Care of "new" long-stay patients in a district general hospital psychiatric unit. The first two years of a hospital-hostel.

Science.gov (United States)

Gibbons, J S

1986-05-01

The paper describes the need for long-term inpatient care in an English health district whose psychiatric services were based on a unit in a District General Hospital. Patients who became long-stay were placed in a new hospital-hostel in a city centre. Three quarters of those eligible could be managed in the hostel, with those rejected posing more control problems. Patients in the hostel became less withdrawn and increased their activity and use of community facilities.

Postpartum care attendance at a rural district hospital in Zambia

NARCIS (Netherlands)

J. Lagro (Joep); A. Liche (Agnes); J. Mumba (John); R. Ntebeka (Ruth); J. van Roosmalen (Jos)

2006-01-01

textabstractPostpartum care is an important tool in both preventive and promotive maternal health care. We studied the postpartum care attendance rate in 540 women who delivered at a district hospital in Zambia. Forty-two percent of the women attended postpartum care within six weeks of delivery.

Healthcare-associated infection in Burkina Faso: an assessment in a district hospital

Directory of Open Access Journals (Sweden)

Hervé Hien

2012-12-01

Full Text Available In developing countries, few data are available on healthcare-associated infections. In Burkina Faso, there has been a failure to take into account risk management and patient safety in the quality assurance program. The main objective of our study was to carry out an assessment of healthcare-associated infection in a first level hospital. We conducted a crosssectional study in June 2011 in the care units of Ziniaré District Hospital (Ziniaré, Burkina Faso. The hospital has been divided in three components: i hospital population (care providers, in-patients and patients’ guardians; ii healthcare and services organization; iii hospital environment. We included: care providers of the clinical services, hospital inpatients and patients’ guardians, hospitalization infrastructure and nursing units, and all the documents relating to standards and protocols. Data collection has been done by direct observation, interviews and biological samples taken at different settings. In hospital population, care providers and patients’ guardians represented a high source of infection: adherence to hygiene practice on the part of care providers was low (12/19, and no patients’ guardian experienced good conditions of staying in the hospital. In healthcare and services organization, healthcare waste management represented a high-risk source of infection. In hospital environment, hygiene level of the infrastructure in the hospital rooms was low (6.67%. Prevalence of isolated bacteria was 71.8%. Urinary-tract catheters infections were the most significant in our sample, followed by surgical-site infections. In total, 56.26% (9/19 of germs were -Lactamase producers (ESBL. They were represented by Escherichia coli and Klebsiella pneumoniae. Our analysis identified clearly healthcare-associated infection as a problem in Ziniaré district hospital. Hence, a national program of quality assurance in the hospitals should now integrate the risk infectious management

Tracheal intubation in the emergency department: the Scottish district hospital perspective.

Science.gov (United States)

Stevenson, A G M; Graham, C A; Hall, R; Korsah, P; McGuffie, A C

2007-06-01

Tracheal intubation is the accepted gold standard for emergency department (ED) airway management. It may be performed by both anaesthetists and emergency physicians (EPs), with or without drugs. To characterise intubation practice in a busy district general hospital ED in Scotland over 40 months between 2003 and 2006. Crosshouse Hospital, a 450-bed district general hospital serving a mixed urban and rural population; annual ED census 58,000 patients. Prospective observational study using data collection sheets prepared by the Scottish Trauma Audit Group. Proformas were completed at the time of intubation and checked by investigators. Rapid-sequence induction (RSI) was defined as the co-administration of an induction agent and suxamethonium. 234 intubations over 40 months, with a mean of 6 per month. EPs attempted 108 intubations (46%). Six patients in cardiac arrest on arrival were intubated without drugs. 29 patients were intubated after a gas induction or non-RSI drug administration. RSI was performed on 199 patients. Patients with trauma constituted 75 (38%) of the RSI group. 29 RSIs (15%) were immediate (required on arrival at the ED) and 154 (77%) were urgent (required within 30 min of arrival at the ED). EPs attempted RSI in 88 (44%) patients and successfully intubated 85 (97%). Anaesthetists attempted RSI in 111 (56%) patients and successfully intubated 108 (97%). Anaesthetists had a higher proportion of good views at first laryngoscopy and there was a trend to a higher rate of successful intubation at the first attempt for anaesthetists. Complication rates were comparable for the two specialties. Tracheal intubations using RSI in the ED are performed by EPs almost as often as by anaesthetists in this district hospital. Overall success and complication rates are comparable for the two specialties. Laryngoscopy training and the need to achieve intubation at the first (optimum) attempt needs to be emphasised in EP airway training.

Emergency general surgery in Rwandan district hospitals: a cross-sectional study of spectrum, management, and patient outcomes.

Science.gov (United States)

Mpirimbanyi, Christophe; Nyirimodoka, Alexandre; Lin, Yihan; Hedt-Gauthier, Bethany L; Odhiambo, Jackline; Nkurunziza, Theoneste; Havens, Joaquim M; Omondi, Jack; Rwamasirabo, Emile; Ntirenganya, Faustin; Toma, Gabriel; Mubiligi, Joel; Bayitondere, Scheilla; Riviello, Robert

2017-12-01

Management of emergency general surgical conditions remains a challenge in rural sub-Saharan Africa due to issues such as insufficient human capacity and infrastructure. This study describes the burden of emergency general surgical conditions and the ability to provide care for these conditions at three rural district hospitals in Rwanda. This retrospective cross-sectional study included all patients presenting to Butaro, Kirehe and Rwinkwavu District Hospitals between January 1st 2015 and December 31st 2015 with emergency general surgical conditions, defined as non-traumatic, non-obstetric acute care surgical conditions. We describe patient demographics, clinical characteristics, management and outcomes. In 2015, 356 patients presented with emergency general surgical conditions. The majority were male (57.2%) and adults aged 15-60 years (54.5%). The most common diagnostic group was soft tissue infections (71.6%), followed by acute abdominal conditions (14.3%). The median length of symptoms prior to diagnosis differed significantly by diagnosis type (p operated on at the district hospital, either by a general surgeon or general practitioner. Patients were more likely to receive surgery if they presented to a hospital with a general surgeon compared to a hospital with only general practitioners (75% vs 43%, p operation in a hospital with a general surgeon as opposed to a general practitioner. This provides evidence to support increasing the surgical workforce in district hospitals in order to increase surgical availability for patients.

Healthcare-associated infection in Burkina Faso: an assessment in a district hospital

OpenAIRE

Hervé Hien; Koiné Maxime Darbo; Laurent Ouédraogo; Salifou Konfé; Sylvain Zeba; Lassana Sangaré; Sidzabda C. Compaoré; Jean Bosco Ouédraogo; Edgard M. Ouendo; Michel Makoutodé; Nicolas Meda

2012-01-01

In developing countries, few data are available on healthcare-associated infections. In Burkina Faso, there has been a failure to take into account risk management and patient safety in the quality assurance program. The main objective of our study was to carry out an assessment of healthcare-associated infection in a first level hospital. We conducted a crosssectional study in June 2011 in the care units of Ziniaré District Hospital (Ziniaré, Burkina Faso). The hospital has been divided in t...

An intervention to improve paediatric and newborn care in Kenyan district hospitals: Understanding the context

Directory of Open Access Journals (Sweden)

Opondo Charles

2009-07-01

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

An intervention to improve paediatric and newborn care in Kenyan district hospitals: understanding the context.

Science.gov (United States)

English, Mike; Ntoburi, Stephen; Wagai, John; Mbindyo, Patrick; Opiyo, Newton; Ayieko, Philip; Opondo, Charles; Migiro, Santau; Wamae, Annah; Irimu, Grace

2009-07-23

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. 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. 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 that might influence success locally included frequent

Temporary emergency pacing-an orphan in district hospitals

DEFF Research Database (Denmark)

Gjesdal, Knut; Johansen, Jens Brock; Gadler, Fredrik

2012-01-01

This editorial discusses a report on the 1 year experience with temporary pacing, especially in the emergency setting, in several Norwegian district hospitals. The vast majority of the patients received transvenous temporary pacing, and the majority of leads were placed by noncardiologists....... The procedure times were long and complications were frequent. The organization of emergency pacing is discussed, and we suggest that unless qualified physicians can establish transvenous pacing, the patients who need that should be transferred with transcutaneous pacing as back-up during transport...

Health worker attrition at a rural district hospital in Rwanda: a need ...

African Journals Online (AJOL)

Health worker attrition at a rural district hospital in Rwanda: a need for improved placement and retention strategies. Jackline Odhiambo, Felix Cyamatare Rwabukwisi, Christian Rusangwa, Vincent Rusanganwa, Lisa Ruth Hirschhorn, Evrard Nahimana, Patient Ngamije, Bethany Lynn Hedt-Gauthier ...

Assessing process of paediatric care in a resource-limited setting: a cross-sectional audit of district hospitals in Rwanda.

Science.gov (United States)

Hategeka, Celestin; Shoveller, Jeannie; Tuyisenge, Lisine; Lynd, Larry D

2018-05-01

Routine assessment of quality of care helps identify deficiencies which need to be improved. While gaps in the emergency care of children have been documented across sub-Saharan Africa, data from Rwanda are lacking. To assess the care of sick infants and children admitted to Rwandan district hospitals and the extent to which it follows currently recommended clinical practice guidelines in Rwanda. Data were gathered during a retrospective cross-sectional audit of eight district hospitals across Rwanda in 2012/2013. Medical records were randomly selected from each hospital and were reviewed to assess the process of care, focusing on the leading causes of under-5 mortality, including neonatal conditions, pneumonia, malaria and dehydration/diarrhoea. Altogether, 522 medical records were reviewed. Overall completion of a structured neonatal admission record was above 85% (range 78.6-90.0%) and its use was associated with better documentation of key neonatal signs (median score 6/8 and 2/8 when used and not used, respectively). Deficiencies in the processes of care were identified across hospitals and there were rural/urban disparities for some indicators. For example, neonates admitted to urban district hospitals were more likely to receive treatment consistent with currently recommended guidelines [e.g. gentamicin (OR 2.52, 95% CI 1.03-6.43) and fluids (OR 2.69, 95% CI 1.2-6.2)] than those in rural hospitals. Likewise, children with pneumonia admitted to urban hospitals were more likely to receive the correct dosage of gentamicin (OR 4.47, 95% CI 1.21-25.1) and to have their treatment monitored (OR 3.75, 95% CI 1.57-8.3) than in rural hospitals. Furthermore, children diagnosed with malaria and admitted to urban hospitals were more likely to have their treatment (OR 2.7, 95% CI 1.15-6.41) monitored than those in rural hospitals. Substantial gaps were identified in the process of neonatal and paediatric care across district hospitals in Rwanda. There is a need to (i

[Integration of district psychiatric hospitals into the development of regional community psychiatry networks--the actual state. Results of a survey among medical directors of Bavarian district hospitals].

Science.gov (United States)

Welschehold, Michael; Kraus, Eva

2004-11-01

In this study, the medical directors of all Bavarian district psychiatric hospitals evaluated certain aspects of the integration of their hospitals into the development of regional community psychiatry networks ("Gemeindepsychiatrische Verbunde" - GPVs). They were asked to rate the actual quantity of cooperation between their hospitals and diverse community based services and to express their requests concerning the quality of cooperation. An estimation of possible advantages of the hospitals' integration in GPVs and expectations to future perspectives of GPV development were also investigated. The data were collected by a written questionnaire. The results of the survey indicate that a high relevance is attached to GPV: inspite of current heterogenous developments and inspite of existing skepticism concerning the feasibility of a complete GPV structure, medical directors strongly approve of seeing their hospitals actively engaged in the further development of community psychiatry networks.

Assessment of surgical and obstetrical care at 10 district hospitals in Ghana using on-site interviews.

Science.gov (United States)

Abdullah, Fizan; Choo, Shelly; Hesse, Afua A J; Abantanga, Francis; Sory, Elias; Osen, Hayley; Ng, Julie; McCord, Colin W; Cherian, Meena; Fleischer-Djoleto, Charles; Perry, Henry

2011-12-01

For most of the population in Africa, district hospitals represent the first level of access for emergency and essential surgical services. The present study documents the number and availability of surgical and obstetrical care providers as well as the types of surgical and obstetrical procedures being performed at 10 first-referral district hospitals in Ghana. After institutional review board and governmental approval, a study team composed of Ghanaian and American surgeons performed on-site surveys at 10 district hospitals in 10 different regions of Ghana in August 2009. Face-to-face interviews were conducted documenting the numbers and availability of surgical and obstetrical personnel as well as gathering data relating to the number and types of procedures being performed at the facilities. A total of 68 surgical and obstetrical providers were interviewed. Surgical and obstetrical care providers consisted of Medical Officers (8.5%), nurse anesthetists (6%), theatre nurses (33%), midwives (50.7%), and others (4.5%). Major surgical cases represented 37% of overall case volumes with cesarean section as the most common type of major surgical procedure performed. The most common minor surgical procedures performed were suturing of lacerations or episiotomies. The present study demonstrates that there is a substantial shortage of adequately trained surgeons who can perform surgical and obstetrical procedures at first-referral facilities. Addressing human resource needs and further defining practice constraints at the district hospital level are important facets of future planning and policy implementation. Copyright © 2011 Elsevier Inc. All rights reserved.

The Management of Sexual Assault Victims at Odi District Hospital in ...

African Journals Online (AJOL)

Background: This six-month study at Odi Hospital in the district of Mabopane in the North-West Province was undertaken to gain insight into the way in which alleged sexual assault victims experienced the treatment they received from doctors, nurses and others and how the quality of the care they received can be improved.

Factors affecting time of access of in-patient care at Webuye District hospital, Kenya

Directory of Open Access Journals (Sweden)

Maxwell M. Lodenyo

2016-10-01

Conclusion: Ten-year increment in age, perception of a supernatural cause of illness(predisposing factors, having an illness that is considered bearable and belief in the effectiveness of treatment offered in-hospital (need factors affect time of access of in-patient healthcare services in the community served by Webuye District hospital and should inform interventions geared towards improving access.

Understanding pathways to better nutrition at district level: lessons ...

African Journals Online (AJOL)

For countries looking to implement multisectoral nutrition plans, it is critical to understand what works and how programs should be delivered and scaled-up in each context. Programs can learn from each other on how to adapt to new information, evidence and events related to scaling-up and district stakeholders can play ...

Turning around an ailing district hospital: a realist evaluation of strategic changes at Ho Municipal Hospital (Ghana

Directory of Open Access Journals (Sweden)

Kegels Guy

2010-12-01

Full Text Available Abstract Background There is a growing consensus that linear approaches to improving the performance of health workers and health care organisations may only obtain short-term results. An alternative approach premised on the principle of human resource management described as a form of 'High commitment management', builds upon a bundles of balanced practices. This has been shown to contribute to better organisational performance. This paper illustrates an intervention and outcome of high commitment management (HiCom at an urban hospital in Ghana. Few studies have shown how HiCom management might contribute to better performance of health services and in particular of hospitals in low and middle-income settings. Methods A realist case study design was used to analyse how specific management practices might contribute to improving the performance of an urban district hospital in Ho, Volta Region, in Ghana. Mixed methods were used to collect data, including document review, in-depth interviews, group discussions, observations and a review of routine health information. Results At Ho Municipal Hospital, the management team dealt with the crisis engulfing the ailing urban district hospital by building an alliance between hospital staff to generate a sense of ownership with a focus around participative problem analysis. The creation of an alliance led to improving staff morale and attitude, and contributed also to improvements in the infrastructure and equipment. This in turn had a positive impact on the revenue generating capacity of the hospital. The quick turn around in the state of this hospital showed that change was indeed possible, a factor that greatly motivated the staff. In a second step, the management team initiated the development of a strategic plan for the hospital to maintain the dynamics of change. This was undertaken through participative methods and sustained earlier staff involvement, empowerment and feelings of reciprocity. We

Improving paediatric and neonatal care in rural district hospitals in the highlands of Papua New Guinea: a quality improvement approach.

Science.gov (United States)

Sa'avu, Martin; Duke, Trevor; Matai, Sens

2014-05-01

In developing countries such as Papua New Guinea (PNG), district hospitals play a vital role in clinical care, training health-care workers, implementing immunization and other public health programmes and providing necessary data on disease burdens and outcomes. Pneumonia and neonatal conditions are a major cause of child admission and death in hospitals throughout PNG. Oxygen therapy is an essential component of the management of pneumonia and neonatal conditions, but facilities for oxygen and care of the sick newborn are often inadequate, especially in district hospitals. Improving this area may be a vehicle for improving overall quality of care. A qualitative study of five rural district hospitals in the highlands provinces of Papua New Guinea was undertaken. A structured survey instrument was used by a paediatrician and a biomedical technician to assess the quality of paediatric care, the case-mix and outcomes, resources for delivery of good-quality care for children with pneumonia and neonatal illnesses, existing oxygen systems and equipment, drugs and consumables, infection-control facilities and the reliability of the electricity supply to each hospital. A floor plan was drawn up for the installation of the oxygen concentrators and a plan for improving care of sick neonates, and a process of addressing other priorities was begun. In remote parts of PNG, many district hospitals are run by under-resourced non-government organizations. Most hospitals had general wards in which both adults and children were managed together. Paediatric case-loads ranged between 232 and 840 patients per year with overall case-fatality rates (CFR) of 3-6% and up to 15% among sick neonates. Pneumonia accounts for 28-37% of admissions with a CFR of up to 8%. There were no supervisory visits by paediatricians, and little or no continuing professional development of staff. Essential drugs were mostly available, but basic equipment for the care of sick neonates was often absent or

STUDIES OF ADVERSE DRUG REACTION PROFILE OF ANTISNAKE VENOM AT DISTRICT GENERAL HOSPITAL

OpenAIRE

Mulchand Shende *, Sneha Gawali , Kanchan Bhongade , Vivek Bhuskade , Abhijit Nandgaonkar

2017-01-01

Snake bite is a common predominant problem of the rural and periurban areas, neglected and frequently devastating environmental and occupational disease, especially in rural areas of tropical developing countries. This study aimed to investigate of the adverse drug reaction profile of anti-snake venom (ASV) in a district general hospital. An observational study was conducted in hospital for six months. A total number of 142 indoor case papers of snake bite from October 2016 to April 2017 were...

Pediatric emergency care capacity in a low-resource setting: An assessment of district hospitals in Rwanda.

Directory of Open Access Journals (Sweden)

Celestin Hategeka

Full Text Available Health system strengthening is crucial to improving infant and child health outcomes in low-resource countries. While the knowledge related to improving newborn and child survival has advanced remarkably over the past few decades, many healthcare systems in such settings remain unable to effectively deliver pediatric advance life support management. With the introduction of the Emergency Triage, Assessment and Treatment plus Admission care (ETAT+-a locally adapted pediatric advanced life support management program-in Rwandan district hospitals, we undertook this study to assess the extent to which these hospitals are prepared to provide this pediatric advanced life support management. The results of the study will shed light on the resources and support that are currently available to implement ETAT+, which aims to improve care for severely ill infants and children.A cross-sectional survey was undertaken in eight district hospitals across Rwanda focusing on the availability of physical and human resources, as well as hospital services organizations to provide emergency triage, assessment and treatment plus admission care for severely ill infants and children.Many of essential resources deemed necessary for the provision of emergency care for severely ill infants and children were readily available (e.g. drugs and laboratory services. However, only 4/8 hospitals had BVM for newborns; while nebulizer and MDI were not available in 2/8 hospitals. Only 3/8 hospitals had F-75 and ReSoMal. Moreover, there was no adequate triage system across any of the hospitals evaluated. Further, guidelines for neonatal resuscitation and management of malaria were available in 5/8 and in 7/8 hospitals, respectively; while those for child resuscitation and management of sepsis, pneumonia, dehydration and severe malnutrition were available in less than half of the hospitals evaluated.Our assessment provides evidence to inform new strategies to enhance the capacity of

Pediatric emergency care capacity in a low-resource setting: An assessment of district hospitals in Rwanda

Science.gov (United States)

Shoveller, Jean; Tuyisenge, Lisine; Kenyon, Cynthia; Cechetto, David F.; Lynd, Larry D.

2017-01-01

Background Health system strengthening is crucial to improving infant and child health outcomes in low-resource countries. While the knowledge related to improving newborn and child survival has advanced remarkably over the past few decades, many healthcare systems in such settings remain unable to effectively deliver pediatric advance life support management. With the introduction of the Emergency Triage, Assessment and Treatment plus Admission care (ETAT+)–a locally adapted pediatric advanced life support management program–in Rwandan district hospitals, we undertook this study to assess the extent to which these hospitals are prepared to provide this pediatric advanced life support management. The results of the study will shed light on the resources and support that are currently available to implement ETAT+, which aims to improve care for severely ill infants and children. Methods A cross-sectional survey was undertaken in eight district hospitals across Rwanda focusing on the availability of physical and human resources, as well as hospital services organizations to provide emergency triage, assessment and treatment plus admission care for severely ill infants and children. Results Many of essential resources deemed necessary for the provision of emergency care for severely ill infants and children were readily available (e.g. drugs and laboratory services). However, only 4/8 hospitals had BVM for newborns; while nebulizer and MDI were not available in 2/8 hospitals. Only 3/8 hospitals had F-75 and ReSoMal. Moreover, there was no adequate triage system across any of the hospitals evaluated. Further, guidelines for neonatal resuscitation and management of malaria were available in 5/8 and in 7/8 hospitals, respectively; while those for child resuscitation and management of sepsis, pneumonia, dehydration and severe malnutrition were available in less than half of the hospitals evaluated. Conclusions Our assessment provides evidence to inform new strategies

An increase in the burden of neonatal admissions to a rural district hospital in Kenya over 19 years

Directory of Open Access Journals (Sweden)

Marsh Kevin

2010-10-01

Full Text Available Abstract Background Most of the global neonatal deaths occur in developing nations, mostly in rural homes. Many of the newborns who receive formal medical care are treated in rural district hospitals and other peripheral health centres. However there are no published studies demonstrating trends in neonatal admissions and outcome in rural health care facilities in resource poor regions. Such information is critical in planning public health interventions. In this study we therefore aimed at describing the pattern of neonatal admissions to a Kenyan rural district hospital and their outcome over a 19 year period, examining clinical indicators of inpatient neonatal mortality and also trends in utilization of a rural hospital for deliveries. Methods Prospectively collected data on neonates is compared to non-neonatal paediatric (≤ 5 years old admissions and deliveries' in the maternity unit at Kilifi District Hospital from January 1st 1990 up to December 31st 2008, to document the pattern of neonatal admissions, deliveries and changes in inpatient deaths. Trends were examined using time series models with likelihood ratios utilised to identify indicators of inpatient neonatal death. Results The proportion of neonatal admissions of the total paediatric ≤ 5 years admissions significantly increased from 11% in 1990 to 20% by 2008 (trend 0.83 (95% confidence interval 0.45 -1.21. Most of the increase in burden was from neonates born in hospital and very young neonates aged 7 mmol/l predicted inpatient neonatal death with a sensitivity of 81% and a specificity of 68%. Conclusions There is clear evidence of increasing burden in neonatal admissions at a rural district hospital in contrast to reducing numbers of non-neonatal paediatrics' admissions aged ≤ 5years. Though the inpatient case fatality for all admissions aged ≤ 5 years declined significantly, neonates now comprise close to 60% of all inpatient deaths. Simple indicators may identify

A 6 year-old boy was referred from a district hospital with congestive ...

African Journals Online (AJOL)

Presentantion of the case. A 6 year-old boy was referred from a district hospital with congestive cardiac failure. His mother reported that he had become progressively short of breath over the previous two months and in the last month he had developed swelling of his feet and abdomen. He had orthopnoea and a marked ...

Identification of the hot-spot areas for sickle cell disease using cord blood screening at a district hospital: an Indian perspective.

Science.gov (United States)

Dixit, Sujata; Sahu, Pushpansu; Kar, Shantanu Kumar; Negi, Sapna

2015-10-01

Sickle cell disease (SCD), a genetic disorder often reported late, can be identified early in life, and hot-spot areas may be identified to conduct genetic epidemiology studies. This study was undertaken to estimate prevalence and to identify hot spot area for SCD in Kalahandi district, by screening cord blood of neonates delivered at the district hospital as first-hand information. Kalahandi District Hospital selected for the study is predominated by tribal population with higher prevalence of SCD as compared to other parts of Odisha. Cord blood screening of SCD was carried out on 761 newborn samples of which 13 were screened to be homozygous for SCD. Information on area of parent's residence was also collected. Madanpur Rampur area was found to be with the highest prevalence of SCD (10.52 %) and the gene distribution did not follow Hardy-Weinberg Equation indicating un-natural selection. The approach of conducting neonatal screening in a district hospital for identification of SCD is feasible and appropriate for prioritizing area for the implementation of large-scale screening and planning control measures thereof.

Cost-effectiveness of anti-retroviral therapy at a district hospital in southern Ethiopia

Directory of Open Access Journals (Sweden)

Robberstad Bjarne

2009-07-01

Full Text Available Abstract Background As the resource implications of expanding anti-retroviral therapy (ART are likely to be large, there is a need to explore its cost-effectiveness. So far, there is no such information available from Ethiopia. Objective To assess the cost-effectiveness of ART for routine clinical practice in a district hospital setting in Ethiopia. Methods We estimated the unit cost of HIV-related care from the 2004/5 fiscal year expenditure of Arba Minch Hospital in southern Ethiopia. We estimated outpatient and inpatient service use from HIV-infected patients who received care and treatment at the hospital between January 2003 and March 2006. We measured the health effect as life years gained (LYG for patients receiving ART compared with those not receiving such treatment. The study adopted a health care provider perspective and included both direct and overhead costs. We used Markov model to estimate the lifetime costs, health benefits and cost-effectiveness of ART. Findings ART yielded an undiscounted 9.4 years expected survival, and resulted in 7.1 extra LYG compared to patients not receiving ART. The lifetime incremental cost is US$2,215 and the undiscounted incremental cost per LYG is US$314. When discounted at 3%, the additional LYG decreases to 5.5 years and the incremental cost per LYG increases to US$325. Conclusion The undiscounted and discounted incremental costs per LYG from introducing ART were less than the per capita GDP threshold at the base year. Thus, ART could be regarded as cost-effective in a district hospital setting in Ethiopia.

Assessment of nurses’ cardiopulmonary resuscitation knowledge and skills within three district hospitals in Botswana

Science.gov (United States)

2018-01-01

Background Nurses are usually the first to identify the need for and initiate cardiopulmonary resuscitation (CPR) on patients with cardiopulmonary arrest in the hospital setting. Cardiopulmonary resuscitation has been shown to reduce in-hospital deaths when received from adequately trained health care professionals. Aim We aimed to investigate nurses’ retention of CPR knowledge and skills at district hospitals in Botswana. Methods A quantitative, quasi-experimental study was conducted at three hospitals in Botswana. A pre-test, intervention, post-test, and a re-test after 6 months were utilised to determine the retention of CPR knowledge and skills. Non-probability, convenience sampling technique was used to select 154 nurses. The sequences of the test were consistent with the American Heart Association’s 2010 basic life support (BLS) guidelines for health care providers. Data were analysed to compare performance over time. Results This study showed markedly deficient CPR knowledge and skills among registered nurses in the three district hospitals. The pre-test knowledge average score (48%) indicated that the nurses did not know the majority of the BLS steps. Only 85 nurses participated in the re-evaluation test at 6 months. While a 26.4% increase was observed in the immediate post-test score compared with the pre-test, the performance of the available participants dropped by 14.5% in the re-test 6 months after the post-test. Conclusion Poor CPR knowledge and skills among registered nurses may impede the survival and management of cardiac arrest victims. Employers and nursing professional bodies in Botswana should encourage and monitor regular CPR refresher courses. PMID:29781687

Assessment of nurses' cardiopulmonary resuscitation knowledge and skills within three district hospitals in Botswana.

Science.gov (United States)

Rajeswaran, Lakshmi; Cox, Megan; Moeng, Stoffel; Tsima, Billy M

2018-04-12

 Nurses are usually the first to identify the need for and initiate cardiopulmonary resuscitation (CPR) on patients with cardiopulmonary arrest in the hospital setting. Cardiopulmonary resuscitation has been shown to reduce in-hospital deaths when received from adequately trained health care professionals.  We aimed to investigate nurses' retention of CPR knowledge and skills at district hospitals in Botswana.  A quantitative, quasi-experimental study was conducted at three hospitals in Botswana. A pre-test, intervention, post-test, and a re-test after 6 months were utilised to determine the retention of CPR knowledge and skills. Non-probability, convenience sampling technique was used to select 154 nurses.The sequences of the test were consistent with the American Heart Association's 2010 basic life support (BLS) guidelines for health care providers. Data were analysed to compare performance over time.  This study showed markedly deficient CPR knowledge and skills among registered nurses in the three district hospitals. The pre-test knowledge average score (48%) indicated that the nurses did not know the majority of the BLS steps. Only 85 nurses participated in the re-evaluation test at 6 months. While a 26.4% increase was observed in the immediate post-test score compared with the pre-test, the performance of the available participants dropped by 14.5% in the re-test 6 months after the post-test.  Poor CPR knowledge and skills among registered nurses may impede the survival and management of cardiac arrest victims. Employers and nursing professional bodies in Botswana should encourage and monitor regular CPR refresher courses.

AN ASSESSMENT OF THE STATUS OF HIV COUNSELLING AND TESTING FACILITY IN GOVERNMENT HOSPITALS OF DISTRICT JHANSI UTTAR PRADESH

Directory of Open Access Journals (Sweden)

Atul Kumar Singh

2010-06-01

Full Text Available Background: Counseling is the face to face communication by which counselor can help the person” client to make decisions and act on them, Effective Counseling and Testing programs can help patients identify and limit- behaviors that increase the risk of’ HIV infection or transmission. Objective: ToAssess the status of HlV Counseling and Testing facilities in Government Hospitals of District Jhansi. Study design: Cross-sectional study. Settings: Four Government Hospitals namely Mèdical College, District Hospital, Railway Hospital and Military Hospital of district Jhansi. Study Period: Two months (l5th August to 15’ October 2008. StatisticalAnalysis: Percentages Results: In most (87.5% of the sessions of all the centers only signature of the patients was taken instead of filling the full consent form whereas rapport with the patients by the counselor was maintained only in 37.5% sessions. In 80% of the sessions the patients were not been told about ‘window period” by the counselors. In 75% of the sessions counselors were not fully attentive towards patient’s concerns. Only in 5% sessions patients were correctly informed about HI V/AIDS. In all the centers, there was no provision for group- session and usually the test results of HlV infection (positive or negative was not provided on the very same day, due to heavy patient load.

Prevalence and risk factors affecting low birth weight in a district hospital at Perambalur, Tamilnadu

Directory of Open Access Journals (Sweden)

Rahul Hanumant Dandekar

2014-03-01

Full Text Available The low birth weight is an index of our status of public health in general and of maternal health and nutrition in particular. The major challenge in the field of public health is to identify the factors influencing low birth weight and to institute remedial measures. This hospital based cross-sectional study was conducted to know the prevalence and to identify risk factors affecting low birth weight in a District Hospital at Perambalur, Tamilnadu during six months period. All pregnant mothers who delivered babies in District Hospital were included in this study. Sample size 300 was calculated by taking 25% as the minimum prevalence of low birth weight with 20% permissible error. The statistical analysis was done by Epi Info™ 7 (7.1.2 software packages. The prevalence of LBW was found as 11.67% in 300 mothers while it was 21.5% in NFHS-3. Significant association was found between Low birth weight and weight gain in pregnancy. Though the prevalence of LBW is lower than national level, it is the need of the hour to strengthen the existing maternal services at the basic level of community.

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

Science.gov (United States)

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

2016-01-01

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

Understanding District-Charter Collaboration Grants. Final Report

Science.gov (United States)

Tuttle, Christina; McCullough, Moira; Richman, Scott; Booker, Kevin; Burnett, Alyson; Keating, Betsy; Cavanaugh, Michael

2016-01-01

In November 2012, the Bill & Melinda Gates Foundation invested in seven innovative district-charter partnerships with "the potential capacity and commitment to accelerate student college ready rates through deep collaboration and sharing of best practices" (District-Charter Collaboration Grant Request for Proposal [RFP]). These…

Management of perforated peptic ulcer in a district general hospital.

Science.gov (United States)

Critchley, A C; Phillips, A W; Bawa, S M; Gallagher, P V

2011-11-01

Laparoscopic surgery has become increasingly popular for elective surgery but it has gained slow transference to emergency surgery. The management of perforated peptic ulcers (PPU) laparoscopically is an accepted strategy yet it still remains infrequently used. The purpose of this study was to analyse the utility and outcomes of laparoscopy versus open repair for PPU in a district general hospital. In addition, we evaluated whether the subspecialty of the on-call consultant affected the method of repair performed and the training opportunities for trainee surgeons. Between 2003 and 2009, 53 patients underwent laparoscopic repair, 89 patients underwent open repair and a further 20 patients had laparoscopic repair that was converted to open repair for PPU. The results from a prospectively compiled database were analysed with primary outcome measures including operative time, length of hospital stay and mortality. The median operating time in the laparoscopic group was 60.0 minutes compared with 50.5 minutes in the open group. Hospital stay in surviving patients was significantly shorter in patients treated completely laparoscopically (5 days) when compared with the open group (6 days) ( p management of PPU. Our findings support the view that this procedure can be successfully used as a training operation.

Characteristics of patients who are admitted with or acquire Pressure Ulcers in a District General Hospital; a 3 year retrospective analysis

NARCIS (Netherlands)

Worsley, P.R.; Smith, G.; Schoonhoven, L.; Bader, D.L.

2016-01-01

AIM: The study aimed to characterize demographic and clinical practice factors associated with community (CAPU) and hospital acquired pressure ulcers (HAPU). DESIGN: A comparative retrospective evaluation of pressure ulcer data, collected from a district general hospital. METHODS: Demographic and

[Hospitalizations for ambulatory care-sensitive conditions: validation study at a Hospital Information System (SIH) in the Federal District, Brazil, in 2012].

Science.gov (United States)

Cavalcante, Danyelle Monteiro; de Oliveira, Maria Regina Fernandes; Rehem, Tânia Cristina Morais Santa Bárbara

2016-03-01

This study analyzes hospitalizations due to ambulatory care-sensitive conditions with a focus on infectious and parasitic diseases (IPDs) and validates the Hospital Information System, Brazilian Unified National Health System (SIH/SUS) for recording hospitalizations due to ambulatory care-sensitive conditions in a hospital in the Federal District, Brazil, in 2012. The study estimates the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the SIH for recording hospitalizations due to ambulatory care-sensitive conditions, with the patient's medical file as the gold standard. There were 1,604 hospitalizations for hospitalizations due to ambulatory care-sensitive conditions (19.6%, 95%CI: 18.7-20.5), and the leading IPDs were renal and urinary tract infection, infection of the skin and subcutaneous tissue, and infectious gastroenteritis. IPDs were the leading cause of hospitalization in the 20 to 29-year age bracket and caused 28 deaths. Sensitivity was 70.1% (95%CI: 60.5-79.7), specificity 88.4% (95%CI: 85.6-91.2), PPV = 51.7% (95%CI: 42.7-60.7), and NPV = 94.3% (95%CI: 92.2-96.4). The findings for admissions due to ACSCs in this hospital were similar to those of other studies, featuring admissions for IPDs. The SIH/SUS database was more specific than sensitive.

The interface between the national tuberculosis control programme and district hospitals in Cameroon: missed opportunities for strengthening the local health system -a multiple case study.

Science.gov (United States)

Keugoung, Basile; Macq, Jean; Buve, Anne; Meli, Jean; Criel, Bart

2013-03-22

Tuberculosis remains a major public health problem in sub-Saharan Africa. District hospitals (DHs) play a central role in district-based health systems, and their relation with vertical programmes is very important. Studies on the impact of vertical programmes on DHs are rare. This study aims to fill this gap. Its purpose is to analyse the interaction between the National Tuberculosis Control Programme (NTCP) and DHs in Cameroon, especially its effects on the human resources, routine health information system (HIS) and technical capacity at the hospital level. We used a multiple case study methodology. From the Adamaoua Region, we selected two DHs, one public and one faith-based. We collected qualitative and quantitative data through document reviews, semi-structured interviews with district and regional staff, and observations in the two DHs. The NTCP trained and supervised staff, designed and provided tuberculosis data collection and reporting tools, and provided anti-tuberculosis drugs, reagents and microscopes to DHs. However, these interventions were limited to the hospital units designated as Tuberculosis Diagnostic and Treatment Centres and to staff dedicated to tuberculosis control activities. The NTCP installed a parallel HIS that bypassed the District Health Services. The DH that performs well in terms of general hospital care and that is well managed was successful in tuberculosis control. Based on the available resources, the two hospitals adapt the organisation of tuberculosis control to their settings. The management teams in charge of the District Health Services are not involved in tuberculosis control. In our study, we identified several opportunities to strengthen the local health system that have been missed by the NTCP and the health system managers. Well-managed DHs perform better in terms of tuberculosis control than DHs that are not well managed. The analysis of the effects of the NTCP on the human resources, HIS and technical capacity of DHs

Budget impact analysis of trastuzumab in early breast cancer: a hospital district perspective.

Science.gov (United States)

Purmonen, Timo T; Auvinen, Päivi K; Martikainen, Janne A

2010-04-01

Adjuvant trastuzumab is widely used in HER2-positive (HER2+) early breast cancer, and despite its cost-effectiveness, it causes substantial costs for health care. The purpose of the study was to develop a tool for estimating the budget impact of new cancer treatments. With this tool, we were able to estimate the budget impact of adjuvant trastuzumab, as well as the probability of staying within a given budget constraint. The created model-based evaluation tool was used to explore the budget impact of trastuzumab in early breast cancer in a single Finnish hospital district with 250,000 inhabitants. The used model took into account the number of patients, HER2+ prevalence, length and cost of treatment, and the effectiveness of the therapy. Probabilistic sensitivity analysis and alternative case scenarios were performed to ensure the robustness of the results. Introduction of adjuvant trastuzumab caused substantial costs for a relatively small hospital district. In base-case analysis the 4-year net budget impact was 1.3 million euro. The trastuzumab acquisition costs were partially offset by the reduction in costs associated with the treatment of cancer recurrence and metastatic disease. Budget impact analyses provide important information about the overall economic impact of new treatments, and thus offer complementary information to cost-effectiveness analyses. Inclusion of treatment outcomes and probabilistic sensitivity analysis provides more realistic estimates of the net budget impact. The length of trastuzumab treatment has a strong effect on the budget impact.

Patient's perceptions about the service quality of public hospitals located at District Kohat.

Science.gov (United States)

Aman, Bakhtiar; Abbas, Faisal

2016-01-01

To determine patients' perception regarding service and quality of healthcare at public-sector institutions. The descriptive quantitative study was conducted in Kohat district, Pakistan, between July and December 2014, and focussed on 30 variables to assess the participants' perceptions of the actual healthcare service quality delivered. SERVQUAL instrument was used to measure the reliability and cronbach alpha was calculated to measure the reliability and validity of the instrument. A total of 200 questionnaires were distributed and 157(78.5%) were received back fully filled. Of them, 105(67%) were men and 52(33%) were women.The mean value of Assurance parameter was 3.05±0.88, indicating trust in public hospitals was high as they had experienced and capable doctors. On the other hand, the lowest mean value of 2.61±0.84 was for Empathy, highlighting the fact that public hospitals lacked the ability to handle patients' problem properly, services were not offered in time and they were short of staff. Public hospitals were largely seen as failing to deliver quality service.

Chart review of acute myocardial infarction at a district hospital in KwaZulu-Natal, South Africa

Directory of Open Access Journals (Sweden)

Roland Chetty

2016-03-01

Full Text Available Background: Incidence and prevalence of non-communicable diseases, including ischaemic heart disease (IHD and associated acute myocardial infarction (AMI, are increasing in South Africa. Local studies are needed as contextual factors, such as healthcare systems, gender and ethnicity, may affect presentation and management. In AMI, reviews on time between onset of chest pain and initiation of urgent treatment are useful, as delays in initiation of thrombolytic treatment significantly increase morbidity and mortality. Aim: The aim of the study was to determine the profile and management of patients admitted with ischaemic chest pain.Setting: The study was carried out in a busy urban-based district hospital in KwaZulu-Natal, South Africa. The population served is poor, and patients are mainly Indian with associated high risk of IHD. Methods: A chart review of all patients seen at the hospital with acute ischaemic chest pain between 01 March and 31 August 2014 was undertaken. Results: More male than female patients were admitted, with a wide variation in age. Most eligible patients received required thrombolytic intervention within an acceptable time period after arrival at hospital. Conclusion: Chest pain and AMI were a relatively common presentation at the study site, and urgent diagnosis and initiation of fibrinolytic therapy are essential. The encouraging door-toneedle time may have been influenced by the availability of specialist family physicians, trained as ‘expert generalists’ to provide appropriate care in a variety of settings and consultant support to junior staff. The role of the family physician and primary healthcare doctor in primary prevention are re-emphasised through the study findings. Keywords: Acute myocardial infarction; KwaZulu-Natal; district hospital; Asian population; hospital chart review; door-to-needle-time

Decentralization in Zambia: resource allocation and district performance.

Science.gov (United States)

Bossert, Thomas; Chitah, Mukosha Bona; Bowser, Diana

2003-12-01

Zambia implemented an ambitious process of health sector decentralization in the mid 1990s. This article presents an assessment of the degree of decentralization, called 'decision space', that was allowed to districts in Zambia, and an analysis of data on districts available at the national level to assess allocation choices made by local authorities and some indicators of the performance of the health systems under decentralization. The Zambian officials in health districts had a moderate range of choice over expenditures, user fees, contracting, targeting and governance. Their choices were quite limited over salaries and allowances and they did not have control over additional major sources of revenue, like local taxes. The study found that the formula for allocation of government funding which was based on population size and hospital beds resulted in relatively equal per capita expenditures among districts. Decentralization allowed the districts to make decisions on internal allocation of resources and on user fee levels and expenditures. General guidelines for the allocation of resources established a maximum and minimum percentage to be allocated to district offices, hospitals, health centres and communities. Districts tended to exceed the maximum for district offices, but the large urban districts and those without public district hospitals were not even reaching the minimum for hospital allocations. Wealthier and urban districts were more successful in raising revenue through user fees, although the proportion of total expenditures that came from user fees was low. An analysis of available indicators of performance, such as the utilization of health services, immunization coverage and family planning activities, found little variation during the period 1995-98 except for a decline in immunization coverage, which may have also been affected by changes in donor funding. These findings suggest that decentralization may not have had either a positive or

Understanding the organisational culture of district health services: Mahalapye and Ngamiland health districts of Botswana.

Science.gov (United States)

Nkomazana, Oathokwa; Mash, Robert; Phaladze, Nthabiseng

2015-11-30

Botswana has a shortage of health care workers, especially in primary healthcare. Retention and high performance of employees are closely linked to job satisfaction and motivation, which are both highest where employees' personal values and goals are realised. The aim of the study was to evaluate employees' personal values, and the current and desired organisational culture of the district health services as experienced by the primary health care workers. The study was conducted in the Ngamiland and Mahalapye health districts. This was a cross sectional survey. The participants were asked to select 10 values that best described their personal, current organisational and desired organisational values from a predetermined list. Sixty and 67 health care workers completed the survey in Mahalapye and Ngamiland districts, respectively. The top 10 prevalent organisational values experienced in both districts were: teamwork, patient satisfaction, blame, confusion, job insecurity, not sharing information and manipulation. When all the current values were assessed, 32% (Mahalapye) and 36% (Ngamiland) selected by health care workers were potentially limiting organisational effectiveness. The organisational values desired by health care workers in both districts were: transparency, professional growth, staff recognition, shared decision-making, accountability, productivity, leadership development and teamwork. The experience of the primary health care workers in the two health districts were overwhelmingly negative, which is likely to contribute to low levels of motivation, job satisfaction, productivity and high attrition rates. There is therefore urgent need for organisational transformation with a focus on staff experience and leadership development.

Technical efficiency of district hospitals: Evidence from Namibia using Data Envelopment Analysis

Directory of Open Access Journals (Sweden)

Mutirua Kautoo

2006-03-01

Full Text Available Abstract Background In most countries of the sub-Saharan Africa, health care needs have been increasing due to emerging and re-emerging health problems. However, the supply of health care resources to address the problems has been continuously declining, thus jeopardizing the progress towards achieving the health-related Millennium Development Goals. Namibia is no exception to this. It is therefore necessary to quantify the level of technical inefficiency in the countries so as to alert policy makers of the potential resource gains to the health system if the hospitals that absorb a lion's share of the available resources are technically efficient. Method All public sector hospitals (N = 30 were included in the study. Hospital capacity utilization ratios and the data envelopment analysis (DEA technique were used to assess technical efficiency. The DEA model used three inputs and two outputs. Data for four financial years (1997/98 to 2000/2001 was used for the analysis. To test for the robustness of the DEA technical efficiency scores the Jackknife analysis was used. Results The findings suggest the presence of substantial degree of pure technical and scale inefficiency. The average technical efficiency level during the given period was less than 75%. Less than half of the hospitals included in the study were located on the technically efficient frontier. Increasing returns to scale is observed to be the predominant form of scale inefficiency. Conclusion It is concluded that the existing level of pure technical and scale inefficiency of the district hospitals is considerably high and may negatively affect the government's initiatives to improve access to quality health care and scaling up of interventions that are necessary to achieve the health-related Millennium Development Goals. It is recommended that the inefficient hospitals learn from their efficient peers identified by the DEA model so as to improve the overall performance of the health

The acceptability of volunteer, repeat blood donations in a hospital setting in the Adamaoua region of Cameroon.

Science.gov (United States)

Rolseth, S; Stange, P; Adamou, D; Roald, B; Danki-Sillong, F; Jourdan, P

2014-12-01

The knowledge of factors that may influence blood donation in Cameroon is limited. The objectives of this study are to assess the characteristics of previous and potential blood donors by exploring the religious beliefs, and knowledge and understanding of blood donations among individuals present at a district hospital. Forty-nine in-depth, semi-structured interviews were conducted among consenting, randomly selected 18 years or older community members present at a district hospital in the Adamaoua region during October and November 2011. Ninety-eight per cent (48/49) of the individuals present at this district hospital had heard of blood transfusions. Forty-seven per cent (23/49) had not previously been asked to donate blood; however, 94% (44/47) said that they would donate if given the opportunity. Thirty-three per cent (16/49) had previously donated blood to family members or for replacement, and 81% of these said they would repeat donations. The majority of both donors and non-donors were motivated to donate blood for altruistic reasons. The findings suggest that community members present at this district hospital in Cameroon may be recruited for repeat blood donations. Although the altruistic motivation to donate blood suggests that donors could be recruited from a district hospital population, targeted information about blood donations and accessible blood transfusion services need to be put in place. The study may add to the understanding of the preconditions for blood donations and the possibility to establish sustainable blood transfusion services in the Adamaoua region in Cameroon. © 2014 British Blood Transfusion Society.

Understanding the organisational culture of district health services: Mahalapye and Ngamiland health districts of Botswana

Directory of Open Access Journals (Sweden)

Oathokwa Nkomazana

2015-11-01

Full Text Available Background: Botswana has a shortage of health care workers, especially in primary healthcare. Retention and high performance of employees are closely linked to job satisfaction and motivation, which are both highest where employees’ personal values and goals are realised. Aim: The aim of the study was to evaluate employees’ personal values, and the current and desired organisational culture of the district health services as experienced by the primary health care workers. Setting: The study was conducted in the Ngamiland and Mahalapye health districts. Method: This was a cross sectional survey. The participants were asked to select 10 values that best described their personal, current organisational and desired organisational values from a predetermined list. Results: Sixty and 67 health care workers completed the survey in Mahalapye and Ngamiland districts, respectively. The top 10 prevalent organisational values experienced in both districts were: teamwork, patient satisfaction, blame, confusion, job insecurity, not sharing information and manipulation. When all the current values were assessed, 32% (Mahalapye and 36% (Ngamiland selected by health care workers were potentially limiting organisational effectiveness. The organisational values desired by health care workers in both districts were: transparency, professional growth, staff recognition, shared decision-making, accountability, productivity, leadership development and teamwork. Conclusions: The experience of the primary health care workers in the two health districts were overwhelmingly negative, which is likely to contribute to low levels of motivation, job satisfaction, productivity and high attrition rates. There is therefore urgent need for organisational transformation with a focus on staff experience and leadership development.

HIV counseling and testing in a tertiary care hospital in Ganjam district, Odisha, India.

Science.gov (United States)

Dash, M; Padhi, S; Sahu, S; Mohanty, I; Panda, P; Parida, B; Sahoo, M K

2013-01-01

Human immunodeficiency virus (HIV) counseling and testing (HCT) conducted at integrated counseling and testing centers (ICTCs) is an entry point, cost-effective intervention in preventing transmission of HIV. To study the prevalence of HIV among ICTC attendees, sociodemographic characteristics, and risk behaviors of HIV-seropositive clients. It was hospital record-based cross-sectional study of 26,518 registered ICTC clients at a tertiary care hospital in Ganjam district, Odisha, India over a 4-year period from January 2009 to September 2012. A total of 1732 (7.5%) out of 22,897 who were tested for HIV were seropositive. Among HIV-seropositives, 1138 (65.7%) were males, while 594 (34.3%) were females. Majority (88.3%) of seropositives were between the age group of 15-49 years. Client-initiated HIV testing (12.1%) was more seropositive compared to provider-initiated (2.9%). Among discordant couples, majority (95.5%) were male partner/husband positive and female partner/wife negative. Positives were more amongst married, less educated, low socioeconomic status, and outmigrants (P<0.0001). Risk factors included heterosexual promiscuous (89.3%), parent-to-child transmission 5.8%, unknown 3.1%, infected blood transfusion 0.8%, homosexual 0.5%, and infected needles (0.5%). There is need to encourage activities that promote HCT in all health facilities. This will increase the diagnosis of new HIV cases. The data generated in ICTC provide an important clue to understand the epidemiology in a particular geographic region and local planning for care and treatment of those infected with HIV and preventive strategies for those at risk especially married, young adults, and outmigrants to reduce new infections.

Prevalence and assessment of malnutrition among children attending the Reproductive and Child Health clinic at Bagamoyo District Hospital, Tanzania.

Science.gov (United States)

Juma, Omar Ali; Enumah, Zachary Obinna; Wheatley, Hannah; Rafiq, Mohamed Yunus; Shekalaghe, Seif; Ali, Ali; Mgonia, Shishira; Abdulla, Salim

2016-10-19

Malnutrition has long been associated with poverty, poor diet and inadequate access to health care, and it remains a key global health issue that both stems from and contributes to ill-health, with 50 % of childhood deaths due to underlying undernutrition. The purpose of this study was to determine the prevalence of malnutrition among children under-five seen at Bagamoyo District Hospital (BDH) and three rural health facilities ranging between 25 and 55 km from Bagamoyo: Kiwangwa, Fukayosi, and Yombo. A total of 63,237 children under-five presenting to Bagamoyo District Hospital and the three rural health facilities participated in the study. Anthropometric measures of age, height/length and weight and measurements of mid-upper arm circumference were obtained and compared with reference anthropometric indices to assess nutritional status for patients presenting to the hospital and health facilities. Overall proportion of stunting, underweight and wasting was 8.37, 5.74 and 1.41 % respectively. Boys were significantly more stunted, under weight and wasted than girls (p-value Children aged 24-59 months were more underweight than 6-23 months (p-value = Children from rural areas experienced increased rates of stunting, underweight and wasting than children in urban areas (p-value malnutrition remains a problem within Tanzania; however our data suggests that the population presenting to BDH and rural health facilities presented with decreased rates of malnutrition compared to the general population. Hospital and facility attending populations of under-five children in and around Bagamoyo suffer moderately high rates of malnutrition. Current nutrition programs focus on education for at risk children and referral to regional hospitals for malnourished children. Even though the general population has even greater malnutrition than the population presenting at the hospital, in areas of high malnutrition, hospital-based interventions should also be considered as

Effect of Clinical Audits of Radiation Use in One Hospital District in Finland

International Nuclear Information System (INIS)

Hirvonen-Kari, M.; Kivisaari, L.; Salo, S.; Dean, K.

2009-01-01

Background: A clinical audit is a systematic, independent, and documented process to improve the quality of radiological processes and radiation safety for patients. Purpose: To evaluate the effect of an audit process by comparing the results of two consecutive audits at the same units. Material and Methods: Audits were carried out twice at each imaging unit in the southwest hospital district of Finland: first, at the end of 2003, and again in November 2007. Both evaluations were carried out in a similar way: by interviewing personnel and examining documents, independent experts from other hospital districts ensured that diagnostic medical imaging processes at each unit were carried out according to generally accepted standards for good medical radiological procedures. The results of the consecutive audits were compared in order to analyze the effects of the clinical audits. Results: The use of radiation was in accordance with the requirements and standards of good medical procedures at every audited unit during both evaluations. The list of audit criteria was fulfilled satisfactorily on both occasions at all of the audited units, and clearly better during the second run. In the first audit, the auditors made 80 recommendations for improving diagnostic procedures and, in the second audit, 53 recommendations. During the first audit, most of the recommendations (22/80) concerned instructions in the fundamental practice of examining a patient. During the second audit, most recommendations were in the category of radiation doses. Conclusion: The clinical audit had a positive impact on the practice of work procedures in radiological departments Most of the recommendations made after the first audit had been taken into consideration by the time of the second audit

"Folk" Understandings of Quality in UK Higher Hospitality Education

Science.gov (United States)

Wood, Roy

2015-01-01

Purpose: The purpose of this paper is to provide an overview of the evolution of "folk" understandings of quality in higher hospitality education and the consequent implications of these understandings for current quality concerns in the field. Design/methodology/approach: The paper combines a historical survey of the stated topic…

Upper gastrointestinal endoscopy in patients aged 85 years or more. Results of a feasibility study in a district general hospital.

NARCIS (Netherlands)

Kouwen, M.C.A. van; Drenth, J.P.H.; Verhoeven, H.M.; Bos, L.P.; Engels, L.G.

2003-01-01

We performed a cross sectional analysis of the feasibility and yield of upper gastrointestinal endoscopy (UGE) in a cohort of patients aged 85 years or more. The study involved 218 patients who underwent diagnostic upper gastrointestinal endoscopy in a district general hospital between 1994 and

Assessment of readability, understandability, and completeness of pediatric hospital medicine discharge instructions.

Science.gov (United States)

Unaka, Ndidi I; Statile, Angela; Haney, Julianne; Beck, Andrew F; Brady, Patrick W; Jerardi, Karen E

2017-02-01

The average American adult reads at an 8th-grade level. Discharge instructions written above this level might increase the risk of adverse outcomes for children as they transition from hospital to home. We conducted a cross-sectional study at a large urban academic children's hospital to describe readability levels, understandability scores, and completeness of written instructions given to families at hospital discharge. Two hundred charts for patients discharged from the hospital medicine service were randomly selected for review. Written discharge instructions were extracted and scored for readability (Fry Readability Scale [FRS]), understandability (Patient Education Materials Assessment Tool [PEMAT]), and completeness (5 criteria determined by consensus). Descriptive statistics enumerated the distribution of readability, understandability, and completeness of written discharge instructions. Of the patients included in the study, 51% were publicly insured. Median age was 3.1 years, and median length of stay was 2.0 days. The median readability score corresponded to a 10th-grade reading level (interquartile range, 8-12; range, 1-13). Median PEMAT score was 73% (interquartile range, 64%-82%; range, 45%-100%); 36% of instructions scored below 70%, correlating with suboptimal understandability. The diagnosis was described in only 33% of the instructions. Although explicit warning signs were listed in most instructions, 38% of the instructions did not include information on the person to contact if warning signs developed. Overall, the readability, understandability, and completeness of discharge instructions were subpar. Efforts to improve the content of discharge instructions may promote safe and effective transitions home. Journal of Hospital Medicine 2017;12:98-101. © 2017 Society of Hospital Medicine.

The Role of Accountants in Implementation Corporate Social Responsibility at Hospital Dr. H. Moh. Anwar Sumenep District

OpenAIRE

Syahril, Syahril; Andini, Isnani Yuli

2017-01-01

Internal accountants has critical leverage to encourage hospitals to be involved in activities such as social or corporate social responsibility.This study aims to examines the role of internal accountants in the implementating of corporate social responsibility at RSUD Moh. Anwar Sumenep District. Research uses descriptive (qualitative) approach to interpret and describe data that obtained from observation, interview and documentation. This research concludes that RSUD Moh. Anwar Sumenep Dis...

Quality of paediatric blood transfusions in two district hospitals in Tanzania: a cross-sectional hospital based study

DEFF Research Database (Denmark)

Mosha, Dominic; Poulsen, Anja; Reyburn, Hugh

2009-01-01

respectively, prior to the BT decision. Pre-transfusion haemoglobin and body temperature were recorded in 2/3 of the patients, but respiratory rate and pulse rate were not routinely recorded. In 40% of BTs, the transfusion time exceeded the recommended 4 hours. The zonal blood bank (ZBB) and local donors......BACKGROUND: Blood transfusion (BT) can be lifesaving for children; however, monitoring the quality of BT is important. The current study describes the quality of paediatric BT delivered in two district hospitals in north-east Tanzania in order to identify areas for quality assurance and improvement...... in the administration of BT. METHODS: All 166 children admitted in the paediatric wards and receiving BT through April to June 2007 were prospectively observed. Medical records, request forms and registers in the laboratories were reviewed to identify blood source, blood screening and indications for BT. BT...

HIV counseling and testing in a tertiary care hospital in Ganjam district, Odisha, India

Directory of Open Access Journals (Sweden)

M Dash

2013-01-01

Full Text Available Background: Human immunodeficiency virus (HIV counseling and testing (HCT conducted at integrated counseling and testing centers (ICTCs is an entry point, cost-effective intervention in preventing transmission of HIV. Objectives: To study the prevalence of HIV among ICTC attendees, sociodemographic characteristics, and risk behaviors of HIV-seropositive clients. Materials and Methods: It was hospital record-based cross-sectional study of 26,518 registered ICTC clients at a tertiary care hospital in Ganjam district, Odisha, India over a 4-year period from January 2009 to September 2012. Results: A total of 1732 (7.5% out of 22,897 who were tested for HIV were seropositive. Among HIV-seropositives, 1138 (65.7% were males, while 594 (34.3% were females. Majority (88.3% of seropositives were between the age group of 15-49 years. Client-initiated HIV testing (12.1% was more seropositive compared to provider-initiated (2.9%. Among discordant couples, majority (95.5% were male partner/husband positive and female partner/wife negative. Positives were more amongst married, less educated, low socioeconomic status, and outmigrants (P<0.0001. Risk factors included heterosexual promiscuous (89.3%, parent-to-child transmission 5.8%, unknown 3.1%, infected blood transfusion 0.8%, homosexual 0.5%, and infected needles (0.5%. Conclusions: There is need to encourage activities that promote HCT in all health facilities. This will increase the diagnosis of new HIV cases. The data generated in ICTC provide an important clue to understand the epidemiology in a particular geographic region and local planning for care and treatment of those infected with HIV and preventive strategies for those at risk especially married, young adults, and outmigrants to reduce new infections.

A STUDY OF THE IMPACT OF THREE DAY TRAINING PROGRAMME ON KNOWLEDGE REGARDING BIOMEDICAL WASTE AMONG PARAMEDICAL STAFF OF DISTRICT HOSPITAL ETAWAH (UP

Directory of Open Access Journals (Sweden)

Dhiraj Kumar Srivastava

2013-12-01

Full Text Available Introduction: Biomedical waste by definition means “Any waste which is generated during the process of diagnosis, treatment or immunization of human or animal or in research activities pertaining there to in the production or testing of biological”Objectives:•    The level of awareness about various aspect of Bio Medical Waste management among the paramedical staff.•    To study the impact of three day training programme on knowledge of Bio Medical Waste management. Material & Methods: The present study  is a Cross sectional Study carried out to assess the impact of three day training programme on knowledge of Paramedical staff posted at District Hospital, Etawah. The change in knowledge was assessed using pre- test and post- test questionnaire.Result: A total of 72 paramedical staff participated in the study. Majority of the participants were unaware about the hazards associated with the improper handing f Biomedical wastes. The knowledge about the different color codes used for the segregation of biomedical waste was also very low. Similarly, the awareness about the vehicle used for the transportation of biomedical waste was also poor.Conclusion: The present study concludes that there is an urgent need for regular training for paramedical staff posted at District Hospital and other government hospital located in small District & town as awareness about the Biomedical waste among them is very low.

A STUDY OF THE IMPACT OF THREE DAY TRAINING PROGRAMME ON KNOWLEDGE REGARDING BIOMEDICAL WASTE AMONG PARAMEDICAL STAFF OF DISTRICT HOSPITAL ETAWAH (UP

Directory of Open Access Journals (Sweden)

Dhiraj Kumar Srivastava

2013-09-01

Full Text Available Introduction: Biomedical waste by definition means “Any waste which is generated during the process of diagnosis, treatment or immunization of human or animal or in research activities pertaining there to in the production or testing of biological”Objectives:•    The level of awareness about various aspect of Bio Medical Waste management among the paramedical staff.•    To study the impact of three day training programme on knowledge of Bio Medical Waste management. Material & Methods: The present study  is a Cross sectional Study carried out to assess the impact of three day training programme on knowledge of Paramedical staff posted at District Hospital, Etawah. The change in knowledge was assessed using pre- test and post- test questionnaire.Result: A total of 72 paramedical staff participated in the study. Majority of the participants were unaware about the hazards associated with the improper handing f Biomedical wastes. The knowledge about the different color codes used for the segregation of biomedical waste was also very low. Similarly, the awareness about the vehicle used for the transportation of biomedical waste was also poor.Conclusion: The present study concludes that there is an urgent need for regular training for paramedical staff posted at District Hospital and other government hospital located in small District & town as awareness about the Biomedical waste among them is very low.

Factors associated with job satisfaction among district hospital health workers in Northern Vietnam: a cross-sectional study.

Science.gov (United States)

Nguyen, Huy Van; Duong, Huong Thao; Vu, Toan Thinh

2017-04-01

In many developing countries, including Vietnam, little is known about job satisfaction among lower level-health staff. The purpose of this study was to assess job satisfaction and its determinants among district hospital health staff. In a cross-sectional quantitative study, 128 health staff from a rural district hospital in Northern Vietnam were approached for data collection. Regression techniques were adopted to assess factors associated with several types of job satisfaction. Overall job satisfaction was moderately high, ranging from 69% to 91%. Across all dimensions, health workers showed their highest satisfaction with co-worker relationships, while, in comparison, it was much lower for their supervisor's style and relationship. However, they claimed their lowest satisfaction with compensation and benefits. In final multivariate models, females and those satisfied with knowledge, skills and job performance were most likely to be satisfied with relationships with co-workers. Staff who were married, received a low pay, who were not satisfied with supervisor style and relationships and who were not satisfied with staff training, development opportunities were least likely to be satisfied with compensation and benefits. The study findings highlight an important need for designing an intervention program that considers organizational factors. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Language Disorder In Schizophrenia Patient: A Case Study Of Five Schizophrenia Paranoid Patients In Simeulue District Hospital

OpenAIRE

Kurnia, Beby Febri

2015-01-01

Language disorder in schizophrenia patients is an acquired language disorder due to thought disorder. This analysis analyzed language disorder in schizophrenia paranoid patients in Simeulue District Hospital. The objective of this analysis were: (1) to find out the types of schizophrenic speech found in schizophrenia paranoid patients, (2) to find out the most dominant type of schizophrenia speech found in schizophrenia paranoid patients, and (3) to find out which patient has most severe lang...

Unit cost of medical services at different hospitals in India.

Directory of Open Access Journals (Sweden)

Susmita Chatterjee

Full Text Available Institutional care is a growing component of health care costs in low- and middle-income countries, but local health planners in these countries have inadequate knowledge of the costs of different medical services. In India, greater utilisation of hospital services is driven both by rising incomes and by government insurance programmes that cover the cost of inpatient services; however, there is still a paucity of unit cost information from Indian hospitals. In this study, we estimated operating costs and cost per outpatient visit, cost per inpatient stay, cost per emergency room visit, and cost per surgery for five hospitals of different types across India: a 57-bed charitable hospital, a 200-bed private hospital, a 400-bed government district hospital, a 655-bed private teaching hospital, and a 778-bed government tertiary care hospital for the financial year 2010-11. The major cost component varied among human resources, capital costs, and material costs, by hospital type. The outpatient visit cost ranged from Rs. 94 (district hospital to Rs. 2,213 (private hospital (USD 1 = INR 52. The inpatient stay cost was Rs. 345 in the private teaching hospital, Rs. 394 in the district hospital, Rs. 614 in the tertiary care hospital, Rs. 1,959 in the charitable hospital, and Rs. 6,996 in the private hospital. Our study results can help hospital administrators understand their cost structures and run their facilities more efficiently, and we identify areas where improvements in efficiency might significantly lower unit costs. The study also demonstrates that detailed costing of Indian hospital operations is both feasible and essential, given the significant variation in the country's hospital types. Because of the size and diversity of the country and variations across hospitals, a large-scale study should be undertaken to refine hospital costing for different types of hospitals so that the results can be used for policy purposes, such as revising

Unit Cost of Medical Services at Different Hospitals in India

Science.gov (United States)

Chatterjee, Susmita; Levin, Carol; Laxminarayan, Ramanan

2013-01-01

Institutional care is a growing component of health care costs in low- and middle-income countries, but local health planners in these countries have inadequate knowledge of the costs of different medical services. In India, greater utilisation of hospital services is driven both by rising incomes and by government insurance programmes that cover the cost of inpatient services; however, there is still a paucity of unit cost information from Indian hospitals. In this study, we estimated operating costs and cost per outpatient visit, cost per inpatient stay, cost per emergency room visit, and cost per surgery for five hospitals of different types across India: a 57-bed charitable hospital, a 200-bed private hospital, a 400-bed government district hospital, a 655-bed private teaching hospital, and a 778-bed government tertiary care hospital for the financial year 2010–11. The major cost component varied among human resources, capital costs, and material costs, by hospital type. The outpatient visit cost ranged from Rs. 94 (district hospital) to Rs. 2,213 (private hospital) (USD 1 = INR 52). The inpatient stay cost was Rs. 345 in the private teaching hospital, Rs. 394 in the district hospital, Rs. 614 in the tertiary care hospital, Rs. 1,959 in the charitable hospital, and Rs. 6,996 in the private hospital. Our study results can help hospital administrators understand their cost structures and run their facilities more efficiently, and we identify areas where improvements in efficiency might significantly lower unit costs. The study also demonstrates that detailed costing of Indian hospital operations is both feasible and essential, given the significant variation in the country’s hospital types. Because of the size and diversity of the country and variations across hospitals, a large-scale study should be undertaken to refine hospital costing for different types of hospitals so that the results can be used for policy purposes, such as revising payment rates

Employees’ Commitment to the Organization of a Public District Hospital: a Case Study

Directory of Open Access Journals (Sweden)

Eyaggelia Tsolaki

2013-01-01

Full Text Available Background: The employees' satisfaction from their job and their commitment to the organization appears to be one of the most determinants factors of organizational effectiveness.Aim: The aim of this study was the research of commitment to the organization of employees' working at Sparta General Hospital, as well as the correlation between job satisfaction and social, economic, demographic or other factors.Methodology: The research’s sample included 121 employees from all departments of a public district hospital. For research purposes, the Organizational Commitment Questionnaire was used. Data specially designed for the research’s purposes.Results: The largest sample’s proportion, declared moderate to very satisfy by their job at that Hospital. The particular job demands, exhausting timetables, stress and organizational weaknesses of the Greek Health System seem to have been key components of the problem. Also, for a large sample proportion, the job demands affect negatively the time and energy that Sparta General Hospital employees’ dedicate to themselves and to their families. Almost half of the participants replied that they are not at all satisfied with their payroll. Regarding the rates of emotional, standing and exemplary commitment, showed that gender, education level, marital status, age and total years of professional seniority correlated with the level of emotional commitment. To higher affective commitment is positively correlated with age of employees and years of service.Conclusions: The research of commitment to the organization can contribute substantially in improving the hospital’s and health system’s effectiveness, the increment of job’s satisfaction, the employees’ efficiency.

Understanding the occupational and organizational boundaries to safe hospital discharge.

Science.gov (United States)

Waring, Justin; Marshall, Fiona; Bishop, Simon

2015-01-01

Safe hospital discharge relies upon communication and coordination across multiple occupational and organizational boundaries. Our aim was to understand how these boundaries can exacerbate health system complexity and represent latent sociocultural threats to safe discharge. An ethnographic study was conducted in two local health and social care systems (health economies) in England, focusing on two clinical areas: stroke and hip fracture patients. Data collection involved 345 hours of observations and 220 semi-structured interviews with health and social care professionals, patients and their lay carers. Hospital discharge involves a dynamic network of interactions between heterogeneous health and social care actors, each characterized by divergent ways of organizing discharge activities; cultures of collaboration and interaction and understanding of what discharge involves and how it contributes to patient recovery. These interrelated dimensions elaborate the occupational and organisational boundaries that can influence communication and coordination in hospital discharge. Hospital discharge relies upon the coordination of multiple actors working across occupational and organizational boundaries. Attention to the sociocultural boundaries that influence communication and coordination can help inform interventions that might support enhanced discharge safety. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Management of uncomplicated malaria in children under 13 years of age at a district hospital in senegal : from official guidelines to usual practices

OpenAIRE

Sarrassat, Sophie; Lalou, Richard; Cisse, M.; Le Hesran, Jean-Yves

2011-01-01

Abstract Background To be effective, national malaria guidelines must be properly followed. This study evaluated nurses' practices in the management of uncomplicated malaria cases at a District Hospital. Its objective was to identify the reasons for discrepancies between official guidelines and usual practices. Methods This study took place at Oussouye hospital, south-western Senegal. Blood smears were available for biological diagnosis in patients aged more than five years while the Integrat...

Technical efficiency of public district hospitals and health centres in Ghana: a pilot study

Directory of Open Access Journals (Sweden)

Kirigia Joses M

2005-09-01

Full Text Available Abstract Background The Government of Ghana has been implementing various health sector reforms (e.g. user fees in public health facilities, decentralization, sector-wide approaches to donor coordination in a bid to improve efficiency in health care. However, to date, except for the pilot study reported in this paper, no attempt has been made to make an estimate of the efficiency of hospitals and/or health centres in Ghana. The objectives of this study, based on data collected in 2000, were: (i to estimate the relative technical efficiency (TE and scale efficiency (SE of a sample of public hospitals and health centres in Ghana; and (ii to demonstrate policy implications for health sector policy-makers. Methods The Data Envelopment Analysis (DEA approach was used to estimate the efficiency of 17 district hospitals and 17 health centres. This was an exploratory study. Results Eight (47% hospitals were technically inefficient, with an average TE score of 61% and a standard deviation (STD of 12%. Ten (59% hospitals were scale inefficient, manifesting an average SE of 81% (STD = 25%. Out of the 17 health centres, 3 (18% were technically inefficient, with a mean TE score of 49% (STD = 27%. Eight health centres (47% were scale inefficient, with an average SE score of 84% (STD = 16%. Conclusion This pilot study demonstrated to policy-makers the versatility of DEA in measuring inefficiencies among individual facilities and inputs. There is a need for the Planning and Budgeting Unit of the Ghana Health Services to continually monitor the productivity growth, allocative efficiency and technical efficiency of all its health facilities (hospitals and health centres in the course of the implementation of health sector reforms.

Prevalence and assessment of malnutrition among children attending the Reproductive and Child Health clinic at Bagamoyo District Hospital, Tanzania

Directory of Open Access Journals (Sweden)

Omar Ali Juma

2016-10-01

Full Text Available Abstract Background Malnutrition has long been associated with poverty, poor diet and inadequate access to health care, and it remains a key global health issue that both stems from and contributes to ill-health, with 50 % of childhood deaths due to underlying undernutrition. The purpose of this study was to determine the prevalence of malnutrition among children under-five seen at Bagamoyo District Hospital (BDH and three rural health facilities ranging between 25 and 55 km from Bagamoyo: Kiwangwa, Fukayosi, and Yombo. Methods A total of 63,237 children under-five presenting to Bagamoyo District Hospital and the three rural health facilities participated in the study. Anthropometric measures of age, height/length and weight and measurements of mid-upper arm circumference were obtained and compared with reference anthropometric indices to assess nutritional status for patients presenting to the hospital and health facilities. Results Overall proportion of stunting, underweight and wasting was 8.37, 5.74 and 1.41 % respectively. Boys were significantly more stunted, under weight and wasted than girls (p-value < 0.05. Children aged 24–59 months were more underweight than 6–23 months (p-value = <0.0001. But, there was no statistical significance difference between the age groups for stunting and wasting. Children from rural areas experienced increased rates of stunting, underweight and wasting than children in urban areas (p-value < 0.05. The results of this study concur with other studies that malnutrition remains a problem within Tanzania; however our data suggests that the population presenting to BDH and rural health facilities presented with decreased rates of malnutrition compared to the general population. Conclusions Hospital and facility attending populations of under-five children in and around Bagamoyo suffer moderately high rates of malnutrition. Current nutrition programs focus on education for at risk children and

[Project for the Creation of a Medical or Hospital Ethical Committee at a Local Level in the San Miguel Arcangel Hospital, District of San Miguelito, Province of Panama. Year 2013].

Science.gov (United States)

Díaz Rivera, Yashiro A

2015-01-01

The next project was based on the design on the creation of a medical ethical Committee at a hospital. It was developed at the San Miguel Arcangel Hospital, District of San Miguelito, Province of Panama, in 2013. Insomuch as the creation of social projects requires unified international parameters, format is taken from the Unesco's guides for the establishing and working of bioethics committees; adapted to the socio-economic, political and cultural context of the San Miguelito District, Panama Province. Furthermore to adapting to socio-ecological aspect where the research project is carried out, the theoretical aspect includes from the ontological personalistic bioethics, where the cornerstone is the dignity of the human person. A study of perceptions of medical staff and nursing was developed on the management of the most common ethical dilemmas in the Hospital San Miguel Arcángel. The instrument used was a previously validated perception survey through a pilot test. Reliability was measured using Cronbach's alpha coefficient, and validity was obtained from the content. Satisfactory statistical results, that verify the working hypotheses on the recognition of the importance of autonomy, confidentiality, protection of vulnerable population, occupational health staff welfare and integration of bioethics at the institutional agenda, were obtained. However, there were particular aspects that indicate some doubt as to the management of some realities that are presented in the context of health care.

Acute admissions to medical departments. A comparison between an urban and a rural district

DEFF Research Database (Denmark)

Hilsted, J C; Evald, T; Elbrønd, R

1995-01-01

of admissions for social reasons was 13 percent to the city hospital versus 3 percent to the district hospital. Relevant alternatives to hospitalization seemed to exist in 50 percent of the admissions to the city hospital versus only 3 percent to the district hospital. Since patients admitted for social reasons...... block hospital beds for a longer time period than those admitted for other reasons, these differences may to some extent explain why length of hospital stay is longer in city hospitals than in rural ones....

Perceptions of health care professionals on the safety and security at Odi District Hospital, Gauteng, South Africa.

Science.gov (United States)

Okeke, Sunday O; Mabuza, Langalibalele H

2017-10-27

For optimum delivery of service, an establishment needs to ensure a safe and secure environment. In 2011, the South African government promulgated the National Core Standards for Health Establishments for safety and security for all employees in all establishments. Little is known about whether these standards are being complied to.Aim and setting: To assess the perceptions of health care professionals (HCPs) on safety and security at Odi District Hospital. A sample of 181 out of a total of 341 HCPs was drawn through a systematic sampling method from each HCP category. Data were collected through a self-administered questionnaire. The SPSS® statistical software version 22 was used for data analysis. The level of statistical significance was set at < 0.05. There were more female respondents than male respondents (136; 75.10%). The dominant age group was 28-47 years (114; 57.46%). Perceptions on security personnel, their efficiency and the security system were significantly affirmed (p = 0.0001). The hospital infrastructure, surroundings and plan in emergencies were perceived to be safe (p < 0.0001). The hospital lighting system was perceived as inadequate (p = 0.0041). Only 36 (20.2%) HCPs perceived that hospital authorities were concerned about employees' safety (p < 0.0001). HCPs had positive perceptions regarding the hospital's security system. Except for the negative perceptions of the lighting system and the perceived lack of hospital authorities' concern for staff safety, perceptions of the HCPs on the hospital working environment were positive. The hospital authorities need to establish the basis of negative perceptions and enforce remedial measures to redress them.

Dysphagia referrals to a district general hospital gastroenterology unit: hard to swallow.

Science.gov (United States)

Melleney, Elizabeth Mary-Ann; Subhani, Javaid Mohammed; Willoughby, Charles Peter

2004-01-01

The aim of our study was to audit dysphagia referrals received by a specialist gastroenterology unit during an entire year. We used a prospective audit carried out over a 12-month period at the District General Hospital gastroenterology unit. The audit included 396 consecutive patients who were referred with swallowing difficulties. We found that 60 referrals (15.2%) were inaccurate and the patients had no swallowing problem. Of the 336 patients with genuine dysphagia, only 29 (8.6%) were new cancer cases. The large majority of subjects had benign disease mostly related to acid reflux. Weight loss was significantly associated with malignancy but also occurred in one third of patients with reflux alone. The temporal pattern of dysphagia was not significantly predictive of cancer. All the cancer patients were above the age of 50 years. Although patients were in general assessed rapidly after hospital referral, the productivity, in terms of early tumor diagnosis, was extremely low. We conclude that there is a substantial rate of inaccurate referrals of dysphagia patients. Most true cases of swallowing difficulty relate to benign disease. Even the devotion of considerable resources to the early diagnosis of esophago gastric malignancy in an attempt to conform with best practice guidelines results in a very low success rate in terms of the detection of potentially curable tumors.

Blood transfusion practice in a rural hospital in Northern Ghana, Damongo, West Gonja District.

Science.gov (United States)

Kubio, Chrysantus; Tierney, Geraldine; Quaye, Theophilus; Nabilisi, James Wewoli; Ziemah, Callistus; Zagbeeb, Sr Mary; Shaw, Sandra; Murphy, William G

2012-10-01

Blood transfusion in rural sub-Saharan Africa presents special challenges. Transfusions are primarily given for emergencies--life-threatening blood loss or anemia; blood is usually collected from family or replacement donors; and facilities to store an adequate reserve in a hospital bank are constrained. We report the everyday and organizational practices in a medium-sized district hospital in Northern Ghana. Information and data on blood transfusion practices at West Gonja Hospital, Damongo, were available from the laboratory reports, from day books and workbooks, and from direct observation in the following four areas: blood collection and blood donors; blood donation testing; blood storage and logistics; and clinical transfusion practice, adverse events, and follow-up. The hospital serves a rural community of 86,000. In 2009, a total of 719 units of whole blood were collected, a rate of 8.36 units per 1000 population. All donors were family or replacement donors. Positivity rates for infectious disease markers were 7.5% (64/853) for hepatitis B surface antigen, 6.1% (50/819) for hepatitis C virus, 3.9% (33/846) for human immunodeficiency virus, and 4.7% (22/468) for syphilis. Supply of laboratory materials was sometimes problematic, especially for temperature-critical materials. Difficulties in sample labeling, storage of blood and laboratory supplies, and disposal of waste were also incurred by operational, material, and financial constraints. Follow-up for outcomes of transfusion is not currently feasible. The operational, demographic, and financial environment pertaining in a rural hospital in Northern Ghana differs substantially from that in which much of current blood transfusion practice and technology evolved. Considerable effort and innovation will be needed to address successfully the challenges posed. © 2012 American Association of Blood Banks.

Public funding of health at the district level in Indonesia after decentralization-sources, flows and contradictions.

Science.gov (United States)

Heywood, Peter; Harahap, Nida P

2009-04-16

During the Suharto era public funding of health in Indonesia was low and the health services were tightly controlled by the central government; district health staff had practically no discretion over expenditure. Following the downfall of President Suharto there was a radical political, administrative and fiscal decentralization with delivery of services becoming the responsibility of district governments. In addition, public funding for health services more than doubled between 2001 and 2006. It was widely expected that services would improve as district governments now had both more adequate funds and the responsibility for services. To date there has been little improvement in services. Understanding why services have not improved requires careful study of what is happening at the district level. We collected information on public expenditure on health services for the fiscal year 2006 in 15 districts in Java, Indonesia from the district health offices and district hospitals. Data obtained in the districts were collected by three teams, one for each province. Information on district government revenues were obtained from district public expenditure databases maintained by the World Bank using data from the Ministry of Finance. The public expenditure information collected in 15 districts as part of this study indicates district governments are reliant on the central government for as much as 90% of their revenue; that approximately half public expenditure on health is at the district level; that at least 40% of district level public expenditure on health is for personnel, almost all of them permanent civil servants; and that districts may have discretion over less than one-third of district public expenditure on health; the extent of discretion over spending is much higher in district hospitals than in the district health office and health centers. There is considerable variation between districts. In contrast to the promise of decentralization there has been

Nursing Personnel Planning for Rural Hospitals in Burdwan District, West Bengal, India, Using Workload Indicators of Staffing Needs

Science.gov (United States)

Roy, Rabindra Nath; Dasgupta, Samir; Bhattacharyya, Krishna Das; Misra, Raghu Nath; Roy, Sima; Saha, Indranil

2014-01-01

ABSTRACT Lack of appropriate human resources planning is an important factor in the inefficient use of the public health facilities. Workforce projections can be improved by using objective methods of staffing needs based on the workload and actual work undertaken by workers, a guideline developed by Peter J. Shipp in collaboration with WHO—Workload Indicators of Staffing Need (WISN). A cross-sectional study was carried out to estimate the nursing stuff requirement for the rural hospitals and provide a quantitative description of imbalances, if there is any, in the allocation at the district level during 2011. The average WISN turns out to be 0.35 for entire district, which means only 35% of the required nurses is available or 65% understaffed. So, there is an urgent need for more allocations and deployment of staff so that workload can be tackled and evenly distributed among all nursing personnel. PMID:25895199

Facility type and primary care performance in sub-district health promotion hospitals in Northern Thailand.

Directory of Open Access Journals (Sweden)

Nithra Kitreerawutiwong

Full Text Available Poor and middle-income Thai people rely heavily on primary care health services. These are staffed by a range of professionals. However, it is unknown whether the performance of primary care varies according to the staffing and organization of local service delivery units. Tambon (sub-district health promotion hospitals (THPHs were introduced in 2009 to upgrade the services offered by the previous health centres, but were faced with continuing shortages of doctors and nurses. The Ministry of Public Health (MoPH designated three categories of THPH, defined according to whether they were regularly staffed by a medical practitioner, a qualified nurse or non-clinical public health officers. This study aimed to compare the performance of primary care offered by the three different types of primary care facilities in one public health region of Northern Thailand (Public Health Region 2.A cross-sectional survey was undertaken in 2013. Data were collected on accessibility, continuity, comprehensiveness, co-ordination and community orientation of care from 825 patients attending 23 primary care facilities. These were selected to include the three officially-designated types of Tambon (sub-district health promotion hospitals (THPHs led by medical, nursing or public health personnel. Survey scores were compared in unadjusted and adjusted analyses.THPHs staffed only by public health officers achieved the highest performance score (Mean = 85.14, SD. = 7.30, followed by THPHs staffed by qualified nurses (Mean = 82.86, SD. = 7.06. THPHs staffed by a doctor on rotation returned the lowest scores (Mean = 81.63, SD. = 7.22.Differences in overall scores resulted mainly from differences in reported accessibility, continuity, and comprehensiveness of care, rather than staff skill-mix per se. Policy on quality improvement should therefore focus on improving performance in these areas.

Perfil das doenças glomerulares em um hospital público do Distrito Federal Profile of glomerular diseases in a public hospital of Federal District, Brazil

Directory of Open Access Journals (Sweden)

Fabio Humberto Ribeiro Paes Ferraz

2010-09-01

different patients were performed by the Renal Division of Hospital Regional da Asa Norte (HRAN between August 2005 and May 2009. Eight renal biopsies in renal-transplant patients were excluded and the medical records of 113 remaining patients were analyzed. Analyzed data: sex, age, laboratory exams, glomerular syndrome, clinical diagnosis, degree of interstitial fibrosis, immunosuppressants use, need for dialysis and clinical outcome. RESULTS: The age average was 34.9 ± 16.2 years-old, a predominance of male patients (51.3%. Major glomerular syndromes were: nephrotic syndrome (41.6% and the rapidly- progressive glomerulonephritis (35.4%. Among primary glomerulopathies focal glomerulosclerosis (26.8% followed by IgA nephropathy (25% were predominant; and among the most prevalent secondary glomerulopathies we had lupus nephritis (50% and diffuse exudative proliferative glomerulonephritis (34.2%.The majority of the patients used immunosuppressants (68.1% and almost one third of them (29.2% needed dialysis during their hospitalization. Progressed to chronic dialysis therapy 13.3% of the patients and 10.6% died. CONCLUSION: This study may contribute to better epidemiological understanding of glomerular diseases in the Federal District, guiding the adoption of public policies aiming the quick clinical treatment of such diseases.

Frequency of hepatitis C in asymptomatic patients in district headquarters hospital Kotli, Azad Kashmir

International Nuclear Information System (INIS)

Saleem, M.; Ahmad, W.; Sarwar, J.

2011-01-01

Background: Hepatitis C is a common problem in developing world. It can affect a large number of asymptomatic people in whom it may cause serious complications in long run. Moreover, these asymptomatic infected people pose a serious risk for the transmission of infection to healthy population. Objective of this study was to estimate the frequency of Hepatitis C in asymptomatic adult patients attending medical OPD of District Headquarters Hospital Kotli, Azad Kashmir, and to assess the risk factors associated with its transmission. Methods: This was a cross-sectional study that included asymptomatic patients of both genders, aged 15-80 years, attending medical OPD of District Head quarter Hospital Kotli, Azad Kashmir from January to December, 2008. They attended the OPD for problems other than Hepatitis and most of them presented with vague complaints like generalised body aches, tiredness and dyspeptic symptoms. They were randomly tested for Hepatitis C virus (HCV) antibodies by Immuno chromatographic kit method. Positive samples for Hepatitis C antibodies were confirmed by third generation ELISA. Those who were confirmed were assessed for the risk factors associated with HCV transmission. Results: The study included 9,564 patients. Out of them 4,2 (44.22%) were males and 5,334 (55.77%) were females. A total of 611 (6.38%) cases were positive for HCV; 257 (6.08%) were males, and 354 (6.64%) were females. Highest frequency (36%) was found between 21 and 30 years of age, and 60.54% positive patients were 21-40 years old. Blood transfusion was the most common (34.36%) risk factor followed by history of dental procedures (24.54%). In 27.16% no risk factor could be detected. Conclusion: Frequency of Hepatitis C is quite high in our population. Rate is higher in young adults. It is needed to adopt organised preventive strategies to overcome this problem. Blood transfusion is still the most significant risk factor followed by dental and surgical procedures. Health related

[Ryazan hospital--80 years].

Science.gov (United States)

Klimov, A S; Gromov, M F

2012-02-01

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

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

Science.gov (United States)

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

2016-03-15

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

Neonatal seizures in a rural Iranian district hospital: etiologies, incidence and predicting factors.

Science.gov (United States)

Sadeghian, Afsaneh; Damghanian, Maryam; Shariati, Mohammad

2012-01-01

Current study determined the overall incidence, common causes as well as main predictors of this final diagnosis among neonates admitted to a rural district hospital in Iran. This study was conducted on 699 neonates who were candidate for admission to the NICU. Study population was categorized in the case group, including patients exposed to final diagnosis of neonatal seizures and the control group without this diagnosis. Neonatal seizure was reported as final diagnosis in 25 (3.6%) of neonates. The most frequent discharge diagnosis in the seizure group was neonatal sepsis and in the non-seizure group was respiratory problems. No significant difference was found in early fatality rate between neonates with and without seizures (8.0% vs. 10.1%). Only gestational age <38 week had a relationship with the appearance of neonatal seizure. Low gestational age has a crucial role for predicting appearance of seizure in Iranian neonates.

Developing a tool to measure health worker motivation in district hospitals in Kenya

Directory of Open Access Journals (Sweden)

Gilson Lucy

2009-05-01

Full Text Available Abstract Background We wanted to try to account for worker motivation as a key factor that might affect the success of an intervention to improve implementation of health worker practices in eight district hospitals in Kenya. In the absence of available tools, we therefore aimed to develop a tool that could enable a rapid measurement of motivation at baseline and at subsequent points during the 18-month intervention study. Methods After a literature review, a self-administered questionnaire was developed to assess the outcomes and determinants of motivation of Kenyan government hospital staff. The initial questionnaire included 23 questions (from seven underlying constructs related to motivational outcomes that were then used to construct a simpler tool to measure motivation. Parallel qualitative work was undertaken to assess the relevance of the questions chosen and the face validity of the tool. Results Six hundred eighty-four health workers completed the questionnaires at baseline. Reliability analysis and factor analysis were used to produce the simplified motivational index, which consisted of 10 equally-weighted items from three underlying factors. Scores on the 10-item index were closely correlated with scores for the 23-item index, indicating that in future rapid assessments might be based on the 10 questions alone. The 10-item motivation index was also able to identify statistically significant differences in mean health worker motivation scores between the study hospitals (p Conclusion The 10-item score developed may be useful to monitor changes in motivation over time within our study or be used for more extensive rapid assessments of health worker motivation in Kenya.

A decentralised model of psychiatric care: Profile, length of stay and outcome of mental healthcare users admitted to a district-level public hospital in the Western Cape

Directory of Open Access Journals (Sweden)

Eileen Thomas

2015-02-01

Full Text Available Background. There is a lack of studies assessing the profile and outcome of psychiatric patients at entry-level public hospitals that are prescribed by the Mental Health Care Act to provide a decentralised model of psychiatric care. Objective. To assess the demographic and clinical profile as well as length of stay and outcomes of mental healthcare users admitted to a district-level public hospital in the Western Cape.  Method. Demographic data, clinical diagnosis, length of stay, referral profile and outcomes of patients (N=487 admitted to Helderberg Hospital during the period 1 January 2011 - 31 December 2011 were collected.  Results. Psychotic disorders were the most prevalent (n=287, 59% diagnoses, while 228 (47% of admission episodes had comorbid/secondary diagnoses. Substance use disorders were present in 184 (38% of admission episodes, 37 (57% of readmissions and 19 (61% of abscondments. Most admission episodes (n=372, 76% were discharged without referral to specialist/tertiary care.  Conclusion. Methamphetamine use places a significant burden on the provision of mental healthcare services at entry-level care. Recommendations for improving service delivery at this district-level public hospital are provided.

Nurses caring for ENT patients in a district general hospital without a dedicated ENT ward score significantly less in a test of knowledge than nurses caring for ENT patients in a dedicated ENT ward in a comparable district general hospital.

Science.gov (United States)

Foxton, C R; Black, D; Muhlschlegel, J; Jardine, A

2014-12-01

To assess whether there is a difference in ENT knowledge amongst nurses caring for patients on a dedicated ENT ward and nurses caring for ENT patients in a similar hospital without a dedicated ENT ward. A test of theoretical knowledge of ENT nursing care was devised and administered to nurses working on a dedicated ENT ward and then to nurses working on generic non-subspecialist wards regularly caring for ENT patients in a hospital without a dedicated ENT ward. The test scores were then compared. A single specialist ENT/Maxillo-Facial/Opthalmology ward in hospital A and 3 generic surgical wards in hospital B. Both hospitals are comparable district general hospitals in the south west of England. Nursing staff working in hospital A and hospital B on the relevant wards were approached during the working day. 11 nurses on ward 1, 10 nurses on ward 2, 11 nurses on ward 3 and 10 nurses on ward 4 (the dedicated ENT ward). Each individual test score was used to generate an average score per ward and these scores compared to see if there was a significant difference. The average score out of 10 on ward 1 was 6.8 (+/-1.6). The average score on ward two was 4.8 (+/-1.6). The average score on ward three was 5.5 (+/-2.1). The average score on ward 4, which is the dedicated ENT ward, was 9.7 (+/-0.5). The differences in average test score between the dedicated ENT ward and all of the other wards are statistically significant. Nurses working on a dedicated ENT ward have an average higher score in a test of knowledge than nurses working on generic surgical wards. This difference is statistically significant and persists despite banding or training. © 2014 John Wiley & Sons Ltd.

Quality of clinical supervision as perceived by attending doctors in university and district teaching hospitals.

Science.gov (United States)

Busari, Jamiu O; Koot, Bart G

2007-10-01

Attending doctors (ADs) play important roles in the supervision of specialist registrars. Little is known, however, about how they perceive the quality of their supervision in different teaching settings. We decided to investigate whether there is any difference in how ADs perceive the quality of their supervision in university teaching hospital (UTH) and district teaching hospital (DTH) settings. We used a standardised questionnaire to investigate the quality of supervision as perceived by ADs. Fifteen items reflecting good teaching ability were measured on a 5-point Likert scale (1-5: never-always). We investigated for factors that influenced the perceived quality of supervision using Likert scale items (1-5: totally disagree-totally agree) and open-ended questionnaires. A total of 83 ADs (UTH: 51; DTH: 32) were eligible to participate in the survey. Of these, 43 (52%) returned the questionnaire (UTH: 25; DTH: 18). There was no difference in the overall mean of the 15 items between the UTH (3.67, standard deviation [SD] 0.35) and DTH (3.73, SD 0.31) ADs. Attending doctors in the DTH group rated themselves better at 'teaching technical skills' (mean 3.50, SD 0.70), compared with their UTH counterparts (mean 3.0, SD 0.76) (P = 0.03). Analysis of variance of the overall means revealed no significant difference between the different hospital settings. The results suggest that teaching hospital environments do not influence how ADs perceive the quality of their supervision. Lack of time for teaching was perceived as responsible for poor supervision. Other factors found to influence AD perceptions of good supervision included effective teaching skills, communication skills and provision of feedback.

More care out of hospital? A qualitative exploration of the factors influencing the development of the district nursing workforce in England.

Science.gov (United States)

Drennan, Vari M

2018-01-01

Objectives Many countries seek to improve care for people with chronic conditions and increase delivery of care outside of hospitals, including in the home. Despite these policy objectives in the United Kingdom, the home visiting nursing service workforce, known as district nursing, is declining. This study aimed to investigate the factors influencing the development of district nursing workforces in a metropolitan area of England. Methods A qualitative study in a metropolitan area of three million residents in diverse socio-economic communities using semi-structured interviews with a purposive sample of senior nurses in provider and commissioning organizations. Thematic analysis was framed by theories of workforce development. All participants reported that the context for the district nursing service was one of major reorganizations in the face of wider National Health Service changes and financial pressures. The analysis identified five themes that can be seen to impact the ways in which the district nursing workforce was developed. These were: the challenge of recruitment and retention, a changing case-mix of patients and the requirement for different clinical skills, the growth of specialist home visiting nursing services and its impact on generalist nursing, the capacity of the district nursing service to meet growing demand, and the influence of the short-term service commissioning process on the need for long-term workforce development. Conclusion There is an apparent paradox between health policies which promote more care within and closer to home and the reported decline in district nursing services. Using the lens of workforce development theory, an explanatory framework was offered with factors such as the nature of the nursing labour market, human resource practices, career advancement opportunities as well as the contractual context and the economic environment.

High prescription of antimicrobials in a rural district hospital in India

Directory of Open Access Journals (Sweden)

Alvarez-Uria G

2014-06-01

Full Text Available Background: The World Health Organization (WHO recommends surveillance of antibiotic use as part of the strategy to fight against antimicrobial resistance. However, there is little information about the antibiotic consumption in developing countries, especially in rural areas. Objective: The objective of this study was to describe the antimicrobial consumption in a rural hospital in India Methods: The study was performed in a district hospital situated in Anantapur, Andhra Pradesh. In accordance with WHO recommendations, we used the defined daily dose (DDD methodology to measure the antibiotic use during one year (from 1st August 2011 to 1st August 2012. The antibiotic use was measured using DDDs/100 admissions and DDDs/100 patient-days for inpatients, and DDDs/100 visits for outpatients. Results: During the study period, there were 15,735 admissions and 250,611 outpatient visits. Antibiotics were prescribed for 86% of inpatients and 12.5% of outpatients. Outpatient prescriptions accounted for 2/3 of the overall antibiotic consumption. For inpatients, the total antibiotic use was 222 DDDs/ 100 patient-days, 693 DDDs/ 100 admissions and the mean number of antibiotics prescribed was 1.8. For outpatients, the total antibiotic use was 86 DDDs/ 100 outpatient visits and the mean number of antibiotics prescribed was 1.2. The most common antibiotics prescribed were aminopenicillins and 3rd generation cephalosporins for inpatients, and tetracyclines and quinolones for outpatients. In a sample of patients with diarrhoea or upper respiratory tract infections (URTI, the proportion of patients who received antibiotics was 84% (95% confidence interval [CI], 67-93 and 52% (95% CI, 43-62, respectively. Conclusion: In this rural setting, the use of antimicrobials was extremely high, even in conditions with a predominantly viral aetiology such as diarrhoea or URTI.

Doctors' views of working conditions in rural hospitals in the Western ...

African Journals Online (AJOL)

management support impact negatively on doctors' views of working in district hospitals. Unless these ... and skills gap of district hospital practitioners in .... or tertiary hospitals, were highly regarded as a means of updating skills. Practical hands-on training was preferred to lectures. Lack of time, need for locums, remoteness.

Prioritizing essential surgery and safe anesthesia for the Post-2015 Development Agenda: operative capacities of 78 district hospitals in 7 low- and middle-income countries.

Science.gov (United States)

LeBrun, Drake G; Chackungal, Smita; Chao, Tiffany E; Knowlton, Lisa M; Linden, Allison F; Notrica, Michelle R; Solis, Carolina V; McQueen, K A Kelly

2014-03-01

Surgery has been neglected in low- and middle-income countries for decades. It is vital that the Post-2015 Development Agenda reflect that surgery is an important part of a comprehensive global health care delivery model. We compare the operative capacities of multiple low- and middle-income countries and identify critical gaps in surgical infrastructure. The Harvard Humanitarian Initiative survey tool was used to assess the operative capacities of 78 government district hospitals in Bangladesh (n = 7), Bolivia (n = 11), Ethiopia (n = 6), Liberia (n = 11), Nicaragua (n = 10), Rwanda (n = 21), and Uganda (n = 12) from 2011 to 2012. Key outcome measures included infrastructure, equipment availability, physician and nonphysician surgical providers, operative volume, and pharmaceutical capacity. Seventy of 78 district hospitals performed operations. There was fewer than one surgeon or anesthesiologist per 100,000 catchment population in all countries except Bolivia. There were no physician anesthesiologists in any surveyed hospitals in Rwanda, Liberia, Uganda, or in the majority of hospitals in Ethiopia. Mean annual operations per hospital ranged from 374 in Nicaragua to 3,215 in Bangladesh. Emergency operations and obstetric operations constituted 57.5% and 40% of all operations performed, respectively. Availability of pulse oximetry, essential medicines, and key infrastructure (water, electricity, oxygen) varied widely between and within countries. The need for operative procedures is not being met by the limited operative capacity in numerous low- and middle-income countries. It is of paramount importance that this gap be addressed by prioritizing essential surgery and safe anesthesia in the Post-2015 Development Agenda. Copyright © 2014 Mosby, Inc. All rights reserved.

Understanding local water conflict and cooperation: The case of Namwala District, Zambia

Science.gov (United States)

Funder, Mikkel; Mweemba, Carol; Nyambe, Imasiku; van Koppen, Barbara; Ravnborg, Helle Munk

Understanding the nature of water conflict and cooperation is a crucial element in water governance within Integrated Water Resources Management (IWRM). Much of the recent attention to the issue has however focused on transboundary aspects, while we know rather less about the nature and dynamics of local water conflict and cooperation. Drawing on the work of the collaborative Competing for Water Research Programme, this article presents selected findings from a quantitative and qualitative mapping and exploration of water conflict and cooperation events in Namwala District of Zambia. It is found that local water competition situations often involve both conflictive and cooperative events in a dynamic succession of each other, but also that the majority of events are conflictive, and that they primarily take place between different types of water uses, and less frequently among the same types of uses. There is a distinct tendency for both conflictive and cooperative events to originate in the dry season, and many events are associated with water infrastructure development, particularly boreholes. The study found that most conflictive and cooperative events took place within individual communities, and only to a lesser extent between two or more communities or between districts. While third parties are involved in some events, these are primarily local village institutions such as Headmen. The article concludes by discussing the implications of these findings for local water governance, including the need to ensure that the very localized nature of such conflict and cooperation events is taken into consideration in the institutional development of IWRM.

Factors influencing specialist outreach and support services to rural populations in the Eden and Central Karoo districts of the Western Cape.

Science.gov (United States)

Schoevers, Johan; Jenkins, Louis

2015-04-21

Access to health care often depends on where one lives. Rural populations have significantly poorer health outcomes than their urban counterparts. Specialist outreach to rural communities is one way of improving access to care. A multifaceted style of outreach improves access and health outcomes, whilst a shifted outpatients style only improves access. In principle, stakeholders agree that specialist outreach and support (O&S) to rural populations is necessary. In practice, however, factors influence whether or not O&S reaches its goals, affecting sustainability.Aim and setting: Our aim was to better understand factors associated with the success or failure of specialist O&S to rural populations in the Eden and Central Karoo districts in the Western Cape. An anonymous parallel three-stage Delphi process was followed to obtain consensus in a specialist and district hospital panel. Twenty eight specialist and 31 district hospital experts were invited, with response rates of 60.7%-71.4% and 58.1%-74.2% respectively across the three rounds. Relationships, communication and planning were found to be factors feeding into a service delivery versus capacity building tension, which affects the efficiency of O&S. The success of the O&S programme is dependent on a site-specific model that is acceptable to both the outreaching specialists and the hosting district hospital. Good communication, constructive feedback and improved planning may improve relationships and efficiency, which might lead to a more sustainable and mutually beneficial O&S system.

Understanding Standards and Assessment Policy in Science Education: Relating and Exploring Variations in Policy Implementation by Districts and Teachers in Wisconsin

Science.gov (United States)

Anderson, Kevin John Boyett

Current literature shows that many science teachers view policies of standards-based and test-based accountability as conflicting with research-based instruction in science education. With societal goals of improving scientific literacy and using science to spur economic growth, improving science education policy becomes especially important. To understand perceived influences of science education policy, this study looked at three questions: 1) How do teachers perceive state science standards and assessment and their influence on curriculum and instruction? 2) How do these policy perspectives vary by district and teacher level demographic and contextual differences? 3) How do district leaders' interpretations of and efforts within these policy realms relate to teachers' perceptions of the policies? To answer these questions, this study used a stratified sample of 53 districts across Wisconsin, with 343 middle school science teachers responding to an online survey; science instructional leaders from each district were also interviewed. Survey results were analyzed using multiple regression modeling, with models generally predicting 8-14% of variance in teacher perceptions. Open-ended survey and interview responses were analyzed using a constant comparative approach. Results suggested that many teachers saw state testing as limiting use of hands-on pedagogy, while standards were seen more positively. Teachers generally held similar views of the degree of influence of standards and testing regardless of their experience, background in science, credentials, or grade level taught. District SES, size and past WKCE scores had some limited correlations to teachers' views of policy, but teachers' perceptions of district policies and leadership consistently had the largest correlation to their views. District leadership views of these state policies correlated with teachers' views. Implications and future research directions are provided. Keywords: science education, policy

Costs and consequences of a cash transfer for hospital births in a rural district of Uttar Pradesh, India.

Science.gov (United States)

Coffey, Diane

2014-08-01

The Janani Suraksha Yojana, India's "safe motherhood program," is a conditional cash transfer to encourage women to give birth in health facilities. Despite the program's apparent success in increasing facility-based births, quantitative evaluations have not found corresponding improvements in health outcomes. This study analyses original qualitative data collected between January, 2012 and November, 2013 in a rural district in Uttar Pradesh to address the question of why the program has not improved health outcomes. It finds that health service providers are focused on capturing economic rents associated with the program, and provide an extremely poor quality care. Further, the program does not ultimately provide beneficiaries a large net monetary transfer at the time of birth. Based on a detailed accounting of the monetary costs of hospital and home deliveries, this study finds that the value of the transfer to beneficiaries is small due to costs associated with hospital births. Finally, this study also documents important emotional and psychological costs to women of delivering in the hospital. These findings suggest the need for a substantial rethinking of the program, paying careful attention to incentivizing health outcomes. Copyright © 2014 Elsevier Ltd. All rights reserved.

Pregnancy outcomes of women with HIV in a district general hospital in the UK.

Science.gov (United States)

Carey, L; Desouza, C; Moorcroft, A; Elgalib, A

2018-03-12

The aim of this study was to describe the obstetrical and virological outcomes in HIV-infected pregnant women who delivered at a district general hospital in south London in the period from 2008 to 2014. Our review identified 137 pregnancies; most (60%, 63/105) of them were unplanned. The commonest mode of delivery was spontaneous vaginal delivery (SVD) (42%, 48/114) followed by emergency Caesarean section (32%, 36/114). Gestational age at delivery was ≥37 weeks in most (84%, 91/106) of the cases. Maternal HIV VL at or closest to delivery was undetectable (1000 copies/mL in 73% (94/129), 90% (116/129) and 6% (8/129) of the pregnancies, respectively. None of the infants were infected with HIV making the rate of MTCT of HIV 0% (zero). Our study shows that favourable virological and obstetrical outcomes of HIV-infected pregnant women are achievable in non-tertiary HIV treatment centres. Impact Statement What is already known on this subject: Prevention of mother-to-child transmission (MTCT) of HIV has been one of the major public health successes in the last decades. This success was evident by the reduction of MTCT of HIV in the UK from 25.6% in the 1993 to only 0.46% in 2011. Furthermore, many reports from individual providers, mainly from tertiary centres, of HIV care in the UK also showed very low rates MTCT of HIV. What the results of this study add: Our study shows that favourable virological and obstetrical outcomes of HIV-infected pregnant women are achievable in non-tertiary HIV treatment centres. The MTCT of HIV rate in our hospital was zero in the period from 2008 to 2014. What the implications are of these findings for clinical practice and/or further research: Staff caring for pregnant HIV positive women in general hospitals and small-to-medium HIV clinics should liaise closely with each other and utilise the skill-mix within their hospital in order to provide a quality care that is similar to what is achieved in large teaching centres; however, a

The Bribery Act 2010: an overview for district nurses.

Science.gov (United States)

Griffith, Richard; Tengnah, Cassam

2012-10-01

The Bribery Act 2010 has been in force for a little over a year and has already served to reinforce the need for NHS organisations to adopt a proactive approach to preventing any suggestion that their staff are accepting inducements, in the form of gifts or hospitality, that could influence their performance. The robust policies on the acceptance of gifts and hospitality demanded by the 2010 Act require district nurses to be very cautious when offered a gift by a patient or commercial organisation. This article considers the implications of the Bribery Act 2010 on district nurse practice and the implications of failing to meet its provisions.

Out of Pocket Expenditure for Hospitalization among Below Poverty Line Households in District Solan, Himachal Pradesh, India, 2013.

Science.gov (United States)

Gupt, Anadi; Kaur, Prabhdeep; Kamraj, P; Murthy, B N

2016-01-01

Health insurance schemes, like Rashtriya Swasthya Bima Yojana (RSBY), should provide financial protection against catastrophic health costs by reducing out of pocket expenditure (OOPE) for hospitalizations. We estimated and compared the proportion and extent of OOPE among below poverty line (BPL) families beneficiaries and not beneficiaries by RSBY during hospitalizations in district Solan, H.P., India, 2013. We conducted a cross sectional survey among hospitalized BPL families in the beneficiaries and non-beneficiaries groups. We compared proportion incurring OOPE and its extent during hospitalization, pre/post-hospitalization periods in different domains. Overall, proportion of non-beneficiaries who incurred OOPE was higher than the beneficiaries but it was not statistically significant (87.2% vs. 80.9%). The median overall OOPE was $39 (Rs 2567) in the non-beneficiaries group as compared to $11 (Rs 713) in the beneficiaries group (p<0.01). Median expenditure on in house and out house drugs and consumables was $23 (Rs 1500) in the non beneficiaries group as compared to nil in the beneficiaries group (p<0.01). Non-beneficiary status was significantly associated [OR: 2.4 (1.3-4.3)] with OOPE above median independently and also after adjusting for various covariates. RSBY has decreased the extent of OOPE among the beneficiaries; however OOPE was incurred mainly due to purchase of drugs from outside the health facility. The treatment seeking behaviour in beneficiaries group has improved among comparatively older group with chronic conditions. RSBY has enabled beneficiaries to get more facilities such as drugs, consumables and diagnostics from the health facility.

Out of Pocket Expenditure for Hospitalization among Below Poverty Line Households in District Solan, Himachal Pradesh, India, 2013.

Directory of Open Access Journals (Sweden)

Anadi Gupt

Full Text Available Health insurance schemes, like Rashtriya Swasthya Bima Yojana (RSBY, should provide financial protection against catastrophic health costs by reducing out of pocket expenditure (OOPE for hospitalizations. We estimated and compared the proportion and extent of OOPE among below poverty line (BPL families beneficiaries and not beneficiaries by RSBY during hospitalizations in district Solan, H.P., India, 2013.We conducted a cross sectional survey among hospitalized BPL families in the beneficiaries and non-beneficiaries groups. We compared proportion incurring OOPE and its extent during hospitalization, pre/post-hospitalization periods in different domains.Overall, proportion of non-beneficiaries who incurred OOPE was higher than the beneficiaries but it was not statistically significant (87.2% vs. 80.9%. The median overall OOPE was $39 (Rs 2567 in the non-beneficiaries group as compared to $11 (Rs 713 in the beneficiaries group (p<0.01. Median expenditure on in house and out house drugs and consumables was $23 (Rs 1500 in the non beneficiaries group as compared to nil in the beneficiaries group (p<0.01. Non-beneficiary status was significantly associated [OR: 2.4 (1.3-4.3] with OOPE above median independently and also after adjusting for various covariates.RSBY has decreased the extent of OOPE among the beneficiaries; however OOPE was incurred mainly due to purchase of drugs from outside the health facility. The treatment seeking behaviour in beneficiaries group has improved among comparatively older group with chronic conditions. RSBY has enabled beneficiaries to get more facilities such as drugs, consumables and diagnostics from the health facility.

Can sonographers offer an accurate upper abdominal ultrasound service in a district general hospital?

International Nuclear Information System (INIS)

Dongola, N.A.; Guy, R.L.; Giles, J.A.; Ward, S.

2003-01-01

Purpose: This study was performed to evaluate the accuracy of upper abdominal ultrasound (US) scanning performed by sonographers in a district general hospital, to identify potential areas of weakness and to make recommendations to improve the service. Materials and methods: Upper abdominal US examinations performed and reported by sonographers over a 4-week period were retrospectively reviewed. The accuracy of the imaging findings and reports were assessed against other imaging, surgical, histological or laboratory findings and against clinical outcome. Results: A heterogenous group of 104 patients were included in the study, 62 of whom had an US abnormality. Errors of scanning or interpretation were identified in 10 patients (9.6%) of whom five (4.8%) were felt to be potentially significant. Conclusions: The sonographers' accuracy in reporting upper abdominal US scans was 90%. However, on the basis of this study we have implemented specific recommendations to improve the quality of the service

Malaria control at the district level in Africa: the case of the muheza district in northeastern Tanzania

DEFF Research Database (Denmark)

Alilio, Martin S; Kitua, Andrew; Njunwa, Kato

2004-01-01

transmission and incidence over time; use of facility-based care services for malaria; patients' access to professional advice; the trend of treatment failure over time of sulfadoxine-pyrimethamine and chloroquine; survival rates of severe cases at the district hospital; a district malaria control strategy......An assessment was done in Tanzania to determine the extent to which the primary health care services have contributed to reducing the burden of malaria since the system was initiated in the 1980s. Seven descriptive processes and outcome indicators of effectiveness were used: changes of malaria...

Future Services for District Heating Solutions in Residential Districts

Directory of Open Access Journals (Sweden)

Hannele Ahvenniemi

2014-06-01

Full Text Available The underlying assumption of this study is that in order to retain the competitiveness while reaching for the EU targets regarding low-energy construction, district heating companies need to develop new business and service models. How district heating companies could broaden their perspective and switch to a more service-oriented way of thinking is a key interest of our research. The used methods in our study are house builder interviews and a questionnaire. With the help of these methods we discussed the potential interest in heating related services acquiring a comprehensive understanding of the customer needs. The results indicate the importance of certain criteria when choosing the heating system in households: easiness, comfort and affordability seem to dominate the house builders’ preferences. Also environmental awareness seems to be for many an important factor when making a decision about the heating of the house. Altogether, based on the results of this study, we suggest that the prospects of district heating could benefit from highlighting certain aspects and strengths in the future. District heating companies need to increase flexibility, readiness to adopt new services, to invest in new marketing strategies and improving the communication skills.

A study of the emotional intelligence of employees at a District Hospital of Greece

Directory of Open Access Journals (Sweden)

Sofia Zyga

2012-01-01

Full Text Available Background: The role of emotional intelligence is one of the main issues in modern management. Contemporary terms withsemiotic meaning that target emotions, such as ‘leading with the heart’, ‘the art of influence’, ‘team mind’ and ‘teamintelligence quotient’, are now quite frequent in Greek and International literature.The objective of this study was the investigation of the level of emotional intelligence in three professional groups ofemployees in a district hospital.Methods: The population of the study consisted of 132 employees of a General Regional Hospital (doctors, nurses,administrative employees. The “Emotional Competence Inventory (ECI”, which was developed in 1999 by Goleman,Boyatzis and Rhee and is applied in organizational environments after relevant permission, was used for data collection.Chi-square test and Takey test (ANOVA / POST –HOC were used in the statistical analysis of the data, which wasperformed with SPSS and Microsoft Office Excel.Results: Chi-square test was used to investigate the relationship between the answers of every professional group, therelationship between males and females of the population of the study, as well as the relationship between the educationlevel of the study’s population. Important differences were found. The values of the answers were summed up (Likert-scale– additive model and were converted to z-scores. According to the study’s model, nurses of the hospital in question are firstin self-awareness, social awareness and cognitive thought; whereas self-management was found in doctors and relationshipmanagement was found in administrative employees.Conclusions: The analysis of the results indicates differences between the professional groups and distinctively points outthe qualitative characteristic elements of each profession which relate with the subfactors that investigate emotionalintelligence. The difference between professionals in how they manage their tasks with

WHO Safety Surgical Checklist implementation evaluation in public hospitals in the Brazilian Federal District

Directory of Open Access Journals (Sweden)

Heiko T. Santana

2016-09-01

Full Text Available Summary: The World Health Organization (WHO created the WHO Surgical Safety Checklist to prevent adverse events in operating rooms. The aim of this study was to analyze WHO checklist implementation in three operating rooms of public hospitals in the Brazilian Federal District. A prospective cross-sectional study was performed with pre- (Period I and post (Period II-checklist intervention evaluations. A total of 1141 patients and 1052 patients were studied in Periods I and II for a total of 2193 patients. Period I took place from December 2012 to March 2013, and Period II took place from April 2013 to August 2014. Regarding the pre-operatory items, most surgeries were classified as clean-contaminated in both phases, and team attire improved from 19.2% to 71.0% in Period II. Regarding checklist adherence in Period II, “Patient identification” significantly improved in the stage “Before induction of anesthesia”. “Allergy verification”, “Airway obstruction verification”, and “Risk of blood loss assessment” had low adherence in all three hospitals. The items in the stage “Before surgical incision” showed greater than 90.0% adherence with the exception of “Anticipated critical events: Anesthesia team review” (86.7% and “Essential imaging display” (80.0%. Low adherence was noted in “Instrument counts” and “Equipment problems” in the stage “Before patient leaves operating room”. Complications and deaths were low in both periods. Despite the variability in checklist item compliance in the surveyed hospitals, WHO checklist implementation as an intervention tool showed good adherence to the majority of the items on the list. Nevertheless, motivation to use the instrument by the surgical team with the intent of improving surgical patient safety continues to be crucial. Keywords: Surgical checklist, Adverse events, Patient safety, Surgical team, Infection control

Assessing the efficiency of hospital pharmacy services in Thai public district hospitals.

Science.gov (United States)

Rattanachotphanit, Thananan; Limwattananon, Chulaporn; Limwattananon, Supon; Johns, Jeff R; Schommer, Jon C; Brown, Lawrence M

2008-07-01

The purpose of this study was to assess the efficiency of hospital pharmacy services and to determine the environmental factors affecting pharmacy service efficiency. The technical efficiency of a hospital pharmacy was assessed to evaluate the hospital's ability to use pharmacy manpower in order to produce the maximum output of the pharmacy service. Data Envelopment Analysis (DEA) was used as an efficiency measurement. The two labor inputs were pharmacists and support personnel and the ten outputs were from four pharmacy activities: drug dispensing, drug purchasing and inventory control, patient-oriented activities, and health consumer protection services. This was used to estimate technical efficiency. A Tobit regression model was used to determine the effect of the hospital size, location, input mix of pharmacy staff, working experience of pharmacists at the study hospitals, and use of technology on the pharmacy service efficiency. Data for pharmacy service input and output quantities were obtained from 155 respondents. Nineteen percent were found to have full efficiency with a technical efficiency score of 1.00. Thirty-six percent had a technical efficiency score of 0.80 or above and 27% had a low technical efficiency score (location were significantly associated with pharmacy service efficiency.

Analysis of the First 100 Patients From the Syrian Civil War Treated in an Israeli District Hospital.

Science.gov (United States)

Biswas, Seema; Waksman, Igor; Baron, Shay; Fuchs, David; Rechnitzer, Hagai; Dally, Najib; Kassis, Shokrey; Hadary, Amram

2016-01-01

An analysis of the injuries and treatment of the first 100 patients from the Syrian civil war was conducted to monitor quality of care and outcome. As reports of the collapse of health care systems in regions within Syria reach the media, patients find themselves crossing the border into Israel for the treatment of war injuries. Among these patients are combatants, noncombatants, women, and children. Treatment, that is free at the point of care, is a humanitarian imperative for war wounded, and this paper reports the care in an Israeli district hospital of the first 100 patients received. With ethics committee approval, data from the Trauma Registry and electronic patient records were collected and analyzed. No identifying data are presented. Most patients (94) were male. Seventeen patients were younger than the age of 18 years; 52 patients were in their twenties. Most injuries were the results of gunshot or blast injury (50 and 29 patients, respectively). Two multiple-trauma patients died, 8 were transferred for specialist care, and 90 patients returned from Ziv Hospital to Syria after discharge. The experience of the care of patients across a hostile border has been unprecedented. Hospital protocols required adjustment to deliver quality clinical and social care to patients suffering from both the acute and chronic effects of civil war.

[Public health impact of a remote diagnosis system implemented in regional and district hospitals in Paraguay].

Science.gov (United States)

Galván, Pedro; Velázquez, Miguel; Benítez, Gualberto; Ortellado, José; Rivas, Ronald; Barrios, Antonio; Hilario, Enrique

2017-06-08

Determine the viability of a remote diagnosis system implemented to provide health care to remote and scattered populations in Paraguay. The study was conducted in all regional and general hospitals in Paraguay, and in the main district hospitals in the country's 18 health regions. Clinical data, tomographic images, sonography, and electrocardiograms (ECGs) of patients who needed a diagnosis by a specialized physician were entered into the system. This information was sent to specialists in diagnostic imaging and in cardiology for remote diagnosis and the report was then forwarded to the hospitals connected to the system. The cost-benefit and impact of the remote diagnosis tool was analyzed from the perspective of the National Health System. Between January 2014 and May 2015, a total of 34 096 remote diagnoses were made in 25 hospitals in the Ministry of Health's telemedicine system. The average unit cost of remote diagnosis was US$2.6 per ECG, tomography, and sonography, while the unit cost of "face-to-face" diagnosis was US$11.8 per ECG, US$68.6 per tomography, and US$21.5 per sonography. As a result of remote diagnosis, unit costs were 4.5 times lower for ECGs; 26.4 times lower for tomography, and 8.3 times lower for sonography. In monetary terms, implementation of the remote diagnosis system during the 16 months of the study led to average savings of US$2 420 037. Paraguay has a remote diagnosis system for electrocardiography, tomography, and sonography, using low-cost information and communications technologies (ICTs) based on free software that is scalable to other types of remote diagnostic studies of interest for public health. Implementation of remote diagnosis helped to strengthen the integrated network of health services and programs, enabling professionals to optimize their time and productivity, while improving quality, increasing access and equity, and reducing costs.

Using the CAUSE Model to Understand Public Communication about Water Risks: Perspectives from Texas Groundwater District Officials on Drought and Availability.

Science.gov (United States)

VanDyke, Matthew S; King, Andy J

2017-12-05

Public communication about drought and water availability risks poses challenges to a potentially disinterested public. Water management professionals, though, have a responsibility to work with the public to engage in communication about water and environmental risks. Because limited research in water management examines organizational communication practices and perceptions, insights into research and practice can be gained through investigation of current applications of these risk communication efforts. Guided by the CAUSE model, which explains common goals in communicating risk information to the public (e.g., creating Confidence, generating Awareness, enhancing Understanding, gaining Satisfaction, and motivating Enactment), semistructured interviews of professionals (N = 25) employed by Texas groundwater conservation districts were conducted. The interviews examined how CAUSE model considerations factor in to communication about drought and water availability risks. These data suggest that many work to build constituents' confidence in their districts. Although audiences and constituents living in drought-prone areas were reported as being engaged with water availability risks and solutions, many district officials noted constituents' lack of perceived risk and engagement. Some managers also indicated that public understanding was a secondary concern of their primary responsibilities and that the public often seemed apathetic about technical details related to water conservation risks. Overall, results suggest complicated dynamics between officials and the public regarding information access and motivation. The article also outlines extensions of the CAUSE model and implications for improving public communication about drought and water availability risks. © 2017 Society for Risk Analysis.

Performance of health product risk management and surveillance conducted by health personnel at sub-district health promotion hospitals in the northeast region of Thailand

OpenAIRE

Kanjanarach, Tipaporn; Jaisa-ard, Raksaworn; Poonaovarat, Nantawan

2014-01-01

Tipaporn Kanjanarach,1,2 Raksaworn Jaisa-ard,1,2 Nantawan Poonaovarat3 1Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand; 2Center for Research and Development of Herbal Health Products, Khon Kaen University, Khon Kaen, Thailand; 3Health Consumer Protection, Chaiyapum Health Provincial Office, Chaiyapum, Thailand Background: Health personnel at sub-district health promotion hospitals (SD-HPHs) are assigned to take responsibility for 15 activities related to health...

Hospital Staff Shortage after the 2011 Triple Disaster in Fukushima, Japan-An Earthquake, Tsunamis, and Nuclear Power Plant Accident: A Case of the Soso District.

Science.gov (United States)

Ochi, Sae; Tsubokura, Masaharu; Kato, Shigeaki; Iwamoto, Shuichi; Ogata, Shinichi; Morita, Tomohiro; Hori, Arinobu; Oikawa, Tomoyoshi; Kikuchi, Antoku; Watanabe, Zenjiro; Kanazawa, Yukio; Kumakawa, Hiromi; Kuma, Yoshinobu; Kumakura, Tetsuo; Inomata, Yoshimitsu; Kami, Masahiro; Shineha, Ryuzaburo; Saito, Yasutoshi

2016-01-01

In 2011, Fukushima was struck by a triple disaster: an earthquake, tsunamis, and a nuclear accident. In the aftermath, there was much fear among hospital staff members about radiation exposure and many staff members failed to report to work. One objective is to measure this shortage in hospital staff and another is to compare the difference in recovery by hospital types and by categories of hospital staff. The monthly records of the number of staff members from May 2011 to September 2012 were extracted anonymously from the records of 7 local hospitals in the Soso district in Fukushima. Change in the number of staff was analyzed. Staff shortages at hospitals reached a maximum within one month after the disaster (47% reported to work). The shortage of clerks was the most severe (38% reported to work), followed by nurses (48% reported to work). The shortages remained even 18 months after the disaster. After a disaster in which the damage to hospital functions surpasses the structural damage, massive support of human resources in the acute phase and a smaller volume of support in the mid-term phase appear to be required, particularly for non-medical staff.

The Epidemiology of District Surgery in Malawi: a Two Year Study of ...

African Journals Online (AJOL)

Paul

Data gathered over a 2-year period from 1993 to 1995 on surgical and anaesthetic ..... difference between the best District Hospital and the Central Hospital. ... be adequately met without any doctor ever appearing in the operating theatre, ...

Screening for Hypothyroidism-Results of a Study Conducted at District Headquarter Hospital, Abbottabad

International Nuclear Information System (INIS)

Gul, N.; Farid, J.; Idris, M.; Sarwar, J.

2016-01-01

Background: Sub-clinically hypo-functioning thyroid is a condition in which there is biochemical evidence of hypothyroidism but patient is clinically asymptomatic. This concept is not new. The typical picture of this condition is increased thyroid stimulating hormone and normal thyroxine levels. Subclinical hypothyroidism has been found to have variable prevalence ranging from 4-10 percent to 10-26 percent. Methods: This cross sectional study was conducted on 378 adult patients coming to outpatient department of District Headquarter Hospital Abbottabad over a period of two years from February 2013 to February 2015. Results: Out of the 378 individuals studied, 37 (9.78 percent) had subclinical hypothyroidism. Mean age of the patients was 43.5±10.5 years. Females outnumbered males, i.e., 24 out of 37 (65 percent). It was noted that there was no correlation between mean TSH level and gender or age of the patients. Conclusion: Subclinical hypothyroidism is not an uncommon condition and its diagnosis is established easily by doing thyroid hormone levels in fasting condition. Early diagnosis and therapeutic intervention may not only prevent the progression to clinical hypothyroidism but also help in preventing the wastage of resources on doing unnecessary investigations. (author)

Screening For Hypothyroidism-Results Of A Study Conducted At District Headquarter Hospital, Abbottabad.

Science.gov (United States)

Gul, Nasreen; Farid, Jamila; Idris, Muhammad; Sarwar, Javed

2016-01-01

Sub-clinically hypo-functioning thyroid is a condition in which there is biochemical evidence of hypothyroidism but patient is clinically asymptomatic. This concept is not new. The typical picture of this condition is increased thyroid stimulating hormone and normal thyroxine levels. Subclinical hypothyroidism has been found to have variable prevalence ranging from 4-10% to 10- 26%. This cross sectional study was conducted on 378 adult patients coming to outpatient department of District Headquarter Hospital Abbottabad over a period of two years from February 2013 to February 2015. Out of the 378 individuals studied, 37 (9.78%) had subclinical hypothyroidism. Mean age of the patients was 43.5±10.5 years. Females outnumbered males, i.e., 24 out of 37 (65%). It was noted that there was no correlation between mean TSH level and gender or age of the patients. Subclinical hypothyroidism is not an uncommon condition and its diagnosis is established easily by doing thyroid hormone levels in fasting condition. Early diagnosis and therapeutic intervention may not only prevent the progression to clinical hypothyroidism but also help in preventing the wastage of resources on doing unnecessary investigations.

District Leaders' Framing of Educator Evaluation Policy

Science.gov (United States)

Woulfin, Sarah L.; Donaldson, Morgaen L.; Gonzales, Richard

2016-01-01

Purpose: Educator evaluation systems have recently undergone scrutiny and reform, and district and school leaders play a key role in interpreting and enacting these systems. This article uses framing theory to understand district leaders' interpretation and advancement of a state's new educator evaluation policy. Research Methods: The article…

Assessing the gap between the acute trauma workload and the capacity of a single rural health district in South Africa. What are the implications for systems planning?

Science.gov (United States)

Clarke, D L; Aldous, C; Thomson, S R

2014-06-01

This study focuses on a single rural health district in South Africa, and attempts to establish the burden of disease and to review the capacity of the district hospitals to deal with this load. Ethical approval to undertake this study was obtained from both the University of Kwa-Zulu Natal and the Department of Health. The audit was performed over a 6-month period in the four district hospitals of rural Sisonke District. There were four components to this audit. 1. Information on the hospital incidence of acute trauma in Sisonke was also sourced from the epidemiology unit of the Department of Health in Pietermaritzburg 2. Each of the district hospitals was visited and the medical manager was interviewed. The medical manager was asked to complete the World Health Organization's Tool for Situational Analysis to Assess Emergency and Essential Surgical Care. (SAT). 3. The operative registers were reviewed to determine the number of index cases for trauma. This information was used to determine the unmet need of acute trauma in the district. 4. Each hospital was classified according to the Trauma Society of South Africa (TSSA) guidelines for levels of trauma care. The annual incidence of trauma in the Sisonke District is estimated to be 1,590 per 100,000 population. Although there appeared to be adequate infrastructure in the district hospitals, the SAT revealed significant deficits in terms of capacity of staff to adequately treat and triage acute trauma patients. There is a significant unmet need for trauma care in Sisonke. The four district hospitals can best be classified as Level IV centers of trauma care. There is a significant burden of trauma in the Sisonke District, yet the capacity to deal with this burden is inadequate. Although the physical infrastructure is adequate, the deficits relate to human resources. The strategic choices are between enhancing the district hospitals' capacity to deal with acute trauma, or deciding to bypass them completely and

Public-Private Partnership in Health Care: A Comparative Cross-sectional Study of Perceived Quality of Care Among Parents of Children Admitted in Two Government District-hospitals, Southern India.

Science.gov (United States)

Baliga, B Shantaram; Ravikiran, S R; Rao, Suchetha S; Coutinho, Anitha; Jain, Animesh

2016-02-01

Perceived better quality of care draws lower socio-economic classes of Indians to more expensive private setups, leading to poverty illness poverty cycle. Urgent measures need to be taken to improve perceived quality of public hospitals. The present study compares the difference in perceived quality of care among parents of children admitted at two government district hospitals. A cross-sectional, comparative, questionnaire based study was conducted between February 2011 and February 2012 at Government medical college hospitals of two district headquarters in South-India: one with private-public-partnership (PPP-model); another directly operated by government - Public Hospital-model (PH-model). A total of 461 inpatients from the PH model hospital and 580 from the PPP model hospital were eligible. Patients who left against advice (LAMA) (n=44 in PH and 19 in PPP) and expired (n=25 in PH and 59 in PPP) were excluded. Fourteen incomplete forms from PH and 10 from PPP model hospital were also excluded. Responders rated perception on a 1-5 scale in each domain: accessibility of health-facility, time spent waiting, manner and quality of physician, manner and quality of nurse, manner and quality of supporting staff, perception of equipment, explanation of treatment details and general comfort. The responders also rated overall satisfaction on a 1-10 scale. In the 1-5 scale, rating≥4 in each domain was considered good. Rating≥8 in 1-10 scale was considered satisfaction. Responders from PPP-model hospital were significantly more satisfied than those from PH-model {n=529 (91.2%) vs. n=148 (32.1%) p<0.001}. This was true even when controlled for age-group, sex, maternal education, family-type, days of hospital-stay and socioeconomic class {O.R.(CI) =23.58 (16.13-34.48); p<0.001} by binary logistic regression model. In the PPP-model hospital the time spent waiting for treatment {4.28(2.07-8.82), p<.001} and manner of support staff {3.64(1.02-12.99), p=0.04} significantly

Measuring the Burden of Surgical Disease Averted by Emergency and Essential Surgical Care in a District Hospital in Papua New Guinea.

Science.gov (United States)

Stokes, Matthew A R; Guest, Glenn D; Mamadi, Perista; Seta, Westin; Yaubihi, Noel; Karawiga, Grace; Naidi, Billy; Watters, David A K

2017-03-01

Timely access to emergency and essential surgical care (EESC) and anaesthesia in low- and middle-income countries (LMICs) prevents premature death, minimises lifelong disability and reduces their economic impact on families and communities. Papua New Guinea is one of the poorest countries in the Pacific region, and provides much of its surgical care at a district hospital level. We aimed to evaluate the surgical capacity of a district hospital in PNG and estimate the effectiveness of surgical interventions provided. We performed a prospective study to calculate the number of DALYs averted for 465 patients treated with surgical care over a 3-month period (Sep-Nov 2013) in Alotau Hospital, Milne Bay Province, PNG (pop 210,000). Data were also collected on infrastructure, workforce, interventions provided and equipment available using the World Health Organization's Integrated Management of Emergency and Essential Surgical Care Toolkit, a survey to assess EESC and surgical capacity. We also performed a retrospective one-year audit of surgical, obstetric and anaesthetic care to provide context with regards to annual disease burden treated and surgical activity. EESC was provided by 11 Surgeons/Anaesthetists/Obstetricians (SAO) providers, equating to 5.7 per 100,000 population (including 4 nurse anaesthetists). They performed 783/100,000 procedures annually. Over the 3-month prospective study period, 4954 DALYs were averted by 465 surgical interventions, 52 % of which were elective. This equates to 18,330 DALYs averted annually or, approximately 18 % of the published but estimated disease burden in the Province in the 2013 Global Burden of Disease Study. The overall peri-operative mortality rate was 1.29 %, with 0.41 % for elective procedures and 2.25 % for emergencies. Much of the burden of surgical disease in Papua New Guinea presenting to Alotau General Hospital serving Milne Bay Province can be effectively treated by a small team providing emergency and

Patient satisfaction at accredited antiretroviral treatment sites in the Gert Sibande District

Directory of Open Access Journals (Sweden)

Selente Bezuidenhout

2014-11-01

Aim: This study sought to explore and describe the general satisfaction or dissatisfaction of patients with accredited ART hospital sites at public health facilities in the Gert Sibande District, Mpumalanga and to identify factors contributing to either satisfaction or dissatisfaction. Setting: Six hospitals that initiated ART in the district, participated in the study. Method: The study was conducted using a sample of 300 patients. Proportional random sampling was used in selecting the number of patients from each facility. A structured interview with each participating patient was conducted using a standardised structured questionnaire. The first available required number of patients that complied with requirements from each of the six hospitals was selected for the interview. Descriptive statistics were used to analyse data and data with qualitative aspects were captured and categorised manually. Results: The major factors contributing to satisfaction included the availability of medicines and knowledge regarding how to take medication. Factors contributing to dissatisfaction on the part of the patients included confidentiality issues, long waiting periods, shortage of staff and dirty toilets. Conclusion: This study indicated general satisfaction with the ART-related services at the accredited ART hospital sites in the Gert Sibande District. Regular monitoring and evaluation are recommended.

A criteria-based clinical audit on the case-management of children presenting with malaria at Mangochi District Hospital, Malawi.

Science.gov (United States)

Diep, Phuong Phuong; Lien, Lars; Hofman, Jan

2007-01-01

Malaria is a major threat to global health and is one of the leading causes of death worldwide. It is estimated that 2.3 billion people live in areas of malaria risk and each year 300-500 million cases of Plasmodium falciparum malaria occur worldwide. This parasitic infection is one of the major causes of morbidity and mortality in Africa and approximately 90% of cases which include life-threatening malaria are in children, the highest mortality rate being found in children under the age of five. Improvement in case-management of malaria in children is one of the strategies in the prevention of infant mortality. In particular, the health system needs to concentrate on good quality care at the first referral level of the district hospital, as health care provided at this level is crucial for reducing child mortality and for a credible and effective support for the primary health care system. The conduct of systematic assessments of clinical care of malaria including the diagnostic process, medical treatment and nursing care in order to reveal shortcomings in case-management and make improvements are vital. Clinical audit is now routinely used and accepted as part of quality assurance in the health care services of many developed countries, but it has yet to be widely applied to the developing world. The principal objective of the study conducted, was therefore to assess the clinical care of children with malaria at district hospital level in a low-income African country to highlight potential areas of improvement in the quality of care of malaria. At the same time, the specific objectives involved: Assessment of diagnostic process, medical treatment and nursing care; Identification of strengths and deficiencies in current practice; Identification of factors contributing to poor quality of care; Finding strategies to improve current practice.

Measuring the Capacity Utilization of Public District Hospitals in Tunisia: Using Dual Data Envelopment Analysis Approach

Directory of Open Access Journals (Sweden)

Chokri Arfa

2017-01-01

Full Text Available Background Public district hospitals (PDHs in Tunisia are not operating at full plant capacity and underutilize their operating budget. Methods Individual PDHs capacity utilization (CU is measured for 2000 and 2010 using dual data envelopment analysis (DEA approach with shadow prices input and output restrictions. The CU is estimated for 101 of 105 PDH in 2000 and 94 of 105 PDH in 2010. Results In average, unused capacity is estimated at 18% in 2010 vs. 13% in 2000. Of PDHs 26% underutilize their operating budget in 2010 vs. 21% in 2000. Conclusion Inadequate supply, health quality and the lack of operating budget should be tackled to reduce unmet user’s needs and the bypassing of the PDHs and, thus to increase their CU. Social health insurance should be turned into a direct purchaser of curative and preventive care for the PDHs.

The incidence, aetiology and outcome of acute seizures in children admitted to a rural Kenyan district hospital

Directory of Open Access Journals (Sweden)

Maitland Kathryn

2008-02-01

Full Text Available Abstract Background Acute seizures are a common cause of paediatric admissions to hospitals in resource poor countries and a risk factor for neurological and cognitive impairment and epilepsy. We determined the incidence, aetiological factors and the immediate outcome of seizures in a rural malaria endemic area in coastal Kenya. Methods We recruited all children with and without seizures, aged 0–13 years and admitted to Kilifi District hospital over 2 years from 1st December 2004 to 30th November 2006. Only incident admissions from a defined area were included. Patients with epilepsy were excluded. The population denominator, the number of children in the community on 30th November 2005 (study midpoint, was modelled from a census data. Results Seizures were reported in 900/4,921(18.3% incident admissions and at least 98 had status epilepticus. The incidence of acute seizures in children 0–13 years was 425 (95%CI 386, 466 per 100,000/year and was 879 (95%CI 795, 968 per 100,000/year in children Conclusion There is a high incidence of acute seizures in children living in this malaria endemic area of Kenya. The most important causes are diseases that are preventable with available public health programs.

Auditing surgical service provision at a South African tertiary institution: Implications for the development of district services.

Science.gov (United States)

Laing, G L; Skinner, D L; Bruce, J L; Aldous, C; Govindasamy, V; Thomson, S R; Clarke, D L

2017-11-01

The optimal management of resources within South African state hospitals has been hampered by a paucity of data due to a lack of robust auditing information systems. This study reviews the use of a Hybrid Electronic Medical Record (HEMR) system to capture and aggregate data pertaining to the inpatient service demands on a South African tertiary surgical service. This dataset was used to analyse the appropriateness of tertiary surgical resource utilisation. The HEMR system was implemented at Greys Hospital, in the city of Pietermaritzburg, Kwa-Zulu Natal, South Africa on 1 January 2013. Inpatient data pertaining to surgical admissions and operative interventions were captured prospectively. Following an 18-month study period, the data were extracted, aggregated and analysed. The district referral hospitals were mapped, and district surgical procedures performed within the tertiary center were identified and quantified. Results: 7314 patients were admitted and managed by the tertiary surgical service during the study period. The median patient age was 33 years (IQR 6.5-42.4 years). 59.7% were male and 40.3% were female. General, trauma and paediatric surgical admissions constituted 54.8%, 28.6% and 16.6% respectively. Emergency admissions constituted 62.4% and elective admissions 37.6%. Referral sources were captured for 6653 (91%) of the cohort. 4338 (65.2%) patients were referred from district hospitals. The district hospital (Northdale) closest to Greys Hospital was responsible for 1675 (25.2%) of surgical referrals. 4174 operative procedures were performed during the study period, 54.7% performed as an emergency, 34.1% electively and 11.2% semi-electively. The median waiting time for emergency operative intervention was 535 minutes (IQR 130-663). A total of 1272 (30.5%) operative procedures performed were assessed as district-level operations. The time intervals of 07:00-07:59 and 17:00-17:59 were identified as the time periods during which the least number of

Spatio-Temporal Variation and Prediction of Ischemic Heart Disease Hospitalizations in Shenzhen, China

Directory of Open Access Journals (Sweden)

Yanxia Wang

2014-05-01

Full Text Available Ischemic heart disease (IHD is a leading cause of death worldwide. Urban public health and medical management in Shenzhen, an international city in the developing country of China, is challenged by an increasing burden of IHD. This study analyzed the spatio-temporal variation of IHD hospital admissions from 2003 to 2012 utilizing spatial statistics, spatial analysis, and space-time scan statistics. The spatial statistics and spatial analysis measured the incidence rate (hospital admissions per 1,000 residents and the standardized rate (the observed cases standardized by the expected cases of IHD at the district level to determine the spatio-temporal distribution and identify patterns of change. The space-time scan statistics was used to identify spatio-temporal clusters of IHD hospital admissions at the district level. The other objective of this study was to forecast the IHD hospital admissions over the next three years (2013–2015 to predict the IHD incidence rates and the varying burdens of IHD-related medical services among the districts in Shenzhen. The results show that the highest hospital admissions, incidence rates, and standardized rates of IHD are in Futian. From 2003 to 2012, the IHD hospital admissions exhibited similar mean centers and directional distributions, with a slight increase in admissions toward the north in accordance with the movement of the total population. The incidence rates of IHD exhibited a gradual increase from 2003 to 2012 for all districts in Shenzhen, which may be the result of the rapid development of the economy and the increasing traffic pollution. In addition, some neighboring areas exhibited similar temporal change patterns, which were also detected by the spatio-temporal cluster analysis. Futian and Dapeng would have the highest and the lowest hospital admissions, respectively, although these districts have the highest incidence rates among all of the districts from 2013 to 2015 based on the prediction

Experience with enterocutaneous fistula management in a district ...

African Journals Online (AJOL)

Experience with enterocutaneous fistula management in a district hospital in Nigeria. ... Malnutrition and sepsis are the leading causes of death. There are no clear guidelines for optimal nutritional management. Aggressive measures to maintain positive nitrogen balance is the ultimate goal of nutritional management.

Micro-Women Entrepreneurship and its potential for hospitality and tourism related enterprises amongst others: a study on YSR District, Andhra Pradesh, India

Directory of Open Access Journals (Sweden)

P Saritha

2011-01-01

Full Text Available The position of women and their status in any society is an index of its level of civilization. Women are to be considered as equal partners in the process of development. But, because of centuries of exploitation and subjugation, Indian women have remained at the receiving end. Women in India have been neglected a great deal. The rate of growth of women employment in India is very low when compared to developed nations. This is because of the low growth rate of new and productive employment. There is a scheme which women can access with less effort than the traditional routes to business development in areas such as food production and even hospitality and tourism, and this is the Self Help Group (SHG which is categorized as micro finance. It is a tool to eradicate poverty and improve entrepreneurship and financial support for women in India. An SHG is a small economically homogeneous affinity group of the rural poor which voluntarily comes together to save small amounts of money but on a regular basis. SHGs enhance the equality and status of women as participants, decision-makers and beneficiaries in the democratic, economic, social and cultural spheres of life. The article focuses on SHG formation, women entrepreneurship and economic empowerment of women after they have joined SHGs in YSR district, A.P. India. YSR district (Kadapa district is one of the pioneering districts for the implementation of the SHG programme as a pilot project in the Andhra Pradesh state. At the present time there are 21 Mandals in YSR district of Andhra Pradesh which consist of a total of 35,338 SHGs. Of these, the best two mandals, namely, Kodur and Ramapuram were selected for this study because of the SHGs in these mandals which are operating very successfully. This success is based on age, education, income level, nature of family, size of the family, reasons for joining SHGs and the amount of loan availed of by the selected women entrepreneurs. There are 19087

Eliminating Rabies in Tanzania? Local Understandings and Responses to Mass Dog Vaccination in Kilombero and Ulanga Districts

Science.gov (United States)

Bardosh, Kevin; Sambo, Maganga; Sikana, Lwitiko; Hampson, Katie; Welburn, Susan C.

2014-01-01

Background With increased global attention to neglected diseases, there has been a resurgence of interest in eliminating rabies from developing countries through mass dog vaccination. Tanzania recently embarked on an ambitious programme to repeatedly vaccinate dogs in 28 districts. To understand community perceptions and responses to this programme, we conducted an anthropological study exploring the relationships between dogs, society, geography and project implementation in the districts of Kilombero and Ulanga, Southern Tanzania. Methodology/Principal Findings Over three months in 2012, we combined the use of focus groups, semi-structured interviews, a household questionnaire and a population-based survey. Willingness to participate in vaccination was mediated by fear of rabies, high medical treatment costs and the threat of dog culling, as well as broader notions of social responsibility. However, differences between town, rural and (agro-) pastoralist populations in livelihood patterns and dog ownership impacted coverage in ways that were not well incorporated into project planning. Coverage in six selected villages was estimated at 25%, well below official estimates. A variety of problems with campaign mobilisation, timing, the location of central points, equipment and staff, and project organisation created barriers to community compliance. Resource-limitations and institutional norms limited the ability for district staff to adapt implementation strategies. Conclusions and Significance In the shadows of resource and institutional limitations in the veterinary sector in Africa, top-down interventions for neglected zoonotic diseases likes rabies need to more explicitly engage with project organisation, capacity and community participation. Greater attention to navigating local realities in planning and implementation is essential to ensuring that rabies, and other neglected diseases, are controlled sustainably. PMID:24945697

Frequency of hepatitis B in asymptomatic patients of district Headquarter hospital Kotli, Azad Kashmir

International Nuclear Information System (INIS)

Sarwar, J.; Ahmad, W.; Saleem, M.; Jamshed, F.; Gul, N.; Idrees, M.

2010-01-01

Background: Hepatitis B is prevalent throughout the world including Pakistan. A large proportion of patients suffering from Hepatitis B may be asymptomatic and can transmit the disease to healthy population. Objectives of this study were to estimate the frequency of Hepatitis B in asymptomatic adult population coming to District Headquarter Hospital Kotli, Azad Kashmir and to determine the risk factors associated with its transmission. Methods: This was a cross-sectional study extending from January to December 2008. Subjects were randomly selected from those who attended the medial OPD of DHQ Hospital Kotli, Azad Kashmir for non-Hepatitis related problems. Both males and females between the ages of 15-80 years were included in the study. Blood samples taken from selected subjects were analysed for Hepatitis B surface antigen (HBsAg) by Immuno chromatographic kit methods (ICT). Hepatitis B positive samples were further confirmed by third generation ELIZA. The patients thus confirmed were interrogated for different risk factors associated with transmission of Hepatitis B. Results: A total of 9,564 patients were analysed. Out of them 4230 (44.22%) were males and 5334 (55.77%) were females. Overall 141 (1.47%) patients were positive for HBSAg, 71 (1.68%) males and 70 (1.31%) females. Patients between 21-30 years of age were most commonly effected (35.46%, n=50). Blood transfusion was the most common risk factor (24.82%, n=35) associated with Hepatitis B transmission followed by dental procedures (14.18%, n=20). Conclusion: Frequency of Hepatitis B in asymptomatic people in this study was quite high. Blood transfusions and dental procedures were the most common risk factors associated with the transmission of Hepatitis B. (author)

Sustaining Community Partnership across Transition in District Leadership

Science.gov (United States)

LeChasseur, Kimberly

2017-01-01

This case of district turnover was developed as part of a project with state leaders and funders supporting local early education systems development. Understanding strategic and reactive activities during district leadership transition can be useful in assisting educators and their partners to prepare for sustainability. In this case, early…

Knowledge and practices of general practitioners at district hospitals towards cervical cancer prevention in Burundi, 2015: a cross-sectional study.

Science.gov (United States)

Ndizeye, Zacharie; Vanden Broeck, Davy; Vermandere, Heleen; Bogers, John Paul; Van Geertruyden, Jean-Pierre

2018-01-16

Well-organized screening and treatment programmes are effective to prevent Invasive Cervical Cancer (ICC) in LMICs. To achieve this, the World Health Organization (WHO) recommends the involvement of existing health personnel in casu doctors, nurses, midwives in ICC prevention. A necessary precondition is that health personnel have appropriate knowledge about ICC. Therefore, to inform policy makers and training institutions in Burundi, we documented the knowledge and practices of general practitioners (GPs) at district hospital level towards ICC control. A descriptive cross-sectional survey was conducted from February to April, 2015 among all GPs working in government district hospitals. A structured questionnaire and a scoring system were used to assess knowledge and practices of GPs. The participation rate was 58.2%. Majority of GPs (76.3%) had appropriate knowledge (score > 70%) on cervical cancer disease; but some risk factors were less well known as smoking and the 2 most important oncogenic HPV. Only 8.4% of the participants had appropriate knowledge on ICC prevention: 55% of the participants were aware that HPV vaccination exists and 48.1% knew cryotherapy as a treatment method for CIN. Further, 15.3% was aware of VIA as a screening method. The majority of the participants (87%) never or rarely propose screening tests to their clients. Only 2 participants (1.5%) have already performed VIA/VILI. Wrong thoughts were also reported: 39.7% thought that CIN could be treated with radiotherapy; 3.1% thought that X-ray is a screening method. In this comprehensive assessment, we observed that Burundian GPs have a very low knowledge level about ICC prevention, screening and treatment. Suboptimal practices and wrong thoughts related to ICC screening and treatments have also been documented. We therefore recommend an adequate pre- and in-service training of GPs and most probably nurses on ICC control before setting up any public health intervention on ICC control.

Measuring the preparedness of health facilities to deliver emergency obstetric care in a South African district.

Science.gov (United States)

Thwala, Siphiwe Bridget Pearl; Blaauw, Duane; Ssengooba, Freddie

2018-01-01

Improving the delivery of emergency obstetric care (EmNOC) remains critical in addressing direct causes of maternal mortality. United Nations (UN) agencies have promoted standard methods for evaluating the availability of EmNOC facilities although modifications have been proposed by others. This study presents an assessment of the preparedness of public health facilities to provide EmNOC using these methods in one South African district with a persistently high maternal mortality ratio. Data collection took place in the final quarter of 2014. Cross-sectional surveys were conducted to classify the 7 hospitals and 8 community health centres (CHCs) in the district as either basic EmNOC (BEmNOC) or comprehensive EmNOC (CEmNOC) facilities using UN EmNOC signal functions. The required density of EmNOC facilities was calculated using UN norms. We also assessed the availability of EmNOC personnel, resuscitation equipment, drugs, fluids, and protocols at each facility. The workload of skilled EmNOC providers at hospitals and CHCs was compared. All 7 hospitals in the district were classified as CEmNOC facilities, but none of the 8 CHCs performed all required signal functions to be classified as BEmNOC facilities. UN norms indicated that 25 EmNOC facilities were required for the district population, 5 of which should be CEmNOCs. None of the facilities had 100% of items on the EmNOC checklists. Hospital midwives delivered an average of 36.4±14.3 deliveries each per month compared to only 7.9±3.2 for CHC midwives (pfacilities in the district. Full EmNOC services were centralised to hospitals to assure patient safety even though national policy guidelines sanction more decentralisation to CHCs. Studies measuring EmNOC availability need to consider facility opening hours, capacity and staffing in addition to the demonstrated performance of signal functions.

Absorptive Capacity: A Conceptual Framework for Understanding District Central Office Learning

Science.gov (United States)

Farrell, Caitlin C.; Coburn, Cynthia E.

2017-01-01

Globally, school systems are pressed to engage in large-scale school improvement. In the United States and other countries, school district central offices and other local governing agencies often engage with external organizations and individuals to support such educational change efforts. However, initiatives with external partners are not…

Hospital campus design related with EeB challenges

NARCIS (Netherlands)

Hoogh, S. de; Giulio, R. di; Quentin, C.; Turillazzi, B.; Sebastian, R.

2015-01-01

Energy efficiency and reduction of carbon emission of Healthcare buildings and districts are a key factor for a sustainable community since their energy use and carbon emission are among the highest of all building types. A hospital - which is a part of a healthcare district - uses 2.5 times more

A multifaceted intervention to improve the quality of care of children in district hospitals in Kenya: a cost-effectiveness analysis.

Science.gov (United States)

Barasa, Edwine W; Ayieko, Philip; Cleary, Susan; English, Mike

2012-01-01

To improve care for children in district hospitals in Kenya, a multifaceted approach employing guidelines, training, supervision, feedback, and facilitation was developed, for brevity called the Emergency Triage and Treatment Plus (ETAT+) strategy. We assessed the cost effectiveness of the ETAT+ strategy, in Kenyan hospitals. Further, we estimate the costs of scaling up the intervention to Kenya nationally and potential cost effectiveness at scale. Our cost-effectiveness analysis from the provider's perspective used data from a previously reported cluster randomized trial comparing the full ETAT+ strategy (n = 4 hospitals) with a partial intervention (n = 4 hospitals). Effectiveness was measured using 14 process measures that capture improvements in quality of care; their average was used as a summary measure of quality. Economic costs of the development and implementation of the intervention were determined (2009 US$). Incremental cost-effectiveness ratios were defined as the incremental cost per percentage improvement in (average) quality of care. Probabilistic sensitivity analysis was used to assess uncertainty. The cost per child admission was US$50.74 (95% CI 49.26-67.06) in intervention hospitals compared to US$31.1 (95% CI 30.67-47.18) in control hospitals. Each percentage improvement in average quality of care cost an additional US$0.79 (95% CI 0.19-2.31) per admitted child. The estimated annual cost of nationally scaling up the full intervention was US$3.6 million, approximately 0.6% of the annual child health budget in Kenya. A "what-if" analysis assuming conservative reductions in mortality suggests the incremental cost per disability adjusted life year (DALY) averted by scaling up would vary between US$39.8 and US$398.3. Improving quality of care at scale nationally with the full ETAT+ strategy may be affordable for low income countries such as Kenya. Resultant plausible reductions in hospital mortality suggest the intervention could be cost

A multifaceted intervention to improve the quality of care of children in district hospitals in Kenya: a cost-effectiveness analysis.

Directory of Open Access Journals (Sweden)

Edwine W Barasa

Full Text Available To improve care for children in district hospitals in Kenya, a multifaceted approach employing guidelines, training, supervision, feedback, and facilitation was developed, for brevity called the Emergency Triage and Treatment Plus (ETAT+ strategy. We assessed the cost effectiveness of the ETAT+ strategy, in Kenyan hospitals. Further, we estimate the costs of scaling up the intervention to Kenya nationally and potential cost effectiveness at scale.Our cost-effectiveness analysis from the provider's perspective used data from a previously reported cluster randomized trial comparing the full ETAT+ strategy (n = 4 hospitals with a partial intervention (n = 4 hospitals. Effectiveness was measured using 14 process measures that capture improvements in quality of care; their average was used as a summary measure of quality. Economic costs of the development and implementation of the intervention were determined (2009 US$. Incremental cost-effectiveness ratios were defined as the incremental cost per percentage improvement in (average quality of care. Probabilistic sensitivity analysis was used to assess uncertainty. The cost per child admission was US$50.74 (95% CI 49.26-67.06 in intervention hospitals compared to US$31.1 (95% CI 30.67-47.18 in control hospitals. Each percentage improvement in average quality of care cost an additional US$0.79 (95% CI 0.19-2.31 per admitted child. The estimated annual cost of nationally scaling up the full intervention was US$3.6 million, approximately 0.6% of the annual child health budget in Kenya. A "what-if" analysis assuming conservative reductions in mortality suggests the incremental cost per disability adjusted life year (DALY averted by scaling up would vary between US$39.8 and US$398.3.Improving quality of care at scale nationally with the full ETAT+ strategy may be affordable for low income countries such as Kenya. Resultant plausible reductions in hospital mortality suggest the intervention could be

Cookery, diet and district nursing in late nineteenth-century London.

Science.gov (United States)

Akiyama, Yuriko

2009-03-01

While health education in late nineteenth-century Britain could be beneficial for every household, it was particularly so where district nurses understood family circumstances and adapted knowledge to individual needs. During this period sick room cookery training and lectures on hygiene and dietetics became standard for nurses--especially following the reforms of Matron Eva Lückes at the London Hospital. Because understanding about health was not widespread in society, due to the living conditions and poverty of so many patients, and because doctors had few opportunities to convey such knowledge, the active support of nurses in the community proved to be essential for translating professional knowledge into words commonly understood. By demonstrating cooking and other health-related skills in the homes of the poor, nurses played an important part in improving the nation's health.

A study on risk factors of breast cancer among patients attending the tertiary care hospital, in Udupi district

Directory of Open Access Journals (Sweden)

Ramchandra Kamath

2013-01-01

Full Text Available Background: Cancer has become one of the ten leading causes of death in India. Breast cancer is the most common diagnosed malignancy in India, it ranks second to cervical cancer. An increasing trend in incidence is reported from various registries of national cancer registry project and now India is a country with largest estimated number of breast cancer deaths worldwide. Aim: To study the factors associated with breast cancer. Objectives: To study the association between breast cancer and selected exposure variables and to identify risk factors for breast cancer. Materials and Methods: A hospital based Case control study was conducted at Shirdi Sai Baba Cancer Hospital and Research Center, Manipal, Udupi District. Results: Total 188 participants were included in the study, 94 cases and 94 controls. All the study participants were between 25 to 69 years of age group. The cases and controls were matched by ± 2 years age range. Non vegetarian diet was one of the important risk factors (OR 2.80, CI 1.15-6.81. More than 7 to 12 years of education (OR 4.84 CI 1.51-15.46 had 4.84 times risk of breast cancer as compared with illiterate women. Conclusion: The study suggests that non vegetarian diet is the important risk factor for Breast Cancer and the risk of Breast Cancer is more in educated women as compared with the illiterate women. Limitation: This is a Hospital based study so generalisability of the findings could be limited.

CE: Original Research: Understanding the Hospital Experience of Older Adults with Hearing Impairment.

Science.gov (United States)

Funk, Amy; Garcia, Christina; Mullen, Tiara

2018-06-01

: Background: Older hospitalized adults with hearing impairment are vulnerable to adverse outcomes. These patients are at risk for being labeled confused, experiencing a loss of control, experiencing heightened fear and anxiety, and misunderstanding the plan of care. This qualitative study sought to assess the hospital experience of older adults with hearing impairment in order to formulate suggestions for improving nursing care. Open-ended interviews were conducted with eight participants, ages 70 to 95 years, who were identified as having a hearing impairment and were admitted as inpatients to a midwestern medical center. Through data analysis, three common themes emerged: health care communication difficulties, passivity and vulnerability, and frustration with family. Nurses will benefit from having a deeper understanding of the hospital experience of this vulnerable population. Efforts to address their needs can be accomplished through the following nursing actions: assess, accommodate, educate, empower, and advocate.

Hospital management practices and availability of surgery in sub-Saharan Africa: a pilot study of three hospitals.

Science.gov (United States)

Funk, Luke M; Conley, Dante M; Berry, William R; Gawande, Atul A

2013-11-01

Sub-Saharan Africa has a high surgical burden of disease but performs a disproportionately low volume of surgery. Closing this surgical gap will require increased surgical productivity of existing systems. We examined specific hospital management practices in three sub-Saharan African hospitals that are associated with surgical productivity and quality. We conducted 54 face-to-face, structured interviews with administrators, clinicians, and technicians at a teaching hospital, district hospital, and religious mission hospital across two countries in sub-Saharan Africa. Questions focused on recommended general management practices within five domains: goal setting, operations management, talent management, quality monitoring, and financial oversight. Records from each interview were analyzed in a qualitative fashion. Each hospital's management practices were scored according to the degree of implementation of the management practices (1 = none; 3 = some; 5 = systematic). The mission hospital had the highest number of employees per 100 beds (226), surgeons per operating room (3), and annual number of operations per operating room (1,800). None of the three hospitals had achieved systematic implementation of management practices in all 14 measures. The mission hospital had the highest total management score (44/70 points; average = 3.1 for each of the 14 measures). The teaching and district hospitals had statistically significantly lower management scores (average 1.3 and 1.1, respectively; p management practices in low resource settings. We observed substantial variation in implementation of basic management practices at the three hospitals. Future research should focus on whether enhancing management practices can improve surgical capacity and outcomes.

Early Experiences Implementing Voluntary School District Mergers in Vermont

Science.gov (United States)

Rogers, John D.; Glesner, Talia J.; Meyers, Herman W.

2014-01-01

This article describes the implementation of an initiative to encourage voluntary school district mergers in Vermont. The law was intended to increase educational opportunities for Vermont students while reducing costs. Three research activities were conducted to understand how districts and supervisory unions around the state responded to the new…

Child deaths at National District Hospital, Free State: one a month is ...

African Journals Online (AJOL)

H Brits

implemented by the NDoH decreased child mortality (MDG 4) at National District ... deaths, gastroenteritis, health strategies, HIV, malnutrition, Millennium Development Goal 4 ... specific indicators.2 The most important initiatives introduced by.

Review of final-year medical students' rural attachment at district ...

African Journals Online (AJOL)

2013-11-15

Nov 15, 2013 ... This paper presents the first phase of an ongoing quality ... a rural district hospital can provide unique learning opportunities for students if the ..... Peabody C, Block A, Jain S. Multi-disciplinary service learning: a medico-legal.

An investigation into work related stressors on diagnostic radiographers in a local district hospital

International Nuclear Information System (INIS)

Verrier, William; Harvey, Jane

2010-01-01

Extensive research on the effects of work related stress amongst healthcare professions and the NHS has been undertaken. However, very little is known about the incidence of stress amongst UK radiographers although the few studies which have been conducted indicate that the prevalence and impact of stress on radiographers are considerable. The purpose of this study was to examine work related stressors which affect diagnostic radiographers in the imaging department of a local district hospital. The study utilised the HSE Indicator and Analysis Tools for Work Related Stress. These tools are based upon the HSE Management Standards for Work Related Stress which identifies six areas that represent potential stress hazards if managed inadequately. Two free response questions and a comments box were appended to the Indicator Tool to gain further insights into the radiographers' experiences of work related stress. The results of the study indicated that the hazards associated with work related stress risk were not being optimally managed in the department. Areas of Managers' Support, Relationships, Role and Change represented the greatest risks. In addition, the radiographers cited staff shortages, heavy workload and volume of patients as the greatest sources of pressure at work and their most common recommendations to reduce stress at work were increased staffing, improved communication and more effective feedback systems.

Using Hospitalization and Mortality Data to Identify Areas at Risk for Adolescent Suicide.

Science.gov (United States)

Chen, Kun; Aseltine, Robert H

2017-08-01

The purpose of this study is to use statewide data on inpatient hospitalizations for suicide attempts and suicide mortality to identify communities and school districts at risk for adolescent suicide. Five years of data (2010-2014) from the Office of the Connecticut Medical Examiner and the Connecticut Hospital Inpatient Discharge Database were analyzed. A mixed-effects Poisson regression model was used to assess whether suicide attempt/mortality rates in the state's 119 school districts were significantly better or worse than expected after adjusting for 10 community-level characteristics. Ten districts were at significantly higher risk for suicidal behavior, with suicide mortality/hospitalization rates ranging from 154% to 241% of their expected rates, after accounting for their community characteristics. Four districts were identified as having significantly lower risk for suicide attempts than expected after accounting for community-level advantages and disadvantages. Data capturing hospitalization for suicide attempts and suicide deaths can inform prevention activities by identifying high-risk areas to which resources should be allocated, as well as low-risk areas that may provide insight into the best practices in suicide prevention. Copyright © 2017 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Snakebites in Two Rural Districts in Lao PDR: Community-Based Surveys Disclose High Incidence of an Invisible Public Health Problem.

Directory of Open Access Journals (Sweden)

Inthanomchanh Vongphoumy

Full Text Available The Lao PDR (Laos is one of the least developed countries in Asia with an estimated 25% of the population living in poverty. It is the habitat of some highly venomous snakes and the majority of the population earns their living from agricultural activities. Under these circumstances the incidence of snakebites is expected to be high.Two cross-sectional, community-based surveys were performed in Champone and Phin district, Savannakhet province, Lao PDR to estimate snakebite incidence. Multistage random sampling was used. In the first stage approximately 40% of all villages in each district were randomly selected. In the second stage 33% of all households in each village were randomly chosen. Members of the selected households were interviewed about snakebites during the previous 12 months.Thirty-five of 9856 interviewees reported a snakebite in a 12 month period in Champone district and 79 of 7150 interviewees in Phin district. The estimated incidence is 355 snakebites per 100,000 persons per year and 1105 per 100,000 in Champone and Phin district respectively. All snakebite victims received treatment by traditional healers or self-treatment at home and nobody went to a hospital. Incidence of snakebites, calculated on the basis of hospital records of 14 district hospitals and Savannakhet provincial hospital, ranged from 3 to 14 cases per 100,000 persons per year between 2012 and 2014.Incidence of snakebites is high in rural communities in Laos with significant regional differences. Poverty most likely contributes significantly to the higher number of snakebites in Phin district. Hospital statistics profoundly underestimates snakebite incidence, because the majority of snakebite victims receive only treatment by traditional healers or self-treatment in their village. There is an urgent need to train medical staff and students in management of snakebite patients and make snake antivenom available to cope effectively with this important public

Snakebites in Two Rural Districts in Lao PDR: Community-Based Surveys Disclose High Incidence of an Invisible Public Health Problem.

Science.gov (United States)

Vongphoumy, Inthanomchanh; Phongmany, Panom; Sydala, Sengdao; Prasith, Nouda; Reintjes, Ralf; Blessmann, Joerg

2015-01-01

The Lao PDR (Laos) is one of the least developed countries in Asia with an estimated 25% of the population living in poverty. It is the habitat of some highly venomous snakes and the majority of the population earns their living from agricultural activities. Under these circumstances the incidence of snakebites is expected to be high. Two cross-sectional, community-based surveys were performed in Champone and Phin district, Savannakhet province, Lao PDR to estimate snakebite incidence. Multistage random sampling was used. In the first stage approximately 40% of all villages in each district were randomly selected. In the second stage 33% of all households in each village were randomly chosen. Members of the selected households were interviewed about snakebites during the previous 12 months. Thirty-five of 9856 interviewees reported a snakebite in a 12 month period in Champone district and 79 of 7150 interviewees in Phin district. The estimated incidence is 355 snakebites per 100,000 persons per year and 1105 per 100,000 in Champone and Phin district respectively. All snakebite victims received treatment by traditional healers or self-treatment at home and nobody went to a hospital. Incidence of snakebites, calculated on the basis of hospital records of 14 district hospitals and Savannakhet provincial hospital, ranged from 3 to 14 cases per 100,000 persons per year between 2012 and 2014. Incidence of snakebites is high in rural communities in Laos with significant regional differences. Poverty most likely contributes significantly to the higher number of snakebites in Phin district. Hospital statistics profoundly underestimates snakebite incidence, because the majority of snakebite victims receive only treatment by traditional healers or self-treatment in their village. There is an urgent need to train medical staff and students in management of snakebite patients and make snake antivenom available to cope effectively with this important public health problem in

Hospital Nursing Workforce Costs, Wages, Occupational Mix,and Resource Utilization.

Science.gov (United States)

Welton, John M

2015-10-01

The objective of the study was to better understand how hospitals use different types of RNs, LPNs, and nurse aides in proprietary (for-profit), nonprofit, and government-owned hospitals and to estimate the wages, cost, and intensity of nursing care using a national data set. This is a cross-sectional observational study of 3,129 acute care hospitals in all 50 states and District of Columbia using data from the 2008 Occupational Mix Survey administered by the Centers for Medicare &Medicaid Services (CMS). Nursing skill mix, hours, and labor costs were combined with other CMS hospital descriptive data, including type of hospital ownership, urban or rural location, hospital beds, and case-mix index. RN labor costs make up 25.5% of all hospital expenditures annually, and all nursing labor costs represent 30.1%, which is nearly a quarter trillion dollars ($216.7 billion) per year for inpatient nursing care. On average, proprietary hospitals employ 1.3 RNs per bed and 1.9 nursing personnel per bed in urban hospitals compared with 1.7 RNs per bed and 2.3 nursing personnel per bed for nonprofit and government-owned hospitals (P G .05). States with higher ratios of RN compared with LPN licenses used fewer LPNs in the inpatient setting. The findings from this study can be helpful in comparing nursing care across different types of hospitals, ownership, and geographic locations and used as a benchmark for future nursing workforce needs and costs.

Bottleneck analysis at district level to illustrate gaps within the district health system in Uganda

Science.gov (United States)

Kiwanuka Henriksson, Dorcus; Fredriksson, Mio; Waiswa, Peter; Selling, Katarina; Swartling Peterson, Stefan

2017-01-01

ABSTRACT Background: Poor quality of care and access to effective and affordable interventions have been attributed to constraints and bottlenecks within and outside the health system. However, there is limited understanding of health system barriers to utilization and delivery of appropriate, high-impact, and cost-effective interventions at the point of service delivery in districts and sub-districts in low-income countries. In this study we illustrate the use of the bottleneck analysis approach, which could be used to identify bottlenecks in service delivery within the district health system. Methods: A modified Tanahashi model with six determinants for effective coverage was used to determine bottlenecks in service provision for maternal and newborn care. The following interventions provided during antenatal care were used as tracer interventions: use of iron and folic acid, intermittent presumptive treatment for malaria, HIV counseling and testing, and syphilis testing. Data from cross-sectional household and health facility surveys in Mayuge and Namayingo districts in Uganda were used in this study. Results: Effective coverage and human resource gaps were identified as the biggest bottlenecks in both districts, with coverage ranging from 0% to 66% for effective coverage and from 46% to 58% for availability of health facility staff. Our findings revealed a similar pattern in bottlenecks in both districts for particular interventions although the districts are functionally independent. Conclusion: The modified Tanahashi model is an analysis tool that can be used to identify bottlenecks to effective coverage within the district health system, for instance, the effective coverage for maternal and newborn care interventions. However, the analysis is highly dependent on the availability of data to populate all six determinants and could benefit from further validation analysis for the causes of bottlenecks identified. PMID:28581379

Developing and Implementing a Pediatric Emergency Care Curriculum for Providers at District Level Hospitals in Sub-Saharan Africa: A Case Study in Kenya

Directory of Open Access Journals (Sweden)

Colleen Diane Fant

2017-12-01

Full Text Available IntroductionEmergency medicine is a relatively new field in sub-Saharan Africa and dedicated training in pediatric emergency care is limited. While guidelines from the African Federation of Emergency Medicine (AFEM regarding emergency training exist, a core curriculum in pediatric emergency care has not yet been established for providers at the district hospital level.MethodsThe objective of the project was to develop a curriculum for providers with limited training in pediatric emergencies, and contain didactic and simulation components with emphasis on treatment and resuscitation using available resources. A core curriculum for pediatric emergency care was developed using a validated model of medical education curriculum development and through review of existing guidelines and literature. Based on literature review, as well as a review of existent guidelines in pediatric and emergency care, 10 core topics were chosen and agreed upon by experts in the field, including pediatric and emergency care providers in Kenya and the United States. These topics were confirmed to be consistent with the principles of emergency care endorsed by AFEM as well as complimentary to existing Kenyan medical school syllabi. A curriculum based on these 10 core topics was created and subsequently piloted with a group of medical residents and clinical officers at a community hospital in western Kenya.ResultsThe 10 core pediatric topics prioritized were airway management, respiratory distress, thoracic and abdominal trauma, head trauma and cervical spine management, sepsis and shock, endocrine emergencies, altered mental status/toxicology, orthopedic emergencies, burn and wound management, and pediatric advanced life support. The topics were incorporated into a curriculum comprised of ten 1.5-h combined didactic plus low-fidelity simulation modules. Feedback from trainers and participating providers gave high ratings to the ease of information delivery, relevance, and

Prevalence of snake bites in Kangar District Hospital, Perlis, west Malaysia: a retrospective study (January 1999-December 2000).

Science.gov (United States)

Jamaiah, I; Rohela, M; Roshalina, R; Undan, R C

2004-12-01

The records of 284 snake bite cases presenting to the Kangar District Hospital, Perlis, west Malaysia, from January 1999 till December 2000 were carefully reviewed. Data on prevalence and types of snake bites, were recorded. The majority of the cases were among Malays (60.2%), followed by Chinese (16.9%), Indians (13%), and others which include Thai nationals, army personnel from Sabah and Sarawak, and foreign tourists (9.8%). A higher incidence was found in males (60.2%) and most cases were seen in the age group of 10-19 years (33%). Snake bites were more common between 2 PM and 9 PM (47.6%) and from 7 AM to 2 PM (33.4%). The snakes were positively identified in 68 cases, of which 50 were common cobras (Naja naja) (73%), 16 were Malayan pit vipers (Agkistrodon rhodostoma) (24%) and two were sea-snakes (3%).

Understanding Personal Learning Environment Perspectives of Thai International Tourism and Hospitality Higher Education Students

Science.gov (United States)

Tanyong, Siriwan; Sharafuddin, Mohamed Ali

2016-01-01

This paper is part of a periodic research conducted in developing a personal learning environment for Thailand's higher education students with English as medium of instruction. The objective of the first phase in this research was to understand the personal learning environment perspectives of Thai International tourism and hospitality higher…

Understanding hospitality house guests' needs: a brief case report.

Science.gov (United States)

Duncan, Mary Katherine Waibel

2011-08-01

A.E. Kazak's (2006) call to develop theory-driven and empirically supported programs aimed at strengthening the competencies of families affected by pediatric illness applies to both medical and nonmedical facilities and institutions that care for pediatric patients and their loved ones. M.K.W. Duncan and A. Blugis (in press, this issue) note that despite the intuitive and practical nature of Maslow's Hierarchy of Needs, no theory translates into an infallible understanding of any individual guest's needs or a program of universally applied best practice standards for meeting those needs. Using Maslow's theory as a framework, this brief report describes the complexity and fluidity of one mother's needs during her stay at a hospitality house following the birth of her premature twin babies. Copyright © 2011 Elsevier Inc. All rights reserved.

GIS Database and Google Map of the Population at Risk of Cholangiocarcinoma in Mueang Yang District, Nakhon Ratchasima Province of Thailand.

Science.gov (United States)

Kaewpitoon, Soraya J; Rujirakul, Ratana; Joosiri, Apinya; Jantakate, Sirinun; Sangkudloa, Amnat; Kaewthani, Sarochinee; Chimplee, Kanokporn; Khemplila, Kritsakorn; Kaewpitoon, Natthawut

2016-01-01

Cholangiocarcinoma (CCA) is a serious problem in Thailand, particularly in the northeastern and northern regions. Database of population at risk are need required for monitoring, surveillance, home health care, and home visit. Therefore, this study aimed to develop a geographic information system (GIS) database and Google map of the population at risk of CCA in Mueang Yang district, Nakhon Ratchasima province, northeastern Thailand during June to October 2015. Populations at risk were screened using the Korat CCA verbal screening test (KCVST). Software included Microsoft Excel, ArcGIS, and Google Maps. The secondary data included the point of villages, sub-district boundaries, district boundaries, point of hospital in Mueang Yang district, used for created the spatial databese. The populations at risk for CCA and opisthorchiasis were used to create an arttribute database. Data were tranfered to WGS84 UTM ZONE 48. After the conversion, all of the data were imported into Google Earth using online web pages www.earthpoint.us. Some 222 from a 4,800 population at risk for CCA constituted a high risk group. Geo-visual display available at following www.google.com/maps/d/u/0/ edit?mid=zPxtcHv_iDLo.kvPpxl5mAs90 and hl=th. Geo-visual display 5 layers including: layer 1, village location and number of the population at risk for CCA; layer 2, sub-district health promotion hospital in Mueang Yang district and number of opisthorchiasis; layer 3, sub-district district and the number of population at risk for CCA; layer 4, district hospital and the number of population at risk for CCA and number of opisthorchiasis; and layer 5, district and the number of population at risk for CCA and number of opisthorchiasis. This GIS database and Google map production process is suitable for further monitoring, surveillance, and home health care for CCA sufferers.

Is the Current Management of Patients Presenting With Spinal Trauma to District General Hospitals Fit for Purpose? Our Experience of Delivering a Spinal Service Using an Electronic Referral Platform in a Large District General Teaching Hospital Without Onsite Spinal Services.

Science.gov (United States)

Hill, Daniel S; Marynissen, Hans

2018-04-12

A retrospective cross-sectional analysis. To describe the provision of a spinal service using an electronic platform to direct management from an external spinal unit, and quantify time taken to obtain definitive management plans whilst under prescribed spinal immobilization. Most attending district general hospitals following spinal trauma will have stable injuries and normal neurology, with only a small proportion requiring urgent transfer to a specialist centre. A retrospective review of 104 patients admitted following vertebral during a 12-month period. The British Orthopaedic Association Standards for Trauma consensus that "spinal immobilisation is not recommended for more than 48 hours" was the standard of care measured against. 100 patients occupied a total of 975 hospital inpatient bed days. 117 radiological investigations were requested after the point of external referral (47 CT-scans, 37 MRI-scans, and 33 weight bearing radiographs). The period between initial referral to the regional spinal service and then receiving a definitive final management had a median value of 72 hours and a range of 0 - 33 days. Patients will have been under some form of prescribed spinal immobilisation until the definitive management plan was communicated. 34 patients (34% of the overall cohort) had a definitive management plan in place within 48 hours. 80 patients had vertebral injuries (73 stable, 6 unstable), 3 patients had prolapsed intervertebral disks, 1 had metastatic disease, and 17 had not evidence of an acute injury following evaluation. Patients are being placed under prescribed immobilisation for longer than is recommended. Delays in obtaining radiological imaging were an important factor, together with the time taken to receive a definitive management plan. Limitations in social care provision and delays in arranging this were additional barriers to hospital discharge following the final management plan. 4.

Estimating the cost of healthcare delivery in three hospitals in southern ghana.

Science.gov (United States)

Aboagye, A Q Q; Degboe, A N K; Obuobi, A A D

2010-09-01

The cost burden (called full cost) of providing health services at a referral, a district and a mission hospital in Ghana were determined. Standard cost-finding and cost analysis tools recommended by World Health Organization are used to analyse 2002 and 2003 hospital data. Full cost centre costs were computed by taking into account cash and non-cash expenses and allocating overhead costs to intermediate and final patient care centres. The full costs of running the mission hospital in 2002 and 2003 were US$600,295 and US$758,647 respectively; for the district hospital, the respective costs were US$496,240 and US$487,537; and for the referral hospital, the respective costs were US$1,160,535 and US$1,394,321. Of these, overhead costs ranged between 20% and 42%, while salaries made up between 45% and 60%. Based on healthcare utilization data, in 2003 the estimated cost per outpatient attendance was US$ 2.25 at the mission hospital, US$ 4.51 at the district hospital and US$8.5 at the referral hospital; inpatient day costs were US$ 6.05, US$ 9.95 and US$18.8 at the respective hospitals. User fees charged at service delivery points were generally below cost. However, some service delivery points have the potential to recover their costs. Salaries are the major cost component of the three hospitals. Overhead costs constitute an important part of hospital costs and must be noted in efforts to recover costs. Cost structures are different at different types of hospitals. Unit costs at service delivery points can be estimated and projected into the future.

Understanding hospital cafeterias: results from cafeteria manager interviews.

Science.gov (United States)

Lederer, Ashley; Toner, Cassiopeia; Krepp, Erica M; Curtis, Christine J

2014-01-01

To describe the characteristics, nutrition-related knowledge, practices, and attitudes of staff managing cafeterias in New York City (NYC) hospitals. An in-person survey was administered over 7 months to cafeteria managers from hospitals participating in the NYC Department of Health and Mental Hygiene's Healthy Hospital Food Initiative. The survey assessed nutrition knowledge and attitudes; hospital cafeteria practices; and nutrition standards and policies. The majority of questions required a yes or no response, followed by an open-ended request for details related to the response. Other questions were multiple choice or used 5-point Likert scales to measure respondent perceptions. Seventeen cafeteria managers completed the survey. Less than a third of respondents had training in nutrition, and less than a quarter of hospitals followed nutrition standards for food offered in the cafeteria. Most respondents thought cafeterias could play a role in reducing sodium consumption, yet less than half correctly identified the largest sources of sodium in the average diet. The most commonly cited limitation to making healthy changes in the cafeteria was perceived lack of demand for healthy foods/customer support. Characteristics, nutrition knowledge, practices, and attitudes of hospital cafeteria managers vary. Communication with consumers and education of staff who lack training and experience in nutrition may be important focus areas for hospitals looking to improve their food environment.

Incidence of trampoline related pediatric fractures in a large district general hospital in the United Kingdom: lessons to be learnt.

Science.gov (United States)

Bhangal, K K; Neen, D; Dodds, R

2006-04-01

To test the observation that the incidence of trampoline related pediatric fractures is increasing-both nationally and in a large district general hospital. A retrospective analysis was undertaken of patient records establishing mechanism of injury of pediatric fractures over three consecutive summers from 2000-03. Theatre records of fractures treated operatively were used as the initial data source. A statistically significant increase in trampoline related injuries was discovered. This reflects the rising incidence of injuries from national data and furthermore corresponds to the growing popularity of domestic use trampolines in the UK. The incidence of injuries is increasing. There are lessons to be learnt from existing work from countries where trampoline prevalence has been greater for longer. The authors recommend various safety measures that may reduce children's injuries.

Impact of urban atmospheric environment on hospital admissions in the elderly

Directory of Open Access Journals (Sweden)

Edelci Nunes da Silva

2012-08-01

Full Text Available OBJECTIVE: To analyze the impact of intra-urban atmospheric conditions on circulatory and respiratory diseases in elder adults. METHODS: Cross-sectional study based on data from 33,212 hospital admissions in adults over 60 years in the city of São Paulo, southeastern Brazil, from 2003 to 2007. The association between atmospheric variables from Congonhas airport and bioclimatic index, Physiological Equivalent Temperature, was analyzed according to the district's socioenvironmental profile. Descriptive statistical analysis and regression models were used. RESULTS: There was an increase in hospital admissions due to circulatory diseases as average and lowest temperatures decreased. The likelihood of being admitted to the hospital increased by 12% with 1ºC decrease in the bioclimatic index and with 1ºC increase in the highest temperatures in the group with lower socioenvironmental conditions. The risk of admission due to respiratory diseases increased with inadequate air quality in districts with higher socioenvironmental conditions. CONCLUSIONS: The associations between morbidity and climate variables and the comfort index varied in different groups and diseases. Lower and higher temperatures increased the risk of hospital admission in the elderly. Districts with lower socioenvironmental conditions showed greater adverse health impacts.

Implementation of a structured paediatric admission record for district hospitals in Kenya – results of a pilot study

Directory of Open Access Journals (Sweden)

Ogutu Bernhards

2006-07-01

Full Text Available Abstract Background The structured admission form is an apparently simple measure to improve data quality. Poor motivation, lack of supervision, lack of resources and other factors are conceivably major barriers to their successful use in a Kenyan public hospital setting. Here we have examined the feasibility and acceptability of a structured paediatric admission record (PAR for district hospitals as a means of improving documentation of illness. Methods The PAR was primarily based on symptoms and signs included in the Integrated Management of Childhood Illness (IMCI diagnostic algorithms. It was introduced with a three-hour training session, repeated subsequently for those absent, aiming for complete coverage of admitting clinical staff. Data from consecutive records before (n = 163 and from a 60% random sample of dates after intervention (n = 705 were then collected to evaluate record quality. The post-intervention period was further divided into four 2-month blocks by open, feedback meetings for hospital staff on the uptake and completeness of the PAR. Results The frequency of use of the PAR increased from 50% in the first 2 months to 84% in the final 2 months, although there was significant variation in use among clinicians. The quality of documentation also improved considerably over time. For example documentation of skin turgor in cases of diarrhoea improved from 2% pre-intervention to 83% in the final 2 months of observation. Even in the area of preventive care documentation of immunization status improved from 1% of children before intervention to 21% in the final 2 months. Conclusion The PAR was well accepted by most clinicians and greatly improved documentation of features recommended by IMCI for identifying and classifying severity of common diseases. The PAR could provide a useful platform for implementing standard referral care treatment guidelines.

Cost-Effective Recruitment need for 24x7 Paediatricians in the State General Hospitals in Relation to the Reduction of Infant Mortality.

Science.gov (United States)

Chatterjee, Ranjana; Chatterjee, Sukanta

2016-10-01

According to World Health Organisation (WHO), improvement of hospital based care can have an impact of upto 30% in reducing Infant Mortality Rate (IMR), whereas, strengthening universal outreach and family-community based care is known to have a greater impact. The study intends to assess how far gaps in the public health facilities contribute towards infant mortality, as 2/3 rd of infant mortality is due to suboptimum care seeking and weak health system. To identify cost-effectiveness of employment of additional paediatric manpower to provide round the clock skilled service to reduce IMR in the present state health facilities at the district general hospitals. A cross-sectional observational study was conducted in a tertiary teaching hospital and district hospitals of 2 districts (Hooghly and Howrah in West Bengal). Factors affecting infant mortality and shift wise analysis of proportion of infant deaths were analysed in both tertiary and district level hospitals. Information was gathered in a predesigned proforma for one year period by verifying hospital records and by personal interview with service personnel in the health establishment. SPSS software version 17 (Chicago, IL) was used. The p-value was calculated by Fischer exact t-test. Available hospital beds per 1000 population were 1.1. Percentage of paediatric beds available in comparison to total hospital bed was disproportionately lower (10%). Dearth of skilled medical care provider at odd hours in district hospitals resulted in significantly greater infant death (p based infant mortality and it is cost-effective.

Management of spontaneous pneumothorax compared to British Thoracic Society (BTS) 2003 guidelines: a district general hospital audit.

Science.gov (United States)

Medford, Andrew Rl; Pepperell, Justin Ct

2007-10-01

In 1993, the British Thoracic Society (BTS) issued guidelines for the management of spontaneous pneumothorax (SP). These were refined in 2003. To determine adherence to the 2003 BTS SP guidelines in a district general hospital. An initial retrospective audit of 52 episodes of acute SP was performed. Subsequent intervention involved a junior doctor educational update on both the 2003 BTS guidelines and the initial audit results, and the setting up of an online guideline hyperlink. After the educational intervention a further prospective re-audit of 28 SP episodes was performed. Management of SP deviated considerably from the 2003 BTS guidelines in the initial audit - deviation rate 26.9%. After the intervention, a number of clinical management deviations persisted (32.1% deviation rate); these included failure to insert a chest drain despite unsuccessful aspiration, and attempting aspiration of symptomatic secondary SPs. Specific tools to improve standards might include a pneumothorax proforma to improve record keeping and a pneumothorax care pathway to reduce management deviations compared to BTS guidelines. Successful change also requires identification of the total target audience for any educational intervention.

FACTORS RELATED TO KNOWLEDGE ON NEWBORN DANGER SIGNS AMONG THE RECENTLY DELIVERED WOMEN IN SUB-DISTRICT HOSPITALS OF BANGLADESH

Directory of Open Access Journals (Sweden)

Sojib Bin Zaman

2017-06-01

Full Text Available Background: Bangladesh continues to be one of the top ten countries with the highest burden of neonatal mortality. While, most of the neonatal deaths are preventable; health system delays, delayed identification of newborn danger signs, late diagnosis and initiation of treatment are claimed to be the main challenges. Objective: 1 to determine the level of knowledge among the recently delivered women (RDW about newborn danger signs and 2 to distinguish the factors associated with ability of identifying the danger signs. Methods: A facility based cross-sectional study was conducted in three sub-district hospitals of Bangladesh among 135 RDW between 1 January 2015 and 30 April 2015. Seven key danger signs were identified, and responses were categorized accordingly. Bivariable logistic regression was conducted to determine the likelihood of the association of factors with danger signs identification. Results: About 51% of RDW could identify one key danger sign. Knowledge on “fever’’ was the most commonly known danger sign (65%. Middle age (OR 1.67, 95% CI: 1.09 - 2.18, high education (OR 2.37, 95% CI: 1.46 - 2.77, increased parity (OR 1.91, 95% CI: 1.17 - 2.89, and previous hospital delivery (OR 1.79, 95% CI: 1.14 - 2.68 were found associated with the knowl¬edge of the danger signs. Conclusion: The findings indicate the immediate need to enhance health education among the RDW about newborn danger signs before their hospital discharge. Community based health education programs can be a cost effective intervention to increase awareness and early recognition of neonatal danger signs.

Severe malnutrition among children under the age of 5 years admitted to a rural district hospital in southern Mozambique.

Science.gov (United States)

Nhampossa, Tacilta; Sigaúque, Betuel; Machevo, Sónia; Macete, Eusebio; Alonso, Pedro; Bassat, Quique; Menéndez, Clara; Fumadó, Victoria

2013-09-01

To describe the burden, clinical characteristics and prognostic factors of severe malnutrition in children under the age of 5 years. Retrospective study of hospital-based data systematically collected from January 2001 to December 2010. Rural Mozambican district hospital. All children aged malnutrition. During the 10-year long study surveillance, 274 813 children belonging to Manhiça’s Demographic Surveillance System were seen at out-patient clinics, almost half of whom (47 %) presented with some indication of malnutrition and 6% (17 188/274 813) with severe malnutrition. Of these, only 15% (2522/17 188) were eventually admitted. Case fatality rate of severe malnutrition was 7% (162/2274). Bacteraemia, hypoglycaemia, oral candidiasis, prostration, oedema, pallor and acute diarrhoea were independently associated with an increased risk of in-hospital mortality, while malaria parasitaemia and breast-feeding were independently associated with a lower risk of a poor outcome. Overall minimum communitybased incidence rate was 15 cases per 1000 child-years at risk and children aged 12–23 months had the highest incidence. Severe malnutrition among admitted children in this Mozambican setting was common but frequently went undetected, despite being associated with a high risk of death. Measures to improve its recognition by clinicians responsible for the first evaluation of patients at the out-patient level are urgently needed so as to improve their likelihood of survival. Together with this, the rapid management of complications such as hypoglycaemia and concomitant co-infections such as bacteraemia, acute diarrhoea, oral candidiasis and HIV/AIDS may contribute to reverse the intolerable toll that malnutrition poses in the health of children in rural African settings.

Carotid Surgery in a District General Hospital

Science.gov (United States)

Fairgrieve, John

1981-01-01

The carotid surgical experience of Cheltenham General Hospital over a 13 year period (1968-81) is presented. This includes 42 operations for stenosis, and 12 further operations for carotid body tumour, carotid aneurysm, subclavian steal syndrome and trauma to the internal carotid artery. The operative techniques and complications are briefly discussed and reasons advanced for a more agressive approach to the problems of extra-cerebral carotid disease in this country. PMID:7185417

[Profile of the Emergency demand and influence of televised soccer games on an extra-hospital center in the Tafalla health care district. Navarre, Spain].

Science.gov (United States)

Pérez-Ciordia, Ignacio; Catalán Fabo, Francisca; Zalacain Nicolay, Fernando; Barriendo Antoñanzas, Maite; Solaegui Diaz de Guereñu, Ramón; Guillén Grima, Francisco

2003-01-01

The demand placed on both hospital as well as extrahospital emergency care units currently continues to increase at a growing rate. This study has a twofold objective: the quantification and study of the personal characteristics of the users who are demanding emergency care and assessing whether televised soccer games have any bearing on the utilization of emergency care services. A longitudinal descriptive study (9,723 users demanding care) and study of cases and controls (1,284 users demanding care) according to whether or not a soccer game was being televised by means of a logistic regression model. The associations were quantified by means of the odds ratio (OR). Those dealt with by telephone or in infirmaries were not included in the study. A total 10.6% of the demand involved home visits, 4.8% of this total having been sent to hospital. A total 13.3% of the demand corresponds to individuals visiting from other healthcare districts, a total of 65 being overusers of emergency care (8 or more visits). The month of August (32.3%). Sundays (44.56%) and the 12:00 p.m.-2:00 p.m. timeframe (8.38%) are the times when the greatest demand for care occurs, the differences being statistically significant. Televised soccer games were associated to a 19.8% (p emergency care units has been found to exist, a major part of the demand being concentrated at highly specific points in time. A major degree of care is provided to those visiting from outside their own healthcare districts. Television soccer game broadcasts is associated with the greater utilization of the emergency care services.

Beginning Teachers' Experiences Working with a District-Employed Mentor in a North Carolina School District

Science.gov (United States)

Hobbs, Kari S.; Putnam, Jennifer

2016-01-01

This study is concerned with the experiences of beginning teachers working with a district-employed mentor. Based on Illeris's (2002) Three Dimensions of Learning, the study sought to understand the cognitive, emotional, and social processes involved in working with a mentor through the use of one-on one, in-depth interviews. Nine beginning…

Legitimacy of hospital reconfiguration: the controversial downsizing of Kidderminster hospital.

Science.gov (United States)

Oborn, Eivor

2008-04-01

This paper examines the contested organizational legitimacy of hospital reconfiguration, which continues to be a central issue in health care management. A qualitative study which focuses on the controversial downsizing of Kidderminster Hospital, a highly publicized landmark case of district general hospital closure. Rhetorical strategies are analysed to examine how legitimacy was constructed by stakeholder groups and how these strategies were used to support or resist change. Stakeholders promoting change legitimized re-organization pragmatically and morally arguing the need for centralization as a rational necessity. Stakeholders resisting change argued for cognitive and moral legitimacy in current service arrangements, contrasting local versus regionalized aspects of safety and provision. Groups managed to talk past each other, failing to establish a dialogue, which led to significant conflict and political upheaval. Stakeholders value hospitals in different ways and argue for diverse accounts of legitimacy. Broader discourses of medical science and democratic participation were drawn into rhetorical texts concerning regionalization to render them more powerful.

Influencing Swedish homeowners to adopt district heating system

Energy Technology Data Exchange (ETDEWEB)

Mahapatra, Krushna; Gustavsson, Leif [Ecotechnology, Mid Sweden University, Akademigatan 1, 831 25 Oestersund (Sweden)

2009-02-15

Improved energy efficiency and greenhouse gas mitigation could be achieved by replacing resistance heaters with district heating system. In 2005, only about 8% of the Swedish detached houses had district heating system. The expansion of such systems largely depends on homeowners' adoption decisions. And, to motivate homeowners to adopt district heating, it is essential to understand their decision-making process. In this context, in June 2005 we carried out a questionnaire survey of about 700 homeowners who lived in the city of Oestersund in houses with resistance heaters (baseline survey). About 84% of the respondents did not intend to install a new heating system. Since then these homeowners were influenced by (a) an investment subsidy by the Swedish government to replace resistance heaters with district heating, a brine/water-based heat pump, or a biomass-based heating system and (b) a marketing campaign by the municipality-owned district heating company. This paper analyses how these two measures influenced about 78% of the homeowners to adopt the district heating system. For this purpose we carried out a follow-up survey of the same homeowners in December 2006 (resurvey). Results showed that the investment subsidy and the marketing campaign created a need among the homeowners to adopt a new heating system. The marketing campaign was successful in motivating them to adopt the district heating system. The marketing strategy by the district heating company corresponds to the results obtained in the baseline survey. (author)

Influencing Swedish homeowners to adopt district heating system

International Nuclear Information System (INIS)

Mahapatra, Krushna; Gustavsson, Leif

2009-01-01

Improved energy efficiency and greenhouse gas mitigation could be achieved by replacing resistance heaters with district heating system. In 2005, only about 8% of the Swedish detached houses had district heating system. The expansion of such systems largely depends on homeowners' adoption decisions. And, to motivate homeowners to adopt district heating, it is essential to understand their decision-making process. In this context, in June 2005 we carried out a questionnaire survey of about 700 homeowners who lived in the city of Ostersund in houses with resistance heaters (baseline survey). About 84% of the respondents did not intend to install a new heating system. Since then these homeowners were influenced by (a) an investment subsidy by the Swedish government to replace resistance heaters with district heating, a brine/water-based heat pump, or a biomass-based heating system and (b) a marketing campaign by the municipality-owned district heating company. This paper analyses how these two measures influenced about 78% of the homeowners to adopt the district heating system. For this purpose we carried out a follow-up survey of the same homeowners in December 2006 (resurvey). Results showed that the investment subsidy and the marketing campaign created a need among the homeowners to adopt a new heating system. The marketing campaign was successful in motivating them to adopt the district heating system. The marketing strategy by the district heating company corresponds to the results obtained in the baseline survey

Influencing Swedish homeowners to adopt district heating system

Energy Technology Data Exchange (ETDEWEB)

Mahapatra, Krushna; Gustavsson, Leif [Ecotechnology, Mid Sweden University, Akademigatan 1, 831 25 Oestersund (Sweden)

2009-02-15

Improved energy efficiency and greenhouse gas mitigation could be achieved by replacing resistance heaters with district heating system. In 2005, only about 8% of the Swedish detached houses had district heating system. The expansion of such systems largely depends on homeowners' adoption decisions. And, to motivate homeowners to adopt district heating, it is essential to understand their decision-making process. In this context, in June 2005 we carried out a questionnaire survey of about 700 homeowners who lived in the city of Oestersund in houses with resistance heaters (baseline survey). About 84% of the respondents did not intend to install a new heating system. Since then these homeowners were influenced by (a) an investment subsidy by the Swedish government to replace resistance heaters with district heating, a brine/water-based heat pump, or a biomass-based heating system and (b) a marketing campaign by the municipality-owned district heating company. This paper analyses how these two measures influenced about 78% of the homeowners to adopt the district heating system. For this purpose we carried out a follow-up survey of the same homeowners in December 2006 (resurvey). Results showed that the investment subsidy and the marketing campaign created a need among the homeowners to adopt a new heating system. The marketing campaign was successful in motivating them to adopt the district heating system. The marketing strategy by the district heating company corresponds to the results obtained in the baseline survey. (author)

Fear of being tested for HIV at ANC clinics associated with low uptake of intermittent preventive treatment (IPT) of malaria among pregnant women attending Bondo District Hospital, Western Kenya.

Science.gov (United States)

Sande, John Hafu; Kaseje, Dan; Nyapada, Linet; Owino, Victor O

2010-03-01

Malaria is a major cause of morbidity and mortality in tropical and subtropical regions, affecting mostly the impoverished sections of the population. Pregnant women living in malaria-endemic areas are at higher risk of malaria infection with higher density of parasitaemia than non-pregnant women. The aim of this study was to assess factors affecting the uptake of IPT among women attending antenatal clinics at Bondo District Hospital, Western Kenya. This study was a hospital-based cross-sectional survey among pregnant women attending clinics. Malaria is endemic in Bondo district. Both women from Bondo town (urban) and greater Bondo District (rural) who had been pregnant for at least 35 weeks or had delivered not more than 6 weeks prior to the survey), and had ANC cards were included in the study. The main outcomes were ANC attendance, IPT doses received and client and provider factors. Results showed that women's knowledge on ANC and IPT was high. The uptake of IPT was low among pregnant women with those from urban areas more likely to make more ANC visits and to get more IPT doses than women from the rural areas. ANC attendance was hampered by the fear of being tested for HIV at the clinic. Perceived side effects associated with IPT-SP hindered IPT uptake and were linked to HIV-related symptoms. Negative attitude among health workers towards pregnant women also adversely impacted IPT uptake. Women suggested that IPT drugs be distributed through community health workers instead of the health facility for improved uptake. Retraining of health workers on the administration of IPT, harmonization of health messages, and assessment of alternative community-based IPT distribution channels ought to be urgently considered. More evidence on the influence of HIV pandemic on perceptions and attitudes toward and uptake of other health interventions is urgently needed.

Geographic variations in avoidable hospitalizations in the elderly, in a health system with universal coverage

Directory of Open Access Journals (Sweden)

Alberquilla Angel

2008-02-01

Full Text Available Abstract Background The study of Hospitalizations for ambulatory care sensitive conditions (ACSH has been proposed as an indirect measure of access to and receipt of care by older persons at the entryway to the Spanish public health system. The aim of this work is to identify the rates of ACSH in persons 65 years or older living in different small-areas of the Community of Madrid (CM and to detect possible differences in ACSH. Methods Cross-sectional, ecologic study, which covered all 34 health districts of the CM. The study population consisted of all individuals aged 65 years or older residing in the CM between 2001 and 2003, inclusive. Using hospital discharge data, avoidable ACSH were selected from the list of conditions validated for Spain. Age- and sex-adjusted ACSH rates were calculated for the population of each health district and the statistics describing the data variability. Point graphs and maps were designed to represent the ACSH rates in the different health districts. Results Of all the hospitalizations, 16.5% (64,409 were ACSH. Globally, the rate was higher among men: 33.15 per 1,000 populations vs. 22.10 in women and these differences were statistically significant (p Conclusion A significant variation is demonstrated in "preventable" hospitalizations between the different districts. In all the districts the men present rates significantly higher than women. Important variations in the access are observed the Primary Attention in spite of existing a universal sanitary cover.

Ownership and technical efficiency of hospitals: evidence from Ghana using data envelopment analysis.

Science.gov (United States)

Jehu-Appiah, Caroline; Sekidde, Serufusa; Adjuik, Martin; Akazili, James; Almeida, Selassi D; Nyonator, Frank; Baltussen, Rob; Asbu, Eyob Zere; Kirigia, Joses Muthuri

2014-04-08

In order to measure and analyse the technical efficiency of district hospitals in Ghana, the specific objectives of this study were to (a) estimate the relative technical and scale efficiency of government, mission, private and quasi-government district hospitals in Ghana in 2005; (b) estimate the magnitudes of output increases and/or input reductions that would have been required to make relatively inefficient hospitals more efficient; and (c) use Tobit regression analysis to estimate the impact of ownership on hospital efficiency. In the first stage, we used data envelopment analysis (DEA) to estimate the efficiency of 128 hospitals comprising of 73 government hospitals, 42 mission hospitals, 7 quasi-government hospitals and 6 private hospitals. In the second stage, the estimated DEA efficiency scores are regressed against hospital ownership variable using a Tobit model. This was a retrospective study. In our DEA analysis, using the variable returns to scale model, out of 128 district hospitals, 31 (24.0%) were 100% efficient, 25 (19.5%) were very close to being efficient with efficiency scores ranging from 70% to 99.9% and 71 (56.2%) had efficiency scores below 50%. The lowest-performing hospitals had efficiency scores ranging from 21% to 30%.Quasi-government hospitals had the highest mean efficiency score (83.9%) followed by public hospitals (70.4%), mission hospitals (68.6%) and private hospitals (55.8%). However, public hospitals also got the lowest mean technical efficiency scores (27.4%), implying they have some of the most inefficient hospitals.Regarding regional performance, Northern region hospitals had the highest mean efficiency score (83.0%) and Volta Region hospitals had the lowest mean score (43.0%).From our Tobit regression, we found out that while quasi-government ownership is positively associated with hospital technical efficiency, private ownership negatively affects hospital efficiency. It would be prudent for policy-makers to examine the

Cesarean Myomectomy Outcome in a Nigerian District Hospital

African Journals Online (AJOL)

Mubeen

One patient had postoperative wound infection two weeks after discharge from the hospital. ... The safe delivery of the baby was always undertaken .... The five patients who spent more than five days had delayed wound healing. They all had emergency lower segment Cesarean section for obstructed labour. One of the ...

The tremendous cost of seeking hospital obstetric care in Bangladesh.

Science.gov (United States)

Afsana, Kaosar

2004-11-01

In Bangladesh, maternal mortality is estimated to be 320 per 100,000 live births, among the highest in the world, and most deliveries in rural areas occur at home. Women with obstetric complications fear to seek hospital care for various reasons; one of which is the tremendous cost. This paper shows how cost impedes rural, poor women's access to emergency obstetric care. The data are from a larger ethnographic study of childbirth practices in 2000--01 in Apurbabari village, the adjacent sub-district health complex and more distant tertiary hospitals at district level. Families had to spend what for them added up to a fortune for a caesarean section and other surgery, medicines, laboratory investigations, blood transfusion, food, travel and other expenses. Corruption in the form of demands for under-the-table payments to obtain these aspects of essential care is rife. Adequate resources should be allocated to the different health facilities, including for emergency obstetric treatment. Thana health complexes (sub-district hospitals) should be upgraded to provide comprehensive obstetric care. The system for prescribing drugs should be reformed and the causes of corruption investigated and addressed. Hospital care should not be allowed to further impoverish the poor. Addressing these issues will help to encourage rural, poor women to seek skilled delivery and post-partum care, particularly in emergency situations.

Dynamics of industrial districts and business groups. The case of the Marche region

NARCIS (Netherlands)

Randelli, F.; Boschma, R.A.

2012-01-01

Italian industrial districts are undergoing fundamental changes due to globalization. Taking a firm perspective, we argue that the analysis of firm strategies, in particular the rise of business groups, is key to understand the organizational adjustments industrial districts have recently gone

A way for reducing drug supply chain cost for a hospital district: A case study

Energy Technology Data Exchange (ETDEWEB)

Postacchini, L.; Ciarapica, F.E.; Bevilacqua, M.; Mazzuto, G.; Paciarotti, C.

2016-07-01

This work aims at providing insights to optimise healthcare logistic of the drug management, in order to deal with the healthcare expenditure cut. In this paper the effects of different drug supply chain configurations, on the resulting average stock, service level and Bullwhip effect, of the studied supply chain, is quantitatively assessed. A case study of an Italian district has been studied, taking into account three echelons: suppliers, central stock, and hospitals. A model of the various supply chain configurations has been created with the use of the simulation. Specifically, 24 supply chain configurations have been examined, stemming from the combination of several supply chain design parameters, namely: transshipment policies (Emergency Lateral Transshipment or Total Inventory Equalization); re-order and inventory management policies (Economic Order Quantity or Economic Order Interval); required service levels (90% or 95%); the number of available vans (one or two). For each configuration, hospital average stock, service level and a “Bullwhip effect” analysis are computed. To know which input variables are statistically significant, a DoE (Design of Experiments) analysis has been executed. The output of this paper provides useful insights and suggestions to optimize the healthcare logistic and drug supply chain. According to the developed DoE analysis, it can be stated that the introduction of transshipment policies provides important improvement in terms of service and stock levels. To reduce the Bullwhip effect, which results in a service level decreasing, and in a managing stock costs increasing, it is worth to adopt an EOQ re-order policy. This research gives practical recommendations to the studied system, in order to reduce costs and maintain a very satisfactory service level. This paper fulfils an identified need to study which combination of transshipment policies, re-order/inventory management policies and required service levels, can be the

A way for reducing drug supply chain cost for a hospital district: A case study

Directory of Open Access Journals (Sweden)

Leonardo Postacchini

2016-03-01

Full Text Available Purpose: This work aims at providing insights to optimise healthcare logistic of the drug management, in order to deal with the healthcare expenditure cut. In this paper the effects of different drug supply chain configurations, on the resulting average stock, service level and Bullwhip effect, of the studied supply chain, is quantitatively assessed. Design/methodology/approach: A case study of an Italian district has been studied, taking into account three echelons: suppliers, central stock, and hospitals. A model of the various supply chain configurations has been created with the use of the simulation. Specifically, 24 supply chain configurations have been examined, stemming from the combination of several supply chain design parameters, namely: transshipment policies (Emergency Lateral Transshipment or Total Inventory Equalization; re-order and inventory management policies (Economic Order Quantity or Economic Order Interval; required service levels (90% or 95%; the number of available vans (one or two. For each configuration, hospital average stock, service level and a “Bullwhip effect” analysis are computed. To know which input variables are statistically significant, a DoE (Design of Experiments analysis has been executed. Findings: The output of this paper provides useful insights and suggestions to optimize the healthcare logistic and drug supply chain. According to the developed DoE analysis, it can be stated that the introduction of transshipment policies provides important improvement in terms of service and stock levels. To reduce the Bullwhip effect, which results in a service level decreasing, and in a managing stock costs increasing, it is worth to adopt an EOQ re-order policy. Practical implications: This research gives practical recommendations to the studied system, in order to reduce costs and maintain a very satisfactory service level. Originality/value: This paper fulfils an identified need to study which combination of

The Relationship between Inpatient Expectations of Staff Responsiveness and Empathy with Inpatient Satisfaction at Wangaya District Hospital Denpasar

Directory of Open Access Journals (Sweden)

Dwidyaniti Wira

2015-04-01

Full Text Available Background and purpose: The evaluation of quality of service within inpatient and outpatient services is very critical to be done. This research aimed to explore the relationship between inpatient expectations of the quality of nursing service and inpatient satisfaction, in the third-class ward Wangaya District General Hospital, Denpasar.Methods: This research was a quantitative study using cross-sectional design. A sample of 111 was selected by simple random sampling. The data was analysed by using univariate, bivariate, and multivariate analysis with logistic regression.Results: The analysis indicated that the level of actual satisfaction compared to inpatient expectations was as low as 45%. Perception of responsiveness with OR=2.404 (95%CI: 1.076–5.373 and perception of empathy with OR=2.594 (95%CI: 1.165-5.779 had a significant relationship with inpatient satisfaction.Conclusion: The study concluded that the patient satisfaction rate is moderate and found to have significant correlation with perceptions of responsiveness and empathy.Keywords: inpatient expectations, nursing service provision, inpatient satisfaction

Hip resurfacing in a district general hospital: 6-year clinical results using the ReCap hip resurfacing system

Directory of Open Access Journals (Sweden)

van der Weegen Walter

2012-12-01

Full Text Available Abstract Background The purpose of our study was to prospectively report the clinical results of 280 consecutive hips (240 patients who received a ReCap Hip Resurfacing System implant (Biomet Inc., Warsaw, USA in a single district general hospital. Literature reports a large variation in clinical results between different resurfacing designs and published results using this particular design are scarce. Methods Mean follow up was 3.3 years (1.0 to 6.3 and four patients were lost to follow-up. All patients were diagnosed with end-stage hip osteoarthritis, their mean age was 54 years and 76.4% of all patients were male. Results There were 16 revisions and four patients reported a Harris Hip Score Conclusions This independent series confirms that hip resurfacing is a demanding procedure, and that implant survival of the ReCap hip resurfacing system is on a critical level in our series. In non-revised patients, reported outcomes are generally excellent. Trial registration ClinicalTrials.gov Identifier: NCT00603395

Study on prevalence of ancylostomosis in dogs at Anand district, Gujarat, India

Directory of Open Access Journals (Sweden)

Nilima N. Brahmbhatt

2015-12-01

Full Text Available Aim: This study was undertaken to derive the prevalence rate of ancylostomosis in dogs by a collection of fecal samples from Anand district. Materials and Methods: The fecal samples were collected from the dogs brought to the Hospital of Veterinary College (Teaching Veterinary Clinical Service Complex and the surrounding areas of Anand district. On the day of collection, fecal samples were collected and brought to the Department of Veterinary Parasitology and processed for standard qualitative examination. The sedimentation technique was used to detect the presence of Ancylostoma spp. eggs in the samples. Result: The highest prevalence rate was observed in the month of May (36.66% fecal samples and the lowest in the month of December (13.79% fecal samples at Anand district. Conclusion: It can be concluded that heavy infection is present in Anand district especially in the season of summer followed by monsoon and the least in winter.

The prevalence of neonatal jaundice and risk factors in healthy term neonates at National District Hospital in Bloemfontein

Science.gov (United States)

2018-01-01

Background Neonatal jaundice affects one in two infants globally. The jaundice is the result of an accumulation of bilirubin as foetal haemoglobin is metabolised by the immature liver. High serum levels of bilirubin result in lethargy, poor feeding and kernicterus of the infant. Aim The main aim of this article was to determine the prevalence of neonatal jaundice and secondly to explore its risk factors in healthy term neonates. Setting Maternity ward, National District Hospital, Bloemfontein, South Africa. Methods In this cross-sectional study, mothers and infants were conveniently sampled after delivery and before discharge. The mothers were interviewed and their case records were reviewed for risk factors for neonatal jaundice and the clinical appearance and bilirubin levels of the infants were measured with a non-invasive transcutaneous bilirubin meter. Results A total of 96 mother-infant pairs were included in the study. The prevalence of neonatal jaundice was 55.2%; however, only 10% of black babies who were diagnosed with jaundice appeared clinically jaundiced. Normal vaginal delivery was the only risk factor associated with neonatal jaundice. Black race and maternal smoking were not protective against neonatal jaundice as in some other studies. Conclusion More than half (55.2%) of healthy term neonates developed neonatal jaundice. As it is difficult to clinically diagnose neonatal jaundice in darker pigmented babies, it is recommended that the bilirubin level of all babies should be checked with a non-invasive bilirubin meter before discharge from hospital or maternity unit as well as during the first clinic visit on day 3 after birth.

Council Districts

Data.gov (United States)

Town of Cary, North Carolina — View the location of the Town of Cary’s four Town Council districts.Please note that one district, District A, is split into two geo-spatial areas. One area is in...

Estimates of thyroid cancer incidence at district level using cancer registries data and linkage of two sources of medico-administrative data, France, 2007-2011

International Nuclear Information System (INIS)

Chatignoux, Edouard; Decool, Elsa; Maria, Florence de; Uhry, Zoe; Remontet, Laurent; Grosclaude, Pascale; Guizard, Anne-Valerie; Delafosse, Patricia; Colonna, Marc

2016-01-01

Objectives - In France, cancer registries cover 20% of the population. The objective of this study was to provide estimations of thyroid cancer incidence at the administrative district level ( 'departements') over the 2007-2011 period in metropolitan France, using registries data and medico-administrative data. Methods - A medico-administrative indicator 'HUL' [Hospital union LLD] combining Hospital discharge data and health insurance data on Long Duration Diseases (LDD) was constructed. It counts the number of people with a new LDD or hospitalized for thyroid cancer. The principle of the estimation consists in adjusting HUL data at the district level by the Incidence/HUL ratio of the registry area. The accuracy of the estimations was first evaluated in the districts covered by registries by comparing estimated to observed incidence. Results - The preliminary phase of the assessment confirmed that the HUL/Incidence ratio were sufficiently accurate to provide district level estimates of thyroid cancer incidence over the whole territory. The district variability of the estimations for the 2007-2011 period was important: the 5. and 95. percentiles of the distribution of standardized incidence rates across districts were 2.8 and 7.1 for 100,000 in men, and 8.3 and 21.2 for 100,000 in women. Areas with significant over-incidence were observed in the South-East, and on the South-West coast of France compared to the national level. Conclusion - This study confirms the magnitude of geographical variability of thyroid cancer incidence between French administrative districts. It also confirms the value of cross-referencing medico-administrative data to estimate the incidence at an administrative district level. (authors)

Perceptions of the Leadership Practices of Principals in a High Performing School District

Science.gov (United States)

Dinning, Molly

2014-01-01

The dissertation, "Perceptions Of The Leadership Practices Of Principals In A High Performing School District," explores the understandings of leadership practices from the perspective of parents, teachers, and principals in one high performing school district. The study addressed the leadership practices deemed important by the…

Estimating the cost of healthcare delivery in three hospitals in ...

African Journals Online (AJOL)

Objective: The cost burden (called full cost) of providing health services at a referral, a district and a mission hospital in Ghana were determined. Methods: Standard cost-finding and cost analysis tools recommended by World Health Organization are used to analyse 2002 and 2003 hospital data. Full cost centre costs were ...

Administrative management of dental departments in hospitals in Taiwan: A field survey

Directory of Open Access Journals (Sweden)

Tsang-Lie Cher

2012-12-01

Conclusion: For the overall administrative management of dental departments, medical centers were superior to regional hospitals, which were better than district hospitals. In order to elevate the quality, we suggest that dental department should be included in teaching hospital accreditation, and the criteria we used can be taken for reference for the dental department accreditation in the future.

[Do laymen understand information about hospital quality? An empirical verification using risk-adjusted mortality rates as an example].

Science.gov (United States)

Sander, Uwe; Kolb, Benjamin; Taheri, Fatemeh; Patzelt, Christiane; Emmert, Martin

2017-11-01

The effect of public reporting to improve quality in healthcare is reduced by the limited intelligibility of information about the quality of healthcare providers. This may result in worse health-related choices especially for older people and those with lower levels of education. There is, as yet, little information as to whether laymen understand the concepts behind quality comparisons and if this comprehension is correlated with hospital choices. An instrument with 20 items was developed to analyze the intelligibility of five technical terms which were used in German hospital report cards to explain risk-adjusted death rates. Two online presentations of risk-adjusted death rates for five hospitals in the style of hospital report cards were developed. An online survey of 353 volunteers tested the comprehension of the risk-adjusted mortality rates and included an experimental hospital choice. The intelligibility of five technical terms was tested: risk-adjusted, actual and expected death rate, reference range and national average. The percentages of correct answers for the five technical terms were in the range of 75.0-60.2%. Between 23.8% and 5.1% of the respondents were not able to answer the question about the technical term itself. The least comprehensible technical terms were "risk-adjusted death rate" and "reference range". The intelligibility of the 20 items that were used to test the comprehension of the risk-adjusted mortality was between 89.5% and 14.2%. The two items that proved to be least comprehensible were related to the technical terms "risk-adjusted death rate" and "reference range". For all five technical terms it was found that a better comprehension correlated significantly with better hospital choices. We found a better than average intelligibility for the technical terms "actual and expected death rate" and for "national average". The least understandable were "risk-adjusted death rate" and "reference range". Since the self

out-patient prescribing practices at mbagathi district hospital-nairobi

African Journals Online (AJOL)

2013-12-01

Dec 1, 2013 ... Objective: To assess medicine use practices by using WHO prescribing and patient care indicators in .... from the hospital administration and ethics approval ..... additional funds to purchase medicines and medical supplies.

A More Detailed Understanding Of Factors Associated With Hospital Profitability.

Science.gov (United States)

Bai, Ge; Anderson, Gerard F

2016-05-01

To identify the characteristics of the most profitable US hospitals, we examined the profitability of acute care hospitals in fiscal year 2013, measured as net income from patient care services per adjusted discharge. Based on Medicare Cost Reports and Final Rule Data, the median hospital lost $82 for each such discharge. Forty-five percent of hospitals were profitable, with 2.5 percent earning more than $2,475 per adjusted discharge. The ten most profitable hospitals, seven of which were nonprofit, each earned more than $163 million in total profits from patient care services. Hospitals with for-profit status, higher markups, system affiliation, or regional power, as well as those located in states with price regulation, tended to be more profitable than other hospitals. Hospitals that treated a higher proportion of Medicare patients, had higher expenditures per adjusted discharge, were located in counties with a high proportion of uninsured patients, or were located in states with a dominant insurer or greater health maintenance organization (HMO) penetration had lower profitability than hospitals that did not have these characteristics. These findings can inform policy reforms, while providing a baseline against which to measure the impact of any subsequent reforms. Project HOPE—The People-to-People Health Foundation, Inc.

Improving the Use of Lipid-lowering Drugs at Brits Hospital | Van ...

African Journals Online (AJOL)

Background: When it was found by the Brits Hospital Pharmacy and Therapeutics Committee (PTC) in 2000 that simvastatin was responsible for extremely high costs in a district hospital, it was decided to undertake a quality improvement study to assess and, if appropriate, rectify the situation. Methods: A Quality ...

Approach to malaria in rural hospitals

Directory of Open Access Journals (Sweden)

Jency Maria Koshy

2014-01-01

Full Text Available Malaria is one of the most common parasitic infections in the developing countries. In Rural India, most patients would be treated by primary and secondary care physicians. This article is aimed at providing a feasible approach to the cases of malaria in mission hospitals and other rural hospitals taking into account all the resource limitations. A study done over one year on patients detected to have malaria at Jiwan Jyoti Christian Hospital in Sonbhadra district has helped the authors to identify the various challenges faced by doctors working in the rural hospitals. The article has looked at the various complications associated with malaria and their management. It has also stressed upon the increasing incidence of chloroquine resistance.

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

Science.gov (United States)

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

1998-01-01

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

An educational conference in a general hospital.

Science.gov (United States)

Caldwell, Gordon

2011-12-01

Western Sussex Hospitals National Health Service (NHS) Trust comprises the District General Hospitals of Worthing and Chichester. Both hospitals have successful postgraduate medical education centres, providing training for junior doctors and continuing professional development for senior doctors. Until now, there have been limited multi-professional teaching and learning activities available. The two hospitals have recently merged. The education executive felt that workplace learning had become undervalued since the implementation of Modernising Medical Careers in the UK. The executive wanted to provide a multi-professional conference on Workplace Learning, both to support the merger and to promote the value of workplace and multi-professional learning. The conference topic covering the 'how' of workplace learning was innovative. Many educational conferences concentrate on the organisation and evaluation of classroom learning, rather than on how learning can be facilitated in the workplace during ordinary working practice. It was also innovative to ensure that the presenters were representative of the multi-professional workforce. The presentations were limited to 8 minutes each to promote high-impact short presentations. The talks were recorded for publishing on the trust's intranet and the internet. A committed team in a district general hospital can provide a high-quality educational conference with wide appeal. Local health care professionals can produce short high-impact presentations. The use of modern information technology and audio-visual systems can make the presentations available to both local and worldwide audiences. © Blackwell Publishing Ltd 2011.

Management of uncomplicated malaria in children under 13 years of age at a district hospital in Senegal: from official guidelines to usual practices.

Science.gov (United States)

Sarrassat, Sophie; Lalou, Richard; Cissé, Moustapha; Le Hesran, Jean-Yves

2011-09-29

To be effective, national malaria guidelines must be properly followed. This study evaluated nurses' practices in the management of uncomplicated malaria cases at a District Hospital. Its objective was to identify the reasons for discrepancies between official guidelines and usual practices. This study took place at Oussouye hospital, south-western Senegal. Blood smears were available for biological diagnosis in patients aged more than five years while the Integrated Management of Childhood Illness recommended treating fevers presumptively in children under five. First line anti-malarial was Amodiaquine plus sulphadoxine-pyrimethamine (AQ+SP) bi-therapy. Hospital records of children under 13 years of age seen between 2004 and 2005 were reviewed. Among children treated with anti-malarials, 74% (2, 063/2, 789) received AQ+SP. However, only 22% (406/1, 879) of febrile children and 19% (429/2, 198) of children diagnosed with malaria got a blood smear. Moreover, an anti-malarial was prescribed for 80% (377/474) of children with a negative blood smear. The transition from chloroquine to AQ+SP was well followed. Nonetheless, blood smear use was very low and many over-prescriptions were reported. Reasons for discrepancies between guidelines and practices can be classified in three main categories: ambiguous guidelines, health system's dysfunctions and nurses' own considerations. Aside from the strengthening of the public health system, in order to guarantee practices complying with guidelines, training content should be more adapted to nurses' own considerations.

Management of uncomplicated malaria in children under 13 years of age at a district hospital in senegal: from official guidelines to usual practices

Directory of Open Access Journals (Sweden)

Le Hesran Jean-Yves

2011-09-01

Full Text Available Abstract Background To be effective, national malaria guidelines must be properly followed. This study evaluated nurses' practices in the management of uncomplicated malaria cases at a District Hospital. Its objective was to identify the reasons for discrepancies between official guidelines and usual practices. Methods This study took place at Oussouye hospital, south-western Senegal. Blood smears were available for biological diagnosis in patients aged more than five years while the Integrated Management of Childhood Illness recommended treating fevers presumptively in children under five. First line anti-malarial was Amodiaquine plus sulphadoxine-pyrimethamine (AQ+SP bi-therapy. Hospital records of children under 13 years of age seen between 2004 and 2005 were reviewed. Results Among children treated with anti-malarials, 74% (2, 063/2, 789 received AQ+SP. However, only 22% (406/1, 879 of febrile children and 19% (429/2, 198 of children diagnosed with malaria got a blood smear. Moreover, an anti-malarial was prescribed for 80% (377/474 of children with a negative blood smear. Conclusions The transition from chloroquine to AQ+SP was well followed. Nonetheless, blood smear use was very low and many over-prescriptions were reported. Reasons for discrepancies between guidelines and practices can be classified in three main categories: ambiguous guidelines, health system's dysfunctions and nurses' own considerations. Aside from the strengthening of the public health system, in order to guarantee practices complying with guidelines, training content should be more adapted to nurses' own considerations.

Health service planning contributes to policy dialogue around strengthening district health systems: an example from DR Congo 2008-2013.

Science.gov (United States)

Rajan, Dheepa; Kalambay, Hyppolite; Mossoko, Mathias; Kwete, Dieudonné; Bulakali, Joseph; Lokonga, Jean-Pierre; Porignon, Denis; Schmets, Gerard

2014-10-31

This case study from DR Congo demonstrates how rational operational planning based on a health systems strengthening strategy (HSSS) can contribute to policy dialogue over several years. It explores the operationalization of a national strategy at district level by elucidating a normative model district resource plan which details the resources and costs of providing an essential health services package at district level. This paper then points to concrete examples of how the results of this exercise were used for Ministry of Health (MoH) decision-making over a time period of 5 years. DR Congo's HSSS and its accompanying essential health services package were taken as a base to construct a normative model health district comprising of 10 Health Centres (HC) and 1 District Hospital (DH). The normative model health district represents a standard set by the Ministry of Health for providing essential primary health care services. The minimum operating budget necessary to run a normative model health district is $17.91 per inhabitant per year, of which $11.86 is for the district hospital and $6.05 for the health centre. The Ministry of Health has employed the results of this exercise in 4 principal ways: 1.Advocacy and negotiation instrument; 2. Instrument to align donors; 3. Field planning; 4. Costing database to extract data from when necessary. The above results have been key in the policy dialogue on affordability of the essential health services package in DR Congo. It has allowed the MoH to provide transparent information on financing needs around the HSSS; it continues to help the MoH negotiate with the Ministry of Finance and bring partner support behind the HSSS.

What keeps health professionals working in rural district hospitals in South Africa?

Directory of Open Access Journals (Sweden)

Louis S. Jenkins

2015-06-01

Full Text Available Background: The theme of the 2014 Southern African Rural Health Conference was ‘Building resilience in facing rural realities’. Retaining health professionals in South Africa is critical for sustainable health services. Only 12% of doctors and 19% of nurses have been retained in the rural areas. The aim of the workshop was to understand from health practitioners why they continued working in their rural settings. Conference workshop: The workshop consisted of 29 doctors, managers, academic family physicians, nurses and clinical associates from Southern Africa, with work experience from three weeks to 13 years, often in deep rural districts. Using the nominal group technique, the following question was explored, ‘What is it that keeps you going to work every day?’ Participants reflected on their work situation and listed and rated the important reasons for continuing to work. Results: Five main themes emerged. A shared purpose, emanating from a deep sense of meaning, was the strongest reason for staying and working in a rural setting. Working in a team was second most important, with teamwork being related to attitudes and relationships, support from visiting specialists and opportunities to implement individual clinical skills. A culture of support was third, followed by opportunities for growth and continuing professional development, including teaching by outreaching specialists. The fifth theme was a healthy work-life balance. Conclusion: Health practitioners continue to work in rural settings for often deeper reasons relating to a sense of meaning, being part of a team that closely relate to each other and feeling supported.

Measuring unmet obstetric need at district level: how an epidemiological tool can affect health service organization and delivery.

Science.gov (United States)

Guindo, Gabriel; Dubourg, Dominique; Marchal, Bruno; Blaise, Pierre; De Brouwere, Vincent

2004-10-01

A national retrospective survey on the unmet need for major obstetric surgery using the Unmet Obstetric Need Approach was carried out in Mali in 1999. In Koutiala, the district health team decided to carry on the monitoring of the met need for several years in order to assess their progress over time. The first prospective study, for 1999, estimated that more than 100 women in need of obstetric care never reached the hospital and probably died as a consequence. This surprising result shocked the district health team and the resulting increased awareness of service deficits triggered operational measures to tackle the problem. The Unmet Obstetric Need study in Koutiala district was implemented without financial support and only limited external technical back-up. The appropriation of the study by the district team for solving local problems of access to obstetric care may have contributed to the success of the experience. Used as a health service management tool, the study and its results started a dialogue between the hospital staff and both health centre staff and community representatives. This had not only the effect of triggering consideration of coverage, but also of quality of obstetric care. Copyright 2004 Oxford University Press

A study on work stress, stress coping strategies and health promoting lifestyle among district hospital nurses in Taiwan.

Science.gov (United States)

Lee, Wei-Lun; Tsai, Shieunt-Han; Tsai, Chao-Wen; Lee, Chia-Ying

2011-01-01

To determine work stress, and stress-coping strategies, and to analyze their the relationships in order to improve health-promoting lifestyle of nurses in Taiwan. Three hundred eighty-five nurses who had work experience for more than 6 mo, were selected from four district hospitals in Kaohsiung and Ping Tung. We used a stratified cluster random sampling method for the selection. The nurses answered a self-report questionnaire, which was categorized into four sections: personal background data, work stress, stress-coping strategies, and health-promoting lifestyle. The findings indicate work stress and the health promoting lifestyle of nurses are at a higher level, with stress-coping strategies being at a medium level. Work stress and stress-coping strategies were significantly and positively correlated. Professional relationships, managerial role, personal responsibility, and recognition of work stress and the responsibilities of a health-promoting lifestyle were negatively correlated. Managerial role, personal responsibility, and organizational atmosphere of work stress as well as realization, an item of health-promoting lifestyle, were negatively correlated. Recognition of work stress and stress management, items of health-promoting lifestyle, were negatively correlated. Health responsibility, and self-actualization, items of health-promoting lifestyle, as well as stress-coping strategies were negatively correlated. Nutrition, an item of health-promoting lifestyle, and the support stress-coping strategy was negatively correlated. Nurses have greater work pressure and better work stress-coping strategies, but worse health responsibility and realization of a health-promoting lifestyle. We suggest hospitals build good relationships and appropriately increase employment of nurses through a good work atmosphere to achieve nurses' realization of a health-promoting lifestyle.

Developing a strategic marketing plan for physical and occupational therapy services: a collaborative project between a critical access hospital and a graduate program in health care management.

Science.gov (United States)

Kash, Bita A; Deshmukh, A A

2013-01-01

The purpose of this study was to develop a marketing plan for the Physical and Occupational Therapy (PT/OT) department at a Critical Access Hospital (CAH). We took the approach of understanding and analyzing the rural community and health care environment, problems faced by the PT/OT department, and developing a strategic marketing plan to resolve those problems. We used hospital admissions data, public and physician surveys, a SWOT analysis, and tools to evaluate alternative strategies. Lack of awareness and negative perception were key issues. Recommended strategies included building relationships with physicians, partnering with the school district, and enhancing the wellness program.

Understanding Afghan healthcare providers: a qualitative study of the culture of care in a Kabul maternity hospital.

Science.gov (United States)

Arnold, R; van Teijlingen, E; Ryan, K; Holloway, I

2015-01-01

To analyse the culture of a Kabul maternity hospital to understand the perspectives of healthcare providers on their roles, experiences, values and motivations and the impact of these determinants on the care of perinatal women and their babies. Qualitative ethnographic study. A maternity hospital, Afghanistan. Doctors, midwives and care assistants. Six weeks of observation followed by 22 semi-structured interviews and four informal group discussions with staff, two focus group discussions with women and 41 background interviews with Afghan and non-Afghan medical and cultural experts. The culture of care in an Afghan maternity hospital. A large workload, high proportion of complicated cases and poor staff organisation affected the quality of care. Cultural values, social and family pressures influenced the motivation and priorities of healthcare providers. Nepotism and cronyism created inequality in clinical training and support and undermined the authority of management to improve standards of care. Staff without powerful connections were vulnerable in a punitive inequitable environment-fearing humiliation, blame and the loss of employment. Suboptimal care put the lives of women and babies at risk and was, in part, the result of conflicting priorities. The underlying motivation of staff appeared to be the socio-economic survival of their own families. The hospital culture closely mirrored the culture and core values of Afghan society. In setting priorities for women's health post-2015 Millennium Development Goals, understanding the context-specific pressures on staff is key to more effective programme interventions and sustainability. © 2014 Royal College of Obstetricians and Gynaecologists.

Factors influencing caries status and treatment needs among pregnant women attending a maternity hospital in Udaipur city, India

OpenAIRE

Kumar, Santhosh; Tadakamadla, Jyothi; Tibdewal, Harish; Duraiswamy, Prabu; Kulkarni, Suhas

2013-01-01

To estimate the prevalence and severity of dental caries along with the treatment needs; to determine the factors that influence dental caries status among pregnant women attending a district maternity hospital in Udaipur, India. Study design: Study sample comprised of 206 pregnant women attending a district maternity hospital in Udaipur, India. Clinical data were collected on dental caries by DMFT and treatment needs as described in World Health Organization Dentition statu...

Statistical investigation on frequency, duration, number of X-ray investigations and radiation exposure to the patients of a district hospital on the outskirts of Munich

Energy Technology Data Exchange (ETDEWEB)

Nordmann, W

1973-04-10

Within the framework of a dissertation, X-ray examined patients were statistically surveyed during one month at the district hospital. The radiation exposure of the patients increased strongly particularly with men of the age of 21 to 30 and of 61 to 70. The causes are the multiply performed investigations after accidents as well as angiography at greater ages. The exposure is in the case of women particularly high between the ages of 66 and 70. In determining the gonadal exposure, the average values for the X-ray investigation at the time were referred to. The numbers give an approximate idea of to what extent single investigations with varying investigation or picture frequency can contribute to gonadal exposure.

Voting pattern of mental patients in a community state hospital.

Science.gov (United States)

Klein, M M; Grossman, S A

1967-06-01

The voting pattern of mental patients in a community-based state hospital was studied. Patients were polled on the New York City mayoralty race. A comparison to the vote of the general population revealed that the hospital sample vote resembled most closely the election results of the hospital district. The results highlight the advantage of community-centered mental health facilities, which undertake the treatment and rehabilitation of mental patients under conditions that maintain ties with family and community.

The Epidemiology of District Surgery in Malawi: a Two Year Study of ...

African Journals Online (AJOL)

Background: The true surgical requirement of a rural African population is also not precisely known. Methods: Data gathered over a 2-year period from 1993 to 1995 on surgical and anaesthetic activities in 18 District Hospitals in Malawi are presented. Results: Theatre records showed that 45,032 operations were carried out ...

Factors influencing caries status and treatment needs among pregnant women attending a maternity hospital in Udaipur city, India

OpenAIRE

Kumar, Santhosh; Tadakamadla, Jyothi; Tibdewal, Harish; Duraiswamy, Prabu; Kulkarni, Suhas

2013-01-01

Objectives: To estimate the prevalence and severity of dental caries along with the treatment needs; to determine the factors that influence dental caries status among pregnant women attending a district maternity hospital in Udaipur, India. Study design: Study sample comprised of 206 pregnant women attending a district maternity hospital in Udaipur, India. Clinical data were collected on dental caries by DMFT and treatment needs as described in World Health Organization Dentition status and ...

Quality Improvement in Hospitals: Identifying and Understanding Behaviors

Directory of Open Access Journals (Sweden)

Lukasz M. Mazur

2012-01-01

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

Productivity of public hospitals in Nepal: a data envelopment analysis.

Science.gov (United States)

Silwal, Pushkar Raj; Ashton, Toni

2017-07-20

Public hospitals in Nepal account for a major share of the total health budget. Therefore, questions are often asked about the performance of these hospitals. Existing measures of performance are limited to historical ratio analyses without any benchmarks. The objective of this study is to explore the trends in inputs, outputs and productivity changes in Nepalese public hospitals from 2011-2012 to 2013-2014. The study was conducted among 32 Nepalese public hospitals (23 district level and 9 higher level) for the three fiscal years from 2011-2012 to 2013-2014. First, basic ratio analyses were conducted for the input and output measures over the study years. Then, Malmquist productivity change scores were obtained using data envelopment analysis. Aggregated as well as separate analyses were conducted for district level and higher level hospitals. Real expenditures of the sampled hospitals declined over the 3-year period from an average of US$ 371 000 in year 1 to US$ 368 730 in year 2 and US$ 328680 in year 3. The average aggregated hospital outputs increased marginally from 8276 in 2011-2012 to 8613 in 2013-2014. The total factor productivity of the study hospitals declined by 6.9% annually from 2011-2012 to 2013-2014. Of the total 32 hospitals, productivity increased in only 12 (37.5%) hospitals and declined in the remaining 20 hospitals. The total factor productivity loss was influenced by a decline in technology change, despite an increase in efficiency. In general, productivity of the study hospitals declined over the study period. Availability and accessibility of accurate, detailed and consistent measures of hospital inputs and outputs is a major challenge for this type of analysis. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Productivity of public hospitals in Nepal: a data envelopment analysis

Science.gov (United States)

Ashton, Toni

2017-01-01

Objectives Public hospitals in Nepal account for a major share of the total health budget. Therefore, questions are often asked about the performance of these hospitals. Existing measures of performance are limited to historical ratio analyses without any benchmarks. The objective of this study is to explore the trends in inputs, outputs and productivity changes in Nepalese public hospitals from 2011–2012 to 2013–2014. Setting and participants The study was conducted among 32 Nepalese public hospitals (23 district level and 9 higher level) for the three fiscal years from 2011–2012 to 2013–2014. Outcome measures First, basic ratio analyses were conducted for the input and output measures over the study years. Then, Malmquist productivity change scores were obtained using data envelopment analysis. Aggregated as well as separate analyses were conducted for district level and higher level hospitals. Results Real expenditures of the sampled hospitals declined over the 3-year period from an average of US$ 371 000 in year 1 to US$ 368 730 in year 2 and US$ 328680 in year 3. The average aggregated hospital outputs increased marginally from 8276 in 2011–2012 to 8613 in 2013–2014. The total factor productivity of the study hospitals declined by 6.9% annually from 2011–2012 to 2013–2014. Of the total 32 hospitals, productivity increased in only 12 (37.5%) hospitals and declined in the remaining 20 hospitals. The total factor productivity loss was influenced by a decline in technology change, despite an increase in efficiency. Conclusions In general, productivity of the study hospitals declined over the study period. Availability and accessibility of accurate, detailed and consistent measures of hospital inputs and outputs is a major challenge for this type of analysis. PMID:28729314

Cultural Understanding of Wounds, Buruli Ulcers and Their Management at the Obom Sub-district of the Ga South Municipality of the Greater Accra Region of Ghana.

Directory of Open Access Journals (Sweden)

Eric Koka

2016-07-01

Full Text Available This study was conducted with the aim to understand some of the cultural belief systems in the management of wounds and patients practices that could contaminate wounds at the Obom sub-district of the Ga South Municipality of Ghana.This was an ethnographic study using in-depth interviews, Focus Group Discussions and participant observation techniques for data collection. Observations were done on Buruli ulcer patients to document how they integrate local and modern wound management practices in the day-to-day handling of their wounds. Content analysis was done after the data were subjected to thematic coding and representative narratives selected for presentation.It was usually believed that wounds were caused by charms or spirits and, therefore, required the attention of a native healer. In instances where some patients' wounds were dressed in the hospital by clinicians whose condition/age/sex contradict the belief of the patient, the affected often redress the wounds later at home. Some of the materials often used for such wound dressing include urine and concoctions made of charcoal and gunpowder with the belief of driving out evil spirits from the wounds.Clinicians must therefore be aware of these cultural beliefs and take them into consideration when managing Buruli ulcer wounds to prevent redressing at home after clinical treatment. This may go a long way to reduce secondary infections that have been observed in Buruli ulcer wounds.

Problematics of open prostatectomy in an Ivorian District Hospital setting.

Science.gov (United States)

Mgbakor, Anthony Chukwura

2012-09-01

Benign prostatic hypertrophy forms the bulk of urology workload in many sub-Saharan African hospitals. However, its management in secondary hospitals encounters specific problems that are rarely seen in the bigger tertiary institutions. We have tried to describe these difficulties across an account of open prostatectomy in regional secondary referral hospitals in the Côte d'Ivoire. This is a retrospective account of the specific difficulties encountered in the management of 327 consecutive cases of open prostatectomy carried out between August 1991 and September 2007 mainly in two secondary referral hospitals in the Côte d'Ivoire. The difficulties were at different levels: late presentation with 309 (94.5%) of the patients having experienced at least an episode of acute retention of urine, surgery while most patients were still carrying a catheter, minimal investigations carried out, scoring the patients in the IPSS scale, shortage of funds in the course of the management, and surveillance in the immediate postoperative period. The overall results were relatively satisfactory given our conditions of work. The most frequent complications were wound infection (14.7%), bleeding requiring transfusion (8.6%) and re-operation for clot retention (4.3%). We had a case (0.3%) of the rare prostato-rectal fistula which was managed conservatively. There were 4 deaths (1.2%). Open prostatectomy is the only surgical option for the management of benign prostatic hypertrophy in most of the urology centers of sub-Saharan Africa. Concerning its management away from the Tertiary Institutes, the surgery team is faced with specific problems which demand precise adaptations. Despite difficult working conditions, the results are sufficiently encouraging and gratifying to justify its pursuit while Urologists await the availability of equipments for transurethral resection of the prostate and other novel techniques.

District heating in Switzerland

International Nuclear Information System (INIS)

Herzog, F.

1991-01-01

District heating has been used in Switzerland for more than 50 years. Its share of the heat market is less than 3% today. An analysis of the use of district heating in various European countries shows that a high share of district heating in the heat market is always dependent on ideal conditions for its use. Market prospects and possible future developments in the use of district heating in Switzerland are described in this paper. The main Swiss producers and distributors of district heating are members of the Association of District Heating Producers and Distributors. This association supports the installation of district heating facilities where ecological, energetical and economic aspects indicate that district heating would be a good solution. (author) 2 tabs., 6 refs

Occupational Safety Precautions among Nurses at Four Hospitals, Nablus District, Palestine

Directory of Open Access Journals (Sweden)

IA Al-Khatib

2015-10-01

Full Text Available Occupational hazards, exposure to blood and body fluids (BBF accidents and safety precautions constitute an important public health issue. We assessed the prevalence and determinants of exposure to occupational hazards among nurses, and their knowledge of occupational safety precautions. In a cross-sectional study, we surveyed 332 nurses working in 4 hospitals, Nablus, West Bank, Palestine, by a questionnaire. Bivariate analysis tested the associations between ever exposure and the high likelihood of BBF exposure and the independent socio-demographic and occupational variables. Binary logistic regression analysis was used to assess the associations between the same two exposures and selected independent variables (those significant in the bivariate analysis. Prevalence of ever exposure to BBF was 51.7%, and was associated with working in private and charitable hospitals (OR 2.62, 2.68, respectively, having 4–6 family members (OR 0.52 and “nursing” being as one's top career choice at university (OR 0.48. The prevalence of high likelihood of BBF exposure was 62.2%, and was associated with working in charitable and private hospitals (OR 7.81, 2.43, respectively and “nursing” being as one's top career choice (OR 0.57. Regarding knowledge, most respondents believed it is necessary to enact laws and regulations regarding occupational safety precautions, reported the use of sharps containers, immediate disinfection after an accident, reporting an accident, and using personal protective equipment. Nurses had adequate knowledge of the risks of their hospital work. Nevertheless, they exhibited high prevalence of exposure to BBF accidents. Future studies are needed to re-evaluate existing occupational safety guidelines in hospitals, establish monitoring and evaluation protocols for health care workers' adherence to the guidelines, and institute well-defined policies for reporting occupational injury incidents so these can be handled appropriately.

Barriers to quality patient care in rural district hospitals

Directory of Open Access Journals (Sweden)

Johanna E. Eygelaar

2012-05-01

Reliability of the instrument was verified using the Cronbach alpha coefficient and a pilot study. The validity, specifically construct and content validity, were assured by means of an extensive literature review, pilot study and use of experts. Ethics approval was obtained from the relevant stakeholders. Results showed that 272 participants (97% disagreed that provision of staff was adequate, with staff above 40 years of age more likely to disagree (p = <0.01. A statistically significant association was shown between availability of doctors and staff not being able to cope with emergencies (p = <0.01. Most participants (n =212; 76% indicated that they were not receiving continuing education, with the registered nurses more likely to disagree (χ² test, p = 0.02. Participants in both hospital types A (n = 131; 82% and B (n = 108; 91% also disagreed that provision of equipment and consumables was adequate. The research showed that inadequacies relating to human resources, professional development, consumables and equipment influenced the quality of patient care. Urgent attention should be given to the problems identified to ensure quality of patient care in rural hospitals.

Increasing understanding of the relationship between geographic access and gendered decision-making power for treatment-seeking for febrile children in the Chikwawa district of Malawi

Directory of Open Access Journals (Sweden)

Victoria L. Ewing

2016-10-01

Full Text Available Abstract Background This study used qualitative methods to investigate the relationship between geographic access and gendered intra-household hierarchies and how these influence treatment-seeking decision-making for childhood fever within the Chikwawa district of Malawi. Previous cross-sectional survey findings in the district indicated that distance from facility and associated costs are important determinants of health facility attendance in the district. This paper uses qualitative data to add depth of understanding to these findings by exploring the relationship between distance from services, anticipated costs and cultural norms of intra-household decision-making, and to identify potential intervention opportunities to reduce challenges experienced by those in remote locations. Qualitative data collection included 12 focus group discussions and 22 critical incident interviews conducted in the local language, with primary caregivers of children who had recently experienced a febrile episode. Results Low geographic accessibility to facilities inhibited care-seeking, sometimes by extending the ‘assessment period’ for a child’s illness episode, and led to delays in seeking formal treatment, particularly when the illness occurred at night. Although carers attempted to avoid incurring costs, cash was often needed for transport and food. Whilst in all communities fathers were normatively responsible for treatment costs, mothers generally had greater access to and control over resources and autonomy in decision-making in the matrilineal and matrilocal communities in the central part of the district, which were also closer to formal facilities. Conclusions This study illustrates the complex interplay between geographic access and gender dynamics in shaping decisions on whether and when formal treatment is sought for febrile children in Chikwawa District. Geographic marginality and cultural norms intersect in remote areas both to increase the

A ward without walls? District nurses' perceptions of their workload management priorities and job satisfaction.

Science.gov (United States)

Stuart, Elaine Haycock; Jarvis, Alison; Daniel, Katie

2008-11-01

To explore district nurses' workload management, job satisfaction and the challenges they face. This paper reports qualitative findings from a qualitative and quantitative study to identify a district nursing perspective on use of time, challenges and work satisfaction. District nursing is under increasing pressure because of the increasing shift to care in the community, early hospital discharge and changes in demography with an ageing population and more people with chronic illnesses. Qualitative. The study took place in one Scottish Health Board and data were collected in February and March 2005. The qualitative approach involved a total of 31 district nurses and senior managers in focus group discussions or individual interviews. Three main themes were identified: (1) the priorities of district nurses and their views on work unrelated to 'hands on' clinical care, (2) aspects of district nursing considered stressful and (3) district nurses' job satisfaction. District nurses and managers agree that caring work with patients is the priority for the service and provides job satisfaction. Many nurses feel overwhelmed by their workload and have little control over the admission of patients to their caseload; they are mainly demand led and therefore reactive care providers. A culture of long hours has developed as district nurses struggle to meet the needs of patients. Feeling devalued lowers satisfaction and Agenda for Change is perceived as de-valuing the skills of community nurses. More clerical support is required so district nurses can deliver care to patients. District nurses can better represent their workload and how it is managed through expressing the nature of assessing risk and caring for patients as opposed to defining patients care needs by medical diagnoses. Extending the hours of the full district nursing service would benefit patients and staff.

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

African Journals Online (AJOL)

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

Immediate post-partum haemorrhage: Epidemiological aspects and maternal prognosis at South N’djamena District Hospital (Chad

Directory of Open Access Journals (Sweden)

Gabkika Bray Madoue

2015-05-01

Full Text Available Background: Post-partum haemorrhage defined as blood loss after delivery over 500mls, affects all countries and is the commonest cause of maternal mortality. It is a frequent obstetric emergency in developing countries. Objective: To identify the causes of post-partum haemorrhage and identify adequate management of immediate post-partum haemorrhage and thus reduce maternal mortality. Patients and methods: This was a prospective and descriptive study of one year from 1st January 2014 to 31stDecember 2014 conducted at South N’Djamena district hospital. Before including a patient in our survey her consent was obtained after explaining to her the need for the survey. All consenting patients with post-partum haemorrhage were included. Data were analyzed using SPSS17.0. Results: We recorded 100 cases of post-partum haemorrhage among 6815 deliveries giving an incidence of 1.47%. The average age of the women was 25.0 years. The majority of deliveries (90% were vaginal. The main cause of immediate post-partum haemorrhage was a third stage of labour bleeding (66% followed by genital lesions (32%. The management was medical (uterotonic drug, fluid replacement and blood transfusion, obstetric (manual removal of placenta or clot, and surgical (suture of lesions, vascular ligature and hysterectomy. There were two maternal deaths (2%. Conclusion: Post-partum haemorrhage is often fatal in our region. Preventive measures and efficient management can help to improve maternal prognosis.

Is the implementation of quality improvement methods in hospitals subject to the neighbourhood effect?

Science.gov (United States)

Yu, Tsung-Hsien; Chung, Kuo-Piao

2014-06-01

Quality improvement (QI) methods have been fashionable in hospitals for decades. Previous studies have discussed the relationships between the implementation of QI methods and various external and internal factors, but there has been no examination to date of whether the neighbourhood effect influences such implementation. The aim of this study was to use a multilevel model to investigate whether and how the neighbourhood effect influences the implementation of QI methods in the hospital setting in Taiwan. This is a retrospective questionnaire-based survey. All medical centres, regional hospitals and district teaching hospitals in Taiwan. Directors or persons in charge of implementing QI methods in hospitals. None. The breadth and depth of QI method implementation. Seventy-two of the 139 hospitals contacted returned the questionnaire, yielding a 52% response rate. The breadth and depth of QI method implementation increased over the 10-year study period, particularly between 2004 and 2006. The breadth and depth of the QI methods implemented in the participating hospitals were significantly associated with the average breadth and depth of those implemented by their competitors in the same medical area during the previous period. In addition, time was positively associated with the breadth and depth of QI method implementation. In summary, the findings of this study show that hospitals' QI implementation status is influenced by that of their neighbours. Hence, the neighbourhood effect is an important factor in understanding hospital behaviour. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

Deficiencies in provision of integrated multidisciplinary podiatry care for patients with inflammatory arthritis: a UK district general hospital experience.

Science.gov (United States)

Juarez, M; Price, E; Collins, D; Williamson, L

2010-01-01

Foot problems are highly prevalent in inflammatory arthritis (IA), especially rheumatoid arthritis (RA). Chronic inflammation can lead to permanent structural changes, deformity and disability. Early podiatry intervention in RA improves long term outcomes. National guidelines recommend that patients should be treated by a multidisciplinary team with dedicated podiatry services. In clinical practice funding constraints limit availability of these services. To assess prevalence of foot problems and quality and availability of foot care services at a UK district general hospital. 1200 IA patients in Swindon (Wiltshire, UK) were invited to complete an anonymised questionnaire regarding access to foot care services and education/information on foot problems. 448 patients. Prevalence of foot problems: 68%. Only 31% of patients had access to appropriate foot specialist. 24% had received foot assessment within 3 months of diagnosis of IA and 17% yearly review thereafter. Despite high prevalence of foot problems in our population we identified significant deficiencies in provision of integrated multidisciplinary podiatry care. The data we present could be used by others to support business cases to obtain funding to improve the links between rheumatology and podiatry services. Copyright 2010 Elsevier Ltd. All rights reserved.

Factors Associated with the Competencies of Public Health Workers in Township Hospitals: A Cross-Sectional Survey in Chongqing Municipality, China.

Science.gov (United States)

He, Zhifei; Cheng, Zhaohui; Fu, Hang; Tang, Shangfeng; Fu, Qian; Fang, Haiqing; Xian, Yue; Ming, Hui; Feng, Zhanchun

2015-11-09

This study aimed to explore the competencies of public health workers (PHWs) of township hospitals in Chongqing Municipality (China), and determine the related impact factors of the competencies of PHWs; A cross-sectional research was conducted on 314 PHWs from 27 township hospitals in three districts in Chongqing Municipality (China), from June to August 2014. A self-assessment questionnaire was established on the basis of literature reviews and a competency dictionary. The differences in competencies among the three districts were determined by adopting the chi-square test, t-test, analysis of variance (ANOVA) method, and the impact factors of the competencies of PHWs were determined by adopting stepwise regression analysis. (1) RESULTS of the demographic characteristics of PHWs in three sample districts of Chongqing Municipality showed that a significant difference in age of PHWs (p = 0.021 competency results of PHWs in township hospitals, seven among the 11 aspects were found to have significant differences in the three districts by the ANOVA test; (3) By adopting the t-test and ANOVA method, results of the relationship between the characteristics of PHWs and their competency scores showed that significant differences were found in the economic level (p = 0.000 competencies of PHWs in township hospitals, including the economic level (p = 0.000 competencies of the township hospital staff in Chongqing Municipality (China), are generally insufficient, therefore, regulating the medical education and training skills of PHWs is crucial to improve the competencies of PHWs in the township hospitals of Chongqing Municipality. The results of this study can be mirrored in other areas of China.

Empowerment Zones and Enterprise Districts - MDC_CommunityDevelopmentDistrict

Data.gov (United States)

NSGIC Local Govt | GIS Inventory — Community Development Districts (CDDs) are special taxing districts or local units of special-purpose government. A CDD may charge separate non-ad valorem special...

Assessing Nutrient Intake and Nutrient Status of HIV Seropositive Patients Attending Clinic at Chulaimbo Sub-District Hospital, Kenya

Directory of Open Access Journals (Sweden)

Agatha Christine Onyango

2012-01-01

Full Text Available Background. Nutritional status is an important determinant of HIV outcomes. Objective. To assess the nutrient intake and nutrient status of HIV seropositive patients attending an AIDS outpatient clinic, to improve the nutritional management of HIV-infected patients. Design. Prospective cohort study. Setting. Comprehensive care clinic in Chulaimbo Sub-District Hospital, Kenya. Subjects. 497 HIV sero-positive adults attending the clinic. Main Outcome Measures. Evaluation of nutrient intake using 24-hour recall, food frequency checklist, and nutrient status using biochemical assessment indicators (haemoglobin, creatinine, serum glutamate pyruvate (SGPT and mean corpuscular volume (MCV. Results. Among the 497 patients recruited (M : F sex ratio: 1.4, mean age: 39 years ± 10.5 y, Generally there was inadequate nutrient intake reported among the HIV patients, except iron (10.49 ± 3.49 mg. All the biochemical assessment indicators were within normal range except for haemoglobin 11.2 g/dL (11.4 ± 2.60 male and 11.2 ± 4.25 female. Conclusions. Given its high frequency, malnutrition should be prevented, detected, monitored, and treated from the early stages of HIV infection among patients attending AIDS clinics in order to improve survival and quality of life.

District nurse training

OpenAIRE

Elliott, Arnold; Freeling, Paul; Owen, John

1980-01-01

Training for district nursing is being reviewed. By 1981 district nurses will have a new administrative structure, a new curriculum, and a new examination. Training for nursing, like that for general practice, is to become mandatory. The history of the development of district nurse training is briefly described.

Strategies Utilized by Superintendents and Mathematics District Personnel That Impact Minority Student Outcomes in Algebra

Science.gov (United States)

DuPree, Jared Bernard

2013-01-01

This study applies the constructs from effective instruction from the literature on teacher education to understand the impact of school district strategies on algebra outcomes for minority students. The purpose of this study was to examine the strategies utilized by superintendents and district personnel and the impact of these identified…

A survey of doctors at a UK teaching hospital to assess understanding of recent changes to consent law.

Science.gov (United States)

O'Brien, J W; Natarajan, M; Shaikh, I

2017-06-01

The UK Supreme Court recently ruled that when consenting patients for treatments or procedures, clinicians must also discuss any associated material risks. We surveyed medical staff at a large UK teaching hospital in order to ascertain knowledge of consent law and current understanding of this change. Email survey sent to medical staff in all specialities at Norfolk and Norwich University Hospital in February 2016. 245 responses (141 Consultants and 104 junior doctors, response rate 32%). 82% consent patients for procedures at least monthly and 23% daily. 31% were not familiar with the concept of material risk. 35% were familiar with the recent change in consent law, 41% were not. 18% were "very uncertain" and 64% "a little uncertain" that their consenting process meets current legal requirements. >92% think that landmark cases and changes in law should be discussed through professional bodies and circulated better locally. The majority were not familiar with the concept of material risk and recent legal changes. A majority were not confident that their practice meets current requirements, suggesting that recent changes in consent law may not be widely understood at this hospital. We suggest more guidance and education may be necessary than is currently available. Increased understanding of recent changes to consent law will reduce the risk taken by NHS trusts and offer patients a service compliant with Supreme Court guidance.

The first general practitioner hospital in The Netherlands: towards a new form of integrated care?

NARCIS (Netherlands)

Moll van Charante, E.; Hartman, E.; IJzermans, J.; Voogt, E.; Klazinga, N.; Bindels, P.

2004-01-01

Objective: To describe the types of patients admitted to the first Dutch general practitioner (GP) hospital, their health-related quality of life and its substitute function. Design: A prospective observational study. Setting. The remaining 20-bed ward of a former district general hospital west of

The first general practitioner hospital in The Netherlands: towards a new form of integrated care?

NARCIS (Netherlands)

Moll van Charante, Eric; Hartman, Esther; Yzermans, Joris; Voogt, Elsbeth; Klazinga, Niek; Bindels, Patrick

2004-01-01

Objective - To describe the types of patients admitted to the first Dutch general practitioner (GP) hospital, their health-related quality of life and its substitute function. Design - A prospective observational study. Setting - The remaining 20-bed ward of a former district general hospital west

District Allocation of Human Resources Utilizing the Evidence Based Model: A Study of One High Achieving School District in Southern California

Science.gov (United States)

Lane, Amber Marie

2013-01-01

This study applies the Gap Analysis Framework to understand the gaps that exist in human resource allocation of one Southern California school district. Once identified, gaps are closed with the reallocation of human resources, according to the Evidenced Based Model, requiring the re-purposing of core classroom teachers, specialists, special…

Smart energy systems and 4th generation district heating

DEFF Research Database (Denmark)

Lund, Henrik; Duic, Neven; Østergaard, Poul Alberg

2016-01-01

scientific understanding on how we can design and implement a suitable and least-cost transformation into a sustainable energy future. The concept of Smart Energy Systems emphasizes the importance of being coherent and cross-sectoral when the best solutions are to be found and how this also calls......This editorial gives an introduction to the important relationship between Smart Energy Systems and 4th Generation District Heating and presents a number of selected papers from the 1st International Conference on the topic. All of the papers elaborate on or otherwise contribute to the theoretical...... for the active inclusion of the heating and cooling sectors. The concept of 4th Generation District Heating emphasizes that district heating and cooling are both important elements but also technologies that have to be developed further into a 4th generation version to be able to fulfil their roles in future...

A Qualitative Study of Provider Perceptions of Influences on Uptake of Pediatric Hospital Guidelines in Lao PDR.

Science.gov (United States)

Gray, Amy Z; Soukaloun, Douangdao; Soumphonphakdy, Bandith

2017-08-01

Strategies to improve the quality of hospital care are needed if ongoing gains in child health and survival are to be made. We previously reported on improvements in the quality of case management in hospitals following a guideline-based intervention in Lao PDR, with variation in the degree of change achieved between clinical conditions. This study aims to understand the factors that influenced the uptake of the guideline-based intervention, and its impact on care. This qualitative study was embedded in a mixed-methods evaluation of guideline implementation in nine hospitals in Lao PDR. Focus groups and individual interviews were conducted with 70 health staff from central, provincial, and district hospitals. The interview guide was based on the Theoretical Domains Framework. Inductive content analysis was performed on interview transcripts to identify themes, supported by field notes from the intervention. Findings were triangulated against previously reported quantitative outcomes using driver diagrams. Key influences on guidelines uptake related to the guideline and intervention (filling a void, physical accessibility, comprehensibility, training in guideline use), health staff (behavior regulation, trust in guidelines, and beliefs about consequences), and the environment (social influences particularly consensus and incorporation into clinical norms). The major barrier was family preference for treatments in conflict with guideline recommendations. This study identifies contextual factors that explain, as well as validate previously identified improvements in care following guideline implementation in Lao PDR. It provides novel understanding of why the same intervention may have a differential impact on different clinical conditions.

Factors Associated with the Competencies of Public Health Workers in Township Hospitals: A Cross-Sectional Survey in Chongqing Municipality, China

Science.gov (United States)

He, Zhifei; Cheng, Zhaohui; Fu, Hang; Tang, Shangfeng; Fu, Qian; Fang, Haiqing; Xian, Yue; Ming, Hui; Feng, Zhanchun

2015-01-01

Purpose: This study aimed to explore the competencies of public health workers (PHWs) of township hospitals in Chongqing Municipality (China), and determine the related impact factors of the competencies of PHWs; Methods: A cross-sectional research was conducted on 314 PHWs from 27 township hospitals in three districts in Chongqing Municipality (China), from June to August 2014. A self-assessment questionnaire was established on the basis of literature reviews and a competency dictionary. The differences in competencies among the three districts were determined by adopting the chi-square test, t-test, analysis of variance (ANOVA) method, and the impact factors of the competencies of PHWs were determined by adopting stepwise regression analysis. Results: (1) Results of the demographic characteristics of PHWs in three sample districts of Chongqing Municipality showed that a significant difference in age of PHWs (p = 0.021 competency results of PHWs in township hospitals, seven among the 11 aspects were found to have significant differences in the three districts by the ANOVA test; (3) By adopting the t-test and ANOVA method, results of the relationship between the characteristics of PHWs and their competency scores showed that significant differences were found in the economic level (p = 0.000 competencies of PHWs in township hospitals, including the economic level (p = 0.000 competencies of the township hospital staff in Chongqing Municipality (China), are generally insufficient, therefore, regulating the medical education and training skills of PHWs is crucial to improve the competencies of PHWs in the township hospitals of Chongqing Municipality. The results of this study can be mirrored in other areas of China. PMID:26569273

Implementation experience during an eighteen month intervention to improve paediatric and newborn care in Kenyan district hospitals

Directory of Open Access Journals (Sweden)

Wamae Annah

2009-07-01

Full Text Available Abstract Background We have conducted an intervention study aiming to improve hospital care for children and newborns in Kenya. In judging whether an intervention achieves its aims, an understanding of how it is delivered is essential. Here, we describe how the implementation team delivered the intervention over 18 months and provide some insight into how health workers, the primary targets of the intervention, received it. Methods We used two approaches. First, a description of the intervention is based on an analysis of records of training, supervisory and feedback visits to hospitals, and brief logs of key topics discussed during telephone calls with local hospital facilitators. Record keeping was established at the start of the study for this purpose with analyses conducted at the end of the intervention period. Second, we planned a qualitative study nested within the intervention project and used in-depth interviews and small group discussions to explore health worker and facilitators' perceptions of implementation. After thematic analysis of all interview data, findings were presented, discussed, and revised with the help of hospital facilitators. Results Four hospitals received the full intervention including guidelines, training and two to three monthly support supervision and six monthly performance feedback visits. Supervisor visits, as well as providing an opportunity for interaction with administrators, health workers, and facilitators, were often used for impromptu, limited refresher training or orientation of new staff. The personal links that evolved with senior staff seemed to encourage local commitment to the aims of the intervention. Feedback seemed best provided as open meetings and discussions with administrators and staff. Supervision, although sometimes perceived as fault finding, helped local facilitators become the focal point of much activity including key roles in liaison, local monitoring and feedback, problem solving

Assessment of anxiety related to dental treatments among patients attending dental clinics and hospitals in Ranga Reddy District, Andhra Pradesh, India.

Science.gov (United States)

Prathima, Vedati; Anjum, M Shakeel; Reddy, P Parthasarathi; Jayakumar, A; Mounica, M

2014-01-01

To assess the levels of dental anxiety among patients anticipating dental treatments in dental clinics/hospitals of Ranga Reddy district. A cross-sectional study was conducted among a representative sample of 1200 subjects (at least 18 years old) in dental clinics/hospitals which were selected from a list obtained through systematic random sampling. The data were collected using a pre-tested and calibrated questionnaire consisting of the Modified Corah Dental Anxiety Scale (MDAS) to assess anxiety levels. The majority (52.4%) of subjects showed a low level of anxiety. Females (11.44 ± 4.41) were found to have higher mean MDAS scores than males, and the highest mean MDAS scores were found among 18- to 34-year-olds (11.28 ± 4.67) (P < 0.05). Significant differences were found among subjects anticipating different treatments, with higher MDAS scores for extraction (11.25 ± 5.4), followed by examination, root canal treatment, gum surgery, scaling, restoration and others, e.g. orthodontic treatment, restoration with crowns, bridges and dentures (7.79 ± 3.80). The highest mean MDAS scores were found among subjects who were apprehensive due to 'past difficult experience in dental treatments', followed by 'drill' and 'injection', with the lowest scores among subjects indicating 'other reasons' (7.82 ± 3.84). The present data show that anxiety levels are higher in patients who have to undergo extractions than those who must be fitted with dentures. Thus, dental health care providers should pay more attention to patients' anxiety levels associated with different types of treatment.

7 CFR 917.14 - District.

Science.gov (United States)

2010-01-01

... District. (g) Contra Costa District includes and consists of Contra Costa County. (h) Santa Clara District... Ventura County. (l) Stockton District includes and consists of San Joaquin County, Amador County...

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

Science.gov (United States)

Flessa, Steffen

2005-12-01

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

Legislative Districts, Four layers - One State Assembly district, one State Senate district, one US House of Rep district, and one US Senate district showing the locations in the County of Polk, WI., Published in 2007, 1:24000 (1in=2000ft) scale, Polk County Government.

Data.gov (United States)

NSGIC Local Govt | GIS Inventory — Legislative Districts dataset current as of 2007. Four layers - One State Assembly district, one State Senate district, one US House of Rep district, and one US...

Evaluation of the isoniazid preventive therapy (IPT) program in Shurugwi District, Midlands Province, Zimbabwe, January 2013 to August 2014.

Science.gov (United States)

Makoni, Annamercy; Chemhuru, Milton; Tshimanga, Mufuta; Gombe, Notion Tafara; Mungati, More; Bangure, Donewell

2015-09-25

Midlands Province started implementing the Isoniazid (INH) preventive therapy (IPT) program in January 2013. Shurugwi and Gokwe North were the piloting district hospitals. In May 2014, four more districts hospitals (Gokwe South, Gweru, Kwekwe and Zvishavane) started implementing IPT. Shurugwi District decentralized the program to its rural health facilities in January 2014. A review of the Shurugwi IPT program, 2013 data, indicated that the majority of eligible clients were not started on IPT. None out of the 400 eligible clients were started on IPT in November against the 100% target according to the World Health Organization and the National Tuberculosis (TB) Program. We conducted a study to evaluate the IPT program in Shurugwi District from January 2013 to August 2014. The logical framework approach was used to evaluate inputs, processes, outputs and outcomes of the IPT program. An interviewer administered questionnaire was used to collect data from key informants. Checklists were used to collect data from IPT program records. Sixteen health facilities were implementing IPT in Shurugwi District. All the facilities had TB screening tools and three did not have TB screening algorithms. The district experienced medicine stock outs in 2013. One formal training at district level and on job trainings in implementing health facilities were done. From January 2013 to August 2014, Shurugwi District screened 6794 antiretroviral (ART) clients for TB. Out of those screened, 5255 were eligible for IPT and 2831 (54%) were started on IPT. A total of 700 clients had completed the IPT 6 month's course by August 2014. The dropout rate due to INH toxicity and TB was 0.6% (n = 18) and 0.3% (n = 8) respectively. Fifty-three advocacy and community sensitization meetings were done. The program had no Information Education and Communication (IEC) materials. The IPT program in Shurugwi District achieved half its target. This could be due to inadequate formally trained staff, lack of IEC

[Assessment of the patient-safety culture in a healthcare district].

Science.gov (United States)

Pozo Muñoz, F; Padilla Marín, V

2013-01-01

1) To describe the frequency of positive attitudes and behaviours, in terms of patient safety, among the healthcare providers working in a healthcare district; 2) to determine whether the level of safety-related culture differs from other studies; and 3) to analyse negatively valued dimensions, and to establish areas for their improvement. A descriptive, cross-sectional study based on the results of an evaluation of the safety-related culture was conducted on a randomly selected sample of 247 healthcare providers, by using the Spanish adaptation of the Hospital Survey on Patient Safety Culture (HSOPSC) designed by the Agency for Healthcare Research and Quality (AHRQ), as the evaluation tool. Positive and negative responses were analysed, as well as the global score. Results were compared with international and national results. A total of 176 completed survey questionnaires were analysed (response rate: 71.26%); 50% of responders described the safety climate as very good, 37% as acceptable, and 7% as excellent. Strong points were: «Teamwork within the units» (80.82%) and «Supervisor/manager expectations and actions» (80.54%). Dimensions identified for potential improvement included: «Staffing» (37.93%), «Non-punitive response to error» (41.67%), and «Frequency of event reporting» (49.05%). Strong and weak points were identified in the safety-related culture of the healthcare district studied, together with potential improvement areas. Benchmarking at the international level showed that our safety-related culture was within the average of hospitals, while at the national level, our results were above the average of hospitals. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

State and district policy influences on district-wide elementary and middle school physical education practices.

Science.gov (United States)

Chriqui, Jamie F; Eyler, Amy; Carnoske, Cheryl; Slater, Sandy

2013-01-01

To examine the influence of state laws and district policies on district-wide elementary school and middle school practices related to physical education (PE) time and the percentage of moderate-to-vigorous physical activity (MVPA) time during PE. Multivariate, cross-sectional analysis of state laws, district wellness and PE policies, and district PE practices for school year 2010-2011 controlling for district-level urbanicity, region, size, race/ethnicity of students, and socioeconomic status and clustered on state. One hundred ninety-five public school districts located in 42 states. District-level PE coordinators for the included districts who responded to an online survey. Minutes and days of PE per week and percent time spent in MVPA during PE time. District PE coordinators reported significantly less PE time than national standards-82.9 and 189.6 minutes at the elementary school and middle school levels, respectively. Physical education was provided an average of 2.5 and 3.7 days per week, respectively; and the percentage of MVPA time in PE was 64.4% and 65.7%, respectively. At the elementary school level, districts in either states with laws governing PE time or in a state and district with a law/policy reported significantly more days of PE (0.63 and 0.67 additional days, respectively), and districts in states with PE time laws reported 18 more minutes of PE per week. At the middle school level, state laws were associated with 0.73 more days of PE per week. Neither state laws nor district policies were positively associated with percent MVPA time in PE. State laws and district policies can influence district-level PE practices-particularly those governing the frequency and duration of PE-although opportunities exist to strengthen PE-related laws, policies, and practices.

Understanding hospital meal experiences by means of participant-driven-photo-elicitation.

Science.gov (United States)

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

2014-04-01

A patients' hospital meal experiences can be complex and often difficult to capture using traditional methods. This study investigated patients' hospital meal experiences using participant-driven-photo-elicitation (PDPE). PDPE invites respondents to photograph their daily lives and combines this with interviews, which can provide deeper insight into multisensory experiences beyond verbal or written discourse. The sample consisted of eight hospitalised patients. Patients completed a photo-essay of their hospital meal experience during a single day at a Danish hospital and afterwards participated in an open-ended interview. Two inductive analytical approaches were selected to assess the patients' reflections on their hospital meal experiences. First, the interview transcripts were analysed using the Semiotic Analysis approach using qualitative data analysis software NVivo 9. Second, the 91 produced photographs and the participants' engagement with the photographs were analysed by means of a Reflexive Content Analysis. The study found that PDPE is a research method that can be used for expanding the conceptualisation of hospital meal experiences, revealing the significance of the meal context, materiality and memories beyond food per se. Copyright © 2013 Elsevier Ltd. All rights reserved.

Do district health systems perform differently because of their managers? Preliminary insights from Indonesia

Directory of Open Access Journals (Sweden)

Augustine Asante

2015-07-01

Full Text Available District health systems (DHS are central to the global efforts to improve health outcomes but many remain ineffective. In many lowresource settings, despite the generally weak DHS there is evidence that some districts consistently perform well against the odds, and this is often attributed to the calibre of managers leading such districts and their management and leadership (M&L skills. This paper examines the M&L practices of district health managers in high and low performing districts in Indonesia in an attempt to understand whether the differences in the performance of DHS can be explained, at least in part, by the differences in the performance of their health managers. We employed a mixed methods case study design focusing on two purposefully selected districts. Data were collected in 2011 using questionnaires and in-depth interviews. The preliminary results suggest that M&L practices of managers in the high and low performing districts are similar and provide little explanation for the differences in the performance of the two DHS. Contextual and health system factors offered a much better explanation for the variations in DHS performance.

GEO-SPATIAL MODELING OF TRAVEL TIME TO MEDICAL FACILITIES IN MUNA BARAT DISTRICT, SOUTHEAST SULAWESI PROVINCE, INDONESIA

Directory of Open Access Journals (Sweden)

Nelson Sula

2018-03-01

Full Text Available Background: Health services are strongly influenced by regional topography. Road infrastructure is a key in access to health services. The geographic information system becomes a tool in modeling access to health services. Objective: To analyze geospatial data of the travel time to medical facilities in Muna Barat district, Southeast Sulawesi Province, Indonesia. Methods: This research used geospatial analysis with classification of raster data then overlaid with raster data such as Digital Elevation Modeling (DEM, Road of Vector data, and the point of Public Health Center (Puskesmas. Results: The result of geospatial analysis showed that the travel time to Puskesmas in Napano Kusambi and Kusambi sub districts is between 90-120 minutes, and travel time to the hospital in Kusambi sub district is required more than 2 hours. Conclusion: The output of this geospatial analysis can be an input for local government in planning infrastructure development in Muna Barat District, Indonesia.

Evaluate the impact of hospital types on the availability of antidotes for the management of acute toxic exposures and poisonings in Malaysia.

Science.gov (United States)

Al-Sohaim, Sulaiman I; Awang, Rahmat; Zyoud, Sa'ed H; Rashid, Sazaroni M D; Hashim, Sirajuddin

2012-03-01

The availability of antidotes may be considered essential and lifesaving in the management of certain poisonings. Surveys carried out in a number of countries have demonstrated inadequate availability of a variety of poisoning antidotes. The purpose of this study was to determine the availability of antidote stocking at hospitals, based on published guidelines for antidote stocking, and to evaluate the impact of hospital types on the availability of antidotes for the management of acute toxic exposures and poisonings in Malaysia. A questionnaire on the availability of antidotes was sent to all government accident and emergency departments in Malaysia. The list of commonly required antidotes and essential drugs was compiled from published guidelines. Collected data were analysed in SPSS version 16 using descriptive and comparative analysis. The response rate was 59.06%. None of the responding hospitals stocked all of the antidotes on the lists. In relation to hospital type, there was great variability in the availability of antidotes (there were significant differences between hospitals for 13 antidotes). The availabilities of most antidotes were far better in the General Hospitals and the District Hospitals with specialists compared to District Hospitals without specialists. Calcium gluconate, sodium bicarbonate, atropine sulphate, naloxone, flumazenil, vitamin K, and pyridoxine were available at all general hospitals. Atropine sulphate and naloxone were available at all district hospitals with specialists. Most Malaysian government hospitals stocked some important antidotes. Raising awareness of the importance of antidotes by education, regular review of antidote storage, distribution plans, and appropriate legislation might provide solutions. Coordination between Malaysian hospitals and the National Poison Centre at Universiti Sains Malaysia is also important.

California Political Districts

Data.gov (United States)

California Natural Resource Agency — This is a series of district layers pertaining to California'spolitical districts, that are derived from the California State Senateand State Assembly information....

District nursing in Dominica

NARCIS (Netherlands)

Kolkman, PME; Luteijn, AJ; Nasiiro, RS; Bruney, [No Value; Smith, RJA; Meyboom-de Jong, B

1998-01-01

District nurses constitute the basis of the primary health care services in Dominica. All encounters of three district nurses were registered using the international classification of primary care. Information on other aspects of district nursing was collected by participating observation and the

On Hospital Design – Identifying Building Attributes of Hospital Design

DEFF Research Database (Denmark)

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

The present paper surveys the input parameters in hospital design and describes them formally as building attributes in preparation for facilitating planning and designing of hospitals with the aim of a more optimal design process. The overview of the hospital functionalities, bonds, logistics...... and needs is based on an approach of understanding the complexity of the hospital functionalities based on capacities, qualities and times beforehand specific department or units are described. This approach attempts to create an overview of the hospital functionalities respecting capacities, qualities...

Private Water Districts

Data.gov (United States)

California Natural Resource Agency — Private Water District boundaries are areas where private contracts provide water to the district in California. This database is designed as a regions polygon...

Pharmacological management of acute myocardial infarction in the municipal district of Rio de Janeiro

Directory of Open Access Journals (Sweden)

Claudia Caminha Escosteguy

Full Text Available CONTEXT: International studies have shown a large variation in the utilization patterns of interventions, in acute myocardial infarction. OBJECTIVE: To analyze utilization patterns of pharmacological interventions in acute myocardial infarction and their corresponding effects on hospital mortality. DESIGN: Cross-sectional study. LOCAL: Hospitals of the Brazilian National Health System (SUS in the municipal district of Rio de Janeiro. SAMPLE: A stratified hospital sample of 391 medical records selected from the 1,936 admissions registered in the SUS Hospital Information System (SIH/SUS with a main diagnosis of acute myocardial infarction, in the studied district in 1997. MAIN MEASUREMENTS: Sex, age, time to treatment, risk factors, severity factors, diagnosis confirmation, use of pharmacological interventions, hospital death, contraindication of the use of thrombolytic therapy, contraindication of aspirin use. RESULTS: We reviewed 98.2% of the sampled medical records. Acute myocardial infarction diagnosis was confirmed in 91.7% (95% CI 88.3 to 94.2. 61.5% were men and 38.5% women, with an average age of 60.2 years (SD 2.4. The median time interval between symptom onset and hospital admission was 11 hours. Hospital mortality was 20.6% (95% CI 16.7 to 25.0. Intravenous thrombolytic therapy was used in 19.5% (95% CI 15.8 to 23.9 of the cases; aspirin in 86.5% (95% CI 82.5 to 89.6; beta-blockers in 49.0% (95% CI 43.8 to 54.1; angiotensin-converting enzyme (ACE inhibitors in 63.3% (95% CI 58.2 to 68.1; nitrates in 82.0% (95% CI 82.4 to 89.6; heparin in 81.3% (95% CI 76.9 to 85.0; calcium antagonists in 30.5% (95% CI 26.0 to 35.4. There was a significant variation in the use of thrombolytic therapy, beta-blockers, ACE inhibitors, calcium antagonists and heparin among hospitals of different juridical nature. CONCLUSIONS: There was underutilization of some interventions with well-established efficacy (thrombolytic therapy, aspirin, beta-blockers and

State Water Districts

Data.gov (United States)

California Natural Resource Agency — State Water Project District boundaries are areas where state contracts provide water to the district in California. This database is designed as a regions polygon...

Understanding Patient Experience Using Internet-based Email Surveys: A Feasibility Study at Mount Sinai Hospital.

Science.gov (United States)

Morgan, Matthew; Lau, Davina; Jivraj, Tanaz; Principi, Tania; Dietrich, Sandra; Bell, Chaim M

2015-01-01

Email is becoming a widely accepted communication tool in healthcare settings. This study sought to test the feasibility of Internet-based email surveys of patient experience in the ambulatory setting. We conducted a study of email Internet-based surveys sent to patients in selected ambulatory clinics at Mount Sinai Hospital in Toronto, Canada. Our findings suggest that email links to Internet surveys are a feasible, timely and efficient method to solicit patient feedback about their experience. Further research is required to optimally leverage Internet-based email surveys as a tool to better understand the patient experience.

Way for reducing drug supply chain cost for a hospital district: a case study

OpenAIRE

Postacchini, Leonardo; Ciarapica, Filippo Emanuele; Bevilacqua, Maurizio; Mazzuto, Giovanni; Paciarotti, Claudia

2016-01-01

Purpose: This work aims at providing insights to optimise healthcare logistic of the drug management, in order to deal with the healthcare expenditure cut. In this paper the effects of different drug supply chain configurations, on the resulting average stock, service level and Bullwhip effect, of the studied supply chain, is quantitatively assessed. Design/methodology/approach: A case study of an Italian district has been studied, taking into account three echelons: suppliers,...

Cost to government health-care services of treating acute self-poisonings in a rural district in Sri Lanka

DEFF Research Database (Denmark)

Wickramasinghe, Kanchana; Steele, Paul; Dawson, Andrew

2009-01-01

pesticides and possibly by improving case management in primary care hospitals. Additional research is needed to assess if increasing infrastructure and staff at peripheral hospitals could reduce the overall cost to the government, optimize case management and reduce pressure on secondary services....... prospectively collected over a one-month period from one general hospital (2005) and five peripheral hospitals (2006) in the Anuradhapura district. Data on transfers to secondary- and tertiary-level facilities were obtained for a 6-month period from 30 peripheral hospitals. The cost of the inputs in United...... States dollars (US$), using 2005 figures, was derived from hospital accounts. FINDINGS: The average total cost of treating a self-poisoned patient at the general hospital was US$ 31.83, with ward staff input and drugs being the highest expenditure category and only US$ 0.19 of this sum related to capital...

Statistical report on lung cancer irradiated in three hospital in Gunma Prefecture

International Nuclear Information System (INIS)

Yamanaka, Mikio; Saito, Yoshihiro; Ikeda, Hajime

1982-01-01

The data on 158 cases of lung cancer treated with radiotherapy at three hospitals (Hospital of School of Med., Gunma Univ., National Takasaki Hospital and Gunma Cancer Center Hospital) were analized. 1. Seventy one cases (44.9%) of all patients were more than 70 years old. As the histological type, epidermoid carcinoma was recognized in 44% of male patients, and adenocarcinoma in 51.5% of female. The number of patients with epidermoid carcinoma tended to increase with age. 2. Gunma Cancer Center was different from other hospitals in that half of the female patients (6/12) were stage I, adenocarcinoma. 3. The dwelling area of patients in Gunma Cancer Center Hospital distributed over towns and counties at the east district in Gunma prefecture, whereas in other hospitals concentrated in Maebashi and Takasaki cities. (author)

Knowledge of the mothers of hospitalized children in a university hospital regarding diarrhea

Directory of Open Access Journals (Sweden)

Ana Paula do Rego

2014-04-01

Full Text Available This qualitative research aimed at identifying the knowledge of the mothers regarding diarrhea. It was conducted with eight mothers of hospitalized children in a university hospital located in Santa Cruz, Rio Grande do Norte, Brazil, in 2012. Data were collected through open interviews and the analysis was based on Bardin. The categories emerging from the analysis were: understanding diarrhea and preventing/treating diarrhea. Regarding the understanding of diarrhea, mothers conceptualize and understand it from the symptoms, habits/eating mistakes and/or cultural beliefs. Concerning the prevention and treatment of the disease, the mothers highlight hygiene and home cleaning as preventive measures, as well the importance of home and hospital care measures. The interviewees have basic knowledge of pathology, further studies are necessary in order to define the current gap between the knowledge of mothers and recurrence of diarrhea cases, resulting in hospitalization and expenses with unnecessary treatment.

Auditing stillbirths at Lower Umfolozi War Memorial Regional Hospital: A 12-month review.

Science.gov (United States)

Govender, I

2017-11-27

Although the total number of stillbirths worldwide was estimated at 2.6 million in 2009, there is currently a dearth of literature on stillbirths in developing countries and rural settings, where the majority of such births occur. The 'Hands Up' Mortality and Morbidity Extraction Tool (HUMMET), developed at Lower Umfolozi War Memorial Regional Hospital (LUWMRH) in 2010, outlines a systematic approach to summarising individual cases of adverse perinatal outcomes. To depict the HUMMET form by describing the detailed demographic and obstetric profile of patients who delivered a stillborn infant at LUWMRH, as well as risk factors associated with these stillbirths between 1 April 2014 and 31 March 2015. The findings add to a global initiative advanced by the Lancet series on stillbirths, aimed at raising awareness of stillbirth statistics in low- and middle-income countries. A total of 310 detailed stillbirth case summaries of 305 patients were collected during the study period, representing 90% of the total number of stillborn infants delivered at LUWMRH. A retrospective audit of the HUMMET forms was conducted and the cases were further summarised in a Microsoft Excel spreadsheet that allowed for a univariate analysis of the variables. The stillbirth rate at LUWMRH is much higher than that at other regional hospitals owing to the number of at-risk referrals and emergency cases from surrounding clinics and district hospitals. Referrals were from local clinics (49%) and district hospitals (45%), 35% of stillbirths were due to abruptio placentae and a large proportion were associated with gestational hypertension, pre-eclampsia and/or eclampsia. Avoidable factors were predominantly a late patient response to reduced fetal movements and delays in transfer to hospital. Twenty percent of stillbirths were associated with inappropriate monitoring or management of the obstetric condition at the district hospital. The HUMMET form provides a systematic approach to analysing cases

Hyponatraemia at hospital admission is a predictor of overall mortality

DEFF Research Database (Denmark)

Balling, L; Gustafsson, F; Goetze, J P

2015-01-01

spectrum of medical and surgical diagnoses. METHODS: Consecutive patients >40 years of age admitted to a general district hospital in Greater Copenhagen between 1 April 1998 and 31 March 1999. Median follow-up time was 5.16 years (range 0-4372 days). Plasma sodium measurements were available in 2960...

Zero Energy Districts

Energy Technology Data Exchange (ETDEWEB)

Polly, Benjamin J [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

2018-05-04

This presentation shows how NREL is approaching Zero Energy Districts, including key opportunities, design strategies, and master planning concepts. The presentation also covers URBANopt, an advanced analytical platform for district that is being developed by NREL.

Ecological Study on Hospitalizations for Cancer, Cardiovascular, and Respiratory Diseases in the Industrial Area of Etang-de-Berre in the South of France

Directory of Open Access Journals (Sweden)

Laurence Pascal

2013-01-01

Full Text Available The Etang-de-Berre area is a large industrialized area in the South of France, exposing 300,000 inhabitants to the plumes of its industries. The possible associated health risks are of the highest concern to the population, who asked for studies investigating their health status. A geographical ecological study based on standardized hospitalizations ratios for cancer, cardiovascular, and respiratory diseases was carried out over the 2004–2007 period. Exposure to air pollution was assessed using dispersion models coupled with a geographic information system to estimate an annual mean concentration of sulfur dioxide (SO2 for each district. Results showed an excess risk of hospitalization for myocardial infarction in women living in districts with medium or high SO2 exposure, respectively, 38% [CI 95% 4 : 83] and 54% [14 : 110] greater than women living in districts at the reference level exposure. A 26% [2 : 57] excess risk of hospitalization for myocardial infarction was also observed in men living in districts with high SO2 levels. No excess risk of hospitalization for respiratory diseases or for cancer was observed, except for acute leukemia in men only. Results illustrate the impact of industrial air pollution on the cardiovascular system and call for an improvement of the air quality in the area.

The impact of medical tourism on Thai private hospital management: informing hospital policy.

Science.gov (United States)

James, Paul T J

2012-01-01

The purpose of this paper is to help consolidate and understand management perceptions and experiences of a targeted group (n=7) of Vice-Presidents of international Private Thai hospitals in Bangkok regarding medical tourism impacts. The method adopted uses a small-scale qualitative inquiry. Examines the on-going development and service management factors which contribute to the establishment and strengthening of relationships between international patients and hospital medical services provision. Develops a qualitative model that attempts to conceptualize the findings from a diverse range of management views into a framework of main (8) - Hospital Management; Hospital Processes; Hospital Technology; Quality Related; Communications; Personnel; Financial; and Patients; and consequent sub-themes (22). Outcomes from small-scale qualitative inquiries cannot by design be taken outside of its topical arena. This inevitably indicates that more research of this kind needs to be carried out to understand this field more effectively. The evidence suggests that Private Thai hospital management have established views about what constitutes the impact of medical tourism on hospital policies and practices when hospital staff interact with international patients. As the private health service sector in Thailand continues to grow, future research is needed to help hospitals provide appropriate service patterns and appropriate medical products/services that meet international patient needs and aspirations. Highlights the increasing importance of the international consumer in Thailand's health industry. This study provides insights of private health service providers in Bangkok by helping to understand more effectively health service quality environments, subsequent service provision, and the integrated development and impacts of new medical technology.

Understanding hospital meal experiences by means of Participant-Driven-Photo-Elicitation

DEFF Research Database (Denmark)

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

2014-01-01

A patients’ hospital meal experiences can be complex and often difficult to capture using traditional methods. This study investigated patients’ hospital meal experiences using participant-driven-photo-elicitation (PDPE). PDPE invites respondents to photograph their daily lives and combines this ...

Hospital clinical pharmacy services in Vietnam.

Science.gov (United States)

Trinh, Hieu T; Nguyen, Huong T L; Pham, Van T T; Ba, Hai L; Dong, Phuong T X; Cao, Thao T B; Nguyen, Hanh T H; Brien, Jo-Anne

2018-04-07

Background Clinical pharmacy is key to the quality use of medicines. While there are different approaches in different countries, international perspectives may inform health service development. The Vietnamese Ministry of Health introduced a legal regulation of clinical pharmacy services in December 2012. Objective To describe the services, and to explore reported barriers and facilitators in implementing clinical pharmacy activities in Vietnamese hospitals after the introduction of Vietnamese Ministry of Health legal regulation. Setting Thirty-nine hospitals in Hanoi, Vietnam, including 22 provincial and 17 district hospitals. Method A mixed methods study was utilized. An online questionnaire was sent to the hospitals. In-depth interviews were conducted with pairs of nominated pharmacists at ten of these hospitals. The questionnaire focused on four areas: facilities, workforce, policies and clinical pharmacy activities. Main outcome measure Proportion of clinical pharmacy activities in hospitals. Themes in clinical pharmacy practice. Results 34/39 (87%) hospitals had established clinical pharmacy teams. Most activities were non-patient-specific (87%) while the preliminary patient-specific clinical pharmacy services were available in only 8/39 hospitals (21%). The most common non-patient-specific activities were providing medicines information (97%), reporting adverse drug reactions (97%), monitoring medication usage (97%). The patient specific activities varied widely between hospitals and were ad hoc. The main challenges reported were: lack of workforce and qualified clinical pharmacists. Conclusion While most hospitals had hospital-based pharmacy activities, the direct patient care was limited. Training, education and an expanded work forces are needed to improve clinical pharmacy services.

Insular pathways to health care in the city: a multilevel analysis of access to hospital care in urban Kerala, India.

Science.gov (United States)

Levesque, Jean-Frédéric; Haddad, Slim; Narayana, Delampady; Fournier, Pierre

2007-07-01

To identify individual and urban unit characteristics associated with access to inpatient care in public and private sectors in urban Kerala, and to discuss policy implications of inequalities in access. We analysed the NSSO survey (1995-1996) for urban Kerala with regard to source and trajectories of hospitalization. Multinomial multilevel regression models were built for 695 cases nested in 24 urban units. Private sector accounts for 62% of hospitalizations. Only 31% of hospitalizations are in free wards and 20% of public hospitalizations involve payment. Hospitalization pathways suggest a segmentation of public and private health markets. Members of poor and casual worker households have lower propensity of hospitalization in paying public wards or private hospitals. There were important variations between cities, with higher odds of private hospitalization in towns with fewer hospital beds overall and in districts with high private-public bed ratios. Cities from districts with better economic indicators and dominance of private services have higher proportion of private hospitalizations. The private sector is the predominant source of inpatient care in urban Kerala. The public sector has an important role in providing access to care for the poor. Investing in the quality of public services is essential to ensure equity in access.

School District Information Technology Disaster Recovery Planning: An Explanatory Case Study

Science.gov (United States)

Gray, Shaun L.

2017-01-01

Despite research and practitioner articles outlining the importance information technology disaster plans (ITDRPs) to organizational success, barriers have impeded the process of disaster preparation for Burlington County New Jersey school districts. The purpose of this explanatory qualitative case study was to understand how technology leader…

Glass injuries seen in the emergency department of a South African district hospital

OpenAIRE

Nzaumvila, Doudou; Govender, Indiran; Kramer, Efraim B.

2015-01-01

BACKGROUND: The emergency department of Embhuleni Hospital frequently manages patients with glass-related injuries. This study assessed these injuries and the glass that caused them in more detail. AIM: The objectives of our study included determining the type of glass causing these injuries and describing the circumstances associated with different types of glass injuries. SETTING: The emergency department of Embhuleni Hospital in Elukwatini, Mpumalanga province, South Africa. METHODS: This ...

Do guidelines influence results in inguinal hernia treatment? A descriptive study of 2,535 hernia repairs in one teaching hospital from 1994 to 2004

NARCIS (Netherlands)

Aufenacker, T. J.; Schmits, S. P.; Gouma, D. J.; Simons, M. P.

2009-01-01

BACKGROUND: The Onze Lieve Vrouwe Gasthuis (OLVG) hospital is a large district teaching hospital with a residency programme for general surgery. Since 1998, inguinal hernia (IH) repairs in this hospital were performed according to the preliminary "evidence-based guidelines" concerning IH repair. The

Nankana West District of Ghana

African Journals Online (AJOL)

Agribotix GCS 077

Local governments in Ghana play very important roles with actors in the ... Metropolitan, Municipal and District Chief Executives (MMDCEs), the .... District Budget Officer, District Finance Officer, Presiding Member, members of the Works Sub-.

Where do the rural poor deliver when high coverage of health facility delivery is achieved? Findings from a community and hospital survey in Tanzania.

Directory of Open Access Journals (Sweden)

Manuela Straneo

Full Text Available As part of maternal mortality reducing strategies, coverage of delivery care among sub-Saharan African rural poor will improve, with a range of facilities providing services. Whether high coverage will benefit all socio-economic groups is unknown. Iringa rural District, Southern Tanzania, with high facility delivery coverage, offers a paradigm to address this question. Delivery services are available in first-line facilities (dispensaries, health centres and one hospital. We assessed whether all socio-economic groups access the only comprehensive emergency obstetric care facility equally, and surveyed existing delivery services.District population characteristics were obtained from a household community survey (n = 463. A Hospital survey collected data on women who delivered in this facility (n = 1072. Principal component analysis on household assets was used to assess socio-economic status. Hospital population socio-demographic characteristics were compared to District population using multivariable logistic regression. Deliveries' distribution in District facilities and staffing were analysed using routine data.Women from the hospital compared to the District population were more likely to be wealthier. Adjusted odds ratio of hospital delivery increased progressively across socio-economic groups, from 1.73 for the poorer (p = 0.0031 to 4.53 (p<0.0001 for the richest. Remarkable dispersion of deliveries and poor staffing were found. In 2012, 5505/7645 (72% institutional deliveries took place in 68 first-line facilities, the remaining in the hospital. 56/68 (67.6% first-line facilities reported ≤100 deliveries/year, attending 33% of deliveries. Insufficient numbers of skilled birth attendants were found in 42.9% of facilities.Poorer women remain disadvantaged in high coverage, as they access lower level facilities and are under-represented where life-saving transfusions and caesarean sections are available. Tackling the challenges

An in-depth, exploratory assessment of the implementation of the National Health Information System at a district level hospital in Tanzania.

Science.gov (United States)

Wilms, Miriam C; Mbembela, Osman; Prytherch, Helen; Hellmold, Peter; Kuelker, Rainer

2014-02-26

A well functioning Health Information System (HIS) is crucial for effective and efficient health service delivery. In Tanzania there is a national HIS called Mfumo wa Taarifa za Uendeshaji Huduma za Afya (MTUHA). It comprises a guideline/manual, a series of registers for primary data collection and secondary data books where information from the registers is totalled or used for calculations. A mix of qualitative methods were used. These included key informant interviews; staff interviews; participant observations; and a retrospective analysis of the hospital's 2010 MTUHA reporting documents and the hospital's development plan. All staff members acknowledged data collection as part of their job responsibilities. However, all had concerns about the accuracy of MTUHA data. Access to training was limited, mathematical capabilities often low, dissemination of MTUHA knowledge within the hospital poor, and a broad understanding of the HIS's full capabilities lacking.Whilst data collection for routine services functioned reasonably well, filling of the secondary data tools was unsatisfactory. Internal inconsistencies between the different types of data tools were found. These included duplications, and the collection of data that was not further used. Sixteen of the total 72 forms (22.2%) that make up one of the key secondary data books (Hospital data/MTUHA book 2) could not be completed with the information collected in the primary data books.Moreover, the hospital made no use of any of the secondary data. The hospital's main planning document was its development plan. Only 3 of the 22 indicators in this plan were the same as indicators in MTUHA, the information for 9 more was collected by the MTUHA system but figures had to be extracted and recalculated to fit, while for the remaining 10 indicators no use could be made of MTUHA at all. The HIS in Tanzania is very extensive and it could be advisable to simplify it to the core business of data collection for routine

A Fifty-Year Sustainability Assessment of Italian Agro-Forest Districts

Directory of Open Access Journals (Sweden)

Fabio Recanatesi

2015-12-01

Full Text Available As cropland management and land use shifted towards more intensive practices, global land degradation increased drastically. Understanding relationships between ecological and socioeconomic drivers of soil and landscape degradation within these landscapes in economically dynamic contexts such as the Mediterranean region, requires multi-target and multi-scalar approaches covering long-term periods. This study provides an original approach for identifying desertification risk drivers and sustainable land management strategies within Italian agro-forest districts. An Environmental Sensitivity Area (ESA approach, based on four thematic indicators (climate, soil, vegetation and land-use and a composite index of desertification risk (ESAI, was used to evaluate changes in soil vulnerability and landscape degradation between the years 1960 and 2010. A multivariate model was developed to identify the most relevant drivers causing changes in land susceptibility at the district scale. Larger districts, and those with a higher proportion of their total surface area classified as agro-forest, had a significantly lower increase in land susceptibility to degradation during the 50 years when compared with the remaining districts. We conclude that preserving economic viability and ecological connectivity of traditional, extensive agricultural systems is a key measure to mitigate the desertification risk in the Mediterranean region.

District Energy Windsor

Energy Technology Data Exchange (ETDEWEB)

NONE

2002-07-01

This paper presents a summary of how District Energy Windsor operates. It includes a system site map and reasons why it is advantageous to get connected to a district heating system. District Energy Windsor is a division of the Windsor Utilities Commission. It was developed in 1996 and was the first in North America to supply both heating and cooling requirements. It supplies nearly 2 million square feet of heating and cooling for Windsor's city centre. The district energy system produces hot water or chilled water at a central plant. Energy is then piped out to buildings in the area, including the Art Gallery of Windsor, the Royal Bank Business Centre, the Windsor Justice Facility, the Windsor Casino, and Northwind Windsor. The energy, which is transferred through heat exchangers, is used for space heating, domestic hot water heating, and air conditioning. The 8 reasons for getting connected are: (1) less management costs, (2) lower energy costs, (3) lower level of risk management, (4) stable energy rates, (5) better use of building space, (6) reliable service, (7) reduced expansion costs, and (8) a cleaner environment. District heating improves air quality through reduced carbon dioxide and nitrogen oxide emissions. In addition, fuel delivery and storage are eliminated. figs.

Measuring regional and district variations in the incidence of pregnancy-induced hypertension in Ghana: challenges, opportunities and implications for maternal and newborn health policy and programmes.

Science.gov (United States)

Antwi, Edward; Klipstein-Grobusch, Kerstin; Quansah Asare, Gloria; Koram, Kwadwo A; Grobbee, Diederick; Agyepong, Irene A

2016-01-01

The objectives were to assess the quality of health management information system (HMIS) data needed for assessment of local area variation in pregnancy-induced hypertension (PIH) incidence and to describe district and regional variations in PIH incidence. A retrospective review of antenatal and delivery records of 2682 pregnant women in 10 district hospitals in the Greater Accra and Upper West regions of Ghana was conducted in 2013. Quality of HMIS data was assessed by completeness of reporting. The incidence of PIH was estimated for each district. Key variables for routine assessment of PIH such as blood pressure (BP) at antenatal visits, weight and height were 95-100% complete. Fundal height, gestational age and BP at delivery were not consistently reported. The incidence of PIH differed significantly between Greater Accra region (6.1%) and Upper West region (3.2%). Prevalence of obesity among pregnant women in Greater Accra region (13.9%) was significantly higher than that of women in Upper West region (2.2%). More attention needs to be given to understanding local area variations in PIH and possible relationships with urbanisation and lifestyle changes that promote obesity, to inform maternal and newborn health policy. This can be done with good quality routine HMIS data. © 2015 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

Revisiting "Rodriguez v. Los Angeles Unified School District": A Case of Intra-District Inequities

Science.gov (United States)

Espinosa, Ruben W.

2010-01-01

The educational community and the courts continue to struggle with the challenges of intra-district resource inequality revealed by the California Supreme Court landmark case "Rodriguez v. Los Angeles Unified School District" (1992). Intra-district school resource inequality is one of the remaining bastions of major inequalities in the…

VII international district heating conference

International Nuclear Information System (INIS)

1988-01-01

The proceedings of the 7th International District Heating Conference contain the full texts of the 89 presented papers of which 11 fall under the INIS Subject Scope. The conference met in seven sessions and dealt with the following problem areas: design and optimization of systems of district heating, integration of the power system and the district heating systems, cooperation of nuclear and fossil burning sources in district heating systems, the use of specific nuclear power plants for heating purposes, questions of the control of systems of district heating, the development of components of heating networks, the reliability and design of heat supply pipes. (Z.M.)

The promises and perils of hospital autonomy: reform by decree in Viet Nam.

Science.gov (United States)

London, Jonathan D

2013-11-01

This article investigates impacts of hospital autonomization in Viet Nam employing a "decision-space" framework that examines how hospitals have used their increased discretion and to what effect. Analysis suggests autonomization is associated with increased revenue, increasing staff pay, and greater investment in infrastructure and equipment. But autonomization is also associated with more costly and intensive treatment methods of uncertain contribution to the Vietnamese government's stated goal of quality healthcare for all. Impacts of autonomization in district hospitals are less striking. Despite certain limitations, the analysis generates key insights into early stages of hospital autonomization in Viet Nam. Copyright © 2013 The Author. Published by Elsevier Ltd.. All rights reserved.

Contract-program evaluation: Impact of the DRG classification system on hospitals' outputs

OpenAIRE

Alves, Helder António Pereira Gomes

2010-01-01

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics The present work project aims at evaluating the impact of contract-program implementation in 2003 and of incentives created in 2007 on hospital output, under the DRG inpatient classification system. A sample of five Portuguese acute public district hospitals was chosen as sample, between 2002 and 2007. Results of hypothesis testing ...

Audit of epidural anaesthesia services at a district hospital in Nigeria ...

African Journals Online (AJOL)

Background: Epidural anaesthesia and analgesia is considered the 'gold standard' analgesic technique for major surgery. However, its practice is limited in most hospitals in Nigeria. The objective of this review was to determine the rate of administration of epidural anaesthesia and to review the challenges affecting its ...

Comprehensive discharge follow-up in patients' homes by GPs and district nurses of elderly patients. A randomized controlled trial

DEFF Research Database (Denmark)

Rytter, L.; Jakobsen, Helle; Rønholt, Finn

2010-01-01

Many hospital admissions are due to inappropriate medical treatment, and discharge of fragile elderly patients involves a high risk of readmission. The present study aimed to assess whether a follow-up programme undertaken by GPs and district nurses could improve the quality of the medical...

District heating in Italy

International Nuclear Information System (INIS)

Sacchi, E.

1998-01-01

The legislative act establishing the electric monopoly virtually shut out the district heating associated with electricity cogeneration, while other laws, issued to counteract the effects of oil shocks, allowed municipal utilities to do so. Thus, district heating has experienced some development, though well below its possibilities. The article analyses the reasons for this lagging, reports district heating data and projects its forecasts against the Kyoto Protocol objectives [it

[One year follow-up after stroke. A preliminary feasibility study in the Józsefváros district of Budapest].

Science.gov (United States)

Szocs, Ildikó; Szatmári, Szabolcs; Fekete, Klára; Orbán-Kis, Károly; Vastagh, Ildikó; Folyovich, András; Ajtay, András; Bereczki, Dániel

2012-03-30

Stroke is a major public health issue in Hungary with considerable regional differences in mortality. We have limited information to explain such regional differences. To assess these differences, we would need comparative followup studies optimally carried out by personal contact with the patient or the carer. According to several epidemiological studies, follow-up can be carried out with significantly lower cost and similar efficiency by telephone contact or regular mail. In this pilot study we intend to assess: 1. the efficacy of telephone follow-up one year after stroke in this geographical region 2. whether the efficacy of follow-up can be further increased with questionnaires sent out by regular mail 3. whether telephone and mail-based assessment is sufficient to perform a larger population based study. We included 135 patients hospitalized consecutively for acute cerebrovascular disease (stroke or TIA) by the Department of Neurology, Semmelweis University in January and February of 2008. Based on residence, patients were divided into three groups: those living in the least wealthy district of Budapest (i.e. District-8); those living in other districts of the city; and those living in suburban areas. One year after the hospital treatment follow-up was possible by telephone in 76%. Further 12 patients could be contacted by questionnaire sent out by regular mail. Efficacy of follow-up was altogether 84%. Even in this small group of patients, we have found a tendency for more severe strokes (p=0.06) and higher acute case fatality (32% vs. 5%, p=0.029) in residents of District-8 of Budapest compared to those residing in more wealthy districts of the city and in suburban areas. Survival rate one year after stroke or TIA was only 39% in those living in District-8, 66% in those living in other districts and 75% in suburban dwellers (p=0.006). Telephone and mail-based questionnaires are insufficient for follow-up in these regions even when applied in combination

Understanding inappropriate hospital admissions of patients presenting to the Emergency Department.

Directory of Open Access Journals (Sweden)

Roberta Siliquini

2005-06-01

Full Text Available

Objectives. To identify 1 the characteristics of patients receiving non acute (inappropriate care and 2 the variables associated to inappropriate hospital use, in order to 3 estimate the relevance of the problem and to 4 focus future concurrent reviews and efforts to allocate patients to alternative health care settings.

Design. A prospective review of a random sample of adult patients who presented to the Emergency Department of the Molinette Hospital. Patients were assessed at admission and on day 3, 5and 8 using the Appropriateness Evaluation Protocol (Italian validated version. Patients: 490 overall; 312 (64 % medical and 178 (36 % surgical.

Outcome measures. Acute (appropriate and non acute (inappropriate admissions, Major Disease Category, costs, mean weights of Diagnosis Related Groups, and length of stay (days.

Results. The proportion of patients requiring acute care declined rapidly from presentation (84.5% to the fifth day of admission (60.9%. Patients admitted during weekends showed a higher rate of inappropriate stay on day 5 (P=0.04. The proportion of inappropriate admissions was higher for medical rather than surgical patients (P=0.07 at presentation and at day 5 (P < 0.01. Traditional social-demographic variables were not significant risk indicators for inappropriate admissions. The likelihood ratio for inappropriate admission at presentation was significantly higher for minor illnesses and disturbances (P=0.03.

Inappropriate stay on day 5 was significantly associated with lower cost (P < 0.01, lower mean DRG weight (P < 0.01 and shorter length of stay (P=0.05 for medical but not for surgical admissions.

Conclusions. Traditional epidemiological indicators are inadequate to target prospective concurrent reviews. Qualitative studies focusing on patient physician dialogue in different situations and contexts could

Hospital burden of road traffic injury: major concern in primary and secondary level hospitals in Bangladesh.

Science.gov (United States)

Mashreky, S R; Rahman, A; Khan, T F; Faruque, M; Svanström, L; Rahman, F

2010-04-01

To assess the burden of road traffic injury (RTI) in primary and secondary level hospitals in Bangladesh, and its economic impact on affected families. Cross-sectional study. The study was carried out in February and March 2001. To estimate the burden of RTI patients and the length of stay in hospital, the discharge records of primary and secondary level hospitals were used as data sources. Records from 16 district hospitals and 45 Upazila health complexes (subdistrict level hospitals), selected at random, were included in this study. A direct interview method was adopted to estimate the patient costs of RTI; this involved interviewing patients or their attendants. In this study, patient costs included money spent by the patient for medicine, transport, food and lodging (including attendants). Approximately 33% of the beds in primary and secondary level hospitals in Bangladesh were occupied by injury-related patients, and more than 19% of the injury patients had been injured in a road traffic accident. People aged 18-45 years were the major victims of RTI, and constituted 70% of the total RTI-related admissions in primary and secondary level hospitals. More than two-thirds of RTI patients were male. The average duration of hospital stay was 5.7 days, and the average patient cost for each RTI patient was US$86 (5834 BDT). RTI is a major cause of hospital admission in Bangladesh, and represents an economic and social burden for the family and the nation. A national strategy and road safety programme need to be developed to reduce the hospital burden and minimize the economic and social impact. 2010 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

7 CFR 958.27 - Districts.

Science.gov (United States)

2010-01-01

...; (2) changes in the relative position of existing districts with respect to onion production; (3) the... and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE ONIONS GROWN IN CERTAIN DESIGNATED... Districts. (a) For the purpose of selecting committee members, the following districts of the production...

Intra-District Disparities in Primary Education: A Case Study of Bankura District, West Bengal

Directory of Open Access Journals (Sweden)

Krishnendu Maji

2017-03-01

Full Text Available The level of education and its response to different educational opportunities vary from one spatial unit to another depending on various factors like social, economic, cultural, and institutional. It is understood that certain regions acquire relative advancements over others in terms of human resource development and human capital formation. The key purpose of this research is to examine the intra-district disparities in primary education in Bankura District one of the districts of West Bengal. It ranks 11thamong the 19 districts of West Bengal (Human Development Report, 2007.  Overall literacy rate of the district stands at 70.26% but the district scores low in terms of female literacy rates, which is 60.05%,whereas the male literacy rate is 80.05%, which is a huge gender literacy gap of 20%. There are also regional inequalities existing at block level. Kotulpur ranks first with a literacy rate of 78.01% while Saltora occupies the bottom position with literacy rate of just 61.45% (Census of India, 2011. The level of educational development is dependent on several factors—enrolment ratio, dropout and repetition rates, pupil-teacher ratio, habitations covered by educational institutions, space-student ratio, drinking water and sanitation facilities in school, etc. In this context, the present study aims at examining the issues of intra-district disparities in educational attainment with regard to various educational amenities of Bankura district, West Bengal. Ten attributes have been selected to examine the level of development in primary education. It is clear from the study that the level of development in eastern part of the district is relatively better in comparison to other regions. Economic backwardness and physical bottlenecks continue to be major issues in western blocks.

A retrospective survey of human hydatidosis based on hospital records during the period 1990-2003 in Ngorongoro, Tanzania.

Science.gov (United States)

Ernest, E; Nonga, H E; Kynsieri, N; Cleaveland, S

2010-12-01

A 13-year (1990-2003) retrospective study was carried out to investigate the occurrence of cystic echinococcosis (CE) in patients at Wasso hospital in Ngorongoro district, Tanzania. Hospitalization records were reviewed and confirmed cases of CE were classified according to ward of residence, age, sex, cyst location and type. A total of 171 hydatidosis patients were diagnosed and operated giving an average of 13 cases per year, equivalent to approximately 10 cases per 100,000 people per year. Cystic echinococcosis affected more females (59.1%) than males (40.9%). A significantly higher number of CE cases were recorded in individuals 30 years of age (2.3-9.4%) (P Ngorongoro district and female and youths are those most affected. These findings merit for more extensive epidemiological investigations of CE in human to better determine the prevalence, economic impact and risk factors for the disease in this district and other areas of Tanzania. © 2009 Blackwell Verlag GmbH.

Estimating leptospirosis incidence using hospital-based surveillance and a population-based health care utilization survey in Tanzania.

Directory of Open Access Journals (Sweden)

Holly M Biggs

Full Text Available The incidence of leptospirosis, a neglected zoonotic disease, is uncertain in Tanzania and much of sub-Saharan Africa, resulting in scarce data on which to prioritize resources for public health interventions and disease control. In this study, we estimate the incidence of leptospirosis in two districts in the Kilimanjaro Region of Tanzania.We conducted a population-based household health care utilization survey in two districts in the Kilimanjaro Region of Tanzania and identified leptospirosis cases at two hospital-based fever sentinel surveillance sites in the Kilimanjaro Region. We used multipliers derived from the health care utilization survey and case numbers from hospital-based surveillance to calculate the incidence of leptospirosis. A total of 810 households were enrolled in the health care utilization survey and multipliers were derived based on responses to questions about health care seeking in the event of febrile illness. Of patients enrolled in fever surveillance over a 1 year period and residing in the 2 districts, 42 (7.14% of 588 met the case definition for confirmed or probable leptospirosis. After applying multipliers to account for hospital selection, test sensitivity, and study enrollment, we estimated the overall incidence of leptospirosis ranges from 75-102 cases per 100,000 persons annually.We calculated a high incidence of leptospirosis in two districts in the Kilimanjaro Region of Tanzania, where leptospirosis incidence was previously unknown. Multiplier methods, such as used in this study, may be a feasible method of improving availability of incidence estimates for neglected diseases, such as leptospirosis, in resource constrained settings.

Estimating Leptospirosis Incidence Using Hospital-Based Surveillance and a Population-Based Health Care Utilization Survey in Tanzania

Science.gov (United States)

Biggs, Holly M.; Hertz, Julian T.; Munishi, O. Michael; Galloway, Renee L.; Marks, Florian; Saganda, Wilbrod; Maro, Venance P.; Crump, John A.

2013-01-01

Background The incidence of leptospirosis, a neglected zoonotic disease, is uncertain in Tanzania and much of sub-Saharan Africa, resulting in scarce data on which to prioritize resources for public health interventions and disease control. In this study, we estimate the incidence of leptospirosis in two districts in the Kilimanjaro Region of Tanzania. Methodology/Principal Findings We conducted a population-based household health care utilization survey in two districts in the Kilimanjaro Region of Tanzania and identified leptospirosis cases at two hospital-based fever sentinel surveillance sites in the Kilimanjaro Region. We used multipliers derived from the health care utilization survey and case numbers from hospital-based surveillance to calculate the incidence of leptospirosis. A total of 810 households were enrolled in the health care utilization survey and multipliers were derived based on responses to questions about health care seeking in the event of febrile illness. Of patients enrolled in fever surveillance over a 1 year period and residing in the 2 districts, 42 (7.14%) of 588 met the case definition for confirmed or probable leptospirosis. After applying multipliers to account for hospital selection, test sensitivity, and study enrollment, we estimated the overall incidence of leptospirosis ranges from 75–102 cases per 100,000 persons annually. Conclusions/Significance We calculated a high incidence of leptospirosis in two districts in the Kilimanjaro Region of Tanzania, where leptospirosis incidence was previously unknown. Multiplier methods, such as used in this study, may be a feasible method of improving availability of incidence estimates for neglected diseases, such as leptospirosis, in resource constrained settings. PMID:24340122

Advanced Practice Nursing in Pediatric Urology: experience report in the Federal District.

Science.gov (United States)

Souza, Bruna Marcela Lima de; Salviano, Cristiane Feitosa; Martins, Gisele

2018-01-01

To describe the creation and implementation of the extension program Advanced Practice Nursing in Pediatric Urology, developed in the outpatient clinic of a teaching hospital in the Federal District. This is an experience report regarding the implementation of an outpatient service aimed at children and adolescents with symptoms of bladder and bowel dysfunction. Because it is an extension program linked to the university, it follows a different model of care, valuing empowerment, informed and shared decision making, which results in a stronger bond between patients, family and the Pediatric Urology nursing team. It has also become a privileged space for the production and use of scientific knowledge, associated with the principles of evidence-based practice. This project shows a different performance of the nurse-specialist-professor-researcher in Pediatric Urology Nursing, and it has become a reference in the Federal District, mainly for undergraduate and graduate nursing students.

Lieutenant Chief Warden Districts

Data.gov (United States)

Vermont Center for Geographic Information — This dataset is a representation overlay of Lieutenant Chief Warden Districts (areas of responsibility). The Vermont Lieutenant Chief Warden Districts layer is part...

Inpatient Profile of Patients with Major Depression in Portuguese National Health System Hospitals, in 2008 and 2013: Variation in a Time of Economic Crisis.

Science.gov (United States)

Rodrigues, Daniel Francisco Santos; Nunes, Carla

2018-02-01

The economic crisis has placed Portugal in a situation of budgetary constraints with repercussions on mental health, since 2009. This study analyses the association between economic crisis and the inpatient profile of major depression in the working-age population in Portuguese National Health System hospitals. This was an observational, descriptive and cross-sectional study. An individual analysis of hospitalisation and an ecological analysis at district level, were performed before 2008 and during the crisis (2013). Data on the hospitalisation episodes, working-age population and psychiatric inpatient beds were analysed. An increase in hospitalisation rates for major depression were observed, and across country, high spatial variations were perceived: districts with lower rates of urbanisation and population density had higher hospitalisation rates for major depression. Hospitalisation rates were positively influenced by the available inpatient beds. The results for 2013 were more critical (higher hospitalisation rates, less beds). Further research is needed to understand all patterns, considering other individual and contextual information.

The development of mental hospitals in West Bengal: A brief history and changing trends.

Science.gov (United States)

Bhattacharyya, Ranjan

2018-02-01

The communication between G. S Bose and Sigmund Freud is a well-documented fact, and philosophical blend of rich cultural experiences is unique to modification of traditional psychoanalysis in the context of development of psychiatry in West Bengal. The Calcutta lunatic asylum was established at Bhowanipore, and first general hospital psychiatric unit was formed at R. G. Kar Medical College, Calcutta. Prof. Ajita Chakraborty was a pioneer to describe her struggling days in the early career and shared her views with experiences in her autobiography. The volume and quality of research work, especially in the field of epidemiology led by Dr. D. N. Nandi is worth mentioning. A jail had been converted to mental hospital which is the largest in terms of bed strength ( n = 350) at Berhampore, Murshidabad district where Kazi Nazrul Islam and Netaji Subhas Chandra Bose had spent some period as prisoner during British rules. Bankura was the first district in West Bengal to start District Mental Health program. The various nongovernmental organizations are working together in public-private partnership model or indigenous ways in tandem over years for the betterment of mental health services both at institutional and community level.

State-Level Guidance and District-Level Policies and Practices for Food Marketing in US School Districts.

Science.gov (United States)

Merlo, Caitlin L; Michael, Shannon; Brener, Nancy D; Blanck, Heidi

2018-06-07

State agencies play a critical role in providing school districts with guidance and technical assistance on school nutrition issues, including food and beverage marketing practices. We examined associations between state-level guidance and the policies and practices in school districts regarding food and beverage marketing and promotion. State policy guidance was positively associated with districts prohibiting advertisements for junk food or fast food restaurants on school property. Technical assistance from states was negatively associated with 2 district practices to restrict marketing of unhealthy foods and beverages, but positively associated with 1 practice to promote healthy options. These findings may help inform the guidance that states provide to school districts and help identify which districts may need additional assistance to address marketing and promotion practices.

The effectiveness of the South African Triage Toll use in Mahalapye District Hospital – Emergency Department, Botswana

Directory of Open Access Journals (Sweden)

Stephane T. Tshitenge

2016-07-01

Full Text Available Background: The study aimed to determine the proportion of each priority level of patients, time of performance in each priority level, and the reliability of the South African Triage Scale (SATS tool at the Mahalapye District Hospital - Emergency Department (MDH-ED, a setting where the majority of the nurses were not formally trained on the use of the SATS. Methods: This was a cross-sectional study using case records in MDH-ED from 1 January 2014 to 31 December 2014. A panel of experts from the Mahalapye site of the Family Medicine Department, University of Botswana, reviewed and scored each selected case record that was compared with the scores previously attributed to the nurse triage. Results: From the 315 case records, both the nurse triage and the panel of expert triage assigned the majority of cases in the routine category (green, 146 (46% and 125 (40%, respectively, or in the urgent category (yellow, they assigned 140 (44% and 111 (35% cases, respectively.Overall, there was an adequate agreement between the nurse triage and the panel of expert triage (k = 0.4, 95% confidence interval: 0.3–0.5, although the level of agreement was satisfactory. Conclusion: Findings of the study reported that the profile of the priority-level categories in MDH-ED was made in the majority of routine and urgent patients, only the routine and the emergency patients were seen within the targeted time and they had a satisfactory level of reliability (between 0.4 and 0.6.

Indications for Caesarean sections in a rural hospital in the Highlands of Papua New Guinea.

Science.gov (United States)

Mark, Terence B; Radcliffe, Jim; Laman, Moses

2014-07-01

We retrospectively documented indications for Caesarean sections in a rural district level hospital in the highlands of Papua New Guinea. Over a 53-month study period, 745 Caesarean sections were performed. Prolonged labour, previous history of Caesarean section, cephalopelvic disproportion, malpresentation and fetal distress accounted for over 88% of Caesarean sections performed. In older mothers (aged >30 years), antepartum haemorrhage (Fisher exact test, P = 0.05) and multiple indications (P = 0.001) were leading reasons for Caesarean sections while cephalopelvic disproportion (P = 0.005) was the leading indication in younger mothers. Further prospective studies incorporating perinatal and maternal mortality rates are required to optimise the value of Caesarean sections at district level hospitals in Papua New Guinea. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

A way for reducing drug supply chain cost for a hospital district: A case study

OpenAIRE

Leonardo Postacchini; Filippo Emanuele Ciarapica; Maurizio Bevilacqua; Giovanni Mazzuto; Claudia Paciarotti

2016-01-01

Purpose: This work aims at providing insights to optimise healthcare logistic of the drug management, in order to deal with the healthcare expenditure cut. In this paper the effects of different drug supply chain configurations, on the resulting average stock, service level and Bullwhip effect, of the studied supply chain, is quantitatively assessed. Design/methodology/approach: A case study of an Italian district has been studied, taking into account three echelons: suppliers, centra...

77 FR 63326 - Huron Wetland Management District, Madison Wetland Management District, and Sand Lake Wetland...

Science.gov (United States)

2012-10-16

..., consistent with sound principles of fish and wildlife management, conservation, legal mandates, and our... FXRS1265066CCP0] Huron Wetland Management District, Madison Wetland Management District, and Sand Lake Wetland Management District, SD; Final Comprehensive Conservation Plan and Finding of No Significant Impact for...

Mental health in primary health care in a rural district of Cambodia: a situational analysis.

Science.gov (United States)

Olofsson, Sofia; Sebastian, Miguel San; Jegannathan, Bhoomikumar

2018-01-01

While mental and substance use disorders are common worldwide, the treatment gap is enormous in low and middle income countries. Primary health care is considered to be the most important way for people to get mental health care. Cambodia is a country with a long history of war and has poor mental health and limited resources for care. The aim of this study was to conduct a situational analysis of the mental health services in the rural district of Lvea Em, Kandal Province, Cambodia. A cross-sectional situational analysis was done to understand the mental health situation in Lvea Em District comparing it with the national one. The Programme for improving mental health care (PRIME) tool was used to collect systematic information about mental health care from 14 key informants in Cambodia. In addition, a separate questionnaire based on the PRIME tool was developed for the district health care centres (12 respondents). Ethical approval was obtained from the National Ethics Committee for Health Research in Cambodia. Mental health care is limited both in Lvea Em District and the country. Though national documents containing guidelines for mental health care exist, the resources available and health care infrastructure are below what is recommended. There is no budget allocated for mental health in the district; there are no mental health specialists and the mental health training of health care workers is insufficient. Based on the limited knowledge from the respondents in the district, mental health disorders do exist but no documentation of these patients is available. Respondents discussed how community aspects such as culture, history and religion were related to mental health. Though there have been improvements in understanding mental health, discrimination and abuse against people with mental health disorders seems still to be present. There are very limited mental health care services with hardly any budget allocated to them in Lvea Em District and Cambodia

Understanding the determinants of antimicrobial prescribing within hospitals: the role of "prescribing etiquette".

Science.gov (United States)

Charani, E; Castro-Sanchez, E; Sevdalis, N; Kyratsis, Y; Drumright, L; Shah, N; Holmes, A

2013-07-01

There is limited knowledge of the key determinants of antimicrobial prescribing behavior (APB) in hospitals. An understanding of these determinants is required for the successful design, adoption, and implementation of quality improvement interventions in antimicrobial stewardship programs. Qualitative semistructured interviews were conducted with doctors (n = 10), pharmacists (n = 10), and nurses and midwives (n = 19) in 4 hospitals in London. Interviews were conducted until thematic saturation was reached. Thematic analysis was applied to the data to identify the key determinants of antimicrobial prescribing behaviors. The APB of healthcare professionals is governed by a set of cultural rules. Antimicrobial prescribing is performed in an environment where the behavior of clinical leaders or seniors influences practice of junior doctors. Senior doctors consider themselves exempt from following policy and practice within a culture of perceived autonomous decision making that relies more on personal knowledge and experience than formal policy. Prescribers identify with the clinical groups in which they work and adjust their APB according to the prevailing practice within these groups. A culture of "noninterference" in the antimicrobial prescribing practice of peers prevents intervention into prescribing of colleagues. These sets of cultural rules demonstrate the existence of a "prescribing etiquette," which dominates the APB of healthcare professionals. Prescribing etiquette creates an environment in which professional hierarchy and clinical groups act as key determinants of APB. To influence the antimicrobial prescribing of individual healthcare professionals, interventions need to address prescribing etiquette and use clinical leadership within existing clinical groups to influence practice.

Consultant-led, multidisciplinary balance clinic: process evaluation of a specialist model of care in a district general hospital.

Science.gov (United States)

Trinidade, A; Yung, M W

2014-04-01

A specialist balance clinic to effectively deal with dizzy patients is recommended by ENT-UK. We audit the patient pathway before and following the introduction of a consultant-led dedicated balance clinic. Process evaluation and audit. ENT outpatients department of a district general hospital. The journey of dizzy patients seen in the general ENT clinic was mapped from case notes and recorded retrospectively. A consultant-led, multidisciplinary balance clinic involving an otologist, a senior audiologist and a neurophysiotherapist was then set up, and the journey was prospectively recorded and compared with that before the change. Of the 44 dizzy patients seen in the general clinic, 41% had further follow-up consultations; 64% were given definitive or provisional diagnoses; 75% were discharged without a management plan. Oculomotor examination was not systematically performed. The mean interval between Visits 1 and 2 was 8.4 weeks and the mean number of visits was 3. In the consultant-led dedicated balance clinic, following Visit 1, only 8% of patients required follow-up; 97% received definitive diagnoses, which guided management; all patients left with definitive management plans in place. In all patients, oculomotor assessment was systematically performed and all patients received consultant and, where necessary, allied healthcare professional input. By standardising the management experience for dizzy patients, appropriate and timely treatment can be achieved, allowing for a more seamless and efficient patient journey from referral to treatment. A multidisciplinary balance clinic led by a consultant otologist is the ideal way to achieve this. © 2014 John Wiley & Sons Ltd.

VT Data - Overlay District 20170419, Colchester

Data.gov (United States)

Vermont Center for Geographic Information — The following Overlay Districts are included in the data:General Development Four Commercial DistrictGeneral Development Four Openspace DistrictShoreland...

[Genital elephantiasis: reconstructive treatment of penoscrotal lymphoedema with a myocutaneous M. gracilis flap. Experiences from a District Hospital in Ethiopia].

Science.gov (United States)

Prica, S; Donati, O F; Schaefer, D J; Peltzer, J

2008-08-01

Genital elephantiasis is an illness leading to serious functional and aesthetic as well as psychosocial impairment. Since the 19th century there have been articles describing methods for surgical ablative treatment of penoscrotal lymphoedema. However, most of these methods ignore the creation a new drainage for the lymph. We now describe a new technique using a myocutaneous M. gracilis muscle flap for the reconstruction of the soft tissue damage resulting from radical excision, thus ensuring drainage of the lymph into the deep muscle compartment of the thigh. In the District Hospital "Mettu-Karl Hospital" in the Ethiopian rain forest region of Illubabor, during a period of 6 months the described surgical procedure was applied to 9 patients suffering from severe forms of this grotesquely disfiguring disease. Two patients presented with combined penoscrotal oedema, while the other 7 patients were suffering from isolated scrotal lymphoedema alone. All patients benefited from reconstruction with a myocutaneous M. gracilis muscle flap after radical excision of the affected tissue. All patients were evaluated after 3 and 12 months postoperatively in the presence of a translator. All nine patients showed a functionally and aesthetically satisfying result after 3 months without postoperative occurrence of infection. The evaluation 12 months postoperatively showed no recurrence of genitoscrotal lymphoedema. All patients reported on having regained normal ability for sexual intercourse and no occurrence of urinary tract infections since the operation. Concerning fertility, no statements could be made. A significant improvement in the quality of life was observed by the regained ability to walk and work and consequently the reintegration of the patients into their socio-economic environment. Radical excision of the affected tissue followed by transferring a functioning lymphatic drainage into the deep muscle compartment of the ipsilateral thigh using a proximally based

The prevalence of human immunodeficiency virus among pregnant women attending a hospital in the Moungo district, Cameroon

NARCIS (Netherlands)

van dan Meeberg, P. C.; Kooiman, R. C.; Buisman, N. J.; Goudsmit, J.; Lange, J. M.; Bannenberg, A. F.

1989-01-01

A seroepidemiological survey conducted from January to May 1986 among 650 pregnant women from mixed rural/urban origin in the Moungo district, Cameroon, revealed a very low prevalence of antibodies to human immunodeficiency viruses (HIV). One subject appeared to be infected with HIV 2. This is

Preventing the preventable through effective surveillance: the case of diphtheria in a rural district of Maharashtra, India.

Science.gov (United States)

Phalkey, Revati K; Bhosale, Rajesh V; Joshi, Abhijeet P; Wakchoure, Sushil S; Tambe, Muralidhar P; Awate, Pradip; Marx, Michael

2013-04-08

Epidemic diphtheria is still poorly understood and continues to challenge both developing and developed countries. In the backdrop of poor immunization coverage, non-existent adult boosters, weak case based surveillance and persistence of multiple foci, there is a heightened risk of re-emergence of the disease in epidemic forms in India. Investigating each outbreak to understand the epidemiology of the disease and its current status in the country is therefore necessary. Dhule a predominantly tribal and rural district in Northern Maharashtra has consistently recorded low vaccination coverages alongside sporaidic cases of diphtheria over the last years. This study reports the findings of an onsite survey conducted to assess a recent outbreak of diphtheria in Dhule district and the response mounted to it. Secondary data regarding outbreak detection and response were obtained from the district surveillance office. Clinical data were extracted from hospital records of eleven lab confirmed cases including one death case. Frequency distributions were calculated for each identified clinical and non- clinical variable using Microsoft™ Excel® 2010. Our findings suggest a shift in the median age of disease to adolescents (10-15 years) without gender differences. Two cases (18%) reported disease despite immunization. Clinical symptoms included cough (82%), fever (73%), and throat congestion (64%). About 64% and 36% of the 11 confirmed cases presented with a well defined pseudomembrane and a tonsillar patch respectively. Drug resistance was observed in all three culture positive cases. One death occurred despite the administration of Anti-Diphtheric Serum in a partially immunized case (CFR 9%). Genotyping and toxigenicity of strain was not possible due to specimen contamination during transport as testing facilities were unavailable in the district. The outbreak raises several concerns regarding the epidemiology of diphtheria in Dhule. The reason for shift in the median

Reinstating district nursing: A UK perspective.

Science.gov (United States)

Morris, Hannah

2017-09-01

As policy directives gather pace for service provision to be delivered in primary care, district nursing has not been recognised as a valuable asset to facilitate this agenda. Investment in district nursing and specialist district nursing education has fallen. This is concurrent with an ageing district nursing workforce, a lack of recruitment and growing caseloads, as district nursing adapts to meet the challenges of the complexities of contemporary healthcare in the community. The district nurse role is complex and multifaceted and includes working collaboratively and creatively to coordinate care. Redressing the shortages of specialist district nurse practitioners with increased numbers of health care support workers will not replace the skill, knowledge, experience required to meet the complex care needs of today's society. District nursing needs to be reinstated as the valuable asset it is, through renewed investment in the service, research development and in specialist practice education. To prevent extinction district nurses need to be able to demonstrate and articulate the complexities and dynamisms of the role to reinstate themselves to their commissioners as a valuable asset for contemporary practice that can meet current health and social care needs effectively. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Trying to understand routine stroke outcome data: the need for adequate casemix adjustment and some practical considerations.

Science.gov (United States)

Weir, N U; Signorini, D F; Dennis, M S; Murdoch, P S

2000-07-01

To determine how far the difference in published stroke case fatality between the Western General Hospital (WGH), Edinburgh and the Falkirk and District Royal Infirmary (FDRI) for the period 1990-93 can be explained by adjusting more fully for casemix. The cases were ascertained and followed prospectively at the WGH and retrospectively at the FDRI; casemix correction was performed using a validated logistic regression model. The WGH is a teaching hospital and the FDRI a district general hospital. Four hundred and thirty seven patients with a verified acute stroke at the WGH; 471 patients assigned a cerebrovascular disease discharge diagnostic code at the FDRI. Thirty day case fatality. About half of the difference in the two hospitals' published stroke case fatality could be accounted for by variation in measured casemix. The residual difference in adjusted case fatality might have been due to differences in the structure of stroke care or simply to remaining differences in casemix. Full investigation of the cause was prevented by the destruction of the deceased patients records. Comparisons of routinely collected stroke outcomes will remain difficult to interpret unless casemix is properly accounted for and deceased patients' records stored for several years.

District Consolidation: Rivals Coming Together

Science.gov (United States)

Mart, Dan

2011-01-01

District consolidation is a highly emotional process. One key to success is sticking to the facts. In Iowa, school districts facing financial difficulties or enrollment concerns do not have to move directly to consolidation. In many cases, districts begin by developing sharing agreements. These sharing agreements may start with simple sharing of…

The impacts of smart cards on hospital information systems--an investigation of the first phase of the national health insurance smart card project in Taiwan.

Science.gov (United States)

Liu, Chien-Tsai; Yang, Pei-Tun; Yeh, Yu-Ting; Wang, Bin-Long

2006-02-01

To investigate the impacts of the first phase of Taiwan's Bureau of National Health Insurance (TBNHI) smart card project on existing hospital information systems. TBNHI has launched a nationwide project for replacement of its paper-based health insurance cards by smart cards (or NHI-IC cards) since November 1999. The NHI-IC cards have been used since 1 July 2003, and they have fully replaced the paper-based cards since 1 January 2004. Hospitals must support the cards in order to provide medical services for insured patients. We made a comprehensive study of the current phase of the NHI-IC card system, and conducted a questionnaire survey (from 1 October to 30 November, 2003) to investigate the impacts of NHI-IC cards on the existing hospital information systems. A questionnaire was distributed by mail to 479 hospitals, including 23 medical centers, 71 regional hospitals, and 355 district hospitals. The returned questionnaires were also collected by prepaid mail. The questionnaire return rates of the medical centers, regional hospitals and district hospitals were 39.1, 29.6 and 20.9%, respectively. In phase 1 of the project, the average number of card readers purchased per medical center, regional hospital, and district hospital were 202, 45 and 10, respectively. The average person-days for the enhancement of existing information systems of a medical center, regional hospital and district hospital were 175, 74 and 58, respectively. Three months after using the NHI-IC cards most hospitals (60.6%) experienced prolonged service time for their patients due to more interruptions caused mainly by: (1) impairment of the NHI-IC cards (31.2%), (2) failure in authentication of the SAMs (17.0%), (3) malfunction in card readers (15.3%) and (4) problems with interfaces between the card readers and hospital information systems (15.8%). The overall hospital satisfaction on the 5-point Likert scale was 2.86. Although most hospitals were OK with the project, there was about 22

Understanding the strategies employed to cope with increased numbers of AIDS-orphaned children in families in rural settings: a case of Mbeya Rural District, Tanzania.

Science.gov (United States)

Fauk, Nelsensius Klau; Mwakinyali, Silivano Edson; Putra, Sukma; Mwanri, Lillian

2017-02-07

The purpose of this study was to understand the strategies employed by families that adopt Acquired Immune Deficiency Syndrome (AIDS)-orphaned children (Adoptive families) for coping with and mitigating the impact of AIDS in Mbeya Rural District, Tanzania. High numbers of AIDS-orphaned children aged below 18 years in Mbeya Region have led to increasing the burden of families caring for them. Understanding the coping strategies and impact mitigation activities employed by adoptive families is important in order to develop programmes to help them. This study employed a qualitative method for data collection (one-on-one in-depth interviews). The respondents included 12 male and 8 female heads of families that provide essential care for AIDS-orphaned children in Mbeya Rural District in Tanzania. The framework approach was used to analyse the data that were collected from 15 July to 15 August 2010. The study findings revealed that adoptive families faced several challenges including financial constraints due to increased needs for basic essentials such as health care expenses, school fees and food. Further impacts on adoptive families included shortage of work opportunities and limited time to address these challenges. To mitigate these challenges, adoptive families employed a range of coping strategies including selling family assets and renting out parts of cultivable land for extra cash. Task reallocation which involved the AIDS-orphaned children entering the labour force was also employed as a strategy to mitigate challenges and involved de-enrolling of children from schools so they could take part in income-generating activities in order to earn supplementary family income. The creation of additional income-generating activities such as poultry farming were other coping mechanisms employed, and these received support from both non-governmental organisations (NGOs) and governmental organisations, including the Isangati Agricultural Development Organization (local

Medical Professionals Designing Hospital Management Models

DEFF Research Database (Denmark)

Byg, Vibeke

Health care administration in many OECD countries has undergone substantial changes in recent years as a consequence of NPM reforms, rising costs, the pace of technological innovation, heightened competition for patients and resources, quality of managed care and demographic shifts. Hospitals...... especially have been reformed due to the high proportion of resources they absorb and the apparent difficulty of prioritizing and coordinating health care within hospitals. There is abundant research literature on the topic of reforming hospital management models. Lacking from the literature, however......, is insight into how we can understand and explain how medical professionals adapt hospital management over time in relation to changing hospital management models that are global in their influence in hospital organizations. The aim of this dissertation is to understand and explain how medical professionals...

33 CFR 3.25-1 - Fifth district.

Science.gov (United States)

2010-07-01

... District § 3.25-1 Fifth district. (a) The District Office is in Portsmouth, Va. (b) The Fifth Coast Guard District is comprised of: North Carolina; Virginia; District of Columbia; Maryland; Delaware; that part of... boundary at the shoreline at the North Carolina-South Carolina border, point located at approximately 30°55...

Deepening our understanding of quality improvement in Europe (DUQuE): overview of a study of hospital quality management in seven countries.

Science.gov (United States)

Secanell, Mariona; Groene, Oliver; Arah, Onyebuchi A; Lopez, Maria Andrée; Kutryba, Basia; Pfaff, Holger; Klazinga, Niek; Wagner, Cordula; Kristensen, Solvejg; Bartels, Paul Daniel; Garel, Pascal; Bruneau, Charles; Escoval, Ana; França, Margarida; Mora, Nuria; Suñol, Rosa

2014-04-01

This paper provides an overview of the DUQuE (Deepening our Understanding of Quality Improvement in Europe) project, the first study across multiple countries of the European Union (EU) to assess relationships between quality management and patient outcomes at EU level. The paper describes the conceptual framework and methods applied, highlighting the novel features of this study. DUQuE was designed as a multi-level cross-sectional study with data collection at hospital, pathway, professional and patient level in eight countries. We aimed to collect data for the assessment of hospital-wide constructs from up to 30 randomly selected hospitals in each country, and additional data at pathway and patient level in 12 of these 30. A comprehensive conceptual framework was developed to account for the multiple levels that influence hospital performance and patient outcomes. We assessed hospital-specific constructs (organizational culture and professional involvement), clinical pathway constructs (the organization of care processes for acute myocardial infarction, stroke, hip fracture and deliveries), patient-specific processes and outcomes (clinical effectiveness, patient safety and patient experience) and external constructs that could modify hospital quality (external assessment and perceived external pressure). Data was gathered from 188 hospitals in 7 participating countries. The overall participation and response rate were between 75% and 100% for the assessed measures. This is the first study assessing relation between quality management and patient outcomes at EU level. The study involved a large number of respondents and achieved high response rates. This work will serve to develop guidance in how to assess quality management and makes recommendations on the best ways to improve quality in healthcare for hospital stakeholders, payers, researchers, and policy makers throughout the EU.

The Role of Hospital Information Systems in Universal Health Coverage Monitoring in Rwanda.

Science.gov (United States)

Karara, Gustave; Verbeke, Frank; Nyssen, Marc

2015-01-01

In this retrospective study, the authors monitored the patient health coverage in 6 Rwandan hospitals in the period between 2011 and 2014. Among the 6 hospitals, 2 are third level hospitals, 2 district hospitals and 2 private hospitals. Patient insurance and financial data were extracted and analyzed from OpenClinic GA, an open source hospital information system (HIS) used in those 6 hospitals. The percentage of patients who had no health insurer globally decreased from 35% in 2011 to 15% in 2014. The rate of health insurance coverage in hospitals varied between 75% in private hospitals and 84% in public hospitals. The amounts paid by the patients for health services decreased in private hospitals to 25% of the total costs in 2014 (-7.4%) and vary between 14% and 19% in public hospitals. Although the number of insured patients has increased and the patient share decreased over the four years of study, the patients' out-of-pocket payments increased especially for in-patients. This study emphasizes the value of integrated hospital information systems for this kind of health economics research in developing countries.

Corporate visual identity: a case in hospitals.

Science.gov (United States)

Alkibay, Sanem; Ozdogan, F Bahar; Ermec, Aysegul

2007-01-01

This paper aims to present a perspective to better understand corporate identity through examining the perceptions of Turkish patients and develop a corporate visual identity scale. While there is no study related to corporate identity research on hospitals in Turkey as a developing country, understanding consumer's perceptions about corporate identity efforts of hospitals could provide different perspectives for recruiters. When the hospitals are considered in two different groups as university and state hospitals, the priority of the characteristics of corporate visual identity may change, whereas the top five characteristics remain the same for all the hospitals.

National Register Historic Districts

Data.gov (United States)

Iowa State University GIS Support and Research Facility — The National Register Historic District layer is a shape file showing the boundaries of Historic Districts that are listed on the National Register of Historic Places.

A survey of doctors at a UK teaching hospital to assess understanding of recent changes to consent law

Directory of Open Access Journals (Sweden)

J.W. O'Brien, BSc MRCS

2017-06-01

Conclusion: The majority were not familiar with the concept of material risk and recent legal changes. A majority were not confident that their practice meets current requirements, suggesting that recent changes in consent law may not be widely understood at this hospital. We suggest more guidance and education may be necessary than is currently available. Increased understanding of recent changes to consent law will reduce the risk taken by NHS trusts and offer patients a service compliant with Supreme Court guidance.

Optimizing antibiotic usage in hospitals: a qualitative study of the perspectives of hospital managers.

Science.gov (United States)

Broom, A; Gibson, A F; Broom, J; Kirby, E; Yarwood, T; Post, J J

2016-11-01

Antibiotic optimization in hospitals is an increasingly critical priority in the context of proliferating resistance. Despite the emphasis on doctors, optimizing antibiotic use within hospitals requires an understanding of how different stakeholders, including non-prescribers, influence practice and practice change. This study was designed to understand Australian hospital managers' perspectives on antimicrobial resistance, managing antibiotic governance, and negotiating clinical vis-à-vis managerial priorities. Twenty-three managers in three hospitals participated in qualitative semi-structured interviews in Australia in 2014 and 2015. Data were systematically coded and thematically analysed. The findings demonstrate, from a managerial perspective: (1) competing demands that can hinder the prioritization of antibiotic governance; (2) ineffectiveness of audit and monitoring methods that limit rationalization for change; (3) limited clinical education and feedback to doctors; and (4) management-directed change processes are constrained by the perceived absence of a 'culture of accountability' for antimicrobial use amongst doctors. Hospital managers report considerable structural and interprofessional challenges to actualizing antibiotic optimization and governance. These challenges place optimization as a lower priority vis-à-vis other issues that management are confronted with in hospital settings, and emphasize the importance of antimicrobial stewardship (AMS) programmes that engage management in understanding and addressing the barriers to change. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

FLASH Technology: Full-Scale Hospital Waste Water Treatments Adopted in Aceh

Science.gov (United States)

Rame; Tridecima, Adeodata; Pranoto, Hadi; Moesliem; Miftahuddin

2018-02-01

A Hospital waste water contains a complex mixture of hazardous chemicals and harmful microbes, which can pose a threat to the environment and public health. Some efforts have been carried out in Nangroe Aceh Darussalam (Aceh), Indonesia with the objective of treating hospital waste water effluents on-site before its discharge. Flash technology uses physical and biological pre-treatment, followed by advanced oxidation process based on catalytic ozonation and followed by GAC and PAC filtration. Flash Full-Scale Hospital waste water Treatments in Aceh from different district have been adopted and investigated. Referring to the removal efficiency of macro-pollutants, the collected data demonstrate good removal efficiency of macro-pollutants using Flash technologies. In general, Flash technologies could be considered a solution to the problem of managing hospital waste water.

The Partnership Pact: Fulfilling School Districts' Research Needs with University-District Partnerships

Science.gov (United States)

Ralston, Nicole; Weitzel, Bruce; Waggoner, Jacqueline; Naegele, Zulema; Smith, Rebecca

2016-01-01

There has been a recent shift in university-district partnership models from traditional transactional partnerships, which lack a shared purpose, to transformational partnerships that are mutually beneficial to both universities and school districts. These transformational research-practice partnerships have gained popularity in the United States…

[The medical organizational aspects of decreasing of preventable mortality in the case of traffic accident in municipal district].

Science.gov (United States)

Voloshina, L V; Plutnitskiĭ, A N

2010-01-01

The article deals with the results of the study of such actual issue as decreasing of preventable mortality in the case of traffic accident in municipal district. The analysis was based on the mortality statistical data and the expertise of causes of lethal outcomes of traffic accidents. The results are used to develop the measures of improving the organization and quality of medical care of victims of road accident on the pre-hospital and hospital stages on the level of municipal health care to decrease the human losses caused by traffic accident.

Levels of Leadership: Effects of District and School Leaders on the Quality of School Programs of Family and Community Involvement

Science.gov (United States)

Epstein, Joyce L.; Galindo, Claudia L.; Sheldon, Steven B.

2011-01-01

Purpose: This study tests key constructs of sociocultural and organizational learning theories with quantitative methods to better understand the nature and impact of district and school leadership and actions on the quality of programs of family and community involvement. Research Design: Survey data from a "nested" sample of 24 districts and 407…

An implementation evaluation of a policy aiming to improve financial access to maternal health care in Djibo district, Burkina Faso.

Science.gov (United States)

Belaid, Loubna; Ridde, Valéry

2012-12-08

To bring down its high maternal mortality ratio, Burkina Faso adopted a national health policy in 2007 that designed to boost the assisted delivery rate and improving quality of emergency obstetrical and neonatal care. The cost of transportation from health centres to district hospitals is paid by the policy. The worst-off are exempted from all fees. The objectives of this paper are to analyze perceptions of this policy by health workers, assess how this health policy was implemented at the district level, identify difficulties faced during implementation, and highlight interactional factors that have an influence on the implementation process. A multiple site case study was conducted at 6 health centres in the district of Djibo in Burkina Faso. The following sources of data were used: 1) district documents (n = 23); 2) key interviews with district health managers (n = 10), health workers (n = 16), traditional birth attendants (n = 7), and community management committees (n = 11); 3) non-participant observations in health centres; 4) focus groups in communities (n = 62); 5) a feedback session on the findings with 20 health staff members. All the activities were implemented as planned except for completely subsidizing the worst-off, and some activities such as surveys for patients and the quality assurance service team aiming to improve quality of care. District health managers and health workers perceived difficulties in implementing this policy because of the lack of clarity on some topics in the guidelines. Entering the data into an electronic database and the long delay in reimbursing transportation costs were the principal challenges perceived by implementers. Interactional factors such as relations between providers and patients and between health workers and communities were raised. These factors have an influence on the implementation process. Strained relations between the groups involved may reduce the effectiveness of the policy

An implementation evaluation of a policy aiming to improve financial access to maternal health care in Djibo district, Burkina Faso

Directory of Open Access Journals (Sweden)

Belaid Loubna

2012-12-01

Full Text Available Abstract Background To bring down its high maternal mortality ratio, Burkina Faso adopted a national health policy in 2007 that designed to boost the assisted delivery rate and improving quality of emergency obstetrical and neonatal care. The cost of transportation from health centres to district hospitals is paid by the policy. The worst-off are exempted from all fees. Methods The objectives of this paper are to analyze perceptions of this policy by health workers, assess how this health policy was implemented at the district level, identify difficulties faced during implementation, and highlight interactional factors that have an influence on the implementation process. A multiple site case study was conducted at 6 health centres in the district of Djibo in Burkina Faso. The following sources of data were used: 1 district documents (n = 23; 2 key interviews with district health managers (n = 10, health workers (n = 16, traditional birth attendants (n = 7, and community management committees (n = 11; 3 non-participant observations in health centres; 4 focus groups in communities (n = 62; 5 a feedback session on the findings with 20 health staff members. Results All the activities were implemented as planned except for completely subsidizing the worst-off, and some activities such as surveys for patients and the quality assurance service team aiming to improve quality of care. District health managers and health workers perceived difficulties in implementing this policy because of the lack of clarity on some topics in the guidelines. Entering the data into an electronic database and the long delay in reimbursing transportation costs were the principal challenges perceived by implementers. Interactional factors such as relations between providers and patients and between health workers and communities were raised. These factors have an influence on the implementation process. Strained relations between the groups involved

District Fiscal Policy and Student Achievement

Directory of Open Access Journals (Sweden)

Gary G. Huang

2002-09-01

Full Text Available School restructuring raises questions about the role of school districts in improving student learning. Centralization by state governments and decentralization to individual schools as proposed in systemic reform leave districts' role unsettled. Empirical research on the district role in the context of ongoing reform is inadequate. This analysis of combined data from the NAEP and the Common Core of Data (CCD was intended to address the issue. We analyzed 1990, 1992, and 1996 NAEP 8th grade mathematics national assessment data in combination with CCD data of corresponding years to examine the extent to which student achievement was related to districts' control over instructional expenditure, adjusting for relevant key factors at both district and student levels. Upon sample modification, we used hierarchical linear modeling (HLM to estimate the relationships of student achievement to two district fiscal policy indictors, current expenditure per pupil (CEPP and districts' discretionary rates for instructional expenditure (DDR. Net of relevant district factors, DDR was found unrelated to districts' average 8th grade math performance. The null effect was consistent in the analysis of the combined NAEP-CCD data for 1990, 1992, and 1996. In contrast, CEPP was found related to higher math performance in a modest yet fairly consistent way. Future research may be productive to separately study individual states and integrate the findings onto the national level.

[Communication between the primary care physician, hospital staff and the patient during hospitalization].

Science.gov (United States)

Menahem, Sasson; Roitgarz, Ina; Shvartzman, Pesach

2011-04-01

HospitaL admission is a crisis for the patient and his family and can interfere with the continuity of care. It may lead to mistakes due to communication problems between the primary care physician and the hospital medical staff. To explore the communication between the primary care physician, the hospital medical staff, the patient and his family during hospitalization. A total of 269 questionnaires were sent to all Clalit Health Services-South District, primary care physicians; 119 of these questionnaires (44.2%) were completed. Half of the primary care physicians thought that they should, always or almost always, have contact with the admitting ward in cases of internal medicine, oncology, surgery or pediatric admissions. However, the actual contact rate, according to their report, was only in a third of the cases. A telephone contact was more common than an actual visit of the patient in the ward. Computer communication between the hospital physicians and the primary care physicians is still insufficiently developed, although 96.6% of the primary care physicians check, with the aid of computer software, for information on their hospitalized patients. The main reasons to visit the hospitalized patient were severe medical conditions or uncertainty about the diagnosis; 79% of the physicians thought that visiting their patients strengthened the level of trust between them and their patients. There are sometimes communication difficulties and barriers between the primary care physicians and the ward's physicians due to partial information delivery and rejection from the hospital physicians. The main barriers for visiting admitted patients were workload and lack of pre-allocated time on the work schedule. No statistically significant differences were found between communication variables and primary care physician's personal and demographic characteristics. The communication between the primary care physician and the hospital physicians should be improved through

a raPid assEssMENt oF distriCt HEaltH sYstEMs iN siX CoUNtriEs ...

African Journals Online (AJOL)

personnel to work in home areas in nigeria. (iv) Emigration of health .... of district hospitals had the required equipment for their operation ..... practices is also related to lack of training of staff at the lower level facilities, non-compliance by many.

Factors affecting integration of midwifery nursing science theory with clinical practice in Vhembe District, Limpopo Province as perceived by professional midwives.

Science.gov (United States)

Malwela, Thivhulawi; Maputle, Sonto M; Lebese, Rachel T

2016-05-24

Professional midwives have an important role to play in midwifery training to produce a competent midwife. According to the social learning theory, professional midwives act as role models for students. When allocated for clinical learning experiences in the training hospitals, students will have the opportunity to observe the well-trained, skilled, and experienced professional midwives. The whole process will enable students to integrate theory with practice and they will become competent. The aim of this study was to determine the factors affecting integration of midwifery nursing science theory with clinical practice as perceived by midwives. The study was conducted at the training hospitals in Vhembe district of the Limpopo Province, South Africa. These hospitals were: Donald Fraser, Siloam, and Tshidzini. A qualitative explorative, descriptive and contextual design was used. A Nonprobability, convenient sampling method was used to select 11 midwives from the following hospitals: Donald Fraser, Siloam, and Tshidzini, in Vhembe district. In-depth individual interviews were conducted. Data were analysed through open coding method. One theme and five sub-themes emerged from the analysed data, namely: shortage of midwives, attitudes towards student midwives, reluctance to perform teaching functions, language barriers, and declining midwifery practice standards. Shortage of midwives in the clinical areas led to fewer numbers of mentors whom the students could observe and imitate to acquire clinical skills. Some of the midwives were reluctant to teach students. Recommendations were made for both training institutions and hospitals to employ preceptors for students in the clinical practical.

The understanding of law professionals from the Federal District about drug users under the current new law / A compreensão dos operadores de direito do Distrito Federal sobre o usuário de drogas na vigência da nova lei

Directory of Open Access Journals (Sweden)

Maria Fátima Olivier Sudbrack

2010-01-01

Full Text Available Drugs users have been receiving contradictory treatments thereby promoting their stigma besides hiding and limiting the understanding of the phenomenon. The objective of this study was to investigate how the District Attorneys and Judges are considering and applying the new law which legislates on the conduct of drug use in Brazil. Eleven Law professionals from the Federal District participated in semi-structured interviews divided in three areas: the point of view in relation to the user of drugs, how the law is being applied, and how they conceive the work of the multidisciplinary teams. The results showed very heterogeneous positions, showing that there is no unanimity on the understanding of the new law. For some, there is a shared belief that drugs abuse is a public health problem, for others, it is believed that the user must receive a punishment for his/her illegal act. An effective and efficient interdisciplinary dialogue should allow a reflective action aiming at favoring those who come to justice.

Understanding the patient multidimensional experience: a qualitative study on coping in hospitals of Assistance Publique-Hôpitaux de Paris, France

Directory of Open Access Journals (Sweden)

Reach G

2015-04-01

Full Text Available Gérard Reach,1 Denis Fompeyrine,2 Carole Mularski21Department of Endocrinology, Diabetes and Metabolic Diseases, Avicenne Hospital APHP and EA 3412, CRNH-IdF, Paris 13 University, Bobigny, France; 2Direction des Patients, Usagers et Associations, Assistance Publique-Hôpitaux de Paris, Paris, FranceObjective: Time spent in hospitals is complex and entails a number of distinct phases that fluctuate depending on many variables. Attempts to understand patients’ experiences often involve focusing on their needs using self-evaluation, but this does not clearly highlight the complexity of coping. Questionnaires based on telephone surveys and emails do not facilitate a sufficient assessment of the coping effort. However, when patients express themselves through spontaneous narration, different dimensions may emerge in their experience at the hospital. This qualitative study explores the various forms of coping among patients with a hospital experience.Methods: Interviews were conducted with 75 patients in six hospital departments. Transcripts from interviews were thematically analyzed and a conceptual, multidimensional model was developed to explain the relationship between patient experience and coping complexity.Results: Patients used a set of about 50 different terms to describe their experiences in the hospital. They described with the greatest number of words the aspects that triggered their stress or distress and forced them to cope. Stress resulting from the experienced situation was classifiable into five dimensions: trauma, environment, medical, interpersonal affective, and social impact, which constitute invariants that may require individual complex coping strategies.Conclusion: Patient experience is hard to evaluate, and this represents a permanent challenge for medical teams. Considering the five coping dimensions delineated in this study may be helpful in improving the patient’s hospital experience.Keywords: patient experience

Advanced Practice Nursing in Pediatric Urology: experience report in the Federal District

Directory of Open Access Journals (Sweden)

Bruna Marcela Lima de Souza

Full Text Available ABSTRACT Objective: To describe the creation and implementation of the extension program Advanced Practice Nursing in Pediatric Urology, developed in the outpatient clinic of a teaching hospital in the Federal District. Method: This is an experience report regarding the implementation of an outpatient service aimed at children and adolescents with symptoms of bladder and bowel dysfunction. Results: Because it is an extension program linked to the university, it follows a different model of care, valuing empowerment, informed and shared decision making, which results in a stronger bond between patients, family and the Pediatric Urology nursing team. It has also become a privileged space for the production and use of scientific knowledge, associated with the principles of evidence-based practice. Conclusion: This project shows a different performance of the nurse-specialist-professor-researcher in Pediatric Urology Nursing, and it has become a reference in the Federal District, mainly for undergraduate and graduate nursing students.

Healthcare Antibiotic Resistance Prevalence - DC (HARP-DC): A Regional Prevalence Assessment of Carbapenem-Resistant Enterobacteriaceae (CRE) in Healthcare Facilities in Washington, District of Columbia.

Science.gov (United States)

Reuben, Jacqueline; Donegan, Nancy; Wortmann, Glenn; DeBiasi, Roberta; Song, Xiaoyan; Kumar, Princy; McFadden, Mary; Clagon, Sylvia; Mirdamadi, Janet; White, Diane; Harris, Jo Ellen; Browne, Angella; Hooker, Jane; Yochelson, Michael; Walker, Milena; Little, Gary; Jernigan, Gail; Hansen, Kathleen; Dockery, Brenda; Sinatro, Brendan; Blaylock, Morris; Harmon, Kimary; Iyengar, Preetha; Wagner, Trevor; Nelson, Jo Anne

2017-08-01

OBJECTIVE Carbapenem-resistant Enterobacteriaceae (CRE) are a significant clinical and public health concern. Understanding the distribution of CRE colonization and developing a coordinated approach are key components of control efforts. The prevalence of CRE in the District of Columbia is unknown. We sought to determine the CRE colonization prevalence within healthcare facilities (HCFs) in the District of Columbia using a collaborative, regional approach. DESIGN Point-prevalence study. SETTING This study included 16 HCFs in the District of Columbia: all 8 acute-care hospitals (ACHs), 5 of 19 skilled nursing facilities, 2 (both) long-term acute-care facilities, and 1 (the sole) inpatient rehabilitation facility. PATIENTS Inpatients on all units excluding psychiatry and obstetrics-gynecology. METHODS CRE identification was performed on perianal swab samples using real-time polymerase chain reaction, culture, and antimicrobial susceptibility testing (AST). Prevalence was calculated by facility and unit type as the number of patients with a positive result divided by the total number tested. Prevalence ratios were compared using the Poisson distribution. RESULTS Of 1,022 completed tests, 53 samples tested positive for CRE, yielding a prevalence of 5.2% (95% CI, 3.9%-6.8%). Of 726 tests from ACHs, 36 (5.0%; 95% CI, 3.5%-6.9%) were positive. Of 244 tests from long-term-care facilities, 17 (7.0%; 95% CI, 4.1%-11.2%) were positive. The relative prevalence ratios by facility type were 0.9 (95% CI, 0.5-1.5) and 1.5 (95% CI, 0.9-2.6), respectively. No CRE were identified from the inpatient rehabilitation facility. CONCLUSION A baseline CRE prevalence was established, revealing endemicity across healthcare settings in the District of Columbia. Our study establishes a framework for interfacility collaboration to reduce CRE transmission and infection. Infect Control Hosp Epidemiol 2017;38:921-929.

District Governance and Student Learning in Indonesia

OpenAIRE

Pradhan, Menno; de Ree, Joppe

2014-01-01

We document the likely importance of district governance and teacher management policies in relation to student learning in Indonesian primary schools. As the responsibility to deliver primary education has been decentralized to district governments, we expect district specific variations in teacher management policies. Consequently, we also expect variations in learning trajectories across districts. We document substantial heterogeneity in learning gains across districts. Furthermore, we sh...

Procedures for selecting and buying district heating equipment. Sofia district heating. Final report

Energy Technology Data Exchange (ETDEWEB)

NONE

1997-11-01

The aim of this Final Report, prepared for the project `Procedures for Selecting and Buying DistRict Heating Equipment - Sofia District Heating Company`, is to establish an overview of the activities accomplished, the outputs delivered and the general experience gained as a result of the project. The main objective of the project is to enable Sofia District Heating Company to prepare specifications and tender documents, identify possible suppliers, evaluate offers, etc. in connection with purchase of district heating equipment. This objective has been reached by using rehabilitation of sub-stations as an example requested by Sofia DH. The project was originally planned to be finalized end of 1995, but due to the extensions of the scope of work, the project has been prolonged until end 1997. The following main activities were accomplished: Preparation of a detailed work plan; Collection of background information; Discussion and advice about technical specifications and tender documents for sub-station rehabilitation; Input to terms of reference for a master plan study; Input to technical specification for heat meters; Collection of ideas for topics and examples related to dissemination of information to consumers about matters related to district heating consumption. (EG)

Towards understanding citizens trust in local government authorities in social service provision: A case of education service in Maswa district Tanzania

Directory of Open Access Journals (Sweden)

Robert Makorere

2012-09-01

Full Text Available The paper stresses on understanding citizens’ trust to local government authorities in the provision of social services, the case of education service in Maswa district. The paper discloses that majority of respondents of 82.2% of total respondents were not involved in full council meetings, although the meetings are supposed to be open to the public and all information that is presented there is public information which includes proposed plans and budgets as well as quarterly progress reports. This shows that there are problems in primary education. Moreover, due to various problems that still exist in primary education in the area under study, they created a sense of distrust between citizens to local government and local leaders to be specific including Village Executive Officers, Ward Executive Officers and councilors since majority of the respondents revealed that they are lazy harass people. This makes people to be reluctant to participate in development activities include refusing to contribute financially in various development initiatives since they do not see importance of their local leaders so they decide to take their own decisions.

Studying the Factors for Selecting Public or Private Hospitals by Non Emergent Patients of Ardabil District in 2012

Directory of Open Access Journals (Sweden)

Saadat Jalili

2014-12-01

Full Text Available Background & objectives: At the present time, health care services have been increasingly transformed to a competitive issue and many factors influence usage of hospital services and selection of a hospital by the patients. This study has been performed for surveying effective factors on selecting a public or private hospital among non-emergent patients of Ardabil hospitals in 2012.   Method: This research was a cross-sectional descriptive-correlational study and the statistical population was non emergent patients of four public and two private hospitals of Ardabil in 2012. The samples (598 patients were collected by stratified random sampling method. Data-gathering tool was a researcher-made questionnaire and data were analyzed by descriptive statistics, frequency [distribution] tables, and logistic regression analysis.   Results: The results depicted a direct interdependence between selecting a hospital (public or private and the three factors of social elements, hospital services, and hospital facilities with a confidence coefficient of 92%. Based on logistic regression analysis and Exp(B coefficient, the patients’ priorities for hospital choosing were hospital services, social elements, and hospital facilities with Exp(B of 1.932, 1.332, and 0.338, respectively.   Conclusion: The most important factor for choosing public hospitals was lower cost of services and for private hospitals was physician’s recommendation. The strong effects of these two factors have overshadowed other variables.

Understanding thermal comfort perception of nurses in a hospital ward work environment.

NARCIS (Netherlands)

Derks, M.T.H.; Mishra, A.K.; Loomans, M.G.L.C.; Kort, H.S.M.

2018-01-01

In indoor comfort research, thermal comfort of care-professionals in hospital environment is a little explored topic. To address this gap, a mixed methods study, with the nursing staff in hospital wards acting as participants, was undertaken. Responses were collected during three weeks in the summer

Going to the Hospital

Science.gov (United States)

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

Opportunities for District Heating Systems in Ukraine. Market survey. Final report

Energy Technology Data Exchange (ETDEWEB)

Brienen, M.

2011-12-15

The market survey should identify the existing and future opportunities for Dutch companies in the district heating sector in Ukraine, facilitate better understanding of the sector specifics by providing a complete picture on the whole district heating chain at specific cities mentioned and surrounding areas, and provide practical information on the best ways to enter this market segment by Dutch companies. The points of special interest are: (a) Analysis of main types of district heating chain in terms of the key stakeholders and their interest; Identification of the cases where the whole chain is under control (if any); Identification of the main directions of change within the existing set-up; (b) Analysis of the pricing model(s) and the procedures for setting up the prices for district heating; Identification of the main influencers on the decision making; (c) Identification of the main opportunities to use renewable energy for heating systems in Ukraine; and (d) Identification of the Dutch clusters with appropriate products, services and knowledge which can be used to achieve optimal results with district heating systems in Ukraine. Another important reason to execute this market survey is the 2g at-sign thereprogramme 'Ukraine-sustainable energy'. One of the consortia supported under the 2g at-sign there programme, is called NUSEP, Netherlands Ukrainian Sustainable Energy Platform. Under this platform 15-20 Dutch companies and institutes have joined forces. All of these companies and institutes are active in the field of(sustainable) energy. In short, the district heating sector in Ukraine offers many opportunities for Dutch companies. This survey will help Dutch companies to do business in Ukraine. The market research has been executed at both national level (where relevant concerns) and is specifically focused on the following cities and surrounding area: Kiev; Poltava; Kamyanets-Podilsky; Kovel; Lviv; Zhytomyr. Since the major developments in

Hospital 360°.

Science.gov (United States)

Giraldo Valencia, Juan Carlos; Delgado, Liliana Claudia

2015-01-01

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

Measurement of health system performance at district level: A study protocol

Directory of Open Access Journals (Sweden)

Atul Sharma

2018-01-01

Full Text Available Background: Limited efforts have been observed in low and middle income countries to undertake health system performance assessment at district level. Absence of a comprehensive data collection tool and lack of a standardised single summary measure defining overall performance are some of the main problems. Present study has been undertaken to develop a summary composite health system performance index at district level. Methods: A broad range of indicators covering all six domains as per building block framework were finalized by an expert panel. The domains were classified into twenty sub-domains, with 70 input and process indicators to measure performance. Seven sub-domains for assessing health system outputs and outcomes were identified, with a total of 28 indicators. Districts in Haryana state from north India were selected for the study. Primary and secondary data will be collected from 378 health facilities, district and state health directorate headquarters. Indicators will be normalized, aggregated to generate composite performance index at district level. Domain specific scores will present the quality of individual building block domains in the public health system. Robustness of the results will be checked using sensitivity analysis. Expected impact for public health: The study presents a methodology for comprehensive assessment of all health system domains on basis of input, process, output and outcome indicators which has never been reported from India. Generation of this index will help identify policy and implementation areas of concern and point towards potential solutions. Results may also help understand relationships between individual building blocks and their sub-components.

Facts about Hospital Worker Safety

Science.gov (United States)

... statistics show that hospitals are still relatively hazardous workplaces, and they have much room to improve. OSHA has developed this factbook to help hospital safety managers and other stakeholders understand the challenges of worker ...

Mental health care in Nepal: current situation and challenges for development of a district mental health care plan.

Science.gov (United States)

Luitel, Nagendra P; Jordans, Mark Jd; Adhikari, Anup; Upadhaya, Nawaraj; Hanlon, Charlotte; Lund, Crick; Komproe, Ivan H

2015-01-01

Globally mental health problems are a serious public health concern. Currently four out of five people with severe mental illness in Low and Middle Income Countries (LMIC) receive no effective treatment. There is an urgent need to address this enormous treatment gap. Changing the focus of specialist mental health workers (psychiatrists and psychologists) from only service delivery to also designing and managing mental health services; building clinical capacity of the primary health care (PHC) workers, and providing supervision and quality assurance of mental health services may help in scaling up mental health services in LMICs. Little is known however, about the mental health policy and services context for these strategies in fragile-state settings, such as Nepal. A standard situation analysis tool was developed by the PRogramme for Improving Mental health carE (PRIME) consortium to systematically analyze and describe the current gaps in mental health care in Nepal, in order to inform the development of a district level mental health care plan (MHCP). It comprised six sections; general information (e.g. population, socio-economic conditions); mental health policies and plans; mental health treatment coverage; district health services; and community services. Data was obtained from secondary sources, including scientific publications, reports, project documents and hospital records. Mental health policy exists in Nepal, having been adopted in 1997, but implementation of the policy framework has yet to begin. In common with other LMICs, the budget allocated for mental health is minimal. Mental health services are concentrated in the big cities, with 0.22 psychiatrists and 0.06 psychologists per 100,000 population. The key challenges experienced in developing a district level MHCP included, overburdened health workers, lack of psychotropic medicines in the PHC, lack of mental health supervision in the existing system, and lack of a coordinating body in the Ministry

Characteristics and outcomes of patients with eclampsia and severe pre-eclampsia in a rural hospital in Western Tanzania : a retrospective medical record study

NARCIS (Netherlands)

Mooij, Rob; Lugumila, Joseph; Mwashambwa, Masumbuko Y.; Mwampagatwa, Ipyana H.; van Dillen, Jeroen; Stekelenburg, Jelle

2015-01-01

Background: Eclampsia and pre-eclampsia are well-recognized causes of maternal and neonatal mortality in low income countries, but are never studied in a district hospital. In order to get reliable data to facilitate the hospital's obstetric audit a retrospective medical record study was performed

Characteristics of uranium districts of the Russian Federation

International Nuclear Information System (INIS)

Boitsov, A.V.; Nikolsky, A.L.

2001-01-01

Uranium deposits are discovered in 15 ore districts of the Russian Federation. They are subdivided into four groups: Streltsovsky district with existing production centre, Stavropolsky district with depleted deposits, three prospective districts and ten reserve districts. The overview of new data on these districts is presented. Streltsovsky district with Priargunsky Production Centre include 19 molybdenum-uranium deposits of structure-bound volcanic type in caldera. The main activities in Stavropolsky district with two depleted uranium deposits are connected with restoration works and wastes rehabilitation. Except Streltsovsky district there are no more deposits in the Russian Federation prepared for uranium production. At the same time some uranium deposits of Vitimsky, Zauralsky, and West-Siberian districts are prospective for new development of production centres. They belong to the sandstone type, related to paleovalley or basal channel, and are suitable for ISL operation. The deposits of the other districts are considered to be reserve and considered unprofitable for uranium production at present and in the nearest future. The biggest of them is Aldansky district with gold-uranium deposits in potassium metasomatites in areas of Mesozoic activation of Archean cratons. Central Transbaikalsky, Yeniseisky, Yergeninsky, Onezhsky, Ladozhsky, Bureinsky, Khankaisky, Volgo-Uralsky reserve districts include mainly small-size deposits of vein, volcanic, surficial and metasomatite types with low uranium grades. (author)

Factors Associated with the Competencies of Public Health Workers in Township Hospitals: A Cross-Sectional Survey in Chongqing Municipality, China

Directory of Open Access Journals (Sweden)

Zhifei He

2015-11-01

Full Text Available Purpose: This study aimed to explore the competencies of public health workers (PHWs of township hospitals in Chongqing Municipality (China, and determine the related impact factors of the competencies of PHWs; Methods: A cross-sectional research was conducted on 314 PHWs from 27 township hospitals in three districts in Chongqing Municipality (China, from June to August 2014. A self-assessment questionnaire was established on the basis of literature reviews and a competency dictionary. The differences in competencies among the three districts were determined by adopting the chi-square test, t-test, analysis of variance (ANOVA method, and the impact factors of the competencies of PHWs were determined by adopting stepwise regression analysis. Results: (1 Results of the demographic characteristics of PHWs in three sample districts of Chongqing Municipality showed that a significant difference in age of PHWs (p = 0.021 < 0.05 and the majors of PHWs (p = 0.045 < 0.05; (2 In terms of the self-evaluation competency results of PHWs in township hospitals, seven among the 11 aspects were found to have significant differences in the three districts by the ANOVA test; (3 By adopting the t-test and ANOVA method, results of the relationship between the characteristics of PHWs and their competency scores showed that significant differences were found in the economic level (p = 0.000 < 0.05, age (p = 0.000 < 0.05, years of working (p = 0.000 < 0.05 and title of PHWs (p = 0.000 < 0.05; (4 Stepwise regression analysis was used to determine the impact factors of the competencies of PHWs in township hospitals, including the economic level (p = 0.000 < 0.001, years of working (p = 0.000 < 0.001, title (p = 0.001 < 0.005, and public health major (p = 0.007 < 0.01. Conclusions: The competencies of the township hospital staff in Chongqing Municipality (China, are generally insufficient, therefore, regulating the medical education and training skills of PHWs is crucial

Fine Particulate Matter Pollution and Hospital Admissions for Respiratory Diseases in Beijing, China.

Science.gov (United States)

Xiong, Qiulin; Zhao, Wenji; Gong, Zhaoning; Zhao, Wenhui; Tang, Tao

2015-09-22

Fine particulate matter has become the premier air pollutant of Beijing in recent years, enormously impacting the environmental quality of the city and the health of the residents. Fine particles with aerodynamic diameters of 0~0.3 μm, 0.3~0.5 μm, and 0.5~1.0 μm, from the yeasr 2007 to 2012, were monitored, and the hospital data about respiratory diseases during the same period was gathered and calculated. Then the correlation between respiratory health and fine particles was studied by spatial analysis and grey correlation analysis. The results showed that the aerial fine particulate matter pollution was mainly distributed in the Zizhuyuan sub-district office. There was a certain association between respiratory health and fine particles. Outpatients with respiratory system disease in this study area were mostly located in the southeastern regions (Balizhuang sub-district office, Ganjiakou sub-district office, Wanshoulu sub-district office, and Yongdinglu sub-district office) and east-central regions (Zizhuyuan sub-district office and Shuangyushu sub-district office) of the study area. Correspondingly, PM₁ (particulate matter with aerodynamic diameter smaller than 1.0 um) concentrations in these regions were higher than those in any other regions. Grey correlation analysis results showed that the correlation degree of the fine particle concentration with the number of outpatients is high, and the smaller fine particles had more obvious effects on respiratory system disease than larger particles.

Fine Particulate Matter Pollution and Hospital Admissions for Respiratory Diseases in Beijing, China

Directory of Open Access Journals (Sweden)

Qiulin Xiong

2015-09-01

Full Text Available Fine particulate matter has become the premier air pollutant of Beijing in recent years, enormously impacting the environmental quality of the city and the health of the residents. Fine particles with aerodynamic diameters of 0~0.3 μm, 0.3~0.5 μm, and 0.5~1.0 μm, from the yeasr 2007 to 2012, were monitored, and the hospital data about respiratory diseases during the same period was gathered and calculated. Then the correlation between respiratory health and fine particles was studied by spatial analysis and grey correlation analysis. The results showed that the aerial fine particulate matter pollution was mainly distributed in the Zizhuyuan sub-district office. There was a certain association between respiratory health and fine particles. Outpatients with respiratory system disease in this study area were mostly located in the southeastern regions (Balizhuang sub-district office, Ganjiakou sub-district office, Wanshoulu sub-district office, and Yongdinglu sub-district office and east-central regions (Zizhuyuan sub-district office and Shuangyushu sub-district office of the study area. Correspondingly, PM1 (particulate matter with aerodynamic diameter smaller than 1.0 um concentrations in these regions were higher than those in any other regions. Grey correlation analysis results showed that the correlation degree of the fine particle concentration with the number of outpatients is high, and the smaller fine particles had more obvious effects on respiratory system disease than larger particles.

Budget Stability, Revenue Volatility, and District Relations: Determinants of Georgia ELOST Distribution to Municipal School Districts

Science.gov (United States)

Reinagel, Tyler P.

2014-01-01

School districts across the United States are often forced into situations where limited public funds must be distributed among multiple districts. These are often reliant on distribution rates negotiated by district leadership and elected officials. An example of this is Georgia's 1% Education Local Option Sales Tax (ELOST). The tax is collected…

Cost to government health-care services of treating acute self-poisonings in a rural district in Sri Lanka

DEFF Research Database (Denmark)

Wickramasinghe, Kanchana; Steele, Paul; Dawson, Andrew

2009-01-01

States dollars (US$), using 2005 figures, was derived from hospital accounts. FINDINGS: The average total cost of treating a self-poisoned patient at the general hospital was US$ 31.83, with ward staff input and drugs being the highest expenditure category and only US$ 0.19 of this sum related to capital...... pesticides and possibly by improving case management in primary care hospitals. Additional research is needed to assess if increasing infrastructure and staff at peripheral hospitals could reduce the overall cost to the government, optimize case management and reduce pressure on secondary services.......OBJECTIVE: To estimate the direct financial costs to the Sri Lanka Ministry of Health of treating patients after self-poisoning, particularly from pesticides, in a single district. METHODS: Data on staff, drug, laboratory and other inputs for each patient admitted for self-poisoning were...

Gentrification in a Post-Socialist Town: The Case of the Supilinn District, Tartu, Estonia

Directory of Open Access Journals (Sweden)

Nele NUTT

2013-12-01

Full Text Available This article deals with the changes that have taken place in the Supilinn district in Tartu, Estonia due to the gentrification process. The gentrification process affects the cultural, social, economic, and physical environment of the area. People have been interested in this topic since the 1960s. Nowadays, there is also reason to discuss this issue in the context of Estonia and of the Supilinn district. Studying and understanding the processes that take place in the living environment, provides an opportunity to be more aware about them and to influence the development of these processes. This article provides an analysis of the conditions necessary for gentrification in the Supilinn district, describes the process of gentrification, and tries to assess the current developmental stage of the gentrification process. Cities are shaped by their people. Every area has a unique look that is shaped not only by the physical environment, but also by the principles, values, and wishes of its residents. Local residents influence the image of the mental and the physical space of the area. What changes has the development of the Supilinn district caused in the population of the area, and how have the residents, in turn, changed the district?

Tackling the workforce crisis in district nursing: can the Dutch Buurtzorg model offer a solution and a better patient experience? A mixed methods case study.

Science.gov (United States)

Drennan, Vari M; Calestani, Melania; Ross, Fiona; Saunders, Mary; West, Peter

2018-06-06

Despite policy intentions for more healthcare out of hospital, district nursing services face multiple funding and staffing challenges, which compromise the care delivered and policy objectives. What is the impact of the adapted Buurtzorg model on feasibility, acceptability and effective outcomes in an English district nursing service? Mixed methods case study. Primary care. Neighbourhood nursing team (Buurtzorg model), patients and carers, general practitioners (GPs), other health professionals, managers and conventional district nurses. The adapted Buurtzorg model of community nursing demonstrated feasibility and acceptability to patients, carers, GPs and other health professionals. For many patients, it was preferable to previous experiences of district nursing in terms of continuity in care, improved support of multiple long-term conditions (encompassing physical, mental and social factors) and proactive care. For the neighbourhood nurses, the ability to make operational and clinical decisions at team level meant adopting practices that made the service more responsive, accessible and efficient and offered a more attractive working environment. Challenges were reported by nurses and managers in relation to the recognition and support of the concept of self-managing teams within a large bureaucratic healthcare organisation. While there were some reports of clinical effectiveness and efficiency, this was not possible to quantify, cost or compare with the standard district nursing service. The adapted Buurtzorg model of neighbourhood nursing holds potential for addressing issues of concern to patients, carers and staff in the community. The two interacting innovations, that is, a renewed focus on patient and carer-centred care and the self-managing team, were implemented in ways that patients, carers, other health professionals and nurses could identify difference for both the nursing care and also the nurses' working lives. It now requires longer term

PHARMACOEPIDEMIOLOGIC ANALYSIS OF ST-ELEVATION MYOCARDIAL INFARCTION REPERFUSION THERAPY AT SARATOV REGION HOSPITALS OF DIFFERENT TYPES

Directory of Open Access Journals (Sweden)

O. V. Reshetko

2016-01-01

Full Text Available Aim. To evaluate the real practice of thrombolytic therapy of patients with ST-elevation myocardial infarction (STEMI at cardiological departments of Saratov and Saratov region hospitals.Material and methods. Retrospective pharmacoepidemiologic study was carried out. Case histories of STEMI patients discharged from cardiologic departments of several central district hospitals (CDH of Saratov region, cardiologic department of one of Saratov general municipal hospitals (MH and urgent cardiology department of Saratov clinical hospital (CH in 2006 were analyzed.Results. In CH all patients received thrombolytic therapy given they did not have contraindications and were admitted to the hospital timely. Few patients received thrombolytic therapy in MH and CDH in 2006.Conclusion. Correlation between hospital type and quality of STEMI management has been revealed.

Utilization of Yard for Vegetable Hydroponics in Serut Village, Panti Sub-District, Jember District

OpenAIRE

dewanti, parawita

2018-01-01

Vegetables as a horticultural product is a food source that is always consumed by humans daily, including in urban areas. Assorted Vegetables can be eaten raw or processed and it takes as a decoration on the food. Needs vegetables including lettuce, green pakcoy and other vegetables from day to day continues to increase. Therefore, it needs supply of vegetables from the area around the town of Jember including Serut Village, District Panti Sub-District, Jember District. Serut village has the ...

Troponin T is a strong marker of mortality in hospitalized patients

DEFF Research Database (Denmark)

Iversen, Kasper; Køber, Lars; Gøtze, Jens Peter

2013-01-01

hospitalized population are unknown. METHODS: Consecutive patients aged >40years admitted to a district hospital between 1 April 1998 and 31 March 1999 were included. A comprehensive medical interview and clinical examination were performed including echocardiography and measurement of natriuretic peptides...... and troponin T with a high-sensitivity assay (hs-TnT). RESULTS: Serum for analyses of hs-TnT was available from 1176 patients. Patients were 73.7years old on average (interquartile range, 64.5-80.0years), 59.2% were women and median follow-up was 11.4years. The prevalence of elevated hs-TnT (> 99th percentile...

7 CFR 982.31 - Grower districts.

Science.gov (United States)

2010-01-01

... 7 Agriculture 8 2010-01-01 2010-01-01 false Grower districts. 982.31 Section 982.31 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements... importance of production in each district and the number of growers in each district; (2) the geographic...

Consanguinity Ratio in Beta-Thalassemia Major Patients in District Bannu

International Nuclear Information System (INIS)

Khan, M. S.; Ahmed, M.; Khan, R. A.; Mushtaq, N.; Shah, M. W. U.

2015-01-01

Objective: To assess the frequency of consanguinity in b-thalassemia major patients and its association with age, gender and hepatitis C virus antibody positivity. Methods: The cross-sectional study was conducted from June 2013 to July 2014 at various hospitals of district Bannu in the North Western Khyber Pakhtunkhwa province of Pakistan. Data was recorded on a predesigned questionnaire. Results: Out of 180 subjects, 133(74 percent) parents were cousins, while 47(26 percent) were unrelated. The frequency of anti-hepatitis C virus antibody positivity was 14(7.77 percent). Conclusion: High prevalence of the disease in the study region was due to consanguineous marriages. (author)

Analysis of Health Facility Based Perinatal Verbal Autopsy of Electoral Constituency 2 of Arghakhanchi District, Nepal.

Science.gov (United States)

Manandhar, S R; Manandhar, D S; Adhikari, D; Shrestha, J; Rai, C; Rana, H; Paudel, M

2015-01-01

Verbal autopsy is a method to diagnose possible cause of death by analyzing factors associated with death through detailed questioning. This study is a part of the operational research program in electoral constituency no. 2 (EC 2) of Arghakhanchi district by MIRA and HealthRight International. Two day essential newborn care training followed by one day perinatal verbal autopsy training and later one day refresher verbal autopsy training was given for health staff of EC 2 of Arghakhanchi district in two groups. Stillbirths of >22wks or > 500 gms and Early neonatal deaths (newborns died within7 days of life) were included in this study. The Nepal Government approved verbal autopsy forms were used for performing autopsies. Perinatal deaths were classified according to Wigglesworth's Classification. Causes of Perinatal deaths were analyzed. Data were analyzed in the form of frequencies and tabulation in SPSS 16 . There were 41 cases of perinatal deaths (PND) were identified. Among them, 37 PNDs were from Arghakhanchi district hospital, 2 PNDs from Thada PHC, and one PND each from Subarnakhal and Pokharathok HPs. Among the 41 PNDs, 26 were stillbirths (SB) and 15 were early neonatal deaths (ENND). The perinatal mortality rate (PMR) of Arghakhanchi district hospital was 32.2 per 1,000 births and neonatal mortality rate (NMR) was 9.8 per 1,000 live births. Out of 26 stillbirths, 54% (14) were fresh SBs and 46% (12) were macerated stillbirths. The most common cause of stillbirth was obstetric complications (47%) where as birth asphyxia (53%) was the commonest cause of ENND. According to Wigglesworth's classification of perinatal deaths, Group IV (40%) was the commonest cause in the health facilities. Obstetric complication was the commonest cause of stillbirth and birth asphyxia was the commonest cause of early neonatal death. This study highlighted the need for regular antenatal check-ups and proper intrapartum fetal monitoring with timely and appropriate intervention to

Report on achievements in fiscal 1999. Environment harmonizing energy community survey project for Public Yatsushika Hospital area (large-scale cogeneration district heat supplying facility); Koritsu Yatsushika byoin chiku kankyo chowagata energy community chosa jigyo chosa hokokusho. Daikibo cogeneration chiiki netsu kyokyu shisetsu

Energy Technology Data Exchange (ETDEWEB)

NONE

2000-03-01

This survey is intended to utilize cogeneration to promote structuring a system to effectively utilize potential energy in a district. In connection with the total rebuilding plan for Yatsushika Hospital, a proposal was made on a cogeneration district heat supply system that could be introduced to six facilities in total including the hospital, its three ancillary facilities, and two neighboring facilities. The proposal is intended to evaluate energy conservation performance, environmentality, and economic performance of the system, and structure an optimal system. Two gas engines having the same capacity were selected as the driving source of the cogeneration system. The waste heat recovering system adopted the 'hot water plus steam recovery system'. Generators were selected that have high energy saving and overall cogeneration efficiency, power dependence, heat dependence, and waste heat utilization factor. As the countermeasures for heat load that cannot be taken care by the waste heat recovery alone, discussions were given on the cogeneration plus gas-burning absorption type cold-hot water device system (the system 1) and the cogeneration plus heat pump heat storing system (the system 2). As a result, the system 2 was selected as the optimal system because it uses both of LNG and commercial electric power effectively, and has stability against variation in fuel prices and excellent environmentality. (NEDO)

Home/Hospital Instruction: Instructional Approach to Working with Students with Major Depressive Disorder

Science.gov (United States)

Newman, Cara

2012-01-01

School districts throughout the United States provide in-home schooling for students whose health problems, both physical and mental, prevent them from attending regular classes. This service is an outgrowth of the federal legislation which addressed the provision of education to all children with special needs. Home/Hospital teachers who serve…

Prevalence of infectious and non-infectious diseases in cattle population in Moulvibazar district of Bangladesh

OpenAIRE

Chowdhury, Q M Monzur Kader; Roy, Sawrab; Alam, Shahrul; Ahmed, Juned

2018-01-01

Infectious and non-infectious diseases of cattle cause great economic losses of farmers as well as country every year by reducing growth, production and mortality of cattle population. The objective of this research work was to find out the prevalence of infectious and non-infectious diseases of cattle at Moulvibazar, Sylhet, Bangladesh. A total of 2285 clinical cases were diagnosed at District Veterinary Hospital in Moulvibazar, Bangladesh during January to June, 2016. Disease diagnosis was ...

Conflict Management in Declining School Districts.

Science.gov (United States)

Boyd, William Lowe; Wheaton, Dennis R.

1983-01-01

Professional literature about managing conflicts associated with declining enrollments indicates the existing tension in this area. A research study shows that, while upper-middle class districts may succeed using a rational approach to decision making, lower class districts, for various reasons, may not. Special problems of urban districts are…

Study on Concentration of Particulate Matter with Diameter Less than 10 Microns, Heavy Metals and Polycyclic Aromatic Hydrocarbons Related to PM2.5 in the Ambient Air of Sina Hospital District

Directory of Open Access Journals (Sweden)

Majid Kermani

2014-03-01

Full Text Available Background:In recent decades, extensive studies have shown a number of short and long-term health effects of particle matters. In addition to particle matters, polycyclic aromatic hydrocarbons (PAHs and heavy metals in airborne particles due to their mutagenic and carcinogenic properties are considered major air pollutants. So, the aim of this study was to evaluate the concentration of PM2.5particulate, 7heavy metal concentrations and 13 PAHs compound associated with fine particles (PM2.5-boud PAHs in the district of Sina hospital, Tehran. Methods: This cross-sectional study was carried out in air of Sina Hospital district in Tehran. Concentrations of fine particulate matter (PM2.5 were determined by gravimetric. Also heavy metal concentrations in samples after digestion were determined with ICP-AES instrument through injection. Then the PAHs compounds from each sample were extracted by ultrasonic method. After this step, extracted sample was injected for analysis by GC-MS and concentration of each compound was read. Results: The daily average concentration of PM2.5 during the study was 41.19 µg/m3.Concentration values for zinc, lead, cadmium, chromium, nickel and arsenic, were 92/69, 05/38, 2/18, 24/4, 19/4 and 34/1 ng/m3 respectively but mercury not found in this study. Average concentrations of PAHs compounds have been variable from0.07 ng/m3 for Chrysene to 1.21ng/m3 for Dibenzo(ahanthracene. Conclusion: In this study, the daily average of PM2.5 concentrations was above the Iranian National PM, WHO (25 µg/m3 and EPA (35 µg/m3 standards established for PM2.5 particles. Heavy metal concentrations in this study were lower than values reported in previous studies in Tehran. The highest concentrations among PAHs compounds belonging toIndeo(cd 1,2,3pyren, Dibenzo(ah anthracene, Benzo (B flouranthin and Benzo (Kflouranthin that all of these compounds are related to vehicle emissions.

Evaluating the impact of continuous quality improvement methods at hospitals in Tanzania: a cluster-randomized trial.

Science.gov (United States)

Kamiya, Yusuke; Ishijma, Hisahiro; Hagiwara, Akiko; Takahashi, Shizu; Ngonyani, Henook A M; Samky, Eleuter

2017-02-01

To evaluate the impact of implementing continuous quality improvement (CQI) methods on patient's experiences and satisfaction in Tanzania. Cluster-randomized trial, which randomly allocated district-level hospitals into treatment group and control group, was conducted. Sixteen district-level hospitals in Kilimanjaro and Manyara regions of Tanzania. Outpatient exit surveys targeting totally 3292 individuals, 1688 in the treatment and 1604 in the control group, from 3 time-points between September 2011 and September 2012. Implementation of the 5S (Sort, Set, Shine, Standardize, Sustain) approach as a CQI method at outpatient departments over 12 months. Cleanliness, waiting time, patient's experience, patient's satisfaction. The 5S increased cleanliness in the outpatient department, patients' subjective waiting time and overall satisfaction. However, negligible effects were confirmed for patient's experiences on hospital staff behaviours. The 5S as a CQI method is effective in enhancing hospital environment and service delivery; that are subjectively assessed by outpatients even during the short intervention period. Nevertheless, continuous efforts will be needed to connect CQI practices with the further improvement in the delivery of quality health care. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Differences in Food and Beverage Marketing Policies and Practices in US School Districts, by Demographic Characteristics of School Districts, 2012.

Science.gov (United States)

Merlo, Caitlin L; Michael, Shannon; Brener, Nancy D; Coffield, Edward; Kingsley, Beverly S; Zytnick, Deena; Blanck, Heidi

2016-12-15

Foods and beverages marketed in schools are typically of poor nutritional value. School districts may adopt policies and practices to restrict marketing of unhealthful foods and to promote healthful choices. Students' exposure to marketing practices differ by school demographics, but these differences have not yet been examined by district characteristics. We analyzed data from the 2012 School Health Policies and Practices Study to examine how food and beverage marketing and promotion policies and practices varied by district characteristics such as metropolitan status, size, and percentage of non-Hispanic white students. Most practices varied significantly by district size: a higher percentage of large districts than small or medium-sized districts restricted marketing of unhealthful foods and promoted healthful options. Compared with districts whose student populations were majority (>50%) non-Hispanic white, a higher percentage of districts whose student populations were minority non-Hispanic white (≤50% non-Hispanic white) prohibited advertising of soft drinks in school buildings and on school grounds, made school meal menus available to students, and provided families with information on school nutrition programs. Compared with suburban and rural districts, a higher percentage of urban districts prohibited the sale of soft drinks on school grounds and used several practices to promote healthful options. Preliminary findings showing significant associations between district demographics and marketing policies and practices can be used to help states direct resources, training, and technical assistance to address food and beverage marketing and promotion to districts most in need of improvement.

The Hospitable Meal Model

DEFF Research Database (Denmark)

Justesen, Lise; Overgaard, Svend Skafte

2017-01-01

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

Understanding end water quality in hospitals and other large buildings

Science.gov (United States)

Local hospitals are depending on the use of copper silver ionization treatment to control Legionella in premise plumbing. Discussion will show some results that speak to the effectiveness of this treatment to control opportunistic pathogens.

Stroke prevention--a population screening day in district XII of Budapest.

Science.gov (United States)

Folyovich, András; Bakos, Mária; Kántor, Zita; Hertelendy, Anna; Horváth, Eszter; Zsiga, Katalin; Lakatos, Henriette; Vadasdi, Károly

2012-03-30

Along with advances in the treatment of acute stroke, new efforts have been made to enhance efficiency of the prevention of cerebrovascular diseases. Population screening is a way to contact high-risk patients, and there is an increasing international and national experience with the procedure. However, efforts are associated with high costs, so an efficient method, complying with local features, should be selected from the various methods. A stroke prevention day was organized in Szent János Hospital, localized in district XII, and data were analyzed. Taking advantage of the potentials of a large hospital, a comprehensive risk assessment - within the capacity of health care workers - was performed. Program and contact information of the screening day was published in the local newspaper of the district. Data of 48 residents of the district were analyzed. In addition to neurologists, a radiologist, a cardiologist and an ophtalmologist, as well as health care workers were involved in the project. A data sheet was filled in for all participants, including known risk factors, BMI, blood pressure and serum cholesterol levels. All participants had duplex sonography of the cervical vessels, cardiac evaluation and ophtalmic examination. Data were analyzed anonymously, and - if participants approved - postcode and educational level were also recorded. Among the 48 individuals screened, 35 were female and 13 were male. Average age was 62.86 (+/- 8.57) years, and participants were typically of higher educational level. 5 individuals had no known risk factors, most of them had 2-3 risk factors, and multiple risk factors were not uncommon. Individuals with six and seven risk factors were also found. 20 of 27 patients with known hypertension had target blood pressure levels. By duplex sonography, 36 individuals had mild, 4 had significant atherosclerosis. There was no significant carotid stenosis or occlusion. Based on ophtalmic evaluation, 26 patients had signs of vascular

Jordan Lake Watershed Protection District

Data.gov (United States)

Town of Chapel Hill, North Carolina — Polygon representing the area of the Jordan Lake Watershed Protection District. The Watershed Protection District (PDF) is a sensitive area of land that drains to...

Investigation of health care waste management in Binzhou District, China

International Nuclear Information System (INIS)

Ruoyan, Gai; Xu Lingzhong; Li Huijuan; Zhou Chengchao; He Jiangjiang; Yoshihisa, Shirayama; Tang Wei; Chushi, Kuroiwa

2010-01-01

In China, national regulations and standards for health care waste management were implemented in 2003. To investigate the current status of health care waste management at different levels of health care facilities (HCF) after the implementation of these regulations, one tertiary hospital, one secondary hospital, and four primary health care centers from Binzhou District were visited and 145 medical staff members and 24 cleaning personnel were interviewed. Generated medical waste totaled 1.22, 0.77, and 1.17 kg/bed/day in tertiary, secondary, and primary HCF, respectively. The amount of medical waste generated in primary health care centers was much higher than that in secondary hospitals, which may be attributed to general waste being mixed with medical waste. This study found that the level of the HCF, responsibility for medical waste management in departments and wards, educational background and training experience can be factors that determine medical staff members' knowledge of health care waste management policy. Regular training programs and sufficient provision of protective measures are urgently needed to improve occupational safety for cleaning personnel. Financing and administrative monitoring by local authorities is needed to improve handling practices and the implementation of off-site centralized disposal in primary health care centers.

VT Data - Overlay District 20170710, South Burlington

Data.gov (United States)

Vermont Center for Geographic Information — Overlay data for the City of South Burlington included in this data:Flood Plain Overlay DistrictTraffic Overlay DistrictInterstate Highway Overlay DistrictScenic...

Differences in Food and Beverage Marketing Policies and Practices in US School Districts, by Demographic Characteristics of School Districts, 2012

Science.gov (United States)

Michael, Shannon; Brener, Nancy D.; Coffield, Edward; Kingsley, Beverly S.; Zytnick, Deena; Blanck, Heidi

2016-01-01

Introduction Foods and beverages marketed in schools are typically of poor nutritional value. School districts may adopt policies and practices to restrict marketing of unhealthful foods and to promote healthful choices. Students’ exposure to marketing practices differ by school demographics, but these differences have not yet been examined by district characteristics. Methods We analyzed data from the 2012 School Health Policies and Practices Study to examine how food and beverage marketing and promotion policies and practices varied by district characteristics such as metropolitan status, size, and percentage of non-Hispanic white students. Results Most practices varied significantly by district size: a higher percentage of large districts than small or medium-sized districts restricted marketing of unhealthful foods and promoted healthful options. Compared with districts whose student populations were majority (>50%) non-Hispanic white, a higher percentage of districts whose student populations were minority non-Hispanic white (≤50% non-Hispanic white) prohibited advertising of soft drinks in school buildings and on school grounds, made school meal menus available to students, and provided families with information on school nutrition programs. Compared with suburban and rural districts, a higher percentage of urban districts prohibited the sale of soft drinks on school grounds and used several practices to promote healthful options. Conclusion Preliminary findings showing significant associations between district demographics and marketing policies and practices can be used to help states direct resources, training, and technical assistance to address food and beverage marketing and promotion to districts most in need of improvement. PMID:27978408

Accountability in district nursing practice: key concepts.

Science.gov (United States)

Griffith, Richard

2015-03-01

Public trust and confidence in district nurses is essential to the nurse-patient relationship that underpins effective care and treatment. That trust and confidence has even greater focus for district nurses who care for patients in their own homes. Those patients need to be able to count on the professionalism and probity of their district nurses. The professionalism and probity of district nurses is based on their accountability, which protects the public by imposing standards on district nurses and holds them answerable for their acts and omissions. This is the first of a series of articles on accountability in district nursing practice to mark the introduction of the revised Nursing and Midwifery Code on the 31 March 2015. This month's article considers the key concepts of accountability.

Assessment of pharmaceutical waste management at selected hospitals and homes in Ghana.

Science.gov (United States)

Sasu, Samuel; Kümmerer, Klaus; Kranert, Martin

2012-06-01

The practice of use and disposal of waste from pharmaceuticals compromises the safety of the environment as well as representing a serious health risk, as they may accumulate and stay active for a long time in the aquatic environment. This article therefore presents the outcome of a study on pharmaceutical waste management practices at homes and hospitals in Ghana. The study was conducted at five healthcare institutions randomly selected in Ghana, namely two teaching hospitals (hospital A, hospital B), one regional hospital (hospital C), one district hospital (hospital D) and one quasi-governmental hospital (hospital E). Apart from hospital E which currently has a pharmaceutical waste separation programmr as well as drug return programme called DUMP (Disposal of Unused Medicines Program), all other hospitals visited do not have any separate collection and disposal programme for pharmaceutical waste. A survey was also carried out among the general public, involving the questioning of randomly selected participants in order to investigate the household disposal of unused and expired pharmaceuticals. The results from the survey showed that more than half of the respondents confirmed having unused, left-over or expired medicines at home and over 75% disposed of pharmaceutical waste through the normal waste bins which end up in the landfills or dump sites.

Pre-ART retention in care and prevalence of tuberculosis among HIV-infected children at a district hospital in southern Ethiopia.

Science.gov (United States)

Westerlund, Emil; Jerene, Degu; Mulissa, Zewdie; Hallström, Inger; Lindtjørn, Bernt

2014-10-04

The Ethiopian epidemic is currently on the wane. However, the situation for infected children is in some ways lagging behind due to low treatment coverage and deficient prevention of mother-to-child transmission. Too few studies have examined HIV infected children presenting to care in low-income countries in general. Considering the presence of local variations in the nature of the epidemic a study in Ethiopia could be of special value for the continuing fight against HIV. The aim of this study is to describe the main characteristics of children with HIV presenting to care at a district hospital in a resource-limited area in southern Ethiopia. The aim was also to analyse factors affecting pre-ART loss to follow-up, time to ART-initiation and disease stage upon presentation. This was a prospective cohort study. The data analysed were collected in 2009 for the period January 2003 through December 2008 at Arba Minch Hospital and additional data on the ART-need in the region were obtained from official reports. The pre-ART loss to follow-up rate was 29.7%. Older children (10-14 years) presented in a later stage of their disease than younger children (76.9% vs. 45.0% in 0-4 year olds, chi-square test, χ2 = 8.8, P = 0.01). Older girls presented later than boys (100.0% vs. 57.1%, Fisher's exact test, P = 0.02). Children aged 0-4 years were more likely to be lost to follow-up (40.0 vs. 21.8%, chi-square test, χ2 = 5.4, P = 0.02) and had a longer time to initiate ART (Cox regression analysis, HR: 0.50, 95% CI: 0.25-0.97, P = 0.04, controlling for sex, place of residence, enrollment phase and WHO clinical stage upon presentation). Neither sex was overrepresented in the sample. Tuberculosis prevalence upon presentation and previous history of tubercolosis were 14.5% and 8% respectively. The loss to follow-up is alarmingly high and children present too late. Further research is needed to explore specific causes and possible solutions.

Simulation of hydrology and nitrate transport in the Hetao irrigation district, Inner Mongolia, China

Science.gov (United States)

Intensive agricultural activities in the Hetao irrigation district have severely degraded local aquatic ecosystems and water quality, and Ulansuhai Lake is now the most rapidly degrading eutrophic lake in China. A better understanding of the hydro-agronomic and pollutant transport processes in the a...

75 FR 43958 - Turlock Irrigation District and Modesto Irrigation District; Notice of Application for Amendment...

Science.gov (United States)

2010-07-27

... to the Turlock Irrigation District's Tuolumne Substation; (2) 23-mile-long, 69-kV Don Pedro-Hawkins Line extending from the Don Pedro switchyard to the Turlock Irrigation District's Hawkins Substation...

Understanding patients' behavioral intentions: evidence from Iran's private hospitals industry.

Science.gov (United States)

Zarei, Ehsan; Arab, Mohammad; Tabatabaei, Seyed Mahmoud Ghazi; Rashidian, Arash; Forushani, Abbas Rahimi; Khabiri, Roghayeh

2014-01-01

In the ever-increasing competitive market of private hospital industry, creating a strong relationship with the customers that shapes patients' loyalty has been considered a key factor in obtaining market share. The purpose of this paper is to test a model of customer loyalty among patients of private hospitals in Iran. This cross-sectional study was carried out in Tehran, the capital of the Islamic Republic of Iran in 2010. The study samples composed of 969 patients who were consecutively selected from eight private hospitals. The survey instrument was designed based on a review of the related literature and included 36 items. Data analysis was performed using structural equation modeling. For the service quality construct, three dimensions extracted: Process, interaction, and environment. Both process and interaction quality had significant effects on perceived value. Perceived value along with the process and interaction quality were the most important antecedents of patient overall satisfaction. The direct effect of the process and interaction quality on behavioral intentions was insignificant. Perceived value and patient overall satisfaction were the direct antecedents of patient behavioral intentions and the mediators between service quality and behavioral intentions. Environment quality of service delivery had no significant effect on perceived value, overall satisfaction, and behavioral intentions. Contrary to previous similar studies, the role of service quality was investigated not in a general sense, but in the form of three types of qualities including quality of environment, quality of process, and quality of interaction.

School District Cash Management. Program Audit.

Science.gov (United States)

New York State Legislative Commission on Expenditure Review, Albany.

New York State law permits school districts to invest cash not immediately needed for district operation and also specifies the kinds of investments that may be made in order to ensure the safety and liquidity of public funds. This audit examines cash management and investment practices in New York state's financially independent school districts.…

Reading a District Budget: Reporter Guide

Science.gov (United States)

McNeil, Michele

2013-01-01

Every school budget tells a story--about a district's spending plan, its priorities, goals, and financial health. The challenge is to wade through the jargon and numbers to unlock that story. Although budgets can vary significantly from district to district, and state to state, this primer seeks to introduce reporters to the fundamental components…

Interim district energy implementation

Energy Technology Data Exchange (ETDEWEB)

Fearnley, R.; Susak, W. [City of Vancouver, BC (Canada); Johnstone, I. [BCG Services Inc., Vancouver, BC (Canada)

2001-07-01

The concept of district energy was introduced in the City of North Vancouver, a city of 45,000, in 1997. A preliminary study was completed in 1997, followed by a tour of some district energy facilities in Finland in the same year. In 1999 a large district energy study was completed by a consultant. The study indicated the need for an investment of $15 million to implement district heating in the City. Lack of sufficient financial resources and immediately connectable heat load, the project was considered a non-starter. Some of the other factors leading to shelving the project included no current significant pricing advantages over competing energy sources and no current opportunity for cogeneration, given the low price that BC Hydro is willing to pay for independently produced power. The project, although shelved for the moment, has not been discarded. Planning and exploration are continuing, aided by the City's commitment to energy efficiency and conservation, its long term planning horizon and its significant influence over the development of some prime real estate.

Pediatric Hospital: The Paradigms of Play in Brazil.

Science.gov (United States)

de Macedo, Lino; da Silva, Gláucia Faria; Setúbal, Sandra Mutarelli

2015-01-29

The role of play in Brazilian children's hospitals is highlighted, as well as the perspective of humanization in Brazil. Some aspects of our culture are crucial to understanding the importance of play considering our society. Sabara Children's Hospital ("Hospital Infantil Sabará") in Brazil is used particularly to discuss humanization. To understand the issue of play in Brazil, it is important to discuss hospitals in their social context, their history, current roles in children's care, humanization history and child development, according to the approaches of Piaget and Winnicott that are used in our culture.

Regional District Attorney's Offices - Alaska Department of Law

Science.gov (United States)

District Stephen B. Wallace, District Attorney Physical Address: 204 Chief Eddie Hoffman Hwy. Bethel, AK Hours M-TH 8-4:30, F 8-12 Kenai - 3rd Judicial District Scot H. Leaders, District Attorney Trading Bay

Energy supply and urban planning projects: Analysing tensions around district heating provision in a French eco-district

International Nuclear Information System (INIS)

Gabillet, Pauline

2015-01-01

Through the analysis of energy supply choices, this article explores the way in which energy priorities and their climate-related features are incorporated into urban public policy. These choices must take account of different factors, as is the case with district heating, which is justified as a vehicle of renewable energy while subject to pressure in eco-districts because its techno-economic balances are destabilised by falls in demand. Our study focuses particularly on the city of Metz (France), which has chosen district heating as the primary source for provision for the municipal area and for its first eco-district. We analyse the tensions within these choices, with particular attention to the way in which they are negotiated inside municipal departments and with the local energy operator. This enables us to explore the tensions in defining the scale that governs decisions and the linkages between energy-related and urban priorities. - Highlights: • Analyses of tensions in the choice of energy supplies for eco-districts. •District heating networks can be vehicles of renewable energy. • District heating networks are threatened by drops in energy consumption. • Energy supply issues oppose urban planning and energy policy in municipal departments. • Technical and financial adjustments can be made by the municipality to justify its energy choices

Cholera in endemic districts in Uganda during El Niño rains: 2002 ...

African Journals Online (AJOL)

Background: El Niño phenomenon causing increased rainfall and flooding has been linked to flare ups and emergence of several disease outbreaks including cholera. The latter has been reported in many districts in Uganda in recent years. Therefore an understanding of factors influencing its pattern of occurrence is ...

New Mexico State Forestry Districts

Data.gov (United States)

Earth Data Analysis Center, University of New Mexico — This dataset contains boundaries of the New Mexico Forestry Districts, plus the names of the district offices. It is in a vector digital structure digitized from a...

Agricultural Land Use in Ahlat District

Directory of Open Access Journals (Sweden)

Necmettin ELMASTAŞ

2009-12-01

Full Text Available Ahlat district has suitable topography for growing of agricultural products. Almost half of Ahlat district is suitable for agricultural. Today, 32.7% of the land use in Ahlat is agricultural area. 90% of agricultural area is dry farming area. 10% of agricultural area is irrigated. 60.3%of land use in Ahlat district is pasturage area. The economy of Ahlat is based on agricultural and animal husbandry. Today, agricultural products such as wheat, potato and sugar beet are grown in agricultural areas. Ahlat district has some problems like unplanned production, irrigation and marketing.

Hospital accreditation: staff experiences and perceptions.

Science.gov (United States)

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

2018-06-11

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

Betrayed trust: healing a broken hospital through servant leadership.

Science.gov (United States)

Yancer, Deborah A

2012-01-01

An investigative reporter with The Washington Post broke the news of a no-confidence vote by the medical staff of a hospital in the suburbs of Washington, District of Columbia. The chaos that followed created a perfect storm for needed change and offered the rare opportunity for unbridled deep and creative collaboration. Issues the hospital faced as a result of this crisis and subsequent events that tested the authenticity of change are summarized. This article focuses on the approach used by the registered nurse chief executive officer (RN-CEO) to humanize the hospital, viewing it as though it were a patient and leading a clinical approach to organizational recovery and health. The relationship that developed between the medical staff leaders and the RN-CEO was pivotal to the hospital's recovery and evolved as a hybrid of servant leadership. Outcomes achieved over a 7-year period and attributable to this relational model are summarized. Finally, the RN-CEO shares lessons learned through experience and reflection and advice for nurses interested in pursuing executive leadership roles.

Ways of understanding the encounter with head and neck cancer patients in the hospital dental team--a phenomenographic study.

Science.gov (United States)

Röing, Marta; Hirsch, J-M; Holmström, Inger

2006-10-01

Head and neck cancer is the sixth most common malignancy in the world. Fifty percent of the patients can be cured by surgery, radiotherapy or a combination approach. Head and neck cancer is life-threatening, and treatment may leave the patient with visible facial disfigurements and impairment of functions such as speech and eating. This affects not only the patient, but may arouse difficult feelings in the treatment staff. Dental personnel are involved in all facets of treatment, yet they have no specific training in cancer care. The aim of this study was to describe the variation in ways dental personnel understand and experience the encounter with head and neck cancer patients, as the way of understanding a certain phenomenon is judged to be fundamental to the way we act and form our beliefs. Twenty members of hospital dental teams were interviewed. The interviews focused on experiences of the encounter with head and neck cancer patients. A qualitative research approach, phenomenography, was used in analysing the interviews. The encounter was perceived in three qualitatively different ways: as an act of caring, as a serious and responsible task and as an overwhelming emotional situation. The results indicate that hospital dental personnel are not able to lean on education and professional training in finding ways of dealing with situations with strong emotional impact. This has implications for the treatment of patients with head and neck cancer, as well as education of dental personnel.

Sociocultural factors contributing to teenage pregnancy in Zomba district, Malawi.

Science.gov (United States)

Kaphagawani, Nanzen Caroline; Kalipeni, Ezekiel

2017-06-01

This study explores sociocultural and other risk factors associated with unplanned teenage pregnancy in Zomba district of Malawi. Data were obtained from 505 participants under the age of 20 years using a questionnaire administered through face-to-face interviews held at five antenatal clinics. The data were analysed using descriptive statistics, frequency tables and chi-square analysis which allowed comparative understanding of the sociocultural risk factors for planned and unplanned teenage pregnancy in Zomba district. The findings revealed that teenage pregnancy is a major health and social problem. Over 76% of the teenage respondents in the study had experienced unplanned pregnancy. Among the prominent factors that stood out in the analysis for this high rate of teenage pregnancy were early sex and marriage, low contraceptive use, low educational levels, low socio-economic status, lack of knowledge of reproductive and sexual health, gender inequity, and physical/sexual violence. The consequences on teenage mothers of unplanned pregnancy have been tragic and have compromised their physical, psychological and socioeconomic wellbeing, not just on them but also their families and society at large. The findings point to the need for a multi-sectoral approach to tackle the problem on teenage pregnancy in this district, and likely throughout Malawi.

Prevalence and risk factors for infantile colic in District Mansehra

International Nuclear Information System (INIS)

Fazil, M.

2011-01-01

Objective: Infantile colic is a common problem among infants age 3 days to 3 months. It may affect parental feelings negatively and the parents may undertake all kinds of actions to stop excessive crying. The objective of this study was to assess the incidence of infantile colic and its risk factors in infants born in District Mansehra. Methods: In this prospective study, all those newborn babies were included who were born at King Abdullah Teaching Hospital Mansehra between January 1 2008 and March 31, 2008, and those newborn babies who were brought to children OPD for routine check-up and EPI centre for vaccination of this hospital during this time period. For every infant, gender, mode of delivery, gestational age at birth, birth weight, birth order, and mother's reproductive history were collected. These babies were seen at least once in a week up to 12 weeks and history from the mothers about the duration of crying and fussiness behaviour was recorded. At the end of 3 months the infants were again assessed and additional information on infant nutritional source was obtained and any medication used for colic relief was identified. Cases of colic were identified by applying Wessel criteria to recorded data. Chi-square tests were used. Results: From total 512 infants, follow-up was completed for 426 infants. In total, 90 infants (21.77%) satisfied the Wessel criteria for infantile colic. No statistical significance was found between colicky and non-colicky infants according to sex, gestational age at birth, birth weight, type of delivery, and, infant's feeding pattern. However, firstborn infants had higher rate for developing colic (p=0.03). Conclusion: Prevalence of colic was 21.77% in this infant population of District Mansehra. Except for birth order, no other variable was significantly associated with infantile colic. (author)

Repeat HIV testing during pregnancy and delivery: missed opportunities in a rural district hospital in Zambia.

Science.gov (United States)

Heemelaar, Steffie; Habets, Nicole; Makukula, Ziche; van Roosmalen, Jos; van den Akker, Thomas

2015-03-01

To assess coverage of repeat HIV testing among women who delivered in a Zambian hospital. HIV testing of pregnant women and repeat testing every 3 months during pregnancy and breastfeeding is the recommended policy in areas of high HIV prevalence. A prospective implementation study in a second-level hospital in rural Zambia. Included were all pregnant women who delivered in hospital during May and June 2012. Data regarding antenatal visits and HIV testing were collected by two investigators using a standardised form. Of 401 women who delivered in hospital, sufficient antenatal data could be retrieved for 322 (80.3%) women. Of these 322 women, 301 (93.5%) had attended antenatal care (ANC) at least once. At the time of discharge after delivery in hospital, 171 (53.1%) had an unclear HIV status because their negative test result was more than 3 months ago or of an unknown date, or because they had not been tested at all during pregnancy or delivery. An updated HIV status was present for 151 (46.9%) women: 25 (7.8%) were HIV positive and 126 (39.1%) had tested negative within the last 3 months. In this last group, 79 (24.5%) had been tested twice or more during pregnancy. During the study period, none of the women was tested during admission for delivery. Despite high ANC coverage, opportunities for repeat HIV testing were missed in almost half of all women who delivered in this hospital in a high-prevalence HIV setting. © 2014 John Wiley & Sons Ltd.

Understanding Technology and People Issues in Hospital Information System (HIS) Adoption: Case study of a tertiary hospital in Malaysia.

Science.gov (United States)

Zakaria, Nasriah; Mohd Yusof, Shafiz Affendi

Hospital Information Systems (HIS) can improve healthcare outcome quality, increase efficiency, and reduce errors. The government of Malaysia implemented HIS across the country to maximize the use of technology to improve healthcare delivery, however, little is known about the benefits and challenges of HIS adoption in each institution. This paper looks at the technology and people issues in adopting such systems. The study used a case study approach, using an in-depth interview with multidisciplinary medical team members who were using the system on a daily basis. A thematic analysis using Atlas.ti was employed to understand the complex relations among themes and sub-themes to discover the patterns in the data. . Users found the new system increased the efficiency of workflows and saved time. They reported less redundancy of work and improved communication among medical team members. Data retrieval and storage were also mentioned as positive results of the new HIS system. Healthcare workers showed positive attitudes during training and throughout the learning process. From a technological perspective, it was found that medical workers using HIS has better access and data management compared to the previously used manual system. The human issues analysis reveals positive attitudes toward using HIS among the users especially from the physicians' side. Copyright © 2016. Published by Elsevier Ltd.

Lack of patients? A hypothesis for understanding discrepancies between hospital resources and productivity.

Science.gov (United States)

Bratlid, Dag

2006-04-02

Despite a substantial increase in hospital resources, increased hospital admissions and out-patient visits, long waiting lists have been a significant problem in Norwegian health care. A detailed analysis of the development in resource allocation and productivity at St. Olavs University Hospital in central Norway was therefore undertaken. Resource allocation and patient volume was analysed during the period 1995 to 2001. Data were analysed both for emergency and elective admissions as well as outpatient visits specified into new referrals and follow-up consultations. Full time employee equivalents for doctors and nurses increased by 36.6% and 25.9%, respectively, and all employees by 28.1%. However, admitted patients, outpatient consultations and surgical procedures only increased by 10%, 15% and 8.3%, respectively. Thus, the productivity for each hospital employee, defined as operations pr. surgeon, outpatient consultations pr. doctor etc. was significantly reduced. A striking finding was that although the number of outpatient consultations increased, the number of new referrals actually went down and the whole increase in activity at the outpatient clinics could be explained by a substantial increase in follow-up consultations. This trend was more evident in the surgical departments, where some departments actually showed a reduction in total outpatient consultations. In view of the slow increase in hospital activity in spite of a significant increase in resources, it can be speculated that patient volume might be a limiting factor for hospital activity. The health market (patient population) might not be big enough in relation to the investments in increased production capacity (equipment and manpower).

Strategic management process in hospitals.

Science.gov (United States)

Zovko, V

2001-01-01

Strategic management is concerned with strategic choices and strategic implementation; it provides the means by which organizations meet their objectives. In the case of hospitals it helps executives and all employees to understand the real purpose and long term goals of the hospital. Also, it helps the hospital find its place in the health care service provision chain, and enables the hospital to coordinate its activities with other organizations in the health care system. Strategic management is a tool, rather than a solution, that helps executives to identify root causes of major problems in the hospital.

District heating in Flensburg

Energy Technology Data Exchange (ETDEWEB)

Prinz, W.

1981-01-01

The majority of our population, but also of our authorities, are still skeptical or even disapproving towards district heating. The reasons of this negative attitude are partly psychological - e.g. the individualism of the Swiss and their dislike for too centralised structures and ''forced connections'' - but also the existence of finished gas supply networks and the fear of considerable pre-investments and torn streets over years. The following article - held as a speech on the information meeting ''District heating and the possible contribution of nuclear energy'' organised by the Swiss Association for Atomic Energy in Bern shows a practical problem solving at the example of the district heating in Flensburg and deals with these questions.

Shortage of energy increases profitability of district heating

International Nuclear Information System (INIS)

2003-01-01

Increased demand will cause the price of district heating to increase, but not to the level of the price of electricity. The cheapest heating alternative in Denmark, Norway and Sweden is district heating. In Norway, district heating is developed primarily for commercial buildings and housing cooperatives. Thirty per cent of all buildings under construction are prepared for district heating and the percentage will increase strongly in the coming time. The total net production of district heating in Norway in 2001 was 2000 GWh, which is only a small part of the total potential for district heating

Corporate Social Responsibility in a Hospitality Organisation

DEFF Research Database (Denmark)

Justenlund, Anders; Rebelo, Sofia

the researchers with structures to set up an interview guide for future qualitative interviews. This research recognises the individual's motives for understanding and excercising CSR in the hospitality industry. The authors aim to construct an analytical framework taking as a starting point the understanding...... of implemented CSR-principles within an international hotel chain, recognised for its best practice. In the long term the intention is to learn how future hospitality professionals (present hospitality students) perceive CSR. The paper also includes refelctions on how different welfare state structures affect...

The effect of sporting events on emergency department attendance rates in a district general hospital in Northern Ireland.

Science.gov (United States)

McGreevy, A; Millar, L; Murphy, B; Davison, G W; Brown, R; O'Donnell, M E

2010-10-01

Previous studies have reported a conflicting relationship between the effect of live and televised sporting events on attendance rates to emergency departments (ED). The objectives of this study were to investigate the relationship of major sporting events on emergency department attendance rates and to determine the potential effects of such events on service provision. A retrospective analysis of ED attendances to a district general hospital (DGH) and subsequent admissions over a 24-h period following live and televised sporting activities was performed over a 5-year period. Data were compiled from the hospital's emergency record books including the number of attendances, patient demographics, clinical complaint and outcome. Review patients were excluded. Analysis of sporting events was compiled for live local, regional and national events as well as world-wide televised sporting broadcasts. A total of 137,668 (80,445 men) patients attended from April 2002 to July 2007. Mean attendance rate per day was 80 patients (men = 47). Mean admission rate was 13.6 patients per day. Major sporting events during the study period included; Soccer: 4 FA Cup and 1 World Cup (WC) finals; Rugby: 47 Six Nations, 25 Six nations games involving Ireland, 1 WC final, 2 WC semi-finals, 2 WC quarter-finals and 4 WC games involving Ireland; and Gaelic Football [Gaelic Athletic Association (GAA)]: 5 All-Ireland finals, 11 semi-finals, 11 quarter-finals and 5 provincial finals. There was a significantly higher patient admission rate during the soccer FA Cup final, Rugby Six Nations and games involving Ireland and for GAA semi- and quarter-final games (p = 0.001-0.01). There was no difference identified in total attendance or non-admission rates for sporting events throughout the study period. Although there was no correlation identified between any of these sporting events and total emergency department attendances (r 0.07), multinomial logistic regression demonstrated that FA Cup final (p

Association of oral health related quality of life with dental anxiety and depression along with general health among people of Bhopal district, Madhya Pradesh

Science.gov (United States)

Shet, RGK; Jain, Gaurvi; Maroli, Sohani; Srivastava, Kirti Jajoo; Kasina, Sitaram Prasad; Shwetha, GS

2013-01-01

Background: To associate oral health related quality of life with dental anxiety and depression along with general health among people of Bhopal district, Madhya Pradesh. Materials & Methods: A cross sectional questionnaires based survey was conducted among the subjects of Bhopal district, Madhya Pradesh. The survey was carried among 101 subjects aging from 20-40 years. Subjects under investigation were belonging to various occupations. They were assigned a questionnaire. Questionnaire consisted of four parts, first part consists of socio-demographic data along with dental visiting habits, second part has OHqOL-questionnaire, third part has general health (sf-12) and fourth part has hospital anxiety and depression questionnaire. Questionnaire was used for assessment of OHqOL. It consists of 16 questions which takes into account both effect and impact of oral health on quality of life. Dental anxiety and depression was measured by Hospital Anxiety and Depression Scale. Each question was provided with four options and numbering ranging from 0-3. For general health consideration sf-12 v2 was being used, which calculates two values PCS and MCS giving result in percentage. Results: A large proportion of respondent perceived oral health as having an enhanced effect on their quality of life in all three aspects that is general health, social and psychological. This is in stark contrast to other studies, where only physical aspects of oral health were more frequently considered to have the greatest overall impact of life quality compared with items relating to social, psychological and general health aspects. Conclusion: Gender variations were not apparent in the study. Both genders were likely to perceive oral health as it is impacting strongly on their quality of life. No significant gender variations are seen. But both have specific oral health needs and are most likely to utilize dental services which may be the key in understanding oral health behavior, including

Ontario Power Authority district energy research report : final report

International Nuclear Information System (INIS)

2010-02-01

This paper presented an analysis of the technical and economic characteristics of district energy in Ontario. The market context for district energy was evaluated, and institutional issues that may influence the future development and operation of district energy systems in Ontario were explored. Technical, economic, and environmental analyses of district energy based on different neighbourhood sizes, types, and district energy systems were presented. Three case studies were included to demonstrate real world district energy applications. A set of interviews conducted with representatives of the province's district energy supply chain was also provided in order to provide a framework for district energy opportunities and challenges within the province. 22 tabs., 16 figs.

Pediatric Hospital: The Paradigms of Play in Brazil

Directory of Open Access Journals (Sweden)

Lino de Macedo

2015-01-01

Full Text Available The role of play in Brazilian children’s hospitals is highlighted, as well as the perspective of humanization in Brazil. Some aspects of our culture are crucial to understanding the importance of play considering our society. Sabara Children’s Hospital (“Hospital Infantil Sabará” in Brazil is used particularly to discuss humanization. To understand the issue of play in Brazil, it is important to discuss hospitals in their social context, their history, current roles in children’s care, humanization history and child development, according to the approaches of Piaget and Winnicott that are used in our culture.

District Heating at Power Failures - Final Report; Fjaerrvaerme vid Elavbrott - Slutrapport

Energy Technology Data Exchange (ETDEWEB)

Lauenburg, Patrick; Johansson, Per-Olof

2008-11-15

Our society is vulnerable to prolonged power cuts. In cold weather interrupted heating is one of the most serious threats. District heating is available at most locations in Sweden and if heat can be transferred to the connected buildings at a power failure, it is of great importance for securing energy supply. In this work it was found that there are good opportunities for upholding heat supply at a power failure through self-circulation in connected radiator system, which has previously been overlooked. Self Circulation occurs when there is a sufficiently large temperature difference between forward and return line in the radiator system. The control and circulation in radiator systems will fail, but if the district heating water can continue to pass through the heat exchangers of the radiator systems self-circulation can occur. A prerequisite for self-circulation in the individual buildings to work is therefore to district heating network can operate at a power failure. District heating supply must have back to maintain the production and distribution of district heating, which is not always the case. Our studies show that there is every reason to this. Moreover there are customers that have their own reserve aggregates, such as hospitals, which are dependent on the district heating network function. In an extensive power failure, it may be desirable to establish a smaller grid, separate from backbone, using local electricity generation. The establishment of such a network requires there is local production which can start to loose voltage networks and has necessary control equipment for the frequency approach. In Malmoe, it is now possible to establish a such a network with the help of local production units. A prerequisite is that there are consumption of heating. It is not unusual for power plants (which produce both electricity and heat) is dependent on the pipe system for cooling the production of electricity. One can from the results also argue that every

Fisheries Districts

Data.gov (United States)

Vermont Center for Geographic Information — The Fisheries districts data layer is part of a larger dataset that contains administrative boundaries for Vermont's Agency of Natural Resources. The dataset...

Wastewater Districts

Data.gov (United States)

Vermont Center for Geographic Information — The Wastewater districts layer is part of a larger dataset that contains administrative boundaries for Vermont's Agency of Natural Resources. The dataset includes...

Wildlife Districts

Data.gov (United States)

Vermont Center for Geographic Information — The Wildlife Districts layer is part of a larger dataset contains administrative boundaries for Vermont's Agency of Natural Resources. The dataset includes feature...

Career Advancement Experiences of Hispanic Secondary Principals in Suburban School Districts: A Phenomenological Study

Science.gov (United States)

Fernandez, Rick

2013-01-01

Purpose: The purpose of this study was to examine the perceptions and experiences of Hispanic secondary school principals who work in suburban school districts regarding their career advancement. Moreover, the objective of this research was to understand these Hispanic principals' motivational drivers and barriers regarding their career choices,…

Analysis of Survival Rates Following Primary Surgery of 178 Consecutive Patients with Oral Cancer in a Large District General Hospital.

Science.gov (United States)

Stathopoulos, Panagiotis; Smith, William P

2017-06-01

The aim of this study is to present the survival rates in patients treated for oral cancer with primary surgery in a large district general hospital. We discuss the influence of the most significant prognostic factors on survival and compare our results with larger centres specializing in the management of oral cancer. All patients diagnosed with oral cancer from 1995 to 2006 and were treated in the Department had their details entered prospectively onto a computerized database. Demographic details of patients, type of treatment, pathological stage of tumor (TNM), local and regional recurrence rate, overall survival, disease specific survival and incidence of involved margins were recorded and calculated. Of the 178 patients, 96 (54 %) were alive and free of oral cancer 5 years after surgery. Forty-four patients died of oral cancer (24.7 %) but 38 (21.3 %) died of other causes. The overall survival rate after primary surgery in relation to stage was: I 84 %, II 71 %, III 36 % and IV 28 %. As almost half of our patients presented with advanced cancer and had discouraging survival rates, we emphasize the need for early recognition of the disease. Advanced disease signifies difficulty in obtaining clear margins which actually indicates a higher recurrence rate. 25 % of our patients died of oral cancer within 5 years of surgery which highlights the poor prognosis that recurrence carries after treatment. Effective educational campaign with purpose to raise oral cancer awareness and earlier referral may result in improvement of survival.

Effects of Community-Based Newborn Care Intervention on Neonate Health Status in a District of Tehran (Iran

Directory of Open Access Journals (Sweden)

Fatemeh Nayeri

2016-08-01

Full Text Available Objective: To identify the effects of community-based interventions on the Neonatal Health Index in one district of Tehran-Iran.Materials and methods: A community and healthcare center-based study was carried out from January 2011 through September 2014. The population of the study included newborns from mothers residing in the 4th district of Tehran, Iran. Demographic data of mothers and infants were recorded in questionnaires before and after intervention. Interventions were implemented in hospitals, participants' homes, and health centers. The primary outcomes were comparison of mean birth weight, weight gain during the first 3-7 days, first week visit rate, hospitalization rate between the before and after intervention groups.Results: The populations in the before and after intervention groups were 274 and 250, respectively. A significant difference was seen between the gestational ages (P value = 0.007 of the two groups. Mean birth height in the first group was 50.35 ± 3.48 and in the second group was 55 ± 5.32 cm (P value = 0.04. Neonatal complications in the second group were 6.9% lower than in the first group (P value = 0.048. In the first group 41 neonates (15% were hospitalized in the NICU while in the second group 12 cases (4.8% were hospitalized (P value = 0.018. Seven cases (2.6% in the first group and one case (0.4% in the second group were resuscitated (P value = 0.0001.Conclusion: The results of implementing community-based newborn care strategies witnessed at the first week postnatal visit included improvements inneonatal gestational growth, management of neonates with potentially serious illnesses, diagnosis of warning signs and neonatal care practices.

Sexual Harassment Policies in Florida School Districts.

Science.gov (United States)

Rienzo, Barbara A.; Moore, Michele Johnson

1998-01-01

Investigated the extent to which Florida's school districts complied with the Florida Department of Education's (FDOE) recommendations for addressing sexual harassment in schools. Surveys of district equity coordinators and analysis of policies indicated that most districts approved sexual harassment policies incorporating many FDOE…

Inpatient antibiotic consumption in a regional secondary hospital in New Zealand.

Science.gov (United States)

Hopkins, C J

2014-02-01

Reporting of antibiotic consumption in hospitals is a crucial component of antibiotic stewardship, but data from Australasian secondary hospitals are scarce. The hypothesis of this audit is that antibiotic consumption in secondary hospitals would be lower than in tertiary centres. The study aims to present the first published audit of antibiotic consumption from a secondary hospital in New Zealand compared with two tertiary centres. Hospital population-level data were retrospectively accessed to identify all systemic antibiotics dispensed to adult inpatients at Taranaki District Health Board during 2011. Consumption was calculated in defined daily doses per 100 inpatient-days and per 100 admissions, stratified by drug class. Comparison was against published data from two tertiary centres. Total consumption was lower, but that of high-risk antibiotic classes was higher than both tertiary centres. The relative consumption of lincosamides was 4.0 and 2.6 times higher than the two tertiary centres, with an associated 14% incidence of Clostridium difficile associated diarrhoea within 3 months. Our secondary hospital appears to consume the wrong types of antibiotic rather than too much. Data from all Australasian hospitals, stratified by clinical service area and hospital level, are required for clinically relevant benchmarking. © 2014 The Author; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

Warden Districts

Data.gov (United States)

Vermont Center for Geographic Information — This dataset is a representation overlay of warden (areas of responsibility). The Vermont Warden Districts layer is part of a dataset that contains administrative...

Park Districts

Data.gov (United States)

Vermont Center for Geographic Information — The Parks Districts layer is part of a dataset contains administrative boundaries for Vermont's Agency of Natural Resources. The dataset includes feature classes for...

Recent lake ice-out phenology within and among lake districts of Alaska, U.S.A.

Science.gov (United States)

Arp, Christopher D.; Jones, Benjamin M.; Grosse, Guido

2013-01-01

The timing of ice-out in high latitudes is a fundamental threshold for lake ecosystems and an indicator of climate change. In lake-rich regions, the loss of ice cover also plays a key role in landscape and climatic processes. Thus, there is a need to understand lake ice phenology at multiple scales. In this study, we observed ice-out timing on 55 large lakes in 11 lake districts across Alaska from 2007 to 2012 using satellite imagery. Sensor networks in two lake districts validated satellite observations and provided comparison with smaller lakes. Over this 6 yr period, the mean lake ice-out for all lakes was 27 May and ranged from 07 May in Kenai to 06 July in Arctic Coastal Plain lake districts with relatively low inter-annual variability. Approximately 80% of the variation in ice-out timing was explained by the date of 0°C air temperature isotherm and lake area. Shoreline irregularity, watershed area, and river connectivity explained additional variation in some districts. Coherence in ice-out timing within the lakes of each district was consistently strong over this 6 yr period, ranging from r-values of 0.5 to 0.9. Inter-district analysis of coherence also showed synchronous ice-out patterns with the exception of the two arctic coastal districts where ice-out occurs later (June–July) and climatology is sea-ice influenced. These patterns of lake ice phenology provide a spatially extensive baseline describing short-term temporal variability, which will help decipher longer term trends in ice phenology and aid in representing the role of lake ice in land and climate models in northern landscapes.

Energy Assessment of Automated Mobility Districts

Energy Technology Data Exchange (ETDEWEB)

Chen, Yuche [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

2017-08-03

Automated vehicles (AVs) are increasingly being discussed as the basis for on-demand mobility services, introducing a new paradigm in which a fleet of AVs displace private automobiles for day-to-day travel in dense activity districts. This project examines such a concept to displace privately owned automobiles within a region containing dense activity generators (jobs, retail, entertainment, etc.), referred to as an automated mobility district (AMDs). The project reviews several such districts including airport, college campuses, business parks, downtown urban cores, and military bases, with examples of previous attempts to meet the mobility needs apart from private automobiles, some with automated technology and others with more traditional transit based solutions. The issues and benefits of AMDs are framed within the perspective of intra-district, inter-district, and border issues, and the requirements for a modeling framework are identified to adequately reflect the breadth of mobility, energy, and emissions impact anticipated with AMDs.

Meeting the needs of vulnerable patients: The need for team working across general practice and community nursing services

Science.gov (United States)

While, Alison E

2014-01-01

General practitioners and district nurses have a long history of providing care outside the hospital setting. With health care increasingly moving out of the hospital setting, there are more opportunities for general practitioners and district nurses to work together to meet the health needs of the local population. However, the reduction in qualified specialist practitioner district nurses over the last decade is concerning. The need for an effective district nursing service has been recognised by the Department of Health in their own model – the nature of district nursing work, often over a long period, enables relationships to develop with the patient, family and informal carers as a basis for anticipatory care to manage long-term conditions. Communication and understanding of the role are central to enhance effective working between general practitioners and district nurses, which can be fostered by engagement in community-oriented integrated care and case management. PMID:25949736

An ecological study of food desert prevalence and 4th grade academic achievement in New York State school districts

Directory of Open Access Journals (Sweden)

Seth E. Frndak

2014-12-01

Full Text Available Background. This ecological study examines the relationship between food desert prevalence and academic achievement at the school district level. Design and methods. Sample included 232 suburban and urban school districts in New York State. Multiple open-source databases were merged to obtain: 4th grade science, English and math scores, school district demographic composition (NYS Report Card, regional socioeconomic indicators (American Community Survey, school district quality (US Common Core of Data, and food desert data (USDA Food Desert Atlas. Multiple regression models assessed the percentage of variation in achievement scores explained by food desert variables, after controlling for additional predictors.Results. The proportion of individuals living in food deserts significantly explained 4th grade achievement scores, after accounting for additional predictors. School districts with higher proportions of individuals living in food desert regions demonstrated lower 4th grade achievement across science, English and math. Conclusions. Food deserts appear to be related to academic achievement at the school district level among urban and suburban regions. Further research is needed to better understand how food access is associated with academic achievement at the individual level.

A good year for district heating

International Nuclear Information System (INIS)

Bakken, Stein Arne

2003-01-01

In Norway, high prices on electric power have caused economic progress for the district heating companies. The price of district heating is determined by the prices of power and fuel oil. However, the government wants to remove the tax on electricity to the industry, which is the district heating companies' major group of customers, along with public buildings. This is likely to entail a great loss of income

District heating in sequential energy supply

International Nuclear Information System (INIS)

Persson, Urban; Werner, Sven

2012-01-01

Highlights: ► European excess heat recovery and utilisation by district heat distribution. ► Heat recovery in district heating systems – a structural energy efficiency measure. ► Introduction of new theoretical concepts to express excess heat recovery. ► Fourfold potential for excess heat utilisation in EU27 compared to current levels. ► Large scale excess heat recovery – a collaborative challenge for future Europe. -- Abstract: Increased recovery of excess heat from thermal power generation and industrial processes has great potential to reduce primary energy demands in EU27. In this study, current excess heat utilisation levels by means of district heat distribution are assessed and expressed by concepts such as recovery efficiency, heat recovery rate, and heat utilisation rate. For two chosen excess heat activities, current average EU27 heat recovery levels are compared to currently best Member State practices, whereby future potentials of European excess heat recovery and utilisation are estimated. The principle of sequential energy supply is elaborated to capture the conceptual idea of excess heat recovery in district heating systems as a structural and organisational energy efficiency measure. The general conditions discussed concerning expansion of heat recovery into district heating systems include infrastructure investments in district heating networks, collaboration agreements, maintained value chains, policy support, world market energy prices, allocation of synergy benefits, and local initiatives. The main conclusion from this study is that a future fourfold increase of current EU27 excess heat utilisation by means of district heat distribution to residential and service sectors is conceived as plausible if applying best Member State practice. This estimation is higher than the threefold increase with respect to direct feasible distribution costs estimated by the same authors in a previous study. Hence, no direct barriers appear with

Forestry Districts

Data.gov (United States)

Vermont Center for Geographic Information — The Forestry Districts layer is part of a dataset that contains administrative boundaries for Vermont's Agency of Natural Resources. This is a layer file which...

The situation of district heating, district cooling and energy supply in Hungary

International Nuclear Information System (INIS)

Sigmond, Gy.

2009-01-01

District heating represents with 650.000 heated dwellings approximately 15% of the Hungarian residential heating market. Since 1990 there is stagnation at the number of connected dwellings because erection of large settlements with prefab buildings has been stopped, and latter ones represent more than 75% of the dwelling heating market. During the same period, residential heat demand shrunk by 33%, because metering of hot water consumption resulted in changing consumer habits, and because of slowly but step by step refurbishment of buildings and heating systems. In Hungary district heating is present in all large and most of the medium size cities, in 92 cities together. Out of them, there is also a single village with a local district heating system, which heats more than 60% of cottages. The capacity os systems is spreading to a large extent. Approximately 36-36% of all heated dwellings are in Budapest and in 10 large cities in the country, while 148 of the total 202 systems have less than 10 MW capacities. In the fuel structure of district heating it is characteristic the overwhelming role of natural gas consumption, which has exceeded 80% already. Only a few numbers of heating power plants are fuelled by crown coal. The use of renewables is growing continuous, but, together with waste and waste energy, it amounts merely 8% of the total fuel use. Oil consumption is negligible. Currently the most promising DH-market is the service sector (public buildings and commercial consumers). DH-companies can sell their surplus supply capacities on the competitive market. Residential market can be preserved only with better legal conditions and with improving of demand side management. The industrial heat market can be gained when the erection of new power plants will be harmonized with industrial development in the frame of territorial planning. District cooling is just at the beginning in Hungary. Many new commercial and office buildings are erected with air conditioning

The Role of School District Science Coordinators in the District-Wide Appropriation of an Online Resource Discovery and Sharing Tool for Teachers

Science.gov (United States)

Lee, Victor R.; Leary, Heather M.; Sellers, Linda; Recker, Mimi

2014-06-01

When introducing and implementing a new technology for science teachers within a school district, we must consider not only the end users but also the roles and influence district personnel have on the eventual appropriation of that technology. School districts are, by their nature, complex systems with multiple individuals at different levels in the organization who are involved in supporting and providing instruction. Varying levels of support for new technologies between district coordinators and teachers can sometimes lead to counterintuitive outcomes. In this article, we examine the role of the district science coordinator in five school districts that participated in the implementation of an online resource discovery and sharing tool for Earth science teachers. Using a qualitative approach, we conducted and coded interviews with district coordinators and teachers to examine the varied responsibilities associated with the district coordinator and to infer the relationships that were developed and perceived by teachers. We then examine and discuss two cases that illustrate how those relationships could have influenced how the tool was adopted and used to differing degrees in the two districts. Specifically, the district that had high support for online resource use from its coordinator appeared to have the lowest level of tool use, and the district with much less visible support from its coordinator had the highest level of tool use. We explain this difference in terms of how the coordinator's promotion of teacher autonomy took distinctly different forms at those two districts.

Patterns of malaria-related hospital admissions and mortality among Malawian children: an example of spatial modelling of hospital register data

Directory of Open Access Journals (Sweden)

Kleinschmidt Immo

2006-10-01