Sample records for baby-friendly hospital initiative

  1. Implementing and revitalizing the Baby-Friendly Hospital Initiative. (United States)

    Saadeh, Randa; Casanovas, Carmen


    The Baby-Friendly Hospital Initiative (BFHI) was launched in the 1990s by the World Health Organization (WHO) and UNICEF as a global effort with hospitals, health services, and parents to ensure babies are breastfed for the best start in life. It is one of the Operational Targets of the Global Strategy for Infant and Young Child Feeding endorsed in 2002 by the Fifty-Fifth World Health Assembly and the UNICEF Executive Board. After about 18 years, great progress has been made, and most countries have breastfeeding authorities or BFHI coordinating groups. The BFHI has led to increased rates of exclusive breastfeeding, which are reflected in improved health and survival. Based on this progress, the Initiative was streamlined according to the experience of the countries and materials were revised. The new package consolidated all WHO and UNICEF materials into one package, reflected new research and experience, revisited the criteria used for the BFHI in light of HIV/ AIDS, reinforced the International Code of Marketing of Breast-Milk Substitutes, provided modules for mother-friendly care, and gave more guidance for monitoring and reassessment. WHO and partners will continue to give support to BFHI implementation as one essential effort contributing to achievement of the Millennium Development Goals.

  2. Expansion of the Baby-Friendly Hospital Initiative Ten Steps to Successful Breastfeeding into Neonatal Intensive Care : Expert Group Recommendations

    NARCIS (Netherlands)

    Nyqvist, Kerstin H.; Haggkvist, Anna-Pia; Hansen, Mette N.; Kylberg, Elisabeth; Frandsen, Annemi L.; Maastrup, Ragnhild; Ezeonodo, Aino; Hannula, Leena; Haiek, Laura N.


    In the World Health Organization/United Nations Children's Fund document Baby-Friendly Hospital Initiative: Revised, Updated and Expanded for Integrated Care, neonatal care is mentioned as 1 area that would benefit from expansion of the original Ten Steps to Successful Breastfeeding. The different s

  3. Expansion of the baby-friendly hospital initiative ten steps to successful breastfeeding into neonatal intensive care

    DEFF Research Database (Denmark)

    Nyqvist, Kerstin H; Häggkvist, Anna-Pia; Hansen, Mette N


    In the World Health Organization/United Nations Children's Fund document Baby-Friendly Hospital Initiative: Revised, Updated and Expanded for Integrated Care, neonatal care is mentioned as 1 area that would benefit from expansion of the original Ten Steps to Successful Breastfeeding. The different...... situations faced by preterm and sick infants and their mothers, compared to healthy infants and their mothers, necessitate a specific breastfeeding policy for neonatal intensive care and require that health care professionals have knowledge and skills in lactation and breastfeeding support, including...... at the breast. Alternatives to bottles should be used until breastfeeding is well established. The discharge program should include adequate preparation of parents, information about access to lactation and breastfeeding support, both professional and peer support, and a plan for continued follow-up....

  4. Expansion of the baby-friendly hospital initiative ten steps to successful breastfeeding into neonatal intensive care: expert group recommendations. (United States)

    Nyqvist, Kerstin H; Häggkvist, Anna-Pia; Hansen, Mette N; Kylberg, Elisabeth; Frandsen, Annemi L; Maastrup, Ragnhild; Ezeonodo, Aino; Hannula, Leena; Haiek, Laura N


    In the World Health Organization/United Nations Children's Fund document Baby-Friendly Hospital Initiative: Revised, Updated and Expanded for Integrated Care, neonatal care is mentioned as 1 area that would benefit from expansion of the original Ten Steps to Successful Breastfeeding. The different situations faced by preterm and sick infants and their mothers, compared to healthy infants and their mothers, necessitate a specific breastfeeding policy for neonatal intensive care and require that health care professionals have knowledge and skills in lactation and breastfeeding support, including provision of antenatal information, that are specific to neonatal care. Facilitation of early, continuous, and prolonged skin-to-skin contact (kangaroo mother care), early initiation of breastfeeding, and mothers' access to breastfeeding support during the infants' whole hospital stay are important. Mother's own milk or donor milk (when available) is the optimal nutrition. Efforts should be made to minimize parent-infant separation and facilitate parents' unrestricted presence with their infants. The initiation and continuation of breastfeeding should be guided only by infant competence and stability, using a semi-demand feeding regimen during the transition to exclusive breastfeeding. Pacifiers are appropriate during tube-feeding, for pain relief, and for calming infants. Nipple shields can be used for facilitating establishment of breastfeeding, but only after qualified support and attempts at the breast. Alternatives to bottles should be used until breastfeeding is well established. The discharge program should include adequate preparation of parents, information about access to lactation and breastfeeding support, both professional and peer support, and a plan for continued follow-up.

  5. The baby-friendly hospital initiative and breastfeeding at birth in Brazil: a cross sectional study

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    Márcia Lazaro de Carvalho


    Full Text Available Resumo Introdução A amamentação na primeira hora de vida é importante para o sucesso do aleitamento materno e para a redução da mortalidade neonatal. Políticas governamentais vêm atuando neste sentido, destacando-se o credenciamento dos hospitais na Iniciativa Hospital Amigo da Criança (IHAC. O objetivo deste estudo é conhecer a associação entre o nascimento em Hospitais Amigos da Criança (HAC - exposição principal e o início oportuno da amamentação (desfecho, comparado com maternidades não HAC. Métodos Os dados vem do inquérito “Nascer no Brasil”, uma amostra de base hospitalar e abrangência nacional, sob a coordenação da Fundação Oswaldo Cruz. Foram estudados uma amostra de 22.035 mães/bebês através de um modelo teórico hierarquizado em três níveis e todas as análises consideraram o desenho complexo da amostra. As razões de chance foram obtidas por regressão logística, com IC 99 %. Resultados Entre o total de nascimentos, 40 % ocorreram em hospitais credenciados ou em processo de credenciamento pela IHAC e 52 % das mulheres foram submetidas à cesariana. No modelo final, no nível distal, as mães com menos de 35 anos, e as que residiam na Região Norte, apresentaram uma chance maior de início oportuno da amamentação. No nível intermediário, a realização de pré-natal no setor público e a orientação sobre amamentação tiveram associação direta com o desfecho. No nível proximal, ter nascido em Hospital Amigo da Criança e via de parto normal aumentaram a chance do início oportuno da amamentação, enquanto ser bebê prematuro e apresentar baixo peso ao nascer reduziram a chance do desfecho. Conclusões A chance de uma criança ser amamentada na primeira hora de vida nos hospitais amigos da criança foi duas vezes maior do que nos hospitais não credenciados, o que mostra a importância dessa iniciativa para o início oportuno da amamentação.

  6. Pregnant & Lactating Mothers' Attitudes and Practice of the Ten Steps to Successful Breastfeeding at King Fahd Hospital of University (KFHU)--Khobar, Saudi Arabia: Appraisal of Baby Friendly Hospital Initiatives (United States)

    Salem, Laila Younis Abu; Al Madani, Maha Mohammed


    Background: World Health organization (WHO) and the United Nations Children's Fund (UNICEF) have been recommended the application of the Ten Steps to Successful Breastfeeding of the Baby-Friendly Hospital Initiative (BFHI) in order to promote & support breastfeeding. The aim of this study was to assess pregnant and lactating mothers' attitudes…

  7. Is baby-friendly breastfeeding support in maternity hospitals associated with breastfeeding satisfaction among Japanese mothers? (United States)

    Hongo, Hiroko; Nanishi, Keiko; Shibanuma, Akira; Jimba, Masamine


    While the World Health Organization's Baby-Friendly Hospital Initiative has increased breastfeeding duration and exclusivity, a survey found that only 8.5 % of maternity hospitals in 31 developed countries could be designated baby-friendly. Baby-friendly breastfeeding support is sometimes criticized as mother unfriendly. This study examined whether baby-friendly breastfeeding support was associated with breastfeeding satisfaction, duration, and exclusivity among Japanese mothers. In this cross-sectional study, 601 breastfeeding Japanese mothers completed questionnaires at their infants' 4-month health checkups at two wards in Yokohama, Japan; 363 were included in the analysis. Baby-friendly breastfeeding support was measured based on the WHO's "Ten Steps to Successful Breastfeeding." We measured satisfaction using two subscales of the Japanese version of the Maternal Breastfeeding Evaluation Scale. The association of baby-friendly support with maternal satisfaction was assessed using multiple linear regression, while the prevalence ratios (PRs) for breastfeeding were estimated using Poisson regression. Mothers were stratified by prepartum exclusive breastfeeding intention (yes, n = 256; no, n = 107). Mothers who experienced early skin-to-skin contact with their infants were more likely to report breastfeeding satisfaction than those who did not. Among mothers without exclusive breastfeeding intention, those who were encouraged to feed on demand were more likely to be breastfeeding without formula at 1 month (PR 2.66 [95 % CI 1.32, 5.36]) and to perceive breastfeeding as beneficial for their baby (regression coefficient = 3.14 [95 % CI 0.11, 6.17]) than those who were not so encouraged. Breastfeeding satisfaction was a useful measure of breastfeeding outcome. Early skin-to-skin contact and encouragement to feed on demand in the hospital facilitate breastfeeding satisfaction.

  8. [Justifications for formula supplementation in low-risk newborns at a Baby-Friendly Hospital]. (United States)

    Meirelles, Cynthia de Almeida Brandão; Oliveira, Maria Inês do Couto; Mello, Rosane Reis de; Varela, Maria Angélica Bonfim; Fonseca, Vânia de Matos


    The Baby-Friendly Hospital Initiative recommends not giving newborn infants any food or drink other than breast milk unless medically indicated. This study investigated the prevalence and alleged reasons for giving formula supplementation to rooming-in newborns at a Baby-Friendly Hospital. Participants were 300 formula-supplemented, exclusively rooming-in newborns at a Baby-Friendly Hospital in Rio de Janeiro, Brazil. Reasons for formula supplementation were classified as acceptable or unacceptable in accordance with the WHO/UNICEF Baby-Friendly Hospital Initiative guidelines. A supplementation prevalence of 33.3% was found. The main allegations were: hypogalactia/ agalactia (36.8%), conditions involving risk of hypoglicemia (21.1%), cesarean section (7.9%), stomatognathic system-related conditions (7.4%), maternal conditions (6.3%), and absence of maternal HIV serology (4.5%). Cesarean section was associated with a higher risk of supplementation (RP = 2.1; 95%CI: 1.77-2.55) as compared to vaginal delivery. Supplementation prevalence was high, and only 9% of the allegations were justified.

  9. Impact of a Baby-Friendly hospital on breastfeeding indicators in Shaqlawa district in Erbil governorate, Kurdistan region of Iraq. (United States)

    Shaker, N Z; Hasan, S S; Ismail, Z A


    This study aimed to assess the impact of the Baby-Friendly Hospital Initiative on WHO-defined breastfeeding indicators in Shaqlawa district in Kurdistan region of Iraq. A household survey was carried out on a purposive non-probability sample of 200 mothers with a child aged < 30 months. Mothers were interviewed using a structured form to determine demographic data and feeding practices of the most recent child. The rate of early initiation of breastfeeding was 38.1%, exclusive breastfeeding was 15.4% and continued breastfeeding was 61.0% and 39.5% at 1 and 2 years of age respectively. A significant relationship was found between delivery at the Baby- Friendly accredited hospital and early initiation of breastfeeding but not with exclusive or continued breastfeeding. While continued breastfeeding at 1 year and 2 year was good, early initiation and exclusive breastfeeding indicators were not at an acceptable level, which indicates an ineffective role for the Baby-Friendly Hospital Initiative.

  10. A iniciativa hospital amigo da criança sob a ótica dos atores sociais que a vivenciam em Teresina, Piauí The baby-friendly hospital initiative as perceived by the social actors who experience it in Teresina, Piauí, Brazil

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    Carmen Viana Ramos


    Full Text Available OBJETIVO: Analisar os reflexos da Iniciativa Hospital Amigo da Criança nos atores sociais que a vivenciam. MÉTODOS: Estudo qualitativo. Utilizaram-se entrevistas semiestruturadas, com auxílio de um roteiro temático, junto a vinte mulheres e dez profissionais de saúde em cinco hospitais amigos da criança em Teresina (PI. Para a análise dos dados foi utilizada a técnica de an��lise de conteúdo do tipo temática. RESULTADOS: A análise das falas levou à construção de dois eixos de discussão: um relacionado à tríade de sustentação da Iniciativa - promoção, proteção e apoio; e o outro a seu próprio modus operandi, os quais permitiram evidenciar dificuldades na implementação das normas e rotinas da Iniciativa Hospital Amigo da Criança desenvolvidas nas instituições. CONCLUSÃO: Os resultados revelaram a necessidade de ajustes para melhorar a resolutividade do programa, com ênfase para: adoção de uma nova matriz ensino-aprendizagem pautada na educação reflexiva e na adoção dos referenciais da pedagogia da problematização; fortalecimento das redes de apoio à mulher; investimentos na melhoria do acolhimento, tornando a relação cliente-profissional mais respeitosa e definição de um processo de monitoramento contínuo que permita a adoção de medidas corretivas sempre que se fizer necessário.OBJECTIVE: This study analyzed the way the Baby-Friendly Hospital Initiative is perceived by the social actors involved in it. METHODS: This qualitative study administered semi-structured interviews aided by a thematic guide to twenty female patients and ten health professionals from five Baby-Friendly Hospitals in Teresina (PI, in Northeast Brazil. Thematic content analysis was used to analyze the data. RESULTS: Analysis of the testimonials led to two axes of discussion: one related to the foundation triad of the initiative - promotion, protection and support; and the other related to its own modus operandi, highlighting

  11. Breastfeeding in the neonatal transitional period at a Baby-Friendly Hospital

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    Jéssica Machado Teles


    Full Text Available The objective of this study was to learn the breastfeeding rates in the neonatal transition period at a child-friendly hospital. A quantitative, exploratory, cross-sectional study was developed with 342 mother-baby pairs. Data were collected by means of interviews and analysis of medical records. Low breastfeeding rates were identified in the first hour of life of the newborns or neonatal reactivity period (53.2%. In the second transition period the rate was 20.7%, and 20.5% in the third period. Encouragement to breastfeeding is not appropriate for the phases of the neonatal transition period, as the rates for the first hour of life were expected to be higher than 90%, considering low risk newborns and births that occurred in a child-friendly hospital. Our findings indicate a need for adopting care strategies that favor the early contact and training of professionals at maternity hospitals toward the adequacy of breastfeeding to the neonatal transition period.

  12. Justificativas para uso de suplemento em recém-nascidos de baixo risco de um Hospital Amigo da Criança Justifications for formula supplementation in low-risk newborns at a Baby-Friendly Hospital

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    Cynthia de Almeida Brandão Meirelles


    Full Text Available A Iniciativa Hospital Amigo da Criança preconiza que não se dê a recém-natos nenhum outro alimento ou líquido além do leite materno, a não ser que haja indicação clínica (passo 6. Este estudo teve como objetivo verificar a prevalência e identificar justificativas alegadas para suplementação ao aleitamento materno em recém-nascidos de alojamento conjunto. A amostra foi composta por 300 recém-nascidos de um Hospital Amigo da Criança do Rio de Janeiro, Brasil, que usaram suplemento dentre os que permaneceram exclusivamente em alojamento conjunto. As justificativas alegadas para uso de suplemento foram classificadas como aceitáveis ou não segundo critérios da Iniciativa Hospital Amigo da Criança. A prevalência de uso de suplemento foi de 33,3%. As principais justificativas foram: hipogalactia/agalactia (36,8%, condições de risco para hipoglicemia (21,1%, parto cesáreo (7,9%, condições relativas ao sistema estomatognático (7,4%, condições maternas (6,3% e ausência de resultado de teste rápido anti-HIV (4,5%. O parto cesáreo esteve associado à maior risco de uso de suplemento (RP = 2,1; IC95%: 1,77-2,55 em relação ao parto vaginal. A prevalência do uso de suplemento foi elevada, sendo 9% das justificativas alegadas aceitáveis.The Baby-Friendly Hospital Initiative recommends not giving newborn infants any food or drink other than breast milk unless medically indicated. This study investigated the prevalence and alleged reasons for giving formula supplementation to rooming-in newborns at a Baby-Friendly Hospital. Participants were 300 formula-supplemented, exclusively rooming-in newborns at a Baby-Friendly Hospital in Rio de Janeiro, Brazil. Reasons for formula supplementation were classified as acceptable or unacceptable in accordance with the WHO/UNICEF Baby-Friendly Hospital Initiative guidelines. A supplementation prevalence of 33.3% was found. The main allegations were: hypogalactia/ agalactia (36.8%, conditions

  13. Ten steps or climbing a mountain: A study of Australian health professionals' perceptions of implementing the baby friendly health initiative to protect, promote and support breastfeeding

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    Sheehan Athena


    Full Text Available Abstract Background The Baby Friendly Hospital (Health Initiative (BFHI is a global initiative aimed at protecting, promoting and supporting breastfeeding and is based on the ten steps to successful breastfeeding. Worldwide, over 20,000 health facilities have attained BFHI accreditation but only 77 Australian hospitals (approximately 23% have received accreditation. Few studies have investigated the factors that facilitate or hinder implementation of BFHI but it is acknowledged this is a major undertaking requiring strategic planning and change management throughout an institution. This paper examines the perceptions of BFHI held by midwives and nurses working in one Area Health Service in NSW, Australia. Methods The study used an interpretive, qualitative approach. A total of 132 health professionals, working across four maternity units, two neonatal intensive care units and related community services, participated in 10 focus groups. Data were analysed using thematic analysis. Results Three main themes were identified: 'Belief and Commitment'; 'Interpreting BFHI' and 'Climbing a Mountain'. Participants considered the BFHI implementation a high priority; an essential set of practices that would have positive benefits for babies and mothers both locally and globally as well as for health professionals. It was considered achievable but would take commitment and hard work to overcome the numerous challenges including a number of organisational constraints. There were, however, differing interpretations of what was required to attain BFHI accreditation with the potential that misinterpretation could hinder implementation. A model described by Greenhalgh and colleagues on adoption of innovation is drawn on to interpret the findings. Conclusion Despite strong support for BFHI, the principles of this global strategy are interpreted differently by health professionals and further education and accurate information is required. It may be that the

  14. Feeding newborns after hospital discharge from a Baby-Friendly Health Care Institution Alimentación del recién nacido después del alta hospitalaria de una Institución Amiga del Niño Alimentação do recém-nascido após alta hospitalar de uma Instituição Amiga da Criança


    Raquel Bosquim Zavanella Vivancos; Adriana Moraes Leite; Maria Cândida de Carvalho Furtado; Fernanda dos Santos Nogueira Góes; Vanderlei José Haas; Carmen Gracinda Silvan Scochi


    OBJECTIVE: To characterize how babies are fed during their hospital stay and after hospital discharge from a Baby-Friendly Health Care Institution, using indicators proposed by the World Health Organization. METHODS: This investigation was performed 30 days after the binomial's discharge, through a telephone interview with the puerperal woman. Data from medical records constituted secondary sources of information. RESULTS: It was observed that, even though newborns had come from these institu...

  15. Avaliação da promoção do aleitamento materno em Hospitais Amigos da Criança Evaluación de la promoción de la lactancia materna en hospitales amigos del niño Evaluation of breastfeeding promotion in Baby-Friendly Hospitals

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    Mateus Freire L Souza


    transversal. Fueron realizadas entrevistas con 100 puerperas en los dos hospitales acreditados en la IHAC en Salvador (Brasil. Se cuestionó sobre la historia obstétrica, lactancia materna anterior, atención prenatal y aspectos relacionados a los Pasos para el Éxito de la Lactancia Materna. Las cuestiones fueron elaboradas conforme a los Criterios Globales para la IHAC. Como mínimo, el 80% de las madres deberían contestar de modo satisfactorio a las preguntas correspondientes a cada paso para que se lo considerara cumplido. Se utilizó la descripción estadística de frecuencia en el SPSS 13.0 para evaluar las respuestas. No se incluyeron madres o recién nacidos que no podrían recibir lactancia materna exclusiva. RESULTADOS: El cumplimiento fue insatisfactorio para: Paso 4 (soporte a la lactancia materna después del parto - 58%, Paso 5 (lactancia materna exclusiva durante la internación - 77% y Paso 10 (encaminamiento al grupo de apoyo a la lactancia materna - 5%. Otros pasos demostraron buenos resultados: Paso 6 (oferta de sustitutos de la leche materna - 19%, Paso 7 (práctica del alojamiento conjunto - 91% y 9 (no utilización de chupos y biberones - 100%. CONCLUSIONES: Esos resultados demostraron buena adherencia a algunos aspectos de los Criterios Globales de IHAC. Se evidencia, sin embargo, la necesidad de ampliar las discusiones sobre los criterios para obtener y mantener el prestigioso título de «Hospital Amigo del Niño», una vez que los resultados fueron insatisfactorios respecto a los pasos 4, 5 y 10.OBJECTIVE: To evaluate the compliance to steps 4 to 10 of the Ten Steps Program to Successful Breastfeeding recommended by the Baby-Friendly Hospital Initiative (BFHI, created by World Health Organization (WHO. METHODS: Cross-sectional descriptive study of 100 mothers in the immediate post-partum period admitted to both BFHI accredited hospitals in Salvador (Northeast Brazil. Newborns that could not be exclusively breastfed were not included. The mothers

  16. Development of a baby friendly non-contact method for measuring vital signs: First results of clinical measurements in an open incubator at a neonatal intensive care unit (United States)

    Klaessens, John H.; van den Born, Marlies; van der Veen, Albert; Sikkens-van de Kraats, Janine; van den Dungen, Frank A.; Verdaasdonk, Rudolf M.


    For infants and neonates in an incubator vital signs, such as heart rate, breathing, skin temperature and blood oxygen saturation are measured by sensors and electrodes sticking to the skin. This can damage the vulnerable skin of neonates and cause infections. In addition, the wires interfere with the care and hinder the parents in holding and touching the baby. These problems initiated the search for baby friendly 'non-contact' measurement of vital signs. Using a sensitive color video camera and specially developed software, the heart rate was derived from subtle repetitive color changes. Potentially also respiration and oxygen saturation could be obtained. A thermal camera was used to monitor the temperature distribution of the whole body and detect small temperature variations around the nose revealing the respiration rate. After testing in the laboratory, seven babies were monitored (with parental consent) in the neonatal intensive care unit (NICU) simultaneously with the regular monitoring equipment. From the color video recordings accurate heart rates could be derived and the thermal images provided accurate respiration rates. To correct for the movements of the baby, tracking software could be applied. At present, the image processing was performed off-line. Using narrow band light sources also non-contact blood oxygen saturation could be measured. Non-contact monitoring of vital signs has proven to be feasible and can be developed into a real time system. Besides the application on the NICU non-contact vital function monitoring has large potential for other patient groups.

  17. Hospital Quality Initiative - Outcome Measures (United States)

    U.S. Department of Health & Human Services — In the interest of promoting high-quality, patient-centered care and accountability, the Centers for Medicare and Medicaid Services (CMS) and Hospital Quality...

  18. Implementing Patient Safety Initiatives in Rural Hospitals (United States)

    Klingner, Jill; Moscovice, Ira; Tupper, Judith; Coburn, Andrew; Wakefield, Mary


    Implementation of patient safety initiatives can be costly in time and energy. Because of small volumes and limited resources, rural hospitals often are not included in nationally driven patient safety initiatives. This article describes the Tennessee Rural Hospital Patient Safety Demonstration project, whose goal was to strengthen capacity for…

  19. The initial hospital response to an epidemic. (United States)

    Petrosillo, Nicola; Puro, Vincenzo; Di Caro, Antonino; Ippolito, Giuseppe


    The last decades have been characterized by the appearance of a substantial number of newly recognized or novel infectious agents and by the re-emergence of infectious diseases with a global impact. The objective of this article is to briefly describe the model of hospital response for early diagnosis and prompt management of patients with highly contagious infectious diseases. We reviewed the main components of hospital preparedness in response to clustering of highly contagious diseases. A model for the initial hospital response to an epidemic in our referral Institute is discussed. Prompt recognition and identification is the initial and indispensable step in facing any communicable diseases, regardless of whether it is a prevalent, a newly emerging one or deliberately released. The importance of developing and implementing nontraditional methods of public health surveillance and a system that allows a wide and immediate dissemination of information and exchange of views on risk assessment and risk management are highlighted. Case identification and laboratory capabilities and isolation procedures are the essential components for an initial hospital response. The recent bioterrorist events and the worldwide outbreaks of highly contagious infectious diseases have evidenced the need for institutional preparedness at each hospital and for identification of referral centers for patient isolation and of laboratories with adequate capabilities. Moreover, hospitals should develop a plan for coordinating all hospital components to respond to critical situations deriving from the admission of patients with highly contagious infectious diseases.

  20. Closing the quality gap: promoting evidence-based breastfeeding care in the hospital. (United States)

    Bartick, Melissa; Stuebe, Alison; Shealy, Katherine R; Walker, Marsha; Grummer-Strawn, Laurence M


    Evidence shows that hospital-based practices affect breastfeeding duration and exclusivity throughout the first year of life. However, a 2007 CDC survey of US maternity facilities documented poor adherence with evidence-based practice. Of a possible score of 100 points, the average hospital scored only 63 with great regional disparities. Inappropriate provision and promotion of infant formula were common, despite evidence that such practices reduce breastfeeding success. Twenty-four percent of facilities reported regularly giving non-breast milk supplements to more than half of all healthy, full-term infants. Metrics available for measuring quality of breastfeeding care, range from comprehensive Baby-Friendly Hospital Certification to compliance with individual steps such as the rate of in-hospital exclusive breastfeeding. Other approaches to improving quality of breastfeeding care include (1) education of hospital decision-makers (eg, through publications, seminars, professional organization statements, benchmark reports to hospitals, and national grassroots campaigns), (2) recognition of excellence, such as through Baby-Friendly hospital designation, (3) oversight by accrediting organizations such as the Joint Commission or state hospital authorities, (4) public reporting of indicators of the quality of breastfeeding care, (5) pay-for-performance incentives, in which Medicaid or other third-party payers provide additional financial compensation to individual hospitals that meet certain quality standards, and (6) regional collaboratives, in which staff from different hospitals work together to learn from each other and meet quality improvement goals at their home institutions. Such efforts, as well as strong central leadership, could affect both initiation and duration of breastfeeding, with substantial, lasting benefits for maternal and child health.

  1. CDC Vital Signs-Hospital Actions Affect Breastfeeding

    Centers for Disease Control (CDC) Podcasts


    This podcast is based on the October 2015 CDC Vital Signs report. Hospitals can implement the Ten Steps to Successful Breastfeeding to be designated as "Baby-Friendly" and support more moms in a decision to breastfeed.  Created: 10/6/2015 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP).   Date Released: 10/6/2015.

  2. Potential savings of harmonising hospital and community formularies for chronic disease medications initiated in hospital.

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    Lauren Lapointe-Shaw

    Full Text Available BACKGROUND: Hospitals in Canada manage their formularies independently, yet many inpatients are discharged on medications which will be purchased through publicly-funded programs. We sought to determine how much public money could be saved on chronic medications if hospitals promoted the initiation of agents with the lowest outpatient formulary prices. METHODS: We used administrative databases for the province of Ontario to identify patients initiated on a proton pump inhibitor (PPI, angiotensin-converting enzyme (ACE inhibitor or angiotensin receptor blocker (ARB following hospital admission from April 1(st 2008-March 31(st 2009. We assessed the cost to the Ontario Drug Benefit Program (ODB over the year following initiation and determined the cost savings if prescriptions were substituted with the least expensive agent in each class. RESULTS: The cost for filling all PPI, ACE inhibitor and ARB prescriptions was $ 2.48 million, $968 thousand and $325 thousand respectively. Substituting the least expensive agent could have saved $1.16 million (47% for PPIs, $162 thousand (17% for ACE inhibitors and $14 thousand (4% for ARBs over the year following discharge. INTERPRETATION: In a setting where outpatient prescriptions are publicly funded, harmonising outpatient formularies with inpatient therapeutic substitution resulted in modest cost savings and may be one way to control rising pharmaceutical costs.


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    Banks, Robert S.; Rainer, David


    This report presents the results of a recent research project originally concerned with review of governmental initiatives for changes to hospital design and operation standards at both the federal and state levels. However. it quickly became apparent that concern with energy conservation was not impacting hospital environmental standards, especially at the state level, irrespective of the energy implications. Consequently, the study was redirected to consider all energy conservation initiatives directed toward design and operating practices unique to the hospital environment. The scope was limited to agency programs (i.e., not undertaken at the initiative of individual hospitals), applicable to non-federal public and private hospitals.

  4. Assessment of Patient Safety Friendly Hospital Initiative in Three Hospitals Affiliated to Tehran University of Medical Sciences

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    Firoozeh Bairami


    Full Text Available Introduction: The aim of this study was to assess the status of patient safety in three hospitals, affiliated to Tehran University of Medical Sciences, based on the critical standards of Patient Safety Friendly Hospital Initiative (PSFHI. Materials and Methods:In this cross-sectional study, conducted in 2014, we used PSFHI assessment tool to evaluate the status of patient safety in three hospitals, affiliated to Tehran University of Medical Sciences; these general referral hospitals were selected purposefully. PSFHI assessment tool is comprised of 140 patient safety standards in five domains, categorized in 24 sub-domains. The five major domains include leadership and management, patient and public involvement, safe evidence-based clinical practices, safe environment, and lifelong learning. Results: All three hospitals met more than 70% of the critical standards. The highest score in critical standards (> 80% was related to the domain of leadership and management in all hospitals. The average score in the domain of safe evidence-based clinical practices was 70% in the studied hospitals. Finally, all the hospitals met 50% of the critical standards in the domains of patient and public involvement and safe environment. Conclusion: Based on the findings, PSFHI is a suitable program for meeting patient safety goals. The selected hospitals in this survey all had a high managerial commitment to patient safety; therefore, they could obtain high scores on critical standards.

  5. Cup versus bottle feeding for hospitalized late preterm infants in Egypt: A quasi-experimental study

    Directory of Open Access Journals (Sweden)

    Dabash Soheir A


    Full Text Available Abstract Background Although previous studies have demonstrated beneficial breastfeeding outcomes when cup feeding rather than bottle feeding was used for feeding preterm infants, cup feeding has not been implemented in Egypt. The aim of the current study was to examine the effect of using cup feeding as an exclusive method of feeding preterm infants during hospitalization on breastfeeding outcomes after discharge. Methods A quasi-experimental design, with the control group studied first, was used to examine the effect of cup feeding for preterm infants on breastfeeding outcomes after discharge. Sixty preterm infants (mean gestational age was 35.13 weeks and mean birth weight was 2150 grams were recruited during Neonatal Intensive Care Unit (NICU stay. Control group infants (n = 30 received only bottle feedings during hospitalization and the experimental group (n = 30 received only cup feedings during hospitalization. Both groups were followed up after discharge for six weeks to evaluate infant's breastfeeding behavior and mother's breastfeeding practices. Data were analyzed using descriptive statistics and repeated measures ANOVA for testing the differences between the cup feeding and bottle feeding groups over six weeks after discharge. Results Cup fed infants demonstrated significantly more mature breastfeeding behaviors when compared to bottle fed infants (p Conclusion Cup fed infants were more exclusively breast fed one week after discharge, supporting the Baby Friendly Hospital Initiative recommendations for using cup feeding and avoiding bottle feeding when providing supplementation for preterm infants. The current study provides initial evidence for the implementation of cup feeding as a method of supplementation for late preterm infants during hospitalization. Trial Registration Clinical Trial NCT00756587.

  6. Early ambulance initiation versus in-hospital initiation of high dose clopidogrel in ST-segment elevation myocardial infarction

    NARCIS (Netherlands)

    Postma, S.; Dambrink, J.H.; Ottervanger, J.P.; Gosselink, A.T.M.; Koopmans, P.C.; Berg, J.M. van den; Suryapranata, H.; Hof, A.W. van 't


    Pre-hospital infarct diagnosis gives the opportunity to start anti-platelet and anti-thrombotic agents before arrival at the PCI centre. However, more evidence is necessary to demonstrate whether high dose (HD) clopidogrel (600 mg) administered in the ambulance is associated with improved initial pa

  7. O Método Mãe Canguru em hospitais públicos do Estado de São Paulo, Brasil: uma análise do processo de implantação Kangaroo Mother Care in public hospitals in the State of São Paulo, Brazil: an analysis of the implementation process

    Directory of Open Access Journals (Sweden)

    Ana Júlia Colameo


    Full Text Available Este estudo foi elaborado para analisar a implantação do Método Mãe Canguru em 28 diferentes hospitais públicos do Estado de São Paulo, Brasil. Os hospitais escola, os amigos da criança, os com banco de leite humano e os com mais de 12 profissionais treinados obtiveram melhores escores de implantação. A resistência dos profissionais de saúde à participação da família tem dado um caráter intra-hospitalar ao método. Mudanças no treinamento, incluir os gestores no programa e prever recursos orçamentários para a adoção, avaliação e controle do Método Mãe Canguru são necessários.This study analyzed the implementation of the Kangaroo Mother method in 28 different São Paulo State public hospitals. Teaching hospitals, Baby-Friendly Hospitals, hospitals with human milk banks, and those with more than 12 trained health professionals showed higher implementation scores. Because of staff resistance to family participation in neonatal care, the Kangaroo Mother method is basically applied in-hospital. Changes in the initial training, including manager awareness-raising and proper financial resource allocation, are necessary for implementation, follow-up, assessment, and feedback.

  8. Effects of Implemented Initiatives on Patient Safety Culture in Fateme Al-zahra Hospital in Najafabad

    Directory of Open Access Journals (Sweden)

    Ahmadreza Izadi


    Full Text Available Introduction: Patient safety improvement requires ongoing culture. This cultural change is the most important challenge that managers are faced with in creation of a safe system. This study aims to show the results of initiatives to improvement in patient safety culture in Fateme Al-zahra hospital. Method: In the quasi-experimental research, patient safety culture was measured using the Persian questionnaire on adaptation of the hospital survey on patient safety culture in 12 dimensions. The research was conducted before (January 2010 and after (September 2012 the improvement initiatives. In this study, all units were determined and no sampling method was used. Reliability of the questionnaire was tested by Alpha Chronbakh (0.83. Data were analyzed using descriptive statistics indices and Independent T-Test by SPSS Software (version 18. Results: 350 questionnaires were distributed in each phaseand overall response rate was 58 and 56 percent, respectively. According to Independent T-test, Management expectations and actions, Organizational learning, Management support, Feedback and communication about error, Communication openness, Overall Perceptions of Safety, Non-punitive Response to Error, Frequency of Event Reporting, and Patient safety culture showed significant differences (P-value0.05. The mean score of Patient safety culture was 2.27 (from 5 and it was increased to 2.46 after initiatives that showed a significant difference (P-value<0.05. Conclusion: Although, improvement in patient safety culture needs teamwork and continuous attempts, the study showed that initiatives implemented in the case hospital had been effective in some dimensions. However, Teamwork within hospital units, Teamwork across units, Hospital handoffs and transitions, and Staffing dimensions were recognized for further intervention. Hospital could improve the patient safety culture with planning and measures in these dimensions.

  9. The GDAHA hospital performance reports project: a successful community-based quality improvement initiative. (United States)

    Snow, Richard J; Engler, David; Krella, Joseph M


    During the past decade there has been increasing distribution of hospital performance information but few examples of how this information is affecting the quality of health care delivery. This article describes the methods of implementation and factors influencing a successful community-based quality improvement initiative in Dayton, Ohio, involving a collaborative of five competing hospitals in partnership with the business community and local and state hospital associations. The initiative contributed to a 36% reduction in acute myocardial infarction mortality over a 3-year period by changing reperfusion patterns in patients with ST segment elevated myocardial infarction. Identification of an opportunity gap, root cause analysis, and development of process measures used to facilitate health care provider change are summarized. The driving and restraining forces that have shaped this initiative from a report card to a quality improvement program are outlined and a list of five contributors to success are presented. These factors can serve as a basis for how other communities can benefit from this collaborative model.

  10. Telephone follow-up initiated by a hospital-based health professional for postdischarge problems in patients discharged from hospital to home. (Review)

    NARCIS (Netherlands)

    Mistiaen, P.; Poot, E.


    Objectives: To determine the effects of follow-up telephone calls (TFU) in the first month post discharge, initiated by hospital-based health professionals, to patients discharged from hospital to home, with regard to physical and psycho-social outcomes in the first three months post discharge. The

  11. Telephone follow-up initiated by a hospital-based health professional for postdischarge problems in patients discharged from hospital to home.

    NARCIS (Netherlands)

    Mistiaen, P.; Poot, E.


    OBJECTIVES: To determine the effects of follow-up telephone calls (TFU) in the first month post discharge, initiated by hospital-based health professionals, to patients discharged from hospital to home, with regard to physical and psycho-social outcomes in the first three months post discharge. The

  12. Initial and long-term costs of patients hospitalized with West Nile virus disease. (United States)

    Staples, J Erin; Shankar, Manjunath B; Sejvar, James J; Meltzer, Martin I; Fischer, Marc


    There are no published data on the economic burden for specific West Nile virus (WNV) clinical syndromes (i.e., fever, meningitis, encephalitis, and acute flaccid paralysis [AFP]). We estimated initial hospital and lost-productivity costs from 80 patients hospitalized with WNV disease in Colorado during 2003; 38 of these patients were followed for 5 years to determine long-term medical and lost-productivity costs. Initial costs were highest for patients with AFP (median $25,117; range $5,385-$283,381) and encephalitis (median $20,105; range $3,965-$324,167). Long-term costs were highest for patients with AFP (median $22,628; range $624-$439,945) and meningitis (median $10,556; range $0-$260,748). Extrapolating from this small cohort to national surveillance data, we estimated the total cumulative costs of reported WNV hospitalized cases from 1999 through 2012 to be $778 million (95% confidence interval $673 million-$1.01 billion). These estimates can be used in assessing the cost-effectiveness of interventions to prevent WNV disease.

  13. Social shaping of food intervention initiatives at worksites: Canteen takeaway schemes at two Danish hospitals

    DEFF Research Database (Denmark)

    Poulsen, Signe; Jørgensen, Michael Søgaard


    , to take home or to eat at the worksite during irregular working hours. Data collection was carried out through semi-structured interviews with stakeholders within the two change processes. Two focus group interviews were also carried out at one hospital and results from a user survey carried out by other...... researchers at the other hospital were included. Theoretically, the study was based on the social constitution approach to change processes at worksites and a co-evolution approach to problem–solution complexes as part of change processes. RESULTS: Both interventions were initiated because of the need....... It is recommended that future planning and analyses of worksite health promotion interventions apply a combination of the social constitution approach to worksites and an integrated food supply and demand perspective based on analyses of the co-evolution of problem–solution complexes....

  14. Development of a comprehensive hospital-based elder abuse intervention: an initial systematic scoping review.

    Directory of Open Access Journals (Sweden)

    Janice Du Mont

    Full Text Available Elder abuse, a universal human rights problem, is associated with many negative consequences. In most jurisdictions, however, there are no comprehensive hospital-based interventions for elder abuse that address the totality of needs of abused older adults: psychological, physical, legal, and social. As the first step towards the development of such an intervention, we undertook a systematic scoping review.Our primary objective was to systematically extract and synthesize actionable and applicable recommendations for components of a multidisciplinary intersectoral hospital-based elder abuse intervention. A secondary objective was to summarize the characteristics of the responses reviewed, including methods of development and validation.The grey and scholarly literatures were systematically searched, with two independent reviewers conducting the title, abstract and full text screening. Documents were considered eligible for inclusion if they: 1 addressed a response (e.g., an intervention to elder abuse, 2 contained recommendations for responding to abused older adults with potential relevance to a multidisciplinary and intersectoral hospital-based elder abuse intervention; and 3 were available in English.The extracted recommendations for care were collated, coded, categorized into themes, and further reviewed for relevancy to a comprehensive hospital-based response. Characteristics of the responses were summarized using descriptive statistics.649 recommendations were extracted from 68 distinct elder abuse responses, 149 of which were deemed relevant and were categorized into 5 themes: Initial contact; Capacity and consent; Interview with older adult, caregiver, collateral contacts, and/or suspected abuser;physical/forensic, mental, psychosocial, and environmental/functional; and care plan. Only 6 responses had been evaluated, suggesting a significant gap between development and implementation of recommendations.To address the lack of evidence to

  15. Understanding the Determinants of Australian Hospital Nurses' Hand Hygiene Decisions Following the Implementation of a National Hand Hygiene Initiative (United States)

    White, Katherine M.; Starfelt, Louise C.; Jimmieson, Nerina L.; Campbell, Megan; Graves, Nicholas; Barnett, Adrian G.; Cockshaw, Wendell; Gee, Phillip; Page, Katie; Martin, Elizabeth; Brain, David; Paterson, David


    Hand hygiene is the primary measure in hospitals to reduce the spread of infections, with nurses experiencing the greatest frequency of patient contact. The "5 critical moments" of hand hygiene initiative has been implemented in hospitals across Australia, accompanied by awareness-raising, staff training and auditing. The aim of this…

  16. Long-term care and hospital collaboration. To survive in a reformed healthcare system, long-term care facilities can initiate hospital-based SNFs. (United States)

    Hume, S K


    Establishing relationships with hospitals may be critical for long-term care facilities facing financial pressures and uncertain futures. One option is to initiate collaborative efforts to develop hospital-based skilled nursing facilities (SNFs). Hospitals, under pressure to move patients to less intensive settings and to diversify, are naturally drawn to long-term care as a related business where they can make limited personnel and financial commitments and extend their continuum of care. Before approaching hospitals to initiate collaborative efforts, long-term care providers should understand how they think and what their strengths and weaknesses are. Long-term and acute care providers have many options for collaboration, including management contracts and joint ventures. In a traditional management contract, the long-term care provider furnishes the administrator and a few key staff in exchange for direct reimbursement for those staff plus a management fee. Another option is for the long-term care facility to provide all the staff for a fee or percentage of revenue. Joint venture options are to form a subsidiary corporation to renovate a floor of the hospital or to have the hospital buy a large percentage of the long-term care facility and share the profits. All these options have potential pitfalls, including differing financial expectations and the threat of unionization at the SNF. Nevertheless, for long-term care facilities struggling under reimbursement cutbacks and other pressures, the benefits may outweigh the risks.


    Directory of Open Access Journals (Sweden)

    Ni Luh Putri Kresnasari


    Full Text Available Diabetes mellitus is a growing global health concern. Types 2 diabetes mellitus poses a major global health threat, especially in the developing country of the world. Most patients will eventually require insulin therapy in order to reach their good glycemic control. But many patients types 2 diabetes mellitus feel some barriers to initiate insulin therapy. This is quantitative descriptive study which take place at interna policlinic Sanglah Hospital from 6-29 January 2011 with total population 94 patient type 2 diabetes mellitus with using insulin therapy and their age > 40 years. Patients interviewed about barriers to initiate insulin therapy. From 94 patients who take insulin therapy, get 38 (40,42% have some barriers. The reasons is fear of needle (19 or 20,21%, fear of pain from insulin injections (16 or 17,02%, fear of weight gain (7 or 7,45%, fear of hypoglicemia or other complications (4 or 4,25%, insulin is too expensive (5 atau 5,32%, not sure of the way using insulin (6 or 6,38%, afraid of negatif conception from the others (4 or 4,25%, and other barriers (1 or 1,06%. This study, we hope physicians can identified the barriers before give the insulin therapy. Growing relationship between doctor and patient with of good communication and give a logic and easy explaination about insulin therapy.

  18. Hospitals (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...

  19. Pneumatic reduction of intussusception in children at Korle Bu Teaching Hospital: An initial experience

    Directory of Open Access Journals (Sweden)

    Yaw Boateng Mensah


    Full Text Available Background: Intussusception is a common abdominal emergency in children which necessitates prompt diagnosis and management. Nonsurgical methods of managing this condition are rapidly gaining popularity with fluoroscopic-guided pneumatic reduction being one of such methods that has been used with great success in many countries. We present our initial experience with fluoroscopic-guided pneumatic reduction of intussusception at Korle Bu Teaching Hospital which is also the first time the technique has been used in Ghana. Materials and Methods: A total of 18 children were enrolled in the study between August 2007 and February 2008 at Korle Bu Teaching Hospital, Accra, Ghana. Patients were given air enema under fluoroscopic-guidance using locally assembled equipment. The intraluminal pressure was monitored with a pressure gauge and was not permitted to go above 120 mmHg. A total of three attempts of 3 min each were allowed. Results: There were 12 males and 6 females. The average age of the patients was 8.3 months (SD= 3 months. Twelve (67% of the cases were reduced successfully while 6 (33% failed to reduce. A majority of those that did not reduced had symptoms for at least 2 days. Bowel perforation occurred in three (16.7% cases. Conclusion: Pneumatic reduction of intussusception is a cost-effective and rapid method of management of intussusception. It however has limitations like high reported rate of bowel perforation and limited ability to identify lead points. The benefits however seem to outweigh these challenges, such as fluoroscopic-guided pneumatic reduction has a very high success rate. Fluoroscopic guided pneumatic reduction should be considered as one of the primary modes of reduction in Ghana and other neighbouring countries that are yet to practice it.

  20. Female sterilization with Hulka clips--initial experience at the University Hospital, Kuala Lumpur. (United States)

    Rahman, A A; Sivanesaratnam, V; Nuruddin, A A


    The initial experience with the use of Hulka clips for sterilization in 100 patients is reported. In July, 1979, University Hospital physicians in Kuala Lumpur introduced spring-loaded clips, and have found the procedure to be safe and the method acceptable. The 86 patients available for the followup were admitted 1 day prior to the operation for a detailed interview, physical and pelvic examinations, pap smear, and hemoglobin estimation. The laparoscopy was performed under general anesthesia, although others report using local anesthesia, and the patients were discharged the following day. Follow-up was conducted at 3, 6, and 12 months. The women were between 25-40 years old and the majority were para 3-5; 10.5% had only 2 live births. The average age of the patients' youngest child at the time of sterilization was 2.8. Indians comprised the largest ethnic group. The problems encountered at laparoscopy generally occurred in the initial stages of the study and included: difficulty at insertion of trochar, inability to visualize fimbria, tubal transection, and the need for additional clips to ensure occlusion. 2 pregnancies were reported, 1 patient had a luteal phase pregnancy and in the other patient, the left tube was only partially occluded. The actual failure rate in the series was 1.16%, which is acceptable and similar to other reports. A distinct advantage of the clip was the low incidence of tubal transection, .6%, which is a more common occurrence with silastic bands. In addition, the clips offer good prospects for reversibility, compared to other sterilization methods.

  1. Long-term survival after initial hospital admission for peripheral arterial disease in the lower extremities

    Directory of Open Access Journals (Sweden)

    Grobbee DE


    Full Text Available Abstract Background As the population ages, peripheral arterial disease (PAD in the lower extremities will become a larger public health problem. Awareness in patients as well clinicians of the high risk of morbidity and mortality is important but seems currently low. Insights in absolute mortality risks following admission for PAD in the lower extremities can be useful to improve awareness as they are easy to interpret. Methods A nationwide cohort of 4,158 patients with an initial admission for PAD in the lower extremities was identified through linkage of the national hospital and population register in 1997 and 2000. Results Over 60% of 4,158 patients were men. 28 days, 1 year and 5 year mortality risk were 2.4%, 10.3% and 31.0% for men and 3.5%, 10.4% and 27.4% for women. Coronary heart disease and stroke were frequent cause of death. Five years mortality risk was higher for men compared to women (HR 1.36, 95% CI 1.21–1.53. Conclusion In conclusion, our findings demonstrate that, 5 year mortality risk is high, especially in men and comparable to that of patients admitted for acute myocardial infarction or ischemic stroke. Though, in general population the awareness of the severity of PAD in the lower extremities is significantly lower than that for any other cardiovascular disease and it seems that cardiovascular risk factor management for prevention in PAD patients is very modest.

  2. Improvements in Pain Outcomes in a Canadian Pediatric Teaching Hospital Following Implementation of a Multifaceted, Knowledge Translation Initiative

    Directory of Open Access Journals (Sweden)

    Lisa M Zhu


    Full Text Available BACKGROUND: A previous audit performed at a tertiary/quaternary pediatric hospital in Toronto, Ontario, demonstrated suboptimal assessment and treatment of children’s pain. Knowledge translation (KT initiatives (education, reminders, audit and feedback were implemented to address identified care gaps; however, the impact is unknown.

  3. Evaluation of early implementations of antibiotic stewardship program initiatives in nine Dutch hospitals

    NARCIS (Netherlands)

    Limburg, van Maarten; Sinha, Bhanu; Lo-Ten-Foe, Jerome R.; Gemert-Pijnen, van Julia E.W.C.


    Background Antibiotic resistance is a global threat to patient safety and care. In response, hospitals start antibiotic stewardship programs to optimise antibiotic use. Expert-based guidelines recommend strategies to implement such programs, but local implementations may differ per hospital. Earlier

  4. Evaluation of early implementations of antibiotic stewardship program initiatives in nine Dutch hospitals

    NARCIS (Netherlands)

    van Limburg, Maarten; Sinha, Bhanu; Lo-Ten-Foe, Jerome R; van Gemert-Pijnen, Julia Ewc


    BACKGROUND: Antibiotic resistance is a global threat to patient safety and care. In response, hospitals start antibiotic stewardship programs to optimise antibiotic use. Expert-based guidelines recommend strategies to implement such programs, but local implementations may differ per hospital. Earlie

  5. Federating clinical data from six pediatric hospitals: process and initial results for microbiology from the PHIS+ consortium. (United States)

    Gouripeddi, Ramkiran; Warner, Phillip B; Mo, Peter; Levin, James E; Srivastava, Rajendu; Shah, Samir S; de Regt, David; Kirkendall, Eric; Bickel, Jonathan; Korgenski, E Kent; Precourt, Michelle; Stepanek, Richard L; Mitchell, Joyce A; Narus, Scott P; Keren, Ron


    Microbiology study results are necessary for conducting many comparative effectiveness research studies. Unlike core laboratory test results, microbiology results have a complex structure. Federating and integrating microbiology data from six disparate electronic medical record systems is challenging and requires a team of varied skills. The PHIS+ consortium which is partnership between members of the Pediatric Research in Inpatient Settings (PRIS) network, the Children's Hospital Association and the University of Utah, have used "FURTHeR' for federating laboratory data. We present our process and initial results for federating microbiology data from six pediatric hospitals.

  6. Identifying the key personnel in a nurse-initiated hospital waste reduction program. (United States)

    McDermott-Levy, Ruth; Fazzini, Carol


    Hospitals in the United States generate more than 6600 tons of trash a day and approximately 85% of the waste is nonhazardous solid waste such as food, cardboard, and plastic. Treatment and management of hospital waste can lead to environmental problems for the communities that receive the waste. One health system's shared governance model provided the foundation to develop a nurse-led hospital waste reduction program that focused on point-of-care waste management. Waste reduction program development required working with a variety of departments within and external to the health system. The interdisciplinary approach informed the development of the waste reduction program. This article identifies the key departments that were necessary to include when developing a hospital waste reduction program.

  7. Extracorporeal Shock-wave Lithotripsy Success Rate and Complications: Initial Experience at Sultan Qaboos University Hospital

    Directory of Open Access Journals (Sweden)

    Mohammed S. Al-Marhoon


    Full Text Available Objective: To assess the efficacy and safety of extracorporeal shock wave lithotripsy with Modularis Vario Siemens in the management of patients with renal and ureteral stones.Methods: Between 2007 and 2009, 225 outpatients were treated with Siemens Modularis Vario lithotripter at Sultan Qaboos University Hospital. Stone size, location, total number of shockwaves, stone-free rate, complications and adjunctive interventions were investigated. Chi-Square and Logistic Regression analyses were used, with p<0.05 set as the level of significance.Results: Of the 225 initial consecutive patients who underwent extracorporeal shock wave lithotripsy, 192 (85% had renal stones and 33 (15% had ureteric stones. The mean±SD stone size was 11.3 ± 4.5 mm, while the mean age of the patients was 39.9 ± 12.8 years with 68.5% males. The mean renal stone size was 11.6 ± 4.7 mm; a mean of 1.3 sessions was required. The mean ureteric stone size was 9.9 ± 3 mm; and a mean of 1.3 sessions was required. Treatment success (defined as complete clearance of ureteric stones, stone-free or clinically insignificant residual fragments of <4 mm for renal stones was 74% for renal stones and 88% for ureteric stones. Additional extracorporeal shock wave lithotripsy and ureteroscopy were the most adjunctive procedures used for stone clearance. Complications occurred in 74 patients (38.5% with renal stones and 13 patients (39.4% with uretetric stones. The most common complication was loin pain (experienced by 16.7% with renal stones and 21% with ureteric stones. Severe renal colic mandating admission occurred in 2% of patients with renal stones and 6% of patients with ureteric stones. In patients with renal stone, steinstrasse occurred in 3.6% and infection post extracorporeal shock wave lithotripsy in 0.5%. Using Multivariate Logistic Regression analysis, factors found to have significant effect on complete stone clearance were serum creatinine (p=0.004 and the number of

  8. Expectations, Worries and Wishes: The Challenges of Returning to Home after Initial Hospital Rehabilitation for Traumatic Spinal Cord Injury

    DEFF Research Database (Denmark)

    Noe, Bodil Bjørnshave; Bjerrum, Merete; Angel, Sanne


    Literature highlights the barriers and problems that individuals who sustain traumatic spinal cord injury (TSCI) meet when they attempt to resume everyday life after hospital rehabilitation. However, what do patients think about before returning home, and what should professionals encourage...... patients to address while the patient is hospitalized in order to balance the patient’s expectations and to reveal what is of importance to the patient. This qualitative study explores the expectations, wishes and worries patients have before they return home after hospital rehabilitation due to TSCI....... Eight Danish residents aged 25-75 years, admitted for initial rehabilitation at the Spinal Cord Injury Center of Western Denmark, participated in an individual interview before returning home. The transcribed interviews were analyzed according to inductive content analysis. Transversal analyses revealed...

  9. Hospitals

    DEFF Research Database (Denmark)

    Mullins, Michael


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

  10. Risk factors for developing clinical infection with methicillin-resistant Staphylococcus aureus (MRSA) amongst hospital patients initially only colonized with MRSA.

    NARCIS (Netherlands)

    R. Coello; J.R. Glynn (Judith); J. J. Picazo; J. Fereres; C. Gaspar


    textabstractIn hospital outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) many patients are initially colonized without infection. The reasons why some progress to infection while others do not are not known. A cohort of 479 hospital patients, initially only colonized with MRSA, was fo

  11. A crisis management quality improvement initiative in a children's psychiatric hospital: design, implementation, and outcome. (United States)

    Paccione-Dyszlewski, Margaret R; Conelea, Christine A; Heisler, Walter C; Vilardi, Jodie C; Sachs, Henry T


    Behavioral crisis management, including the use of seclusion and restraint, is the most high risk process in the psychiatric care of children and adolescents. The authors describe hospital-wide programmatic changes implemented at a children's psychiatric hospital that aimed to improve the quality of crisis management services. Pre/post quantitative and qualitative data suggest reduced restraint and seclusion use, reduced patient and staff injury related to crisis management, and increased patient satisfaction during the post-program period. Factors deemed beneficial in program implementation are discussed.

  12. Expansion of the ten steps to successful breastfeeding into neonatal intensive care

    DEFF Research Database (Denmark)

    Nyqvist, Kerstin Hedberg; Häggkvist, Anna-Pia; Hansen, Mette Ness


    ; and for external assessment to decide whether neonatal intensive/intermediate care units meet the conditions required to be designated as Baby-Friendly. The documents will be finalized after consultation with the World Health Organization/United Nations Children's Fund, and the goal is to offer these documents......The World Health Organization/United Nations Children's Fund Baby-Friendly Hospital Initiative: Revised, Updated, and Expanded for Integrated Care (2009) identifies the need for expanding the guidelines originally developed for maternity units to include neonatal intensive care. For this purpose......-discharge care. The goal of the expert group is to create a final document, the Baby Friendly Hospital Initiative for Neonatal Units, including standards and criteria for each of the 3 Guiding Principles, Ten Steps, and the Code; to develop tools for self-appraisal and monitoring compliance with the guidelines...

  13. Initial experience with transperitoneal laparoscopic nephrectomy in an Irish hospital setting.

    LENUS (Irish Health Repository)

    Forde, J C


    Laparoscopic nephrectomy has gained widespread acceptance as a treatment for both benign and malignant conditions and is becoming increasingly popular in Irish hospitals. We report a single surgeon, single centre experience with 20 consecutive laparoscopic nephrectomies comparing them to 20 open cases performed prior to the establishment of a laparoscopic service.

  14. Downsizing-initiated job transfer of hospital nurses: how do the job transferees fare? (United States)

    Armstrong-Stassen, M; Cameron, S J; Horsburgh, M E


    In this longitudinal panel study, the authors compared the reactions to hospital amalgamation of 66 nurses who had been transferred to a different unit for a downsizing-related reason (bumped/displaced, unit closed, redundancy) with the reactions of 181 nurses who remained on their same unit. Prior to any job transfers, the two groups perceived comparable levels of support and held similar attitudes towards their job and the hospital. Two years later, after job transfers had taken place, transferred nurses perceived significantly lower coworker support. They also reported a significantly greater decrease in organizational commitment than nurses who were not transferred. However, both groups reported a significant decrease between time a and time 2 in perceived organizational support, satisfaction with amount of work and career future, hospital identification, and organization trust. Overall, the results indicate that the downsizing associated with the amalgamation of the hospitals had a highly negative effects not only on those nurses who were transferred because of the downsizing but also on those nurses who remained on their original unit.

  15. Pre-hospital and initial management of head injury patients: An update

    Directory of Open Access Journals (Sweden)

    Tumul Chowdhury


    Full Text Available Background: Most of the bad outcomes in patients with severe traumatic brain injury (TBI are related to the presence of a high incidence of pre-hospital secondary brain insults. Therefore, knowledge of these variables and timely management of the disease at the pre-hospital period can significantly improve the outcome and decrease the mortality. The Brain Trauma Foundation guideline on "Prehospital Management" published in 2008 could provide the standardized protocols for the management of patients with TBI; however, this guideline has included the relevant papers up to 2006. Methods: A PubMed search for relevant clinical trials and reviews (from 1 January 2007 to 31 March 2013, which specifically discussed about the topic, was conducted. Results: Based on the evidence, majority of the management strategies comprise of rapid correction of hypoxemia and hypotension, the two most important predictors for mortality. However, there is still a need to define the goals for the management of hypotension and inclusion of newer difficult airway carts as well as proper monitoring devices for ensuring better intubation and ventilatory management. Isotonic saline should be used as the first choice for fluid resuscitation. The pre-hospital hypothermia has more adverse effects; therefore, this should be avoided. Conclusion: Most of the management trials published after 2007 have focused mainly on the treatment as well as the prevention strategies for secondary brain injury. The results of these trials would be certainly adopted by new standardized guidelines and therefore may have a substantial impact on the pre-hospital management in patients with TBI.

  16. [The department budget, in the context of the hospital global budget. Initial results in general medicine]. (United States)

    Besançon, F


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

  17. Continuous quality improvement programs provide new opportunities to drive value innovation initiatives in hospital-based radiology practices. (United States)

    Steele, Joseph R; Schomer, Don F


    Imaging services constitute a huge portion of the of the total dollar investment within the health care enterprise. Accordingly, this generates competition among medical specialties organized along service lines for their pieces of the pie and increased scrutiny from third-party payers and government regulators. These market and political forces create challenge and opportunity for a hospital-based radiology practice. Clearly, change that creates or builds greater value for patients also creates sustainable competitive advantage for a radiology practice. The somewhat amorphous concept of quality constitutes a significant value driver for innovation in this scenario. Quality initiatives and programs seek to define and manage this amorphous concept and provide tools for a radiology practice to create or build more value. Leadership and the early adoption of these inevitable programs by a radiology practice strengthens relationships with hospital partners and slows the attrition of imaging service lines to competitors.

  18. Initiation of breastfeeding and prevalence of exclusive breastfeeding at hospital discharge in urban, suburban and rural areas of Zhejiang China

    Directory of Open Access Journals (Sweden)

    Binns Colin W


    Full Text Available Abstract Background Rates of exclusive breastfeeding in China are relatively low and below national targets. The aim of this study was to document the factors that influence exclusive breastfeeding initiation in Zhejiang, PR China. Methods A cohort study of infant feeding practices was undertaken in Zhejiang Province, an eastern coastal region of China. A total of 1520 mothers who delivered in four hospitals located in city, suburb and rural areas during late 2004 to 2005 were enrolled in the study. Multivariate logistic regression analysis was used to explore factors related to exclusive breastfeeding initiation. Results On discharge from hospital, 50.3% of the mothers were exclusively breastfeeding their infants out of 96.9% of the mothers who had earlier initiated breastfeeding. Exclusive breastfeeding was positively related to vaginal birth, baby's first feed being breast milk, mother living in the suburbs or rural areas, younger age of mother, lower maternal education level and family income. Conclusion The exclusive breastfeeding rate in Zhejiang is only 50.3% on discharge and does not reach Chinese or international targets. A number of behaviours have been identified in the study that could be potentially incorporated into health promotion activities.

  19. Adult allogeneic bone marrow transplantation: initial experience in the University Hospital, Kuala Lumpur. (United States)

    Teh, A; Bosco, J J; Leong, K W; Saw, M H; Menaka, N; Devashanti, P


    Prior to 1993, bone marrow transplantation for adult patients was not available in Malaysia. Adult allogeneic bone marrow transplantation commenced in Malaysia when the first transplant was conducted at the University Hospital, Kuala Lumpur on 2 November 1993. Up till July 1995, 10 adult bone marrow transplants had been conducted at the University Hospital. Five patients had acute myeloid leukaemia in first remission, 4 had chronic myeloid leukaemia and 1 had acute lymphoblastic leukaemia in first partial remission. The age range of patients at the time of transplant is 16-40 years (mean 25.5 years). All patients engrafted successfully and the survival for the first 100 days post-transplant is 90%. One patient demonstrated haematological relapse post-transplant but achieved remission with donor buffy-coat infusion. The mean drug cost incurred was RM28,269 for the first 100 days. Locally available adult allogeneic bone marrow transplantation is safe, affordable and has comparable results with reputable overseas transplant centres.

  20. 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

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    Randal Henrique de Oliveira


    Full Text Available Objetivo: comparar os custos hospitalares entre a histerectomia vaginal assistida por laparoscopia (HVAL e a histerectomia total abdominal (HTA, relatando a experiência inicial com a nova abordagem em um hospital geral comunitário. Pacientes e Métodos: foram comparados 11 casos de HVAL e 23 de HTA, realizados de setembro de 1998 a julho de 1999. Prontuários e demonstrativos das despesas hospitalares de cada paciente foram revistos para coletar as variáveis analisadas. Resultados: não houve diferença estat��stica entre os grupos quanto à idade, paridade e cirurgia abdominal prévia. A principal indicação cirúrgica para ambos os grupos foi leiomiomatose uterina. O grupo das HVAL apresentou tempo de internação menor, com mediana de 1 dia e o das HTA, de 2 dias (pPurpose: to compare hospital costs between laparoscopically assisted vaginal hysterectomy (LAVH and total abdominal hysterectomy (TAH, reporting the initial experience with the new approach in a communitary general hospital. Patients and Methods: eleven cases of LAVH and 23 of TAH, carried out from September 1998 to July 1999, were compared. Each patient's records and hospital charges were reviewed to collect the analyzed variables. Results: there was no statistical difference between the groups in relation to age, parity, and previous abdominal surgery. The main surgical indication for both groups was uterine leiomyomatosis. The LAVH group presented a shorter hospital stay with a median of one day, and the TAH group, of two days (p<0.01. LAVH showed to be 40.2% more expensive than TAH (p<0.01. Operating room charges contributed to the major part of hospital costs for both groups, corresponding to 79.8 and 57.9% of the total, for LAVH and TAH, respectively. LAVH infirmary charges were smaller than for TAH, with a statistically significant difference (p = 0.002. Conclusion: with shorter hospital stay and smaller infirmary costs, we demonstrated that LAVH provides better

  1. [Amoxicillin and clavulanic acid versus amoxicillin plus gentamicin in the empirical initial treatment of urinary tract infections in hospitalized patients]. (United States)

    Verzasconi, R; Rodoni, P; Monotti, R; Marone, C; Mombelli, G


    We compared the fixed combination amoxicillin plus clavulanic acid with that of amoxicillin plus gentamicin in the empirical initial treatment of severe urinary tract infections. The study included 87 hospitalized patients (51 women and 36 men, mean age 58 +/- 22 years) with acute uncomplicated pyelonephritis (n = 48) or with complicated urinary tract infections (n = 39). 80 patients (92%) had fever and 31 patients (36%) positive blood cultures. 45 patients were randomly assigned to amoxicillin plus clavulanic acid and 42 to amoxicillin plus gentamicin. Overall, 18 patients (21%) were infected with organisms resistant in vitro to amoxicillin plus clavulanic acid, whereas no pathogen was isolated with resistance to amoxicillin plus gentamicin (p amoxicillin plus gentamicin (p amoxicillin plus gentamicin group. Although the in-vitro resistance did not result in a lower clinical efficacy of amoxicillin plus clavulanic acid compared to amoxicillin plus gentamicin in our relatively small sample of patients, the data indicate that the antimicrobial activity of amoxicillin plus clavulanic acid is inadequate to cover the spectrum of causative agents in hospitalized patients with pyelonephritis or complicated urinary tract infections. Amoxicillin plus clavulanic acid should therefore not be used in the initial empirical treatment of these infections.

  2. Reducing socioeconomic inequalities in COPD care in the hospital outpatient setting - A nationwide initiative

    DEFF Research Database (Denmark)

    Tøttenborg, Sandra S; Lange, Peter; Thomsen, Reimar W


    -ever outpatient contact for COPD during 2008-2012 (N = 23,741). Adjusted year-specific relative risks (RR) of fulfilling all relevant process performance measures was compared according to ethnicity, education, income, employment, and cohabitation using Poisson regression. RESULTS: Quality of care improved...... during the study period. CONCLUSION: A systematic quality improvement initiative including regular audits, knowledge sharing, and detailed disease-specific recommendations for care improvement may increase the overall quality of care and considerably modify the substantial socioeconomic inequalities...

  3. The Effects of a Customer Service Initiative at Moncrief Army Community Hospital (United States)


    Carlsmith, 1959). The theory further suggests: a) dissonance is psychologically uncomfortable enough to motivate people to achieve consonance , and b...response rates 13 Cognitive dissonance theory 14 Purpose 14 METHODS AND PROCEDURES 16 RESULTS 23 HI (ICE Card Overall Satisfaction) test...finding will become crucial to the utility of the ICE card initiative regardless of the outcomes of the surveys. Cognitive dissonance theory

  4. Survey of the initial management and imaging protocols for occult scaphoid fractures in UK hospitals

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    Brookes-Fazakerley, S.D.; Kumar, A.J.S. [Countess of Chester Hospital NHS Foundation Trust, Department of Trauma and Orthopaedics, Chester (United Kingdom); Oakley, J. [Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Oswestry, Shropshire (United Kingdom)


    The aim of this research was to survey how occult fractures of the scaphoid bone are both imaged and managed initially. A total of 832 questionnaires were sent via e-mail to active associate members of the British Orthopaedic Association. Included was a series of questions regarding the timing of initial and subsequent orthopaedic review of this group of patients and the use of serial radiographs and second-line imaging techniques. Nearly half of the UK's acute NHS trusts were represented (45%). The response rate was 16% (130 out of 832). Only 16% of respondents were aware of a local imaging protocol for the investigation of suspected fractures of the scaphoid. Ninety-four percent of respondents performed a second radiograph at first fracture clinic review. Fifty-eight percent used magnetic resonance imaging (MRI) as a second-line investigation; with computed tomography scan and radionuclide isotope bone scan being performed by 26% and 16% respondents, respectively. The survey revealed a wide variation in the management of occult fractures of the scaphoid. MRI has been shown to be both sensitive and specific in diagnosing occult carpal bone fractures. There is a need to standardise the management of these injuries to ensure early diagnosis and limit unnecessary wrist immobilisation. (orig.)

  5. Breastfeeding support in neonatal intensive care

    DEFF Research Database (Denmark)

    Maastrup, Ragnhild; Bojesen, Susanne Norby; Kronborg, Hanne


    was to describe breastfeeding support in Danish NICUs, where approximately 98% of mothers initiate lactation. Methods: A national survey of all 19 Danish NICUs was conducted in 2009. Four NICUs were at designated Baby-Friendly hospitals, and 5 had a lactation consultant. In all NICUs, it was possible for some...

  6. A "migrant friendly hospital" initiative in Geneva, Switzerland: evaluation of the effects on staff knowledge and practices.

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    Patricia Hudelson

    Full Text Available BACKGROUND: International migration poses important challenges to European health care systems. The development of "migrant friendly hospitals" has been identified as a priority in both Europe and Switzerland. METHODS: A multi-pronged initiative was developed at Geneva University Hospitals (HUG to improve staff knowledge and use of existing "migrant friendly" resources. A self-administered questionnaire was sent pre and post-intervention to random samples of 4 major professional groups with direct patient contact at the HUG. The questionnaire assessed staff knowledge, attitudes and reported practices regarding the care of migrant patients. RESULTS: Overall response rate was 51% (N = 1460 in 2010 but only 19% (N = 761 in 2013 owing to an institutionally imposed change in survey method. Despite these difficulties, and after adjusting for sample differences, we found that respondents in 2013 were significantly more likely to have received training in how to organize an appointment with an interpreter, how to work with an interpreter and about health and social services available for migrant patients. Respondents were also significantly more likely to have used several Migrant Friendly structures at the HUG. Use of, preference for and perceived skill at working with professional interpreters all improved, and respondents were both more likely to be encouraged by their supervisors to use professional interpreters, and less likely to be encouraged to look for alternative solutions for communicating with non francophone patients. Finally, 2013 respondents encountered fewer difficulties caring for migrant patients, although lack of time and language barriers continued to be the most important sources of difficulty. CONCLUSION: Our results suggest that an institution-wide information campaign may contribute to increased awareness and use of migrant friendly resources by clinical staff. Hospital commitment and financing, along with inter

  7. Four Simple Ward Based Initiatives to Reduce Unnecessary In-Hospital Patient Stay: A Quality Improvement Project (United States)

    Shabbir, Asad; Wali, Gorav; Steuer, Alan


    Prolonged hospital stay not only increases financial stress on the National Health Service but also exposes patients to an unnecessarily high risk of adverse ward events. Each day accumulates approximately £225 in bed costs with additional risks of venousthromboembolism, hospital acquired infections, prescription errors, and falls. Despite being medically fit for discharge (MFFD), patients awaiting care packages with prolonged length of stay (LoS) have poorer outcomes and experience increased rates of mortality as a result. A six cycle prospective audit was carried out to investigate if four simple ward based initiatives could optimise patient flow through a medical ward and reduce LoS of inpatients awaiting social packages and placement. The four daily initiatives were: A morning board round between nurses and doctors to prioritise new or sick patients for early review.A post ward round meeting between the multidisciplinary team to expedite rehabilitation and plan discharges early.An evening board round to highlight which patients needed discharge paperwork for the next day to alleviate the wait for pharmacy.A ‘computer on wheels’ on ward rounds so investigations could be ordered and reviewed at the bedside allowing more time to address patient concerns. A control month in August 2013 and five intervention cycles were completed between September 2013 and January 2014. Prior to intervention, mean time taken for patients to be discharged with a package of care, once declared MFFD, was 25 days. With intervention this value dropped to 1 day. The total LoS fell from 46 days to 16 days. It was also found that the time taken from admission to MFFD status was reduced from 21 days to 15 days. In conclusion this data shows that with four simple modifications to ward behaviour unnecessary inpatient stay can be significantly reduced. PMID:26734432

  8. Four Simple Ward Based Initiatives to Reduce Unnecessary In-Hospital Patient Stay: A Quality Improvement Project. (United States)

    Shabbir, Asad; Wali, Gorav; Steuer, Alan


    Prolonged hospital stay not only increases financial stress on the National Health Service but also exposes patients to an unnecessarily high risk of adverse ward events. Each day accumulates approximately £225 in bed costs with additional risks of venousthromboembolism, hospital acquired infections, prescription errors, and falls. Despite being medically fit for discharge (MFFD), patients awaiting care packages with prolonged length of stay (LoS) have poorer outcomes and experience increased rates of mortality as a result. A six cycle prospective audit was carried out to investigate if four simple ward based initiatives could optimise patient flow through a medical ward and reduce LoS of inpatients awaiting social packages and placement. The four daily initiatives were: A morning board round between nurses and doctors to prioritise new or sick patients for early review.A post ward round meeting between the multidisciplinary team to expedite rehabilitation and plan discharges early.An evening board round to highlight which patients needed discharge paperwork for the next day to alleviate the wait for pharmacy.A 'computer on wheels' on ward rounds so investigations could be ordered and reviewed at the bedside allowing more time to address patient concerns. A control month in August 2013 and five intervention cycles were completed between September 2013 and January 2014. Prior to intervention, mean time taken for patients to be discharged with a package of care, once declared MFFD, was 25 days. With intervention this value dropped to 1 day. The total LoS fell from 46 days to 16 days. It was also found that the time taken from admission to MFFD status was reduced from 21 days to 15 days. In conclusion this data shows that with four simple modifications to ward behaviour unnecessary inpatient stay can be significantly reduced.

  9. Predictors of mortality among HIV-infected patients initiating anti retroviral therapy at a tertiary care hospital in Eastern India

    Institute of Scientific and Technical Information of China (English)

    Ananya Bhowmik; Subhasis Bhandari; Rajyasree De; Subhasish Kamal Guha


    Objective: To assess early mortality and identify its predictors among the ART naive HIV-infected patients initiating anti retroviral therapy (ART) available free of cost at the ART Centres.Methods: A retrospective cohort analysis of routinely collected programme data was done for assessing mortality of all ART naive adult patients who received first-line ART at a government tertiary care hospital in eastern India during 1st March 2009 and 28th February 2010. Bivariate and multiple regression analyses of the baseline demographic, clinical and laboratory records using SPSS 15.0 were done to identify independent predictors of mortality. Results: The mortality rate at one year was estimated to be 7.66 (95% CI 5.84-9.83) deaths/100 patient-years and more than 50% of the deaths occurred during first three months of ART initiation with a median time interval of 73 days. Tuberculosis was the major cause of death. ART naive patients with baseline serum albumin <3.5 mg/dL were eight (OR 7.9; 95% CI: 3.8-16.5) at risk of death than those with higher serum albumin levels and patients with CD4 count <100 cells/μL were two times (OR 2.2;95% CI: 1.1-4.4) at risk of death compared to higher CD4 counts. Conclusions: Risk of mortality is increased when ART is initiated at advanced stages of immunosuppression denoted by low serum albumin levels and CD4 cell counts. This highlights the importance of early detection of HIV infection, early management of opportunistic infections including tuberculosis and timely initiation of the antiretroviral drugs in the resource-limited countries, now available free in the Indian national ART programme.

  10. An investigation of quality improvement initiatives in decreasing the rate of avoidable 30-day, skilled nursing facility-to-hospital readmissions: a systematic review (United States)

    Mileski, Michael; Topinka, Joseph Baar; Lee, Kimberly; Brooks, Matthew; McNeil, Christopher; Jackson, Jenna


    Objectives The main objective was to investigate the applicability and effectiveness of quality improvement initiatives in decreasing the rate of avoidable 30-day, skilled nursing facility (SNF)-to-hospital readmissions. Problem The rate of rehospitalizations from SNF within 30 days of original discharge has increased within the last decade. Setting The research team participants conducted a literature review via Cumulative Index of Nursing and Allied Health Literature and PubMed to collect data about quality improvement implemented in SNFs. Results The most common facilitator was the incorporation of specialized staff. The most cited barriers were quality improvement tracking and implementation. Conclusion These strategy examples can be useful to acute care hospitals attempting to lower bounce back from subacute care providers and long-term care facilities seeking quality improvement initiatives to reduce hospital readmissions. PMID:28182162

  11. Factors associated with initiation and exclusive breastfeeding at hospital discharge: late preterm compared to 37 week gestation mother and infant cohort

    Directory of Open Access Journals (Sweden)

    Ayton Jennifer


    Full Text Available Abstract Background To investigate and examine the factors associated with initiation of, and exclusive breastfeeding at hospital discharge of, late preterm (34 0/7 - 36 6/7 weeks compared to 37 week gestation (37 0/7 - 37 6/7 week mother and baby pairs. Methods A retrospective population-based cohort study using a Perinatal National Minimum Data Set and clinical medical records review, at the Royal Hobart Hospital, Tasmania, Australia in 2006. Results Late preterm and 37 week gestation infants had low rates of initiation of breastfeeding within one hour of birth, 31 (21.1% and 61 (41.5% respectively. After multiple regression analysis, late preterm infants were less likely to initiate breastfeeding within one hour of birth (OR 0.3 95% CI 0.1, 0.7 p = 0.009 and were less likely to be discharged exclusively breastfeeding from hospital (OR 0.4 95% CI 0.1, 1.0 p = 0.04 compared to 37 week gestation infants. Conclusion A late preterm birth is predictive of breastfeeding failure, with late preterm infants at greater risk of not initiating breastfeeding and/or exclusively breastfeeding at hospital discharge, compared with those infants born at 37 weeks gestation. Stratifying breastfeeding outcomes by gestational age groups may help to identify those sub-populations at greatest risk of premature cessation of breastfeeding.

  12. An investigation of quality improvement initiatives in decreasing the rate of avoidable 30-day, skilled nursing facility-to-hospital readmissions: a systematic review

    Directory of Open Access Journals (Sweden)

    Mileski M


    Full Text Available Michael Mileski, Joseph Baar Topinka, Kimberly Lee, Matthew Brooks, Christopher McNeil, Jenna Jackson School of Health Administration, Texas State University, San Marcos, TX, USA Objectives: The main objective was to investigate the applicability and effectiveness of quality improvement initiatives in decreasing the rate of avoidable 30-day, skilled nursing facility (SNF-to-hospital readmissions. Problem: The rate of rehospitalizations from SNF within 30 days of original discharge has increased within the last decade. Setting: The research team participants conducted a literature review via Cumulative Index of Nursing and Allied Health Literature and PubMed to collect data about quality improvement implemented in SNFs. Results: The most common facilitator was the incorporation of specialized staff. The most cited barriers were quality improvement tracking and implementation. Conclusion: These strategy examples can be useful to acute care hospitals attempting to lower bounce back from subacute care providers and long-term care facilities seeking quality improvement initiatives to reduce hospital readmissions. Keywords: readmissions, skilled nursing, quality improvement, hospital, finance, Medicare, transfers

  13. Evaluation of the Beneficial Effects of rooming-in care, in icteric hospitalized neonates

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    Mohammad Kazemian


    Full Text Available Background: Rooming-in, motivated by World Health Organization (WHO strategies and baby-friendly hospital policies, is a practice followed in many maternity hospitals of Iran. Mother-infant dyad may easily be damaged by the separation caused by medical and surgical problems, which result in hospital stay. Regarding this, the aim of this study was to investigate the effects of the rooming-in practice in icteric newborns admitted to Mofid Children's Hospital of Tehran, Iran. Methods: This study was conducted on 220 neonates admitted to Mofid Children's Hospital with the complaint of jaundice. Out of the 220 newborns, 124 cases were assigned into the intervention group (the rooming-in care and 96 neonates were categorized into the control group (the routine-care. The two groups were compared in terms of the length of hospital stay, maternal satisfaction, nursing care time, and hospital stay complications. The data were collected by some trained mid-wives using a validated questionnaire. Data analysis was performed using paired sample t-test through SPSS version 16. Results: According to the results of the study, about 55% of the neonates were male. The neonatal mean ages of the intervention and control groups were 6.6 ±3.7 and 7 ± 3.8 days, respectively. Maternal satisfaction with neonatal care and maternal comfort during hospital stay were significantly higher in the intervention group (P=0.027. Furthermore, the two groups had no significant difference regarding the complications of hospital stay (P=0.655. Conclusion: As the findings of the present study demonstrated, in spite of the similarities of the health issues, nursery essentials, and hospital stay complications between the two groups, the rooming-in was more favorable according to the mothers’ viewpoints.

  14. The ESTHER hospital partnership initiative: a powerful levy for building capacities to combat the HIV pandemic in low-resource countries. (United States)

    Raguin, Gilles


    Partnerships between hospitals in high income countries and low resource countries are uniquely capable of fulfilling the tripartite needs of care, training, and research required to address health care crises in low resource countries. Of particular interest, at a time when the EBOLA crisis highlights the weaknesses of health systems in resource-poor settings, the institutional resources and expertise of hospitals can also contribute to strengthening health systems with long-term sustainability.We describe a partnership network between French Hospitals and hospitals/health structures in 19 countries that demonstrates the power and efficacy of health partnership in the response to the HIV/AIDS pandemic in sub-Saharan Africa and south East Asia. Through the ESTHER initiative, the partnership network currently provides capacity development, care and treatment to over 165,000 HIV-positive patients at 87 urban and 92 peripheral sites in 17 countries and enrolls 19,000 new HIV positive patients, delivers psychosocial services to 120 000 people and tests more than 35,000 pregnant women for HIV annually. It also, engages communities and assists with the development of a robust electronic information system.Launched in 2002, the ESTHER (Ensemble pour une Solidarite Thérapeutique Hospitalière En Reseau) initiative has grown from small projects with a focus on access to antiretroviral treatment in a limited number of West African countries at its outset into a large and comprehensive HIV/AIDS-control system in Western and Central Africa. The partnership's rapid achievements in the fight against HIV/AIDS, combined with the comprehensive and long-term approach to countries' health care needs, suggest that this "twinning" and medical mentoring model can and should be duplicated and developed to address the ever more pressing demand for response to global health needs in low resource countries.

  15. Endovascular Aneurysm Repair (EVAR) for Infra-renal Abdominal Aortic Aneurysm (AAA) under Local Anaesthesia - Initial Experience in Hospital Kuala Lumpur. (United States)

    Syed, A; Zainal, A A; Hanif, H; Naresh, G


    This is our initial report on the first 4 cases of infra-renal abdominal aortic aneurysm undergoing Endovascular Aneurysm Repair (EVAR) with local anaesthesia, controlled sedation and monitoring by an anaesthetist. All four patients were males with a mean age of 66.7 years. Only one required ICU stay of two days for cardiac monitoring due to bradycardia and transient hypotension post procedure. No mortality or major post operative morbidity was recorded and the mean hospital stay post procedure was 3.5 days (range 2-5 days).

  16. Initial Management of Poisoned Patients in Emergency Medical Services and Non-poisoning Hospitals in Tehran: The Comparison between Expected and Performed Managements

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    Hossein Hassanian-Moghadam


    Full Text Available Background: There is no clear data on the adherence of emergency medical services (EMS paramedics and hospital staff rather than those working in poisoning centers to the guidelines for managing acutely poisoned patients in developing countries. Methods: During a 6-month period, all EMS-managed poisoned patients along with those initially managed in a non-poisoning center before being referred to a poisoning hospital in Tehran, Iran, were instructed. Then the indications for administrating the activated charcoal (AC as well as performing gastric lavage (GL and tracheal intubation were studied and compared to the recommended guidelines. Results: A total of 3347 cases, including 1859 males (55.6%, were evaluated. There were significant differences between expected and performed endotracheal intubations in both EMS and other medical centers (P-value = 0.002 and 0.001, respectively as well as the administration of GL and AC in other medical centers (P-values= 0.003 and 0.03, respectively. Conclusion: More extensive educational programs should be established to improve the preliminary management of poisoned patients performed by EMS paramedics and staff of hospitals other than poisoning centers.

  17. Speech recognition interface to a hospital information system using a self-designed visual basic program: initial experience. (United States)

    Callaway, Edward C; Sweet, Clifford F; Siegel, Eliot; Reiser, John M; Beall, Douglas P


    Speech recognition (SR) in the radiology department setting is viewed as a method of decreasing overhead expenses by reducing or eliminating transcription services and improving care by reducing report turnaround times incurred by transcription backlogs. The purpose of this study was to show the ability to integrate off-the-shelf speech recognition software into a Hospital Information System in 3 types of military medical facilities using the Windows programming language Visual Basic 6.0 (Microsoft, Redmond, WA). Report turnaround times and costs were calculated for a medium-sized medical teaching facility, a medium-sized nonteaching facility, and a medical clinic. Results of speech recognition versus contract transcription services were assessed between July and December, 2000. In the teaching facility, 2042 reports were dictated on 2 computers equipped with the speech recognition program, saving a total of US dollars 3319 in transcription costs. Turnaround times were calculated for 4 first-year radiology residents in 4 imaging categories. Despite requiring 2 separate electronic signatures, we achieved an average reduction in turnaround time from 15.7 hours to 4.7 hours. In the nonteaching facility, 26600 reports were dictated with average turnaround time improving from 89 hours for transcription to 19 hours for speech recognition saving US dollars 45500 over the same 6 months. The medical clinic generated 5109 reports for a cost savings of US dollars 10650. Total cost to implement this speech recognition was approximately US dollars 3000 per workstation, mostly for hardware. It is possible to design and implement an affordable speech recognition system without a large-scale expensive commercial solution.

  18. Perspectives of staff nurses of the reasons for and the nature of patient-initiated call lights: an exploratory survey study in four USA hospitals

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    Tzeng Huey-Ming


    Full Text Available Abstract Background Little research has been done on patient call light use and staff response time, which were found to be associated with inpatient falls and satisfaction. Nurses' perspectives may moderate or mediate the aforementioned relationships. This exploratory study intended to understand staff's perspectives about call lights, staff responsiveness, and the reasons for and the nature of call light use. It also explored differences among hospitals and identified significant predictors of the nature of call light use. Methods This cross-sectional, multihospital survey study was conducted from September 2008 to January 2009 in four hospitals located in the Midwestern region of the United States. A brief survey was used. All 2309 licensed and unlicensed nursing staff members who provide direct patient care in 27 adult care units were invited to participate. A total of 808 completed surveys were retrieved for an overall response rate of 35%. The SPSS 16.0 Window version was used. Descriptive and binary logistic regression analyses were conducted. Results The primary reasons for patient-initiated calls were for toileting assistance, pain medication, and intravenous problems. Toileting assistance was the leading reason. Each staff responded to 6 to 7 calls per hour and a call was answered within 4 minutes (estimated. 49% of staff perceived that patient-initiated calls mattered to patient safety. 77% agreed that that these calls were meaningful. 52% thought that these calls required the attention of nursing staff. 53% thought that answering calls prevented them from doing the critical aspects of their role. Staff's perceptions about the nature of calls varied across hospitals. Junior staff tended to overlook the importance of answering calls. A nurse participant tended to perceive calls as more likely requiring nursing staff's attention than a nurse aide participant. Conclusions If answering calls was a high priority among nursing tasks, staff

  19. Susceptibility to transmitting HIV in patients initiating antiretroviral therapy in rural district hospitals in Cameroon (Stratall ANRS 12110/ESTHER Trial.

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    Gilbert Ndziessi

    Full Text Available OBJECTIVES: Using cohort data nested in a randomized trial conducted in Cameroon, this study aimed to investigate time trends and predictors of the susceptibility to transmitting HIV during the first 24 months of treatment. METHODS: The outcome, susceptibility to transmitting HIV, was defined as reporting inconsistent condom use and experiencing incomplete virological suppression. Mixed logistic regressions were performed to identify predictors of this outcome among 250 patients reporting to have had sexual relationships either with HIV-negative or unknown HIV status partner(s. RESULTS: Despite an initial decrease from 76% at M0 to 50% at M6, the rate of inconsistent condom use significantly increased from M12 (59% to M24 (66% (p = 0.017. However, the proportion of patients susceptible to transmitting HIV significantly decreased over follow-up from 76% at M0, to 50% at M6, 31% at M12 and 27% at M24 (p<0.001. After controlling for age, gender and intervention group, we found that perceiving healthcare staff's readiness to listen as poor (adjusted odds ratios (AOR [95% Confidence Interval (CI] = 1.87 [1.01-3.46], reporting to have sexual relationships more than once per week (AOR [95%CI] = 2.52 [1.29-4.93], having more than one sexual partner (AOR [95%CI] = 2.53 [1.21-5.30] and desiring a/another child (AOR [95%CI] = 2.07 [1.10-3.87] were all associated with a higher risk of being susceptible to transmitting HIV. Conversely, time since ART initiation (AOR [95%CI] = 0.66 [0.53-0.83] for an extra 6 months and ART adherence (AOR [95%CI] = 0.33 [0.15-0.72] were significantly associated with a lower risk of being susceptible to transmitting HIV. CONCLUSIONS: The decrease observed in the susceptibility to transmitting HIV suggests that fear of behavioural disinhibition should not be a barrier to universal access to ART. However, developing adequate preventive interventions matching patients' expectations -like the desire to have children- and

  20. Autoeficácia no Aleitamento Materno em Ambiente Baby-Friendly


    Guerrilhas, Lisa; Sim-Sim, Margarida


    Introduction: According to the World Health Organization, breastfeeding guarantees countless individual and collective benefits (WHO, 2010). Some authors consider it to be an innate skill (Colson, 2008, 2012) while others see it as a skill that must be acquired (Rolfes, Pinna & Whitney, 2009). Objectives: identify the effect of 1)parity and participation in antenatal classes and 2) type of delivery and precocity of the first breastfeeding moment on self-efficacy in breastfeeding. Methodology:...

  1. Report from the Country of Georgia: Protecting and Promoting Breastfeeding through Regulation of Artificial-Feeding Marketing Practices


    Nemsadze, Ketevan


    This paper highlights the southwest Asian country of Georgia's experience in creating efforts to protect and promote breastfeeding and to implement the International Code of Marketing of Breast-milk Substitutes. Since 1994, the country of Georgia (of the former Soviet Union) has successfully implemented the Baby-Friendly Hospital Initiative. In 1997–1998, Georgia conducted a study throughout the country's various regions to evaluate compliance with the International Code of Marketing of Breas...

  2. Case Fatality among Patients Hospitalized for Community-acquired Pneumonia according to Initial Antibiotic Treatment. A Comparison of Two Case Series

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    Luis Alberto Corona Martínez


    Full Text Available Background: community-acquired pneumonia is one of the major health problems worldwide and in the hospital of Cienfuegos.Objective: to determine the changes in the relationship between the type of antimicrobial agent used empirically at admission and case fatality for community-acquired pneumonia in two case series designed at different times.Methods: an observational, descriptive study was conducted to compare two case series of patients hospitalized due to the condition under study. The relationship between the antimicrobial agents selected (amoxicillin/sulbactam, cefuroxime, ceftriaxone and cefotaxime and case fatality was analyzed taking into account potentially confounding variables. In the statistical analysis, the Chi-square test was used to compare the proportions, and Fisher's exact test was applied, with a 95% confidence level (p <.05. Results: in the two case series, the same pattern was observed in terms of the antimicrobial agents associated with the lowest and highest case fatality: cefuroxime and cefotaxime, respectively. In contrast to the A series, the B series showed a more uniform behavior of case fatality with the use of the antimicrobials selected, which meant a considerable reduction in case fatality among patients treated initially with third-generation cephalosporins in the B series. In this sense, the most significant impact on case fatality was observed in patients receiving ceftriaxone.Conclusions: cefuroxime remains the initial empirical antimicrobial agent associated with the lowest case fatality among patients with community-acquired pneumonia. In the second case series, a clear reduction in case fatality was found in patients treated with ceftriaxone and cefotaxime.

  3. Intratympanic steroids as primary initial treatment of idiopathic sudden sensorineural hearing loss. The Hospital Universitario Ramón y Cajal experience and review of the literature. (United States)

    Labatut, Tomás; Daza, María José; Alonso, Antonio


    The objective of this study was to determine the effectiveness, dosage, safety and comfort of intratympanic steroids as primary initial treatment of idiopathic sudden sensorineural hearing loss (ISSHL). Prospective nonrandomized clinical practice study was performed in Tertiary referral center university hospital. A total of 35 consecutive patients suffering from newly diagnosed sudden sensorineural hearing loss with mean pure-tone average thresholds of 81 ± 21 dB were treated. No previous therapy had been undertaken. Intratympanic steroid injection as primary initial treatment was administered during 2 weeks on a twice a week schedule, between 2010 and 2011. Treatment was started on average within 2 days of symptoms onset. Pre and post-treatment audiometric evaluations were analyzed on follow-up as well as tolerance of the procedure and possible adverse effects. 66-85 % of patients achieved successful treatment according to the different outcome criteria used to evaluate hearing improvement (Furuhashi criteria/improvement of ≥10 dB in pure-tone average). Mean post-treatment improvement regarding pure-tone average was 34 ± 21 dB. A 48 ± 43 % improvement in speech discrimination score was observed. Patients received an average of 18 mg of methylprednisolone per injection and a total dose of 72 mg per treatment cycle. No serious adverse effects were noted. Intratympanic steroid injection is an effective, safe and well-tolerated office based-procedure for the treatment of ISSHL as primary initial treatment that can avoid the potential adverse effects of systemic steroids. A higher dose, schedule of administration as well as standardization of hearing recovery criteria still need to be established.

  4. HCAHPS Hospital Survey (United States)

    U.S. Department of Health & Human Services — Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Hospital Survey The intent of the HCAHPS initiative is to provide a standardized survey...

  5. Long-term outcome of infective endocarditis: A study on patients surviving over one year after the initial episode treated in a Finnish teaching hospital during 25 years

    Directory of Open Access Journals (Sweden)

    Engblom Erik


    Full Text Available Abstract Background Only a few previous studies have focused on the long-term prognosis of the patients with infective endocarditis (IE. Our purpose was to delineate factors potentially associated with the long-term outcome of IE, recurrences of IE and requirement for late valve surgery. Methods A total of 326 episodes of IE in 303 patients were treated during 1980–2004 in the Turku University Hospital. We evaluated the long-term outcome and requirement for late valve surgery for 243 of these episodes in 226 patients who survived longer than 1 year after the initial admission. Factors associated with recurrences were analysed both for the 1-year survivors and for all 303 patients. Results The mean (SD follow-up time for the 1-year survivors was 11.5 (7.3 years (range 25 days to 25.5 years. The overall survival was 95%, 82%, 66%, 51% and 45% at 2, 5, 10, 15 and 20 years. In age and sex adjusted multivariate analyses, significant predictors for long-term overall mortality were heart failure within 3 months of admission (HR 1.97, 95% CI 1.27 to 3.06; p = 0.003 and collagen disease (HR 2.54, 95% CI 1.25 to 5.19; p = 0.010 or alcohol abuse (HR 2.39, 95% CI 1.30 to 4.40; p = 0.005 as underlying conditions, while early surgery was significantly associated with lower overall mortality rates (HR 0.31, 95% CI 0.17 to 0.58; p Conclusion Heart failure during the index episode of IE was the complication, which significantly predicted a poor long-term outcome. Patients who underwent surgery during the initial hospitalisation for IE faired significantly better than those who did not.

  6. The Comparison Of The Efficacy Of Cefriaxon Monotherapy With Ceftazidim Plus Amikacin As Initial Empiric Antibiotic Therapy In Febrile Neutropenic Patients Emam Hospital (2000-2001

    Directory of Open Access Journals (Sweden)

    Mohammadi S M


    Full Text Available Neutropenic state with fever is exactly regarded as a medical emergency, with high mortality and morbidity rate, unless treated urgently and correctly. Every attempt should be made to find and establish the offending organism, but postponing treatment until obtaining culture results is not advised. Controversy exist on which antibiotic regimen to be used while waiting for culture results. Many antibiotic regiments both monotherapy or combination treatments have been used with varying result. The objective of this study is to compare the efficacy of cefriaxon monothenapy with ceftazidim. Plus Amikacin as initial empiric antibiotic therapy in febrile neutropenic patients."nMaterials and Methods: We performed a randomized, single blind clinical trial in 57 adult (age>12 years, neutropenic (PMN<1000 patients with fever (Temperature, oral >38.5c in Hematology ward, Imam khomeini hospital. After careful physical exam and obtaining blood & urine samples for culture, the patients were randomized to each of the two arms: Cefriaxon 2 grams daily, intravenously (arm A and; Ceftazidim 2g thrice daily plus amikacin 500 mg twice daily (arm B. Patients with shock, organ failure or previous antibiotic intake (during 48 hour before fever were excluded. If needed, dose adjustment of drugs were allowed. Effervescence in 3 days following initiation of treatment, lasting 48 hours or more, were regarded as effective (positive result."nResults: During a twelve months period of study, a total of 57 patients (17female, 40male were included. They were randomly selected to each arm of empirical treatment. Of 28 pts in arm A, 19 (67 percent, the treatment was effective, compared to 15 of 29 (51.7 percent in groups B. The duration of fever after initiation of treatment was 37.9 ± 17 hours in arm A and 40. 1 ± 20 h in arm B. Blood and / or urine culture was equally positive in two arms (25 percent in arm A and 27.6 percent in arm B."nConclusion: Cefriaxon monotherapy is at

  7. Effectiveness of a government-organized and hospital-initiated treatment for multidrug-resistant tuberculosis patients--a retrospective cohort study.

    Directory of Open Access Journals (Sweden)

    Pei-Chun Chan

    Full Text Available BACKGROUND: In contrast to the conventional model of hospital-treated and government directly observed treatment (DOT for multidrug-resistant tuberculosis (MDR-TB patient care, the Taiwan MDR-TB Consortium (TMTC was launched in May 2007 with the collaboration of five medical care groups that have provided both care and DOT. This study aimed to determine whether the TMTC provided a better care model for MDR-TB patients than the conventional model. METHODS AND FINDINGS: A total of 651 pulmonary MDR-TB patients that were diagnosed nation-wide from January 2000-August 2008 were enrolled. Of those, 290 (45% MDR-TB patients whose initial sputum sample was taken in January 2007 or later were classified as patients in the TMTC era. All others were classified as patients in the pre-TMTC era. The treatment success rate at 36 months was better in the TMTC era group (82% than in the pre-TMTC era group (61% (p<0.001. With multiple logistic regressions, diagnosis in the TMTC era (adjusted odds ratio (aOR 2.8, 95% confidence interval (CI 1.9-4.2 was an independent predictor of a higher treatment success rate at 36 months. With the time-dependent proportional hazards method, a higher treatment success rate was still observed in the TMTC era group compared to the pre-TMTC era group (adjusted hazard ratio 6.3, 95% CI 4.2-9.5. CONCLUSION: The improved treatment success observed in the TMTC era compared to the pre-TMTC era is encouraging. The detailed TMTC components that contribute the most to the improved outcome will need confirmation in follow-up studies with large numbers of MDR-TB patients.

  8. ¿Por qué los pacientes utilizan los servicios de urgencias hospitalarios por iniciativa propia? Why do patients use hospital emergency services on their own initiative?

    Directory of Open Access Journals (Sweden)

    Jesús M Aranaz Andrés


    Full Text Available Introducción: Se pretende describir el perfil de usuario y determinar su motivación para visitar el servicio de urgencias hospitalario (SUH por iniciativa propia. Método: Se elaboró un cuestionario ad hoc que se aplicó por selección consecutiva a los pacientes que podían esperar asistencia (nivel 1 del triage durante una semana de noviembre de 2002. Resultados: Respondieron el cuestionario 348 pacientes, acudiendo por iniciativa propia el 82,5%. De éstos, el 17,7% desconocía el funcionamiento de atención primaria respecto a urgencias; el 18,8% consultó con su centro de salud; el 55,0% refirió preferencia por el SUH y el 13,5% acudió por demora en otros niveles asistenciales. El 50,5% era menor de 40 años y el 9,2%, extranjero. Conclusiones: Los cambios en el patrón de consumo de servicios sanitarios pueden comprometer la organización del Sistema Nacional de Salud, si no se adapta la oferta a la necesidad expresada y/o se interviene modulando el uso racional de los recursos sanitarios.Introduction: The aim of this study was to determine the reasons why patients use hospital emergency services (HES on their own initiative and the characteristics of these users. Method: An ad hoc questionnaire was designed and applied by consecutive selection to patients who could have waited for medical care (level 1 triage over a 1-week period in November 2002. Results: A total of 348 patients completed the questionnaire; 82.5% attended on their own initiative; of these, 17.7% reported they did not know how Primary Care worked in relation to the Emergency Services; 18.8% consulted a Primary Care physician; 55.0% preferred the HES and 13.5% attended because of a delay in another health care setting. Half the patients (50.5% were younger than 40 years old and 9.2% were foreigners. Conclusions: Changes in health services' consumption patterns could jeopardize the public health system unless supply is adapted to the demand expressed and

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

    Steffen, Th; Hochberger, G; Eisner, L


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

  10. Clinical benefits of eplerenone in patients with systolic heart failure and mild symptoms when initiated shortly after hospital discharge : analysis from the EMPHASIS-HF trial

    NARCIS (Netherlands)

    Girerd, Nicolas; Collier, Tim; Pocock, Stuart; Krum, Henry; McMurray, John J.; Swedberg, Karl; Van Veldhuisen, Dirk J.; Vincent, John; Pitt, Bertram; Zannad, Faiez


    Aims Cardiovascular hospitalization (CVH) in patients with heart failure (HF) is associated with a high post-discharge rate of early re-admission and CV death. Eplerenone might be effective in reducing the incidence of these adverse clinical outcomes during this period. Methods and results The EMPHA

  11. Health service support for breastfeeding in the northern region of Ghana

    Directory of Open Access Journals (Sweden)

    Paul Armah Aryee


    Full Text Available The Baby-Friendly Hospital Initiative (BFHI is a global effort to improve the role of maternity services and to enable mothers to breastfeed their infants, thus ensuring the best start in life for their infants. The foundation for the BFHI is the Ten Steps to Successful Breastfeeding (BF. It has been shown, however, that there is the tendency of health facilities backsliding and even reverting to the old patterns of maternity care and practices and may be ineffective and discouraging to successful BF practices. The study was therefore conducted to ascertain and measure the extent of compliance with the Ten Steps to BF in designated Baby Friendly Health facilities in the Northern Region of Ghana. The study followed a cross-sectional design and was set in the Savelugu/Nanton, Tolon/Kunbungu Districts and Tamale Metropolis in the Northern Region. Nine (9 designated Baby Friendly facilities participated in the study; for which observation lists were completed and verified by interviewer-administered questionnaires to sixty-one (61 Health Care Workers (HCWs and two hundred and seventy (270 breastfeeding mothers. The overall compliance with the Ten Steps was 85.6% (S.E, 4.2% indicating high compliance, with 66.7% of the health facilities being highly compliant whilst 33.3% were moderately compliant. During the study there were no posters or other materials promoting breast-milk substitutes, bottles and pacifiers displayed in the facilities. The study highlighted a high degree of compliance with most of the BF policies (Ten Steps to successful breastfeeding and of the correct implementation of these policies in the designated baby friendly health facilities. Nevertheless, some elements relevant to Steps 4 and 5 require further work to make the needed improvement.

  12. Hospitals; hospitals13 (United States)

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

  13. FacilitiesHospitals_HOSPITAL (United States)

    Vermont Center for Geographic Information — This data layer contains point locations of all major community, regional, comprehensive health, and healthcare provider hospitals in the state of Vermont. The...

  14. Radiation dose in coronary angiography and intervention: initial results from the establishment of a multi-centre diagnostic reference level in Queensland public hospitals

    Energy Technology Data Exchange (ETDEWEB)

    Crowhurst, James A, E-mail: [The Prince Charles Hospital, Chermside, Queensland (Australia); School of Medicine, University of Queensland, St. Lucia, Brisbane, Queensland (Australia); Whitby, Mark [The Prince Charles Hospital, Chermside, Queensland (Australia); Biomedical Technology Services, Health Services Support Agency, Queensland Health, Herston, Queensland (Australia); Thiele, David [Biomedical Technology Services, Health Services Support Agency, Queensland Health, Herston, Queensland (Australia); Halligan, Toni [Allied Health Professions' Office of Queensland, Brisbane, Queensland (Australia); Westerink, Adam [Royal Brisbane and Women' s Hospital, Herston, Queensland (Australia); Crown, Suzanne [Princess Alexandra Hospital, Woolloongabba, Queensland (Australia); Milne, Jillian [Cardiac Clinical Informatics Unit - Queensland Health, Herston, Queensland (Australia); The Prince Charles Hospital, Chermside, Queensland (Australia)


    Radiation dose to patients undergoing invasive coronary angiography (ICA) is relatively high. Guidelines suggest that a local benchmark or diagnostic reference level (DRL) be established for these procedures. This study sought to create a DRL for ICA procedures in Queensland public hospitals. Data were collected for all Cardiac Catheter Laboratories in Queensland public hospitals. Data were collected for diagnostic coronary angiography (CA) and single-vessel percutaneous intervention (PCI) procedures. Dose area product (P{sub KA}), skin surface entrance dose (K{sub AR}), fluoroscopy time (FT), and patient height and weight were collected for 3 months. The DRL was set from the 75th percentile of the P{sub KA.} 2590 patients were included in the CA group where the median FT was 3.5 min (inter-quartile range = 2.3–6.1). Median K{sub AR} = 581 mGy (374–876). Median P{sub KA} = 3908 uGym{sup 2} (2489–5865) DRL = 5865 uGym{sup 2}. 947 patients were included in the PCI group where median FT was 11.2 min (7.7–17.4). Median K{sub AR} = 1501 mGy (928–2224). Median P{sub KA} = 8736 uGym{sup 2} (5449–12,900) DRL = 12,900 uGym{sup 2}. This study established a benchmark for radiation dose for diagnostic and interventional coronary angiography in Queensland public facilities.

  15. Cues-to-Action in Initiating Lesbian, Gay, Bisexual, and Transgender-Related Policies Among Magnet Hospital Chief Nursing Officers: A Demographic Assessment. (United States)

    Klotzbaugh, Ralph; Spencer, Gale


    This study explored Magnet Chief Nursing Officers' cues-to-action initiating lesbian, gay, bisexual, or transgender (LGBT)-specific policies. Homonegativity has a negative effect on employee recruitment and retention and patient satisfaction. Little has been known about what cues-to-action might initiate LGBT inclusive training. Surveys were mailed to 343 Chief Nursing Officers. Cues-to-action survey was used to assess what inspires initiation of LGBT training. Demographic surveys were used to assess what impact variables might have on cues-to-action. Age, sex, religiosity, location, and region had significant effect on cues-to-action. Developing demographically informed training and policies for LGBT equality in health care is suggestive of greater employee and patient satisfaction.

  16. Radiation dose in coronary angiography and intervention: initial results from the establishment of a multi-centre diagnostic reference level in Queensland public hospitals (United States)

    Crowhurst, James A; Whitby, Mark; Thiele, David; Halligan, Toni; Westerink, Adam; Crown, Suzanne; Milne, Jillian


    Introduction Radiation dose to patients undergoing invasive coronary angiography (ICA) is relatively high. Guidelines suggest that a local benchmark or diagnostic reference level (DRL) be established for these procedures. This study sought to create a DRL for ICA procedures in Queensland public hospitals. Methods Data were collected for all Cardiac Catheter Laboratories in Queensland public hospitals. Data were collected for diagnostic coronary angiography (CA) and single-vessel percutaneous intervention (PCI) procedures. Dose area product (PKA), skin surface entrance dose (KAR), fluoroscopy time (FT), and patient height and weight were collected for 3 months. The DRL was set from the 75th percentile of the PKA. Results 2590 patients were included in the CA group where the median FT was 3.5 min (inter-quartile range = 2.3–6.1). Median KAR = 581 mGy (374–876). Median PKA = 3908 uGym2 (2489–5865) DRL = 5865 uGym2. 947 patients were included in the PCI group where median FT was 11.2 min (7.7–17.4). Median KAR = 1501 mGy (928–2224). Median PKA = 8736 uGym2 (5449–12,900) DRL = 12,900 uGym2. Conclusion This study established a benchmark for radiation dose for diagnostic and interventional coronary angiography in Queensland public facilities. PMID:26229649

  17. Retention in care among HIV-positive patients initiating second-line antiretroviral therapy: a retrospective study from an Ethiopian public hospital clinic

    Directory of Open Access Journals (Sweden)

    Sten Wilhelmson


    Full Text Available Background: Access to second-line antiretroviral therapy (ART for HIV-positive patients remains limited in sub-Saharan Africa. Furthermore, outcomes of second-line ART may be compromised by mortality and loss to follow-up (LTFU. Objective: To determine retention in care among patients receiving second-line ART in a public hospital in Ethiopia, and to investigate factors associated with LTFU among adults and adolescents. Design: HIV-positive persons with documented change of first-line ART to a second-line regimen were retrospectively identified from hospital registers, and data were collected at the time of treatment change and subsequent clinic visits. Baseline variables for adults and adolescents were analyzed using multivariate Cox proportional hazards models comparing subjects remaining in care and those LTFU (defined as a missed appointment of ≥90 days. Results: A total of 383 persons had started second-line ART (330 adults/adolescents; 53 children and were followed for a median of 22.2 months (the total follow-up time was 906 person years. At the end of study follow-up, 80.5% of patients remained in care (adults and adolescents 79.8%; children 85.7%. In multivariate analysis, LTFU among adults and adolescents was associated with a baseline CD4 cell count <100 cells/mm3 and a first-line regimen failure that was not confirmed by HIV RNA testing. Conclusions: Although retention in care during second-line ART in this cohort was satisfactory, and similar to that reported from first-line ART programs in Ethiopia, our findings suggest the benefit of earlier recognition of patients with first-line ART failure and confirmation of suspected treatment failure by viral load testing.

  18. Results of early cranial decompression as an initial approach for damage control therapy in severe traumatic brain injury in a hospital with limited resources

    Directory of Open Access Journals (Sweden)

    José D Charry


    Full Text Available Introduction: Severe traumatic brain injury (sTBI is a disease that generates significant mortality and disability in Latin America, and specifically in Colombia. The purpose of this study was to evaluate the 12-month clinical outcome in patients with sTBI managed with an early cranial decompression (ECD as the main procedure for damage control (DC therapy, performed in a University Hospital in Colombia over a 4-year period. Materials and Methods: A database of 106 patients who received the ECD procedure, and were managed according to the strategy for DC in neurotrauma, was analyzed. Variables were evaluated, and the patient outcome was determined according to the Glasgow Outcome Score (GOS at 12 months postinjury. This was used to generate a dichotomous variable with “favorable” (GOS of 4 or 5 or “unfavorable” (GOS of 1–3 outcomes; analysis of variance was performed with the Chi-square, Wilcoxon–Mann–Whitney and Fisher tests. Results: An overall survival rate of 74.6% was observed for the procedure, At 12 months postsurgery, a favorable clinical outcome (GOS 4–5 was found in 70 patients (66.1%, Unfavorable outcomes in patients were associated with the following factors: Closed trauma, an Injury Severity Score >16 , obliterated basal cisterns, subdural hematoma as the main injury seen on the admission computed tomography, and nonreactive pupils observed in the emergency department. Conclusion: Twelve months outcome of patients with sTBI managed with ECD in a neuromonitoring limited resource University Hospital in Colombia shows an important survival rate with favorable clinical outcome measure with GOS.

  19. Cost analysis of initial highly active antiretroviral therapy regimens for managing human immunodeficiency virus-infected patients according to clinical practice in a hospital setting

    Directory of Open Access Journals (Sweden)

    Colombo GL


    Full Text Available Giorgio L Colombo,1,2 Antonella Castagna,3 Sergio Di Matteo,2 Laura Galli,3 Giacomo Bruno,2 Andrea Poli,3 Stefania Salpietro,3 Alessia Carbone,3 Adriano Lazzarin3,41Department of Drug Sciences, School of Pharmacy, University of Pavia, Italy; 2Studi Analisi Valutazioni Economiche (S.A.V.E., Milan, 3Infectious Diseases Department, San Raffaele Hospital, Milan, 4Vita-Salute San Raffaele University, Milan, ItalyObjective: In the study reported here, single-tablet regimen (STR versus (vs multi-tablet regimen (MTR strategies were evaluated through a cost analysis in a large cohort of patients starting their first highly active antiretroviral therapy (HAART. Adult human immunodeficiency virus (HIV 1-naïve patients, followed at the San Raffaele Hospital, Milan, Italy, starting their first-line regimen from June 2008 to April 2012 were included in the analysis.Methods: The most frequently used first-line HAART regimens (>10% were grouped into two classes: 1 STR of tenofovir disoproxil fumarate (TDF + emtricitabine (FTC + efavirenz (EFV and 2 MTR including TDF + FTC + EFV, TDF + FTC + atazanavir/ritonavir (ATV/r, TDF + FTC + darunavir/ritonavir (DRV/r, and TDF + FTC + lopinavir/ritoavir (LPV/r. Data were analyzed from the point of view of the Lombardy Regional Health Service. HAART, hospitalizations, visits, medical examinations, and other concomitant non-HAART drug costs were evaluated and price variations included. Descriptive statistics were calculated for baseline demographic, clinical, and laboratory characteristics; associations between categorical variables and type of antiretroviral strategy (STR vs MTR were examined using chi-square or Fisher's exact tests. At multivariate analysis, the generalized linear model was used to identify the predictive factors of the overall costs of the first-line HAART regimens.Results: A total of 474 naïve patients (90% male, mean age 42.2 years, mean baseline HIV-RNA 4.50 log10 copies/mL, and cluster of

  20. Hospital Compare (United States)

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

  1. HCAHPS - Hospital (United States)

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

  2. One-year outcomes of out-of-hospital administration of intravenous glucose, insulin, and potassium (GIK) in patients with suspected acute coronary syndromes (from the IMMEDIATE [Immediate Myocardial Metabolic Enhancement During Initial Assessment and Treatment in Emergency Care] Trial). (United States)

    Selker, Harry P; Udelson, James E; Massaro, Joseph M; Ruthazer, Robin; D'Agostino, Ralph B; Griffith, John L; Sheehan, Patricia R; Desvigne-Nickens, Patrice; Rosenberg, Yves; Tian, Xin; Vickery, Ellen M; Atkins, James M; Aufderheide, Tom P; Sayah, Assaad J; Pirrallo, Ronald G; Levy, Michael K; Richards, Michael E; Braude, Darren A; Doyle, Delanor D; Frascone, Ralph J; Kosiak, Donald J; Leaming, James M; Van Gelder, Carin M; Walter, Gert-Paul; Wayne, Marvin A; Woolard, Robert H; Beshansky, Joni R


    The Immediate Myocardial Metabolic Enhancement During Initial Assessment and Treatment in Emergency care Trial of very early intravenous glucose-insulin-potassium (GIK) for acute coronary syndromes (ACS) in out-of-hospital emergency medical service (EMS) settings showed 80% reduction in infarct size at 30 days, suggesting potential longer-term benefits. Here we report 1-year outcomes. Prespecified 1-year end points of this randomized, placebo-controlled, double-blind, effectiveness trial included all-cause mortality and composites including cardiac arrest, mortality, or hospitalization for heart failure (HF). Of 871 participants randomized to GIK versus placebo, death occurred within 1 year in 11.6% versus 13.5%, respectively (unadjusted hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.57 to 1.23, p = 0.36). The composite of cardiac arrest or 1-year mortality was 12.8% versus 17.0% (HR 0.71, 95% CI 0.50 to 1.02, p = 0.06). The composite of hospitalization for HF or mortality within 1 year was 17.2% versus 17.2% (HR 0.98, 95% CI 0.70 to 1.37, p = 0.92). The composite of mortality, cardiac arrest, or HF hospitalization within 1 year was 18.1% versus 20.4% (HR 0.85, 95% CI 0.62 to 1.16, p = 0.30). In patients presenting with suspected ST elevation myocardial infarction, HRs for 1-year mortality and the 3 composites were, respectively, 0.65 (95% CI 0.33 to 1.27, p = 0.21), 0.52 (95% CI 0.30 to 0.92, p = 0.03), 0.63 (95% CI 0.35 to 1.16, p = 0.14), and 0.51 (95% CI 0.30 to 0.87, p = 0.01). In patients with suspected acute coronary syndromes, serious end points generally were lower with GIK than placebo, but the differences were not statistically significant. However, in those with ST elevation myocardial infarction, the composites of cardiac arrest or 1-year mortality, and of cardiac arrest, mortality, or HF hospitalization within 1 year, were significantly reduced.

  3. Study on the effect of nursing intervention on 49 patients with generalized anxiety disorder due to the initial hospitalization%首次入院广泛性焦虑49例护理干预效果研究

    Institute of Scientific and Technical Information of China (English)

    周卓娅; 王向阳; 罗思欢


    目的:探讨护理干预对首次入院广泛性焦虑患者临床疗效的影响.方法:将98例首次入院广泛性焦虑住院患者随机分为常规组和干预组各49例,常规组行安全护理、日常生活护理、饮食护理等常规护理措施,干预组在常规组护理基础上给予心理护理、特殊护理、睡眠护理等特殊护理干预措施.结果:4周后干预组患者汉密顿焦虑量表(HAMA)评分、睡眠质量及临床疗效明显优于常规组,差异均有统计学意义(P<0.05).结论:对首次入院广泛性焦虑患者实施特殊护理干预措施可显著提高临床疗效.%Objective: To investigate the effect of nursing intervention on the patients with generalized anxiety disorder due to the initial hospitalization.Methods: 98 patients with generalized anxiety disorder due to the initial hospitalization were randomly divided into routine nursing care group and intervention group ( 49 cases for each group ).The routine nursing measures were taken in the routine nursing care, including safety care, daily living care and diet care.The nursing intervention measures were applied in the intervention group based on routine nursing care , such as psychological care, special care and sleep care.Results:The scores of Hamilton Anxiety Scale ( HAMA), sleep quality and clinical efficacy were superior to in the intervention group to the routine nursing care group after the intervention for 4 weeks and the differences were statistically significant between the two groups ( P < 0.05 ).Conclusion: The special nursing intervention measures applied to the patients with generalized anxiety disorder due to the initial hospitalization can significantly improve the clinical efficacy of treatment.

  4. Nursing Facility Initiative Annual Report (United States)

    U.S. Department of Health & Human Services — This annual report summarizes impacts from the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents in 2014. This initiative is designed...

  5. Initial serum (1,3)-β-D-glucan as a predictor of mortality in proven candidaemia: findings from a retrospective study in two teaching hospitals in Italy and Brazil. (United States)

    Giacobbe, D R; Esteves, P; Bruzzi, P; Mikulska, M; Furfaro, E; Mesini, A; Tatarelli, P; Grignolo, S; Viscoli, C; Colombo, A L; Del Bono, V


    A retrospective study was conducted to assess the role of initial serum (1,3)-β-d-glucan (BDG) values in predicting mortality in proven candidaemia. The study was conducted in two large teaching hospitals in Italy and Brazil. From January 2009 to June 2014, all patients with proven candidaemia who underwent a BDG test within 96 hours before or after the first positive blood culture were included in the study. The primary end point was 28-day mortality, with the role of initial BDG being assessed by univariate and multivariate analyses. A total of 104 patients met the inclusion criteria. Overall, the crude 28-day mortality was 30% (31/104). In the final multivariate model, an initial BDG of >287 pg/mL (odds ratio (OR) 4.40, 95% confidence interval (CI) 1.56-12.39, p 0.005), haemodialysis (OR 4.33, 95% CI 1.24-15.17, p 0.022) and a Pitt score of ≥ 2 (OR 4.10, 95% CI 1.24-13.54, p 0.021) were significant predictors of 28-day mortality. The >287 pg/mL cutoff predicted 28-day mortality with 65% sensitivity and 70% specificity. Centre of enrolment (p for interaction 0.012), haemodialysis (p for interaction 0.062) and timing of BDG test of more than 24 hours before or after the positive culture (p for interaction 0.143) appeared to interact with BDG's ability to predict mortality. Although not statistically significant, the last two of these interactions might partially explain why BDG's ability to predict mortality was present only in the Italian cohort.

  6. Drawing Hospital Foodscapes

    DEFF Research Database (Denmark)

    Tvedebrink, Tenna Doktor Olsen; Fisker, Anna Marie; Kirkegaard, Poul Henning

    This poster presents a series of drawings depicting the initial considerations made with the Ph.D. project for an improved ‘Interior Design for Food’ in a Danish hospital ward. The project concerns a study on the ontological and symbolic interrelationship possibly existing between food and archit......This poster presents a series of drawings depicting the initial considerations made with the Ph.D. project for an improved ‘Interior Design for Food’ in a Danish hospital ward. The project concerns a study on the ontological and symbolic interrelationship possibly existing between food...

  7. Expansion of the ten steps to successful breastfeeding into neonatal intensive care: expert group recommendations for three guiding principles. (United States)

    Nyqvist, Kerstin Hedberg; Häggkvist, Anna-Pia; Hansen, Mette Ness; Kylberg, Elisabeth; Frandsen, Annemi Lyng; Maastrup, Ragnhild; Ezeonodo, Aino; Hannula, Leena; Koskinen, Katja; Haiek, Laura N


    The World Health Organization/United Nations Children's Fund Baby-Friendly Hospital Initiative: Revised, Updated, and Expanded for Integrated Care (2009) identifies the need for expanding the guidelines originally developed for maternity units to include neonatal intensive care. For this purpose, an expert group from the Nordic countries and Quebec, Canada, prepared a draft proposal, which was discussed at an international workshop in Uppsala, Sweden, in September 2011. The expert group suggests the addition of 3 "Guiding Principles" to the Ten Steps to support this vulnerable population of mothers and infants: 1. The staff attitude to the mother must focus on the individual mother and her situation. 2. The facility must provide family-centered care, supported by the environment. 3. The health care system must ensure continuity of care, that is, continuity of pre-, peri-, and postnatal care and post-discharge care. The goal of the expert group is to create a final document, the Baby Friendly Hospital Initiative for Neonatal Units, including standards and criteria for each of the 3 Guiding Principles, Ten Steps, and the Code; to develop tools for self-appraisal and monitoring compliance with the guidelines; and for external assessment to decide whether neonatal intensive/intermediate care units meet the conditions required to be designated as Baby-Friendly. The documents will be finalized after consultation with the World Health Organization/United Nations Children's Fund, and the goal is to offer these documents to international health care, professional, and other nongovernmental organizations involved in lactation and breastfeeding support for mothers of infants who require special neonatal care.

  8. Hospitality within hospital meals –

    DEFF Research Database (Denmark)

    Justesen, Lise; Gyimóthy, Szilvia; Mikkelsen, Bent Egberg


    Hospital meals and their role in nutritional care have been studied primarily from a life and natural science perspective. This article takes a different approach and explores the idea of hospitality inspired by Jacques Derrida’s work on the ontology of hospitality. By drawing on ethnographic...... fieldwork in a Danish hospital, hospitality practices were studied using a socio-material assemblage approach. The study showed that rethinking the meal event could change the wards into temporary “pop-up-restaurants,” transcending the hospital context and providing a scene for shifting host...... and management involved in hospital food service and in nutritional care to work more systematically with the environment for improved hospital meal experiences in the future...

  9. 新生儿院内纯母乳喂养情况及其影响因素分析%Status of in-hospital exclusive breastfeeding and its influence factors

    Institute of Scientific and Technical Information of China (English)

    张悦; 王惠珊; 罗倩; 张丽晋; 王硕; 姚礼明


    [Objective] To find out the status of in-hospital exclusive breastfeeding in urban areas of China,and explore the influence factors to in-hospital exclusive breastfeeding. {Methods] 1 288 data were collected in 32 maternity and children health care hospitals of provincial and municipal levels. The breastfeeding status within 24 hours were recalled. The associations between in-hospital exclusive breastfeeding with socio-demographic variables, pregnant and puerperal factors and hospital related factors were explored by Chi-square analyses and binary Logistic regression analyses. [Results] The rate of in-hospital exclusive breastfeeding was 46. 6%. Logistic regression showed that high education level,high family income were negative effects to in-hospital exclusive breastfeeding;sucking breast within 30 minutes after-born,breastfeeding during the first day and without feeding sugar water were positive effects to in-hospital exclusive breastfeeding. [Conclusion] Actively carrying out baby-friendly hospital implementation, promoting breastfeeding of focus person, will promote breastfeeding success.%[目的]了解我国城市地区新生儿院内纯母乳喂养情况及孕产情况、产后医院护理行为对院内纯母乳喂养的影响. [方法]以全国32所省、市级妇幼保健院的1 288例产妇为研究对象,采用单因素和Logistic回归法分析产妇出院前24 h内母乳喂养情况及影响院内纯母乳喂养的可能因素. [结果] 出院前产妇的纯母乳喂养率为46.6%.文化程度高、家庭收入高对纯母乳喂养有负性作用;生后半小时早开奶、生后第1天母乳喂养、不添加糖水对纯母乳喂养是正性作用. [结论]积极贯彻爱婴医院的措施,开展有针对性的母乳喂养干预,将有利于促进住院期间母乳喂养成功.

  10. Hospitality Industry

    Directory of Open Access Journals (Sweden)

    Marian Ionel


    Full Text Available Development of accommodation, as basic services offered to tourists, led to the creation of a genuine hospitality industry. Currently, the hospitality industry is no longer just the accommodation service itself but also requires an atmosphere that ensures leisure tourists in the hotel. Thus, hospitable unit manager offers its service in addition to accommodation and catering services, leisure services, treatment services, business services required.. The existence of factors such as revenue growth, increasing leisure time, the development of transport services, the emergence of new tourist attractions have caused increasing international flows of tourists, with consequent development of units hospitable, and therefore a strong hospitality industry. In Romania, after 1990, the tourism sector experienced a true expansion, both through the development of the hotel sector, but also by developing rural hospitality units.

  11. Norovirus - hospital (United States)

    Gastroenteritis - norovirus; Colitis - norovirus; Hospital acquired infection - norovirus ... are not treated with antibiotics because antibiotics kill bacteria, not viruses. Receiving plenty of extra fluids through ...

  12. Initial approach of patients admitted to third level hospitals with systemic inflamatory response syndrome Enfoque inicial de los pacientes admitidos a hospitales de tercer nivel con síndrome de respuesta inflamatoria sistémica (SRIS

    Directory of Open Access Journals (Sweden)

    Fabián Alberto Jaimes Barragán


    Full Text Available Objective: To know the initial approach of patients with diagnosis of SIRS from infectious origin in emergency rooms. Design: Analytic observational study of a concurrent cohort. Setting: Emergency rooms of Hospital Universitario San Vicente de Paúl (HUSVP and Hospital General de Medellín (HGM. Patients: Admitted through emergency rooms with non-traumatic SIRS between August, 1998, and March, 1999, older than 14 and with suspicion of infection as one of the main diagnosis at admission. Measurements: Description of the associated diseases frequency, the risk factors and findings on basic physical examination; also the usefulness of diagnostic tools, previous antibiotic use and empirical antibiotic therapy at the time of admission. We used chi2 or Fisher´s exact test to compare proportions. Results: 502 patients were admitted. The main antecedents were chronic obstructive pulmonary disease (COPD (21.5% and trauma or previous surgery (18.7%; vital signs were determined as follows: heart rate in 100%, breath rate in 94.8%, blood pressure in 99.2%, temperature in 80.3%, Glasgow scale in 75.6% of the patients. Laboratory requests were done in the following proportions : white blood cell count in 98.4%, chest X rays in 71.1%, platelet count in 94.4% and creatinine determination in 89% of patients. In 26.5% of the patients cultures were not requested; blood cultures were done in 48.8% of the patients and results were positive in 19.2% of the specimens. In 22.3% of the patients antibiotics had previously been used but this fact did not show association with the growth of microorganisms or the prescription of empiric antibiotic therapy in the emergency room (p=0.65. Conclusions: All of the signs that define SIRS are not determined in patients with suspected infection; neurological state, as determined by the Glasgow scale, and temperature, although being mandatory parameters in emergency room patients, are not determined in 25% of the patients

  13. Hospital Inspections (United States)

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

  14. Hospital marketing. (United States)

    Carter, Tony


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

  15. Aleitamento materno exclusivo na alta de recém-nascidos internados em berçário de alto risco e os fatores associados a essa prática Exclusive breastfeeding at the point of discharge of high-risk newborns at a Neonatal Intensive Care Unit and the factors associated with this practice

    Directory of Open Access Journals (Sweden)

    Paula G. Bicalho-Mancini


    Full Text Available OBJETIVO: Avaliar as taxas e o padrão de aleitamento materno dos recém-nascidos internados em berçário de alto risco no momento de sua alta hospitalar e analisar os potenciais fatores que interferem na prática do aleitamento materno exclusivo. MÉTODOS: Foram estudados prontuários médicos de 495 recém-nascidos internados no berçário de alto risco da Maternidade Odete Valadares, Minas Gerais, antes e após receber o título de Hospital Amigo da Criança. Foram excluídos os nascidos fora da maternidade e durante o período de transição, crianças ou mães que foram a óbito ou transferidas da instituição e crianças abandonadas e/ou de mães com contra-indicação para amamentar. Foram calculadas razões de chance (odds ratio, OR e intervalos de confiança de 95% a partir de análises bivariadas e multivariadas utilizando a técnica da regressão logística. RESULTADOS: A taxa de aleitamento materno exclusivo na alta passou de 36% no período anterior para 54,6% no período posterior à implementação da Iniciativa Hospital Amigo da Criança. Os fatores de risco independentemente associados com ausência de aleitamento exclusivo foram: uso da dieta por sonda (OR = 3,01, número de consultas pré-natais menor que seis (OR = 2,21, uso de translactação (OR = 2,66, peso ao nascer OBJECTIVE: To study the rate of exclusive breastfeeding at the moment of hospital discharge of newborns admitted to a neonatal Intensive Care Unit and to analyze potential risk factors. METHODS: Four hundred and ninety-five medical records were studied, pertaining to neonates born between 1998 and 1999, admitted to a neonatal intensive care unit, before and after the implementation of the Baby Friendly Hospital Initiative policies. Babies born during the Baby Friendly Hospital Initiative transition period and outside the Maternity ward were excluded from the study, as were children or mothers who were transferred from the institution, abandoned children and

  16. Regional overview of maternal and child malnutrition: trends, interventions and outcomes. (United States)

    Djazayery, A


    The proportions of underweight, wasted, and stunted children, as well as the infant and under-5 mortality rates, have all exhibited downward trends in the Region over the past 2 decades. This is in part attributable to maternal and child nutrition intervention programmes, especially those in which women were actively involved. Programmes which support and promote breastfeeding, such as the Baby Friendly Hospital Initiative, have also contributed to this trend, although the number of baby friendly hospitals varies considerably between countries. Available information also shows that anemia is quite common among women, many of whom also have a low weight and stature and seem to suffer from osteoporosis. In several countries of the Region a number of micronutrient deficiency control programmes are in progress, such as iron supplementation for pregnant women, fortification of flour and iodization of salt. Iodine deficiency disorders are under control in 2 countries of the Region and legislation for salt iodization is in place in 17 countries. Prevalence of severe malnutrition in children is much lower than that of milder levels, thus, promotion of the nutrition status of mildly to moderately malnourished children could lead to a sizeable reduction in child mortality.

  17. Evaluation of supportive breastfeeding hospital practices: a community perspective Evaluación de prácticas hospitalarias de lactancia: una perspectiva comunitaria Avaliação de práticas hospitaleres de lactancia de apoio: uma perspectiva comunitária

    Directory of Open Access Journals (Sweden)



    Full Text Available Study objectives: (1 describe the existing supportive hospital breastfeeding practices in a major urban region and (2 determine if supportive hospital breastfeeding practices are influenced by hospital characteristics. Methods: A cross-sectional telephone survey of all hospitals with maternity services (N = 21 in Maricopa County, Arizona (USA, was conducted between July 2009 and March 2010. This major urban county, which includes Phoenix, is the fourth largest city in the USA. Supportive breastfeeding practices were 12 maternity care practices consistent with WHO Baby Friendly Hospital Initiative Ten Steps. Hospital characteristics measured were professional breastfeeding services available, institutional ownership, number of births per year, births paid for by public funds, and the level of care provided. Descriptive and inferential statistics were conducted. Results: The total number of supportive practices ranged from 5 to 10 (M = 7.52; SD = 1.53. Two practices were uniformly implemented; the remainder varied from low (> 25% to moderate (50-75% levels of implementation. 86% of hospitals had widespread use of supplements and provided gift bags containing formula. The number of Board Certified Lactation Consultants (IBCLCs employed by a hospital was the only variable predicting higher levels of supportive practices. Facility ownership status was significantly correlated with the number of IBCLCs. Discussion: The differences in supportive hospital practices among hospitals suggest the effectiveness of IBCLCs in changing practice; however, additional research is needed to further explore this thesis. Findings of this study, while unique to the community studied, were consistent with a number of findings reported by researchers around the globe.Objetivos del estudio: (1 describir las prácticas de lactancia hospitalaria de apoyo en una gran región urbana y (2 determinar si las prácticas de lactancia hospitalaria de apoyo están bajo la

  18. Building Research- Oriented Military Hospital by Scientific Planning and Initiative Practicing%科学谋划主动作为建设研究型军队医院

    Institute of Scientific and Technical Information of China (English)



    With the gradual perfection of socialist market economy and the medical and health system reform further, military hospital must persist in the following aspects in order to achieve scientifically development. The main opinions included the discipline development were the front, talent construction was a foundation, infor-matization construction was a mean, quality construction was the core. Additionally, scientific planning, serve as actively, seeking breakthroughs and development in the competition and difficulties, and creating a research, innovative hospital, were all the key aspects.%随着社会主义市场经济的逐步完善和医药卫生体制改革的深入,坚持以学科发展为龙头、人才建设为基础、信息化建设为抓手、医疗质量建设为核心,科学谋划,有效作为,在竞争中求突破、困境中谋发展,努力创建研究型、创新型数字化医院,是实现医院科学高效发展的关键.

  19. [Historical exploration of Acapulco hospitals, Guerrero, Mexico]. (United States)

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


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

  20. The Effect of the Acupuncture Therapy in Combination with Soyeom Pharmacopuncture Therapy on the Improvement of the Symptoms of the Patients with Herniated Intervertebral Disk of L-spine in His Initial Stage of Hospitalization

    Directory of Open Access Journals (Sweden)

    Song Hyong-gun


    Full Text Available Objectives: Herniated Intervertebral Disk(HIVD of L-spine is one of the most common diseases that cause back pain and radiating pain. The aim of this study is to find out if the acupuncture therapy combined with Soyeom Pharmacopuncture therapy can improve the symptoms of the patients suffering from the disease more effectively than the acupuncture only therapy. Methods: We separated 30 patients into two groups. Group A was treated with the acupuncture only therapy, and Group B was treated with Soyeom Pharmacopuncture therapy in addition to the acupuncture therapy. We have observed patients for 7 days. We checked the Visual Analog Scale(VAS for 4 times and did Straight Leg Raising Test(SLRT twice. Results: 1. For 7 days from the admission day, the VAS score has been decreased significantly in both Group A and Group B. 2. For 7 days from the admission day, the VAS score of Group B has been appeared signifi cantly lower than that of Group A, so that we can know that patients in Group B has more rapidly improved than patients in Group A 3. From the admission day to the 3rd hospital day, the improvement index of VAS scroe of Group B has appeared significantly higher than that of Group A, but after 5th hospital day, there was no significance between the improvement index of VAS score of Group A and that of Group B. 4. For 7 days from the admission day, the SLRT(degree has been improved significantly in both Group A and B, but there was no significance between the SLRT(degree of Group A and that of Group B. Conclusion: We can use Soyeom Pharmacopuncture therapy with acupuncture therapy to make the patients suffering from back pain and radiating pain improve more rapidly.

  1. How midwives learn about breastfeeding. (United States)

    Cantrill, Ruth M; Creedy, Debra K; Cooke, Marie


    Little is known about how midwives learn about breastfeeding. This study asked midwives to identify breastfeeding information resources used and perceived value for their learning. A mail questionnaire was sent to midwives (n = 3500) through the Australian College of Midwives Inc. (ACMI). A response rate of 31.6% (n = 1105) was obtained. On-the-job experience was the most common source accessed and continuing education the most valuable. Very few respondents (3.1% n = 34) acknowledged either their hospital or university midwifery education program as a valuable breastfeeding information source. There is scope for continuing education programs to address evidence-based lactation and infant feeding information. Midwifery curricula need to teach in-depth knowledge of human lactation and develop clinicians' skill base to assist breastfeeding women. The development of national standards for course accreditation on lactation and infant feeding by ACMI, Baby Friendly Hospital Initiative (BFHI) and Australian Breastfeeding Association (ABA) would be a useful quality measure.

  2. Valoración nutricional al ingreso hospitalario: iniciación al estudio entre distintas metodologías Nutritional assessment at the time of hospital-admission: study initiation smong different methodologies

    Directory of Open Access Journals (Sweden)

    L. Villamayor Blanco


    Full Text Available Antecedentes y Objetivos: Las altas cifras iniciales de prevalencia de desnutrición en los enfermos hospitalizados-cercanos al 40%- es un dato preocupante. Esto permite deducir que la identificación precoz de enfermos desnutridos o en riesgo de estarlo, mediante métodos de valoración nutricional eficaces puede constituir una herramienta fundamental de cara a la planificación nutricional. El objetivo del presente trabajo ha sido aplicar a un mismo grupo de pacientes distintos métodos de valoración nutricional (objetivos y subjetivos a su ingreso hospitalario, a fin de valorar el grado de efectividad para su aplicación en la clínica. Ámbito, Pacientes e Intervenciones: Se diseña un estudio prospectivo y aleatorio, en el cual se incluyen 50 pacientes ingresados en nuestro hospital entre el 1 de octubre y el 31 de diciembre del 2004, siendo desestimados 9 casos por fallos en las analíticas. En los tres primeros días de estancia hospitalaria se les realiza antropometría(peso, talla, circunferencia del brazo y medida del pliegue tricipital, bioquímica (hemograma, alb��mina, prealbúmina,proteína ligada al retinol, transferrina y colesterol dos encuestas de valoración nutricional (Valoración Subjetiva Global (VSG y Mini Nutricional Assessment (MNA. Resultados: Se ha aplicado el test de χ² para comparar los resultados obtenidos de los diferentes métodos objetivos, por separado y en conjunto, con métodos MNA y VSG, estableciéndose las siguientes comparaciones:Antropometría/MNA, Bioquímica/MNA, Inmunología/ MNA, Chang/MNA, Antropometría/VSG, Bioquímica/VSG, Inmunología/VSG, Chang/VSG y MNA/VSG.La significación estadística se ha considerado para un valor de p Background and objectives: The elevated prevalence figures of hyponutrition in hospitalized patients -near 40%- is an issue of concern. This allows deducing that early identification of malnourished, or at risk for hyponutrition, patients by means of effective

  3. Hospital Outpatient PPS Partial Hospitalization Program LDS (United States)

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

  4. Developing a strategic marketing plan for hospitals. (United States)

    Dychtwald, K; Zitter, M


    The initial stages of developing a strategic marketing plan for hospitals are explored in this excerpt from the book, The Role of the Hospital in an Aging Society: A Blueprint for Action. The elderly have unique perceptual, cognitive, social, and psychological needs and preferences, and a marketing strategy for eldercare services must reflect these factors, as well as the financial role of third-party payers and the decision-making influence of families and physicians. Among the elements the hospital must address when developing a marketing strategy are market selection and segmentation, targeting markets with specific services, pricing, and positioning the hospital for a maximum share of the eldercare market.

  5. Structural Measures - Hospital (United States)

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

  6. Hospital-acquired pneumonia (United States)

    ... tends to be more serious than other lung infections because: People in the hospital are often very sick and cannot fight off ... prevent pneumonia. Most hospitals have programs to prevent hospital-acquired infections.

  7. Patient survey (HCAHPS) - Hospital (United States)

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

  8. Federal government expands compliance initiatives. (United States)

    Dugan, J K


    In 1995, the Federal government initiated Operation Restore Trust to increase enforcement of fraud and abuse regulations in Medicare and Medicaid programs. With the success of the original initiative, the government is expanding the project to additional states and program areas. The initial scrutiny of home health agencies, nursing homes, hospice care, and durable medical equipment is being expanded to managed care plans and acute care hospitals with an eye toward DRG creep. To manage this increased enforcement activity, healthcare organizations should institute comprehensive corporate compliance programs. Such programs should provide a framework that delineates responsibilities and provides a systematic means to resolve issues in a timely manner.

  9. Adaptação transcultural da versão brasileira do Hospital Survey on Patient Safety Culture: etapa inicial Translation and cross-cultural adaptation of the Brazilian version of the Hospital Survey on Patient Safety Culture: initial stage

    Directory of Open Access Journals (Sweden)

    Claudia Tartaglia Reis


    Full Text Available A avaliação da cultura de segurança do paciente permite aos hospitais identificar e gerir prospectivamente questões relevantes de segurança em suas rotinas de trabalho. Este artigo descreve a adaptação transcultural do Hospital Survey on Patient Safety Culture (HSOPSC para a Língua Portuguesa e contexto brasileiro. Adotou-se abordagem universalista para avaliar a equivalência conceitual, de itens e semântica. A metodologia incluiu os seguintes estágios: (1 tradução do questionário para o Português; (2 retradução para o Inglês; (3 painel de especialistas para elaboração da versão preliminar; (4 avaliação da compreensão verbal pela população-alvo. O questionário foi traduzido para o Português e sua versão final incluiu 42 itens. A população-alvo avaliou todos os itens como de fácil compreensão. O questionário encontra-se traduzido para o Português e adaptado para o contexto brasileiro, entretanto, faz-se necessário avaliar sua equivalência de mensuração, validade externa e reprodutibilidade.Patient safety culture assessment allows hospitals to identify and prospectively manage safety issues in work routines. This article aimed to describe the cross-cultural adaptation of the Hospital Survey on Patient Safety Culture (HSOPSC into Brazilian Portuguese. A universalist approach was adopted to assess conceptual, item, and semantic equivalence. The methodology involved the following stages: (1 translation of the questionnaire into Portuguese; (2 back-translation into English; (3 an expert panel to prepare a draft version; and (4 assessment of verbal understanding of the draft by a sample of the target population. The questionnaire was translated into Portuguese, and the scale's final version included 42 items. The target population sample assessed all the items as easy to understand. The questionnaire has been translated into Portuguese and adapted to the Brazilian hospital context, but it is necessary to assess

  10. Initial Study

    DEFF Research Database (Denmark)

    Torp, Kristian


    Congestion is a major problem in most cities and the problem is growing (Quiroga, 2000) (Faghri & Hamad, 2002). When the congestion level is increased the drivers notice this as delays in the traffic (Taylor, Woolley, & Zito, 2000), i.e., the travel time for the individual driver is simply...... increased. In the initial study presented here, the time it takes to pass an intersection is studied in details. Two major signal-controlled four-way intersections in the center of the city Aalborg are studied in details to estimate the congestion levels in these intersections, based on the time it takes...

  11. Characteristics, treatment and in-hospital outcomes of patients with STEMI in a metropolitan area of a developing country: an initial report of the extended Jakarta Acute Coronary Syndrome registry (United States)

    Dharma, Surya; Andriantoro, Hananto; Purnawan, Ismi; Dakota, Iwan; Basalamah, Faris; Hartono, Beny; Rasmin, Ronaly; Isnanijah, Herawati; Yamin, Muhammad; Wijaya, Ika Prasetya; Pratama, Vireza; Gunawan, Tjatur Bagus; Juwana, Yahya Berkahanto; Suling, Frits R W; Witjaksono, A M Onny; Lasanudin, Hengkie F; Iskandarsyah, Kurniawan; Priatna, Hardja; Tedjasukmana, Pradana; Wahyumandradi, Uki; Kosasih, Adrianus; Budhiarti, Imelda A; Pribadi, Wisnoe; Wirianta, Jeffrey; Lubiantoro, Utojo; Pramesti, Rini; Widowati, Diah Retno; Aminda, Sissy Kartini; Basalamah, M Abas; Rao, Sunil V


    Objective We studied the characteristics of patients with ST segment elevation myocardial infarction (STEMI) after expansion of a STEMI registry as part of the STEMI network programme in a metropolitan city and the surrounding area covering ∼26 million inhabitants. Design Retrospective cohort study. Setting Emergency department of 56 health centres. Participants 3015 patients with acute coronary syndrome, of which 1024 patients had STEMI. Main outcome measure Characteristics of reperfusion therapy. Results The majority of patients with STEMI (81%; N=826) were admitted to six academic percutaneous coronary intervention (PCI) centres. PCI centres received patients predominantly (56%; N=514) from a transfer process. The proportion of patients receiving acute reperfusion therapy was higher than non-reperfused patients (54% vs 46%, p<0.001), and primary PCI was the most common method of reperfusion (86%). The mean door-to-device (DTD) time was 102±68 min. In-hospital mortality of non-reperfused patients was higher than patients receiving primary PCI or fibrinolytic therapy (9.1% vs 3.2% vs 3.8%, p<0.001). Compared with non-academic PCI centres, patients with STEMI admitted to academic PCI centres who underwent primary PCI had shorter mean DTD time (96±44 min vs 140±151 min, p<0.001), higher use of manual thrombectomy (60.2% vs13.8%, p<0.001) and drug-eluting stent implantation (87% vs 69%, p=0.001), but had similar use of radial approach and intra-aortic balloon pump (55.7% vs 67.2%, and 2.2% vs 3.4%, respectively). In patients transferred for primary PCI, TIMI risk score ≥4 on presentation was associated with a prolonged door-in to door-out (DI-DO) time (adjusted OR 2.08; 95% CI 1.09 to 3.95, p=0.02). Conclusions In the expanded JAC registry, a higher proportion of patients with STEMI received reperfusion therapy, but 46% still did not. In developing countries, focusing the prehospital care in the network should be a major focus of care to improve the DI

  12. Hospital marketing revisited. (United States)

    Costello, M M


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

  13. 42 CFR 456.233 - Initial continued stay review date. (United States)


    ... assigns the initial continued stay review date within 1 working day after the mental hospital is notified... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals... must provide that— (a) When a recipient is admitted to the mental hospital under admission...

  14. Openness initiative

    Energy Technology Data Exchange (ETDEWEB)

    Duncan, S.S. [Los Alamos National Lab., NM (United States)


    Although antinuclear campaigns seem to be effective, public communication and education efforts on low-level radioactive waste have mixed results. Attempts at public information programs on low-level radioactive waste still focus on influencing public opinion. A question then is: {open_quotes}Is it preferable to have a program focus on public education that will empower individuals to make informed decisions rather than trying to influence them in their decisions?{close_quotes} To address this question, a case study with both quantitative and qualitative data will be used. The Ohio Low-Level Radioactive Waste Education Program has a goal to provide people with information they want/need to make their own decisions. The program initiated its efforts by conducting a statewide survey to determine information needed by people and where they turned for that information. This presentation reports data from the survey and then explores the program development process in which programs were designed and presented using the information. Pre and post data from the programs reveal attitude and knowledge shifts.

  15. 初次住院与重复住院冠状动脉硬化性心脏病患者健康教育认知缺陷的对比研究%The Comparative Study on Health Education Cognition Defects for the Coronary Artery Heart Disease Patients in the Aspect of being Hospitalized for Initial or Repetition

    Institute of Scientific and Technical Information of China (English)

    张旭; 王蕊; 隋雪芝; 王晓琳


    Objective To understand the health education cognition defects for coronary artery heart dis‐ease patients in the aspect of be hospitalized for initial or repetition ,and compare the differences of cogni‐tion and analyze its influencing factors ,to provide evidence for set a measure for health education efficient‐ly .Methods By convenience sampling ,197 cases of coronary heart disease patients were selected and divid‐ed into initial and repetition be hospitalized .T he participants w ere investigated by using health education cognition defects questionnaire .Results There was no significant statistical difference between two groups of patients in the aspects of age ,sex ,education background ,genetic history ,blood lipids ,blood pressure ,di‐abetes ,smoking and so on(all P>0 0.5) .The two groups of patients on the level of cognitive education were higher than norm ;the initial patients were poor than those who has repetition be hospitalized (P0 0.5) ,while there was statistic significance of patients in healthy lifestyle cognition(P<0 0.5) .Conclusion Nurse should be differently to patients based on the times be hospitalized ,fully assess cognitive deficits inpatients with coronary heart disease and lay a foundation to provide effective health education .%目的:了解初次住院与重复住院冠状动脉硬化性心脏病(简称冠心病)患者健康教育认知缺陷状况,比较其认知差异并分析其影响因素,以期为临床制定有效的健康教育措施提供依据。方法2012年3-12月,便利抽样法选择在哈尔滨医科大学附属第二医院心内科住院治疗的197例冠心病患者为研究对象,按其是否为初次住院患者将其分为初次住院组和重复住院组,采用冠心病患者健康教育认知缺陷问卷对其进行调查。结果两组患者在年龄、性别、文化程度、遗传史、血脂、血压、糖尿病、吸烟等方面的差异均无统计学意义(均 P>00.5)。

  16. The application of hospitality elements in hospitals. (United States)

    Wu, Ziqi; Robson, Stephani; Hollis, Brooke


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

  17. Improving hospital efficiency: a process model of organizational change commitments. (United States)

    Nigam, Amit; Huising, Ruthanne; Golden, Brian R


    Improving hospital efficiency is a critical goal for managers and policy makers. We draw on participant observation of the perioperative coaching program in seven Ontario hospitals to develop knowledge of the process by which the content of change initiatives to increase hospital efficiency is defined. The coaching program was a change initiative involving the use of external facilitators with the goal of increasing perioperative efficiency. Focusing on the role of subjective understandings in shaping initiatives to improve efficiency, we show that physicians, nurses, administrators, and external facilitators all have differing frames of the problems that limit efficiency, and propose different changes that could enhance efficiency. Dynamics of strategic and contested framing ultimately shaped hospital change commitments. We build on work identifying factors that enhance the success of change efforts to improve hospital efficiency, highlighting the importance of subjective understandings and the politics of meaning-making in defining what hospitals change.

  18. Hospital Compare - Archived Data (United States)

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

  19. Hospitals as health educators (United States)

    ... look no further than your local hospital. From health videos to yoga classes, many hospitals offer information families need to stay healthy. You also may be able to find ways to save money on health supplies and services.

  20. Health initiatives conducted outside hospitals and other medical settings

    DEFF Research Database (Denmark)

    Mik-Meyer, Nanna


    The aim of this essay is to critically reflect on the concept of health. ‘Health’ refers not only to the absence of biomedical diseases and bodily and mental dysfunctionalities; today, the concept is also synonymous with wellness, happiness, and a good life. However, this broad definition of what...... it means to be healthy nowadays produces a number of problems for citizens who struggle to meet the standards of this changed ideal of health. Consequently, unhealthy citizens, such as overweight individuals, possess not only a biomedically defined unhealthy body or mind; they are also, in a broader sense...

  1. Sex differences in clinical characteristics, hospital management practices, and in-hospital outcomes in patients hospitalized in a Vietnamese hospital with a first acute myocardial infarction.

    Directory of Open Access Journals (Sweden)

    Hoa L Nguyen

    Full Text Available BACKGROUND: Cardiovascular disease is one of the leading causes of morbidity and mortality in Vietnam. We conducted a pilot study of Hanoi residents hospitalized with acute myocardial infarction (AMI at the Vietnam National Heart Institute in Hanoi. The objectives of this observational study were to examine sex differences in clinical characteristics, hospital management, in-hospital clinical complications, and mortality in patients hospitalized with an initial AMI. METHODS: The study population consisted of 302 Hanoi residents hospitalized with a first AMI at the largest tertiary care medical center in Hanoi in 2010. RESULTS: The average age of study patients was 66 years and one third were women. Women were older (70 vs. 64 years and were more likely than men to have had hyperlipidemia previously diagnosed (10% vs. 2%. During hospitalization, women were less likely to have undergone percutaneous coronary intervention (PCI compared with men (57% vs. 74%, and women were more likely to have developed heart failure compared with men (19% vs. 10%. Women experienced higher in-hospital case-fatality rates (CFRs than men (13% vs. 4% and these differences were attenuated after adjustment for age and history of hyperlipidemia (OR: 2.64; 95% CI: 1.01, 6.89, and receipt of PCI during hospitalization (OR: 2.09; 95% CI: 0.77, 5.09. CONCLUSIONS: Our pilot data suggest that among patients hospitalized with a first AMI in Hanoi, women experienced higher in-hospital CFRs than men. Full-scale surveillance of all Hanoi residents hospitalized with AMI at all Hanoi medical centers is needed to confirm these findings. More targeted and timely educational and treatment approaches for women appear warranted.

  2. Evaluation methods for hospital facilities

    DEFF Research Database (Denmark)

    Fronczek-Munter, Aneta


    Initial position & background: There are various methods and tools for evaluating facilities. The focus is usually on the technical building performance, function/usability or form/beauty. Examples are: Post-Occupancy Evaluation (POE) and Usability Appraisal. Nevertheless, evaluations of buildings...... according to focus areas and proposes which evaluation methods to use in different building phases of healthcare facilities. Hospital evaluations with experts and users are also considered; their subjective view on space, function, technology, usability and aesthetics. Results & solutions: This paper...... of creating buildings with enhanced usability. Additionally various evaluation methods used in hospital cases in Denmark and Norway are presented. Involvement of users is proposed, not just in defining requirements but also in co-creation/design and evaluation of solutions. The theories and preliminary...

  3. Medicare Hospital Spending Per Patient - Hospital (United States)

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

  4. Interruptions: Derrida and Hospitality

    Directory of Open Access Journals (Sweden)

    Mark W. Westmoreland


    Full Text Available Come in. Welcome. Be my guest and I will be yours. Shall we ask, in accordance with the Derridean question, "Is not hospitality an interruption of the self?" What is the relationship between the interruption and the moment one enters the host's home? Derrida calls us toward a new understanding of hospitality - as an interruption. This paper will illuminate the history of hospitality in the West as well as trace Derrida's discussions of hospitality throughout many of works. The overall goal of this project is to provide readers of Derrida with a sort of reference guide for his discussions on and deconstructive approach to hospitality.

  5. Towards the collaborative hospital

    DEFF Research Database (Denmark)

    Prætorius, Thim; Hasle, Peter; Edwards, Kasper;


    of the collaborative hospital concern the creation of an appropriate balance between standardization and local autonomy, shared purpose centred around providing the best possible care, and use of enabling structures that sustain the new ways of collaborative work. The chapter builds on the theoretical framework...... for the collaborative hospital as new organizational form which is better equipped to respond to the challenges facing modern hospitals. The collaborative hospital is an ambidextrous organization that opens for pursuing both exploration and exploitation within the same organizational structure. The basic principles...... of the collaborative organization which is used for a discussion of theoretical and empirical aspects of the collaborative hospital....

  6. Santa Barbara Cottage Hospital. (United States)


    The 465-bed Santa Barbara Cottage Hospital is the largest medical facility on the California coast between Los Angeles and the San Francisco bay area. The hospital dates back to 1888, when a group of local citizens began raising funds to build a "cottage-style" hospital for the growing community. Their original plans called for a complex in which each medical specialty would be housed in a separate bungalow. Even then, however, such a decentralized plan was too costly, so work began instead on a single cottage for all hospital departments. The first Cottage Hospital opened in 1891, with 25 beds housed in a two story Victorian building. Now a hugh medical complex employing some 1,500 people, the hospital continues to be called "Cottage" after the original home-like building. Rodney J. Lamb has been Hospital Administrator for the last 30 years.

  7. Two Belgian University Hospitals

    Directory of Open Access Journals (Sweden)

    M. Huylebrouck


    Full Text Available Background. Bevacizumab (BEV, a humanized immunoglobulin G1 monoclonal antibody that inhibits VEGF has demonstrated activity against recurrent high-grade gliomas (HGG in phase II clinical trials. Patients and Methods. Data were collected from patients with recurrent HGG who initiated treatment with BEV outside a clinical trial protocol at two Belgian university hospitals. Results. 19 patients (11 M/8 F were administered a total of 138 cycles of BEV (median 4, range 1–31. Tumor response assessment by MRI was available for 15 patients; 2 complete responses and 3 partial responses for an objective response rate of 26% for the intent to treat population were observed on gadolinium-enhanced T1-weighted images; significant regressions on T2/FLAIR were documented in 10 out of 15 patients (67%. A reduced uptake on PET was documented in 3 out of 4 evaluable patients. The six-month progression-free survival was 21% (95% CI 2.7–39.5. Two patients had an ongoing tumor response and remained free from progression after 12 months of BEV treatment. Conclusions. The activity and tolerability of BEV were comparable to results from previous prospective phase II trials. Reduced uptake on PET suggests a metabolic response in addition to an antiangiogenic effect in some cases with favorable clinical outcome.

  8. Initial Egyptian ECMO experience

    Directory of Open Access Journals (Sweden)

    Akram Abdelbary


    Results: A total of twelve patients received ECMO between January 2014 and June 2015. The mean age was 35.9 years. (range 13–65 years, 8 males, with VV ECMO in 10 patients, and VA ECMO in 2 patients. Out of ten patients of VV ECMO, one had H1N1 pneumonia, one had advanced vasculitic lung, four had bacterial pneumonia, two traumatic lung contusions and one with organophosphorus poisoning, and one undiagnosed etiology leading to severe ARDS. Lung injury score range was 3–3.8, PaO2/FiO2 (20–76 mechanical ventilation duration before ECMO 1–14 days, Femoro-jugular cannulation in 7 patients and femoro-femoral in 2 patients and femoro-subclavian in 1 patient; all patients were initially sedated and paralyzed for (2–4 days and ventilated on pressure controlled ventilation with Pmax of 25 cm H2O and PEEP of 10 cm H2O. In VA ECMO patients were cannulated percutaneously using femoro-femoral approach. One patient showed no neurologic recovery and died after 24 h, the other had CABG on ECMO however the heart didn’t recover and died after 9 days. Heparin intravenous infusion was used initially in all patients and changed to Bivalirudin in 2 patients due to possible HIT. Pump flow ranged from 2.6 to 6.5 L/min. Average support time was 12 days (range 2–24 days. Seven patients (63.3% were successfully separated from ECMO and survived to hospital discharge. Hospital length of stay ranged from 3 to 42 days, tracheostomy was done percutaneously in 5 patients and surgically in 3. Gastrointestinal bleeding occurred in 6 patients, VAP in 7 patients, neurologic complications in 1 patient with complete recovery, cardiac arrhythmias in 3 patients, pneumothorax in 9 patients, and deep venous thrombosis in 2 patients.

  9. Hospital information system institutionalization processes in indonesian public, government-owned and privately owned hospitals. (United States)

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


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

  10. Medical education and the quality improvement spiral: A case study from Mpumalanga, South Africa

    Directory of Open Access Journals (Sweden)

    Martin Bac


    Full Text Available Background: The short timeframe of medical students’ rotations is not always conducive to successful, in-depth quality-improvement projects requiring a more longitudinal approach.Aim: To describe the process of inducting students into a longitudinal quality-improvement project,using the topic of the Mother- and Baby-Friendly Initiative as a case study; and to explore the possible contribution of a quality-improvement project to the development of student competencies.Setting: Mpumalanga clinical learning centres, where University of Pretoria medical students did their district health rotations.Method: Consecutive student groups had to engage with a hospital’s compliance with specific steps of the Ten Steps to Successful Breastfeeding that form the standards for the Mother- and Baby-Friendly Initiative. Primary data sources included an on-site PowerPoint group presentation (n = 42, a written group report (n = 42 and notes of individual interviews in an end-of-rotation objectively structured clinical examination station (n = 139.Results: Activities in each rotation varied according to the needs identified through the application of the quality-improvement cycle in consultation with the local health team. The development of student competencies is described according to the roles of a medical expert in the CanMEDS framework: collaborator, health advocate, scholar, communicator, manager and professional. The exposure to the real-life situation in South African public hospitals had a great influence on many students, who also acted as catalysts for transforming practice.Conclusion: Service learning and quality-improvement projects can be successfully integrated in one rotation and can contribute to the development of the different roles of a medical expert. More studies could provide insight into the potential of this approach in transforming institutions and student learning.

  11. Hospital design for better infection control

    Directory of Open Access Journals (Sweden)

    Lateef Fatimah


    Full Text Available The physical design and infrastructure of a hospital or institution is an essential component of its infection control measure. Thus is must be a prerequisite to take these into consideration from the initial conception and planning stages of the building. The balance between designing a hospital to be an open, accessible and public place and the control to reduce the spread of infections diseases is a necessity. At Singapore General Hospital, many lessons were learnt during the SARS outbreak pertaining to this. During and subsequent to the SARS outbreak, many changes evolved in the hospital to enable us to handle and face any emerging infectious situation with calm, confidence and the knowledge that staff and patients will be in good stead. This paper will share some of our experiences as well as challenges

  12. Cost estimate of hospital stays for premature newborns in a public tertiary hospital in Brazil

    Directory of Open Access Journals (Sweden)

    Claudia Maria Desgualdo


    Full Text Available OBJECTIVES: To estimate the direct costs of hospital stays for premature newborns in the Interlagos Hospital and Maternity Center in São Paulo, Brazil and to assess the difference between the amount reimbursed to the hospital by the Unified Health System and the real cost of care for each premature newborn. METHODS: A cost-estimate study in which hospital and professional costs were estimated for premature infants born at 22 to 36 weeks gestation during the calendar year of 2004 and surviving beyond one hour of age. Direct costs included hospital services, professional care, diagnoses and therapy, orthotics, prosthetics, special materials, and blood products. Costs were estimated using tables published by the Unified Health System and the Brasindice as well as the list of medical procedures provided by the Brazilian Classification of Medical Procedures. RESULTS: The average direct cost of care for initial hospitalization of a premature newborn in 2004 was $2,386 USD. Total hospital expenses and professional services for all premature infants in this hospital were $227,000 and $69,500 USD, respectively. The costs for diagnostic testing and blood products for all premature infants totaled $22,440 and $1,833 USD. The daily average cost of a premature newborn weighing less than 1,000 g was $115 USD, and the daily average cost of a premature newborn weighing more than 2,500 g was $89 USD. Amounts reimbursed to the hospital by the Unified Health System corresponded to only 27.42% of the real cost of care. CONCLUSIONS: The cost of hospital stays for premature newborns was much greater than the amount reimbursed to the hospital by the Unified Health System. The highest costs corresponded to newborns with lower birth weight. Hospital costs progressively and discretely decreased as the newborns' weight increased.

  13. MANPOWER FOR CALIFORNIA HOSPITALS, 1964-1975. (United States)

    California State Commission on Manpower, Automation, and Technology, Sacramento.


  14. Developing an Undergraduate Hospital Dentistry Program. (United States)

    Gibson, G. B.; Swanson, A. E.


    The process used by the University of British Columbia to establish and improve an undergraduate hospital dentistry program is chronicled. The program's initial structure and objectives, use of student input for program improvement, and the success of the approach in developing an effective program are discussed. (MSE)

  15. Central line infections - hospitals (United States)

    ... infection; Central venous catheter - infection; CVC - infection; Central venous device - infection; Infection control - central line infection; Nosocomial infection - central line infection; Hospital acquired ...

  16. [Water hygiene in hospitals]. (United States)

    Kerwat, Klaus; Wulf, Hinnerk


    As a general rule drinking water in hospitals does not represent a risk for the normal patient. However, for high-risk patients with compromised immune defense systems drinking water in hospitals may become a source of nosocomial infections. It may be contaminated with microorganisms that may have the potential to be infectious agents in the hospital environment. Of particular significance in such circumstances are the Gram-negative rods such as Pseudomonas aeruginosa, Acinetobacter spp. and Legionella bacteria. Accordingly, specific behavior patterns and measures in the handling of drinking water in hospitals are meaningful in order to reduce the risks of water-associated nosocomial infections.

  17. What accounting leaves out of hospital financial management. (United States)

    Boles, K E; Glenn, J K


    As PPS and other fixed-price initiatives replace cost-based reimbursement in the hospital industry, the burden of assuming the risk for business success or failure shifts from the payor to the hospital. As a consequence, theories of risk to the business firm which have found application in other industries now deserve attention by hospital management. Incorporating such risk concepts into hospital strategies and actions requires a view of financial management that goes beyond the generally accepted accounting principles of managing and assigning costs for maximum revenue and profitability. This article examines the financial theory of risk in business firms, illustrates the various components of risk as they apply to a hospital business, and discusses how the hospital management strategies of cost-reduction, marketing, diversification, and multiorganizational affiliation can alter the risk characteristics of a hospital business.

  18. Virtual Pediatric Hospital (United States)

    ... Digital Storytelling System for Teaching Common Pediatric Problems Virtual Pediatric Hospital is the Apprentice's Assistant™ Last revised ... pediatric resources: | | Virtual Pediatric Hospital is curated by Donna M. D' ...

  19. Hospital benefit segmentation. (United States)

    Finn, D W; Lamb, C W


    Market segmentation is an important topic to both health care practitioners and researchers. The authors explore the relative importance that health care consumers attach to various benefits available in a major metropolitan area hospital. The purposes of the study are to test, and provide data to illustrate, the efficacy of one approach to hospital benefit segmentation analysis.

  20. The Ethic of Hospitality


    Christopher Muller


    The idea of hospitality is evident in several types of human behavior including obligatory duties, commercial activity, and prosocial action. These are intertwined and revolve around the commitment to caring for others whether they are relatives, guests, or strangers. This article explores the ethic of hospitality in its various forms.

  1. The Ethic of Hospitality

    Directory of Open Access Journals (Sweden)

    Christopher Muller


    Full Text Available The idea of hospitality is evident in several types of human behavior including obligatory duties, commercial activity, and prosocial action. These are intertwined and revolve around the commitment to caring for others whether they are relatives, guests, or strangers. This article explores the ethic of hospitality in its various forms.

  2. The impact of critical total quality management practices on hospital performance in the ministry of health hospitals in saudi arabia. (United States)

    Alaraki, Mohammad Shamsuddin


    Total Quality Management (TQM) offers a method for solving quality and patient safety problems and bringing significant improvement to hospital performance. However, only few studies have been conducted in this area in developing countries, particularly in Saudi Arabia. This research is carried out in an attempt to address this gap, exploring the impact of applying TQM practices on hospital performance in the Saudi Ministry of Health hospitals. The study has included 4 hospitals in Tabuk Region, namely, King Khaled Hospital, King Fahad Hospital, Maternity and Children Hospital, and Hagel General Hospital. The data collection was done by the researcher when 400 questionnaires were distributed using a convenient sampling technique to access the required data. The response rate was 67.25% of the total questionnaires distributed. The TQM practices used in the study were as follows: leadership, employee management, information analysis, training, customer focus, continuous improvement, process management, and supplier management. The findings of the research show a significant positive correlation between the 8 practices of TQM and hospital performance with a correlation coefficient r value of 0.9 (P = .0001). The study also reveals that Saudi hospitals are facing difficulties in engaging the clinical staff in their quality initiative. Moreover, our findings show that accredited hospitals have significantly applied TQM practices more than unaccredited hospitals.

  3. Hjertestop uden for hospital

    DEFF Research Database (Denmark)

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


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

  4. Driving hospital transformation with SLMTA in a regional hospital in Cameroon

    Directory of Open Access Journals (Sweden)

    Laura T. Eno


    Full Text Available Background: Inspired by the transformation of the Regional Hospital Buea laboratory through implementation of the Strengthening Laboratory Management Toward Accreditation (SLMTA programme, hospital management adapted the SLMTA toolkit to drive hospital wide quality improvement.Objective: This paper describes changes in the hospital following the quality improvement activities in hygiene and sanitation, the outpatient waiting area and the surgical and maternity wards.Methods: In March 2011, hospital management established a quality improvement task force and created a hospital-wide quality improvement roadmap, following the SLMTA model. The roadmap comprised improvement projects, accountability plans, patient feedback forms and log books to track quality indicators including patient wait time, satisfaction level, infectionrates, birth outcomes and hospital revenue.Results: There was steady improvement in service delivery during the 11 months after the introduction of the quality improvement initiatives: patient wait time at the reception was reduced from three hours to less than 30 minutes and patient satisfaction increased from 15% to 60%. Treatment protocols were developed and documented for various units, infrastructure and workflow processes were improved and there was increased staff awareness of the importance of providing quality services. Maternal infection rates dropped from 3% to 0.5% and stillbirths from 5% to < 1%. The number of clients increased as a result of improvedservices, leading to a 25% increase in hospital revenue.Conclusion: The SLMTA approach was adapted successfully to meet the needs of the entire hospital. Such a programme has the potential to impact positively on hospital quality systems; consideration should be made for development of a formal SLMTA-like programmefor hospital quality improvement.

  5. Hospital diversification: evaluating alternatives. (United States)

    Hammer, L


    The appropriateness of diversification as a growth strategy for hospitals is discussed, and planning for diversification is described. Because new forms of health-care delivery are now in direct competition with hospitals, many hospitals are confronting environmental pressures and preparing for future survival through diversification. To explore the potential risks and benefits of diversification, the hospital must identify opportunities for new business ventures. Diversification can be "related," through an expansion of the primary product line (health care), or "unrelated," into areas not directly associated with health care. The hospital must establish specific criteria for evaluating each diversification alternative, and the two or three most attractive options should be analyzed further through a financial feasibility study. The hospital should also seek legal advice to determine the implications of diversification for maintenance of tax status, antitrust limitations, and applicability of certificate of need. Although diversification may not be appropriate for every institution, hospitals should consider it as a strategy for increasing their revenue base, confronting environmental pressures, and securing future survival.

  6. Survival after in-hospital Cardiopulmonary Resuscitation

    Directory of Open Access Journals (Sweden)

    M Adib Hajbaghery


    Full Text Available Background: During recent years, cardiopulmonary resuscitation (CPR in hospital has received much attention. However, the survival rate of CPR in Iran’s hospitals is unknown. This study was designed to evaluate outcome of in-hospital CPR in Kashan. Methods: A longitudinal case registry study was conducted on all cases of in-hospital CPR during 6 months at 2002. Necessary data including; age, sex, underlying disease, working shift, time from cardiac arrest until initiating of CPR and until defibrillation, duration and result of CPR, frequency of tracheal intubations and time served for it were collected in a checklist. Results: In six months study, 206 cases of cardiopulmonary resuscitation attempted. The survival rate was similar for both sexes. Short-term survival observed in19.9% of cases and only 5.3% survived to discharge. Conclusions: Duration of CPR, time of the first defibrillation, response time and the location of cardiac arrest are the key predictors of survival to hospital discharge and in-hospital CPR strategies require improvement. This study promotes a national study on post CPR survival for accurate data on our performance in attention to chain of survival. KeyWords: Cardiopulmonary Resuscitation (CPR, Survival rate, Iran

  7. Does hospital diversification improve financial outcomes? (United States)

    Clement, J P


    Service or product diversification is a popular recommendation made to hospitals to increase profitability and reduce financial risk as they face a more hostile environment. This paper presents results from an empirical study of these claims. Using data from all California nonprofit hospitals, the study finds that diversification, regardless of whether it is related or unrelated to preexisting services, is not associated with either increased profitability or reduced financial risk. However, other variables that do have these effects are identified in the research. Future research should evaluate the effect of both the size of and the length of time since the initial diversifying investment on financial variables.

  8. On spaces of hospitality

    DEFF Research Database (Denmark)

    Greve, Anni

    Although specialists in hospitality have worked extensively on hospitality with respect to relations between different nations or between nations and individuals of a different nationality, for instance when they seek asylum, Jacques Derrida preferred to focus instead upon the relationship between...... the market place, the religious sanctuary and places for the performing arts and cultural heritage. For the modern city they are the tightly woven fabric of social reality, and their configuration can make certain cities more hospitable than others, is the leading idea....

  9. Clinical coder training initiatives in Ireland. (United States)

    Bramley, Michelle; Reid, Beth A


    The Hospital In-Patient Enquiry and National Perinatal Reporting System (HIPE & NPRS) Unit of the Economic and Social Research Institute in Ireland requested a review of its coder training programs and data quality initiatives, primarily because of the decision to implement a major change in Ireland's morbidity classification in January 2005. In August 2004, a formative evaluation using qualitative methods was conducted to assess the Unit's programs and initiatives. A number of opportunities for building on the solid frameworks the Unit has implemented were identified. In this paper, we focus on the Unit's coder training programs. The Unit's data quality initiatives will be discussed in a subsequent paper (Bramley & Reid 2005).

  10. Optimal Hospital Layout Design

    DEFF Research Database (Denmark)

    Holst, Malene Kirstine

    foundation. The basis of the present study lies in solving the architectural design problem in order to respond to functionalities and performances. The emphasis is the practical applicability for architects, engineers and hospital planners for assuring usability and a holistic approach of functionalities......This PhD project presents a design model that generates and evaluates hospital designs with respect to long-term performances and functionalities. By visualizing and quantifying costs and performances in the early design phases, it is possible to make design choices based on a qualified, profound...... and performances. By formal descriptions, a design model can weigh and compare the impact of different perspectives and, even in the early design phase, it can visualize and quantify consequences for design choices. By qualitative study of hospital design and hospital functionality, formal descriptions develop...

  11. Critical Access Hospitals (CAH) (United States)

    ... healthcare facilities finance new construction, refinance debt, or purchase new equipment such as hospital beds and office ... our site? Suggest a resource SHARE THIS PAGE Facebook Twitter LinkedIn Google+ Email © 2002–2017 Rural Health ...

  12. Hospital Readmissions Reduction Program (United States)

    U.S. Department of Health & Human Services — In October 2012, CMS began reducing Medicare payments for Inpatient Prospective Payment System hospitals with excess readmissions. Excess readmissions are measured...

  13. Hospital Readmission Reduction (United States)

    U.S. Department of Health & Human Services — In October 2012, CMS began reducing Medicare payments for Inpatient Prospective Payment System hospitals with excess readmissions. Excess readmissions are measured...

  14. Allegheny County Diabetes Hospitalization (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This data includes the number of people hospitalized with diabetes between 2013-2015, by age group, for Allegheny County Zip Codes.

  15. Speech intelligibility in hospitals. (United States)

    Ryherd, Erica E; Moeller, Michael; Hsu, Timothy


    Effective communication between staff members is key to patient safety in hospitals. A variety of patient care activities including admittance, evaluation, and treatment rely on oral communication. Surprisingly, published information on speech intelligibility in hospitals is extremely limited. In this study, speech intelligibility measurements and occupant evaluations were conducted in 20 units of five different U.S. hospitals. A variety of unit types and locations were studied. Results show that overall, no unit had "good" intelligibility based on the speech intelligibility index (SII > 0.75) and several locations found to have "poor" intelligibility (SII speech intelligibility across a variety of hospitals and unit types, offers some evidence of the positive impact of absorption on intelligibility, and identifies areas for future research.

  16. VT Hospital Site Locations (United States)

    Vermont Center for Geographic Information — (Link to Metadata) This data layer contains point locations of all major community, regional, comprehensive health, and healthcare provider hospitals in the state of...

  17. Hospital Outpatient PPS (United States)

    U.S. Department of Health & Human Services — Section 4523 of the Balanced Budget Act of 1997 (BBA) provides authority for CMS to implement a prospective payment system (PPS) under Medicare for hospital...

  18. Outpatient Imaging Efficiency - Hospital (United States)

    U.S. Department of Health & Human Services — Use of medical imaging - provider data. These measures give you information about hospitals' use of medical imaging tests for outpatients. Examples of medical...

  19. Physician-Owned Hospitals (United States)

    U.S. Department of Health & Human Services — Section 6001 of the Affordable Care Act of 2010 amended section 1877 of the Social Security Act to impose additional requirements for physician-owned hospitals to...

  20. Hospital Compare Data (United States)

    U.S. Department of Health & Human Services — These are the official datasets used on the Hospital Compare Website provided by the Centers for Medicare and Medicaid Services. These data allow you to...

  1. Service Robots for Hospitals

    DEFF Research Database (Denmark)

    Özkil, Ali Gürcan

    services to maintain the quality of healthcare provided. This thesis and the Industrial PhD project aim to address logistics, which is the most resource demanding service in a hospital. The scale of the transportation tasks is huge and the material flow in a hospital is comparable to that of a factory. We...... believe that these transportation tasks, to a great extent, can be and will be automated using mobile robots. This thesis consequently addresses the key technical issues of implementing service robots in hospitals. In simple terms, a robotic system for automating hospital logistics has to be reliable...... manual work and offer many advantages beyond robotics. Finally, this thesis outlines our contributions in representation of multi-floor buildings, which is a vital requirement to achieve robust and practical, real-world service robot applications....

  2. Hospitals of The Future

    Institute of Scientific and Technical Information of China (English)


    An overseas biometric and RFID solutions provider eyes up China’s emerging healthcare IT solutions market New mothers in China can look forward to more peaceful hos-pital stays without worries that their precious newborns might be

  3. Allegheny County Hypertension Hospitalization (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Hypertension Hospitalization data for 2013-2015, by age group, for Allegheny County. The information provided shows the number of individuals who were diagnosed...

  4. American Hospital Association (United States)

    ... replay of the AHA’s breakdown of the 2016 election results and what they mean for hospitals. Click ... Forum Trustee and Community Leadership Volunteers and Auxiliary Leaders Workforce Center News Center Press Releases AHA Awards ...

  5. [Hospital organizational structure]. (United States)

    Bittar, O J


    The basic point for an Institution to work is the existence of a definite organizational structure that puts together similar areas allowing decisions and the operationalization of different tasks. Knowledge and analysis of structures of private and public hospitals and a bibliography review about the issue is the purpose of this paper. Suggestions are given about the elaboration of small structures and the utilization of matrix management in order to accomplish the hospitals objectives.

  6. Nutrition support in hospitals

    DEFF Research Database (Denmark)

    Kondrup, Jens


    Nutrition support in hospitals is becoming an area of focus because of the evidence showing improved clinical outcome with nutrition support, its status as a human rights issue and its integration into quality assurance.......Nutrition support in hospitals is becoming an area of focus because of the evidence showing improved clinical outcome with nutrition support, its status as a human rights issue and its integration into quality assurance....

  7. Hospitality, Tourism, and Politics


    Stephen W. Litvin


    Government policy has a significant impact on the hospitality and tourism industry, but it is unclear if political leaders fully understand this economic sector when crafting policies. This article offers new research about the direct involvement of industry practitioners in the political process, by analyzing the backgrounds of legislators in the six New England states. The data indicate that only 3% of these legislators have current or former careers related to hospitality and tourism. The ...

  8. Sisters in Dutch hospitals. (United States)

    van den Bergh-Braam, A H


    This study focuses on hospital sisters in 30 Dutch hospitals. The so-called role-set approach has been adopted. In this approach the sisters are the focal persons. Direct superiors, specialists, registered nurses and student nurses acted as role-senders. The possible number of respondents is 600 (120 of each group). The response of hospital sisters is 100%, that of role-senders 88%. The study started out as an attempt to collect background information on the causes of wastage of sisters. High wastage rates are generally regarded as an indication of an unfavourable working environment. Since hospital sisters occupy a key position in hospitals, the ward problems will be studied from their angle. Although wastage rates have dropped recently, it does not necessarily follow that the working environment has improved. Wastage is known to act as a safety valve, thus allowing tensions to resolve. The threat of unemployment clogs this outlet, which increases the tensions on the hospital ward. Data from the study show that work overload is one of the major stress factors for sisters. Analyses demonstrated that there exists a relationship between work overload and tensions with the management and direct superiors, tensions in job execution, irritableness on the ward, low self-esteem, health complaints and psychological condition. Sisters with an excessive job involvement refer to work overload more often than their moderate colleagues. There is a relationship between an unfavourable working environment and irritableness of sisters.

  9. Corporate social responsibility and hospitals: US theory, Japanese experiences, and lessons for other countries. (United States)

    Takahashi, Toshiro; Ellen, Moriah; Brown, Adalsteinn


    This paper examines the role that corporate social responsibility can play in advancing hospital management. Corporate social responsibility is the integration of social and environmental concerns within business operations. The authors discuss how corporate social responsibility can help hospitals and provide suggestions to hospitals in deciding which corporate social responsibility initiatives to pursue.

  10. The Plus 50 Initiative Evaluation: Initiative Impact (United States)

    American Association of Community Colleges (NJ1), 2012


    The American Association of Community Colleges (AACC), with funding from The Atlantic Philanthropies, created the Plus 50 Initiative (2008-2012). This initiative was designed to build the capacity of community colleges nationwide to develop programming that engages the plus 50 learner. This report contains: (1) An overview of the Plus 50…

  11. Nutrition in the hospitalized patient. (United States)

    Kirkland, Lisa L; Kashiwagi, Deanne T; Brantley, Susan; Scheurer, Danielle; Varkey, Prathibha


    Almost 50% of patients are malnourished on admission; many others develop malnutrition during admission. Malnutrition contributes to hospital morbidity, mortality, costs, and readmissions. The Joint Commission requires malnutrition risk screening on admission. If screening identifies malnutrition risk, a nutrition assessment is required to create a nutrition care plan. The plan should be initiated early in the hospital course, as even patients with normal nutrition become malnourished quickly when acutely ill. While the Harris-Benedict equation is the most commonly used method to estimate calories, its accuracy may not be optimal in all patients. Calculating the caloric needs of acutely ill obese patients is particularly problematic. In general, a patient's caloric intake should be slightly less than calculated needs to avoid the metabolic risks of overfeeding. However, most patients do not receive their goal calories or receive parenteral nutrition due to erroneous practices of awaiting return of bowel sounds or holding feeding for gastric residual volumes. Patients with inadequate intake over time may develop potentially fatal refeeding syndrome. The hospitalist must be able to recognize the risk factors for malnutrition, patients at risk of refeeding syndrome, and the optimal route for nutrition support. Finally, education of patients and their caregivers about nutrition support must begin before discharge, and include coordination of care with outpatient facilities. As with all other aspects of discharge, it is the hospitalist's role to assure smooth transition of the nutrition care plan to an outpatient setting.

  12. Trends in green hospital engineering. (United States)

    Vernon, Walter N


    When health-care facilities do pursue green initiatives, it's often because there is some incentive available to them that buys down the cost. When hospitals make claims that green does not cost more, generally, these claims are based on strategies that simply cost less, and would therefore be pursued regardless of green goals, and/or strategies implemented because of a one-time opportunity to buy-down the cost through some kind of incentive programme. Engineers who design health-care facilities are often cast as being "nay-sayers"; we can't find ways to do better systems because we are too constrained. Behind the voluminous green smoke that surrounds healthcare building, there is some real green fire.

  13. Initialized Fractional Calculus (United States)

    Lorenzo, Carl F.; Hartley, Tom T.


    This paper demonstrates the need for a nonconstant initialization for the fractional calculus and establishes a basic definition set for the initialized fractional differintegral. This definition set allows the formalization of an initialized fractional calculus. Two basis calculi are considered; the Riemann-Liouville and the Grunwald fractional calculi. Two forms of initialization, terminal and side are developed.

  14. Trick questions: cosmopolitan hospitality

    Directory of Open Access Journals (Sweden)

    Eleanor Byrne


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

  15. Hospital overcrowding: an opportunity for case managers. (United States)

    Simmons, Florence M


    Hospital overcrowding is primarily a shortage of inpatient beds, not a lack of emergency department capacity, as initially assumed. According to Asplin et al., many factors contribute to overcrowding, including inadequate or inflexible nurse-to-patient staffing ratios, isolation precautions, or delays in cleaning rooms after patient discharge; an overreliance on intensive care or telemetry beds; inefficient diagnostic and ancillary services on inpatient units; and delays in discharging hospitalized patients to postacute-care facilities. Hospital overcrowding presents a challenge for hospital employees and clients, often leading to frustration and dissatisfaction. Overcrowding also has a direct effect on patient care, including compromised patient safety, increased costs, increased length of stay, and increased mortality and morbidity rates. The emergency department is changed from a temporary holding area to an extended patient care unit, decreasing its ability to handle new admissions and to manage a mass casualty. Beds in the critical care units become filled with inappropriate patients if floor beds are not available, making placement of seriously ill patients difficult. Trauma patients may have to be diverted to other hospitals to receive the appropriate level of care. Patients who require specialty services may have to wait for extended periods to obtain a bed in a referral center.

  16. Internal auditing in hospitals. (United States)

    Edwards, Don; Kusel, Jim; Oxner, Tom


    The authors analyzed two national surveys to determine answers for two basic questions: How do the roles of internal auditors compare with those of their counterparts in other industries and to what extent over the past 6 years have the activities of internal auditors changed? Internal auditors in hospitals allocate their time primarily to financial/compliance and operational types of audits, as do their counterparts. The current trend is toward more operational types of audits. In the early years of employment, staff turnover in hospitals is significantly higher than in all combined industries, often leading to internal auditors' filling other positions in the organization. Hospital staff salaries are higher than are salaries in other industries combined. Staff composition continues to reflect the growing presence of women in the field. The majority of internal auditing directors believe that their salaries are fair, would recommend internal auditing as a career position, and are treated as valued consultants in the organization.

  17. 42 CFR 407.14 - Initial enrollment period. (United States)


    ... PROGRAM SUPPLEMENTARY MEDICAL INSURANCE (SMI) ENROLLMENT AND ENTITLEMENT Individual Enrollment and Entitlement for SMI § 407.14 Initial enrollment period. (a) Duration. (1) The initial enrollment period is the... eligibility requirements for SMI n the first day he or she becomes entitled to hospital insurance or...

  18. Marketing the hospital library. (United States)

    Bridges, Jane


    Many librarians do not see themselves as marketers, but marketing is an essential role for hospital librarians. Library work involves education, and there are parallels between marketing and education as described in this article. It is incumbent upon hospital librarians actively to pursue ways of reminding their customers about library services. This article reinforces the idea that marketing is an element in many of the things that librarians already do, and includes a list of suggested marketing strategies intended to remind administrators, physicians, and other customers that they have libraries in their organizations.

  19. Toward healthier hospitals. (United States)

    Mintzberg, H


    This article builds around a framework of cure, care, control, and community, with collaboration at the center, to consider 12 issues common to many hospitals. These include, among others, the fragmentation of efforts, confusion in mission (and in mission statements), the problems of bundling research with clinical work, selectivity in informing board members, the dangers of professional management, and the difficulties of combining external advocacy with internal reconciliation in the senior manager's job. The article concludes that hospitals could better learn how to solve systemic problems systemically, and that to do so will require not the wish lists of strategic planning and structural reorganizing, but tangible changes in their collective behavior.

  20. Hospitality, Tourism, and Politics

    Directory of Open Access Journals (Sweden)

    Stephen W. Litvin


    Full Text Available Government policy has a significant impact on the hospitality and tourism industry, but it is unclear if political leaders fully understand this economic sector when crafting policies. This article offers new research about the direct involvement of industry practitioners in the political process, by analyzing the backgrounds of legislators in the six New England states. The data indicate that only 3% of these legislators have current or former careers related to hospitality and tourism. The author suggests that practitioners should seek election to political office, to better influence government policy.

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

    Directory of Open Access Journals (Sweden)

    Glenn A. Melnick PhD


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

  2. German hospital database-allocation of patients to appropriate hospitals. (United States)

    Schneider, Rita; Reiners, Christoph


    Effective response to radiological emergencies requires information about available qualified hospitals and defined methods to timely allocate patients to appropriate hospitals. In Germany, updated information about hospitals concerning their qualification and willingness to treat radiological emergency patients is not summarized. The objectives were to identify qualified hospitals, assess hospital capacities and treatment capabilities, to examine willingness to respond to various radiological emergencies and to develop a concept for matching patients to hospitals. A Germany-wide combined postal/Web survey of 99 selected hospitals conducted in 2007 covered relevant organizational characteristics, hospital resources, treatment expertise, and the willingness to accept radiological emergency patients by a self-reported written questionnaire with 57 items. Survey results were documented in a Microsoft Access database. A database-driven Web application was developed to allocate patients to hospitals. Of 99 hospitals, 69 responded and 54 indicated their willingness to accept radiological emergency patients. 17,512 total hospital beds, 2,084 intensive care, and 170 reverse isolation beds were reported. Availability of laboratory and in-patient departments ranged from 14 radiobiology to 47 laboratory medicine departments and from 13 burn care to 52 trauma surgery departments. 48 and 40 hospitals stated treatment competence for local and whole body external exposure, respectively. 34 and 29 hospitals reported treatment expertise for contamination and incorporation, respectively. In this publication baseline data of qualified hospitals concerning capacities and competence to manage radiological emergency patients are presented, and an allocation concept for radiological emergency patients is provided.

  3. Mechanical engineering in hospitals. (United States)

    Wallington, J W


    The design of a modern hospital owes more to engineering than the layman may realize. In this context, many engineers are in the position of laymen, being unfamiliar with the multitude of services that lies behind the impressive facade of a modern hospital. In recent years medicine and surgery themselves have taken on many of the characteristics of a technology. This has required a matching development of the services both mechanical and electrical that are required in modern health care buildings. In medical terms, if the architectural features provide the 'skin' of the hospital, the mechanical and electrical engineering services provide the nerves and sinews. If we take as an example the recently completed Freeman Hospital, Newcastle upon Tyne, (Fig. 1), which cost 10 million pounds at current cost, the service network was responsible for about half the total cost. About 400 miles (643 km) of electrical wiring and more than 40 mile (64.5 km) of copper and steel piping were used to service 3000 separate rooms. This compares with percentages of between 18 and 25 per cent for other large buildings such as office blocks, hotels and sports complexes.

  4. Hospitals as food arenas

    DEFF Research Database (Denmark)

    Poulsen, Signe; Jørgensen, Michael Søgaard


    also identified. Research limitations: The assessment of the dietary changes based on the canteen take-away food was only based on indirect assessments based on interviews with users and non-users and furthermore based on a questionnaire at one of the hospitals. Value/originality: Canteen take...

  5. Innovations in Hospitality Industry (United States)

    Dzhandzhugazova, Elena A.; Blinova, Ekaterina A.; Orlova, Liubov N.; Romanova, Marianna M.


    The article focuses on the study of the role and importance of innovation, its classification, the problems of its application in the hotel industry with emphasis on the application of sensory marketing tools in the development of the innovative marketing mix within the hospitality industry. The article provides an analysis of the "seven…

  6. Responsible Hospitality. Prevention Updates (United States)

    Colthurst, Tom


    Responsible Hospitality (RH)--also called Responsible Beverage Service (RBS)--encompasses a variety of strategies for reducing risks associated with the sale and service of alcoholic beverages. RH programs have three goals: (1) to prevent illegal alcohol service to minors; (2) to reduce the likelihood of drinkers becoming intoxicated; and (3) to…

  7. Hospital restructuring and burnout. (United States)

    Greenglass, Esther R; Burke, Ronald J


    Increasingly, organizations are experiencing changes as a result of extensive downsizing, restructuring, and merging. In Canada, government-sponsored medicine has been affected as hospitals have merged or closed, reducing essential medical services and resulting in extensive job loss for hospital workers, particularly nurses. Hospital restructuring has also resulted in greater stress and job insecurity in nurses. The escalation of stressors has created burnout in nurses. This study examines predictors of burnout in nurses experiencing hospital restructuring using the MBI-General Survey which yields scores on three scales: Emotional exhaustion, Cynicism, and Professional efficacy. Multiple regressions were conducted where each burnout scale was the criterion and stressors (e.g., amount of work, use of generic workers to do nurses' work), restructuring effects, social support, and individual resources (e.g., control coping, self-efficacy, prior organizational commitment) were predictors. There were differences in the amount of variance accounted for in the burnout components by stressors and resources. Stressors contributed most to emotional exhaustion and least to professional efficacy. Individual resources were more likely to contribute to professional efficacy and least to emotional exhaustion. Stressors and resources accounted for approximately equal amounts of variance in cynicism. Three conclusions were drawn. First, present findings parallel others by showing that individual coping patterns contribute to professional efficacy. Second, emotional exhaustion was found to be the prototype of stress. Third, prior organizational commitment, self-efficacy, and control coping resulted in lower burnout.

  8. Care initiation area yields dramatic results. (United States)


    The ED at Gaston Memorial Hospital in Gastonia, NC, has achieved dramatic results in key department metrics with a Care Initiation Area (CIA) and a physician in triage. Here's how the ED arrived at this winning solution: Leadership was trained in and implemented the Kaizen method, which eliminates redundant or inefficient process steps. Simulation software helped determine additional space needed by analyzing arrival patterns and other key data. After only two days of meetings, new ideas were implemented and tested.

  9. [Leadership in the hospital]. (United States)

    Schrappe, Matthias


    Current concepts in leadership and governance on the level of supervisory board, management and departments are often considered as insufficient to cope with the profound structural change which actually takes place in the German health care system. While vertical and horizontal disconnecting is typical of the professional bureaucracy of hospitals, transition from functional to divisional structure further increases this risk. Accordingly, medical experts are oriented towards their professional peers and patient care on the one side; on the other side the management gets isolated and looses operative and strategic control. Several studies provide evidence for the relevance of role models to serve as agents of change, which are now developed into the concept of "Clinical Governance": evidence-based medicine, guidelines, continuous quality improvement, safety culture, resource accountability and organisational learning. The present situation makes it necessary to extend this conception, which focuses on the departmental level in an organisation with divisional features, to one of "Clinical Corporate Governance". This term, which also includes supervisory structures and the management board and is relevant for the total hospital and company, respectively, is based on the corporate governance concept. Inside the hospital, the management and the heads of the departments have to agree that (1) experts really need to be integrated into the decision process, and that (2) the outcomes of the entire hospital have to be regarded as equal or superior to the aims of a single department. The public image of the hospital should be one of a strong and reliable partner in health care and health care business on a local, regional and national level. Members of the supervisory board should clearly put corporate aspects above political and other implications and pay attention to personal independence from the leaders of the medical departments.

  10. When "Other" Initiate Repair. (United States)

    Schegloff, Emanuel A.


    Elaborates on the locus of other-initiated repair, and reports on a number of environments in which others initiate repair turns later than the one directly following the trouble-source turn. Describes several ways that other initiation of repair, which occurs in next-turn position, may be delayed within that position. (Author/VWL)

  11. The politics of hospital payment. (United States)

    Feder, J; Spitz, B


    This paper analyzes the politics of hospital payment over the last decade. The authors explain how provider interests and judgments became a standard for appropriate hospital payment: the impact of that standard on hospital costs; and the political obstacles to imposing an alternative standard and controlling hospital costs. The authors draw lessons from this experience, here and in other countries, to propose an alternative approach to hospital payment that would allow policymakers, accountable to the public, to make explicit choices about the level and nature of hospital expenditures.

  12. Hospital-acquired infections - when are hospitals legally liable? (United States)

    McQuoid-Mason, David


    Hospital-acquired infections (nosocomial infections) are acquired in healthcare settings by patients admitted for reasons unrelated to the infection or not previously infected when admitted to the facility. Liability for hospital-acquired infections depends on whether the hospital: (i) has introduced best practice infection control measures; (ii) has implemented best practice infection control measures; or (iii) will be vicariously liable for negligent or intentional failures by staff to comply with the infection control measures implemented. A hospital and hospital administrators may be held directly liable for not introducing or implementing best practice infection control measures, resulting in harm to patients. The hospital may also be held vicariously liable where patients have been harmed because hospital staff negligently or intentionally failed to comply with the infection control measures that have been implemented by the hospital, during the course and scope of their employment.

  13. Hospital malnutrition: a 33-hospital screening study. (United States)

    Kamath, S K; Lawler, M; Smith, A E; Kalat, T; Olson, R


    A collaborative study involving nutrition screening of 3,047 patients (excluding 125 pregnant women) at admission to 33 hospitals in and around the greater Chicago area was carried out to identify patients at nutritional risk. Information on sex, age, admitting diagnosis, serum albumin, hemoglobin, total lymphocyte count, and height and weight was collected from the medical chart within 48 hours of admission. Nutrition screening could not be completed for a larger number of patients (60%) because data at admission were not available. Of the remaining 40% of patients, more than 50% had below normal values for one or more of the variables studied: serum albumin, hemoglobin, and total lymphocyte count. A large number of the patients (40%) also were considered at nutritional risk as judged by the criteria of weight/height (measured only). Early nutrition intervention for high-risk patients cannot be implemented, nor can the efficacy of nutrition services be evaluated, unless nutrition screening is carried out on patients at admission.

  14. [Hospital clinical ethics committees]. (United States)

    Gómez Velásquez, Luis; Gómez Espinosa, Luis Néstor


    The scientific and technological advances have been surprising, more in the two last decades, but they don't go united with to the ethical values of the medical professional practice, it has been totally escaped, specially when the biological subsistence, the maintenance of the life through apparatuses and the mechanisms that prolong the existence are who undergoes an alteration that until recently time was mortal shortly lapse. It is common listening that exist a crisis in the medical profession, but what really is it of human values, which as soon and taken into nowadays, actually professional account, which gives rise to a dehumanization towards the life, the health, the disease, the suffering and the death. The ideal of the doctor to give to service to the man in its life and health, as well to be conscious that the last biological process that must fulfill is the death, and when it appears, does not have considered as a actually professional failure. It has protect to the patient as the extreme cruelty therapeutic, that it has right a worthy death. It's taking to the birth of the hospital ethics committees, they have like function to analyze, to advise and to think about the ethical dilemmas that appear actually clinical or in the biomedical investigation. In 1982 in the UEA only 1% of its hospitals had a ethics committees; by 1988, it was 67% and the 100% in 2000. In Mexico the process of the formation by these committees begins, only in the Military Central Hospital, to count the ethics committee on 1983, also the Hospital no. 14 of the IMSS in Guadalajara, it works with regularity from 1995, with internal teaching of bioethic. The Secretariat of Health has asked the formation of the bioethical committees in each hospital, and order the it was be coordinated by the National Committee of Bioética. The integration of these committees is indispensable that their members have the knowledge necessary of bioética. The Mexican Society of Ortopedia, conscious of

  15. On Hospital Design – Identifying Building Attributes of Hospital Design

    DEFF Research Database (Denmark)

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

    The present paper surveys the input parameters in hospital design and describes them formally as building attributes in preparation for facilitating planning and designing of hospitals with the aim of a more optimal design process. The overview of the hospital functionalities, bonds, logistics...

  16. The Changzhou Mode Hospital Worker Develops Therapy for Mental Patients

    Institute of Scientific and Technical Information of China (English)


    ON an autumn afternoon, I walked into the well-known De’an Hospital in Changzhou, Jiangsu Province, and could hardly believe this neat and tidy compound was a mental hospital. The facility is famous for its methods for the prevention of mental illness and home therapy, which was initiated by Gu Hanping, president of the hospital. Gu, 39, has been praised by authoritative persons of the World Health Organization as the "Changzhou Mode in China." After I met this quick-minded woman, I no longer was surprised by the stories that had been told

  17. A Multidisciplinary Hospital-based Antimicrobial Use Program: Impact on Hospital Pharmacy Expenditures and Drug Use

    Directory of Open Access Journals (Sweden)

    Suzette Salama


    Full Text Available The authors’ hospital embarked on a three-component, multidisciplinary, hospital-based antimicrobial use program to cut costs and reduce inappropriate antimicrobial use. Initially, antimicrobial use patterns and costs were monitored for 12 months. For the next two years, an antimicrobial use program was implemented consisting of three strategies: automatic therapeutic interchanges; antimicrobial restriction policies; and parenteral to oral conversion. The program resulted in a reduction in the antimicrobial portion of the total pharmacy drug budget from 41.6% to 28.2%. Simultaneously, the average cost per dose per patient day dropped from $11.88 in 1991 to $10.16 in 1994. Overall, mean monthly acquisition cost savings rose from $6,810 in 1992 to $27,590 in 1994. This study demonstrates that a multidisciplinary antimicrobial use program in a Canadian hospital can effect dramatic cost savings and serve as a quality assurance activity of physician antimicrobial prescribing behaviour.

  18. Hacking the hospital environment

    DEFF Research Database (Denmark)

    Boisen, Kirsten A; Boisen, Anne Bank; Thomsen, Stine Legarth


    BACKGROUND: There is a need for youth-friendly hospital environments as the ward environment may affect both patient satisfaction and health outcomes. OBJECTIVE: To involve young people in designing youth-friendly ward environment. METHODS: We arranged a design competition lasting 42 h (Hackathon...... participation. The design concepts and ideas were in line with current evidence regarding pleasing hospital environment and youth-friendly inpatient facilities and may be applicable to other young patients....... presented their products to a jury and relevant stakeholders. RESULTS: The groups created eight unique design concepts. The young designers were extremely flexible listening to ideas and experiences from the young patients, which led to common features including individual and flexible design, privacy...

  19. Hospitals report on cancer centers. (United States)

    Rees, T


    Woman's Hospital, Baton Rouge, La., is first-place winner among cancer centers. Holy Cross Hospital's Michael and Dianne Bienes Comprehensive Cancer Center, Ft. Lauderdale, Fla., is named second; and, Cardinal Health System's Ball Cancer Center, Muncie, Ind., third.

  20. Wearing gloves in the hospital (United States)

    ... gloves; PPE - wearing gloves; Nosocomial infection - wearing gloves; Hospital acquired infection - wearing gloves ... Wearing gloves in the hospital helps prevent the spread of germs. This helps protect both patients and health care workers from infection.

  1. Hospital ICUs May Be Overused (United States)

    ... page: Hospital ICUs May Be Overused Single medical center study ... While this is a study of just one hospital and results may differ at other medical centers, ...

  2. HSIP Hospitals in New Mexico (United States)

    Earth Data Analysis Center, University of New Mexico — Hospitals in New Mexico The term "hospital" ... means an institution which- (1) is primarily engaged in providing, by or under the supervision of physicians, to...

  3. Preventing Infections in the Hospital (United States)

    ... Share | With attention increasing on the incidence of infection in hospitals, patients everywhere need sensible principles to manage their ... will reduce the chance of developing a lung infection while in the hospital and may also improve your healing abilities following ...

  4. Hospitalized Patients and Fungal Infections (United States)

    ... These types of infections are called healthcare-associated infections (HAIs). Hospital staff and healthcare providers do everything they can ... IV tube) can increase your risk for fungal infection. During your hospital stay you may need a central venous catheter, ...

  5. E-procurement in hospitals. (United States)

    Hidalgo, Julio Villalobos; Orrit, Joan; Villalobos, Juan Pablo


    This article describes the history, current status, advantages of and opposition to the implementation of e-procurement in hospitals and examines the results of its implementation in a psychiatric hospital.

  6. Little hospital has big ideas. (United States)

    Friedman, E


    Many hospitals have been looking at diversification of services with increased interest in recent years, and a small hospital in rural Wisconsin has shown that the concept need not be limited to large, urban institutions.

  7. Hospital Presbiteriano Valley

    Directory of Open Access Journals (Sweden)

    Luckman, Charles


    Full Text Available This hospital is built on the circular system. This arrangement has economic and functional advantages. The nurses walk 40 % less distance than in a hospital of similar size, of conventional layout. The rooms are situated along the external perimeter and the beds are orientated towards the corridor, rather than towards the window. However, the patients can see out of doors by turning on their side. The hospital is most carefully fitted out, and is very comfortable. There is air conditioning, and patients can control their own TV sets. There are also curtains separating each bed form the rest, thus providing maximum independence. Warm colours have been adopted in the decoration of rooms facing north, whilst those facing south are painted in cooler tones. The circular design arrangement makes the distribution far more flexible, and it will be easier to include further units later on; by adding small adjustments to the central building. To reduce external noise, and to improve the surrounding landscape, small sand hills have been provided in the garden, and the parking site also serves to partially absorb the noise.Presenta esta solución de unidades circulares numerosas ventajas de tipo económico, ahorra espacio y da eficiencia a la circulación— las enfermeras recorren un 40 por 100 menos de camino que en otro hospital de dimensiones similares—. Las habitaciones están distribuidas a lo largo del perímetro exterior y tienen las camas orientadas hacia los corredores, en lugar de hacia las ventanas, pero de tal modo que los pacientes puedan contemplar el exterior al volverse sobre uno de sus costados. Están cuidadosamente diseñadas y dotadas de las máximas comodidades: aire acondicionado y aparatos de televisión controlados por el paciente; así como cortinas divisorias que le proporcionan el grado de aislamiento deseado.

  8. Hospital Princesa Margarita

    Directory of Open Access Journals (Sweden)

    Powell y Moya, Aquitectos


    Full Text Available El amplio programa desarrollado en este grande e importante Centro sanitario, abarcó tres fases de construcción, al final de las cuales se consiguió el Hospital General, capaz para 600 camas. En la primera parte se construyeron los siguientes departamentos: Enfermos del exterior, Accidentes, Medicina Física, Patología, Rayos X, y el primero de los cuatro núcleos quirúrgicos.

  9. Health care quality in NHS hospitals. (United States)

    Youssef, F N; Nel, D; Bovaird, T


    Hospitals provide the same type of service, but they do not all provide the same quality of service. No one knows this better than patients. Reports the results of a market research exercise initiated to ascertain the different factors which patients of health care identify as being necessary to provide error-free service quality in the NHS hospitals. To measure patients' satisfaction with NHS hospitals, the internationally-used market research technique called SERVQUAL was used in order to measure patients' expectations before admission, record their perceptions after discharge from the hospital, and then to close the gap between them. This technique compares expectations with perceptions of service received across five broad dimensions of service quality, namely: tangibility; reliability; responsiveness; assurance; and empathy. This analysis covered 174 patients who had completed the SERVQUAL questionnaire, including patients who had had treatment in surgical, orthopaedic, spinal injury, medicinal, dental and other specialties in the West Midlands region. Recorded the average weighted NHS service quality score overall for the five dimensions as significantly negative.

  10. Killybegs Community Hospital, Killybegs, Donegal.

    LENUS (Irish Health Repository)

    McKeown, Kieran


    More people die in hospital than in any other setting which is why it is important to study the outcomes of hospital care at end of life. This study analyses what influenced outcomes in a sample of patients who died in hospital in Ireland in 2008\\/9. The study was undertaken as part of the Irish Hospice Foundation\\'s Hospice Friendly Hospitals Programme (2007-2012).

  11. Pseudomonas aeruginosa from hospital environment

    Directory of Open Access Journals (Sweden)

    Milind Davane


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

  12. Parametric Optimization of Hospital Design

    DEFF Research Database (Denmark)

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


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

  13. Exploring hospitality within hospital meals by means of visual methodologies

    DEFF Research Database (Denmark)

    Justesen, Lise


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

  14. Testing the efficacy of a molecular surveillance network: methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus faecium (VREF) genotypes in six hospitals in the metropolitan New York City area. The BARG Initiative Pilot Study Group. Bacterial Antibiotic Resistance Group. (United States)

    de Lencastre, H; Severina, E P; Roberts, R B; Kreiswirth, B N; Tomasz, A


    Molecular fingerprinting techniques are rapidly becoming indispensable tools for hospital epidemiology. On the other hand, the relative complexity and unfamiliarity of these techniques to most hospital diagnostic laboratories limit their usefulness. In an attempt to provide a solution for this dilemma, we tested the feasibility and efficacy of a cooperative venture in which molecular typing of isolates recovered from patients in six hospitals was performed at two microbiology research laboratories with expertise in these techniques. In a small preliminary study, 30 methicillin-resistant Staphylococcus aureus (MRSA) and 30 vancomycin-resistant Enterococcus faecium (VREF) isolates were collected over a 3-week period from six hospitals in the metropolitan New York area and transported to the Laboratory of Microbiology at The Rockefeller University during the summer months of 1994. Nineteen of the 27 confirmed MRSA isolates were closely related strains carrying the same mecA and the same Tn554 polymorphs in a pulsed-field gel electrophoresis (PFGE) background represented by closely related subtypes of a single pattern, indicating the wide distribution of this MRSA clone among the participating hospitals. Typing of the same 27 MRSA isolates was also performed at the Tuberculosis Center of the Public Health Research Institute and identical results were obtained. The 29 confirmed VREF isolates were highly heterogeneous and belonged to as many as 23 distinct clonal types as defined by PFGE patterns and probing with vanA. Characterization of the 60 isolates by these methods was completed in one month of full-time effort by a single experienced laboratory assistant guided by a doctoral-level expert in molecular fingerprinting techniques. The collection of samples for both MRSA and VREF was not intended to address epidemiological questions but to determine the feasibility of a multicenter study. On the basis of our preliminary findings we are encouraged that a larger

  15. Strategic market planning for hospitals. (United States)

    Zallocco, R L; Joseph, W B; Doremus, H


    The application of strategic market planning to hospital management is discussed, along with features of the strategic marketing management process. A portfolio analysis tool, the McKinsey/G.E. Business Screen, is presented and, using a large urban hospital as an example, discussed in detail relative to hospital administration. Finally, strategic implications of the portfolio analysis are examined.

  16. Childrens Hospital Inservice Education Curriculum. (United States)

    Lutz, Joan

    A description is provided of a 15-month, in-service nursing education program at Childrens Hospital (Los Angeles, California). The first sections of the paper describe Childrens Hospital and provide a rationale for the hospital-based program. A listing of program goals and objectives is also provided, indicating that the curriculum is designed to…

  17. Hospitality Studies: Escaping the Tyranny? (United States)

    Lashley, Conrad


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

  18. Sustainable Agricultural Marketing Initiatives


    Hakan Adanacıoğlu


    Sustainable marketing is a holistic approach that puts equal emphasis on environmental, social equity, and economic concerns in the development of marketing strategies. The purpose of the study is to examine and discuss the sustainable agricultural marketing initiatives practiced throughout the World and Turkey, and to put forth suggestions to further improve the performance of agricultural marketing initiatives in Turkey. Some of the sustainable agricultural marketing initiatives practiced a...

  19. Emerging Pathogens Initiative (EPI) (United States)

    Department of Veterans Affairs — The Emerging Pathogens Initiative (EPI) database contains emerging pathogens information from the local Veterans Affairs Medical Centers (VAMCs). The EPI software...

  20. [Hospital Infection Epidemiology Nederland (ZIEN): from club to study group]. (United States)

    Vandenbroucke-Grauls, C M; Kluytmans, J A; Voss, A


    Medical care is increasingly a technical business, and hospitalised patients are more and more susceptible to infections, notably due to the application of aggressive therapies for all kinds of disorders. As a consequence the epidemiology of hospital infections requires serious attention. Following the initiative of some medical microbiologists in the Netherlands, a study group was established to tackle this epidemiology and to initiate relevant research (Working party on Hospital Infections and Epidemiology of the Netherlands; WHEN). Recent subjects include fungemia in hospitalised patients, risk factors for acquiring methicillin-resistant Staphylococcus aureus during a stay abroad, and prevalence of vancomycin-resistant enterococci.

  1. Pre-hospital and early in-hospital management of severe injuries: changes and trends. (United States)

    Hussmann, Bjoern; Lendemans, Sven


    The pre-hospital and early in-hospital management of most severely injured patients has dramatically changed over the last 20 years. In this context, the factor time has gained more and more attention, particularly in German-speaking countries. While the management in the early 1990s aimed at comprehensive and complete therapy at the accident site, the premise today is to stabilise trauma patients at the accident site and transfer them into the hospital rapidly. In addition, the introduction of training and education programmes such as Pre-hospital Trauma Life Support (PHTLS(®)), Advanced Trauma Life Support (ATLS(®)) concept or the TEAM(®) concept has increased the quality of treatment of most severely injured trauma patients both in the preclinical field and in the emergency trauma room. Today, all emergency surgical procedures in severely injured patients are generally performed in accordance with the Damage Control Orthopaedics (DCO) principle. The advancements described in this article provide examples for the improved quality of the management of severely injured patients in the preclinical field and during the initial in-hospital treatment phase. The implementation of trauma networks, the release of the S3 polytrauma guidelines, and the DGU "Weißbuch" have contributed to a more structured management of most severely injured patients.


    DEFF Research Database (Denmark)

    Jacobsen, Peter; Jørgensen, Pelle Morten Thomas


    In order to cope with the future challenges of the health care sector, there is an urging need for improving efficiency at hospitals. The study presents a framework enabling health care managers of improving the in-house logistics. The distinctiveness of the framework is the way in which it relates...... technology, logistics, structure and procedures to efficiency. Changing one factor e.g. technology, initiates an iterative loop focusing on change in the related factors in order to obtain the optimal efficiency. The search for an optimal efficient solution is the driving force of the framework...... at a Danish hospital. The framework is tested on the blood sample logistics between the emergency department and laboratory with the goal of enhancing the efficiency of the emergency department....

  3. [Refuse disposal at the hospital]. (United States)

    Knoll, K H


    For the classification of hospital-wastes in the categories infectious-contaminate or special waste are only significant views of the prevention by nosocomial infection in the hospital. Solely infectious waste become removed hospital-intern and -extern on conditions of hygienic prevention, namely through secure packing during the transport, combustion or desinfection. Special wastes to be defeated by special-conditions. The hygienist of the hospital is only competent for the classification of the wastes in the hospital as well as for their refuse.

  4. Variation in duration of hospital stay between hospitals and between doctors within hospitals

    NARCIS (Netherlands)

    Westert, Gert P.; Nieboer, Anna P.; Groenewegen, Peter P.


    Whether one examines the average length of hospital stay at the level of geographic areas, at the level of hospitals, or at the level of doctors, length-of-stay figures are known to vary widely. Even for hospital admissions for comparable surgical procedures among comparable groups of patients, sign

  5. Variation in duration in hospital stay between hospitals and between doctors within hospitals.

    NARCIS (Netherlands)

    Westert, G.P.; Nieboer, A.P.; Groenewegen, P.P.


    Whether one examines the average length of hospital stay at the level of geographic areas, at the level of hospitals, or at the level of doctors, length-of-stay figures are known to vary widely. Even for hospital admissions for comparable surgical procedures among comparable groups of patients, sign


    NARCIS (Netherlands)



    Whether one examines the average length of hospital stay at the level of geographic areas, at the level of hospitals, or at the level of doctors, length-of-stay figures are known to vary widely. Even for hospital admissions for comparable surgical procedures among comparable groups of patients, sign

  7. Hospital clowning: a paediatrician's view. (United States)

    van Venrooij, Lennard T; Barnhoorn, Pieter C


    This study investigates the current position of hospital clowns from the perspective of paediatricians and paediatric residents. A total of 14 attending paediatricians and paediatric residents participated in two focus group sessions. Data were analysed using Atlas.ti 5.0. In general, physicians reported positive experiences regarding the interaction between hospital clowns and paediatric patients on the ward. Physicians were more interested in research on children's perception of hospital clowns than in research on the clinical efficacy of hospital clowning. No direct collaboration between physicians and hospital clowns was reported. However, physicians proposed conditions which may streamline their encounters with hospital clowns such as clear communication prior to hospital clown visits, and the condition that visits do not impede medical interventions.

  8. From corporate governance to hospital governance. Authority, transparency and accountability of Belgian non-profit hospitals' board and management. (United States)

    Eeckloo, Kristof; Van Herck, Gustaaf; Van Hulle, Cynthia; Vleugels, Arthur


    As a result of multiple developments in health care and health care policy, hospital administrators, policy makers and researchers are increasingly challenged to reflect on the meaning of good hospital governance and how they can implement it in the hospital organisations. The question arises whether and to what extent governance models that have been developed within the corporate world can be valuable for these reflections. Due to the unique societal position of hospitals--which involves a large diversity of stakeholders--the claim for autonomy of various highly professional groups and the lack of clear business objectives, principles of corporate governance cannot be translated into the hospital sector without specific adjustments. However, irrespective of these contextual differences, corporate governance can provide for a comprehensive 'frame of reference', to which the hospital sector will have to give its own interpretation. A multidisciplinary research unit of the university of Leuven has taken the initiative to develop a governance model for Belgian hospitals. As part of the preliminary research work a survey has been performed among 82 hospitals of the Flemish Community on their governance structure, the composition of the governance entities, the partition of competencies and the relationship between management and medical staff.

  9. Initial symptoms and clinical features in osteosarcoma

    Institute of Scientific and Technical Information of China (English)

    Sujia Wu; Xing Shi; Jianling Zhao; Yurong Wang; Jun Zhang; Liwu Zhou; Yuexian Cheng; Guangxin Zhou


    Objective: To establish the initial symptoms and physical signs of osteosarcoma from the records of the first medical visit and to identify early characteristics of the diseases to shorten the delay of diagnosis. Methods: A group of patients with osteosarcoma in extremities was identified from Nanjing Jinling Hospital. Records from the first medical visit due to symptoms and physical signs related to the bone tumor were obtained from 71 patients with osteosarcoma. Results: The results of the data recorded about the first medical visit,reasons for consultation, pain,trauma,initial diagnosis,delay in diagnosis were reported respectively. Conclusion: Pair an initial symptom of osteosarcoma, and was intermittent but not frequently felt at night. A history of trauma was common, but the clinical course often diverged from what was expected from trauma. The most important clinical feature was a palpable mass. This finding emphasizes that a thorough physical examination is absolutely necessary.



    Kanwal Nasim; Saquib Yusaf Janjua


    Management of hospitals should take initiatives to improve the overall service quality of patient care. Regular feed-back from patients should be taken and rules should be made considering the expectations and requirements of patients. This study attempts to examine the satisfaction of patients from service quality they received from hospitals. Moreover, satisfaction is measured in both public and private hospital.

  11. Art in Hospitals Project

    DEFF Research Database (Denmark)

    Baceviciute, Sarune; Bruni, Luis Emilio; Burelli, Paolo

    in hospitals. Most of these guidelines favor figurative over abstract art, based on ideas leaning to the emotional congruence theory, which would claim that abstract art leads to ambiguity and therefore it could augment the current emotional base-line of an already stressed patient. The early ethnographic...... studies of the “Art in Hospitals” project challenged this perspective by investigating the positive or negative effects of “lower-level” specific features (e.g.: bright colors vs. darker, contrast, predominant shapes) independent of whether they were present in abstract or figurative art, which...

  12. Controlling hospital library theft


    Cuddy, Theresa M.; Marchok, Catherine


    At Capital Health System/Fuld Campus (formerly Helene Fuld Medical Center), the Health Sciences Library lost many books and videocassettes. These materials were listed in the catalog but were missing when staff went to the shelves. The hospital had experienced a downsizing of staff, a reorganization, and a merger. When the library staff did an inventory, $10,000 worth of materials were found to be missing. We corrected the situation through a series of steps that we believe will help other li...

  13. Glutaraldehyde degradation in hospital wastewater by photoozonation. (United States)

    Kist, Lourdes Teresinha; Rosa, Ellen Caroline; Machado, Enio Leandro; Camargo, Maria Emilia; Moro, Celso Camilo


    In this paper, we assessed aqueous solutions of glutaraldehyde (GA), a chemical used for the disinfection of hospital materials, using advanced oxidative processes, O3, and UV, and the combination of the latter two. Assays with different ozone concentrations at distinct pH levels were conducted to determine the best treatment process. GA concentrations before and after each treatment were measured by spectrophotometry. The best treatment was that which combined O3 and UV, yielding a degradation of 72.0-75.0% in relation to the initial concentration with pH between 4 and 9. Kinetics demonstrated that GA degradation is not dependent on pH, as there was a first-order reaction with a rate constant of k = 0.0180 min(-1) for initial pH 9 and of k = 0.0179 min(-1) for initial pH 7, that is, the values are virtually the same. Secondary wastewater samples were also analysed using the septic tank/filter system of a regional hospital in Vale do Rio Pardo, state of Rio Grande do Sul, southern Brazil. In this case, the characteristics of the wastewater were described and, after treatment, a GA degradation rate of 23.3% was noted, with reductions of 75% for chemical oxygen demand, 81% for biochemical oxygen demand, 68% for turbidity, 70% for surfactants and total disinfection in terms of thermotolerant coliforms.

  14. Implementing medical teaching policy in university hospitals. (United States)

    Engbers, Rik; Fluit, Cornelia R M G; Bolhuis, Sanneke; de Visser, Marieke; Laan, Roland F J M


    Within the unique and complex settings of university hospitals, it is difficult to implement policy initiatives aimed at developing careers in and improving the quality of academic medical teaching because of the competing domains of medical research and patient care. Factors that influence faculty in making use of teaching policy incentives have remained underexplored. Knowledge of these factors is needed to develop theory on the successful implementation of medical teaching policy in university hospitals. To explore factors that influence faculty in making use of teaching policy incentives and to develop a conceptual model for implementation of medical teaching policy in university hospitals. We used the grounded theory methodology. We applied constant comparative analysis to qualitative data obtained from 12 semi-structured interviews conducted at the Radboud University Medical Center. We used a constructivist approach, in which data and theories are co-created through interaction between the researcher and the field and its participants. We constructed a model for the implementation of medical teaching policy in university hospitals, including five factors that were perceived to promote or inhibit faculty in a university hospital to make use of teaching policy incentives: Executive Board Strategy, Departmental Strategy, Departmental Structure, Departmental Culture, and Individual Strategy. Most factors we found to affect individual teachers' strategies and their use of medical teaching policy lie at the departmental level. If an individual teacher's strategy is focused on medical teaching and a medical teaching career, and the departmental context offers support and opportunity for his/her development, this promotes faculty's use of teaching policy incentives.

  15. Medicare's Hospital Compare quality reports appear to have slowed price increases for two major procedures. (United States)

    Dor, Avi; Encinosa, William E; Carey, Kathleen


    Previous research has found that Hospital Compare, Medicare's public reporting initiative, has had little impact on patient outcomes. However, little is known about the initiative's impact on hospital prices, which may be significant because private insurers are generally well positioned to respond to quality information when negotiating prices with hospitals. We estimated difference-in-differences models of the effects of Hospital Compare quality reporting on transaction prices for two major cardiac procedures, coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI). States that had mandated their own public reporting systems before the implementation of Hospital Compare formed the control group. We found that prices for these procedures continued to increase overall after the initiation of Hospital Compare quality scores, but the rate of increase was significantly lower in states with no quality reporting metrics of their own before Hospital Compare, when compared to the control states (annual rates of increase of 4.4 percent versus 8.7 percent for PCI, and 3.9 percent versus 10.6 percent for CABG, adjusted for overall inflation). This finding implies that Hospital Compare provided leverage to purchasers in moderating price increases, while adding competitive pressures on hospitals. Providing accurate quality information on both hospitals and health plans could benefit consumers.

  16. Hospital antibiogram: A necessity

    Directory of Open Access Journals (Sweden)

    Joshi S


    Full Text Available The hospital antibiogram is a periodic summary of antimicrobial susceptibilities of local bacterial isolates submitted to the hospital′s clinical microbiology laboratory. Antibiograms are often used by clinicians to assess local susceptibility rates, as an aid in selecting empiric antibiotic therapy, and in monitoring resistance trends over time within an institution. Antibiograms can also used to compare susceptibility rates across institutions and track resistance trends. Some hospitals have adequate support from the computer department to be able to extract data from their reporting module. The WHONET software can be freely downloaded and used for analysis. Consensus guidelines have been developed by the Clinical and Laboratory Standards Institute (CLSI to standardise methods used in constructing antibiograms. These guidelines can be incorporated into the WHONET software for analysis. Only the first isolate from the patient is to be included in the analysis. The analysis should be done on the basis of patient location and specimen type. The percentage susceptibility of the most frequently isolated bacteria should be presented in the antibiogram, preferably in a tabular form. The antibiogram must be printed or put up in the intranet for easy access to all clinicians. Antibiotic policy is one of the mandatory requirements for accreditation, and making an antibiogram is the first step before framing the antibiotic policy. The future of antibiograms would be the incorporation of patient related data to make information more reliable and for predicting outbreaks.

  17. Design of paediatric hospitals. (United States)

    Lambert, Veronica


    The impact of healthcare environments on children and young people's (CYP) health and psychosocial wellbeing has attracted much attention in recent years. This sits within the realm of the political drive for enhanced awareness of the need to take account of the rights and voice of the child. Perhaps as a direct result of the United Nations Convention on the Rights of the Child, and recognition from evidence in adult population studies of the impact of healthcare environments on psychosocial healing, contemporary times have witnessed a discernible movement towards enhancing quality care by promoting child and adolescent-friendly hospital environments. The Council of Europe guidelines on child-friendly health care moved to place the rights and needs of children at the heart of health care. The Council acknowledges that the delivery of child-oriented services, which includes the notion of family-centred care, should be delivered in child and family friendly environments. However, knowledge about what constitutes a child-friendly healthcare environment from CYP's perspective is often lacking with hospital architectural blueprints predominantly designed around adult proxy-reported assumptions about the needs and desires of children.

  18. [Satisfaction of hospitalized patients in a hospital in Apurimac, Peru]. (United States)

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


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

  19. [Family and psychiatric hospitalization in a general hospital]. (United States)

    de Mello, Rita Mello; Schneider, Jacó Fernando


    This study aims to identify the reasons that lead relatives to hospitalize patients in a psychiatric unit of a general hospital. It is a qualitative study based on Alfred Schutz' phenomenological sociology. Fourteen relatives, each with one family member hospitalized, were interviewed from August to October 2009. The guiding question of the phenomenological interview was "What do you expect from psychiatric hospitalization in a general hospital?". Phenomenological sociology was used to understand and interpret the interviews. Statements showed three concrete categories, that lead to the reasons for: treatment guidelines and continuity; prospects for improvement; ideas about normality. This research shows the experiences of relatives, contributing with mental health professionals' reflection about their actions and about the involvement of families in a general hospital's psychiatric unit.

  20. The Yekaterinburg headache initiative

    DEFF Research Database (Denmark)

    Lebedeva, Elena R; Olesen, Jes; Osipova, Vera V


    for a demonstrational interventional project in Russia, undertaken within the Global Campaign against Headache. The initiative proposes three actions: 1) raise awareness of need for improvement; 2) design and implement a three-tier model (from primary care to a single highly specialized centre with academic affiliation...... of a health-care needs assessment, and as a model for all Russia. We present and discuss early progress of the initiative, justify the investment of resources required for implementation and call for the political support that full implementation requires. The more that the Yekaterinburg headache initiative...

  1. Electronic Cigarettes on Hospital Campuses

    Directory of Open Access Journals (Sweden)

    Clare Meernik


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

  2. Electronic Cigarettes on Hospital Campuses. (United States)

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


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

  3. Structural determinants of hospital closure. (United States)

    Longo, D R; Chase, G A


    In a retrospective case-control study, structural characteristics of hospitals that closed during the years 1976-1980 were contrasted with three comparison groups: hospitals that were acquired in a merger; hospitals that joined a multihospital system; and hospitals that remained autonomously opened, to investigate these characteristics as predictors of closure. Characteristics investigated included environmental, structural, and process variables. The independent variables were measured 5 years prior to outcome. Findings indicate that closed hospitals resemble hospitals acquired in a merger ("failure"), and likewise autonomous hospitals resemble hospitals that join a multihospital system ("success"). The most important predictors of hospital failure were the physician-to-population ratio, the East North Central and West North Central census regions, the level of diversification, low occupancy rate, location in a standard metropolitan statistical area, the chief executive officer's lack of affiliation in the American College of Hospital Administrators, profit status, bed size of less than 50, and presence in a state with a rate-setting agency. Surprisingly, this study shows the bed-to-population ratio to be unrelated to closure. In addition, the findings strongly support the open-system perspective, which, unlike the closed-system perspective, is concerned with the vulnerability of the organization to the uncontrollable and often unpredictable influences of the environment.


    Directory of Open Access Journals (Sweden)

    Steeve Haryanto


    consideration in implementing an information system in the field of hospitality industry. The method used in this paper is a literature review and analysis. The initial step in the analysis is to conduct a survey on the current system in hotels in Jakarta, and analysis of the survey results and the identification of the need for local companies to compete with foreign companies. Implementation of the system is no longer measured by how many facilities are available but the system is measured by how stable revenue generated calculations per day running at a hotel with no lost posts.

  5. Total quality in acute care hospitals: guidelines for hospital managers. (United States)

    Holthof, B


    Quality improvement can not focus exclusively on peer review and the scientific evaluation of medical care processes. These essential elements have to be complemented with a focus on individual patient needs and preferences. Only then will hospitals create the competitive advantage needed to survive in an increasingly market-driven hospital industry. Hospital managers can identify these patients' needs by 'living the patient experience' and should then set the hospital's quality objectives according to its target patients and their needs. Excellent quality program design, however, is not sufficient. Successful implementation of a quality improvement program further requires fundamental changes in pivotal jobholders' behavior and mindset and in the supporting organizational design elements.

  6. Factors associated with breastfeeding cessation in nursing mothers in a peer support programme in Eastern Lancashire

    Directory of Open Access Journals (Sweden)

    Verma Arpana


    Full Text Available Abstract Background The UK has one of the lowest breastfeeding rates worldwide and in recent years the Government has made breastfeeding promotion one of its priorities. The UNICEF UK Baby Friendly Initiative is likely to increase breastfeeding initiation but not duration. Other strategies which involve provision of support for breastfeeding mothers in the early weeks after birth are therefore required to encourage UK mothers to breastfeed for the recommended duration. This paper examines the effects of maternal socio-demographic factors, maternal obstetric factors, and in-hospital infant feeding practices on breastfeeding cessation in a peer support setting. Methods Data on mothers from Blackburn with Darwen (BwD and Hyndburn in Eastern Lancashire who gave birth at the Royal Blackburn Hospital and initiated breastfeeding while in hospital were linked to the Index of Multiple Deprivation (IMD. The data were analysed to describe infant feeding methods up to 6 months and the association between breastfeeding cessation, and maternal factors and in-hospital infant feeding practices. Results The mean breastfeeding duration was 21.6 weeks (95% CI 20.86 to 22.37 weeks and the median duration was 27 weeks (95% CI 25.6 to 28.30 weeks. White mothers were 69% more likely to stop breastfeeding compared with non-White mothers (HR: 0.59; 95% CI, 0.52 to 0.67 [White mothers were the reference group]. Breastfeeding cessation was also independently associated with parity and infant feeding practices in hospital. There were no significant associations between breastfeeding cessation and marital status, mode of delivery, timing of breastfeeding initiation and socio-economic deprivation. Conclusion In this study ethnicity, parity and in-hospital infant feeding practices remained independent predictors of breastfeeding cessation in this peer support setting. However other recognised predictors such as marital status, mode of delivery, timing of breastfeeding

  7. RAS Initiative - Events (United States)

    The NCI RAS Initiative has organized multiple events with outside experts to discuss how the latest scientific and technological breakthroughs can be applied to discover vulnerabilities in RAS-driven cancers.

  8. Prairie Reconstruction Initiative Project (United States)

    US Fish and Wildlife Service, Department of the Interior — The purpose of the Prairie Reconstruction Initiative Advisory Team (PRIAT) is to identify and take steps to resolve uncertainties in the process of prairie...

  9. Surgical Critical Care Initiative (United States)

    Federal Laboratory Consortium — The Surgical Critical Care Initiative (SC2i) is a USU research program established in October 2013 to develop, translate, and validate biology-driven critical care....

  10. Quality Initiatives - General Information (United States)

    U.S. Department of Health & Human Services — CMS has developed a standardized approach for the development of quality measures that it uses in its quality initiatives. Known as the Measures Management System...

  11. RAS Initiative - Community Outreach (United States)

    Through community and technical collaborations, workshops and symposia, and the distribution of reference reagents, the RAS Initiative seeks to increase the sharing of knowledge and resources essential to defeating cancers caused by mutant RAS genes.

  12. Nursing Home Quality Initiative (United States)

    U.S. Department of Health & Human Services — This Nursing Home Quality Initiative (NHQI) website provides consumer and provider information regarding the quality of care in nursing homes. NHQI discusses quality...

  13. Prairie Reconstruction Initiative (United States)

    US Fish and Wildlife Service, Department of the Interior — The purpose of the Prairie Reconstruction Initiative Advisory Team (PRIAT) is to identify and take steps to resolve uncertainties in the process of prairie...

  14. Nursing Home Quality Initiative (United States)

    U.S. Department of Health & Human Services — This Nursing Home Quality Initiative (NHQI) website provides consumer and provider information regarding the quality of care in nursing homes. NHQI discusses...

  15. [Using SWOT to analyze breastfeeding education results in a medical center]. (United States)

    Lee, Pei-Shan; Huang, Chiu-Mieh


    The breastfeeding rate within the first month after postpartum dropped from 95% in 1962 to 25% in 1989. As a result, the Department of Health, Executive Yuan, has made a lot of effort to promote a baby-friendly hospital policy since 2001, with the aim of increasing the breastfeeding rate. However, many studies have pointed out that the Department of Health is encountering difficulties when implementing this policy. This study is designed to use the Strengths, Weakness, Opportunities, and Threats (SWOT) Analysis to evaluate the development of breastfeeding education in a certain medical center. We divide those factors that influence the effect of this policy into extrinsic environmental factors and intrinsic environmental factors. The intrinsic environmental factors are the strengths and weaknesses of the baby-friendly hospital policy. The extrinsic environmental factors are the opportunities and threats. The SWOT Matrix is also applied to develop appropriate strategies to take the greatest possible advantage of opportunities available. With the SWOT approach, managers can not only readily extinguish intrinsic advantages from intrinsic disadvantages, but also recognize external opportunities and threats. Furthermore, it assists managers in resolving problems and turning adversity into opportunity. In providing the SWOT analysis, we hope clinical nursing staff will gain a better understanding of the baby-friendly hospital policy and deliver higher quality of health care for postpartum mothers, thus increasing the breastfeeding rate.

  16. Progress in Initiator Modeling

    Energy Technology Data Exchange (ETDEWEB)

    Hrousis, C A; Christensen, J S


    There is great interest in applying magnetohydrodynamic (MHD) simulation techniques to the designs of electrical high explosive (HE) initiators, for the purpose of better understanding a design's sensitivities, optimizing its performance, and/or predicting its useful lifetime. Two MHD-capable LLNL codes, CALE and ALE3D, are being used to simulate the process of ohmic heating, vaporization, and plasma formation in the bridge of an initiator, be it an exploding bridgewire (EBW), exploding bridgefoil (EBF) or slapper type initiator. The initiation of the HE is simulated using Tarver Ignition & Growth reactive flow models. 1-D, 2-D and 3-D models have been constructed and studied. The models provide some intuitive explanation of the initiation process and are useful for evaluating the potential impact of identified aging mechanisms (such as the growth of intermetallic compounds or powder sintering). The end product of this work is a simulation capability for evaluating margin in proposed, modified or aged initiation system designs.

  17. Choice of initial therapy

    Directory of Open Access Journals (Sweden)

    Manuel Battegay


    Full Text Available Current international and national treatment guidelines such as EACS, BHIVA, DHHS or IAS update regularly recommendations on the choice of initial combination antiretroviral treatment (cART regimens. Preferred cART regimens include a backbone with two nucleoside (nucleotide reverse transcriptase inhibitors combined either with one non-nucleoside reverse transcriptase inhibitor or one ritonavir boosted protease inhibitor or more recently one integrase inhibitor. Response rates according to viral load measurements increased in recent years, in particular due to better tolerability. The choice of initial therapy is flexible and influenced by several factors such as height of viral load, genotypic resistance testing, CD4 cell count, co-morbidities, interactions, potential adverse events, (potential for pregnancy, convenience, adherence, costs as well as physician's and patient's preferences. Diverse highly potent initial cART regimens exist. Following the many possibilities, the choice of a regimen is based on a mixture of evidence-informed data and individualized concepts, some of the latter only partly supported by strong evidence. For example, different perceptions and personal experiences exist about boosted protease inhibitors compared to non-nucleoside reverse transcriptase inhibitors or integrase inhibitors and vice versa which may influence the initial choice. This lecture will discuss choices of initial cART in view of international guidelines and the evidence for individualization of initial HIV therapy.

  18. Union Density and Hospital Outcomes. (United States)

    Koys, Daniel J; Martin, Wm Marty; LaVan, Helen; Katz, Marsha


    The authors address the hospital outcomes of patient satisfaction, healthcare quality, and net income per bed. They define union density as the percentage of a hospital's employees who are in unions, healthcare quality as its 30-day acute myocardial infraction (AMI; heart attack) mortality rate, and patient satisfaction as its overall Hospital Consumer Assessment of Healthcare Providers and Systems score. Using a random sample of 84 union and 84 nonunion hospitals from across the United States, multiple regression analyses show that union density is negatively related to patient satisfaction. Union density is not related to healthcare quality as measured by the AMI mortality rate or to net income per bed. This implies that unions per se are not good or bad for hospitals. The authors suggest that it is better for hospital administrators to take a Balanced Scorecard approach and be concerned about employee satisfaction, patient satisfaction, healthcare quality, and net income.

  19. Does outsourcing affect hospital profitability? (United States)

    Danvers, Kreag; Nikolov, Pavel


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

  20. Hospital customer service in a changing healthcare world: does it matter? (United States)

    Howard, J


    The healthcare industry is undergoing a rapid transformation to meet the ever-increasing needs and demands of the patient population. Employers and health plans such as HMOs are demanding better service and higher quality care, and hospitals are trying to tackle reimbursement cutbacks, streamline services, and serve a diverse population. Hospitals have begun to realize that to overcome these obstacles and meet the needs of the health care plans and consumers, they must focus on the demands of the customer. Customer service initiatives increase patient satisfaction and loyalty and overall hospital quality, and many hospitals have found that consumer demands can be met through initiating and maintaining a customer service program. This article describes how the administrator can create, implement, and manage customer service initiatives within the hospital.

  1. RFID solution benefits Cambridge hospital. (United States)

    James, Andrew


    Keeping track of thousands of pieces of equipment in a busy hospital environment is a considerable challenge, but, according to RFID tagging and asset tracking specialist, Harland Simon, RFID technology can make the task considerably simpler. Here Andrew James, the company's RFID sales manager, describes the positive benefits the technology has brought the Medical Equipment Library (MEL) at Addenbrooke's Hospital, one of the world's most famous teaching hospitals.

  2. Controlling hospital library theft. (United States)

    Cuddy, Theresa M; Marchok, Catherine


    At Capital Health System/Fuld Campus (formerly Helene Fuld Medical Center), the Health Sciences Library lost many books and videocassettes. These materials were listed in the catalog but were missing when staff went to the shelves. The hospital had experienced a downsizing of staff, a reorganization, and a merger. When the library staff did an inventory, $10,000 worth of materials were found to be missing. We corrected the situation through a series of steps that we believe will help other libraries control their theft. Through regularly scheduling inventories, monitoring items, advertising, and using specific security measures, we have successfully controlled the library theft. The January 2002 inventory resulted in meeting our goal of zero missing books and videocassettes. We work to maintain that goal.

  3. Good management. Corporate governance: 'the hospital is listening'. (United States)

    Brown, Pauline; Craig, Andrew


    Homerton University Hospital trust, a first-wave foundation, commissioned a specialist consultancy to devise an induction programme for the governors. It was vital to tailor activities to individual needs while retaining overall consistency. A concluding exercise demonstrated that the majority agreed they had overcome initial hesitancy.

  4. Data mining based hospital management

    Institute of Scientific and Technical Information of China (English)

    TSUMOTO Yuko; TSUMOTO Shusaku


    Rapid progress in information technology has come to enable us to store all the information in a hospital in- formation system, including management data, patient records, discharge summary and laboratory data. Although the reuse of those data has not started, it has been expected that the stored data will contribute to analysis of hospi-tal management. In this paper, the diseharge summary of Chiba University Hospital, which has been stored since 980's were analyzed to characterize the university hospital. The results show several interesting results, which uggests that the reuse of stored data will give a powerful tool to support a long-period management of a university ospital.

  5. [Hospitals and surgeons: Madrid 1940]. (United States)

    de Quevedo, Francisco Vázquez


    The history of the hospitals and general surgeons that best represent the centres in Madrid are here in reviewed, comprising the period between 1940 and the closure of the Hospital Clinico (1957) as well as the Hospital General (General Hospital) (1967), both in Atocha. Other hospitals which are reviewed and highlighted are: the H. de la Princesa (the Princess Hospital), the H. del Nifio Jesus (Hospital of the Child Jesus), the H. Militar (Military Hospital) and the Cruz Roja (Red Cross). Data is provided on the permanent surgeons in the following centres: H. General: J. Goyanes, J. Die, J. de la Villa, T. Rodriguez, E. Diaz, G. Bueno e H. Huerta; H. Clinico: L. de la Peña, L. Cardenal, L. Olivares, R. Argüelles, J. Estella y M. F. Zumel; H. Militar: M. G. Ulla, M. Bastos, M. G. Durán, J. S. Galindo, y A. G. Durán; Hospital de la Cruz Roja: V. M. Noguera, L. Serrada, F. Luque y L. L. Durán; H. de la Princesa: P. Cifuentes, P. G. Duarte, L. Estella y R. Aiguabella; H. del Niño Jesús: J. Garrido Lestache; H. Clinico, last time, Atocha: F. M. Lagos, R. Vara y A. de la Fuente.

  6. Can soda fountains be recommended in hospitals? (United States)

    Chaberny, Iris F; Kaiser, Peter; Sonntag, Hans-Günther


    Mineral water (soda water) is very popular in Germany. Therefore, soda fountains were developed as alternatives to the traditional deposit bottle system. Nowadays, different systems of these devices are commercially available. For several years, soda fountains produced by different companies have been examined at the University Hospital of Heidelberg. In 1998, it was possible for the first time to observe and evaluate one of these systems over a period of 320 days in a series of microbiological examinations. The evaluation was implemented on the basis of the German drinking water regulation (Anonymous, 1990. Gesetz über Trinkwasser und Wasser für Lebensmittelbetriebe (Trinkwasserverordnung - TrinkwV) vom 12. Dezember 1990. Bundesgesetzblatt 66, 2613ff). Initially, the bacteria counts exceeded the reference values imposed by the German drinking water regulation in almost 50% of the analyses. Pseudomonas aeruginosa was also detected in almost 38% of the samples. After a re-arrangement of the disinfection procedure and the removal of the charcoal filter, Pseudomonas aeruginosa was not detectable any more. However, the bacteria counts still frequently exceeded the reference values of the German drinking water regulation. Following our long-term analysis, we would not recommend soda fountains in high-risk areas of hospitals. If these devices are to be used in hospitals, the disinfection procedures should be executed in weekly or fortnightly intervals and the water quality should be examined periodically.

  7. Simulating Service System and Estimating the Hospital Beds for ICU Patients of Behbahan Shahidzade Hospital in 2015

    Directory of Open Access Journals (Sweden)

    Gholamreza Shahbazi Moghadam


    Full Text Available Introduction: Hospital bed is one of the most important resources of a hospital. The optimal estimation of the future number of beds needed is one of the important and interesting subjects for the policy makers. The aim of the present study was to simulate the service system and estimate the hospital beds for the ICU patients. Method: This is a simulation and modeling study. Stochastic simulation method was used to model the services system of ICU. The initial research population was consisted of 560 patients hospitalized in the ICU of Shahidzadeh general hospital in Behbahan, Khuzestan. The beds needed in the future was estimated based on key and significant parameters and variables including length of stay, admissions rate, and discharges rate for 10000 days and 5000 patients simulated (admission rate, =2 Data were analyzed using SPSS 18.0 and EXCEL 2010 software’s. Findings: the results showed that mean and median of the patients' length of stay were 5.4 9.3 and 3 days, respectively. Among the different variables, the patients' age, having diabetes, having dyslipidemia , the number of diagnostic tests, and the number of radiography services were the most important predictors of the patients' length of stay .The findings of simulation model showed that if the bed estimation is performed based on 10 and 20 initial beds , ICU will approximately encounter the shortage of bed up to the future 13 years (5000 days . If only the ICU works with 40 initial beds, it will need some additional hospital beds for 42.7 % of days (2135 days. Therefore, the ICU in the study can provide service for 57.3% of days (2865 days with the same existing 40 beds. Conclusion: we concluded that according to the existing beds and resources, the studied hospital will strongly face a shortage of ICU beds in most of the future days.

  8. Pre-hospital emergency medicine. (United States)

    Wilson, Mark H; Habig, Karel; Wright, Christopher; Hughes, Amy; Davies, Gareth; Imray, Chirstopher H E


    Pre-hospital care is emergency medical care given to patients before arrival in hospital after activation of emergency medical services. It traditionally incorporated a breadth of care from bystander resuscitation to statutory emergency medical services treatment and transfer. New concepts of care including community paramedicine, novel roles such as emergency care practitioners, and physician delivered pre-hospital emergency medicine are re-defining the scope of pre-hospital care. For severely ill or injured patients, acting quickly in the pre-hospital period is crucial with decisions and interventions greatly affecting outcomes. The transfer of skills and procedures from hospital care to pre-hospital medicine enables early advanced care across a range of disciplines. The variety of possible pathologies, challenges of environmental factors, and hazardous situations requires management that is tailored to the patient's clinical need and setting. Pre-hospital clinicians should be generalists with a broad understanding of medical, surgical, and trauma pathologies, who will often work from locally developed standard operating procedures, but who are able to revert to core principles. Pre-hospital emergency medicine consists of not only clinical care, but also logistics, rescue competencies, and scene management skills (especially in major incidents, which have their own set of management principles). Traditionally, research into the hyper-acute phase (the first hour) of disease has been difficult, largely because physicians are rarely present and issues of consent, transport expediency, and resourcing of research. However, the pre-hospital phase is acknowledged as a crucial period, when irreversible pathology and secondary injury to neuronal and cardiac tissue can be prevented. The development of pre-hospital emergency medicine into a sub-specialty in its own right should bring focus to this period of care.

  9. Hospital admissions. Cold remedies. (United States)

    Pascoe, S; Pratt, J


    The closure of a casualty department provoked a crisis in Hillingdon in the winter of 1996-97. Worried by the publicity, elderly people contacted the health authority to ask what would happen to them if they became ill. An all-day workshop, attended by elderly people, chief executives, nurses, social workers and representatives from the community health council and ambulance services, led to several initiatives, including a rapid response home service, which helped prevent a crisis last winter.

  10. Longitudinal analysis on the development of hospital quality management systems in the Netherlands.

    NARCIS (Netherlands)

    Dückers, M.; Makai, P.; Vos, L.; Groenewegen, P.; Wagner, C.


    OBJECTIVE: Many changes have been initiated in the Dutch hospital sector to optimize health-care delivery: national agenda-setting, increased competition and transparency, a new system of hospital reimbursement based on diagnosis-treatment combinations, intensified monitoring of quality and a multi-

  11. Changing hospital care: evaluation of a multi-layered organisational development and quality improvement programme

    NARCIS (Netherlands)

    Dückers, M.L.A


    In the last decades many different policy changes have been initiated in the Dutch hospital sector to optimise health care delivery: national agenda-setting, increased competition and transparency, a new system of hospital reimbursement based on diagnosis-treatment-combinations, intensified monitori

  12. Initial conditions for inflation

    CERN Document Server

    Dimopoulos, Konstantinos


    A novel proposal is presented, which manages to overcome the initial conditions problem of inflation with a plateau. An earlier period of proto-inflation, beginning at Planck scale, accounts for the Universe expansion and arranges the required initial conditions for inflation on the plateu to commence. We show that, if proto-inflation is power-law, it does not suffer from any eternal inflationary stage. A simple model realisation is constructed in the context of $\\alpha$-attractors, which can both generate the inflationary plateau and the exponential slopes around it, necessary for the two inflation stages. Our mechanism allows to assume chaotic initial conditions at the Planck scale for proto-inflation, it is generic and it is shown to work without fine-tunings.

  13. Win-win initiatives

    Energy Technology Data Exchange (ETDEWEB)

    Specter, Herschel


    This paper explores the use of win-win initiatives as a means of making safety improvements while simultaneously reducing plant operating costs. A two-phased process for implementing these initiatives is provided. Near-term progress is emphasized in the first phase by using presently available information. The second phase addresses complex issues such as closure in the regulatory process, modernizing the role of determinism in decisionmaking, closer coupling of performance-based regulation and risk-informed regulation, modernizing the testing of important plant equipment, and the treatment of uncertainties.

  14. Initiation of HIV therapy


    Ho, Charlotte Yuk-Fan; Ling, Bingo Wing-Kuen


    In this paper, we numerically show that the dynamics of the HIV system is sensitive to both the initial condition and the system parameters. These phenomena imply that the system is chaotic and exhibits a bifurcation behavior. To control the system, we propose to initiate an HIV therapy based on both the concentration of the HIV-1 viral load and the ratio of the CD4 lymphocyte population to the CD8 lymphocyte population. If the concentration of the HIV-1 viral load is higher than a threshold,...

  15. Comparing Candidate Hospital Report Cards

    Energy Technology Data Exchange (ETDEWEB)

    Burr, T.L.; Rivenburgh, R.D.; Scovel, J.C.; White, J.M.


    We present graphical and analytical methods that focus on multivariate outlier detection applied to the hospital report cards data. No two methods agree which hospitals are unusually good or bad, so we also present ways to compare the agreement between two methods. We identify factors that have a significant impact on the scoring.

  16. Hospital evacuation : Exercise versus reality

    NARCIS (Netherlands)

    Haverkort, J. J Mark; Biesheuvel, Tessa H.; Bloemers, Frank W.; de Jong, MB; Hietbrink, Falco; van Spengler, Lukas L.; Leenen, Luke P H


    Introduction: The Dutch Major Incident Hospital (MIH) is a standby, highly prepared, 200-bed hospital strictly reserved to provide immediate, large-scale, and emergency care for victims of disasters and major incidents. It has long-standing experience training for various major incident scenarios, i

  17. Video interpretations in Danish hospitals

    DEFF Research Database (Denmark)

    Søbjerg, Lene Mosegaard; Noesgaard, Susanne; Henriksen, Jan Erik;


    This article presents a study of an RCT comparing video interpretation with in-person interpretation at the Endocrinology Ward at Odense University Hospital.......This article presents a study of an RCT comparing video interpretation with in-person interpretation at the Endocrinology Ward at Odense University Hospital....

  18. Latex in the Hospital Environment (United States)

    LATEX in the Hospital Environment Updated Fall 2015 This list provides a guide to some of the most common objects containing latex and offers some ... remover–Sepha Pharm) 1 LATEX in the Hospital Environment (continued) Frequently contains LATEX OR/Infection Control masks, ...

  19. Brief hospitalizations of elderly patients

    DEFF Research Database (Denmark)

    Strømgaard, Sofie; Rasmussen, Søren Wistisen; Schmidt, Thomas Andersen


    BACKGROUND: Crowded departments are a common problem in Danish hospitals, especially in departments of internal medicine, where a large proportion of the patients are elderly. We therefore chose to investigate the number and character of hospitalizations of elderly patients with a duration of less...

  20. The Cradle of American Hospitality


    Bradford Hudson, Ph.D.


    An astonishing array of firsts and near firsts in the history of the modern hospitality sector have occurred in and around Boston, and some of the oldest surviving hospitality businesses in the United States may be found in the area today. This article explores the evolution of hotels and restaurants in Boston from 1633 to the present.

  1. The Cradle of American Hospitality

    Directory of Open Access Journals (Sweden)

    Bradford Hudson, Ph.D.


    Full Text Available An astonishing array of firsts and near firsts in the history of the modern hospitality sector have occurred in and around Boston, and some of the oldest surviving hospitality businesses in the United States may be found in the area today. This article explores the evolution of hotels and restaurants in Boston from 1633 to the present.

  2. Segmentation in local hospital markets. (United States)

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


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

  3. The effect of hospital-physician integration on health information technology adoption. (United States)

    Lammers, Eric


    The US federal government has recently made a substantial investment to enhance the US health information technology (IT) infrastructure. Previous literature on the impact of IT on firm performance across multiple industries has emphasized the importance of a process of co-invention whereby organizations develop complementary practices to achieve greater benefit from their IT investments. In health care, employment of physicians by hospitals can confer greater administrative control to hospitals over physicians' actions and resources and thus enable the implementation of new technology and initiatives aimed at maximizing benefit from use of the technology. In this study, I tested for the relationship between hospital employment of physicians and hospitals' propensity to use health IT. I used state laws that prohibit hospital employment of physicians as an instrument to account for the endogenous relationship with hospital IT use. Hospital employment of physicians is associated with significant increases in the probability of hospital health IT use. Therefore, subsidization of health IT among hospitals not employing physicians may be less efficient. Furthermore, state laws prohibiting hospitals from employing physicians may inhibit adoption of health IT, thus working against policy initiatives aimed at promoting use of the technology.

  4. National hospital development, 1948-2000: The WHO as an international propagator

    DEFF Research Database (Denmark)

    Malmmose, Margit


    This study investigates the role of hospitals in the interrelation between the World Health Organization (WHO) and Anglo-Saxon health initiatives prior to and during the New Public Management wave. The analysis is undertaken according to a discursive, governmentality framework. The results find......-war nationalisation, hospitals have come to play a dominant role in the set-up of governmental health infrastructure, and are formed by political and legal reform initiatives mobilised through calculative practices....

  5. CMS Nonpayment Policy, Quality Improvement, and Hospital-Acquired Conditions: An Integrative Review. (United States)

    Bae, Sung-Heui

    This integrative review synthesized evidence on the consequences of the Centers for Medicare & Medicaid Services (CMS) nonpayment policy on quality improvement initiatives and hospital-acquired conditions. Fourteen articles were included. This review presents strong evidence that the CMS policy has spurred quality improvement initiatives; however, the relationships between the CMS policy and hospital-acquired conditions are inconclusive. In future research, a comprehensive model of implementation of the CMS nonpayment policy would help us understand the effectiveness of this policy.

  6. Designing a modern hospital pharmacy. (United States)

    Kay, B G; Boyar, R L; Raspante, P S


    Cooperation between the pharmacy director and the hospital's architects in planning a modern hospital pharmacy is described. The pharmacy director at an 870-bed voluntary nonprofit institution and the hospital's architects planned the design for a new 3250-square foot pharmacy department. They developed a preliminary floor plan based on the following functions that the pharmacy would perform: centralized unit dose drug distribution; compounding; bulk and unit dose prepackaging; preparation of sterile products; controlled substance storage; outpatient and employee prescription dispensing; reserve stock storage; purchasing, receiving, and inventory control; drug information services; and administrative services. A final floor plan was designed that incorporated these functions with structural and utility requirements, such as placement of the computer system and dispensing and lighting fixtures. By integrating modern material management concepts with contemporary hospital pharmacy practice, the pharmacy director and the hospital's architects were able to plan and construct a pharmacy that receives, processes, and dispenses medication efficiently.

  7. Functional textiles in hospital interiors

    DEFF Research Database (Denmark)

    Mogensen, Jeppe

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

  8. New directions in hospital governance. (United States)

    Shortell, S M


    This article suggests new directions for hospital governance to meet the demands of a rapidly changing health care environment. Board members must increasingly play roles as risk takers, strategic directors, experts, mentors, and evaluators. Lessons from other industries regarding risk taking, use of expertise, and streamlining decision making must be adapted to meet hospital needs. Recent data suggest that these needs may still differ by hospital ownership despite a convergence in investor-owned and not-for-profit corporate structures. The effectiveness of hospital boards in the future will depend on their ability to: (1) manage a diverse group of stakeholders; (2) involve physicians in the management and governance process; (3) meet the governance needs of multi-institutional systems and hospital restructuring; (4) meet the challenges of diversification and vertical integration; and (5) understand strategy formulation and implementation as interdependent and interrelated processes.

  9. Information Technology Initiative (Videorecording), (United States)

    Physical description: 1 VHS video; col.; sd.; mono.; standard playback sp.; 35:40 mins.; 1/2 in. In this video, Dr. Kurt Fisher, Deputy Director for Information Technology , introduces the Corporate Information Management (CIM) program and explains the following major technical initiatives: reuse/repositories; I-case; data administration; information technology architecture; software process improvement; standards.

  10. Best Practices & Outstanding Initiatives (United States)

    Training, 2011


    In this article, "Training" editors recognize innovative and successful learning and development programs and practices. They share best practices from Automatic Data Processing, Inc., Farmers Insurance Group, FedEx Express, InterContinental Hotels Group, and Oakwood Temporary Housing. They also present the outstanding initiatives of EMD Serono,…

  11. Global healthy backpack initiatives. (United States)

    Jayaratne, Kapila; Jacobs, Karen; Fernando, Dulitha


    Schoolbag use by children is a global common concern.. Children carry school books and other amenities in their school bags. Global evidence indicates that daily load carried by school children may have negative health implications. Backpack as a school bag model, is the healthiest way of load carriage for school children. Several initiatives have been launched world over to minimize unhealthy consequences resulting from schoolbags. Based on a situation analysis, Sri Lanka implemented a national healthy schoolbag campaign by joint efforts of Ministries of Health and Education. Actions were contemplated on; strategies for bag weight reduction, introduction of an ergonomically modeled schoolbag and bag behaviour change. New strategies were introduced with awareness campaigns to policy makers, bag manufacturers, parents, teachers and children. Four million schoolchildren benefitted. In 2000, the backpack strategy of "Pack it Light, Wear it Right" was started as a public health initiative in the United States by the American Occupational Therapy Association (AOTA). Over the last eleven years, thousands of occupational therapy practitioners and students participated in educational programs and outreach activities. In 2004, modeled after the success AOTA initiative, the Icelandic Occupational Therapy Association launched a national backpack awareness initiative. This article shares examples of practices that could be implemented in any context to the promote health of children.

  12. The SEED Initiative (United States)

    Teich, Carolyn R.


    Committed to fulfilling the promise of the green economy, the American Association of Community Colleges (AACC) launched the Sustainability Education and Economic Development (SEED) initiative ( in October 2010. The project advances sustainability and clean energy workforce development practices at community colleges by…

  13. Initial Symptoms of ALS (United States)

    ... Research In Your Community Advocate Get Involved Donate Symptoms and Diagnosis En español Symptoms The initial symptoms of ALS can be quite ... the eyes and bladder are generally not affected. Diagnosis ALS is a difficult disease to diagnose. There ...

  14. Ontario's Student Voice Initiative (United States)

    Courtney, Jean


    This article describes in some detail aspects of the Student Voice initiative funded and championed by Ontario's Ministry of Education since 2008. The project enables thousands of students to make their voices heard in meaningful ways and to participate in student-led research. Some students from grades 7 to 12 become members of the Student…

  15. Measuring nutritional risk in hospitals

    Directory of Open Access Journals (Sweden)

    Henrik H Rasmussen


    Full Text Available Henrik H Rasmussen1,2, Mette Holst3, Jens Kondrup41Centre for Nutrition and Bowel Disease, Department of Medical Gastroenterology, Aarhus University Hospital, Aalborg, Denmark; 2Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; 3Centre for Nutrition and Bowel Disease, Aarhus University Hospital, Aalborg, Denmark; 4Department of Human Nutrition, Faculty of Life Sciences, University of Copenhagen, Clinical Nutrition Unit, Rigshospitalet University Hospital, Copenhagen, DenmarkAbstract: About 20%–50% of patients in hospitals are undernourished. The number varies depending on the screening tool amended and clinical setting. A large number of these patients are undernourished when admitted to the hospital, and in most of these patients, undernutrition develops further during hospital stay. The nutrition course of the patient starts by nutritional screening and is linked to the prescription of a nutrition plan and monitoring. The purpose of nutritional screening is to predict the probability of a better or worse outcome due to nutritional factors and whether nutritional treatment is likely to influence this. Most screening tools address four basic questions: recent weight loss, recent food intake, current body mass index, and disease severity. Some screening tools, moreover, include other measurements for predicting the risk of malnutrition. The usefulness of screening methods recommended is based on the aspects of predictive validity, content validity, reliability, and practicability. Various tools are recommended depending on the setting, ie, in the community, in the hospital, and among elderly in institutions. The Nutrition Risk Screening (NRS 2002 seems to be the best validated screening tool, in terms of predictive validity ie, the clinical outcome improves when patients identified to be at risk are treated. For adult patients in hospital, thus, the NRS 2002 is recommended.Keywords: nutritional risk screening

  16. Do hospitals cross-subsidize? (United States)

    David, Guy; Lindrooth, Richard C; Helmchen, Lorens A; Burns, Lawton R


    Despite its salience as a regulatory tool to ensure the delivery of unprofitable medical services, cross-subsidization of services within hospital systems has been notoriously difficult to detect and quantify. We use repeated shocks to a profitable service in the market for hospital-based medical care to test for cross-subsidization of unprofitable services. Using patient-level data from general short-term hospitals in Arizona and Colorado before and after entry by cardiac specialty hospitals, we study how incumbent hospitals adjusted their provision of three uncontested services that are widely considered to be unprofitable. We estimate that the hospitals most exposed to entry reduced their provision of psychiatric, substance-abuse, and trauma care services at a rate of about one uncontested-service admission for every four cardiac admissions they stood to lose. Although entry by single-specialty hospitals may adversely affect the provision of unprofitable uncontested services, these findings warrant further evaluation of service-line cross-subsidization as a means to finance them.

  17. Radiofrequency field surveys in hospitals. (United States)

    Foster, K R; Soltys, M; Arnofsky, S; Doshi, P; Hanover, D; Mercado, R; Schleck, D


    The authors surveyed levels of radiofrequency (RF) fields in the frequency range 0.1-1,000 MHz in four hospitals in the Philadelphia area, to obtain background information related to the possible interference of radiofrequency fields with medical equipment. Two large center-city hospitals, a regional county hospital, and two suburban hospitals were surveyed. Measurements were made at six to 12 sites in each hospital, in each of the three frequency bands. More limited additional measurements were conducted in a fifth hospital as well. Sites were selected to include areas where strong RF signals from transmitting antennas might be expected to be present (e.g., locations close to windows in upper stories of buildings near paging antennas) as well as other representative sites in the hospital. The median RF field strengths were quite low (0.1-0.5 V/m), but at specific locations the RF signals from broadcast sources exceeded 1 V/m. Much stronger fields were recorded close to electrosurgical units and hand-held transmitters (cellular telephones and UHF transceivers).


    Directory of Open Access Journals (Sweden)

    Karina Alejandra Cruz-Pallares


    Full Text Available The document presents results of a research that used as strategy a complementary training project with thirty-three students of a Bachelors Degree in Primary School 1997(DPS,1997 of an Education Faculty for the initial training of investigators, applied by four teachers members of the academic research group in Mexico; that develops through process of action research methodology. Highlighted in results is the strengthening of the competition of reading, understanding and writing scientific texts, which is analogous to the first feature of the graduate profile called intellectual skills. Among the conclusions it is emphasized that the initial training of teachers in a task that is quite interesting, challenging and complex, as is the educational complex phenomenon.

  19. Rosmarinus officinalis vitroculture initiation

    Directory of Open Access Journals (Sweden)

    Liviu POP


    Full Text Available In this experiment we have initiated a Rosmarinus officinalis vitroculture, on different growth media. As biological material we used apexes, taken from an only plant. The development medium have consisted in Murashige and Skoog standard mixture, where growth regulators were added, resulting 4 experimental variants: V0 – control variant – basic medium (BM, V1 – BM + 2mg/l BA + 1mg/l IBA, V2 - BM + 2mg/l BA + 1mg/l IAA, V3 –BM + 2mg/l BA + 1mg/l NAA. The experiment lasted for 90 days. We have found that the initiation of Rosmarinus officinalis vitroculture is possible, the best growth medium for this purpose being the basic one (V0 - Murashige and Skoog without growth regulators.

  20. Renormalizing an initial state

    CERN Document Server

    Collins, Hael; Vardanyan, Tereza


    The intricate machinery of perturbative quantum field theory has largely been devoted to the 'dynamical' side of the theory: simple states are evolved in complicated ways. This article begins to address this lopsided treatment. Although it is rarely possible to solve for the eigenstates of an interacting theory exactly, a general state and its evolution can nonetheless be constructed perturbatively in terms of the propagators and structures defined with respect to the free theory. The detailed form of the initial state in this picture is fixed by imposing suitable `renormalization conditions' on the Green's functions. This technique is illustrated with an example drawn from inflation, where the presence of nonrenormalizable operators and where an expansion that naturally couples early times with short distances make the ability to start the theory at a finite initial time especially desirable.

  1. Self-initiated expatriates

    DEFF Research Database (Denmark)

    Selmer, Jan; Lauring, Jakob


    Purpose – As it has been suggested that adult third-culture kids may be more culturally adaptable than others, they have been labelled “the ideal” expatriates. In this article, we explore the adjustment of self-initiated expatriate academics in Hong Kong, comparing adult third-culture kids...... with adult mono-culture kids. Design/methodology/approach – We use survey results from 267 self-initiated expatriate academics in Hong Kong. Findings – Exploratory results show that adult third-culture kids had a higher extent of general adjustment. No significant results were found in relation...... to interaction adjustment and job adjustment. We also found that recent expatriate experiences generally had a positive association with the adjustment of adult mono-culture kids, but this association only existed in terms of general adjustment for adult third-culture kids. Originality/value – Once corroborated...

  2. Measuring LEED–NC applicability in design for hospitality

    Directory of Open Access Journals (Sweden)

    Teresa Marie Cracknell


    Full Text Available Mounting awareness of climate change in recent years has led the construction industry to initiate new approaches toward sustainable building design, yet stakeholders in hospitality development still hesitate to build green. This reluctance is due to perceived high guest expectations of comfort levels and amenity access among these properties. Research was conducted to determine precisely which green building innovations present the most significant barriers to incorporating sustainability into design for hospitality. Average LEED credit implementation rates among 28 existing LEED hotel projects were calculated and compared with average credits employed among common commercial building projects. 15 of those projects’ designers also offered survey opinions on which sustainable innovations were most commonly avoided in their approaches for hospitality. The results indicate that certain credits do experience decreased popularity among hospitality projects, yet guest comfort was not the only barrier identified. Cost of implementation and local applicability affected by climate and local bylaws were also found as major role players in the selection of credits specific to hospitality design. Conclusions are presented according to the data and recommendations made to support further growth and success in future applications of LEED sustainable design in hospitality.

  3. [Hospitals' evolution through the ages]. (United States)

    de Micheli, Alfredo


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

  4. Northwest Manufacturing Initiative (United States)


    Training areas included Total Productive Maintenance, First Aide and Safety, Lean Training, Inventory Management, Purchasing Supply Chain, ISO 13485 ...improve their business through quality certifications and initiatives such as AS9100, ISO 9001-2000, and implementing Lean Manufacturing. All of these...not show up on a visible profile. 13 Certifications: Quality Certifications such as AS9100, ISO etc. a. List Certifying Agency and number

  5. Internet connectivity for hospitals and hospital libraries: strategies. (United States)

    Fuller, S S


    Access to Internet resources and communications has rapidly become a necessity in many hospitals nationally. The results of a Pacific Northwest pilot Intenet connections project provides important evidence of the value of librarians in establishing such connections in their institutions The pilot project has resulted in a wealth of information regarding approaches to promoting the utility of the Internet to health professionals in hospitals. Roles that librarians are playing in support of such connections include facilitator, negotiator, provider, publisher, integrator, and educator.

  6. Internet connectivity for hospitals and hospital libraries: strategies.


    Fuller, S S


    Access to Internet resources and communications has rapidly become a necessity in many hospitals nationally. The results of a Pacific Northwest pilot Intenet connections project provides important evidence of the value of librarians in establishing such connections in their institutions The pilot project has resulted in a wealth of information regarding approaches to promoting the utility of the Internet to health professionals in hospitals. Roles that librarians are playing in support of suc...

  7. Trends affecting hospitals' human resources. (United States)

    Neudeck, M M


    Hospital workers at every level--from administrators to housekeepers--will be affected by the interaction of changes already underway in the healthcare industry. Societal forces that will affect the hospital workforce include demographic change, the rise of the participatory ethic and decentralization, a growing philosophy of job entitlement, and new pressures for unionization. At the same time, the industry is faced with changing manpower requirements, cost containment, and the oversupply of physicians. This article identifies some of the likely effects of these changes on hospital human resources and suggests ways that administrators can prepare for them.

  8. Martyrs of the psychiatric hospitals

    Directory of Open Access Journals (Sweden)

    Serra Paolo


    Full Text Available This article is based on the history of an Italian psychiatric hospital (Arezzo that closed in 1989 and was turned into a university. The illegal and inhumane treatment in asylum-type institutions is condemned. In particular the treatment of those patients who, according to the analysis, hospital directors referred to as “social cases.” These individuals did not stay in hospital because of health problems but only due to the lack of social care by the state. AS a consequence they are condemned to be “prisoners” without committing any crimes.

  9. A Decomposition of Hospital Profitability

    Directory of Open Access Journals (Sweden)

    Jason Turner


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

  10. Energy audits at 48 hospitals (United States)

    Hirst, E.


    Staff at the Oak Ridge Associated Universities (ORAU) conducted energy audits at 48 hospitals in four states (New York, Pennsylvania, Virginia, Tennessee) between 1978 and 1980. Staff at the Oak Ridge National Laboratory (ORNL) and ORAU developed and organized a computerized data base containing information from these audits. This paper describes the ORAU audit process; summarizes the data collected from these audits on hospital characteristics annual energy use, and the audit recommendations; and analyzes the audit data in terms of cost effectiveness, type of recommendations, and the relationship between potential energy saving and characteristics of the individual hospital.

  11. Interdisciplinary teamwork in hospitals: a review and practical recommendations for improvement. (United States)

    O'Leary, Kevin J; Sehgal, Niraj L; Terrell, Grace; Williams, Mark V


    Recognizing the importance of teamwork in hospitals, senior leadership from the American College of Physician Executives (ACPE), the American Hospital Association (AHA), the American Organization of Nurse Executives (AONE), and the Society of Hospital Medicine (SHM) established the High Performance Teams and the Hospital of the Future project. This collaborative learning effort aims to redesign care delivery to provide optimal value to hospitalized patients. With input from members of this initiative, we prepared this report which reviews the literature related to teamwork in hospitals. Teamwork is critically important to provide safe and effective hospital care. Hospitals with high teamwork ratings experience higher patient satisfaction, higher nurse retention, and lower hospital costs. Elements of effective teamwork have been defined and provide a framework for assessment and improvement efforts in hospitals. Measurement of teamwork is essential to understand baseline performance, and to demonstrate the utility of resources invested to enhance it and the subsequent impact on patient care. Interventions designed to improve teamwork in hospitals include localization of physicians, daily goals of care forms and checklists, teamwork training, and interdisciplinary rounds. Though additional research is needed to evaluate the impact on patient outcomes, these interventions consistently result in improved teamwork knowledge, ratings of teamwork climate, and better understanding of patients' plans of care. The optimal approach is implementation of a combination of interventions, with adaptations to fit unique clinical settings and local culture.

  12. In-hospital Cardiac Arrest at Cork University Hospital. (United States)

    O'Sullivan, E; Deasy, C


    We describe the incidence and outcomes of in-hospital cardiac arrest (IHCA) at Cork University Hospital over a one year time period (2011), prior to the implementation of national early warning scoring (NEWS) systems. There were 43 217 coded CUH admissions, in 2011, to 518 in-patient beds. The Hospital In-Patient Enquiry Database was used to identify adults (>/= 18 years) who sustained IHCA. Available Utstein variables were collected. Fifty-two patients were found to be incorrectly coded IHCA. 17 of 63 (27.0%) IHCA survived to discharge. IHCA with shockable rhythm had significantly higher survival. IHCA survival was significantly lower on wards versus any other hospital location. Median days of stay prior to arrest were significantly different between survivors and non-survivors. All survivors (n = 17) had intact neurological outcome post-event. Our outcomes from IHCA are poorest on hospital wards when compared to other areas of the hospital. Those that survive have excellent function and one-year survival.

  13. The Hospital System and the Urban Resilience

    Directory of Open Access Journals (Sweden)

    Francesca Pirlone


    Full Text Available The concept of resilience is critical when addressing the issue of natural hazards. The role of an urban planner is to analyze the territorial system, consisting of several functional sub-systems (housing, education, health, etc.. and its vulnerability. In order to have a specific knowledge of the territory in question, before the occurrence of a disaster it would be necessary, for each functional system, analyze various aspects and define risk simulations. In a city, in fact, there are strategic elements that should not lose functionality during or following a natural event; the definition of specific scenarios could put structures exposed to risk on safety in order not to compromise the system. In this paper I report a specific experience of research carried out within the hospital system that, in case of occurrence of a natural event, is often simultaneously exposed, and therefore need of rescue, and it is a dispenser of rescue. It’s considered strategic because it has to ensure the functionality of its service regardless of the occurrence of external events, such as natural ones; its functionality must be ensured in the continuum. In today is not very thorough the scientific literature about the analysis of the hospital system in respect of such events. Given the importance of the theme there are several initiatives, also promoted by The Italian Civil Protection, in particular the drafting of hospital emergency plans, which cover issues such as fire, road accidents, floods, ... Interesting was the collaboration between the Italian Civil Protection Department with Applied Technology Council for the planning of a background paper intended for the preparation of earthquake emergency plans, within which there are also aspects of prevention such as the evaluation of seismic vulnerability of hospitals themselves. The described methodology has allowed the definition of risk simulations for the hospital system, starting from the determination of

  14. TB as a cause of hospitalization and in-hospital mortality among people living with HIV worldwide: a systematic review and meta-analysis (United States)

    Ford, Nathan; Matteelli, Alberto; Shubber, Zara; Hermans, Sabine; Meintjes, Graeme; Grinsztejn, Beatriz; Waldrop, Greer; Kranzer, Katharina; Doherty, Meg; Getahun, Haileyesus


    Introduction Despite significant progress in improving access to antiretroviral therapy over the past decade, substantial numbers of people living with HIV (PLHIV) in all regions continue to experience severe illness and require hospitalization. We undertook a global review assessing the proportion of hospitalizations and in-hospital deaths because of tuberculosis (TB) in PLHIV. Methods Seven databases were searched to identify studies reporting causes of hospitalizations among PLHIV from 1 January 2007 to 31 January 2015 irrespective of age, geographical region or language. The proportion of hospitalizations and in-hospital mortality attributable to TB was estimated using random effects meta-analysis. Results From an initial screen of 9049 records, 66 studies were identified, providing data on 35,845 adults and 2792 children across 42 countries. Overall, 17.7% (95% CI 16.0 to 20.2%) of all adult hospitalizations were because of TB, making it the leading cause of hospitalization overall; the proportion of adult hospitalizations because of TB exceeded 10% in all regions except the European region. Of all paediatric hospitalizations, 10.8% (95% CI 7.6 to 13.9%) were because of TB. There was insufficient data among children for analysis by region. In-hospital mortality attributable to TB was 24.9% (95% CI 19.0 to 30.8%) among adults and 30.1% (95% CI 11.2 to 48.9%) among children. Discussion TB remains a leading cause of hospitalization and in-hospital death among adults and children living with HIV worldwide. PMID:26765347

  15. TB as a cause of hospitalization and in-hospital mortality among people living with HIV worldwide: a systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Nathan Ford


    Full Text Available Introduction: Despite significant progress in improving access to antiretroviral therapy over the past decade, substantial numbers of people living with HIV (PLHIV in all regions continue to experience severe illness and require hospitalization. We undertook a global review assessing the proportion of hospitalizations and in-hospital deaths because of tuberculosis (TB in PLHIV. Methods: Seven databases were searched to identify studies reporting causes of hospitalizations among PLHIV from 1 January 2007 to 31 January 2015 irrespective of age, geographical region or language. The proportion of hospitalizations and in-hospital mortality attributable to TB was estimated using random effects meta-analysis. Results: From an initial screen of 9049 records, 66 studies were identified, providing data on 35,845 adults and 2792 children across 42 countries. Overall, 17.7% (95% CI 16.0 to 20.2% of all adult hospitalizations were because of TB, making it the leading cause of hospitalization overall; the proportion of adult hospitalizations because of TB exceeded 10% in all regions except the European region. Of all paediatric hospitalizations, 10.8% (95% CI 7.6 to 13.9% were because of TB. There was insufficient data among children for analysis by region. In-hospital mortality attributable to TB was 24.9% (95% CI 19.0 to 30.8% among adults and 30.1% (95% CI 11.2 to 48.9% among children. Discussion: TB remains a leading cause of hospitalization and in-hospital death among adults and children living with HIV worldwide.

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

    DEFF Research Database (Denmark)

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


    PURPOSE: To investigate adherence rates to hospital drug formularies (HDFs) and cost of drugs in hospitals. METHODS: Data on drugs used during 2010 were analyzed for ten hospitals (two hospitals from each of the five regions), constituting 30 % of hospitals and 45 % of hospital beds in Denmark. D...

  17. Financial issues for hospital auxiliaries. (United States)

    Fogel, L A


    Auxiliaries can serve a more important financial role in today's environment than ever before. Hospitals are searching for positive avenues to promote themselves to the community and to generate more financial support to help offset the losses created by decreasing inpatient utilization and payments from third-party payers. Auxiliaries should recognize that their financial role has never been more important to the financial viability of their hospitals. Auxiliaries should communicate closely with hospital administration so that both organizations work to achieve compatible goals. Auxiliaries should be operated more like businesses, which means establishing goals and objectives, preparing effective budgets and interim financial statements, thinking and planning innovatively, and establishing adequate inventory controls, investment policies, and pricing structures. If auxiliaries follow these steps, they will not only succeed in providing more financial support to hospitals than ever before but will also receive the recognition and support they deserve for their effort.

  18. Hospital Value-Based Purchasing (United States)

    U.S. Department of Health & Human Services — Hospital Value-Based Purchasing (VBP) is part of the Centers for Medicare and Medicaid Services (CMS) long-standing effort to link Medicares payment system to a...

  19. [Hospital structure and control measures]. (United States)

    Gürkan, I


    A new legislation concerning financial matters of hospitals in Germany requires fundamental changes and adjustment. Formerly grown structures of a high-grade centralization erode into a process of change. Despite hospitals will maintain their non-profit character in public health services, modifications of medical care processes will promote elements of cost-centres. All medical care units as well as hospital management are confronted with rising requirements concerning performance and transparency. Increasingly patients and social health insurances behave like self-confident customers not willing to accept rising costs. Public health services loose their character of a planned economy. Hospitals with features of health-entrepreneurship are on the incline. A process of quality-planning and efficient management has been evoqued.

  20. Medicaid Disproportionate Share Hospital Payments (United States)

    U.S. Department of Health & Human Services — Medicaid Disproportionate Share Hospital (DSH) Payments This link provides you with information about Medicaid DSH Payments. You can find information on DSH Audit...

  1. VT - Vermont Hospital Service Areas (United States)

    Vermont Center for Geographic Information — Hospital service areas (HSAs) are organized by towns and are based on inpatient discharges where the diagnosis indicated the need for immediate care. Plurality...


    Directory of Open Access Journals (Sweden)

    Ana Cláudia Afonso Valladares


    Full Text Available ABSTRACT: Hospitalization may have negative effects on child development. It takes the child off her routine and prevents her from contacts with stimulating environments. The aim of this work was to evaluate the development and quality on drew productions, before and after art therapy intervention, during the hospitalization of 7 to 10 years old children, with infectious diseases. It was proposed a quasi experimental design with a control group (n=9 and a group that was submitted to art therapy intervention (n=10. Results show that these interventions were effective in improving the development and the quality of the drawings. Hospitals can also be stimulating environments for children offering them caring practices that go beyond the disease. KEY WORDS: Art therapy; Pediatric Nursing; Hospitalization.

  3. Regional approaches to hospital preparedness. (United States)

    Maldin, Beth; Lam, Clarence; Franco, Crystal; Press, David; Waldhorn, Richard; Toner, Eric; O'Toole, Tara; Inglesby, Thomas V


    This article describes issues related to the engagement of hospitals and other community partners in a coordinated regional healthcare preparedness and response effort. The report is based on interviews with public health and hospital representatives from 13 regions or states across the country. It aims to identify key ingredients for building successful regional partnerships for healthcare preparedness as well as critical challenges and policy and practical recommendations for their development and sustainability.

  4. Facility management in German hospitals. (United States)

    Gudat, H


    Facility management and optimum building management offer for hospitals a chance to reduce costs and to increase quality, process sequences, employee motivation and customer satisfaction. Some years ago simple services such as cleaning, catering or laundry were outsourced. Now, German hospitals progress to more complex fields such as building and medical technology, clinical support processes such as pharmacy, central laboratory and sterilization, goods and logistics services.

  5. Initial Cooling Experiment (ICE)

    CERN Multimedia

    Photographic Service


    In 1977, in a record-time of 9 months, the magnets of the g-2 experiment were modified and used to build a proton/antiproton storage ring: the "Initial Cooling Experiment" (ICE). It served for the verification of the cooling methods to be used for the "Antiproton Project". Stochastic cooling was proven the same year, electron cooling followed later. Also, with ICE the experimental lower limit for the antiproton lifetime was raised by 9 orders of magnitude: from 2 microseconds to 32 hours. For its previous life as g-2 storage ring, see 7405430. More on ICE: 7711282, 7809081, 7908242.

  6. Hanford tanks initiative plan

    Energy Technology Data Exchange (ETDEWEB)

    McKinney, K.E.


    Abstract: The Hanford Tanks Initiative (HTI) is a five-year project resulting from the technical and financial partnership of the U.S. Department of Energy`s Office of Waste Management (EM-30) and Office of Science and Technology Development (EM-50). The HTI project accelerates activities to gain key technical, cost performance, and regulatory information on two high-level waste tanks. The HTI will provide a basis for design and regulatory decisions affecting the remainder of the Tank Waste Remediation System`s tank waste retrieval Program.

  7. Stirling to Flight Initiative (United States)

    Hibbard, Kenneth E.; Mason, Lee S.; Ndu, Obi; Smith, Clayton; Withrow, James P.


    Flight (S2F) initiative with the objective of developing a 100-500 We Stirling generator system. Additionally, a different approach is being devised for this initiative to avoid pitfalls of the past, and apply lessons learned from the recent ASRG experience. Two key aspects of this initiative are a Stirling System Technology Maturation Effort, and a Surrogate Mission Team (SMT) intended to provide clear mission pull and requirements context. The S2F project seeks to lead directly into a DOE flight system development of a new SRG. This paper will detail the proposed S2F initiative, and provide specifics on the key efforts designed to pave a forward path for bringing Stirling technology to flight.

  8. UNLV Nuclear Hydrogen Initiative

    Energy Technology Data Exchange (ETDEWEB)

    Hechanova, Anthony E.; Johnson, Allen; O' Toole, Brendan; Trabia, Mohamed; Peterson, Per


    Evaluation of the Crack growth rate (CGR) of Alloy 617 and Alloy 276 under constant K at ambient temperature has been completed. Creep deformation of Alloy 230 at different temperature range and load level has been completed and heat to heat variation has been noticed. Creep deformation study of Alloy 276 has been completed under an applied initial stress level of 10% of yield stress at 950ºC. The grain size evaluation of the tested creep specimens of Alloy 276 has been completed.

  9. Initiation of slug flow

    Energy Technology Data Exchange (ETDEWEB)

    Hanratty, T.J.; Woods, B.D. [Univ. of Illinois, Urbana, IL (United States)


    The initiation of slug flow in a horizontal pipe can be predicted either by considering the stability of a slug or by considering the stability of a stratified flow. Measurements of the shedding rate of slugs are used to define necessary conditions for the existence of a slug. Recent results show that slugs develop from an unstable stratified flow through the evolution of small wavelength waves into large wavelength waves that have the possibility of growing to form a slug. The mechanism appears to be quite different for fluids with viscosities close to water than for fluids with large viscosities (20 centipoise).

  10. Hospital diversification and financial management. (United States)

    Eastaugh, S R


    Hospital diversification and its impact on the operating ratio are studied for 62 New York hospitals during the period 1974-1979. Diversification and operating ratio are modeled in a two-stage least squares (TSLS) framework as being jointly dependent. Institutional diversification is found to yield better financial position, and the better operating ratio allows the institution the wherewithal to diversify. The impact of external government planning and hospital competition are also measured. An institution life cycle hypothesis is advanced to explain hospital behavior: boom and bust, diversification and divestiture, occasionally leading to closure or merger. These results should not be generalized beyond the New York State context. Restructuring of the organization, unrelated business ventures, and transactions with related organizations were not a problem in this sample. However, in 1983, many a new corporation is set up whose revenues do not become part of the hospital's and whose complex transactions conceal unallowable costs and maximize reimbursement. A number of hypotheses are advanced concerning hospital administrator's attitude toward risk.

  11. Foodborne listeriosis acquired in hospitals. (United States)

    Silk, Benjamin J; McCoy, Morgan H; Iwamoto, Martha; Griffin, Patricia M


    Listeriosis is characterized by bacteremia or meningitis. We searched for listeriosis case series and outbreak investigations published in English by 2013, and assessed the strength of evidence for foodborne acquisition among patients who ate hospital food. We identified 30 reports from 13 countries. Among the case series, the median proportion of cases considered to be hospital-acquired was 25% (range, 9%-67%). The median number of outbreak-related illnesses considered to be hospital-acquired was 4.0 (range, 2-16). All patients were immunosuppressed in 18 of 24 (75%) reports with available data. Eight outbreak reports with strong evidence for foodborne acquisition in a hospital implicated sandwiches (3 reports), butter, precut celery, Camembert cheese, sausage, and tuna salad (1 report each). Foodborne acquisition of listeriosis among hospitalized patients is well documented internationally. The number of listeriosis cases could be reduced substantially by establishing hospital policies for safe food preparation for immunocompromised patients and by not serving them higher-risk foods.

  12. Candiduria in Hospitalized Patients in Teaching Hospitals of Ahvaz

    Directory of Open Access Journals (Sweden)

    Ali Zarei Mahmoudabadi


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

  13. Initiatives for proliferation prevention

    Energy Technology Data Exchange (ETDEWEB)



    Preventing the proliferation of weapons of mass destruction is a central part of US national security policy. A principal instrument of the Department of Energy`s (DOE`s) program for securing weapons of mass destruction technology and expertise and removing incentives for scientists, engineers and technicians in the newly independent states (NIS) of the former Soviet Union to go to rogue countries or assist terrorist groups is the Initiatives for Proliferation Prevention (IPP). IPP was initiated pursuant to the 1994 Foreign Operations Appropriations Act. IPP is a nonproliferation program with a commercialization strategy. IPP seeks to enhance US national security and to achieve nonproliferation objectives by engaging scientists, engineers and technicians from former NIS weapons institutes; redirecting their activities in cooperatively-developed, commercially viable non-weapons related projects. These projects lead to commercial and economic benefits for both the NIS and the US IPP projects are funded in Russian, Ukraine, Kazakhstan and Belarus. This booklet offers an overview of the IPP program as well as a sampling of some of the projects which are currently underway.

  14. Global cancer research initiative

    Directory of Open Access Journals (Sweden)

    Richard R Love


    Full Text Available Richard R LoveThe Ohio State University Comprehensive Cancer Center, Columbus, OH, USAAbstract: Cancer is an increasing problem for low- and middle-income countries undergoing an epidemiologic transition from dominantly acute communicable disease to more frequent chronic disease with increased public health successes in the former domain. Progress against cancer in high-income countries has been modest and has come at enormous expense. There are several well-conceived global policy and planning initiatives which, with adequate political will, can favorably impact the growing global cancer challenges. Most financial resources for cancer, however, are spent on diagnosis and management of patients with disease in circumstances where specific knowledge about effective approaches is significantly limited, and the majority of interventions, other than surgery, are not cost-effective in resource-limited countries by global standards. In summary, how to intervene effectively on a global scale for the majority of citizens who develop cancer is poorly defined. In contrast to technology-transfer approaches, markedly increased clinical research activities are more likely to benefit cancer sufferers. In these contexts, a global cancer research initiative is proposed, and mechanisms for realizing such an effort are suggested.Keywords: breast cancer, research, global, international, low-income, middle-income

  15. Some account of the origin and plan of an association formed for the establishment of a house of recovery or fever hospital in the city of Dublin

    LENUS (Irish Health Repository)


    This particular year\\'s reports cover the initial meeting in October 1801, an appendix which considers the experience of fever hospital\\'s in Manchester and Waterford and finally medical testimony supporting the building of a fever hospital.\\r\

  16. TQM implementation strategies in hospitals: an empirical perspective. (United States)

    Bringelson, L S; Basappa, L S


    This article reports an analysis of the effectiveness of Total Quality Management (TQM) programs. The objective of the study was gain a better understanding of how hospitals implement TQM and quality improvement initiatives. Results show that some hospital staffs have not realized that they are implementing TQM, even though they report to be using the strategies for quality improvement. On the other hand, some hospitals said that they were involved in quality programs, though not practically implementing TQM strategies. These results suggest two major conclusions about the implementation of TQM programs. First, data indicate that TQM programs may not be as effective as promised, due to a lack of understanding about TQM by the people within the organization. Second, implementation strategies that are statistically correlated are identified. These conclusions may be helpful for successful TQM implementation in from healthcare organizations as well as other service industries.

  17. Quality Improvement in Hospitals: Identifying and Understanding Behaviors

    Directory of Open Access Journals (Sweden)

    Lukasz M. Mazur


    Full Text Available Improving operational performance in hospitals is complicated, particularly if process improvement requires complex behavioral changes. Using single-loop and double-loop learning theory as a foundation, the purpose of this research is to empirically uncover key improvement behaviors and the factors that may be associated with such behaviors in hospitals. A two-phased approach was taken to collect data regarding improvement behaviors and associated factors, and data analysis was conducted using methods proposed by grounded theorists. The contributions of this research are twofold. First, five key behaviors related to process improvement are identified, namely Quick Fixing, Initiating, Conforming, Expediting, and Enhancing. Second, based on these observed behaviors, a set of force field diagrams is developed to structure and organize possible factors that are important to consider when attempting to change improvement behaviors. This begins to fill the gap in the knowledge about what factors drive effective improvement efforts in hospital settings.

  18. Hospital innovation portfolios: Key determinants of size and innovativeness

    DEFF Research Database (Denmark)

    Schultz, Carsten; Zippel-Schultz, Bettina; Salomo, Søren


    and reward systems) organizational mechanisms. Methodology: To develop hypotheses, we integrated the innovation management literature into the hospital context. Detailed information about the innovation portfolio of 87 German hospitals was generated and combined with multirespondent survey data using ratings....... Reward systems did not have direct effects on the composition of innovation portfolios. However, they adjusted bottom-up employee and top-down strategic initiatives to match with the existing organization, thereby decreasing the degree of innovativeness and enforcing exploitation. Practice Implications......Background: Health care organizations face an increasing demand for strategic change and innovation; however, there are also several barriers to innovation that impede successful implementation. Purposes: We aimed to shed light on key issues of innovation management in hospitals and provide...

  19. Nursing care plan standardized breastfeeding

    Directory of Open Access Journals (Sweden)

    Susana de la Flor Picado


    Full Text Available The superiority of human milk in feeding the human infant is incontestable. Breastmilk is a living food can´t be copied and is supported by numerous arguments in support of excellence, both biological and anthropometric or economic. Despite it, has been a significant decline in this practice. Scientific advances, sociological changes and the lack f health personnel have contributed to this expense. Currently, both the WHO and UNICEF cone try relaunching excusive breastfeeding as feeding the infant until 6 months of life. Initiatives whit the Baby Friendly Hospital or the Strategic Plan for the Protection, Promotion and Support of Breastfeeding trying to promote the recognition of breastfeeding as irrefutable cornerstone for optimal growth and development of our children.Goal: Unify care criteria and actions to promote breastfeeding initiation and maintenance of the same, improving communication between professionals and between them and patients.Methodology: Care Development Plan following the NANDA taxonomies, NOC, NIC.Conclusions: Standardized work promotes decision making and performance of nursing staff to develop a happy breastfeeding.

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

    LENUS (Irish Health Repository)

    Kellett, John


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

  1. In-hospital stroke: characteristics and outcomes.

    LENUS (Irish Health Repository)

    Briggs, R


    In-hospital stroke (IS) made up 6.5% of strokes recorded in the Irish National Stroke Register in 2012. International research has demonstrated poorer outcomes post IS compared to out of hospital stroke (OS). We aimed to profile all IS and OS over a 22 month period and compare the two groups by gathering data from the HIPE portal stroke register. The study site is a primary stroke centre. IS represented 11% (50\\/458) of total strokes with over half (27\\/50, 54%) admitted initially with medical complaints. IS patients had a significantly longer length of stay (79.2 +\\/- 87.4 days vs. 21.9 +\\/- 45.9 days, p < 0.01) and higher mortality (13\\/50 vs. 39\\/408, p < 0.01). Patients in the IS group were also less likely to receive stroke unit care (1\\/50 vs. 136\\/408, p < 0.01). This study demonstrates the significant morbidity and mortality associated with IS and highlights the need for efforts to be made to optimize identification and management of acute stroke in this cohort.

  2. Refeeding syndrome in hospitalized pediatric patients. (United States)

    Dunn, Rebecca L; Stettler, Nicolas; Mascarenhas, Maria R


    Refeeding syndrome has been well documented over the years, primarily through case reports and literature reviews. Awareness of refeeding syndrome is crucial in preventing the occurrence of, and the metabolic and physiologic complications associated with, aggressive nutrition support in malnourished populations. Once compromised patients have been identified to be at risk of refeeding syndrome, nutrition rehabilitation should be cautiously initiated. We have found a lack of clinical validation for instituting nutrition support in high-risk pediatric patients who may develop refeeding syndrome. The purposes of our investigation were to determine the incidence of refeeding syndrome in pediatric hospitalized patients beginning on parenteral nutrition and to determine how consistently the Department of Clinical Nutrition standards of care for screening and prevention were followed at our institution.

  3. Hospital Acquired Pneumonia: Issues in Therapy

    Directory of Open Access Journals (Sweden)

    Lionel A Mandell


    Full Text Available In December 1992. a meeting was convened in Toronto to develop guidelines for the initial treatment of hospital acquired pneumonia. Issues considered related lo the patient. the possible drugs used for treatment, and the pathogen(s. From the perspective of the patient. the two major issues were the presence or absence of risk factors for specific microbial pathogens and the severity of illness upon clinical presentation, Criteria for defining severly ill patients were developed and are presented in this paper. Drug and pathogen related issues focused on selection of antimicrobial agents thal would provide coverage for the likely pathogens. Concern was also expressed regarding use of aminoglycosides as single-agent treatment of Gram-negative infections in the lung. and the issue of monotherapy versus combination therapy of Pseudomonas aeruginosa infections was discussed. The use of various diagnostic tests was briefly reviewed. including the protected specimen brush and bronchoalveolar lavage. Treatment regimens are presented in tabular format.

  4. The Ombudperson Initiative Group

    CERN Multimedia

    Laura Stewart

    Following many discussions that took place at some of the ATLAS Women's Network lunch gatherings, a few ATLAS women joined forces with similarly concerned CERN staff women to form a small group last Fall to discuss the need for a CERN-wide Ombudsperson. This has since evolved into the Ombudsperson Initiative Group (OIG) currently composed of the following members: Barbro Asman, Stockholm University; Pierre Charrue, CERN AB; Anna Cook, CERN IT; Catherine Delamare, CERN and IT Ombudsperson; Paula Eerola, Lund University; Pauline Gagnon, Indiana University; Eugenia Hatziangeli, CERN AB; Doreen Klem, CERN IT; Bertrand Nicquevert, CERN TS and Laura Stewart, CERN AT. On June 12, members of the OIG met with representatives of Human Resources (HR) and the Equal Opportunity Advisory Panel (EOAP) to discuss the proposal drafted by the OIG. The meeting was very positive. Everybody agreed that the current procedures at CERN applicable in the event of conflict required a thorough review, and that a professionnally trai...

  5. Quality initiative at ESO (United States)

    Rupprecht, Gero; Arsenault, Robin; Hanuschik, Reinhard; Kraus, Maximilian; Sivera, Paola; Tromp, Arnout; Verzichelli, Gianluca


    An initiative is under way at ESO Headquarters to optimise operations, in particular in the engineering, technical and associated management areas. A systematic approach to strengthen the operating processes is in preparation, starting with a mapping of the extensive existing process network. Processes identified as sufficiently important and complex to merit an in-depth analysis will be properly specified and their implementation optimised to strike a sensible balance between organisational overhead (documentation) and efficiency. By applying methods and tools tried and tested in industry we expect to achieve a more unified approach to address recurrent tasks. This will enable staff to concentrate more on new challenges and improvement and avoid spending effort on issues already resolved in the past.

  6. Breckinridge Project, initial effort

    Energy Technology Data Exchange (ETDEWEB)

    None, None


    Report III, Volume 1 contains those specifications numbered A through J, as follows: General Specifications (A); Specifications for Pressure Vessels (C); Specifications for Tanks (D); Specifications for Exchangers (E); Specifications for Fired Heaters (F); Specifications for Pumps and Drivers (G); and Specifications for Instrumentation (J). The standard specifications of Bechtel Petroleum Incorporated have been amended as necessary to reflect the specific requirements of the Breckinridge Project, and the more stringent specifications of Ashland Synthetic Fuels, Inc. These standard specifications are available to the Initial Effort (Phase Zero) work performed by all contractors and subcontractors. Report III, Volume 1 also contains the unique specifications prepared for Plants 8, 15, and 27. These specifications will be substantially reviewed during Phase I of the project, and modified as necessary for use during the engineering, procurement, and construction of this project.

  7. Instrumented Pipeline Initiative

    Energy Technology Data Exchange (ETDEWEB)

    Thomas Piro; Michael Ream


    This report summarizes technical progress achieved during the cooperative agreement between Concurrent Technologies Corporation (CTC) and U.S. Department of Energy to address the need for a for low-cost monitoring and inspection sensor system as identified in the Department of Energy (DOE) National Gas Infrastructure Research & Development (R&D) Delivery Reliability Program Roadmap.. The Instrumented Pipeline Initiative (IPI) achieved the objective by researching technologies for the monitoring of pipeline delivery integrity, through a ubiquitous network of sensors and controllers to detect and diagnose incipient defects, leaks, and failures. This report is organized by tasks as detailed in the Statement of Project Objectives (SOPO). The sections all state the objective and approach before detailing results of work.

  8. Predictors of inhospital mortality and re-hospitalization in older adults with community-acquired pneumonia: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Marrie Tom


    Full Text Available Abstract Background A better understanding of potentially modifiable predictors of in-hospital mortality and re-admission to the hospital following discharge may help to improve management of community-acquired pneumonia in older adults. We aimed to assess the associations of potentially modifiable factors with mortality and re-hospitalization in older adults hospitalized with community-acquired pneumonia. Methods A prospective cohort study was conducted from July 2003 to April 2005 in two Canadian cities. Patients aged 65 years or older hospitalized for community-acquired pneumonia were followed up for up to 30 days from initial hospitalization for mortality and these patients who were discharged alive within 30 days of initial hospitalization were followed up to 90 days of initial hospitalization for re-hospitalization. Separate logistic regression analyses were performed identify the predictors of mortality and re-hospitalization. Results Of 717 enrolled patients hospitalized for community-acquired pneumonia, 49 (6.8% died within 30 days of hospital admission. Among these patients, 526 were discharged alive within 30 days of hospitalization of whom 58 (11.2% were re-hospitalized within 90 days of initial hospitalization. History of hip fracture (odds ratio (OR = 4.00, 95% confidence interval (CI = (1.46, 10.96, P = .007, chronic obstructive pulmonary disease (OR = 2.31, 95% CI = (1.18, 4.50, P = .014, cerebrovascular disease (OR = 2.11, 95% CI = (1.03, 4.31, P = .040 were associated with mortality. Male sex (OR = 2.35, 95% CI = (1.13, 4.85, P = .022 was associated with re-hospitalization while vitamin E supplementation was protective (OR = 0.37 (0.16, 0.90, P = .028. Lower socioeconomic status, prior influenza and pneumococcal vaccinations, appropriate antibiotic prescription upon admission, and lower nutrition risk were not significantly associated with mortality or re-hospitalization. Conclusion Chronic comorbidities appear to be the most

  9. Hyperoxia Early After Hospital Admission in Comatose Patients with Non-Traumatic Out-of-Hospital Cardiac Arrest (United States)

    Christ, Martin; von Auenmueller, Katharina Isabel; Brand, Michael; Amirie, Scharbanu; Sasko, Benjamin Michel; Trappe, Hans-Joachim


    Background The clinical effect of hyperoxia in patients with non-traumatic out-of-hospital cardiac arrest (OHCA) remains uncertain. We therefore initiated this study to find out whether there is an association between survival and hyperoxia early after return of spontaneous circulation (ROSC) in OHCA patients admitted to our hospital. Material/Methods All OHCA patients admitted to our hospital between 1 January 2008 and 30 June 2015 were identified by analysis of our central admission register. Data from individual patients were collected from patient health records and anonymously stored on a central database. Results Altogether, there were 280 OHCA patients admitted to our hospital between 1 January 2008 and 30 June 2015, including 35 patients (12.5%) with hyperoxia and 99 patients (35.4%) with normoxia. Comparison of these 2 groups showed lower pH values in OHCA patients admitted with normoxia compared to those with hyperoxia (7.10±0.18 vs. 7.21±0.17; p=0.001) but similar rates of initial lactate (7.92±3.87 mmol/l vs. 11.14±16.40 mmol/l; p=0.072). Survival rates differed between both groups (34.4% vs. 54.3%; p=0.038) with better survival rates in OHCA patients with hyperoxia at hospital admission. Conclusions Currently, different criteria are used to define hyperoxia following OHCA, but if the negative effects of hyperoxia in OHCA patients are a cumulative effect over time, hyperoxia < 60 min after hospital admission as investigated in this study would be equivalent to a short period of hyperoxia. It may be that the positive effect of buffering metabolic acidosis early after cardiac arrest maintains the negative effects of hyperoxia in general. PMID:27638399

  10. 46 CFR 108.209 - Hospital spaces. (United States)


    ... 46 Shipping 4 2010-10-01 2010-10-01 false Hospital spaces. 108.209 Section 108.209 Shipping COAST... Construction and Arrangement Accommodation Spaces § 108.209 Hospital spaces. (a) Each unit carrying twelve or more persons on a voyage of more than three days must have a hospital space. (b) Each hospital...

  11. Report: hospitals need more sophisticated planning efforts. (United States)

    Anderson, H J


    Sophisticated planning efforts are increasing among hospitals. However, hospital planners and marketers still have far to go before they can match their counterparts in industry. This is according to a report on hospital planning recently released by the Society for Healthcare Planning and Marketing of the American Hospital Association, Chicago.

  12. Hospitality and its Ambivalences : On Zygmunt Bauman

    NARCIS (Netherlands)

    Welten, R.B.J.M.


    Hospitality is often understood as an ethical openness towards the other. Hospitality, in this way, is a gift. But is this really the situation of hospitality in the world today? Europeans have created another, bespoke hospitality and they insist on being given a generous welcome all over the world

  13. Solid waste management in the hospitality industry: a review. (United States)

    Pirani, Sanaa I; Arafat, Hassan A


    Solid waste management is a key aspect of the environmental management of establishments belonging to the hospitality sector. In this study, we reviewed literature in this area, examining the current status of waste management for the hospitality sector, in general, with a focus on food waste management in particular. We specifically examined the for-profit subdivision of the hospitality sector, comprising primarily of hotels and restaurants. An account is given of the causes of the different types of waste encountered in this sector and what strategies may be used to reduce them. These strategies are further highlighted in terms of initiatives and practices which are already being implemented around the world to facilitate sustainable waste management. We also recommended a general waste management procedure to be followed by properties of the hospitality sector and described how waste mapping, an innovative yet simple strategy, can significantly reduce the waste generation of a hotel. Generally, we found that not many scholarly publications are available in this area of research. More studies need to be carried out on the implementation of sustainable waste management for the hospitality industry in different parts of the world and the challenges and opportunities involved.

  14. Achieving hospital operating objectives in the light of patient preferences. (United States)

    Ramirez Valdivia, M T; Crowe, T J


    Patient satisfaction is becoming increasingly important for the successful operation of private and public hospitals. The quality of the service provided can be improved if internal and external customers' opinions are taken into account during the definition of hospital operating objectives. This research presents a new methodology, called the simulation service quality system (SSQS), developed to improve operating performance measures in the light of customer preferences. The motivation for the development of the SSQS methodology arose from the need to achieve timeliness standards at United States Veterans' Hospitals. The Harry S. Truman Memorial Veterans' Hospital in Columbia Missouri served as the validation and initial application site for the SSQS methodology. Details one such project: the objective of reducing customer waiting times to 30 minutes or less at an outpatient treatment clinic. Through the identification of relationships and interactions, discrete-event simulation techniques are applied to model and experiment with the system to ultimately arrive at recommended changes in hospital operating policies which achieve the objective.

  15. Management of Hyperglycemia and Enteral Nutrition in the Hospitalized Patient. (United States)

    Davidson, Patricia; Kwiatkowski, Cynthia Ann; Wien, Michelle


    There has been increased attention on the importance of identifying and distinguishing the differences between stress-induced hyperglycemia (SH), newly diagnosed hyperglycemia (NDH), and hyperglycemia in persons with established diabetes mellitus (DM). Inpatient blood glucose control is now being recognized as not only a cost issue for hospitals but also a concern for patient safety and care. The reasons for the increased incidence of hyperglycemia in hospitalized patients include preexisting DM, undiagnosed DM or prediabetes, SH, and medication-induced hyperglycemia with resulting transient blood glucose variability. It is clear that identifying and documenting hyperglycemia in hospitalized patients with and without a previous diagnosis of DM and initiating prompt insulin treatment are important. Agreement on the optimum treatment goals for hyperglycemia remains quite controversial, and the benefits of intensive glucose management may be lost at the cost of hypoglycemia in intensive care unit patients. Nutrition support in the form of enteral nutrition (EN) increases the risk of hyperglycemia in both critical and non-critically ill hospitalized patients. Reasons for beginning a tube feeding are the same whether a person has NDH or DM. What differs is how to incorporate EN into the established insulin management protocols. The risk for hyperglycemia with the addition of EN is even higher in those without a previous diagnosis of DM. This review discusses the incidence of hyperglycemia, the pathogenesis of hyperglycemia, factors contributing to hyperglycemia in the hospitalized patient, glycemic management goals, current glycemic management recommendations, and considerations for EN formula selection, administration, and treatment.

  16. Measuring gain-sharing dividends in acute care hospitals. (United States)

    Barbusca, A; Cleek, M


    Hospitals have responded to industry consolidation by increasing productivity with nonmanagement, group-incentive compensation, known as gain sharing. A nationwide study conducted to obtain quantitative performance data for gain-sharing programs revealed that they are most successful during the initial stages of the program. Many variables affect the size of employee bonuses and the duration of employee support. Employers must identify how to appropriately install their gain-sharing program so that employee motivation, participation, and trust in management are maximized.

  17. Impact of hospital accreditation on patients' safety and quality indicators


    Al-Awa, Bahjat


    Ecole de Santé Publique Université Libre de Bruxelles Academic Year 2010-2011 Al-Awa, Bahjat Impact of Hospital Accreditation on Patients' Safety and Quality Indicators Dissertation Summary I. Introduction: There is increased interest around the world in the evaluation of healthcare, coming not only from governments, but also from providers and consumers [1]. Therefore initiatives to address quality of health care have become worldwide phenomena [2]. As quality is crucial fa...


    Energy Technology Data Exchange (ETDEWEB)

    Peters, John; McCloskey, Jay; Douglas, Trevor; Young, Mark; Snyder, Stuart; Gurney, Brian


    Project Objective: The overarching objective of the Montana Palladium Research Initiative is to perform scientific research on the properties and uses of palladium in the context of the U.S. Department of Energy's Hydrogen, Fuel Cells and Infrastructure Technologies Program. The purpose of the research will be to explore possible palladium as an alternative to platinum in hydrogen-economy applications. To achieve this objective, the Initiatives activities will focus on several cutting-edge research approaches across a range of disciplines, including metallurgy, biomimetics, instrumentation development, and systems analysis. Background: Platinum-group elements (PGEs) play significant roles in processing hydrogen, an element that shows high potential to address this need in the U.S. and the world for inexpensive, reliable, clean energy. Platinum, however, is a very expensive component of current and planned systems, so less-expensive alternatives that have similar physical properties are being sought. To this end, several tasks have been defined under the rubric of the Montana Palladium Research Iniative. This broad swath of activities will allow progress on several fronts. The membrane-related activities of Task 1 employs state-of-the-art and leading-edge technologies to develop new, ceramic-substrate metallic membranes for the production of high-purity hydrogen, and develop techniques for the production of thin, defect-free platinum group element catalytic membranes for energy production and pollution control. The biomimetic work in Task 2 explores the use of substrate-attached hydrogen-producing enzymes and the encapsulation of palladium in virion-based protein coats to determine their utility for distributed hydrogen production. Task 3 work involves developing laser-induced breakdown spectroscopy (LIBS) as a real-time, in situ diagnostic technique to characterize PGEs nanoparticles for process monitoring and control. The systems engineering work in task 4

  19. Fluid fragmentation from hospital toilets

    CERN Document Server

    Traverso, G; Lu, C -C; Maa, R; Langer, R; Bourouiba, L


    Hospital-acquired infections represent significant health and financial burdens to society. Clostridium difficile (C. difficile) is a particularly challenging bacteria with the potential to cause severe diarrhea and death. One mode of transmission for C. difficile, as well as other pathogens, which has received little attention is the potential air contamination by pathogen-bearing droplets emanating from toilets. In the fluid dynamics video submitted to the APS DFD Gallery of Fluid Motion 2013, we present flow visualizations via high-speed recordings showing the capture of the product of the fluid fragmentation generated by hospital toilet high-pressure flushes. Important quantities of both large and small droplets are observed. We illustrate how high-pressure flushes and cleaning products currently used in hospital toilets result in aggravating, rather than alleviating, the suspension and recirculation of tenacious airborne pathogen-bearing droplets.

  20. Light Therapy in Mental Hospitals. (United States)

    Cormac, H D


    The position of actinotherapy in Mental Hospitals in this country is reviewed. An investigation of the results of ultra-violet irradiation in mental disorders at Parkside Mental Hospital is described and it is shown that certain types of the psychoses appear to benefit. The physiological action of actinic rays in relation to mental disorders is discussed and their mode of action on the nervous system suggested. Reference is made to substances which sensitize the body tissues to sunlight and ultra-violet radiation. An allusion is made to glass, penetrable by a portion of the actinic rays, and its uses. The need for ultra-violet ray apparatus in every mental hospital is urged both for treatment of mental and physical conditions and for the study of its action.

  1. Mobile Robots for Hospital Logistics

    DEFF Research Database (Denmark)

    Özkil, Ali Gürcan

    be and will be automated using mobile robots. This talk consequently addresses the key technical issues of implementing service robots in hospitals. In simple terms, a robotic system for automating hospital logistics has to be reliable, adaptable and scalable. Robots have to be semi-autonomous, and should reliably...... for localization. The system features automatic annotation, which significantly reduces manual work and offer many advantages beyond robotics. A case study on logistics solutions is finally presented. A robotic solution is tested in a hospital to handle the transportation of blood samples between the clinic...... and the lab. Without any environmental modification; it is shown that lab turnover time can be reduced from hours to minutes; by simply replacing the human porter with a mobile robot....

  2. Scientific Component Technology Initiative

    Energy Technology Data Exchange (ETDEWEB)

    Kohn, S; Bosl, B; Dahlgren, T; Kumfert, G; Smith, S


    The laboratory has invested a significant amount of resources towards the development of high-performance scientific simulation software, including numerical libraries, visualization, steering, software frameworks, and physics packages. Unfortunately, because this software was not designed for interoperability and re-use, it is often difficult to share these sophisticated software packages among applications due to differences in implementation language, programming style, or calling interfaces. This LDRD Strategic Initiative investigated and developed software component technology for high-performance parallel scientific computing to address problems of complexity, re-use, and interoperability for laboratory software. Component technology is an extension of scripting and object-oriented software development techniques that specifically focuses on the needs of software interoperability. Component approaches based on CORBA, COM, and Java technologies are widely used in industry; however, they do not support massively parallel applications in science and engineering. Our research focused on the unique requirements of scientific computing on ASCI-class machines, such as fast in-process connections among components, language interoperability for scientific languages, and data distribution support for massively parallel SPMD components.

  3. The new childcare initiative

    CERN Document Server

    Cigdem Issever

    The ATLAS Women's Network recently sent out a general mailing to all ATLAS and CMS members to announce a new initiative aimed at improving childcare facilities for Users coming to CERN. Several people have expressed the need that CERN should provide or facilitate affordable day care for children of temporary visitors at CERN. The ATLAS Women's Network is now forming a child care task force from concerned people and invites all those interested to join this effort. You can do so by either adding your name to the mailing list in Simba or by contacting and More than 50 people have already joined this effort. Those who have joined the mailing list will soon receive all the details about the next conference call meeting which has been scheduled for Thursday October 25th from 16:30 to 18:00 CERN time. The preliminary agenda is the following: Summary of our first contact of ATLAS and CMS (5 min) Discussion about the co-conv...

  4. ALOS-2 initial results (United States)

    Kankaku, Yukihiro; Suzuki, Shinichi; Shimada, Masanobu


    The Advanced Land Observing Satellite-2 (ALOS-2) was launched from Tanegashima Space Center by H-IIA rocket successfully on 24th May 2014. ALOS-2 carries the Phased Array type L-band Synthetic Aperture Radar-2 (PALSAR-2) as the state-of-the-art L-band SAR system which succeeds to PALSAR onboard ALOS. PALSAR-2 uses almost whole bandwidth allocated for L-band active sensor of Earth Exploration Satellites Service specified by the Radio Regulation in order to realize the high resolution observation, and also, it transmits more than 6 kW power for lower Noise Equivalent Sigma Zero using 180 TRMs driven by Gallium Nitride (GaN) amplifier which is the first use in space. Furthermore, because ALOS-2 carries the SAR system only, PALSAR-2 antenna can be mounted under the satellite body. It enables to observe right-/left-looking observation by satellite maneuvering. And the high accuracy orbit control to maintain the satellite within 500 m radius tube against the reference orbit enables high coherence for the InSAR processing. Using these new technologies, ALOS-2 has been operating to fulfill the mission requirements such as disaster monitoring and so on. This document introduces the initial result of ALOS-2 from the first year operation.

  5. Hospital-integrated PACS at the University Hospital of Geneva (United States)

    Ratib, Osman M.; Ligier, Yves; Hochstrasser, Denis; Scherrer, Jean-Raoul


    The PACS under development at the University Hospital of Geneva is a hospital-wide image management system for radiological as well as non-radiological medical images which is part of one of the widest hospital information systems (HIS) in Switzerland (Diogene system). It is based on a multi-vendor open architecture and a set of widely available industry standards, namely: Unix as the operating system, TCP-IP as network protocol and an SQL-based distributed database (INGRES) that handles both the PACS and the HIS. The PACS is based on a distributed architecture of servers of two types: the archive servers connected to the sources of images and equipped with large optical disk libraries (jukeboxes) and display servers distributed over the hospital. A standard image storage format was developed based on the ACR-NEMA standard. This file format (the PAPYRUS format) allows storage of sets of images as a sequence of ACR-NEMA messages in an 'encapsulated' file structure. In order to provide a more uniform user interface on a variety of different workstations, a common platform for image display and manipulation called OSIRIS is developed based on X-11 windowing system and OSF/Motif extension. Such a platform is designed to be portable to any computer running Unix and equipped with a graphic display system running X-11. Because this software is written in the object-oriented language C++, it is easily expandable and easily adaptable to different needs and requirements.

  6. Field guide to hospital cafeterias. (United States)

    Smith, R P


    We have all faced the problem of whether or not to venture into that gastronomic wasteland known as the hospital cafeteria. Hospital cafeterias have developed a reputation, deserved or otherwise, as less than ideal places to eat. Many people overlook the fact that this is a direct result of trying to provide patient meals that are salt-free, sugar-free, fiber-free, and taste-free. (Some faint traces of color may, occasionally, be found.) How then does one go about choosing whether to venture in, and how does one survive the encounter once there? The following guide has been assembled to help the reader through this difficult process.

  7. St. James Hospital. Lutcher, Louisiana

    Directory of Open Access Journals (Sweden)

    Curtis & Davis, Arquitectos


    Full Text Available Un hospital debe estar proyectado, especialmente, para la comodidad y el cuidado de los enfermos. Atendiendo a este postulado, en el hospital St. James se ha buscado que los dormitorios se orienten al sur, y que desde ellos puedan apreciarse a través de amplias superficies acristaladas, la belleza del paisaje circundante. El gran ventanal corrido que compone la fachada meridional está protegido con parteluces giratorios verticales, que cada paciente puede abrir o cerrar a voluntad desde la misma cama.

  8. Evaluation methods for hospital projects. (United States)

    Buelow, Janet R; Zuckweiler, Kathryn M; Rosacker, Kirsten M


    The authors report the findings of a survey of hospital managers on the utilization of various project selection and evaluation methodologies. The focus of the analysis was the empirical relationship between a portfolio of project evaluation(1) methods actually utilized for a given project and several measures of perceived project success. The analysis revealed that cost-benefit analysis and top management support were the two project evaluation methods used most often by the hospital managers. The authors' empirical assessment provides evidence that top management support is associated with overall project success.

  9. Por um hospital mais urbano


    Figueiredo, Ana Teresa


    Dissertação de Mestrado Integrado em Arquitectura, apresentada ao Departamento de Arquitectura da F. C. T. da Univ. de Coimbra. A partir do século XX, uma nova linguagem, proveniente da revolução industrial, torna-se transversal a todo o discurso arquitectónico. O hospital pavilhonar é substituído por uma nova tipologia – o hospital vertical. Com o acelerado crescimento urbano proveniente do processo de industrialização das cidades, as novas construções hospitalares tendem a oc...


    Directory of Open Access Journals (Sweden)

    Kanwal Nasim


    Full Text Available Management of hospitals should take initiatives to improve the overall service quality of patient care. Regular feed-back from patients should be taken and rules should be made considering the expectations and requirements of patients. This study attempts to examine the satisfaction of patients from service quality they received from hospitals. Moreover, satisfaction is measured in both public and private hospital.

  11. 76 FR 25550 - Medicare and Medicaid Programs: Changes Affecting Hospital and Critical Access Hospital... (United States)


    ... and Medicaid Programs: Changes Affecting Hospital and Critical Access Hospital Conditions of...) for both hospitals and critical access hospitals (CAHs). The final rule will implement a new.... Currently, a hospital or CAH receiving telemedicine services must go through a burdensome credentialing...

  12. Epidemiology of hospitalized pediatric glaucoma patients in Beijing Tongren Hospital

    Institute of Scientific and Technical Information of China (English)

    QIAO Chun-yan; WANG Liang-hai; TANG Xin; WANG Tao; YANG Di-ya; WANG Ning-li


    Background No population-based assessment of the prevalence and incidence of pediatric glaucoma in China are available. Here we describe the spectrum of hospitalized pediatric glaucoma patients in Beijing Tongren Hospital in China.Methods We reviewed the charts of pediatric patients, from birth to 18 years old, with a discharge diagnosis of glaucoma in Beijing Tongren Hospital, from 2002 to 2008. All children were admitted for anti-glaucoma surgery, treating the sequelae of the glaucoma, or managing postoperative complications. We evaluated the demographic characteristics and the proportion of different glaucoma subtypes.Results Pediatric patients (n=1452) accounted for 12.91% of the total glaucoma in-patients from 2002 to 2008, and at last data of pediatric glaucoma were presented for 1055 children who came from 28 provinces, municipalities and autonomous regions in China. Boys were more common in all subtypes and et all ages, with a total ratio of boys to girls of 2.32:1. Congenital glaucoma was the most common subtype, accounting for 46.07% in all patients and accounting for 69.95% in children under 3 years of age. The median presenting age of congenital glaucoma patients was 2 years.Patients with traumatic glaucoma were the second most common group (n=128, 12.13%), and presented at older age (the median presenting age was 11 years). The majority of traumatic glaucoma occurred in children between 10 and 15 years of age (n=72, 56.25%). Aphakic glaucoma was the third most common (9.19%) subtype.Conclusions Congenital glaucoma is the most prevalent glaucoma subtype in hospitalized pediatric patients in Beijing Tongren Hospital. The prevention and treatment of traumatic glaucoma can reduce the incidence of visual damage in developing countries. Close follow-up for glaucoma is important after pediatric cataract surgery.

  13. Initial Cladding Condition

    Energy Technology Data Exchange (ETDEWEB)

    E. Siegmann


    The purpose of this analysis is to describe the condition of commercial Zircaloy clad fuel as it is received at the Yucca Mountain Project (YMP) site. Most commercial nuclear fuel is encased in Zircaloy cladding. This analysis is developed to describe cladding degradation from the expected failure modes. This includes reactor operation impacts including incipient failures, potential degradation after reactor operation during spent fuel storage in pool and dry storage and impacts due to transportation. Degradation modes include cladding creep, and delayed hydride cracking during dry storage and transportation. Mechanical stresses from fuel handling and transportation vibrations are also included. This Analysis and Model Report (AMR) does not address any potential damage to assemblies that might occur at the YMP surface facilities. Ranges and uncertainties have been defined. This analysis will be the initial boundary condition for the analysis of cladding degradation inside the repository. In accordance with AP-2.13Q, ''Technical Product Development Planning'', a work plan (CRWMS M&O 2000c) was developed, issued, and utilized in the preparation of this document. There are constraints, caveats and limitations to this analysis. This cladding degradation analysis is based on commercial Pressurized Water Reactor (PWR) fuel with Zircaloy cladding but is applicable to Boiling Water Reactor (BWR) fuel. Reactor operating experience for both PWRs and BWRs is used to establish fuel reliability from reactor operation. It is limited to fuel exposed to normal operation and anticipated operational occurrences (i.e. events which are anticipated to occur within a reactor lifetime), and not to fuel that has been exposed to severe accidents. Fuel burnup projections have been limited to the current commercial reactor licensing environment with restrictions on fuel enrichment, oxide coating thickness and rod plenum pressures. The information provided in this analysis

  14. Sustainable Forest Bioenergy Initiative

    Energy Technology Data Exchange (ETDEWEB)

    Breger, Dwayne; Rizzo, Rob


    In the state’s Electricity Restructuring Act of 1998, the Commonwealth of Massachusetts recognized the opportunity and strategic benefits to diversifying its electric generation capacity with renewable energy. Through this legislation, the Commonwealth established one of the nation’s first Renewable Energy Portfolio Standard (RPS) programs, mandating the increasing use of renewable resources in its energy mix. Bioenergy, meeting low emissions and advanced technology standards, was recognized as an eligible renewable energy technology. Stimulated by the state’s RPS program, several project development groups have been looking seriously at building large woody biomass generation units in western Massachusetts to utilize the woody biomass resource. As a direct result of this development, numerous stakeholders have raised concerns and have prompted the state to take a leadership position in pursuing a science based analysis of biomass impacts on forest and carbon emissions, and proceed through a rulemaking process to establish prudent policy to support biomass development which can contribute to the state’s carbon reduction commitments and maintain safeguards for forest sustainability. The Massachusetts Sustainable Forest Bioenergy Initiative (SFBI) was funded by the Department of Energy and started by the Department of Energy Resources before these contentious biomass issues were fully raised in the state, and continued throughout the substantive periods of this policy development. Thereby, while SFBI maintained its focus on the initially proposed Scope of Work, some aspects of this scope were expanded or realigned to meet the needs for groundbreaking research and policy development being advanced by DOER. SFBI provided DOER and the Commonwealth with a foundation of state specific information on biomass technology and the biomass industry and markets, the most comprehensive biomass fuel supply assessment for the region, the economic development impact

  15. Tratamento endovascular do aneurisma da aorta abdominal infrarrenal em pacientes com anatomia favorável para o procedimento: experiência inicial em um serviço universitário Endovascular treatment of infrarenal abdominal aortic aneurysm in patients with favorable anatomy for the repair: initial experience in a university hospital

    Directory of Open Access Journals (Sweden)

    José Manoel da Silva Silvestre


    Full Text Available CONTEXTO: Desde sua introdução, em 1991, o reparo endovascular do aneurisma da aorta abdominal infrarrenal tem se tornado uma alternativa atraente para o tratamento dessa doença. Avaliar nossos resultados iniciais quanto à segurança e eficácia dessa técnica nos levou à realização deste estudo. OBJETIVOS: Analisar a mortalidade perioperatória, a sobrevida tardia, as reoperações, as taxas de perviedade e o comportamento do saco aneurismático em pacientes com anatomia favorável para a realização do procedimento. MÉTODOS: Trata-se de um estudo longitudinal, observacional e retrospectivo realizado entre outubro de 2004 e janeiro de 2009 com 41 pacientes que foram submetidos à correção endovascular do aneurisma de aorta abdominal infrarrenal por apresentarem anatomia favorável para o procedimento. Foram analisados os achados dos exames diagnósticos, o tratamento e o seguimento em todos os pacientes. RESULTADOS: Foram implantadas, com sucesso, 31 (75,6% próteses bifurcadas e 10 (24,5% monoilíacas, de 5 diferentes marcas. O diâmetro médio dos aneurismas fusiformes era de 62 mm. A mortalidade perioperatória foi de 4,8% e a sobrevida tardia, 90,2%. Durante o acompanhamento médio de 30 meses, 2 (4,8% pacientes necessitaram de reintervenção, um por migração da endoprótese e outro por vazamento tipo II. Dois (4,8% pacientes apresentaram oclusão de ramo da prótese. Oito (19,5% vazamentos foram diagnosticados e não houve nenhuma rotura dos aneurismas. CONCLUSÃO: Apesar do pequeno número de pacientes, os resultados observados parecem justificar a realização do procedimento endovascular nos pacientes com anatomia favorável.BACKGROUND: Since its introduction in 1991, endovascular repair of infrarenal aortic aneurysms has become an attractive option to treat this disease. The evaluation of our initial results about safety and efficacy of this technique has led us to carry out this study. OBJECTIVES: To analyze

  16. Antidepressant utilization after hospitalization with depression

    DEFF Research Database (Denmark)

    Wallach-Kildemoes, Helle; Thomsen, Louise Thirstrup; Kriegbaum, Margit;


    BACKGROUND: Antidepressant (AD) therapy is recommended for patients 4-12 months after remission from depression. The aim was to examine whether immigrants (refugees or family reunited immigrants) from non-Western countries are at greater risk than Danish-born residents of 1) not initiating AD the...... only minor impact on these associations. CONCLUSION: Immigrants seem less likely to receive the recommended AD treatment after hospitalization with depression. This may indicate a need for a better understanding of the circumstances of this vulnerable group.......BACKGROUND: Antidepressant (AD) therapy is recommended for patients 4-12 months after remission from depression. The aim was to examine whether immigrants (refugees or family reunited immigrants) from non-Western countries are at greater risk than Danish-born residents of 1) not initiating AD...... therapy after discharge and 2) early AD discontinuation. METHODS: A cohort of immigrants from non-Western countries (n = 132) and matched Danish-born residents (n = 396) discharged after first admission with moderate to severe depression between 1 January 1996 and 31 May 2008 was followed in the Danish...

  17. Antidepressant utilization after hospitalization with depression

    DEFF Research Database (Denmark)

    Wallach-Kildemoes, Helle; Thomsen, Louise Thirstrup; Kriegbaum, Margit;


    Background: Antidepressant (AD) therapy is recommended for patients 4-12months after remission from depression. The aim was to examine whether immigrants (refugees or family reunited immigrants) from non-Western countries are at greater risk than Danish-born residents of 1) not initiating AD ther...... treatment after hospitalization with depression. This may indicate a need for a better understanding of the circumstances of this vulnerable group.......Background: Antidepressant (AD) therapy is recommended for patients 4-12months after remission from depression. The aim was to examine whether immigrants (refugees or family reunited immigrants) from non-Western countries are at greater risk than Danish-born residents of 1) not initiating AD...... therapy after discharge and 2) early AD discontinuation. Methods: A cohort of immigrants from non-Western countries (n=132) and matched Danish-born residents (n=396) discharged after first admission with moderate to severe depression between 1 January 1996 and 31 May 2008 was followed in the Danish...



    Saxena, Shekhar; Mohan, D.


    SUMMARY The present paper documents and discusses the rapid increase in the problem of heroin dependence in the city of Delhi in the recent years. Initial observations on patients with heroin dependence attending the Deaddiction Clinic of a large general hospital are described with difficulties encountered in the clinical management of these patients. It is suggested that sustained efforts be made to control this problem because heroin is likely to give rise to medical and social consequences...

  19. 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)


    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

  20. Nurse perceptions of safety climate in Australian acute hospitals: a cross-sectional survey. (United States)

    Soh, Sze-Ee; Morello, Renata; Rifat, Sheral; Brand, Caroline; Barker, Anna


    implications for practitioners? Programs or strategies that aim to enhance teamwork performance and skills may be beneficial to improving the culture of safety in hospitals. Wards may also have their own safety 'subculture' that is distinct from the overall hospital safety culture. This highlights the importance of tailoring and targeting quality improvement initiatives at the ward level.

  1. 30-Day Survival Probabilities as a Quality Indicator for Norwegian Hospitals: Data Management and Analysis.

    Directory of Open Access Journals (Sweden)

    Sahar Hassani

    for AMI in 2011 varied from 80.6% (in the hospital with lowest estimated survival to 91.7% (in the hospital with highest estimated survival, whereas it ranged from 83.8% to 91.2% in 2013.Since 2011, several hospitals and hospital trusts have initiated quality improvement projects, and some of the hospitals have improved the survival over these years. Public reporting of survival/mortality indicators are increasingly being used as quality measures of health care systems. Openness regarding the methods used to calculate the indicators are important, as it provides the opportunity of critically reviewing and discussing the methods in the literature. In this way, the methods employed for establishing the indicators may be improved.

  2. Hospital de Morges – Suiza

    Directory of Open Access Journals (Sweden)

    Bosshabdt, E.


    Full Text Available This hospital basically serves the districts of Aubonne and Morges and partly those of Cossonay and Rolle. It comprises a block of six storeys, with the actual hospital, and another one of five storeys with a college for nurses and male nurses; both of them equipped with the latest inventions with regard to technique and comfort. Both centres mutually use the service installations and the rooms that the other building disposes of, for a more rational utilization of the investment made. The complex has a magnificent location in a natural environment. The construction is traditional, the structure being of reinforced concrete and the finishing of high quality.Este hospital atiende fundamentalmente a los distritos Aubonne y Morges y, parcialmente, a los de Cossonay y Rolle. Consta de un bloque de seis plantas, como hospital propiamente dicho, y otro de cinco plantas, para escuela de enfermeras y enfermeros asistentes; ambos dotados con los últimos adelantos de la técnica y el confort. Uno y otro centro utilizan, recíprocamente, los servicios y locales de que disponen, para un más racional aprovechamiento de la inversión realizada. El conjunto está magníficamente ambientado en el entorno natural que lo rodea. La construcción es tradicional, con estructura de hormigón armado y acabados de gran calidad.

  3. Usability Briefing for hospital design

    DEFF Research Database (Denmark)

    Fronczek-Munter, Aneta

    This PhD thesis is a contribution to an ongoing debate in Denmark about improving the building design processes of complex buildings, especially in relation to the current hospital developments. It provides knowledge about capturing user needs and defines the process model for usability briefing ...... of complex buildings, such as hospitals. The research results have relevance to researchers, architects, facility managers and client organizations planning new complex facilities, and especially for professionals working with briefing and design of hospitals.......This PhD thesis is a contribution to an ongoing debate in Denmark about improving the building design processes of complex buildings, especially in relation to the current hospital developments. It provides knowledge about capturing user needs and defines the process model for usability briefing...... and evaluations, can be fed into briefing and design processes. This PhD thesis proposes methods for usability briefing.Usability is a concept similar to functionality, but usability depends on: subjective view of users, context, culture, situation and experience. Understanding usability is achieved by involving...

  4. Hospitalized Older Adults’ Patient Satisfaction

    Directory of Open Access Journals (Sweden)

    Neale R. Chumbler


    Full Text Available This article examines the extent to which older adult patients’ perceptions of inpatient dimensions of care experiences are associated with their overall satisfaction. A secondary objective is to determine if these specific care experiences differed between elderly female and male patients. Patient satisfaction data from 6,021 older patients (65 years of age and older were collected by using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS Survey through telephone interviews of older patients who were recently discharged. Multiple linear regression analyses with older patients’ HCAHPS dimensions (Communication With Nurses, Communication With Doctors, Responsiveness of Hospital Staff, Communication About Medicines, Cleanliness of the Hospital Environment, and Quietness of Hospital Environment and gender were conducted while controlling for self-rated health status, age, race, and education. Multiple linear regression analysis showed that all of the HCAHPS dimensions were significantly associated with overall satisfaction. Older female patients reported substantially more positive global evaluations than their male counterparts. However, for older male patients, Communication With Doctors was more influential in their ratings of overall satisfaction than for older female patients. For older female patients, Communication With Nurses was more influential in their ratings of overall satisfaction than for older male patients.

  5. Præhospital ultralyd

    DEFF Research Database (Denmark)

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


    Danish anaesthesiologists use ultrasound (US) to examine and treat acutely ill or traumatized patients in the emergency room, operating theatre and intensive care unit. They are also involved in pre-hospital care where US may theoretically be beneficial for both diagnostic and therapeutic purpose...

  6. Organizing for the Collaborative Hospital

    DEFF Research Database (Denmark)

    Prætorius, Thim; Hasle, Peter; Nielsen, Anders Paarup

    To meet demands for high quality and efficient care, hospitals increasingly organize horizontally around standardized processes (like lean and care pathways) and/or set-up formal structural arrangements such as using performance boards, having daily huddles or assigning specific roles. This trend...

  7. Displacement Ventilation in Hospital Environments

    DEFF Research Database (Denmark)

    Li, Yuguo; Nielsen, Peter V.; Sandberg, Mats


    Hospital differ from conventional buildings in terms of ventilation needs. Exhaled infectious droplets or droplet nuclei of an infected patient need to be removed in general wards, waiting areas and isolation rooms to minimize transmission to health-care workers, other patients and visitors...

  8. Antifungal therapy in European hospitals

    DEFF Research Database (Denmark)

    Zarb, P; Amadeo, B; Muller, A;


    respiratory (19.2%) and gastrointestinal (18.8%). The most used antifungal was fluconazole (60.5%) followed by caspofungin (10.5%). Antifungal-antibacterial combinations were frequently used (77.5%). The predominance of fluconazole use in participating hospitals could result in an increase in prevalence...

  9. Hospital mutual aid evacuation plan. (United States)

    Phillips, R


    Health care facilities need to be prepared for disasters such as floods, tornadoes and earthquakes. Rochester, NY, and its surrounding communities devised a hospital mutual aid evacuation plan in the event a disaster occurs and also to comply with the Joint Commission. This document discusses the plan's development process and also provides the end result.

  10. Facts about Hospital Worker Safety (United States)

    ... 2000. 1 According to the Bureau of Labor Statistics, the healthcare industry as a whole is projected to add 5. ... hospitals (see Section 2). 1 Bureau of Labor Statistics. Current Population Survey. Employed Persons by Detailed Industry, Sex, and Age. www. bls. gov/ cps/ demographics. ...

  11. Smart Hospital based on Internet of Things

    Directory of Open Access Journals (Sweden)

    Lei Yu


    Full Text Available In this paper, we propose an architecture and a scheme of smart hospital based on Internet of Things (IOT in order to overcome the disadvantages of the present hospital information system, such as the fixed information point, inflexible networking mode and so on. The key technologies and construction of smart hospital is presented based on understanding of the connotation and architecture of smart hospital. Furthermore, taking a third grade-A hospital as an example, a scheme of smart hospital is given, and its logic structure, application framework, the construction of basic network environment etc. are described in detail. Experiment proves that deployment of smart hospital can effectively solve the prominent problems existing the diagnosis and treatment of hospital and it brings a positive and profound effect for the present diagnosis and treatment mode in hospital.

  12. Measuring efficiency among US federal hospitals. (United States)

    Harrison, Jeffrey P; Meyer, Sean


    This study evaluates the efficiency of federal hospitals, specifically those hospitals administered by the US Department of Veterans Affairs and the US Department of Defense. Hospital executives, health care policymakers, taxpayers, and federal hospital beneficiaries benefit from studies that improve hospital efficiency. This study uses data envelopment analysis to evaluate a panel of 165 federal hospitals in 2007 and 157 of the same hospitals again in 2011. Results indicate that overall efficiency in federal hospitals improved from 81% in 2007 to 86% in 2011. The number of federal hospitals operating on the efficiency frontier decreased slightly from 25 in 2007 to 21 in 2011. The higher efficiency score clearly documents that federal hospitals are becoming more efficient in the management of resources. From a policy perspective, this study highlights the economic importance of encouraging increased efficiency throughout the health care industry. This research examines benchmarking strategies to improve the efficiency of hospital services to federal beneficiaries. Through the use of strategies such as integrated information systems, consolidation of services, transaction-cost economics, and focusing on preventative health care, these organizations have been able to provide quality service while maintaining fiscal responsibility. In addition, the research documented the characteristics of those federal hospitals that were found to be on the Efficiency Frontier. These hospitals serve as benchmarks for less efficient federal hospitals as they develop strategies for improvement.

  13. Peptic ulcers: mortality and hospitalization. (United States)

    Riley, R


    This study analyzes data on peptic ulcer disease based on deaths for 1951-1988 and hospital separations for 1969-1988. The source of the data are mortality and morbidity statistics provided to Statistics Canada by the provinces. The age-standardized mortality rates (ASMR) for peptic ulcer disease decreased from 1951 to 1988 by 69.4% for men (8.5 to 2.6 per 100,000 population), and 31.8% for women (2.2 to 1.5). Separation rates from hospitals during 1969-1988 for peptic ulcer disease also decreased by 59.8% for men (242.7 to 97.6 per 100,000 population) and 35.6% for women (103.2 to 66.5). Age-specific rates for both mortality and hospital separations increased with age. Epidemiological studies indicate that the incidence of peptic ulcer disease is declining in the general population. The downward trends in mortality and hospitalization rates for peptic ulcer disease reflect this change in incidence, but additional factors probably contribute as well to this decline. Male rates for both mortality and hospital separations were much higher than female rates at the beginning of the study period; but toward the end, the gap between the sexes narrowed considerably, mainly because the male rates declined substantially while the female rates decline moderately. The slower decline in the rates for women may be related to such factors as the increasing labour force participation among women and the slower decline in the population of female smokers.

  14. Nursing: the hospital's competitive edge. (United States)

    Shaffer, F A; Preziosi, P


    The health care marketplace is becoming increasingly competitive. The hospital has a built-in marketing force with the nursing department, because nurses are in constant, direct contact with the customer. Nursing must identify the case mix profile of the community and focus the hospital product lines to meet community needs. The nursing department should decentralize, change, measure, and innovate the staff mix needed to operationalize these product lines. The development of nursing practice standards for the case mix will help to identify the staff mix needed and create systems to efficiently manage the product lines. Nursing management must become aware of cross-subsidization and downward skill substitution of nursing personnel. Nursing information systems must generate quality reports that invoke cost consciousness on the part of nursing staff. Quality assurance programs must become unit based and complete with frequent audits to correlate length of stay with nursing quality. Correlations must be determined between nursing productivity and case mix to determine the hospital's niche in the marketplace. The transformation of health care into a competitive business industry has created many opportunities for nursing. The health care industry's incentives for efficiency along with the decreasing demand for inpatient hospital services will be the forces driving health care toward a competitive marketplace. The hospital's nursing department should be strategically positioned to become accountable for increasing market share and enhancing quality patient outcomes. The focus has shifted from the theoretical to the tactical, which is a step in the right direction, particularly for nursing. Nursing, if strategically positioned, will not only thrive but will also excel in this chaotic environment by capturing the opportunities and being innovative.

  15. Risk factors for recurrent hospital-acquired Clostridium difficile infection in a Japanese university hospital

    Directory of Open Access Journals (Sweden)

    Hikone M


    Full Text Available Mayu Hikone,1 Yusuke Ainoda,1,2 Sayaka Tago,2 Takahiro Fujita,2 Yuji Hirai,2 Kaori Takeuchi,2 Kyoichi Totsuka31Department of Infectious Diseases, Tokyo Metropolitan Bokutoh General Hospital, 2Department of Infectious Diseases, Tokyo Women's Medical University, 3Department of Internal Medicine, Kitatama Hospital, Tokyo, JapanBackground: Clostridium difficile infection (CDI is a highly prevalent hospital-associated infection. Although most patients respond well to discontinuation of antibiotics, 20%–30% of patients relapse. To initiate early therapeutic measures, the risk factors for recurrent CDI must be identified, although very few Japanese studies have used standard surveillance definitions to identify these risk factors.Methods: We retrospectively reviewed the medical records of patients with health care facility-onset CDI between August 2011 and September 2013. Patients with diarrhea who were positive for Clostridium difficile (via an enzyme immunoassay were defined as having CDI. Clinical data (eg, demographics, comorbidities, medication, laboratory results, and clinical outcomes were evaluated, and multivariate analysis was used to identify risk factors that were associated with recurrent CDI.Results: Seventy-six health care facility-onset CDI cases were identified, with an incidence rate of 0.8 cases per 10,000 patient-days. Fourteen cases (18.4% were recurrent, with 13 patients having experienced a single recurrent episode and one patient having experienced three recurrent episodes. The 30-day and 90-day mortality rates were 7.9% and 14.5%, respectively. Multivariate analysis revealed that recurrent patients were more likely to have underlying malignant disease (odds ratio: 7.98; 95% confidence interval: 1.22–52.2; P=0.03 and a history of intensive care unit hospitalization (odds ratio: 49.9; 95% confidence interval: 1.01–2,470; P=0.049.Conclusion: Intensive care unit hospitalization and malignancy are risk factors for recurrent

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

    Directory of Open Access Journals (Sweden)

    Antonio DeRosa


    time (3.7 score on Likert scale. A lack of information services was second to the time issue with a Likert scale score of 3.6.Conclusion – Based on the research results, the authors affirmed the invaluable role of hospital libraries. The hospital library can help to eliminate the obstacles faced by healthcare professionals by providing support in the areas of weakness based on the survey results. This can be made possible through the hospital library’s involvement in educational activities, investigation of information technologies, and development of information services to accommodate the difficulties regularly experienced by hospital staff. Researchers revealed that funding for hospital libraries in Greece is an issue preventing many new initiatives, that there is no association to represent hospital libraries in Greece, that the few libraries operating in hospitals in Greece are understaffed with no administrative control, and the majority of Greek hospitals do not have adequate library facilities. These drawbacks contribute to the information-seeking challenges experienced by Greek healthcare professionals.

  17. Nutritional status of children hospitalized for parapneumonic effusion.

    Directory of Open Access Journals (Sweden)

    Koen Huysentruyt

    Full Text Available BACKGROUND & AIMS: Among children hospitalized for pneumonia, those with parapneumonic effusion (PPE are at particular risk for nutritional deterioration. This study aimed to 1 investigate the evolution of the nutritional status during hospitalization and at outpatient follow-up; 2 determine clinical risk factors for weight loss during hospitalization; 3 describe the nutritional interventions for these children. METHODS: Retrospective chart review (January '07 - September '12 of 56 children with pneumonia, complicated by PPE in two Belgian hospitals for data on body weight and height at admission (t0 and discharge (t1, and two weeks (t2 and one month (t3 after discharge. Length of hospitalization (LoS, length of stay in paediatric intensive care (LoSPICU and maximal in-hospital weight loss (tmax were calculated and nutritional interventions were recorded. RESULTS: The median (range age was 3.5 (1.0-14.8 years. Weight or height was lacking in five (8.9% children at t0 and in 28 (50% at t1; 21.4% was weighed only once during hospitalization. At tmax, respectively 17/44 and 5/44 children lost ≥ 5% and ≥ 10% of their weight. Median (range LoS and LoSPICU were 18.0 (10-41 and 4.0 (0-23 days. One-fourth received a nutritional intervention. Weight for height at admission (WFH(t0 significantly predicted maximal weight loss (β (95% CI = -0.34 (-2.0--0.1; p = 0.03. At t2 and t3, 13/32 and 5/22 of the children with available follow-up data did not reach WFH(t0, whilst in 4/35 and 5/26 body weight remained ≥ 5% under the weight(t0. CONCLUSIONS: One-third of children with pneumonia complicated by PPE and monitored for weight and height, lost ≥ 5% of their body weight during hospitalization. One-fourth did not reach initial WFH one month after discharge. Those with a higher WFH at admission were at higher risk of weight loss. More attention for monitoring of weight loss and the nutritional policy during and after hospitalization is warranted.

  18. Florida Hydrogen Initiative

    Energy Technology Data Exchange (ETDEWEB)

    Block, David L


    The Florida Hydrogen Initiative (FHI) was a research, development and demonstration hydrogen and fuel cell program. The FHI program objectives were to develop Florida?s hydrogen and fuel cell infrastructure and to assist DOE in its hydrogen and fuel cell activities The FHI program funded 12 RD&D projects as follows: Hydrogen Refueling Infrastructure and Rental Car Strategies -- L. Lines, Rollins College This project analyzes strategies for Florida's early stage adaptation of hydrogen-powered public transportation. In particular, the report investigates urban and statewide network of refueling stations and the feasibility of establishing a hydrogen rental-car fleet based in Orlando. Methanol Fuel Cell Vehicle Charging Station at Florida Atlantic University ? M. Fuchs, EnerFuel, Inc. The project objectives were to design, and demonstrate a 10 kWnet proton exchange membrane fuel cell stationary power plant operating on methanol, to achieve an electrical energy efficiency of 32% and to demonstrate transient response time of less than 3 milliseconds. Assessment of Public Understanding of the Hydrogen Economy Through Science Center Exhibits, J. Newman, Orlando Science Center The project objective was to design and build an interactive Science Center exhibit called: ?H2Now: the Great Hydrogen Xchange?. On-site Reformation of Diesel Fuel for Hydrogen Fueling Station Applications ? A. Raissi, Florida Solar Energy Center This project developed an on-demand forecourt hydrogen production technology by catalytically converting high-sulfur hydrocarbon fuels to an essentially sulfur-free gas. The removal of sulfur from reformate is critical since most catalysts used for the steam reformation have limited sulfur tolerance. Chemochromic Hydrogen Leak Detectors for Safety Monitoring ? N. Mohajeri and N. Muradov, Florida Solar Energy Center This project developed and demonstrated a cost-effective and highly selective chemochromic (visual) hydrogen leak detector for safety

  19. Funding Melbourne's hospitals: some historical moments. (United States)

    Walker, C


    In 1993 the Victorian Government introduced casemix funding as part of its restructure of the public hospital system. Casemix funding provides a new basis for government funding according to outcomes. At the same time, restructure of hospitals allows for a reconsideration of who is eligible to use them. Historical research into the growth of the public hospital system in Melbourne shows that attempts to reform the hospital system are as old as the system itself. This paper argues that the views of hospitals in funding crises and the solutions that are recommended have more to do with the politics of the day than the economics of running hospitals.

  20. Strategies for survival in the hospital industry. (United States)

    Coddington, D C; Palmquist, L E; Trollinger, W V


    Hospitals, besieged by new competitors and pressured to cut costs, are entering a new and unfamiliar environment. As usage declines and the government's new prospective payment system makes itself felt, hospitals are feeling the pinch. Nonprofit hospitals face competition from newer, for-profit providers of health care. These authors discuss the factors that have led some hospitals to close and forced most others to consider how they can lower costs while maintaining high-quality care. Several strategies exist to help hospitals cope with their new problems. The authors point out the advantages and disadvantages of downsizing, diversification, and joint ventures, among other practical measures that hospitals can take.

  1. Malnutrition among hospitalized patients in King Khalid University Hospital, Riyadh. (United States)

    Bani, I A; Al-Kanhal, M A


    The present study was undertaken to determine the incidence of malnutrition among hospitalized patients. A cross-sectional study of patients were evaluated for findings suggestive of protein calorie malnutrition (PCM). Hundred and sixty patients admitted to the medical and surgical wards over a period of five months were studied. Anthropometrics and biochemical measurements were used. Nutrition status was calculated based on some nutrition parameters weight for height, midarm, circumference, serum albumin and total lymphocyte count. Anthropometric measurements, weight for height and midarm circumference reflected malnutrition (PCM) of 33.8% and 30% respectively. The overall prevalence of obesity was 21%. A higher proportion (23.9%) of medical cases were found to be obese compared to surgical cases (19.7%). If malnutrition can be documented on hospital admission, attempts can be made to reverse malnutrition in the high risk patients.

  2. Malnutrition among hospitalized patients in King Khalid university hospital, Riyadh

    Directory of Open Access Journals (Sweden)

    Bani Ibrahim


    Full Text Available The present study was undertaken to determine the incidence of malnutrition among hospitalized patients. A cross-sectional study of patients were evaluated for findings suggestive of protein calorie malnutrition (PCM. Hundred and sixty patients admitted to the medical and surgical wards over a period of five months were studied. Anthropometrics and biochemical measurements were used. Nutrition status was calculated based on some nutrition parameters weight for height, midarm, circumference, serum albumin and total lymphocyte count. Anthropometric measurements, weight for height and midarm circumference reflected malnutrition (PCM of 33.8% and 30% respectively. The overall prevalence of obesity was 21%. A higher proportion (23.9% of medical cases were found to be obese compared to surgical cases (19.7%. If malnutrition can be documented on hospital admission, attempts can be made to reverse malnutrition in the high risk patients.

  3. 42 CFR 409.63 - Reduction of inpatient psychiatric benefit days available in the initial benefit period. (United States)


    ... 42 Public Health 2 2010-10-01 2010-10-01 false Reduction of inpatient psychiatric benefit days available in the initial benefit period. 409.63 Section 409.63 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM HOSPITAL INSURANCE BENEFITS Scope of Hospital Insurance Benefits §...

  4. Initial assessment of jaundice in otherwise healthy infants--a comparison of methods in two postnatal units.

    LENUS (Irish Health Repository)

    Allen, N M


    Transcutaneous bilirubin (TcB) has the potential to reduce total serum bilirubin (TS) sampling. The principal aim of this study was to determine and compare the number of initial TSB samples (TSBs) in two postnatal units (hospitals A & B) whereby hospital A used TcB and hospital B did not. A secondary aim was to determine the clinical factors that led to initial TSBs exceeding exchange transfusion level in both hospitals. Results demonstrated both hospitals had similar populations and patient numbers following selection criteria. 1645 neonates (10.4%) had one or more TSBs performed in hospital A, versus 2373 neonates (15.1%) in hospital B (p < 0.01). Fourteen neonates in hospital A and 3 neonates in hospital B had initial TSBs above exchange transfusion level. For neonates with TSBs above exchange, preventable factors related to earlier testing and follow up. In routine clinical practice, TcB is associated with a significantly reduced number of TSB measurements. TSB levels above exchange transfusion are linked to preventable factors, in otherwise healthy neonates.

  5. Malnutrition among hospitalized patients in King Khalid university hospital, Riyadh


    Bani Ibrahim; Al-Kanhal Mohammad


    The present study was undertaken to determine the incidence of malnutrition among hospitalized patients. A cross-sectional study of patients were evaluated for findings suggestive of protein calorie malnutrition (PCM). Hundred and sixty patients admitted to the medical and surgical wards over a period of five months were studied. Anthropometrics and biochemical measurements were used. Nutrition status was calculated based on some nutrition parameters weight for height, midarm, circumference, ...

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


    Soumya Nayak; Lloyd J. Taylor


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

  7. The Impact of China's Entry into WTO on Chinese Public Hospitals

    Institute of Scientific and Technical Information of China (English)



    China's entry into WTO has had a tremendous effect on Chinese public hospitals as it introduced some challenges and, ushered in an opportunity to provide a new development space. This report aims at to analyze and evaluate the initial impact of China's entry into the WTO on Chinese public hospitals, particularly in the field of the human resources department, financial department and quality service control department. As well as make feasible recommendations to the Chinese government.

  8. Design Innovations and Implementation Challenges - A Case of Smart Textiles in Future Hospital Interiors

    DEFF Research Database (Denmark)

    Mogensen, Jeppe; Jørgensen, Poul-Erik; Poulsen, Søren Bolvig


    Concerned with the overall challenges of implementing design innovations, this paper relates to the specific case of applying smart textiles in future hospital interiors. The methodological approach is inspired by design thinking and implementation processes, and through the scope of a developed...... strategic framework, the implementation challenges will be discussed from a holistic integrative design perspective. With this explorative initiative, our aim is to present specific approaches to progress the design innovation of smart textiles, and the implementation climate of future hospitals....

  9. Is the pro-competition policy an effective solution for China's public hospital reform? (United States)

    Pan, Jay; Qin, Xuezheng; Hsieh, Chee-Ruey


    The new round of health care reforms in China achieved significant initial results. New and emerging problems coinciding with the deepening of the reforms, however, require further institutional changes to strengthen the competition mechanism and promote public hospital efficiency. This paper provides a conceptual framework and preliminary assessment of public hospital competition in China. Specifically, we distinguish between two closely related concepts - competition and privatization, and identify several critical conditions under which hospital competition can be used as a policy instrument to improve health care delivery in China. We also investigate the current performance and identify several unintended consequences of public hospital competition - mainly, medical arms race, drug over-prescription and the erosion of a trusting relationship between patients and physicians. Finally, we discuss the policy options for enhancing the internal competition in China's hospital market, and conclude that public investment on information provision is key to reaping the positive outcomes of pro-competition policies.

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

    DEFF Research Database (Denmark)

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


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

  11. How a new 'public plan' could affect hospitals' finances and private insurance premiums. (United States)

    Dobson, Allen; DaVanzo, Joan E; El-Gamil, Audrey M; Berger, Gregory


    Two key health reform bills in the House of Representatives and Senate include the option of a "public plan" as an additional source of health coverage. At least initially, the plan would primarily be structured to cover many of the uninsured and those who now have individual coverage. Because it is possible, and perhaps even likely, that this new public payer would pay less than private payers for the same services, such a plan could negatively affect hospital margins. Hospitals may attempt to recoup losses by shifting costs to private payers. We outline the financial pressures that hospitals and private payers could experience under various assumptions. High uninsured enrollment in a public plan would bolster hospital margins; however, this effect is reversed if the privately insured enter a public plan in large proportions, potentially stressing the hospital industry and increasing private insurance premiums.

  12. Conversations with the community: the Methodist Hospital System's experience with social media. (United States)

    Angelle, Denny; Rose, Clare L


    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.

  13. Suicide risk in relation to psychiatric hospitalization: evidence based on longitudinal registers

    DEFF Research Database (Denmark)

    Qin, Ping; Nordentoft, Merete


    with affective disorders and in persons with short hospital treatment. These findings should lead to systematic evaluation of suicide risk among inpatients before discharge and corresponding outpatient treatment, and family support should be initiated immediately after the discharge......BACKGROUND: Persons with a history of admission to a psychiatric hospital are at high risk for suicide, but little is known about how this is influenced by factors related to psychiatric hospitalization. OBJECTIVE: To explore suicide risk according to time since admission, diagnosis, length...... of hospital treatment, and number of prior hospitalizations. DESIGN: Nested case-control design. SETTING: Individual data are drawn from various Danish longitudinal registers. PARTICIPANTS: All 13 681 male and 7488 female suicides committed in Denmark from January 1, 1981, to December 31, 1997, and 423 128...

  14. Florida Hydrogen Initiative

    Energy Technology Data Exchange (ETDEWEB)

    Block, David L


    The Florida Hydrogen Initiative (FHI) was a research, development and demonstration hydrogen and fuel cell program. The FHI program objectives were to develop Florida?s hydrogen and fuel cell infrastructure and to assist DOE in its hydrogen and fuel cell activities The FHI program funded 12 RD&D projects as follows: Hydrogen Refueling Infrastructure and Rental Car Strategies -- L. Lines, Rollins College This project analyzes strategies for Florida's early stage adaptation of hydrogen-powered public transportation. In particular, the report investigates urban and statewide network of refueling stations and the feasibility of establishing a hydrogen rental-car fleet based in Orlando. Methanol Fuel Cell Vehicle Charging Station at Florida Atlantic University ? M. Fuchs, EnerFuel, Inc. The project objectives were to design, and demonstrate a 10 kWnet proton exchange membrane fuel cell stationary power plant operating on methanol, to achieve an electrical energy efficiency of 32% and to demonstrate transient response time of less than 3 milliseconds. Assessment of Public Understanding of the Hydrogen Economy Through Science Center Exhibits, J. Newman, Orlando Science Center The project objective was to design and build an interactive Science Center exhibit called: ?H2Now: the Great Hydrogen Xchange?. On-site Reformation of Diesel Fuel for Hydrogen Fueling Station Applications ? A. Raissi, Florida Solar Energy Center This project developed an on-demand forecourt hydrogen production technology by catalytically converting high-sulfur hydrocarbon fuels to an essentially sulfur-free gas. The removal of sulfur from reformate is critical since most catalysts used for the steam reformation have limited sulfur tolerance. Chemochromic Hydrogen Leak Detectors for Safety Monitoring ? N. Mohajeri and N. Muradov, Florida Solar Energy Center This project developed and demonstrated a cost-effective and highly selective chemochromic (visual) hydrogen leak detector for safety

  15. How can emerging disinfection technologies gain a foothold in the current culture of hospitals? (United States)

    St Clair, David


    In the United States, more than 90% of hospitals still use only the traditional "spray and wipe" disinfection methods initiated over a century ago to protect patients from their environment; international adoption of new methods is even lower. Innovative approaches like whole room disinfection find an inhospitable reception in spite of clearly superior reductions in health care-acquired infections. Much of the resistance is due to a lack of true accountability for patient safety in hospital organizations and to perverse incentive structures in historical reimbursement policies. But all of that may change in the coming years as hospitals and doctors become more responsible for the health outcomes of their patients.

  16. Hospital automation system RFID-based: technology embedded in smart devices (cards, tags and bracelets). (United States)

    Florentino, Gustavo H P; Paz de Araujo, Carlos A; Bezerra, Heitor U; Junior, Helio B A; Xavier, Marcelo Araujo; de Souza, Vinicius S V; de M Valentim, Ricardo A A; Morais, Antonio H F; Guerreiro, Ana M G; Brandao, Glaucio B


    RFID is a technology being adopted in many business fields, especially in the medical field. This work has the objective to present a system for automation of a hospital clinical analysis laboratory. This system initially uses contactless smart cards to store patient's data and for authentication of hospital employees in the system. The proposed system also uses RFID tags stuck to containers containing patient's collected samples for the correct identification of the patient who gave away the samples. This work depicts a hospital laboratory workflow, presents the system modeling and deals with security matters related to information stored in the smart cards.

  17. Initiation of bacterial spore germination. (United States)

    Vary, J C; Halvorson, H O


    To investigate the problem of initiation in bacterial spore germination, we isolated, from extracts of dormant spores of Bacillus cereus strain T and B. licheniformis, a protein that initiated spore germination when added to a suspension of heat-activated spores. The optimal conditions for initiatory activity of this protein (the initiator) were 30 C in 0.01 to 0.04 m NaCl and 0.01 m tris(hydroxymethyl)aminomethane (pH 8.5). The initiator was inhibited by phosphate but required two co-factors, l-alanine (1/7 of K(m) for l-alanine-inhibited germination) and nicotinamide adenine dinucleotide (1.25 x 10(-4)m). In the crude extract, the initiator activity was increased 3.5-fold by heating the extract at 65 C for 10 min, but the partially purified initiator preparation was completely heat-sensitive (65 C for 5 min). Heat stability could be conferred on the purified initiator by adding 10(-3)m dipicolinic acid. A fractionation of this protein that excluded l-alanine dehydrogenase and adenosine deaminase from the initiator activity was developed. The molecular weight of the initiator was estimated as 7 x 10(4). The kinetics of germination in the presence of initiator were examined at various concentrations of l-alanine and nicotinamide adenine dinucleotide.

  18. Management of hepatic encephalopathy in the hospital. (United States)

    Leise, Michael D; Poterucha, John J; Kamath, Patrick S; Kim, W Ray


    Hepatic encephalopathy (HE) develops in up to 50% of patients with cirrhosis and is a feature of decompensated cirrhosis. With the goal of reviewing the evidence for treatment and prevention of overt hepatic encephalopathy, pubmed was searched using search terms hepatic encephalopathy AND treatment, limited to human studies from January 1, 2003, through December 1, 2013, and supplemented by key references. The inpatient incidence of HE is approximately 23,000 annually, and management of these patients is common for internists and subspecialists. Treatment of the hospitalized patient with HE has changed in recent years. Treatment entails 2 phases: induction and maintenance of remission. Most cases of significant HE are precipitated by infection, gastrointestinal bleeding, medications, or other culprits. All patients should be evaluated for secondary triggers of HE, and treatment should be initiated with a nonabsorbable disaccharide (ie, lactulose) in most patients. Rifaximin (off label) can be added in patients not responding to lactulose. Neomycin is a less preferred alternative to rifaximin owing to its adverse effect profile. Other therapies, including zinc, L-ornithine-L-aspartate, and branched-chain amino acids, can be considered for patients not responding to disaccharides and nonabsorbable antibiotics. Large portosystemic shunts may be embolized in patients with medically refractory recurrent or severe HE with otherwise well-compensated cirrhosis. Molecular Adsorbent Recirculating System is now available for patients with severe HE who do not respond to medical therapy. It is critically important that patients hospitalized with significant HE continue maintenance therapy at the time of dismissal to prevent further episodes. Patients with a first-time episode of HE can be administered lactulose, and careful instructions should be provided to patients and caregivers about dose titration to achieve 3 bowel movements daily. Patients with recurrent HE episodes

  19. Handgrip strength predicts functional decline at discharge in hospitalized male elderly: a hospital cohort study.

    Directory of Open Access Journals (Sweden)

    Carmen García-Peña

    Full Text Available Functional decline after hospitalization is a common adverse outcome in elderly. An easy to use, reproducible and accurate tool to identify those at risk would aid focusing interventions in those at higher risk. Handgrip strength has been shown to predict adverse outcomes in other settings. The aim of this study was to determine if handgrip strength measured upon admission to an acute care facility would predict functional decline (either incident or worsening of preexisting at discharge among older Mexican, stratified by gender. In addition, cutoff points as a function of specificity would be determined. A cohort study was conducted in two hospitals in Mexico City. The primary endpoint was functional decline on discharge, defined as a 30-point reduction in the Barthel Index score from that of the baseline score. Handgrip strength along with other variables was measured at initial assessment, including: instrumental activities of daily living, cognition, depressive symptoms, delirium, hospitalization length and quality of life. All analyses were stratified by gender. Logistic regression to test independent association between handgrip strength and functional decline was performed, along with estimation of handgrip strength test values (specificity, sensitivity, area under the curve, etc.. A total of 223 patients admitted to an acute care facility between 2007 and 2009 were recruited. A total of 55 patients (24.7% had functional decline, 23.46% in male and 25.6% in women. Multivariate analysis showed that only males with low handgrip strength had an increased risk of functional decline at discharge (OR 0.88, 95% CI 0.79-0.98, p = 0.01, with a specificity of 91.3% and a cutoff point of 20.65 kg for handgrip strength. Females had not a significant association between handgrip strength and functional decline. Measurement of handgrip strength on admission to acute care facilities may identify male elderly patients at risk of having functional decline

  20. Generalist palliative care in hospital

    DEFF Research Database (Denmark)

    Bergenholtz, Heidi; Jarlbæk, Lene; Hølge-Hazelton, Bibi


    Background: It can be challenging to provide generalist palliative care in hospitals, owing to difficulties in integrating disease-orientedtreatment with palliative care and the influences of cultural and organisational conditions. However, knowledge on the interactionsthat occur is sparse. Aim......: a quantitative study, in whichthree independent datasets were triangulated to study the organisation and evaluation of generalist palliative care, and a qualitative,ethnographic study exploring the culture of generalist palliative nursing care in medical departments. Setting/participants: A Danish regional......: To investigate the interactions between organisation and culture as conditions for integrated palliative care in hospital and, ifpossible, to suggest workable solutions for the provision of generalist palliative care. Design: A convergent parallel mixed-methods design was chosen using two independent studies...

  1. Optimizing sterilization logistics in hospitals. (United States)

    van de Klundert, Joris; Muls, Philippe; Schadd, Maarten


    This paper deals with the optimization of the flow of sterile instruments in hospitals which takes place between the sterilization department and the operating theatre. This topic is especially of interest in view of the current attempts of hospitals to cut cost by outsourcing sterilization tasks. Oftentimes, outsourcing implies placing the sterilization unit at a larger distance, hence introducing a longer logistic loop, which may result in lower instrument availability, and higher cost. This paper discusses the optimization problems that have to be solved when redesigning processes so as to improve material availability and reduce cost. We consider changing the logistic management principles, use of visibility information, and optimizing the composition of the nets of sterile materials.


    Directory of Open Access Journals (Sweden)

    Ivica Batinić


    Full Text Available Hospitality industry is a complex product-service economic activity which besides accommodation, food and beverages offers a variety of complementary and ancillary services in order to meet modern needs, demands and desires of tourists consumers. Contemporary needs, demands and desires of tourists consumers (increased need for security and preservation of health; emphasis on ecology and healthy food; pure nature stay; growing demand for adventure activities and excitement; convention facilities and incentive offerings; visits to towns, big sports, cultural, religious, business events; new travel motivation have led to the emergence of new trends in hospitality offering design. Wellness and spa hotels, boutique hotels, all inclusive hotels, slow-food restaurants, and wine and lounge bars are just some of the main trends, and successful hoteliers and caterers will examine each of the trends and devise development politics in accordance with the new requirements and global market needs.

  3. Leaving the hospital - your discharge plan (United States)

    ... patientinstructions/000867.htm Leaving the hospital - your discharge plan To use the sharing features on this page, ... once you leave. This is called a discharge plan. Your health care providers at the hospital will ...

  4. National Hospital Ambulatory Medical Care Survey (United States)

    U.S. Department of Health & Human Services — The National Hospital Ambulatory Medical Care Survey (NHAMCS) is designed to collect data on the utilization and provision of ambulatory care services in hospital...

  5. Hospital-Acquired Condition Reduction Program (United States)

    U.S. Department of Health & Human Services — In October 2014, CMS began reducing Medicare payments for subsection (d) hospitals that rank in the worst performing quartile with respect to hospital-acquired...

  6. Acute IPPS - Disproportionate Share Hospital - DSH (United States)

    U.S. Department of Health & Human Services — There are two methods for a hospital to qualify for the Medicare DSH adjustment. The primary method is for a hospital to qualify based on a statutory formula that...

  7. Birthing Centers and Hospital Maternity Services (United States)

    ... What are the hospital's statistics for cesarean sections, episiotomies, and mortality? (Keep in mind, though, that these ... What are the center's statistics for hospital transfers, episiotomies, and mortality? What procedures are followed after your ...

  8. Non-VA Hospital System (NVH) (United States)

    Department of Veterans Affairs — The Veterans Health Administration (VHA) pays for care provided to VA beneficiaries in non-VA hospitals through its contract hospitalization program as mandated by...

  9. Hospital Outpatient Prospective Payment System (OPPS) Lim... (United States)

    U.S. Department of Health & Human Services — Hospital Outpatient Prospective Payment System (OPPS) Limited Data Set This file contains select claim level data and is derived from 2010 hospital outpatient PPS...

  10. Enhancing Medicares Hospital Acquired Conditions Policy (United States)

    U.S. Department of Health & Human Services — The current Medicare policy of non-payment to hospitals for Hospital Acquired Conditions (HAC) seeks to avoid payment for preventable complications identified within...

  11. Nevada Training Initiative Environmental Assessment (United States)


    1) N N N Hospitals and nursing homes............................ Y 25 30 N N N Churches, auditoria , and concert halls................ Y 25 30 N N...brac Those carefully balanced or on edges can fall; fine glass, e.g., large goblets, can fall and break. Other Dust falls in chimneys. 2 - 4 Glass

  12. Business Intelligence in Hospital Management. (United States)

    Escher, Achim; Hainc, Nicolin; Boll, Daniel


    Business intelligence (BI) is a worthwhile investment, and will play a significant role in hospital management in the near future. Implementation of BI is challenging and requires resources, skills, and a strategy, but enables management to have easy access to relevant analysis of data and visualization of important key performance indicators (KPI). Modern BI applications will help to overcome shortages of common "hand-made" analysis, save time and money, and will enable even managers to do "self-service" analysis and reporting.

  13. Hospitality Management: Learning, Doing, Knowing

    Directory of Open Access Journals (Sweden)

    Christopher Muller


    Full Text Available Is there something distinct about the traditional Hospitality Management curriculum? First offered in 1893 at the Ecole Hoteliere Lausanne in Switzerland and launched in the United States at The School of Hotel Administration at Cornell University in 1922, has this course of study evolved over time to focus on both of Meyer's skills - originally based on technical skills but now transforming to emotional skills?

  14. Welfare standards in hospital mergers. (United States)

    Katona, Katalin; Canoy, Marcel


    There is a broad literature on the consequences of applying different welfare standards in merger control. Total welfare is usually defined as the sum of consumer and provider surplus, i.e., potential external effects are not considered. The general result is then that consumer welfare is a more restrictive standard than total welfare, which is advantageous in certain situations. This relationship between the two standards is not necessarily true when the merger has significant external effects. We model mergers on hospital markets and allow for not-profit-maximizing behavior of providers and mandatory health insurance. Mandatory health insurance detaches the financial and consumption side of health care markets, and the concept consumer in merger control becomes non-evident. Patients not visiting the merging hospitals still are affected by price changes through their insurance premiums. External financial effects emerge on not directly affected consumers. We show that applying a restricted interpretation of consumer (neglecting externality) in health care merger control can reverse the relation between the two standards; consumer welfare standard can be weaker than total welfare. Consequently, applying the wrong standard can lead to both clearing socially undesirable and to blocking socially desirable mergers. The possible negative consequences of applying a simple consumer welfare standard in merger control can be even stronger when hospitals maximize quality and put less weight on financial considerations. We also investigate the implications of these results for the practice of merger control.

  15. Hospital management contracts: institutional and community perspectives.


    Wheeler, J. R.; Zuckerman, H S


    Previous studies have shown that external management by contract can improve the performance of managed hospitals. This article presents a conceptual framework which develops specific hypotheses concerning improved hospital operating efficiency, increased ability to meet hospital objectives, and increased ability to meet community objectives. Next, changes in the process and structure of management under contractual arrangements, based on observations from two not-for-profit hospital systems,...

  16. Market orientation and organizational culture in hospitals. (United States)

    Proenca, E J


    Hospitals have been advised to respond to environmental pressures by changing from a product to a market orientation. Such changes are difficult to accomplish because of the entrenched behaviors and attitudes of hospitals employees. This article proposes organizational cultures as the avenue to a market orientation. It describes the role of hospital culture as an antecedent to market orientation. It also suggests ways to develop and maintain a market-oriented culture in hospitals.


    DEFF Research Database (Denmark)

    Gish, Liv


    In new product development a central activity is to provide new ideas. Over the last decades experiences with stimulating employee creativity and establishing idea promoting initiatives have been made in industrial practice. Such initiatives are often labeled Idea Management – a research field...... with a growing interest. In this paper I examine three different idea promoting initiatives carried out in Grundfos, a leading pump manufacturer. In the analysis I address what understandings of idea work are inscribed in the initiatives and what role these initiatives play in the organization with respect...... understandings of idea work are inscribed in the idea promoting initiatives as they to some degree have to fit with the understandings embedded in practice in order to work....

  18. HSMR : Comparing Death Rates Across UK Hospitals

    NARCIS (Netherlands)

    Nauta, Frans; Teeuwen, Ben; Ngo, Thuy


    The Hospital Standardized Mortality Ratio (HSMR) is a measurement tool that shows hospitals’ death rates. The HSMR compares deaths that occur in hospitals with death ratios that one would normally expect based on patients’ diseases. It is used as a benchmark for adjusted hospital death rates. These

  19. CEOs: Gulf crisis hits hospitals' bottom line. (United States)

    Johnsson, J


    Hospital CEOs say the Persian Gulf crisis could hit them hard where it counts. In fact, hospitals are already seeing some adverse impact from events in the Middle East. From fundraising to plant management to strategic planning, the confrontations in the Gulf are having an impact on the hospital's bottom line.

  20. Patients who fall in hospital - Contributing factors

    Directory of Open Access Journals (Sweden)

    M.I. Bright


    Full Text Available This is a retrospective study of the factors which contributed to accidental injuries sustained by those patients who fell in a White provincial hospital in die period 1 January to 30 June 1982. The research study was undertaken by Diploma in Nursing Administration students during their 3-week hospital practice at a White provincial hospital.

  1. State of malnutrition in hospitals of Ecuador

    Directory of Open Access Journals (Sweden)

    Sylvia Gallegos Espinosa


    Full Text Available Rationale: Hospital malnutrition is a global health problem affecting 30-50% of hospitalized patients. There are no estimates of the size of this problem in Ecuadorian hospitals. Hospital malnutrition might influence the quality of medical assistance provided to hospitalized populations. Objectives: To estimate the current frequency of malnutrition among patients admitted to Ecuadorian public hospitals. Materials and methods: The Ecuadorian Hospital Malnutrition Study was conducted between November 2011 and June 2012 with 5,355 patients (Women. 37.5%; Ages ≥ 60 years. 35.1%; Length of stay ≤ 15 days. 91.2% admitted to 36 public hospitals located in the prominent cities of 22 out of the 24 provinces of the country. Malnutrition frequency was estimated by means of the Subjective Global Assessment survey. Results: Malnutrition affected 37.1% of the surveyed patients. Malnutrition was dependent upon patient's age and education level; as well as the presence of cancer, sepsis, and chronic organic failure. Hospital areas showed different frequencies of hospital malnutrition. Health condition leading to hospital admission influenced negatively upon nutritional status. Malnutrition frequency increased as length of stay prolonged. Conclusions: Malnutrition currently affects an important proportion of patients hospitalized in public health institutions of Ecuador. Policies and actions are urgently required in order to successfully deal with this health problem and thus to ameliorate its negative impact upon quality of medical care

  2. Images of hospitality: validation of experiential dimensions

    NARCIS (Netherlands)

    Pijls-Hoekstra, Ruth; Groen, Brenda H.; Galetzka, M.; Pruyn, A.T.H.


    Hospitality is a much-researched topic, but its definition is still debated. This paper is part of a larger research project into the perception of hospitality. Previous research using the Delphi-method (hospitality providers and experts) and the Critical Incident Technique (guests and consumers) yi

  3. Distributed Pyro Initiation System Project (United States)

    National Aeronautics and Space Administration — Evaluate Current State of the Art; Define Critical Performance Requirements; Select Components; Smart Initiator or Smart Connector; Perform Detailed Cost/Benefit...

  4. Home initiation of parenteral nutrition. (United States)

    Newton, Alyce F; DeLegge, Mark H


    Parenteral nutrition (PN) has been successfully initiated in the home since the early 1990s. The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Standards for Specialized Nutrition Support: Home Care Patients, Safe Practices for Parenteral Nutrition, and Guidelines for the Use of Parenteral and Enteral Nutrition in Adult and Pediatric Patients do not contain specific information on the initiation of home PN (HPN). Peer-reviewed, published guidelines are necessary to provide safe and appropriate initiation of HPN. Certain patients should not have PN initiated in the home, such as those with organ failure, uncontrolled diabetes, or uncorrectable electrolyte abnormalities. Excellent candidates for initiation of HPN include patients who have failed enteral feedings, have gastrointestinal (GI) diseases without excessive GI losses, or those with an oncology diagnosis and inability to tube feed. One concern of initiation of HPN is the potential for refeeding syndrome. Refeeding syndrome can be prevented when patients are properly evaluated and managed before initiation of PN. Refeeding syndrome can be avoided by rehydration with fluid and electrolytes before initiation of HPN to normalize blood chemistry when necessary and by starting with a moderate-volume, low-carbohydrate HPN solution compounded with optimal potassium, phosphorus, and magnesium content, and slowly advanced to goal. The "start low and go slow" motto of nutrition support should continue to be followed, but more specific guidelines are needed to assist nutrition support clinicians with safe and appropriate initiation of HPN.

  5. Quality Improvement Initiative Reduces Serious Safety Events in Pediatric Hospital Patients (United States)

    ... Prevención y bienestar Condiciones y enfermedades Atención médica Medicamentos La seguridad del paciente Calidad de atención médica ... from radiation therapy for older women with breast cancer Women less ... oral contraceptives effective in treating abnormal uterine bleeding Poor ...

  6. Initial experience at a university teaching hospital from using telemedicine to promote education through video conferencing

    Directory of Open Access Journals (Sweden)

    Bruno Monteiro Tavares Pereira

    Full Text Available CONTEXT AND OBJECTIVE: Telehealth and telemedicine services are advancing rapidly, with an increasing spectrum of information and communication technologies that can be applied broadly to the population's health, and to medical education. The aim here was to report our institution's experience from 100 videoconferencing meetings between five different countries in the Americas over a one-year period. DESIGN AND SETTING: Retrospective study at Universidade Estadual de Campinas. METHODS: Through a Microsoft Excel database, all conferences in all specialties held at our institution from September 2009 to August 2010 were analyzed retrospectively. RESULTS: A total of 647 students, physicians and professors participated in telemedicine meetings. A monthly mean of 8.3 (± 4.3 teleconferences were held over the analysis period. Excluding holidays and the month of inaugurating the telemedicine theatre, our teleconference rate reached a mean of 10.3 (± 2.7, or two teleconferences a week, on average. Trauma surgery and meetings on patient safety were by far the most common subjects discussed in our teleconference meetings, accounting for 22% and 21% of the total calls. CONCLUSION: Our experience with telemedicine meetings has increased students' interest; helped our institution to follow and discuss protocols that are already accepted worldwide; and stimulated professors to promote telemedicine-related research in their own specialties and keep up-to-date. These high-technology meetings have shortened distances in our vast country, and to other reference centers abroad. This virtual proximity has enabled discussion of international training with students and residents, to increase their overall knowledge and improve their education within this institution.

  7. Student initiative: A conceptual analysis

    Directory of Open Access Journals (Sweden)

    Polovina Nada


    Full Text Available In the description and scientific consideration of the attitude of children and youth towards their education and development, the concept of student initiative has been gaining ground lately, and it is hence the subject of analysis in this paper. The analysis is important because of the discrepancy between the increased efforts of the key educational policy holders to promote the idea about the importance of the development of student initiative and rare acceptance of this idea among theoreticians, researchers and practitioners dealing with the education and development of children and youth. By concretising the features of initiative student behaviour, our aim was, on the one hand, to observe the structural determinants and scientific status of the very concept of an initiative student, and, on the other, to contribute to the understanding of the initiative behaviour in practice. In the first part of the paper we deal with different notions and concretisations of the features of initiative behaviour of children and youth, which includes the consideration of: basic student initiative, academic student initiative, individual student initiative, the capacity for initiative and personal development initiative. In the second part of the paper, we discuss the relations of the concept of student initiative with the similar general concepts (activity/passivity, proactivity, agency and the concepts immediately related to school environment (student involvement, student participation. The results of our analysis indicate that the concept of student initiative has: particular features that differentiate it from similar concepts; the potential to reach the status of a scientific concept, bearing in mind the initial empirical specifications and general empirical verifiability of the yet unverified determinants of the concept. In the concluding part of the paper, we discuss the implications of the conceptual analysis for further research, as well as for

  8. 42 CFR 419.22 - Hospital outpatient services excluded from payment under the hospital outpatient prospective... (United States)


    ... 42 Public Health 3 2010-10-01 2010-10-01 false Hospital outpatient services excluded from payment under the hospital outpatient prospective payment system. 419.22 Section 419.22 Public Health CENTERS... PROSPECTIVE PAYMENT SYSTEM FOR HOSPITAL OUTPATIENT DEPARTMENT SERVICES Categories of Hospitals and...

  9. 75 FR 68799 - Medicare Program; Inpatient Hospital Deductible and Hospital and Extended Care Services... (United States)


    ... Hospital Deductible and Hospital and Extended Care Services Coinsurance Amounts for CY 2011 AGENCY: Centers... inpatient hospital deductible and the hospital and extended care services coinsurance amounts for services... (c) $141.50 for the 21st through 100th day of extended care services in a skilled nursing facility...

  10. 77 FR 29033 - Medicare and Medicaid Programs; Reform of Hospital and Critical Access Hospital Conditions of... (United States)


    ... hospitals, if hospitals so choose. Nursing care plan: We have allowed hospitals the options of having a stand-alone nursing care plan or a single interdisciplinary care plan that addresses nursing and other... hospitals to have a stand-alone nursing care plan or a single interdisciplinary care plan that...

  11. Hospital characteristics and patient populations served by physician owned and non physician owned orthopedic specialty hospitals

    Directory of Open Access Journals (Sweden)

    Vaughan-Sarrazin Mary S


    Full Text Available Abstract Background The emergence of physician owned specialty hospitals focusing on high margin procedures has generated significant controversy. Yet, it is unclear whether physician owned specialty hospitals differ significantly from non physician owned specialty hospitals and thus merit the additional scrutiny that has been proposed. Our objective was to assess whether physician owned specialty orthopedic hospitals and non physician owned specialty orthopedic hospitals differ with respect to hospital characteristics and patient populations served. Methods We conducted a descriptive study using Medicare data of beneficiaries who underwent total hip replacement (THR (N = 10,478 and total knee replacement (TKR (N = 15,312 in 29 physician owned and 8 non physician owned specialty orthopedic hospitals during 1999–2003. We compared hospital characteristics of physician owned and non physician owned specialty hospitals including procedural volumes of major joint replacements (THR and TKR, hospital teaching status, and for profit status. We then compared demographics and prevalence of common comorbid conditions for patients treated in physician owned and non physician owned specialty hospitals. Finally, we examined whether the socio-demographic characteristics of the neighborhoods where physician owned and non physician owned specialty hospitals differed, as measured by zip code level data. Results Physician owned specialty hospitals performed fewer major joint replacements on Medicare beneficiaries in 2003 than non physician owed specialty hospitals (64 vs. 678, P Conclusion Physician owned specialty orthopedic hospitals differ significantly from non physician owned specialty orthopedic hospitals and may warrant the additional scrutiny policy makers have proposed.

  12. Use of complementary and alternative medicine at Norwegian and Danish hospitals

    Directory of Open Access Journals (Sweden)

    Launsø Laila


    Full Text Available Abstract Background Several studies have found that a high proportion of the population in western countries use complementary and alternative medicine (CAM. However, little is known about whether CAM is offered in hospitals. The aim of this study was to describe to what extent CAM is offered in Norwegian and Danish hospitals and investigate possible changes in Norway since 2001. Methods A one-page questionnaire was sent to all included hospitals in both countries. The questionnaire was sent to the person responsible for the clinical activity, typically the medical director. 99 hospitals in the authority (85% in Norway and 126 in Denmark (97% responded. Given contact persons were interviewed. Results CAM is presently offered in about 50% of Norwegian hospitals and one-third of Danish hospitals. In Norway CAM was offered in 50 hospitals, 40 of which involved acupuncture. 19 hospitals gave other alternative therapies like biofeedback, hypnosis, cupping, ear-acupuncture, herbal medicine, art therapy, homeopathy, reflexology, thought field therapy, gestalt therapy, aromatherapy, tai chi, acupressure, yoga, pilates and other. 9 hospitals offered more than one therapy form. In Denmark 38 hospitals offered acupuncture and one Eye Movement Desensitization and Reprocessing Light Therapy. The most commonly reported reason for offering CAM was scientific evidence in Denmark. In Norway it was the interest of a hospital employee, except for acupuncture where the introduction is more often initiated by the leadership and is more based on scientific evidence of effect. All persons (except one responsible for the alternative treatment had a medical or allied health professional background and their education/training in CAM treatment varied substantially. Conclusions The extent of CAM being offered has increased substantially in Norway during the first decade of the 21st century. This might indicate a shift in attitude regarding CAM within the conventional

  13. Incorporating the USAF Flight Center's TQM plan in a hospital. (United States)

    Bridges, R D; Mathews, K A


    A total quality management (TQM) plan has been instituted by the United States Air Force Flight Test Center at Edwards Air Force Base. To determine the feasibility of implementing the same basic TQM plan in a district hospital, a joint industry-government team was established. Five areas of concentration were selected for review: infrastructure, methodology, training, strategic plan, and a "Quality Bill of Rights." The TQM "infrastructure" is intended to match and complement the existing organizational structure and chain of command, not to supplant it. As the overall plan seemed well-adapted for implementation in a hospital setting, a three-phase implementation approach was identified that included conceptual planning, initial training and goal setting, and full-scale implementation. Each phase is described in terms of objectives, staffing, and timing requirements.

  14. [Marketing in hospitals and practices: from theory to implementation]. (United States)

    Mattmüller, R; Gebauer, J


    Although hospitals and medical practices are typical service providers from a marketing perspective, only very few engage in topics relevant to marketing. Best practice examples do, however, show how important and meaningful the implementation of marketing tools can be for medical service providers. This article thus deals with the question of how the service of hospitals and practices may be improved by marketing initiatives. As a first step, the particular challenges these service providers face need to be analyzed. A significant focus will therefore be put on the examination of service-related quality and will then be applied to medical services. Thus it becomes evident that the path to success is based on adapting to patients' needs. Possibilities to minimize the uncertainties and risks experienced by the patients need to be identified. At the same time, the perceived service quality needs to be maximized.

  15. Out-of-Hospital Cardiac Arrest in Denmark

    DEFF Research Database (Denmark)

    Wissenberg Jørgensen, Mads

    challenges, due to the victim’s physical location, which brings an inherent risk of delay (or altogether absence) of recognition and treatment of cardiac arrest. A low frequency of bystander cardiopulmonary resuscitation and low 30-day survival after out-of-hospital cardiac arrest were identified nearly ten......BACK COVER TEXT Cardiac arrest is an emergency medical condition characterized by the cessation of cardiac mechanical activity; without immediate and decisive treatment, a victim’s chances of survival are minimal. Out-of-hospital cardiac arrest is a particular arrest subgroup that poses additional...... years ago in Denmark. These findings led to several national initiatives to strengthen bystander resuscitation attempts and advance care. Despite these nationwide efforts, it was unknown prior to this project whether these efforts resulted in changes in resuscitation attempts by bystanders and changes...

  16. Supporting statistics in the workplace: experiences with two hospitals

    Directory of Open Access Journals (Sweden)

    M. Y. Mortlock


    Full Text Available This paper provides some reflections on the promotion of lifelong learning in statistics in the workplace. The initiative from which the reflections are drawn is a collaboration between a university and two public hospitals, of which one of the stated aims is to develop statistical skills among the hospitals' researchers. This is realized in the provision of ‘biostatistical clinics’ in which workplace teaching and learning of statistics takes place in one-on-one or small group situations. The central issue that is identified is the need to accommodate diversity: in backgrounds, motivations and learning needs of workplace learners (in this case medical researchers, in the workplace environments themselves and in the projects encountered. Operational issues for the statistician in providing such training are addressed. These considerations may reflect the experiences of the wider community of statisticians involved in service provision within a larger organization.

  17. Military Interoperable Digital Hospital Testbed (United States)


    Subject outcome measures include blood pressure, waist circumference , weight, body mass index (BMI), body fat, HDL cholesterol, triglycerides, glucose...HRPO) on 12 April 2012. This no greater than minimal risk study was initially approved by the HRPO on 18 May 2010. 2. The Conemaugh Memorial Medical...minimal risk study was initially approved by the HRPO on 18 August 2010. 2. The Memorial Medical Center Institutional REWiew Board documentation

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

    DEFF Research Database (Denmark)

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


    In this paper, the need for automated transportation systems for hospitals is investigated. Among other alternatives, mobile robots stand out as the most prominent means of automation of transportation tasks in hospitals. Existing transportation routines of a hospital are analyzed in order to ver...... for implementing mobile service robots for transportation tasks in hospitals.......In this paper, the need for automated transportation systems for hospitals is investigated. Among other alternatives, mobile robots stand out as the most prominent means of automation of transportation tasks in hospitals. Existing transportation routines of a hospital are analyzed in order...

  19. Strategic management of Public Hospitals' medical services. (United States)

    Hao, Aimin; Yi, Tao; Li, Xia; Wei, Lei; Huang, Pei; Xu, Xinzhou; Yi, Lihua


    Purpose: The quality of medical services provided by competing public hospitals is the primary consideration of the public in determining the selection of a specific hospital for treatment. The main objective of strategic planning is to improve the quality of public hospital medical services. This paper provides an introduction to the history, significance, principles and practices of public hospital medical service strategy, as well as advancing the opinion that public hospital service strategy must not merely aim to produce but actually result in the highest possible level of quality, convenience, efficiency and patient satisfaction.

  20. Corporate visual identity: a case in hospitals. (United States)

    Alkibay, Sanem; Ozdogan, F Bahar; Ermec, Aysegul


    This paper aims to present a perspective to better understand corporate identity through examining the perceptions of Turkish patients and develop a corporate visual identity scale. While there is no study related to corporate identity research on hospitals in Turkey as a developing country, understanding consumer's perceptions about corporate identity efforts of hospitals could provide different perspectives for recruiters. When the hospitals are considered in two different groups as university and state hospitals, the priority of the characteristics of corporate visual identity may change, whereas the top five characteristics remain the same for all the hospitals.

  1. Uncompensated care: hospitals' responses to fiscal pressures. (United States)

    Mann, J; Melnick, G; Bamezai, A; Zwanziger, J


    This Data Watch examines the impact of hospital competition, the Medicare prospective payment system (PPS), and Medi-Cal selective contracting on the provision of uncompensated care by private hospitals in California during 1980-1989. It finds that hospitals subject to more intense competition and greater fiscal pressure from Medicare and Medi-Cal reduced their provision of uncompensated care relative to hospitals facing less pressure from these sources. We estimate that had hospitals not been subjected to increasing price competition from growth of managed care plans and financial tightening in public programs, they would have provided 36 percent more uncompensated care than was actually provided in 1989.

  2. A Computerized Hospital Patient Information Management System (United States)

    Wig, Eldon D.


    The information processing needs of a hospital are many, with varying degrees of complexity. The prime concern in providing an integrated hospital information management system lies in the ability to process the data relating to the single entity for which every hospital functions - the patient. This paper examines the PRIMIS computer system developed to accommodate hospital needs with respect to a central patient registry, inpatients (i.e., Admission/Transfer/Discharge), and out-patients. Finally, the potential for expansion to permit the incorporation of more hospital functions within PRIMIS is examined.

  3. Technical Efficiency of Hospitals in Tehran, Iran

    Directory of Open Access Journals (Sweden)

    Edris KAKEMAM


    Full Text Available Background: Nowadays, restriction on access and optimum use of resources is the main challenge of development in all organizations. Therefore, the aim of this study was to determine the technical efficiency and its factors, influencing hospitals of Tehran.Methods: This research was a descriptive-analytical and retrospective study conducted in 2014-2015. Fifty two hospitals with public, private, and social security ownership type were selected for this study. The required data was collected by a researcher-made check list in 3 sections of background data, inputs and outputs. The data was analyzed by DEAP 1.0.2, and STATA-13 technique.Results: Seventeen (31/48 of hospitals had the efficiency score of 1 as the highest technical efficiency. The highest average score of efficiency was related to social security hospitals as 84.32, and then the public and private hospitals with the average of 84.29 and 79.64 respectively. Tobit regression results showed that the size, type of practice, and ownership of hospitals were effective on the degree of their technical efficiency. However, there was no significant correlation between teaching / non-teaching hospitals with technical efficiency.Conclusion: Establishment of competition system among hospitals, constitution of medium size hospitals and allocation of budget to hospitals based on national accreditation system are recommended. Keywords: Technical efficiency, Data envelopment analysis, Hospital, Iran

  4. [Medical clowns at hospitals and their effect on hospitalized children]. (United States)

    Bornstein, Yossi


    Healing by the use of humor has become popular over the last few years and it is used not only in alternative medicine but also in conventional medicine in hospitals all over the world, particularly in the USA and Europe. This practice has been well implemented in pediatric wards. It is easier to make a child laugh than an adult. In the framework of healing by humor, use is made of a medical clown who is in fact a person who has undergone special training in acting and clowning, combined with medical knowledge and an understanding of patient behavior. Some medical clowns come from the world of entertainment, and are actors, clowns, and magicians. Some have a paramedical or medical background. Medical research demonstrates that medical clowns and humor have a positive effect on patients. The implementation of medical clowning has been increasing throughout the world from year to year and has, slowly but surely, started a movement to integrate it into formal frameworks in both pediatric and adult wards in hospitals. However, there is still a necessity to conduct larger, well controlled clinical trials regarding the influence of the different programs. Maybe the growing awareness in the world will fill the void that demands resources of both personnel and budgets, both of which are often missing from health budgets.

  5. 'Patient satisfaction' in hospitalized cancer patients. (United States)

    Skarstein, Jon; Dahl, Alv A; Laading, Jacob; Fosså, Sophie D


    Predictors of 'patient satisfaction' with hospitalization at a specialized cancer hospital in Norway are examined in this study. Two weeks after their last hospitalization, 2021 consecutive cancer patients were invited to rate their satisfaction with hospitalization, quality of life, anxiety and depression. Compliance rate was 72% (n = 1453). Cut-off levels separating dissatisfied from satisfied patients were defined. It was found that 92% of the patients were satisfied with their stay in hospital, independent of cancer type and number of previous admissions. Performance of nurses and physicians, level of information perceived, outcome of health status, reception at the hospital and anxiety independently predicted 'patient satisfaction'. The model explained 35% of the variance with an area under the curve of 0.76 of the Receiver Operator Curve. Cancer patients' satisfaction with their hospital stay was high, and predicted by four independently predictive variables related to the performance of caregivers. These suggest areas for further improvement in the healthcare service.

  6. [Historical analysis of the hospital bed]. (United States)

    Fajardo-Ortiz, Guillermo; Fajardo-Dolci, Germán


    Until now the bed has been the basic physical resource in hospitals. This type of furniture has served to study and treat patients, through out the centuries it has undergone changes in the materials they are made of dimensions, functionality, accessories, aesthetic, and design. The hospital bed history is not well known, there are thousands of documents about the evolution of hospitals, but not enough is known about hospital beds, a link between the past and the present. The medical, anthropological, technological, social, and economic dynamics and knowledge have produced a variety of beds in general and hospital beds in particular. From instinctive, rustic, poor and irregular "sites" that have differed in shape and size they had evolved into ergonomic equipment. The history of the hospital bed reflects the culture, techniques and human thinking. Current hospital beds include several types: for adults, for children, for labor, for intensive therapy, emergency purposes, census and non census beds etc.

  7. The Life Saving Effects of Hospital Proximity

    DEFF Research Database (Denmark)

    Bertoli, Paola; Grembi, Veronica

    We assess the lifesaving effect of hospital proximity using data on fatality rates of road-traffic accidents. While most of the literature on this topic is based on changes in distance to the nearest hospital triggered by hospital closures and use OLS estimates, our identification comes from the ...... more when the road safety is low; the emergency service is not properly organized, and the nearest hospital has lower quality standards.......We assess the lifesaving effect of hospital proximity using data on fatality rates of road-traffic accidents. While most of the literature on this topic is based on changes in distance to the nearest hospital triggered by hospital closures and use OLS estimates, our identification comes from...

  8. [Dialogical leadership in hospitals institutions]. (United States)

    Amestoy, Simone Coelho; Trindade, Letícia de Lima; Waterkemper, Roberta; Heidman, Ivonete Teresinha Schülter; Boehs, Astrid Egged; Backes, Vânia Marli Schubert


    The aim of this study is make a theorical-reflection about the importance of using dialogical leadership in hospital institutions through Freirean referencial. The dialogical leadership pattern differs from the coercive and autocratic methods, for being reasoned on the establishment of an efficient communicational process, able to stimulate autonomy, co-responsibility and appreciation of each member from nurse team. The dialogical leadership, unlike the directive one, is a management instrument, that pursuits to minimize the conflicts and stimulate the formation of healthy interpersonal relationships, which can contribute to the improvement of organizational atmosphere and quality care provided to health services users.

  9. Light Atmosphere in Hospital Wards

    DEFF Research Database (Denmark)

    Stidsen, Lone Mandrup

    . The four key aspects are: ‘Light’, ‘Space’, ‘Users’ and ‘Time’. The ‘Light’ aspect describes, as shown in (Fig 0.6), the character of the light, light information and light effect i.e. function, aesthetics or symbolism. The ‘Space’ aspect looks into the dimension of the space, geographical orientation...... in Denmark are lastly an investigation on light zones at the hospital ward defined in order to optimize the illumination. The third cycle of iteration is an experimental study testing a lighting concept developed and grounded in the knowledge gained through the first and second cycle. The fourth cycle...

  10. [Extra-hospital nephrology: a challenge for our near future]. (United States)

    Orte, L Maria


    The Spanish nephrology is one of the medical specialties that have experienced a greater development in the last years. Defined initially as an activity in the hospital and consolidated in this sense, at the present time the "Libro Blanco of the Spanish Nephrology" makes a call of attention on the necessity of a change of welfare direction. The attention was called on the little development of the prevention activities and the delay in the arrival of the patient to the Service of Nephrology, which causes a worsening of his pathology. In order to approach us this reality it is necessary to give priority to the attendance of the patient out of the hospital and to guarantee a logical continuity between welfare levels. The welfare initiatives that have been carried out in the Spanish territory are scarce and still insufficient. The progressive increase in the incidence and prevalence of the ERD associated with a bad evolution and elevated costs is converting ERD in an important problem of public health, that requires specific plans of detection and prevention. The improvement of the coordination between general practioners and nephrologists is necessary. Multiple papers show a delayed reference of the patients with renal disease to the nephrologists. The initiatives of coordination between both levels should be centered in studies epidemiologists that clarify the real meaning of the renal pathology and in educating the GP on the early reference to the nephrologist of the patients with renal failure.

  11. Assessment of Aerobic Exercise Adverse Effects during COPD Exacerbation Hospitalization

    Directory of Open Access Journals (Sweden)

    Caroline Knaut


    Full Text Available Introduction. Aerobic exercise performed after hospital discharge for exacerbated COPD patients is already recommended to improve respiratory and skeletal muscle strength, increase tolerance to activity, and reduce the sensation of dyspnea. Previous studies have shown that anaerobic activity can clinically benefit patients hospitalized with exacerbated COPD. However, there is little information on the feasibility and safety of aerobic physical activity performed by patients with exacerbated COPD during hospitalization. Objective. To evaluate the effects of aerobic exercise on vital signs in hospitalized patients with exacerbated COPD. Patients and Methods. Eleven COPD patients (63% female, FEV1: 34.2 ± 13.9% and age: 65 ± 11 years agreed to participate. Aerobic exercise was initiated 72 hours after admission on a treadmill; speed was obtained from the distance covered in a 6-minute walk test (6MWT. Vital signs were assessed before and after exercise. Results. During the activity systolic blood pressure increased from 125.2 ± 13.6 to 135.8 ± 15.0 mmHg (p=0.004 and respiratory rate from 20.9 ± 4.4 to 24.2 ± 4.5 rpm (p=0.008 and pulse oximetry (SpO2 decreased from 93.8 ± 2.3 to 88.5 ± 5.7% (p<0.001. Aerobic activity was considered intense, heart rate ranged from 99.2 ± 11.5 to 119.1 ± 11.1 bpm at the end of exercise (p=0.092, and patients reached on average 76% of maximum heart rate. Conclusion. Aerobic exercise conducted after 72 hours of hospitalization in patients with exacerbated COPD appears to be safe.

  12. Maternity Care Practices and Breastfeeding Among Adolescent Mothers Aged 12-19 Years--United States, 2009-2011. (United States)

    Olaiya, Oluwatosin; Dee, Deborah L; Sharma, Andrea J; Smith, Ruben A


    The American Academy of Pediatrics recommends that infants be breastfed exclusively for the first 6 months of life, and that mothers continue breastfeeding for at least 1 year. However, in 2011, only 19.3% of mothers aged ≤20 years in the United States exclusively breastfed their infants at 3 months, compared with 36.4% of women aged 20-29 years and 45.0% of women aged ≥30 years. Hospitals play an essential role in providing care that helps mothers establish and continue breastfeeding. The U.S. Surgeon General and numerous health professional organizations recommend providing care aligned with the Baby-Friendly Hospital Initiative (BFHI), including adherence to the Ten Steps to Successful Breastfeeding (Ten Steps), as well as not providing gift packs containing infant formula. Implementing BFHI-aligned maternity care improves duration of any and exclusive breastfeeding among mothers; however, studies have not examined associations between BFHI-aligned maternity care and breastfeeding outcomes solely among adolescent mothers (for this report, adolescents refers to persons aged 12-19 years). Therefore, CDC analyzed 2009-2011 Pregnancy Risk Assessment Monitoring System (PRAMS) data and determined that among adolescent mothers who initiated breastfeeding, self-reported prevalence of experiencing any of the nine selected BFHI-aligned maternity care practices included in the PRAMS survey ranged from 29.2% to 95.4%. Among the five practices identified to be significantly associated with breastfeeding outcomes in this study, the more practices a mother experienced, the more likely she was to be breastfeeding (any amount or exclusively) at 4 weeks and 8 weeks postpartum. Given the substantial health advantages conferred to mothers and children through breastfeeding, and the particular vulnerability of adolescent mothers to lower breastfeeding rates, it is important for hospitals to provide evidence-based maternity practices related to breastfeeding as part of their

  13. Hospital physicians' influence on gastrointestinal protection during treatment with non-steroidal anti-inflammatory drugs and acetylsalicylic acid and the impact on prescribing in primary care.

    Directory of Open Access Journals (Sweden)

    Michael Due Larsen

    Full Text Available BACKGROUND: The aim of this study was to describe the use of gastrointestinal (GI protection before, during and after hospitalisation for elderly patients using NSAID or low-dose ASA. METHODS: This study included all elderly patients (75+ admitted to hospital in the period of 1(st April 2010 to 31(st March 2011 at Odense University Hospital, Denmark, who were regular users of NSAID or low-dose ASA before hospital admission, or had one of these drugs initiated during hospital stay. By using pharmacy dispensing data and a hospital-based pharmacoepidemiological database, the treatment strategy for the individual patients was followed across hospital stay. RESULTS: In total, 3,587 patients were included. Before hospital admission, 93 of 245 NSAID users (38.0% and 597 of 1994 user of low-dose ASA (29.9% had used GI protection. During hospital stay, use of GI protection increased to 75% and 33.9%, respectively. When hospital physicians initiated new treatment with NSAID or with low-dose ASA, 305 of 555 (55.0% and 647 of 961 (67.3% were initiated without concomitant use of GI protection. When hospital physicians initiated GI protection, 26.8-51.0% were continued in primary care after discharge. CONCLUSIONS: During hospital stay, the use of GI protection increases, but when new treatment with NSAIDs or low-dose ASA is initiated in hospital, the use of gastrointestinal protection is low. The low use of GI protection is carried on in primary care after discharge.

  14. Policy initiatives to promote healthy aging. (United States)

    Infeld, Donna Lind; Whitelaw, Nancy


    An overwhelming array of policies and programs can be used to help older people (and future older people) maintain healthy lifestyles. How can clinicians help ensure that their patients take advantage of these opportunities? How can these broad-scope policies, educational and information initiatives, and direct service programs be turned into tools to help older people maximize health and independence? First, physicians do not need to do it all themselves. They need to know where to send their patients. For example, case managers in local aging service organizations and social workers, nurses, and discharge planners in hospitals can help connect elderly patients to appropriate benefits and services. Physicians play a critical role in creating a bridge between patients and the array of programs and information that can help them change their individual patterns of behavior. A serious lack of integration exists between what is known about healthy behaviors and lifestyles and what is really happening and available to older people today. From the earlier articles in this issue we know that much can be done to prevent many types of age-related disease and disability. This article provides examples of mechanisms that can be used to broadly disseminate knowledge about effective behavior and treatment changes and create mechanisms to turn this knowledge into real and widespread client-level, practice-level, health system, and community-wide interventions. Second, physicians need to understand that they are not merely subject to these policies and initiatives. They can help formulate and shape them. This political involvement includes active participation in policy initiatives of professional associations, involvement in research and demonstration activities, keeping informed about policy proposals at the federal and state levels, and helping advance ideas for improving health behaviors by speaking up and working toward change. These changes go beyond health initiatives to

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

    Directory of Open Access Journals (Sweden)

    Thomas Plochg


    Full Text Available 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 jeopardised. Their narrowed orientation on delivering the most advanced services to the sickest patients challenges their missions in patient care, science and education. By linking up with local health care providers, university hospitals create synergistic relationships that should secure these three academic missions for the future. Methods: We conducted a multiple case study in two stages. Initially, division leaders and the director of integrated care were consulted to identify all existing collaborative initiatives of the Academic Medical Centre. Successively, face-to-face interviews were held with the leaders of these initiatives. During these interviews data were primarily collected through a questionnaire. Notes of the interviewer, and documents (if available were also collected. The analysis focused on systematically describing and characterising the initiatives using the concept of ‘community-based integrated care’. Results: Twenty-seven heterogeneous initiatives were identified. Half of these initiatives are targeted to the adjacent community of the Academic Medical Centre, but only four of them are initiated on the basis of community information and involve the community and/or patients. Furthermore, the extent of integration differed per dimension. Functional integration within the initiatives has been relatively low, clinical integration mixed, and professional integration quite advanced. Conclusions: The results indicate that a considerable number of collaborative initiatives have emerged. Still, these initiatives are loosely ‘community-based’ and hardly focus on the full integration of care services. This suggests that the community

  16. Motility initiation in active gels

    CERN Document Server

    Recho, Pierre; Truskinovsky, Lev


    Motility initiation in crawling cells requires a symmetry breaking mechanism which transforms a symmetric state into a polarized state. Experiments on keratocytes suggest that polarization is triggered by increased contractility of motor proteins. In this paper we argue that contraction can be responsible not only for the symmetry breaking transition but also for the incipient translocation of the segment of an active gel mimicking the crawling cell. Our model suggests that when the contractility increases sufficiently far beyond the motility initiation threshold, the cell can stop and re-symmetrizes. The proposed theory reproduces the motility initiation pattern in fish keratocytes and the behavior of keratocytes prior to cell division.

  17. Canada's family violence initiative: partnerships

    Directory of Open Access Journals (Sweden)

    Elaine Scott


    Full Text Available Under Canada's four-year, $136 million Family Violence Initiative, the federal government is calling upon all Canadians to work in partnerships towards the elimination of family violence - child abuse, violence against women, and elder (senior abuse. Family violence is a complex problem and requires the efforts of all Canadians to resolve it. One of the key themes of the Initiative - a multidisciplinary approach to the problem of family violence - is reflected in the selection and development of projects. Activities funded by the seven federal departments and agencies involved in the Initiative emphasize partnerships with the professional, voluntary, corporate, non-government and government sectors.

  18. Diversification strategies for hospital pharmacies. (United States)

    Smith, J E; Phillips, D J; Meyer, G E


    Several ways used by the pharmacy department of a large university hospital to generate revenue through diversification are described. The department offers its facilities and staff as a resource in training medical service representatives for several pharmaceutical manufacturers, which is projected to provide $85,000 in net income for fiscal year (FY) 1983-84. The pharmacy department also conducts a six-month program for training pharmacy technicians, which yields a small net profit. The pharmacy department actively participates in educational programs such as college courses and clerkships earning extra income. An apothecary-style outpatient pharmacy was set up under a for-profit corporation. Services have been expanded to include the preparation of i.v. solutions that support home care. A durable medical equipment (DME) business is planned. The ambulatory and home-care programs are expected to generate approximately $165,000 in net profit next year. Contract pharmaceutical services are provided to another hospital. The net income generated through diversification in this pharmacy department will exceed $250,000 in FY 1983-84.

  19. Intravenous heparin dosing strategy in hospitalized patients with atrial dysrhythmias. (United States)

    Roswell, Robert O; Greet, Brian; Shah, Sunny; Bernard, Samuel; Milin, Alexandra; Lobach, Iryna; Guo, Yu; Radford, Martha J; Berger, Jeffrey S


    Patients with non-valvular atrial fibrillation (AF) have an elevated stroke risk that is 2-7 times greater than in those without AF. Intravenous unfractionated heparin (UFH) is commonly used for hospitalized patients with atrial fibrillation and atrial flutter (AFL) to prevent stroke. Dosing strategies exist for intravenous anticoagulation in patients with acute coronary syndromes and venous thromboembolic diseases, but there are no data to guide providers on a dosing strategy for intravenous anticoagulation in patients with AF/AFL. 996 hospitalized patients with AF/AFL on UFH were evaluated. Bolus dosing and initial infusion rates of UFH were recorded along with rates of stroke, thromboemobolic events, and bleeding events as defined by the International Society on Thrombosis and Haemostasis criteria. Among 226 patients included in the analysis, 76 bleeding events occurred. Using linear regression analysis, initial rates of heparin infusion ranging from 9.7 to 11.8 units/kilogram/hour (U/kg/h) resulted in activated partial thromboplastin times that were within therapeutic range. The median initial infusion rate in patients with bleeding was 13.3 U/kg/h, while in those without bleeding it was 11.4 U/kg/h; p = 0.012. An initial infusion rate >11.0 U/kg/h yielded an OR 1.95 (1.06-3.59); p = 0.03 for any bleeding event. Using IV heparin boluses neither increased the probability of attaining a therapeutic aPTT (56.1 vs 56.3 %; p = 0.99) nor did it significantly increase bleeding events in the study (35.7 vs 31.3 %; p = 0.48). The results suggest that higher initial rates of heparin are associated with increased bleeding risk. From this dataset, initial heparin infusion rates of 9.7-11.0 U/kg/h without a bolus can result in therapeutic levels of anticoagulation in hospitalized patients with AF/AFL without increasing the risk of bleeding.

  20. Impact of North Carolina's motorcycle helmet law on hospital admissions and charges for care of traumatic brain injuries. (United States)

    Naumann, Rebecca B; Marshall, Stephen W; Proescholdbell, Scott K; Austin, Anna; Creppage, Kathleen


    BACKGROUND North Carolina requires motorcyclists of all ages to wear federally approved safety helmets. The purpose of this article is to estimate the impact of this state law in terms of hospital admissions for traumatic brain injury (TBI) and associated hospital charges. METHODS Hospital admissions of North Carolina motorcyclists with TBIs and associated hospital charges in 2011 were extracted from the North Carolina Hospital Discharge Data system. We estimated hospital admissions and charges for the same year under the counterfactual condition of North Carolina without a universal motorcycle helmet law by using various substitutes (Florida, Pennsylvania, and South Carolina residents treated in North Carolina). RESULTS North Carolina's universal helmet law prevented an estimated 190 to 226 hospital admissions of North Carolina motorcyclists with TBI in 2011. Averted hospital charges to taxpayer-funded sources (ie, government and public charges) were estimated to be between $9.5 million and $11.6 million for 2011, and total averted hospital charges for 2011 were estimated to be between $25.3 million and $31.0 million. LIMITATIONS Cost estimates are limited to inpatients during the initial period of hospital care. This study was unable to capture long-term health care costs and productivity losses incurred by North Carolina's TBI patients and their caregivers. CONCLUSIONS North Carolina's universal motorcycle helmet law generates health and economic benefits for the state and its taxpayers.