locally acceptable alternative, and elements that characterized the decision-making process. The issues found to be influential in the conversion decision and the features that made the MAF locally acceptable were those that made the provision of basic services more stable and sustainable. The study suggests that programs to maintain health care services in isolated communities should allow for and encourage an expanded role for nonphysician providers. The lessons learned from the communities included in this study are instructive to rural communities nationwide that are considering a CAH as well as to policy-makers, researchers, and regional and national health care decision makers.

  6. Hospital Community Benefit in the Context of the Larger Public Health System: A State-Level Analysis of Hospital and Governmental Public Health Spending Across the United States.

    Science.gov (United States)

    Singh, Simone R; Bakken, Erik; Kindig, David A; Young, Gary J

    2016-01-01

    Achieving meaningful population health improvements has become a priority for communities across the United States, yet funding to sustain multisector initiatives is frequently not available. One potential source of funding for population health initiatives is the community benefit expenditures that are required of nonprofit hospitals to maintain their tax-exempt status. In this article, we explore the importance of nonprofit hospitals' community benefit dollars as a funding source for population health. Hospitals' community benefit expenditures were obtained from their 2009 IRS (Internal Revenue Service) Form 990 Schedule H and complemented with data on state and local public health spending from the Association of State and Territorial Health Officials and the National Association of County & City Health Officials. Key measures included indicators of hospitals' community health spending and governmental public health spending, all aggregated to the state level. Univariate and bivariate statistics were used to describe how much hospitals spent on programs and activities for the community at large and to understand the relationship between hospitals' spending and the expenditures of state and local health departments. Tax-exempt hospitals spent a median of $130 per capita on community benefit activities, of which almost $11 went toward community health improvement and community-building activities. In comparison, median state and local health department spending amounted to $82 and $48 per capita, respectively. Hospitals' spending thus contributed an additional 9% to the resources available for population health to state and local health departments. Spending, however, varied widely by state and was unrelated to governmental public health spending. Moreover, adding hospitals' spending to the financial resources available to governmental public health agencies did not reduce existing inequalities in population health funding across states. Hospitals' community

  7. Community Priorities for Hospital-Based Prevention Initiatives: Results From a Deliberating Public.

    Science.gov (United States)

    Gold, Marthe R; Realmuto, Lindsey; Scherer, Maya; Kamler, Alexandra; Weiss, Linda

    2017-06-21

    Internal revenue service provisions require not-for-profit hospitals to provide "community benefit." In addition, the Affordable Care Act requires these hospitals to conduct community health needs assessments that involve appropriate stakeholders. These requirements signal government interest in creating opportunities for developing programs that are well tailored and responsive to the needs of the communities served. Gaining meaningful input from residents is a critical aspect of these processes. To implement public deliberations that explore local resident priorities for use of a hospital's community benefit resources to prevent chronic disease. Public deliberation is a method of community engagement that can provide guidance to decision makers on value-laden issues when technical solutions alone are inadequate to provide direction or set priorities. Three deliberations featuring presentations by experts and discussions among participants were convened with a cross section of residents in Brooklyn, New York. Participants were asked whether new hospital initiatives should prioritize: clinical prevention, community-based interventions, or action on broader policies affecting population health. Pre- and postsurveys, as well as qualitative methods, were used to assess knowledge and attitudes. Postdeliberation, participants had significant changes in knowledge, particularly on the impact of education on health. Participants prioritized community-based and policy interventions over expanding clinical prevention capacity. Public deliberation offers a method to probe informed constituent views of how a hospital can best promote its community's health. Informed local residents felt that hospitals should frame health-promoting activities more broadly than is current practice. Not-for-profit hospitals gain significant tax advantages. Increased insurance rates suggest that some hospitals will experience savings in uncompensated care that can be used to promote health more

  8. Hospitalization Rate and Population-Based Incidence of Hospitalization for Community-Acquired Pneumonia Among Children in Suzhou, China.

    Science.gov (United States)

    Shan, Wei; Shi, Ting; Zhang, Xiyan; Xue, Jian; Wang, Yin; Yu, Jia; Huang, Yukai; Lin, Sheng; Zhao, Genming; Tian, Jianmei; Zhang, Tao

    2018-03-22

    Data on hospitalization burden of CAP in children is very limited in China. This study aimed to estimate the hospitalization rate and population-based incidence of hospitalization of CAP for children <15 years of age in Suzhou, China. This was a retrospective study of children hospitalized in Soochow University Affiliated Children's Hospital (SCH) from January 2010 to December 2014. Children who were residents of downtown Suzhou, 29 days to <15 years of age, with discharge diagnosis codes (ICD-10) including J09 to J18 and J20 to J22 were included. All-cause clinical community-acquired pneumonia (CCAP) and radiographically confirmed pneumonia (RCAP) were identified based on individual medical chart review. The hospitalization rate (HR) and population-based cumulative incidence of hospitalization (HI) were calculated. Among 184,734 children <15 years old admitted to SCH during the study period, 31,302 children were identified as having CCAP, and 24,218 (77.4%) children confirmed as having RCAP. CCAP hospitalization occurred year round and peaked during winter and early spring. The overall HRs for CCAP and RCAP were 189.0 (95%CI, 187.1-190.9) and 146.2 (95%CI, 144-148) per 1,000 hospitalizations respectively, and the HIs per 100,000 children annually were CCAP, 3,235.8 (95%CI, 3207.3-3264.2) and RCAP, 2,503.5 (95%CI, 2,478.3-2,528.6). For children <5 years old, the HR for CCAP was 248.4 (95%CI, 245.9-250.9) and RCAP 194.0 (95%CI, 191.4-196.3) per 1,000 hospitalizations; the HI for CCAP was 6,956.2 (95%CI: 6,892.8-7,019.6) and 5,431.9 (95%CI: 5,375.4-5,488.4) per 100,000 children for RCAP. The highest HR and HI were observed in children 29 days to <6 months old: HR for CCAP was 407.4 (95%CI: 400.9-413.9) per 1,000 hospitalizations and HI for CCAP was 11,203.7 (95%CI: 11,026.8-11,380.6) per 100,000 children annually. There is a considerable burden of CAP among children <15 years of age in Suzhou, particularly among children 29 days to <6 months of age and during winter

  9. The application of a biometric identification technique for linking community and hospital data in rural Ghana.

    Science.gov (United States)

    Odei-Lartey, Eliezer Ofori; Boateng, Dennis; Danso, Samuel; Kwarteng, Anthony; Abokyi, Livesy; Amenga-Etego, Seeba; Gyaase, Stephaney; Asante, Kwaku Poku; Owusu-Agyei, Seth

    2016-01-01

    The reliability of counts for estimating population dynamics and disease burdens in communities depends on the availability of a common unique identifier for matching general population data with health facility data. Biometric data has been explored as a feasible common identifier between the health data and sociocultural data of resident members in rural communities within the Kintampo Health and Demographic Surveillance System located in the central part of Ghana. Our goal was to assess the feasibility of using fingerprint identification to link community data and hospital data in a rural African setting. A combination of biometrics and other personal identification techniques were used to identify individual's resident within a surveillance population seeking care in two district hospitals. Visits from resident individuals were successfully recorded and categorized by the success of the techniques applied during identification. The successes of visits that involved identification by fingerprint were further examined by age. A total of 27,662 hospital visits were linked to resident individuals. Over 85% of those visits were successfully identified using at least one identification method. Over 65% were successfully identified and linked using their fingerprints. Supervisory support from the hospital administration was critical in integrating this identification system into its routine activities. No concerns were expressed by community members about the fingerprint registration and identification processes. Fingerprint identification should be combined with other methods to be feasible in identifying community members in African rural settings. This can be enhanced in communities with some basic Demographic Surveillance System or census information.

  10. Visual outcome and its prognostic factors in patients presenting with ocular war injuries at an army hospital in Pakistan.

    Science.gov (United States)

    Hassan Naqvi, Syed Abid; Malik, Sidra; Syed, Zulfiqar Ud Din; Anwar, Syeda Birjees; Nayyar, Shahzad

    2017-12-01

    To determine the visual outcome and its prognostic factors in patients presenting with ocular war injuries. This descriptive, observational study was conducted at the Combined Military Hospital, Peshawar, Pakistan, from June 2012 to March 2016, and comprised soldiers with ocular war injuries. Informed consent was obtained from all participants. A predesigned proforma was used to record patient's demographic details along with the cause, side, type and severity of injury. Injuries were classified as open globe or closed globe injuries. Ocular trauma score grade was used to describe the severity of injury. There were 210 participants with an overall mean age of 29.34±5.35 years (range: 20-43 years). All of them were male. Left side was more frequently involved, i.e. in 126(60%) cases. The most frequent underlying cause was improvised explosive device blast injury 114(54.3%), followed by blunt trauma 42(20%) and road traffic accidents 24(11.4%). Closed globe injuries were more frequent and were recorded in 120(57.1%) patients. The visual outcome was good in 62(29.5%) patients, followed by fair in 51(24.3%) patients while 51(24.3%) patients had worst visual outcome. When stratified, there was no significant difference of worst visual outcome with patient's age (p=0.279). However, improvised explosive device blast (p=0.002), open globe injury (p=0.000), ocular trauma score grade 1; open globe (p=0.049), closed globe (p=0.003) were associated with significantly higher frequency of worst visual outcome. Zone-III injury was also prognostic of worst visual outcome, but the difference was significant only in case of open globe injury (p=0.003). Improvised explosive device blast, open globe injury and ocular trauma score grade 1 were poor prognostic features and resulted in significantly higher frequency of poor visual outcome.

  11. Felt stigma and self-esteem among psychiatric hospital outdoor and community camp attending patients

    OpenAIRE

    Shantna Kumari; Inderjeet Banerjee; G Majhi; Suprakash Chaudhury; Amool R Singh; A N Verma

    2014-01-01

    Background: Self-stigma of people with mental illness is a major obstacle to recovery, limiting opportunities and undermining self-esteem. Aim: The aim of this study is to compare felt stigma and self-esteem in psychiatric patients receiving treatment from hospital outdoor clinic or from Community Outreach Program (COP). Materials and Methods: This cross-sectional study was conducted on psychiatric patients who were on outpatient treatment for at least 6 months, but had never been hospitalize...

  12. The clinical spectrum and antibiotic sensitivity patterns of staphylococcal pyodermas in the community and hospital

    Directory of Open Access Journals (Sweden)

    Shireen Furtado

    2014-01-01

    Full Text Available Context: The uncontrolled use of antibiotics has resulted in a relentless spread of multiresistant strains of Staphylococcus aureus. There are studies conducted in medical colleges in Chandigarh, Chennai, Mumbai and Vellore comparing pyodermas in the community and hospital setting based on clinical and bacteriological parameters. Aims: This study, conducted over 1½ years from March 2009 to August 2010, aimed at analyzing the clinical spectrum and antibiotic sensitivity pattern of community and hospital-associated (HA staphylococcal pyoderma. It also assessed the prevalence of methicillin-resistant S. aureus (MRSA in the community and hospital cohort settings. Subjects and Methods: The study comprised of 200 cases of staphylococcal pyodermas, derived from the community (150 cases and hospital (50 cases. Patients were evaluated based on their clinical presentation; antibiotic susceptibility was tested using the Kirby-Bauer disk diffusion method. Statistical Analysis Used: Statistical significance between individual attributes between the community and HA staphylococcal pyoderma groups was analyzed using Chi-square test and mean differences using student′s t-test. Results: Factors associated with community-associated (CA pyodermas were young age (P = 0.0021, primary pyodermas, and involvement of extremities, while those with HA pyodermas were middle age, secondary pyodermas, and significantly increased body surface involvement (P = 0.041. Incidence of CA-MRSA was 11.3%, while that of HA-MRSA was 18%. Conclusions: A high level of resistance to first-line drugs such as penicillin, ciprofloxacin and cotrimoxazole was observed, more so in the hospital strain than in the community strain. S. aureus demonstrated good susceptibility to cephalosporins. Though the two strains of MRSA differed clinically, they showed 100% sensitivity to vancomycin and linezolid.

  13. Penicillin as empirical therapy for patients hospitalised with community acquired pneumonia at a Danish hospital

    DEFF Research Database (Denmark)

    Kirk, O; Glenthøj, Jonathan Peter; Dragsted, Ulrik Bak

    2001-01-01

    INTRODUCTION: We report on the outcome of a study of patients hospitalised with community acquired pneumonia (HCAP) at a Danish university hospital. METHODOLOGY: In a retrospective study of 243 consecutive patients with radiographically verified HCAP, data on clinical and laboratory findings.......3%, respectively, p = 0.94, and the readmission rate 20.3%, 24.0%, and 14.8%, respectively; p = 0.63. CONCLUSION: Patients treated for community-acquired pneumonia at a Danish university hospital had clinical outcomes fully at height with findings from other countries, and half of the patients were successfully...

  14. Implementation of a safety program for handling hazardous drugs in a community hospital.

    Science.gov (United States)

    Massoomi, Firouzan Fred; Neff, Bill; Pick, Amy; Danekas, Paula

    2008-05-01

    The implementation of a safety program for handling hazardous drugs in a community hospital is described. A committee of representatives of the departments of pharmacy, nursing, human resources, safety, radiology, performance improvement, employee health, and environmental services and members of the hospital administration was formed to formally address the management of hazardous drugs in a community, not-for-profit, adult hospital in Omaha, Nebraska. Published guidelines and regulations were reviewed to determine the hospital's compliance with the handling of hazardous drugs. A knowledge deficit regarding the risk and severity of occupational exposure to hazardous drugs was identified. A formal education plan was immediately implemented providing inservice education to all staff who may come into contact with hazardous drugs. Each drug was electronically tagged in the hospital computer system. The nitrile gloves used in the pharmacy were switched to a brand tested for resistance to chemotherapy drug permeation. The use of personal protective equipment for all health care workers who may come into contact with hazardous drugs was also instituted. Waste stream management was addressed, and a new waste stream was identifed and implemented to address chemicals regulated by the Resource Conservation Recovery Act. Nursing, pharmacy, and housekeeping personnel were extensively educated on the different waste streams and the importance of segregating waste at the point of use. All gloves for housekeeping and laundry service staff were replaced with hazardous-drug-rated nitrile gloves. A gap analysis allowed a multidisciplinary team to establish a safety program for managing hazardous drugs in a community hospital.

  15. Tax-exempt hospitals and community benefits: a review of state reporting requirements.

    Science.gov (United States)

    Hellinger, Fred Joseph

    2009-02-01

    In June 2007 the Internal Revenue Service proposed a major overhaul of its reporting requirements for tax-exempt hospitals and released draft Form 990 (the IRS form filed by tax-exempt organizations each year). In December 2007 the IRS promulgated the final Form 990 after incorporating some of the recommendations made in the almost seven hundred public comments on the discussion draft. One recommendation adopted in the final Form 990 is the postponement until tax year 2009 (returns filed in 2010) of the requirement for hospitals to submit detailed information on the percentage of total expenses attributable to charity care, unreimbursed Medicaid costs, and community-health improvement programs (the discussion draft required this information for tax year 2007). Although the IRS will not require tax-exempt hospitals to provide detailed information about community benefits until the 2009 tax year, sixteen states have laws requiring tax-exempt hospitals to enumerate the benefits that they provide to the community. Information about the impact of these laws on the provision of community benefits (e.g., charity and uncompensated care) is examined in this study whose primary purpose is to highlight information policy makers may glean from states that have adopted community-benefit reporting laws.

  16. The role of the neonatal nurse practitioner in the community hospital level I nursery.

    Science.gov (United States)

    Hatch, Julie

    2012-01-01

    Neonatal nurse practitioners (NNPs) have played a significant role in providing medical coverage to many of the country's Level III neonatal intensive care units (NICUs). Extensive education and experience are required for a nurse practitioner (NP) to become competent in caring for these critically ill newborns. The NNP can take this competence and experience and expand her role out into the community Level I nurseries. Clinical care of the infants and close communication with parents, pediatricians, and the area tertiary center provide a community service with the goal of keeping parents and babies together in the community hospital without compromising the health of the baby. The NNP service, with 24-hour nursery and delivery coverage, supports an ongoing obstetric service to the community hospital. The NNP's experience enables her to provide a neonatal service that encompasses a multitude of advanced practice nursing roles.

  17. Implementation of an enterprise risk-management program in a community teaching hospital.

    Science.gov (United States)

    Behamdouni, Genefer; Millar, Kathy

    2010-01-01

    As the complexity of healthcare and expectations of comprehensive and transparent public accountability heighten, so too must a hospital's approach to assessing and managing risk. Over a period of two years, the area of patient safety and risk at our hospital has moved from a traditional focus on clinical risk management to an enterprise-wide risk management approach. One of the first community hospitals to embrace enterprise risk management (ERM), St. Joseph's Health Centre, in Toronto, Ontario, has seen early benefits in this transformational journey. This article discusses our approach to the development of an ERM program, tools used and lessons learned.

  18. Modeling the impacts of hospitality and tourism enterprises on community quality of life

    OpenAIRE

    Yi, Sangchoul

    2015-01-01

    The present research examined the impacts of hospitality and tourism businesses on community quality of life using existing public domain databases. In the tourism literature, various methodological approaches have been proposed to investigate the impacts of tourism on a host community and its residents. However, these approaches are limited because of innate methodological constraints such as the bias of the survey respondents' perceptions. To overcome such a limitation, alternative research...

  19. Conversations with the community: the Methodist Hospital System's experience with social media.

    Science.gov (United States)

    Angelle, Denny; Rose, Clare L

    2011-01-01

    The Methodist Hospital System has maintained a social media presence on Facebook, Twitter, and YouTube since 2009. After initial unofficial excursions into the world of social media, we discovered that social media can be a useful tool to extend a conversation with our patients and the community at large and share our hospital's culture with a larger base of like-minded people. But with this new power comes a heightened responsibility--platforms that can potentially reach millions of viewers and readers also provide a potential for misuse that can jeopardize patient privacy and place hospitals at risk. Because of their unique restrictions, even hospitals that use the tools regularly have much left to learn about social media. With constant monitoring and stewardship and a commitment to educating staff, hospitals can effectively use social media tools for marketing and education.

  20. Collection performance: an empirical analysis of not-for-profit community hospitals.

    Science.gov (United States)

    Prince, T R; Ramanan, R

    1992-01-01

    Many not-for-profit community hospitals had major shifts in their annual collection performance between 1986 and 1988. The collection performance is measured by excess collection time; this is computed as the difference between the actual average collection time for a hospital and the median for one of the six panels to which the hospital is assigned based on ownership, control code, and financial reporting practices. The sample for this study has 1,246 not-for-profit hospitals comprising over 50 percent of total revenue and expenses of all community hospitals (about 5,500). More than 16 percent of these hospitals had annual changes of ten-plus days in each of the years. Excess collection time within the six panels was examined by state, payer mix (Medicare, Medicaid, and Blue Cross), membership in the Council of Teaching Hospitals, medical school affiliation, case-mix index for Medicare, contractual allowance rate, debt-service coverage, return on assets, new investments, age of property, and urban location. Major findings were that collection patterns are different among some states. The proportions of Medicare, Medicaid, and Blue Cross are negatively associated with excess collection time in three of the panels. Contractual allowance is positively related, and return on assets is negatively associated with excess collection time in two of the panels. The other factors had virtually no effect on the collection performance.

  1. Sustainable Community Sanitation for a Rural Hospital in Haiti

    Directory of Open Access Journals (Sweden)

    Jason Jawidzik

    2012-12-01

    Full Text Available A fully sustainable sanitation system was developed for a rural hospital in Haiti. The system operates by converting human waste into biogas and fertilizer without using external energy. It is a hybrid anaerobic/aerobic system that maximizes methane production while producing quality compost. The system first separates liquid and solid human waste at the source to control carbon to nitrogen ratio and moisture content to facilitate enhanced biodegradation. It will then degrade human waste through anaerobic digestion and capture the methane gas for on-site use as a heating fuel. For anaerobic decomposition and methane harvesting a bioreactor with two-stage batch process was designed. Finally, partially degraded human waste is extracted from the bioreactor with two-stage batch process and applied to land farming type aerobic composter to produce fertilizer. The proposed system is optimized in design by considering local conditions such as waste composition, waste generation, reaction temperature, residence time, construction materials, and current practice. It is above ground with low maintenance requirements.

  2. Postdischarge community pharmacist-provided home services for patients after hospitalization for heart failure.

    Science.gov (United States)

    Kalista, Tom; Lemay, Virginia; Cohen, Lisa

    2015-01-01

    To establish a community pharmacist-provided home health service to improve medication adherence and reduce 30-day heart failure-related hospital readmissions. Visiting Nurse Services of Newport and Bristol Counties located in Portsmouth, RI, from December 2013 to April 2014. Each patient received one in-home visit provided by a Postgraduate Year 1 community pharmacy resident within 1 week of admission to visiting nurse services followed by two follow-up telephone calls, 1 week and 4 weeks after the visit. The in-home visit consisted of a baseline assessment of medication adherence using the Morisky 8-Item Medication Adherence Questionnaire as well as pharmacist-provided education regarding chronic heart failure management. The follow-up telephone calls were used to reassess patient adherence and to monitor for hospital readmission within 30 days of the initial in-home visit. Community pharmacist-provided in-home medication reconciliation and medication teaching has not been described in the literature previously. In addition, pharmacists are often not included on home health care teams placing patients undergoing transitions in care at risk for potential medication-related errors. Improvement in medication adherence and reduction in 30-day heart failure-related hospital readmission rates. Ten patients were enrolled from December 2013 through April 2014. Following intervention, all patients saw improvements in adherence questionnaire scores during follow-up. Hospital readmission rates for patients seen by the pharmacist were lower compared with agencywide figures over a similar time period. A community pharmacist-provided in-home medication teaching service for patients following recent hospital discharge helps facilitate successful transitions of care from an inpatient to outpatient setting, improves medication adherence and has produced lower observed 30-day heart failure-related hospital readmission rates. Expansion of this or a similar service within the

  3. Bacterial Communities and Antibiotic Resistance Communities in a Full-Scale Hospital Wastewater Treatment Plant by High-Throughput Pyrosequencing

    Directory of Open Access Journals (Sweden)

    Youngho Ahn

    2016-12-01

    Full Text Available The community of whole microbes and antibiotic resistance bacteria (ARB in hospital wastewater treatment plants (WWTP receiving domestic wastewater (DWW and hospital wastewater (HWW was investigated. Samples from an influent of a secondary clarifier, at each treatment train, were characterized for the whole microbial community and ARB on the antibiotic resistance database, based on high-throughput pyrosequencing. The pyrosequencing analysis revealed that the abundance of Bacteroidetes in the DWW sample was higher (~1.6 times than in the HWW sample, whereas the abundance of Proteobacteria in the HWW sample was greater than in the DWW sample. At the top twenty of the genus level, distinct genera were observed—Saprospiraceae in the DWW and Zoogloea in the HWW. Apart from the top twenty genera, minor genera showed various antibiotic resistance types based on the antibiotic resistance gene database.

  4. the evolution of hospitals from antiquity to the renaissance 1.

    African Journals Online (AJOL)

    Larger Jewish communities e.g. in Cologne and. Regensburg had their own hospitals (Mundy 1998:86-87). 7. ISLAM. With their eastern conquests consolidated and the western offensive decisively defeated at Tours by a Frankish army under Charles Martel. (723), the Islamic revolution, started by Muhammed in 632, conso-.

  5. Rotavirus disease in Guinea-Bissau, West Africa: a review of longitudinal community and hospital studies

    DEFF Research Database (Denmark)

    Fischer, Thea Kølsen; Aaby, Peter; Mølbak, Kåre

    2010-01-01

    Rotavirus is one of the most common causes of childhood diarrheal disease and deaths in sub-Saharan Africa. This article reviews community- and hospital-based surveillance of rotavirus disease in Bissau, Guinea-Bissau, West Africa. Here, rotavirus infections exhibit a seasonal pattern, with annual...

  6. [COMMUNITY, HOSPITAL AND IN-BETWEEN: QUALITY MEASURES FOR THE CONTINUITY OF CARE].

    Science.gov (United States)

    Weinstein, Orly; Cohen, Arnon D; Comaneshter, Doron; Limon, Yehuda; Hazanov, Ilia; Dery, Michael Mishori; Bitterman, Haim; Codish, Shlomi; Davidson, Ehud

    2016-05-01

    The southern district of Clalit Health Services and Soroka University Medical Center are combined in an organizational configuration: the Southern Region. The Region has developed joint programs in order to advance the quality of medical care whilst optimizing the utilization of available resources. An objective continuous method of assessment was needed to evaluate the continuity of care between the community and the hospital. To produce objective tools for quantification based on pre-existing data systems, which enable ongoing assessment of the quality of continuity of care between the community and hospital, and the impact of the introduction of novel means of improvement. We defined a set of measurements that exemplify continuity of care in different areas of transition between community and hospital, all directly retrievable from existing computerized data sources. About forty different measurements have been defined, in different clinical areas. Of these, a dozen have already been implemented by mapping the process and the main obstacles that the patient goes through, followed by implementation of appropriate solutions. The application of an objective system of assessment of the results of continuity of care, utilizing pre-existing data sources, is essential for advancing the initiative, and is a breakthrough in the quantification of continuity of care. Continuity of care between community and hospital has been applied in the Southern Region to dozens of quality measurements. This is a novel project developing an objective system of measurement, directly assessing the quality of continuity of care for the individual patient.

  7. High-sensitivity cardiac troponin T predicts mortality after hospitalization for community-acquired pneumonia

    NARCIS (Netherlands)

    Vestjens, Stefan M T; Spoorenberg, Simone M C; Rijkers, Ger T.; Grutters, Jan C; ten Berg, Jurriën M; Noordzij, Peter G.; Van de Garde, Ewoudt M.W.; Bos, Willem Jan W; Biesma, Douwe H.; Endeman, Henrik; Hardeman, Hans; Heijligenberg, Rik; Meijvis, Sabine C A; Remmelts, Hilde H.F.; van Velzen-Blad, Heleen; Voorn, Paul G P

    2017-01-01

    Background and objective: Mortality after hospitalization with community-acquired pneumonia (CAP) is high, compared with age-matched controls. Available evidence suggests a strong link with cardiovascular disease. Our aim was to explore the prognostic value of high-sensitivity cardiac troponin T

  8. Acute hospital, community, and indirect costs of stroke associated with atrial fibrillation: population-based study.

    LENUS (Irish Health Repository)

    Hannon, Niamh

    2014-10-30

    No economic data from population-based studies exist on acute or late hospital, community, and indirect costs of stroke associated with atrial fibrillation (AF-stroke). Such data are essential for policy development, service planning, and cost-effectiveness analysis of new therapeutic agents.

  9. Community- And Hospital-Based Early Intervention Team Members' Attitudes and Perceptions of Teamwork

    Science.gov (United States)

    Malone, Michael; McPherson, Jenny

    2004-01-01

    Sixty early intervention team members (30 community-based and 30 hospital-based) were surveyed regarding their attitudes and perceptions of teamwork. Respondents were recruited using a purposive non-probability sampling technique and completed a packet of questionnaires consisting of a detailed demographic survey, Attitudes About Teamwork Survey,…

  10. Manchester Clinical Placement Index (MCPI): Conditions for medical students’ learning in hospital and community placements

    NARCIS (Netherlands)

    Dornan, Tim; Muijtjens, Arno; Graham, Jennifer; Scherpbier, Albert; Boshuizen, Els

    2012-01-01

    Dornan, T., Muijtjens, A., Graham, J., Scherpbier, A., & Boshuizen, H. P. A. (2012). Manchester Clinical Placement Index (MCPI): Conditions for medical students’ learning in hospital and community placements. Advances in Health Sciences Education, 17, 703-716. doi:10.1007/s10459-10011-19344-x

  11. Predictors for individual patient antibiotic treatment effect in hospitalized community-acquired pneumonia patients

    NARCIS (Netherlands)

    Simonetti, A. F.; van Werkhoven, C. H.; Schweitzer, V. A.; Viasus, D.; Carratalà, J.; Postma, D. F.; Oosterheert, J. J.; Bonten, M. J.M.

    2017-01-01

    Objective: Our objective was to identify clinical predictors of antibiotic treatment effects in hospitalized patients with community-acquired pneumonia (CAP) who were not in the intensive care unit (ICU). Methods: Post-hoc analysis of three prospective cohorts (from the Netherlands and Spain) of

  12. Hospitalization costs for community-acquired pneumonia in Dutch elderly : an observational study

    NARCIS (Netherlands)

    Vissink, Conrad E; Huijts, Susanne M; de Wit, G Ardine; Bonten, Marc J M; Mangen, Marie-Josée J

    2016-01-01

    BACKGROUND: Community-acquired pneumonia (CAP) is one of the most common infections, especially in the elderly (≥65 years). The aim of this study was to quantify hospitalization costs for CAP in different age groups and in patients with different CAP risk profiles. Secondary objectives were to

  13. Nosocomial transmission of community-associated methicillin-resistant Staphylococcus aureus in Danish Hospitals

    DEFF Research Database (Denmark)

    Hetem, David J; Westh, Henrik; Boye, Kit

    2012-01-01

    The emergence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has changed the epidemiology of MRSA infections worldwide. In contrast to hospital-associated MRSA (HA-MRSA), CA-MRSA more frequently affects healthy individuals, both with and without recent healthcare...

  14. What have you done for me lately? Assessing hospital community benefit.

    Science.gov (United States)

    Salinsky, Eileen

    2007-04-19

    This issue brief reviews key aspects of the ongoing policy debate related to not-for-profit hospitals, the advantages they derive from tax exemption, and the benefits they provide to communities served. It provides a historical context for how federal standards for assessing hospitals' tax-exempt status have evolved and describes recent activities to explore additional policy changes. Legislative and regulatory actions at the state and local level are also examined. Evidence on the performance of not-for-profit hospitals in comparison to their for-profit competitors on measures of cost, quality, and access is summarized, and perspectives on the need to preserve a not-for-profit presence in health care are explored. Efforts to develop standardized metrics for measuring community benefit are described, and alternative conventions for reporting charity care contributions are discussed.

  15. Market Assessment of Brooke Army Medical Center - A Strategy for Today and the Future

    Science.gov (United States)

    1985-08-01

    suggested changes. 8. The results of the pretest were utilized to design the final survey format . 9. The final survey was administered in March, 1984. It...to veterinary and optometry students enrolled in the Army Health Profesional Scholarship Program. (5) Residency and intern training in Health Care...34 Family and Community Health 7 (November 1983): 41-51. Levitan, Mark S. "Let Ethical Approach Be Guiding Force in Marketing, Teaching Hospital Head Says

  16. TeamSTEPPS implementation in community hospitals: adherence to recommended training approaches.

    Science.gov (United States)

    Ward, Marcia M; Zhu, Xi; Lampman, Michelle; Stewart, Greg L

    2015-01-01

    Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is being widely promoted in healthcare settings to train staff in evidence-based approaches that promote patient safety. It involves a comprehensive curriculum that spells out key principles and actionable tools for a culture change toward patient-safety-focussed teamwork. Activities begin with selected personnel attending TeamSTEPPS Master Trainer Training (MTT) and then organizing and providing TeamSTEPPS training for staff in their organization. The authors conducted interviews with respondents at community hospitals conducting TeamSTEPPS staff training. To structure the interviews, the authors used 11 key questions identified by Weaver et al. in their in-depth team training literature review. The purpose of this paper is to examine approaches taken by community hospital personnel and compare those to the best practices recommended by Weaver et al. The authors interviewed 57 staff and administrators at 22 community hospitals sending teams to TeamSTEPPS MTT. The authors find that training implementation in community hospitals differs significantly from the established, research-based principles for effective team training described in the research literature, which is largely based in academic medical centers. The current findings suggest that several TeamSTEPPS training features could be enhanced in community hospitals including: choosing staff who have the skills to be effective trainers in this train-the-trainer model; emphasizing active learning; and sustaining lessons through on-the-job application, practice and feedback. These principles apply to many training approaches employed in small healthcare organizations.

  17. The application of a biometric identification technique for linking community and hospital data in rural Ghana

    Directory of Open Access Journals (Sweden)

    Eliezer Ofori Odei-Lartey

    2016-03-01

    Full Text Available Background: The reliability of counts for estimating population dynamics and disease burdens in communities depends on the availability of a common unique identifier for matching general population data with health facility data. Biometric data has been explored as a feasible common identifier between the health data and sociocultural data of resident members in rural communities within the Kintampo Health and Demographic Surveillance System located in the central part of Ghana. Objective: Our goal was to assess the feasibility of using fingerprint identification to link community data and hospital data in a rural African setting. Design: A combination of biometrics and other personal identification techniques were used to identify individual's resident within a surveillance population seeking care in two district hospitals. Visits from resident individuals were successfully recorded and categorized by the success of the techniques applied during identification. The successes of visits that involved identification by fingerprint were further examined by age. Results: A total of 27,662 hospital visits were linked to resident individuals. Over 85% of those visits were successfully identified using at least one identification method. Over 65% were successfully identified and linked using their fingerprints. Supervisory support from the hospital administration was critical in integrating this identification system into its routine activities. No concerns were expressed by community members about the fingerprint registration and identification processes. Conclusions: Fingerprint identification should be combined with other methods to be feasible in identifying community members in African rural settings. This can be enhanced in communities with some basic Demographic Surveillance System or census information.

  18. A Community-Based Continuing Care Program for the Elderly Disabled. An Evaluation of Planned Intermittent Hospital Readmission

    Science.gov (United States)

    Robertson, Duncan; And Others

    1977-01-01

    Utilizing flexible community-supporting services integrated with a hospital-based program of planned intermittent relief of the patients' supporters, patients (N=50) were maintained in the community at an average cost of 79.5 hospital bed days per patient per annum. The Continuing Care Program is an alternative to institutionalization. (Author)

  19. Cultural diversity between hospital and community nurses: implications for continuity of care

    Directory of Open Access Journals (Sweden)

    Ragnhild Hellesø

    2010-02-01

    Full Text Available Introduction: Health care systems and nurses need to take into account the increasing number of people who need post-hospital nursing care in their homes. Nurses have taken a pivotal role in discharge planning for frail patients. Despite considerable effort and focus on how to undertake hospital discharge successfully, the problem of ensuring continuity of care remains. Challenges: In this paper, we highlight and discuss three challenges that seem to be insufficiently articulated when hospital and community nurses interact during discharge planning. These three challenges are: how local practices circumvent formal structures, how nurses' different perspectives influence their assessment of patients' need for post-hospital care, and how nurses have different understanding of what it means to be ‘ready to be discharged’. Discussion: We propose that nurses need to discuss these challenges and their implications for nursing care so as to be ready to face changing demands for health care in future.

  20. COMPARISON OF METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS IN HEALTHY COMMUNITY HOSPITAL VISITORS[CA-MRSA] AND HOSPITAL STAFF [HA-MRSA

    Directory of Open Access Journals (Sweden)

    Nirmal A Pathare

    2015-10-01

    Full Text Available Background: The prevalence of community associated methicillin resistant Staphylococcus aureus [CA-MRSA] in unknown in Oman. Methods: Nasal and cell phones swabs were collected from hospital visitors and health-care workers on sterile polyester swabs and directly inoculated onto a mannitol salt agar containing oxacillin, allowing growth of methicillin-resistant microorganisms. Antibiotic susceptibility tests were performed using Kirby Bauer’s disc diffusion method on the isolates. A brief survey questionnaire was requested be filled to ascertain the exposure to known risk factors for CA-MRSA carriage. Results: Overall, nasal colonization with CA-MRSA was seen in 34 individuals (18%, 95% confidence interval [CI] =12.5%-23.5%, whereas, CA-MRSA was additionally isolated from the cell phone surface in 12 participants (6.3%, 95% CI =5.6%-6.98%. Nasal colonization prevalence with HA-MRSA was seen in 16 individuals (13.8%, 95% confidence interval [CI] =7.5%-20.06%, whereas, HA-MRSA was additionally isolated from the cell phone surface in 3 participants (2.6%, 95% CI =1.7-4.54.  Antibiotic sensitivity was 100% to linezolid and rifampicin in the CA-MRSA isolates. Antibiotic resistance to vancomycin and clindamycin varied between 9-11 % in the CA-MRSA isolates.  There was no statistically significant correlation between CA-MRSA nasal carriage and the risk factors (P>0.05, Chi-square test. Conclusions: The prevalence of CA-MRSA in the healthy community hospital visitors was 18 % (95% CI, 12.5% to 23.5% as compared to 13.8% [HA-MRSA] in the hospital health-care staff. In spite of a significant prevalence of CA-MRSA, these strains were mostly sensitive. Recommendation the universal techniques of hand washing, personal hygiene and sanitation are thus warranted.

  1. Describing the continuum of collaboration among local health departments with hospitals around the community health assessments.

    Science.gov (United States)

    Wilson, Kristin D; Mohr, Lisa Buettner; Beatty, Kate E; Ciecior, Amanda

    2014-01-01

    Hospitals and local health departments (LHDs) are under policy requirements from the Affordable Care Act and accreditation standards through the Public Health Accreditation Board. Tax exempt hospitals must perform a community health needs assessment (CHNA), similar to the community health assessment (CHA) required for LHDs. These efforts have led to a renewed interest in hospitals and LHDs working together to achieve common goals. The purpose of this study is to gain a better understanding of levels of joint action leading toward collaboration between LHDs and hospitals and describe collaboration around CHAs. Local health departments were selected on the basis of reporting collaboration (n = 26) or unsure about collaboration (n = 29) with local hospitals. Local health departments were surveyed regarding their relationship with local hospitals. For LHDs currently collaborating with a hospital, a collaboration continuum scale was calculated. Appropriate nonparametric tests, chi-squares, and Spearman's rank correlations were conducted to determine differences between groups. A total of 44 LHDs responded to the survey (80.0%). Currently collaborating LHDs were more likely to be interested in accreditation and to refer to their CHA 5 or more times a year compared to the unsure LHDs. In the analysis, a collaboration continuum was created and is positively correlated with aspects of the CHA and CHA process. This study is the first attempt to quantify the level of collaboration between LHDs and hospitals around CHAs. Better understanding of the levels of joint action required may assist LHDs in making informed decisions regarding deployment of resources on the path to accreditation.

  2. Lessons learned from implementation of computerized provider order entry in 5 community hospitals: a qualitative study.

    Science.gov (United States)

    Simon, Steven R; Keohane, Carol A; Amato, Mary; Coffey, Michael; Cadet, Bismarck; Zimlichman, Eyal; Bates, David W

    2013-06-24

    Computerized Provider Order Entry (CPOE) can improve patient safety, quality and efficiency, but hospitals face a host of barriers to adopting CPOE, ranging from resistance among physicians to the cost of the systems. In response to the incentives for meaningful use of health information technology and other market forces, hospitals in the United States are increasingly moving toward the adoption of CPOE. The purpose of this study was to characterize the experiences of hospitals that have successfully implemented CPOE. We used a qualitative approach to observe clinical activities and capture the experiences of physicians, nurses, pharmacists and administrators at five community hospitals in Massachusetts (USA) that adopted CPOE in the past few years. We conducted formal, structured observations of care processes in diverse inpatient settings within each of the hospitals and completed in-depth, semi-structured interviews with clinicians and staff by telephone. After transcribing the audiorecorded interviews, we analyzed the content of the transcripts iteratively, guided by principles of the Immersion and Crystallization analytic approach. Our objective was to identify attitudes, behaviors and experiences that would constitute useful lessons for other hospitals embarking on CPOE implementation. Analysis of observations and interviews resulted in findings about the CPOE implementation process in five domains: governance, preparation, support, perceptions and consequences. Successful institutions implemented clear organizational decision-making mechanisms that involved clinicians (governance). They anticipated the need for education and training of a wide range of users (preparation). These hospitals deployed ample human resources for live, in-person training and support during implementation. Successful implementation hinged on the ability of clinical leaders to address and manage perceptions and the fear of change. Implementation proceeded smoothly when institutions

  3. PROGNOSTIC IMPACT OF COMMUNITY-ACQUIRED AND HOSPITAL-ACQUIRED HYPONATREMIA IN PATIENTS WITH DECOMPENSATED HEART FAILURE

    Directory of Open Access Journals (Sweden)

    D. Yu. Shchekochikhin

    2015-09-01

    Full Text Available Aim. To compare prognostic impact of community-acquired and hospital-acquired hyponatremia in hospitalized patients with decompensated heart failure Material and methods. Data of 120 patients with decompensated heart failure were analyzed. Hyponatremia was defined as serum sodium concentration of 135 mmol/l or less. Several outcomes were analyzed: mortality, transfer to intensive care unit (ICU, resistance to loop diuretics and worsening renal function.Results. 13.0% of patients had community-acquired hyponatremia, 9.6% - hospital-acquired hyponatremia. Community-acquired hyponatremia was associated with increased mortality [odds ratio (OR=7.8], admission to ICU (OR=19.1 and resistance to loop diuretics (OR=4.8. Hospital-acquired hyponatremia was associated with worsening renal function (OR=12.4.Conclusion. Both, community-acquired and hospital hyponatremia have negative impact in hospitalized patients with decompensated heart failure.

  4. PROGNOSTIC IMPACT OF COMMUNITY-ACQUIRED AND HOSPITAL-ACQUIRED HYPONATREMIA IN PATIENTS WITH DECOMPENSATED HEART FAILURE

    Directory of Open Access Journals (Sweden)

    D. Yu. Shchekochikhin

    2014-01-01

    Full Text Available Aim. To compare prognostic impact of community-acquired and hospital-acquired hyponatremia in hospitalized patients with decompensated heart failure Material and methods. Data of 120 patients with decompensated heart failure were analyzed. Hyponatremia was defined as serum sodium concentration of 135 mmol/l or less. Several outcomes were analyzed: mortality, transfer to intensive care unit (ICU, resistance to loop diuretics and worsening renal function.Results. 13.0% of patients had community-acquired hyponatremia, 9.6% - hospital-acquired hyponatremia. Community-acquired hyponatremia was associated with increased mortality [odds ratio (OR=7.8], admission to ICU (OR=19.1 and resistance to loop diuretics (OR=4.8. Hospital-acquired hyponatremia was associated with worsening renal function (OR=12.4.Conclusion. Both, community-acquired and hospital hyponatremia have negative impact in hospitalized patients with decompensated heart failure.

  5. Topical Decolonization Does Not Eradicate the Skin Microbiota of Community-Dwelling or Hospitalized Adults

    Science.gov (United States)

    Hogan, Patrick G.; Wallace, Meghan A.; Deych, Elena; Shannon, William; Warren, David K.

    2016-01-01

    Topical antimicrobials are often employed for decolonization and infection prevention and may alter the endogenous microbiota of the skin. The objective of this study was to compare the microbial communities and levels of richness and diversity in community-dwelling subjects and intensive care unit (ICU) patients before and after the use of topical decolonization protocols. We enrolled 15 adults at risk for Staphylococcus aureus infection. Community subjects (n = 8) underwent a 5-day decolonization protocol (twice daily intranasal mupirocin and daily dilute bleach-water baths), and ICU patients (n = 7) received daily chlorhexidine baths. Swab samples were collected from 5 anatomic sites immediately before and again after decolonization. A variety of culture media and incubation environments were used to recover bacteria and fungi; isolates were identified using matrix-assisted laser desorption ionization–time of flight mass spectrometry. Overall, 174 unique organisms were recovered. Unique communities of organisms were recovered from the community-dwelling and hospitalized cohorts. In the community-dwelling cohort, microbial richness and diversity did not differ significantly between collections across time points, although the number of body sites colonized with S. aureus decreased significantly over time (P = 0.004). Within the hospitalized cohort, richness and diversity decreased over time compared to those for the enrollment sampling (from enrollment to final sampling, P = 0.01 for both richness and diversity). Topical antimicrobials reduced the burden of S. aureus while preserving other components of the skin and nasal microbiota. PMID:27671074

  6. Reduced pre-hospital and in-hospital survival rates after out-of-hospital cardiac arrest of patients with type-2 diabetes mellitus: an observational prospective community-based study

    NARCIS (Netherlands)

    van Hoeijen, Daniel A.; Blom, Marieke T.; Bardai, Abdennasser; Souverein, Patrick C.; de Boer, Anthonius; Tan, Hanno L.

    2015-01-01

    Out-of-hospital cardiac arrest (OHCA) remains a major cause of death. We aimed to determine whether type-2 diabetes mellitus (T2DM) is associated with reduced pre-hospital and in-hospital survival rates after OHCA. An observational community-based cohort study was performed among 1549 OHCA patients

  7. Reduced pre-hospital and in-hospital survival rates after out-of-hospital cardiac arrest of patients with type-2 diabetes mellitus : An observational prospective community-based study

    NARCIS (Netherlands)

    Van Hoeijen, Daniel A.; Blom, Marieke T.; Bardai, Abdennasser; Souverein, Patrick C.; De Boer, Anthonius; Tan, Hanno L.

    2015-01-01

    Aims Out-of-hospital cardiac arrest (OHCA) remains a major cause of death. We aimed to determine whether type-2 diabetes mellitus (T2DM) is associated with reduced pre-hospital and in-hospital survival rates after OHCA. Methods and results An observational community-based cohort study was performed

  8. Patients' knowledge of new medicines after discharge from hospital: What are the effects of hospital-based discharge counseling and community-based medicines use reviews (MURs)?

    Science.gov (United States)

    Elson, Rachel; Cook, Helen; Blenkinsopp, Alison

    Interventions to reduce medicines discontinuity at transitions during and reinforced after discharge are effective. However, few studies have linked hospital-based counseling with onward referral for community pharmacy-based follow-up to support patients' medicines use. To determine the effects of targeted hospital pharmacist counseling on discharge or targeted community pharmacy medicines reviews post-discharge on patients' knowledge of newly started medication. The study was a controlled trial of targeted medicines discharge counseling provided by hospital pharmacists or follow-up post-discharge medicines review provided by community pharmacists compared with usual care (nurse counseling). Outcomes measured using a structured telephone survey conducted at two and four weeks after patients were discharged from hospital. Patients who received hospital pharmacist counseling were significantly more likely to report being told the purpose of their new medicine and how to take it versus those receiving usual care. Fewer than half of the patients who were allocated to receive a community pharmacy medicines review received one. Patient knowledge of medicines newly prescribed in the hospital was increased by targeted counseling of hospital pharmacists. The findings suggest the need to improve the consistency of the information covered when providing counseling, perhaps by the implementation of a counseling checklist for use by all disciplines of staff involved in patient counseling. The potential of community pharmacy follow-up medicines review is currently undermined by several barriers to uptake. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Occupational stressors, burnout and coping strategies between hospital and community psychiatric nurses in a Dublin region.

    Science.gov (United States)

    McTiernan, K; McDonald, N

    2015-04-01

    Burnout negatively impacts the delivery of mental health services. Psychiatric nurses face stressors that are distinct from other nursing specialities. The research was conducted in Ireland and captured a relatively large sample of respondents. The results compared the stressors, coping strategies and burnout levels between hospital and community-based psychiatric nurses. Occupational stress can negatively impact on the well-being of psychiatric nurses, which in turn can lead to poor client care. There is a dearth of published research conducted in Ireland that examines stress within the discipline. A between-groups study, undertaken in February 2011, investigated stressors, burnout and coping strategies between hospital and community-based psychiatric nurses in a Dublin region. Sixty-nine participants (8 males and 61 females), aged between 18 to 60 years voluntarily completed the Mental Health Professional Stress Scale, the Maslach Burnout Inventory and the PsychNurse Methods of Coping Scale. The findings revealed that nurses were operating in a moderately stressful environment. Stressors focused on organizational issues as opposed to client issues. The main stressors identified were lack of resources, workload and organizational structures/processes. Both groups reported average levels of emotional exhaustion, low levels of depersonalization and average levels of personal accomplishment. A Mann-Whitney U-test and Independent Samples t-test found significant differences between hospital and community-based nurses regarding depersonalization and personal accomplishment, respectively. Hospital nurses reported higher depersonalization scores, and community nurses had a greater sense of personal accomplishment. The personal accomplishment scores of hospital nurses were below mental health professional norms. No significant differences emerged regarding coping strategies. Avoidant coping strategies were favoured by both groups. It is recommended that interventions

  10. Felt stigma and self-esteem among psychiatric hospital outdoor and community camp attending patients

    Directory of Open Access Journals (Sweden)

    Shantna Kumari

    2014-01-01

    Full Text Available Background: Self-stigma of people with mental illness is a major obstacle to recovery, limiting opportunities and undermining self-esteem. Aim: The aim of this study is to compare felt stigma and self-esteem in psychiatric patients receiving treatment from hospital outdoor clinic or from Community Outreach Program (COP. Materials and Methods: This cross-sectional study was conducted on psychiatric patients who were on outpatient treatment for at least 6 months, but had never been hospitalized. The study sample included 130 patients receiving outdoor treatment from a Psychiatric Hospital and a matched group of 140 patients receiving treatment from COP of the same hospital. Demographic and clinical details of the patients were recorded on a specially designed proforma. Modified felt stigma scale and Rosenberg self-esteem scale were used to assess stigma and self-esteem, respectively. Results: On the modified felt stigma scale, the mean (±standard deviation [SD] score of psychiatric hospital outpatients (31.89 ± 6.51 was significantly higher than the scores of patients attending COP (29.20 ± 6.80. On Rosenberg self-esteem scale, mean (±SD scores of patients with psychosis (17.98 ± 1.69 was significantly lower compared to scores of patients with epilepsy (21.83 ± 1.60. There was no significant correlation between stigma and self-esteem. Conclusion: As psychiatric hospital outpatients have significantly more self-stigma when compared to patients attending community outreach camps, the availability of more community outreach camps along with educating people about psychiatric illnesses may help in lowering stigma of psychiatric disorders.

  11. The role of non-operating income in community benefit provision by not-for-profit hospitals.

    Science.gov (United States)

    Song, Paula H; McCullough, Jeffrey S; Reiter, Kristin L

    2013-01-01

    Not-for-profit hospitals are under increased public scrutiny for providing what some view as insufficient levels of community benefit compared to their tax-exempt benefits. One potential driver of community benefit is financial surplus, which arises from both patient care (operating) activities and non-patient care (non-operating) activities. This study addresses the effect of hospitals' non-operating income on not-for-profit hospitals' provision of community benefit. The study sample includes 217 unique not-for-profit, non-governmental, general, acute care hospitals in California between 1997 and 2010 that filed annual reports with the California Office of Statewide Health Planning and Development (OSHPD). We model the effect of hospitals' operating and non-operating incomes on hospitals' community benefit, controlling for observable hospital characteristics such as scale and system membership, local competition, time trends, and hospital fixed effects. Our results indicate that non-operating income has no effect on levels of community benefit provided by not-for-profit hospitals. This finding suggests that not-for-profit hospitals budget for uncompensated care at levels that are prioritized over other potential investments if non-operating income falls, but remain fixed if non-operating income rises.

  12. Army Medical Imaging System - ARMIS

    Science.gov (United States)

    1992-08-08

    Melvin P. Siedband Frank C. Grenzow Craig A. Heilman James R. Gray Huilian Zhang A ... NTtS CFA?•I " U ; J C l A t j. University of Wisconsin _. I e...Medical Imaging System - ARMIS Contract # 6.AUTHOR(S) Melvin P. Siedband James R. Gray DAMDI7-88C-8058 Frank C. Grenzow Huilian Zhang 63807A Craig A...its use is inconsistent to the people who must manage it. The consistency of the Macin- tosh operating system permits easier staff training as imaging

  13. A Study to Determine the Best Method of Delivering Nutrition Education Services at Darnall Army Community Hospital

    Science.gov (United States)

    1988-08-01

    fruits and fiber coconut or palm oil - a saturated thatalsocontainaddedsugarand needed for good nutrition, fat which contributes to high fat. In fact...percent or and avoid those cereals that con- percent or not more than 4 g-rams usually about 1 ounce and table- tain coconut or palm oil or par- of...Wilson and Brownell 1980). They have also been used to decrease serum cholesterol and triglycerides in individuals (Foreyt et al. 1981, Lovibond et al

  14. An Analysis of the Need for a Whole-Body CT Scanner at US Darnall Army Community Hospital

    Science.gov (United States)

    1980-05-01

    invasion. neoplasms of the neck. * Evaluation of bony abnormalities of the cervical spine including neoplasms, fractures, dislocations, and congen- Ital...of invasion of vena cava by tumor. tasis. Detection of primary tumor in patient with positive sputum cytology and negative chest radiography Spine ...Differentiation of solid, cystic, inflammatory.malities (spina bifida , andinvasculare, lesions.e diastematomyelia). and vascular lesions. * Evaluation (type I or II

  15. A Study of Waste Management within the COL Florence A. Blanchfield Army Community Hospital, Fort Campbell, Kentucky.

    Science.gov (United States)

    1981-08-01

    virulent microorganisms, the facility must take specific steps designed to ameliorate the microbial insult to patients’ health. 15 These actions...tularensis MycoatRum avium, M. bovis, M. tuberculosis Pasteurella multocida type B ("Fuffalo" and other foreign virulent strains) Pseudomonas pseudomal lei...whitepox which, depending on experiments, are in Class 3 or Class 4 Rabies virus - all strains except Rabies street virus, which should be classified

  16. Inappropriate Utilization of the Emergency Treatment Room at DeWitt Army Community Hospital Fort Belvoir, Virginia.

    Science.gov (United States)

    1991-07-16

    Herniated intervertebral disc Herpes Simplex Herpes zoster Hives Hyperemesis gravidarum Hyperpyrexia (fever) Hypertension Hypertensive crisis...abortion, self-induced abortion, spontaneous eclampsia - hemorrhage hyperemesis gravidarum labor, false premature threatened premature Prostate

  17. A Study of the Average Cost of Obstetric Services Delivered at Womack Army Community Hospital, Fort Bragg, North Carolina

    Science.gov (United States)

    1985-08-01

    Prevention of program PL 89-97 1079 duplication with Social Security Administration and private insurers D. Cost containment PL 89-188 1078,1081 E...section herpes gonococcus syphillis history of preeclampsia incompetent cervix multiple gestation cervical cerclage asthma placenta previa 3) Maternal...other variables. To prevent the error of disregarding a variable that is in fact statistically significant when cost variables interrelationships are

  18. An Analysis of the Effectiveness of the Retail Pharmacy Utilization Intervention at General Leonard Wood Army Community Hospital

    Science.gov (United States)

    2009-04-23

    utilization between the plans. This supports the findings in a 2001 study by Gaither, Kirking, Ascione , and Welage which indicated consumers would...pharmacy.html Gaither, C. A., Kirking, D. M., Ascione , F. J., & Welage, L. S. Retail Pharmacy Intervention 35 (2001). Consumers’ views on

  19. Scheduling Operative Surgical Services to Recover CHAMPUS Surgical Procedures at Blanchfield Army Community Hospital, Fort Campbell, Kentucky

    Science.gov (United States)

    1993-08-01

    number of deliveries and cesarean sections. Similarly, the number of circumcisions performed under CHAMPUS 50 attributable to the urology service...for accurate scheduling: case length and physician history . More in depth information is needed about the duration of each procedure. Currently, all...4,050.30 $2,025.15 89 TOT AVE CODE PROCEDURE CASES COST COST 7359 OTH MANUALLY ASSISTED DELIVERY 49 $150,376.79 $3,068.91 736 EPISIOTOMY 36 $96,595.63

  20. Hospital community benefits other than charity care: implications for tax exemption and public policy.

    Science.gov (United States)

    Buchmueller, T C; Feldstein, P J

    1996-01-01

    Recent policy initiatives attempt to link the tax treatment of nonprofit hospitals more closely with the provision of social benefits. A key issue in defining these benefits is the treatment of "community benefit" programs and services. While their costs are often unreimbursed, these programs differ from traditional charity care in terms of the populations whom they benefit and the motivation for their provision. Community benefit programs are typically targeted to the general population, rather than the poor or other underserved groups, and often serve a marketing function.

  1. Penicillin as empirical therapy for patients hospitalised with community acquired pneumonia at a Danish hospital

    DEFF Research Database (Denmark)

    Kirk, O; Glenthøj, Jonathan Peter; Dragsted, Ulrik Bak

    2001-01-01

    INTRODUCTION: We report on the outcome of a study of patients hospitalised with community acquired pneumonia (HCAP) at a Danish university hospital. METHODOLOGY: In a retrospective study of 243 consecutive patients with radiographically verified HCAP, data on clinical and laboratory findings...... three months was 12% and the readmission rate within three months was 20%. The three treatment groups were comparable with respect to most demographic and clinical criteria at baseline. No significant differences in outcome between the groups were found: the mortality was 12.5%, 13.0%, and 10.......3%, respectively, p = 0.94, and the readmission rate 20.3%, 24.0%, and 14.8%, respectively; p = 0.63. CONCLUSION: Patients treated for community-acquired pneumonia at a Danish university hospital had clinical outcomes fully at height with findings from other countries, and half of the patients were successfully...

  2. Administration: Army Congressional Fellowship Program

    National Research Council Canada - National Science Library

    2000-01-01

    This printing publishes a new Army Regulation. This regulation presents the policies and procedures under which the Army manages the Army Congressional Fellowship Program and supplements applicable Department...

  3. Army medical imaging system: ARMIS

    International Nuclear Information System (INIS)

    Siedband, M.P.; Kramp, D.C.

    1987-01-01

    Recent advances of stimulable phosphor screens, data cards using optical storage means, and new personal computers with image processing capability have made possible the design of economical filmless medical imaging systems. The addition of communication links means that remote interpretation of images is also possible. The Army Medical Imaging System uses stimulable phosphor screens, digital readout, a small computer, an optical digital data card device, and a DIN/PACS link. Up to 200 images can be stored in the computer hard disk for rapid recall and reading by the radiologist. The computer permits image processing, annotation, insertion of text, and control of the system. Each device contains an image storage RAM and communicates with the computer via the small computer systems interface. Data compression is used to reduce the required storage capacity and transmission times of the 1-mB images. The credit card-size optical data cards replace film and can store 12 or more images. The data cards can be read on an independent viewer. The research is supported by the U.S. Army Biomedical Research and Development Laboratory

  4. Obstetric referrals from a rural clinic to a community hospital in Honduras.

    Science.gov (United States)

    Josyula, Srirama; Taylor, Kathryn K; Murphy, Blair M; Rodas, Dairamise; Kamath-Rayne, Beena D

    2015-11-01

    referrals between health care facilities are important in low-resource settings, particularly in maternal and child health, to transfer pregnant patients to the appropriate level of obstetric care. Our aim was to characterise the obstetrical referrals from a rural clinic to a community referral hospital in Honduras, to identify barriers in effective transport/referral, and to describe subsequent patient outcomes. we performed a descriptive retrospective study of patients referred during a 9-month period. We reviewed patient charts to review diagnosis, referral, and treatment times at both sites to understand the continuity of care. ninety-two pregnant patients were referred from the rural clinic to the community hospital. Twenty six pregnant patients (28%) did not have complete and accurate medical records and were excluded from the study. The remaining 66 patients were our study population. Of the 66 patients, 54 (82%) received antenatal care with an average of 5.5±2.4 visits. The most common diagnoses requiring referral were non-reassuring fetal status, hypertensive disorders of pregnancy, and preterm labour. The time spent in the rural clinic until transfer was 7.35±8.60 hours, and transport times were 4.42±1.07 hours. Of the 66 women transferred, 24 (36%) had different primary diagnoses and 16 (24%) had additional diagnoses after evaluation in the community hospital, whereas the remaining 26 (40%) had diagnoses that remained the same. No system was in place to give feedback to the referring clinic doctors regarding their primary diagnoses. our results demonstrate challenges seen in obstetric transport from a rural clinic to a community hospital in Honduras. Further research is needed for reform of emergency obstetric care management, targeting both healthcare personnel and medical referral infrastructure. The example of Honduras can be taken to motivate change in other resource-limited areas. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Computer-assisted instruction: a library service for the community teaching hospital.

    Science.gov (United States)

    McCorkel, J; Cook, V

    1986-04-01

    This paper reports on five years of experience with computer-assisted instruction (CAI) at Winthrop-University Hospital, a major affiliate of the SUNY at Stony Brook School of Medicine. It compares CAI programs available from Ohio State University and Massachusetts General Hospital (accessed by telephone and modem), and software packages purchased from the Health Sciences Consortium (MED-CAPS) and Scientific American (DISCOTEST). The comparison documents one library's experience of the cost of these programs and the use made of them by medical students, house staff, and attending physicians. It describes the space allocated for necessary equipment, as well as the marketing of CAI. Finally, in view of the decision of the National Board of Medical Examiners to administer the Part III examination on computer (the so-called CBX) starting in 1988, the paper speculates on the future importance of CAI in the community teaching hospital.

  6. Oseltamivir Use Among Children and Adults Hospitalized With Community-Acquired Pneumonia.

    Science.gov (United States)

    Oboho, Ikwo K; Bramley, Anna; Finelli, Lyn; Fry, Alicia; Ampofo, Krow; Arnold, Sandra R; Self, Wesley H; Williams, Derek J; Courtney, D Mark; Zhu, Yuwei; Anderson, Evan J; Grijalva, Carlos G; McCullers, Jonathan A; Wunderink, Richard G; Pavia, Andrew T; Edwards, Kathryn M; Jain, Seema

    2017-01-01

    Data on oseltamivir treatment among hospitalized community-acquired pneumonia (CAP) patients are limited. Patients hospitalized with CAP at 6 hospitals during the 2010-2012 influenza seasons were included. We assessed factors associated with oseltamivir treatment using logistic regression. Oseltamivir treatment was provided to 89 of 1627 (5%) children (<18 years) and 143 of 1051 (14%) adults. Among those with positive clinician-ordered influenza tests, 39 of 61 (64%) children and 37 of 48 (77%) adults received oseltamivir. Among children, oseltamivir treatment was associated with hospital A (adjusted odds ratio [aOR], 2.76; 95% confidence interval [CI], 1.36-4.88), clinician-ordered testing performed (aOR, 2.44; 95% CI, 1.47-5.19), intensive care unit (ICU) admission (aOR, 2.09; 95% CI, 1.27-3.45), and age ≥2 years (aOR, 1.43; 95% CI, 1.16-1.76). Among adults, oseltamivir treatment was associated with clinician-ordered testing performed (aOR, 8.38; 95% CI, 4.64-15.12), hospitals D and E (aOR, 3.46-5.11; 95% CI, 1.75-11.01), Hispanic ethnicity (aOR, 2.06; 95% CI, 1.18-3.59), and ICU admission (aOR, 2.05; 95% CI, 1.34-3.13). Among patients hospitalized with CAP during influenza season, oseltamivir treatment was moderate overall and associated with clinician-ordered testing, severe illness, and specific hospitals. Increased clinician education is needed to include influenza in the differential diagnosis for hospitalized CAP patients and to test and treat patients empirically if influenza is suspected. Published by Oxford University Press on behalf of Infectious Diseases Society of America 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  7. Didactic and simulation nontechnical skills team training to improve perinatal patient outcomes in a community hospital.

    Science.gov (United States)

    Riley, William; Davis, Stanley; Miller, Kristi; Hansen, Helen; Sainfort, Francois; Sweet, Robert

    2011-08-01

    Birth trauma is a low-frequency, high-severity event, making obstetrics a major challenge for patient safety. Yet, few strategies have been shown to eliminate preventable perinatal harm. Interdisciplinary team training was prospectively evaluated to assess the relative impact of two different learning modalities to improve nontechnical skills (NTS)--the cognitive and interpersonal skills, such as communication and teamwork, that supplement clinical and technical skills and are necessary to ensure safe patient care. Between 2005 and 2008, perinatal morbidity and mortality data were prospectively collected using the Weighted Adverse Outcomes Score (WAOS) and a culture of safety survey (Safety Attitudes Questionnaire) at three small-sized community hospitals. In a small cluster randomized clinical trial conducted in the third quarter of 2007, one of the hospitals served as a control group and two served as the treatment intervention sites--one hospital received the TeamSTEPPS didactic training program and one hospital received both the TeamSTEPPS program along with a series of in-situ simulation training exercises. A statistically significant and persistent improvement of 37% in perinatal morbidity was observed between the pre- and postintervention for the hospital exposed to the simulation program. There were no statistically significant differences in the didactic-only or the control hospitals. Baseline perceptions of culture of safety were high at all three hospitals, and there were no significant changes. A comprehensive interdisciplinary team training program using in-situ simulation can improve perinatal safety in the hospital setting. This is the first evidence providing a clear association between simulation training and improved patient outcomes. Didactics alone were not effective in improving perinatal outcomes.

  8. Impact of pre-hospital antibiotic use on community-acquired pneumonia.

    Science.gov (United States)

    Simonetti, A F; Viasus, D; Garcia-Vidal, C; Grillo, S; Molero, L; Dorca, J; Carratalà, J

    2014-09-01

    Information on the influence of pre-hospital antibiotic treatment on the causative organisms, clinical features and outcomes of patients with community-acquired pneumonia (CAP) remains scarce. We performed an observational study of a prospective cohort of non-immunosuppressed adults hospitalized with CAP between 2003 and 2012. Patients were divided into two groups: those who had received pre-hospital antibiotic treatment for the same episode of CAP and those who had not. A propensity score was used to match patients. Of 2179 consecutive episodes of CAP, 376 (17.3%) occurred in patients who had received pre-hospital antibiotic treatment. After propensity score matching, Legionella pneumophila was more frequently identified in patients with pre-hospital antibiotic treatment, while Streptococcus pneumoniae was less common (p sensitivity and specificity of the pneumococcal urinary antigen test for diagnosing pneumococcal pneumonia were similar in the two groups. Patients with pre-hospital antibiotic treatment were less likely to present fever (p 0.02) or leucocytosis (p 0.001). Conversely, chest X-ray cavitation was more frequent in these patients (p 0.04). No significant differences were found in the frequency of patients classified into high-risk Pneumonia Severity Index classes, in intensive care unit admission, or in 30-day mortality between the groups. In conclusion, L. pneumophila occurrence was nearly three times higher in patients who received pre-hospital antibiotics. After a propensity-adjusted analysis, no significant differences were found in prognosis between study groups. Pre-hospital antibiotic use should be considered when choosing aetiological diagnostic tests and empirical antibiotic therapy in patients with CAP. © 2013 The Authors Clinical Microbiology and Infection © 2013 European Society of Clinical Microbiology and Infectious Diseases.

  9. Nursing implementation of a telestroke programme in a community hospital in the US.

    Science.gov (United States)

    Rafter, Roseanne H; Kelly, Teresa M

    2011-03-01

    To describe the nursing implementation of a telestroke programme including the development of a stroke care delivery model in a community hospital. Successful nursing implementation of a telestroke programme in a community hospital requires planning, education, and preparation. Telemedicine technology provides the bedside clinician with rapid, expert, neuroscience stroke consultation in order to optimize outcomes in patients with acute stroke. Nursing implementation of a telestroke programme includes the development of a practical, precise, evidence-based stroke care delivery model. Such a model requires delineation of specific roles and responsibilities, development of a detailed treatment timeline, provision of comprehensive education, preparation of policies and procedures, standardization of education and initiation of programme quality monitoring. Nursing implementation of a telestroke programme can be accomplished by nurse leaders and the Stroke team with comprehensive planning and preparation. The stroke care delivery model must be designed specifically with the community hospital's resources and organizational capabilities in mind. IMPLICATIONS FOR MANAGEMENT: Nurse leaders need to facilitate a vision, motivation, and a practice framework when implementing a telestroke programme. Multidisciplinary collaboration is key to a successful planning process. Allocation of nursing resources and the impact of the stroke care delivery model on nursing operations needs to be considered and evaluated by nurse leaders. © 2011 The Authors. Journal compilation © 2011 Blackwell Publishing Ltd.

  10. Association of dialysis with in-hospital disability progression and mortality in community-onset stroke.

    Science.gov (United States)

    Usui, Tomoko; Hanafusa, Norio; Yasunaga, Hideo; Nangaku, Masaomi

    2018-02-22

    End-stage renal disease is associated with increased risk of cerebrovascular disease, but the effect on post-stroke clinical outcomes has not been thoroughly investigated. Using the Japanese Diagnosis Procedure Combination database, which includes administrative claims and discharge abstract data, we examined the association between risk factors including dialysis therapy and in-hospital disability progression or mortality in patients with community-onset stroke. We extracted data of patients aged ≥20 years old who were admitted to the hospital within 3 days after onset of stroke between July 2010 and March 2013. The disability level was divided into modified Rankin Scale (mRS) 0-1, 2-3, 4-5, and 6 (death). Disability progression was defined as an increase in disability level. Odds ratios for in-hospital disability progression and mortality were calculated using logistic regression models. Of 435,403 patients, 7,562 (1.7%) received dialysis therapy. The median length of stay was 21 and 20 days for patients with and without dialysis, respectively. During the hospital stay, disability progressed in 100,402 (23.1%) patients and 45,919 (10.5%) died. Patients on dialysis had a higher prevalence of disability progression (26.8%) and mortality (13.1%) compared to those without dialysis (23.0% and 10.5%, respectively). Dialysis was associated with an increased risk of in-hospital disability progression (odds ratio, 1.56; 95% confidence interval, 1.47-1.66) and mortality (odds ratio 1.70; 95% confidence interval, 1.57-1.84). These risks were comparable among subtypes of stroke. Dialysis was associated with an increased risk of in-hospital disability progression and mortality among patients with community-onset stroke, regardless of stroke subtype. This article is protected by copyright. All rights reserved.

  11. Inpatient management of community-acquired pneumonia at the European Gaza Hospital: a clinical audit.

    Science.gov (United States)

    Alyacoubi, Said; Abuowda, Yousef; Albarqouni, Loai; Böttcher, Bettina; Elessi, Khamis

    2018-02-21

    Disease severity scores such as CURB-65 are often used to guide the management of patients with community-acquired pneumonia. Early and adequate empirical antibiotic treatment reduces mortality. The aim of this study was to examine the severity assessment and management of patients presenting with community-acquired pneumonia at the European Gaza Hospital in the Gaza Strip and to compare this to the best available evidence. Medical records of all patients admitted to the European Gaza Hospital with a diagnosis of community-acquired pneumonia between Dec 1, 2015, and March 31, 2016, were reviewed retrospectively. Clinical practice was compared with recommendations for severity assessment and the management of community-acquired pneumonia, as reported in guidelines by the National Institute for Health and Care Excellence and the American Thoracic Society. Ethical approval was obtained from the General Directorate of Human Resources. 141 patients were admitted to the European Gaza Hospital with community-acquired pneumonia during the study period. Records of 41 patients were missing or could not be retrieved. The mean age of patients was 55·9 years (SD 20·2). Blood urea and nitrogen concentrations were not documented for 48 (48%) patients, and respiratory rate was not documented for 73 (73%) patients. The CURB-65 score was determined only for 12 (12%) patients. Microbiological testing was done only for two (2%) patients. Although 18 different antibiotic regimens were used, 81 (81%) patients received a β-lactam plus macrolide combination therapy, either given alone (49 [49%] patients) or with another antibiotic (32 [32%] patients), which is in line with the recommendations for patients admitted to hospital with community-acquired pneumonia. 43 (43%) patients received anti-viral drugs, and 41 (41%) patients received corticosteroids. Clinicians were poorly adherent to current standards of care in severity assessment and management of community-acquired pneumonia

  12. Comprehensive Soldier Fitness: A Vision for Psychological Resilience in the U.S. Army

    Science.gov (United States)

    Casey, George W., Jr.

    2011-01-01

    The stress and strain on the U.S. Army's community due to nearly a decade of protracted war is well documented in the press and in scientific literature. In response, the Army's Comprehensive Soldier Fitness (CSF) program is a preventive program that seeks to enhance psychological resilience among all members of the Army community, which includes…

  13. Challenges in the delivery of nutrition services to hospital discharged older adults: the community connections demonstration project.

    Science.gov (United States)

    Sahyoun, Nadine R; Akobundu, Ucheoma; Coray, Kevin; Netterville, Linda

    2009-04-01

    The objective of this project was to explore the effort necessary to transform the Older Americans Act Nutrition Program (OAANP) into core programs within an integrated health care delivery system that serves hospital-discharged older adults in order to assist them in reintegrating into the community. Six OAANPs in six states were funded and provided technical assistance to develop coalitions with hospitals and community organizations. Each demonstration site was unique and faced many challenges in reaching out to a hospitalized vulnerable population. This project also provided opportunities to try out new initiatives and examine their sustainability within the community.

  14. Community-Acquired Pneumonia Requiring Hospitalization among U.S. Adults.

    Science.gov (United States)

    Jain, Seema; Self, Wesley H; Wunderink, Richard G; Fakhran, Sherene; Balk, Robert; Bramley, Anna M; Reed, Carrie; Grijalva, Carlos G; Anderson, Evan J; Courtney, D Mark; Chappell, James D; Qi, Chao; Hart, Eric M; Carroll, Frank; Trabue, Christopher; Donnelly, Helen K; Williams, Derek J; Zhu, Yuwei; Arnold, Sandra R; Ampofo, Krow; Waterer, Grant W; Levine, Min; Lindstrom, Stephen; Winchell, Jonas M; Katz, Jacqueline M; Erdman, Dean; Schneider, Eileen; Hicks, Lauri A; McCullers, Jonathan A; Pavia, Andrew T; Edwards, Kathryn M; Finelli, Lyn

    2015-07-30

    Community-acquired pneumonia is a leading infectious cause of hospitalization and death among U.S. adults. Incidence estimates of pneumonia confirmed radiographically and with the use of current laboratory diagnostic tests are needed. We conducted active population-based surveillance for community-acquired pneumonia requiring hospitalization among adults 18 years of age or older in five hospitals in Chicago and Nashville. Patients with recent hospitalization or severe immunosuppression were excluded. Blood, urine, and respiratory specimens were systematically collected for culture, serologic testing, antigen detection, and molecular diagnostic testing. Study radiologists independently reviewed chest radiographs. We calculated population-based incidence rates of community-acquired pneumonia requiring hospitalization according to age and pathogen. From January 2010 through June 2012, we enrolled 2488 of 3634 eligible adults (68%). Among 2320 adults with radiographic evidence of pneumonia (93%), the median age of the patients was 57 years (interquartile range, 46 to 71); 498 patients (21%) required intensive care, and 52 (2%) died. Among 2259 patients who had radiographic evidence of pneumonia and specimens available for both bacterial and viral testing, a pathogen was detected in 853 (38%): one or more viruses in 530 (23%), bacteria in 247 (11%), bacterial and viral pathogens in 59 (3%), and a fungal or mycobacterial pathogen in 17 (1%). The most common pathogens were human rhinovirus (in 9% of patients), influenza virus (in 6%), and Streptococcus pneumoniae (in 5%). The annual incidence of pneumonia was 24.8 cases (95% confidence interval, 23.5 to 26.1) per 10,000 adults, with the highest rates among adults 65 to 79 years of age (63.0 cases per 10,000 adults) and those 80 years of age or older (164.3 cases per 10,000 adults). For each pathogen, the incidence increased with age. The incidence of community-acquired pneumonia requiring hospitalization was highest among

  15. Implementation of Continuous Video-Electroencephalography at a Community Hospital Enhances Care and Reduces Costs.

    Science.gov (United States)

    Kolls, Brad J; Mace, Brian E; Dombrowski, Keith E

    2017-10-24

    Despite data indicating the importance of continuous video-electroencephalography (cvEEG) monitoring, adoption has been slow outside major academic centers. Barriers to adoption include the need for technologists, equipment, and cvEEG readers. Advancements in lower-cost lead placement templates and commercial systems with remote review may reduce barriers to allow community centers to implement cvEEG. Here, we report our experience, lessons learned, and financial impact of implementing a community hospital cvEEG-monitoring program. We implemented an adult cvEEG service at Duke Regional Hospital (DRH), a community hospital affiliate, in June of 2012. Lead placement templates were used in the implementation to reduce the impact on technologists by using other bedside providers for EEG initiation. Utilization of the service, study quality, and patient outcomes were tracked over a 3-year period following initiation of service. Service was implemented at essentially no cost. Utilization varied from a number of factors: intensive care unit (ICU) attending awareness, limited willingness of bedside providers to perform lead placement, and variation in practice of the consulting neurologists. A total of 92 studies were performed on 88 patients in the first 3 years of the program, 24 in year one, 27 in year two, and 38 in year three, showing progressive adoption. Seizures were seen in 25 patients (27%), 19 were in status, of which 18 were successfully treated. Transfers to the main hospital, Duke University Medical Center, were prevented for 53 patients, producing an estimated cost savings of $145,750. The retained patients produced a direct contribution margin of about $75,000, and the margin was just over $100,000 for the entire monitored cohort. ICU cvEEG service is feasible and practical to implement at the community hospital level. Service was initiated at little to no cost and clearly enhanced care, increased breadth of care, increased ICU census, and reduced

  16. Fox Chase Network: Fox Chase Cancer Center's community hospital affiliation program.

    Science.gov (United States)

    Higman, S A; McKay, F J; Engstrom, P F; O'Grady, M A; Young, R C

    2000-01-01

    Fox Chase Cancer Center developed a format for affiliation with community providers in 1986. Fox Chase Network was formed to establish hospital-based community cancer centers to increase access to patients involved in clinical research. Under this program, the Fox Chase Network now contributes 500 patients per year to prevention and clinical research studies. As relationships with community providers form, patient referrals have increased at Fox Chase Cancer Center and for each Fox Chase Network member. A dedicated staff is required to operate the central office on a day-to-day basis as well as at each affiliate. We have found this to be a critical element in each program's success. New challenges in the cancer business-increasing volumes with declining revenue-have caused us to reconfigure the services offered to affiliates, while maintaining true to our mission: to reduce the burden of human cancer.

  17. Improving financial performance by modeling and analysis of radiology procedure scheduling at a large community hospital.

    Science.gov (United States)

    Lu, Lingbo; Li, Jingshan; Gisler, Paula

    2011-06-01

    Radiology tests, such as MRI, CT-scan, X-ray and ultrasound, are cost intensive and insurance pre-approvals are necessary to get reimbursement. In some cases, tests may be denied for payments by insurance companies due to lack of pre-approvals, inaccurate or missing necessary information. This can lead to substantial revenue losses for the hospital. In this paper, we present a simulation study of a centralized scheduling process for outpatient radiology tests at a large community hospital (Central Baptist Hospital in Lexington, Kentucky). Based on analysis of the central scheduling process, a simulation model of information flow in the process has been developed. Using such a model, the root causes of financial losses associated with errors and omissions in this process were identified and analyzed, and their impacts were quantified. In addition, "what-if" analysis was conducted to identify potential process improvement strategies in the form of recommendations to the hospital leadership. Such a model provides a quantitative tool for continuous improvement and process control in radiology outpatient test scheduling process to reduce financial losses associated with process error. This method of analysis is also applicable to other departments in the hospital.

  18. Defining the value of community benefits. Analyzing the kinds of goods society produces clarifies hospitals' charity care contribution.

    Science.gov (United States)

    Sanders, S M

    1992-01-01

    Community benefits occur when a hospital bears all or part of the relatively unquantifiable costs of promoting, sponsoring, or engaging in religious, educational, scientific, or health-related activities designed to improve community health. By the very nature of their health-related activities, not-for-profit hospitals make extensive and varied contributions to community benefit. When a hospital free clinic inoculates a child for measles, the community as a whole benefits because the inoculation reduces the chance that measles will spread. Not-for-profit hospitals also provide many goods that are "undersupplied" by the for-profit private sector or the public sector, such as research, trauma centers used disproportionately by self-pay patients, and advocacy to rid the community of health hazards. Moreover, a number of factors impose a legal and normative obligation on not-for-profit hospitals to engage in activities that benefit the community. These include Internal Revenue Service rules governing tax exemption, hospitals' fiduciary responsibilities to philanthropic donors, their obligations as "institutional actors" in their communities, and their mission to reach out to the poor and underserved.

  19. Nutritional risk, hospitalization and mortality among community-dwelling Canadians aged 65 or older.

    Science.gov (United States)

    Ramage-Morin, Pamela L; Gilmour, Heather; Rotermann, Michelle

    2017-09-20

    Nutritional risk has been associated with various negative health outcomes among older people. Limited longitudinal research has examined the relationship between nutritional risk and hospitalization and death in community-dwelling older people. Data from the 2008/2009 Canadian Community Health Survey-Healthy Aging (CCHS-HA) linked to the Discharge Abstract Database and the Canadian Mortality Database were used to estimate the prevalence of nutritional risk among seniors and examine its relationship with acute care hospitalization and death during the 25- to 36-month period following the CCHS-HA interview. Multivariate Cox proportional hazards models were used to identify important covariates, while adjusting for demographic and socioeconomic characteristics, health status, and lifestyle factors. A third (34%; 979,000) of Canadians aged 65 or older living in 9 provinces (excluding Quebec) were at nutritional risk in 2008/2009. These seniors had a higher risk of an acute care hospitalization (hazard ratio (HR) 1.2; 95% CI: 1.1 to 1.4) or death (HR 1.6; 95% CI: 1.3 to 2.0) during the follow-up period, even when potential confounders were taken into account. Seniors at nutritional risk in 2008/2009 were more likely than those not at nutritional risk to die during follow-up (9% versus 5%) and averaged shorter survival times: 498 days (95% CI: 462 to 534) compared with 538 days (95% CI: 501 to 574). Based on an analysis of data from a large population-based survey linked to routinely collected hospital and death data, nutritional risk is independently associated with acute care hospitalization and mortality. Results highlight the importance of monitoring seniors for nutritional risk.

  20. Net Income of Pharmacy Faculty Compared to Community and Hospital Pharmacists.

    Science.gov (United States)

    Chisholm-Burns, Marie A; Gatwood, Justin; Spivey, Christina A; Dickey, Susan E

    2016-09-25

    Objective. To compare the net cumulative income of community pharmacists, hospital pharmacists, and full-time pharmacy faculty members (residency-trained or with a PhD after obtaining a PharmD) in pharmacy practice, medicinal chemistry, pharmaceutics, pharmacology, and social and administrative sciences. Methods. Markov modeling was conducted to calculate net projected cumulative earnings of career paths by estimating the costs of education, including the costs of obtaining degrees and student loans. Results. The economic model spanned 49 years, from ages 18 to 67 years. Earning a PharmD and pursuing an academic career resulted in projected net cumulative lifetime earnings ranging from approximately $4.7 million to $6.3 million. A pharmacy practice faculty position following public pharmacy school and one year of residency resulted in higher net cumulative income than community pharmacy. Faculty members with postgraduate year 1 (PGY1) training also had higher net income than other faculty and hospital pharmacy career paths, given similar years of prepharmacy education and type of pharmacy school attended. Faculty members with either a PharmD or PhD in the pharmacology discipline may net as much as $5.9 million and outpace all other PhD graduates by at least $75 000 in lifetime earnings. Projected career earnings of postgraduate year 2 (PGY2) trained faculty and PharmD/PhD faculty members were lower than those of community pharmacists. Findings were more variable when comparing pharmacy faculty members and hospital pharmacists. Conclusion. With the exception of PGY1 trained academic pharmacists, faculty projected net cumulative incomes generally lagged behind community pharmacists, likely because of delayed entry into the job market as a result of advanced training/education. However, nonsalary benefits such as greater flexibility and autonomy may enhance the desirability of academic pharmacy as a career path.

  1. The HOSPITAL score and LACE index as predictors of 30 day readmission in a retrospective study at a university-affiliated community hospital

    Directory of Open Access Journals (Sweden)

    Robert Robinson

    2017-03-01

    overall performance. The Hosmer–Lemeshow goodness of fit test shows a χ2 value of 4.97 with a p value of 0.66. Discussion This single center retrospective study indicates that the HOSPITAL score has superior discriminatory ability when compared to the LACE index as a predictor of hospital readmission within 30 days at a medium-sized university-affiliated teaching hospital. Conclusions The internationally validated HOSPITAL score may be superior to the LACE index in moderate-sized community hospitals to identify patients at high risk of hospital readmission within 30 days.

  2. 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...

  3. Evaluating Hospitals’ Provision of Community Benefit: An Argument for an Outcome-Based Approach to Nonprofit Hospital Tax Exemption

    Science.gov (United States)

    Singh, Simone Rauscher; Jacobson, Peter D.

    2013-01-01

    Nonprofit hospitals are exempt from federal income taxation if they pass organizational and operational tests, including satisfying the community-benefit standard. Policymakers, however, have questioned the adequacy of the community benefits that nonprofit hospitals provide in exchange for these exemptions. The Internal Revenue Service recently responded to these concerns by redesigning its tax forms for nonprofit hospitals. The new Form 990 Schedule H requires nonprofit hospitals to provide additional information about their community-benefit activities. This new reporting requirement, however, places an undue focus on input-based community-benefit indicators, in particular expenditures. We argue that expanding the current input-based reporting requirement to include not only monetary inputs but also population health outcomes would achieve greater benefit for society. PMID:23409909

  4. A hospital-randomized controlled trial of a formal quality improvement educational program in rural and small community Texas hospitals: one year results.

    Science.gov (United States)

    Filardo, Giovanni; Nicewander, David; Herrin, Jeph; Edwards, Janine; Galimbertti, Percy; Tietze, Mari; McBride, Susan; Gunderson, Julie; Collinsworth, Ashley; Haydar, Ziad; Williams, Josie; Ballard, David J

    2009-08-01

    To investigate the effectiveness of a quality improvement educational program in rural hospitals. Hospital-randomized controlled trial. A total of 47 rural and small community hospitals in Texas that had previously received a web-based benchmarking and case-review tool. The 47 hospitals were randomized either to receive formal quality improvement educational program or to a control group. The educational program consisted of two 2-day didactic sessions on continuous quality improvement techniques, followed by the design, implementation and reporting of a local quality improvement project, with monthly coaching conference calls and annual follow-up conclaves. Performance on core measures for community-acquired pneumonia and congestive heart failure were compared between study groups to evaluate the impact of the educational program. No significant differences were observed between the study groups on any measures. Of the 23 hospitals in the intervention group, only 16 completed the didactic program and 6 the full training program. Similar results were obtained when these groups were compared with the control group. While the observed results suggest no incremental benefit of the quality improvement educational program following implementation of a web-based benchmarking and case-review tool in rural hospitals, given the small number of hospitals that completed the program, it is not conclusive that such programs are ineffective. Further research incorporating supporting infrastructure, such as physician champions, financial incentives and greater involvement of senior leadership, is needed to assess the value of quality improvement educational programs in rural hospitals.

  5. Transitions from hospital to community care: the role of patient-provider language concordance.

    Science.gov (United States)

    Rayan, Nosaiba; Admi, Hanna; Shadmi, Efrat

    2014-01-01

    Cultural and language discordance between patients and providers constitutes a significant challenge to provision of quality healthcare. This study aims to evaluate minority patients' discharge from hospital to community care, specifically examining the relationship between patient-provider language concordance and the quality of transitional care. This was a multi-method prospective study of care transitions of 92 patients: native Hebrew, Russian or Arabic speakers, with a pre-discharge questionnaire and structured observations examining discharge preparation from a large Israeli teaching hospital. Two weeks post-discharge patients were surveyed by phone, on the transition from hospital to community care (the Care Transition Measure (CTM-15, 0-100 scale)) and on the primary-care post-discharge visit. Overall, ratings on the CTM indicated fair quality of the transition process (scores of 51.8 to 58.8). Patient-provider language concordance was present in 49% of minority patients' discharge briefings. Language concordance was associated with higher CTM scores among minority groups (64.1 in language-concordant versus 49.8 in non-language-concordant discharges, P Language-concordant care, coupled with extensive discharge briefings and post-discharge explanations for ongoing care, are important contributors to the quality of care transitions of ethnic minority patients.

  6. Transition from Hospital to Community Care: The Experience of Cancer Patients

    Directory of Open Access Journals (Sweden)

    Hanna Admi

    2015-12-01

    Full Text Available Purpose: This study examines care transition experiences of cancer patients and assesses barriers to effective transitions.Methods: Participants were adult Hebrew, Arabic, or Russian speaking oncology patients and health care providers from hospital and community settings. Qualitative (n=77 and quantitative (n=422 methods such as focus groups, interviews and self-administered questionnaires were used. Qualitative analysis showed that patients faced difficulties navigating a complex and fragmented healthcare system.Results: Mechanisms to overcome barriers included informal routes such as personal relationships, coordinating roles by nurse coordinators and the patients' general practitioners (GPs. The most significant variable was GPs involvement, which affected transition process quality as rated on the CTM (p<0.001. Our findings point to the important interpersonal role of oncology nurses to coordinate and facilitate the care transition process.Conclusion: Interventions targeted towards supporting the care transition process should emphasize ongoing counseling throughout a patient’s care, during and after hospitalization.-----------------------------------------Cite this article as:  Admi H, Muller E, Shadmi E. Transition from Hospital to Community Care: The Experience of Cancer Patients. Int J Cancer Ther Oncol 2015; 3(4:34011.[This abstract was presented at the BIT’s 8th Annual World Cancer Congress, which was held from May 15-17, 2015 in Beijing, China.

  7. Community-based fall assessment compared with hospital-based assessment in community-dwelling older people over 65 at high risk of falling: a randomized study.

    Science.gov (United States)

    Suman, Sanjay; Myint, Phyo K; Clark, Allan; Das, Partha; Ring, Liam; Trepte, Nicola J B

    2011-02-01

    The effectiveness of community-based fall assessment programs in older people is unclear. In this study, we examined the effectiveness of community-based fall assessment compared with hospital-based assessment. A randomized un-blind study was conducted in 369 older adults aged 65 years and over at high risk of falling. Participants were drawn from a larger cohort of community-dwelling older people. Eligible participants were identified by means of a simple five-item screening tool. A randomly chosen subset population of people at high risk of falling was then randomized into two arms, community-based and hospital-based fall assessments. The total number of falls in both groups was recorded by following up subjects' diaries and telephone interviews at 3, 6 and 12 months. Incidence Rate Ratios (IRR) for the rate of falls at 12 months between community- and hospital-based assessments were analysed as primary outcome, by intention-to-treat analysis. A total of 349 participants completed the study. Attendance to community-based assessment was significantly higher compared with hospital-based assessment in this older population (p=0.012). There were no statistically significant differences between the two groups in total number of falls at the 12 month follow-up. According to Negative Binomial regression, the adjusted IRR of falls in the community based arm was not significantly different from the hospital-based one (IRR 0.95; 95% CI 0.58-1.45, p=0.83). This study showed the increased risk of falling according to community-based fall assessment program with respect to a traditional hospital-based one in community-dwelling older adults at high risk of falling.

  8. Independent radiographic prognostic factors in patients with hospital-treated community-acquired pneumonia

    International Nuclear Information System (INIS)

    Wilhelm, K.; Textor, J.; Schild, H.; Ewig, S.; Luederitz, B.; Krollmann, G.

    1999-01-01

    Purpose: To evaluate the independent prognostic impact of the chest radiograph for mortality from community-acquired pneumonia requiring hospitalization. Methods: Chest radiographs of 67 patients with hospital-treated community-acquired pneumonia were analyzed with regard to the prognostic implications of radiographic patterns, extent and density of infiltrates, and its evolution during treatment. Results: Non-survivors had a significantly higher extent of infiltrates (p=0.008), density of infiltrates (p=0.05), and radiographic spread during follow-up within 48-72 hours (p=0.0001). In multivariate analysis, persistent or progressive infiltrates were associated with a 47fold increase, and persistent or progressive density of infiltrates with an 18fold increase in risk of mortality. The presence of both parameters could correctly predict 96% of survivors and 90% of non-survivors. Conclusions: The chest radiograph is an independent predictor of the severity of pneumonia. Both persistent or progressive infiltrates and persistent or progressive density of infiltrates are independently associated with mortality from community-acquired pneumonia. (orig.) [de

  9. Crisis visits and psychiatric hospitalizations among patients attending a community clinic in rural Southern California.

    Science.gov (United States)

    Camacho, Alvaro; Ng, Bernardo; Bejarano, Anabel; Simmons, Alan; Chavira, Denise

    2012-04-01

    Ethnic minorities from disadvantaged socioeconomic backgrounds report increased utilization of mental health emergency services; however findings have been inconsistent across ethnic/racial groups. In this study we describe patients who present to a rural crisis unit in Southern California, examine rates of psychiatric hospitalizations across ethnic/racial groups, and investigate factors that are associated with increased psychiatric hospitalizations in this sample. This is a retrospective study of 451 racially and ethnically diverse patients attending a crisis unit in Imperial County, California. Chart review and data abstraction methods were used to characterize the sample and identify factors associated with psychiatric crises and subsequent hospitalizations. The sample was predominantly Latino/Hispanic (58.5%). Based on chart review, common psychosocial stressors which prompted a crisis center visit were: (a) financial problems; (b) homelessness; (c) partner or family conflict; (d) physical and health problems; (e) problems at school/work; (f) medication compliance; (g) aggressive behavior; (h) delusional behavior; (i) addiction and (j) anxiety/depression. Bivariate analyses revealed that Hispanics had a disproportionately lower rate of psychiatric hospitalizations while African Americans had a higher rate. Multivariate analyses which included demographic, clinical and psychosocial stressor variables revealed that being African American, having a psychotic disorder, and presenting as gravely disabled were associated with a higher likelihood of hospitalization while partner/family conflict was associated with a lesser likelihood in this rural community. These data elucidate the need for longitudinal studies to understand the interactions between psychosocial stressors, ethnicity and social support as determinants of psychiatric hospitalizations.

  10. The Risk of Malnutrition in Community-Living Elderly on Admission to Hospital for Major Surgery.

    Science.gov (United States)

    Geurden, B; Franck, E; Weyler, J; Ysebaert, D

    2015-01-01

    With prevalence rates varying from 10 to 60%, malnutrition in acute hospitals has been acknowledged as a persistent problem in older adults worldwide. This publication is to describe the nutritional condition and associated risk factors of malnutrition in free living elderly on admission to the hospital for major elective surgery. A cross sectional, multi-center study in eight surgical wards in three Belgian hospitals. A total of 204 free living elderly, aged 74.8 ± 6.6 years (Mean ± SD), on admission to the hospital for major elective surgery and requiring at least 3 days of hospitalization, were consecutively recruited to the study. The nutritional status was assessed on admission and before surgery using the recommended NRS-2002. Data on possible associated factors were collected during post-operative stay using a structured questionnaire. A total of 107 patients (51.4%) were at high risk of malnutrition. In patients older than 70 years (n 150) the risk of malnutrition increased up to 66%. None of the included patients reported preoperative referral to a dietician or nutritional advice nor any prescribed preoperative nutritional supplement. In a multivariate regression analysis it appeared that none of the possible associated factors were significantly associated with malnutrition. This study confirms the high risk of malnutrition in community living elderly on admission to hospital for elective surgery. According to the NRS-2002 these patients might benefit from nutritional support. However, it appears that nutritional support is not yet commonly implemented in preoperative care for this population at risk. © Acta Chirurgica Belgica.

  11. Pharmacokinetics and Dosing of Ceftobiprole Medocaril for the Treatment of Hospital- and Community-Acquired Pneumonia in Different Patient Populations

    NARCIS (Netherlands)

    A. Torres; J.W. Mouton (Johan); Pea, F. (Federico)

    2016-01-01

    textabstractHospital-acquired pneumonia (HAP) and community-acquired pneumonia (CAP) are among the most common infections treated in the hospital setting, and together they place a significant burden on healthcare systems. Successful management of HAP and CAP depends on rapid initiation of empirical

  12. Association of frailty in hospitalized and institutionalized elderly in the community-dwelling

    Directory of Open Access Journals (Sweden)

    Suzele Cristina Coelho Fabrício-Wehbe

    2016-08-01

    Full Text Available ABSTRACT Objective: to investigate the association between frailty with hospitalization and institutionalization in a follow-up study of elderly residents. Method: the follow-up study was performed in 2008 and 2013 with elderly of both genders, aged 65 years and older who were living in the community-dwelling. The sampling procedure performed was probabilistic, with dual-stage clustering. In 2008, 515 elderly people were interviewed and, in 2013, 262. We used the socioeconomic and demographic data, self-reported morbidity, specific data of hospitalization and institutionalization. Frailty was measured by the Edmonton Frail Scale (EFS, and functional capacity through the Functional Independence Measure. Results: we found the mean gross EFS score was higher among resident elderly who were hospitalized and institutionalized and was statistically significant in both investigated years. Conclusion: the confirmation of association between frailty and hospitalization and institutionalization reinforces the importance of the subject, and highlights frailty as an important tool for risk estimates for these adverse events.

  13. Risk factors for Clostridium difficile infection in hospitalized patients with community-acquired pneumonia.

    Science.gov (United States)

    Chalmers, James D; Akram, Ahsan R; Singanayagam, Aran; Wilcox, Mark H; Hill, Adam T

    2016-07-01

    Clostridium difficile infection (CDI) is strongly associated with anti-biotic treatment, and community-acquired pneumonia (CAP) is the leading indication for anti-biotic prescription in hospitals. This study assessed the incidence of and risk factors for CDI in a cohort of patients hospitalized with CAP. We analysed data from a prospective, observational cohort of patients with CAP in Edinburgh, UK. Patients with diarrhoea were systematically screened for CDI, and risk factors were determined through time-dependent survival analysis. Overall, 1883 patients with CAP were included, 365 developed diarrhoea and 61 had laboratory-confirmed CDI. The risk factors for CDI were: age (hazard ratio [HR], 1.06 per year; 95% confidence interval [CI], 1.03-1.08), total number of antibiotic classes received (HR, 3.01 per class; 95% CI, 2.32-3.91), duration of antibiotic therapy (HR, 1.09 per day; 95% CI, 1.00-1.19 and hospitalization status (HR, 13.1; 95% CI, 6.0-28.7). Antibiotic class was not an independent predictor of CDI when adjusted for these risk factors (P > 0.05 by interaction testing). These data suggest that reducing the overall antibiotic burden, duration of antibiotic treatment and duration of hospital stay may reduce the incidence of CDI in patients with CAP. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  14. The Community Intervention Team as a means of Improving the transition from hospital to home for patients

    OpenAIRE

    Kearns, Michelle; Curran, Margaret; Collier, Dorcas; Burke, Mary; Lawler, Michelle

    2017-01-01

    Introduction: Too frequently patients are discharged from hospital to their home without local support from healthcare professionals. Without this support patients are often readmitted to hospital unnecessarily.Short description of practice change implemented: Networked Community intervention team (CIT) services make a unique contribution in facilitating the transition between hospital and home.Aim and theory of change: The aim is to facilitate early discharge from an acute setting, providing...

  15. Magnetic resonance imaging - guided vacuum-assisted breast biopsy: an initial experience in a community hospital

    International Nuclear Information System (INIS)

    Friedman, P.; Enis, S.; Pinyard, J.

    2009-01-01

    To evaluate the effectiveness in diagnosing mammographically and sonographically occult breast lesions by using magnetic resonance imaging (MRI) guided vacuum-assisted breast biopsy in patients who presented to a community-based hospital with a newly established breast MRI program. The records of 142 consecutive patients, median age of 55 years, who had undergone MRI-guided biopsy at our institution between July 2006 and July 2007 were reviewed. From these patients, 197 mammographically and sonographically occult lesions were biopsied at the time of discovery. The pathology was then reviewed and correlated with the MRI findings. Cancer was present and subsequently discovered in 8% of the previously occult lesions (16/197) or 11% of the women studied (16/142). Of the cancerous lesions, 56% were invasive carcinomas (9/16) and 44% were ductal carcinomas in situ (7/16). Fourteen percent of the discovered lesions (28/197) were defined as high risk and included atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, and radial scar. In total, occult cancerous and high-risk lesions were discovered in 22% of the found lesions (44/197) or 31% of the women who underwent MRI-guided biopsy (44/142). This study demonstrated that detection of cancerous and high-risk lesions can be significantly increased when an MRI-guided biopsy program is introduced at a community-based hospital. We believe that as radiologists gain confidence in imaging and histologic correlation, community-based hospitals can achieve similar rates of occult lesion diagnosis as those found in data emerging from academic institutions. (author)

  16. Magnetic resonance imaging - guided vacuum-assisted breast biopsy: an initial experience in a community hospital

    Energy Technology Data Exchange (ETDEWEB)

    Friedman, P.; Enis, S.; Pinyard, J., E-mail: jpinyard@gmail.com [Morristown Memorial Hospital, The Carol W. and Julius A. Rippel Breast Center, The Carol G. Simon Cancer Centre, Morristown, New Jersey (United States)

    2009-10-15

    To evaluate the effectiveness in diagnosing mammographically and sonographically occult breast lesions by using magnetic resonance imaging (MRI) guided vacuum-assisted breast biopsy in patients who presented to a community-based hospital with a newly established breast MRI program. The records of 142 consecutive patients, median age of 55 years, who had undergone MRI-guided biopsy at our institution between July 2006 and July 2007 were reviewed. From these patients, 197 mammographically and sonographically occult lesions were biopsied at the time of discovery. The pathology was then reviewed and correlated with the MRI findings. Cancer was present and subsequently discovered in 8% of the previously occult lesions (16/197) or 11% of the women studied (16/142). Of the cancerous lesions, 56% were invasive carcinomas (9/16) and 44% were ductal carcinomas in situ (7/16). Fourteen percent of the discovered lesions (28/197) were defined as high risk and included atypical ductal hyperplasia, atypical lobular hyperplasia, lobular carcinoma in situ, and radial scar. In total, occult cancerous and high-risk lesions were discovered in 22% of the found lesions (44/197) or 31% of the women who underwent MRI-guided biopsy (44/142). This study demonstrated that detection of cancerous and high-risk lesions can be significantly increased when an MRI-guided biopsy program is introduced at a community-based hospital. We believe that as radiologists gain confidence in imaging and histologic correlation, community-based hospitals can achieve similar rates of occult lesion diagnosis as those found in data emerging from academic institutions. (author)

  17. Long-Term Cognitive Impairment after Hospitalization for Community-Acquired Pneumonia: a Prospective Cohort Study.

    Science.gov (United States)

    Girard, Timothy D; Self, Wesley H; Edwards, Kathryn M; Grijalva, Carlos G; Zhu, Yuwei; Williams, Derek J; Jain, Seema; Jackson, James C

    2018-01-26

    Recent studies suggest older patients hospitalized for community-acquired pneumonia are at risk for new-onset cognitive impairment. The characteristics of long-term cognitive impairment after pneumonia, however, have not been elucidated. To characterize long-term cognitive impairment among adults of all ages hospitalized for community-acquired pneumonia. Prospective cohort study. Adults without severe preexisting cognitive impairment who were hospitalized with community-acquired pneumonia. At enrollment, we estimated baseline cognitive function with the Short Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). At 2- and 12-month follow-up, we assessed cognition using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and tests of executive function, diagnosing cognitive impairment when results were ≥ 1.5 standard deviations below published age-adjusted means for the general population. We also identified subtypes of mild cognitive impairment using standard definitions. We assessed 58 (73%) of 80 patients who survived to 2-month follow-up and 57 (77%) of 74 who survived to 12-month follow-up. The median [range] age of survivors tested was 57 [19-97] years. Only 8 (12%) had evidence of mild cognitive impairment at baseline according to the Short IQCODE, but 21 (38%) at 2 months and 17 (30%) at 12 months had mild cognitive impairment per the RBANS. Moderate-to-severe cognitive impairment was common among adults ≥ 65 years [4/13 (31%) and 5/13 (38%) at 2 and 12 months, respectively] but also affected many of those impairment in multiple cognitive domains affected one-third of patients ≥ 65 years old and 20% of younger patients, and another third of survivors had mild cognitive impairment.

  18. Implementation of home-based medication order entry at a community hospital.

    Science.gov (United States)

    Thorne, Alicia; Williamson, Sarah; Jellison, Tara; Jellison, Chris

    2009-11-01

    The implementation of a home-based order-entry program at a community hospital is described. Parkview Hospital is a 600-bed, community-based facility located in Fort Wayne, Indiana, that provides 24-hour pharmacy services. The main purpose for establishing a home-based order-entry program was to provide extra pharmacist coverage during the event of a spontaneous order surge in an effort to maintain excellent customer service. A virtual private network (VPN) was created to ensure the security and confidentiality of patients' health care information. The names of volunteer pharmacists who met specific criteria and who were capable of performing home-based order entry were collected. These pharmacists were trained and tested in the home-based order-entry process. When home-based order-entry is needed, the lead pharmacist contacts the pharmacists on the list by telephone. If available, the pharmacists (maximum of three) are notified to log into the Internet, access the VPN, and perform order entry with the same vigilance, confidentiality, and care as they would onsite. Home-based order entry is discontinued when off-trigger points are met. Pharmacists entering orders from home are paid by the time spent conducting order entry. Pharmacists reported that the program was easy to contact home-based order-entry volunteers, there were no problems with logging into the VPNs, and turnaround time was close to our target of 25 minutes. A community-based hospital successfully implemented a home-based medication order-entry program. The program alleviated the shortage of pharmacists during spontaneous surges of medication orders.

  19. Reliability and minimal detectable change of gait variables in community-dwelling and hospitalized older fallers.

    Science.gov (United States)

    Hars, Mélany; Herrmann, François R; Trombetti, Andrea

    2013-09-01

    Gait variables may constitute surrogate outcomes for fall risk. Their reliability in a specific population of older fallers has not been fully established, which limits their research and clinical applications. This study aimed to determine test-retest reliability and minimal detectable change (MDC) values for selected fall-related gait variables in older adults with a recent fall history. Community-dwelling (n=30) and hospitalized (n=30) fallers aged≥65 years were assessed twice using an instrumented pressure-sensitive walkway, under single- and dual-task gait conditions. Intraclass correlation coefficient (ICC(2,1)), standard error of measurement (SEM; SEM%) and MDC at 95% confidence level (MDC95; MDC95%), were used as reliability estimates. The ICC(2,1) for gait velocity was greater than 0.84 across all gait conditions and groups; SEM% and MDC95% did not exceed 6.5% and 18.1%, respectively. Gait variability measures returned lower ICC(2,1) (range 0.18-0.79), and markedly higher SEM% (16.3-31.9%) and MDC95% (45.3-88.3%). Overall, hospitalized fallers exhibited larger SEM and MDC95 values for variability measures compared to community-dwellers in all gait conditions, while larger values were found for all variables while dual-tasking compared to single-tasking in both groups. Gait velocity was found to be highly reliable and likely to be sensitive to change over repeated sessions in community-dwelling and hospitalized older fallers, both under single- and dual-task conditions. Gait variability measures showed lower reliability, irrespective of gait condition or group, displaying consistently larger measurement error, particularly under dual-task conditions. Clinicians should consider MDC95 values before using gait variability variables as evaluative outcome measures at patient level. Copyright © 2013 Elsevier B.V. All rights reserved.

  20. Community-acquired pneumonia requiring hospitalization among U.S. children.

    Science.gov (United States)

    Jain, Seema; Williams, Derek J; Arnold, Sandra R; Ampofo, Krow; Bramley, Anna M; Reed, Carrie; Stockmann, Chris; Anderson, Evan J; Grijalva, Carlos G; Self, Wesley H; Zhu, Yuwei; Patel, Anami; Hymas, Weston; Chappell, James D; Kaufman, Robert A; Kan, J Herman; Dansie, David; Lenny, Noel; Hillyard, David R; Haynes, Lia M; Levine, Min; Lindstrom, Stephen; Winchell, Jonas M; Katz, Jacqueline M; Erdman, Dean; Schneider, Eileen; Hicks, Lauri A; Wunderink, Richard G; Edwards, Kathryn M; Pavia, Andrew T; McCullers, Jonathan A; Finelli, Lyn

    2015-02-26

    Incidence estimates of hospitalizations for community-acquired pneumonia among children in the United States that are based on prospective data collection are limited. Updated estimates of pneumonia that has been confirmed radiographically and with the use of current laboratory diagnostic tests are needed. We conducted active population-based surveillance for community-acquired pneumonia requiring hospitalization among children younger than 18 years of age in three hospitals in Memphis, Nashville, and Salt Lake City. We excluded children with recent hospitalization or severe immunosuppression. Blood and respiratory specimens were systematically collected for pathogen detection with the use of multiple methods. Chest radiographs were reviewed independently by study radiologists. From January 2010 through June 2012, we enrolled 2638 of 3803 eligible children (69%), 2358 of whom (89%) had radiographic evidence of pneumonia. The median age of the children was 2 years (interquartile range, 1 to 6); 497 of 2358 children (21%) required intensive care, and 3 (<1%) died. Among 2222 children with radiographic evidence of pneumonia and with specimens available for bacterial and viral testing, a viral or bacterial pathogen was detected in 1802 (81%), one or more viruses in 1472 (66%), bacteria in 175 (8%), and both bacterial and viral pathogens in 155 (7%). The annual incidence of pneumonia was 15.7 cases per 10,000 children (95% confidence interval [CI], 14.9 to 16.5), with the highest rate among children younger than 2 years of age (62.2 cases per 10,000 children; 95% CI, 57.6 to 67.1). Respiratory syncytial virus was more common among children younger than 5 years of age than among older children (37% vs. 8%), as were adenovirus (15% vs. 3%) and human metapneumovirus (15% vs. 8%). Mycoplasma pneumoniae was more common among children 5 years of age or older than among younger children (19% vs. 3%). The burden of hospitalization for children with community-acquired pneumonia

  1. Norovirus Genotypes in Hospital Settings - Differences between Nosocomial and Community-Acquired Infections

    DEFF Research Database (Denmark)

    Franck, Kristina Træholt; Nielsen, Rikke Thoft; Holzknecht, Barbara Juliane

    2015-01-01

    positive for norovirus in Denmark, 2002-2010, and to study the distribution of norovirus genotypes among inpatients with nosocomial and community-acquired norovirus infections, respectively. METHODS:  Admission and stool sampling dates from 3656 NoV infected patients were used to estimate the proportion...... of nosocomial infections. The associations between nosocomial infection and patient age, gender, and norovirus genotype GII.4 were examined. RESULTS:  Of the 3656 inpatients, 63% were classified as having nosocomial infections. Among these 9 capsid and 8 polymerase norovirus genotypes were detected whereas...... among the smaller group of inpatients with community-acquired infections, 12 capsid and 9 polymerase genotypes were detected. Nosocomial norovirus infections were associated with age ≥60 years and infections with genotype GII.4. CONCLUSION:  The majority of norovirus infections in hospitalized patients...

  2. Verbal and physical violence towards hospital- and community-based physicians in the Negev: an observational study

    Directory of Open Access Journals (Sweden)

    Freud Tami

    2005-08-01

    Full Text Available Abstract Background Over recent years there has been an increasing prevalence of verbal and physical violence in Israel, including in the work place. Physicians are exposed to violence in hospitals and in the community. The objective was to characterize acts of verbal and physical violence towards hospital- and community-based physicians. Methods A convenience sample of physicians working in the hospital and community completed an anonymous questionnaire about their experience with violence. Data collection took place between November 2001 and July 2002. One hundred seventy seven physicians participated in the study, 95 from the hospital and 82 from community clinics. The community sample included general physicians, pediatricians, specialists and residents. Results Ninety-nine physicians (56% reported at least one act of verbal violence and 16 physicians (9% reported exposure to at least one act of physical violence during the previous year. Fifty-one hospital physicians (53.7% were exposed to verbal violence and 9 (9.5% to physical violence. Forty-eight community physicians (58.5% were exposed to verbal violence and 7 (8.5% to physical violence. Seventeen community physicians (36.2% compared to eleven hospital physicians (17.2% said that the violence had a negative impact on their family and on their quality of life (p Conclusion Verbal and/or physical violence against physicians is common in both the hospital and in community clinics. The impatience that accompanies waiting times may have a cultural element. Shortening waiting times and providing more information to patients and families could reduce the rate of violence, but a cultural change may also be required.

  3. Prevalence of Clostridium difficile infection and colonization in a tertiary hospital and elderly community of North-Eastern Peninsular Malaysia.

    Science.gov (United States)

    Zainul, N H; Ma, Z F; Besari, A; Siti Asma, H; Rahman, R A; Collins, D A; Hamid, N; Riley, T V; Lee, Y Y

    2017-10-01

    Little is known about Clostridium difficile infection (CDI) in Asia. The aims of our study were to explore (i) the prevalence, risk factors and molecular epidemiology of CDI and colonization in a tertiary academic hospital in North-Eastern Peninsular Malaysia; (ii) the rate of carriage of C. difficile among the elderly in the region; (iii) the awareness level of this infection among the hospital staffs and students. For stool samples collected from hospital inpatients with diarrhea (n = 76) and healthy community members (n = 138), C. difficile antigen and toxins were tested by enzyme immunoassay. Stool samples were subsequently analyzed by culture and molecular detection of toxin genes, and PCR ribotyping of isolates. To examine awareness among hospital staff and students, participants were asked to complete a self-administered questionnaire. For the hospital and community studies, the prevalence of non-toxigenic C. difficile colonization was 16% and 2%, respectively. The prevalence of CDI among hospital inpatients with diarrhea was 13%. Out of 22 C. difficile strains from hospital inpatients, the toxigenic ribotypes 043 and 017 were most common (both 14%). In univariate analysis, C. difficile colonization in hospital inpatients was significantly associated with greater duration of hospitalization and use of penicillin (both P < 0·05). Absence of these factors was a possible reason for low colonization in the community. Only 3% of 154 respondents answered all questions correctly in the awareness survey. C. difficile colonization is prevalent in a Malaysian hospital setting but not in the elderly community with little or no contact with hospitals. Awareness of CDI is alarmingly poor.

  4. Establishing a Baseline: Community Benefit Spending by Not-for-Profit Hospitals Prior to Implementation of the Affordable Care Act

    Science.gov (United States)

    Tung, Greg J.; Lindrooth, Richard C.; Johnson, Emily K.; Hardy, Rose; Castrucci, Brian C.

    2017-01-01

    Context: Community Benefit spending by not-for-profit hospitals has served as a critical, formalized part of the nation's safety net for almost 50 years. This has occurred mostly through charity care. This article examines how not-for-profit hospitals spent Community Benefit dollars prior to full implementation of the Affordable Care Act (ACA). Methods: Using data from 2009 to 2012 hospital tax and other governmental filings, we constructed national, hospital-referral-region, and facility-level estimates of Community Benefit spending. Data were collected in 2015 and analyzed in 2015 and 2016. Data were matched at the facility level for a non-profit hospital's IRS tax filings (Form 990, Schedule H) and CMS Hospital Cost Report Information System and Provider of Service data sets. Results: During 2009, hospitals spent about 8% of total operating expenses on Community Benefit. This increased to between 8.3% and 8.5% in 2012. The majority of spending (>80%) went toward charity care, unreimbursed Medicaid, and subsidized health services, with approximately 6% going toward both community health improvement and health professionals' education. By 2012, national spending on Community Benefit likely exceeded $60 billion. The largest hospital systems spent the vast majority of the nation's Community Benefit; the top 25% of systems spent more than 80 cents of every Community Benefit dollar. Discussion: Community Benefit spending has remained relatively steady as a proportion of total operating expenses and so has increased over time—although charity care remains the major focus of Community Benefit spending overall. Implications: More than $60 billion was spent on Community Benefit prior to implementation of the ACA. New reporting and spending requirements from the IRS, alongside changes by the ACA, are changing incentives for hospitals in how they spend Community Benefit dollars. In the short term, and especially the long term, hospital systems would do well to partner

  5. Prevalence of Methicillin Resistant Staphylococcus aureus in pyogenic community and hospital acquired skin and soft tissues infections

    International Nuclear Information System (INIS)

    Ahmad, M. K.; Asrar, A.

    2014-01-01

    Objective: To determine the percentage and frequency of Methicillin Resistant Staphylococcus aureus in community and hospital-acquired pyogenic skin and soft tissue infections. Methods: The descriptive cross-sectional study was conducted at the Dermatology Department of Combined Military Hospital, Abbottabad, from June 2009 to March 2010, and comprised 144 community-acquired and 54 hospital-acquired skin and soft tissue infections. Pus swabs from the infected lesions one from each individual were sent to laboratory for culture and sensitivity tests. Methicillin resistance was detected by 1 (mu) g oxacillin disk. Organisms were labelled methicillin-resistant once the inhibition zone for oxocillin was less than 10 mm. Data analysis was done by using SPSS 20. Results: Of the 198 patients in the study, 98(49.5%) were males and 100(50.5%) were females, with an overall mean age of 33.7+-14.8144 years. There were 144(72.72%) community-acquired infections and 54(27.27%) had hospital-acquired infections. Community-acquired Methicillin Resistant Staphylococcus aureus numbered 40(27.8%) and hospital-acquired ones numbered 26(48.1%). Conclusion: Prevalence of Methicillin Resistant Staphylococcus aureus in community and hospital-acquired pyogenic skin and soft tissue infections was high. (author)

  6. U.S. Army Medical Department Journal (July-September 1998)

    National Research Council Canada - National Science Library

    Peake, James B; Goodman, Robert L; Hillhouse, Roger H; Newsome, Steve; Reed, Lester H; Hume, Jr., Carroll R. Dotson ;Roderick F; Gussenhoven, Elisabeth; Garland, Frederick N; Still, Ron; Campbell, Kyle D; Austerman, Wayne R

    1998-01-01

    .... The "MAMC Improvement Award Program" describes the Madigan Army Medical Center's incentive program to reward organizational groups within a military hospital for improving efficiency, quality of care...

  7. Enterobacteriaceae Antibiotic Resistance in Ready-to-Eat Foods Collected from Hospital and Community Canteens: Analysis of Prevalence.

    Science.gov (United States)

    Vincenti, Sara; Raponi, Matteo; Sezzatini, Romina; Giubbini, Gabriele; Laurenti, Patrizia

    2018-03-01

    Foodborne diseases and antibiotic resistance are serious widespread health problems in the contemporary world. In this study, we compared the microbiological quality of ready-to-eat (RTE) foods found in community canteens versus hospital canteens in Rome, Italy, focusing on detection and quantification of Enterobacteriaceae and the antibiotic resistance of these bacteria. Our findings show a remarkable difference in Enterobacteriaceae contamination between RTE foods distributed in community canteens (33.5% of samples) and those distributed in hospital canteens (5.3% of samples). This result highlights greater attention to good manufacturing practices and good hygiene practices by the food operators in hospitals compared with food operators in community canteens. As expected, a higher percentage of cold food samples (70.9%) than of hot food samples (10.8%) were positive for these bacteria. Excluding the intrinsic resistance of each bacterial strain, 92.3% of the isolated strains were resistant to at least one antibiotic, and about half of the isolated strains were classified as multidrug resistant. The prevalence of multidrug-resistant strains was 50% in the community samples and 33.3% in hospital canteens. Our results indicate that approximately 38% of RTE foods provided in community canteens is not compliant with microbiological food safety criteria and could be a special risk for consumers through spread of antibiotic-resistant strains. Hygienic processing and handling of foods is necessary for both hospital and community canteens.

  8. An audit of hospital based outpatient infusions and a pilot program of community-based monoclonal antibody infusions.

    LENUS (Irish Health Repository)

    Doran, J-P

    2012-02-01

    INTRODUCTION: Infliximab, a chimeric monoclonal antibody to tumour necrosis factor alpha, is administered as an intravenous infusion requiring a costly hospital day case or inpatient admission. METHODS: An audit of all current therapies given by intravenous infusions in an outpatient setting in St Vincent\\'s University Hospital (SVUH) was undertaken. Furthermore, in conjunction with TCP homecare, we established in a general practise health clinic, the first Irish community infusion centre for the administration of infliximab in August 2006. RESULTS: All outpatient departments indicated that they would favour a centralized hospital infusion unit. There were no adverse events and the mean global satisfaction improved in the community infliximab infusion pilot programme of seven patients. CONCLUSION: This study suggests efficiencies in providing centralized infusion facilities, while the community based infusion of infliximab is feasible and safe in this small cohort and identifies the community infusion unit as a viable and cost efficient alternative for administration of infliximab.

  9. Population Screening Using Sewage Reveals Pan-Resistant Bacteria in Hospital and Community Samples.

    Science.gov (United States)

    Meir-Gruber, Lital; Manor, Yossi; Gefen-Halevi, Shiraz; Hindiyeh, Musa Y; Mileguir, Fernando; Azar, Roberto; Smollan, Gill; Belausov, Natasha; Rahav, Galia; Shamiss, Ari; Mendelson, Ella; Keller, Nathan

    2016-01-01

    The presence of pan-resistant bacteria worldwide possesses a threat to global health. It is difficult to evaluate the extent of carriage of resistant bacteria in the population. Sewage sampling is a possible way to monitor populations. We evaluated the presence of pan-resistant bacteria in Israeli sewage collected from all over Israel, by modifying the pour plate method for heterotrophic plate count technique using commercial selective agar plates. This method enables convenient and fast sewage sampling and detection. We found that sewage in Israel contains multiple pan-resistant bacteria including carbapenemase resistant Enterobacteriacae carrying blaKPC and blaNDM-1, MRSA and VRE. blaKPC carrying Klebsiella pneumonia and Enterobacter cloacae were the most common Enterobacteriacae drug resistant bacteria found in the sewage locations we sampled. Klebsiella pneumonia, Enterobacter spp., Escherichia coli and Citrobacter spp. were the 4 main CRE isolated from Israeli sewage and also from clinical samples in our clinical microbiology laboratory. Hospitals and Community sewage had similar percentage of positive samplings for blaKPC and blaNDM-1. VRE was found to be more abundant in sewage in Israel than MRSA but there were more locations positive for MRSA and VRE bacteria in Hospital sewage than in the Community. Therefore, our upgrade of the pour plate method for heterotrophic plate count technique using commercial selective agar plates can be a useful tool for routine screening and monitoring of the population for pan-resistant bacteria using sewage.

  10. Implementing an electronic hand hygiene monitoring system: Lessons learned from community hospitals.

    Science.gov (United States)

    Edmisten, Catherine; Hall, Charles; Kernizan, Lorna; Korwek, Kimberly; Preston, Aaron; Rhoades, Evan; Shah, Shalin; Spight, Lori; Stradi, Silvia; Wellman, Sonia; Zygadlo, Scott

    2017-08-01

    Measuring and providing feedback about hand hygiene (HH) compliance is a complicated process. Electronic HH monitoring systems have been proposed as a possible solution; however, there is little information available about how to successfully implement and maintain these systems for maximum benefit in community hospitals. An electronic HH monitoring system was implemented in 3 community hospitals by teams at each facility with support from the system vendor. Compliance rates were measured by the electronic monitoring system. The implementation challenges, solutions, and drivers of success were monitored within each facility. The electronic HH monitoring systems tracked on average more than 220,000 compliant HH events per facility per month, with an average monthly compliance rate >85%. The sharing of best practices between facilities was valuable in addressing challenges encountered during implementation and maintaining a high rate of use. Drivers of success included a collaborative environment, leadership commitment, using data to drive improvement, consistent and constant messaging, staff empowerment, and patient involvement. Realizing the full benefit of investments in electronic HH monitoring systems requires careful consideration of implementation strategies, planning for ongoing support and maintenance, and presenting data in a meaningful way to empower and inspire staff. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  11. Qualitative insights into job satisfaction and dissatisfaction with management among community and hospital pharmacists.

    Science.gov (United States)

    Ferguson, Jane; Ashcroft, Darren; Hassell, Karen

    2011-09-01

    Job satisfaction research in pharmacy has predominantly been investigated using quantitative measures that have generally overlooked satisfaction with management. This article explores pharmacists' experiences and perceptions of management and examines the implications for job satisfaction. Semi-structured interviews were conducted with a convenience sample of 11 community and 15 hospital pharmacists in the North West of England (n=26). The interview schedule was composed of broad questions relating to job satisfaction and dissatisfaction, allowing for the exploration of original themes. Interviews were transcribed verbatim and entered into NVivo8. Template analysis was used to develop a hierarchical list of codes representing themes and the relationships between themes. Dissatisfaction with management emerged as a dominant aspect of pharmacists' job dissatisfaction. Of the 26 pharmacists interviewed, 24 commented on their dissatisfaction with management, whereas only 8 participants commented on positive experiences. Both hospital and community pharmacists expressed dissatisfaction with their line management, and how the organizations they worked for were managed. Findings suggest that satisfaction with management is an important and significant contributor to job satisfaction overall. It would appear that pharmacists' job satisfaction is compromised by poor line management, lack of recognition, and support from management, which may lead to an increase in turnover and a reduction in job satisfaction. Copyright © 2011 Elsevier Inc. All rights reserved.

  12. Hospitals

    DEFF Research Database (Denmark)

    Mullins, Michael

    2013-01-01

    The challenge could be briefly seen in these terms: hospitals as places for treatment where there’s a technology focus and hospitals for healing where there’s a human focus. In the 60s - 70s wave of new hospital building, an emphasis on technology can be seen. It’s time to move from the technology....... Documentation exists in; well-being of patients and staff, sleep disorders, pain distraction, confidentiality and privacy, levels of errors in hospitals. Art and the use of color: Art can be context related so one should be aware whether it is in a private ward or the foyer and related to the experience...... of the patient. Art can be used as a stress reducing factor, pain distracter, and also to orientate and to provide landmarks in the hospital landscape. Air, the use of natural ventilation as much as possible, complemented by mechanical ventilation in most cases, particularly in northern Europe; the emphasis...

  13. The clinical ethics consultant: verifying the qualifications of a new type of practitioner in a community hospital.

    Science.gov (United States)

    Andereck, William S; McGaughey, J Westly; Jonsen, Albert R

    2012-01-01

    Ethics consultation has been occurring in various forms within hospitals for more than 30 years. These consultations constitute a clinical act, and as such, the qualifications of those who provide them must be verified by the hospitals at which the ethics consultants practice. The clinical nature of the practice exposes the participants to malpractice liability. The field of medical ethics has struggled to provide a clear set of knowledge and skills that characterize its practitioners. Hospitals are faced with the immediate task of assessing the qualifications of and ensuring malpractice coverage for individuals providing clinical ethics consultation. We offer one example of how a community hospital has addressed this challenge.

  14. The etiology and impact of co-infections in children hospitalized with community-acquired pneumonia.

    Science.gov (United States)

    Nolan, Vikki G; Arnold, Sandra R; Bramley, Anna M; Ampofo, Krow; Williams, Derek J; Grijalva, Carlos G; Self, Wesley H; Anderson, Evan J; Wunderink, Richard G; Edwards, Kathryn M; Pavia, Andrew T; Jain, Seema; McCullers, Jonathan A

    2017-12-08

    Recognition that co-infections are common in children with community-acquired pneumonia (CAP) is increasing, but gaps remain in our understanding of their frequency and importance. We analyzed data from 2219 children hospitalized with CAP and compared demographics, clinical characteristics, and outcomes between groups with viruses alone, bacteria alone, or co-infections. We also assessed the frequency of selected pairings of co-detected pathogens and their clinical characteristics. 576 (26%) of the children studied had a co-infection. Children with only virus detection were younger and more likely to be black and have co-morbidities such as asthma compared to those with bacteria alone. Children with virus-bacteria co-infections had a higher frequency of leukocytosis, consolidation on chest X-ray, increased length of stay, and more frequent parapneumonic effusions, intensive care unit admission, and need for mechanical ventilation when compared to viruses alone. Virus-virus co-infections were generally comparable to single virus infections, with the exception of the need for oxygen supplementation, which was higher during the first 24 hours of hospitalization in some virus-virus pairings. Co-infections occurred in 26% of children hospitalized for CAP. Children with bacterial infections, alone or complicated by a virus, have worse outcomes than children infected with a virus alone. © The Author(s) 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

  15. Optimal Decision Model for Sustainable Hospital Building Renovation-A Case Study of a Vacant School Building Converting into a Community Public Hospital.

    Science.gov (United States)

    Juan, Yi-Kai; Cheng, Yu-Ching; Perng, Yeng-Horng; Castro-Lacouture, Daniel

    2016-06-24

    Much attention has been paid to hospitals environments since modern pandemics have emerged. The building sector is considered to be the largest world energy consumer, so many global organizations are attempting to create a sustainable environment in building construction by reducing energy consumption. Therefore, maintaining high standards of hygiene while reducing energy consumption has become a major task for hospitals. This study develops a decision model based on genetic algorithms and A* graph search algorithms to evaluate existing hospital environmental conditions and to recommend an optimal scheme of sustainable renovation strategies, considering trade-offs among minimal renovation cost, maximum quality improvement, and low environmental impact. Reusing vacant buildings is a global and sustainable trend. In Taiwan, for example, more and more school space will be unoccupied due to a rapidly declining birth rate. Integrating medical care with local community elder-care efforts becomes important because of the aging population. This research introduces a model that converts a simulated vacant school building into a community public hospital renovation project in order to validate the solutions made by hospital managers and suggested by the system. The result reveals that the system performs well and its solutions are more successful than the actions undertaken by decision-makers. This system can improve traditional hospital building condition assessment while making it more effective and efficient.

  16. Optimal Decision Model for Sustainable Hospital Building Renovation—A Case Study of a Vacant School Building Converting into a Community Public Hospital

    Science.gov (United States)

    Juan, Yi-Kai; Cheng, Yu-Ching; Perng, Yeng-Horng; Castro-Lacouture, Daniel

    2016-01-01

    Much attention has been paid to hospitals environments since modern pandemics have emerged. The building sector is considered to be the largest world energy consumer, so many global organizations are attempting to create a sustainable environment in building construction by reducing energy consumption. Therefore, maintaining high standards of hygiene while reducing energy consumption has become a major task for hospitals. This study develops a decision model based on genetic algorithms and A* graph search algorithms to evaluate existing hospital environmental conditions and to recommend an optimal scheme of sustainable renovation strategies, considering trade-offs among minimal renovation cost, maximum quality improvement, and low environmental impact. Reusing vacant buildings is a global and sustainable trend. In Taiwan, for example, more and more school space will be unoccupied due to a rapidly declining birth rate. Integrating medical care with local community elder-care efforts becomes important because of the aging population. This research introduces a model that converts a simulated vacant school building into a community public hospital renovation project in order to validate the solutions made by hospital managers and suggested by the system. The result reveals that the system performs well and its solutions are more successful than the actions undertaken by decision-makers. This system can improve traditional hospital building condition assessment while making it more effective and efficient. PMID:27347986

  17. Implementation and first-year results of an antimicrobial stewardship program at a community hospital.

    Science.gov (United States)

    Bartlett, James M; Siola, Patricia L

    2014-06-01

    The implementation of an antimicrobial stewardship program (ASP) at a small community hospital affiliated with an accountable care organization (ACO) is described, including a report on first-year program outcomes. With no infectious diseases (ID)-trained pharmacists on staff, a 155-bed hospital formed an ASP by restructuring its clinical pharmacy services. One full-time pharmacist led the program; nine full- or part-time pharmacists-none of whom had residency training-shared ASP responsibilities on a weekly rotation. Under a contract with a private medical group, an ID physician reviewed cases with ASP pharmacists for up to two hours each weekday. ASP interventions and tracking and reporting of outcomes were done primarily by pharmacists. Monitoring of pharmacy purchases in the first year of the program indicated an annualized 26% decrease in overall antimicrobial expenditures from prior-year spending, with a nearly 18% decrease in defined daily doses per 1000 patient-days. Total first-year direct cost savings attributed to the ASP were estimated at $145,353. Pharmacist-initiated conversions of patients from i.v. to oral antimicrobial therapy increased by 688% (p acceptance of ASP-recommended interventions (mainly streamlining of therapy, limiting the duration of therapy to a specific stop date, and discontinuation of nonindicated drugs) was 74%. An ASP was implemented at a small ACO-affiliated community hospital by a team of pharmacists without specialized ID training. During the first year of the program, antimicrobial expenditures were reduced and there was a significant increase in pharmacist-initiated i.v.-to-oral conversions. Copyright © 2014 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  18. Diagnostic error in children presenting with acute medical illness to a community hospital.

    Science.gov (United States)

    Warrick, Catherine; Patel, Poonam; Hyer, Warren; Neale, Graham; Sevdalis, Nick; Inwald, David

    2014-10-01

    To determine incidence and aetiology of diagnostic errors in children presenting with acute medical illness to a community hospital. A three-stage study was conducted. Stage 1: retrospective case note review, comparing admission to discharge diagnoses of children admitted to hospital, to determine incidence of diagnostic error. Stage 2: cases of suspected misdiagnosis were examined in detail by two reviewers. Stage 3: structured interviews were conducted with clinicians involved in these cases to identify contributory factors. UK community (District General) hospital. All medical patients admitted to the paediatric ward and patients transferred from the Emergency Department to a different facility over a 90-day period were included. Incidence of diagnostic error, type of diagnostic error and content analysis of the structured interviews to determine frequency of emerging themes. Incidence of misdiagnosis in children presenting with acute illness was 5.0% (19/378, 95% confidence interval (CI) 2.8-7.2%). Diagnostic errors were multi-factorial in origin, commonly involving cognitive factors. Reviewers 1 and 2 identified a median of three and four errors per case, respectively. In 14 cases, structured interviews were possible; clinicians believed system-related errors (organizational flaws, e.g. inadequate policies, staffing or equipment) contributed more commonly to misdiagnoses, whereas reviewers found cognitive factors contributed more commonly to diagnostic error. Misdiagnoses occurred in 5% of children presenting with acute illness and were multi-factorial in aetiology. Multi-site longitudinal studies further exploring aetiology of errors and effect of educational interventions are required to generalize these findings and determine strategies for mitigation. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  19. Norovirus Genotypes in Hospital Settings: Differences Between Nosocomial and Community-Acquired Infections.

    Science.gov (United States)

    Franck, Kristina Træholt; Nielsen, Rikke Thoft; Holzknecht, Barbara Juliane; Ersbøll, Annette Kjær; Fischer, Thea Kølsen; Böttiger, Blenda

    2015-09-15

    Norovirus (NoV) is a major cause of gastroenteritis and hospital outbreaks, leading to substantial morbidity and direct healthcare expenses as well as indirect societal costs. The aim of the study was to estimate the proportion of nosocomial NoV infections among inpatients testing positive for NoV in Denmark, 2002-2010, and to study the distribution of NoV genotypes among inpatients with nosocomial and community-acquired NoV infections, respectively. Admission and stool sampling dates from 3656 NoV-infected patients were used to estimate the proportion of nosocomial infections. The associations between nosocomial infection and patient age, sex, and NoV genotype GII.4 were examined. Of the 3656 inpatients, 63% were classified as having nosocomial infections. Among these, 9 capsid and 8 polymerase NoV genotypes were detected, whereas in the smaller group of inpatients with community-acquired infections, 12 capsid and 9 polymerase genotypes were detected. Nosocomial NoV infections were associated with age ≥60 years and infections with genotype GII.4. The majority of NoV infections in hospitalized patients were nosocomial. Nosocomial infection was mainly associated with older age but also with the specific genotype GII.4. The genotypes in community-acquired NoV infections were more heterogeneous than in nosocomial infections. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  20. Role of 'atypical pathogens' among adult hospitalized patients with community-acquired pneumonia.

    Science.gov (United States)

    Lui, Grace; Ip, Margaret; Lee, Nelson; Rainer, Timothy H; Man, Shin Y; Cockram, Clive S; Antonio, Gregory E; Ng, Margaret H L; Chan, Michael H M; Chau, Shirley S L; Mak, Paulina; Chan, Paul K S; Ahuja, Anil T; Sung, Joseph J Y; Hui, David S C

    2009-11-01

    Agents such as Mycoplasma pneumoniae, Chlamydophila pneumoniae and Legionella pneumophila are recognized as important causes of community-acquired pneumonia (CAP) worldwide. This study examined the role of these 'atypical pathogens' (AP) among adult hospitalized patients with CAP. A prospective, observational study of consecutive adult CAP (clinico-radiological diagnosis) patients hospitalized during 2004-2005 was conducted. Causal organisms were determined using cultures, antigen testing and paired serology. Clinical/laboratory/radiological variables and outcomes were compared between different aetiologies, and a clinical prediction rule for AP was constructed. There were 1193 patients studied (mean age 70.8 +/- 18.0 years, men 59.3%). Causal organisms were identified in 468 (39.2%) patients: 'bacterial' (48.7%), 'viral' (26.9%), 'AP' (28.6%). The AP infections comprised Mycoplasma or Chlamydophila pneumoniae (97.8%) and co-infection with bacteria/virus (30.6%). The majority of AP infections involved elderly patients (63.4%) with comorbidities (41.8%), and more than one-third of patients were classified as 'intermediate' or 'high' risk CAP on presentation (pneumonia severity index IV-V (35.1%); CURB-65 2-5 (42.5%)). Patients with AP infections had disease severities and outcomes similar to patients with CAP due to other organisms (oxygen therapy 29.1% vs 29.8%; non-invasive ventilation 3.7% vs 3.3%; admission to the intensive care unit 4.5% vs 2.7%; length of hospitalization 6 day vs 7 day; 30-day mortality: 2.2% vs 6.0%; overall P > 0.05). Age or =38.0 degrees C, respiratory rate 130 mmol/L, leucocyte count pneumoniae and C. pneumoniae as single/co-pathogens are important causes of severe pneumonia among older adults. No reliable clinical indicators exist, so empirical antibiotic coverage for hospitalized CAP patients may need to be considered.

  1. Community-Acquired Pneumonia Hospitalization among Children with Neurologic Disorders.

    Science.gov (United States)

    Millman, Alexander J; Finelli, Lyn; Bramley, Anna M; Peacock, Georgina; Williams, Derek J; Arnold, Sandra R; Grijalva, Carlos G; Anderson, Evan J; McCullers, Jonathan A; Ampofo, Krow; Pavia, Andrew T; Edwards, Kathryn M; Jain, Seema

    2016-06-01

    To describe and compare the clinical characteristics, outcomes, and etiology of pneumonia among children hospitalized with community-acquired pneumonia (CAP) with neurologic disorders, non-neurologic underlying conditions, and no underlying conditions. Children <18 years old hospitalized with clinical and radiographic CAP were enrolled at 3 US children's hospitals. Neurologic disorders included cerebral palsy, developmental delay, Down syndrome, epilepsy, non-Down syndrome chromosomal abnormalities, and spinal cord abnormalities. We compared the epidemiology, etiology, and clinical outcomes of CAP in children with neurologic disorders with those with non-neurologic underlying conditions, and those with no underlying conditions using bivariate, age-stratified, and multivariate logistic regression analyses. From January 2010-June 2012, 2358 children with radiographically confirmed CAP were enrolled; 280 (11.9%) had a neurologic disorder (52.1% of these individuals also had non-neurologic underlying conditions), 934 (39.6%) had non-neurologic underlying conditions only, and 1144 (48.5%) had no underlying conditions. Children with neurologic disorders were older and more likely to require intensive care unit (ICU) admission than children with non-neurologic underlying conditions and children with no underlying conditions; similar proportions were mechanically ventilated. In age-stratified analysis, children with neurologic disorders were less likely to have a pathogen detected than children with non-neurologic underlying conditions. In multivariate analysis, having a neurologic disorder was associated with ICU admission for children ≥2 years of age. Children with neurologic disorders hospitalized with CAP were less likely to have a pathogen detected and more likely to be admitted to the ICU than children without neurologic disorders. Published by Elsevier Inc.

  2. Job satisfaction of registered nurses in a community hospital in the Limpopo Province in South Africa

    Directory of Open Access Journals (Sweden)

    H.P.P. Kekana

    2007-09-01

    Full Text Available Nurses are confronted daily with the demands of an increased workload and insufficient facilities in the public healthcare sector in South Africa. The purpose o f the study was therefore to determine the degree of job satisfaction of registered nurses in a community hospital in the Limpopo Province of South Africa. A quantitative descriptive design was used to meet the objectives of the study. The population was not sampled because of the small size of it. All the registered nurses who had one or more years experience in this hospital were included in the study. A self-administered questionnaire was used to collect data from them regarding the working conditions in the hospital including the emotional and social climate. The questionnaire was based on an instrument developed by Humphries and Turner (1989:303 to determine the degree o f job satisfaction of nursing staff in a unit for elderly mentally retarded patients. The findings indicated that the majority of the respondents were dissatisfied about the working conditions and emotional climate in the hospital while they were fairly satisfied with the social climate. The workload and degree of fair remuneration, under the working conditions, were the most highly rated as dissatisfying (83% o f the participants while under the emotional climate they indicated that the pressure under which they worked was highly dissatisfying (82% o f the participants. As the results indicated that the social climate was satisfactory; having a best friend at work and the chance to help other people while at work, were rated positively by 88% and 76% of the participants respectively.

  3. Etiology and anti-microbial sensitivity of organisms causing community acquired pneumonia: A single hospital study

    Directory of Open Access Journals (Sweden)

    Resmi U Menon

    2013-01-01

    Full Text Available Objective: The objective of this study was to identify the common etiological pathogens causing community acquired pneumonia (CAP in our hospital and sensitivity patterns to the common antibiotics used. Materials and Methods: This study was undertaken in a 750 bedded multi-specialty referral hospital in Kerala catering to both urban and semi-urban populations. It is a prospective study of patients who attended the medical out-patient department and those admitted with a clinical diagnosis of CAP, during the year 2009. Data were collected based on detailed patient interview, clinical examination and laboratory investigations. The latter included sputum culture and sensitivity pattern. These were tabulated and percentage incidence of etiological pathogens calculated. The antimicrobial sensitivity pattern was also classified by percentage and expressed as bar diagram. Results: The study showed Streptococcus pneumoniae to be the most common etiological agent for CAP, in our hospital setting. The other organisms isolated in order of frequency were Klebsiella pneumoniae, Pseudomonas aeruginosa, Alpha hemolytic streptococci, Escherichia coli, Beta hemolytic streptococci and atypical coli. S. pneumoniae was most sensitive to linezolid, followed by amoxicillin-clavulanate (augmentin, cloxacillin and ceftriaxone. Overall, the common pathogens causing CAP showed highest sensitivity to amikacin, followed by ofloxacin, gentamycin, amoxicillin-clavulanate (augmentin, ceftriaxone and linezolid. The least sensitivity rates were shown to amoxicillin and cefoperazone. Conclusion: In a hospital setting, empirical management for cases of CAP is not advisable. The present study has shown S. pneumoniae as the most likely pathogen and either linezolid or amikacin as the most likely effective antimicrobial in cases of CAP, in our setting.

  4. Key issues and barriers to obstetrical anesthesia care in Ontario community hospitals with fewer than 2,000 deliveries annually.

    Science.gov (United States)

    Angle, Pamela; Kurtz Landy, Christine; Murthy, Yamini; Cino, Peter

    2009-09-01

    Lack of the availability of anesthesia services may be a factor in the closure of maternity services in rural Canada, limiting the capacity for Cesarean delivery and intensifying the urbanization of maternity care. Unlike other professions involved in maternal newborn care, health services research in obstetrical anesthesia is virtually non-existent. This study explored barriers physicians encountered in providing obstetrical anesthesia care in Ontario community hospitals experiencing low volumes (fewer than 2,000) deliveries per annum (PA). Solutions proposed by a mixed focus group of academic and community hospital leaders were also described. Following Research Ethics Board approval, the authors performed a secondary analysis of qualitative data from 18 anesthesiologists and family practitioner (FP/GP) anesthetists who had participated in a larger provincial study that was also conducted by the authors. Participants were leaders from community hospitals with fewer than 2000 deliveries PA and university-based teaching programs from across Ontario. Fourteen community physicians participated in focus groups that explored key issues and barriers to care and their potential solutions. A final group of eight academic and community physician key informants further explored solutions. Three themes emerged: Obstetrical Anesthesia in the "Periphery", "Key Issues and Barriers to Obstetrical Anesthesia Care", and "A Multi-faceted but Context-Specific Solution is Required." The physicians identified barriers within the greater context of those encountered during the provision of anesthesia services in the periphery, including lack of time, need for continuing medical education (CME), need for hospital infrastructure support to develop and implement best practice protocols, and need for resources and anesthesia mentorship supports from the system. Difficulties were greatest for FP/GP anesthetists in rural communities who described lack of locums, need for relevant CME, and

  5. Hospitalization, Depression and Dementia in Community-Dwelling Older Americans: Findings from the National Health and Aging Trends Study

    Science.gov (United States)

    Davydow, Dimitry S.; Zivin, Kara; Langa, Kenneth M.

    2014-01-01

    Objective To estimate the prevalence of both dementia and depression among community-dwelling older Americans, and to determine if hospitalization is independently associated with dementia or depression in this population. Method This cross-sectional study utilized data from a nationally representative, population-based sample of 7,197 community-dwelling adults ≥ 65 years old interviewed in 2011 as part of the National Health and Aging Trends Study. Information on hospitalizations was obtained from self or proxy-report. Possible and probable dementia was assessed according to a validated algorithm. Depressive symptoms were assessed with the Patient Health Questionnaire-2. Results An estimated 3.1 million community-dwelling older Americans may have dementia, and approximately 5.3 million may have substantial depressive symptoms. After adjusting for demographic and social characteristics, medical diagnoses, smoking history, serious falls, and pain symptoms, being hospitalized in the previous year was independently associated with greater odds of probable dementia (odds ratio [OR]: 1.42, 95% confidence interval[95%CI]: 1.16, 1.73) and substantial depressive symptoms (OR: 1.60, 95%CI: 1.29, 1.99). Conclusions Dementia and depression are common in community-dwelling older Americans, and hospitalization is associated with these conditions. Additional research increasing understanding of the bi-directional relationship between hospitalizations, dementia, and depression, along with targeted interventions to reduce hospitalizations, are needed. PMID:24388630

  6. Perceptions on hospitality when visiting secluded communities of guaranis, caiçaras e quilombolas in Paraty region

    Directory of Open Access Journals (Sweden)

    Luis Alberto Beares

    2008-10-01

    Full Text Available Tourism in secluded communities puts different cultures in contact with each other and must be handled carefully not to cause environmental damage as well as cultural loss which might jeopardize the local development and create hostile relationships. The proposal of in sito tourism, considering the local memory and patrimony as a hospitality potential, was observed during technical visitations to three communities located in the Paraty region and surroundings: Guarani, Caiçara (fishermen and Quilombola(African slaves descendants. Through field work involving visitations to communities and interviews with locals, information regarding cultural differences and the importance of the land occupation in the history of each of the communities was assessed. The common link in the history of these peoples is the struggle for the right of land possession. During visits when people shared their territory various forms of hospitality in each community were verified, issued from different cultures and cultural values.

  7. Anemia increases risk for falls in hospitalized older adults: an evaluation of falls in 362 hospitalized, ambulatory, long-term care, and community patients.

    Science.gov (United States)

    Dharmarajan, T S; Avula, Sai; Norkus, Edward P

    2007-03-01

    The objective of this study was to determine if a relationship exists between the presence of anemia and the occurrence of falls during hospitalization in ambulatory older adults from long-term care and community settings. All individuals were hospitalized for acute conditions not related to a fall. Three hundred sixty-two hospitalized, ambulatory older (59-104 years) adults. Laboratory values (hemoglobin [Hb], hematocrit [Hct]), routine laboratory tests, pertinent medical history, and demographics. Ambulatory hospitalized patients who fell were compared to controls (no falls during hospitalization) of similar age (P = .283) and gender distribution (P = .554). Patients who fell had significantly lower Hb (P falls and included the covariates of age, gender, place of residence, and race. The model described a 22% decreased risk of falls for every 1.0 g/dL increase in Hb (P falls in anemic patients (P falls during hospitalization. These findings suggest a potentially important link between anemia and the risk of falls during hospitalization in ambulatory older patients. Further studies are needed to determine if the risk of falls can be modified by correction of anemia and to determine the applicability of these findings to older adults in different settings.

  8. "The family is the clinic, the community is the hospital": community mental health in Timor-Leste.

    Science.gov (United States)

    Hawkins, Zoe; Tilman, Teofilo

    2011-07-01

    This paper describes the history and recent development of mental health services in Timor-Leste, a small developing country recovering from conflict. Challenges to effective service delivery are discussed as well as plans for future development. Timor-Leste's mental health service began just over a decade ago. Unlike many other low and middle income countries where hospital-based services predominate, the mental health model in Timor-Leste is entirely community based. However, challenges to effective mental health care delivery are similar to most developing countries and include a lack of sufficient financial resources, human resources, and mental health infrastructure. Addressing these issues successfully requires political will, a greater prioritization of mental health services, close coordination between stakeholders, as well as developments in the area of education, training and infrastructure. Greater understanding and education about the links between mental and physical health would benefit the overall health of the population, and integration of these respective policies may prove a successful method of more equitably redistributing finances and resources.

  9. Project Octo-Pills - A practice model engaging community pharmacists in the care of patients from a tertiary hospital.

    Science.gov (United States)

    Ong, Kheng Yong; Chung, Wing Lam; Mamun, Kaysar; Chen, Li Li

    2017-10-13

    Even while pharmacy practice evolves to a more patient-centric mode of practice, local hospitals, due to high patient load as well as space and resource constraints, find it challenging to conduct thorough medication review and physical medication reconciliation for all patients. In light of this, optimizing the local current healthcare system to involve community pharmacists in the care of patients from public hospitals could potentially better cater to the healthcare needs of the older population. Due to easy accessibility, community pharmacies are often the first point of contact in the healthcare system. Project Octo-Pills aims to engage community pharmacists in the collaborative care of patients from a tertiary hospital, providing patients with quality medication reconciliation and review services from a more convenient location within their neighborhood. This paper describes the model for this pilot initiative. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Adherence to Therapeutic Guidelines for Patients with Community-Acquired Pneumonia in Australian Hospitals

    Directory of Open Access Journals (Sweden)

    N.R. Adler

    2014-01-01

    Full Text Available Community-acquired pneumonia (CAP is a significant cause of morbidity and mortality, particularly in elderly patients, and is associated with a considerable economic burden on the healthcare system. The combination of high incidence and substantial financial costs necessitate accurate diagnosis and appropriate management of patients admitted with CAP. This article will discuss the rates of adherence to clinical guidelines, the use of severity scoring tools and the appropriateness of antimicrobial prescribing for patients diagnosed with CAP. The authors maintain that awareness of national and hospital guidelines is imperative to complement the physicians’ clinical judgment with evidence-based recommendations. Increased use of pneumonia severity assessment tools and greater adherence to therapeutic guidelines will enhance concordant antimicrobial prescribing for patients with CAP. A robust and multifaceted educational intervention, in combination with antimicrobial stewardship programs, may enhance compliance of CAP guidelines in clinical practice in Australia.

  11. The effects of innovation factors on smartphone adoption among nurses in community hospitals.

    Science.gov (United States)

    Putzer, Gavin J; Park, Yangil

    2010-01-01

    A relatively new mobile technological device is the smartphone-a phone with advanced features such as Windows Mobile software, access to the Internet, and other computer processing capabilities. This article investigates the decision to adopt a smartphone among healthcare professionals, specifically nurses. The study examines constructs that affect an individual's decision to adopt a smartphone by employing innovation attributes leading to perceived attitudes. We hypothesize that individual intentions to use a smartphone are mostly determined by attitudes toward using a smartphone, which in turn are affected by innovation characteristics. Innovation characteristics are factors that help explain whether a user will adopt a new technology. The study consisted of a survey disseminated to 200 practicing nurses selected from two community hospitals in the southeastern United States. In our model, the innovation characteristics of observability, compatibility, job relevance, internal environment, and external environment were significant predictors of attitude toward using a smartphone.

  12. Getting published in an academic-community hospital: the success of writing groups.

    Science.gov (United States)

    Salas-Lopez, Debbie; Deitrick, Lynn; Mahady, Erica T; Moser, Kathleen; Gertner, Eric J; Sabino, Judith N

    2012-01-01

    Expressed barriers to writing for publication include lack of time, competing demands, anxiety about writing and a lack of knowledge about the submission process. These limitations can be magnified for practitioners in non-university environments in which there are fewer incentives or expectations regarding academic publication productivity. However, as members of professional disciplines, practitioners have both the responsibility and, oftentimes, the insights to make valuable contributions to the professional literature. Collaborative writing groups can be a useful intervention to overcome barriers, provide the necessary skills and encouragement as well as produce publications and conference presentations that make worthy additions to the professional body of knowledge. This article discusses the evolution and outcomes of writing groups at Lehigh Valley Health Network and describes how this strategy can be adopted by other academic community hospitals to promote professional development and publication.

  13. Complexity and Army Transformation

    Science.gov (United States)

    Calhoun, Mark T.

    On 12 Octther 1999, the U.S. Army began a journey down a new path to innovation, when General Eric Shinseki presented his vision of Army Transformation at the 45th annual meeting of the Association of the United States Army. In this speech, General Shinseki described the Army as an organization consisting of heavy forces with excellent staying power but poor strategic responsiveness, light forces with excellent responsiveness but poor staying power, and a logistics system with an excessively large footprint. His proposed solution, a comprehensive change of the Army resulting in full-spectrum dominance and strategic responsiveness, would occur so quickly as to "be unnerving to some." [Shinseki. 1999] While this prediction has turned out in some ways to be true, it is not necessarily the speed of change that is unnerving to many of the people studying Army Transformation.

  14. Implementation of cerebral microdialysis at a community-based hospital: A 5-year retrospective analysis.

    Science.gov (United States)

    Chen, Jeff W; Rogers, Shana L; Gombart, Zoe J; Adler, David E; Cecil, Sandy

    2012-01-01

    Cerebral microdialysis (MD) provides valuable information about brain metabolism under normal and pathologic conditions. The CMA 600 microdialysis analyzer received US Food and Drug Administration (FDA) approval for clinical use in the United States in 2005. Since then, cerebral MD has been increasingly utilized nationally in the multimodal monitoring of traumatic brain injury (TBI), stroke, aneurysmal subarachnoid hemorrhage, and brain tumors. We describe a 5-year, single-institutional experience using cerebral MD at a community-based hospital, Legacy Emanuel Medical Center (LEMC). Implications for the adoption and utility of MD in medical centers with limited resources are discussed. This is a retrospective chart review and data analysis of 174 consecutive patients who had cerebral MD as part of multimodal brain monitoring. All cerebral MD catheters were placed by board-certified, attending neurosurgeons at LEMC. Clinical severity in the TBI patients was reported using initial Glasgow Coma Scale (GCS); radiologic severity was graded with the Marshall CT grading scale. Measures of the risks of MD placement included post-placement hemorrhage, cerebral infection, and dislodgement. Between July 2005 and July 2010, 248 cerebral MD catheters were placed in 174 patients undergoing multimodal brain monitoring. One hundred and eighty-five catheters were placed at the time of open craniotomy. None were associated with cranial infection. Patients ranged in age from 5 months to 90 years, with a mean of 49 years. The male to female ratio was 1.4:1. The underlying pathologies were: TBI (126), cerebral vascular accident (24), aneurysmal subarachnoid hemorrhage (17), and tumor (7). Cerebral MD was readily implemented in a community-based hospital. No cerebral hemorrhages or infections were attributed to cerebral MD. Examples of how MD may be a useful adjunct in the clinical decision making of patients with brain injuries are presented.

  15. Procalcitonin Accurately Identifies Hospitalized Children With Low Risk of Bacterial Community-Acquired Pneumonia.

    Science.gov (United States)

    Stockmann, Chris; Ampofo, Krow; Killpack, Jarrett; Williams, Derek J; Edwards, Kathryn M; Grijalva, Carlos G; Arnold, Sandra R; McCullers, Jonathan A; Anderson, Evan J; Wunderink, Richard G; Self, Wesley H; Bramley, Anna; Jain, Seema; Pavia, Andrew T; Blaschke, Anne J

    2018-02-19

    Lower procalcitonin (PCT) concentrations are associated with reduced risk of bacterial community-acquired pneumonia (CAP) in adults, but data in children are limited. We analyzed serum PCT concentrations from children hospitalized with radiographically confirmed CAP enrolled in the Centers for Disease Control and Prevention's Etiology of Pneumonia in the Community (EPIC) Study. Blood and respiratory specimens were tested using multiple pathogen detection methods for typical bacteria (eg, Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus), atypical bacteria (Mycoplasma pneumoniae and Chlamydophila pneumoniae), and respiratory viruses. Multivariable regression was used to assess associations between PCT concentrations and etiology and severity. Among 532 children (median age, 2.4 years; interquartile range [IQR], 1.0-6.3), patients with typical bacteria had higher PCT concentrations (±viruses; n = 54; median, 6.10; IQR, 0.84-22.79 ng/mL) than those with atypical bacteria (±viruses; n = 82; median, 0.10; IQR, 0.06-0.39 ng/mL), viral pathogens only (n = 349; median, 0.33; IQR, 0.12-1.35 ng/mL), or no pathogen detected (n = 47; median, 0.44; IQR, 0.10-1.83 ng/mL) (P < .001 for all). No child with PCT <0.1 ng/mL had typical bacteria detected. Procalcitonin <0.25 ng/mL featured a 96% negative predictive value (95% confidence interval [CI], 93-99), 85% sensitivity (95% CI, 76-95), and 45% specificity (95% CI, 40-50) in identifying children without typical bacterial CAP. Lower PCT concentrations in children hospitalized with CAP were associated with a reduced risk of typical bacterial detection and may help identify children who would not benefit from antibiotic treatment. © The Author 2017. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  16. Relationship Between Body Mass Index and Outcomes Among Hospitalized Patients With Community-Acquired Pneumonia.

    Science.gov (United States)

    Bramley, Anna M; Reed, Carrie; Finelli, Lyn; Self, Wesley H; Ampofo, Krow; Arnold, Sandra R; Williams, Derek J; Grijalva, Carlos G; Anderson, Evan J; Stockmann, Chris; Trabue, Christopher; Fakhran, Sherene; Balk, Robert; McCullers, Jonathan A; Pavia, Andrew T; Edwards, Kathryn M; Wunderink, Richard G; Jain, Seema

    2017-06-15

    The effect of body mass index (BMI) on community-acquired pneumonia (CAP) severity is unclear. We investigated the relationship between BMI and CAP outcomes (hospital length of stay [LOS], intensive care unit [ICU] admission, and invasive mechanical ventilation) in hospitalized CAP patients from the Centers for Disease Control and Prevention Etiology of Pneumonia in the Community (EPIC) study, adjusting for age, demographics, underlying conditions, and smoking status (adults only). Compared with normal-weight children, odds of ICU admission were higher in children who were overweight (adjusted odds ratio [aOR], 1.7; 95% confidence interval [CI], 1.1-2.8) or obese (aOR, 2.1; 95% CI, 1.4-3.2), and odds of mechanical ventilation were higher in children with obesity (aOR, 2.7; 95% CI, 1.3-5.6). When stratified by asthma (presence/absence), these findings remained significant only in children with asthma. Compared with normal-weight adults, odds of LOS >3 days were higher in adults who were underweight (aOR, 1.6; 95% CI, 1.1-2.4), and odds of mechanical ventilation were lowest in adults who were overweight (aOR, 0.5; 95% CI, .3-.9). Children who were overweight or obese, particularly those with asthma, had higher odds of ICU admission or mechanical ventilation. In contrast, adults who were underweight had longer LOS. These results underscore the complex relationship between BMI and CAP outcomes. Published by Oxford University Press for the Infectious Diseases Society of America 2017. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  17. Development and implementation of an interdisciplinary oncology program in a community hospital.

    Science.gov (United States)

    Chung, Clement; Collins, Angela; Cui, Nancy

    2011-09-15

    The development and implementation of an interdisciplinary oncology program in a community hospital are described. Before the program was established, clinical pharmacists responsible for order entry and verification did not have a defined structure and resource to effectively communicate with medical oncologists and nurses on patient care issues and oncology drug information. The practice model did not meet practice needs, departmental safety, quality, or cost-saving goals. An interdisciplinary team was established to determine where current processes and procedures were needed to decrease errors and improve efficiency associated with chemotherapy services. Three stages of practice development were planned, and an interdisciplinary oncology program involving nursing and pharmacy team members and medical oncologists was established. Standardized order forms, various pharmacy collaborative agreements, protocols, improved oncology nursing and pharmacy processes, and established standards in order writing, dispensing, administration, and monitoring were developed. An oncology pharmacist specialist position was requested, and this pharmacist played an essential role in helping the hospital realize significant cost savings and improve the quality of care provided to patients receiving chemotherapy services. Data were collected for 96 chemotherapy orders before program implementation and for 75 orders after program implementation, and a 45% reduction in total error related to chemotherapy drugs was observed (p cause of errors was missing information, typically an omitted duration or frequency, dose, route, or premedication (63% of all errors documented). The development and implementation of an interdisciplinary oncology program resulted in decreased medication-error rates, expanded pharmacy services, and cost savings.

  18. Discovering the Army's Core Competencies

    National Research Council Canada - National Science Library

    Rudesheim, Frederick

    2001-01-01

    This paper seeks to answer the question, "Has the Army correctly identified its core competencies to ensure the Army can adequately respond to the national military strategy?" FM 1, The Army (Prototype Draft...

  19. Azithromycin is not associated with QT prolongation in hospitalized patients with community-acquired pneumonia.

    Science.gov (United States)

    Goldstein, Lee Hilary; Gabin, Ahmad; Fawaz, Abdallah; Freedberg, Nahum Adam; Schwartz, Naama; Elias, Mazen; Saliba, Walid

    2015-10-01

    Large data-based studies have reported excess cardiovascular mortality in high-risk patients treated with azithromycin, but whether or not azithromycin causes QT prolongation remains controversial. The purpose of this study was to examine the association of azithromycin treatment on QT prolongation in a cohort of patients hospitalized with community-acquired pneumonia (CAP) METHODS: One-hundred twenty-two hospitalized patients with CAP were enrolled in the study. We compared the baseline QTc, with daily post antibiotic QTc. Other risk factors for QT prolongation such as medication or electrolyte abnormalities were recorded. Ninety (73.8%) patients were treated with azithromycin (usually in combination with ceftriaxone), and 32 (26.2%) patients with other antibiotics (ampicillin-clavulanate, chloramphenicol, doxcycline, or ceftriaxone); 72.1% (88) of the cohort experienced QT lengthening; 72.7% with QT lengthening had a normal baseline QTc. Azithromycin was not associated with the post-antibiotic QTc. Wide (pathological) post-antibiotic QTc was associated with the pneumonia score. Every 10-point increase in the pneumonia score raised the risk for a pathological post antibiotic QTc by 1.249 (95%CI: 1.050-1.486). Analysis of patients with non-pathological baseline QTc revealed that pathological post-antibiotic QTc was only associated with previous stroke and not with the type of antibiotic. Azithromycin treatment was not associated with QT prolongation in patients with severe CAP. Nonetheless, in a large majority of hospitalized CAP patients, QT prolongation and pathological QTc develop regardless of the antibiotic used, especially in patients with previous stroke or a higher pneumonia score. Copyright © 2015 John Wiley & Sons, Ltd.

  20. The research activities of Ontario's large community acute care hospitals: a scoping review.

    Science.gov (United States)

    DiDiodato, Giulio; DiDiodato, John Alexander; McKee, Aidan Samuel

    2017-08-16

    Ontario's large community hospitals (LCHs) provide care to 65% of the province's hospitalized patients, yet we know very little about their research activities. By searching for research publications from 2013 to 2015, we will describe the extent, type and collaborative nature of Ontario's LCHs' research activities. We conducted a scoping review by searching PubMed, Embase and the Cumulative Index to Nursing and Allied Health Literature databases from January 1, 2013 until December 31, 2015 for all publication types whose author(s) was affiliated with any of the 44 LCHs. Articles were screened and abstracted by three reviewers, independently. The data were charted and results described using summary statistics, scatter plots, and bar charts. We included 798 publications from 39 LCHs and 454 authors. The median number of publications was 7 (Interquartile range (IQR) 23). Observational study design was most commonly reported in over 50% of publications. Program evaluation was the focus in 40% of publications. Primary LCH authorship was observed for 535 publications. Over 25% and 65% of the publications were attributable to 24 authors and 9 LCHs, respectively. There was minimal collaboration both within (21.2%) and between (7.8%) LCHs. LCH size and geographic proximity to academic hospitals had minimal impact on research activity. Ontario's LCHs publish infrequently, collaborate infrequently, and their role in translational research activity is not well defined. A future survey questionnaire to LCH researchers identified through this review is planned to both validate and elicit their interpretations of our study findings and opinions about LCH involvement in research.

  1. Microvascular free-flap reconstruction of a large defect of the scalp. Experience in a community hospital

    Energy Technology Data Exchange (ETDEWEB)

    Singer, J.B.; Gulin, S.P.; Needham, C.W.

    1990-02-01

    The authors present a patient who had postradiation necrosis of the skull and scalp measuring over 300 cm square which was reconstructed with a free latissimus dorsi muscle flap with overlying skin grafts. The procedure was performed in a community hospital with a team comprising two plastic surgeons and a neurosurgeon, with backup from physicians assistants and nursing staff. The successful outcome of this procedure was a direct result of the concerted effort of the surgical team. We believe that microvascular free-flap reconstruction, although a complicated procedure, can be performed at the community hospital as long as appropriate measures for the care of the patient are planned and carried out.

  2. Microvascular free-flap reconstruction of a large defect of the scalp. Experience in a community hospital.

    Science.gov (United States)

    Singer, J B; Gulin, S P; Needham, C W

    1990-02-01

    The authors present a patient who had postradiation necrosis of the skull and scalp measuring over 300 cm square which was reconstructed with a free latissimus dorsi muscle flap with overlying skin grafts. The procedure was performed in a community hospital with a team comprising two plastic surgeons and a neurosurgeon, with backup from physicians assistants and nursing staff. The successful outcome of this procedure was a direct result of the concerted effort of the surgical team. We believe that microvascular free-flap reconstruction, although a complicated procedure, can be performed at the community hospital as long as appropriate measures for the care of the patient are planned and carried out.

  3. Microvascular free-flap reconstruction of a large defect of the scalp. Experience in a community hospital

    International Nuclear Information System (INIS)

    Singer, J.B.; Gulin, S.P.; Needham, C.W.

    1990-01-01

    The authors present a patient who had postradiation necrosis of the skull and scalp measuring over 300 cm square which was reconstructed with a free latissimus dorsi muscle flap with overlying skin grafts. The procedure was performed in a community hospital with a team comprising two plastic surgeons and a neurosurgeon, with backup from physicians assistants and nursing staff. The successful outcome of this procedure was a direct result of the concerted effort of the surgical team. We believe that microvascular free-flap reconstruction, although a complicated procedure, can be performed at the community hospital as long as appropriate measures for the care of the patient are planned and carried out

  4. Army Maintenance System Transformation

    National Research Council Canada - National Science Library

    Gilbertson, Frank V

    2006-01-01

    .... Used in conjunction with pertinent historical data and developed with Army transformation goals in mind, General Systems thinking can provide the framework for guiding maintenance transformation...

  5. Hospital

    African Journals Online (AJOL)

    Burkitt's lymphoma of the head and neck region in a Nigerian tertiary. Hospital ... Some complications of treatment were noted. Discussion: ..... Cancer. Biother Radiopharm 1999 14: 251-62 (Medline). Reece DE. Evidence based management of Hodgkin's disease. The role of autologous stem cell transplantation. Cancer ...

  6. Availability of snacks, candy and beverages in hospital, community clinic and commercial pharmacies.

    Science.gov (United States)

    Whitehouse, Anne; Simon, Anna; French, Simone A; Wolfson, Julian

    2012-06-01

    The purpose of the present study was to measure the availability of energy-dense foods and sugar-sweetened beverages in pharmacies and to examine differences by pharmacy type and presence of a food policy. Trained research staff visited pharmacies (n 37) to measure shelf space and variety of snacks, candy and sugar-sweetened beverages available within 10 ft (3·05 m) of the pharmacy register. Community clinic, hospital and commercial pharmacies in Minneapolis, MN, USA. Employees were interviewed regarding pharmacy food policies. Approximately 60 % of pharmacies had foods and/or sugar-sweetened beverages available for purchase within 10 ft (3·05 m) of the pharmacy register. Total shelf space (P = 0·02) and variety (P = 0·0003) differed significantly by pharmacy type and were greatest among community clinic pharmacies. Over half of pharmacies had no food policy (58·3 %). Pharmacies with food policies were less likely to have foods/beverages available within 10 ft (3·05 m) of the pharmacy register than pharmacies with no food policies (P = 0·03). Candy, snacks and sugar-sweetened beverages are highly available in the pharmacy environment. Presence of a policy is associated with less food availability within 10 ft (3·05 m) of the pharmacy register and represents an important potential intervention strategy.

  7. Evaluation of Sofia Fluorescent immunoassay analyzer for pneumococcal urinary antigen detection in hospitalized patients with community-acquired pneumonia.

    Science.gov (United States)

    Vicente, Diego; López-Olaizola, Maddi; de la Caba, Idoia; Cilla, Gustavo

    2017-10-01

    The Sofia Streptococcus pneumoniae FIA® test was prospectively evaluated in non-concentrated urine samples of 106 hospitalized patients with community-acquired pneumonia. The test detected pneumococcal urinary antigen in 24/31 (77.4%) confirmed pneumococcal community-acquired pneumonia episodes. The specificity of the test was 86.7% (92% after urine heating). Copyright © 2017 Elsevier B.V. All rights reserved.

  8. Clinical Definitions of Sarcopenia and Risk of Hospitalization in Community-Dwelling Older Men: The Osteoporotic Fractures in Men Study.

    Science.gov (United States)

    Cawthon, Peggy M; Lui, Li-Yung; Taylor, Brent C; McCulloch, Charles E; Cauley, Jane A; Lapidus, Jodi; Orwoll, Eric; Ensrud, Kristine E

    2017-10-01

    The association between various definitions of sarcopenia and hospitalization has not been evaluated in community-dwelling older men. We used data from 1,516 participants at Visit 3 of the Osteoporotic Fractures in Men (MrOS) study who also had linked Medicare Fee-For-Service Claims data available. We examined the association between several sarcopenia definitions (International Working Group, European Working Group for Sarcopenia in Older Persons, Foundation for the NIH Sarcopenia Project, Baumgartner, and Newman) and hospitalization, using two-part ("hurdle") models, adjusted for age, clinical center, functional limitations, self-reported health, comorbidity, and cognitive function. Predictors included sarcopenia status (the summary definitions and the components of slowness, weakness, and/or lean mass); outcomes included hospitalization and cumulative inpatient days/year in the 3 years following the Visit 3 exam. After accounting for confounding factors, none of the summary definitions or the definition components (slowness, weakness, or low lean mass) were associated with likelihood of hospitalization, the rate ratio of inpatient days among those hospitalized, or the mean rate of inpatient days amongst all participants. Sarcopenia was not associated hospitalization in community-dwelling older men. These results provide further evidence that current sarcopenia definitions are unlikely to identify those who are most likely to have greater hospitalization. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  9. Community joins forces to care for uninsured.

    Science.gov (United States)

    2012-04-01

    Faced with a high rate of unemployment and an increase in uninsured patients, Lee Memorial Health system in Ft. Myers, FL sponsored a community-wide effort to provide health care options for unfunded patients. Triage Center provides post-acute medical care for the homeless. Salvation Army operates 10-bed respite unit that provides skilled nursing services for homeless. Hospital operates free clinics for the uninsured.

  10. Action of mouthwashes on Staphylococcus spp: isolated in the saliva of community and hospitalized individuals

    Directory of Open Access Journals (Sweden)

    Denise de Andrade

    2009-09-01

    Full Text Available The use of mouthwashes in critical patients has been a source of concern for health professionals due to the diverse range of products, causing uncertainty about which is the most indicated. This study aimed to assess the susceptibility of Staphylococcus spp. isolated in the saliva of individuals from the community and patients in Intensive Care Units (ICU as to antiseptic mouthwashes. The following oral antiseptics were assessed: cetylpyridinium chloride solution, Listerine® and Neen®. Calcium alginate swab was used for saliva collection to isolate Staphylococcus spp. Microbiological processing involved growth, isolation, strain identification and determination of MID (maximum inhibitory dilution. MID was considered the greatest dilution that completely inhibited the strains. The products efficacy was analyzed by a two-factor ANOVA repeated measures and by Bonferroni adjustments in multiple comparisons, considering a significance level of α=0.05. In total, 80 strains of Staphylococcus spp. were isolated, 40 from ICU patients and 40 from community individuals. MID results revealed that cetylpyridinium chloride solution presented better results in comparison to other products, that is, 39 (97.5% strains from hospital patients with MID 1:128, and 37 (92.5% of individuals from the community had MID 1:64. Neen® inhibited all strains in both groups at a dilution from 1:2 to 1:4. Listerine® presented the worst MID results, 65% of the strains from individuals from the community and 10% of hospital strains were not inhibited at a dilution of 1:2.O uso de antissépticos bucais tem sido uma das preocupações dos profissionais de saúde considerando a diversidade de produtos, o que traz a insegurança sobre qual é o mais adequado. Objetivou-se avaliar a suscetibilidade de Staphylococcus spp. isolado da saliva de indivíduos adultos da comunidade e do hospital frente a antissépticos bucais. Os antissépticos avaliados foram: solução de Cloreto de

  11. Return on investment for vendor computerized physician order entry in four community hospitals: the importance of decision support.

    Science.gov (United States)

    Zimlichman, Eyal; Keohane, Carol; Franz, Calvin; Everett, Wendy L; Seger, Diane L; Yoon, Catherine; Leung, Alexander A; Cadet, Bismarck; Coffey, Michael; Kaufman, Nathan E; Bates, David W

    2013-07-01

    In-hospital adverse events are a major cause of morbidity and mortality and represent a major cost burden to health care systems. A study was conducted to evaluate the return on investment (ROI) for the adoption of vendor-developed computerized physician oder entry (CPOE) systems in four community hospitals in Massachusetts. Of the four hospitals, two were under one management structure and implemented the same vendor-developed CPOE system (Hospital Group A), while the other two were under a second management structure and implemented another vendor-developed CPOE system (Hospital Group B). Cost savings were calculated on the basis of reduction in preventable adverse drug event (ADE) rates as measured previously. ROI, net cash flow, and the breakeven point during a 10-year cost-and-benefit model were calculated. At the time of the study, none of the participating hospitals had implemented more than a rudimentary decision support system together with CPOE. Implementation costs were lower for Hospital Group A than B ($7,130,894 total or $83/admission versus $19,293,379 total or $113/admission, respectively), as were preventable ADE-related avoided costs ($7,937,651 and $16,557,056, respectively). A cost-benefit analysis demonstrated that Hospital Group A had an ROI of 11.3%, breaking even on the investment eight years following implementation. Hospital Group B showed a negative return, with an ROI of -3.1%. Adoption of vendor CPOE systems in community hospitals was associated with a modest ROI at best when applying cost savings attributable to prevention of ADEs only. The modest financial returns can beattributed to the lack of clinical decision support tools.

  12. Understanding transitions in care from hospital to homeless shelter: a mixed-methods, community-based participatory approach.

    Science.gov (United States)

    Greysen, S Ryan; Allen, Rebecca; Lucas, Georgina I; Wang, Emily A; Rosenthal, Marjorie S

    2012-11-01

    Coordinated transitions from hospital to shelter for homeless patients may improve outcomes, yet patient-centered data to guide interventions are lacking. To understand patients' experiences of transitions from hospital to a homeless shelter, and determine aspects of these experiences associated with perceived quality of these transitions. Mixed methods with a community-based participatory research approach, in partnership with personnel and clients from a homeless shelter. Ninety-eight homeless individuals at a shelter who reported at least one acute care visit to an area hospital in the last year. Using semi-structured interviews, we collected quantitative and qualitative data about transitions in care from the hospital to the shelter. We analyzed qualitative data using the constant comparative method to determine patients' perspectives on the discharge experience, and we analyzed quantitative data using frequency analysis to determine factors associated with poor outcomes from patients' perspective. Using qualitative analysis, we found homeless participants with a recent acute care visit perceived an overall lack of coordination between the hospital and shelter at the time of discharge. They also described how expectations of suboptimal coordination exacerbate delays in seeking care, and made three recommendations for improvement: 1) Hospital providers should consider housing a health concern; 2) Hospital and shelter providers should communicate during discharge planning; 3) Discharge planning should include safe transportation. In quantitative analysis of recent hospital experiences, 44 % of participants reported that housing status was assessed and 42 % reported that transportation was discussed. Twenty-seven percent reported discharge occurred after dark; 11 % reported staying on the streets with no shelter on the first night after discharge. Homeless patients in our community perceived suboptimal coordination in transitions of care from the hospital to the

  13. Biofilm formation of methicillin-resistant coagulase negative staphylococci (MR-CoNS) isolated from community and hospital environments

    Science.gov (United States)

    Seng, Rathanin; Kitti, Thawatchai; Thummeepak, Rapee; Kongthai, Phattaraporn; Leungtongkam, Udomluk; Wannalerdsakun, Surat

    2017-01-01

    Methicillin-resistant coagulase negative staphylococci (MR-CoNS) are the major cause of infectious diseases because of their potential ability to form biofilm and colonize the community or hospital environments. This study was designed to investigate the biofilm producing ability, and the presence of mecA, icaAD, bap and fnbA genes in MR-CoNS isolates. The MR-CoNS used in this study were isolated from various samples of community environment and five wards of hospital environments, using mannitol salt agar (MSA) supplemented with 4 μg/ml of oxacillin. The specie level of Staphylococcus haemolyticus, Staphylococcus epidermidis, Staphylococcus hominis and Staphylococcus warneri was identified by specific primers of groESL (S. haemolyticus), rdr (S. epidermidis) and nuc (S. hominis and S. warneri). The remainder isolates were identified by tuf gene sequencing. Biofilm production was determined using Congo red agar (CRA) and Microtiter plate (MTP) assay. The mecA and biofilm associated genes (icaAD, fnbA and bap) were detected using PCR method. From the 558 samples from community and hospital environments, 292 MR-CoNS were isolated (41 from community environments, and 251 from hospital environments). S. haemolyticus (41.1%) and S. epidermidis (30.1%) were the predominant species in this study. Biofilm production was detected in 265 (90.7%) isolates by CRA, and 260 (88.6%) isolates were detected by MTP assay. The staphylococci isolates derived from hospital environments were more associated with biofilm production than the community-derived isolates. Overall, the icaAD and bap genes were detected in 74 (29.5%) and 14 (5.6%) of all isolates from hospital environments. When tested by MTP, the icaAD gene from hospital environment isolates was associated with biofilm biomass. No association was found between bap gene and biofilm formation. The MR-CoNS isolates obtained from community environments did not harbor the icaAD and bap genes. Conversely, fnbA gene presented in MR

  14. Biofilm formation of methicillin-resistant coagulase negative staphylococci (MR-CoNS) isolated from community and hospital environments.

    Science.gov (United States)

    Seng, Rathanin; Kitti, Thawatchai; Thummeepak, Rapee; Kongthai, Phattaraporn; Leungtongkam, Udomluk; Wannalerdsakun, Surat; Sitthisak, Sutthirat

    2017-01-01

    Methicillin-resistant coagulase negative staphylococci (MR-CoNS) are the major cause of infectious diseases because of their potential ability to form biofilm and colonize the community or hospital environments. This study was designed to investigate the biofilm producing ability, and the presence of mecA, icaAD, bap and fnbA genes in MR-CoNS isolates. The MR-CoNS used in this study were isolated from various samples of community environment and five wards of hospital environments, using mannitol salt agar (MSA) supplemented with 4 μg/ml of oxacillin. The specie level of Staphylococcus haemolyticus, Staphylococcus epidermidis, Staphylococcus hominis and Staphylococcus warneri was identified by specific primers of groESL (S. haemolyticus), rdr (S. epidermidis) and nuc (S. hominis and S. warneri). The remainder isolates were identified by tuf gene sequencing. Biofilm production was determined using Congo red agar (CRA) and Microtiter plate (MTP) assay. The mecA and biofilm associated genes (icaAD, fnbA and bap) were detected using PCR method. From the 558 samples from community and hospital environments, 292 MR-CoNS were isolated (41 from community environments, and 251 from hospital environments). S. haemolyticus (41.1%) and S. epidermidis (30.1%) were the predominant species in this study. Biofilm production was detected in 265 (90.7%) isolates by CRA, and 260 (88.6%) isolates were detected by MTP assay. The staphylococci isolates derived from hospital environments were more associated with biofilm production than the community-derived isolates. Overall, the icaAD and bap genes were detected in 74 (29.5%) and 14 (5.6%) of all isolates from hospital environments. When tested by MTP, the icaAD gene from hospital environment isolates was associated with biofilm biomass. No association was found between bap gene and biofilm formation. The MR-CoNS isolates obtained from community environments did not harbor the icaAD and bap genes. Conversely, fnbA gene presented in MR

  15. Implementation of the Tobacco Tactics intervention versus usual care in Trinity Health community hospitals

    Directory of Open Access Journals (Sweden)

    Sonia A. Duffy

    2016-11-01

    Full Text Available Abstract Background Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM implementation framework, a National Institutes of Health-sponsored study compared the nurse-administered Tobacco Tactics intervention to usual care. A prior paper describes the effectiveness of the Tobacco Tactics intervention. This subsequent paper provides data describing the remaining constructs of the RE-AIM framework. Methods This pragmatic study used a mixed methods, quasi-experimental design in five Michigan community hospitals of which three received the nurse-administered Tobacco Tactics intervention and two received usual care. Nurses and patients were surveyed pre- and post-intervention. Measures included reach (patient participation rates, characteristics, and receipt of services, adoption (nurse participation rates and characteristics, implementation (pre-to post-training changes in nurses' attitudes, delivery of services, barriers to implementation, opinions about training, documentation of services, and numbers of volunteer follow-up phone calls, and maintenance (continuation of the intervention once the study ended. Results Reach: Patient participation rates were 71.5 %. Compared to no change in the control sites, there were significant pre- to post-intervention increases in self-reported receipt of print materials in the intervention hospitals (n = 1370, p < 0.001. Adoption: In the intervention hospitals, all targeted units and several non-targeted units participated; 76.0 % (n = 1028 of targeted nurses and 317 additional staff participated in the training, and 92.4 % were extremely or somewhat satisfied with the training. Implementation: Nurses in the intervention hospitals reported increases in providing advice to quit, counseling, medications, handouts, and DVD (all p < 0.05 and reported decreased barriers to implementing smoking cessation services (p < 0.001. Qualitative comments were very

  16. CKD and Risk for Hospitalization With Infection: The Atherosclerosis Risk in Communities (ARIC) Study.

    Science.gov (United States)

    Ishigami, Junichi; Grams, Morgan E; Chang, Alexander R; Carrero, Juan J; Coresh, Josef; Matsushita, Kunihiro

    2017-06-01

    Individuals on dialysis therapy have a high risk for infection, but risk for infection in earlier stages of chronic kidney disease has not been comprehensively described. Observational cohort study. 9,697 participants (aged 53-75 years) in the Atherosclerosis Risk in Communities (ARIC) Study. Participants were followed up from 1996 to 1998 through 2011. Estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (ACR). Risk for hospitalization with infection and death during or within 30 days of hospitalization with infection. During follow-up (median, 13.6 years), there were 2,701 incident hospitalizations with infection (incidence rate, 23.6/1,000 person-years) and 523 infection-related deaths. In multivariable analysis, HRs of incident hospitalization with infection as compared to eGFRs≥90mL/min/1.73m 2 were 2.55 (95% CI, 1.43-4.55), 1.48 (95% CI, 1.28-1.71), and 1.07 (95% CI, 0.98-1.16) for eGFRs of 15 to 29, 30 to 59, and 60 to 89mL/min/1.73m 2 , respectively. Corresponding HRs were 3.76 (95% CI, 1.48-9.58), 1.62 (95% CI, 1.20-2.19), and 0.99 (95% CI, 0.80-1.21) for infection-related death. Compared to ACRsinfection were 2.30 (95% CI, 1.81-2.91), 1.56 (95% CI, 1.36-1.78), and 1.34 (95% CI, 1.20-1.50) for ACRs≥300, 30 to 299, and 10 to 29mg/g, respectively. Corresponding HRs were 3.44 (95% CI, 2.28-5.19), 1.57 (95% CI, 1.18-2.09), and 1.39 (95% CI, 1.09-1.78) for infection-related death. Results were consistent when separately assessing risk for pneumonia, kidney and urinary tract infections, bloodstream infections, and cellulitis and when taking into account recurrent episodes of infection. Outcome ascertainment relied on diagnostic codes at time of discharge. Increasing provider awareness of chronic kidney disease as a risk factor for infection is needed to reduce infection-related morbidity and mortality. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  17. Management of chronic heart failure in the community: role of a hospital based open access heart failure service

    OpenAIRE

    Shah, S; Davies, M K; Cartwright, D; Nightingale, P

    2004-01-01

    Objective: To evaluate the role of an open access heart failure service based at a teaching hospital for the diagnosis and treatment optimisation of patients with heart failure in the community and to identify measures that may further enhance the effectiveness of such a service.

  18. Implementation of Endovenous Laser Ablation for Varicose Veins in a Large Community Hospital : The First 400 Procedures

    NARCIS (Netherlands)

    van den Bremer, J.; Joosten, P. Ph. A. Hedeman; Hamming, J. F.; Moll, F. L.

    Endovenous Laser ablation (ELA) has become a standard treatment of the incompetent great saphenous vein (GSV). Our prospective audit examines the implementation of this new method in a large community hospital with special attention to obstacles, technical results, pain scores, failures and our

  19. Community-onset extended-spectrum-β-lactamase-producing Escherichia coli sequence type 131 at two Korean community hospitals: The spread of multidrug-resistant E. coli to the community via healthcare facilities.

    Science.gov (United States)

    Kim, Young Ah; Kim, Jin Ju; Kim, Heejung; Lee, Kyungwon

    2017-01-01

    The recent molecular epidemiology of ESBL-producing Escherichia coli infection in two Korean community hospitals was evaluated in this prospective observational study. We collected non-duplicated E. coli isolates from consecutive, sequentially encountered patients with community-onset episodes between March and April 2016 in two community hospitals in Gyeonggi-do province, Korea. We studied the prevalence, clinical characteristics and molecular epidemiology of E. coli sequence type 131 (ST131) isolated from the community. From a total of 213 E. coli isolates collected from the community, 94 (44.1%) were community-onset healthcare-associated isolates and 119 (55.9%) were community-associated isolates, of which urinary tract infection was the majority. A total of 55 (25.8%) of the 213 E. coli isolates were confirmed to have ESBL genes, which were mainly CTX-M types such as CTX-M-14 and CTX-M-15. There was no difference in the proportion of globally epidemic ST131 clones or that of O25, O16, H30, or H30Rx subclones between community-associated and community-onset healthcare-associated isolates. In this study, considerable ST131 E. coli isolations in the community were observed and about half of them were related to the history of a visit to the healthcare facilities, indicating the spread of multidrug-resistant E. coli to the community via healthcare facilities. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  20. Community-acquired Clostridium difficile: Epidemiology, Ribotype, Risk Factors, Hospital and Intensive Care Unit Outcomes, and Current and Emerging Therapies.

    Science.gov (United States)

    Ofori, Emmanuel; Ramai, Daryl; Dhawan, Monica; Mustafa, Fareeza; Gasperino, James; Reddy, Madhavi

    2018-01-30

    The epidemiological landscape of Clostridium difficile infection (CDI) has changed over the past 30 years. To review studies of CDI in the community setting. Electronic databases including PubMed, MEDLINE, Embase, Google Scholar, Scopus, ClinicalTrials.gov, and Cochrane Databases were searched for human studies performed between 2000 and 2017 that assessed the epidemiology, risk factors, ribotypes, hospital and intensive care unit outcomes, and management of community-acquired CDI. We also manually searched references to identify additional relevant studies. In total, 39 articles met our inclusion criteria. The incidence of community acquired CDI has almost doubled in the past decade. Approximately half of all cases of CDI are attributed to community origin. Individuals who are younger, female, in the presence of infants, frequently use proton pump inhibitors or specific classes of antibiotics, or live near farms and livestock are at higher risk for community-acquired CDI. Additionally, about 40% of all community-acquired cases require hospitalization, where severity has been linked to hypervirulent ribotypes 027 and 078 with poor outcomes. Emerging data on treatment paradigms have led to the revision of clinical guidelines and two potential vaccines in phase three clinical trials. However, ribotype specific response to current treatment strategies is lacking. Community-acquired CDI represents a growing public health threat and burden on healthcare systems. A multidisciplinary approach will be required to stem the tides. Copyright © 2018. Published by Elsevier Ltd.

  1. Epidemiological and molecular characterization of community and hospital acquired Staphylococcus aureus strains prevailing in Shenyang, Northeastern China

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    Dan Dan Sun

    Full Text Available In order to obtain adequate information for the treatment of methicillin resistant Staphylococcus aureus (MRSA infections, it is crucial to identify trends in epidemiological and antimicrobial resistance patterns of local S. aureus strains. Community and hospital acquired S. aureus isolates (n = 202 were characterized using staphylococcal cassette chromosome mec (SCCmec typing, pulse field gel electrophoresis (PFGE analysis, spa typing and minimal inhibitory concentration (MIC determination. The prevalence of the Panton-Valentine leukocidine (pvl and several antibiotic resistance genes among the isolates were also detected by PCR. All of the S. aureus isolates were susceptible to vancomycin, daptomycin and linezolid. Three hospital isolates were resistant to teicoplanin while 14 showed intermediate resistance to teicoplanin. The resistance patterns of community-acquired MRSA (CA-MRSA isolates to other antimicrobials were similar to those of hospital-acquired MRSA (HA-MRSA isolates except for clindamycin and gentamicin. There was excellent correlation between phenotypes and genotypes in the determination of S. aureus resistance to erythromycin, gentamicin, and tetracycline. The SCCmec type II and SCCmec type IV were the predominant types detected in hospital and community isolates, respectively. The most frequently encountered spa types were t002 and t030 both in HA-and CA-MRSA isolates. Pulsotype A was the most predominant pulsotype identified among the isolates tested, followed by pulsotype B. Seventy-two hospital isolates (19 HA-MRSA and 53 HA-MSSA and 10 CA-MRSA were positive for the pvl gene. This study shows that the combination of susceptibility testing and various molecular methods has provided useful information on the antibiotic resistance and molecular diversity of S. aureus in a specific region of China. The high proportion of pvl positive MSSA and MRSA isolates observed in this study indicates that adequate measures are needed to

  2. What do medical students learn when they follow patients from hospital to community? A longitudinal qualitative study

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    Rukshini Puvanendran

    2012-07-01

    Full Text Available Context: Although longitudinal community-based care of patients provides opportunities for teaching patient centredness and chronic disease management, there is a paucity of literature assessing learning outcomes of these clerkships. This study examines learning outcomes among students participating in longitudinal community based follow-up of patients discharged from the hospital. Methods: The authors conducted a thematic analysis of 253 student narratives written by 44 third-year medical students reflecting on their longitudinal interactions with patients with chronic medical illnesses. The narratives were written over three periods: after acute hospital encounter, after a home visit and at the end of the 10-month follow-up. Analysis involved coding of theme content and counting of aggregate themes. Results: The most frequent theme was ‘chronic disease management’ (25% followed by ‘patient-centred care’ (22%, ‘health care systems’ (20.9%, ‘biomedical issues’ (19.7%, ‘community services’ (9.5% and ‘student's role conflict’ (2.3%. There was a shift in the relative frequency of the different themes, as students moved from hospital to community with their patients. Biomedical (44.3% and health systems (18.2% were the dominant themes following the acute hospitalization encounter. Chronic disease management (35.1% and patient centredness (31.8% were the dominant themes after the 10-month longitudinal follow-up. Conclusion: Longitudinal community-based interaction with patients resulted in learning about chronic disease management, patient centredness and health care systems over time. Students shifted from learning biomedical knowledge during the acute hospitalization, to focus on better understanding of long-term care and patient centredness, at the end of the module.

  3. Long-term exposure to ambient air pollution and risk of hospitalization with community-acquired pneumonia in older adults.

    Science.gov (United States)

    Neupane, Binod; Jerrett, Michael; Burnett, Richard T; Marrie, Thomas; Arain, Altaf; Loeb, Mark

    2010-01-01

    Little is known about the long-term effects of air pollution on pneumonia hospitalization in the elderly. To assess the effect of long-term exposure to ambient nitrogen dioxide, sulfur dioxide, and fine particulate matter with diameter equal to or smaller than 2.5 microm (PM(2.5)) on hospitalization for community-acquired pneumonia in older adults. We used a population-based case-control study in Hamilton, Ontario, Canada. We enrolled 345 hospitalized patients aged 65 years or more for community-acquired pneumonia and 494 control participants, aged 65 years and more, randomly selected from the same community as cases from July 2003 to April 2005. Health data were collected by personal interview. Annual average levels of nitrogen dioxide, sulfur dioxide, and PM(2.5) before the study period were estimated at the residential addresses of participants by inverse distance weighting, bicubic splined and land use regression methods and merged with participants' health data. Long-term exposure to higher levels of nitrogen dioxide and PM(2.5) was significantly associated with hospitalization for community-acquired pneumonia (odds ratio [OR], 2.30; 95% confidence interval [CI], 1.25 to 4.21; P = 0.007 and OR, 2.26; 95% CI, 1.20 to 4.24; P = 0.012, respectively, over the 5th-95th percentile range increase of exposure). Sulfur dioxide did not appear to have any association (OR, 0.97; 95% CI, 0.59 to 1.61; P = 0.918). Results were somewhat sensitive to the choice of methods used to estimate air pollutant levels at residential addresses, although all risks from nitrogen dioxide and PM(2.5) exposure were positive and generally significant. In older adults, exposure to ambient nitrogen dioxide and PM(2.5) was associated with hospitalization for community-acquired pneumonia.

  4. Persistence of microbial communities including Pseudomonas aeruginosa in a hospital environment: a potential health hazard

    Science.gov (United States)

    2014-01-01

    Background The persistence of microbial communities and how they change in indoor environments is of immense interest to public health. Moreover, hospital acquired infections are significant contributors to morbidity and mortality. Evidence suggests that, in hospital environments agent transfer between surfaces causes healthcare associated infections in humans, and that surfaces are an important transmission route and may act as a reservoir for some of the pathogens. This study aimed to evaluate the diversity of microorganisms that persist on noncritical equipment and surfaces in a main hospital in Portugal, and are able to grow in selective media for Pseudomonas, and relate them with the presence of Pseudomonas aeruginosa. Results During 2 years, a total of 290 environmental samples were analyzed, in 3 different wards. The percentage of equipment in each ward that showed low contamination level varied between 22% and 38%, and more than 50% of the equipment sampled was highly contaminated. P. aeruginosa was repeatedly isolated from sinks (10 times), from the taps’ biofilm (16 times), and from the showers and bedside tables (two times). Two ERIC clones were isolated more than once. The contamination level of the different taps analyzed showed correlation with the contamination level of the hand gels support, soaps and sinks. Ten different bacteria genera were frequently isolated in the selective media for Pseudomonas. Organisms usually associated with nosocomial infections as Stenotrophomonas maltophilia, Enterococcus feacalis, Serratia nematodiphila were also repeatedly isolated on the same equipment. Conclusions The environment may act as a reservoir for at least some of the pathogens implicated in nosocomial infections. The bacterial contamination level was related to the presence of humidity on the surfaces, and tap water (biofilm) was a point of dispersion of bacterial species, including potentially pathogenic organisms. The materials of the equipment

  5. A Simulation-Based Quality Improvement Initiative Improves Pediatric Readiness in Community Hospitals.

    Science.gov (United States)

    Whitfill, Travis; Gawel, Marcie; Auerbach, Marc

    2017-07-17

    The National Pediatric Readiness Project Pediatric Readiness Survey (PRS) measured pediatric readiness in 4149 US emergency departments (EDs) and noted an average score of 69 on a 100-point scale. This readiness score consists of 6 domains: coordination of pediatric patient care (19/100), physician/nurse staffing and training (10/100), quality improvement activities (7/100), patient safety initiatives (14/100), policies and procedures (17/100), and availability of pediatric equipment (33/100). We aimed to assess and improve pediatric emergency readiness scores across Connecticut's hospitals. The aim of this study was to compare the National Pediatric Readiness Project readiness score before and after an in situ simulation-based assessment and quality improvement program in Connecticut hospitals. We leveraged in situ simulations to measure the quality of resuscitative care provided by interprofessional teams to 3 simulated patients (infant septic shock, infant seizure, and child cardiac arrest) presenting to their ED resuscitation bay. Assessments of EDs were made based on a composite quality score that was measured as the sum of 4 distinct domains: (1) adherence to sepsis guidelines, (2) adherence to cardiac arrest guidelines, (3) performance on seizure resuscitation, and (4) teamwork. After the simulation, a detailed report with scores, comparisons to other EDs, and a gap analysis were provided to sites. Based on this report, a regional children's hospital team worked collaboratively with each ED to develop action items and a timeline for improvements. The National Pediatric Readiness Project PRS scores, the primary outcome of this study, were measured before and after participation. Twelve community EDs in Connecticut participated in this project. The PRS scores were assessed before and after the intervention (simulation-based assessment and gap analysis/report-out). The average time between PRS assessments was 21 months. The PRS scores significantly improved 12

  6. Empiric antibiotic coverage of atypical pathogens for community acquired pneumonia in hospitalized adults.

    Science.gov (United States)

    Robenshtok, E; Shefet, D; Gafter-Gvili, A; Paul, M; Vidal, L; Leibovici, L

    2008-01-23

    Community acquired pneumonia (CAP) is caused by various pathogens, traditionally divided to 'typical' and 'atypical'. Initial antibiotic treatment of CAP is usually empirical, customarily covering both typical and atypical pathogens. To date, no sufficient evidence exists to support this broad coverage, while limiting coverage is bound to reduce toxicity, resistance and expense. To assess the efficacy and need of adding antibiotic coverage for atypical pathogens in hospitalized patients with CAP, in terms of mortality and successful treatment. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 1) which includes the Acute Respiratory Infection Group's specialized register; MEDLINE (January 1966 to March 2007); and EMBASE (January 1980 to January 2007). Randomized trials of adult patients hospitalized due to CAP, comparing antibiotic regimens with atypical antibiotic coverage to a regimen without atypical antibiotic coverage. Two review authors independently appraised the quality of each trial and extracted the data from included trials. Relative risks (RR) with 95% confidence intervals (CI) were estimated, assuming an intention-to-treat (ITT) basis for the outcome measures. Twenty five trials were included, encompassing 5244 randomized patients. There was no difference in mortality between the atypical arm and the non-atypical arm (RR 1.15; 95% CI 0.85 to 1.56). The atypical arm showed an insignificant trend toward clinical success and a significant advantage to bacteriological eradication, which disappeared when evaluating methodologically high-quality studies alone. Clinical success for the atypical arm was significantly higher for Legionella pneumophilae (L. pneumophilae) and non-significantly lower for pneumococcal pneumonia. There was no significant difference between the groups in the frequency of (total) adverse events, or those requiring discontinuation of treatment. However, gastrointestinal events

  7. The prevalence and reliability of self-reported penicillin allergy in a community hospital

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    Khasawneh FA

    2013-12-01

    Full Text Available Faisal A Khasawneh,1 Megan A R Slaton,2 Stephen L Katzen,2 Ashley A Woolbert,2 Sean D Anderson,2 Michelle B Parker,2 Rachel M Anderson,2 Krystal K Haase,3 Roger D Smalligan41Section of Infectious Diseases, Department of Internal Medicine, 2School of Medicine, 3School of Pharmacy, 4Department of Internal Medicine, Texas Tech University Health Sciences Center, Amarillo, TX, USABackground: Penicillin (PCN accounts for most cases of antibiotic allergies. Reported PCN allergy deprives the patient from this class of antibiotics and creates hesitancy in using other beta-lactam antibiotics. The aim of this study is to report the prevalence of self-reported PCN allergy among adult patients admitted to the hospital and to examine the probable validity of these reports.Methods: A questionnaire was conducted among 192 patients with self-reported PCN allergy who were admitted to a community hospital between July 25, 2011 and January 25, 2012. Patients admitted with an infection and treated with a beta-lactam were also followed until hospital discharge.Results: The mean age of patients at the time of their self-reported allergic reaction was 20.3 years. The most common allergic symptoms reported in decreasing order of frequency were itchy rash, angioedema, and urticaria. Based on analysis of the questionnaires, 121 patients (63.0% had probable PCN allergy, 54 (28.1% had possible PCN allergy, and 17 (8.9% were unlikely to have a PCN allergy. Fifty-one participants (26.6% had self-reported subsequent exposure to PCN in their life. This subsequent exposure was well tolerated in 86.3% of the participants. Fifty participants (25.9% had self-reported subsequent exposure to a first generation cephalosporin and it was well tolerated in 78.4% of them.Conclusion: Taking a detailed history from patients with self-reported PCN allergy can help to distinguish a true PCN allergy from a false positive report of allergy and hence allow clinicians to use this important class

  8. Evaluation of the utility and energy monitoring and control system installed at the US Army, Europe, 409th Base Support Battalion, Military Community at Grafenwoehr, Germany

    Energy Technology Data Exchange (ETDEWEB)

    Broders, M.A.; Ruppel, F.R.

    1993-05-01

    Under the provisions of Interagency Agreement DOE 1938-B090-A1 between the US Department of Energy (DOE) and the US Army Europe (USAREUR), Martin Marietta Energy Systems, Inc., is providing technical assistance to USAREUR in the areas of computer science, information engineering, energy studies, and engineering and systems development. One of the initial projects authorized under this interagency agreement is the evaluation of utility and energy monitoring and control systems (UEMCSs) installed at selected US Army installations in Europe. This report is an evaluation of the overall energy-conservation effectiveness and use of the UEMCS at the 409th Base Support Battalion located in Grafenwoehr, Germany. The 409th Base Support Battalion is a large USAREUR military training facility that comprises a large training area, leased housing, the main post area, and the camp areas that include Camps Aachen, Algier, Normandy, Cheb, and Kasserine. All of these facilities are consumers of electrical and thermal energy. However, only buildings and facilities in the main post area and Camps Aachen, Algier, and Normandy are under the control of the UEMCS. The focus of this evaluation report is on these specific areas. Recommendations to further increase energy and cost savings and to improve operation of the UEMCS are proposed.

  9. Differential characteristics of bacteraemias according to age in a community hospital.

    Science.gov (United States)

    Toyas, C; Aspiroz, C; Martínez-Álvarez, R M; Ezpeleta, A I; Arazo, P; Ferrando, J C

    To describe the characteristics of bacteraemias, according to age, in a community hospital. A prospective study of bacteraemias was conducted in 2011. The patients were classified into 3 age groups: younger than 65 years, 65 to 79, and 80 or older. The study collected variables on the patients and episodes. The study analysed 233 bacteraemias in 227 patients (23.8% in those younger than 65 years; 38.3% in the 65 to 79 age group; and 37.9% in the 80 years or older group). The most common underlying disease in all the groups was diabetes mellitus. In the most elderly patients, the Charlson index was highest, there was a lower proportion of exogenous factors, and almost 25% were severely dependent (Barthel index<20). Escherichia coli was the most common germ, and the main focus was urological. The patients aged 80 years or older had predominantly healthcare-associated infections, less severe symptoms (sepsis) (66.3%) and higher mortality (29.1%) compared with the younger patients. The very elderly patients with bacteraemia presented fewer exogenous factors, greater comorbidity and a poorer functional situation. The most common focus was urological and the origin was healthcare related. Despite their less severe clinical presentation, these patients' mortality was greater, and their degree of dependence was a highly relevant independent risk factor. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  10. [Community-acquired bacteremia in adult patients attending the emergency service of a teaching hospital].

    Science.gov (United States)

    Artico, Muriel J; Rocchi, Marta; Gasparotto, Ana; Ocaña Carrizo, Valeria; Navarro, Mercedes; Mollo, Valeria; Avilés, Natalia; Romero, Vanessa; Carrillo, Sonia; Monterisi, Aída

    2012-01-01

    Bacteremia is an important cause of morbimortality. This study describes the episodes of community-acquired bacteremia in adult patients registered at our hospital. Between January 2005, and December 2009, 271 episodes were studied. The diagnostic yield of blood cultures was 13.5 %. A total of 52 % of patients were male and 48 % female. The mean age was 60. The most frequent comorbidities were: diabetes (21 %), neoplasia (18 %), cardiopathy (11 %), and HIV infection (8 %). The focus was- respiratory (21 %), urinary (15 %), cutaneous (9 %), and others (13 %). Gram-positive bacteria prevailed (51.4%). The most frequent microorganisms were Escherichia coli (25 %), Streptococcus pneumoniae (22.9 %), and Staphylococcus aureus (12.3 %). Bacteremia was polymicrobial in 7 % of the cases. Thirty three percent of E. coli isolates were resistant to ciprofloxacin and 6 % to ceftazidime. Fourteen percent of S. aureus strains were resistant to oxacillin whereas only 7 % of S. pneumoniae expressed high resistance to penicillin with MICs = 2 ug/ml, according to meningitis breakpoints.

  11. Establishment of a renal supportive care program: Experience from a rural community hospital in Taiwan

    Directory of Open Access Journals (Sweden)

    Chia-Ter Chao

    2016-07-01

    Full Text Available Renal supportive care (RSC denotes a care program dedicated for patients with acute, chronic renal failure, and end-stage renal disease (ESRD, aiming to offer maximal symptom relief and optimize patients' quality of life. The uncertainty of prognosis for patients with chronic kidney disease and ESRD, the sociocultural issues inherent to the Taiwanese society, and the void of structured and practical RSC pathway, contributes to the underrecognition and poor utilization of RSC. Taiwanese patients rarely receive information regarding RSC as part of a standardized care and are not commonly offered this option. In National Taiwan University Hospital Jinshan branch, we started a RSC subprogram, supported by the community-based palliative/hospice care main program. We focused on understanding the need and providing the choice of RSC to suitable candidates. A three-step and four-phase protocol was designed and implemented to identify appropriate patients and to enhance the applicability of the RSC. We harnessed family visit and home-based family meeting as a vehicle to understand the patients' preferences, to discover what ESRD patients and their family value most, and to introduce the option of RSC. In the current review, we described our pilot experience of establishing a RSC program in Taiwan, and discuss its potential advantage.

  12. Risk factors for cardiovascular events in hospitalized patients with community-acquired pneumonia.

    Science.gov (United States)

    Griffin, Allen T; Wiemken, Timothy L; Arnold, Forest W

    2013-12-01

    An increased risk of cardiovascular complications has been found in those with community-acquired pneumonia (CAP). Preliminary data suggest that pneumococcal pneumonia, more severe pneumonia, older age, renal disease, hypoalbuminemia, and inpatient sliding scale insulin administration contribute to risk. The objective of this study was to ascertain additional factors influencing cardiovascular events in CAP. This investigation was a retrospective cohort study of inpatients with CAP. Outcomes evaluated were development of a cardiovascular event during hospitalization, defined as acute pulmonary edema, cardiac arrhythmia, or myocardial infarction. Those with and without events were compared across cardiovascular- and pneumonia-specific variables by logistic regression to ascertain factors that independently increase risk or reduce risk. Of 3068 inpatients with pneumonia, 376 (12%) developed a cardiovascular event. Hyperlipidemia, more severe pneumonia, and Staphylococcus aureus or Klebsiella pneumoniae as etiologies were associated with increased risk, while statin use was associated with decreased risk. This study highlights variables in CAP patients that should make clinicians vigilant for the development of cardiac complications. Additional research is needed to determine if statins attenuate cardiac risk in CAP. Copyright © 2013 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  13. Community acquired pneumonia in the elderly: the Pneumonia in Italian Acute Care for Elderly units (PIACE study protocol by the Italian Society of Hospital and Community Geriatrics (SIGOT

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    Filippo Luca Fimognari

    2017-01-01

    Full Text Available Pneumonia is a frequent cause of hospital admission in elderly patients. Diagnosis of pneumonia in elderly persons with comorbidity may be challenging, due to atypical presentation and complex clinical scenarios. Community-acquired pneumonia (CAP arises out-of-hospital in subjects without previous contact with the healthcare system. Healthcare associated pneumonia (HCAP occurs in patients who have frequent contacts with the healthcare system and should be treated with empiric broad spectrum antibiotic therapy also covering multi-drug resistant (MDR pathogens. Recent findings, however, have questioned this approach, because the worse prognosis of HCAP compared to CAP may better reflect increased level of comorbidity and frailty (poor functional status, older age of HCAP patients, as well as poorer quality of hospital care provided to such patients, rather than pneumonia etiology by MDR pathogens. The Pneumonia in Italian Acute Care for Elderly units (PIACE Study, promoted by the Società Italiana di Geriatria Ospedale e Territorio (SIGOT, is an observational prospective cohort study of patients consecutively admitted because of pneumonia to hospital acute care units of Geriatrics throughout Italy. Detailed information regarding clinical presentation, diagnosis, etiology, comprehensive geriatric assessment, antibiotic therapy, possible complications and comorbidities was recorded to identify factors potentially predicting in-hospital mortality (primary endpoint, 3-month mortality, length of hospital stay, postdischarge rate of institutionalization and other secondary endpoints. This paper describes the rationale and method of PIACE Study and reviews the main evidence on pneumonia in the elderly.

  14. Microbiology and prognostic factors of hospital- and community-acquired aspiration pneumonia in respiratory intensive care unit.

    Science.gov (United States)

    Wei, Chaojie; Cheng, Zhenshun; Zhang, Li; Yang, Jiong

    2013-10-01

    Incidence of aspiration pneumonia in hospital-acquired pneumonia and community-acquired pneumonia is high; however, many features of this disease remain imprecise. Our objective was to characterize the microbial etiology and their antibiotic resistance and to determine the prognostic factors in aspiration pneumonia among patients admitted to a respiratory intensive care unit (RICU). A prospective survey was conducted in 112 patients exhibiting hospital-or community-acquired aspiration pneumonia in the RICU of a provincial general hospital from 2010-2012. Bronchoalveolar lavage sampling was collected, and then followed by standard culture and drug-sensitive test. Risk factors were analyzed by multivariate logistic analysis. One hundred twenty-eight strains were isolated in 94 patients, gram-negative bacilli (57.8%) was the predominant cultured microorganism, followed by fungus (28.9%) and gram-positive cocci (13.3%). The 5 main isolated bacteria demonstrated high and multiantibiotic resistance. The crude overall mortality was 43.8%, 50%, and 40%, respectively, in hospital- and community-acquired aspiration pneumonia group. Multivariate logistic analysis identified age older than 65 years, use of inotropic support, and ineffective initial therapy as independent risk factors of poor outcome. The predominant pathogenic bacteria of aspiration pneumonia in patients admitted to an RICU were antibiotic-resistant bacteria, and effective initial supportive management secured better prognosis. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  15. High prevalence of methicillin-resistant Staphylococcus aureus clone ST80-IV in hospital and community settings in Algiers.

    Science.gov (United States)

    Antri, K; Rouzic, N; Dauwalder, O; Boubekri, I; Bes, M; Lina, G; Vandenesch, F; Tazir, M; Ramdani-Bouguessa, N; Etienne, J

    2011-04-01

    USA300 is an epidemic community-acquired methicillin-resistant Staphylococcus aureus (C-MRSA) clone in the USA, whereas the European C-MRSA clone ST80-IV has mainly a sporadic diffusion in Europe. The prevalence of European clone ST80-IV in Algeria is poorly documented. We prospectively studied S. aureus infections at Mustapha Bacha hospital in Algiers over a 20-month period. S. aureus nasal colonization was studied during a further 6-month period. The European clone ST80-IV was responsible for more than one-third of both community infections (35.7%) and hospital infections (35.8%). Panton-Valentine leukocidin (PVL)-positive MRSA isolated from hospital inpatients were resistant to multiple antibiotics, including fluoroquinolones in 44.9% of cases. The PVL-positive MRSA nasal carriage rate was high among patients and staff in the dermatology unit (8.7% and 18.5%, respectively), but low (2.7%) among patients attending the outpatient clinic. The European PVL-positive C-MRSA clone ST80-IV is widespread in the Algiers hospital and community settings. © 2010 The Authors. Journal Compilation © 2010 European Society of Clinical Microbiology and Infectious Diseases.

  16. Association Between Hospitalization With Community-Acquired Laboratory-Confirmed Influenza Pneumonia and Prior Receipt of Influenza Vaccination.

    Science.gov (United States)

    Grijalva, Carlos G; Zhu, Yuwei; Williams, Derek J; Self, Wesley H; Ampofo, Krow; Pavia, Andrew T; Stockmann, Chris R; McCullers, Jonathan; Arnold, Sandra R; Wunderink, Richard G; Anderson, Evan J; Lindstrom, Stephen; Fry, Alicia M; Foppa, Ivo M; Finelli, Lyn; Bramley, Anna M; Jain, Seema; Griffin, Marie R; Edwards, Kathryn M

    2015-10-13

    Few studies have evaluated the relationship between influenza vaccination and pneumonia, a serious complication of influenza infection. To assess the association between influenza vaccination status and hospitalization for community-acquired laboratory-confirmed influenza pneumonia. The Etiology of Pneumonia in the Community (EPIC) study was a prospective observational multicenter study of hospitalizations for community-acquired pneumonia conducted from January 2010 through June 2012 at 4 US sites. In this case-control study, we used EPIC data from patients 6 months or older with laboratory-confirmed influenza infection and verified vaccination status during the influenza seasons and excluded patients with recent hospitalization, from chronic care residential facilities, and with severe immunosuppression. Logistic regression was used to calculate odds ratios, comparing the odds of vaccination between influenza-positive (case) and influenza-negative (control) patients with pneumonia, controlling for demographics, comorbidities, season, study site, and timing of disease onset. Vaccine effectiveness was estimated as (1 - adjusted odds ratio) × 100%. Influenza vaccination, verified through record review. Influenza pneumonia, confirmed by real-time reverse-transcription polymerase chain reaction performed on nasal/oropharyngeal swabs. Overall, 2767 patients hospitalized for pneumonia were eligible for the study; 162 (5.9%) had laboratory-confirmed influenza. Twenty-eight of 162 cases (17%) with influenza-associated pneumonia and 766 of 2605 controls (29%) with influenza-negative pneumonia had been vaccinated. The adjusted odds ratio of prior influenza vaccination between cases and controls was 0.43 (95% CI, 0.28-0.68; estimated vaccine effectiveness, 56.7%; 95% CI, 31.9%-72.5%). Among children and adults hospitalized with community-acquired pneumonia, those with laboratory-confirmed influenza-associated pneumonia, compared with those with pneumonia not

  17. Association between hospitalization with community acquired laboratory-confirmed influenza pneumonia and prior receipt of influenza vaccination

    Science.gov (United States)

    Grijalva, Carlos G.; Zhu, Yuwei; Williams, Derek J.; Self, Wesley H.; Ampofo, Krow; Pavia, Andrew T.; Stockmann, Chris R.; McCullers, Jonathan; Arnold, Sandra R.; Wunderink, Richard G.; Anderson, Evan J.; Lindstrom, Stephen; Fry, Alicia M.; Foppa, Ivo M.; Finelli, Lyn; Bramley, Anna M.; Jain, Seema; Griffin, Marie R.; Edwards, Kathryn M.

    2015-01-01

    Importance Few studies have evaluated the relationship between influenza vaccination and pneumonia, a serious complication of influenza infection. Objective Assess the association between influenza vaccination status and hospitalization for community-acquired laboratory-confirmed influenza pneumonia. Design, Setting and Participants The Etiology of Pneumonia in the Community (EPIC) study was a prospective observational multicenter study of hospitalizations for community-acquired pneumonia conducted from January 2010 through June 2012 in four US sites. We used EPIC study data from patients ≥6 months of age with laboratory-confirmed influenza infection and verified vaccination status during the influenza seasons, and excluded patients with recent hospitalization, from chronic care residential facilities, and with severe immunosuppression. Logistic regression was used to calculate odds ratios, comparing the odds of vaccination between influenza-positive (cases) and influenza-negative (controls) pneumonia patients, controlling for demographics, co-morbidities, season, study site and timing of disease onset. Vaccine effectiveness was estimated as (1-odds ratio) × 100%. Exposure Influenza vaccination, verified through record review. Outcome Influenza pneumonia, confirmed by real-time reverse transcription-polymerase chain reaction performed on nasal/oropharyngeal swabs. Results Overall, 2767 patients hospitalized for pneumonia were eligible for the study; 162 (5.9%) were influenza positive. Twenty-eight (17%) of 162 cases with influenza-associated pneumonia and 766 (29%) of 2605 controls with influenza-negative pneumonia had been vaccinated. The adjusted odds ratio of prior influenza vaccination between cases and controls was 0.43 (95% CI 0.28–0.68 [estimated vaccine effectiveness 56.7% (95% CI 31.9–72.5)]). Conclusions and relevance Among children and adults hospitalized with community-acquired pneumonia, those with laboratory confirmed influenza

  18. Epidemiology, species distribution, antifungal susceptibility and outcome of candidemia among Internal Medicine Wards of community hospitals of Udine province, Italy

    Directory of Open Access Journals (Sweden)

    Federico Silvestri

    2014-09-01

    Full Text Available Candidemia is an emerging problem among patients hospitalized in Internal Medicine Wards (IMW. We performed a retrospective study to assess the epidemiology, species distribution, antifungal susceptibility and outcome of candidaemia recorded over a 3-year period (2010-2012 among IMW of community hospitals of Udine province in Italy: forty-eight patients were identified, with an overall incidence of 1.44 cases/1000 hospital admissions/year. Candida albicans was the most frequent species, followed by Candida parapsilosis that accounted for 42.9% of Tolmezzo cases. All isolates were susceptible to amphotericin and caspofungin, while 11.4% of strains were not-susceptible to voriconazole and 14.3% to fluconazole. Crude mortality was 41.7%. In conclusion, in community hospitals overall incidence of candidemia is similar to tertiary care hospitals, but 80% of cases are detected in IMW. Candida species distribution is overlapping, but differences in local epidemiology were found and should be taken into consideration. No resistance to amphotericin and caspofungin was found while resistance to azoles was observed. Knowledge of this data might be useful when planning the best therapeutic strategy.

  19. Implementation of the ABCDE Bundle to Improve Patient Outcomes in the Intensive Care Unit in a Rural Community Hospital.

    Science.gov (United States)

    Kram, Stacey L; DiBartolo, Mary C; Hinderer, Katherine; Jones, Ruth Ann

    2015-01-01

    The ABCDE bundle is an evidence-based, multidisciplinary approach to optimizing patient outcomes in the adult intensive care unit (ICU). The ABCDE bundle incorporates awakening, breathing, coordination, delirium monitoring and management, and early mobility to minimize potentially deleterious effects of prolonged hospitalization, including the development of delirium. Health care organizations that implement the ABCDE bundle have improved patient outcomes such as decreased ICU and hospital lengths of stay, decreased duration of mechanical ventilation, decreased prevalence and duration of delirium, and decreased health care costs. The purpose of this evidence-based practice project was to implement the ABCDE bundle in a six-bed general adult ICU of a rural community hospital. Implementation of the bundle decreased average patient hospital length of stay by 1.8 days, reduced length of mechanical ventilation by an average of 1 day, and established a baseline delirium prevalence of 19% over a 3-month time period. The results of this project indicate that the ABCDE bundle can be implemented in rural, community-based hospitals and provides a safe, cost-effective method for enhancing ICU patient outcomes.

  20. 76 FR 39043 - TRICARE; Reimbursement of Sole Community Hospitals and Adjustment to Reimbursement of Critical...

    Science.gov (United States)

    2011-07-05

    ... hospitals located within Military Treatment Facility (MTF) Prime Service Areas (PSAs) and deemed essential... concerned that some hospitals might leave the TRICARE network if payments were reduced too quickly. This was.... (2) Maryland hospitals are excluded. List of Subjects in 32 CFR Part 199 Claims, Dental health...

  1. Hospitalization, a risk factor for antibiotic-resistant Escherichia coli in the community?

    NARCIS (Netherlands)

    Bruinsma, N; Filius, PMG; van den Bogaard, AE; Nys, S; Degener, J; Endtz, HP; Stobberingh, EE

    Objective: The impact of hospitalization on the prevalence of resistant Escherichia coli in the intestinal flora of patients admitted to the surgical wards of three Dutch university-affiliated hospitals was analysed prospectively. Methods: Faecal samples were obtained on admission to the hospital,

  2. Empiric antibiotic coverage of atypical pathogens for community-acquired pneumonia in hospitalized adults.

    Science.gov (United States)

    Eliakim-Raz, Noa; Robenshtok, Eyal; Shefet, Daphna; Gafter-Gvili, Anat; Vidal, Liat; Paul, Mical; Leibovici, Leonard

    2012-09-12

    Community-acquired pneumonia (CAP) is caused by various pathogens, traditionally divided into 'typical' and 'atypical'. Initial antibiotic treatment of CAP is usually empirical, customarily covering both typical and atypical pathogens. To date, no sufficient evidence exists to support this broad coverage, while limiting coverage is bound to reduce toxicity, resistance and expense. The main objective was to estimate the mortality and proportion with treatment failure using regimens containing atypical antibiotic coverage compared to those that had typical coverage only. Secondary objectives included the assessment of adverse events. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) Issue 3, 2012 which includes the Acute Respiratory Infection Group's Specialized Register, MEDLINE (January 1966 to April week 1, 2012) and EMBASE (January 1980 to April 2012). Randomized controlled trials (RCTs) of adult patients hospitalized due to CAP, comparing antibiotic regimens with atypical coverage (quinolones, macrolides, tetracyclines, chloramphenicol, streptogramins or ketolides) to a regimen without atypical antibiotic coverage. Two review authors independently assessed the risk of bias and extracted data from included trials. We estimated risk ratios (RRs) with 95% confidence intervals (CIs). We assessed heterogeneity using a Chi(2) test. We included 28 trials, encompassing 5939 randomized patients. The atypical antibiotic was administered as monotherapy in all but three studies. Only one study assessed a beta-lactam combined with a macrolide compared to the same beta-lactam. There was no difference in mortality between the atypical arm and the non-atypical arm (RR 1.14; 95% CI 0.84 to 1.55), RR atypical arm. The atypical arm showed an insignificant trend toward clinical success and a significant advantage to bacteriological eradication, which disappeared when evaluating methodologically high quality studies alone. Clinical success for the atypical arm

  3. Toward Army Maneuver Transformation

    National Research Council Canada - National Science Library

    O'Brien, Charles B

    2006-01-01

    ..., can be satisfied to form the nucleus of land domain Force Application formations. This branch will be responsive to the needs of the joint force in Unified Action by adjusting the institutional inputs to force development of Army Maneuver Forces...

  4. A geographic information system analysis of the impact of a statewide acute stroke emergency medical services routing protocol on community hospital bypass.

    Science.gov (United States)

    Asimos, Andrew W; Ward, Shana; Brice, Jane H; Enright, Dianne; Rosamond, Wayne D; Goldstein, Larry B; Studnek, Jonathan

    2014-01-01

    Our goal was to determine if a statewide Emergency Medical Services (EMSs) Stroke Triage and Destination Plan (STDP), specifying bypass of hospitals unable to routinely treat stroke patients with thrombolytics (community hospitals), changed bypass frequency of those hospitals. Using a statewide EMS database, we identified stroke patients eligible for community hospital bypass and compared bypass frequency 1-year before and after STDP implementation. Symptom onset time was missing for 48% of pre-STDP (n = 2385) and 29% of post-STDP (n = 1612) cases. Of the remaining cases with geocodable scene addresses, 58% (1301) in the pre-STDP group and 61% (2,078) in the post-STDP group were ineligible for bypass, because a community hospital was not the closest hospital to the stroke event location. Because of missing data records for some EMS agencies in 1 or both study periods, we included EMS agencies from only 49 of 100 North Carolina counties in our analysis. Additionally, we found conflicting hospital classifications by different EMS agencies for 35% of all hospitals (n = 38 of 108). Given these limitations, we found similar community hospital bypass rates before and after STDP implementation (64%, n = 332 of 520 vs. 63%, n = 345 of 552; P = .65). Missing symptom duration time and data records in our state's EMS data system, along with conflicting hospital classifications between EMS agencies limit the ability to study statewide stroke routing protocols. Bypass policies may apply to a minority of patients because a community hospital is not the closest hospital to most stroke events. Given these limitations, we found no difference in community hospital bypass rates after implementation of the STDP. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  5. ORIGINAL ARTICLE: Preparedness of Prospective Nurses to Work as Midwives in Hospital and Community

    Directory of Open Access Journals (Sweden)

    Pratibha A Chandekar

    2012-01-01

    Full Text Available Background: It is desirable to have skilled midwives to provide competent care in hospital and community setting. Aims and Objectives: The objectives were to assess curriculum adequacy, preparedness and job preferences of prospective nurses. Materials and Methods: A descriptive survey was used for the study. Thestudy was carried out at nursing institutes in Ahmednagar District, Maharashtra, India. The participants were the 200 prospective Nurses(final year Nursing students of General Nursing and B.Sc Nursing Programme, who had undergone midwifery examination. A semi structured questionnaire with self report technique method was used. Results: 20.57% and 89.1% students respectively felt that, thetheory input and allotted clinical hours were adequate. During the clinical posting, 29.7% felt that they did not get the opportunity to work in midwifery sections. 33.1% students expressed that they did not get cases as per the requirement prescribed by Indian NursingCouncil.13.7% and 33.7% students respectively agreed that they lacked confidence to perform abdominal palpation of antenatal cases & conduct deliveries independently. A few (26.2% expressed their inability to resuscitate the newborn. 89.1% said that they needed more experience to work independently as midwives. Everyone felt the need of in-service education and majority (77.2% felt that its duration should be either three months or more. Conclusion: Present study reveals that only 7% of the prospective nurses are ready to work in midwifery section. Only 13.7% of the prospective nurses are ready to work in rural area. Since there is a shortfall of 70.02% forspeciality of obstetrics and gynecology in rural health (GOI, 1997, and there are only 40 qualified nurse midwives per 100,000 births inIndia or only one midwife for 2500 births in rural areas, it is imperative to strengthen midwifery training to bridge this gap.

  6. Food Choices and Consequences for the Nutritional Status: Insights into Nutrition Transition in an Hospital Community.

    Science.gov (United States)

    Piple, Jitendra; Gora, Ranjeet; Purbiya, Pragati; Puliyel, Ashish; Chugh, Parul; Bahl, Pinky; Puliyel, Jacob

    2015-01-01

    Although economic development is generally accompanied by improvements in the overall nutritional status of the country's population the 'nutritional transition' often involves a shift to high energy diets and less exercise with negative consequences. This pilot study was done to examine if education of parents operates at the household level to influence dietary choices and the nutritional status of children in a small community of hospital workers. 3 groups of persons with varying skill and education levels participated. Weighed food logs were used in all households to calculate 'adult equivalent' per-capita-consumption. Nutrients were calculated using nutrients calculator software. BMI was used to classify children as underweight, normal weight and overweight. 128 individuals participated from 30 families included 47 children. 10 children (21%) were underweight, 29 (62%) were normal and 8 (17%) were overweight. Energy consumption was highest in families with overweight children 2692 +/-502 compared to 2259 +/-359 in families with normal weight and 2031+/-354 in the family of underweight children. These differences were statistically significant. 42% underweight children belonged to Class 1 at the lowest skill level and there were no overweight children in this group. Most of the overweight children belonged to Class 2. In Class 3 there were no underweight children and the majority was normal weight children. Underweight children came from the poorer households. Per capita intake of the family as a whole correlated well with BMI in the children. There was increased obesity in middle income families belonging to Class 2-probably in families who move up the scale from deprivation. Nutritional status in children correlated mostly with maternal education status.

  7. Using the Targeted Solutions Tool® to Improve Emergency Department Handoffs in a Community Hospital.

    Science.gov (United States)

    Benjamin, Mignon F; Hargrave, Sarah; Nether, Klaus

    2016-03-01

    There is little evidence for solutions to improve the handoff process between units, particularly from the emergency department (ED) to the inpatient unit. A systematic approach was used to improve the handoff communication process between the ED and the four private physician groups serving Juneau, Alaska, that admit and deliver care to patients of a 73-bed, Level 4 trauma center community hospital. Data were collected in using the Joint Commission Center for Transforming Healthcare's Targeted Solutions Tool (®)(TST(®)) to determine the rate of defective handoff communications and the factors that contributed to those defective handoff communications. Targeted solutions were then implemented to specifically address the identified contributing factors. A random sample of 107 handoff opportunities was collected during the baseline phase (November 4, 2011- January 12, 2012) to measure performance and identify the contributing factors that led to defective handoffs. The baseline handoff communications defective rate was 29.9% (32 defective handoffs/107 handoff opportunities). The top four contributing factors, together accounting for 69.8% of all the causes of defective handoffs, were inaccurate/incomplete information, method ineffective, no standardized procedures for an effective handoff, and the person initiating the handoff, known as the "sender," lacks knowledge about the patient. After implementation of targeted solutions to the identified contributing factors, the handoff communications defective rate for the "improve" phase (April 1, 2012-July 29, 2012) was reduced from baseline by 58.2% to 12.5% (13 defective handoffs/104 handoff opportunities), p = 0.002; 2-proportions test. The number of adverse events related to hand-off communications declined as the handoff communications defective rate improved. Use of the TST was associated with improvement in the ED handoff communication process.

  8. Quality assurance of HDR prostate plans: Program implementation at a community hospital

    International Nuclear Information System (INIS)

    Rush, Jennifer B.; Thomas, Michael D.

    2005-01-01

    Adenocarcinoma of the prostate is currently the most commonly diagnosed cancer in men in the United States, and the second leading cause of cancer mortality. The utilization of radiation therapy is regarded as the definitive local therapy of choice for intermediate- and high-risk disease, in which there is increased risk for extracapsular extension, seminal vesicle invasion, or regional node involvement. High-dose-rate (HDR) brachytherapy is a logical treatment modality to deliver the boost dose to an external beam radiation therapy (EBRT) treatment to increase local control rates. From a treatment perspective, the utilization of a complicated treatment delivery system, the compressed time frame in which the procedure is performed, and the small number of large dose fractions make the implementation of a comprehensive quality assurance (QA) program imperative. One aspect of this program is the QA of the HDR treatment plan. Review of regulatory and medical physics professional publications shows that substantial general guidance is available. We provide some insight to the implementation of an HDR prostate plan program at a community hospital. One aspect addressed is the utilization of the low-dose-rate (LDR) planning system and the use of existing ultrasound image sets to familiarize the radiation therapy team with respect to acceptable HDR implant geometries. Additionally, the use of the LDR treatment planning system provided a means to prospectively determine the relationship between the treated isodose volume and the product of activity and time for the department's planning protocol prior to the first HDR implant. For the first 12 HDR prostate implants, the root-mean-square (RMS) deviation was 3.05% between the predicted product of activity and time vs. the actual plan values. Retrospective re-evaluation of the actual implant data reduced the RMS deviation to 2.36%

  9. Food Choices and Consequences for the Nutritional Status: Insights into Nutrition Transition in an Hospital Community.

    Directory of Open Access Journals (Sweden)

    Jitendra Piple

    Full Text Available Although economic development is generally accompanied by improvements in the overall nutritional status of the country's population the 'nutritional transition' often involves a shift to high energy diets and less exercise with negative consequences. This pilot study was done to examine if education of parents operates at the household level to influence dietary choices and the nutritional status of children in a small community of hospital workers.3 groups of persons with varying skill and education levels participated. Weighed food logs were used in all households to calculate 'adult equivalent' per-capita-consumption. Nutrients were calculated using nutrients calculator software. BMI was used to classify children as underweight, normal weight and overweight.128 individuals participated from 30 families included 47 children. 10 children (21% were underweight, 29 (62% were normal and 8 (17% were overweight. Energy consumption was highest in families with overweight children 2692 +/-502 compared to 2259 +/-359 in families with normal weight and 2031+/-354 in the family of underweight children. These differences were statistically significant. 42% underweight children belonged to Class 1 at the lowest skill level and there were no overweight children in this group. Most of the overweight children belonged to Class 2. In Class 3 there were no underweight children and the majority was normal weight children.Underweight children came from the poorer households. Per capita intake of the family as a whole correlated well with BMI in the children. There was increased obesity in middle income families belonging to Class 2-probably in families who move up the scale from deprivation. Nutritional status in children correlated mostly with maternal education status.

  10. Army Public Service Advertising.

    Science.gov (United States)

    1982-12-01

    publicists who are ever searching for economical forums through which to communicate Army viewpoints. The majority of interview and information programs...Guard to obtain public service time on stations which normally 48 reject regular Army requests. There is evidence that National Guard publicists have... Audiovisual Agency at Norton Air Force Base where it is dubbed on a C-type audio cassette and mailed directly to eighty-four radio stations. The cost of

  11. No Specific Time Window Distinguishes between Community-, Healthcare-, and Hospital-Acquired Bacteremia, but They Are Prognostically Robust

    DEFF Research Database (Denmark)

    Gradel, Kim Oren; Nielsen, Stig Lønberg; Pedersen, Court

    2014-01-01

    mortality pertaining to bacteremia 0, 1, 2, …, 30, and 31 days and later after admission. Next, we assessed whether different admission (0-1, 0-2, 0-3, 0-7 days) and HCA (30, 90 days) time windows were associated with changes in odds ratio (OR) and area under the receiver operating characteristic (ROC......Objective. We examined whether specific time windows after hospital admission reflected a sharp transition between community and hospital acquisition of bacteremia. We further examined whether different time windows to distinguish between community acquisition, healthcare association (HCA......) curve for 30-day mortality, adjusting for sex, age, comorbidity, and microorganisms. Results. For 56,606 bacteremic episodes, no sharp transitions were detected on a specific day after admission. Among the 8 combined time windows, ORs for 30-day mortality varied from 1.30 (95% confidence interval [CI...

  12. Emergence of Community-Genotype Methicillin-Resistant Staphylococcus aureus in Korean Hospitals: Clinical Characteristics of Nosocomial Infections by Community-Genotype Strain

    Science.gov (United States)

    Kim, So Hyun; Baek, Jin Yang; Lee, Nam Yong; Cho, Sun Young; Ha, Young Eun; Kang, Cheol-In; Peck, Kyong Ran; Song, Jae-Hoon

    2017-01-01

    Background As community-genotype methicillin-resistant Staphylococcus aureus (MRSA) strains spread into hospitals, the genotypes of the MRSA strains causing hospital-acquired (HA) infections have become more diverse. We describe clinical characteristics of nosocomial MRSA infections by a community-genotype of sequence type (ST) 72. Materials and Methods A case-control study was designed among patients with HA-MRSA infections. Forty patients with infections caused by ST72-MRSA SCCmec type IV were selected as cases. Cases were matched to the controls with 106 patients infected with ST5/ST239 MRSA, which are representative hospital genotypes in Korea. Results Patients infected with ST72 isolates were younger than those with ST5/ST239 isolates. Female gender predominated among ST72 MRSA group compared to ST5/ST239 MRSA group. Solid tumor was a more frequent underlying disease in MRSA infections by ST72 isolates, whereas underlying renal, lung, heart, and neurologic diseases were more frequently found in those by ST5/ST239 isolates. The most common type of infection was pneumonia in both ST72 and ST5/ST239 groups (45.0% vs. 51.9%), followed by skin and soft tissue infection (SSTI). Female gender and underlying solid tumor were identified to be independent predictors for MRSA infections by ST72 isolates. All-cause mortality rates (20.0% vs. 30.2%) were not different between the groups. Conclusion A community-genotype MRSA, ST72 isolate has emerged as a nosocomial pathogen presenting as hospital-acquired pneumonia and SSTI. Although differences in underlying disorders were found, the distribution of infection type and mortality rate did not differ between the groups. PMID:28608660

  13. Implementing an intensified antibiotic stewardship programme targeting cephalosporin and fluoroquinolone use in a 200-bed community hospital in Germany.

    Science.gov (United States)

    Borde, J P; Litterst, S; Ruhnke, M; Feik, R; Hübner, J; deWith, K; Kaier, K; Kern, W V

    2015-02-01

    Prescription of third-generation cephalosporins and fluoroquinolones has been linked to an increasing incidence of gram-negative bacteria producing extended-spectrum beta-lactamases, methicillin-resistant Staphylococcus aureus and nosocomial infection with Clostridium difficile. Antibiotic stewardship (ABS) programmes offer evidence-based tools to control antibiotic prescription rates and thereby influence the incidence of nosocomial infection and contain the development of multidrug-resistant bacteria, but there is limited experience with such programmes at community hospitals. We implemented an ABS programme at a 200-bed community hospital and aimed at a > 30 % reduction of cephalosporin and fluoroquinolone consumption within 1 year. Pharmacy data were obtained to estimate hospital-wide drug use density expressed in WHO-ATC-defined daily doses (DDD) or hospital-adapted recommended daily doses (RDD) per 1,000 patient days. The effect of the ABS intervention on drug use density was analysed using interrupted time-series analysis for the periods between January 2011 and March 2013 as pre-intervention, and between April 2013 and March 2014 as post-intervention period. The CDI incidence was calculated based on microbiology laboratory data. Cephalosporin use (measured in RDD/1,000 patient days) decreased by 33 %, and fluoroquinolone use decreased by 31 %, respectively. Interrupted time-series analysis confirmed significant changes in the drug use density trends for both cephalosporins and fluoroquinolones after the intervention as well as for total antibiotic use that decreased by 11 % while no significant effect was noted for CDI incidence rates. ABS programmes can be effective in community hospitals and may help establish ecologically advantageous antibiotic strategies when needed.

  14. Comparison of community and hospital pharmacists' attitudes and behaviors on medication error disclosure to the patient: A pilot study.

    Science.gov (United States)

    Kim, ChungYun; Mazan, Jennifer L; Quiñones-Boex, Ana C

    To determine pharmacists' attitudes and behaviors on medication errors and their disclosure and to compare community and hospital pharmacists on such views. An online questionnaire was developed from previous studies on physicians' disclosure of errors. Questionnaire items included demographics, environment, personal experiences, and attitudes on medication errors and the disclosure process. An invitation to participate along with the link to the questionnaire was electronically distributed to members of two Illinois pharmacy associations. A follow-up reminder was sent 4 weeks after the original message. Data were collected for 3 months, and statistical analyses were performed with the use of IBM SPSS version 22.0. The overall response rate was 23.3% (n = 422). The average employed respondent was a 51-year-old white woman with a BS Pharmacy degree working in a hospital pharmacy as a clinical staff member. Regardless of practice settings, pharmacist respondents agreed that medication errors were inevitable and that a disclosure process is necessary. Respondents from community and hospital settings were further analyzed to assess any differences. Community pharmacist respondents were more likely to agree that medication errors were inevitable and that pharmacists should address the patient's emotions when disclosing an error. Community pharmacist respondents were also more likely to agree that the health care professional most closely involved with the error should disclose the error to the patient and thought that it was the pharmacists' responsibility to disclose the error. Hospital pharmacist respondents were more likely to agree that it was important to include all details in a disclosure process and more likely to disagree on putting a "positive spin" on the event. Regardless of practice setting, responding pharmacists generally agreed that errors should be disclosed to patients. There were, however, significant differences in their attitudes and behaviors

  15. Improving Access to Adjuvant Intravesical Therapy for Non-Muscle Invasive Bladder Cancer in a Community Hospital.

    Science.gov (United States)

    Carvalho, Dorothy R

    2015-01-01

    Relative to the high incidence of bladder cancer in Connecticut, an analysis of practice patterns in treatment of early stage bladder cancer was undertaken in a 275-bed community hospital, to determine if the practice patterns mirrored National Comprehensive Cancer Network guidelines. A nurse-led performance improvement project followed. Subsequently change in bladder cancer recurrence rates related to change in practice patterns was assessed.

  16. The Characteristics of Personal Order Sets in a Computerized Physician Order Entry System at a Community Hospital

    OpenAIRE

    Thomas, Sean M.; Davis, Daniel C.

    2003-01-01

    Personal order sets (POS) have been touted as important for the success of a computerized physician order entry (CPOE) system1. However, POS may systematize practice variability and are difficult to centrally administer. Few studies have looked at the characteristics and use of POS in a community hospital. We examined how POS are used at the Queen’s Medical Center (QMC). POS are an important part of the success of the QMC CPOE, but have definite disadvantages.

  17. Tracks FAQs: How Do Heart Attack Hospitalization Rates In My Community Compare With Other Counties Or States?

    Centers for Disease Control (CDC) Podcasts

    2011-09-01

    In this podcast, CDC Tracking experts discuss how to compare heart attack hospitalization rates in your community with other counties or states. Do you have a question for our Tracking experts? Please e-mail questions to trackingsupport@cdc.gov.  Created: 9/1/2011 by National Center for Environmental Health, Division of Environmental Hazards and Health Effects, Environmental Health Tracking Branch.   Date Released: 9/1/2011.

  18. Falls prevention education between older adults and healthcare providers during transition from hospital to community-living

    OpenAIRE

    Lee, Den-Ching Angel

    2017-01-01

    Background: Falls are a problem for older adults. In particular, older hospitalised adults and those recently discharged from hospital have been shown to be at an increased risk of falls compared to older adults living in the community. Falls impact negatively on the physical and psychosocial well-being of older adults. They increase the burden of care for their family, caregivers and the healthcare system. However, many falls in older adults are preventable. Cochrane reviews demonstrated man...

  19. Characteristics of the Websites of the Community of Madrid Hospitals: Relationship between Web Quality and Corporate Social Responsibility

    Directory of Open Access Journals (Sweden)

    Herenia Gutiérrez-Ponce

    2018-02-01

    Full Text Available The aim of this research is to analyse the quality of websites of the public and private hospitals of the Community of Madrid; as well as to identify its relationship with the indicators of Corporate Social Responsibility (CSR. This study is in tune with the increasing demand of digital information about health institutions in follow-up of the Law of Transparency, Access to the Public Information and Good Government. The methodology used, supported by previous academic publications, consists on exploring the scores of hospitals by means of questionnaires and accessibility tools able to identify the quality of a web information, and its statistical relation with CSR indicators, especially in the case of public hospitals.

  20. 50th Anniversary Celebration: 46th Sagamore Army Materials Research Conference on Advances and Needs in Multi-Spectral Transparent Materials Technology

    National Research Council Canada - National Science Library

    Sands, James M; McCauley, James W

    2008-01-01

    ... technology issues of critical importance to the U.S. Army community. The 46th Sagamore Army Materials Research Conference continued this tradition with a focus on Advances and Needs in Multi-Spectral Transparent Materials Technology...

  1. Community-based management of multiple drug resistant tuberculosis in a tertiary hospital in Tanzania: a best practice implementation project.

    Science.gov (United States)

    Jelly, Isaya; Peters, Micah D J

    2017-12-01

    The World Health Organization (WHO) has prioritized collaboration with communities in its 2016 "End TB" implementation strategy. Acknowledging the difficulties that some communities face in gaining access to health facilities due to barriers such as stigma, discrimination, healthcare expenditure, transport and income loss, partnering with communities in the roll-out of community-based TB management activities is vital. The aim of this project was to make a contribution to promoting evidence-based practice with regards to the community-based management of multidrug-resistant tuberculosis (MDR-TB) at Kibong'oto National Infectious Disease Hospital, Tanzania, and thereby supporting improvements in patient outcomes and resource utilization. The project utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI PACES) program to facilitate the collection of pre- and post-audit data. The Getting Research into Practice (GRiP) module was also used to analyze the potential barriers and for designing the final action plan. This project was conducted in three phases over a three-month period at the MDR-TB unit in a referral hospital in Northern Tanzania. The project showed that there were significant improvements in compliance rates in staff education and documentation of patients' suitability and preferences in receiving community-based care for MDR-TB. The compliance rate of criterion 2, which was already 100% at baseline, was slightly lower at follow-up. The project achieved significant improvements in the delivery of evidence-based practice with regards to community-based management of MDR-TB.

  2. Shifting contours of boundaries: an exploration of inter-agency integration between hospital and community interprofessional diabetes programs.

    Science.gov (United States)

    Wong, Rene; Breiner, Petra; Mylopoulos, Maria

    2014-09-01

    This article reports on research into the relationships that emerged between hospital-based and community-based interprofessional diabetes programs involved in inter-agency care. Using constructivist grounded theory methodology we interviewed a purposive theoretical sample of 21 clinicians and administrators from both types of programs. Emergent themes were identified through a process of constant comparative analysis. Initial boundaries were constructed based on contrasts in beliefs, practices and expertise. In response to bureaucratic and social pressures, boundaries were redefined in a way that created role uncertainty and disempowered community programs, ultimately preventing collaboration. We illustrate the dynamic and multi-dimensional nature of social and symbolic boundaries in inter-agency diabetes care and the tacit ways in which hospitals can maintain a power position at the expense of other actors in the field. As efforts continue in Canada and elsewhere to move knowledge and resources into community sectors, we highlight the importance of hospitals seeing beyond their own interests and adopting more altruistic models of inter-agency integration.

  3. [Local communalization of clinical records between the municipal community hospital and local medical institutes by using information technology].

    Science.gov (United States)

    Iijima, Shohei; Shinoki, Keiji; Ibata, Takeshi; Nakashita, Chisako; Doi, Seiko; Hidaka, Kumi; Hata, Akiko; Matsuoka, Mio; Waguchi, Hideko; Mito, Saori; Komuro, Ryutaro

    2012-12-01

    We introduced the electronic health record system in 2002. We produced a community medical network system to consolidate all medical treatment information from the local institute in 2010. Here, we report on the present status of this system that has been in use for the previous 2 years. We obtained a private server, set up a virtual private network(VPN)in our hospital, and installed dedicated terminals to issue an electronic certificate in 50 local institutions. The local institute applies for patient agreement in the community hospital(hospital designation style). They are then entitled to access the information of the designated patient via this local network server for one year. They can access each original medical record, sorted on the basis of the medical attendant and the chief physician; a summary of hospital stay; records of medication prescription; and the results of clinical examinations. Currently, there are approximately 80 new registrations and accesses per month. Information is provided in real time allowing up to date information, helping prescribe the medical treatment at the local institute. However, this information sharing system is read-only, and there is no cooperative clinical pass system. Therefore, this system has a limit to meet the demand for cooperation with the local clinics.

  4. Methicillin-Resistant Staphylococcus aureus in the Community in Luanda, Angola: Blurred Boundaries with the Hospital Setting.

    Science.gov (United States)

    Conceição, Teresa; Coelho, Céline; Santos Silva, Isabel; de Lencastre, Hermínia; Aires-de-Sousa, Marta

    2016-01-01

    Although the nosocomial prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in Angola is over 60% and one of the highest in Africa, the extent of MRSA in the community is unknown. To fill this gap, we conducted a hospital-based study in which 158 children attending the emergency ward and ambulatory services of a pediatric hospital in Luanda, the capital of Angola, were screened for S. aureus nasal colonization. Overall, 70 (44.3%) individuals were colonized with S. aureus, of which 20 (28.6%) carried MRSA, resulting in a prevalence of 12.7% (20/158) of MRSA in the population screened. Molecular characterization by pulsed-field gel electrophoresis (PFGE), spa typing, multilocus sequence typing, and SCCmec typing distributed the isolates into two major MRSA clones and one dominant methicillin-susceptible S. aureus (MSSA) lineage, corresponding to the main clones circulating in hospitals in Luanda. The MRSA isolates mainly belonged to clones A (PFGE type A, spa type t105, ST5-IVa-65%) and B (PFGE B, t3869, ST88-IVa-30%), while MSSA isolates mainly belonged to clone L (PFGE type L, t861, ST508-42%). S. aureus isolates showed resistance to penicillin (96%), rifampin (87%), and trimethoprim-sulfamethoxazole (21%). In conclusion, the prevalence of MRSA among children in the community in Luanda is high and seems to originate from hospitals, warranting continuous monitoring and implementation of additional infection control measures.

  5. The Institutional Army, FY1975-FY2002

    National Research Council Canada - National Science Library

    Brinkerhoff, John

    2002-01-01

    This report examines the Army's mission and functions to determine a useful way to report and analyze the Institutional Army-that part of the Army that supports the Title 10 responsibilities of the Army...

  6. Adherence with national guidelines in hospitalized patients with community-acquired pneumonia: results from the CAPO study in Venezuela.

    Science.gov (United States)

    Levy, Gur; Perez, Mario; Rodríguez, Benito; Hernández Voth, Ana; Perez, Jorge; Gnoni, Martin; Kelley, Robert; Wiemken, Timothy; Ramirez, Julio

    2015-04-01

    The Community-Acquired Pneumonia Organization (CAPO) is an international observational study in 130 hospitals, with a total of 31 countries, to assess the current management of hospitalized patients with community-acquired pneumonia (CAP). 2 Using the centralized database of CAPO was decided to conduct this study with the aim of evaluate the level of adherence with national guidelines in Venezuela, to define in which areas an intervention may be necessary to improve the quality of care of hospitalized patients with CAP. In this observational retrospective study quality indicators were used to evaluate the management of hospitalized patients with CAP in 8 Venezuelan's centers. The care of the patients was evaluated in the areas of: hospitalization, oxygen therapy, empiric antibiotic therapy, switch therapy, etiological studies, blood cultures indication, and prevention. The compliance was rated as good (>90%), intermediate (60% to 90%), or low (<60%). A total of 454 patients with CAP were enrolled. The empiric treatment administered within 8 hours of the patient arrival to the hospital was good (96%), but the rest of the indicators showed a low level of adherence (<60%). We can say that there are many areas in the management of CAP in Venezuela that are not performed according to the national guidelines of SOVETHORAX.1 In any quality improvement process the first step is to evaluate the difference between what is recommended and what is done in clinical practice. While this study meets this first step, the challenge for the future is to implement the processes necessary to improve the management of CAP in Venezuela. Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.

  7. Separate treatment of hospital and urban wastewaters: A real scale comparison of effluents and their effect on microbial communities.

    Science.gov (United States)

    Chonova, Teofana; Keck, François; Labanowski, Jérôme; Montuelle, Bernard; Rimet, Frédéric; Bouchez, Agnès

    2016-01-15

    Hospital wastewaters (HWW) contain wider spectrum and higher quantity of pharmaceuticals than urban wastewaters (UWW), but they are generally discharged in sewers without pretreatment. Since traditional urban wastewater treatment plants (WWTP) are not designed to treat HWWs, treated effluents may still contain pollutants that could impair receiving aquatic environments. Hence, a better understanding of the effect of pharmaceuticals in the environment is required. Biofilms are effective "biological sensors" for assessing the environmental effects of pharmaceuticals due to their ability to respond rapidly to physical, chemical and biological fluctuations by changes in their structure and composition. This study evaluated the efficiency of biological treatment with conventional activated sludge system performed parallel on HWW and UWW. Furthermore, six successive monthly colonizations of biofilms were done on autoclaved stones, placed in grid-baskets in the hospital treated effluents (HTE) and urban treated effluents (UTE). The biomass of these biofilms as well as the structure and diversity of their bacterial communities were investigated. Results showed better treatment efficiency for phosphate and nitrite/nitrate during the treatment of UWW. Pharmaceuticals from all investigated therapeutic classes (beta-blockers, nonsteroidal anti-inflammatory drugs, antibiotics, analgesics and anticonvulsants) were efficiently removed, except for carbamazepine. The removal efficiency of the antibiotics, NSAIDs and beta-blockers was higher during the treatment of HWW. HTE and UTE shaped the bacterial communities in different ways. Higher concentrations of pharmaceuticals in the HTE caused adapted development of the microbial community, leading to less developed biomass and lower bacterial diversity. Seasonal changes in solar irradiance and temperature, caused changes in the community composition of biofilms in both effluents. According to the removal efficiency of pharmaceuticals

  8. Index to Army Times 1992.

    Science.gov (United States)

    1993-02-01

    shortages. Army Times; June 1, 1992; 52("): p. 22. CHEMICAL WARFARE--CLOTHING Overprotective . Army Times; July 27, 1992; 52(53): p. 49. CHEMICAL WARFARE...Army Times; Nov. 30, 1992; 53(18): p. 26. CHILD ABUSE Allowance would help keep victimized families afloat. Army Times; May 18, 1992; 52(42): p. 11... CHILD ABUSE--COMPENSATION Benefits for abuse victims OK’d. Army Times; Oct. 19, 1992; 53(12): p. 26. CHILD ABUSE--GERMANY Germany: More child abuse? Army

  9. The 1991 Department of the Army Service Response Force exercise: Procedural Guide SRFX-91

    Energy Technology Data Exchange (ETDEWEB)

    Madore, M.A.; Thomson, R.S.; Haffenden, R.A.; Baldwin, T.E.; Meleski, S.A.

    1991-09-01

    This procedural guide was written to assist the US Army in planning for a chemical emergency exercise at Tooele Army Depot in Utah. The roles of various members of the emergency response community are described for various accident scenarios, and the relationships between the various responders are identified. For the June 1991 exercise at Tooele, the emergency response community includes the command structure at Tooele Army Depot; the US Army Service Response Force and other Department of Defense agencies; emergency response personnel from Tooele, Salt Lake, and Utah counties and municipal governments; the Utah Comprehensive Emergency Management Agency and other state agencies; and various federal agencies.

  10. [Evaluation of a Two-day Hospital On-site Training Program for Community Pharmacists: Approach to Facilitate Collaboration among Community Healthcare Professionals].

    Science.gov (United States)

    Sumi, Masaki; Hasegawa, Chiaki; Morii, Hiroaki; Hoshino, Nobuo; Okunuki, Yumi; Kanemoto, Kashie; Horie, Miya; Okamoto, Haruka; Yabuta, Naoki; Matsuda, Masashi; Kamiya, Takaki; Sudo, Masatomo; Masuda, Kyouko; Iwashita, Yuri; Matsuda, Kaori; Motooka, Yoshiko; Hira, Daiki; Morita, Shin-Ya; Terada, Tomohiro

    2018-01-01

     The importance of community-based care systems has increased due to the highly aging population and diversity of disease. To enhance the cooperation among healthcare professionals in community-based care systems, a two-day on-site training program for community pharmacists based on a multidisciplinary team approach was conducted at the Medical Science Hospital of Shiga University from April 2015 to March 2017. There were two professional courses in this training program: the palliative care course and nutrition support course. Both courses consisted of common pharmaceutical care training as follows: regional cooperation among healthcare professionals, pharmacist's clinical activities in the ward, pressure ulcer care, infection control, and aseptic technique for parenteral solutions. Each course was limited to 2 participants. A questionnaire was given to participants in the training program. Seventy-five pharmacists participated in the training and all of them answered the questionnaire. According to the questionnaire, 86% of participants felt that 2 days was an appropriate term for the training program. Positive answers regarding the content of each program and overall satisfaction were given by 100% and 99% of the participants, respectively. In the categorical classification of free comments regarding the expected change in pharmacy practice after the training, both "support for patients under nutritional treatment" and "cooperation with other medical staff" were answered by 24 participants. These results suggested that the 2-day on-site training for community pharmacists facilitated cooperation among healthcare professionals in the community.

  11. On being the right size: the impact of population size and stochastic effects on the evolution of drug resistance in hospitals and the community.

    Science.gov (United States)

    Kouyos, Roger D; Abel Zur Wiesch, Pia; Bonhoeffer, Sebastian

    2011-04-01

    The evolution of drug resistant bacteria is a severe public health problem, both in hospitals and in the community. Currently, some countries aim at concentrating highly specialized services in large hospitals in order to improve patient outcomes. Emergent resistant strains often originate in health care facilities, but it is unknown to what extent hospital size affects resistance evolution and the resulting spillover of hospital-associated pathogens to the community. We used two published datasets from the US and Ireland to investigate the effects of hospital size and controlled for several confounders such as antimicrobial usage, sampling frequency, mortality, disinfection and length of stay. The proportion of patients acquiring both sensitive and resistant infections in a hospital strongly correlated with hospital size. Moreover, we observe the same pattern for both the percentage of resistant infections and the increase of hospital-acquired infections over time. One interpretation of this pattern is that chance effects in small hospitals impede the spread of drug-resistance. To investigate to what extent the size distribution of hospitals can directly affect the prevalence of antibiotic resistance, we use a stochastic epidemiological model describing the spread of drug resistance in a hospital setting as well as the interaction between one or several hospitals and the community. We show that the level of drug resistance typically increases with population size: In small hospitals chance effects cause large fluctuations in pathogen population size or even extinctions, both of which impede the acquisition and spread of drug resistance. Finally, we show that indirect transmission via environmental reservoirs can reduce the effect of hospital size because the slow turnover in the environment can prevent extinction of resistant strains. This implies that reducing environmental transmission is especially important in small hospitals, because such a reduction not only

  12. Modifiable Risk Factors for Pneumonia Requiring Hospitalization among Community-Dwelling Older Adults: The Health, Aging, and Body Composition Study

    Science.gov (United States)

    Juthani-Mehta, Manisha; De Rekeneire, Nathalie; Allore, Heather; Chen, Shu; O’Leary, John R.; Bauer, Douglas C.; Harris, Tamara B.; Newman, Anne B.; Yende, Sachin; Weyant, Robert J.; Kritchevsky, Stephen; Quagliarello, Vincent

    2013-01-01

    Background Pneumonia requiring hospitalization remains a major public health problem among community-dwelling older adults. Impaired oral hygiene is a modifiable risk factor for healthcare-associated pneumonia, but its role in community-acquired pneumonia is unclear. Objectives To identify novel modifiable risk factors, focusing on oral hygiene, for pneumonia requiring hospitalization among community-dwelling older adults. Design Prospective observational cohort study Setting Memphis, Tennessee and Pittsburgh, Pennsylvania Participants Of 3075 well-functioning community-dwelling adults aged 70–79 years enrolled in the Health, Aging, and Body Composition Study from 1997–1998, 1441 had complete data, dental exam within six months of baseline, and were eligible for this study. Measurements The primary outcome was pneumonia requiring hospitalization through 2008. Results Of 1441 participants, 193 were hospitalized for pneumonia. In a multivariable model, male gender (HR 2.07, 95%CI 1.51–2.83), white race (HR 1.44, 95%CI 1.03–2.01), history of pneumonia (HR 3.09, 95%CI 1.86–5.14), pack-years of smoking (HR 1.006, 95%CI 1.001–1.011), and percent predicted FEV1 (moderate vs. mild/normal lung function [HR 1.78, 95%CI 1.28–2.48], severe vs. mild/normal lung function [HR 2.90, 95%CI 1.51–5.57]) were non-modifiable risk factors for pneumonia. Incident mobility limitation (HR 1.77, 95%CI 1.32–2.38) and higher mean oral plaque score (HR 1.29, 95%CI 1.02–1.64) were modifiable risk factors for pneumonia. Average Attributable Fractions revealed that 11.5% of pneumonias were attributed to incident mobility limitation and 10.3% to mean oral plaque score ≥1. Conclusion Incident mobility limitation and higher mean oral plaque score were two modifiable risk factors attributable for 22% of pneumonias requiring hospitalization. These data suggest innovative opportunities for pneumonia prevention among community-dwelling older adults. PMID:23772872

  13. Army aeromedical crash rates.

    Science.gov (United States)

    De Lorenzo, R A; Freid, R L; Villarin, A R

    1999-02-01

    Safety is a principal concern for everyone in aviation, including those in military and civilian aeromedical programs. The U.S. Army flies thousands of helicopter missions each year, including many aeromedical flights. The comparison between Army general and aeromedical aviation crash data provides a benchmark for establishing patterns in aeromedical safety and may be useful for similar programs examining safety profiles. To determine the crash rates of Army aeromedical rotary-wing (helicopter) programs and compare them with crash rates in Army general aviation. Retrospective review of safety data from 1987 to 1995. Crashes or mishaps are categorized into three classes: A, B, and C. Class A reflects the most serious mishap and involves loss of life or aircraft destruction, whereas classes B and C represent lesser but still significant mishaps. Crash rates are compared on a year-by-year basis and are reported as events per 100,000 flight hours. Statistical analysis was performed by the z test with Yates' correction, with significance set at p crash rate was 1.86 compared with the aeromedical rate of 2.02. The mean general class A to C crash rate was 7.37 compared with the aeromedical rate of 7.44. Between 1992 and 1995, there were 3 years when the Army aeromedical program suffered no class A mishaps. Differences between study groups are statistically significant, but they are interpreted conservatively given the very low incidence of mishaps in both groups. Both rates are comparable with published civilian mishap rates. There is a very low overall incidence of crashes in both groups. There may be no practical difference between Army general and aeromedical aviation mishap rates. Furthermore, Army crash rates are comparable with published civilian mishap rates.

  14. Association Between Initial Route of Fluoroquinolone Administration and Outcomes in Patients Hospitalized for Community-acquired Pneumonia.

    Science.gov (United States)

    Belforti, Raquel K; Lagu, Tara; Haessler, Sarah; Lindenauer, Peter K; Pekow, Penelope S; Priya, Aruna; Zilberberg, Marya D; Skiest, Daniel; Higgins, Thomas L; Stefan, Mihaela S; Rothberg, Michael B

    2016-07-01

    Fluoroquinolones have equivalent oral and intravenous bioavailability, but hospitalized patients with community-acquired pneumonia (CAP) generally are treated intravenously. Our objectives were to compare outcomes of hospitalized CAP patients initially receiving intravenous vs oral respiratory fluoroquinolones. This was a retrospective cohort study utilizing data from 340 hospitals involving CAP patients admitted to a non-intensive care unit (ICU) setting from 2007 to 2010, who received intravenous or oral levofloxacin or moxifloxacin. The primary outcome was in-hospital mortality. Secondary outcomes included clinical deterioration (transfer to ICU, initiation of vasopressors, or invasive mechanical ventilation [IMV] initiated after the second hospital day), antibiotic escalation, length of stay (LOS), and cost. Of 36 405 patients who met inclusion criteria, 34 200 (94%) initially received intravenous treatment and 2205 (6%) received oral treatment. Patients who received oral fluoroquinolones had lower unadjusted mortality (1.4% vs 2.5%; P = .002), and shorter mean LOS (5.0 vs 5.3; P fluoroquinolones for CAP, there was no association between initial route of administration and outcomes. More patients may be treated orally without worsening outcomes. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  15. Epidemiology and patterns of care for invasive breast carcinoma at a community hospital in Southern India

    Directory of Open Access Journals (Sweden)

    Venkata Phanindra

    2007-05-01

    Full Text Available Abstract Background Breast cancer incidence in India is on rise. We report epidemiological, clinical and survival patterns of breast cancer patients from community perspective. Methods All breast cancer patients treated at this hospital from July 2000 to July 2005 were included. All had cytological or histological confirmation of breast cancer. TNM guidelines for staging and Immunohistochemistry to assess the receptor status were used. Either lumpectomy with axillary lymph node dissection or Modified radical mastectomy (MRM was done for operable breast cancer, followed by 6 cycles of adjuvant chemotherapy with FAC or CMF regimens to patients with pT >1 cm or lymph node positive or estrogen receptor negative and radiotherapy to patients after breast conservation surgery, pT size > 5 cm, 4 or more positive nodes and stage IIIB disease. Patients with positive Estrogen receptor or Progesterone receptor were advised Tamoxifene 20 mg per day for 3 years. Descriptive analysis was performed. Independent T test and Chi-square test were used. Overall survival time was computed by Kaplan – Meier method. Results Of 1488 cancer patients, 122 (8.2% had breast cancer. Of 122 patients, 96.7% had invasive breast carcinoma and 3.3% had sarcoma. 94% came from the rural and semi urban areas. Premenopausal women were 27%. The median age was 50 years. Stage I-6.8%, II-45.8%, III-22%, IV-6.8%, Bilateral breast cancer – 2.5%. The mean pT size was 3.9 cm. ER and PR were positive in 31.6% and 28.1% respectively. MRM was done in 93.8%, while 6.3% patients underwent breast conservation surgery. The mean of the lymph nodes dissected were 3. CMF and FAC regimens were used in 48.8% and 51.2% of patients respectively. FAC group were younger than the CMF group (43.6 yr vs. 54 yrs, P = 0.000. Toxicities were more in FAC than CMF group, alopecia (100% vs. 26.2%, grade2 or more emesis (31.8% vs. 9.2%, grade2 or more fatigue (40.9% vs.19%, anemia (43.1% vs. 16.6%. Median

  16. Reasons for encounter and diagnoses of new outpatients at a small community hospital in Japan: an observational study

    Directory of Open Access Journals (Sweden)

    Takeshima T

    2014-06-01

    Full Text Available Taro Takeshima,1,2 Maki Kumada,3,4 Junichi Mise,5 Yoshinori Ishikawa,6 Hiromichi Yoshizawa,4 Takashi Nakamura,3,4 Masanobu Okayama,1 Eiji Kajii11Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke, Japan; 2Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan; 3Division of The Project for Integration of Community Health, Center for Community Medicine, Jichi Medical University, Shimotsuke, Japan; 4Department of General Internal Medicine, Chikusei City Hospital, Chikusei, Japan; 5Division of Human Resources Development for Community Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke, Japan; 6Department of Surgery, Chikusei City Hospital, Chikusei, JapanPurpose: Although many new patients are seen at small hospitals, there are few reports of new health problems from such hospitals in Japan. Therefore, we investigated the reasons for encounter (RFE and diagnoses of new outpatients in a small hospital to provide educational resources for teaching general practice methods.Methods: This observational study was conducted at the Department of General Internal Medicine in a small community hospital between May 6, 2010 and March 11, 2011. We classified RFEs and diagnoses according to component 1, “Symptoms/Complaints”, and component 7, “Diagnosis/Diseases”, of the International Classification of Primary Care, 2nd edition (ICPC-2. We also evaluated the differences between RFEs observed and common symptoms from the guidelines Model Core Curriculum for Medical Students and Goals of Clinical Clerkship.Results: We analyzed the data of 1,515 outpatients. There were 2,252 RFEs (1.49 per encounter and 170 ICPC-2 codes. The top 30 RFE codes accounted for 80% of all RFEs and the top 55 codes accounted for 90%. There were 1,727 diagnoses and 196 ICPC-2 codes. The top 50 diagnosis codes accounted for

  17. Associations between nursing home performance and hospital 30-day readmissions for acute myocardial infarction, heart failure and pneumonia at the healthcare community level in the United States.

    Science.gov (United States)

    Pandolfi, Michelle M; Wang, Yun; Spenard, Ann; Johnson, Florence; Bonner, Alice; Ho, Shih-Yieh; Elwell, Timothy; Bakullari, Anila; Galusha, Deron; Leifheit-Limson, Erica; Lichtman, Judith H; Krumholz, Harlan M

    2017-12-01

    To evaluate community-specific nursing home performance with community-specific hospital 30-day readmissions for Medicare patients discharged with acute myocardial infarction, heart failure or pneumonia. Cross-sectional study using 2009-2012 hospital risk-standardised 30-day readmission data for Medicare fee-for-service patients hospitalised for all three conditions and nursing home performance data from the Centers for Medicare & Medicaid Services Five-Star Quality Rating System. Medicare-certified nursing homes and acute care hospitals. 12,542 nursing homes and 3,039 hospitals treating 30 or more Medicare fee-for-service patients for all three conditions across 2,032 hospital service areas in the United States. Community-specific hospital 30-day risk-standardised readmission rates. Community-specific nursing home performance measures: health inspection, staffing, Registered Nurses and quality performance; and an aggregated performance score. Mixed-effects models evaluated associations between nursing home performance and hospital 30-day risk-standardised readmission rates for all three conditions. The relationship between community-specific hospital risk-standardised readmission rates and community-specific overall nursing home performance was statistically significant for all three conditions. Increasing nursing home performance by one star resulted in decreases of 0.29% point (95% CI: 0.12-0.47), 0.78% point (95% CI: 0.60-0.95) and 0.46% point (95% CI: 0.33-0.59) of risk-standardised readmission rates for AMI, HF and pneumonia, respectively. Among the specific measures, higher performance in nursing home overall staffing and Registered Nurse staffing measures was statistically significantly associated with lower hospital readmission rates for all three conditions. Notable geographic variation in the community-specific nursing home performance was observed. Community-specific nursing home performance is associated with community-specific hospital 30-day

  18. Transformation of the Romanian Army

    National Research Council Canada - National Science Library

    Rus, Cristian

    2006-01-01

    .... By employing the Army Force Management and the Universal Joint Task List the study examines the development of the Romanian Army's current and programmed capabilities and identifies capability gaps...

  19. The Army's Occupational Analysis Program

    National Research Council Canada - National Science Library

    1996-01-01

    .... The OA Program is to be the Army's center of excellence for job analysis and design. The program is in a transition period, adapting its procedures and methods to meet the needs of today's fast-paced Army...

  20. Predicting the decisions of hospital based child protection teams to report to child protective services, police and community welfare services.

    Science.gov (United States)

    Benbenishty, Rami; Jedwab, Merav; Chen, Wendy; Glasser, Saralee; Slutzky, Hanna; Siegal, Gil; Lavi-Sahar, Zohar; Lerner-Geva, Liat

    2014-01-01

    This study examines judgments made by hospital-based child protection teams (CPTs) when determining if there is reasonable suspicion that a child has been maltreated, and whether to report the case to a community welfare agency, to child protective services (CPS) and/or to the police. A prospective multi-center study of all 968 consecutive cases referred to CPTs during 2010-2011 in six medical centers in Israel. Centers were purposefully selected to represent the heterogeneity of medical centers in Israel in terms of size, geographical location and population characteristics. A structured questionnaire was designed to capture relevant information and judgments on each child referred to the team. Bivariate associations and multivariate multinomial logistic regressions were conducted to predict whether the decisions would be (a) to close the case, (b) to refer the case to community welfare services, or (c) to report it to CPS and/or the police. Bivariate and multivariate analyses identified a large number of case characteristics associated with higher probability of reporting to CPS/police or of referral to community welfare services. Case characteristics associated with the decisions include socio-demographic (e.g., ethnicity and financial status), parental functioning (e.g., mental health), previous contacts with authorities and hospital, current referral characteristics (e.g., parental referral vs. child referral), physical findings, and suspicious behaviors of child and parent. Most of the findings suggest that decisions of CPTs are based on indices that have strong support in the professional literature. Existing heterogeneity between cases, practitioners and medical centers had an impact on the overall predictability of the decision to report. Attending to collaboration between hospitals and community agencies is suggested to support learning and quality improvement. Copyright © 2013 Elsevier Ltd. All rights reserved.

  1. Medication incidents related to automated dose dispensing in community pharmacies and hospitals--a reporting system study.

    Directory of Open Access Journals (Sweden)

    Ka-Chun Cheung

    Full Text Available INTRODUCTION: Automated dose dispensing (ADD is being introduced in several countries and the use of this technology is expected to increase as a growing number of elderly people need to manage their medication at home. ADD aims to improve medication safety and treatment adherence, but it may introduce new safety issues. This descriptive study provides insight into the nature and consequences of medication incidents related to ADD, as reported by healthcare professionals in community pharmacies and hospitals. METHODS: The medication incidents that were submitted to the Dutch Central Medication incidents Registration (CMR reporting system were selected and characterized independently by two researchers. MAIN OUTCOME MEASURES: Person discovering the incident, phase of the medication process in which the incident occurred, immediate cause of the incident, nature of incident from the healthcare provider's perspective, nature of incident from the patient's perspective, and consequent harm to the patient caused by the incident. RESULTS: From January 2012 to February 2013 the CMR received 15,113 incidents: 3,685 (24.4% incidents from community pharmacies and 11,428 (75.6% incidents from hospitals. Eventually 1 of 50 reported incidents (268/15,113 = 1.8% were related to ADD; in community pharmacies more incidents (227/3,685 = 6.2% were related to ADD than in hospitals (41/11,428 = 0.4%. The immediate cause of an incident was often a change in the patient's medicine regimen or relocation. Most reported incidents occurred in two phases: entering the prescription into the pharmacy information system and filling the ADD bag. CONCLUSION: A proportion of incidents was related to ADD and is reported regularly, especially by community pharmacies. In two phases, entering the prescription into the pharmacy information system and filling the ADD bag, most incidents occurred. A change in the patient's medicine regimen or relocation was the immediate causes of an

  2. Genetic Counseling in Military Hospitals

    Science.gov (United States)

    1987-04-01

    mother allegedly mistreated for preeclampsia at Tripler Army Medical Center could maintain an action for medical malpractice nothwithstanding Feres.1 2...perinatologists at most military hospitals perform genetic counseling. Due to their primary responsibilities fo management of high risk pregnancies

  3. Efficacy and Safety of, and Patient Satisfaction with, Colonoscopic-Administered Fecal Microbiota Transplantation in Relapsing and Refractory Community- and Hospital-Acquired Clostridium difficile Infection

    Directory of Open Access Journals (Sweden)

    Muhammad Ali Khan

    2014-01-01

    Full Text Available OBJECTIVE: To report the efficacy and safety of, and patient satisfaction with, colonoscopic fecal microbiota transplantation (FMT for community- and hospital-acquired Clostridium difficile infection (CDI.

  4. Exchanging knowledge within a community of practice: toward an epistemology of practice in Occupational Therapy paediatric hospital care

    Directory of Open Access Journals (Sweden)

    Sandra Maria Galheigo

    2017-09-01

    Full Text Available Objective: This research proposed the creation of a community of practice (CoP with the objective of: (i analysing the feasibility of a CoP as a means of generating knowledge among occupational therapists and (ii investigating the practice of occupational therapy with hospitalized children and adolescents. This article privileges the results of one of the predominantly discussed themes - the use of assessments and strategies of evaluation in Occupational Therapy in the hospital context. Method: A participatory action research study was undertaken with nine occupational therapists in face-to-face meetings combined with virtual tasks on an on-line platform. A hermeneutic and dialectical method was used to interpret the results. Results: The CoP produced practical knowledge about the use of assessments with hospitalized children and adolescents and demonstrated to be a strategy of knowledge development through dialogue and collaborative reflection on practice. Conclusion: Research on the implementation of communities of practice offers a promising approach to the production of knowledge in occupational therapy. The generated knowledge is representative of occupational therapists’ experiences and demonstrates an example of an epistemology of practice.

  5. Usefulness of multiple-locus VNTR fingerprinting in detection of clonality of community- and hospital-acquired Staphylococcus aureus isolates.

    Science.gov (United States)

    Luczak-Kadlubowska, Agnieszka; Sabat, Artur; Tambic-Andrasevic, Arjana; Payerl-Pal, Marina; Krzyszton-Russjan, Jolanta; Hryniewicz, Waleria

    2008-11-01

    Staphylococcus aureus has become a major source of hospital infections and the risk of colonisation and infection by community-acquired methicillin-resistant S. aureus (CA-MRSA) is increasingly higher. Because of the importance of S. aureus to public health, many molecular typing methods have been developed to determine its transmission routes and source of infection during epidemiological investigations. In this study we evaluated the usefulness of multiplex PCR based Multi-Locus VNTR Fingerprinting (MLVF) as the first step method for rapid differentiation of Croatian and Polish S. aureus isolates in hospital and community settings. This is a first report of the usefulness of MLVF in typing of hospital-acquired methicillin-sensitive S. aureus (HA-MSSA) and four CA-MRSA isolates. A total of 47 isolates of S. aureus recovered in Croatia in 2004 and in Poland in 2006 and 2007 were tested. The MLVF results were compared to those produced by other typing methods, such as Pulsed-Field Gel Electrophoresis (PFGE), Multi-Locus Sequence Typing (MLST) and spa typing. The MLVF analysis showed almost the same clonality results as the remaining typing methods although some differences were found. Epidemiological data about the relation among S. aureus isolates and the results produced by typing methods applied in the present study indicate that because of the advantages in ease and speed of Variable Number of Tandem Repeats (VNTR) procedure over PFGE, spa typing and MLST, MLVF can be used as a first screening method followed by additional typing.

  6. X-linked agammaglobulinemia in community-acquired pneumonia cases revealed by immunoglobulin level screening at hospital admission.

    Science.gov (United States)

    Vancikova, Z; Freiberger, T; Vach, W; Trojanek, M; Rizzi, M; Janda, A

    2013-11-01

    In children with primary immunodeficiencies, the onset of symptoms precedes the diagnosis and the initiation of appropriate treatment by months or years. This delay in diagnosis is due to the fact that while these disorders are rare, some of the infections seen in immunodeficient patients are common. Defective antibody production represents the largest group among these disorders, with otitis, sinusitis and pneumonia as the most frequent initial manifestation. We performed a prospective study of humoral immunity in children hospitalized due to community-acquired pneumonia in tertiary care hospital. Out of 254 patients (131 boys, 123 girls, median age 4.5 years) recruited over 3 years, we found 2 boys (age 11 and 21 months) lacking serum immunoglobulins and circulating B cells. Subsequent genetic analysis confirmed diagnosis of X-linked agammaglobulinemia. Despite their immunodeficiency, the pneumonia was uncomplicated in both patients and did not call for immunological evaluation. However, the immunoglobulin screening at admission allowed for an early diagnosis of the immunodeficiency and timely initiation of immunoglobulin substitution, the key prerequisite for a favorable course of the disease.Simple and inexpensive immuno-globulin measurement during the manage-ment of hospitalized children with community-acquired pneumonia may help in early identification of patients with compromised humoral immunity and prevent serious complications. © Georg Thieme Verlag KG Stuttgart · New York.

  7. Diversity and Adaptation of Human Respiratory Syncytial Virus Genotypes Circulating in Two Distinct Communities: Public Hospital and Day Care Center

    Directory of Open Access Journals (Sweden)

    Gustavo Rocha Garcia

    2012-10-01

    Full Text Available HRSV is one of the most important pathogens causing acute respiratory tract diseases as bronchiolitis and pneumonia among infants. HRSV was isolated from two distinct communities, a public day care center and a public hospital in São José do Rio Preto – SP, Brazil. We obtained partial sequences from G gene that were used on phylogenetic and selection pressure analysis. HRSV accounted for 29% of respiratory infections in hospitalized children and 7.7% in day care center children. On phylogenetic analysis of 60 HRSV strains, 48 (80% clustered within or adjacent to the GA1 genotype; GA5, NA1, NA2, BA-IV and SAB1 were also observed. SJRP GA1 strains presented variations among deduced amino acids composition and lost the potential O-glycosilation site at amino acid position 295, nevertheless this resulted in an insertion of two potential O-glycosilation sites at positions 296 and 297. Furthermore, a potential O-glycosilation site insertion, at position 293, was only observed for hospital strains. Using SLAC and MEME methods, only amino acid 274 was identified to be under positive selection. This is the first report on HRSV circulation and genotypes classification derived from a day care center community in Brazil.

  8. Index to Army Times 1989

    Science.gov (United States)

    1992-08-01

    COMPETITIONS Those winning Golden Knights. Army Times; Sept. 4, 1989; 50(4): p. 2. GOVERNMENT RENTAL HOUSING PROGRAM ( GRHP ) New housing scheme. Army...Army Times; Apr. 3, 1989; 49(34): p. 17. GRHP SEE GOVERNMENT RENTAL HOUSING PROGRAM ( GRHP ) GUIDED MISSILES Countries try to keep Leaks from going

  9. Volunteers for community health. An Ohio hospital sponsors parish nursing programs for area churches and synagogues.

    Science.gov (United States)

    Drummond, M; Buss, T F; Ladigo, M A

    1992-06-01

    Since 1989, St. Elizabeth Hospital Medical Center, Youngstown, OH, has been conducting a hospital-based, multidenominational volunteer parish nurse program, which now extends to 11 Roman Catholic, Lutheran, Presbyterian, Methodist, Jewish, and Greek Orthodox congregations. Seventeen volunteer nurses are involved, responding to needs within their congregations by providing a variety of healthcare and educational services while revitalizing the Church's healing ministry. Volunteers selected are competent, experienced registered nurses who can relate to and communicate with people of all ages, accurately assess health-related problems, and make appropriate nursing decisions. Parish nurses focus on preventive care, health maintenance, and personal responsibility for maintaining a healthy life-style. Volunteer nurses determine their own schedule, contributing as much time as they can. Each volunteer nurse is responsible for developing a record-keeping system, documenting his or her parish activities, and submitting a quarterly report of volunteer hours and activities to the hospital. Hospital supports include the initial two-day orientation; monthly meetings at the hospital for information sharing, education, and mutual support; and nursing continuing education programs In addition, an advisory committee provides program support and education. St. Elizabeth Hospital Medical Center is exploring several methods of enhancing its health ministry outreach to congregations in dire need of such services.

  10. Process of care and prescription in pneumonia acquired in the community in university hospitals in Colombia

    International Nuclear Information System (INIS)

    Martinez, Carlos Eli; Jaimes, Fabian A; Montufar, Franco E; Hincapie, Gustavo A; Morales, Alvaro; Acero, Rafael; Muneton, David; Gomez, Sujey; Cuenca, Diana Maria; Salinas, Juan Carlos; Zabaleta Joel E

    2003-01-01

    The objective is to describe the process of care and prescription practices for CAP patients in four university hospitals in Colombia. Patients older than 15 years with a diagnosis of CAP during the two years study period. Collection of demographic and clinical status data and management during the first day of consult, classification in severity groups according to fine's prediction rule. Evaluation of the frequency of use of ancillary diagnostic tests antimicrobials prescription and agreement with ATS guidelines according to severity group and hospital. 734 patients were included, mean age 56 years old, 50.5% males, mean length of stay 8.6 days, 39% fine's classes IV to V. Frequency of sputum sampling (overall cohort between hospitals rank) was 46% (10 - 67%), chest x-ray 95% (57-100%), blood cultures 34% (0 -63%) and arterial blood gas analysis 71% (10-88%). the use of ancillary diagnostic test had wide variation between hospitals and severity classes, specially for sputum and blood gases. At least 45 different antimicrobial protocols were used in the cohort. Overall agreement between actual prescription and guidelines recommendations was variable (mean 44%, range 22 to 72%) between groups and hospitals, but without significant impact on mortality. There are many differences between actual clinical practice and guidelines for the management of CAP and wide variations between hospitals, but the precise effect of the lack of guideline-adherence on mortality is unclear

  11. Management of chronic heart failure in the community: role of a hospital based open access heart failure service.

    Science.gov (United States)

    Shah, S; Davies, M K; Cartwright, D; Nightingale, P

    2004-07-01

    To evaluate the role of an open access heart failure service based at a teaching hospital for the diagnosis and treatment optimisation of patients with heart failure in the community and to identify measures that may further enhance the effectiveness of such a service. 963 patients with suspected heart failure seen over an eight year period referred by their general practitioners to the cardiology department at a district general hospital. Presence or absence of left ventricular systolic dysfunction (LVSD) (left ventricular ejection fraction 60 years of age (33.5% v 20.8%, p 0.5 on chest radiograph (44.3% v 17.8%, p < 0.001, RR 2.5) were found to be good predictors of LVSD. A normal ECG (negative predictive value 80.5%) and a cardiothoracic ratio of < 0.5 (negative predictive value 82.2%) can be used as baseline measures to identify patients with lower risk of developing LVSD (combined negative predictive value 87.9%). An open access heart failure clinic is effective for the diagnosis and management of chronic heart failure in community based patients. The presence of risk factors and simple baseline tests can be used to identify patients with LVSD in the community. The introduction of a protocol based on these findings into a referral system can improve the efficiency and cost effectiveness of such a service.

  12. The use of the temporal scan statistic to detect methicillin-resistant Staphylococcus aureus clusters in a community hospital.

    Science.gov (United States)

    Faires, Meredith C; Pearl, David L; Ciccotelli, William A; Berke, Olaf; Reid-Smith, Richard J; Weese, J Scott

    2014-07-08

    In healthcare facilities, conventional surveillance techniques using rule-based guidelines may result in under- or over-reporting of methicillin-resistant Staphylococcus aureus (MRSA) outbreaks, as these guidelines are generally unvalidated. The objectives of this study were to investigate the utility of the temporal scan statistic for detecting MRSA clusters, validate clusters using molecular techniques and hospital records, and determine significant differences in the rate of MRSA cases using regression models. Patients admitted to a community hospital between August 2006 and February 2011, and identified with MRSA>48 hours following hospital admission, were included in this study. Between March 2010 and February 2011, MRSA specimens were obtained for spa typing. MRSA clusters were investigated using a retrospective temporal scan statistic. Tests were conducted on a monthly scale and significant clusters were compared to MRSA outbreaks identified by hospital personnel. Associations between the rate of MRSA cases and the variables year, month, and season were investigated using a negative binomial regression model. During the study period, 735 MRSA cases were identified and 167 MRSA isolates were spa typed. Nine different spa types were identified with spa type 2/t002 (88.6%) the most prevalent. The temporal scan statistic identified significant MRSA clusters at the hospital (n=2), service (n=16), and ward (n=10) levels (P ≤ 0.05). Seven clusters were concordant with nine MRSA outbreaks identified by hospital staff. For the remaining clusters, seven events may have been equivalent to true outbreaks and six clusters demonstrated possible transmission events. The regression analysis indicated years 2009-2011, compared to 2006, and months March and April, compared to January, were associated with an increase in the rate of MRSA cases (P ≤ 0.05). The application of the temporal scan statistic identified several MRSA clusters that were not detected by hospital

  13. Community-associated methicillin resistant Staphylococcus aureus in south Florida hospital and recreational environments

    Science.gov (United States)

    Strains of methicillin resistant Staphylococcus aureus (MRSA), a frequent human pathogen, may also be found in the flora of healthy persons and in the environments that they frequent. Strains of MRSA circulating in the community classified as USA 300 are now found not only in the community but also...

  14. Risk Factors for Fall-Related Injuries Leading to Hospitalization Among Community-Dwelling Older Persons: A Hospital-Based Case-Control Study in Thiruvananthapuram, Kerala, India.

    Science.gov (United States)

    Ravindran, Rekha M; Kutty, V Raman

    2016-01-01

    This study intended to identify the risk factors for injurious falls that led to hospitalization of older persons living in the community. A hospital-based unmatched incident case-control study was done among 251 cases and 250 controls admitted at a tertiary care centre in Kerala. Mean age of cases was 71.6 ± 9.13 years and that of controls was 67.02 ± 6.17 years. Hip fractures were the predominant injury following falls. Falls were mostly a result of intrinsic causes. After adjusting for other variabes, the risk factors for all injuries were age above 70 years (odds ratio [OR] = 2.25; 95% confidence interval [CI] = 1.46-3.46), previous fall history (OR = 2.76; 95% CI = 1.08-7.08), impaired vision (OR = 4.49; 95% CI = 2.77-7.30), not living with spouse (OR = 1.97; 95% CI = 1.31-2.97), door thresholds (OR = 1.52; 95% CI = 1.01-2.29), and slippery floor (OR = 2.37; 95% CI = 1.31-4.32). The risk factors for hip fractures and other injuries were identified separately. Fall prevention strategies among older persons are warranted in Kerala. © 2015 APJPH.

  15. Prevalence and clinical features of respiratory syncytial virus in children hospitalized for community-acquired pneumonia in northern Brazil

    Directory of Open Access Journals (Sweden)

    Lamarão Letícia

    2012-05-01

    Full Text Available Abstract Background Childhood pneumonia and bronchiolitis is a leading cause of illness and death in young children worldwide with Respiratory Syncytial Virus (RSV as the main viral cause. RSV has been associated with annual respiratory disease outbreaks and bacterial co-infection has also been reported. This study is the first RSV epidemiological study in young children hospitalized with community-acquired pneumonia (CAP in Belém city, Pará (Northern Brazil. Methods With the objective of determining the prevalence of RSV infection and evaluating the patients’ clinical and epidemiological features, we conducted a prospective study across eight hospitals from November 2006 to October 2007. In this study, 1,050 nasopharyngeal aspirate samples were obtained from hospitalized children up to the age of three years with CAP, and tested for RSV antigen by direct immunofluorescence assay and by Reverse Transcription Polymerase Chain Reaction (RT-PCR for RSV Group identification. Results RSV infection was detected in 243 (23.1% children. The mean age of the RSV-positive group was lower than the RSV-negative group (12.1 months vs 15.5 months, pppppp Conclusion The present study highlights the relevance of RSV infection in hospitalized cases of CAP in our region; our findings warrant the conduct of further investigations which can help design strategies for controlling the disease.

  16. Community-Engaged Public Health Research to Inform Hospital Campus Planning in a Low Socioeconomic Status Urban Neighborhood.

    Science.gov (United States)

    Brittin, Jeri; Elijah-Barnwell, Sheila; Nam, Yunwoo; Araz, Ozgur; Friedow, Bethany; Jameton, Andrew; Drummond, Wayne; Huang, Terry T-K

    2015-01-01

    To compare sociodemographic and motivational factors for healthcare use and identify desirable health-promoting resources among groups in a low socioeconomic status (SES) community in Chicago, IL. Disparities in health services and outcomes are well established in low SES urban neighborhoods in the United States and many factors beyond service availability and quality impact community health. Yet there is no clear process for engaging communities in building resources to improve population-level health in such locales. A hospital building project led to a partnership of public health researchers, architects, and planners who conducted community-engaged research. We collected resident data and compared factors for healthcare use and choice and likelihood of engaging new health-promoting services. Neighborhood areas were strongly associated with ethnic groupings, and there were differences between groups in healthcare choice and service needs, such as, proximity to home was more important to Latinos than African Americans in choice of healthcare facility ( p adj = .001). Latinos expressed higher likelihood to use a fitness facility ( p adj = .001). Despite differences in vehicle ownership, >75% of all respondents indicated that nearby public transportation was important in choosing healthcare. Knowledge of community needs and heterogeneity is essential to decision makers of facility and community development plans. Partnerships between public health, urban planning, architecture, and local constituents should be cultivated toward focus on reducing health disparities. Further work to integrate community perspectives through the planning and design process and to evaluate the long-term impact of such efforts is needed. © The Author(s) 2015.

  17. Epidemiology of Hospitalizations and Deaths from Heat Illness in Soldiers

    National Research Council Canada - National Science Library

    Carter III, Robert; Cheuvront, Samuel N; Williams, Jeffrey O; Kolka, Margaret A; Stephenson, Lou A; Sawka, Michael N; Amoroso, Paul J

    2005-01-01

    .... Hospitalization data were obtained from the Total Army Injury Health Outcomes Database (TAIHOD) coded according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM...

  18. Accelerating Best Care in Pennsylvania: adapting a large academic system's quality improvement process to rural community hospitals.

    Science.gov (United States)

    Haydar, Ziad; Gunderson, Julie; Ballard, David J; Skoufalos, Alexis; Berman, Bettina; Nash, David B

    2008-01-01

    Industrial quality improvement (QI) methods such as continuous quality improvement (CQI) may help bridge the gap between evidence-based "best care" and the quality of care provided. In 2006, Baylor Health Care System collaborated with Jefferson Medical College of Thomas Jefferson University to conduct a QI demonstration project in select Pennsylvania hospitals using CQI techniques developed by Baylor. The training was provided over a 6-month period and focused on methods for rapid-cycle improvement; data system design; data management; tools to improve patient outcomes, processes of care, and cost-effectiveness; use of clinical guidelines and protocols; leadership skills; and customer service skills. Participants successfully implemented a variety of QI projects. QI education programs developed and pioneered within large health care systems can be adapted and applied successfully to other settings, providing needed tools to smaller rural and community hospitals that lack the necessary resources to establish such programs independently.

  19. Pediatric Medication Safety in Adult Community Hospital Settings: A Glimpse Into Nationwide Practice.

    Science.gov (United States)

    Alvarez, Francisco; Ismail, Lana; Markowsky, Allison

    2016-12-01

    Most children in the United States are treated in adult settings. Studies show that the pediatric population is vulnerable to medication errors. It can be extrapolated that children cared for in adult settings are at equal or higher risk for errors. The goal of this study was to assess the existing pediatric medication safety infrastructure within adult hospitals. Questionnaire developed through Research Electronic Data Capture (REDCap) and distributed to pediatric hospitalist programs listed on the American Academy of Pediatrics, Section on Hospital Medicine web site and members of the American Academy of Pediatrics Quality Improvement Innovation Networks listserv. There were >20 questions regarding the use of various safety measures and characteristics of the hospital. Thirty-eight program staff and 26 Quality Improvement Innovation Networks listserv members completed the survey (total = 64). Of these, 90.6% use order sets or computerized provider order entry with pediatric weight-based dosing, 79.7% review pediatric medication safety events or concerns, 58.7% were aware that their hospital had defined or documented maximum doses on orders, and 50.0% had milligram-per-kilogram dosing required to be in the order. A majority of respondents document weights only in the metric system (kilograms or grams) in both the emergency department and the pediatric unit (84.4% and 92.1%, respectively). A total of 57.8% of hospitals had pharmacists trained in pediatrics, with hospitals with >300 beds more likely to have a pediatric pharmacist than those with Pediatric medication safety infrastructure shows variations within the sites surveyed. Our results indicate that certain deficiencies are more widespread than others, providing opportunities for targeted, but hospital-specific interventions. Copyright © 2016 by the American Academy of Pediatrics.

  20. Efficacy of a simple and inexpensive exercise training program for advanced chronic obstructive pulmonary disease patients in community hospitals.

    Science.gov (United States)

    Pothirat, Chaicharn; Chaiwong, Warawut; Phetsuk, Nittaya

    2015-04-01

    Exercise training is an important part of pulmonary rehabilitation; however it may not be appropriate for large-scale practice in community hospitals due to the complexity of the program and expensive training equipment, including cycle ergometry and treadmills. This study therefore aims to evaluate the efficacy of a more simplified exercise training program with inexpensive training equipment. A multicentre study of a mild to moderate intensity exercise training program was conducted based on incremental strength and endurance with two 35-40-minute sessions per week for 8 weeks. The program was performed by 30 outpatients from five community hospitals. Patients were monitored regularly for various parameters including strength of trained muscles, level of dyspnea, 6-minute walk distance, and quality of life (QoL) at baseline at 1, 2, 3, 6, 9 and 12 months. Unpaired t-tests were applied to determine the progress of trained muscle strength and minimal clinically important differences (MCIDs) were used to assess clinical outcomes. Thirty patients (13 males, 17 females) were enrolled with a mean age of 69.1±8.9 years, body mass index 20.5±4.4 kg/m(2), and mean % of predicted forced expiratory volume in the first second (FEV1) 45.1±10.8. According to GOLD classification, eight (26.7%) cases were in stage II, 20 (66.7%) cases in stage III, and two (6.6%) cases in stage IV. Limb and chest wall muscle strength, dyspnea level, exercise capacity and QoL showed statistically significant improvements throughout the 12-month follow-up (Pinexpensive exercise training program was shown to be effective for advanced chronic obstructive pulmonary disease patients in community hospitals.

  1. Biomarkers of Mineral and Bone Metabolism and 20-Year Risk of Hospitalization With Infection: The Atherosclerosis Risk in Communities Study.

    Science.gov (United States)

    Ishigami, Junichi; Jaar, Bernard G; Rebholz, Casey M; Grams, Morgan E; Michos, Erin D; Wolf, Myles; Kovesdy, Csaba P; Uchida, Shinichi; Coresh, Josef; Lutsey, Pamela L; Matsushita, Kunihiro

    2017-12-01

    Mineral and bone disorders (MBDs) might be relevant in the etiology of infection. To determine whether MBD biomarkers were associated with the incidence of hospitalization with infection. We also assessed the cross-sectional association between MBD biomarker levels and kidney function. Community-based cohort study of 11,218 participants with an estimated glomerular filtration rate (eGFR) ≥30 mL/min/1.73m2 in the Atherosclerosis Risk in Communities study. We assessed the cross-sectional associations of five MBD markers-fibroblast growth factor 23 (FGF23), 25-hydroxyvitamin D [25(OH)D], parathyroid hormone (PTH), calcium corrected for hypoalbuminemia, and phosphorus-with eGFR from 1990 to 1992 and their longitudinal associations with incident hospitalization with infection in 1990 to 2013. Incident hospitalization with infection. In age-, sex-, and race-adjusted models, lower eGFRs were significantly associated with greater levels of FGF23, PTH, and corrected calcium but not 25(OH)D or phosphorus. During follow-up, 5078 hospitalizations with infection occurred. In fully adjusted Cox models, with the second quartile as the reference, the hazard ratio (HR) was significantly greater in the highest quartile of FGF23 [HR, 1.12; 95% confidence interval (CI), 1.03 to 1.21], PTH (HR, 1.09; 95% CI, 1.01 to 1.18), and corrected calcium (HR, 1.11; 95% CI, 1.03 to 1.20), and lowest quartile for 25(OH)D (HR, 1.11; 95% CI, 1.03 to 1.21). The association with phosphorus was significant only when the outcome was restricted to primary diagnosis of infection. These findings were consistent across subgroups of age, sex, race, and eGFR (infection, supporting MBD involvement in the etiology of infection. Copyright © 2017 Endocrine Society

  2. [Transferring palliative-care patients from hospital to community care: A qualitative study].

    Science.gov (United States)

    Correa-Casado, Matías; Granero-Molina, José; Hernández-Padilla, José Manuel; Fernández-Sola, Cayetano

    To know the experience of case-manager nurses with regard to transferring palliative-care patients from the hospital to their homes. Qualitative phenomenological study carried out in 2014-2015. Poniente and Almería health districts, which referral hospitals are Poniente Hospital and Torrecárdenas Hospital, respectively. A purposive sample comprised of 12 case-manager nurses was recruited from the aforementioned setting. Theoretical data saturation was achieved after performing 7 in-depth individual interviews and 1 focus group. Data analysis was performed following Colaizzi's method. Three themes emerged: (1) 'Case-management nursing as a quality, patient-centred service' (2) 'Failures of the information systems', with the subthemes "patients" insufficient and inadequate previous information" and "ineffective between-levels communication channels for advanced nursing"; (3) 'Deficiencies in discharge planning', with the subthemes "deficient management of resources on admission", "uncertainty about discharge" and "insufficient human resources to coordinate the transfer". Case-manager nurses consider themselves a good-quality service. However, they think there are issues with coordination, information and discharge planning of palliative patients from hospital. It would be useful to review the communication pathways of both care and discharge reports, so that resources needed by palliative patients are effectively managed at the point of being transferred home. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  3. Serum Creatinine Trajectories for Community- versus Hospital-Acquired Acute Kidney Injury.

    Science.gov (United States)

    Warnock, David G; Powell, T Clark; Siew, Edward D; Donnelly, John P; Wang, Henry E; Mehta, Ravindra L

    2016-01-01

    Patterns of acute kidney injury (AKI) can be distinguished by the rate of changes in the serum creation concentrations during hospitalizations. We hypothesized that the timing and values of minimum and maximum serum creatinine (sCr) could be used to distinguish between transient hospital-associated AKI (THA-AKI) and hospital-acquired AKI (HA-AKI). We evaluated adults admitted to 2 regionally distinct academic medical centers. Peak sCr during the hospitalization was used to define AKI, using absolute changes and timing from the minimum sCr. sCr trajectories were derived based on the rate of change between the minimum and peak creatinine concentrations. Peak creatinine followed the minimum creatinine for HA-AKI, while the peak creatinine preceded the minimum creatinine for THA-AKI. There were 82,403 patients included in the analyses, and 53,882 (65%) did not have AKI during the index hospitalization. There were 2,611 inpatient deaths; HA-AKI had a 4.8-fold increased risk relative to those without AKI (p Creatinine trajectories can be used to describe the rate of development as well as recovery from inpatient AKI. The 24- and 48-hour interval slopes may be early indicators of developing AKI. © 2016 S. Karger AG, Basel.

  4. The Utrecht Pharmacy Practice network for Education and Research: a network of community and hospital pharmacies in the Netherlands.

    Science.gov (United States)

    Koster, Ellen S; Blom, Lyda; Philbert, Daphne; Rump, Willem; Bouvy, Marcel L

    2014-08-01

    Practice-based networks can serve as effective mechanisms for the development of the profession of pharmacists, on the one hand by supporting student internships and on the other hand by collection of research data and implementation of research outcomes among public health practice settings. This paper presents the characteristics and benefits of the Utrecht Pharmacy Practice network for Education and Research, a practice based research network affiliated with the Department of Pharmaceutical Sciences of Utrecht University. Yearly, this network is used to realize approximately 600 student internships (in hospital and community pharmacies) and 20 research projects. To date, most research has been performed in community pharmacy and research questions frequently concerned prescribing behavior or adherence and subjects related to uptake of regulations in the pharmacy setting. Researchers gain access to different types of data from daily practice, pharmacists receive feedback on the functioning of their own pharmacy and students get in depth insight into pharmacy practice.

  5. A hospital-based child and adolescent overweight and obesity treatment protocol transferred into a community healthcare setting

    DEFF Research Database (Denmark)

    Mollerup, Pernille Maria; Gamborg, Michael Orland; Trier, Cæcilie

    2017-01-01

    ) and waist circumference (WC) would occur during 1.5 years of community-based overweight and obesity treatment based upon an effective hospital-based overweight and obesity treatment protocol, The Children's Obesity Clinics' Treatment protocol. Height, weight, and WC were measured at all consultations......BACKGROUND: Due to the pandemic of child and adolescent overweight and obesity, improvements in overweight and obesity treatment availability and accessibility are needed. METHODS: In this prospective study, we investigated if reductions in body mass index (BMI) standard deviation scores (SDS...... was invested per child per year. CONCLUSION: BMI SDS and WC were reduced after 1.5 years of treatment. Hence, this community-based overweight and obesity treatment program may help accommodate the need for improvements in treatment availability and accessibility....

  6. Histerectomia Laparoscópica em um Hospital Geral Comunitário Experiência Inicial e Comparação de Custos Hospitalares Laparoscopic Hysterectomy in a Community General Hospital Initial Experience and Comparison of Hospital Costs

    Directory of Open Access Journals (Sweden)

    Randal Henrique de Oliveira

    2000-03-01

    postoperative conditions and faster recovery than TAH. When done in a community general hospital, despite being more expensive, LAVH is an excellent option for uterine removal, and should be part of the therapeutical arsenal of gynecologic surgeons.

  7. 1998 Army Modernization Plan

    Science.gov (United States)

    1998-01-01

    System (APKWS) guided munition (to complement the Hydra -70 family of rockets and supplement HELLFIRE) to provide a lower cost, more capable means of...and confirmation of biological and chemical warfare agents and toxins . Veterinary Services The Army Veterinary Corps is the DoD executive agent for

  8. Developing the Army Pentathlete

    National Research Council Canada - National Science Library

    McElroy, Kevin

    2007-01-01

    .... How will they do it, and where will they find the personnel to fill the job?. The Army is forced to deal with insurgency in Iraq, a type of engagement they have not dedicated training to since the end of Vietnam...

  9. A mixed methods investigation into the use of non-technical skills by community and hospital pharmacists.

    Science.gov (United States)

    Irwin, A; Weidmann, A E

    2015-01-01

    Non-technical skills refer to the social and cognitive factors that may influence efficient and safe job performance. Non-technical skills are an important element of patient safety in a variety of health care disciplines, including surgery, anesthesia and nursing. However, the use of non-technical skills in pharmacy practice has not yet been fully assessed. To examine attitudes toward, and use of, non-technical skills by pharmacy personnel. A mixed methods approach was used: An attitude survey explored pharmacy personnel attitudes towards non-technical skills and inter-professional collaboration, with community and hospital pharmacy staff (n = 62). Qualitative interviews were then conducted using the critical incident technique, with community pharmacists (n = 11). The survey results demonstrated differences in the opinions of community and hospital pharmacists on three non-technical skill constructs: team structure, mutual support, and situation monitoring, with community pharmacists reporting significantly more positive attitudes about all three constructs. Both groups reported low levels of collaboration with primary care physicians. The interviews identified five non-technical skills as key elements of successful pharmacist performance from the interview transcripts: teamwork; leadership; task management; situation awareness; decision-making. The survey and interviews identified the non-technical skills that are important to pharmacists. This represents the first step towards the development of a behavioral rating system for training purposes that could potentially improve the non-technical skills of pharmacists and enhance patient safety. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Hospital discharge: What are the problems, information needs and objectives of community pharmacists? A mixed method approach

    Directory of Open Access Journals (Sweden)

    Brühwiler LD

    2017-09-01

    Full Text Available Background: After hospital discharge, community pharmacists are often the first health care professionals the discharged patient encounters. They reconcile and dispense prescribed medicines and provide pharmaceutical care. Compared to the roles of general practitioners, the pharmacists’ needs to perform these tasks are not well known. Objective: This study aims to a Identify community pharmacists’ current problems and roles at hospital discharge, b Assess their information needs, specifically the availability and usefulness of information, and c Gain insight into pharmacists’ objectives and ideas for discharge optimisation. Methods: A focus group was conducted with a sample of six community pharmacists from different Swiss regions. Based on these qualitative results, a nationwide online-questionnaire was sent to 1348 Swiss pharmacies. Results: The focus group participants were concerned about their extensive workload with discharge prescriptions and about gaps in therapy. They emphasised the importance of more extensive information transfer. This applied especially to medication changes, unclear prescriptions, and information about a patient's care. Participants identified treatment continuity as a main objective when it comes to discharge optimisation. There were 194 questionnaires returned (response rate 14.4%. The majority of respondents reported to fulfil their role as defined by the Joint-FIP/WHO Guideline on Good Pharmacy Practice (rather badly. They reported many unavailable but useful information items, like therapy changes, allergies, specifications for “off-label” medication use or contact information. Information should be delivered in a structured way, but no clear preference for one particular transfer method was found. Pharmacists requested this information in order to improve treatment continuity and patient safety, and to be able to provide better pharmaceutical care services. Conclusion: Surveyed Swiss community

  11. An exploratory study of radiographer's perceptions of radiographer commenting on musculo-skeletal trauma images in rural community based hospitals

    International Nuclear Information System (INIS)

    Howard, Morag L.

    2013-01-01

    Aim: This study sought to explore the perceptions of community hospital based radiographers in North East Scotland regarding the practice of radiographer commenting on musculo-skeletal trauma images. Method: A purposive sample of radiographers (n = 8) were recruited from community hospitals throughout the North-east of Scotland. A qualitative, exploratory study was conducted employing semi-structured interviews consisting of one focus group and two individual interviews. The interviews were audio recorded and transcribed in full to allow thematic analysis of the data using a framework adapted from Pope and Mays (2006). Main findings: This study revealed that the practice of radiographer commenting in the community provides a valuable front line opinion on musculo-skeletal trauma image appearances to enhance diagnostic outcomes for patients and streamline their care pathway. The appreciation shown from inter-professional colleagues for this practice induced feelings of professional pride and job satisfaction in the sample group. All participants expressed a desire to undertake additional training to allow progression from radiographer commenting to radiographer reporting of musculo-skeletal trauma images. Perceived barriers to the practice of radiographer commenting were time constraints and a lack of support with regards to continuing professional development (CPD) opportunities and mentorship from radiology colleagues. Conclusion: The practice of radiographer commenting in the community setting should be supported by ongoing training, and radiologist involvement in mentoring could provide radiographers with a valuable support mechanism. The voice of all radiographers regarding this extended role must be heard by professional leaders to ensure that the skills and education required for radiographer commenting are provided and subsequent patient care is not compromised

  12. Four decades of bariatric surgery in a community hospital of Spain.

    Science.gov (United States)

    Baltasar, Aniceto; Bou, Rafael; Bengochea, Marcelo; Serra, Carlos; Ferri, Lirios; Pérez, Nieves; Arlandis, Francisco; Martínez, Rosa; Cipagauta, Luis

    2017-07-28

    Bariatric surgical practice changes in the community setting may be under-reported. We present the developments in a Spanish bariatric surgical practice in the community setting of Alcoy from its origin in 1977 through the present. Bariatric surgical techniques employed in a country community setting over the course of nearly four decades were reviewed retrospectively and qualitatively. Surgeons and medical professionals from Alcoy, Spain were involved in the evolution of bariatric surgery patient management and surgical technique from 1977s through 2017. During the last 40 years, 1,475 patients were treated in our clinics. Spanish bariatric surgeons contributed to advances in gastric bypass in the 1970s, vertical banded gastroplasty in the 1980s, bilio-pancreatic diversion/duodenal switch in the 1990s, and innovations associated with laparoscopy from the 1990s onward. Outcomes and approaches to prevention and treatment of bariatric surgical complications are reviewed from a community perspective. Contributions to the bariatric surgical nomenclature and weight-loss reporting are noted. The practice of bariatric surgery in the community setting must be updated continuously, as in any human and surgical endeavor. Medical professionals in community bariatric practices should contribute their experiences to the field through all avenues of scientific interaction and publication.

  13. Peri-operative morbidity associated with radical cystectomy in a multicenter database of community and academic hospitals.

    Directory of Open Access Journals (Sweden)

    Luke T Lavallée

    Full Text Available OBJECTIVE: To characterize the frequency and timing of complications following radical cystectomy in a cohort of patients treated at community and academic hospitals. PATIENTS AND METHODS: Radical cystectomy patients captured from NSQIP hospitals from January 1 2006 to December 31 2012 were included. Baseline information and complications were abstracted by study surgical clinical reviewers through a validated process of medical record review and direct patient contact. We determined the incidence and timing of each complication and calculated their associations with patient and operative characteristics. RESULTS: 2303 radical cystectomy patients met inclusion criteria. 1115 (48% patients were over 70 years old and 1819 (79% were male. Median hospital stay was 8 days (IQR 7-13 days. 1273 (55.3% patients experienced at least 1 post-operative complication of which 191 (15.6% occurred after hospital discharge. The most common complication was blood transfusion (n = 875; 38.0%, followed by infectious complications with 218 (9.5% urinary tract infections, 193 (8.4% surgical site infections, and 223 (9.7% sepsis events. 73 (3.2% patients had fascial dehiscence, 82 (4.0% developed a deep vein thrombosis, and 67 (2.9% died. Factors independently associated with the occurrence of any post-operative complication included: age, female gender, ASA class, pre-operative sepsis, COPD, low serum albumin concentration, pre-operative radiotherapy, pre-operative transfusion >4 units, and operative time >6 hours (all p<0.05. CONCLUSION: Complications remain common following radical cystectomy and a considerable proportion occur after discharge from hospital. This study identifies risk factors for complications and quality improvement needs.

  14. In-hospital mortality risk factors in community acquired pneumonia: evaluation of immunocompetent adult patients without comorbidities

    Directory of Open Access Journals (Sweden)

    Miguel Hernan Vicco

    2015-04-01

    Full Text Available Summary Objective: several scores were developed in order to improve the determination of community acquired pneumonia (CAP severity and its management, mainly CURB-65 and SACP score. However, none of them were evaluated for risk assessment of in-hospital mortality, particularly in individuals who were non-immunosuppressed and/or without any comorbidity. In this regard, the present study was carried out. Methods: we performed a cross-sectional study in 272 immunocompetent patients without comorbidities and with a diagnosis of CAP. Performance of CURB- 65 and SCAP scores in predicting in-hospital mortality was evaluated. Also, variables related to death were assessed. Furthermore, in order to design a model of in-hospital mortality prediction, sampled individuals were randomly divided in two groups. The association of the variables with mortality was weighed and, by multiple binary regression, a model was constructed in one of the subgroups. Then, it was validated in the other subgroup. Results: both scores yielded a fair strength of agreement, and CURB-65 showed a better performance in predicting in-hospital mortality. In our casuistry, age, white blood cell counts, serum urea and diastolic blood pressure were related to death. The model constructed with these variables showed a good performance in predicting in-hospital mortality; moreover, only one patient with fatal outcome was not correctly classified in the group where the model was constructed and in the group where it was validated. Conclusion: our findings suggest that a simple model that uses only 4 variables, which are easily accessible and interpretable, can identify seriously ill patients with CAP

  15. Hospitalizations and emergency department use in Mayo Clinic Biobank participants within the employee and community health medical home.

    Science.gov (United States)

    Takahashi, Paul Y; Ryu, Euijung; Olson, Janet E; Anderson, Kari S; Hathcock, Matthew A; Haas, Lindsey R; Naessens, James M; Pathak, Jyotishman; Bielinski, Suzette J; Cerhan, James R

    2013-09-01

    To evaluate the participants in the Mayo Clinic Biobank for their representativeness to the entire Employee and Community Health program (ECH) primary care population with regard to hospital utilization. Participants enrolled in the Mayo Clinic Biobank from April 1, 2009, to December 31, 2010, were linked to the ECH population. These individuals were categorized into risk tiers (0-4) on the basis of the number of health conditions present as of December 31, 2010. Outcomes were ascertained through December 31, 2011. Hazard ratios (HRs) and 95% CIs for risk of hospitalization, emergency department (ED) visits, and for risk of hospitalization and emergency department (ED) visits were estimated. The 8927 Biobank participants were part of ECH (N=84,872). Compared with the entire ECH population, the Biobank-ECH participants were more likely to be female (64.3% vs 54.6%), older (median age, 58 years vs 47 years), and categorized to tier 0 (6.4% vs 24.0%). There were strong positive associations between tier (tier 4 vs combined tiers 0 and 1) and risk of hospitalization (HR, 5.8; 95% CI, 4.6-7.5) and ED visits (HR, 5.4; 95% CI, 4.2-6.8) among Biobank-ECH participants. Similar associations for risk of hospitalization (HR, 8.5; 95% CI, 7.8-9.3) and ED visits (HR, 6.9; 95% CI, 6.4-7.5) were observed for the entire ECH population. Although the Biobank-ECH participants were older and had more chronic conditions compared with the overall ECH population, the associations of risk tier with utilization outcomes were similar, supporting the use of the Biobank participants to assess biomarkers for health care outcomes in the primary care setting. Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  16. The Deinstitutionalisation of St. Nicholas Hospital: II Lifestyle, Community Contact and Family Attitudes.

    Science.gov (United States)

    Cummins, Robert A.; Dunt, David

    1990-01-01

    This article reports on a deinstitutionalization project for children with severe multiple intellectual and physical disabilities, in which 98 hospital residents were relocated to small group homes. Relocation generally resulted in a more varied life-routine for residents, a broader range of social activities and greater contact with their…

  17. 78 FR 48303 - TRICARE; Reimbursement of Sole Community Hospitals and Adjustment to Reimbursement of Critical...

    Science.gov (United States)

    2013-08-08

    ... concerned that some hospitals might leave the TRICARE network if payments were reduced too quickly. This was... Subjects in 32 CFR Part 199 Claims, Dental health, Health care, Health insurance, Individuals with... qualified for special treatment under the Medicare prospective payment system as an SCH (see subpart G of 42...

  18. Out-of-hospital cardiac arrest and placement of automated external defibrillators in the community

    DEFF Research Database (Denmark)

    Folke, Fredrik

    2010-01-01

    INDLEDNING Chancen for at overleve et hjertestop udenfor hospital er i de første minutter efter kollaps afhængig af hjælpen fra nærmeste tilstedeværende. Dette har faciliteret strategier for placering af automatiske eksterne defibrillatorer (AED) i det offentlige rum og muliggjort hurtig defibril...

  19. The nature of culture: technological variation in chimpanzee predation on army ants revisited

    DEFF Research Database (Denmark)

    Schöning, Caspar; Humle, Tatyana; Möbius, Yasmin

    2008-01-01

    Chimpanzee (Pan troglodytes) predation on army ants (Dorylus, subgenus Anomma) is an impressive example of skillful use of elementary technology, and it has been suggested to reflect cultural differences among chimpanzee communities. Alternatively, the observed geographic diversity in army-ant-ea...

  20. Strategic Planning for Irwin Army Community Hospital: The Assessment and Implementation of Services, in Order to Meet Fort Riley’s Increasing Population

    Science.gov (United States)

    2008-07-05

    PESTLE Analysis 7 6 Appendix C . SWOT Analysis 77 Appendix D. IACH Potential Strategies Map 7 8 Appendix E. MEDCOM Strategy Map 7 9 Appendix F...rotated from duties in Europe to Fort Riley until 1965, when the Vietnam conflict called for 1st Division to leave its home. This deployment lasted...11 B S r- c IACH STRATEGIC PLAN 7 6 Appendix B. PESTLE Analysis Category Factors Political • Warrior in Transition Unit Emphasis

  1. Assessment of Health Behaviors, Health Education Interests, and Injuries among Employees at the General Leonard Wood Army Community Hospital, October 2014 - December 2014

    Science.gov (United States)

    2016-05-06

    70 (18%) 6.2 Health and Health Behaviors Sixteen survey questions addressed respondents’ self -evaluation of their health . 6.2.1 Overall...fitness, weight management, nutrition, and stress management, which correlate with the predominant self -reported unhealthy behaviors. 7.2 Injuries... self -reported feelings of stress, no associations can be made between injury and specific stress-related behavioral health diagnoses (e.g., anxiety

  2. A Study of Veterans Administration/Department of Defense Health Care Resources Sharing at Keller Army Community Hospital West Point, New York 10996

    Science.gov (United States)

    1984-04-01

    VA and DOD beneficiaries. Any accion taken to implement the resource sharing portion of PL 97-174 must, necessarily, address these findings. PL 97-174...identified for each potencial sharir.g area to support the estimated demand from the Montrose VA. Concern, however, was voiced by the Chief, ER/OPC38

  3. A Study to Determine the Best Method of Caring for Certain Short-Stay Surgical Patients at Reynolds Army Community Hospital

    Science.gov (United States)

    1988-09-01

    there are some cautions. High-risk infants are those with anemia, a history of apnea or of aspiration with feeding, and babies born prematurely . These...services. Second, a quality of care issue has arisen which concerns the growing amount of surgery being performed in clinic treatment rooms. This is...Surgical Patients 19 Chapter II - Discussion Surgical Procedure Selection Development of Procedures List The scope of treatment to be provided in an

  4. A Study to Develop a Case Mix Model for the Allocation of Impatient Workload for Silas B. Hays Army Community Hospital Fort Ord, California

    Science.gov (United States)

    1987-06-26

    AND/CR C. C. 0.6503 326 01 M K EY & URINARY TRACT SIGNS & SYMPM AGE 18-69 W/O C. C. 0.5156 327 011 M KMI & tRDR TRACT SIGNS & SYMPTOMS AGE 0-17...PROCEWRED A 0-17 1.0407 406 017 S MYEMPROLI DIS(RD OR POORLY DIFF NOAS W MAJ O.R. PROC & CC 2.5302 407 017 S MYLLIF DISOD OR POORLY DIN N W )QJ O.R. PROC W/O...E DED WC/R O1! SYNPT 0.7096 435 020 AM V D ECE, DETM AND/OR OTHER SYWM TIC TREATT 0.7978 436 020 AW5 /IIIJ MF3WC WITH REBII1T7TIC THERAPY 1.0166 437

  5. A Strategic Marketing Plan for Women and Infant Services, DeWitt Army Community Hospital and the DeWitt Health Care System

    National Research Council Canada - National Science Library

    Soh, Kelly

    1999-01-01

    ..." for attracting and retaining more patients. Maternal/Child Health is DeWitt's second most important product line, with a target market of 25,000 female beneficiaries between the ages of 18 and 45...

  6. A Study to Determine the Feasibility of Establishing an Ambulatory Surgery Program at Keller Army Community Hospital, West Point, New York

    Science.gov (United States)

    1987-05-01

    other than hydrocele (hematocele) * 62.0 Incision of testis 62.12 Other biopsy of testis * 62.2 Excision or destruction of testicular lesion * 62.3...Excision of Varicocele and Hydrocele of Spermatic Cord 63.73 Vasectomy 64.00 Circumcision 7. OPERATIONS ON THE FEMALE GENITAL SYSTEM ICD-9-CM CODE...Release of Urethral Structure 2 5 25 Needle Biopsy of Prostate 1 1 12 Other Biopsy of Prostate 3 3 36 Excision of Varicocele and Hydrocele of Spermatic

  7. The use of ertapenem for the treatment of community-acquired pneumonia in routine hospital practice: a matched cohort study.

    Science.gov (United States)

    Sousa, D; Bravo-Ferrer, J M; Seoane-Pillado, T; Vázquez-Rodríguez, P; Ramos-Merino, L; Gutiérrez-Urbón, J M; Pita, S; Llinares, P

    2016-10-01

    The clinical response to ertapenem in community-acquired pneumonia (CAP) at the setting of routine hospital practice has been scarcely evaluated. We retrospectively compared CAP cases treated with ertapenem or with other standard antimicrobials (controls) at a tertiary 1,434-bed center from 2005 to 2014. Out of 6,145 patients hospitalized with CAP, 64 (1%) ertapenem-treated and 128 controls were studied (PSI IV-V 72%, mean age 73 years.). A significant higher proportion of bedridden patients (41% vs. 21%), residence in nursing homes (19% vs. 7%), previous use of antibiotics (39% vs. 29%) and necrotizing (13% vs. 1%) or complicated (36% vs. 19%) pneumonia, was observed in the ertapenem vs. non-ertapenem patients. Initial treatment with ertapenem was independently associated with an earlier resolution of signs of infection. In patients aged 65 or older the independent risks factors for mortality were: PSI score (7.0, 95%CI 1.8-27.7), bedridden status (4.6, 95%CI 1.1-20.9) and Health Care Associated Pneumonia (HCAP) (4.6, 95%CI 1.3-16.5). First-line treatment with ertapenem was an independent protector factor in this subgroup of patients (0.1, 95%CI 0.1-0.7). Ertapenem showed a superior clinical response in frail elderly patients with complicated community-acquired pneumonia, and it may be considered as a first-line therapeutic regimen in this setting.

  8. Modifiable risk factors for pneumonia requiring hospitalization of community-dwelling older adults: the Health, Aging, and Body Composition Study.

    Science.gov (United States)

    Juthani-Mehta, Manisha; De Rekeneire, Nathalie; Allore, Heather; Chen, Shu; O'Leary, John R; Bauer, Douglas C; Harris, Tamara B; Newman, Anne B; Yende, Sachin; Weyant, Robert J; Kritchevsky, Stephen; Quagliarello, Vincent

    2013-07-01

    To identify novel modifiable risk factors, focusing on oral hygiene, for pneumonia requiring hospitalization of community-dwelling older adults. Prospective observational cohort study. Memphis, Tennessee, and Pittsburgh, Pennsylvania. Of 3,075 well-functioning community-dwelling adults aged 70 to 79 enrolled in the Health, Aging, and Body Composition Study from 1997 to 1998, 1,441 had complete data in the data set of all variables used, a dental examination within 6 months of baseline, and were eligible for this study. The primary outcome was pneumonia requiring hospitalization through 2008. Of 1,441 participants, 193 were hospitalized for pneumonia. In a multivariable model, male sex (hazard ratio (HR) = 2.07, 95% confidence interval (CI) = 1.51-2.83), white race (HR = 1.44, 95% CI = 1.03-2.01), history of pneumonia (HR = 3.09, 95% CI = 1.86-5.14), pack-years of smoking (HR = 1.006, 95% CI = 1.001-1.011), and percentage of predicted forced expiratory volume in 1 minute (moderate vs mild lung disease or normal lung function, HR = 1.78, 95% CI = 1.28-2.48; severe lung disease vs mild lung disease or normal lung function, HR = 2.90, 95% CI = 1.51-5.57) were nonmodifiable risk factors for pneumonia. Incident mobility limitation (HR = 1.77, 95% CI = 1.32-2.38) and higher mean oral plaque score (HR = 1.29, 95% CI = 1.02-1.64) were modifiable risk factors for pneumonia. Average attributable fractions revealed that 11.5% of cases of pneumonia were attributed to incident mobility limitation and 10.3% to a mean oral plaque score of 1 or greater. Incident mobility limitation and higher mean oral plaque score were two modifiable risk factors that 22% of pneumonia requiring hospitalization could be attributed to. These data suggest innovative opportunities for pneumonia prevention among community-dwelling older adults. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

  9. Association between underweight and hospitalization, emergency room visits, and mortality among patients in community medical homes

    Directory of Open Access Journals (Sweden)

    Takahashi PY

    2013-01-01

    Full Text Available Paul Y Takahashi.1 Jennifer L St Sauver,2 Timothy C Olson,1 Jill M Huber,1 Stephen S Cha,2 Jon O Ebbert11Division of Primary Care Internal Medicine, 2Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USABackground: In older adults, underweight (body mass index [BMI] < 18.5 has been associated with increased mortality. This increased mortality risk may be associated with increased health care utilization. We evaluated the relationship between underweight and hospitalization, emergency room visits, and mortality.Methods: An analysis of a retrospective cohort study was conducted at a multisite academic primary care medical practice in Minnesota. The patients were ≥60 years of age, impaneled within primary care on January 1, 2011, and had a BMI measurement recorded between January 1, 2011, and December 31, 2011. Individuals were excluded if they refused review of their medical record. The primary measurement was BMI, which was categorized as underweight (BMI < 18.5 or normal and obese (BMI ≥ 18.5. The outcomes were hospitalization, emergency room visits, and mortality in the 2011 calendar year. Associations between underweight and each outcome were calculated using logistic regression. Interactions between underweight and gender were assessed in the logistic regression models. The final results were adjusted for age, gender, comorbid health conditions, and single living status.Results: The final cohort included 21,019 patients, of whom 220 (1% were underweight. Underweight patients had a higher likelihood of hospitalization compared with patients with higher BMI (adjusted odds ratio [OR] 1.64; 95% confidence interval [CI] 1.21–2.22. Underweight patients were also more likely to visit the emergency room (adjusted OR 1.70; 95% CI 1.28–2.25 or to die (adjusted OR 3.64; 95% CI 2.33–5.69. Men with a BMI < 18.5 compared with those having a BMI ≥ 18.5 had the highest odds of hospitalization (OR 3.45; 95% CI 1.59–7

  10. Time to Guideline-Based Empiric Antibiotic Therapy in the Treatment of Pneumonia in a Community Hospital: A Retrospective Review.

    Science.gov (United States)

    Erwin, Beth L; Kyle, Jeffrey A; Allen, Leland N

    2016-08-01

    The 2005 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) guidelines for hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and health care-associated pneumonia (HCAP) stress the importance of initiating prompt appropriate empiric antibiotic therapy. This study's purpose was to determine the percentage of patients with HAP, VAP, and HCAP who received guideline-based empiric antibiotic therapy and to determine the average time to receipt of an appropriate empiric regimen. A retrospective chart review of adults with HAP, VAP, or HCAP was conducted at a community hospital in suburban Birmingham, Alabama. The hospital's electronic medical record system utilized International Classification of Diseases, Ninth Revision (ICD-9) codes to identify patients diagnosed with pneumonia. The percentage of patients who received guideline-based empiric antibiotic therapy was calculated. The mean time from suspected diagnosis of pneumonia to initial administration of the final antibiotic within the empiric regimen was calculated for patients who received guideline-based therapy. Ninety-three patients met the inclusion criteria. The overall guideline adherence rate for empiric antibiotic therapy was 31.2%. The mean time to guideline-based therapy in hours:minutes was 7:47 for HAP and 28:16 for HCAP. For HAP and HCAP combined, the mean time to appropriate therapy was 21:55. Guideline adherence rates were lower and time to appropriate empiric therapy was greater for patients with HCAP compared to patients with HAP. © The Author(s) 2015.

  11. Problems and solutions on issues of medical care quality in community-acquired pneumonia in hospitals of Saratov region

    Directory of Open Access Journals (Sweden)

    Lotsmanov Yu.F.

    2011-06-01

    Full Text Available Qualitative assessment of diagnostics and treatment of patients with community-acquired pneumonia (CAP was carried out in ten therapeutic departments of urban and district hospitals of Saratov region, using quality indicators (Qls. Each case of CAP was assessed in expert health care quality (HCQ card according to the diagnostic and treatment quality federal standards and the basic Ql. The application of Ql in CAP patients allowed revealing the following: low CAP agent isolation rate; late hospitalization of CAP patients; low frequency of sputum bacteriological and bacterioscopic investigations prior to antibiotic therapy; insufficient frequency of step-by-step introduction of antibiotics. Recommendations on CAP patients dispenserization were not properly prescribed; recommendations on vaccination were absent. The basic measures of HCQ improvement are as follows: organizing for each CAP patient therapeutic and diagnostic quality control according to Ql; quick administrative decisions; using of HCQ expertise during the first 2-3 days of treatment to correct diagnosis and treatment; optimizing hospital diagnostic resources (laboratory and instrumental and rational pharmacotherapy

  12. Nurses' Interest in Independently Initiating End-of-Life Conversations and Palliative Care Consultations in a Suburban, Community Hospital.

    Science.gov (United States)

    Mehta, Ambereen K; Wilks, Steven; Cheng, M Jennifer; Baker, Karen; Berger, Ann

    2018-03-01

    Patients who receive early palliative care consults have clinical courses and outcomes more consistent with their goals. Nurses have been shown to be advocates for early palliative care involvement and are able to lead advanced care planning discussions. The purpose of this study was to assess whether after a brief educational session, nurses at a suburban, community hospital could demonstrate knowledge of palliative care principles, would want to independently initiate end-of-life conversations with patients and families, and would want to place specialty palliative care consults. Four 1 hour presentations were made at 4 nursing leadership council meetings from November through December 2015. Anonymous pre- and post-presentation surveys were distributed and collected in person. Setting/Participant: Nonprofit, suburban, community hospital in Maryland. Participants were full-time or part-time hospital employees participating in a nursing leadership council who attended the presentation. We compared responses from pre- and post-presentation surveys. Fifty nurses (19 departments) completed pre-presentation surveys (100% response rate) and 49 nurses completed post-presentation surveys (98% response rate). The average score on 7 index questions increased from 71% to 90%. After the presentations, 86% strongly agreed or agreed that nurses should be able to independently order a palliative care consult and 88% strongly agreed or agreed with feeling comfortable initiating an end-of-life conversation. Brief educational sessions can teach palliative care principles to nurses. Most participants of the study would want to be able to directly consult palliative care and would feel comfortable initiating end-of-life conversations after this educational session.

  13. Implementing and evaluating e-communication to improve intersectoral cooperation between hospitals and local communities

    DEFF Research Database (Denmark)

    Nicolaisen, Anne; Qvist, Peter

    2015-01-01

    in-between the two health care sectors. The initiative was initiated in 2009 and the quality standards are continuously revised. Aim: To evaluate to which degree the specified quality standards have been complied. Method: An explicit audit performed in all local municipalities and at selected...... it in an electronic form. Data will be analysed at the regional Centre for Quality. Results from each hospital and the municipalities will be presented at local audit meetings, in which challenges and initiatives to address those are discussed and further actions are decided. Results: The audit is ongoing......Background: There has been an increased focus on how to improve the quality of care to patients, which receives services from more than one provider in the health care system. An important factor is rapid and timely exchange of communication between hospitals and municipalities that provides...

  14. Atypical bacterial pathogens in community-acquired pneumonia in children: a hospital-based study.

    Science.gov (United States)

    Agarwal, Jyotsna; Awasthi, Shally; Rajput, Anuradha; Tiwari, Manoj; Jain, Amita

    2009-04-01

    A total of 243 children aged one month to five years with World Health Organization defined severe community acquired pneumonia were studied for the presence of atypical bacterial pathogens: 24 were found positive for mycoplasma infection. There was no significant association with any of the clinical, laboratory and radiological variables in children with pneumonia by the atypical pathogen.

  15. A case of community-acquired Acinetobacter baumannii meningitis - has the threat moved beyond the hospital?

    NARCIS (Netherlands)

    Lowman, Warren; Kalk, Thomas; Menezes, Colin N.; John, Melanie A.; Grobusch, Martin P.

    2008-01-01

    Acinetobacter baumannii is a prolific nosocomial pathogen renowned for its multidrug-resistant nature. We report a case of community-acquired meningitis due to A. baumannii. The case highlights the potential pathogenicity of this organism and raises concerns that this highly adaptable organism may

  16. Army Programs: Army Finance and Accounting Quality Assurance Program

    National Research Council Canada - National Science Library

    1988-01-01

    This regulation discusses the primary responsibilities of commanders and staff officers at installation and higher levels for execution of the Army Finance and Accounting Quality Assurance (QA) Program...

  17. Influence of socioeconomic status on community-acquired pneumonia outcomes in elderly patients requiring hospitalization: a multicenter observational study

    Directory of Open Access Journals (Sweden)

    Carratalà Jordi

    2010-07-01

    Full Text Available Abstract Background The associations between socioeconomic status and community-acquired pneumonia outcomes in adults have been studied although studies did not always document a relationship. The aim of this multicenter observational study was to determine the association between socioeconomic status and community-acquired pneumonia outcomes in the elderly, in the context of a public health system providing universal free care to the whole population. Methods A total of 651 patients aged ≥65 years hospitalized due to community-acquired pneumonia through the emergency departments of five Spanish public hospitals were recruited and followed up between May 2005 and January 2007. The primary outcomes studied were: length of stay, intensive care unit admission, overall mortality and readmission. Socioeconomic status was measured using both individual and community data: occupation [categorized in six social groups (I, II, III, IVa, IVb and V], educational level (≤ primary level or ≥ secondary level and disposable family income of the municipality or district of residence [>12,500 € (high municipality family income and ≤12,500 € (low municipality family income]. The six social groups were further categorized as upper/middle social class (groups I-IVb and lower class (group V. Bivariate and multivariate analyses were performed. OR and their 95% confidence intervals were calculated. All statistical tests were two tailed and statistical significance was established as p Results 17.7% of patients lived in a municipality or district with a high municipality family income and 63.6% were upper/middle social class (I-IVb. Only 15.7% of patients had a secondary education. The adjusted analysis showed no association between pneumonia outcomes and social class, educational level or municipality family income. However, length of stay increased significantly in patients in whom the factors, living alone and being a smoker or ex-smoker coincided (p

  18. [Acupuncture treatment programs for post-stroke motor rehabilitation in community hospitals: study protocol of a multicenter, randomized, controlled trial].

    Science.gov (United States)

    Fu, Qin-hui; Pei, Jian; Jia, Qi; Song, Yi; Gu, Yue-hua; You, Xiao-xin

    2012-05-01

    Stroke is responsible for increasingly high rates of mortality and disability worldwide. Approximately two million people suffer from stroke for the first time in China each year. The high incidence (50%) of post-stroke disability brings a heavy burden to patients and their caregivers. Acupuncture has been widely used in the communities for post-stroke rehabilitation in China. The objective of this trial is to apply our acupuncture research achievement to treatment and evaluation of post-stroke hemiplegic patients in community. A multicenter, randomized, controlled trial will be performed in Longhua Hospital and a number of community health service centers in Shanghai. A total of 124 patients (estimated sample size) with post-stroke hemiplegia will be randomly divided into an acupuncture group and a control group. The patients undergoing randomization should be stratified according to National Institutes of Health Stroke Scale score at baseline. Within the acupuncture group, different acupuncture protocols are administered to patients with flaccid paralysis or spastic paralysis based on the Ashworth Scale. Patients in the acupuncture group will also be treated with comprehensive rehabilitation therapy. The control group will be treated with comprehensive rehabilitation therapy only. The primary outcome measures are the Simplified Fugl-Meyer Motor Scale, the Modified Barthel Index, and the Burden of Stroke Scale. Secondary outcome measures are the modified Rankin Scale, the modified Ashworth Scale and the Stroke Scale of Traditional Chinese Medicine. Outcome measures will be performed after 4 and 8 weeks of treatment. The patients will be followed up after 6 months. The results of this study are expected to demonstrate that our standardized acupuncture protocol for treating and evaluating post-stroke hemiplegic patients will improve motor function and lessen the burden of post-stroke patients within the communities. This will provide the evidence to support

  19. A mixed-methods approach to conducting Internal Revenue Service-compliant community health needs assessments: a case example for nonprofit hospital leaders

    Directory of Open Access Journals (Sweden)

    Oglesby WH

    2014-10-01

    Full Text Available Willie H Oglesby, Ken Slenkovich Department of Health Policy and Management, College of Public Health, Kent State University, Kent, OH, USA Background: The Patient Protection and Affordable Care Act created new requirements for nonprofit hospitals to conduct a Community Health Needs Assessment (CHNA at least once every 3 years, with a significant tax penalty for noncompliance. While some resources exist to help nonprofit hospital leaders conduct various aspects of a CHNA, few reflect the new Internal Revenue Service requirements. Methods: Many different models of CHNAs have emerged over the years. Although each has its unique features, the essential elements of a CHNA include engaging stakeholders, defining the community, gathering sufficient representative data, prioritizing information, and reporting results. In this paper, we expand upon this basic approach by offering a practical step-by-step guide to conducting CHNAs that meets new Internal Revenue Service regulations. Results: We developed and tested this methodology in partnership with several nonprofit hospital systems in Northeast Ohio, USA. In this paper, we discuss our use of the methodology and identify recommendations for other nonprofit hospital leaders. Conclusion: The methodology presented in this paper is a cost-effective approach to satisfying new CHNA requirements and nonprofit hospital leaders should consider using it or modifying it to fit their unique needs. Keywords: Affordable Care Act, CHNA, community benefit, community hospital

  20. Patterns of prescription drugs use among pregnant women at Sultan Qaboos University Hospital and Sultan Qaboos University Hospital Family and Community Medicine Clinic, Oman

    Directory of Open Access Journals (Sweden)

    J Z Al-Hamimi

    2016-01-01

    Full Text Available Objective: This study evaluates the patterns of prescription drugs use among women attending antenatal clinic at Sultan Qaboos University Hospital (SQUH and SQUH Family and Community Medicine clinic (FAMCO, Oman. Methods: The study was a descriptive retrospective cross-sectional study on pregnant women who attended the antenatal clinic at SQUH and FAMCO from February to April 2014 and received a prescription containing at least one drug. Patients' information was extracted from SQUH electronic records. Results: A total of 105 pregnant women were included in the study. Among the recruited pregnant women, 35 (33.3% had at least one chronic disease. The average number of drugs prescribed per patient per prescription during the period of pregnancy was 2.33 ± 1.43. Vitamins and minerals were the most frequently prescribed class of drugs (30.60% followed by analgesics (11.19% and antidiabetic drugs (10.13%. According to the Food and Drug Administration risk classification, most of the prescribed drugs were from category B (30.0% and C (27.14%. No drug was prescribed from category X. There was a significant decrease in prescribing category A drugs over the three trimesters (20.7%, 12.7%, and 9.3%, respectively (P < 0.047. Conclusion: The study gives an overview of the extent of drug prescription during pregnancy and increases the awareness of health-care providers and women about the potential risks of drug use during pregnancy.

  1. Army Efficiency Initiatives

    Science.gov (United States)

    2011-04-28

    Service College Fellows. The views expressed in this student academic research paper are those of the author and do not reflect the official policy...this student academic research paper are those of the author and do not reflect the official policy or position of the Department of the Army...for procrastination . Nothing worries rational human beings more than the great unknown or even an element of uncertainty regarding the future. To

  2. Army Equipment Modernization Plan

    Science.gov (United States)

    2013-01-01

    Vehicle (LEMV). Provides sustainment to LEMV Airship 1 operations achieving Initial Operating Capability and fully mission capable status in OEF and...builds additional airships and configurable ISR / communications payloads. • Funded $163M in FY12 for 350 of the Gen3 Electronic Control Units for...Intelligence Package High Altitude Long Endurance ( airship ) High Band COMINT Table of Contents 59 www.g8.army.mil HBCT HCCC HEMTT HEMTT-LHS HET HF HIIDE

  3. [Craniocerebral trauma in acute surgical management. Primary care in a general community hospital].

    Science.gov (United States)

    Friedl, W; Karches, C

    1996-11-01

    Head traumas frequently occur in polytrauma patients but are also found as isolated injuries. In our hospital trauma center without a neurosurgical department, in a 21-month period, 489 patients with head/brain trauma were treated. This represents 6.5% of all patients treated in the trauma and reconstructive surgery clinic. In commotio cerebri (CC = 89.5% of the patients) constant conservative management and an uneventful course were observed; in 69 patients with contusio cerebri, 18 craniotomy operations had to be performed. In contrast, in only two cases was reoperation because of recurrent hematoma necessary. In four cases with complex and/or additional injuries, transfer to a neurosurgical center took place, and in two cases photophone consultation with that center was used. The mortality was 14.5%. The diagnostic and therapeutic regimens for the different types of injury and the requirements for the management of head/brain trauma in trauma centers without neurosurgical departments are presented: emergency service and medical staff, emergency room management, intensive care management, qualified neurological examination, X-ray imaging, including CT scan, OP-room equipment and trained surgeons. If these requirements are not available in a given hospital, early transfer of all patients for whom surgical management could be necessary to a neurosurgical department should be attempted. Only in patients with severe bleeding must immediate craniotomy be performed even in hospitals which do not have all the above mentioned facilities. In patients with intracerebral bleeding, bleeding in the dorsal fossa, injury of brain nerves, carotid artery or sinus cavernosus injuries, frontobasal injuries with liquor fistula or pneumonencephalon, transfer of the patients to specialized neurosurgical centers is indicated. With this selection, we obtained the same results in a trauma center without a neurosurgical department as reported in the literature. This avoids overloading

  4. The theology of community benefit. Our tradition obliges us to reach out beyond our hospital walls.

    Science.gov (United States)

    Sister Patricia A Talone

    2005-01-01

    The Catholic health ministry's concern for communities stems from the church's belief that human dignity is most fully expressed and recognized within the context of community. We humans are social beings by our very beings, and unless we involve ourselves in relationships with others, we fail to develop our innate human gifts. We who serve Catholic health care recognize that Jesus had a special affection for and ministry for the poor and vulnerable. Our church calls on us to provide service and advocacy for people whose disadvantages put them at society's margins. This obligation arises from the fact that all people--the healthy and the sick, the rich and the poor, the well-educated and the untaught--are children of the same loving God. Sharing that God, we are our "brother's keeper."

  5. Community Hospital TeleHealth Consortium: Development of a Statewide TeleHealth Network

    Science.gov (United States)

    2000-02-25

    the CHTC). With broad and far-reaching goals, the CHTC set out to improve and expand the opportunity of rural and urban underserved patient...Office of Naval Research Grant # N00014-99-1-0614 Southwest Louisiana Healthcare System, Inc. Lake Charles, LA Final Technical Report Community...the LCMH TeleMedicine Department. Our Lady of the Lake Medical Center in Baton Rouge, Louisiana, focussed on the urban underserved, placing

  6. The Army Profession: A Narrative

    Science.gov (United States)

    2013-05-23

    profile cases of alleged misconduct” were symptomatic of “a much larger issue affecting the armed forces.”9 In the Associated Press, Lolita Baldor ...of-misconduct-among-high-level-military-leaders?lite (accessed January 02, 2013). 10Lolita C. Baldor , "US Army Brigadier General Jeffrey Sinclair to...Science: An Academic Discipline." Army Magazine, no. 5 (May 2005): 14-15. Baldor , Lolita C. and Michael Biesecker. "US Army Brigadier General

  7. Rehabilitating the Wounded: Historical Perspective on Army Policy

    Science.gov (United States)

    2008-06-01

    Patients 57 4. 1946-1956: A Changing Balance in Federal Healthcare: Introduction 61 The VA Readjusts to Peace 61 The AMEDD Amid...veterans, and did not object when much care was provided through the VA. The VA Readjusts To Peace As the military demobilized from WWII...cardiologists in Army hospitals, while sending endocrinologists and pediatric hematologists for training in civilian hospitals.269 Some of these programs

  8. Index to Army Times, 1993

    Science.gov (United States)

    1994-02-01

    13): p. 37. AH-64 (HELICOPTER)--COCKPIT CANOPY Plastic covers to shield Apaches. Army Times; Aug. 16, 1993; 54(3): p. 35. AH-64 (HELICOPTER...prepares for radical surgery . Army Times; Jan. 4, 1993; 53(23): p. 26. Reform could sound death knell for CHAMPUS. Army Times; Aug. 2, 1993; 54(1): p...p. 6. FEDERAL TORT CLAIMS ACT Court upholds malpractice ban. Army Times; Mar. 8, 1993; 53(32): p. 17. FERES DOCTRINE Court upholds malpractice ban

  9. Index to Army Times 1988

    Science.gov (United States)

    1992-08-01

    p. 7. Teams will strike at child abuse problems . Army Times; Mar. 21, 1988; 48(31): p. 27. CHILD CARE CENTERS SEE DAY CARE CENTERS CHILD MOLESTING ...COMPUTER PROGRAM LANGUAGE) Ada works well in hellfire tests. Army Times; Ju 6󈨜 48(43): p. 34. ADATS SEE AIR DEFENSE ANTITANK SYSTEM (ADATS) O3 ADOPT ...A-SCHOOL PROGRAM Adopt -a-school. Army Times; May 9, 1988; 48(39): p. 27. ADOPTION AID PROGRAM Adoption reimbursement under way. Army Times; Aug. 8

  10. [Physical structure, human resources, and health care quality indicators in public hospital emergency departments in the autonomous communities of Madrid and Catalonia: a comparative study].

    Science.gov (United States)

    Del Arco Galán, Carmen; Rodríguez Miranda, Belén; González Del Castillo, Juan; Carballo, César; Bibiano Guillén, Carlos; Artillo, Santiago; Miró, Òscar; Martín-Sánchez, F Javier

    2017-01-01

    To compare the general, structural, and organizational characteristics of public hospital emergency departments in the Spanish autonomous communities of Madrid and Catalonia. Descriptive survey-based study covering 3 areas of inquiry: general hospital features (18 questions), structural features of the emergency department (14 questions), and organizational and work-related policies of the emergency department (30 questions). Hospitals were grouped according to complexity: local hospitals (level 1), high-technology or referral hospitals (levels 2-3). We studied 26 hospital departments in Madrid (21, levels 2-3; 5, level 1) and 55 in Catalonia (24, levels 2-3; 31, level 1). Hospitals in Madrid are in newer buildings (P=.002), have more beds on conventional wards and in critical care units (P<.001, both comparisons), are more often affiliated with a university (P<.001), and serve larger populations (P=.027). The emergency departments in Madrid have larger surface areas available for clinical care and more cubicles for preliminary evaluations and observation beds (P=.001, all comparisons). Hospitals in Madrid also attended a larger median number of emergencies (P<.001). More physicians were employed in Catalonia overall, but the numbers of physician- and nurse-hours per hospital were higher in Madrid, where it was more usual for physicians to work exclusively in the emergency department (92.5% in Madrid vs 56.8% in Catalonia, P<.001). However, fewer of the employed physicians had permanent contracts in Madrid (30.5% vs 75.1% in Catalonia, P<.001). The ratio of resident physicians to staff physicians differs between the 2 communities on afternoon/evening, night, and holiday shifts (3:1 in Madrid; 1:1 in Catalonia). The physical and functional structures of hospital emergency departments in the communities of Madrid and Catalonia differ significantly. The differences cannot be attributed exclusively to geographic location.

  11. Diverticulitis Outcomes are Equivalent Between Level 1 Trauma Centers and Community Hospitals in New Jersey.

    Science.gov (United States)

    Gale, Stephen C; Arumugam, Dena; Dombrovskiy, Viktor Y

    2015-06-01

    Traditionally, general surgeons provide emergency general surgery (EGS) coverage by assigned call. The acute care surgery (ACS) model is new and remains confined mostly to academic centers. Some argue that in busy trauma centers, on-call trauma surgeons may be unable to also care for EGS patients. In New Jersey, all three Level 1 Trauma Centers (L1TC) have provided ACS services for many years. Analyzing NJ state inpatient data, we sought to determine whether outcomes in one common surgical illness, diverticulitis, have been different between L1TC and nontrauma centers (NTC) over a 10-year period. The NJ Medical Database was queried for patients aged 18 to 90 hospitalized from 2001 to 2010 for acute diverticulitis. Demographics, comorbidities, operative rates, and mortality were compiled and analyzed comparing L1TC to NTC. For additional comparison between L1TC and NTC, 1:1 propensity score matching with replacement was accomplished. χ(2), t test, and Cochran-Armitage trend test were used. From 2001 to 2010, 88794 patients were treated in NJ for diverticulitis. 2621 patients (2.95%) were treated at L1TCs. Operative rates were similar between hospital types. Patients treated at L1TCs were more often younger (63.1 ± 0.3 vs 64.7 ± 0.1; P diverticulitis are equivalent between LT1C and NTC in NJ. Trauma centers in NJ more commonly provide care to minority and uninsured patients.

  12. Integrating Health Care for the Most Vulnerable: Bridging the Differences in Organizational Cultures Between US Hospitals and Community Health Centers.

    Science.gov (United States)

    Ko, Michelle; Murphy, Julia; Bindman, Andrew B

    2015-11-01

    Policymakers have increasingly promoted health services integration to improve quality and efficiency. The US health care safety net, which comprises providers of health care to uninsured, Medicaid, and other vulnerable patients, remains a largely fragmented collection of providers. We interviewed leadership from safety net hospitals and community health centers in 5 US cities (Boston, MA; Denver, CO; Los Angeles, CA; Minneapolis, MN; and San Francisco, CA) throughout 2013 on their experiences with service integration. We identify conflicts in organizational mission, identity, and consumer orientation that have fostered reluctance to enter into collaborative arrangements. We describe how smaller scale initiatives, such as capitated model for targeted populations, health information exchange, and quality improvements led by health plans, can help bridge cultural differences to lay the groundwork for developing integrated care programs.

  13. Abundance of antibiotics, antibiotic resistance genes and bacterial community composition in wastewater effluents from different Romanian hospitals.

    Science.gov (United States)

    Szekeres, Edina; Baricz, Andreea; Chiriac, Cecilia Maria; Farkas, Anca; Opris, Ocsana; Soran, Maria-Loredana; Andrei, Adrian-Stefan; Rudi, Knut; Balcázar, Jose Luis; Dragos, Nicolae; Coman, Cristian

    2017-06-01

    Antimicrobial resistance represents a growing and significant public health threat, which requires a global response to develop effective strategies and mitigate the emergence and spread of this phenomenon in clinical and environmental settings. We investigated, therefore, the occurrence and abundance of several antibiotics and antibiotic resistance genes (ARGs), as well as bacterial community composition in wastewater effluents from different hospitals located in the Cluj County, Romania. Antibiotic concentrations ranged between 3.67 and 53.05 μg L -1 , and the most abundant antibiotic classes were β-lactams, glycopeptides, and trimethoprim. Among the ARGs detected, 14 genes confer resistance to β-lactams, aminoglycosides, chloramphenicol, macrolide-lincosamide-streptogramin B (MLSB) antibiotics, sulfonamides, and tetracyclines. Genes encoding quaternary ammonium resistance and a transposon-related element were also detected. The sulI and qacEΔ1 genes, which confer resistance to sulfonamides and quaternary ammonium, had the highest relative abundance with values ranging from 5.33 × 10 -2 to 1.94 × 10 -1 and 1.94 × 10 -2 to 4.89 × 10 -2 copies/16 rRNA gene copies, respectively. The dominant phyla detected in the hospital wastewater samples were Proteobacteria, Bacteroidetes, Firmicutes, and Actinobacteria. Among selected hospitals, one of them applied an activated sludge and chlorine disinfection process before releasing the effluent to the municipal collector. This conventional wastewater treatment showed moderate removal efficiency of the studied pollutants, with a 55-81% decrease in antibiotic concentrations, 1-3 order of magnitude lower relative abundance of ARGs, but with a slight increase of some potentially pathogenic bacteria. Given this, hospital wastewaters (raw or treated) may contribute to the spread of these emerging pollutants in the receiving environments. To the best of our knowledge, this study quantified for the first time the

  14. Working to Full Scope: The Reorganization of Nursing Work in Two Canadian Community Hospitals.

    Science.gov (United States)

    MacKinnon, Karen; Butcher, Diane L; Bruce, Anne

    2018-01-01

    Work relationships between registered nurses (RNs) and practical nurses (LPNs) are changing as new models of nursing care delivery are introduced to create more flexibility for employers. In Canada, a team-based, hospital nursing care delivery model, known as Care Delivery Model Redesign (CDMR), redesigned a predominantly RN-based staffing model to a functional team consisting of fewer RNs and more LPNs. The scope of practice for LPNs was expanded, and unregulated health care assistants introduced. This study began from the standpoint of RNs and LPNs to understand their experiences working on redesigned teams by focusing on discourses activated in social settings. Guided by institutional ethnography, the conceptual and textual resources nurses are drawing on to understand these changing work relationships are explicated. We show how the institutional goals embedded in CDMR not only mediate how nurses work together, but how they subordinate holistic standards of nursing toward fragmented, task-oriented, divisions of care.

  15. Association of Panton Valentine Leukocidin (PVL) genes with methicillin resistant Staphylococcus aureus (MRSA) in Western Nepal: a matter of concern for community infections (a hospital based prospective study).

    Science.gov (United States)

    Bhatta, Dharm R; Cavaco, Lina M; Nath, Gopal; Kumar, Kush; Gaur, Abhishek; Gokhale, Shishir; Bhatta, Dwij R

    2016-05-15

    Methicillin resistant Staphylococcus aureus (MRSA) is a major human pathogen associated with nosocomial and community infections. Panton Valentine leukocidin (PVL) is considered one of the important virulence factors of S. aureus responsible for destruction of white blood cells, necrosis and apoptosis and as a marker of community acquired MRSA. This study was aimed to determine the prevalence of PVL genes among MRSA isolates and to check the reliability of PVL as marker of community acquired MRSA isolates from Western Nepal. A total of 400 strains of S. aureus were collected from clinical specimens and various units (Operation Theater, Intensive Care Units) of the hospital and 139 of these had been confirmed as MRSA by previous study. Multiplex PCR was used to detect mecA and PVL genes. Clinical data as well as antimicrobial susceptibility data was analyzed and compared among PVL positive and negative MRSA isolates. Out of 139 MRSA isolates, 79 (56.8 %) were PVL positive. The majority of the community acquired MRSA (90.4 %) were PVL positive (Positive predictive value: 94.9 % and negative predictive value: 86.6 %), while PVL was detected only in 4 (7.1 %) hospital associated MRSA strains. None of the MRSA isolates from hospital environment was found positive for the PVL genes. The majority of the PVL positive strains (75.5 %) were isolated from pus samples. Antibiotic resistance among PVL negative MRSA isolates was found higher as compared to PVL positive MRSA. Our study showed high prevalence of PVL among community acquired MRSA isolates. Absence of PVL among MRSA isolates from hospital environment indicates its poor association with hospital acquired MRSA and therefore, PVL may be used a marker for community acquired MRSA. This is first study from Nepal, to test PVL among MRSA isolates from hospital environment.

  16. Molecular Detection and Characterization of Mycoplasma pneumoniae Among Patients Hospitalized With Community-Acquired Pneumonia in the United States.

    Science.gov (United States)

    Diaz, Maureen H; Benitez, Alvaro J; Cross, Kristen E; Hicks, Lauri A; Kutty, Preeta; Bramley, Anna M; Chappell, James D; Hymas, Weston; Patel, Anami; Qi, Chao; Williams, Derek J; Arnold, Sandra R; Ampofo, Krow; Self, Wesley H; Grijalva, Carlos G; Anderson, Evan J; McCullers, Jonathan A; Pavia, Andrew T; Wunderink, Richard G; Edwards, Kathryn M; Jain, Seema; Winchell, Jonas M

    2015-09-01

    Background.  Mycoplasma pneumoniae is a common cause of community-acquired pneumonia (CAP). The molecular characteristics of M pneumoniae detected in patients hospitalized with CAP in the United States are poorly described. Methods.  We performed molecular characterization of M pneumoniae in nasopharyngeal/oropharyngeal swabs from children and adults hospitalized with CAP in the Centers for Disease Control and Prevention Etiology of Pneumonia in the Community (EPIC) study, including P1 typing, multilocus variable-number tandem-repeat analysis (MLVA), and macrolide susceptibility genotyping. Results.  Of 216 M pneumoniae polymerase chain reaction-positive specimens, 40 (18.5%) were obtained from adults and 176 (81.5%) from children. P1 type distribution differed between adults (64% type 1 and 36% type 2) and children (84% type 1, 13% type 2, and 3% variant) (P < .05) and among sites (P < .01). Significant differences in the proportions of MLVA types 4/5/7/2 and 3/5/6/2 were also observed by age group (P < .01) and site (P < .01). A macrolide-resistant genotype was identified in 7 (3.5%) specimens, 5 of which were from patients who had recently received macrolide therapy. No significant differences in clinical characteristics were identified among patients with various strain types or between macrolide-resistant and -sensitive M pneumoniae infections. Conclusions.  The P1 type 1 genotype and MLVA type 4/5/7/2 predominated, but there were differences between children and adults and among sites. Macrolide resistance was rare. Differences in strain types did not appear to be associated with differences in clinical outcomes. Whole genome sequencing of M pneumoniae may help identify better ways to characterize strains.

  17. Moxifloxacin monotherapy is effective in hospitalized patients with community-acquired pneumonia: the MOTIV study--a randomized clinical trial.

    Science.gov (United States)

    Torres, Antoni; Garau, Javier; Arvis, Pierre; Carlet, Jean; Choudhri, Shurjeel; Kureishi, Amar; Le Berre, Marie-Aude; Lode, Hartmut; Winter, John; Read, Robert C

    2008-05-15

    The aim of this study was to show that sequential intravenous and oral moxifloxacin monotherapy (400 mg once per day) is as efficacious and safe as a combination regimen (intravenous ceftriaxone, 2 g once per day, plus sequential intravenous and oral levofloxacin, 500 mg twice per day) in patients hospitalized with community-acquired pneumonia. We conducted a prospective, multicenter, randomized, double-blind noninferiority trial. Patients with a Pneumonia Severity Index (PSI) of III-V were stratified on the basis of PSI risk class before randomization. The primary efficacy end point was clinical response at test of cure (4-14 days after the completion of treatment). Secondary efficacy end points were clinical and bacteriological response at end of treatment (days 7-14) and at follow-up assessment (21-28 days after the end of treatment), overall mortality, and mortality attributable to pneumonia. Seven hundred thirty-three patients were enrolled in the study (368 in the moxifloxacin arm and 365 in the comparator arm); 49% had a PSI of IV, and 10% had a PSI of V. Of 569 patients (291 in the moxifloxacin arm and 278 in the comparator arm) valid for per-protocol analysis, the overall clinical cure rates at test of cure were 86.9% for moxifloxacin and 89.9% for the comparator regimen (95% confidence interval, -8.1% to 2.2%). Bacteriological success at test of cure was 83.3% for moxifloxacin and 85.1% for the comparator regimen (95% confidence interval, -15.4% to 11.8%). There were no significant differences between moxifloxacin and comparator treatments in the incidence of treatment-emergent adverse events or in mortality. Monotherapy with sequential intravenous/oral moxifloxacin was noninferior to treatment with ceftriaxone plus levofloxacin combination therapy in patients with community-acquired pneumonia who required hospitalization.

  18. How much do Blantyre dispensers in hospital and community pharmacies know about the new malaria treatment guidelines?

    Science.gov (United States)

    Minyaliwa, Collins; Bandawe, Chiwoza; Mwale, Richman James

    2012-03-01

    To determine the knowledge of dispensers in hospital and community pharmacies within Blantyre on new malaria treatment guidelines. An interviewer administered questionnaire was used for data collection and the questions focused on the knowledge of dispensers on the new malaria treatment guidelines and whether the subjects were involved in the preparation or implementation of the guidelines or had undertaken any training on how to dispense the new anti-malarial medicines. None of the participants had been involved in the preparation of the treatment guidelines and only 45.5% of the participants had undertaken the pre-implementation training. Ninety percent of the interviewees had knowledge concerning the appropriate treatment of malaria in pregnancy. However, as many as 90.9% of the interviewed participants could not mention any possible five or more side-effects of LA and only 13.6% knew how to properly manage the possible effects. Only 27.3% knew the correct dose regimen of LA and none of them knew the condition of taking LA with a fatty meal for improved absorption. Lack of involvement of the pharmaceutical personnel working in hospital and community pharmacies, from the preparation of new malaria treatment guidelines to their implementation, inadequate training and qualifications of the dispensing personnel contributed to their lack of knowledge and skill on how to rationally dispense the medicines. Pharmaceutical personnel dispensing in the pharmacies need to be involved from the beginning in the preparation of treatment guidelines. Adequate training should be provided and followed by continuous professional education.

  19. Esophagus and contralateral lung-sparing IMRT for locally advanced lung cancer in the community hospital setting

    Directory of Open Access Journals (Sweden)

    Johnny eKao

    2015-06-01

    Full Text Available Background: The optimal technique for performing lung IMRT remains poorly defined. We hypothesize that improved dose distributions associated with normal tissue sparing IMRT can allow for safe dose escalation resulting in decreased acute and late toxicity. Methods: We performed a retrospective analysis of 82 consecutive lung cancer patients treated with curative intent from 1/10 to 9/14. From 1/10 to 4/12, 44 patients were treated with the community standard of 3-dimensional conformal radiotherapy or IMRT without specific esophagus or contralateral lung constraints (standard RT. From 5/12 to 9/14, 38 patients were treated with normal tissue-sparing IMRT with selective sparing of contralateral lung and esophagus. The study endpoints were dosimetry, toxicity and overall survival.Results: Despite higher mean prescribed radiation doses in the normal tissue-sparing IMRT cohort (64.5 Gy vs. 60.8 Gy, p=0.04, patients treated with normal tissue-sparing IMRT had significantly lower lung V20, V10, V5, mean lung, maximum esophagus and mean esophagus doses compared to patients treated with standard RT (p≤0.001. Patients in the normal tissue-sparing IMRT group had reduced acute grade ≥3 esophagitis (0% vs. 11%, p<0.001, acute grade ≥2 weight loss (2% vs. 16%, p=0.04, late grade ≥2 pneumonitis (7% vs. 21%, p=0.02. The 2-year overall survival was 52% with normal tissue-sparing IMRT arm compared to 28% for standard RT (p=0.015.Conclusion: These data provide proof of principle that suboptimal radiation dose distributions are associated with significant acute and late lung and esophageal toxicity that may result in hospitalization or even premature mortality. Strict attention to contralateral lung and esophageal dose volume constraints are feasible in the community hospital setting without sacrificing disease control.

  20. Clinical Pharmacist Management of Bacteremia in a Community Hospital Emergency Department.

    Science.gov (United States)

    Waters, C Dustin; Bitton, Bryce J; Torosyan, Annie; Myers, Kevin P

    2017-06-01

    Bacteremia is a serious condition that leads to high morbidity and mortality. Data describing pharmacist involvement in the management of bacteremia in the emergency department are lacking. To determine if pharmacist involvement in the management of bacteremia in the emergency department (ED) led to an increase in appropriate treatment of bacteremia as well as improvements in patient outcomes. The primary outcome of this retrospective cohort study was the rate of appropriate treatment of bacteremia. Secondary outcomes included the rate of unplanned, infectious disease-related 90-day admission or readmission to the ED or hospital as well as infectious disease-related 90-day mortality. All patients seen in the ED and subsequently discharged who had a positive blood culture determined not to be a contaminant were included in the study. Patients were analyzed in 2 cohorts: those that were physician managed (107 patients) and those that were pharmacist managed (138 patients). In the physician-managed cohort, 50 of 107 (47%) patients were treated appropriately compared with 131 of 138 (95%) patients in the pharmacist-managed cohort ( P managed patients, which occurred in 4 of 138 patients (2.9%) versus the physician-managed patient cohort in which 13 of 107 patients (12.1%) were readmitted ( P = 0.01). There was no difference in mortality between the groups ( P = 0.8337). Pharmacist involvement in the management of bacteremia in the ED was associated with higher rates of appropriate treatment and a corresponding decrease in the rates of attributable 90-day admission or readmission to the hospital or ED.

  1. Psychosocial functioning of individuals with schizophrenia in community housing facilities and the psychiatric hospital in Zurich.

    Science.gov (United States)

    Jaeger, Matthias; Briner, David; Kawohl, Wolfram; Seifritz, Erich; Baumgartner-Nietlisbach, Gabriela

    2015-12-15

    Individuals with severe mental illness frequently have difficulties in obtaining and maintaining adequate accommodation. If they are not willing or able to adapt to requirements of traditional supported housing institutions they may live in sheltered and emergency accommodation. Adequate mental health services are rarely available in these facilities. The aim of the present study was to evaluate mental health, functional and social status of individuals living in community sheltered housing facilities. A cross-sectional survey of n=338 individuals in sheltered housing compared to a sample of patients at intake in acute inpatient psychiatry (n=619) concerning clinical and social variables was carried out in the catchment area of Zurich. Matched subsamples of individuals with schizophrenia (n=168) were compared concerning functioning and impairments on the Health of the Nation Outcome Scales (HoNOS). Individuals with schizophrenia in sheltered housing (25% of the residents) have significantly more problems concerning substance use, physical illness, psychopathological symptoms other than psychosis and depression, and relationships, daily activities and occupation than patients with schizophrenia at intake on an acute psychiatric ward. Community sheltered accommodation although conceptualized to prevent homelessness in the general population de facto serve as housing facilities for individuals with schizophrenia and other severe mental illness. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  2. Phoenix Park Community Nursing Units, St. Mary's Hospital,Phoenix Park, Dublin 20.

    LENUS (Irish Health Repository)

    Brabazon, E D

    2010-01-01

    The use of routinely available electronic sources of healthcare data on the spread of influenza has the potential to enhance current surveillance activities. This study aimed to develop a method for identifying influenza-related records from general practitioner(GP) out-of-hours (OOH) services in Ireland. Data from one such service were interrogated for keywords relating to influenza-like illness (ILI) and a proxy measure of influenza activity in the community setting was developed. Comparison of this syndromic surveillance measure with national data on ILI consultation rates demonstrated a statistically significant temporal correlation.In five out of six influenza seasons investigated,peaks in the GP OOH influenza-related calls appeared at least one week ahead of peaks in the national ILI consultation rates. The method described in this paper has been extended to nine OOH services in Ireland (covering 70% of the Irish population) to provide weekly figures on self-reported illness for influenza in the community and its data have been incorporated into the national weekly influenza reports produced by the Health Protection Surveillance Centre. These data should provide early warnings of both seasonal and pandemic influenza in Ireland.

  3. The Most Common Detected Bacteria in Sputum of Patients with Community Acquired Pneumonia (CAP) Treated In Hospital.

    Science.gov (United States)

    Cukic, Vesna; Hadzic, Armin

    2016-10-01

    Community acquired pneumonia (CAP) is the most common infective pulmonary disease. To show the most common detected bacteria in bacterial culture of sputum in patients with CAP hospitalized in Clinic for Pulmonary Diseases and TB "Podhrastovi" in four-year period: from 2012 to 2015. This is the retrospective analysis. Each patient gave sputum 3 days in a row when admitted to hospital. Sputum has been examined: bacterial culture with antibiotics sensitivity, Gram stain, Mycobacterium tuberculosis; in cases with high temperature blood cultures were done; when we were suspicious about bronchial carcinoma bronchoscopy with BAL (bronchoalveolar lavage) was done. We show analyzed patients according to age, sex, whether they had pneumonia or bronchopneumonia, bacteria isolated in sputum and in BAL. 360 patients with CAP were treated in four-year period (247 males and 113 females). 167 or 43, 39 % had pneumonia (119 males and 48 females). Number of males was significantly bigger (χ 2 = 30,186; ppneumonia. Number of patients with negative bacterial culture of sputum (154- 79, 79%) was significantly bigger than number of patients with positive culture (39- 20, 21%) (χ 2 = 68,523; ppneumoniae was significantly most common detected bacterium compared with the number of other isolated bacteria; in pneumonia (χ 2 =33,222; p<0,001) and in bronchopneumonia (χ 2 =51,231; p<0,001). It is very important to detect the bacterial cause of CAP to administrate the targeted antibiotic therapy.

  4. Is There a Return on a Children's Hospital's Investment in a Pediatric Residency's Community Health Track? A Cost Analysis.

    Science.gov (United States)

    Lichtenstein, Cara; Cora-Bramble, Denice; Ottolini, Mary; Agrawal, Dewesh

    2018-04-01

    Academic Medical Centers incur significant expenses associated with training residents and caring for underserved populations. No previous studies have analyzed hospital-level graduate medical education economics for pediatric residency training. Using data from the 2010-2011 academic year, we quantified total direct costs per year for training 12 community health track (CHT) residents. Utilizing sensitivity analyses, we estimated revenues generated by residents in inpatient and outpatient settings. The total yearly direct cost of training 12 CHT residents was $922,640 including salaries, benefits, and administrative costs. The estimated additional yearly inpatient net revenue from attending-resident clinical teams compared to attendingonly service was $109,452. For primary care clinics, the estimated yearly revenue differential of resident-preceptor teams was $455,940, compared to attending-only clinics. The replacement cost of 12 CHT residents with advanced practitioners was $457,596 per year.This study suggests there is positive return on a children's hospital's investment in a CHT.

  5. Clinical course of community-acquired respiratory syncytial virus pneumonia in newborns hospitalized in neonatal intensive care unit.

    Science.gov (United States)

    Aydın, Banu; Zenciroğlu, Ayşegül; Dilli, Dilek; Okumuş, Nurullah; İpek, M Sah; Aydın, Mustafa; Uzunalıç, Nuran; Hakan, Nilay; Kundak, Ahmet Afşin; Dursun, Arzu; Karadağ, Nilgün; Korukluoğlu, Gülay

    2013-01-01

    Respiratory syncytial virus (RSV) is a major cause of pneumonia in infants worldwide. We aimed to evaluate the clinical course of community-acquired RSV pneumonia in newborns hospitalized in neonatal intensive care unit. All the newborns diagnosed as pneumonia were prospectively evaluated for RSV infection between November 2010 and April 2011. Fifty-four specimens of nasopharyngeal secretions were tested in parallel with the RAT and the multiplex real time polymerase chain reaction (RT- PCR). Downes' score was used to assess the disease severity in patients with pneumonia. RAT has a sensitivity of 90% and a specificity of 78.5%, as the PCR technique target assay. Four of the patients with RSV pneumonia had secundum atrial septal defect (ASD) and all of four needed mechanical ventilation support. The first day Downes' score was positively correlated with time of intravenous fluid requirement (p= 0.001, r= 0.48), total oxygen need (p= 0.000, r= 0.63), and re-enteral feeding (p= 0.001, r= 0.46). Blood pH (p= 0.031, r= 0.46) were negatively correlated with Downes' score. The second day Downes' score was higher in patients with ASD than those of without ASD (3.8 ± 2.6 vs. 2 ± 1.1, p= 0.01). The most possible risk factor for longer hospital stay was the higher second day Downes' score (p= 0.02 OR: 1.9, CI 95% (1.1-3.2). All infants were discharged from hospital in a good health. RAT is sensitive and specific in detecting RSV infections in newborns. Physicians may use Downes' score for evaluation of disease severity in infants with RSV pneumonia. In these patients, ASD has increased the disease severity.

  6. Comparisons of the mortality and clinical presentations of status epilepticus in private practice community and university hospital settings in Richmond, Virginia.

    Science.gov (United States)

    DeLorenzo, Robert J; Kirmani, Batool; Deshpande, Laxmikant S; Jakkampudi, Vamsy; Towne, Alan R; Waterhouse, Elizabeth; Garnett, Linda; Ramakrishnan, Viswanathan

    2009-07-01

    We prospectively compared the clinical course of 119 patients treated for status epilepticus (SE) in private practice community hospitals and 344 SE patients treated in the VCU university hospitals in Richmond, Virginia USA over a 2-year period to test the hypothesis that SE presents with the same mortality and clinical patterns in both clinical settings. Of the patients reviewed, the major etiologies for SE were cerebrovascular disease, decreased anti-epileptic drug levels in epileptic patients, anoxia-hypoxia, and remote symptomatic. The other etiologies included were alcohol related, trauma, central nervous system infections, tumors, systemic infection, metabolic disorders, idiopathic, and hemorrhage. These observations provide the first direct prospective comparison of SE present in university and private practice community hospital settings in the same geographic area. Mortality was the highest in the elderly population while the pediatric population had low mortality in both clinical settings. Etiology risk factors for outcome were similar for both the populations. The data also suggest that the higher degree of illness severity in university hospitals may be associated with a higher incidence of SE, but not with mortality or a different clinical presentation of the condition. The results of this study demonstrate that SE has the same mortality and is present in an essentially identical manner in university and private practice community hospitals and underscores the fact that mortality in SE is not just associated with tertiary care hospitals and the importance of recognizing the severity of SE in the private practice setting.

  7. Return-on-Investment (ROI) Analyses of an Inpatient Lay Health Worker Model on 30-Day Readmission Rates in a Rural Community Hospital.

    Science.gov (United States)

    Cardarelli, Roberto; Bausch, Gregory; Murdock, Joan; Chyatte, Michelle Renee

    2017-07-07

    The purpose of the study was to assess the return-on-investment (ROI) of an inpatient lay health worker (LHW) model in a rural Appalachian community hospital impacting 30-day readmission rates. The Bridges to Home (BTH) study completed an evaluation in 2015 of an inpatient LHW model in a rural Kentucky hospital that demonstrated a reduction in 30-day readmission rates by 47.7% compared to a baseline period. Using the hospital's utilization and financial data, a validated ROI calculator specific to care transition programs was used to assess the ROI of the BTH model comparing 3 types of payment models including Diagnosis Related Group (DRG)-only payments, pay-for-performance (P4P) contracts, and accountable care organizations (ACOs). The BTH program had a -$0.67 ROI if the hospital had only a DRG-based payment model. If the hospital had P4P contracts with payers and 0.1% of its annual operating revenue was at risk, the ROI increased to $7.03 for every $1 spent on the BTH program. However, if the hospital was an ACO as was the case for this study's community hospital, the ROI significantly increased to $38.48 for every $1 spent on the BTH program. The BTH model showed a viable ROI to be considered by community hospitals that are part of an ACO or P4P program. A LHW care transition model may be a cost-effective alternative for impacting excess 30-day readmissions and avoiding associated penalties for hospital systems with a value-based payment model. © 2017 National Rural Health Association.

  8. Some Recent Sensor-Related Army Critical Technology Events

    Science.gov (United States)

    2013-02-01

    dimensional visualization developed by ARL has been applied to all Buckeye data and any imagery available on the AGC website today is three...research excellence, and a corporate gestalt that creates the environment which nourishes scientific élan. The Army S&T community of laboratories is

  9. Etiologic spectrum and occurrence of coinfections in children hospitalized with community-acquired pneumonia.

    Science.gov (United States)

    Jiang, Wujun; Wu, Min; Zhou, Jing; Wang, Yuqing; Hao, Chuangli; Ji, Wei; Zhang, Xinxing; Gu, Wenjing; Shao, Xuejun

    2017-12-20

    Co-infections are common in childhood community acquired pneumonia (CAP). However, their etiological pattern and clinical impact remains inconclusive. Eight hundred forty-six consecutive children with CAP were evaluated prospectively for the presence of viral and bacterial pathogens. Nasopharyngeal aspirates were examined by direct immunofluorescence assay or polymerase chain reaction (PCR) for viruses. PCR of nasopharyngeal aspirates and enzyme-linked immunosorbent assays were performed to detect M. pneumoniae. Bacteria was detected in blood, bronchoalveolar lavage specimen, or pleural fluid by culture. Causative pathogen was identified in 70.1% (593 of 846) of the patients. The most commonly detected pathogens were respiratory syncytial virus (RSV) (22.9%), human rhinovirus (HRV) (22.1%), M. pneumoniae (15.8%). Coinfection was identified in 34.6% (293 of 846) of the patients. The majority of these (209 [71.3%] of 293) were mixed viral-bacterial infections. Age pneumonia pathogens.

  10. Hospital preparedness in community measles outbreaks—challenges and recommendations for low-resource settings

    Science.gov (United States)

    Shakoor, Sadia; Mir, Fatima; Zaidi, Anita K. M.; Zafar, Afia

    2015-01-01

    We have reviewed various strategies involved in containment of measles in healthcare facilities during community outbreaks. The strategies that are more applicable to resource-poor settings, such as natural ventilation, mechanical ventilation with heating and air-conditioning systems allowing unidirectional air-flow, and protection of un-infected patients and healthcare workers (HCWs), have been examined. Ventilation methods need innovative customization for resource-poor settings followed by validation and post-implementation analysis for impact. Mandatory vaccination of all HCWs with two doses of measles-containing vaccine, appropriate post-exposure prophylaxis of immunocompromised inpatients, and stringent admission criteria for measles cases can contribute toward reduction of nosocomial and secondary transmission within facilities. PMID:25882388

  11. High incidence of community-acquired pneumonia among rapidly aging population in Japan: a prospective hospital-based surveillance.

    Science.gov (United States)

    Takaki, Masahiro; Nakama, Takahiro; Ishida, Masayuki; Morimoto, Hitomi; Nagasaki, Yuka; Shiramizu, Rina; Hamashige, Naohisa; Chikamori, Masayuki; Yoshida, Laymyint; Ariyoshi, Koya; Suzuki, Motoi; Morimoto, Konosuke

    2014-01-01

    The age-group-specific incidence and etiological patterns of community-acquired pneumonia (CAP) have not been fully established in Japan. A 2-year prospective surveillance was conducted in Kochi city, Western Japan. All CAP patients aged ≥15 years who visited a community-based hospital were enrolled in the study. Clinical samples were examined by conventional bacterial culture and urinary antigen tests, and 6 bacterial pathogens and 16 respiratory viruses were identified from sputum samples by multiplex polymerase chain reaction assays. The age-group-specific incidence of CAP was estimated using a population-based data set of the total number of outpatients in the whole city. Ninety of the 131 enrolled patients, 68.7% were positive for respiratory pathogens. Streptococcus pneumoniae was the leading bacterial pathogen identified (28.2%). Respiratory viruses were identified in 36 patients (27.5%), and human entero-rhinovirus was the most common (13.3%) among them. The estimated overall incidence of adult CAP in Kochi was 9.6 per 1,000 person-years (PY); the estimated age group-specific incidence was 3.4, 10.7, and 42.9 per 1,000 PY for those aged 15-64, 65-74, and ≥75 years, respectively. The high incidence of CAP in these rural city of Japan, probably reflects the substantial aged population. S. pneumoniae and respiratory viruses play important roles in CAP in all age groups.

  12. Neumonia adquirida en la comunidad en dos poblaciones hospitalarias Community-acquired pneumonia in patients from two different hospitals

    Directory of Open Access Journals (Sweden)

    O. J. Caberlotto

    2003-01-01

    Full Text Available Se estudiaron en forma prospectiva pacientes con diagnóstico de neumonía adquirida en la comunidad que acudieron a la consulta en un hospital general y en un centro especializado en medicina respiratoria ubicados en la provincia de Buenos Aires, y que requirieron internación. Se evaluaron la distribución por sexo y edad, las comorbilidades asociadas, los agentes etiológicos, su incidencia y la mortalidad. Se incluyeron 52 pacientes (marzo 1998-febrero 1999 del Hospital General de Agudos Manuel Belgrano (HMB y 23 pacientes (junio 2000-mayo 2001 del Hospital del Tórax Dr. Antonio A. Cetrángolo (HCET. Se excluyeron pacientes con tuberculosis o micosis pulmonar, neoplasia de pulmón y diagnóstico serológico para HIV. Se completó una historia clínica y se realizaron estudios microbiológicos para gérmenes comunes, virus respiratorios y micobacterias. Para el estudio de los agentes productores de neumonías atípicas (Chlamydia spp, Coxiella burnetii, Mycoplasma pneumoniae y Legionella spp. y como complemento del estudio virológico, se utilizaron pruebas serológicas. No se observaron diferencias por sexo y edad en los dos grupos. En el HMB las comorbilidades más frecuentes fueron EPOC, diabetes e insuficiencia cardíaca, en tanto que en el HCET fueron EPOC, asma y fibrosis pulmonar. Se obtuvo un diagnóstico microbiológico en el 48% y 65.2% de los pacientes para ambos grupos. Los agentes hallados más frecuentemente fueron Mycoplasma pneumoniae, Streptococcus pneumoniae, influenza A y Legionella spp, este último germen con una incidencia del 12% en pacientes que evolucionaron favorablemente y que en su mayoría pertenecían al HMB. La mortalidad fue similar para ambos grupos (13.3%. En el HMB estuvo relacionada con la existencia de comorbilidades en 7 de 8 casos y en el HCET con el agravamiento de la insuficiencia respiratoria crónica.Patients hospitalized with community acquired pneumonia were studied prospectively in two hospitals

  13. Antiseptics: a forgotten weapon in the control of antibiotic resistant bacteria in hospital and community settings?

    Science.gov (United States)

    Payne, D N; Gibson, S A; Lewis, R

    1998-02-01

    The aim of this study was to ascertain the activity of a selection of widely-used antiseptic/disinfectant agents against antibiotic resistant bacteria and strains isolated from patients infected with clinically significant species. Four antiseptic agents (Dettol, Dettol Hospital Concentrate, Savlon and Betadine) were tested against Staphylococcus aureus, Methicillin Resistant S. aureus (MRSA), Enterococcus hirae, Vancomicin Resistant Enterococcus sp (VRE), Escherichia coli and E. coli 0157. The antiseptics were applied at recommended use dilutions and at a half and a quarter of those concentrations in a standard suspension test (EST). Organic material was added to mimic the presence of blood, protein and other such contaminants to be found in the clinical situation. All antiseptics tested were effective against both the antibiotic sensitive and antibiotic resistant strains of S. aureus and E. hirae as well as normal and clinical strains of E. coli at recommended concentrations. All but Betadine were also effective against the antibiotic resistant bacteria at a half and a quarter of normal concentration. The iodine containing antiseptic, however, failed the test against MRSA at a half normal concentration and showed virtually no activity against MRSA at a quarter normal concentration.

  14. Motivating safety belt use at a community hospital: an effective integration of incentive and commitment strategies.

    Science.gov (United States)

    Nimmer, J G; Geller, E S

    1988-06-01

    An effective hospital-based safety-belt program incorporated several advantages over prior attempts to increase safety belt use, including (a) the use of indigenous staff as program sponsors, coordinators, and delivery agents; (b) a yearlong program evaluation; and (c) a combination of extrinsic incentives and intrinsic commitment. To be eligible for a weekly $5, employees met the following contingencies: (a) signed a pledge card; (b) displayed the signed pledge card in their vehicle; and (c) wore a safety belt. Overall, belt use increased from a 2-week baseline mean of 15.6% to 34.7% during the 6-month intervention, and decreased to 25.6% at withdrawal. For the pledge card signers (n = 188) and the nonsigners (n = 533), belt use increased from baseline means of 29.4% and 11.8% to intervention use rates of 75.1 and 17.7%, respectively. Withdrawal and 4-month follow-up use rates were 56.0% and 44.9% for the Pledge group, and 17.2% and 22.1% for the Nonpledge group.

  15. Scheduled Cesarean Delivery: Maternal and Neonatal Risks in Primiparous Women in a Community Hospital Setting

    Science.gov (United States)

    Quiroz, Lieschen H.; Chang, Howard; Blomquist, Joan L.; Okoh, Yvonne K.; Handa, Victoria L.

    2011-01-01

    We compared the short-term maternal and neonatal outcomes of women who deliver by cesarean without labor compared with women who deliver by cesarean after labor or by vaginal birth. This was a retrospective cohort study of women delivering a first baby from 1998 to 2002. Hospital discharge diagnostic coding identified unlabored cesarean deliveries (UCDs), labored cesarean deliveries (LCDs), and vaginal births (VBs). Medical records were abstracted and mode of delivery confirmed. The three outcomes of interest were maternal bleeding complications, maternal febrile morbidity, and neonatal respiratory complications. Using logistic regression for each outcome, we investigated whether mode of delivery was associated with the outcome, independent of other factors. The study groups included 513 UCDs, 261 LCDs, and 251 VBs. Compared with the UCD group, the adjusted odds of bleeding complications was higher in the LCD comparison group (odds ratio [OR] 2.3; 95% confidence interval [CI] 1.21, 4.53) and the VB comparison group (OR 1.96; 95% CI 0.95, 4.02). The incidence of febrile morbidity was similar for both cesarean groups but lower in the VB group. Both comparison groups had lower odds of neonatal complications than the UCD group (OR for LCD comparison group 0.52; 95% CI 0.27, 0.95 and OR for VB comparison group 0.26; 95% CI 0.098, 0.59). Scheduled cesarean is associated with increased odds of neonatal respiratory complications but decreased odds of maternal bleeding complications. PMID:19021093

  16. Prevalence of orthostatic hypotension among diabetic patients in a community hospital of Peshawar

    International Nuclear Information System (INIS)

    Rahman, S.U.; Ahmad, R.; Aamir, A.H.

    2010-01-01

    background: The postural drop in blood pressure caused by autonomic neuropathy in diabetes mellitus is regarded as a risk factor for cardiovascular disease. The objectives of this study were to assess the prevalence of orthostatic hypotension and its relation with hypertension in patients with diabetes mellitus admitted in a tertiary care hospital. Methods: Two hundred indoor diabetic patients were assessed. Lying and standing blood pressure of each patient was determined using standard procedure for determination of orthostatic hypotension. Patients having orthostatic hypotension were compared with those having no orthostatic hypotension for different clinical and biochemical parameters using statistical program for social sciences. Results: Twenty-six percent of the patients were found to have orthostatic hypotension. Fifty two percent of the total patients showed hypertension. Proportion of hypertension in the patients having orthostatic hypotension was more than those without orthostatic hypotension while other parameters showed no difference. Conclusion: Orthostatic hypotension is a common phenomenon in our diabetic patients admitted to tertiary care facilities. Diabetic hypertensive patients are more likely to have postural drop in blood pressure as compared to diabetic normotensive patients. (author)

  17. Extended-spectrum cephalosporin-resistant Escherichia coli in community, specialized outpatient clinic and hospital settings in Switzerland.

    Science.gov (United States)

    Seiffert, Salome N; Hilty, Markus; Kronenberg, Andreas; Droz, Sara; Perreten, Vincent; Endimiani, Andrea

    2013-10-01

    Resistance to extended-spectrum cephalosporins (ESCs) in Escherichia coli can be due to the production of ESBLs, plasmid-mediated AmpCs (pAmpCs) or chromosomal AmpCs (cAmpCs). Information regarding type and prevalence of β-lactamases, clonal relations and plasmids associated with the bla genes for ESC-R E. coli (ESC-R-Ec) detected in Switzerland is lacking. Moreover, data focusing on patients referred to the specialized outpatient clinics (SOCs) are needed. We analysed 611 unique E. coli isolated during September-December 2011. ESC-R-Ec were studied with microarrays, PCR/DNA sequencing for blaESBLs, blapAmpCs, promoter region of blacAmpC, IS elements, plasmid incompatibility group, and also implementing transformation, aIEF, rep-PCR and MLST. The highest resistance rates were observed in the SOCs, whereas those in the hospital and community were lower (e.g. quinolone resistance of 22.6%, 17.2% and 9.0%, respectively; P = 0.003 for SOCs versus community). The prevalence of ESC-R-Ec in the three settings was 5.3% (n = 11), 7.8% (n = 22) and 5.7% (n = 7), respectively. Thirty isolates produced CTX-M ESBLs (14 were CTX-M-15), 5 produced CMY-2 pAmpC and 5 hyper-expressed cAmpCs due to promoter mutations. Fourteen isolates were of sequence type 131 (ST131; 10 with CTX-M-15). blaCTX-M and blaCMY-2 were associated with an intact or truncated ISEcp1 and were mainly carried by IncF, IncFII and IncI1plasmids. ST131 producing CTX-M-15 is the predominant clone. The prevalence of ESC-R-Ec (overall 6.5%) is low, but an unusual relatively high frequency of AmpC producers (25%) was noted. The presence of ESC-R-Ec in the SOCs and their potential ability to be exchanged between hospital and community should be taken into serious consideration.

  18. A hospital-based child and adolescent overweight and obesity treatment protocol transferred into a community healthcare setting.

    Science.gov (United States)

    Mollerup, Pernille Maria; Gamborg, Michael; Trier, Cæcilie; Bøjsøe, Christine; Nielsen, Tenna Ruest Haarmark; Baker, Jennifer Lyn; Holm, Jens-Christian

    2017-01-01

    Due to the pandemic of child and adolescent overweight and obesity, improvements in overweight and obesity treatment availability and accessibility are needed. In this prospective study, we investigated if reductions in body mass index (BMI) standard deviation scores (SDS) and waist circumference (WC) would occur during 1.5 years of community-based overweight and obesity treatment based upon an effective hospital-based overweight and obesity treatment protocol, The Children's Obesity Clinics' Treatment protocol. Height, weight, and WC were measured at all consultations. Changes in BMI SDS and WC were analyzed using linear mixed models based upon the repeated measures in each child. From June 2012 to January 2015, 1,001 children (455 boys) were consecutively enrolled in the community-based treatment program. Upon entry, the median age was 11 years (range: 3-18), and the median BMI SDS was 2.85 (range: 1.26-8.96) in boys and 2.48 (range: 1.08-4.41) in girls. After 1.5 years of treatment BMI SDS was reduced in 74% of the children. BMI SDS was reduced by a mean of 0.38 (95% confidence interval (CI): 0.30-0.45, p0.08). WC was reduced by a mean of 3.8 cm (95% CI: 2.7-4.9, p>0.0001) in boys and 5.1 cm (95% CI: 4.0-6.2, p>0.0001) in girls. The dropout rate was 31% after 1.5 years. A median of 4.5 consultation hours was invested per child per year. BMI SDS and WC were reduced after 1.5 years of treatment. Hence, this community-based overweight and obesity treatment program may help accommodate the need for improvements in treatment availability and accessibility.

  19. Prescription errors and the impact of computerized prescription order entry system in a community-based hospital.

    Science.gov (United States)

    Jayawardena, Suriya; Eisdorfer, Jacob; Indulkar, Shalaka; Pal, Sethi Ajith; Sooriabalan, Danushan; Cucco, Robert

    2007-01-01

    Adverse drug events occur often in hospitals. They can be prevented to a large extent by minimizing the human errors of prescription writing. To evaluate the efficacy of a computerized prescription order entry (CPOE) system with the help of ancillary support in minimizing prescription errors. Retrospective study carried out in a community-based urban teaching hospital in south Brooklyn, NY from January 2004 to January 2005. Errors were categorized into inappropriate dosage adjustment for creatinine clearance, duplication, incorrect orders, allergy verification, and incomplete orders. The pharmacists identified the type of error, the severity of error, the class of drug involved, and the department that made the error. A total of 466,311 prescriptions were entered in the period of 1 year. There were 3513 errors during this period (7.53 errors per 1000 prescriptions). More than half of these errors were made by the internal medicine specialty. In our study, 50% of the errors were severe errors (overdosing medications with narrow therapeutic index or over-riding allergies), 46.28% were moderate errors (overdosing, wrong dosing, duplicate orders, or prescribing multiple antibiotics), and 3.71% were not harmful errors (wrong dosing or incomplete orders). The errors were also categorized according to the class of medication. Errors in antibiotic prescription accounted for 53.9% of all errors. The pharmacist detected all these prescription errors as the prescriptions were reviewed in the CPOE system. Prescription errors are common medical errors seen in hospitals. The CPOE system has prevented and alerted the prescriber and pharmacist to dosage errors and allergies. Involvement of the pharmacist in reviewing the prescription and alerting the physician has minimized prescription errors to a great degree in our hospital setting. The incidence of prescription errors before the CPOE has been reported to range from 3 to 99 per 1000 prescriptions. The disparity could be due to

  20. Fecal Carriage of Staphylococcus aureus in the Hospital and Community Setting: A Systematic Review

    Science.gov (United States)

    Claassen-Weitz, Shantelle; Shittu, Adebayo O.; Ngwarai, Michelle R.; Thabane, Lehana; Nicol, Mark P.; Kaba, Mamadou

    2016-01-01

    Background and rationale: Staphylococcus aureus fecal carriage has been identified as a potential source for nosocomial transmission and a risk factor for disease development. This systematic review determined the overall S. aureus [including methicillin susceptible and resistant S. aureus (MSSA and MRSA)] fecal carriage rates within the community and healthcare settings. Methodology: Peer-reviewed articles indexed in Medline, Scopus, Academic Search Premier, Africa-Wide Information, CINAHL, and Web of Science were identified using applicable and controlled vocabulary through to 11 November 2015. Eligible studies were ascertained by three independent reviewers. Random-effects meta-analyses of proportions were performed to determine S. aureus, MSSA and MRSA fecal carriage rates reported by eligible studies. Results: Twenty six studies were included in this review. The pooled estimates for S. aureus, MSSA and MRSA fecal carriage were 26% (95% confidence interval (CI): 16.8–36.3%), 86% (95% confidence interval (CI): 65.9–97.9%) and 10% (95% CI: 0.7–27.0%), respectively. Fecal S. aureus carriage rates increased on average from 10 to 65% during the first 8 weeks of life, followed by an average carriage rate of 64% at 6 months and 46% at 1 year of life. Genotyping techniques were employed mainly in studies conducted in developed countries and comprised largely of gel-based techniques. Six studies reported on the role of S. aureus fecal strains in diarrhea (n = 2) and the risk for acquiring infections (n = 4). Eight of the 26 studies included in this review performed antibiotic susceptibility testing of S. aureus fecal isolates. Conclusion: This study provides evidence that screening for S. aureus fecal carriage, at least in populations at high risk, could be an effective measure for the prevention of S. aureus transmission and infection in the healthcare and community setting. More well-structured studies need to be conducted and sequence-based genotyping

  1. Faecal carriage of Staphylococcus aureus in the hospital and community setting: a systematic review

    Directory of Open Access Journals (Sweden)

    Shantelle eClaassen-Weitz

    2016-05-01

    Full Text Available Background and rationale: Staphylococcus aureus faecal carriage has been identified as a potential source for nosocomial transmission and a risk factor for disease development. This systematic review determined the overall S. aureus (including methicillin susceptible and resistant S. aureus (MSSA and MRSA faecal carriage rates within the community and healthcare settings.Methodology: Peer-reviewed articles indexed in Medline, Scopus, Academic Search Premier, Africa-Wide Information, CINAHL, and Web of Science were identified using applicable and controlled vocabulary through to 11 November 2015. Eligible studies were ascertained by three independent reviewers. Random-effects meta-analyses of proportions were performed to determine S. aureus, MSSA and MRSA faecal carriage rates reported by eligible studies.Results: Twenty six studies were included in this review. The pooled estimates for S. aureus, MSSA and MRSA faecal carriage were 26 % (95 % confidence interval (CI: 16.8 % - 36.3 %, 86 % (95 % confidence interval (CI: 65.9 % - 97.9 % and 10 % (95 % CI: 0.7 % - 27.0 %, respectively. Faecal S. aureus carriage rates increased on average from 10 % to 65 % during the first eight weeks of life, followed by an average carriage rate of 64 % at six months and 46 % at one year of life. Genotyping techniques were employed mainly in studies conducted in developed countries and comprised largely of gel-based techniques. Six studies reported on the role of S. aureus faecal strains in diarrhoea (n = 2 and the risk for acquiring infections (n = 4. Eight of the 26 studies included in this review performed antibiotic susceptibility testing of S. aureus faecal isolates.Conclusion: This study provides evidence that screening for S. aureus faecal carriage, at least in populations at high risk, could be an effective measure for the prevention of S. aureus transmission and infection in the healthcare and community setting. More well-structured studies need to be

  2. Comparison of prevalence of metabolic syndrome in hospital and community-based Japanese patients with schizophrenia

    Directory of Open Access Journals (Sweden)

    Yamashita Hakuei

    2011-09-01

    Full Text Available Abstract Background Lifestyle factors, such as an unbalanced diet and lack of physical activity, may affect the prevalence of metabolic syndrome (MetS in schizophrenic patients. The aim of this study was to compare the MetS prevalence between inpatients and outpatients among schizophrenic population in Japan. Methods We recruited inpatients (n = 759 and outpatients (n = 427 with a Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV diagnosis of schizophrenia or schizoaffective disorder from 7 psychiatric hospitals using a cross-sectional design. MetS prevalence was assessed using three different definitions, including the adapted National Cholesterol Education Program Adult Treatment Panel (ATP III-A. Results The overall MetS prevalences based on the ATP III-A definition were 15.8% in inpatients and 48.1% in outpatients. In a logistic regression model with age and body mass index as covariates, being a schizophrenic outpatient, compared to being a schizophrenic inpatient, was a significant independent factor (odds ratio = 3.66 for males, 2.48 for females in the development of MetS under the ATP III-A definition. The difference in MetS prevalence between inpatients and outpatients was observed for all age groups in males and for females over 40 years of age. Conclusions Outpatients with schizophrenia or schizoaffective disorder in Japan had a high prevalence of MetS compared to inpatients. MetS in schizophrenic outpatients should be carefully monitored to minimize the risks. A change of lifestyle might improve MetS in schizophrenic patients.

  3. Improving life-cycle cost management in the US. Army: analysis of the U.S. Army and Commercial Businesses life-cycle cost management.

    OpenAIRE

    White, Bradley A.

    2001-01-01

    The roles and responsibilities of the Army acquisition and logistics communities, as they pertain to the life-cycle management, are undergoing fundamental change. The early identification and total control of life-cycle cost, in particular operations and sustainment costs which comprises as much as 70-80% of a systems total life-cycle cost, is a high priority for the Army. The basis of this change is adoption of commercial best practices to support the Army's goal to organize. tram. equip, an...

  4. 76 FR 66282 - Army Educational Advisory Committee

    Science.gov (United States)

    2011-10-26

    ... Committee: U.S. Army War College Subcommittee of the Army Education Advisory Committee. Dates of Meeting: November 15, 2011. Place of Meeting: U.S. Army War College, 122 Forbes Avenue, Carlisle, PA, Command... issues and matters related to the continued growth and development of the United States Army War College...

  5. 76 FR 72914 - Army Educational Advisory Committee

    Science.gov (United States)

    2011-11-28

    ...: U.S. Army War College Subcommittee of the Army Education Advisory Committee. Dates of Meeting: December 14, 2011. Place of Meeting: U.S. Army War College, 122 Forbes Avenue, Carlisle, PA, Command... issues and matters related to the continued growth and development of the United States Army War College...

  6. A Developmental Curriculum Plan To Achieve a Sequenced Curriculum between High School Courses in Food Preparation and the Mattatuck Community College Hospitality/Food Services Program. Final Report.

    Science.gov (United States)

    Mattatuck Community Coll., Waterbury, CT.

    This document contains a developmental curriculum plan for an articulated curriculum in hospitality/food service for Connecticut's Mattatuck Community College and area high schools. The curriculum guide includes a course description, criteria for evaluation, attendance policy, objectives, a curriculum area outline, 17 content area objectives, a…

  7. How much? Price is becoming a contentious issue in sales of not-for-profit hospitals, as communities seek fair value and challenge secrecy.

    Science.gov (United States)

    Lutz, S

    1996-02-12

    When a tax-exempt hospital is sold, board members may wax eloquently about the synergies, mission and vision of the deal. But how much the facility sells for is becoming the key issue in many communities where tax-exempts have been purchased by investor-owned companies.

  8. Signatures of cytoplasmic proteins in the exoproteome distinguish community-and hospital-associated methicillin-resistant Staphylococcus aureus USA300 lineages

    NARCIS (Netherlands)

    Mekonnen, Solomon A.; Medina, Laura M. Palma; Glasner, Corinna; Tsompanidou, Eleni; de Jong, Anne; Grasso, Stefano; Schaffer, Marc; Maeder, Ulrike; Larsen, Anders R.; Gumpert, Heidi; Westh, Henrik; Voelker, Uwe; Otto, Andreas; Becher, Doerte; van Dijl, Jan Maarten

    2017-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) is the common name for a heterogeneous group of highly drug-resistant staphylococci. Two major MRSA classes are distinguished based on epidemiology, namely community-associated (CA) and hospital-associated (HA) MRSA. Notably, the distinction of

  9. Profile of Anemia on Lung Tuberculosis at Dr. Hasan Sadikin General Hospital and Community Lung Health Center Bandung

    Directory of Open Access Journals (Sweden)

    Marizka Adzani

    2016-03-01

    Full Text Available Background: Tuberculosis (TB is a chronic infectious disease caused by Mycobacterium tuberculosis that can cause anemia. Anemia is a lack of erythrocyte mass needed to carry adequate oxygen to the whole bodies. The aim of this study was to describe the anemia in adult lung TB patients at Dr. Hasan Sadikin General Hospital and Community Lung Health Center (Balai Kesehatan Paru Masyarakat, BKPM Bandung. Methods: This descriptive study was conducted from August to October 2014. Study subjects were adult TB patients who came for their first control to TB Clinic Dr. Hasan Sadikin General Hospital and BKPM Bandung after receiving oral antituberculosis drugs, and willing to comply in study. The exclusion criteria were patients with other chronic diseases, pregnant, menorrhagia, and hemoptoe. Three mL of vein blood was taken and put into EDTA tube for routine hematologic measurement using automatic hematologic analyzer, sysmex KX-21®. Results: There was 31 (63.26% from 49 adult lung TB patients suffered anemia. In male subjects, mild and moderate anemia were found 57.14% and 42.86% respectively, and in female subjects were 58.82% and 41.18% respectively. In males, there were 42.86% normochromic normocytic, 42.86% hypochromic microcytic, 7.14% normochromic microcytic, and 7.14% hypochromic normocytic, while in females, there were 5.88% normochromic normocytic, 47.06% hypochromic microcytic, 17.65% normochromic microcytic, 29.41% hypochromic normocytic. Conclusions: Anemia is found in 63.26% adult lung TB patients, most of which are mild anemia and hypochromic microcytic, especially in female subjects.

  10. Pharmacokinetics and Dosing of Ceftobiprole Medocaril for the Treatment of Hospital- and Community-Acquired Pneumonia in Different Patient Populations.

    Science.gov (United States)

    Torres, Antonio; Mouton, Johan Willem; Pea, Federico

    2016-12-01

    Hospital-acquired pneumonia (HAP) and community-acquired pneumonia (CAP) are among the most common infections treated in the hospital setting, and together they place a significant burden on healthcare systems. Successful management of HAP and CAP depends on rapid initiation of empirical antibiotic therapy with broad-spectrum antibiotics. Ceftobiprole is a new-generation, broad-spectrum cephalosporin antibiotic for the treatment of HAP (excluding ventilator-associated pneumonia) and CAP. It displays potent in vitro activity against a broad range of pathogens important in pneumonia. This review summarizes the pharmacokinetic profile of ceftobiprole, and considers the pharmacokinetic parameters and pharmacodynamics underlying the choice of dosing regimen. Ceftobiprole shows linear pharmacokinetics after single and multiple doses and is eliminated predominantly through the kidneys. Ceftobiprole is administered as a 500 mg intravenous infusion over 2 h every 8 h, and steady-state concentrations are reached on the first day of dosing. Dose adjustment is recommended for patients with moderate or severe renal impairment and for those with end-stage renal disease. Extending the infusion time of ceftobiprole to 4 h is recommended to optimize drug exposure in critically ill patients with augmented renal clearance. However, there is no need for dose adjustments based on age, sex or ethnicity, or for patients with severe obesity. Population pharmacokinetic modelling and Monte Carlo simulations were used to determine the optimal dosing regimen for ceftobiprole in special patient populations, including paediatric patients. Future studies of ceftobiprole in patients with HAP and CAP would be of interest.

  11. Evaluation of an algorithm for persistent/ chronic diarrhea in children at a community hospital adjoining slums in Agra, north India.

    Science.gov (United States)

    Garg, Pankaj

    2006-05-01

    The objective of this study was to evaluate an algorithm for the management of children with persistent/chronic diarrhea at a community level hospital. The study was carried out in the pediatric OPD of a 150 bed trust hospital catering to children from poor, rural and urban slums. Fifty clinically stable children (6 months-5 years old, mean = 19.7 months) with persistent or chronic diarrhea refusing admission, being managed on an outpatient basis, were enrolled prospectively. A detailed history and physical examination were done for each child to ascertain the cause of diarrhea. They were managed using a pre-tested simplified algorithm and monitored for symptom improvement using a questionnaire 15 days, 1 month and 3 months after initiation of therapy. The average cost for treatment of each child was also calculated. Twenty-one (42%) children had persistent diarrhea. Seven (14%) infants with a typical history of lactose malabsorption responded to a trial of WHO feeding protocols or lactose/sucrose free milk. Four (8%) infants had chronic non-specific diarrhea. A total of 71.8% (28/39) of children were treated satisfactorily with albendazole or metronidazole and Cotrimaxazole along with hematinics and multivitamins. Three (6%) children were diagnosed with abdominal tuberculosis. Four (8%) had raised anti-tissue tranglutaminase antibodies (age 18-34 months). The algorithm used was successful in managing all the children with chronic diarrhea. The average cost per managed case was US$10. Further, multi-center evaluations of similar algorithms are needed to validate the observations in the present study.

  12. Improvements in hepatitis B virus screening before rituximab therapy: A community-based, safety-net hospital experience.

    Science.gov (United States)

    Junus, Kevin; Aguilar, Maria; Patel, Priya; Irwin, David; Yee, Stephen; Liu, Benny; Bhuket, Taft; Wong, Robert J

    2017-02-15

    Individuals with chronic hepatitis B virus infection (HBV) or previously resolved HBV are at increased risk of HBV exacerbation or reactivation when they receive treatment with anti-CD20 monoclonal antibodies (against B-lymphocyte antigen cluster of differentiation 20 [CD20], an activated-glycosylated phosphoprotein) like rituximab (RTX). The objective of the current study was to evaluate the rates of appropriate HBV screening before patients started receiving RTX, at the initiation of HBV treatment, and during HBV flares among an underserved safety-net population. In total, 244 consecutive adults who received treatment with RTX from 2006 to 2015 at an urban safety-net hospital were evaluated to determine appropriate HBV screening (HBV surface antigen [HBsAg] and HBV total core antibody [HBcAb]) before starting RTX. The initiation of prophylactic antiviral therapy and the development of HBV flares after starting RTX were evaluated. Predictors of appropriate HBV screening were evaluated using multivariate logistic regression models. Most patients were women (52.7%; n = 128) and of Hispanic ethnicity (30.7%; n = 74). Before starting RTX, 60.5% (n = 147) of patients received appropriate HBV screening. The HBV screening rates before RTX improved from 14.7% (2006-2009) to 74.7% (2010-2012), and to 87.1% (2013-2015; P HBcAb-positive/HBsAg-negative patients who did not receive antiviral therapy experienced HBV reactivation. No patient-specific or disease-specific predictors of receiving HBV screening before RTX therapy were identified. Among adults receiving RTX therapy in a single community-based hospital system, HBV screening rates were suboptimal, and 28.6% of HBsAg-positive patients and 7.4% of HBsAg-negative/HBcAb-positive patients who did not receive antiviral treatment experienced HBV reactivation or flare. Cancer 2017;123:650-656. © 2016 American Cancer Society. © 2016 American Cancer Society.

  13. Factors affecting the deceased organ donation rate in the Chinese community: an audit of hospital medical records in Hong Kong.

    Science.gov (United States)

    Cheung, C Y; Pong, M L; Au Yeung, S F; Chau, K F

    2016-12-01

    The number of actual donors per million population is the most commonly used metric to measure organ donation rates worldwide. It is deemed inadequate, however, because it does not take into account the potential donor pool. The aim of this study was to determine the true potential for solid organ donation from deceased brain-dead donors and the reasons for non-donation from potential donors in the Chinese community. Medical records of all hospital deaths between 1 January and 31 December 2014 at a large regional hospital in Hong Kong were reviewed. Those who were on mechanical ventilation with documented brain injury and aged ≤75 years were classified as possible organ donors. The reasons why some potential organ donors did not become utilised organ donors were recorded and evaluated. Among 3659 patient deaths, 121 were classified as possible organ donors. The mean age of the possible organ donors was 59.4 years and 72.7% of them were male. The majority (88%) were from non-intensive care units. Of the 121 possible organ donors, 108 were classified as potential organ donors after excluding 13 unlikely to fulfil brain death criteria. Finally 11 patients became actual organ donors with an overall conversion rate of 10%. Reasons for non-donation included medical contra-indication (46%), failure to identify and inform organ donation coordinators (14%), failure of donor maintenance (11%), brain death diagnosis not established (18%), and refusal by relatives (11%). It is possible to increase the organ donation rate considerably by action at different stages of the donation process. Ongoing accurate audit of current practice is necessary.

  14. Community-Academic Partnership to Investigate Low Birth Weight Deliveries and Improve Maternal and Infant Outcomes at a Baltimore City Hospital.

    Science.gov (United States)

    Harvey, Elizabeth M; Strobino, Donna; Sherrod, Leslie; Webb, Mary Catherine; Anderson, Caroline; White, Jennifer Arice; Atlas, Robert

    2017-02-01

    Purpose Mercy Medical Center (MMC), a community hospital in Baltimore Maryland, has undertaken a community initiative to reduce low birth weight (LBW) deliveries by 10 % in 3 years. MMC partnered with a School of Public Health to evaluate characteristics associated with LBW deliveries and formulate collaborations with obstetricians and community services to improve birth outcomes. Description As part of the initiative, a case control study of LBW was undertaken of all newborns weighing strategy to address pregnant women at risk of LBW infants is to improve the intake and referral system to better triage women to appropriate services in the community. Meetings were held with community organizations and feedback was operationalized into collaboration strategies which can be jointly implemented. Conclusion Education sessions with providers about the referral system are one ongoing strategy to improve birth outcomes in Baltimore City, as well as provision of timely home visits by nurses to high-risk women.

  15. Factors associated with nursing home placement of all patients admitted for inpatient rehabilitation in Singapore community hospitals from 1996 to 2005: a disease stratified analysis.

    Directory of Open Access Journals (Sweden)

    Cynthia Chen

    Full Text Available OBJECTIVES: To (1 identify social and rehabilitation predictors of nursing home placement, (2 investigate the association between effectiveness and efficiency in rehabilitation and nursing home placement of patients admitted for inpatient rehabilitation from 1996 to 2005 by disease in Singapore. DESIGN: National data were retrospectively extracted from medical records of community hospital. DATA SOURCES: There were 12,506 first admissions for rehabilitation in four community hospitals. Of which, 8,594 (90.3% patients were discharged home and 924 (9.7% patients were discharged to a nursing home. Other discharge destinations such as sheltered home (n = 37, other community hospital (n = 31, death in community hospital (n = 12, acute hospital (n = 1,182 and discharge against doctor's advice (n = 24 were excluded. OUTCOME MEASURE: Nursing home placement. RESULTS: Those who were discharged to nursing home had 33% lower median rehabilitation effectiveness and 29% lower median rehabilitation efficiency compared to those who were discharged to nursing homes. Patients discharged to nursing homes were significantly older (mean age: 77 vs. 73 years, had lower mean Bathel Index scores (40 vs. 48, a longer median length of stay (40 vs. 33 days and a longer time to rehabilitation (19 vs. 15 days, had a higher proportion without a caregiver (28 vs. 7%, being single (21 vs. 7% and had dementia (23 vs. 10%. Patients admitted for lower limb amputation or falls had an increased odds of being discharged to a nursing home by 175% (p<0.001 and 65% (p = 0.043 respectively compared to stroke patients. CONCLUSIONS: In our study, the odds of nursing home placement was found to be increased in Chinese, males, single or widowed or separated/divorced, patients in high subsidy wards for hospital care, patients with dementia, without caregivers, lower functional scores at admission, lower rehabilitation effectiveness or efficiency at discharge and primary diagnosis groups such

  16. The dissemination of ST80-SCCmec-IV community-associated methicillin resistant Staphylococcus aureus clone in Kuwait hospitals

    Directory of Open Access Journals (Sweden)

    Sarkhoo Eiman

    2010-11-01

    Full Text Available Abstract Background Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA is a global healthcare problem. The purpose of this study was to characterize CA-MRSA clones and their distribution in Kuwait hospitals. Methods In total, 135 CA-MRSA isolates, carrying the SCCmec IV or V genetic elements, isolated in eight hospitals were characterized using antibiogram, pulsed-field gel electrophoresis, multilocus sequence typing, and carriage of genes for Panton-Valentine Leukocidin (PVL, capsular polysaccharides types (cap 5 and 8, accessory genes regulators (agr, Staphylococcal enterotoxins (SE and toxic shock syndrome toxin 1 (tst. Results They were susceptible to vancomycin, teicoplanin and linezolid but resistant to kanamycin (62%, fusidic acid (42.2%, tetracycline (39.3%, erythromycin and clindamycin (21.5%, gentamicin (5.9%, streptomycin (6.7%, trimethoprim (5.9%, mupirocin (6.6% and cadmium acetate (82.2%. They consisted of 10 pulsotypes with the majority belonging to PFGE type I (51.1%, type II (22.2%, type IV (13.3% and type III (3.7%. They belonged to 10 sequence types (ST comprising ST80 (51.1%, ST30 (22.2%, ST5 (14.1%, ST1 (4.45, ST6 (3.7%, ST88 (1.5%, ST834 (1.5%, ST8 (0.7%, ST46 (0.7% and ST950 (0.7%. Genes for PVL, cap 8, cap 5 and agr III, agr I and agr II were detected in 61.5%, 77.3%, 20.7% and 62.2%, 17% and 8.1% of the isolates respectively. Nine (6.7% isolates contained tst while 103 isolates were positive for SE genes with sei (63.0%, seg (41.5% and sed (29.6% as the common SE genes. Conclusions ST80-SCCmecIV was the most common CA-MRSA clone in Kuwait hospitals presenting new challenges for infection control.

  17. The mediating effect of severity of client aggression on burnout between hospital inpatient and community residential staff who support adults with intellectual disabilities.

    Science.gov (United States)

    Hensel, Jennifer M; Lunsky, Yona; Dewa, Carolyn S

    2014-05-01

    To compare exposure to client aggressive behaviour, perceived self-efficacy in managing this behaviour and burnout between community residential group home and specialised hospital inpatient staff who provide care for adults with intellectual disabilities (ID). To assess the mediating role of aggression exposure on burnout in these two staff groups. Aggressive behaviour is a common indication for admission to hospital so these staff typically experience more frequent and severe forms compared to staff working in the community. There have been mixed results in few studies examining burnout and perceived self-efficacy between these two groups. This study used a demographically matched sample of cross-sectional survey data from community residential group home and hospital staff who care for adults with ID in Ontario, Canada. Exposure to aggression, perceived self-efficacy and burnout were compared for 42 matched pairs using descriptive statistics. A mediation analysis was used to examine the role of aggression severity in the relationship between care setting and burnout. Hospital staff were exposed to more severe client aggression and scored higher in emotional exhaustion (EE). There were no differences in perceived self-efficacy. Severity of aggression was a partial mediator of the higher EE among hospital staff. Exposure to more severe forms of client aggression among hospital staff contributes, at least in part, to them feeling more emotionally exhausted. This study contributes to further understanding exposure to aggression in these different settings and the impact it can have on emotional outcomes. There may be a role for policy and resource development aimed at reducing aggression and preventing or managing the associated emotional consequences. This is particularly true in hospitals, where aggression is most severe. © 2013 John Wiley & Sons Ltd.

  18. Discrepancies between Patients' Preferences and Educational Programs on Oral Anticoagulant Therapy: A Survey in Community Pharmacies and Hospital Consultations.

    Directory of Open Access Journals (Sweden)

    Diane Macquart de Terline

    Full Text Available Oral anticoagulation therapy is increasingly used for the prevention and treatment of thromboembolic complications in various clinical situations. Nowadays, education programs for patients treated with anticoagulants constitute an integrated component of their management. However, such programs are usually based on the healthcare providers' perceptions of what patients should know, rather than on patients' preferences.To investigate patients' viewpoints on educational needs and preferred modalities of information delivery.We conducted an observational study based on a self-administered questionnaire. To explore several profiles of patients, the study was designed for enrolling patients in two settings: during outpatient consultations in a cardiology department (Saint Antoine Hospital, Paris, France and in community pharmacies throughout France.Of the 371 patients who completed the questionnaire, 187 (50.4% were recruited during an outpatient consultation and 184 (49.6% were recruited in community pharmacies. 84.1% of patients were receiving a vitamin K antagonist and 15.6% a direct oral anticoagulant. Patients ranked 16 of 21 (76.2% questionnaire items on information about their treatment as important or essential; information on adverse effects of treatment was the highest ranked domain (mean score 2.38, 95% CI 2.30-2.46. Pharmacists (1.69, 1.58-1.80, nurses (1.05, 0.95-1.16, and patient associations (0.36, 0.29-0.44, along with group sessions (0.85, 0.75-0.95, the internet (0.77, 0.67-0.88, and delivery of material at the patient's home (1.26, 1.14-1.38, were ranked poorly in terms of delivering educational material.This study revealed substantial discrepancies between patient preferences and current educational programs. These findings should be useful for tailoring future educational programs that are better adapted to patients, with a potential associated enhancement of their effectiveness.

  19. 76 FR 56406 - Science and Technology Reinvention Laboratory Demonstration Project; Department of the Army; Army...

    Science.gov (United States)

    2011-09-13

    ... DEPARTMENT OF DEFENSE Office of the Secretary Science and Technology Reinvention Laboratory Demonstration Project; Department of the Army; Army Research, Development and Engineering Command; Tank... Berry, U. S. Army Tank Automotive Research, Development and Engineering Center (TARDEC), 6501 East 11...

  20. Operating Profitability of For-Profit and Not-for-Profit Florida Community Hospitals During Medicare Policy Changes, 2000 to 2010

    Science.gov (United States)

    Langland-Orban, Barbara; Large, John T.; Sear, Alan M.; Zhang, Hanze; Zhang, Nanhua

    2015-01-01

    Medicare Advantage was implemented in 2004 and the Recovery Audit Contractor (RAC) program was implemented in Florida during 2005. Both increase surveillance of medical necessity and deny payments for improper admissions. The purpose of the present study was to determine their potential impact on for-profit (FP) and not-for-profit (NFP) hospital operating margins in Florida. FP hospitals were expected to be more adversely affected as admissions growth has been one strategy to improve stock performance, which is not a consideration at NFPs. This study analyzed Florida community hospitals from 2000 through 2010, assessing changes in pre-tax operating margin (PTOM). Florida Agency for Health Care Administration data were analyzed for 104 community hospitals (62 FPs and 42 NFPs). Academic, public, and small hospitals were excluded. A mixed-effects model was used to assess the association of RAC implementation, organizational and payer type variables, and ownership interaction effects on PTOM. FP hospitals began the period with a higher average PTOM, but converged with NFPs during the study period. The average Medicare Advantage effect was not significant for either ownership type. The magnitude of the RAC variable was significantly negative for average PTOM at FPs (−4.68) and positive at NFPs (0.08), meaning RAC was associated with decreasing PTOM at FP hospitals only. RAC complements other Medicare surveillance systems that detect medically unnecessary admissions, coding errors, fraud, and abuse. Since its implementation in Florida, average FP and NFP operating margins have been similar, such that the higher margins reported for FP hospitals in the 1990s are no longer evident. PMID:26294267

  1. Operating Profitability of For-Profit and Not-for-Profit Florida Community Hospitals During Medicare Policy Changes, 2000 to 2010

    Directory of Open Access Journals (Sweden)

    Barbara Langland-Orban PhD

    2015-08-01

    Full Text Available Medicare Advantage was implemented in 2004 and the Recovery Audit Contractor (RAC program was implemented in Florida during 2005. Both increase surveillance of medical necessity and deny payments for improper admissions. The purpose of the present study was to determine their potential impact on for-profit (FP and not-for-profit (NFP hospital operating margins in Florida. FP hospitals were expected to be more adversely affected as admissions growth has been one strategy to improve stock performance, which is not a consideration at NFPs. This study analyzed Florida community hospitals from 2000 through 2010, assessing changes in pre-tax operating margin (PTOM. Florida Agency for Health Care Administration data were analyzed for 104 community hospitals (62 FPs and 42 NFPs. Academic, public, and small hospitals were excluded. A mixed-effects model was used to assess the association of RAC implementation, organizational and payer type variables, and ownership interaction effects on PTOM. FP hospitals began the period with a higher average PTOM, but converged with NFPs during the study period. The average Medicare Advantage effect was not significant for either ownership type. The magnitude of the RAC variable was significantly negative for average PTOM at FPs (−4.68 and positive at NFPs (0.08, meaning RAC was associated with decreasing PTOM at FP hospitals only. RAC complements other Medicare surveillance systems that detect medically unnecessary admissions, coding errors, fraud, and abuse. Since its implementation in Florida, average FP and NFP operating margins have been similar, such that the higher margins reported for FP hospitals in the 1990s are no longer evident.

  2. Retrospective Evaluation of Pharmacist Interventions on Use of Antimicrobials Using a Clinical Surveillance Software in a Small Community Hospital

    Directory of Open Access Journals (Sweden)

    Samuel R. Huber

    2016-10-01

    Full Text Available The Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America “Guidelines for Developing an Institutional Program to Enhance Antimicrobial Stewardship” recommend the use of computer-based surveillance programs for efficient and thorough identification of potential interventions as part of an antimicrobial stewardship program (ASP. This retrospective study examined the benefit of utilizing a clinical surveillance software program to help guide antimicrobial therapy in an inpatient setting, in a small community hospital, without a formal ASP. The electronic health record (EHR was used to retrieve documentations for the following types of antibiotic interventions: culture surveillance, duplicate therapy, duration of therapy and renal dose adjustments. The numbers of interventions made during the three-month periods before and after implementation of the clinical surveillance software were compared. Antibiotic related interventions aggregated to 144 and 270 in the pre- and post-implementation time frame, respectively (p < 0.0001. The total number of antibiotic interventions overall and interventions in three of the four sub-categories increased significantly from the pre-implementation to post-implementation period. Clinical surveillance software is a valuable tool to assist pharmacists in evaluating antimicrobial therapy.

  3. Epidemiology and outcomes of community-onset methicillin-susceptible Staphylococcus aureus bacteraemia in a university hospital in Singapore

    Directory of Open Access Journals (Sweden)

    Tambyah Paul

    2008-02-01

    Full Text Available Abstract Background Methicillin-susceptible Staphylococcus aureus (MSSA bacteraemia remains a condition associated with considerable morbidity and mortality worldwide. It is a common but little-studied problem outside of Europe and North America. Methods A single-centre retrospective case series profiling all patients with community onset-MSSA bacteraemia presenting between March 2005 and February 2006 to a tertiary acute-care university hospital in Singapore. In addition to epidemiological and clinical data collection, risk factors for complicated bacteremia and attributable mortality were analysed. Results A total of 100 patients met the case definition. Patients were more likely to be male (65% and below 65 years of age (69%. Seventeen patients were intravenous drug abusers, while 38 had diabetes mellitus. There were 18 cases of endocarditis, with 11 occurring in intravenous buprenorphine abusers. Attributable mortality was 11%, and 46% of patients developed complicated bacteremia. On multivariate analysis, age > 65 years and presence of chronic pulmonary disease were the only significant risk factors for the former, while valvular heart disease was a significant risk factor for the latter. Conclusion MSSA bacteraemia is associated with a significant risk of serious complications in Singapore. Other Asian cities should be alert to the risk factors for adverse outcomes for this important cause of morbidity and mortality.

  4. Response bias, weighting adjustments, and design effects in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS).

    Science.gov (United States)

    Kessler, Ronald C; Heeringa, Steven G; Colpe, Lisa J; Fullerton, Carol S; Gebler, Nancy; Hwang, Irving; Naifeh, James A; Nock, Matthew K; Sampson, Nancy A; Schoenbaum, Michael; Zaslavsky, Alan M; Stein, Murray B; Ursano, Robert J

    2013-12-01

    The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) is a multi-component epidemiological and neurobiological study designed to generate actionable recommendations to reduce US Army suicides and increase knowledge about determinants of suicidality. Three Army STARRS component studies are large-scale surveys: one of new soldiers prior to beginning Basic Combat Training (BCT; n = 50,765 completed self-administered questionnaires); another of other soldiers exclusive of those in BCT (n = 35,372); and a third of three Brigade Combat Teams about to deploy to Afghanistan who are being followed multiple times after returning from deployment (n = 9421). Although the response rates in these surveys are quite good (72.0-90.8%), questions can be raised about sample biases in estimating prevalence of mental disorders and suicidality, the main outcomes of the surveys based on evidence that people in the general population with mental disorders are under-represented in community surveys. This paper presents the results of analyses designed to determine whether such bias exists in the Army STARRS surveys and, if so, to develop weights to correct for these biases. Data are also presented on sample inefficiencies introduced by weighting and sample clustering and on analyses of the trade-off between bias and efficiency in weight trimming. Copyright © 2013 John Wiley & Sons, Ltd.

  5. [High prevalence of community- and hospital-acquired infections of methicillin-resistant Staphylococcus aureus containing Panton-Valentine leukocidin gene in Algiers].

    Science.gov (United States)

    Antri, K; Rouzic, N; Boubekri, I; Dauwalder, O; Beloufa, A; Ziane, H; Djennane, F; Neggazi, M; Benhabyles, B; Bes, M; Tazir, M; Etienne, J; Ramdani-Bouguessa, N

    2010-04-01

    To determine the prevalence of community acquired and hospital methicillin-resistant Staphylococcus aureus (S. aureus) infections and the Panton-Valentine leukocidin. Seven hundred S. aureus strains were collected during 21 months period in Mustapha Bacha hospital. Bacterial identification was based on standard methods and susceptibilities were tested by disk diffusion method. Molecular study (toxins, mecA gene and agr alleles) were determined for 221 S. aureus isolates by multiplex PCR. The global MRSA prevalence was 42 %, 35 % in the community and 49 % in hospital setting. The frequency of strains containing PVL genes (PVL+) was 36 %, their molecular profile was: agr3, mecA+, etd, edin, which correspond to the C-MRSA major ST80 clone in Europe and the Maghreb. The H-MRSA-PVL+ were multidrug resistant. Among the MSSA, 13 strains contained the tst gene and five contained the exfoliatine genes ETA and ETB. Our results show a high rate of MRSA-PVL+ in the community and the hospital setting. The H-MRSA-PVL+ were multidrug resistant complicating their antibiotic treatment options. Copyright 2009 Elsevier Masson SAS. All rights reserved.

  6. Christian Contributions to Army Values

    National Research Council Canada - National Science Library

    D'Emma, Gregory

    2000-01-01

    .... The Army trains the soldier's body through physical training and combining arms training events designed to build physical strength and endurance so that the soldier will be physically capable...

  7. Social Structures Affecting Army Performance

    National Research Council Canada - National Science Library

    Segal, David R

    2007-01-01

    The Center for Research on Military Organization undertook a multi-year research program on the impact of social change on the performance of Army units and of Soldiers after the end of the Cold War...

  8. Lessons from Army System Developments

    National Research Council Canada - National Science Library

    Lucas, William A; Rhoades, Richard G

    2007-01-01

    This paper documents the results of a multi-year Army Materiel Command-sponsored research project which employed a structured case study approach to examine the history and processes that had resulted...

  9. Racial Extremism in the Army

    National Research Council Canada - National Science Library

    Hudson, Walter M

    1998-01-01

    ... modem phenomenon of "skinheads." I then discuss the history of white supremacist extremism in the Army, culminating in the December, 1995 murders of two black civilians by soldiers assigned to the 82d Airborne Division at Fort Bragg, North Carolina...

  10. Transforming the Army Sustaining Base

    National Research Council Canada - National Science Library

    Nobles, Danny

    2000-01-01

    The Army has embarked on its transformation venture. The goal is to provide an agile, but lethal force that is capable of rapid deployment to any area of the world where America's interests are threatened...

  11. The Army's Distribution of Labor: New Force Structure and Missions for the Army National Guard

    National Research Council Canada - National Science Library

    Roberson, Melvin

    1997-01-01

    This Strategy Research Project recommends a new Army National Guard (ARNG) force structure which will successfully accomplish current missions and serve the Total Army's requirements for the future...

  12. How to Build Democratic Armies

    Science.gov (United States)

    2011-12-01

    influence is also considerable in the postcolonial and post–civil war settings, but in the others the project of building demo- cratic armies is usually...Germany, yemen, South Africa table. external influence is considerable in postcolonial and post–civil war settings, but in the others building...Most often, postcolonial armies are not built from scratch but are built on the foundations of the armed forces left behind by the colonial power

  13. Anxiety and Depression during Transition from Hospital to Community in Older Adults: Concepts of a Study to Explain Late Age Onset Depression

    Directory of Open Access Journals (Sweden)

    Aislinn F. Lalor

    2015-06-01

    Full Text Available The transition between extended hospitalization and discharge home to community-living contexts for older adults is a critical time period. This transition can have an impact on the health outcomes of older adults such as increasing the risk for health outcomes like falls, functional decline and depression and anxiety. The aim of this work is to identify and understand why older adults experience symptoms of depression and anxiety post-discharge and what factors are associated with this. This is a mixed methods study of adults aged 65 years and over who experienced a period of hospitalization longer than two weeks and return to community-living post-discharge. Participants will complete a questionnaire at baseline and additional monthly follow-up questionnaires for six months. Anxiety and depression and their resulting behaviors are major public health concerns and are significant determinants of health and wellbeing among the ageing population. There is a critical need for research into the impact of an extended period of hospitalization on the health status of older adults post-discharge from hospital. This research will provide evidence that will inform interventions and services provided for older adults after they have been discharged home from hospital care.

  14. Integrating the hospital library with patient care, teaching and research: model and Web 2.0 tools to create a social and collaborative community of clinical research in a hospital setting.

    Science.gov (United States)

    Montano, Blanca San José; Garcia Carretero, Rafael; Varela Entrecanales, Manuel; Pozuelo, Paz Martin

    2010-09-01

    Research in hospital settings faces several difficulties. Information technologies and certain Web 2.0 tools may provide new models to tackle these problems, allowing for a collaborative approach and bridging the gap between clinical practice, teaching and research. We aim to gather a community of researchers involved in the development of a network of learning and investigation resources in a hospital setting. A multi-disciplinary work group analysed the needs of the research community. We studied the opportunities provided by Web 2.0 tools and finally we defined the spaces that would be developed, describing their elements, members and different access levels. WIKINVESTIGACION is a collaborative web space with the aim of integrating the management of all the hospital's teaching and research resources. It is composed of five spaces, with different access privileges. The spaces are: Research Group Space 'wiki for each individual research group', Learning Resources Centre devoted to the Library, News Space, Forum and Repositories. The Internet, and most notably the Web 2.0 movement, is introducing some overwhelming changes in our society. Research and teaching in the hospital setting will join this current and take advantage of these tools to socialise and improve knowledge management.

  15. The role of transthoracic ultrasonography in predicting the outcome of community-acquired pneumonia in hospitalized children.

    Directory of Open Access Journals (Sweden)

    I-Chen Chen

    Full Text Available TUS findings of fluid bronchogram, multifocal involvement, and pleural effusion were associated with adverse outcomes, including longer hospital stay, ICU admission, and tube thoracotomy in hospitalized CAP children. Therefore, TUS is a novel tool for prognostic stratifications of CAP in hospitalized children.

  16. Incidência de cefaléia em uma comunidade hospitalar Headache incidence in a hospital community

    Directory of Open Access Journals (Sweden)

    VIVIANE H. FLUMIGNAN ZÉTOLA

    1998-09-01

    Full Text Available O objetivo foi determinar em um grupo de pessoas de uma comunidade hospitalar a incidência de cefaléia e para esta a frequência, principais características e investigações médicas mais solicitadas. Utilizamos a combinação de questionário e entrevista. Do total de 1006 fichas aleatoriamente preenchidas, 987 pessoas responderam corretamente aos quesitos e destas 380 (38,5% eram portadoras de cefaléia. Baseados na Classificação Internacional de Cefaléia dividimos os portadores em dois principais grupos, a migrânea e a cefaléia do tipo tensional. As demais foram agrupadas num terceiro grupo. A idade média foi 31,18 anos, com predomínio do sexo feminino em todos os tipos de cefaléia. A presença de história familiar foi positiva em 76,8% dos entrevistados. As características mais frequentes foram: localização frontal, tipo pulsátil e intensidade moderada. O principal fator desencadeante foi o estresse. A procura de acompanhamento médico deu-se em 41,3% dos portadores. Destes, aproximadamente 56% consultaram um clínico geral, 23% consultaram um neurologista e 21% procuraram outras especialidades. O RX de crânio foi o exame mais solicitado pelos generalistas e o eletrencefalograma pelos neurologistas. A tomografia computadorizada do crânio não foi solicitada com frequênciaThe purpose was to describe the main features of headache incidence in a hospital community, its frequency and the most requested medical investigation. Due to the stressful work environment, hospital is considered to hold a high-risk population. Interviews and questionnaires were utilized. Of a 1006 files, which were randomly filled out, 987 could be analyzed. Of all, 38,5% were from headache sufferers. By using a table of pain symptoms taken from the International Headache Society classification as a pattern, headaches were assigned as migraine, tension-type and other. The mean age was 31.18 and the frequency in females was higher than in males, at any

  17. Insights about the process and impact of implementing nursing guidelines on delivery of care in hospitals and community settings

    Directory of Open Access Journals (Sweden)

    Ploeg Jenny

    2008-02-01

    Full Text Available Abstract Background Little is known about the impact of implementing nursing-oriented best practice guidelines on the delivery of patient care in either hospital or community settings. Methods A naturalistic study with a prospective, before and after design documented the implementation of six newly developed nursing best practice guidelines (asthma, breastfeeding, delirium-dementia-depression (DDD, foot complications in diabetes, smoking cessation and venous leg ulcers. Eleven health care organisations were selected for a one-year project. At each site, clinical resource nurses (CRNs worked with managers and a multidisciplinary steering committee to conduct an environmental scan and develop an action plan of activities (i.e. education sessions, policy review. Process and patient outcomes were assessed by chart audit (n = 681 pre-implementation, 592 post-implementation. Outcomes were also assessed for four of six topics by in-hospital/home interviews (n = 261 pre-implementation, 232 post-implementation and follow-up telephone interviews (n = 152 pre, 121 post. Interviews were conducted with 83/95 (87% CRN's, nurses and administrators to describe recommendations selected, strategies used and participants' perceived facilitators and barriers to guideline implementation. Results While statistically significant improvements in 5% to 83% of indicators were observed in each organization, more than 80% of indicators for breastfeeding, DDD and smoking cessation did not change. Statistically significant improvements were found in > 50% of indicators for asthma (52%, diabetes foot care (83% and venous leg ulcers (60%. Organizations with > 50% improvements reported two unique implementation strategies which included hands-on skill practice sessions for nurses and the development of new patient education materials. Key facilitators for all organizations included education sessions as well as support from champions and managers while key barriers were lack

  18. Community-based pediatric palliative care for health related quality of life, hospital utilization and costs lessons learned from a pilot study.

    Science.gov (United States)

    Goldhagen, Jeffrey; Fafard, Mark; Komatz, Kelly; Eason, Terry; Livingood, William C

    2016-08-03

    Children with chronic complex-medical conditions comprise a small minority of children who require substantial healthcare with major implications for hospital utilization and costs in pediatrics. Community-Based Pediatric Palliative Care (CBPPC) provides a holistic approach to patient care that can improve their quality of life and lead to reduced costs of hospital care. This study's purpose was to analyze and report unpublished evaluation study results from 2007 that demonstrate the potential for CBPPC on Health Related Quality of Life (HRQoL) and hospital utilization and costs in light of the increasing national focus on the care of children with complex-medical conditions, including the Affordable Care Act's emphasis on patient-centered outcomes. A multi-method research design used primary data collected from caregivers to determine the Program's potential impact on HRQoL, and administrative data to assess the Program's potential impact on hospital utilization and costs. Caregivers (n=53) of children enrolled in the Northeast Florida CBPPC program (Community PedsCare) through the years 2002-2007 were recruited for the Health Related Quality of Life (HRQoL) study. Children (n=48) enrolled in the Program through years 2000-2006 were included in the utilization and cost study. HRQoL was generally high, and hospital charges per child declined by $1203 for total hospital services (p=.34) and $1047 for diagnostic charges per quarter (p=0.13). Hospital length of stay decreased from 2.92 days per quarter to 1.22 days per quarter (pquality of care available for children with complex-medical conditions and their caregivers.

  19. Longitudinal Evaluation of Hospitalized Burn Patients in Sivas City Center for Six Months and Comparison with a Previously Held Community-based Survey

    Directory of Open Access Journals (Sweden)

    Ömer Faruk Erin

    2016-03-01

    Full Text Available Objective: This study was designed to longitudinally demonstrate the rate and epidemiology of hospitalized burn patients in Sivas city center within 6 months. The second aim was to compare the results of the current study with those of a previously held community-based survey in the same region. Material and Methods: Patients who were hospitalized due to burn injuries in Sivas city for six months were longitudinally evaluated. Epidemiological data of these patients were analyzed. Results: During the course of the study, 87 patients (49 males and 38 females were hospitalized. The ratio of burn patients to the total number of hospitalized patients was 0.38%. The most common etiologic factor was scalds (70.1%. Burns generally took place in the kitchen (41.4% and living room (31.4%, and majority of the patients received cold water as first-aid treatment at the time of injury. The vast majority of patients were discharged from the hospital without the need of surgical intervention (83.9%, and the duration of treatment was between 1 and 14 days for 73.6% of the patients. Sixty patients (68.9% had a total burn surface area under 10%. The total cost of the hospitalization period of these patients was 137.225 Turkish Lira (83.308–92.908$, and the average cost per patient was 1.577 Turkish Lira (957–1067$. Conclusion: Our study revealed a considerable inconsistency when compared with the results of the community-based survey, which had been previously conducted in the same region. We concluded that hospital-based studies are far from reflecting the actual burn trauma potential of a given district in the absence of a reliable, standard, nation-wide record system. Population-based surveys should be encouraged to make an accurate assessment of burn rates in countries lacking reliable record systems.

  20. Effectiveness of 23-valent pneumococcal polysaccharide vaccination in preventing community-acquired pneumonia hospitalization and severe outcomes in the elderly in Spain.

    Science.gov (United States)

    Domínguez, Àngela; Soldevila, Núria; Toledo, Diana; Torner, Núria; Force, Luis; Pérez, María José; Martín, Vicente; Rodríguez-Rojas, Lourdes; Astray, Jenaro; Egurrola, Mikel; Sanz, Francisco; Castilla, Jesús

    2017-01-01

    Pneumococcal pneumonia is a serious cause of morbidity and mortality in the elderly, but investigation of the etiological agent of community-acquired pneumonia (CAP) is not possible in most hospitalized patients. The aim of this study was to estimate the effect of pneumococcal polysaccharide vaccination (PPSV23) in preventing CAP hospitalization and reducing the risk of intensive care unit admission (ICU) and fatal outcomes in hospitalized people aged ≥65 years. We made a multicenter case-control study in 20 Spanish hospitals during 2013-2014 and 2014-2015. We selected patients aged ≥65 years hospitalized with a diagnosis of pneumonia and controls matched by sex, age and date of hospitalization. Multivariate analysis was performed using conditional logistic regression to estimate vaccine effectiveness and unconditional logistic regression to evaluate the reduction in the risk of severe and fatal outcomes. 1895 cases and 1895 controls were included; 13.7% of cases and 14.4% of controls had received PPSV23 in the last five years. The effectiveness of PPSV23 in preventing CAP hospitalization was 15.2% (95% CI -3.1-30.3). The benefit of PPSV23 in avoiding ICU admission or death was 28.1% (95% CI -14.3-56.9) in all patients, 30.9% (95% CI -32.2-67.4) in immunocompetent patients and 26.9% (95% CI -38.6-64.8) in immunocompromised patients. In conclusion, PPSV23 showed a modest trend to avoidance of hospitalizations due to CAP and to the prevention of death or ICU admission in elderly patients hospitalized with a diagnosis of CAP.

  1. Community Hospital Telehealth Consortium

    National Research Council Canada - National Science Library

    Williams, Elton

    2003-01-01

    .... The central tenet of the CHTC project is the utilization of TeleHealth technology to improve and expand the opportunity for rural and urban underserved populations to receive quality, affordable health care...

  2. Community Hospital Telehealth Consortium

    National Research Council Canada - National Science Library

    Williams, Jr, Elton L

    2007-01-01

    .... The central tenet of the CHTC project is the utilization of TeleHealth technology to improve and expand the opportunity for rural and urban underserved populations to receive quality, affordable health care...

  3. Community Hospital Telehealth Consortium

    National Research Council Canada - National Science Library

    Williams, Elton

    2004-01-01

    .... The central tenet of the CHTC project is the utilization of TeleHealth technology to improve and expand the opportunity for rural and urban underserved populations to receive quality, affordable health care...

  4. Community.

    Science.gov (United States)

    Grauer, Kit, Ed.

    1995-01-01

    Art in context of community is the theme of this newsletter. The theme is introduced in an editorial "Community-Enlarging the Definition" (Kit Grauer). Related articles include: (1) "The Children's Bridge is not Destroyed: Heart in the Middle of the World" (Emil Robert Tanay); (2) "Making Bridges: The Sock Doll…

  5. Comparing antiretroviral treatment outcomes between a prospective community-based and hospital-based cohort of HIV patients in rural Uganda

    Directory of Open Access Journals (Sweden)

    Alibhai Arif

    2011-11-01

    Full Text Available Abstract Background Improved availability of antiretroviral therapy in sub-Saharan Africa is intended to benefit all eligible HIV-infected patients; however in reality antiretroviral services are mainly offered i