Lyon, A; Love, D R
A survey of all deaths occurring over a two-year period in a group practice population was carried out to assess the contribution of the local general practitioner hospital to terminal care overall. With the availability of the hospital, the general practitioners were able to provide a higher proportion of terminal care for their patients than in areas where general practitioners did not have access to hospital beds. This was particularly so in terminal care for patients dying of cancer.
Ferrua, Marie; Sicotte, Claude; Lalloué, Benoît; Minvielle, Etienne
Context The strategy of publicly reporting quality indicators is being widely promoted through public policies as a way to make health care delivery more efficient. Objective To assess general practitioners’ (GPs) use of the comparative hospital quality indicators made available by public services and the media, as well as GPs’ perceptions of their qualities and usefulness. Method A telephone survey of a random sample representing all self-employed GPs in private practice in France. Results A...
Ferrua, Marie; Sicotte, Claude; Lalloué, Benoît; Minvielle, Etienne
Context The strategy of publicly reporting quality indicators is being widely promoted through public policies as a way to make health care delivery more efficient. Objective To assess general practitioners’ (GPs) use of the comparative hospital quality indicators made available by public services and the media, as well as GPs’ perceptions of their qualities and usefulness. Method A telephone survey of a random sample representing all self-employed GPs in private practice in France. Results A large majority (84.1%–88.5%) of respondents (n = 503; response rate of 56%) reported that they never used public comparative indicators, available in the mass media or on government and non-government Internet sites, to influence their patients’ hospital choices. The vast majority of GPs rely mostly on traditional sources of information when choosing a hospital. At the same time, this study highlights favourable opinions shared by a large proportion of GPs regarding several aspects of hospital quality indicators, such as their good qualities and usefulness for other purposes. In sum, the results show that GPs make very limited use of hospital quality indicators based on a consumer choice paradigm but, at the same time, see them as useful in ways corresponding more to the usual professional paradigms, including as a means to improve quality of care. PMID:26840429
Leila Mariza Hildebrandt; João Fernando Marcolan
Objective: to understand the concepts of Nursing professionals about the hospitalization of people with mental disorders admitted to psychiatric units of general hospitals. Methods: this is a qualitative research developed in three general hospitals. The data collection was carried out through semi-structured interviews and systematic observation. Thirty Nursing professionals were interviewed. The data analysis was based on content analysis. Results: issues concerning fragility were identifie...
Full Text Available Abstract Background Continual collaboration between physicians and hospital-based palliative care teams represents a very important contributor to focusing on patients' symptoms and maintaining their quality of life during all stages of their illness. However, the traditionally late introduction of palliative care has caused misconceptions about hospital-based palliative care teams (PCTs among patients and general physicians in Japan. The objective of this study is to identify the factors related to physicians' attitudes toward continual collaboration with hospital-based PCTs. Methods This cross-sectional anonymous questionnaire-based survey was conducted to clarify physicians' attitudes toward continual collaboration with PCTs and to describe the factors that contribute to such attitudes. We surveyed 339 full-time physicians, including interns, employed in a general acute-care hospital in an urban area in Japan; the response rate was 53% (N = 155. We assessed the basic characteristics, experience, knowledge, and education of respondents. Multiple logistic regression analysis was used to determine the main factors affecting the physicians' attitudes toward PCTs. Results We found that the physicians who were aware of the World Health Organization (WHO analgesic ladder were 6.7 times (OR = 6.7, 95% CI = 1.98-25.79 more likely to want to treat and care for their patients in collaboration with the hospital-based PCTs than were those physicians without such awareness. Conclusion Basic knowledge of palliative care is important in promoting physicians' positive attitudes toward collaboration with hospital-based PCTs.
Johnsen Roar; Windspoll Rolf; Garåsen Helge
Abstract Background Demographic changes together with an increasing demand among older people for hospital beds and other health services make allocation of resources to the most efficient care level a vital issue. The aim of this trial was to study the efficacy of intermediate care at a community hospital compared to standard prolonged care at a general hospital. Methods In a randomised controlled trial 142 patients aged 60 or more admitted to a general hospital due to acute illness or exace...
Hayes, Nicky; Dearnley, Barbara
User involvement is high on the NHS agenda. At King's College Hospital, London, older people helped to develop the Improving Hospital Care for Older People project by producing teaching and learning materials for staff using e-learning. The project was set up by holding focus groups with older people. Staff surveys were also conducted to explore views and identify issues to be addressed. Older people's representatives were selected and directly involved in developing learning materials. This article describes the process of working together and includes the personal reflections of some of the key players. It discusses barriers to effective user involvement work between staff and older people, and identifies some benefits and opportunities presented by this approach. PMID:17518196
BACKGROUND—Many hospitals lack the facilities for high dependency care, and patients requiring this level of care are nursed on the surgical ward. The aim of this study was to assess the extent of this problem in a district general hospital, looking at the impact of providing high dependency unit (HDU) care at ward level. METHODS—A 28 bed surgical ward was studied for 39 consecutive days. Patients were assessed as being either appropriately placed (routine) or inappropriately placed (HDU). Nu...
Results: Among 116 patients of generalized lymphadenopathy 59.5% were non-malignant causes where 40.5% diagnosed as malignant causes. Among them tuberculosis consist of 39 (33.6%, NHL 18 (15.5%, reactive lymphadenopathy 16 (13.8%, CLL and HD 8 (6.9% each, ALL 7 (6%, SLE 5(4.3%, Kikuchi's disease 4 (3.4%, AML and RA 3 (2.6% each and castleman's disease, phenytoin lymphadenopathy, metastatic lung and breast carcinoma 1 (0.9% each. Cervical groups of lymph nodes were most commonly involved 86 patients (74.1% followed by axillary groups 73 patients (62.9%. Lymph nodes size 1.5cm were due to malignant and non-malignant granulomatous cases. FNAC give definite diagnosis 80.9% malignant cases where 76.8% in non-malignant cases. HPE shown definite diagnosis in 100% cases both malignant and non-malignant diseases. Conclusions: Tuberculosis is most common cause of generalized lymphadenopathy followed by lymphoma. And reactive lymphadenitis is also an important consideration. [Int J Res Med Sci 2016; 4(8.000: 3542-3548
Kilsdonk, Melvin J; Siesling, Sabine; Otter, Rene; van Harten, Wim H
External peer review was introduced in general hospitals in the Netherlands in 1994 to assess and improve the multidisciplinary team approach in cancer care. This paper aims to explore the value, perceived impact, and (future) role of external peer review in cancer care. Semistructured interviews were held with clinicians, oncology nurses, and managers from fifteen general hospitals that participated in three rounds of peer review over a period of 16 years. Interviewees reflected on the goals and expectations, experiences, perceived impact, and future role of external peer review. Transcriptions of the interviews were coded to discover recurrent themes. Improving clinical care and organization were the main motives for participation. Positive impact was perceived on multiple aspects of care such as shared responsibilities, internal prioritization of cancer care, improved communication, and a clear structure and position of cancer care within general hospitals. Establishing a direct relationship between the external peer review and organizational or clinical impact proved to be difficult. Criticism was raised on the content of the program being too theoretical and organization-focussed after three rounds. According to most stakeholders, external peer review can improve multidisciplinary team work in cancer care; however, the acceptance is threatened by a perceived disbalance between effort and visible clinical impact. Leaner and more clinically focused programs are needed to keep repeated peer reviews challenging and worthwhile. PMID:26714788
Jurgens Fiona J
Full Text Available Abstract Background Families and other carers report widespread dissatisfaction with general hospital care for confused older people. Methods We undertook a qualitative interviews study of 35 family carers of 34 confused older patients to ascertain their experiences of care on geriatric and general medical, and orthopaedic wards of a large English hospital. Transcripts were analysed using a grounded theory approach. Themes identified in interviews were categorised, and used to build a model explaining dissatisfaction with care. Results The experience of hospital care was often negative. Key themes were events (illness leading to admission, experiences in the hospital, adverse occurrences including deterioration in health, or perceived poor care; expectations (which were sometimes unrealistic, usually unexplored by staff, and largely unmet from the carers’ perspective; and relationships with staff (poor communication and conflict over care. Expectations were influenced by prior experience. A cycle of discontent is proposed. Events (or ‘crises’ are associated with expectations. When these are unmet, carers become uncertain or suspicious, which leads to a period of ‘hyper vigilant monitoring’ during which carers seek out evidence of poor care, culminating in challenge, conflict with staff, or withdrawal, itself a crisis. The cycle could be completed early during the admission pathway, and multiple cycles within a single admission were seen. Conclusion People with dementia who have family carers should be considered together as a unit. Family carers are often stressed and tired, and need engaging and reassuring. They need to give and receive information about the care of the person with dementia, and offered the opportunity to participate in care whilst in hospital. Understanding the perspective of the family carer, and recognising elements of the ‘cycle of discontent’, could help ward staff anticipate carer needs, enable relationship
Full Text Available Abstract Access to timely and quality maternal health care remains to be a major development challenge in many developing economies particularly in Kenya. The countrys system of providing maternal health care also continue to be anchored on conventional methods of physical presence of the patient and the doctor in a hospital setup. The countrys ICT and health policies also place very little emphasis on the use of these platforms. This study therefore sought to establish the factors affecting the adoption of mHealth by focusing on maternal health in Nakuru Provincial General Hospital. Objectives of the study were to determine the extent to knowledge and awareness affects the adoption of mHealth in maternal health care at Nakuru PGH to identify the government policies affecting the adoption of mHealth in maternal health care at Nakuru PGH to assess how access to technology affects the adoption of mHealth in maternal healthcare to establish the effects of ICT infrastructure on the adoption of mHealth in maternal health care and to identify the cost aspects affecting the adoption of mHealth in maternal health care at Nakuru Provincial General Hospital. It is envisaged that the study could provide useful information on the adoption of mHealth in managing maternal health care in Nakuru Provincial General Hospital. Descriptive survey research design will be used where all the medical staff and patients of Nakuru Provincial General Hospital was surveyed. The study population therefore was made up of 24 medical staff and 3460 mothers visiting the antenatal clinic selected using clustered random sampling technique. The main instrument for primary data collection was the questionnaire. Data analysis was then done using both descriptive and inferential statistics. Descriptive statistics to be used include frequency counts percentages and measures of central tendency. Inferential statistics on the other hand include t-test analysis and spearman correlation
BACKGROUND: Robust international data support the effectiveness of stroke unit (SU) care. Despite this, most stroke care in Ireland are provided outside of this setting. Limited data currently exist on the quality of care provided. AIM: The aim of this study is to examine the quality of care for patients with stroke in two care settings-Regional General Hospital (RGH) and Stroke Rehabilitation Unit (SRU). METHODS: A retrospective analysis of the stroke records of consecutive patients admitted to the SRU between May-November 2002 and April-November 2004 was performed applying the UK National Sentinel Audit of Stroke (NSAS) tool. RESULTS: The results of the study reveal that while SRU processes of care was 74% compliant with standards; compliance with stroke service organisational standards was only 15 and 43% in the RGH and SRU, respectively. CONCLUSION: The quality of stroke care in our area is deficient. Comprehensive reorganisation of stroke services is imperative.
Milton Luiz Gorzoni
Full Text Available Instituições de longa permanência para idosos interagem periodicamente com hospitais gerais para internações de casos agudos ou dos que necessitam de métodos diagnósticos complexos e da atenção de várias especialidades simultaneamente. A decisão de indicar hospitalização é multifatorial, sendo influenciada por circunstâncias como a gravidade do quadro clínico e a infra-estrutura das instituições de longa permanência para idosos. Internações hospitalares apresentam benefícios e riscos, como o desenvolvimento de iatrogenias, delirium e declínios funcionais, podendo resultar em piora do estado geral e da qualidade de vida do idoso asilado durante e/ou após a hospitalização. O objetivo do estudo foi abordar aspectos peculiares na avaliação, tratamento e manejo de idosos asilados em internações hospitalares, particularmente quanto a cuidados que os auxiliem efetivamente nessas circunstâncias. Discutiram-se situações freqüentes como delirium, iatrogenias, desnutrição, declínio funcional e cuidados paliativos e características próprias de residentes em instituições para idosos durante internações em hospitais gerais.Long-term care facilities for the elderly have regularly to work together with general hospitals to provide care to acutely ill residents or when they require all together more complex diagnostic procedures and multi-specialty care. The decision to hospitalize a nursing home elderly resident is multifactorial and it is based on factors such as illness severity and care facility infrastructure. Hospitalizations have benefits and risks such developing iatrogenic diseases, delirium, and functional decline, which may deteriorate patients' general condition and their quality of life during and/or after hospitalization. This study aimed at addressing specific aspects of assessment, treatment and management of nursing home elderly who require to be hospitalized, especially focusing on their effective care
Healthcare provision for minority ethnic groups in the UK has generally revealed inequalities in access and differential service provision. British healthcare policy has started to address such issues. However, very few studies have specifically examined the experiences of nurses caring for minority ethnic patients. This paper focuses on the focus group interviews of a broader ethnographic study, aimed at describing nurses' experiences of caring for South Asian minority ethnic patients, in a general hospital in the south of England. A sample of 43 nurses of all grades from six medical wards took part in the focus groups: three ward sisters, 22 staff nurses and 18 care assistants; 40 participants were white, one was African-Caribbean and two were South Asian. Data analysis revealed eight themes: changes in service provision; false consciousness of equity; limited cultural knowledge; victim blaming; valuing of the relatives; denial of racism; ethnocentrism, and self-disclosure. The study revealed a good local service response to government policies in addressing inequality. However, there was a tendency to treat all minority ethnic patients the same, with evidence of ethnocentric practices, victim-blaming approaches and poor cultural competence in nursing staff, which raise questions about the quality of service provision. The study indicates that ongoing training and development in the area of cultural competence is necessary. PMID:16494664
Schütz, F; Maleika, A; Poeschl, J; Domschke, C; Seitz, H; Beuter-Winkler, P; Sohn, C
Hospital managers and the heads of medical departments are nowadays being faced with ever increasing demands. It is becoming difficult for some small hospitals to find highly experienced or even experienced medical staff, to provide specific health-care services at break-even prices and to maintain their position in competition with other hospitals. On the other hand, large hospitals are facing enormous pressure in the investment and costs fields. Cooperation could provide a solution for these problems. For an optimal strategic exploitation of the hospitals, their direction could be placed in the hands of a joint medical director. However, the directorship of two hospitals is associated both with opportunities and with risks. The present article illustrates the widely differing aspects of the cooperation between a medical centre and a general hospital providing standard care from both a theoretical point of view and on the basis of practical experience with an actual cooperation of this type in Heidelberg. PMID:25308978
Full Text Available Abstract Background The aim of this paper was to study the collaboration between emergency departments (EDs in general hospitals and community health services (CHS in Norway when providing psychosocial care and aftercare to patients treated in EDs following a suicide attempt. We wanted to explore the extent to which quality indicators at the hospital level measured in 1999 and 2006 could predict the presence or absence of a chain of care structure in the CHS in 2006. Methods Data were collected through structured interviews with informants from 95% of all general hospitals in Norway in 1999 and 2006, and informants from CHS, in a stratified sample of Norwegian municipalities in 2006 (n = 47. Results In 15 of the 47 municipalities (32%, the CHS reported having a chain of care structure in 2006. A discriminant function analysis revealed that the hospitals that in 1999 had: (a a collaboration agreement with aftercare providers, and (b written guidelines, including a quality assurance system, were significantly more likely to have municipalities with a chain of care structure in their catchment area in 2006. Conclusions Hospitals' and municipalities' self-reported provision of aftercare services for patients treated after a suicide attempt was markedly below the recommendations given in national standards. Systems at the hospital level for the management and care of patients admitted after a suicide attempt and systematic collaboration between hospitals and aftercare providers seem to be important elements in the long-term maintenance of continuity of care for suicide attempters.
Throughout the past 30 years, there has been a lot of controversy surrounding the proliferation of new forms of health care delivery organizations that challenge and compete with general NFP community hospitals. Traditionally, the health care system in the United States has been dominated by general NFP (NFP) voluntary hospitals. With the number of for-profit general hospitals, physician-owned specialty hospitals, and ambulatory surgical centers increasing, a question arises: “Why is the general NFP community hospital the dominant model?” In order to address this question, this paper reexamines the history of the hospital industry. By understanding how the “general NFP hospital” model emerged and dominated, we attempt to explain the current dominance of general NFP hospitals in the ever changing hospital industry in the United States. PMID:22324062
Cuidado ecológico: o significado para profissionais de um hospital geral Cuidado ecológico: el significado para profesionales de un hospital general Ecological care: meaning for health care professionals from a general hospital
Marli Terezinha Stein Backes
ón general, todavía incipiente, respecto a la problemática ambiental. La preocupación principal está relacionada a la separación, reciclaje y destino adecuado de la basura, aunque algunos profesionales hayan destacado la importancia de medidas preventivas como el lavado de las manos, utilización de productos biodegradables, entre otros.OBJECTIVE: To understand the meaning of ecological care in view of complex thinking and how ecological care had been associated with the clinical practice of health care professionals from a general hospital. METHODS: This was a qualitative descriptive study among 15 health care professionals working in the laundry, nutrition, or inpatient unit. A semi-structured questionnaire was used to collect the data. Bardin's recommendations guided the content analysis. RESULTS: The following categories emerged: Meaning of ecological care, significance of ecological care for clinical practice, and preventive measures associated with ecological care. CONCLUSIONS: Although incipient, the findings suggest that there is a general concern regarding environmental issues. Even though some health care professionals stated the significance of hand washing and use of biodegradable products as preventive measures, the main concern was related to the separation, recycling, and disposal of trash.
Full Text Available Objective: The aim of this study was to determine the mortality rate and factors affecting the mortality of trauma patients in general intensive care unit (ICU of a state hospital. Material and Method: Data of trauma patients hospitalized between January 2012 and March 2013 in ICU of Konya Numune Hospital were retrospectively analyzed. Demographic characteristics and clinical data of patients were recorded. Patients were divided into two groups as survivors and dead. Mortality rate and factors affectin mortality were examined. Results: A total of 108 trauma patients were included in the study. The mortality rate of overall group was 19.4%. Median age of the patients was 44.5 years and 75.9% of them were males. Median Glasgow Coma Scale of death group was lower (5 (3-8 vs. 15 (13-15, p<0.0001, median APACHE II score was higher (20 (15-26 vs. 10 (8-13, p<0.0001 and median duration of ICU stay was longer (27 (5-62,5 vs. 2 (1-5, p<0.0001 than those in the survival group. The most common etiology of trauma was traffic accidents (47.2% and 52.7% of patients had head trauma. The rate of patients with any fracture was significantly higher in the survival group (66.7% vs. 33.3%, p=0.007. The rate of erythrocyte suspension, fresh frozen plasma, trombocyte suspension and albumin were 38.9%, 27.8%, 0.9% and 8.3%, respectively in all group. The number of patients invasive mechanically ventilated was 27.8% and median length of stay of these patients were 5 (1.75-33.5 days. The rate of operated patients was 42.6%. The rate of tracheostomy, renal replacement therapy, bronchoscopy and percutaneous endoscopic gastrostomy enforcements were higher in the death group. The advanced age (p=0.016, OR: 1.054; 95% CI: 1.010-1100 and low GCS (p<0.0001, OR: 0.583; 95% CI: 0.456-0.745 were found to be independent risk factors the ICU mortality of trauma patients in logistic regression analysis. Conclusion: We believe that the determination of these risk factors affecting
Raj Nath Makroo; Aakanksha Bhatia; Vikas Hegde; Mohit Chowdhry; Uday Kumar Thakur; N L Rosamma
Background & objectives: The development of alloantibodies can significantly complicate transfusion therapy and results in difficulties in cross-matching of blood. Most literature on alloimmunization is limited to multitransfused individuals, with very few studies on the general hospital patients. This study was aimed at assessing the frequency and type of unexpected red cell antibodies in the general patient population at a multispecialty tertiary care centre in New Delhi, India. Methods...
Anna E. van den Heever
Full Text Available Facilitation of a therapeutic relationship is an essential skill in nursing, particularly in mental-health care. Nurses and care workers in private general hospitals are exposed to the emotional effects of physical illness as well as the increase in admission of patients with mental-health needs. Poor nurse-patient relationships have been reported by patients and in the media. The researchers experienced incidents of apparent misunderstandings during nurse-patient interactions whilst working in private general hospitals. No studies have been done regarding how nurses and care workers perceive a therapeutic relationship with patients in terms of the patients’ emotional and mental-health needs. A quantitative, contextual and deductive study was conducted in three private general hospitals in Gauteng, South Africa with a purposive sample of 154 nurses and 30 care workers. Based on the concepts of a therapeutic relationship, empathy, positive regard, genuineness, concreteness and self-exploration, nurses and care workers’ perceptions of facilitating a therapeutic relationship were self-assessed using five-point scales in a questionnaire. Data were analysed using descriptive statistics and non-parametric statistical techniques. Specific hypotheses were tested to identify whether statistically-significant differences existed between the perceptions of two or more groups of nurses and care workers. Results showed a general insensitivity and lack of awareness and reflection on the part of nurses and care workers with regard to the patients’ emotional needs. When categories of nurses were compared, no statistically-significant differences were found between the perceptions of the various groups tested. There is a need for self-awareness, continued interpersonal skills training and supervision of nurses and care workers. A large percentage of the participants were younger than 40 years, subprofessional, with less than 10 years’ experience as
Léa Fialkow; Maurício Farenzena; Iuri Christmann Wawrzeniak; Janete Salles Brauner; Sílvia Regina Rios Vieira; Alvaro Vigo; Mary Clarisse Bozzetti
OBJECTIVES: To determine the characteristics, the frequency and the mortality rates of patients needing mechanical ventilation and to identify the risk factors associated with mortality in the intensive care unit (ICU) of a general university hospital in southern Brazil. METHOD: Prospective cohort study in patients admitted to the ICU who needed mechanical ventilation for at least 24 hours between March 2004 and April 2007. RESULTS: A total of 1,115 patients admitted to the ICU needed mecha...
Fialkow, Léa; Farenzena, Maurício; Wawrzeniak, Iuri Christmann; Brauner, Janete Salles; Vieira, Sílvia Regina Rios; Vigo, Alvaro; Bozzetti, Mary Clarisse
OBJECTIVES: To determine the characteristics, the frequency and the mortality rates of patients needing mechanical ventilation and to identify the risk factors associated with mortality in the intensive care unit (ICU) of a general university hospital in southern Brazil. METHOD: Prospective cohort study in patients admitted to the ICU who needed mechanical ventilation for at least 24 hours between March 2004 and April 2007. RESULTS: A total of 1,115 patients admitted to the ICU needed mechani...
Idongesit S. Ukpe
Full Text Available Background: South Africa is one of the countries in the world with a high burden of tuberculosis (TB. High rates of unfavourable treatment outcomes have remained a feature of TB control in the country. The objective of the current study was to examine the treatment outcomes of TB among health care workers (HCWs at a rural general hospital in the Mpumalanga province of the country, as well as the clinical care that was provided to the HCWs. The purpose of the study was to identify possible areas for improvement in the TB care services provided to HCWs in the hospital, especially with regard to their clinical management.Method: The research described in this article consists of a retrospective descriptive study. Relevant data on HCWs diagnosed with TB in the hospital during 2007, the TB care services offered to the HCWs, and the treatment outcomes of the HCWs were captured from the occupational health and TB control programme registers at the hospital onto a data capture sheet for the study and were subsequently analysed manually.Results: Nine HCWs, eight females and one male, were diagnosed and treated for TB in the hospital during 2007, an incidence rate of 941/100 000. Their ages ranged from 39 to 54 years, with a mean age of 48 years. By occupation, the nine HCWs consisted of six nurses (67%, one porter (11%, one general assistant (11%, and one clerk (11%. Of those treated for TB, seven (78% had smearpositive pulmonary TB (PTB and two (22% had extra-pulmonary TB (EPTB. TB culture and drug susceptibility testing (DST was undertaken for only one HCW. The HIV status was known for only two (22% of the nine HCWs under review. Neither of the two HCWs with EPTB had the diagnosis confirmed by bacteriological or histopathological method. The seven HCWs with smear- positive PTB achieved a cure, and the two HCWs with EPTB successfully completed treatment, resulting in a treatment success rate of 100% for the nine HCWs.Conclusion: The HCWs at Themba
Full Text Available Teshome Abebe, Mullu Girmay, Girma G/Michael, Million Tesfaye Department of Anesthesia, Jimma University, Jimma, Ethiopia Background: In least developing countries, there are few data on children's critical care. This makes the provision of aid and improvement of outcome difficult. Objectives: To describe admission and outcome patterns of children managed in a general intensive care unit at Jimma University Specialized Hospital (JUSH, Ethiopia, over a 5-year period. Methods: A retrospective cross-sectional study design was used. All children from birth to 14 years of age who were admitted to the general ICU of the hospital from 2009–2013 were included. Patient charts and ICU documentation log were reviewed. Results: A total of 170 children were admitted to the ICU of JUSH over the study period. The greater share was taken by males (54.7%, with a male-to-female ratio of 1.2:1. The overall mortality rate was 40%. The majority of the children were in the age range of 10–14 years (38.8%. Of the total number of patients admitted, 34.7% were trauma cases, 45.8% of whom died. The highest percentage, 69.5%, of trauma patients were admitted for head injuries. Among the trauma cases, burn and polytrauma were the second and third leading causes (15.3% of admission. Postoperative patients and medical patients accounted for the rest of the admitted cases (28.2% and 27.6% of the cases respectively. Conclusion: The leading cause of admission and death was trauma. Postoperative and medical causes of admission were also significant. The mortality rate in the ICU was very high, and this could be due to various factors. Further research benchmarking and interventions are highly recommended. Keywords: trauma, critical care, pediatric, ICU, ventilation, oxygenation
Choi, Mankyu; Lee, Keon-Hyung
In this study, the determinants of hospital profitability were evaluated using a sample of 142 hospitals that had undergone hospital standardization inspections by the South Korea Hospital Association over the 4-year period from 1998 to 2001. The measures of profitability used as dependent variables in this study were pretax return on assets, after-tax return on assets, basic earning power, pretax operating margin, and after-tax operating margin. Among those determinants, it was found that ownership type, teaching status, inventory turnover, and the average charge per adjusted inpatient day positively and statistically significantly affected all 5 of these profitability measures. However, the labor expenses per adjusted inpatient day and administrative expenses per adjusted inpatient day negatively and statistically significantly affected all 5 profitability measures. The debt ratio negatively and statistically significantly affected all 5 profitability measures, with the exception of basic earning power. None of the market factors assessed were shown to significantly affect profitability. In conclusion, the results of this study suggest that the profitability of hospitals can be improved despite deteriorating external environmental conditions by facilitating the formation of sound financial structures with optimal capital supplies, optimizing the management of total assets with special emphasis placed on inventory management, and introducing efficient control of fixed costs including labor and administrative expenses. PMID:19011410
van Hoof, Sofie Johanna Maria; Kroese, Mariëlle Elisabeth Aafje Lydia; Spreeuwenberg, Marieke Dingena; Elissen, Arianne Mathilda Josephus; Meerlo, Ronald Johan; Hanraets, Monique Margaretha Henriëtte; Ruwaard, Dirk
Objective: To analyse barriers and facilitators in substituting hospital care with primary care to define preconditions for successful implementation.Methods: A descriptive feasibility study was performed to collect information on the feasibility of substituting hospital care with primary care. General practitioners were able to refer patients, about whom they had doubts regarding diagnosis, treatment and/or the need to refer to hospital care, to medical specialists who performed low-complex ...
Murugasu, G Dr.
Under the Quality and Continuing Care Directorate (QCCD) in stroke care Cavan General Hospital was identified as a hospital that received a large number of stroke and TIA patients. A programme was established to improve services to this population.
李景波; 张勇; 吴昊; 罗旭
分析了大型综合性医院的医疗质量管理需求和医院质量管理理论的进展,从医院医疗质量管理的实践出发,认为医疗质量管理的核心是医院的全面科学化管理,应结合医院评审的发展方向,通过全面质量管理体系,强化质量管理和质量文化建设,实现医疗质量的长效化管理,以提升医院核心竞争力.%The paper analyzed the needs for care quality management in large general hospitals and progresses made in hospital quality management theories. In respect of care quality management in hospitals, authors hold that the key to care quality is comprehensive scientific management of hospitals, and it is necessary to put in place a long-term management of care quality in line with the development direction of hospital evaluation and by means of total quality management system, as well as enhanced quality management and quality culture building.
Bergenholtz, Heidi; Jarlbæk, Lene; Hølge-Hazelton, Bibi
Background: It can be challenging to provide generalist palliative care in hospitals, owing to difficulties in integrating disease-orientedtreatment with palliative care and the influences of cultural and organisational conditions. However, knowledge on the interactionsthat occur is sparse. Aim: To...... investigate the interactions between organisation and culture as conditions for integrated palliative care in hospital and, ifpossible, to suggest workable solutions for the provision of generalist palliative care. Design: A convergent parallel mixed-methods design was chosen using two independent studies: a...... hospital with 29 department managements and one hospital management. Results: Two overall themes emerged: (1) ‘generalist palliative care as a priority at the hospital’, suggesting contrasting issues regardingprioritisation of palliative care at different organisational levels, and (2) ‘knowledge and use...
Deborah Chollet; Su Liu; Gilbert Gimm; Cheryl Fahlman; Laurie Felland; Anneliese Gerland; Michelle Banker; Allison Liebhaber
In Texas, as in other states, the proliferation of niche hospitals has raised concern about the potential financial impact of these hospitals on full-service general hospitals. This report compares the financial status of physician-owned niche hospitals and general hospitals in Texas, analyzes the impact of niche hospitals on general hospital financial margins and levels of uncompensated care, analyzes potential bias in physician-owners' referral patterns, investigates stakeholders' perceptio...
Priso, Eugene Belley; Njamen, Theophile Nana; Tchente, Charlotte Nguefack; Kana, Albert Justin; Landry, Tchuenkam; Tchawa, Ulrich Flore Nyaga; Hentchoya, Romuald; Beyiha, Gerard; Halle, Marie Patrice; Aminde, Leopold; Dzudie, Anastase
Introduction Hypertensive disorders in pregnancy (HDP) are a major cause of maternal morbidity and mortality. We aimed at determining the trends in admission, profiles and outcomes of women admitted for preeclampsia and eclampsia to an intensive care unit (ICU) in Cameroon. Methods A retrospective study involving 74 women admitted to the ICU of the Douala General Hospital for severe preeclampsia and eclampsia from January 2007 to December 2014. Clinical profiles and outcome data were obtained...
Full Text Available BACKGROUND: Retrospective and prospective randomized studies have compared general and locoregional anesthesia for carotid endarterectomy, but without definitive results.OBJECTIVES: Evaluate the incidence of complications (medical, surgical, neurological, and hospital mortality in a tertiary center in Portugal and review the literature.METHODS: Retrospective analysis of patients undergoing endarterectomy between 2000 and 2011, using a software for hospital consultation.RESULTS: A total of 750 patients were identified, and locoregional anesthesia had to be converted to general anesthesia in 13 patients. Thus, a total of 737 patients were included in this analysis: 74% underwent locoregional anesthesia and 26% underwent general anesthesia. There was no statistically significant difference between the two groups regarding per operative variables. The use of shunt was more common in patients undergoing general anesthesia, a statistically significant difference. The difference between groups of strokes and mortality was not statistically significant. The average length of stay was shorter in patients undergoing locoregional anesthesia with a statistically significant difference.CONCLUSIONS: We found that our data are overlaid with the literature data. After reviewing the literature, we found that the number of studies comparing locoregional and general anesthesia and its impact on delirium, cognitive impairment, and decreased quality of life after surgery is still very small and can provide important data to compare the two techniques. Thus, some questions remain open, which indicates the need for randomized studies with larger number of patients and in new centers.
Full Text Available In our country there have been many efforts in recent years to introduce laws that lead to the introduction of the concept of quality in the field of public hospitals. The implementation of health quality systems contributes to health care improvement, while the assessment of quality services is a basic tool in quality management. Purpose: The purpose of the study was to describe the benefits that can be gained by a public institute of health when a quality model is applied. Material and methods: This paper focus on the application of the ISO 9001:2008 standard in the Intensive Care Unit of the General Hospital of Larissa during the years 2010-2012. The results and benefits of its implementation, recorded by measuring satisfaction of the relatives of the patients. The questionnaire Family Satisfaction with Care in the Intensive Care Unit (FS-ICU 24 and quality indicators were applied. The study sample was all the relatives of the patients hospitalized in ICU during 2010-2012. Descriptive statistics was performed. Results: Quality indicators were considerably improved after ISO implementation with SMR falling to 35% in 2012 (from 58% in 2007, thus being one of the lowest in Greece and below European ICU’s SMR mean value. Over 80% of patients’ relatives answered that Nursing and Medical care was “excellent” and over 10% characterized it as “very good”. Family members’ total satisfaction surpassed 90%. Medical and Nursing care were highly appreciated by family members (very positive attitude expressed by over 90% of participants and satisfaction from nursing services approaches 100%. Conclusion: The implementation of quality systems in healthcare organizations is not easy and has many dimensions. However, it offers competitive advantage, improves the efficiency and effectiveness of the health care service providers and substantially contributes to the improvement of the delivered heath care.
Beekman Aartjan TF
Full Text Available Abstract Background Depressive disorder is one of the most common disorders, and is highly prevalent in chronically ill patients. The presence of comorbid depression has a negative influence on quality of life, health care costs, self-care, morbidity, and mortality. Early diagnosis and well-organized treatment of depression has a positive influence on these aspects. Earlier research in the USA has reported good results with regard to the treatment of depression with a collaborative care approach and an antidepressant algorithm. In the UK 'Problem Solving Treatment' has proved to be feasible. However, in the general hospital setting this approach has not yet been evaluated. Methods/Design CC: DIM (Collaborative Care: Depression Initiative in the Medical setting is a two-armed randomised controlled trial with randomisation at patient level. The aim of the trial is to evaluate the treatment of depressive disorder in general hospitals in the Netherlands based on a collaborative care framework, including contracting, 'Problem Solving Treatment', antidepressant algorithm, and manual-guided self-help. 126 outpatients with diabetes mellitus, chronic obstructive pulmonary disease, or cardiovascular diseases will be randomised to either the intervention group or the control group. Patients will be included if they have been diagnosed with moderate to severe depression, based on the DSM-IV criteria in a two-step screening method. The intervention group will receive treatment based on the collaborative care approach; the control group will receive 'care as usual'. Baseline and follow-up measurements (after 3, 6, 9, and 12 months will be performed by means of questionnaires. The primary outcome measure is severity of depressive symptoms, as measured with the PHQ-9. The secondary outcome measure is the cost-effectiveness of these treatments according to the TiC-P, the EuroQol and the SF-36. Discussion Earlier research has indicated that depressive disorder is
Evolution of nutritional status of pediatric in patients of a tertiary care general hospital in Brazil Evolución del estado nutritivo de pacientes pediátricos ingresados en hospital general terciario de Brasil
C. R. De Moraes Silveira; E. D. De Mello; P. R. Antonacci Carvalho
Justification and objective: Identify changes in the nutritional status of hospitalized children is fundamental for the early establishment of interventions. This study aims at describing the prevalence of undernutrition at admission and over the weeks of in-hospital stay in pediatric patients and evaluate the association between nutritional status and length of in-hospital stay. Materials and methods: A cohort study was carried out. It followed all the in-patients admitted to the general ped...
Saywell, R M; Zollinger, T W; Chu, D K; MacBeth, C A; Sechrist, M E
For this study, a sample of 1,689 patients classified as "charity" and "bad debt" cases in 1986 were identified from 27 general acute care hospitals and one tertiary hospital in Indiana. Half of the hospitals were in rural areas and 57 percent were small (less than 150 beds). Most of the patients (87.2 percent) incurred uncompensated amounts under $2,500, and 40 percent of the cases were below $500. About 72 percent of the patients with uncompensated care were from the same county as the location of the hospital (range from 30.9% to 100.0%). The majority of the cases (79.4 percent) with over $5,000 in uncompensated care were treated in urban hospitals. The average age of these patients was 27.2 years. Fifty-four percent of the patients were single, 60.7 percent were female, and nearly all (83.0 percent) were discharged to home care. Only 44.6 percent of the patients with uncompensated care had no insurance; 46.8 percent had some form of commercial insurance which covered part of the charges for care. The most common diagnosis for these patients was pregnancy and childbirth (22.8 percent), with injury and poisoning second (10.7 percent). The cases with $5,000 or more in bad debt (about 4 percent of the cases) account for 28.3 percent of the total uncollected amount. Bad debt represents a cost of doing business. Any national effort to contain health care costs must address this problem. PMID:2738351
Kalisch, Beatrice J.; Tschannen, Dana; Lee, Hyunhwa; Friese, Christopher R.
Quality of nursing care across hospitals is variable, and this variation can result in poor patient outcomes. One aspect of quality nursing care is the amount of necessary care omitted. This paper reports on the extent and type of nursing care missed and the reasons for missed care. The MISSCARE Survey was administered to nursing staff (n = 4086) who provide direct patient care in ten acute care hospitals. Missed nursing care patterns, as well as reasons for missing care (labor resources, mat...
Full Text Available BACKGROUND: The recent developments in healthcare units are precisely made for the prevention and protection of community health. Sophisticated instruments have come into existence in various operations for disease treatment. Such improvement and advances in scientific knowledge has resulted in per capita per patient generation of wastes in health care units. Waste generated in the process of health care are composed of variety of wastes including hypodermic needles, scalpels, blades, surgical cotton, gloves, bandages, discarded medicine, body fluids, human tissues and organs, chemicals etc., other wastes generated in healthcare settings include radioactive wastes, mercury containing instruments, PVC plastics etc., so the awareness of personnel involved in the management of biomedical waste is important. AIM: To assess the waste handling and treatment system of hospital bio-medical solid waste and its mandatory compliance with regulatory notifications for bio-medical waste (BMW management rules 1998, under Environment Protection Act (EPA 1986, Ministry of Environment & Forest, Government of India at Government General Hospital (GGH, Vijayawada, Andhra Pradesh. SETTINGS AND DESIGN: This cross sectional study was conducted in GGH at Vijayawada, Andhra Pradesh. MATERIAL AND METHODS: 75 study subjects selected were personnel involved in management of hospital solid waste observed for one month and frequency tables, percentages, and proportions were used as statistical applications. STATISTICAL ANALYSIS: Analysis was done using MS – Excel software. RESULTS AND CONCLUSIONS: Out of gross total quantity of BMW generated in entire GGH, Vijayawada 74% of it is general waste. Knowledge levels regarding storage of BMW was more among class IV employees, were as awareness in differentiation of infectious and non-infectious waste was more among staff nurses.
U.S. Department of Health & Human Services — The National Hospital Ambulatory Medical Care Survey (NHAMCS) is designed to collect data on the utilization and provision of ambulatory care services in hospital...
Full Text Available Context: Hospitalized patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD may be managed by either respiratory specialists (RS or general medicine physicians (GMP. While previous studies have audited the hospital AECOPD management of RS, only a small number of studies have evaluated the management of GMP. Aims: The aims of this study were to firstly examine the differences in AECOPD management of GMP and RS and secondly compare their care to national COPD guidelines. Methods: A retrospective review was undertaken of consecutive AECOPD patients admitted to two hospitals (one hospital where all AECOPD patients were managed by RS and another where all AECOPD patients were managed by GMP over a 3-month period. Electronic medical records, medical case notes, pathology and radiology data for the admission were reviewed. Results: There were 201 COPD exacerbations in 169 patients (49.7% male, mean age 72.3. GMP managed 84 (41.7% exacerbations. In comparison to RS, GMP performed fewer spirometry tests, blood gas analysis and less frequently treated patients with guideline-recommended medications. Referral to pulmonary rehabilitation was poor for both groups of clinicians. Median length of stay was shorter in GMP patients versus RS patients (3 days vs. 5 days, P = 0.001. There were no differences in the 12-month re-admission (41.7% vs. 38.5%, P = 0.664 and mortality rates (10.7% vs. 6%, P = 0.292 between both groups of patients. Conclusion: Our study found differences in the hospital AECOPD management of GMP and RS, but these did not translate into different clinical outcomes between their patients. We also found suboptimal adherence to national COPD guidelines, suggesting that there is scope for improvement in the AECOPD management of both groups of clinicians.
韩俊林; 王润兰; 李建华
Objective: To explore an assessment scale which is suitable for evaluating the present nursing care quality in general hospitals. Method: Through investigation of small group of patients and Delphi procedure, a draft scale was developed. Then 700 inpatients in two general hospitals were investigated by this final scale. Results: The answer rate was 98.71％, the Cronbach's alpha coefficient was 0.881. Confirmatory factor analysis showed five factors was fully consistent with five dimensions of questionnaire, criterion-related validity correlation was r=0.826. Conclusion: The scale has acceptable reliability and validity. It might be helpful for improving nursing care quality.%目的:探索研制适合我国现阶段综合医院的护理服务质量评价量表.方法:在住院患者护理服务需求调查的基础上,经小样本调查结合专家咨询形成正式量表,选取2所综合医院的700名住院患者进行调查.结果:调查量表回收率为98.71%.Cronbach's α系数为0.881,证实性因子分析显示,5个因素与问卷设计的5个维度完全吻合,效标关联效度检验r=0.826.结论:所研制量表具有良好的信度和效度,对护理服务质量改进具有指导作用.
These guidelines have been drown up to assist all those involved in the management and maintenance of hospitals and health care establishments. Compliance with this guidance should minimise the risk of pollution occurring. The guidelines are jointly produced by the Environment Agency for England and Wales, the Scottish Environment Protection Agency and the Environment and Heritage Service for Northern Ireland, referred to as the Agency or Agencies. It includes guidelines on site drainage, sewage and waste water disposal, treatment of surface water drainage and waste management
The Surrey Section of the London Branch held a very successful meeting on Wednesday 9th September 1992 at which Mr Stephen Kirby BSc, CEng, Director of Estates, gave a talk and tour of the new Private Ward Unit and Ultra Clean Ventilation Theatre at Epsom General Hospital. The new Northey Ward, is a result of the refurbishment of what was a 31 bed section of the Hospital Surgical Block on the 5th floor. The new Ward provides a total of 18 single bed Wards, each complete with bathroom/WC, the Unit also accommodates a 5 bed Day Ward. All the facilities provided are of extremely high standard, which given the very tight building programme, detailed elsewhere, is indicative of the dedication of both the Designers and Contractors who are congratulated on their achievement. With regard to the UCV Theatre the following information was prepared by Aidan Hardy who is a Project Engineer with Epsom General Hospital. We are delighted to be able to print this report for our readers. PMID:10122458
Tajvar, Abdolhamid; Saraji, Gebraeil Nasl; GHANBARNEJAD, Amin; Omidi, Leila; Hosseini, Seyed Sodabeh Seyed; Abadi, Ali Salehi Sahl
Background: Many nurses have reported experiencing high levels of occupational stress in their work environment. Stress, as an outcome of stressful workplaces and tasks, affects nursing behavior in hospital wards. The objectives of this research were to determine the prevalence of occupational stress and mental health problems in nurses in the intensive care unit (ICU) at Shahid Mohammadi Hospital in Bandar Abbas in 2013 and to determine the relationship between occupational stress and mental...
Moreno, R; Metnitz, P; Metnitz, B; Bauer, P.; Afonso de Carvalho, S; Hoechtl, A; SAPS 3 Investigators
OBJECTIVE: The objective of the study was to develop a model for estimating patient 28-day in-hospital mortality using 2 different statistical approaches. DESIGN: The study was designed to develop an outcome prediction model for 28-day in-hospital mortality using (a) logistic regression with random effects and (b) a multilevel Cox proportional hazards model. SETTING: The study involved 305 intensive care units (ICUs) from the basic Simplified Acute Physiology Score (SAPS) 3 cohort. ...
The risk of decubitus on hospitalized patients Decubitus risk in patients varies. Elderly patients with total care and partial care in hospitals a chance to suffer from decubitus. This research aims to know the risks in patients treated decubitus in General Hospital of Haji Adam Malik Medan. This research uses descriptive design with the total sample obtained 48 respondents. Samples were taken using the technique of total sampling. Data collection is done using the research instrument consist...
Mårtensson, Solvej; Hansen, Kristine Halling; Olsen, Kim Rose;
number of contacts with a specialist in 2006 was related to participation in preventive child health care between 2002 and 2005. To control for the potential effect of difference in GP behaviour the data were analysed using a multilevel Poisson model linking each child to the GP with whom he or she was...... specialist than children from more affluent families. CONCLUSIONS: Ensuring participation in preventive child health care at the GP may reduce the social gap in utilisation of specialised health care that exists between children from families of different income levels.......INTRODUCTION: The primary purposes of preventive child health care in Denmark are to help ensure a healthy childhood and to create preconditions for a healthy adult life. The aim of this study is to examine whether participation in age-appropriate preventative child health care affects the...
Freeman, Victoria A.; Walsh, Joan; Rudolf, Matthew; Slifkin, Rebecca T.; Skinner, Asheley Cockrell
Context: Although critical access hospitals (CAHs) have limitations on number of acute care beds and average length of stay, some of them provide intensive care unit (ICU) services. Purpose: To describe the facilities, equipment, and staffing used by CAHs for intensive care, the types of patients receiving ICU care, and the perceived impact of…
Unni Alice Dahl
Full Text Available Introduction: Intermediate care is an organisational approach to improve the coordination of health care services between health care levels. In Central Norway an intermediate care hospital was established in a municipality to improve discharge from a general hospital to primary health care. The aim of this study was to investigate how health professionals experienced hospital discharge of elderly patients to primary health care with and without an intermediate care hospital. Methods: A qualitative study with data collected through semi-structured focus groups and individual interviews. Results: Discharge via the intermediate care hospital was contrasted favourably compared to discharge directly from hospital to primary health care. Although increased capacity to receive patients from hospital and prepare them for discharge to primary health care was viewed as a benefit, professionals still requested better communication with the preceding care level concerning further treatment and care for the elderly patients. Conclusions: The intermediate care hospital reduced the coordination challenges during discharge of elderly patients from hospital to primary health care. Nevertheless, the intermediate care was experienced more like an extension of hospital than an included part of primary health care and did not meet the need for communication across care levels.
U.S. Department of Health & Human Services — Timely and Effective Care measures - provider data. This data set includes provider-level data for measures of heart attack care, heart failure care, pneumonia...
Ekanem EI; Agan TU; Efiok EE; Ekott MI; Okodi E
Objective:To assess the prevalence of anemia and asymptomatia malaria parasitemia and the effect of prior antimalarials therapy on the parasite density in pregnant women at their first antenatal visit at the secondary level health care facility in Nigeria. Methods:This cross sectional observational study was carried out in the antenatal clinic of General Hospital, Ikot Ekpene, Akwa Ibom State, Nigeria for 3 months period (1st June to 31st August, 2009). Five hundred and fourteen women attending their first antenatal registration visits in the hospital were recruited in the study. Socio-demographic information was obtained using pre-tested questionnaires. The malaria parasite was obtained by examining thick and thin blood films prepared on 2 glass slides while the hematocrit was obtained through 2 capillary tubes read by a Hawksleys microhematocrit reader. Results:A total of 514 pregnant women participated in the study with a mean maternal age of 21.4 years and a mean gestational age at booking of 18.3 weeks. The primigravid women booked at significantly lower gestational age than multigravidae (16.2 weeks vs 21.6 weeks). Most of the women (59.3%) were anemic, out of which 60.4%were primigravida. More than half of the women had moderate to high parasite density and only 6.8%had no malaria parasitemia. All patients with severe anemia were parasitemic. Out of the 479 (93.2%) women with parasitemia, a third had taken antimalarial drugs. A majority (60.3%) of those without prior antimalarial drugs had moderate to high density parasitemia. Conclusions:This study shows high prevalence of anemia in women with asymptomatic malarial parasitemia, particularly the primigravida. The severity of anemia is directly related to the density of malaria parasitemia. Those with effective antimalarial therapy appear to have low density parasitemia and therefore mild anemia. Routine screening for anemia and malaria parasites at booking, prompt parasite clearance and correction of anemia
BACKGROUND: In Ireland, specialist paediatric surgery is carried out in paediatric hospitals in Dublin. General surgeons\\/consultants in other surgical specialities provide paediatric surgical care in regional centres. There has been a failure to train general surgeons with paediatric skills to replace these surgeons upon retirement. AIM: To assess paediatric surgical workload in one regional centre to focus the debate regarding the future provision of general paediatric surgery in Ireland. METHODS: Hospital in-patient enquiry (HIPE) system was used to identify total number of paediatric surgical admissions and procedures. Cases assessed requiring hospital transfer. RESULTS: Of 17,478 surgical patients treated, 2,584 (14.8%) were under 14 years. A total of 2,154 procedures were performed. CONCLUSION: Regional centres without dedicated paediatric surgeons deliver care to large numbers of paediatric patients. The demand for care highlights the need for formal paediatric services\\/appropriate surgical training for general surgical trainees.
Evolution of nutritional status of pediatric in patients of a tertiary care general hospital in Brazil Evolución del estado nutritivo de pacientes pediátricos ingresados en hospital general terciario de Brasil
C. R. De Moraes Silveira
Full Text Available Justification and objective: Identify changes in the nutritional status of hospitalized children is fundamental for the early establishment of interventions. This study aims at describing the prevalence of undernutrition at admission and over the weeks of in-hospital stay in pediatric patients and evaluate the association between nutritional status and length of in-hospital stay. Materials and methods: A cohort study was carried out. It followed all the in-patients admitted to the general pediatric unit, composed of 72 beds, in the Hospital de Clínicas de Porto Alegre (HCPA, in the south of Brazil, from 20 march to 20 october in 2004. Patients who were between 1 month and 12 years of age and who had been admitted for clinical or/and surgical reasons were included. Those with Down Syndrome or without clinical condition and/or stature for weight measurement were excluded. Anthropometric data were collected up to 48 hours after admission and, weekly, up to hospital discharge (at admission, on 7th, 14th, and 21st day after admission. In children below 5 years of age, the standard defined by the World Heath Organization (WHO/2006 for the classification of the z-score for the stature/age (S/A, weight/age (W/A and weight/stature (W/S scores was used. In children from 5 to 10 years of age, the standards of the National Center for Health Statistics (NCHS, 1977 were used to classify the same rates as reference values. In children above 10 years of age, the classification of the Body Mass Index (BMI was used (OMS/1995. In order to compare the z-scores over the four evaluation moments, analysis of variance (ANOVA was used for repeated measurements, with Bonferroni's Post-Hoc test, and, for the evaluation of the in-hospital stay length, according to the nutritional status, Kaplan-Meier's survival curve, in the SPSS program, version 12.0, was used. Results: 426 patients were included in the study. 57% of them were male and 50.7% were below one year of age
Paul, Bobby; Basu, Mausumi; Dutta, Sinjita; Chattopadhyay, Sita; Sinha, Debasis; Misra, Raghunath
Background: Periodontal diseases, dental caries, malocclusion, and oral cancer are the most prevalent dental diseases affecting people in the Indian community. Objective: The study was conducted to assess the awareness and practices on oral hygiene and its association with the sociodemographic factors among patients attending the general Outpatient Department (OPD). Materials and Methods: A cross-sectional study was conducted among 224 patients attending the general OPD of the SSKM Hospital, ...
Auerbach, Andrew D.; Patel, Mitesh S.; Metlay, Josh; Schnipper, Jeffrey; Williams, Mark V.; Robinson, Edmondo; Kripalani, Sunil; Lindenauer, Peter K.
Converting the health care delivery system into a learning organization is a key strategy for improving health outcomes. While the learning organization approach has been successful in neonatal intensive care units and disease specific collaboratives there are few examples in general medicine and fewer still have leveraged the role of hospitalists to implement improvements. This paper describes the rationale for and early work of the Hospital Medicine Reengineering Network (HOMERuN), a collaborative of hospitals, hospitalists, and care teams whose overarching purpose is to use data to guide collaborative efforts aimed at improving the care of hospitalized patients. We review HOMERuN’s collaborative model, which focuses on a community-based participatory approach modified to include hospital-based as well as the larger community, and HOMERuN’s initial project focusing on care transition improvement using perspectives from the patient and caregiver. PMID:24448050
Barra, Daniela Couto Carvalho; Waterkemper, Roberta; Kempfer, Silvana Silveira; Carraro, Telma Elisa; Radünz, Vera
Qualitative research whose purpose was to reflect and argue about the relationship between hospitality, care and nursing according to experiences of PhD students. The research was developed from theoretic and practical meeting carried through by disciplines "the care in Nursing and Health" of PhD nursing Program at Santa Catarina Federal University. Its chosen theoretical frame of Hospitality perspective while nursing care. Data were collected applying a semi-structured questionnaire at ten doctoral students. The analysis of the data was carried through under the perspective of the content analysis according to Bardin. Hospitality it is imperative for the individuals adaptation in the hospital context or any area where it is looking for health care. PMID:20520990
Marilia Bense Othero
Full Text Available The Extra-hospital Care offered by hospitals is one of the performance areas of the “OccupationalTherapy in Hospital Care Contexts” specialty and refers to the assistance provided by the hospitals at the patients’homes. The aim of this article is to introduce the area main concepts and describe the practice of OccupationalTherapy. There are four kinds of home health care assistance in Brazil, as recommended by the Ministry ofHealth, and all of them are in the area of occupational performance. The main focus of the occupational therapist’sintervention depends on the assistance level, and it may include preparation and information for hospitaldischarge, assessment and adaptation of the home environment, recovery of meaningful activities, promotion ofindependence and autonomy, cognitive rehabilitation, sensorial stimuli, information about positioning, prescriptionand manufacturing of adaptive devices, and guidance for family and care givers. There are many challenges to befaced in this professional area, such as: domiciliary context complexity, payment and organization, team work,support networks, etc. Occupational Therapy plays a very important role in extra-hospital care.
Đurišić Jasna; Marković-Denić Ljiljana N.; Ilić Slobodanka; Ramadani Ruždi
Introduction Sick newborn babies in the neonatal intensive care units (NICU) are al increased risk for hospital-acquired infections (HI). The aim of our study was to determine the incidence and localization of neonatal hospital infections in NICU. Material and methods A prospective, six-month study was carried out in a NICU. All patients hospitalized in NICU longer then 48 hours were examined according to their basic descriptive-epidemiological characteristics and the incidence of all hospita...
There are so many obvious delays and inefficiencies in our traditional system of acute hospital care; it is clear that if outcomes are to be improved prompt accurate assessment immediately followed by competent and efficient treatment is essential. Early warning scores (EWS) help detect acutely ill patients who are seriously ill and likely to deteriorate. However, it is not known if any EWS has universal applicability to all patient populations. The benefit of Rapid Response Systems (RRS) such as Medical Emergency Teams has yet to be proven, possibly because doctors and nurses are reluctant to call the RRS for help. Reconfiguration of care delivery in an Acute Medical Assessment Unit has been suggested as a "proactive" alternative to the "reactive" approach of RRS. This method ensures every patient is in an appropriate and safe environment from the moment of first contact with the hospital. Further research is needed into what interventions are most effective in preventing the deterioration and\\/or resuscitating seriously ill patients. Although physicians expert in hospital care decrease the cost and length of hospitalization without compromising outcomes hospital care will continue to be both expensive and potentially dangerous.
Full Text Available Rates of hospital-acquired infections, such as methicillin-resistant Staphylococcus aureus (MRSA, are increasingly used as quality indicators for hospital hygiene. Alternatively, these rates may vary between hospitals, because hospitals differ in admission and referral of potentially colonized patients. We assessed if different referral patterns between hospitals in health care networks can influence rates of hospital-acquired infections like MRSA. We used the Dutch medical registration of 2004 to measure the connectedness between hospitals. This allowed us to reconstruct the network of hospitals in the Netherlands. We used mathematical models to assess the effect of different patient referral patterns on the potential spread of hospital-acquired infections between hospitals, and between categories of hospitals (University medical centers, top clinical hospitals and general hospitals. University hospitals have a higher number of shared patients than teaching or general hospitals, and are therefore more likely to be among the first to receive colonized patients. Moreover, as the network is directional towards university hospitals, they have a higher prevalence, even when infection control measures are equally effective in all hospitals. Patient referral patterns have a profound effect on the spread of health care-associated infections like hospital-acquired MRSA. The MRSA prevalence therefore differs between hospitals with the position of each hospital within the health care network. Any comparison of MRSA rates between hospitals, as a benchmark for hospital hygiene, should therefore take the position of a hospital within the network into account.
... National Technical Information Service NCHS Rural and Urban Hospitals' Role in Providing Inpatient Care, 2010 Recommend on ... Survey, inpatient hospital utilization What share of inpatient hospital care was delivered in rural compared with urban ...
Whitman, Marilyn V.; Harbison, Phillip Adam
Purpose: This paper aims to examine the level of smoke-free policies in general hospitals and the barriers faced in implementing restrictive policies banning smoking inside buildings and on surrounding grounds. Design/methodology/approach; A survey was developed to gather data on hospitals' current smoke-free policies, including the challenges…
Full Text Available A prospective study was undertaken to compare the patterns of psychiatric referrals in two general hospitals in Bombay viz. the King Edward Memorial Hospital (64 cases and the Jaslok Hospital and Research Centre (62 cases. It was observed that depressive symptoms were the most common presenting symptoms in these patients attending either of the hospitals. Similarly, the commonest diagnoses were depression and organic mental disorder. Attempted suicide with organophosphorous compounds was the commonest reason for hospitalization at K.E.M. Hospital (p less than 0.001. A significant number of these patients were females (p less than 0.05. The psychiatric referrals at Jaslok had been hospitalized mainly for suspected medical or neurological illness (p less than 0.001. These patients belonged to higher economic strata and hence had a better paying capacity compared to patients at KEM hospital, a significant number of whom were unemployed (p less than 0.001. The duration of pre-referred illness of patients and their stay at Jaslok hospital were longer as compared to those at KEM Hospital (p less than 0.01. The number of non-relevant special investigations carried out on patients in Jaslok was more (p less than 0.01. Further analysis of diagnoses revealed that a significant number of patients at KEM Hospital were admitted as primary psychiatric illness (p less than 0.05.
Santos, Paulo Roberto; Monteiro, Diego Levi Silveira
Background Acute kidney injury (AKI) is common among intensive care unit (ICU) patients and is associated with high mortality. Type of ICU, category of admission diagnosis, and socioeconomic characteristics of the region can impact AKI outcomes. We aimed to determine incidence, associated factors and mortality of AKI among trauma and non-trauma patients in a general ICU from a low-income area. Methods We studied 279 consecutive patients in an ICU during a follow-up of one year. Patients with ...
Y. van Ierland (Yvette)
markdownabstract__Abstract__ Children constitute a substantial part of the workload of physicians in primary care and hospital emergency care. In the Netherlands, about 70% of the 3.9 million inhabitants less than 20 years of age had one or more contacts with their general practitioner (GP) in 2011
... 2013 Rates and to the Long Term Care Hospital PPS and FY 2013 Rates'' (77 FR 53257). Therefore, the... Hospital Deductible and Hospital and Extended Care Services Coinsurance Amounts for CY 2013 AGENCY: Centers... inpatient hospital deductible and the hospital and extended care services coinsurance amounts for...
Jan P. Vlasblom
Full Text Available Many patients wish to discuss spiritual issues with nurses. Previous work has shown that nurses do so infrequently. A mixed methods research approach was used to investigate the perceptions of spiritual care of nurses and patients. Fifty-one nurses and 75 patients of five hospital departments of a non-academic hospital in the Netherlands were surveyed in 2007. We recorded the nurses’ perception of patient wishes, perceived relevance of spiritual care for patients, spiritual care provided in practice, and their evaluation of the spiritual care provided for the patients. With regard to the patients the nurses cared for, we recorded their satisfaction with the information and experiences of spiritual care provided by the nurses. Furthermore, semi-structured qualitative interviews with eight nurses examined the nurses’ perceptions of spiritual care including perceived barriers and facilitators of spiritual care giving. The nurses generally perceived spiritual care as important. The quantitative and qualitative research indicated that time to listen, availability, empathic skills, openness to other opinions, and a good relationship of trust were important facilitators. Fortyone per cent of the nurses said that few patients received sufficient attention to their spiritual needs. Patients also experienced limitations in the support for and registration of their spiritual needs. Both nurses and patients acknowledged shortcomings in the provision of spiritual care. Even though some issues may be improved relatively easily, such as registering needs, in practice giving spiritual care is complex, as it requires being available and building a relationship with the patient.
Epilepsy care in Ireland is shared between primary, secondary and tertiary care services with the General Practitioner (GP) managing the process. Barriers to effective epilepsy care in Irish general practice remain undocumented although sub-optimal and fragmented services are frequently anecdotally reported. This survey of Irish GPs reports on such barriers to epilepsy care and on the Information & Communication Technology (ICT) issues potentially relevant to the use of an epilepsy specific Electronic Patient Record (EPR). The response rate was 247\\/700 (35.3%). Respondents supported the concept of shared care for epilepsy 237 (96%) however they were very dissatisfied with existing neurology services, including pathways of referral 207 (84%) and access to specialist neurology advice and investigations 232 (94%). They reported that neurology services and investigations may be accessed more expeditiously by patients with private health insurance than those without 178 (72%). Consequently many patients are referred to the emergency department for assessment and treatment 180 (73%). A deficit in epilepsy care expertise among GPs was acknowledged 86 (35%). While computerisation of GP practices appears widespread 230 (93%), just over half the respondents utilise available electronic functionalities specific to chronic disease management. GP specific electronic systems infrequently link or communicate with external electronic sources 133 (54%). While the current pathways of care for epilepsy in Ireland appear fragmented and inadequate, further investigations to determine the quality and cost effectiveness of the current service are required.
De V Meiring, P
Much of the work of the public medical wards at Grey's Hospital is concerned with the care of aged persons. In the absence of separate geriatric facilities, this work forms an integral part of internal medicine. During the last decade two surveys, and experience gained, have determined a comprehensive approach to the social and medical problems encountered. While team work can accomplish much, the responsibility for care of the aged currently remains divided among a number of government and private agencies. Without a unified policy and further expenditure of a certain amount of money, many of our senior citizens will continue to be denied easy access to health care facilities. PMID:857323
Full Text Available Abstract Background Patient satisfaction is an important indicator of quality of care in hospitals. Reliable and valid instruments to measure clinical and outpatient satisfaction already exist. Recently hospitals have increasingly provided day care, i.e., admitting patients for one day without an overnight stay. This article describes the adaption of the ‘Core questionnaire for the assessment of Patient Satisfaction’ (COPS for general Day care (COPS-D, and the subsequent validation of the COPS-D. Methods The clinical COPS was supplemented with items to cover two new dimensions: Pre-admission visit and Operation Room. It was sent to a sample of day care patients of five general Dutch hospitals to investigate dimensionality, acceptability, reliability, construct and external validity. Construct validity was established by correlating the dimensions of the COPS-D with patients’ overall satisfaction. Results The COPS-D was returned by 3802 patients (response 46%. Factor analysis confirmed its’ structure: Pre-intake visit, Admission, Operation room, Nursing care, Medical care, Information, Autonomy and Discharge and aftercare (extraction communality 0.63-0.90. The internal consistency of the eight dimensions was good (α = 0.82-0.90; the item internal consistency corrected for overlap was satisfactory (>0.40; all inter-item correlations were higher than 0.45 but not too high (Information dimension had the strongest correlation with overall day care satisfaction. Conclusions The COPS-D is a reliable and valid instrument for measuring satisfaction with day care. It complements the model of measuring patient satisfaction with clinical and outpatient care given in hospitals. It also fulfils the conditions made while developing the clinical and outpatient COPS: a short, core instrument to screen patient satisfaction.
que se tem dado ao tratamento ambulatorial. Em relação ao padrão qualitativo de atendimento, foram encontradas as mesmas limitações anteriormente descritas.The situation of hospital care is analysed in the metropolitan area of S. Paulo, which consists of 37 cities and contains a population of about 8 000 000 inhabitants. In 1970, the number of hospitals was 207 with 43 639 beds (5.5 beds/1000 inhabitants. Compared to other Brazilian capitals and other countries, this rate of beds is too low and it doesn't suit to the level of its social and economic development. The general hospital care is given by 166 units and 86% belongs to private agencies and it has 25 574 beds (3.2 beds/1000 inhabitants. The actual situation is unsatisfactory when considering 5 beds/1000 inhabitants satisfactory and there is a deficit of 14 331 beds. This deficit increases since there has not been a rational criteria in the local distribuition of hospitals. From the 37 urban communities that exist in the area, 19 (250 000 inhabitants have not general hospital and 35 cannot receive any general public hospital assistance. The city of São Paulo has 2 491 infant beds. Since we admit that 21% of general beds for children is satisfactory, there is a deficit of 3649 beds (59% of the existing beds. The hospital care given to the psychopath includes 34 hospitals which have 15686 beds (2 beds/1000 inhabitants. There is a deficit of 8 257 beds considering as satisfactory the rate of 3 beds/1000 inhabitants. The quality of the hospital care is insufficient because these hospitals are overcrowded. There is need of medical and paramedical persons, and this situation is harmful to the medical hospital care. More than 80% of beds in the State of São Paulo (almost 18 000 000 inhabitants is centralized in the metropolitan area. Related to the available beds that give care to the tuberculosis and leprous patients there is no deficit and there are even vacant beds. This situation can be explained in large
van Ierland, Yvette
markdownabstract__Abstract__ Children constitute a substantial part of the workload of physicians in primary care and hospital emergency care. In the Netherlands, about 70% of the 3.9 million inhabitants less than 20 years of age had one or more contacts with their general practitioner (GP) in 2011. Primary out-ofhours care is annually visited by approximately 600,000 children younger than 14 years of age and hospital emergency departments (EDs) by nearly 400,000 children in this age group. F...
... 2011 LTCH PPS) (75 FR 50042-50677).'' Therefore, the percentage increase for hospitals paid under the... Hospital Deductible and Hospital and Extended Care Services Coinsurance Amounts for CY 2011 AGENCY: Centers... inpatient hospital deductible and the hospital and extended care services coinsurance amounts for...
Marlos Victor Fonsêca de Lima
Full Text Available This study aimed to identify the profile of external causes in the emergency room of a public reference hospital in the state. Descriptive research document with a quantitative approach. The data analysis revealed that from January to December 2009 were made 4464 external causes. The higher frequency of injuries occurred in individuals aged 21 to 40 years (37.70%, males (68.6%. Regarding the causes, falls (29% was the biggest variable, followed by motorcycle accidents (17.98%, domestic accidents (16.53%, physical abuse (10.43% and bicycle accident (8, 84%. It was observed that 23.3% of the visits made to the emergency room were the people coming from surrounding municipalities. The study revealed the need to improve the quality of information about the grievances motivated by external causes, which are major causes of hospitalization and health care expenses.
Aaraas, I.; Forde, O. H.; Kristiansen, I S; Melbye, H.
STUDY OBJECTIVE: To assess whether populations with access to general practitioner hospitals (GP hospitals) utilise general hospitals less than populations without such access. DESIGN: Observational study comparing the total rates of admissions and of occupied bed days in general hospitals between populations with and without access to GP hospitals. Comparisons were also made separately for diagnoses commonly encountered in GP hospitals. SETTING: Two general hospitals serving the popula...
A.A.J. Hendriks; E.M.A. Smets; M.R. Vrielink; S.Q. van Es; J.C.J.M. de Haes
Objective. We investigated to what extent personality is associated with patient satisfaction with hospital care. A sizeable association with personality would render patient satisfaction invalid as an indicator of hospital care quality. Design. Overall satisfaction and satisfaction with aspects of
By using a luminescent material as a substitute for radioactive contamination a realistic assessment of the emergency plans for dealing with contaminated radiation casualties at a Regional General Hospital was made. The areas where problems arose in these plans are described and the changes now made to them given. (author)
Auerbach, Andrew D; Patel, Mitesh S; Metlay, Joshua P; Schnipper, Jeffrey L; Williams, Mark V; Robinson, Edmondo J; Kripalani, Sunil; Lindenauer, Peter K
Converting the health care delivery system into a learning organization is a key strategy for improving health outcomes. Although the collaborative learning organization approach has been successful in neonatal intensive care units and disease-specific collaboratives, there are few examples in general medicine and none in adult medicine that have leveraged the role of hospitalists nationally across multiple institutions to implement improvements. The authors describe the rationale for and early work of the Hospital Medicine Reengineering Network (HOMERuN), a collaborative of hospitals, hospitalists, and multidisciplinary care teams founded in 2011 that seeks to measure, benchmark, and improve the efficiency, quality, and outcomes of care in the hospital and afterwards. Robust and timely evaluation, with learning and refinement of approaches across institutions, should accelerate improvement efforts. The authors review HOMERuN's collaborative model, which focuses on a community-based participatory approach modified to include hospital-based staff as well as the larger community. HOMERuN's initial project is described, focusing on care transition measurement using perspectives from the patient, caregiver, and providers. Next steps and sustainability of the organization are discussed, including benchmarking, collaboration, and effective dissemination of best practices to stakeholders. PMID:24448050
Nayeri, Nahid Dehghan; Gholizadeh, Leila; Mohammadi, Eesa; Yazdi, Khadijeh
Family participation in caregiving to elderly inpatients is likely to improve the quality of care to older patients. This qualitative design study applied semi-structured interviews to elicit experiences from nurses, families, and patients on the notion of family participation in the care of elderly patients in two general teaching hospitals in Iran. Data were gathered using individual interviews, field notes, and participant observations. Interviews were recorded, transcribed verbatim, and analyzed using manifest and latent content analysis. The following main themes emerged through the data analysis process: (a) safety and quality in patient care and (b) unplanned and unstructured patient care participation. The study concludes that family involvement in caregiving to elderly patients is important, yet the participation should be based upon a planned and structured framework to ensure a safe and satisfying experience for patients, families, and health care team. PMID:24652880
Background Communication regarding medicines at hospital discharge via discharge summaries is notoriously poor and negatively impacts on patient care. With the process being dependant on the quality of patient records during admission, junior doctors who write them and General Practitioners (GPs) who receive them, the objectives of this thesis were, with respect to discharge summaries, to:- assess their timeliness, accuracy and quality describe GP preferences explore experie...
...; Payment Policies Related to Patient Status '' (78 FR 50608). Therefore, the percentage increase for... Hospital Deductible and Hospital and Extended Care Services Coinsurance Amounts for CY 2014 AGENCY: Centers... inpatient hospital deductible and the hospital and extended care services coinsurance amounts for...
Dijs-Elsinga, J.; Otten, W.; Versluijs, M.; Smeets, H.J.; Kievit, J.; Vree, R.; Made, W.J. van der; Marang-Van De Mheen, P.J.
OBJECTIVE: To assess whether patients use information on quality of care when choosing a hospital for surgery compared with more general hospital information. METHODS: In this cross-sectional study in 3 Dutch hospitals, questionnaires were sent to 2122 patients who underwent 1 of 6 elective surgical
Goodfellow, P B; Fretwell, I. A.; Simms, J M
INTRODUCTION: This study describes the first full year of independent practice by a newly appointed nurse endoscopist in a district general hospital. PATIENTS AND METHODS: Patients underwent either 'one stop' flexible sigmoidoscopy and barium enema or flexible sigmoidoscopy alone. Barium enema results, video photography, clinical follow-up, and histology were used to validate the results of the flexible sigmoidoscopy. One stop clinic: 161 endoscopies were performed, with 104 female patients (...
Staffurth, J. S.
Nuclear medicine is a recognised clinical specialty both nationally and internationally. Compared with other countries, it is inadequately developed in Britain, particularly in district general hospitals. To create clinical radioisotope services at district level physicians or radiologists with experience in nuclear medicine need to be trained and appointed. Such appointments would allow facilities to evolve that would provide either a comprehensive nuclear medicine service formed around a ph...
Singh, G; Harvey, R; Dyne, A; Said, A; Scott, I
We assessed the impact of completion and feedback of discharge summary scorecards on the quality of discharge summaries written by interns in a general medicine service of a tertiary hospital. The scorecards significantly improved summary quality in the first three rotations of the intern year and could be readily adopted by other units as a quality improvement intervention for optimizing clinical handover to primary care providers. PMID:26444698
Full Text Available This is a report of an outbreak of Salmonella worthington in neonates at Sassoon General Hospitals, Pune, which occurred during August and September 2000. A total of 148 blood, 4 CSF and 6 stool specimens were received from neonates admitted to the hospital. Salmonella worthington could be isolated from 17 clinical specimens [15 blood (10.8%, 1 CSF (25% and 1 stool (16.6% sample]. Environmental swabs were also processed. An attempt was made to detect carriers in health care personnel. However, no source or carrier of Salmonella worthington in the hospital environment could be identified. Intensive cleaning measures and fumigation were undertaken. All these measures succeeded in aborting the outbreak.
Full Text Available E Scott Sills,1,2 Liubomir Chiriac,3 Denis Vaughan,4 Christopher A Jones,5 Shala A Salem11Division of Reproductive Endocrinology, Pacific Reproductive Center, Irvine, CA, USA; 2Graduate School of Life Sciences, University of Westminster, London, UK; 3Department of Mathematics, California Institute of Technology, Pasadena, CA, USA; 4Department of Obstetrics and Gynaecology, School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland; 5Global Health Economics Unit and Department of Surgery, Center for Clinical and Translational Science, University of Vermont College of Medicine, Burlington, VT, USABackground: This investigation evaluated standardized process of care data collected on selected hospitals serving a remote rural section of westernmost North Carolina.Methods: Centers for Medicare and Medicaid Services data were analyzed retrospectively for multiple clinical parameters at Fannin Regional Hospital, Murphy Medical Center, and Union General Hospital. Data were analyzed by paired t-test for individual comparisons among the three study hospitals to compare the three facilities with each other, as well as with state and national average for each parameter.Results: Centers for Medicare and Medicaid Services “Hospital Compare” data from 2011 showed Fannin Regional Hospital to have significantly higher composite scores on standardized clinical process of care measures relative to the national average, compared with Murphy Medical Center (P = 0.01 and Union General Hospital (P = 0.01. This difference was noted to persist when Fannin Regional Hospital was compared with Union General Hospital using common state reference data (P = 0.02. When compared with national averages, mean process of care scores reported from Murphy Medical Center and Union General Hospital were both lower but not significantly different (−3.44 versus −6.07, respectively, P = 0.54.Conclusion: The range of process of care scores submitted by acute care
Moja, Lorenzo; Polo Friz, Hernan; Capobussi, Matteo; Kwag, Koren; Banzi, Rita; Ruggiero, Francesca; González-Lorenzo, Marien; Liberati, Elisa Giulia; Mangia, Massimo; Nyberg, Peter; Kunnamo, Ilkka; Cimminiello, Claudio; Vighi, Giuseppe; Grimshaw, Jeremy; Bonovas, Stefanos
Background Computerized decision support systems (CDSSs) are information technology-based software that provide health professionals with actionable, patient-specific recommendations or guidelines for disease diagnosis, treatment, and management at the point-of-care. These messages are intelligently filtered to enhance the health and clinical care of patients. CDSSs may be integrated with patient electronic health records (EHRs) and evidence-based knowledge. Methods/design We designed a pragm...
Scott, Ian A; Denaro, Charles P; Bennett, Cameron J; Hickey, Annabel C; Mudge, Alison M; Flores, Judy L; Sanders, Daniela C J; Thiele, Justine M; Wenck, Beres; Bennett, John W; Jones, Mark A
In patients hospitalised with acute coronary syndromes (ACS) and congestive heart failure (CHF), evidence suggests opportunities for improving in-hospital and after-hospital care, patient self-care, and hospital-community integration. A multidisciplinary quality improvement program was designed and instigated in Brisbane in October 2000 involving 250 clinicians at three teaching hospitals, 1080 general practitioners (GPs) from five Divisions of General Practice, 1594 patients with ACS and 904 patients with CHF. Quality improvement interventions were implemented over 17 months after a 6-month baseline period and included: clinical decision support (clinical practice guidelines, reminders, checklists, clinical pathways); educational interventions (seminars, academic detailing); regular performance feedback; patient self-management strategies; and hospital-community integration (discharge referral summaries; community pharmacist liaison; patient prompts to attend GPs). Using a before-after study design to assess program impact, significantly more program patients compared with historical controls received: ACS: Angiotensin-converting enzyme (ACE) inhibitors and lipid-lowering agents at discharge, aspirin and beta-blockers at 3 months after discharge, inpatient cardiac counselling, and referral to outpatient cardiac rehabilitation. CHF: Assessment for reversible precipitants, use of prophylaxis for deep-venous thrombosis, beta-blockers at discharge, ACE inhibitors at 6 months after discharge, imaging of left ventricular function, and optimal management of blood pressure levels. Risk-adjusted mortality rates at 6 and 12 months decreased, respectively, from 9.8% to 7.4% (P = 0.06) and from 13.4% to 10.1% (P = 0.06) for patients with ACS and from 22.8% to 15.2% (P improvement programs that feature multifaceted interventions across the continuum of care can change clinical culture, optimise care and improve clinical outcomes. PMID:15139843
Valenzuela, Carla; Ugarte-Gil, Cesar; Paz, Jorge; Echevarria, Juan; Gotuzzo, Eduardo; Vermund, Sten H; Kipp, Aaron M
HIV stigma as a barrier to retention in HIV care has not been well-studied outside the United States. We conducted a case-control study in Lima, Peru to examine this issue. Cases were out-of-care for ≥12 months (n = 66) and controls were recruited from patients in active care presenting for a clinic visit (n = 110). A previously validated HIV stigma scale with four domains was used. Associations between being out-of-care and each stigma domain were assessed using multivariable logistic regression. Stigma scores were highest for disclosure concerns. Modest associations were found for greater disclosure concerns (OR 1.16; 95 % CI 0.99, 1.36) and concerns with public attitudes (OR 1.20; 95 % CI 1.03, 1.40). Enacted stigma and negative self-image showed non-linear associations with being out-of-care that plateaued or declined, respectively, at higher levels of stigma. The threshold effect for enacted stigma warrants further exploration, while disclosure concerns may be especially amenable to intervention in this population. PMID:25269871
Fatores de risco associados à mortalidade em pacientes com sepse em unidade de terapia intensiva de hospital privado de Pernambuco Risk factors associated to mortality on septic patients in an intensive care unit of a general private hospital from Pernambuco
Joana Corrêa de A. Koury
Full Text Available JUSTIFICATIVA E OBJETIVOS: Verificar a associação entre as características clínicas, epidemiológicas e laboratoriais com a mortalidade de pacientes com sepse, internados em UTI de hospital privado do estado de Pernambuco (Nordeste do Brasil, a fim de melhorar o atendimento a essa população, através da identificação precoce dos pacientes com risco de desenvolver falência de órgãos. MÉTODO: Estudo de caso-controle aninhado a uma coorte prospectiva e observacional que incluiu os pacientes adultos admitidos na UTI com sepse ou que a desenvolveram durante a internação. Foram colhidos os dados epidemiológicos, avaliados os escores clínicos e exames laboratoriais como: D-dímero, antitrombina III, INR, contagem de plaquetas, sódio, albumina, lactato e creatinina, sendo analisada sua associação com a mortalidade. Os pacientes foram acompanhados até a alta da UTI ou óbito. RESULTADOS: Foram incluídos no estudo 199 pacientes. Após regressão logística, apenas o tempo de internação na UTI maior que 72h, a presença de doença crônica associada, o número de órgãos acometidos superior a três e o lactato maior que 4 mmol/L estiveram associados com a mortalidade. Com relação à associação com o intervalo de tempo para o óbito, apenas o escore SOFA foi significativo, pois um terço dos pacientes com pontuação superior a 12 foram a óbito em menos de 72h. CONCLUSÕES: Os pacientes admitidos com sepse na UTI provenientes da comunidade (tempo de internação hospitalar BACKGROUND AND OBJECTIVES: Verify the association between clinical, epidemiological and laboratorial characteristics with mortality of septic patient in an Intensive Care Unit (ICU from Pernambuco, northeast of Brazil, to improve the attention for patients with sepse which are in risk of developing organ dysfunction. METHODS: Case-control study, without intervention, that included adults' patients admitted in ICU with sepsis or that developed it during ICU
This article discusses an ignored problem--the plight of infants and toddlers in foster care who find themselves hospitalized. A majority of the children in foster care will be hospitalized for medical treatment while in foster care because they are more likely to have serious medical problems or developmental disabilities than their age peers.…
Valdovinos, Erica; Le, Sidney; Hsia, Renee Y
In exchange for sizable tax exemptions, not-for-profit hospitals must engage in activities that meet the Internal Revenue Service's community benefit standard. The provision of charity care-free care to those unable to pay-can help meet that standard. Bad debt, the other form of uncompensated care, cannot be used to meet the standard, although Medicaid shortfalls can. However, the ACA lacks guidelines for providing charity care, and federal law sets no minimum requirements for community benefit activities. Using data from California, we examined whether the levels of charity and uncompensated care provided differed across general acute care hospitals by profit status and other characteristics during 2011-13. The mean proportion of total operating expenses spent on charity care differed significantly between not-for-profit (1.9 percent) and for-profit hospitals (1.4 percent), in contrast to the mean proportion spent on uncompensated care. Both types of spending varied widely across hospitals. Policy makers should consider measures that remove disincentives to meeting the persistent considerable need for charity care-for example, increasing supports to offset rising Medicaid shortfalls resulting from program expansion-and facilitate the tracking of ACA impacts on the distribution of charity care and uncompensated care delivery. PMID:26240242
Lateef, Fatimah; Anantharaman, Venkataraman
Medical care for the sick and injured on a variety of sea-faring vessels throughout the world represents a challenging area of medical care. The scope is extremely broad and unique in terms of the problems encountered at sea, logistical difficulties in assessment and treatment of patients, as well as the provision of definitive care. The problems of sparse resources availability, great distances, isolation, communications, accessibility, and weather are also very real. In Singapore, radio-medical advice was first coordinated by the Port Health Authority. In 1980, the accident and emergency department at Singapore General Hospital took over this responsibility. This report analyzes 2,320 calls received over a period of 21 years (January 1980 to December 2000). It highlights the common consultations, modes of communications, treatment and management prescribed, training requirements, as well as the challenges for the future. PMID:12098185
Evaluation of a Medical and Mental Health Unit compared with standard care for older people whose emergency admission to an acute general hospital is complicated by concurrent 'confusion': a controlled clinical trial. Acronym: TEAM: Trial of an Elderly Acute care Medical and mental health unit
Gladman John RF
Full Text Available Abstract Background Patients with delirium and dementia admitted to general hospitals have poor outcomes, and their carers report poor experiences. We developed an acute geriatric medical ward into a specialist Medical and Mental Health Unit over an eighteen month period. Additional specialist mental health staff were employed, other staff were trained in the 'person-centred' dementia care approach, a programme of meaningful activity was devised, the environment adapted to the needs of people with cognitive impairment, and attention given to communication with family carers. We hypothesise that patients managed on this ward will have better outcomes than those receiving standard care, and that such care will be cost-effective. Methods/design We will perform a controlled clinical trial comparing in-patient management on a specialist Medical and Mental Health Unit with standard care. Study participants are patients over the age of 65, admitted as an emergency to a single general hospital, and identified on the Acute Medical Admissions Unit as being 'confused'. Sample size is 300 per group. The evaluation design has been adapted to accommodate pressures on bed management and patient flows. If beds are available on the specialist Unit, the clinical service allocates patients at random between the Unit and standard care on general or geriatric medical wards. Once admitted, randomised patients and their carers are invited to take part in a follow up study, and baseline data are collected. Quality of care and patient experience are assessed in a non-participant observer study. Outcomes are ascertained at a follow up home visit 90 days after randomisation, by a researcher blind to allocation. The primary outcome is days spent at home (for those admitted from home, or days spent in the same care home (if admitted from a care home. Secondary outcomes include mortality, institutionalisation, resource use, and scaled outcome measures, including quality of
... fiscal year FPL Federal poverty line FQHC Federally qualified health center FR Federal Register FTE Full... CFR Parts 412, 418, 482, et al. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Proposed Fiscal...
... INFORMATION: I. Background In FR Doc. 2011-19719 of August 18, 2011 (76 FR 51476), the final rule entitled... Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates; Corrections AGENCY: Centers...
Vaughan-Sarrazin Mary S
Full Text Available Abstract Background There is growing concern certain not-for-profit hospitals are not providing enough uncompensated care to justify their tax exempt status. Our objective was to compare the amount of uncompensated care provided by not-for-profit (NFP, for-profit (FP and government owned hospitals. Methods We used 2005 state inpatient data (SID for 10 states to identify patients hospitalized for three common conditions: acute myocardial infarction (AMI, coronary artery bypass grafting (CABG, or childbirth. Uncompensated care was measured as the proportion of each hospital's total admissions for each condition that were classified as being uninsured. Hospitals were categorized as NFP, FP, or government owned based upon data obtained from the American Hospital Association. We used bivariate methods to compare the proportion of uninsured patients admitted to NFP, FP and government hospitals for each diagnosis. We then used generalized linear mixed models to compare the percentage of uninsured in each category of hospital after adjusting for the socioeconomic status of the markets each hospital served. Results Our cohort consisted of 188,117 patients (1,054 hospitals hospitalized for AMI, 82,261 patients (245 hospitals for CABG, and 1,091,220 patients for childbirth (793 hospitals. The percentage of admissions classified as uninsured was lower in NFP hospitals than in FP or government hospitals for AMI (4.6% NFP; 6.0% FP; 9.5% government; P Conclusions For the three conditions studied NFP and FP hospitals appear to provide a similar amount of uncompensated care while government hospitals provide significantly more. Concerns about the amount of uncompensated care provided by NFP hospitals appear warranted.
Kristensen, Troels; Rose Olsen, Kim
Background: Point-of-care testing (POCT) of HbA1c may result in improved diabetic control, better patient outcomes and enhanced clinical efficiency with fewer patient visits and subsequent reductions in hospitalizations and costs. In 2008, the Danish regulators agreed to create a new tariff...... for the remuneration of POCT of HbA1c in primary care. Aim: The aim of this study is to assess whether there is an association between the use of POCT of HbA1c and preventable hospital admissions among diabetes patients in general practice. Method: We apply logistic regression analyses to examine whether...... there is a link between preventable hospital admissions and POCT of HbA1c in general practice. Preventable hospital admissions were assessed through the ambulatory care sensitive conditions (ACSCs) classification of hospital admissions. We include independent variables such as gender, age, ethnicity...
Ouslander, Joseph G; Maslow, Katie
Reducing preventable hospitalizations is fundamental to the "triple aim" of improving care, improving health, and reducing costs. New federal government initiatives that create strong pressure to reduce such hospitalizations are being or will soon be implemented. These initiatives use quality measures to define which hospitalizations are preventable. Reducing hospitalizations could greatly benefit frail and chronically ill adults and older people who receive long-term care (LTC) because they often experience negative effects of hospitalization, including hospital-acquired conditions, morbidity, and loss of functional abilities. Conversely, reducing hospitalizations could mean that some people will not receive hospital care they need, especially if the selected measures do not adequately define hospitalizations that can be prevented without jeopardizing the person's health and safety. An extensive literature search identified 250 measures of preventable hospitalizations, but the measures have not been validated in the LTC population and generally do not account for comorbidity or the capacity of various LTC settings to provide the required care without hospitalization. Additional efforts are needed to develop measures that accurately differentiate preventable from necessary hospitalizations for the LTC population, are transparent and fair to providers, and minimize the potential for gaming and unintended consequences. As the new initiatives take effect, it is critical to monitor their effect and to develop and disseminate training and resources to support the many community- and institution-based healthcare professionals and emergency department staff involved in decisions about hospitalization for this population. PMID:23194066
Restuccia Joseph D
Full Text Available Abstract Background Recently, there has been considerable effort to promote the use of health information technology (HIT in order to improve health care quality. However, relatively little is known about the extent to which HIT implementation is associated with hospital patient care quality. We undertook this study to determine the association of various HITs with: hospital quality improvement (QI practices and strategies; adherence to process of care measures; risk-adjusted inpatient mortality; patient satisfaction; and assessment of patient care quality by hospital quality managers and front-line clinicians. Methods We conducted surveys of quality managers and front-line clinicians (physicians and nurses in 470 short-term, general hospitals to obtain data on hospitals’ extent of HIT implementation, QI practices and strategies, assessments of quality performance, commitment to quality, and sufficiency of resources for QI. Of the 470 hospitals, 401 submitted complete data necessary for analysis. We also developed measures of hospital performance from several publicly data available sources: Hospital Compare adherence to process of care measures; Medicare Provider Analysis and Review (MEDPAR file; and Hospital Consumer Assessment of Healthcare Providers and Systems HCAHPS® survey. We used Poisson regression analysis to examine the association between HIT implementation and QI practices and strategies, and general linear models to examine the relationship between HIT implementation and hospital performance measures. Results Controlling for potential confounders, we found that hospitals with high levels of HIT implementation engaged in a statistically significant greater number of QI practices and strategies, and had significantly better performance on mortality rates, patient satisfaction measures, and assessments of patient care quality by hospital quality managers; there was weaker evidence of higher assessments of patient care quality by
The medical care of prisoners "declaring sick" to the medical officer and hospital officers in Bedford Prison was surveyed and compared with the medical care given to the medical officer's patients in general practice. The consultation rate of prisoners was higher than that of patients in the practice. Part of this increase was because household remedies were not available to prisoners except through the prison medical service and part may also have been due to the stresses of life in prison....
Brown, H Shelton; Pagán, José A
Managed care penetration has been partly responsible for slowing down increases in health care costs in recent years. This study uses a 1992-1996 Health Care Utilization Project sample of hospitals to analyze the relationship between managed care penetration in local insurance markets and hospital scale efficiency. After controlling for hospital and market area variables, we find that managed care insurance, particularly the preferred provider type, is associated with increases in hospital scale efficiency in tertiary cases. The results presented here are consistent with the view that managed care can lead to reductions in health cost inflation by controlling the diffusion of technology via improvements in the scale efficiency of hospitals. PMID:17111213
Background: Hospital acquired infections continue to be an important cause of morbidity and mortality among hospitalized patients. Hospital acquired pneumonia (HAP) results in a significant increase in the cost of care of hospitalized patients. Its development prolongs a patient's stay in the Intensive Care Unit (ICU). Accurate information concerning the clinical profile of HAP is lacking in South India. This study was conducted prospectively to evaluate the clinical profile of HAP in ICU pat...
Ensuring that older patients are discharged from hospital in a safe and appropriate manner is a fundamental aspect of nursing care. However, it is clear from the literature and clinical practice that determining people's capacity and whether they are able to decide where they live on discharge is a significant challenge. There is variation in practice despite the legal framework provided by the Mental Capacity Act (MCA) 2005, covering England and Wales, which raises questions about adherence to the legislation. Using a case study, this article explores aspects of the MCA and clinical practice that affect older patients' outcomes on discharge from general hospital settings. It demonstrates how effective multidisciplinary working, using the legal frameworks available, can ensure that an individual's independence and well-being are maintained. PMID:27573964
Bergenholtz, Heidi; Jarlbæk, Lene; Hølge-Hazelton, Bibi
Background: In many countries, approximately half of the population dies in hospital, making general palliative nursing care (GPNC) a core nursing task. GPNC in the hospital setting is described as challenging, however little is known about its actual practice. Aim: To explore the GPNC culture in...... medical departments. Methods: An ethnographic study, using Spradley's 12-step method, with observational field studies and interviews with nurses from three medical departments in a Danish regional hospital. Findings: Three cultural themes emerged from the analysis, focusing on the setting, the practice...... and the nurses' reflections on GPNC: (1) GPNC provided in a treatment setting, (2) transition to loving care and the licence to perform palliative care (PC) and (3) potential for team improvement. Conclusions: GPNC as a culture in medical departments seemed to be embedded in a setting not suited for...
Full Text Available Background: Elevation of blood pressure during pregnancy can adversely affect both fetal and maternal outcomes. Other maternal and fetal complications may also arise which may result to maternal and fetal mortality. Objective: This study aimed to determine the fetal and maternal outcomes of hospitalized pregnant clients with hypertension. Methods: This 6-year retrospective research design was carried out in Shaqra General Hospital between January 2008 and November 2013. Following approval by the hospital research ethics committee and hospital administrators, hospital records were reviewed and examined using guide checklist. Universal sampling was applied totaling to 56 evaluable cases of pregnant women with hypertension. Results: Of 56 cases studied, year 2008 to 2013 had the most frequency of hypertensive mothers. Most women are in middle adulthood stage with age 25 years old and above, had more than one pregnancy (multigravida and more than one viable pregnancy (multipara. Fetal outcome resulted to high number of babies who were term, appropriate for gestational age, with good Apgar score, no birth defect but high frequency of neonatal intensive care unit (NICU admissions. Maternal outcome recorded no maternal deaths; however, 4% maternal complications (i.e., post-partum hemorrhage and HELLP syndrome and more caesarean section deliveries were observed. Conclusion: Good Apgar score and absence of birth defects is associated with higher frequency of roomed-in babies and less NICU admissions. There were lesser complications to mothers who had more than one pregnancy. There were more NICU admissions from caesarean section deliveries.
Akubue, B. N.; Anikweze, G. U.
The purpose of this study was to investigate the health care practices for medical textiles in government hospitals Enugu State, Nigeria. Specifically, the study determined the availability and maintenance of medical textiles in government hospitals in Enugu State, Nigeria. A sample of 1200 hospital personnel were studied. One thousand two hundred…
markdownabstractAbstract Hospital quality indicators are widely implemented for purposes such as accountability, transparency and the overarching aim of quality improvement. However, it is not clear whether currently used hospital quality indicators actually reflect quality of care. The aim of this thesis was to expand our knowledge on how to measure quality of hospital care with the focus on external comparison. I specifically investigated reliability and validity as these are key aspects of...
Goldberg, R J
Psychiatry programs are facing significant business and financial challenges. This paper provides an overview of these management challenges in five areas: departmental, hospital, payment system, general finance, and policy. Psychiatric leaders will require skills in a variety of business management areas to ensure their program success. Many programs will need to develop new compensation models with more of an emphasis on revenue collection and overhead management. Programs which cannot master these areas are likely to go out of business. For academic programs, incentive systems must address not only clinical productivity, but academic and teaching output as well. General hospital programs will need to develop increased sophistication in differential cost accounting in order to be able to advocate for their patients and program in the current management climate. Clinical leaders will need the skills (ranging from actuarial to negotiations) to be at the table with contract development, since those decisions are inseparable from clinical care issues. Strategic planning needs to consider the value of improving integration with primary care, along with the ability to understand the advantages and disadvantages of risk-sharing models. Psychiatry leaders need to define and develop useful reports shared with clinical division leadership to track progress and identify problems and opportunities. Leaders should be responsible for a strategy for developing appropriate information system architecture and infrastructure. Finally, it is hoped that some leaders will emerge who can further our needs to address inequities in mental health fee schedules and parity issues which affect our program viability. PMID:11313073
Kristensen, Troels; Laudicella, Mauro; Ejersted, Charlotte;
. The volume of patients, and the number and diversity of specialties involved in caring for diabetic patients do not explain variation in the cost of treating diabetic patients across hospitals. Conclusion: Health Resource Groups and diagnostic markers are significant patient-related cost drivers in diabetes......Aims: We analyse the in-hospital costs of diabetic patients admitted to English hospitals and aim to assess what proportions of cost variation are explained by patient and hospital characteristics. Methods: We use Hospital Episode Statistics and reference costs for all patients admitted to diabetes...... care for all English hospitals for the financial year 2005/06. Our sample includes 31,371 patients admitted to 148 hospitals. We apply a multilevel approach. We analyse the relationship between patient costs and patient characteristics. We estimate the average cost of being treated in each hospital...
Koukoufilippou J; Koinis A.
Introduction: The family planning centres must be upgraded to a cornerstone of primary health care, and prevent, advise and protect the citizen's health while reducing hospitalization costs for hospitals. Aim: The purpose of this literature review is the family planning centre development in general hospital of Argolida that has a similar clinic. Material and Methods: Literature review was conducted of published English and Greek Articles from bibliographic databases Medline, Goog...
Amar D Bavle
Full Text Available Context: Antenatal depression is not easily visible, though the prevalence is high. The idea of conducting this study was conceived from this fact. Aims and Objectives: The aim of this study was to estimate the prevalence of antenatal depression and identify the risk factors, for early diagnosis and intervention. Settings and Design: The study conducted in a Tertiary Care Hospital was prospective and cross-sectional. Materials and Methods: Pregnant women between 18 and 40 years of age were studied. The sample size comprised 318 women. They were assessed using Edinburgh Postnatal Depression Scale (EPDS score, Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I Disorders, Life Event Stress Scale (LESS, and Life Distress Inventory (LDI. Statistical Analysis Used: The Statistical Package for Social Sciences (SPSS Version 15 software was used to measure percentages, mean, correlation, and P < 0.05 were considered significant. Results: Prevalence of antenatal depression in the study was 12.3%. Correlation of the sociodemographic factors, obstetric factors, LDI, and LESS with EPDS scores showed statistical significance for unplanned pregnancy, distress associated with relationships, physical health, financial situation, social life, presence of personality disorder, being a homemaker, and higher educational status. Conclusion: The study showed a high prevalence rate of depression and identified risk factors.
Kane, R L; Chen, Q.; Finch, M; Blewett, L; Burns, R; Moskowitz, M.
OBJECTIVE: To estimate the differences in functional outcomes attributable to discharge to one of four different venues for post-hospital care for each of five different types of illness associated with post-hospital care: stroke, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), hip procedures, and hip fracture, and to estimate the costs and benefits associated with discharge to the type of care that was estimated to produce the greatest improvement. STUDY SETTING...
A survey of stoma care in general practice is reported. It demonstrates a wide diversity in the patterns of care provided to ostomates, with only half of the general practitioners reporting regular follow-up by a member of the health care team. Dealing with appliance difficulties was found to be an aspect of stoma care in which a majority of general practitioners have little confidence. The district nurse and stoma nurse are considered to be the most valuable sources of back-up. It is suggest...
Prior, Anders; Vestergaard, Mogens; Davydow, Dimitry S;
BACKGROUND: Psychiatric disorders are associated with an increased risk for ambulatory care-sensitive condition (ACSC)-related hospitalizations, but it remains unknown whether this holds for individuals with nonsyndromic stress that is more prevalent in the general population. OBJECTIVES.......67) after fully adjusting for multimorbidity and socioeconomic factors. Individuals with above reference stress levels experienced 1703 excess ACSC-related hospitalizations (18% of all). A dose-response relationship was observed between perceived stress and the ACSC-related hospitalization rate regardless...
Hansson, Eva Helena; Kjaergaard, H; Schmiegelow, K;
The study aims to describe the experiences of a hospital-based home care programme in the families of children with cancer. Fourteen parents, representing 10 families, were interviewed about their experiences of a hospital-based home care programme during a 4-month period in 2009 at a university...... decreased the strain on the family and the ill child, maintained normality and an ordinary everyday life and fulfilled the need for safety and security. According to family members of children with cancer, hospital-based home care support enhanced their quality of life during the child's cancer trajectory...... hospital in Denmark. Five children participated in all or part of the interview. The interviews were transcribed verbatim and analysed using qualitative content analysis. The findings indicate that hospital-based home care enabled the families to remain intact throughout the course of treatment, as it...
Hsieh, Hui-Min; Bazzoli, Gloria J.
This study examines the association between hospital uncompensated care (UC) and reductions in Medicaid Disproportionate Share Hospital (DSH) payments resulting from the 1997 Balanced Budget Act. Data on California hospitals from 1996 to 2003 were examined using two-stage least squares with a first-differencing model to control for potential feedback effects. Our findings suggest that not-for-profit hospitals did reduce UC provision in response to reductions in Medicaid DSH, but the response ...
White, K R; Thompson, J M; Patel, U B
The hospital marketing function has been widely adopted as a way to learn about markets, attract sufficient resources, develop appropriate services, and communicate the availability of such goods to those who may be able to purchase such services. The structure, tasks, and effectiveness of the marketing function have been the subject of increased inquiry by researchers and practitioners alike. A specific understanding of hospital marketing in a growing managed care environment and the relationship between marketing and managed care processes in hospitals is a growing concern. Using Kotler and Clarke's framework for assessing marketing orientation, we examined the marketing orientation of hospitals in a single state at two points in time--1993 and 1999. Study findings show that the overall marketing orientation score decreased from 1993 to 1999 for the respondent hospitals. The five elements of the Kotler and Clarke definition of marketing orientation remained relatively stable, with slightly lower scores related to customer philosophy. In addition, we evaluated the degree to which selected managed care activities are carried out as part of its marketing function. A significant (p managed care processes coordinated with the formal marketing function was evident from 1993 to 1999. With increasing numbers of managed care plan enrollees, hospitals are likely focusing on organizational buyers as important customers. In order to appeal to organizational buyers, hospital executives may be focusing more on clinical quality and cost efficiency in the production of services, which will improve a hospital's position with organizational buyers. PMID:11570344
Full Text Available In this project standards for nursing records in general hospitals were formulated and then validated by a group o f nurses. An instrument was then designed to evaluate to what extent the standards are reached in a particular hospital. The instrument was then tested in a sample o f nine hospitals. The reliability and validity o f the instrument is discussed.
Neuwelt, Pat M; Kearns, Robin A; Cairns, Isobel R
INTRODUCTION The care work of general practice receptionists has received limited research attention, despite receptionists position at the beginning of patients' journeys in many health care systems. We examine receptionists' perceptions of their work and the opportunities and constraints they experience in caring for patients while providing administrative support to practices. METHODS Data were collected in focus group interviews with 32 receptionists from urban and rural general practices in the Auckland and Northland regions of New Zealand. We employed tools from inductive thematic analysis and Straussian grounded theory in interpreting the data. FINDINGS We found that the way receptionists identified with a caring role strongly challenged the pejorative view of them in public discourse. Receptionists provide care in two key ways: for the practice and for patients. The juggling they do between the demands of the practice and of patients creates considerable work tensions that are often invisible to other staff members. CONCLUSION Receptionists have a critical role as the first step in the patient care pathway, bridging health care system and community. For general practice to be patient-centred and improve accessibility for the most vulnerable, the care work of receptionists must be considered core. KEYWORDS Receptionists; general practice; care; New Zealand. PMID:27477554
Bell, D.; Layton, A J; Gabbay, J.
OBJECTIVES--To design an audit questionnaire and pilot its use by an audit assistant to monitor inpatient management of acute asthma and to compare the care given by chest physicians and general physicians. DESIGN--Retrospective review by a chest physician and audit assistant of a random sample of 76 case records of patients by a criterion based questionnaire developed from hospital guidelines on management of acute asthma. SETTING--One district general hospital. PATIENTS--76 adult patients w...
U.S. Department of Health & Human Services — Payment measures and value of care displays â provider data. This data set includes provider data for the payment measures and value of care displays associated...
. The volume of patients, the number and diversity of specialties involved in caring for diabetics was rejected as significant cost drivers. . Conclusion: Health Resource Groups (HRGS) and diagnostic markers are significant patient-related cost drivers in diabetes care. Costs are not lower in hospitals......Background: Many diabetic patients are admitted to hospital, where care is costly and where there may be scope to improve efficiency. Aims: We analyse the costs and characteristics of diabetic patients admitted to English hospitals and aim to assess what proportions of cost variation are explained...... by patient and hospital characteristics. Methods: We apply a multilevel approach recognising that patients are clustered in hospitals. We first analyse the relationship between patient costs and their characteristics, such as HRG, age, gender, diagnostic markers and socio-economic status. We derive...
Jarallah, Jamal S.
Background: Referral between primary care and hospitals is of great importance for patient care and follow-up. This study was conducted because of the importance of the quality of referral letters and feedback reports. Objectives: To evaluate the quality of referrals from primary health care (PHC) centers to general hospital in four regions in Saudi Arabia. Methods: This was a cross-sectional study of a random sample of referrals from the PHC centers. The first sampling unit was the general h...
NSGIC GIS Inventory (aka Ramona) — This Hospitals dataset, was produced all or in part from Published Reports/Deeds information as of 2006. It is described as 'care facility attribute'. Data by this...
Marlos Victor Fonsêca de Lima; Romântiezer Lourenço Pereira Silva; Nicelha Maria Guedes de Albuquerque; Jonas Sâmi Albuquerque de Oliveira; Cleonice Andréa Alves Cavalcante; Maria Lúcia Azevedo Ferreira de Macêdo
This study aimed to identify the profile of external causes in the emergency room of a public reference hospital in the state. Descriptive research document with a quantitative approach. The data analysis revealed that from January to December 2009 were made 4464 external causes. The higher frequency of injuries occurred in individuals aged 21 to 40 years (37.70%), males (68.6%). Regarding the causes, falls (29%) was the biggest variable, followed by motorcycle accidents (17.98%), domestic ac...
Viney, Linda L.; And Others
Compared quality of life of terminal cancer patients (n=182) in two palliative care units with that of those in general hospital. Patients in specialized palliative care units were found to differ from those dying in hospital, showing less indirectly expressed anger but more positive feelings. They also reported more anxiety about death but less…
C. Fischer (Claudia)
markdownabstractAbstract Hospital quality indicators are widely implemented for purposes such as accountability, transparency and the overarching aim of quality improvement. However, it is not clear whether currently used hospital quality indicators actually reflect quality of care. The aim of
Abstract Generalized anxiety disorder (GAD) is a mental health problem, which is characterized by excessive anxiety and worry, problems that are difficult to control. In the general population, the 12-month prevalence of GAD is 2-3%, with the lifetime prevalence being about 5%. However, GAD is more prevalent among primary care utilizers i.e. approximately 5-8% of them suffer from this disorder. Earlier studies have revealed GAD to be associated with a high utilization of health care resou...
Inarvis Medina González
Full Text Available Background: application of palliative care to patients with chronic respiratory conditions is a current problem related to the quality of nursing care provided to them.Objective: to identify the nurses’ level of knowledge of palliative care for patients with chronic respiratory conditions in the Pneumological Hospital.Methods: a descriptive study was conducted in the Pneumological Hospital from January through May 2014. It included 33 nurses who provide care to hospitalized patients. The variables analyzed were years of experience, educational level, knowledge of defining aspects of palliative care, pain management, intervention for control of dyspnea, criteria for drug administration and choice of route of administration as well as nurses’ perception of their knowledge of palliative care. Results: thirty percent have more than 30 years of professional work experience, 51% are graduates. Fifty four point five percent consider that palliative care should not be provided at home; 63.6% believe that they should not be provided to patients with chronic non-cancerous diseases in advanced stages; 69.9% suggest that mixed therapies should not be used for pain management; 51.5% do not consider that breathing techniques should be used to control dyspnea. Forty eight point four percent recognize their lack of knowledge about palliative care. Conclusions: nurses from the Pneumological Hospital do not have sufficient knowledge about the different dimensions of palliative care for patients with chronic respiratory conditions.
... Register citations affecting § 412.22, see the List of CFR Sections Affected, which appears in the Finding... 42 Public Health 2 2010-10-01 2010-10-01 false Excluded hospitals and hospital units: General... HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL...
Full Text Available BACKGROUND: With market-oriented economic and health-care reform, public hospitals in China have received unprecedented pressures from governmental regulations, public opinions, and financial demands. To adapt the changing environment and keep pace of modernizing healthcare delivery system, public hospitals in China are expanding clinical services and improving delivery efficiency, while controlling costs. Recent experiences are valuable lessons for guiding future healthcare reform. Here we carefully study three teaching hospitals, to exemplify their experiences during this period. METHODS: We performed a systematic analysis on hospitalization costs, health-care quality and delivery efficiencies from 2006 to 2010 in three teaching hospitals in Beijing, China. The analysis measured temporal changes of inpatient cost per stay (CPS, cost per day (CPD, inpatient mortality rate (IMR, and length of stay (LOS, using a generalized additive model. FINDINGS: There were 651,559 hospitalizations during the period analyzed. Averaged CPS was stable over time, while averaged CPD steadily increased by 41.7% (P<0.001, from CNY 1,531 in 2006 to CNY 2,169 in 2010. The increasing CPD seemed synchronous with the steady rising of the national annual income per capita. Surgical cost was the main contributor to the temporal change of CPD, while medicine and examination costs tended to be stable over time. From 2006 and 2010, IMR decreased by 36%, while LOS reduced by 25%. Increasing hospitalizations with higher costs, along with an overall stable CPS, reduced IMR, and shorter LOS, appear to be the major characteristics of these three hospitals at present. INTERPRETATIONS: These three teaching hospitals have gained some success in controlling costs, improving cares, adopting modern medical technologies, and increasing hospital revenues. Effective hospital governance and physicians' professional capacity plus government regulations and supervisions may have played a role
The responsibility of the state for ensuring the provision of hospital care services to its citizens derives from the welfare state principle laid down in Sect. 20 para. 1 GG (Grundgesetz, i.e., the German constitutional law). The state fulfils this responsibility by means of planning and funding regulations in the Hospital Funding Act (KHG), the Hospital Remuneration Act (KHEntG), the National Ordinance on Hospital Rates (BPflV), the Hospital Laws of the German federal states and other supplementary legislation. The funding of hospitals is based on a dual funding system, meaning that hospital investment costs generally need to be borne by the German federal states as required, while operating costs will have to be funded through the remuneration for hospital treatments. Because of the tight budget situation of the German federal states a considerable backlog of investment has built up. After a transition period (between 2005 and 2009) operating costs are now funded on the basis of the so-called DRG system (DRG=Diagnosis Related Groups)--irrespective of the actual costs incurred by each individual hospital, which has led to a commodification of hospital care services. Whether this commodification avoids bottlenecks in the provision of health services to hospital patients or creates additional bottlenecks, is a controversial issue. PMID:20870488
The World Health Organization cites tobacco use as one of the biggest public health threats the world has ever faced. Tobacco is the number one preventable cause of disability and death. Tobacco has many negative health effects which many of the smokers know them well. In Pakistan tobacco use is common in general public and the health professionals don't lack behind this habit. To study the smoking trends amongst young doctors of Mayo Hospital. Questionnaire based descriptive study. This study was conducted at the Institute of Chest Medicine, Mayo Hospital - A tertiary care hospital affiliated with King Edward Medical University, Lahore. Out of 250 doctors, 180 (72%) were males and 70 (28%) were female. Amongst 180 male doctors 97 (53.88%) were smokers and 83 (46.21%) were non smokers. Amongst 70 female doctors 8 (11.43%) were smokers and 62 (88.57%) were non smokers. Smoking is common among male young doctors but it is less common in female doctors. (author)
Møller Pedersen, Kjeld; Andersen, John Sahl; Søndergård, Jens
challenges. Practice units are fairly small: close to 2 GPs per unit plus nurses and secretaries. The units are fully computerized, that is, with computer-based patient records and submission of prescriptions digitally to pharmacies etc. Over the past few years a decrease in solo practices has been seen and......General practice is the corner stone of Danish primary health care. General practitioners (GPs) are similar to family physicians in the United States. On average, all Danes have 6.9 contacts per year with their GP (in-person, telephone, or E-mail consultation). General practice is characterized by...... postgraduate education. The contract is (re)negotiated every 2 years. General practice is embedded in a universal tax-funded health care system in which GP and hospital services are free at the point of use. The current system has evolved over the past century and has shown an ability to adapt flexibly to new...
This presentation will explore the possibility of community first responders and other prehospital emergency care providers developing PTSD. It will also discuss possible methods to reduce the likelihood of being susceptible and the support available to those working in this high pressure are of care
Kodner, Dennis L
The Massachusetts General Care Management Program (Mass General CMP or CMP) was designed as a federally supported demonstration to test the impact of intensive, practice-based care management on high-cost Medicare fee-for-service (FFS) beneficiaries-primarily older persons-with multiple hospitalisations and multiple chronic conditions. The Massachusetts General Care Management Program operated over a 6-year period in two phases (3 years each). It started during the first phase at Massachusetts General Hospital, a major academic medical centre in Boston, Massachusetts in collaboration with Massachusetts General Physicians Organisation. During the second phase, the programme expanded to two more affiliated sites in and around the Boston area, including a community hospital, as well as incorporated several modifications primarily focused on the management of transitions to post-acute care in skilled nursing facilities. At the close of the demonstration in July 2012, Mass General Massachusetts General Care Management Program became a component of a new Pioneer accountable care organisation (ACO). The Massachusetts General Care Management Program is focused on individuals meeting defined eligibility criteria who are offered care that is integrated by a case manager embedded in a primary care practice. The demonstration project showed substantial cost savings compared to fee-for-service patients served in the traditional Medicare system but no impact on hospital readmissions. The Massachusetts General Care Management Program does not rest upon a "whole systems" approach to integrated care. It is an excellent example of how an innovative care co-ordination programme can be implemented in an existing health-care organisation without making fundamental changes in its underlying structure or the way in which direct patient care services are paid for. The accountable care organisation version of the Massachusetts General Care Management Program includes the staffing structure
Dennis L Kodner
Full Text Available The Massachusetts General Care Management Program (Mass General CMP or CMP was designed as a federally supported demonstration to test the impact of intensive, practice-based care management on high-cost Medicare fee-for-service (FFS beneficiaries—primarily older persons—with multiple hospitalisations and multiple chronic conditions. The Massachusetts General Care Management Program operated over a 6-year period in two phases (3 years each. It started during the first phase at Massachusetts General Hospital, a major academic medical centre in Boston, Massachusetts in collaboration with Massachusetts General Physicians Organisation. During the second phase, the programme expanded to two more affiliated sites in and around the Boston area, including a community hospital, as well as incorporated several modifications primarily focused on the management of transitions to post-acute care in skilled nursing facilities. At the close of the demonstration in July 2012, Mass General Massachusetts General Care Management Program became a component of a new Pioneer accountable care organisation (ACO. The Massachusetts General Care Management Program is focused on individuals meeting defined eligibility criteria who are offered care that is integrated by a case manager embedded in a primary care practice. The demonstration project showed substantial cost savings compared to fee-for-service patients served in the traditional Medicare system but no impact on hospital readmissions. The Massachusetts General Care Management Program does not rest upon a “whole systems” approach to integrated care. It is an excellent example of how an innovative care co-ordination programme can be implemented in an existing health-care organisation without making fundamental changes in its underlying structure or the way in which direct patient care services are paid for. The accountable care organisation version of the Massachusetts General Care Management Program
Full Text Available Drug utilization in the in-patient setting can provide mechanisms to assess drug prescribing trends, efficiency and cost-effectiveness of hospital formularies and examine sub-populations such as children for which prescribing habits are different from adults. Objectives: The aim of this descriptive study was to analyze general medication utilization patterns and costs excluding antimicrobials prescriptions and to compare two pediatric admission units in a tertiary care university hospital. Methods: The total number of admitted children was 1,521 and 1,467 for the A and B admission units, respectively. The electronic data from 252 and 253 hospitalized children in the A and B admission unit were prospectively screened for general medication prescriptions, children on antimicrobials were excluded from the analysis. Their electronic charts were viewed once weekly from October 15, 2007 up to April 7, 2008 using the prescription-point prevalence method. One medication was considered to be one prescription. Results: The general medications prescription number was 790 for 94 children (8.4 prescription/patient in A and 959 for 88 children (10.9 prescription/patient in B (p=0.02. The general medications defined daily dose (DDD and drug utilization 90% (DU90% index were 2,509.63, 2,259 for A; and 6,110.35, 5,499 for B, respectively. The DU90% index placed salbutamol inhalation with 835 DDD and sodium heparin with 2,102 DDD in the first place for the A and B admission units, respectively. A net increment in medication cost was registered according to the calculated cost from the depicted DU90% when the A (20,263 NIS and B (6,269 NIS admission units were compared (p=0.04. Conclusions: A significant difference in the prescription utilization of general medications was shown between the A and B admission units. The A admission unit had lower prescriptions measured by the DU90% index with higher medication cost. Potential drug-drug interactions were depicted in
... care hospital quality measures. SUPPLEMENTARY INFORMATION: I. Background In FR Doc. 2011-19719 of August 18, 2011 (76 FR 51476), the final rule entitled ``Medicare Program; Hospital Inpatient Prospective... requirements. IV. Correction of Errors In FR Doc. 2011-19719 of August 18, 2011 (76 FR 51476), make...
.... SUPPLEMENTARY INFORMATION: I. Background In FR Doc. 2012-19079 of August 31, 2012 (77 FR 53258), there were a... effective date requirements. ] IV. Correction of Errors In FR Doc. 2012-19079 of August 31, 2012 (77 FR...-AR12 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and...
... Program. SUPPLEMENTARY INFORMATION: I. Background In FR Doc. 2013-10234 of May 10, 2013 (78 FR 27486... errors. ] III. Correction of Errors In FR Doc. 2013-10234 of May 10, 2013 (78 FR 27486), make the...-AR53 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and...
Madaris, Linda L; Onyebueke, Mirian; Liebman, Janet; Martin, Allyson
The complex nature of spinal cord injury (SCI) and the level of care required for health maintenance frequently result in repeated hospital admissions for recurrent medical complications. Prolonged hospitalizations of persons with SCI have been linked to the increased risk of hospital-acquired infections and development or worsening pressure ulcers. An evidence-based alternative for providing hospital-level care to patients with specific diagnoses who are willing to receive that level of care in the comfort of their home is being implemented in a Department of Veterans Affairs SCI Home Care Program. The SCI Hospital in Home (HiH) model is similar to a patient-centered interdisciplinary care model that was first introduced in Europe and later tested as part of a National Demonstration and Evaluation Study through Johns Hopkins School of Medicine and School of Public Health. This was funded by the John A. Hartford Foundation and the Department of Veterans Affairs. The objectives of the program are to support veterans' choice and access to patient-centered care, reduce the reliance on inpatient medical care, allow for early discharge, and decrease medical costs. Veterans with SCI who are admitted to the HiH program receive daily oversight by a physician, daily visits by a registered nurse, access to laboratory services, oxygen, intravenous medications, and nursing care in the home setting. In this model, patients may typically access HiH services either as an "early discharge" from the hospital or as a direct admit to the program from the emergency department or SCI clinic. Similar programs providing acute hospital-equivalent care in the home have been previously implemented and are successfully demonstrating decreased length of stay, improved patient access, and increased patient satisfaction. PMID:26938182
Meyer, A A; Fakhry, S M; Sheldon, G F
Surgical critical care (SCC) was recently identified as an essential component of general surgery by the American Board of Surgery (ABS). Previous studies have found limited attention to critical care education in general surgery programs. This survey was developed to determine the changes in critical care education, following the emphasis by the ABS. The survey determined the format for SCC education, the time and resources committed, and the views of the program directors toward SCC. Program directors of all 296 approved general surgery residencies were surveyed, with a 79% response. Most program directors (91%) agree that SCC is an essential component of general surgery, and 72% believe a separate intensive care unit (ICU) rotation should be used in SCC education. Education in SCC was provided by a separate ICU service in 110 (47%) of the programs. The remaining 53% used care of patients in the ICU during traditional services as their educational experience. The average ICU rotation for surgery residents was 9 weeks and usually occurred in the second year of training. In 97% of the 110 programs with an ICU service, lectures and conferences were conducted regularly. Seventeen programs sponsored critical care fellowships, and 25 additional programs were considering them. Ninety percent of surgical ICU services had faculty that consisted exclusively of surgeons or surgeons and other specialists. Only 53% of surgeons attending on an ICU service had a reduction in their other responsibilities. Despite overwhelming agreement that critical care is an essential component of general surgery, less than half of the training programs have an ICU service to coordinate resident education in SCC. If surgeons are to continue to provide total care to their patients, there needs to be increased commitment to SCC education. PMID:2763037
Bardiau, Françoise; Braeckman, M.M.; Seidel, Laurence; Albert, Adelin; Boogaerts, J.G.
STUDY OBJECTIVES: To assess the effects of an Acute Pain Service (APS) inception on postoperative pain management in a general teaching hospital using pain indicators as performance measures. DESIGN: Open, prospective, nonrandomized, observational study. SETTING: Postanesthesia Care Unit, surgical wards of University Hospital Center of Charleroi. PATIENTS: 1304 patients in the pre-APS inception phase and 671 patients after its implemention who have undergone various types of surgery (orthoped...
The Act to Partially Amend the Act on Mental Health and Welfare for the Mentally Disabled was passed on June 13, 2013. Major amendments regarding hospitalization for medical care and protection include the points listed below. The guardianship system will be abolished. Consent by a guardian will no longer be required in the case of hospitalization for medical care and protection. In the case of hospitalization for medical care and protection, the administrators of the psychiatric hospital are required to obtain the consent of one of the following persons: spouse, person with parental authority, person responsible for support, legal custodian, or curator. If no qualified person is available, consent must be obtained from the mayor, etc. of the municipality. The following three obligations are imposed on psychiatric hospital administrators. (1) Assignment of a person, such as a psychiatric social worker, to provide guidance and counseling to patients hospitalized for medical care and protection regarding their postdischarge living environment. (2) Collaboration with community support entities that consult with and provide information as necessary to the person hospitalized, their spouse, a person with parental authority, a person responsible for support, or their legal custodian or curator. (3) Organizational improvements to promote hospital discharge. With regard to requests for discharge, the revised law stipulates that, in addition to the person hospitalized with a mental disorder, others who may file a request for discharge with the psychiatric review board include: the person's spouse, a person with parental authority, a person responsible for support, or their legal custodian or curator. If none of the above persons are available, or if none of them are able to express their wishes, the mayor, etc. of the municipality having jurisdiction over the place of residence of the person hospitalized may request a discharge. In order to promote transition to life in the
Muñoz, E; Barrau, L; Goldstein, J; Benacquista, T; Mulloy, K; Wise, L
Several federal bodies provide ongoing analyses of the Medicare DRG prospective hospital payment system. Many states are using DRG prospective "all payor systems" for hospital reimbursement (based on the federal model). In All Payor Systems, Medicare, Medicaid, Blue Cross and other commercial insurers pay by the DRG mode; New York State has been All Payor since 1/1/88. This study simulated DRG All Payor methods on a large sample (n = 1,662) of pulmonary medicine patients for a two-year period using both federal and New York DRG reimbursement now in effect at our hospital. Medicare patients had (on average) a longer hospital length of stay and total hospital cost compared to patients from Medicaid, Blue Cross, and other commercial payors. Medicare patients also had a greater severity of illness compared to patients from Blue Cross Medicaid or other payors. All payors, however, (Medicaid, Blue Cross, Medicare and commercial insurers) generated significant financial risk under the DRG All Payor scheme. These data suggest that federal, state, and private payors may be underreimbursing for the care of the hospitalized pulmonary medicine patients using the DRG prospective hospital payment scheme. Health care financing policy, as demonstrated in this study, may limit both the access and quality of care for many pulmonary medicine patients in the future. PMID:2491799
Kim, Eun Mi; Baek, Hee Joon
The Nutrition Care Process (NCP), developed by the American Dietetic Association, is a significant issue to dietetic professionals in many countries and there are rising needs for NCP implementation in Korea. We surveyed clinical nutrition managers of Korean general hospitals regarding the perception of NCP, the status of NCP implementation, and the opinions on NCP. The questionnaire was collected from 35 hospitals. Most clinical nutrition managers perceived NCP, but NCP implementation in hos...
Tania Cristina Morais Santa Barbara Rehem
Full Text Available OBJECTIVE: to estimate the sensitivity, specificity and positive and negative predictive values of the Unified Health System's Hospital Information System for the appropriate recording of hospitalizations for ambulatory care-sensitive conditions. METHOD: the hospital information system records for conditions which are sensitive to ambulatory care, and for those which are not, were considered for analysis, taking the medical records as the gold standard. Through simple random sampling, a sample of 816 medical records was defined and selected by means of a list of random numbers using the Statistical Package for Social Sciences. RESULT: the sensitivity was 81.89%, specificity was 95.19%, the positive predictive value was 77.61% and the negative predictive value was 96.27%. In the study setting, the Hospital Information System (SIH was more specific than sensitive, with nearly 20% of care sensitive conditions not detected. CONCLUSION: there are no validation studies in Brazil of the Hospital Information System records for the hospitalizations which are sensitive to primary health care. These results are relevant when one considers that this system is one of the bases for assessment of the effectiveness of primary health care.
McKay, Niccie L; Meng, Xiaoxian
This study examines the effect of managed care on hospitals' provision of uncompensated care, using a new measure of managed care that is hospital-specific, rather than measured for the area as a whole, and which includes payment by preferred provider organizations (PPOs) as well as by health maintenance organizations (HMOs). Based on data for Florida hospitals in the period 1998-2002, the results indicate that a higher percentage of private managed care patient-days was associated with a decrease in uncompensated care as a percentage of total operating expenses, holding net profit margin and other factors constant. The results suggest that spillover effects on uncompensated care should be taken into account when considering increases in managed care payment. PMID:17583265
Armstrong, Susan J; Laetitia C. Rispel; Loveday Penn-Kekana
Background: Improving the quality of health care is central to the proposed health care reforms in South Africa. Nursing unit managers play a key role in coordinating patient care activities and in ensuring quality care in hospitals. Objective: This paper examines whether the activities of nursing unit managers facilitate the provision of quality patient care in South African hospitals. Methods: During 2011, a cross-sectional, descriptive study was conducted in nine randomly selected hospital...
Armstrong, Susan J; Laetitia C. Rispel; Penn-Kekana, Loveday
Background: Improving the quality of health care is central to the proposed health care reforms in South Africa. Nursing unit managers play a key role in coordinating patient care activities and in ensuring quality care in hospitals.Objective: This paper examines whether the activities of nursing unit managers facilitate the provision of quality patient care in South African hospitals.Methods: During 2011, a cross-sectional, descriptive study was conducted in nine randomly selected hospitals ...
Full Text Available The hospital districts in Finland determine the pricing of hospital services without any national guidelines. However, over the last few years the use of the DRG (Diagnosis-Related Groups based pricing system has expanded in Finland. The aim of this article was to explore the use of DRGs in hospital care and to discuss the experiences and potential problems associated with DRGs in the Finnish context. We reviewed studies analysing the impacts of the DRG system in Finland. In order to discover the current and planned use of DRGs in various applications, we sent a questionnaire to all hospital districts in Finland. A clear majority of the hospital districts, 13 out of 20, already use DRGs in their internal reporting and management. DRG-based pricing systems were used in 6 hospital districts, covering 45% of the entire population in Finland, and several others were planning to use DRGs for pricing and contracting in the near future. The motivation for the use of DRGs has had a practical basis, mainly for simplifying product definitions used in hospital management. The adoption of DRGs may have partly been associated with a ‘signalling game’ between hospitals and municipalities whereby hospital administrations signal that they are seriously concerned with efficiency issues. In the near future, DRGs will play an increasingly important role in assisting Finnish municipalities to compare quality, costs and prices of services among hospitals.
Loubeau, P R; Jantzen, R
Marketing is a central activity of modern organizations. To survive and succeed, organizations must know their markets, attract sufficient resources, convert these resources into appropriate services, and communicate them to various consuming publics. In the hospital industry, a marketing orientation is currently recognized as a necessary management function in a highly competitive and resource-constrained environment. Further, the literature supports a marketing orientation as superior to other orientation types, namely production, product and sales. In this article, the results of the first national cross-sectional study of the marketing orientation of U.S. hospitals in a managed care environment are reported. Several key lessons for hospital executives have emerged. First, to varying degrees, U.S. hospitals have adopted a marketing orientation. Second, hospitals that are larger, or that have developed strong affiliations with other providers that involve some level of financial interdependence, have the greatest marketing orientation. Third, as managed care organizations have increased their presence in a state, hospitals have become less marketing oriented. Finally, contrary to prior findings, for-profit institutions are not intrinsically more marketing oriented than their not-for-profit counterparts. This finding is surprising because of the traditional role of marketing in non-health for-profit enterprises and management's greater emphasis on profitability. An area of concern for hospital executives arises from the finding that as managed care pressure increases, hospital marketing orientation decreases. Although a marketing orientation is posited to lead to greater customer satisfaction and improved business results, a managed care environment seems to force hospitals to focus more on cost control than on customer satisfaction. Hospital executives are cautioned that cost-cutting, the primary focus in intense managed care environments, may lead to short
Lehner, Dana C; Sadler, Lois S
This review investigated developmental delays toddlers may encounter after a lengthy pediatric hospitalization (30 days or greater). Physical, motor, cognitive, and psychosocial development of children aged 1 to 3 years was reviewed to raise awareness of factors associated with developmental delay after extensive hospitalization. Findings from the literature suggest that neonatal and pediatric intensive care unit (NICU/PICU) graduates are most at risk for developmental delays, but even non-critical hospital stays interrupt development to some extent. Primary care practitioners (PCPs) may be able to minimize risk for delays through the use of formal developmental screening tests and parent report surveys. References and resources are described for developmental assessment to help clinicians recognize delays and to educate families about optimal toddler development interventions. Pediatric PCPs play a leading role in coordinating health and developmental services for the young child following an extensive hospital stay. PMID:26665423
Noronha, Marina Ferreira de; Portela, Margareth Crisóstomo; Lebrão, Maria Lúcia
The All Patient Diagnosis Related Groups (AP-DRG) provide a classification system for general hospital inpatients, aggregating hospitalizations based on resource use and clinical criteria. The different versions of the AP-DRG have been applied to inpatient care management and reimbursement. This paper aimed to describe the classification and explore the potential for generating information on inpatient care management based on data from the Ribeirão Preto region (Sao Paulo State, Brazil) in 1997, including public, private, and charity hospitals. We compared average length of stay related to DRGs in the Ribeirão Preto region and the United States. Using the relative cost weights of the AP-DRGs constructed for New York State, we verified the profile of inpatient care provided by 30 hospitals in the Ribeirão Preto region, and reimbursement for hospital care provided to patients referred from other municipalities and covered by the Unified National Health System (SUS). Our findings indicate the applicability of the classification to inform the decision-making process on inpatient care regionalization and organization in levels of complexity, as well as for improvement of inpatient care monitoring and reimbursement. PMID:15608938
Healthcare financing and insurance is changing everywhere. We want to understand the impact that financial pressures can have for the uninsured in advanced economies. To do so we focus on analyzing the effect of the introduction in the US of managed care and the big rise in financial pressures that it implied. Traditionally, in the US safety net hospitals have financed their provision of unfunded care through a complex system of cross-subsidies. Our hypothesis is that financial pressures undermine the ability of a hospital to cross-subsidize and challenges their survival. We focus on the impact of price pressures and cost-controlling mechanisms imposed by managed care. We find that financial pressures imposed by managed care disproportionately affect the closure of safety net hospitals. Moreover, amongst those hospitals that remain open, in areas where managed care penetration increases the most, they react by closing the health services most commonly used by the uninsured. PMID:23389814
Hospital activity in paediatric cancerology was described on treatment type and hospital category, by care territories. Pathways of care were also studied, especially for ALL and CNS tumours.Hospital stays linked to cancer care from french hospital claim databases were studied in individuals below 25 on number of stays, breakdown by care territory, hospital category and treatment type. Pathways of care were studied during the first year after diagnosis.In 2012, 142208 stays were extracted for...
Dahl, Unni Alice
Better care for elderly people with chronic conditions and comprehensive care needs has become a health policy priority in many countries. Elderly patients are particularly vulnerable to discontinuities in care, and are often those most in need of a health care system that is capable of appropriate collaboration and communication across care levels. Various arrangements have been introduced to improve coordination of health care services for these patients. Intermediate care is...
Silva Pereira, Yvonne Da; Estibeiro, Ajoy; Dhume, Rajesh; Fernandes, John
This retrospective study aimed to explore the Socio-demographic characteristics and clinical profile of patients aged 60 years and above, attending psychiatric services for the first time at the Institute of Psychiatry and Human Behaviour, Goa during 1993-1998. Hospital case files of six hundred and ninety-eight patients formed the study sample. Preliminary analysis revealed that 70% of the sample was between 60-69 years. Mean age was 65.8 years (Sd ±6.11). Sex ratio male to female was 38:62....
Ahmed M. Abbas
Conclusions: Preeclampsia and PPH, as well as their complications are the leading causes of death in one of the biggest tertiary care university hospitals in Egypt. However, there are other important avoidable predisposing factors that should be dealt with including lack of patient education, delayed transfer from other hospitals, and substandard practice. [Int J Reprod Contracept Obstet Gynecol 2016; 5(5.000: 1466-1471
J. Michael Bostwick
Suicidal phenomena in the general hospital can take a variety of forms that can be parsed by taking into account whether or not the patient 1) intended to hasten death, and 2) included collaborators, including family and health care providers, in the decision to act. These two criteria can be used to distinguish entities as diverse as true suicide, non-compliance, euthanasia/physician-assisted suicide, and hospice/palliative care. Characterizing the nature of “suicide” events facilitates appr...
Schootman, Mario; Tran, Rebecca; Kung, Nathan; Evanoff, Bradley A.; Perlmutter, Joel S.; Racette, Brad A.
Objective: To investigate the impact of neurologist care on Parkinson disease (PD)–related hospitalizations. Recent data indicate that neurologist treatment in PD may be associated with improved survival, yet is underutilized. Factors contributing to this improved survival remain unknown, but may be due in part to optimal disease treatment or avoidance of disease-related complications. Methods: This was a retrospective cohort study of Medicare beneficiaries diagnosed with PD in 2002 and still living in 2006. Hospitalization for PD-related (neurodegenerative disease, psychosis, depression, urinary tract infection, and traumatic injury) and general medical (hypertension, diabetes, congestive heart failure, angina, and gastrointestinal obstruction) illnesses was compared by PD treating physician specialty using Cox proportional hazard models, adjusting for confounders. Secondary analyses included PD-related rehospitalization and cost stratified by frequency of neurologist care. Results: We identified 24,929 eligible incident PD cases; 13,489 had neurologist care. There were 9,112 PD-related hospitalizations, and these occurred and recurred less often among neurologist-treated patients. Neurologist PD care was associated with lower adjusted odds of both initial and repeat hospitalization for psychosis (hazard ratio [HR] 0.71, 95% confidence interval [CI] 0.59–0.86), urinary tract infection (HR 0.74, 0.63–0.87), and traumatic injury (HR 0.56, 0.40–0.78). PD-related outcomes improved with frequency of neurologist care in a stepwise manner. Odds of general illness hospitalization or hospitalization did not differ by neurologist involvement. Conclusions: Regular neurologist care in PD is specifically associated with lower risk of hospitalization and rehospitalization for several PD-related illnesses. This may reflect an improved ability of neurologists to prevent, recognize, or treat PD complications. PMID:23054239
Muñoz, E; Zahtz, G; Goldstein, J; Benacquista, T; Mulloy, K; Wise, L
The Medicare diagnosis related group (DRG) prospective payment model is changing hospital payment. Currently many states are using DRG prospective "All Payor Systems" for hospital reimbursement. In All Payor Systems, Medicare, Medicaid, Blue Cross, and other commercial insurers pay by the DRG mode; New York State has been All Payor since Jan 1, 1988. This study simulated DRG All Payor methods on a large sample (N = 1074) of adult otolaryngology patients for a two-year period using both federal and New York DRG reimbursement now in effect. Both Medicare and Medicaid patients had (on average) a longer hospital stay and total hospital cost compared with patients from Blue Cross and other commercial payors. Medicare and Medicaid patients also had a greater severity of illness compared with patients from Blue Cross or other payors. All payors (ie, Medicaid, Blue Cross, and commercial insurers), except Medicare, generated financial risk under the DRG All Payor scheme. These data suggest that state and private payors may be underreimbursing for the care of the hospitalized otolaryngology patient using the DRG prospective hospital payment scheme. Health care financing policy described in this study may limit both the access and/or the quality of care for many otolaryngology patients in the future. PMID:3139014
Muñoz, E; Johnson, H; Goldstein, J; Benacquista, T; Mulloy, K; Wise, L
The Medicare diagnostic-related group (DRG) prospective payment model is changing hospital payment. Currently many states are using DRG prospective "all payer systems" for hospital reimbursement. In all payer systems, Medicare, Medicaid, Blue Cross, and other commercial insurers pay by the DRG mode; New York State has had an all payer system since January 1, 1988. This study simulated DRG all payer methods on a large sample (N = 6,134) of adult black medical and surgical patients for a three-year period using both federal and New York DRG reimbursement. Both Medicare and Medicaid patients had, on average, a longer hospital stay and total hospital cost compared with patients covered by Blue Cross and other commercial insurers. Medicare and Medicaid patients also had a greater severity of illness compared with those of Blue Cross and others. All insurers (ie, Medicaid, Blue Cross, Medicare, and commercial) generated substantial financial risk under the DRG all payer scheme. These data suggest that federal, state, and private payers may be under-reimbursing for the care of the hospitalized black patient using the DRG prospective hospital payment scheme. Health care financing policy such as that demonstrated in this study may limit both the access and quality of care for many black patients in the future. PMID:3149307
Munoz, E; Chalfin, D; Goldstein, J; Lackner, R; Mulloy, K; Wise, L
Prospective hospital payment systems using the federal Medicare DRG payment model are changing hospital reimbursement. Currently, many states have adopted diagnosis related group (DRG) prospective "all payer systems" using the federal model. All payer systems, whereby Medicaid, Blue Cross, and other commercial insurers pay by the DRG mode, prevent cost shifting between payers. New York state has used an all payer system since Jan 1, 1988. This study simulated DRG all payer methods for a large sample (N = 16,084) of pediatric patients for a three-year period using the New York DRG all payer reimbursement system now in effect. Medicaid pediatric patients had (adjusted for DRG weight index) a longer hospital stay and greater total hospital cost compared with pediatric patients from Blue Cross and other commercial payers. Medicaid pediatric patients also had a greater severity of illness compared with patients from Blue Cross and other payers. Pediatric patients in all payment groups (ie, Medicaid, Blue Cross, and other commercial insurers) generated financial risk under the DRG all payer scheme. Medicaid pediatric patients generated the greatest financial risk, however. These data suggest that state and private payers may be under-reimbursing for the care of the hospitalized pediatric patient using the DRG prospective hospital payment scheme. Health care financing policy for pediatric patients may limit both access and quality of care. PMID:2492754
Bailey Kerry A
Full Text Available Abstract Background Antiretroviral treatment services delivered in hospital settings in Africa increasingly lack capacity to meet demand and are difficult to access by patients. We evaluate the effectiveness of nurse led primary care based antiretroviral treatment by comparison with usual hospital care in a typical rural sub Saharan African setting. Methods We undertook a prospective, controlled evaluation of planned service change in Lubombo, Swaziland. Clinically stable adults with a CD4 count > 100 and on antiretroviral treatment for at least four weeks at the district hospital were assigned to either nurse led primary care based antiretroviral treatment care or usual hospital care. Assignment depended on the location of the nearest primary care clinic. The main outcome measures were clinic attendance and patient experience. Results Those receiving primary care based treatment were less likely to miss an appointment compared with those continuing to receive hospital care (RR 0·37, p p = 0·001. Those receiving primary care based, nurse led care were more likely to be satisfied in the ability of staff to manage their condition (RR 1·23, p = 0·003. There was no significant difference in loss to follow-up or other health related outcomes in modified intention to treat analysis. Multilevel, multivariable regression identified little inter-cluster variation. Conclusions Clinic attendance and patient experience are better with nurse led primary care based antiretroviral treatment care than with hospital care; health related outcomes appear equally good. This evidence supports efforts of the WHO to scale-up universal access to antiretroviral treatment in sub Saharan Africa.
Sumner, Jennifer; Liberman, Aaron; Rotarius, Timothy; Wan, Thomas T H; Eaglin, Ronald
Health care in the United States is a system that, organizationally speaking, is fragmented. Each hospital facility is independently operated and is responsible for the hiring of its own employees. Corrupt individuals can take advantage of this fragmentation and move from hospital to hospital, gaining employment while hiding previous employment history. However, the need to exchange pertinent information regarding employees will become necessary as hospitals seek to fill positions throughout their organizations. One way to promote this information exchange is to develop trusted information sharing networks among hospital units. This study examined the problems surrounding organizational information sharing and the cultural factors necessary to enhance the exchange of employee information. Surveys were disseminated to 2,603 hospital chief executive officers and chief information officers throughout the nation. A sample of 154 respondents provided data into their current hiring practices and on their willingness to engage in the sharing of employee information. Findings indicated that, although fear of defamation and privacy violations do hinder the exchange of information between hospitals during the hiring process, by increasing external trust, linking the sharing process with the organizational goals of the hospital, and developing a "sharing culture" among hospitals, the exchange of employee information could be enhanced. PMID:19910705
Merry Raphael; Seyed Hanif Karimzad; Jatin Agarwal; Anirudh Arun Bhandakar; Girish Thunga; Shreedhar N; Vijayanarayana K; Muralidhar Varma; Sureshwar Pandey
Background: Ventilator associated pneumonia (VAP) is a major cause of poor outcome among patients in the intensive care units (ICU) world-wide. OP poisoning patients are very susceptible to respiratory associated problems especially respiratory muscle paralysis. Such patients generally need ventilation support which has high chances of getting VAP. Objective: To find out the Prevalence, causative organisms and treatment pattern of VAP in OP poisoning patients in tertiary care hospital in Sout...
Hansson, Eva Helena; Kjaergaard, Hanne; Johansen, Christoffer;
BACKGROUND: To assess the feasibility and psychosocial impact of a hospital-based home care (HBHC) program for children with cancer. PROCEDURE: A HBHC program was carried out with 51 children (0-18 years) with cancer to assess its feasibility in terms of satisfaction, care preferences, safety, and...... home-care group. No significant difference was found in the Family Impact Module. CONCLUSION: This study indicates that HBHC is a feasible alternative to hospital care for children with cancer, and is greatly preferred by parents. Specific aspects of children's HRQOL may be improved with HBHC and the...... cost. A controlled trial was conducted to assess children's health-related quality of life (HRQOL) using the parent-reported and self-reported PedsQL Generic Core Scale and PedsQL Cancer Module, and the psychosocial impact on the family by PedsQL Family Impact Module comprising a subsample of 28...
刘彦春; 徐克沂; 张福杰; 赵红心; 李兴旺; 李秀兰; 闫会文
Objective: To elucidate general characteristics of HIV/AIDS patients seeking care at Ditan Hospital in an attempt to guide early diagnosis in routine medical care. Materials and methods: A retrospective analysis of 185 HIV/AIDS cases from January 1990 to June 2002 was completed using SPSS statistical analysis. Results: Male to female ratio was 1.8:1. Subjects ranged in age from 1 year old to 64 years old. 16 cases were younger than 20 years old with the median age among the younger subset at 7.7 years. 169 cases were older than 20 years old with a median age of 36 years old. 29% of the subjects were peasants. The remaining 71%, were of other unspecifiedoccupations. 90.8% of individuals were of Han descent while 3.7% of individuals were of a minority heritage. 50.3% of subjects were married; 23.8% have never married; 8.1% were divorced; and the remaining 17.8% were of unknown marital status. Of those represented in this study, 36.8% came from the Henan province; 17.8% were from Beijing; 8.6% were from Shanxi; 31.4% from the other 20 provinces of China; and 5.4% from outside of China. Mode of transmission: 40.0% (74/185) contracted HIV through unprotected sexual contact; 29.2% (54/185) through receiving blood or plasma transfusions; 21.1%(39/185) through donating plasma; 7 cases were intravenous drug users; 7 cases were vertically transmitted. Mode of transmission was unknown in 4 cases. Clinical categories: An included 45 cases; B included 85 cases: C consisted of 76 cases. 12 cases were deceased. Initial presentation: 39 cases presented with_fever ,cough and diarrhea. 37 cases had fever and cough only-38 cases presented with chronic diarrhea. 16 cases were discovered incidentally at time of operation. 8 cases presented with fungal infection of the oral cavity or in esophagus. The common HIV associated symptoms and opportunistic infections were: weight loss and diarrhea, respiratory diseases, dermatologic diseases, anemia, neutropenia. Diseases of other organ
A large scale study on maternity care in the Netherlands, describing many facets of midwifery care in relation to the preferred place of birth (at home or in hospital), the obstetric result, and the experiences of childbirth. In the Netherlands only women with low risk pregnancies are free to choose where to give birth, at home or in hospital, assisted by an midwife (or general practitioner). The study showed that for these women the outcome of planned home births is at least as good as that ...
Hara, Tsuyoshi; Kawashiri, Hiroaki; Hirakata, Makoto; Yamasaki, Misaki; Sato, Mariko; Miura, Hiroshi; Murata, Tsuneari; Takagi, Hiroaki
In 2006, we reconfirmed Suwachuo hospital slogan as "When there is a need of community, we will do our best to meet it" and the department of home nursing care is officially established in our hospital next spring. A death rate at home is generally used to evaluate a home nursing care, and this rate at our department was 60.8% in 2008. However, community needs various options in addition to death at home. Keeping an eye on community opinions is of great importance. PMID:20443392
markdownabstractAbstract This thesis addresses two major topics in measuring, comparing and improving quality of care. We found considerable influence of random variation and case-mix in comparing hospitals using performance indicators. Although we found a significant relation between outcome and care processes, chance variation is the major limitation for the interpretability of indicators used for quality measurement or quality improvement. Like a one hand clock, we roughly know what time i...
Sydnor, Emily R. M.; Perl, Trish M.
Summary: Health care-associated infections (HAIs) have become more common as medical care has grown more complex and patients have become more complicated. HAIs are associated with significant morbidity, mortality, and cost. Growing rates of HAIs alongside evidence suggesting that active surveillance and infection control practices can prevent HAIs led to the development of hospital epidemiology and infection control programs. The role for infection control programs has grown and continues to...
Berghout, Mathilde; van Exel, Job; Leensvaart, Laszlo; Cramm, Jane M
Background Patient-centered care (PCC) is a main determinant of care quality. Research has shown that PCC is a multi-dimensional concept, and organizations that provide PCC well report better patient and organizational outcomes. However, little is known about the relative importance of PCC dimensions. The aim of this study was therefore to investigate the relative importance of the eight dimensions of PCC according to hospital-based healthcare professionals, and examine whether their viewpoin...
In the years between 1999 and 2004 data from 908 MRSA-positive patients was collected in a tertiary care hospital with approximately 1,200 beds. An increase in epidemiological parameters such as MRSA-rate and MRSA-day-prevalence shows the growing significance of MRSA as a nosocomial pathogen. MRSA was found primarily on non-surgical wards, especially on internal care wards. MRSA patients showed a significantly higher mortality rate as well as a considerably higher median age. The ...
Full Text Available BACKGROUND : Haemorrhoids is a common problem throughout the world. Many procedures are available for management of grade II and grade III hemorrhoids. The main postoperative complications associated with any of these procedures are pain and bleeding per rectum and pro longed healing time. Liga Surel TM haemorroidectomy was evaluated in this study for post - operative complications and symptomatic relief. METHODS: We analyzed 50 patients of hemorrhoids of grade II, III and IV who underwent Ligasure Precise haemorroidectomy by a classical Milligan - Morgan technique. The outcome factors analyzed were total operative time, blood loss, post - operative pain on visual analogue scale, any other complication and days of hospital stay. RESULTS: Of all the 50 patients, the operative ti me was less than 10 minutes in 27 patients (54% and the blood loss, as was measured by number of soaked gauze pieces only one gauze piece was soaked in 31 patients (62%. The Average Post - operative pain score measured on Visual Analogue Scale (VAS at 12, 24 & 48 hours were 6.54, 4.52 and 3.12 respectively. In all patients postoperative period and follow up was uneventful except for one patient who developed transient flatus incontinence. With physiotherapy and dietary management this problem resolved ther eafter. CONCLUSIONS: Liga Sure Hemarrhoidectomy is a safe, Technically easy and fast modality of treatment for 2 nd , 3 rd & 4 th degree of hemorrhoids whether single or multiple, requiring very less operating ti me, with no major post - operative complications an d early return to day to day activities
Orav, E John; Jena, Anupam B; Dudzinski, David M; Le, Sidney T; Jha, Ashish K
Objective To compare physician owned hospitals (POHs) with non-POHs on metrics around patient populations, quality of care, costs, and payments. Design Observational study. Setting Acute care hospitals in 95 hospital referral regions in the United States, 2010. Participants 2186 US acute care hospitals (219 POHs and 1967 non-POHs). Main outcome measures Proportions of patients using Medicaid and those from ethnic and racial minority groups; hospital performance on patient experience metrics, care processes, risk adjusted 30 day mortality, and readmission rates; costs of care; care payments; and Medicare market share. Results The 219 POHs were more often small (<100 beds), for profit, and in urban areas. 120 of these POHs were general (non-specialty) hospitals. Compared with patients from non-POHs, those from POHs were younger (77.4 v 78.4 years, P<0.001), less likely to be admitted through an emergency department (23.2% v. 29.0%, P<0.001), equally likely to be black (5.1% v 5.5%, P=0.85) or to use Medicaid (14.9% v 15.4%, P=0.75), and had similar numbers of chronic diseases and predicted mortality scores. POHs and non-POHs performed similarly on patient experience scores, processes of care, risk adjusted 30 day mortality, 30 day readmission rates, costs, and payments for acute myocardial infarction, congestive heart failure, and pneumonia. Conclusion Although POHs may treat slightly healthier patients, they do not seem to systematically select more profitable or less disadvantaged patients or to provide lower value care. PMID:26333819
Fleissig, A; Kroll, D; McCarthy, M
New recommendations suggesting that maternity care should be increasingly community-based have generated concern regarding the interprofessional cooperation between general practitioners and midwives. In Camden, London, this service was expanded in 1993. Although existing joint antenatal care arrangements between GPs and midwives were not expected to alter significantly, the shift of care from hospital to community midwives, and the expansion of community-led care to women with complications,...
Max Joseph Herman
Full Text Available Drug is one of the essential elements in healthcare that should be effectively and efficiently managed. Following thedecentralization in 2001 in Indonesia, drug management has changed in district drug management units and also in District General Hospitals. Certainly this condition influences the sustainability of drug access in primary health care such as in Community Health Center and District General Hospital, especially in drug financing policy. A cross sectional descriptive study to obtain information on drug management in public healthcare in district had been carried out between July and December 2006 in 10 District Public Drug Management Units from 10 district health offices and 9 district general hospitals as samples. Data were collected by interviewing heads of Drug Section in District Health Offices and heads of Hospital Pharmacies using structured questionnaires and observing drug storage in District Drug Management Units, Community Health Centers, and Hospital Pharmacies. Results of the study show that drug planning in District Health Offices and General Hospitals did not meet the basic real need in some districts nor District Hospitals. The minimum health service standards had no been achieved yet. Furthermore, drug procurement, storage and recording as well as reporting was not good enough either, such as shown by the existence of expired drugs. Lead time for drug delivery to community health centers in some districts was longer than the average of lead time in the past 3 years.
... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Hospital care and medical... VETERANS AFFAIRS MEDICAL Use of Public Or Private Hospitals § 17.52 Hospital care and medical services in... economical hospital care or medical services because of geographic inaccessibility or are not capable...
A.M. van Dishoeck (Anne-Margreet)
markdownabstractAbstract This thesis addresses two major topics in measuring, comparing and improving quality of care. We found considerable influence of random variation and case-mix in comparing hospitals using performance indicators. Although we found a significant relation between outcome
Foster, Patricia H.; Whitworth, J. M.
Describes a program model, Medical Foster Care, which uses registered nurses as foster parents who work closely with biological parents of abused and neglected children with acute health problems. The program reunites families, improves parenting skills, and saves money in long-term hospitalization. (Author/BB)
Sandhya Devi; Madhuri; Sarada Bai; Srividya
BACKGROUND: A woman dies from complications of child birth every minute . The major causes for maternal mortality in India are uncontrolled fertility , inaccessibility or inadequate utilization of health care facilities , illiteracy , ignorance and gender discrimination . OBJECTIV ES: (1 ) To identify various causes of maternal deaths in a teaching hospital . (2 ) To study the profile of population attending the tertiary hos...
Modern hospitals are facing several challenges and, over the last decade in particular, many of these institutions have become dysfunctional. Paradoxically as medicine has become more successful the demand for acute hospital care has increased, yet there is no consensus on what conditions or complaints require hospital admission and there is wide variation in the mortality rates, length of stay and possibly standards of care between different units. Most acutely ill patients are elderly and instead of one straightforward diagnosis are more likely to have a complex combination of multiple co-morbid conditions. Any elderly patient admitted to hospital is at considerable risk which must be balanced against the possible benefits. Although most of the patients in hospital die from only approximately ten diagnoses, obvious life saving treatment is often delayed by a junior doctor in-training first performing an exhaustive complete history and physical, and then ordering a number of investigations before consulting a senior colleague. Following this traditional hierarchy delays care with several "futile cycles" of clinical activity thoughtlessly directed at the patient without any benefit being delivered. If acute hospital medicine is to be improved changes in traditional assumptions, attitudes, beliefs and practices are needed.
Muñoz, E; Barrau, L; Goldstein, J; Benacquista, T; Mulloy, K; Wise, L
The Medicare diagnosis-related group (DRG) prospective payment system is now entering its 6th year, with no reported major adverse effects on the health status of the American people. Currently 13 states are using DRG prospective "all-payer systems" for hospital reimbursement; other state may adopt DRG all payer systems. In DRG all-payer systems, Medicare, Medicaid, Blue Cross, and other commercial insurers pay by the DRG mode; New York state has been all-payer since January 1, 1988. This study simulated DRG all-payer methods on a large sample (n = 558) of adult nephrology patients for a 2-year period using both federal and New York DRG reimbursements now in effect. Both Medicare and Medicaid patients had (on average) longer hospital lengths of stay and higher total hospital costs compared with patients from Blue Cross and other commercial payers. Medicare and Medicaid patients also had greater severity of illness than patients from Blue Cross or other payers. However, all payers (ie, Medicaid, Blue Cross, Medicare, and commercial insurers) generated significant financial risk under our DRG all-payer scheme. These data suggest that federal, state, and private payers may be underreimbursing for the care of hospitalized nephrology patients using the DRG prospective hospital payment scheme. As DRG payment rates are further reduced compared with the real hospital costs of treating patients, both the access to and the quality of care for many nephrology patients may be jeopardized. PMID:3143261
Escarce, J J; Shea, J A; Chen, W
Commercially insured and Medicare patients who are not in health maintenance organizations (HMOs) tend to use different hospitals than HMO patients use. This phenomenon, called market segmentation, raises important questions about how hospitals that treat many HMO patients differ from those that treat few HMO patients, especially with regard to quality of care. This study of patients undergoing coronary artery bypass graft surgery found no evidence that HMOs in southeast Florida systematically channel their patients to high-volume or low-mortality hospitals. These findings are consistent with other evidence that in many areas of the country, incentives for managed care plans to reduce costs may outweigh incentives to improve quality. PMID:9444826
Akbari, Mostafa; Soleimani, Pezhman; Kohi, Farzaneh; Kahrizi, Somayeh
Abstract: Background: Substance and other relative compounds prevents of physiological Adernocorticotropin secretion from pituitary gland and lead to mental exciting and arousal. Present study investigated impact of addiction on improvement process of coma in addiction and general patients. Methods: 170 coma patients hospitalized in Taleghani hospital in 1390 were investigated, that 10 persons of them were addict, therefore 10 addict patients and 10 general patients with GCS 5/6 were selected...
Møller Pedersen, Kjeld; Andersen, John Sahl; Søndergaard, Jens
postgraduate education. The contract is (re)negotiated every 2 years. General practice is embedded in a universal tax-funded health care system in which GP and hospital services are free at the point of use. The current system has evolved over the past century and has shown an ability to adapt flexibly to new...... is expected to accelerate, in part because of the GP age structure, with many GPs retiring and new GPs not wanting to practice alone. This latter workforce trend is pointing toward a new model with employed GPs, particularly in rural areas....
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.
Full Text Available Background: It is believed that intensive care greatly improves the prognosis for critically ill children and that critically ill children admitted to a dedicated Paediatric Intensive Care Unit (PICU do better than those admitted to a general intensive care unit (ICU. Methods: A retrospective study of all paediatric (< 16 years admissions to our general ICU from January 1994 to December 2007. Results: Out of a total of 1364 admissions, 302 (22.1% were in the paediatric age group. Their age ranged from a few hours old to 15 years with a mean of 4.9 ± 2.5 years. The male: female ratio was 1.5:1. Postoperative admissions made up 51.7% of the admissions while trauma and burn made up 31.6% of admissions. Medical cases on the other hand constituted 11.6% of admissions. Of the 302 children admitted to the ICU, 193 were transferred from the ICU to other wards or in some cases other hospitals while 109 patients died giving a mortality rate of 36.1%. Mortality was significantly high in post-surgical paediatric patients and in patients with burn and tetanus. The length of stay (LOS in the ICU ranged from less than one day to 56 days with a mean of 5.5 days. Conclusion: We found an increasing rate of paediatric admissions to our general ICU over the years. We also found a high mortality rate among paediatric patients admitted to our ICU. The poor outcome in paediatric patients managed in our ICU appears to be a reflection of the inadequacy of facilities. Better equipping our ICUs and improved man-power development would improve the outcome for our critically ill children. Hospitals in our region should also begin to look into the feasibility of establishing PICUs in order to further improve the standard of critical care for our children.
Background In Kenya, cancers as a disease group rank third as a cause of death after infectious and cardiovascular diseases. It is estimated that the annual incidence of cancer is about 37,000 new cases with an annual mortality of 28,000 cases (Kenya National Cancer Control Strategy 2010). The incidence of non-communicable diseases accounts for more than 50% of total hospital admissions and over 55% of hospital deaths (Kenya National Strategy for the Prevention and Control of Non Communicable Diseases 2015–2020). The prevalence of HIV is 6.8 (KIAS 2014). Most of these patients will benefit from palliative care services, hence the need to integrate palliative care services in the public healthcare system. Method The process of integrating palliative care in public hospitals involved advocacy both at the national level and at the institutional level, training of healthcare professionals, and setting up services within the hospitals that we worked with. Technical support was provided to each individual institution as needed. Results Eleven provincial hospitals across the country have now integrated palliative care services (Palliative Care Units) and are now centres of excellence. Over 220 healthcare providers have been trained, and approximately, over 30,000 patients have benefited from these services. Oral morphine is now available in the hospital palliative care units. Conclusion As a success of the pilot project, Kenya Hospices and Palliative Care Association (KEHPCA) is now working with the Ministry of Health Kenya to integrate palliative care services in 30 other county hospitals across the country, thus ensuring more availability and access to more patients. Other developing countries can learn from Kenya’s successful experience.
Lange, P.; Andersen, Klaus Kaae; Munch, E.;
Background: We studied the quality of care for COPD patients in 22 hospital-based outpatient clinics in Denmark and evaluated if participation by the staff in an educational programme could improve the quality of care and adherence to the COPD guidelines. Methods: We performed two audits of the...... hospital records one year apart before and after the educational programme for the participating doctors and nurses. A total of 941 patient records were included in the first audit and 927 in the second. The indicators of quality of care comprised amongst others referral to pulmonary rehabilitation......, smoking cessation advice, nutritional advice, instruction in inhalation technique and assessment of BMI, smoking status, pack years, lung function parameters, dyspnoea oxygen saturation and comorbidities. Results. In general, the quality of care for COPD patients in Denmark was suboptimal and not in...
SHI Ying-kang; WANG Lan-lan; LIN Yi-dan; PEI Fu-xing; KANG Yan
To review the challenges and countermeasures in the hospital care for Wenchuan earthquake casualties and draw lessons for the protective response in the future. Medical records and laboratory findings of the victims admitted in West China Hospital (WCH) were retrospectively analyzed. Related data were compared between beforemath and aftermath of the earthquake and between WCH and frontier county hospitals. One thousand and thirty-one earthquake survivors were hospitalized, 1358 victims underwent surgery and 142 victims were transferred to intensive care unit. The incidence of infection, crush syndrome and multiple organ dysfunction syndrome (MODS)was 39.6%, 20.7% and 2.3% respectively. Wound classification showed that the incidence of extremity damage was 72%, while the incidence of chest trauma, abdominal trauma and brain trauma was less than 10% respectively. Isolating rates of environmental pathogens were increased in the aftermath of earthquake, and the spectrum of the pathogens and related antibiotic sensitivities were quite different from those in the beforemath of earthquake. The social economic and population conditions in the earthquake-stricken areas affected the composition of the victims and the geographic features restricted the efficiency of rescue. Trauma-induced MODS, crush syndrome and severe infections all constituted the dilemma for the hospital care, to resolve whether the multidiscipline team work was proved to be an optimizing choice. For a more effective disaster protective response in the future,the study on rescue plan and the ladder therapies for massive casualties should be potentiated.
Robin L. Gabriels
Full Text Available Pediatric patients with autism spectrum disorders (ASD and/or intellectual disabilities (ID are at greater risk for psychiatric hospitalization compared to children with other disorders. However, general psychiatric hospital environments are not adapted for the unique learning styles, needs, and abilities of this population, and there are few specialized hospital-based psychiatric care programs in the United States. This paper compares patient outcomes from a specialized psychiatric hospital program developed for pediatric patients with an ASD and/or ID to prior outcomes of this patient population in a general psychiatric program at a children’s hospital. Record review data indicate improved outcomes for patients in the specialized program of reduced recidivism rates (12% versus 33% and decreased average lengths of inpatient stay (as short as 26 days versus 45 days. Available data from a subset of patients (=43 in the specialized program showed a decrease in irritability and hyperactivity behaviors from admission to discharge and that 35 previously undetected ASD diagnoses were made. Results from this preliminary study support specialized psychiatric care practices with this population to positively impact their health care outcomes.
Full Text Available AbstractObjective: to verify the occurrence and the causes of hospital readmissions within a year after discharge from hospitalizations due to traffic accidents.Methods: victims of multiple traumas due to traffic accidents were included, who were admitted to an Intensive Care Unit. Sociodemographic data, accident circumstances, body regions affected and cause of readmission were collected from the patient histories.Results: among the 109 victims of traffic accidents, the majority were young and adult men. Most hospitalizations due to accidents involved motorcycle drivers (56.9%. The causes of the return to the hospital were: need to continue the surgical treatment (63.2%, surgical site infection (26.3% and fall related to the physical sequelae of the trauma (10.5%. The rehospitalization rate corresponded to 174/1,000 people/year.Conclusion: the hospital readmission rate in the study population is similar to the rates found in other studies. Victims of severe limb traumas need multiple surgical procedures, lengthier hospitalizations and extended rehabilitation.
De Korte-Verhoef Maria C
Full Text Available Abstract Background Many patients are transferred from home to hospital during the final phase of life and the majority die in hospital. The aim of the study is to explore hospital referrals of palliative care patients for whom an out-of-hours general practitioner was called. Methods A retrospective descriptive chart study was conducted covering a one-year period (1/Nov/2005 to 1/Nov/2006 in all eight out-of-hours GP co-operatives in the Amsterdam region (Netherlands. All symptoms, sociodemographic and medical characteristics were recorded in 529 charts for palliative care patients. Multivariate logistic regression analysis was performed to identify the variables associated with hospital referrals at the end of life. Results In all, 13% of all palliative care patients for whom an out-of-hours general practitioner was called were referred to hospital. Palliative care patients with cancer (OR 5,1, cardiovascular problems (OR 8,3, digestive problems (OR 2,5 and endocrine, metabolic and nutritional (EMN problems (OR 2,5 had a significantly higher chance of being referred. Patients receiving professional nursing care (OR 0,2 and patients for whom their own general practitioner had transferred information to the out-of-hours cooperative (OR 0,4 had a significantly lower chance of hospital referral. The most frequent reasons for hospital referral, as noted by the out-of-hours general practitioner, were digestive (30%, EMN (19% and respiratory (17% problems. Conclusion Whilst acknowledging that an out-of-hours hospital referral can be the most desirable option in some situations, this study provides suggestions for avoiding undesirable hospital referrals by out-of-hours general practitioners at the end of life. These include anticipating digestive, EMN, respiratory and cardiovascular symptoms in palliative care patients.
Hjortdahl, Magnus; Zakariassen, Erik; Wisborg, Torben
Background: Together with the ambulances staffed with emergency medical technicians (EMTs), general practitioners (GPs) on call are the primary resources for handling emergencies outside hospitals in Norway. The benefit of the GP accompanying the ambulance to pre-hospital calls is a matter of controversy in Norway. The purpose of the present study was to gain better insight into the EMT ’ s experiences with the role of the GPs in the care for critically ill patients in the pre-hospital ...
Full Text Available Introduction: Malnutrition adversely affects clinical outcome of hospitalized patients. This observational prospective study was done to assess the prevalence of malnutrition and its grade among patients admitted in a mixed intensive care unit (ICU of a tertiary care hospital in order to help devise a comprehensive nutrition program for the malnourished. Materials and Methods: A total of 500 sequential patients admitted to the ICU were screened on admission over a year period for malnutrition using the Subjective Global Nutritional Assessment (SGNA score. Distribution of the degree of malnutrition according to co-morbidities was also documented. Results: Of the total, 198 (39.6% patients were malnourished, including one patient qualifying as severely malnourished; 68% patients were male, however, there was no statistically significant difference between nutrition status between sexes. Hypertension, diabetes, and cancer were the three most commonly encountered co-morbidities among the malnourished. A total of 86% of all cancer patients admitted were malnourished against only 12% of trauma patients. Conclusion: This study showed that almost two-fifth of the patients admitted were malnourished in this tertiary care hospital and that there is an urgent need to develop a comprehensive nutritional care program in many such Indian ICUs.
McLeod Robin S
Full Text Available Abstract Background While many factors can influence the way that cancer care is delivered, including the way that evidence is packaged and disseminated, little research has evaluated how health care professionals who manage cancer patients seek and use this information to identify whether and how this could be supported. Through interviews we identified that general surgeons experience challenges in coordinating care for complex cancer patients whose management is not easily addressed by guidelines, and conducted a population-based survey of general surgeon information needs and information seeking practices to extend these findings. Methods General surgeons with privileges at acute care hospitals in Ontario, Canada were mailed a questionnaire to solicit information needs (task, importance, information seeking (source, frequency of and reasons for use, key challenges and suggested solutions. Non-responders received up to three reminder packages. Significant differences among sub-groups (age, setting were examined statistically (Kruskal Wallis, Mann Whitney, Chi Square. Standard qualitative methods were used to thematically analyze open-ended responses. Results The response rate was 44.2% (170/385 representing all 14 health regions. System resource constraints (60.4%, comorbidities (56.4% and physiologic factors (51.8% were top-ranked issues creating information needs. Local surgical colleagues (84.6%, other local colleagues (82.2% and the Internet (81.1% were top-ranked sources of information, primarily due to familiarity and speed of access. No resources were considered to be highly applicable to patient care. Challenges were related to limitations in diagnostics and staging, operative resources, and systems to support multidisciplinary care, together accounting for 76.0% of all reported issues. Findings did not differ significantly by surgeon age or setting of care. Conclusion General surgeons appear to use a wide range of information
Patzer, G L; Rawwas, M Y
The current study provides guidance to hospital administrators in their effort to develop more effective marketing communication strategies. Two types of communication factors are revealed: primary and secondary. Marketers of psychiatric hospitals may use the primary factors as basic issues for their communication campaign, while secondary factors may be used for segmentation or positioning purposes. The primary factors are open wards, special treatment for adolescents, temporary absence, while patient, in-patient care, and visitation management. The secondary factors are temporary absence while a patient, voluntary consent to admit oneself, visitation management, health insurance, open staff, accreditation, physical plant, and credentials of psychiatrists. PMID:10137171
Shen, Jay J; Cochran, Christopher R; Moseley, Charles B
General hospitals are becoming the safety net provider for the seriously mentally ill (SMI) in the United States, but these patients are faced with a number of potential barriers when accessing these hospitals. Hospital ownership and market forces are two potential organizational and healthcare system barriers that may affect the SMI patient's access, because the psychiatric and medical services they need are unprofitable services. This study examines the relationship among hospital ownership, market forces, and admission of the SMI patient from the emergency department into the general hospital. This was a cross-sectional study of a large sample of SMI patients from the 2002 State Inpatient Datasets for five states. Multiple logistic regression was applied in the multivariable analysis. After controlling for patient, hospital, and county covariates and when compared with not-for-profit hospitals, public hospitals were more likely to admit while investor-owned hospitals were less likely to admit SMI patients. Hospitals in competitive markets were less likely to admit while hospitals with capitation revenues were slightly less likely to admit these patients. Policy options that can address this "market failure" include strengthening the public psychiatric inpatient care system, making private health insurance coverage of the SMI more equitable, revising Medicare prospective payment system to better reimburse the treatment of the SMI, and allowing not-for-profit hospitals to count care of the SMI as a community benefit. Results of this study will be useful to healthcare managers searching for ways to reduce unnecessary administrative costs while continuing to maintain the level of administrative activities required for the provision of safe, effective, and high-quality care. PMID:18720688
Hartvigsen, Jan; Davidsen, Michael; Søgaard, Karen;
seeking of care with general practitioners, physiotherapists, chiropractors, outpatient hospital contacts and hospital admissions are reported for persons reporting no musculoskeletal pain and for persons reporting pain in the neck, shoulder, wrist/hands, mid back, low back, hips, knees and ankles....../feet. Results: Regardless of site, persons experiencing a musculoskeletal complaint had a statistically increased risk of consulting a general practitioner when compared with persons reporting no musculoskeletal complaint. For physiotherapists and chiropractors, only persons complaining of neck pain and back...
Radi, M; Merdan, A I; Labib, I
Fly sampling was evaluated under laboratory conditions before starting the field surveys. Three different fly traps were tested, of which the Spiralettes (a commercial one) proved to be the most efficient. Sampling conditions were also considered in this laboratory evaluation, light, air current, swinging, height and temperature were tested, all of them have affected fly trapping except height. Fly density and distribution in two general hospitals and two specialized ones, were estimated in order to evaluate them epidemiologically in relation to hospital bacterial contamination. Results of these surveys revealed the followings: (1) The location of the hospital has no impact on the fly density. (2) Flies are attracted more to swinging hanged ribbon traps than to fixed ones. (3) Fly densities were relatively high in the main kitchens and the main garbages followed by toilets (common ones), patient wards, outpatients investigating rooms, surgical theaters and plasterrooms of the hospitals. (4) Fly density is higher during warm seasons than in cold ones. PMID:1765698
Oye Nathaniel David
Full Text Available Health care in Nigeria as in many other countries is confronted with growing demand for medical treatment and services. The medical records must appropriately have all of the patients’ medical history. Physicians must maintain flawless records, because this document serves a number of purposes. This study on hospital patient datable management system was design to transform the manual way of searching, sorting, keeping and accessing patient medical information (files into electronic medical record (EMR in order to solve the problem associate with manual method. The existing system (manual has been studied and hence a computer based application was provided to replace this manual method. These computer based systems generate the patient report as the patient register in and out of the hospital. This paper generally looks for a more accurate, reliable and efficient method of computer to facilitate patient record’s keeping in General Hospitals to ensure efficient outcome that will lessen time consuming. The study proposed that the design of hospital patient database record will be a solution to the problem being experienced by the current manual method of keeping patient medical record.
Full Text Available BACKGROUND: A woman dies from complications of child birth every minute . The major causes for maternal mortality in India are uncontrolled fertility , inaccessibility or inadequate utilization of health care facilities , illiteracy , ignorance and gender discrimination . OBJECTIV ES: (1 To identify various causes of maternal deaths in a teaching hospital . (2 To study the profile of population attending the tertiary hospital . Methodology : A retrospective study was conducted in a tertiary hospital over a period of 2 years (January 2013 - December 2014 and data was analysed manually using case sheets and maternal death audit forms . RESULTS: In the study period , there were 11636 deliveries and 97 maternal deaths . The direct causes accounted for 77 maternal deaths with haemorrhage , hype rtension and sepsis as leading causes of maternal mortality . Conclusion : Emphasis on health education , need for regular antenatal checkups and proper training of health personnel is required to reduce maternal mortality .
Full Text Available Purpose: This study examines care transition experiences of cancer patients and assesses barriers to effective transitions.Methods: Participants were adult Hebrew, Arabic, or Russian speaking oncology patients and health care providers from hospital and community settings. Qualitative (n=77 and quantitative (n=422 methods such as focus groups, interviews and self-administered questionnaires were used. Qualitative analysis showed that patients faced difficulties navigating a complex and fragmented healthcare system.Results: Mechanisms to overcome barriers included informal routes such as personal relationships, coordinating roles by nurse coordinators and the patients' general practitioners (GPs. The most significant variable was GPs involvement, which affected transition process quality as rated on the CTM (p<0.001. Our findings point to the important interpersonal role of oncology nurses to coordinate and facilitate the care transition process.Conclusion: Interventions targeted towards supporting the care transition process should emphasize ongoing counseling throughout a patient’s care, during and after hospitalization.-----------------------------------------Cite this article as: Admi H, Muller E, Shadmi E. Transition from Hospital to Community Care: The Experience of Cancer Patients. Int J Cancer Ther Oncol 2015; 3(4:34011.[This abstract was presented at the BIT’s 8th Annual World Cancer Congress, which was held from May 15-17, 2015 in Beijing, China.
Yeliz İrem Tunçel; Menşure Kaya; Rukiye Neslihan Kuru; Saadet Menteş; Süheyla Ünver
Objective: Burnout is common in intensive care units (ICU) because of high demands and difficult working conditions. The aim of this study was to analyse nurses’ burnout in our oncology ICU and to determine which factors are associated with. Material and Method: The study was carried out in Ankara Oncology Hospital ICU. A self- reporting questionnaire in an envelope was used for the evaluation of burnout (Turkish- language version of Maslach Burnout Inventory) and depression (Beck Depressi...
Laila Ashrafun; Mohammad Jasim Uddin
The objective of this study is to identify factors associated with satisfaction among inpatients receiving medical and surgical care for urinary, cardiovascular, respiratory, and ophthalmology diseases at Dhaka Government Medical College Hospital, Bangladesh. The data of this study is collected from 190 inpatients by using a patient judgments questionnaire covering 10 dimensions of satisfaction (appointment waiting time for doctor after admission, doctor’s treatment and behavior, behavior and...
Orešković, Anto; Mihanović, Mate; Mimica, Nino; Bodor, Davor; Petrov, Božo
Alcohol addiction treatment represents complex and lingering therapeutic procedure which can be provided stationary, within specialized psychiatric wards, and through partial hospitalization or day care hospitals for alcoholism. A psychiatric hospital day care, or partial hospitalization, represents facility for patients requiring intensive psychiatric treatment within relatively structured environment. While it offers the same variety of treatment procedures as the mental h...
Jellinek, Michael S.
In this article, the author describes "Primary Supervision", a seminar he has led for approximately 20 years, which is designed for the entire class of nine first-year residents in Child and Adolescent Psychiatry training at Massachusetts General Hospital. The seminar meets for 1 hour each week throughout the first year. Through 900 hours of…
Falvey, Jason R; Burke, Robert E; Malone, Daniel; Ridgeway, Kyle J; McManus, Beth M; Stevens-Lapsley, Jennifer E
Hospital readmissions in older adult populations are an emerging quality indicator for acute care hospitals. Recent evidence has linked functional decline during and after hospitalization with an elevated risk of hospital readmission. However, models of care that have been developed to reduce hospital readmission rates do not adequately address functional deficits. Physical therapists, as experts in optimizing physical function, have a strong opportunity to contribute meaningfully to care transition models and demonstrate the value of physical therapy interventions in reducing readmissions. Thus, the purposes of this perspective article are: (1) to describe the need for physical therapist input during care transitions for older adults and (2) to outline strategies for expanding physical therapy participation in care transitions for older adults, with an overall goal of reducing avoidable 30-day hospital readmissions. PMID:26939601
Perelman, Julian; Felix, Sónia; Santana, Rui
The Great Recession started in Portugal in 2009, coupled with severe austerity. This study examines its impact on hospital care utilization, interpreted as caused by demand-side effects (related to variations in population income and health) and supply-side effects (related to hospitals' tighter budgets and reduced capacity). The database included all in-patient stays at all Portuguese NHS hospitals over the 2001-2012 period (n=17.7 millions). We analyzed changes in discharge rates, casemix index, and length of stay (LOS), using a before-after methodology. We additionally measured the association of health care indicators to unemployment. A 3.2% higher rate of discharges was observed after 2009. Urgent stays increased by 2.5%, while elective in-patient stays decreased by 1.4% after 2011. The LOS was 2.8% shorter after the crisis onset, essentially driven by the 4.5% decrease among non-elective stays. A one percentage point increase in unemployment rate was associated to a 0.4% increase in total volume, a 2.3% decrease in day cases, and a 0.1% decrease in LOS. The increase in total and urgent cases may reflect delayed out-patient care and health deterioration; the reduced volume of elective stays possibly signal a reduced capacity; finally, the shorter stays may indicate either efficiency-enhancing measures or reduced quality. PMID:25583679
... 7 Agriculture 14 2010-01-01 2009-01-01 true Debt restructuring-hospitals and health care... Settlement-Community and Business Programs § 1956.143 Debt restructuring—hospitals and health care facilities. This section pertains exclusively to delinquent Community Facility hospital and health care...
... hospital care and medical services. As discussed in a separate notice (78 FR 39832, July 2, 2013), we are... their service at Camp Lejeune. Section 102 of Public Law 112-154 requires VA to provide hospital care... AFFAIRS 38 CFR Part 17 RIN 2900-AO78 Hospital Care and Medical Services for Camp Lejeune Veterans...
... hospital care. 831.7001-4 Section 831.7001-4 Federal Acquisition Regulations System DEPARTMENT OF VETERANS... and Procedures 831.7001-4 Medical services and hospital care. (a) VA may pay the customary student... Government. (b) When the customary student's health fee does not cover medical services or hospital care,...
... medical services and inpatient hospital care. 17.49 Section 17.49 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.49 Priorities for outpatient medical services and inpatient hospital care. In scheduling appointments for outpatient...
Full Text Available Abstract Background Delivery by a skilled birth attendant (SBA in a hospital is advocated to improve maternal health; however, hospital expenses for delivery care services are a concern for women and their families, particularly for women who pay out-of-pocket. Although health insurance is now implemented in Lao PDR, it is not universal throughout the country. The objectives of this study are to estimate the total health care expenses for vaginal delivery and caesarean section, to determine the association between health insurance and family income with health care expenditure and assess the effect of health insurance from the perspectives of the women and the skilled birth attendants (SBAs in Lao PDR. Methods A cross-sectional study was carried out in two provincial hospitals in Lao PDR, from June to October 2010. Face to face interviews of 581 women who gave birth in hospital and 27 SBAs was carried out. Both medical and non-medical expenses were considered. A linear regression model was used to assess influencing factors on health care expenditure and trends of medical and non-medical expenditure by monthly family income stratified by mode of delivery were assessed. Results Of 581 women, 25% had health care insurance. Health care expenses for delivery care services were significantly higher for caesarean section (270 USD than for vaginal delivery (59 USD. After adjusting for the effect of hospital, family income was significantly associated with all types of expenditure in caesarean section, while it was associated with non-medical and total expenditures in vaginal delivery. Both delivering women and health providers thought that health insurance increased the utilisation of delivery care. Conclusions Substantially higher delivery care expenses were incurred for caesarean section compared to vaginal delivery. Three-fourths of the women who were not insured needed to be responsible for their own health care payment. Women who had higher family
Ambulatory care-sensitive conditions (ACSC) are defined as conditions that lead to a hospital admission of which the onset could have been prevented through a more easily accessible ambulatory sector or one that provides better quality care. They are used by health-care systems as a quality indicator for the ambulatory sector. The definition for ACSC varies internationally. Sets of conditions have been defined and evaluated already in various countries, e. g., USA, England, New Zealand and Canada, but not yet for Germany. Therefore this study aims to evaluate the hospital costs of ACSC in Germany using the National Health Service's set of ACSC. In order to calculate these costs a model has been set up for the time period between 2003 and 2010. It is based on G-DRG browsers issued by the German Institute for the Hospital Remuneration System as required by German law. Within these browsers all relevant DRG-ICD combinations have been extracted. The number of cases per combination was then multiplied by their corresponding cost weights and the average effective base rates. The results were then aggregated into their corresponding ICD groups and then into their respective conditions which lead to the costs per condition and the total costs. The total number of cases and total costs were then compared to another second source. These calculations resulted in 11.7 million cases, of which 10.7% were defined as ambulatory care-sensitive. Within the analysed time period the number of ambulatory care-sensitive cases increased by 6% in total and had a 0.9% CAGR. The corresponding costs amounted to a total of EUR 37.6B and to EUR 3.3B for ACSC. 60% of the costs were caused by three of the 19 ACSC. These results validate that it is worthwhile to further investigate this quality indicator for the ambulatory sector. PMID:25918929
This thesis is about nursing work and the ways in which nurses in a general hospital accomplished occupational jurisdiction. It is based on ethnographic data generated on a surgical ward and a medical ward in a single NHS trust hospital. The study is set in the context of recent developments in nursing and medical education (DHSS, 1987; GMC, 1993; UKCC, 1987) and health policy (DH, 1989) which have created the impetus for shifts in the division of labour in health care, reviving deep-rooted h...
Full Text Available BACKGROUND AND OBJECTIVES: Poisoning is an important public health problem causing significant morbidity and mortality throughout the world. Knowledge of general pattern of poisoning in a particular region will help in early diagnosis and treatment of cases, thus decreasing the rate of mortality and morbidity. Information available in our locality with regard to acute poisoning is limited. The present study was carried out with the objective to investigate the pattern of acute poisoning cases in a tertiary care hospital in Coimbatore, Tamilnadu. MATERIALS AND METHODS: A retrospective analysis of all acute poisoning cases admitted to the emergency department of Karpagam Faculty of Medical Sciences and Research from April 2003 to March 2004 was done to study the pattern of poisoning. Data regarding age, sex, marital status, occupation, religion, locality, route of exposure, time elapsed after intake, circumstances of poisoning, name of poisonous substance, chemical type, duration of hospitalization and outcome were collected and analyzed. RESULTS: All reported cases were found to be suicidal poisoning. Majority of cases were in the age group of 11 – 20 years. Females (112 cases, 70% outnumbered males (48 cases, 30%. Students attempted to commit suicide much commoner than others followed by house wives and daily wage laborers. The commonest poison consumed was cow dung powder. The mortality rate was higher among those consumed rat killer poison (37.5%. CONCLUSION: This study adds information to the existing data which may help to develop prevention strategies. Health education to adolescents at school and college level about poisoning, regular counseling program for all high school children either by an in house trained faculty or a child psychologist and early detection of risk taking behavior in adolescents may to some extent prevent deliberate self-harm in teenagers. Ban on cow dung powder sales in grocery shops should be followed by district
Full Text Available Abstract Background A variety of approaches have been used to contain escalating hospital costs. One approach is intensifying price competition. The increase in price based competition, which changes the incentives hospitals face, coupled with the fact that consumers can more easily evaluate the quality of hotel services compared with the quality of clinical care, may lead hospitals to allocate more resources into hotel rather than clinical services. Methods To test this hypothesis we studied hospitals in California in 1982 and 1989, comparing resource allocations prior to and following selective contracting, a period during which the focus of competition changed from quality to price. We estimated the relationship between clinical outcomes, measured as risk-adjusted-mortality rates, and resources. Results In 1989, higher competition was associated with lower clinical expenditures levels compared with 1982. The trend was stronger for non-profit hospitals. Lower clinical resource use was associated with worse risk adjusted mortality outcomes. Conclusions This study raises concerns that cost reductions may be associated with increased mortality.
In all systems of health care there are certain essential levels of care and service. These take the form of self-care within the family unit; primary professional care by general medical nursing or social practitioners within a local neighbourhood; general specialist care in a district and super-specialist care in a region. Each of these has its own special roles and responsibilities and each is considered in this paper.
Daniel Ferreira Dahdah
Full Text Available There is a consensus in the literature that the company of a family member during the hospitalization period increases patient recovery. However, this can have some negative effects on the caregiver’s health. With the purpose of reducing these negatives effects, it is useful to let family members express themselves. The State Hospital of Ribeirão Preto created a Group of Family Companions coordinated by the Occupational Therapy and Social Service. This study focuses on the assistance offered in a general hospital to families that undergo the whole illness and hospitalization process of their family member, suffering the impacts of this process in their daily lives, and on the intervention of Occupational Therapy in these cases.
Full Text Available Objectives: To determine the effectiveness of nutritional screening programmes in improving quality of care and patient outcomes compared with usual care. Methods: Searches were performed on MEDLINE, EMBASE, CINHAL, the Cochrane database, and Current Controlled Trials. Due to the assumed scarcity of high quality evidence, interventional studies in hospital or primary care settings with adequate reporting and comparisons were considered as eligible. Team members met after reviewing the papers. Decisions on inclusion or exclusion of papers were made when all agreed. Two reviewers independently extracted data from included studies. Results: 705 abstracts were considered and thirty full-text papers were ordered and reviewed. Following further review of the extracted data two papers met the inclusion criteria. One was a clustered randomized study of 26 general practices to evaluate the effectiveness of screening for elderly ailments including malnutrition. It concluded nutritional screening did not improve referral to dieticians, detection of nutritional problems, or patients’ quality of life. This study was underpowered for evaluating the effectiveness of nutritional screening. A non-randomized controlled before-after study of four hospital wards concluded that intervention improved weight recording, but not referral to dieticians or care at the mealtime of at risk patients. Discussion: Very few studies assess the effectiveness of nutritional screening with relevant outcomes and acceptable quality. The available evidence does not support systematic application of screening tools to hospital, or general practice patients. Given the current level of interest and political support for nutritional screening, further studies are urgently required.
Shamsuz Zaman; Rahul Chaurasia; Kabita Chatterjee; Rakesh Mohan Thapliyal
Background. Red blood cell (RBC) alloimmunization results from genetic disparity of RBC antigens between donor and recipients. Data about alloimmunization rate in general patient population is scarce especially from resource limited countries. We undertook this study to determine prevalence and specificity of RBC alloantibodies in patients admitted in various clinical specialties at a tertiary care hospital in North India. Methods. Antibody screening was carried out in 11,235 patients on auto...
Manisha Bisht; Bist, S. S.; Dhasmana, D. C.; Sunil Saini
Aim: Advanced cancer, irrespective of the site of the cancer, is characterized by a number of associated symptoms that impair the quality of life of patients. The management of these symptoms guides palliative care. The present study aims to describe the symptoms and appropriate palliation provided in patients with advanced cancer in a tertiary care hospital in Uttarakhand. Methods: This was an observational study. A total of 100 patients with advanced cancer were included in the study. T...
Steers, Julie; Brereton, Louise; Ingleton, Christine
The provision of palliative care in the UK has traditionally focused on people with cancer. People who are elderly, live in rural areas or have diagnoses other than cancer often have difficulty accessing palliative care services. Community hospitals could be important for those groups currently under-served. A literature review was conducted to determine the role played by community hospitals in the provision of palliative care in the U.K. Papers were identified using a keyword search of six electronic databases and hand search of five journals. Fifteen papers were identified according to inclusion and exclusion criteria. Findings indicate that many community hospitals in the UK already have the resources to counter inequalities in access to general palliative care. Much of the evidence uses quantitative methods based on small or non-representative samples and retrospective data collection approaches. Insufficient information about the populations involved meant that findings could not be fully interpreted. More prospective research using qualitative methods involving patients, carers and nurses is required to fully understand the complexities of providing palliative care in this setting. PMID:18018819
Kamper-Jørgensen, Mads; Andersen, Lise Geisler; Simonsen, Jacob;
The objective was to study the effect of age at first enrollment into child care and other child care-related factors on the risk for hospitalization from gastrointestinal infection.......The objective was to study the effect of age at first enrollment into child care and other child care-related factors on the risk for hospitalization from gastrointestinal infection....
Bostwick, J. Michael
Suicidal phenomena in the general hospital can take a variety of forms that can be parsed by taking into account whether or not the patient 1) intended to hasten death, and 2) included collaborators, including family and health care providers, in the decision to act. These two criteria can be used to distinguish entities as diverse as true suicide, non-compliance, euthanasia/physician-assisted suicide, and hospice/palliative care. Characterizing the nature of “suicide” events facilitates appropriate decision-making around management and disposition. PMID:25973265
J. Michael Bostwick
Full Text Available Suicidal phenomena in the general hospital can take a variety of forms that can be parsed by taking into account whether or not the patient 1 intended to hasten death, and 2 included collaborators, including family and health care providers, in the decision to act. These two criteria can be used to distinguish entities as diverse as true suicide, non-compliance, euthanasia/physician-assisted suicide, and hospice/palliative care. Characterizing the nature of “suicide” events facilitates appropriate decision-making around management and disposition.
The value of radioisotopes in medicine has become increasingly apparent over the last few years. Nuclear medicine however recent, has nevertheless reached adult hood and doctors appreciate its substantial contribution in the field of diagnosis especially. So far nuclear medicine has been confined to University Hospital Centres, mainly for legal reasons. However the considerable help offered by this discipline is now taken for granted in the medical world and the wholly experimental stage is long past. While this aspect of nuclar medicine still exists, and is still dealt with by the services of University Hospital Centres, radioisotopes are now used to a large extend and on a day-to-day basis in pathology. Owing to pressure of work it is difficult for UH Centres to meet all request for examinations, so would the presence of nuclear medicine Service be justified in general Hospitals. The existence of one such service at the Bayonne HC might help to answer this question. For this reason the activity of the Bayonne HC Nuclear Medicine Service during its first year of practice is examined here. For a better understanding of the position this report first presents the Bayonne Hospital and the place occupied by a nuclear Medicine service in such an establishment. The activity of this service during its first year is then studied and the situation weighed up generally
Full Text Available Background: Nurses constitute the major professional group offering constant hospital patients’ care. Willingness to recommend their hospital reflects confidence in the offered care, satisfaction and identification with the work place. The aim of the present study has been to investigate which elements of hospital environment and nurse personal related factors predict recommendation of the hospital as a place of care by employed nurses. Material and Methods: Cross-sectional, correlation study was, based on 1723 self-reported, anonymous questionnaires of nurses working in 30 acute hospitals. Data was analyzed using the logistic regression model, with general estimation equations. Results: About 25% of nurses were unwilling to recommend their hospital as the place of care. The odds ratio (OR of the lack of willingness to recommend the hospital was related to assessment of patients’ safety (OR = 0.28, 95% confidence interval (CI: 0.18–0.46, p = 0.00, decrease in the quality of patient care during the preceding year (OR = 0.62, 95% CI: 0.41–0.93, p = 0.02, overall work conditions (OR = 0.35, 95% CI: 0.22–0.57, p = 0.00, weak cooperation between nurses and physicians (OR = 0.37, 95% CI: 0.25–0.54, p = 0.00, poor work schedule flexibility (OR = 0.74, 95% CI: 0.55– 0.99, p = 0.04 and educational opportunities (OR = 0.71, 95% CI: 0.54–0.95, p = 0.02 and the level of nurses depersonalization (OR = 1.78, 95% CI: 1.18–1.68, p = 0.00. Conclusions: The hospital manager should consider strategies which improve patients’ safety and the staff working conditions. Thanks to that they will also achieve better and more competitive image of the hospital in the local community. Med Pr 2016;67(4:447–454
Keith, David A; Dodson, Thomas B; Kaban, Leonard B
Founded in 1811, the Massachusetts General Hospital recently celebrated its bicentennial. The War of 1812 delayed construction of the building so the first patient actually was admitted to the hospital 10 years later, on September 3, 1821. By 1823, the 60 hospital beds were full. Patient 66 was admitted on February 28, 1823, and his hospital course, as described in the admissions book, was transcribed for the Massachusetts General Hospital bicentennial celebration. That case history is reproduced and a case series of 6 similar patients published in 1828 by Dr John Warren, surgeon-in-chief and a founder of the hospital, is presented. In this report, the authors comment on the diagnosis, treatment, and outcome of these patients in the context of the contemporaneous health care environment and in light of the current knowledge of facial pain disorders. This article was adapted from the authors' commentary for the bicentennial celebration. PMID:23866949
Seddon, M; Marshall, M.; Campbell, S; Roland, M.
Objectives—Little is known about the quality of clinical care provided outside the hospital sector, despite the increasingly important role of clinical generalists working in primary care. In this study we aimed to summarise published evaluations of the quality of clinical care provided in general practice in the UK, Australia, and New Zealand.
Meretoja, Atte; Kaste, Markku
Acute ischemic stroke is a time-critical emergency for which thrombolytic therapy is the only medical treatment. Many patients who would benefit from this treatment are deprived of it due to delays. Failure to call for help rapidly is the main obstacle, but even when the call is made in time, the prehospital evaluation, transportation, and emergency department (ED) diagnostics often take too long to treat the patient with thrombolysis. Interventions to reduce pre- and in-hospital delays have been described; although no single intervention is likely to make a major difference, a whole set of interventions needs to be implemented. The intersection of the pre- and in-hospital care is of special importance. With successful protocols and good communication between the emergency medical service and ED, delays can be significantly reduced. On the basis of our experience, 94% of patients can be treated within 60 min of arrival, based largely on using the prehospital time effectively. PMID:22994234
Sloan, Frank A.; Gabriel A. Picone; Donald H. Taylor, Jr.; Shin-Yi Chou
This paper compares cost and quality of care for Medicare patients hospitalized in for-profit hospitals contrasted with those in nonprofit and government hospitals following admission for hip fracture, stroke, coronary heart disease, or congestive heart failure. Cost of care in for-profit hospitals was similar to that of nonprofits, but patients admitted to government hospitals incurred less Medicare payments on average. There were only small differences in survival between for-profit, nonpro...
Ocello, M. G
Full Text Available RESUMEN Desde su creación, el Hospital Provincial “Dr. José María Cullen” posee la característica de ser un hospital de emergencias, sostenido por la Sociedad de Beneficencia y la Hermanas de la Caridad.Su funcionamiento responde a un Modelo Clínico-Asistencial, lo cual influye en la inserción de Terapia Ocupacional debiendo adaptar sus funciones a las características de la Institución.Los marcos de referencia teóricos y programas que se implementandeber ser acordes con las necesidades surgidas de un Hospital General de Agudos y de emergencias.En el Sector de Terapia Ocupacional se desarrolla la actividad docente cumpliendo con los requisitos reglamentados por el Ministerio de Salud de la Provincia de Santa Fe.ABSTRACT Ever since its start the Provincial Hospital “Dr. José María Cullen” is characterised for being an emergency hospital under the guidance of the Benfit Society of Hermanas de la Caridad.Its function responds to a Clinical Assistential Model, which influences the insertion of Occupational Therapy, adapting its functiones to the characteristics of the Institution as and when called for.The theoretical points of reference and programmes that are used must be in accordance with tehe necessities that appear in an Acute and Emergency General Hospital.In the Occupational Therapy Sector the teaching activity is developed as required by rules and regulations of the Ministry of Health for the Province of Santa Fe.
Full Text Available Abstract Background The Hospital Anxiety and Depression Scale (HADS has been used in several languages to assess anxiety and depression in general hospital patients with good results. Methods The HADS was administered to 521 participants (275 controls and 246 inpatients and outpatients of the Internal Medicine and Surgical Departments in 'Attikon' General Hospital in Athens. The Beck Depression Inventory (BDI and the State-Trait Anxiety Inventory (STAI were used as 'gold standards' for depression and anxiety respectively. Results The HADS presented high internal consistency; Cronbach's α cofficient was 0.884 (0.829 for anxiety and 0.840 for depression and stability (test-retest intraclass correlation coefficient 0.944. Factor analysis showed a two-factor structure. The HADS showed high concurrent validity; the correlations of the scale and its subscales with the BDI and the STAI were high (0.722 – 0.749. Conclusion The Greek version of HADS showed good psychometric properties and could serve as a useful tool for clinicians to assess anxiety and depression in general hospital patients.
Blum, J D
This article deals with the application of economic measures to the appointment, reappointment, and delineation of medical staff privileges, the so-called practice of economic credentialing. The concept of economic credentialing is first explored in the hospital context with a focus on legal and political issues. The second part of the article examines how economic credentialing will evolve in new managed care practice settings. Emphasis is placed on how the law and legislation will be utilized by organized medicine to protect physician interests in the process of selective contracting. Specific discussion focuses on the American Medical Association's Patient Protection Act and the implications of "any willing provider" provisions. PMID:8528826
Hansson, Helena; Hallström, Inger; Kjaergaard, Hanne;
Hospital-based home care (HBHC) is widely applied in Pediatric Oncology. We reviewed the potential effect of HBHC on children's physical health and risk of adverse events, parental and child satisfaction, quality of life of children and their parents, and costs. A search of PubMed, CINAHL......, and EMBASE led to identification of five studies that met the inclusion criteria. All sample sizes were small, and both the interventions and the outcome measures were diverse. Although burdened by these limitations, the studies indicate that HBHC is feasible and carries no crucial negative effects...
Chen, Tsung-Tai; Chen, Chia-Pei; Kuang, Shao-Hua; Wang, Vinchi
During acute stroke care, rehabilitation usage may be influenced by patient- and hospital-related factors. We would like to identify patient- and hospital-level determinants of population-level inpatient rehabilitation usage associated with acute stroke care.From data obtained from the claim information from the National Health Insurance Administration (NHIA) in Taiwan (2009-2011), we enrolled 82,886 stroke patients with intracerebral hemorrhage and cerebral infarction from 207 hospitals. A generalized linear mixed model (GLMM) analyses with patient-level factors specified as random effects were conducted (for cross-level interactions).The rate of rehabilitation usage was 51% during acute stroke care. The hospital-related factors accounted for a significant amount of variability (intraclass correlation, 50%). Hospital type was the only significant hospital-level variable and can explain the large amount of variability (58%). Patients treated in smaller hospitals experienced few benefits of rehabilitation services, and those with surgery in a smaller hospital used fewer rehabilitation services. All patient-level variables were significant.With GLMM analyses, we identified the hospital type and its cross-level interaction, and explained a large portion of variability in rehabilitation for stroke patients in Taiwan. PMID:27175671
Full Text Available Abstract
Background: Hospitalization may often be prevented by timely and effective outpatient care either by preventing the onset of an illness, controlling an acute illness or managing a chronic disease with an appropriate follow-up. The objective of the study is to examine the variability of hospital admissions within Italian regions for Ambulatory Care Sensitive Conditions (ACSCs, and their relationship with primary care supply.
Methods: Hospital discharge data aggregated at a regional level collected in 2005 were analysed by type of ACS conditions. Main outcome measures were regional hospital admission rates for ACSCs. Negative binomial models were used to analyse the association with individual risk factors (age and gender and regional risk factors (propensity to hospitalisation and prevalence of specific conditions.
Non-parametric correlation indexes between standardised hospital admission rates and quantitative measures of primary care services were calculated.
Results: ACSC admissions accounted for 6.6% of total admissions, 35.7% were classified as acute conditions and 64.3% as chronic conditions. Admission rates for ACSCs varied widely across Italian regions with different patterns for chronic and acute conditions. Southern regions showed significantly higher rates for chronic conditions and North-eastern regions for acute conditions. We found a significant negative association between the provision of ambulatory specialist services and standardised hospitalization rates
(SHR for ACS chronic conditions (r=-0.50; p=0.02 and an inverse correlation among SHR for ACS acute conditions and the rate of GPs per 1,000 residents, although the latter was not statistically significant.
Conclusions: In Italy, about 480,000 inpatient hospital admissions in 2005 were attributable to ACSCs. Even
adjusting for potential confounders
Full Text Available AIMS : The aim of this retrospective study was to analyze the rate and chara cteristics of acute poisoning cases admitted to adult intensive care unit ( ICU in a tertiary care medical college hospital. We report clinical features , demographic data , laboratory results , mortality rate , and the results of our treatment in cases who ca me with the history of poisoning. METHODS: The study was done in patients admitted with history of poisoning under the department of medicine at RRMCH Hospital , Bengaluru from December 2013 to November 2014. This study includes 84 poisoning Patients who we re admitted to ICU care. Detailed history , clinical examination and laboratory inv est igations were done in all patients. Ventilator support and supportive treatment was instituted to required patients as p er our ICU criteria of intubation and Ventilation. Data was collected in structured format and analyzed. RESULTS: Majority of the cases were due to organophosphorus compound poisoning ( n=47 , 61% . Others had consumed drugs which included analgesics , carbomates , anti - hypertensive , spirit , benzodiazepines. A mongst these , 4 had consumed aluminum phosphide and all 4 of them died. In some history did not reveal the identity of the drugs. The most common indication for mechanical ventilation in these patients was respiratory failure due to OP poisoning. CONCLUSIO N: Pesticides were the main cause of poisoning ( 68.97% . The reasons being agriculture based economics , poverty due to poor agricultural yield and easy availability of pesticides. Patient education by conducting community based public awareness camps and l ectures might also help in bringing down the incidence of poisoning. The mortality could be decreased by enhanced ICU care , better medical management , appropriate supportive therapy and further restrictions on the highly toxic pesticides.
Full Text Available Abstract Background It is increasingly appreciated that the interpretation of health systems research studies is greatly facilitated by detailed descriptions of study context and the process of intervention. We have undertaken an 18-month hospital-based intervention study in Kenya aiming to improve care for admitted children and newborn infants. Here we describe the baseline characteristics of the eight hospitals as environments receiving the intervention, as well as the general and local health system context and its evolution over the 18 months. Methods Hospital characteristics were assessed using previously developed tools assessing the broad structure, process, and outcome of health service provision for children and newborns. Major health system or policy developments over the period of the intervention at a national level were documented prospectively by monitoring government policy announcements, the media, and through informal contacts with policy makers. At the hospital level, a structured, open questionnaire was used in face-to-face meetings with senior hospital staff every six months to identify major local developments that might influence implementation. These data provide an essential background for those seeking to understand the generalisability of reports describing the intervention's effects, and whether the intervention plausibly resulted in these effects. Results Hospitals had only modest capacity, in terms of infrastructure, equipment, supplies, and human resources available to provide high-quality care at baseline. For example, hospitals were lacking between 30 to 56% of items considered necessary for the provision of care to the seriously ill child or newborn. An increase in spending on hospital renovations, attempts to introduce performance contracts for health workers, and post-election violence were recorded as examples of national level factors that might influence implementation success generally. Examples of factors
... hospital care. 405.1206 Section 405.1206 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT... Expedited Determinations and Reconsiderations of Provider Service Terminations, and Procedures for Inpatient Hospital Discharges § 405.1206 Expedited determination procedures for inpatient hospital care....
Ellerbeck, Edward F.; Bhimaraj, Arvind; Perpich, Denise
One in 4 Americans lives in a rural community and relies on rural hospitals and medical systems for emergent care of acute myocardial infarctions (AMI). The infrastructure and organization of AMI care in rural and urban Kansas hospitals was examined. Using a nominal group process, key elements within hospitals that might influence quality of AMI…
van Bruggen, J.A.R.
In the Netherlands, a quality incentive is expected to ensue from improved collaboration between healthcare professionals. Whether this view is supported by sufficient evidence is, however, questionable. Therefore, the first study included in this thesis is a systematic review of studies on the effects of sharing and delegating diabetes care tasks. It became apparent that sharing and delegating care tasks can improve the process of care and glycaemic control. Sharing or delegating care, howev...
Full Text Available Background: Improving diabetic patients’ foot care behaviors is one of the most effective strategies in minimizing diabetic foot ulceration and its further negative impacts, either in diabetic hospitalized patients or outpatients.Purpose: To describe foot care knowledge and behaviors among hospitalized diabetic patients, to apply selected foot care knowledge and behaviors improvement evidence, and to evaluate its effectiveness.Method: Four diabetic patients who were under our care for at least three days and could communicate in Thai language were selected from a surgical ward in a university hospital. The authors applied educational program based on patients’ learning needs, provided diabetic foot care leaflet, and assisted patients to set their goal and action plans. In the third day of treatment, we evaluated patients’ foot care knowledge and their goal and action plan statements in improving foot care behaviors.Result: Based on the data collected among four hospitalized diabetic patients, it was shown that all patients needed foot care behaviors improvement and the educational program improved hospitalized patients’ foot care knowledge and their perceived foot care behaviors. The educational program that combined with goal setting and action plans method was easy, safe, and seemed feasibly applicable for diabetic hospitalized patients.Conclusion: The results of this study provide valuable information for improvement of hospitalized diabetic patients’ foot care knowledge and behaviors. The authors recommend nurses to use this evidence-based practice to contribute in improving the quality of diabetic care.Keywords: Intervention, diabetic foot care, hospitalized diabetic patients
Full Text Available Abstract Background: Appropriate management of care – for example, avoiding unnecessary attendances at, or admissions to, hospital emergency units when they could be handled in primary care – is an important part of health strategy. However, some variations in these outcomes could be due to genuine variations in health need. This paper proposes a new method of explaining variations in hospital utilisation across small areas and the general practices (GPs responsible for patient primary care. By controlling for the influence of true need on such variations, one may identify remaining sources of excess emergency attendances and admissions, both at area and practice level, that may be related to the quality, resourcing or organisation of care. The present paper accordingly develops a methodology that recognises the interplay between population mix factors (health need and primary care factors (e.g. referral thresholds, that allows for unobserved influences on hospitalisation usage, and that also reflects interdependence between hospital outcomes. A case study considers relativities in attendance and admission rates at a North London hospital involving 149 small areas and 53 GP practices. Results: A fixed effects model shows variations in attendances and admissions are significantly related (positively to area and practice need, and nursing home patients, and related (negatively to primary care access and distance of patient homes from the hospital. Modelling the impact of known factors alone is not sufficient to produce a satisfactory fit to the observations, and random effects at area and practice level are needed to improve fit and account for overdispersion. Conclusion: The case study finds variation in attendance and admission rates across areas and practices after controlling for need, and remaining differences between practices may be attributable to referral behaviour unrelated to need, or to staffing, resourcing, and access issues. In
Tjibbe Donker; Jacco Wallinga; Hajo Grundmann
Rates of hospital-acquired infections, such as methicillin-resistant Staphylococcus aureus (MRSA), are increasingly used as quality indicators for hospital hygiene. Alternatively, these rates may vary between hospitals, because hospitals differ in admission and referral of potentially colonized patients. We assessed if different referral patterns between hospitals in health care networks can influence rates of hospital-acquired infections like MRSA. We used the Dutch medical registration of 2...
Donker, Tjibbe; Wallinga, Jacco; Grundmann, Hajo
Rates of hospital-acquired infections, such as methicillin-resistant Staphylococcus aureus (MRSA), are increasingly used as quality indicators for hospital hygiene. Alternatively, these rates may vary between hospitals, because hospitals differ in admission and referral of potentially colonized patients. We assessed if different referral patterns between hospitals in health care networks can influence rates of hospital-acquired infections like MRSA. We used the Dutch medical registration of 2...
Background: An adverse drug reaction is unintentional which occurs at doses used for prophylaxis, diagnosis or treatment. Objectives: To determine the frequency of various cutaneous drug eruptions that occur in patients in a tertiary care hospital setting. Patients and Methods: All patients with cutaneous drug eruptions seen at the Dermatology Department of Mayo Hospital, Lahore, over 6 months were enrolled and the pattern of drug eruptions like urticaria, angioedema, fixed drug eruption, maculopapular rash, erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis etc. were recorded, along with drugs that caused it. Results:A total of 160 patients (86 males, 74 females) were included in the study. Mean age of patients was 30.7+-15.4 years. Major eruptions were fixed drug eruption (21.3%) followed by urticaria without angioedema (10%), maculopapular rash (9.3%), lichenoid drug eruption (8.7%), acneiform drug eruption (7.5%), Stevens-Johnson syndrome (6.9%), vesiculobullous eruption (5.6%), erythema multiforme and eczematous eruption (5% each). Common drugs causing eruptions were sulfonamides (16.3%), followed by NSAIDs (14.4%), herbal and homeopathic medications (12.5%), penicillins (9.3%), tetracyclines (8.7%), antituberculous drugs, cephalosporins and antiepileptics (6.3% each). Conclusion: Fixed drug eruption and urticaria without angioedema were commonest eruptions while, sulfonamides and NSAIDs were the major causative drugs. Policy message: Reporting of adverse drug reactions is not done in Pakistan and needs to be done in each hospital. (author)
Hawton, Keith; Bale, Liz; Casey, Deborah; Shepherd, Anna; Simkin, Sue; Harriss, Louise
Monitoring of deliberate self-harm (DSH) presentations to hospitals (and in other settings) is receiving increased attention in many countries. This is due to greater recognition of the size of the problem and awareness of its relevance to suicide prevention policy initiatives, because of the strong association between DSH and suicide. A system for monitoring all DSH presentations has been in place in the general hospital in Oxford for 30 years. Based on our experience, in this paper we describe procedures for monitoring, including case definition and identification, linkage of persons and episodes in order to investigate repetition of DSH and other outcomes (including deaths), and data protection and ethical issues. We also provide details of how to carry out monitoring, including different models of data collection, and what data to collect. Finally we consider the potential uses of the data for both clinical and research purposes, including evaluation of national suicide prevention initiatives. PMID:17219747
The strict separation of the out-patient and hospital-based health care delivery sectors in Germany leads to deficits in effectiveness and efficiency. Newly introduced legal initiatives to overcome this separation, namely 'Ambulantes Operieren' (Paragraph 115b SGB V), 'Ambulante Behandlung durch Krankenhaeuser' and Disease Management Programs (Paragraphen 116a-b SGB V) are described in detail in this article. Their impact on hospital-based health provision for out-patients is discussed. The aim of a better integration of different sectors with a better quality and a more efficient use of resources seems to be the target of these initiatives. (orig.)
Marta Maria da Silva Lira-Batista; Jaqueline Virgulino Ribeiro; Hayanne Osiro Pauletti; Antônio Messias Gama Rospendowiski; Gabriella Novelli Oliveira; Emilia Godoy de Souza
The Multidisciplinary Residency in Hospital Care (MRHC) should be taken as a paradigm of care model adopted in primary care, valuing full attention and establishing a relationship. The Basic Heath Unity is a very rich place for the integration of activities among its professionals and multidisciplinary residents. That experience helped in building a new outlook and new process of health work in primary care both while in hospital care. All program activities developed allowed MRHC integratio...
Persoon, Anke; Bakker, Franka C.; van der Wal-Huisman, Hanneke; Rikkert, Marcel G. M. Olde
ObjectivesTo develop a questionnaire, the Geriatric In-hospital Nursing Care Questionnaire (GerINCQ), to measure, in an integrated way, the care that older adults receive in the hospital and nurses' attitudes toward and perceptions about caring for older adults. DesignQuestionnaire development. Sett
Freund, T.; Campbell, S.M.; Geissler, S.; Kunz, C.U.; Mahler, C.; Peters-Klimm, F.; Szecsenyi, J.
PURPOSE: Hospitalizations for ambulatory care-sensitive conditions (ACSCs) are seen as potentially avoidable with optimal primary care. Little is known, however, about how primary care physicians rate these hospitalizations and whether and how they could be avoided. This study explores the complex c
Kim, C J
This study was done in order to provide basic data to a Fee System for hospital based Home Health Care services in Korea in the future. It was done by investigating activities provided to possible Home Health Care clients who could be discharged early from general hospitals and then estimating the nursing care fee according to each nursing activity based upon the time used for activity. The subjects of the study were selected by convenience sampling and consisted of 35 clients who might be clients for Home Nursing Care and were presently admitted to a medical-surgical ward of Y University Medical Center located in Seoul, Korea. The data collection period was from September 1, 1991 to September 30, 1991. The research instruments utilized for the study were a client selection criteria for Home Health Care developed by Choo (1991) and a check-list of nursing activity developed by researcher. The results of the study were as follows: 1. There were 44 different nursing activities provided in the seven days but the time was calculated for only 25 of the nursing activities. 2. Fees for the 25 different nursing activities were calculated by multiplying the median of the average wage of a staff nurse having five years experience in an A grade general hospital to the time of the nursing activity. The results were compared with the insurance fee which the government recognized as an appropriate fee for that activity. The nursing activities with a lower calculated fee than the insurance fee were suction, catheterization, exercise education and dressing change. The nursing activities with a higher calculated fee than the government recognized fee were IM injection and vital sign check. 3. There was a range of 1-15 nursing activities provided daily to the client. For the average number of nursing activities per day of 6.26 events the nursing care fee was calculated at W 6136 per day. 4. Based upon the results of the study, a recommendation for a Home Health Care fee per visit
BACKGROUND: For people with type 2 diabetes to enjoy improved longevity and quality of life, care needs to be organised in a systematic way. AIM: To test if processes and intermediate outcomes for patients with type 2 diabetes changed with the move to structured care in general practice shared with secondary care. METHODS: An audit of process and intermediate outcomes for patients with type 2 diabetes before and after the change to structured care in 10 Dublin general practices shared with secondary care four years on. RESULTS: Structured diabetes care in general practice has led to more dedicated clinics improved processes of care and increased access to multidisciplinary expertise. Improvement in blood pressure control, the use of aspirin and the use of lipid lowering agents indicate a significant decrease in absolute risk of vascular events for this population. CONCLUSIONS: Structured care in general practice improves intermediate outcomes for people with type 2 diabetes. Further improvements need to be made to reach international targets.
Anderson, R J; Milburn, L T
Texas not-for-profit hospitals recently received intense scrutiny regarding their involvement in charity-related contributions when Texas Attorney General Jim Mattox formed the Task Force to Study Not-for-Profit Hospitals and Unsponsored Charity Care. This article details the task force's recommendations concerning charity care obligations of Texas not-for-profit hospitals. Setting the stage for these recommendations was a broad definition of charitable services that included costs for delivering services to indigents and for providing community services to fulfill the hospital's charitable, religious, educational, research, or eleemosynary purposes. The task force unanimously agreed that a mandated level of charity care was incongruent with the hospitals' individual missions and specific community needs, but they supported the formation of standard accounting procedures for charitable services and the voluntary submission of their mission statements to the attorney general of Texas. While the hospitals' role in providing charitable services is very important, the task force emphasized that the overall need for adequate financing and reimbursement of health care is a societal problem that needs specific state and federal actions. PMID:2336640
Full Text Available Background Considering patients’ needs and expectations in the process of healthcare delivery improves the quality of services. This study aimed to investigate the responsiveness of general public and private hospitals in Mashhad, Iran. Methods In this cross-sectional and explanatory study, hospitalized patients (with at least 2 days of stay in general private and public hospitals in Mashhad were investigated. In total 425 patients (259 from private and 166 from public hospitals were selected using a stratified and simple random sampling. Standard responsiveness questionnaire was used as the data collection tool. Data were analysed using descriptive statistics, independent t-tests and ANOVA by SPSS 16 at a significance level of 0.05. Results Access to the social support during hospitalization as well as confidentiality of the patient’s information achieved the highest score (3.21±0.73 while the patient participation in decision-making process of treatment received the least score (2.34±1.24. Among the research population 1.6%, 4.1%, 17.6%, 63.3% and 13.2% commented on the responsiveness level as very low, low, moderate, good, and excellent, respectively. There was no significant difference between the overall responsiveness scores of public and private hospitals ( P-Value ≥0.05. Conclusion The hospitals have enough potential to improve various aspects of their responsiveness. We suggest a number of measures can help improve the non-clinical aspects of care. These include: using educational courses to improve the knowledge and attitudes of medical and nonmedical staff, changing the resource allocation method, and using quality tools such as reengineering to modify the healthcare delivery processes.
Freqüência e percentual de suscetibilidade de bactérias isoladas em pacientes atendidos na unidade de terapia intensiva do Hospital Geral de Fortaleza Frequency and susceptibility percentile of bacteria isolated in patients assisted in the intensive care unit of the General Hospital of Fortaleza
Everardo Albuquerque Menezes
suscetibilidade para ciprofloxacina. Os S. aureus e SCN foram isolados principalmente do cateter, sendo suscetíveis à vancomicina (100%. CONCLUSÃO: Os patógenos que mais causaram infecções na UTI do HGF foram Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii, S aureus e SCN.INTRODUCTION: Nosocomial infections are prominent problem in hospital environment, mainly in intensive care units (ICU, where innumerous factors favoring the development of these infections are found. Objectives: To determine the frequency and the antibiotic resistance pattern of bacteria isolated from ICU patients in the General Hospital of Fortaleza (HGF. MATERIAL AND METHODS: Bacteria were isolated in culture medium and the identification and test of susceptibility to antimicrobials was performed using MicroScan WalkWay automation device. RESULTS: From January to December of 2002, 34% of specimens from tracheal secretion; 10% from catheter cultures; 26% from urine and 30% from the blood yielded isolates. Specimens more frequent in tracheal secretion were Pseudomonas aeruginosa (16% e Klebsiella pneumoniae (15%. In catheter cultures, we found high prevalence of Staphylococcus negative coagulase (SNC (25% and Staphylococcus aureus (25%; in urine, Klebsiella pneumoniae (16% and Pseudomonas aeruginosa (14% were the most prevalent. From blood, we isolated mostly SNC (41% and Staphylococcus aureus (17%. About antimicrobial susceptibility patterns of Pseudomonas aeruginosa isolated from tracheal secretion, we found a high sensitivity to piperacilin and high resistance to ceftriaxone and cefotaxime. Klebsiella pneumoniae isolated fom tracheal secretion showed high sensibility to imipenem, but no resistance to other antimicrobials althogeter. Susceptibility to ceftazidime was 54%. Isolates from catheters showed broad resistance pattern (ampicillin/sulbactam, cefepime, cefotaxime, ceftazidime, ceftriaxone, cefuroxime, gentamicin, piperacillin/tazobactam, piperacillin, ticarcillin
Priya Darshini Kulkarni
Full Text Available The reason that probably prompted Dame Cicely Saunders to launch the palliative care movement was the need to move away from the impersonal, technocratic approach to death that had become the norm in hospitals after the Second World War. Palliative care focuses on relieving the suffering of patients and families. Not limited to just management of pain, it includes comprehensive management of any symptom, which affects the quality of life. Care is optimized through early initiation and comprehensive implementation throughout the disease trajectory. Effective palliative care at the outset can help accelerate a positive clinical outcome. At the end of life, it can enhance the opportunity for the patient and family to achieve a sense of growth, resolve differences, and find a comfortable closure. It helps to reduce the suffering and fear associated with dying and prepares the family for bereavement.
Full Text Available Abstract Background Complex care management is seen as an approach to face the challenges of an ageing society with increasing numbers of patients with complex care needs. The Medical Research Council in the United Kingdom has proposed a framework for the development and evaluation of complex interventions that will be used to develop and evaluate a primary care-based complex care management program for chronically ill patients at high risk for future hospitalization in Germany. Methods and design We present a multi-method procedure to develop a complex care management program to implement interventions aimed at reducing potentially avoidable hospitalizations for primary care patients with type 2 diabetes mellitus, chronic obstructive pulmonary disease, or chronic heart failure and a high likelihood of hospitalization. The procedure will start with reflection about underlying precipitating factors of hospitalizations and how they may be targeted by the planned intervention (pre-clinical phase. An intervention model will then be developed (phase I based on theory, literature, and exploratory studies (phase II. Exploratory studies are planned that entail the recruitment of 200 patients from 10 general practices. Eligible patients will be identified using two ways of 'case finding': software based predictive modelling and physicians' proposal of patients based on clinical experience. The resulting subpopulations will be compared regarding healthcare utilization, care needs and resources using insurance claims data, a patient survey, and chart review. Qualitative studies with healthcare professionals and patients will be undertaken to identify potential barriers and enablers for optimal performance of the complex care management program. Discussion This multi-method procedure will support the development of a primary care-based care management program enabling the implementation of interventions that will potentially reduce avoidable
Mullen-Fortino, Margaret; Sites, Frank D; Soisson, Michael; Galen, Julie
Tele-intensive care units (ICUs) typically provide remote monitoring for ICUs of acute care, short-stay hospitals. As part of a joint venture project to establish a long-term acute level of care, Good Shepherd Penn Partners became the first facility to use tele-ICU technology in a nontraditional setting. Long-term acute care hospitals care for patients with complex medical problems. We describe describes the benefits and challenges of integrating a tele-ICU program into a long-term acute care setting and the impact this model of care has on patient care outcomes. PMID:22828067
Full Text Available Abstract Background The influenza vaccination rate in hospitals among health care workers in Europe remains low. As there is a lack of research about management factors we assessed factors reported by administrators of general hospitals that are associated with the influenza vaccine uptake among health care workers. Methods All 81 general hospitals in the Netherlands were approached to participate in a self-administered questionnaire study. The questionnaire was directed at the hospital administrators. The following factors were addressed: beliefs about the effectiveness of the influenza vaccine, whether the hospital had a written policy on influenza vaccination and how the hospital informed their staff about influenza vaccination. The questionnaire also included questions about mandatory vaccination, whether it was free of charge and how delivered as well as the vaccination campaign costs. The outcome of this one-season survey is the self-reported overall influenza vaccination rate of health care workers. Results In all, 79 of 81 hospitals that were approached were willing to participate and therefore received a questionnaire. Of these, 42 were returned (response rate 52%. Overall influenza vaccination rate among health care workers in our sample was 17.7% (95% confidence interval: 14.6% to 20.8%. Hospitals in which the administrators agreed with positive statements concerning the influenza vaccination had a slightly higher, but non-significant, vaccine uptake. There was a 9% higher vaccine uptake in hospitals that spent more than €1250,- on the vaccination campaign (24.0% versus 15.0%; 95% confidence interval from 0.7% to 17.3%. Conclusions Agreement with positive statements about management factors with regard to influenza vaccination were not associated with the uptake. More economic investments were related with a higher vaccine uptake; the reasons for this should be explored further.
Frank, Richard G.; David S. Salkever; Jean Mitchell
The research presented here focuses on the impact of competitive forces on the provision of social or merit goods by non-profit hospitals. We specifically examine the behavior of altruistic non-profit hospitals in the supply of charity care. The effects of competitive pressures and past charity care provision on the supply of philanthropic donations to nonprofit hospitals are also examined. Empirical models of the supply of donations and charity care are specified and estimated using data on ...
van Rosse, F.; Suurmond, J.; Wagner, C; de Bruijne, M.; M. L. Essink-Bot
Objective Relatives of ethnic minority patients often play an important role in the care process during hospitalisation. Our objective was to analyse the role of these relatives in relation to the safety of patients during hospital care. Setting Four large urban hospitals with an ethnic diverse patient population. Participants On hospital admission of ethnic minority patients, 20 cases were purposively sampled in which relatives were observed to play a role in the care process. Outcome measur...
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...
Ibak Gönen, Mehmet Faruk Geyik
Full Text Available Objectives: Percutaneous injuries (PCIs remain a common incident among healthcare workers (HCWs despite the introductionof safety programs. The aim of this study was to assess the PCIs, required precautions, and applications after the injuries among healthcare workers in a small general hospital.Materials and methods: We assessed the occurrence of PCIs at a General Hospital (EGH from January 2007 to November2010. During this period, all injury cases among HCWs were reported to the Infection Control Committee (ICC using percutaneous injury notification form. The injury notification forms were evaluated retrospectively.Results: Totally 275 health personnel were working in our hospital, 36 healthy workers have been exposed to PCIs during this period. The incidence of PCIs was 2,9/10000 in 2007, 3,1/10000 in 2008, 3,8/10000 in 2009 and 3,9/10000 patient-days in 2010. Injured staff were recorded as, 16 nurses (44%, 12 cleaning staffs (34%, and eight (22% doctors. The device leading to damage was most frequently the needle-channel. Ten sources (27% were detected positive for hepatitis B virus (HBV, four (11% for hepatitis C virus (HCV, and two (5% for Crimean-Congo hemorrhagic fever virus (CCHFV. No case of seroconversion has been recognized for any of the above mentioned infections.Conclusions: Percutaneous injuries remain to occur among HCWs. Since some the sources were infected, the health personnel are endangered for infections due to PCIs. The health personnel should presume that all patients are infected,and thus should work following universal precautions to avoid complications about the PCIs. J Microbiol Infect Dis 2011;1(1:26-30.
Anuradha, Mavilla; Dandekar, Rahul Hanumant
Title: Knowledge, Attitude and Practice among food handlers on food borne diseases: A hospital based study in tertiary care hospital.Running title: KAP study among food handlers in a Hospital at Perambalur.Background: Food handlers play an important role in ensuring food safety throughout the chain of production, processing, storage and preparation.Staphylococcus aureus infections used to respond to ß-lactam and related group of antibiotics but the emergence of Methicillin-resistant S. Aureus...
AIMS: To examine (1) the prevalence of alcohol use disorders in adult general hospital inpatients; (2) the accuracy of documentation in relation to alcohol use. METHODS: A total of 210 random patients were interviewed out of 1,448 consecutive new admissions to CUH over 7 days. Case notes were reviewed for 206 (98%). Alcohol consumption was assessed using the Fast Alcohol Screening Test (FAST) and weekly drinking diary. FAST-positive (and a random sample of FAST-negative) patients then had a standardized interview. RESULTS: A total of 82% admitted for drinking alcohol. Among them 22% were drinking in excess of guidelines, 9% had DSM-IV Alcohol Abuse and 7% dependence. The sensitivity and specificity of the FAST for detecting those drinking above guidelines were 89 and 94% and for detecting a DSM-IV diagnosis was 100 and 73%. The majority of case notes contained inadequate information about alcohol intake. CONCLUSION: Alcohol use disorders are common and often undetected in the general hospital setting.
Estudo da mortalidade de recém-nascidos internados na UTI neonatal do Hospital Geral de Caxias do Sul, Rio Grande do Sul Newborn mortality study in the neonatal intensive care unit of Caxias do Sul General Hospital, Rio Grande do Sul
Breno Fauth de Araújo
Full Text Available OBJETIVOS: conhecer as causas e variáveis relacionadas com o óbito de recém-nascidos (RN de uma UTI neonatal de referência na região Sul do Brasil. MÉTODOS: estudo descritivo envolvendo 2.247 RN acompanhados até a alta. Foram analisadas variáveis maternas, do RN e variáveis da gestação, parto e atendimento. Foi utilizada a análise univariada e a regressão logística múltipla para relacionar as variáveis estudadas com o óbito. RESULTADOS: ocorreram 184 óbitos, com uma letalidade de 8,2%. A mortalidade dos RN com peso 2.500g ou a termo. As variáveis relacionadas ao óbito foram o peso OBJECTIVES: to determine causes and variables related to newborn deaths of a neonate intensive care unite (ICU in the Southern region of Brazil. METHODS: a descriptive study involving 2.247 newborns followed up until discharge date. Maternal variables were analyzed, as well as of the newborn and pregnancy, delivery and medical assistance variables. Univariate analysis and multiple logistic regression were used to relate the variables studied with death occurrence. RESULTS: 184 deaths occurred, corresponding to a 8.2% lethality rate. Newborn mortality variables were the following: weight of 2.500g or born at pregnancy term. Death related variables were weight of <2.000 grams, Apgar at 5' <4, no prenatal medical care, the need of delivery room resuscitation procedures and mechanic ventilation during hospitalization. Deaths basic causes were malformations (25.6%, maternal hypertension (17.9% and maternal infections (12.0%. CONCLUSIONS: many of the deaths occurred because of the poor medical care offered to pregnant women and newborns, a challenge that need to be faced by neonatologists, obstetricians and the government.
Sanjay Melville Masih; Shewtank Goel; Abhishek Singh; Sanjeev Kumar Khichi; Vasundhara; Rakesh Tank
Background: Nosocomial infections (NIs) result in increased morbidity, mortality and length of hospital stay. The Incidence of NIs, their risk factors and the antibiogram patterns vary across and within countries. We assessed the rates, infection sites, pathogens and risk factors of health-care-associated infections in ICU of a tertiary care hospital. Methods: In this retrospective study, all the patients admitted in Intensive Care Unit over a period of 6 months during August 2015 to Janu...
Full Text Available Context: Hand hygiene (HH is the most important measure to prevent hospital-acquired infections but the compliance is still low. Aims: To assess the compliance, identify factors influencing compliance and to study the knowledge, attitude and perceptions associated with HH among health care workers (HCW. Settings and Design: Cross-sectional study conducted in 42 bedded Medical (Pulmonary, Medicine and Stroke intensive care units (ICU of a tertiary care hospital. Materials and Methods: HCWs (doctors and nurses were observed during routine patient care by observers posted in each ICU and their HH compliance was noted. Thereafter, questionnaire regarding knowledge, perception and attitudes toward HH was filled by each HCW. Statistical Analysis: Percentages and χ2 test. Results: The overall compliance was 43.2% (394/911 opportunities. It was 68.9% (31/45 in the intensivists, 56.3% (18/32 in attending physicians, 40.0% (28/70 in the postgraduate residents and 41.3% (301/728 in the nurses. Compliance was inversely related to activity index. Compliance for high, medium and low risk of cross-transmission was 38.8% (67/170, 43.8% (175/401 and 44.7% (152/340, respectively. Conclusions: Compliance of the study group is affected by the activity index (number of opportunities they come across per hour and professional status. The HCWs listed less knowledge, lack of motivation, increased workload as some of the factors influencing HH.
Guassora, Ann Dorrit Kristiane; Jarlbæk, Lene; Thorsen, Thorkil
Background: Many patients consider the interface between secondary and primary care difficult, and in particular, the transition of care between these different parts of the healthcare system presents problems. This interface has long been recognized as a critical point for quality of care. The...... professionals in both primary and secondary healthcare. Participants discussed solutions to problems which had previously been identified in patient interviews and in focus groups with general practitioners (GPs), hospital doctors, and nursing staff. The data were analyzed using framework analysis. Results......: Solutions, endorsed by all groups at the seminar to improve transition back to general practice after primary treatment for cancer, were: 1) To add nurses’ discharge letters addressing psychosocial matters to medical discharge letters; 2) To send medical discharge letters earlier from some hospital...
Mohammad Adineh; Tahereh Toulabi; Yadollah Pournia Pournia; Shahram Baraz
Background A child's hospitalization in intensive care units causes stress and worry in other family members. This study aimed to determine the effect of family presence during pediatric ICU bedside on family general health. Materials and Methods In this clinical trial study, 46 family members of the pediatrics hospitalized in the ICU in Teaching hospital affiliated with the Lorestan University of Medical Sciences in Khorramabad in April to November 2014 were divided into two groups using the...
Clark, M.; Spry, E.; Daoh, K.; Baion, D.; Skordis-Worrall, J
Background The demand for high quality hospital care for children in low resource countries is not being met. This paper describes a number of strategies to improve emergency care at a children's hospital and evaluates the impact of these on inpatient mortality. In addition, the cost-effectiveness of improving emergency care is estimated. Methods and Findings A team of local and international staff developed a plan to improve emergency care for children arriving at The Ola During Children's H...
Yeliz İrem Tunçel
Full Text Available Objective: Burnout is common in intensive care units (ICU because of high demands and difficult working conditions. The aim of this study was to analyse nurses’ burnout in our oncology ICU and to determine which factors are associated with. Material and Method: The study was carried out in Ankara Oncology Hospital ICU. A self- reporting questionnaire in an envelope was used for the evaluation of burnout (Turkish- language version of Maslach Burnout Inventory and depression (Beck Depression Scale. Results: From a total of 37 ICU nurses, 35 participated in the study (%94,5 response rate. High levels of emotional exhaustion in 82% and depersonalization in 51,4% of nurses was determined. Personal accomplishment was higher at 80%. Mild to moderate emotional state and mild anxiety was revealed. Years in profession,finding salary insufficient, finding the profession in its proper, choosing the profession of his own accord, work environment satisfaction and finding the social activity adequate were associated with burnout (p≤0.05. Conclusion: In our study, intensive care unit nurses’ burnout scores were found to be higher. Burnout was rare in nurses that choose the profession of his own accord, find the nursing profession in its proper, and social activity adequate and are satisfied with the work environment. Therefore, we believe that attention should be given to individual needs and preferences in the selection of ICU staff.
Problem. Health care delivery in Germany has to face severe challenges that will lead to a closer integration of services for in- and out-patients. University hospitals play an important role due to their activities in research, education and health care delivery. They are requested to promote and evaluate new means and ways for health care delivery. Methods. The Institute of Clinical Radiology at the University Hospital of the Ludwig-Maximilians-University started teleradiological services for hospitals and general practices in January 1999 in the framework of the ''Imaging services - teleradiological center of excellence''. Legal, technical and organizational prerequisites were analyzed. Results. Networks between university hospitals and general practices are not likely to solve all future problems. They will, however, increase the availability of the knowledge of experts even in rural areas and contribute to a quality ensured health care at the patients home. Future developments may lead to international co-operations and such services may be available to patients abroad. Conclusion. Legal, technical and organizational obstacles have to be overcome to create a framework for high quality telemedical applications. University hospitals will play an important role in promoting and evaluating teleradiological services. (orig.)
Full Text Available Anita Gupta1, Sarah Daigle2, Jeffrey Mojica3, Robert W Hurley41Pain Management Division, Department of Anesthesiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA; 2Department of Anesthesiology and Critical Care, 3Department of Anesthesiology and Critical Care, Division of Pain Medicine, University of Pennsylvania, Philadelphia, PA, USA; 4Medical Director of the Johns Hopkins Pain Treatment Center, Division of Pain Medicine, Deparment of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USAStudy objective: Assessment of patients’ perception of pain control in hospitals in the United States.Background: Limited data are available regarding the quality of pain care in the hospitalized patient. This is particularly valid for data that allow for comparison of pain outcomes from one hospital to another. Such data are critical for numerous reasons, including allowing patients and policy-makers to make data-driven decisions, and to guide hospitals in their efforts to improve pain care. The Hospital Quality Alliance was recently created by federal policy makers and private organizations in conjunction with the Centers for Medicare and Medicare Services to conduct patient surveys to evaluate their experience including pain control during their hospitalization.Methods: In March 2008, the results of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS survey was released for review for health care providers and researchers. This survey includes a battery of questions for patients upon discharge from the hospital including pain-related questions and patient satisfaction that provide valuable data regarding pain care nationwide. This study will review the results from the pain questions from this available data set and evaluate the performance of these hospitals in pain care in relationship to patient satisfaction. Furthermore, this analysis will be providing valuable
Park, Subin; Ahn, Myung Hee; Na, Riji; Kim, Seon-Ok; Yoon, Jin Sang; Park, Jun-Hyuk; Hong, Jin Pyo
This study aims to highlight the factors associated with suicide method among psychiatric patients in a general hospital in Korea. In a sample of 467 suicides by patients who had received mental health care in a general hospital in Korea, the relationship between suicide method and time of death as well as clinical characteristics, including psychiatric adiagnosis, was examined using multinomial logistic regression analysis. Compared with the general population, psychiatric patients, regardless of disorder, committed suicide by jumping from heights more often than by hanging (OR=2.35-8.64). In particular, patients with psychotic disorders and female patients were more likely to use jumping from a height than hanging to kill themselves (OR=2.98 and 1.83, respectively). Patients were more likely to use suicide methods other than hanging (e.g., OR=6.7 for jumping, 5.3 for drowning, and 2.7 for self-poisoning) between midnight and dawn. Possible suicide-prevention strategies suggested by this study include limiting access to or fencing off tall structures in close proximity to psychiatric institutions and residential care homes. At night, limiting access to or instituting heightened supervision of tall structures is specifically indicated. PMID:24055162
Kaal, Suzanne E J; Kuijken, Noortje M J; Verhagen, Constant A H H V M; Jansen, Rosemarie; Servaes, Petra; van der Graaf, Winette T A
This study aims to analyze the experiences of Dutch bereaved parents and general practitioners (GPs) with palliative care of AYAs (18-35 years) in the terminal stage. Fifteen parents and nine GPs involved with nine deceased AYAs filled out questionnaires and were interviewed by telephone, respectively. In general, the parents were satisfied with the emotional care they themselves received and the medical care that their child received. The GPs were very satisfied with the cooperation with the palliative team. Gaps are present in the areas of symptom control, communication between hospital professionals and parents, aftercare, and transition between hospital and GP. PMID:26812457
Brink-Muinen, A. van den; Bensing, J.M.; Kerssens, J.J.
Objectives: differences were investigated between general practitioners providing women's health care (4 women) and general practitioners providing regular health care (8 women and 8 men). Expectations were formulated on the basis of the principles of women's health care and literature about gender
mechanisms of coordination, this paper finds that standardized work processes such as care pathways should be considered as a bundle of coordination mechanisms—plans and rules, objects, routines, roles and proximity—rather than a mechanism of its own. The bundle builds the accountability, predictability and...... attention to identify and reinforce those underlying mechanisms. This provides solutions to deal with the fundamental challenge of care coordination in hospitals. The research builds on an in-depth, embedded case study of hospital care pathways. Care pathways are particularly interesting because they mirror......Hospitals face substantial coordination challenges. To meet this hospitals more and more use standardized work processes such as care pathways. By drawing on recent coordination theory that increasingly emphasizes the role of lateral and emergent interactions alongside traditional, programmed...
Full Text Available The Nutrition Care in Canadian Hospitals (2010–2013 study identified the prevalence of malnutrition on admission to medical and surgical wards as 45%. Nutrition practices in the eighteen hospitals, including diagnosis, treatment and monitoring of malnourished patients, were ad hoc. This lack of a systematic approach has demonstrated the need for the development of improved processes and knowledge translation of practices aimed to advance the culture of nutrition care in hospitals. A narrative review was conducted to identify literature that focused on improved care processes and strategies to promote the nutrition care culture. The key finding was that a multi-level approach is needed to address this complex issue. The organization, staff, patients and their families need to be part of the solution to hospital malnutrition. A variety of strategies to promote the change in nutrition culture have been proposed in the literature, and these are summarized as examples for others to consider. Examples of strategies at the organizational level include developing policies to support change, use of a screening tool, protecting mealtimes, investing in food and additional personnel (healthcare aides, practical nurses and/or diet technicians to assist patients at mealtimes. Training for hospital staff raises awareness of the issue, but also helps them to identify their role and how it can be modified to improve nutrition care. Patients and families need to be aware of the importance of food to their recovery and how they can advocate for their needs while in hospital, as well as post-hospitalization. It is anticipated that a multi-level approach that promotes being “food aware” for all involved will help hospitals to achieve patient-centred care with respect to nutrition.
NISHIDA, Kayo; SAKASHITA, Emiko; OKAWA, Yuriko; KONISHI, Madoka
The purpose of this study is to survey the current state and reality of the implementation of new nursing staff training （from now on, “new staff training”）, tolearn how the staff training directors perceive end-of-life care education for new graduate nurses, and to see how these training programs are implemented. Questionnaireswere sent to 179 facilities requesting one training director for the new nursing staff（ hereinafter“ training director”） from each institution to answer anonymouslythe...
... Prospective Payment System for Inpatient Hospital Capital Costs Special Rules for Puerto Rico Hospitals § 412.370 General provisions for hospitals located in Puerto Rico. Except as provided in § 412.374, hospitals located in Puerto Rico are subject to the rules in this subpart governing the prospective...
O Cathain, A.; Froggett, M; Taylor, M. P.
BACKGROUND. In November 1992, a pilot scheme was established in Doncaster to provide an on-site physiotherapy service in six non-fundholding general practices covering a population of approximately 44,000 people. AIM. The aim of the pilot scheme was to transfer a hospital-based physiotherapy service, to which general practitioners had direct access, to a primary care setting and to reduce referrals to an orthopaedics outpatient department. METHOD. Use of physiotherapy services and referrals t...
Chilingerian, J A
An analysis of current trends in the health care industry points to buyers seeking high quality, yet efficient, care as an emerging market segment. To target this market segment, hospitals must be prepared to market the efficient physicians. In the coming years, hospitals that can identify and market their best practicing providers will achieve a competitive advantage. PMID:1428863
... reasons enumerated in 38 CFR 17.47(i)(2). (Authority: 38 U.S.C. 1724) Enrollment Provisions and Medical... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Hospital care and medical... VETERANS AFFAIRS MEDICAL Hospital Or Nursing Home Care and Medical Services in Foreign Countries §...
Baldwin, Laura-Mae; MacLehose, Richard F.; Hart, L. Gary; Beaver, Shelli K.; Every,Nathan; Chan,Leighton
Context: Acute myocardial infarction (AMI) is a common and important cause of admission to US rural hospitals, as transport of patients with AMI to urban settings can result in unacceptable delays in care. Purpose: To examine the quality of care for patients with AMI in rural hospitals with differing degrees of remoteness from urban centers.…
Brasso, K; Friis, S; Juel, K;
We studied the need for hospital care of patients 74 years old or younger with clinically localized prostate cancer managed by deferred endocrine therapy.......We studied the need for hospital care of patients 74 years old or younger with clinically localized prostate cancer managed by deferred endocrine therapy....
Bar-Sela, Gil; Bentur, Netta; Schultz, Michael; Corn, Benjamin W
Faced with a serious, incurable illness, disability, and other symptoms, both physical and mental, some patients find themselves wondering about the meaning of their Lives. They need the help of a professional who can perceive their mental turmoil and identify their spiritual needs, and who knows how to help them find meaning in their uncertain state. Spiritual care providers are professionals whose role it is to provide patients with support in their hour of need, to help them preserve their identity in life-threatening situations, and to help them re-endow their world with meaning, employing a special language and set of tools that enable patients to get in touch with their spiritual resources and internal powers of healing. Spiritual care providers serve on the medical staff in Western countries. In the United States, some 2,600 are employed in general hospitals, psychiatric hospitals, long-term care facilities, and palliative care units. Approximately ten years ago, the profession began developing in Israel. Today, dozens of spiritual care providers are now working in the healthcare system. There is a spiritual care network with 21 member organizations. Although the profession is laying down roots in the healthcare system in this country, it is still in its infancy and has to contend with substantial barriers and challenges, including professional recognition, creating positions, and identifying sources of funding for positions. The profession still has much room to grow as it is further incorporated into the healthcare system and continues undergoing adaptation to the Israeli cultural setting. PMID:25112121
Wulff, Christian N; Vedsted, Peter; Søndergaard, Jens
BACKGROUND: Case management (CM) models based on experienced nurses are increasingly used to improve coordination and continuity of care for patients with complex health care needs. Anyway, little is known about the effects of hospital-based CM in cancer care.Aim.To analyse the effects of hospital......-based CM on (i) GPs' evaluation of information from the hospital and collaboration with the hospital staff and (ii) patients' contacts with GPs during daytime and out of hours. DESIGN: A randomized controlled trial allocated 280 colorectal cancer patients 1:1 to either a control group or CM intervention...
Andersson Hagiwara, Magnus; Nilsson, Lena; Stromsoe, Anneli; Axelsson, Christer; Kangstrom, Anna; Herlitz, Johan
Background: Patient safety issues in pre-hospital care are poorly investigated. The aim of the planned study is to survey patient safety problems in pre-hospital care in Sweden. Methods/Design: The study is a retro-perspective structured medical record review based on the use of 11 screening criteria. Two instruments for structured medical record review are used: a trigger tool instrument designed for pre-hospital care and a newly development instrument designed to compare the pre-hospital as...
Landman, Adam B.; Spatz, Erica S.; Cherlin, Emily J.; Krumholz, Harlan M.; Bradley, Elizabeth H.; Curry, Leslie A.
Objective Evidence suggests that active collaboration between hospitals and emergency medical services (EMS) is significantly associated with lower acute myocardial infarction (AMI) mortality rates; however, the nature of such collaborations is not well understood. We sought to characterize views of key hospital staff regarding collaboration with EMS in the care of patients hospitalized with AMI. Methods We performed an exploratory analysis of qualitative data previously collected from site visits and in-depth interviews with 11 US hospitals that ranked in the top or bottom 5% of performance on 30-day risk-standardized AMI mortality rates (RSMRs) using Centers for Medicare and Medicaid Services data from 2005–2007. We selected all codes from the first analysis in which EMS was most likely to have been discussed. A multidisciplinary team analyzed the data using the constant comparative method to generate recurrent themes. Results Both higher and lower performing hospitals reported that EMS is critical to the provision of timely care for patients with AMI. However, close, collaborative relationships with EMS were more apparent in the higher performing hospitals. Higher performing hospitals demonstrated specific investment in and attention to EMS through: 1) respect for EMS as valued professionals and colleagues; 2) strong communication and coordination with EMS; and 3) active engagement of EMS in hospital AMI quality improvement efforts. Conclusion Hospital staff from higher performing hospitals described broad, multifaceted strategies to support collaboration with EMS in providing AMI care. The association of these strategies with hospital performance should be tested quantitatively in a larger, representative study. PMID:23146627
Susan J. Armstrong
Full Text Available Background: Improving the quality of health care is central to the proposed health care reforms in South Africa. Nursing unit managers play a key role in coordinating patient care activities and in ensuring quality care in hospitals. Objective: This paper examines whether the activities of nursing unit managers facilitate the provision of quality patient care in South African hospitals. Methods: During 2011, a cross-sectional, descriptive study was conducted in nine randomly selected hospitals (six public, three private in two South African provinces. In each hospital, one of each of the medical, surgical, paediatric, and maternity units was selected (n=36. Following informed consent, each unit manager was observed for a period of 2 hours on the survey day and the activities recorded on a minute-by-minute basis. The activities were entered into Microsoft Excel, coded into categories, and analysed according to the time spent on activities in each category. The observation data were complemented by semi-structured interviews with the unit managers who were asked to recall their activities on the day preceding the interview. The interviews were analysed using thematic content analysis. Results: The study found that nursing unit managers spent 25.8% of their time on direct patient care, 16% on hospital administration, 14% on patient administration, 3.6% on education, 13.4% on support and communication, 3.9% on managing stock and equipment, 11.5% on staff management, and 11.8% on miscellaneous activities. There were also numerous interruptions and distractions. The semi-structured interviews revealed concordance between unit managers’ recall of the time spent on patient care, but a marked inflation of their perceived time spent on hospital administration. Conclusion: The creation of an enabling practice environment, supportive executive management, and continuing professional development are needed to enable nursing managers to lead the provision
Bulgaria over the period 2001-2009, published in NCMI Bulletin No10. The analysis of the published report coincides with the general development trend in the area of health care in the EU and corresponds to the hospital care development forecasts in theRepublic of Bulgaria to 2014. The priorities of financing hospital care in the EU and theRepublic of Bulgaria are discussed by G.Komitovand, S.Genev.Considerable attention is paid to health care issues in the hospital sector of Bulgaria. These are analyzed in the context of European reality and priorities, discussed at regular scientific and practical forums. As an example, directly relating to this publication, the author speaks of the Fifth national conference Information technologies and relations in health care challenges of the 21st century, held in Sofia in 2009.The author notes that the major role is played by the Government and the National Assembly of Republic of Bulgaria in the process of reforming health care and expresses its agreement on the importance of issues related with economy in health care. Regular documents on national and institutional level analyse the condition and the perspectives of development and restructuring of the hospital sector in Bulgaria.Analysing dynamics of hospital inpatient care in the European countries and RB the author finds similar tendencies, coinciding with data given by other authors [8; 13] and demonstrates analogous trends, connected with cost reduction in the hospital sector over the past 20 years by 55% to 30-35%. The author agrees with other researchers, that the tendencies are determined by the following major macro- and microeconomic changes: restructuring of medical services;reduction of the hospitals number (except for Bulgaria and Romania, where an increase is found related to the increased demand for certain hospital services; reduction of budget expenses for hospitals financing; increased efficiency and rationality of hospital medical care; improved hospital
Ukwaja, Kingsley N; Talabi, Ademola A; Aina, Olufemi B
WHO/UNICEF currently recommend that childhood malaria and pneumonia be managed together in the community; most African countries are in the process of developing this policy. We conducted a cross-sectional study to determine maternal awareness of general danger signs of childhood illnesses and the prevalence, determinants and sources of pre-hospital treatment by mothers during their child's acute respiratory illness in a poor urban community in south-western Nigeria. A total of 226 mothers were interviewed. Only 4.9% of the mothers were aware of the two pneumonia symptoms: difficult breathing and fast breathing. About 75% of the children were given pre-hospital medication at home and only 16.5% of them received the drugs within 24 hour of symptom recognition. Drug shops/patent medicine vendors (PMVs; 70.6%) were the most common source of care. Wishing to try home management first (46.6%); waiting for the child to improve (14.4%) and lack of money (31.6%) delayed care-seeking. Older maternal age (aOR 2.3; 95% CI 1.2-4.4) and having a child with cough and difficult and/or fast breathing (aOR 2.3; 95% CI 1.1-5.2) were positive predictors of pre-hospital treatment. Maternal education and adequately equipping PMVs could improve prompt access to integrated community-based child health services in Nigeria. PMID:24029675
Magnus, Stephen A; Smith, Dean G; Wheeler, John R C
Not-for-profit hospitals undertook unprecedented amounts of debt in the mid to late 1990s. Corporate finance theory and the literature on hospital financing suggest that debt may constrain hospitals' capacity to deliver uncompensated care. Using data from audited financial statements for a sample of hospitals, this article explores whether debt financing is associated with hospitals' provision of uncompensated care, an output central to many hospitals' service missions. Contrary to expectations, our analysis finds that higher debt is associated with higher levels of uncompensated care. However, the results may reflect the unusual economic and stock-market conditions prevailing in the mid 1990s, and they are consistent with the views of hospital financial managers and other practitioners whom we interviewed. PMID:15682952
Full Text Available Abstract Background The objective of this study was to investigate how medical and nursing staff of the Nicosia General Hospital is affected by specific motivation factors, and the association between job satisfaction and motivation. Furthermore, to determine the motivational drive of socio-demographic and job related factors in terms of improving work performance. Methods A previously developed and validated instrument addressing four work-related motivators (job attributes, remuneration, co-workers and achievements was used. Two categories of health care professionals, medical doctors and dentists (N = 67 and nurses (N = 219 participated and motivation and job satisfaction was compared across socio-demographic and occupational variables. Results The survey revealed that achievements was ranked first among the four main motivators, followed by remuneration, co-workers and job attributes. The factor remuneration revealed statistically significant differences according to gender, and hospital sector, with female doctors and nurses and accident and emergency (A+E outpatient doctors reporting greater mean scores (p 55 years of age reported higher job satisfaction when compared to the other groups. Conclusions The results are in agreement with the literature which focuses attention to management approaches employing both monetary and non-monetary incentives to motivate health care professionals. Health care professionals tend to be motivated more by intrinsic factors, implying that this should be a target for effective employee motivation. Strategies based on the survey's results to enhance employee motivation are suggested.
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
Bergenholtz, H; Hølge-Hazelton, B; Jarlbæk, Lene
Background Hospitals have a responsibility to ensure that palliative care is provided to all patients with life-threatening illnesses. Generalist palliative care should therefore be acknowledged and organized as a part of the clinical tasks. However, little is known about the organization and...... evaluation of generalist palliative care in hospitals. Therefore the aim of the study was to investigate the organization and evaluation of generalist palliative care in a large regional hospital by comparing results from existing evaluations. Methods Results from three different data sets, all aiming to...... evaluate generalist palliative care, were compared retrospectively. The data-sets derived from; 1. a national accreditation of the hospital, 2. a national survey and 3. an internal self-evaluation performed in the hospital. The data were triangulated to investigate the organization and evaluation of...
Full Text Available INTRODUCTION: Stenotrophomonas maltophilia is acquiring increasing importance as a nosocomial pathogen. METHODS: We retrospectively studied the characteristics and outcome of patients with any type of S. maltophilia infection at the University Hospital of Heraklion, Crete, Greece, between 1/2005-12/2010. S. maltophilia antimicrobial susceptibility was tested with the agar dilution method. Prognostic factors for all-cause in-hospital mortality were assessed with multivariate logistic regression. RESULTS: Sixty-eight patients (median age: 70.5 years; 64.7% males with S. maltophilia infection, not related to cystic fibrosis, were included. The 68 patients were hospitalized in medical (29.4%, surgical (26.5%, hematology/oncology departments (23.5%, or the intensive care units (ICU; 20.6%. The most frequent infection types were respiratory tract (54.4%, bloodstream (16.2%, skin/soft tissue (10.3%, and intra-abdominal (8.8% infection. The S. maltophilia-associated infection was polymicrobial in 33.8% of the cases. In vitro susceptibility was higher to colistin (91.2%, trimethoprim/sulfamethoxazole and netilmicin (85.3% each, and ciprofloxacin (82.4%. The empirical and the targeted treatment regimens were microbiologically appropriate for 47.3% and 63.6% of the 55 patients with data available, respectively. Most patients received targeted therapy with a combination of agents other than trimethoprim/sulfamethoxazole. The crude mortality and the mortality and the S. maltophilia infection-related mortality were 14.7% and 4.4%, respectively. ICU hospitalization was the only independent prognostic factor for mortality. CONCLUSION: S. maltophilia infection in a general hospital can be associated with a good prognosis, except for the patients hospitalized in the ICU. Combination reigmens with fluoroquinolones, colistin, or tigecycline could be alternative treatment options to trimethoprim/sulfamethoxazole.
Ryan, T; Ingleton, C.; Gardiner, C.; Parker, C; Gott, M.; Noble, B
Background: The requirement to meet the palliative needs of acute hospital populations has grown in recent years. With increasing numbers of frail older people needing hospital care as a result of both malignant and nonmalignant conditions, emphasis is being placed upon understanding the physical, psychological and social burdens experienced by patients. This study explores the extent of burden in two large UK hospitals, focusing upon those patients who meet palliative care criter...
Adnan Tüfek; Recep Tekin; Tuba Dal; Orhan Tokgöz; Erdal Doğan; Gönül Ölmez Kavak; Salih Hoşoğlu
Objectives: Hospital acquired infections (HAI) are majorhealth problem in intensive care units. We aimed to determinethe nosocomial infection rate, distribution of HAI andthe distribution of microorganisms isolated from nosocomialinfections and their antibiotic resistance profiles in hospitalizedpatients in intensive care unit.Materials and methods: A total 222 patients with a diagnosisof hospital-acquired infection hospitalized between January2003 and June 2012 at Dicle University Medical Fa...
Full Text Available OBJETIVO: Avaliar a prática de profilaxia para tromboembolia venosa (TEV em pacientes em um hospital geral. MÉTODOS: Estudo de coorte transversal conduzido no Hospital Nossa Senhora da Conceição, localizado na cidade de Porto Alegre (RS, com uma amostra constituída de pacientes internados selecionados randomicamente entre outubro de 2008 e fevereiro de 2009. Foram incluídos pacientes maiores de 18 anos e internados por mais de 48 h. Os critérios de exclusão foram pacientes em uso de anticoagulantes, história de doença tromboembólica, gestação e puerpério. A adequação da profilaxia foi avaliada seguindo as recomendações de um protocolo criado pela instituição e tendo como base principal a diretriz da American College of Chest Physician, oitava edição. RESULTADOS: Foram incluídos 262 pacientes com média de idade de 59,1 ± 16,6 anos. Os fatores de risco mais comuns foram imobilização (70,6%, infecção (44,3%, câncer (27,5%, obesidade (23,3% e cirurgia maior (14,1%. Na avaliação do nível de risco para TEV, 143 (54,6% e 117 pacientes (44,7%, respectivamente, foram classificados como de risco alto e moderado. No geral, 46,2% dos pacientes tiveram profilaxia adequada, assim como 25% dos pacientes com três ou mais fatores de risco e 18% dos pacientes com câncer, e houve diferenças estatisticamente significativas entre esses grupos quando comparados àqueles com menos de três fatores de risco e sem câncer (p OBJECTIVE: To evaluate the use of venous thromboembolism (VTE prophylaxis in a general hospital. METHODS: A cross-sectional cohort study at the Hospital Nossa Senhora da Conceição, located in the city of Porto Alegre, Brazil, involving a random sample of patients admitted between October of 2008 and February of 2009. We included patients over 18 years of age and hospitalized for more than 48 h. The exclusion criteria were anticoagulant use, pregnancy, puerperium, and a history of thromboembolic disease. The
McCloskey, Rose; Jarrett, Pamela; Stewart, Connie; Nicholson, Patricia
Background Patients in acute care hospitals no longer in need of acute care are called Alternate Level of Care (ALC) patients. This is growing and common all across Canada. A better understanding of this patient population would help to address this problem. Methods A chart review was conducted in two hospitals in New Brunswick. All patients designated as ALC on July 1, 2009 had their charts reviewed. Results Thirty-three per cent of the hospital beds were occupied with ALC patients; 63% had a diagnosis of dementia. The mean length of stay was 379.6 days. Eighty-six per cent were awaiting a long-term care bed in the community. Most patients experienced functional decline during their hospitalization. One year prior to admission, 61% had not been admitted to hospital and 59.2% had had at least one visit to the emergency room. Conclusions The majority of the ALC patients in hospital have a diagnosis of dementia and have been waiting in hospital for over one year for a long-term care bed in the community. Many participants were recipients of maximum home care in the community, suggesting home maker services alone may not be adequate for some community-dwelling older adults. Early diagnosis of dementia, coupled with appropriate care in the community, may help to curtail the number of patients with dementia who end up in hospital as ALC patients. PMID:25232367
Steele, Joseph Rodgers; Jones, A Kyle; Clarke, Ryan K; Shoemaker, Stowe
The patient experience has moved to the forefront of health care-delivery research. The University of Texas MD Anderson Cancer Center Department of Diagnostic Radiology began collaborating in 2011 with the University of Houston Conrad N. Hilton College of Hotel and Restaurant Management, and in 2013 with the University of Nevada, Las Vegas, William F. Harrah College of Hotel Administration, to explore the application of service science to improving the patient experience. A collaborative pilot study was undertaken by these 3 institutions to identify and rank the specific needs and expectations of patients undergoing imaging procedures in the MD Anderson Department of Diagnostic Radiology. We first conducted interviews with patients, providers, and staff to identify factors perceived to affect the patient experience. Next, to confirm these factors and determine their relative importance, we surveyed more than 6,000 patients by e-mail. All factors considered important in the interviews were confirmed as important in the surveys. The surveys showed that the most important factors were acknowledgment of the patient's concerns, being treated with respect, and being treated like a person, not a "number"; these factors were more important than privacy, short waiting times, being able to meet with a radiologist, and being approached by a staff member versus having one's name called out in the waiting room. Our work shows that it is possible to identify and rank factors affecting patient satisfaction using techniques employed by the hospitality industry. Such factors can be used to measure and improve the patient experience. PMID:25533732
Full Text Available Background: Accidental needle stick injuries (NSIs are an occupational hazard for healthcare workers (HCWs. A recent increase in NSIs in a tertiary care hospital lead to a 1-year review of the pattern of injuries, with a view to determine risk factors for injury and potential interventions for prevention. Methods: We reviewed 1-year (July 2006-June 2007 of ongoing surveillance of NSIs. Results: The 296 HCWs reporting NSIs were 84 (28.4% nurses, 27 (9.1% nursing interns, 45 (21.6% cleaning staff, 64 (21.6% doctors, 47 (15.9% medical interns and 24 (8.1% technicians. Among the staff who had NSIs, 147 (49.7% had a work experience of less than 1 year ( P < 0.001. The devices responsible for NSIs were mainly hollow bore needles ( n = 230, 77.7%. In 73 (24.6% of the NSIs, the patient source was unknown. Recapping of needles caused 25 (8.5% and other improper disposal of the sharps resulted in 55 (18.6% of the NSIs. Immediate post-exposure prophylaxis for HCWs who reported injuries was provided. Subsequent 6-month follow-up for human immunodeficiency virus showed zero seroconversion. Conclusion: Improved education, prevention and reporting strategies and emphasis on appropriate disposal are needed to increase occupational safety for HCWs.
Full Text Available BACKGROUND: Organophosphorus (OP compounds are the most common suicidal poison in developing countries and mortality continues to be high. The present study was aimed to know the pattern and outcome of the OP poisoning. METHODOLOGY: A record based retrospective study from January 2013 - December 2013 was Conducted in a tertiary care hospital and data regarding age, gender, domicile, type of poison, manner of poisoning, seasonal trends, marital status, motive behind poisoning , socio - economic status and outcome was collected in a pre - structured Performa. All data were documented, analyzed and interpreted as per the laid down protocol. RESULTS : out of total 1575 cases of OP compound poisoning, 71.73% (1130 were male, 28.27% (445 were female, 34.6% were in the age group 21 - 30 years, 70.95% were of low socio - economic status, Occupation wise agricultural workers were on top of the list (70.07%, The commonest (93.78% motive behind poisoning was suicidal in both males and females, Financial problem was one of the commonest (51.22% reasons of poisoning. The mortality rate in our study was 13.47%. CONCLUSION : Y oung and adult males of Low socio - economic class, rural, both literate and illiterate agriculturists commonly abuse this substance to commit suicide
Full Text Available Introduction : Neurological diseases are very important causes of prolonged morbidity and disability, leading to profound financial loss. Epilepsy is one of the most important neurological disorders Healthcare seeking by epilepsy patients is quite diverse and unique. Aims and Objectives: The study was conducted among the epilepsy patients, to assess their healthcare-seeking behavior and its determinants. Materials and Methods: Three hundred and fifteen epilepsy patients, selected by systematic random sampling, in the neuromedicine outpatient department of a tertiary care hospital were interviewed with a predesigned, pretested, semi-structured proforma. Results and Conclusion: More than 90% sought healthcare just after the onset of a seizure. The majority opted for allopathic medicine and the causes for not seeking initial care from allopaths were ignorance, faith in another system, constraint of money, and so on. A significant association existed between rural residence and low social status of the patients with initial care seeking from someone other than allopaths. No association was found among sex, type of seizure, educational status of the patients, and care seeking. The mean treatment gap was 2.98 ± 10.49 months and the chief motivators were mostly the family members. Patients for anti epileptic drugs preferred neurologists in urban areas and general practitioners in rural areas. District care model of epilepsy was proposed in the recommendation.
Full Text Available The purpose of this study is to identify risk factors of physical violence in Chinese township hospitals.A cross-sectional survey was used in a sample of 442 general practitioners and 398 general nurses from 90 township hospitals located in Heilongjiang province, China (response rate = 84.8%.A total of 106 of the 840 (12.6% respondents reported being physically attacked in their workplace in the previous 12 months. Most perpetrators were the patients' relatives (62.3%, followed by the patient (22.6%; 73.6% of perpetrators were aged between 20 and 40 years. Of the physical violence incidents, about 56.6% (n = 60 resulted in a physical injury, and 45.4% of respondents took two or three days of sick leave. Reporting workplace violence in hospitals to superiors or authorities was low (9.4%. Most respondents (62.8% did not receive training on how to avoid workplace violence. Logistic regression analyses indicated that general nurses, aged 35 years or younger, and with a higher-level professional title were more likely to experience physical violence. Healthcare workers with direct physical contact (washing, turning, lifting with patients had a higher risk of physical violence compared to other health care workers. Procedures for reporting workplace violence were a protective factor for physical violence; when in place, reporting after psychological violence (verbal abuse, bullying/mobbing, harassment, and threats was more protective than waiting until an instance of physical violence (beating, kicking, slapping, stabbing, etc..Physical violence in Chinese township hospitals is an occupational hazard of rural public health concern. Policies, procedures, and intervention strategies should be undertaken to manage this issue.
Rhode, Marianne Grønnebæk; Vandborg, Mads Partridge; Bladt, Vibeke; Rognås, Leif
Background Pre-hospital endotracheal intubation is challenging and repeated endotracheal intubation is associated with increased morbidity and mortality. We investigated whether the introduction of the McGrath MAC video laryngoscope as the primary device for pre-hospital endotracheal intubation could improve first-pass success rate in our anaesthesiologist-staffed pre-hospital critical care services. We also investigated the incidence of failed pre-hospital endotracheal intubation, the use of...
More people die in hospital than in any other setting which is why it is important to study the outcomes of hospital care at end of life. This study analyses what influenced outcomes in a sample of patients who died in hospital in Ireland in 2008\\/9. The study was undertaken as part of the Irish Hospice Foundation\\'s Hospice Friendly Hospitals Programme (2007-2012).
Dale, Bjørg; Hvalvik, Sigrun
BACKGROUND: Older persons in transition between hospital and home care services are in a particularly vulnerable situation and risk unfortunate consequences caused by organizational inefficiency. The purpose of the study reported here was to elucidate how home nursing leaders experience the administration of care to older people in transition from hospital to their own homes. METHODS: A qualitative study design was used. Ten home nursing leaders in two municipalities in southern Norway par...
Shakila Mulla; Pankaj Kumar Gupta; Shakeel Ansari
Introduction: In developing countries like India, maternal mortality ratio is still very high. Current study is an attempt to analyze maternal mortality and its determinants in a tertiary care hospital where highest quality of medical care is provided. Methods: It was a retrospective study. Five years data from January 2004 to December 2008 was reviewed from medical record department of tertiary care hospital in Mumbai. Fisher’s exact test was applied; Odds ratio and 95% confidence interval w...
Tucker, Anita L; Nembhard, Ingrid M.; Amy C. Edmondson
This paper contributes to research on organizational learning by investigating specific learning activities undertaken by improvement project teams in hospital intensive care units and proposing an integrative model to explain implementation success. Organizational learning is important in this context because medical knowledge changes constantly and hospital care units must learn new practices if they are to provide high-quality care. To develop a model of factors affecting improvement proje...
Zhang X.; Oyama T
Xing Zhang, Tatsuo Oyama National Graduate Institute for Policy Studies, Tokyo, Japan Abstract: Japan's health care system is considered one of the best health care systems in the world. Hospitals are one of the most important health care resources in Japan. As such, we investigate Japanese hospitals from various viewpoints, including their roles, ownership, regional distribution, and characteristics with respect to the number of beds, staff, doctors, and financial performance. Applying ...
C. Paranthakan; P. K. Govindarajan
Background: The poisoning due to various reasons commonly occurs among population. Normally tertiary care hospitals receive large numbers of referral. During treatment many die due to poisoning. Objectives of the study were to find out the magnitude of admissions due to poisoning and to find out various type of poisoning and related mortality. Methods: The secondary data was collected from records available in Intensive care unit of toxicology department of tertiary care hospital. The adm...
Beattie, Michelle; Lauder, William; Atherton, Iain; Murphy, Douglas J.
Background Improving and sustaining the quality of care in hospitals is an intractable and persistent challenge. The patients’ experience of the quality of hospital care can provide insightful feedback to enable clinical teams to direct quality improvement efforts in areas where they are most needed. Yet, patient experience is often marginalised in favour of aspects of care that are easier to quantify (for example, waiting time). Attempts to measure patient experience have been hindered by a ...
receivers. Question To explore experiences of post bureaucratic hospital reforms and their impact on care provision. Method Data builds on nine mini group interviews with midwives (n = three), nurses (n = three) and physiotherapists (n = three), in all thirty participants. Data was analysed using existing....... Although midwives, nurses and physiotherapists share similar experiences of post bureaucratic hospital reforms, changes in care provision can impact these professions in different ways. As a discipline, midwifery is founded on relationships between women and midwives. Standardised clinical care...
Major changes brought about by managed care have redefined the nursing profession. Current trends such as case management, downsizing, restructuring of the workforce, and changes in the patient profile have had numerous effects, particularly on job satisfaction among hospital-based nurses. Strategies to improve job satisfaction during this era of increased managed care penetration include enhanced communication mechanisms, support from hospital administration, implementation of care models that promote professional nursing practice, adequate staffing, and competitive salaries and benefits. PMID:11033702
Sérgio H. Loss
Full Text Available OBJECTIVE: To assess the incidence, costs, and mortality associated with chronic critical illness (CCI, and to identify clinical predictors of CCI in a general intensive care unit. METHODS: This was a prospective observational cohort study. All patients receiving supportive treatment for over 20 days were considered chronically critically ill and eligible for the study. After applying the exclusion criteria, 453 patients were analyzed. RESULTS: There was an 11% incidence of CCI. Total length of hospital stay, costs, and mortality were significantly higher among patients with CCI. Mechanical ventilation, sepsis, Glasgow score < 15, inadequate calorie intake, and higher body mass index were independent predictors for cci in the multivariate logistic regression model. CONCLUSIONS: CCI affects a distinctive population in intensive care units with higher mortality, costs, and prolonged hospitalization. Factors identifiable at the time of admission or during the first week in the intensive care unit can be used to predict CCI.
Wan, T T; Vanostenberg, P R; Salley, J J; Singley, D W; West, J. L.
To provide hospital dental programs with useful information about the expansion of dental services and the identification of pertinent financial information, a production function and cost function analysis was performed. Results showed that hospital ownership (public or private) and size of the dental clinics were associated with the cost of providing dental services and the volume of services provided. Among 23 hospitals studied, private hospitals had a much lower cost per visit, had more p...
Full Text Available The quality of clinical accompaniment of the student enrolled for the post-basic diploma in Medical and Surgical Nursing Science: Critical Care Nursing (General is an important dimension of the educational/learning programme. The clinical accompanist/mentor is responsible for ensuring the student’s compliance with the clinical outcomes of the programme in accordance with the requirements laid down by the Nursing Education Institution and the South African Nursing Council. The purpose of this study was to explore and describe the experiences of the students enrolled for a post-basic diploma in Medical and Surgical Nursing Science: Critical Care Nursing (General, in relation to the clinical accompaniment in a private hospital in Gauteng. An exploratory, descriptive and phenomenological research design was utilised and individual interviews were conducted with the ten students in the research hospital. A content analysis was conducted and the results revealed both positive and negative experiences by the students in the internal and external worlds. The recommendations include the formulation of standards for clinical accompaniment of students. the evaluation of the quality of clinical accompaniment of students and empowerment of the organisation, clinical accompanists/mentors and clinicians.
When embarking on a partnership or acquisition, a rural hospital and a larger health system can accomplish a smooth transition, as long as they both keep in mind: > The fundamental (and financial) differences between urban and rural hospitals > The areas where the rural hospital in the partnership or acquisition is profitable > The importance of a clinic strategy in a partnership. PMID:26685441
Santucci, W; Day, R O; Baysari, M T
We conducted an observational study with interviews in a 12-bed general/neurological intensive care unit (ICU) at a teaching hospital in Sydney, Australia, to determine whether hospital-wide computerised decision support (CDS) embedded in an electronic prescribing system is used and perceived as useful by doctors in an ICU setting. Twenty doctors were shadowed by the observer while on ward rounds (33.6 hours) and non-ward rounds (28 hours) in the ICU. These doctors were also interviewed to explore views of CDS. We found that computerised alerts were triggered frequently in the ICU (n=166, in 59% of orders), less than half of the alerts were read by doctors and only four alerts resulted in a medication order being changed. Pre-written orders were utilised frequently, however reference material was rarely accessed. Interviews with doctors revealed a willingness to use CDS features; however the primary barrier to use was lack of customisation for the ICU setting. Doctors working in the ICU triggered a high number of alerts when prescribing, 40% more alerts than doctors working on general wards of the same hospital. Certain procedures in place in the ICU (e.g. daily microbiology ward rounds) made many alerts redundant in this setting. Lack of customisation for the ICU led to dissatisfaction with CDS and infrequent use of some CDS features. PMID:27456183
Izumi, Shigeko; Baggs, Judith G.; Knafl, Kathleen A.
The quality of nursing care as perceived by hospitalized patients with advanced illness has not been examined. A concept of quality nursing care for this population was developed by integrating the literature on constructs defining quality nursing care with empirical findings from interviews of 16 patients with advanced illness. Quality nursing care was characterized as competence and personal caring supported by professionalism and delivered with an appropriate demeanor. Although the attribu...
Marjan Vejdani; Alireza Rezazadeh; Marzieh Javadi; Arefeh Pourtaleb; Ahmad Khanijahani; Ali Vafaei Najjar; Hossein Ebrahimipour; Arash Shirdel
Background Considering patients’ needs and expectations in the process of healthcare delivery improves the quality of services. This study aimed to investigate the responsiveness of general public and private hospitals in Mashhad, Iran. Methods In this cross-sectional and explanatory study, hospitalized patients (with at least 2 days of stay) in general private and public hospitals in Mashhad were investigated. In total 425 patients (259 from private and 166 from public hospitals) were sele...
Silvana M.M. Cavalcanti
Full Text Available Staphylococcus aureus is one of the principal human pathogens that colonize healthy individuals in the community in general, and it is responsible for severe infections in hospitalized patients. Due to an increase in the prevalence of strains of methicillin-resistant S. aureus (MRSA, combating these microorganisms has become increasingly difficult. A descriptive study was carried out on 231 patients in intensive care at the Oswaldo Cruz University Hospital (HUOC in Recife, Brazil between January and April 2003 to determine the prevalence of S. aureus and MRSA and to evaluate risk factors for colonization by these bacteria when introduced into Intensive Care Units (ICUs. Body secretions were collected from the nostrils, axillary and perineal regions, and from broken skin lesions, of all patients during the first 48 hours following admission to the ICU. Samples were inoculated into blood agar and mannitol-salt-agar culture medium and identified by Gram staining, and by coagulase, DNAse and agglutination (Slidex Staph Test® tests. Growth in Mueller-Hinton agar with 4% sodium chloride and 6mg/L oxacillin was used to identify MRSA. In addition, the latex agglutination test was performed to identify penicillin-binding protein, PBP 2A. The prevalence of S. aureus and MRSA was 87/231 (37.7% and 30/231 (12.98%, respectively. There was no association between any risk factor studied (age, sex, origin of the patient - whether hospital or community, previous hospitalization, use of current or previous antibiotic therapy, corticotherapy and/or immunotherapy, reason for hospitalization and place of hospitalization and the presence of S. aureus. However, a significant association was established between previous hospitalization and the presence of MRSA (RR:1.85; CI:1.00-3.41; p=0.041. The nostrils were the principal site of colonization by both S. aureus (80.4% and MRSA (26.4%, followed by the perineal area, with rates of 27.6% and 12.6%, respectively. If only
Gimm, Gilbert W; Kitsantas, Panagiota
Prior research has shown a relationship between falls, hospitalizations, and depression among older adults in nursing home settings, but few studies have explored these relationships for younger and older adults in residential care facilities. This study examined risk factors for hospitalizations among assisted living residents. Using the 2010 National Survey of Residential Care Facilities, the study found that 24% of residents had a hospital stay in the past year. Residents with falls were more than twice as likely to have a hospitalization. For younger residents, depression was a key risk factor (OR = 1.74, p depression and severe mental illness, who are at greater risk of hospitalization. Reducing avoidable hospitalizations can improve well-being for older and younger adults in residential care facilities. PMID:27147680
Hayes, A J; Davda, A; El-Hadi, M; Murphy, P; Papettas, T
Introduction Surgeons are increasingly performing surgery on older patients. There are currently no tools specifically for risk prediction in this group. The aim of this study was to review general surgical operations carried out on patients aged over 90 years and their outcome, before comparing these with predictors of morbidity and mortality. Methods A retrospective review was carried out at our district general hospital of all general surgery patients aged over 90 years who underwent a general surgical operation over a period of 14 years. Information collected included demographics, details of procedures, P-POSSUM (Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity), complications and outcomes. Results A total of 119 procedures were carried out, 72 involving entry into the peritoneal cavity. Overall, 14 patients (12%) died within 30 days and 34 (29%) died within one year. Postoperative complications included infection (56%), renal failure (24%), need for transfusion (17%) and readmission within 30 days (11%). Logistical regression analysis showed that the P-POSSUM correlated well with observed mortality and infection was a significant predictor of in-hospital mortality (p=0.003). Conclusions The P-POSSUM correlates significantly with outcome and should be used when planning major elective or emergency surgery in patients over 90 years of age. Infective complications appear to be a significant predictor of postoperative mortality. This study supports operative intervention as an option in this extreme age group but we emphasise the importance of appropriate patient selection and judicious clinical care. PMID:27138856
Full Text Available Hospitalization of family member in intensive care can be a trigger of stress in the family. Several factors which could create a stressful situation in a family are changes of environment, rules in the ward, changes of family emotional status, changes of family member roles, changes of daily activities, changes in financial situation and health care workers' attitude when giving information on patient’s health status. This study was a cross-sectional study. The number of subjects included in this study were 60 representing families whose member was hospitalized in the General Intensive Care Unit (GICU of Dr. Hasan Sadikin General Hospital (RSHS Bandung during the period of March to May 2012. The sampling technique used was purposive sampling. The instrument used to measure the stress predictors was developed based on theoretical review and modification of family inventory live events standard instrument. Meanwhile, the instrument used for measuring the family stress was the Depression Anxiety Stress Scale 42. Data were analyzed using chi-square test and logistic regression. The results of this study showed environmental changes, rules in the ward, emotional status changes and daily activity changes significantly corelated with stress (p value 0.01, 0.04 and 0.03, respectively. In conclusion, none of the 6 family predictors dominantly predicts stress. Nurses are expected to do early detection on psychological family problems in intensive care unit and optimize supportive-educative treatment in the form of counseling for family members.
Rosano, A.; Peschel, P.; Kugler, J.; Zee, J. van der; Ricciardi, W.; Guasticchi, G.
Background: Hospitalization may often be prevented by timely and effective outpatient care. For Italy we found that the type and density of primary-care facilities, among other factors, influence admission rates. However, results from Italy may not be valid for other types of health-care systems, e.
This has already been a busy year for practitioners, with Accident and Emergency departments full, hospitals closing to non-emergency admissions and elective surgery being cancelled. In addition, all the political parties are using the NHS as a priority area for the upcoming general election. Health care and its funding continues to be an issue that dominates headlines, with each political party promising it will be safe in their hands. But what are the major parties promising?
Full Text Available Abstract Background The allocation of outcome of suicide attempters is extremely important in emergency situations. Following categorization of suicidal attempters who visited the emergency room by outcome, we aimed to identify the characteristics and potential needs of each group. Methods The outcomes of 1348 individuals who attempted suicide and visited the critical care center or the psychiatry emergency department of the hospital were categorized into 3 groups, "hospitalization in the critical care center (HICCC", "hospitalization in the psychiatry ward (HIPW", or "non-hospitalization (NH", and the physical, mental, and social characteristics of these groups were compared. In addition, multiple logistic analysis was used to extract factors related to outcome. Results The male-to-female ratio was 1:2. The hospitalized groups, particularly the HICCC group, were found to have biopsychosocially serious findings with regard to disturbance of consciousness (JCS, general health performance (GAS, psychiatric symptoms (BPRS, and life events (LCU, while most subjects in the NH group were women who tended to repeat suicide-related behaviors induced by relatively light stress. The HIPW group had the highest number of cases, and their symptoms were psychologically serious but physically mild. On multiple logistic analysis, outcome was found to be closely correlated with physical severity, risk factor of suicide, assessment of emergent medical intervention, and overall care. Conclusion There are different potential needs for each group. The HICCC group needs psychiatrists on a full-time basis and also social workers and clinical psychotherapists to immediately initiate comprehensive care by a medical team composed of multiple professionals. The HIPW group needs psychological education to prevent repetition of suicide attempts, and high-quality physical treatment and management skill of the staff in the psychiatric ward. The NH group subjects need a
To highlight the presentation and management of various vascular injuries and their outcome. Thirty nine cases of vascular trauma were referred to vascular surgeon CMH Rawalpindi, in the above mentioned period. These cases were evaluated for mechanism of injury, age, gender and time of presentation. Out of these, only thirty cases were found suitable for surgical intervention. These thirty cases were evaluated for site of vascular injury, associated injuries, type of surgery performed and the outcome. Blunt trauma was the predominant cause of vascular injuries in our study 16/39 (41%). Fourteen cases (35.8%) had gun shot wounds. Only thirty patients (76.9 %) underwent various surgical procedures. Primary end to end anastomosis was possible in only 5/30 cases (16.6%) while reversed venous graft was used in 13/30 cases (43.3%). Wound infection occurred in 2/30(6.6%) cases out of which 1 case (3.3%) ultimately had an amputation. The time period between injury and surgical intervention ranged between 1 to 20 hours for most of the vascular injuries while delayed presentation in the form of traumatic arteriovenous fistula or pseudoaneurysm was between 48 hours to 3 months. There are reasonable numbers of vascular trauma cases being referred to a tertiary care hospital. Most of these cases reach us quite late due to unnecessary investigations, delayed referral and transportation. Early intervention and revascularization definitely reduces amputation and complication rate. All gunshot wounds not only require thorough surrounding soft tissue debridement but also liberal excision of traumatised vessel itself, resulting in interposition graft repair. (author)
Full Text Available Health programs implemented by microfinance institutions (MFIs aim to benefit the poor, but whether these services reach the poorest remains uncertain. This study intended to investigate the socioeconomic distribution of patients in hospitals operated by microfinance institutions (i.e. MFI hospitals in Bangladesh and compare the differences with public hospitals to determine if the programs were consistent with their pro-poor mandate.In this cross-sectional study, we used the convenience sampling method to conduct an interviewer-assisted questionnaire survey among 347 female outpatients, with 170 in public hospitals and 177 in MFI hospitals. Independent variables were patient characteristics categorized into predisposing factors (age, education, marital status, family size, enabling factors (microcredit membership, household income and need factors (self-rated health, perceived needs for care. We employed Generalized Estimating Equations (GEE to evaluate how these factors contributed to MFI hospital use.Use of MFI hospitals was associated with microcredit membership over 5 years (OR=2.9, p<.01, moderately poor household (OR=4.09, p<.001, non-poor household (OR=7.34, p<.01 and need for preventive care (OR=3.4, p<.01, compared with public hospitals. Combining membership and income, we found microcredit members had a higher tendency towards utilization but membership effect pertained to the non- and moderately-poor. Compared with the group who were non-members and the poorest, microcredit members who were non-poor had the highest likelihood (OR=7.46, p<.001 to visit MFI hospitals, followed by members with moderate income (OR=6.91, p<.001 and then non-members in non-poor households (OR=4.48, p<.01. Those who were members but the poorest had a negative association (OR=0.42, though not significant. Despite a higher utilization of preventive services in MFI hospitals, expenditure there was significantly higher.Inequity was more pronounced in MFI
Forster Della A
Full Text Available Abstract Background Concerns have been raised in Australia and internationally regarding the quality and effectiveness of hospital postnatal care, although Australian women receiving postnatal care in the private maternity sector rate their satisfaction with care more highly than women receiving public maternity care. In Victoria, Australia, two-thirds of women receive their maternity care in the public sector and the remainder in private health care sector. A statewide review of public hospital postnatal care in Victoria from the perspective of care providers found many barriers to care provision including the busyness of postnatal wards, inadequate staffing and priority being given to other episodes of care; however the study did not include private hospitals. The aim of this study was replicate the review in the private sector, to explore the structure and organisation of postnatal care in private hospitals and identify those aspects of care potentially impacting on women's experiences and maternal and infant care. This provides a more complete overview of the organisational structures and processes in postnatal care in all Victorian hospitals from the perspective of care providers. Methods A mixed method design was used. A structured postal survey was sent to all Victorian private hospitals (n = 19 and key informant interviews were undertaken with selected clinical midwives, maternity unit managers and obstetricians (n = 11. Survey data were analysed using descriptive statistics and interview data analysed thematically. Results Private hospital care providers report that postnatal care is provided in very busy environments, and that meeting the aims of postnatal care (breastfeeding support, education of parents and facilitating rest and recovery for women following birth was difficult in the context of increased acuity of postnatal care; prioritising of other areas over postnatal care; high midwife-to-woman ratios; and the number and
Full Text Available The development of innovations for clinical practice warrants active engagement of clinicians in the research process. This requires attention to factors that serve as incentive to participate. The explanation for the success of factors that encourage practitioners to participate in research can be found in sources of satisfaction and dissatisfaction with clinical practice. It is also important to consider intrinsic incentives such as common and troublesome clinical presentations that are related to workload or unsatisfactory clinical encounters. This review will consider each of these factors and suggest ways in which clinicians, especially general practitioners, may be invited to assist on research projects.
... in determining eligibility for hospital, nursing home or domiciliary care. 17.47 Section 17.47... Nursing Home Care § 17.47 Considerations applicable in determining eligibility for hospital, nursing home... hospital or nursing home care under § 17.47(a), a veteran will be determined unable to defray the...
The aim of the project was to evaluate the development of ‘Critical Care Paramedics’ (CCPs) at South East Coast Ambulance NHS Trust (SECAmb) in the UK. SECAmb has developed a new CCP role in response to numerous national reports critical of sub-standard pre-hospital care for seriously ill and injured patients, and the need to save more lives. There is an ongoing debate on the use of doctors and paramedics in pre-hospital care and the evidence is mixed whether one is more effective...
Full Text Available Introduction: The family planning centres must be upgraded to a cornerstone of primary health care, and prevent, advise and protect the citizen's health while reducing hospitalization costs for hospitals. Aim: The purpose of this literature review is the family planning centre development in general hospital of Argolida that has a similar clinic. Material and Methods: Literature review was conducted of published English and Greek Articles from bibliographic databases Medline, Google Scholar and Scopus for the period 2001-2014, using keywords like: "Family Planning», «SWOT analysis", "functional design" "prevention", "health promotion", "economic cost". The option of creating inpatient center was made after analysis SWOT, by defining objectives, performance indicators and existing alternatives. Also the timing of implementation and functional design, provide the springboard effort for effective operation. Conclusions: The development of family planning centres in the country and abroad is designed to address very important problems in the bud, in order to improve the quality of citizens' health, then reduce the financial burden on the health system as a result of prevention, and contribute indirectly to the mental balance of citizens.
The quality of the diagnostic and therapeutic process of 1262 newly diagnosed breast cancer patients was evaluated in 63 Italian general hospital over the period March 1983 - April 1984. Most of the patients (91%) discovered their own lesion, which was a nodule in 83% of the cases. Practice of breast self examination was reported by 418 (33%) patients, only 28% of whom did that on a regular monthly basis. A diagnostic delay>3 months was present in 36% of the patients. Among the preoperative work-up examinations, skeletal X-ray or bone scan was not performed in 20% of patients, whereas other essential examinations were done in most. The Patey type of radical mastectomy was the most frequent surgical procedure; quadrantectomy was performed in only 26% of eligible patients, more frequently in younger (34%) than in older patients (21%). Adjuvant chemotherapy was recommended for 11% and 6% of pre- and postmenopausal N- patients, and for 78% and 47% of pre- and postmenopausal N+ patients. Forty-three of the 63 participating hospitals reported they adhered to the guidelines defined by the Italian Breast Cancer Task Force (F.O.N.Ca.M.) but this was not associated with substantial evidence of better quality of care. Similary, no associations emerged between several hospitals' organizational features and adherence to recommended treatment guidelines. The study is ongoing to assess the quality of postsurgical treatment and to measure its impact on patients' survival
Lundstrøm, Louise Hyldborg; Johnsen, Anna Thit; Ross, Lone;
Background. Cancer care usually involves several health professionals from different parts of the health care system. Often, the GP has an important role. Patients’ experiences of continuity and support may be related to characteristics of health care, disease or patients. Objectives. To investig......Background. Cancer care usually involves several health professionals from different parts of the health care system. Often, the GP has an important role. Patients’ experiences of continuity and support may be related to characteristics of health care, disease or patients. Objectives. To...... cancer patients, a random sample of 1490 patients completed a validated questionnaire regarding patient experiences. A mixed methods approach was applied. Associations between patient experiences and background variables were analysed in ordinal logistic regression models and patients’ written comments...... were analysed qualitatively. Results. One-third of the patients evaluated the cooperation between hospitals and primary care as suboptimal. Younger patients and patients from the capital Copenhagen were most dissatisfied. A third had needed support from their GP, and 41% of these patients had not fully...
Bjørg Dale,1 Sigrun Hvalvik21Centre for Caring Research – Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, 2Centre for Caring Research – Southern Norway, Faculty of Health and Social Studies, Telemark University College, Porsgrunn, NorwayBackground: Older persons in transition between hospital and home care services are in a particularly vulnerable situation and risk unfortunate consequences caused by organizational inefficie...
Dale B; Hvalvik S
Bjørg Dale,1 Sigrun Hvalvik21Centre for Caring Research – Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, 2Centre for Caring Research – Southern Norway, Faculty of Health and Social Studies, Telemark University College, Porsgrunn, NorwayBackground: Older persons in transition between hospital and home care services are in a particularly vulnerable situation and risk unfortunate consequences caused by organizational inefficiency. The pur...
Sarit Sharma; Shruti Sharma; Deepinder Chhina; Chhina, R. S.
Varicella-zoster virus (VZV) causes 2 clinically and epidemiologically distinct forms of diseases. Chickenpox (varicella) is the disease that results from primary infection with the VZV. Herpes zoster (HZ) results from the reactivation of VZV latently infecting the dorsal root ganglia. We are reporting an outbreak of varicella infection among the health care workers (HCWs) in the Intensive Care Unit (ICU) of a tertiary care hospital. We found transmission of varicella among eight HCWs of pulm...
Sonali Kar; Shalini Ray; Dayanidhi Meher
Diabetes mellitus is a major public health problem that can cause a number of serious complications. Foot ulceration is one of its most common complications. Poor foot care knowledge and practices are important risk factors for foot problems among diabetics. The present study was undertaken in the diabetes outpatient department of a tertiary care hospital to assess the practices regarding foot care in diabetes, find out the determinants of foot ulcer in diabetics, and offer suggestions to imp...
Fugate, D L; Decker, P J
Health care has entered an era of rapid change. Most observers agree that important long-term changes will fundamentally reshape health care as we know it. To that end, health care providers should consider the benefits of operating vertically integrated marketing system with hospitals as the channel leader. Whether an administered VMS (hospitals have the power to gain compliance) or a corporate VMS (hospitals own successive levels of care providers), integrated channel management holds the promise of cost containment and quality patient care for the future. However, a great deal of integrating work must be done before VMSs will become a practical solution. Research studies are needed on each of the issues just discussed. As marketers, it is time we make a transition from treating health care marketing as a disjointed entity and instead treat it as an industry where all marketing principles are considered including channel management. PMID:10106898
da Silva, Hilderjane Carla; Pessoa, Renata de Lima; de Menezes, Rejane Maria Paiva
Objective: to identify the prevalence of trauma in elderly people and how they accessed the health system through pre-hospital care. Method: documentary and retrospective study at a mobile emergency care service, using a sample of 400 elderly trauma victims selected through systematic random sampling. A form validated by experts was used to collect the data. Descriptive statistical analysis was applied. The chi-square test was used to analyze the association between the variables. Results: Trauma was predominant among women (52.25%) and in the age range between 60 and 69 years (38.25%), average age 74.19 years (standard deviation±10.25). Among the mechanisms, falls (56.75%) and traffic accidents (31.25%) stood out, showing a significant relation with the pre-hospital care services (p<0.001). Circulation, airway opening, cervical control and immobilization actions were the most frequent and Basic Life Support Services (87.8%) were the most used, with trauma referral hospitals as the main destination (56.7%). Conclusion: trauma prevailed among women, victims of falls, who received pre-hospital care through basic life support services and actions and were transported to the trauma referral hospital. It is important to reorganize pre-hospital care, avoiding overcrowded hospitals and delivering better care to elderly trauma victims. PMID:27143543
Hilderjane Carla da Silva
Full Text Available Objective: to identify the prevalence of trauma in elderly people and how they accessed the health system through pre-hospital care. Method: documentary and retrospective study at a mobile emergency care service, using a sample of 400 elderly trauma victims selected through systematic random sampling. A form validated by experts was used to collect the data. Descriptive statistical analysis was applied. The chi-square test was used to analyze the association between the variables. Results: Trauma was predominant among women (52.25% and in the age range between 60 and 69 years (38.25%, average age 74.19 years (standard deviation±10.25. Among the mechanisms, falls (56.75% and traffic accidents (31.25% stood out, showing a significant relation with the pre-hospital care services (p<0.001. Circulation, airway opening, cervical control and immobilization actions were the most frequent and Basic Life Support Services (87.8% were the most used, with trauma referral hospitals as the main destination (56.7%. Conclusion: trauma prevailed among women, victims of falls, who received pre-hospital care through basic life support services and actions and were transported to the trauma referral hospital. It is important to reorganize pre-hospital care, avoiding overcrowded hospitals and delivering better care to elderly trauma victims.
Newman, Christy E; de Wit, John B F; Crooks, Levinia; Reynolds, Robert H; Canavan, Peter G; Kidd, Michael R
As the management of HIV changes and demand for HIV health services in primary care settings increases, new approaches to engaging the general practice workforce with HIV medicine are required. This paper reports on qualitative research conducted with 47 clinicians who provide HIV care in general practice settings around Australia, including accredited HIV s100 prescribers as well as other GPs and general practice nurses. Balanced numbers of men and women took part; less than one-quarter were based outside of urban metropolitan settings. The most significant workforce challenges that participants said they faced in providing HIV care in general practice were keeping up with knowledge, navigating low caseload and regional issues, balancing quality care with cost factors, and addressing the persistent social stigma associated with HIV. Strategic responses developed by participants to address these challenges included thinking more creatively about business and caseload planning, pursuing opportunities to share care with specialist clinicians, and challenging prejudiced attitudes amongst patients and colleagues. Understanding and supporting the needs of the general practice workforce in both high and low HIV caseload settings will be essential in ensuring Australia has the capacity to respond to emerging priorities in HIV prevention and care. PMID:24581265
Umran Yesiltepe Oskay
comprehensive nursing care, education and counseling and were on partial or complete bed rest experienced less physical and psychological problems and hospital stressors (p<0.05. Conclusion: In hospitalized high-risk pregnant women with complete or partial bed rest, a comprehensive nursing care, education and counseling services were quite effective in relieving physical and psychological symptoms and stressors. For this population, it will be beneficial to generalize using of comprehensive nursing care and providing of printed material about bed rest in pregnancy. [TAF Prev Med Bull 2012; 11(2.000: 163-172
Point prevalence surveys (PPS) are increasingly used to examining and compare hospital antibiotic consumption. The aim of this study was to identify the (1) point prevalence of antibiotic use in one regional hospital and (2) compare PPS data from similar regional\\/general hospitals.
Kietzmann, Diana; Hannig, Christian; Schmidt, Silke
This study was designed to explore the views of migrants and professionals on culturally sensitive pre-hospital emergency care in order to adapt such care to migrants' needs. Interviews were conducted with 41 migrants who had received direct (as a patient) or indirect (as a significant other) pre-hospital emergency care. Furthermore, 20 professionals in the field of pre-hospital emergency care were interviewed. The content analysis showed five distinguishable categories based on the statements by the migrants and six categories based on the statements by the professionals. While migrants gave priority to basic proficiencies of first responders such as 'social/emotional competencies' and 'communication skills', the professionals considered '(basic) cultural knowledge', 'awareness' and 'attitude' the most important. Furthermore, migrants provided practical indications, e.g. regarding areas of cultural knowledge, whereas professionals seemed to view the issue of culturally pre-hospital emergency care from a more theoretical perspective. The issues of the culturally sensitive pre-hospital emergency care itself, as well as the varying points of view of the two groups interviewed, resulted in eight recommendations for culturally sensitive pre-hospital emergency care. PMID:26123882
Full Text Available Abstract Background In Britain over 39,000 reports were received by the National Patient Safety Agency relating to failures in documentation in 2007 and the UK Health Services Journal estimated in 2008 that over a million hospital outpatient visits each year might take place without the full record available. Despite these high numbers, the impact of missing clinical information has not been investigated for hospital outpatients in the UK. Studies in primary care in the USA have found 13.6% of patient consultations have missing clinical information, with this adversely affecting care in about half of cases, and in Australia 1.8% of medical errors were found to be due to the unavailability of clinical information. Our objectives were to assess the frequency, nature and potential impact on patient care of missing clinical information in NHS hospital outpatients and to assess the principal causes. This is the first study to present such figures for the UK and the first to look at how clinicians respond, including the associated impact on patient care. Methods Prospective descriptive study of missing information reported by surgeons, supplemented by interviews on the causes. Data were collected by surgeons in general, gastrointestinal, colorectal and vascular surgical clinics in three teaching hospitals across the UK for over a thousand outpatient appointments. Fifteen interviews were conducted with those involved in collating clinical information for these clinics. The study had ethics approval (Hammersmith and Queen Charlotte's & Chelsea Research Ethics Committee, reference number (09/H0707/27. Participants involved in the interviews signed a consent form and were offered the opportunity to review and agree the transcript of their interview before analysis. No patients were involved in this research. Results In 15% of outpatient consultations key items of clinical information were missing. Of these patients, 32% experienced a delay or disruption
Sampson, Rod; Barbour, Rosaline; Wilson, Philip
Background Improving the quality of care of at the medical primary-secondary care interface is both a national and a wider concern. In a qualitative exploration of clinicians’ relationship at the interface, we want to study how both GPs and hospital specialists regard and behave towards each other and how this may influence patient care. Method A qualitative interview study was carried out in primary and secondary care centres in NHS Highland health board area, Scotland. Eligible clinicians (...
Bethel Ann Powers; Norton, Sally A.; Schmitt, Madeline H.; Quill, Timothy E.; Maureen Metzger
Objective. To illustrate distinctions and intersections of palliative care (PC) and end-of-life (EOL) services through examples from case-centered data of older adults cared for during a four-year ethnographic study of an acute care hospital palliative care consultation service. Methods. Qualitative narrative and thematic analysis. Results. Description of four practice paradigms (EOL transitions, prognostic uncertainty, discharge planning, and patient/family values and preferences) and identi...
Lange, Peter; Rasmussen, Finn Vejlø; Borgeskov, Hanne;
We studied the quality of care for COPD patients in a large sample of general practices in Denmark. We focussed on whether participation by general practitioners (GPs) in an educational programme could enhance the use of spirometry in the diagnosis and staging of the disease and improve adherence...
To determine the pattern of nosocomial infections in two ICUs' of a teaching hospital in terms of frequency, common sites of infection, the pathogens involved and the antibiotic sensitivity patterns. It was conducted in two medical ICUs (Neurology and Nephrology) of a public tertiary care hospital. Data was collected prospectively on patients suspected to have developed nosocomial infection after 48 hours of admission to the ICU according to objective. There were 101 cases of suspected nosocomial infection out of a total of 254 patients. The frequency of nosocomial infection was 39.7%. UTI developed in 44.6%, while 27% had blood stream infection, and 21% had pneumonia. Each of the three major sites of infection was strongly associated with the use of invasive devices. Escherichia (E.) coli was the most common organism isolated followed by Pseudomonas aeruginosa and Klebsiella. E. coli and Klebsiella showed a maximum sensitivity to Imipenem followed by Tazocin (pipericillin + tazobactam). Pseudomonas aeruginosa was sensitive to Amikacin and Fosfomycin. The high frequency of nosocomial infection suggests that more strict measures regarding invasive devices should be taken in future to control the infection and limit the emergence of antibiotic resistant organisms. (author)
... 42 Public Health 5 2010-10-01 2010-10-01 false Special requirements for hospital providers of long... PARTICIPATION FOR HOSPITALS Requirements for Specialty Hospitals § 482.66 Special requirements for hospital providers of long-term care services (“swing-beds”). A hospital that has a Medicare provider agreement...
Elderkamp-de Groot Rianne
Full Text Available Abstract Background Long-term care is often associated with high health care expenditures. In the Netherlands, an ageing population will likely increase the demand for long-term care within the near future. The development of risk profiles will not only be useful for projecting future demand, but also for providing clues that may prevent or delay long-term care utilization. Here, we report our identification of predictors of long-term care utilization in a cohort of hospital patients aged 65+ following their discharge from hospital discharge and who, prior to hospital admission, were living at home. Methods The data were obtained from three national databases in the Netherlands: the national hospital discharge register, the long-term care expenses register and the population register. Multinomial logistic regression was applied to determine which variables were the best predictors of long-term care utilization. The model included demographic characteristics and several medical diagnoses. The outcome variables were discharge to home with no formal care (reference category, discharge to home with home care, admission to a nursing home and admission to a home for the elderly. Results The study cohort consisted of 262,439 hospitalized patients. A higher age, longer stay in the hospital and absence of a spouse were found to be associated with a higher risk of all three types of long-term care. Individuals with a child had a lower risk of requiring residential care. Cerebrovascular diseases [relative risk ratio (RRR = 11.5] were the strongest disease predictor of nursing home admission, and fractures of the ankle or lower leg (RRR = 6.1 were strong determinants of admission to a home for the elderly. Lung cancer (RRR = 4.9 was the strongest determinant of discharge to the home with home care. Conclusions These results emphasize the impact of age, absence/presence of a spouse and disease on long-term care utilization. In an era of demographic and
Lankford, Mary G.; Zembower, Teresa R.; Trick, William E.; Hacek, Donna M.; Noskin, Gary A.; Peterson, Lance R.
We assessed the effect of medical staff role models and the number of health-care worker sinks on hand-hygiene compliance before and after construction of a new hospital designed for increased access to handwashing sinks. We observed health-care worker hand hygiene in four nursing units that provided similar patient care in both the old and new hospitals: medical and surgical intensive care, hematology/oncology, and solid organ transplant units. Of 721 hand-hygiene opportunities, 304 (42%) we...
Conclusions: Measures to improve detection and reporting of adverse drug reactions by all health care professionals is recommended to be undertaken, to ensure, and improve patient′s safety. In this way, hospital/clinical pharmacists play the cornerstone role.
Hermens, R.P.M.G.; Haagen, E.C.; Nelen, W.L.D.M.; Tepe, E.M.; Akkermans, R.P.; Kremer, J.A.M.; Grol, R.P.T.M.
OBJECTIVE: To assess the association of patient and hospital characteristics with adherence to guidelines for intrauterine insemination (IUI) care. DESIGN: Retrospective cohort study using multilevel regression analysis. Characteristics studied at the patient level were female age, type and duration
Older people are intensive users of hospital and long-term care services. This paper explores the extent to which these services are substitutes. A small area analysis was used with both care home and (tariff cost-weighted) hospital utilisation for older people aggregated to electoral wards in England.Health and social-care structural equations were specified using a theoretical model. The estimation accounted for the skewed and censored nature of the data. For health utilisation, both a fixed effects instrumental variables GMM model and a generalised estimating equations (GEE) model were fitted, the later on a log dependent variable with predicted values of social care utilisation used to account for endogeneity (bootstrapping was used to derive standard errors). In addition to a GMM model, the social-care estimation used both two-part and tobit models (also with predicted health utilisation and bootstrapping).The results indicate that for each additional pound1 spent on care homes, hospital expenditure falls by pound0.35. Also, pound1 additional hospital spend corresponds to just over pound0.35 reduction on care home spend. With these cost substitution effects offsetting, a transfer of resources to care homes is efficient if the resultant outcome gain is greater than the outcome loss from reduced hospital use. PMID:19206085
Full Text Available Joel Katz,1–3 Aliza Weinrib,1,2 Samantha R Fashler,2 Rita Katznelzon,1,3 Bansi R Shah,1 Salima SJ Ladak,1 Jiao Jiang,1 Qing Li,1 Kayla McMillan,1 Daniel Santa Mina,5,6 Kirsten Wentlandt,7 Karen McRae,1,3 Diana Tamir,1,3 Sheldon Lyn,1,3 Marc de Perrot,8 Vivek Rao,9 David Grant,10 Graham Roche-Nagle,11 Sean P Cleary,12 Stefan OP Hofer,13 Ralph Gilbert,14 Duminda Wijeysundera,1,3 Paul Ritvo,15 Tahir Janmohamed,16 Gerald O’Leary,1,3 Hance Clarke1,3 1Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, University of Toronto, 2Department of Psychology, York University, 3Department of Anesthesia, University of Toronto, 4Palliative Care, University Health Network, University of Toronto, 5Princess Margaret Cancer Centre, University Health Network, University of Toronto, 6Faculty of Kinesiology and Physical Education, University of Toronto, 7Department of Family and Community Medicine, University of Toronto, 8Division of Thoracic Surgery, Toronto General Hospital, 9Division of Cardiovascular Surgery, Toronto General Hospital, 10Multiorgan Transplant Program, Toronto General Hospital, 11Division of Vascular Surgery, Toronto General Hospital, 12Division of General Surgery, Toronto General Hospital, 13Division of Plastic Surgery, Toronto General Hospital, 14Division of Otolaryngology – Head and Neck Surgery, Toronto General Hospital, 15Department of Kinesiology and Health Science, York University, 16ManagingLife, Toronto, ON, CanadaAbstract: Chronic postsurgical pain (CPSP, an often unanticipated result of necessary and even life-saving procedures, develops in 5–10% of patients one-year after major surgery. Substantial advances have been made in identifying patients at elevated risk of developing CPSP based on perioperative pain, opioid use, and negative affect, including depression, anxiety, pain catastrophizing, and posttraumatic stress disorder-like symptoms. The Transitional Pain Service (TPS at
Tohyama, Teruhiko; Senko, Yoshitaka
This report is a kind of empirical study on disaster psychiatric services following the Great Hanshin Earthquake.Our work was performed at a general hospital (the Higashi-Kobe Hospital) located in the middle of the disaster area. Before the quake there were no psychiatric facilities at that hospital ; nevertheless many patients with mental problems visited there. And our team; consisting of several volunteer psychiatrists from all over Japan and some nurses of that hospital, immediately set u...
Syed Masuma Rizvi
Full Text Available Background: Obstructed labour is still a major cause of maternal morbidity and mortality and adverse outcome of newborn in low income countries. It is the leading cause of hospitalization, comprising of 39% of all obstetric patients in developing countries. Objectives: To study frequency, causes outcome and complications of obstructed labour. Methods: 402 patients admitted with feature of obstructed labour were studied. Detailed history included sociodemographic factors, obstetric history, features of obstruction, intrapartum events were recorded. Condition of patients, mode of delivery, preoperative and postoperative complications, maternal and fetal outcomes was recorded. Results: A total of 23381 deliveries were conducted during one year, 402 cases of obstructed labour were found with incidence of 1.71%. 86.5 % of the patients were from rural areas and 78.1 % of patients were unbooked and73.3% patients were primigravida. The commonest cause of obstructed labour was cephalopelvic disproportion (55% followed by Malposition (22.9% and Malpresentation (17.9%. The commonest mode of delivery was cesarean section (83.8%. Instrumental deliveries were conducted in 10.5% of cases. Destructive procedures are discouraged in out set up. Rupture uterus was seen in 16 cases (4.16% out of which repair was done in 11 cases and subtotal hysterectomy was performed in 5 patients. The common maternal complications were sepsis [pyrexia (15.1%, wound infections (12.8%, urinary tract infection (7%, abdominal distention (11.2%, postpartum hemorrhage (9.7%. Perinatal mortality was 107/402 (26.6%, live birth rate 316/402 (78.7%, still birth rate 86/402 (21.3%. Perinatal morbidity was most commonly due to birth asphyxia (28.8%, jaundice (16.9%, septicemia (14.75%, meconium aspiration syndrome (9.9%. Conclusions: Obstructed labour is a preventable condition prevalent in developing countries. Improving nutrition, antenatal care, early diagnosis and timely intervention may
Full text: In the floors six, seven and eight of the general hospital of Vienna over eighty research laboratories for medical investigations with open and closed radioactive sources are installed. In these laboratories different working places and digestors for the handling of open radioactive materials in gaseous, liquid and aerosol form are placed for medical research purposes. These laboratories are divided due to the manner of handling and the amount of activity in three categories. The laboratories themselves and the different types of digestors are mantled and shielded with lead of variable thickness. For all these categories of working places and digestors the radionuclides were listed and the highest amount of these different radionuclides were calculated and tabulated in a form sheet, which is the basis for working procedures in these laboratories. Also the paper shows all radiation protection measures and the results of the dose- and dose rate measurements and the various inspection tests. At least the licensing procedures for radiation protection in detail will be shown and the important features listed. (author)
Abdel-Hady El-Gilany; Karima Badawy; Bernadette Sarraf
Abstract Aim: to assess knowledge of Standard Precautions and infection control by health care providers (HCPs) at the Students’ Hospital, Mansoura University, Egypt. Methods: All HCPs were targeted for a cross-sectional study. A previously validated self-administered questionnaire was used to gather information regarding basic characteristics and the following knowledge domains; the general concept of standard precautions, hand hygiene, personal protective equipments, sharp disposal, e...
Full Text Available Stroke is the third leading cause of death in the United States (US and a leading cause of serious, long-term disability. Incidence of ischemic stroke is higher than hemorrhagic stroke. The aim is to conduct pharmacoepidemiology study on cerebrovascular accident patient by evaluating the use and the effects of drugs, and quantification of adverse drug reactions, drug utilization studies to improve the quality and use of medicines. A prospective observational study was conducted in department of general medicine and ICU at Mallareddy hospital, data was collected from 130 patients and it was proposed to be conducted for 6 months. Among 130 patients 78(60% are males and 52(40% are females. Among all age groups major number of CVA patients was seen in 60-69 years (30%. Among them 92% of strokes are Ischemic majorly seen in both males and females and8% strokes are hemorrhagic. Ischemic stroke (94.87% is majorly seen in 60-69 yr age group. Among various risk factors Hypertension (36.43% is the major risk factor found in males (60% and females (40%.Antiplatelet drugs (25.75% are the highest number of drugs given in patients 71.27% in males and 28.72% in females. Highest numbers of drugs are given in 50-59yrs age group and are antiplatelets. As a clinical pharmacist 16 adverse drug reactions and 25 drug interactions are reported. Proper patient counselling is needed to reduce hypertension and to reduce the risk for cerebrovascular accident. Among all antiplatelet drugs are majorly given in males and lipid lowering drugs in females.
Grier Gareth; Davies Gareth; Habig Karel; Bredmose Per P; Lockey David J
Abstract Introduction We describe a system of scenario-based training using simple mannequins under realistic circumstances for the training of pre-hospital care providers. Methods A simple intubatable mannequin or student volunteers are used together with a training version of the equipment used on a routine basis by the pre-hospital care team (doctor + paramedic). Training is conducted outdoors at the base location all year round. The scenarios are led by scenario facilitators who are predo...
Campbell, Harry; Duke, Trevor; Weber, Martin; English, Mike; Carai, Susanne; Tamburlini, Giorgio
Deficiencies in the quality of health care are major limiting factors to the achievement of the Millennium Development Goals for child and maternal health. Quality of patient care in hospitals is firmly on the agendas of Western countries, but has been slower to gain traction in developing countries, despite evidence that there is substantial scope for improvement, that hospitals have a major role in child survival and that inequities in quality may be as important as inequities in access. Th...
Campbell, Harry; Duke, Trevor; Weber, Martin; English, Mike; Carai, Susanne; Tamburlini, Giorgio; Pediat Hosp Improvement Grp
Deficiencies in the quality of health care are major limiting factors to the achievement of the Millennium Development Goals for child and maternal health. Quality of patient care in hospitals is firmly on the agendas of Western countries but has been slower to gain traction in developing countries, despite evidence that there is substantial scope for improvement, that hospitals have a major role in child survival, and that inequities in quality may be as important as inequities in access. Th...
Al-Baharna, Marwa M.; Whitford, David L
Objectives: Primary care audits in Bahrain have consistently revealed a failure to meet recognised standards of delivery of process and outcome measures to patients with diabetes. This study aimed to establish for the first time the quality of diabetes care in a Bahraini hospital setting. Methods: A retrospective clinical audit was conducted of a random sample of patients attending the Diabetes and Endocrine Center at the Bahrain Defence Forces Hospital over a 15-month period which ended in J...
Sorensen, Bjarke Lund; Elsass, Peter; Nielsen, Brigitte Bruun;
OBJECTIVE: (i) To identify clinical causes of maternal deaths at a regional hospital in Tanzania and through confidential enquiry (CE) assess major substandard care and make a comparison to the findings of the internal maternal deaths audits (MDAs); (ii) to describe hospital staff reflections on ......, and staff dedication to the process was questioned. CONCLUSION: Quality assurance of emergency obstetric care might be strengthened by supplementing internal MDA with external CE....
Janaína Lopes da Silva; Emelynne Gabrielly de Oliveira Santos; Cintia Capistrano Teixeira Rocha; Cecília Nogueira Valença; Osvaldo de Góes Bay Júnior
Objective: to discuss the organization of Nursing technician’s work in the interface of the care of family members of hospitalized children and to identify their perception of the insertion of family in caring for this child. Methods: this is an exploratory descriptive study with a qualitative approach, undertaken in the pediatric inpatient unit of a university hospital with six Nursing technicians, through semi-structured interviews. Results: professionals realized the importance of the fami...
Judy Rashotte; Geraldine Coburn; Denise Harrison; Stevens, Bonnie J; Janet Yamada; Abbott, Laura K; the CIHR Team in Children’s Pain
BACKGROUND: Although documentation of children’s pain by health care professionals is frequently undertaken, few studies have explored the nature of the language used to describe pain in the medical records of hospitalized children.OBJECTIVES: To describe health care professionals’ use of written language related to the quality and quantity of pain experienced by hospitalized children.METHODS: Free-text pain narratives documented during a 24 h period were collected from the medical records of...
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 ...
Background: Self esteem (SE) and organizational commitment (OC) have significant impact on the quality of work life. Aim: This study aims to gain a better understanding of the relationships between SE and OC among health information management staff in tertiary care hospitals in Tehran (Iran). Methods: This was a descriptive correlational and cross sectional study conducted on the health information management staff of tertiary care hospitals in Tehran, Iran. A total of 155 participants were ...
Full Text Available Aim: Advanced cancer, irrespective of the site of the cancer, is characterized by a number of associated symptoms that impair the quality of life of patients. The management of these symptoms guides palliative care. The present study aims to describe the symptoms and appropriate palliation provided in patients with advanced cancer in a tertiary care hospital in Uttarakhand. Methods: This was an observational study. A total of 100 patients with advanced cancer were included in the study. The data obtained from the patients included symptoms reported by the patients, currently prescribed treatments and the site of cancer. Results: The average number of symptoms reported per patient was 5.33 ± 0.67 (mean ± SE. The most common symptoms were pain, weakness/fatigue, anorexia, insomnia, nausea/vomiting, dyspnea, constipation and cough. Polypharmacy was frequent. Patients consumed approximately 8.7 ± 0.38 (mean ± SE drugs on average during the 2-month period of follow-up. Conclusion: The result gives insight into the varied symptomatology of patients with advanced cancer. Polypharmacy was quite common in patients with advanced cancer, predisposing them to complicated drug interactions and adverse drug reactions.
Ylipalosaari, Pekka; Ala-Kokko, Tero I; Laurila, Jouko; Ohtonen, Pasi; Syrjälä, Hannu
Introduction The aim of this study was to elucidate the impact of intensive care unit (ICU)-acquired infection on hospital mortality. Methods Patients with a longer than 48 hour stay in a mixed 10 bed ICU in a tertiary-level teaching hospital were prospectively enrolled between May 2002 and June 2003. Risk factors for hospital mortality were analyzed with a logistic regression model. Results Of 335 patients, 80 developed ICU-acquired infection. Among the patients with ICU-acquired infections,...
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.
Witbrodt, Jane; Bond, Jason; Kaskutas, Lee Ann; Weisner, Constance; Jaeger, Gary; Pating, David; Moore, Charles
Male and female managed care clients randomized to day hospital (n=154) or community residential treatment (n=139) were compared on substance use outcomes at 6 and 12 months. To address possible bias in naturalistic studies, outcomes were also examined for clients who self-selected day hospital (n=321) and for clients excluded from randomization…
Franzin-Garrec, Martine; Hoden, Romy
Hospital at home structures are healthcare institutions in their own right, with the same obligations in terms of governance with regard to quality of care and risk management. However, hospital at home services are characterised by the remote management of the activity and the nursing staff, with specific constraints. PMID:27085929
Rasmussen, F.V.; Borgeskov, H.; Dollerup, J.; Jensen, M.S.; Roslind, K.; Nielsen, L.M.; Lange, Peter
We investigated whether the quality of management of COPD in general practice could be improved by the participation of general practitioners and their staff in a COPD-specific educational programme. One-hundred and fifty-four doctors participated in the study, and 2549 patient record forms were...... programme can improve the quality of COPD care in general practice Udgivelsesdato: 2008/8/25...
Tansella, M; Bellantuono, C
The main features of the psychiatric system and of the general practice system in Italy since the psychiatric reform and the introduction of a national health service are briefly described. Research conducted in Italy confirms that a large proportion of patients seen by general practitioners have psychological disorders and that only some of those patients whose psychological problems are identified by general practitioners are referred to specialist psychiatric care. Thus, the need to identi...
Full Text Available Rabies is a uniformly fatal disease, but preventable by timely and correct use of post exposure prophylaxis (PEP. Unfortunately, many health care facilities in Pakistan do not carry modern life-saving vaccines and rabies immunoglobulin (RIG, assuming them to be prohibitively expensive and unsafe. Consequently, Emergency Department (ED health care professionals remain untrained in its application and refer patients out to other hospitals. The conventional Essen regimen requires five vials of cell culture vaccine (CCV per patient, whereas Thai Red Cross intradermal (TRC-id regimen requires only one vial per patient, and gives equal seroconversion as compared with Essen regimen.This study documents the cost savings in using the Thai Red Cross intradermal regimen with cell culture vaccine instead of the customary 5-dose Essen intramuscular regimen for eligible bite victims. All patients presenting to the Indus Hospital ED between July 2013 to June 2014 with animal bites received WHO recommended PEP. WHO Category 2 bites received intradermal vaccine alone, while Category 3 victims received vaccine plus wound infiltration with Equine RIG. Patients were counseled, and subsequent doses of the vaccine administered on days 3, 7 and 28. Throughput of cases, consumption utilization of vaccine and ERIG and the cost per patient were recorded.Government hospitals in Pakistan are generally underfinanced and cannot afford treatment of the enormous burden of dog bite victims. Hence, patients are either not treated at all, or asked to purchase their own vaccine, which most cannot afford, resulting in neglect and high incidence of rabies deaths. TRC-id regimen reduced the cost of vaccine to 1/5th of Essen regimen and is strongly recommended for institutions with large throughput. Training ED staff would save lives through a safe, effective and affordable technique.
Grantham, M; Ross, S E; MacKay, R; Banfield, V; Brown, J; Beanlands, H
A career advancement program for nurses has been developed and implemented at the Victoria General Hospital, Halifax, as part of a manpower planning strategy for recruitment and retention of clinical nurses. A competency based performance appraisal system was developed and implemented as part of the program. This system identifies four levels of clinical expertise. Progression through each level indicates that a nurse has achieved a certain level of skill, knowledge and abilities. Demonstrated competence in one level is a prerequisite to promotion to the next level of practice. Implementation of this system provides clinical career opportunities for nurses in direct patient care. This article will provide the nurse administrator with an insight into the development and implementation of a clinical career advancement program. Future articles will described the research evaluation of the Clinical Performance Appraisal System and clinical nurses' reactions to the new system. PMID:2486680
Bathma Vishal; Likhar Swarn K; Mishra Mahesh K; Athavale Arvind V; Agarwal Sanjay; Shukla Uma S
Background: Biomedical waste (BMW) is waste generated during diagnosis, treatment or immunization of human beings or animals. Approximately 10-25% of the Bio-Medical waste is hazardous and can be injurious to humans or animals and deleterious to environment. It is estimated that annually about 0.33 million tones of hospital waste are generated in India. Objectives: To assess the knowledge regarding hospital waste management amongst hospital staff. Material and Methods: The study comprises of ...
U.S. Department of Health & Human Services — The Medicare Provider Analysis and Review (MEDPAR) file contains records for 100 percent of Medicare beneficiaries who received hospital inpatient services at a...
Full Text Available Introduction. In the Republic of Serbia the activity of general hospitals has not been sufficiently evaluated. Objective. The aim of this study was to evaluate, by analyzing the basic indicators of general hospitals condition and functioning, the network, utilization and efficacy of general hospitals for further improvement of their organization and work. Methods. The paper is a part of a retrospective-prospective analysis of hospital healthcare services which we performed in 2011. The research involved all 40 general hospitals in Serbia evaluated as a general hospitals system. We selected seven basic indicators of hospitals condition and functioning that we followed-up in the period 2000-2009. As the data source we used the Reports of the Office for Hospital Stationary Treatment of general hospitals and the Report of the Republican Institution for Statistics entitled Vital Events in the Republic of Serbia. Numerical data were analyzed using the methods of descriptive statistics and the program Microsoft Office Excel 2007 and SPSS for Windows. Statistical significance indicators of differences were determined by Student’s t-test. Results. In general hospitals during the studied years, the number of beds decreased by 16.5% (pt=0.057. The number of discharged patients was increased by 11.8% (pt=0.035. The number of hospitalization days was reduced by 11.2% (pt=0.038. The average length of treatment was reduced by 1.9 days (pt=0.074. The average daily bed occupancy was increased by 4% (pt=0.020. The utilization of beds was increased by 4.5% (pt=0.019. Throughput capacity of beds increased by 8.5 patients per bed or by 27.8% (pt=0.091. Conclusion. The most significant indicators of the utilization and efficacy of general hospitals were improved. Nevertheless, European and domestic guidelines were achieved only in the average length of treatment.
Kalavathi D. Biradar
Background: Infertility is a condition with important psychological, economic, demographic and medical implications. Male infertility refers to a male's inability to result pregnancy in a fertile female. Methods: The present hospital based study was conducted in the Department of Obstetrics and Gynaecology, East Point Hospital, Bangalore. Duration of the study was for 6 months from October 2015 to March 2016. A total of 250 infertile couples couple coming for evaluation to the outpatient d...
Abbas, Ahmed M.; Mariam T. Amin; Shymaa S. Ali; Neima Z. Salem
Background: Maternal mortality is one of the major challenges which face the developing countries throughout the world. The aim of the study is to assess the causes of maternal mortality at Women Health Hospital, Assiut University, Egypt, and to identify the avoidable ones. Methods: Data were collected from records of patients who presented to and/or delivered at Women Health Hospital between 2009 and 2014. Only cases of maternal mortality were included in this study. In our study, we foun...
Møller, JK; Bak, AL; Bülow, P;
strains from general practice. Multiple resistance was common especially in strains from hospital. R factors was found in 23% of the 317 drug-resistant strains from hospital and in 11% of the 46 drug-resistant strains from general practice. Resistance to streptomycin, sulphonamide and tetracycline either...
Greene, Frederick L; Gilkerson, Sharon; Tedder, Paige; Smith, Kathy
The hospital registry is a valuable tool for evaluating quality benchmarks in cancer care. As payment for performance standards are adopted, the registry will assume a more dynamic and economically important role in the hospital setting. At Carolinas Medical Center, the registry has been a key instrument in the comparison of state and national benchmarks and for program improvement in meeting standards in the care of breast and colon cancer. One of the significant successes of the American College of Surgeons Commission on Cancer (CoC) Hospital Approvals Program is the support of hospital registries, especially in small and midsized community hospitals throughout the United States. To become a member of the Hospital Approvals Program, a registry must be staffed appropriately and include analytic data for patients who have their primary diagnosis or treatment at the facility 1. The current challenge for most hospitals is to prove that the registry has specific worth when many facets of care are not compensated. Unfortunately a small number of hospitals have disbanded their registries because of the short-sighted decision that the registry and its personnel are a drain on the hospital system and do not generate revenue. In the present era of meeting benchmarks for care as a prelude to being paid by third party and governmental agencies 2,3, a primary argument is that the registry can be revenue-enhancing by quantifying specific outcomes in cancer care. Without having appropriate registry and abstract capability, the hospital leadership cannot measure the specific outcome benchmarks required in the era of "pay for performance" or "pay for participation". PMID:19466739
Full Text Available Background: Ventilator associated pneumonia (VAP is a major cause of poor outcome among patients in the intensive care units (ICU world-wide. OP poisoning patients are very susceptible to respiratory associated problems especially respiratory muscle paralysis. Such patients generally need ventilation support which has high chances of getting VAP. Objective: To find out the Prevalence, causative organisms and treatment pattern of VAP in OP poisoning patients in tertiary care hospital in South India. Methods: A retrospective study was conducted in a tertiary care teaching hospital of South India from 2008 to 2013, total of 500 patients were enrolled for the study and data was collected from the medical records in a suitable designed case record form. Information regarding demographical details, severity assessment, type of pneumonia acquired, causative organisms for VAP, complications, treatment and outcome measures of patients was recorded. Data was entered in SPSS 20.0 and analyzed for the results. Results and Conclusion: The mean age of the Patients admitted was 33.31 ± 14.5 years and majority of them were found to be males (69.4% and (30.6% were females. Among the study population, 54 (10.8% patients acquired VAP. The most common organisms found to have caused pneumonia were gram negative organisms such as Pseudomonas aeruginosa (1.2%, Klebsiella pneumoniae (1.0% and Acinobacter (0.6%. The most commonly used antibiotics in the treatment of VAP were beta-lactam antibiotics like Cephalosporins (56.1%, Penicillins (31.9%. Respiratory problems are common in OP poisoning patients and hence are very susceptible to VAP. Proper screening and identification of organisms in the early stage with appropriate antibiotics will help in better outcome.
LaQuia A. Vinson
Full Text Available The purpose of this study was to determine if differences in behavior exist following dental treatment under hospital-based general anesthesia (HBGA or office-based general anesthesia (OBGA in the percentage of patients exhibiting positive behavior and in the mean Frankl scores at recall visits. This retrospective study examined records of a pediatric dental office over a 4 year period. Patients presenting before 48 months of age for an initial exam who were diagnosed with early childhood caries were included in the study. Following an initial exam, patients were treated under HBGA or OBGA. Patients were followed to determine their behavior at 6-, 12- and 18-month recall appointments. Fifty-four patients received treatment under HBGA and 26 were treated under OBGA. OBGA patients were significantly more likely to exhibit positive behavior at the 6- and 12-month recall visits p = 0.038 & p = 0.029. Clinicians should consider future behavior when determining general anesthesia treatment modalities in children with early childhood caries presenting to their office.
... payments published in the FY 2011 IPPS final rule (75 FR 50042). Overall, all hospitals will experience an... exceptions policy (see the FY 2005 IPPS final rule, 69 FR 49105). ** This hospital has been assigned a wage... 2011 IPPS/LTCHPPS final rule) appeared in the August 16, 2010 Federal Register (75 FR 50042) and...
Krüger, A J; Lossius, H M; Mikkelsen, S;
All Scandinavian countries provide anaesthesiologist-staffed pre-hospital services. Little is known of the incidence of critical illness or injury attended by these services. We aimed to investigate anaesthesiologist-staffed pre-hospital services in Scandinavia with special emphasis on incidence...
... relating to the administration of vaccines by nursing staff as well as the CoPs for critical access... Administration, Validation, and Reconsideration Issues. Shaheen Halim, (410) 786-0641, Hospital Inpatient Quality... of American Hospitals FDA Food and Drug Administration FFY Federal fiscal year FPL Federal...
Full Text Available Abstract Background Ambulatory care-sensitive conditions (ACSC, such as hypertension, diabetes, chronic heart failure, chronic obstructive pulmonary disease and asthma, are conditions that can be managed with timely and effective outpatient care reducing the need of hospitalization. Avoidable hospitalizations for ACSC have been used to assess access, quality and performance of the primary care delivery system. The aims of this study were to quantify the proportion of avoidable hospital admissions for ACSCs, to identify the related patient's socio-demographic profile and health conditions, to assess the relationship between the primary care access characteristics and preventable hospitalizations, and the usefulness of avoidable hospitalizations for ACSCs to monitor the effectiveness of primary health care. Methods A random sample of 520 medical records of patients admitted to medical wards (Cardiology, Internal Medicine, Pneumology, Geriatrics of a non-teaching acute care 717-bed hospital located in Catanzaro (Italy were reviewed. Results A total of 31.5% of the hospitalizations in the sample were judged to be preventable. Of these, 40% were for congestive heart failure, 23.2% for chronic obstructive pulmonary disease, 13.5% for angina without procedure, 8.4% for hypertension, and 7.1% for bacterial pneumonia. Preventable hospitalizations were significantly associated to age and sex since they were higher in older patients and in males. The proportion of patients who had a preventable hospitalization significantly increased with regard to the number of hospital admissions in the previous year and to the number of patients for each primary care physician (PCP, with lower number of PCP accesses and PCP medical visits in the previous year, with less satisfaction about PCP health services, and, finally, with worse self-reported health status and shorter length of hospital stay. Conclusion The findings from this study add to the evidence and the
Patel Disha A, Patel Kiran B, Bhatt Seema K, Shah Hetal S
Present study was undertaken to know the rate of Hospital acquired infection in general surgical wards with special reference to surgical site infections with their antibiotic resistance pattern and to find out the source of the infection to develop preventive measures to reduce the risk of hospital acquired infection. Prospective surveillance for hospital acquired infections was performed during period from January 2006 to June 2006 in the wards of general surgery. One day prevalence study w...
Baldwin, Laura-Mae; Chan, Leighton; Andrilla, C. Holly A.; Huff, Edwin D.; Hart, L. Gary
Background: In the mid-1990s, significant gaps existed in the quality of acute myocardial infarction (AMI) care between rural and urban hospitals. Since then, overall AMI care quality has improved. This study uses more recent data to determine whether rural-urban AMI quality gaps have persisted. Methods: Using inpatient records data for 34,776…
A large scale study on maternity care in the Netherlands, describing many facets of midwifery care in relation to the preferred place of birth (at home or in hospital), the obstetric result, and the experiences of childbirth. In the Netherlands only women with low risk pregnancies are free to cho
Conclusions: Universal precaution practice was poor. Training of the health care workers, proper equipment supply, posters displaying guidelines and proper hospital policy of patient load management would help in improving the implementation of universal precaution thus restoring occupational safety of health care workers. [Int J Res Med Sci 2016; 4(2.000: 606-609
Lomborg, Kirsten; Bjoern, Agnes; Dahl, Ronald;
inability to manage personal body care by themselves have not previously been explored. This study explored patients' experiences of being assisted with personal body care. Methods. A grounded theory methodology was used with a convenience sample of 12 patients. Data were gathered from participant...
Zhang, Xing; Oyama, Tatsuo
Japan's health care system is considered one of the best health care systems in the world. Hospitals are one of the most important health care resources in Japan. As such, we investigate Japanese hospitals from various viewpoints, including their roles, ownership, regional distribution, and characteristics with respect to the number of beds, staff, doctors, and financial performance. Applying a multivariate analysis and regression model techniques, we show the functional differences between urban populated prefectures and remote ones; the equality gap among all prefectures with respect to the distribution of the number of beds, staff, and doctors; and managerial differences between private and public hospitals. We also review and evaluate the local public hospital reform executed in 2007 from various financial aspects related to the expenditure and revenue structure by comparing public and private hospitals. We show that the 2007 reform contributed to improving the financial situation of local public hospitals. Strategic differences between public and private hospitals with respect to their management and strategy to improve their financial situation are also quantitatively analyzed in detail. Finally, the remaining problems and the future strategy to further improve the Japanese health care system are described. PMID:27051323
Angeles C, A.; Hernandez C, J. E.; Rodriguez A, F.; Garcia A, J
The Ciudad del Carmen general hospital, dependent of PEMEX, It request consultant of the ININ to be able to maintain their sanitary license for the use of X-ray equipment for the radiologic diagnostic.The proposal of the ININ was to be a program of technical attendance, schedule monthly to be able to solve the observations that are presented in the use of those equipment, and that the hospital can conserve its respective sanitary license.(Author)
Chung, Roger Y.; Mercer, Stewart W.; Yip, Benjamin H. K.; Chan, Stephanie W. C.; Lai, Francisco T. T.; Wang, Harry H. X.; Wong, Martin C. S.; Wong, Carmen K. M.; Sit, Regina W. S.; Yeoh, Eng-Kiong; Wong, Samuel Y. S.
Using data collected from 25,780 Hong Kong citizens in a household survey, this study aimed to investigate the association between having regular source of primary care and hospitalization amongst people with and without multimorbidity (two or more chronic conditions). Potential interaction effects of regular primary care with multimorbidity were also examined. Results revealed a significant association between having regular source of primary care from General Practitioners and reduced hospitalization amongst respondents with multimorbidity (RR = 0.772; 95% CI = 0.667–0.894), adjusting for other potential confounding factors (i.e., socio-demographic factors and medical insurance and benefits). In contrast, having regular Specialist care was significantly associated with increased risk of hospitalization among both people with multimorbidity (RR = 1.619; 95% CI = 1.256–2.087) and without multimorbidity (RR = 1.981; 95% CI = 1.246–3.149), adjusting for potential confounders. A dose-response relationship between the number of chronic diseases and hospitalization was also observed, regardless of whether participants had regular source of primary care or not; relative risks and predicted probabilities for hospitalization were generally greater for those without regular source of primary care. Further studies are warranted to explore the role of healthcare system, informatics, organizational and practice-related factors on healthcare and functional outcomes. PMID:27435519
Cordova, Richard D; Beaudin, Christy L; Iwanabe, Kelly E
Healthcare disparities are a major challenge for hospital and healthcare system leadership. Leaders must possess vision, visibility, and ability to drive organizational change toward an environment that fosters diversity and cultural competence. As challenging economic conditions force management to make difficult budgetary decisions, the integration of equity into the organization's core mission and strategic process is essential for sustainability. Building organizational capacity requires systematic actions including workforce composition, training and development, and policy advocacy. This article offers perspectives on the current state of diversity in hospitals, exemplars from pediatric hospitals, and considerations for the future. Healthcare leaders are influential in shaping the future of the organization through strategic planning and resource allocation to those efforts that enhance services, programs, and processes that support a culture of diversity and equity. PMID:20364641
Daniel Ferreira Dahdah; Ana Maria Pimenta Carvalho; Juliana Carla Delsim; Bruna Romano Gomes; Vanessa Spera de Miguel
There is a consensus in the literature that the company of a family member during the hospitalization period increases patient recovery. However, this can have some negative effects on the caregiver’s health. With the purpose of reducing these negatives effects, it is useful to let family members express themselves. The State Hospital of Ribeirão Preto created a Group of Family Companions coordinated by the Occupational Therapy and Social Service. This study focuses on the assistance offered ...
Miller, Andrew D.; Mishra, Sonali R.; Kendall, Logan; Haldar, Shefali; Pollack, Ari H.; Pratt, Wanda
Informal caregivers, such as close friends and family, play an important role in a hospital patient’s care. Although CSCW researchers have shown the potential for social computing technologies to help patients and their caregivers manage chronic conditions and support health behavior change, few studies focus on caregivers’ role during a multi-day hospital stay. To explore this space, we conducted an interview and observation study of patients and caregivers in the inpatient setting. In this paper, we describe how caregivers and patients coordinate and collaborate to manage patients’ care and wellbeing during a hospital stay. We define and describe five roles caregivers adopt: companion, assistant, representative, navigator, and planner, and show how patients and caregivers negotiate these roles and responsibilities throughout a hospital stay. Finally, we identify key design considerations for technology to support patients and caregivers during a hospital stay.
Dias, Casimiro; Escoval, Ana
The perspective of innovation as the strategic lever of organizational performance has been widespread in the hospital sector. While public value of innovation can be significant, it is not evident that innovation always ends up in higher levels of performance. Within this context, the purpose of the article was to critically analyze the relationship between innovation and performance,taking into account the specificities of the hospital sector. This article pulls together primary data on organizational flexibility, innovation, and performance from 95 hospitals in Portugal,collected through a survey, data from interviews to hospital administration boards, and a panel of 15 experts. The diversity of data sources allowed for triangulation. The article uses mixed methods to explore the relationship between innovation and performance in the hospital sector in Portugal. The relationship between innovation and performance is analyzed through cluster analysis, supplemented with content analysis of interviews and the technical nominal group. The main findings reveal that the cluster of efficient innovators has twice the level of performance than other clusters. Organizational flexibility and external cooperation are the 2 major factors explaining these differences. The article identifies various organizational strategies to use innovation in order to enhance hospital performance. Overall, it proposes the alignment of perspectives of different stakeholders on the value proposition of hospital services, the embeddedness of information loops, and continuous adjustments toward high-value services. PMID:24902144
McCarroll, Michele L; Armbruster, Shannon D; Chung, Jae Eun; Kim, Junghyun; McKenzie, Alissa; von Gruenigen, Vivian E
The objective of this article is to illustrate user characteristics of a hospital's social media structure using analytics and user surveys. A 1-year retrospective analysis was conducted along with an Internet survey of users of the hospital's Facebook, Twitter, and blog. Of the survey respondents (n = 163), 95.7% are female and 4.3% are male; most are ages 50-59 years (31.5%) and 40-49 years (27.8%); and 93.2% are Caucasian. However, the hospital system database revealed 55% female and 37% minority population, respectively. Of the survey respondents, 61.4% reported having a bachelor's degree or higher, whereas only 11.7% reported having a high school degree/equivalent or lower. However, within the hospital patient databases, 93% of patients have a high school degree/equivalent or lower and only 3% have a bachelor's degree or higher in our women's services population. Social media were used to seek personal health information 68.7% (n = 112), to learn about hospital programming 27.6% (n = 45), and to seek family health information 25.2% (n = 41). Respondents younger than 49 years of age were more likely to seek personal health information using social media compared to those 50 years of age and older (p = .02). Respondents with a bachelor's degree or higher education were statistically less likely to search for physician information compared to those less educated individuals (p = .04). We conclude that social media may play an important role in personal health information, especially for young female respondents; however, the survey provides strong evidence that further research is needed to ensure that social network sites provided by hospitals are reaching the full spectrum of health system patients. PMID:24295109
Gonsaga Ricardo; Brugugnolli Izabela; Fraga Gustavo
Abstract Objectives Pre-hospital care (PH) in Brazil is currently in the phase of implementation and expansion, and there are few studies on the impacts of this public health service. The purpose of this study is to assess the quality of care and severity of trauma among the population served, using trauma scores, attendance response times, and mortality rates. This work compares two pre-hospital systems: the Mobile Emergency Care Service, or SAMU 192, and the Fire Brigade Group, or CB. Metho...
Wolfe, Barbara E; Dunne, Julie P; Kells, Meredith R
Eating disorders are chronic psychiatric illnesses with significant medical complications, psychological distress, and psychiatric comorbidity. Although many patients are treated on an outpatient basis, inpatient care for the more severely ill hospitalized patient can be challenging given the severity of illness and concurrent issues requiring intervention. This article provides an overview of the clinical characteristics of eating disorders typically seen for inpatient care, focusing primarily on anorexia nervosa and bulimia nervosa, and the associated key areas for nursing assessment, diagnoses, and plan of care during hospitalization. PMID:27229277
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...
Yu, Mo; Guerriere, Denise N; Coyte, Peter C
In Canada, health system restructuring has led to a greater focus on home-based palliative care as an alternative to institutionalised palliative care. However, little is known about the effect of this change on end-of-life care costs and the extent to which the financial burden of care has shifted from the acute care public sector to families. The purpose of this study was to assess the societal costs of end-of-life care associated with two places of death (hospital and home) using a prospective cohort design in a home-based palliative care programme. Societal cost includes all costs incurred during the course of palliative care irrespective of payer (e.g. health system, out-of-pocket, informal care-giving costs, etc.). Primary caregivers of terminal cancer patients were recruited from the Temmy Latner Centre for Palliative Care in Toronto, Canada. Demographic, service utilisation, care-giving time, health and functional status, and death data were collected by telephone interviews with primary caregivers over the course of patients' palliative trajectory. Logistic regression was conducted to model an individual's propensity for home death. Total societal costs of end-of-life care and component costs were compared between home and hospital death using propensity score stratification. Costs were presented in 2012 Canadian dollars ($1.00 CDN = $1.00 USD). The estimated total societal cost of end-of-life care was $34,197.73 per patient over the entire palliative trajectory (4 months on average). Results showed no significant difference (P > 0.05) in total societal costs between home and hospital death patients. Higher hospitalisation costs for hospital death patients were replaced by higher unpaid caregiver time and outpatient service costs for home death patients. Thus, from a societal cost perspective, alternative sites of death, while not associated with a significant change in total societal cost of end-of-life care, resulted in changes in the distribution of
Interconsulta psicológica: demanda e assistência em hospital geral Interconsulta psicológica: demanda y asistencia en hospital general Consultation-liaison psychology: demand and assistance in general hospital
Nátali Castro Antunes Santos
adaptación del paciente a la hospitalización (41%. El modelo adoptado referencia psicológica era apropiado en el contexto estudiado, con la participación del equipo multidisciplinario en la efectividad de la práctica.The consultation-liaison psychology in general hospitals represents a modality of clinical and a methodological tool used by psychologists in inpatient care, upon the request of other health professionals. The study aimed to characterize the psychological demands of the liaison in a general hospital, from the analysis of attendance records request. One hundred and seven patients were treated between January and June 2010, in which 53% of the participants were male and 57% of adults over 45 years. Most requests were performed by physicians (44% and nurses (38%, formally (59%, and previous contact between interconsultor and the applicant (85%. The main reasons given for the request liaison were: psychological symptoms related to illness (43% and identification of impairment in the patient's adaptation to hospitalization (41%. The psychological liaison model adopted was appropriate to the studied context, with engagement of the multidisciplinary team in the effectiveness of practice.
Park, Dong Won; Moon, Jae Young; Ku, Eun Yong; Kim, Sun Jong; Koo, Young-Mo; Kim, Ock-Joo; Lee, Soon Haeng; Jo, Min-Woo; Lim, Chae-Man; Armstrong, John David; Koh, Younsuck
This research aimed to investigate the changes in ethical issues in everyday clinical practice recognized by critical care nurses during two observation periods. We conducted a retrospective analysis of data obtained by prospective questionnaire surveys of nurses in the intensive care units (ICU) of a tertiary university-affiliated hospital in Seoul, Korea. Data were collected prospectively during two different periods, February 2002-January 2003 (Period 1) and August 2011-July 2012 (Period 2...
Arambepola, Carukshi; Lalini C. Rajapaksa; Galwaduge, Chandani
Background Good quality post-abortion-care (PAC) is essential to prevent death and long-term complications following unsafe abortion, especially in countries with restrictive abortion laws. We assessed the PAC given to women following an unsafe abortion, compared to the routine hospital care following spontaneous abortion or unintended pregnancy carried to term in Sri Lanka. Methods A case–control study was conducted in Sri Lanka among 171 cases following unsafe abortion, 638 controls followi...
Baggot, Deirdre; Edeburn, Andy
Health care is on the brink of an industrywide shift to a bundled payment model in which payment covers episodes of care extending from prehospitalization into post-acute care. Hospitals and health systems should begin development of a post-acute care network strategy in preparation for bundled payments. The strategic effort will require four broad phases: Defining the value proposition. Developing the post-acute care network. Building the bundle. Executing smartly from the start with new delivery models that reduce clinical variation and real-time performance monitoring. PMID:26595978
Kassim, M S; George, R; Kassim, K; Begum, M; Cherian, M P; Tajudin, A K; Chandran, V; Anan, A; Reddy, R; Singh, J
Eighty-six children diagnosed as child abuse and/or neglect were admitted to the Paediatric wards of the General Hospital, Kuala Lumpur during 1985 and 1986. Of these cases, 62 were of physical abuse, six of sexual abuse, one case of both physical and sexual abuse and 17 of neglect. There were 25 boys and 61 girls. Thirty-four of these children were Malays, 16 Chinese, 26 Indians, three mixed and seven illegal immigrants. Twenty-one were below the age of one year, 24 from one to four years, 25 from five to nine years and 16 were ten years and above. The abusers were mainly close members of the family. Of these children, 24 were sent back to their parents and 11 to their relatives home. Twenty-seven were taken into care by the Ministry of Social Welfare and the remaining seven children who were illegal immigrants, were deported with their parents. Only one child was successfully fostered. Eleven children were taken away from the hospital by their parents or guardians without the knowledge of the health staff. There were five deaths in the series. PMID:2626119
Ball, J.; Griffiths, P; Rafferty, A; Lindqvist, R.; Murrells, T; Tishelman, C.
Aims: To determine factors associated with variation in ‘care left undone’ (also referred to as “missed care”) by registered nurses in acute hospital wards in Sweden. Background: ‘Care left undone’ has been examined as a factor mediating the relationship between nurse staffing and patient outcomes. The context has not previously been explored to determine what other factors are associated with variation in ‘care left undone’ by registered nurses. Design: Cross-sectional su...
Background: Malnutrition is a common problem for residents of nursing homes and long-term care hospitals. It has a negative influence on elderly residents and patients health and quality of life. Nutritional care seems to have a positive effect on elderly individuals nutritional status and well-being. Studies of Finnish elderly people s nutrition and nutritional care in institutions are scarce. Objectives: The primary aim was to investigate the nutritional status and its associated fa...
Full Text Available BACKGROUND: The demand for high quality hospital care for children in low resource countries is not being met. This paper describes a number of strategies to improve emergency care at a children's hospital and evaluates the impact of these on inpatient mortality. In addition, the cost-effectiveness of improving emergency care is estimated. METHODS AND FINDINGS: A team of local and international staff developed a plan to improve emergency care for children arriving at The Ola During Children's Hospital, Freetown, Sierra Leone. Following focus group discussions, five priority areas were identified to improve emergency care; staff training, hospital layout, staff allocation, medical equipment, and medical record keeping. A team of international volunteers worked with local staff for six months to design and implement improvements in these five priority areas. The improvements were evaluated collectively rather than individually. Before the intervention, the inpatient mortality rate was 12.4%. After the intervention this improved to 5.9%. The relative risk of dying was 47% (95% CI 0.369-0.607 lower after the intervention. The estimated number of lives saved in the first two months after the intervention was 103. The total cost of the intervention was USD 29 714, the estimated cost per death averted was USD 148. There are two main limitation of the study. Firstly, the brevity of the study and secondly, the assumed homogeneity of the clinical cases that presented to the hospital before and after the intervention. CONCLUSIONS: This study demonstarted a signficant reductuion in inpatient mortality rate after an intervention to improve emergency hospital care If the findings of this paper could be reproduced in a larger more rigorous study, improving the quality of care in hospitals would be a very cost effective strategy to save children's lives in low resource settings.
... of the beneficiary's inpatient admission and the hospital does not attest that such service is... the long-term care hospital prospective payment system. 412.540 Section 412.540 Public Health CENTERS... PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care...
Full Text Available Abstract Background In the majority of China, the Centre for Disease Control (CDC at the county level provides both clinical and public health care for TB cases, with hospitals and other health facilities referring suspected TB cases to the CDC. In recent years, an integrated model has emerged, where the CDC remains the basic management unit for TB control, while a general hospital is designated to provide clinical care for TB patients. This study aims to explore the factors that influence the integration of TB services in general hospitals and generate knowledge to aid the scale-up of integration of TB services in China. Methods This study adopted a qualitative approach using interviews from sites in East and West China. Analysis was conducted using a thematic framework approach. Results The more prosperous site in East China was more coordinated and thus had a better method of resource allocation and more patient-orientated service, compared with the poorer site in the West. The development of public health organizations appeared to influence how effectively integration occurred. An understanding from staff that hospitals had better capacity to treat TB patients than CDCs was a strong rationale for integration. However, the economic and political interests might act as a barrier to effective integration. Both sites shared the same challenges of attracting and retaining a skilled workforce for the TB services. The role of the health bureau was more directive in the Western site, while a more participatory and collaborative approach was adopted in the Eastern site. Conclusion The process of integration identifies similarities and differences between sites in more affluent East China and poorer West China. Integration of TB services in the hospitals needs to address the challenges of stakeholder motivations and resource allocation. Effective inter-organizational collaboration could help to improve the efficiency and quality of TB service. Key
This manual is intended for young people with spinal cord injuries who are receiving rehabilitation services within the Spinal Cord Injury Unit at Shriners Hospital (San Francisco, California). An introduction describes the rehabilitation program, which includes family conferences, an individualized program, an independent living program,…
Louis, D Z; Yuen, E J; Braga, M.; A. Cicchetti; Rabinowitz, C; Laine, C; Gonnella, J S
OBJECTIVE: To examine potential changes in quality of care associated with a recent financing system implementation in Italy: in 1995, hospital financing reform implemented in Italy included the introduction of a DRG-based hospital financing system with the goals of controlling the growth of hospital costs and making hospitals more accountable for their productivity. DATA SOURCES: Hospital discharge abstract data from 1993 through 1996 for all hospitals (N=32) in the Friuli-Venezia-Giulia reg...
Parasuicide cases among youth (15-24 years) referred to the clinical psychology section of a regional hospital from 1995 to 1998 were reviewed. In all 100 cases (37 males and 63 females) were identified being about 10% of the caseload. As part of the clinical psychological assessment sociodemographic, clinical characteristics, trigger factors, employed methods and suicide intentions were analysed. Most patients were students (79%) or unemployed (16%). The major method employed to attempt suic...
Full Text Available In our scientific approach we tried to develop a model with which to highlight the effect of financing hospital health care providers using the hospital 's Diagnosis Related Groups (DRG and Mean Relative Values (MRV. The econometric model used is simple linear regression model form. Development of the model was performed by using the EViews 7 to the municipal hospitals in Romania during 2010 - 2012, being considered DRG dependent variable and independent variables: C and MRV. Analyzing in detail the results recorded by providers following simple regression model is observed that there are units which, although recorded low values in the number of patients discharged, they were able to achieve a relatively high VRM or to contract a level of TAC over average of the entire sample.
Full Text Available Jordana K Schmier,1 Carolyn K Hulme-Lowe,1 Svetlana Semenova,2 Juergen A Klenk,3 Paul C DeLeo,4 Richard Sedlak,5 Pete A Carlson6 1Health Sciences, Exponent, Inc., Alexandria, VA, 2EcoSciences, Exponent, Inc., Maynard, MA, 3Health Sciences, Exponent, Inc., Alexandria, VA, 4Environmental Safety, 5Technical and International Affairs, American Cleaning Institute, Washington, DC, 6Regulatory Affairs, Ecolab, Saint Paul, MN, USA Objectives: Health care-associated infections (HAIs pose a significant health care and cost burden. This study estimates annual HAI hospital costs in the US avoided through use of health care antiseptics (health care personnel hand washes and rubs; surgical hand scrubs and rubs; patient preoperative and preinjection skin preparations. Methods: A spreadsheet model was developed with base case inputs derived from the published literature, supplemented with assumptions when data were insufficient. Five HAIs of interest were identified: catheter-associated urinary tract infections, central line-associated bloodstream infections, gastrointestinal infections caused by Clostridium difficile, hospital- or ventilator-associated pneumonia, and surgical site infections. A national estimate of the annual potential lost benefits from elimination of these products is calculated based on the number of HAIs, the proportion of HAIs that are preventable, the proportion of preventable HAIs associated with health care antiseptics, and HAI hospital costs. The model is designed to be user friendly and to allow assumptions about prevention across all infections to vary or stay the same. Sensitivity analyses provide low- and high-end estimates of costs avoided. Results: Low- and high-end estimates of national, annual HAIs in hospitals avoided through use of health care antiseptics are 12,100 and 223,000, respectively, with associated hospital costs avoided of US$142 million and US$4.25 billion, respectively. Conclusion: The model presents a novel
Raja Sekhar Kennedy
Full Text Available INTRODUCTION: Tumors of the Central Nervous S ystem , are the second commonest childhood tumors and are the most common solid paediatric tumors comprising 40% - 50% of all tumors . 1 2 Posterior fossa brain tumors are one of the most devastating forms of human illnesses wh ich are more common in children. AIMS AND OBJECTIVES : To study the incidence, clinicopathological features and management of paediatric posterior fossa tumors. MATERIALS AND METHOD S : This is a prospective study done in the Department of Neurosurgery, Ranga raya Medical College, Government General Hospital, Kakinada from 2012 to 2015. It is a Tertiary Care Hospital. A total of 25 paediatric patients ranging from infants to 15 years were included in the study. DISCUSSION AND CONCL USION: Posterior fossa tumors are the commonest solid brain tumors of children with a rate of 2.4 per lakh of children at risk per year. The predominant symptoms are headache and vomiting followed by cerebellar symptoms (gait disturbances. Posterior fossa tumors are predominantly seen in children with peak incidence in first decade. Commonest presenting symptoms are due to raised intracranial pressure with headache and vomiting followed by cerebellar symptoms. Meticulous microsurgical techniques are to be followed in removing these tum ors. The incidence of recurrence is very less after gross total excision. Prognosis is good in patients with total excision
Full Text Available Abstract Background Telemedicine technology can improve care to patients in rural and medically underserved communities yet adoption has been slow. The objective of this study was to study organizational readiness to participate in an academic-community hospital partnership including clinician education and telemedicine outreach focused on sepsis and trauma care in underserved, rural hospitals. Methods This is a multi-method, observational case study. Participants included staff from 4 participating rural South Carolina hospitals. Using a readiness-for-change model, we evaluated 5 general domains and the related factors or topics of organizational context via key informant interviews (n=23 with hospital leadership and staff, compared these to data from hospital staff surveys (n=86 and triangulated data with investigators’ observational reports. Survey items were grouped into 4 categories (based on content and fit with conceptual model and scored, allowing regression analyses for inferential comparisons to assess factors related to receptivity toward the telemedicine innovation. Results General agreement existed on the need for the intervention and feasibility of implementation. Previous experience with a telemedicine program appeared pivotal to enthusiasm. Perception of need, task demands and resource need explained nearly 50% of variation in receptivity. Little correlation emerged with hospital or ED leadership culture and support. However qualitative data and investigator observations about communication and differing support among disciplines and between staff and leadership could be important to actual implementation. Conclusions A mixed methods approach proved useful in assessing organizational readiness for change in small organizations. Further research on variable operational definitions, potential influential factors, appropriate and feasible methods and valid instruments for such research are needed.
Vos, L; van Oostenbrugge, R.J.; Limburg, M.; Merode, G.G. van; Groothuis, S.
Dutch hospitals are in the midst of a transition towards process-oriented organisation to realise optimal and undisturbed care processes. Between 2004 and 2007, the University Hospital of Maastricht conducted a case study implementing process-oriented in-hospital stroke unit care. The case study consisted of four steps: (1) process analysis; (2) identification of bottlenecks; (3) setting goals for process-oriented care, and selection of coordination measures; and (4) implementation and evalua...
Muñoz, E; Goldstein, J; Benacquista, T; Mulloy, K; Wise, L
The Medicare system of prospective payment to hospitals based on diagnostic related groups (DRG) has been severely criticized at a number of levels. Many states are using DRG prospective "All Payor Systems" for reimbursement to hospitals with the federal DRG system as a model. In All Payor Systems, Medicare, Medicaid, Blue Cross and other commercial insurers pay by the DRG mode; the state of New York has been All Payor since 1 January 1988. This study simulated DRG All Payor methods on a large sample (N = 17,560) of surgical patients for a two year period, using both federal and New York DRG reimbursement methods currently in effect. Both Medicare and Medicaid patients had, on average, a longer length of stay in the hospital and higher total cost of hospitalization compared with patients from Blue Cross and other commercial payors. Medicare and Medicaid patients also had a greater severity of illness compared with patients from Blue Cross or other payors. All except commercial insurors (that is, Medicaid, Blue Cross and Medicare) had greater financial risk under the DRG All Payor scheme. Results from our study suggest that federal, state and private payors may not be adequately reimbursing health care providers for the care of the hospitalized surgical patient under the DRG prospective scheme of hospital payment. It appears that the financing policy for health care, especially at the federal and state level, could limit both the access and quality of care for surgical patients. PMID:2496483
HAO Zhen-feng; AO Jun-hong; HAO Fei; YANG Rong-ya; ZHU He; ZHANG Jie
Background Invasive fungal infections have constituted an increasingly important cause of morbidity and mortality in immunocompromised patients. In this study, a surveillance project was conducted in three different intensive care units of two large tertiary hospitals in China.Methods A one-year surveillance project was conducted in two tertiary hospitals which located in northern China and southwest China respectively. Air, surfaces and tap water were sampled twice a month in a central intensive care unit, a bone marrow transplant unit, a neurosurgery intensive care unit and a live transplant department. Environmental conditions such as humidity, temperature and events taking place, for example the present of the visitors, healthcare staff and cleaning crew were also recorded at the time of sampling.Results The air fungal load was 91.94 cfu/m3 and 71.02 cfu/m3 in the southwest China hospital and the northern China hospital respectively. The five most prevalent fungi collected from air and surfaces were Penicillium spp., Cladospcrium spp., Altemaria spp., Aspergillus spp. and Saccharomyces spp. in the southwest China hospital, meanwhile Penicillium spp., Fusarium spp., Aspergillus spp., Altemaria spp. and Cladospcrium spp. in the northern China hospital. The least contaminated department was intensive care units, and the heaviest contaminated department was neurosurgery intensive care unit. Seventy-three percent of all surfaces examined in the northern China hospital and eighty-six percent in the southwest China hospital yielded fungi. Fifty-four percent of water samples from the northern China hospital and forty-nine percent from the southwest China hospital yielded fungi.Conclusions These findings suggested that the fungus exist in the environment of the hospital including air, surface and water. Air and surface fungal load fluctuated over the year. Air fungal load was lower in winter and higher In summer and autumn, but seldom exceeded acceptable level. The
Maria Lucia Medeiros Lenz
Full Text Available The hospitalization of a child, in addition to bringing about major family distress, is a costly event for the health system. Besides, it can often be avoided on an outpatient care basis. The aim of this study was to identify the percentage of hospitalizations for Ambulatory Care Sensitive (ACS conditions, i.e. those for which effective and timely care can avoid hospital admission. We investigated 3.329 hospitalizations of patients under 19 years of age, occurred between 2001 and 2004 in four hospitals of the Brazilian Health System (SUS, the main references for a population of areas astricted to a primary care service (PCS. The hospitalizations in this population were identified using the hospital information system of the GHC (Grupo Hospitalar Conceição. Univariate and multivariate analysis were employed to verify associations between independent variables and the occurrence of admissions for ACS conditions. A hospitalization rate of 2.9% was found for the studied age group. Respiratory system disorders were the leading cause of admission (36%, followed by perinatal diseases (14%, infectious and parasitic diseases (10%, disorders of the digestive system (9%, and external causes (6%. Readmission accounted for 16% of the total admissions. The hospitalization rate for ACS conditions was 35.6%, ranging from 25% to 43% across the Health Care Centers of the PCS. The variables associated with higher occurrence of hospitalizations for this reason were: age between 1 and 4 years (p<0.01; having gone straight to the hospital because the Unit was closed (p=0.04; and having gone straight to the hospital due to the severity of the case (p=0.03. The study points to the need for a better monitoring of hospitalizations for ACS conditions - occurring more frequently in the winter months and involving children from 1 to 9 years of age for being more vulnerable to respiratory diseases - and of the number of readmissions, which did not decrease over the last
Ana Cleide Guedes Moreira; Cassandra Regina de Amorim Pamplona
Este trabalho participa de investigação sobre a inserção da Psicanálise no campo institucional e hospitalar de saúde, objetivando formular contribuições, a partir da clínica da melancolia e dos estados depressivos, para a construção de dispositivos clínicos em hospital geral do Sistema Único de Saúde.This paper is a part of a research project that investigates the insertion of Psychoanalysis into the health institutional field and hospitals; the objective is to formulate contributions from th...
Bao, Yuhua; Sturm, Roland
BACKGROUND: Inpatient care in the United States accounts for one third of the health care expenditures. There exists a well-established trend towards fewer inpatient admissions and shorter lengths of stay for all inpatient care, which can be attributed to cost containment efforts through managed care and advances in treatment technologies. However, different illnesses may not necessarily share the same pattern of change in inpatient care utilization. In particular, mental health and substance abuse (MHSA) care has experienced a particularly dramatic growth of specialized managed behavioral organizations, which could have led to an even faster decline. AIMS OF THE STUDY: This study contrasts the trends of MHSA inpatient care in U.S. community hospitals with medical inpatient care over the years 1988 to 1997. It also analyzes the trends for subgroups of MHSA stays by diagnostic groups, age and primary payer. METHODS: We use the National Inpatient Sample (NIS) from the Health Care Cost and Utilization Project (HCUP) to estimate both number of inpatient discharges per 1,000 population and average length of stay over the years and relate the two indices. Inpatient MHSA stays are categorized into subgroups by age, primary payer of the care, and diagnostic group. We use the Clinical Classification Software (CCS) to distinguish between affective disorders, schizophrenia and related disorders, other psychoses, anxiety and related disorders, pre-adult disorders, and alcohol-, substance- related mental disorders and other mental disorders. Trends of population adjusted discharges and length of stay were tested using a weighted least squares method. RESULTS: Population-adjusted MHSA discharges from community hospitals increased by 8.1% over the study period, whereas discharges for all conditions decreased. Within MHSA discharges, the 20-39 and 40-64 age groups experienced significant increase relative to other age group; the increase was particularly high for affective and
Freqüência e percentual de suscetibilidade de bactérias isoladas em pacientes atendidos na unidade de terapia intensiva do Hospital Geral de Fortaleza Frequency and susceptibility percentile of bacteria isolated in patients assisted in the intensive care unit of the General Hospital of Fortaleza
Everardo Albuquerque Menezes; Kélvia Miranda Sá; Francisco Afrânio Cunha; Maria Rozellê Ferreira Ângelo; Inácio Regis Nascimento Oliveira; Maria Núbia Cavalcante Salviano
INTRODUÇAO: As infecções hospitalares, hoje, são motivo de grande preocupação no âmbito hospitalar, principalmente nas unidades de terapia intensiva (UTIs), nas quais encontramos uma associação de fatores propícios ao surgimento de infecções. Objetivos: Verificar a freqüência e o perfil de suscetibilidade aos antimicrobianos das bactérias isoladas de pacientes da UTI do Hospital Geral de Fortaleza (HGF). MATERIAL E MÉTODOS: As bactérias foram isoladas em meio de cultura e a identificação e o ...
Cline, Daniel D; Dickson, Victoria Vaughan; Kovner, Christine; Boltz, Marie; Kolanowski, Ann; Capezuti, Elizabeth
The rapidly aging population and their frequent use of hospital services will create substantial quality challenges in the near future. Redesigning rural hospital work environments is the key to improving the quality of care for older adults. This study explored how the work environment influences registered nurses' (RNs') perceived quality of geriatric care in rural hospitals. We used an exploratory mixed-methods research design emphasizing the qualitative data (in-depth, semi-structured interviews). Quantitative data (questionnaire) measuring the RN work environment were also collected to augment qualitative data. Four themes emerged: (a) collegial RN relationships, (b) poor staffing/utilization, (c) technology benefits/challenges, and (d) RN-physician interactions, which were identified as key factors influencing the quality of geriatric care. We concluded that rural hospital work environments may not be optimized to facilitate the delivery of quality geriatric care. Targeted interventions are needed to improve overall quality of care for hospitalized older adults in rural settings. PMID:24319004
Dhawal H. Agrawal; Pratik D. Gheewala; Kushnood M. Sheikh; Manisha B. Shastri
Introduction: Pars planavitrectomy is the final step in management of many disease. Taking into consideration usefulness and necessity of Pars planavitrectomy in today's world we would like to do this study to evaluate the surgical outcome of 20 gauge pars planavitreoretinal surgery. Materials and methods: A hospital-based prospective interventional study of series of 46 patients was carried out in retina clinic of SMIMER, Surat, Gujarat, From July 2012 to November 2014 who underwent vitreo-r...
Carey, R G
Hospitals need the data that valid surveys can provide. However, no data are better than inaccurate or poorly interpreted data. Survey research appears to be deceptively simple. Many hospital managers are not sensitive to the pitfalls in writing a quality questionnaire and some who have their own personal computers believe that they can enter and tabulate the data. However, just as medical technology has advanced and become more complicated in recent years, survey research has also become more sophisticated during the past decade. The use of computers has assisted in the display of vast amounts of survey data, but interpretation is still the key to effective survey research. Many people can read the same table of data but come to different conclusions, depending on their point of view and their level of involvement with the issues being discussed. It is only human nature to interpret data to support what we believe to be the truth. Hospital managers should understand that interpretation of survey data is best done by neutral and skilled professionals who have worked closely with those who have authority to make costly decisions based on the results. A radiologist will tell you that reading a CT scan is an art as well as a science. So is quality survey research. PMID:10295772
Acute mesenteric ischemia is an abdominal catastrophe. This has been described as a complex of diseases rather than a single clinical entity. The incidence in United States is 1 in 1000 hospital admissions. The objective of this descriptive study was to determine the clinical presentations and out come after surgery of patients with acute mesenteric ischemia. It was conducted at Dubai Hospital, Dubai, United Arab Emirates. Methods: All patients having per operative or histopathological diagnosis of acute mesenteric ischemia from 2002 to 2006 were included. There were 16 patients in all. Their mean age was 51 years, 12 were male and 4 were female. Abdominal pain was present in 16 patients, vomiting in 12 and anorexia in 9 patients. Abdominal tenderness was present in 16 patients, abdominal distension and rebound tenderness in 12 patients. Five patients had hypertension, 4 had myocardial infarction and 4 had diabetes mellitus as risk factors. X-Ray abdomen was done in 13 patients, Ultrasound in 9 and CT Scan in one patient. Resection of bowel was done in 14 patients. Post operatively 5 patients developed pneumonia, 3 had wound dehiscence, 3 had sepsis, and 3 had Lower GI bleeding. Five patients were expired after surgery in the hospital. Four patients were lost to follow up. We should have a high index of suspicion for mesenteric ischemia in patients with unexplained abdominal pain. Early diagnosis and prompt surgical intervention improves the outcome. (author)
Full Text Available Abstract Background Little is known about the prevalence of latent tuberculosis infections (LTBI in health care workers (HCW in low-incidence countries especially in hospitals for pulmonary diseases. With Interferon-gamma release assays (IGRA, a new method for diagnosis of LTBI is available which is more specific than the tuberculin skin test (TST. Objectives The study was designed to estimate prevalence of LTBI among 270 HCW in a Hospital of Pulmonary Diseases routinely screened for TB. Methods LTBI was assessed by the QuantiFERON-Gold In Tube (QFT-IT. Information on gender, age, workplace, job title, BCG vaccination and history of both TB and TST were collected using a standardised questionnaire. Adjusted odds ratios for potential risk factors for LTBI were calculated. Results The prevalence of LTBI was 7.2%. In HCW younger than 30 years LTBI prevalence was 3.5% and in those older than 50 years 22%. Physicians and nurses showed a higher prevalence rate than other professions (10.8% to 4.5%. The putative risk factors for LTBI were age (>50 year OR 9.3, 95%CI 2.5–33.7, working as physicians/nurses (OR 3. 95%CI 1.2–10.4 and no previous TST in medical history (OR 4.4, 95%CI 1.01–18.9 when compared to those with a negative TST. Conclusion Prevalence of LTBI assessed by QFT-IT is low, this indicates a low infection risk even in hospitals for pulmonary diseases. No statement can be made regarding the occupational risk as compared to the general population because there are no LTBI prevalence data from Germany available. The higher LTBI prevalence rate in older HCWs might be due to the cohort effect or the longer time at risk.
Mitropoulos, Panagiotis; Mitropoulos, Ioannis; Sissouras, Aris
This paper evaluates the efficiency of public hospitals with two alternative conceptual models. One model targets resource usage directly to assess production efficiency, while the other model incorporates financial results to assess economic efficiency. Performance analysis of these models was conducted in two stages. In stage one, we utilized data envelopment analysis to obtain the efficiency score of each hospital, while in stage two we took into account the influence of the operational environment on efficiency by regressing those scores on explanatory variables that concern the performance of hospital services. We applied these methods to evaluate 96 general hospitals in the Greek national health system. The results indicate that, although the average efficiency scores in both models have remained relatively stable compared to past assessments, internal changes in hospital performances do exist. This study provides a clear framework for policy implications to increase the overall efficiency of general hospitals. PMID:23111541
Full Text Available OBJECTIVE: The clinical consequences of HIV infection encompass a wide spectrum. The Early recognition of persons who have HIV will help in early interventions to halt or slow the progress of HIV disease and to extend fruitful lives. METHODOLOGY: This cross-sectional study was conducted among patient referred to the voluntary counseling and testing center (VCTC from various departments in, BRIMS Teaching Hospital, Taluka Hospital, Humnabad, Taluka Hospital, Basavakalyan, Taluka Hospital Aurad and Taluka Hospital Bhalki, to find out the pattern of disease/ symptoms high risk behaviors (HRB for HIV and HIV serostatus among the hospital patients. Following the guidelines prescribed by the National AIDS Control Organization (NACO anonymous data were collected through interview from 500 individuals. Where a specific diagnosis of a disease was obtained mutually exclusive symptoms were considered for analysis. RESULTS: The major diseases/ symptoms observed among those patients were tuberculosis in 32.19%, STD in 29.97% prolonged explained fever in 19.41 of the patients. The overall rate of HIV seroreactivity was 17.44%. The HIV serostaus by diseases/ symptoms showed that 32.91% of patients with prolonged unexplained fever were HIV seroreacive; the rate was 12.90% among patients with skin diseases, 12.29% in STD and 12.21 in tuberculosis patients. Overall, 332 patients (66.34% had HRD for HIA/ AIDS. The rate of HIV seroreactivity was more among patients who had HRB for HIV/ AIDS and who were referred from indoor departments (23.24% compared to outdoor departments (13.65%. The patients suffering from prolonged unexplained fever need greater attention fro HIV screening. CONCLUSION: Early detection of HIV positive patients makes interventions possible at a very early stage and this can slow down/ block the progress of HIV disease and as a result can extend fruitful life
Full Text Available Varicella-zoster virus (VZV causes 2 clinically and epidemiologically distinct forms of diseases. Chickenpox (varicella is the disease that results from primary infection with the VZV. Herpes zoster (HZ results from the reactivation of VZV latently infecting the dorsal root ganglia. We are reporting an outbreak of varicella infection among the health care workers (HCWs in the Intensive Care Unit (ICU of a tertiary care hospital. We found transmission of varicella among eight HCWs of pulmonary ICU. They had a history of contact with a patient having HZ infection. Investigation of the outbreak was conducted as per guidelines. Better dissemination of information on disease transmission, isolation of infected patients inside the hospital, and adequate protection (including vaccination for susceptible employees are important to prevent such outbreaks.
Sarit, Sharma; Shruti, Sharma; Deepinder, Chhina; Chhina, R S
Varicella-zoster virus (VZV) causes 2 clinically and epidemiologically distinct forms of diseases. Chickenpox (varicella) is the disease that results from primary infection with the VZV. Herpes zoster (HZ) results from the reactivation of VZV latently infecting the dorsal root ganglia. We are reporting an outbreak of varicella infection among the health care workers (HCWs) in the Intensive Care Unit (ICU) of a tertiary care hospital. We found transmission of varicella among eight HCWs of pulmonary ICU. They had a history of contact with a patient having HZ infection. Investigation of the outbreak was conducted as per guidelines. Better dissemination of information on disease transmission, isolation of infected patients inside the hospital, and adequate protection (including vaccination) for susceptible employees are important to prevent such outbreaks. PMID:26816447
Chan, Regina; Molassiotis, Alexander; Chan, Eunice; Chan, Virene; Ho, Becky; Lai, Chit-ying; Lam, Pauline; Shit, Frances; Yiu, Ivy
A cross-sectional survey was conducted to investigate the nurses' knowledge of and compliance with Universal Precautions (UP) in an acute hospital in Hong Kong. A total of 450 nurses were randomly selected from a population of acute care nurses and 306 were successfully recruited in the study. The study revealed that the nurses' knowledge of UP was inadequate. In addition, UP was not only insufficiently and inappropriately applied, but also selectively practiced. Nearly all respondents knew that used needles should be disposed of in a sharps' box after injections. However, nurses had difficulty in distinguishing between deep body fluids and other general body secretions that are not considered infectious in UP. A high compliance was reported regarding hand-washing, disposal of needles and glove usage. However, the use of other protective wear such as masks and goggles was uncommon. The results also showed no significant relationships between the nurses' knowledge and compliance with UP. It is recommended that UP educational programmes need to consider attitudes in conjunction with empirical knowledge. Nurse managers and occupational health nurses should take a leadership role to ensure safe practices are used in the care of patients. PMID:11755446
Full Text Available Background: India is one of the high tuberculosis (TB burden countries in the world. India ranks second in harboring multi drug resistant (MDR-TB cases. About 50,000 of MDR cases are recorded in retreatment pulmonary TB cases. This study was conducted in a tertiary care facility (Government General and Chest Hospital in Hyderabad, India. Objectives: Toassess: Proportion of the TB patients having MDR-TB at the initiation of retreatment regimen; the prevalence of isoniazid (INH resistance in this geographical area. Materials and Methods: An analytical, observational, prospective cohort study of patients attending the out-patient department from December 2010 to March 2011. Results: Sputum samples from 100 patients were subjected to acid fast bacilli (AFB culture and drug sensitivity testing. Of these, 28 (28% were MDR-TB, 42 (42% were non-MDR-TB and 39% being INH resistance. Conclusions: In conclusion, one third of the retreatment pulmonary TB cases attending a tertiary care institute for TB will be MDR-TB at the initiation of treatment and there is a need to include ethambutol in the continuation phase of new TB case treatment in view of high INH resistance.
Rosado, Iana Vasconcelos Moreira; Russo, Gláucia Helena Araújo; Maia, Eulália Maria Chaves
In general terms, health is influenced and generated by the interaction of biological, social, economic, political and cultural factors. From this standpoint, the scope of this paper was to analyze the relationship between working in emergency care units of public hospitals and the health/sickness of the professionals who work in them. It involved a quantitative and qualitative survey, in which 240 health professionals (doctors, nurses, social workers, psychologists, dentists, nutritionists, audiologists, physiotherapists and occupational therapists) filled out a questionnaire. All the results acknowledged the importance of work to ensure favorable conditions for good health. However, they highlighted its deleterious physical and mental effects on workers, which included stress, lack of a healthy life-style, high blood pressure and musculoskeletal, gastrointestinal and sleep disorders. It is therefore important to tackle this reality in order to enhance the health of professionals and, consequently, the quality of care provided to the user, since illnesses among health workers are strongly linked to the existing health model in society. PMID:26465845
Condra, M; Groll, L; Walker, D M; Abrams, M O; Sims, P.
We describe the development and operation of an emergency support service team in the Emergency Department of the Kingston General Hospital, Kingston, Ont. The team, composed of professionals from other departments of the hospital, provides emotional and practical support to family members or survivors in medical emergencies. We discuss the roles of the team members and their procedures for dealing with distress and grief.
Audit is a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the review of change. Objective of this study was to report the patterns of admissions in our surgical emergency and the comparison of results with the available data Methods: All the patients presented in the surgical emergency of Unit III from April to December 2014. Detail of all surgical patients admitted during the period was recorded from the emergency entry register maintained by the staff nurse. Demographic data mode of admission, diagnosis and outcomes were recorded on proforma. Results: Results: Total number of patients were 11140, out of which 5998 (53.8%) were males and 5142 (46%) were females, mostly were between 18-56 years of age. Emergency surgeries were performed in 650 of our cases whereas the rest of the patients were managed conservatively, treated at minor operation theatre (MOT), referred to their concerned emergencies or discharged. The most common presentation was road traffic accidents followed by trauma, urological emergencies and intestinal obstruction. Overall mortality was estimated as 1.5%. Conclusions: Surgical audit should be made a regular practice to serve as an important and effective tool of accountibilty on clinical outcomes and self evaluation and in improving the quality of our health care system. (author)
Ko Henry CH
Full Text Available Abstract Background Patient safety is a fundamental component of good quality health care. Checklists have been proposed as a method of improving patient safety. This systematic review, asked "In acute hospital settings, would the use of safety checklists applied by medical care teams, compared to not using checklists, improve patient safety?" Methods We searched the Cochrane Library, MEDLINE, CINAHL, and EMBASE for randomised controlled trials published in English before September 2009. Studies were selected and appraised by two reviewers independently in consultation with colleagues, using inclusion, exclusion and appraisal criteria established a priori. Results Nine cohort studies with historical controls studies from four hospital care settings were included-intensive care unit, emergency department, surgery, and acute care. The studies used a variety of designs of safety checklists, and implemented them in different ways, however most incorporated an educational component to teach the staff how to use the checklist. The studies assessed outcomes occurring a few weeks to a maximum of 12 months post-implementation, and these outcomes were diverse. The studies were generally of low to moderate quality and of low levels of evidence, with all but one of the studies containing a high risk of bias. The results of these studies suggest some improvements in patient safety arising from use of safety checklists, but these were not consistent across all studies or for all outcomes. Some studies showed no difference in outcomes between checklist use and standard care without a checklist. Due to the variations in setting, checklist design, educational training given, and outcomes measured, it was unfeasible to accurately summarise any trends across all studies. Conclusions The included studies suggest some benefits of using safety checklists to improve protocol adherence and patient safety, but due to the risk of bias in these studies, their results
Surekha K. Chavan
Conclusions: Not a single case of anaphylactic reactions, TRALI, acute immune hemolytic transfusion reaction, and Sepsis was observed. This can be an underestimation of the true incidence because of under reporting which can be improved by proper hemovigilence system to provide better patient care. [Int J Res Med Sci 2016; 4(6.000: 2402-2407
O Donnell, Máire
Despite a shift in diabetes care internationally from secondary to primary care, diabetes care in the Republic of Ireland remains very hospital-based. Significant variation in the facilities and resources available to hospitals providing outpatient diabetes care have been reported in the UK. The aim of this study was to ascertain the structure of outpatient diabetes care in public hospitals in the Republic of Ireland and whether differences existed in services provided across hospitals.
Chincha, Omayra; Cornelio, Elia; Valverde, Violeta; Acevedo, Mónica
In order to describe the incidence of nosocomial infections associated to invasive devices in intensive care units (UCI) of the National Hospital Cayetano Heredia, a retrospective observational study was conducted using the data from the Office of Epidemiology and Environmental Health from 2010 to 2012. A total number of 222 nosocomial infections were reported; the general medicine UCI reported the highest incidence of pneumonia cases associated to a mechanical ventilator in 1000 days of use of the device (28.6); infection of the blood stream associated to central venous catheter (11.9), and infection of the urinary tract associated to a catheter (8,1). The main infectious agents isolated were Pseudomona sp. (32.3%) in the emergency UCI, negative Staphylococcus coagulasa (36%) in the general medicine UCI and Candida sp (69.2%) in the Surgery UCI. The rates of infections associated to invasive devices were high as in other national hospitals with limited resources and infrastructure. PMID:24448938
P. Gómez Salcedo
representative of opioid consumption in inpatients were the Recovery Room in the General and Traumatology Hospitals, Critical Care, Oncology, Hematology and Palliative Care. In the last 5 years of the study, the overall use of these drugs increased by 20%, irrespective of the active principles involved. Analysis of analgesic intake at La Paz Hospital showed widespread use (104 DDD per 100 hospital stays. Opioids represented 7.4% of total analgesic consumption, the most frequently used analgesics being acetaminophen and metamizol. Conclusions: The results of our study show an increasing trend in opioid consumption in this hospital. We believe this increase reflects an improvement in the management of both acute and chronic pain, since the use of all opioid active ingredients increased. In hospitals with very high activity and complex clinical work, such as La Paz Hospital, this kind of study constitutes a specific tool that allows opioid use in distinct services and hospitals to be compared. This type of study also allows patterns of consumption and possible deviations to be identified and improvements to be made in the distinct clinical services involved in treating pain.
Full Text Available INTRODUCTION: Antenatal care (ANC services has the potential to affect maternal and foetal outcome positively. The ideal gestational age for booking is within the first ten weeks of pregnancy. METHODOLOGY: An Institution based cross-sectional study amongst puerperal women was conducted at B.J. Government Medical College and Sassoon General Hospitals, Pune, Maharashtra, India. Variables studied were socio-demographic factors, parity, complications in previous pregnancy etc. Analysis was done with the Fishers exact test. RESULTS: Out of the total 370 women, 38% reported late/no ANC registration. The husband and wife’s education, husband’s alcoholism, history of complication in previous pregnancy were significantly associated with the time of ANC registration. Early registered women revealed a positive impact on the number of ANC visits; number of ferrous sulphate (FS & Folic acid (FA consumed and birth weight. Strongest driving force to seek ANC was ‘to know the fetal condition’. Women were referred for Ultrasonography without ANC registration and very few had been advised timely anomaly scan. CONCLUSION: There is scope to improve early ANC registration if special efforts are taken to enroll the women at risk of late/no registration, focus on the benefits of early registration and tap the missed opportunities.
Wikström, U; Weibull, H; Klockars, M
In 1995, advanced home treatment services were introduced at Västra Nyland district hospital in Finland. For selected patients the new services constitute an alternative where hospitalisation would otherwise be necessary. Some of the hospital bed resources were moved to the patients' homes together with a trained team with immediate responsibility for the patients and providing 24-hour care, backed up by access to hospital resources in terms of specialised knowledge and sophisticated technology. Two years' experience of 500 patients so treated showed their diseases to have represented the complete spectrum of specialists fields. The most common diagnoses were oncological and infectious diseases. Although preliminary assessment suggests advanced home care to be a cheaper alternative than hospitalised care, the preeminent advantage from the patients' point of view was improved quality of life. PMID:9894412
Rehn, Marius; Krüger, Andreas J
Pre-hospital critical care is considered to be a complex intervention with a weak evidence base. In quality improvement literature, the value equation has been used to depict the inevitable relationship between resources expenditure and quality. Increased value of pre-hospital critical care involves moving a system from quality assurance to quality improvement. Agreed quality indicators can be integrated in existing quality improvement and complex intervention methodology. A QI system for pre-hospital critical care includes leadership involvement, multi-disciplinary buy-in, data collection infrastructure and long-term commitment. Further, integrating process control with governance systems allows evidence-based change of practice and publishing of results. PMID:24887186
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... Federal Register a notice (75 FR 31118) that contained the final wage indices, hospital reclassifications... March 14, 2011, at 76 FR 13515, is confirmed as final without change. Applicability dates: The update to... LTCH PPS in the same documents that update the IPPS (73 FR 26797 through 26798). 4. Critical...
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... H. Payments for Direct Graduate Medical Education (GME) Costs 1. Background 2. Identifying... Analysis m. Recommendation of Update Factors for Operating Cost Rates of Payment for Hospital Inpatient... Medical Education (IME) Adjustment 1. Background 2. IME Adjustment Factor for FY 2011 3....
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Full Text Available Background: Biomedical waste (BMW is waste generated during diagnosis, treatment or immunization of human beings or animals. Approximately 10-25% of the Bio-Medical waste is hazardous and can be injurious to humans or animals and deleterious to environment. It is estimated that annually about 0.33 million tones of hospital waste are generated in India. Objectives: To assess the knowledge regarding hospital waste management amongst hospital staff. Material and Methods: The study comprises of assessment of the knowledge regarding BMW management. For this purpose, a 10% sample of each of the 4 categories of staff on roll was randomly selected for the study; the sample consisted of 110 respondents: 38 doctors, 44 nurses, 21 Lab-technicians and 7 waste handlers/supporting staff. Results: The knowledge of doctors about BMW management & handling rule was much better (92.1% as compared to nurses (54.5% and Lab-technicians (47.6% and it was statistically significant (p-value < 0.05. Conclusion: The doctors where observed to be good in theoretical knowledge. While in case of nurses and lab-technicians the reverse was true. Recommendation: The need of comprehensive training programs regarding Bio-Medical waste management is highly recommended to all hospital staff.
Schwierz, Christoph; Augurzky, Boris; Focke, Axel; Wasem, Jürgen
In times of peak demand hospitals may fail to deliver the high standard of treatment quality that they are able to offer their patients at regular times. To assess the magnitude of these effects, this study analyzes the effects of low staff-to-patients ratios on patient outcomes empirically. We use the variation of patient admissions over time as a proxy for varying staff level. Further, we control for within diagnosis unobservable variation in severity across days with as opposed to days wit...
Pallavi Sarji Uthkarsh; Gopalkrishna Gururaj; Sai Sabharish Reddy; Mandya Siddalingaiah Rajanna
Objective: To assess the availability of trauma care services in a district referral hospital of Southern India. Methods: This was a cross-sectional study being performed during 2013 in a tertiary healthcare centre in Southern Indian. A detailed assessment of trauma care services was done in a 400 bed speciality hospital which is an apex referral hospital in the public health system using a check list based on WHO guidelines for evaluation of essential trauma care services, along with in-d...
Powers, Bethel Ann; Norton, Sally A; Schmitt, Madeline H; Quill, Timothy E; Metzger, Maureen
Objective. To illustrate distinctions and intersections of palliative care (PC) and end-of-life (EOL) services through examples from case-centered data of older adults cared for during a four-year ethnographic study of an acute care hospital palliative care consultation service. Methods. Qualitative narrative and thematic analysis. Results. Description of four practice paradigms (EOL transitions, prognostic uncertainty, discharge planning, and patient/family values and preferences) and identification of the underlying structure and communication patterns of PC consultation services common to them. Conclusions. Consistent with reports by other researchers, study data support the need to move beyond equating PC with hospice or EOL care and the notion that EOL is a well-demarcated period of time before death. If professional health care providers assume that PC services are limited to assisting with and helping patients and families prepare for dying, they miss opportunities to provide care considered important to older individuals confronting life-limiting illnesses. PMID:21584232
Varghese, Jophy; Mary P Chacko; Rajaiah, Molly; Daniel, Dolly
Background & objectives: Detection of maternal alloimmunization against red cell antigens is vital in the management of haemolytic disease of the foetus and newborn (HDFN). This study was conducted to measure the presence of allosensitization to blood group antibodies in the antenatal women attending a tertiary care hospital and to observe the proportion of minor blood group antibodies to assess the benefit of screening for the same. Methods: All antenatal women registered in the hospital bet...
Aljuaid, Mohammed; Mannan, Fahmida; Chaudhry, Zain; Rawaf, Salman; Majeed, Azeem
Objectives To identify the key issues, problems, barriers and challenges particularly in relation to the quality of care in university hospitals in the Kingdom of Saudi Arabia (KSA), and to provide recommendations for improvement. Methods A systematic search was carried out using five electronic databases, for articles published between January 2004 and January 2015. We included studies conducted in university hospitals in KSA that focused on the quality of healthcare. Three independent revie...
E.F. dos Santos; Lauria-Pires, L.; Pereira, M. G.; De Silva, A.E.; Rodrigues, I. P.; M.O. Maia
It is essential to monitor the utilisation of antibacterial drugs in order to establish appropriate measures for their control. The pattern of usage of antibacterial drugs, and its association with indicators of hospital infection, has been investigated in a non-specialized adult intensive care unit (ICU) located in Santa Luzia Hospital (Brasília, DF, Brazil). The study was conducted between January 2001 and June 2004. Data concerning the utilisation of systemic antibacterial drugs, classifie...
According to new findings, hospitals with the highest HCAHPS scores suggest that hourly rounding on patients is one of the best ways to elevate the patient experience. In a survey of top-performing hospitals, 83% reported they employed the practice of regular nurse rounding on patients, and 62% employed leadership rounding. When rounding on patients, experts suggest nurses should always consider pain, the plan of care, and duration, or "PPD". PMID:26447259
Qureshi, Fawad; Shafi, Azhar; Ali, Sheeraz; Siddiqui, Neelam
Objective: To determine the clinical predictors of anticipatory emesis in patients treated with chemotherapy at a tertiary care cancer hospital. Methods: This was a cross-sectional study conducted on 200 patients undergoing first line chemotherapy with minimum of two cycles at inpatient department and chemotherapy bay of Shaukat Khanum Memorial Cancer Hospital and Research Centre Pakistan. Anticipatory nausea and vomiting develops before administration of chemotherapy. Clinical signs and symp...
Jophy Varghese; Chacko, Mary P.; Molly Rajaiah; Dolly Daniel
Background & objectives: Detection of maternal alloimmunization against red cell antigens is vital in the management of haemolytic disease of the foetus and newborn (HDFN). This study was conducted to measure the presence of allosensitization to blood group antibodies in the antenatal women attending a tertiary care hospital and to observe the proportion of minor blood group antibodies to assess the benefit of screening for the same. Methods: All antenatal women registered in the hospital...
Tamima Al-Dughaishi; Yusra Al Harrasi; Maymoona Al-Duhli; Ikhlass Al-Rubkhi; Nihal Al-Riyami; Al-Riyami, Arwa Z.; Pathare, Anil V.; Vaidyanathan Gowri
Objectives: The detection of maternal alloimmunization against red cell antigens is vital in the management of hemolytic disease of the fetus and newborn. We sought to measure the presence of allosensitization to Rhesus D (RhD) antibodies in antenatal women attending a tertiary care hospital and assess the fetal outcome in sensitized women. Methods: We conducted a retrospective review of pregnant Omani women who registered at the Sultan Qaboos University Hospital between June 2011 and Ju...
This study examined the psychometric properties of the Swedish and the original version of the Hospital Survey on Patient Safety Culture within a Swedish hospital setting and described health care staff’s per- ceptions of patient safety culture. A web-survey was used to obtain data from registered nurses, enrolled nurses and physicians (N = 1023). Psychometric properties were tested using Confirmatory Factor Analysis and internal consistency using Cronbach’s alpha coefficient. Root mean squar...
Young, G; Beekun, R I; Ginn, G O
Contingency theory suggests that for a hospital governing board to be effective in taking on a more active role in strategic management, the board needs to be structured to complement the overall strategy of the organization. A survey study was conducted to examine the strategies of acute care hospitals as related to the structural characteristics of their governing boards. After controlling for organizational size and system membership, results indicated a significant relationship between th...
Rulisa, Stephen; Umuziranenge, Immaculee; Small, Maria; van Roosmalen, Jos
Background To determine the prevalence and factors associated with severe (‘near miss’) maternal morbidity and mortality in the University Teaching Hospital of Kigali – Rwanda. Methods We performed a cross sectional study of all women admitted to the tertiary care University Hospital in Kigali with severe “near miss” maternal morbidity and mortality during a one year period using the WHO criteria for ‘near miss’ maternal mortality. We assessed maternal demographic characteristics and disease ...
Phung, Viet-Hai; Coster, Joanne; Wilson, Richard; Turner, Janette; Booth, Andrew; Siriwardena, A Niroshan
Background: Ambulance service performance measurement has previously focused on response times and survival (particularly from out-of-hospital cardiac arrest). The PhOEBE (Pre-hospital Outcomes for Evidence Based Evaluation) project is a 5-year research programme which aims to develop new ways of measuring the performance, quality and impact of ambulance service care. As part of this programme we conducted a systematic review of the international literature on quality measures and outcomes re...
Full Text Available Parasuicide cases among youth (15-24 years referred to the clinical psychology section of a regional hospital from 1995 to 1998 were reviewed. In all 100 cases (37 males and 63 females were identified being about 10% of the caseload. As part of the clinical psychological assessment sociodemographic, clinical characteristics, trigger factors, employed methods and suicide intentions were analysed. Most patients were students (79% or unemployed (16%. The major method employed to attempt suicide was ingestion of harmful substances (like paraffin, pesticides or battery acid(73%. Acute social conflicts (38%, socio-economic deprivation (17%, AIDS phobia (17%, academic failure (14%, teenage pregnancy (10% and mental illness (5% triggered suicide attempts. Fifty-eight percent of the attempts were categorised as demonstrative and 27% as genuine. The psychodynamics of parasuicides are discussed in case studies and with reference to other studies.
Omolase, C.O.; Adeleke, O.E.; Afolabi, A. O.; Afolabi, O.T.
Aim: This study was designed to determine the proportion of general out patients who practice self medication, the drugs employed and the reasons for resorting to self medication. Methodology: This study was conducted between June and December, 2007 at the General Outpatient Clinic of the Federal Medical Centre, Owo, Ondo State, Nigeria. Two hundred consenting respondents were selected by simple random sampling and interviewed with the aid of semi structured questionnaire by the authors with ...
Cesar Roberto Busato
Full Text Available CONTEXT: Deep vein thrombosis (DVT is a serious, common disease whose complications include pulmonary thromboembolism (PTE and postthrombotic syndrome. The importance and benefits of correct and effective pharmacological prophylaxis for DVT are well documented. OBJECTIVES: The aims of this study were to evaluate adequacy of prophylaxis for DVT and PTE at the Santa Casa de Misericórdia de Ponta Grossa (SCMPG, Paraná, Brazil, and determine risk stratification for patients hospitalized in this institution. METHODS: A cohort study was conducted to assess DVT prophylaxis of patients hospitalized on May 15th, 2009. The study population consisted of a sample of 104 patients, subdivided into clinical and surgical groups and stratified into different specialties. Correct use of DVT prophylaxis was evaluated according to recommendations published by The Brazilian Society for Angiology and Vascular Surgery and took into account prophylactic methods specified explicitly in information found in each patient's medical chart. RESULTS: Of the 104 patients interviewed, 51 (49.04% were clinical patients and 53 (50.96% surgical. Based on risk stratification, 17 (16.35% were classified as low risk, 37 (35.58% as moderate risk, 46 (44.23% as high risk and 4 (3.85% as extremely high risk for DVT/PTE. A total of 68 patients (65.38% received prophylaxis, but of these only 56 (53.85% received the correct prophylaxis, and 36 (34.62% did not receive any prophylaxis. CONCLUSION: The rates of prophylaxis use for DVT and PTE in this service are higher than rates published in the literature.
Full Text Available Objective: Detect the presence of carbapenemases producing Enterobacteriaceae (CPE and associated epidemiological, microbiological, and clinical characteristics of patients in our hospital Methods: During 15 months period, all non duplicate Enterobacteriaceae isolates with reduced susceptibility to carbapenem detected by MicroScan WalkAway system and confirmed by E test were collected. These suspected isolates were further screened by modified Hodge test and carbapenemase inhibition discs to identify CPE. Results: Out of 54 suspected Enterobacteriaceae isolates, 44 (88.5% isolates were either extended spectrum beta-lactamases (ESBLs or AmpC producers with porin loss whereas 10 isolates (18.5% were confirmed to produce carbapenemase representing (0.74% of the total Enterobacteriaceae. Among these 10 isolates, 6 were OXA 48 producers and 2 isolates were class B and class A each. Six out of the 10 CPE were detected in ICU and specimen source was tracheal aspirate in 5 CPE isolates. All CPE isolates were sensitive to colistin and all but one to tigecycline. All patients had history of previous antibiotic exposure and hospital stays for more than 5 days. Conclusion: Although CPE is not the main cause of carbapenem resistance in Enterobacteriaceae in our setting, its emergence there represents a serious infection control and therapeutic challenge. This mandates its early detection using MHT and carbapenemase inhibition tests together with strict infection control measures to limit its spread. J Microbiol Infect Dis 2015;5(2: 57-62
Chattopadhyay, Shankar Das; Karmakar, Nisith Chandra; Sengupta, Ritankar; SenGupta, Tamal Kanti; Ray, Debasis; Basus, Shibaji
The number of polytrauma patient with associated brain injury or commonly referred as 'head injury' has increased tremendously in recent times courtesy to road traffic accident or other causes. This prospective observational study was conducted in patients of head injury admitted through emergency in the department of general surgery in NRS Medical College, Kolkata during the year 2011 to determine the pattern of head injury patients admitted and nature of intervention. A total number of 3861 patients were admitted in a single year. Obviously this represents the tip of the iceburg. Traumatic brain injury was the highest in the age group of 31-40 years (33.5%) followed by 21-30 years (29.1%) in the most fruitful phase of life. The traumatic brain injury death was more common in males. The maximum number of cases was from rural areas ie, farmers and labours. To minimise the morbidity and mortality resulting from head injury there is need for better maintenance of roads, improvement of road visibility and lighting, rigid enforcement of traffic rules and imparting road safety education to school children. Despite valiant efforts and advancement in medical sciences and infrastructure in the form of neurosurgery departments and trauma care units to cope with the changing world of trauma, there still remains a huge responsibility and a definite part to be played by the general surgeons to manage head injury patient even in tertiary hospitals. PMID:24968524