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Sample records for baby-friendly hospital initiative

  1. The Baby-friendly Hospital Initiative and Qatar, 2016

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    Mohamad A. Chehab, MBBCh

    2018-06-01

    Full Text Available Breastfeeding instills countless benefits that extend beyond the infant and child to the entire nation. One of the global targets set by the WHO to improve maternal, infant, and young child nutrition is to increase the rate of exclusive breast-feeding “in the first 6 months” up to at least 50% by 2025.3 Thus, as a global endeavor to promote and sustain breastfeeding, the WHO and UNICEF launched the Baby-friendly Hospital Initiative (BFHI 1 year after the Innocenti Declaration of 1990. Regarding the State of Qatar, there was a 34% rate of early initiation of breastfeeding “within the first hour of birth” and a 29% rate of exclusive breastfeeding between 2010 and 2015. In Qatar during 2016, many obstacles in achieving the aforementioned global target remained. In addition, there are still no hospitals with a BFHI accreditation. Keywords: Baby-friendly Hospital Initiative, Breastfeeding, Maternal health, Qatar

  2. Effects of baby-friendly hospital initiative on breast-feeding practices in Sindh

    International Nuclear Information System (INIS)

    Khan, M.; Akram, D.S.

    2013-01-01

    To determine changes in the breastfeeding practices of mothers after receiving counseling on Ten Steps to Successful Breastfeeding as defined by the Baby Friendly Hospital Initiative comparing baby friendly hospitals (BFHs) and non-baby-friendly hospitals in Sindh, Pakistan. Methods: The observational study was conducted from June 2007 to June 2009 in randomly selected baby-friendly and non-baby-friendly hospitals of Sindh, Pakistan. Non-probability purposive sampling was employed. The maternity staff was trained on Ten Steps to Successful Breastfeeding. The changes in breastfeeding practices were analysed by SPSS version 15. Results: A total of 236 women were included in the study. Of them, 196 (83.05%) were from baby-friendly hospitals and 40 (16.94%) from non-baby-friendly hospitals. Besides, 174 (88.7%) mothers in baby-friendly hospitals and 5 (12.5%) in non-baby-friendly hospitals during antenatal care received counseling by healthcare providers. There was an increase in breastfeeding practice up to 194 (98.97%) in the first category compared to 12 (30%) in the other category. Conclusion: Counseling under the Baby Friendly Hospital Initiative improved breastfeeding practices up to 98.97% in baby-friendly compared to non-baby-friendly hospitals. (author)

  3. CE: Beyond Maternity Nursing: The Baby-Friendly Hospital Initiative.

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    Cardaci, Regina

    2017-08-01

    : The Baby-Friendly Hospital Initiative (BFHI) is a program developed by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) to promote breastfeeding in hospitals and birthing facilities worldwide. Since the program was launched in 1991, breastfeeding initiation, duration, and exclusivity have increased globally, a trend largely attributed to changes in hospital policies and practices brought about by the BFHI. This article provides an overview of these practices and policies, the institutional benefits of achieving BFHI certification, and the process through which health care facilities can do so. All nurses-whether they work in maternity care or another nursing specialty in a hospital, ambulatory, or community setting-can play a role in promoting societal health through their support of long-term breastfeeding as recommended by the WHO and UNICEF.

  4. Barriers and facilitators to implementing the Baby-Friendly hospital initiative in neonatal intensive care units.

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    Benoit, Britney; Semenic, Sonia

    2014-01-01

    To explore manager, educator, and clinical leader perceptions of barriers and facilitators to implementing Baby-Friendly practice in the neonatal intensive care unit (NICU). Qualitative, descriptive design. Two university-affiliated level-III NICUs in Canada. A purposive sample of 10 medical and nursing managers, nurse educators, lactation consultants, and neonatal nurse practitioners. In-depth, semistructured interviews transcribed and analyzed using qualitative content analysis. Participants valued breastfeeding and family-centered care yet identified numerous contextual barriers to Baby-Friendly care including infant health status, parent/infant separation, staff workloads and work patterns, gaps in staff knowledge and skills, and lack of continuity of breastfeeding support. Facilitators included breastfeeding education, breastfeeding champions, and interprofessional collaboration. Despite identifying numerous barriers, participants recognized the potential value of expanding the Baby-Friendly Hospital Initiative (BFHI) to the NICU setting. Recommendations include promoting BFHI as a facilitator of family-centered care, interdisciplinary staff education, increasing access to lactation consultants, and establishing a group of NICU champions dedicated to BFHI implementation. © 2014 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

  5. Global baby-friendly hospital initiative monitoring data: update and discussion.

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    Labbok, Miriam H

    2012-08-01

    The World Health Organization (WHO)/UNICEF Baby-Friendly Hospital Initiative (BFHI) was developed to support the implementation of the Ten Steps for Successful Breastfeeding. The purpose of this study is to assess trends in the numbers facilities ever-designated "baby-friendly," to consider uptake of the new WHO/UNICEF BFHI materials, and to consider implications for future breastfeeding support. The national contacts from the 2006-2007 UNICEF BFHI update were recontacted, as were WHO and UNICEF officers worldwide, to ascertain the number of hospitals ever-designated "baby-friendly," presence of a government breastfeeding oversight committee, use of the new BFHI materials and, if yes, use of the new maternity or human immunodeficiency virus (HIV) materials. Seventy countries reporting in 2010-2011 and the updates from an additional 61 reporting in 2006-2007 (n=131, or 66% of the 198 countries) confirm that there are at least 21,328 ever-designated facilities. This is 27.5% of maternities worldwide: 8.5% of those in industrialized countries and 31% in less developed settings. In 2010, government committees were reported by 18 countries, and 34 reported using the new BFHI materials: 14 reported using the maternity care and 11 reported using the HIV materials. Rates of increase in the number of ever-certified "baby-friendly" hospitals vary by region and show some chronological correlation with trends in breastfeeding rates. Although it is not possible to attribute this increase to the BFHI alone, there is ongoing interest in Ten Steps implementation and in BFHI. The continued growth may reflect the dedication of ministries of health and national BFHI groups, as well as increasing recognition that the Ten Steps are effective quality improvement practices that increase breastfeeding and synergize with community interventions and other program efforts. With renewed interest in maternal/neonatal health, revitalization of support for Ten Steps and their effective

  6. Assessment of the Baby Friendly Hospital Initiative Implementation in the Eastern Mediterranean Region.

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    Al-Jawaldeh, Ayoub; Abul-Fadl, Azza

    2018-03-11

    The Baby-Friendly Hospital Initiative (BFHI) is a global program for promoting support and protection for breastfeeding. However, its impact on malnutrition, especially in countries of the Eastern Mediterranean region (EMR) that are facing the turmoil of conflict and emergencies, deserves further investigation. Having said that, this paper aims to discuss the status and challenges to BFHI implementation in the EMR countries. Data on BFHI implementation, breastfeeding practices, and nutritional status were collected from countries through structured questionnaires, personal interviews, and databases. The 22 countries of the EMR were categorized as follows: 8 countries in advanced nutrition transition stage (group I), 5 countries in early nutrition transition stage (group II), 4 countries with significant undernutrition (group III), and 5 countries in complex emergency (group IV). The challenges to BFHI implementation were discussed in relation to malnutrition. BFHI was not implemented in 22.7% of EMR countries. Designated Baby-Friendly hospitals totaled 829 (group I: 78.4%, group II: 9.05%; group III: 7.36%; group: IV5.19%). Countries with advanced nutrition transition had the highest implementation of BFHI but the lowest breastfeeding continuity rates. On the other hand, poor nutritional status and emergency states were linked with low BFHI implementation and low exclusive breastfeeding rates but high continuity rates. Early initiation and longer duration of breastfeeding correlated negatively with overweight and obesity ( p < 0.001). In countries with emergency states, breastfeeding continues to be the main source of nourishment. However, suboptimal breastfeeding practices prevail because of poor BFHI implementation which consequently leads to malnutrition. Political willpower and community-based initiatives are needed to promote breastfeeding and strengthen BFHI in the region.

  7. Assessment of the Baby Friendly Hospital Initiative Implementation in the Eastern Mediterranean Region

    Directory of Open Access Journals (Sweden)

    Ayoub Al-Jawaldeh

    2018-03-01

    Full Text Available The Baby-Friendly Hospital Initiative (BFHI is a global program for promoting support and protection for breastfeeding. However, its impact on malnutrition, especially in countries of the Eastern Mediterranean region (EMR that are facing the turmoil of conflict and emergencies, deserves further investigation. Having said that, this paper aims to discuss the status and challenges to BFHI implementation in the EMR countries. Data on BFHI implementation, breastfeeding practices, and nutritional status were collected from countries through structured questionnaires, personal interviews, and databases. The 22 countries of the EMR were categorized as follows: 8 countries in advanced nutrition transition stage (group I, 5 countries in early nutrition transition stage (group II, 4 countries with significant undernutrition (group III, and 5 countries in complex emergency (group IV. The challenges to BFHI implementation were discussed in relation to malnutrition. BFHI was not implemented in 22.7% of EMR countries. Designated Baby-Friendly hospitals totaled 829 (group I: 78.4%, group II: 9.05%; group III: 7.36%; group: IV5.19%. Countries with advanced nutrition transition had the highest implementation of BFHI but the lowest breastfeeding continuity rates. On the other hand, poor nutritional status and emergency states were linked with low BFHI implementation and low exclusive breastfeeding rates but high continuity rates. Early initiation and longer duration of breastfeeding correlated negatively with overweight and obesity (p < 0.001. In countries with emergency states, breastfeeding continues to be the main source of nourishment. However, suboptimal breastfeeding practices prevail because of poor BFHI implementation which consequently leads to malnutrition. Political willpower and community-based initiatives are needed to promote breastfeeding and strengthen BFHI in the region.

  8. Assessment of the Baby Friendly Hospital Initiative Implementation in the Eastern Mediterranean Region

    Science.gov (United States)

    Al-Jawaldeh, Ayoub; Abul-Fadl, Azza

    2018-01-01

    The Baby-Friendly Hospital Initiative (BFHI) is a global program for promoting support and protection for breastfeeding. However, its impact on malnutrition, especially in countries of the Eastern Mediterranean region (EMR) that are facing the turmoil of conflict and emergencies, deserves further investigation. Having said that, this paper aims to discuss the status and challenges to BFHI implementation in the EMR countries. Data on BFHI implementation, breastfeeding practices, and nutritional status were collected from countries through structured questionnaires, personal interviews, and databases. The 22 countries of the EMR were categorized as follows: 8 countries in advanced nutrition transition stage (group I), 5 countries in early nutrition transition stage (group II), 4 countries with significant undernutrition (group III), and 5 countries in complex emergency (group IV). The challenges to BFHI implementation were discussed in relation to malnutrition. BFHI was not implemented in 22.7% of EMR countries. Designated Baby-Friendly hospitals totaled 829 (group I: 78.4%, group II: 9.05%; group III: 7.36%; group: IV5.19%). Countries with advanced nutrition transition had the highest implementation of BFHI but the lowest breastfeeding continuity rates. On the other hand, poor nutritional status and emergency states were linked with low BFHI implementation and low exclusive breastfeeding rates but high continuity rates. Early initiation and longer duration of breastfeeding correlated negatively with overweight and obesity (p < 0.001). In countries with emergency states, breastfeeding continues to be the main source of nourishment. However, suboptimal breastfeeding practices prevail because of poor BFHI implementation which consequently leads to malnutrition. Political willpower and community-based initiatives are needed to promote breastfeeding and strengthen BFHI in the region. PMID:29534482

  9. Baby-Friendly Hospital Initiative: evaluation of the Ten Steps to Successful Breastfeeding

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    Soraia da Silva Lopes

    2013-12-01

    Full Text Available OBJECTIVE: To asses the performance of the Ten Steps to Successful Breastfeeding in an university hospital. METHODS: Descriptive and quantitative research, in which 103 people were interviewed in the outpatient prenatal clinic, in the maternity-ward and in the Neonatal Intensive Care Unit of a university hospital in Vitória, Southeast Brazil. The "Institutional Self-Evaluation Questionnaire" of the Baby Friendly Hospital Initiative was applied. Using this tool, the outcome was measured by the concordance index (CI proposed by the World Health Organization and by the United Nations Children's Fund. RESULTS: Although the hospital does not have a policy that addresses promotion, protection and support for breastfeeding, 93.3% of the mothers had contact with their babies immediately after birth (step 4, 83.3% of the professionals guided mothers how to breastfeed (step 5, 86.6% of the neonates did not receive any food or drink other than breast milk (step 6, 100% of babies were housed together with their mothers (step 7, 83.3% of the women were encouraged for breastfeeding on demand (step 8 and 100% of the infants did not use bottles or pacifiers (step 9. CONCLUSIONS: 60% of the steps were completed by the hospital. The greatest difficulty was to inform pregnant women about the importance and the management of breastfeeding (step 3. Therefore, visits to pregnant women are recommended, in order to prepare them for breastfeeding and to explain about the infants' healthy feeding habits.

  10. The bumpy road to implementing the Baby-Friendly Hospital Initiative in Austria: a qualitative study.

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    Wieczorek, Christina C; Schmied, Hermann; Dorner, Thomas E; Dür, Wolfgang

    2015-01-01

    The Baby-Friendly Hospital Initiative (BFHI) aims to promote and support breastfeeding. Globally, around 20,000 facilities have been designated Baby-Friendly. In Austria, however, only 16% of the maternity units have received BFHI-certification. Internationally, few studies have investigated facilitating or hindering factors for BFHI implementation. The need to extend BFHI-certification rates has been investigated previously, but little is known about why maternity units decide to become BFHI-certified, how BFHI is installed at the unit level, and which factors facilitate or impede the operation of the BFHI in Austria and how barriers are overcome. Using a qualitative approach, (health) professionals' perceptions of the selection, installation, as well as facilitators of and barriers to the BFHI were investigated. 36 semi-structured interviews with persons responsible for BFHI implementation (midwives, nurses, physicians, quality manager) were conducted in three Austrian maternity units. Data were analyzed using thematic analysis. Interviewees mentioned several motives for selecting the BFHI, including BFHI as a marketing tool, improvement of existing services, as well as collaboration between different professional groups. In each hospital, "change agents" were identified, who promoted the BFHI, teamed up with the managers of other professional groups and finally, with the manager of the unit. Installation of BFHI involved the adoption of project management, development and dissemination of new standards, and training of all staff. Although multiple activities were planned to prepare for actually putting the BFHI into practice, participants mentioned not only facilitating, but also several hindering factors. Interpretations of what facilitated or impeded the operation of BFHI differed among and between professional groups. Successful implementation of the BFHI in Austria depends on a complex interplay of multiple factors including a consensual "bottom

  11. An historical document analysis of the introduction of the Baby Friendly Hospital Initiative into the Australian setting.

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    Atchan, Marjorie; Davis, Deborah; Foureur, Maralyn

    2017-02-01

    Breastfeeding has many known benefits yet its support across Australian health systems was suboptimal throughout the 20th Century. The World Health Organization launched a global health promotion strategy to help create a 'breastfeeding culture'. Research on the programme has revealed multiple barriers since implementation. To analyse the sociopolitical challenges associated with implementing a global programme into a national setting via an examination of the influences on the early period of implementation of the Baby Friendly Hospital Initiative in Australia. A focused historical document analysis was attended as part of an instrumental case study. A purposeful sampling strategy obtained a comprehensive sample of public and private documents related to the introduction of the BFHI in Australia. Analysis was informed by a 'documents as commentary' approach to gain insight into individual and collective social practices not otherwise observable. Four major themes were identified: "a breastfeeding culture"; "resource implications"; "ambivalent support for breastfeeding and the BFHI" and "business versus advocacy". "A breastfeeding culture" included several subthemes. No tangible support for breastfeeding generally, or the Baby Friendly Hospital Initiative specifically, was identified. Australian policy did not follow international recommendations. There were no financial or policy incentives for BFHI implementation. Key stakeholders' decisions negatively impacted on the Baby Friendly Hospital Initiative at a crucial time in its implementation in Australia. The potential impact of the programme was not realised, representing a missed opportunity to establish and provide sustainable standardised breastfeeding support to Australian women and their families. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  12. 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

    2013-01-01

    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...... 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...

  13. Expansion of the baby-friendly hospital initiative ten steps to successful breastfeeding into neonatal intensive care: expert group recommendations.

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

    2013-08-01

    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.

  14. Self-reported breast feeding practices and the Baby Friendly Hospital Initiative in Riyadh, Saudi Arabia: prospective cohort study.

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    Mosher, Cynthia; Sarkar, Abdullah; Hashem, Alaa AbouBakr; Hamadah, Reem E; Alhoulan, Asma; AlMakadma, Yosra A; Khan, Tehreem A; Al-Hamdani, Abdurahman K; Senok, Abiola

    2016-12-16

    The Baby Friendly Hospital Initiative (BFHI) is a practice guideline for healthcare providers to promote breastfeeding and increase breastfeeding rates. This study aimed to examine reported experiences and views on breastfeeding of women using prenatal and postnatal services, and opinions of staff, in the context of the BFHI programme in Riyadh, Saudi Arabia. Prospective cohort study. This prospective, longitudinal study was conducted from December 2013 to September 2015 at two healthcare facilities (BFHI and non-BFHI) in Riyadh Saudi Arabia. Women 36-40 weeks gestation receiving antenatal care at the hospitals were enrolled. Questionnaires were administered prenatally, at 1, 3 and 6 months postnatal and to the administrator and maternity staff. We recruited 277 women with an estimated 80% response rate. 156 (BFHI=78/139, non-BFHI=78/138, 56%) participants completed all questionnaires. Most BFHI-hospital participants (77.9%, n=8 for this question) acknowledged seeing the breast feeding policy compared to 23.5% (n=23) at the non-BFHI-hospital (p<0.01). Breast feeding education and encouragement was higher at the BFHI-hospital (93.3%) compared to the non-BFHI-hospital (48.2%; p<0.01). At postpartum discharge, 51% (n=53) of mothers in the BFHI-hospital were breast feeding exclusively versus 29.6% (n=29) at the non-BFHI-hospital. Where formula feed was introduced, women in the BFHI-hospital more often practiced mixed feeding rather than exclusive formula feeding with some switching from mixed feeding to exclusive breast feeding between 3 and 6 months postpartum. Exclusive breast feeding rates declined in both hospitals at 3 and 6 months postpartum with lack of community services for lactation being a major reason. Although BFHI-hospital staff (n=9) were more conversant with BFHI principles, defects in adherence to the BFHI 10 Steps were identified. This is the first study assessing the effectiveness of BFHI implementation in Saudi Arabia. Although women

  15. Effect on Baby-Friendly Hospital Steps When Hospitals Implement a Policy to Pay for Infant Formula.

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    Tarrant, Marie; Lok, Kris Y W; Fong, Daniel Y T; Wu, Kendra M; Lee, Irene L Y; Sham, Alice; Lam, Christine; Bai, Dorothy Li; Wong, Ka Lun; Wong, Emmy M Y; Chan, Noel P T; Dodgson, Joan E

    2016-05-01

    The Baby-Friendly Hospital Initiative requires hospitals to pay market price for infant formula. No studies have specifically examined the effect of hospitals paying for infant formula on breastfeeding mothers' exposure to Baby-Friendly steps. To investigate the effect of hospitals implementing a policy of paying for infant formula on new mothers' exposure to Baby-Friendly steps and examine the effect of exposure to Baby-Friendly steps on breastfeeding rates. We used a repeated prospective cohort study design. We recruited 2 cohorts of breastfeeding mother-infant pairs (n = 2470) in the immediate postnatal period from 4 Hong Kong public hospitals and followed them by telephone up to 12 months postpartum. We assessed participants' exposure to 6 Baby-Friendly steps by extracting data from the medical record and by maternal self-report. After hospitals began paying for infant formula, new mothers were more likely to experience 4 out of 6 Baby-Friendly steps. Breastfeeding initiation within the first hour increased from 28.7% to 45%, and in-hospital exclusive breastfeeding rates increased from 17.9% to 41.4%. The proportion of mothers who experienced all 6 Baby-Friendly steps increased from 4.8% to 20.5%. The risk of weaning was progressively higher among participants experiencing fewer Baby-Friendly steps. Each additional step experienced by new mothers decreased the risk of breastfeeding cessation by 8% (hazard ratio = 0.92; 95% CI, 0.89-0.95). After implementing a policy of paying for infant formula, breastfeeding mothers were exposed to more Baby-Friendly steps, and exposure to more steps was significantly associated with a lower risk of breastfeeding cessation. © The Author(s) 2015.

  16. Factors influencing the intention of perinatal nurses to adopt the baby-friendly hospital initiative in southeastern quebec, Canada: implications for practice.

    Science.gov (United States)

    Chabot, Guylaine; Lacombe, Marie

    2014-01-01

    Nurses play a major role in promoting the baby-friendly hospital initiative (BFHI), yet the adoption of this initiative by nurses remains a challenge in many countries, despite evidences of its positive impacts on breastfeeding outcomes. The aim of this study was to identify the factors influencing perinatal nurses to adopt the BFHI in their practice. Methods. A sample of 159 perinatal nurses from six hospital-based maternity centers completed a survey based on the theory of planned behavior. Hierarchical multiple linear regression analyses were performed to assess the relationship between key independent variables and nurses' intention to adopt the BFHI in their practice. A discriminant analysis of nurses' beliefs helped identify the targets of actions to foster the adoption the BFHI among nurses. Results. The participants are mainly influenced by factors pertaining to their perceived capacity to overcome the strict criteria of the BFHI, the mothers' approval of a nursing practice based on the BFHI, and the antenatal preparation of the mothers. Conclusions. This study provides theory-based evidence for the development of effective interventions aimed at promoting the adoption of the BFHI in nurses' practice.

  17. Health Facility Staff Training for Improving Breastfeeding Outcome: A Systematic Review for Step 2 of the Baby-Friendly Hospital Initiative.

    Science.gov (United States)

    Balogun, Olukunmi O; Dagvadorj, Amarjargal; Yourkavitch, Jennifer; da Silva Lopes, Katharina; Suto, Maiko; Takemoto, Yo; Mori, Rintaro; Rayco-Solon, Pura; Ota, Erika

    2017-11-01

    The Baby-Friendly Hospital Initiative (BFHI) implemented through the "Ten Steps to Successful Breastfeeding" has been widely promoted as an intervention that improves breastfeeding rates. Step 2 requires the training of all healthcare staff in skills that are necessary to implement the policy. This systematic review provides evidence about the effect of training healthcare staff in hospitals and birth centers on breastfeeding outcomes. Randomized controlled trials (RCT), quasi-RCT, and controlled before and after (CBA) studies comparing training of healthcare staff on breastfeeding and supportive feeding practices with no training were included in this review. We searched CENTRAL PubMed, EMBASE, CINAHL, Web of Science, and the British Nursing Index for studies. Studies were screened against predetermined criteria, and risk of bias of included studies was assessed using the Risk of Bias Assessment tool for Non-Randomized Studies for non-RCT studies and the Cochrane Handbook for Systematic Reviews of Interventions for RCT studies. Of the six studies included in this review, three were RCT whereas three were CBA studies. The studies were conducted in 5 countries and involved 390 healthcare staff. Provision of educational interventions aimed at increasing knowledge and practice of BFHI and support was found to improve health worker's knowledge, attitude, and compliance with the BFHI practices. In one study, the rate of exclusive breastfeeding increased at the intervention site but no differences were found for breastfeeding initiation rates. All included studies had methodological limitations, and study designs and methodologies lacked comparability.

  18. The struggle for inter-professional teamwork and collaboration in maternity care: Austrian health professionals' perspectives on the implementation of the Baby-Friendly Hospital Initiative.

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    Wieczorek, Christina C; Marent, Benjamin; Dorner, Thomas E; Dür, Wolfgang

    2016-03-14

    The health benefits of breastfeeding for mothers and babies are well documented in the scientific literature. Research suggests that support of breastfeeding during pre- and postnatal maternity care is an important determinant of breastfeeding initiation and duration. To support and promote breastfeeding on maternity units, the Baby-Friendly Hospital Initiative (BFHI) was launched in 1991. In Austria, however, less than one fifth of hospitals with a maternity unit are currently BFHI-certified. Implementation of BFHI and adjunct changes in work practices seem to represent a major challenge to maternity units. This article builds upon previous research that has identified a number of facilitators of and barriers to BFHI implementation in Austria. A major barrier has been the lack of intra- and inter-professional collaboration. Therefore, this article investigates the ways in which different healthcare professionals struggle to work together to successfully integrate the BFHI into practice. In this study, a qualitative research approach was used. Thirty-six semi-structured interviews with 11 midwives, 11 nurses, 13 physicians, and one quality manager, working across three maternity units, were interviewed on-site. Data analysis followed thematic analysis. Midwives, nurses, and physicians had diverse approaches to childbirth and breastfeeding (medicalization vs. naturalness) and worked along different jurisdictions that became manifest in strict spatial divisions of maternity units. In their engagement within the BFHI, midwives, nurses, and physicians pursued different strategies (safeguarding vs. circumvention strategies). These differences hindered inter-professional teamwork and collaboration and, therefore, the integration of BFHI into practice. Differing approaches to childbirth and breastfeeding, deep seated professional jurisdictions, as well as spatial constraints, challenge inter-professional teamwork and collaboration on maternity units. Inter

  19. Barriers, facilitators, and recommendations related to implementing the Baby-Friendly Initiative (BFI): an integrative review.

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    Semenic, Sonia; Childerhose, Janet E; Lauzière, Julie; Groleau, Danielle

    2012-08-01

    Despite growing evidence for the positive impact of the Baby-Friendly Initiative (BFI) on breastfeeding outcomes, few studies have investigated the barriers and facilitators to the implementation of Baby-Friendly practices that can be used to improve uptake of the BFI at the local or country levels. This integrative review aimed to identify and synthesize information on the barriers, facilitators, and recommendations related to the BFI from the international, peer-reviewed literature. Thirteen databases were searched using the keywords Baby Friendly, Baby-Friendly Hospital Initiative, BFI, BFHI, Ten Steps, implementation, adoption, barriers, facilitators, and their combinations. A total of 45 English-language articles from 16 different countries met the inclusion criteria for the review. Data analysis was guided by Cooper's five stages of integrative research review. Using a multiple intervention program framework, findings were categorized into sociopolitical, organizational-level, and individual-level barriers and facilitators to implementing the BFI, as well as intra-, inter-, and extraorganizational recommendations for strengthening BFI implementation. A wide variety of obstacles and potential solutions to BFI implementation were identified. Findings suggest some priority issues to address when pursuing Baby-Friendly designation, including the endorsements of both local administrators and governmental policy makers, effective leadership of the practice change process, health care worker training, the marketing influence of formula companies, and integrating hospital and community health services. Framing the BFI as a complex, multilevel, evidence-based change process and using context-focused research implementation models to guide BFI implementation efforts may help identify effective strategies for promoting wider adoption of the BFI in health services.

  20. A Tale of Two Baby-Friendly Hospitals: Comparison of a Military and a Civilian Experience.

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    Terry, Melissa V; Barnes, Courtney; Beal, Katie; Enciso, Angel Jaime; Love-Zaranka, Angela

    2016-10-01

    To compare and contrast military hospital and civilian hospital experiences of achieving Baby-Friendly designation, and to examine administration and staff responses as well as institutional and patient postimplementation outcomes. Staff, administration, and chairs of Baby-Friendly committees at both hospitals were interviewed. Motivating factors and perceived administrative support were similar at both institutions. Both sites saw an increase in exclusive breastfeeding rates upon discharge to a rate of 80-90%, and both noted an overall increase in delivery rates, which may also be attributed to achieving Baby-Friendly designation. Significant differences included the amount of time it took to achieve Baby-Friendly status, the number of specialties represented on the Baby-friendly committee, the percentage of employees who received training, pediatrics involvement and support, and funding sources for staff training.

  1. Role of Baby-Friendly Hospital Care in Maternal Role Competence.

    Science.gov (United States)

    Barabach, Lynn; Ludington-Hoe, Susan M; Dowling, Donna; Lotas, Marilyn

    The objective of this pilot study was to determine women's perceptions of their levels of maternal role competence at discharge from a Baby-Friendly hospital. A convenience sample of 30 women completed two self-report questionnaires: a demographic questionnaire and the Perceived Maternal Parenting Self-Efficacy scale. Women report that they perceived high levels of maternal role competence with a mean total score of 69.80 (standard deviation = 6.86) out of 80. As women experience breastfeeding in Baby-Friendly hospitals, maternal role competence may develop with appropriate support. © 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses.

  2. Impact of a Baby-Friendly hospital on breastfeeding indicators in Shaqlawa district in Erbil governorate, Kurdistan region of Iraq.

    Science.gov (United States)

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

    2016-03-15

    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.

  3. Need for baby friendly commu- nity initiative to improve the low ...

    African Journals Online (AJOL)

    Ekanem EE. Fajola AO. Need for baby friendly commu- nity initiative to improve the low exclusive breastfeeding rates in. Nigeria. Accepted: 26th April 2016. Ekanem EE. Department of Paediatrics,. University of Calabar, Calabar, Nigeria. Email:emmanuelekanem@unical.edu.ng. Fajola AO. Regional Community Health,.

  4. Investigation of the Effect of Training on Promoting Breast-feeding at Baby-Friendly Hospital Case Study; Tohid Hospital in Jam, Bushehr

    Directory of Open Access Journals (Sweden)

    Azam Nickkhaha

    2015-06-01

    Full Text Available Background: The Baby-Friendly Hospital Initiative was launched in 1989 by World Health Organization and the United Nations Children's Fund for the promotion of breastfeeding. This program was implemented in many departments of gynecology and obstetrics and resulted in reduced malnutrition, infection, morbidity and mortality in children. This program has introduced 10 specific steps to support successful breastfeeding. For instance, in the fourth step, skin-to-skin contact and breastfeeding are promoted since the time of birth, and in the fifth step, mothers are instructed on how to breastfeed or persist in breastfeeding. In these ten steps, mothers are trained in various fields. Methods: In this cross-sectional study, a standardized questionnaire was used to collect data at baby-friendly hospitals. To assess the difference between multiple nominal variables, variance analysis was performed, using SPSS version 17. Results: Based on the analysis, mothers' awareness of the benefits of breast milk and breastfeeding was 83% in a baby-friendly hospital. Also, their awareness of proper breastfeeding was estimated at 78.5%. In addition, mothers' knowledge about the frequency of breastfeeding was 70%. Conclusion: Given the role of Baby-Friendly Hospital Initiative in training mothers on the importance of breastfeeding and its persistence in future, careful monitoring of these hospitals, breastfeeding support services and breastfeeding training by midwives at healthcare centers are of great importance.

  5. Excessive weight loss in exclusively breastfed full-term newborns in a Baby-Friendly Hospital

    Directory of Open Access Journals (Sweden)

    Maria Aparecida Mezzacappa

    Full Text Available Abstract Objective: To determine the risk factors for weight loss over 8% in full-term newborns at postpartum discharge from a Baby Friendly Hospital. Methods: The cases were selected from a cohort of infants belonging to a previous study. Healthy full-term newborns with birth weight ≥2.000g, who were exclusively breastfed were included and excluded twins and those undergoing phototherapy as well as those discharged after 96h of life. The analyzed maternal and neonatal variables were maternal age, parity, ethnicity, type of delivery, maternal diabetes, gender, gestational age and appropriate weight for age. Adjusted multiple and univariate Cox regression analyses were used, considering as significant p8% were cesarean delivery and older maternal age. At the adjusted multiple regression analysis, the model to explain the weight loss was cesarean delivery (Relative risk 2.27, 95% of Confidence Interval 1.54–3.35. Conclusions: The independent predictor for weight loss>8% in exclusively breastfed full-term newborns in a Baby-Friendly Hospital was the cesarean delivery. It is possible to reduce the number of cesarean sections to minimize neonatal excessive weight loss and the resulting use of infant formula during the first week of life.

  6. Effectiveness of Baby Friendly Community Initiative (BFCI) on complementary feeding in Koibatek, Kenya: a randomized control study.

    Science.gov (United States)

    Maingi, Mildred; Kimiywe, Judith; Iron-Segev, Sharon

    2018-05-08

    Appropriate infant and young child nutrition is critical for proper growth and development. In order to promote optimal nutrition at an early age, the World Health Organization (WHO) and UNICEF have developed the Baby Friendly Hospital Initiative (BFHI) to address poor breastfeeding practices in maternity wards. However, impact is limited in less developed countries like Kenya, where more than half of all births are home deliveries. Therefore, Kenya has explored the adoption of Baby Friendly Community Initiative (BFCI) in its rural settings. In contrast to the BFHI, the BFCI supports breastfeeding and optimal infant feeding in community. BFCI has been implemented in Koibatek, in rural Kenya. This study aimed at assessing the effectiveness of BFCI on complementary feeding practices of children aged 6-23 months, by comparing intervention and control groups. This was a randomized control study design that included 270 mother-infant pairs enrolled in the Baby Friendly Community Initiative (BFCI) project in Koibatek. Evaluation was carried out using structured questionnaires. A statistically significantly higher proportion of children in the intervention group compared to the control group attained minimum dietary diversity (77% vs. 58%; p = 0.001), minimum meal frequency (96% vs. 89%; p = 0.046) and minimum acceptable diet (77% vs. 61%; p = 0.005). The odds of attaining minimum dietary diversity, minimum meal frequency and minimum acceptable diet were statistically significantly higher for the intervention group compared to control group (OR: 4.95; 95%CI 2.44-10.03, p = < 0.001; OR: 14.84; 95%CI 2.75-79.9, p = 0.002; OR: 4.61; 95%CI 2.17-9.78, p = < 0.001 respectively). The BFCI intervention was successful in improving complementary feeding practices. Strengthening and prioritizing BFCI interventions could have a significant impact on child health outcomes in rural Kenya. ISRCTN03467700 . Registration 24 September 2014. Retrospectively

  7. Implementing the WHO/UNICEF Baby Friendly Initiative in the community: a 'hearts and minds' approach.

    Science.gov (United States)

    Thomson, Gill; Bilson, Andy; Dykes, Fiona

    2012-04-01

    to describe a 'hearts and minds' approach to community Baby Friendly Initiative implementation developed from the views of multidisciplinary professionals. a qualitative descriptive study utilising focus groups and interviews, with thematic networks analysis conducted. forty-seven professionals were consulted from two primary health-care facilities located in the North-West of England. thematic networks analysis generated a global theme of a 'hearts and minds approach' to BFI implementation, which embodies emotional and rational engagement. The three underpinning organising themes (and their associated basic themes): 'credible leadership', 'engagement of key partners' and 'changing attitudes and practice' reflect the context, processes and outcomes of a 'hearts and minds' approach. a 'hearts and minds' approach transcends the prescriptive aspects of a macro-level intervention with its emphasis upon audits, training, statistics and 'hard' evidence through valuing other professionals and engaging staff at all levels. It offers insights into how organisational change may move beyond traditional top-down mechanisms for driving change to incorporate ways that value others and promote cooperation and reflection. Copyright © 2011 Elsevier Ltd. All rights reserved.

  8. 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

    Directory of Open Access Journals (Sweden)

    Carmen Viana Ramos

    2010-12-01

    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

  9. Bringing Baby-Friendly to the Indian Health Service: A Systemwide Approach to Implementation.

    Science.gov (United States)

    Karol, Susan; Tah, Tina; Kenon, Clifton; Meyer, Jenna; Yazzie, Jeannette; Stephens, Celissa; Merewood, Anne

    2016-05-01

    The Baby-Friendly Hospital Initiative (BFHI) increases exclusive breastfeeding. Breastfeeding protects against obesity and diabetes, conditions to which American Indians and Alaska Natives are particularly prone. As part of the First Lady'sLet's Move! in Indian Countryinitiative, the US Department of Health and Human Services' Indian Health Service (IHS) began implementing the BFHI in 2011. The IHS administers 13 US birthing hospitals. There are 5 tribally administered hospitals in the lower 48 states that receive IHS funding, and the IHS encouraged them to seek Baby-Friendly designation also. In the 13 federally administered hospitals, the IHS implemented a Baby-Friendly infant feeding policy, extensive clinician training, and Baby-Friendly compatible medical records. All hospitals also became compliant with the World Health Organization's International Code of Marketing of Breast-Milk Substitutes. Strategies and solutions were shared systemwide via webinars and conference calls. Quality improvement methods, technical assistance, and site visits assisted with the implementation process. Between 2011 and December 2014, 100% (13 of 13) of IHS federally administered hospitals gained Baby-Friendly designation. The first Baby-Friendly hospitals in Arizona, New Mexico, North Dakota, Oklahoma, and South Dakota were all IHS sites; 6% of all US Baby-Friendly hospitals are currently IHS hospitals. One tribal site has also been Baby-Friendly designated and 3 of the 5 remaining tribally administered hospitals in the lower 48 states are pursuing Baby-Friendly status. Baby-Friendly Hospital Initiative implementation systemwide is possible in a US government agency serving a high-risk, underprivileged population. Other systems looking to implement the BFHI can learn from the IHS model. © International Lactation Consultant Association 2015.

  10. Feasibility and effectiveness of the baby friendly community initiative in rural Kenya: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Kimani-Murage, Elizabeth W; Kimiywe, Judith; Kabue, Mark; Wekesah, Frederick; Matiri, Evelyn; Muhia, Nelson; Wanjohi, Milka; Muriuki, Peterrock; Samburu, Betty; Kanyuira, James N; Young, Sera L; Griffiths, Paula L; Madise, Nyovani J; McGarvey, Stephen T

    2015-09-28

    Interventions promoting optimal infant and young child nutrition could prevent a fifth of under-5 deaths in countries with high mortality. Poor infant and young child feeding practices are widely documented in Kenya, with potential detrimental effects on child growth, health and survival. Effective strategies to improve these practices are needed. This study aims to pilot implementation of the Baby Friendly Community Initiative (BFCI), a global initiative aimed at promoting optimal infant and young child feeding practices, to determine its feasibility and effectiveness with regards to infant feeding practices, nutrition and health outcomes in a rural setting in Kenya. The study, employing a cluster-randomized trial design, will be conducted in rural Kenya. A total of 12 clusters, constituting community units within the government's Community Health Strategy, will be randomized, with half allocated to the intervention and the other half to the control arm. A total of 812 pregnant women and their respective children will be recruited into the study. The mother-child pairs will be followed up until the child is 6 months old. Recruitment will last approximately 1 year from January 2015, and the study will run for 3 years, from 2014 to 2016. The intervention will involve regular counseling and support of mothers by trained community health workers and health professionals on maternal, infant and young child nutrition. Regular assessment of knowledge, attitudes and practices on maternal, infant and young child nutrition will be done, coupled with assessment of nutritional status of the mother-child pairs and morbidity for the children. Statistical methods will include analysis of covariance, multinomial logistic regression and multilevel modeling. The study is funded by the NIH and USAID through the Program for Enhanced Research (PEER) Health. Findings from the study outlined in this protocol will inform potential feasibility and effectiveness of a community

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

    Directory of Open Access Journals (Sweden)

    Jéssica Machado Teles

    2015-03-01

    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. Baby-Friendly Practices Minimize Newborn Infants Weight Loss.

    Science.gov (United States)

    Procaccini, Diane; Curley, Ann L Cupp; Goldman, Martha

    2018-04-01

    It is accepted that newborns lose weight in the first few days of life. Baby-Friendly practices that support breastfeeding may affect newborn weight loss. The objective of this study were: 1) To determine whether Baby-Friendly practices are associated with term newborn weight loss day 0-2 in three feeding categories (exclusively breastfed, mixed formula fed and breastfed, and formula fed). 2) To determine whether Baby-Friendly practices increase exclusive breast feeding rates in different ethnic populations. This was a retrospective case-control study. Term newborn birth weight, neonatal weights days 0-2, feeding type, type of birth, and demographic information were collected for 1,000 births for the year before Baby-Friendly designation (2010) and 1,000 in 2013 (after designation). Ultimately 683 in the first group and 518 in the second met the inclusion criteria. Mean weight loss decreased day 0-2 for infants in all feeding types after the initiation of Baby-Friendly practices. There was a statistically significant effect of Baby-Friendly designation on weight loss for day 0-2 in exclusively breastfed infants (p Baby-Friendly practices were put in place. There was a decrease in mean weight loss day 0-2 regardless of feeding type after Baby-Friendly designation. Exclusive breast feeding increased in the presence of Baby-Friendly practices.

  13. 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

    Directory of Open Access Journals (Sweden)

    Cynthia de Almeida Brandão Meirelles

    2008-09-01

    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

  14. 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.

    Science.gov (United States)

    Schmied, Virginia; Gribble, Karleen; Sheehan, Athena; Taylor, Christine; Dykes, Fiona C

    2011-08-31

    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. 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. 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. 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 current processes used to disseminate and implement BFHI need to be

  15. 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

    Directory of Open Access Journals (Sweden)

    Sheehan Athena

    2011-08-01

    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

  16. Trends in Baby-Friendly® Care in the United States: Historical Influences on Contemporary Care.

    Science.gov (United States)

    Salera-Vieira, Jean; Zembo, Cynthia T

    2016-01-01

    The protection that breast-feeding affords both mother and infant against acute and chronic illness is well documented. The grassroots, public health, and governmental supports for breast-feeding have influenced changes in maternal and newborn care. History indicates that the additional influence has come in the form of governmental workshops and initiatives, professional organizations, as well as The Joint Commission. This includes the influence that the Baby-Friendly® Hospital Initiative and the Ten Steps to Successful Breastfeeding have had on infant care throughout the years. The requirements that hospitals must follow to implement all, or some, of the Ten Steps lead to change in care that not only increases breast-feeding rates but also leads to health improvements. This article reviews how an upward trend in the adoption of Baby-Friendly practices to support breast-feeding impacts infant care.

  17. DEMOGRAPHIC-ANAMNESTIC PARAMETERS WHICH AFFECT IMPLEMENTATION OF BABY FRIENDLY PROGRAM

    Directory of Open Access Journals (Sweden)

    Bozidar Jovanovic

    2005-12-01

    Full Text Available Various studies and extensive researches, particularly during recent years, on the advantages of breastfeeding and the use of breast milk in infant`s nourishment, have stressed its immeasurable benefit to mothers, infants, family and society. The objective of the research was to ascertain demographic and anamnestic factors affecting the implementation of the baby friendly program. The study was undertaken at OGC CC Kragujevac and based on data from 432 women. The mean age of the examinees was 25,9 years and they were 6 months younger than the corresponding examinees from similar world researches. In most cases, the examinees were from urban areas and lived in bigger families, which did not affect the implementation of the program. With equal probability, it was the first or second pregnancy and in most cases, there were no hospitalizations during the pregnancy in both tested groups. Medications are more often used during the implementation of the baby friendly program. The reason for positive influence of the use of medications during the pregnancy on implementation of the baby friendly program probably lies in better supervision of the pregnancy. The gestation age did not influence the selection into the program. By means of higher level of supervision and by the use of medications during pregnancy, we can positively influence mother`s and infant`s starting with the baby friendly programme implementation.

  18. 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

    Directory of Open Access Journals (Sweden)

    Mateus Freire L Souza

    2011-12-01

    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

  19. Best Fed Beginnings: A Nationwide Quality Improvement Initiative to Increase Breastfeeding.

    Science.gov (United States)

    Feldman-Winter, Lori; Ustianov, Jennifer; Anastasio, Julius; Butts-Dion, Sue; Heinrich, Patricia; Merewood, Anne; Bugg, Kimarie; Donohue-Rolfe, Sarah; Homer, Charles J

    2017-07-01

    In response to a low number of Baby-Friendly-designated hospitals in the United States, the Centers for Disease Control and Prevention funded the National Institute for Children's Health Quality to conduct a national quality improvement initiative between 2011 and 2015. The initiative was entitled Best Fed Beginnings and enrolled 90 hospitals in a nationwide initiative to increase breastfeeding and achieve Baby-Friendly designation. The intervention period lasted from July 2012 to August 2014. During that period, data on process indicators aligned with the Ten Steps to Successful Breastfeeding and outcome measures (overall and exclusively related to breastfeeding) were collected. In addition, data on the Baby-Friendly designation were collected after the end of the intervention through April 2016. Hospitals assembled multidisciplinary teams that included parent partners and community representatives. Three in-person learning sessions were interspersed with remote learning and tests of change, and a Web-based platform housed resources and data for widespread sharing. By April 2016, a total of 72 (80%) of the 90 hospitals received the Baby-Friendly designation, nearly doubling the number of designated hospitals in the United States. Participation in the Best Fed Beginnings initiative had significantly high correlation with designation compared with hospital applicants not in the program (Pearson's r [235]: 0.80; P initiative of maternity care hospitals accomplished rapid transformative changes to achieve Baby-Friendly designation. These changes were accompanied by a significant increase in exclusive breastfeeding. Copyright © 2017 by the American Academy of Pediatrics.

  20. The Sharjah Baby-Friendly Campaign: A Community-Based Model for Breastfeeding Promotion, Protection, and Support.

    Science.gov (United States)

    Al Ghazal, Hessa; Rashid, Shehnaz; Ruf, Evelyne

    2015-11-01

    Breastfeeding promotion, protection, and support are one of the most cost-effective public health interventions to advance maternal and child health. The World Health Organization, the United Nations International Children's Emergency Fund, and numerous health organizations have recommended exclusive breastfeeding for the first 6 months of life, which is a key indicator of breastfeeding promotion programs worldwide. Despite the recommendations and various initiatives to promote breastfeeding, most women do not reach the exclusive breastfeeding target in both developed and developing countries. Such has been the case in the United Arab Emirates (UAE). Therefore, based on the decree for breastfeeding promotion, protection, and support by the ruler of the Emirate of Sharjah, UAE, H.H. Sheikh Doctor Sultan Al Qasimi, a multisectorial, multidirectional breastfeeding campaign--the Sharjah Baby-Friendly Campaign--was launched in March 2012 by H.E. Sheikha Bodour Al Qasimi, under her patronage. It consisted of four initiatives-namely, Baby-Friendly Health Facility, Mother-Friendly Workplace, Breastfeeding-Friendly Nursery, and Mother-Baby Friendly Public Place. Once an organization met the criteria for any of these initiatives, it was awarded the designation or accreditation of that initiative. The campaign initiatives worked through capacity building of healthcare workers, provided professional support and facilitation for the accreditation process, developed breastfeeding education content and resources, and organized and conducted breastfeeding promotion seminars in health facilities and community, as well as community outreach through social media and an innovative mobile mother' room. The positive impact of the campaign on breastfeeding promotion, protection, and support is evident by the increased exclusive breastfeeding rate at 6 months and decreased bottle feeding rates at both 4 and 6 months.

  1. Caesarean section delivery and breastfeeding initiation at the ...

    African Journals Online (AJOL)

    Background: Caesarean section (CS) presents a challenge for early breastfeeding of the newborn infant. It is expected that with the Baby Friendly Hospital Initiative (BFHI), mothers who deliver by CS can be helped to initiate breastfeeding early. Objectives: This study aims to determine the time of initiation of breastfeeding in ...

  2. 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

    Science.gov (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.

    2014-02-01

    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.

  3. 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.

  4. Hospital Quality Initiative - Outcome Measures

    Data.gov (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...

  5. Implementing Patient Safety Initiatives in Rural Hospitals

    Science.gov (United States)

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

    2009-01-01

    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…

  6. CDC Vital Signs: Hospital Actions Affect Breastfeeding

    Science.gov (United States)

    ... mothers to community programs for support once they leave the hospital. Hospitals can Implement the Ten Steps to Successful Breastfeeding and work towards achieving Baby-Friendly designation. Use CDC’s Maternity Practices in Infant Nutrition and Care (mPINC) survey ...

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

    Science.gov (United States)

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

    2015-11-01

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

  8. Private finance initiative hospital architecture: towards a political economy of the Royal Liverpool University Hospital.

    Science.gov (United States)

    Jones, Paul

    2018-02-01

    Sociological analysis has done much to illuminate the architectural contexts in which social life takes place. Research on care environments suggests that the built environment should not be understood as a passive backdrop to healthcare, but rather that care is conditioned by the architecture in which it happens. This article argues for the importance of going beyond the hospital walls to include the politics that underwrite the design and construction of hospital buildings. The article assesses the case of the yet-to-be-realised Liverpool Royal University Hospital, and the private finance initiative (PFI) funding that underpins the scheme, which is suggested as a salient 'external' context for understanding architecture's role in the provision of healthcare of many kinds for many years to come. PFI has major implications for democratic accountability and local economy, as well as for the architecture of the hospital as a site of care. Critical studies can illuminate these paradoxically visible-but-opaque hospital spaces by going beyond that which is immediately empirically evident, so as to reveal the ways in which hospital architecture is conditioned by political and economic forces. © 2018 Foundation for the Sociology of Health & Illness.

  9. CDC Vital Signs-Hospital Actions Affect Breastfeeding

    Centers for Disease Control (CDC) Podcasts

    2015-10-06

    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.

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

    Directory of Open Access Journals (Sweden)

    Lauren Lapointe-Shaw

    Full Text Available 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.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.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.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.

  11. Improving Exclusive Breastfeeding in an Urban Academic Hospital.

    Science.gov (United States)

    Ward, Laura P; Williamson, Susan; Burke, Stephanie; Crawford-Hemphill, Ruby; Thompson, Amy M

    2017-02-01

    Breastfeeding has many well-established health benefits for infants and mothers. There is greater risk reduction in health outcomes with exclusive breastfeeding (EBF). Our urban academic facility has had long-standing low EBF rates, serving a population with breastfeeding disparities. We sought to improve EBF rates through a Learning Collaborative model by participating in the Best Fed Beginnings project. Formal improvement science methods were used, including the development of a key driver diagram and plan-do-study-act cycles. Improvement activities followed the Ten Steps to Successful Breastfeeding. We demonstrated significant improvement in the median adherence to 2 process measures, rooming in and skin-to-skin after delivery. Subsequently, the proportion of infants exclusively breastfed at hospital discharge in our facility increased from 37% to 59%. We demonstrated an increase in sustained breastfeeding in a subset of patients at a postpartum follow-up visit. These improvements led to Baby-Friendly designation at our facility. This quality improvement initiative resulted in a higher number of infants exclusively breastfed in our patient population at "high risk not to breastfeed." Other hospitals can use these described methods and techniques to improve their EBF rates. Copyright © 2017 by the American Academy of Pediatrics.

  12. Clinical practices in the hospital care of healthy newborn infant in Brazil.

    Science.gov (United States)

    Moreira, Maria Elisabeth Lopes; Gama, Silvana Granado Nogueira da; Pereira, Ana Paula Esteves; Silva, Antonio Augusto Moura da; Lansky, Sônia; Souza Pinheiro, Rossiclei de; Carvalho Gonçalves, Annelise de; Carmo Leal, Maria do

    2014-08-01

    The aim of this study was to evaluate the care of healthy full-term newborns and to identify variations in childbirth care and practices in the first hour of life. We used data from the Birth in Brazil survey. Unadjusted and adjusted odds ratio (OR) of hospital-delivered care for the mother and during childbirth were estimated for the following outcomes: upper airways and gastric aspiration, use of inhaled oxygen, use of incubator, skin-to-skin contact after birth, rooming-in and breastfeeding in the delivery room and within the first hour of life. We observed wide variations in the care of healthy full-term newborn in the delivery room. Practices considered inadequate, such as use of inhaled oxygen, (9.5%) aspiration of airways (71.1%) and gastric suctioning (39.7%), and the use of incubator (8.8%) were excessively used. Breastfeeding in the delivery room was low (16%), even when the Baby-Friendly Hospital Initiative had been implemented (24%). The results suggest poor knowledge and compliance by health practitioners to good clinical practice. Such noncompliance was probably not due to the differences in resources, since most births take place in hospitals where the necessary resources are available.

  13. Impact of health professional training in breastfeeding on their knowledge, skills, and hospital practices: a systematic review

    Directory of Open Access Journals (Sweden)

    Patricia Carvalho de Jesus

    Full Text Available Abstract Objective To identify the impact of training in breastfeeding on knowledge, skills, and professional and hospital practices. Data source The systematic review search was carried out through the MEDLINE, Scopus, and LILACS databases. Reviews, studies with qualitative methodology, those without control group, those conducted in primary care, with specific populations, studies that had a belief and/or professional attitude as outcome, or those with focus on the post-discharge period were excluded. There was no limitation of period or language. The quality of the studies was assessed by the adapted criteria of Downs and Black. Summary of data The literature search identified 276 articles, of which 37 were selected for reading, 26 were excluded, and six were included through reference search. In total, 17 intervention articles were included, three of them with good internal validity. The studies were performed between 1992 and 2010 in countries from five continents; four of them were conducted in Brazil. The training target populations were nursing practitioners, doctors, midwives, and home visitors. Many kinds of training courses were applied. Five interventions employed the theoretical and practical training of the Baby-Friendly Hospital Initiative. All kinds of training courses showed at least one positive result on knowledge, skills, and/or professional/hospital practices, most of them with statistical significance. Conclusions Training of hospital health professionals has been effective in improving knowledge, skills, and practices.

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

    Directory of Open Access Journals (Sweden)

    Firoozeh Bairami

    2016-01-01

    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.

  15. Initial management of hospital evacuations caused by Hurricane Rita: a systematic investigation.

    Science.gov (United States)

    Downey, Erin L; Andress, Knox; Schultz, Carl H

    2013-06-01

    Hurricanes remain a major threat to hospitals throughout the world. The authors attempted to identify the planning areas that impact hospital management of evacuations and the challenges faced when sheltering-in-place. This observational, retrospective cohort study examined acute care institutions from one hospital system impacted by Hurricane Rita in 2005. Investigators used a standardized survey instrument and interview process, previously used in the hospital evacuation context, to examine hospitals' initial internal situational awareness and subsequent decision making that resulted in evacuation due to Hurricane Rita. Participants from each hospital included representatives from senior leadership and clinical and nonclinical staff that comprised the Incident Management Team (IMT). The main measured outcomes were responses to 95 questions contained in the survey. Seven of ten eligible hospitals participated in the study. All facilities evacuated the sickest patients first. The most significant factors prompting evacuation were the issuing of mandatory evacuation orders, storm dynamics (category, projected path, storm surge), and loss of regional communications. Hospitals that sheltered-in-place experienced staff shortages, interruptions to electrical power, and loss of water supplies. Three fully-evacuated institutions experienced understaffing of 40%-60%, and four hospitals sustained depressed staffing levels for over four weeks. Five hospitals lost electricity for a mean of 4.8 days (range .5-11 days). All facilities continued to receive patients to their Emergency Departments (EDs) while conducting their own evacuation. Hospital EDs should plan for continuous patient arrival during evacuation. Emergency Operation Plans (EOPs) that anticipate challenges associated with evacuation will help to maximize initial decision making and management during a crisis situation. Hospitals that shelter-in-place face critical shortages and must provide independent patient

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

    Directory of Open Access Journals (Sweden)

    Ahmadreza Izadi

    2015-01-01

    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.

  17. Unique factors rural Veterans' Affairs hospitals face when implementing health care-associated infection prevention initiatives.

    Science.gov (United States)

    Harrod, Molly; Manojlovich, Milisa; Kowalski, Christine P; Saint, Sanjay; Krein, Sarah L

    2014-01-01

    Health care-associated infection (HAI) is costly to hospitals and potentially life-threatening to patients. Numerous infection prevention programs have been implemented in hospitals across the United States. Yet, little is known about infection prevention practices and implementation in rural hospitals. The purpose of this study was to understand the infection prevention practices used by rural Veterans' Affairs (VA) hospitals and the unique factors they face in implementing these practices. This study used a sequential, mixed methods approach. Survey data to identify the HAI prevention practices used by rural VA hospitals were collected, analyzed, and used to inform the development of a semistructured interview guide. Phone interviews were conducted followed by site visits to rural VA hospitals. We found that most rural VA hospitals were using key recommended infection prevention practices. Nonetheless, a number of challenges with practice implementation were identified. The 3 most prominent themes were: (1) lack of human capital including staff with HAI expertise; (2) having to cultivate needed resources; and (3) operating as a system within a system. Rural VA hospitals are providing key infection prevention services to ensure a safe environment for the veterans they serve. However, certain factors, such as staff expertise, limited resources, and local context impacted how and when these practices were used. The creative use of more accessible alternative resources as well as greater flexibility in implementing HAI-related initiatives may be important strategies to further improve delivery of these important services by rural VA hospitals. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

  18. Reducing hospital admissions of healthy children with functional constipation: a quality initiative.

    Science.gov (United States)

    Deneau, Mark; Mutyala, Ramakrishna; Sandweiss, David; Harnsberger, Janet; Varier, Raghu; Pohl, John F; Allen, Lauren; Thackeray, Callie; Zobell, Sarah; Maloney, Christopher

    2017-01-01

    Functional constipation (FC) is a common medical problem in children, with minimal risk of long-term complications. We determined that a large number of children were being admitted to our children's hospital for FC in which there was no neurological or anatomical cause. Our hospital experienced a patient complication in which a patient died after inpatient treatment of FC. Subsequently, we developed a standardised approach to determine when paediatric patients needed hospitalisation for FC, as well as to develop a regimented outpatient therapeutic approach for such children to prevent hospitalisation. Our quality improvement initiative resulted in a large decrease in the number of children with FC admitted into the hospital as well as a decrease in the number of children needing faecal disimpaction in the operating room. Our quality improvement process can be used to decrease hospitalisations, decrease healthcare costs and improve patient care for paediatric FC.

  19. A QI Initiative to Reduce Hospitalization for Children With Isolated Skull Fractures.

    Science.gov (United States)

    Lyons, Todd W; Stack, Anne M; Monuteaux, Michael C; Parver, Stephanie L; Gordon, Catherine R; Gordon, Caroline D; Proctor, Mark R; Nigrovic, Lise E

    2016-06-01

    Although children with isolated skull fractures rarely require acute interventions, most are hospitalized. Our aim was to safely decrease the hospitalization rate for children with isolated skull fractures. We designed and executed this multifaceted quality improvement (QI) initiative between January 2008 and July 2015 to reduce hospitalization rates for children ≤21 years old with isolated skull fractures at a single tertiary care pediatric institution. We defined an isolated skull fracture as a skull fracture without intracranial injury. The QI intervention consisted of 2 steps: (1) development and implementation of an evidence-based guideline, and (2) dissemination of a provider survey designed to reinforce guideline awareness and adherence. Our primary outcome was hospitalization rate and our balancing measure was hospital readmission within 72 hours. We used standard statistical process control methodology to assess change over time. To assess for secular trends, we examined admission rates for children with an isolated skull fracture in the Pediatric Health Information System administrative database. We identified 321 children with an isolated skull fracture with a median age of 11 months (interquartile range 5-16 months). The baseline admission rate was 71% (179/249, 95% confidence interval, 66%-77%) and decreased to 46% (34/72, 95% confidence interval, 35%-60%) after implementation of our QI initiative. No child was readmitted after discharge. The admission rate in our secular trend control group remained unchanged at 78%. We safely reduced the hospitalization rate for children with isolated skull fractures without an increase in the readmissions. Copyright © 2016 by the American Academy of Pediatrics.

  20. Initial default among sputum-positive pulmonary TB patients at a referral hospital in Uttarakhand, India.

    Science.gov (United States)

    Mehra, Darshan; Kaushik, Rajeev M; Kaushik, Reshma; Rawat, Jagdish; Kakkar, Rajesh

    2013-09-01

    Initial default is a serious issue which can enhance the transmission of TB. We determined the magnitude of and the causative factors for initial default among sputum-positive pulmonary TB (PTB) patients. In this prospective study, 2310 patients attending a referral hospital in Uttarakhand state, north India, with presumptive TB were investigated and 555 patients with sputum-positive PTB were followed-up for initiation of anti-TB treatment (ATT) during 2010-2012. The patients not confirmed as having started ATT were considered initial defaulters. Initial default was seen in 120 (21.6%) patients comprising 22 (18.3%) defaulters during diagnosis and 98 (81.6%) defaulters after referral for directly observed treatment, short-course (DOTS). The initial default rate was significantly higher among patients from rural areas than urban areas, illiterate patients than literate patients and smokeless tobacco-users than non-users (pdefault among patients referred for DOTS were limited trust in DOTS (n = 44, 44.8%), adverse effects of previous ATT (n = 41, 41.8%), dissatisfaction with health services (n = 38, 38.7%), local deaths while taking DOTS (n = 28, 28.5%), advice by others against DOTS (n = 25, 25.5%), disbelief in the diagnosis (n = 18, 18.3%) and patient death before starting treatment (n = 4, 4.0%). A high initial default rate was seen among patients with PTB. There is an urgent need to promote public awareness to lower the initial default rate.

  1. Patients "falling through the cracks". The Canterbury Charity Hospital: initial progress report.

    Science.gov (United States)

    Bagshaw, Philip F; Allardyce, Randall A; Bagshaw, Susan N; Stokes, Brian W; Shaw, Carl S; Proffit, Lorraine J; Nicholls, M Gary; Begg, Evan J; Frampton, Christopher M

    2010-08-13

    To present the early experience of establishing a community-funded and volunteer-staffed hospital in Christchurch, New Zealand. This was to provide free selected elective healthcare services to patients in the Canterbury region who were otherwise unable to access treatment in the public health system or afford private healthcare. Data were reviewed relating to the establishment, financing, staffing and running of the Canterbury Charity Hospital. Details were provided of patients referred by their general practitioners who were seen and treated during the first two and a half years of function. Canterbury Charity Hospital Trust, established in 2004, completed the purchase of a residential villa in 2005 and converted it into the Canterbury Charity Hospital, which performed its first operations in 2007. By the end of December 2009, 115 volunteer health professionals and 79 non-medical volunteers had worked at the Hospital, provided a total of 966 outpatient clinic appointments, of which 609 were initial assessments, and performed 610 surgical procedures. Funding of $NZ4.3 million (end of last financial year) came from fundraising events, donations, grants and interest from investments. There has been no government funding. There is a substantial unmet need for elective healthcare in Canterbury, and this has, in part, been addressed by the recently established Canterbury Charity Hospital. The overwhelming community response we have experienced in Canterbury raises the question of whether the current public health system needs attention to be re-focused on unmet need. We contend that unless this occurs it might be necessary to establish charity-type hospitals elsewhere throughout the country.

  2. Healthy hospital food initiatives in the United States: time to ban sugar sweetened beverages to reduce childhood obesity

    OpenAIRE

    Wojcicki, Janet M

    2013-01-01

    While childhood obesity is a global problem, the extent and severity of the problem in United States, has resulted in a number of new initiatives, including recent hospital initiatives to limit the sale of sweetened beverages and other high calorie drinks in hospital vending machines and cafeterias. These proposed policy changes are not unique to United States, but are more comprehensive in the number of proposed hospitals that they will impact. Meanwhile, however, it is advised, that these i...

  3. 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.

    2003-01-01

    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

  4. 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.

    2006-01-01

    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

  5. An Intervention to Increase Availability of Healthy Foods and Beverages in New York City Hospitals: The Healthy Hospital Food Initiative, 2010-2014.

    Science.gov (United States)

    Moran, Alyssa; Krepp, Erica M; Johnson Curtis, Christine; Lederer, Ashley

    2016-06-09

    Hospitals serve millions of meals and snacks each year; however, hospital food is often unhealthy. Hospitals are ideal settings for modeling healthy eating, but few programs have sought to improve nutrition in all venues where food is served. The New York City Department of Health and Mental Hygiene created the Healthy Hospital Food Initiative (HHFI) to improve the healthfulness of food served in hospitals. The HHFI built on prior work implementing mandatory nutrition standards for patient meals and vending in public hospitals. Public hospitals joined the HHFI by voluntarily adopting standards for cafeterias and cafés. Private hospitals joined by implementing nutrition standards for patient meals, food and beverage vending machines, and cafeterias and cafés. Hospitals were recruited from 2010 through 2014 and provided technical assistance from health department staff. Implementation in each of the 4 areas was monitored through on-site assessments and menu review. Twenty-eight hospital cafeterias and cafés were evaluated at baseline and at the end of the HHFI to assess changes. Sixteen public hospitals and 24 private hospitals joined the HHFI. Most (n = 18) private hospitals implemented standards in at least 2 areas. In cafeterias, most hospitals introduced a healthy value meal (n = 19), removed unhealthy items from the entrance and checkout (n = 18), increased whole grains to at least half of all grains served (n = 17), and reduced calories in pastries and desserts (n = 15). Most New York City hospitals joined the HHFI and voluntarily adopted rigorous nutrition standards. Partnerships between hospitals and local government are feasible and can lead to significant improvements in hospital food environments.

  6. An Intervention to Increase Availability of Healthy Foods and Beverages in New York City Hospitals: The Healthy Hospital Food Initiative, 2010–2014

    Science.gov (United States)

    Krepp, Erica M.; Johnson Curtis, Christine; Lederer, Ashley

    2016-01-01

    Background Hospitals serve millions of meals and snacks each year; however, hospital food is often unhealthy. Hospitals are ideal settings for modeling healthy eating, but few programs have sought to improve nutrition in all venues where food is served. Community Context The New York City Department of Health and Mental Hygiene created the Healthy Hospital Food Initiative (HHFI) to improve the healthfulness of food served in hospitals. The HHFI built on prior work implementing mandatory nutrition standards for patient meals and vending in public hospitals. Public hospitals joined the HHFI by voluntarily adopting standards for cafeterias and cafés. Private hospitals joined by implementing nutrition standards for patient meals, food and beverage vending machines, and cafeterias and cafés. Methods Hospitals were recruited from 2010 through 2014 and provided technical assistance from health department staff. Implementation in each of the 4 areas was monitored through on-site assessments and menu review. Twenty-eight hospital cafeterias and cafés were evaluated at baseline and at the end of the HHFI to assess changes. Outcome Sixteen public hospitals and 24 private hospitals joined the HHFI. Most (n = 18) private hospitals implemented standards in at least 2 areas. In cafeterias, most hospitals introduced a healthy value meal (n = 19), removed unhealthy items from the entrance and checkout (n = 18), increased whole grains to at least half of all grains served (n = 17), and reduced calories in pastries and desserts (n = 15). Interpretation Most New York City hospitals joined the HHFI and voluntarily adopted rigorous nutrition standards. Partnerships between hospitals and local government are feasible and can lead to significant improvements in hospital food environments. PMID:27281392

  7. 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

  8. Development of a Comprehensive Hospital-Based Elder Abuse Intervention: An Initial Systematic Scoping Review

    Science.gov (United States)

    Du Mont, Janice; Macdonald, Sheila; Kosa, Daisy; Elliot, Shannon; Spencer, Charmaine; Yaffe, Mark

    2015-01-01

    Introduction 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. Objectives 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. Methods 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. Analysis 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. Results 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; Assessment: 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

  9. Successfully Reducing Hospitalizations of Nursing Home Residents: Results of the Missouri Quality Initiative.

    Science.gov (United States)

    Rantz, Marilyn J; Popejoy, Lori; Vogelsmeier, Amy; Galambos, Colleen; Alexander, Greg; Flesner, Marcia; Crecelius, Charles; Ge, Bin; Petroski, Gregory

    2017-11-01

    The goals of the Missouri Quality Initiative (MOQI) for long-stay nursing home residents were to reduce the frequency of avoidable hospital admissions and readmissions, improve resident health outcomes, improve the process of transitioning between inpatient hospitals and nursing facilities, and reduce overall healthcare spending without restricting access to care or choice of providers. The MOQI was one of 7 program sites in the United States, with specific interventions unique to each site tested for the Centers for Medicaid and Medicare Services (CMS) Innovations Center. A prospective, single group intervention design, the MOQI included an advanced practice registered nurse (APRN) embedded full-time within each nursing home (NH) to influence resident care outcomes. Data were collected continuously for more than 3 years from an average of 1750 long-stay Medicare, Medicaid, and private pay residents living each day in 16 participating nursing homes in urban, metro, and rural communities within 80 miles of a major Midwestern city in Missouri. Performance feedback reports were provided to each facility summarizing their all-cause hospitalizations and potentially avoidable hospitalizations as well as a support team of social work, health information technology, and INTERACT/Quality Improvement Coaches. The MOQI achieved a 30% reduction in all-cause hospitalizations and statistically significant reductions in 4 single quarters of the 2.75 years of full implementation of the intervention for long-stay nursing home residents. As the population of older people explodes in upcoming decades, it is critical to find good solutions to deal with increasing costs of health care. APRNs, working with multidisciplinary support teams, are a good solution to improving care and reducing costs if all nursing home residents have access to APRNs nationwide. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  10. Metronidazole stewardship initiative at Christchurch hospitals-achievable with immediate benefits.

    Science.gov (United States)

    Gardiner, Sharon J; Metcalf, Sarah Cl; Chin, Paul Kl; Doogue, Matthew P; Dalton, Simon C; Chambers, Stephen T

    2018-04-13

    To evaluate an antimicrobial stewardship (AMS) initiative to change hospital prescribing practice for metronidazole. In October 2015, the Canterbury District Health Board (CDHB) AMS committee changed advice for metronidazole to promote two times daily dosing for most indications, prioritisation of the oral route and avoidance of double anaerobic cover. Adoption of the initiative was facilitated via change in prescribing guidelines, education and ongoing pharmacy support. Usage and expenditure on metronidazole for adult inpatients were compared for the five years pre- and two years post-change. Other district health boards (DHBs) were surveyed to determine their dosing recommendation for metronidazole IV. Mean annual metronidazole IV use, as defined daily doses per 1,000 occupied bed days, decreased by 43% post-initiative. Use of non-IV (oral or rectal) formulations increased by 104%. Total savings associated with the initiative were approximately $33,400 in drug costs plus $78,200 per annum in IV giving sets and post-dose flushes. Twelve of 20 (60%) DHBs (including CDHB) endorse twice daily IV dosing. In addition to financial savings, reduction in IV doses has potential benefits, including avoidance of IV catheter-associated complications such as bloodstream infections. Approaches to metronidazole dosing vary across DHBs and could benefit from national coordination.

  11. Accuracy of self-reported smoking abstinence in clinical trials of hospital-initiated smoking interventions.

    Science.gov (United States)

    Scheuermann, Taneisha S; Richter, Kimber P; Rigotti, Nancy A; Cummins, Sharon E; Harrington, Kathleen F; Sherman, Scott E; Zhu, Shu-Hong; Tindle, Hilary A; Preacher, Kristopher J

    2017-12-01

    To estimate the prevalence and predictors of failed biochemical verification of self-reported abstinence among participants enrolled in trials of hospital-initiated smoking cessation interventions. Comparison of characteristics between participants who verified and those who failed to verify self-reported abstinence. Multi-site randomized clinical trials conducted between 2010 and 2014 in hospitals throughout the United States. Recently hospitalized smokers who reported tobacco abstinence 6 months post-randomization and provided a saliva sample for verification purposes (n = 822). Outcomes were salivary cotinine-verified smoking abstinence at 10 and 15 ng/ml cut-points. Predictors and correlates included participant demographics and tobacco use; hospital diagnoses and treatment; and study characteristics collected via surveys and electronic medical records. Usable samples were returned by 69.8% of the 1178 eligible trial participants who reported 7-day point prevalence abstinence. The proportion of participants verified as quit was 57.8% [95% confidence interval (CI) = 54.4, 61.2; 10 ng/ml cut-off] or 60.6% (95% CI = 57.2, 63.9; 15 ng/ml). Factors associated independently with verification at 10 ng/ml were education beyond high school education [odds ratio (OR) = 1.51; 95% CI = 1.07, 2.11], continuous abstinence since hospitalization (OR = 2.82; 95% CI = 2.02, 3.94), mailed versus in-person sample (OR = 3.20; 95% CI = 1.96, 5.21) and race. African American participants were less likely to verify abstinence than white participants (OR = 0.64; 95% CI = 0.44, 0.93). Findings were similar for verification at 15 ng/ml. Verification rates did not differ by treatment group. In the United States, high rates (40%) of recently hospitalized smokers enrolled in smoking cessation trials fail biochemical verification of their self-reported abstinence. © 2017 Society for the Study of Addiction.

  12. Social shaping of food intervention initiatives at worksites: canteen takeaway schemes at two Danish hospitals.

    Science.gov (United States)

    Poulsen, Signe; Jørgensen, Michael Søgaard

    2011-09-01

    The aim of this article is to analyse the social shaping of worksite food interventions at two Danish worksites. The overall aims are to contribute first, to the theoretical frameworks for the planning and analysis of food and health interventions at worksites and second, to a foodscape approach to worksite food interventions. The article is based on a case study of the design of a canteen takeaway (CTA) scheme for employees at two Danish hospitals. This was carried out as part of a project to investigate the shaping and impact of schemes that offer employees meals to buy, 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. Both interventions were initiated because of the need to improve the food supply for the evening shift and the work-life balance. The shaping of the schemes at the two hospitals became rather different change processes due to the local organizational processes shaped by previously developed norms and values. At one hospital the change process challenged norms and values about food culture and challenged ideas in the canteen kitchen about working hours. At the other hospital, the change was more of a learning process that aimed at finding the best way to offer a CTA scheme. Worksite health promotion practitioners should be aware that the intervention itself is an object of negotiation between different stakeholders at a worksite based on existing norms and values. The social contextual model and the setting approach to worksite health interventions lack

  13. Understanding the Determinants of Australian Hospital Nurses' Hand Hygiene Decisions Following the Implementation of a National Hand Hygiene Initiative

    Science.gov (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

    2015-01-01

    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…

  14. Medical identity theft: prevention and reconciliation initiatives at Massachusetts General Hospital.

    Science.gov (United States)

    Judson, Timothy; Haas, Mark; Lagu, Tara

    2014-07-01

    Medical identity theft refers to the misuse of another individual's identifying medical information to receive medical care. Beyond the financial burden on patients, hospitals, health insurance companies, and government insurance programs, undetected cases pose major patient safety challenges. Inaccuracies in the medical record may persist even after the theft has been identified because of restrictions imposed by patient privacy laws. Massachusetts General Hospital (MGH; Boston) has conducted initiatives to prevent medical identity theft and to better identify and respond to cases when they occur. Since 2007, MGH has used a notification tree to standardize reporting of red flag incidents (warning signs of identity theft, such as suspicious personal identifiers or account activity). A Data Integrity Dashboard allows for tracking and reviewing of all potential incidents of medical identity theft to detect trends and targets for mitigation. An identity-checking policy, VERI-(Verify Everyone's Identity) Safe Patient Care, requires photo identification at every visit and follow-up if it is not provided. Data from MGH suggest that an estimated 120 duplicate medical records are created each month, 25 patient encounters are likely tied to identity theft or fraud each quarter, and 14 patients are treated under the wrong medical record number each year. As of December 2013, 80%-85% of patients were showing photo identification at appointments. Although an organization's policy changes and educational campaigns can improve detection and reconciliation of medical identity theft cases, national policies should be implemented to streamline the process of correcting errors in medical records, reduce the financial disincentive for hospitals to detect and report cases, and create a single point of entry to reduce the burden on individuals and providers to reconcile cases.

  15. North by Northwestern: initial experience with PACS at Northwestern Memorial Hospital

    Science.gov (United States)

    Channin, David S.; Hawkins, Rodney C.; Enzmann, Dieter R.

    2000-05-01

    This paper describes the initial phases and configuration of the Picture Archive and Communication System (PACS) deployed at Northwestern Memorial Hospital. The primary goals of the project were to improve service to patients, improve service to referring physicians, and improve the process of radiology. Secondary goals were to enhance the academic mission, and modernize institutional information systems. The system consists of a large number of heterogeneous imaging modalities sending imaging studies via DICOM to a GE medical Systems PathSpeed PACS. The radiology department workflow is briefly described. The system is currently storing approximately 140,000 studies and over 5 million images, growing by approximately 600 studies and 25,000 images per day. Data reflecting use of the short term and long term storage is provided.

  16. Risk factors for adverse events after vaccinations performed during the initial hospitalization of infants born prematurely.

    Science.gov (United States)

    Wilińska, Maria; Warakomska, Małgorzata; Głuszczak-Idziakowska, Ewa; Jackowska, Teresa

    There are significant delays in implementing vaccination among preterm infants. Description of the frequency and kinds of adverse events following immunization in preterms. Establishment of the group of preterms who will distinctively be susceptible to adverse events. Demographical, clinical data and the occurrence of adverse events after DTaP, HIB and pneumococcal vaccination among preterms during their initial hospitalization were prospectively collected with the use of an electronic data form between 1st June 2011 and 31st May 2015. The analysis was conducted on 138 patients. The groups were divided according to maturity (I: ≤ GA 28w n=73 and GA 29-36 w n=65). There were no statistically significant differences between the groups in the occurrence of adverse events. Out of the total group, following vaccination apnoea developed in 6 newborns (4%) and activity dysfunctions were observed in 13 newborns (10%). The occurrence of apnoea after vaccination positively correlated with the time of non-invasive ventilation and the occurrence of late infection. There were no statistically significant demographical or clinical risk factors for the development of activity dysfunctions following vaccination. Term vaccination in clinically stable preterm infants is a safe medical procedure. However, long-term non-invasive respiratory support and late infections are risk factors for apnea following vaccinations. In these patients vaccinations should be considered during hospitalization.

  17. Adherence of private health system hospitals to dissemination of outcomes according to the Global Reporting Initiative (GRI) model.

    Science.gov (United States)

    Machado, Celso; César, Robson Danúbio da Silva; Souza, Maria Tereza Saraiva de

    2017-01-01

    To verify if there is an analogy between the indicators of the Global Reporting Initiative adopted by hospitals in the private healthcare system. Documentary research supported by reports that are electronically available on the website of the companies surveyed. The organizations surveyed had a significant adherence of their economic, social and environmental indicators of the model proposed by the Global Reporting Initiative, showing an analogous field of common indicators between them. There is similarity between the indicators adopted by companies, but one of the hospitals analyzed had a greater number of converging indicators to Global Reporting Initiative.

  18. Neonatal Hypothermia and Associated Risk Factors at Baby Friendly ...

    African Journals Online (AJOL)

    unknown. The results of this study showed that the overall prevalence of neonatal ... 2015, IP: 41.135.175.131] || Click here to download free Android application for this journal .... Source of Support: This work has been financially supported by.

  19. Neonatal Hypothermia and Associated Risk Factors at Baby Friendly ...

    African Journals Online (AJOL)

    Temperatures were recorded immediately after birth and at the age of 1, 2 and 4 h after birth in order to estimate the prevalence of neonatal hypothermia, defined as axillary temperature less than ... Odds ratios (ORs) were assessed using maximum likelihood and associated 95% confidence intervals were computed.

  20. Use of Nutrition Standards to Improve Nutritional Quality of Hospital Patient Meals: Findings from New York City's Healthy Hospital Food Initiative.

    Science.gov (United States)

    Moran, Alyssa; Lederer, Ashley; Johnson Curtis, Christine

    2015-11-01

    Most hospital patient meals are considered regular-diet meals; these meals are not required to meet comprehensive nutrition standards for a healthy diet. Although programs exist to improve nutrition in hospital food, the focus is on retail settings such as vending machines and cafeterias vs patient meals. New York City's Healthy Hospital Food Initiative (HHFI) provides nutrition standards for regular-diet meals that hospitals can adopt, in addition to retail standards. This study was undertaken to describe regular-diet patient menus before and after implementation of the HHFI nutrition standards. The study involved pre- and post- menu change analyses of hospitals participating in the HHFI between 2010 and 2014. Eight New York City hospitals, selected based on voluntary participation in the HHFI, were included in the analyses. Nutritional content of regular-diet menus were compared with the HHFI nutrition standards. Nutrient analysis and exact Wilcoxon signed-rank tests were used for the analysis of the data. At baseline, no regular-diet menu met all HHFI standards, and most exceeded the daily limits for percentage of calories from fat (n=5), percentage of calories from saturated fat (n=5), and milligrams of sodium (n=6), and they did not meet the minimum grams of fiber (n=7). Hospitals met all key nutrient standards after implementation, increasing fiber (25%, Pfood service operations, indicating feasibility of this framework in a range of hospital settings. Copyright © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    Whitfill, Travis; Gawel, Marcie; Auerbach, Marc

    2017-07-17

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

  2. Improving immediate newborn care practices in Philippine hospitals: impact of a national quality of care initiative 2008-2015.

    Science.gov (United States)

    Silvestre, Maria Asuncion A; Mannava, Priya; Corsino, Marie Ann; Capili, Donna S; Calibo, Anthony P; Tan, Cynthia Fernandez; Murray, John C S; Kitong, Jacqueline; Sobel, Howard L

    2018-03-31

    To determine whether intrapartum and newborn care practices improved in 11 large hospitals between 2008 and 2015. Secondary data analysis of observational assessments conducted in 11 hospitals in 2008 and 2015. Eleven large government hospitals from five regions in the Philippines. One hundred and seven randomly sampled postpartum mother-baby pairs in 2008 and 106 randomly sampled postpartum mothers prior to discharge from hospitals after delivery. A national initiative to improve quality of newborn care starting in 2009 through development of a standard package of intrapartum and newborn care services, practice-based training, formation of multidisciplinary hospital working groups, and regular assessments and meetings in hospitals to identify actions to improve practices, policies and environments. Quality improvement was supported by policy development, health financing packages, health facility standards, capacity building and health communication. Sixteen intrapartum and newborn care practices. Between 2008 and 2015, initiation of drying within 5 s of birth, delayed cord clamping, dry cord care, uninterrupted skin-to-skin contact, timing and duration of the initial breastfeed, and bathing deferred until 6 h after birth all vastly improved (P<0.001). The proportion of newborns receiving hygienic cord handling and the hepatitis B birth dose decreased by 11-12%. Except for reduced induction of labor, inappropriate maternal care practices persisted. Newborn care practices have vastly improved through an approach focused on improving hospital policies, environments and health worker practices. Maternal care practices remain outdated largely due to the ineffective didactic training approaches adopted for maternal care.

  3. Paramedic-Initiated CMS Sepsis Core Measure Bundle Prior to Hospital Arrival: A Stepwise Approach.

    Science.gov (United States)

    Walchok, Jason G; Pirrallo, Ronald G; Furmanek, Douglas; Lutz, Martin; Shope, Colt; Giles, Brandi; Gue, Greta; Dix, Aaron

    2017-01-01

    To improve patient outcomes, the Center for Medicare and Medicaid Services (CMS) implemented core measures that outline the initial treatment of the septic patient. These measures include initial blood culture collection prior to antibiotics, adequate intravenous fluid resuscitation, and early administration of broad spectrum antibiotics. We sought to determine if Paramedics can initiate the CMS sepsis core measure bundle in the prehospital field reliably. This is a retrospective, case series from a 3rd service EMS system model in Greenville, South Carolina between November 17, 2014 and February 20, 2016. An adult Prehospital Sepsis Assessment Tool was created using the 2012 Surviving Sepsis guidelines: 2 of 3 signs of systemic inflammatory response (heart rate, respiratory rate, oral temperature) and a known or suspected source of infection. A "Sepsis Alert" was called by paramedics and upon IV access a set of blood cultures and blood for lactate analysis was collected prior to field antibiotic administration. The Sepsis Alert was compared to serum lactate levels and ICD 9 or 10 admitting diagnosis of Sepsis, Severe Sepsis, or Septic Shock. Blood culture contamination, serum lactate, and antibiotic match were determined by in-hospital laboratory analysis. A total of 120 trained paramedics called 1,185 "Sepsis Alerts" on 56,643 patients (50.3% Male, mean age 70). Patients with missing discharge diagnosis were eliminated (n = 31). The admitting diagnosis of sepsis overall was 73.5% (848/1154): Sepsis 50% (578/1154), Severe Sepsis 14.6% (169/1154), Septic Shock 8.9% (101/1154). A total of 946 blood cultures were collected in the prehospital setting, with a 95.04% (899/946) no contamination rate. Contamination was found in 4.96% (47/946). A total of 179 (18.9%) of the uncontaminated blood cultures were found to have positive growth with 720 (76.1%) having no growth. EMS administered antibiotics matched blood culture positive growth in 72% of patients. The lactate

  4. Neonatal extracorporeal membrane oxygenation: Initial experience of Hospital de São João

    Directory of Open Access Journals (Sweden)

    G. Rocha

    2014-11-01

    Full Text Available The purpose of this series is to report the initial ECMO experience of the Neonatal Intensive Care Unit of Hospital de São João. The first three clinical cases are reported. Case report 1: a 39 weeks gestational age girl with severe lung hypoplasia secondary to a bilateral congenital diaphragmatic hernia. Case report 2: a 39 weeks gestational age girl with a right congenital diaphragmatic hernia and a tracheal stenosis. Case report 3: a 34 weeks gestational age boy, with 61 days of life, with a Bordetella pertussis pneumonia, severe pulmonary hypertension, shock, hyperleukocytosis and seizures. Resumo: O objetivo desta série é apresentar a experiência inicial da Unidade de Cuidados Intensivos Neonatais do Hospital de São João com ECMO no recém-nascido. São apresentados os 3 primeiros casos. Caso 1: recém-nascido de 39 semanas de idade gestacional, com hipoplasia pulmonar severa secundária a hérnia diafragmática congénita bilateral. Caso 2: recém-nascido de 39 semanas de idade gestacional, com hérnia diafragmática congénita direita e estenose traqueal. Caso 3: pré-termo de 34 semanas de idade gestacional, sexo masculino, com 61 dias de vida, com pneumonia por Bordetella pertussis, hipertensão pulmonar severa, choque, hiperleucocitose e convulsões. Keywords: Extracorporeal membrane oxygenation, Newborn, Congenital diaphragmatic hernia, Tracheal stenosis, Bordetella pertussis infection, Palavras-chave: Oxigenação por membrana extracorporal, Recém-nascido, Hérnia diafragmática congénita, Estenose traqueal, Infeção por Bordetella pertussis

  5. Healthy hospital food initiatives in the United States: time to ban sugar sweetened beverages to reduce childhood obesity.

    Science.gov (United States)

    Wojcicki, Janet M

    2013-06-01

    While childhood obesity is a global problem, the extent and severity of the problem in United States, has resulted in a number of new initiatives, including recent hospital initiatives to limit the sale of sweetened beverages and other high calorie drinks in hospital vending machines and cafeterias. These proposed policy changes are not unique to United States, but are more comprehensive in the number of proposed hospitals that they will impact. Meanwhile, however, it is advised, that these initiatives should focus on banning sugar sweetened beverages, including sodas, 100% fruit juice and sports drinks, from hospital cafeterias and vending machines instead of limiting their presence, so as to ensure the success of these programs in reducing the prevalence of childhood obesity. If US hospitals comprehensively remove sugar sweetened beverages from their cafeterias and vending machines, these programs could subsequently become a model for efforts to address childhood obesity in other areas of the world. Hospitals should be a model for health care reform in their communities and removing sugar sweetened beverages is a necessary first step. ©2013 Foundation Acta Paediatrica. Published by Blackwell Publishing Ltd.

  6. 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

    2014-01-01

    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.

  7. A public health initiative to increase annual influenza immunization among hospital health care personnel: the San Diego Hospital Influenza Immunization Partnership.

    Science.gov (United States)

    Sawyer, Mark H; Peddecord, K Michael; Wang, Wendy; Deguire, Michelle; Miskewitch-Dzulynsky, Michelle; Vuong, David D

    2012-09-01

    A public health department-supported intervention to increase influenza immunization among hospital-based health care practitioners (HCPs) in San Diego County took place between 2005 and 2008. The study included all major hospitals in the county, with a population of approximately 3.5 million. Information on hospital activities was collected from before, during and after initiative activities. Vaccination status and demographics were collected directly from HCP using hospital-based and random-dialed telephone surveys. Between 2006 and 2008, hospitals increased promotion activities and reported increases in vaccination rates. Based on the random-dialed surveys, HCP influenza vaccination coverage rates did not increase significantly. Vaccination rates were significantly higher in HCPs who reported that employers provided free vaccination and those who believed that their employers mandated influenza vaccination. This local public health initiative and concurrent state legislation were effective in increasing employer efforts to promote influenza vaccination; however, population-based surveys of HCPs did not show significant increases in influenza vaccination. Overall, this study suggests that public health leadership, intensive employer promotion activities, and state-required declinations alone were not sufficient to significantly increase HCP influenza vaccination. Policymakers and employers should consider mandates to achieve optimal influenza vaccination among HCPs. Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  8. Post-acute referral patterns for hospitals and implications for bundled payment initiatives.

    Science.gov (United States)

    Lau, Christopher; Alpert, Abby; Huckfeldt, Peter; Hussey, Peter; Auerbach, David; Liu, Hangsheng; Sood, Neeraj; Mehrotra, Ateev

    2014-09-01

    Under new bundled payment models, hospitals are financially responsible for post-acute care delivered by providers such as skilled nursing facilities (SNFs) and home health agencies (HHAs). The hope is that hospitals will use post-acute care more prudently and better coordinate care with post-acute providers. However, little is known about existing patterns in hospitals׳ referrals to post-acute providers. Post-acute provider referrals were identified using SNF and HHA claims within 14 days following hospital discharge. Hospital post-acute care network size and concentration were estimated across hospital types and regions. The 2008 Medicare Provider Analysis and Review claims for acute hospitals and SNFs, and the 100% HHA Standard Analytic Files were used. The mean post-acute care network size for U.S. hospitals included 57.9 providers with 37.5 SNFs and 23.4 HHAs. The majority of these providers (65.7% of SNFs, 60.9% of HHAs) accounted for 1 percent or less of a hospital׳s referrals and classified as "low-volume". Other post-acute providers we classified as routine. The mean network size for routine providers was greater for larger hospitals, teaching hospitals and in regions with higher per capita post-acute care spending. The average hospital works with over 50 different post-acute providers. Moreover, the size of post-acute care networks varies considerably geographically and by hospital characteristics. These results provide context on the complex task hospitals will face in coordinating care with post-acute providers and cutting costs under new bundled payment models. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. Adherence of private health system hospitals to dissemination of outcomes according to the Global Reporting Initiative (GRI) model

    OpenAIRE

    Machado Junior, Celso; César, Robson Danúbio da Silva; Souza, Maria Tereza Saraiva de

    2017-01-01

    ABSTRACT Objective To verify if there is an analogy between the indicators of the Global Reporting Initiative adopted by hospitals in the private healthcare system. Methods Documentary research supported by reports that are electronically available on the website of the companies surveyed. Results The organizations surveyed had a significant adherence of their economic, social and environmental indicators of the model proposed by the Global Reporting Initiative, showing an analogous fie...

  10. Adherence of private health system hospitals to dissemination of outcomes according to the Global Reporting Initiative (GRI) model

    OpenAIRE

    Machado, Celso; César, Robson Danúbio da Silva; de Souza, Maria Tereza Saraiva

    2017-01-01

    ABSTRACT Objective To verify if there is an analogy between the indicators of the Global Reporting Initiative adopted by hospitals in the private healthcare system. Methods Documentary research supported by reports that are electronically available on the website of the companies surveyed. Results The organizations surveyed had a significant adherence of their economic, social and environmental indicators of the model proposed by the Global Reporting Initiative, showing an analogous field of ...

  11. 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

    2012-01-01

    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.

  12. Teleradiology service for mission hospitals: initial experiences in Ethiopia and Kenya

    Directory of Open Access Journals (Sweden)

    Matthew Larrison

    2016-01-01

    Full Text Available Throughout their history, mission hospitals have provided high quality and lifesaving medical care to regions of the world where medical care is sparse. These hospitals are generally built and equipped through a combination of governmental and non-governmental sources. As advances in diagnostic medical imaging have progressed and become mainstream in the developed world, mission hospitals have adopted advanced imaging modalities. These modalities provide early diagnosis and treatment options for their patients. In addition to the installation and operation of advanced imaging equipment, the need for professional expert interpretation of these studies remains a challenge for mission hospitals. Historically these hospitals have used either voluntary services on site or paid for interpretations from local radiologists; however, with the introduction of high speed internet, teleradiology has become a possibility. This article describes the teleradiology experience of two mission hospitals in rural Africa.

  13. Teleradiology service for mission hospitals: initial experiences in Ethiopia and Kenya

    OpenAIRE

    Matthew Larrison; Stanley G. Cheng; Stephen McManus

    2016-01-01

    Throughout their history, mission hospitals have provided high quality and lifesaving medical care to regions of the world where medical care is sparse. These hospitals are generally built and equipped through a combination of governmental and non-governmental sources. As advances in diagnostic medical imaging have progressed and become mainstream in the developed world, mission hospitals have adopted advanced imaging modalities. These modalities provide early diagnosis and treatment options ...

  14. Associations Between Nurse-Guided Variables and Plasma Oxytocin Trajectories in Premature Infants During Initial Hospitalization.

    Science.gov (United States)

    Weber, Ashley; Harrison, Tondi M; Sinnott, Loraine; Shoben, Abigail; Steward, Deborah

    2018-02-01

    Oxytocin (OT) is a social hormone that may help researchers understand how nurse-guided interventions during initial infant hospitalization, such as supporting human milk expression, promoting comforting touch, and reducing exposure to stressors, affect preterm brain development. To determine whether factors related to human milk, touch, or stressor exposure are related to plasma OT trajectories in premature infants. Plasma from 33 premature infants, born gestational ages 25 to (Equation is included in full-text article.)weeks, was collected at 14 days of life and then weekly until 34 weeks' corrected gestational age (CGA). Variables related to feeding volumes of human milk and formula; touch, as indexed by skin-to-skin contact (SSC) and swaddled holding; and clinical stressors were extracted from the electronic medical record. Linear mixed-models tested associations between nurse-guided variables and plasma OT trajectories. In the final model, same-day SSC was positively related not only to plasma OT levels at 27 weeks' CGA (β= .938, P = .002) but also to a decline in plasma OT levels over time (β=-.177, P = .001). Volume of enteral feeds (mL/kg/d), its interaction with CGA, and number of stressful procedures were not statistically significant (β= .011, P = .077; β=-.002, P = .066; and β= .007, P = .062, respectively). Nurse-guided interventions are associated with infant plasma OT levels, suggesting nurses may impact the neurobiology of the developing premature infant. Replication with larger sample sizes and randomized controlled trial designs is needed to test effects of specific nursing interventions on infant OT.

  15. Analysis of Internet Usage Among Cancer Patients in a County Hospital Setting: A Quality Improvement Initiative

    Science.gov (United States)

    Lilley, Lisa; Lodrigues, William; Dreadin-Pulliam, Julie; Xie, Xian-Jin; Mathur, Sakshi; Rao, Madhu; Harvey, Valorie; Leitch, Ann Marilyn; Rao, Roshni

    2014-01-01

    Background Cancer is one of the most common diseases that patients research on the Internet. The Commission on Cancer (CoC) recommended that Parkland Memorial Hospital (PMH) improve the oncology services website. PMH is Dallas County’s public health care facility, serving a largely uninsured, minority population. Most research regarding patient Internet use has been conducted in insured, Caucasian populations, raising concerns that the needs of PMH patients may not be extrapolated from available data. The PMH Cancer Committee, therefore, adopted a quality improvement initiative to understand patients’ Internet usage. Objective The objective of the study was to obtain and analyze data regarding patients’ Internet usage in order to make targeted improvements to the oncology services section of the institutional website. Methods A task force developed an 11-question survey to ascertain what proportion of our patients have Internet access and use the Internet to obtain medical information as well as determine the specific information sought. Between April 2011 and August 2011, 300 surveys were administered to newly diagnosed cancer patients. Multivariate analyses were performed. Results Of 300 surveys, 291 were included. Minorities, primarily African-American and Hispanic, represented 78.0% (227/291) of patients. Only 37.1% (108/291) of patients had Internet access, most (256/291, 87.9%) having access at home. Younger patients more commonly had Internet access, with a mean age of 47 versus 58 years for those without (PInternet research was to develop questions for discussion with one’s physician. Patients most frequently sought information regarding cancer treatment options, outcomes, and side effects. Conclusions Less than one-half of PMH oncology patients have Internet access. This is influenced by age, educational level, and ethnicity. Those with access use it to obtain information related to their cancer diagnosis. The most effective way of addressing our

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

    DEFF Research Database (Denmark)

    Poulsen, Signe; Jørgensen, Michael Søgaard

    2011-01-01

    to improve the food supply for the evening shift and the work–life balance. The shaping of the schemes at the two hospitals became rather different change processes due to the local organizational processes shaped by previously developed norms and values. At one hospital the change process challenged norms...

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

    NARCIS (Netherlands)

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

    2014-01-01

    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

  18. Proton Radiation Therapy in the Hospital Environment: Conception, Development, and Operation of the Initial Hospital-Based Facility

    Science.gov (United States)

    Slater, James M.; Slater, Jerry D.; Wroe, Andrew J.

    The world's first hospital-based proton treatment center opened at Loma Linda University Medical Center in 1990, following two decades of development. Patients' needs were the driving force behind its conception, development, and execution; the primary needs were delivery of effective conformal doses of ionizing radiation and avoidance of normal tissue to the maximum extent possible. The facility includes a proton synchrotron and delivery system developed in collaboration with physicists and engineers at Fermi National Accelerator Laboratory and from other high-energy-physics laboratories worldwide. The system, operated and maintained by Loma Linda personnel, was designed to be safe, reliable, flexible in utilization, efficient in use, and upgradeable to meet demands of changing patient needs and advances in technology. Since the facility opened, nearly 14,000 adults and children have been treated for a wide range of cancers and other diseases. Ongoing research is expanding the applications of proton therapy, while reducing costs.

  19. Hospitals

    Data.gov (United States)

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

  20. Impact of a hospital improvement initiative in Bangladesh on patient experiences and satisfaction with services: two cross-sectional studies

    Directory of Open Access Journals (Sweden)

    Omer Khalid

    2011-12-01

    Full Text Available Abstract Background The Bangladesh government implemented a pilot Hospital Improvement Initiative (HII in five hospitals in Sylhet division between 1998 and 2003. This included management and behaviour change training for staff, waste disposal and procurement, and referral arrangements. Two linked cross-sectional surveys in 2000 and 2003 assessed the impact of the HII, assessing both patients' experience and satisfaction and public views and use of the hospitals. Methods In each survey we asked 300 consecutive outpatients and a stratified random sample of 300 inpatients in the five hospitals about waiting and consultation time, use of an agent for admission, and satisfaction with privacy, cleanliness, and staff behaviour. The field teams observed cleanliness and privacy arrangements, and visited a sample of households in communities near the hospitals to ask about their opinions and use of the hospital services. Analysis examined changes over time in patients' experience and views. Multivariate analysis took account of other variables potentially associated with the outcomes. Survey managers discussed the survey findings with gender stratified focus groups in each sample community. Results Compared with 2000, an outpatient in three of the hospitals in 2003 was more likely to be seen within 10 minutes and for at least five minutes by the doctor, but outpatients were less likely to report receiving all the prescribed medicines from the hospital. In 2003, inpatients were more likely to have secured admission without using an agent. Although patients’ satisfaction with several aspects of care improved, most changes were not statistically significant. Households in 2003 were significantly more likely to rate the hospitals as good than in 2000. Use of the hospitals did not change, except that more households used the medical college hospital for inpatient care in 2003. Focus groups confirmed criticisms of services and suggested improvements

  1. Evaluation of smoking cessation treatment initiated during hospitalization in patients with heart disease or respiratory disease

    Directory of Open Access Journals (Sweden)

    Thaís Garcia

    Full Text Available ABSTRACT Objective: To evaluate the effectiveness of a smoking cessation program, delivered by trained health care professionals, in patients hospitalized for acute respiratory disease (RD or heart disease (HD. Methods: Of a total of 393 patients evaluated, we included 227 (146 and 81 active smokers hospitalized for HD and RD, respectively. All participants received smoking cessation treatment during hospitalization and were followed in a cognitive-behavioral smoking cessation program for six months after hospital discharge. Results: There were significant differences between the HD group and the RD group regarding participation in the cognitive-behavioral program after hospital discharge (13.0% vs. 35.8%; p = 0.003; smoking cessation at the end of follow-up (29% vs. 31%; p < 0.001; and the use of nicotine replacement therapy (3.4% vs. 33.3%; p < 0.001. No differences were found between the HD group and the RD group regarding the use of bupropion (11.0% vs. 12.3%; p = 0.92. Varenicline was used by only 0.7% of the patients in the HD group. Conclusions: In our sample, smoking cessation rates at six months after hospital discharge were higher among the patients with RD than among those with HD, as were treatment adherence rates. The implementation of smoking cessation programs for hospitalized patients with different diseases, delivered by the health care teams that treat these patients, is necessary for greater effectiveness in smoking cessation.

  2. Different usage of the same oncology information system in two hospitals in Sydney--lessons go beyond the initial introduction.

    Science.gov (United States)

    Yu, Ping; Gandhidasan, Senthilkumar; Miller, Alexis A

    2010-06-01

    The experience of clinicians at two public hospitals in Sydney, Australia, with the introduction and use of an oncology information system (OIS) was examined to extract lessons to guide the introduction of clinical information systems in public hospitals. Semi-structured interviews were conducted with 12 of 15 radiation oncologists employed at the two hospitals. The personnel involved in the decision making process for the introduction of the system were contacted and their decision making process revisited. The transcribed data were analyzed using NVIVO software. Themes emerged included implementation strategies and practices, the radiation oncologists' current use and satisfaction with the OIS, project management and the impact of the OIS on clinical practice. The hospitals had contrasting experiences in their introduction and use of the OIS. Hospital A used the OIS in all aspects of clinical documentation. Its implementation was associated with strong advocacy by the Head of Department, input by a designated project manager, and use and development of the system by all staff, with timely training and support. With no vision of developing a paperless information system, Hospital B used the OIS only for booking and patient tracking. A departmental policy that data entry for the OIS was centrally undertaken by administrative staff distanced clinicians from the system. All the clinicians considered that the OIS should continuously evolve to meet changing clinical needs and departmental quality improvement initiatives. This case study indicates that critical factors for the successful introduction of clinical information systems into hospital environment were an initial clear vision to be paperless, strong clinical leadership and management at the departmental level, committed project management, and involvement of all staff, with appropriate training. Clinician engagement is essential for post-adoption evolution of clinical information systems. Copyright 2010

  3. Federating clinical data from six pediatric hospitals: process and initial results for microbiology from the PHIS+ consortium.

    Science.gov (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

    2012-01-01

    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.

  4. Smoke-free hospital site conversations: how nurses can initiate change.

    Science.gov (United States)

    Mackereth, Peter; Finchett, Charlotte; Holt, Melody

    2016-11-24

    Smoking tobacco continues to be the world's most preventable cause of death and disability with over six trillion cigarettes sold each year. Patients, visitors and health professionals who smoke on hospital sites present a challenge to the effectiveness of public health messages. Health professionals who ignore 'No smoking' hospital/clinic signage, and avoid smoking-cessation activity, help to sustain the perception that smoking is tolerated. Case studies, with a focus on lung cancer and chronic obstructive pulmonary disease (COPD), are used to illustrate how nurses can 'seed' the idea of hospitals becoming smoke-free, provide brief interventions and support patients, carers and colleagues to make that change.

  5. 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

    2013-07-01

    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

  6. Identifying the key personnel in a nurse-initiated hospital waste reduction program.

    Science.gov (United States)

    McDermott-Levy, Ruth; Fazzini, Carol

    2010-01-01

    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. 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

    1997-01-01

    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

  8. A crisis management quality improvement initiative in a children's psychiatric hospital: design, implementation, and outcome.

    Science.gov (United States)

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

    2012-07-01

    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.

  9. Diagnostic performance of initial serum albumin level for predicting in-hospital mortality among aspiration pneumonia patients.

    Science.gov (United States)

    Kim, Hyosun; Jo, Sion; Lee, Jae Baek; Jin, Youngho; Jeong, Taeoh; Yoon, Jaechol; Lee, Jeong Moon; Park, Boyoung

    2018-01-01

    The predictive value of serum albumin in adult aspiration pneumonia patients remains unknown. Using data collected during a 3-year retrospective cohort of hospitalized adult patients with aspiration pneumonia, we evaluated the predictive value of serum albumin level at ED presentation for in-hospital mortality. 248 Patients were enrolled; of these, 51 cases died (20.6%). The mean serum albumin level was 3.4±0.7g/dL and serum albumin levels were significantly lower in the non-survivor group than in the survivor group (3.0±0.6g/dL vs. 3.5±0.6g/dL). In the multivariable logistic regression model, albumin was associated with in-hospital mortality significantly (adjusted odds ratio 0.30, 95% confidential interval (CI) 0.16-0.57). The area under the receiver operating characteristics (AUROC) for in-hospital survival was 0.72 (95% CI 0.64-0.80). The Youden index was 3.2g/dL and corresponding sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratio were 68.6%, 66.5%, 34.7%, 89.1%, 2.05 and 0.47, respectively. High sensitivity (98.0%) was shown at albumin level of 4.0g/dL and high specificity (94.9%) was shown at level of 2.5g/dL. Initial serum albumin levels were independently associated with in-hospital mortality among adult patients hospitalized with aspiration pneumonia and demonstrated fair discriminative performance in the prediction of in-hospital mortality. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Downsizing-initiated job transfer of hospital nurses: how do the job transferees fare?

    Science.gov (United States)

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

    2001-01-01

    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.

  11. Risk for Alcoholic Liver Cirrhosis After an Initial Hospital Contact With Alcohol Problems

    DEFF Research Database (Denmark)

    Askgaard, Gro; Leon, David A.; Kjr, Mette S.

    2017-01-01

    cirrhosis in these patients relative to the general population. Age and alcohol diagnosis were significant predictors of alcoholic liver cirrhosis risk in men and women, whereas civil status, education, and type of hospital care were not. In men, the 15-year absolute risk was 0.7% (95% confidence interval...

  12. On the first occupational medicine initiatives in Mexico: The Real del Monte miners’ hospital.

    Science.gov (United States)

    Gómez, José Luis; Rodríguez-Paz, Carlos Agustín

    2018-01-01

    Despite the legislation of Otto von Bismarck (1815-1898) on social security rights formulated in 1883 in Germany where it is stated that it is the duty of the State to promote the welfare of all members of society, particularly the weakest and most needy, using the means available to them, and the proposals of laws against accidents issued on April 30, 1904 in the State of Mexico in 1904, in the Mexico of the Porfirio Díaz era, providing workers with formal medical care was not contemplated, except in the case of some railway companies, hospitals for the care of patients with occupational diseases were not built. One of these exceptions was the Hospital del Mineral del Real del Monte de Pachuca, founded in the late nineteenth century and after the mining company passed to the Americans in 1906, it was agreed that the company acquired the hospital and equated it with the medical and surgical advances of the time for immediate care of injuries, especially of the orthopedic type, which enabled not only the healing of wounds, but also rehabilitation. This hospital is one of the oldest in Mexico with regard to three disciplines: orthopedics, occupational medicine and rehabilitation. It ceased to operate in 1982, and currently it is a museum with a rich collection of documents and instruments related to the aforementioned disciplines. Copyright: © 2018 SecretarÍa de Salud.

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

    LENUS (Irish Health Repository)

    Forde, J C

    2009-08-01

    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. The American Organization of Nurse Executives and American Hospital Association Initiatives Work to Combat Violence.

    Science.gov (United States)

    Wray, Karen

    2018-04-01

    Violence affecting healthcare workers and healthcare organizations continues to be a serious safety issue. In this Leadership Perspectives column, Karen Wray, an American Organization of Nurse Executives (AONE) member who has experienced a mass causality incident 1st hand, outlines AONE's continuing work to promote safety and combat violence. She discusses recent work on violence issues by the American Hospital Association, AONE's parent organization.

  15. Initial experience of Da Vinci robotic thoracic surgery at the First Affiliated Hospital of Zhejiang University

    Science.gov (United States)

    He, Zhehao; Zeng, Liping; Zhang, Chong; Wang, Luming; Wang, Zhitian; Rustam, Azmat; Du, Chengli; Lv, Wang

    2017-01-01

    Robot-assisted thoracic surgery (RATS) is a relatively new but rapidly adopted technique, pioneered by the urological and gynecological departments. The primary objective of this study is to present the current status, a series of improvement and innovation of Da Vinci robotic surgery in the Department of Thoracic Surgery at First Affiliated Hospital of Zhejiang University. In addition, we discuss the prospect of robotic surgical technology. PMID:29302429

  16. The Effects of a Customer Service Initiative at Moncrief Army Community Hospital

    Science.gov (United States)

    2008-04-06

    Vroom (1964) in job satisfaction , Linder-Pelz argued that expectancy (i.e., the evaluation of object attributes) was determined by the relationship...Sf. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADORESS(ES) MONCRIEF ARMY COMMUNITY HOSPITAL 4 500 STUART STREET FORT JACKSON, SC 29207...8. PERFORMING ORGANIZATION REPORT NUMBER 9. SPONSORING / MONITORING AGENCY NAME(S) AND ADDRESS(ES) US ARMY MEDICAL DEPARTMENT CENTER AND SCHOOL

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

    Science.gov (United States)

    Besançon, F

    1984-02-23

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

  18. Development and Evaluation of an Educational Initiative to Improve Hospital Personnel Preparedness to Care for Children with Autism Spectrum Disorder.

    Science.gov (United States)

    Lucarelli, Jennifer; Welchons, Leah; Sideridis, Georgios; Sullivan, Nancy R; Chan, Eugenia; Weissman, Laura

    2018-06-01

    To evaluate the effectiveness of a multimodal educational curriculum on increasing hospital personnel's awareness of successful strategies and comfort in caring for children with autism spectrum disorder (ASD). We developed a 3-part training for front-line staff (i.e., front desk, clinical assistants, and phlebotomists) in 8 outpatient hospital departments frequented by patients with ASD. Following a needs assessment, participants completed an online educational module and then attended an in-person seminar tailored to each department. To evaluate training effectiveness, we administered pre-, immediate post-, and 1 month post-training surveys assessing personnel attitudes, comfort, perceived knowledge, and behaviors around caring for patients with ASD. We trained 168 staff members from 8 departments. On the needs assessment, participants (N = 129) reported a mean 2.5 behavioral incidents involving patients with ASD over the previous 3 months; 92% believed that the training would be helpful for their work. Across pre-, immediate- and 1-month post-training surveys, scores improved on all questions related to personnel attitudes about the importance of ASD-friendly care, comfort interacting with patients with ASD, perceived knowledge about ASD, and self-reported frequency of behaviors intended to help children with ASD adjust to the hospital setting (p initiative led to improvement in attitudes, comfort level, perceived knowledge, and self-reported behaviors of hospital personnel working with patients with ASD, which was maintained over 1 month.

  19. Early administration of epinephrine (adrenaline) in patients with cardiac arrest with initial shockable rhythm in hospital: propensity score matched analysis.

    Science.gov (United States)

    Andersen, Lars W; Kurth, Tobias; Chase, Maureen; Berg, Katherine M; Cocchi, Michael N; Callaway, Clifton; Donnino, Michael W

    2016-04-06

    To evaluate whether patients who experience cardiac arrest in hospital receive epinephrine (adrenaline) within the two minutes after the first defibrillation (contrary to American Heart Association guidelines) and to evaluate the association between early administration of epinephrine and outcomes in this population. Prospective observational cohort study. Analysis of data from the Get With The Guidelines-Resuscitation registry, which includes data from more than 300 hospitals in the United States. Adults in hospital who experienced cardiac arrest with an initial shockable rhythm, including patients who had a first defibrillation within two minutes of the cardiac arrest and who remained in a shockable rhythm after defibrillation. Epinephrine given within two minutes after the first defibrillation. Survival to hospital discharge. Secondary outcomes included return of spontaneous circulation and survival to hospital discharge with a good functional outcome. A propensity score was calculated for the receipt of epinephrine within two minutes after the first defibrillation, based on multiple characteristics of patients, events, and hospitals. Patients who received epinephrine at either zero, one, or two minutes after the first defibrillation were then matched on the propensity score with patients who were "at risk" of receiving epinephrine within the same minute but who did not receive it. 2978 patients were matched on the propensity score, and the groups were well balanced. 1510 (51%) patients received epinephrine within two minutes after the first defibrillation, which is contrary to current American Heart Association guidelines. Epinephrine given within the first two minutes after the first defibrillation was associated with decreased odds of survival in the propensity score matched analysis (odds ratio 0.70, 95% confidence interval 0.59 to 0.82; P<0.001). Early epinephrine administration was also associated with a decreased odds of return of spontaneous circulation

  20. 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

    2014-01-01

    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...... four categories of barriers and problems: “facing uncertainty when leaving the rehabilitation center and peers”, “hoping to get back to work and safe economy”, “needing understanding from the community”, and “relying on resilience of significant others”. These categories were combined into one major...... theme: “relations”. The findings indicate that there is a need for professionals to address patients´ close relations and to initiate dialog with patients and their families on how SCI may impact close relations in order to promote a good life on new terms....

  1. Continuous quality improvement programs provide new opportunities to drive value innovation initiatives in hospital-based radiology practices.

    Science.gov (United States)

    Steele, Joseph R; Schomer, Don F

    2009-07-01

    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.

  2. 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

    2009-01-01

    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.

  3. Alignment of an interprofessional student learning experience with a hospital quality improvement initiative.

    Science.gov (United States)

    Fowler, Terri O; Wise, Holly H; Mauldin, Mary P; Ragucci, Kelly R; Scheurer, Danielle B; Su, Zemin; Mauldin, Patrick D; Bailey, Jennifer R; Borckardt, Jeffrey J

    2018-04-11

    Assessment of interprofessional education (IPE) frequently focuses on students' learning outcomes including changes in knowledge, skills, and/or attitudes. While a foundational education in the values and information of their chosen profession is critical, interprofessional learning follows a continuum from formal education to practice. The continuum increases in significance and complexity as learning becomes more relationship based and dependent upon the ability to navigate complex interactions with patients, families, communities, co-workers, and others. Integrating IPE into collaborative practice is critical to enhancing students' experiential learning, developing teamwork competencies, and understanding the complexity of teams. This article describes a project that linked students with a hospital-based quality-improvement effort to focus on the acquisition and practice of teamwork skills and to determine the impact of teamwork on patient and quality outcome measures. A hospital unit was identified with an opportunity for improvement related to quality care, patient satisfaction, employee engagement, and team behaviours. One hundred and thirty-seven students from six health profession colleges at the Medical University of South Carolina underwent TeamSTEPPS® training and demonstrated proficiency of their teamwork-rating skills with the TeamSTEPPS® Team Performance Observation Tool (T-TPO). Students observed real-time team behaviours of unit staff before and after staff attended formal TeamSTEPPS® training. The students collected a total of 778 observations using the T-TPO. Teamwork performance on the unit improved significantly across all T-TPO domains (team structure, communication, leadership, situation monitoring, and mutual support). Significant improvement in each domain continued post-intervention and at 15-month follow-up, improvement remained significant compared to baseline. Student engagement in TeamSTEPPS® training and demonstration of their

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

    International Nuclear Information System (INIS)

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

    2009-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-10-15

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

  6. Initiation of a medical toxicology consult service at a tertiary care children's hospital.

    Science.gov (United States)

    Wang, George Sam; Monte, Andrew; Hatten, Benjamin; Brent, Jeffrey; Buchanan, Jennie; Heard, Kennon J

    2015-05-01

    Currently, only 10% of board-certified medical toxicologists are pediatricians. Yet over half of poison center calls involve children toxicology consultation is not common at children's hospitals. In collaboration with executive staff from Department of Pediatrics and Emergency Medicine, regional poison center, and our toxicology fellowship, we established a toxicology consulting service at our tertiary-care children's hospital. There were 139 consultations, and the service generated 13 consultations in the first month; median of 11 consultations per month thereafter (range 8-16). The service increased pediatric cases seen by the fellowship program from 30 to 94. The transition to a consult service required a culture change. Historically, call center advice was the mainstay of consulting practice and the medical staff was not accustomed to the availability of bedside medical toxicology consultations. However, after promotion of the service and full attending and fellowship coverage, consultations increased. In collaboration with toxicologists from different departments, a consultation service can be rapidly established. The service filled a clinical need that was disproportionately utilized for high acuity patients, immediately utilized by the medical staff and provided a robust pediatric population for the toxicology fellowship.

  7. Rational use of antibiotics: a quality improvement initiative in hospital setting

    International Nuclear Information System (INIS)

    Nausheen, S.; Hammad, R.; Khan, A.

    2013-01-01

    Objectives: To minimise irrational use of antibiotics by implementing guidelines for antibiotic usage in obstetrics and Gynaecology. Methods: The observational study was conducted from January to December 2010 at the maternity unit of Aga Khan Hospital for Women and children, Kharadar, a secondary care facility in Karachi, Pakistan. Data was collected from medical records related to the study period. Prophylactic antibiotics were given according to the American College of Obstetricians and Gynaecologists recommendation 2009. Surveillance was done by surgical site infection rates and infectious morbidity. Data was analysed on SPSS 13. Results: Therapeutic antibiotic use was rationalized, reducing the use of therapeutic antibiotics from 97% (n= 160/165) in January 2010 to 8% (n=10/125) in December 2010. Surgical site infection rates were less than 5%. Cost of antibiotics per patient decreased by 90%. Decrease in the length of stay and workload on nursing staff was also observed. Conclusion: Implementing guidelines for antibiotic use in obstetrics and gynaecology and translating it into our protocols was effective in decreasing the irrational antibiotic consumption and increasing the rational use of antibiotics in the hospital. (author)

  8. HDR brachytherapy in carcinoma of cervix: initial experience at AWARE hospitals

    International Nuclear Information System (INIS)

    Rajendran, M.; Reddy, K.D.; Reddy, R.M.; Reddy, J.M.; Reddy, B.V.N.; Kiran Kumar; Gopi, S.; Dharaniraj; Janardhanan

    2002-01-01

    High dose rate (HDR) brachytherapy is well established in the management of gynaecological malignancies. A report on the initial results of one and half year experience with a consistent dose/fractionation schedule and procedure of planning with delivery of treatment schedule is presented

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

    DEFF Research Database (Denmark)

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

    2017-01-01

    Objective: Socioeconomic differences in quality of care have been suggested to contribute to inequality in clinical prognosis of COPD. We examined socioeconomic differences in the quality of COPD outpatient care and the potential of a systematic quality improvement initiative in reducing potentia...

  10. Hospitals

    DEFF Research Database (Denmark)

    Mullins, Michael

    2013-01-01

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

  11. A Cross-sectional Descriptive Study was to Estimate the Prevalence of the Early Initiation of and Exclusive Breast Feeding in the Rural Health Training Centre of a Medical College in Tamilnadu, South India.

    Science.gov (United States)

    Jennifer, H Gladius; Muthukumar, K

    2012-11-01

    The World Health Organization and the National guidelines on infant and young child feeding recommend the practice of exclusive breastfeeding of infants for the first 6 months after their birth. The objective of this study was to estimate the prevalence of the early initiation of and exclusive breast feeding. A cross sectional, descriptive study was done. 79 infants and children who attended the under five clinic in the Rural Health Training Centre (RHTC), Pulipakkam Village, were chosen for the study by convenient sampling. This study was conducted by interviewing 79 mothers of the children in the ages of 0-24 months, who attended the under five clinic of RHTC, Pulipakkam. The data was collected by using a pre tested, structured questionnaire to obtain the information on the breast feeding and the hygienic feeding practices among mothers. The statistical analysis was done by the authors by using the SPSS, version 16. The significance in the differences were evaluated by using the Chi square test and the relationship between the variables were evaluated by using Kendall's tau correlation. A p value of breast feeding was 97.5% and the prevalence of exclusive breast feeding in the study population was 68%. Inadequate exclusive breast feeding and the lack of hygienic feeding practices among the mothers were significantly associated with an increased incidence of upper and lower respiratory tract infections and gastro intestinal infections in the infants and the children. The education of the antenatal mothers on the benefits of breast feeding and hygienic feeding practices and making all hospitals baby friendly have to be focused on, in order to achieve 80% exclusive breast feeding as per the national guidelines on infant and young child feeding. We need to strengthen the MCH services in the study area in order to achieve 100% immunization.

  12. Association of public health initiatives with outcomes for out-of-hospital cardiac arrest at home and in public locations

    DEFF Research Database (Denmark)

    Christopher B., Fordyce; Carolina M., Hansen; Kragholm, Kristian

    2017-01-01

    Importance  Little is known about the influence of comprehensive public health initiatives according to out-of-hospital cardiac arrest (OHCA) location, particularly at home, where resuscitation efforts and outcomes have historically been poor.Objective  To describe temporal trends in bystander...... cardiopulmonary resuscitation (CPR) and first-responder defibrillation for OHCAs stratified by home vs public location and their association with survival and neurological outcomes.Design, Setting, and Participants  This observational study reviewed 8269 patients with OHCAs (5602 [67.7%] at home and 2667 [32.......3%] in public) for whom resuscitation was attempted using data from the Cardiac Arrest Registry to Enhance Survival (CARES) from January 1, 2010, through December 31, 2014. The setting was 16 counties in North Carolina.Exposures  Patients were stratified by home vs public OHCA. Public health initiatives...

  13. Failure of initial disease control in bullous pemphigoid: a retrospective study of hospitalized patients in a single tertiary center.

    Science.gov (United States)

    Kremer, Noa; Zeeli, Tal; Sprecher, Eli; Geller, Shamir

    2017-10-01

    Bullous pemphigoid (BP) is the most prevalent autoimmune blistering skin disease in Western countries and in Israel. Initial disease control is achieved in 60-90% of BP patients within 1-4 weeks of corticosteroid therapy. In the remainder of patients, recalcitrant disease is controlled with additional immunosuppressive treatment. We aimed to evaluate the rate of BP patients who needed adjuvant therapy to achieve initial disease control and to identify potential predictors for recalcitrant disease. We conducted a retrospective study of newly diagnosed BP patients who were hospitalized at the Tel Aviv Sourasky Medical Center between the years 2008-2014. We performed statistical analyses to assess the association between clinical factors and failure of initial disease control. Among 114 hospitalized patients with newly diagnosed BP, 1.8% presented with oral mucosa involvement. Seven patients (6.1%) required systemic agents in addition to corticosteroids to achieve disease control. Hypertension (P = 0.048), involvement of the head region (P = 0.042), and metformin treatment (P = 0.02) were significantly more prevalent among patients with recalcitrant disease. The low frequency of recalcitrant BP (6.1%) and the rarity of involvement of the oral mucosa (1.8%) in this study suggest that Israeli BP patients present a milder phenotype compared to similar patients from other geographic areas. Hypertension, head involvement, and metformin therapy were found to be significantly associated with the need for adjuvant therapy to achieve initial control, suggesting that these parameters may serve as predictors of treatment response in BP. © 2017 The International Society of Dermatology.

  14. Evaluation of costs accrued through inadvertent continuation of hospital-initiated proton pump inhibitor therapy for stress ulcer prophylaxis beyond hospital discharge: a retrospective chart review

    Directory of Open Access Journals (Sweden)

    Shin S

    2015-04-01

    Full Text Available Sooyoung Shin Ajou University College of Pharmacy, Yeongtong-gu, Suwon-si, Gyeonggi-do, South Korea Background: Stress ulcers and related upper gastrointestinal bleeding are well-known complications in intensive care unit (ICU patients. Proton pump inhibitor (PPI-based stress ulcer prophylaxis (SUP has been widely prescribed in noncritically ill patients who are at low risk for clinically significant bleeding, which is then injudiciously continued after hospital discharge. This study aimed to evaluate the incidence of inappropriate prescribing of PPI-based preventative therapy in ICU versus non-ICU patients that subsequently continued postdischarge, and to estimate the costs incurred by the unwarranted outpatient continuation of PPI therapy.Methods: A retrospective review of patient data at a major teaching hospital in Korea was performed. During the 4-year study period, adult patients who were newly initiated on PPI-based SUP during hospital admission and subsequently discharged on a PPI without a medical indication for such therapy were captured for data analysis. The incidence rates of inappropriate prescribing of PPIs were compared between ICU and non-ICU patients, and the costs associated with such therapy were also examined.Results: A total of 4,410 patients, more than half of the inpatient-initiated PPI users, were deemed to have been inadvertently prescribed a PPI at discharge in the absence of a medical need for acid suppression. The incidence of inappropriate outpatient continuation of the prophylaxis was higher among ICU patients compared with non-ICU patients (57.7% versus 52.2%, respectively; P=0.001. The total expenditure accrued through the continuation of nonindicated PPI therapy was approximately US$40,175.Conclusion: This study confirmed that excess usage of PPIs for SUP has spread to low-risk, non-ICU patients. The overuse of unwarranted PPI therapy can incur large health care expenditure, as well as clinical complications

  15. Cost Analysis of a High Support Housing Initiative for Persons with Severe Mental Illness and Long-Term Psychiatric Hospitalization.

    Science.gov (United States)

    Rudoler, David; de Oliveira, Claire; Jacob, Binu; Hopkins, Melonie; Kurdyak, Paul

    2018-01-01

    The objective of this article was to conduct a cost analysis comparing the costs of a supportive housing intervention to inpatient care for clients with severe mental illness who were designated alternative-level care while inpatient at the Centre for Addiction and Mental Health in Toronto. The intervention, called the High Support Housing Initiative, was implemented in 2013 through a collaboration between 15 agencies in the Toronto area. The perspective of this cost analysis was that of the Ontario Ministry of Health and Long-Term Care. We compared the cost of inpatient mental health care to high-support housing. Cost data were derived from a variety of sources, including health administrative data, expenditures reported by housing providers, and document analysis. The High Support Housing Initiative was cost saving relative to inpatient care. The average cost savings per diem were between $140 and $160. This amounts to an annual cost savings of approximately $51,000 to $58,000. When tested through sensitivity analysis, the intervention remained cost saving in most scenarios; however, the result was highly sensitive to health system costs for clients of the High Support Housing Initiative program. This study suggests the High Support Housing Initiative is potentially cost saving relative to inpatient hospitalization at the Centre for Addiction and Mental Health.

  16. Implementation of a Quality Improvement Initiative: Improved Congenital Muscular Torticollis Outcomes in a Large Hospital Setting.

    Science.gov (United States)

    Strenk, Mariann L; Kiger, Michelle; Hawke, Jesse L; Mischnick, Amy; Quatman-Yates, Catherine

    2017-06-01

    The American Physical Therapy Association (APTA) published a guideline for congenital muscular torticollis (CMT) in 2013. Our division adopted the guideline as the institutional practice standard and engaged in a quality improvement (QI) initiative to increase the percentage of patients who achieved resolution of CMT within 6 months of evaluation. The aims of this report are to describe the QI activities conducted to improve patient outcomes and discuss the results and implications for other institutions and patient populations. This was a quality improvement study. In alignment with the Chronic Care Model and Model of Improvement, an aim and operationally defined key outcome and process measures were established. Interventions were tested using Plan-Do-Study-Act cycles. A CMT registry was established to store and manage data extracted from the electronic record over the course of testing. Statistical process control charts were used to monitor progress over time. The QI initiative resulted in an increase in the percentage of patients who achieved full resolution of CMT within a 6-month episode of care from 42% to 61% over an 18-month period. Themes that emerged as key drivers of improvement included: (1) timely, optimal access to care, (2) effective audit and clinician feedback, and (3) accurate, timely documentation. The initiative took place at a single institution with a supportive culture and strong QI resources, which may limit direct translation of interventions and findings to other institutions and patient populations. Improvement science methodologies provided the tools and structure to improve division-wide workflow and increase consistency in the implementation of the APTA CMT guideline. In doing so, significant CMT population outcome improvements were achieved. © 2017 American Physical Therapy Association

  17. Characteristics of patients who stop falling after a risk-based multidisciplinary intervention initiated in a geriatric day hospital.

    Science.gov (United States)

    Flabeau, O; Laurendeau, G; Laksir, H; Castaings-Pelet, S; Harston, S; Bourdel-Marchasson, I

    2013-02-01

    Multidisciplinary interventions for fallers have provided conflicting results in part due to the diversity of fallers' profiles. to determine the characteristics of the subgroup of patients with a positive response to a multidisciplinary fall prevention program initiated in a geriatric day hospital. Prospective observational study in day hospital. Patients > 75 years referred for falls during the last 3 months benefited from a multidisciplinary assessment to record their characteristics at baseline and to tailor a risk-based multidisciplinary intervention for fall prevention. Patients free from falls at the 3rd or 6th month were compared to persistent fallers for baseline characteristics. Sixty-nine patients were assessed at baseline (mean age 85.2 y (SD=0.6)), 44 at the 3rd month and 21 at the 6th month. Baseline characteristics of the patients free from falls at the 3rd month were the lower number of previous non-serious falls (p=0.013), living in nursing home (p=0.045), a higher Berg balance score (p=0.02) and a better mental health-related quality of life (M HQol, p=0.045). On multivariate analysis restricted to home-dwelling patients, the positive predictive factors were less isolation at home (OR=0.028, 95%CI [0-0.813], p=0.037), a lower number of non-serious previous falls (OR= 0.526 [0.309- 0.894], p=0.018), a better M HQol (OR=1.205 [1.000-1.452], p=0.050) and a trend for younger age (OR= 0.662, [0.426-1.027], p=0.066). Being able to call upon a support person (familial or institutional) to apply advice and a less serious risk of falling may be preliminary conditions for success in a multidisciplinary intervention initiated in a day hospital.

  18. [Shortened hospital stay for elective cesarean section after initiation of a fast-track program and midwifery home-care].

    Science.gov (United States)

    Gunnarsdottir, Johanna; Bjornsdottir, Thorbjörg Edda; Halldorsson, Thorhallur Ingi; Halldorsdottir, Gudrun; Geirsson, Reynir Tomas

    2011-07-01

    To audit whether hospital stay shortened without increasing readmissions after implementation of fast-track methodology for elective cesarean section and characterize what influences length of stay. A fast-track program was initiated in November 2008, with a one year clinical audit and satisfaction survey. Discharge criteria were predefined and midwife home visits included if discharge was within 48 hours. Hospital stay by parity for women with elective section for singleton pregnancy between 1.11. 2008 - 31.10. 2009 (n=213, fast-track 182) was compared to 2003 (n=199) and 2007 (n=183). Readmissions and outpatient visits 2007 and 2008-9 were counted. Reasons for longer stay were recorded in fast-track, and body mass index. Median hospital stay decreased significantly from 81 to 52 hours between 2007 and 2008-9. Readmissions were four in each period and outpatient visit rates similar. In 2008-9, 66% of all women were discharged within 48 hours. Women in the fast-track program were satisfied with early discharge. Hospital stay for parous women was shorter in 2007 compared to 2003, but unchanged for nulliparas. Parity had a minimal influence on length of stay in 2008-9, although nulliparous women ≤ 25 years were more likely to stay >48 hours. Body mass index did not correlate with length of stay. Pain was rarely the reason for a longer stay in the fast-track program and 90% were satisfied with pain-medication after discharge. Most healthy women can be discharged early after singleton birth by elective cesarean, without increasing readmissions.

  19. Prevalent infant feeding practices among the mothers presenting at a tertiary care hospital in Garhwal Himalayan region, Uttarakhand, India

    Directory of Open Access Journals (Sweden)

    Vyas Kumar Rathaur

    2018-01-01

    30.7% respectively. There appeared to be an association between longer duration of exclusive breastfeeding and lower prevalence of stunting and underweight at 6 months of age. Conclusions: This study shows that undesirable infant feeding practices are still prevalent in the community. Lower prevalence of stunting and underweight was observed in infants with longer duration of exclusive breastfeeding. A comprehensive plan to address the problems in infant feeding should be formulated. Antenatal counselling of mothers should be done. Revitalization of the Baby Friendly Hospital Initiative(BHFI in health facilities is recommended.

  20. Initial Steps for Quality Improvement of Obesity Care Across Divisions at a Tertiary Care Pediatric Hospital

    Directory of Open Access Journals (Sweden)

    Sheila Z. Chang

    2014-09-01

    Full Text Available Background: Pediatric subspecialists can participate in the care of obese children. Objective: To describe steps to help subspecialty providers initiate quality improvement efforts in obesity care. Methods: An anonymous patient data download, provider surveys and interviews assessed subspecialty providers’ identification and perspectives of childhood obesity and gathered information on perceived roles and care strategies. Participating divisions received summary analyses of quantitative and qualitative data and met with study leaders to develop visions for division/service-specific care improvement. Results: Among 13 divisions/services, subspecialists’ perceived role varied by specialty; many expressed the need for cross-collaboration. All survey informants agreed that identification was the first step, and expressed interest in obtaining additional resources to improve care. Conclusions: Subspecialists were interested in improving the quality and coordination of obesity care for patients across our tertiary care setting. Developing quality improvement projects to achieve greater pediatric obesity care goals starts with engagement of providers toward better identifying and managing childhood obesity.

  1. Problematic video game use scale: initial psychometric properties with psychiatrically hospitalized adolescents.

    Science.gov (United States)

    Topor, David R; Swenson, Lance P; Liguori, Gina M; Spirito, Anthony; Lowenhaupt, Elizabeth A; Hunt, Jeffrey I

    2011-12-01

    Excessive video game use among youth has been a growing concern in the United States and elsewhere. The aims of this study are to establish validity of a video game measure in a large adolescent inpatient sample, identify clinical factors underlying problem video game use, and identify associations with measures of psychopathology. Three hundred eighty participants admitted to an adolescent inpatient psychiatric unit between November 2007 and March 2009 were administered a battery of self-report measures, including a questionnaire developed for this study that assessed reinforcers and consequences of past-year video game use (ie, Problematic Video Game Use Scale). Factor analysis was used to identify the underlying structure of behaviors associated with problem video game use. A factor analysis of the Problematic Video Game Use Scale indicated 2 primary factors. One was associated with engaging in problem behaviors that impaired the adolescent's functioning as a result of playing video games and one reflected the reinforcing effects of playing video games. Both factors were associated with measures of psychopathology, although associations were generally stronger for impairment in functioning than for reinforcing effects. Both factors were significantly correlated with self-reported daily video game use (P video game playing: impairment in functioning and reinforcing effects. Initial evidence of the content validity of the video game measure was established. Findings highlight the importance of assessing video game use among an adolescent population, the factors associated with video game use, and associations with symptoms of psychopathology. Limitations include a common reporter for multiple measures and cross-sectional data that do not allow for causal links to be made. © Copyright 2011 Physicians Postgraduate Press, Inc.

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

    Science.gov (United States)

    Hudelson, Patricia; Dominice Dao, Melissa; Perneger, Thomas; Durieux-Paillard, Sophie

    2014-01-01

    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. 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. 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. 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-departmental participation in all activities were important in creating and

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

    Directory of Open Access Journals (Sweden)

    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

  4. Initial experience with intravenous pentobarbital sedation for children undergoing MRI at a tertiary care pediatric hospital: the learning curve

    International Nuclear Information System (INIS)

    Greenberg, S.B.; Adams, R.C.; Aspinall, C.L.

    2000-01-01

    Objective. Our purpose is to describe the initial experience with intravenous pentobarbital sedation in children undergoing MRI at a tertiary pediatric hospital to identify errors associated with inexperience. Subjects and methods. The study included the first 100 children sedated with intravenous pentobarbital prior to magnetic resonance examination at a tertiary pediatric hospital. The protocol included a maximum dose of 6 mg/kg administered in three divided doses with the total dose not to exceed 200 mg. Flow sheets documenting vital signs, administered drug doses, and adverse reactions were maintained contemporaneous to sedation. Results. Sedation was successful in 92 children. Of the eight children who failed sedation, three were at least 12 years old and three weighed more than 50 kg. χ 2 tests identified significantly greater failure rates in children older than 11 years or weight greater than 50 kg. Two children had prolonged sedation after the maximum suggested dose was exceeded. Conclusions. The success rate was good, but could have been improved by restricting the use of pentobarbital to children less than 12 years of age and weighing less than 50 kg. Radiologists inexperienced with intravenous sedation should strictly observe the maximum suggested dose of pentobarbital to prevent prolonged sedation. (orig.)

  5. Audit of feeding practices in the neonatal wards at the Charlotte ...

    African Journals Online (AJOL)

    Breastfeeding is the preferred choice of infant feeding. The Baby Friendly Hospital Initiative (BFHI) is a ten-step plan to help ... A total of 98 (24%) were very low birth weight (VLBW) (1 500 g or more. Only 94 ...

  6. Knowledge, attitudes and practices of nursing staff regarding the ...

    African Journals Online (AJOL)

    Objectives: The objectives of this study were to assess nursing staff knowledge, attitudes and practices regarding the Baby-Friendly Hospital Initiative (BFHI); to assess the knowledge of maternity obstetric unit (MOU) managers regarding BFHI principles and their attitude towards BFHI implementation; and to describe the ...

  7. AWARENESS OF THE BENEFITS OF BREASTFEEDING AMONG ...

    African Journals Online (AJOL)

    FOBUR

    Breastfeeding is a cultural practice conferring important health and development benefits to. 1,2 children, families, communities and the nation. It is the fundamental component of the child-survival strategy. The Baby Friendly Hospital Initiative. (BFHI) was designed to support, protect and promote breastfeeding practices.

  8. Effect of initial lactate level on short-term survival in patients with out-of-hospital cardiac arrest

    Directory of Open Access Journals (Sweden)

    Tuba Sarıaydın, MD

    2017-12-01

    Full Text Available Purpose: This study evaluated whether serum lactate levels (SLL at admission in patients with cardiac arrest (CA can predict successful return of spontaneous circulation (ROSC or short-term survival, especially within the first 24 h. Materials and methods: This prospective, observational study was conducted in the emergency department (ED of a training and research hospital from April 2015 through February 2016. It included all patients older than 18 years who presented to the ED during the study period with non-traumatic out-of-hospital cardiac arrest (OHCA. The study measured two outcomes: whether ROSC was achieved and whether short-term survival was achieved. ROSC was defined as the presence of spontaneous circulation for the first hour after cardiopulmonary resuscitation (CPR. Survival was defined as having survived for a minimum of 24 h after ROSC. Results: The study included 140 patients who were admitted to the ED with OHCA. ROSC was achieved in 55 patients (39.3%, and survival for 24 h following CA was achieved in 42 patients (30%. The mean SLL in the ROSC (+ and ROSC (- groups were 9.1 ± 3.2 mmol/L and 9.8 ± 2.9 mmol/L, respectively. The mean SLL in the survivor and non-survivor groups were 8.6 ± 2.9 mmol/L and 10 ± 3.1 mmol/L, respectively. These differences were not statistically significant (p = 0.1. A multivariate regression model assessing the factors that predicted both ROSC and 24-h survival showed the odds ratio (OR of initial SLL was 1.3 (95% CI: 1.05–1.6 and 1.1 (95% CI: 0.9–1.3, respectively. Conclusions: This study showed that in OHCA patients, SLL on admission was not associated with increased ROSC achievement or 24-h survival. Keywords: Cardiac arrest, Out-of-hospital cardiac arrest (OHCA, Return of spontaneous circulation (ROSC, Serum lactate, Emergency department

  9. Right ventricular stroke work index as a negative predictor of mortality and initial hospital stay after lung transplantation.

    Science.gov (United States)

    Armstrong, Hilary F; Schulze, P Christian; Kato, Tomoko S; Bacchetta, Matthew; Thirapatarapong, Wilawan; Bartels, Matthew N

    2013-06-01

    Studies have shown that patients with poor pre-lung transplant (LTx) right ventricular (RV) function have prolonged post-operative ventilation time and intensive care stay as well as a higher risk of in-hospital death. RV stroke work index (RVSWI) calculates RV workload and contractility. We hypothesized that patients with higher RV workload capacity, indicated by higher RVSWI, would have better outcomes after LTx. A retrospective record review was performed on all LTx patients between 2005 and 2011 who had right heart catheterizations (RHC) 1-year before LTx. In addition, results for echocardiograms and cardiopulmonary exercise testing within 1-year of RHCs were gathered. Mean RVSWI was 9.36 ± 3.59 for 115 patients. There was a significant relation between mean pulmonary artery pressure (mPAP), RVSWI, RV end-diastolic diameter (RVEDd), left atrial dimension (LAD), peak and resting pressure of end-tidal carbon dioxide, minute ventilation /volume of carbon dioxide production, and 1-year mortality after LTx. Contrary to our hypothesis, those who survived had lower RVSWI than those who died within 1 year (8.99 ± 3.38 vs 11.6 ± 4.1, p = 0.026). Hospital length of stay significantly correlated with mPAP, RVSWI, left ventricular ejection fraction, percentage of fractional shortening, RVEDd, RV fractional area change, LAD, and RV wall thickness in diastole. Intensive care length of stay also significantly correlated with these variables and with body mass index. RVSWI was significantly different between groups of different RV function, indicating that increased RVSWI is associated with impairment of RV structure and function in patients undergoing LTx evaluation. This study demonstrates an association between 1-year mortality, initial hospital and intensive care length of stay, and pre-LTx RVSWI. Increased mPAP is a known risk for outcomes in LTx patients. Our findings support this fact and also show increased mortality with elevation of RVSWI, demonstrating the value

  10. Under Pressure: Financial Effect of the Hospital-Acquired Conditions Initiative-A Statewide Analysis of Pressure Ulcer Development and Payment.

    Science.gov (United States)

    Meddings, Jennifer; Reichert, Heidi; Rogers, Mary A M; Hofer, Timothy P; McMahon, Laurence F; Grazier, Kyle L

    2015-07-01

    To assess the financial effect of the 2008 Hospital-Acquired Conditions Initiative (HACI) pressure ulcer payment changes on Medicare, other payers, and hospitals. Retrospective before-and-after study of all-payer statewide administrative data for more than 2.4 million annual adult discharges in 2007 and 2009 using the Healthcare Cost and Utilization Project State Inpatient Datasets for California. How often and by how much the 2008 payment changes for pressure ulcers affected hospital payment was assessed. Nonfederal acute care California hospitals (N = 311). Adults discharged from acute-care hospitals. Pressure ulcer rates and hospital payment changes. Hospital-acquired pressure ulcer rates were low in 2007 (0.28%) and 2009 (0.27%); present-on-admission pressure ulcer rates increased from 2.3% in 2007 to 3.0% in 2009. According to clinical stage of pressure ulcer (available in 2009), hospital-acquired Stage III and IV ulcers occurred in 603 discharges (0.02%); 60,244 discharges (2.42%) contained other pressure ulcer diagnoses. Payment removal for Stage III and IV hospital-acquired ulcers reduced payment in 75 (0.003%) discharges, for a statewide payment decrease of $310,444 (0.001%) for all payers and $199,238 (0.001%) for Medicare. For all other pressure ulcers, the Hospital-Acquired Conditions Initiative reduced hospital payment in 20,246 (0.81%) cases (including 18,953 cases with present-on-admission ulcers), reducing statewide payment by $62,538,586 (0.21%) for all payers and $47,237,984 (0.32%) for Medicare. The total financial effect of the 2008 payment changes for pressure ulcers was negligible. Most payment decreases occurred by removal of comorbidity payments for present-on-admission pressure ulcers other than Stages III and IV. The removal of payment for hospital-acquired Stage III and IV ulcers by implementation of the HACI policy was 1/200th that of the removal of payment for other types of pressure ulcers that occurred in implementation of the

  11. High initiation and long duration of breastfeeding despite absence of early skin-to-skin contact in Karen refugees on the Thai-Myanmar border: a mixed methods study.

    Science.gov (United States)

    White, Adrienne L; Carrara, Verena I; Paw, Moo Kho; Malika; Dahbu, Colleypaw; Gross, Mechthild M; Stuetz, Wolfgang; Nosten, Francois H; McGready, Rose

    2012-12-13

    Early skin-to-skin contact (SSC) after birth is recommended as part of the United Nations Children's Fund (UNICEF) baby friendly health initiative to promote optimum breastfeeding. This paper reports rates of breastfeeding initiation and duration in a low resource environment, where early SSC is not practised, and explores views of pregnant women and midwives surrounding breastfeeding and swaddling. Data from records from a single hospital on the Thai-Myanmar border where refugee women gave birth during a one-year period (2010) were used to determine breastfeeding initiation rates and the time of the first breastfeed, and duration of breastfeeding of the previous alive child in multigravidae. Focus group discussions (FGD) were conducted to obtain information from pregnant women attending antenatal care about their intended or previous duration of breastfeeding and views on breastfeeding. Interviews with local midwives explored reasons for high rates of breastfeeding in this setting and the practice of newborn swaddling. Of 1404 live births in 2010 in Maela refugee camp there were 982 evaluable mother-newborn pairs, including 80 infants born before 37 weeks gestation. Initiation of breastfeeding within the first hour after birth and exclusive breastfeeding at discharge in term mother-newborn pairs was 91.2% (823/902) and 99.3% (896/902); and before 37 weeks gestation, 48.8% (39/80) and 98.8% (79/80). Reported duration of previous breastfeeding was 19 (range 2 to 72) months.During FGD all primigravidae (n = 17) intended to breastfeed and all multigravidae (n = 33) had previously breastfed; expected or previous duration of feeding was for more than one year or longer. The major theme identified during FGD was breastfeeding is "good". Women stated their intention to breastfeed with certainty. This certainty was echoed during the interviews with midwifery staff. SSC requires a delay in early swaddling that in Karen people, with animistic beliefs, could risk loss

  12. U-curve association between timing of renal replacement therapy initiation and in-hospital mortality in postoperative acute kidney injury.

    Directory of Open Access Journals (Sweden)

    Chih-Chung Shiao

    Full Text Available BACKGROUND: Postoperative acute kidney injury (AKI is associated with poor outcomes in surgical patients. This study aims to evaluate whether the timing of renal replacement therapy (RRT initiation affects the in-hospital mortality of patients with postoperative AKI. METHODOLOGY: This multicenter retrospective observational study, which was conducted in the intensive care units (ICUs in a tertiary hospital (National Taiwan University Hospital and its branch hospitals in Taiwan between January, 2002, and April, 2009, included adult patients with postoperative AKI who underwent RRT for predefined indications. The demographic data, comorbid diseases, types of surgery and RRT, and the indications for RRT were documented. Patients were categorized according to the period of time between the ICU admission and RRT initiation as the early (EG, ≦1 day, intermediate (IG, 2-3 days, and late (LG, ≧4 days groups. The in-hospital mortality rate censored at 180 day was defined as the endpoint. RESULTS: Six hundred forty-eight patients (418 men, mean age 63.0±15.9 years were enrolled, and 379 patients (58.5% died during the hospitalization. Both the estimated probability of death and the in-hospital mortality rates of the three groups represented U-curves. According to the Cox proportional hazard method, LG (hazard ratio, 1.527; 95% confidence interval, 1.152-2.024; P = 0.003, compared with IG group, age (1.014; 1.006-1.021, diabetes (1.279; 1.022-1.601; P = 0.031, cirrhosis (2.147; 1.421-3.242, extracorporeal membrane oxygenation support (1.811; 1.391-2.359, initial neurological dysfunction (1.448; 1.107-1.894; P = 0.007, pre-RRT mean arterial pressure (0.988; 0.981-0.995, inotropic equivalent (1.006; 1.001-1.012; P = 0.013, APACHE II scores (1.055; 1.037-1.073, and sepsis (1.939; 1.536-2.449 were independent predictors of the in-hospital mortality (All P<0.001 except otherwise stated. CONCLUSIONS: The current study found a U

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

    Science.gov (United States)

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

    2017-01-01

    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. The rate of rehospitalizations from SNF within 30 days of original discharge has increased within the last decade. 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. The most common facilitator was the incorporation of specialized staff. The most cited barriers were quality improvement tracking and implementation. 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.

  14. The use of resource allocation approach for hospitals based on the initial efficiency by using data envelopment analysis

    Directory of Open Access Journals (Sweden)

    Nahid Yazdian Hossein Abadi

    2017-10-01

    Full Text Available Introduction: Recourse allocation is very important in today’s highly competitive environment to enhance the quality and reduce costs due to limited resources and unlimited needs of the society. The aim of this study was to implement resource allocation in order to improve the efficiency of hospital. Method: This is a mixed method study. The data used in this paper are secondary data related to the 30 large acute and general hospitals in the US. Bed, service mix, full-time equivalent (FTE, and operational expenses are input indicators in hospital, and adjusted admissions and outpatient visits are output indicators. Using goal programming (GP model and data envelopment analysis (DEA model with a common weights, we suggest three scenarios for resource allocation and budget allocation. “Resource allocation based on efficiency”, “budget allocation based on efficiency” and “two stage allocation of budget”. The first scenario was used for allocating the resources and the second and third ones for allocating budget to decision making units (DMUs. The data were analyzed by LINGO software. Results: Before the allocation, four hospitals were efficient and the efficiency of six hospitals was less than 50%, but after allocation, in the first case of the first scenario 14 hospitals, 11 hospitals in the second case of the first scenario, 24 hospitals in the second scenario and 17 hospitals in the third scenario were efficient, and it is an important point that after the allocation, efficiency of all hospitals increased. Conclusion: This study can be useful for hospital administrators; it can help them to allocate their resource and budget and increase the efficiency of their hospitals.

  15. Impact of time of initiation of once-monthly paliperidone palmitate in hospitalized Asian patients with acute exacerbation of schizophrenia: a post hoc analysis from the PREVAIL study.

    Science.gov (United States)

    Li, Huafang; Li, Yan; Feng, Yu; Zhuo, Jianmin; Turkoz, Ibrahim; Mathews, Maju; Tan, Wilson

    2018-01-01

    To evaluate the differences in efficacy and safety outcomes in acute exacerbating schizophrenia patients between 2 subgroups (≤1 week and >1 week), differing in time interval from hospitalization to time of initiation of once-monthly paliperidone palmitate. PREVAIL was a multicenter, single-arm, open-label, prospective Phase IV study in hospitalized Asian patients (either sex, aged 18-65 years) diagnosed with schizophrenia ( Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition). Change from baseline to week 13 in primary (Positive and Negative Syndrome Scale [PANSS] total score), secondary endpoints (PANSS responder rate, PANSS subscale, PANSS Marder factor, Clinical Global Impression-Severity, and Personal and Social Performance scale scores, readiness for hospital discharge questionnaire) and safety were assessed in this post hoc analysis. Significant mean reduction from baseline to week 13 in the PANSS total score, 30% PANSS responder rates ( P ≤0.01), PANSS subscales (positive and general psychopathology; all P ≤0.01), PANSS Marder factor (positive symptoms, uncontrolled hostility, and excitement and anxiety/depression; all P ≤0.01), Personal and Social Performance scale scores ( P ≤0.05) and Clinical Global Impression-Severity categorical summary ( P ≤0.05) were significantly greater in the ≤1 week subgroup versus >1 week subgroup ( P ≤0.05). The readiness for hospital discharge questionnaire improved over time for the overall study population, but remained similar between subgroups at all-time points. Treatment-emergent adverse events were similar between the subgroups. Early initiation of once-monthly paliperidone palmitate in hospitalized patients with acute exacerbation of schizophrenia led to greater improvements in psychotic symptoms with comparable safety than treatment initiation following 1 week of hospitalization.

  16. Not All Clefts Are Created Equal: Patterns of Hospital-Based Care Use among Children with Cleft Lip and Palate within 4 Years of Initial Surgery.

    Science.gov (United States)

    Ligh, Cassandra A; Fox, Justin P; Swanson, Jordan; Yu, Jason W; Taylor, Jesse A

    2016-06-01

    This study compares hospital-based care and associated charges among children with cleft lip, cleft palate, or both, and identifies subgroups generating the greatest cumulative hospital charges. The authors conducted a retrospective cohort study of cleft lip, cleft palate, or cleft lip and palate who underwent initial surgery from 2006 to 2008 in four U.S. states. Primary outcome was hospital-based care-emergency, outpatient, inpatient-within 4 years of surgery. Regression models compared outcomes and classification tree analysis identified patients at risk for being in the highest quartile of cumulative hospital charges. The authors identified 4571 children with cleft lip (18.2 percent), cleft palate (39.2 percent), or cleft lip and palate (42.6 percent). Medical comorbidity was frequent across all groups, with feeding difficulty (cleft lip, 2.4 percent; cleft palate, 13.4 percent; cleft lip and palate, 6.0 percent; p cleft lip, 1.8 percent; cleft palate, 9.4 percent; cleft lip and palate, 3.6 percent; p cleft palate were most likely to return to the hospital (p cleft lip group, yet comparable among those with cleft palate and cleft lip and palate (p cleft palate cohort (cleft lip, $56,966; cleft palate, $106,090; cleft lip and palate, $91,263; p cleft lip versus cleft palate with or without cleft lip), and age at initial surgery were the most important factors associated with the highest quartile of cumulative hospital charges. Cleft lip and palate children experience a high rate of hospital-based care early in life, with degree of medical comorbidity being a significant burden. Understanding this relationship and associated needs may help deliver more efficient, patient-centered care.

  17. Impact of time of initiation of once-monthly paliperidone palmitate in hospitalized Asian patients with acute exacerbation of schizophrenia: a post hoc analysis from the PREVAIL study

    Directory of Open Access Journals (Sweden)

    Li H

    2018-04-01

    Full Text Available Huafang Li,1,2 Yan Li,1,2 Yu Feng,3 Jianmin Zhuo,4 Ibrahim Turkoz,5 Maju Mathews,5 Wilson Tan3 1Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, China; 2Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China; 3Janssen Pharmaceutical Companies of Johnson and Johnson, Singapore; 4Janssen China Research and Development, Shanghai, China; 5Janssen Research & Development LLC, Titusville, NJ, USA Purpose: To evaluate the differences in efficacy and safety outcomes in acute exacerbating schizophrenia patients between 2 subgroups (≤1 week and >1 week, differing in time interval from hospitalization to time of initiation of once-monthly paliperidone palmitate. Patients and methods: PREVAIL was a multicenter, single-arm, open-label, prospective Phase IV study in hospitalized Asian patients (either sex, aged 18–65 years diagnosed with schizophrenia (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Change from baseline to week 13 in primary (Positive and Negative Syndrome Scale [PANSS] total score, secondary endpoints (PANSS responder rate, PANSS subscale, PANSS Marder factor, Clinical Global Impression-Severity, and Personal and Social Performance scale scores, readiness for hospital discharge questionnaire and safety were assessed in this post hoc analysis. Results: Significant mean reduction from baseline to week 13 in the PANSS total score, 30% PANSS responder rates (P≤0.01, PANSS subscales (positive and general psychopathology; all P≤0.01, PANSS Marder factor (positive symptoms, uncontrolled hostility, and excitement and anxiety/depression; all P≤0.01, Personal and Social Performance scale scores (P≤0.05 and Clinical Global Impression-Severity categorical summary (P≤0.05 were significantly greater in the ≤1 week subgroup versus >1 week subgroup (P≤0.05. The readiness for hospital discharge questionnaire improved over time for the overall study population, but

  18. Initial Experience of a Primary Urgent Care Clinic Curriculum and Subspecialty Lectureship Series Implementation in a Los Angeles County Hospital.

    Science.gov (United States)

    Agrawal, Harsh; Martinez, Anna; Volkmann, Elizabeth R; Melamed, Oleg; Wali, Soma

    2017-05-01

    Urgent care clinics are extremely busy in the University of California-Los Angeles (UCLA) County hospital system. We determined that residents and medical students in the internal medicine residency program who are rotating through these clinics did not receive enough teaching during their rotation. We decided to create and implement an urgent care curriculum and lectures to help achieve structure for the rotation. The goal of this series was to educate and assist residents in the primary care setting to comfortably manage subspecialty conditions, help reduce the already-overwhelmed county subspecialty referral system, and promote learning. The Olive View-UCLA Medical Center internal medicine residency program has a total of 74 residents, which includes postgraduate year-1 (PGY-1) to PGY-4, with PGY-4 being combined internal medicine-pediatrics or emergency medicine-internal medicine residents. We used core curriculum topics as provided by the Accreditation Council for Graduate Medical Education to design the curriculum. We sent e-mails to the stakeholders whom we identified as the residents and the attending physicians working in urgent care, inquiring after topics they wanted to discuss during the rotation. Using these responses we compiled a list of all of the topics that could be discussed and reviewed during the rotation. These topics were broken down into short 10- to 15-minute-long lectures. During the lectures, we provided a retrospective post- then prequestionnaire to the residents for evaluation of the program and the lectures. A benefit of the post-then-pre design is that participants answer the postquestions and the prequestions together after the lecture, thereby reducing the possibility of response shift bias. Of the 74 residents in the program, 25 responded; the response rate was approximately 33%. Regarding content, 92% (23) said it was appropriate, 4% (1) said it was too low a level, and 4% (1) did not respond. Overall, 36% (9) said the lecture was

  19. Feasibility of hospital-initiated non-facilitator assisted advance care planning documentation for patients with palliative care needs.

    Science.gov (United States)

    Kok, Maaike; van der Werff, Gertruud F M; Geerling, Jenske I; Ruivenkamp, Jaap; Groothoff, Wies; van der Velden, Annette W G; Thoma, Monique; Talsma, Jaap; Costongs, Louk G P; Gans, Reinold O B; de Graeff, Pauline; Reyners, Anna K L

    2018-05-24

    Advance Care Planning (ACP) and its documentation, accessible to healthcare professionals regardless of where patients are staying, can improve palliative care. ACP is usually performed by trained facilitators. However, ACP conversations would be more tailored to a patient's specific situation if held by a patient's clinical healthcare team. This study assesses the feasibility of ACP by a patient's clinical healthcare team, and analyses the documented information including current and future problems within the palliative care domains. This multicentre study was conducted at the three Groningen Palliative Care Network hospitals in the Netherlands. Patients discharged from hospital with a terminal care indication received an ACP document from clinical staff (non-palliative care trained staff at hospitals I and II; specialist palliative care nurses at hospital III) after they had held ACP conversations. An anonymised copy of this ACP document was analysed. Documentation rates of patient and contact details were investigated, and documentation of current and future problems were analysed both quantitatively and qualitatively. One hundred sixty ACP documents were received between April 2013 and December 2014, with numbers increasing for each consecutive 3-month time period. Advance directives were frequently documented (82%). Documentation rates of current problems in the social (24%), psychological (27%) and spiritual (16%) domains were low compared to physical problems (85%) at hospital I and II, but consistently high (> 85%) at hospital III. Of 545 documented anticipated problems, 92% were physical or care related in nature, 2% social, 5% psychological, and will improve identification and documentation of non-physical problems remains to be investigated.

  20. Healthy cooking classes at a children’s cancer hospital and patient/survivor summer camp: initial reactions and feasibility

    Science.gov (United States)

    Raber, Margaret; Crawford, Karla; Chandra, Joya

    2018-01-01

    Objective Childhood cancer survivors (CCS) have been shown to practice sub-optimal dietary intake and may benefit from nutrition interventions during and after treatment. Cooking classes have become popular for encouraging healthy eating behaviors in community-based programming and academic research, however, literature on teaching cooking classes in CCS is limited. The purpose of this study is to address the development and implementation of classes for CCS based on a recently developed framework of healthy cooking behavior. Design A conceptual framework was developed from a systematic literature review and used to guide healthy cooking classes for CCS in different settings. Setting One pediatric cancer hospital inpatient unit, one pediatric cancer in-hospital camp program and two off-site pediatric cancer summer camp programs. Subjects One hundred and eighty nine CCS of varying ages and thirteen parents of CCS. Results Seventeen classes were taught at camps and seven classes in the hospital inpatient unit. Healthy cooking classes based on the conceptual framework are feasible and were well received by CCS. Conclusions Cooking classes for CCS, both at the hospital and at camp, reinforced the principles of the conceptual framework. Future trials should assess the dietary and anthropometric impact of evidence-based healthy cooking classes in CCS. PMID:28463101

  1. Predictors for total hospital and cardiology cost claims among patients with atrial fibrillation initiating dabigatran or acenocoumarol in the Netherlands

    NARCIS (Netherlands)

    Jacobs, M S; van Leent, M W J; Tieleman, R G; Jansman, F G A; Cao, Q; Postma, M J; van Hulst, M

    2017-01-01

    Aims: The prevalence of atrial fibrillation (AF) has increased over the past years due to aging of the population, and healthcare costs associated with AF reflect a significant financial burden. The aim of this study was to explore predictors for the real-world AF-related in-hospital costs in

  2. Initial Results of the Master's Degree Programme in "Leadership in Medicine" – Impact on hospital-based follow-on training of doctors

    Directory of Open Access Journals (Sweden)

    Wulfert, Chris-Henrik

    2017-11-01

    Full Text Available Objective: This pilot project, which was jointly conducted by a hospital and a university, describes the development of the Master's Degree Programme in Leadership in Medicine, a course designed to supplement medical specialty training. The aim of the pilot project is to demonstrate how hospital-based projects on personnel and organisational development undertaken under academic supervision can be used to increase leadership responsibility among doctors whose duties include providing initial and follow-on training and to professionalise medical specialty training as a leadership task. This need arose from the nationwide requirements and an internal audit regarding follow-on training. The version of the degree programme described below aims to further the personnel development of the participants in the field of didactics. Method: Each of the nine modules is made up of two classroom-based phases and one distance learning phase. The distance learning phase involves undertaking hospital-based projects on personnel and organisational development under academic supervision. The pilot phase participants were hospital doctors who, as part of their duties, hold leadership responsibility or are involved in the follow-on training of doctors.Results: The 17 participants successfully implemented more than 30 hospital-based projects during the distance learning phases of the nine modules. These projects included the development of medical specialty curricula, relevant didactic methods and evaluation design and were subsequently presented and subjected to reflection in interdisciplinary groups. The project presentation together with the project report were regarded as proof of competency. Conclusion: In addition to enhancing participant competency, the degree model described, which interlinks theory and practice, promotes organisational development through the implementation of projects undertaken under academic supervision. This has a double impact on the

  3. Hospital length of stay in patients initiated on direct oral anticoagulants versus warfarin for venous thromboembolism: a real-world single-center study.

    Science.gov (United States)

    Badreldin, Hisham

    2018-07-01

    This study was conducted to describe the real-world hospital length of stay in patients treated with all of the U.S. Food and Drug Administration approved direct oral anticoagulants (DOACs) versus warfarin for new-onset venous thromboembolism (VTE) at a large, tertiary, academic medical center. A retrospective cohort analysis of all adult patients diagnosed with acute onset VTE was conducted. Of the 441 patients included, 261 (57%) patients received DOACs versus 180 (41%) patients received warfarin. In the DOAC group, a total of 92 (35%) patients received rivaroxaban, followed by 83 (32%) patients received apixaban, 50 (19%) patients received dabigatran, and 36 (14%) patients received edoxaban. Patients initiated on DOACs had a statistically significant shorter hospital length of stay compared to patients initiated on warfarin (median 3 days, [IQR 0-5] vs. 8 days [IQR 5-11], P < 0.05). Despite the shorter hospital length of stay in patients receiving DOACs, the overall reported differences between the DOACs group and the warfarin group in terms of recurrent VTE, major bleeding, intracranial bleeding, and gastrointestinal bleeding at 3 and 6 months were deemed to be statistically insignificant.

  4. Target temperature management of 33°C and 36°C in patients with out-of-hospital cardiac arrest with initial non-shockable rhythm

    DEFF Research Database (Denmark)

    Frydland, Martin; Kjaergaard, Jesper; Erlinge, David

    2015-01-01

    PURPOSE: Despite a lack of randomized trials in comatose survivors of out-of-hospital cardiac arrest (OHCA) with an initial non-shockable rhythm (NSR), guidelines recommend induced hypothermia to be considered in these patients. We assessed the effect on outcome of two levels of induced hypothermia...... in comatose patient resuscitated from NSR. METHODS: Hundred and seventy-eight patients out of 950 in the TTM trial with an initial NSR were randomly assigned to targeted temperature management at either 33°C (TTM33, n=96) or 36°C (TTM36, n=82). We assessed mortality, neurologic function (Cerebral Performance...... Score (CPC) and modified Rankin Scale (mRS)), and organ dysfunction (Sequential Organ Failure Assessment (SOFA) score). RESULTS: Patients with NSR were older, had longer time to ROSC, less frequently had bystander CPR and had higher lactate levels at admission compared to patients with shockable rhythm...

  5. Bundled payment initiatives for Medicare and non-Medicare total joint arthroplasty patients at a community hospital: bundles in the real world.

    Science.gov (United States)

    Doran, James P; Zabinski, Stephen J

    2015-03-01

    In the setting of current United States healthcare reform, bundled payment initiatives and episode of care payment models for total joint arthroplasty (TJA) have become increasingly common. The following is a review of our results and experience in a community hospital with bundled payment initiatives for both non-Medicare and Medicare TJA patients since 2011. We have successfully decreased the cost of the TJA episode of care in comparison to our historical averages prior to 2011. This cost-reduction has primarily been achieved through decreased length of inpatient stay, increased discharge to home rather than to skilled nursing or inpatient rehabilitation facilities, reduction in implant cost, improvement in readmission rate and migration of cases to lower cost sites of service. Copyright © 2015 Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Hossein Hassanian-Moghadam

    2014-06-01

    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.

  7. Systemic inflammatory response syndrome and model for end-stage liver disease score accurately predict the in-hospital mortality of black African patients with decompensated cirrhosis at initial hospitalization: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Mahassadi AK

    2018-04-01

    Full Text Available Alassan Kouamé Mahassadi,1 Justine Laure Konang Nguieguia,1 Henriette Ya Kissi,1 Anthony Afum-Adjei Awuah,2 Aboubacar Demba Bangoura,1 Stanislas Adjeka Doffou,1 Alain Koffi Attia1 1Medicine and Hepatogastroenterology Unit, Centre Hospitalier et Universitaire de Yopougon, Abidjan, Côte d’Ivoire; 2Kumasi Centre for Collaborative Research in Tropical Medicine, Kumasi, Ghana Background: Systemic inflammatory response syndrome (SIRS and model for end-stage liver disease (MELD predict short-term mortality in patients with cirrhosis. Prediction of mortality at initial hospitalization is unknown in black African patients with decompensated cirrhosis.Aim: This study aimed to look at the role of MELD score and SIRS as the predictors of morbidity and mortality at initial hospitalization.Patients and methods: In this retrospective cohort study, we enrolled 159 patients with cirrhosis (median age: 49 years, 70.4% males. The role of Child–Pugh–Turcotte (CPT score, MELD score, and SIRS on mortality was determined by the Kaplan–Meier method, and the prognosis factors were assessed with Cox regression model.Results: At initial hospitalization, 74.2%, 20.1%, and 37.7% of the patients with cirrhosis showed the presence of ascites, hepatorenal syndrome, and esophageal varices, respectively. During the in-hospital follow-up, 40 (25.2% patients died. The overall incidence of mortality was found to be 3.1 [95% confidence interval (CI: 2.2–4.1] per 100 person-days. Survival probabilities were found to be high in case of patients who were SIRS negative (log-rank test= 4.51, p=0.03 and in case of patients with MELD score ≤16 (log-rank test=7.26, p=0.01 compared to the patients who were SIRS positive and those with MELD score >16. Only SIRS (hazard ratio (HR=3.02, [95% CI: 1.4–7.4], p=0.01 and MELD score >16 (HR=2.2, [95% CI: 1.1–4.3], p=0.02 were independent predictors of mortality in multivariate analysis except CPT, which was not relevant in our study

  8. Reducing Overutilization of Testing for Clostridium difficile Infection in a Pediatric Hospital System: A Quality Improvement Initiative.

    Science.gov (United States)

    Klatte, J Michael; Selvarangan, Rangaraj; Jackson, Mary Anne; Myers, Angela L

    2016-01-01

    Study objectives included addressing overuse of Clostridium difficile laboratory testing by decreasing submission rates of nondiarrheal stool specimens and specimens from children ≤12 months of age and determining resultant patient and laboratory cost savings associated with decreased testing. A multifaceted initiative was developed, and components included multiple provider education methods, computerized order entry modifications, and automatic declination from laboratory on testing stool specimens of nondiarrheal consistency and from children ≤12 months old. A run chart, demonstrating numbers of nondiarrheal plus infant stool specimens submitted over time, was developed to analyze the initiative's impact on clinicians' test-ordering practices. A p-chart was generated to evaluate the percentage of these submitted specimens tested biweekly over a 12-month period. Cost savings for patients and the laboratory were assessed at the study period's conclusion. Run chart analysis revealed an initial shift after the interventions, suggesting a temporary decrease in testing submission; however, no sustained differences in numbers of specimens submitted biweekly were observed over time. On the p-chart, the mean percentage of specimens tested before the intervention was 100%. After the intervention, the average percentage of specimens tested dropped to 53.8%. Resultant laboratory cost savings totaled nearly $3600, and patient savings on testing charges were ∼$32 000. Automatic laboratory declination of nondiarrheal stools submitted for CDI testing resulted in a sustained decrease in the number of specimens tested, resulting in significant laboratory and patient cost savings. Despite multiple educational efforts, no sustained changes in physician ordering practices were observed. Copyright © 2016 by the American Academy of Pediatrics.

  9. Initial hospital management of irradiated and radio-contaminated victims in case of accidental exposure of populations

    International Nuclear Information System (INIS)

    Foehrenbach; Mantzarides, M.; Bonardel, G.; Gontier, E.; Laroche, P.; Carbonnieres, H. de

    2006-01-01

    The current risk of radiologic exposure of the population occurs in many circumstances. The industrial accident is remarkably illustrated by the Tchernobyl event. Another kind is still virtual but the international situation does not allow to turn this hypothesis down. It is terrorist utilization of radioactive material. In these situations, medical problems are specific and require particular knowledge about the two forms of exposure which are external irradiation and external and internal contamination. Pathophysiological mechanisms of radiation effects concerning biological tissues are similar in these situations but care actions are dedicated. These elements are mandatory for the elaboration of procedures for the reception of irradiated or contaminated victims, being wounded or not, in a first-aid department. These procedures must comprise two aspects: the recognition of the radiologic exposition and the therapeutic actions taking into account the severity of associated injuries. Diagnosis of a radioactive contamination is rather simple by external detection. Conversely, to estimate the reality of an external irradiation is much more difficult but necessary for dosimetric evaluation. This latter is of the highest importance for the prevision of delayed clinical manifestations. At the hospital level, despite the training effort for first aid departments staff, the nuclear medicine physician, specialist for radioactive contamination, can play a specific role for the preparation of the equipment, the procedures and during intervention after a radiologic event has happened. This emphasizes the obligation for him to update his knowledge about this subject. (author)

  10. The immunological response of HIV-positive patients initiating HAART at the Komfo Anokye Teaching Hospital, Kumasi, Ghana.

    Science.gov (United States)

    Annison, L; Dompreh, A; Adu-Sarkodie, Y

    2013-12-01

    The study sought to document the experience of immunological improvement among Ghanaian PLHIV on HAART comparing different categories of patients. Serology Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana. The study comprised a convenient sample of 303 treatment naïve HIV patients due to start HAART. Questionnaires were used to collect patient demographic and clinical data. Four CD4 counts were measured at six-monthly intervals to determine rates of CD4 change. These were pre-therapy, 1(st) post-therapy, 2(nd) post-therapy, and 3(rd) post-therapy counts. The rates of CD4 change among the different categories of patients were also compared. At baseline, women had higher CD4 count (mean of 77.4 cells/μl), and mean age of participants was 40 years. The CD4 count increased from a mean baseline of 70.2 cells/μl to 229.2, 270.0, and 297.6 cells/μl at 6, 12, and 18 months of treatment respectively (P response. There was no difference (P=0.18) in treatment response comparing those with CD4 immunological recovery during 12 months of treatment The study, therefore, concludes that significant immunological improvement is possible among Ghanaian PLHIV on HAART as long as a high level of treatment adherence is observed.

  11. Dynamic effects of adrenaline (epinephrine) in out-of-hospital cardiac arrest with initial pulseless electrical activity (PEA).

    Science.gov (United States)

    Nordseth, Trond; Olasveengen, Theresa Mariero; Kvaløy, Jan Terje; Wik, Lars; Steen, Petter Andreas; Skogvoll, Eirik

    2012-08-01

    In cardiac arrest, pulseless electrical activity (PEA) is a challenging clinical syndrome. In a randomized study comparing intravenous (i.v.) access and drugs versus no i.v. access or drugs during advanced life support (ALS), adrenaline (epinephrine) improved return of spontaneous circulation (ROSC) in patients with PEA. Originating from this study, we investigated the time-dependent effects of adrenaline on clinical state transitions in patients with initial PEA, using a non-parametric multi-state statistical model. Patients with available defibrillator recordings were included, of whom 101 received adrenaline and 73 did not. There were significantly more state transitions in the adrenaline group than in the no-adrenaline group (rate ratio = 1.6, pAdrenaline markedly increased the rate of transition from PEA to ROSC during ALS and slowed the rate of being declared dead; e.g. by 20 min 20% of patients in the adrenaline group had been declared dead and 25% had obtained ROSC, whereas 50% in the no-adrenaline group have been declared dead and 15% had obtained ROSC. The differential effect of adrenaline could be seen after approx. 10 min of ALS for most transitions. For both groups the probability of deteriorating from PEA to asystole was highest during the first 15 min. Adrenaline increased the rate of transition from PEA to ventricular fibrillation or -tachycardia (VF/VT), and from ROSC to VF/VT. Adrenaline has notable clinical effects during ALS in patients with initial PEA. The drug extends the time window for ROSC to develop, but also renders the patient more unstable. Further research should investigate the optimal dose, timing and mode of adrenaline administration during ALS. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Tzeng Huey-Ming

    2010-02-01

    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

  13. Changes in sexual activity and risk behaviors among PLWHA initiating ART in rural district hospitals in Cameroon -- data from the STRATALL ANRS 12110/ESTHER trial.

    Science.gov (United States)

    Ndziessi, Gilbert; Cohen, Julien; Kouanfack, Charles; Boyer, Sylvie; Moatti, Jean-Paul; Marcellin, Fabienne; Laurent, Christian; Spire, Bruno; Delaporte, Eric; Carrieri, Maria Patrizia

    2013-01-01

    The continued scaling-up of antiretroviral therapy (ART) in Sub-Saharan Africa provides an opportunity to further study its impact on sexual behaviors among people living with HIV/AIDS (PLWHA). We explored time trend and correlates of sexual activity among PLWHA initiating ART in Cameroon and compared sexual risk behaviors between patients sexually active before and after initiating ART and those resuming sexual activity after ART initiation. Analyses were based on longitudinal data collected within the randomized trial (n=459) conducted in nine rural district hospitals in Cameroon. Sexual activity was defined as reporting at least one sexual partner during the previous 3 months. Inconsistent condom use (ICU) was defined as reporting to have "never," "sometimes," or "nearly always" used condoms at least once with a partner(s) either HIV-negative or of unknown HIV status during the same period. Mc Nemar tests were used to assess time trend, while mixed-effect logistic regressions were conducted to analyze the effect of time since ART initiation on sexual activity. The proportion of sexually active patients significantly increased over time: from 31.8% at baseline to 40.2 and 47.1% after 6 and 12 months of ART, respectively (p=0.001), to 55.9% after 24 months (p=0.02). After adjustment for behavioral and psychosocial factors, time since ART initiation was independently associated with reporting sexual activity (AOR [95% CI]=1.30 [1.17-1.46] per 6-month increase, p=0.001). ICU was more frequent among patients sexually active both before and after ART initiation than among those who resumed sexual activity after ART initiation (82 vs. 59%, pART initiation fosters resumption of sexual activity in patients who are inactive before starting treatment; unsafe sexual behaviors remain less frequent in this population than in patients who are already sexually active before starting ART. Risk reduction programs should be reinforced among PLWHA in the context of ART scaling-up.

  14. Prevalence of thrombocytopenia before and after initiation of HAART among HIV infected patients at black lion specialized hospital, Addis Ababa, Ethiopia: a cross sectional study.

    Science.gov (United States)

    Woldeamanuel, Gashaw Garedew; Wondimu, Diresibachew Haile

    2018-01-01

    Hematological abnormalities are common in HIV positive patients. Of these, thrombocytopenia is a known complication which has been associated with a variety of bleeding disorders. However, its magnitude and related factors have not been well-characterized in the era of highly active antiretroviral therapy (HAART) in Ethiopia. Therefore, this study aimed to assess the prevalence of thrombocytopenia before and after initiation of HAART among HIV positive patients attending Black Lion Specialized Hospital, Addis Ababa, Ethiopia. A cross sectional study was conducted from February to April 2017 in Black Lion Specialized Hospital, Addis Ababa, Ethiopia. A total of 176 patients on HAART were selected using simple random sampling techniques. Socio-demographic and clinical characteristics of the study patients were collected using structured questionnaire. Measurements of platelet counts and CD4 + T cell counts were made using Sysmex XT 2000i hematology analyzer and BD FACS Count CD4 analyzer, respectively. Statistical analysis of the data (Paired T- test and binary logistic regression) was done using SPSS version 20. P -value  18 years old) were enrolled in this study and had a mean age of 40.08 ± 9.38 years. There was significant increase in the mean values of platelet counts (218.44 ± 106.6 × 10 3 /μl vs 273.65 ± 83.8 × 10 3 /μl, p  < 0.001) after six months of HAART initiation compared to the baseline. Prevalence of thrombocytopenia before and after HAART initiation was 25 and 5.7% respectively. HIV patients whose CD4 counts < 200 Cells/μl were more likely to have thrombocytopenia than HIV patients whose CD4 count ≥350 Cells/μl. However, it was not statistically associated with prevalence of thrombocytopenia. This study has shown that the prevalence of thrombocytopenia after HAART initiation was decreased significantly. Based on our results, a number of study participants still had thrombocytopenia after initiation of HAART

  15. Comparison of team-focused CPR vs standard CPR in resuscitation from out-of-hospital cardiac arrest: Results from a statewide quality improvement initiative.

    Science.gov (United States)

    Pearson, David A; Darrell Nelson, R; Monk, Lisa; Tyson, Clark; Jollis, James G; Granger, Christopher B; Corbett, Claire; Garvey, Lee; Runyon, Michael S

    2016-08-01

    Team-focused CPR (TFCPR) is a choreographed approach to cardiopulmonary resuscitation (CPR) with emphasis on minimally interrupted high-quality chest compressions, early defibrillation, discourages endotracheal intubation and encourages use of the bag-valve-mask (BVM) and/or blind-insertion airway device (BIAD) with a ventilation rate of 8-10 breaths/min to minimize hyperventilation. Widespread incorporation of TFCPR in North Carolina (NC) EMS agencies began in 2011, yet its impact on outcomes is unknown. To determine whether TFCPR improves survival with good neurological outcome in out-of-hospital cardiac arrest (OHCA) patients compared to standard CPR. This retrospective cohort analysis of NC EMS agencies reporting data to the Cardiac Arrest Registry for Enhanced Survival (CARES) database from January 2010 to June 2014 included adult, non-traumatic OHCA with presumed cardiac etiology where EMS performed CPR or patient received defibrillation. Exclusions were arrest terminated per EMS policy or DNR. EMS agencies self-reported the TFCPR implementation dates. Patients were categorized as receiving either TFCPR or standard CPR. The primary outcome was good neurologic outcome at time of hospital discharge defined as Pittsburgh Cerebral Performance Category (CPC) 1-2. Of 14,994 OHCAs, 14,129 patients were included for analysis with a mean age 65 (IQR 50-81) years, 61% male, 7.3% with good neurologic outcome, 24.3% with shockable initial rhythm, and 71.5% receiving TFCPR. Of the 3427 (24.3%) with an initial shockable rhythm, 739 (71.9%) had a good neurological outcome. Good neurologic outcome was higher with TFCPR [836 (8.3%, 95%CI 7.7-8.8%)] vs. standard CPR [193 (4.8%, 95%CI 4.2-5.5%)]. Logistic regression controlling for demographic and arrest characteristics revealed TFCPR (OR 1.5), witnessed arrest (OR 4.3), initial shockable rhythm (OR 7.1), and in-hospital hypothermia (OR 3.3) were associated with good neurologic outcome. Mechanical CPR device (OR 0.68), CPR

  16. [Management of diabetic children at the University Hospital Center of Rabat: an example of partnership or personal initiative on the periphery of the school of medicine?].

    Science.gov (United States)

    Balafrej, A

    2003-04-01

    In Morocco there are at least 10,000 children under the age of 15 who suffer from type 1 diabetes who, due to the lack of appropriate management and care, are extremely susceptible to repeated hospital re-admission and long-term disabling degenerative complications. With the aim to reduce the frequency of complications, a specialised outpatient clinic was created at the children's hospital in Rabat in 1986. A multi-disciplinary team provides medical care as well as initial training and continuing education to the patients and their families according to a standardised protocol. The 700 young diabetics who are monitored in the clinic are at present autonomous in the delivery of their own daily treatment and continue to increasingly improve. After 10 years, this group of patients has experienced a diabetic retinopathy rate which is six times lower than since the onset of their illness. The programme is administered in partnership and with the financial support of a private sponsor and assistance of a parents' association. The programme is designed in compliance with the WHO Towards Unity for Health strategy and its core principles, namely: relevance, equity, quality, and effectiveness. In order to achieve sustainability, the programme needs an adopted geographic management structure and more formalised relationships linking the partners. Nevertheless, the programme could be considered as a laboratory experiment for the School of Medicine, in its search to create a wider social movement. This level of commitment implies recasting the foci of the medical training curriculum, promoting therapeutic patient education, giving more attention to the hospital's operations and building sustainable partnerships.

  17. [A scale for early assessment of risk of death and myocardial infarction during initial hospitalization of patients with acute coronary syndromes (based on data from the RECORD registry)].

    Science.gov (United States)

    Érlikh, A D

    2010-01-01

    Independent predictors of death and death or myocardial infarction (MI) during initial hospitalization of patients with acute coronary syndromes (ACS) were determined using database of Russian independent ACS registry RECORD. These predictors (admission Killip class II, ST-segment elevation 1 mm, systolic blood pressure 100 mm Hg, hemoglobin <110 g/L, age 65 years, history of diabetes) were attributed equal weight (1 point) and combined in a prognostic scale for assessment of risk of inhospital death and death or MI. The scale did not include markers of necrosis, and the most time consuming component was measurement of hemoglobin. Sensitivity and specificity of risk scores for prediction of death were 78.5%. The use of GRACE score in this group of patients gave similar results. These preliminary data require confirmation on larger populations of patients with ACS.

  18. Iniciativas para el control del tabaquismo: la Red Catalana de Hospitales Libres de Humo Initiatives for smoking control: The Catalan Network of Smoke-Free Hospitals

    Directory of Open Access Journals (Sweden)

    Elvira Méndez

    2004-04-01

    Full Text Available La Red Catalana de Hospitales Libres de Humo, promovida por el Instituto Catalán de Oncología (ICO y en funcionamiento desde el año 2000, cuenta en la actualidad (diciembre, 2003 con 45 de los 66 hospitales de utilización pública de Cataluña. El funcionamiento organizativo mediante una red favorece y refuerza el intercambio de experiencias en tiempo real, el apoyo mutuo respecto a instrumentos educativos, de formación y evaluación, y posibilita la realización de una formación continuada común. Iniciativas de este tipo, a partir de un trabajo consensuado y en red, facilitan el avance en el control del consumo de tabaco.The Catalan Network of Smoke-Free Hospitals was created by the Catalan Institute of Oncology in 2000. Currently (December 2003, 45 of the 66 hospitals of the Public Health System in Catalonia are members of this network. Organization through a network promotes and strengthens the exchange of experiences in real time. It provides mutual support in education, training and evaluation and enables common continuing training. Such an initiative, based on consensual work through a network, facilitates progress in tobacco control.

  19. Impact of participation in the California Healthcare-Associated Infection Prevention Initiative on adoption and implementation of evidence-based practices for patient safety and health care-associated infection rates in a cohort of acute care general hospitals.

    Science.gov (United States)

    Halpin, Helen Ann; McMenamin, Sara B; Simon, Lisa Payne; Jacobsen, Diane; Vanneman, Megan; Shortell, Stephen; Milstein, Arnold

    2013-04-01

    In 2008, hospitals were selected to participate in the California Healthcare-Associated Infection Prevention Initiative (CHAIPI). This research evaluates the impact of CHAIPI on hospital adoption and implementation of evidence-based patient safety practices and reduction of health care-associated infection (HAI) rates. Statewide computer-assisted telephone surveys of California's general acute care hospitals were conducted in 2008 and 2010 (response rates, 80% and 76%, respectively). Difference-in-difference analyses were used to compare changes in process and HAI rate outcomes in CHAIPI hospitals (n = 34) and non-CHAIPI hospitals (n = 149) that responded to both waves of the survey. Compared with non-CHAIPI hospitals, CHAIPI hospitals demonstrated greater improvements between 2008 and 2010 in adoption (P = .021) and implementation (P = .012) of written evidence-based practices for overall patient safety and prevention of HAIs and in assessing their compliance (P = .033) with these practices. However, there were no significant differences in the changes in HAI rates between CHAIPI and non-CHAIPI hospitals over this time period. Participation in the CHAIPI collaborative was associated with significant improvements in evidence-based patient safety practices in hospitals. However, determining how evidence-based practices translate into changes in HAI rates may take more time. Our results suggest that all hospitals be offered the opportunity to participate in an active learning collaborative to improve patient safety. Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  20. Breastfeeding practices and policies in WHO European Region Member States.

    Science.gov (United States)

    Bagci Bosi, Ayse Tulay; Eriksen, Kamilla Gehrt; Sobko, Tanja; Wijnhoven, Trudy M A; Breda, João

    2016-03-01

    To provide an update on current practices and policy development status concerning breastfeeding in the WHO European Region. National surveys and studies conducted by national health institutions were prioritized. Sub-national data were included where no national data or studies existed. Information on national breastfeeding policies was collected mainly from the WHO Seventh Meeting of Baby-Friendly Hospital Initiative Coordinators and European Union projects. Owing to the different data sources and methods, any comparisons between countries must be made with caution. WHO European Member States. Data from fifty-three WHO European Member States were investigated; however, a large proportion had not reported any data. Rates of early initiation of breastfeeding, exclusive breastfeeding and continued breastfeeding to 1 year all varied considerably within the WHO European Region. Exclusive breastfeeding rates declined considerably after 4 months, and were low in infants under 6 months and at 6 months of age. The majority of the countries with existing data reported having a national infant and young child feeding policy and the establishment of a national committee on breastfeeding or infant and young child feeding. The majority of the countries with existing data reported having baby-friendly hospitals, although the proportion of baby-friendly hospitals to the total number of national hospitals with maternity units was low in most countries. Breastfeeding practices within the WHO European Region, especially exclusive breastfeeding rates, are far from complying with the WHO recommendations. There are marked differences between countries in breastfeeding practices, infant and young child feeding policy adoption and proportion of baby-friendly hospitals.

  1. Medical Errors Reduction Initiative

    National Research Council Canada - National Science Library

    Mutter, Michael L

    2005-01-01

    The Valley Hospital of Ridgewood, New Jersey, is proposing to extend a limited but highly successful specimen management and medication administration medical errors reduction initiative on a hospital-wide basis...

  2. Using a clinic based creativity initiative to reduce HIV related stigma at the Infectious Diseases Institute, Mulago National Referral Hospital, Uganda.

    Science.gov (United States)

    Neema, S; Atuyambe, L M; Otolok-Tanga, E; Twijukye, C; Kambugu, A; Thayer, L; McAdam, K

    2012-06-01

    Stigma has been associated with chronic health conditions such as HIV/AIDS, leprosy, tuberculosis, Mental illness and Epilepsy. Different forms of stigma have been identified: enacted stigma, perceived stigma, and self stigma. Stigma is increasingly regarded as a key driver of the HIV/AIDS epidemic and has a major impact on public health interventions. The initiative was to provide activities in the clinic while patients waited to be seen by healthcare professionals. It was envisaged this would contribute to reduction of clinic based stigma felt by clients. This was a repeated cross-sectional survey (October-November 2005 and March-April 2007) that was conducted at the Infectious Diseases Institute clinic (IDC) at Mulago, the national referral hospital in Uganda. We utilized quantitative (survey) and qualitative (key informants, focus group discussions) methods to collect the data. Data were collected on stigma before the creativity initiative intervention was implemented, and a second phase survey was conducted to assess effectiveness of the interventions. Clients who attended the IDC before the creativity intervention were about twice as likely to fear catching an infection as those who came after the intervention. The proportion that had fears to be seen by a friend or relative at the clinic decreased. Thus during the implementation of the Creativity intervention, HIV related stigma was reduced in this clinic setting. The creativity intervention helped to build self esteem and improved communication among those attending the clinic; there was observed ambiance at the clinic and clients became empowered, with creative, communication and networking skills. Improved knowledge and communication are key in addressing self stigma among HIV positive individuals.

  3. Association of initial rhythm with neurologically favorable survival in non-shockable out-of-hospital cardiac arrest without a bystander witness or bystander cardiopulmonary resuscitation.

    Science.gov (United States)

    Fukuda, Tatsuma; Ohashi-Fukuda, Naoko; Matsubara, Takehiro; Doi, Kent; Kitsuta, Yoichi; Nakajima, Susumu; Yahagi, Naoki

    2016-05-01

    Out-of-hospital cardiac arrest (OHCA) has a predominantly non-shockable rhythm. Non-shockable rhythm, and the absence of a bystander witness or bystander cardiopulmonary resuscitation (CPR) are associated with poor outcomes. However, the association between the type of non-shockable rhythm and outcomes is not well known. To examine the association between the initial rhythm and neurologically favorable outcomes after non-shockable OHCA without a bystander witness or bystander CPR. In a nationwide, population-based, cohort study, we analyzed 213,984 adult OHCA patients with a non-shockable rhythm who had neither a bystander witness nor bystander CPR. They were identified through the Japanese national OHCA registry data from January 1, 2005 to December 31, 2010. The primary outcome was neurologically favorable survival. Among 213,984 patients, the initial rhythm was Pulseless Electrical Activity (PEA) in 31,179 patients (14.6%) and Asystole in 182,805 patients (85.4%). The neurological outcome was more favorable in PEA than in Asystole (1.4% vs. 0.2%, padvanced airway management, time from call to contact with patient, and calendar year, PEA was associated with an increased neurologically favorable survival rate (odds ratio 7.86; 95% confidence interval 6.81-9.07). In subgroup analysis stratified by age group (18-64, 65-84, or ≥85years), the neurologically favorable survival rate was ≥1% in PEA, even for patients aged ≥85years, but <1% in Asystole among all age groups. PEA and Asystole should not be considered to be identical to non-shockable rhythm, but rather should be clearly distinguished from each other from the perspective of quantitative medical futility. Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  4. Transcatheter closure of patent ductus arteriosus in children weighing 10 kg or less: Initial experience at Sohag University Hospital.

    Science.gov (United States)

    Ali, Safaa; El Sisi, Amel

    2016-04-01

    To assess the challenges, feasibility, and efficacy of device closure of patent ductus arteriosus (PDA) in small children weighing ⩽10 kg for different types of devices used in an initial experience at Sohag University hospital. Between March 2011 and September 2014, 91 patients with PDA underwent transcatheter closure in our institute, among whom 54 weighed ⩽10 kg. All of these patients underwent transcatheter closure of PDA using either a Cook Detachable Coil, PFM Nit-Occlud, or Amplatzer duct occluder. A retrospective review of the treatment results and adverse events was performed. Successful device placement was achieved in 53/54 small children (98.1%). The median minimum PDA diameter was 2.4 mm [interquartile range (IQR, 1.8-3.5 mm), median weight 8 kg (IQR, 7-10 kg), and median age 10 months (IQR, 8-17 months)]. Mild aortic obstruction occurred in one case (1.9%), as the device became displaced towards the aorta after release. The device embolized in one case (1.9%) and no retrieval attempt was made. Five cases (9.3%) had minor vascular complications. With the current availability of devices for PDA closure, transcatheter closure of PDA is considered safe and efficacious in small children weighing ⩽10 kg with good mid-term outcome. The procedure had a low rate of high-severity adverse events even with the initial experience of the catheterization laboratory.

  5. Gastrointestinal tolerance and plasma status of carotenoids, EPA and DHA with a fiber-enriched tube feed in hospitalized patients initiated on tube nutrition: Randomized controlled trial.

    Science.gov (United States)

    Jakobsen, L H; Wirth, R; Smoliner, C; Klebach, M; Hofman, Z; Kondrup, J

    2017-04-01

    During the first days of tube feeding (TF) gastrointestinal (GI) complications are common and administration of sufficient nutrition is a challenge. Not all standard nutritionally complete formulas contain dietary fiber, fish oil or carotenoids, key dietary nutrients for health and wellbeing. The aim of this study was to investigate the effects of a fiber, fish oil and carotenoid enriched TF formula on diarrhea, constipation and nutrient bioavailability. A multi-center randomized, double-blind, controlled, parallel trial compared the effects of a dietary fiber, fish oil and carotenoid-enriched TF formula (test) with an isocaloric non-enriched formula (control) in 51 patients requiring initiation of TF. Incidence of diarrhea and constipation (based on stool frequency and consistency) was recorded daily. Plasma status of EPA, DHA and carotenoids was measured after 7 days. The incidence of diarrhea was lower in patients receiving the test formula compared with the control group (19% vs. 48%, p = 0.034). EPA and DHA status (% of total plasma phospholipids) was higher after 7 days in test compared with control group (EPA: p = 0.002, DHA: p = 0.082). Plasma carotenoid levels were higher after 7 days in the test group compared with control group (lutein: p = 0.024, α-carotene: p = 0.005, lycopene: p = 0.020, β-carotene: p = 0.054). This study suggests that the nutrient-enriched TF formula tested might have a positive effect on GI tolerance with less diarrhea incidence and significantly improved EPA, DHA and carotenoid plasma levels during the initiation of TF in hospitalized patients who are at risk of diarrhea and low nutrient status. This trial was registered at trialregister.nl; registration number 2924. Copyright © 2016. Published by Elsevier Ltd.

  6. Comparison of hospitalizations, emergency department visits, and costs in a historical cohort of Texas Medicaid patients with chronic obstructive pulmonary disease, by initial medication regimen.

    Science.gov (United States)

    Rascati, Karen L; Akazawa, Manabu; Johnsrud, Michael; Stanford, Richard H; Blanchette, Christopher M

    2007-06-01

    Limited information is available on the relative outcomes and treatment costs of various pharmacotherapies for chronic obstructive pulmonary disease (COPD) in a Medicaid population. This study compared the effects of initial medication regimens for COPD on COPD-related and all-cause events (hospitalizations and/or emergency department [ED] visits) and COPD-related and all-cause costs. The study population was a historical cohort of Texas Medicaid beneficiaries aged 40 to 64 years with COPD-related medical costs (International Classification of Diseases, Ninth Revision, Clinical Modification codes 491.xx, 492.xx, 496.xx), 24 months of continuous Medicaid enrollment (12 months before and after the index prescription), and at least 1 prescription claim (index) for a combination product containing fluticasone propionate + salmeterol, an inhaled corticosteroid, salmeterol, or ipratropium between April 1, 2001, and March 31, 2003. The analyses of events employed Cox proportional hazards regression, controlling for baseline factors and preindex events. The analyses of costs used a 2-part model with logistic regression and generalized linear model to adjust for baseline characteristics and preindex utilization and costs. The study population included 6793 patients (1211 combination therapy, 968 inhaled corticosteroid, 401 salmeterol, and 4213 ipratropium). Only combination therapy was associated with a significantly lower risk for any COPD-related event (hazard ratio [HR] = 0.733; 95% CI, 0.650-0.826) and any all-cause event (HR = 0.906; 95% CI, 0.844-0.972) compared with ipratropium. COPD-related prescription costs were higher in all cohorts compared with the ipratropium cohort, but COPD-related medical costs were lower, offsetting the increase in prescription costs. For all-cause costs, prescription costs were higher in the combination-therapy cohort (+$415; P costs in the combination-therapy cohort (-$1735; P costs. In this historical population of Texas Medicaid

  7. The Belgian trial with azithromycin for acute COPD exacerbations requiring hospitalization: an investigator-initiated study protocol for a multicenter, randomized, double-blind, placebo-controlled trial

    Directory of Open Access Journals (Sweden)

    Vermeersch K

    2016-03-01

    Full Text Available Kristina Vermeersch,1 Maria Gabrovska,2 Griet Deslypere,3 Ingel K Demedts,4 Hans Slabbynck,5 Joseph Aumann,3 Vincent Ninane,2 Geert M Verleden,1 Thierry Troosters,1,6 Kris Bogaerts,7,8 Guy G Brusselle,9 Wim Janssens1 On behalf of the BACE Trial Investigators 1KU Leuven, Laboratory of Respiratory Diseases, Department of Clinical and Experimental Medicine, Faculty of Medicine, Leuven, Belgium; 2Department of Pneumology, Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium; 3Department of Pneumology, Jessa Ziekenhuis, Hasselt, Belgium; 4Department of Respiratory Medicine, AZ Delta Roeselare-Menen, Roeselare, Belgium; 5Department of Respiratory Medicine, ZNA Middelheim, Antwerpen, Belgium; 6KU Leuven, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Leuven, Belgium; 7KU Leuven, Department of Public Health and Primary Care, I-BioStat, Leuven, Belgium; 8Hasselt University, Hasselt, Belgium; 9Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium Background: Long-term use of macrolide antibiotics is effective to prevent exacerbations in chronic obstructive pulmonary disease (COPD. As risks and side effects of long-term intervention outweigh the benefits in the general COPD population, the optimal dose, duration of treatment, and target population are yet to be defined. Hospitalization for an acute exacerbation (AE of COPD may offer a targeted risk group and an obvious risk period for studying macrolide interventions.Methods/design: Patients with COPD, hospitalized for an AE, who have a smoking history of ≥10 pack-years and had ≥1 exacerbation in the previous year will be enrolled in a multicenter, randomized, double-blind, placebo-controlled trial (NCT02135354. On top of a standardized treatment of systemic corticosteroids and antibiotics, subjects will be randomized to receive either azithromycin or placebo during 3 months, at an uploading dose of 500 mg once a day for

  8. Fatores associados ao início da amamentação em uma cidade do sul do Brasil Factors associated with the initiation of breastfeeding in a city in the south of Brazil

    Directory of Open Access Journals (Sweden)

    Regina Bosenbecker da Silveira

    2008-03-01

    . Univariate, bivariate and logistic regression analyses were performed. RESULTS: 2,741 mothers were interviewed and 35.5% breastfed in the first hour after delivery. Mothers who began breastfeeding earliest were the younger ones, those who had a lower level of education and lower family income. Mothers whose deliveries were cesarean had a risk two times higher of not breastfeeding in the first hour of the newborn's life. CONCLUSIONS: it is important that delivery be performed in an appropriate manner, since c-sections increase the time of separation between mother and baby. It would be worthwhile encouraging expansion of the "Baby-Friendly Hospital Initiative" in order to promote and protect breastfeeding.

  9. ¿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

    2006-08-01

    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

  10. 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

    2012-01-01

    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...... 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......; 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...

  11. The effectiveness of a nurse-initiated intervention to reduce catheter-associated bloodstream infections in an urban acute hospital: an intervention study with before and after comparison.

    Science.gov (United States)

    Tsuchida, Toshie; Makimoto, Kiyoko; Toki, Masayo; Sakai, Keiko; Onaka, Emiko; Otani, Yoshiko

    2007-11-01

    Catheter care is considered to be important for prevention of catheter-associated bloodstream infections (CABSIs) although epidemiological evidence is sparse. To identify problems associated with catheter care and evaluate the effectiveness of nurse-initiated interventions to reduce CABSIs. An intervention study with before and after comparison. CABSI surveillance was conducted in a 560-bed acute hospital located in a major urban area in Japan. Patients were enrolled in this study from April 2000 to December 2002 based on the following criteria: (1) adult inpatients; and (2) those in whom central venous lines or Swan-Ganz catheters were inserted for 2 days or longer. In the first year, risk factors for CABSI and problems associated with catheter care were identified by inspection of the infection control nurse (ICN) or four trained link nurses, and the laboratory results. In the subsequent 2 years, the following interventions based on the surveillance results were implemented: (1) enhanced skin preparation by scrubbing with regular bathing soap and tap water; (2) a new method for stabilisation of the catheter inserted into the internal jugular vein, where additional dressing was placed over the sterilised dressing; (3) educating the staff on maximal sterile precautions by teaching staff members at their section meetings and displaying posters; (4) use of a check list and observation of catheter insertion by link nurses to monitor compliance; and (5) selection of a disinfectant that requires shorter contact time and has longer residual effect. After these interventions were implemented, the overall bloodstream infection (BSI) rate declined from 4.0/1000 device-days to 1.1/1000 device-days (p<0.005). We identified four problems-those related to skin preparation, dressing, sterile precautions and disinfectant. We implemented a series of interventions to reduce CABSIs; the overall CABSI rate decreased significantly.

  12. Study protocol for the FITR Heart Study: Feasibility, safety, adherence, and efficacy of high intensity interval training in a hospital-initiated rehabilitation program for coronary heart disease.

    Science.gov (United States)

    Taylor, Jenna; Keating, Shelley E; Leveritt, Michael D; Holland, David J; Gomersall, Sjaan R; Coombes, Jeff S

    2017-12-01

    For decades, moderate intensity continuous training (MICT) has been the cornerstone of exercise prescription for cardiac rehabilitation (CR). High intensity interval training (HIIT) is now recognized in CR exercise guidelines as an appropriate and efficient modality for improving cardiorespiratory fitness, a strong predictor of mortality. However, the clinical application of HIIT in a real world CR setting, in terms of feasibility, safety, and long-term adherence, needs further investigation to address ongoing reservations. Furthermore, studies using objective measures of exercise intensity (such as heart rate; HR) have produced variable outcomes. Therefore we propose investigating the use of subjective measures (such as rating of perceived exertion (RPE)) for prescribing exercise intensity. One hundred adults with coronary artery disease (CAD) attending a hospital-initiated CR program will be randomized to 1) HIIT: 4 × 4 min high intensity intervals at 15-18 RPE interspersed with 3-min active recovery periods or 2) MICT: usual care exercise including 40 min continuous exercise at a moderate intensity corresponding to 11-13 RPE. Primary outcome is change in exercise capacity (peak VO 2 ) following 4 weeks of exercise training. Secondary outcome measures are: feasibility, safety, exercise adherence, body composition, vascular function, inflammatory markers, intrahepatic lipid, energy intake, and dietary behavior over 12-months; and visceral adipose tissue (VAT) following 12 weeks of exercise training. This study aims to address the ongoing concerns regarding the practicality and safety of HIIT in CR programs. We anticipate study findings will lead to the development of a standardized protocol to facilitate CR programs to incorporate HIIT as a standard exercise option for appropriate patients.

  13. Rational and design of a stepped-wedge cluster randomized trial evaluating quality improvement initiative for reducing cardiovascular events among patients with acute coronary syndromes in resource-constrained hospitals in China.

    Science.gov (United States)

    Li, Shenshen; Wu, Yangfeng; Du, Xin; Li, Xian; Patel, Anushka; Peterson, Eric D; Turnbull, Fiona; Lo, Serigne; Billot, Laurent; Laba, Tracey; Gao, Runlin

    2015-03-01

    Acute coronary syndromes (ACSs) are a major cause of morbidity and mortality, yet effective ACS treatments are frequently underused in clinical practice. Randomized trials including the CPACS-2 study suggest that quality improvement initiatives can increase the use of effective treatments, but whether such programs can impact hard clinical outcomes has never been demonstrated in a well-powered randomized controlled trial. The CPACS-3 study is a stepped-wedge cluster-randomized trial conducted in 104 remote level 2 hospitals without PCI facilities in China. All hospitalized ACS patients will be recruited consecutively over a 30-month period to an anticipated total study population of more than 25,000 patients. After a 6-month baseline period, hospitals will be randomized to 1 of 4 groups, and a 6-component quality improvement intervention will be implemented sequentially in each group every 6months. These components include the following: establishment of a quality improvement team, implementation of a clinical pathway, training of physicians and nurses, hospital performance audit and feedback, online technical support, and patient education. All patients will be followed up for 6months postdischarge. The primary outcome will be the incidence of in-hospital major adverse cardiovascular events comprising all-cause mortality, myocardial infarction or reinfarction, and nonfatal stroke. The CPACS-3 study will be the first large randomized trial with sufficient power to assess the effects of a multifaceted quality of care improvement initiative on hard clinical outcomes, in patients with ACS. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Profiling the initial 1st Year cohort of patients utilizing a tertiary hospital-based geriatric mental health-care service using the “Service Evaluation Framework”

    Directory of Open Access Journals (Sweden)

    Subhash Das

    2018-01-01

    Full Text Available Background: Increase in life expectancy of Indians will require revamping the health-care infrastructure for the elderly. In India, either there are not too many specialized geriatric mental health services available across the country or those that are available have problems of resources and quality. With this perspective, the Department of Psychiatry, Government Medical College and Hospital, Chandigarh, developed the Geriatric Mental Health Clinic (GMHC for the elderly residing in and around Chandigarh. The aim of the study was to study the initial 1-year cohort and assess their satisfaction levels as well as to see whether their functioning improves with the intervention so provided. Materials and Methods: Using the “service evaluation framework,” the patients and caregivers who attended the GMHC over a period of 1 year were evaluated using tools such as Hindi Mental State Examination (HMSE, Everyday Abilities Scale for India (EASI, Global Assessment of Function (GAF scale, World Health Organization quality of life-BREF (WHO-QoL-BREF-Hindi version, and Patient Satisfaction Scale (PAT-SAT. In addition, sociodemographic and clinical profile data of the service users were compiled. Results: A total of 105 cases formed the cohort under study, wherein 70% had functional psychiatric illness and almost more than half of the cases had comorbid physical illness, hypertension being the most common. GAF score of 45.42 and WHO-QoL-BREF score of 78.7 at the time of follow-up suggested that there was “slight impairment in socio-occupational functioning” and “poor QoL,” respectively. However, GAF and HMSE scores were significantly decreased in those with organicity. Overall service users reported good service-cum-clinician satisfaction scores on PAT-SAT; there was also significant reduction of EASI score from that of baseline, suggesting improvement in functioning. Conclusions: Findings show that the newly started GMHC, even though in its

  15. The ESTHER hospital partnership initiative: a powerful levy for building capacities to combat the HIV pandemic in low-resource countries

    OpenAIRE

    Raguin, Gilles

    2016-01-01

    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 sustainabil...

  16. The System-Wide Effect of Real-Time Audiovisual Feedback and Postevent Debriefing for In-Hospital Cardiac Arrest: The Cardiopulmonary Resuscitation Quality Improvement Initiative.

    Science.gov (United States)

    Couper, Keith; Kimani, Peter K; Abella, Benjamin S; Chilwan, Mehboob; Cooke, Matthew W; Davies, Robin P; Field, Richard A; Gao, Fang; Quinton, Sarah; Stallard, Nigel; Woolley, Sarah; Perkins, Gavin D

    2015-11-01

    To evaluate the effect of implementing real-time audiovisual feedback with and without postevent debriefing on survival and quality of cardiopulmonary resuscitation quality at in-hospital cardiac arrest. A two-phase, multicentre prospective cohort study. Three UK hospitals, all part of one National Health Service Acute Trust. One thousand three hundred and ninety-five adult patients who sustained an in-hospital cardiac arrest at the study hospitals and were treated by hospital emergency teams between November 2009 and May 2013. During phase 1, quality of cardiopulmonary resuscitation and patient outcomes were measured with no intervention implemented. During phase 2, staff at hospital 1 received real-time audiovisual feedback, whereas staff at hospital 2 received real-time audiovisual feedback supplemented by postevent debriefing. No intervention was implemented at hospital 3 during phase 2. The primary outcome was return of spontaneous circulation. Secondary endpoints included other patient-focused outcomes, such as survival to hospital discharge, and process-focused outcomes, such as chest compression depth. Random-effect logistic and linear regression models, adjusted for baseline patient characteristics, were used to analyze the effect of the interventions on study outcomes. In comparison with no intervention, neither real-time audiovisual feedback (adjusted odds ratio, 0.62; 95% CI, 0.31-1.22; p=0.17) nor real-time audiovisual feedback supplemented by postevent debriefing (adjusted odds ratio, 0.65; 95% CI, 0.35-1.21; p=0.17) was associated with a statistically significant improvement in return of spontaneous circulation or any process-focused outcome. Despite this, there was evidence of a system-wide improvement in phase 2, leading to improvements in return of spontaneous circulation (adjusted odds ratio, 1.87; 95% CI, 1.06-3.30; p=0.03) and process-focused outcomes. Implementation of real-time audiovisual feedback with or without postevent debriefing did not

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

    Science.gov (United States)

    Steffen, Th; Hochberger, G; Eisner, L

    2002-04-24

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

  18. Patient characteristics, resource use and outcomes associated with general internal medicine hospital care: the General Medicine Inpatient Initiative (GEMINI) retrospective cohort study.

    Science.gov (United States)

    Verma, Amol A; Guo, Yishan; Kwan, Janice L; Lapointe-Shaw, Lauren; Rawal, Shail; Tang, Terence; Weinerman, Adina; Cram, Peter; Dhalla, Irfan A; Hwang, Stephen W; Laupacis, Andreas; Mamdani, Muhammad M; Shadowitz, Steven; Upshur, Ross; Reid, Robert J; Razak, Fahad

    2017-12-11

    The precise scope of hospital care delivered under general internal medicine services remains poorly quantified. The purpose of this study was to describe the demographic characteristics, medical conditions, health outcomes and resource use of patients admitted to general internal medicine at 7 hospital sites in the Greater Toronto Area. This was a retrospective cohort study involving all patients who were admitted to or discharged from general internal medicine at the study sites between Apr. 1, 2010, and Mar. 31, 2015. Clinical data from hospital electronic information systems were linked to administrative data from each hospital. We examined trends in resource use and patient characteristics over the study period. There were 136 208 admissions to general internal medicine involving 88 121 unique patients over the study period. General internal medicine admissions accounted for 38.8% of all admissions from the emergency department and 23.7% of all hospital bed-days. Over the study period, the number of admissions to general internal medicine increased by 32.4%; there was no meaningful change in the median length of stay or cost per hospital stay. The median patient age was 73 (interquartile range [IQR] 57-84) years, and the median number of coexisting conditions was 6 (IQR 3-9). The median acute length of stay was 4.6 (IQR 2.5-8.6) days, and the median total cost per hospital stay was $5850 (IQR $3915-$10 061). Patients received at least 1 computed tomography scan in 52.2% of admissions. The most common primary discharge diagnoses were pneumonia (5.0% of admissions), heart failure (4.7%), chronic obstructive pulmonary disease (4.1%), urinary tract infection (4.0%) and stroke (3.6%). Patients admitted to general internal medicine services represent a large, heterogeneous, resource-intensive and growing population. Understanding and improving general internal medicine care is essential to promote a high-quality, sustainable health care system. Copyright 2017

  19. District-level hospital trauma care audit filters: Delphi technique for defining context-appropriate indicators for quality improvement initiative evaluation in developing countries.

    Science.gov (United States)

    Stewart, Barclay T; Gyedu, Adam; Quansah, Robert; Addo, Wilfred Larbi; Afoko, Akis; Agbenorku, Pius; Amponsah-Manu, Forster; Ankomah, James; Appiah-Denkyira, Ebenezer; Baffoe, Peter; Debrah, Sam; Donkor, Peter; Dorvlo, Theodor; Japiong, Kennedy; Kushner, Adam L; Morna, Martin; Ofosu, Anthony; Oppong-Nketia, Victor; Tabiri, Stephen; Mock, Charles

    2016-01-01

    Prospective clinical audit of trauma care improves outcomes for the injured in high-income countries (HICs). However, equivalent, context-appropriate audit filters for use in low- and middle-income country (LMIC) district-level hospitals have not been well established. We aimed to develop context-appropriate trauma care audit filters for district-level hospitals in Ghana, was well as other LMICs more broadly. Consensus on trauma care audit filters was built between twenty panellists using a Delphi technique with four anonymous, iterative surveys designed to elicit: (i) trauma care processes to be measured; (ii) important features of audit filters for the district-level hospital setting; and (iii) potentially useful filters. Filters were ranked on a scale from 0 to 10 (10 being very useful). Consensus was measured with average percent majority opinion (APMO) cut-off rate. Target consensus was defined a priori as: a median rank of ≥9 for each filter and an APMO cut-off rate of ≥0.8. Panellists agreed on trauma care processes to target (e.g. triage, phases of trauma assessment, early referral if needed) and specific features of filters for district-level hospital use (e.g. simplicity, unassuming of resource capacity). APMO cut-off rate increased successively: Round 1--0.58; Round 2--0.66; Round 3--0.76; and Round 4--0.82. After Round 4, target consensus on 22 trauma care and referral-specific filters was reached. Example filters include: triage--vital signs are recorded within 15 min of arrival (must include breathing assessment, heart rate, blood pressure, oxygen saturation if available); circulation--a large bore IV was placed within 15 min of patient arrival; referral--if referral is activated, the referring clinician and receiving facility communicate by phone or radio prior to transfer. This study proposes trauma care audit filters appropriate for LMIC district-level hospitals. Given the successes of similar filters in HICs and obstetric care filters in LMICs

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

    Directory of Open Access Journals (Sweden)

    Paul Armah Aryee

    2013-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Paul Armah Aryee

    2013-11-01

    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.

  2. Opioid Patient Controlled Analgesia (PCA) use during the Initial Experience with the IMPROVE PCA Trial: A Phase III Analgesic Trial for Hospitalized Sickle Cell Patients with Painful Episodes

    OpenAIRE

    Dampier, Carlton D.; Smith, Wally R.; Kim, Hae-Young; Wager, Carrie Greene; Bell, Margaret C.; Minniti, Caterina P.; Keefer, Jeffrey; Hsu, Lewis; Krishnamurti, Lakshmanan; Mack, A. Kyle; McClish, Donna; McKinlay, Sonja M.; Miller, Scott T.; Osunkwo, Ifeyinwa; Seaman, Phillip

    2011-01-01

    Opioid analgesics administered by patient-controlled analgesia (PCA) are frequently used for pain relief in children and adults with sickle cell disease (SCD) hospitalized for persistent vaso-occlusive pain, but optimum opioid dosing is not known. To better define PCA dosing recommendations, a multi-center phase III clinical trial was conducted comparing two alternative opioid PCA dosing strategies (HDLI-higher demand dose with low constant infusion or LDHI- lower demand dose and higher const...

  3. Applying the Model of the Interrelationship of Leadership Environments and Outcomes for Nurse Executives: a community hospital's exemplar in developing staff nurse engagement through documentation improvement initiatives.

    Science.gov (United States)

    Adams, Jeffrey M; Denham, Debra; Neumeister, Irene Ramirez

    2010-01-01

    The Model of the Interrelationship of Leadership, Environments & Outcomes for Nurse Executives (MILE ONE) was developed on the basis of existing literature related to identifying strategies for simultaneous improvement of leadership, professional practice/work environments (PPWE), and outcomes. Through existing evidence, the MILE ONE identifies the continuous and dependent interrelationship of 3 distinct concept areas: (1) nurse executives influence PPWE, (2) PPWE influence patient and organizational outcomes, and (3) patient and organizational outcomes influence nurse executives. This article highlights the application of the MILE ONE framework to a community district hospital's clinical documentation performance improvement projects. Results suggest that the MILE ONE is a valid and useful framework yielding both anticipated and unexpected enhancements to leaders, environments, and outcomes.

  4. 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

    2013-12-01

    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

  5. Assessing the initial adaptability and impact of a mobile dictation and reporting system in the radiology department of an academic hospital

    Science.gov (United States)

    Gali, Raja L.; Dave, Jaydev K.

    2017-03-01

    Mobile Radiologist 360, rolled out as part of the voice dictation system upgrade from Nuance Powerscribe 5.0 to PS360 allows an attending radiologist to edit and sign-off a report assigned by a trainee or that has been started by the radiologist on a workstation. The purpose of this study was to evaluate the adoptability and impact of this application. Report turnaround time data was extracted from the RIS (GE-Centricity RIS-IC) for 60 days before- (period-1) and 60 days after- (period-2) the application implementation and then, for 60 days after end of period-2 (period-3). Adoptability of the application was evaluated using two metrics; first, the number of attending radiologists who signed-off reports using the application in periods 2 and 3, and second, the proportion of reports signed-off by the top five users of the mobile application using the application. Impact of the application was evaluated by comparing the time from initial dictation to final sign-off (time_PF) for the top five users of the mobile application to the time_PF by other five radiologists who did not use the application. 41% radiologists used the mobile application at least once during the study period; the proportion of cases signed-off using the mobile application ranged from 1% to 20%. ANOVA revealed no statistically significant effect of the mobile application system on time_PF (p=0.842). In conclusion, there was low initial adoptability and no impact of the mobile dictation and reporting system in reducing the time from initial dictation to final sign-off on a radiology report.

  6. Opioid Patient Controlled Analgesia (PCA) use during the Initial Experience with the IMPROVE PCA Trial: A Phase III Analgesic Trial for Hospitalized Sickle Cell Patients with Painful Episodes

    Science.gov (United States)

    Dampier, Carlton D.; Smith, Wally R.; Kim, Hae-Young; Wager, Carrie Greene; Bell, Margaret C.; Minniti, Caterina P.; Keefer, Jeffrey; Hsu, Lewis; Krishnamurti, Lakshmanan; Mack, A. Kyle; McClish, Donna; McKinlay, Sonja M.; Miller, Scott T.; Osunkwo, Ifeyinwa; Seaman, Phillip; Telen, Marilyn J.; Weiner, Debra L.

    2015-01-01

    Opioid analgesics administered by patient-controlled analgesia (PCA) are frequently used for pain relief in children and adults with sickle cell disease (SCD) hospitalized for persistent vaso-occlusive pain, but optimum opioid dosing is not known. To better define PCA dosing recommendations, a multi-center phase III clinical trial was conducted comparing two alternative opioid PCA dosing strategies (HDLI-higher demand dose with low constant infusion or LDHI- lower demand dose and higher constant infusion) in 38 subjects who completed randomization prior to trial closure. Total opioid utilization (morphine equivalents, mg/kg) in 22 adults was 11.6 ± 2.6 and 4.7 ± 0.9 in the HDLI and in the LDHI arms, respectively, and in 12 children it was 3.7 ± 1.0 and 5.8 ± 2.2, respectively. Opioid-related symptoms were mild and similar in both PCA arms (mean daily opioid symptom intensity score: HDLI 0.9 ± 0.1, LDHI 0.9 ± 0.2). The slow enrollment and early study termination limited conclusions regarding superiority of either treatment regimen. This study adds to our understanding of opioid PCA usage in SCD. Future clinical trial protocol designs for opioid PCA may need to consider potential differences between adults and children in PCA usage. PMID:21953763

  7. Opioid patient controlled analgesia use during the initial experience with the IMPROVE PCA trial: a phase III analgesic trial for hospitalized sickle cell patients with painful episodes.

    Science.gov (United States)

    Dampier, Carlton D; Smith, Wally R; Kim, Hae-Young; Wager, Carrie Greene; Bell, Margaret C; Minniti, Caterina P; Keefer, Jeffrey; Hsu, Lewis; Krishnamurti, Lakshmanan; Mack, A Kyle; McClish, Donna; McKinlay, Sonja M; Miller, Scott T; Osunkwo, Ifeyinwa; Seaman, Phillip; Telen, Marilyn J; Weiner, Debra L

    2011-12-01

    Opioid analgesics administered by patient-controlled analgesia (PCA)are frequently used for pain relief in children and adults with sickle cell disease (SCD) hospitalized for persistent vaso-occlusive pain, but optimum opioid dosing is not known. To better define PCA dosing recommendations,a multi-center phase III clinical trial was conducted comparing two alternative opioid PCA dosing strategies (HDLI—higher demand dose with low constant infusion or LDHI—lower demand dose and higher constant infusion) in 38 subjects who completed randomization prior to trial closure. Total opioid utilization (morphine equivalents,mg/kg) in 22 adults was 11.6 ± 2.6 and 4.7 ± 0.9 in the HDLI andin the LDHI arms, respectively, and in 12 children it was 3.7 ± 1.0 and 5.8 ± 2.2, respectively. Opioid-related symptoms were mild and similar in both PCA arms (mean daily opioid symptom intensity score: HDLI0.9 ± 0.1, LDHI 0.9 ± 0.2). The slow enrollment and early study termination limited conclusions regarding superiority of either treatment regimen. This study adds to our understanding of opioid PCA usage in SCD. Future clinical trial protocol designs for opioid PCA may need to consider potential differences between adults and children in PCA usage.

  8. Serum albumin levels in burn people are associated to the total body surface burned and the length of hospital stay but not to the initiation of the oral/enteral nutrition.

    Science.gov (United States)

    Pérez-Guisado, Joaquín; de Haro-Padilla, Jesús M; Rioja, Luis F; Derosier, Leo C; de la Torre, Jorge I

    2013-01-01

    Serum albumin levels have been used to evaluate the severity of the burns and the nutrition protein status in burn people, specifically in the response of the burn patient to the nutrition. Although it hasn't been proven if all these associations are fully funded. The aim of this retrospective study was to determine the relationship of serum albumin levels at 3-7 days after the burn injury, with the total body surface area burned (TBSA), the length of hospital stay (LHS) and the initiation of the oral/enteral nutrition (IOEN). It was carried out with the health records of patients that accomplished the inclusion criteria and were admitted to the burn units at the University Hospital of Reina Sofia (Córdoba, Spain) and UAB Hospital at Birmingham (Alabama, USA) over a 10 years period, between January 2000 and December 2009. We studied the statistical association of serum albumin levels with the TBSA, LHS and IOEN by ANOVA one way test. The confidence interval chosen for statistical differences was 95%. Duncan's test was used to determine the number of statistically significantly groups. Were expressed as mean±standard deviation. We found serum albumin levels association with TBSA and LHS, with greater to lesser serum albumin levels found associated to lesser to greater TBSA and LHS. We didn't find statistical association with IOEN. We conclude that serum albumin levels aren't a nutritional marker in burn people although they could be used as a simple clinical tool to identify the severity of the burn wounds represented by the total body surface area burned and the lenght of hospital stay.

  9. Nursing Facility Initiative Annual Report

    Data.gov (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...

  10. Hospitals; hospitals13

    Data.gov (United States)

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

  11. Predictors of CD4 count over time among HIV patients initiated ART in Felege Hiwot Referral Hospital, northwest Ethiopia: multilevel analysis.

    Science.gov (United States)

    Gezie, Lemma Derseh

    2016-07-30

    The response of HIV patients to antiretroviral therapy could be measured by its strong predictor, the CD4+ T cell (CD4) count for the initiation of antiretroviral therapy and proper management of disease progress. However, in addition to HIV, there are other factors which can influence the CD4 cell count. Patient's socio-economic, demographic, and behavioral variables, accessibility, duration of treatment etc., can be used to predict CD4 count. A retrospective cohort study was conducted to examine the predictors of CD4 count among ART users enrolled in the first 6 months of 2010 and followed upto mid 2014. The covariance components model was employed to determine the predictors of CD4 count over time. A total of 1196 ART attendants were used to analyze their data descriptively. Eight hundred sixty-one of the attendants had two or more CD4 count measurements and were used in modeling their data using the linear mixed method. Thus, the mean rates of incensement of CD4 counts for patients with ambulatory/bedridden and working baseline functional status were 17.4 and 30.6 cells/mm(3) per year, respectively. After adjusting for other variables, for each additional baseline CD4 count, the gain in CD4 count during treatment was 0.818 cells/mm(3) (p value ART users who reached the normal range of CD4 count was very low. To see their long term treatment outcome, it requires further research with a sufficiently longer follow up data. In line with this, the local CD4 count for HIV negative persons should also be investigated for better comparison and proper disease management.

  12. A systematic review of structured versus non-structured breastfeeding programmes to support the initiation and duration of exclusive breastfeeding in acute and primary healthcare settings.

    Science.gov (United States)

    Beake, Sarah; Pellowe, Carol; Dykes, Fiona; Schmied, Virginia; Bick, Debra

    2011-01-01

    Joanna Briggs Institute. Two independent reviewers conducted critical appraisal and data extraction. Twenty-six articles were included; one randomised controlled trial, two non randomised trials, one cross-sectional study, five systematic reviews, 15 cohort studies and two descriptive studies. Due to the poor quality of evidence presented and clinical and methodological heterogeneity of study designs, including definitions of breastfeeding and duration of follow-up, it was not possible to combine studies or individual outcomes in meta-analyses, therefore findings are presented in a narrative form.In most studies the structured programme of interest reflected some or all of the Baby Friendly Hospital Initiative 'Ten Steps'. Most studies found a statistically significant improvement in initiation of breastfeeding following introduction of a structured breastfeeding programme, although effect sizes varied widely.The impact of introducing a structured programme on the duration of exclusive breastfeeding and duration of any breastfeeding was also evident, although not all studies found statistically significant differences. At hospital discharge or within the first week post-birth, implementation of a structured programme appeared to increase duration of exclusive breastfeeding and the duration of any breastfeeding compared with usual care. After hospital discharge and up to six months post-birth, use of structured programmes also appeared to support continued duration of exclusive and any breastfeeding although differences in outcomes were not reported across all included studies. At six months, three of five studies which included data on longer-term outcomes showed women were statistically significantly more likely to be exclusively breastfeeding. Only one of these studies compared outcomes following implementation of BFHI. Despite the poor overall quality of studies, structured programmes, regardless of content, compared with standard care appear to influence the uptake

  13. Initiation of effective postpartum contraceptive use in public hospitals in Guatemala Inicio de un método anticonceptivo eficaz durante el puerperio en hospitales públicos de Guatemala

    Directory of Open Access Journals (Sweden)

    Edgar Kestler

    2011-02-01

    Full Text Available OBJECTIVE: Low frequency of effective contraceptive use remains a challenging problem. This article examines the frequency of effective postpartum contraception and the methods used before discharge in public hospitals in Guatemala. It also discusses the need to implement best practices in providing family-planning and contraceptive services. METHODS: In March 2006, a surveillance system was implemented to collect data on the initiation of effective contraceptive methods. Postpartum women were monitored in 34 public hospitals. Univariate and bivariate analyses were performed, and a chi-square test for linear trends was used to compare female surgical sterilization rates after vaginal delivery and cesarean section. RESULTS: Between 1 March 2006 and 31 December 2008, of the 218 656 women who had a postpartum event, 31% received an effective contraceptive method before hospital discharge. The frequency of initiation of effective postpartum methods varied across hospitals. Hospital results were consistent with national data on women of reproductive age. Among women who underwent surgical sterilization, differences between those who had delivered vaginally and those who had a cesarean section were statistically significant. CONCLUSIONS: The overall frequency of initiation of effective postpartum contraceptive use is low in public hospitals in Guatemala. It is higher, however, in hospitals at lower health care levels with strong community ties. Routine data collection revealed specific areas for improvement, particularly the need to enhance health providers' knowledge of medical eligibility criteria for effective contraceptive use postpartum. The priority is to promote the provision of highquality family-planning and contraceptive services in Guatemala's public health system.OBJETIVO: La baja frecuencia del uso de métodos anticonceptivos eficaces sigue siendo un arduo problema. En este artículo se analiza la frecuencia con que se adopta un m

  14. Hospital Compare

    Data.gov (United States)

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

  15. HCAHPS - Hospital

    Data.gov (United States)

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

  16. Effect of changing from the National Health and Nutritional Examination Survey III spirometry reference range to that of the Global Lung Initiative 2012 at Gold Coast Hospital and Health Service.

    Science.gov (United States)

    Embling, Laura A K; Zagami, Debbie; Sriram, Krishna Bajee; Gordon, Robert J; Sivakumaran, Pathmanathan

    2016-12-01

    The categorisation of lung disease into obstructive ventilatory defect (OVD) and tendency to a restrictive ventilatory defect (TRVD) patterns using spirometry is used to guide both prognostication and treatment. The effectiveness of categorisation depends upon having reference ranges that accurately represent the population they describe. The Global Lung Initiative 2012 (GLI 2012) has spirometry reference ranges drawn from the largest sample size to date. This study aimed to determine whether using spirometry reference ranges from the new GLI 2012 dataset, compared to the previously used National Health and Nutritional Examination Survey III (NHANES III) dataset, resulted in a change in diagnosis between OVD, TRVD and normal ventilatory pattern (NVP). Spirometry data were collected from 301 patients, aged 18-80 years, undergoing investigation at the Gold Coast Hospital and Health Service (GCHHS) throughout February and March 2014. OVD was defined as a forced expiratory volume in 1 second (FEV 1 ) divided by forced vital capacity (FVC) less than lower limit of normal (LLN). TRVD was defined as FEV 1 /FVC ≥ LLN, FEV 1 reference range resulted in a change in diagnosis of lung disease in 5.9% of the individuals included in this study. This variance in diagnosis when changing reference ranges should be taken into account by clinicians as it may affect patient management.

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

    Directory of Open Access Journals (Sweden)

    2000-04-01

    urgencias (p = 0.65. Conclusiones: no todos los signos definitorios de SRIS se determinan en los pacientes con sospecha de infección. El estado neurológico, determinado por la escala de Glasgow, y la toma de temperatura, a pesar de ser parámetros obligatorios de urgencias, se omiten en una cuarta parte de los pacientes. La solicitud de exámenes de laboratorio y los estudios microbiológicos no concuerdan en todos los casos con el diagnóstico de ingreso y la antibioterapia empírica. 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

  18. The founding of Zemun Hospital

    Directory of Open Access Journals (Sweden)

    Milanović Jasmina

    2014-01-01

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

  19. Hospital staffing and hospital costs.

    Science.gov (United States)

    Andrew, R R

    1976-08-07

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

  20. 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...

  1. Manufacturing Initiative

    Data.gov (United States)

    National Aeronautics and Space Administration — The Advanced Manufacturing Technologies (AMT) Project supports multiple activities within the Administration's National Manufacturing Initiative. A key component of...

  2. Collaborative effects of bystander-initiated cardiopulmonary resuscitation and prehospital advanced cardiac life support by physicians on survival of out-of-hospital cardiac arrest: a nationwide population-based observational study.

    Science.gov (United States)

    Yasunaga, Hideo; Horiguchi, Hiromasa; Tanabe, Seizan; Akahane, Manabu; Ogawa, Toshio; Koike, Soichi; Imamura, Tomoaki

    2010-01-01

    There are inconsistent data about the effectiveness of prehospital physician-staffed advanced cardiac life support (ACLS) on the outcomes of out-of-hospital cardiac arrest (OHCA). Furthermore, the relative importance of bystander-initiated cardiopulmonary resuscitation (BCPR) and ACLS and the effectiveness of their combination have not been clearly demonstrated. Using a prospective, nationwide, population-based registry of all OHCA patients in Japan, we enrolled 95,072 patients whose arrests were witnessed by bystanders and 23,127 patients witnessed by emergency medical service providers between 2005 and 2007. We divided the bystander-witnessed arrest patients into Group A (ACLS by emergency life-saving technicians without BCPR), Group B (ACLS by emergency life-saving technicians with BCPR), Group C (ACLS by physicians without BCPR) and Group D (ACLS by physicians with BCPR). The outcome data included 1-month survival and neurological outcomes determined by the cerebral performance category. Among the 95,072 bystander-witnessed arrest patients, 7,722 (8.1%) were alive at 1 month, including 2,754 (2.9%) with good performance and 3,171 (3.3%) with vegetative status or worse. BCPR occurred in 42% of bystander-witnessed arrests. In comparison with Group A, the rates of good-performance survival were significantly higher in Group B (odds ratio (OR), 2.23; 95% confidence interval, 2.05 to 2.42; P < 0.01) and Group D (OR, 2.80; 95% confidence interval, 2.28 to 3.43; P < 0.01), while no significant difference was seen for Group C (OR, 1.18; 95% confidence interval, 0.86 to 1.61; P = 0.32). The occurrence of vegetative status or worse at 1 month was highest in Group C (OR, 1.92; 95% confidence interval, 1.55 to 2.37; P < 0.01). In this registry-based study, BCPR significantly improved the survival of OHCA with good cerebral outcome. The groups with BCPR and ACLS by physicians had the best outcomes. However, receiving ACLS by physicians without preceding BCPR significantly

  3. Effect of Filmless Imaging on Utilization of Radiologic Services with a Two-stage, Hospital-Wide Implementation of a Picture Archiving and Communication System: Initial Experience of a Fee-for-Service Model

    Directory of Open Access Journals (Sweden)

    Yu-Ting Kuo

    2003-02-01

    Full Text Available A medium-sized general hospital using a fee-for-service model implemented a hospital-wide picture archiving and communication system (PACS in two stages. This study evaluated the reporting time with filmless operation and the effect of filmless imaging on referring physicians' use of the radiologic service before and after completion of the second stage of PACS implementation. The relationship between the total number of hospital patients and the number of radiologic department patients was also evaluated. All sample images were retrieved from the PACS. All corresponding reports except for one for a computerized tomography study were available. The median reporting time for different studies performed during working hours was less than 2 hours. There was a significantly positive and linear relationship (p < 0.01 between the total number of hospital patients and the number of radiologic department patients after hospital-wide implementation of PACS. We conclude that the fee-for-service model had no negative impact on referring physicians' use of radiologic services in a filmless hospital.

  4. Unilateral initiatives

    International Nuclear Information System (INIS)

    Anon.

    1988-01-01

    This paper reports on arms control which is generally thought of in terms of formal negotiations with an opponent, with the resulting agreements embodied in a treaty. This is not surprising, since arms control discussions between opponents are both important and politically visible. There are, however, strong reasons for countries to consider and frequently take unilateral initiatives. To do so is entirely consistent with the established major precepts of arms control which state that arms control is designed to reduce the risk of war, the costs of preparing for war, and the death and destruction if war should come. Unilateral initiatives on what weapons are purchased, which ones are eliminated and how forces are deployed can all relate to these objectives. There are two main categories of motives for unilateral initiatives in arms control. In one category, internal national objectives are the dominant, often sole, driving force; the initiative is undertaken for our own good

  5. Ports Initiative

    Science.gov (United States)

    EPA's Ports Initiative works in collaboration with the port industry, communities, and government to improve environmental performance and increase economic prosperity. This effort helps people near ports breath cleaner air and live better lives.

  6. Fostering the practice of rooming-in in newborn care

    Directory of Open Access Journals (Sweden)

    Saurabh R. Shrivastava

    2013-09-01

    Full Text Available Practice of rooming-in meant that baby and mother stayed together in the same room day and night in the hospital, right from the time of delivery till the time of discharge. Adoption of rooming-in offers multiple benefits to the newborn, mother, and mother-child as a unit. It is a cost-effective approach wherefewer instruments are required and spares additional manpower. Rooming-in endeavors the opportunity to contribute signifi cantly in the child’s growth, development and survival by assisting in timely initiation of breastfeeding. To ensure universal application of rooming-in in hospitals, a comprehensive and technically sound strategy should be formulated and implemented with active participation of healthcare professionals. Measures such as advocating institutional delivery through outreach awareness activities; adoption of baby-friendly hospital initiative; inculcating a sense of ownership among health professionals, can be strategically enforced for better maternal and child health related outcomes.

  7. Hospital Inspections

    Data.gov (United States)

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

  8. Hospital marketing.

    Science.gov (United States)

    Carter, Tony

    2003-01-01

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

  9. Hospital outreach to support faith community nursing.

    Science.gov (United States)

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

    2012-01-01

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

  10. Initial Study

    DEFF Research Database (Denmark)

    Torp, Kristian

    2009-01-01

    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. Academic Hospitality

    Science.gov (United States)

    Phipps, Alison; Barnett, Ronald

    2007-01-01

    Academic hospitality is a feature of academic life. It takes many forms. It takes material form in the hosting of academics giving papers. It takes epistemological form in the welcome of new ideas. It takes linguistic form in the translation of academic work into other languages, and it takes touristic form through the welcome and generosity with…

  12. Boosting antenatal care attendance and number of hospital deliveries among pregnant women in rural communities: a community initiative in Ghana based on mobile phones applications and portable ultrasound scans.

    Science.gov (United States)

    Amoah, Benjamin; Anto, Evelyn A; Osei, Prince K; Pieterson, Kojo; Crimi, Alessandro

    2016-06-14

    The World Health Organization has recommended at least four antenatal care (ANC) visits and skilled attendants at birth. Most pregnant women in rural communities in low-income countries do not achieve the minimum recommended visits and deliver without skilled attendants. With the aim of increasing number of ANC visits, reducing home deliveries, and supplementing care given by ANC clinics, a proposed system based on low-cost mobile phones and portable ultrasound scan machines was piloted. A sample of 323 pregnant women from four rural communities in the Central Region of Ghana were followed within a 11-month project. In each community, at least one health worker was trained and equipped with a mobile phone to promote ANC and hospital deliveries in her own community. If women cannot attend ANC, technicians acquired scans by using portable ultrasound machines in her community directly and sent them almost in real time to be analyzed by a gynecologist in an urban hospital. A preliminary survey to assess ANC status preceding the pilot study was conducted. During this, one hundred women who had had pregnancies within five years prior to the study were interviewed. The preliminary survey showed that women who attended ANC were less likely to have a miscarriage and more likely to have delivery at hospital or clinic than those who did not, and women who attained at least four ANC visits were less likely to practice self-medication. Among the women involved in the project, 40 gave birth during the period of observation. The proposed prenatal care approach showed that 62.5 % of pregnant women who gave birth during the observation period included in the project (n=40) had their labor attended in clinics or hospitals as against 37.5 % among the cases reported in the pre-survey. One case of ectopic and two cases of breech pregnancies were detected during the pilot through the proposed approach, and appropriate medical interventions were sought. Our results show that the proposed

  13. Hospitality and hostility in hospitals

    DEFF Research Database (Denmark)

    Jensen, Tina Blegind; Aanestad, Margunn

    2007-01-01

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

  14. 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)

    MYUNGHAN CHOI

    2010-12-01

    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

  15. Hospital Malnutrition

    OpenAIRE

    Asumadu-Sarkodie, Samuel

    2012-01-01

    Malnutrition seen in hospitals usually occurs as some form of protein-energy malnutrition (PEM). Primary PEM results from an acute or chronic deficiency of both protein and calories. Secondary PEM, or cachexia, results from a disease or medical condition such as cancer or gastrointestinal disease that alters requirements or impairs utilization of nutrients. This record was migrated from the OpenDepot repository service in June, 2017 before shutting down.

  16. Openness initiative

    International Nuclear Information System (INIS)

    Duncan, S.S.

    1995-01-01

    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

  17. Openness initiative

    Energy Technology Data Exchange (ETDEWEB)

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

    1995-12-31

    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.

  18. Initiative hard coal; Initiative Steinkohle

    Energy Technology Data Exchange (ETDEWEB)

    Leonhardt, J.

    2007-08-02

    In order to decrease the import dependence of hard coal in the European Union, the author has submitted suggestions to the director of conventional sources of energy (directorate general for energy and transport) of the European community, which found a positive resonance. These suggestions are summarized in an elaboration 'Initiative Hard Coal'. After clarifying the starting situation and defining the target the presupposition for a better use of hard coal deposits as raw material in the European Union are pointed out. On that basis concrete suggestions for measures are made. Apart from the conditions of the deposits it concerns thereby also new mining techniques and mining-economical developments, connected with tasks for the mining-machine industry. (orig.)

  19. Breastfeeding, baby friendliness and birth in transition in North Western Russia: a study of women's perceptions of the care they receive when giving birth in six maternity homes in the cities of Archangelsk and Murmansk, 1999.

    Science.gov (United States)

    Helsing, E; Chalmers, B E; Dinekina, T J; Kondakova, N I

    2002-01-01

    Women's own views on the quality of the birthing care they received were recorded in a small study in the cities of Archangelsk and Murmansk in February 1999. Six maternity wards took part; one hospital had already been designated as a Baby Friendly Hospital (BFH) according to the strict global criteria of the WHO/UNICEF-recommended Baby Friendly Hospital Initiative (BFHI). Two of the hospitals had made profound changes in feeding routines and were by their own reckoning close to achieving this distinction, and were included in the BFH group. Three maternity wards were far from being in compliance with the BFHI approach and were grouped as the Non-Baby-Friendly Hospitals (NBFH). A total of 180 newly delivered mothers answered a 60-item questionnaire about their birthing and breastfeeding experiences. The questions were chosen from an existing protocol, the WEB (Women's Experiences of Birth) developed by one of the authors (BC). The study was part of an informal evaluation of five years of BFHI activities in the Barents Region, supported by Norway, and also aimed at recording any positive carry-over effect of the BFHI into obstetric routines as a whole. It was found that the project definitely had had an impact; feeding practices at the BFH were markedly closer to the international BFHI recommendations than at the NBFH. BFH mothers, however, reported suffering from breastfeeding problems just as often or more so than NBFH mothers. Possible explanations are discussed; it is concluded that this cross-sectional study may depict a transitory situation in the BFH. At the two hospitals not yet assessed, although staff felt that they had made profound changes, they may not yet have grasped the full extent and stringency of the changes required. The study shows that, despite good will, some practical details had not yet been worked out, resulting in a mixed outcome for the mothers. There was no noticeable carry-over of the attitudes and basic ideas of the project into

  20. Initial hospital management of irradiated and radio-contaminated victims in case of accidental exposure of populations; Prise en charge hospitaliere initiale de victimes irradiees et contaminees dans un contexte d'exposition accidentelle de populations

    Energy Technology Data Exchange (ETDEWEB)

    Foehrenbach; Mantzarides, M.; Bonardel, G.; Gontier, E. [Hopital d' Instruction des Armees du Val-de-Grace, Service de Medecine Nucleaire, 75 - Paris (France); Laroche, P.; Carbonnieres, H. de [Hopital des Armees Percy, Service de Protection Radiologique, 92 - Clamart (France)

    2006-08-15

    The current risk of radiologic exposure of the population occurs in many circumstances. The industrial accident is remarkably illustrated by the Tchernobyl event. Another kind is still virtual but the international situation does not allow to turn this hypothesis down. It is terrorist utilization of radioactive material. In these situations, medical problems are specific and require particular knowledge about the two forms of exposure which are external irradiation and external and internal contamination. Pathophysiological mechanisms of radiation effects concerning biological tissues are similar in these situations but care actions are dedicated. These elements are mandatory for the elaboration of procedures for the reception of irradiated or contaminated victims, being wounded or not, in a first-aid department. These procedures must comprise two aspects: the recognition of the radiologic exposition and the therapeutic actions taking into account the severity of associated injuries. Diagnosis of a radioactive contamination is rather simple by external detection. Conversely, to estimate the reality of an external irradiation is much more difficult but necessary for dosimetric evaluation. This latter is of the highest importance for the prevision of delayed clinical manifestations. At the hospital level, despite the training effort for first aid departments staff, the nuclear medicine physician, specialist for radioactive contamination, can play a specific role for the preparation of the equipment, the procedures and during intervention after a radiologic event has happened. This emphasizes the obligation for him to update his knowledge about this subject. (author)

  1. Breastfeeding Support in Neonatal Intensive Care: A National Survey

    DEFF Research Database (Denmark)

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

    2012-01-01

    Background: The incidence of breastfeeding of preterm infants is affected by the support provided at the hospital and in the neonatal intensive care unit (NICU). However, policies and guidelines promoting breastfeeding vary both nationally and internationally. Objectives: The aim of this survey...... 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...... parents to stay overnight; 2 units had short restrictions on parents' presence. Five NICUs had integrated postpartum care for mothers. Breastfeeding policies, written guidelines, and systematic breastfeeding training for the staff were common in most NICUs. Seventeen NICUs recommended starting breast milk...

  2. Forskelle mellem hospitaler i prognose efter hjertestop uden for hospital

    DEFF Research Database (Denmark)

    Kjaergaard, Jesper; Bro-Jeppesen, John; Rasmussen, Lars Simon

    2009-01-01

    /pVT) as their initial rhythm, and they had more frequently received bystander cardiopulmonary resuscitation. Survival at 4.6 years was 41% in patients admitted to the tertiary hospital and 10% in patients admitted to other hospitals, p

  3. spine injury in mulago hospital

    African Journals Online (AJOL)

    Muiruri

    from arrival in hospital to review by a clinician. Figure i of adequate cervical spine X-rays(22, 25). High pick-up summarizes our findings. rates are only attained with adequate X-rays. Studies done elsewhere have shown that up to 45% of initial. Clinical evaluation: Not all patients were assessed for. X-rays are inadequate.

  4. 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

    2012-11-01

    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

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

    Science.gov (United States)

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

    2017-10-01

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

  6. The German hospital malnutrition study.

    Science.gov (United States)

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

    2006-08-01

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

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

    Science.gov (United States)

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

    2006-01-01

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

  8. Initiation devices, initiation systems including initiation devices and related methods

    Energy Technology Data Exchange (ETDEWEB)

    Daniels, Michael A.; Condit, Reston A.; Rasmussen, Nikki; Wallace, Ronald S.

    2018-04-10

    Initiation devices may include at least one substrate, an initiation element positioned on a first side of the at least one substrate, and a spark gap electrically coupled to the initiation element and positioned on a second side of the at least one substrate. Initiation devices may include a plurality of substrates where at least one substrate of the plurality of substrates is electrically connected to at least one adjacent substrate of the plurality of substrates with at least one via extending through the at least one substrate. Initiation systems may include such initiation devices. Methods of igniting energetic materials include passing a current through a spark gap formed on at least one substrate of the initiation device, passing the current through at least one via formed through the at least one substrate, and passing the current through an explosive bridge wire of the initiation device.

  9. Developing a strategic marketing plan for hospitals.

    Science.gov (United States)

    Dychtwald, K; Zitter, M

    1988-09-01

    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.

  10. Hospital Outpatient PPS Partial Hospitalization Program LDS

    Data.gov (United States)

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

  11. Can hospitals compete on quality? Hospital competition.

    Science.gov (United States)

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

    2015-09-01

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

  12. Initial Egyptian ECMO experience

    Directory of Open Access Journals (Sweden)

    Akram Abdelbary

    2016-04-01

    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.

  13. Future directions.

    Science.gov (United States)

    Lhotska, L; Armstrong, H

    2000-11-01

    Despite progress in promotion and support of breastfeeding over the past decade, the HIV pandemic necessitates new actions based on human rights, such as voluntary and confidential testing and counseling, offering HIV-positive women objective information on the risks and costs of all infant feeding options, and providing appropriate support for their decisions. Implementation of the Baby-Friendly Hospital Initiative and the International Code of Marketing are essential components of a rights-based policy response to HIV and will lessen spillover of replacement feeding among HIV-negative women. Protective effects of nevirapine and exclusive breastfeeding, as well as the listed additional topics, require further research. We have yet to make exclusive breastfeeding easy and common when mothers choose to breastfeed.

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

    Science.gov (United States)

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

    2012-01-01

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

  15. Help prevent hospital errors

    Science.gov (United States)

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

  16. Innovations in health service delivery: the corporatization of public hospitals

    National Research Council Canada - National Science Library

    Harding, April; Preker, Alexander S

    2003-01-01

    ... hospitals play a critical role in ensuring delivery of health services, less is known about how to improve the efficiency and quality of care provided. Much can be learned in this respect from the experiences of hospital reforms initiated during the 1990s. Innovations in Health Service Delivery: The Corporatization of Public Hospitals is an a...

  17. Evaluation methods for hospital facilities

    DEFF Research Database (Denmark)

    Fronczek-Munter, Aneta

    2013-01-01

    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...... presents the different methods for evaluating buildings in use in a new model, the Evaluation Focus Flower, and proposes which evaluation methods are suitable for various aims and building phases, i.e. which is giving best input for the initial briefing process of new hospital facilities with ambition...... 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...

  18. The architecture of enterprise hospital information system.

    Science.gov (United States)

    Lu, Xudong; Duan, Huilong; Li, Haomin; Zhao, Chenhui; An, Jiye

    2005-01-01

    Because of the complexity of the hospital environment, there exist a lot of medical information systems from different vendors with incompatible structures. In order to establish an enterprise hospital information system, the integration among these heterogeneous systems must be considered. Complete integration should cover three aspects: data integration, function integration and workflow integration. However most of the previous design of architecture did not accomplish such a complete integration. This article offers an architecture design of the enterprise hospital information system based on the concept of digital neural network system in hospital. It covers all three aspects of integration, and eventually achieves the target of one virtual data center with Enterprise Viewer for users of different roles. The initial implementation of the architecture in the 5-year Digital Hospital Project in Huzhou Central hospital of Zhejiang Province is also described.

  19. Health initiatives conducted outside hospitals and other medical settings

    DEFF Research Database (Denmark)

    Mik-Meyer, Nanna

    2016-01-01

    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......, believed to lead a lesser work life, family life, love life, etc....

  20. Organization of infection control in European hospitals.

    Science.gov (United States)

    Hansen, S; Zingg, W; Ahmad, R; Kyratsis, Y; Behnke, M; Schwab, F; Pittet, D; Gastmeier, P

    2015-12-01

    The Prevention of Hospital Infections by Intervention and Training (PROHIBIT) survey was initiated to investigate the status of healthcare-associated infection (HCAI) prevention across Europe. This paper presents the methodology of the quantitative PROHIBIT survey and outlines the findings on infection control (IC) structure and organization including management's support at the hospital level. Hospitals in 34 countries were invited to participate between September 2011 and March 2012. Respondents included IC personnel and hospital management. Data from 309 hospitals in 24 countries were analysed. Hospitals had a median (interquartile range) of four IC nurses (2-6) and one IC doctor (0-2) per 1000 beds. Almost all hospitals (96%) had defined IC objectives, which mainly addressed hand hygiene (87%), healthcare-associated infection reduction (84%), and antibiotic stewardship (66%). Senior management provided leadership walk rounds in about half of hospitals, most often in Eastern and Northern Europe, 65% and 64%, respectively. In the majority of hospitals (71%), sanctions were not employed for repeated violations of IC practices. Use of sanctions varied significantly by region (P hospitals should be a public health priority. Copyright © 2015. Published by Elsevier Ltd.

  1. Hospital accreditation: staff experiences and perceptions.

    Science.gov (United States)

    Bogh, Søren Bie; Blom, Ane; Raben, Ditte Caroline; Braithwaite, Jeffrey; Thude, Bettina; Hollnagel, Erik; Plessen, Christian von

    2018-06-11

    Purpose The purpose of this paper is to understand how staff at various levels perceive and understand hospital accreditation generally and in relation to quality improvement (QI) specifically. Design/methodology/approach In a newly accredited Danish hospital, the authors conducted semi-structured interviews to capture broad ranging experiences. Medical doctors, nurses, a quality coordinator and a quality department employee participated. Interviews were audio recorded and subjected to framework analysis. Findings Staff reported that The Danish Healthcare Quality Programme affected management priorities: office time and working on documentation, which reduced time with patients and on improvement activities. Organisational structures were improved during preparation for accreditation. Staff perceived that the hospital was better prepared for new QI initiatives after accreditation; staff found disease specific requirements unnecessary. Other areas benefited from accreditation. Interviewees expected that organisational changes, owing to accreditation, would be sustained and that the QI focus would continue. Practical implications Accreditation is a critical and complete hospital review, including areas that often are neglected. Accreditation dominates hospital agendas during preparation and surveyor visits, potentially reducing patient care and other QI initiatives. Improvements are less likely to occur in areas that other QI initiatives addressed. Yet, accreditation creates organisational foundations for future QI initiatives. Originality/value The authors study contributes new insights into how hospital staff at different organisational levels perceive and understand accreditation.

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

    Science.gov (United States)

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

    2008-04-01

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

  3. Hospital marketing revisited.

    Science.gov (United States)

    Costello, M M

    1987-05-01

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

  4. Hospital Library Administration.

    Science.gov (United States)

    Cramer, Anne

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

  5. ELEMENTAL FORMS OF HOSPITALITY

    OpenAIRE

    Maximiliano Emanuel Korstanje

    2010-01-01

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

  6. Hospitable Classrooms: Biblical Hospitality and Inclusive Education

    Science.gov (United States)

    Anderson, David W.

    2011-01-01

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

  7. Hospitality Healthscapes: The New Standard for Making Hospitals More Hospitable

    Directory of Open Access Journals (Sweden)

    Courtney Suess Raeisinafchi

    2017-06-01

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

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

    Science.gov (United States)

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

    2013-10-01

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

  9. The application of hospitality elements in hospitals.

    Science.gov (United States)

    Wu, Ziqi; Robson, Stephani; Hollis, Brooke

    2013-01-01

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

  10. Using Quality Tools and Methodologies to Improve a Hospital's Quality Position.

    Science.gov (United States)

    Branco, Daniel; Wicks, Angela M; Visich, John K

    2017-01-01

    The authors identify the quality tools and methodologies most frequently used by quality-positioned hospitals versus nonquality hospitals. Northeastern U.S. hospitals in both groups received a brief, 12-question survey. The authors found that 93.75% of the quality hospitals and 81.25% of the nonquality hospitals used some form of process improvement methodologies. However, there were significant differences between the groups regarding the impact of quality improvement initiatives on patients. The findings indicate that in quality hospitals the use of quality improvement initiatives had a significantly greater positive impact on patient satisfaction and patient outcomes when compared to nonquality hospitals.

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

    Directory of Open Access Journals (Sweden)

    Martin Bac

    2015-05-01

    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.

  12. Initialized Fractional Calculus

    Science.gov (United States)

    Lorenzo, Carl F.; Hartley, Tom T.

    2000-01-01

    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.

  13. Community Hospital Telehealth Consortium

    National Research Council Canada - National Science Library

    Williams, Elton

    2004-01-01

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

  14. The interstices of hospitality

    African Journals Online (AJOL)

    jane.b

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

  15. Community Hospital Telehealth Consortium

    National Research Council Canada - National Science Library

    Williams, Elton

    2003-01-01

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

  16. Unplanned Hospital Visits - National

    Data.gov (United States)

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

  17. The Hospitable Meal Model

    DEFF Research Database (Denmark)

    Justesen, Lise; Overgaard, Svend Skafte

    2017-01-01

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

  18. Structural Measures - Hospital

    Data.gov (United States)

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

  19. Hospital Compare - Archived Data

    Data.gov (United States)

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

  20. Research in Hospitality Management

    African Journals Online (AJOL)

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

  1. Community Hospital Telehealth Consortium

    National Research Council Canada - National Science Library

    Williams, Jr, Elton L

    2007-01-01

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

  2. Outcome of surgical implant generation network nail initiative in ...

    African Journals Online (AJOL)

    in Uganda, was propagated in to Kenya mainly in resource poor hospitals, and has changed long bone fractures' management and outcomes. The goal of this study was to describe applicability of the SIGN initiative in fracture care in a Kenyan hospital. AbstrAct. Background: Closed interlocked intra-medullary nailing (IM), ...

  3. Two Belgian University Hospitals

    Directory of Open Access Journals (Sweden)

    M. Huylebrouck

    2012-01-01

    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.

  4. Medicare Hospital Spending Per Patient - Hospital

    Data.gov (United States)

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

  5. Hospitality and prosumption | Ritzer | Research in Hospitality ...

    African Journals Online (AJOL)

    Research in Hospitality Management. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 5, No 1 (2015) >. Log in or Register to get access to full text downloads.

  6. Initial Results of Peripheral-Blood Stem-Cell Mobilization, Collection, Cryopreservation, and Engraftment After Autologous Transplantation Confirm That the Capacity-Building Approach Offers Good Chances of Success in Critical Contexts: A Kurdish-Italian Cooperative Project at the Hiwa Cancer Hospital, Sulaymaniyah

    Directory of Open Access Journals (Sweden)

    Ignazio Majolino

    2017-12-01

    Full Text Available Introduction: At Hiwa Cancer Hospital (Sulaymaniyah, Iraqi Kurdistan after the center was started by a cooperative project in June 2016, autologous transplantation was developed. Patients and Methods: To develop the project, the capacity-building approach was adopted, with on-site training and coaching of personnel, educational meetings, lectures, on-the-job training, and the implementation of quality management planning. Results: Here, we report initial results of peripheral-blood stem-cell mobilization and collection of the first 27 patients (age 12 to 61 years; 19 males and 8 females; multiple myeloma, n = 10; plasma cell leukemia, n = 1; Hodgkin lymphoma, n = 12; non-Hodgkin lymphoma, n = 3; and acute myeloid leukemia, n = 1. Only three (11.5% of 26 patients experienced a failure of mobilization. A median of 6.1 × 106/kg CD34-positive cells per patient were collected (range, 2.4 to 20.8, with two apheretic runs. Twenty-four patients underwent autologous transplantation. All but one transplantation engrafted fully and steadily, with 0.5 and 1.0 × 109/L polymorphonucleates on day 10.5 (range, 8 to 12 and day 11 (range, 9 to 15, respectively, and with 20 and 50 × 109/L platelets on day 13 (range, 10 to 17 and day 17 (range, 2 to 44, respectively. More than 95% of patients are projected to survive 1 year after autograft. Conclusion: These data are the result of an Italian effort to establish in Iraqi Kurdistan a leading center for hemopoietic stem-cell transplantation. The capacity building approach was used, with on-site training and coaching as instruments for the development of provider ability and problem solving. With future limitations for immigration, this method will be helpful, especially in the field of high-technology medicine.

  7. Waste management in small hospitals: trouble for environment.

    Science.gov (United States)

    Pant, Deepak

    2012-07-01

    Small hospitals are the grassroots for the big hospital structures, so proper waste management practices require to be initiated from there. Small hospitals contribute a lot in the health care facilities, but due to their poor waste management practices, they pose serious biomedical waste pollution. A survey was conducted with 13 focus questions collected from the 100 hospital present in Dehradun. Greater value of per day per bed waste was found among the small hospitals (178 g compared with 114 g in big hospitals), indicating unskilled waste management practices. Small hospitals do not follow the proper way for taking care of segregation of waste generated in the hospital, and most biomedical wastes were collected without segregation into infectious and noninfectious categories.

  8. Referring physician satisfaction: toward a better understanding of hospital referrals.

    Science.gov (United States)

    Ponzurick, T G; France, K R; Logar, C M

    1998-01-01

    Customer satisfaction literature has contributed significantly to the development of marketing strategies in the health-care arena. The research has led to the development of hospital-driven relationship marketing programs. This study examines the inclusion of referring physicians as partners in the hospital's relationship marketing program. In exploring this relationship, medical and hospital facility characteristics that referring physicians find important in making patient referrals to specialty care hospitals are identified and analyzed. The results lead to the development of strategic initiatives which hospital marketers should consider when developing relationship marketing programs designed to satisfy their referring physicians.

  9. Service Robots for Hospitals

    DEFF Research Database (Denmark)

    Özkil, Ali Gürcan

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

  10. Hospitality and Institutional Meals

    DEFF Research Database (Denmark)

    Justesen, Lise; Strøjer, Anna-Lise

    2017-01-01

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

  11. Hospital turnaround strategies.

    Science.gov (United States)

    Langabeer, James

    2008-01-01

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

  12. ELEMENTAL FORMS OF HOSPITALITY

    Directory of Open Access Journals (Sweden)

    Maximiliano Emanuel Korstanje

    2010-11-01

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

  13. Dioxin Exposure Initiative

    Science.gov (United States)

    The Dioxin Exposure Initiative (DEI) is no longer active. This page contains a summary of the dioxin exposure initiative with illustrations, contact and background information.Originally supported by scientist Matthew Lorber, who retired in Mar 2017.

  14. Tall Buildings Initiative

    Science.gov (United States)

    Initiative 2017 TBI Guidelines Version 2.03 Now Available Screen Shot 2017-10-10 at 3.05.10 PM PEER has just initiative to develop design criteria that will ensure safe and usable tall buildings following future earthquakes. Download the primary product of this initiative: Guidelines for Performance-Based Seismic Design

  15. Intervening to promote early initiation of breastfeeding in the LDR.

    Science.gov (United States)

    Komara, Carol; Simpson, Diana; Teasdale, Carla; Whalen, Gaye; Bell, Shay; Giovanetto, Laurie

    2007-01-01

    To evaluate the effectiveness of an interventional protocol for the early initiation of breastfeeding that would remove barriers in the labor, delivery, recovery (LDR) unit. Descriptive design using 100 postpartum mothers who were interviewed before discharge at a large university hospital in the south-central United States. Descriptive statistics were used for analysis. The protocol was effective for initiating breastfeeding, and breastfeeding increased from 53% to 66%. When barriers to breastfeeding are reduced in the LDR setting, women will breastfeed. It is possible that reducing hospital barriers to breastfeeding in the LDR can also set the stage for sustained breastfeeding during hospitalization and for less supplementation with formula.

  16. A hospital's teamwork and CQI advance shared vision, interdependence among top managers. Interview by Paula Eubanks.

    Science.gov (United States)

    Biltz, J; Mild, L

    1992-09-20

    As quality improvement programs are initiated in growing numbers of hospitals, senior executives in those hospitals find themselves addressing a range of issues: team building, leadership and interpersonal interaction. CEO Jim Biltz and nurse executive Linda Mild of 760-bed HCA Wesley Medical Center, Wichita, KS, tell Hospitals Staff Editor Paula Eubanks how their participative management style and the hospital's continuous quality improvement (CQI) initiative have fostered new levels of teamwork and shared vision among the institution's top managers.

  17. MANPOWER FOR CALIFORNIA HOSPITALS, 1964-1975.

    Science.gov (United States)

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

    AN EXAMINATION OF THE HOSPITAL AND NURSING AND CONVALESCENT HOME INDUSTRY IN 1964 AND EMPLOYMENT PROJECTIONS ARE PRESENTED AS AN INITIAL CONTRIBUTION TO THE DEVELOPMENT OF AN ONGOING MANPOWER INFORMATION PROGRAM IN THE STATE. DATA WERE COMPILED FROM POPULATION PROJECTIONS BY THE CALIFORNIA DEPARTMENT OF FINANCE, WAGE SURVEY STUDIES BY THE…

  18. [The professional mobility of hospital nurses].

    Science.gov (United States)

    Van Schingen, Édith; Ladegaillerie, Geneviève; Lefebvre, Hélène; Challier, Marie-Pierre; Rothan-Tondeur, Monique

    2015-09-01

    For several decades, hospitals have been faced with the voluntary departures of nurses. In parallel to this external mobility, internal mobility is also on the rise and is not always initiated by the nurse. This new mode of management has repercussions for professionals, patients as well as for the quality of care. Copyright © 2015. Published by Elsevier Masson SAS.

  19. Hospital diversification strategy.

    Science.gov (United States)

    Eastaugh, Steven R

    2014-01-01

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

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

    Science.gov (United States)

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

    2016-11-01

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

  1. Workplace breastfeeding support for hospital employees.

    Science.gov (United States)

    Dodgson, Joan E; Chee, Yuet-Oi; Yap, Tian Sew

    2004-07-01

    Breastfeeding initiation rates have been steadily rising in Hong Kong, but most employed women wean prior to returning to work. While health care providers promote breastfeeding, women receive little support from employers. A few health care facilities offer some workplace breastfeeding support, but little is known about the specific types and amount of support that are offered. This paper reports a study whose aim was to describe workplace supports available to breastfeeding women employed by hospitals that provide maternity services in Hong Kong, and to determine if differences in workplace supports exist based on the hospitals' numbers of employees or funding source. In late 2001, a cross-sectional survey was completed by nurse managers or lactation consultants most knowledgeable about supports to breastfeeding employees in 19 hospitals. The number of workplace breastfeeding supports or Breastfeeding Support Score (M = 7.47; sd = 3.37) varied considerably. Mean Breastfeeding Support Score for government-funded hospitals was significantly higher (t = 2.31; P = 0.03) than for private hospitals. Of the 14 hospitals that had a designated space for using a breast pump, only five (26.3%) had a private room with a door that locked. Only two hospitals (11.1%) allowed employees to take breaks as needed to use a pump; employees in 10 (55.6%) had to use their meal and regular break times. Hospitals having a hospital-wide committee that addressed workplace breastfeeding issues had a more supportive environment for breastfeeding employees. Although all surveyed hospitals returned the questionnaire, the sample size was small. It was difficult to ensure accuracy and to differentiate subtle variations in the services provided using a self-report survey. Facilitating continued breastfeeding after employees' return to work requires that employers understand the needs of breastfeeding employees. Policy at the level of the employer and government is an essential component of

  2. Hospital design for better infection control

    Directory of Open Access Journals (Sweden)

    Lateef Fatimah

    2009-01-01

    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

  3. Predicting hospitalization in children with acute asthma.

    Science.gov (United States)

    Buyuktiryaki, A Betul; Civelek, Ersoy; Can, Demet; Orhan, Fazıl; Aydogan, Metin; Reisli, Ismail; Keskin, Ozlem; Akcay, Ahmet; Yazicioglu, Mehtap; Cokugras, Haluk; Yuksel, Hasan; Zeyrek, Dost; Kocak, A Kadir; Sekerel, Bulent E

    2013-05-01

    Acute asthma is one of the most common medical emergencies in children. Appropriate assessment/treatment and early identification of factors that predict hospitalization are critical for the effective utilization of emergency services. To identify risk factors that predict hospitalization and to compare the concordance of the Modified Pulmonary Index Score (MPIS) with the Global Initiative for Asthma (GINA) guideline criteria in terms of attack severity. The study population was composed of children aged 5-18 years who presented to the Emergency Departments (ED) of the tertiary reference centers of the country within a period of 3 months. Patients were evaluated at the initial presentation and the 1(st) and 4(th) hours. Of the 304 patients (median age: 8.0 years [interquartile range: 6.5-9.7]), 51.3% and 19.4% required oral corticosteroids (OCS) and hospitalization, respectively. Attack severity and MPIS were found as predicting factors for hospitalization, but none of the demographic characteristics collected predicted OCS use or hospitalization. Hospitalization status at the 1(st) hour with moderate/severe attack severity showed a sensitivity of 44.1%, specificity of 82.9%, positive predictive value of 38.2%, and negative predictive value of 86.0%; for MPIS ≥ 5, these values were 42.4%, 85.3%, 41.0%, and 86.0%, respectively. Concordance in prediction of hospitalization between the MPIS and the GINA guideline was found to be moderate at the 1(st) hour (κ = 0.577). Attack severity is a predictive factor for hospitalization in children with acute asthma. Determining attack severity with MPIS and a cut-off value ≥ 5 at the 1(st) hour may help physicians in EDs. Having fewer variables and the ability to calculate a numeric value with MPIS makes it an easy and useful tool in clinical practice. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. Hospital Dermatology, Introduction.

    Science.gov (United States)

    Fox, Lindy P

    2017-03-01

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

  5. Hospital-acquired listeriosis.

    Science.gov (United States)

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

    2002-06-01

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

  6. Hospital Management Software Development

    OpenAIRE

    sobogunGod, olawale

    2012-01-01

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

  7. Assessment of hospital-based adult triage at emergency receiving ...

    African Journals Online (AJOL)

    The study was conducted in 6 of the 7 hospitals in the region. ... gency department, the rest receive emergency patients/perform triage from .... gional Referral Hospital (government facility) with emer- ... sionals who were involved in daily initial management of ..... for receiving emergency cases can be complex especially.

  8. Fraud in Hospitals

    OpenAIRE

    Musau, Steve; Vian, Taryn

    2008-01-01

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

  9. Initial Evaluation of Patients with Presumed Syncope

    Directory of Open Access Journals (Sweden)

    Ilknur Can, MD

    2008-01-01

    Full Text Available Syncope is a common clinical problem, but nevertheless is but one element of the broader issue of ‘transient loss of consciousness’ (TLOC. The first step is to ascertain whether the patient actually suffered a syncopal episode, and thereafter the goal must be to determine the basis of symptoms with sufficient confidence to assess prognosis and initiate an effective treatment strategy. The initial evaluation of these patients, which usually takes place in an emergency department (ED. or acute care facility, is challenging since patients are usually asymptomatic when they come for medical attention, may have little or no recall of the event, and witnesses, if any, often cannot provide reliable information. Given these circumstances, it is understandable that frontline physicians often tend to take a seemingly ‘safe’ approach, and admit both high-risk and intermediate-risk syncope patients to hospital. This strategy has many implications, including life-style and economic concerns for the patient, and health care management issues for physicians, hospital administrators and the overall health care system. The European Society of Cardiology (ESC. guidelines and several clinical studies provide helpful advice regarding “risk stratification” to help guide physicians in selecting patients for either early hospital admission or later oupatient subspeciality evaluation. The utility of syncope management units in the ED, and a guideline-based approach to the syncope patient, has tended to both diminish the number of undiagnosed cases and reduce the hospital admission rate. In this review, we have attempted to both highlight a cost-effective diagnostic pathway beginning with the initial evaluation of the patient with suspected syncope, and to provide criteria which may help frontline physicians better base their decisions regarding need for in-hospital versus outpatient clinic evaluation of syncope patients.

  10. International and national initiatives in biobanking.

    Science.gov (United States)

    Ectors, N

    2011-01-01

    Translational research and biobanking are "in", also in Flanders and in Belgium. In Flanders the Advice report 120 from the Flemish Council for Science and innovation, entitled "Extension of translational research in Flanders" paved the way for the Center for Medical Innovation. The Center for Medical Innovation aims at promoting collaboration between Flemish Universities, university hospitals, pharma and biotech industry and the Flemish Government specifically in the domain of translational research. The Initiative # 27 of the Cancer plan from the Federal Government aims at financing a virtual interuniversity tumor bank in order to promote "cancer" translational research in a collaborative network between academic structures, general hospitals en different industrial partners (pharmacy, biotechnology, diagnostics, ...) active in research in Belgium. However, the scientific interest in the human tissues is not new, at all. This text aims at giving an overview of the development and evolutions of "biobanking" initiatives.

  11. Benefits of task-shifting HIV care to nurses in terms of health-related quality of life in patients initiating antiretroviral therapy in rural district hospitals in Cameroon [Stratall Agence Nationale de Recherche sur le SIDA (ANRS) 12110/Ensemble pour une Solidarité Thérapeutique Hospitalière en Réseau (ESTHER) substudy].

    Science.gov (United States)

    Suzan-Monti, M; Blanche, J; Boyer, S; Kouanfack, C; Delaporte, E; Bonono, R-C; Carrieri, P M; Protopopescu, C; Laurent, C; Spire, B

    2015-05-01

    The World Health Organization (WHO) recommends task-shifting HIV care to nurses in low-resource settings with limited numbers of physicians. However, the effect of such task-shifting on the health-related quality of life (HRQL) of people living with HIV (PLHIV) has seldom been evaluated. We aimed to investigate the effect of task-shifting HIV care to nurses on HRQL outcomes in PLHIV initiating antiretroviral therapy (ART) in rural district hospitals in Cameroon. Outcomes in PLHIV were longitudinally collected in the 2006-2010 Stratall trial. PLHIV were followed up for 24 months by nurses and/or physicians. Six HRQL dimensions were assessed during face-to-face interviews using the WHO Quality of Life (WHOQOL)-HIV BREF scale: physical health; psychological health; independence level; social relationships; environment; and spirituality/religion/personal beliefs. The degree of task-shifting was estimated using a consultant ratio (i.e. the ratio of nurse-led to physician-led visits). The effect of task-shifting and other potential correlates on HRQL dimensions was explored using a Heckman two-stage approach based on linear mixed models to adjust for the potential bias caused by missing data in the outcomes. Of 1424 visits in 440 PLHIV (70.5% female; median age 36 years; median CD4 count 188 cells/μL at enrolment), 423 (29.7%) were task-shifted to nurses. After multiple adjustment, task-shifting was associated with higher HRQL level for four dimensions: physical health [coefficient 0.7; 95% confidence interval (CI) 0.1-1.2; P = 0.01], psychological health (coefficient 0.5; 95% CI 0.0-1.0; P = 0.05), independence level (coefficient 0.6; 95% CI 0.1-1.1; P = 0.01) and environment (coefficient 0.6; 95% CI 0.1-1.0; P = 0.02). Task-shifting HIV care to nurses benefits the HRQL of PLHIV. Together with the previously demonstrated comparable clinical effectiveness of physician-based and nurse-based models of HIV care, our results support the WHO recommendation

  12. NMR imaging of the brain: initial impressions

    International Nuclear Information System (INIS)

    Spencer, D.H.; Bydder, G.M.

    1983-01-01

    An NMR imaging system designed and built by Thorn-EMI Ltd was installed at Hammersmith Hospital in March 1981. In the first year of operation 180 patients and 40 volunteers have had cranial examinations and initial impressions bases on this experience are presented. Patients with a wide variety of neurological diseases have been studied to provide a basis for diagnostic interpretation, to define distinctive features, and to evaluate different types of scanning sequences. NMR imaging appears to be of considerable value in neurological diagnosis and has a number of advantages over CT. The detailed evaluation of NMR imaging will require much more work but the initial results are very promising

  13. Initial performance of the PIGMI prototype

    International Nuclear Information System (INIS)

    Stovall, J.E.

    1979-01-01

    The PIGMI (Pion Generator for Medical Irradiations) program at LASL is an accelerator development program aimed at completing the design of an accelerator suitable for use as a pion generator in a hospital-based radiotherapy program. The major thrust of the program has been the design of a 7 MeV prototype accelerator which emphasizes compactness, economy of construction, and operation and reliability. To achieve these goals the design of the prototype has exploited a number of innovations in proton linac technology. An overview of the program discussing the major innovative features of the prototype is presented. The initial operating experience is discussed and initial performance measurements are presented

  14. Care initiation area yields dramatic results.

    Science.gov (United States)

    2009-03-01

    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.

  15. [Initiating psychiatric care for young, isolated foreigners].

    Science.gov (United States)

    Woestelandt, Laure; Touhami, Fatima; Radjack, Rahmeth; Moro, Marie Rose; Lachal, Jonathan

    The various traumatic events experienced by young isolated foreigners can weaken them psychologically and cause psychiatric decompensation. A qualitative study, carried out by the Maison de Solenn and the Avicenne hospital, aimed to provide better understanding of the conditions for initiating psychiatric care with these adolescents. The different results show that this type of care for these young migrants must be cross-cultural and multi-disciplinary. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  16. Emerging Pathogens Initiative (EPI)

    Data.gov (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...

  17. What accounting leaves out of hospital financial management.

    Science.gov (United States)

    Boles, K E; Glenn, J K

    1986-01-01

    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. Hospitals, The featured data collection is the USGS-LAGIC Coastal Parishes Structures Project. This ongoing project was started in 2009 with the intent to map critical infrastructure in the Coastal Zone. The initial four parishes included Lafourche, Plaquemine, St. , Published in 2011, 1:12000 (1in=1000ft) scale, LSU Louisiana Geographic Information Center (LAGIC).

    Data.gov (United States)

    NSGIC Education | GIS Inventory — Hospitals dataset current as of 2011. The featured data collection is the USGS-LAGIC Coastal Parishes Structures Project. This ongoing project was started in 2009...

  19. Hospitals, The featured data collection is the USGS-LAGIC Coastal Parishes Structures Project. This ongoing project was started in 2009 with the intent to map critical infrastructure in the Coastal Zone. The initial four parishes included Lafourche, Plaquemine, St., Published in 2011, 1:12000 (1in=1000ft) scale, LSU Louisiana Geographic Information Center (LAGIC).

    Data.gov (United States)

    NSGIC Education | GIS Inventory — Hospitals dataset current as of 2011. The featured data collection is the USGS-LAGIC Coastal Parishes Structures Project. This ongoing project was started in 2009...

  20. Going to the Hospital

    Science.gov (United States)

    ... and therapists will show you how to use pieces of equipment, like crutches, if you need them. Some hospitals have child life specialists. Their job is to make sure kids in the hospital understand what's going on around them and help them feel more ...

  1. Hospitality Services Reference Book.

    Science.gov (United States)

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

    This reference book provides information needed by employees in hospitality services occupations. It includes 29 chapters that cover the following topics: the hospitality services industry; professional ethics; organization and management structures; safety practices and emergency procedures; technology; property maintenance and repair; purchasing…

  2. GENERAL PRACTITIONERS AND HOSPITALS

    African Journals Online (AJOL)

    In recent years in South Africa the position of the general practi- tioner in hospitals has ... ments, and it is in these hospitals that difficulties have arisen. On the other hand, ... great extent deprived of contact with his colleagues. He comes to ... eventually lose interest in the results of treatment and advances in medicine. In fact ...

  3. Hospital 360°.

    Science.gov (United States)

    Giraldo Valencia, Juan Carlos; Delgado, Liliana Claudia

    2015-01-01

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

  4. Hospitality services generate revenue.

    Science.gov (United States)

    Bizouati, S

    1993-01-01

    An increasing number of hospitals are undertaking external revenue-generating activities to supplement their shrinking budgets. Written at the request of Leadership, this article outlines an example of a successful catering service -- a money-generating business that more Canadian hospitals could profitably consider.

  5. Virtual Pediatric Hospital

    Science.gov (United States)

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

  6. Hospitality Services. Curriculum Guide.

    Science.gov (United States)

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

    This guide, which was developed as part of Texas' home economics education program, is intended to assist teachers of a hospitality services course focusing on the food and lodging segments of the hospitality and tourism industry. The first 40% of the approximately 600-page guide consists of strategies for teaching each of 29 essential…

  7. Hospitality Occupations. Curriculum Guide.

    Science.gov (United States)

    California State Dept. of Education, Sacramento. Bureau of Homemaking Education.

    This curriculum guide on the hospitality occupations was developed to help secondary and postsecondary home economics teachers prepare individuals for entry-level jobs in the hospitality industry. The content is in seven sections. The first section presents organizational charts of a medium-size hotel, food and beverage division, housekeeping and…

  8. Towards the collaborative hospital

    DEFF Research Database (Denmark)

    Prætorius, Thim; Hasle, Peter; Edwards, Kasper

    2015-01-01

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

  9. On spaces of hospitality

    DEFF Research Database (Denmark)

    Greve, Anni

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

  10. Hjertestop uden for hospital

    DEFF Research Database (Denmark)

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

    1989-01-01

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

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

    Science.gov (United States)

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

    2014-07-01

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

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

    Science.gov (United States)

    Flessa, Steffen

    2005-12-01

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

  13. AC Initiation System.

    Science.gov (United States)

    An ac initiation system is described which uses three ac transmission signals interlocked for safety by frequency, phase, and power discrimination...The ac initiation system is pre-armed by the application of two ac signals have the proper phases, and activates a load when an ac power signal of the proper frequency and power level is applied. (Author)

  14. Sustainable Agricultural Marketing Initiatives

    Directory of Open Access Journals (Sweden)

    Hakan Adanacıoğlu

    2015-07-01

    Full Text Available 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 around the world are carried out through civil organizations. Furthermore; some of these initiatives have also launched by farmers, consumers, food processors and retailers. The long-term strategies to increase these initiatives should be determined due to the fact that examples of successful sustainable agricultural marketing initiatives are inadequate and cannot be spread in Turkey. In this context, first of all, the supports provided by the government to improve agricultural marketing systems, such as EU funds for rural development should be compatible with the goals of sustainable marketing. For this purpose, it should be examined whether all proposed projects related to agricultural marketing meet the social, economic, and environmental principles of sustainable marketing. It is important that supporting organizations, especially civil society organisations, should take an active role for faster dissemination and adoption of sustainable agricultural marketing practices in Turkey. These organizations may provide technical assistance in preparing successful project proposals and training to farm groups. In addition, the other organizations, such as local administrations, producers' associations, cooperatives, can contribute to the success of sustainable agricultural marketing initiatives. The use of direct marketing strategies and vertical integration attempts in sustainable agricultural marketing initiatives that will likely be implemented in Turkey is

  15. Measuring distance through dense weighted networks: The case of hospital-associated pathogens.

    Directory of Open Access Journals (Sweden)

    Tjibbe Donker

    2017-08-01

    Full Text Available Hospital networks, formed by patients visiting multiple hospitals, affect the spread of hospital-associated infections, resulting in differences in risks for hospitals depending on their network position. These networks are increasingly used to inform strategies to prevent and control the spread of hospital-associated pathogens. However, many studies only consider patients that are received directly from the initial hospital, without considering the effect of indirect trajectories through the network. We determine the optimal way to measure the distance between hospitals within the network, by reconstructing the English hospital network based on shared patients in 2014-2015, and simulating the spread of a hospital-associated pathogen between hospitals, taking into consideration that each intermediate hospital conveys a delay in the further spread of the pathogen. While the risk of transferring a hospital-associated pathogen between directly neighbouring hospitals is a direct reflection of the number of shared patients, the distance between two hospitals far-away in the network is determined largely by the number of intermediate hospitals in the network. Because the network is dense, most long distance transmission chains in fact involve only few intermediate steps, spreading along the many weak links. The dense connectivity of hospital networks, together with a strong regional structure, causes hospital-associated pathogens to spread from the initial outbreak in a two-step process: first, the directly surrounding hospitals are affected through the strong connections, second all other hospitals receive introductions through the multitude of weaker links. Although the strong connections matter for local spread, weak links in the network can offer ideal routes for hospital-associated pathogens to travel further faster. This hold important implications for infection prevention and control efforts: if a local outbreak is not controlled in time

  16. "Telemarketing" hospital services: benefits, pitfalls and the planning process.

    Science.gov (United States)

    Hafer, J C

    1984-01-01

    "Telemarketing" is an innovative concept used by many firms to increase the efficiency and effectiveness of product delivery efforts. It can be used by hospitals to benefit both patients and physicians. Further, it can be a tool that, if used properly, can improve the image of the hospital and assist in positioning the organization uniquely among its competitors. This paper discusses the exploratory nature, potential problems, and benefits of telemarketing hospital services and offers pre- and post-implementation considerations. This paper also provides an outline of a sample marketing plan that could serve as an initial model for hospitals that might consider this unique marketing approach.

  17. A Strategic Framework for Improving the Patient Experience in Hospitals.

    Science.gov (United States)

    Birkelien, Natalie L

    Hospitals are taking new approaches to satisfy consumers and deliver on customer expectations by enhancing their patients' comprehensive experience. The HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey and value-based purchasing initiatives have tied reimbursement to patient satisfaction scores, bringing patient perspectives on care to the forefront of hospitals' strategic priorities. This essay reviews the patient experience literature and argues that hospitals should adopt an expanded approach beyond HCAHPS measures to enhance the patient experience. Such an approach allows providers to deliver quality outcomes that satisfy patients' wants and needs.

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

    Data.gov (United States)

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

  19. 1996 environmental initiatives report

    International Nuclear Information System (INIS)

    1996-01-01

    Progress by Consumers Gas in addressing environmental challenges were reviewed. Proposed environmental initiatives for the next fiscal year and beyond were introduced. Proposed initiatives were placed into three priority categories, high, medium or low, which together with the environmental management framework form the the utility's overall environmental agenda. High on the list of environmental priorities for the company are atmospheric air emissions, planning and construction practices, energy conservation and efficiency, environmental compliance, and methane emissions. The present state of the initiatives by the various company divisions and regions, compiled from the respective business plans, were reported. 21 figs

  20. Hospital employee assault rates before and after enactment of the california hospital safety and security act.

    Science.gov (United States)

    Casteel, Carri; Peek-Asa, Corinne; Nocera, Maryalice; Smith, Jamie B; Blando, James; Goldmacher, Suzi; O'Hagan, Emily; Valiante, David; Harrison, Robert

    2009-02-01

    This study examines changes in violent event rates to hospital employees before and after enactment of the California Hospital Safety and Security Act in 1995. We compared pre- and post-initiative employee assault rates in California (n = 116) emergency departments and psychiatric units with those in New Jersey (n = 50), where statewide workplace violence initiatives do not exist. Poisson regression with generalized estimating equations was used to compare assault rates between a 3-year pre-enactment period (1993-1995) and a 6-year post-enactment period (1996-2001) using New Jersey hospitals as a temporal control. Assault rates among emergency department employees decreased 48% in California post-enactment, compared with emergency department employee assault rates in New Jersey (rate ratio [RR] = 0.52, 95% confidence interval [CI]: 0.31, 0.90). Emergency department employee assault rates decreased in smaller facilities (RR = 0.46, 95% CI: 0.21, 0.96) and for-profit-controlled hospitals (RR = 0.39, 95% CI: 0.19, 0.79) post-enactment. Among psychiatric units, for-profit-controlled hospitals (RR = 0.41, 95% CI: 0.19, 0.85) and hospitals located in smaller communities (RR = 0.44, 95% CI: 0.21, 0.92) experienced decreased assault rates post-enactment. Policy may be an effective method to increase safety to health care workers.

  1. Research Programs & Initiatives

    Science.gov (United States)

    CGH develops international initiatives and collaborates with other NCI divisions, NCI-designated Cancer Centers, and other countries to support cancer control planning, encourage capacity building, and support cancer research and research networks.

  2. Nursing Home Quality Initiative

    Data.gov (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...

  3. Surgical Critical Care Initiative

    Data.gov (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....

  4. Global Methane Initiative

    Science.gov (United States)

    The Global Methane Initiative promotes cost-effective, near-term methane recovery through partnerships between developed and developing countries, with participation from the private sector, development banks, and nongovernmental organizations.

  5. RAS Initiative - Community Outreach

    Science.gov (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.

  6. RAS Initiative - Events

    Science.gov (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.

  7. PESP Landscaping Initiative

    Science.gov (United States)

    Landscaping practices can positively or negatively affect local environments and human health. The Landscaping Initiative seeks to enhance benefits of landscaping while reducing need for pesticides, fertilizers, etc., by working with partners.

  8. About the RAS Initiative

    Science.gov (United States)

    The RAS Initiative, a "hub and spoke" model, connects researchers to better understand and target the more than 30% of cancers driven by mutations in RAS genes. Includes oversight and contact information.

  9. The Yekaterinburg headache initiative

    DEFF Research Database (Denmark)

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

    2013-01-01

    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......) for efficient and equitable delivery of headache-related health care; 3) develop a range of educational initiatives aimed at primary-care physicians, non-specialist neurologists, pharmacists and the general public to support the second action. RESULTS AND CONCLUSION: We set these proposals in a context...... 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...

  10. The RAS Initiative

    Science.gov (United States)

    NCI established the RAS Initiative to explore innovative approaches for attacking the proteins encoded by mutant forms of RAS genes and to ultimately create effective, new therapies for RAS-related cancers.

  11. Piezoelectrically Initiated Pyrotechnic Igniter

    Science.gov (United States)

    Quince, Asia; Dutton, Maureen; Hicks, Robert; Burnham, Karen

    2013-01-01

    This innovation consists of a pyrotechnic initiator and piezoelectric initiation system. The device will be capable of being initiated mechanically; resisting initiation by EMF, RF, and EMI (electromagnetic field, radio frequency, and electromagnetic interference, respectively); and initiating in water environments and space environments. Current devices of this nature are initiated by the mechanical action of a firing pin against a primer. Primers historically are prone to failure. These failures are commonly known as misfires or hang-fires. In many cases, the primer shows the dent where the firing pin struck the primer, but the primer failed to fire. In devices such as "T" handles, which are commonly used to initiate the blowout of canopies, loss of function of the device may result in loss of crew. In devices such as flares or smoke generators, failure can result in failure to spot a downed pilot. The piezoelectrically initiated ignition system consists of a pyrotechnic device that plugs into a mechanical system (activator), which on activation, generates a high-voltage spark. The activator, when released, will strike a stack of electrically linked piezo crystals, generating a high-voltage, low-amperage current that is then conducted to the pyro-initiator. Within the initiator, an electrode releases a spark that passes through a pyrotechnic first-fire mixture, causing it to combust. The combustion of the first-fire initiates a primary pyrotechnic or explosive powder. If used in a "T" handle, the primary would ramp the speed of burn up to the speed of sound, generating a shock wave that would cause a high explosive to go "high order." In a flare or smoke generator, the secondary would produce the heat necessary to ignite the pyrotechnic mixture. The piezo activator subsystem is redundant in that a second stack of crystals would be struck at the same time with the same activation force, doubling the probability of a first strike spark generation. If the first

  12. Students in Action Initiative

    OpenAIRE

    Ryan, Theresa; Mottiar, Ziene; Quinn, Bernadette; Gorman, Catherine; Griffin, Kevin; Craggs, Ruth; Quinn, Deirdre

    2015-01-01

    The Students in Action Project in the School of Hospitality Management and Tourism was established in 2012 as a way of engaging students and working with stakeholders in a destination. The overall aim of the project was to immerse students in an active collaborative learning environment within the destination to identify ways in which tourism could be enhanced. In the 2014/2015 academic year the project involved over 300 students from a variety of programmes and modules working with local sta...

  13. 78 FR 8329 - Federal Housing Administration (FHA): Hospital Mortgage Insurance Program-Refinancing Hospital Loans

    Science.gov (United States)

    2013-02-05

    ... available through other sources, and to eliminate from eligibility hospitals with poor financial performance... terminology, based on experience to date, to facilitate understanding how the Section 242 program works. C... divide other. Additionally, revises certain threshold factors that make an initial determination of a...

  14. Supply Chain Initiatives Database

    Energy Technology Data Exchange (ETDEWEB)

    None

    2012-11-01

    The Supply Chain Initiatives Database (SCID) presents innovative approaches to engaging industrial suppliers in efforts to save energy, increase productivity and improve environmental performance. This comprehensive and freely-accessible database was developed by the Institute for Industrial Productivity (IIP). IIP acknowledges Ecofys for their valuable contributions. The database contains case studies searchable according to the types of activities buyers are undertaking to motivate suppliers, target sector, organization leading the initiative, and program or partnership linkages.

  15. Premier Hospital Historical Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — To provide a historical overview of the participating hospitals, before the first project report, Premier Healthcare Informatics has used data already available for...

  16. [Ryazan hospital--80 years].

    Science.gov (United States)

    Klimov, A S; Gromov, M F

    2012-02-01

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

  17. Hospital Compare Data

    Data.gov (United States)

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

  18. Hospital Outpatient PPS

    Data.gov (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...

  19. VT Hospital Site Locations

    Data.gov (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...

  20. Critical Access Hospitals (CAH)

    Science.gov (United States)

    ... for Success Am I Rural? Evidence-based Toolkits Economic Impact Analysis Tool Community Health Gateway Sustainability Planning ... hospitals and improve access to healthcare by keeping essential services in rural communities. To accomplish this goal, ...

  1. Physician-Owned Hospitals

    Data.gov (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...

  2. Hospitals as health educators

    Science.gov (United States)

    ... offer discounts to healthy activities in the area: Biking, hiking, or walking tours Museums Fitness clubs Farms Festivals Your hospital may offer discounts for: Retail stores such as sporting goods, health food, and art stores Acupuncture Skin care Eye ...

  3. Hospital Readmission Reduction

    Data.gov (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...

  4. Hospital Readmissions Reduction Program

    Data.gov (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...

  5. Research in Hospitality Management

    African Journals Online (AJOL)

    Research in Hospitality Management. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 5, No 1 (2015) >. Log in or Register to get access to full text downloads.

  6. Allegheny County Hospitals

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — The data on health care facilities includes the name and location of all the hospitals and primary care facilities in Allegheny County. The current listing of...

  7. Practice Hospital Bed Safety

    Science.gov (United States)

    ... Home For Consumers Consumer Updates Practice Hospital Bed Safety Share Tweet Linkedin Pin it More sharing options ... It depends on the complexity of the bed." Safety Tips CDRH offers the following safety tips for ...

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

    Science.gov (United States)

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

    2017-02-01

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

  9. Ionizing radiation in hospitals

    International Nuclear Information System (INIS)

    Blok, K.; Ginkel, G. van; Leun, K. van der; Muller, H.; Oude Elferink, J.; Vesseur, A.

    1985-10-01

    This booklet dels with the risks of the use of ionizing radiation for people working in a hospital. It is subdivided in three parts. Part 1 treats the properties of ionizing radiation in general. In part 2 the various applications are discussed of ionizing radiation in hospitals. Part 3 indicates how a not completely safe situation may be improved. (H.W.). 14 figs.; 4 tabs

  10. Preventing falls in hospital.

    Science.gov (United States)

    Pearce, Lynne

    2017-02-27

    Essential facts Falls are the most frequent adverse event reported in hospitals, usually affecting older patients. Every year, more than 240,000 falls are reported in acute hospitals and mental health trusts in England and Wales, equivalent to more than 600 a day, according to the Royal College of Physicians (RCP). But research shows that when nurses, doctors and therapists work together, falls can be reduced by 20-30%.

  11. Nutrition support in hospitals

    DEFF Research Database (Denmark)

    Kondrup, Jens

    2005-01-01

    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....

  12. [Hospital organizational structure].

    Science.gov (United States)

    Bittar, O J

    1994-01-01

    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.

  13. 77 FR 3787 - Notice of Submission of Proposed Information Collection to OMB; Office of Hospital Facilities...

    Science.gov (United States)

    2012-01-25

    ... administration and initial/final endorsement of projects undertaken by Office of Hospital Facilities. DATES... Proposed Information Collection to OMB; Office of Hospital Facilities Transactional Forms for FHA Programs... Lists the Following Information Title of Proposal: Office of Hospital Facilities Transactional Forms for...

  14. Corporate social responsibility and hospitals: US theory, Japanese experiences, and lessons for other countries.

    Science.gov (United States)

    Takahashi, Toshiro; Ellen, Moriah; Brown, Adalsteinn

    2013-01-01

    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.

  15. 78 FR 32663 - Medicare Program; Notification of Closure of Teaching Hospitals and Opportunity To Apply for...

    Science.gov (United States)

    2013-05-31

    ...] Medicare Program; Notification of Closure of Teaching Hospitals and Opportunity To Apply for Available... announces the closure of two teaching hospitals and the initiation of an application process where hospitals... modifying language at section 1886(d)(5)(B)(v) of the Act, to instruct the Secretary to establish a process...

  16. Analisa Penerapan Sistem pada Hospitality Industry

    Directory of Open Access Journals (Sweden)

    Steeve Haryanto

    2014-12-01

    Full Text Available Analysis on the application of the system hospitality industry aims to determine whether the system from outside has a considerable influence on the number of luxury hotels in Jakarta as well as the factors that influence in picking the hospitality industry service system. The results of this survey are expected to be a 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 dayrunning at a hotel with no lost posts.

  17. Hospital waste management in nonteaching hospitals of Lucknow City, India

    Directory of Open Access Journals (Sweden)

    Manish Kumar Manar

    2014-01-01

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

  18. Exposure measurement in the neighboring hospital beds during an x-ray procedure in hospitalization unit

    Energy Technology Data Exchange (ETDEWEB)

    Goto, Rafael E.; Capeleti, Felipe F.; Cabete, Henrique V., E-mail: rafael.goto@fcmsantacasasp.edu.br, E-mail: felipe.capeleti@fcmsantacasasp.edu.br, E-mail: henrique@gmpbrasil.com.br [Faculdade de Ciencias Medicas da Santa Casa Sao Paulo, SP (Brazil); GMP Consultoria em Radioprotecao e Fisica Medica e Assessoria LTDA, Sao Paulo, SP (Brazil)

    2017-11-01

    There are lots of discussion about the exposure in hospitalization units in Brazil, especially around labor legislation and economic advantages of unhealthiness. With the attention focused on hospitalized patients, there were measured the exposure in neighboring beds of the patient submitted to an X-ray procedure with a mobile X-ray system that could be used to illustrate the discussion with consistent values. The most common X-ray procedure made in hospitalization units are chests images with techniques between 70 to 120 kV and 5 to 20 mAs. The measurement was made during routine exposure and simulations using a scattering phantom with Radcal AccuPro electrometer and 1800cc ionization chamber in a private hospital and a philanthropic hospital, both in Sao Paulo, Brazil. The ionization chambers are placed at 2 meters distance of the patient exposed of both sides during the routine procedure. During the simulation, a nylon phantom of 20 centimeters thick and 30 x 30 cm² size was placed on the bed, a typical exposure technique was used and the exposure was measured surrounding the phantom at 0.6, 1.0 and 2.0 meters distance for scattered radiation characterization. Initial results showed that the neighboring exposure at about 2 meters distance from the exposed patient bed have low values, even when exposure is integrated during the length of hospital stay. Therefore, the exposure in hospitalization units are very low compared to the exams doses. (author). (author)

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

    Science.gov (United States)

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

    2016-09-22

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

  20. Geriatrics and the triple aim: defining preventable hospitalizations in the long-term care population.

    Science.gov (United States)

    Ouslander, Joseph G; Maslow, Katie

    2012-12-01

    Reducing preventable hospitalizations is fundamental to the "triple aim" of improving care, improving health, and reducing costs. New federal government initiatives that create strong pressure to reduce such hospitalizations are being or will soon be implemented. These initiatives use quality measures to define which hospitalizations are preventable. Reducing hospitalizations could greatly benefit frail and chronically ill adults and older people who receive long-term care (LTC) because they often experience negative effects of hospitalization, including hospital-acquired conditions, morbidity, and loss of functional abilities. Conversely, reducing hospitalizations could mean that some people will not receive hospital care they need, especially if the selected measures do not adequately define hospitalizations that can be prevented without jeopardizing the person's health and safety. An extensive literature search identified 250 measures of preventable hospitalizations, but the measures have not been validated in the LTC population and generally do not account for comorbidity or the capacity of various LTC settings to provide the required care without hospitalization. Additional efforts are needed to develop measures that accurately differentiate preventable from necessary hospitalizations for the LTC population, are transparent and fair to providers, and minimize the potential for gaming and unintended consequences. As the new initiatives take effect, it is critical to monitor their effect and to develop and disseminate training and resources to support the many community- and institution-based healthcare professionals and emergency department staff involved in decisions about hospitalization for this population. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

  1. International EUREKA: Initialization Segment

    International Nuclear Information System (INIS)

    1982-02-01

    The Initialization Segment creates the starting description of the uranium market. The starting description includes the international boundaries of trade, the geologic provinces, resources, reserves, production, uranium demand forecasts, and existing market transactions. The Initialization Segment is designed to accept information of various degrees of detail, depending on what is known about each region. It must transform this information into a specific data structure required by the Market Segment of the model, filling in gaps in the information through a predetermined sequence of defaults and built in assumptions. A principal function of the Initialization Segment is to create diagnostic messages indicating any inconsistencies in data and explaining which assumptions were used to organize the data base. This permits the user to manipulate the data base until such time the user is satisfied that all the assumptions used are reasonable and that any inconsistencies are resolved in a satisfactory manner

  2. Initiating events frequency determination

    International Nuclear Information System (INIS)

    Simic, Z.; Mikulicic, V.; Vukovic, I.

    2004-01-01

    The paper describes work performed for the Nuclear Power Station (NPS). Work is related to the periodic initiating events frequency update for the Probabilistic Safety Assessment (PSA). Data for all relevant NPS initiating events (IE) were reviewed. The main focus was on events occurring during most recent operating history (i.e., last four years). The final IE frequencies were estimated by incorporating both NPS experience and nuclear industry experience. Each event was categorized according to NPS individual plant examination (IPE) initiating events grouping approach. For the majority of the IE groups, few, or no events have occurred at the NPS. For those IE groups with few or no NPS events, the final estimate was made by means of a Bayesian update with general nuclear industry values. Exceptions are rare loss-of-coolant-accidents (LOCA) events, where evaluation of engineering aspects is used in order to determine frequency.(author)

  3. Hospitals look to hospitality service firms to meet TQM goals.

    Science.gov (United States)

    Hard, R

    1992-05-20

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

  4. RCRA facility stabilization initiative

    International Nuclear Information System (INIS)

    1995-02-01

    The RCRA Facility Stabilization Initiative was developed as a means of implementing the Corrective Action Program's management goals recommended by the RIS for stabilizing actual or imminent releases from solid waste management units that threaten human health and the environment. The overall goal of stabilization is to, as situations warrant, control or abate threats to human health and/or the environment from releases at RCRA facilities, and/or to prevent or minimize the further spread of contamination while long-term remedies are pursued. The Stabilization initiative is a management philosophy and should not be confused with stabilization technologies

  5. The association of hospital governance with innovation in Taiwan.

    Science.gov (United States)

    Yang, Chen-Wei; Yan, Yu-Hua; Fang, Shih-Chieh; Inamdar, Syeda Noorein; Lin, Hsien-Cheng

    2018-01-01

    Hospitals in Taiwan are facing major changes and innovation is increasingly becoming a critical factor for remaining competitive. One determinant that can have a significant impact on innovation is hospital governance. However, there is limited prior research on the relationship between hospital governance and innovation. The purpose of this study is to propose a conceptual framework to hypothesize the relationship between governance mechanisms and innovation and to empirically test the hypotheses in hospital organizations. We examine the relationship between governance mechanisms and innovation using data on 102 hospitals in Taiwan from the Taiwan Joint Commission on Hospital Accreditation and Quality Improvement. We model governance mechanisms using board structure, information transparency and strategic decision-making processes. For our modeling and data analysis we use measurement and structural models. We find that in hospital governance, information transparency and strategic decision making did impact innovation. However, governance structure did not. To facilitate innovation, hospital boards can increase information transparency and improve the decision-making process when considering strategic investments in innovative initiatives. To remain competitive, hospital boards need to develop and monitor indices that measure hospital innovation to ensure ongoing progress. Copyright © 2017 John Wiley & Sons, Ltd.

  6. Trick questions: cosmopolitan hospitality

    Directory of Open Access Journals (Sweden)

    Eleanor Byrne

    2013-08-01

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

  7. [Communication among hospital leaders].

    Science.gov (United States)

    Haberey-Knuessi, Véronique; Heeb, Jean-Luc; De Morgan, Paula Emilie

    2013-12-01

    New management styles imposed on hospital institutions in recent years, have fundamentally changed the organization of the latter. Many texts discuss the consequences, specifically on the field of communication. The aim of this study was to understand the real impact of new management methods on communication by managers in hospital, but also on care teams in termes of satisfaction and/or stress. This two-year study was conducted among 900 executives in hospitals in Western Switzerland using a mixed methodology. A first phase of questionnaires highlighted the problematic areas, while a second phase in the form of organized group interviews in each hospital, had the objective of achieving a better understanding of the relationship between management and communication. The latter proved to be particularly significant in terms of results, and this is the one we focused on in this article.These results indeed show that a crucial role is given to communication by carers, and, at the same time a lessening of the time devoted to relationships, both among peers and with patients. Frustration then arises, which is not without consequences both for the management of patients and the institutions themselves. It is by means of these results that awareness is raised of the omnipresence of communication at all levels and the major advantages that positive dynamic supports. And, on the contrary, of the serious problems which may arise from management practice that do not give due importance to the dimension of communication, present in all sectors of the hospital.

  8. Quantitative tools for addressing hospital readmissions

    Directory of Open Access Journals (Sweden)

    Lagoe Ronald J

    2012-11-01

    Full Text Available Abstract Background Increased interest in health care cost containment is focusing attention on reduction of hospital readmissions. Major payors have already developed financial penalties for providers that generate excess readmissions. This subject has benefitted from the development of resources such as the Potentially Preventable Readmissions software. This process has encouraged hospitals to renew efforts to improve these outcomes. The aim of this study was to describe quantitative tools such as definitions, risk estimation, and tracking of patients for reducing hospital readmissions. Findings This study employed the Potentially Preventable Readmissions software to develop quantitative tools for addressing hospital readmissions. These tools included two definitions of readmissions that support identification and management of patients. They also included analytical approaches for estimation of the risk of readmission for individual patients by age, discharge status of the initial admission, and severity of illness. They also included patient specific spreadsheets for tracking of target populations and for evaluation of the impact of interventions. Conclusions The study demonstrated that quantitative tools including the development of definitions of readmissions, estimation of the risk of readmission, and patient specific spreadsheets could contribute to the improvement of patient outcomes in hospitals.

  9. The SEED Initiative

    Science.gov (United States)

    Teich, Carolyn R.

    2011-01-01

    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 (www.theseedcenter.org) in October 2010. The project advances sustainability and clean energy workforce development practices at community colleges by…

  10. Major New Initiatives

    Indian Academy of Sciences (India)

    First page Back Continue Last page Overview Graphics. Major New Initiatives. Multi-party multi-rate video conferencing OOPS. Live Lecture OOPS. Rural ATM Machine Vortex. Finger print detection HP-IITM. Medical Diagnostic kit NeuroSynaptic. LCD projection system TeNeT. Web Terminal MeTeL Midas. Entertainment ...

  11. Mixed-Initiative Clustering

    Science.gov (United States)

    Huang, Yifen

    2010-01-01

    Mixed-initiative clustering is a task where a user and a machine work collaboratively to analyze a large set of documents. We hypothesize that a user and a machine can both learn better clustering models through enriched communication and interactive learning from each other. The first contribution or this thesis is providing a framework of…

  12. Monolithic exploding foil initiator

    Science.gov (United States)

    Welle, Eric J; Vianco, Paul T; Headley, Paul S; Jarrell, Jason A; Garrity, J. Emmett; Shelton, Keegan P; Marley, Stephen K

    2012-10-23

    A monolithic exploding foil initiator (EFI) or slapper detonator and the method for making the monolithic EFI wherein the exploding bridge and the dielectric from which the flyer will be generated are integrated directly onto the header. In some embodiments, the barrel is directly integrated directly onto the header.

  13. Costing the Australian National Hand Hygiene Initiative.

    Science.gov (United States)

    Page, K; Barnett, A G; Campbell, M; Brain, D; Martin, E; Fulop, N; Graves, N

    2014-11-01

    The Australian National Hand Hygiene Initiative (NHHI) is a major patient safety programme co-ordinated by Hand Hygiene Australia (HHA) and funded by the Australian Commission for Safety and Quality in Health Care. The annual costs of running this programme need to be understood to know the cost-effectiveness of a decision to sustain it as part of health services. To estimate the annual health services cost of running the NHHI; the set-up costs are excluded. A health services perspective was adopted for the costing and collected data from the 50 largest public hospitals in Australia that implemented the initiative, covering all states and territories. The costs of HHA, the costs to the state-level infection-prevention groups, the costs incurred by each acute hospital, and the costs for additional alcohol-based hand rub are all included. The programme cost AU$5.56 million each year (US$5.76, £3.63 million). Most of the cost is incurred at the hospital level (65%) and arose from the extra time taken for auditing hand hygiene compliance and doing education and training. On average, each infection control practitioner spent 5h per week on the NHHI, and the running cost per annum to their hospital was approximately AU$120,000 in 2012 (US$124,000, £78,000). Good estimates of the total costs of this programme are fundamental to understanding the cost-effectiveness of implementing the NHHI. This paper reports transparent costing methods, and the results include their uncertainty. Copyright © 2014 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  14. Next generation initiation techniques

    Science.gov (United States)

    Warner, Tom; Derber, John; Zupanski, Milija; Cohn, Steve; Verlinde, Hans

    1993-01-01

    Four-dimensional data assimilation strategies can generally be classified as either current or next generation, depending upon whether they are used operationally or not. Current-generation data-assimilation techniques are those that are presently used routinely in operational-forecasting or research applications. They can be classified into the following categories: intermittent assimilation, Newtonian relaxation, and physical initialization. It should be noted that these techniques are the subject of continued research, and their improvement will parallel the development of next generation techniques described by the other speakers. Next generation assimilation techniques are those that are under development but are not yet used operationally. Most of these procedures are derived from control theory or variational methods and primarily represent continuous assimilation approaches, in which the data and model dynamics are 'fitted' to each other in an optimal way. Another 'next generation' category is the initialization of convective-scale models. Intermittent assimilation systems use an objective analysis to combine all observations within a time window that is centered on the analysis time. Continuous first-generation assimilation systems are usually based on the Newtonian-relaxation or 'nudging' techniques. Physical initialization procedures generally involve the use of standard or nonstandard data to force some physical process in the model during an assimilation period. Under the topic of next-generation assimilation techniques, variational approaches are currently being actively developed. Variational approaches seek to minimize a cost or penalty function which measures a model's fit to observations, background fields and other imposed constraints. Alternatively, the Kalman filter technique, which is also under investigation as a data assimilation procedure for numerical weather prediction, can yield acceptable initial conditions for mesoscale models. The

  15. Rural hospital wages

    Science.gov (United States)

    Hendricks, Ann M.

    1989-01-01

    Average fiscal year 1982 wages from 2,302 rural American hospitals were used to test for a gradient descending from hospitals in counties adjacent to metropolitan areas to those not adjacent. Considerable variation in the ratios of adjacent to nonadjacent averages existed. No statistically significant difference was found, however. Of greater importance in explaining relative wages within States were occupational mix, mix of part-time and full-time workers, case mix, presence of medical residencies, and location in a high-rent county within the State. Medicare already adjusts payments for only two of these variables. PMID:10313454

  16. Hospital mergers: a panacea?

    Science.gov (United States)

    Weil, Thomas

    2010-10-01

    Hospital mergers in Europe and North America have been launched to scale down expenditure, enhance the delivery of health care and elevate quality. However, the outcome of mergers suggest that they neither generated cost savings nor improved the quality of care. Almost all consolidations fall short, since those in leadership positions lack the necessary understanding and appreciation of the differences in culture, values and goals of the existing facilities. In spite of these shortcomings, hospital mergers will continue to be pursued in order to improve market share, eliminate excess capacity, gain access to capital and enhance the personal egos of the organizations' leaders.

  17. Costs of hospital malnutrition.

    Science.gov (United States)

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

    2017-10-01

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

  18. 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...... a correlation matrix. The correlation factor defines the framework for conceptual design, whereby the design considers functionalities and their requirements and preferences. It facilitates implementation of evidence-based design as it is prepared for ongoing update and it is based on actual data. Hence......, this contribution is a model for hospital design, where design derives as a response to the defined variables, requirements and preferences....

  19. Hospitality, Tourism, and Politics

    Directory of Open Access Journals (Sweden)

    Stephen W. Litvin

    2012-09-01

    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.

  20. Characteristics of Hospitals Associated with Complete and Partial Implementation of Electronic Health Records.

    Science.gov (United States)

    Bhounsule, Prajakta; Peterson, Andrew M

    2016-01-01

    (1) To determine the proportion of hospitals with and without implementation of electronic health records (EHRs). (2) To examine characteristics of hospitals that report implementation of EHRs partially or completely versus those that report no implementation. (3) To identify hospital characteristics associated with nonimplementation to help devise future policy initiatives. This was a retrospective cross-sectional study using the 2012 American Hospital Association Annual Survey Database. The outcome variable was the implementation of EHRs completely or partially. Independent variables were hospital characteristics, such as staffing, organization structure, accreditations, ownership, and services and facilities provided at the hospitals. Descriptive frequencies were determined, and multinomial logistic regression was used to determine variables independently associated with complete or partial implementation of EHRs. In this study, 12.6 percent of hospitals reported no implementation of EHRs, while 43.9 percent of hospitals implemented EHRs partially and 43.5 percent implemented EHRs completely. Overall characteristics of hospitals with complete and partial implementation were similar. The multinomial regression model revealed a positive association between the number of licensed beds and complete implementation of EHRs. A positive association was found between children's general medical, surgical, and heart hospitals and complete implementation of EHRs. Conversely, psychiatric and rehabilitation hospitals, limited service hospitals, hospitals participating in a network, service hospitals, government nonfederal hospitals, and nongovernment not-for-profit hospitals showed less likelihood of complete implementation of EHRs. Study findings suggest a disparity of EHR implementation between larger, for-profit hospitals and smaller, not-for-profit hospitals. Low rates of implementation were observed with psychiatric and rehabilitation hospitals. EHR policy initiatives

  1. Funding Initiatives | Women in Science | Initiatives | Indian Academy ...

    Indian Academy of Sciences (India)

    Home; Initiatives; Women in Science; Funding Initiatives ... The Fellowship Scheme for Women Scientists for societal programmes is initiative of the ... at a young age of 52, after a valiant battle with cancer, today on 29th March 2016 in Delhi.

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

    Directory of Open Access Journals (Sweden)

    Glenn A. Melnick PhD

    2016-06-01

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

  3. Sustaining Participatory Design Initiatives

    DEFF Research Database (Denmark)

    Iversen, Ole Sejer; Dindler, Christian

    2014-01-01

    While many participatory design (PD) projects succeed in establishing new organisational initiatives or creating technology that is attuned to the people affected, the issue of how such results are sustained after the project ends remains an important challenge. We explore the challenge...... these various forms of sustainability may be pursued in PD practice and how they can become a resource in reflecting on PD activities. Finally, we discuss implications for PD practice, suggesting that a nuanced conception of sustainability and how it may relate to PD practice are useful resources for designers...... of sustaining PD initiatives beyond the individual project and discuss implications for PD practice. First, based on current PD literature, we distinguish between four ideal typical forms of sustainability: maintaining, scaling, replicating and evolving. Second, we demonstrate from a case study how...

  4. Initial management of breastfeeding.

    Science.gov (United States)

    Sinusas, K; Gagliardi, A

    2001-09-15

    Breast milk is widely accepted as the ideal source of nutrition for infants. In order to ensure success in breastfeeding, it is important that it be initiated as early as possible during the neonatal period. This is facilitated by skin-to-skin contact between the mother and infant immediately following birth. When possible, the infant should be allowed to root and latch on spontaneously within the first hour of life. Many common nursery routines such as weighing the infant, administration of vitamin K and application of ocular antibiotics can be safely delayed until after the initial breastfeeding. Postpartum care practices that improve breastfeeding rates include rooming-in, anticipatory guidance about breastfeeding problems and the avoidance of formula supplementation and pacifiers.

  5. Self-initiated expatriates

    DEFF Research Database (Denmark)

    Selmer, Jan; Lauring, Jakob

    2014-01-01

    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...

  6. INITIAL TRAINING OF RESEARCHERS

    Directory of Open Access Journals (Sweden)

    Karina Alejandra Cruz-Pallares

    2015-07-01

    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.

  7. Hacking the hospital environment

    DEFF Research Database (Denmark)

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

    2017-01-01

    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...

  8. Vocabulary of hospitality

    NARCIS (Netherlands)

    Bedir, M.

    2014-01-01

    Attitudes about refugees begin with the words we ascribe them. In Turkey – which has historically absorbed newcomers from a variety of outside conflicts – the term ‘guest’ is commonly used. Taking this as a starting point, Merve Bedir questions the laws of hospitality in Turkey, and the inherent

  9. Innovations in Hospitality Industry

    Science.gov (United States)

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

    2016-01-01

    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…

  10. Nigerian Hospital Practice

    African Journals Online (AJOL)

    Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives. Journal Homepage Image. The aim of the Nigerian Hospital Practice Journal is to aid in enhancing the advancement of medicine globally by acting as a medium for disseminating information on current clinical and drug practices in ...

  11. American Hospital Association

    Science.gov (United States)

    ... Central Office-Coding Resources AHA Team Training Health Career Center Health Forum Connect More Regulatory Relief The regulatory burden faced by hospitals is substantial and unsustainable. Read the report . More AHA Opioid Toolkit Stem the Tide: Addressing the Opioid Epidemic More ...

  12. Responsible Hospitality. Prevention Updates

    Science.gov (United States)

    Colthurst, Tom

    2004-01-01

    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…

  13. Nigerian Hospital Practice: Submissions

    African Journals Online (AJOL)

    It also publishes miscellaneous articles – hospital administration, business practice, accounting, Law for health practitioners and letters about published papers. All manuscript will be subject to blinded peer-review and the decision of the editor would be final. Articles submitted for consideration by the author should not have ...

  14. Hospitals as food arenas

    DEFF Research Database (Denmark)

    Poulsen, Signe; Jørgensen, Michael Søgaard

    2010-01-01

    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...

  15. Tygerberg Hospital, 1980

    African Journals Online (AJOL)

    haematocrit, cord bilirubin, number of liveborn babies, birth weight, neonatal death, hyaline membrane disease .... report the outcome of babies of mothers with severe. Rh disease treated at Tygerberg Hospital since 1980 by ..... Walker W. Haemolytic disease of the newborn. In: Gairdner D, Hull 0, eds. Recent Advances iD ...

  16. Hospitals : a design manual

    NARCIS (Netherlands)

    Wagenaar, C.; Mens, N.

    Hospitals as a building type have undergone a substantial evolution in the past years. Changes in healthcare, the impact of evidence-based medicine and aspects of healthcare economics (such as the clustering of diagnostic procedures in specialized clinics) pose new and different challenges for the

  17. Surgery, Hospitals, and Medications

    Science.gov (United States)

    ... involved in your hospital care that you have Sjögren’s syndrome. • Share information about your dryness symptoms and routine ... neck, jaw, or back. For more information on Sjögren’s syndrome, visit the SSF Web site at www.sjogrens. ...

  18. Drama Therapies in Hospitals

    Science.gov (United States)

    Goodman, Judith; Prosperi, Mario

    1976-01-01

    Explores the use of drama as a therapeutic tool at various hospitals and records specific therapy groups dialogues. Available from: The Drama Review, 51 West 4th Street, Room 300, New York, N.Y. 10012. Subscription Rates: $12.50 per year. (MH)

  19. Official Centre Hospitality

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

    Sylvain Dufour

    Approved by the Management Executive Committee. - 1 -. Version 3.1.0 effective 2017-06-28. Official Centre Hospitality. 1. Objective. 2. Application. 3. Definitions. 4. Roles and Responsibilities. 5. Authorization. 6. Consultants and Contractors. 7. Reimbursement. 1. Objective. To define the circumstances under which ...

  20. Enhancing hospital productivity

    NARCIS (Netherlands)

    van Hulst, B.L.

    2016-01-01

    Healthcare expenditure in Western countries is substantial and outpaces economic growth, therefore cost containment in healthcare is high on the political agenda. One option is to increase productivity in healthcare, do more with less. This thesis uses the Dutch hospitals as a case-study and

  1. Hospital emergency preparedness

    African Journals Online (AJOL)

    Tamara Shefer

    to make informed decisions about prioritising hazards in view of limited resources ... contingency plan, for instance, the Oshikoto Regional Council has identified ..... hospital relies on exercises conducted by the Namibia Airports Company (NAC) ... Small scale exercises can also be done in which certain elements of the plan ...

  2. [Leadership in the hospital].

    Science.gov (United States)

    Schrappe, Matthias

    2009-01-01

    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.

  3. El hospital universitario

    Directory of Open Access Journals (Sweden)

    José Félix Patiño-Restrepo

    2016-10-01

    Full Text Available Según el Diccionario de la Real Academia Española (1, el vocablo hospital viene del latín hospitālis y en su primera acepción se define como: “1. m. Establecimiento destinado al diagnóstico y tratamiento de enfermos, donde a menudo se practican la investigación y la docencia”. Sin embargo, las otras acepciones se refieren a sus orígenes medievales: “2. m. Casa que servía para recoger pobres y peregrinos por tiempo limitado. 3. adj. ant. Afable y caritativo con los huéspedes. 4. adj. ant. Perteneciente o relativo al buen hospedaje”. El hospital moderno, en realidad, es la combinación de ciencia, tecnología, hospedaje y humanitarismo. ¿Cuándo nació el hospital y cuál es su historia? En la Edad Media temprana surgieron los xenodochia, albergues para pobres y peregrinos fundados por la iglesia católica en el marco del sentido humanitario del cristianismo. En los comienzos del siglo XIII, cuando las ciudades acumularon riqueza para sostener sus propios ejércitos, se presentó un fenómeno de crecimiento en el número de albergues y estos empezaron a caracterizarse por atender enfermos; ya para esta época no eran solo fundados por la iglesia, sino también por autoridades civiles. Aunque se siguió el modelo del Hospital del Santo Spirito de Roma, construido por orden del papa Inocencio III (1161-1216, en Francia se fundaron los Hôtel-Dieu, generalmente en la vecindad de las catedrales, que aún conservaban la característica de ser más bien albergues para los más necesitados y desamparados.

  4. A quality control exercise of radionuclide calibrators among Belgian hospitals

    International Nuclear Information System (INIS)

    Reher, D.F.G.; Merlo, P.

    1990-01-01

    On the initiative of the Belgian Association of Hospital Physicists, eleven Belgian hospitals participated in a quality control of radionuclide calibrators conducted in collaboration with the Central Bureau for Nuclear Measurements of the Commission of the European Communities. For practical reasons the nuclide 57 Co was chosen. The results from 20 different radionuclide calibrators show a fair agreement with a similar comparison carried out in 1980 in the UK. (orig.)

  5. Factors Influencing Hospital Stay for Pulmonary Embolism. A Cohort Study.

    Science.gov (United States)

    Rodríguez-Núñez, Nuria; Ruano-Raviña, Alberto; Abelleira, Romina; Ferreiro, Lucía; Lama, Adriana; González-Barcala, Francisco J; Golpe, Antonio; Toubes, María E; Álvarez-Dobaño, José M; Valdés, Luis

    2017-08-01

    The aim of this study was to identify factors influencing hospital stay due to pulmonary embolism. We performed a retrospective cohort study of patients hospitalized between 2010 and 2015. Patients were identified using information recorded in hospital discharge reports (ICD-9-CM codes 415.11 and 415.19). We included 965 patients with a median stay of 8 days (IQR 6-13 days). Higher scores on the simplified Pulmonary Embolism Severity Index (sPESI) were associated with increased probability of longer hospital stay. The probability of a hospital stay longer than the median was 8.65 (95% CI 5.42-13.79) for patients referred to the Internal Medicine Department and 1.54 (95% CI 1.07-2.24) for patients hospitalized in other departments, compared to those referred to the Pneumology Department. Patients with grade 3 on the modified Medical Research Council dyspnea scale had an odds ratio of 1.63 (95% CI: 1.07-2.49). The likelihood of a longer than median hospital stay was 1.72 (95% CI: 0.85-3.48) when oral anticoagulation (OAC) was initiated 2-3 days after admission, and 2.43 (95% CI: 1.16-5.07) when initiated at 4-5 days, compared to OAC initiation at 0-1 days. sPESI grade, the department of referral from the Emergency Department, the grade of dyspnea and the time of initiating OAC were associated with a longer hospital stay. Copyright © 2017 SEPAR. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Rolling out Productive Ward foundation modules across a hospital trust.

    Science.gov (United States)

    Foster, Sam; Gordon, Pete; McSherry, Wilfred

    The Shrewsbury and Telford Hospitals NHS Trust has spent the last 12 months rolling out the Productive Ward foundation modules across the whole organisation. This has resulted in measurable increases in time spent on direct care, and reduced infection rates and ward non-pay (non-staffing) expenditure. This article discusses the initiative and looks at how problems with the hospital supply chain are being addressed.

  7. Hospital pharmacy workforce in Brazil.

    Science.gov (United States)

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

    2018-01-04

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

  8. Hanford tanks initiative plan

    International Nuclear Information System (INIS)

    McKinney, K.E.

    1997-01-01

    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

  9. UNLV Nuclear Hydrogen Initiative

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-10-25

    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.

  10. Feedback stabilization initiative

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-06-01

    Much progress has been made in attaining high confinement regimes in magnetic confinement devices. These operating modes tend to be transient, however, due to the onset of MHD instabilities, and their stabilization is critical for improved performance at steady state. This report describes the Feedback Stabilization Initiative (FSI), a broad-based, multi-institutional effort to develop and implement methods for raising the achievable plasma betas through active MHD feedback stabilization. A key element in this proposed effort is the Feedback Stabilization Experiment (FSX), a medium-sized, national facility that would be specifically dedicated to demonstrating beta improvement in reactor relevant plasmas by using a variety of MHD feedback stabilization schemes.

  11. Feedback stabilization initiative

    International Nuclear Information System (INIS)

    1997-06-01

    Much progress has been made in attaining high confinement regimes in magnetic confinement devices. These operating modes tend to be transient, however, due to the onset of MHD instabilities, and their stabilization is critical for improved performance at steady state. This report describes the Feedback Stabilization Initiative (FSI), a broad-based, multi-institutional effort to develop and implement methods for raising the achievable plasma betas through active MHD feedback stabilization. A key element in this proposed effort is the Feedback Stabilization Experiment (FSX), a medium-sized, national facility that would be specifically dedicated to demonstrating beta improvement in reactor relevant plasmas by using a variety of MHD feedback stabilization schemes

  12. Initiation of slug flow

    Energy Technology Data Exchange (ETDEWEB)

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

    1995-12-31

    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).

  13. Stirling to Flight Initiative

    Science.gov (United States)

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

    2016-01-01

    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.

  14. Initiating statistical maintenance optimization

    International Nuclear Information System (INIS)

    Doyle, E. Kevin; Tuomi, Vesa; Rowley, Ian

    2007-01-01

    Since the 1980 s maintenance optimization has been centered around various formulations of Reliability Centered Maintenance (RCM). Several such optimization techniques have been implemented at the Bruce Nuclear Station. Further cost refinement of the Station preventive maintenance strategy includes evaluation of statistical optimization techniques. A review of successful pilot efforts in this direction is provided as well as initial work with graphical analysis. The present situation reguarding data sourcing, the principle impediment to use of stochastic methods in previous years, is discussed. The use of Crowe/AMSAA (Army Materials Systems Analysis Activity) plots is demonstrated from the point of view of justifying expenditures in optimization efforts. (author)

  15. [The role of patient flow and surge capacity for in-hospital response in mass casualty events].

    Science.gov (United States)

    Sefrin, Peter; Kuhnigk, Herbert

    2008-03-01

    Mass casualty events make demands on emergency services and disaster control. However, optimized in- hospital response defines the quality of definitive care. Therefore, German federal law governs the role of hospitals in mass casualty incidents. In hospital casualty surge is depending on resources that have to be expanded with a practicable alarm plan. Thus, in-hospital mass casualty management planning is recommended to be organized by specialized persons. To minimise inhospital patient overflow casualty surge principles have to be implemented in both, pre-hospital and in-hospital disaster planning. World soccer championship 2006 facilitated the initiation of surge and damage control principles in in-hospital disaster planning strategies for German hospitals. The presented concept of strict control of in-hospital patient flow using surge principles minimises the risk of in-hospital breakdown and increases definitive hospital treatment capacity in mass casualty incidents.

  16. Timing of antiretroviral therapy initiation in adults with HIV ...

    African Journals Online (AJOL)

    Timing of antiretroviral therapy initiation in adults with HIV-associated tuberculosis: Outcomes of therapy in an urban hospital in KwaZulu-Natal. ... We aimed to compare clinical outcomes of patients with HIV-associated TB who commenced ART at different stages of TB therapy. Methods. A retrospective chart review was ...

  17. Time Interval to Initiation of Contraceptive Methods Following ...

    African Journals Online (AJOL)

    Objectives: The objectives of the study were to determine factors affecting the interval between a woman's last childbirth and the initiation of contraception. Materials and Methods: This was a retrospective study. Family planning clinic records of the Barau Dikko Teaching Hospital Kaduna from January 2000 to March 2014 ...

  18. Hospitality within hospital meals—Socio-material assemblages

    DEFF Research Database (Denmark)

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

    2016-01-01

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

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

    African Journals Online (AJOL)

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

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

    DEFF Research Database (Denmark)

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

    2012-01-01

    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......: Hospitals should intertwine employee encouragement, analytical approaches, and formal reward systems depending on organizational goals....

  1. Avoiding mandatory hospital nurse staffing ratios: an economic commentary.

    Science.gov (United States)

    Buerhaus, Peter I

    2009-01-01

    The imposition of mandatory hospital nurse staffing ratios is among the more visible public policy initiatives affecting the nursing profession. Although the practice is intended to address problems in hospital nurse staffing and quality of patient care, this commentary argues that staffing ratios will lead to negative consequences for nurses involving the equity, efficiency, and costs of producing nursing care in hospitals. Rather than spend time and effort attempting to regulate nurse staffing, this commentary offers alternatives strategies that are directed at fixing the problems that motivate the advocates of staffing ratios.

  2. Pediatric Palliative Care Initiative in Cambodia

    Directory of Open Access Journals (Sweden)

    Mahmut Yaşar Çeliker

    2017-07-01

    Full Text Available Cancer care with curative intent remains difficult to manage in many resource-limited settings such as Cambodia. Cambodia has a small workforce with limited financial and health-care resources resulting in delayed diagnoses and availability of limited therapeutic tools. Thus, palliative care becomes the primary form of care in most cases. Although palliative care is becoming an integral part of medical care in developed countries, this concept remains poorly understood and utilized in developing countries. Angkor Hospital for Children serves a relatively large pediatric population in northern Cambodia. According to the modern definition of palliative care, approximately two-thirds of the patients admitted to the hospital were deemed candidates to receive palliative care. In an effort to develop a pediatric palliative care team utilizing existing resources and intensive training, our focus group recruited already existing teams with different health-care expertise and other motivated members of the hospital. During this process, we have also formed a palliative care training team of local experts to maintain ongoing palliative care education. Feedback from patients and health-care providers confirmed the effectiveness of these efforts. In conclusion, palliative and sustainable care was offered effectively in a resource-limited setting with adequately trained and motivated local providers. In this article, the steps and systems used to overcome challenges in Cambodia are summarized in the hope that our experience urges governmental and non-governmental agencies to support similar initiatives.

  3. Pediatric Palliative Care Initiative in Cambodia

    Science.gov (United States)

    Çeliker, Mahmut Yaşar; Pagnarith, Yos; Akao, Kazumi; Sophearin, Dim; Sorn, Sokchea

    2017-01-01

    Cancer care with curative intent remains difficult to manage in many resource-limited settings such as Cambodia. Cambodia has a small workforce with limited financial and health-care resources resulting in delayed diagnoses and availability of limited therapeutic tools. Thus, palliative care becomes the primary form of care in most cases. Although palliative care is becoming an integral part of medical care in developed countries, this concept remains poorly understood and utilized in developing countries. Angkor Hospital for Children serves a relatively large pediatric population in northern Cambodia. According to the modern definition of palliative care, approximately two-thirds of the patients admitted to the hospital were deemed candidates to receive palliative care. In an effort to develop a pediatric palliative care team utilizing existing resources and intensive training, our focus group recruited already existing teams with different health-care expertise and other motivated members of the hospital. During this process, we have also formed a palliative care training team of local experts to maintain ongoing palliative care education. Feedback from patients and health-care providers confirmed the effectiveness of these efforts. In conclusion, palliative and sustainable care was offered effectively in a resource-limited setting with adequately trained and motivated local providers. In this article, the steps and systems used to overcome challenges in Cambodia are summarized in the hope that our experience urges governmental and non-governmental agencies to support similar initiatives. PMID:28804708

  4. “... And Gladly Teach”: The American Hospital Association's Experience in Conducting Institutes on Hospital Librarianship

    Science.gov (United States)

    Yast, Helen

    1964-01-01

    As part of its overall educational program, the American Hospital Association has since 1959 conducted three institutes on hospital librarianship to meet the demand for more competent librarians in medical, nursing school, and patients' libraries. The purpose of such institutes is to teach the basic elements of library science to untrained personnel in hospital libraries. Discussed are steps in initiating an institute; factors determining length, date, and place; financing; publicity; choice and responsibility of local advisory committee; program content; qualifications of instructors; characteristics of registrants; materials for distribution; evaluations. Details of the most recent institute are outlined. A summary of problems still facing this type of educational program and suggestions for future improvements conclude the paper. PMID:14119309

  5. Hospital pharmacy services in teaching hospitals in Nepal: Challenges and the way forward

    Directory of Open Access Journals (Sweden)

    P Ravi Shankar

    2016-01-01

    Full Text Available In Nepal, a developing country in South Asia, hospital pharmacies in teaching hospitals faces a number of challenges. Design and location of the pharmacy is inadequate, the pharmacy is often rented out to private parties, there may be a lack of separation of outpatient and inpatient pharmacy services, medicines are not selected based on objective criteria, too many brands are stocked, pharmaceutical care services are not provided, and pharmaceutical promotion is not regulated within the hospital premises. Furthermore, there is often a lack of pharmacy management software to help dispensing, continuing pharmacy education is not provided, medicines are not compounded or packaged in house, there are problems with medicines availability and medicine quality, and drug utilization studies are not linked with initiatives to promote the rational use of medicines. In this article, the authors examine these challenges and put forward possible solutions.

  6. The impact of HMO and hospital competition on hospital costs.

    Science.gov (United States)

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

    2005-01-01

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

  7. The LHCb Starterkit initiative

    CERN Document Server

    Puig Navarro, Albert

    2017-01-01

    The vast majority of high-energy physicists use and produce software every day. Software skills are usually acquired on the go and dedicated training courses are rare. The LHCb Starterkit is a new training format for getting LHCb collaborators started in effectively using software to perform their research. The initiative, combining courses and online tutorials, focuses on teaching basic skills for research computing, as well as LHCb software specifics. Unlike traditional tutorials we focus on starting with basics, performing all the material live, with a high degree of interactivity, giving priority to understanding the tools as opposed to handing out recipes that work “as if by magic”. The LHCb Starterkit was started by young members of the collaboration inspired by the principles of Software Carpentry, and the material is created in a collaborative fashion using the tools we teach. Three successful entry-level workshops, as well as two advanced ones, have taken place since the start of the initiative i...

  8. Combat Wound Initiative program.

    Science.gov (United States)

    Stojadinovic, Alexander; Elster, Eric; Potter, Benjamin K; Davis, Thomas A; Tadaki, Doug K; Brown, Trevor S; Ahlers, Stephen; Attinger, Christopher E; Andersen, Romney C; Burris, David; Centeno, Jose; Champion, Hunter; Crumbley, David R; Denobile, John; Duga, Michael; Dunne, James R; Eberhardt, John; Ennis, William J; Forsberg, Jonathan A; Hawksworth, Jason; Helling, Thomas S; Lazarus, Gerald S; Milner, Stephen M; Mullick, Florabel G; Owner, Christopher R; Pasquina, Paul F; Patel, Chirag R; Peoples, George E; Nissan, Aviram; Ring, Michael; Sandberg, Glenn D; Schaden, Wolfgang; Schultz, Gregory S; Scofield, Tom; Shawen, Scott B; Sheppard, Forest R; Stannard, James P; Weina, Peter J; Zenilman, Jonathan M

    2010-07-01

    The Combat Wound Initiative (CWI) program is a collaborative, multidisciplinary, and interservice public-private partnership that provides personalized, state-of-the-art, and complex wound care via targeted clinical and translational research. The CWI uses a bench-to-bedside approach to translational research, including the rapid development of a human extracorporeal shock wave therapy (ESWT) study in complex wounds after establishing the potential efficacy, biologic mechanisms, and safety of this treatment modality in a murine model. Additional clinical trials include the prospective use of clinical data, serum and wound biomarkers, and wound gene expression profiles to predict wound healing/failure and additional clinical patient outcomes following combat-related trauma. These clinical research data are analyzed using machine-based learning algorithms to develop predictive treatment models to guide clinical decision-making. Future CWI directions include additional clinical trials and study centers and the refinement and deployment of our genetically driven, personalized medicine initiative to provide patient-specific care across multiple medical disciplines, with an emphasis on combat casualty care.

  9. Initiatives for proliferation prevention

    International Nuclear Information System (INIS)

    1997-04-01

    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

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

    African Journals Online (AJOL)

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

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

    African Journals Online (AJOL)

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

  12. [Hospital emergency rooms].

    Science.gov (United States)

    Tudela, Pere; Mòdol, Josep Maria

    2003-05-17

    Overuse of hospital emergency rooms (HERs) is parallel to their controversy. To understand this problem, some concepts should be first clarified. In HERs, there are some intrinsic aspects which are directly related to the emergency itself and thus cannot be modified (intermittent patient flow, need to prioritize, difficulty to achieve a rapid diagnosis, influence of time on treatment, value of clinical follow up, patient's expectations, impact of HER on the overall hospital working dynamics). On the other hand, there are some extrinsic aspects which indeed are not related to HER itself but are rather historically associated with it (precarious structure, delay on admission, lack of privacy, inadequate triage of cases, lack of professionalization); these latter aspects may be potentially modified and should be reconsidered.

  13. HOSPITALITY TODAY AND TOMORROW

    Directory of Open Access Journals (Sweden)

    Ray F. IUNIUS

    2017-08-01

    Full Text Available As a wise man once said, “Don’t worry about what you don’t know. Be worried about what you think you know, but don’t.” Regarding different ways “hospitality” is understood, the root of the problem lies in part in the different interpretations that hospitality has in different cultures and languages. In American English, for example, when we speak about “hospitality” we first think of it as an industry and only secondarily as an attribute of an individual or community. In other cultures, the primary meaning of hospitality is more a characteristic of people, or of a country or city, etc., and encompasses such ideas as welcome, reception, amiability, generosity, etc. – not an industry! Even in American English, other words are sometimes used to describe the same economic activity: lodging, accommodation, etc.

  14. [Play therapy in hospital].

    Science.gov (United States)

    Gold, Katharina; Grothues, Dirk; Leitzmann, Michael; Gruber, Hans; Melter, Michael

    2012-01-01

    The following article presents an overview of current research studies on play therapy in the hospital. It highlights individual diagnoses for which play therapy has shown reasonable success. The aim of this review is to describe the current status of the scientific debate on play therapy for sick children in order to allow conclusions regarding the indications for which play therapy is or might be useful.

  15. Hospital nurses' work motivation.

    Science.gov (United States)

    Toode, Kristi; Routasalo, Pirkko; Helminen, Mika; Suominen, Tarja

    2015-06-01

    The knowledge surrounding nurses' work motivation is currently insufficient, and previous studies have rarely taken into account the role of many influential background factors. This study investigates the motivation of Estonian nurses in hospitals, and how individual and organisational background factors influence their motivation to work. The study is quantitative and cross-sectional. An electronically self-reported questionnaire was used for data collection. The sample comprised of 201 Registered Nurses working in various hospital settings in Estonia. Data were analysed using descriptive statistics, two-sample Wilcoxon rank-sum (Mann-Whitney) test, Kruskal-Wallis equality-of-populations rank test and Spearman's correlation. Both extrinsic and intrinsic motivations were noted among hospital nurses. Nurses were moderately externally motivated (M = 3.63, SD = 0.89) and intrinsically strongly motivated (M = 4.98, SD = 1.03). A nurses' age and the duration of service were positively correlated with one particular area of extrinsic work motivation, namely introjected regulation (p extrinsic motivation (p = 0.016) and intrinsic work motivation (p = 0.004). The findings expand current knowledge of nurses' work motivation by describing the amount and orientation of work motivation among hospital nurses and highlighting background factors which should be taken into account in order to sustain and increase their intrinsic work motivation. The instrument used in the study can be an effective tool for nurse managers to determine a nurse's reasons to work and to choose a proper motivational strategy. Further research and testing of the instrument in different countries and in different contexts of nursing is however required. © 2014 Nordic College of Caring Science.

  16. Patient life in hospital

    DEFF Research Database (Denmark)

    Ludvigsen, Mette Spliid

    Patient life in hospital.A qualitative study of informal relationships between hospitalised patients Introduction Within a patientology framework, this PhD dissertation is about an empirical study on patient life that provides insight into the nature of informal relationships between patients...... are created through stories about three roughly framed aspects of hospitalisation: A. Being together with fellow patients entails a constant dilemma, B. Relationships between patients are restricted and extended and C. Shifting perspectives in solidarity. Conclusion Patients' hospitalisation is strongly...

  17. Hospital Presbiteriano Valley

    Directory of Open Access Journals (Sweden)

    Luckman, Charles

    1964-12-01

    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.

  18. [Analysis on workload for hospital DOTS service].

    Science.gov (United States)

    Nagata, Yoko; Urakawa, Minako; Kobayashi, Noriko; Kato, Seiya

    2014-04-01

    A directly observed treatment short course (DOTS) trial was launched in Japan in the late 1990s and targeted patients with social depression at urban areas. Based on these findings, the Ministry of Health, Labour and Welfare established the Japanese DOTS Strategy in 2003, which is a comprehensive support service ensuring the adherence of tuberculosis patients to drug administration. DOTS services are initially provided at the hospital to patients with infectious tuberculosis who are hospitalized according to the Infectious Diseases Control Law. After being discharged from the hospital, the patients are referred to a public health center. However, a survey conducted in 2008 indicated that all the patients do not receive appropriate DOTS services at some hospitals. In the present study, we aimed to evaluate the protocols and workload of DOTS at hospitals that are actively involved in tuberculosis medical practice, including DOTS, to assess whether the hospital DOTS services were adequate. We reviewed a series of articles on hospital DOTS from a Japanese journal on nursing for tuberculosis patients and identified 25 activities regarding the hospital DOTS service. These 25 items were then classified into 3 categories: health education to patients, support for adherence, and coordination with the health center. In total, 20 hospitals that had > 20 authorized tuberculosis beds were selected--while considering the geographical balance, schedule of this survey, etc.--from 33 hospitals where an ex-trainee of the tuberculosis control expert training program in the Research Institute of Tuberculosis (RIT) was working and 20 hospitals that had collaborated with our previous survey on tuberculosis medical facilities. All the staff associated with the DOTS service were asked to record the total working time as well as the time spent for each activity. The data were collected and analyzed at the RIT. The working times for each activity of the DOTS service for nurses, pharmacists

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

    Science.gov (United States)

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

    2017-06-01

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

  20. [Trends in hospital care].

    Science.gov (United States)

    Vecina Neto, Gonzalo; Malik, Ana Maria

    2007-01-01

    This paper analyses trends in the delivery of hospital services in Brazil, considering the setting, the current situation and its challenges, examining what still remains to be done. The variables studied for the analysis of the setting are: demography, epidemiological profile, human resources, technology, medicalization, costs, review of the role of the citizen, legislation, equity, hospital-centricity and regionalization, care fractioning and bed availability. The Brazilian setting was studied through the supplementary healthcare model, financing and the healthcare area production chain. The observations of the current situation present external evaluation models, outsourcing, public-private relationships, de-hospitalization and financing. The analysis of the challenges examines the need for long range planning, the quest for new legal models for the 'business', the use of information and information systems, cost controls and the need for enhanced efficiency and compliance with legal directives, guaranteed universal access to full healthcare facilities, the inclusion of primary prevention in healthcare procedures, integrating the public and private sectors and engaging physicians in solving problems.

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

    Directory of Open Access Journals (Sweden)

    Verma Arpana

    2010-01-01

    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

  2. Facts about Hospital Worker Safety

    Science.gov (United States)

    ... statistics show that hospitals are still relatively hazardous workplaces, and they have much room to improve. OSHA has developed this factbook to help hospital safety managers and other stakeholders understand the challenges of worker ...

  3. HSIP Hospitals in New Mexico

    Data.gov (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...

  4. [Using SWOT to analyze breastfeeding education results in a medical center].

    Science.gov (United States)

    Lee, Pei-Shan; Huang, Chiu-Mieh

    2005-08-01

    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.

  5. Evaluation Program initiative

    International Nuclear Information System (INIS)

    Rich, B.L.

    1987-01-01

    The purpose of this paper is to provide the Department of Energy's (DOE) safeguards and security community with some insights on an important management initiative by the Office of Security Evaluations (OSE). The paper will present the ''what, where, who, when, and why'' of a new Evaluation Program. The Evaluation Program will be comprised of a continuing series of regular and special evaluations of DOE safeguards and security programs and policies. The evaluations will be integrative and ''crosscutting,'' i.e. will extend across DOE organizational lines. Evaluations will be offered as positive advisories to DOE managers with safeguards and security responsibilities and will not be rated. They will complement the ongoing OSE Inspection Program of inspections conducted by OSE's Inspection Division. The purpose for the evaluations is to establish an accurate and current assessment of the effectiveness and status of safeguards and security programs and policies and to provide DOE managers with required information on program and policy effectiveness

  6. Breckinridge Project, initial effort

    Energy Technology Data Exchange (ETDEWEB)

    None, None

    1982-09-01

    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. The climate technology initiative

    Energy Technology Data Exchange (ETDEWEB)

    Smith, Adam [International Energy Agency, Climate Technology Initiative, Paris (France)

    2000-12-01

    The CTI (Climate Technology Initiative) aims to promote those technologies which cause the minimum of harm to the environment: reducing emissions of greenhouse gases and supporting those countries most vulnerable to climate change are priorities. A strong case for cogeneration is made and it is pointed out that both the European Union and the USA aim to double their cogeneration capacity by 2010. The CTI holds training courses and seminars all over the world where the barriers to the expansion of climate-friendly technology are discussed. The article also mentions the CTI Co-operation Technology Implementation Plan, research and development, its website and search engine, its presence at all UNFCCC events and its awards programme.

  8. The climate technology initiative

    International Nuclear Information System (INIS)

    Smith, Adam

    2000-01-01

    The CTI (Climate Technology Initiative) aims to promote those technologies which cause the minimum of harm to the environment: reducing emissions of greenhouse gases and supporting those countries most vulnerable to climate change are priorities. A strong case for cogeneration is made and it is pointed out that both the European Union and the USA aim to double their cogeneration capacity by 2010. The CTI holds training courses and seminars all over the world where the barriers to the expansion of climate-friendly technology are discussed. The article also mentions the CTI Co-operation Technology Implementation Plan, research and development, its website and search engine, its presence at all UNFCCC events and its awards programme

  9. Initial brain aging

    DEFF Research Database (Denmark)

    Thomsen, Kirsten; Yokota, Takashi; Hasan-Olive, Md Mahdi

    2018-01-01

    Brain aging is accompanied by declining mitochondrial respiration. We hypothesized that mitochondrial morphology and dynamics would reflect this decline. Using hippocampus and frontal cortex of a segmental progeroid mouse model lacking Cockayne syndrome protein B (CSB(m/m)) and C57Bl/6 (WT......) controls and comparing young (2-5 months) to middle-aged mice (13-14 months), we found that complex I-linked state 3 respiration (CI) was reduced at middle age in CSB(m/m) hippocampus, but not in CSB(m/m) cortex or WT brain. In hippocampus of both genotypes, mitochondrial size heterogeneity increased....... Mitochondrial DNA content was lower, and hypoxia-induced factor 1α mRNA was greater at both ages in CSB(m/m) compared to WT brain. Our findings show that decreased CI and increased mitochondrial size heterogeneity are highly associated and point to declining mitochondrial quality control as an initial event...

  10. Materials Genome Initiative

    Science.gov (United States)

    Vickers, John

    2015-01-01

    The Materials Genome Initiative (MGI) project element is a cross-Center effort that is focused on the integration of computational tools to simulate manufacturing processes and materials behavior. These computational simulations will be utilized to gain understanding of processes and materials behavior to accelerate process development and certification to more efficiently integrate new materials in existing NASA projects and to lead to the design of new materials for improved performance. This NASA effort looks to collaborate with efforts at other government agencies and universities working under the national MGI. MGI plans to develop integrated computational/experimental/ processing methodologies for accelerating discovery and insertion of materials to satisfy NASA's unique mission demands. The challenges include validated design tools that incorporate materials properties, processes, and design requirements; and materials process control to rapidly mature emerging manufacturing methods and develop certified manufacturing processes

  11. 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...

  12. Instrumented Pipeline Initiative

    Energy Technology Data Exchange (ETDEWEB)

    Thomas Piro; Michael Ream

    2010-07-31

    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.

  13. Pseudomonas aeruginosa from hospital environment

    Directory of Open Access Journals (Sweden)

    Milind Davane

    2014-03-01

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

  14. Parametric Optimization of Hospital Design

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  15. Differences within the groups of physicians and managers in Dutch hospitals providing leads for intergroup cooperation : Running head: group differences in hospitals

    NARCIS (Netherlands)

    van Harten, Willem H.

    2010-01-01

    Background: Effective cooperation between physicians and managers is difficult to achieve but is an important factor in successfully implementing improvement initiatives in hospitals. Intergroup literature suggests that large differences between groups hinder effective cooperation. - Purposes:

  16. The Enzyme Function Initiative.

    Science.gov (United States)

    Gerlt, John A; Allen, Karen N; Almo, Steven C; Armstrong, Richard N; Babbitt, Patricia C; Cronan, John E; Dunaway-Mariano, Debra; Imker, Heidi J; Jacobson, Matthew P; Minor, Wladek; Poulter, C Dale; Raushel, Frank M; Sali, Andrej; Shoichet, Brian K; Sweedler, Jonathan V

    2011-11-22

    The Enzyme Function Initiative (EFI) was recently established to address the challenge of assigning reliable functions to enzymes discovered in bacterial genome projects; in this Current Topic, we review the structure and operations of the EFI. The EFI includes the Superfamily/Genome, Protein, Structure, Computation, and Data/Dissemination Cores that provide the infrastructure for reliably predicting the in vitro functions of unknown enzymes. The initial targets for functional assignment are selected from five functionally diverse superfamilies (amidohydrolase, enolase, glutathione transferase, haloalkanoic acid dehalogenase, and isoprenoid synthase), with five superfamily specific Bridging Projects experimentally testing the predicted in vitro enzymatic activities. The EFI also includes the Microbiology Core that evaluates the in vivo context of in vitro enzymatic functions and confirms the functional predictions of the EFI. The deliverables of the EFI to the scientific community include (1) development of a large-scale, multidisciplinary sequence/structure-based strategy for functional assignment of unknown enzymes discovered in genome projects (target selection, protein production, structure determination, computation, experimental enzymology, microbiology, and structure-based annotation), (2) dissemination of the strategy to the community via publications, collaborations, workshops, and symposia, (3) computational and bioinformatic tools for using the strategy, (4) provision of experimental protocols and/or reagents for enzyme production and characterization, and (5) dissemination of data via the EFI's Website, http://enzymefunction.org. The realization of multidisciplinary strategies for functional assignment will begin to define the full metabolic diversity that exists in nature and will impact basic biochemical and evolutionary understanding, as well as a wide range of applications of central importance to industrial, medicinal, and pharmaceutical efforts.

  17. Green Power Initiative

    Energy Technology Data Exchange (ETDEWEB)

    Butler, Patrick Barry [Univ. of Iowa, Iowa City, IA (United States)

    2013-01-28

    National energy policy supports the gathering of more detailed and authoritative data on the introduction of renewable bio-based fuels into new and existing district energy systems via the application of biomass gasification. The University of Iowa developed a biomass-fueled, university-scale steam generation system based on biomass gasification technologies. The system serves as a state-of-the-art research and educational facility in the emerging application of gasification in steam generation. The facility, which includes a smaller down-draft gasifier and a larger multi-stage biomass boiler, was designed to operate primarily on wood-based fuels, but has provisions for testing other biomass fuel sources produced within a 100-mile radius, providing enough flexibility to meet the fluctuating local supply of biomass from industry and Midwest agriculture. The equipment was installed in an existing, staffed facility. The down-draft gasifier unit is operated by College of Engineering staff and students, under the direct technical supervision of qualified Utilities plant staff. The Green Power Initiative also includes a substantial, innovative educational component. In addition to an onsite, graduate-level research program in biomass fuels, the investigators have integrated undergraduate and graduate level teaching – through classroom studies and experiential learning – and applied research into a biomass-based, university-scale, functioning power plant. University of Iowa is unique in that it currently has multiple renewable energy technologies deployed, including significant biomass combustion (oat hulls) at its Main Power Plant and a new reciprocating engine based renewable district energy system. This project complements and supports the national energy policy and State of Iowa initiatives in ethanol and biodiesel. Byproducts of ethanol and biodiesel processes (distiller grains) as well as industry residues (oat hulls, wood chips, construction and demolition

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

    DEFF Research Database (Denmark)

    Justesen, Lise

    2016-01-01

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

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

    DEFF Research Database (Denmark)

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

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

  20. Physician recruitment in Ontario Provincial Psychiatric Hospitals.

    Science.gov (United States)

    Draper, R; Galbraith, D; Frost, B

    1989-11-01

    Recruitment of Physicians/Psychiatrists to staff the Ontario Provincial Psychiatric Hospitals remains an ongoing problem despite the introduction of measures such as University Affiliation and Incentive Grants. Historically there has been heavy reliance upon Foreign Medical Graduates (GOFM's) who have been denied the possibility of professional mobility and advancement because of restrictive licences. Recent changes in regulations have severely restricted the recruitment of GOFM's. During 1987, details of all physicians employed in the provincial hospitals during the preceeding five years were entered into a computerized data base. This paper presents some initial analyses which indicate that Canadian graduates have provided low levels of service, especially outside major urban centres, quite insufficient to replace the GOFM's. These findings raise urgent social and professional concerns.

  1. IMPROVING HOSPITAL LOGISTICS BY RETHINKING TECHNOLOGY ASSESSMENT

    DEFF Research Database (Denmark)

    Jacobsen, Peter; Jørgensen, Pelle Morten Thomas

    2011-01-01

    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....

  2. Income smoothing by Dutch hospitals

    NARCIS (Netherlands)

    Boterenbrood, D.R.

    2014-01-01

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

  3. Hospitality Services. Student Activity Book.

    Science.gov (United States)

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

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

  4. Library Hospitality: Some Preliminary Considerations

    Science.gov (United States)

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

    2011-01-01

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

  5. Hospitality in College Composition Courses

    Science.gov (United States)

    Haswell, Janis; Haswell, Richard; Blalock, Glenn

    2009-01-01

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

  6. Hospitality Studies: Escaping the Tyranny?

    Science.gov (United States)

    Lashley, Conrad

    2015-01-01

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

  7. The initial experience of trans-rectal ultrasound and biopsy in ...

    African Journals Online (AJOL)

    The initial experience of trans-rectal ultrasound and biopsy in diagnosis of carcinoma prostate in Gezira Hospital for Renal Disease and Surgery (GHRDS). Walaa Eldin Ibraheem, Sami Mahjoub Taha, Mustafa Omran Mansour, Mohammed El Imam Mohamed Ahmed ...

  8. A randomised controlled trial of early initiation of oral feeding after ...

    African Journals Online (AJOL)

    A randomised controlled trial of early initiation of oral feeding after Caesarean ... The outcome measures were rate of ileus symptoms, post operative presence of ... more rapid recovery and expressed their interest in earlier hospital discharge.

  9. Glutaraldehyde degradation in hospital wastewater by photoozonation.

    Science.gov (United States)

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

    2013-01-01

    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.

  10. Nursing magnet hospitals have better CMS hospital compare ratings

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2017-11-01

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

  11. Laryngopharyngeal abnormalities in hospitalized patients with dysphagia.

    Science.gov (United States)

    Postma, Gregory N; McGuirt, W Frederick; Butler, Susan G; Rees, Catherine J; Crandall, Heather L; Tansavatdi, Kristina

    2007-10-01

    To determine the prevalence of laryngopharyngeal (LP) abnormalities in hospitalized patients with dysphagia referred for flexible endoscopic evaluation of swallowing (FEES). Retrospective, blinded review by two otolaryngologists of 100 consecutive FEES studies performed and video-recorded by a speech-language pathologist (SLP). Two otolaryngologists reviewed videos of 100 consecutive FEES studies on hospitalized patients with dysphagia for the presence of abnormal LP findings. Sixty-one male and 38 female patients comprised the hospital dysphagia cohort. The mean age was 62. One subject could not be evaluated because of the severity of the retained secretions, leaving 99 subjects in the cohort. Seventy-six percent had been previously intubated, with a mean intubation duration of 13 days. The overall prevalence of abnormal LP findings was 79%. Forty-five percent of the patients presented with two or more findings, which included arytenoid edema (33%), granuloma (31%), vocal fold paresis (24%), mucosal lesions (17%), vocal fold bowing (14%), diffuse edema (11%), airway stenosis (3%), and ulcer (6%). There was a significant difference in LP findings between those individuals who had or had not been intubated. Hospitalized patients with dysphagia are at high risk for LP abnormalities, particularly if they have been intubated, and may benefit from either 1) an initial joint examination by the SLP and otolaryngologist or 2) an otolaryngologist's review of the recorded examination conducted by the SLP. Such otolaryngology involvement could identify airway stenosis patients at an earlier stage, initiate granuloma treatment sooner, enable earlier biopsy of unexpected lesions, and allow follow-up of mucosal and neuromuscular findings that do not respond to medical management.

  12. The Impact of Hospital Size on CMS Hospital Profiling.

    Science.gov (United States)

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

    2016-04-01

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

  13. Beyond the clinic: redefining hospital ambulatory care.

    Science.gov (United States)

    Rogut, L

    1997-07-01

    Responding to changes in health care financing, government policy, technology, and clinical judgment, and the rise of managed care, hospitals are shifting services from inpatient to outpatient settings and moving them into the community. Institutions are evolving into integrated delivery systems, developing the capacity to provide a continuum of coordinated services in an array of settings and to share financial risk with physicians and managed care organizations. Over the past several years, hospitals in New York City have shifted considerable resources into ambulatory care. In their drive to expand and enhance services, however, they face serious challenges, including a well-established focus on hospitals as inpatient centers of tertiary care and medical education, a heavy reliance upon residents as providers of medical care, limited access to capital, and often inadequate physical plants. In 1995, the United Hospital Fund awarded $600,000 through its Ambulatory Care Services Initiative to support hospitals' efforts to meet the challenges of reorganizing services, compete in a managed care environment, and provide high-quality ambulatory care in more efficient ways. Through the initiative, 12 New York City hospitals started projects to reorganize service delivery and build an infrastructure of systems, technology, and personnel. Among the projects undertaken by the hospitals were:--broad-based reorganization efforts employing primary care models to improve and expand existing ambulatory care services, integrate services, and better coordinate care;--projects to improve information management, planning and testing new systems for scheduling appointments, registering patients, and tracking ambulatory care and its outcomes;--training programs to increase the supply of primary care providers (both nurse practitioners and primary care physicians), train clinical and support staff in the skills needed to deliver more efficient and better ambulatory care, prepare staff

  14. MONTANA PALLADIUM RESEARCH INITIATIVE

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-05-09

    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

  15. Mobile Robots for Hospital Logistics

    OpenAIRE

    Özkil, Ali Gürcan

    2012-01-01

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

  16. Strategic management process in hospitals.

    Science.gov (United States)

    Zovko, V

    2001-01-01

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

  17. An ideal hospital.

    Science.gov (United States)

    Chandrasiri, Singithi Sidney

    2017-07-03

    Purpose The purpose of this paper is to explore a novel overarching strategy in tackling the key issues raised by the recent inquiry into bullying, harassment and discrimination in surgical practice and surgical training in Australian and New Zealand hospitals. Design/methodology/approach The approach taken is an analysis of the available evidence-based literature to inform the proposed viewpoint. The theoretical subject scope presented is a discussion of how and why the various strategies put forward in this paper should be integrated into and led from an overarching workforce engagement platform. Findings The key themes isolated from the Inquiry into Australian and New Zealand surgical practice ranged from abuse of power by those in leadership positions, gender inequity in the surgical workforce, opaque and corrupt complaints handling processes, excessive surgical trainee working hours to bystander silence secondary to a fear of reprisal. A workforce engagement perspective has elicited the potential to counter various impacts, that of clinical ineffectiveness, substandard quality and safety, inefficient medical workforce management outcomes, adverse economic implications and the operational profitability of a hospital. Generic strategies grounded in evidence-based literature were able to then be aligned with specific action areas to provide a new leadership framework for addressing these impacts. Originality/value To the author's knowledge, this is one of the first responses providing a framework on how medical managers and hospital executives can begin to lead a comprehensive and practical strategy for changing the existing culture of bullying, harassment and discrimination in surgical practice by using a staff engagement framework.

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

    Science.gov (United States)

    Rees, Tom

    2002-01-01

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

  19. From corporate governance to hospital governance. Authority, transparency and accountability of Belgian non-profit hospitals' board and management.

    Science.gov (United States)

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

    2004-04-01

    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.

  20. TFTR initial operations

    International Nuclear Information System (INIS)

    Young, K.M.; Bell, M.; Blanchard, W.R.

    1984-01-01

    TFTR (Tokamak Fusion Test Reactor) has operated since December 1982 with ohmically heated plasmas. Routine operation with feedback control of plasma current, position and density has been obtained for plasmas with Isub(p) approx.= 800 kA, a = 68 cm, R = 250 cm, and Bsub(t) = 27 kG. A maximum plasma current of 1 MA was achieved with q approx.= 2.5. Energy confinement times of approx. 150 msec were measured for hydrogen and deuterium plasmas with n-barsub(e) approx.= 2 x 10 13 cm -3 , Tsub(e)(O) approx.= 1.5 keV, Tsub(i)(O) approx.= 1.5 keV and Zsub(eff) approx.= 3. The preliminary results suggest a size-cubed scaling from PLT, and are consistent with Alcator C scaling where tau approx. nR 2 a. Initial measurements of plasma disruption characteristics indicate current decay rates of approx. 800 kA in 8 ms which is within the TFTR design requirement of 3 MA in 3 ms. (author)