Tramontina MY; Heineck I; Dos Santos L
Objectives: To characterise the prescription of non-formulary drugs to children and neonates at a Brazilian teaching hospital and identify adverse drug reactions (ADRs), drug interactions, and prescription of potentially hazardous medicines.Methods: A prospective exploratory study was carried out between January and May 2011 at the general paediatric wards and paediatric oncology, paediatric intensive care, and neonatal care units of the study hospital. Non-formulary drugs were categorised as...
Fabiana Rossi Varallo; Helaine Carneiro Capucho; Cleópatra da Silva Planeta; Patrícia de Carvalho Mastroianni
OBJECTIVES: Drug safety problems can lead to hospital admission. In Brazil, the prevalence of hospitalization due to adverse drug events is unknown. This study aims to estimate the prevalence of hospitalization due to adverse drug events and to identify the drugs, the adverse drug events, and the risk factors associated with hospital admissions. METHOD: A cross-sectional study was performed in the internal medicine ward of a teaching hospital in São Paulo State, Brazil, from August to Decemb...
Fabiana Rossi Varallo
Full Text Available OBJECTIVES: Drug safety problems can lead to hospital admission. In Brazil, the prevalence of hospitalization due to adverse drug events is unknown. This study aims to estimate the prevalence of hospitalization due to adverse drug events and to identify the drugs, the adverse drug events, and the risk factors associated with hospital admissions. METHOD: A cross-sectional study was performed in the internal medicine ward of a teaching hospital in São Paulo State, Brazil, from August to December 2008. All patients aged ≥18 years with a length of stay ≥24 hours were interviewed about the drugs used prior to hospital admission and their symptoms/complaints/causes of hospitalization. RESULTS: In total, 248 patients were considered eligible. The prevalence of hospitalization due to potential adverse drug events in the ward was 46.4%. Overprescribed drugs and those indicated for prophylactic treatments were frequently associated with possible adverse drug events. Frequently reported symptoms were breathlessness (15.2%, fatigue (12.3%, and chest pain (9.0%. Polypharmacy was a risk factor for the occurrence of possible adverse drug events. CONCLUSION: Possible adverse drug events led to hospitalization in a high-complexity hospital, mainly in polymedicated patients. The clinical outcomes of adverse drug events are nonspecific, which delays treatment, hinders causality analysis, and contributes to the underreporting of cases.
Silva, Kesia Esther; Cayô, Rodrigo; Carvalhaes, Cecilia Godoy; Patussi Correia Sacchi, Flávia; Rodrigues-Costa, Fernanda; Ramos da Silva, Ana Carolina; Croda, Julio; Gales, Ana Cristina; Simionatto, Simone
We describe an outbreak caused by KPC-2- and IMP-10-producing Serratia marcescens isolates in a Brazilian teaching hospital. Tigecycline was the only active antimicrobial agent tested. The blaIMP-10 gene was located in a new class 1 integron, named In990, carried by a nonconjugative plasmid, in contrast to blaKPC-2. PMID:25878341
Pereira da Fonseca, Tairacan Augusto; Pessôa, Rodrigo; Felix, Alvina Clara; Sanabani, Sabri Saeed
Frequently used hand-touch surfaces in hospital settings have been implicated as a vehicle of microbial transmission. In this study, we aimed to investigate the overall bacterial population on four frequently used surfaces using a culture-independent Illumina massively parallel sequencing approach of the 16S rRNA genes. Surface samples were collected from four sites, namely elevator buttons (EB), bank machine keyboard buttons (BMKB), restroom surfaces, and the employee biometric time clock system (EBTCS), in a large public and teaching hospital in São Paulo. Taxonomical composition revealed the abundance of Firmicutes phyla, followed by Actinobacteria and Proteobacteria, with a total of 926 bacterial families and 2832 bacterial genera. Moreover, our analysis revealed the presence of some potential pathogenic bacterial genera, including Salmonella enterica, Klebsiella pneumoniae, and Staphylococcus aureus. The presence of these pathogens in frequently used surfaces enhances the risk of exposure to any susceptible individuals. Some of the factors that may contribute to the richness of bacterial diversity on these surfaces are poor personal hygiene and ineffective routine schedules of cleaning, sanitizing, and disinfecting. Strict standards of infection control in hospitals and increased public education about hand hygiene are recommended to decrease the risk of transmission in hospitals among patients. PMID:26805866
Tairacan Augusto Pereira da Fonseca
Full Text Available Frequently used hand-touch surfaces in hospital settings have been implicated as a vehicle of microbial transmission. In this study, we aimed to investigate the overall bacterial population on four frequently used surfaces using a culture-independent Illumina massively parallel sequencing approach of the 16S rRNA genes. Surface samples were collected from four sites, namely elevator buttons (EB, bank machine keyboard buttons (BMKB, restroom surfaces, and the employee biometric time clock system (EBTCS, in a large public and teaching hospital in São Paulo. Taxonomical composition revealed the abundance of Firmicutes phyla, followed by Actinobacteria and Proteobacteria, with a total of 926 bacterial families and 2832 bacterial genera. Moreover, our analysis revealed the presence of some potential pathogenic bacterial genera, including Salmonella enterica, Klebsiella pneumoniae, and Staphylococcus aureus. The presence of these pathogens in frequently used surfaces enhances the risk of exposure to any susceptible individuals. Some of the factors that may contribute to the richness of bacterial diversity on these surfaces are poor personal hygiene and ineffective routine schedules of cleaning, sanitizing, and disinfecting. Strict standards of infection control in hospitals and increased public education about hand hygiene are recommended to decrease the risk of transmission in hospitals among patients.
Lilian Andreia Fleck Reinato
Full Text Available OBJECTIVE: to evaluate the prevalence of nasal colonization with Staphylococcus aureus in individuals with HIV/AIDS under inpatient treatment in a teaching hospital in the state of São Paulo (Brazil. METHOD: a cross-sectional study undertaken in two units specialized in attending people living with HIV/AIDS, in the period August 2011 - July 2012. Socio-demographic and clinical data was collected through individual interviews and from the medical records; samples of nasal secretion were collected with Stuart swabs on the first day of inpatient treatment. Ethical aspects were respected. RESULT: of the 229 individuals with HIV/AIDS hospitalized in this period, 169 participated in the study, with Staphylococcus aureus being identified in the culture tests of 46 (27.2% of the individuals, resistance to oxacillin being evidenced in 10 (21.8% participants. CONCLUSION: the results of the research indicate that the prevalence of colonization with Staphylococcus aureus in individuals with HIV/AIDS in the specialized units was considered relevant, possibly contributing to future investigations and, moreover, to the implementation of measures to prevent and control this pathogen in this population.
Silveria, P V; Nishioka, S de A
A retrospective survey of 473 cases of snake bite admitted to a Brazilian teaching hospital from 1984 to 1990 revealed 91 cases of bite without envenoming and/or caused by non-venomous snakes. In 17 of these cases the snake was identified, and one patient was bitten by a snake-like reptile (Amphisbaena mertensii). In 43 cases diagnosis was made on clinical grounds (fang marks in the absence of signs of envenoming). The other 30 cases were of patients who complained of being bitten but who did not show any sign of envenoming or fang mark. Most cases occurred in men (66;73%), in the 10-19 years age group (26;29%), in the lower limbs (51/74;69%), between 6 A. M. and 2 P.M. (49;61%) and in the month of April (16;18%). One patient bitten by Philodryas olfersii developed severe local pain, swelling and redness at the site of the bite, with normal clotting time. The patient bitten by Drymarcon corais was misdiagnosed as being bitten by a snake of the genus Bothrops, was given the specific antivenom, and developed anaphylaxis. One patient bitten by Sibynomorphus mikanii presented prolonged clotting time, and was also given antivenom as a case of Bothrops bite. Correct identification of venomous snakes by physicians is necessary to provide correct treatment to victims of snake bite, avoiding unnecessary distress to the patient, and overprescription of antivenom, which may eventually cause severe untoward effects. PMID:1342117
Daniela Oliveira Melo
Full Text Available This study proposes to measure frequency and to characterize the profile of potential drug interactions (pDDI in a general medicine ward of a teaching hospital. Data about identification and clinical status of patients were extracted from medical records between March to August 2006. The occurrence of pDDI was analyzed using the database monographs Micromedex® DrugReax® System. From 5,336 prescriptions with two or more drugs, 3,097 (58.0% contained pDDI. The frequency of major and well document pDDI was 26.5%. Among 647 patients, 432 (66.8% were exposed to at least one pDDI and 283 (43.7% to major pDDI. The multivariate analysis identified that factors related to higher rates of major pDDI were the same age (p< 0.0001, length of stay (p< 0.0001, prevalence of hypertension [OR=3.42 (p< 0.0001] and diabetes mellitus [OR=2.1 (p< 0.0001], cardiovascular diseases (p< 0.0001 and the number of prescribed drugs (Spearman’s correlation=0.640622, p< 0.0001. Between major pDDI, the main risk was hemorrhage (50.3%, the most frequent major pDDI involved combination of anticoagulants and antiplatelet drugs. Among moderate pDDI, 3,866 (90.8% involved medicines for the treatment of chronic non-communicable diseases, mainly hypertension. In HU-USP, the profile of pDDI was similar among adults and elderly (the most frequent pDDI and major pDDI were same, the difference was only the frequency in either group. The efforts of the clinical pharmacists should be directed to elderly patients with cardiovascular compromise, mainly in use of anticoagulants and antiplatelet drugs. Furthermore, hospital managers should increase the integration between levels of health care to promote safety patient after discharge.Keywords: Drug interactions. Aged. Internal Medicine. Hospitals, University. RESUMOInterações medicamentosas potenciais em um hospital escolar brasileiro: diferenças relacionadas à idade?O estudo tem por objetivo descrever o perfil de intera
Paulo E Marchiori
Full Text Available OBJECTIVES: This study was undertaken to characterize the neuroinfection profile in a tertiary neurological ward. INTRODUCTION: Neuroinfection is a worldwide concern and bacterial meningitis, tetanus and cerebral malaria have been reported as the commonest causes in developing countries. METHODS: From 1999 to 2007, all patients admitted to the Neurology Ward of Hospital das Clínicas, São Paulo University School of Medicine because of neuroinfection had their medical records reviewed. Age, gender, immunological status, neurological syndrome at presentation, infectious agent and clinical outcome were recorded. RESULTS: Three hundred and seventy four cases of neuroinfectious diseases accounted for 4.2% of ward admissions and the identification of infectious agent was successful in 81% of cases. Mean age was 40.5 + 13.4 years, 63.8% were male, 19.7% were immunocompromised patients and meningoencephalitis was the most common clinical presentation despite infectious agent. Viruses and bacteria were equally responsible for 29.4% of neuroinfectious diseases; parasitic, fungal and prion infections accounted for 28%, 9.6% and 3.5% respectively. Human immunodeficiency virus (HIV, herpes simplex virus 1 (HSV1, Mycobacterium tuberculosis, Treponema pallidum, Taenia solium, Schistosoma mansoni, Cryptococcus neoformans and Histoplasma capsulatum were the more common infectious pathogens in the patients. Infection mortality rate was 14.2%, of which 62.3% occurred in immunocompetent patients. CONCLUSION: Our institution appeared to share some results with developed and developing countries. Comparison with literature may be considered as quality control to health assistance.
Flávia Alves Ferreira Rossini
Full Text Available INTRODUCTION: Vancomycin-resistant enterococci (VRE can colonize or cause infections in high-risk patients and contaminate the environment. Our objective was to describe theepidemiological investigation of an outbreak of VRE, the interventions made, and their impact on its control. METHODS: We conducted a retrospective, descriptive, non-comparative study by reviewing the charts of patients with a VRE-positive culture in the University Hospital of Campinas State University, comprising 380 beds, 40 of which were in intensive care units (ICUs, who were admitted from February 2008-January 2009. Interventions were divided into educational activity, reviewing the workflow processes, engineering measures, and administrative procedures. RESULTS: There were 150 patients, 139 (92.7% colonized and 11 (7.3% infected. Seventy-three percent were cared for in non-ICUs (p = 0.028. Infection was more frequent in patients with a central-line (p = 0.043, mechanical ventilation (p = 0.013, urinary catheter (p = 0.049, or surgical drain (p = 0.049. Vancomycin, metronidazole, ciprofloxacin, and third-generation cephalosporin were previously used by 47 (31.3%, 31 (20.7%, 24 (16%, and 24 (16% patients, respectively. Death was more frequent in infected (73% than in colonized (17% patients (p < 0.001. After the interventions, the attack rate fell from 1.49 to 0.33 (p < 0.001. CONCLUSIONS: Classical risk factors for VRE colonization or infection, e.g., being cared for in an ICU and previous use of vancomycin, were not found in this study. The conjunction of an educational program, strict adhesion to contact precautions, and reinforcement of environmental cleaning were able to prevent the dissemination of VRE.
Ferraz, Valéria de Souza
The Brazilians image is often associated with sympathy and joy. However these characteristics do not necessarily make them hospitable. To be hospitable it´s not just have a smile or be helpful, you must have hospitability, that is, the ability to offer hospitality. Hospitality is a social phenomenon that manifests in the domestic, commercial or public context. It is believed that the Brazilian has a natural talent for the domestic hospitality, which extends somehow into the ...
Valéria Cataneli Pereira
Full Text Available Objective: To determine, by phenotypic and genotypic methods, oxacillin susceptibility in Staphylococcus aureus strains isolated from pediatric and neonatal intensive care unit patients seen at the University Hospital of the Botucatu School of Medicine.Methods: A total of 100 S. aureus strains isolated from the following materials were studied: 25 blood cultures, 21 secretions, 12 catheters, 3 cannulae and one chest drain from 62 patients in the neonatal unit, and 36 blood cultures, one pleural fluid sample and one peritoneal fluid sample from 38 patients in the pediatric unit. Resistance of the S. aureus isolates to oxacillin was evaluated by the disk diffusion method with oxacillin (1 μg and cefoxitin (30 μg, agar screening test using Mueller-Hinton agar supplemented with 6 μg/ml oxacillin and 4% NaCl, and detection of the mecA gene by PCR. In addition, the isolates were tested for β-lactamase production using disks impregnated with Nitrocefin and hyperproduction of β-lactamase using amoxicillin (20 μg and clavulanic acid (10 μg disks.Results: Among the 100 S. aureus strains included in the study, 18.0% were resistant to oxacillin, with 16.1% MRSA being detected in the neonatal unit and 21.0% in the pediatric unit. The oxacillin (1 μg and cefoxitin (30 μg disk diffusion methods presented 94.4% and 100% sensitivity, respectively, and 98.8% specificity. The screening test showed 100% sensitivity and 98.8% specificity. All isolates produced β-lactamase and one of these strains was considered to be a hyperproducer.Conclusions: The 30 μg cefoxitin disk diffusion method presented the best result when compared to the 1 μg oxacillin disk. The sensitivity of the agar screening test was similar to that of the cefoxitin disk diffusion method and higher than that of the oxacillin disk diffusion method. We observed variations in the percentage of oxacillin-resistant isolates during the study period, with a decline over the last years which
Sheyla Maria Lemos Lima
Full Text Available São discutidas as possibilidades e os limites da contratualização para a melhoria do desempenho, o incremento da prestação de contas, o aprimoramento da gestão, a melhoria da assistência e a maior inserção dos hospitais de ensino na rede de serviços no âmbito do Programa de Reestruturação dos Hospitais de Ensino no Sistema Único de Saúde/SUS. Quatro hospitais contratados e suas secretarias contratantes são entrevistados. Segundo os dirigentes de hospitais, é frágil a associação entre contratualização e a presença de mecanismos de inserção na rede, de práticas e estruturas de qualificação assistencial e gerencial nos hospitais. Hospitais mais estruturados assistencial e gerencialmente apresentaram uma contratualização mais estruturada com a secretaria. Houve um aumento de produção da média complexidade ambulatorial e uma diminuição dos procedimentos de atenção básica em todos os hospitais. Sugere-se o desenvolvimento gerencial contínuo do hospital e da secretaria, a revisão do plano operativo, orçamento, mecanismos de monitoramento e sistema de incentivos, pactuação com as equipes, dentre outros.This study identifies the potential and limitations of contracting to improve health care management, accountability and quality, and expand the participation of teaching hospitals in the health service network in the context of the Restructuring Program of Teaching Hospitals in the Brazilian Unified Health System. It is a case study of four teaching hospitals and their contracting State Health Departments. According to the hospital managers, the association is weak between contracting and the presence of mechanisms for hospital insertion into the health service network with practices and structures for managerial and healthcare qualification in the hospital. More structured hospitals in managerial and healthcare terms were more structured between contracting and the State Health Department. There was an increase
Non-venomous snake bite and snake bite without envenoming in a brazilian teaching hospital: analysis of 91 cases Acidentes por serpentes não-peçonhentas e acidentes por serpentes peçonhentas sem envenenamento em hospital universitário brasileiro: análise de 91 casos
Paulo Vitor Portella Silveira; Sérgio de Andrade Nishioka
A retrospective survey of 473 cases of snake bite admitted to a Brazilian teaching hospital from 1984 to 1990 revealed 91 cases of bite without envenoming and/or caused by non-venomous snakes. In 17 of these cases the snake was identified, and one patient was bitten by a snake-like reptile (Amphisbaena mertensii). In 43 cases diagnosis was made on clinical grounds (fang marks in the absence of signs of envenoming). The other 30 cases were of patients who complained of being bitten but who did...
Joice Mara Cruciol-Souza
Full Text Available PURPOSE: Although drug-drug interactions constitute only a small proportion of adverse drug reactions, they are often predictable and therefore avoidable or manageable. There are few studies on drug-drug interactions from Brazil. This study aimed to assess the frequency of drug-drug interactions in prescriptions and their potential clinical significance in patients of a Brazilian teaching hospital. METHODS: From January to April 2004, a sample of 1785 drug prescriptions was drawn from a total of 11,250. Drug-drug interactions were identified by using Micromedex® DrugReax® System. Patients'records with major drug-drug interactions were reviewed by a pharmacist and a medical doctor looking for signs, symptoms, and lab tests that could indicate adverse drug reactions due to such interactions. RESULTS: From the 1785 prescriptions examined, 1089 (61% were from the male adult ward. Patients' average age was 52.7 years (SD = 18.9; range, 12-98. The median number of drugs in each prescription was 7 (range, 2-26. At least 1 drug-drug interactions was present in 887 (49.7% prescriptions. Regarding the severity of the clinical result, the interactions were classified as minor (20; 2.3%, moderate (184; 20.7%, major (30; 3.4%, and undetermined because of an incidence of more than 1 interaction in a single patient (653; 73.6%. From the 30 patients with major interactions, 17 (56.7% presented adverse drug reactions induced by exposure to a major drug-drug interaction. CONCLUSIONS: Patients did suffer adverse drug reactions from major drug-drug interactions. Many physicians may be unaware of drug-drug interactions. Education, computerized prescribing systems and drug information, collaborative drug selection, and pharmaceutical care are strongly encouraged for physicians and pharmacists.INTRODUÇÃO: Embora as interações medicamentosas constituam uma pequena parcela das reações adversas a medicamentos, elas geralmente são previsíveis e às vezes podem
Camila Carrillo; Heloisa Vizeu; Luis Alberto Soares-Júnior; Marcelo Fava; Vicente Odone Filho
OBJECTIVES: The objective of this paper was to characterize the population seen at the dentistry unit of the hematology-oncology service of the Oncology-Hematology Service, Instituto da Criança at the Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo. Oral problems resulting from cancer therapy increase the risk of infection, length of hospital stay, treatment cost and negative impact on the course and prognosis of the disease. METHOD: Of the 367 medical records of cance...
Fink, Daniel J.
University teaching hospitals face increasing competition from community hospitals, expanding regulation of health care, consumerism, and a declining urban population base. New marketing strategies are seen as ways in which teaching hospitals can achieve better relationships with institutions, practitioners, and surrounding communities and…
José Weber Vieira de Faria
Full Text Available This study aimed at observing aspects of epidemiology in order to investigate the use of alcohol in patients older than 18 with severe and moderate traumatic brain injury, which were attended in the Clinics Hospital of the University of Uberlândia. Positive alcoholemy was found in 39.3% of the patients. Of the 33 positive exams alcoholemy was found higher than 60 mg/dL in 28 (84.6%. There was not significant relation between alcoholemy levels and trauma severity. The major prevalence occurred on Saturdays nights. The most frequent types of external causes were transportation accidents (64.74 followed by accidental falls (17.27% and physical aggression (16.55%. 93.9% of the patients with positive alcoholemy were men aged 20-29. 24.2% of the ones with positive alcoholemy died yet no significant difference was found in the study of the ones with negative alcoholemy (n=51 (p=0.93; RR= 0.9; IC95%=0.40-2.08.Os objetivos deste estudo são investigar aspectos da epidemiologia e identificar o uso de álcool em pacientes com traumatismo craniencefálico grave e moderado em maiores de 18 anos atendidos no Hospital de Clínicas da Universidade Federal de Uberlândia. Encontrou-se alcoolemia positiva em 39,3% dos pacientes. Nos 33 exames positivos, foram observadas alcoolemias superiores a 60 mg/dL em 28 (84,6%. Não houve relação significativa entre os níveis de alcoolemia e a gravidade do trauma. Maior prevalência ocorreu aos sábados, no período noturno. Os tipos de causa externa mais frequentes foram os acidentes de transporte (64,74%, seguidos de quedas acidentais (17,27% e de agressões (16,55%. Dos pacientes com alcoolemia positiva, 93,9% eram do sexo masculino, com maior prevalência dos 20 aos 29 anos. Dentre aqueles com alcoolemia positiva, 24,2% vieram a falecer, não havendo diferença significante com os pacientes com alcoolemia negativa (n=51 (p=0,93; RR= 0,9; IC95%=0,40-2,08.
Antônio Artur de Souza
Full Text Available This paper presents the results of a research that aimed at developing a financial analysis of a sample of Brazilian hospitals between 2006 and 2011. The data were collected from financial statements of 23 hospitals and from the Database of United Health System. These secondary data were analyzed through the following techniques: descriptive statistics, Spearman’s correlation, Kolmogorov-Smirnov’s test, Kruskal-Wallis’ test and Chi-square’s test. It was verified that the sample presents unsatisfactory general results about financial performance, especially when related to financial ratios of profitability and return. However, the analysis of different categories of hospitals displays relevant and significant divergences, especially about the type of hospitals: publics and voluntaries ones. The voluntary hospitals present higher liquidity ratios and the best profitability and their capital structure usually focus on long term financing obtained from external agents. These evidences suggest that those organizations focus on financial leverage to achieve better results without deteriorate their liquidity. On the other hand, the public hospitals present lower liquidity as well as worse profitability and return ratios. It was verified that the large-sized hospitals usually present lower financial ratios (liquidity, profitability and return than the medium-sized hospitals.
Vale, Eucléa Gomes; Fernandes, Josicelia Dumêt
The present study shows some of the most relevant actions of the Brazilian Association of Nursing in favor of the education process of the nursing professionals in Brazil, contextualizing those actions in the historical moment in which they occurred. In this manner, the study represents not only production of knowledge in the field, but also an element of record of the history of undergraduate nursing teaching in Brazil, offering instruments of analysis of the current situation of this teaching. The text highlights the contributions of the Brazilian Association of Nursing (ABEn) in the education process of the nursing professionals, and in the elaboration and sustainability of the National Curricular Guidelines of the Undergraduate Nursing Course. PMID:17165386
Two of London's three major teaching hospitals joined forces recently to form Canada's second-largest teaching hospital. The merger is considered a harbinger as teaching hospitals strive to maintain current teaching, research and clinical activities in the face of decreasing government spending.
Thier, Samuel O; Kelley, William N; Pardes, Herbert; Knight, Amy Wimpey; Wietecha, Mark
Merger has served as a major strategy for the leaders of academic medical centers (i.e., teaching hospitals) who are pursuing health system development for their institutions. Applying hindsight to their personal experience, the authors explore common themes in several mergers that have survived the test of time. Although many elements influence merger outcomes, experience suggests several of unique importance. These include effective leadership in the areas of creating trust, managing uncertainty, ensuring medical staff stability, and bridging cultural divides across the organizations. While a quantitative business case should support any merger, the authors' experiences underscore the importance of successfully assessing and managing organizational and individual dynamics when bringing together major teaching hospitals. PMID:24362373
Non-venomous snake bite and snake bite without envenoming in a brazilian teaching hospital: analysis of 91 cases Acidentes por serpentes não-peçonhentas e acidentes por serpentes peçonhentas sem envenenamento em hospital universitário brasileiro: análise de 91 casos
Paulo Vitor Portella Silveira
Full Text Available A retrospective survey of 473 cases of snake bite admitted to a Brazilian teaching hospital from 1984 to 1990 revealed 91 cases of bite without envenoming and/or caused by non-venomous snakes. In 17 of these cases the snake was identified, and one patient was bitten by a snake-like reptile (Amphisbaena mertensii. In 43 cases diagnosis was made on clinical grounds (fang marks in the absence of signs of envenoming. The other 30 cases were of patients who complained of being bitten but who did not show any sign of envenoming or fang mark. Most cases occurred in men (66;73%, in the 10-19 years age group (26;29%, in the lower limbs (51/74;69%, between 6 A. M. and 2 P.M. (49;61% and in the month of April (16; 18%. One patient bitten by Philodryas olfersii developed severe local pain, swelling and redness at the site of the bite, with normal clotting time. The patient bitten by Drymarcon corais was misdiagnosed as being bitten by a snake of the genus Bothrops, was given the specific antivenom, and developed anaphylaxis. One patient bitten by Sibynomorphus mikanii presented prolonged clotting time, and was also given antivenom as a case of Bothrops bite. Correct identification of venomous snakes by physicians is necessary to provide correct treatment to victims of snake bite, avoiding unnecessary distress to the patient, and overprescription of antivenom, which may eventually cause severe untoward effects.Um levantamento retrospectivo de 473 casos de acidentes ofídicos admitidos em um hospital-escola brasileiro de 1984 a 1990 revelou 91 casos sem envenenamento e/ou causados por serpentes não-peçonhentas. Em 17 casos a serpente foi identificada e um paciente foi mordido por um réptil que se assemelha às serpentes (Amphisbaena mertensii. Em 43 casos o diagnóstico foi clínico (sinal das presas na ausência de sinais de envenenamento. Os demais 30 casos foram de pacientes que se queixavam de terem sido mordidos mas que não apresentavam nem sinal de
Dann, W L
Increasingly, British medical schools are using hospitals other than designated teaching hospitals for the provision of undergraduate clinical experience. This paper reports upon a study which compared students' experience in 'peripheral' and 'teaching' hospitals. Students report greater involvement in peripheral hospital firms and a more encouraging atmosphere. They gain more experience of practical procedures in these hospitals, and devote more time to ward and operating theatre work. More ...
Douglas, Jeffrey S.
The Virginia-Maryland Regional College of Veterinary Medicine's Veterinary Teaching Hospital has introduced a new radioactive iodine therapy for an endocrine disorder that commonly affects older cats.
Pedro Gabriel Melo de Barros e Silva
Full Text Available ABSTRACT OBJECTIVE: To report the initial changes after quality-improvement programs based on STS-database in a Brazilian hospital. METHODS: Since 2011 a Brazilian hospital has joined STS-Database and in 2012 multifaceted actions based on STS reports were implemented aiming reductions in the time of mechanical ventilation and in the intensive care stay and also improvements in evidence-based perioperative therapies among patients who underwent coronary artery bypass graft surgeries. RESULTS: All the 947 patients submitted to coronary artery bypass graft surgeries from July 2011 to June 2014 were analyzed and there was an improvement in all the three target endpoints after the implementation of the quality-improvement program but the reduction in time on mechanical ventilation was not statistically significant after adjusting for prognostic characteristics. CONCLUSION: The initial experience with STS registry in a Brazilian hospital was associated with improvement in most of targeted quality-indicators.
Electricity demands in hospitals are characterized by their need for high quality, guaranteed supplies. The existence of captive electricity uses and the size and regularity of the electrical and heat loads required by hospitals are aspects that could well buttress the possibility of installing cogeneration plants fired by natural gas (CHP). The purpose of this paper is to estimate the CHP technical potential in Brazilian hospitals. Based on a classification of Brazilian hospitals by specific energy consumption indicators, this potential is assessed, taking into consideration gas fueled engines associated with absorption cooling systems. A potential figure of approximately 500 MWe was obtained, whose effective implementation runs up against the obstacles inherent to Brazil's hospital sector, listed at the end of this paper. Consequently, some actions are proposed for surmounting these barriers
Rudimar Antunes da Rocha
Full Text Available The article deals with the Hospital Accreditation as a quality parameter of hospitals in Brazil and the world. The focus was to identify how the hospitals of the host cities of the FIFA World Cup in 2014 are classified by the National Accreditation Organization (ONA and Joint Commission on Accreditation of Hospitals (JCI - the Brazilian Consortium for Accreditation (CBA. The Brazilian Manual of Accreditation establishes three stamps of hospital quality: Level 1: Accredited, Level 2: Fully Accredited and Level 3: Accredited with Excellence. From the methodological point of view the study was regarded as an exploratory approach, with a kind psychographic survey, with the intentional collection of data, ie the host cities. The research had a qualitative and quantitative treatment. Data were collected during March and April 2011 through the official websites of the ONA, JCI-CBA and FIFA on the Internet. It was concluded that the cities of Sao Paulo, Rio de Janeiro and Belo Horizonte are the best prepared in time for hospital accreditation by ONA and / or JCI-CBA. The hospitals of other offices need to create mechanisms to achieve a quality accreditation of types urgently. Only thus will avoid the negative image of the Brazilian health services to foreigners who, by bad luck, requiring medical and hospital during the World Cup 2014.
Dov C. Goldenberg, MD, PhD; Gal M. Dini, MD, PhD; Max D. Pereira, MD, PhD; Augusto Gurgel, MD; Endrigo O. Bastos, MD; Purushottam Nagarkar, MD; Rolf Gemperli, MD, PhD; Lydia M. Ferreira, MD, PhD
Background: Soccer is the most popular sport in Brazil and a high incidence of related trauma is reported. Maxillofacial trauma can be quite common, sometimes requiring prolonged hospitalization and invasive procedures. To characterize soccer-related facial fractures needing surgery in 2 major Brazilian Centers. Methods: A retrospective review of trauma medical records from the Plastic Surgery Divisions at the Universidade Federal de São Paulo–Escola Paulista de Medicina and the Hospital das ...
Hjelm, N M; Lee, J C K; Cheng, D; Chui, C
The planning and installation of a telemedicine system for communication within a teaching hospital and its academic and hospital units with a capacity for accommodation of up to 400 video-stations is described. The system is intended for improving the communication between patients and health professionals, and between the health professionals themselves. It also provides the basis for improving pre-graduate teaching, especially problem-based learning, and all aspects of postgraduate teaching. PMID:12052428
Junqueira, Joao Carlos
This study investigates how the Pierre Verger Cultural Space (PVCS), an educational organization dedicated to teaching Afro-Brazilian culture in Bahia, uses music to construct a sense of Afro-Brazilian self. Located in a poverty-stricken neighborhood of Salvador, Bahia, the PVCS sees its mission as "rescuing" ("resgatar") an Afro-Brazilian sense…
Many therapeutic, diagnostic and prophylactic procedures used in hospitals are of potential genetic risk. An evaluation was made of genotoxic occupational risk in 42 workers from the Hospital de Clínicas de Porto Alegre, RS, Brazil, who had been occupationally exposed to lead (solder), ethylene oxide (sterilization area), antineoplastic drugs (nurses and pharmacists) or ionizing radiation. They were compared with 42 unexposed individuals. There was an increase in the frequency of binucleated ...
Preventing catheter-associated infections in the Pediatric Intensive Care Unit: impact of an educational program surveying policies for insertion and care of central venous catheters in a Brazilian teaching hospital
Marcelo Luiz Abramczyk
Full Text Available Objectives: To determine the impact of an educational program on the prevention of central venous catheter-related infections in a Brazilian Pediatric Intensive Care Unit. Patients and Methods: All patients admitted to the unit between February 2004 and May 2005 were included in the cohort study in a longitudinal assessment. An educational program was developed based on the Centers for Disease Control and Prevention recommendations for prevention of catheter-associated infections and was adapted to local conditions and resources after an initial observational phase. Incidence of catheter-associated infections was measured by means of on-site surveillance. Results: One hundred eighteen nosocomial infections occurred in 253 patients (46.6 infections per 100 admissions and in 2,954 patient-days (39.9 infections per 1,000 patient-days. The incidence-density of catheter infections was 31.1 episodes per 1.000 venous central catheter-days before interventions, and 16.5 episodes per 1,000 venous central catheter-days afterwards (relative risk 0.53 [95% CI 0.28-1.01]. Corresponding rates for exit-site catheter infections were 8.0 and 2.5 episodes per 1,000 venous central catheter-days [0.32 (0.07-1.49], and the rates for bloodstream infections were 23.1 and 13.9 episodes per 1,000 venous central catheter-days, before and after interventions [0.61 (0.32-1.14]. Conclusion: A prevention strategy targeted at the insertion and maintenance of vascular access can decrease rates of vascular-access infections in pediatric intensive care unit.
Beginning in June 2009, the Virginia-Maryland Regional College of Veterinary Medicine at Virginia Tech's Veterinary Teaching Hospital will introduce a new outpatient advanced imaging service for surrounding small animal veterinarian practices.
Arthur C Onwuchekwa; Godspower E Asekomeh
Arthur C Onwuchekwa, Godspower E AsekomehDepartment of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, NigeriaBackground: Congestive cardiac failure (CCF) has emerged as a major public health problem worldwide and imposes an escalating burden on the health care system. Objective: To determine the causes and mortality rate of CCF in the University of Port Harcourt Teaching Hospital (UPTH), south Nigeria, over a five-year period f...
Robert S. Huckman; Jason Barro
The impact of labor turnover on productivity has received a great deal of attention in the literature on organizations. We consider the impact of cohort turnover -- the simultaneous exit of a large number of experienced employees and a similarly sized entry of new workers -- on productivity in the context of teaching hospitals. In particular, we examine the impact of the annual July turnover of house staff (i.e., residents and fellows) in American teaching hospitals on levels of resource util...
Full Text Available Abstract Tuberculosis (TB is considered an occupational disease among health-care workers (HCWs. Direct contact with TB patients leads to an increased risk to become latently infected by Mycobacterium tuberculosis. The objective of this study is to estimate the prevalence of latent M. tuberculosis minfection among nursing professionals of a hospital in Rio Grande do Sul, Brazil, assessed by tuberculin skin test (TST. From November 2009 to May 2010, latent M. tuberculosis infection was assessed by TST in 55 nursing professionals. Epidemiological information was collected using a standardized questionnaire. A positive TST result (> or = 10 mm was observed in 47.3% of the HCWs tested. There was no significant difference in TST positivity when duration of employment or professional category (technician or nurse was evaluated. The results of this work reinforce the need for control measures to prevent latent M. tuberculosis infection among nursing professionals at the hospital where the study was conducted.
Hayes, O W
Classroom facilities in teaching hospitals have evolved from simple rooms with blackboards to sophisticated amphitheaters with high-tech audiovisual equipment. This article presents a "blueprint," which was used in an osteopathic hospital, to renovate existing space into classrooms that are conducive to learning. PMID:8349484
Juliana Mika Kato
Full Text Available Objective: to analyze the epidemiology, clinical features and survival rate of patients undergoing orbital exenteration (OE in a tertiary referral hospital. Methods : we conducted a retrospective study of all patients undergoing OE at the Hospital das Clínicas, FMUSP between January 2007 and December 2012. We collected data records related to gender, age, origin, length of stay, duration of the disease, other treatments related to the disease, number of procedures outside of the face related to the disease, follow-up and histological diagnosis. Results : we treated 37 patients in the study period. The average survival in one year was 70%, in two years, 66.1%, and 58.3% in three years. There was no significant difference in the one-year survival related to histological diagnosis (p=0.15, days of hospitalization (p=0.17, gender (p=0.43, origin (p=0.78, disease duration (p=0.27 or the number of operations for the tumor (p=0.31. Mortality was higher in elderly patients (p=0.02. The average years of life lost was 33.9 in patients under 60 years, 14.7 in patients in the 61-80 years range and 11.3 in patients over 80 years. Conclusion : the present series of cases is significant in terms of prevalence of orbital exenteration; on the other hand, it shows one of the lowest survival rates in the literature. This suggests an urgent need for improved health care conditions to prevent deforming, radical resections.
Sharbel Weidner Maluf
Full Text Available Many therapeutic, diagnostic and prophylactic procedures used in hospitals are of potential genetic risk. An evaluation was made of genotoxic occupational risk in 42 workers from the Hospital de Clínicas de Porto Alegre, RS, Brazil, who had been occupationally exposed to lead (solder, ethylene oxide (sterilization area, antineoplastic drugs (nurses and pharmacists or ionizing radiation. They were compared with 42 unexposed individuals. There was an increase in the frequency of binucleated cytochalasin-blocked lymphocytes with micronuclei, though it was not significant (P = 0.058. The groups exposed to antineoplastic drugs and radiation had a significant increase in micronuclei frequency (P = 0.038 and P = 0.022, respectively. The high frequencies of dicentric bridges suggest the action of clastogenics in these two groups. These results suggest that the safety procedures adopted were very important to protect workers from exposure to mutagenic agents and should be improved in the radiological and chemotherapeutical areas.Vários procedimentos terapêuticos, diagnósticos e profiláticos usados em hospitais apresentam um risco genético. Para avaliar o risco genotóxico ocupacional, 42 trabalhadores do Hospital de Clínicas de Porto Alegre, RS, Brasil, ocupacionalmente expostos a chumbo (uso de soldas, óxido de etileno (área de esterilização, drogas antineoplásicas (enfermeiros e farmacêuticos e radiação ionizante foram comparados com 42 indivíduos não expostos. A análise de linfócitos binucleados apresentou um aumento estatisticamente não significativo (P = 0.058 na freqüência de micronúcleos. Quando analisados separadamente, os grupos expostos a drogas antineoplásicas e radiação ionizante apresentaram um aumento estatisticamente significativo (P = 0.038 e P = 0.0217, respectivamente na freqüência de micronúcleos. As freqüências de pontes dicêntricas e anomalias de fuso sugerem a ação de clastogênicos nestes dois
Loureiro, Natalia I. V.; Viana, Henrique V.; Rodrigues, Carlos R.; Cabral, Lucio Mendes; Silva, Thais D. N.; Cardoso, Fernanda Serpa; Santos, Dilvani Oliveira; Castro, Helena C.
Changes are occurring within Brazilian institutes of higher education; currently several universities are reviewing their course offerings and teaching approaches to determine if they meet the needs of today's undergraduate students. When changes are made to the curriculum of experimental courses, there should be an understood guarantee that all…
Reis Adriana O.
Full Text Available The emergence of vancomycin-resistant enterococci (VRE has been described recently in Brazil. This is in contrast to the USA and Europe, where the VRE appeared in the late 1980s. The progressive increase in VRE isolation poses important problems in the antimicrobial therapy of nosocomial infections. Treatment options and effective antimicrobial agents for VRE are often limited and the possibility of transfer of vancomycin genes to other Gram-positive microorganisms continues. In the search for antimicrobial agents for multiresistant Gram-positive cocci, compounds such as linezolid and quinupristin/dalfopristin have been evaluated. The present study was conducted to evaluate the in vitro activity of the oxazolidinone linezolid and 10 other antimicrobial agents, including quinupristin-dalfopristin, against multiresistant enterococci isolated in Brazilian hospitals. Thirty-three vancomycin resistant isolates (17 Enterococcus faecium and 16 E. faecalis, were analyzed. Strains were isolated from patients at São Paulo Hospital, Oswaldo Cruz Hospital, Hospital do Servidor Público Estadual, Santa Marcelina Hospital, Santa Casa de Misericórdia de São Paulo, and Hospital de Clínicas do Paraná. The samples were tested by a broth microdilution method following the National Committee for Clinical Laboratory Standards (NCCLS recommendations. All isolates were molecular typed using pulsed-field gel electrophoresis (PFGE. Linezolid was the most active compound against these multiresistant enterococci, showing 100% inhibition at the susceptible breakpoints. Quinupristin/dalfopristin and teicoplanin showed poor activity against both species. The molecular typing results suggest that there has been interhospital spread of vancomycin resistant E. faecium and E. faecalis among Brazilian hospitals. The results of this study indicate that linezolid is an appropriate therapeutic option for the treatment of vancomycin-resistant enterococci infections in Brazil.
Reis, A O; Cordeiro, J C; Machado, A M; Sader, H S
The emergence of vancomycin-resistant enterococci (VRE) has been described recently in Brazil. This is in contrast to the USA and Europe, where the VRE appeared in the late 1980s. The progressive increase in VRE isolation poses important problems in the antimicrobial therapy of nosocomial infections. Treatment options and effective antimicrobial agents for VRE are often limited and the possibility of transfer of vancomycin genes to other Gram-positive microorganisms continues. In the search for antimicrobial agents for multiresistant Gram-positive cocci, compounds such as linezolid and quinupristin/dalfopristin have been evaluated. The present study was conducted to evaluate the in vitro activity of the oxazolidinone linezolid and 10 other antimicrobial agents, including quinupristin-dalfopristin, against multiresistant enterococci isolated in Brazilian hospitals. Thirty-three vancomycin resistant isolates (17 Enterococcus faecium and 16 E. faecalis), were analyzed. Strains were isolated from patients at São Paulo Hospital, Oswaldo Cruz Hospital, Hospital do Servidor Público Estadual, Santa Marcelina Hospital, Santa Casa de Misericórdia de São Paulo, and Hospital de Clínicas do Paraná. The samples were tested by a broth microdilution method following the National Committee for Clinical Laboratory Standards (NCCLS) recommendations. All isolates were molecular typed using pulsed-field gel electrophoresis (PFGE). Linezolid was the most active compound against these multiresistant enterococci, showing 100% inhibition at the susceptible breakpoints. Quinupristin/dalfopristin and teicoplanin showed poor activity against both species. The molecular typing results suggest that there has been interhospital spread of vancomycin resistant E. faecium and E. faecalis among Brazilian hospitals. The results of this study indicate that linezolid is an appropriate therapeutic option for the treatment of vancomycin-resistant enterococci infections in Brazil. PMID:11779450
Ramona Fernanda Ceriotti Toassi
Full Text Available The aim of this study was to analyze the role of teaching at primary healthcare services within the Brazilian National Health System (SUS in dentists' training, at a public university in the south of Brazil. A qualitative methodological approach (case study was used. Interviews were conducted with 12 dentistry students, six dentists who were preceptors working in public primary healthcare services and three teachers connected with this curricular training. Our findings showed that the curricular training in SUS primary healthcare services had an impact on the dentists' education through establishment of bonds, autonomy in problem-solving and multiprofessional teamwork. It was seen that they learned about how healthcare services function, about healthcare and about development of cultural competence. There is a need to maintain constant questioning regarding these practices, and to ensure the presence of infrastructure and qualified professionals for teaching at these services.
Putu Wuri Handayani
Full Text Available Currently, hospitals are required to improve their quality of health services to meet the higher standards. This improvement is supported by Ministry of Health which has launched electronic health (e-health program. Under this program, hospitals are required to have Hospital Information System (HIS or Enterprise Resource Planning (ERP for healthcare. However, to date only a few hospitals have implemented an integrated HIS. The purpose of this research is to asses the Information Technology (IT maturity of a teaching hospital in implementing HIS. This IT assessment observes from four layers namely business process, Information System (IS, Information Technology (IT and IS/IT management and organization. The result of this research is that teaching hospitals should prepare a plan to restructure their network with adequate infrastructure, create IT blue print and policy, IT organization restructuring, IT staff competency development and build integrated HIS.
... teaching hospitals. 415.190 Section 415.190 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... in Teaching Settings § 415.190 Conditions of payment: Assistants at surgery in teaching hospitals. (a... schedule basis for the services of an assistant at surgery in a teaching hospital. This section is based...
Henrique Borges Kappel
Full Text Available Introduction Insects have been described as mechanical vectors of nosocomial infections. Methods Non-biting flying insects were collected inside a pediatric ward and neonatal-intensive care unit (ICU of a Brazilian tertiary hospital. Results Most (86.4% of them were found to carry one or more species of bacteria on their external surfaces. The bacteria isolated were Gram-positive bacilli (68.2% or cocci (40.9%, and Gram-negative bacilli (18.2%. Conclusions Insects collected inside a hospital were carrying pathogenic bacteria; therefore, one must consider the possibility they may act as mechanical vectors of infections, in especially for debilitated or immune-compromised patients in the hospital environments where the insects were collected.
Guerra, Mariana; de Souza, Antônio Artur; Moreira, Douglas Rafael
This article describes a proposal for analyzing the performance of public Brazilian hospitals using financial and non-financial rates (i.e., operational rates), and thereby highlights the effectiveness (or otherwise) of the financial management of organizations in this study. A total of 72 hospitals in the Brazilian Unified Health Care System (in Portuguese, Sistema Unico de Saúde-SUS), were selected for accessibility and completeness of their data. Twenty-six organizations were used for the study sample, consisting of entities that had publicly disclosed financial statements for the period from 2008 (in particular, via the Internet) and whose operational data could be found in the SUS database. Our proposal, based on models using the method of Data Envelopment Analysis (DEA), was the construction of six initial models that were later compiled into a standard model. The relations between the rates that comprised the models were based on the variables and the notes of: Schuhmann, McCue and Nayar, Barnum and Kutzin, Younis, Younies, and Okojie, Marinho, Moreno, and Cavalini, and Ersoy, Kavuncubasi, Ozcan, and Harris II. We put forward an enhanced grant proposal applicable to Brazil aiming to (i) confirm or refute the rates that show the effectiveness or ineffectiveness of financial management of national hospitals; and (ii) determine the best performances, which could be used as a reference for future studies. Obtained results: (i) for all financial indicators considered, only one showed no significance in all models; and (ii) for operational indicators, the results were not relevant when the number of occupied beds was considered. Though the analysis was related to only services provided by SUS, we conclude that our study has great potential for analyzing the financial management performance of Brazilian hospitals in general, for the following reasons: (i) it shows the relationship of financial and operational rates that can be used to analyze the performance of
Sunil; Adarsh; Sahana; Prema; Tamil; Purushotham; Rajanish; Sebastain
OBJECTIVE : To study the mortality pattern in a level III neonatal intensive care unit (NICU)in a low resource teaching hospital. METHODS : A retrospective study was conducted over a period of three years from January 2011 to December 2013. The medical records of all babies who died after being admitte d to the NICU were reviewed. Survival was defined as the discharge of a live infant from the hospital. Data regarding...
Catarina Savastano; Elisa de Oliveira Silva; Lindyanne Lemos Gonçalves; Jéssica Maria Nery; Naiara Chaves Silva; Amanda Latercia Tranches Dias
Abstract The incidence of the species Candida albicans and non-albicans Candida was evaluated in a Brazilian Tertiary Hospital from the environment and health practitioners. In a 12-month period we had a total positivity of 19.65% of Candida spp. The most recurring non-albicans Candida species was C. glabrata (37.62%), generally considered a species of low virulence, but with a higher mortality rate than C. albicans. Subsequently, C. parapsilosis (25.74%) and C. tropicalis (16.86%) were the s...
CARIZA TEIXEIRA BOHRER; EDUARDO RAUPP DE VARGAS
This paper proposes a reflection to induce a better understanding of R&D in services, based on case studies carried out in Brazilian University Hospitals (UHs). The results show that the generation and increase of the stock of knowledge in services go beyond those reported in the material component. We also found that a diversity of actors contributed in an informal way to these dynamics. Concerning R&D funding, we noticed that service R&D is not always planned through a formal project. Then ...
Mello-Carpes, Pâmela B; Granjeiro, Érica Maria; Montrezor, Luís Henrique; Rocha, Maria José Alves
Members of the Education Committee of the Brazilian Society of Physiology have developed multiple outreach models to improve the appreciation of science and physiology at the precollege level. The members of this committee act in concert with important Brazilian governmental strategies to promote training of undergraduate students in the teaching environment of secondary and high schools. One of these governmental strategies, the Programa Institucional de Bolsas de Iniciação à Docência, a Brazilian public policy of teaching enhancement implemented by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) since 2007, represents a well-articulated public policy that can promote the partnership between University and Schools (7). Furthermore, the Program "Novos Talentos" (New Talents)/CAPES/Ministry of Education is another government initiative to bring together university and high-level technical training with the reality of Brazilian schools. Linked to the New Talents Program, in partnership with the British Council/Newton Fund, CAPES recently promoted the visit of some university professors that coordinate New Talents projects to formal and informal educational science spaces in the United Kingdom (Science, Technology, Engineering, and Mathematics, Brazil-United Kingdom International Cooperation Program) to qualify the actions developed in this area in Brazil, and one of us had the opportunity to participate with this. PMID:27231260
van Rossum, Tiuri R; Scheele, Fedde; Scherpbier, Albert J J A; Sluiter, Henk E; Heyligers, Ide C
Innovation and change in postgraduate medical education programs affects teaching hospital organizations, since medical education and clinical service are interrelated.Recent trends towards flexible, time-independent and individualized educational programs put pressure on this relationship. This pressure may lead to organizational uncertainty, unbalance and friction making it an important issue to analyze.The last decade was marked by a transition towards outcome-based postgraduate medical education. During this transition competency-based programs made their appearance. Although competency-based medical education has the potential to make medical education more efficient, the effects are still under debate. And while this debate continues, the field of medical education is already introducing next level innovations: flexible and individualized training programs. Major organizational change, like the transition to flexible education programs, can easily lead to friction and conflict in teaching hospital organizations.This article analyses the organizational impact of postgraduate medical education innovations, with a particular focus on flexible training and competency based medical education. The characteristics of teaching hospital organizations are compared with elements of innovation and complexity theory.With this comparison the article argues that teaching hospital organizations have complex characteristics and behave in a non-linear way. This perspective forms the basis for further discussion and analysis of this unexplored aspect of flexible and competency based education. PMID:27048264
Adami, Fernando; Figueiredo, Francisco Winter dos Santos; Paiva, Laércio da Silva; de Sá, Thiago Hérick; Santos, Edige Felipe de Sousa; Martins, Bruno Luis; Valenti, Vitor Engrácia; de Abreu, Luiz Carlos
Introduction The objective was to analyze rates of stroke-related mortality and incidence of hospital admissions in Brazilians aged 15 to 49 years according to region and age group between 2008 and 2012. Methods Secondary analysis was performed in 2014 using data from the Hospital and Mortality Information Systems and the Brazilian Institute of Geography and Statistics. Stroke was defined by ICD, 10th revision (I60–I64). Crude and standardized mortality (WHO reference) and incidence of hospital admissions per 100,000 inhabitants, stratified by region and age group, were estimated. Absolute and relative frequencies; and linear regression were also used. The software used was Stata 11.0. Results There were 35,005 deaths and 131,344 hospital admissions for stroke in Brazilians aged 15–49 years old between 2008 and 2012. Mortality decreased from 7.54 (95% CI 7.53; 7.54) in 2008 to 6.32 (95% CI 6.31; 6.32) in 2012 (β = -0.27, p = 0.013, r2 = 0.90). During the same time, incidence of hospital admissions stabilized: 24.67 (95% CI 24.66; 24.67) in 2008 and 25.11 (95% CI 25.10; 25.11) in 2012 (β = 0.09, p = 0.692, r2 = 0.05). There was a reduction in mortality in all Brazilian regions and in the age group between 30 and 49 years. Incidence of hospitalizations decreased in the South, but no significant decrease was observed in any age group. Conclusion We observed a decrease in stroke-related mortality, particularly in individuals over 30 years old, and stability of the incidence of hospitalizations; and also regional variation in stroke-related hospital admission incidence and mortality among Brazilian young adults. PMID:27332892
Full Text Available Introduction: The sources of racial disparity in duration of patients’ visits to emergency departments (EDs have not been documented well enough for policymakers to distinguish patient-related factors from hospital- or area-related factors. This study explores the racial disparity in duration of routine visits to EDs at teaching and non-teaching hospitals.Methods: We performed retrospective data analyses and multivariate regression analyses to investigate the racial disparity in duration of routine ED visits at teaching and non-teaching hospitals. The Healthcare Cost and Utilization Project (HCUP State Emergency Department Databases (SEDD were used in the analyses. The data include 4.3 million routine ED visits encountered in Arizona, Massachusetts, and Utah during 2008. We computed duration for each visit by taking the difference between admission and discharge times.Results: The mean duration for a routine ED visit was 238 minutes at teaching hospitals and 175 minutes at non-teaching hospitals. There were significant variations in duration of routine ED visits across race groups at teaching and non-teaching hospitals. The risk-adjusted results show that the mean duration of routine ED visits for Black/African American and Asian patients when compared to visits for white patients was shorter by 10.0 and 3.4%, respectively, at teaching hospitals; and longer by 3.6 and 13.8%, respectively, at non-teaching hospitals. Hispanic patients, on average, experienced 8.7% longer ED stays when compared to white patients at non-teaching hospitals.Conclusion: There is significant racial disparity in the duration of routine ED visits, especially in non-teaching hospitals where non-White patients experience longer ED stays compared to white patients. The variation in duration of routine ED visits at teaching hospitals when compared to non-teaching hospitals was smaller across race groups. [West J Emerg Med. 2013;14(5:529–541.
Babyak, Jonathan M; Sharp, Claire R
OBJECTIVE To describe the epidemiology of the systemic inflammatory response syndrome (SIRS) and sepsis in cats hospitalized in a veterinary teaching hospital. DESIGN Observational study. ANIMALS 246 client-owned cats. PROCEDURES During a 3-month period, daily treatment records were evaluated for all hospitalized cats. Information extracted included signalment, temperature, heart rate, respiratory rate, diagnostic test results, diagnosis, duration of hospitalization, and outcome (survival or death). Cats were classified into 1 of 4 disease categories (sepsis [confirmed infection and SIRS], infection [confirmed infection without SIRS], noninfectious SIRS [SIRS without a confirmed infection], and no SIRS [no SIRS or infection]). RESULTS Of the 246 cats, 26 and 3 were hospitalized 2 and 3 times, respectively; thus, 275 hospitalizations were evaluated. When SIRS was defined as the presence of ≥ 2 of 4 SIRS criteria, 17 cats had sepsis, 16 had infections, 81 had noninfectious SIRS, and 161 were classified in the no SIRS category at hospital admission. The prevalence of sepsis at hospital admission was 6.2 cases/100 admissions. Four cats developed sepsis while hospitalized, resulting in a sepsis incidence rate of 1.5 cases/100 hospital admissions. Four of 17 cats with sepsis at hospital admission and 3 of 4 cats that developed sepsis while hospitalized died or were euthanized, resulting in a mortality rate of 33.3% for septic cats; 239 hospitalizations resulted in survival, 28 resulted in euthanasia, and 8 resulted in death. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that many hospitalized cats have evidence of SIRS and some have sepsis. In cats, sepsis is an important clinical entity with a high mortality rate. PMID:27308883
L O Abdur-Rahman
Full Text Available Background: The practice and pattern of male infants circumcised is influenced by culture, religion and socio-economic classification. The debate about the benefits and risks of circumcision has made a hospital-based practice the most acceptable. Objective: The objective of this study is to evaluate the ages, indications, co-morbidity, types and methods of circumcision, usage and mode of anaesthesia and outcome of male circumcision at a tertiary health centre in Nigeria. Materials and Methods: A retrospective review of male circumcision in a paediatric surgery unit was done from January 2002 to December 2007. The data was analysed using SPSS software version 15. Results: There were 438 boys with age ranged between 6 days and 10 years (median 28 days, mean 53.6 days standard deviation 74.2. Neonatal circumcision (<29 days was 201 (46% and 318 (72.6% of the children were circumcised by the 3 rd month of live. Religion or tradition were the major indicators in 384 (87.7% patients while phimosis 38 (8.7%, paraphimosis 4 (1%, redundant post circumcision skin 10 (2.3% and defective prepuce in 2 (0.5% were other indications. Plastibel™ (PD was used in 214 (48.9%, classical circumcision 194 (44.2%, guillotine technique (GT and Gomco™ 10 (2.3% cases each while 10 (2.3% had a refashioning/re-excision post previous circumcision. There was an increase in use of PD, drop in the use of GT; and increase in the number of circumcision done over the years. Only 39.7% had anaesthesia administered and complication rate was 6.7%. Conclusion: Neonatal circumcision was highest in the hospital-based circumcision practice, which allowed the expected ideals in the use of devices in a tertiary health centre. However, the low rate of anaesthetic use is unacceptable.
Full Text Available Formulary is a continually revised compilation of pharmaceuticals (plus important ancillary information that reflects the current clinical judgment of medical staff. Kasturba Hospital is a 1400 bedded tertiary care teaching hospital with different specialties, having more than 3000 brands and ancillary products in use. The hospital does not have a formulary of any kind. Present study involved development of a formulary for the hospital and comparing it with WHO Model Formulary. Monographs of the drugs were prepared as per the recommendation of Pharmacy and Therapeutic Committee of the hospital. Prepared hospital formulary consisted of 476 generic drugs of various categories and 95 fixed dose combinations. Availability of brands varied from single to many. About 75 medicines recommended by the essential medicine list were not present in the prepared hospital formulary. The drugs to be avoided or used with caution in renal failure, hepatic failure and in pregnancy were categorized and included in the formulary as additional information. The prepared hospital formulary was recommended for implementation in the hospital, which could thereby help as a tool to promote rational drug use.
Siegel, Pamela; da Motta, Pedro Mourão Roxo; da Silva, Luis G; Stephan, Celso; Lima, Carmen Silvia Passos; de Barros, Nelson Filice
The purpose of this pilot study was to explore whether individualized Reiki given to cancer patients at a Brazilian hospital improved symptoms and well-being. Data from 36 patients who received 5 Reiki sessions were collected using the MYMOP and were compared before and after their treatment and also with 14 patients who did not receive Reiki and who acted as a comparison group. Twenty-one patients reported feeling better, 12 felt worse, and 3 reported no change. Of the comparison group, 6 patients reported feeling better and 8 felt worse. The Reiki practice delivered as part of the integrative care in oncology did produce clinically significant effects, although not statistically significant results, for more than half of the patients undergoing cancer treatment. PMID:27078812
M.B.M. Linhares; F.N.P. Doca; Martinez, F.E.; A.P.P. Carlotti; R.G.M. Cassiano; Pfeifer, L.I.; Funayama, C.A.; L.R.G. Rossi; Finley, G.A.
The goal of this study was to examine the prevalence, assessment and management of pediatric pain in a public teaching hospital. The study sample consisted of 121 inpatients (70 infants, 36 children, and 15 adolescents), their families, 40 physicians, and 43 nurses. All participants were interviewed except infants and children who could not communicate due to their clinical status. The interview included open-ended questions concerning the inpatients’ pain symptoms during the 24 h prece...
Lucas Vilas Bôas Magalhães
Full Text Available The two-arm Clinical Decisions/Diagnostic Workshop (CD/DW approach to undergraduate medical education has been successfully used in Brazil. Objective Present the CD/DW approach to the teaching of stroke, with the results of its pre-experimental application and of a comparative study with the traditional lecture-case discussion approach. Method Application of two questionnaires (opinion and Knowledge-Attitudes-Perceptions-KAP to investigate the non-inferiority of the CD/DW approach. Results The method was well accepted by teachers and students alike, the main drawback being the necessarily long time for its completion by the students, a feature that may better cater for different educational needs. The comparative test showed the CD/DW approach to lead to slightly higher cognitive acquisition as opposed to the traditional method, clearly showing its non-inferiority status. Conclusion The CD/DW approach seems to be another option for teaching neurology in undergraduate medical education, with the bonus of respecting each learner`s time.
Mauro, Marianna; Cardamone, Emma; Cavallaro, Giusy; Minvielle, Etienne; Rania, Francesco; Sicotte, Claude; Trotta, Annarita
This paper explores the performance dimensions of Italian teaching hospitals (THs) by considering the multiple constituent model approach, using measures that are subjective and based on individual ideals and preferences. Our research replicates a study of a French TH and deepens it by adjusting it to the context of an Italian TH. The purposes of this research were as follows: to identify emerging views on the performance of teaching hospitals and to analyze how these views vary among hospital stakeholders. We conducted an in-depth case study of a TH using a quantitative survey method. The survey uses a questionnaire based on Parsons' social system action theory, which embraces the major models of organizational performance and covers three groups of internal stakeholders: physicians, caregivers and administrative staff. The questionnaires were distributed between April and September 2011. The results confirm that hospital performance is multifaceted and includes the dimensions of efficiency, effectiveness and quality of care, as well as organizational and human features. There is a high degree of consensus among all observed stakeholder groups about these values, and a shared view of performance is emerging. Our research provides useful information for defining management priorities to improve the performance of THs. PMID:24560230
... to beneficiaries is made by Medicare on the basis of reasonable cost if the hospital exercises the... organized medical staff of the teaching hospital or medical school as provided for in paragraph (d) of this... beneficiaries in a teaching hospital are payable as provider services on a reasonable-cost basis. (2)...
Extended-spectrum beta-lactamases in Klebsiella spp and Escherichia coli obtained in a Brazilian teaching hospital: detection, prevalence and molecular typing beta-lactamases de espectro ampliado em Klebsiella spp e em Escherichia coli obtidas em um hospital escola brasileiro: detecção, prevalência e tipagem molecular
Ana Lúcia Peixoto de Freitas
Full Text Available His study was performed to compare the methods of detection and to estimate the prevalence of extended-spectrum beta-lactamases (ESBL among Klebsiella spp and E.coli in a university hospital in southern Brazil. We also used a molecular typing method to evaluate the genetic correlation between isolates of ESBL K.pneumoniae. Production of ESBL was investigated in 95 clinical isolates of Klebsiella spp and Escherichia coli from Hospital de Clínicas de Porto Alegre, using Kirby-Bauer zone diameter (KB, double-disk diffusion (DD, breakpoint for ceftazidime (MIC CAZ, increased zone diameter with clavulanate (CAZ/CAC and ratio of ceftazidime MIC/ceftazidime-clavulanate MIC (MIC CAZ/CAC. Molecular typing was performed by DNA macrorestriction analysis followed by pulsed-field gel electrophoresis. The KB method displayed the highest rates of ESBL (up to 70% of Klebsiella and 59% of E.coli, contrasting with all the other methods (p Este estudo foi desenvolvido para comparar métodos de detecção e para estimar a prevalência de Klebsiella spp e E.coli produtoras de beta-lactamases de espetro ampliado (ESBL em um Hospital Universitário no sul do Brasil. A correlação genética, determinada através de método molecular de tipagem, entre as amostras de K. pneumoniae também foi determinada. A produção de ESBL foi investigada em 95 amostras de Klebsiella spp e E.coli obtidas de pacientes no Hospital de Clínicas de Porto Alegre usando-se: medida do diâmetro a zona de inibição (KB, dupla-difusão de disco (DD, valores de concentração inibitória mínima da ceftazidima (MIC CAZ, aumento do diâmetro da zona de inibição com adição de clavulanato (CAZ/CAC e a relação entre o MIC da ceftazidima/MIC ceftazidima com clavulanato (MIC CAZ/CAC. A tipagem molecular foi realizada utilizando-se o método de macrorestrição de DNA e eletroforese em campo pulsado (PFGE. O método KB apresentou as maiores taxas de produção de ESBL (> 70% para Klebsiella e
Full Text Available Background Nosocomial infections (NIs have increasingly resulted in death and patients have to bear high treatment costs. Healthcare personnel could play a prominent role in prevention and control of NIs. Objectives The aim of this study was to evaluate NIs in patients admitted to a teaching hospital in Ahvaz, southwest of Iran, during 2013. Patients and Methods The present study was a cross-sectional study conducted in Razi Hospital, Ahvaz during 12 months from March 2013 to March 2014. All patients hospitalized with no signs and symptoms of infection within 48 hours of admission and presenting signs and symptoms of infection after 48 hours of hospitalization were included in the study. Data about patients’ age, sex, site of infection, ward of hospitalization and type of NIs were collected. Bacterial strains were isolated from various clinical samples of patients and identified by conventional methods. Results The incidence of NIs was low (i.e. < 2%. Among 16936 admitted patients in this hospital, 174 patients (79 males and 95 females with a mean age of 51.7 ± 24.6 years (range, 5 to 90 years were diagnosed with an NI. Incidence density of NIs were 3.18% in infectious diseases ward, 2.17% in intensive care unit (ICU, 2% in orthopedic ward, 0.68% in obstetrics and gynecology (OBGYN ward and 0.278% in general surgery. Regarding the etiology of infection, coagulase-negative staphylococci in 23.69%, Bacillus in 21.05%, Escherichia coli was found in 18.42%, and coagulase-positive staphylococci in 13.16% of the cases. The results indicated that coagulase-negative staphylococci was the most frequent pathogen. Conclusions The frequency of NIs in this hospital was lower in comparison with other worldwide studies. However, low incidence of health care-associated infections in our study may be due to under diagnosis and underreporting of such infections by health care staff.
Full Text Available Naila Nadeem,1,* Ranish Deedar Ali Khawaja,2,3,* Madiha Beg,1 Muhammad Naeem,4 Zain Majid41Department of Radiology, 2Aga Khan University Hospital, Karachi, Pakistan; 3Massachusetts General Hospital, Harvard Medical School, Boston, USA; 4Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan*These authors contributed equally to this workBackground: In an integrated method of education, medical students are introduced to radiology in their preclinical years. However, no study has been conducted in Pakistan to demonstrate an academic framework of medical radiology education at an undergraduate level. Therefore, we aimed to document and compare the current level of teaching duties, teaching methodologies, and teaching rewards among radiologists and residents in private and public teaching hospitals in Karachi, Pakistan.Methods: A survey was conducted among 121 radiologists and residents in two private and two public teaching hospitals in Karachi, Pakistan. Radiologists who were nationally registered with the Pakistan Medical and Dental Council either part-time or full-time were included. Radiology residents and fellows who were nationally registered with the Pakistan Medical and Dental Council were also included. Self-administered questionnaires addressing teaching duties, methods, and rewards were collected from 95 participants.Results: The overall response rate was 78.51% (95/121. All of the radiologists were involved in teaching residents and medical students, but only 36% reported formal training in teaching skills. Although most of the respondents (76% agreed that medical students appeared enthusiastic about learning radiology, the time spent on teaching medical students was less than five hours per week annually (82%. Only 37% of the respondents preferred dedicated clerkships over distributed clerkships (41%. The most common preferred teaching methodology overall was one-on-one interaction. Tutorials, teaching rounds, and
Nyathi, T; Chirwa, TF; van der Merwe, DG
Purpose: The purpose of this study was to assess radiographer familiarity and preferences with digital radiography in four teaching hospitals and thereafter make recommendations in line with the migration from screen film to digital radiography. Materials and methods: A questionnaire was designed to collect data from either qualified or student radiographers from four teaching hospitals. From the four teaching hospitals, there were a total of 205 potential respondents. Among other things, res...
Perfil dos pacientes com lúpus eritematoso sistêmico, internados na unidade de terapia intensiva de um hospital universitário de Fortaleza Characteristics of patients with systemic lupus erythematosus admitted to the intensive care unit in a brazilian teaching hospital
Denison de Oliveira Couto
Full Text Available OBJETIVOS: Face à demanda de nosso serviço, buscamos descrever as características e a evolução dos pacientes com lúpus eritematoso sistêmico (LES internados na unidade de terapia intensiva do Hospital Universitário Walter Cantídio. MÉTODOS: Os pacientes foram, retrospectivamente, caracterizados quanto aos dados demográficos, tempo de diagnóstico da doença, disfunções orgânicas e exames laboratoriais à admissão, suportes terapêuticos usados durante a internação, tempo de internação hospitalar prévio à admissão, tempo de permanência na unidade, reinternações e desfecho evolutivo. Foram avaliados os escores Systemic Lupus Erythematosus Disease Activity (SLEDAI e Acute Physiological and Chronic Health Evaluation II (APACHE II à admissão, a mortalidade prevista e a razão de mortalidade padronizada. RESULTADOS: No período de novembro de 2003 a outubro de 2006, 1.052 pacientes foram admitidos à UTI, 50 (4,75% dos quais com LES. Houve predomínio do sexo feminino (88,2%, com média de idade de 30,3 ± 12,8 anos. A mediana do tempo de diagnóstico da doença foi de 67 meses. As disfunções mais prevalentes à admissão foram: renal (70,6%, cardiovascular (61,8%, respiratória (55,9% e neurológica (55,9%. As principais disfunções motivadoras da admissão na unidade de terapia intensiva foram: respiratória (38,2%, cardiovascular (29,4% e neurológica (29,4%. Os tratamentos mais utilizados foram: hemocomponentes (44,1%, fármacos vasopressores (41,2%, ventilação mecânica (35,3% e diálise (23,5%. A média do SLEDAI foi 15 ± 12,2 pontos e a do APACHE II foi 19,3 ± 6,8 pontos, com mortalidade prevista de 37,6%. Registrou-se óbito de 20,6% após 48 horas na unidade de terapia intensiva e 8,8%, com menos de 48h. A razão de mortalidade padronizada foi 0,78. Os pacientes com APACHE II maior que 18 pontos, com mais de três disfunções orgânicas, leucopenia (menor que 4.000 mm³ e acometimento gastrintestinal ou
Dickler, R; Shaw, G
The Balanced Budget Act of 1997 had a profound impact on the financing and organization of many health care services. The Act disproportionately affected U.S. teaching hospitals, leading to substantial budget reductions in many institutions and the threat of cuts in major programs and services that teaching hospitals provide to communities. This paper examines the overall financial and organizational impact of the Balanced Budget Act on teaching hospitals and considers its effect on residency education. It also discusses to what degree the Balanced Budget Refinement Act of 1999 will mitigate these effects and posits other solutions to the serious financial issues facing teaching hospitals in the United States. PMID:10819706
Edenir I. Palmero
Full Text Available Abstract The identification of families at-risk for hereditary cancer is extremely important due to the prevention potential in those families. However, the number of Brazilian genetic services providing oncogenetic care is extremely low for the continental dimension of the country and its population. Therefore, at-risk patients do not receive appropriate assistance. This report describes the creation, structure and management of a cancer genetics service in a reference center for cancer prevention and treatment, the Barretos Cancer Hospital (BCH. The Oncogenetics Department (OD of BCH offers, free of charge, to all patients/relatives with clinical criteria, the possibility to perform i genetic counseling, ii preventive examinations and iii genetic testing with the best quality standards. The OD has a multidisciplinary team and is integrated with all specialties. The genetic counseling process consists (mostly of two visits. In 2014, 614 individuals (371 families were seen by the OD. To date, over 800 families were referred by the OD for genetic testing. The support provided by the Oncogenetics team is crucial to identify at-risk individuals and to develop preventive and personalized behaviors for each situation, not only to the upper-middle class population, but also to the people whose only possibility is the public health system.
Arthur C Onwuchekwa
Full Text Available Arthur C Onwuchekwa, Godspower E AsekomehDepartment of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, NigeriaBackground: Congestive cardiac failure (CCF has emerged as a major public health problem worldwide and imposes an escalating burden on the health care system. Objective: To determine the causes and mortality rate of CCF in the University of Port Harcourt Teaching Hospital (UPTH, south Nigeria, over a five-year period from January 2001 to December 2005.Methods: A retrospective study of CCF cases were identified from the admission and discharge register of the medical wards of UPTH and the case notes were retrieved from the medical records department and analyzed.Results: There were 423 patients: 242 males and 181 females. Their ages ranged from 18 to 100 years with a mean of 54.4 ± 17.3. The commonest causes of CCF were hypertension (56.3% and cardiomyopathy (12.3%. Chronic renal failure, rheumatic heart disease, and ischemic heart disease accounted for 7.8%, 4.3%, and 0.2% of CCF, respectively. Peripartum heart disease was rare despite being commonly reported in northern Nigerian females. Eighteen patients died from various complications with a mortality rate of 4.3%.Conclusion: The burden of CCF in the Niger Delta is mainly attributed to hypertension. Efforts should be geared towards hypertension awareness, detection, treatment, and prevention in the region.Keywords: pattern, cardiac failure, Nigeria, etiological factors
Full Text Available Objective. To determine the influence of age and parity on the surgical management of uterine fibroids, clinical presentation, presence of pelvic adhesions, cadre of surgeons, and postoperative complications at the Aminu Kano Teaching Hospital, Kano, Nigeria. Methods. A retrospective analysis of 105 cases of uterine fibroids that were managed between 1st January 2003 and 31st December 2007. Results. The period prevalence of uterine fibroids was 24.7% of all major gynecological operations. The mean age was 35.8 ± 7.6 and mean parity 4.7 ± 2.8. Abdominal hysterectomy accounted for 58.1% of the cases and myomectomy 41.9%. The odd of using abdominal hysterectomy was about twice that of myomectomy. Pelvic adhesions were found in 67.6% of the cases. Menorrhagia (86.7% was the commonest symptom, while post operative anemia and pyrexia showed significant association with myomectomy. There was no maternal mortality. Conclusion. Surgical operations for uterine fibroids are safe and common kind of gynecological operations at the Aminu Kano Teaching Hospital. Uterine fibroid is associated more with high parity and dominance of abdominal hysterectomy over myomectomy, because early girl marriage is common in our community.
Laryngeal cancer is the commonest head and neck cancer seen at the Ear Nose and Throat (ENT) Unit Korle Bu Teaching Hospital. The aim of this study was to determine the number of cases of laryngeal cancer seen at the Korle Bu Teaching Hospital, establish epidemiological parameters of the disease and to outline preventive measures. One hundred and fifteen (115) patients who were managed for laryngeal cancer from 1st January 1998 to 31st December 2003 were studied retrospectively with respect to age, sex, duration of symptoms at presentation, risk factors, symptoms complex, histopathology, stage of tumor, details of treatment offered and follow up. The age range was 17-85 years with a mean of 55.5 years (SD10.7). Majority of the patients (90.4%) were above 40 years. The commonest symptom at presentation was dysphonia. A significant proportion of cases (37.3%) presented with locally advanced disease. The commonest histological type of laryngeal tumour seen was squamous cell carcinoma. The treatment offered consisted of radiotherapy for 83 (79.8%) patients and total laryngectomy with neck dissection when necessary for 17 (16.3%) patients who also had postoperative radiotherapy. Only 58 (69.9%) patients completed radiotherapy treatment and in all 32 (24.3 %) patients did not report for any treatment. Majority of patients failed to report for post treatment follow-up. We conclude that significant number of patients with laryngeal cancer presented with locally advanced disease and dysphonia was the commonest symptom. (au)
Radiologists from 28 veterinary schools and one private teaching hospital responded to a survey questionnaire focused on diagnostic image reporting. Radiologists at 26 hospitals generated a hard copy report on essentially all imaging studies performed. At 25 hospitals, radiologists dictated and transcriptionists typed all or most reports; radiologists at two institutions typed all or some of their reports. At five hospitals, preliminary and/or final handwritten reports were generated. The range of reports generated per day was <10 to 40 per radiologist on duty. Seven respondents generated reports as films came from the processor and another 12 routinely generated reports the day the studies were completed. Clinician access to a processed report averaged 2 to 4 days after study was completed (reported range: several hours to 7 or more days). Fifteen responding radiologists personally mounted films from storage jackets for a majority of their reporting. Fourteen respondents generated reports from films mounted on motorized or stationary viewers. Nineteen respondents generated reports in a busy viewing area where they were frequently interrupted. Radiologists' impression of clinician and resident satisfaction regarding availability of radiology reports was that they were satisfied or very satisfied at 15 of the 29 hospitals. Five respondents reported that clinicians and residents were not concerned about availability of processed radiology reports. Thirteen radiologists were planning to change their reporting method within the next 2 years. The change most frequently sought (12 respondents) was to decrease turn-around time of reports. Ten radiologists indicated an interest in trying a voice recognition dictation system. The most common reasons given for not planning any changes in radiology reporting in the next 2 years were: limited number of radiologists (8) and 1 ''satisfied as is'' (7). Turn-around of radiology reports at these veterinary institutions averaged 2
Práticas e nível de conhecimento sobre doença cerebrovascular em um hospital universitário: Parte 1. Educação do corpo de enfermagem: prioridade para o tratamento do infarto cerebral Knowledge and attitudes regarding stroke in a Brazilian teaching hospital: Part 1. Results in health care workers and non-health care workers
further subdivided according to level of schooling, resulting in seven strata. A closed questionnaire addressing epidemiology, risk factors, pathophysiology, typical symptoms, treatment, clinical course and personal attitudes towards smoking and blood pressure control, was applied to a random sample of each stratum (total n = 309. Kruskal-Wallis test for multiple comparisons of non-parametric data was used. RESULTS: Significant differences between the seven groups were found. Knowledge was strongly associated with being a HCW and with level of formal education (p<0.001, even after excluding physicians from the analysis (p<0.001. In NHCW groups, knowledge was not associated with level of education (p=0.421. In these groups, personal fear of suffering a stroke was the only variable predictive of knowledge. Smoking and poor monitoring of blood pressure levels were also more common in strata with the lowest levels of education and among NHCW. CONCLUSION: Poor knowledge and wrong attitudes towards stroke are frequent among individuals working in a Brazilian university hospital. Although these results are not necessarily applicable to the general population, they will certainly be useful for the development of educational programs on stroke.
Cristiana Fernandes De Muylder
Full Text Available http://dx.doi.org/10.5007/2175-8077.2013v15n37p82Is it possible to teach someone to become an entrepreneur? It is this question that motivated this field survey in a Brazilian entrepreneurial training high school. A quantitative survey was carried out with a population of 313 students of the chosen school, being that 175 students were freshmen and 138 graduates. It was possible to observe that the freshmen and the graduate students confirm that the education and training that they received in the school, did contribute to become entrepreneurs, although a few divergences were described. The students considered that innovating capacity, dealing with risks and gain professional maturity was important factors to achieve success within organizations or businesses. It was suggested new study comparing schools that do not have, as also to carry out studies in other countries with different cultural characteristics.
Full Text Available Objectives: Evaluate the way the topics for the study of pain mechanisms in general, and Orofacial Pain (OFP and temporomandibular disorders (TMDs more specifically, are addressed in undergraduate courses curricula, and also to verify the existence of specialist OFP/TMD teachers in Brazilian dental schools. Methods: Between July 2010 and January 2011, course Coordinators/Directors of all dental schools duly registered at the Ministry of Education were invited to answer a questionnaire on topics related to OFP/TMD teaching in their institutions. Results: Fifty-three dental schools representatives answered the questionnaire. The study of pain mechanisms was found to cover an average of less than 10% of the courses' total time. Pharmacology, Endodontics and Physiology were identified as the departments usually responsible for addressing pain mechanisms in dental courses. Psychosocial aspects were found to occupy a very small proportion in the syllabi, while most of the content referred to biological or somatic aspects. OFP/TMD is addressed by a specific department in only 28.4% of the participating dental schools, while in most cases (46.3%, OFP/TMD is under the responsibility of the Prosthodontics department. Only 38.5% of respondents indicated that they had a specialist OFP/TMD teacher in their Schools. Conclusion: Among the Brazilian dental schools participating in the study, the teaching of OFP/TMD was found to be insufficient, segmented or with an extremely restricted focus. This initial assessment indicates that Curricular Guidelines for the study of OFP/TMD at undergraduate dental schools should be developed and implemented to facilitate their appropriate inclusion into the curricula and in specific pedagogical projects.
SIMM, Wagner; GUIMARÃES, Antônio Sérgio
Objectives Evaluate the way the topics for the study of pain mechanisms in general, and Orofacial Pain (OFP) and temporomandibular disorders (TMDs) more specifically, are addressed in undergraduate courses curricula, and also to verify the existence of specialist OFP/TMD teachers in Brazilian dental schools. Methods Between July 2010 and January 2011, course Coordinators/Directors of all dental schools duly registered at the Ministry of Education were invited to answer a questionnaire on topics related to OFP/TMD teaching in their institutions. Results Fifty-three dental schools representatives answered the questionnaire. The study of pain mechanisms was found to cover an average of less than 10% of the courses' total time. Pharmacology, Endodontics and Physiology were identified as the departments usually responsible for addressing pain mechanisms in dental courses. Psychosocial aspects were found to occupy a very small proportion in the syllabi, while most of the content referred to biological or somatic aspects. OFP/TMD is addressed by a specific department in only 28.4% of the participating dental schools, while in most cases (46.3%), OFP/TMD is under the responsibility of the Prosthodontics department. Only 38.5% of respondents indicated that they had a specialist OFP/TMD teacher in their Schools. Conclusion Among the Brazilian dental schools participating in the study, the teaching of OFP/TMD was found to be insufficient, segmented or with an extremely restricted focus. This initial assessment indicates that Curricular Guidelines for the study of OFP/TMD at undergraduate dental schools should be developed and implemented to facilitate their appropriate inclusion into the curricula and in specific pedagogical projects. PMID:24473717
Wung Cathy; Huang Chung-I; Yang Che-Ming
Abstract Background The purpose of this study is to establish teaching hospital accreditation standards anew with the hope that Taiwan's teaching hospitals can live up to the expectations of our society and ensure quality teaching. Methods The development process lasted two years, 2005-2006, and was separated into three stages. The first stage centered on leadership meetings and consensus building, the second on drafting the new standards with expert focus groups, and the third on a pilot stu...
Huang, Chung-I; Wung, Cathy; Yang, Che-Ming
Background The purpose of this study is to establish teaching hospital accreditation standards anew with the hope that Taiwan's teaching hospitals can live up to the expectations of our society and ensure quality teaching. Methods The development process lasted two years, 2005-2006, and was separated into three stages. The first stage centered on leadership meetings and consensus building, the second on drafting the new standards with expert focus groups, and the third on a pilot study and su...
Full Text Available Introduction: Quality of life (QOL of emergency medicine specialists can be effective in providing services to patients. The aim of the present study was evaluating the lifestyle of emergency medicine practitioners, understanding their problems, and addressing the solutions to enhance and improve their lifestyles, in teaching hospitals in Iran. Method: This descriptive cross-sectional study was conducted on emergency medicine physicians in 10 teaching hospitals of Iran in 2011. Emergency physicians with at least three years of experience who interested in the study, were enrolled in the project. All participants filled out the consent form and QOL questionnaires, then underwent physical examinations and some medical laboratory tests. Categorical variables were reported as percentages, while continuous variables expressed as means and standard deviations. p <0.05 was considered statistically significant. Results: Totally, 100 subjects participated in the study, of whom 48 were male. The mean and standard deviation of the physicians’ age were 38.7±5.1 years. 43% of physicians had an average QOL, while 37% good. 96% of studied physicians had a good condition regarding habitual history, while 93% of them had a poor condition in performing screening tests. Exercise program and personal health in individuals with normal BMI were correlated with higher levels of QOL. BMI was higher in 40-50 years old subjects than youngers. Hypertension was present in five cases (5%, hypercholesterolemia in six (6%, hypertriglyceridemia in six (6%, increased LDL in four (4%, low HDL in four (4%, and impaired FBS in 4 (4%. Conclusion: The findings showed that 63% of studied emergency physicians had an average level of QOL and other ones good. The majority of physicians had undesirable situation regarding the performance of screening tests.
Full Text Available Introduction: Blood glucose control has been found to be an important component in the care of hospitalized patients. Maintaining blood glucose within a target range using insulin intensively is a challenging task for physicians and requires skill and experience. We hypothesized that there may be more hyper- and hypoglycemia in July in teaching hospitals when new resident physicians begin their training. Methods: We reviewed point-of-care blood glucose data from hospitalized patients at four community teaching hospitals for 2010. We defined severe hypoglycemia as blood glucose < 41 mg/dL and severe hyperglycemia as blood glucose > 399 mg/dL. Occurrence of hyper- and hypoglycemic events was assessed overall at the particular hospital globally and based on individual nursing units. Monthly occurrence rates were compared against the annual mean for that unit. Results: The occurrence of hyper- and hypoglycemic events in July 2010 did not differ from the mean annual percentage of events at the applicable hospital. However, when the data were analyzed by the nursing unit, these extreme glucose events were significantly more common in 4 of the 11 units studied. Three of those four units were resident teaching units. Conclusions: These data suggest that there is some potential for increased risk of extreme hyper- and hypoglycemia at teaching hospitals in July, when new residents begin training.
Mohsen Ghobadi Tara; Kamran Haji Nabi
Introduction: Continuing education and training of employees significantly affect a hospital’s performance and efficiency, and learning organizations usually exhibit higher efficiency. Hence, the objective of this study was to evaluate the correlation between the hospital employees’ continuing education and performance indicators in the teaching hospitals affiliated to Tehran’s Azad University. Method: A cross-sectional study was conducted in the teaching hospitals affiliated to Tehran’s A...
Full Text Available Communication between individuals has a vital role in human beingâs life, specially their professional. In medical practice it is a certain and economical way recognize the patientâs problems and identify them. It is necessary to communicate with patients suffering mental or physical problems to be able to look after them. An analytical-descriptive cross-sectional study was conducted. The population under study consisted of the patients being discharged from a teaching hospital during a 15-day period. The patients were interviewed at discharge time. A sample of 100 patients was included in the study. The samples were selected through simple random method. The data were gathered using a valid questionnaire which was approved by the experts in this field. The reliability of the questionnaire was determined to be 82% using the method test- retest and Cronbachâs alpha test. Fisher test and T test analyses were carried out to determine the association between each variable and satisfaction status. patientsâ satisfaction with hospital services concerning medical, nursing, paraclinical and discharge services, section and Patientsâ general satisfaction with hospital services were in general, 13.2, 45, 20.1, 7.6 and 2.8% were quiet satisfied, satisfied, rather satisfied and quiet dissatisfied respectively. The statistical-analytical test showed that there was a significant statistical relation between the age of the patients and the degree of their satisfaction with the nursing staff treatment (p = 0.012 and that of service staff (p = 0.009.
Raehl, Cynthia; Bond, C. A.
Analyzed databases from four U.S. National Clinical Pharmacy Services Studies and the American Hospital Association for trends in hospital involvement in pharmacy education. Detailed findings indicated that clinical pharmacy services within the nation's teaching hospitals are not standardized and that financial pressures impede a full, consistent…
Logsdon, M. Cynthia; Foltz, Melissa Pinto; Scheetz, James; Myers, John A.
Based upon the Self-Efficacy Theory, this study examined the relationship between self-efficacy, self-efficacy-related variables, and postpartum depression teaching behaviors of hospital-based perinatal nurses. Findings revealed that teaching new mothers about postpartum depression is related to a perinatal nurse's self-efficacy in postpartum-depression teaching, self-esteem, and the following self-efficacy-related variables: social persuasion (supervisor's expectations for teaching); mastery...
Li, Tianming; Song, Yan; Zhu, Yuanjun; Du, Xin; Li, Min
Background To control the spread of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals, infection control measures such as hand hygiene practices were introduced into the teaching hospitals in Shanghai, China, in 2008. Currently, there is limited information characterizing the latest hospital-acquired S. aureus infections in this area. Therefore, we sought to determine the prevalence, molecular characteristics, and genotype-phenotype correlation of hospital-acquired S. aureus inf...
Full Text Available AIMS & OBJECTIVES: Patients presenting with acute quadriparesis may pose therapeutic challenge to the treating physician especially the development of bulbar palsy and respiratory paralysis and require intensive monitoring and treatment in acute clinical and respiratory care units. So this study was conducted to know the etiology of cases of non - traumatic Quadriparesis and its outcome. MATERIALS AND METHODS: 50 adult patients admitted in medical and neurology wards with non - traumatic quadriparesis were prospectively studied b etween October ’2012 to September ’2014at Government General Hospital, Kakinada, a teaching hospital with rural referrals. OBSERVATIONS AND RESULTS: In the study cohort of 50 cases the age of patients ranged from 13 to 80 years with more number of male patients. 29 patients (58% presented with flaccid and 21 cases (42% with spastic quadriparesis. Guillian barre syndrome with 18 (36% cases was the most common cause of quadriparesis followed by Spondylotic myelopathy 11 cases ( 22% and Hypokalemic perio dic paralysis in 8 cases (16%. Transverse Myelitis. Caries spine. Secondaries cervical spine, spinal epidural abscess were in other cases.7 (14% patients had cranial nerve dysfunction. 4(8% patients had facial nerve palsy . CONCLUSION: Guillian barre syn drome constituted the most common cause of nontraumatic quadriparesis, followed by Spondylotic myelopathy, Transverse Myelitis. Caries spine. S econdaries cervical spine, spinal epidural abscess . AIDP and Hypokalemic periodic paralysis were the most frequen t causes of flaccid quadriparesis while Spondylotic myelopathy was the most common cause of spastic quadriparesis . M.R.I was the most useful and appropriate investigation . Severity of paralysis and need for ventilator support were associated with poor prog nosis in patients with acute flaccid quadriparesis . Decompressive surgery in spondylotic myelopathy had good recovery after surgery. Patient recovery was
The objective of this study was to assess the effectiveness of mask ventilation performed by 112 doctors with clinical responsibilities at a tertiary referral teaching hospital. Participant doctors were asked to perform mask ventilation for three minutes on a Resusci Anne mannequin using a facemask and a two litre self inflating bag. The tidal volumes generated were quantified using a Laerdal skillmeter computer as grades 0-5, corresponding to 0, 334, 434, 561, 673 and > 800 ml respectively. The effectiveness of mask ventilation (i.e. the proportion of ventilation attempts which achieved a volume delivery of > 434 mls) was greater for anaesthetists [78.0 (29.5)%] than for non anaesthetists [54.6 (40.0)%] (P = 0.012). Doctors who had attended one or more resuscitation courses where no more effective at mask ventilation than their colleagues who had not undertaken such courses. It is likely that first responders to in-hospital cardiac arrests are commonly unable to perform adequate mask ventilation.
Full Text Available Background The main purpose of any government from a healthcare reform is to improve the service quality and raised public satisfaction. Objectives As the important role of managerial human resources in any organizational changes, this paper tried to examine the point of view of this group about the recent reform in governmental hospitals of Qazvin. Patients and Methods This cross-sectional study was conducted in January 2015. The statistical population consisted of 50 executive managers of Qazvin teaching hospitals. The data gathering instrument was a research-made questionnaire with approved reliability and validity (α = 0.84. Data analyse was performed in SPSS version 20 using descriptive and analytic statistics (analysis of variance (ANOVA, Pearson correlation test and one sample t-test. Results A total of 43.2% of managers believed that this reform was a good restrictor for malpractices in healthcare and 31.8% believed that it will not be so useful to improve the society health status. The average score of resource preparation, insurance companies coordination, changing the routine workflows, and finally achieving the goals, had a meaningful difference (P ˂ 0.05 and the average score of these fields were upper than average. Conclusions The findings showed that based on the managers’ point of view, the reform plan was able to achieve its primary goals; however, it could not meet their exceptions in improving the society health status. Therefore, it is necessary to design some interventions for changing this perception.
The article first analyzes the status quo and problems of the teaching quality of teaching hospitals. Then it proposes enhancing teaching awareness, improving teaching, strengthening teaching management and improving teaching conditions so as to improve the teaching quality of teaching hospitals.%通过对教学医院教学质量的现状和存在问题分析,提出应从增强教学意识,提升教学水平,加强教学管理和改善教学条件四个方面,促进教学医院教学质量的提升.
Full Text Available OBJECTIVE : To study the mortality pattern in a level III neonatal intensive care unit (NICUin a low resource teaching hospital. METHODS : A retrospective study was conducted over a period of three years from January 2011 to December 2013. The medical records of all babies who died after being admitte d to the NICU were reviewed. Survival was defined as the discharge of a live infant from the hospital. Data regarding birth weight , gestational age , final cause of death and diagnosis was analyzed. Exclusion criteria were to exclude (A babies who came in the NICU for a few hours observation and were shifted to mother. (B Any baby who could not be successfully resuscitated in labor room and (C babies who left the hospital against medical advice and calculation of survival was done after subtracting them f rom total admission. RESULTS : A total of 1031 babies were admitted in this 3 year period in our NICU. Out of these , 95.5% babies survived and 46 babies expired (4.4%. The total number of deliveries in these three years was 5400 and the neonatal mortality r ate (NMR in this study was 8.5% per 1000 live births. In the very low birth weight (VLBW group the survival was 92% (n=101 and in extremely low birth weight (ELBW group it was 60% (n=10. In low birth weight (LBW group 95.1% babies survived (n=502. T otal Survival of VLBW & ELBW together was 89%. Out of 46 expired babies 86.9% (n=40 were premature and 45.6% babies (n=21 were below 30 weeks of gestational age. Sepsis was the predominant cause of death (34.7% followed by hyaline membrane disease (HMD (19.2% and Hypoxic Ischemic Encephalopathy (HIE (15.2% in these 46 babies. CONCLUSIONS : This study identified neonatal sepsis , Hyaline membrane disease or Respiratory distress syndrome (RDS and HIE as the major contributors to the neonatal mortality. A dequate antenatal care to at risk mothers and advances in the neonatal intensive care with the use of sophisticated technology will improve the
Mohammad Zakaria Kiaei; Amir Ziaee; Rafat Mohebbifar; Hamideh Khoshtarkib; Elnaz Ghanati; Azadeh Ahmadzadeh; Saeideh Teymoori; Omid Khosravizadeh; Masoumeh Zieaeeha
Introduction: Patient safety culture is an important part of improvement in the safety of health care. Knowing its present status is required for development of safety culture. The present study aimed to evaluate the current status of Patient safety culture in hospitals of three central provinces of Iran. Method: The present cross-sectional study was performed in teaching hospitals of Tehran, Alborz, and Qazvin provinces. The standard HSOPSC questionnaire was used for evaluation of the pat...
Paula Buck de Oliveira Ruiz
Full Text Available Abstract OBJECTIVE To map the sub processes related to turnover of nursing staff and to investigate and measure the nursing turnover cost. METHOD This is a descriptive-exploratory study, classified as case study, conducted in a teaching hospital in the southeastern, Brazil, in the period from May to November 2013. The population was composed by the nursing staff, using Nursing Turnover Cost Calculation Methodology. RESULTS The total cost of turnover was R$314.605,62, and ranged from R$2.221,42 to R$3.073,23 per employee. The costs of pre-hire totaled R$101.004,60 (32,1%, and the hiring process consumed R$92.743,60 (91.8% The costs of post-hire totaled R$213.601,02 (67,9%, for the sub process decreased productivity, R$199.982,40 (93.6%. CONCLUSION The study identified the importance of managing the cost of staff turnover and the financial impact of the cost of the employee termination, which represented three times the average salary of the nursing staff.
Ruiz, Paula Buck de Oliveira; Perroca, Marcia Galan; Jericó, Marli de Carvalho
OBJECTIVE To map the sub processes related to turnover of nursing staff and to investigate and measure the nursing turnover cost. METHOD This is a descriptive-exploratory study, classified as case study, conducted in a teaching hospital in the southeastern, Brazil, in the period from May to November 2013. The population was composed by the nursing staff, using Nursing Turnover Cost Calculation Methodology. RESULTS The total cost of turnover was R$314.605,62, and ranged from R$2.221,42 to R$3.073,23 per employee. The costs of pre-hire totaled R$101.004,60 (32,1%), and the hiring process consumed R$92.743,60 (91.8%) The costs of post-hire totaled R$213.601,02 (67,9%), for the sub process decreased productivity, R$199.982,40 (93.6%). CONCLUSION The study identified the importance of managing the cost of staff turnover and the financial impact of the cost of the employee termination, which represented three times the average salary of the nursing staff. PMID:27007427
Gilberto José Miranda
Full Text Available O Custeio Baseado em Atividades tem se mostrado como uma alternativa promissora para fazer frente à complexidade que caracteriza os custos hospitalares. Nos últimos dez anos, somente na Plataforma Lattes, foram encontrados mais de uma centena de estudos dessa natureza. Este trabalho tem como objetivo, conhecer, empiricamente, a utilização do Custeio ABC nos hospitais universitários e de ensino brasileiros e comparar os resultados, conforme as possibilidades, com as pesquisas realizadas nas maiores empresas brasileiras pelos autores: Khoury (1999, Beuren e Roedel (2002 e Azevedo, Santos e Pamplona (2004. Dos 115 questionários enviados aos hospitais universitários, 34 foram respondidos. O estudo levou a conclusões importantes, como: Os sistemas de custos atuais dos hospitais têm poucas condições de fornecer informações úteis à gestão; o Custeio ABC é bastante conhecido no ambiente, mas o número de usuários ainda é relativamente pequeno: apenas 15% da amostra; mas existe expectativa por parte de 44% dos hospitais com relação ao uso futuro da abordagem. As principais causas apresentadas para a não-utilização do Sistema ABC foram: (a o sistema utilizado atende às necessidades da organização e (b o Custeio Baseado em Atividades é muito complexo.The Cost Based Activity has been a promising alternative to deal with the complexity that characterizes hospital costs. In the last ten years, only in the Plataforma Lattes, more than a hundred studies of this nature had been found. This work aims to find out, empirically, the use of ABC Costing in Brazilian university hospitals and to compare the results, according to the possibilities, with the researches that have been made in the biggest Brazilian companies by the authors: Khoury (1999, Beuren and Roedel (2002 and Azevedo, Santos and Pamplona (2004. A hundred and fifteen questionnaires were sent to the university hospitals, 34 had been answered. The study relates important
D'Sa, M M; Hill, D S; Stratton, T P
Lag times in the diffusion of new drugs in the hospital setting have both patient care and pharmaceutical industry implications. This two-part series uses diffusion theory to examine differences in the adoption rates of new drugs in British Columbia teaching and non-teaching hospitals. Formulary addition of a new drug by a hospital's Pharmacy and Therapeutics Committee was considered the adoption indicator. Time for adoption was defined as the difference between a drug's Canadian market approval date and the date of formulary addition. Surveys were mailed in September 1990 to 41 hospital pharmacies (response rate = 88%), asking respondents to provide formulary inclusion dates of 29 drugs marketed between July 1987 and March 1990. A significant difference (Mann-Whitney U Test, p < 0.0358) in median adoption time was observed between the six teaching and 25 non-teaching study hospitals, with the former adopting a new drug in 7.5 months versus the latter adopting a new drug in 12.1 months. PMID:10139270
Sara AlMutar,1 Lulwa AlTourah,1 Hussain Sadeq,2 Jumanah Karim,2 Yousef Marwan3 1Department of Medicine, 2Department of Pediatrics, Mubarak Al-Kabeer Hospital, 3Department of Orthopedic Surgery, Al-Razi Orthopedic Hospital, Kuwait City, Kuwait Background: Teaching sessions for medical students during ward rounds are an essential component of bedside teaching, providing students with the opportunity to regard patients as actual people, and to observe their physical conditions directly, allowin...
Ago BU; Abeshi S; Njoku C; TU Agan; Ekabua J
Boniface Uji Ago, Sylvester Abeshi, Charles Njoku, Thomas Udagbor Agan, John EkabuaDepartment of Obstetrics and Gynaecology, University of Calabar Teaching Hospital, Calabar, NigeriaBackground: Teenage pregnancy is high-risk and associated with complications due to adverse physiological, anatomical, and socioeconomic factors. The purpose of this study was to determine the patterns and obstetric outcomes of booked teenage pregnancies at the University of Calabar Teaching Hospital (UCTH) in Nig...
Rwakatema, Deogratias Stanslaus; Ananduni, Kanankira Nnko; Katiti, Victor William; Msuya, Marycelina; Chugulu, Juliet; Kapanda, Gibson
Background This study aimed to determine the prevalence and severity of dental caries, oral hygiene levels and assessment of the oral health knowledge and practices of nursing students at Kilimanjaro Christian Medical Centre teaching hospital in Moshi, Tanzania. Methods A cross-sectional survey was done on 217 student nurse population at Kilimanjaro Christian Medical Centre Teaching Hospital in Moshi, Tanzania in 2014. Ethical approval was obtained from the Kilimanjaro Christian Medical Unive...
Dhande Priti P, Beri Shirish G, Patel Hardik R
Background: Prevention of tetanus is far easier than its treatment where mortality is very high. Most cases of tetanus occur due to lack of proper vaccination against the disease and incomplete immunization on exposure. Residents in a tertiary care teaching hospital constitute the first contact physicians for patients. Aim: To assess the perception about Tetanus immunization among residents in a tertiary care teaching hospital of Pune city. Methodology: A pre tested questionnaire was used to ...
Full Text Available Background: Medically inappropriate, ineffective and economically inefficient use of drugs is very common in our country. About 40% or more drugs expenditure may be wasted through irrational prescribing and dispensing. The need for promoting rational use of drugs is not only because of economic considerations; also it is an essential element for achieving quality of the health and medical care for patients and the community. For this purpose a cross sectional study was carried out among the individuals attending the outpatient departments (OPD of Medicine, Surgery, Gynecology & Obstetrics, Pediatrics, Orthopedics, Dermatology & Venereology, Ophthalmology and Otolaryngology of two tertiary care teaching hospitals of Dhaka, Bangladesh. Objective: To observe the prescribing pattern in outpatient departments of two tertiary care teaching hospitals (Dhaka by using World Health Organization (WHO core prescribing indicators. Materials and Methods: Six hundred prescriptions of patients attending the OPD of Medicine, Surgery, Gynecology & Obstetrics, Pediatrics, Orthopedics, Dermatology & Venereology, Ophthalmology and Otolaryngology of Enam Medical College Hospital (private hospital and Sir Salimullah Medical College Hospital (public hospital were collected randomly on working days from April to September 2014. Then the prescriptions were analyzed by following the “Prescribing indicators form” as recommended by the International Organization of Rational Use of Drugs (INRUD/WHO. Results: Average number of drugs per prescription was significantly high (3.07 in public hospital and 3.00 in private hospital. Generic prescribing was significantly lower in private hospital (4.00% than that in public hospital (21.00%. Antibiotic prescription was higher in private hospital (42.35%. Injection prescribed in public hospital was 5.74% whereas 5.66% in private hospital. Drugs prescribed from Essential Drug List of Bangladesh were less in both the hospitals (42
As the healthcare marketplace, characterized by declining revenues and heavy price competition, continues to evolve toward managed care, teaching hospitals are being forced to act more like traditional industrial organizations. Profit-oriented behavior, including emphases on market strategies and competitive advantage, is now a necessity if these hospitals are going to survive the transition to managed care. To help teaching hospitals evaluate strategic options that maximize financial effectiveness, this study examined the financial and operating data for 100 major U.S. teaching hospitals to determine relationships among competitive strategy, market environment, and financial return on invested capital. Results should help major hospitals formulate more effective strategies to combat environmental turbulence. PMID:10338929
B. A. Alex-Hart
Full Text Available Problem statement: Hand washing with soap is an important means of preventing hospital acquired infections .However the rate of hand washing with soap and water is unacceptably low amongst health workers. Few studies on this subject have been done amongst health workers in Nigeria. The aims of this study were to explore perceptions, attitudes and hand washing practices amongst health workers in a tertiary health institution in Port Harcourt, Nigeria. Approach: This was a descriptive cross sectional survey carried out amongst randomly selected doctors and nurses in University of Port Harcourt Teaching Hospital. A simple questionnaire exploring perceptions, attitudes and self reported behavior was used. Information obtained included bio data, awareness information and practice. Data were analyzed using descriptive statistics. Results: A total of 258 health workers (139 doctors and 119 nurses participated in this study. Male to female ratio was 1: 3.3. The rate of hand washing before and after interacting with patients were 9.3 and 51.2% respectively (χ2= 105.19, p-value=0.000. The rate of hand washing before and after simple procedures were 13.6 and 59.7% respectively (χ2 = 116.25, p-value = 0.000. Soapy water in a basin was most frequently (55.8% used for hand washing. Doctors were more likely than nurses to wash hands before interacting with patients (χ2 = 7.98, p-value = 0.005 and before simple procedures (χ2 = 4.29, p-value = 0.039. The rates of hand washing before meals and after defaecation were 69.0% and 58.1% respectively. Soap and running water were more frequently used after defecation (61.6% than before meals and snacks (46.5%.The greatest motivation for hand washing was fear of contracting disease, whilst constraints included lack of soap and water. Conclusion/Recommendations: Hand washing rates are low amongst health workers in Port Harcourt. There is need for regular education and re-education and provision of
Full Text Available Afsaneh Vazin,1 Mohammad Ali Davarpanah,2 Setareh Ghalesoltani3 1Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran; 2HIV Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; 3International Branch of Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran Abstract: To evaluate pattern of using of three antifungal drugs: fluconazole, amphotericin B and voriconazole, at the hematology–oncology and bone marrow transplant wards of one large teaching hospital. In a prospective cross-sectional study, we evaluated the appropriateness of using antifungal drugs in patients, using Infectious Disease Society of America (IDSA and National Comprehensive Cancer Network (NCCN guidelines. All the data were recorded daily by a pharmacist in a form designed by a clinical pharmacist and infectious diseases specialist, for antifungals usage, administration, and monitoring. During the study, 116 patients were enrolled. Indications of prescribing amphotericin B, fluconazole, and voriconazole were appropriate according to guidelines in 83.4%, 80.6%, and 76.9% respectively. The duration of treatments were appropriate according to guidelines in 75%, 64.5%, and 71.1% respectively. The dose of voriconazole was appropriate according to guidelines in 46.2% of patients. None of the patients received salt loading before administration of amphotericin B. The most considerable problems with the mentioned antifungals were about the indications and duration of treatment. In addition, prehydration for amphotericin B and dosage of voriconazole were not completely compatible with the mentioned guidelines. A suitable combination of controlling the use of antifungals and educational programs could be essential for improving the general process of using antifungal drugs at our hospital. Keywords: utilization evaluation, fluconazole, amphotericin B, voriconazole, neutropenia
Full Text Available The goal of this study was to examine the prevalence, assessment and management of pediatric pain in a public teaching hospital. The study sample consisted of 121 inpatients (70 infants, 36 children, and 15 adolescents, their families, 40 physicians, and 43 nurses. All participants were interviewed except infants and children who could not communicate due to their clinical status. The interview included open-ended questions concerning the inpatients’ pain symptoms during the 24 h preceding data collection, as well as pain assessment and pharmacological/non-pharmacological management of pain. The data were obtained from 100% of the eligible inpatients. Thirty-four children/adolescents (28% answered the questionnaire and for the other 72% (unable to communicate, the family/health professional caregivers reported pain. Among these 34 persons, 20 children/adolescents reported pain, 68% of whom reported that they received pharmacological intervention for pain relief. Eighty-two family caregivers were available on the day of data collection. Of these, 40 family caregivers (49% had observed their child’s pain response. In addition, 74% reported that the inpatients received pharmacological management. Physicians reported that only 38% of the inpatients exhibited pain signs, which were predominantly acute pain detected during clinical procedures. They reported that 66% of patients received pharmacological intervention. The nurses reported pain signs in 50% of the inpatients, which were detected during clinical procedures. The nurses reported that pain was managed in 78% of inpatients by using pharmacological and/or non-pharmacological interventions. The findings provide evidence of the high prevalence of pain in pediatric inpatients and the under-recognition of pain by health professionals.
Full Text Available Abstract Background Medication errors can occur at any of the three steps of the medication use process: prescribing, dispensing and administration. We aimed to determine the incidence, type and clinical importance of drug administration errors and to identify risk factors. Methods Prospective study based on disguised observation technique in four wards in a teaching hospital in Paris, France (800 beds. A pharmacist accompanied nurses and witnessed the preparation and administration of drugs to all patients during the three drug rounds on each of six days per ward. Main outcomes were number, type and clinical importance of errors and associated risk factors. Drug administration error rate was calculated with and without wrong time errors. Relationship between the occurrence of errors and potential risk factors were investigated using logistic regression models with random effects. Results Twenty-eight nurses caring for 108 patients were observed. Among 1501 opportunities for error, 415 administrations (430 errors with one or more errors were detected (27.6%. There were 312 wrong time errors, ten simultaneously with another type of error, resulting in an error rate without wrong time error of 7.5% (113/1501. The most frequently administered drugs were the cardiovascular drugs (425/1501, 28.3%. The highest risks of error in a drug administration were for dermatological drugs. No potentially life-threatening errors were witnessed and 6% of errors were classified as having a serious or significant impact on patients (mainly omission. In multivariate analysis, the occurrence of errors was associated with drug administration route, drug classification (ATC and the number of patient under the nurse's care. Conclusion Medication administration errors are frequent. The identification of its determinants helps to undertake designed interventions.
Vishma Hydie Menezes
Conclusion: The study shows that prescription pattern in palliative care unit of this hospital was in accordance with WHO pain management guidelines. The study showed the current trend in prescription of analgesic drugs in the teaching hospital where the study was conducted.
Urology cover is commonly available out-of-hours in most teaching hospitals. However, increased pressure to reduce hospital expenditure has forced many institutions to consider removing middle grade cover outside of normal working hours. The aim of this study was to audit the emergency urology activity in our institution over a 12-month period.
Kozhimannil, Katy B; Thao, Viengneesee; Hung, Peiyin; Tilden, Ellen; Caughey, Aaron B; Snowden, Jonathan M
Objectives This study aims to examine the relationship between hospital birth volume and multiple maternal morbidities among low-risk pregnancies in rural hospitals, urban non-teaching hospitals, and urban teaching hospitals, using a representative sample of U.S. hospitals. Study Design Using the 2011 Nationwide Inpatient Sample from 607 hospitals, we identified 508,146 obstetric deliveries meeting low-risk criteria and compared outcomes across hospital volume categories. Outcomes include postpartum hemorrhage (PPH), chorioamnionitis, endometritis, blood transfusion, severe perineal laceration, and wound infection. Results Hospital birth volume was more consistently related to PPH than to other maternal outcomes. Lowest-volume rural (< 200 births) and non-teaching (< 650 births) hospitals had 80% higher odds (adjusted odds ratio [AOR] = 1.80; 95% CI = 1.56-2.08) and 39% higher odds (AOR = 1.39; 95% CI = 1.26-1.53) of PPH respectively, than those in corresponding high-volume hospitals. However, in urban teaching hospitals, delivering in a lower-volume hospital was associated with 14% lower odds of PPH (AOR = 0.86; 95% CI = 0.80-0.93). Deliveries in rural hospitals had 31% higher odds of PPH than urban teaching hospitals (AOR = 1.31; 95% CI = 1.13-1.53). Conclusions Low birth volume was a risk factor for PPH in both rural and urban non-teaching hospitals, but not in urban teaching hospitals, where higher volume was associated with greater odds of PPH. PMID:26731180
Rafael de Melo Franco
Full Text Available OBJETIVO: Verificar se a profilaxia da trombose venosa profunda está sendo utilizada de maneira correta e rotineira em um hospital de ensino. MÉTODOS E CASUÍSTICA: Foi realizado um estudo transversal de pacientes internados em sete setores (enfermarias do Conjunto Hospitalar de Sorocaba (Hospital de Ensino, no período de agosto de 2004 a agosto de 2005. Para estratificação do risco de trombose venosa profunda de cada paciente, foram pesquisados fatores clínicos e cirúrgicos, segundo o protocolo preconizado pela Sociedade Brasileira de Angiologia e Cirurgia Vascular. No período estudado, foram analisados 216 prontuários, dos quais 30 eram da cirurgia abdominal, 30 da cirurgia vascular, 30 da urologia, 31 da clínica médica, 31 da unidade de terapia intensiva, 31 da ortopedia e 33 da ginecologia/obstetrícia. RESULTADOS: Do total de pacientes, foi efetuada profilaxia para trombose venosa profunda em 57 (26%, sendo que, em 51 (89%, a execução foi de maneira correta e, em 6 (11%, não-preconizada. O método profilático mais utilizado foi o medicamentoso; 49 de 57 pacientes fizeram uso de heparina de baixo peso molecular. Também foi verificada a utilização de meias elásticas em cinco pacientes e deambulação precoce em sete. Já a compressão pneumática intermitente não foi utilizada em nenhum deles. CONCLUSÃO: De acordo com os resultados e com base no protocolo, concluiu-se que, no período da pesquisa, a profilaxia para trombose venosa profunda, no Conjunto Hospitalar de Sorocaba, foi executada rotineiramente e de forma adequada em apenas 23,6% (51 do total de 216 pacientes.OBJECTIVE: To verify whether deep venous thrombosis prophylaxis is being correctly and routinely used at a teaching hospital. METHODS: A cross-sectional study of hospitalized patients on seven sectors at Conjunto Hospitalar de Sorocaba (Hospital de Ensino was performed from August 2004 to August 2005. For the deep venous thrombosis risk stratification of
Bahrami, Mohammad Amin; Barati, Omid; Ghoroghchian, Malake-sadat; Montazer-alfaraj, Razieh; RANJBAR EZZATABADI, Mohammad
Objective The commitment of employees is affected by several factors, including factors related to the organizational climate. The aim of this study was to investigate the relationship between organizational commitment of nurses and the organizational climate in hospital settings. Methods A cross-sectional study was conducted in 2014 at two teaching hospitals in Yazd, Iran. A total of 90 nurses in these hospitals participated. We used stratified random sampling of the nursing population. The ...
OBJECTIVES: To determine the nature, extent and costs of injuries to health care workers caused by physical abuse. DESIGN: Retrospective study. SETTING: Large acute and tertiary care teaching hospital in Winnipeg. PARTICIPANTS: All health care workers at the hospital who filed reports of abuse-related injuries and of verbal abuse and threatening behaviour from Apr. 1, 1991, to Mar. 31, 1993. OUTCOME MEASURES: Frequency of physical and verbal abuse of hospital personnel according to job catego...
Full Text Available Introduction: Due to the importance of Electronic Medical Record (EMR in the quality of health care services, checking the readiness of hospitals to implement it is a vital step to define success or failure of the Electronic Medical Record in the first place. The aim of this study was to evaluate the readiness of Shiraz teaching hospitals to implement Electronic Medical Record. Method: This study was a cross-sectional descriptive study done in 2015. The study population included Health Information Management (HIM staff of Shiraz teaching hospitals. Five hospitals from a total of 14 hospitals were selected as Single-stage cluster sampling with a population of 79 health information management staff. Data collection was performed by using a validated questionnaire. The questionnaire consisted of three main dimensions including technical, organizational and legal requirements. For data analysis, SPSS software version 16 and one way Analysis of Variance (ANOVA for comparisons between five hospitals were used. Results:The results showed that Shiraz teaching hospitals have high readiness (3.66 out of 5 to implement Electronic Medical Record. Shiraz teaching hospitals are better prepared in terms of legal requirements. Also, a significant difference was not observed among the hospitals in any of the technical, organizational and legal aspects (P > 0.05. Conclusion: Due to the importance of the technical, organizational and legal aspects in the implementation of Electronic Medical Record, it is recommended that the authorities consider these aspects in implementation of Electronic Medical Record. Also, according to the high readiness of Shiraz teaching hospitals to implement Electronic Medical Record, it is recommended that authorities should take necessary measures, including financial support in order to run it.
Filho, Jose Carlos Serufo; Grillo, Tania Moreira
The management requires a hospital organization to provision their costs/expenses with tools that approximate reality. The task of measuring productivity can be complex and uncertain, several methods are tested and the use of the DRG has been efficient, being used to assess the productivity through clinical outcomes. Cross-sectional study evaluated 145.710 hospitalizations in the period 2012-2014, using the DRG methodology for measuring productivity from the median length of hospitalization. When we group all hospitalizations in clinical (37.6%) and surgical (62.4%), multiple analyzes could be made according to this criterion. The DRG as a tool for prediction of hospital days is an effective alternative, thereby contributing to the control of productivity that directly influences the costs of hospital expenses and product and service quality.
Nakamura-Pereira, Marcos; Mendes-Silva, Wallace; Dias, Marcos Augusto Bastos; Reichenheim, Michael E; Lobato, Gustavo
This study aimed to investigate the performance of the Hospital Information System of the Brazilian Unified National Health System (SIH-SUS) in identifying cases of maternal near miss in a hospital in Rio de Janeiro, Brazil, in 2008. Cases were identified by reviewing medical records of pregnant and postpartum women admitted to the hospital. The search for potential near miss events in the SIH-SUS database relied on a list of procedures and codes from the International Classification of Diseases, 10th revision (ICD-10) that were consistent with this diagnosis. The patient chart review identified 27 cases, while 70 potential occurrences of near miss were detected in the SIH-SUS database. However, only 5 of 70 were "true cases" of near miss according to the chart review, which corresponds to a sensitivity of 18.5% (95%CI: 6.3-38.1), specificity of 94.3% (95%CI: 92.8-95.6), area under the ROC of 0.56 (95%CI: 0.48-0.63), and positive predictive value of 10.1% (IC95%: 4.7-20.3). These findings suggest that SIH-SUS does not appear appropriate for monitoring maternal near miss. PMID:23843001
Pasquini, T.A.S.; H.D. Neder; Araújo-Junqueira, L.; De-Souza, D.A.
Protein-energy malnutrition (PEM) is a treatable disease with high prevalence among hospitalized patients. It can cause significant increases in the duration of hospitalization and costs. PEM is especially important for health systems since malnourished patients present higher morbidity and mortality. The objective of the present study was to assess the evolution of nutritional status (NS) and the effect of malnutrition on clinical outcome of patients at a public university hospital of high c...
Antonio Isidro-Filho; Tomás de Aquino Guimarães; Marcelo Gattermann Perin; Ricky C. Leung
Competencies mobilized by service providers form an element of hospital services insofar as scientific and technological procedures that are part of the service become tangible. In view of the fact that hospitals have adopted Information and Communication Technologies (ICT), it would be logical to assume that learning contributes towards acquiring competencies related to changes in hospitals resulting from the adoption of new technologies. This paper aims to analyze relationships between work...
Blagojevic, Joanne; Stephens, Sigrid
Discharge teaching in a pediatric hospital setting is difficult because the situation involves multiple learners, time constraints, and differing skill levels of nurse teachers. Shortened length of stay forces nurses to complete patient education efficiently. Unstructured education can lead to failed learning, as evidenced by readmissions and postdischarge feedback. A performance improvement project was conducted to evaluate the effectiveness of standardized teaching plans for diabetes mellitus and infant cardiopulmonary resuscitation. Preliminary data indicated a passing score of at least 90% on posttests by all learners, suggesting that standardized teaching plans may help nurses complete prescribed discharge teaching. PMID:18507236
Leonardi, Robert A.; Townsend, Jacob C; Bonnema, D. Dirk; Patel, Chetan A.; Gibbons, Michael T.; Todoran, Thomas M.; Nielsen, Christopher D.; Powers, Eric R.; Steinberg, Daniel H
This study sought to examine the safety of percutaneous coronary intervention (PCI) before and during the de novo establishment of a transradial (TR) program at a teaching hospital. TR access remains underused in the United States, where cardiology fellowship programs continue to produce cardiologists with little TR experience. The establishment of TR programs at teaching hospitals may affect PCI safety. Starting in July of 2009, a TR program was established at teaching hospital. PCI-related ...
Custer, W S; Willke, R J
This article examines the effect of medical staff behavior on the cost of hospital-based care and graduate medical education, and shows its implications for estimation of hospital costs. The empirical work brings a unique new data source for these characteristics to the estimation process. Our results indicate that there are important economies of scale and scope in hospital production, both for inpatient stays and for residency training. Controlling for medical staff characteristics signific...
Full Text Available Abstract Background The purpose of this study is to establish teaching hospital accreditation standards anew with the hope that Taiwan's teaching hospitals can live up to the expectations of our society and ensure quality teaching. Methods The development process lasted two years, 2005-2006, and was separated into three stages. The first stage centered on leadership meetings and consensus building, the second on drafting the new standards with expert focus groups, and the third on a pilot study and subsequent revision. Results Our new teaching hospital accreditation standards have six categories and 95 standards as follows: educational resources (20 items, teaching and training plans and outcomes (42 items, research and results (9 items, development of clinical faculty and continuing education (8 items, academic exchanges and community education (8 items, and administration (8 items. Conclusions The new standards have proven feasible and posed reasonable challenges in the pilot study. We hope the new standards will strengthen teaching and research, and improve the quality of hospital services at the same time.
Helio Roberto Hekis
Full Text Available Hospital portals that manage health related data are becoming increasingly popular since they play an important role to provide, acquire and exchange information to its users. This study aims to verify how the hospital portals are contributing to the expansion of users knowledge by the analysis of interactive features associated with three mechanisms of knowledge management: Knowledge Access (KA; Knowledge Creation (KC; and Knowledge Transfer (KT. The study is exploratory, descriptive and qualitative, classified as a survey, and involves the standardization of data collection instruments (questionnaires and interviews applied directly to people of a particular population to evaluate the knowledge management the portals present on the university hospitals from northeastern of Brazil. The results indicated that the proceeds of access to knowledge (AK prevailed over other confirming the results found on the Asians and Americans hospital portals.
Cabral Lucio M; de Souza Ana HA; Huf Gisele
Abstract Background Sildenafil is a cyclic guanosine monophosphate-specific phosphodiesterase-5 inhibitor used for treating pulmonary hypertension. Although the use of sildenafil in patients under 18 years old is off-label, this inhibitor has been widely prescribed for children treatment at hospitals in Brazil. In this work we evaluated the current practices in using sildenafil in the three main reference hospitals of Rio de Janeiro to design a clinical trial. Then we analyzed the content of ...
Full Text Available Competencies mobilized by service providers form an element of hospital services insofar as scientific and technological procedures that are part of the service become tangible. In view of the fact that hospitals have adopted Information and Communication Technologies (ICT, it would be logical to assume that learning contributes towards acquiring competencies related to changes in hospitals resulting from the adoption of new technologies. This paper aims to analyze relationships between workplace learning strategies and professional competencies after the adoption of innovations supported ICT in hospitals. Eleven interviews were carried out with professionals from three different hospitals and identifying the professional competencies resulting from innovations supported by ICT. This was followed by a cross-sectional survey involving 425 employees at the hospitals surveyed. The data analysis was undertaken by means of structural equation modeling (SEM. The results confirm the hypothesis and indicate that the performance of professional competences based on new ICT is determined by the way the respondents think, change and apply their knowledge, skills and attitudes in the workplace by use of new information and communication technologies.
K. Mendonça de Araujo
Full Text Available We analyzed the trends of scientific output of the University Hospital, Federal University of Rio de Janeiro. A total of 1420 publications were classified according to pattern and visibility. Most were non-research publications with domestic visibility. With time, there was a tendency to shift from non-research (or education-oriented publications with domestic visibility to research publications with international visibility. This change may reflect new academic attitudes within the institution concerning the objectives of the hospital and the establishment of scientific research activities. The emphasis of this University Hospital had been on the training of new physicians. However, more recently, the production of new knowledge has been incorporated as a new objective. The analysis of the scientific production of the most productive sectors of the hospital also showed that most are developing non-research studies devoted to the local public while a few of the sectors are carrying out research studies published in journals with international status. The dilemma of quality versus quantity and of education versus research-oriented publication seems, however, to continue to exist within the specialized sectors. The methodology described here to analyze the scientific production of a university hospital can be used as a tool to better understand the evolution of medical research in Brazil and also to help formulate public policies and new strategies to include research among the major objectives of University Hospitals.
Full Text Available Introduction: In recent decades the strategies to improve science education has grown exponentially. Thus, the scientific production in the area is also growing, with the purpose of identifying parameters and methodologies that contribute to their qualification. The teaching of biochemistry is intimately linked to that context. However, it is still little explored in basic education and with character technicist in higher education. The aim of this study was identify areas that received most attention in the scientific literature about teaching and education in biochemistry that were presented at the Congress of the Brazilian Society of Biochemistry and Molecular Biology from 2004 to 2012. Material and Methods: To conduct the survey were analyzed summaries available on the website of the Brazilian Journal of Education for Biochemistry and Molecular Biology published in the proceedings of the event, where they were encontrados176 summaries. For expression of results was used categorization from the content analysis. Results and Discussion: The results observed to establish nine categories based on the analysis of the titles and content of the work, which, in descending order, were: information and communication technologies, alternative methods teaching and learning, biochemistry in Elementary Education and / or Medium, experiential activities, teacher training, dissemination of science, proposition and evaluation of content and / or science curricular and History and Philosophy. It is noticed that the three most important categories were consolidated along editions. In education, however, there was a significant decrease in the number of abstracts submitted abstracts for the past five years. Conclusions: We conclude that all categories listed seeking alternatives to improve teaching practices and promote education of biochemistry in different contexts.
Denilson Campos de Albuquerque
Full Text Available Background: Heart failure (HF is one of the leading causes of hospitalization in adults in Brazil. However, most of the available data is limited to unicenter registries. The BREATHE registry is the first to include a large sample of hospitalized patients with decompensated HF from different regions in Brazil. Objective: Describe the clinical characteristics, treatment and prognosis of hospitalized patients admitted with acute HF. Methods: Observational registry study with longitudinal follow-up. The eligibility criteria included patients older than 18 years with a definitive diagnosis of HF, admitted to public or private hospitals. Assessed outcomes included the causes of decompensation, use of medications, care quality indicators, hemodynamic profile and intrahospital events. Results: A total of 1,263 patients (64±16 years, 60% women were included from 51 centers from different regions in Brazil. The most common comorbidities were hypertension (70.8%, dyslipidemia (36.7% and diabetes (34%. Around 40% of the patients had normal left ventricular systolic function and most were admitted with a wet-warm clinical-hemodynamic profile. Vasodilators and intravenous inotropes were used in less than 15% of the studied cohort. Care quality indicators based on hospital discharge recommendations were reached in less than 65% of the patients. Intrahospital mortality affected 12.6% of all patients included. Conclusion: The BREATHE study demonstrated the high intrahospital mortality of patients admitted with acute HF in Brazil, in addition to the low rate of prescription of drugs based on evidence.
K. S. Carvalho
Full Text Available
The hospital environment, especially surfaces, represents a secondary reservoir for pathogens such as Staphylococcus aureus. The present study was carried out at the Hospital de Clínicas da Universidade Federal de Uberlândia (HC-UFU in Brazil, from January to August 2004, with the aim of qualitatively and quantitatively assessing the presence of S. aureus on surfaces touched by hands (bed rail, bedside table and door handle, on the floor and in the air, in wards where the patients were infected or not infected with this organism. Twenty-six wards with at least one infected patient and 26 wards with uninfected patients were investigated. Surfaces and air were sampled during bed making, by means of sterile 10cm2 adhesive tapes and 90mm-diameter exposed culture plates, respectively. Cultures were carried out on Egg Yolk Salt Agar, containing 7.5% NaCl and 1% egg yolk, and colonies identified by lecithinase and coagulase tests and Gram stain. About 50% of the wards were S. aureus contaminated, without significant differences between the groups (46.1% in the infected patient wards versus 53.8% in controls; the correlation between counts of the pathogen on the surfaces and in the air was 66.7%. In spite of the fact that these bacteria were frequently present in the assessed wards, the microbial density was low (less than 1 CFU/cm2. The association between environmental contamination and the epidemiology of S. aureus nosocomial infections is complex and thus further investigations are needed to reach a better understanding of this relationship. Keywords: environmental contamination; nosocomial infections; Staphylococcus aureus.
TU Agan; EI Archibong; JE Ekabua; et al
TU Agan1, EI Archibong1, JE Ekabua1, EI Ekanem1, S E Abeshi1, TA Edentekhe2, EE Bassey21Department of Obstetrics and Gynecology and 2Department of Anesthesia, College of Medical Sciences, University of Calabar Teaching Hospital, NigeriaBackground: Maternal mortality remains a major public health challenge, not only at the University of Calabar Teaching Hospital, but in the developing world in general.Objective: The objective of this study was to assess trends in maternal mortality in a tertia...
Protein-energy malnutrition (PEM) is a treatable disease with high prevalence among hospitalized patients. It can cause significant increases in the duration of hospitalization and costs. PEM is especially important for health systems since malnourished patients present higher morbidity and mortality. The objective of the present study was to assess the evolution of nutritional status (NS) and the effect of malnutrition on clinical outcome of patients at a public university hospital of high complexity in Brazil. Patients hospitalized in internal medicine (n = 54), oncology (n = 43), and infectious diseases (n = 12) wards were included. NS was evaluated using subjective global assessment up to 48 h after admission, and thereafter at intervals of 4-6 days. On admission, patients (n = 109) were classified as well-nourished (n = 73), moderately malnourished or at risk of malnutrition (n = 28), and severely malnourished (n = 8). During hospitalization, malnutrition developed or worsened in 11 patients. Malnutrition was included in the clinical diagnosis of only 5/36 records (13.9% of the cases, P = 0.000). Nutritional therapy was administered to only 22/36 of the malnourished patients; however, unexpectedly, 6/73 well-nourished patients also received commercial enteral diets. Complications were diagnosed in 28/36 malnourished and 9/73 well-nourished patients (P = 0.000). Death occurred in 12/36 malnourished and 3/73 well-nourished patients (P = 0.001). A total of 24/36 malnourished patients were discharged regardless of NS. In summary, malnutrition remains a real problem, often unrecognized, unappreciated, and only sporadically treated, even though its effects can be detrimental to the clinical course and prognosis of patients. The amount of public and private funds unnecessarily dispersed because of hospital malnutrition is significant
Pasquini, T.A.S. [Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, MG (Brazil); Neder, H.D. [Instituto de Economia, Universidade Federal de Uberlândia, Uberlândia, MG (Brazil); Araújo-Junqueira, L. [Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, MG (Brazil); De-Souza, D.A. [Programa de Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, MG (Brazil); Departamento de Clínica Médica e Curso de Nutrição, Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, MG (Brazil)
Protein-energy malnutrition (PEM) is a treatable disease with high prevalence among hospitalized patients. It can cause significant increases in the duration of hospitalization and costs. PEM is especially important for health systems since malnourished patients present higher morbidity and mortality. The objective of the present study was to assess the evolution of nutritional status (NS) and the effect of malnutrition on clinical outcome of patients at a public university hospital of high complexity in Brazil. Patients hospitalized in internal medicine (n = 54), oncology (n = 43), and infectious diseases (n = 12) wards were included. NS was evaluated using subjective global assessment up to 48 h after admission, and thereafter at intervals of 4-6 days. On admission, patients (n = 109) were classified as well-nourished (n = 73), moderately malnourished or at risk of malnutrition (n = 28), and severely malnourished (n = 8). During hospitalization, malnutrition developed or worsened in 11 patients. Malnutrition was included in the clinical diagnosis of only 5/36 records (13.9% of the cases, P = 0.000). Nutritional therapy was administered to only 22/36 of the malnourished patients; however, unexpectedly, 6/73 well-nourished patients also received commercial enteral diets. Complications were diagnosed in 28/36 malnourished and 9/73 well-nourished patients (P = 0.000). Death occurred in 12/36 malnourished and 3/73 well-nourished patients (P = 0.001). A total of 24/36 malnourished patients were discharged regardless of NS. In summary, malnutrition remains a real problem, often unrecognized, unappreciated, and only sporadically treated, even though its effects can be detrimental to the clinical course and prognosis of patients. The amount of public and private funds unnecessarily dispersed because of hospital malnutrition is significant.
Adesiyun, Abiodun A.; Tisha A. M. Harper; Bridgewater, Shelley; Brown, Latoya; Pow-Brown, Patricia; Stewart-Johnson, Alva
Background: Airborne microorganisms within the hospital environment can potentially cause infection in susceptible patients. The objectives of this study were to identify, quantify, and determine the nosocomial potential of common airborne microorganisms present within a small animal teaching hospital. Methods: Bioaerosol sampling was done initially in all 11 rooms and, subsequently, weekly samples were taken from selected rooms over a 9-week period. Samples were collected twice (morning and ...
Md. Shamsur Rahman, Zinnat Ara Begum; and Md. Khoshroz Samad
The prescribing pattern of non-steroidal anti-inflammatory drugs (NSAIDs) in prescriptions prescribed by the qualified medical personnel in the outpatient departments of three selected teaching hospitals in Dhaka city were studied. A total of 600 prescriptions containing NSAIDs were collected. The clinical conditions for which NSAIDs prescribed were identical in all the three hospitals, although there were wide variations in the prescribing pattern with respect to pharmacological sub-classes ...
Zhu XP; Zhu LL; Zhou Q
Xiu-Ping Zhu,1 Ling-Ling Zhu,2 Quan Zhou11Department of Pharmacy, 2Cadre Department, Division of Nursing, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People’s Republic of ChinaBackground: A retrospective utilization study was performed to evaluate utilization patterns for enteral nutrition in a university teaching hospital.Methods: Enteral nutrition was divided into three types according to the nitrogen source, ie, total prot...
Agan, TU; Archibong, EI; Ekabua, JE; Ekanem, EI; Abeshi, S E; Edentekhe, TA; Bassey, EE
Background Maternal mortality remains a major public health challenge, not only at the University of Calabar Teaching Hospital, but in the developing world in general. Objective The objective of this study was to assess trends in maternal mortality in a tertiary health facility, the maternal mortality ratio, the impact of sociodemographic factors in the deaths, and common medical and social causes of these deaths at the hospital. Methodology This was a retrospective review of obstetric servic...
Ryder, Kerry J
Introduction. This project aims to improve the service user experience by designing and publishing an accessible indoor map in an academic teaching hospital. On a daily basis approximately 600 service users will be disoriented in the hospital resulting in 18 hours/day staff time spent helping patients find their way. 84% (n=109) of staff categorised indoor maps as a service improvement. Patients who get lost can feel anxiety, shame and even panic. Maps can improve patient autonomy¹. Internati...
Joy D. Jocson
This survey-correlational study aimed to investigate the self-concept, values orientation, and teaching performance among hospitality educators of the West Visayas State University System. The study was conducted in January 2013 and utilized 42 randomly selected hospitality educators as participants. The simple random sampling method was used in the selection of the participants. Three (3) standardized and published datagathering instruments were adapted to obtain the data for the...
This paper explores the cost structure of Swiss hospitals, focusing on differences due to teaching activities and those across different ownership and subsidization types. A stochastic total cost frontier with a Cobb-Douglas functional form has been estimated for a panel of 150 general hospitals over the six-year period from 1998 and 2003. Inpatient cases adjusted by DRG cost weights and ambulatory revenues are considered as two separate outputs. The adopted econometric specification allows f...
Nigussie, Seifu; Belachew, Tefera; Wolancho, Wadu
Background Hospitalization and surgery are critical negative life events that lead to the experience of considerable anxiety in patients. Patients may perceive the day of surgery as the biggest and the most threatening day in their lives. There is paucity of information on predictors of anxiety in the current study area. The main objective of this study is to assess predictors of preoperative anxiety among patients scheduled for surgery in Jimma University Specialized Teaching Hospital. Metho...
Eneida Simões da Fonseca
Full Text Available A legislação brasileira reconhece o direito de crianças e jovens hospitalizados (CNDCA, 1995 ao atendimento pedagógico-educacional, durante seu período de internação. Esta modalidade de atendimento denomina-se classe hospitalar, segundo terminologia do MEC/SEESP (1994. A inexistência de teorias ou estudos desta natureza em território nacional gera, tanto na área educacional quanto na de saúde, o desconhecimento desta modalidade de ensino e integralização da atenção de saúde às crianças e aos jovens hospitalizados. Considerando este fato, o presente estudo realizou um levantamento nacional dos estados federativos que oferecem o atendimento de classe hospitalar e as formas como este é ministrado. No Brasil, há 39 classes hospitalares distribuídas e em funcionamento em 13 unidades federadas. Esse tipo de atendimento decorre, em sua maioria, de convênio firmado entre as Secretarias de Educação e de Saúde dos estados, embora existam classes hospitalares resultantes de iniciativas de entidades filantrópicas e universidades. Noventa e cinco professores atuam nessa modalidade de ensino, atendendendo mais de 2.000 crianças/mês na faixa etária entre 0 e 15 anos de idade. Abre-se, com este estudo, a necessidade de formular propostas e aprofundar conhecimentos teóricos e metodológicos, com vistas a, efetivamente, atingir o objetivo de dar continuidade aos processos de desenvolvimento psíquico e cognitivo das crianças e jovens hospitalizados. Faz-se necessária a elaboração de uma política voltada para as necessidades pedagógico-educacionais e os direitos à educação e à saúde desta clientela em particular etapa de vida quanto ao crescimento e desenvolvimento físico e emocional.The Brazilian legislation recognizes the right of children and youngsters to pedagogical-educational service during their stay in a hospital (CNDCA, 1995. This type of service is called hospital class according to MEC/SEESP (1994 terminology
Lara Stefânia Netto de Oliveira LEÃO-VASCONCELOS; Lima, Ana Beatriz Mori; COSTA, Dayane de Melo; Larissa Oliveira ROCHA-VILEFORT; de OLIVEIRA, Ana Claúdia Alves; GONÇALVES, Nádia Ferreira; VIEIRA, José Daniel Gonçalves; PRADO-PALOS, Marinésia Aparecida
The evaluation of workers as potential reservoirs and disseminators of pathogenic bacteria has been described as a strategy for the prevention and control of healthcare-associated infections (HAIs). The aim of this study was to evaluate the presence of Enterobacteriaceae in the oral cavity of workers at an oncology hospital in the Midwest region of Brazil, as well as to characterize the phenotypic profile of the isolates. Saliva samples of 294 workers from the hospital’s healthcare and suppor...
Mendonça de Araujo K.; Mourão P.A.S.; Leta J.
We analyzed the trends of scientific output of the University Hospital, Federal University of Rio de Janeiro. A total of 1420 publications were classified according to pattern and visibility. Most were non-research publications with domestic visibility. With time, there was a tendency to shift from non-research (or education-oriented) publications with domestic visibility to research publications with international visibility. This change may reflect new academic attitudes within the institut...
Guimarães Márcia Aparecida
Full Text Available Nosocomial infections are an important cause of morbidity and mortality all over the world. It has been shown that appropriate environmental hygienic and disinfection practices can be very helpful to hospital infection control. The purpose of this study was to evaluate the bactericidal activity of some disinfectants against antibiotic-susceptible and antibiotic-resistant hospital bacterial isolates. The susceptibility of 27 clinical isolates to disinfectants and antibiotics was determined by the Association of Official Analytical Chemist?s (AOAC Use-Dilution method and by the Kirby-Bauer method, respectively. All strains tested were susceptible to sodium hypochlorite, glutaraldehyde and to the association quaternary ammonium - formaldehyde - ethyl alcohol disinfectants. However, the susceptibility of strains to phenol and to one quaternary ammonium compound was variable. Among twenty-one antibiotic-multiresistant strains (methicillin-resistant staphylococci, Enterococcus spp, Pseudomonas aeruginosa, Klebsiella pneumoniae, Proteus mirabilis, Enterobacter cloacae, Serratia marcescens and Escherichia coli eleven (52% and eight (38% strains were resistant to the quaternary ammonium and phenol compounds, respectively. Among six isolates that demonstrated susceptibility to antibiotics (staphylococci, Enterococcus spp, P. mirabilis, E. cloacae and E. coli two strains (33% showed resistance to these disinfectants. The results demonstrated the lack of correlation between antibiotic-susceptibility and susceptibility to disinfectants in hospital strains.
Ginawi, I.; Saleem, Mohd; Sigh, Mastan; Vaish, A.K.; I. Ahmad; Srivastava, V.K.; Abdullah, A. Fahad M.
Objective: To investigate the incidence of Nosocomial Infection (NI) and type of bacteriological isolates among the patients admitted in the medical and surgical wards of a non-teaching secondary care hospital in north India.
Mohsen Ghobadi Tara
Full Text Available Introduction: Continuing education and training of employees significantly affect a hospital’s performance and efficiency, and learning organizations usually exhibit higher efficiency. Hence, the objective of this study was to evaluate the correlation between the hospital employees’ continuing education and performance indicators in the teaching hospitals affiliated to Tehran’s Azad University. Method: A cross-sectional study was conducted in the teaching hospitals affiliated to Tehran’s Azad University in 2014. The subjects consisted of 70 professional hospital employees, including physicians, nurses, midwives and other personnel who had attended continuing education courses. A data collection form was used to collect the data. The data were analyzed with SPSSW-20 software. Pearson correlation coefficient was used at a significance level of 0.05. Results:The number of continuing education courses held for physicians and nurses was equal five courses, while fewer courses were held for the remaining personnel. There were significant associations between the employees’ continuing education and bed occupancy rate (p=0.009 and bed turnover interval (p=0.01. There was no significant association between the employees’ continuing education and hospital death rate (p=0.19. Conclusion: Training employees ultimately affects their performance in the hospital. Hence, a deeper insight into the significance of hospital training is needed for decision-making policy-makers and for hospitals’ executive managers to efficiently use the limited therapeutic resources and eventually achieve optimum effectiveness.
Dedey, Florence; Wu, Lily; Ayettey, Hannah; Sanuade, Olutobi A.; Akingbola, Titilola S.; Hewlett, Sandra A.; Tayo, Bamidele O.; Cole, Helen V.; de-Graft Aikins, Ama; Ogedegbe, Gbenga; Adanu, Richard
Background: Breast cancer is the leading cause of cancer-related mortality among women in Ghana. Data are limited on the predictors of poor outcomes in breast cancer patients in low-income countries; however, prolonged waiting time has been implicated. Among breast cancer patients who received treatment at Korle Bu Teaching Hospital, this study…
Chan, Linda S.; Bernstein, Sol
A method of estimating the number of house officers needed for direct patient care in teaching hospitals is discussed. An application of the proposed method is illustrated for 11 clinical services at the Los Angeles County-University of Southern California Medical Center. (Author/MLW)
Young, Philip E.
The changing social milieu has removed the charity patient but not the need for a teaching population. The University Hospital's program is described, in which patients prepaid a fixed, single fee for all obstetrics-related care through the third post partum day. (LBH)
The purpose of this study was to compare Salmonella enterica serotype Infantis isolates obtained from patients or the environment of a veterinary teaching hospital over a period of nine years following a nosocomial outbreak to determine whether isolates were epidemiologically related or represented ...
E.R. Heddema; E.J. van Hannen; B. Duim; B.M. de Jongh; J.A. Kaan; R. van Kessel; J.T. Lumeij; C.E. Visser; C.M.J.E. Vandenbroucke-Grauls
An outbreak of psittacosis in a veterinary teaching hospital was recognized in December 2004. Outbreak management was instituted to evaluate the extent of the outbreak and to determine the avian source. Real-time PCR, serologic testing and sequencing of the ompA gene of Chlamydophila psittaci were p
Mahmood A. Khan, professor of hospitality and tourism management at Virginia Tech's Pamplin College of Business, has been awarded a Fulbright-Nehru Scholar grant to teach at the Indian Institute of Technology in New Delhi during the 2009-10 academic year.
Rabia Parveen; Minal; Vanita; Patra; Swati
BACKGROUND : Immunophenotyping of leukemi a by flowcytometry offers a better classification of the hematopoietic lineage of malignant cells as compared to morphology. AIM : To determine the immunophenotypic subtypes of acute leukemia in a tertiary care teaching hospital. MATERIAL & METHODS : A one y ear study of morphologic & flowcytometric data of patients with acute leukemia. RESULTS : Total numbers ...
Saiba Eugène Semanyenzi
Full Text Available Background: Eye injuries are the most common cause of referral to the Ophthalmology department, KUTH. No research data is available on ocular trauma in Rwanda. To understand the impact of eye injuries in KUTH and to plan for preventive strategies, it is important to understand the magnitude of this problem.Aim: The aim of this study was to identify the patterns of ocular trauma at Kigali University Teaching Hospital.Methods: In this retrospective study, 352 reviewed patients were referred to KUTH, from January 1st, 2007 to January 1st, 2013. Patient’s ocular trauma details were recorded and analyzed. Patients’ demographic data, medical history, diagnosis, treatment and possible complication were retrieved from files in archive and recorded on a questionnaire for further analysis.Results: Out of the 352 patient’s files, 72.7% were males and 27.3% were females. The male to female ratio was 2.7. Majority of patients were of age group between 11 and 40 years. Among files reviewed, 75.2% sustained blunt ocular injuries whereas 22.1% sustained penetrating injuries. Main risk factors for those injured patients were work place injuries (37%, road traffic accident (21% and assault (15%. Most frequent offending agents were pieces of wood (21.5%, foreign bodies (16.4% and vehicle crush (16.1%. However, metal objects, motorbike and stone missile represented important causes of ocular trauma at KUTH respectively 13.9%, 13.06% and 11.07%. A big number of patients were found to have corneo-limbal perforation (29.2%, corneal abrasions (18.4%, sub-conjunctival hemorrhage (17.8% and peri-orbital injuries (17.6%. The common visual acuity observed on the affected eye on admission was (6/60-3/60 (38% and below 3/60 (30%. The main post-traumatic complication at KUTH was corneal scaring (42.04%.Conclusion: Males and young patients were more affected by ocular injuries because of their involvement in high risk activities in their daily life. Blunt and penetrating
Parul Sinha; Kiran Pandey; Anand Srivastava; Iti Chowdhary
Background: Infertility is defined as failure to conceive even after one year of regular, frequent and unprotected intercourse. Infertility has, in the last few years surfaced in society as a significant problem affecting as many as 15% of couples. This study aimed at identifying the characteristics of infertility among Indian couples. Methods: The present study was carried out on 100 infertile couples attending the OPD of upper India sugar exchange maternity hospital attached to GSVM med...
Fereshteh Farzianpour; Abbas R. Foroushani; Hossein Kamjoo; Sayed S. Hosseini
Problem statement: Organizational behavior is desirable for any organization, as it is associated with important organizational variables such as job satisfaction, organizational productivity and system maintenance. The main purpose of this study is to evaluate the mean organizational behavior score among the managers of the hospitals affiliated to Shahid Sadoughi University of Medical Sciences and Health Services, Yazd. Approach: A descriptive-analytic cross-sectional study was conducted on ...
Keite da Silva Nogueira
Full Text Available INTRODUCTION: Epidemiological data on the prevalence of extended-spectrum β-lactamases (ESBLs are scarce in Brazil despite the fact that these data are essential for empirical treatment and control measures. The objective of this study was to evaluate the prevalence of different ESBLs by type and distribution in a tertiary hospital in southern Brazil. METHODS: We evaluated 1,827 enterobacterial isolates between August 2003 and March 2008 isolated from patients at a tertiary hospital. Samples were identified using a Vitek automated system and were confirmed by biochemical testing. The identified ESBL strains were characterized by phenotypic methods, polymerase chain reaction (PCR, and sequencing. Genetic similarities were evaluated by pulsed-field gel electrophoresis. RESULTS: It was 390 (21.3% ESBL-producing strains, which expressed the ESBLs CTX-M (292, SHV (84, CTX and SHV (10, TEM (2, and PER (2. CONCLUSIONS: The prevalence of ESBL-expressing strains was high, especially in Klebsiella pneumoniae and Enterobacter spp. CTX-M was the predominant type of ESBL observed, and its genetic variability indicates a polyclonal distribution.
Joy D. Jocson
Full Text Available This survey-correlational study aimed to investigate the self-concept, values orientation, and teaching performance among hospitality educators of the West Visayas State University System. The study was conducted in January 2013 and utilized 42 randomly selected hospitality educators as participants. The simple random sampling method was used in the selection of the participants. Three (3 standardized and published datagathering instruments were adapted to obtain the data for the study. To ascertain the degree of self-concept, Girdano and Everly’s (1979 Self-perception Test instrument was used. In determining the pre-dominant values orientation, Rokeach’s (1973 Value Survey Form used by Rabago (1988 was utilized. To ascertain the level of teaching performance, the WVSU F-PES was employed. Frequency counts, rank, percentage analyses, mean scores, and standard deviations were employed as descriptive statistics; while t-test for independent samples, one-way ANOVA, and Pearson’s Product Moment Coefficient of Correlation (Pearson’s r were employed as inferential statistics. The criterion for the acceptance or rejection of the null hypotheses was set at .05 alpha level. The results of the study revealed that, generally, the hospitality educators had outstanding teaching performance and strong self-concept. Family security, salvation, and happiness were their most important terminal values while social recognition, a world of beauty and pleasure were their least important values. Loving, responsible, and honest were their most important instrumental values and imaginative, ambitious, and clean were their least important values. In terms of teaching performance, no significant differences existed when hospitality educators were classified according sex, age, civil status, educational attainment, status of employment and number of years in teaching. Significant differences existed in the degree of self-concept among hospitality educators grouped
Silvia Mendes da Cunha
Full Text Available Introduction: Crack cocaine use is associated with polydrug abuse, and inpatients dependent on crack exhibit profiles of serious consumption patterns. Use of alcohol and tobacco and other drugs is a risk factor for experimentation of additional drugs, including crack cocaine.Objectives:The present study describes the characteristics and crack consumption patterns among inpatients in treatment during 2011 and 2012 at the Hospital Psiquiátrico São Pedro (Porto Alegre, Brazil. An additional objective was to identify the sequence of alcohol and tobacco consumption prior to crack use.Methods: The participants were 53 male inpatients addicted to crack with a mean age of 27.5±7.3 years. A sociodemographic questionnaire; the Alcohol, Smoking and Substance Involvement Screening Test and the Mini Mental State Examination were all administered to participants. Inclusion criteria were crack cocaine dependency (based on the 10th edition of the International Classification of Diseases [ICD-10] and being abstinent for 7 days. Patients with cognitive difficulties who were unable to understand and/or respond to the questionnaires were excluded from the sample.Results: The participants were young male adults with low educational level and low incomes and were polydrug users. The majority had made more than one attempt to quit. Use of legal drugs in early adolescence, prior to crack use, was identified.Conclusions: The profiles of the inpatients addicted to crack treated at this hospital indicate a serious usage pattern among those who seek specialized support. Crack use is frequent and is associated with use of other drugs and with difficulty sustaining abstinence. The pattern of progression from alcohol and tobacco use to crack cocaine dependency demands the attention of those responsible for prevention policies.
Rafael de Melo Franco; Victor Simezo; Rafael Rodrigo Bortoleti; Elias Lobo Braga; Ana Rita Abrão; Fábio Linardi; José Augusto Costa
OBJETIVO: Verificar se a profilaxia da trombose venosa profunda está sendo utilizada de maneira correta e rotineira em um hospital de ensino. MÉTODOS E CASUÍSTICA: Foi realizado um estudo transversal de pacientes internados em sete setores (enfermarias) do Conjunto Hospitalar de Sorocaba (Hospital de Ensino), no período de agosto de 2004 a agosto de 2005. Para estratificação do risco de trombose venosa profunda de cada paciente, foram pesquisados fatores clínicos e cirúrgicos, segundo o proto...
Trotta, Annarita; Cardamone, Emma; Cavallaro, Giusy; Mauro, Marianna
Teaching hospitals (THs) simultaneously serve three different roles: offering medical treatment, teaching future doctors and promoting research. The international literature recognises such organisations as 'peaks of excellence' and highlights their economic function in the health system. In addition, the literature describes the urgent need to manage the complex dynamics and inefficiency issues that threaten the survival of teaching hospitals worldwide. In this context, traditional performance measurement systems that focus only on accounting and financial measures appear to be inadequate. Given that THs are highly specific and complex, a multidimensional system of performance measurement, such as the Balanced Scorecard (BSC), may be more appropriate because of the multitude of stakeholders, each of whom seek a specific type of accountability. The aim of the paper was twofold: (i) to review the literature on the BSC and its applications in teaching hospitals and (ii) to propose a scorecard framework that is suitable for assessing the performance of THs and serving as a guide for scholars and practitioners. In addition, this research will contribute to the ongoing debate on performance evaluation systems by suggesting a revised BSC framework and proposing specific performance indicators for THs. PMID:23081849
Aljamir Duarte Chedid
Full Text Available RACIONAL: A diverticulite cecal é uma condição rara, especialmente em populações ocidentais. Sua importância reside no fato de fazer parte do diagnóstico diferencial da apendicite aguda e do carcinoma ulcerado de ceco. CASUÍSTICA E MÉTODOS: Apresenta-se a experiência de um hospital geral do sul do Brasil no tratamento da diverticulite cecal. Descrevem-se quatro casos de divertículo único inflamado de ceco. Um destes teve diagnóstico pré-operatório através de tomografia computadorizada de abdome, tendo o paciente tratado clinicamente com remissão do quadro de diverticulite. Os outros três pacientes foram submetidos a colectomia direita com íleo-transverso anastomose. RESULTADOS: A mortalidade foi nula e nos casos operados não houve complicações pós-operatórias. Quando se consegue obter diagnóstico pré-operatório, pode-se optar por manejo clínico. CONCLUSÃO: Recomendamos laparotomia exploradora quando não há certeza diagnóstica. Preconizamos manejo cirúrgico radical quando o diagnóstico é efetuado através de laparotomia.BACKGROUND: Cecal diverticulitis is a rare condition, specially in western people. Its importance concerns of being part of the differential diagnosis of acute appendicitis and ulcerated cecal carcinoma. AIM: To present the experience of southern Brazilian general hospital in the treatment of cecal diverticulitis. MATERIAL AND METHODS: We present four cases of single inflamed cecal diverticulum. One was diagnosed by pre-operatively computer tomography and was treated medically without complications. The other three cases were diagnosed during operation and treated by right hemicolectomy and ileotransverse anastomosis. RESULTS:There were no deaths or complications. When cecal diverticulitis is pre-operatively diagnosed it may be treated medically. We preclude laparotomy when the diagnosis is uncertain. CONCLUSION: We recommend radical surgical management when the diagnosis is made during operation.
Full Text Available Introduction Proton pump inhibitors (PPIs are highly prescribed drugs in Italy and in particular in the Sicilian region but little is known about their use in the hospital setting.Materials and methods PPI utilization and related costs were reviewed retrospectively by examining the pharmaceutical records of drug dispensation to the various wards of the Policlinico Universitario P. Giaccone of Palermo in 2010. Differences in the prescribing rates and drug preferences among the different clinical wards were analyzed.Results A total of 20,420 patients were hospitalized at the Policlinico of Palermo in 2010. Overall, the consumption of PPIs was 120 DDD/100 bed-days for the year 2010 with a total cost of 42,780 euros. Omeprazole and esomeprazole were the most commonly prescribed molecules accounting for over 70% of all prescriptions: nevertheless, wide differences in drug choices were noted even within the same ward. As expected, greater utilization rates were registered in the Internal Medicine and General Surgery departments. In particular, the highest consumption was observed in the Oncology, Geriatry and Obesity Surgery wards, with about 250 DDD/100 bed-days. All wards reported intravenous PPI administration suggesting some inappropriate use.Discussion From our data, PPIs appear to be moderately over-used at the Policlinico of Palermo. This practice may lead to the inappropriate continuation of therapy in primary care, further increasing costs and risks of adverse events. A survey evaluating in more detail the appropriateness of prescriptions is advisable.
Zaidah AR; Siti SMN; Zahiruddin WM; Zeehaida M
Objective:Pseudomonas aeruginosa is an opportunistic pathogen and the leading cause of nosocomial infec-tions.Currently a notable increase in the prevalence of multidrug-resistant P.aeruginosa worldwide has been reported in hospitalized patients and was associated with high morbidity and mortality.Methods:A retrospec-tive laboratory based analysis regarding the spectrum and distribution of P.aeruginosa from a wide range of clinical samples in Hospital Universiti Sains Malaysia since January 2003 to December 2007 was done.Re-sults:Altogether,there were 2 308 clinical isolates analyzed.The main sources of P.aeruginosa were from swab,respiratory,urine and blood specimens which accounted for 28.2 %,21.8 %,13.2 % and 12.8 %respectively.Results showed significant reduction in percentage of resistant towards three antibiotic namely ciprofloxacin,ceftazidime and imipenem.However the percentage of pan-resistant P.aeruginosa increased steadily over these years.Conclusion:This data is helpful to the clinician in guiding the choice of appropriate antibiotic to treat P.aeruginosa infection.At the same time,it warrants a more aggressive infection control ac-tivity to be implemented to control the spread of pan resistant strain in this centre.
Guimarães, Valeriana de Castro
Full Text Available Introduction: The precocious diagnosis and the intervention in the deafness are of basic importance in the infantile development. The loss auditory and more prevalent than other joined riots to the birth. Objective: Esteem the prevalence of auditory alterations in just-born in a hospital school. Method: Prospective transversal study that evaluated 226 just-been born, been born in a public hospital, between May of 2008 the May of 2009. Results: Of the 226 screened, 46 (20.4% had presented absence of emissions, having been directed for the second emission. Of the 26 (56.5% children who had appeared in the retest, 8 (30.8% had remained with absence and had been directed to the Otolaryngologist. Five (55.5% had appeared and had been examined by the doctor. Of these, 3 (75.0% had presented normal otoscopy, being directed for evaluation of the Evoked Potential Auditory of Brainstem (PEATE. Of the total of studied children, 198 (87.6% had had presence of emissions in one of the tests and, 2 (0.9% with deafness diagnosis. Conclusion: The prevalence of auditory alterations in the studied population was of 0,9%. The study it offers given excellent epidemiologists and it presents the first report on the subject, supplying resulted preliminary future implantation and development of a program of neonatal auditory selection.
Full Text Available Background: Infertility is defined as failure to conceive even after one year of regular, frequent and unprotected intercourse. Infertility has, in the last few years surfaced in society as a significant problem affecting as many as 15% of couples. This study aimed at identifying the characteristics of infertility among Indian couples. Methods: The present study was carried out on 100 infertile couples attending the OPD of upper India sugar exchange maternity hospital attached to GSVM medical college, Kanpur, other hospital and nursing homes of Kanpur. Both the partners were completely evaluated by taking proper history, examination and investigation to assess the cause of infertility. Results: Majority of female partners were between ages of 25-29. Female factors were found in 45% couples and male factors in 30 % couples. Among female factors, tuboperitoneal factor was found in 32% cases and ovulatory factor was found in 40% cases. Oligospermia was the commonest cause in male factor infertility. Conclusions: From this study we concluded that infertility is a public health problem in India and the main infertility pattern is a primary rather than secondary infertility. [Int J Reprod Contracept Obstet Gynecol 2015; 4(2.000: 373-377
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Introduction The risk management project of The University Hospital “A. Gemelli” aims to define the necessary procedures to manage clinical risk, by identifying the structures involved within this process, so that all of the personnel can contribute to a measurable improvement in the safety of both patients and staff.
Methods The Risk Management Program is comprised of 5 long-term phases: Phase 1 - Strategy Definition and Communication: a clear and shared Risk Management Strategy is indispensable to guarantee a coordinated action plan, in order to focus all of the interventions towards the achievement of common and measurable results. Phase 2 - Risk Management System Governance: all of the organisational structures have been activated in order to effectively manage the Risk Management System. The system has been introduced to interact within all areas of the hospital and to transfer information. Phase 3 - Promotion within the Organisation: this phase fosters the aims of the project within the whole organisation, by stressing the concept of “learning from errors”. This is crucial if organisational and healthcare workers are to understand the true aims of risk prevention and protection and offer to contribute to the process. Phase 4 - Risk Assessment: a data survey system was created and institutionalized. This phase begins with an analysis of the information flow, in order to estimate the probabilities that certain risks occur, and ends with defining the interventions to undertake. Risk assessment makes it possible to forecast the consequences of certain risks and thus prioritise those for prevention. Phase 5 - Risk Management: this consists of planning and implementing all of the actions necessary to prevent risks, protect and finance (in terms of prevention A. Gemelli University Hospital.
Results The results achieved are remarkable especially when one
Ojo, Adebowale I; Popoola, Sunday O
Nowadays, an electronic health information management system (EHIMS) is crucial for patient care in hospitals. This paper explores the aspects and elements that contribute to the success of EHIMS in Nigerian teaching hospitals. The study adopted a survey research design. The population of study comprised 442 health information management personnel in five teaching hospitals that had implemented EHIMS in Nigeria. A self-developed questionnaire was used as an instrument for data collection. The findings revealed that there is a positive, close relationship between all the identified factors and EHIMS’s success: technical factors (r = 0.564, P < 0.05); social factors (r = 0.616, P < 0.05); organizational factors (r = 0.621, P < 0.05); financial factors (r = 0.705, P < 0.05); and political factors (r = 0.589, P < 0.05). We conclude that consideration of all the identified factors was highly significant for the success of EHIMS in Nigerian teaching hospitals. PMID:25983557
Eisen, T F; Lacouture, P G; Woolf, A
Freezing point depression osmometry is preferred over vapor pressure with ingestions of volatile substances. Sixty-six laboratories nationwide (23 teaching hospital, 22 nonteaching hospital, and 21 commercial facilities) were surveyed to determine the availability and use of these techniques. Overall, 80% conducted serum osmometry (teaching, 100%; nonteaching, 82%; commercial, 57%). Freezing point depression was the most common method used by all laboratories; however, 33% of commercial laboratories and 11% of nonteaching laboratories used vapor pressure exclusively. One half of all laboratory supervisors did not identify why one method was preferred. Only 3% identified vapor pressure as a possible source of error in ingestions of volatile substances. Most laboratories estimated that they were aware of the patient diagnosis less than 50% of the time. Because vapor pressure osmometry is a potential source of false negative results when estimating serum concentrations of volatile substances, clinicians treating patients who have ingested ethanol, ethylene glycol, isopropanol, or methanol need to be aware of the methodology used in their reference laboratories. PMID:2712885
Adriana Estela Biasotti Gomes
Full Text Available Introduction Surgical site infections (SSIs often manifest after patients are discharged and are missed by hospital-based surveillance. Methods We conducted a case-reference study nested in a prospective cohort of patients from six surgical specialties in a teaching hospital. The factors related to SSI were compared for cases identified during the hospital stay and after discharge. Results Among 3,427 patients, 222 (6.4% acquired an SSI. In 138 of these patients, the onset of the SSI occurred after discharge. Neurological surgery and the use of steroids were independently associated with a greater likelihood of SSI diagnosis during the hospital stay. Conclusions Our results support the idea of a specialty-based strategy for post-discharge SSI surveillance.
Lara Stefânia Netto de Oliveira LEÃO-VASCONCELOS
Full Text Available The evaluation of workers as potential reservoirs and disseminators of pathogenic bacteria has been described as a strategy for the prevention and control of healthcare-associated infections (HAIs. The aim of this study was to evaluate the presence of Enterobacteriaceae in the oral cavity of workers at an oncology hospital in the Midwest region of Brazil, as well as to characterize the phenotypic profile of the isolates. Saliva samples of 294 workers from the hospital’s healthcare and support teams were collected. Microbiological procedures were performed according to standard techniques. Among the participants, 55 (18.7% were colonized by Enterobacteriaceae in the oral cavity. A total of 64 bacteria were isolated, including potentially pathogenic species. The most prevalent species was Enterobacter gergoviae (17.2%. The highest rates of resistance were observed for β-lactams, and 48.4% of the isolates were considered multiresistant. Regarding the enterobacteria isolated, the production of ESBL and KPC was negative. Nevertheless, among the 43 isolates of the CESP group, 51.2% were considered AmpC β-lactamase producers by induction, and 48.8% were hyper-producing mutants. The significant prevalence of carriers of Enterobacteriaceae and the phenotypic profile of the isolates represents a concern, especially due to the multiresistance and production of AmpC β-lactamases.
Bráulio Matias de Carvalho
Full Text Available Infection with both Human Immunodeficiency Virus (HIV and Mycobacterium tuberculosis is currently the world's leading cause of death due to infectious agents. We evaluated factors related to the development of tuberculosis (TB in HIV-infected patients who were being treated at an infectious diseases hospital in Fortaleza, Ceará, Brazil. From January 2004 to December 2005, we made an epidemiological study through the analysis of the medical records of 171 patients, who were diagnosed as having both HIV and tuberculosis. Among these co-infected patients, most (81%, p=0.0006 were male. Co-infection was more frequent (87.8% among patients over 40 years of age and those with lower educational levels (less than eight years of schooling. Forty-one percent of the patients in the study had not had a smear culture test for acid-fast bacilli (AFB. CD4 cell counts were lower than 200 cells/µL in 71.9% of the patients, the mean being 169 cells/µL. This type of data is important for establishing strategies to improve the control of tuberculosis in HIV-infected patients.
Full Text Available Abstract Background Hospital-associated infections are an increasing cause of morbidity and mortality in veterinary patients. With the emergence of multi-drug resistant bacteria, these infections can be particularly difficult to eradicate. Sources of hospital-associated infections can include the patients own flora, medical staff and inanimate hospital objects. Cellular phones are becoming an invaluable feature of communication within hospitals, and since they are frequently handled by healthcare personnel, there may be a potential for contamination with various pathogens. The objective of this study was to determine the prevalence of contamination of cellular phones (hospital issued and personal carried by personnel at the Ontario Veterinary College Health Sciences Centre with methicillin-resistant Staphylococcus pseudintermedius (MRSP and methicillin-resistant Staphylococcus aureus (MRSA. Results MRSP was isolated from 1.6% (2/123 and MRSA was isolated from 0.8% (1/123 of cellular phones. Only 21.9% (27/123 of participants in the study indicated that they routinely cleaned their cellular phone. Conclusions Cellular phones in a veterinary teaching hospital can harbour MRSP and MRSA, two opportunistic pathogens of significant concern. While the contamination rate was low, cellular phones could represent a potential source for infection of patients as well as infection of veterinary personnel and other people that might have contact with them. Regardless of the low incidence of contamination of cellular phones found in this study, a disinfection protocol for hospital-issued and personal cellular phones used in veterinary teaching hospitals should be in place to reduce the potential of cross-contamination.
Ferreira, Diogo Antonio Valente; Aranha, Renata Nunes; de Souza, Maria Helena Faria Ornellas
Background Performance of qualified professionals committed to cancer care on a global scale is critical. Nevertheless there is a deficit in Cancer Education in Brazilian medical schools (MS). Projects called Academic Leagues (AL) have been gaining attention. However, there are few studies on this subject. AL arise from student initiative, arranged into different areas, on focus in general knowledge, universal to any medical field. They are not obligatory and students are responsible for the ...
Full Text Available Patience Olayinka Akinwusi,1,2 Akinwumi Oluwole Komolafe,3 Olanrewaju Olayinka Olayemi,2 Adeleye Abiodun Adeomi41Department of Medicine, College of Health Sciences, Osun State University, 2Department of Medicine, LAUTECH Teaching Hospital, Osogbo, 3Department of Morbid Anatomy, Obafemi Awolowo University Teaching, Hospitals Complex, Ile-Ife, Osun State, 4Department of Community Medicine, LAUTECH Teaching Hospital, Ogbomoso, Oyo State, NigeriaBackground: The purpose of this study was to determine the etiology and epidemiologic characteristics of sudden death at Ladoke Akintola University of Technology (LAUTECH Teaching Hospital, South West Nigeria.Methods: This was a retrospective descriptive study of all cases of natural unexpected death, either occurring out of hospital or less than 24 hours after admission to LAUTECH Teaching Hospital, over a nine-year period from January 2003 to December 2011. Data were generated from information in the case notes and autopsy reports for these cases.Results: Sudden death accounted for 29 (4.0% of 718 adult medical deaths and 1.0% of all adult medical admissions. Out-of-hospital deaths occurred in 72.4% of cases. The mean age of the patients was 46.8 ± 11.5 (range 25–74 years. The male to female ratio was 6.25:1. Cardiovascular disease were the most common cause of death (51.7%, followed by respiratory disease (20.7%, pulmonary thromboembolism (10.4%, central nervous system disease (13.8%, gastrointestinal disorders (13.8%, severe chemical/drug poisoning (13.8%, and combined cardiovascular and central nervous system disease (13.8%. Hypertension-related causes were responsible for 14/29 (48.3% of the sudden deaths. Hypertensive heart disease accounted for 86.7% of the cardiovascular deaths, hypertensive heart failure accounted for 73.3%, whilst all heart failure cases accounted for 80.0%. Left ventricular hypertrophy was present in 69.2% of the patients with hypertensive heart disease. Moderate to severe
Full Text Available Problem statement: Organizational behavior is desirable for any organization, as it is associated with important organizational variables such as job satisfaction, organizational productivity and system maintenance. The main purpose of this study is to evaluate the mean organizational behavior score among the managers of the hospitals affiliated to Shahid Sadoughi University of Medical Sciences and Health Services, Yazd. Approach: A descriptive-analytic cross-sectional study was conducted on 117 managers in various organizational levels working at the study hospitals who were randomly selected. questionnaire was used which validity and reliability are approved by the university management professors and Cronbachs alpha coefficient of 0.70, respectively. All the questions were presented in a Likert scale with five options measuring four dimensions: (A Generosity (B Civil behavior (C Conscious (3 D Friendship. The data were entered in the SPSS software and Fisher exact test and chi-square test were used for data analysis. Results: The mean age of the study population is 39 years among whom 66.7% were male and 33.3%were female. The working experience of the study population was averagely 15.6 years. A total of 78 (66.7% managers are educated in medicine, allied medicine and basic sciences. Considering the scores in different components of organizational behavior, generosity was placed first with a mean score of 12.3 and conscious was placed fourth with a mean score of 5.47. Conclusion: There was statistically significant association between sex, education level and the field of study and being placed in certain quartiles of OCBs domains (p<0.05.
Full Text Available Background: Medical diseases vary depending on the locality and it reflects the pattern of medical admissions into a medical centre. We set out to collect, analyse, present the report of results from Igbinedion University Teaching Hospital to the wider scientific community on pattern and outcome of patients in medical wards in the hospital between January 2009 to December 2012. This we believe would reflect the relative pattern, trend of diseases burden and relative importance of diseases in the hospital locality. Methods: The study was a retrospective descriptive study where data of admission cases in both male and female medical wards were collected (from the admission register with occasional reference to some patients′ case notes and analysed. Results: A total of 1066 patients were admitted during the study period, Male patients constituted 52.5% while female were 47.5% (Male: Female ratio 1.11:1 , age range 14-99 years while under 20 years, Under 30 years and Elderly constituted 30.1%, 59.3% and 12.5% respectively. Malaria, hypertension, Vaso-occlussive Crisis in Sickle Cell Diseases, Peptic Ulcer Disease, Gastroenteritis and Enteric Fever were the most common diseases admitted during the study period. Infectious and parasitic diseases was found to constitute the majority of diseases admitted. 81.2%, 4.6% and 1.6% of admitted patients were discharged, referred and died respectively. Discussions and Conclusion: The large proportion of patients in younger age groups was likely due to the university community that is located in the same town with the teaching hospital. Elderly patients accounted for 11.1% of total hospitalization similar to value gotten in another Teaching Hospital. The study showed essentially that Infectious diseases constituted the bulk of admission with malaria being the largest single disease. Non-Communicable Diseases (NCDs were also prominent. Majority of the patients were discharged home with lesser outcome of
José Luiz Rodrigues Leles
Full Text Available BACKGROUND: Maxillofacial injuries occur in a significant number of trauma patients. Epidemiological assessments are essential to reaffirm patterns, identify new trends and develop clinical and research priorities for effective treatment and prevention of these injuries. OBJECTIVE: The aim of this study was to identify the epidemiological profile and risk factors associated with maxillofacial trauma treated at a referral emergency hospital for the Public Health System in the State Capital of Goiás, Brazil. MATERIAL AND METHODS: A cross-sectional study was designed including 530 patients with maxillofacial trauma, 76% male, with a mean age of 25.5±15.0 years. Data were collected between May 2003 and August 2004 over weekly shift-working periods. RESULTS: The main causes of trauma were traffic accidents (45.7% and physical assaults (24.3%, and differences in etiological factors were identified according to gender (p<0.001. The distribution of patients according to age and etiology showed significant differences for traffic accidents (p<0.01, physical assaults (p<0.001, falls (p<0.001 and sport injuries (p<0.01. In the multinomial logistic regression analysis (R² = 0.233; p<0.05, age was associated with injury in traffic accidents and falls (p<0.01, sports-related accidents were associated with males (p<0.05, and alcohol consumption with assaults and traffic accidents (p<0.001. Facial soft tissue lesions were found in 98% of patients and facial fractures in 51%. CONCLUSIONS: The significant association of maxillofacial trauma with young males and alcohol consumption reinforces the need for educational strategies and the development of policies for the prevention and reduction of associated damage in this specific risk group.
Foroughinia, Farzaneh; Madhooshi, Mohammad
Objective: In this study, we aimed to evaluate the attachment to stress ulcer prophylaxis (SUP) guideline in the neurology wards of two teaching and nonteaching hospitals. Methods: A total of 243 patients were retrospectively reviewed in the neurology wards of two teaching and nonteaching hospitals. To assess the appropriate administration of SUP, an internal guideline was prepared using the American Society of Health-System Pharmacists (ASHP) protocol. Findings: SUP prescriptions were noncom...
Mirghani, Hyder O.; Elnour, Mohammed A.; Taha, Akasha M.; Elbadawi, Abdulateef S.
Background: Gender differences among patients with the acute coronary syndrome is still being debated, no research has been done on gender inequality among coronary syndrome patients in Sudan. Objectives: To study gender differences in presentation, management, and outcomes of acute coronary syndrome in Sudan. Subjects and Methods: This cross-sectional descriptive longitudinal study was conducted in Omdurman Teaching Hospital between July 2014 and August 2015. Patients were invited to sign a written informed consent form, were interviewed and examined by a physician, and then followed during their hospital stay. Information collected includes coronary risk factors, vital signs, echocardiography findings, arrhythmias, heart failure, cardiogenic shock, and death. The Ethical Committee of Omdurman Teaching Hospital approved the research. Results: A total of 197 consecutive acute coronary syndrome patients were included, 43.1% were females. A significant statistical difference was evident between males and females regarding the type of acute coronary syndrome, its presentation, and time of presentation to the hospital, smoking, and receipt of thrombolysis (P 0.05). Conclusion: Women were less likely to receive thrombolytic therapy, present with chest pain, and diagnosed with ST-segment elevation myocardial infarction. No gender differences were found in acute coronary syndrome risk factors apart from smoking, which was more common in males, and there were no differences between males and females as regards in-hospital complications.
Hyder O Mirghani
Full Text Available Background: Gender differences among patients with the acute coronary syndrome is still being debated, no research has been done on gender inequality among coronary syndrome patients in Sudan. Objectives: To study gender differences in presentation, management, and outcomes of acute coronary syndrome in Sudan. Subjects and Methods: This cross-sectional descriptive longitudinal study was conducted in Omdurman Teaching Hospital between July 2014 and August 2015. Patients were invited to sign a written informed consent form, were interviewed and examined by a physician, and then followed during their hospital stay. Information collected includes coronary risk factors, vital signs, echocardiography findings, arrhythmias, heart failure, cardiogenic shock, and death. The Ethical Committee of Omdurman Teaching Hospital approved the research. Results: A total of 197 consecutive acute coronary syndrome patients were included, 43.1% were females. A significant statistical difference was evident between males and females regarding the type of acute coronary syndrome, its presentation, and time of presentation to the hospital, smoking, and receipt of thrombolysis (P 0.05. Conclusion: Women were less likely to receive thrombolytic therapy, present with chest pain, and diagnosed with ST-segment elevation myocardial infarction. No gender differences were found in acute coronary syndrome risk factors apart from smoking, which was more common in males, and there were no differences between males and females as regards in-hospital complications.
Full text: The design of the layout and radiation shielding for diagnostic imaging and nuclear medicine facilities in a modern teaching hospital requires the collaboration of persons from a number of professions including architects, engineers, radiologists, nuclear medicine physi cians, medical imaging technologists and medical physicists. This paper discusses the design of such facilities, including PET/CT and T-131 ablation therapy suites for a major new tertiary hospital in Perth. The importance of involving physicists on the planning team from the earliest stages of the design process is stressed, design plans presented, and some of the problems which may present themselves and their solutions are illustrated.
Blake, Lindsay; Ballance, Darra
Key roles in teaching evidence-based practice (EBP) are of interest to many hospital and academic librarians. This article describes how three academic librarians, in collaboration with the academic medical center's EBP Nursing Council, developed a seminar consisting of three credit hours of instruction in the basics of evidence-based practice. The seminar consists of three core elements: basic principles of EBP and finding literature, clinical experience and integration of knowledge into the hospital setting, and patient education and participation. Emphasis is placed upon analysis of the literature, institutional models of practice change, and the importance of patient roles in guideline development. PMID:23394424
Toufen Junior Carlos; Hovnanian André Luiz Dresler; Franca Suelene Aires; Carvalho Carlos Roberto Ribeiro
OBJECTIVE: To determine the prevalence rates of infections among intensive care unit patients, the predominant infecting organisms, and their resistance patterns. To identify the related factors for intensive care unit-acquired infection and mortality rates. DESIGN: A 1-day point-prevalence study. SETTING:A total of 19 intensive care units at the Hospital das Clínicas - University of São Paulo, School of Medicine (HC-FMUSP), a teaching and tertiary hospital, were eligible to participate in th...
The role of the physician executive is explored in this article using a case study approach to outline administrative performance. Based on a survey of clinician executives at University Hospital in London, Ontario, a profile of background characteristics, activities and responsibilities, and reports on physician attitudes on the merit of administrative training, qualities that make good physician leaders, ethics in health care, and the nature of physician participation in management is presented. Recommendations from this research for developing an administrative training program designed for clinician executives in a teaching hospital follow. PMID:10316246
Eloiza H. Campana; Barbosa, Paula P.; Fehlberg, Lorena C. C.; Ana C. Gales
In Brazil, the presence of plasmid-mediated AmpC (pAmpC)-producing isolates has been sporadically reported. We evaluated the frequency of pAmpC among 133 Enterobacteriaceae clinical isolates. The bla CMY-2-like gene was detected in a single Klebsiella pneumoniae isolate. In our study, the pAmpC frequency was very low as previously reported.
Muhammad Javed; Abdul Majid Memon
Objective:To study organisms in cases of early neonatal sepsis, and sensitivity patterns of these isolates. Methods: All pregnant mothers admitted from Jan 2006-Dec 2006 were registered. Neonates delivered at the hospital were examined upto 72 hours of birth, with special emphasis on the signs and symp-toms of suspected sepsis. Neonates with no maternal or neonatal risk factor were included in the study, blood examination and appropriate cultures were taken. Antibiotics as cephatexime and amikacin were started on em-pirical bases until final cultures report was received. In cases of negative cultures, antibiotics were stopped. Other wise it continued according to culture and sensitivity for 10 to 14 days. Results: Among these 257 ca-ses, 113 neonates full filled our criteria. Staph aureus being the commonest organism in our study (59.29%) followed by KlebsieUa pneumoniae (19.47%) and Entrococci (19.47%). These findings are not consistent with other studies in the country. Conclusion: Neonatal sepsis is a major cause of mortality and morbidity. Choice of antibiotic should depend on the local studies from time to time.
Seng, M; Sng, G K J; Zhao, X; Venkatachalam, I; Salmon, S; Fisher, D
This study investigated the incidence and risk to staff groups for sustaining needlestick injuries (NSIs) in the National University Hospital (NUH), Singapore. A retrospective cohort review of incident NSI cases was undertaken to determine the injury rate, causation, and epidemiological profile of such injuries. Analysis of the risk of sustaining recurrent NSI by occupation and location was done using the Cox proportional hazards model. There were 244 NSI cases in 5957 employees in NUH in 2014, giving an incidence rate of 4·1/100 healthcare workers (HCWs) per year. The incidence rate was highest for doctors at 21·3, and 2·7 for nurses; 40·6% of injuries occurred in wards, and 32·8% in operating theatres. There were 27 cases of repeated NSI cases. The estimated cost due to NSIs in NUH ranged from US$ 109 800 to US$ 563 152 in 2014. We conclude that creating a workplace environment where top priority is given to prevention of NSIs in HCWs, is essential to address the high incidence of reported NSIs. The data collected will be of value to inform the design of prevention programmes to reduce further the risk of NSIs in HCWs. PMID:27151164
Morris, D E
Market share for academic medical centers and teaching hospitals will decline over the next five years necessitating new strategies to ensure growth and profitability. These types of institutions are, however, in a strong position to compete and gain market share locally by building a defensible competitive advantage. This article offers three avenues for increasing market share: networking, brand name product differentiation, and business diversification. PMID:10271804
Brien, W F; Butler, R J; Inwood, M J
As part of a quality assurance program a retrospective audit of transfusion practices for packed red blood cells, fresh frozen plasma and albumin was undertaken with predetermined criteria in a general teaching hospital. Of 520 transfusion episodes with 1218 units of packed red blood cells given to 297 patients 88% were considered appropriate; of 106 episodes with 405 units of fresh frozen plasma given to 83 patients 90% were deemed appropriate; and of 187 episodes with 320 units of albumin g...
Srinath Dhandapani; Aravind Srinivasan; Rajalakshmi Rajagopalan; Santhosh Chellamuthu; Aishwarya Rajkumar; Paramesh Palaniswamy
Introduction: Lung cancer is one of the leading causes of cancer related deaths in the world. The incidence of lung cancer is increasing in India and there is a need to understand the natural history of this disease. Aim of the study: To study the clinico- pathological- radiological profile of patients diagnosed with lung cancer from January 2013 to May 2015 at a tertiary care teaching hospital. Materials and Methods: Inpatient records of all patients admitted during the study period were exa...
Perry, Lin; Lamont, Scott; Brunero, Scott; Gallagher, Robyn; Duffield, Christine
Background Nursing is an emotionally demanding profession and deficiencies in nurses’ mental wellbeing, characterised by low vitality and common mental disorders, have been linked to low productivity, absenteeism and presenteeism. Part of a larger study of nurses’ health, the aim of this paper was to describe the mental health status and related characteristics of nurses working in two acute metropolitan teaching hospitals. Methods A cross sectional survey design was used. The Registered and ...
Saiba Eugène Semanyenzi; Egide Abahuje
The aim of this study was to assess the pattern of normal ocular bacterial flora isolated from patients attending the Department of ophthalmology at the Kigali University Teaching Hospital and to evaluate their in vitro susceptibility to common antimicrobial agents. From June to October 2011, collection of specimen was performed by rotating a sterile cotton swab on the lower conjunctival sac from the temporal to the medial fornix. Gram stain and culture was performed and antibiotic sensitivit...
Sylvia Miranda Carneiro; Herica Silva Dutra; Fernanda Mazzoni da Costa; Simone Emerich Mendes; Cristina Arreguy-Sena
Objective: to evaluate the use of abbreviations in nursing records of a teaching hospital and describing their profile in different sectors, work shifts and professional nursing categories. Methods: documentary study that analyzed 627 nursing records in 24 patient charts using a systematic observation script. Results: we identified 1,792 abbreviations, and 35.8% were nonstandard. The incidence of abbreviations was higher in the Intensive Care Unit, used by nurses and in the night shift. Concl...
Adebamowo Clement A; Ogbimi Roseline I
Abstract Background Smooth working relationships between nurses and doctors are necessary for efficient health care delivery. However, previous studies have shown that this is often absent with negative impact on the quality of health care delivery. In 2002, we studied factors that affect nurse-doctor working relationships in University Teaching Hospitals (UTH) in Southern Nigeria in order to characterize it and identify managerial and training needs that might be used to improve it. Method Q...
Amir Ashkan Nasiripour; Bahram Delgoshaie; Rohollah Kalhor; Mohammad Zakaria Kiaei; Elham Shahbahrami; Seyed Saeed Tabatabaee
Background and Aim: The Effectiveness and success of an organization depends on two factors; one is the employees’ Performances and the other is the level of understanding between managers and employees in prioritize of different job motivators. The aim of this study was to determine factors that affect staffs’ performances in Qazvin teaching hospitals based on the Herzberg’s theory. Materials and Methods: This research was a descriptive study. To achieve the main aim of this study, one hundr...
Maryam Vahidi; Mina Hosseinzadeh
Seclusion is one of the methods in controlling violent behavior of inpatients in psychiatric wards. In current descriptive analytic study, data collection instrument included the seclusion list of inpatients by considering individual, social and clinical characteristics in one of the psychiatry wards In the Razi teaching hospital of Tabriz in the first six months of 2012. Among 264 admitted patients, 24 patients (9.1%) had been secluded and a total of 29 isolated incidents w...
Fowad Khurshid et al.
Study objective: To investigate the use of antihypertensive drugs in hypertensive patients and to identify whether such pattern of prescription is appropriate in accordance with international guidelines for management of hypertension. Methods: This was a prospective analysis. A prescription based survey among patients with established hypertension was conducted at the Medicine Out-Patient Department of University Teaching Hospital in South Delhi, India. Data were collected from patients’ medi...
Anderson, Todd J.; Bryant, Heather E; Deirdre L Church
The usefulness of a rapid latex agglutination method for the detection of Candida antigen (Cand-Tec; Ramco Laboratories. Texas) was retrospectively assessed in a university teaching hospital over a one year period. Patients were enrolled when the managing physician requested Cand-Tec testing for confirmation of possible invasive candidal infection. The majority of patients were critically ill; 56% were in the intensive care unit, and 30% subsequently died. Analyses were available from 79 pati...
BACKGROUND AND OBJECTIVES: Current evidence suggests that modification of atherosclerosis risk factors plays an important role in reducing adverse cardiovascular outcomes in patients with peripheral arterial disease (PAD). This study was undertaken to determine whether patients in this high-risk group were adequately using risk factor modification therapy. DESIGN AND SETTING: Prospective study of consecutive patients with PAD from a teaching hospital. PATIENTS AND METHODS: The collected data ...
Giwa Abdulganiyu; Tayo Fola
Purpose: To conduct cost-effectiveness analysis of anti-diabetic therapy in a University Teaching Hospital in 2010. Methods: A retrospective review of selected case-notes was conducted. World Health Organization Defined Daily Dose Method of evaluating drug use and probability method for potential effectiveness of antidiabetic therapeutic options from literature analysis was employed in determining cost-effectiveness of each anti-diabetic therapeutic option identified from anti-diabetic dru...
Rasoulinejad, Seyed Ahmad; Hajian-Tilaki, Karimollah; Mehdipour, Elnaz
Background: Information regarding the frequency and severity of eye involvement in diabetic patients and its risk factors can be useful for prevention and treatment. This study aimed to determine the prevalence of diabetic retinopathy and its associated risk factors in diabetic patients who referred to teaching hospitals in Babol, Mazandaran. Methods: In this study a total of 1562 patients with the definite diagnosis of diabetes mellitus were chosen and referred to the eye clinic of Shahid Be...
Pote S; Tiwari P; D’Cruz S
Background: To prevent medication errors in prescribing, one needs to know their types and relative occurrence. Such errors are a great cause of concern as they have the potential to cause patient harm. The aim of this study was to determine the nature and types of medication prescribing errors in an Indian setting.Methods: The medication errors were analyzed in a prospective observational study conducted in 3 medical wards of a public teaching hospital in India. The medication errors were an...
Full Text Available Abstract Background The duty of a doctor to take care presumes the person who offers medical advice and treatment to unequivocally possess the skills and knowledge to do so. However, a sense of responsibility cannot be guaranteed in the absence of accountability, which in turn requires a comprehensive medical law system to be in place. Such a system is almost non-existent in Pakistan. Keeping the above in mind, we designed this study to assess the knowledge, attitudes and practices of surgeons regarding malpractice at a tertiary care center in Pakistan. Methods This was an observational, cross-sectional, questionnaire-based study conducted during a three month period from 31st March, 2012 to 30th June, 2012 at Civil Hospital, Karachi. Surgeons who were available during the period of our study and had been working in the hospital for at least 6 months were included. Self-administered questionnaires were distributed after seeking informed, written consent. The specialties included were general surgery, cardiothoracic surgery, neurosurgery, ophthalmology, otolaryngology, plastic surgery, pediatric surgery, orthopedic surgery, oral and maxillofacial surgery and gynecology and obstetrics. The study questionnaire comprised of four sections. The first section was concerned with the demographics of the surgeons. The second section analyzed the knowledge of the respondents regarding professional negligence and malpractice. The third section assessed the attitudes surgeons with regard to malpractice. The last section dealt with the general and specific practices and experiences of surgeons regarding malpractice. Results Of the 319 surgeons interviewed, 68.7% were oblivious of the complete definition of malpractice. Leaving foreign objects inside the patient (79.6% was the most commonly agreed upon form of malpractice, whereas failure to break news in entirety (43.9% was most frequently disagreed. In the event of a medical error, majority (67.7% were ready
Full Text Available Isaac Kajja,1 Cees Th Smit Sibinga21Department of Orthopedics, Makerere University, Kampala, Uganda; 2ID Consulting for International Development of Transfusion Medicine (IDTM, Groningen, The NetherlandsBackground: A number of factors come into play in determining the timing of an elective surgical intervention, particularly in the developing world. The present study explores the factors that contribute to the timing of elective surgery and patients' opinions on their quality of life as they wait for surgery.Methods: We followed adult patients with delayed elective surgical interventions (n=204. The causes for the delay and, particularly, the influence of blood shortage on the timing of the procedure were noted. Patients' perceptions on their quality of life as they waited for surgery were also noted.Results: We were able to establish a cause for delayed elective surgery in 133 patients. Shortage of operating space was the leading cause of surgery delay in 44 patients, while blood shortage followed closely in 40 patients. The higher the amount of blood ordered for use in the perioperative time, the longer the delay to surgery (P=0.001. Patients waiting for surgery had a low opinion of their in-hospital quality of life. Here, the key indicators included the threat of losing a job, limited family time, and an increase in day-to-day living costs.Conclusion: Blood shortage is the second most common cause of the delayed performance of elective surgical interventions in our institution. The patients have a low opinion on their quality of life as they wait for surgery.Keywords: blood shortage, delayed elective surgery, quality of life
Luciane Francielli Maroneze
Full Text Available This article aims to analyze the new configurations that characterize the work of teachers connected to basic education, having as reference the changes brought with the process of capitalist reorganization and the new requirements for the Brazilian educational policy after 1990, limiting its articulation with the new parameters of productive restructuring, which emerged during this new phase of globalization of capital. With a closer look at the changes in Brazilian educational policy after 1990, we seek to establish a dialog with the following sources: Law of Directives and Bases of National Education (Brazil, 1996, the National Plan of Education (BRAZIL, 2001 and the Fund for the Maintenance and Development of the Fundamental Education and Valorization of Teaching (Brazil, 1996, aiming to analyze what guidance these documents provide on the teaching profession, particularly, on the enhancement of professional status. This approach demonstrates, in a contradictory move, the mediation between valorization and the complex relationship of precarization of this kind of work.
Balassiano, Ilana T; dos Santos-Filho, Joaquim; Vital-Brazil, Juliana M; Nouér, Simone A; Souza, Claudia R C; Brazier, Jon S; Ferreira, Eliane de O; Domingues, Regina M C P
Clostridium difficile is an important nosocomial enteric pathogen and is the etiological agent of pseudomembranous colites. Recently, the rates of C. difficile infection (CDI) have increased worldwide, but in Brazil few data about this situation and the incidence of clonal types of C. difficile exist. This study aimed to isolate and characterize C. difficile strains from samples obtained of a university hospital (HUCFF) in Rio de Janeiro city, Brazil. CDI was identified by ELISA in 27.1% of HUCFF-in-patients enrolled in the study, and the bacterium was recovered from eight of these fecal samples. All strains, except one, presented tcdA and tcdB genes and presented neither the cdtA and cdtB genes nor any significant deletions in the tcdC gene. All strains were sensitive to metronidazole, vancomycin and moxifloxacin, and resistant to clindamycin, ciprofloxacin and levofloxacin. PCR-ribotyping and PFGE revealed four different clonal types among the isolates. The Brazilian PCR-ribotype 133 accounted for 50% of strains isolated, and PCR-ribotype 233 strains were obtained from 25% of the in-patients. The prevalence and resurgence of the Brazilian PCR-ribotype 133 among the hospitalized patients of HUCFF was established, and cross-infection of different patients associated to the same PCR-ribotypes was detected. Our results emphasize the importance of the diagnosis and control of CDI in order to prevent the emergence of specific clones that can lead to C. difficile-associated outbreaks in Brazilian hospitals. PMID:20623188
Laiq-uz-Zaman Khan, Muhammad; Jawaid, Masood; Hafeez, Kamran
Objective: Patients’ attitude towards medical students’ presence during treatment depends on the cultural values of the society. This study was conducted to find out the patients’ receptiveness in our society to be involved in teaching process for medical students during consultation in out patient department of a teaching hospital in Karachi Pakistan. Methodology: This cross sectional study was conducted in the surgical Out Patient Department (OPD) at Dow University Hospital from May 2012 to...
Gyawali, Sudesh; Shankar, P Ravi; Saha, Archana; Mohan, Lalit
Unnecessary, excessive and poor injection practices in the South East Asia region (including Nepal) have been observed previously. The authors aim to study prescription of injectable drugs to inpatients in a teaching hospital in Western Nepal. Prescription of injectable drugs (IDs) and intravenous fluids (IVFs) to inpatients discharged from the wards of the Manipal Teaching Hospital during 1st January to 30th June 2006 was studied. The mean number of drugs, IDs and IVFs administered, median c...
Iyoke CA; Lawani LO; Ugwu GO; Ajah LO; Ezugwu EC; Onah P; Onwuka CI
Chukwuemeka Anthony Iyoke,1 Lucky Osaheni Lawani,2 George Onyemaechi Ugwu,1 Leonard Ogbonna Ajah,2 Euzebus Chinonye Ezugwu,1 Paul Onah,1 Chidinma Ifechi Onwuka1 1Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria; 2Department of Obstetrics and Gynaecology, Federal Teaching Hospital, Abakaliki, Nigeria Background: Interdisciplinary team working could facilitate the efficient provision and coordination of increasingly diverse health ...
Full Text Available Sara AlMutar,1 Lulwa AlTourah,1 Hussain Sadeq,2 Jumanah Karim,2 Yousef Marwan3 1Department of Medicine, 2Department of Pediatrics, Mubarak Al-Kabeer Hospital, 3Department of Orthopedic Surgery, Al-Razi Orthopedic Hospital, Kuwait City, Kuwait Background: Teaching sessions for medical students during ward rounds are an essential component of bedside teaching, providing students with the opportunity to regard patients as actual people, and to observe their physical conditions directly, allowing a better understanding of illnesses to be developed. We aim to explore medical students’ perceptions regarding medical and surgical ward rounds within the Faculty of Medicine at Kuwait University, and to evaluate whether this teaching activity is meeting the expectation of learners. Methods: A pretested questionnaire was used to collect data from 141 medical students during the 2012–2013 academic year. They were asked to provide their current and expected ratings about competencies that were supposed to be gained during ward rounds, on a scale from 1 (lowest to 5 (highest. Mean scores were calculated, and the Student t-test was used to compare results. P < 0.05 was the cut-off level for significance. Results: Only 17 students (12.1% declined to participate in the study. The students' current competency scores (for competencies taught within both disciplines – medical and surgical were significantly lower than the scores indicating students’ expectations (P < 0.001. The best-taught competency was bedside examination, in both medical (mean: 3.45 and surgical (mean: 3.05 ward rounds. However, medical ward rounds were better than surgical rounds in covering some competencies, especially the teaching of professional attitude and approach towards patients (P < 0.001. Conclusion: Both medical and surgical ward rounds were deficient in meeting the students’ expectations. Medical educators should utilize the available literature to improve the bedside
Savan Sara Mathew
Full Text Available Biomedical waste (BMW is waste generated during diagnosis, treatment or immunization of human beings or animals, or in research activities pertaining thereto, or in the production and testing of biologicals, and is contaminated with human fluids.1 Though 75-80% of wastes generated from hospitals are non-infectious, 20-25% is hazardous.2 It is a potential health hazard to health workers, public, flora and fauna of the area.3 The Government of India has given specifications for hospital waste management under the Environment (Protection Act Biomedical Waste (Management and Handling Rules 1998.4 The present study was undertaken to assess the knowledge and practices regarding BMW management amongst staff of a large tertiary care teaching hospital in Ludhiana, with about 700 beds which, according to its Chief Maintenance Officer, generates about 70 kg biomedical waste per day.
Guacira Corrêa de Matos
Full Text Available A albumina humana é freqüentemente usada sem que haja correspondência entre suas propriedades farmacológicas e as doenças. Este é um estudo das prescrições de albumina humana em um hospital da rede pública no Rio de Janeiro, Brasil, com ênfase no grau de adesão das mesmas a protocolos de tratamento. As informações foram extraídas dos registros do Serviço de Farmácia e dos prontuários médicos de 99 pacientes adultos, que receberam, entre março e agosto de 2001, 1.475 unidades de albumina humana, solicitadas em 498 prescrições. A análise de confiabilidade das informações sobre indicação terapêutica resultou num kappa de 0,79 (IC95%: 0,72-0,85. As indicações terapêuticas foram avaliadas como apropriadas, inapropriadas ou controversas, com base em quatro protocolos de países diferentes. Do total de prescrições, 33,1% foram consideradas apropriadas, 61,8% inapropriadas, 4,6% controversas e 0,4% indeteminadas. Identificaram-se dois casos suspeitos de reações adversas. A proporção de prescrições inapropriadas é preocupante, dado o elevado custo do produto e o seu potencial para causar reações adversas. A implantação das diretrizes nacionais expressas no protocolo da ANVISA é estratégica para a promoção do uso racional da albumina humana em hospitais.Human albumin is frequently used without regard for the relationship between its pharmacological properties and the respective disease. We investigated the prescription of human albumin in a Brazilian public hospital with emphasis on adherence to international guidelines. Data were gathered from pharmacy and medical records. From March to August 2001, 99 patients (> 15 years received 1,475 units of human albumin, ordered in 498 prescriptions. The reason for prescribing human albumin was independently collected from medical records by two health professionals, and agreement was assessed by kappa statistics (95%CI: 0.72-0.85. According to different guidelines
Huang, Hai-yan; Luo, Jian
Objective: Establish position requirements-oriented training system of ICU training nurses in secondary hospital .To standardize the teaching management and improve the training effect for the training nurses in our ICU. Methods: Form the ICU training nurse teaching staff; Formulate training manual according to survey results of nurse training demand；Implement clinical teaching in stages according to the content of the training manual; Proceed comprehensive skills assessment in the different ...
Costa, Adriana Corrêa; Rohde, Luis Augusto; Dorneles, Beatriz Vargas
Storage and/or automatic retrieval of the basic facts of addition from the long-term memory seems to be impaired in children with ADHD presenting arithmetical difficulties. The present study was carried out to evaluate the effectiveness of an educational intervention model designed to teach basic facts of addition as a means of advancing from…
Full Text Available Background: The burden of diabetes mellitus, especially Type-2, continues to increase across the world. Medication adherence is considered an integral component in its management. Poor glycemic controls due to medication nonadherence accelerates the development of long-term complications which consequently leads to increased hospitalization and mortality. Objective: This study examined the level of adherence to oral antidiabetic drugs among patients who visited the teaching hospital and explored the probable contributory factors to non-adherence. Methods: A cross-sectional descriptive study using systematic sampling to collect quantitative data was undertaken. Questionnaires were administered to out-patients of the medical department of a teaching hospital in Ghana. Logistic regression was performed with statistical significance determined at p<0.05. Results: A total of 200 diabetic patients participated in the study. Using the Morisky Medication Adherence scale, the level of adherence determined was 38.5%. There were significant correlations between level of adherence and educational level [(OR=1.508; (CI 0.805- 2.825, P=0.019, and mode of payment [(OR=1.631; (CI 0.997- 2.669, P=0.05. Conclusion: Adherence in diabetic patients was low among respondents and this can be improved through education, counseling and reinforcement of self-care. There were several possible factors that contributed to the low adherence rate which could benefit from further studies.
Seyedin, Hesam; Goharinezhad, Salime; Vatankhah, Soodabeh; Azmal, Mohammad
Background: Patient education is widely recognized as a core component of nursing. Patient education can lead to quality outcomes including adherence, quality of life, patients' knowledge of their illness and self-management. This study aimed to clarify patient education process in teaching hospitals affiliated to Tehran University of Medical Sciences (TUMS) in Iran. Methods: This cross-sectional study was conducted in 2013. In this descriptive quantitative study, the sample covered 187 head nurses selected from ten teaching hospitals through convenience sampling. Data were collected with a questionnaire developed specifically for this study. The questionnaire measured patient education process in four dimensions: need assessment, planning, implementing and evaluating. Results: The overall mean score of patient education was 3.326±0.0524. Among the four dimensions of the patient education process, planning was in the highest level (3.570±0.0591) and the lowest score belonged to the evaluation of patient education (2.840 ±0.0628). Conclusion: Clarifying patient education steps, developing standardized framework and providing easily understandable tool-kit of the patient education program will improve the ability of nurses in delivering effective patient education in general and specialized hospitals. PMID:26478878
Arthur C Onwuchekwa
Full Text Available Arthur C Onwuchekwa, Sunday ChinenyeDepartment of Internal Medicine, University of Port Harcourt Teaching Hospital, NigeriaBackground: Hypertension in Nigeria is a widespread problem of immense social and economic importance because of its high prevalence and the severity of its complications.Aim: To define the morbidity and mortality pattern of hypertension at the University of Port Harcourt Teaching Hospital (UPTH.Method: Records of all patients admitted to the medical wards of the UPTH over a 5-year period with essential hypertension or any of its complications were retrieved from the ward and medical records and reviewed.Result: A total of 780 hypertensive patients were reviewed, constituting 28.2% of all medical admissions. Only 424 (15.2% had complete records and were analyzed. Record keeping was poor. There were 173 (41% males and 251 (59% females with a male to female ratio of 1:1.5. The ages ranged from 18 years to 100 years with a mean of 56.5 ± 16.2. Stroke was responsible for 169 (39.9% hypertensive complications. Heart failure occurred in 97 (22% cases while renal failure and encephalopathy accounted for 40 (9.4% and 7 (1.7% hypertensive complications respectively. There were 99 deaths out of which 51 (51.5% were due to stroke, 14 (14.12% were due to heart failure, and 12 (12.1% were due to renal failure.Conclusion: The contribution of systemic hypertension to the morbidity and mortality of adults at UPTH is quite significant.Keywords: clinical profile, hypertension, University of Port Harcourt Teaching Hospital
Yazdi-Feyzabadi, Vahid; Gozashti, Mohammad Hossein; Komsari, Samane; Mohammadtaghizadeh, Sedigheh; Amiresmaili, Mohammadreza
Introduction Clinical education is one of the most important components of the resource generation function of health systems, and it has a very important role in graduates’ competency with respect to effective, practical education. This study aimed to assess the quality of clinical services in Kerman’s teaching hospitals located in southeastern Iran. Methods This cross-sectional study was conducted in 2011 on 303 medical students at different levels of medical education at Kerman’s teaching hospitals. A modified SERVQUAL instrument was used to collect the data after its validity and reliability were checked. The data were analyzed by SPSS 18.0 using the paired t-test, Kruskal-Wallis, and post hoc tests, when appropriate. Results In all five dimensions of quality, gaps were observed between students’ perceptions and expectations as follows: Assurance (mean = −1.18), Responsiveness (−1.56), Empathy (−1.4), Reliability (−1.27), and Tangibles (−1.21). There was a significant difference between the quality perceptions and expectations of the medical students (p internships, and assistantships regarding the dimensions of the quality gaps (p < 0.001). Conclusion The clinical services provided by teaching hospitals in the study did not meet the students’ expectations at any of the three educational levels. As we precisely assessed the dimensions and items that had the higher quality gaps, it was apparent that, for most part, clinical education officials could improve the quality by designing interventions, which would not be very difficult to do. PMID:26767094
Dhande Priti P, Beri Shirish G, Patel Hardik R
Full Text Available Background: Prevention of tetanus is far easier than its treatment where mortality is very high. Most cases of tetanus occur due to lack of proper vaccination against the disease and incomplete immunization on exposure. Residents in a tertiary care teaching hospital constitute the first contact physicians for patients. Aim: To assess the perception about Tetanus immunization among residents in a tertiary care teaching hospital of Pune city. Methodology: A pre tested questionnaire was used to assess the knowledge & recommendations about tetanus immunization among randomly selected 157 residents. Results: 73.25% residents were not aware of the number of doses of tetanus vaccine recommended for children under the age of 16 years. Around 50% residents were not aware of the recommended number of doses of tetanus vaccine for adults over the age of 16 years and during pregnancy. Nearly 60% of the residents considered the wound after every injury to be tetanus prone. 75.8% of residents thought burn injuries to be prone to the development of tetanus while 13.4% and 36.9% of the residents did not consider animal bite and human bite to be tetanus prone respectively. 99.4% residents considered tetanus toxoid administration in wound with rusted iron. The knowledge regarding tetanus immunization in relation to the wound categories depending on the immunization status of the patients was very poor amongst the residents. Conclusion: Better awareness and adherence of tetanus prophylaxis recommendations is needed in residents who are the first tier of health care providers in teaching hospitals.
Nwankwo, Okechukwu Emmanuel
Gas gangrene (clostridial myonecrosis) is rarely seen and this rarity, coupled with its dramatic presentation and often devastating outcome, makes each case of gas gangrene a spectacular and memorable experience. This study analyses the cases managed, the causes and outcome. Gunshot wounds, compounded by late presentation with its accompanying florid infections, were seen as the causes in 14 cases of gas gangrene seen at the University of Nigeria Teaching Hospital, Enugu during the four-year study period from July 2000 to June 2004. PMID:18453489
Naveen Sulakshan Salins
Full Text Available Aim: The purpose of this clinical audit was to determine how accurately documentation of anticipatory Not for Resuscitation (NFR orders takes place in a major metropolitan teaching hospital of Australia. Materials and Methods: Retrospective hospital-based study. Independent case reviewers using a questionnaire designed to study NFR documentation reviewed documentation of NFR in 88 case records. Results: Prognosis was documented in only 40% of cases and palliative care was offered to two-third of patients with documented NFR. There was no documentation of the cardiopulmonary resuscitation (CPR process or outcomes of CPR in most of the cases. Only in less than 50% of cases studied there was documented evidence to suggest that the reason for NFR documentation was consistent with patient′s choices. Conclusion: Good discussion, unambiguous documentation and clinical supervision of NFR order ensure dignified and quality care to the dying.
AIM: Pressure ulceration is a significant, but preventable, cause of morbidity and resource utilisation in hospital populations. Data on pressure ulcer prevalence in Ireland are limited. This study aims to determine (i) the point-prevalence of pressure ulcers in three teaching hospitals in Ireland and (ii) risk factors for their development. METHODS: Eight teams of one doctor and one nurse visited 672 adult patients over a 2-day period in three teaching hospitals. Each patient was examined and pressure ulcers graded with the European Pressure Ulcer Advisory Panel system. Mental test score, Barthel index, type of support surface, length of stay, documentation of risk assessment and serum albumin were recorded. RESULTS: Point-prevalence of pressure ulceration was 18.5%. Seventy-seven percent of pressure ulcers were hospital-acquired, 49% grade 1, 37% grade 2, 11% grade 3 and 3% grade 4. Reduced mobility, urinary incontinence, cognitive impairment, low serum albumin and length of stay were significantly associated with pressure ulcers. Multivariate logistic regression analysis found reduced mobility (odds ratio 8.84; 95% CI 5.04-15.48, p<0.0001) and length of stay (odds ratio 1.02; 95% CI 1.01-1.02, p<0.0001) to be predictive of the presence of pressure ulcers. Age, gender and risk assessment documentation were not associated with pressure ulcers. Sixty-five percent of patients with pressure ulcers were positioned on appropriate support surfaces. DISCUSSION: Point-prevalence of pressure ulceration was 18.5%, similar to international data. Regular audit of prevalence, prevention and management strategies may raise awareness, influence resource allocation and ultimately improve patient care.
Awosika SA; Olajubu FA; Amusa NA
Objective:To investigate the quality of indoor air of different wards and units of Olabisi Onabanjo University Teaching Hospital, Sagamu, to ascertain their contribution to infection rate in the hospital. Methods: The microbial quality of indoor air of nine wards/units of Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria was conducted. Sedimentation technique using open Petri-dishes containing different culture media was employed and samplings were done twice daily, one in the morning shortly after cleaning and before influx of people/patients into the wards/units and the other in the evening when a lot of activities would have taken place in these wards. Isolates were identified according to standard methods. Results: Results showed that there was a statistically significant difference (χ²=6.016 7) in the bacteria population of the different sampling time whereas it was not so for fungi population (χ²= 0.285 7). Male medical ward (MMW) and male surgical general (MSG) recorded the highest bacterial and fungal growth while the operating theatre (OT) was almost free of microbial burden. The bacteria isolates were Staphylococcus aureus, Klebsiella sp., Bacillus cereus, Bacillus subtilis, Streptococcus pyogenes and Serratia marscences while the fungi isolates included Aspergillus flavus, Penicillium sp., Fusarium sp., Candida albicans and Alternaria sp. Staphylococcus aureus was the predominantly isolated bacterium while Penicillium sp. was the most isolated fungus. Conclusions: Though most of the microbial isolates were potential and or opportunistic pathogens, there was no correlation between the isolates in this study and the surveillance report of nosocomial infection during the period of study, hence the contribution of the indoor air cannot be established. From the reduction noticed in the morning samples, stringent measures such as proper disinfection and regular cleaning, restriction of patient relatives’ movement in and out of the wards
Rosenblatt, M; Rabkin, M T; Tosteson, D C
The economic forces that are reshaping the practice of medicine and the funding of medical research will have great impact on clinical education and research in teaching hospitals and their associated medical schools. Changes in the setting of and approach to medical education will need to be made in order to continue to train physicians at the same high level as in the past and to maintain the productivity of our national biomedical research enterprise and its contributions to health. Academic leaders, such as department chiefs who have clinical service responsibilities, are finding it more and more difficult to manage simultaneously the demands of the clinical business, education, and research. In an effort to organize a teaching hospital and a medical school in a manner that would position them to maintain more effectively their common academic mission front and center with the clinical business, Harvard Medical School and the Beth Israel Hospital created a joint venture in 1996. The new nonprofit Institute for Education and Research has education and research as its top (and only) mission. It is designed to provide additional and specific academic leadership and to enable the joint venture to undertake strategic planning for the academic mission. In addition to the challenges it faces from changes in the external environment, the Institute for Education and Research will need to establish a new pattern of interactions internally within the parent institutions. Collaborations with department chairs and faculty are an essential ingredient for its success. It is hoped that this structure will prove to be a useful template for organizing other medical school-hospital collaborations on behalf of the academic mission. PMID:9200578
Full Text Available Background: Increasing number of reports on medication errors and relevant subsequent damages, especially in medical centers has become a growing concern for patient safety in recent decades. Patient safety and in particular, medication safety is a major concern and challenge for health care professionals around the world. Our prospective study was designed to detect prescribing, transcribing, dispensing, and administering medication errors in two major university hospitals. Materials and Methods: After choosing 20 similar hospital wards in two large teaching hospitals in the city of Isfahan, Iran, the sequence was randomly selected. Diagrams for drug distribution were drawn by the help of pharmacy directors. Direct observation technique was chosen as the method for detecting the errors. A total of 50 doses were studied in each ward to detect prescribing, transcribing and administering errors in each ward. The dispensing error was studied on 1000 doses dispensed in each hospital pharmacy. Results: A total of 8162 number of doses of medications were studied during the four stages, of which 8000 were complete data to be analyzed. 73% of prescribing orders were incomplete and did not have all six parameters (name, dosage form, dose and measuring unit, administration route, and intervals of administration. We found 15% transcribing errors. One-third of administration of medications on average was erroneous in both hospitals. Dispensing errors ranged between 1.4% and 2.2%. Conclusion: Although prescribing and administrating compromise most of the medication errors, improvements are needed in all four stages with regard to medication errors. Clear guidelines must be written and executed in both hospitals to reduce the incidence of medication errors.
Adebamowo Clement A
Full Text Available Abstract Background Smooth working relationships between nurses and doctors are necessary for efficient health care delivery. However, previous studies have shown that this is often absent with negative impact on the quality of health care delivery. In 2002, we studied factors that affect nurse-doctor working relationships in University Teaching Hospitals (UTH in Southern Nigeria in order to characterize it and identify managerial and training needs that might be used to improve it. Method Questionnaire survey of doctors and nurses working in four UTH in Southern Nigeria was done in 2002. The setting and subjects were selected by random sampling procedures. Information on factors in domains of work, union activities, personnel and hospital management were studied using closed and open-ended questionnaires. Results Nurse-doctor working relationships were statistically significantly affected by poor after-work social interaction, staff shortages, activist unionism, disregard for one's profession, and hospital management and government policies. In general, nurses had better opinion of doctors' work than doctors had about nurses' work. Conclusion Working relationships between doctors and nurses need to be improved through improved training and better working conditions, creation of better working environment, use of alternative methods of conflict resolution and balanced hospital management and government policies. This will improve the retention of staff, job satisfaction and efficiency of health care delivery in Nigeria.
Milne, Jacqueline; Greenfield, David; Braithwaite, Jeffrey
Collaborative practice among early career staff is at the bedrock of interprofessional care. This study investigated factors influencing the enactment of interprofessional practice by using the day-to-day role of six junior doctors in three teaching hospitals as a gateway to understand the various professions' interactive behaviours. The contextual framework used for the study was Strauss' theory of negotiated order. Ethnographic techniques were applied to observe the actions and interactions of participants on typical working days in their hospital environments. Field notes were created and thematic analysis was applied to the data. Three themes explored were culture, communication, and collaboration. Issues identified highlight the bounded organisational and professional cultures within which junior doctors work, and systemic problems in interprofessional interaction and communication in the wards of hospitals. There are indications that early career doctors are interprofessional isolates. The constraints of short training terms and pressure from multi-faceted demands on junior doctors can interfere with the establishment of meaningful relationships with nurses and other health professionals. The realisation of sustained interprofessional practice is, therefore, practically and structurally difficult. Enabling factors supporting the sharing of expertise are outweighed by barriers associated with professional and hospital organisational cultures, poor interprofessional communication, and the pressure of competing individual task demands in the course of daily practice. PMID:25646898
Miles, Anna; Friary, Philippa; Jackson, Bianca; Sekula, Julia; Braakhuis, Andrea
This study evaluated hospital readiness and interprofessional clinical reasoning in speech-language pathology and dietetics students following a simulation-based teaching package. Thirty-one students participated in two half-day simulation workshops. The training included orientation to the hospital setting, part-task skill learning and immersive simulated cases. Students completed workshop evaluation forms. They filled in a 10-question survey regarding confidence, knowledge and preparedness for working in a hospital environment before and immediately after the workshops. Students completed written 15-min clinical vignettes at 1 month prior to training, immediately prior to training and immediately after training. A marking rubric was devised to evaluate the responses to the clinical vignettes within a framework of interprofessional education. The simulation workshops were well received by all students. There was a significant increase in students' self-ratings of confidence, preparedness and knowledge following the study day (p < .001). There was a significant increase in student overall scores in clinical vignettes after training with the greatest increase in clinical reasoning (p < .001). Interprofessional simulation-based training has benefits in developing hospital readiness and clinical reasoning in allied health students. PMID:26803776
Full Text Available Boniface Uji Ago, Sylvester Abeshi, Charles Njoku, Thomas Udagbor Agan, John EkabuaDepartment of Obstetrics and Gynaecology, University of Calabar Teaching Hospital, Calabar, NigeriaBackground: Teenage pregnancy is high-risk and associated with complications due to adverse physiological, anatomical, and socioeconomic factors. The purpose of this study was to determine the patterns and obstetric outcomes of booked teenage pregnancies at the University of Calabar Teaching Hospital (UCTH in Nigeria.Methods: A retrospective comparative analysis of teenage pregnancies and mature mothers at UCTH was carried out from January 2011 to December 2011. A total of 82 teenage pregnancies and 72 mature pregnancies were compared.Results: There were 145 teenage deliveries from a total of 2313 deliveries, ie, 6.3% of total deliveries. There was no statistically significant difference in the mode of delivery (cesarean section, spontaneous vaginal delivery, instrumental delivery between the groups of mothers. There was also no difference in risk of complications, including obstructed labor, retained placenta, uterine atony, pre-eclampsia/eclampsia, and antepartum hemorrhage. However, teenage mothers had more perineal lacerations (P = 0.02 and more preterm labor (P = 0.05, and delivered more low-birth-weight babies (P = 0.02.Conclusion: Supervised teenage pregnancy may not be as hazardous as previously thought.Keywords: teenage pregnancy, booked pregnancy, obstetric outcome
Full Text Available Background: Tuberculosis is the leading cause of death from any single pathogen and it has consistently continued to be a major public health challenge globally. Data show that Nigeria ranks tenth among the 22 high tuberculosis burden countries. Aim: This study intends to describe the profile of tuberculosis infections in Babcock University Teaching Hospital. Methods: This was a retrospective cross sectional study of patients presenting to the Tuberculosis Laboratory of Babcock University Teaching Hospital. Results: Patients presenting to BUTH were 2.29 times more likely to have a positive AFB sputum smear result when compared to samples from Primary Health Care Centers – P = 0.05, χ 2 = 3.83, O.R = 2.29, R.R = 1.17, CI = 1.0 – 5.34. Patients presenting to BUTH were more likely to be HIV positive when compared to those from PHC’s p = 0.00, χ 2 = 24.74, df = 2. Conclusion: The burden of tuberculosis is still high in our environment and challenges in its rapid and accurate diagnosis still remain. In order to strengthen tuberculosis control, attention needs to be placed on rapid diagnosis and prompt treatment.
Full Text Available Osaheni L Lawani,1 Chukwuemeka A Iyoke,2 Azubuike K Onyebuchi1 1Department of Obstetrics and Gynecology, Federal Teaching Hospital, Ebonyi State, Nigeria; 2Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Enugu State, Nigeria Background: Obstetric hemorrhage has been repeatedly implicated as a leading cause of maternal mortality in Nigeria, yet there are very few studies that evaluate the practice of blood transfusion in obstetrics as a life saving measure. Objectives: The aim of this study was to evaluate the practice of obstetric blood transfusion, the mean decision-transfusion interval, and the outcome in parturients who had blood transfusions. Methods: This was a prospective descriptive study conducted at the Federal Teaching Hospital, Abakaliki, South-East Nigeria, between 1st January, 2012 and 31st December, 2012. Statistical analysis was done using SPSS version 15.0 for Windows. Results: Out of 151 parturients who received blood transfusion, 141/151 (97.4% were knowledgeable about blood transfusion, while only 10/151 (2.6% had no knowledge of it. The hospital was the source of information for 120/151 (80.8% of the participants. Blood transfusion rate was 7.04% of all parturients. The mean decision-transfusion interval was 12.0 ± 4.3 hours. All participants were transfused with either whole blood or sedimented cells. The mean number of blood units transfused was 1.77 ± 0.93 units. The indications for transfusion were: anemia, 109/151 (72.2%; shock, 13/151 (8.6%; postpartum hemorrhage, 23/151 (15.2%; antepartum hemorrhage, 6 (4%. Six (4% women died; mortality was due to renal failure in 3/6 (50% and disseminated intravascular coagulopathy in 3/6 (50%. These deaths were due to delays and difficulty in securing blood for transfusion, while those who got transfused on time were salvaged with minimal morbidity, 21/151 (14%, or with no morbidity, 130/151 (86%. Conclusion: Excessive blood loss and anemia still
江艇; 郭彦琼; 向国春
Teaching hospital plays a central role in training excellent doctor.Clinical teaching secretaries act as the advisor,coordinator,logistics people and supervisor in hospital clinical teaching management.Their duties include helping leader form and fulfill teaching plan,collect and arrange teaching records.To better accomplish the teaching secretarial job,a clinical teaching secretary should keep improving professional quality and personal comprehensive ability,ameliorating working methods and enhancing innovative thinking in a sound managing and evaluating system.%教学医院是培养优秀医学生的重要平台.临床教学秘书在医院教学管理中担任着参谋者、协调者、保障者和监督者的角色,具体职责包括协助制定和实施教学计划、收集和管理教学档案等.在健全的管理和考核制度下,教学秘书只有不断提高业务素质和个人综合能力、改善工作方法、加强创新意识,才能更好地完成教学秘书工作.
Full Text Available Background: Emergence of polyantimicrobial resistant strains of hospital pathogens has presented a challenge in the provision of good quality in-patient care. Inappropriate use of antibiotics in the hospital is largely responsible for this catastrophe. Bacteriological surveillance of the cases of nosocomial infections is crucial for framing an evidence-based antimicrobial policy for a hospital. Materials and Methods: A prospective study was undertaken among 498 patients from medicine and surgery wards in a tertiary teaching hospital in Goa. The patients were followed up clinico-bacteriologically for the occurrence of nosocomial infections (NI. Antibiotic susceptibility testing was done using Kirby-Bauer disc diffusion method. Results: The overall infection rate was 33.93 ± 4.16 infections per 100 patients. Urinary tract infection was the most common NI (26.63%, followed by surgical site infection (23.67%, wound infection (23% and nosocomial pneumonia (18.34%. Ninety-seven percent of the isolates were bacterial, while the others were fungal. More than 80% of the NIs were caused by Gram-negative bacteria, predominantly Pseudomonas aeruginosa, Escherichia coli and Aceinetobacter baumanii . Almost 70% of the isolates were resistant to all the antibiotics for which susceptibility was tested; the rest were sensitive to amikacin, cefoperazone-sulbactam and other antibiotics including methicillin, co-trimoxazole, teicoplenin, vancomycin and rifampicin, either singly or in combination. The proportion of MRSA was 71.4%. Resistance to a particular antibiotic was found to be directly proportional to the antibiotic usage in the study setting. Conclusion: Surveillance of nosocomial infections with emphasis on the microbiologic surveillance and frequent antimicrobial audit are critical towards curbing the evil of polyantimicrobial resistant nosocomial infections in a hospital.
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...
Dedey, Florence; Wu, Lily; Ayettey, Hannah; Sanuade, Olutobi A; Akingbola, Titilola S; Hewlett, Sandra A; Tayo, Bamidele O; Cole, Helen V; de-Graft Aikins, Ama; Ogedegbe, Gbenga; Adanu, Richard
Background Breast cancer is the leading cause of cancer-related mortality among women in Ghana. Data are limited on the predictors of poor outcomes in breast cancer patients in low-income countries; however, prolonged waiting time has been implicated. Among breast cancer patients who received treatment at Korle Bu Teaching Hospital, this study evaluated duration and factors that influenced waiting time from first presentation to start of definitive treatment. Method We conducted a hospital-based retrospective study of 205 breast cancer patients starting definitive treatment at Korle Bu Teaching Hospital between May and December 2013. We used descriptive statistics to summarize patient characteristics. Mann-Whitney U and Kruskal-Wallis tests and Spearman rank correlation were performed to examine the patients, health system, and health worker factors associated with median waiting time. Poisson regression was used to examine the determinants of waiting time. Results The mean age of the patients was 51.1 ± 11.8 years. The median waiting time was 5 weeks. The determinants of waiting time were level of education, age, income, marital status, ethnicity, disease stage, health insurance status, study sites, time interval between when biopsy was requested and when results were received and receipt of adequate information from health workers. Conclusion A prolonged waiting time to treatment occurs for breast cancer patients in Ghana, particularly for older patients, those with minimal or no education, with lower income, single patients, those with late disease, those who are insured, and who did not receive adequate information from the health workers. Time to obtain biopsy reports should be shortened. Patients and providers need education on timely treatment to improve prognosis. PMID:27091222
Objective was to evaluate the intra-operative complications of outpatient interval tubal sterilization at a teaching hospital. The data of 461 patients who underwent interval tubal ligation ITL at the Family Planning Clinic of Ankara Etlik Maternity and Women's Health Teaching and Research Hospital, Ankara, Turkey between January 2002 and December 2005 were reviewed from a computerized database. The demographic characteristics, operative technique and intra- and early postoperative complications of patients were evaluated. Only 11 patients had minilaparotomy for ITL. Laparoscopic ITL was performed using bipolar cautery. The cases who were hospitalized or had a complication and/or an unplanned laparotomy were analyzed. The mean age of patients was 35.1 range: 21-51, gravidity was 4.6 range: 2-9, parity was 3.2 range: 2-7 and number of living children was 3.1 range 2-6. Out of 461 patients, only 20.4% had complications related with general anesthesia. Two cases 0.4% had bleeding from the port-site, 3 cases 0.6% had meso-salpingeal and meso-ovarian bleeding, one had omental bleeding 0.2% from vagina wall. There was only one 0.2% intestinal burn that required a laparotomy and segmental resection followed by end-to-end anastomosis. The mortality was nil, whilst the morbidity was found to be 2.1% and all the complications were encountered in patients who had laparoscopic surgery. Outpatient tubal ligation is a convenient and safe procedure and implementing endoscopic surgical techniques is necessary for correction of the complications. (author)
Shristi Raut; Shishir Gokhale; Bipin Adhikari
Objective: To isolate, identify and phenotypically characterize extended spectrum beta-lactamase (ESBL)-producing Escherichia coli andKlebsiella spp in Manipal Teaching Hospital.Methods: Cross sectional study was conducted among E. coli and Klebsiella spp recovered from patients’ various samples to establish the prevalence of organisms producing ESBL in Manipal Teaching Hospital, Pokhara, Nepal between October 2011 and April 2012. ESBL production was detected by Clinical laboratory Standards ...
To find out the frequency of patients attending Casualty department of a Teaching Hospital with sudden severe thunderclap headache, their diagnostic out-come and follow up. The study was conducted in Casualty and Medical, Departments of Saidu Teaching Hospital, Saidu Sharif, from January 2006 to December 2006. Out of 22,000 patients with different Medical problems attended Casualty department during study period of which 128 cases had acute severe thunderclap headache. Age range was 15 to 80 years with mean age of 46+-10 years. Seventy eight patients (61%) were female and fifty (39%) were male. Protocol included proper clinical examination, basic laboratory investigations, admission to the General medical ward / Intensive care unit for observation, treatment and follow-up. CT scan of brain and or lumber puncture was performed in all the studied patients. The in-hospital follow up period was from two to fourteen days. The patients were reviewed one month later after discharge from hospital. Out of 120 patients twenty cases (15.6%) had Subarachnoid haemorrhage (SAH) seven patients (5.4%) had Cerebral infarction, five patients (3.9%) had an Intracerebral Haematoma. Five patients (3.9%) had aseptic meningitis. Two cases (1.5%) were reported as cerebral edema. One case (0.8%) had venous sinus thrombosis. As there was no specific finding on investigations and follow up of 88 cases (69%): these were labeled as idiopathic thunder-clap headache. Past history of not more than three similar episodes was present in 33 cases (25.78%). Out of these 33 cases, thirty belonged to the benign group of 88; other three cases had organic causes. Clinical diagnosis of Migraine was made in 37 cases out of these 88 cases. Attack of severe thunderclap headache is not an un-common emergency. Attack due to Subarachnoid haemorrhage (SAH) or other serious underlying disease cannot be distinguished from non specific headaches on clinical grounds alone. It is recommended that all such patients be
Full Text Available TU Agan1, EI Archibong1, JE Ekabua1, EI Ekanem1, S E Abeshi1, TA Edentekhe2, EE Bassey21Department of Obstetrics and Gynecology and 2Department of Anesthesia, College of Medical Sciences, University of Calabar Teaching Hospital, NigeriaBackground: Maternal mortality remains a major public health challenge, not only at the University of Calabar Teaching Hospital, but in the developing world in general.Objective: The objective of this study was to assess trends in maternal mortality in a tertiary health facility, the maternal mortality ratio, the impact of sociodemographic factors in the deaths, and common medical and social causes of these deaths at the hospital.Methodology: This was a retrospective review of obstetric service delivery records of all maternal deaths over an 11-year period (01 January 1999 to 31 December 2009. All pregnancy-related deaths of patients managed at the hospital were included in the study.Results: A total of 15,264 live births and 231 maternal deaths were recorded during the period under review, giving a maternal mortality ratio of 1513.4 per 100,000 live births. In the last two years, there was a downward trend in maternal deaths of about 69.0% from the 1999 value. Most (63.3% of the deaths were in women aged 20–34 years, 33.33% had completed at least primary education, and about 55.41% were unemployed. Eight had tertiary education. Two-thirds of the women were married. Obstetric hemorrhage was the leading cause of death (32.23%, followed by hypertensive disorders of pregnancy. Type III delay accounted for 48.48% of the deaths, followed by Type I delay (35.5%. About 69.26% of these women had no antenatal care. The majority (61.04% died within the first 48 hours of admission.Conclusion: Although there was a downward trend in maternal mortality over the study period, the extent of the reduction is deemed inadequate. The medical and social causes of maternal deaths identified in this study are preventable, especially
Leggat, Sandra G; Tse, Nancy
Globalization is impacting on Hong Kong and Australia in different ways, but the experience of the public healthcare systems in both jurisdictions suggests a need for teaching and research hospitals to refocus from the management of international patients to better meet the needs for global health. Traditional globalization suggests a stockpiling of capital--a focus on improving global health suggests dismantling the stockpiles and sharing access to the necessary data, information, knowledge and discoveries to further develop local health expertise. Consistent with its position as a leading healthcare provider, the University Health Network (UHN) has been reflecting on the impact of increasing globalization on hospitals. The goals of the UHN paper on globalization are threefold--to suggest how the external and internal environments of hospitals will change as a result of globalization; to suggest a role for hospitals in a globalized world; and to stimulate discussion and debate. Given our perspective, from the other side of the world, we are pleased to contribute to the discussion and debate but will limit our comments to the future role of teaching and research hospitals based on some of the experiences of Australia and Hong Kong. The citizens of Hong Kong have been acutely aware of the issue of globalization--the excellent deep-water harbour has ensured the position of Hong Kong as a major trading hub. Hong Kong has also had a continually evolving role as a financial centre and gateway to China, and with China's accession to the World Trade Organization the impact of globalization will be even greater. On the other hand, the citizens of Australia have lived with geographic isolation, relatively limited natural resources and a small population, all of which have limited their role in global trade and financial markets. However, both Hong Kong and Australia have seen recent benefits from the increasing speed of communication and information transfer and exchange
Full Text Available OBJECTIVE : Uterine rupture is a preventable obstetric complication. The aim of the study is to know the incidence of uterine rupture, find out the predisposing factors, maternal and foetal outcome in a tertiary teaching hospital and suggest measures to decrease the incidence of rupture uterus. MATERIAL AND METHODS: All cases referred to the hospital with rupture uterus and cases delivered in the hospital with rupture of uterus between July 2010 to June 2015 were included in the study. Age, parity, gestational age, mo de of delivery, type of rupture, surgery done, and foetomaternal outcome were noted. RESULTS : The incidence of rupture uterus in the present study was 1.32 per 1,000 deliveries. Most of these patients were young with mean age of 24.23 years, 1 st and 2 nd gr avida. Previous caesarean scar and traumatic instrumental delivery with forceps were common risk factors. Maternal morbidity was high and maternal mortality was 7.89% and foetal loss was high ( 78.95%. Uterine repair with bilateral tubectomy was the common est surgery performed. CONCLUSION: Causes of rupture uterus are preventable. Proper antenatal care, early referral of patients with risk factors to centres equipped with facilities for surgical intervention and facilities for blood transfusion , c areful mon itoring of women in labour with partogram, judicious use of oxytocin will go a long way in decreasing the incidence of rupture uterus.
M.A. Ebrahimzadeh, Ph.D.
Full Text Available AbstractBackground and Purpose: Due to an increase in cases of irrational drug prescription and it's health and economic consequences, evaluation of the rational use of drugs seemed necessary. Among drug groups antibiotics are greatly significant.Materials and Methods: Utilization pattern of antibiotics in different wards of Sari Imam Khomeini teaching hospital in the first half of 2000 and 2005 were reviewed. ATC/DDD (Anatomic, Therapeutic, Chemical/ Defined Daily Dose methodology was used.Results: Data showed, use of antibiotics jumped from 95.4 DBDs (DDD per patient’s bed-days to 124 DBDs. Distribution of different class of anti-microbial, showed the highest increase in use of vancomycin and clindamycin. Use of cotrimoxazole and aminoglycosides remained fairly unchanged, howerrs consumption of Penicillin G dropped. In year 2005, ICU ward followed by gynecology, were among the University Hospital departments with the highest consumption of antibiotics. Cefazolin was the most prescribed antibiotics during this study.Conclusion: It appers that there is a need for more national drug policities and drug education program for health care professionals. Evaluation of drug distribution in hospitals seems to be necessary.Key words:
Roxana Sharifian; Nasrin Shokrpour; Fahimeh Salehpour
Introduction: Recognition and implementation of knowledge management have an important effect on improving the quality of hospital activities. According to the direct relationship with the society’s health, health and treatment departments need knowledgeable and skillful staff. Thus, this research investigated different dimensions of the knowledge management processes in teaching hospitals of Shiraz University of Medical Sciences in 2014. Method: This cross-sectional analytical st...
ALIREZA ABDOLLAHI; SHAHNAZ ADINEH
OROGINAL ARTICLE Occupational diseases are any chronic ailment that occurs as a result of work or occupational activity. This study was conducted to examine the frequency and risk factors of some Skin and Musculoskeletal Disorders among nurses at a referral-teaching hospital. All 197 nurses in the hospital from different working shifts were engaged in the study. All nurses filled out a questionnaire containing demographic and occupational data. In the questionnaire, they specified the followi...
Danny A Asogun; Adomeh, Donatus I.; Jacqueline Ehimuan; Ikponmwonsa Odia; Meike Hass; Martin Gabriel; Stephan Olschläger; Beate Becker-Ziaja; Onikepe Folarin; Eric Phelan; Ehiane, Philomena E.; Ifeh, Veritas E.; Uyigue, Eghosasere A.; Oladapo, Yemisi T.; Muoebonam, Ekene B.
BACKGROUND: Lassa fever is a viral hemorrhagic fever endemic in West Africa. However, none of the hospitals in the endemic areas of Nigeria has the capacity to perform Lassa virus diagnostics. Case identification and management solely relies on non-specific clinical criteria. The Irrua Specialist Teaching Hospital (ISTH) in the central senatorial district of Edo State struggled with this challenge for many years. METHODOLOGY/PRINCIPAL FINDINGS: A laboratory for molecular diagnosis of Lassa fe...
Peterside, Oliemen; Pondei, Kemebradikumo; Felix O Akinbami
Background: Sepsis is one of the most common causes of neonatal hospital admissions and is estimated to cause 26% of all neonatal deaths worldwide. While waiting for results of blood culture, it is necessary to initiate an empirical choice of antibiotics based on the epidemiology of causative agents and antibiotic sensitivity pattern in a locality. Objective: To determine the major causative organisms of neonatal sepsis at the Niger Delta University Teaching Hospital (NDUTH), as well as their...
Cummings, Kevin J.; Rodriguez-Rivera, Lorraine D; Mitchell, Katharyn J; Hoelzer, Karin; Wiedmann, Martin; McDonough, Patrick L.; Altier, Craig; Warnick, Lorin D.; Perkins, Gillian A
Nosocomial salmonellosis continues to pose an important threat to veterinary medical teaching hospitals. The objectives of this study were to describe an outbreak of salmonellosis caused by Salmonella enterica serovar Oranienburg within our hospital and to highlight its unique features, which can be used to help mitigate or prevent nosocomial outbreaks in the future. We retrospectively analyzed data from patients that were fecal culture-positive for Salmonella Oranienburg between January 1, 2...
Full Text Available Problem statement: Considering the importance of emergency departments in healthcare system and the high mortality rate of patients referred to these departments, it is crucial to provide quality services in emergency departments. Accreditation is a systematic process for improving quality of care and it enables managers to assess and evaluate the healthcare system. Accreditation of an organization provides an obvious commitment for improving quality of safety, quality of patient care, ensuring safety surveillance and continuous activities for reducing dangers which threaten patients and staff. Therefore, given the vital role as well as and the perpetual and indispensable service provided by the emergency departments, it is necessary to re-evaluate the manner of service provision in these departments according to the standards and criteria of accreditation, so that an observance of these criteria will lead to improvement of emergency medicine in Iran. Thus, the present study was undertaken with the purpose of accreditation of emergency department of a teaching hospital of Tehran University of Medical Sciences according to the standards of Iranian Deputy of Health and the JCI. Approach: This is a descriptive-analytic study with a cross-sectional structure. Our study population consisted of 50 individuals of the healthcare staff (physicians and nurses working in morning and evening work shifts of the emergency department in the teaching hospital. Data collection tools consisted of standard questionnaires of the Deputy of Health (9 series and questionnaires developed by authors based on the standards of the Joint Commission International (JCI regarding patient satisfaction with services provided in emergency departments. In order to determine the reliability and validity of the data collection tools, professors and experts reviewed the questionnaire of quality and patient safety in accordance with standards of quality patient safety from the
Full Text Available Background Workplace violence is one of the factors which can strongly reduce job satisfaction and the quality of working life of nurses. The aim of this study was to measure nurses’ exposure to workplace violence in one of the major teaching hospitals in Tehran in 2010. Methods We surveyed the nurses in a cross-sectional design in 2010. The questionnaire was adapted from a standardized questionnaire designed collaboratively by the International Labor Office (ILO, the International Health Organization (IHO, the International Council of Nurses (ICN, and the Public Services International (PSI. Finally, in order to analyze the relationships among different variables in the study, T-test and Chi-Square test were used. Results Three hundred and one nurses responded to the questionnaire (a response rate of 73%. Over 70% of the nurses felt worried about workplace violence. The participants reported exposure to verbal abuse (64% CI: 59-70%, bullying-mobbing (29% CI: 24-34% and physical violence (12% CI: 9-16% at least once during the previous year. Relatives of hospital patients were responsible for most of the violence. Nurses working in the emergency department and outpatient clinics were more likely to report having experienced violence. Nurses were unlikely to report violence to hospital managers, and 40% of nurses were unaware of any existing policies within the hospital for reducing violence. Conclusion We observed a considerable level of nurse exposure to workplace violence. The high rate of reported workplace violence demonstrates that the existing safeguards that aim to protect the staff from abusive patients and relatives are inadequate.
Purushottam A. Giri
Full Text Available Non-communicable diseases including cancer are emerging as major public health problems in India. Cancer usually means malignancy, has become one of the ten leading cause of death in India. The leading sites of cancer vary from country to country. Oral cancer ranks in the top three of all cancers in India, accounting for over 30% of all cancers reported in the country and its control is quickly becoming a global health priority. The present study was conducted to find out the contribution of different type of oral cancer in a tertiary care teaching hospital of western Maharashtra, India. A retrospective hospital record based study was carried out for the period of 2007-2011 in the department of Radiotherapy of Pravara Rural Hospital, Loni, Maharashtra, India. A total of 5879 patients who were diagnosed with cancer, of them 633 (10.76% patients had oral cancer. Data was collected on the basis of the patients record in the hospital and analyzed in the form of percentage and proportions whenever appropriate. A total of 633 oral cancer patients were screened, of which 411 (64.93% were males and 222 (35.07% were females. Among oral cancer, buccal mucosa was highest (37.12%; followed by tongue (36.80%, oropharynx (4.74% and lip and palate (3.15%. Oral cancer is one of the common malignancies in developing countries like India. It is common in males compared to females and is usually seen after middle age. [Int J Res Med Sci 2013; 1(3.000: 233-236
Full Text Available BACKGROUND : Immunophenotyping of leukemi a by flowcytometry offers a better classification of the hematopoietic lineage of malignant cells as compared to morphology. AIM : To determine the immunophenotypic subtypes of acute leukemia in a tertiary care teaching hospital. MATERIAL & METHODS : A one y ear study of morphologic & flowcytometric data of patients with acute leukemia. RESULTS : Total numbers of acute leukemia patients diagnosed morphologically were 45, out of which 20 patients underwent immunophenotyping by flowcytometry. Maximum patients wer e in the age group of 0 - 10 yrs followed by 11 - 20 yrs with males outnumbering female. Immunophenotypically they belonged to ALL - B cell lineage, ALL - T cell lineage, AML, biphenotypic, inconclusive. CONCLUSION : Immunophenotyping of acute leukemias by flowcyto metry, not only helps to confirm the morphologic diagnosis but also helps in assigning specific lineage to the blasts, particularly in acute lymphoid leukemia
The radiological protection assessment based on the shielding of the Co-60 Radiotherapy facility at the Korle Bu Teaching Hospital after the source replacement has been carried out. The results indicate that the concrete biological shield is adequate to attenuate the gamma photons from the new 222 TBq Co-60 source in use. The dose rates at critical locations of the public access area are within the recommended dose rate limit of O.5J..1Sv/h and 7.5J..1Sv/h for public and staff respectively. Thus the shielding has not deteriorated and still provides adequate protection for members of the public and the operating staff (au).
Full Text Available Seclusion is one of the methods in controlling violent behavior of inpatients in psychiatric wards. In current descriptive analytic study, data collection instrument included the seclusion list of inpatients by considering individual, social and clinical characteristics in one of the psychiatry wards In the Razi teaching hospital of Tabriz in the first six months of 2012. Among 264 admitted patients, 24 patients (9.1% had been secluded and a total of 29 isolated incidents were recorded. Most of secluded incidents occurred on weekdays (75.9%, first week of inpatient (87.7%, and during the evening shifts (48.3%. The results obtained in this study demonstrate that in 55.2% cases, the duration of isolation was two hours and the most common cause of seclusion was aggressive behaviors. Most of secluded patients (66.7% were diagnosed with mood disorders.
Hanselman, Beth A; Kruth, Stephen; Weese, J Scott
Nasal, axillary and rectal swabs were collected from 193 dogs admitted to the Ontario Veterinary College Veterinary Teaching Hospital. Enrichment culture was performed and coagulase positive staphylococci were identified via standard methods. Methicillin-resistant Staphylococcus pseudintermedius was isolated from 4/193 (2.1%) dogs, and methicillin-resistant Staphylococcus aureus and methicillin-resistant Staphylococcus schleiferi subsp. coagulans were each isolated from 1/193 (0.5%) dogs. Methicillin-resistant Staphylococcus intermedius was not identified. All S. pseudintermedius isolates were unrelated on pulsed-field gel electrophoresis. Evaluation of the epidemiology of methicillin-resistant staphylococcal colonization is necessary to understand the apparent emergence of these strains and to develop appropriate control strategies. PMID:17643874
Intussusceptions is the telescoping or invagination of a portion of intestine (intussusceptum) into an adjacent segment (intussuscipiens). It is one of the common causes of bowel obstruction in infants and toddlers. Sonography has now been accepted as a method for guiding hydrostatic reduction of intussusception with tap water, normal saline or Ringer’s lactate solution. This method is currently being used at Korle Bu Teaching Hospital. It is a very simple, efficient, economical and quick method of managing intussusception. The duration of the procedure ranges between two minutes and thirty minutes, with the majority being under ten minutes. A total of twenty intussusceptions were managed in eighteen patients over a nine month period. In fifteen patients (75%) the intussusception was reduced successfully. In five patients (25%), the procedure failed to reduce the intussusceptions. (author)
This thesis was designed to study the pattern of neurological disorders of admitted patients to the neurology centre at El shaab teaching hospital in the period from january 1997 to december 1998. 402 cases were admitted. (35%) were in the age group 21-40, 30% in 41-60, 20% in 61-80, 14% in 0-20 and 1% in >81 males constituted 72% and females 28%. Cerebrovascular diseases top the list with 18.9%, followed by paraplegia's with 17.4%, peripheral neuropathies 11.7, (guillain barre was the most common). Brain space occupying lesions 10.4% (tumors and tuberculomas was the most common),movement disorders with 10% (Parkinson's disease was the most encountered), muscle disorders 6.2% (myasthenia gravis was the commonest). Ataxias 5.5%, headache and migraine was the least group of disorders
Rao, K B
During the 13 years 1960-1972, in a teaching hospital that serves a predominantly rural and semiurban population in southern India, there were 74,384 deliveries and 1245 maternal deaths, a maternal mortality rate of 16.7 per 1000 births. Direct obstetric factors caused 854 (65.5%) of these deaths. The leading indirect or associated causes of maternal deaths were anemia, cerebrovascular accidents, and infectious hepatitis. During the past 13 years, monthly maternal mortality meetings have helped to reduce the incidence of avoidable factors in maternal deaths among patients from the city but not among those brought from the surrounding countryside. The important causes of maternal deaths in this developing country, and their prevention, are individually discussed. PMID:1080844
Oral tumours in patients attending the oral Surgery Department of the Korle Bu Teaching Hospital, Accra, during a 12 month period from February 1998 to January 1999 were studied and classified. In all, 50 patients were included in the study out of which 33 were fully characterised and classified historically. Fifteen (45.4%) of the tumours examined were squamous cell carcinoma (SCC), 6(18.2%) ameloblastoma (AME), 3 (9.1%) each of Lympoma (L), adenoid cystic carcinoma (ADC) and pleomorphic adenoma (PA), 2(61.1%) ossifying fibroma (OF) and 1(3.0%) embryonal rhabdomyosar coma (ER). There was significant observed between the prevalence rates in men and women. OSCC was found to occur more frequently in the palate/maxillary sinus and the parotid gland whilst ameloblastoma was the commonest benign neoplasm within the fourth decade. (author)
Maria Cristina Soares Rodrigues
Full Text Available Adverse events for drugs (AED is a public health problem worldwide, many are due to undesirable drug interactions and preventable nature. This descriptive study aimed to characterize the profile pharmacotherapy and to identify drug interactions (DIs. It was analyzed 110 prescriptions of the patients with age of one to 12 years, in a teaching hospital of Brasilia, Federal District, from October 2005 to February 2006. It found the record of 292 medicines, mainly from the class of the nervous system (37.7%, prevailing prescriptions with up to five drugs (67.3%. It found prescription drugs unapproved and unauthorized for pediatric use. We identified six potential DIs and degree of moderate severity (66.7%. The time of drug administration follows a pattern at 6 am, 12 am, 18 pm and 22 pm, disregarding possible DIs. Knowing the profile pharmacotherapy involving the pediatric patient is extremely important for the prevention of avoidable AAM, such as unwanted DIs.
Full Text Available Purpose: The aim of this study was to determine the types and nature of traditional eye medications (TEMs, their sources, and the ocular complications that may arise from use in a teaching hospital in Nigeria. Materials and Methods: A prospective study of consecutive subjects who used TEM before presentation to the Eye Clinic of the University of Benin Teaching Hospital, Benin City, Nigeria between July 1, 2004 and June 30, 2008. P < 0.05 was considered statistically significant. Results: A total of 113 subjects were evaluated of which 64 were males (56.6%, females (43.4% were females. There was no significant difference in the number of males and females (P > 0.05. Rural dwellers were more likely to use TEM than urban dwellers (P < 0.0001. The mean age of the subjects was 47.9 22.3 years (range, 4-90 years. The most common traditional medication was derived from plant extracts (54.9% followed by concoctions (21.2%. Complications occurred in 54.8% of the subjects. Ocular complications included corneal opacities in 13.35% of subjects, staphyloma in 9%, and corneal ulcers in 8%. Other complications were panophthalmitis, endophthalmitis, uveitis, cataract, and bullous keratopathy. Eleven subjects underwent evisceration or enucleation of the affected eye. There was no significant difference in the type of medication used and ocular complications (P = 0.956. Sources of TEM were self-medication in 38.9% of subjects, relatives in 27.4%, and traditional healers in 17.7%. Conclusion: The use of TEM is a common practice that could be harmful and lead to blindness. Proper health education of the public and traditional healers can reduce the prevalence of preventable blindness.
Thomas, Arun Z
To examine the magnitude of potentially avoidable iatrogenic complications of male urethral catheterization (UC) within a tertiary-care supra-regional teaching hospital, and to evaluate risk factors and subjective feeling of interns in our institution on the adequacy of training on UC.
Chinyere Nnenne Pedro-Egbe
Conclusion: This is the first study in the literature on ocular cranial nerve palsies in Southern Nigeria. Third and sixth cranial nerve palsies were the most common cases to present to the University of Port Harcourt Teaching Hospital Eye Clinic. There was a statistically significant association to systemic disorders such as hypertension and DM and majority of cases with 6 th cranial nerve palsy.
Maria Auxiliadora Parreiras Martins; Sérgia Maria Starling de Magalhães; Cibele Comini César; Adriano Max Moreira Reis; Mauro Henrique Nogueira Guimarães de Abreu
Unfractionated heparin (UFH) and low-molecularweight heparins (LMWHs) are widely used in curative and preventive treatments of thromboembolic disorders. The aim of the study was to investigate factors associated with the choice of these types of heparin to treat patients with unstable angina under real conditions of hospital use. A cross-sectional study was performed in a private general hospital in Belo Horizonte, Brazil, from January 1st to December 31th, 2001. Data...
Full Text Available Abstract Background Nosocomial infections caused by Pseudomonas aeruginosa presenting resistance to beta-lactam drugs are one of the most challenging targets for antimicrobial therapy, leading to substantial increase in mortality rates in hospitals worldwide. In this context, P. aeruginosa harboring acquired mechanisms of resistance, such as production of metallo-beta-lactamase (MBLs and extended-spectrum beta-lactamases (ESBLs have the highest clinical impact. Hence, this study was designed to investigate the presence of genes codifying for MBLs and ESBLs among carbapenem resistant P. aeruginosa isolated in a Brazilian 720-bed teaching tertiary care hospital. Methods Fifty-six carbapenem-resistant P. aeruginosa strains were evaluated for the presence of MBL and ESBL genes. Strains presenting MBL and/or ESBL genes were submitted to pulsed-field gel electrophoresis for genetic similarity evaluation. Results Despite the carbapenem resistance, genes for MBLs (blaSPM-1 or blaIMP-1 were detected in only 26.7% of isolates. Genes encoding ESBLs were detected in 23.2% of isolates. The blaCTX-M-2 was the most prevalent ESBL gene (19.6%, followed by blaGES-1 and blaGES-5 detected in one isolate each. In all isolates presenting MBL phenotype by double-disc synergy test (DDST, the blaSPM-1 or blaIMP-1 genes were detected. In addition, blaIMP-1 was also detected in three isolates which did not display any MBL phenotype. These isolates also presented the blaCTX-M-2 gene. The co-existence of blaCTX-M-2 with blaIMP-1 is presently reported for the first time, as like as co-existence of blaGES-1 with blaIMP-1. Conclusions In this study MBLs production was not the major mechanism of resistance to carbapenems, suggesting the occurrence of multidrug efflux pumps, reduction in porin channels and production of other beta-lactamases. The detection of blaCTX-M-2,blaGES-1 and blaGES-5 reflects the recent emergence of ESBLs among antimicrobial resistant P. aeruginosa and
Efunkoya, Akinwale Adeyemi; Omeje, Kelvin Uchenna; Amole, Ibiyinka Olushola; Osunde, Otasowie Daniel; Akpasa, Izegboya Olohitae
Background: Cleft lip (CL) and palate (CLP) management is multidisciplinary. A cleft team was formed in a Nigerian Tertiary Hospital to address the health needs of cleft patients in the centre. Aim: This paper aims at documenting the Aminu Kano Teaching Hospital (AKTH) management protocol for orofacial clefts and also to review our experience with CLP surgeries performed at AKTH since our partnering with Smile Train. Materials and Methods: A retrospective review of all the cleft patients surgically treated from January 2006 to December 2014 under Smile Train sponsorship was undertaken. A descriptive narrative of the cleft team protocol was also given. Results: One hundred and fifty-five patients (80 males, 75 females) had surgical repairs of either the lip or palate. CL patients were 83 (53.55%), while CLP patients were 45 (29.03%) and isolated cleft palate patients were 27 (17.42%). Conclusion: The inclusion of various specialities in the cleft team is highly desirable. Poverty level amongst our patients frequently limits our management to surgical treatment sponsored by the Smile Train, despite the presence of other residual problems. PMID:26712291
William H.C. Tiong
Full Text Available Previous studies in USA and Canada have found that physicians and physicians in training have a limited understanding of medical care costs. In this study, we set out to survey all grades of doctors in the surgical department, emergency department, and anaesthetic department in a university-affiliated, Irish teaching hospital. Open-ended questionnaires on cost of 25 routinely used items in the hospital were sent to each department. The aims of the study were to assess the present knowledge of cost among the various grades of doctors, and to evaluate the level of professional experience on cost awareness and their confidence in their estimates. We had an overall response rate of 56.8% with 68.5% of doctors admitted to have estimated more than 90% of their responses. Ninety three percent of doctors have no confidence in their estimates on cost of listed items. We found that the lack of cost awareness was universal among doctors of all grades (P = 0.236. The doctors in our study population showed a high level of inaccuracy on their estimates of cost of routinely used items with 84% of the items overestimated. Our results were discouraging and demonstrated that considerable educational activity will be necessary if doctors are to be more cost effective in meeting the national health care budget.
Binit N Jhaveri
Full Text Available Aim: To evaluate the use of potentially inappropriate medicines in elderly inpatients in a tertiary care teaching hospital. Materials and Methods: Retrospective analysis was performed for cases of elderly patients admitted between January 2010 and December 2010. Data on age, gender, diagnosis, duration of hospital stay, treatment, and outcome were collected. Prescriptions were assessed for the use of potentially inappropriate medications in geriatric patients by using American Geriatric Society Beer′s criteria (2012 and PRISCUS list (2010. Results: A total of 676 geriatric patients (52.12% females were admitted in the medicine ward. The average age of geriatric patients was 72.69 years. According to Beer′s criteria, at least one inappropriate medicine was prescribed in 590 (87.3% patients. Metoclopramide (54.3%, alprazolam (9%, diazepam (8%, digoxin > 0.125 mg/day (5%, and diclofenac (3.7% were the commonly used inappropriate medications. Use of nonsteroidal anti-inflammatory drugs (NSAIDs in heart and renal failure patients was the commonly identified drug-disease interaction. According to PRISCUS list, at least one inappropriate medication was prescribed in 210 (31.06% patients. Conclusion: Use of inappropriate medicines is highly prevalent in elderly patients.
Juliana Santana de Freitas
Full Text Available OBJECTIVES: assess the quality of nursing care, the patients' satisfaction and the correlation between both.METHOD: cross-sectional study, involving 275 patients hospitalized at a teaching hospital in the Central-West of Brazil. The data were collected through the simultaneous application of three instruments. Next, they were included in an electronic database and analyzed in function of the positivity, median value and Spearman's correlation coefficients.RESULTS: among the nursing care assessed, only two were considered safe - hygiene and physical comfort; nutrition and hydration - while the remainder were classified as poor. Nevertheless, the patients were satisfied with the care received in the domains assessed: technical-professional, confidence and educational. This can be justified by the weak to moderate correlation that was observed among these variables.CONCLUSION: Despite the quality deficit, the patients' satisfaction level with the nursing care received was high. These results indicate that the institution needs to center its objectives on a continuing evaluation system of the care quality, aiming to attend to the patients' expectations.
Ng, Y W; Hassim, I Noor
Needlestick injury has been recognized as one of the occupational hazards which results in transmission of bloodborne pathogens. A cross-sectional study was carried out among 136 health care workers in the Accident and Emergency Department of two teaching hospitals from August to November 2003 to determine the prevalence of cases and episodes of needlestick injury. In addition, this study also assessed the level of knowledge of blood-borne diseases and Universal Precautions, risk perception on the practice of Universal Precautions and to find out factors contributing to needlestick injury. Prevalence of needlestick injury among the health care workers in the two hospitals were found to be 31.6% (N = 43) and 52.9% (N = 87) respectively. Among different job categories, medical assistants appeared to face the highest risk of needlestick injury. Factors associated with needlestick injury included shorter tenure in one's job (p risk of needlestick injury while performing procedures on patients. Therefore, comprehensive infection control strategies should be applied to effectively reduce the risk of needlestick injury. PMID:17682562
Objective was to explore and analyze the current status in management of patients with perforated peptic ulcers (PPU). A retrospective study carried out at the Surgical Department, Al-Gamhouria Teaching Hospital, Aden, Yemen. Patients admitted with perforated benign peptic ulcers from January 1997 to December 2006 were included in the study. A total of 156 patients, 138 (88.5%) male and 18 (11.5%) female, with an overall mean age of 39.08 years (range 14-75 years) and a higher frequency of PPU were noted in patients 21-40 years (58.3%). The perforated duodenal ulcer and perforated gastric ulcer ratio was 4.8:1. The mean time of presentation was 16.5 hours, and operative intervention after admission was 5.25 hours. Simple perforation closure was used in 91.7% of the patients. Postoperative complication rate was 41% (statistically significant in cases admitted later than 12 hours) wound sepsis making the majority at 55.2%, 6 deaths (3.9%), the correlation with presentation time was not significant. The overall mean post-operative hospitalization period was 12.76 days; 14.7% of the patients stayed more than 3 weeks. Younger patients (21-40 years) were frequently affected. Emphasis should be placed on shortening the time to surgery. Simple closure remains the selected treatment in the majority of patients. Overall post-operative mortality was low (3.9%). Improving the surgical skills, wound care, administrative regulations, hospital environment and the equipments are needed to reduce the high rate of complications. (author)
Objective: To determine the prevalence and pattern of congenital malformations among neonates in a teaching hospital. Methods: The prospective hospital-based study was conducted over a period of 18 months in the neonatal unit of Combined Military Hospital, Kharian, from September 2011 to February 2013. All neonates from newborn to 28 days of age admitted to the unit irrespective of their condition comprised the study population. Neonatal examination was done by the Registrar at the time of admission followed by neonatologist/paediatrician. Information regarding gender, weight, gestational age, mode of delivery, consanguinity, maternal age, antenatal visit record and family history were recorded on a predesigned proforma. After clinical examination, if required, relevant investigations like ultrasonography, radiology, echocardiography, laboratory and genetic studies were done to confirm diagnosis. Data was statistically analysed by using SPSS 20. Results: Out of 3,210 total admissions, 226 (7%) neonates were congenitally malformed. Of them, 130 (57.52 %) were male and 96 (42.47 %) females. Among different body systems affected, anomalies related to the central nervous system were 46(20.35%) musculoskeletal 42(18.58%), genitourinary 34 (15.04%), cardiovascular system 30 (13.27%), ear, eye, face, neck 27(11.94%), digestive system 19 (8.40%), syndromes and skin 14 (6.19%) each. Conclusion: Congenital Malformations are not rare in our community and central nervous system is the most commonly affected system. Healthcare managers must stress upon primary prevention in the form of vaccination, nutrition and drugs to decrease preventable share of congenital malformations. (author)
Full Text Available Background: To prevent medication errors in prescribing, one needs to know their types and relative occurrence. Such errors are a great cause of concern as they have the potential to cause patient harm. The aim of this study was to determine the nature and types of medication prescribing errors in an Indian setting.Methods: The medication errors were analyzed in a prospective observational study conducted in 3 medical wards of a public teaching hospital in India. The medication errors were analyzed by means of Micromedex Drug-Reax database.Results: Out of 312 patients, only 304 were included in the study. Of the 304 cases, 103 (34% cases had at least one error. The total number of errors found was 157. The drug-drug interactions were the most frequently (68.2% occurring type of error, which was followed by incorrect dosing interval (12% and dosing errors (9.5%. The medication classes involved most were antimicrobial agents (29.4%, cardiovascular agents (15.4%, GI agents (8.6% and CNS agents (8.2%. The moderate errors contributed maximum (61.8% to the total errors when compared to the major (25.5% and minor (12.7% errors. The results showed that the number of errors increases with age and number of medicines prescribed.Conclusion: The results point to the establishment of medication error reporting at each hospital and to share the data with other hospitals. The role of clinical pharmacist in this situation appears to be a strong intervention; and the clinical pharmacist, initially, could confine to identification of the medication errors.
Full Text Available Edris Abda,1 Leja Hamza,2 Fasil Tessema,3 Waqtola Cheneke4 1Department of Medicine, College of Medicine and Health Sciences, Madda Walabu University, Bale Robe, 2Department of Internal Medicine, 3Department of Epidemiology, 4Department of Medical Laboratory Sciences and Pathology, College of Health Sciences, Jimma University, Jimma, Ethiopia Background: Developing countries are now experiencing the epidemiologic transition, whereby the burden of chronic diseases, like metabolic syndrome, is increasing. However, no study had previously been conducted to show the status of metabolic syndrome among outpatients of Jimma University Teaching Hospital. Therefore, this study was designed to determine the prevalence of metabolic syndrome and associated factors among adult (≥20 years patients. Methods: A cross-sectional hospital-based study was conducted in July 2014 among adult (≥20 years patients attending Jimma University Teaching Hospital, outpatient department. All patients attending the outpatient department and were willing to participate in the study were included. Anthropometric and biochemical measurements were undertaken for all the study subjects to know the status of metabolic syndrome. Metabolic syndrome was identified using the National Cholesterol Education Program’s Adult Treatment Panel III criteria. Results: A total of 225 participants were included in the study, of whom 106 (47.1% were males and 119 (52.9% were females. A total of 59 (26% adults were found to have metabolic syndrome, which was seen more than twice as much in females, 42 (35%, as compared with males, 17 (16%, (P<0.01. The most frequent metabolic syndrome parameters were hypertension (45%, hyperglycemia (39%, decreased high-density lipoprotein (HDL (31%, central obesity (26%, and elevated triglycerides (18%. Elevated blood pressure is more common in females (44.5% than in males (34.9%. Decreased HDL-cholesterol was observed among 37% of females versus 24% males (P
Postpartum Haemorrhage (PPH) remains a significant cause of maternal mortality and morbidity like hypovolemic shock, anaemia, multi organ failure, consumptive coagulopathy, disseminated intra vascular coagulation (DIC), blood transfusion related complications and hysterectomy leading to loss of childbearing potential. The present study was conducted to determine the frequency of PPH and the associated maternal morbidity at the Department of Gynaecology Unit B, Ayub Teaching Hospital Abbottabad. The study was carried out in the Department of Obstetrics and Gynaecology Unit B of the Ayub teaching Hospital Abbottabad from 18th April 2006 to 17 July 2006. The study population included all cases admitted with primary PPH during the study period. For calculation of frequencies, the total number of deliveries in the setting during the study period was used. All subjects underwent a complete obstetrical clinical workup comprising of history, general physical examination, abdominal and pelvic examination, relevant laboratory investigations. The maternal condition was assessed and managed according to established hospital protocols which included both pharmacological and surgical intervention. All maternal complications were noted and recorded on pre-designed proformas. Data was entered and analyzed by computer. A total of 50 cases of primary PPH were recorded during the study period. The frequency of PPH was calculated as 7.1%. The major cause of PPH was uterine atony found in 29 (58%) cases, followed by cervical, vaginal and perineal tears in 12 (24%) cases. Initially all patients were managed pharmacologically followed by surgical intervention. Subtotal (haemostatic) hysterectomy was performed in 10 (20%) cases. Maternal morbidity was detected in 31 (62%) of cases; the major morbidities were DIC in 3 (6%) cases. Acute renal failure in 3 (6%) patients and shock in 2 (9.9%) cases and anaemia in 20 (90.1%) cases. The study concludes that the frequency of primary PPH in this
BACKGROUND: Warfarin is an oral anticoagulant (OAT) that needs active management to ensure therapeutic range. Initial management is often carried out as an inpatient, though not requiring inpatient facilities. This mismatch results in financial costs which could be directed more efficaciously. The extent of this has previously been unknown. Here we aim to calculate the potential number of bed nights which may be saved among those being dose optimized as inpatients and examine associated factors. METHODS: A 6 week prospective audit of inpatients receiving OAT, at Cork University Hospital, was carried out. The study period was from 11th June 2007 to 20th July 2007. Data was collected from patient\\'s medications prescription charts, medical record files, and computerised haematology laboratory records. The indications for OAT, the patient laboratory coagulation results and therapeutic intervals along with patient demographics were analysed. The level of potentially avoidable inpatient nights in those receiving OAT in hospital was calculated and the potential cost savings quantified. Potential avoidable bed nights were defined as patients remaining in hospital for the purpose of optimizing OAT dosage, while receiving subtherapeutic or therapeutic OAT (being titred up to therapeutic levels) and co-administered covering low molecular weight heparin, and requiring no other active care. The average cost of euro638 was taken as the per night hospital stay cost for a non-Intensive Care bed. Ethical approval was granted from the Ethical Committee of the Cork Teaching Hospitals, Cork, Ireland. RESULTS: A total of 158 patients were included in the audit. There was 94 men (59.4%) and 64 women (40.6%). The mean age was 67.8 years, with a median age of 70 years.Atrial Fibrillation (43%, n = 70), followed by aortic valve replacement (15%, n = 23) and pulmonary emboli (11%, n = 18) were the commonest reasons for prescribing OAT. 54% had previously been prescribed OAT prior to
O'Connor Mortimer B
Full Text Available Abstract Background Warfarin is an oral anticoagulant (OAT that needs active management to ensure therapeutic range. Initial management is often carried out as an inpatient, though not requiring inpatient facilities. This mismatch results in financial costs which could be directed more efficaciously. The extent of this has previously been unknown. Here we aim to calculate the potential number of bed nights which may be saved among those being dose optimized as inpatients and examine associated factors. Methods A 6 week prospective audit of inpatients receiving OAT, at Cork University Hospital, was carried out. The study period was from 11th June 2007 to 20th July 2007. Data was collected from patient's medications prescription charts, medical record files, and computerised haematology laboratory records. The indications for OAT, the patient laboratory coagulation results and therapeutic intervals along with patient demographics were analysed. The level of potentially avoidable inpatient nights in those receiving OAT in hospital was calculated and the potential cost savings quantified. Potential avoidable bed nights were defined as patients remaining in hospital for the purpose of optimizing OAT dosage, while receiving subtherapeutic or therapeutic OAT (being titred up to therapeutic levels and co-administered covering low molecular weight heparin, and requiring no other active care. The average cost of €638 was taken as the per night hospital stay cost for a non-Intensive Care bed. Ethical approval was granted from the Ethical Committee of the Cork Teaching Hospitals, Cork, Ireland. Results A total of 158 patients were included in the audit. There was 94 men (59.4% and 64 women (40.6%. The mean age was 67.8 years, with a median age of 70 years. Atrial Fibrillation (43%, n = 70, followed by aortic valve replacement (15%, n = 23 and pulmonary emboli (11%, n = 18 were the commonest reasons for prescribing OAT. 54% had previously been prescribed
Sheyla R. C. Furtado
Full Text Available Background: Environmental factors are essential for the characterization of human functioning and disability; however, the shortage of standardized instruments to assess environmental factors has limited the design of scientific investigations directed at identifying barriers to and facilitators of social participation of people with disabilities. Objectives : To translate to Brazilian Portuguese, cross-culturally adapt, and verify the reliability of an environmental assessment questionnaire, entitled Craig Hospital Inventory of Environmental Factors (CHIEF. Method : The questionnaire was translated to Portuguese, analyzed, translated back to English, and compared with the original version. The final version (CHIEF-BR was submitted to 47 caregivers of children and adolescents with cerebral palsy (CP. The intra-rater reliability was tested using quadratic kappa and intraclass correlation coefficients (ICC, through interviews of 23 caregivers drawn from the total sample, on two occasions 10 days apart. Results : During submission of the questionnaires, it was observed that examples were needed in order to facilitate the understanding of the questions related to the politics sub-scale. Quadratic kappa showed that test-retest reliability of each question varied from 0.28 to 1.0 for the frequency score and from 0.30 to 0.98 for the magnitude score. Intraclass correlation coefficients for total scores showed high consistency indices (ICC≥0.92 for test-retest. Conclusion : The Brazilian version of the CHIEF was reproducible and applicable to the study sample. It may serve as an instrument to characterize the environmental barriers as well as a way to document the effects of interventions aimed at minimizing the impact of such barriers on the participation of children and adolescents with CP.
Moloney, E; Smith, D.; Bennett, K.; O'Riordan, D; Silke, B.
Objective: To find out if there was a difference between hospital consultants, all trained in acute general medicine, in length of stay (LOS), re-admission rates, resource utilisation, and diagnostic coding, among patients admitted as emergencies to St James' Hospital (SJH) Dublin.
Maria Auxiliadora Parreiras Martins
Full Text Available
Unfractionated heparin (UFH and low-molecularweight heparins (LMWHs are widely used in curative and preventive treatments of thromboembolic disorders. The aim of the study was to investigate factors associated with the choice of these types of heparin to treat patients with unstable angina under real conditions of hospital use. A cross-sectional study was performed in a private general hospital in Belo Horizonte, Brazil, from January 1st to December 31th, 2001. Data were collected from the hospital electronic database. Inpatients with angina who received enoxaparin or UFH were included in the survey. Data for 555 patients were recorded, including 401 treated with enoxaparin and 154 with UFH. Univariate analysis showed that male and elderly people predominated in both groups, with no statistical difference in the proportions (p>0.05. Multivariate analysis showed 4 factors associated with the use of enoxaparin: cardiac revascularization surgery (OR=0.434, arrhythmias (OR=9.343, risk factors for coronary artery disease (OR=1.333 and private health insurance (OR=0.297. Thus, clinical and organizational factors were associated with the type of heparin used by patients with unstable angina at this hospital. Further drug utilization studies are necessary to expand and improve the data available on the use of heparins in the hospital setting. Keywords: Hospital pharmacy/assessment. Angina pectoris/treatment. Heparin/prescription. Enoxaparin/prescription. RESUMO Fatores associados com os tipos de heparina usados no tratamento da angina instável em um hospital brasileiro A heparina não-fracionada (HNF e heparinas de baixo peso molecular (HBPM são amplamente utilizadas em tratamentos curativos e preventivos de tromboembolismo. O objetivo do estudo foi investigar os fatores associados com a escolha desses tipos de heparinas para tratar pacientes com angina instável sob as condições reais de uso hospitalar. Trata-se de um estudo
Breast cancer incidence is increasing. The survival rate varies and is longer in high-income countries. In Brazil, lower-income populations rely on the Unified Public Health System (Sistema Único de Saude, SUS) for breast cancer care. The goal of our study is to evaluate the survival of patients with operable breast cancer stages I-III at a Brazilian public hospital that treats mostly patients from the SUS. A cohort study of patients who underwent surgery for breast cancer treatment at the Clinical Hospital of the Federal University of Minas Gerais from 2001 to 2008 was performed, with a population of 897 cases. Information on tumor pathology and staging, as well as patients’ age and type of health coverage (SUS or private system) was collected. A probabilistic record linkage was performed with the database of the Mortality Information System to identify patients who died by December 31th, 2011. The basic cause of death was retrieved, and breast cancer-specific survival rates were estimated with the Kaplan-Meier method. The Cox proportional hazards model was used for univariate and multivariate analysis of factors related to survival. A total of 282 deaths occurred during the study’s period, 228 of them due to breast cancer. Five-year breast cancer-specific survival rates were 95.5% for stage I, 85.1% for stage II and 62.1% for stage III disease. Patients from the SUS had higher stages at diagnosis (42% was in stage III, and from the private system only 17.6% was in this stage), and in the univariate but not multivariate analysis, being treated by the SUS was associated with shorter survival (hazard ratio, HR = 2.22, 95% CI 1.24-3.98). In the multivariate analysis, larger tumor size, higher histologic grade, higher number of positive nodes and age older than 70 years were associated with a shorter breast cancer-specific survival. Five-year breast cancer survival was comparable to other Brazilian cohorts. Patients treated by the SUS, rather than by the private
Adriane Lenhard-Vidal; Rosilene Fressatti Cardoso; Rubia Andreia Falleiros de Pádua; Vera Lúcia Dias Siqueira
The production of extended-spectrum beta-lactamases (ESBL) is considered one of the most important resistance mechanisms that impair antimicrobial treatment of infections caused by Enterobacteriaceae. Data on culture and susceptibility tests were collected from the Clinical Analyses and Research Laboratory charts reporting on patients admitted to the University Hospital of Maringá (HUM) from January 2004 to December 2009. The following Enterobacteriaceae were selected: Escherichia coli, Klebs...
Pieri, Fabio A; Vargas, Taise F; Galvão, Newton N; Nogueira, Paulo A; Orlandi, Patrícia P
The aim of this study was to characterize and compare Staphylococcus spp. isolated from hospitalized patients and beef marketed in the city of Porto Velho-RO, Brazil. The isolates were subjected to antibiogram tests, adherence capacity tests, detection of the mecA gene, and epidemiological investigation by the random amplified polymorphic DNA (RAPD) technique, using the primers M13 and H12. Among the 123 Staphylococcus spp. isolates, 50 were identified as S. aureus and 73 as coagulase-negative Staphylococcus; among the latter, 7 species were identified. It was observed that the coagulase-negative Staphylococcus isolates showed greater adhesion ability than S. aureus. The profile of antimicrobial susceptibility was different among isolates, all of which were susceptible to vancomycin and linezolid, and had high penicillin resistance rates, varying according to the bacterial class and the source. In this study, all strains were negative for mecA gene detection; however, 36% of S. aureus and 17% of coagulase-negative Staphylococcus were resistant to oxacillin. The genetic relationship of these bacteria, analyzed by RAPD, was able to discriminate the species of coagulase-negative Staphylococcus strains of S. aureus along its origin. It was concluded that the isolates of Staphylococcus spp. derived from beef and human infections differ genetically. Thus, it is suggested that isolates from beef, which were grouped within hospital isolates, were probably carried via contact with beef in hospital professionals or patients. PMID:26824600
Tisha A. M. Harper
Full Text Available Background: Airborne microorganisms within the hospital environment can potentially cause infection in susceptible patients. The objectives of this study were to identify, quantify, and determine the nosocomial potential of common airborne microorganisms present within a small animal teaching hospital. Methods: Bioaerosol sampling was done initially in all 11 rooms and, subsequently, weekly samples were taken from selected rooms over a 9-week period. Samples were collected twice (morning and afternoon at each site on each sampling day. The rooms were divided into two groups: Group 1, in which morning sampling was post-cleaning and afternoon sampling was during activity, and Group 2, in which morning sampling was pre-cleaning and afternoon sampling was post-cleaning. The total aerobic bacterial plate counts per m3 and bacterial identification were done using standard microbiological methods. Results: A total of 14 bacterial genera were isolated with the most frequent being Micrococcus spp. followed by species of Corynebacterium, Bacillus, and Staphylococcus. There was a significant interaction between location and time for rooms in Group 1 (p=0.0028 but not in Group 2 (p>0.05. Microbial counts for rooms in Group 2 were significantly greater in the mornings than in the afternoon (p=0.0049. The microbial counts were also significantly different between some rooms (p=0.0333. Conclusion: The detection of significantly higher airborne microbial loads in different rooms at different times of the day suggests that the probability of acquiring nosocomial infections is higher at these times and locations.
Hana A. Qhalib
Full Text Available Objectives: This study aimed to describe the pattern of hepatobiliary complications among patients with sickle cell disease (SCD and to assess their correlation with age, gender and other risk factors. Methods: This cross-sectional study assessed 106 patients with SCD who were admitted to Al Wahda Teaching Hospital in Aden, Yemen, between January and June 2009. A full history, thorough examination, essential laboratory investigations (including a complete blood count, liver function test and viral markers test and an abdominal ultrasound were performed on all patients. The clinicopathological characteristics of the hepatobiliary complications were analysed for their correlation to different risk factors such as age and gender. Results: It was found that 46.2% of the patients with SCD had hepatobiliary complications. Of these, 36.7% had viral hepatitis, 26.0% had cholecystitis and 20% had gallstones. A total of 60.4% of the affected patients were male. The mean levels of alanine aminotransferase (59.4 and 56.0 U/L and aspartate transaminase (40.1 and 38.3 U/L were significantly elevated in patients with viral hepatitis and cholecystitis, respectively. Hepatitis B virus surface antigen showed higher positivity (10.4% than anti-hepatitis A and anti-hepatitis C antibodies. Hepatobiliary complications increased significantly with age and were notably higher among those who were often admitted to hospital and/or underwent frequent blood transfusions. Conclusion: This study suggests that hepatobiliary complications are common among SCD patients and the likelihood of developing such complications increases as patients age. Thus, regular clinical follow-ups, abdominal ultrasound studies and periodic liver function tests, as well as serological tests for viral hepatitis, are strongly recommended. These can help in the early detection of these complications and allow opportunities for their management and prevention.
Celine TM, Jimmy Antony
Full Text Available Background and objective: cardiovascular diseases are increased in each year in India. Cardiovascular diseases more are occurred in the economically productive age group. This will affect their family and also the nation. Aim of the study is to find out the different types of heart diseases and the case fatality rate of cardiovascular disease from 1st April 2005 to 31st March 2010 in a teaching hospital. Materials and Methods: The retrospective study conducted on hospitalized patients admitted with cardiovascular diseases from 1st April 2005 to 31st March 2010. Medical records department follows the guide lines of International Classification of Diseases (ICD-10 coding for entering the data, from that data were collected. Results: Of 10427 cases, 6324 (60.65% were males and 4103(39.35% females. Cardiovascular disease was more among males than females. It was more occurred in ≥60 years. Most of them were occurred due to cerebrovascular disease (33.7%. Ischemic heart disease was more among males than females. Total number of deaths due to cardiovascular disease was 797. Of them 525(65.87% were males and 272(34.13% females. Case fatality due to cardiovascular diseases was 7.64%. Case fatality among males (8.3% were more than females (6.63% (P=0.00. Conclusion: This study mentioned that most of the cases and deaths were occurred in 60 and above years. Second leading age group is 25-59 years. Accident in economically productive people was high. It will affect their family and also the nation. Hence it can be reduced by conducting health awareness programme.
Full Text Available Nosocomial infections (NI result in considerably high mortality and morbidity rates, especially among pediatric patients. Considering current worldwide changes, information about the occurrence of pathogens and susceptibility tests are now seen as decisive for optimizing treatment. The purpose of this research was to determine the frequency of microorganisms, antimicrobial and genetic profiles, and risk factors associated with nosocomial infections in a teaching hospital in Campo Grande, Mato Grosso do Sul. From January 1998 to December 1999, 108 patients were characterized as having nosocomial infection, from which 137 pathogens were isolated. Identification and antimicrobial susceptibility was determined by conventional and automated techniques. Staphylococcus aureus and Klebsiella pneumoniae strains were characterized by Pulsed Field Gel Electrophoresis (PFGE. Pathogens were most often isolated from infants one-month old or younger, and bloodstream infections were the most frequent. The main isolated agents isolated were: coagulase-negative staphylococci (38, Pseudomonas aeruginosa (19, S. aureus (26, K. pneumoniae (18, and Candida spp. (13. The risk conditions that were most closely related to NI acquisition were: prolonged hospital stays (69.4%, prematurity (60.9% and exposure to high-risk device procedures (95.4%. Ciprofloxacin and imipenem were the most effective drugs, inhibiting all or almost all of the Enterobacteriaceae, P. aeruginosa and Acinetobacter calcoaceticus isolates. Only 23% of the S. aureus samples were resistant to oxacillin. Genomic typing revealed 10 distinct patterns for S. aureus and 13 for K. pneumoniae, suggesting that most them did not belong to the same clone. PFGE was effective in differentiating the strains.
Full Text Available Background It is believed that healthcare staff play an important role in minimizing complications related to urethral catheterization. The purpose of this study was to determine whether or not healthcare staff complied with the standards for urethral catheterization. Methods This study was conducted in Imam Reza teaching hospital, Tabriz, Iran, from July to September 2013. A total of 109 catheterized patients were selected randomly from surgical and medical wards and intensive care units (ICUs. A questionnaire was completed by healthcare staff for each patient to assess quality of care provided for catheter insertion, while catheter in situ, draining and changing catheter bags. Items of the questionnaire were obtained from guidelines for the prevention of infection. Data analysis was performed with SPSS 16. Results The mean age of the patients was 50.54 ± 22.13. Of the 109 patients, 56.88% were admitted to ICUs. The mean duration of catheter use was 15.86 days. Among the 25 patients who had a urinalysis test documented in their hospital records, 11 were positive for urinary tract infection (UTI. The lowest rate of hand-washing was reported before bag drainage (49.52%. The closed drainage catheter system was not available at all. Among the cases who had a daily genital area cleansing, in 27.63% cases, the patients or their family members performed the washing. In 66.35% of cases, multiple-use lubricant gel was applied; single-use gel was not available. The rate of documentation for bag change was 79%. Conclusion The majority of the guideline statements was adhered to; however, some essential issues, such as hand hygiene were neglected. And some patients were catheterized routinely without proper indication. Limiting catheter use to mandatory situations and encouraging compliance with guidelines are recommended.
Objective: To study the mortality and morbidity of unsafe abortion in a University Teaching Hospital. Methods: A cross-sectional, descriptive study was conducted in Department of Obstetrics and Gynaecology, Unit III, Dow Medical College and Civil Hospital Karachi from January 2005 to December 2009. Data regarding the socio demographic characteristics, reasons and methods of abortion, nature of provider, complications and treatment were collected for 43 women, who were admitted with complications of unsafe abortion, and an analysis was done. Results: The frequency of unsafe abortion was 1.35% and the case fatality rate was 34.9%. Most of the women belonged to a very poor socioeconomic group (22/43; 51.2%) and were illiterate (27/43; 62.8%). Unsafe abortion followed an induced abortion in 29 women and other miscarriages in 14 women. The majority of women who had an induced abortion were married (19/29, 65.5%). A completed family was the main reason for induced abortion (14/29; 48.2%) followed by being unmarried (8/29, 27.5%) and domestic violence in 5/29 cases (17.2%). Instruments were the commonest method used for unsafe abortion (26/43;68.4%).The most frequent complication was septicaemia (34; 79%) followed by uterine perforation with or without bowel perforation (13, 30.2%) and haemorrhage (9; 20.9%). Majority of induced abortions were performed by untrained providers (22/26; 84.6%) compared to only 3/14 cases (21.4%) of other miscarriages (p=0.0001). Conclusion: The high maternal mortality and morbidity of unsafe abortion in our study highlights the need for improving contraceptive and safe abortion services in Pakistan. (author)
Full Text Available Background: Trauma to the face often causes varying degrees of cosmetic blemish for the patients. This can affect the psychological and social constitutions of such patients. Aim: The study investigated the pattern of post trauma anxiety and depression disturbance among patients in the maxillofacial unit of the University of Uyo Teaching Hospital, Nigeria. Methods: A 12-month prospective study of post trauma psychological disorders among patients who had accidental facial trauma is presented. The study was conducted on 121 patients (males and females attending the outpatient clinic. The Hospital Anxiety and Depression Scale (HADS, a self-assessment questionnaire was used for the study. Result: A total of 121 patients were studied. There were 75 males and 46 females, giving a male to female ratio of 1.6:1. The age range varied between 18 and 77 years and the mean age was 38.36+14.86 years. Eighty- five (70% of the patients showed no features of depression. Twenty-four (20% had probable depression. Eighty-six (71% patients scored 7 points or less on the anxiety subscale of the HADS, denoting absence of anxiety, while 25 (21% scored more than 11 points which connotes probable anxiety. More females had probable anxiety and depression profiles than males, and this relationship was statistically significant (p = 0.003. Probable depression and anxiety were higher among the singles and the employed, showing that depression and anxiety were significantly influenced by employment status (P = 0.001. Conclusion: Facial trauma produces psychological complaints with female gender, marital status, and employment being the risk factors.
John Owoade Agboola
Full Text Available Background: Abdominal pain of sudden onset is the hallmark of most non-traumatic emergency surgical presentations. This presents a scenario of urgency to the young surgeon who has to determine which of a myriad of disease conditions the patient is presenting with. Such a physician has to rely on experience and a sound knowledge of the local aetiological spectrum in making a clinical diagnosis. Objective: To determine the epidemiology and aetiological spectrum of diseases presenting as acute abdomen in the adult population at the hospital surgical emergency unit. Patients and Methods: Two hundred and seventy-six patients presenting at the University of Ilorin Teaching Hospital emergency unit and managed by the general surgeons between 1 st of May 2009 and 30 th of April 2010 were recruited and followed-up throughout the period of admission. The biodata and clinical information inclusive of diagnosis, investigations, treatment modality and outcome were entered in a structured questioner. Standardised treatment was given to all patients and difficulties encountered in their management were also noted. The data collected was evaluated using SPSS16. Results: Acute abdomen constituted 9.6% of total surgical emergency admissions with patients aged 16-45 years constituting 78.3%. The commonest cause of acute abdomen was appendicitis (30.3% followed by intestinal obstruction (27.9%, perforated typhoid ileitis 14.9% and peptic ulcer disease (7.6%, respectively. Conclusion: The result from the study is similar to what has been reported in other tropical settings with inflammatory lesions being the major problem. There is also a rising incidence of post-operative adhesions and gradual decline in incidence of obstructed hernia.
Full Text Available Purpose: To conduct cost-effectiveness analysis of anti-diabetic therapy in a University Teaching Hospital in 2010. Methods: A retrospective review of selected case-notes was conducted. World Health Organization Defined Daily Dose Method of evaluating drug use and probability method for potential effectiveness of antidiabetic therapeutic options from literature analysis was employed in determining cost-effectiveness of each anti-diabetic therapeutic option identified from anti-diabetic drug utilization studies. Sample Size, n=1200. Subjects’ case-notes were selected by systematic random sampling (Sampling Interval = 1. Results: Glibenclamide (N1.76/unit of effectiveness which was more cost-effective than chlopropamide (N2.97/unit of effectiveness in the management of moderate hyperglycemia in non-obese Type II Diabetes Mellitus was more frequently prescribed (81.5%. Glibenclamide + Metformin (N7.63/unit of effectiveness which was more frequently prescribed (92.5% was not necessarily more cost-effective than Chlopropamide + Metformin (N9.76/unit of effectiveness in the management of moderate hyperglycemia in obese Type II Diabetes- Mellitus. Biphasic Isophane Insulin (N12.65/unit of effectiveness which was more cost-effective than soluble insulin + insulin zinc (N30.37/unit of effectiveness in the management of serve hyperglycemia in non-obese Type II Diabetes Mellitus was less frequently prescribed (42.3%. Biphasic Isophane Insulin + Metformin (N15.91/unit of effectiveness which was more cost-effective than soluble insulin + insulin zinc + metformin (N34.45/ unit of effectiveness in the management of severe hyperglycemia in obese Type II Diabetes Mellitus patients was less frequently prescribed (25%. Conclusions: Prescription of lees cost-effective anti-diabetic drugs was rampant in Hospitals.
Micaela La Regina
Full Text Available What is the future of internal medicine in Italy? Which competencies? Which potentialities? To this aim Ligurian FADOI Regional Society performed a census among 18 Internal Medicine Wards (IMWs in non-teaching Ligurian Hospital. We administered, by email, a questionnaire to the heads of IMWs. Data about staffing, equipment, skills, competencies and productivity during 2011 were collected from 1st to 31st November 2012. A total of 15/18 (83.3% chiefs answered to the questionnaire. The number of beds was largely variable among the wards. In 2011, mean diagnosis-related group (DRG-weight was 1.09 (range 0.91-1.6 and that revenues/costs ratio much higher than 1.5. Staff was quite adequate to standards defined by current law, only 33% has got a doctor:patients ratio superior to 1:6.4. However, annual hospitalizations exceed the availability of beds in medicine and the complexity of the patients would require a lower doctor:patients ratio, at least for a group of patients. In fact, 4 wards have a progressive care organization with a defined area for more seriously ill patients. Mean length of stay was 10 days. Expertise was wide, covering almost all medical sub-specialties. Acquired skills such as abdominal, heart and vascular ultrasounds, invasive procedures and their comprehensive knowledge make internists complete and cost-effective specialists. IMWs, as a concentrate of medical knowledge and skills, are the natural destination of current patients with co-morbidities. Staffing and number of beds should be revised according to this new demand. Their revenues/costs ratio resulted favorable and their global approach to patients and not to disease can be useful for resource rationalization. Wider and further studies are needed to improve the awareness of stakeholders about Internal Medicine.
Full Text Available To review the bacteriological features of infectious spondylodiscitis and provide recommendations for the initial therapy which remains empirical in our context. Retrospective study including patients diagnosed with spondylodiscitis over a period of 4 years (2006-2009 at the Rabat Military Teaching Hospital. During the study period, we analysed 30 cases: the mean age was 49.9 years and 21 cases (70% were male. The patients were predominantly hospitalized in neurosurgery department (15/30 followed by rheumatology department (10/30. The site of infection was lumbar in 21 cases (21/30, dorsal in 7 cases (7/30. 26 cultures were positive of which 19 (19/26 were monomicrobial. Tuberculosis (TB was implicated in 10 cases (10/30 including 4 cases in association with common organisms (Propionibacterium acnes, Staphylococcus aureus, Staphylococcus epidermidis, Corynebacterium species. Brucella melitensis was isolated in 1 case. Infections caused by pyogenic bacteria were isolated in 15 cases of which 12 (12/15 revealed simple organisms including Gram-positive cocci in 9 cases (9/12 with 3 cases of S. aureus and Gram-negative bacilli in 3 cases (3/12 with 2 cases of P. aeruginosa. Blood cultures carried out for 16 patients were positive in 7 cases. The anatomopathologic exams carried out for 20 patients found in 6 cases epithelioid granulomata and giants cells with caseous necrosis in total concordance with TB culture. TB is the most frequent cause of spondylodiscitis in Morocco. Our study found the same frequency for non-specific and specific germs. Empirical treatment must take into account S. aureus and M. tuberculosis.
Full Text Available Objective: A prospective medicine usage evaluation based on prescription monitoring was conducted in the medicine OPD of our university teaching hospital to know prescribing trends of different categories of medicines. Materials and Methods: A total of 600 patients were included in the study comprising of 339 (56.5% males and 261 (43.5% females. The data were recorded within the OPD by a registered pharmacist on a medicine usage evaluation form, approved by The University Institutional Review Board (IRB. Results: A total of 2365 medicines were prescribed to 600 patients during the 3 months study period. The mean number of medicines per prescription were found to be 3.94. Medicines were most frequently prescribed as solid dosage forms (85.62%, especially tablets (70.82%, and liquid formulations (14.12%. Oral route (96.17% was the most preferred mode of administration, followed by topical (2.11% and parenteral (1.60% routes. Combination therapy (94.33% was more prevalent than monotherapy (5.66%. An overwhelming tendency for prescribing medicines by brand names (99% was observed by the physicians. The most frequently prescribed class of medicines were antimicrobials > analgesics > cardiovascular > gastrointestinal agents. The most prescribed individual medicines among various therapeutic classes included isoniazid (antimicrobial, amlodipine (cardiovascular, metformin (hypoglycemic, cetirizine (antiallergic, rabeprazole (GI medicine, atorvastatin (hypolipidemic, dextromethorphan (respiratory medicine, alprazolam (sedative-hypnotic, paracetamol (analgesic. Conclusions: There is a considerable scope of improvement in the existing prescribing practice, especially prescribing by generic names, needs to be encouraged and a hospital formulary has to be developed for the purpose. The number of medicines to be included per prescription should be judged rationally and polypharmacy ought to be curbed. Use of antimicrobial also needs to be rationalized as over
Egyir, Beverly; Guardabassi, Luca; Nielsen, Søren Saxmose;
There is a paucity of data on Staphylococcus aureus epidemiology in Africa. Prevalence of nasal carriage and genetic diversity of S. aureus were determined among hospital staff (HS) and inpatients (IP) at the largest hospital in Ghana. In total, 632 nasal swabs were obtained from 452 IP and 180 HS...... and ST72–SCCmec V). Altogether, these data indicate a high diversity of S. aureus, low levels of MRSA carriage, and a higher chance of nasal carriage of multidrug-resistant S. aureus among IP compared with HS in this hospital....... in the Child Health Department (CHD) and Surgical Department (SD). S. aureus carriage prevalences were 13.9% in IP and 23.3% in HS. The chance of being a carrier was higher in HS (P = 0.005) and IP staying ≤7 days in hospital (P = 0.007). Resistance to penicillin (93%), tetracycline (28%) and fusidic acid (12...
Cleusa Maria Andrade Scroferneke
Full Text Available O artigo propõe, a partir da análise comparativa dos resultados da pesquisa realizada junto a Hospitais Universitários Brasileiros e Espanhóis, discutir sobre a relevância das ‘ouvidorias’ virtuais como espaço de interlocução, como lugar de comunicação,tendo o Paradigma da Complexidade (Morin, 2005, 2001 como opção de Método. Os procedimentos metodológicos envolvem levantamento bibliográfico, acompanhamento e análise mensal dos sites/portais dos Hospitais em relação à nomenclatura de ‘ouvidorias’ virtuais, acessibilidade, formas de contato, presença [ou não] de mídias sociais. Trata-se de um recorte de uma pesquisa mais ampla que conta com o apoio do Conselho Nacional de Desenvolvimento Científico e Tecnológico/ CNPq e da Universidade. / Based on the comparative analysis of results of research conducted in Brazilian and Spanish University Hospitals, this article aims to discuss the relevance of online “complaints departments” as a space for dialogue and communication using the paradigm of Complexity (Morin, 2005, 2001 as a method option. The methodological procedures adopted included a literature review, questionnaires, monthly monitoring and analysis of Hospital websites/portals in relation to the nomenclature of online “complaint departments”, accessibility, points of contact, and presence (or not of social media. It forms part of a broader study supported by the National Council of Scientific and Technological Development /CNPq and the University.
Botega, N J; Pereira, W A; Bio, M R; Garcia Júnior, C; Zomignani, M A
The 12-item General Health Questionnaire (GHQ-12) and the revised Clinical Interview Schedule (CIS-R) were used to estimate the prevalence of psychiatric morbidity among 78 consecutive admissions to a general medical ward in a Brazilian university hospital (43 males and 35 females; mean age = 43.2 years). The CIS-R was administered by three 5th-year medical students after a brief training. A prevalence rate of 36% was found for psychiatric disorders. The most frequent symptoms were sleep disorders (48.7%), worry (35.9%), depression (28.2%) and anxiety (26.9%). The sensitivity and specificity of the GHQ-12 were 71% and 76%, respectively. The CIS-R was simple to administer and acceptable both to patients and interviewers. Misunderstanding was most likely to occur with the poorly educated (20% were illiterate) in questions involving time calculation. Alternative options might be used to specify the length of time in future studies. The findings support the feasibility of the CIS-R and the use of 'lay' interviewers to produce epidemiological information on psychiatric disorders in developing countries at lower costs. PMID:7624806
Sabouri Kashani Ahmad
Full Text Available Abstract Background Abdominal surgical site infections are among the most common complications of inpatient admissions and have serious consequences for outcomes and costs. Different risk factors may be involved, including age, sex, nutrition and immunity, prophylactic antibiotics, operation type and duration, type of shaving, and secondary infections. This study aimed to determine the risk factors affecting abdominal surgical site infections and their incidence at Imam Khomeini, a major referral teaching hospital in Iran. Methods Patients (n = 802 who had undergone abdominal surgery were studied and the relationships among variables were analyzed by Student's t and Chi-square tests. The subjects were followed for 30 days and by a 20-item questionnaire. Data were collected through pre- and post-operative examinations and telephone follow-ups. Results Of the 802 patients, 139 suffered from SSI (17.4%. In 40.8% of the cases, the wound was dirty infected. The average age for the patients was 46.7 years. The operations were elective in 75.7% of the cases and 24.7% were urgent. The average duration of the operation was 2.24 hours, the average duration of pre-operative hospital stay 4.31 days and the average length of (pre- and post-operation hospital stay 11.2 days. Three quarters of the cases were shaved 12 hours before the operation. The increased operation time, increased bed stay, electivity of the operation, septicity of the wound, type of incision, the administration of prophylactic antibiotic, type of operation, background disease, and the increased time lapse between shaving and operation all significantly associated with SSI with a p-value less than 0.001. Conclusion In view of the high rate of SSI reported here (17.4% compared with the 14% quoted in literature, this study suggests that by reducing the average operation time to less than 2 hours, the average preoperative stay to 4 days and the overall stay to less than 11 days, and
Merlita C. Medallon
Full Text Available Assessment in the classroom is done to determine the effectiveness of the lesson delivery and the extent of learning acquired by the students. The study identified the determinants of teaching effectiveness and learning acquisition of students enrolled in selected major courses in the International Hospitality Management Program. Utilizing a descriptive-evaluative design, data were collected from 210 students enrolled in courses of the International Tourism and Hospitality Management Program. Findings show that the level of interest of the students is a great consideration in increasing their level of learning acquisition. The significant determinants of teaching effectiveness are number of absences and the level of interest of the students. The significant determinant of learning acquisition is the level of interest of the students.
A N Jamali
Full Text Available Objective : The present study was conducted to monitor adverse drug reactions in patients of bronchial asthma in outpatient department and inpatient department of a university teaching hospital in South Delhi. Materials and Methods : About 200 patients irrespective of age and sex with established asthma were interviewed during the time period of January 2006 to April 2006 using structured questionnaire. Naranjo′s adverse drug reaction probability scale was used to assess the adverse drug reactions. Results : A total of 15 adverse drug reactions were reported in 13 out of 200 asthmatic patients. Among the 13 patients reported with adverse drug reactions, 5 (38.5% were male and 8 (61.5% patients were female. Maximum percentage of ADRs (2 in 15 prescriptions, 13.3% observed with montelukast, followed by beclomethasone (1 in 12 prescriptions, 8.3%, salbutamol (6 in 109 prescriptions, 5.5%, and ipratropium (3 in 63 prescriptions, 4.8%. Conclusions : Montelukast was found to be associated with greater percentage of adverse drug reactions as compared to other antiasthamatics. The above findings are constrained by a small sample size and need to be corroborated by conducting long-term studies using a larger sample size.
All the 33 male doctors and para-medical staff employed in the radiology departments of two teaching hospitals have been studied for their fertility status. Their mean age was 32.5 years and they had been doing radiological work for 8.6 years on an average. Out of the 33 males, all of whom were married, one had primary infertility with severe oligospermia. He was successfully treated with oral vitamin A and E along with a 3-month off from handling x-ray machines; the child born was healthy and normal. Another 5 subjects had been married for only less than two years and their seminograms were essentially normal. They were classified as 'Unproven fertility'. The remaining 27 persons had fathered 61 children-16 born before the father had started working in radiology and 45 conceived later. There was 1 case of still-birth and 1 of microcephaly. However, the overall incidence of infertility and congenital defects was not significantly different than in the general population. (author)
The practices related to patient radiation protection are poorly documented in sub- Saharan Africa because of the lack and/or weak enforcement of the related legislative and regulatory frameworks. This study investigates the justification and optimization of pediatric CT scans in two university teaching hospitals in Yaounde in Cameroon. 171 CT scans in pediatric patients below 15 years of age performed during one trimester were surveyed. The data collection form was adapted from a dosimetric assessment sheet from the French Institut de radioprotection et de surete nucleaire. The guidelines were those of the Societe francaise de radiologie and the Societe francophone d'imagerie pediatrique et prenatale. Each CT scan was assessed and the CT dose index and dose length product were compared with the Diagnostic Reference Levels (DRLs) of the above-mentioned guidelines. While all the CT exams were justified, protocols were not readily available and varied amongst teams and units. The tension conformed in 87.7% of cases and 15.2% of DLPs were higher than the DRL for thoracic and abdominal CT scans performed under helical mode and brain CT scans performed sequentially. Readily available optimal CT protocols for children are urgent to improve upon the pediatric CT practices in these two units with a high turn-over rate of technologists and radiology residents. (authors)
Saiba Eugène Semanyenzi
Full Text Available The aim of this study was to assess the pattern of normal ocular bacterial flora isolated from patients attending the Department of ophthalmology at the Kigali University Teaching Hospital and to evaluate their in vitro susceptibility to common antimicrobial agents. From June to October 2011, collection of specimen was performed by rotating a sterile cotton swab on the lower conjunctival sac from the temporal to the medial fornix. Gram stain and culture was performed and antibiotic sensitivity determined in case of bacterial growth. Of the 120 collected samples, 74 (61.6% showed bacterial growth and all were gram positive. 48.6% were Staphylococcus aureus , while 51.4% were Staphylococcus epidermidis . There was high sensitivity of Staphylococcus aureus to chloramphenicol (100%, clindamycine (92%, oxacilline (86.7%, ciprofloxacine (76.7% and norfloxacine (71.9%. However, there was a high resistance of Staphylococcus aureus to penicilline G (11.1% and tetracycline (52.8%. Staphylococcus epidermidis was highly sensitive to chloramphenicol (71.9% and oxacilline (71.1% while it was resistant to erythromycine (28.6%, norfloxacine (35.3% and penicilline G (40.6%. In this study, all of the isolated pathogens were revealed to be gram-positive bacteria. Chloramphenicol, clindamycine and oxacilline showed good activity against normal flora of the ocular surface and should be used in prevention of post-operative end ophtalmitis.
Full Text Available Background: Increasing antimicrobial resistance is now a critical point of human being in the world. Especially wide spectrum antibiotics resistance germs like vancomycin-resistant enterococci (VRE should be dealt as soon as possible as an emergency conflict. Our study tries to reveal the amount of irrational use of vancomycin in a teaching hospital in Iran.Methods: We elected the whole inpatients that received vancomycin between February 2007 and May 2008.Results: Forty four out of those 45 patients had inappropriate indication and dosing regimen of vancomycin (97.7%. The most use of vancomycin was recorded in hematology – oncology ward and then Intensive Care Unit (ICU. Culture responses were negative despite great clinical evidence of infection.Conclusion: Vancomycin irrational use was high compared to other countries and it could be concerned as a major health problem by health policy makers and physicians to deal. However more detailed researches are needed to reveal the other aspects of this problem. Implementation of antibiotic protocols and standard treatment guidelines are recommended.
Ferreira, Carolina Justus Buhrer; Plodek, Caroline Koga; Soares, Franciny Kossemba; de Andrade, Rayza Assis; Teleginski, Fernanda; da Rocha, Maria Dagmar
Abstract Objective: to analyze the impact of guidelines regarding errors in medications prescribed for administration through enteral tubes. Method: quantitative study, in three phases, undertaken in internal medicine, neurology and an intensive care unit in a general teaching hospital. In Phase 1, the following was undertaken: a protocol for dilution and unit-dose repackaging and administration for 294 medications via enteral tubes; a decision flowchart; operational-standard procedures for dilution and unit-dose repackaging of oral pharmaceutical forms and for administration of medications through enteral tubes. In phase 2, errors in 872 medications prescribed through enteral tubes, in 293 prescriptions for patients receiving inpatient treatment between March and June, were investigated. This was followed by training of the teams in relation to the guidelines established. In Phase 3, pharmaceutical errors and interventions in 945 medications prescribed through enteral tubes, in 292 prescriptions of patients receiving inpatient treatment between August and September, were investigated prospectively. The data collected, in a structured questionnaire, were compiled in the Microsoft Office Excel(r) program, and frequencies were calculated. Results: 786 errors were observed, 63.9% (502) in Phase 2, and 36.1% (284) in Phase 3. In Phase 3, a reduction was ascertained in the frequency of prescription of medications delivered via enteral tubes, medications which were contraindicated, and those for which information was not available. Conclusion: guidelines and pharmaceutical interventions were determined in the prevention of errors involving medications delivered through enteral tubes. PMID:27276019
Aim: To assess the precision of radiation dose delivery to Radiotherapy cancer patients at the Lagos University Teaching Hospital (LUTH), Nigeria. Method and materials: Entrance doses for breast, cervical, prostate and head and neck cancer patients were determined using in-vivo thermo-luminescent dosimetry (TLD) technique. Total number of patients admitted for this study is 30. The TLDs were divided into four groups; breast (10), cervical (10), head and neck (5) and prostate (5). Two TLD chips were placed on each patient to obtain the average value. The patients were treated under normal conditions with TLD detectors placed at suitable points in the beam on the patient's skin, under a dose build-up material. The ELEKTA clinical linear accelerator (LINAC) available at the LINAC Center of our Radiotherapy Department served as the source of the 6 MV photon beam. Results: The results showed that 27 of 30 patients admitted were within ±5% of the recommended international limit. Prostate and cervical patients had doses within the range of the limit. Two of the breast patients were −5.05% and −5.88%. The maximum value of −6.01% was recorded in one of the head and neck treatments. Conclusions: This study was part of efforts to optimize patient dose in our radiotherapy center. It has given us a preliminary description of the current practice of radiotherapy in this institution. The values obtained show no major differences from similar studies reported in the literature
To determine the infection control practices of Anaesthesiologist in the teaching hospitals of Pakistan. Cross-sectional survey. The survey was closed after allowing 6 months for return of the replies. A questionnaire was distributed to 170 consultant anaesthesiologist randomly selected from all over Pakistan. Out of these, 90 (53%) were returned and analyzed. To reduce self-report bias, the forms were filled anonymously. Thirty four percent of the respondents always used masks, and only 9% used gloves in their every day practice. Only 18% of respondents stated that they always washed their hands after every patient contact and 54% reported that they always used aseptic technique for placing an indwelling cannula. Most respondents had a good knowledge of universal precautions for prevention of occupational transmission of infection. Five percent of the anaesthetists reported frequently or always reusing syringes for more than one patient. The practice of reusing syringes was significantly greater when the same consultants were anaesthetizing patients in private clinics rather than in their primary institutions (p 5, in 58% of cases. Whereas most responding anaesthesiologist exhibit appropriate infection control behaviour, there are several potentially hazardous practices that continue unabated. (author)
Objective: To study the characteristics of smokers and their knowledge about smoking, among Family Practice Patients, at a teaching hospital in Karachi, Pakistan. Main outcome measures: Age at starting smoking, duration and number of cigarettes smoked, started smoking under influence of friends, colleagues, family members or self motivation, number of friends and colleagues who smoked, whether smoking is unhealthy, and actual chance of harm to an individual due to smoking is very rare or not. Results: One hundred patients who visited Family Practice Center were interviewed. Sixty one percent were young married men, well educated and either student, in private service, self employed or unemployed. Eighty-four (84%) smokers started smoking between 16-25 years of age, and smoked 6-20 cigarettes daily for two to twenty five years. Sixty-nine (69%) of them started smoking under the influence of friends and had 3-5 friends and colleagues who smoked. 91% of smokers believed that smoking is unhealthy and were aware that it causes lung cancer and heart disease. Majority of them (69%) believed that the actual harm of smoking to an individual is not very rare. Conclusion: We have documented the characteristics of smokers and their knowledge about smoking among Family Practice patients. Majority of the respondents started smoking at a young age under the influence of friends though they were aware of its harmful effects. Though the sample size is small but it does give an indication about the responsible factors to plan interventional preventive strategies. (author)
Vishal R Tandon
Full Text Available Background & objectives: Drug-induced diseases (DIDs are well known but least studied. Data on DIDs from India are not available. Hence, this retrospective cross-sectional study was undertaken using suspected adverse drug reaction (ADR data collected form Pharmacovigilance Programme of India (PvPI to evaluate profile of DIDs over two years, in a tertiary care teaching hospital from north India. Methods: The suspected ADRs in the form of DID were evaluated for drug and disease related variables and were classified in terms of causality. Results: DID rate was 38.80 per cent. Mean duration of developing DIDs was 26.05 ± 9.6 days; 25.16 per cent had more than one co-morbid condition. Geriatric population (53.99% accounted for maximum DIDs followed by adult (37.79% and paediatric (8.21%. Maximum events were probable (93.98% followed by possible (6.04%. All DIDs required intervention. Gastritis (7.43%, diarrhoea (5.92%, anaemia (4.79%, hypotension (2.77%, hepatic dysfunction (2.69%, hypertension (1.51%, myalgia (1.05%, and renal dysfunction (1.01% were some of the DIDs. Anti-tubercular treatment (ATT, anti- retroviral treatment (ART, ceftriaxone injection, steroids, non-steroidal anti-inflammatory drugs, antimicrobials and anticancer drugs were found as commonly offending drugs. Interpretation & conclusions: Our findings show that DIDs are a significant health problem in our country, which need more attention.
Chen, Zhilong; Niu, Hui; Chen, Guangyu; Li, Mingcheng; Li, Ming; Zhou, Yuqing
This study was to explore the molecular dissemination of P. aeruginosa producing extended spectrum β-lactamase (ESBLs) recovered from the different wards in a teaching hospital, Jilin. Among 240 isolates, 91 strains were isolated from burn wards and 149 strains from surgical wards. A total of 210 strains (87.5%) produced ESBLs, 30 strains (12.5%) didn’t produce ESBLs. All ESBLs isolates showed identical antimicrobial susceptibility profiles. The genotypic prevalence of ESBLs for bla SHV-12, bla TEM-24, bla CTX-M-1, bla CTX-M-2, bla CTX-M-3, bla PER and bla VEB genes was 17.6%, 20.5%, 14.3%, 9.6%, 12.9%, 13.8% and 11.4% respectively. All P. aeruginosa strains producing ESBLs had three to six plasmids and contained class 1 integrons, which transferred resistance to E. coli C 600 by conjuation. The data indicated a high prevalence of ESBL among P. aeruginosa isolates in this region and their enzyme types were diverse. PMID:26770582
Sangeeta D Patel
Full Text Available Background: Enteric opportunistic parasitic infections are the major source of diarrheal disease in developing countries mainly in Human Immunodeficiency virus (HIV infected patients. Objective: The study was to detect enteric parasites causing diarrhea and their association with immune status in HIV-seropositive patients. Methods: The present study was conducted in tertiary care teaching Hospital, Baroda between January 2006 to January 2007 involving 100 Human Immunodeficiency virus (HIV positive patients. Stool was examined for enteric parasites by microscopy with special staining methods. Results: A total of 100 HIV sero-positive patients with and without diarrhea were included in the study. Of the 100 patients, the protozoan parasitic infection was found in 28% (28/100. Out of 100 patients, 50 had diarrhea in which parasitic infection was 24 (48% and 4 (4/50 protozoal parasites positive cases did not have diarrhea. A significant difference (p<0.05 was observed in the level of infection of intestinal protozoan between the HIV seropositive with diarrhea and HIV-seropositive without diarrhea. Conclusion Enteric opportunistic parasitic infections were detected in 28% among HIV-seropositive patients. Early detection of enteric parasitic infections will help in the management and to improve the quality of life for HIV-infected individuals. [Natl J Med Res 2015; 5(3.000: 190-193
Background: Neonatal seizures (NS) affect approximately 1% of neonates. Clonic, tonic, myoclonic and subtle seizures are the common types. Birth asphyxia, sepsis, metabolic derangements, intracranial bleed, kernicterus, tetanus and 5th day fits are the common aetiologies. This study was planned to evaluate the types and causes of neonatal seizures. Methods: It was a descriptive case series conducted at Ayub Teaching Hospital, Abbottabad from 12th December 2006 to 25th September 2007 on neonates having seizures. Serum chemistry, blood counts, cerebrospinal fluid examination and cranial ultrasound were done in all patients. Blood culture, renal and liver function tests, computerised tomography scan, metabolic and septic screening was done in selected patients. Descriptive statistics were applied for analysis. Results: Tonic clonic seizure was the commonest type (28%) followed by multi-focal clonic, and focal tonic seizures (25% each). Birth asphyxia was found to be the main aetiology (46%). Conclusion: Tonic clonic seizure was the commonest type and birth asphyxia the main aetiology identified in the majority of neonatal seizures. (author)
Sérgio de Andrade Nishioka
Full Text Available A retrospective survey done from 1987 till 1990 revealed that 23 patients bitten by pigs sought medical help at a teaching hospital in Uberlândia, in southeastern Brazil. Most cases (21 were from Uberlândia. The cases were evenly distributed by month and by year; most of them (14/16; 87.5% occurred between 7. OOa.m. and 7.00 p. m. The male to female ratio was 6.7:1. Age ranged from 6 to 73 (mean 38.95 ± SD 22.06, median 36. The bites were more common on the upper limbs, particularly on the forearms. In 11(47.8% cases the injury was described as deep. In most cases where information was available the injury was related to capture, transport or immobilisation ofthe pigfor slaughter. The following medical procedures were performed: local cleansing in 19(82.6% cases, rabies vaccine (12; 52.2%, antirabies serum (2; 8.7%, suturing (6; 26.1% and tetanus vaccine (12; 52.2%. There was no case of infection at the bite site, neither of rabies or tetanus. By our data, the annual incidence of pig bite in Uberlândia can be estimated to be about 1.5/100.000.
Full Text Available Patients usually undergo repeated X-ray examinations after their initial X-ray radiographs are rejected due to poor image quality. This subjects the patients to an excess radiation exposure and extra cost and necessitates the need to investigate the causes of reject. The use of reject analysis as part of the overall quality assurance programs in clinical radiography and radiology services is vital in the evaluation of image quality of a well-established practice. It is shown that, in spite of good quality control maintained by the Radiology Department of a Teaching hospital in Ghana, reject analysis performed on a number of radiographic films developed indicated 14.1% reject rate against 85.9% accepted films. The highest reject rate was 57.1 ± 0.7% which occurs in cervical spine and the lowest was7.7 ± 0.5% for lumbar spine. The major factors contributing to film rejection were found to be over exposure and patient positioning in cervical spine examinations. The most frequent examination was chest X-ray which accounts for about 42.2% of the total examinations. The results show low reject rates by considering the factors for radiographic rejection analysis in relation to both equipment functionality and film development in the facility.
Opara Kingsley O
Full Text Available Abstract Background Albinism is a genetic disorder characterized by lack of skin pigmentation. It has a worldwide distribution but is commoner in areas close to the equator like Nigeria. Skin cancers are a major risk associated with albinism and are thought to be a major cause of death in African albinos. Challenges faced in the care of these patients need to be highlighted in order to develop a holistic management approach with a significant public health impact. The aim of the study was to determine the pattern of skin cancers seen in Albinos, and to highlight problems encountered in their management. Method Case records of albinos managed in Imo state University teaching Hospital from June 2007 to May 2009 were reviewed. The data obtained was analyzed using descriptive statistics. Results and discussion In the period under review, albinos accounted for 67% of patients managed for primary skin cancers. There were twenty patients with thirty eight (38 lesions. Sixty one percent of the patients were below 40 years. Average duration of symptoms at presentation was 26 months. The commonest reason for late presentation was the lack of funds. Squamous cell carcinoma was the commonest histologic variant. Most patients were unable to complete treatment due to lack of funds. Conclusion Albinism appears to be the most important risk factor in the development of skin cancers in our environment. Late presentation and poor rate of completion of treatment due to poverty are major challenges.
Full Text Available Objective: This prospective study examined the frequency of Post-Dural Puncture Headache (PDPH in361 parturient women undergoing spinal anesthesia for cesarean section in a teaching hospital ofTehran University of Medical Sciences.Materials and methods: Spinal anesthesia was performed using 25 gauge Quincke needles in allwomen. Patients were followed up to determine incidence of PDPH and then tried to compare those withor without PDPH using statistical methods to determine risk factors of PDPH.Results: The overall incidence of PDPH was 10.8 percent in this study. In terms of probable risk factorswhich were compared between the two groups of patients, no statistically significant differences werefound.Conclusion: The incidence of PDPH in our study was higher than studies which used pencil - tippedneedles and we determined that the occurrence of PDPH is not associated to some factors like theprevious history of nonspecific headache, Body Mass Index, age, type of local anesthetic, previoushistory of PDPH, experience of operator, history of habitual tea and coffee drinking.
Arvind Kumar Yadav
Full Text Available Objective: To study drug use pattern in patients of primary open angle glaucoma (POAG and to analyze the cost of different anti-glaucoma medications. Materials and Methods: This prospective study was carried in the glaucoma clinic of a tertiary care teaching hospital over a period of 9 months. The data collected for patients with POAG included the patient′s demographic details and the drugs prescribed. Data were analyzed for drug use pattern and cost drugs used. Results: In a total 180 prescriptions (297 drugs analyzed, most drugs (83.83% were prescribed by topical route as eye drops. β blockers (93.88% were found to be the most frequently prescribed for POAG. Timolol (82.22% was the most frequently prescribed drug and timolol with acetazolamide (17.22% was the most commonly prescribed drug combination. Fixed dose combinations constituted 26.66% of prescriptions. β blockers were found to be cheaper than other anti-glaucoma drugs while prostaglandins analogs were the costliest. Instructions about the route, frequency and duration of treatment were present in all prescriptions. However, instructions regarding instillation of eye drops were missing in all prescriptions.
Berenice das Dores Gonçalves
Full Text Available OBJETIVO: Descrever o monitoramento epidemiológico da exposição à tuberculose realizado em ambiente hospitalar e analisar o perfil da doença em um hospital geral universitário. MÉTODOS: Estudo descritivo e retrospectivo dos casos diagnosticados de tuberculose no período entre 2000 e 2006, com a determinação de indicadores de morbidade e mortalidade, que foram comparados a população geral de pacientes atendidos no hospital e com o total de funcionários do hospital que desenvolveram tuberculose ativa. RESULTADOS: Foram atendidos 763 pacientes com tuberculose ativa (média, 109 pacientes/ano, sendo 481 (63,1% do sexo masculino. A faixa etária mais atingida foi a de 30 a 59 anos. As formas clínicas pulmonares e extrapulmonares exclusivas foram predominantes. Entretanto, entre os pacientes internados, as formas pulmonares associadas às extrapulmonares e as formas pulmonares não bacilíferas exclusivas foram mais frequentes. A presença de comorbidades foi mais prevalente entre os pacientes internados e entre os que evoluíram para óbito. Apenas 52,8% dos casos atendidos no hospital foram notificados. Os indicadores hospitalares gerais demonstraram maior tempo de internação hospitalar e mortalidade entre os pacientes com tuberculose. CONCLUSÕES: A incidência e prevalência indicam um alto risco de exposição à tuberculose no hospital no período estudado. Os indicadores propostos apresentam um potencial de padronização dos procedimentos de monitoramento da tuberculose hospitalar, e o perfil epidemiológico aqui descrito poderá contribuir para um melhor entendimento da situação da doença no país.OBJECTIVE: To describe the epidemiological monitoring of exposure to tuberculosis in a hospital environment and to analyze the profile of the disease in a general teaching hospital. METHODS: A descriptive and retrospectivestudy of tuberculosis cases diagnosed between 2000 and 2006, with the determination of indicators of morbidity
Fereshteh Farzianpour; Sara Aghababa; Bahram Delgoshaei; Marjan Haghgoo
Problem statement: Today, organizations are willing to achieve quality as a source of competitive advantage. Therefore, their performance evaluation and quality improvement is essential. One of the international models in this field is Baldrige health care model. Approach: The study aimed to evaluate Performance Evaluation a teaching Hospital Affiliated to Tehran University of Medical Sciences Based on Baldrige Excellence Model. Performance was evaluated by two types ...
Chinyere Nnenne Pedro-Egbe; Bassey Fiebai; Elizabeth Akon Awoyesuku
Purpose: To provide the types, frequency and clinical information on common cranial nerve palsies seen at the Eye Clinic at the University of Port Harcourt Teaching Hospital. Materials and Methods: A chart review was performed of patients who presented with cranial nerve palsy at the Eye Clinic over a 3-year period (January 2009-December 2011). Data were collected on age, sex, type of cranial nerve palsy, a history of systemic disease such as diabetes mellitus (DM), hypertension and cereb...
Yii-Ching Lee; Chih-Hsuan Huang; Shao-Jen Weng; Wan-Lin Hsieh; Hsin-Hung Wu
This study uses independent sample test for mean differences and analysis of variance to observe if physicians and nurses with different demographic variables from a regional teaching hospital in Taiwan perceive differently emotional exhaustion in terms of nine questions from the 2014 internal surveyed data based on the Chinese version of safety attitudes questionnaire. The results show that supervisor/manager, job position, age, experience in organization, and experience in position are more...
Suresh B; Sreedhar Babu KV; Arun R; Chandra Mouli P; Jothibai DS
Introduction: Each unit of blood is precious and has to be utilized properly with minimal discards. The aim of this study was to find out the reasons for discarding blood and blood components. Materials and Methods: We retrospectively studied all whole blood and blood components collected during January 2013 to June 2014 at our tertiary care teaching hospital blood bank in South India. Results: Of the 5261 whole blood bags, 298 (5.7%) were discarded. Of these, 146 (49%) were discarded b...
Larsen, Eric R.; Lloyd, James W.
The potential need for several new services within the Veterinary Teaching Hospital (VTH) is unknown. However, based on focus groups and practitioner surveys conducted over the last several years, potential new services were identified: overnight emergency, behavior medicine, equine sports medicine, dentistry, oncology and exotic animal medicine. Michigan State University's College of Veterinary Medicine (MSU-CVM) has recently expanded its equine research, diagnostic and therapy capabilities ...
Using qualitative data on post abortion care services at the Komfo Anokye Teaching Hospital in Kumasi, Ghana, the paper explored evidence of social stigma as a factor in post abortion care. Results from 6 focus group discussions, 10 narratives and observations identified three areas of stigma. The Patients (perspective and experience), the Providers (the medical environment and setting) and the Community (family, relations and peers). Evidence from the focus group discussions, narratives and ...
Elwyn Chomba; Laura Murray; Michele Kautzman; Alan Haworth; Mwaba Kasese-Bota; Chipepo Kankasa; Kaunda Mwansa; Mia Amaya; Don Thea; Katherine Semrau
Objective. To improve care of sexually abused children by establishment of a “One Stop Centre” at the University Teaching Hospital. Methodology. Prior to opening of the One Stop Centre, a management team comprising of clinical departmental heads and a technical group of professionals (health workers, police, psychosocial counselors lawyers and media) were put in place. The team evaluated and identified gaps and weaknesses on the management of sexually abused children prev...
Giri, Purushottam A; Jayant D Deshpande; Deepak B Phalke; Karle, Laximan B.
Background: Blood transfusion is a life-saving measure in various medical and surgical emergencies. Transfusion medicine, apart from being important for the medical treatment of each patient, also has great public health importance. Objectives: The present study was conducted to estimate the prevalence of transfusion transmitted infections in voluntary blood donors at a rural tertiary care teaching hospital in western Maharashtra, India. Materials and Methods: All voluntary donors reporting t...
Akpan-Idiok, Paulina Ackley; Anarado, Agnes Nonye
Introduction Cancer care is devastating to families. This research studied the informal caregivers’ perceptions of burden of caregiving to cancer patients attending University of Calabar Teaching Hospital, Calabar. Methods The research adopted a cross-sectioned descriptive design and 210 caregivers providing care to advanced cancer patients were purposively selected. Data were collected using a researcher developed questionnaire and standardized Zarit Burden Interview scale (ZBIS). Data colle...
Pondei, Kemebradikumo; Fente, Beleudanyo G.; Oladapo, Oluwatoyosi
Background: Wound infections continue to be problematic in clinical practice where empiric treatment of infections is routine. Objectives: A retrospective cross-sectional study to determine the current causative organisms of wound infections and their antibiotic susceptibility patterns in the Niger Delta University Teaching Hospital (NDUTH), Okolobiri, Bayelsa State of Nigeria. Methods: Records of wound swabs collected from 101 patients with high suspicion of wound infection were analysed. Sm...
FARZAD MAHMOUDIAN; SEYED ZIAEDDIN TABEI; PARISA NABEIEI; NEDA MOADAB; MEHRNAZ MARDANI; ZAHRA HOUSHMAND SARVESTANI; ZAHRA GHASEMI
Introduction: Professional ethics is a very important issue for managers who are role models for students and staff. It can also be very effective in organizational activities. The main objective of this research is to describe the result of managers’ self assessment in Shiraz teaching hospitals. Methods: The present research is a cross-sectional study. The statistical society of this research includes all senior, middle and executive managers of Nemazi, Faghihi and Chamran ...
B. N. Macharia; Iddah, M. A.; F. M. Ndiangui; Keter, A.
Problem statement. Suicide is one of the ten leading causes of death in the world, accounting for more than 400,000 deaths annually. The pattern of suicide and the incidence of suicide vary from country to country. Cultural, religious and social values play some role in suicide. Currently, there is no data regarding the incidence of suicide in Kenya. Setting. Moi Teaching and Referral Hospital Mortuary. Study population. A seven-year retrospective study of all the autopsies performed at the M...
Guru Prasad; Kulkarni; Rajasekhar; Rajesh; Raghavendra,; Vinodraj; Advaitha; Nikhilesh
Infections of the ear, nose and throat (E.N.T) are common clinical problems occurring in the general population. Prescription pattern study of ENT infections was conducted in ENT OPD of a rural teaching hospital with the objective of evaluating prescribing pattern of drugs and to study the rationality of the antimicrobial therapy. The study showed that in the 768 prescriptions, the AMAs (Antimicrobial agents) were indicated therapeutically in 79.68%, prophylactically in 9.16% ...
Full Text Available The production of extended-spectrum beta-lactamases (ESBL is considered one of the most important resistance mechanisms that impair antimicrobial treatment of infections caused by Enterobacteriaceae. Data on culture and susceptibility tests were collected from the Clinical Analyses and Research Laboratory charts reporting on patients admitted to the University Hospital of Maringá (HUM from January 2004 to December 2009. The following Enterobacteriaceae were selected: Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, Enterobacter spp. and Proteus mirabilis. All tests were performed according to the recommendations of the Clinical and Laboratory Standards Institute (biochemical identification; susceptibility tests; initial screening and phenotypic confirmatory tests for ESBL. For Enterobacter spp. isolates, a disk approximation test was carried out, adding a cefepime disk. Seven hundred samples were analyzed, and E. coli was the most prevalent bacteria (n= 356. ESBLs were detected phenotypically in 7.3% of E. coli, 61.7% of K. pneumoniae, 33.3% of K. oxytoca, 7.1% of P. mirabilis, and 13.4% of Enterobacter spp samples. Overall ESBL prevalence reached 22% when all producers were taken together. Although HUM is considered a small-sized hospital, it showed high levels of resistance to antimicrobial agents, similar to those observed in bigger hospitals, which demonstrated the need for careful epidemiological surveillance.A produção de beta-lactamases de espectro ampliado (ESBL é considerada um dos mais importantes mecanismos de resistência aos antimicrobianos, o que dificulta o tratamento de infecções causadas por enterobactérias. Dados sobre cultura e testes de sensibilidade foram coletados das fichas do Laboratório de Ensino e Pesquisa de Análises Clínicas de pacientes atendidos no Hospital Universitário de Maringá (HUM, de janeiro de 2004 a dezembro de 2009. As enterobactérias escolhidas foram: Escherichia coli, Klebsiella
Abdulaziz M Alsubaie
Full Text Available Background: Primary care services utilization is dependent on socioeconomic factors. It is proven that variation in socioeconomic factors result in discrepancies in the use of such services. Admittedly, research is limited on the socioeconomic factors affecting the utilization of primary care services in Saudi Arabia. Objectives: The aim of this research was to study the effect of the main socioeconomic factors affecting patients′ utilization of primary care services at a tertiary teaching hospital, Riyadh, Saudi Arabia. Materials and Methods: A cross-sectional study was conducted from January to February 2014 in a primary care clinic of a tertiary teaching hospital in Riyadh city; subjects selected using a random consecutive sampling technique. A self-administered questionnaire in Arabic was given to the participants to collect the data which comprised sociodemographic data, utilization measures, and health needs. The data were analyzed using SPSS version 21. Results: A total of 358 subjects participated in the study. The main factors that best determine the utilization of primary health care clinic in a tertiary teaching hospital were the possession of a health insurance (P = 0.046, odds ratio [OR] = 8.333, and bad self-health-perception (P < 0.014, OR: 2.088. Chronic illness was also associated with higher utilization (OR = 2.003. Conclusion: Our results reveal that chronic health problems, self-health-perception, and health insurance are the most significant socioeconomic factors affecting the utilization of primary care services.
Fonseca, Felipe Paiva; Santos Silva, Alan Roger; Lopes, Márcio Ajudarte; de Almeida, Oslei Paes; Vargas, Pablo Agustín
Objectives: Several medical and dental schools have described their experience in the transition from conventional to digital microscopy in the teaching of general pathology and histology disciplines; however, this transitional process has scarcely been reported in the teaching of oral pathology. Therefore, the objective of the current study is to report the transition from conventional glass slide to virtual microscopy in oral pathology teaching, a unique experience in Latin America. Study D...
is to minimize the negative effects of stress inducing environments based on research results. Which stress inducing factors? We can look around at some old hospitals and see they are noisy, confusing, ugly, monotonous, hard, cold, artificial, and dark; qualitative terms which can indicate what we shouldn...... in the navigation experience and wasted time of medical staff in providing directions. Space in hospitals: space can be divided into personal, social and outdoor space. Personal space: single rooms have been well documented in: admission length, mortality rates, comfort levels, sense of privacy, all users......’ satisfaction. Social space: attention to spatial qualities, volume and interior design in terms of encouraging physical contact between users in wards, waiting areas and semi-private rooms. Outdoor space: Landscape and gardens are not enough in themselves; they should be visible, centrally or strategically...
Hossein Khoshkharam-Roodmajani; Jamal Sarvari; Abdollah Bazargani; Mohammad Reza Kandekar-Ghahraman; Ali Nazari-Alam; Mohammad Motamedifar
Background and objectives To investigate coagulase gene polymorphism of MRSA and MSSA isolates from Shiraz teaching hospitals from 2011 to 2012. Materials and Methods A total of 302 isolates of Staphylococcus aureus were collected from clinical specimens in three major teaching hospitals and confirmed on the basis of morphological characteristics and biochemical tests. The isolates were subjected to molecular typing on the basis of coagulase enzyme gene polymorphism by PCR-RFLP. Results There...
Full Text Available Xiu-Ping Zhu,1 Ling-Ling Zhu,2 Quan Zhou11Department of Pharmacy, 2Cadre Department, Division of Nursing, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, People’s Republic of ChinaBackground: A retrospective utilization study was performed to evaluate utilization patterns for enteral nutrition in a university teaching hospital.Methods: Enteral nutrition was divided into three types according to the nitrogen source, ie, total protein type [Nutrison Fibre®, Fresubin Energy Fibre®, Fresubin®, Supportan® (a special immunonutrition for cancer patients or patients with increased demands for omega-3 fatty acids, Fresubin Diabetes® (a diabetes-specific formula, Ensure®]; short peptide type (Peptison®; and amino acid type (Vivonex®. A pharmacoeconomic analysis was done based on defined daily dose methodology.Results: Among hospitalized patients taking enteral nutrition, 34.8% received enteral nutrition alone, 30% concomitantly received parenteral nutrition, and 35.2% received enteral nutrition after parenteral nutrition. Combined use of the different formulas was observed in almost all hospitalized patients receiving enteral nutrition. In total, 61.5% of patients received triple therapy with Nutrison Fibre, Fresubin Diabetes, and Supportan. Number of defined daily doses (total dose consumed/defined daily dose, also called DDDs of formulas in descending order were as follows: Nutrison Fibre, Fresubin Energy Fibre, Fresubin Diabetes > Supportan > Peptison, Ensure > Vivonex, Fresubin. The ratio of the cumulative DDDs for the three types of enteral nutrition was 35:2.8:1 (total protein type to short peptide type to amino acid type. Off-label use of Fresubin Diabetes was also observed, with most of this formula being prescribed for patients with stress hyperglycemia. Only 2.1% of cancer patients received Supportan. There were 35 cases of near misses in dispensing look-alike or sound-alike enteral
Upper gastrointestinal bleeding in a Brazilian hospital: a retrospective study of endoscopic records Sangramento digestivo alto em um hospital brasileiro: estudo retrospectivo de registros endoscópicos
Full Text Available Background - Upper gastrointestinal bleeding is a frequent and potentially severe complication of most digestive diseases of the upper gastrointestinal tract. Upper endoscopy has a crucial role in the diagnosis and treatment of upper gastrointestinal bleeding, however epidemiological studies are still limited in our country. Aims - To assess the clinical characteristics, endoscopic accuracy, treatment efficiency and clinical outcome of patients admitted to the endoscopic unit with upper gastrointestinal bleeding. Methods - A retrospective study of consecutive records from patients who underwent emergency endoscopy for upper gastrointestinal bleeding was performed during a period of 2 years. Results - Most patients were male 68.7%, with a mean age of 54.5 ± 17.5 years. A bleeding site could be detected in 75.6% of the patients. Diagnostic accuracy was greater within the first 24 hours of the bleeding onset, and in the presence of hematemesis. Peptic ulcer was the main cause of upper gastrointestinal bleeding (35%. The prevalence of variceal bleeding (20.45% indicates a high rate of underlying liver disease. Endoscopic treatment was performed in 23.86% of the patients. Permanent hemostasis was achieved in 86% of the patients at the first endoscopic intervention, and in 62.5% of the patients after rebleeding. Emergency surgery was seldom necessary. The average number of blood units was 1.44 ± 1.99 per patient. The average length of hospital stay was 7.71 ± 12.2 days. Rebleeding was reported in 9.1% of the patients. The overall mortality rate of 15.34% was significantly correlated with previous liver disease. Conclusions - Diagnostic accuracy was related to the time interval between the bleeding episode and endoscopy, and to clinical presentation. Endoscopic therapy was an effective tool for selected patients. The resulting increased duration of hospitalization and higher mortality rate in the patients submitted to therapeutic endoscopy were
Full Text Available Background In 2004, the health system in Iran initiated an organizational reform aiming to increase the autonomy of teaching hospitals and make them more decentralized. The policy led to the formation of a board of trustees in each hospital and significant modifications in hospitals’ financing. Since the reform aimed to improve its predecessor policy (implementation of hospital autonomy began in 1995, it expected to increase user satisfaction, as well as enhance effectiveness and efficiency of healthcare services in targeted hospitals. However, such expectations were never realized. In this research, we explored the perceptions and views of expert stakeholders as to why the board of trustees’ policy did not achieve its perceived objectives. Methods We conducted 47 semi-structured face-to-face interviews and two focus group discussions (involving 8 and 10 participants, respectively with experts at high, middle, and low levels of Iran’s health system, using purposive and snowball sampling. We also collected a comprehensive set of relevant documents. Interviews were transcribed verbatim and analyzed thematically, following a mixed inductive-deductive approach. Results Three main themes emerged from the analysis. The implementation approach (including the processes, views about the policy and the links between the policy components, using research evidence about the policy (local and global, and policy context (health system structure, health insurers capacity, hospitals’ organization and capacity and actors’ interrelationships affected the policy outcomes. Overall, the implementation of hospital decentralization policies in Iran did not seem to achieve their intended targets as a result of assumed failure to take full consideration of the above factors in policy implementation into account. Conclusion The implementation of the board of trustees’ policy did not achieve its desired goals in teaching hospitals in Iran. Similar
Full Text Available Problem statement: Today, organizations are willing to achieve quality as a source of competitive advantage. Therefore, their performance evaluation and quality improvement is essential. One of the international models in this field is Baldrige health care model. Approach: The study aimed to evaluate Performance Evaluation a teaching Hospital Affiliated to Tehran University of Medical Sciences Based on Baldrige Excellence Model. Performance was evaluated by two types Baldrige questionnaire (i.e., process and result criteria. Six process criteria (Leadership; Strategic Planning; Focus on Patients, Other Customers and Markets; Measurement, Analysis and Knowledge Management; Workforce Focus; and Process Management with 12 sub-criteria, were evaluated based on four factors of Approach, Deployment, Learning and Integration. Results criteria with six subcriteria were evaluated based on four factors of performance level, rate and breath of performance improvement, comparative and benchmark data and relevance of evaluation result scales. Results: The teaching hospital obtained 145/21 scores (26/40 percent out of a total of 550 points in process criteria and 90/37 scores (20/08 percent out of a total of 450 points in result criteria. Studied hospital obtained the highest score in Measurement, Analysis and Knowledge Management 28/1 scores (31/22 percent. In Sum, the hospital obtained 235/58 scores (23/55 percent out of 1000 points. Conclusion: Scores obtained by hospital showed the first level of excellence. The outcome of this study clearly indicates that Baldrige model criteria act as a powerful tool to analyze the quality performance of the hospitals. The researchers attempted to create a common language and a roadmap in order to follow the path of excellence in health care organizations in Iran.
General Accounting Office, Washington, DC. Health, Education, and Human Services Div.
This report evaluates the Department of Health and Human Services PATH (Physicians at Teaching Hospitals) initiative involving audits of Medicare billing processes and procedures. The PATH audits resulted from concerns that medical records did not adequately document the direct involvement of teaching physicians in services provided by resident…
Bezzaoucha, A; El Kebboub, A; Aliche, A
Within the framework of the active information system set up by the department of epidemiology on hospital mortality at the Blida (Algeria) University Teaching Hospital (CHU), a study was carried out to assess the importance and evolution of neonatal mortality recorded at the CHU in the last eight years (1999-2006) as well as the causes of neonatal death. The International Classification of Diseases (ICD-9) was used to encode the nature of the causal disease. Using the software EpiInfo™ in its sixth version performed data entry, monitoring and analysis. On the whole, 2,167 neonatal deaths were recorded at the CHU during the study period, representing a proportional mortality of 25.4%. Early neonatal mortality (0-6 days) accounted for 83.4% of all neonatal mortality. Nearly two thirds of early neonatal deaths occurred in the first three days of life. The monthly evolution of the number of early neonatal deaths revealed a significant rising trend during the study period (P < 0.05) without identification of seasonal effect. The sex ratio was practically the same for early and late neonatal mortality, respectively 1.4 and 1.5. Prematurity accounted for 42.1% of the deaths in early neonatal deaths, followed by respiratory distress syndrome and infection, respectively 17.0 and 14.4%. Infections, with a relative frequency of 36.2%, represented the most common cause for the late neonatal mortality. The rate of early neonatal mortality during the study period, when this one took for denominator the number of newborns admitted in neonatology to express the mortality of service, was 15.6%. Throughout the study period, the rate of early neonatal mortality, without counting the deaths among transferred newborms, could be estimated at 19.2 per 1,000 live births, while the overall neonatal mortality rate could be estimated at 22.3 per 1,000 live births. No significant temporal tendency was pointed out. The CHU of Blida is not characterized by a lower risk of neonatal mortality
Marsel C. Pereira
Full Text Available There are few studies that approach the epidemiology of deaths in racehorses in a broad manner. The majority focus on a specific affection or procedure. Brazil does not have a program instituted for the monitoring of deaths of horses. By means of a descriptive study in association with a multivariate analysis method, an epidemiologic profile was determined for deaths related to musculoskeletal (MS, gastrointestinal (GI, respiratory (RES systems, neurologic origin (NEU and sudden death (SD for the years of 2002 to 2008, at the Octavio Dupont Veterinary Hospital-Rio de Janeiro (ODVH. Males comprised the majority of deaths and that deaths were related to, decreasing order, MS>GI>SD>NEU>RES, with respect to general mortality rate per large group of determined causes (TSPMr. The majority of deaths registered included horses aged four to five years (ID4-ID5. We observed the following correspondence relations: (3-year period = SM - ID>5 - SD; ID>5 - GI; ID4-5 - MS; SF - ID5 - GI; SF - ID5. The present study points out the importance and necessity of epidemiologic studies of lesions in horses, based on diagnosis for the recognition of predisposing factors and prevention.
Telma Rocha de Assis
Full Text Available Epilepsy in the elderly has high incidence and prevalence and is often underecognized. Objective To describe etiological prevalence of epilepsy and epileptic seizures in elderly inpatients. Methods Retrospective analysis was performed on elderly patients who had epilepsy or epileptic seizures during hospitalization, from January 2009 to December 2010. One hundred and twenty patients were enrolled. They were divided into two age subgroups (median 75 years with the purpose to compare etiologies. Results The most common etiology was ischemic stroke (36.7%, followed by neoplasias (13.3%, hemorrhagic stroke (11.7%, dementias (11.4% and metabolic disturbances (5.5%. The analysis of etiological association showed that ischemic stroke was predominant in the younger subgroup (45% vs 30%, and dementias in the older one (18.9% vs 3.8%, but with no statistical significance (p = 0.23. Conclusion This study suggests that epilepsy and epileptic seizures in the elderly inpatients have etiological association with stroke, neoplasias and dementias.
Md Redzuan A
Full Text Available Adyani Md Redzuan, Meng Soon Lee, Noraida Mohamed Shah Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia Purpose: Asthma affects an estimated 300 million people worldwide. Poor adherence to prescribed preventive medications, especially among children with asthma, leads to increased mortality and morbidity. The purpose of this study was to assess the adherence and persistence levels of asthmatic children at the Universiti Kebangsaan Malaysia Medical Center (UKMMC, a tertiary care teaching hospital, and to determine the factors that influence adherence to prescribed preventive medications. Patients and methods: Participants were asthmatic patients aged 18 years and younger with at least one prescription for a preventive medication refilled between January and December 2011. Refill records from the pharmacy dispensing database were used to determine the medication possession ratio (MPR and continuous measure of gaps (CMG, measures of adherence and persistence levels, respectively. Results: The sample consisted of 218 children with asthma from the General and Respiratory pediatric clinics at UKMMC. The overall adherence level was 38% (n=83; MPR ≥80%, and the persistence level was 27.5% (n=60; CMG ≤20%. We found a significant association between the adherence and persistence levels (r=0.483, P<0.01. The presence of comorbidities significantly predicted the adherence (odds ratio [OR] =16.21, 95% confidence interval [CI]: 7.76–33.84, P<0.01 and persistence level (OR=2.63, 95% CI: 0.13–52.79, P<0.01. Other factors, including age, sex, ethnicity, duration of asthma diagnosis, and number of prescribed preventive medications did not significantly affect adherence or persistence (P>0.05. Conclusion: In conclusion, the adherence level among children with asthma at UKMMC was low. The presence of comorbidities was found to influence adherence towards preventive medications in asthmatic children. Keywords: asthma, persistence
Fowad Khurshid et al.
Full Text Available Study objective: To investigate the use of antihypertensive drugs in hypertensive patients and to identify whether such pattern of prescription is appropriate in accordance with international guidelines for management of hypertension. Methods: This was a prospective analysis. A prescription based survey among patients with established hypertension was conducted at the Medicine Out-Patient Department of University Teaching Hospital in South Delhi, India. Data were collected from patients’ medical records as well as patients’ interviews.Results: A total of 192 hypertensive patients fulfilled the criteria for inclusion in the study analysis. Combination therapy was used more commonly than monotherapy (54.6% vs 45.4. Among the monotherapy category, the various classes of drugs used were as follows: beta- blockers (28.8%, diuretics (24.1%, calcium channel blockers (21.8%, ACE inhibitors (18.4%, angiotensin II receptor blockers (5.7% and α 1- blocker (1.1%. With respect to overall utilization pattern, diuretics (42.2% were the most frequently prescribed class, beta- blockers (41.2% ranked second followed by calcium channel blockers (39.1%, ACE inhibitors (26.0%, angiotensin II receptor blockers (23.4% and α 1- blocker (9.4%. As for individual medicines, amlodipine (35.4% was the most commonly prescribed antihypertensive drug followed by atenolol (17.8%, ramipril (17.2 % and furosemide (13.0 %. Among the combination therapies, 2- drug treatment was preferred for 75% of the hypertensive patients with CCB and β-blocker being the most frequent drug combination (22.4%.Conclusion: The general pattern of antihypertensive utilization seems to be in accordance with the international guidelines for management of hypertension.
Chidozie Emmanuel Mbada
Full Text Available AIMS: Studies comparing the occurrence and characteristics of work – related musculoskeletal disorders (WMSDs across various occupational groups in the health sector from Sub-Sahara Africa are sparse. This study investigated the prevalence and pattern of WMSDs among health workers in Obafemi Awolowo University Teaching Hospitals complex, Ile-Ife, Nigeria. METHODS: An adapted questionnaire from the Nordic musculoskeletal questionnaire was used as the survey instrument. Data were collected on demographics, lifetime, 12-months and point prevalence, and pattern and consequence of WMSDs. A response rate of 91% was obtained in this study. RESULTS: Sixty eight point seven percent of the respondents have experienced WMSDs in their occupational lives with a higher percentage among males than females (39.6 vs.29.1%. The 12-months period and point prevalence rate of WMSDs was 64.4% and 48.2% respectively. WMSDs reported mostly for low back (50% followed by the shoulder (27.5% and knees (18.1%. Nurses (30.4% had the highest rate of WMSDs among the health workers. Most nurses with complaints (53.4% took a sick leave as a result of WMSDs, followed by doctors (32% and support staff (25%. CONCLUSIONS: WMSDs are common among health workers from Nigeria with the low back being injured most often. The rate of WMSDs and consequent sick leave is higher among nurses than other health workers. Preventive programmes on musculoskeletal disorders among health workers are recommended in order to reduce the rate of WMSDs among them and to promote efficiency in patient care. [TAF Prev Med Bull 2012; 11(5.000: 583-588
Full Text Available Background: Extrauterine growth restriction remains a common and serious problem in newborns especially who are small, immature, and critically ill. Very low birth weight infants (VLBW had 97% and 40% growth failure at 36 weeks and 18-22 months post-conceptual age respectively. The postnatal development of premature infants is critically dependent on an adequate nutritional intake that mimics a similar gestational stage. Deficient protein or amino acid administration over an extended period may cause significant growth delay or morbidity in VLBW infants. The purpose of this study was to evaluate current nutritional status in the neonatal intensive care unit in a teaching hospital. Methods: During this prospective observational study, the nutritional status of 100 consecutive critically ill neonates were evaluated by anthropometric and biochemical parameters in a tertiary neonatal intensive care unit. Their demographic characteristics (weight, height and head circumference, energy source (dextrose and lipid and protein were recorded in the first, 5th, 10th, 15th and 20th days of admission and blood samples were obtained to measure serum albumin and prealbumin. The amount of calorie and protein were calculated for all of preterm and term neonates and compared to standard means separately. Results: The calorie and amino acids did not meet in the majority of the preterm and term neonates and mean daily parenteral calorie intake was 30% or lower than daily requirements based on neonates’ weight. Mortality rate was significantly higher in neonates with lower serum albumin and severity of malnutrition but not with serum prealbumin concentration. Conclusion: Infants were studied did not receive their whole of daily calorie and protein requirements and it is recommended early and enough administration of calorie source (dextrose, lipids and amino acids. Prealbumin was a more benefit biochemical parameter than albumin to evaluate short term nutrition
Full Text Available Background:Extrauterine growth restriction remains a common and serious problem in newborns especially who are small, immature, and critically ill. Very low birth weight infants (VLBW had 97% and 40% growth failure at 36 weeks and 18-22 months post-conceptual age respectively. The postnatal development of premature infants is critically dependent on an adequate nutritional intake that mimics a similar gestational stage. Deficient protein or amino acid administration over an extended period may cause significant growth delay or morbidity in VLBW infants. The purpose of this study was to evaluate current nutritional status in the neonatal intensive care unit in a teaching hospital.Methods:During this prospective observational study, the nutritional status of 100 consecutive critically ill neonates were evaluated by anthropometric and biochemical parameters in a tertiary neonatal intensive care unit. Their demographic characteristics (weight, height and head circumference, energy source (dextrose and lipid and protein were recorded in the first, 5th, 10th, 15th and 20th days of admission and blood samples were obtained to measure serum albumin and prealbumin. The amount of calorie and protein were calculated for all of preterm and term neonates and compared to standard means separately. Results: The calorie and amino acids did not meet in the majority of the preterm and term neonates and mean daily parenteral calorie intake was 30% or lower than daily requirements based on neonates’ weight. Mortality rate was significantly higher in neonates with lower serum albumin and severity of malnutrition but not with serum prealbumin concentration. Conclusion: Infants were studied did not receive their whole of daily calorie and protein requirements and it is recommended early and enough administration of calorie source (dextrose, lipids and amino acids. Prealbumin was a more benefit biochemical parameter than albumin to evaluate short term nutrition
Full Text Available Abstract Background Despite education and availability of drugs and vaccines, hepatitis B virus (HBV is still the most common severe liver infection in the world accounting for >1 million annual deaths worldwide. Transfusion of infected blood, unprotected sex and mother to child transmission are 3 key transmission routes of HBV in Ghana. There is high incidence of blood demanding health situations in northern Ghana resulting from anemia, accidents, malnutrition, etc. The higher the demand, the higher the possibility of transmitting HBV through infected blood. The aim of the investigation was to estimate the prevalence of HBV in blood donors which will provide justification for interventions that will help minimize or eliminate HBV infection in Ghana. Findings We investigated the prevalence of HBV infection among blood donors at Tamale Teaching Hospital. The Wondfo HBsAg test kit was used to determine the concentration of HBsAg in 6,462 (576 voluntary and 5,878 replacement donors as being ≥1 ng/ml. 10.79% of voluntary donors and 11.59% of replacement donors were HBsAg+. The 20-29 year group of voluntary donors was >2 times more likely to be HBsAg + than 40-60. Also the 20-29 year category of replacement donors was >4 times as likely to be HBsAg + than 50-69. Conclusions Risk of infection was age, sex and donor type dependent. The 20-29 year category had the highest prevalence of HBsAg + cases, mostly males residing within the metropolis.
Full Text Available Incidence of gestational diabetes mellitus varies between 0.5 – 5% and is defined as carbohydrate intolerance of variable severity with onset during pregnancy. The present study comprised of patients with GDM who were referred to Department of Medicine in a teaching hospital in Kerala. Total of 3678 pregnant women were screened during the study period , out of which 40 patients who had GDM according to criteria set by O. Sullivan and Mahan , were taken for the study. The clinical profile and response to insulin therapy were analyzed; also insulin required in our population was compared with that of western population. Incidence of GDM in the study was 1.09%. GDM cases were maximum in 26 – 30 years age group. 47.5% of patients gave a significant family history of diabetes mellitus. Regarding the type of labor 67.5% patients were subjected to LSCS. Bad obstetric history and previous LSCS remained the major indications for this (74%. Majority of cases were managed with insulin in the dose of 8 – 20 u nits per day. The incidence of GDM is in the range (0.5 - 5 % as per literature. Maximum cases were in second gravida followed by primi and third gravid. Hence , parity does not seem to influence the glucose tolerance. A higher incidence of GDM was seen in t he 25 – 29 years age group. Significant family history of diabetes mellitus was relevant in the study. Regarding the obstetric outcome , majority of patients had to undergo LSCS. Macrosomia was not a significant problem where majority babies had normal birt h weight . Insulin was required as the mainstay of treatment in the study to control glycemic status. Majority of cases were managed with low dose insulin. This was in contrast to western population where the insulin requirement was around 90 units per day for glycemic control.
Jayant D Deshpande , Kailash K Singh , Deepak B Phalke
Full Text Available Background: Cancer is one of the major public health problems worldwide. Prevalence and pattern of cancer is known to vary from region to region. Epidemiological information on cancer including the pattern is an important basis for determining the priorities for cancer control in any population group. Objective: Present work is an attempt to study magnitude, profile and some epidemiological aspects in relation to cancer cases at a tertiary care level teaching hospital in rural area. Method: All records were studied and analyzed. A total of 1106 patients were treated during the period studied. A proforma was used to collect data such as age, sex, place of residence, type of cancers and treatment given. The data collected were entered into MS-Excel sheets and analysis was carried out. The information obtained was tabulated analyzed using the software GraphPad Instat demo version. Results: A total of 1106 cancer patients were treated during the January 2010 to December 2010. Among these, 626(56.60 were females and 480(43.39 were females. In males, the common cancers were oral cavity cancers, lung cancers and GIT cancers. The most common cancers among females were the cervical carcinomas, which constituted 32.10% of the total number of cancers cases followed by cancers of breast. Almost 2/3rd of cases occurred in the age group of 41 to 70 years. Maximum frequency was observed in 51–60 year age group in both sexes. Maximum numbers (74.59% of the cases were from rural area. The main methods of cancer treatment were surgery, chemotherapy and radiotherapy, used alone or in combination. Conclusion: Tobacco and alcohol related cancers predominated in males. In females, cervical cancer predominated over breast cancer. Human behavior is a major determinant in the successful control of cancer. Understanding cancer magnitude, risk and trends will be of help in cancer control.
Eze Uchenna IH
Full Text Available The major approach to patients? health problems is the use of drugs particularly in the co morbid states. In this study we intend to evaluate the prescribing pattern, determine the nature and extent of irrational drug use and assess rate of medication adherence and reasons for non adherence among patients attending an outpatient clinic of Olabisi Onabanjo University Teaching Hospital (OOUTH Sagamu, Ogun State, Nigeria. A two fold study was done using 100 case notes belonging to diabetic hypertensive patients of whom 67 patients were available for oral interview on medication adherence. Data on sex, age, groups of medicines prescribed, number of prescriptions and number of medicines occurring per prescription were obtained, World Health Organization (WHO prescribing indicators were calculated and occurrence of irrational prescribing was detected. Analysis was done using Microsoft Excel 2000. Female to male ratio was 1:0.59 and average age + SD of the patients was 63+10 years. Anti diabetics were the most prescribed medicines 1152(31.8% followed by anti-hypertensives 865(23.9%. Average no of drugs per prescription was 4.7; Percentage of drugs prescribed as generics 40.1%; Percentage of antibiotics and injections per prescription were 9.4% and 2.1% respectively. Extravagant prescribing occurred in 92.7% of the cases. Forty nine (73.1% were adherent. Cost (63.2% and forgetfulness915.7% were reasons for non adherence. Prescribing in this group of patients is sub-optimal, however majority claimed to be adherent. Interventions are needed for health care providers and the patients alike.
Kashiwaya, Kiyoshi; Saga, Tomoo; Ishii, Yoshikazu; Sakata, Ryuji; Iwata, Morihiro; Yoshizawa, Sadako; Chang, Bin; Ohnishi, Makoto; Tateda, Kazuhiro
Pneumococcal Molecular Epidemiology Network (PMEN) clones are representatives of worldwide-spreading pathogens. DiversiLab system, a repetitive PCR system, has been proposed as a less labor-and time-intensive genotyping platform alternative to conventional methods. However, the utility and analysis parameters of DiversiLab for identifying worldwide lineages was not established. To evaluate and optimize the performance of DiversiLab for identifying worldwide pneumococcal lineages, we examined 245 consecutive isolates of clinical Streptococcus pneumoniae from all age-group patients at a teaching hospital in Japan. The capsular swelling reaction of all isolates yielded 24 different serotypes. Intensive visual observation (VO) of DiversiLab band pattern difference divided all isolates into 73 clusters. Multilocus sequence typing (MLST) of representative 73 isolates from each VO cluster yielded 51 different STs. Among them, PMEN-related lineages accounted for 63% (46/73). Although the serotype of PMEN-related isolates was identical to that of the original PMEN clone in 70% (32/46), CC156-related PMEN lineages, namely Greece(6B)-22 and Colombia(23F)-26, harbored various capsular types discordant to the original PMEN clones. Regarding automated analysis, genotyping by extended Jaccard (XJ) with a 75% similarity index cutoff (SIC) showed the highest correlation with serotyping (adjusted Rand's coefficient, 0.528). Elevating the SIC for XJ to 85% increased the discriminatory power sufficient for distinguishing two major PMEN-related isolates of Taiwan(19F)-14 and Netherlands(3)-31. These results demonstrated a potential utility of DiversiLab for identifying worldwide lineage of pneumococcus. An optimized parameters of automated analysis should be useful especially for comparison for reference strains by "identification" function of DiversiLab. PMID:27107736
P A Agaba
Full Text Available Background: Physicians who have the task of caring for the sick also need to be cared for when they take ill. Healthseeking habits of physicians have been found to be poor in most developed countries. Utilization of health services by physicians in developing countries is not known. We sought to describe the health seeking habits of physicians in Nigeria. Materials and Methods: A cross-sectional survey was carried out among physicians at the Jos University Teaching Hospital, a tertiary referral health facility in North-central Nigeria. A pre-tested questionnaire was administered to physicians to get information on their self-reported health seeking habits. Results: Self prescription was practiced by 98.6% of the physicians, with antimalarials being the most prescribed drugs (62.5%. Only 46.9% consulted another physician when they take ill, although 78.2% felt they needed a family physician. Many (23.8% of respondents treated their family members when last sick. The major factors considered by the respondents in choosing the physician they consulted were the specialty of the physician consulted (42.2%; the physician being in the same unit with them (38.5%, and friendship (15.6%. Four (3.7% of the respondents would not consider any particular factor for choosing a physician if they have to. Conclusion: This study showed that a large proportion of physicians self-medicate and a few have family physicians. Guidelines need to be instituted to regulate self-prescribing among physicians in Nigeria. The role of family physicians in primary care needs to be emphasized.
Diabetes Mellitus is emerging as a major health challenge with the incidence and prevalence of the disease on the increase. It also contributes to overall morbidity and mortality with complications like cardiovascular disease, neuropathy, nephropathy, retinopathy and lower extremity amputation. There are few local studies on the clinical characteristics of the disease in our wet up and this study therefore set out to characterize the clinical profile of newly presenting diabetic patients in a health facility in Nigeria. It is a cross sectional, descriptive study carried out at the diabetes clinic of the University of Uyo Teaching Hospital between January 2007 and September 2008. Data obtained included age, sex, anthropometric indices, symptomatology, co-morbidities, complications and treatment of diabetes. Data was analyzed using SPSS version 10. A total of two hundred and seventy patients were studied (120 males, 150 females). About 89.2% were Type 2 DM patients and majority of the study subjects were overweight. Diabetic neuropathy was the commonest complication present in 38.8% of the subjects. Polyuria was the commonest symptom and hypertension the commonest comorbidity. Majority of the subjects were on oral hypolgycaemic agents for the management of their disease with the sulphonyureas and biguanides being the most common medication that was taken by them. A few of the patients were also taking herbal medication for treatment of their disease. Majority of the patients presenting in our facility have Type 2 diabetes, were hypertensive and overweight. Hypertension was the commonest co-morbidity and diabetic neuropathy the commonest complication. Adequate health education, subsidies on medications and proper funding of the health sector is necessary to stem the tide of the burden attributable to the disease. (author)
Full Text Available Background: Hypertensive disorders in pregnancy (HDP represent a group of conditions associated with high blood pressure during pregnancy. It is an important cause of feto-maternal morbidity and mortality, particularly in developing countries. The aims of the study were to find the prevalence of hypertensive disorders and its associated risk factors among women attending the antenatal clinic of Usmanu Danfodiyo University Teaching Hospital,(UDUTH Sokoto. Materials and Methods: A longitudinal study of 216 consecutively recruited women that were less than 20 weeks pregnant at booking was carried out. Blood pressure was measured for each woman at booking and at subsequent visits. Urinalysis was done at booking and whenever blood pressure was elevated. Patients were followed-up to delivery and 6 weeks postpartum. Data entry and analysis was done using Statistical Analysis System (SAS statistical package. Results: The prevalence of HDP in the study was 17% while preeclampsia was 6%. Previous history of preeclampsia (P < 0.001; Relative risk (RR 4.2; conficence interval (CI 2.144-6.812, multiple gestation (P < 0.03; RR 3.8; CI 1.037-6.235, gestational diabetes (P < 0.02; RR 4.8; CI 1.910-6.751 and obesity (P < 0.002; RR 2.7; CI 1.373-5.511 were the significant risk factors in the development of HDP among the study population. Conclusion: The prevalence of HDP in the study group is high. Therefore, paying attention to the risk factors will ensure early detection and prevention of the progression of the disease and its sequelae.
D. C. F. Moreira
Full Text Available Introduction: While enteral diets for hospitalized patients normally follow nutrient composition guidelines, more than 90% of hospitalized patients receive oral diets with unknown mineral composition. Objective: To evaluate the mineral contents and adequacy of three types of oral diets (regular, blend and soft and complementary snacks offered to patients of a Brazilian hospital. Methods: The amount of minerals was determined in two non-consecutive days in duplicate samples of breakfast, collation, lunch, snack, dinner, supper and a complementary snack meal. Dietary Reference Intakes (DRIs were used to determine the adequacy of the daily amounts served to patients. Results and discussion: The regular diet met the RDA (Recommended Dietary Allowances requirements only for Mn, P and Se, while the blend diet was deficient in Ca, K and Mg, and the soft diet met RDA requirements only for P and Zn. Iron was below the RDA requirement in all diets for women in fertile age, and Na was above the safe limit of intake (UL in all the diets. The use of complementary snack was effective in meeting RDA requirements for Cu in the regular diet, and Mn and Se in the soft diet, but promoted overconsumption of Na. Conclusions: Evident nutritional imbalances have been detected at a key interphase between nutrition and public health services, but a solution does not appear to be insurmountable. A permanent nutritional evaluation of hospital oral diets should be an integral part of routine health care in order to speed the recovery of the hospitalized patient and dispel eventual risks due to critical mineral imbalances.Introducción: Mientras las dietas enterales para pacientes hospitalizados siguen normas de composición nutricional, más del 90% de los pacientes internados en Latinoamérica reciben dietas orales de composición mineral desconocida. Objetivo: Evaluar el contenido mineral y la adecuación de tres tipos de dietas orales (regular, blanda y fluida y
Nadeem N; Khawaja RDA; Beg M; Naeem M; Majid Z
Naila Nadeem,1,* Ranish Deedar Ali Khawaja,2,3,* Madiha Beg,1 Muhammad Naeem,4 Zain Majid41Department of Radiology, 2Aga Khan University Hospital, Karachi, Pakistan; 3Massachusetts General Hospital, Harvard Medical School, Boston, USA; 4Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan*These authors contributed equally to this workBackground: In an integrated method of education, medical students are introduced to radiology in their preclinical years. However, no study...
Performance of different organizations, such as hospitals is mainly influenced by their managers’ performance. Nursing managers have an important role in hospital performance and their managerial skills can improve the quality of the services. Hence, the present study was conducted in order to assess the relationship between the managerial skills and the results of their performance evaluation in Teaching Hospitals of Iran University of Medical Science in 2013. The research used the cross sec...
Peron, Isabela Haddad; Reichert-Lima, Franqueline; Busso-Lopes, Ariane Fidelis; Nagasako, Cristiane Kibune; Lyra, Luzia; Moretti, Maria Luiza
Candida albicans caused 44% of the overall candidemia episodes from 2006 to 2010 in our university tertiary care hospital. As different antifungal agents are used in therapy and also immunocompromised patients receive fluconazole prophylaxis in our institution, this study aimed to perform an antifungal susceptibility surveillance with the C.albicans bloodstream isolates and to characterize the fluconazole resistance in 2 non-blood C.albicans isolates by sequencing ERG11 gene. The study included 147 C. albicans bloodstream samples and 2 fluconazole resistant isolates: one from oral cavity (LIF 12560 fluconazole MIC: 8μg/mL) and one from esophageal cavity (LIF-E10 fluconazole MIC: 64μg/mL) of two different patients previously treated with oral fluconazole. The in vitro antifungal susceptibility to amphotericin B (AMB), 5-flucytosine (5FC), fluconazole (FLC), itraconazole (ITC), voriconazole (VRC), caspofungin (CASP) was performed by broth microdilution methodology recommended by the Clinical and Laboratory Standards Institute documents (M27-A3 and M27-S4, CLSI). All blood isolates were classified as susceptible according to CLSI guidelines for all evaluated antifungal agents (MIC range: 0,125–1.00 μg/mL for AMB, ≤0.125–1.00 μg/mL for 5FC, ≤0.125–0.5 μg/mL for FLC, ≤0.015–0.125 μg/mL for ITC, ≤0.015–0.06 μg/mL for VRC and ≤0.015–0.125 μg/mL for CASP). In this study, we also amplified and sequenced the ERG11 gene of LIF 12560 and LIF-E10 C.albicans isolates. Six mutations encoding distinct amino acid substitutions were found (E116D, T128K, E266D, A298V, G448V and G464S) and these mutations were previously described as associated with fluconazole resistance. Despite the large consumption of antifungals in our institution, resistant blood isolates were not found over the trial period. Further studies should be conducted, but it may be that the very prolonged direct contact with the oral antifungal agent administered to the patient from which
Ekpo Memfin Dan
Full Text Available Background: Autopsy is an essential auditing tool in clinical practice. ObjectiveS: The study set out to review all autopsies that were performed over a four-year period in order to determine the rate, indications, as well as the age and sex distribution of dead bodies, which autopsies were performed on them in the Hospital. Setting and Design: This was a retrospective study that was undertaken at the department of Pathology of the University of Uyo Teaching Hospital (UUTH, Uyo, Nigeria between January 2007 and December 2010. Materials and Methods: All the cases of death that underwent pathological autopsies in the UUTH were reviewed. The autopsy records, clinical case notes, gross and histopathological specimens as well as slides were retrieved and examined. Results: A total of 1679 dead bodies were received at the mortuary of the institution studied during the 4-year period. Autopsies were performed in 78 cases giving a request rate of 4.7%. Coroner′s autopsy was commonly performed, and this accounted for 60 (76.9% cases, while the remaining 18 (23.1% were clinical autopsies. Autopsies were commonly performed on male bodies more than females (M: F = 2.6:1.0 with the majority having died at their second decade of life. It was observed that the majority (57.7% of the request for autopsies were from peripheral centers outside the teaching hospital, while the remaining 42.3% cases were drawn from various clinical departments in the teaching hospital. Road traffic accident was the leading indication for coroner′s autopsy (51.7%, while gastroenteritis and chronic liver disease were the two most common indications for clinical autopsy, 27.8% and 22.2% respectively. The concordance rate between clinical diagnosis and autopsy diagnosis was found to be 72.2% (13/18 cases. Conclusion: The rate of request for Autopsy at the University of Uyo Teaching Hospital during the period of this study was low, similar to other previous reports.
Full Text Available A Hughes,1 L Davies,1 R Hale,1 JE Gallagher21Kings College Hospital NHS Foundation Trust, 2King's College London Dental Institute, London, United KingdomBackground: The safety and protection of patients and health care workers is of paramount importance in dentistry, and this includes students in training who provide clinical care. Given the nature of dental care, adverse incidents can and do occur, exposing health care workers to body fluids and putting them at risk of infection, including contracting a blood-borne virus. The aim of this research was to analyze trends in the volume, rate, nature, management, and outcome of adverse incidents reported at one dental teaching hospital from 2005 to 2010.Methods: Descriptive analysis of trends in the volume, rate, nature, management, and outcome of adverse incidents reported at one dental teaching hospital over a six-year period was undertaken in relation to the level of outpatient and day surgery activity.Results: In total, 287 incidents were reported over a six-year period, which amounted to 0.039% of outpatient or day surgery appointments. Nearly three quarters of all the incidents (n = 208, 72% took place during treatment or whilst clearing away after the appointment. The most frequent incidents were associated with administration of local anesthetic (n = 63, 22%, followed by burs used in dental hand pieces (n = 51, 18%.Conclusion: This research confirms that adverse incidents are a feature of dental hospitals and reports the common sources. The importance of accurate and consistent reporting of data to ensure that these issues are monitored to inform action and reduce risks to staff, students, and patients are highlighted.Keywords: risk management, blood-borne virus, dental hospital, body fluids exposure, adverse event reporting
Full Text Available Objective: Establish position requirements-oriented training system of ICU training nurses in secondary hospital .To standardize the teaching management and improve the training effect for the training nurses in our ICU. Methods: Form the ICU training nurse teaching staff; Formulate training manual according to survey results of nurse training demand；Implement clinical teaching in stages according to the content of the training manual; Proceed comprehensive skills assessment in the different stages of training. Results: The pass rate of the 84 training nurses in 2013was 100%, the excellent rate was 25.72%,the good rate was 36.37%. 84 training nurses completed the training task perfectly according to the training manual, and during the training there was no nursing security incidents. Conclusion: To establish position requirements-oriented training system of ICU training nurses is the main method to solve the shortage of nursing professionals in secondary hospital. This kind of training system is appropriate to the needs of the development of intensive care ,training requirement and clinical requirement. It should be extended in nurse training work in ICU.
Full Text Available Purpose: To determine the incidence of vitreous loss in patients undergoing cataract surgery and the visual outcome in a tertiary teaching hospital. Methods: Hospital records of 2095 consecutive patients undergoing cataract surgery between July 1999 and June 2000 were reviewed in this non-concurrent cohort study. Incidence and visual outcome of vitreous loss managed using standard vitrectomy techniques were assessed for different cataract surgical techniques (extracapsular, Blumenthal technique and phacoemulsification as well as at different levels of surgical training. The outcome was compared with matched cases without vitreous loss (controls. Results: Vitreous loss occurred in 160 of 2095 eyes (7.63%; CI -7 to 9.3: 8.3% for ECCE, 8.1% for the Blumenthal technique and 5% with phacoemulsification. Vision 6/18 was achieved in 85% of cases and 95% of controls. For experienced surgeons, 95% of the cases and controls had vision 6/18. 5.8 % of cases and 0.7% of controls had vision < 6/60. One patient in each group was blind following cataract surgery; both had operable cataracts in the fellow eye. Conclusions: The vitreous loss rate in this tertiary teaching hospital is relatively high. This complication, managed with standard surgical techniques, is compatible with good visual outcome. In eyes with vitreous loss, the final visual acuity achieved by experienced surgeons was similar to that in uncomplicated cases.
Ana Conceição Norbim Prado Cunha
Full Text Available Summary Objective: This study aims to describe the profile of medical schools that introduced courses on Geriatrics and Elderly Health or Aging in their curriculum, and compare such information with the age distribution and health epidemiological data of the Brazilian population, using data until the year of 2013. Methods: 180 universities offering medical undergraduate courses and registered with the Ministry of Education and Culture of Brazil (MEC were found, as seen on the MEC website (www.emec.mec.gov.br in February 2013. Based on the list of institutions, the authors created a database. Results: Brazil's Southeast region is the one presenting most of the courses, both offered as core or elective subjects, in the area of Geriatrics. The Midwest region had the least offer of Geriatrics and Elderly Health and Care courses. The Southeast region presents the greater absolute number of institutions with elective subjects, followed by the South and Northeast regions, each with a single institution. The Southeast region was at the same time the one that presented the biggest absolute number of institutions offering core subjects in the area of Geriatrics, being followed by the Northeast, South, North, and Midwest regions. Conclusion: By analyzing the availability of courses that emphasize aging and Geriatrics in brazilian medical schools, the present study reveals that specialized training should be encouraged with respect to the specificities of health care given to the elderly population, which has a higher frequency of chronic and degenerative diseases.
This study was conducted to determine the knowledge, attitude and practice (KAP) about kidney diseases among medical officers working in different hospitals of Lahore.Doctors working on the medical floors of different tertiary care teaching hospitals (Mayo Hospital (MH), Sir Ganga Ram Hospital (SGRH), Service Institute of Medical Sciences (SIMS), Fatima Memoral Hospitals (FMH), Lahore General Hospitals (LGH), Shalamar Hospital (SH), Jinnah hospital (JH)) of Lahore were included in the study. Each doctor was given a questionnaire comprising of 28 questions. Each participant was given 10-15 minutes for completing the questionnaire at the spot. Categorization of doctors according to the KAP score was done as poor (70%).Results: One hundred eighty five doctors participated in the study who fulfilled the criteria. In this study majority 134 (62.6%) of the doctors were not taught about nephrology during their graduation which was statistically significant. Most of the doctors either had some knowledge or didn't know about procedures done in nephrology. Majority of the doctors 208(97.2%) know that nephrology deals with medical diseases of the kidney which was statistically significant. Most of the doctors 138(64.5) feel that nephrology services are insufficient in their hospital. More than 90% doctors want that kidney diseases should be taught during MBBS curriculum and separate nephrology department should be established which was statistically significant. Most of the doctors don't know the management of hyperkalemia very well. About 90% of the doctors know that there are five stages of CKD. Majority of the doctors know that ACE inhibitors are used in hypertension and diabetic nephropathy. They also know that urine complete examination help in early detection of diabetic nephropathy which was statistically significant.Conclusion:Most of the doctors have poor to average knowledge and practice about kidney diseases. Most of the doctors think that nephrology services are
Mohammad Parsa Mahjob
Full Text Available Background and objective: Medical record documentation, often use to protect the patients legal rights, also providing information for medical researchers, general studies, education of health care staff and qualitative surveys is used. There is a need to control the amount of data entered in the medical record sheets of patients, considering the completion of these sheets is often carried out after completion of service delivery to the patients. Therefore, in this study the prevalence of completeness of medical history, operation reports, and physician order sheets by different documentaries in Jahrom teaching hospitals during year 2009 was analyzed. Methods and Materials: In this descriptive / retrospective study, the 400 medical record sheets of the patients from two teaching hospitals affiliated to Jahrom medical university was randomly selected. The tool of data collection was a checklist based on the content of medical history sheet, operation report and physician order sheets. The data were analyzed by SPSS (Version10 software and Microsoft Office Excel 2003. Results: Average of personal (Demography data entered in medical history, physician order and operation report sheets which is done by department's secretaries were 32.9, 35.8 and 40.18 percent. Average of clinical data entered by physician in medical history sheet is 38 percent. Surgical data entered by the surgeon in operation report sheet was 94.77 percent. Average of data entered by operation room's nurse in operation report sheet was 36.78 percent; Average of physician order data in physician order sheet entered by physician was 99.3 percent. Conclusion: According to this study, the rate of completed record papers reviewed by documentary in Jahrom teaching hospitals were not desirable and in some cases were very weak and incomplete. This deficiency was due to different reason such as medical record documentaries negligence, lack of adequate education for documentaries, High work
Schellack, N; Martins, V; Botha, N; Meyer, J C
Poor management of pharmaceuticals could lead to wastage of financial resources and poor services in the public sector. The main aim of the study was to investigate the quality of pharmaceutical services at ward level in a teaching hospital. The design of the study was descriptive. Three data collection instruments were designed and pilot-tested prior to the actual data collection. Two structured questionnaires were used to interview the sister-in-charge of each ward and the stock and drug controller at the pharmacy. A checklist for the management of pharmaceuticals was completed for each ward. Descriptive statistics were used to describe and summarise the data. Sisters-in-charge of 30 wards and the stock and drug controller at the pharmacy participated in the study. The relationship with the pharmacy was perceived to be average by 54% (n = 30) of the sisters-in-charge of the wards. Communication with the pharmacy was mainly by telephone and 57% of the sisters-in-charge mentioned that they experienced difficulties in conveying messages to the pharmacy. Ten of the wards received regular ward visits by a pharmacist. Expiry dates were checked by all wards but at different intervals. The majority of the wards (90%) used patient cards, which refer to prescription charts, for stock control and ordering from the pharmacy. Fridge temperatures were checked and charted on a daily basis by 30% of the wards. Written standard operating procedures (SOPs) were used by the pharmacy for issuing ward stock. Although 83% of the wards indicated that they used SOPs, evidence of written SOPs was not available. The results indicated that the management of pharmaceutical services at ward level could be improved. Implementation of appropriate communication systems will enhance cooperation between the pharmacy and the wards. A uniform ward stock control system, either by computer or stock cards, should be introduced. Regular ward visits by a pharmacist to oversee ward stock management are
Yue Cheng; Gary Shun-Pan Cheung; Zhuan Bian; Bin Peng
目的:了解根管预备后疼痛发生率,并对一些可能与疼痛发生有关的因素进行分析.方法:选取2001年7月至2002年2月间武汉大学口腔医院牙体牙髓科完成的非一次法根管治疗纪录表,将相关信息输入计算机后作Chi-square test和logistic回归分析.结果:根管预备后疼痛发生率为11.5%.单因素分析和logistic回归发现身体状况、年龄、牙位于上颌或下颌、术前有无叩痛及牙髓活力为影响疼痛发生率的主要因素.结论:根管预备术后疼痛发生率较低;根管预备术后疼痛发生率受多种因素影响.%Objective:To investigate the incidence of postpreparation pain during root canal therapy(RCT)in a dental teaching hospital and to evaluate the factors affecting the pain experience.Methods:A total of 3512 cases were collected at RCT appointments on demographics,presenting symptoms,treatment procedures and periradicular status.Root canals were conventional instrumented and then medicated.The presence and severity of postpreparation pain after a subsequent endodontic treatment was recorded.The data of postpreparation pain cases were statistically analyzed using the Chi-square test and a multiple logistic regression model.Results:The incidence of postpreparation pain was 11.5%.Analyses of all potential factom revealed that patient age,health status,tooth location,pre-operative percussion pain and pulp status were the factors to significantly influence postpreparation pain experience.Conclusion:The prevalence of postpreparation pain Was low and significantly influenced by multiple factors.
Full Text Available Abstract Background Diarrheal diseases are the major causes of morbidity and mortality in developing world. Understanding the etiologic agents of diarrheal diseases and their association with socio-demographic characteristics of patients would help to design better preventive measures. Thus, this study was aimed to determine the prevalence of intestinal parasites and enteropathogenic bacteria in diarrheic patients. Methods A cross-sectional study involving 384 consecutive diarrheal patients who visited Gondar teaching hospital, Gondar, Ethiopia from October 2006 to March 2007 was conducted. Stool specimens were collected and examined for intestinal parasites and enteropathogenic bacteria following standard parasitological and microbiological procedures. Results Intestinal parasites were diagnosed in 36.5% of the patients. The most frequently encountered protozoan parasite was Entamoeba histolytica/dispar (7.3% followed by Giardia lamblia (5.0%, Cryptosporidium parvum (1.8% and Isospora belli (1.3%. The dominant helminthic parasite identified was Ascaris lumbricoides (5.5% followed by Strongyloides stercoralis and Schistosoma mansoni (3.1% each, hookworm infection (1.8%, and Hymenolepis species (1.3%. Multiple infections of intestinal parasites were also observed in 6.3% of the patients. Among the enteropathogenic bacteria Shigella and Salmonella species were isolated from 15.6% and 1.6%, respectively, of the patients. Escherichia coli O57:H7 was not found in any of the stool samples tested. Eighty eight percent and 83.3% of the Shigella and Salmonella isolates were resistant to one or more commonly used antibiotics, respectively. Intestinal parasitosis was higher in patients who live in rural area, in patients who were washing their hands after visiting toilet either irregularly with soap and without soap or not at all, in patients who used well and spring water for household consumption, and in patients who had nausea (P P Conclusions The high
Full Text Available Background: Hirschsprung′s disease (HD is a common cause of intestinal obstruction in children. Despite increased understanding of the disease and several techniques of treatment, significant complications continued to be associated with its management. Objective: To study the outcome of management of HD in the University Teaching Hospital, Ilorin, Nigeria. Materials and Methods: The clinical records of all children managed for HD between January 1998 and December 2005 were retrospectively reviewed. Demographic data, modes of presentation, methods of diagnosis, age at colostomy formation, age and type of definitive operations were noted from patients′ records. Complications associated with colostomy, pre- and postoperative complications, final outcome and duration of follow-up were also noted. Results: Twenty-one patients (20 males, one female managed for HD were reviewed. Eight (38% were diagnosed in the neonatal period, the mean age at diagnosis being 22 months. Fourteen patients had completed the three stages of the operation, one is awaiting colostomy closure and two patients are waiting for definitive operations. Out of the 15 patients who had definitive surgery, nine had Swenson′s pull-through operations while six had Duhamel operations. At presentation, six patients had enterocolitis, one of whom had spontaneous colonic perforation, two patients had sepsis. Colostomy-related complications recorded included sixteen patients with dermatitis, nine with colostomy prolapse, one patient with colostomy diarrhea and one with enterocolitis and sepsis. Following definitive surgery, three patients had wound infection, one partial intestinal obstruction, one postDuhamel hemorrhage and two enterocolitis. Complications after colostomy closure included two wound infections and one severe enterocolitis. There were five deaths (23.8%-two from sepsis, two from enterocolitis and one from an adverse drug reaction. One of the children who had
Background: Intramedullary spinal cord tumours (IMSCT) are among the uncommon lesions at spinal cord. They can present with a vast array of symptoms and cause severe neurological deficits. With advent and frequent use of MRI more and more patients with IMSCT are picked up. By using modern microsurgical techniques better surgical outcome is achieved. The Objective was to analyse the surgical outcome of the patients with intramedullary Spinal Tumour operated at Ayub Teaching Hospital (ATH), Abbottabad. Methods: Eighteen patients with IMSCT who presented at Neurosurgery Unit, ATH, Abbottabad during 2000 - 2010 were included in this study. Patients were diagnosed on the basis of MRI. They were operated using standard microsurgical techniques. Patients were followed up for a mean duration of 18 months after surgery and their preoperative and postoperative neurological status was analysed. Results: Patients with age group ranging from 15 - 50 (37.72 +- 8.94) years with IMSCT were operated. Sixty-one percent of the patients were male and 39% were female. The region most commonly affected was cervical (44%) followed by conus medullaris (33%), cervicothoracic and thoracic each had frequency of 11%. Gross total removal (>95%) was possible in 72% of cases while in rest of 28% cases resection of 80 - 95% was possible. Histologically 38.9% of the lesions were ependymomas, 27.8% were astrocytomas and 22.2% were teratomas. Neurofibromas and Primitive Neuroectodermal Tumours (PNET) each accounted for 5.5% of the cases. Overall postoperative neurology improved in 10 (55%) of patients, remained unchanged in 5 (27%) of cases, and deteriorated in 3 (16%) patients. One patient was lost in follow-up. Surgery on tumours in cervical and thoracic region carried a relatively poor outcome as compared to the lesion of conus. There were no deaths due to surgery. Conclusion: Surgical removal of IMSCT is beneficial to patients with acceptable surgical risk. Better outcome is expected if the
Full Text Available : BACKGROUND: Allergic contact dermatitis (ACD is a common inflammatory skin disease. Appropriate and effective drug therapy can ensure immense therapeutic benefit in patients suffering from ACD. The study was carried out to find out prescribing pattern in ACD at a tertiary care teaching hospital in south India. METHODOLOGY: Patients of allergic contact dermatitis who attended Dermatology outpatient department of KVG Medical College and hospital were the subjects of study. Prescription patterns and other relevant findings were recorded in proforma for analysis and interpretation of data. RESULTS: 209 patients of ACD were included in the study group. Topical corticosteroids and antibiotics were prescribed as monotherapy and polytherapy. Corticosteroides, antibiotics, antihistaminics were prescribed as systemic monotherapy and polytherapy. Statistical analysis revealed p-value was > 0.05. CONCLUSIONS: Prescription patterns were in consensus with the general guidelines, with few changes perhaps, in the choice of established therapeutic agents.
Kamat U; Ferreira AMA; Savio R; Motghare D
Background: Emergence of polyantimicrobial resistant strains of hospital pathogens has presented a challenge in the provision of good quality in-patient care. Inappropriate use of antibiotics in the hospital is largely responsible for this catastrophe. Bacteriological surveillance of the cases of nosocomial infections is crucial for framing an evidence-based antimicrobial policy for a hospital. Materials and Methods: A prospective study was undertaken among 498 patients from medicine and s...
Gautam Lal; Rajendra Kumar
AIM: Evaluation of Clinico - hematological profile and outcome of cerebral malaria in semi urban hospital situated in endemic area. MATERIAL AND METHODS : A cross - sectional hospital - based study was conducted from August to November, 2014 at Department of Paediatrics SRG Zanana Hospital, Jhalawar Rajasthan. Every child, except who was previously abnormal neurologically, of the age of six month to 12 years, presented with a history of fever in...
VAHID KESHTKAR; NAHID HATAM; EHSANOLAH NIIKAEIN
Introduction: Hospital managers, as one of the most important health care workers, are the subject of continuous education. In some countries around the world, health management education is an important part of health reforms. The aim of present research is to perform evidence-based studies based on assessing hospital managers’ needs. Therefore, it should be considered that educational need assessment regarding hospital managers is essential in today’s health care managemen...
Full Text Available Accurate local prevalence of microbial diseases and microbial resistance data are vital for optimal treatment of patients. However, there are few reports of these data from developing countries, especially from sub-Saharan Africa. The status of Aga Khan University Hospital Nairobi as an internationally accredited hospital and a laboratory with an electronic medical record system has made it possible to analyze local prevalence and antimicrobial susceptibility data and compare it with other published data.We have analyzed the spectrum of microbial agents and resistance patterns seen at a 300 bed tertiary private teaching hospital in Kenya using microbial identity and susceptibility data captured in hospital and laboratory electronic records between 2010 and 2014.For blood isolates, we used culture collection within the first three days of hospitalization as a surrogate for community onset, and within that group, Escherichia coli was the most common, followed by Staphylococcus aureus. In contrast, Candida spp. and Klebsiella pneumoniae were the most common hospital onset causes of bloodstream infection. Antimicrobial resistance rates for the most commonly isolated Gram negative organisms was higher than many recent reports from Europe and North America. In contrast, Gram positive resistance rates were quite low, with 94% of S. aureus being susceptible to oxacillin and only rare isolates of vancomycin-resistant enterococci.The current report demonstrates high rates of antimicrobial resistance in Gram negative organisms, even in outpatients with urinary tract infections. On the other hand, rates of resistance in Gram positive organisms, notably S. aureus, are remarkably low. A better understanding of the reasons for these trends may contribute to ongoing efforts to combat antimicrobial resistance globally.
Full Text Available Background: Diabetic ketoacidosis (DKA is one of the commonly encountered diabetes mellitus emergencies. Aim: This study aimed at describing the clinical profiles and hospitalization outcomes of DKA patients at the University Teaching Hospital (UTH in Lusaka, Zambia and to investigate the role of coma on mortality outcome. Materials and Methods: This was a cross-sectional analytical study of hospitalized DKA patients at UTH. The data collected included clinical presentation, precipitating factors, laboratory profiles, complications, and hospitalization outcomes. Primary outcome measured was all-cause in-hospital mortality. Results: The median age was 40 years. Treatment noncompliance was the single highest identified risk factor for development of DKA, followed by new detection of diabetes, then infections. Comatose patients were significantly younger, had lower baseline blood pressure readings, and higher baseline respiratory rates compared to noncomatose patients. In addition, comatose patients had higher baseline admission random blood glucose readings. Their baseline sodium and chloride levels were also higher. The prevalences of hypokalemia, hypernatremia, and hyperchloremia were also higher among comatose patients compared to noncomatose patients. Development of aspiration during admission with DKA, pneumonia at baseline, development of renal failure, and altered mental status were associated with an increased risk of mortality. Development of renal failure was independently predictive of mortality. Conclusion: The mortality rate from DKA hospitalizations is high at UTH. Treatment noncompliance is the single highest identifiable precipitant of DKA. Aspiration, development of renal failure, altered sensorium, and pneumonia at baseline are associated with an increased risk of mortality. Development of renal failure during admission is predictive of mortality.
Dhrubajyoti J Debnath
Full Text Available Background: Malnutrition is a major public health problem in a developing country like India. Keeping this in mind a study was carried out to find the proportion of under-five children suffering from malnutrition among the under-five hospitalized children and to study co-morbid illnesses and epidemiological factors associated with malnutrition. Methods: This was a hospital-based cross sectional study carried out in the pediatric ward of a tertiary care teaching hospital in Pune, India. All under-five children suffering from malnutrition were studied over a period of 1 month. Results: Total number of under five children diagnosed as malnourished were 47 (39.83%. Moderate and severe/very severe malnutrition was statistically significantly higher in a girl child. The proportion of moderate and severe/very severe malnutrition was higher in low birth weight babies, children who were incompletely immunized for age. Faulty infant feeding practice was observed in 28 (59.6% children. Some of the co-morbid illnesses contributing to morbidity in the malnourished child were acute diarrheal diseases, acute respiratory infection, anemia, and septicemia. Conclusion: A large proportion of hospitalized children were malnourished. Girl child suffered from moderate to severe forms of malnutrition as compared to male child and this was the only statistically significant association. This may be due to neglect of girl child.
Full Text Available Abstract Background Tuberculosis (TB is an established occupational disease affecting health care workers (HCWs. Determining the risk of TB among HCWs is important to enable authorites to take preventative measures in health care facilities and protect HCWs. This study was designed to assess the incidence of TB in a teaching hospital in Istanbul, Turkey. This study is retrospective study of health records of HCWs in our hospital from 1991 to 2000. Results The mean workforce of the hospital was 3359 + 33.2 between 1991 and 2000. There were 31 cases (15 male meeting the diagnostic criteria for TB, comprising eight doctors, one nurse and 22 other health professionals. Mean incidence of TB was 96 per 100,000 for all HCWs (relative risk: 2.71, 79 per 100,000 for doctors (relative risk: 2.2, 14 per 100,000 for nurses and 121 per 100,000 (relative risk: 3.4 for other professionals. The mean incidence of TB in Turkey between 1991 and 2000 was 35.4 per 100,000. Incidence of TB was similar in the Departments of Chest Diseases and Clinical Medicine but there were no TB cases in the Basic Science and Managerial Departments. Conclusion HCWs in Turkey who work in clinics have an increased risk for TB. Post-graduate education and prevention programs reduce the risk of TB. Control programs to prevent nosocomial transmission of TB should be established in hospitals to reduce risk for HCWs.
Full Text Available Introduction: Hospital managers, as one of the most important health care workers, are the subject of continuous education. In some countries around the world, health management education is an important part of health reforms. The aim of present research is to perform evidence-based studies based on assessing hospital managers’ needs. Therefore, it should be considered that educational need assessment regarding hospital managers is essential in today’s health care management. Methods: A total of 26 hospital managers were surveyed using a data gathering form (questionnaire including 59 open questions designed in order to obtain data in 3 different areas. These included managers’ insight towards job duties and the capabilities required to fulfill their duty along with educational needs determined by managers. The next step involved presenting standard description of job duties to hospitals managers and asking them to document their educational needs regarding capabilities required to fulfill their duties. The standard description of job duties originated from ISO 9001 certified hospitals. For each manager, a score ranging from 0 to 19 was attained. For each correct matched statement, a positive point was considered and in the case of unmatched statements, managers received no points. Results: Out of 26 participating managers, only 20 did state the educational needs of hospitals managers. In describing job duties of hospital managers, the mean scores regarding hospital managers of public sector was 10.27 while it was 8 with private hospital managers. Conclusion: The findings of our study indicate that hospital managers as the leaders of the most sophisticated health care facilities delivering expensive complicated services need proper training regarding job competency. Therefore, it seems that continuous need assessment in this area should be carried out.
Full Text Available BACKGROUND: The emergency regarding recent immigration waves into Italy makes continued healthcare monitoring of these populations necessary. METHODS: Through a survey of hospital admissions carried out during the last five years at the S. Orsola-Malpighi General Hospital of Bologna (Italy, all causes of admission of these subjects were evaluated, together with their correlates. Subsequently, we focused on admissions due to infectious diseases. All available data regarding foreign citizens admitted as inpatients or in Day-Hospital settings of our teaching hospital from January 1, 1999, to March 31, 2004, were assessed. Diagnosis-related group (DRG features, and single discharge diagnoses, were also evaluated, and a further assessment of infectious diseases was subsequently made. RESULTS: Within a comprehensive pool of 339,051 hospitalized patients, foreign citizen discharges numbered 7,312 (2.15%, including 2,542 males (34.8% and 4,769 females (65.2%. Males had a mean age of 36.8±14.7 years, while females were aged 30.8±12.2 years. In the assessment of the areas of origin, 34.6% of hospitalizations were attributed to patients coming from Eastern Europe, 15.3% from Northern Africa, 7.3% (comprehensively from Western Europe and United States, 6.9% from the Indian subcontinent, 5.9% from sub-Saharan Africa, 5.7% from Latin America, 4.1% from China, 2.5% from the Philippines, and 1.1% from the Middle East. Among women, most hospitalizations (58.8% were due to obstetrical-gynecological procedures or diseases, including assistance with delivery (27.1%, and pregnancy complications (18.7%, followed by psycho-social disturbances (5.9%, malignancies (5.1%, gastrointestinal diseases (4.7%, and voluntary pregnancy interruption (4.4%. Among men, the most frequent causes of admissions were related to trauma (15.9%, followed by gastroenteric disorders (12%, heart-vascular diseases (8.9%, psycho-social disorders (8.4%, respiratory (7.1%, kidney (6.1%, liver
Comparison of prescribing and adherence patterns of anti-osteoporotic medications post-admission for fragility type fracture in an urban teaching hospital and a rural teaching hospital in Ireland between 2005 and 2008.
INTRODUCTION: Poor adherence reduces the potential benefits of osteoporosis therapy, lowering gains in bone mineral density resulting in increased risk of fractures. AIM: To compare prescribing and adherence patterns of anti-osteoporotic medications in patients admitted to an urban teaching hospital in Ireland with a fragility type fracture to patients admitted to a rural hospital in the North Western region. METHODOLOGY: We identified all patients >55 years admitted to Sligo General Hospital between 2005 and 2008 with a fragility fracture (N = 744) using the hospital in-patient enquiry system (HIPE). The medical card number of those patients eligible for the primary care reimbursement services scheme (PCRS) facilitated the linkage of the HSE-PCRS scheme database to the HIPE database which enabled a study to identify persistence rates of patients prescribed osteoporosis therapy after discharge. The results were compared to the findings of a similar study carried out in St. James\\'s Hospital, Dublin. RESULTS: The 12 months post-fracture prescribing increased from 11.0 % (95 % CI 9.6, 12.4) in 2005 to 47 % (95 % CI 43.6, 50.3) in 2008 in the urban setting and from 25 % (95 % CI 21.5, 28.9) to 39 % (95 % CI 34.5, 42.7) in the rural setting. Adherence levels to osteoporosis medications at 12 months post-initiation of therapy was <50 % in both study groups. Patients on less frequent dosing regimes were better adherers. CONCLUSION: The proportion of patients being discharged on anti-osteoporosis medications post-fragility fracture increased between 2005 and 2008 in both patient groups. Sub-optimal adherence levels to osteoporosis medications continue to be a major concern.
Danny A Asogun
Full Text Available BACKGROUND: Lassa fever is a viral hemorrhagic fever endemic in West Africa. However, none of the hospitals in the endemic areas of Nigeria has the capacity to perform Lassa virus diagnostics. Case identification and management solely relies on non-specific clinical criteria. The Irrua Specialist Teaching Hospital (ISTH in the central senatorial district of Edo State struggled with this challenge for many years. METHODOLOGY/PRINCIPAL FINDINGS: A laboratory for molecular diagnosis of Lassa fever, complying with basic standards of diagnostic PCR facilities, was established at ISTH in 2008. During 2009 through 2010, samples of 1,650 suspected cases were processed, of which 198 (12% tested positive by Lassa virus RT-PCR. No remarkable demographic differences were observed between PCR-positive and negative patients. The case fatality rate for Lassa fever was 31%. Nearly two thirds of confirmed cases attended the emergency departments of ISTH. The time window for therapeutic intervention was extremely short, as 50% of the fatal cases died within 2 days of hospitalization--often before ribavirin treatment could be commenced. Fatal Lassa fever cases were older (p = 0.005, had lower body temperature (p<0.0001, and had higher creatinine (p<0.0001 and blood urea levels (p<0.0001 than survivors. Lassa fever incidence in the hospital followed a seasonal pattern with a peak between November and March. Lassa virus sequences obtained from the patients originating from Edo State formed--within lineage II--a separate clade that could be further subdivided into three clusters. CONCLUSIONS/SIGNIFICANCE: Lassa fever case management was improved at a tertiary health institution in Nigeria through establishment of a laboratory for routine diagnostics of Lassa virus. Data collected in two years of operation demonstrate that Lassa fever is a serious public health problem in Edo State and reveal new insights into the disease in hospitalized patients.
Aguinel José Bastian Júnior; Marcos Francisco Dall'Oglio; Alexandre Crippa; Getúlio Rodrigues de Oliveira Filho; Luís Felipe Piovesan; Ricardo Kupka da Silva; Leite, Katia R. M.; Miguel Srougi
Purposes(a) To externally validate the Crippa and colleagues’ nomograms combining PSA, percentage of positive biopsy cores (PPBC) and biopsy Gleason score to predict organ-confined disease (OCD) in a contemporary sample of patients treated at a tertiary teaching institution. (b) To adjust such variables, resulting in predictive nomograms for OCD and seminal vesicle invasion (SVI): the USP nomograms.Materials and MethodsThe accuracy of Crippa and colleagues’ nomograms for OCD prediction was ex...
Full Text Available Objective: To isolate, identify and phenotypically characterize extended spectrum beta-lactamase (ESBL-producing Escherichia coli and Klebsiella spp in Manipal Teaching Hospital. Methods: Cross sectional study was conducted among E. coli and Klebsiella spp recovered from patients’ various samples to establish the prevalence of organisms producing ESBL in Manipal Teaching Hospital, Pokhara, Nepal between October 2011 and April 2012. ESBL production was detected by Clinical laboratory Standards Institute (CLSI recommendations. Results: E. coli (n=285 and Klebsiella spp (n=55 were isolated from various clinical samples. The specimens were urine 255 (75%, blood 18 (5.3%, pus 48 (14.1%, sputum 17 (5.1%, and body fluid 2 (0.6%. Seventy six (22.4% were ESBL producing organisms by phenotypic confirmatory test with double disk diffusion method. ESBL group of organisms showed 100% resistance to ampicillin and cefotaxime. All the organisms in this study were 100% sensitive to imipenem and 95.6% sensitive to cefoperazone+sulbactam combination. ESBL producing isolates showed high rate of resistance to ciprofloxacin (90.7%, ceftriaxone (89.4%, ceftazidime (89.4%, cotrimoxazole (90.4% and norfloxacin (88.1% as compared to non-ESBL group. Conclusion: ESBL producing E. coli and Klebsiella spp showed high prevalence in Nepal. Routine laboratory testing for ESBL in Nepalese hospitals is needed in order to optimize antibiotic management and reduce the risk of spread of infections caused by ESBL producers. J Microbiol Infect Dis 2015;5(2: 69-75
Full Text Available Background Multidrug resistant (MDR and extensively drug resistant (XDR Acinetobacter baumannii are among important causes of nosocomial infections and cause therapeutic problems worldwide. The emergence of extensively drug-resistant A. baumannii (XDRAB cause serious threats to hospital acquired infections (HAI worldwide and further limit the treatment options. Objectives The current study aimed to identify and isolate the MDR and XDR Acinetobacter baumannii from different wards of a teaching hospital in Isfahan, Iran, and determine the susceptibility pattern of these bacteria. Materials and Methods One hundred and twenty one (121 isolates of A. baumannii collected from a teaching hospital in Isfahan, Iran, within eight months (between September 2013 and April 2014 were included in the current study. The samples were isolated from different wards and different specimens. To confirm the species of A. baumannii, Polymerase chain reaction (PCRwas conducted to identify blaoxa-51 gene. Disk diffusion method was employed to evaluate antimicrobial susceptibility against cefotaxime, ceftriaxone, ampicillin-sulbactam, cefepime, meropenem, tobramycin, amikacin, tetracycline, ciprofloxacin, trimethoprim- sulfamethoxazole, and aztreonam. Results Among the 121 isolated A. baumannii, 44% and 56% were isolated from female and male, respectively. Samples cultured from the trachea (36%, urine (15%, blood (10%, wound (10%, cerebrospinal fluid (7%, bronchial (4% and the others (18%. Most of the isolates (50% were obtained from intensive care unit (ICU. Isolated A. baumannii showed high resistance to the evaluated antibiotics except ampicillin-sulbactam, which showed only 33.9% resistance. Also, 62.8% and 100% of the isolates were identified as XDR and MDR. Conclusions The result of the current study showed the growing number of nosocomial infections associated with XDR A. baumannii causing difficulties in antibiotic therapy. Resistant strains increasingly cause
Full Text Available Aim: Spontaneous voluntary adverse drug reaction (ADR reporting is paramount to the success of the Pharmacovigilance Programme of India. There has however been minimal and sporadic voluntary reporting of ADR's at the ADR Monitoring Centre (AMC Gangtok, Sikkim. Knowledge, perception, attitude, and awareness of health professionals are determinants of reporting practices. This questionnaire study aims at evaluating these indicators in the teaching hospital attached to the Medical Institute and find out methods to improve existing reporting practices. Materials and Methods: This is a cross-sectional questionnaire-based observational study carried out in the Medical, Surgical and Pathology Departments of the Teaching Hospital, Gangtok, Sikkim over a period of 2 months. The questionnaires were filled by the respondents and returned back to us within the next 24 h. Data obtained from filled questionnaires were thereby analyzed. Results: The overall correct response rate to the knowledge-based questions was 56.3%. While 97% of respondents were of the view that ADR reporting was necessary, 35% of the respondents felt that the difficulty in deciding the causality of an ADR discouraged them from reporting. 79% of the respondents were not aware of the presence of an AMC affiliated to the hospital, and 87% of the respondents admitted that they were not sending filled ADR forms to the AMC. Conclusions: The study indicates that the respondents have an average knowledge and positive attitude toward ADR reporting and pharmacovigilance. There is however a lack of awareness and poor ADR reporting practices. Efforts are required to enhance awareness and attitude toward pharmacovigilance and ADR reporting.
Full Text Available Aim To monitor the adverse drug reactions (ADRs caused by antihypertensive medicines prescribed in a university teaching hospital.Methods:he present work was an open, non-comparative, observational study conducted on hypertensive patients attending the Medicine OPD of Majeedia Hospital, Jamia Hamdard, New Delhi, India by conducting patient interviews and recording the data on ADR monitoring form as recommended by Central Drugs Standard Control Organization (CDSCO, Government of India.Results:A total of 21 adverse drug reactions were observed in 192 hypertensive patients. Incidence of adverse drug reactions was found to be higher in patients more than 40 years in age, and females experienced more ADRs (n = 14, 7.29 % than males, 7 (3.64 %. Combination therapy was associated with more number of adverse drug reactions (66.7 % as against monotherapy (33.3 %. Calcium channel blockers were found to be the most frequently associated drugs with adverse drug reactions (n = 7, followed by diuretics (n = 5, and beta- blockers (n = 4. Among individual drugs, amlodipine was found to be the commonest drug associated with adverse drug reactions (n = 7, followed by torasemide (n = 3. Adverse drug reactions associated with central nervous system were found to be the most frequent (42.8 % followed by musculo-skeletal complaints (23.8 % and gastro-intestinal disorders (14.3 %. Conclusions:The present pharmacovigilance study represents the adverse drug reaction profile of the antihypertensive medicines prescribed in our university teaching hospital. The above findings would be useful for physicians in rational prescribing. Calcium channel blockers were found to be the most frequently associated drugs with adverse drug reactions.
Jim Tsaltas; Gab Kovacs; Jenny Dennis; Amanda Pratt
The establishment of a laparoscopically assisted hysterectomy program at Box Hill Hospital is described. The first eight cases have been reviewed and recommendations are made to other gynaecology units who wish to establish a minimally invasive gynaecological surgery unit.
Francois, P.; Vinck, D.; Labarere, J.; Reverdy, T; Peyrin, J.
Background: Successful implementation of continuous quality improvement (CQI) programs in hospitals remains rare in all countries, making it necessary to experiment with implementation methods while considering the cultural factors of resistance to change.
Akinlolu Tolulope Jegede
Conclusion: A large number of dentists practicing in the tertiary hospital had good oral health practices and good oral health knowledge. However, the proportion of dentists with good caries prevention practices was low.
Full Text Available Quality service delivery to the consumer of health is a legal reality as it is emphasised in the White Paper on the Transformation of Public Service delivery (South Africa, 1997. The guiding philosophy adopted within this framework is that of Batho Pele, which means placing the consumer at the centre of healthcare service delivery. Increasing attention has been paid to hospital processes from a quality perspective. By analogy, outpatient departments can be viewed as industrial plants where technological know-how is transferred to patients through service delivery, which is a cornerstone of a hospital’s business. Outpatients, as consumers of healthcare, draw conclusions about the quality of service delivery based on their experiences of such services. In this vein, an outpatient’s experience of a particular service is an indicator of his/her level of satisfaction with the quality of that service. No South African study can be found in the literature on out-patients’ experiences of quality service delivery. This study’s purpose is to explore and describe outpatients’ experiences of the quality of service delivery at a teaching hospital in Gauteng. A qualitative, explorative, descriptive study that was contextual in nature was conducted to achieve this aim. Focus group interviews were conducted with outpatients who met the selection criteria. Open coding was used to analyse the contents from the transcripts and field notes typed verbatim. Strategies for trustworthiness, namely co-coding, prolonged engagement, triangulation and adequate referencing, were employed to ensure the credibility of the study and research findings. The results reflect themes that were reduced into two main categories, namely positive and negative experiences. The positive experiences reflect outpatients’ experience of their relationship with medical staff and their satisfaction with the quality of medical care. Negative experiences relate predominantly to a lack
Full Text Available Introduction: Recognition and implementation of knowledge management have an important effect on improving the quality of hospital activities. According to the direct relationship with the society’s health, health and treatment departments need knowledgeable and skillful staff. Thus, this research investigated different dimensions of the knowledge management processes in teaching hospitals of Shiraz University of Medical Sciences in 2014. Method: This cross-sectional analytical study was performed on 103 top and middle-ranked managers of Shiraz University of Medical Sciences hospitals. The instrument was a valid and reliable questionnaire containing six knowledge management dimensions. Data were analyzed in SPSS software version 16, using the one-sample t-test and ANOVA. Results: The results of the study showed that among the processes of knowledge management dimensions, “acquisition and knowledge creation”(mean=3.2 and “strategy and policy of knowledge” (mean=3.13 had the highest ranks and “assessment and feedback of knowledge” (mean=2.86 and “knowledge sharing” (mean=2.61 were at the lowest levels. The comparison between these six dimensions demonstrated that there were significant relationships among “strategy and policy of knowledge” and “acquisition and knowledge creation” (p=0.047,“strategy and policy of knowledge” and “organizing and documenting of knowledge” (p=0.206, “organizing and documenting of knowledge” and “knowledge sharing” (p=0.259, “organizing and documenting of knowledge” and “use and reuse of knowledge” (p=0.325, “use and reuse of knowledge”, and “knowledge sharing” (p=0.100. Conclusion: According to the results, the conditions of “strategy and policy of knowledge” and “acquisition and knowledge creation” dimensions are at the average level and other dimensions of knowledge management processes are poor in teaching hospitals of Shiraz University of Medical
Gediwon Negash; Yonathan Kebede; Segewkal Hawaze
Background: The emergency unit is a high risk environment for inappropriate medication use due to stressors and time sensitive nature of the service. Objective: To assess incidence and type of Medication Errors in Tikur Anbesa Specialized Hospital. Materials and Methods: A prospective cross-sectional study was conducted on the interventions by prescribing physicians and attending nurses for patients seen at the emergency unit of Tikur Anbesa Specialized Hospital from May 2-20, 2011. Data ...
Van Balen, Joany; Mowery, Jade; Piraino-Sandoval, Micha; Nava-Hoet, Rocio C; Kohn, Catherine; Hoet, Armando E.
The role that environmental contamination might play as a reservoir and a possible source of Methicillin-resistant Staphylococcus aureus (MRSA) for patients and personnel at equine veterinary hospitals remains undefined, as the environment has only been monitored during outbreaks or for short periods. Therefore, the objectives of this study were to determine the monthly presence, distribution, and characteristics of environmental MRSA at an equine hospital, and to establish patterns of contam...
Chigozie Jesse Uneke; Chinwendu Daniel Ndukwe; Patrick Gold Oyibo; Kingsley Onuoha Nwakpu; Richard Chukwuka Nnabu; Nittita Prasopa-Plaizier
Background: Health care-associated infection remains a significant hazard for hospitalized patients. Hand hygiene is a fundamental action for ensuring patient safety. Objective: To promote adoption of World Health Organization Hand Hygiene Guidelines to enhance compliance among doctors and nurses and improve patient safety. Methods: The study design was a cross sectional intervention in a Federal Teaching Hospital South-eastern Nigeria. Interventions involved training/education; introduct...
Endalkachew Admassie; Tesfahun Melese; Woldeselassie Mequanent; Wubshet Hailu; B Akshaya Srikanth
The aim of this study was to assess the extent of poly-pharmacy, occurrence, and associated factors for the occurrence of drug–drug interaction (DDI) and potential adverse drug reaction (ADR) in Gondar University Teaching Referral Hospital. Institutional-based retrospective cross-sectional study. This study was conducted on prescriptions of both in and out-patients for a period of 3 months at Gondar University Hospital. Both bivariate analysis and multivariate logistic regression were used to...
Full Text Available In this article we approach the ecological thinking in the Brazilian Cordel literature which, by relating areas like nature, environment, religion, technique, science, teaching, citizenship and the denunciation of inequalities and injustices against people, living and non-living beings, shapes a cycle that the Brazilian Educational System is giving more and more attention to.Abordamos en este artículo el pensamiento ecológico de la literatura de cordel brasileña, que, al relacionar áreas como la naturaleza, el medio ambiente, la religión, la técnica, la ciencia, la enseñanza, la ciudadanía y la denuncia de desigualdades e injusticias contra personas, seres vivos y no vivos, configura un ciclo al que la Escuela brasileña está prestando cada vez más atención.
The research of the sentinel lymph node in early breast cancer, an already worldwide established method, was standardized at the teaching hospital 'Hospital das Clinicas' in Belo Horizonte (MG, Brazil). This standardization was carried out from December 2000 through December 2002, in which 39 patients were included in a learning curve and method validation. The applied methodology is based on the combination of a lymphoscintillography and the blue stain. A periareolar colloid 99mTc injection was given 24 hours before the surgery. The blue dye was injected in the peritumoral region during the surgery. The sentinel lymph node was identified by the blue color pattern of the lymph node and by the use of a portable gamma probe detector. Radioactive contamination was evaluated before, during and after the surgery. The measurement of the radioactivity of the breast area was taken by using a GM detector and an ionization chamber on a humid piece of gauze (passed on the breast area), from which the radioactivity was recorded as well as the gloves used during the surgery, and the gauzes with contaminated blood. The sentinel lymph node identification rate was found to be 95%, there was a false negative rate of 4,8% and a predictive negative value (PNV) of 94%. The identification figures, the predictive negative value and the false negative rate were similar to the figures found in technical literature. The technique of the biopsy of the sentinel lymph node (BSL) is the method chosen for staging patients with invasive breast cancer and with clinically negative results for the armpit. The combined method using radio-colloid and the stain is the most indicated. There is a minimum radio isotopic contamination and there is scarcely any danger for the patient or the medical staff involved in the procedure. (author)
Full Text Available Background: Psychological Capital (PsyCap is a core construct in the literature of positive psychology. However, there is considerably less evidence on its positive effects on Employee Attitudes (EA and Employee Performance (EP. Purpose: The objective of this study was to provide empirical evidence on the relationships between PsyCap, EA and EP. This paper also seeks to present the theoretical development of PsyCap, Job Satisfaction (JS, Organizational Commitment (OC, EP and their application to employees at Teaching Hospitals practices. Research Design/Methodology: To assess positive PsyCap refer to (PsyCap Questionnaire, Luthans et al., 2006, JS (JS Survey, Judge & Bono, 2001; and Best & Thurston, 2004, OC (OC Questionnaire, Porter et al., 1974; and Trimble, 2006. EP (EP Questionnaire, Black & Porter, 1991; and Caligiuri, 1997. Out of the 357 questionnaires that were distributed to employees at Teaching Hospitals in Egypt, 315 usable questionnaires were returned, a response rate of 88%. Findings: The results indicated the expected significant positive relationships between PsyCap, JS, OC and EP. In other words, self-efficacy, optimism, hope and resilience significantly correlated with EA and EP. The results also supported the hypothesized model. The study findings support the view that PsyCap, JS, OC, and EP are related constructs. Practical Implications: The study suggests that Teaching Hospitals in Egypt can improve EA and EP by influencing its PsyCap, specifically, by developing self-efficacy, optimism, hope and resilience. The study provided that it is necessary to pay more attention to the dimensions of PsyCap as a key source for organizations to enhance the competitive advantage which is of prime significance for EA and EP. Originality/Value: Preliminary evidence of the psychometric properties of the PCQ-24, which measures the construct of PsyCap (hope, self-efficacy, resilience and optimism on an Egyptian sample, was provided in this
Full Text Available NJ Obiechina, VE Okolie, ZC Okechukwu, CF Oguejiofor, OI Udegbunam, LSA Nwajiaku, C Ogbuokiri, R Egeonu Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria Background: Maternal mortality is high the world over, especially in sub-Saharan Africa, including Nigeria. Nigeria has consistently demonstrated one of the most abysmally poor reproductive health indices in the world, maternal mortality inclusive. This is a sad reminder that, unless things are better organized, Southeast Nigeria, which Nnamdi Azikiwe University Teaching Hospital (NAUTH represents, may not join other parts of the world in attaining Millennium Development Goal 5 to improve maternal health in 2015. Objectives: This study was conducted to assess NAUTH'S progress in achieving a 75% reduction in the maternal mortality ratio (MMR and to identify the major causes of maternal mortality. Materials and methods: This was a 10-year retrospective study, conducted between January 1, 2003 and December 31, 2012 at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Southeast Nigeria. Results: During the study period, there were 8,022 live births and 103 maternal deaths, giving an MMR of 1,284/100,000 live births. The MMR was 1,709 in 2003, reducing to 1,115 in 2012. This is to say that there was a 24.86% reduction over 10 years, hence, in 15 years, the reduction should be 37%. This extrapolated reduction over 15 years is about 38% less than the target of 75% reduction. The major direct causes of maternal mortality in this study were: pre-eclampsia/eclampsia (27%, hemorrhage (22%, and sepsis (12%. The indirect causes were: anemia, anesthesia, and HIV encephalopathy. Most of the maternal deaths occurred in unbooked patients (98% and within the first 48 hours of admission (76%. Conclusion: MMRs in NAUTH are still very high and the rate of reduction is very slow. At this rate, it will take this health facility 30 years, instead of 15 years, to
O. A. Mokuolu
Full Text Available In Nigeria, over 900,000 children under the age of five years die every year. Early neonatal death is responsible for a little over 20% of these deaths. Prematurity remains a significant cause of these early neonatal deaths. In some series, it is reported to be responsible for 60-70% of these deaths. This study aimed to determine the prevalence and determinants of pre-term deliveries at the University of Ilorin Teaching Hospital, Ilorin. This was a prospective cohort study conducted over a 9-month period at the University of Ilorin Teaching Hospital. Records of deliveries and data on maternal socio-biological and antenatal variables were collected during this period in order to determine the prevalence and determinants of pre-term deliveries. Out of the 2,489 deliveries that took place over a 9-month period, there were 293 pre-terms, giving a pre-term delivery rate of 120 per 1,000 deliveries. Of the total deliveries, 1,522 singleton deliveries that satisfied inclusion criteria were recruited; 185 of them were pre-term deliveries giving a case:control ratio of 1:7. Significant determinants of pre-term delivery identified were previous pre-term delivery (P=0.001; OR=3.55; 95% CI=1.71-7.30, antepartum hemorrhage (P=0.000; OR=8.95; 95%CI=4.06-19.78, premature rupture of the membranes (P=0.000; OR=6.48; 95%CI=4.33-9.67, maternal urinary tract infection (P=0.006; OR=5.89; 95%CI=1.16-27.57, pregnancy induced hypertension (P=0.007; OR=3.23; 95%CI=2.09-4.99, type of labor (P=0.000; OR=6.44; 95%CI=4.42-9.38 and booking status (P=0.000; OR=4.67; 95%CI=3.33-6.56. The prevalence of pre-term delivery was 120 per 1,000 live births. Factors significantly associated with pre-term delivery were low socio-economic class, previous pre-term delivery, antepartum hemorrhage, premature rupture of fetal membranes, urinary tract infection, pregnancy induced hypertension, induced labor, and booking elsewhere outside the teaching hospital.
Hass, Meike; Gabriel, Martin; Ölschläger, Stephan; Becker-Ziaja, Beate; Folarin, Onikepe; Phelan, Eric; Ehiane, Philomena E.; Ifeh, Veritas E.; Uyigue, Eghosasere A.; Oladapo, Yemisi T.; Muoebonam, Ekene B.; Osunde, Osagie; Dongo, Andrew; Okokhere, Peter O.; Okogbenin, Sylvanus A.; Momoh, Mojeed; Alikah, Sylvester O.; Akhuemokhan, Odigie C.; Imomeh, Peter; Odike, Maxy A. C.; Gire, Stephen; Andersen, Kristian; Sabeti, Pardis C.; Happi, Christian T.; Akpede, George O.; Günther, Stephan
Background Lassa fever is a viral hemorrhagic fever endemic in West Africa. However, none of the hospitals in the endemic areas of Nigeria has the capacity to perform Lassa virus diagnostics. Case identification and management solely relies on non-specific clinical criteria. The Irrua Specialist Teaching Hospital (ISTH) in the central senatorial district of Edo State struggled with this challenge for many years. Methodology/Principal Findings A laboratory for molecular diagnosis of Lassa fever, complying with basic standards of diagnostic PCR facilities, was established at ISTH in 2008. During 2009 through 2010, samples of 1,650 suspected cases were processed, of which 198 (12%) tested positive by Lassa virus RT-PCR. No remarkable demographic differences were observed between PCR-positive and negative patients. The case fatality rate for Lassa fever was 31%. Nearly two thirds of confirmed cases attended the emergency departments of ISTH. The time window for therapeutic intervention was extremely short, as 50% of the fatal cases died within 2 days of hospitalization—often before ribavirin treatment could be commenced. Fatal Lassa fever cases were older (p = 0.005), had lower body temperature (p<0.0001), and had higher creatinine (p<0.0001) and blood urea levels (p<0.0001) than survivors. Lassa fever incidence in the hospital followed a seasonal pattern with a peak between November and March. Lassa virus sequences obtained from the patients originating from Edo State formed—within lineage II—a separate clade that could be further subdivided into three clusters. Conclusions/Significance Lassa fever case management was improved at a tertiary health institution in Nigeria through establishment of a laboratory for routine diagnostics of Lassa virus. Data collected in two years of operation demonstrate that Lassa fever is a serious public health problem in Edo State and reveal new insights into the disease in hospitalized patients. PMID:23029594
It is proposed that literature can contribute to the teaching of human values in pharmaceutical education. Two texts illustrating pertinent issues are examined, and the process and relevance of literature instruction in humanistic education are discussed. Where, when, and why to integrate literature into the pharmacy curriculum are also addressed.…
Nutrition Screening Week results from 2010 and 2011 indicated that one in three to four patients admitted to Irish Hospitals are at risk of disease-related malnutrition, 74-75% of whom are at high risk1. Nutrition screening tools are used to screen for malnutrition risk. One such tool, the Malnutrition Universal Screening Tool (MUST)2 is a practical, easy to use tool that often takes ≤5 minutes to complete. MUST has been validated across care settings and across patient populations, and has been recommended for use in Irish Hospitals by the Department of Health and Children as part of standard care3. The National Institute for Health and Clinical Excellence in the UK has demonstrated significant financial savings associated with the use of routine nutrition screening, in part due to reduced length of hospital stay4. The Irish Society for Clinical Nutrition and Metabolism (IrSPEN) has also demonstrated this5
Ibadin, O. K.
Full Text Available Male Urogenital tract infection plays an important role in men infertility. Asymptomtic bacteriospermia has been regarded as of the contributing factor to male infertility. In this study, 87 semen samples of infertile men attending the Human Reproduction Research Programme and Invitrofertilization unit (HRRP/IVF of University Benin Teaching Hospital were evaluated Bacteriologically using standard Bacterial culture method. Standard semen analysis was performed according to WHO guidelines. Among the total cases, 36 (41.4% showed at least one pathogen. Staphylococcus aureus (16.1%, Staphylococcus Saprophyticus (9.1%, Escherichia Coli (6.9% Proteus mirabilis (3.4% Klebsiella spp (2.3% Pseudomonas aerouginosa (1.1% and Proteus vulgaris (2.3%. There was a significant relation between bacteriospermia and the rate of number of total motility and morphologically abnormal sperms (p 0.05. It seems that leukocytopermia is not a good maker to predict bacteriospermia.
Intrahospital spread of carbapenem-resistant Pseudomonas aeruginosa in a University Hospital in Florianópolis, Santa Catarina, Brazil Disseminação Intrahospitalar de Pseudomonas aeruginosa em Hospital Universitário de Florianópolis, Santa Catarina, Brasil
Mara Cristina Scheffer; Maria Luiza Bazzo; Mario Steindel; Ana Lucia Darini; Eduardo Clímaco; Libera Maria Dalla-Costa
INTRODUCTION: Carbapenem-resistant Pseudomonas aeruginosa (CRPA) has been isolated with increasing frequency in Brazilian hospitals. Since June 2003, its detection in a teaching hospital in the city of Florianópolis, Brazil, has increased. This study aimed to investigate the minimal inhibitory concentration (MIC), presence of Metallo-β-lactamase (MβL) and a possible clonal relationship among the isolates. METHODS: The study included 29 CRPA and seven isolates with reduced susceptibi...
... Care Hospital Prospective Payment System final rule (FY 2013 IPPS/LTCH PPS final rule (77 FR 53434... November 24, 2010 Calendar Year (CY) 2011 Outpatient Prospective Payment System (OPPS) final rule (75 FR... comment period, a copy of the FY 2013 IPPS/LTCH PPS final rule (77 FR 53434 through 53447), and a list...
Niegsch, Mark; Fabritius, Maria Louise; Anhøj, Jacob
In 2007, the initiation of a patient safety campaign led to the introduction of Ward Observational Charts (WOC) and Medical Early Warning Score (MEWS) at Naestved Regional Hospital. This included systematic measuring of vital signs of all patients in order to prevent patient deterioration and...
Conclusion: Incidence and types of medication errors committed in Tikur Anbesa Specialized Hospital Adult Emergency Unit were substantiated; moreover, necessary information on factors within the healthcare delivery system that predispose healthcare professionals to commit errors have been pointed, which should be addressed by healthcare professionals through multidisciplinary efforts and involvement of decision makers at national level.
Conclusions: The study accomplished that ADRs are widespread and a few of them raised the healthcare expenditure due to the increased hospital stay. The reporting of ADRs to regional pharmacovigilance centres should be encouraged to ensure drug safety. [Int J Basic Clin Pharmacol 2016; 5(1.000: 209-212
Gabriela Favaro Faria Guerrer
Full Text Available The objective of this exploratory study was to describe and map out the billing process in a public tertiary-level university hospital specialized in cardiology and pulmonology. In the period between May and June of 2012, we identified and documented the steps in the process validated by the professionals involved in the hospital bill audit service. We found that during billing pre-analysis, auditors make corrections to justify the billing of procedures and to avoid unwarranted billing and loss of revenue. Mapping out the process allowed us to propose strategies to minimize the time for presenting bills to payment sources. By bringing visibility to this process, which is fundamental for the economic-financial balance of the studied hospital, we bring such knowledge to the public domain. Thus, it is accessible to other health organizations that wish to increment their revenue and reduce divergences between patient charts and the patient’s hospital bill. doi: 10.5216/ree.v16i3.23487.
Sachin C. Deorukhkar
Full Text Available Health care associated infections (HCAIs add incrementally to the morbidity, mortality, and cost expected of the patient’s underlying diseases alone. Approximately, about half all cases of HCAIs are associated with medical devices. As Candida medical device-associated infection is highly drug resistant and can lead to serious life-threatening complications, there is a need of continuous surveillance of these infections to initiate preventive and corrective measures. The present study was conducted at a rural tertiary care hospital of India with an aim to evaluate the rate of medical device-associated Candida infections. Three commonly encountered medical device-associated infections (MDAI, catheter-associated urinary tract infection (CA-UTI, intravascular catheter-related blood stream infections (CR-BSI, and ventilator-associated pneumonia (VAP, were targeted. The overall rate of MDAI in our hospital was 2.1 per 1000 device days. The rate of Candida related CA-UTI and CR-BSI was noted as 1.0 and 0.3, respectively. Untiring efforts taken by team members of Hospital Acquired Infection Control Committee along with maintenance of meticulous hygiene of the hospital and wards may explain the low MDAI rates in our institute. The present surveillance helped us for systematic generation of institutional data regarding MDAI with special reference to role of Candida spp.
Full Text Available Communicable and respiratory tract diseases especially chronic obstructive pulmonary diseases are the main reasons of admission in medical ward of low and middle income countries. This is different from the developed countries where non communicable diseases are the main reasons of hospital admission. In developing countries the data of hospital admission are still lacking. Therefore this study will help us to assess the common patterns of diseases admitted in a medical ward, the average length of hospital stay etc. The record of 1040 hospitalized patients in medical ward was analyzed for the period of six months from Jan 2010 to Jun 2010. Patient’s medical records were retrieved and data analysis was done to obtain age, sex, common diagnosis, the affected system and the duration of the hospital stay. The data was analyzed by using SPSSV 16. After reviewing the data the most common age of patients being admitted were between 46-65 years (31.5% followed by more than 65 years (25% between 26-45 years (21.28% and less than 25 years (21.28%. Among the admitted patients females were more than the males except in neurolog ward. The most effected system was respiratory (31.73 %,and the most common diagnosis was Chronic obstructive pulmonary diseases (23.17%. The next common system involved was gastroenterology including liver (18.64% ,genitourinary (12.01%, cardiovascular ( 11.34%, neurology (9.23%, endocrine (4.80% hematology (2.30%. The cause for hospital admission by infection in different system was (30.08% The average duration of hospital stay of the patients was less than 7 days. The respiratory diseases and the infectious disease are the most common disease in Nepal. The communicable diseases still hold a greater position, while non communicable diseases are main reasons for admission to the medical wards in developed countries. Journal of College of Medical Sciences-Nepal,2012,Vol-8,No-2, 7-11 DOI: http://dx.doi.org/10.3126/jcmsn.v8i2.6831
Ji Yun Noh
Full Text Available BACKGROUND: A well-constructed and properly operating influenza surveillance scheme is essential for public health. This study was conducted to evaluate the distribution of respiratory viruses in patients with influenza-like illness (ILI through the first teaching hospital-based surveillance scheme for ILI in South Korea. METHODS: Respiratory specimens were obtained from adult patients (≥18 years who visited the emergency department (ED with ILI from week 40, 2011 to week 22, 2012. Multiplex PCR was performed to detect respiratory viruses: influenza virus, adenovirus, coronavirus, respiratory syncytial virus, rhinovirus, human metapneumovirus, parainfluenza virus, bocavirus, and enterovirus. RESULTS: Among 1,983 patients who visited the ED with ILI, 811 (40.9% were male. The median age of patients was 43 years. Influenza vaccination rate was 21.7% (430/1,983 during the 2011-2012 season. At least one comorbidity was found in 18% of patients. The positive rate of respiratory viruses was 52.1% (1,033/1,983 and the total number of detected viruses was 1,100. Influenza A virus was the dominant agent (677, 61.5% in all age groups. The prevalence of human metapneumovirus was higher in patients more than 50 years old, while adenovirus was detected only in younger adults. In 58 (5.6% cases, two or more respiratory viruses were detected. The co-incidence case was identified more frequently in patients with hematologic malignancy or organ transplantation recipients, however it was not related to clinical outcomes. CONCLUSION: This study is valuable as the first extensive laboratory surveillance of the epidemiology of respiratory viruses in ILI patients through a teaching hospital-based influenza surveillance system in South Korea.
Full Text Available Background: Tobacco-attributable mortality in India is estimated to be at least 10%. Tobacco cessation is more likely to avert millions of deaths before 2050 than prevention of tobacco use initiation. Objective: To describe the clinico-epidemiological profile of attendees of a tobacco cessation clinic in a teaching hospital in Bangalore city. Materials and Methods: A descriptive study of 189 attendees seen over 2 years in the Tobacco Cessation Clinic of a tertiary-care teaching hospital in Bangalore, with information on socio demographic characteristics, tobacco-use details, nicotine dependence, family/medical history, past quit attempts, baseline stage-of-change, and treatment initiated. Results: Only 5% were ′walk-in′ patients; 98% of attendees were smokers; 97% were males. The mean (±SD age of attendees was 48.0 (±14.0 years. Most participants were married (88%, and predominantly urban (69%. About 62% had completed at least 8 years of schooling. Two-thirds of smokers reported high levels of nicotine dependence (Fagerström score >5/10. About 43% of patients had attempted quitting earlier. Four-fifths (79% of tobacco-users reported a family member using tobacco. Commonly documented comorbidities included: Chronic respiratory disease (44%, hypertension (23%, diabetes (12%, tuberculosis (9%, myocardial infarction (2%, stroke (1%, sexual dysfunction (1% and cancer (0.5%. About 52% reported concomitant alcohol use. At baseline, patients′ motivational stage was: Precontemplation (14%, contemplation (48%, preparation/action (37% and maintenance (1%. Treatment modalities started were: Counseling alone (41%, nicotine replacement therapy alone (NRT (34%, medication alone (13%, and NRT+medication (12%. Conclusions: This is the first study of the baseline profile of patients attending a tobacco cessation clinic located within a chest medicine department in India. Important determinants of outcome have been captured for follow-up and prospective
B. N. Macharia
Full Text Available Problem statement. Suicide is one of the ten leading causes of death in the world, accounting for more than 400,000 deaths annually. The pattern of suicide and the incidence of suicide vary from country to country. Cultural, religious and social values play some role in suicide. Currently, there is no data regarding the incidence of suicide in Kenya. Setting. Moi Teaching and Referral Hospital Mortuary. Study population. A seven-year retrospective study of all the autopsies performed at the Moi Teaching and Referral Hospital was analysed and the cases that were definitely determined as suicides were further studied. Objective. To characterize the pattern of suicide cases through autopsies conducted at MTRH mortuary between the years 2005 to 2012. Methodology. Retrospective descriptive cross-sectional study. Suicide cases were identified from the MTRH autopsy record books. From these record books, the autopsy number was used to retrieve the pathologists autopsy report. Data regarding age, gender and methods of suicide was retrieved and entered into a data collection form. Data analysis: Data collected was analysed using Stata version 10. Results. There were 213 autopsies performed. Majority were male 180(85%. The subjects had a median age of 29(IQR: 23–37 years. Organophosphate poisoning was the most preferred method followed by hanging. Organophosphate poisoning accounted for 195(91.54% and hanging for 17(7.98% of the subjects. Conclusion. The preferred methods of suicide were poisoning and hanging. The study may have missed some cases where the relatives could have declined for the postmortem procedure and hence the body released without postmortem examinations.
Full Text Available Background: Therapeutic drug monitoring (TDM makes use of serum drug concentrations as an adjunct to decision-making. Preliminary data in our hospital showed that approximately one-fifth of all drugs monitored by TDM service were gentamicin. Objective: In this study, we evaluated the costs associated with providing the service in patients with bronchopneumonia and treated with gentamicin. Methods: We retrospectively collected data from medical records of patients admitted to the Hospital Universiti Sains Malaysia over a 5-year period. These patients were diagnosed with bronchopneumonia and were on gentamicin as part of their treatment. Five hospitalisation costs were calculated; (i cost of laboratory and clinical investigations, (ii cost associated with each gentamicin dose, (iii fixed and operating costs of TDM service, (iv cost of providing medical care, and (v cost of hospital stay during gentamicin treatment. Results: There were 1920 patients admitted with bronchopneumonia of which 67 (3.5% had TDM service for gentamicin. Seventy-three percent (49/67 patients were eligible for final analysis. The duration of gentamicin therapy ranged from 3 to 15 days. The cost of providing one gentamicin assay was MYR25, and the average cost of TDM service for each patient was MYR104. The average total hospitalisation cost during gentamicin treatment for each patient was MYR442 (1EUR approx. MYR4.02. Conclusion: Based on the hospital perspective, in patients with bronchopneumonia and treated with gentamicin, the provision of TDM service contributes to less than 25% of the total cost of hospitalization.
van Balen, Joany; Mowery, Jade; Piraino-Sandoval, Micha; Nava-Hoet, Rocio C; Kohn, Catherine; Hoet, Armando E
The role that environmental contamination might play as a reservoir and a possible source of Methicillin-resistant Staphylococcus aureus (MRSA) for patients and personnel at equine veterinary hospitals remains undefined, as the environment has only been monitored during outbreaks or for short periods. Therefore, the objectives of this study were to determine the monthly presence, distribution, and characteristics of environmental MRSA at an equine hospital, and to establish patterns of contamination over time using molecular epidemiological analyses. For this purpose, a yearlong active MRSA surveillance was performed targeting the environment and incoming patients. Antimicrobial susceptibility testing, SCCmec typing, PFGE typing, and dendrographic analysis were used to characterize and analyze these isolates. Overall, 8.6% of the surfaces and 5.8% of the horses sampled were positive for MRSA. The most common contaminated surfaces were: computers, feed-water buckets, and surgery tables-mats. Ninety percent of the isolates carried SCCmec type IV, and 62.0% were classified as USA500. Molecular analysis showed that new pulsotypes were constantly introduced into the hospital throughout the year. However, maintenance of strains in the environment was also observed when unique clones were detected for 2 consecutive months on the same surfaces. Additionally, pulsotypes were circulating throughout several areas and different contact surfaces of the hospital. Based on these results, it is evident that MRSA is constantly introduced and frequently found in the equine hospital environment, and that some contact surfaces could act as "hot-spots". These contaminated surfaces should be actively targeted for strict cleaning and disinfection as well as regular monitoring. PMID:24641543
Full Text Available Background: Current effective treatments available for asthma are mainly the inhalers. Nurses play a vital role in imparting correct knowledge of asthma care and teaching inhaler techniques to patients. The aims of the study were to, a determine the knowledge of nurses regarding asthma and its management and b evaluate the competence of nurses to use inhalers.Methods: A simple random sample of registered nurses was taken from the medical surgical units of the hospital. Data was collected by using pre and post test asthma questionnaire and a nine step inhaler skill checklist.Results: The pre-test data shows 40-50% of RNs lacked the knowledge of causes, sign and symptoms and the management of asthma. More than 30% were not able to demonstrate the correct inhaler technique of MDIs. Evaluation after several teaching sessions shows 80-90% improvement in the knowledge and competence of nurses to use inhalers.Conclusion: Continuous training programs and workshops are needed to improve the knowledge of nurses about asthma, their competence to use inhalers and to demonstrate to patients.
Full Text Available Using qualitative data on post abortion care services at the Komfo Anokye Teaching Hospital in Kumasi, Ghana, the paper explored evidence of social stigma as a factor in post abortion care. Results from 6 focus group discussions, 10 narratives and observations identified three areas of stigma. The Patients (perspective and experience, the Providers (the medical environment and setting and the Community (family, relations and peers. Evidence from the focus group discussions, narratives and observations suggested social stigma as a significant factor in the process of pre-marital sex, abortion and post abortion care. At the individual level there was fear, shame and embarrassment. The medical setting was judgmental, indifferent and/or showed disdain while there was moral consensus, the morality of abortion by family, peers and community. In recognition of the dangers inherent in unsafe abortion outside the medical setting and in view of the fact that death from complications of unsafe abortion is preventable, these findings have implications for intervention and policy. The paper recommended collective effort to addressing all three areas of stigma and post abortion care. Sustained education, sensitization and dissemination using all available channels including traditional teachings and practices to reduce stigma and provide safer alternatives were suggested.
Full Text Available CONTEXT: Prescription order is an important transaction between the physician and the patient. Irrational prescribing is found throughout the world but because of scarcity of funds and resources, assumes increasing importance in the developing countries. AIM: To f ind out the elements of prescription writing in the geriatric age group patients in a tertiary care hospital. SETTINGS AND DESIGN: Teaching hospital, Tirupati, Andhra Pradesh. The subjects were selected using Systematic Random Sampling design. METHODS AND MATERIAL: The study was carried out during January - March 2011 among 140 patients ( B oth outpatient and inpatient of the medical units. STATISTICAL ANALYSIS USED: The prescriptions were analyzed using MS Excel and Epiinfo 3.3.4 version software and appropri ate statistical tests of significance tests applied. RESULTS: In all cases, prescription was written in lower writing case with a short signature. Although superscription and transcription was satisfactory, the inscription dose, route and duration were men tioned only in 56.4%, 32.1% and 26.4% cases respectively while subscription was satisfactory in 26.4% only. The prescription was written for inappropriate duration, dose and frequency in 69.3%, 45.0% and 4.3% cases respectively. CONCLUSIONS: The prescripti on writing does not conform to the stipulated guidelines in majority of cases.
M. Shashi Kumar
Full Text Available Introduction: The Laundry Department plays an important role in preventing the spread of infection and continuously supplying clean linen to various departments in any hospital. Objectives of the Study: To identify existing practices and occupational safety and health (OSH measures in the Laundry Department and to assess the use of personal protective equipments (PPEs among health care workers. Materials and Methods: A cross-sectional study was carried out in a private tertiary care teaching hospital. An observation checklist was developed, which was partially based on occupational hazard checklist of OSHA for Laundry Department. This was field tested and validated for applicability for this study. Results: The potential biological hazards are infections through exposure to aerosols, spills and splashes during various activities, fungal infection due to wet clothes and environment and infections through fomites. The potential physical hazards are injuries due to slips and falls, exposure to heat, humidity, dust, noise, and vibration. The potential chemical hazards are contact dermatitis and allergic asthma due to exposure to detergents, phenyl solution, bleaching powder, and soap oil solution. The potential ergonomic hazards are musculoskeletal diseases and repetitive stress injuries at the shoulder, elbow, and small joints of the hands. PPEs were not used consistently in most areas of the department.
Full Text Available OROGINAL ARTICLE Occupational diseases are any chronic ailment that occurs as a result of work or occupational activity. This study was conducted to examine the frequency and risk factors of some Skin and Musculoskeletal Disorders among nurses at a referral-teaching hospital. All 197 nurses in the hospital from different working shifts were engaged in the study. All nurses filled out a questionnaire containing demographic and occupational data. In the questionnaire, they specified the following: sex, age, job experience, any history of respiratory, skeletal and muscular diseases over the past year, chemicals and physical conditions they have been exposed to, history of allergy. Thirty nine nurses had skin diseases. Those who did not regularly wear gloves were further susceptible to skin diseases. 68 nurses in this study had musculoskeletal, respiratory and allergic diseases. The skin and respiratory diseases had nothing to do with gender, but skeletal, muscular and allergic diseases were more in women. In 93% of the cases, skin diseases left lesions in the elbows, wrists, palms and fingers. In our study, it was demonstrated that 39 nurses had skin diseases. 68 nurses in this study had skeletal, muscular, respiratory and allergic diseases. Out of 93 percent of the cases, skin diseases were characterized by the appearance of lesions. The incidence of Skin and Musculoskeletal Disorders had no meaningful relationship with age, height, employment and matrimonial status of the nurses, but it did have with the number of working shifts and beds under their supervision.
Nippak, Pria Md; Veracion, Julius Isidro; Muia, Maria; Ikeda-Douglas, Candace J; Isaac, Winston W
This report is a description of a balanced scorecard design and evaluation process conducted for the health information management department at an urban non-teaching hospital in Canada. The creation of the health information management balanced scorecard involved planning, development, implementation, and evaluation of the indicators within the balanced scorecard by the health information management department and required 6 months to complete. Following the evaluation, the majority of members of the health information management department agreed that the balanced scorecard is a useful tool in reporting key performance indicators. These findings support the success of the balanced scorecard development within this setting and will help the department to better align with the hospital's corporate strategy that is linked to the provision of efficient management through the evaluation of key performance indicators. Thus, it appears that the planning and selection process used to determine the key indicators within the study can aid in the development of a balanced scorecard for a health information management department. In addition, it is important to include the health information management department staff in all stages of the balanced scorecard development, implementation, and evaluation phases. PMID:24948412
Odigie JO; Siminialayi IM
Objective:To elucidate the awareness and approach to pre-operative human immunodeficiency virus (HIV) testing and emphasis on the attendant components of HIV testing.Methods:The study was conducted at the theatres of the University of Port Harcourt Teaching Hospital among 123 nursing, anaesthetic, and operating staff. A descriptive cross sectional design was adopted with stratified sampling. The study instrument was a structured, self administered pro forma.Results: All respondents were all aware of HIV infection and all had transmission through infected blood and tissues (100.0%). 88.6% had infection through needle stick injuries, 62.6% through vertical transmission, and 98.4% through blood transfusion. Sixty three percent of respondents correctly knew what preoperative testing was, while 58.5% were aware of the preoperative testing policy of the hospital. All respondents favoured the policy of preoperative testing. Attitudinal values to seropositive patients were not very different as 72.4% of respondents claimed they treated every patient as high risk, and all respondents used personal protective equipment.Conclusions: Routine HIV testing now represents a conventional means providing patients with knowledge of their HIV status. Such testing should be accompanied by informed consent, counselling, confidentiality, protection, and access to treatment.
To study the risk factors of cerebral infarction in stroke patients. It is a descriptive hospital based study conducted at the Department of Medicine, Naseer Teaching Hospital, Peshawar from January 2005 to December 2005. One hundred patients of stroke with cerebral infarction confirmed on C.T. scan brain and more than twenty years of age were included. Risk factors for cerebral infarction were defined in terms of hypertension, diabetes mellitus, ischemic heart disease, smoking, dyslipidaemia, TIAs (transient ischemic attacks), carotid artery stenosis and family history of stroke. Data of 100 cases with cerebral infarction was recorded. Most of the patients had more than one risk factors for cerebral infarction. hypertension was commonest risk factor (55%), smoking (30%), ischemic heart disease (34%), diabetes mellitus) (26%), hyperlipedaemia (30%), atrial fibrillation (25%), carotid artery stenosis (27%), obesity (15%) and family history of stroke (12%). 39% of patients had physical inactivity. Males were slightly predominant than females (51% vs 49%) and mean age was 50 years. females were rather older with mean age of 53 years. Cerebral infarction accounts for 80% to 85% of cases of stroke, which is a common neurological disorder. It increases a burden of disability and misery for patients and their families. Most of the risk factors of cerebral infarction are modifiable, its prevention should be the main cause of concern for the community. (author)
Eveillard, M; Eb, F; Tramier, B; Schmit, J L; Lescure, F X; Biendo, M; Canarelli, B; Daoudi, F; Laurans, G; Rousseau, F; Thomas, D
From February 1999 to January 2000, a control programme to prevent the spread multi-resistant bacteria (MRB) was implemented in a French teaching hospital. This programme focused on methicillin-resistant Staphylococcus aureus (MRSA) and Enterobacteriaceae producing extended-spectrum beta-lactamases (ESBL), and was based on the application of barrier precautions (washing hands with antiseptic soaps, wearing disposable gloves and gowns, identifying MRB carriers). No changes in antibiotic policy occurred during the year. Our aim was to conduct an evaluation of this programme by measuring incidence rates. Concurrently, the effect of barrier precautions was estimated in an indirect way, by documenting the availability of barrier precautions in MRB carriers' rooms and by analysing the monthly correlation between the supply of such material and the theoretical cumulated length of MRB carriers' isolation in six randomized wards. All MRB isolated in hospitalized patients were recorded, and differentiated between acquisition in our hospital or from elsewhere. For the analysis of trends, the year was divided in three periods of four months. Over the year, the global MRB incidence was 1.26 per 1000 patient-days (PD) [95% confidence interval (95%CI)=1.16-1.36]. The MRSA incidence was 0.89 per 1000 PD (95%CI=0.81- 0.97) and the ESBL incidence was 0.38 per 1000 PD (95% CI=0.33-0.43). The MRB incidence decreased significantly in all types of specialties except for surgical wards. The incidence decreased by 17.9% for MRSA, 54.9% for ESBL and 34.8% for both MRB. Concurrently, the proportion of strains acquired in our hospital decreased for MRSA (P for trend > or = 0.05) and ESBL (P for trend > or = 0.01), whereas the incidence of imported strains increased slightly. The proportion of multiresistant strains in S. aureus (36.8%) and Enterobacter aerogenes (37.0%) remained similar throughout the year. Thus, the decrease of the incidence concerned both resistant and susceptible strains
BACKGROUND: Increasing economic pressures coupled with an expanding and ageing population and a hostile economic climate have led to growing interest in the optimisation of bed usage within hospitals. There are many causes for delay in a patient\\'s discharge. METHODS: This prospective observational study assessed consecutive patients admitted and discharged from hospital within a 52-day period for waiting times in the provision of requested diagnostic tests and services. RESULTS: Seventy patients were included in the study. There were median delays of 2 and 3 days for an MRI and colonoscopy, a delay of 3 days for a Holter monitor report, and 9 days for an occupational therapy referral. The median wait for consults was 1 day across all three services. CONCLUSIONS: Significant remediable delays exist during the course of many acute medical admissions. Addressing these factors will enable the provision of a faster and more cost-efficient service.
Pancieri, Ana Paula; Santos, Bruna Pegorer; de Avila, Marla Andréia Garcia; Braga, Eliana Mara
This study aimed to apply the WHO surgical safety checklist in the surgical specialties of a university hospital and to evaluate the opinion of the team regarding the influence of its application on the safety of the surgical process and on the interpersonal communication of the team. It is a descriptive, analytical qualitative field study conducted in the surgical center of a university hospital Data were collected by applying the checklist in a total of 30 surgeries. The researcher conducted its application in three phases, and then members of the surgical team were invited to voluntarily participate in the study, signifying their agreement to participate by signing an informed consent form and answering guiding questions. Bardin's Content Analysis Method was used to organize and analyze the data. The subjects did not notice any changes in their interpersonal communication when using the checklist; however, they gave suggestions and reported that its use provided greater safety to the procedure. PMID:23781726
Results: A Total of 82 cases were studied in our hospital. Out of these 82 Poisonous bites, 42 (51.22% cases were viper bites, 20 (24.39% cases were unidentified poisonous bites, 16 (19.51% cases were Krait, and 4 (4.88% cases were Cobra. Coagulopathy, cellulitis, wound infection, renal failure and respiratory paralysis were the common complications. Average dose of ASV administered range from 8.57 (+/- 0.98 to 20.78 (+/- 4.18 Vials. An increase in mortality, ASV dose and complications were directly proportional to the Bite to ASV Administration time. Conclusions: Delay in hospitalization is associated with poor prognosis and increased mortality rate due to complications. There is an emergent need of awareness among the community for avoidance of traditional form of treatment and delay in early medical interventions. [Int J Res Med Sci 2015; 3(9.000: 2419-2424
Radha Krishnan; Srinivas
Valvular heart disease is still a common causes of mortality and morbidity in India and rheumatic heart disease is still far more frequent. AIMS AND OBJECTIVES: To study the prevalence and clinical profile of rheumatic and non - rheumatic valvular heart dise ase in patients attending to Government General Hospital, Kakinada. MATERIALS AND METHODS: 100 Adult patients with valvular abnormalities attending to the Medicine and Cardiol...
Vaidehi J. Mehta; Kikani, Kunjan M.; Sanjay J. Mehta
Background: Diabetic foot lesions are a major medical, social and economic problem and are the leading cause of hospitalization for patients with diabetes worldwide. Infection sometimes leads to amputation of the infected foot if not treated promptly. The present study was conducted to isolate and identify the bacterial pathogens associated with diabetic foot ulcer and to find out its antibiotic susceptibility pattern to reduce the risk of complications. Methods: Total 100 pus samples were...
Conclusions: The maternal mortality rate is much more than the national MMR. Haemorrhage was the leading cause of death followed by septicemia, both of them being preventable by adequate transfusion of blood and its components, delivery in a well-equipped hospital, early identification and prompt action, good antibiotic coverage, and early transportation. [Int J Reprod Contracept Obstet Gynecol 2016; 5(3.000: 890-893
Arreola, Manuel; Neiman, Harvey L.; Sugarman, Amy; Laurenti, Larry; Forys, Ron
Because of their typically small in-house computer and network staff, non-university hospitals often hesitate to consider picture archiving and communication system (PACS) as a solution to the very demanding financial, clinical, and technological needs of today’s Radiology Department. This article presents the experiences of the 3-year process for the design and implementation of the Radiology Electronic Imaging Network (REIN) in the Department of Radiology at The Western Pennsylvania Hospita...
Mohebbifar, Rafat; Kiaei, Mohammad Zakaria; Khosravizadeh, Omid; Mohseni, Mohammad
Recognition of career motivators and understanding of managers and employees in prioritizing them, in order to plan incentives for this understanding, can play an important role in increasing productivity and creating harmony between the goals of the organization and staff. This study was done to survey the importance of career motivating factors from perspective of employees and managers in educational hospitals of Iran. In this study 269 from a total of 1843 employees of educational hospita...
John Kiprop Mutai; Sudhir Vinayak; William Stones; Nigel Hacking; Charles Mariara
Objective: Characterization of magnetic (MRI) features in women undergoing uterine fibroid embolization (UFE) and identification of clinical correlates in an African population. Materials and Methods: Patients with symptomatic fibroids who are selected to undergo UFE at the hospital formed the study population. The baseline MRI features, baseline symptom score, short-term imaging outcome, and mid-term symptom scores were analyzed for interval changes. Assessment of potential associations betw...
Afroz Abidi; Surabhi Gupta; Saurabh Kansal; Ramgopal
Background: In India, a proper reporting of medication errors in the hospital is not available. Drugs worth crores of rupee are consumed every year but a substantial part of these drugs are irrationally prescribed. In order to promote rational drug usage standard policies on use of drugs must be set, and this can be done only after the current prescription practices have been audited. The prescriptions were analyzed based on the objectives of the study in order to promote rational use of drug...
Bangal, Vidyadhar B; Patel, Shrutiben M; Khairnar, Devendra N
Twin gestation is considered as high risk pregnancy due to associated high maternal morbidity and perinatal mortality in comparison with singleton pregnancies .Overall, the rate of twin gestation is on rise due to inadvertent use of ovulation induction drugs in assisted reproductive techniques. This observational study was carried out to find the maternal and perinatal outcome in 100 cases of twin gestation delivered at tertiary care referral hospital over a period of fifteen months. It was o...
Savan Sara Mathew; A I Benjamin; Paramita Sengupta
Biomedical waste (BMW) is waste generated during diagnosis, treatment or immunization of human beings or animals, or in research activities pertaining thereto, or in the production and testing of biologicals, and is contaminated with human fluids.1 Though 75-80% of wastes generated from hospitals are non-infectious, 20-25% is hazardous.2 It is a potential health hazard to health workers, public, flora and fauna of the area.3 The Government of India has given sp...
Kaddoum, Roland; Fadlallah, Racha; Hitti, Eveline; El-Jardali, Fadi; El Eid, Ghada
Background Cancellation of elective scheduled operations on the day of surgery leads to an inefficient use of operating room (OR) time and a waste of resources. It also causes inconvenience for patients and families. Moreover, day of surgery (DOS) cancellation creates logistic and financial burden associated with extended hospital stay and repetitions of pre-operative preparations as well as opportunity costs of lost time and missed income. The objective of this study is to establish the rate...
Hall, L M; Duke, B; Urwin, G.; Guiney, M
Enterococcus faecalis is a frequent cause of urinary tract infection in hospitalized patients. Recent reports have suggested that the organism may frequently be acquired by cross-infection from other patients. In this study, we used total DNA restriction patterns to type 135 urine isolates of E. faecalis from four sets of patients. Isolates were placed into types (all bands identical) and into groups (most bands identical). Most isolates were discriminated by the typing method, and the result...
Increased patient choice and competition are well renowned reform strategies in European Healthcare systems. Despite some debate, these strategies are generally felt to improve efficacy and quality of healthcare. The National Health Service (NHS), England’s publicly funded healthcare system, is similarly undergoing significant government reforms as a result of substantial increases in health care spending and an ageing population. Prior to the reforms, hospitals in England were given a fixed ...
West LM; Cordina M; Cunningham S
Appropriate prescribing remains an important priority in all medical areas of practice. Objective The objective of this study was to apply a Medication Appropriateness Index (MAI) to identify issues of inappropriate prescribing amongst patients admitted from the Emergency Department (ED). Methods This study was carried out at Malta's general hospital on 125 patients following a two-week pilot period on 10 patients. Patients aged 18 years and over and on medication therapy were included. Medic...
Peterside, Oliemen; Pondei, Kemebradikumo; Akinbami, Felix O
Background: Sepsis is one of the most common causes of neonatal hospital admissions and is estimated to cause 26% of all neonatal deaths worldwide. While waiting for results of blood culture, it is necessary to initiate an empirical choice of antibiotics based on the epidemiology of causative agents and antibiotic sensitivity pattern in a locality. Objective: To determine the major causative organisms of neonatal sepsis at the Niger Delta University Teaching Hospital (NDUTH), as well as their antibiotic sensitivity patterns, with the aim of formulating treatment protocols for neonates. Methods: Within a 27-month period (1st of October 2011 to the 31st of December 2013), results of blood culture for all neonates screened for sepsis at the Special Care Baby Unit of the hospital were retrospectively studied. Results: Two hundred and thirty-three (49.6%) of the 450 neonates admitted were screened for sepsis. Ninety-seven (43.5%) of them were blood culture positive, with 52 (53.6%) of the isolated organisms being Gram positive and 45 (46.4%) Gram negative. The most frequently isolated organism was Staphylococcus aureus (51.5%) followed by Escherichia coli (16.5%) and Klebsiella pneumoniae (14.4%). All isolated organisms demonstrated the highest sensitivity to the quinolones. Conclusion: Neonatal sepsis is a significant cause of morbidity among neonates admitted at the NDUTH. There is a need for regular periodic surveillance of the causative organisms of neonatal sepsis as well as their antibiotic susceptibility pattern to inform the empirical choice of antibiotic prescription while awaiting blood culture results. PMID:26543394
de Graaf J
Full Text Available Background: Adverse transfusion reactions can cause morbidity and death to patients who receive a blood transfusion. Blood transfusion practice in Mulago Hospital, Kampala, Uganda is analyzed to see if and when these practices play a role in the morbidity and mortality of patients. Materials and Methods: An observational study on three wards of Mulago Hospital. Physicians, paramedics, nurses, medical students and nurse students were observed using two questionnaires. For comparison, a limited observational study was performed in the University Medical Centre Groningen (UMCG in Groningen, The Netherlands. Results: In Mulago Hospital guidelines for blood transfusion practice were not easily available. Medical staff members work on individual professional levels. Students perform poorly due to inconsistency in their supervision. Documentation of blood transfusion in patient files is scarce. There is no immediate bedside observation, so transfusion reactions and obstructions in the blood transfusion flow are not observed. Conclusion: The poor blood transfusion practice is likely to play a role in the morbidity and mortality of patients who receive a blood transfusion. There is a need for a blood transfusion policy and current practical guidelines.
Aguinel José Bastian Júnior
Full Text Available Purposes(a To externally validate the Crippa and colleagues’ nomograms combining PSA, percentage of positive biopsy cores (PPBC and biopsy Gleason score to predict organ-confined disease (OCD in a contemporary sample of patients treated at a tertiary teaching institution. (b To adjust such variables, resulting in predictive nomograms for OCD and seminal vesicle invasion (SVI: the USP nomograms.Materials and MethodsThe accuracy of Crippa and colleagues’ nomograms for OCD prediction was examined in 1002 men submitted to radical prostatectomy between 2005 and 2010 at the University of São Paulo (USP. ROC-derived area under the curve (AUC and Brier scores were used to assess the discriminant properties of nomograms for OCD. Nomograms performance was explored graphically with LOESS smoothing plots. Furthermore, univariate analysis and logistic regression models targeted OCD and SVI. Variables consisted of PSA, PPBC, biopsy Gleason score and clinical stage. The resulted predictive nomograms for OCD and SVI were internally validated with bootstrapping and the same abovementioned procedures.ResultsCrippa and colleagues’ nomograms for OCD showed ROC AUC = 0.68 (CI: 0.65-0.70, Brier score = 0.17 and overestimation in LOESS plots. USP nomograms for OCD and SVI showed ROC AUC of 0.73 (CI: 0.70-0.76 and 0.77 (CI: 0.73-0.79, respectively, and Brier scores of 0.16 and 0.08, respectively. The LOESS plots showed excellent calibration for OCD and underestimation for SVI.ConclusionsCrippa and colleagues’ nomograms showed moderate discrimination and considerable OCD overestimation. USP nomograms showed good discrimination for OCD and SVI, as well as excellent calibration for OCD and SVI underestimation.
Viale, P; Tumietto, F; Giannella, M; Bartoletti, M; Tedeschi, S; Ambretti, S; Cristini, F; Gibertoni, C; Venturi, S; Cavalli, M; De Palma, A; Puggioli, M C; Mosci, D; Callea, E; Masina, R; Moro, M L; Lewis, R E
We performed a quasi-experimental study of a multifaceted infection control programme for reducing carbapenem-resistant Enterobacteriaceae (CRE) transmission and bloodstream infections (BSIs) in a 1420-bed university-affiliated teaching hospital during 2010-2014, with 30 months of follow-up. The programme consisted of the following: (a) rectal swab cultures were performed in all patients admitted to high-risk units (intensive-care units, transplantation, and haematology) to screen for CRE carriage, or for any room-mates of CRE-positive patients in other units; (b) cohorting of carriers, managed with strict contact precautions; (c) intensification of education, cleaning and hand-washing programmes; and (d) promotion of an antibiotic stewardship programme carbapenem-sparing regimen. The 30-month incidence rates of CRE-positive rectal cultures and BSIs were analysed with Poisson regression. Following the intervention, the incidence rate of CRE BSI (risk reduction 0.96, 95% CI 0.92-0.99, p 0.03) and CRE colonization (risk reduction 0.96, 95% CI 0.95-0.97, p accounting for changes in monthly census and percentage of externally acquired cases (positive at ≤72 h), the average institutional monthly rate of compliance with CRE screening procedures was the only independent variable associated with a declining monthly incidence of CRE colonization (p 0.002). The monthly incidence of CRE carriage was predictive of BSI (p 0.01). Targeted screening and cohorting of CRE carriers and infections, combined with cleaning, education, and antimicrobial stewardship measures, significantly decreased the institutional incidence of CRE BSI and colonization, despite endemically high CRE carriage rates in the region. PMID:25658534
Full Text Available Abstract Background Several studies have investigated attitudes to and compliance with smoking bans, but few have been conducted in healthcare settings and none in such a setting in Portugal. Portugal is of particular interest because the current ban is not in line with World Health Organization recommendations for a "100% smoke-free" policy. In November 2007, a Portuguese teaching-hospital surveyed smoking behaviour and tobacco control (TC attitudes before the national ban came into force in January 2008. Methods Questionnaire-based cross-sectional study, including all eligible staff. Sample: 52.9% of the 1, 112 staff; mean age 38.3 ± 9.9 years; 65.9% females. Smoking behaviour and TC attitudes and beliefs were the main outcomes. Bivariable analyses were conducted using chi-squared and MacNemar tests to compare categorical variables and Mann-Whitney tests to compare medians. Multilogistic regression (MLR was performed to identify factors associated with smoking status and TC attitudes. Results Smoking prevalence was 40.5% (95% CI: 33.6-47.4 in males, 23.5% (95% CI: 19.2-27.8 in females (p Conclusions Smoking prevalence was high, especially among the lower socio-economic groups. The findings showed a very high level of support for smoking bans, despite the pro-smoking environment. Most staff reported passive behaviour, despite high SHS exposure. This and the high smoking prevalence may contribute to low compliance with the ban and low participation on smoking cessation activities. Smoking behaviour had greater influence in TC attitudes than health professionals' education. Our study is the first in Portugal to identify potential predictors of non-compliance with the partial smoking ban, further emphasising the need for a 100% smoke-free policy, effective enforcement and public health education to ensure compliance and promote social norm change.
Full Text Available Problem statement: In modern age, the service quality and sensitivity towards better qualified service are among the priorities of the global community. Quality is defined as the customers desire and the customers perceptions and expectations constitute the key factor determining quality. The issue of quality is particularly important in healthcare service. Nowadays, alongside the human, financial and economic capitals, a new form of capital entitled social capital is being utilized. Social capital may influence the service quality. Facilitating science and improving team work and organizational commitment would probably translate into better quality of products and social capital encompasses all these issues. Approach: This is a cross-sectional, descriptive-analytic study conducted in educational hospitals of Tabriz, Iran in 2010. The target community consists of workers working in educational hospitals of Tabriz and patients referring to these hospitals. A total of 320 workers and 320 patients were selected for the study. Our data collection tool consisted of two questionnaires which were distributed among the participants after their validity and reliability were established. Once the questionnaires were completed, the statistical coefficients relating to the types of variables (t-test, Pearson correlation coefficient and analysis of variance were calculated and analyzed using SPSS software version 16. Results: Our findings indicate that there is a significant, positive relationship between organizational social capital and the service quality from the patients point of view, with the correlation between the two variables on a strong level (r = 0.6, pConclusion: The existence of a significant relationship between the dimensions of social capital and service quality highlights the importance of social capital of workers in the organization.
Azira, N M S; Zairi, N Z; Amry, A R; Zeehaida, M
Plasmodium knowlesi is a simian malaria parasite and is recently recognized as the fifth malaria parasite infecting humans. Manifestation of the infection may resemble other infection particularly dengue fever leading to inappropriate management and delay in treatment. We reported three cases of naturally acquired P. knowlesi in Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia. Clinical manifestations were quite similar in those cases. Microscopically, the diagnosis might be challenging. These cases were confirmed by polymerase chain reaction method which serves as a gold standard. PMID:23018503
Hellerstein, David J
"The City of the Hospital" is a creative nonfiction writing workshop for medical students, which the author has conducted annually since 2002. Part of the required preclinical Narrative Medicine curriculum at the Columbia University College of Physicians and Surgeons, this six-week intensive workshop includes close readings of literary works and in-class assignments that are then edited by fellow class members and rewritten for final submission. Over the years, students have produced a wide range of compelling essays and stories, and they describe the class as having an effect that lasts throughout their further medical training. This special section includes selected works from class members. PMID:26179365
临床实习教育是临床医学专业人才培养的重要教学阶段，其水平的高低、质量的好坏直接影响医学教育质量和医学人才的培养质量，而临床教学医院的管理方法是指导临床实习教育的重要部分。本文探讨规范实习生教学管理，提高临床教学质量的措施和途径。从健全教学管理机制、规范教学管理程序和改革教学方法，调动教学双方的积极性两方面，就临床教学医院如何保障和提高实习教学质量进行了初步的探索和实践。%Clinical practicum is an important teaching stage of training professional personnel and its quality will exert direct impact on the quality of medical education as well as medical personnel. The management of clinical teaching in hospital plays a key role in guiding clinical practicum. This article explored how to standardize the practicum teaching management and improve the quality of clinical teaching. The author conducted a preliminary exploration and practice of that how clinical teaching hospitals protect and improve the teaching quality from the perspectives of the teaching management system improvement, standardizing management procedures and teaching methods reform as well as mobilizing enthusiasm of both teachers and students.
Sarani, Hamed; Balouchi, Abbas; Masinaeinezhad, Nosratollah; Ebrahimitabs, Ebrahim
Background and Objectives: Hospital-acquired infection (HAI) is one of the common problems and difficulties faced by hospitals in all countries around the world. Since nurses are part of the healthcare team that plays a unique role in the control of hospital infection, this study is conducted to analyze the knowledge and practice of healthcare personnel about standard precautions for hospital infection. Materials and Methods: This descriptive study was conducted on 170 nurses worked in medica...
Praveen Kumar N
Full Text Available A cross-sectional study of in-patients over the age of 60 years was conducted at district McGann Hospital, Shimoga on patients who were classified as bed blockers. Level of dependency and cognitive function of these patients were assessed using Barthel scale and Abbreviated mental test (AMT respectively. Median age of the study population was 67 years; majority of them were men. Most of them were admitted in the medical ward and the median time to be labeled as bed blocker was 32 days. These bed blockers were a weak group of patients with an average 3.1 pathology per case. Majority of them suffered from neurological disorders and cardiovascular disease. High level of dependence was noted with a mean Barthel score of 29.68 (Range 0 -100. Low levels of cognitive function was also noted among these patients with a mean AMT of 4.76 (Range 0 -10.These findings demonstrate that the bed blockers in McGann hospital suffer not only from genuine health problems but also have a high dependency level in activities of daily living which hamper their discharge to the community. Community based rehabilitation using an intersectoral approach may help at least the less dependent to return home.
Full Text Available OBJECTIVE To study the clinical and histopathological presentation of ovarian masses. METHOD Hospital based retrospective study done on 200 patients in the Department of Gynaecology, Gandhi Hospital, Secunderabad, who are clinically and sonologically diagnosed to have ovarian masses during the period of January 2014 to September 2015. RESULTS The prevalence of ovarian masses in our study was 0.6%. Among the 200 cases, 60.5% were neoplastic and 39.5% were non-neoplastic. Among neoplasms 90% were benign, 8.26% malignant and 1.65% borderline. Serous cystadenoma was the commonest benign tumor (55% followed by Mucinous (27.5% and Dermoid (15.5%. Most common malignant ovarian tumor was Serous cystadenocarcinoma (60%. CONCLUSION Ovarian neoplasms have twice the incidence of non-neoplasms. Maximum incidence of malignancy is in between 40-49 years of age group. Non-specific abdominal symptoms should be given more importance, as it may be the only clue to the underlying malignancy. So effective clinical, biochemical and radiological diagnosis helps in early intervention to increase the survival rates in malignancy. Sixty million people are affected with glaucoma worldwide and more than 20 million have PACG. Of these more than 5 million with PACG are blind, which is twice more than POAG. Early detection and timely treatment with Nd:YAG laser iridotomy and associated complications determine visual outcome.
Full Text Available Introduction: Early neonates are more prone towards infections and deaths. As a result we are interested in finding out the health behavior of inborn early neonates in a district hospital of Mysore. Materials and Methods: A total of 24,578 live births were monitored for their morbidity status from September 2011 to June 2013. The number of morbidity causes was detected for every 100 early neonates, monthly wise. The non-conformities behavior was observed through Poisson u-chart with variable control limits. 20% vital few contributors that contributes to variations in morbidity and mortality aspects of early neonates were detected through checklists and super imposed Pareto charts. Results: The number of causes per inspection unit for sample number 9 is out of control. Values corresponding to samples 1 and 2 are within the warning region. It appears that hypoxic ischemic encephalopathy (HIE/moderate-severe birth asphyxia is the major contributing factor for both morbidity and mortality based on the occurrences. However, in the process of detecting the impact of morbidity factor on their corresponding mortality, it is found that the major nonconformity factor is major congenital malformation (MCM and not HIE/Moderate-severe birth asphyxia as MCM has 0.217 chance of causing mortality, whereas HIE has 0.19 chance standing at the fourth position. Conclusion: We conclude that the hospital management needs to develop appropriate preventive and management strategies for the major causes viz., MCM, sepsis/pneumonia/meningitis and respiratory distress syndrome.
Ajay M. Khade
Full Text Available Background: Use of irrational and unnecessary antimicrobials remains common in the developing countries. The present study was conducted to evaluate the use of antimicrobial agents in the tribal district hospital of Andhra Pradesh India. Methods: In this retrospective study, 200 hospitalized cases from medicine, surgery, obstetrics and gynaecology and paediatrics departments were randomly selected. Results: Most common diagnosis was febrile illness (15% followed by gastroenteritis (10% and malaria (8%. Antimicrobials were used in 57% cases. All the cases were managed by empirical treatment. Cefixime (40% was the most common antimicrobial followed by ampicillin (32.50%, metronidazole (30% and ciprofloxacin (26.50%. Use of antimicrobial monotherapy (41.67% and 2 drug therapy (36.46% was common. Conclusion: Empirical use of higher antimicrobial agents is routine and cheap antimicrobials like ampicillin are still most useful drugs in the region. There is a need of specific essential drug list for the region. [Int J Basic Clin Pharmacol 2013; 2(5.000: 567-570
Full Text Available Objective: To estimate magnitude, determinants of perinatal mortality and suggest remedial measures for its reduction. Background: Perinatal mortality is mirror reflection of maternal and child health and socioeconomic environment of community. It is influenced by various medicosocial preventable causes. It can be reduced by improving maternal and child health services and by health education. Methods: A retrospective hospital based study of perinatal deaths among 2333 deliveries was conducted from June 2008 to June 2010 in our hospital. Fetomaternal factors like maternal age, religion, residence, parity, mode of delivery, booking status, antenatal complications, baby’s sex, birth weight, congenital anomalies, neonatal complications influencing perinatal mortality rate were tabulated and analyzed. Cause of perinatal death was assessed. Results: perinatal mortality rate was 127.4/1000 total births. Maternal factors like age more than 35 years, muslim religion, inadequate antenatal care, primiparity, grand multiparity, induced deliveries and neonatal factors like low birth weight, prematurity were associated with increased perinatal mortality. The leading cause of stillbirth was antepartum hemorrhage and prematurity for neonatal mortality. Conclusion: Apart from clinical causes high perinatal mortality was due to poverty, illiteracy, lack of health awareness, inadequate antenatal care and delayed referral. Health education, identification of high risk mothers, timely referral, advanced life support of preterm neonates should significantly help to reduce perinatal deaths.
Katebe, K R
This is a clinical trial which was carried out at the University Teaching Hospital, Lusaka from the 1st of July to the 31st December, 1994. It involved treatment of burns in forty children using gamma irradiated amniotic membrane produced at the hospital. The results showed that it is feasible to produce Gamma irradiated biological dressings from amniotic membrane at this hospital. The amniotic membrane was easy to apply on burns and the treatment was acceptable to the majority of parents with burnt children. The use of amniotic membrane was non inflammatory to the wounds in all forty patients (100%), reduced wound infection in thirty three patients (82.5%), increased the rate of wound healing in thirty nine patients (97.5%), and resulted in good quality wound healing in thirty one patients (77.5%). Therefore, the treatment offers a good alternative in the treatment of burns in children at the hospital
This is a clinical trial which was carried out at the University Teaching Hospital, Lusaka from the 1st of July to the 31st December, 1994. It involved treatment of burns in forty children using gamma irradiated amniotic membrane produced at the hospital. The results showed that it is feasible to produce Gamma irradiated biological dressings from amniotic membrane at this hospital. The amniotic membrane was easy to apply on burns and the treatment was acceptable to the majority of parents with burnt children. The use of amniotic membrane was non inflammatory to the wounds in all forty patients (100%), reduced wound infection in thirty three patients (82.5%), increased the rate of wound healing in thirty nine patients (97.5%), and resulted in good quality wound healing in thirty one patients (77.5%). Therefore, the treatment offers a good alternative in the treatment of burns in children at the hospital
BACKGROUND: The adverse effects of smoking are well documented and it is crucial that this modifiable risk factor is addressed routinely. Professional advice can be effective at reducing smoking amongst patients, yet it is not clear if all hospital in-patient smokers receive advice to quit. AIMS: To explore smoking prevalence amongst hospital in-patients and smoking cessation advice given by health professionals in a large university teaching hospital. METHODS: Interviews were carried out over 2 weeks in February 2011 with all eligible in-patients in Beaumont Hospital. RESULTS: Of the 205 patients who completed the survey, 61% stated they had been asked about smoking by a healthcare professional in the past year. Only 44% of current\\/recent smokers stated they had received smoking cessation advice from a health professional within the same timeframe. CONCLUSIONS: Interventions to increase rates of healthcare professional-provided smoking cessation advice are urgently needed.
Objective: To explore practical effects of reformed nursing teaching mode "working and learning alternation" performed by hospital and school together. Method: On the foundation of meeting the requirement of major courses, corresponding class featured in hospital and clinical practice teaching, which centered on nursing practice teaching and guided by employment, were administered to students by hospital. Result: Nursing teaching mode "working and learning mode" could effectively help students accumulate clinical work experience, enhance personal communication skills, fully improve comprehensive quality of students and also the scores of nursing licensed exam. Conclusion: Nursing teaching mode "working and learning alternation" demonstrates remarkable advantages in improving students' comprehensive quality, master and application of the knowledge compared with traditional teaching mode of school.%目的:探讨学校与医院联合进行"工学交替"护理教学模式改革的实践效果.方法:医院以护理实践教学为中心,以就业为导向,在满足学校本专业课程的基础上,对学生进行具有医院特色的课堂教学及临床实践教学.结果:"工学交替"的护理教学模式有效促进了学生实际工作经验的积累,增强了学生的人际沟通技巧,全面提高了学生的综合素质,学生护理执业考试成绩大幅提高.结论:"工学交替"的护理教学模式相较于学校传统教学模式在学生的综合素质提高、知识的掌握及运用上都有明显优势.
Sistema hospitalar como fonte de informações para estimar a mortalidade neonatal e a natimortalidade The Brazilian hospital system as a source of information to estimate stillbirth and neonatal mortality rates
Joyce MA Schramm
Full Text Available OBJETIVO: Apesar da reconhecida importância em acompanhar a evolução temporal da mortalidade infantil precoce, a deficiência das estatísticas vitais no Brasil ainda permanece na agenda atual dos problemas que impedem o seu acompanhamento espaço-temporal. Realizou-se estudo com o objetivo de investigar o Sistema de Informações Hospitalares (SIH/SUS como fonte de informações, para estimar a natimortalidade e a mortalidade neonatal. MÉTODOS: Propõe-se um método para estimar a natimortalidade e a mortalidade neonatal, o qual foi aplicado para todos os Estados das regiões Nordeste, Sul e Sudeste e para o Pará, no ano de 1995. Para fins comparativos, o Sistema de Informações sobre Mortalidade (SIM/MS foi utilizado para estimar as taxas sob estudo, após a correção do número de nascidos vivos por um método demográfico. RESULTADOS: O SIH/SUS forneceu mais óbitos fetais e neonatais precoces do que o SIM/MS em grande parte das unidades federadas da região Nordeste. Adicionalmente para os Estados localizados nas regiões Sul e Sudeste, que apresentam, em geral, boa cobertura do registro de óbitos, as taxas calculadas pelos dois sistemas de informação tiveram valores semelhantes. CONCLUSÕES: Considerando a cobertura incompleta das estatísticas vitais no Brasil e a agilidade do SIH/SUS em disponibilizar as informações em meio magnético, conclui-se que o uso do SIH/SUS poderá trazer inúmeras contribuições para análise do comportamento espaço-temporal do componente neonatal da mortalidade infantil no território brasileiro, em anos recentes.OBJECTIVE: Studies on the evolution of infant mortality rate are very relevant. Nevertheless, lack of vital statistics in Brazil limits the temporal and spatial analysis of this indicator. This study aims to investigate the possible use of the Brazilian Hospital Information System as an alternative information source for stillbirth and neonatal mortality rates by age group. METHODS: A
Full Text Available AIM: Evaluation of Clinico - hematological profile and outcome of cerebral malaria in semi urban hospital situated in endemic area. MATERIAL AND METHODS : A cross - sectional hospital - based study was conducted from August to November, 2014 at Department of Paediatrics SRG Zanana Hospital, Jhalawar Rajasthan. Every child, except who was previously abnormal neurologically, of the age of six month to 12 years, presented with a history of fever in the last 7 days, with o r without convulsion, and/or impaired consciousness, screened for malaria by peripheral blood smear examination and rapid diagnostic test for malaria parasite. On the basis of this screening examination, these children were classified definite cerebral mal aria where the peripheral smear was positive and probable cerebral malaria where the peripheral smear was negative. If the patients presented with fever, convulsion, and/or impaired level of consciousness, they were treated with Artesunate intravenously em pirically. Patients were followed - up regularly till they regained consciousness and when, they were able to swallow, treated with oral Artisunate and single dose of Sulphadoxine and Pyrimethamine combination is also given. RESULTS: Of the3332 admissions, 8 69 (26.08% were admitted for fever. Out of these 869 febrile patients 352 patients were having other obvious clinical diagnosis for fever. In remaining 517(59.49% cases were suspected to be suffering from malaria, but all of these children who were admit ted with the diagnosis of fever, were screened for malaria and 74(08.51%were found to be positive for malaria parasite either by peripheral blood smear or rapid diagnostic test or both. Cerebral malaria developed in 37 patients. Most cases were of age gro up of 2 - 5 years, 14children had definite cerebral malaria and 9 were labelled as suspected to have probable cerebral malaria. Neurological symptoms of altered sensorium, convulsion and abnormal behaviour ranged from 35
Full Text Available Objectives: Thoracic injury is a challenge to the thoracic surgeon practicing in developing countries. This prospective study was conducted to see the mode of injury, injury types and overall outcome of thoracic injury in our settings. Materials and methods: This prospective study was conducted in 100 thoracic injury patients between December 2011 to June 2012. The demographic features, type of the trauma, radiological assessment, associated organ injuries, management of the injury, surgical interventions, morbidity, mortality, length of hospital stay were analysed. Results: In this study the ages ranged from 7 to 84 years. There were 73 (73% males and 27 (27% females. The majority of patients (83% were injured during the evening and night time. The majority of patients 92(92% sustained blunt chest injuries. The mechanism of injury was not significantly associated with length of hospital stay (P > 0.05 and mortality (P > 0.05.Road traffic accident was the most common cause of injuries affecting 68(68% of patients followed by fall injury of 19(19%. Rib fractures, haemothorax, pneumothorax and lung contusion were the most common type of injuries accounting for 83.0%, 57%,34% and 33% respectively. Associated extra-thoracic injuries were noted in 64.0% of patients. 45(45% of the cases of haemothorax, pneumotharax and haemopneumothorax were treated by tube thoracotomy. Four patients (04% had undergone thoracotomy. There were 09(09% patients of flail chest and treated conservatively. Fourty six patients (46% were admitted in the ICU. Eleven (11% patients were treated with ventilator support. Seventeen (17% patients had complication. The overall length of hospital stay ranged from 0 to 25 days. Conclusion: Road traffic accidents and fall from height are the major public health problems. Preventive measures at reducing road traffic accidents and timely management with closed tube thoracotomy are the main factors to be considered in the thoracic
Renata Almeida de Assunção
Full Text Available OBJECTIVE: This study aimed to evaluate the perinatal outcome of twin pregnancies delivered in a tertiary teaching hospital according to chorionicity. METHODS: A retrospective study involving 289 twin pregnancies delivered from January 2003 to December 2006 was carried out. Maternal and perinatal data were obtained from hospital charts and delivery logs. Chorionicity was determined by ultrasonography or histopathological study. RESULTS: Incidence of twin gestations was 3.4% and 96.4% were spontaneously conceived. 60.5% were dichorionic (DC, 30.8% of monochorionic diamniotic (MCDA, 6.6% monochorionic monoamniotic (MCMA and for 2.1% chorionicity was unknown. The mean gestation age at delivery was respectively 35.4, 33.6, 32.9 for DC, MCDA and MCMA. The mean birth weight was 2.171, 1.832 and 1.760 g respectively for DC, MC and MCMA. The proportion of fetuses delivered with less than 34 weeks in DC was of 21.7%, while in MCDA it was of 39.3% and in MCMA of 42.1%. Birth weight below the 10th centile occurred in 15.7% for DC, 22.5% for MCDA and 26.3% in MCMA. Congenital anomalies were observed in 21.3% in monochorionic and in 7.4% in the dichorionic. Lenght of hospital stay was shorter for DC when compared to MCDA and MCMA twins (13.1, 17.3 and 23.3 days, respectively. The proportion of twin pregnancies with both babies discharged alive were 85.7% in DC and 61.1% in MC. CONCLUSION: The rate of preterm deliveries and low birth weight is higher in monochorionic pregnancies when compared to dichorionic twins. However, when adjusted for complications such as fetal abnormalities and twin-twin transfusion syndrome, double survival rates were similar in the two groups.OBJETIVO: Avaliar o resultado perinatal nas gestações gemelares com partos em hospital universitário segundo a corionicidade. MÉTODOS: Estudo retrospectivo de 289 gestações gemelares com partos no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, no per
Full Text Available Introduction: Nursing profession requires knowledge of ethics to guide performance. The nature of this profession necessitates ethical care more than routine care. Today, worldwide definition of professional ethic code has been done based on human and ethical issues in the communication between nurse and patient. To improve all dimensions of nursing, we need to respect ethic codes. The aim of this study is to assess knowledge and performance about nursing ethic codes from nurses' and patients' perspective.Methods: A cross-sectional comparative study Conducted upon 345 nurses and 500 inpatients in six teaching hospitals of Tabriz, 2012. To investigate nurses' knowledge and performance, data were collected by using structured questionnaires. Statistical analysis was done using descriptive and analytic statistics, independent t-test and ANOVA and Pearson correlation coefficient, in SPSS13.Results: Most of the nurses were female, married, educated at BS degree and 86.4% of them were aware of Ethic codes also 91.9% of nurses and 41.8% of patients represented nurses respect ethic codes. Nurses' and patients' perspective about ethic codes differed significantly. Significant relationship was found between nurses' knowledge of ethic codes and job satisfaction and complaint of ethical performance. Conclusion: According to the results, consideration to teaching ethic codes in nursing curriculum for student and continuous education for staff is proposed, on the other hand recognizing failures of the health system, optimizing nursing care, attempt to inform patients about Nursing ethic codes, promote patient rights and achieve patient satisfaction can minimize the differences between the two perspectives.
Ahuja, Rajeev B; Goswami, Prasenjit
There is an extreme paucity of studies examining cost of burn care in the developing world when over 85% of burns take place in low and middle income countries. Modern burn care is perceived as an expensive, resource intensive endeavour, requiring specialized equipment, personnel and facilities to provide optimum care. If 'burn burden' of low and middle income countries (LMICs) is to be tackled deftly then besides prevention and education we need to have burn centres where 'reasonable' burn care can be delivered in face of resource constraints. This manuscript calculates the cost of providing inpatient burn management at a large, high volume, tertiary burn care facility of North India by estimating all cost drivers. In this one year study (1st February to 31st January 2012), in a 50 bedded burn unit, demographic parameters like age, gender, burn aetiology, % TBSA burns, duration of hospital stay and mortality were recorded for all patients. Cost drivers included in estimation were all medications and consumables, dressing material, investigations, blood products, dietary costs, and salaries of all personnel. Capital costs, utility costs and maintenance expenditure were excluded. The burn unit is constrained to provide conservative management, by and large, and is serviced by a large team of doctors and nurses. Entire treatment cost is borne by the hospital for all patients. 797 patients (208 60% BSA burns. 258/797 patients died (32.37%). Of these deaths 16, 68 and 174 patients were from 0 to 30%, 31 to 60% and >60% BSA groups, respectively. The mean length of hospitalization for all admissions was 7.86 days (ranging from 1 to 62 days) and for survivors it was 8.9 days. There were 299 operations carried out in the dedicated burns theatre. The total expenditure for the study period was Indian Rupees (Rs) 46,488,067 or US$ 845,237. At 1 US$=Rs 55 it makes the cost per patient to be US$ 1060.5. Almost 70% of cost of burn management resulted from salaries, followed by
McHugh, S M
BACKGROUND: Post-splenectomy infection has a mortality rate of up to 70%. Previously we have published data confirming the poor adherence to best practice guidelines with relation to management of the asplenic patient. A defined protocol of care was established, staff education commenced and a \\'patient information leaflet\\' made available. AIM: To ascertain whether management of the asplenic patient has improved since the implementation of a structured programme of care. METHOD: Retrospective chart review of all splenectomies performed in Beaumont Hospital between 2002 and 2008. RESULTS: Overall, 75.9% of patients were documented as having received the recommended vaccinations. Of these, 48.7% were not timed according to recommended guidelines. Prophylactic antibiotics were documented as prescribed in all but five patients discharged. CONCLUSIONS: These results demonstrate an improvement in post-splenectomy care between 2002 and 2008. However, further improvements are necessary.
Laura de Azevedo Guido
Full Text Available This study aimed at identifying the stressors, the level of stress and coping strategies used by nurses in a surgical clinic of a university hospital. It is a cross-sectional study whose population consisted of nine nurses. Data were collected, between May and June 2005, through the Survey Form for Daily Activities and Coping Strategies Inventory. It was verified that activities related to personnel management were valued as the most stressful. Indicating a nurse in a state of alert for high levels of stress was valued like three medium levels and five with low level of stress. It was observed that solving problems was the most commonly used factor to face stress. Knowledge of the stressors and the ways of coping with them can help assist in the development of possible solutions to minimize their effects and become the most productive and less stressful aspect of the daily life.
McHugh, S M
BACKGROUND: Post-splenectomy infection has a mortality rate of up to 70%. Previously we have published data confirming the poor adherence to best practice guidelines with relation to management of the asplenic patient. A defined protocol of care was established, staff education commenced and a \\'patient information leaflet\\' made available. AIM: To ascertain whether management of the asplenic patient has improved since the implementation of a structured programme of care. METHOD: Retrospective chart review of all splenectomies performed in Beaumont Hospital between 2002 and 2008. RESULTS: Overall, 75.9% of patients were documented as having received the recommended vaccinations. Of these, 48.7% were not timed according to recommended guidelines. Prophylactic antibiotics were documented as prescribed in all but five patients discharged. CONCLUSIONS: These results demonstrate an improvement in post-splenectomy care between 2002 and 2008. However, further improvements are necessary.
Yeruva, Sri Lakshmi Hyndavi; Sinha, Archana; Sarraf-Yazdy, Mariam; Gajjala, Jhansi
As endemic malaria is not commonly seen in the United States, most of the cases diagnosed and reported are associated with travel to and from the endemic places of malaria. As the number of imported cases of malaria has been increasing since 1973, it is important to look into these cases to study the morbidity and mortality associated with this disease in the United States. In this study, we would like to share our experience in diagnosing and treating these patients at our institution. We did a retrospective chart review of 37 cases with a documented history of imported malaria from 1998 to 2012. Among them, 16 patients had complicated malaria during that study period, with a mean length of hospital stay of 3.5 days. Most common place of travel was Africa, and chemoprophylaxis was taken by only 11% of patients. Travel history plays a critical role in suspecting the diagnosis and in initiating prompt treatment. PMID:27417079
Full Text Available IZ Isaac,1 AS Mainasara,2 Erhabor Osaro,1 ST Omojuyigbe,1 MK Dallatu,3 LS Bilbis,3 TC Adias4 1Department of Haematology and Transfusion Medicine, 2Department of Chemical Pathology, 3Department of Biochemistry, Usmanu Danfodiyo University, Sokoto, Nigeria; 4Bayelsa State College of Health Technology, Ogbia, Nigeria Abstract: Glucose-6-phosphate dehydrogenase (G6PD deficiency is one of the most common human enzyme deficiencies in the world. It is particularly common in populations living in malaria-endemic areas, affecting more than 400 million people worldwide. This present study was conducted with the aim of determining the prevalence of G6PD deficiency among children visiting the Emergency Paediatric Unit of Usmanu Danfodiyo University Teaching Hospital for pediatric-related care. The study included 118 children, made up of 77 (65.3% males and 41 (34.7% females aged ≤5 years with mean age of 3.26 ± 1.90 years. Randox G6PD quantitative in vitro test screening was used for the diagnosis of G6PD deficiency. Of the 118 children tested, 17 (14.4% were G6PD-deficient. Prevalence of G6PD deficiency was concentrated predominantly among male children (22.1%. Male sex was significantly correlated with G6PD deficiency among the children studied (r = 7.85, P = 0.01. The highest prevalence occurred among children in the 2- to 5-year age-group. Of the 17 G6PD-deficient children, twelve (70.2% were moderately deficient, while five (29.4% were severely deficient. Blood film from G6PD-deficient children indicated the following morphological changes; Heinz bodies, schistocytes, target cells, nucleated red cells, spherocytes, and polychromasia. This present study has shown a high prevalence of G6PD deficiency among children residing in Sokoto in the northwestern geopolitical zone of Nigeria. The study indicated a male sex bias in the prevalence of G6PD deficiency among the children studied. There is a need for the routine screening of children for G6PD
Full Text Available Christopher U Iklaki, Anthony U Agbakwuru, Atim E Udo, Sylvester E Abeshi Department of Obstetrics and Gynaecology, University of Calabar, Calabar, Nigeria Background: The intrauterine devices (IUDs are widely used contraceptive methods all over the world today. They are effective and recommended for use up to 10 years. They are not without side effects, which often prompt the users to request for removal. Objective: To determine the utilization rate of copper T intrauterine contraceptive device (IUCD, side effects, and request for removal at the University of Calabar Teaching Hospital, Calabar. Methods: The data on usage of the various forms of temporary contraception provided by the Family Planning Clinic of this center from January 1, 2006 to December 31, 2010 were collated. The records of usage of IUCD during same period were carefully studied. Results: During this period, a total of 10,880 users were provided with various forms of contraceptives. Copper T IUD was the commonest form of contraception used at the University of Calabar Teaching Hospital Family Planning Unit over the period under review (2006–2010 with a rate of 4,069 (37.40%. There was a yearly higher request for IUCD over other forms of contraceptives over the period. Of a total of 4,069 users of the copper T IUD method over the period, 1,410 (34.65% belonged to the age group of 25–29 years. Eleven (4.61% of the users requested for its removal due to abnormal vaginal bleeding, while five (2.08% removed theirs due to abnormal vaginal discharge. The major reason for removal was the desire for pregnancy that accounted for 165 (70.26%, while one (0.51% was removed due to dysmenorrhea. Conclusion: The copper T380A was very effective, safe with fewer side effects, and easily available in this study. The request for removal is also low in our environment. Keywords: copper T380A, contraception, request for removal
Full Text Available Abstract Background Breast cancer is the most common cancer among women in both the developed and the developing world. The incidence of breast cancer in Karachi, Pakistan is 69.1 per 100,000 with breast cancer presentation in stages III and IV being common (≥ 50%. The most pragmatic solution to early detection lies in breast cancer education of women. Nurses constitute a special group having characteristics most suited for disseminating breast cancer information to the women. We assessed the level of knowledge of breast cancer risk factors among registered female nurses in teaching hospitals of Karachi. We also identified whether selected factors among nurses were associated with their knowledge of breast cancer risk factors, so that relevant measures to improve knowledge of nurses could be implemented. Methods A cross-sectional survey was conducted in seven teaching hospitals of Karachi using stratified random sampling with proportional allocation. A total of 609 registered female nurses were interviewed using a structured questionnaire adapted from the Stager's Comprehensive Breast Cancer Knowledge Test. Knowledge of breast cancer risk factors was categorized into good, fair and poor categories. Ordinal regression was used to identify factors associated with risk knowledge among nurses. Results Thirty five percent of nurses had good knowledge of risk factors. Graduates from private nursing schools (aOR = 4.23, 95% CI: 2.93, 6.10, nurses who had cared for breast cancer patients (aOR = 1.41, 95% CI: 1.00, 1.99, those having received a breast examination themselves (aOR = 1.56, 95% CI: 1.08, 2.26 or those who ever examined a patient's breast (aOR = 1.87, 95% CI: 1.34, 2.61 were more likely to have good knowledge. Conclusion A relatively small proportion of the nursing population had good level of knowledge of the breast cancer risk factors. This knowledge is associated with nursing school status, professional breast cancer exposure and self
Diabetes mellitus is associated with significant morbidity and mortality worldwide and Nigeria is no exception. To determine the morbidity and mortality in patients admitted with Diabetes Mellitus in a tertiary teaching hospital of Nigeria, through retrospective analysis of admission and death records. Admission and death certificate records from the medical wards of the University of Benin Teaching Hospital, Benin City, Nigeria, were retrospectively analysed from 1, August 2003 to 31, July 2004. Data included age, gender, total numbers of admissions and those due to Diabetes Mellitus, the indications for admissions, presenting symptoms and method of diagnoses in diabetic patients, mortality rates and causes of death. Data obtained were analysed using chi square. Out of 1567 medical admissions, 852(54.4%) were males and 715(45.6%) females. Diabetes was detected in 145(9.3%) patients [81(55.9%) males, 64(44.1%) females]. The mean age of diabetic patients was 53.6+16.1 years (range 18 - 94 years). Poor glycaemic control (29%) and diabetic foot syndrome (23.4%) were the most common reasons for admission in diabetic cases. The overall mortality rate among medical admissions was 21.8%, with diabetes accounting for 6.7% deaths. Within the cohort of diabetic cases, mortality was 15.9%, with significantly higher mortality in those aged > 65 years (p < 0.05). The most common causes of death in diabetic cases were Cerebrovascular disease and complications associated with the foot syndrome, accounting for 26.1% and 21.7% of deaths respectively; the least common causes of death in diabetic patients were Malaria, Hepatic Encephalopathy, and Carcinoma of the Cervix, accounting for 4.4% of deaths. Cerebrovascular disease was the most frequent cause of mortality among admitted diabetic patients with diabetic foot syndrome (a preventable complication) as the second most frequent cause of mortality. Increased screening for diabetes mellitus morbidities in the clinic and community
Full Text Available Valvular heart disease is still a common causes of mortality and morbidity in India and rheumatic heart disease is still far more frequent. AIMS AND OBJECTIVES: To study the prevalence and clinical profile of rheumatic and non - rheumatic valvular heart dise ase in patients attending to Government General Hospital, Kakinada. MATERIALS AND METHODS: 100 Adult patients with valvular abnormalities attending to the Medicine and Cardiology Units of Government General Hospital, Kakinada from Nov 2011 - May 2013 were studied. C linical history including various symptoms, past history of rheumatic fever, followed by systemic examination was done. A detailed cardiovascular examination with relevant investigations and evaluation was done. OBSERVATIONS AND RESULTS: The most common cause of acquired valvular heart disease is Rheumatic Heart Disease. Mitral valve involvement is the most common valve involvement with Mitral regurgitation as the most common valvular lesion. Mitral stenosis is the most common valvular lesion amon g rheumatic valvular heart disease. The most common complaint is breathlessness and the most common complication is Congestive heart failure. Multi valvular lesion is the most common valve involvement in patients presenting with congestive heart failure an d infective endocarditis. Patients having atrial fibrillation are noted to have mitral stenosis more commonly. Mitral stenosis is the valve abnormality commonly noted in patients presenting with haemoptysis, respiratory tract infection and chorea. Left sid ed hemiplegia is common in patients with acquired valvular heart disease. CONCLUSIONS: Though the incidencen of rheumatic valvular disease is decreased in modern era, still continuing in our country. The analysis of the present study gives us insight into the various types of presentation of acquired valvular heart disease and to increase awareness besides early detection of valvular diseases clinically. It also helps in planning of
Objective: To document and analyse the presentation and outcome of surgical management of liver trauma. Methods: The study was a retrospective review of records of all surgeries carried out at the Department of General Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad, from January 2003 to December 2010. The study included all adult patients of either gender who presented with liver trauma and underwent operative management. Convenience sampling technique was employed. The study excluded patients who were managed conservatively. The data were collected through a proforma and analysed through SPSS 10. Results: Out of 113 cases of liver trauma, 91 (80.5%) were males and 22 (19.4%) were females. The mean age was 34.8+-9.7 years. Road traffic accidents were the leading cause (n=75; 66.3%) of injuries. There were 37 (32.7%) patients with grade I injury; 41 (36.2%) with grade II injury; 29 (25.6%) with grade III injury; and 7 (6.1%) patients with grade IV injury. Besides, 62 (54.8%) patients had associated extra-hepatic injuries. Majority of the patients presented with haemodynamic compromise (n= 97; 85.8%). Perihepatic packing was the commonest operative procedure instituted (n=43;38%). The in-hospital mortality was 9.7% (n=11). Conclusion: Liver trauma constitutes an important cause of emergency hospitalisation, morbidity and in-hospital mortality in our population. It predominantly affects the younger males and road traffic accidents are the leading cause. Majority of the patients are successfully managed with perihepatic packing. (author)
Siti Suraiya Md Noor; Zaidah Abdul Rahman; Sarimah Abdullah; Zakuan Zainy Deris; Che Wan Aminuddin
Objective:To investigate the prevalence,clinical and bacteriological features and outcome of extrapulmonary tuberculosis in patients attending a tertiary care hospital at Kota Bharu,Kelantan.Methods:All culture posi-tive tuberculosis cases recorded in Hospital Universiti Sains Malaysia at Kota Bharu during five years period from 2003-2007 were included in the study.Mycobacterium detected in samples originating from sites other than lungs was considered as a case of extrapulmonary tuberculosis.Age,site of infection,bacteriological find-ings and outcomes were analyzed.Results:Out of 437 tuberculosis cases recorded from 2002-2006,59 cases had culture positive extrapulmonary tuberculosis.Their mean age was 37 years and 44% were between the ages of 20-40 years.About 63% were negative for acid-fast bacilli by Z-N stain.Of the 59,97% was Mycobacteri-um tuberculosisc (M.tuberculosis)while two (3%)were atypical Mycobacterium Runyon Group-IV.Only 3 (5%)were isoniazid resistant.Extrapulmonary sites involved were lymph nodes 19 (31%),central nervous system 12 (20%),pleural 11(19%)spine 8 (14%),renal 3 (5.1%)and others 6 (10.2%).In this se-ries,11(18%)were positive for HIV.There was no significant association between extrapulmonary tuberculo-sis and HIV status.The outcome of CNS tuberculosis was the poorest with a mortality rate of 25%.Conclu-sion:M.tuberculosis is the predominant organism in extrapulmonary tuberculosis and culture is the most effec-tive method for its diagnosis.
Full Text Available BACKGROUND: Blood transfusion is a life - saving procedure. However , the recipient has the potential risk of acquiring transfusion - transmissible infections (TTI , important infectious agents being Human Immunodeficiency Virus (HIV , Hepatitis B & C viruses , and Treponema pallidum. AIM: This study was undertaken to know the prev alence of TTI in our hospital blood bank and hence evaluate the safety of the blood units . MATERIAL AND METHOD: The present study was conducted at the Blood Bank of our Medical College Hospital. Data was collected retrospectively for a 4.5 - year period from January 2008 to June 2012. Donor data including demographic details and results of the screening tests were recorded. RESULTS: In the 4.5 - year period , there were 7128 donors – both voluntary and replacement donors. The donors were in the age group 18 to 5 0 years. Out of the 116 donors tested positive for any test , there were 5 female donors and the 111 male donors. The donors who tested positive formed 1.6% of the total number of donors. The maximum number of donors were positive for HBsAg (n=47 , followed by positivity for HCV (n=45. The seroprevalence of HBsAg , HCV , HIV and Syphilis was 0.66% , 0.63% , 0.25% and 0.1% respectively. There was no case with smear positive for malaria parasite. CONCLUSION: The seroprevalence of TTI is minimal in our set up. The risk can be kept to a minimum by proper donor selection and testing of the collected units
Mohebbifar, Rafat; Zakaria Kiaei, Mohammad; Khosravizadeh, Omid; Mohseni, Mohammad
Recognition of career motivators and understanding of managers and employees in prioritizing them, in order to plan incentives for this understanding, can play an important role in increasing productivity and creating harmony between the goals of the organization and staff. This study was done to survey the importance of career motivating factors from perspective of employees and managers in educational hospitals of Iran. In this study 269 from a total of 1843 employees of educational hospitals in Qazvin province of Iran were selected through Quota-Random sampling and studied along with all 49 Managers. Lawrence Lindale questionnaire with 10 factors where used in order to determine motivational priorities. The results indicated that among the 10 studied motivational factors, from employees' viewpoint; "Good wages", "Good Working Conditions" and "Job Security" have the greatest roles in motivating employees. In the context of perspective agreement amongst employees and managers, the results showed 20 percent agreement. In this study, results of "Independent T" test showed a significant difference in comparison, between prioritizing employees' view and prediction of managers in the factors of "Job Security" (p = 0/031) and "Interesting Work" (p = 0/001). With respect to increase disagreement in the views of managers and employees as compared to previous studies, Managers need to pay more attention to cognition of motivational factors and make their viewpoints closer to actual motivational need of their employees. Attention to this fact can be a great help to the growth and productivity of the organization, making the organizational and individual goals closer and also keeping managers safe from execution of constant and undue motivational patterns. PMID:25363113
Manejo não-farmacológico de pacientes hospitalizados com insuficiência cardíaca em hospital universitário Non-pharmacological management of patients hospitalized with heart failure at a teaching hospital
Eneida R. Rabelo
Full Text Available OBJETIVO: Descrever o manejo não-farmacológico de pacientes internados com insuficiência cardíaca (IC em um hospital universitário. MÉTODOS: Estudo de coorte longitudinal de pacientes com IC diagnosticados pelo escore de Boston. Durante as 72 horas iniciais de internação, enfermeiras da clínica de IC realizaram entrevistas padronizadas e revisões de prontuários. RESULTADOS: Foram avaliadas 283 internações de 239 pacientes (idade = 64 ± 15 anos, aproximadamente 50% sexo masculino e 37% de etiologia isquêmica. O padrão de prescrição dos diferentes cuidados não-farmacológicos foi restrição de sal em 97%, controle de diurese em 85%, balanço hídrico em 75%, controle de peso em 61% e restrição hídrica em apenas 25% das internações. Embora os cuidados referidos estivessem nas prescrições, freqüentemente não eram realizados pela equipe responsável (p OBJECTIVE: To describe non-pharmacological management of patients admitted with heart failure (HF in a teaching hospital. METHODS: A cohort longitudinal study of patients diagnosed with HF according to the Boston score. Within the first 72 hours of admission, the nursing staff of the HF clinic conducted structured interviews and medical chart reviews. RESULTS: Two hundred and eighty-three admissions of 239 patients (age = 64 ± 15 years were evaluated; approximately 50% of the patients were male and 37% had heart failure of ischemic etiology Non-pharmacological measures included salt restriction in 97%, urine output monitoring in 85%, fluid balance in 75%, weight monitoring in 61%, and fluid restriction in only 25% of the patients. However, they were often not carried out by the team in charge (p < 0.01 for all comparisons. Irregular use of prescribed drugs in the week prior to admission was 22% and 21% in non-readmitted and readmitted patients, respectively (p = 1.00. Readmitted patients (n = 38 had severe systolic dysfunction, more previous hospitalizations, and longer
Staff and the general public's safety during the operation of the 137Cs brachytherapy unit at the Korle Bu teaching hospital depends on the adequacy of the shielding of the facility. Shielding design of the brachytherapy unit at the hospital was based on postulated workload and postulated occupancy factors to critical locations at the facility where the public and staff may occupy. This facility has been in existence for the past twelve (12) years and has accumulated operational workload data which differs from the postulated one. A study was carried out to re-evaluate the integrity of the biological shielding of the 137Cs brachytherapy unit. This study analyzed the accumulated workload data and used the information to perform shielding calculations to verify the adequacy of the biological shielding thicknesses to provide sufficient protection of staff and the public. Dose rate calculations were verified by measurements with calibrated dose rate meters. This provided the basis for determining the current state of protection and safety for staff and the general public. The results show that despite the variation in actual and postulated workloads, the dose rates were below the reference values of 0.5μSv/h for public areas and 7.5μSv/h for controlled areas. It was confirmed that the present shielding thickness of 535 mm can accommodate a high dose rate (HDR) 192Ir source with activity in the range 370 - 570 GBq with an operational workload of 30 patients per week and an average treatment time of 10 minutes.
In this work management of paediatric patients doses for Computed Tomography examinations have been studied at Korle-Bu Teaching Hospital. The assessment of the management system involved: evaluation of the frequency of examinations, comparison of techniques factors used for adult and children; estimation of CTDIw, CTDIvol, DLP and effective dose; evaluation of quality assurance and quality control programmes to optimise paediatric patient doses. The frequency of CT examinations for paediatric patients accounted for 1300 out 5200 examinations (25%) of the total examinations recorded for the year 2008 which is five times that of the East European countries, indicating an overuse of CT examinations for children not taking into account paediatric patient anatomy and the section of the body being scanned. Adult CT exposure parameters such as the KV, mAs, scan length, pitch, and collimation values were being used in paediatric CT examination. Effective dose estimated for children were higher than that for adults by factors 5.1, 1.8, 3.1 and 3.9 more for head, chest, abdomen and pelvis examinations respectively. From the questionnaire administered and dosimetry results there was no established justification policy, procedures and referral criteria for CT examination requests for children. There was no Quality Assurance Committee to see to the implementation of dose management system dedicated to paediatrics patients. There was the need for the Hospital Authorities to formulate policies in the training of CT equipment operators, radiographers and radiographers and radiologist in modern CT technology as well as in the selection of appropriate parameters tailored to individual patient size that can achieve desirable diagnostic image quality at low doses. (au)
Suvarna S Rathod
Full Text Available Background: Inappropriate or excessive use of topical corticosteroids can lead to cutaneous and systemic adverse effects which occur more commonly with the use of very potent steroids. Monitoring and analysis of the prescription practices of topical steroids can help to achieve rational prescription of these drugs. Aim: The present study was carried out to study and analyze the pattern of prescribing topical corticosteroids among outpatients attending the dermatology clinic in a rural tertiary care and teaching hospital, Ambajogai, Maharashtra. Materials and Methods: A cross-sectional descriptive study was conducted for a duration of two months from August 2011 to September 2011, and 500 prescriptions were randomly collected from the dermatology pharmacy and analyzed. Results: About 66% of the prescriptions contained four to five drugs per prescription. Topical steroids were given in 28.4% of all the prescriptions. In almost all the prescriptions, strength, quantity of the steroid to be used, frequency, site, and duration of application was not mentioned. The chief complaints and diagnoses were not mentioned in about 85% of the prescriptions for topical corticosteroids. About 94.36% of the prescriptions contained very potent steroids. Conclusion: Inadequate prescribing information is a clear characteristic of the dermatological prescriptions containing topical corticosteroids. Doctors should be educated about the importance of giving patients sufficient information regarding the use of steroids. There is a need to revise hospital formulary where low-potency steroids can also be included along with potent ones so that the latter can be avoided in conditions where they are unnecessary.
Background: The assessment of dental anxiety among children will aid in dealing with management issues related to dental treatment. There is no study available from Pakistan on dental anxiety in children. The aim of this study was to assess the prevalence of dental anxiety in children attending a teaching dental hospital in Islamabad, Pakistan. Method: A cross-sectional study was conducted on 252 children aged between 5-10 years attending a dental clinic in a dental hospital in Islamabad, Pakistan. Dental anxiety was assessed by using the Faces Version of the Modified Child Dental Anxiety Scale. This scale uses faces as pictograms to indicate the levels of dental anxiety making it easier for children to answer the questionnaire. Results: A total of 252 children were observed for assessment of dental anxiety having mean age of 7.88±1.55 years with 123 (48.8 percentage) males and 129 (51.2 percentage) females. Out of these children 150 (59.5 percentage) had previously visited a dentist and 102 (40.5 percentage) had no experience with a dentist before; 38 percentage (95/252) of children had moderate and severe dental anxiety. Dental anxiety decreased significantly with age (p=0.0003). The difference in anxiety levels was not statistically significant between males and females and in different socio-economic status. Conclusion: This study has highlighted dental anxiety as a potential public health concern regarding children in Pakistan. Assessment of dental anxiety is a useful way to identify anxious dental patients. (author)
Full Text Available Introduction: Diabetes mellitus is a major public health problem worldwide. Diabetic patients are at risk of developing blindness from diabetic retinopathy. While occurrence of diabetic retinopathy cannot be prevented, its complications can be minimized. This requires awareness of the sight-threatening potential of diabetes and the need for regular eye examinations. Aim: To study the knowledge of ocular complications of diabetes, among type II diabetics visiting a tertiary level hospital. Settings and Design: This was a prospective study in a tertiary care teaching hospital. Methods and Material: This was a questionnaire based study on 350 type II diabetics. All patients were interviewed by the same investigator. Statistical analysis used: The data was analysed using chi square test. Results: With increase in the duration of illness, the awareness about diabetic retinopathy is more. Even though the awareness of the disease increased with increasing duration of the disease, 51.4% of the diabetics did not know how diabetes can affect the eye, 49.7% of diabetics did not know if diabetic retinopathy can be treated and 67.4% had not heard of any treatment modality for diabetic retinopathy. This shows that lack of knowledge about the disease was significant. Conclusions: Prevention of non-communicable disease through increased awareness needs to be the thrust of the effort in resource poor contexts, where the treatment can be prohibitively costly. These measures would help to bring about more awareness and understanding about the disease among the patients and therefore prevent sight-threatening complications by timely intervention and management.
White, Stephen D; Bourdeau, Patrick; Bruet, Vincent; Kass, Philip H; Tell, Lisa; Hawkins, Michelle G
This retrospective study reviews the medical records of 301 reptiles with dermatological lesions that were examined at the Veterinary Medical Teaching Hospital, University of California at Davis (VMTH-UCD) and the Unité de Dermatologie-Parasitologie-Mycologie, Ecole Nationale Vétérinaire de Nantes (UDPM-ENVN) from 1 January 1992 to 1 July 2008. The most common reptile groups differed between the two hospitals, with lizards being the most common at the VMTH-UCD and chelonians at the UDPM-ENVN. At the VMTH-UCD, boa constrictors (Boa constrictor), ball pythons (Python regius) and other Python species were over-represented, and box turtles (Terrapene carolina) were under-represented in the dermatological lesion caseload. When institutional data were combined, 47% of all reptiles at both institutions with confirmed or suspected cases of sepsis had petechiae, with the highest association seen in chelonians at 82%. Dependent on institution and reptile group, from 29% to 64% of the cases had underlying husbandry issues. Sixty-two per cent of all cases were alive at final status. Veterinarians treating reptiles with skin disease should be aware of the following: (i) that boa constrictors and Python species may be predisposed to dermatological lesions; (ii) that client education is important for proper husbandry; and (iii) that there is a possible association between petechiae and sepsis, especially in chelonians. The conjectural association between certain skin lesions and sepsis remains to be confirmed by systematically derived data that demonstrate a causal relationship between the two. PMID:20887405
Lekhjung J Thapa
Full Text Available Objective: Acute encephalitis syndrome is a cause of significant morbidity and mortality in Nepal. Although Japanese encephalitis virus (JEV was thought to be a major cause for acute encephalitis syndrome, more non-Japanese encephalitis virus cases are reported. The outcome of patients with acute encephalitis syndrome is variable. Our study was designed to study the clinical profile and outcome of patients with acute encephalitis syndrome managed in tertiary care center in central Nepal. Methods: The record of patients admitted with diagnosis of acute encephalitis syndrome,from January 2010 to December 2010 in College of Medical Sciences-Teaching Hospital (CMS-TH was reviewed. They were classified clinically as meningitis, encephalitis and meningoencephalitis. The clinical details and reports of the patients were recorded and analyzed. Results: Total of 85 cases of meningitis and encephalitis were identified. Mean age was 19.18 years. Fifty-six (65.9% patients were males and 29 (34.1% were females. Sixty (70.58% patients had meningitis, 8 (9.41% had encephalitis, and 17 (20.0% had meningoencephalitis. JE serology was positive in 4 patients (4.7%. Seventy-two (84.7% patients made full recovery and were discharged from hospital. Thirteen (15.3% patients left against medical advice (LAMA. Conclusion: Acute encephalitis syndrome is still a major public health problem in Nepal. Few of these patients have Japanese Encephalitis. There is a trend towards improved outcome because of availability of improved health services. However, financial constraint remains a challenge in management of acute encephalitis syndrome. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-2, 31-37 DOI: http://dx.doi.org/10.3126/jcmsn.v9i2.9685
Over the last few decades the ever-increasing level of bacterial resistance to antimicrobials has been a cause of worldwide concern. Fluoroquinolones, particularly ciprofloxacin has been used indiscriminately for both gram-positive and gram-negative bacterial infections. The increased use of ciprofloxacin has led to a progressive loss of bacterial susceptibility to this antibiotic. Therefore it is necessary to have update knowledge of resistance pattern of bacteria to this antibiotic so that alternate appropriate antibiotics can be used for ciprofloxacin-resistant bacterial infections. Objective: To evaluate the trends of ciprofloxacin resistance pattern in commonly isolated gram positive bacteria over time in a Saudi Arabian teaching hospital. Methods: A retrospective analysis was carried out for ciprofloxacin susceptibility patterns of 5534 isolates of gram-positive bacteria isolated from clinical specimens submitted to microbiology laboratories at King Fahd Hospital of the University (KFHU), Al-Khobar, Saudi Arabia during the period from January 2002 to August 2005. Results: Increase in ciprofloxacin resistance rates with some fluctuations, among these isolates, were observed. For Staphylococcus aureus, it varied from 4.62, 1.83, 7.01 and 3.98%, methicillin resistant Staphylococcus aureus (MRSA) 97.92, 97.75, 87.01 and 88.26%, Streptococcus pyogenes 5.35, 4.47, 14.44 and 3.53% during the years 2002, 2003, 2004 and 2005 respectively. Cirprofloxacin resistance during the years 2002, 2004 and 2005 for other isolates was as follows: Streptococcus pneumoniae, 30.23, 23.02 and 26.47%; enterococcus group D, 43.05, 20.68 and 57.03% and non-enterococcus group D, 62.96, 76.92 and 87.50% respectively. Conclusion: Ciprofloxacin resistance in gram positive bacterial clinical isolates particularly Staphylococcus aureus, methicillin resistant Staphylococcus aureus (MRSA) enterococcus group D, and non-enterococcus group D, has greatly increased and ciprofloxacin no more remains
Full Text Available Medication errors account for about 78% of serious medical errors in intensive care unit (ICU. So far no study has been performed in Iran to evaluate all type of possible medication errors in ICU. Therefore the objective of this study was to reveal the frequency, type and consequences of all type of errors in an ICU of a large teaching hospital. The prospective observational study was conducted in an 11 bed internal ICU of a university hospital in Shiraz. In each shift all processes that were performed on one selected patient was observed and recorded by a trained pharmacist. Observer would intervene only if medication error would cause substantial harm. The data was evaluated and then were entered in a form that was designed for this purpose. The study continued for 38 shifts. During this period, a total of 442 errors per 5785 opportunities for errors (7.6% occurred. Of those, there were 9.8% administration errors, 6.8% prescribing errors, 3.3% transcription errors and, 2.3% dispensing errors. Totally 45 interventions were made, 40% of interventions result in the correction of errors. The most common causes of errors were observed to be: rule violations, slip and memory lapses and lack of drug knowledge. According to our results, the rate of errors is alarming and requires implementation of a serious solution. Since our system lacks a well-organize detection and reporting mechanism, there is no means for preventing errors in the first place. Hence, as the first step we must implement a system where errors are routinely detected and reported.
Langhi, R.; Vilaça, J.
The objective of Brazilian Eratosthenes Project is the development and application of teaching training actions according the ``docent autonomy" concept to basic Astronomy Education. Argentina coordinates the project in South America, but Brazil works in this project since 2010 with the theme ``Projeto Eratóstenes Brasil" in the homepage: http://sites.google.com/site/projetoerato. Two schools measure a sticks shadow and communicate their results. After, they calculate an average radius of Earth. The stick (gnomon) should stay in vertical position in the leveled ground. Since 2010, the project received hundreds of Brazilian schools with different experiments that were constructed with autonomy, because our site doesn't show some itinerary pre-ready to elaborate the experiments. To collect data for our research, we will use interviews via Skype with the teachers. These data are useful to researches about Science Education area and the Teaching Formation. Teaching professional practice could change and we see modifications in the teachers work, what depends of their realities and context. This project intents to respect the docent autonomy. This autonomy to responsible modifications during continued formation is called ``activist formative model" according Langhi & Nardi (Educação em Astronomia: repensando a formação de professores. São Paulo: Escrituras Editora, 2012). This project discusses about researches in Astronomy Education - still extreme rare in Brazil, when we compare with other areas in Science Education. We believe that actions like this could motivate the students to learn more Astronomy. Furthermore, this national action can be a rich source of data to investigations about teaching formation and scientific divulgation.
Full Text Available Background: In India, a proper reporting of medication errors in the hospital is not available. Drugs worth crores of rupee are consumed every year but a substantial part of these drugs are irrationally prescribed. In order to promote rational drug usage standard policies on use of drugs must be set, and this can be done only after the current prescription practices have been audited. The prescriptions were analyzed based on the objectives of the study in order to promote rational use of drugs in a population. Methods: The study was carried out prospectively over a period of two months and 15 days in general medicine OPD of our tertiary care hospital. A specially designed performa was used with pre-inserted carbons. Results: Two hundred and thirty seven prescriptions were analyzed. Total no. of drugs in 237 prescriptions were 1001. Therefore average number of drugs/prescription is 4.22. Drugs were prescribed by generic names in 3.79% of cases, drugs on EDL are only 53.25% and fixed dose combinations are 26.87% of total drugs. Dosage forms used were mostly oral -93.51%. Injectables were only 6.19% and topical forms were least 0.299%. Doctors profile indicates that maximum number i.e. 93.67% were general practitioners. Basic information of patient was written in 72.57% prescriptions. Complete diagnoses were written in 70.04% prescriptions. Only 88.61% prescriptions were legible and only 76.79% prescriptions were complete in terms of dose, route, strength, frequency and dosage forms. Disease pattern seen was variable. Diseases of respiratory system were maximum 44.72 % followed by infectious and parasitic diseases - 16.03 % and diseases of digestive system - 13.92 %. The most common drug groups prescribed were NSAIDs± serratiopeptidases, antibiotics, antihistaminics, multivitamins, minerals, enzymes and expectorants & bronchodilators. The incidence of polypharmacy was also common with maximum number of drugs which were prescribed per prescription
Endalkachew Admassie*, Birhan Begashaw and Wubshet Hailu
Full Text Available Background: Rational drug use is a tool through which safe, effective and economic medication is provided. Rational prescribing ensures adherence to treatment and protects drug consumers from unnecessary adverse drug reactions. Rational dispensing on the other hand, promotes the safe, effective and economic use of drugs.Objectives: The aim of this study was to assess drug use practices and completeness of information on prescriptions in Gondar University Hospital.Methodology: A combination of retrospective and cross sectional study was conducted in outpatient pharmacy in the facility. Of the total of 30,000, some 1145 prescriptions containing drugs prescribed during the month of May 1, 2010 to April 30, 2011 were reviewed for retrospective and 31 patients coming with their prescriptions to outpatient pharmacy were interviewed in the middle of the week on the day of January 25, 2012.Results: The mean number of drugs per prescriptions was 1.76, percentage of prescriptions containing < 2 drugs per prescription was 80.87%. The generic name of the medication was used in 99.16 % of the prescriptions. Antibiotics were prescribed in 29.14 % of prescriptions and injections were prescribed in 28.50% of prescriptions. The drugs prescribed in 98.89% of prescriptions were part of the hospital essential drug list indicating the acceptance of this list by health care professionals. Patients age, sex and card number were written 86.64%, 67.93% and 73.54% respectively. Address of the patient and diagnosis were omitted 97.29% and 99.99% respectively. The correct name and strength of the drug were clearly stated in 80% of the prescriptions whereas dose, frequency and durations were clearly indicated in 81.38%, 76.07% and 82.01% of the prescriptions respectively. 33.42%, 96.69%, 72.56% and 16.09% of the prescriptions contain the name, signature, date and qualification of the prescribers. 80% of patients interviewed had adequate knowledge of how to take the