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Sample records for general hospital inpatients

  1. A qualitative study on nurses' reactions to inpatient suicide in a general hospital

    Directory of Open Access Journals (Sweden)

    Shujie Wang

    2016-12-01

    Conclusions: Nurses who experienced inpatient suicide became stressed. Effective interventions must be implemented to improve the coping mechanisms of nurses against the negative consequences of inpatient suicide. The findings of this study will allow administrators to gain insight into the impacts of inpatient suicides on nurses in general hospitals. Such information can be used to develop effective strategies and provide individual support and ongoing education. Consequently, nurses will acquire suicide prevention skills and help patients achieve swift recovery.

  2. Nurses' experiences of inpatients suicide in a general hospital

    African Journals Online (AJOL)

    Mirriam Matandela

    assist the nurses to deal with their emotions following experience of adverse events. Copyright .... gation. Inpatient suicide is an unnatural death that is reported ... were in fear of being disciplined and reported to the SANC. ... happened during the period 2008e2012 (Gauteng Provincial ... Discovering the body of the patient.

  3. Quality of psychiatric care in the general hospital: referrer perceptions of an inpatient liaison psychiatry service.

    Science.gov (United States)

    Solomons, Luke C; Thachil, Ajoy; Burgess, Caroline; Hopper, Adrian; Glen-Day, Vicky; Ranjith, Gopinath; Hodgkiss, Andrew

    2011-01-01

    To explore the experience of senior staff on acute medical wards using an established inpatient liaison psychiatry service and obtain their views on clinically relevant performance measures. Semistructured face-to-face interviews with consultants and senior nurses were taped, transcribed and analyzed manually using the framework method of analysis. Twenty-five referrers were interviewed. Four key themes were identified - benefits of the liaison service, potential areas of improvement, indices of service performance such as speed and quality of response and expanded substance misuse service. Respondents felt the liaison service benefited patients, staff and service delivery in the general hospital. Medical consultants wanted stepped management plans devised by consultant liaison psychiatrists. Senior nurses, who perceived themselves as frontline crisis managers, valued on-the-spot input on patient management. Consultants and senior nurses differed in their expectations of liaison psychiatry. Referrers valued speed of response and regarded time from referral to definitive management plan as a key performance indicator for benchmarking services. Copyright © 2011 Elsevier Inc. All rights reserved.

  4. Child and Adolescent Inpatient Unit in General Hospital “Tzaneio”

    Directory of Open Access Journals (Sweden)

    E. Tseva

    2017-01-01

    Full Text Available The Child and Adolescent Psychiatry Inpatient Service offers comprehensive diagnostic evaluation and treatment of children and adolescents (typical age ranges from 3-16 years old with a variety of emotional and behavioral problems including mood disorders, anxiety disorders, psychotic disorders, severe disruptive behavior, and suicide attempts. Treatment Team. The inpatient treatment team includes psychiatrists, psychologists, registered nurses, special education teacher, social worker, speech and occupational therapists. In addition, pediatricians from a full range of medical subspecialties are available for consultations. The multi-disciplinary staff emphasizes a family-oriented approach and parents and care-givers are encouraged to be active participants in the treatment team throughout a child’s stay. Treatment Program. The program offers developmentally appropriate therapeutic activities in a closely supervised environment. Extensive opportunities for observation, assessment, and intervention are possible in this intensive setting. Specialized assessments including neuropsychological testing, speech and language testing, and occupational therapy assessments are all available. Treatment plans typically include a combination of individual psychotherapy, behavior management, family counseling and medications. Staff members develop an individualized treatment plan emphasizing safety for each patient during the hospital stay. The plan is closely coordinated with families, outpatient providers, and resource programs to coordinate aftercare plans and facilitate a smooth transition to home.

  5. 42 CFR 441.12 - Inpatient hospital tests.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Inpatient hospital tests. 441.12 Section 441.12... General Provisions § 441.12 Inpatient hospital tests. Except in an emergency situation (see § 440.170(e)(1) of this chapter for definition), FFP is not available in expenditures for inpatient hospital tests...

  6. Recreational activities performed with neoplasia carrier Inpatients in a general hospital

    OpenAIRE

    2012-01-01

    This study aims at apprehending the contribution of recreational activities in the treatment of hospitalized cancer patients and identifying the most stimulating resources for them. This is a qualitative research of phenomenological nature, it was approved by the Ethics in Research Committee, Protocol 139/2010. It was conducted with patients with cancer in a general hospital, located in Alfenas, in March and April, 2011.The research began from these guiding questions: What are your thoughts o...

  7. Investigation on Depression of Inpatients in Medical Ward in General Hospital%综合医院内科住院病人抑郁状况调查

    Institute of Scientific and Technical Information of China (English)

    陈庆红; 舒德海; 刘宇宁; 曹伟; 张可

    2003-01-01

    Objective:To investigate the depression of inpatients in general hospital. Methods:252 inpatients in medical ward were investigated by SDS. Results:there were 100(39.7 % ) cases with depression symptoms according to SDS(SDS total scores 1>50) .There were significant correlations between the incidence of depression and kind of disease or education level. Conclusion:There are 39.7% patients with depression sympoms in medical ward of general hosoital.

  8. Hypokalaemia: Improving the investigation, management and therapeutic monitoring of hypokalaemic medical inpatients at a district general hospital.

    Science.gov (United States)

    Jordan, Mark; Caesar, Jenny

    2015-01-01

    Hypokalaemia is prevalent in 20% of hospitalised patients. Furthermore, inadequate management of hypokalemia was identified in 24% of these patients. Associated with significant patient morbidity and mortality, the identification, investigation, and treatment of hypokalaemia was identified as an area for improvement in the management of medical inpatients. The project aims to measure the assessment, management, and therapeutic monitoring of medical inpatients with hypokalaemia in a district general hospital. All medical inpatients over a one week period who met the criteria for hypokalaemia (serum potassium <3.5 mmol/L on standard biochemical sample) were included in the audit. Patient's notes were located and evaluated to identify if they had mild, moderate, or severe hypokalaemia. Further data on ECG requests, repeat U&Es, serum magnesium analysis, treatment prescribed, and medication review dates was collated. A re-audit was completed after the introduction of a set of interventions which included a hypokalaemia treatment algorithm. Pre-intervention analysis of all medical inpatients, who met our inclusion criteria for hypokalaemia, identified 32 patients. 25 of these patients met the criteria for mild hypokalaemia (3.1-3.4 mmol/L) and 7 met the criteria for moderate hypokalaemia (2.5-3.0 mmol/L). Only 7/32 (22 %) patients were receiving adequate treatment based on trust guidelines. Post intervention results showed marked improvement in the management of patients with hypokalaemia. A total of 30 patients were identified in this post-intervention group. There were 16/30 patients who qualified as mild hypokalaemia (3.1-3.4 mmol/L) and 14/30 with moderate hypokalaemia (2.5-3.0 mmol/L). 19/30 (63%) patients in the post-intervention group were correctly prescribed appropriate medication doses consistent with the treatment algorithm. Following the initial success of the project, analysis at 3 months showed a positive trend for sustained improvement when compared to

  9. Reducing transfers of psychiatric inpatients to emergency rooms of general hospitals in Singapore: a clinical practice improvement project.

    Science.gov (United States)

    Low, Tchern Kuang Lambert; Tay, Kai Hong; Fang, Tina; Fung, Daniel Shuen Sheng

    2017-03-01

    Patients admitted to a psychiatric hospital commonly suffer from comorbid medical problems which sometimes require urgent medical attention. Twenty-two percent of emergency medical transfers from the Institute of Mental Health (IMH) to the emergency rooms of general hospitals were preventable and could be managed at IMH itself. We undertook a quality improvement project to understand the reasons behind such preventable referrals and implemented changes to address this. Using the model for improvement, we deconstructed our processes and analysed root causes for such preventable referrals. Thereafter changes were implemented with Plan-Do-Study-Act (PDSA) cycles to analyse their outcomes. During the 6-month study period, we achieved a 100% reduction in preventable referrals through strategies aimed at reducing pressure on our on-call physicians in the making of medical decisions, maximising usage of our medical resources, constant education and raising awareness of this issue. Reducing preventable transfer of inpatients from a psychiatric hospital to the emergency departments of general hospitals is a worthwhile endeavour. Such initiatives optimise use of healthcare resources, improve patient care and increase satisfaction.

  10. Recreational activities performed with neoplasia carrier Inpatients in a general hospital

    Directory of Open Access Journals (Sweden)

    Caroline de Castro Moura

    2012-09-01

    Full Text Available This study aims at apprehending the contribution of recreational activities in the treatment of hospitalized cancer patients and identifying the most stimulating resources for them. This is a qualitative research of phenomenological nature, it was approved by the Ethics in Research Committee, Protocol 139/2010. It was conducted with patients with cancer in a general hospital, located in Alfenas, in March and April, 2011.The research began from these guiding questions: What are your thoughts on the recreational team work and the activities they do? What do you suggest for this group to be developed? It was perceived that ludic activities help patients to face the disease, that they eased the interaction between the recreational group and the multiprofessional team, besides providing a happy and welcoming environment. The most well accepted activities were music and games the clowns provided. We suggest implementing the humanization by using ludic resources.

  11. The frequency of smoking and problem drinking among general hospital inpatients in Brazil - using the AUDIT and Fagerström questionnaires

    Directory of Open Access Journals (Sweden)

    Neliana Buzi Figlie

    2000-09-01

    Full Text Available CONTEXT: Although the CAGE questionnaire is one of the most widely used alcohol screening instruments, it has been criticized for not identifying people who are drinking heavily or who have alcohol related problems but do not as yet show symptoms of alcohol dependence. The AUDIT (Alcohol Use Disorder Identification Test questionnaire was developed by WHO as a screening instrument specifically designed to identify problem drinkers, as well as those who were already dependent on alcohol. OBJECTIVE: The aim of this study was to use the AUDIT and Fagerström questionnaires in a general hospital inpatient population to measure the frequency of problem drinking and nicotine dependence, and to see if levels varied between medical speciality. DESIGN: Retrospective cross-sectional study. SETTING: Federally funded public teaching hospital. SAMPLE: 275 inpatients from both genders. MAIN MEASUREMENTS: Socio-demographic data, AUDIT (Alcohol Use Disorders Identification Test and Fagerström Test for Nicotine Dependence. RESULTS: We interviewed 275 inpatients, 49% of whom were men and 51% women. Thirty-four patients were identified as "cases" by the Audit questionnaire; 22% of the male patients and 3% of the females. Just over 21% of inpatients were current smokers. The gastroenterology (26% and general medicine (16% inpatient units had the largest number of individual cases. CONCLUSIONS: Only by knowing the prevalence of alcohol abuse/dependence and nicotine dependence in a general hospital can we evaluate the need for a specialized liaison service to identify and treat these patients.

  12. Antibiotic utilization evaluation of inpatient and outpatient prescriptions in a rural general hospital in Iran

    Directory of Open Access Journals (Sweden)

    Aida Sefidani Forough

    2015-06-01

    Conclusion: Our study showed that implementation of strict regulations for antibiotic use is extremely needed in this rural hospital. Establishing local guidelines, providing adequate education for healthcare professionals and putting restrictions for broad-spectrum antibiotic use can be beneficial. [Int J Basic Clin Pharmacol 2015; 4(3.000: 531-536

  13. Causes of Death in an Acute Psychiatric Inpatient Unit of a Portuguese General Hospital.

    Science.gov (United States)

    Barbosa, Sofia; Sequeira, Márcia; Castro, Sara; Manso, Rita; Klut Câmara, Catarina; Trancas, Bruno; Borja-Santos, Nuno; Maia, Teresa

    2016-08-01

    Introdução: Os doentes afectos de patologia psiquiátrica apresentam maior risco de morte, tanto por causas naturais como não naturais. Este estudo avalia as causas de morte de todos os doentes de uma unidade de internamento de agudos de Psiquiatria num hospital geral em Portugal, ao longo de dezasseis anos (de 1998 a 2013). Material e Métodos: Vinte e um doentes morreram na unidade de internamento de doentes agudos entre 1998 e 2013 (média 1,3 por ano). As características demográficas, os diagnósticos médicos e psiquiátricos foram recolhidos através de um estudo retrospectivo que consistiu na análise dos processos clínicos da amostra selecionada. Os doentes transferidos para outras enfermarias durante o internamento não foram incluídos no estudo. Resultados: As doenças do sistema circulatório foram as causas de morte mais prevalentes, ocorrendo em 2/3 dos doentes, incluindo embolismo pulmonar (n = 6), acidente vascular cerebral (n = 3), arritmia cardíaca (n = 2), enfarte agudo do miocárdio (n = 1), rutura de aneurisma da aorta abdominal (n = 1) e insuficiência cardíaca (n = 1). Dois doentes morreram de pneumonia e em quatro casos a causa de morte foi indeterminada. Apenas um caso de suicídio foi registado. Discussão: As doenças do aparelho circulatório foram as causas de morte mais frequentes nesta unidade de agudos. O suicídio em doentes internados, apesar de constituir um evento raro, é uma realidade que comporta consequências complexas para os profissionais de saúde, familiares e restantes doentes, devendo permanecer como foco de prevenção continuada. Conclusão: Os estudos de mortalidade são importantes para determinar a qualidade dos cuidados de saúde e criar recomendações para medidas preventivas.

  14. A CBT Approach to Inpatient Psychiatric Hospitalization

    Science.gov (United States)

    Masters, Kim J.

    2005-01-01

    During a psychiatric hospitalization of 5 to 10 days, cognitive-behavioral therapy (CBT) strategies can be used for the management of inpatients and to support the transition to outpatient treatment. This format was chosen after several years of frustration dealing with crisis inpatient care. The use of CBT is well known, and it seemed that an…

  15. Factors related to positive and negative outcomes in psychiatric inpatients in a General Hospital Psychiatric Unit: a proposal for an outcomes index

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    HUGO KARLING MORESCHI

    2015-02-01

    Full Text Available Background General Hospital Psychiatric Units have a fundamental importance in the mental health care systems. However, there is a lack of studies regarding the level of improvement of patients in this type of facility. Objective To assess factors related to good and poor outcomes in psychiatric inpatients using an index composed by clinical parameters easily measured. Methods Length of stay (LOS, Global Assessment of Functioning (variation and at discharge and Clinical Global Impression (severity and improvement were used to build a ten-point improvement index (I-Index. Records of psychiatric inpatients of a general hospital during an 18-month period were analyzed. Three groups (poor, intermediate and good outcomes were compared by univariate and multivariate models according to clinical and sociodemographic variables. Results Two hundred and fifty patients were included, with a percentage in the groups with poor, regular and good outcomes of 16.4%, 59,6% and 24.0% respectively. Poor outcome at the discharge was associated mainly with lower education, transient disability, antipsychotics use, chief complaint “behavioral change/aggressiveness” and psychotic features. Multivariate analysis found a higher OR for diagnoses of “psychotic disorders” and “personality disorders” and others variables in relation to protective categories in the poor outcome group compared to the good outcome group. Discussion Our I-Index proved to be an indicator of that allows an easy and more comprehensive evaluation to assess outcomes of inpatients than just LOS. Different interventions addressed to conditions such as psychotic disorders and disruptive chief complaints are necessary.

  16. Suicide risk among inpatients at a university general hospital Risco de suicídio em pacientes internados em um hospital geral universitário

    Directory of Open Access Journals (Sweden)

    Marianne Herrera Falceti Ferreira

    2007-03-01

    Full Text Available OBJECTIVE: To estimate the proportion of inpatients at a university general hospital who are at risk of committing suicide. METHOD: A random sample of 253 patients (57% males aged 18 years old or older, admitted to surgical and clinical wards, was assessed using the the Mini International Neuropsychiatric Interview, which has a section that evaluates the risk for suicide. Uni- and multivariate analyses were performed. RESULTS: There were 58 (23% patients with a risk for suicide, 13 (5% of total of whom presented a high risk. The prevalence of suicide risk was greater in young adult patients, those with no matrimonial relationship and those diagnosed with major depression (univariate analysis, Chi-squared test; p = 0.01, 0.03 and 0.0001, respectively. The multivariate analysis revealed that the risk for suicide in individuals younger than 30 years old was two fold higher than in those individuals between the ages of 30 and 59 years (OR = 0.45, 95% CI = 0.22-0.93; p = 0.03 and four fold greater than in those who were 60 years old or older (OR = 0.25, 95% CI = 0.1-0.64; p = 0.004. CONCLUSION: When young adults are admitted to general hospitals they should receive special attention due to their suicidal potential.OBJETIVO: Estimar a proporção de pacientes internados em um hospital geral universitário que têm risco de suicídio. MÉTODO: Uma amostra aleatória de 253 pacientes (57% do sexo masculino com 18 anos ou mais, internados em enfermarias clínicas e cirúrgicas, foi avaliada por meio do Mini International Neuropsychiatric Interview, o qual possui uma seção que avalia risco de suicídio. Foram realizadas analises uni e multivariadas. RESULTADOS: Cinqüenta e oito (23% pacientes tinham risco de suicídio, 13 dos quais (5% do total risco elevado. A prevalência de risco de suicídio foi maior em adultos jovens, nos que não tinham vínculo matrimonial e nos que tiveram um diagnóstico de depressão maior (análise univariada, teste do Qui

  17. Suicides following inpatient psychiatric hospitalization: A nationwide case control study.

    Science.gov (United States)

    Winkler, Petr; Mladá, Karolína; Csémy, Ladislav; Nechanská, Blanka; Höschl, Cyril

    2015-09-15

    Research shows the elevated risk of suicide associated with current or recent inpatient psychiatric hospitalization. However, it is unclear whether this applies in the area of post-communist Central and Eastern Europe where mental health care has not been deinstitutionalized yet. The present study aims to examine the rates of suicides among psychiatric patients during and shortly after discharge from inpatient hospitalization in the Czech Republic. All inpatient psychiatric hospitalizations and all suicides committed between 2008 and 2012 have been merged on an individual data basis. The time horizon between the admission and two months after the discharge from inpatient psychiatric facility was utilized and multiple logistic regression was performed to calculate the odds of committing suicide. A total of 137,290 inpatients were hospitalized in Czech psychiatric facilities between 2008 and 2012, and 402 of the inpatients committed suicide during the hospitalization or within the 2 months after the discharge. Highly elevated risks of suicides were found to be associated with being a male, having a history of multiple hospitalizations, and having a diagnosis of affective, anxiety, or personality disorder. Limitations are related to the design of the study, and its reliance on routinely collected data. Also, it was not possible to assess the odds of suicide associated with inpatient psychiatric hospitalization against the odds of suicide in general population. During psychiatric treatment and recovery, suicial behavior and idealiation is increased. In psychiatry, hospitalization may be a risky period for suicide behavior. Suicide rates during and soon after the psychiatric hospitalization identified in this study from Central and Eastern Europe are similar to the findings from Western Europe. Preventive strategies should be tailored accordingly. Copyright © 2015 Elsevier B.V. All rights reserved.

  18. Development of the 24/7 Nurse Practitioner Model on the Inpatient Pediatric General Surgery Service at a Large Tertiary Care Children's Hospital and Associated Outcomes.

    Science.gov (United States)

    Rejtar, Marketa; Ranstrom, Lee; Allcox, Christina

    Nurse practitioners (NPs) have been providing high-quality and safe patient care for a few decades, and evidence showing the extent of their impact is emerging. This article describes the implementation of a 24/7 NP patient care model on an inpatient pediatric general surgery service in a tertiary free-standing Children's Hospital in the Northeastern United States. The literature shows that there is limited evidence regarding NP models of care and their effect on patient outcomes. In response to policy changes leading to reduction of resident work hours and a more acute and complex inpatient pediatric general surgery patient population, our existing NP model evolved into a 24/7 NP Model in June 2011. The results from two quality improvement projects showed positive registered nurse and attending surgeon staff satisfaction with the 24/7 NP Model of care and a decreased trend of unplanned intensive care unit patient transfers after the 24/7 NP Model implementation. These findings further support the evidence in the literature that NPs provide safe and quality patient care. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

  19. Point-of-care testing of HbA1c in Type 2 diabetes care in general practice and the effect on hospital outpatient visits and inpatient admissions related to diabetes care:

    DEFF Research Database (Denmark)

    Kristensen, Troels

    admissions. Methods: Difference-in-differences models were applied at the GP clinic level to analyze the casual effects and event study analysis was used to visualize the effect over time. The fee was used to measure the amount of POCT of HbA1c. Outcomes in terms of diabetes patient hospital activity were...... was addressed through GP fixed effects as well as time-varying control variables. The parallel trend assumption was visually inspected and tested. Finally, the sensitivity of our results was assessed via event history analysis and different treatment definitions. Data: Panel data collected between the years...... level measures. Findings: There was no significant effect of POCT of HbA1c in general practice on hospital care in terms of reducing diabetes related outpatient hospital care visits, ordinary inpatient hospitalizations and hospital inpatient admissions for ACSCs. In a majority of the cases the parallel...

  20. Evolving Healthcare Quality in Top Tertiary General Hospitals in China during the China Healthcare Reform (2010-2012 from the Perspective of Inpatient Mortality.

    Directory of Open Access Journals (Sweden)

    Xie-Min Ma

    Full Text Available Healthcare reforms (HR initiated by many countries impacts on healthcare systems worldwide. Being one of fast developing countries, China launched HR in 2009. Better understanding of its impact is helpful for China and others in further pursuit of HR. Here we evaluate inpatient mortality, a proxy to healthcare quality, in 43 top tertiary hospitals in China during this critical period. This is a hospital-based observational study with 8 million discharge summary reports (DSR from 43 Chinese hospitals from 2010-2012. Using DSRs, we extract the vita status as the outcome, in addition to age, gender, diagnostic codes, and surgical codes. Nearly all hospitals have expanded their hospitalization capacities during this period. As of year 2010, inpatient mortality (IM across hospitals varies widely from 2‰ to 20‰. Comparing IM of year 2011 and 2012 with 2010, the overall IM has been substantially reduced (OR = 0.883 and 0.766, p-values<0.001, showing steady improvements in healthcare quality. Surgical IM correlates with the overall IM (correlation = 0.60, p-value <0.001, but is less uniform. Over these years, surgical IM has also been steadily reduced (OR = 0.890 and 0.793, p-values<0.001. Further analyses of treatments on five major diseases and six major surgeries revealed that treatments of myocardial infarction, cerebral hemorrhage and cerebral infarction have significant improvement. Observed temporal and spatial variations demonstrate that there is a substantial disparity in healthcare quality across tertiary hospitals, and that these hospitals are rapidly improving healthcare quality. Evidence-based assessment shed light on the reform impact. Lessons learnt here are relevant to further refining HR.

  1. Research on the Risk Management about Non-psychiatric Inpatient Suicide in General Hospital%综合医院非精神科住院患者自杀风险管理研究

    Institute of Scientific and Technical Information of China (English)

    刘书婷

    2015-01-01

    分析综合医院非精神科住院患者自杀的原因及其自杀风险评估现状,从识别综合医院住院患者自杀高危群体、建立综合医院住院患者自杀风险预警机制、防范综合医院高危人群自杀行为等3个方面提出了综合医院非精神科住院患者自杀风险管理建议,以期最大程度减少住院患者自杀行为的发生。%This paper analyzed the cause, current suicide risk assessment associated with non-psychiatric inpatients in general hospitals, so as to put forward a comprehensive hospital management recommendations to prevent non-psychiatric inpatients suicide, include:identifying inpa⁃tients suicide risk groups, establishing early warning mechanism of general hospital inpatients suicide, prevent them from suicide, getting the goal of the maximum degree of reducing suicidal incidence of hospitalized patients.

  2. 42 CFR 409.83 - Inpatient hospital coinsurance.

    Science.gov (United States)

    2010-10-01

    ... chargeable to a beneficiary for each day after the first 60 days of inpatient hospital care or inpatient CAH care or both in a benefit period. (2) For each day from the 61st to the 90th day, the coinsurance... the hospital long enough to use coinsurance days in 1982, the coinsurance amount charged for...

  3. 42 CFR 440.10 - Inpatient hospital services, other than services in an institution for mental diseases.

    Science.gov (United States)

    2010-10-01

    ... furnished by a hospital with a swing-bed approval. ... 42 Public Health 4 2010-10-01 2010-10-01 false Inpatient hospital services, other than services in...: GENERAL PROVISIONS Definitions § 440.10 Inpatient hospital services, other than services in an institution...

  4. Hazards of Hospitalization: Hospitalists and Geriatricians Educating Medical Students about Delirium and Falls in Geriatric Inpatients

    Science.gov (United States)

    Lang, Valerie J.; Clark, Nancy S.; Medina-Walpole, Annette; McCann, Robert

    2008-01-01

    Geriatric patients are at increased risk for complications from delirium or falls during hospitalization. Medical education, however, generally places little emphasis on the hazards of hospitalization for older inpatients. Geriatricians conducted a faculty development workshop for hospitalists about the hazards of hospitalization for geriatric…

  5. Inpatient hospital complications and lengths of stay: a short report

    Directory of Open Access Journals (Sweden)

    Johnson Pamela E

    2011-05-01

    Full Text Available Abstract Background Increasingly, efforts are being made to link health care outcomes with more efficient use of resources. The current difficult economic times and health care reform efforts provide incentives for specific efforts in this area. Findings This study defined relationships between inpatient complications for urinary tract infection and pneumonia and hospital lengths of stay in three general hospitals in the metropolitan area of Syracuse, New York. It employed the Potentially Preventable Complications (PPC software developed by 3M™ Health Information Services to identify lengths of stay for patients with and without urinary tract infection and pneumonia. The patient populations included individuals assigned to the same All Patients Refined Diagnosis Related Groups and severity of illness. The comparisons involved two nine month periods in 2008 and 2009. The study demonstrated that patients who experienced the complications had substantially longer inpatient hospital stays than those who did not. Patients with a PPC of urinary tract infection stayed a mean of 8.9 - 11.9 days or 161 - 216 percent longer than those who did not for the two time periods. This increased stay produced 2,020 - 2,427 additional patient days. The study demonstrated that patients who experienced the complications had substantially longer inpatient hospital stays than those who did not. Patients with a PPC of pneumonia stayed a mean of 13.0 - 16.3 days or 232 - 281 percent longer than those who did not for the two time periods. This increased stay produced 2,626 - 3,456 additional patient days. Similar differences were generated for median lengths of stay. Conclusions The differences in hospital stays for patients in the same APR DRGs and severity of illness with and without urinary tract infection and pneumonia in the Syracuse hospitals were substantial. The additional utilization for these complications was valued at between $2,000,000 - $3,000,000 for a

  6. Clinical Analysis of 87 Cases Inpatients with Herpes Zoster in General Hospital%住院患者发生带状疱疹87例临床分析

    Institute of Scientific and Technical Information of China (English)

    孙晓燕; 张美芳; 马小萍; 党倩丽

    2012-01-01

    Objective To investigate the risk facters of inpatients with herpes zoster during hosipitalitation in general hospital. Methods Eighty-seven cases of inpatients with herpes zoster were analyzed by a retrospective way from January 2007 to January 2010. Results Eighty-seven patients were infected herpes zoster during hosipitalitation in 86 975 inpatients (0. 10% ). Fifty-four patients were infected herpes zoster during hosipitalitation in 44 913 inpatients who were more than 50 years old (0.12% ). Thirty-three patients were infected herpes zoster in 42 062 inpatients who were less than 50 years old (0.08% ). Eighty-seven patients with herpes zoster during hosipitalitation were suffered with another disease, in which 33 patients with cardiovascular disease, 18 patients with cancer, 10 patients with diabetes mellitus. Conclusion Over 50 age, with Cardiovascular disease, cancer and diabetes mellitus were risk factors of inpatient with herpes zoster during hosipitalitation%目的 探讨住院患者发生带状疱疹的危险因素.方法 对2007年1月-2010年1月本院住院患者住院期间87例发生带状疱疹患者的临床资料进行回顾性分析.结果 86 975例住院患者中,住院期间发生带状疱疹87例(0.10%),其中50岁以上住院患者44 913例,发生带状疱疹54例(0.12%);年龄<50岁的住院患者42 062例,共发生带状疱疹33例(发生率0.08%);87例带状疱疹患者所患基础疾病包括:心脑血管病(34例)、恶性肿瘤(18例)和糖尿病(10例).结论 年龄> 50岁、伴有心脑血管疾病、糖尿病和恶性肿瘤等是住院患者发生带状疱疹的高危险因素.

  7. The utilization of antipsychotics in elderly inpatients of general hospital : clinical analysis%综合性医院老年住院患者抗精神病药物使用状况的临床分析

    Institute of Scientific and Technical Information of China (English)

    邢秋泓; 赵坤英; 解恒革

    2011-01-01

    Objective To study the utilization of antipsychotics and its potential effects on physiology and psychology in elderly inpatients of general hospital. Methods 280 inpatients ≥58y who were in the department of geriatrics in our hospital in November 2008 were investigated. Results Thirty-two(11. 4%) inpatients ≥80y received an antipsychotic drug,and 43. 8% of them took the drug for ≥12 months,56. 3% of them took the combination of hypnotics and sedatives. Most of the drugs were atypical antipsychotics. Dementia was the most frequently reported diagnoses a-mong the elderly inpatients using an antipsychotic agent(46. 9%). The main conditions for receiving antipsychotic treatment were the diagnosis of acute delirium or psychosis symptoms, depression and anxiety, and neuropsychiatric symptoms of dementia. Conclusions Dementia, delirium, depression and anxiety,and neuropsychiatric symptoms of dementia are the main causes of elderly inpatients in general hospital for using antipsychotics. Nearly two thirds of them use the combination of hypnotics and sedatives. The study findings suggest that there is a need to monitor antipsychotic drug use by elderly inpatients in general hospital in light of efficacy and safety of atypical agents.%目的 了解综合性医院老年住院患者抗精神病药物使用情况及其对生理心理的潜在影响.方法 选择2008年11月在我院老年病各科住院的、年龄≥58岁患者280例,随访2年,调查分析患者抗精神病药物的使用情况.结果 共32例惠者使用了抗精神病药物,年龄均≥80岁,绝大部分患者服用非经典抗精神病药物.痴呆患者占46.9%,痴呆是老年住院患者使用抗精神病药物的主要疾病.抗精神病药物的使用主要与急性谵妄或精神病性症状、焦虑抑郁、痴呆相关的精神行为症状等有关.43.8%的患者连续服用≥1年,56.3%的患者合用镇静催眠药.结论 痴呆、谵妄、焦虑抑郁症状是综合性医院老年住院

  8. Contribution of ED admissions to inpatient hospital revenue.

    Science.gov (United States)

    Sacchetti, Alfred; Harris, Russell H; Warden, Todd; Roth, Sandra

    2002-01-01

    Emergency department (ED) practices are traditionally profiled in terms of their patient encounters. Such evaluations reflect a preponderance of outpatient visits while crediting income from admitted patients to traditional hospital-based services. This study evaluates the contribution of ED admissions to inpatient hospital revenue. The study was set at an urban tertiary care community hospital with university affiliation. Information referable to ED patients was collected from the hospital's Universal Billing Code (UB-92)-based patient information warehouse. Data fields referable to hospital charges, insurance type, and disposition were used for analysis of a 1-year period from September 1, 1998 to August 31, 1999. Statistical analysis was through chi square and ANOVA. During the study period 33,174 patients were treated in the ED with 6,671 (20%) admitted to inpatient services. Total hospital charges for all ED patients during this time were $107 million dollars with $9.1 million (8.5%) generated from discharged patients and $98.0 million (91.5%) from admitted ED patients (P revenue for inpatient services for the study period was $288 million of which 34% was contributed from admitted ED patients. ED services represent a major source of inpatient hospital revenue. The recognition of the ED's potential in this area may be lost if income from patients admitted through the ED is credited to traditional hospital-based services.

  9. Prevalence and Clinical Characteristics of Depression in City General Hospital Inpatients%某市市级综合医院住院患者抑郁症检出率及临床特征

    Institute of Scientific and Technical Information of China (English)

    桑文华; 栗克清; 赵素银; 严保平; 魏昆岭; 张彦恒; 米琨; 徐保彦; 杨老虎; 孙秀丽; 孙振卿

    2016-01-01

    Objective :To investigate the prevalence and clinical characteristics of depression in Baoding municipal general hospital inpatients for the relevant departments to carry out the work to provide the basis of mental health . Methods :A hospital - based cross - sectional study was conducted in three - ranked general hospitals in Baoding cit‐y ,a total of 1306 patients completed general survey and self - rated Hospital Anxiety and Depression Scale .The pa‐tients whose HAD scores were 8 and above were interviewed by psychiatrists ,psychiatric diagnoses were made ac‐cording to the DSM - IV criteria by using the Mini International Neuropsychiatric Interview (M IN I) .Results :81 hospitalization cases were checked .the adjusted occurrence rate of depressive disorder of the inpatients in city general hospitals was 12 .8% ;Occurrence among the top five departments were cardiology department ,neurology depart‐ment ,digest and endocrinology department ,oncology and gynecology department .Conclusion :The occurrence of the major depressive disorder among the inpatients in general hospitals in Baoding City is higher ,many patients with de‐pression are associated with anxiety .%目的:了解保定市市级综合医院住院患者中抑郁症的检出率及临床特征,为相关部门开展精神卫生相关工作提供依据。方法:采用随机整群抽样方法抽取保定市市级综合医院住院患者共658名,进行一般情况问卷调查及医院用抑郁量表筛查,对量表筛查>8分者采用抑郁和焦虑自评量表评定并用简明国际神经精神障碍访谈检查中文版(Mini International Neuropsychiatric Interview ,MINI)诊断。结果:MINI 共诊断抑郁症患者81例,市级综合医院住院患者中抑郁症校正检出率为12.8%;抑郁症检出率排在前5位的科室是心内科15例(14.4%)、神经内科18例(14.3%)、肿瘤内科13例(14.1%)、消化及内分泌科12例(12.6

  10. 42 CFR 409.68 - Guarantee of payment for inpatient hospital or inpatient CAH services furnished before...

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Guarantee of payment for inpatient hospital or inpatient CAH services furnished before notification of exhaustion of benefits. 409.68 Section 409.68 Public... HOSPITAL INSURANCE BENEFITS Scope of Hospital Insurance Benefits § 409.68 Guarantee of payment...

  11. 综合性医院入院患者合并压疮的相关因素研究分析%Analysis of Related Factors of Inpatients with Pressure ulcers in General hospital

    Institute of Scientific and Technical Information of China (English)

    於琴; 秦玉霞

    2014-01-01

    Objective: To explore related factors of pressure ulcers of Inpatients in General hospital. Methods:Using uniform pressure ulcers assessment methods,pressure ulcers escalation process, conduct descriptive statistical analysis of reported data of inpatients with pressure ulcers of 2009-2012 in Anhui Provincial Hospital,and count its incidence. Results:Prevalence of inpatients with pressure ulcers was 0.611%. common in patients with COPD, cere-brovascular diseases and advanced tumors,the most common site was the sacral. Conclusion:Inpatients of≥60 years of age was the main crowd of pressure ulcers,and sacral, Intertrochanteric, and the heel were the main sites of pressure ulcers, high incidence of pressure ulcers was found in department of traditional respiratory medicine, emergency medicine and neurology medicine.%目的:探索综合性医院入院合并压疮的患者,其发生压疮的相关因素。方法:使用统一的压疮评估方法、压疮上报流程,对某医院2009~2012年入院患者合并压疮上报资料进行分项描述性统计分析,统计其发生率。结果:入院患者合并压疮患病率为0.611%。常见于慢性阻塞性肺炎、脑血管疾病、肿瘤晚期等患者。最常见部位是骶尾部。结论:≥60岁的入院患者是合并压疮的主要人群;骶尾部、股骨粗隆、足跟部是压疮主要发生部位;呼吸中医科、急诊内科、神经内科等科室是压疮高发科室。

  12. 77 FR 34326 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2012-06-11

    ... Assistance Program No. 93.773, Medicare--Hospital Insurance; and Program No. 93.774, Medicare-- Supplementary... 0938-AR12 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals' Resident...

  13. [Dual diagnosis in psychiatric inpatients: prevalence and general characteristics].

    Science.gov (United States)

    Rodríguez-Jiménez, Roberto; Aragüés, María; Jiménez-Arriero, Miguel Angel; Ponce, Guillermo; Muñoz, Antonio; Bagney, Alexandra; Hoenicka, Janet; Palomo, Tomás

    2008-06-01

    Comorbidity between a substance use disorder (SUD) and another psychiatric disorder is known as dual diagnosis. It is of great relevance due to its important clinical consequences and costs of care. There are practically no published studies on dual diagnosis prevalence in patients admitted to psychiatric hospitalization units in general hospitals (PHUGH) in our country. The objectives were to estimate the prevalence of dual diagnosis in psychiatric inpatients admitted consecutively to a Psychiatric Hospitalization Unit (Hospital Universitario 12 de Octubre, Madrid, Spain) in one year, to compare clinical and sociodemographic variables between the dual diagnosis group (DD group) and the group with a psychiatric disorder but no SUD (PD group), and to study the types of substances used. This is a retrospective study, based on the review of the clinical charts of the 257 patients admitted to this PHUGH in one year. The results showed that, excluding nicotine dependence, 24.9% of our inpatients had a SUD as well as another psychiatric disorder. A statistically significant predominance of men was found in the DD group, as well as a younger age at the time of the study, at the beginning of their psychiatric attention and on their first psychiatric admission, and they had received diagnoses of schizophrenia or related psychoses more often than the PD group, who had mostly affective disorders. The substances most frequently used in the DD group were alcohol (78.1%), cannabis (62.5%), and cocaine (51.6%). Due to the high prevalence and repercussions of dual diagnosis, it would be advisable to have specialized therapeutic programs for its treatment.

  14. Inpatient hospital care of children with trisomy 13 and trisomy 18 in the United States.

    Science.gov (United States)

    Nelson, Katherine E; Hexem, Kari R; Feudtner, Chris

    2012-05-01

    Trisomy 13 and trisomy 18 are generally considered fatal anomalies, with a majority of infants dying in the first year after birth. The inpatient hospital care that these patients receive has not been adequately described. This study characterized inpatient hospitalizations of children with trisomy 13 and trisomy 18 in the United States, including number and types of procedures performed. Retrospective repeated cross-sectional assessment of hospitalization data from the nationally representative US Kids' Inpatient Database, for the years 1997, 2000, 2003, 2006, and 2009. Included hospitalizations were of patients aged 0 to 20 years with a diagnosis of trisomy 13 or trisomy 18. The number of hospitalizations for each trisomy type ranged from 846 to 907 per year for trisomy 13 (P = .77 for temporal trend) and 1036 to 1616 per year for trisomy 18 (P < .001 for temporal trend). Over one-third (36%) of the hospitalizations were of patients older than 1 year of age. Patients underwent a total of 2765 major therapeutic procedures, including creation of esophageal sphincter (6% of hospitalizations; mean age 23 months), repair of atrial and ventricular septal defects (4%; mean age 9 months), and procedures on tendons (4%; mean age 8 years). Children with trisomy 13 and trisomy 18 receive significant inpatient hospital care. Despite the conventional understanding of these syndromes as lethal, a substantial number of children are living longer than 1 year and undergoing medical and surgical procedures as part of their treatment.

  15. 42 CFR 412.75 - Determination of the hospital-specific rate for inpatient operating costs based on a Federal...

    Science.gov (United States)

    2010-10-01

    ... inpatient operating costs based on a Federal fiscal year 1987 base period. 412.75 Section 412.75 Public... hospital-specific rate for inpatient operating costs based on a Federal fiscal year 1987 base period. (a) Base-period costs—(1) General rule. Except as provided in paragraph (a)(2) of this section, for...

  16. A comparison of suicides in psychiatric in-patients, after discharge and in not recently hospitalized individuals.

    Science.gov (United States)

    Deisenhammer, Eberhard A; Behrndt, Elisa-Marie; Kemmler, Georg; Haring, Christian; Miller, Carl

    2016-08-01

    Time of in-patient treatment and the first weeks after hospital discharge have repeatedly been described as periods of increased suicide risk. This study compared demographic, clinical and suicide related factors between in-patient, post-discharge and not recently hospitalized suicides. Suicide data from the Tyrol Suicide Register were linked with registers of three psychiatric hospitals in the state of Tyrol, Austria. Suicide cases then were categorized as in-patient suicides, post-discharge suicides (suicide within 12weeks after discharge) or never/not within 12weeks before death hospitalized suicides. Data were collected between 2004 and 2011. Of the total of 711 cases, 30 were in-patient, 89 post-discharge and 592 not recently hospitalized suicides. The three groups differed with regard to male-to-female ratio (lower in both hospitalized groups), marital status, suicide method used (jumping in in-patients, hanging in not recently hospitalized suicides), history of attempted suicide and suicide threats (highest in in-patients) and whether suicides had been in psychiatric or general practitioner treatment shortly before death. In most variables with significant differences there was a gradual increase/decrease with post-discharge suicides taking the middle place between the two other groups. The three suicide populations differed in a number of variables. Varying factors appear to influence suicide risk and choice of method differently in in-patient, post-discharge and not hospitalized suicides. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. 75 FR 68799 - Medicare Program; Inpatient Hospital Deductible and Hospital and Extended Care Services...

    Science.gov (United States)

    2010-11-09

    ... Hospital Deductible and Hospital and Extended Care Services Coinsurance Amounts for CY 2011 AGENCY: Centers... inpatient hospital deductible and the hospital and extended care services coinsurance amounts for services... (c) $141.50 for the 21st through 100th day of extended care services in a skilled nursing facility...

  18. 78 FR 61197 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2013-10-03

    ... Program No. 93.773, Medicare--Hospital Insurance; and Program No. 93.774, Medicare-- Supplementary Medical...-AR53 and 0938-AR73 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2014 Rates; Quality...

  19. 广州市综合医院住院患者抑郁障碍患病率调查%Prevalence of depressive disorder in inpatients in general hospitals in Guangzhou

    Institute of Scientific and Technical Information of China (English)

    苏敬华; 胡号应; 陈晓东; 陈夕圆; 梅芳; 卢慧贤; 杨宁

    2012-01-01

    目的 了解广州市综合医院住院患者抑郁障碍的患病及诊疗状况.方法 采用分层随机抽样法抽取广州市3家综合医院,在2010年10月25日~12月20日使用美国《精神疾病诊断与统计手册第四版》DSM-Ⅳ轴I障碍定式临床检查病人版(SCID)完成对≥16岁的539例住院患者的调查.结果 广州市综合医院各类抑郁障碍总的现患病率为12.24%(95% CI:9.48~15.01),其中重性抑郁障碍为5.94% (95% CI:3.94 ~7.93),未特定抑郁障碍为3.90% (95% CI:2.26~5.53).在66例抑郁障碍现患者中,仅有7例(10.61%)得到正确诊断,2例(3.03%%)接受治疗.抑郁障碍现患率女性显著高于男性(17.42% vs7.27%,RR =2.69,95%CI:1.54~4.69),内科高于外科(15.60% vs8.29%,RR =2.04,95% CI:1.15 ~3.65).结论 广州市综合医院住院患者抑郁障碍患病率高、识别率及治疗率低,应尽快制定相应措施以提高综合医院患者抑郁障碍的诊治率.%Objective To investigate the prevalence of depressive disorders and the care-seeking of depressed individuals in inpatients in general hospitals in Guangzhou. Methods 539 inpatients aged 16 years old and above screened from 3 general hospitals in Guangzhou by the means of stratified randomization sampling were interviewed with the Structured Clinical Interview for DSM-FV Axis I Disorders (SCID) from October 25, 2010 to December 20, 2010. Results The point prevalence of depressive disorders was 12. 24% (95% Cl;9.48 ~ 15.01) , that of major depression and not-otherwise-specified depressive disorders was 5. 94% (95% C/: 3. 94 ~7. 93) , 3. 90% (95% C1: 2. 26 ~ 5.53) respectively. Among the 66 patients with depressive disorder, only 7 cases (10. 61%) had been accurately diagnosed and only 2 cases (3.03% ) had been treated. The prevalence of depressive disorder was significandy higher in females than in males (17.42% vs. 7. 27% , RR =2. 69, 95% C1: 1. 54 ~4. 69), and was significantly higher in

  20. 综合医院老年住院患者谵妄影响因素及临床特点分析%Analysis on clinical features and influence factors of elderly in-patients' delirium in general hospitals

    Institute of Scientific and Technical Information of China (English)

    周敏; 刘中华; 佘子瑜; 梁群娣; 周霭婷

    2014-01-01

    目的 探讨综合医院老年住院患者发生谵妄的相关因素及临床特点.方法 回顾性分析2011年1月至2012年12月收治的年龄≥65岁、住院期间发生谵妄的33例患者的临床资料,同期年龄≥65岁的住院患者40例为对照组,将单因素分析差异有统计学意义的指标进行logistic回归分析,研究谵妄发生的影响因素并分析临床特点.结果 研究显示,低氧、机械通气、睡眠障碍、疼痛、电解质紊乱、低血压、重症监护室治疗≥24 h是发生谵妄的主要危险因素(P<0.05),两种以上疾病同时存在时谵妄发生的风险增加.结论 老年患者谵妄发生风险高,综合医院老年住院患者发生谵妄与多重因素相关,同时存在2种或2种以上疾病时风险明显增加,早期识别、控制危险因素、药物治疗是治疗谵妄的有效措施,尽早处理,多数患者可以改善,临床医生对高风险患者及低觉醒型谵妄应给予重视.%Objective To investigate the clinical features and relative factors of elderly inpatients' delirium in general hospitals.Methods A total of 73 elderly in-patients aged over 65 years from our hospital from January 2011 to December 2012 were randomly enrolled in the study.33 cases with the episode of delirium were assigned to the observation group,and 40 cases without delirium were subjected in the control group.The significant influencing factors from single factor analysis for delirium were investigated by logistic regression analysis.Results Multiple logistic repression analysis showed that the major risk factors for delirium were as follows:hypoxia,mechanical ventilation,dyssomnia,pain,electrolyte disorder,and hypotension intensive care time over 24 hours.Moreover,the risk of delirium was increased in the cases with more than one risk factor concurrently.Conclusion The elderly in-patients in general hospital are with higher risk of delirium related to multiple factors.When it comes more than one risk

  1. Variability in inpatient management of children hospitalized with bronchiolitis.

    Science.gov (United States)

    Macias, Charles G; Mansbach, Jonathan M; Fisher, Erin S; Riederer, Mark; Piedra, Pedro A; Sullivan, Ashley F; Espinola, Janice A; Camargo, Carlos A

    2015-01-01

    To determine the variability between hospitals in diagnostic testing and management interventions for children with bronchiolitis admitted to inpatient wards and identify its association with patient characteristics. A prospective, multicenter (16 hospitals), multiyear (2007-2010) observational study of children (age bronchiolitis. Outcomes included variability in diagnostic testing (complete blood count, chest radiographs) and medications or interventions (bronchodilator, systemic corticosteroid, antibiotic, IV placement) by hospital. A modified Respiratory Distress Severity Score was utilized to assess severity of illness. For all outcomes, intraclass correlation coefficient (ICC) was calculated from a model to estimate the random effects of hospital without added covariates and compared to ICCs from a second model that adjusted for demographic and clinical patient characteristics. A second unadjusted and adjusted model was created for age ≥ 2 months. Of 2207 subjects, 1715 were identified as admitted to inpatient wards. We observed wide variations in the proportion of patients who received diagnostic testing (complete blood count 21-75%, chest radiograph 36-85%) and medications/interventions (bronchodilators 19-91%, systemic corticosteroids 8-44%, antibiotics 17-43%, IV placement 38-93%). Adjusting for demographic and clinical patient characteristics did not materially affect the proportion of variability attributable to hospitals (differences in ICCs with and without model adjustment bronchiolitis treated on the inpatient wards at 16 US hospitals were not attributable to demographic or clinical patient characteristics. These results further support efforts to standardize care for bronchiolitis through active quality improvement strategies. Copyright © 2015 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  2. Hospital Related Stress Among Patients Admitted to a Psychiatric In-patient Unit in India

    Directory of Open Access Journals (Sweden)

    Latha KS

    2011-04-01

    Full Text Available The psychiatric patient’s attitudes towards hospitalization have found an association between patient perceptions of the ward atmosphere and dissatisfaction. The aim of the study was to determine the aspects of stress related to hospitalization in inpatients admitted to a psychiatric facility. Fifty in-patients of both sexes admitted consecutively to a psychiatric unit in a General Hospital were asked to rate the importance of, and their satisfaction with, 38 different aspects of in-patient care and treatment. Results showed that the major sources of stress were related to having a violent patient near to his/her bed; being away from family; having to stay in closed wards; having to eat cold and tasteless food; losing income or job due to illness, being hospitalized away from home; not able to understand the jargons used by the clinical staff and not getting medication for sleep. A well-differentiated assessment of stress and satisfaction has implications for the evaluation of the quality of psychiatric care and for the improvement of in-patient psychiatric care.

  3. Marijuana use and inpatient outcomes among hospitalized patients: analysis of the nationwide inpatient sample database.

    Science.gov (United States)

    Vin-Raviv, Neomi; Akinyemiju, Tomi; Meng, Qingrui; Sakhuja, Swati; Hayward, Reid

    2017-01-01

    The purpose of this paper is to examine the relationship between marijuana use and health outcomes among hospitalized patients, including those hospitalized with a diagnosis of cancer. A total of 387,608 current marijuana users were identified based on ICD-9 codes for marijuana use among hospitalized patients in the Nationwide Inpatient Sample database between 2007 and 2011. Logistic regression analysis was performed to determine the association between marijuana use and heart failure, cardiac disease, stroke, and in-hospital mortality. All models were adjusted for age, gender, race, residential income, insurance, residential region, pain, and number of comorbidities. Among hospitalized patients, marijuana use was associated with a 60% increased odds of stroke (OR: 1.60, 95% CI: 1.44-1.77) compared with non-users, but significantly reduced odds of heart failure (OR: 0.78, 95% CI: 0.75-0.82), cardiac disease (OR: 0.86, 95% CI: 0.82-0.91), or in-hospital mortality (OR: 0.41, 95% CI: 0.38-0.44). Among cancer patients, odds of in-hospital mortality was significantly reduced among marijuana users compared with non-users (OR: 0.44, 95% CI: 0.35-0.55). Hospitalized marijuana users were more likely to experience a stroke compared with non-users, but less likely to experience in-hospital mortality. Prospective studies will be needed to better characterize the health effects of marijuana use, especially among older, sicker, and/or hospitalized patients. In the meantime, conversations regarding marijuana use/misuse may be warranted in the clinical setting in order for patients and healthcare providers to adequately weigh the anticipated benefits of marijuana use with potentially significant health risks. © 2016 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

  4. Hospital-based inpatient resource utilization associated with autosomal dominant polycystic kidney disease in the US.

    Science.gov (United States)

    Blanchette, Christopher M; Craver, Christopher; Belk, Kathy W; Lubeck, Deborah P; Rossetti, Sandro; Gutierrez, Benjamin

    2015-04-01

    Polycystic kidney disease (PKD) is a clinically and genetically heterogeneous class of genetic disorders characterized by development of renal cysts leading to renal failure and end stage renal disease (ESRD). Autosomal dominant polycystic kidney disease (ADPKD) accounts for the majority of PKD cases and is the predominant monogenic cause of ESRD. Limited information on patient characteristics and healthcare resource utilization is available in this population. This study assessed hospital-based inpatient utilization of patients with ADPKD in the US to help further understand the disease, which may lead to treatments that delay progression and reduce healthcare resource utilization. A cross-sectional analysis was conducted using MedAssets Health System Data to investigate inpatient resource utilization for a total of 1876 patients hospitalized with ADPKD or chronic kidney disease (CKD). Patient characteristics and inpatient resource utilization were compared between hospitalized patients with ADPKD and CKD, including demographic and clinical characteristics, overall health, rates of complications and surgical interventions, and average length of hospital and intensive care unit stay. Compared with patients with CKD, patients with ADPKD were more likely to have commercial insurance as their primary payer (36.1 vs 17.8%) and were significantly younger (mean age 57.9 vs 69.5 years) and generally healthier (Charlson Comorbidity Score of 2.0 vs 3.3). Patients with ADPKD also had a substantially shorter average length of hospital stay (6.3 vs 10.3 days). However, patients with ADPKD experienced more kidney-related complications and a higher surgical procedure rate (mainly for transplant and complete nephrectomy). Although patients with ADPKD were generally healthier than patients with CKD, specific kidney function complications were more frequent. Patients with ADPKD had a higher rate of major kidney procedures, which may contribute to the high burden of ADPKD

  5. [Tasks performed by nurses at inpatient units in a training hospital].

    Science.gov (United States)

    Costa, Rita de Almeida; Shimizu, Helena Eri

    2005-01-01

    The purpose of this study was to identify and analyze tasks performed by nurses at inpatient units in a large general hospital in Brasilia, Federal District, which also functions as a training hospital. A quantitative, exploratory, descriptive study was carried out and involved a total of 612 hours of direct observation of the activities performed by 18 nurses at the General Medicine, Surgical, Pediatric and Maternity units. The tasks observed were classified as: administration, nursing care delivery, education and related to information system. Nurses dedicate a large part of their time to administrative tasks, followed by tasks related to nursing care delivery and information system, performing almost no educative tasks.

  6. Health System's Responsiveness of Inpatients: Hospitals of Iran.

    Science.gov (United States)

    Bazzaz, Mojtaba Mousavi; Taghvaee, Majid Reza Erfanian; Salehi, Maryam; Bakhtiari, Matin; Shaye, Zahra Abbasi

    2015-03-26

    Additional to improving health and ensuring equitable financing that are two predominant goals of health system, another important goal of health systems is responsiveness to people's non-medical expectations. In this study we try to assess the health system's responsiveness in academic and non-academic hospitals. This is a cross sectional study done in summer 2014 in Mashhad-Iran, we surveyed a total number of 403 inpatients by multi-stage sampling. A questionnaire of responsiveness and a check list included demographic variables and characteristics of hospitalization were completed by trained interviewers. Scales from 0 to 10 was applied for each questionnaire at the end of assessment of questions. 403 participants Took part in this survey from 10 hospitals (6 academic and 4 non-academic hospitals). 124(30.8%) were from non-academic and 279(69.2%) from academic hospitals 140(34.7%) of patients were male and 263(65.3%) were female. mean age of participants was 36.77±1.52 years. The mean total score of responsiveness was 7.12±1.31 in academic hospitals and 6.99±1.38 in non-academic hospitals, considered as good performance. There was no significant difference between total scores of these two groups (p=0.38). Health care responsiveness score was higher in private (8.35±0.95) than other kinds of hospitals and charity hospitals had the lowest score (5.98±0.51). Responsiveness of health care system at hospitals is an important parameter for measuring patients' perception of quality of health care. Although responsiveness rate of our hospitals are good but some components such as: choice health care providers, respect to autonomy of individuals, clear communication and confidentiality received lower responsiveness scores, therefore they require more attention and these domains can be the more significant choices that should be considered while designing improvement programs.

  7. A survey of in-patient ’s palliative needs in two general hospitals%两家综合性医院住院患者姑息照护需求的调查*

    Institute of Scientific and Technical Information of China (English)

    傅静; 王益平; 李德华

    2013-01-01

    Objective: To explore the in-patient’s needs of palliative care in general hospitals, and investigate the consistency between palliative care needs by doctors and nurses and according to GSF standard. To provide some suggestions for the practice of palliative care in general hospitals. Methods: The survey method involved questionnaire and interview. Results: 36% of the inpatients were in need of palliative care according to GSF standard,their average age was 78.89.5% of them were experiencing one or more complications, 27.3% of them were cancer victims and 72.7% were patients with non-malignant diseases. Both qualitative and quantitative study revealed the fact that paramedics’ evaluation and judgment of in-patient’s palliative care needs are not consistent with GSF standard. Conclusion: More efforts should be made to promote palliative care so that patients can live a relatively easy life in their final days.%目的:了解综合性医院环境中住院患者的姑息照护需求,了解不同方法确认患者姑息照护需求之间的一致性,为在综合性医院中开展姑息与临终关怀服务提供依据。方法:问卷调查法与访谈法。结果:根据GSF标准,超过三分之一(36%)的住院患者符合提供姑息照护的标准,平均年龄为78岁,绝大部分(89.5%)有一到多个并发症,多次住院治疗,癌症患者仅占27.3%,非恶性疾病患者占72.7%。医护人员对患者姑息照护需求的评估与判断与GSF标准缺乏一致性。结论:综合性医院应投入人力、物力与财力开展姑息照护服务,使得具有姑息照护需求的无治愈希望的患者能最大限度地提高生活质量。

  8. Techniques and Behaviors Associated with Exemplary Inpatient General Medicine Teaching: An Exploratory Qualitative Study.

    Science.gov (United States)

    Houchens, Nathan; Harrod, Molly; Moody, Stephanie; Fowler, Karen; Saint, Sanjay

    2017-07-01

    Clinician educators face numerous obstacles to their joint mission of facilitating high-quality learning while also delivering patient-centered care. Such challenges necessitate increased attention to the work of exemplary clinician educators, their respective teaching approaches, and the experiences of their learners. To describe techniques and behaviors utilized by clinician educators to facilitate excellent teaching during inpatient general medicine rounds. An exploratory qualitative study of inpatient teaching conducted from 2014 to 2015. Inpatient general medicine wards in 11 US hospitals, including university-affiliated hospitals and Veterans Affairs medical centers. Participants included 12 exemplary clinician educators, 57 of their current learners, and 26 of their former learners. In-depth, semi-structured interviews of exemplary clinician educators, focus group discussions with their current and former learners, and direct observations of clinical teaching during inpatient rounds. Interview data, focus group data, and observational field notes were coded and categorized into broad, overlapping themes. Each theme elucidated a series of actions, behaviors, and approaches that exemplary clinician educators consistently demonstrated during inpatient rounds: (1) they fostered positive relationships with all team members by building rapport, which in turn created a safe learning environment; (2) they facilitated patient-centered teaching points, modeled excellent clinical exam and communication techniques, and treated patients as partners in their care; and (3) they engaged in coaching and collaboration through facilitation of discussion, effective questioning strategies, and differentiation of learning among team members with varied experience levels. This study identified consistent techniques and behaviors of excellent teaching during inpatient general medicine rounds.

  9. 77 FR 69848 - Medicare Program; Inpatient Hospital Deductible and Hospital and Extended Care Services...

    Science.gov (United States)

    2012-11-21

    ...) of the Act requires us to determine and publish each year the amount of the inpatient hospital... (see section 1886(b)(3)(B)(xii)(II) of the Act), and an adjustment based on changes in the economy-wide.... In addition, section 1102(b) of the Social Security Act requires us to prepare a regulatory impact...

  10. Inpatient capacity at children's hospitals during pandemic (H1N1) 2009 outbreak, United States.

    Science.gov (United States)

    Sills, Marion R; Hall, Matthew; Fieldston, Evan S; Hain, Paul D; Simon, Harold K; Brogan, Thomas V; Fagbuyi, Daniel B; Mundorff, Michael B; Shah, Samir S

    2011-09-01

    Quantifying how close hospitals came to exhausting capacity during the outbreak of pandemic influenza A (H1N1) 2009 can help the health care system plan for more virulent pandemics. This ecologic analysis used emergency department (ED) and inpatient data from 34 US children's hospitals. For the 11-week pandemic (H1N1) 2009 period during fall 2009, inpatient occupancy reached 95%, which was lower than the 101% occupancy during the 2008-09 seasonal influenza period. Fewer than 1 additional admission per 10 inpatient beds would have caused hospitals to reach 100% occupancy. Using parameters based on historical precedent, we built 5 models projecting inpatient occupancy, varying the ED visit numbers and admission rate for influenza-related ED visits. The 5 scenarios projected median occupancy as high as 132% of capacity. The pandemic did not exhaust inpatient bed capacity, but a more virulent pandemic has the potential to push children's hospitals past their maximum inpatient capacity.

  11. Data Mining Application in Customer Relationship Management for Hospital Inpatients

    Science.gov (United States)

    2012-01-01

    Objectives This study aims to discover patients loyal to a hospital and model their medical service usage patterns. Consequently, this study proposes a data mining application in customer relationship management (CRM) for hospital inpatients. Methods A recency, frequency, monetary (RFM) model has been applied toward 14,072 patients discharged from a university hospital. Cluster analysis was conducted to segment customers, and it modeled the patterns of the loyal customers' medical services usage via a decision tree. Results Patients were divided into two groups according to the variables of the RFM model and the group which had significantly high frequency of medical use and expenses was defined as loyal customers, a target market. As a result of the decision tree, the predictable factors of the loyal clients were; length of stay, certainty of selectable treatment, surgery, number of accompanying treatments, kind of patient room, and department from which they were discharged. Particularly, this research showed that when a patient within the internal medicine department who did not have surgery stayed for more than 13.5 days, their probability of being a classified as a loyal customer was 70.0%. Conclusions To discover a hospital's loyal patients and model their medical usage patterns, the application of data-mining has been suggested. This paper suggests practical use of combining segmentation, targeting, positioning (STP) strategy and the RFM model with data-mining in CRM. PMID:23115740

  12. Data mining application in customer relationship management for hospital inpatients.

    Science.gov (United States)

    Lee, Eun Whan

    2012-09-01

    This study aims to discover patients loyal to a hospital and model their medical service usage patterns. Consequently, this study proposes a data mining application in customer relationship management (CRM) for hospital inpatients. A recency, frequency, monetary (RFM) model has been applied toward 14,072 patients discharged from a university hospital. Cluster analysis was conducted to segment customers, and it modeled the patterns of the loyal customers' medical services usage via a decision tree. Patients were divided into two groups according to the variables of the RFM model and the group which had significantly high frequency of medical use and expenses was defined as loyal customers, a target market. As a result of the decision tree, the predictable factors of the loyal clients were; length of stay, certainty of selectable treatment, surgery, number of accompanying treatments, kind of patient room, and department from which they were discharged. Particularly, this research showed that when a patient within the internal medicine department who did not have surgery stayed for more than 13.5 days, their probability of being a classified as a loyal customer was 70.0%. To discover a hospital's loyal patients and model their medical usage patterns, the application of data-mining has been suggested. This paper suggests practical use of combining segmentation, targeting, positioning (STP) strategy and the RFM model with data-mining in CRM.

  13. Health System’s Responsiveness of Inpatients: Hospitals of Iran

    Science.gov (United States)

    Bazzaz, Mojtaba Mousavi; Taghvaee, Majid Reza Erfanian; Salehi, Maryam; Bakhtiari, Matin; Shaye, Zahra Abbasi

    2015-01-01

    Introduction: Additional to improving health and ensuring equitable financing that are two predominant goals of health system, another important goal of health systems is responsiveness to people’s non-medical expectations. In this study we try to assess the health system’s responsiveness in academic and non-academic hospitals. Methods: This is a cross sectional study done in summer 2014 in Mashhad-Iran, we surveyed a total number of 403 inpatients by multi-stage sampling. A questionnaire of responsiveness and a check list included demographic variables and characteristics of hospitalization were completed by trained interviewers. Scales from 0 to 10 was applied for each questionnaire at the end of assessment of questions. Result: 403 participants Took part in this survey from 10 hospitals (6 academic and 4 non-academic hospitals). 124(30.8%) were from non-academic and 279(69.2%) from academic hospitals 140(34.7%) of patients were male and 263(65.3%) were female. mean age of participants was 36.77±1.52 years. The mean total score of responsiveness was 7.12±1.31 in academic hospitals and 6.99±1.38 in non-academic hospitals, considered as good performance. There was no significant difference between total scores of these two groups (p=0.38). Health care responsiveness score was higher in private (8.35±0.95) than other kinds of hospitals and charity hospitals had the lowest score (5.98±0.51). Conclusion: Responsiveness of health care system at hospitals is an important parameter for measuring patients’ perception of quality of health care. Although responsiveness rate of our hospitals are good but some components such as: choice health care providers, respect to autonomy of individuals, clear communication and confidentiality received lower responsiveness scores, therefore they require more attention and these domains can be the more significant choices that should be considered while designing improvement programs. PMID:26153210

  14. Recognition of mood disorders in elderly inpatients in a general hospital%综合医院老年住院患者情感障碍的识别

    Institute of Scientific and Technical Information of China (English)

    曾平; 孟波; 洪霞; 刘晓红

    2014-01-01

    目的:探讨对综合医院老年病房住院老年患者进行老年综合评估与精神科医师会诊相结合的方式对情感障碍的识别作用。方法某三级甲等医院老年病房2011年8月至2013年3月收治的≥65岁老年住院患者,在入院时进行包括Zung抑郁自评量表(SDS)和老年抑郁量表(GDS)15项在内的老年综合评估,由老年科医师决定是否进行多学科团队查房及精神科医师会诊。精神科医师根据国际疾病分类第10版(ICD-10)标准诊断情感障碍。结果研究期间共收治≥65岁老年住院患者281例,年龄(75.2±6.8)岁,男︰女为136︰145,其中49例(17.4%)患者罹患情感障碍,年龄(73.5±6.0)岁,男︰女为16︰33,其中抑郁发作39例,恶劣心境障碍5例,双相情感障碍2例,复发性抑郁2例,未特定抑郁障碍(NOS)1例,情感障碍患病率17.4%。确诊的49例患者中,提请精神科会诊的第一位原因分别为:有相关病史7例,医师注意到患者有情绪问题23例,失眠2例,存在疾病不能解释的躯体症状5例,量表筛查阳性12例。结论情感障碍是老年住院患者常见的精神疾患,采用老年综合评估与精神科医师会诊相结合的方式有利于识别老年情感障碍,是一种值得推广的老年精神医学服务模式。%Objective To determine the efficacy of comprehensive geriatric assessment combined with psychiatric consultation on the recognition of mood disorders in general hospitals. Methods Elderly inpatients (over 65 years old) admitted to a geriatrics ward in a class AAA general hospital from August 2011 to March 2013 were assessed with comprehensive geriatric assessment [Zung’s Self-rated Depression Scale (SDS) and Geriatric Depression Scale (GDS) -15) at admission. Geriatric interdisciplinary team services and psychiatric consultation were offered when it was necessary. Mood disorders were diagnosed by a psychiatrist

  15. 42 CFR 440.140 - Inpatient hospital services, nursing facility services, and intermediate care facility services...

    Science.gov (United States)

    2010-10-01

    ... Definitions § 440.140 Inpatient hospital services, nursing facility services, and intermediate care facility... 42 Public Health 4 2010-10-01 2010-10-01 false Inpatient hospital services, nursing facility services, and intermediate care facility services for individuals age 65 or older in institutions...

  16. 5 CFR 890.905 - Limits on inpatient hospital and physician charges.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Limits on inpatient hospital and physician charges. 890.905 Section 890.905 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT... Inpatient Hospital Charges, Physician Charges, and FEHB Benefit Payments § 890.905 Limits on...

  17. Quality of inpatient care in public and private hospitals in Sri Lanka.

    Science.gov (United States)

    Rannan-Eliya, Ravindra P; Wijemanne, Nilmini; Liyanage, Isurujith K; Dalpatadu, Shanti; de Alwis, Sanil; Amarasinghe, Sarasi; Shanthikumar, Shivanthan

    2015-03-01

    To compare the quality of inpatient clinical care in public and private hospitals in Sri Lanka. A retrospective, cross-sectional comparison was done of inpatient quality, in a sample of 11 public and 10 private hospitals in three of 25 districts. Data were collected for 55 quality indicators from medical records of 2523 public and 1815 private inpatient admissions. These covered treatment of asthma, acute myocardial infarction (AMI), childbirth and five other conditions, along with outcome indicators, and medicine prescribing indicators. Overall quality scores were better in the public sector than the private sector (77 vs 69%). Performance was similar for management of AMI and childbirth and somewhat better in the private sector for management of asthma. The public sector performed better in those indicators that are not constrained by resources (94 vs 81%), but worse in indicators that are highly resource intensive (10 vs 31%). Quality was comparable in assessment and investigation, but the public sector performed better in treatment and management (70 vs 62%) and drug prescribing (68 vs 60%), and modestly worse in terms of outcomes (92 vs 97%). For a range of indicators where comparisons were possible, quality of inpatient clinical care in Sri Lanka was comparable to levels reported from upper-middle income Asian countries, and often approaches that in developed countries, although the findings cannot be generalized. Quality in the public sector is better than in the private sector in many areas, despite spending being substantially less. Quality in public hospitals is resource constrained, and needs greater government investment for improvement, but when resource limitations are not critical, the public sector appears able to deliver equal or better quality than the private sector. Overall similarities in quality between the two sectors suggest the importance of physician training and other factors. Published by Oxford University Press in association with The

  18. Alcohol, cognitive impairment and the hard to discharge acute hospital inpatients.

    LENUS (Irish Health Repository)

    Popoola, A

    2012-02-03

    AIM: To examine the role of alcohol and alcohol-related cognitive impairment in the clinical presentation of adults in-patients less than 65 years who are \\'hard to discharge\\' in a general hospital. METHOD: Retrospective medical file review of inpatients in CUH referred to the discharge coordinator between March and September 2006. RESULTS: Of 46 patients identified, the case notes of 44 (25 male; age was 52.2 +\\/- 7.7 years) were reviewed. The average length of stay in the hospital was 84.0 +\\/- 72.3 days and mean lost bed days was 15.9 +\\/- 36.6 days. The number of patients documented to have an overt alcohol problem was 15 (34.1%). Patients with alcohol problems were more likely to have cognitive impairment than those without an alcohol problem [12 (80%) and 9 (31%) P = 0.004]. Patients with alcohol problems had a shorter length of stay (81.5 vs. 85.3 days; t = 0.161, df = 42, P = 0.87), fewer lost bed days (8.2 vs. 19.2 days; Mann-Whitney U = 179, P = 0.34) and no mortality (0 vs. 6) compared with hard to discharge patients without alcohol problem. CONCLUSION: Alcohol problems and alcohol-related cognitive impairment are hugely over-represented in acute hospital in-patients who are hard to discharge. Despite these problems, this group appears to have reduced morbidity, less lost bed days and a better outcome than other categories of hard to discharge patients. There is a need to resource acute hospitals to address alcohol-related morbidity in general and Wernicke-Korsakoff Syndrome in particular.

  19. Drug Administration Errors in Hospital Inpatients: A Systematic Review

    Science.gov (United States)

    Berdot, Sarah; Gillaizeau, Florence; Caruba, Thibaut; Prognon, Patrice; Durieux, Pierre; Sabatier, Brigitte

    2013-01-01

    Context Drug administration in the hospital setting is the last barrier before a possible error reaches the patient. Objectives We aimed to analyze the prevalence and nature of administration error rate detected by the observation method. Data Sources Embase, MEDLINE, Cochrane Library from 1966 to December 2011 and reference lists of included studies. Study Selection Observational studies, cross-sectional studies, before-and-after studies, and randomized controlled trials that measured the rate of administration errors in inpatients were included. Data Extraction Two reviewers (senior pharmacists) independently identified studies for inclusion. One reviewer extracted the data; the second reviewer checked the data. The main outcome was the error rate calculated as being the number of errors without wrong time errors divided by the Total Opportunity for Errors (TOE, sum of the total number of doses ordered plus the unordered doses given), and multiplied by 100. For studies that reported it, clinical impact was reclassified into four categories from fatal to minor or no impact. Due to a large heterogeneity, results were expressed as median values (interquartile range, IQR), according to their study design. Results Among 2088 studies, a total of 52 reported TOE. Most of the studies were cross-sectional studies (N=46). The median error rate without wrong time errors for the cross-sectional studies using TOE was 10.5% [IQR: 7.3%-21.7%]. No fatal error was observed and most errors were classified as minor in the 18 studies in which clinical impact was analyzed. We did not find any evidence of publication bias. Conclusions Administration errors are frequent among inpatients. The median error rate without wrong time errors for the cross-sectional studies using TOE was about 10%. A standardization of administration error rate using the same denominator (TOE), numerator and types of errors is essential for further publications. PMID:23818992

  20. Potentially avoidable inpatient nights among warfarin receiving patients; an audit of a single university teaching hospital.

    LENUS (Irish Health Repository)

    Forde, Dónall

    2009-01-01

    current admission.It was confirmed that, there are potentially avoidable nights in patients receiving OAT. The majority of this group were those being commenced on OAT for the first time (p = 0.00002), in the specialities of Cardiology, Cardiothoracic surgery and Care of the Elderly. The potential number of bed nights to be saved is 13 per week for the hospital or 1.1 bed nights per 10,000 general hospital admissions. These were predominantly weekday nights. The estimated cost of avoidable inpatient OAT dose optimization was approximately euro8300 per week. CONCLUSION: With rising costs and the increasing demands for acute hospital beds, alterations to inpatient management for this group of patients should be considered. Alternatives include increasing the size of current anticoagulation clinics, introduction of POCT (point of care testing) devices and increased GP management. POCT can be justified based upon the publication by Gardiner et al, who showed that 87% of patients find self testing straightforward, 87% were confident in the result they obtained using the devices and 77% preferred self testing.

  1. Acute psychiatric inpatient care: A cross-cultural comparison between two hospitals in Germany and Japan

    OpenAIRE

    2012-01-01

    Background: Intercultural differences influence acute inpatient psychiatric care systems. Aims: To evaluate characteristics of acute inpatient care in a German and a Japanese hospital. Method: Based on a sample of 465 admissions to the Psychiatric State Hospital Regensburg (BKR) and 91 admissions to the Hirakawa Hospital (HH) over a six-month period in 2008, data from the psychiatric basic documentation system (BADO) were analysed with regard to socio-demographic characteristics, treatm...

  2. 42 CFR 405.1206 - Expedited determination procedures for inpatient hospital care.

    Science.gov (United States)

    2010-10-01

    ... hospital care. 405.1206 Section 405.1206 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT... Hospital Discharges § 405.1206 Expedited determination procedures for inpatient hospital care. (a... expedited determination by the QIO when a hospital (acting directly or through its utilization review...

  3. A Thorn in the Flesh? Forensic Inpatients in General Psychiatry

    DEFF Research Database (Denmark)

    Møllerhøj, Jette; Stølan, Liv Os; Brandt-Christensen, Anne Mette

    2016-01-01

    of staff identify the care of mentally disordered offenders in general psychiatric units as either "a parking space" or a very difficult or frightening course, where staff members tend to behave like pleasers in order to avoid risks of conflict or physical violence. Either way, it seems hard to provide......PURPOSE: To illuminate whether and how taking care of forensic inpatients is experienced as a burden among staff and managers in general psychiatry. DESIGN AND METHODS: Qualitative analytical strategies based on interviews and questionnaires. FINDINGS: The interplay between physical environment...... sufficient mental health care. PRACTICE IMPLICATIONS: Nationwide training and teaching as well as knowledge exchange between specialized forensic psychiatry and general psychiatry are recommended. Further exploration is needed on patient perspectives and on avenues to increase efficiency and decrease...

  4. Changes to Hospital Inpatient Volume After Newspaper Reporting of Medical Errors.

    Science.gov (United States)

    Fukuda, Haruhisa

    2017-06-30

    The aim of this study was to investigate the influence of medical error case reporting by national newspapers on inpatient volume at acute care hospitals. A case-control study was conducted using the article databases of 3 major Japanese newspapers with nationwide circulation between fiscal years 2012 and 2013. Data on inpatient volume at acute care hospitals were obtained from a Japanese government survey between fiscal years 2011 and 2014. Panel data were constructed and analyzed using a difference-in-differences design. Acute care hospitals in Japan. Hospitals named in articles that included the terms "medical error" and "hospital" were designated case hospitals, which were matched with control hospitals using corresponding locations, nurse-to-patient ratios, and bed numbers. Medical error case reporting in newspapers. Changes to hospital inpatient volume after error reports. The sample comprised 40 case hospitals and 40 control hospitals. Difference-in-differences analyses indicated that newspaper reporting of medical errors was not significantly associated (P = 0.122) with overall inpatient volume. Medical error case reporting by newspapers showed no influence on inpatient volume. Hospitals therefore have little incentive to respond adequately and proactively to medical errors. There may be a need for government intervention to improve the posterror response and encourage better health care safety.

  5. Are You a Hospital Inpatient or Outpatient? If You have Medicare -- Ask!

    Science.gov (United States)

    ... information on how Medicare covers hospital services, including premiums, deductibles, and copayments, visit Medicare.gov/publications to ... an inpatient day. What are my rights? No matter what type of Medicare coverage you have, you ...

  6. Interventions to improve antibiotic prescribing practices for hospital inpatients.

    Science.gov (United States)

    Davey, Peter; Brown, Erwin; Charani, Esmita; Fenelon, Lynda; Gould, Ian M; Holmes, Alison; Ramsay, Craig R; Wiffen, Philip J; Wilcox, Mark

    2013-04-30

    The first publication of this review in Issue 3, 2005 included studies up to November 2003. This update adds studies to December 2006 and focuses on application of a new method for meta-analysis of interrupted time series studies and application of new Cochrane Effective Practice and Organisation of Care (EPOC) Risk of Bias criteria to all studies in the review, including those studies in the previously published version. The aim of the review is to evaluate the impact of interventions from the perspective of antibiotic stewardship. The two objectives of antibiotic stewardship are first to ensure effective treatment for patients with bacterial infection and second support professionals and patients to reduce unnecessary use and minimize collateral damage. To estimate the effectiveness of professional interventions that, alone or in combination, are effective in antibiotic stewardship for hospital inpatients, to evaluate the impact of these interventions on reducing the incidence of antimicrobial-resistant pathogens or Clostridium difficile infection and their impact on clinical outcome. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE from 1980 to December 2006 and the EPOC specialized register in July 2007 and February 2009 and bibliographies of retrieved articles. The main comparison is between interventions that had a restrictive element and those that were purely persuasive. Restrictive interventions were implemented through restriction of the freedom of prescribers to select some antibiotics. Persuasive interventions used one or more of the following methods for changing professional behaviour: dissemination of educational resources, reminders, audit and feedback, or educational outreach. Restrictive interventions could contain persuasive elements. We included randomized clinical trials (RCTs), controlled clinical trials (CCT), controlled before-after (CBA) and interrupted time series studies (ITS). Interventions

  7. Interventions to improve antibiotic prescribing practices for hospital inpatients.

    Science.gov (United States)

    Davey, Peter; Marwick, Charis A; Scott, Claire L; Charani, Esmita; McNeil, Kirsty; Brown, Erwin; Gould, Ian M; Ramsay, Craig R; Michie, Susan

    2017-02-09

    Antibiotic resistance is a major public health problem. Infections caused by multidrug-resistant bacteria are associated with prolonged hospital stay and death compared with infections caused by susceptible bacteria. Appropriate antibiotic use in hospitals should ensure effective treatment of patients with infection and reduce unnecessary prescriptions. We updated this systematic review to evaluate the impact of interventions to improve antibiotic prescribing to hospital inpatients. To estimate the effectiveness and safety of interventions to improve antibiotic prescribing to hospital inpatients and to investigate the effect of two intervention functions: restriction and enablement. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library), MEDLINE, and Embase. We searched for additional studies using the bibliographies of included articles and personal files. The last search from which records were evaluated and any studies identified incorporated into the review was January 2015. We included randomised controlled trials (RCTs) and non-randomised studies (NRS). We included three non-randomised study designs to measure behavioural and clinical outcomes and analyse variation in the effects: non- randomised trials (NRT), controlled before-after (CBA) studies and interrupted time series (ITS) studies. For this update we also included three additional NRS designs (case control, cohort, and qualitative studies) to identify unintended consequences. Interventions included any professional or structural interventions as defined by the Cochrane Effective Practice and Organisation of Care Group. We defined restriction as 'using rules to reduce the opportunity to engage in the target behaviour (or increase the target behaviour by reducing the opportunity to engage in competing behaviours)'. We defined enablement as 'increasing means/reducing barriers to increase capability or opportunity'. The main comparison was between intervention and

  8. Redesigning the Medicare inpatient PPS to reduce payments to hospitals with high readmission rates.

    Science.gov (United States)

    Averill, Richard F; McCullough, Elizabeth C; Hughes, John S; Goldfield, Norbert I; Vertrees, James C; Fuller, Richard L

    2009-01-01

    A redesign of the Medicare inpatient prospective payment system (IPPS) that reduces payments to hospitals that have high-risk adjusted readmission rates is proposed. The redesigned IPPS uses a readmission performance standard from best practice hospitals to determine the risk-adjusted number of excess readmissions in a hospital and determines the payment reduction for a hospital based on its excess number of readmissions. Extrapolating from Florida Medicare 2004-2005 discharge data, the redesigned IPPS is estimated to reduce overall annual Medicare inpatient expenditures nationally by $1.25, 1.92, and 2.58 billion for readmission windows of 7, 15, and 30 days, respectively.

  9. A Thorn in the Flesh? Forensic Inpatients in General Psychiatry.

    Science.gov (United States)

    Møllerhøj, Jette; Stølan, Liv Os; Brandt-Christensen, Mette

    2016-01-01

    To illuminate whether and how taking care of forensic inpatients is experienced as a burden among staff and managers in general psychiatry. Qualitative analytical strategies based on interviews and questionnaires. The interplay between physical environment, bottlenecks, poor information exchange, lack of knowledge and competences, complex psychopathology, and a vague and therefore uncomfortable task of nursing leads to a focus on criminal offenses rather than mental disorders and an increased risk of brutalization and stigmatization in nursing practices. Members of staff identify the care of mentally disordered offenders in general psychiatric units as either "a parking space" or a very difficult or frightening course, where staff members tend to behave like pleasers in order to avoid risks of conflict or physical violence. Either way, it seems hard to provide sufficient mental health care. Nationwide training and teaching as well as knowledge exchange between specialized forensic psychiatry and general psychiatry are recommended. Further exploration is needed on patient perspectives and on avenues to increase efficiency and decrease bottlenecks throughout the clinical pathways. Furthermore, we need additional knowledge of the impact on general patient populations' resources for treatment and their safety. © 2015 Wiley Periodicals, Inc.

  10. A cross sectional study of satisfaction of in-patients in a private medical college hospital in A.P

    Directory of Open Access Journals (Sweden)

    Rajagopal Rao Kodali

    2011-01-01

    Full Text Available Objectives: To study the level of satisfaction of in-patients and to find out the causes for dissatisfaction. Materials and Methods : Study area - Pinnamaneni Siddhartha General Hospital.Study population: In-patients admitted in the Medicine, Surgery, Obstetrics and Gynecology, Orthopedics wards. Sample size: 200. Study Design: A well designed cross-sectional study using pre tested structural pro forma. Duration of study: 2 Months. Survey method: The sample size is randomly selected. Respondent is the patient. Patient satisfaction was assessed in relation to doctors, nurses, housekeeping and billing. The satisfactory levels were divided into Very good, Good, Fair, Bad, and Very bad. Results: The satisfaction of in-patients expressed by majority was Good followed by Fair, Bad, Very good, and Very bad. The satisfaction expressed was more with nursing services followed by doctors and billing and least with housekeeping.

  11. Improving the smoking patterns in a general hospital psychiatric unit

    OpenAIRE

    Celso Iglesias García; María José Alonso Villa; Juan Carlos Bernaldo de Quirós; Elena Bocanegra Suárez; Julia Cueta Gonzalo; Rosario García del Valle; José Manuel González González; Álvaro Miranda García; Ana Belén Palacio Bande

    2009-01-01

    Objectives: The purpose of the present paper is to evaluate the effects of a smoking ban in a general hospital psychiatric unit. Methods: We study the effects of smoking ban in 40 consecutive psychiatric inpatients. The staff registered socio-demographic and tobacco-related variables. We also registered any kind of behavioral effects of smoking ban.Results: The patients were willing to stop smoking during their hospital stay (with or without nicotine replacement) with two mild behavioural inc...

  12. A point-prevalence survey of public hospital inpatients with palliative care needs in Cape Town, South Africa.

    Science.gov (United States)

    van Niekerk, L; Raubenheimer, P J

    2014-02-01

    To assess the need for palliative care among inpatients occupying acute beds in the public sector hospitals of the Cape Town Metropole. A cross-sectional, contemporaneous, point-prevalence study was performed at 11 public sector hospitals in the Cape Town Metropole using a standardised palliative care identification tool. Data were collected on the socio-demographic characteristics, diagnoses, and prior and current care planning of patients. The case notes of 1 443 hospital inpatients were surveyed, and 16.6% were found to have an active life-limiting disease. The mean age of the group was 56 years. The diagnoses were cancer in 50.8%, organ failure in 32.5%, and HIV/tuberculosis in 9.6%. The greatest burden of disease was in the general medical wards, to which an overall 54.8% of patients meeting the requirements for palliative care were admitted. This study provides evidence for the need for palliative care services in public sector hospitals and in the health system as a whole. The young age of patients and the high prevalences of end-stage renal failure and HIV are unique, and the burden in the general medical wards suggests a focus for initial inpatient programmes.

  13. The Clinical Characteristics of 60 Case of HIV Infection in General Hospital Inpatients%综合医院住院患者中60例HIV感染者临床资料分析

    Institute of Scientific and Technical Information of China (English)

    郭强; 罗月萍; 黄红梅; 韦凌波

    2012-01-01

    Objective To explore the epidemiology and clinical features of the iripatients who are preliminarily screened as HIV infectors in Cenxi People' s Hospital. Method Review and analysis the clinical data(2008 ~2010)of 60 cases of these infectors, including demography for inpatient population, opportunistic infections and HIV screenings. Results Among the 60 cases, 10 cases from 2008(0. 065% of the inpatient population of the year) , and 20 from 2009(0. 116% of the whole infection population). Thirty -nine cases,Were male(65% ) and 21 were female (35% ). 20 ~ 50 years old to be the high incidence age group, accounting for 70.00%. 49 cases of infections through sex, 7 cases from drug Use, 3 cases of infection by blood transfusion. Distributed mostly in internal medicine and surgery, with a ratio of 1 ;0. 56. In opportunistic infections, Bacteria pneumonia werer6 cases (10% ) , Tuberculosis were 7 cases (11.70% ) , Oral candidiasis were 8 cases (13. 30% ) , Dermatology and Venereology were 16 cases (28% ). 25 HIV infectors were in good condition which complications and secondary affections were cured or getting better so as td leave the hospital, 51 cases moved to the local Disease Prevention and Control Center, 9 cases gaved up treatment, and 15 cases died. Conclusion Rate of HIV infections grows year by year, and infectors are distributed widely in different departments. Infectors u- ? Sually are in good condition, so it is hard to realize the infection. As a result, if it is possible, we recommend doing HIV screening for all inpatients.%目的 探讨岑溪市人民医院住院患者中经初筛为HIV感染者的流行病学、临床特点.方法 回顾分析2008-2010年本院住院患者中60例初筛为HIV感染者的临床数据资料,包括住院人口统计学、机会感染疾病及HIV筛查情况等.结果 60例中,2008年10例(占2008年总住院患者15284人数的0.065%),2009年20例(占2009年总住院患者17276人数的0.116%),2010年30例(占2010

  14. Estimating the cost of diabetes mellitus-related events from inpatient admissions in Sweden using administrative hospitalization data.

    Science.gov (United States)

    Gerdtham, Ulf-G; Clarke, Philip; Hayes, Alison; Gudbjornsdottir, Soffia

    2009-01-01

    To estimate short- and long-term costs of inpatient hospitalization in Sweden for major diabetes mellitus-related events. Costs were estimated using administrative hospital data from the Swedish National Board of Health and Welfare, which is linked to the Swedish National Diabetes Register. Data were available for 179 749 patients with diabetes in Sweden from 1998 to 2003 (mean and median duration of 6 years' follow-up). Costing of inpatient admissions was based on Nordic diagnosis-related groups (NordDRG). Multiple regression analysis (linear and generalizing estimating equation models) was used to estimate inpatient care costs controlling for age, sex and co-morbidities. The data on hospitalizations were converted to costs (euro) using 2003 exchange rates. The average annual costs (linear model) associated with inpatient admissions for a 60-year-old male in the year the first event first occurred were as follows: euro6488 (95% CI 5034, 8354) for diabetic coma; euro6850 (95% CI 6514, 7204) for heart failure; euro7853 (95% CI 7559, 8144) for non-fatal stroke; euro8121 (95% CI 7104, 9128) for peripheral circulatory complications; euro8736 (95% CI 8474, 9001) for non-fatal myocardial infarction (MI); euro10 360 (95% CI 10 085, 10 643) for ischaemic heart disease; euro11 411 (95% CI 10 298, 12 654) for renal failure; and euro14 949 (95% CI 13 849, 16 551) for amputation. On average, the costs were higher when co-morbidity was accounted for (e.g. MI with co-morbidity was twice as costly as MI alone). Average hospital inpatient costs associated with common diabetes-related events can be estimated using panel data regression methods. These could assist in modelling of long-term costs of diabetes and in evaluating the cost effectiveness of improving care.

  15. 42 CFR 424.122 - Conditions for payment for emergency inpatient hospital services.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Conditions for payment for emergency inpatient hospital services. 424.122 Section 424.122 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES... hospital services, the beneficiary was— (1) In the United States; or (2) In Canada traveling between Alaska...

  16. Relationship between psychiatric nurse work environments and nurse burnout in acute care general hospitals.

    Science.gov (United States)

    Hanrahan, Nancy P; Aiken, Linda H; McClaine, Lakeetra; Hanlon, Alexandra L

    2010-03-01

    Following deinstitutionalization, inpatient psychiatric services moved from state institutions to general hospitals. Despite the magnitude of these changes, evaluations of the quality of inpatient care environments in general hospitals are limited. This study examined the extent to which organizational factors of the inpatient psychiatric environments are associated with psychiatric nurse burnout. Organizational factors were measured by an instrument endorsed by the National Quality Forum. Robust clustered regression analysis was used to examine the relationship between organizational factors in 67 hospitals and levels of burnout for 353 psychiatric nurses. Lower levels of psychiatric nurse burnout was significantly associated with inpatient environments that had better overall quality work environments, more effective managers, strong nurse-physician relationships, and higher psychiatric nurse-to-patient staffing ratios. These results suggest that adjustments in organizational management of inpatient psychiatric environments could have a positive effect on psychiatric nurses' capacity to sustain safe and effective patient care environments.

  17. QECH general hospital strike

    African Journals Online (AJOL)

    Malawi's only medical school and also hosts the Blantyre cam- pus for the ... 1993 when general civil disobedience in form of street demon- strations, riots and strikes ... However their own rights are limited by their responsibility to save life and ...

  18. The dynamics of psychiatric bed use in general hospitals.

    Science.gov (United States)

    Slade, Eric P; Goldman, Howard H

    2015-03-01

    This study examines general hospitals' adjustments in psychiatric bed utilization practices in response to increases in psychiatric inpatient admissions. Using panel data from 439 hospitals, monthly observations (N = 7,831) between 2007 and 2010 on psychiatric admissions, psychiatric bed occupancy rates, and average length-of-stay were created for psychiatric inpatients. In fixed-effects regressions, an increase in psychiatric admissions was associated with an increase in the probability of psychiatric bed use exceeding 100 % occupancy and with a reduction of mean length-of-stay. These results were confirmed in instrumental variables models. General hospitals may dynamically adjust bed utilization practices in response to changing psychiatric bed needs. An implication of this dynamic adjustment model is that bed shortages are likely to be local, transitory events.

  19. The dynamics of psychiatric bed use in general hospitals

    Science.gov (United States)

    Slade, Eric P; Goldman, Howard H

    2014-01-01

    This study examines general hospitals' adjustments in psychiatric bed utilization practices in response to increases in psychiatric inpatient admissions. Using panel data from 439 hospitals, monthly observations (N=7831) between 2007 and 2010 on psychiatric admissions, psychiatric bed occupancy rates, and average length-of-stay were created for psychiatric inpatients. In fixed-effects regressions, an increase in psychiatric admissions was associated with an increase in the probability of psychiatric bed use exceeding 100% occupancy and with a reduction of mean length-of-stay. These results were confirmed in instrumental variables models. General hospitals may dynamically adjust bed utilization practices in response to changing psychiatric bed needs. An implication of this dynamic adjustment model is that bed shortages are likely to be local, transitory events. PMID:24756929

  20. Outpatient and Inpatient Satisfaction in a Public Training and Research Hospital

    OpenAIRE

    Levent Hekimoğlu1; A. Selda Tekiner2; Gülsen Ceyhun Peker2

    2015-01-01

    Objective: The aim of the article is to determine patient satisfaction among outpatients and inpatients in a subspecialty hospital. Methods: The study was carried out at Bursa Yuksek Ihtisas Teaching and Research Hospital between June 2011 and July 2012. This descriptive study is designed as cross-sectional and target population is consisted of 420 outpatients and 240 hospitalized patients. In this study Patient Satisfaction Survey was developed by Performance Management and Quality Devel...

  1. Inpatient child mortality by travel time to hospital in a rural area of Tanzania

    OpenAIRE

    Manongi, R; Mtei, F; Mtove, G; Nadjm, B; Muro, F; Alegana, V; Noor, AM; J. Todd; Reyburn, H.

    2014-01-01

    ObjectiveTo investigate the association, if any, between child mortality and distance to the nearest hospital. MethodsThe study was based on data from a 1-year study of the cause of illness in febrile paediatric admissions to a district hospital in north-east Tanzania. All villages in the catchment population were geolocated, and travel times were estimated from availability of local transport. Using bands of travel time to hospital, we compared admission rates, inpatient case fatality rates ...

  2. Novel Approach to Inpatient Glucometric Monitoring and Variability in a Community Hospital Setting

    Science.gov (United States)

    Koziol, James; Johnson, Keith; Brenner, Kathy; Fortmann, Addie; Morrisey, Robin; Philis-Tsimikas, Athena

    2014-01-01

    Background: Hyperglycemia and glucose variability in the hospital environment are associated with higher rates of complications, longer lengths of stay, and mortality. Standardized metrics are needed to assess the efficacy and safety of glucose management interventions. Methods: Glucometric data were collected from 2024 inpatients in a San Diego hospital between 2009 and 2011. As a complementary measure of glucose control, individual patient excursion rates were calculated using counts of distinct excursions from normal to critical glucose ranges >180 or 180 mg/dL was 0.456 per 24 hours. The proportion of zero excursions decreased as severity of illness decreased, but was unrelated to age. Excursion rates were slightly smaller for major and extreme severity of illness compared to mild or moderate illness severity. Excursion rates did not vary in a monotone fashion with age, although the general pattern reflected a reduction in excursion rates from the first age quartile (19 to 59) through the last age quartile (83 to 100). Using the Akaike information criterion, zero-inflated negative binomial models were identified as appropriate for analyzing glucose excursion rates. Conclusions: Systematic approaches to glucose reporting and management in the hospital environment offer “windows of opportunity” to improve diabetes care. PMID:25539653

  3. Perfil clínico, epidemiológico e etiológico de pacientes com pneumonia adquirida na comunidade internados em um hospital geral da microrregião de Sumaré, SP Clinical, epidemiological, and etiological profile of inpatients with community-acquired pneumonia at a general hospital in the Sumaré microregion of Brazil

    Directory of Open Access Journals (Sweden)

    Maria Rita Donalisio

    2011-04-01

    against influenza was significantly lower among the inpatients than in the general population of the Sumaré microregion (52.6% vs. > 70%. Fever was less common among the elderly patients (p < 0.05. The clinical evolution was associated with the PSI scores but not with age. The etiology was confirmed in 31 cases (50.8% and was attributed to S. pneumoniae, principally detected by the urinary antigen test, in 21 (34.4%, followed by C. pneumoniae, in 5 (8.2%. The mortality rate was 4.9%, and 80.3% of the patients were classified as cured at discharge. CONCLUSIONS: The knowledge of the etiologic profile of CAP at the regional level favors the appropriate choice of empirical treatment, which is particularly relevant in elderly patients and in those with comorbidities. The lack of influenza vaccination in elderly patients is a risk factor for hospitalization due to CAP.

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

    Directory of Open Access Journals (Sweden)

    Maxwell M. Lodenyo

    2016-03-01

    Full Text Available Background: Among many Kenyan rural communities, access to in-patient healthcare services is seriously constrained. It is important to understand who has ready access to the facilities and services offered and what factors prevent those who do not from doing so.Aim: To identify factors affecting time of access of in-patient healthcare services at a rural district hospital in Kenya.Setting: Webuye District hospital in Western Kenya.Methods: A cross-sectional, comparative, hospital-based survey among 398 in-patients using an interviewer-administered questionnaire. Results were analysed using SPSS V.12.01.Results: The median age of the respondents, majority of whom were female respondents(55%, was 24 years. Median time of presentation to the hospital after onset of illness was 12.5 days. Two hundred and forty seven patients (62% presented to the hospital within 2 weeks of onset of illness, while 151 (38% presented after 2 weeks or more. Ten-year increase in age, perception of a supernatural cause of illness, having an illness that was considered bearable and belief in the effectiveness of treatment offered in-hospital were significant predictors for waiting more than 2 weeks to present at the hospital.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.

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

    Directory of Open Access Journals (Sweden)

    Maxwell M. Lodenyo

    2016-03-01

    Full Text Available Background: Among many Kenyan rural communities, access to in-patient healthcare services is seriously constrained. It is important to understand who has ready access to the facilities and services offered and what factors prevent those who do not from doing so.Aim: To identify factors affecting time of access of in-patient healthcare services at a rural district hospital in Kenya.Setting: Webuye District hospital in Western Kenya.Methods: A cross-sectional, comparative, hospital-based survey among 398 in-patients using an interviewer-administered questionnaire. Results were analysed using SPSS V.12.01.Results: The median age of the respondents, majority of whom were female respondents(55%, was 24 years. Median time of presentation to the hospital after onset of illness was 12.5 days. Two hundred and forty seven patients (62% presented to the hospital within 2 weeks of onset of illness, while 151 (38% presented after 2 weeks or more. Ten-year increase in age, perception of a supernatural cause of illness, having an illness that was considered bearable and belief in the effectiveness of treatment offered in-hospital were significant predictors for waiting more than 2 weeks to present at the hospital.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.

  6. INPATIENTS NUTRITIONAL REQUIREMENTS INDICATOR AT ARMY HOSPITAL DR. SOEPRAOEN MALANG

    Directory of Open Access Journals (Sweden)

    Kumboyono Kumboyono

    2017-04-01

    Full Text Available Introduction: Patient acceptance to diet in fl uences patient intake during the hospitalization. Patient acceptance on meals provided by the hospital can be seen from the left over. Whilst factors which in fl uences patient motivation to finish their meals including addtional food, taste, and adaptation level to the hospital, the aim of this research was to identify factors that related to patient acceptance on meals provided by the hospital in class three ward dr. Soepraoen Hospital, Malang. Method: Descriptive analitic was used as research design with cross-sectional approach. As many as 51 samples were chosen with purposive sampling. Data was analyzed with chi square with 95%signi fi cance. Results: The results showed a signi fi cant relation between additional food and the leftover (p-Value = 0,018. There is signi fi cant relation on the taste and the leftover (p-Value = 0.032 and adaptation level and leftover (p-Value = 0.026. Discussion: It can be concluded that additional food, taste, and adaptation level to the hospital have signi fi cant relation with hospitalized patient acceptance on their diet. It is suggested that nurse pay more attention on these factors to fulfi ll patient nutrition needs during hospitalization.

  7. Supervising the beginning group leader in inpatient and partial hospital settings.

    Science.gov (United States)

    Vannicelli, Marsha

    2014-04-01

    This paper provides a guide for supervisors in inpatient and partial hospital settings who train beginning group therapists in a variety of group modalities. It addresses basic issues facing the neophyte therapist, including structural aspects of the group, problematic member behaviors, and useful interventions that maximize member engagement and increase overall therapeutic effectiveness.

  8. Hospital heavies. Venture capital bulks up companies that outsource medicine's newest specialty: inpatient-only care.

    Science.gov (United States)

    Huff, C

    They're the designated drivers of inpatient care, cutting hospital stays by 19 percent on average. Yet as venture capital firms infuse hospitalist startup companies, some primary care doctors complain that their sickest patients are being taken away from them.

  9. Enhancing Treatment Team Process through Mindfulness-Based Mentoring in an Inpatient Psychiatric Hospital

    Science.gov (United States)

    Singh, Nirbhay N.; Singh, Subhashni D.; Sabaawi, Mohamed; Myers, Rachel E.; Wahler, Robert G.

    2006-01-01

    The authors investigated changes in treatment team functioning in an adult inpatient psychiatric hospital after the implementation of a mindfulness-based mentoring intervention. Using a multiple baseline across treatment teams design, the authors assessed levels of functioning of three treatment teams using a 50-item rating scale and then…

  10. Reasons for inpatients not to seek clarity at Dr George Mukhari Academic Hospital, Pretoria

    Directory of Open Access Journals (Sweden)

    Langalibalele H. Mabuza

    2014-01-01

    Full Text Available Background: Healthcare practitioners should provide patients with information regarding their clinical conditions. Patients should also feel free to seek clarity on information provided. However, not all patients seek this clarity.Objectives: To explore the reasons inpatients gave for not seeking clarity on information that was received but not understood.Methods: This was a qualitative arm of a larger study, titled ‘Are inpatients aware of the admission reasons and management plans of their clinical conditions? A survey at a tertiary hospital in South Africa’, conducted in 2010. Of the 264 inpatients who participated in the larger study, we extracted the unstructured responses from those participants (n = 152 who had indicated in the questionnaire that there was information they had not understood during their encounter with healthcare practitioners, but that they had nonetheless not sought clarity.Data were analysed thematically.Results: Themes that emerged were that inpatients did not ask for clarity as they perceived healthcare practitioners to be ‘too busy’, aloof, non-communicators and sometimes uncertain about patients’ conditions. Some inpatients had unquestioning trust in healthcare practitioners,whilst others had experiences of bad treatment. Inpatients had poor self-esteem, incapacitating clinical conditions, fear of bad news and prior knowledge of their clinical conditions. Some inpatients stated that they had no reason for not seeking clarity.Conclusion: The reasons for not seeking clarity were based on patients’ experiences with the healthcare practitioners and their perceptions of the latter and of themselves. A programme should be developed in order to educate inpatients on effective communication with their healthcare practitioners.

  11. Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 1998 rates--HCFA. Final rule.

    Science.gov (United States)

    1998-05-12

    This final rule responds to public comments received on those portions of a final rule with comment period published in the Federal Register on August 29, 1997, that revised the Medicare hospital inpatient prospective payment systems for operating costs and capital-related costs to implement necessary changes resulting from the Balanced Budget Act (BBA) of 1997, Public Law 105-33. This rule also addresses public comments on other BBA changes relating to cost limits for hospitals and hospital units excluded from the prospective payment systems as well as direct graduate medical education payments that were included in the August 29, 1997 document. Generally, these BBA changes were applicable to hospital discharges occurring on or after October 1, 1997.

  12. The ED-inpatient dashboard: Uniting emergency and inpatient clinicians to improve the efficiency and quality of care for patients requiring emergency admission to hospital.

    Science.gov (United States)

    Staib, Andrew; Sullivan, Clair; Jones, Matt; Griffin, Bronwyn; Bell, Anthony; Scott, Ian

    2017-06-01

    Patients who require emergency admission to hospital require complex care that can be fragmented, occurring in the ED, across the ED-inpatient interface (EDii) and subsequently, in their destination inpatient ward. Our hospital had poor process efficiency with slow transit times for patients requiring emergency care. ED clinicians alone were able to improve the processes and length of stay for the patients discharged directly from the ED. However, improving the efficiency of care for patients requiring emergency admission to true inpatient wards required collaboration with reluctant inpatient clinicians. The inpatient teams were uninterested in improving time-based measures of care in isolation, but they were motivated by improving patient outcomes. We developed a dashboard showing process measures such as 4 h rule compliance rate coupled with clinically important outcome measures such as inpatient mortality. The EDii dashboard helped unite both ED and inpatient teams in clinical redesign to improve both efficiencies of care and patient outcomes. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  13. Drug use by elderly inpatients of a philanthropic hospital

    OpenAIRE

    Rômulo Moreira dos Santos; Ivana Maria Fechine Sette; Lindomar de Farias Belém

    2011-01-01

    The high incidence of chronic diseases in the elderly leads to increased intermittent drug therapies. The presence of concomitant diseases and prescriptions made out by various health professionals facilitate the practice of polypharmacy, the emergence of iatrogenic diseases, and therapeutic regimens that are inconvenient for patients. The present study was carried out among elderly patients hospitalized at the Hospital Care Foundation of Paraiba, Campina Grande, with the objectives of studyi...

  14. Accessing Inpatient Rehabilitation after Acute Severe Stroke: Age, Mobility, Prestroke Function and Hospital Unit Are Associated with Discharge to Inpatient Rehabilitation

    Science.gov (United States)

    Hakkennes, Sharon; Hill, Keith D.; Brock, Kim; Bernhardt, Julie; Churilov, Leonid

    2012-01-01

    The objective of this study was to identify the variables associated with discharge to inpatient rehabilitation following acute severe stroke and to determine whether hospital unit contributed to access. Five acute hospitals in Victoria, Australia participated in this study. Patients were eligible for inclusion if they had suffered an acute severe…

  15. Accessing Inpatient Rehabilitation after Acute Severe Stroke: Age, Mobility, Prestroke Function and Hospital Unit Are Associated with Discharge to Inpatient Rehabilitation

    Science.gov (United States)

    Hakkennes, Sharon; Hill, Keith D.; Brock, Kim; Bernhardt, Julie; Churilov, Leonid

    2012-01-01

    The objective of this study was to identify the variables associated with discharge to inpatient rehabilitation following acute severe stroke and to determine whether hospital unit contributed to access. Five acute hospitals in Victoria, Australia participated in this study. Patients were eligible for inclusion if they had suffered an acute severe…

  16. Nosocomial Infections of Inpatients:An 3-year Clinical Investigation and Analysis in Basic-level general hospital%基层综合性医院连续3年医院感染调查分析

    Institute of Scientific and Technical Information of China (English)

    赵中; 谭倩

    2010-01-01

    目的 探讨基层综合性医院住院患者医院感染的特点,以采取相应有效措施预防和控制医院感染的发生.方法 采用回顾性统计调查分析.结果 医院感染率为1.63%,其中以呼吸道最高,依次为泌尿道、手术切口;临床分离的致病菌为G-菌,占55.45%,G+菌,占20%,真菌,占24.55%,比较本院近3年医院感染,条件致病菌各年构成比差异虽无统计学意义,但仍占主导地位.结论 加强医院感染管理,减少侵袭性操作,及时病原菌监测,合理应用抗菌药物是降低医院感染的有效措施.%Objective To investigate the feature of nosocomial infections in Basic-level general hospital, based on which effective methods are taken to prevent and control the incidence of nosocomial infection. Methods An analysis was made on the basis of the survey, the data came from hospitalized cases in the recent three years. Results The rate of nosocomial fungus infection was 1.63 %,the main infection site was respiratory tract, and followed by urinary tract and surgical incision. Among bacteria isolated from clinical cases, 55.45 % were G-, 20.00 % were G+, and 24.55 % were fungi. However,differences of the proportion of conditional bacteria were insignificantly (P>0.05) during the past three years,the conditional bacteria were the major pathogenic in nosocomial infections. Conclusions Strengthening the nosocomial infection management, Lessing invasive process, supervising towards bacteria, and using antibacterial drug rationally are effective methods to reducing the nosocomial infections.

  17. Impact of Inpatient Versus Outpatient Total Joint Arthroplasty on 30-Day Hospital Readmission Rates and Unplanned Episodes of Care.

    Science.gov (United States)

    Springer, Bryan D; Odum, Susan M; Vegari, David N; Mokris, Jeffrey G; Beaver, Walter B

    2017-01-01

    This article describes a study comparing 30-day readmission rates between patients undergoing outpatient versus inpatient total hip (THA) and knee (TKA) arthroplasty. A retrospective review of 137 patients undergoing outpatient total joint arthroplasty (TJA) and 106 patients undergoing inpatient (minimum 2-day hospital stay) TJA was conducted. Unplanned hospital readmissions and unplanned episodes of care were recorded. All patients completed a telephone survey. Seven inpatients and 16 outpatients required hospital readmission or an unplanned episode of care following hospital discharge. Readmission rates were higher for TKA than THA. The authors found no statistical differences in 30-day readmission or unplanned care episodes.

  18. Strategies for Managing Mobile Devices for Use by Hospitalized Inpatients.

    Science.gov (United States)

    Dykes, Patricia C; Stade, Diana; Dalal, Anuj; Clements, Marsha; Collins, Sarah; Chang, Frank; Fladger, Anne; Getty, George; Hanna, John; Kandala, Ravali; Lehmann, Lisa S; Leone, Kathleen; Massaro, Anthony F; Mlaver, Eli; McNally, Kelly; Ravindran, Sucheta; Schnock, Kumiko; Bates, David W

    2015-01-01

    Despite the potential advantages, implementation of mobile devices and ongoing management pose challenges in the hospital environment. Our team implemented the PROSPECT (Promoting Respect and Ongoing Safety through Patient-centeredness, Engagement, Communication and Technology) project at Brigham and Women's Hospital. The goal of PROSPECT is to transform the hospital environment by providing a suite of e-tools to facilitate teamwork among nurses, physicians, patients and to engage patients and care partners in their plan of care. In this paper, we describe the device-related decisions and challenges faced including device and accessory selection, integration, information and device security, infection control, user access, and ongoing operation and maintenance. We relate the strategies that we used for managing mobile devices and lessons learned based on our experiences.

  19. Improving the smoking patterns in a general hospital psychiatric unit

    Directory of Open Access Journals (Sweden)

    Celso Iglesias García

    2009-01-01

    Full Text Available Objectives: The purpose of the present paper is to evaluate the effects of a smoking ban in a general hospital psychiatric unit. Methods: We study the effects of smoking ban in 40 consecutive psychiatric inpatients. The staff registered socio-demographic and tobacco-related variables. We also registered any kind of behavioral effects of smoking ban.Results: The patients were willing to stop smoking during their hospital stay (with or without nicotine replacement with two mild behavioural incidences registered throughout the study. Conclusions: The benefits of non-smoking policy in a psychiatric unit can be significant. The introduction of smoking bans in psychiatric inpatients settings is possible and safe.

  20. Provision of general paediatric surgical services in a regional hospital.

    LENUS (Irish Health Repository)

    Zgraj, O

    2012-01-31

    BACKGROUND: In Ireland, specialist paediatric surgery is carried out in paediatric hospitals in Dublin. General surgeons\\/consultants in other surgical specialities provide paediatric surgical care in regional centres. There has been a failure to train general surgeons with paediatric skills to replace these surgeons upon retirement. AIM: To assess paediatric surgical workload in one regional centre to focus the debate regarding the future provision of general paediatric surgery in Ireland. METHODS: Hospital in-patient enquiry (HIPE) system was used to identify total number of paediatric surgical admissions and procedures. Cases assessed requiring hospital transfer. RESULTS: Of 17,478 surgical patients treated, 2,584 (14.8%) were under 14 years. A total of 2,154 procedures were performed. CONCLUSION: Regional centres without dedicated paediatric surgeons deliver care to large numbers of paediatric patients. The demand for care highlights the need for formal paediatric services\\/appropriate surgical training for general surgical trainees.

  1. Inpatient hospital outcomes following injury in Suriname: lessons for prevention.

    Science.gov (United States)

    Pracht, Etienne

    2014-03-01

    Traumatic injury is an important and indiscriminant contributor to mortality. Hypothesizing that outcomes from severe injuries do not vary by demographic factors or socioeconomic status, this research analyzed the relationship between race, ethnicity, injury characteristics, and fatality following hospitalization in Suriname. Data were obtained for all hospital episodes in 2008 from the only hospital within the greater Paramaribo area that provides emergency department services. A logistic regression was used to analyze the subset of 544 non-elderly adult trauma victims to assess the contribution of patient demographics and anatomic injury severity to outcome, which was defined as mortality during acute hospitalization. The specific demographics included were patient age, gender, race, and insurance status. Injury severity was measured using the International Classification Injury Severity Score. The results indicate that age, insurance status, injury type, and injury severity were significant predictors for survival. While the uninsured experienced a higher rate of mortality, the model suggests this result is not due to physiologic reasons but behavioral and socioeconomic. The higher mortality is driven by greater injury severity, which increases not only the mortality rate but also the cost of care. Injury severity itself, independent of all other factors, is the most important contributor. The results suggest that a reduction of 10% in injury severity, around the mean, would reduce the probability of mortality by 70%. This suggests that targeting risk-taking behavior, perhaps relating to compliance with safety practices (e.g. seat belt and helmet laws), driver education, and road safety measures can play important roles in reducing mortality and morbidity from injury in Suriname.

  2. Tablet computers for hospitalized patients: a pilot study to improve inpatient engagement.

    Science.gov (United States)

    Greysen, S Ryan; Khanna, Raman R; Jacolbia, Ronald; Lee, Herman M; Auerbach, Andrew D

    2014-06-01

    Inadequate patient engagement in hospital care inhibits high-quality care and successful transitions to home. Tablet computers may provide opportunities to engage patients, particularly during inactive times between provider visits, tests, and treatments, by providing interactive health education modules as well as access to their personal health record (PHR). We conducted a pilot project to explore inpatient satisfaction with bedside tablets and barriers to usability. Additionally, we evaluated use of these devices to deliver 2 specific Web-based programs: (1) an interactive video to improve inpatient education about hospital safety, and (2) PHR access to promote inpatient engagement in discharge planning. We enrolled 30 patients; 17 (60%) were aged 40 years or older, 17 (60%) were women, 17 (60%) owned smartphones, and 6 (22%) owned tablet computers. Twenty-seven (90%) reported high overall satisfaction with the device, and 26 (87%) required ≤ 30 minutes for basic orientation (70% required ≤ 15 minutes). Twenty-five (83%) independently completed an interactive educational module on hospital patient safety. Twenty-one (70%) accessed their personal health record (PHR) to view their medication list, verify scheduled appointments, or send a message to their primary care physician. Next steps include education on high-risk medications, assessment of discharge barriers, and training clinical staff (such as respiratory therapists, registered nurses, or nurse practitioners) to deliver tablet interventions. © 2014 Society of Hospital Medicine.

  3. Inpatient child mortality by travel time to hospital in a rural area of Tanzania.

    Science.gov (United States)

    Manongi, Rachel; Mtei, Frank; Mtove, George; Nadjm, Behzad; Muro, Florida; Alegana, Victor; Noor, Abdisalan M; Todd, Jim; Reyburn, Hugh

    2014-05-01

    To investigate the association, if any, between child mortality and distance to the nearest hospital. The study was based on data from a 1-year study of the cause of illness in febrile paediatric admissions to a district hospital in north-east Tanzania. All villages in the catchment population were geolocated, and travel times were estimated from availability of local transport. Using bands of travel time to hospital, we compared admission rates, inpatient case fatality rates and child mortality rates in the catchment population using inpatient deaths as the numerator. Three thousand hundred and eleven children under the age of 5 years were included of whom 4.6% died; 2307 were admitted from time between admission and death. Assuming uniform mortality in the catchment population, the predicted number of deaths not benefiting from hospital admission prior to death increased by 21.4% per hour of travel time to hospital. If the same admission and death rates that were found at <3 h from the hospital applied to the whole catchment population and if hospital care conferred a 30% survival benefit compared to home care, then 10.3% of childhood deaths due to febrile illness in the catchment population would have been averted. The mortality impact of poor access to hospital care in areas of high paediatric mortality is likely to be substantial although uncertainty over the mortality benefit of inpatient care is the largest constraint in making an accurate estimate. © 2014 The Authors Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

  4. Drug use by elderly inpatients of a philanthropic hospital

    Directory of Open Access Journals (Sweden)

    Rômulo Moreira dos Santos

    2011-06-01

    Full Text Available The high incidence of chronic diseases in the elderly leads to increased intermittent drug therapies. The presence of concomitant diseases and prescriptions made out by various health professionals facilitate the practice of polypharmacy, the emergence of iatrogenic diseases, and therapeutic regimens that are inconvenient for patients. The present study was carried out among elderly patients hospitalized at the Hospital Care Foundation of Paraiba, Campina Grande, with the objectives of studying the consumption of drugs by these patients, noting the possible adverse drug reactions (ADR, drug interactions and the presence of high-risk drugs prescribed to this age group. The study had a descriptive and cross-sectional quantitative design and involved a sample of 65 patients accompanied by the Pharmacovigilance Centre of the hospital, from August 2009 to July 2010. Over 90% of the patients were on polypharmacy, and the possible ADR found were related to the gastrointestinal tract where the most frequent interactions were with cardiovascular drugs. Within the context of pharmacoepidemiology, pharmacists can contribute by improving the quality of life of patients and preventing unnecessary expense with erroneous and poorly evaluated treatments.A elevada incidência de doenças crônicas na terceira idade induz ao aumento de terapias medicamentosas intermitentes. A presença de patologias concomitantes e prescrições elaboradas por diversos profissionais de saúde facilitam a prática da polifarmácia, surgimento de doenças iatrogênicas e esquemas terapêuticos pouco cômodos para o paciente. O estudo foi realizado junto aos pacientes idosos internados no Hospital da Fundação Assistencial da Paraíba (FAP, Campina Grande, com objetivo de estudar o consumo de medicamentos por estes pacientes, observando as possíveis reações adversas a medicamentos (RAM, interações medicamentosas apresentadas e a presença de medicamentos de alto risco

  5. Prevalence of antibacterial resistant bacterial contaminants from mobile phones of hospital inpatients

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    B. Vinod Kumar

    2014-10-01

    Full Text Available Mobile phones contaminated with bacteria may act as fomites. Antibiotic resistant bacterial contamination of mobile phones of inpatients was studied. One hundred and six samples were collected from mobile phones of patients admitted in various hospitals in Jazan province of Saudi Arabia. Eighty-nine (83.9% out of 106 mobile phones were found to be contaminated with bacteria. Fifty-two (49.0% coagulase-negative Staphylococcus, 12 (11.3% Staphylococcus aureus, 7 (6.6% Enterobacter cloacae, 3 (2.83% Pseudomonas stutzeri, 3 (2.83% Sphingomonas paucimobilis, 2 (1.8% Enterococcus faecalis and 10 (9.4% aerobic spore bearers were isolated. All the isolated bacteria were found to be resistant to various antibiotics. Hence, regular disinfection of mobile phones of hospital inpatients is advised.

  6. Length of stay of general psychiatric inpatients in the United States: systematic review.

    LENUS (Irish Health Repository)

    Tulloch, Alex D

    2011-05-01

    Psychiatric length of stay (LOS) has reduced but is still longer than for physical disorders. Inpatient costs are 16% of total mental health spending. Regression analyses of the determinants of LOS for US adult psychiatric inpatients were systematically reviewed. Most studies predated recent LOS reductions. Psychosis, female gender and larger hospital size were associated with longer LOS, while discharge against medical advice, prospective payment, being married, being detained and either younger or middle age were associated with shorter LOS. Associations appeared consistent, especially where sample size was above 3,000. Updated studies should be adequately powered and include the variables above.

  7. Heat-related inpatient hospitalizations and emergency room visits among California residents, May-September, 2000-2010.

    Data.gov (United States)

    California Environmental Health Tracking Program — This dataset contains case counts, rates, and confidence intervals of heat-related inpatient hospitalizations and ED visits among California residents for the years...

  8. Orodental status and medical problems of stroke inpatients undergoing rehabilitation at a rehabilitation hospital in Japan.

    Science.gov (United States)

    Asahi, Yoshinao; Omichi, Shiro; Ono, Takahiro

    2015-09-01

    Many stroke patients may have oral problems and systemic diseases, but clinical information on treatment provided to stroke patients for dental problems during inpatient rehabilitation is rare. The objective of this study was to research stroke inpatients' requirements for dental treatment and the accompanying risks. We included 165 stroke patients undergoing inpatient rehabilitation at Morinomiya Hospital during the year 2010 and researched the causes of stroke and the patients' orodental status, underlying diseases, antithrombotic drugs prescribed and special considerations or difficulties in the treatment. Cerebral infarction was the most common causes of stroke. Many patients had hypertension, heart disease or diabetes mellitus, and 54.5% had been prescribed antithrombotic drugs. Dentists diagnosed 57.0% patients with untreated dental cavities. Approximately 30% did not use dentures despite having a requirement. In total, 142 patients underwent dental treatment including periodontal treatment, prosthetic treatment and tooth extraction under management of circulation and haemostasis such as monitoring vital signs and surgical splints in cases of the difficult extraction. The current study revealed a high requirement for dental treatment among stroke patients and demonstrated the effectiveness of performing dental treatment during inpatient rehabilitation of these patients. © 2014 John Wiley & Sons A/S and The Gerodontology Society. Published by John Wiley & Sons Ltd.

  9. Analysis on clinical data of elderly in-patients with delirium during psychiatric consultation at Chinese general hospitals%综合医院精神科会诊中老年谵妄患者临床资料分析

    Institute of Scientific and Technical Information of China (English)

    许凌峰; 王希林; 徐晓燕; 胜利; 姜荣环; 刘尚军

    2013-01-01

      目的了解谵妄在综合医院老年住院患者中的临床特点。方法2008年至2011年内综合医院老年住院患者中经精神科会诊明确诊断为谵妄者364例,采用自编调查表对会诊原因、原发躯体疾病、会诊后药物处理等临床资料进行分析。结果意识障碍(55.2%)和言行紊乱(24.6%)是最常见的请求会诊原因;老年谵妄患者的躯体疾病主要集中在神经系统(25.0%),手术后(24.7%),心血管系统(22.5%)和呼吸系统(19.2%);83.5%老年患者应用了药物治疗,常用的药物为奥氮平(46.2%)、氟哌啶醇(29.7%)、喹硫平(5.2%)、利培酮(3.8%)和苯二氮类(3.8%)药物,其中奥氮平所占比例从2008年的35.3%上升到2011年的56.9%(P<0.01),而氟哌啶醇所占比例从2008年的38.2%下降至2011年的19.3%(P<0.01)。结论老年患者是发生谵妄的高风险人群,尤其是脑梗死、感染、手术后的老年患者更需要重点关注。%Objective To investigate the clinical features of elderly in-patients with delirium in the psychiatric consultations at general hospitals. Methods A total of 364 elderly in-patients (over 65 years old) from general hospitals who were diagnosed as delirium during the psychiatric consultation by our department during 2008 to 2011 were subjected in this study. Detailed clinical data of all subjects were retrospectively surveyed by self-made questionnaire for consultation reasons, primary physical diseases, and drug treatment after consultation, and then summarized and analyzed. Results The most common reasons for psychiatric consultation were disturbance of consciousness (55.2%) and verbal or behavioral confusion (24.6%). Medical conditions of these subjects were mainly neurological diseases (25.0%), post-operation (24.7%), cardiovascular diseases (22.5%) and respiratory diseases (19.2%). Neuroleptics were administered to 83.5%of the subjects, and they were

  10. The Role of Hospital Inpatients in Supporting Medication Safety: A Qualitative Study.

    Directory of Open Access Journals (Sweden)

    Sara Garfield

    Full Text Available Inpatient medication errors are a significant concern. An approach not yet widely studied is to facilitate greater involvement of inpatients with their medication. At the same time, electronic prescribing is becoming increasingly prevalent in the hospital setting. In this study we aimed to explore hospital inpatients' involvement with medication safety-related behaviours, facilitators and barriers to this involvement, and the impact of electronic prescribing.We conducted ethnographic observations and interviews in two UK hospital organisations, one with established electronic prescribing and one that changed from paper to electronic prescribing during our study. Researchers and lay volunteers observed nurses' medication administration rounds, pharmacists' ward rounds, doctor-led ward rounds and drug history taking. We also conducted interviews with healthcare professionals, patients and carers. Interviews were audio-recorded and transcribed. Observation notes and transcripts were coded thematically.Paper or electronic medication records were shown to patients in only 4 (2% of 247 cases. However, where they were available during patient-healthcare professional interactions, healthcare professionals often viewed them in order to inform patients about their medicines and answer any questions. Interprofessional discussions about medicines seemed more likely to happen in front of the patient where paper or electronic drug charts were available near the bedside. Patients and carers had more access to paper-based drug charts than electronic equivalents. However, interviews and observations suggest there are potentially more significant factors that affect patient involvement with their inpatient medication. These include patient and healthcare professional beliefs concerning patient involvement, the way in which healthcare professionals operate as a team, and the underlying culture.Patients appear to have more access to paper-based records than

  11. The inpatient costs and hospital service use associated with invasive meningococcal disease in South Australian children.

    Science.gov (United States)

    Wang, Bing; Haji Ali Afzali, Hossein; Marshall, Helen

    2014-08-20

    Invasive meningococcal disease (IMD) remains a serious public health concern due to a sustained high case fatality rate and morbidity in survivors. This study aimed to estimate the hospital service costs associated with IMD and variables associated with the highest costs in Australian children admitted to a tertiary paediatric hospital. Clinical details were obtained from medical records and associated inpatient costs were collected and inflated to 2011 Australian dollars using the medical and hospital services component of the Australian Consumer Price Index. Both unadjusted and adjusted analyses were undertaken. Multivariate regression models were used to adjust for potential covariates and determine independent predictors of high costs and increased length of hospital stay. Of 109 children hospitalised with IMD between May 2000 and April 2011, the majority were caused by serogroup B (70.6%). Presence of sequelae, serogroup B infection, male gender, infants less than one year of age, and previous medical diagnosis were associated with higher inpatient costs and length of stay (LOS) in hospital (pcosts and LOS during the IMD related readmissions for patients with sequelae (passociated long-term sequelae result in high health care costs, which should be considered in meningococcal B vaccine funding considerations. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. The epidemiology of assault-related hospital in-patient admissions and ED attendances.

    LENUS (Irish Health Repository)

    O'Farrell, A

    2013-03-01

    The aim of this study was to describe the epidemiology and impact of serious assault warranting in-patient care over six years and its impact on ED attendances in a large teaching hospital in Dublin over 2 years. There were 16,079 emergency assault-related inpatient hospital discharges reducing from 60.1 per 100,000 population in 2005 to 50.6 per 100,000 population in 2010. The median length of stay was 1 day (1-466) representing 49,870 bed days. The majority were young males (13,921, 86.6%; median age 26 years). Overall crime figures showed a similar reduction. However, knife crimes did not reduce over this period. Data on ED attendances confirmed the age and gender profile and also showed an increase at weekends. Alcohol misuse was recorded in 2,292\\/16079 (14%) of in-patient cases and 242\\/2484 (10%) in ED attendances. An inter-sectoral preventative approach specifically targeting knife crime is required to reduce this burden on health services.

  13. Perceptions of Yoga Therapy Embedded in Two Inpatient Rehabilitation Hospitals: Agency Perspectives

    Science.gov (United States)

    Van Puymbroeck, Marieke; Miller, Kristine K.; Dickes, Lori A.; Schmid, Arlene A.

    2015-01-01

    Inpatient medical rehabilitation has maintained a typical medical-model focus and structure for many years. However, as integrative therapies, such as yoga therapy, emerge as treatments which can enhance the physical and mental health of its participants, it is important to determine if they can be easily implemented into the traditional rehabilitation structure and milieu. Therefore, the purpose of this study was to examine the perceptions of key agency personnel on the feasibility and utility of yoga therapy implemented in inpatient rehabilitation. This study reports the results of focus groups and an individual interview with key stakeholders (administrators and rehabilitation therapists) from two rehabilitation hospitals following the implementation of yoga therapy. Results focused on several key themes: feasibility from the therapist and administrator perspectives, challenges to implementation, and utility and benefit. Overall, the implementation and integration of yoga therapy were positive; however, some programmatic and policy and organizational considerations remain. Implications for practice and future research are provided. PMID:26491457

  14. Perceptions of Yoga Therapy Embedded in Two Inpatient Rehabilitation Hospitals: Agency Perspectives

    Directory of Open Access Journals (Sweden)

    Marieke Van Puymbroeck

    2015-01-01

    Full Text Available Inpatient medical rehabilitation has maintained a typical medical-model focus and structure for many years. However, as integrative therapies, such as yoga therapy, emerge as treatments which can enhance the physical and mental health of its participants, it is important to determine if they can be easily implemented into the traditional rehabilitation structure and milieu. Therefore, the purpose of this study was to examine the perceptions of key agency personnel on the feasibility and utility of yoga therapy implemented in inpatient rehabilitation. This study reports the results of focus groups and an individual interview with key stakeholders (administrators and rehabilitation therapists from two rehabilitation hospitals following the implementation of yoga therapy. Results focused on several key themes: feasibility from the therapist and administrator perspectives, challenges to implementation, and utility and benefit. Overall, the implementation and integration of yoga therapy were positive; however, some programmatic and policy and organizational considerations remain. Implications for practice and future research are provided.

  15. Pathway for inpatients with depressive episode in Flemish psychiatric hospitals: a qualitative study

    Directory of Open Access Journals (Sweden)

    Simoens Steven R

    2009-10-01

    Full Text Available Abstract Background Within the context of a biopsychosocial model of the treatment of depressive episodes, a multidisciplinary approach is needed. Clinical pathways have been developed and implemented in hospitals to support multidisciplinary teamwork. The aim of this study is to explore current practice for the treatment of depressive episodes in Flemish psychiatric hospitals. Current practice in different hospitals is studied to get an idea of the similarities (outlined as a pathway and the differences in the treatment of depressive episodes. Methods A convenience sample of 11 Flemish psychiatric hospitals participated in this qualitative study. Semi-structured interviews were conducted with different types of health care professionals (n = 43. The websites of the hospitals were searched for information on their approach to treating depressive episodes. Results A flow chart was made including the identified stages of the pathway: pre-admission, admission (observation and treatment, discharge and follow-up care. The characteristics of each stage are described. Although the stages are identified in all hospitals, differences between hospitals on various levels of the pathway exist. Hospitals emphasized the individual approach of each patient. The results point to a biopsychosocial approach to treating depressive episodes. Conclusion This study outlined current practice as a pathway for Flemish inpatients with depressive episodes. Within the context of surveillance of quality and quantity of care, this study may encourage hospitals to consider developing clinical pathways.

  16. Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 1997 rates--HCFA. Final rule.

    Science.gov (United States)

    1996-08-30

    We are revising the Medicare hospital inpatient prospective payment systems for operating costs and capital-related costs to implement necessary changes arising from our continuing experience with the systems. In addition, in the addendum to this final rule, we are describing changes in the amounts and factors necessary to determine prospective payment rates for Medicare hospital inpatient services for operating costs and capital-related costs. These changes are applicable to discharges occurring on or after October 1, 1996. We are also setting forth rate-of-increase limits as well as policy changes for hospitals and hospital units excluded from the prospective payment systems.

  17. Remarkably Few Sputum Cultures from People with Parkinson’s Disease during Hospital In-Patient Admission

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    Richard W. Walker

    2015-01-01

    Full Text Available Although respiratory tract infections can be a common complication in people with Parkinson’s disease (PD, there is little published data on the nature of such infections in this patient group. We wished to investigate whether sputum samples were being taken from PD patients in order to establish whether an infection was present and if so which bacteria were responsible for the infection. We recorded the number of positive sputum samples taken from admission to North Tyneside General Hospital in North-East England across a ten-year period from June 2001 to June 2011. Of 643 in-patient episodes involving people with PD, positive sputum samples were recorded for only 12 episodes (1.9% in eight patients. All patients were in early stage disease. In all admissions to the NHS Trust running the hospital, there were 23,069 sputum cultures from 1,056,693 in-patient episodes (2.2%. Our findings may reflect the difficultly of expectorating in many people with PD, particularly in late-stage disease. Since people with PD are especially vulnerable to respiratory tract infections, clinicians need to ensure that, where possible, a sputum sample is obtained from people with PD when clinically indicated.

  18. Impact of the health insurance scheme for stateless people on inpatient utilization in Kraburi Hospital, Thailand

    Science.gov (United States)

    Suphanchaimat, Rapeepong; Prakongsai, Phusit; Limwattananon, Supon; Mills, Anne

    2016-01-01

    Objectives This study sought to investigate the impact of the Thai “Health Insurance for People with Citizenship Problems” (HI-PCP) on access to care for stateless patients, compared to Universal Coverage Scheme patients and the uninsured, using inpatient utilization as a proxy for impact. Methods Secondary data analysis of inpatient records of Kraburi Hospital, Ranong province, between 2009 (pre-policy) and 2012 (post-policy) was employed. Descriptive statistics and multivariate analysis by difference-in-difference model were performed. Results The volume of inpatient service utilization by stateless patients expanded after the introduction of the HI-PCP. However, this increase did not appear to stem from the HI-PCP per se. After controlling for key covariates, including patients’ characteristics, disease condition, and domicile, there was only a weak positive association between the HI-PCP and utilization. Critical factors contributing significantly to increased utilization were older age, proximity to the hospital, and presence of catastrophic illness. Conclusion A potential explanation for the insignificant impact of the HI-PCP on access to inpatient care of stateless patients is likely to be a lack of awareness of the existence of the scheme among the stateless population and local health staff. This problem is likely to have been accentuated by operational constraints in policy implementation, including the poor performance of local offices in registering stateless people. A key limitation of this study is a lack of data on patients who did not visit the health facility at the first opportunity. Further study of health-seeking behavior of stateless people at the household level is recommended. PMID:27942240

  19. Profile and pattern of crack consumption among inpatients in a Brazilian psychiatric hospital

    Directory of Open Access Journals (Sweden)

    Silvia Mendes da Cunha

    2015-09-01

    Full Text Available Introduction: Crack cocaine use is associated with polydrug abuse, and inpatients dependent on crack exhibit profiles of serious consumption patterns. Use of alcohol and tobacco and other drugs is a risk factor for experimentation of additional drugs, including crack cocaine.Objectives:The present study describes the characteristics and crack consumption patterns among inpatients in treatment during 2011 and 2012 at the Hospital Psiquiátrico São Pedro (Porto Alegre, Brazil. An additional objective was to identify the sequence of alcohol and tobacco consumption prior to crack use.Methods: The participants were 53 male inpatients addicted to crack with a mean age of 27.5±7.3 years. A sociodemographic questionnaire; the Alcohol, Smoking and Substance Involvement Screening Test and the Mini Mental State Examination were all administered to participants. Inclusion criteria were crack cocaine dependency (based on the 10th edition of the International Classification of Diseases [ICD-10] and being abstinent for 7 days. Patients with cognitive difficulties who were unable to understand and/or respond to the questionnaires were excluded from the sample.Results: The participants were young male adults with low educational level and low incomes and were polydrug users. The majority had made more than one attempt to quit. Use of legal drugs in early adolescence, prior to crack use, was identified.Conclusions: The profiles of the inpatients addicted to crack treated at this hospital indicate a serious usage pattern among those who seek specialized support. Crack use is frequent and is associated with use of other drugs and with difficulty sustaining abstinence. The pattern of progression from alcohol and tobacco use to crack cocaine dependency demands the attention of those responsible for prevention policies.

  20. Inpatient dermatology: Characteristics of patients and admissions in a tertiary level hospital in Eastern India

    Directory of Open Access Journals (Sweden)

    Arpita Sen

    2016-01-01

    Full Text Available Introduction: Dermatology is primarily a non-acute, outpatient-centered clinical specialty, but substantial number of patients need indoor admission for adequate management. Over the years, the need for inpatient facilities in Dermatology has grown manifold; however, these facilities are available only in some tertiary centers. Aims and Objectives: To analyze the characteristics of the diseases and outcomes of patients admitted in the dermatology inpatient Department of a tertiary care facility in eastern India. Materials and Methods: We undertook a retrospective analysis of the admission and discharge records of all patients, collected from the medical records department, admitted to our indoor facility from 2011 to 2014. The data thus obtained was statistically analyzed with special emphasis on the patient's demographic profile, clinical diagnosis, final outcome, and duration of stay. Results and Analysis: A total of 375 patients were admitted to our indoor facility during the period. Males outnumbered females, with the median age in the 5th decade. Immunobullous disorders (91 patients, 24.27% were the most frequent reason for admissions, followed by various causes of erythroderma (80 patients, 21.33% and infective disorders (73 patients, 19.47%. Other notable causes included cutaneous adverse drug reactions, psoriasis, vasculitis, and connective tissue diseases. The mean duration of hospital stay was 22.2±15.7 days; ranging from 1 to 164 days. Majority of patients (312, 83.2% improved after hospitalization; while 29 (7.73% patients died from their illness. About 133 patients (35.64% required referral services during their stay, while 8 patients (2.13% were transferred to other departments for suitable management. Conclusion: Many dermatoses require inpatient care for their optimum management. Dermatology inpatient services should be expanded in India to cater for the large number of cases with potentially highly severe dermatoses.

  1. Prescription pattern of benzodiazepines for inpatients at a tertiary care university hospital in Pakistan.

    Science.gov (United States)

    Khawaja, Muhammad Rizwanulhaq; Khawaja, Muhammad Rizwanullah; Majeed, A; Malik, F; Merchant, K A; Maqsood, M; Malik, R; Mazahir, S; Naqvi, H

    2005-06-01

    To determine the point prevalence of benzodiazepine prescriptions for inpatients at a tertiary care university hospital in Pakistan and to correlate it with prescription patterns of various specialties, indications and demographic variables of the patients. This 24-hours point prevalence study was done at The Aga Khan University Hospital, Karachi. By convenient random sampling, 208 inpatients were interviewed. Patients' files were also studied to record the drugs administered. Data was entered into questionnaires and analyzed by SPSS 10.0. The point prevalence of the benzodiazepines was 21.2%. It was higher among males than females and among surgical than non-surgical patients. Midazolam was the most commonly used benzodiazepine, followed by Alprazolam and Lorazepam. Pre-anesthesia and psychiatric symptoms were the two most common indications. Oral route was used in 84% patients for drug administration and mean Valium equivalent dosage was 4.86 mg/day. Mean length of prescription was 3 days. Longer duration of hospitalization was a significant predictor of the requirement of benzodiazepine prescription (p-value = 0.020). Prescription pattern of benzodiazepines at a tertiary care university hospital is similar to that reported in the developed countries through monitoring at various levels by physicians, clinical pharmacist and nursing staff. Data regarding the prescription pattern of benzodiazepines is scarce, and it needs to be expanded to formulate clear guidelines regarding their prescription.

  2. An analysis of the recording of tobacco use among inpatients in Irish hospitals.

    LENUS (Irish Health Repository)

    Sheridan, A

    2014-10-01

    Smoking is the largest avoidable cause of premature mortality in the world. Hospital admission is an opportunity to identify and help smokers quit. This study aimed to determine the level of recording of tobacco use (current and past) in Irish hospitals. Information on inpatient discharges with a tobacco use diagnosis was extracted from HIPE. In 2011, a quarter (n=84, 679) of discharges had a recording of tobacco use, which were more common among males (29% (n=50,161) male v. 20% (n=30,162) female), among medical patients (29% (n=54,375) medical v. 20% (n=30,162) other) and was highest among those aged 55-59 years (30.6%; n=7,885). SLAN 2007 reported that 48% of adults had smoked at some point in their lives. This study would suggest an under- reporting of tobacco use among hospital inpatients. Efforts should be made to record smoking status at hospital admission, and to improve the quality of the HIPE coding of tobacco use.

  3. Cost analysis of in-patient cancer chemotherapy at a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Mohammad Ashraf Wani

    2013-01-01

    Materials and Methods: After permission from the Ethical Committee, a prospective study of 6 months duration was carried out to study the cost of treatment provided to in-patients in Medical Oncology. Direct costs that include the cost of material, labor and laboratory investigations, along with indirect costs were calculated, and data analyzed to compute unit cost of treatment. Results: The major cost components of in-patient cancer chemotherapy are cost of drugs and materials as 46.88% and labor as 48.45%. The average unit cost per patient per bed day for in-patient chemotherapy is Rs. 5725.12 ($125.96. This includes expenditure incurred both by the hospital and the patient (out of pocket. Conclusion: The economic burden of cancer treatment is quite high both for the patient and the healthcare provider. Modalities in the form of health insurance coverage need to be established and strengthened for pooling of resources for the treatment and transfer of risks of these patients.

  4. Bortezomib Inpatient Prescribing Practices in Free-Standing Children's Hospitals in the United States.

    Directory of Open Access Journals (Sweden)

    Amanda M DiNofia

    Full Text Available This study is a pharmacoepidemiologic description of pediatric bortezomib use. Exposure was identified through billing codes in patients admitted to US children's hospitals that participated with the Pediatric Health Information System between 2004 and 2013. Associated information on underlying diseases, demographics, institutional use, mortality, and physician type was collected. Exposure to bortezomib was identified in 314 patients. Hematologist/Oncologists prescribed half of the bortezomib used. Use increased during the study period. Inpatient volume was positively correlated with bortezomib utilization. Bortezomib use in pediatrics is increasing for a variety of diseases. Variation in use exists across institutions. Further studies are needed to characterize bortezomib's efficacy in pediatric diseases.

  5. Impact of inpatient caseload, emergency department duties, and online learning resource on General Medicine In-Training Examination scores in Japan.

    Science.gov (United States)

    Kinoshita, Kensuke; Tsugawa, Yusuke; Shimizu, Taro; Tanoue, Yusuke; Konishi, Ryota; Nishizaki, Yuji; Shiojiri, Toshiaki; Tokuda, Yasuharu

    2015-01-01

    Both clinical workload and access to learning resource are important components of educational environment and may have effects on clinical knowledge of residents. We conducted a survey with a clinical knowledge evaluation involving postgraduate year (PGY)-1 and -2 resident physicians at teaching hospitals offering 2-year postgraduate training programs required for residents in Japan, using the General Medicine In-Training Examination (GM-ITE). An individual-level analysis was conducted to examine the impact of the number of assigned patients and emergency department (ED) duty on the residents' GM-ITE scores by fitting a multivariable generalized estimating equations. In hospital-level analysis, we evaluated the relationship between for the number of UpToDate reviews for each hospital and for the hospitals' mean GM-ITE score. A total of 431 PGY-1 and 618 PGY-2 residents participated. Residents with four or five times per month of the ED duties exhibited the highest mean scores compared to those with greater or fewer ED duties. Those with largest number of inpatients in charge exhibited the highest mean scores compared to the residents with fewer inpatients in charge. Hospitals with the greater UpToDate topic viewing showed significantly greater mean score. Appropriate ED workload and inpatient caseload, as well as use of evidence-based electronic resources, were associated with greater clinical knowledge of residents.

  6. Hospital organization and importance of an interventional radiology inpatient admitting service: Italian single-center 3-year experience.

    Science.gov (United States)

    Simonetti, Giovanni; Bollero, Enrico; Ciarrapico, Anna Micaela; Gandini, Roberto; Konda, Daniel; Bartolucci, Alberto; Di Primio, Massimiliano; Mammucari, Matteo; Chiocchi, Marcello; D'Alba, Fabrizio; Masala, Salvatore

    2009-03-01

    In June 2005 a Complex Operating Unit of Interventional Radiology (COUIR), consisting of an outpatient visit service, an inpatient admitting service with four beds, and a day-hospital service with four beds was installed at our department. Between June 2005 and May 2008, 1772 and 861 well-screened elective patients were admitted to the inpatient ward of the COUIR and to the Internal Medicine Unit (IMU) or Surgery Unit (SU) of our hospital, respectively, and treated with IR procedures. For elective patients admitted to the COUIR's inpatient ward, hospital stays were significantly shorter and differences between reimbursements and costs were significantly higher for almost all IR procedures compared to those for patients admitted to the IMU and SU (Student's t-test for unpaired data, p organization of the patient pathway that came with it, evidenced more efficient use of resources, with the possibility for the hospital to save money and obtain positive margins (differences between reimbursements and costs). During 3 years of activity, the inpatient admitting service of our COUIR yielded a positive difference between reimbursements and effective costs of 1,009,095.35 euros. The creation of an inpatient IR service and the admission of well-screened elective patients allowed short hospitalization times, reduction of waiting lists, and a positive economic outcome.

  7. Frequent use of hospital inpatient services during a nine year period: a retrospective cohort study.

    Science.gov (United States)

    Springer, Adelle M; Condon, John R; Li, Shu Q; Guthridge, Steven L

    2017-05-12

    Frequent use (FU) of hospital services impacts on patients and health service expenditure. Studies examining FU in emergency departments and inpatient settings have found heterogeneity and the need to differentiate between potentially preventable FU and that associated with ongoing management of complex conditions. Psychosocial factors have often been reported as underpinning or exacerbating the phenomena. Most FU studies have been limited by time, to a single study site, or restricted to specific diagnoses or patient groups. This study provides a comprehensive description of adult patient characteristics, conditions and risk factors associated with FU, based on admissions to the five public hospitals in the Northern Territory (NT) of Australia over a nine year period. The study population is distinctive comprising both Aboriginal and non-Aboriginal patients. Data on all inpatient episodes in NT public hospitals between 2005 and 2013 was analysed to identify patients with any FU (four or more episodes within any 12-month period) and measure FU duration (number of FU years) and intensity (mean number of episodes per FU year). Pregnancy, alcohol-related and mental health condition flags were assigned to patients with any episode with relevant diagnoses during the study period. Multivariate analysis was used to assess factors associated with any FU, FU duration and FU intensity, separately for Aboriginal and non-Aboriginal patients. Of people with any inpatient episodes during the study period, 13.6% were frequent users (Aboriginal 22%, non-Aboriginal 10%) accounting for 46.6% of all episodes. 73% of frequent users had only one FU year. Any FU and increased FU duration were more common among individuals who were: Aboriginal; older; female; and those with a pregnancy, alcohol or mental health flag. Having two or more alcohol-related episodes in the nine-year period was strongly associated with any FU for both Aboriginal (odds ratio 8.9, 95% CI. 8.20-9.66) and non

  8. The spectrum of rheumatic in-patient diagnoses at a pediatric hospital in Kenya.

    Science.gov (United States)

    Migowa, Angela; Colmegna, Inés; Hitchon, Carol; Were, Eugene; Ng'ang'a, Evelyn; Ngwiri, Thomas; Wachira, John; Bernatsky, Sasha; Scuccimarri, Rosie

    2017-01-14

    Pediatric rheumatic diseases are chronic illnesses that can cause considerable disease burden to children and their families. There is limited epidemiologic data on these diseases in East Africa. The aim of this study was to assess the spectrum of pediatric rheumatic diagnoses in an in-patient setting and determine the accuracy of ICD-10 codes in identifying these conditions. Medical records from Gertrude's Children's Hospital in Kenya were reviewed for patients diagnosed with "diseases of the musculoskeletal system and connective tissue" as per ICD-10 diagnostic codes assigned at discharge between January and December 2011. Cases were classified as "rheumatic" or "non-rheumatic". Accuracy of the assigned ICD-10 code was ascertained. Death records were reviewed. Longitudinal follow-up of "rheumatic" cases was done by chart review up to March 2014. Twenty six patients were classified as having a "rheumatic" condition accounting for 0.32% of patients admitted. Of these, 11 (42.3%) had an acute inflammatory arthropathy, 6 (23.1%) had septic arthritis, 4 (15.4%) had Kawasaki disease, 2 (7.7%) had pyomyositis, and there was one case each of septic bursitis, rheumatic fever, and a non-specific soft tissue disorder. No cases of juvenile idiopathic arthritis (JIA) were identified. One case of systemic lupus erythematosus was documented by death records. The agreement between the treating physician's discharge diagnosis and medical records ICD-10 code assignment was good (Kappa: 0.769). On follow-up, one child had recurrent knee swelling that was suspicious for JIA. Pediatric rheumatic conditions represented 0.32% of admissions at a pediatric hospital in Kenya. Acute inflammatory arthropathies, septic arthritis and Kawasaki disease were the most frequent in-patient rheumatic diagnoses. Chronic pediatric rheumatic diseases were rare amongst this in-patient population. Despite limitations associated with the use of administrative diagnostic codes, they can be a first step in

  9. Using routine inpatient data to identify patients at risk of hospital readmission

    Directory of Open Access Journals (Sweden)

    Howell Stuart

    2009-06-01

    Full Text Available Abstract Background A relatively small percentage of patients with chronic medical conditions account for a much larger percentage of inpatient costs. There is some evidence that case-management can improve health and quality-of-life and reduce the number of times these patients are readmitted. To assess whether a statistical algorithm, based on routine inpatient data, can be used to identify patients at risk of readmission and who would therefore benefit from case-management. Methods Queensland database study of public-hospital patients, who had at least one emergency admission for a chronic medical condition (e.g., congestive heart failure, chronic obstructive pulmonary disease, diabetes or dementia during 2005/2006. Multivariate logistic regression was used to develop an algorithm to predict readmission within 12 months. The performance of the algorithm was tested against recorded readmissions using sensitivity, specificity, and Likelihood Ratios (positive and negative. Results Several factors were identified that predicted readmission (i.e., age, co-morbidities, economic disadvantage, number of previous admissions. The discriminatory power of the model was modest as determined by area under the receiver operating characteristic (ROC curve (c = 0.65. At a risk score threshold of 50, the algorithm identified only 44.7% (95% CI: 42.5%, 46.9% of patients admitted with a reference condition who had an admission in the next 12 months; 37.5% (95% CI: 35.0%, 40.0% of patients were flagged incorrectly (they did not have a subsequent admission. Conclusion A statistical algorithm based on Queensland hospital inpatient data, performed only moderately in identifying patients at risk of readmission. The main problem is that there are too many false negatives, which means that many patients who might benefit would not be offered case-management.

  10. Overweight, obesity and related conditions: a cross-sectional study of adult inpatients at a Norwegian Hospital

    Science.gov (United States)

    2014-01-01

    Background Overweight, obesity and associated conditions are major public health concerns in Norway. The prevalence of overweight and obesity in the general population in Norway is increasing, but there are limited data on how the situation is in hospitals. This study aimed to find the prevalence of overweight and obesity, and explore the associations of overweight, obesity and its related medical conditions in an adult in-patient sample at specified somatic and psychiatric departments at St. Olavs Hospital, Trondheim. Results A total of 497 patients participated. The mean BMI for the total sample at screening was 25.4 kg/m2. The prevalence of overweight and obesity was 45.1%. There was a higher association of overweight and obesity among patients aged 40–59 years (OR: 1.7) compared to those being younger. There was no significant difference between the somatic and the psychiatric samples. In the somatic sample overweight and obesity was associated with obesity-related conditions for both genders (OR: 2.0 and 2.1, respectively), when adjusted for age. Conclusion The substantial prevalence of overweight and obese patients may pose a threat to future hospital services. To further address the burden of overweight and obesity in hospitals, we need more knowledge about consequences of length of stay, use of resources and overall cost. PMID:24571809

  11. [Impact of nurse, nurses' aid staffing and turnover rate on inpatient health outcomes in long term care hospitals].

    Science.gov (United States)

    Kim, Yunmi; Lee, Ji Yun; Kang, Hyuncheol

    2014-02-01

    This study was conducted to explore the impact of registered nurse/nurses' aid (RN/NA) staffing and turnover rate on inpatient health outcomes in long term care hospitals. A secondary analysis was done of national data from the Health Insurance Review and Assessment Services including evaluation of long term care hospitals in October-December 2010 and hospital general characteristics in July-September 2010. Final analysis of data from 610 hospitals included RN/NA staffing, turnover rate of nursing staff and 5 patient health outcome indicators. Finding showed that, when variables of organization and community level were controlled, patients per RN was a significant indicator of decline in ADL for patients with dementia, and new pressure ulcer development in the high risk group and worsening of pressure ulcers. Patients per NA was a significant indicator for new pressure ulcer development in the low risk group. Turnover rate was not significant for any variable. To maintain and improve patient health outcomes of ADL and pressure ulcers, policies should be developed to increase the staffing level of RN. Studies are also needed to examine causal relation of NA staffing level, RN staffing level and patient health outcomes with consideration of the details of nursing practice.

  12. Health literacy and English language comprehension among elderly inpatients at an urban safety-net hospital.

    Science.gov (United States)

    Cordasco, Kristina M; Asch, Steven M; Franco, Idalid; Mangione, Carol M

    2009-01-01

    To evaluate the relationship between health literacy and age in chronically-ill inpatients at a safety-net hospital. We recruited 399 English- and Spanish-speaking inpatients being evaluated or treated for Congestive Heart Failure or Coronary Artery Disease at a large, urban safety-net teaching hospital in Southern California. Participants were interviewed to ascertain education, English comprehension, and in-home language use. Health literacy was assessed using The Test of Functional Health Literacy in Adults (TOFHLA). We compared by age (aged 65 or more, 51 to 64 years of age, and less than age 50) levels of health literacy, educational attainment, English comprehension, and language use. Prevalence of inadequate health literacy significantly increased with increasing age (87.2% in > or = 65, 48.9% for 51-64, and 26.3% in or = 65, 6.5% for 51-64, and 1.5% in or = 65, 9.0% for 51-64, and 0.8% in or = 65, 43.5% for 51-64, and 35.8% in language at home (82.3% in > or = 65, 70.2% for 51-64, and 62.2% in development and implementation of low-literacy educational materials, programs, and services.

  13. Patient Satisfaction with Hospital Inpatient Care: Effects of Trust, Medical Insurance and Perceived Quality of Care

    Science.gov (United States)

    Wu, Qunhong; Liu, Chaojie; Jiao, Mingli; Hao, Yanhua; Han, Yuzhen; Gao, Lijun; Hao, Jiejing; Wang, Lan; Xu, Weilan; Ren, Jiaojiao

    2016-01-01

    Objective Deteriorations in the patient-provider relationship in China have attracted increasing attention in the international community. This study aims to explore the role of trust in patient satisfaction with hospital inpatient care, and how patient-provider trust is shaped from the perspectives of both patients and providers. Methods We adopted a mixed methods approach comprising a multivariate logistic regression model using secondary data (1200 people with inpatient experiences over the past year) from the fifth National Health Service Survey (NHSS, 2013) in Heilongjiang Province to determine the associations between patient satisfaction and trust, financial burden and perceived quality of care, followed by in-depth interviews with 62 conveniently selected key informants (27 from health and 35 from non-health sectors). A thematic analysis established a conceptual framework to explain deteriorating patient-provider relationships. Findings About 24% of respondents reported being dissatisfied with hospital inpatient care. The logistic regression model indicated that patient satisfaction was positively associated with higher level of trust (OR = 14.995), lower levels of hospital medical expenditure (OR = 5.736–1.829 as compared with the highest quintile of hospital expenditure), good staff attitude (OR = 3.155) as well as good ward environment (OR = 2.361). But patient satisfaction was negatively associated with medical insurance for urban residents and other insurance status (OR = 0.215–0.357 as compared with medical insurance for urban employees). The qualitative analysis showed that patient trust—the most significant predictor of patient satisfaction—is shaped by perceived high quality of service delivery, empathic and caring interpersonal interactions, and a better designed medical insurance that provides stronger financial protection and enables more equitable access to health care. Conclusion At the core of high levels of patient dissatisfaction

  14. Educational clowning – a serious development in the educational work with children receiving inpatient hospital treatment

    Directory of Open Access Journals (Sweden)

    Alexander Wertgen

    2009-06-01

    Full Text Available Children and youth, receiving inpatient hospital treatment, are living under exceptional physical, psychological, and social circumstances. The engagement of clinic clowns has recently been established as an educational outreach program in many hospitals. Clinic clowns are responsive to the special educational needs of young patients and, according to experience, are able to lastingly influence their state of health in a positive way. Based on an anecdote of a visit from a clinic clown, a description of the professional role of a clown, respectively a clinic clown, the effects and the beneficial results of clowns’ work are explained. The article ends with a discussion on how and to what extent educational clowning can be considered as a new discipline in the extracurricular educational work with sick children.

  15. Encephalitis hospitalization rates and inpatient mortality in the United States, 2000-2010.

    Directory of Open Access Journals (Sweden)

    Benjamin P George

    Full Text Available Encephalitis rates by etiology and acute-phase outcomes for encephalitis in the 21st century are largely unknown. We sought to evaluate cause-specific rates of encephalitis hospitalizations and predictors of inpatient mortality in the United States.Using the Nationwide Inpatient Sample (NIS from 2000 to 2010, a retrospective observational study of 238,567 patients (mean [SD] age, 44.8 [24.0] years hospitalized within non-federal, acute care hospitals in the U.S. with a diagnosis of encephalitis was conducted. Hospitalization rates were calculated using population-level estimates of disease from the NIS and population estimates from the United States Census Bureau. Adjusted odds of mortality were calculated for patients included in the study.In the U.S. from 2000-2010, there were 7.3±0.2 encephalitis hospitalizations per 100,000 population (95% CI: 7.1-7.6. Encephalitis hospitalization rates were highest among females (7.6±0.2 per 100,000 and those 65 years of age with rates of 13.5±0.9 and 14.1±0.4 per 100,000, respectively. Etiology was unknown for approximately 50% of cases. Among patients with identified etiology, viral causes were most common (48.2%, followed by Other Specified causes (32.5%, which included predominantly autoimmune conditions. The most common infectious agents were herpes simplex virus, toxoplasma, and West Nile virus. Comorbid HIV infection was present in 7.7% of hospitalizations. Average length of stay was 11.2 days with mortality of 5.6%. In regression analysis, patients with comorbid HIV/AIDS or cancer had increased odds of mortality (odds ratio [OR]  = 1.70; 95% CI: 1.30-2.22 and OR = 2.26; 95% CI: 1.88-2.71, respectively. Enteroviral, postinfectious, toxic, and Other Specified causes were associated with lower odds vs. herpes simplex encephalitis.While encephalitis and encephalitis-related mortality impose a considerable burden in the U.S. in the 21st Century, the reported demographics of hospitalized

  16. [Family and psychiatric hospitalization in a general hospital].

    Science.gov (United States)

    de Mello, Rita Mello; Schneider, Jacó Fernando

    2011-06-01

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

  17. A MiniReview of the Use of Hospital-based Databases in Observational Inpatient Studies of Drugs

    DEFF Research Database (Denmark)

    Larsen, Michael Due; Cars, Thomas; Hallas, Jesper

    2013-01-01

    The majority of pharmacoepidemiological data resources are based on data generated in primary health care. Although inpatient data resources have existed since the 1960s, inpatient pharmacoepidemiological studies are relatively scarce. The objectives of this MiniReview were to describe pharmacoep......The majority of pharmacoepidemiological data resources are based on data generated in primary health care. Although inpatient data resources have existed since the 1960s, inpatient pharmacoepidemiological studies are relatively scarce. The objectives of this MiniReview were to describe...... pharmacoepidemiological studies in hospital settings and the underlying databases to provide an overview of research questions addressed by such databases. The studies were retrieved by chain searching. We included pharmacoepidemiological studies in hospital settings containing data on inpatient drug use. Twelve...... inpatient databases in Asia, the United States and Europe were found. Most databases were automatically collected from claims data or generated from electronic medical records. The contents of the databases varied as well as the potential for linkage with other data sources such as laboratory and outpatient...

  18. Patient experiences of inpatient hospital care: a department matter and a hospital matter.

    NARCIS (Netherlands)

    Krol, M.W.; Boer, D. de; Sixma, H.; Hoek, L. van der; Rademakers, J.J.D.J.M.; Delnoij, D.M.

    2015-01-01

    Objective: To examine the added value of measuring and possibly presenting patient experiences at the department level, in addition to the hospital level, and to explore the possibility that patient experiences differ according to the ‘type’ of hospital department. Design: Secondary analysis of data

  19. Inpatient Hospitalization of Oncology Patients: Are We Missing an Opportunity for End-of-Life Care?

    Science.gov (United States)

    Rocque, Gabrielle B.; Barnett, Anne E.; Illig, Lisa C.; Eickhoff, Jens C.; Bailey, Howard H.; Campbell, Toby C.; Stewart, James A.; Cleary, James F.

    2013-01-01

    Introduction: Despite advances in the care of patients with cancer over the last 10 years, cancer remains the second leading cause of death in the United States. Many patients receive aggressive, in-hospital end-of-life care at high cost. There are few data on outcomes after unplanned hospitalization of patients with metastatic cancer. Methods: In 2000 and 2010, data were collected on admissions, interventions, and survival for patients admitted to an academic inpatient medical oncology service. Results: The 2000 survey included 191 admissions of 151 unique patients. The 2010 survey assessed 149 admissions of 119 patients. Lung, GI, and breast cancers were the most common cancer diagnoses. In the 2010 assessment, pain was the most common chief complaint, accounting for 28%. Although symptoms were the dominant reason for admission in 2010, procedures and imaging were common in both surveys. The median survival of patients after discharge was 4.7 months in 2000 and 3.4 months in 2010. Despite poor survival in this patient population, hospice was recommended in only 23% and 24% of patients in 2000 and 2010, respectively. Seventy percent of patients were discharged home without additional services. Conclusion: On the basis of our data, an unscheduled hospitalization for a patient with advanced cancer strongly predicts a median survival of fewer than 6 months. We believe that hospital admission represents an opportunity to commence and/or consolidate appropriate palliative care services and end-of-life care. PMID:23633971

  20. Music listening preferences and preadmission dysfunctional psychosocial behaviors of adolescents hospitalized on an in-patient psychiatric unit.

    Science.gov (United States)

    Weidinger, C K; Demi, A S

    1991-01-01

    This study investigated the relationship between music listening preferences and preadmission, dysfunctional psychosocial behaviors (PDPB) of 60 adolescents who were hospitalized on an in-patient psychiatric unit. Findings were that hospitalized adolescents who primarily listened to music with negative lyrics/themes had a history of more PDPB than hospitalized adolescents who primarily listened to music that did not contain negative lyrics/themes; and hospitalized adolescents who primarily listened to heavy metal music had a history of more PDPB than hospitalized adolescents who primarily listened to other types of music.

  1. Hospital characteristics related to the hospital length of stay among inpatients receiving invasive cervical discectomy due to road traffic accidents under automobile insurance in South Korea.

    Science.gov (United States)

    Shin, Kyoung Won; Lee, Hyo Jung; Nam, Chung Mo; Moon, Ki Tae; Park, Eun-Cheol

    2017-08-16

    In South Korea, people injured in road traffic accidents receive compensation for medical costs through their automobile insurance. However, the automobile insurance system appears to manage health care inefficiently. This study aimed to investigate the factors associated with the hospital length of stay (LOS), which was used as an indicator of healthcare utilization, for inpatients covered by automobile insurance and undergoing invasive cervical discectomy. Insurance claims data from 158 hospitals were used. The study included 850 inpatients who were involved in automobile accidents in 2014 and 2015 and who underwent invasive cervical discectomy. Poisson regression analysis was performed to examine the associations between the LOS and hospital-level characteristics. The mean LOS for inpatients covered by automobile insurance was 25.75 days. A higher proportion of inpatients with automobile insurance were associated with a longer LOS (rate ratio [RR]: 1.027 per 1% increase, 95% confidence interval [CI]: 1.012-1.042). A higher hospital volume of invasive cervical discectomy (RR: 0.970 per 10 case increase, 95% CI: 0.945-0.997), bed turnover rate (RR: 0.988 per 1 increase, 95% CI: 0.979-0.997), and number of neurosurgeons or orthopedic specialists (RR: 0.930 per 1/100 beds increase, 95% CI: 0.876-0.987) were associated with a shorter LOS. Our findings suggest that inpatients covered by automobile insurance were associated with a longer LOS when treated at small-sized, low-provider, and low-volume hospitals with high proportions of such patients. Based on these findings, policymakers and healthcare professionals ought to consider improved strategies for efficient management of automobile insurance for inpatients in small-sized hospitals.

  2. The effect of additional physiotherapy to hospital inpatients outside of regular business hours: a systematic review.

    Science.gov (United States)

    Brusco, Natasha K; Paratz, Jennifer

    2006-12-01

    Provision of out of regular business hours (OBH) physiotherapy to hospital inpatients is widespread in the hospital setting. This systematic review evaluated the effect of additional OBH physiotherapy services on patient length of stay (LOS), pulmonary complications, discharge destination, discharge mobility status, quality of life, cost saving, adverse events, and mortality compared with physiotherapy only within regular business hours. A literature search was completed on databases with citation tracking using key words. Two reviewers completed data extraction and quality assessment independently by using modified scales for historical cohorts and case control studies as well as the PEDro scale for randomized controlled trials and quasi-randomised controlled trials. This search identified nine articles of low to medium quality. Four reported a significant reduction in LOS associated with additional OBH physiotherapy, with two articles reporting overall significance and two reporting only for specific subgroups. Two studies reported significant reduction in pulmonary complications for two different patient groups in an intensive care unit (ICU) with additional OBH physiotherapy. Three studies accounted for discharge destination and/or discharge mobility status with no significant difference reported. Quality of life, adverse events, and mortality were not reported in any studies. Cost savings were considered in three studies, with two reporting a cost saving. This systematic review was unable to conclude that the provision of additional OBH physiotherapy made significant improvement to patient outcomes for all subgroups of inpatients. One study in critical care reported that overnight physiotherapy decreased LOS and reduced pulmonary complications of patients in the ICU. However, the studies in the area of orthopaedics, neurology, postcardiac surgery, and rheumatology, which all considered additional daytime weekend physiotherapy intervention, did not provide

  3. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and Fiscal Year 2014 rates; quality reporting requirements for specific providers; hospital conditions of participation; payment policies related to patient status. Final rules.

    Science.gov (United States)

    2013-08-19

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of the changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. These changes will be applicable to discharges occurring on or after October 1, 2013, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits will be effective for cost reporting periods beginning on or after October 1, 2013. We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes that were applied to the LTCH PPS by the Affordable Care Act. Generally, these updates and statutory changes will be applicable to discharges occurring on or after October 1, 2013, unless otherwise specified in this final rule. In addition, we are making a number of changes relating to direct graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or have revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program and the Hospital Readmissions Reduction Program. In addition, we are revising the conditions of participation (CoPs) for hospitals relating to the

  4. Frequency of Djinnati Syndrome among Inpatient Admissions at Baharan Psychiatric Hospital in Zahedan, Iran

    Directory of Open Access Journals (Sweden)

    Sanaz Ghasemi

    2014-08-01

    Full Text Available Background: A culture-bound syndrome common in Baluchistan is Djinnati that is classified as trance and possession state, a sub-class of dissociative disorders NOS, in DSM IV-TR. The present study aims to determine the frequency of Djinnati syndrome among in-patients at Baharan psychiatric hospital in Zahedan, Iran. Materials and Methods: In this descriptive study, the statistical community includes all patients (N=773 who were admitted in Baharan psychiatric hospital during a 6 months period. After considering the inclusion and exclusion criteria, 150 subjects (61 males and 89 females were selected. Semi-structural interview and Dissociative Experience Scale (DES questionnaire were performed for them. Spearman’s rank correlation coefficient, χ2, and t-tests were employed for analysis of data in SPSS-18. Results: Frequency of Djinnati syndrome among patients admitted in this referral psychiatric hospital was 4.1% and this syndrome showed a significant dominance in female sex (M/F=1/3. There was also a positive and significant correlation between child abuse and dissociative experiences including Djinnati. Conclusion: The study has shown that dissociative disorders NOS, in the form of trance and possession states (such as Djinnati, are not rare especially in the eastern parts of Iran and among poor and young women. It is important to define Djinnati syndrome in this region and prepare medical students and psychiatric residents for diagnosing and managing this condition. Its relationship with child abuse should be considered in preventive medicine.

  5. 77 FR 27869 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2012-05-11

    ... record FAH Federation of Hospitals FDA Food and Drug Administration FFY Federal fiscal year FQHC... 2008, Public Law 110-275 MMA Medicare Prescription Drug, Improvement, and Modernization Act of 2003... (B) Antineoplastic Chemotherapy Induced Anemia (C) Cardiomyopathy and Congestive Heart Failure...

  6. 77 FR 53257 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2012-08-31

    ... Electronic medical record FAH Federation of Hospitals FDA Food and Drug Administration FFY Federal fiscal... for Patients and Providers Act of 2008, Public Law 110-275 MMA Medicare Prescription Drug, Improvement... Diagnosis Codes for FY 2013 (A) Protein-Calorie Malnutrition (B) Antineoplastic Chemotherapy Induced Anemia...

  7. 78 FR 64953 - Medicare Program; Inpatient Hospital Deductible and Hospital and Extended Care Services...

    Science.gov (United States)

    2013-10-30

    ... entities include small businesses, nonprofit organizations, and small governmental jurisdictions. Most hospitals and most other providers and suppliers are small entities, either by nonprofit status or by having... and states are not included in the definition of a small entity. As discussed above, this...

  8. 75 FR 60640 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2010-10-01

    ... 50547 in Table 4J, we inadvertently omitted providers located in Tarrant County, TX that are eligible to... 360096 * 0.0011 COLUMBIANA 36140 670023 0.0054 TARRANT 45910 670042 0.0054 TARRANT 45910 670046 0.0054 TARRANT 45910 6. On pages 50593 and 50604, in Table 9A.--Hospital Reclassifications and...

  9. 75 FR 50041 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2010-08-16

    ... New Technology Add-On Payments a. Auto Laser Interstitial Thermal Therapy (AutoLITT TM ) System b... Neutrality Adjustment for the Rural and Imputed Floors 3. Floor for Area Wage Index for Hospitals in Frontier... Affordable Care Act returning the rural floor budget neutrality to a uniform national adjustment.) Table...

  10. Does hospital need more hospice beds? Hospital charges and length of stays by lung cancer inpatients at their end of life: A retrospective cohort design of 2002-2012.

    Science.gov (United States)

    Kim, Sun Jung; Han, Kyu-Tae; Kim, Tae Hyun; Park, Eun-Cheol

    2015-10-01

    Previous studies found that hospice and palliative care reduces healthcare costs for end-of-life cancer patients. To investigate hospital inpatient charges and length-of-stay differences by availability of hospice care beds within hospitals using nationwide data from end-of-life inpatients with lung cancer. A retrospective cohort study was performed using nationwide lung cancer health insurance claims from 2002 to 2012 in Korea. Descriptive and multi-level (patient-level and hospital-level) mixed models were used to compare inpatient charges and lengths of stay. Using 673,122 inpatient health insurance claims, we obtained aggregated hospital inpatient charges and lengths of stay from a total of 114,828 inpatients and 866 hospital records. Hospital inpatient charges and length of stay drastically increased as patients approached death; a significant portion of hospital inpatient charges and lengths of stay occurred during the end-of-life period. According to our multi-level analysis, hospitals with hospice care beds tend to have significantly lower end-of-life hospital inpatient charges; however, length of stay did not differ. Hospitals with more hospice care beds were associated with reduction in hospital inpatient charges within 3 months before death. Higher end-of-life healthcare hospital charges were found for lung cancer inpatients who were admitted to hospitals without hospice care beds. This study suggests that health policy-makers and the National Health Insurance program need to consider expanding the use of hospice care beds within hospitals and hospice care facilities for end-of-life patients with lung cancer in South Korea, where very limited numbers of resources are currently available. © The Author(s) 2015.

  11. Does hospital admission provide an opportunity for improving pharmacotherapy among elderly inpatients?

    Directory of Open Access Journals (Sweden)

    Daniela Oliveira de Melo

    Full Text Available ABSTRACT The purpose of the work was to assess the incidence of potential drug interactions (pDDI, major pDDI, and the use of potentially inappropriate medication (PIM at hospital admission, during hospitalization, and at discharge to evaluate whether hospital admission provides an opportunity for improving pharmacotherapy in elderly patients at a University hospital that has a clinical pharmacist. A prospective cohort study was carried out using data from the medical records of patients admitted to an internal medicine ward. All admissions and prescriptions were monitored between March and August 2006. Micromedex(r DrugReax(r and Beers Criteria 2015 were used to identify pDDI, major pDDI, and PIMs, respectively. A comparison of admission and discharge prescriptions showed the following: an increase in the proportion of patients using antithrombotic agents (76 versus 144; p<0.001, lipid modifying agents (58 versus 81; p=0.024, drugs for acid-related disorders (99 versus 152; p<0.001, and particularly omeprazole (61 versus 87; p=0.015; a decrease in the number of patients prescribed psycholeptics (73 versus 32; p<0.001 and diazepam (54 versus 13; p<0.001; and a decrease in the proportion of patients exposed to polypharmacy (16.1% versus 10.1%; p=0.025, at least one pDDI (44.5% versus 32.8%; p=0.002, major pDDI (19.9% versus 12.2%; p=0.010 or PIM (85.8% versus 51.9%; p<0.001. The conclusion is that admission to a hospital ward that has a clinical pharmacist was associated with a reduction in the number of patients exposed to polypharmacy, pDDI, major pDDI, and the use of PIMs among elderly inpatients.

  12. Medicare program; changes to the hospital inpatient prospective payment systems and fiscal year 1999 rates--HCFA. Final rule.

    Science.gov (United States)

    1998-07-31

    We are revising the Medicare hospital inpatient prospective payment systems for operating costs and capital-related costs to implement applicable statutory requirements, including section 4407 of the Balanced Budget Act of 1997 (BBA), as well as changes arising from our continuing experience with the systems. In addition, in the addendum to this final rule, we describe changes in the amounts and factors necessary to determine rates for Medicare hospital inpatient services for operating costs and capital-related costs. These changes are applicable to discharges occurring on or after October 1, 1998. We also set forth rate-of-increase limits as well as changes for hospitals and hospital units excluded from the prospective payment systems. Finally, we are implementing the provisions of section 4625 of the BBA concerning payment for the direct costs of graduate medical education.

  13. Hospital Anxiety and Depression Scale (HADS: validation in a Greek general hospital sample

    Directory of Open Access Journals (Sweden)

    Patapis Paulos

    2008-03-01

    Full Text Available Abstract Background The Hospital Anxiety and Depression Scale (HADS has been used in several languages to assess anxiety and depression in general hospital patients with good results. Methods The HADS was administered to 521 participants (275 controls and 246 inpatients and outpatients of the Internal Medicine and Surgical Departments in 'Attikon' General Hospital in Athens. The Beck Depression Inventory (BDI and the State-Trait Anxiety Inventory (STAI were used as 'gold standards' for depression and anxiety respectively. Results The HADS presented high internal consistency; Cronbach's α cofficient was 0.884 (0.829 for anxiety and 0.840 for depression and stability (test-retest intraclass correlation coefficient 0.944. Factor analysis showed a two-factor structure. The HADS showed high concurrent validity; the correlations of the scale and its subscales with the BDI and the STAI were high (0.722 – 0.749. Conclusion The Greek version of HADS showed good psychometric properties and could serve as a useful tool for clinicians to assess anxiety and depression in general hospital patients.

  14. [Bottlenecks in the provision of inpatient care--caused by the Hospital Funding Act].

    Science.gov (United States)

    Jansen, Christoph

    2010-01-01

    The responsibility of the state for ensuring the provision of hospital care services to its citizens derives from the welfare state principle laid down in Sect. 20 para. 1 GG (Grundgesetz, i.e., the German constitutional law). The state fulfils this responsibility by means of planning and funding regulations in the Hospital Funding Act (KHG), the Hospital Remuneration Act (KHEntG), the National Ordinance on Hospital Rates (BPflV), the Hospital Laws of the German federal states and other supplementary legislation. The funding of hospitals is based on a dual funding system, meaning that hospital investment costs generally need to be borne by the German federal states as required, while operating costs will have to be funded through the remuneration for hospital treatments. Because of the tight budget situation of the German federal states a considerable backlog of investment has built up. After a transition period (between 2005 and 2009) operating costs are now funded on the basis of the so-called DRG system (DRG=Diagnosis Related Groups)--irrespective of the actual costs incurred by each individual hospital, which has led to a commodification of hospital care services. Whether this commodification avoids bottlenecks in the provision of health services to hospital patients or creates additional bottlenecks, is a controversial issue.

  15. Inpatient resource utilization, disease severity, mortality and insurance coverage for patients hospitalized for hepatitis C virus in the United States.

    Science.gov (United States)

    Younossi, Z M; Otgonsuren, M; Henry, L; Arsalla, Z; Stepnaova, M; Mishra, A; Venkatesan, C; Hunt, S

    2015-02-01

    Although the incidence of new hepatitis C virus (HCV) infection has fallen, HCV-related complications are on the rise. Our aim was to assess and describe the 2005-2009 national inpatient mortality and resource utilization trends for patients with HCV. Data from the National Inpatient Sample (NIS) and the National Hospital Discharge Survey (NHDS) between 2005 and 2009 were analyzed. Included were all adult hospital discharges with HCV-related ICD-9 codes. Incremental hospital charge, in-hospital mortality and length of stay (LOS) were estimated using n = 1000 bootstrap replicates clustered by unique hospital identifier. A total of 123 939 (0.38%) discharges were related to HCV (primary or secondary diagnosis). In-hospital mortality increased from 1.7% (2005) to 2.6% (2009) (P hospital costs ($6500) remaining stable while at the same time, hospital-to-hospital transfer admissions and disposition to home health care increased. HCV-related hepatocellular carcinoma predicted longer hospital stay and death; older age predicted death; and receiving more procedures predicted higher hospital costs. The percentage of patients with private insurance significantly decreased (4.7%), while government-sponsored insurance and uninsured increased by 2.5% and 2.1%, respectively (P hospitalization than those with government-sponsored insurance. HCV-related inpatient mortality and resource utilization have increased. HCC was the largest predictor for mortality and resource utilization. These data are consistent with the rising clinical and societal burden of chronic hepatitis C in the United States. © 2014 John Wiley & Sons Ltd.

  16. Interdepartmental Dermatology: Characteristics and Impact of Dermatology Inpatient Referrals at a Teaching Hospital in Eastern India

    Science.gov (United States)

    Chowdhury, Satyendra Nath; Podder, Indrasish; Saha, Abanti; Bandyopadhyay, Debabrata

    2017-01-01

    Background: Dermatology is primarily considered to be an outpatient-centered specialty. However, several inpatient admissions to other specialties require dermatologic consultation for optimum management. Aims: To analyze the causes of inpatient dermatology referrals, departments sending referrals, and impact of dermatology consultation on patient management. Materials and Methods: We conducted a cross-sectional study by analyzing the records of 486 patient referrals over a 4-year period. The demographic details, specialties requesting consultation, cause of referral, and dermatological advice have been recorded and analyzed. Results: Dermatology consultation changed the dermatologic diagnosis and treatment of almost two-thirds of patients. General medicine requested the maximum number of referrals, “skin rash” being the most common cause for referral. Accurate diagnosis on referrals was provided by only 30.2% of nondermatologists. Common dermatological disorders were often misdiagnosed by these physicians, and dermatology referrals had significant impact on the diagnosis and subsequent management of these patients. Conclusion: While dermatologic referral leads to improved patient care, there is a need for better training of nondermatologists enabling them to recognize and treat common dermatoses. PMID:28216722

  17. Impact of inpatient caseload, emergency department duties, and online learning resource on General Medicine In-Training Examination scores in Japan

    Directory of Open Access Journals (Sweden)

    Kinoshita K

    2015-10-01

    Full Text Available Kensuke Kinoshita,1 Yusuke Tsugawa,2 Taro Shimizu,3 Yusuke Tanoue,4 Ryota Konishi,5 Yuji Nishizaki,6 Toshiaki Shiojiri,7 Yasuharu Tokuda8 1Department of Medicine, Mito Kyodo General Hospital, University of Tsukuba, Mito City, Ibaraki, Japan; 2Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA; 3Tokyo Joto Hospital, Koto-ku, Tokyo, 4Good Medicine Japan, Miyagi, 5Department of General Internal Medicine, Kanto Rosai Hospital, Kawasaki, Kanagawa, 6Department of Cardiology, Juntendo University Graduate School of Medicine, Tokyo, 7Department of General Internal Medicine, Asahi General Hospital, Asahi, Chiba, 8Japan Community Healthcare Organization, Minato-ku, Tokyo, Japan Background: Both clinical workload and access to learning resource are important components of educational environment and may have effects on clinical knowledge of residents. Methods: We conducted a survey with a clinical knowledge evaluation involving postgraduate year (PGY-1 and -2 resident physicians at teaching hospitals offering 2-year postgraduate training programs required for residents in Japan, using the General Medicine In-Training Examination (GM-ITE. An individual-level analysis was conducted to examine the impact of the number of assigned patients and emergency department (ED duty on the residents' GM-ITE scores by fitting a multivariable generalized estimating equations. In hospital-level analysis, we evaluated the relationship between for the number of UpToDate reviews for each hospital and for the hospitals' mean GM-ITE score. Results: A total of 431 PGY-1 and 618 PGY-2 residents participated. Residents with four or five times per month of the ED duties exhibited the highest mean scores compared to those with greater or fewer ED duties. Those with largest number of inpatients in charge exhibited the highest mean scores compared to the residents with fewer inpatients in charge. Hospitals with the greater Up

  18. Estimating the Effect of Intravenous Acetaminophen for Postoperative Pain Management on Length of Stay and Inpatient Hospital Costs.

    Science.gov (United States)

    Shaffer, E Eve; Pham, An; Woldman, Robert L; Spiegelman, Andrew; Strassels, Scott A; Wan, George J; Zimmerman, Thomas

    2017-01-01

    The provision of safe, effective, cost-efficient perioperative inpatient acute pain management is an important concern among clinicians and administrators within healthcare institutions. Overreliance on opioid monotherapy in this setting continues to present health risks for patients and increase healthcare costs resulting from preventable adverse events. The goal of this study was to model length of stay (LOS), potential opioid-related complications, and costs for patients reducing opioid use and adding intravenous acetaminophen (IV APAP) for management of postoperative pain. Data for this study were de-identified inpatient encounters from The Advisory Board Company across 297 hospitals from 2012-2014, containing 2,238,433 encounters (IV APAP used in 12.1%). Encounters for adults ≥18 years of age admitted for cardiovascular, colorectal, general, obstetrics and gynecology, orthopedics, or spine surgery were included. The effects of reducing opioids and adding IV APAP were estimated using hierarchical statistical models. Costs were estimated by multiplying modeled reductions in LOS or complication rates by observed average volumes for medium-sized facilities, and by average cost per day or per complication (LOS: US$2383/day; complications: derived from observed charges). Across all surgery types, LOS showed an average reduction of 18.5% (10.7-32.0%) for the modeled scenario of reducing opioids by one level (high to medium, medium to low, or low to none) and adding IV APAP, with an associated total LOS-related cost savings of $4.5 M. Modeled opioid-related complication rates showed similar improvements, averaging a reduction of 28.7% (5.4-44.0%) with associated cost savings of $0.2 M. In aggregate, costs decreased by an estimated $4.7 M for a medium-sized hospital. The study design demonstrates associations only and cannot establish causal relationships. The cost impact of LOS is modeled based on observed data. This investigation indicates that reducing opioid

  19. Characterization of Escherichia coli isolates from hospital inpatients or outpatients with urinary tract infection.

    Science.gov (United States)

    Toval, Francisco; Köhler, Christian-Daniel; Vogel, Ulrich; Wagenlehner, Florian; Mellmann, Alexander; Fruth, Angelika; Schmidt, M Alexander; Karch, Helge; Bielaszewska, Martina; Dobrindt, Ulrich

    2014-02-01

    Uropathogenic Escherichia coli (UPEC) is the most common cause of community- and hospital-acquired urinary tract infections (UTIs). Isolates from uncomplicated community-acquired UTIs express a variety of virulence traits that promote the efficient colonization of the urinary tract. In contrast, nosocomial UTIs can be caused by E. coli strains that differ in their virulence traits from the community-acquired UTI isolates. UPEC virulence markers are used to distinguish these facultative extraintestinal pathogens, which belong to the intestinal flora of many healthy individuals, from intestinal pathogenic E. coli (IPEC). IPEC is a diarrheagenic pathogen with a characteristic virulence gene set that is absent in UPEC. Here, we characterized 265 isolates from patients with UTIs during inpatient or outpatient treatment at a hospital regarding their phylogenies and IPEC or UPEC virulence traits. Interestingly, 28 of these isolates (10.6%) carried typical IPEC virulence genes that are characteristic of enteroaggregative E. coli (EAEC), Shiga toxin-producing E. coli (STEC), and atypical enteropathogenic E. coli (aEPEC), although IPEC is not considered a uropathogen. Twenty-three isolates harbored the astA gene coding for the EAEC heat-stable enterotoxin 1 (EAST1), and most of them carried virulence genes that are characteristic of UPEC and/or EAEC. Our results indicate that UPEC isolates from hospital patients differ from archetypal community-acquired isolates from uncomplicated UTIs by their spectrum of virulence traits. They represent a diverse group, including EAEC, as well as other IPEC pathotypes, which in addition contain typical UPEC virulence genes. The combination of typical extraintestinal pathogenic E. coli (ExPEC) and IPEC virulence determinants in some isolates demonstrates the marked genome plasticity of E. coli and calls for a reevaluation of the strict pathotype classification of EAEC.

  20. [Epidemiological analysis on inpatients with epidemic encephalitis B at No. 1 Hospital of Lian Yungang from 1988-1996].

    Science.gov (United States)

    Sun, G

    1998-08-01

    To study the morbidity and mortality of inpatients with epidemic encephalitis B (EEB) admitted to No. 1 hospital of Lian Yungang city from 1988-1996, 107 inpatients with EEB in the pediatrics department the hospital were analyzed epidemiologically. Results showed that 107 children with EEB had a proportion of 0.65% to all children admitted in the pediatrics department during that 9 years including 98 cases from the countryside and 9 cases from cities. The ratio was 10.8/1.0 when comparing countryside to city. 87 inpatients (81.3%) of EEB children were below 4 year of age consisting. Most patients were infected in late July or early August in 1990 and 1992 with number of 55 out of 107 (51.4%) that consisted 1.56% and 1.53% of the inpatients in pediatrics those years. It was concluded that EEB had a strict seasonal feature. By comparing data from the first 4 years with the latter 5 years, we noticed that the incidence of the latter had a considerable decrease with more milder cases. The morbidity and mortality of the whole city also appeared a decreasing tendency.

  1. Cachexia & debility diagnoses in hospitalized children and adolescents with complex chronic conditions: evidence from the Kids’ Inpatient Database

    Directory of Open Access Journals (Sweden)

    Bryce A Van Doren

    2015-02-01

    Full Text Available Objective: To characterize the frequency, cost, and hospital-reported outcomes of cachexia and debility in children and adolescents with complex chronic conditions (CCCs. Methods: We identified children and adolescents (aged ≤20 years with CCCs, cachexia, and debility in the Kids’ Inpatient Database [Healthcare Cost and Utilization Project, Agency for Healthcare Research & Quality]. We then compared the characteristics of patients and hospitalizations, including cost and duration of stay, for CCCs with and without cachexia and/ or debility. We examined factors that predict risk of inpatient mortality in children and adolescents with CCCs using a logistic regression model. We examined factors that impact duration of stay and cost in children and adolescents with CCCs using negative binomial regression models. All costs are reported in US dollars in 2014 using Consumer Price Index inflation adjustment. Results: We estimated the incidence of hospitalization of cachexia in children and adolescents with CCCs at 1,395 discharges during the sample period, which ranged from 277 discharges in 2003 to 473 discharges in 2012. We estimated the incidence of hospitalization due to debility in children and adolescents with CCCs at 421 discharges during the sample period, which ranged from 39 discharges in 2003 to 217 discharges in 2012. Cachexia was associated with a 60% increase in the risk of inpatient mortality, whereas debility was associated with a 40% decrease in the risk of mortality. Cachexia and debility increased duration of stay in hospital (17% and 39% longer stays, respectively. Median cost of hospitalization was $15,441.59 and $23,796.16 for children and adolescents with cachexia and debility, respectively. Conclusions: Incidence of hospitalization for cachexia in children and adolescents with CCCs is less than that for adults but the frequency of cachexia diagnoses increased over time. Estimates of the incidence of hospitalization with

  2. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2013 rates; hospitals' resident caps for graduate medical education payment purposes; quality reporting requirements for specific providers and for ambulatory surgical centers. final rule.

    Science.gov (United States)

    2012-08-31

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of the changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. These changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits will be effective for cost reporting periods beginning on or after October 1, 2012. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes made by the Affordable Care Act. Generally, these changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule. In addition, we are implementing changes relating to determining a hospital's full-time equivalent (FTE) resident cap for the purpose of graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare. We also are establishing new administrative, data completeness, and extraordinary circumstance waivers or extension requests requirements, as well as a reconsideration process, for quality reporting by ambulatory surgical centers

  3. Use of identification wristbands among patients receiving inpatient treatment in a teaching hospital.

    Science.gov (United States)

    Hoffmeister, Louíse Viecili; de Moura, Gisela Maria Schebella Souto

    2015-01-01

    to evaluate the use of identification wristbands among patients hospitalized in inpatient units. quantitative, descriptive and transversal research, with a sample of 385 patients. Data collection occurred through the observational method through the filling out of a structured questionnaire which aimed to check the presence of the identification wristband and the identifiers used. Descriptive statistics with absolute and relative frequencies was used for analysis. it was obtained that 83.9% of the patients were found to have the correctly identified wristband, 11.9% had a wristband with errors, and 4.2% of the patients were without a wristband. The main nonconformities found on the identification wristbands were incomplete name, different registration numbers, illegibility of the data and problems with the physical integrity of the wristbands. the study demonstrated the professionals' engagement in the process of patient identification, evidencing a high rate of conformity of the wristbands. Furthermore, it contributed to identify elements in the use of wristbands which may be improved for a safe identification process.

  4. Use of identification wristbands among patients receiving inpatient treatment in a teaching hospital

    Directory of Open Access Journals (Sweden)

    Louíse Viecili Hoffmeister

    2015-02-01

    Full Text Available OBJECTIVE: to evaluate the use of identification wristbands among patients hospitalized in inpatient units.METHOD: quantitative, descriptive and transversal research, with a sample of 385 patients. Data collection occurred through the observational method through the filling out of a structured questionnaire which aimed to check the presence of the identification wristband and the identifiers used. Descriptive statistics with absolute and relative frequencies was used for analysis.RESULTS: it was obtained that 83.9% of the patients were found to have the correctly identified wristband, 11.9% had a wristband with errors, and 4.2% of the patients were without a wristband. The main nonconformities found on the identification wristbands were incomplete name, different registration numbers, illegibility of the data and problems with the physical integrity of the wristbands.CONCLUSION: the study demonstrated the professionals' engagement in the process of patient identification, evidencing a high rate of conformity of the wristbands. Furthermore, it contributed to identify elements in the use of wristbands which may be improved for a safe identification process.

  5. Alcohol misuse in the general hospital: some hard facts.

    LENUS (Irish Health Repository)

    Bradshaw, P

    2012-02-03

    AIMS: To examine (1) the prevalence of alcohol use disorders in adult general hospital inpatients; (2) the accuracy of documentation in relation to alcohol use. METHODS: A total of 210 random patients were interviewed out of 1,448 consecutive new admissions to CUH over 7 days. Case notes were reviewed for 206 (98%). Alcohol consumption was assessed using the Fast Alcohol Screening Test (FAST) and weekly drinking diary. FAST-positive (and a random sample of FAST-negative) patients then had a standardized interview. RESULTS: A total of 82% admitted for drinking alcohol. Among them 22% were drinking in excess of guidelines, 9% had DSM-IV Alcohol Abuse and 7% dependence. The sensitivity and specificity of the FAST for detecting those drinking above guidelines were 89 and 94% and for detecting a DSM-IV diagnosis was 100 and 73%. The majority of case notes contained inadequate information about alcohol intake. CONCLUSION: Alcohol use disorders are common and often undetected in the general hospital setting.

  6. Seroprevalence of selected viral, bacterial and parasitic infections among inpatients of a public psychiatric hospital of Mexico

    OpenAIRE

    2008-01-01

    We sought to determine the frequency of serological markers of selected infections in a population of psychiatric patients in Durango City, Mexico, and to determine whether there are any epidemiological characteristics of the subjects associated with the infections. One hundred and five inpatients of a public psychiatric hospital of Durango were examined for HBsAg, anti-HCV antibodies, anti-HIV antibodies, anti-Brucella antibodies, rapid plasma reagin and anti-Cysticercus antibodies by commer...

  7. Gender-related Differences in Maximum Gait Speed and Daily Physical Activity in Elderly Hospitalized Cardiac Inpatients

    Science.gov (United States)

    Izawa, Kazuhiro P.; Watanabe, Satoshi; Hirano, Yasuyuki; Matsushima, Shinya; Suzuki, Tomohiro; Oka, Koichiro; Kida, Keisuke; Suzuki, Kengo; Osada, Naohiko; Omiya, Kazuto; Brubaker, Peter H.; Shimizu, Hiroyuki; Akashi, Yoshihiro J.

    2015-01-01

    Abstract Maximum gait speed and physical activity (PA) relate to mortality and morbidity, but little is known about gender-related differences in these factors in elderly hospitalized cardiac inpatients. This study aimed to determine differences in maximum gait speed and daily measured PA based on sex and the relationship between these measures in elderly cardiac inpatients. A consecutive 268 elderly Japanese cardiac inpatients (mean age, 73.3 years) were enrolled and divided by sex into female (n = 75, 28%) and male (n = 193, 72%) groups. Patient characteristics and maximum gait speed, average step count, and PA energy expenditure (PAEE) in kilocalorie per day for 2 days assessed by accelerometer were compared between groups. Gait speed correlated positively with in-hospital PA measured by average daily step count (r = 0.46, P < 0.001) and average daily PAEE (r = 0.47, P < 0.001) in all patients. After adjustment for left ventricular ejection fraction, step counts and PAEE were significantly lower in females than males (2651.35 ± 1889.92 vs 4037.33 ± 1866.81 steps, P < 0.001; 52.74 ± 51.98 vs 99.33 ± 51.40 kcal, P < 0.001), respectively. Maximum gait speed was slower and PA lower in elderly female versus male inpatients. Minimum gait speed and step count values in this study might be minimum target values for elderly male and female Japanese cardiac inpatients. PMID:25789953

  8. Effect of implementing dental services in Israeli psychiatric hospitals on the oral and dental health of inpatients.

    Science.gov (United States)

    Ponizovsky, Alexander M; Zusman, Shlomo P; Dekel, Dan; Masarwa, Abd-el-Samia; Ramon, Tirza; Natapov, Lena; Yoffe, Rinat; Weizman, Abraham; Grinshpoon, Alexander

    2009-06-01

    Psychiatric disorders (schizophrenia, mood disorders, and organic brain disorders) and their treatment may lead to oral diseases, but assessment of dental status and oral care needs among patients with these disorders is lacking. This study reports changes in dental health and oral care needs of psychiatric inpatients after 1998, when psychiatric hospitals in Israel were required to provide regular dental examinations and treatment for every inpatient hospitalized longer than a year. Two epidemiological cohorts from 1997 and 2006 representing long-term psychiatric inpatients before (N=431) and after (N=254) the reform of dental services were compared on the standardized criteria of the Decayed, Missing, and Filled Teeth (DMFT) index scores and DMFT component scores, as well as on the use of and need for dentures. Compared with the prereform cohort, the postreform cohort had fewer decayed teeth and lower DMFT index scores. These differences were independent of gender and clinical diagnosis. No between-cohort differences were found in the use of and need for dentures. On-site dental services were more effective than outsourced services in improving dental health. The results suggest a substantial improvement in the dental health of this at-risk population after the dental reform in psychiatric hospitals. However, oral health needs are still not fully met, and therefore, additional organizational efforts for further prevention and treatment of dental diseases are required.

  9. Effects of Peer Mentoring on Self-Efficacy and Hospital Readmission After Inpatient Rehabilitation of Individuals With Spinal Cord Injury: A Randomized Controlled Trial.

    Science.gov (United States)

    Gassaway, Julie; Jones, Michael L; Sweatman, W Mark; Hong, Minna; Anziano, Peter; DeVault, Karen

    2017-08-01

    To investigate the effect of intensive peer mentoring on patient-reported outcomes of self-efficacy and unplanned hospital readmissions for persons with spinal cord injury/disease (SCI/D) within the first 6 months after discharge from inpatient rehabilitation. Randomized controlled trial. Nonprofit inpatient rehabilitation hospital specializing in care of persons with SCI/D and brain injury. Patients (N=158) admitted to the SCI/D rehabilitation program whose discharge location was a community setting. Participants (51% with paraplegia and 49% with tetraplegia) were 73% white and 77% men, with a mean age of 38 years. Participants in the experimental group received initial consult/introduction with a peer support program liaison and were assigned a peer mentor, who met with the participant weekly throughout the inpatient stay and made weekly contact by phone, e-mail, or in person for 90 days postdischarge. Participants also were encouraged to participate in regularly scheduled peer support activities. Nonexperimental group participants were introduced to peer support and provided services only on request. General Self-efficacy Scale (adapted to SCI/D), project-developed community integration self-efficacy scale, and patient-reported unplanned rehospitalizations. Growth rate for self-efficacy in the first 6 months postdischarge was significantly higher for experimental group participants than nonexperimental group participants. Experimental group participants also had significantly fewer unplanned hospital days. This study provides evidence that individuals receiving intensive peer mentoring during and after rehabilitation for SCI/D demonstrate greater gains in self-efficacy over time and have fewer days of unplanned rehospitalization in the first 180 days postdischarge. More research is needed to examine the long-term effects of this intervention on health care utilization and the relation between improved health and patient-reported quality of life outcomes

  10. Mental Capacity Assessments Among Inpatients Referred to the Consultation-Liaison Psychiatry Unit at a University Hospital in Bangkok, Thailand.

    Science.gov (United States)

    Pariwatcharakul, Pornjira; Singhakant, Supachoke

    2017-03-01

    Clinicians routinely assess patients' mental capacity on a daily basis, but a more thorough assessment may be needed in complex cases. We aimed to identify the characteristics of inpatients in a general hospital, who were referred to a liaison psychiatry service for mental capacity assessment, reasons for the referrals, and the factors associated with their mental capacity. A 6-year retrospective study (2008-2013) was conducted using data collected routinely (e.g., age, gender, diagnosis, Thai Mental State Examination score, reasons for the referral, and the outcome of capacity assessment) on referrals for mental capacity assessment to a Consultation-liaison Psychiatry Unit at a university hospital in Thailand. Among 6194 consecutive referrals to the liaison-psychiatry services, only 0.6 % [n = 37, mean age (SD), 59.83 (20.42)] were referred for capacity assessment, 43.24 % of which lacked mental capacity. The most common requests from referring physicians were for assessment of testamentary capacity (15 assessed, 53.33 % lacking capacity), financial management capacity (14 assessed, 50 % lacking capacity), and capacity to consent to treatment (9 assessed, 22.22 % lacking capacity). Delirium, rather than dementia or other mental disorders, was associated with mental incapacity (p < 0.001) and being more dependent during the admission (p = 0.048). There were no significant differences for mean age (p = 0.257) or Thai Mental State Examination score (p = 0.206). The main request from referring clinicians was to assess testamentary capacity. Delirium and being more dependent during the admission were associated with lack of mental capacity, whereas age and dementia were not.

  11. Assessment of Stress and Depression among Geriatric Inpatients at a Tertiary Care Teaching Hospital in Rural Area

    Directory of Open Access Journals (Sweden)

    Jayant D Deshpande

    2014-04-01

    Full Text Available AIM: Elderly people are at risk of mental health problems. Recognizing these problems is even a greater issue in a rural community where mental health resources may be lacking or inadequate. The purpose of this study was to assess stress and depression levels among patients above 60 years attending a tertiary care teaching hospital in in rural India. METHOD: A cross sectional study was conducted at a tertiary care hospital in rural India. Patients aged 60 years and above seeking help at the various in-patient departments of Medical College and those who agree with written inform consent were included in study. General health questionnaire (GHQ-12 used for assessment of stress. Geriatric Depression Scale (GDS-30 was used as screening instruments to detect depression among the elderly. RESULT: A total of 229 elderly participated in the study out of which 138 (60.26% were males and 91 (39.73% were females. The mean age of the subjects was 67.68 +/- 6.61 years. The prevalence of mild depression was 25.32% and severe depression was 8.7%. There was no significant difference in the prevalence of depression for different gender. Factors like lack of family support, chronic morbidity, lack of economic support, dependence on others for day to day activities and neoplastic conditions were significantly associated with depression. Depression according to marital status was found to be significantly higher in the elderly who were widowed. CONCLUSION: Physical morbidity, lack of family support, lack of economic support, dependence on others for day to day activities and neoplastic conditions seem to be associated with increased depressive symptoms in elderly population over 60 years of age [TAF Prev Med Bull 2014; 13(2.000: 125-132

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

    Science.gov (United States)

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

    2016-10-10

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

  13. ANALYSIS OF INA-CBG’S FARE AND GOVERNOR REGULATION FAREON SURGERY AT INPATIENT ROOM OF UNDATA REGIONAL PUBLIC HOSPITAL IN PALU

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    Muh. Ryman Napirah

    2016-03-01

    Full Text Available Aim: In order to determine the fares of surgery, there are two types of fares used by hospitals namely Indonesian Case Based Groups fare (INA-CBG s and Governor Regulation fare. This study aimed to identify and analyze both types of fares in orthopedic surgery, general, eyes, midwifery, mouth, ENT, urology at inpatient room of Undata Regional Public Hospital in Palu during year 2014. Method: This was a quantitative study with descriptive approach with 46 cases as the number of surgery. Data were collected through observation and analysis of secondary data were gotten from medical record, pharmaceutical installation of IBS/IDR, inpatient therapy room (Matahari, Aster, and Teratai pavilions and cashier of inpatient room in form of cost details and patient data from January to December 2014. Data Presentation was formed on tables, where the existing fares are grouped based on the component of each cost then summed and calculated the deviation between the two types of fares. Results: This study indicated that orthopedic surgery with deviation of Rp 11.311.365, general surgery with deviation of Rp 6.438.409, eyes surgery with deviation of Rp 45.173.741, midwifery surgery with deviation of Rp 6.645.765, oral surgery with deviation of Rp 6.105.659, and urological surgery with deviation of Rp. 3.809.959. Conclusion: It can be concluded that INA-CBG's fares are higher than Governor Regulation fares except orthopedic surgery, where the Governor Regulation faresare higher than INA-CBG’s fares.

  14. Assessment of parents' perception of quality of pediatric oncology inpatient care at Kenyatta National Hospital

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    Eunice Mmbone Keiza

    2017-01-01

    Full Text Available Objective: Adequate knowledge of parents' perception of quality of pediatric cancer care helps to identify the areas of care improvement which would contribute to disease outcome in regard to the quality of life and satisfaction with the care provided. The aim of the study was to assess the parents' perception of the quality of Pediatric Oncology Inpatient Care at Kenyatta National Hospital. Methods: A cross-sectional descriptive quantitative and qualitative study was undertaken using a pretested semi-structured questionnaire and a focused group discussion guide. Assessment of parents' perception of quality of care was done in relation to the institution's structures and care delivery processes. These included the ward environment, resources for cancer treatment, care processes, service providers, and parents' knowledge empowerment. Participants were systematically selected. Parents' perception was defined as satisfaction or dissatisfaction with the care provided. Data were analyzed using SPSS version 20.0 (Armonk, NY: IBM Corp. and presented as frequencies and percentages. Chi-square was used to test the significant association between variables. Level of significance was set at a P ≤ 0.05. Results: A total of 107 respondents were interviewed and 57.9% were satisfied with the overall quality of care they received. The determinants of overall satisfaction in this study were found to be related to resources for cancer treatment (odds ratio [OR] =3.10; 95% confidence interval [CI] =1.39–6.90; P = 0.005, care delivery processes (OR = 2.87; 95% CI = 1.28–6.43; P = 0.009, and the ward environment (OR = 2.59; 95% CI = 1.17–5.74; P = 0.018. Conclusions: The parents were moderately satisfied with the oncology care services their children received. The gaps identified in service delivery included those related to the availability of the required resources for efficient care delivery and also educational as well as psychosocial needs of the

  15. Inpatient Psychiatric Facility PPS

    Data.gov (United States)

    U.S. Department of Health & Human Services — Since October 1, 1983, most hospitals have been paid under the hospital inpatient prospective payment system (PPS). However, certain types of specialty hospitals and...

  16. Inpatient hospital costs and length of stay for the treatment of affective and somatoform disorders – evidence from Germany

    Science.gov (United States)

    Romeyke, Tobias; Scheuer, Hans Christoph; Stummer, Harald

    2014-01-01

    Introduction Diagnosis related costs analyses are the subject of science and research and are of great relevance and importance for decision makers in the hospital and for funding bodies, but also for international health policy. Up to now, standardized costs analyses with valid costs data have not been available for inpatient care of patients with affective and somatoform disorders. Background This clinical picture presents a major challenge for the provision of outpatient and inpatient care. An interdisciplinary approach in an inpatient setting can be beneficial for already “chronified” patients with severe forms of progression. Because of its structural and procedural demands, this type of care is associated with a greater expenditure of resources. Methods Costs data from the years 2008 to 2012 were analyzed for a total of 17,424 hospitalized patients in more than 200 different hospitals in Germany. The study compared the costs of treating patients with the main diagnosis affective and somatoform disorders using standardized interdisciplinary therapy, with the costs of conventional therapy. Results Interdisciplinary patient care is characterized by a high proportion of the costs derived from the structural and procedural implementation and the medical and nursing care. For interdisciplinary therapy with a mean period of hospitalization of 15.2 days, over 60% of the total costs were incurred by the personnel and material costs of the medical and non-medical infrastructure. The outlay is considerably greater than would be incurred by a conventional therapeutic approach without interdisciplinary therapy. Discussion and conclusion For the first time, detailed diagnosis-related costs data are published which were generated by consistent, standardized cost unit accounting. An interdisciplinary, holistic approach to the clinical picture results in a significant increase in costs for the hospitals. PMID:25506252

  17. Medicare Program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system changes and FY2011 rates; provider agreements and supplier approvals; and hospital conditions of participation for rehabilitation and respiratory care services; Medicaid program: accreditation for providers of inpatient psychiatric services. Final rules and interim final rule with comment period.

    Science.gov (United States)

    2010-08-16

    : We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems and to implement certain provisions of the Affordable Care Act and other legislation. In addition, we describe the changes to the amounts and factors used to determine the rates for Medicare acute care hospital inpatient services for operating costs and capital-related costs. We also are setting forth the update to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. We are updating the payment policy and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and setting forth the changes to the payment rates, factors, and other payment rate policies under the LTCH PPS. In addition, we are finalizing the provisions of the August 27, 2009 interim final rule that implemented statutory provisions relating to payments to LTCHs and LTCH satellite facilities and increases in beds in existing LTCHs and LTCH satellite facilities under the LTCH PPS. We are making changes affecting the: Medicare conditions of participation for hospitals relating to the types of practitioners who may provide rehabilitation services and respiratory care services; and determination of the effective date of provider agreements and supplier approvals under Medicare. We are also setting forth provisions that offer psychiatric hospitals and hospitals with inpatient psychiatric programs increased flexibility in obtaining accreditation to participate in the Medicaid program. Psychiatric hospitals and hospitals with inpatient psychiatric programs will have the choice of undergoing a State survey or of obtaining accreditation from a national accrediting organization whose hospital accreditation

  18. Comparison of the patient satisfaction from inpatient and outpatient fissurectomy in Motahari clinic and Shahid Faghihi hospital, Shiraz, Iran

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    L Mohammadinia

    2014-01-01

    Full Text Available Introduction: Satisfaction of the patients is considered as an important index in evaluating the performance of the hospitals and is highly effective in developing and improving the quality of the provided services .so, the present study aims to compare the satisfaction of the patients suffering from anal fissure from inpatient and outpatient treatments. Method: This cross-sectional study was conducted on 212 subjects who were selected through systematic sampling from the patients with anal fissure referring to Motahari clinic and Shahid Faghihi hospital. In order to compare the patient satisfaction in two inpatient and outpatient groups, 21-item questionnaire was designed in order to assess the patient satisfaction. Independent t-test and chi-square test were used to analyze this data. Results: satisfaction of the inpatients was significantly more than that of the outpatients (P0.001, quality, and other services compared to the outpatients (P=0.041. Conclusion: According to the advantages that mentioned, outpatient operations can be a better choice for small surgeries; of course, health planners should pay more attention to its importance and necessity and provide more equipments and welfare facilities in treatment centers.

  19. The risk of hemorrhagic complications in hospital in-patients who fall while receiving antithrombotic therapy

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    Li Marilyn

    2005-01-01

    Full Text Available Abstract Background The use of antithrombotic agents and falls are independently associated with an increased risk of hemorrhagic injury. However, few studies have delineated the risk of fall-related hemorrhagic complications in persons who are taking antithrombotic therapy. The objective of this study was to compare the rates of fall-related hemorrhagic injury in hospital in-patients who are taking and not taking antithrombotic therapy. Methods A 4-year retrospective chart review of consecutive patients who fell during admission to a 500-bed tertiary-care teaching hospital was conducted. Major hemorrhagic injuries including subdural hematomas and major bleeding/cuts, patients' use of antithrombotic medication (warfarin, aspirin, clopidogrel and heparin and their anticoagulation status at the time of their fall were recorded. Results A total of 2635 falls in 1861 patients were reviewed. Approximately 10% of falls caused major hemorrhagic injury. One fall resulted in a subdural hematoma. Persons taking warfarin were less likely to suffer a fall-related major hemorrhagic injury compared with persons not taking antithrombotic therapy (warfarin, 6%; no therapy, 11%; p = 0.01. Logistic regression showed that fall-related major hemorrhagic injury was associated with female gender (odds ratio 1.6; 95% CI 1.3, 2.1, use of aspirin (odds ratio 1.4; 95% CI 1.1, 1.8 and use of clopidogrel (odds ratio 2.2; 95% CI 1.1, 4.8, but not with the use of warfarin or heparin, or the intensity of anticoagulation. Conclusions In this study, compared with persons taking no antithrombotic therapy, those taking warfarin had lower rates of fall-related hemorrhagic injuries. The absolute rate of the development of fall-related intracranial hemorrhagic injury such as subdural hematomas was low, even in persons taking warfarin. These counter-intuitive results may be due to selection bias, and suggest that physicians are very conservative in selecting patients for warfarin

  20. Cost of providing inpatient burn care in a tertiary, teaching, hospital of North India.

    Science.gov (United States)

    Ahuja, Rajeev B; Goswami, Prasenjit

    2013-06-01

    There is an extreme paucity of studies examining cost of burn care in the developing world when over 85% of burns take place in low and middle income countries. Modern burn care is perceived as an expensive, resource intensive endeavour, requiring specialized equipment, personnel and facilities to provide optimum care. If 'burn burden' of low and middle income countries (LMICs) is to be tackled deftly then besides prevention and education we need to have burn centres where 'reasonable' burn care can be delivered in face of resource constraints. This manuscript calculates the cost of providing inpatient burn management at a large, high volume, tertiary burn care facility of North India by estimating all cost drivers. In this one year study (1st February to 31st January 2012), in a 50 bedded burn unit, demographic parameters like age, gender, burn aetiology, % TBSA burns, duration of hospital stay and mortality were recorded for all patients. Cost drivers included in estimation were all medications and consumables, dressing material, investigations, blood products, dietary costs, and salaries of all personnel. Capital costs, utility costs and maintenance expenditure were excluded. The burn unit is constrained to provide conservative management, by and large, and is serviced by a large team of doctors and nurses. Entire treatment cost is borne by the hospital for all patients. 797 patients (208 60% BSA burns. 258/797 patients died (32.37%). Of these deaths 16, 68 and 174 patients were from 0 to 30%, 31 to 60% and >60% BSA groups, respectively. The mean length of hospitalization for all admissions was 7.86 days (ranging from 1 to 62 days) and for survivors it was 8.9 days. There were 299 operations carried out in the dedicated burns theatre. The total expenditure for the study period was Indian Rupees (Rs) 46,488,067 or US$ 845,237. At 1 US$=Rs 55 it makes the cost per patient to be US$ 1060.5. Almost 70% of cost of burn management resulted from salaries, followed by

  1. Hospital-acquired infection rate in a tertiary care teaching hospital in China: a cross-sectional survey involving 2434 inpatients

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    Xiu-Bin Tao

    2014-10-01

    Full Text Available A single-day hospital-acquired infections (HAIs point prevalence study was conducted in a tertiary care hospital in China. The overall prevalence rate of HAIs was 3.53% (95% confidence interval 2.80–4.26% among 2434 inpatients surveyed. Respiratory system infection was the most common type of HAI (49.43%, followed by surgical site infection (22.99%. The pathogen detection results for 50 patients showed Pseudomonas aeruginosa to account for 24.00% of isolates, followed by Klebsiella pneumoniae (14.00% and Escherichia coli (14.00%.

  2. Inpatient hospital costs and length of stay for the treatment of affective and somatoform disorders – evidence from Germany

    Directory of Open Access Journals (Sweden)

    Romeyke T

    2014-12-01

    Full Text Available Tobias Romeyke,1,2 Hans Christoph Scheuer,2 Harald Stummer1 1Department of Public Health and Health Technology Assessment: Division for Organizational Behaviour Research and Workplace Health Promotion, University for Health Sciences, Medical Informatics and Technology, Vienna, Austria; 2Department of Acute Internal and Integrative Medicine and Pain Management, Waldhausklinik Deuringen, Germany Introduction: Diagnosis related costs analyses are the subject of science and research and are of great relevance and importance for decision makers in the hospital and for funding bodies, but also for international health policy. Up to now, standardized costs analyses with valid costs data have not been available for inpatient care of patients with affective and somatoform disorders. Background: This clinical picture presents a major challenge for the provision of outpatient and inpatient care. An interdisciplinary approach in an inpatient setting can be beneficial for already "chronified" patients with severe forms of progression. Because of its structural and procedural demands, this type of care is associated with a greater expenditure of resources. Methods: Costs data from the years 2008 to 2012 were analyzed for a total of 17,424 hospitalized patients in more than 200 different hospitals in Germany. The study compared the costs of treating patients with the main diagnosis affective and somatoform disorders using standardized interdisciplinary therapy, with the costs of conventional therapy. Results: Interdisciplinary patient care is characterized by a high proportion of the costs derived from the structural and procedural implementation and the medical and nursing care. For interdisciplinary therapy with a mean period of hospitalization of 15.2 days, over 60% of the total costs were incurred by the personnel and material costs of the medical and non-medical infrastructure. The outlay is considerably greater than would be incurred by a conventional

  3. Inpatient Mortality Risk Scores and Postdischarge Events in Hospitalized Heart Failure Patients: A Community-Based Study.

    Science.gov (United States)

    Win, Sithu; Hussain, Imad; Hebl, Virginia B; Dunlay, Shannon M; Redfield, Margaret M

    2017-07-01

    The Acute Decompensated Heart Failure National Registry (ADHERE) and Get With The Guidelines (GWTG) registries have developed simple heart failure (HF) in-hospital mortality risk scores. We hypothesized that HF scores predictive of in-hospital mortality would perform as well for early postdischarge mortality risk stratification. In this single-center, community-based, retrospective study of all consecutive primary HF hospitalizations (6203 hospitalizations in 3745 patients) from 2000 to 2013, the ADHERE and GWTG risk scores were calculated from admission data. There were 176 (3.0%) and 399 (6.7%), 869 (14.7%), and 1272 (21.5%) deaths in-hospital and at 30, 90, and 180 days postdischarge, respectively. The GWTG but not ADHERE risk score was well calibrated for in-hospital mortality. Both the ADHERE (C statistic 0.66 and 0.67, 0.64, and 0.64) and GWTG (C statistic 0.74 and 0.73, 0.71, and 0.70) HF risk scores were similarly predictive of in-hospital and 30-, 90-, and 180-day postdischarge mortality. The ADHERE risk score identified 10% and the GWTG risk score identified 20% of hospitalizations where 180-day postdischarge mortality was 50%, a prognostic bench mark for hospice referral. In contrast, hospitalizations characterized as lowest risk by the ADHERE (57% of hospitalizations; 180-day mortality 16.2%) or GWTG score (20% of hospitalizations; 180-day mortality 8.0%) had substantially lower mortality (odds ratios high versus low risk of 5-8 [ADHERE] and 11-18 [GWTG] across time points; P<0.0001 for all). The simple ADHERE and GWTG scores stratify hospitalized HF patients for both inpatient and early postdischarge mortality risk, allowing comprehensive risk assessment on admission. © 2017 American Heart Association, Inc.

  4. General medications utilization and cost patterns in hospitalized children

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    Kassis I

    2009-03-01

    Full Text Available Drug utilization in the in-patient setting can provide mechanisms to assess drug prescribing trends, efficiency and cost-effectiveness of hospital formularies and examine sub-populations such as children for which prescribing habits are different from adults. Objectives: The aim of this descriptive study was to analyze general medication utilization patterns and costs excluding antimicrobials prescriptions and to compare two pediatric admission units in a tertiary care university hospital. Methods: The total number of admitted children was 1,521 and 1,467 for the A and B admission units, respectively. The electronic data from 252 and 253 hospitalized children in the A and B admission unit were prospectively screened for general medication prescriptions, children on antimicrobials were excluded from the analysis. Their electronic charts were viewed once weekly from October 15, 2007 up to April 7, 2008 using the prescription-point prevalence method. One medication was considered to be one prescription. Results: The general medications prescription number was 790 for 94 children (8.4 prescription/patient in A and 959 for 88 children (10.9 prescription/patient in B (p=0.02. The general medications defined daily dose (DDD and drug utilization 90% (DU90% index were 2,509.63, 2,259 for A; and 6,110.35, 5,499 for B, respectively. The DU90% index placed salbutamol inhalation with 835 DDD and sodium heparin with 2,102 DDD in the first place for the A and B admission units, respectively. A net increment in medication cost was registered according to the calculated cost from the depicted DU90% when the A (20,263 NIS and B (6,269 NIS admission units were compared (p=0.04. Conclusions: A significant difference in the prescription utilization of general medications was shown between the A and B admission units. The A admission unit had lower prescriptions measured by the DU90% index with higher medication cost. Potential drug-drug interactions were depicted in

  5. The General Hospital Colombo Rehabilitation Project.

    Science.gov (United States)

    Jayasuriya, L

    1992-12-01

    The General Hospital Colombo (GHC) Rehabilitation Project was to be implemented in 6 phases in about 25 years. The proposed funding was a grant of 100% from Finland for technical assistance and training, and 85% for investments. The development objective was to reinforce the status of the hospital as the apex of the medical care system. In Phase I (1985-1990) an 8 storeyed accident and orthopaedic services building with modern facilities has been commissioned. A water tower and a 'septic' operating theatre have been built. Infection control and maintenance organizations have been started. Phase I cost Rs.960 million. In the Bridging Phase, the existing six storeyed building is being renovated. Phase II has been drastically curtailed. It will concentrate on infrastructure development such as water supply, kitchen, stores and transport, and the construction of four new medical wards. The project will end in 1993.

  6. Control costs, enhance quality, and increase revenue in three top general public hospitals in Beijing, China.

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    Lue-Ping Zhao

    Full Text Available BACKGROUND: With market-oriented economic and health-care reform, public hospitals in China have received unprecedented pressures from governmental regulations, public opinions, and financial demands. To adapt the changing environment and keep pace of modernizing healthcare delivery system, public hospitals in China are expanding clinical services and improving delivery efficiency, while controlling costs. Recent experiences are valuable lessons for guiding future healthcare reform. Here we carefully study three teaching hospitals, to exemplify their experiences during this period. METHODS: We performed a systematic analysis on hospitalization costs, health-care quality and delivery efficiencies from 2006 to 2010 in three teaching hospitals in Beijing, China. The analysis measured temporal changes of inpatient cost per stay (CPS, cost per day (CPD, inpatient mortality rate (IMR, and length of stay (LOS, using a generalized additive model. FINDINGS: There were 651,559 hospitalizations during the period analyzed. Averaged CPS was stable over time, while averaged CPD steadily increased by 41.7% (P<0.001, from CNY 1,531 in 2006 to CNY 2,169 in 2010. The increasing CPD seemed synchronous with the steady rising of the national annual income per capita. Surgical cost was the main contributor to the temporal change of CPD, while medicine and examination costs tended to be stable over time. From 2006 and 2010, IMR decreased by 36%, while LOS reduced by 25%. Increasing hospitalizations with higher costs, along with an overall stable CPS, reduced IMR, and shorter LOS, appear to be the major characteristics of these three hospitals at present. INTERPRETATIONS: These three teaching hospitals have gained some success in controlling costs, improving cares, adopting modern medical technologies, and increasing hospital revenues. Effective hospital governance and physicians' professional capacity plus government regulations and supervisions may have played a role

  7. Who's that sleeping in my bed? Potential and actual utilization of public and private in-patient beds in Irish acute public hospitals.

    Science.gov (United States)

    O'Reilly, Jacqueline; Wiley, Miriam

    2010-10-01

    To examine the impact of the unusual public/private mix on public and private in-patient bed utilization within Irish acute public hospitals. Data from the Department of Health and Children and the Hospital In-Patient Enquiry were used to estimate and compare potential and actual utilization of public and private designated in-patient beds in 54 acute public hospitals from 2000 to 2004. Private in-patients used more bed days than were potentially available to them in 14.1% of hospital-year observations. The equivalent figure for public in-patients was 12.6%. Although the prevalence of excess utilization of private beds was relatively small, it did increase over the study period. Hospitals with excess private utilization were characterized by a relatively low proportion of private- or non-designated beds despite their patient profile being broadly similar to that of hospitals where there was no excess private utilization. Despite policies designed to limit private practice in Irish acute public hospitals, some hospitals have apparently been able to overcome these restrictions. In a system where financial incentives to treat private patients exist both for consultants and hospitals, it is not clear whether this excess private practice in public hospitals reflects a more efficient utilization of resources (when demand from public patients is low) or the displacement of public patients in favour of private patients. However, that a smaller number on hospital waiting lists possess private health insurance provides some support for the displacement hypothesis. Thus, it appears that policy-makers may need to reconsider attempts to ensure an appropriate division of acute public hospital resources between public and private patients.

  8. Hospital Guidelines for Diabetes Management and the Joint Commission-American Diabetes Association Inpatient Diabetes Certification.

    Science.gov (United States)

    Arnold, Pamela; Scheurer, Danielle; Dake, Andrew W; Hedgpeth, Angela; Hutto, Amy; Colquitt, Caroline; Hermayer, Kathie L

    2016-04-01

    The Joint Commission Advanced Inpatient Diabetes Certification Program is founded on the American Diabetes Association's Clinical Practice Recommendations and is linked to the Joint Commission Standards. Diabetes currently affects 29.1 million people in the USA and another 86 million Americans are estimated to have pre-diabetes. On a daily basis at the Medical University of South Carolina (MUSC) Medical Center, there are approximately 130-150 inpatients with a diagnosis of diabetes. The program encompasses all service lines at MUSC. Some important features of the program include: a program champion or champion team, written blood glucose monitoring protocols, staff education in diabetes management, medical record identification of diabetes, a plan coordinating insulin and meal delivery, plans for treatment of hypoglycemia and hyperglycemia, data collection for incidence of hypoglycemia, and patient education on self-management of diabetes. The major clinical components to develop, implement, and evaluate an inpatient diabetes care program are: I. Program management, II. Delivering or facilitating clinical care, III. Supporting self-management, IV. Clinical information management and V. performance measurement. The standards receive guidance from a Disease-Specific Care Certification Advisory Committee, and the Standards and Survey Procedures Committee of the Joint Commission Board of Commissioners. The Joint Commission-ADA Advanced Inpatient Diabetes Certification represents a clinical program of excellence, improved processes of care, means to enhance contract negotiations with providers, ability to create an environment of teamwork, and heightened communication within the organization. Published by Elsevier Inc.

  9. The National Hospital Discharge Survey and Nationwide Inpatient Sample: the databases used affect results in THA research.

    Science.gov (United States)

    Bekkers, Stijn; Bot, Arjan G J; Makarawung, Dennis; Neuhaus, Valentin; Ring, David

    2014-11-01

    The National Hospital Discharge Survey (NHDS) and the Nationwide Inpatient Sample (NIS) collect sample data and publish annual estimates of inpatient care in the United States, and both are commonly used in orthopaedic research. However, there are important differences between the databases, and because of these differences, asking these two databases the same question may result in different answers. The degree to which this is true for arthroplasty-related research has, to our knowledge, not been characterized. We tested the following null hypotheses: (1) there are no differences between the NHDS and NIS in patient characteristics, comorbidities, and adverse events in patients with hip osteoarthritis treated with THA, and (2) there are no differences between databases in factors associated with inpatient mortality, adverse events, and length of hospital stay after THA. The NHDS and NIS databases use different methods of data collection and weighting to provide data representative of all nonfederal hospital discharges in the United States. In 2006 the NHDS database contained 203,149 patients with hip arthritis treated with hip arthroplasty, and the NIS database included 193,879 patients. Multivariable analyses for factors associated with inpatient mortality, adverse events, and days of care were constructed for each database. We found that 26 of 42 of the factors in demographics, comorbidities, and adverse events after THA in the NIS and NHDS databases differed more than 10%. Age and days of care were associated with inpatient mortality with the NHDS and the NIS although the effect rates differ more than 10%. The NIS identified seven other factors not identified by the NHDS: wound complications, congestive heart failure, new mental disorder, chronic pulmonary disease, dementia, geographic region Northeast, acute postoperative anemia, and sex, that were associated with inpatient mortality even after controlling for potentially confounding variables. For inpatient

  10. A survey of the prevalence of smoking and smoking cessation advice received by inpatients in a large teaching hospital in Ireland.

    LENUS (Irish Health Repository)

    Bartels, C

    2012-01-06

    BACKGROUND: The adverse effects of smoking are well documented and it is crucial that this modifiable risk factor is addressed routinely. Professional advice can be effective at reducing smoking amongst patients, yet it is not clear if all hospital in-patient smokers receive advice to quit. AIMS: To explore smoking prevalence amongst hospital in-patients and smoking cessation advice given by health professionals in a large university teaching hospital. METHODS: Interviews were carried out over 2 weeks in February 2011 with all eligible in-patients in Beaumont Hospital. RESULTS: Of the 205 patients who completed the survey, 61% stated they had been asked about smoking by a healthcare professional in the past year. Only 44% of current\\/recent smokers stated they had received smoking cessation advice from a health professional within the same timeframe. CONCLUSIONS: Interventions to increase rates of healthcare professional-provided smoking cessation advice are urgently needed.

  11. 76 FR 2453 - Medicare Program; Hospital Inpatient Value-Based Purchasing Program

    Science.gov (United States)

    2011-01-13

    ... Information Security and Management Act HCAHPS Hospital Consumer Assessment of Healthcare Providers and... Indicators/Nursing Sensitive Care. Three of the measures are structural measures that assess hospital... quietness of the hospital environment, pain ] management, communication about medicines, discharge...

  12. Use of neuroleptics in a general hospital

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    Castellanos Virgilio

    2002-05-01

    Full Text Available Abstract Background This study investigates the clinical use of neuroleptics within a general hospital in acutely ill medical or surgical patients and its relation with dementia three months after admission compared with control subjects. Methods Cases were defined as every adult patient to whom a neuroleptic medication was prescribed during their hospitalization in our Hospital from February 1st, to June 30th, 1998. A control matched by age and sex was randomly selected among patients who had been admitted in the same period, in the same department, and had not received neuroleptics drugs (205 cases and 200 controls. Demographic, clinical and complementary data were compared between cases and controls. Crude odds ratios estimating the risk of dementia in non previously demented subjects compared with the risk in non-demented control subjects were calculated. Results 205 of 2665 patients (7.7% received a neuroleptic drug. The mean age was 80.0 ± 13.6 years and 52% were females. They were older and stayed longer than the rest of the population. Only 11% received a psychological evaluation before the prescription. Fifty two percent were agitated while 40% had no reason justifying the use of neuroleptic drug. Three months after neuroleptic use 27% of the surviving cases and 2.6% of the surviving controls who were judged non-demented at admission were identified as demented. Conclusions The most common reason for neuroleptic treatment was to manage agitation symptomatically in hospitalised patients. Organic mental syndromes were rarely investigated, and mental status exams were generally absent. Most of neuroleptic recipients had either recognised or unrecognised dementia.

  13. The High Cost of HIV-Positive Inpatient Care at an Urban Hospital in Johannesburg, South Africa.

    Directory of Open Access Journals (Sweden)

    Lawrence C Long

    Full Text Available While most HIV care is provided on an outpatient basis, hospitals continue to treat serious HIV-related admissions, which is relatively resource-intensive and expensive. This study reports the primary reasons for HIV-related admission at a regional, urban hospital in Johannesburg, South Africa and estimates the associated lengths of stay and costs.A retrospective cohort study of adult, medical admissions was conducted. Each admission was assigned a reason for admission and an outcome. The length of stay was calculated for all patients (N = 1,041 and for HIV-positive patients (n = 469, actual utilization and associated costs were also estimated. Just under half were known to be HIV-positive admissions. Deaths and transfers were proportionately higher amongst HIV-positive admissions compared to HIV-negative and unknown. The three most common reasons for admission were tuberculosis and other mycobacterial infections (18%, n = 187, cardiovascular disorders (12%, n = 127 and bacterial infections (12%, n = 121. The study sample utilized a total of 7,733 bed days of those, 55% (4,259/7,733 were for HIV-positive patients. The average cost per admission amongst confirmed HIV-positive patients, which was an average of 9.3 days in length, was $1,783 (United States Dollars.Even in the era of large-scale antiretroviral treatment, inpatient facilities in South Africa shoulder a significant HIV burden. The majority of this burden is related to patients not on ART (298/469, 64%, and accounts for more than half of all inpatient resources. Reducing the costs of inpatient care is thus another important benefit of expanding access to ART, promoting earlier ART initiation, and achieving rates of ART retention and adherence.

  14. National trends in inpatient admissions following stereotactic radiosurgery and the in-hospital patient outcomes in the United States from 1998 to 2011

    Science.gov (United States)

    Ho, Allen L.; Li, Alexander Y.; Sussman, Eric S.; Pendharkar, Arjun V.; Iyer, Aditya; Thompson, Patricia A.; Tayag, Armine T.; Chang, Steven D.

    2016-01-01

    Purpose This study sought to examine trends in stereotactic radiosurgery (SRS) and in-hospital patient outcomes on a national level by utilizing national administrative data from the Nationwide Inpatient Sample (NIS) database. Methods and materials Using the NIS database, all discharges where patients underwent inpatient SRS were included in our study from 1998 – 2011 as designated by the ICD9-CM procedural codes. Trends in the utilization of primary and adjuvant SRS, in-hospital complications and mortality, and resource utilization were identified and analyzed. Results Our study included over 11,000 hospital discharges following admission for primary SRS or for adjuvant SRS following admission for surgery or other indication. The most popular indication for SRS continues to be treatment of intracranial metastatic disease (36.7%), but expansion to primary CNS lesions and other non-malignant pathology beyond trigeminal neuralgia has occurred over the past decade. Second, inpatient admissions for primary SRS have declined by 65.9% over this same period of time. Finally, as inpatient admissions for SRS become less frequent, the complexity and severity of illness seen in admitted patients has increased over time with an increase in the average comorbidity score from 1.25 in the year 2002 to 2.29 in 2011, and an increase in over-all in-hospital complication rate of 2.8 times over the entire study period. Conclusions As the practice of SRS continues to evolve, we have seen several trends in associated hospital admissions. Overall, the number of inpatient admissions for primary SRS has declined while adjuvant applications have remained stable. Over the same period, there has been associated increase in complication rate, length of stay, and mortality in inpatients. These associations may be explained by an increase in the comorbidity-load of admitted patients as more high-risk patients are selected for admission at inpatient centers while more stable patients are

  15. 北京医院住院患者满意度研究%Study on inpatient satisfaction with Beijing Hospital

    Institute of Scientific and Technical Information of China (English)

    贺鹏

    2013-01-01

    Founded in 1905, Beijing hospital was previously a German hospital and now has become a tertiary A-level hospital which is directly under the Ministry of Health. It is a modern general hospital which centers on senior cadres’ healthcare, focuses on geriatrics research and opens to the public with offering medical care, education, scientific research and prevention. In this paper, there is a study on satisfaction of Beijing Hospital targeting at finding some useful results and elements that can be utilized ultimately for similar hospitals in management to avoid detours and that can be as a basis on which correct decisions are made to improve inpatient satisfaction and achieve the sustainable development of the hospital.%我院的前身是德国医院,始建于1905年。是卫生部直属的大型公立三甲综合医院。是一所以高干医疗保健为中心、老年医学研究为重点、向社会开放的医疗、教学、科研、预防全面发展的现代化综合性医院。本文通过对我院住院患者满意度的研究,从中总结提炼出一些有益的成果和要素,使其有利于吸取医院管理中的经验教训,从而加以参考利用,最终有利于同类医院在发展中少走弯路,通过正确的制订和选择决策提高患者满意度,实现医院的可持续发展。

  16. The probability of readmission within 30 days of hospital discharge is positively associated with inpatient bed occupancy at discharge--a retrospective cohort study.

    Science.gov (United States)

    Blom, Mathias C; Erwander, Karin; Gustafsson, Lars; Landin-Olsson, Mona; Jonsson, Fredrik; Ivarsson, Kjell

    2015-12-14

    Previous work has suggested that given a hospital's need to admit more patients from the emergency department (ED), high inpatient bed occupancy may encourage premature hospital discharges that favor the hospital's need for beds over patients' medical interests. We argue that the effects of such action would be measurable as a greater proportion of unplanned hospital readmissions among patients discharged when the hospital was full than when not. In response, the present study tested this hypothesis by investigating the association between inpatient bed occupancy at the time of hospital discharge and the 30-day readmission rate. The sample included all inpatient admissions from the ED at a 420-bed emergency hospital in southern Sweden during 2011-2012 that resulted in discharge before 1 December 2012. The share of unplanned readmissions within 30 days was computed for levels of inpatient bed occupancy of 105% at the hour of discharge. A binary logistic regression model was constructed to adjust for age, time of discharge, and other factors that could affect the outcome. In all, 32,811 visits were included in the study, 9.9% of which resulted in an unplanned readmission within 30 days of discharge. The proportion of readmissions was 9.0% for occupancy levels of occupancy, 10.8% for 100-105% occupancy, and 10.5% for >105% occupancy (p = 0.0001). Results from the multivariate models show that the OR (95% CI) of readmission was 1.11 (1.01-1.22) for patients discharged at 95-100% occupancy, 1.17 (1.06-1.29) at 100-105% occupancy, and 1.15 (0.99-1.34) at >105% occupancy. Results indicate that patients discharged from inpatient wards at times of high inpatient bed occupancy experience an increased risk of unplanned readmission within 30 days of discharge.

  17. Effect of cause-of-death training on agreement between hospital discharge diagnoses and cause of death reported, inpatient hospital deaths, New York City, 2008-2010.

    Science.gov (United States)

    Ong, Paulina; Gambatese, Melissa; Begier, Elizabeth; Zimmerman, Regina; Soto, Antonio; Madsen, Ann

    2015-01-15

    Accurate cause-of-death reporting is required for mortality data to validly inform public health programming and evaluation. Research demonstrates overreporting of heart disease on New York City death certificates. We describe changes in reported causes of death following a New York City health department training conducted in 2009 to improve accuracy of cause-of-death reporting at 8 hospitals. The objective of our study was to assess the degree to which death certificates citing heart disease as cause of death agreed with hospital discharge data and the degree to which training improved accuracy of reporting. We analyzed 74,373 death certificates for 2008 through 2010 that were linked with hospital discharge records for New York City inpatient deaths and calculated the proportion of discordant deaths, that is, death certificates reporting an underlying cause of heart disease with no corresponding discharge record diagnosis. We also summarized top principal diagnoses among discordant reports and calculated the proportion of inpatient deaths reporting sepsis, a condition underreported in New York City, to assess whether documentation practices changed in response to clarifications made during the intervention. Citywide discordance between death certificates and discharge data decreased from 14.9% in 2008 to 9.6% in 2010 (P New York City heart disease mortality trends. Other vital records jurisdictions should employ similar interventions to improve cause-of-death reporting and use linked discharge data to monitor data quality.

  18. Effect of Cause-of-Death Training on Agreement Between Hospital Discharge Diagnoses and Cause of Death Reported, Inpatient Hospital Deaths, New York City, 2008–2010

    Science.gov (United States)

    Ong, Paulina; Gambatese, Melissa; Begier, Elizabeth; Zimmerman, Regina; Soto, Antonio

    2015-01-01

    Introduction Accurate cause-of-death reporting is required for mortality data to validly inform public health programming and evaluation. Research demonstrates overreporting of heart disease on New York City death certificates. We describe changes in reported causes of death following a New York City health department training conducted in 2009 to improve accuracy of cause-of-death reporting at 8 hospitals. The objective of our study was to assess the degree to which death certificates citing heart disease as cause of death agreed with hospital discharge data and the degree to which training improved accuracy of reporting. Methods We analyzed 74,373 death certificates for 2008 through 2010 that were linked with hospital discharge records for New York City inpatient deaths and calculated the proportion of discordant deaths, that is, death certificates reporting an underlying cause of heart disease with no corresponding discharge record diagnosis. We also summarized top principal diagnoses among discordant reports and calculated the proportion of inpatient deaths reporting sepsis, a condition underreported in New York City, to assess whether documentation practices changed in response to clarifications made during the intervention. Results Citywide discordance between death certificates and discharge data decreased from 14.9% in 2008 to 9.6% in 2010 (P New York City heart disease mortality trends. Other vital records jurisdictions should employ similar interventions to improve cause-of-death reporting and use linked discharge data to monitor data quality. PMID:25590598

  19. Length of psychiatric hospitalization is correlated with CYP2D6 functional status in inpatients with major depressive disorder

    Science.gov (United States)

    Ruaño, Gualberto; Szarek, Bonnie L; Villagra, David; Gorowski, Krystyna; Kocherla, Mohan; Seip, Richard L; Goethe, John W; Schwartz, Harold I

    2016-01-01

    Aim This study aimed to determine the effect of the CYP2D6 genotype on the length of hospitalization stay for patients treated for major depressive disorder. Methods A total of 149 inpatients with a diagnosis of major depressive disorder at the Institute of Living, Hartford Hospital (CT, USA), were genotyped to detect altered alleles in the CYP2D6 gene. Prospectively defined drug metabolism indices (metabolic reserve, metabolic alteration and allele alteration) were determined quantitatively and assessed for their relationship to length of hospitalization stay. Results Hospital stay was significantly longer in deficient CYP2D6 metabolizers (metabolic reserve <2) compared with functional or suprafunctional metabolizers (metabolic reserve ≥2; 7.8 vs 5.7 days, respectively; p = 0.002). Conclusion CYP2D6 enzymatic functional status significantly affected length of hospital stay, perhaps due to reduced efficacy or increased side effects of the medications metabolized by the CYP2D6 isoenzyme. Functional scoring of CYP2D6 alleles may have a substantial impact on the quality of care, patient satisfaction and the economics of psychiatric treatment. PMID:23734807

  20. The beginning of the journey to study patient safety and care quality in hospital settings using inpatient falls as an example

    Institute of Scientific and Technical Information of China (English)

    Huey-Ming Tzeng

    2011-01-01

    The purpose of this paper is to share with readers the beginning of my journey to study patient safety and care quality in hospital settings with a focus on inpatient falls. Studying patient safety and care quality can be overwhelming because of the breadth and depth of this subject and the many gaps that must be addressed to move nursing science forward. I used a graphic method, concept mapping, to capture my research journey. Data sources used in my program specific to inpatient falls for adults in hospital inpatient care include: (1) publicly available datasets; (2) published legal cases; (3) archived hospital data; (4) surveys; and (5)interviews, focus groups, observation, and field studies. I have summarized a series of my studies related to the relationship between nursing staff's response time to call lights and the prevalence or occurrence of inpatient falls in acute hospital settings. Thesestudies illustrate the development of a line of research on inpatient falls. Finally, I discuss the pivotal points in pursuing this research and scholarship. To sustain the persistence and resilience on this journey requires passion for the subjects of patient safety and care quality.

  1. Hypnotics and the Occurrence of Bone Fractures in Hospitalized Dementia Patients: A Matched Case-Control Study Using a National Inpatient Database

    OpenAIRE

    2015-01-01

    Background Preventing falls and bone fractures in hospital care is an important issue in geriatric medicine. Use of hypnotics is a potential risk factor for falls and bone fractures in older patients. However, data are lacking on the association between use of hypnotics and the occurrence of bone fracture. Methods We used a national inpatient database including 1,057 hospitals in Japan and included dementia patients aged 50 years or older who were hospitalized during a period of 12 months bet...

  2. The probability of readmission within 30 days of hospital discharge is positively associated with inpatient bed occupancy at discharge – a retrospective cohort study

    OpenAIRE

    Blom, Mathias C; Erwander, Karin; Gustafsson, Lars; Landin-Olsson, Mona; Jonsson, Fredrik; Ivarsson, Kjell

    2015-01-01

    Background Previous work has suggested that given a hospital’s need to admit more patients from the emergency department (ED), high inpatient bed occupancy may encourage premature hospital discharges that favor the hospital’s need for beds over patients’ medical interests. We argue that the effects of such action would be measurable as a greater proportion of unplanned hospital readmissions among patients discharged when the hospital was full than when not. In response, the present study test...

  3. Neuritic Patient at Sanglah General Hospital Denpasar

    Directory of Open Access Journals (Sweden)

    Ni Putu Dita-Rinjani

    2012-05-01

    Full Text Available Objective: Treatment of optic neuritic as recommended by the Optic Neuritic Treatment Trial (ONTT was intravenous methylprednisolon followed by oral prednisone. This study aims to describe  characteristics and response to intravenous methylprednisolon followed by oral prednisone treatment of optic neuritic patient in Sanglah General Hospital Denpasar. Method: This report is an analytical cross sectional study. Data were collected retrospectively from medical report of optic neuritic patient who came to Sanglah General Hospital during a period of January 1st 2010 until December 31st 2011. Patient characteristics were analyzed with descriptive analyses and presented as frequency, percentage, mean and standar deviation. Visual acuity and contrast sensitivity improvement after intravenous methylprednisolon followed by oral prednisone treatment were statistically analyzed with Wilcoxon test Results:  Optic neuritic were found in twenty-three patients (33 eyes, majority was in age group of 15-40 years (56.5% with female predominance (65.2% and unilateral involvement was 56.3%. Mean onset patient presented to the hospital was 21.7±2.21 days and the most common symptom was decreasing vision (87.9%.  The majority of patient presented with papillitis (54.5%, totally color blindness found in 39.4% eyes, and the type of visual field defect at presentation was central scotoma (18.2%. All cases show lesion of optic nerve from visual evoked potential (VEP examination and magnetic resonance imaging (MRI shows normal results (39.1% patient. The mean of pretreatment logMAR visual acuity and contrast sensitivity were significant improve after treatment from 1.59±0.47 to 0.59±0.62 (p=0.0001 and 0.31±0.56 to 1.25±0.56 (p=0.0001, respectively. All cases in this study were idiopathic. Recurrences were seen in 2 eyes and none of patient had clinical features suggestive of multiple sclerosis. Conclusions: Visual acuity and contrast sensitivity improvement

  4. Heparin-induced thrombocytopenia: reducing misdiagnosis via collaboration between an inpatient anticoagulation pharmacy service and hospital reference laboratory.

    Science.gov (United States)

    Burnett, Allison E; Bowles, Harmony; Borrego, Matthew E; Montoya, Tiffany N; Garcia, David A; Mahan, Charles

    2016-11-01

    Misdiagnosis of heparin-induced thrombocytopenia (HIT) is common and exposes patients to high-risk therapies and potentially serious adverse events. The primary objective of this study was to evaluate the impact of collaboration between an inpatient pharmacy-driven anticoagulation management service (AMS) and hospital reference laboratory to reduce inappropriate HIT antibody testing via pharmacist intervention and use of the 4T pre-test probability score. Secondary objectives included clinical outcomes and cost-savings realized through reduced laboratory testing and decreased unnecessary treatment of HIT. This was a single center, pre-post, observational study. The hospital reference laboratory contacted the AMS when they received a blood sample for an enzyme-linked immunosorbent HIT antibody (HIT Ab). Trained pharmacists prospectively scored each HIT Ab ordered by using the 4T score with subsequent communication to physicians recommending for or against processing and reporting of lab results. Utilizing retrospective chart review and a database for all patients with a HIT Ab ordered during the study period, we compared the incidence of HIT Ab testing before and after implementation of the pharmacy-driven 4T score intervention. Our intervention significantly reduced the number of inappropriate HIT Ab tests processed (176 vs. 63, p < 0.0001), with no increase in thrombotic or hemorrhagic events. Overall incidence of suspected and confirmed HIT was <3 and <0.005 %, respectively. Overall cost savings were $75,754 (US) or 62 % per patient exposed to heparin between the pre and post intervention groups. Collaboration between inpatient pharmacy AMS and hospital reference laboratories can result in reduction of misdiagnosis of HIT and significant cost savings with similar safety.

  5. Tongue Strength is Associated with Grip Strength and Nutritional Status in Older Adult Inpatients of a Rehabilitation Hospital.

    Science.gov (United States)

    Sakai, Kotomi; Nakayama, Enri; Tohara, Haruka; Maeda, Tomomi; Sugimoto, Motonobu; Takehisa, Takahiro; Takehisa, Yozo; Ueda, Koichiro

    2017-04-01

    The aim of this cross-sectional study was to investigate whether tongue strength observed in older adult inpatients of a rehabilitation hospital is associated with muscle function, nutritional status, and dysphagia. A total of 174 older adult inpatients aged 65 years and older in rehabilitation (64 men, 110 women; median age, 84 years; interquartile range, 80-89 years) who were suspected of having reduced tongue strength due to sarcopenia were included in this study. Isometric tongue strength was measured using a device fitted with a disposable oral balloon probe. We evaluated age, muscle function as assessed by the Barthel index and grip strength, nutritional status as measured by the Mini Nutritional Assessment-short form (MNA-SF), body mass index, serum albumin, controlling nutritional status, and calf circumference and arm muscle area to assess muscle mass. In addition, the functional oral intake scale (FOIS) was used as an index of dysphagia. Multivariate linear regression analysis revealed that isometric tongue strength was independently associated with grip strength (coefficient = 0.33, 95 % confidence interval (CI) 0.12-0.54, p = 0.002), MNA-SF (coefficient = 0.74, 95 % CI 0.12-1.35, p = 0.019), and FOIS (coefficient = 0.02, 95 % CI 0.00-0.15, p = 0.047). To maintain and improve tongue strength in association with sarcopenic dysphagia, exercise therapy and nutritional therapy interventions, as well as direct interventions to address tongue strength, may be effective in dysphagia rehabilitation in older adult inpatients.

  6. Pediatric Diabetes Outpatient Center at Rhode Island Hospital: The impact of changing initial diabetes education from inpatient to outpatient.

    Science.gov (United States)

    Pingul, Mia M; Mulvihill, Erin M; Reinert, Steven E; Gopalakrishnan, Geetha; Plante, Wendy A; Boney, Charlotte M; Bialo, Shara R; Quintos, Jose Bernardo

    2017-02-01

    This study compared outcomes and costs for new-onset Type 1 diabetes mellitus (T1DM) patients educated at the outpatient versus inpatient settings. Retrospective study examining the following variables: 1) hemoglobin A1c (HbA1c), 2) severe hypoglycemia, 3) admissions for diabetic ketoacidosis (DKA) or ER visits, and 4) healthcare cost. 152 patients with new-onset T1DM from September 2007-August 2009. There were no differences between outpatient group (OG) and inpatient group (IG) in mean HbA1c levels at 1, 2 and 3 years post-diagnosis (OG 8%, 8.5%, 9.3%; IG 8.3%, 8.9%, 9%, p=0.51). Episodes of severe hypoglycemia, DKA, and ER visits were not different between the two groups. Mean total hospital costs for OG and pure OG were significantly less than IG (OG: $2886 vs. IG: $4925, p<0.001), (pure OG: $1044 vs. IG: $4925, p<0.0001). Our study demonstrates that outpatient- based pediatric diabetes education lowers healthcare cost without compromising medical outcomes. [Full article available at http://rimed.org/rimedicaljournal-2017-02.asp].

  7. Alternate Level of Care Patients in Public General Hospital Psychiatry.

    Science.gov (United States)

    Marcos, Luis R.; Gil, Rosa M.

    1984-01-01

    Analyzes the interaction between psychiatric services in public general hospitals and in other institutional settings. A one-day census of patients in a New York general hospital showed the hospital was providing care to a large number of patients in need of other, less intensive institutional settings. (BH)

  8. Oxygen saturations of medical inpatients in a Malawian hospital: cross-sectional study of oxygen supply and demand

    Directory of Open Access Journals (Sweden)

    Hywel-Gethin Tudur Evans

    2012-05-01

    Full Text Available Normal 0 false false false EN-GB JA X-NONE Oxygen is a World Health Organisation listed essential drug yet provision of oxygen in developing countries often fails to meet demand.  The aim of this study was to evaluate the need for supplementary oxygen against oxygen delivery capacity at a large teaching hospital in Malawi.  A cross‐sectional study of all adult medical inpatients and assessment of oxygen provision over a 24‐hour period was conducted.    144 patients were included in the study, 14 of whom met local and international criteria for oxygen therapy (oxygen saturations of <90%.  Four were receiving oxygen.  Of the 8 oxygen concentrators available, only 4 were functional.  In conclusion, we identified a need for oxygen that was greater than the supply.

  9. Lead-time reduction utilizing lean tools applied to healthcare: the inpatient pharmacy at a local hospital.

    Science.gov (United States)

    Al-Araidah, Omar; Momani, Amer; Khasawneh, Mohammad; Momani, Mohammed

    2010-01-01

    The healthcare arena, much like the manufacturing industry, benefits from many aspects of the Toyota lean principles. Lean thinking contributes to reducing or eliminating nonvalue-added time, money, and energy in healthcare. In this paper, we apply selected principles of lean management aiming at reducing the wasted time associated with drug dispensing at an inpatient pharmacy at a local hospital. Thorough investigation of the drug dispensing process revealed unnecessary complexities that contribute to delays in delivering medications to patients. We utilize DMAIC (Define, Measure, Analyze, Improve, Control) and 5S (Sort, Set-in-order, Shine, Standardize, Sustain) principles to identify and reduce wastes that contribute to increasing the lead-time in healthcare operations at the pharmacy understudy. The results obtained from the study revealed potential savings of > 45% in the drug dispensing cycle time.

  10. Ontology-guided distortion control for robust-lossless database watermarking: application to inpatient hospital stay records.

    Science.gov (United States)

    Franco-Contreras, J; Coatrieux, G; Cuppens-Boulahia, N; Cuppens, F; Roux, C

    2014-01-01

    In this paper, we propose a new semantic distortion control method for database watermarking. It is based on the identification of the semantic links that exist in-between attribute's values in tuples by means of an ontology. Such a database distortion control provides the capability for any watermarking scheme to avoid incoherent records and consequently ensures: i) the normal interpretation of watermarked data, i.e. introducing a watermark semantically imperceptible; ii) prevent the identification by an attacker of watermarked tuples. The solution we present herein successfully combines this semantic distortion control method with a robust lossless watermarking scheme. Experimental results conducted on a medical database of more than one half million of inpatient hospital stay records also show a non-negligible gain of performance in terms of robustness and database distortion.

  11. [Neuropediatric healthcare demand in a general hospital].

    Science.gov (United States)

    Herrera Martín M; Gracia Remiro R; Santana Rodríguez C; Jiménez Moya A; Ayala Curiel J; Cuadrado Bello P

    2000-08-01

    The few existing studies on the demand for neuropediatric care in Spain offer information of enormous value, contributing to our knowledge of this specialty and of the needs of specialists and their training, as well as to the correct planning and use of economic and human resources. To determine the real demand, predominant disorders and usefulness of complementary examinations with a view to determining the need for neuropediatric care in a general hospital. Descriptive, retrospective study of patients attending the neuropediatric department for the first time during a 7-year period and for follow-up visits during a 4-year period. The periods were randomly selected. During this period 1130 children, generating 5033 consultations, were assessed. The total number of visits amounted to 25% of all consultations in the Pediatric Department, involving 31% of the children under 14 years of age in the pediatric population of Segovia. The overall rate of reexaminations/new patients was 3.4. The most frequent diagnosis was headache (32%), followed by non-epileptic paroxysms, febrile convulsions and epilepsy. The disorders requiring the greatest number of follow-up consultations were epilepsy (20%), headache (9%) and febrile convulsions (5%). The rate of reexamination/new patients was significantly higher in pediatric cerebral palsy and epilepsy. Electroencephalogram was the most frequently requested complementary examination, followed by neuroradiological studies. Demand for neuropediatric care mainly involves headaches, epilepsy, convulsions, non-epileptic paroxysmal disorders, and neonatal neurology in the first years of life. Pressure on neuropediatric departments is great due to the number of patients attending consulting rooms because of functional or self-limiting disorders. This pressure could be reduced by appropriate neurological training of general pediatricians or family doctors.

  12. Noise at night in hospital general wards: a mapping of the literature.

    Science.gov (United States)

    Fillary, Julie; Chaplin, Hema; Jones, Gill; Thompson, Angela; Holme, Anita; Wilson, Patricia

    English NHS inpatient surveys consistently identify that noise at night in hospitals and its impact on patients' sleep is a persisting problem that needs addressing. To identify how noise at night in hospital affects patients on general wards and the range of interventions aimed at reducing the problem, a systematic mapping of the literature was undertaken. All primary studies and relevant literature published January 2003-July 2013 were included. Key issues identified in the literature included noise levels and causes, impact on patient experience, and lack of staff awareness. Interventions to reduce noise were targeted at staff education, behaviour modification, care organisation and environmental solutions. The scoping suggested that when compared with specialist units, there is little evidence on effective interventions reducing disturbance from night-time noise on general wards. The available evidence suggests a whole systems approach should be adopted to aid quality sleep and promote recovery.

  13. Assessing the Reliability and Validity of a Physical Therapy Functional Measurement Tool--the Modified Iowa Level of Assistance Scale--in Acute Hospital Inpatients.

    Science.gov (United States)

    Kimmel, Lara A; Elliott, Jane E; Sayer, James M; Holland, Anne E

    2016-02-01

    Functional outcome measurement tools exist for individual diagnoses (eg, stroke), but no prospectively validated mobility measure is available for physical therapists' use across the breadth of acute hospital inpatients. The modified Iowa Level of Assistance Scale (mILOA), a scale measuring assistance required to achieve functional tasks, has demonstrated functional change in inpatients with orthopedic conditions and trauma, although its psychometric properties are unknown. The aim of this study was to assess interrater reliability, known-groups validity, and responsiveness of the mILOA in acute hospital inpatients. This was a cohort, measurement-focused study. Patients at a large teaching hospital in Melbourne, Australia, were recruited. One hundred fifty-two inpatients who were functionally stable across 5 clinical groups had an mILOA score calculated during 2 independent physical therapy sessions to assess interrater reliability. Known-groups validity ("ready for discharge"/"not ready for discharge") and responsiveness also were assessed. The mean age of participants in the reliability phase of the study was 62.5 years (SD=17.7). The interrater reliability was excellent (intraclass correlation coefficient [2,1]=.975; 95% confidence interval=.965, .982), with a mean difference between scores of -.270 and limits of agreement of ±5.64. The mILOA score displayed a mean difference between 2 known groups of 15.3 points. Responsiveness was demonstrated with a minimal detectable change of 5.8 points. Participants were included in the study if able to give consent for themselves, thereby limiting generalizability. Construct validity was not assessed due to the lack of a gold standard. The mILOA has excellent interrater reliability and good known-groups validity and responsiveness to functional change across acute hospital inpatients with a variety of diagnoses. It may provide opportunities for physical therapists to collect a functional outcome measure to demonstrate

  14. Hospital-based inter-professional strategy to reduce in-patient admissions and emergency department visits for pediatric asthma.

    Science.gov (United States)

    Fleming, Karen; Kuzik, Brian; Chen, Chee

    2011-01-01

    Pediatric asthma is a common reason for emergency department (ED) visits and in-patient hospital admissions. Evidence demonstrates that asthma management initiated in the ED has limited benefit unless followed by ongoing coordinated inter-professional care (IPC). The Royal Victoria Hospital (RVH) of Barrie, Ontario, has developed a best practice model of care for pediatric asthma. Primary care providers and ED physicians are actively encouraged to refer children with any recurrent respiratory problems consistent with asthma to the Paediatric Asthma Clinic (PAC). Quarterly PAC visits with a certified asthma educator and a pediatrician include lung function measurement, written action plans and primary care provider communication. Ongoing outcome monitoring of patients receiving IPC has revealed that, compared with 12 months prior to enrolment in the PAC, patients show a two-thirds decrease in asthma-related ED visits and an 85% decrease in admissions. The PAC has contributed to an ongoing decline in the rates of pediatric asthma-related ED visits and admissions at RVH, which are currently less than half the rates seen at our peer hospitals. IPC for chronic diseases is best practice, and our model of care for pediatric asthma continues to provide critical data demonstrating and supporting the advantages of IPC in chronic disease management. RVH modifies practice and policy to meet best practices, optimizing the care provided to children with pediatric asthma.

  15. Financial Loss for Inpatient Care of Medicaid-Insured Children.

    Science.gov (United States)

    Colvin, Jeffrey D; Hall, Matt; Berry, Jay G; Gottlieb, Laura M; Bettenhausen, Jessica L; Shah, Samir S; Fieldston, Evan S; Conway, Patrick H; Chung, Paul J

    2016-11-01

    Medicaid payments tend to be less than the cost of care. Federal Disproportionate Share Hospital (DSH) payments help hospitals recover such uncompensated costs of Medicaid-insured and uninsured patients. The Patient Protection and Affordable Care Act reduces DSH payments in anticipation of fewer uninsured patients and therefore decreased uncompensated care. However, unlike adults, few hospitalized children are uninsured, while many have Medicaid coverage. Therefore, DSH payment reductions may expose extensive Medicaid financial losses for hospitals serving large absolute numbers of children. To identify types of hospitals with the highest Medicaid losses from pediatric inpatient care and to estimate the proportion of losses recovered through DSH payments. This retrospective cross-sectional analysis evaluated Medicaid-insured hospital discharges of patients 20 years and younger from 23 states in the 2009 Kids' Inpatient Database. The dates of the analysis were March to September 2015. Hospitals were categorized as freestanding children's hospitals (FSCHs), children's hospitals within general hospitals, non-children's hospital teaching hospitals, and non-children's hospital nonteaching hospitals. Financial records of FSCHs in the data set were used to estimate the proportion of Medicaid losses recovered through DSH payments. Hospital financial losses from inpatient care of Medicaid-insured children (defined as the reimbursement minus the cost of care) were compared across hospital types. For our subsample of FSCHs, Medicaid-insured inpatient financial losses were calculated with and without each hospital's DSH payment. The 2009 Kids' Inpatient Database study population included 1485 hospitals and 843 725 Medicaid-insured discharges. Freestanding children's hospitals had a higher median number of Medicaid-insured discharges (4082; interquartile range [IQR], 3524-5213) vs non-children's hospital teaching hospitals (674; IQR, 258-1414) and non-children's hospital

  16. Deterioro funcional en ancianos ingresados en un hospital sin unidades geriátricas Functional impairment in elderly inpatients in a hospital without geriatric units

    Directory of Open Access Journals (Sweden)

    Alfonso Jesús Cruz Lendínez

    2010-03-01

    ás influyen en la variación de la capacidad funcional durante la hospitalización. La hospitalización de ancianos en un hospital sin unidad geriátrica supone peores resultados en la capacidad funcional de los pacientes frente a los hospitales que cuentan con unidad de hospitalización geriátrica.Introduction: Increased population of elderly people is becoming more frequent admission to hospitals of people older than 65 years. Hospital stay in conventional units can lead to functional worsening in the elderly. Aim: To identify the profile of elderly patients treated in the Internal Medicine Hospital of Jaén. To analyze variation in functional ability of elderly people following admission to inpatient units of a public hospital. To identify variables that influence the changes in the functional ability of elderly inpatients in hospitals without geriatric units. Methods: Prospective observational study in 3 units of internal medicine units in a hospital belonging to the Andalusian Health Service. A sample of 190 hospitalized elderly patients has been included. Variables related to demographic, hospitalization and functional ability using Barthel Index, were reported. Results: Hospitalization in internal medicine units did not help to improve functional ability in older people; rather, they had a negative effect, promoting functional worsening in an important group of these patients. Depending on the age, among patients studied (65-85 and over, younger patients got better results on functional recovery at discharge, while those above 85 years got worst results. 16% under 85 years and 67.5% of those over 85 lose functional capacity. Conclusions: Most important factors affecting functional ability change during hospitalization were age, functional ability at admission, functional ability at discharge, the presence of companions during hospitalization and discharge destination. Hospitalization of elderly in a nongeriatric inpatient unit at hospital assumes no worse results in

  17. House staff member awareness of older inpatients' risks for hazards of hospitalization.

    Science.gov (United States)

    Fernandez, Helen M; Callahan, Kathryn E; Likourezos, Antonios; Leipzig, Rosanne M

    2008-02-25

    Many hospitalized older adults develop iatrogenic complications unrelated to their presenting diagnoses that can result in longer hospitalizations, functional impairment, or unanticipated medical or surgical interventions. These complications are often referred to as "hazards of hospitalization" and include delirium, malnutrition, urinary incontinence, pressure ulcers, depression, falls, restraint use, infection, functional decline, adverse drug effects, and death. The aims of this study were to assess house staff member awareness of older patients' risk factors for developing hazards of hospitalization and to determine areas in which interventions may help improve recognition. A cross-sectional study was performed, from December 1, 1999, through August 31, 2002, of internal medicine and medicine or pediatric house staff members and their patients from 4 medical units at Mount Sinai Medical Center. Each house staff member completed a 23-item survey on 3 of their recently admitted patients. These patients and, if appropriate, their surrogates were interviewed by the study investigator within 2 hours of the completion of the house staff survey. House staff member responses are compared with those obtained by the study investigator. The completed house staff surveys were compared with the reference standard, and areas of agreement and disagreement were noted. Eighty-six house staff teams, consisting of 1 intern and 1 resident (in either the second or third postgraduate year), and 105 patients were enrolled in the study. The house staff members were in frank disagreement or poor agreement with the reference standard in knowing the following: how well their patients were oriented to place or how long they had been hospitalized; patients' quality of sleep, presence of pain, history of falls, mood, quantity of food intake, and use of hearing aids, glasses, or an ambulation assistive device when at home; and the name of their patients' primary care physicians. This study

  18. Improving acute psychiatric hospital services according to inpatient experiences. A user-led piece of research as a means to empowerment.

    Science.gov (United States)

    Walsh, Jim; Boyle, Joan

    2009-01-01

    This paper has been undertaken by people with experience with mental health issues and mental health care systems. The aim of the research was to explore psychiatric inpatients' strategies for coping with mental ill health and in what ways acute inpatient psychiatric hospital services are facilitative to the individual attempting recovery. Ten focus groups were facilitated and data were analysed through systematic content analysis. Findings revealed that the main areas of concern for inpatients were: information, communication, relationships, activities, self-help, patient involvement in care treatment plans, and the physical environment. The authors also make a case to improve the status of user-led research as a means to understand the needs of mental health service users.

  19. Inpatient satisfaction and usage patterns of personalized smart bedside station system for patient-centered service at a tertiary university hospital.

    Science.gov (United States)

    Ryu, Borim; Kim, Seok; Lee, Kee-Hyuck; Hwang, Hee; Yoo, Sooyoung

    2016-11-01

    Bedside stations, also known as bedside terminals, are in place to enhance the quality and experience of a hospital's healthcare service delivery. The purpose of this study was to identify information needs and overall satisfaction with the personalized patient bedside system, called Smart Bedside Station (SBS) system, embedded in a tertiary general university hospital. End-user responses on the satisfaction survey and system usage logs of the SBS system were collected and analyzed. For the user opinion survey, 156 nurses and 1914 patients, their family members, or caregivers participated during the evaluation period of 2013 to 2014 in this study. All working nurses in the SBS-installed ward were answered the paper-based evaluation, for complete enumeration survey. Inpatients were voluntary participated to deliver the online questionnaire on the SBS menu. We also explored system log data including page calls and usage time from December 2013 to 2015. Regarding the relationship of overall satisfaction of the SBS with patient's characteristics, patient's education status and degree of familiarity with the smart device were statistically significant. From the analysis of system logs, Personalized My Menu(28.0%) was the most frequently used menu item (except for TV and Internet entertainment service use of 62.7%),it provides individual health information, such as laboratory test results, hospital fee check, message logs, daily medication information, and meal information. Next frequently used menus were information support(4.9%) which deliver hospital guide and health information and convenience service ordering(4.4%) such as meal order, bed sheet change. Satisfaction survey results and log data results show that the personalized service enhances the user satisfaction during hospital admission. Our post-implementation experience and subsequent assessment of SBS system is capable of providing insights into improving the hospital information system and service contents

  20. 42 CFR 413.40 - Ceiling on the rate of increase in hospital inpatient costs.

    Science.gov (United States)

    2010-10-01

    ... reporting period subject to the ceiling if there is a significant increase in the average hourly wage for... wage survey data collected for the cost reporting period subject to the ceiling is at least 8.0 percent... 42 Public Health 2 2010-10-01 2010-10-01 false Ceiling on the rate of increase in hospital...

  1. 76 FR 26489 - Medicare Program; Hospital Inpatient Value-Based Purchasing Program

    Science.gov (United States)

    2011-05-06

    ... Myocardial Infarction CCN CMS Certification number CLABSI Central line-associated bloodstream infections CMMI... furnished by hospitals in connection with four topics: Acute Myocardial Infarction (AMI); Heart Failure (HF... of variation DRA Deficit Reduction Act of 2005 DRG Diagnosis-Related Group EHR Electronic...

  2. Effectiveness of outpatient, day hospital, and inpatient psychotherapeutic treatment for patients with Cluster B personality disorders

    NARCIS (Netherlands)

    A. Bartak; H. Andrea; M.D. Spreeuwenberg; U.M. Ziegler; J. Dekker; B.V. Rossum; E.F.M Hamers; W. Scholte; J. Aerts; J.J.V. Busschbach; R. Verheul; T. Stijnen; P.M.G. Emmelkamp

    2011-01-01

    Background: For patients with cluster B personality disorders there is no consensus regarding the optimal treatment setting. The aim of this study was to compare the effectiveness of different psychotherapeutic settings for patients with cluster B personality disorders, i.e. outpatient, day hospital

  3. 75 FR 30917 - Medicare Program; Supplemental Proposed Changes to the Hospital Inpatient Prospective Payment...

    Science.gov (United States)

    2010-06-02

    .... Free public access is available on a Wide Area Information Server (WAIS) through the Internet and via... of Documents' home Web page address is http://www.gpoaccess.gov/ ), by using local WAIS client...)(3)(B)(iv) of the Act provides that the applicable percentage increase applicable to the hospital...

  4. Examining patient race and area predictors of inpatient admission for schizophrenia among hospital users in California.

    Science.gov (United States)

    Durbin, Anna; Rudoler, David; Durbin, Janet; Laporte, Audrey; Callaghan, Russell C

    2014-12-01

    According to international research African-Caribbean and Black African populations have increased risk of hospitalization for schizophrenia, compared to Whites. Less is known about admission risk for other racial-ethnic groups. This study investigated racial-ethnic differences in hospital admission for schizophrenia in California. It also investigated the influence of area social factors (racial-ethnic neighborhood composition, and per capita income) and health service factors (presence of primary care clinics). The study sample included individuals admitted to a California hospital during 1990-2005 with a primary appendicitis related diagnosis, and without a prior or concurrent indication of schizophrenia. The adjusted logistic model examined how patient racial-ethnicity (White, Black, Hispanic, Other), other personal, area social characteristics and presence of primary care clinics influenced hospital admissions for schizophrenia. Black individuals were almost twice as likely as Whites to be admitted while Hispanics and Other race individuals were less to be admitted. In addition, male sex, having more comorbidities and living in areas with greater proportions of non-Whites increased risk. The increased risk for Blacks compared to Whites was consistent with the existing literature. However, this is among the first studies to report that Hispanics had a reduced risk of admission for schizophrenia, compared to Whites. Future studies may want to include a broader range of health services to better understand patterns of care use among individuals with schizophrenia.

  5. Early detection of pneumology inpatients at risk of extended hospital stay and need for psychosocial treatment

    NARCIS (Netherlands)

    Lobo, Elena; De Jonge, Peter; Huyse, Frits J.; Slaets, Joris P. J.; Rabanaque, Maria-Jose; Lobo, Antonio

    2007-01-01

    Background: In a context of increasing concern for complex care needs in medical patients, this study is intended to document the utility in pneumology patients of INTERMED, a reliable and valid instrument to assess case complexity at the time of hospital admission. Methods: Three hundred and fiftee

  6. Malaria and HIV among pediatric inpatients in two Tanzanian referral hospitals: A prospective study.

    Science.gov (United States)

    Smart, Luke R; Orgenes, Neema; Mazigo, Humphrey D; Minde, Mercy; Hokororo, Adolfine; Shakir, Muhammad; Verweij, Jaco J; Downs, Jennifer A; Peck, Robert N

    2016-07-01

    Malaria remains common in sub-Saharan Africa, but it is frequently over-diagnosed and over-treated in hospitalized children. HIV is prevalent in many malaria endemic areas and may delay parasite clearance and increase mortality among children with malaria. This prospective cohort study enrolled children with suspected malaria between 3 months and 12 years of age hospitalized at two referral hospitals in Tanzania. Both a thick blood smear (BS) and a malaria rapid diagnostic test (mRDT) were performed. If discordant results were obtained, PCR was performed for Plasmodium falciparum. Malaria was confirmed if two out of three tests were positive. Malaria parasite densities were determined for two consecutive days after diagnosis and treatment of malaria. All participants were tested for HIV. Among 1492 hospitalized children, 400 (26.8%) were enrolled with suspected malaria infection. There were 196/400 (49.0%) males, and the median age was 18 [9-36] months. BS was positive in 95/400 (23.8%), and mRDT was positive in 70/400 (17.5%), with moderate agreement (Kappa=0.598). Concordant results excluded malaria in 291/400 (72.8%) and confirmed malaria in 56/400 (14.0%). PCR performed on 53 discordant results confirmed malaria in 1/39 of the BS-positive/mRDT-negative cases, and 6/14 of the BS-negative/mRDT-positive cases. The prevalence of confirmed malaria was 63/400 (15.8%). In multivariable logistic regression, malaria was associated with HIV (OR 3.45 [1.65-7.20], p=0.001). Current breastfeeding (OR 0.25 [0.11-0.56], p=0.001) and higher hemoglobin (OR 0.70 [0.60-0.81], pmalaria. Malaria parasite clearance was delayed in HIV-infected participants (pMalaria is over-diagnosed even at referral centers in high transmission areas. Hospitalized HIV-infected children are more likely to have malaria and exhibit delayed clearance of parasites. Hospitals should consider using mRDTs as a first step for malaria testing among hospitalized children in sub-Saharan Africa.

  7. High Levels Of Bed Occupancy Associated With Increased Inpatient And Thirty-Day Hospital Mortality In Denmark

    DEFF Research Database (Denmark)

    Madsen, Flemming; Ladelund, Steen; Linneberg, Allan

    2014-01-01

    High bed occupancy rates have been considered a matter of reduced patient comfort and privacy and an indicator of high productivity for hospitals. Hospitals with bed occupancy rates of above 85 percent are generally considered to have bed shortages. Little attention has been paid to the impact...... of these shortages on patients' outcomes. We analyzed all 2.65 million admissions to Danish hospitals' departments of medicine in the period 1995-2012. We found that high bed occupancy rates were associated with a significant 9 percent increase in rates of in-hospital mortality and thirty-day mortality, compared...... to low bed occupancy rates. Being admitted to a hospital outside of normal working hours or on a weekend or holiday was also significantly associated with increased mortality. The health risks of bed shortages, including mortality, could be better documented as a priority health issue. Resources should...

  8. AN EPIDEMIOLOGY BASED INPATIENT DATA ANALYSIS AT AN INFECTIOUS DISEASE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Meera

    2015-04-01

    Full Text Available INTRODUCTION: Communicable diseases continue to be the leading cause of considerable m ortality & morbidity in our country . At the hospital where the study was done , patients with febrile illnesses from various parts of the state are admitted for infectious diseases which include Viral fevers , acute diarrheal diseases ( ADD , Enteric fever , Cholera , Infectious hepatitis , Malaria , Dengue , Chikungunya , Measles , Mumps , Chicken pox , Diphtheria , Tetanus , Dog bites & Rabies . CONTEXT: Patients attending outpatient department ( OPD of an infectious disease hospital with febrile illnesses . AIM OF THE STUDY: The aim of the study was to determine the prevalence of various communicable diseases among patients attending the OPD of the hospital , the rate of admission with provisional diagnosis and patient outcome in relation to the disease . MATERIAL & METHO DS: Patients who attended the OPD from September 2012 till August 2013 were included in the study . Clinical and personal data was documented for each patient . Laboratory investigations were done as guided by clinical presentation . All patients with moderat e to severe morbidity & serious illnesses were admitted . RESULT OF THE STUDY: The study showed that while the incidence of infective illnesses like acute diarrhea , malaria , dengue & clinical diphtheria is high , tetanus and rabies cases are not uncommon .

  9. 河南省5所公立医院住院患者就医体验调查%Survey on inpatient medical experience at five public hospitals in Henan

    Institute of Scientific and Technical Information of China (English)

    方明旺; 陈加军; 陈全州; 张旭; 贾晓灿; 闫梦青; 孙长青

    2015-01-01

    目的 了解河南省公立医院住院患者就医体验状况及其影响因素.方法 使用自行设计的住院患者体验量表(IPEQ),采用随机抽样的方法,对河南省5所公立三级甲等医院的500名住院患者进行现场调查.结果 患者就医体验的总体满意度为8.48分,其中技术水平满意度最高(4.19分)、情感支持的满意度最低(3.31分).相关性分析显示,医生技术水平与患者体验相关程度最高(0.652).结论 河南省公立医院住院患者总体体验满意度较高,但医院在人文关怀和服务流程等方面需进一步改善.%Objective To learn the medical experience of inpatients at public hospitals in Henan and the influencing factors.Methods Inpatient experience questionnaire (IPEQ) was customized for a random sampling of 500 inpatients at five tertiary public hospitals in Henan.Results Overall satisfaction of inpatients experience scored 8.48,of which the satisfaction for technical competence was the highest (4.19)and that for emotional support the lowest(3.31).The correlation analysis revealed that the doctors' technical competence score the highest correlation with the experiences (0.652).Conclusion Overall satisfaction of inpatients experience at public hospitals in Henan was found high in general,but humanistic care and service flow at the hospitals require further improvement.

  10. Intravenous lacosamide in seizure emergencies: Observations from a hospitalized in-patient adult population.

    Science.gov (United States)

    d'Orsi, Giuseppe; Pascarella, Maria Grazia; Martino, Tommaso; Carapelle, Elena; Pacillo, Francesca; Di Claudio, Maria Teresa; Mancini, Daniela; Trivisano, Marina; Avolio, Carlo; Specchio, Luigi M

    2016-11-01

    to evaluate the efficacy and safety of intravenous (IV) lacosamide (LCM) in the treatment of seizure clusters (SC) and status epilepticus (SE) in hospitalized adult patients. we prospectively analyzed treatment response, seizure outcome, and adverse effects of IV LCM in 38 patients with seizure emergencies (15 with SC, 23 with SE) during a hospital stay. The loading dose of IV LCM was 200-400mg and the maintenance dose was 200-400mg daily. Response to IV LCM was evaluated within 20min, 4h and 24h of LCM infusion. an acute anti-seizure effect after IV LCM was especially evident when it was first used - (SC) or second line (established SE) treatment. In particular, 87% of SC patients (13/15) and 80% of established SE (8/10) demonstrated response to LCM treatment, while no patients with super-refractory SE (0/8) responded to IV LCM according to our criteria. The loading of IV LCM was well tolerated, with mild adverse effects (2/38 temporary dizziness). In most patients, during and after administration of the loading dose of IV LCM a temporary (30min-1h) sedation was observed. No ECG and laboratory values-changes were documented in any of the patients. LCM is an effective and well-tolerated treatment when used to treat SC in hospitalized adult patients. As add-on therapy, it may be useful to stop seizure activity in patients with focal SE not responding to first/second-line intravenous AEDs. Copyright © 2016 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  11. National Veterans Health Administration inpatient risk stratification models for hospital-acquired acute kidney injury.

    Science.gov (United States)

    Cronin, Robert M; VanHouten, Jacob P; Siew, Edward D; Eden, Svetlana K; Fihn, Stephan D; Nielson, Christopher D; Peterson, Josh F; Baker, Clifton R; Ikizler, T Alp; Speroff, Theodore; Matheny, Michael E

    2015-09-01

    Hospital-acquired acute kidney injury (HA-AKI) is a potentially preventable cause of morbidity and mortality. Identifying high-risk patients prior to the onset of kidney injury is a key step towards AKI prevention. A national retrospective cohort of 1,620,898 patient hospitalizations from 116 Veterans Affairs hospitals was assembled from electronic health record (EHR) data collected from 2003 to 2012. HA-AKI was defined at stage 1+, stage 2+, and dialysis. EHR-based predictors were identified through logistic regression, least absolute shrinkage and selection operator (lasso) regression, and random forests, and pair-wise comparisons between each were made. Calibration and discrimination metrics were calculated using 50 bootstrap iterations. In the final models, we report odds ratios, 95% confidence intervals, and importance rankings for predictor variables to evaluate their significance. The area under the receiver operating characteristic curve (AUC) for the different model outcomes ranged from 0.746 to 0.758 in stage 1+, 0.714 to 0.720 in stage 2+, and 0.823 to 0.825 in dialysis. Logistic regression had the best AUC in stage 1+ and dialysis. Random forests had the best AUC in stage 2+ but the least favorable calibration plots. Multiple risk factors were significant in our models, including some nonsteroidal anti-inflammatory drugs, blood pressure medications, antibiotics, and intravenous fluids given during the first 48 h of admission. This study demonstrated that, although all the models tested had good discrimination, performance characteristics varied between methods, and the random forests models did not calibrate as well as the lasso or logistic regression models. In addition, novel modifiable risk factors were explored and found to be significant. Published by Oxford University Press on behalf of the American Medical Informatics Association 2015. This work is written by US Government employees and is in the public domain in the US.

  12. [Treatment in psychiatric day hospital in comparison with inpatient wards in different European health care systems--objectives of EDEN project].

    Science.gov (United States)

    Kiejna, Andrzej; Kallert, Thomas W; Rymaszewska, Joanna

    2002-01-01

    The paper presents the objectives and design of an ongoing multicenter randomized, controlled trial EDEN (European Day Hospital EvaluatioN). The EDEN-study aims to evaluate the efficacy of acute psychiatric treatment in a day hospital setting in five European centres: Dresden, London, Michalovce, Prague and Wroclaw. The main hypothesis is that day hospital treatment for acute psychiatric patients is as effective as conventional inpatient hospital care. The objectives of the study are to evaluate the viability and effectiveness of day hospitals for acute psychiatric treatment, to identify subgroups of patients with a more or less favourable outcome so that the treatment setting might be specifically applied and to ascertain the cost-effectiveness of day hospital treatment compared to conventional inpatient treatment. The study utilises a Randomised Controlled Trial (RCT) design with repeated measures at a maximum of six time points: at admission (t1), one week after admission (t2), four weeks after admission (t3), discharge (t4), three months after discharge (t5), and 12 months after discharge (t6). A combination of well-established standardised assessment instruments and open questions is used in 6 time periods. If the findings accept the main hypothesis of the study, some practical consequences could be inevitable: at a mental health policy level, these results could lead to an increase in the capacity of day hospitals; at the clinical level clinicians could redefine their concepts of care to consider the day hospital as an alternative to conventional inpatient treatment; from economic point of view could lead to reduction of treatment costs.

  13. Non-steroidal anti-inflammatory drug prescriptions in hospital inpatients: are we assessing the risks?

    LENUS (Irish Health Repository)

    Kitchen, J

    2012-02-01

    AIM: To determine non-steroidal anti-inflammatory drug (NSAID) prescribing practices in a tertiary referral hospital. METHODS: A single time-point audit of drug kardexes and clinical notes of n = 388 patients on 2 July 2008 was carried out assessing demographics, gastrointestinal and coronary heart disease risk factors, renal function and co-prescribed medications. RESULTS: Fifty-seven of 388 (14.7%) hospital patients were on NSAIDs. Forty-nine were prescribed NSAID after admission. Nineteen (32.2%) were on regular NSAID (11\\/19 on PPI) and 38 patients were on PRN NSAID (12\\/38 on PPI). Seventeen of 49 patients were on other medications associated with gastrointestinal bleeding (10\\/17 were on PPI). Nineteen patients (33.3%) were >60 years. Eight patients had three or four risk factors for gastrointestinal bleeding; six were on PPI. Thirteen patients had two risks; 7 were on PPI. Six of 19 patients with one risk factor were on PPI. 40.3% had stage 2\\/3 chronic kidney disease. 35.1% had ischaemic heart disease. CONCLUSIONS: NSAIDs and PPIs are often prescribed inappropriately.

  14. Quality of Services and Health Financing efficiency of Community Health Insurance (Jamkesmas at 21 General and Specialty Hospitals in Indonesia

    Directory of Open Access Journals (Sweden)

    Ristrini Ristrini

    2014-08-01

    Full Text Available Background: Community Health Insurance (Jamkesmas has been implementing maintained since 2008 with 76.4million individual quota increased to 86.4 million in 2012. The major problem of involved is unfairness (inequity in the quality and financing of health services for participants. This study aims to analyse the quality and financing of health perspective of Jamkesmas participants in the hospital. Method: This study was conducted in 21 general and specialty hospitals in Indonesia, The sample were selected purposively They were 9 Central Government hospitals (RSUP, Regional hospital and 3 specialty hospital ie cancer hospital, cardiologie hospital and stroke hospital. Those hospital involved covers 8 RSU Class A General Hospital. 8 RSU Class B, 2 RSU Class Cand 3 Specialty Hospital. Primary data wascollected by interviewing 1700 outpatient and inpatients, and 280 hospital staffs. Secondary data were human resources, finance and coverage. Results: Quality of services review on the adequacy of the physician’s quality was very varied.There were 570–2372 outpatient visits per physician, and 37-674 inpatients per doctor visit. Adequacy of nursing staff(nurses and midwives was better, 123–671 outpatient visits per nursing staff and 3–127 inpatient visits per nursing staff.Quality of services according to health officers perceptions on equipment and facilities was good and complete. Quality ofservices according to patients’ expectations and reality was appropriate, never the less the direct heath services, were low. Hospital financing was very large, 33–460 billion, and one third for Jamkesmas and Regency Community Health Insurance (Jamkesda services. Proportion Jamkesda funding in RSUD was larger than Jamkesmas while in RSUP, Jamkesda was smaller than Jamkesmas. Jamkesmas financing perspective according to the staff, was most of them stated that funding for Jamkesmas was matched and appropriate the number of served patients served

  15. Discharge dispositions, complications, and costs of hospitalization in spinal cord tumor surgery: analysis of data from the United States Nationwide Inpatient Sample, 2003-2010.

    Science.gov (United States)

    Sharma, Mayur; Sonig, Ashish; Ambekar, Sudheer; Nanda, Anil

    2014-02-01

    The aim of this study was to analyze the incidence of adverse outcomes and inpatient mortality following resection of intramedullary spinal cord tumors by using the US Nationwide Inpatient Sample (NIS) database. The overall complication rate, length of the hospital stay, and the total cost of hospitalization were also analyzed from the database. This is a retrospective cohort study conducted using the NIS data from 2003 to 2010. Various patient-related (demographic categories, complications, comorbidities, and median household income) and hospital-related variables (number of beds, high/low case volume, rural/urban location, region, ownership, and teaching status) were analyzed from the database. The adverse discharge disposition, in-hospital mortality, and the higher cost of hospitalization were taken as the dependent variables. A total of 15,545 admissions were identified from the NIS database. The mean patient age was 44.84 ± 19.49 years (mean ± SD), and 7938 (52%) of the patients were male. Regarding discharge disposition, 64.1% (n = 9917) of the patients were discharged to home or self-care, and the overall in-hospital mortality rate was 0.46% (n = 71). The mean total charges for hospitalization increased from $45,452.24 in 2003 to $76,698.96 in 2010. Elderly patients, female sex, black race, and lower income based on ZIP code were the independent predictors of other than routine (OTR) disposition (p cost incurred to the hospitals (p cost incurred to the hospitals (p cost incurred to the hospitals were as follows: young patients, higher median household income, nonprivate insurance, presence of complications, higher comorbidity index, hospitals with high volume and a large number of beds, West region, teaching hospitals, and weekend and nonelective admissions.

  16. Using Hospital Inpatient Discharge Data to Supplement Active Surveillance for Invasive Pneumococcal Disease: Is the Extract Worth the Exertion?

    Science.gov (United States)

    Nichols, Megin C; Bareta, Joseph; Coyle, Alexander; Landen, Michael

    2016-01-01

    Invasive pneumococcal disease (IPD) surveillance systems monitor morbidity, mortality, and vaccine impact; accurate surveillance is important to detect changes in epidemiology. We evaluated completeness of IPD reporting in New Mexico by comparing data from the Hospital Inpatient Discharge Database (HIDD) and the New Mexico Active Bacterial Core Surveillance (ABCs) program. We linked data from the HIDD and the ABCs program. We defined cases of IPD in the HIDD among New Mexico residents with hospitalizations during 2007-2009 as specific (320.1 or 038.2) or nonspecific (481, 320.2, or 041.2) using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. To validate if HIDD records that could not be matched to ABCs data were true IPD cases, we reviewed laboratory data and determined if Streptococcus pneumoniae (S. pneumoniae) had been isolated from a sterile body site. We examined 732 HIDD records for cases that were not matched in the ABCs database; of such records, S. pneumoniae was isolated from a sterile body site in 10 HIDD records. ABCs data detected the majority of IPD cases in New Mexico. Laboratory and medical record review is essential when using HIDD data because ICD-9-CM coding alone does not ensure data accuracy. The addition of IPD cases to the ABCs program from the HIDD was minimally beneficial to active surveillance and reporting completeness in New Mexico. States that rely exclusively on passive reporting and that have access to HIDD data might use linkages of pneumococcal and IPD-specific ICD-9-CM-coded HIDD data to improve IPD surveillance and case ascertainment.

  17. Quality of inpatient pediatric case management for four leading causes of child mortality at six government-run Ugandan hospitals.

    Directory of Open Access Journals (Sweden)

    David Sears

    Full Text Available A better understanding of case management practices is required to improve inpatient pediatric care in resource-limited settings. Here we utilize data from a unique health facility-based surveillance system at six Ugandan hospitals to evaluate the quality of pediatric case management and the factors associated with appropriate care.All children up to the age of 14 years admitted to six district or regional hospitals over 15 months were included in the study. Four case management categories were defined for analysis: suspected malaria, selected illnesses requiring antibiotics, suspected anemia, and diarrhea. The quality of case management for each category was determined by comparing recorded treatments with evidence-based best practices as defined in national guidelines. Associations between variables of interest and the receipt of appropriate case management were estimated using multivariable logistic regression.A total of 30,351 admissions were screened for inclusion in the analysis. Ninety-two percent of children met criteria for suspected malaria and 81% received appropriate case management. Thirty-two percent of children had selected illnesses requiring antibiotics and 89% received appropriate antibiotics. Thirty percent of children met criteria for suspected anemia and 38% received appropriate case management. Twelve percent of children had diarrhea and 18% received appropriate case management. Multivariable logistic regression revealed large differences in the quality of care between health facilities. There was also a strong association between a positive malaria diagnostic test result and the odds of receiving appropriate case management for comorbid non-malarial illnesses - children with a positive malaria test were more likely to receive appropriate care for anemia and less likely for illnesses requiring antibiotics and diarrhea.Appropriate management of suspected anemia and diarrhea occurred infrequently. Pediatric quality

  18. Adult Patients’ Satisfaction with Inpatient Nursing Care and Associated Factors in an Ethiopian Referral Hospital, Northeast, Ethiopia

    Directory of Open Access Journals (Sweden)

    Kokeb Haile Eyasu

    2016-01-01

    Full Text Available Introduction. Patient satisfaction with nursing care is considered as an important factor in explaining patients’ perceptions of service quality. Care assessed to be high quality according to clinical, economic, or other provider-defined criteria is far from ideal if as a result of that care the patient is unhappy or dissatisfied. Objective. The aim of this study was to assess adult patients’ satisfaction with inpatient nursing care and associated factors in Dessie Referral Hospital, Northeast Ethiopia. Methods. Institution based quantitative cross-sectional study was conducted among patients admitted in medical, surgical, orthopedics, gynecology, and ophthalmology wards of the hospital from March 24 to April 30, 2013. All admitted patients who stayed in the study wards for at least two days during the data collection time were interviewed. Newcastle Satisfaction with Nursing Scale questionnaire was used to collect the data and was analyzed using SPSS version 20. Odds ratios with their 95% confidence intervals and p values in a multiple logistic regression were used to identify factors associated with patient satisfaction with nursing care. Result. The overall patient satisfaction was 52.5%. Respondents’ sex, age, admission ward, self-reported health status, and class of admission were the variables significantly associated with patient satisfaction with nursing care. Conclusion and Recommendation. The rate of patient satisfaction with nursing care was found to be low in this study. Being female, younger age group (18–30 years, good self-reported current health status, being admitted in ophthalmology ward, and first class of admission were significantly associated with better patient satisfaction with nursing care. In-service training programs for nurses, with special emphasis on communication skills, are recommended.

  19. Prevalence of alcohol problems among adult somatic in-patients of a Copenhagen hospital

    DEFF Research Database (Denmark)

    Nielsen, S D; Storgaard, H; Moesgaard, F

    1994-01-01

    the entry criteria, but 181 patients (26.2%) had to be excluded owing to predefined exclusion criteria (terminal illness, dementia, etc.), and 74 patients (14.5%) refused to participate. Among the 437 interviewed patients, 125 patients (28.6%; 95%-confidence limits 24.4-33.1%) fulfilled one or more......The adult patients of somatic departments of a Copenhagen hospital were screened on a randomly selected day during a 14 day period by interviewers who examined them using a structured questionnaire regarding life-style. A patient was considered having an alcohol problem if one or more...... of the following criteria was fulfilled: (1) a self-reported daily alcohol consumption for at least 2 years of at least 60 g of ethanol in men and 36 g in women, (2) a Michigan Alcoholism Screening Test (MAST) score of or above 5, (3) an alcohol-related discharge diagnosis. In total, 692 patients fulfilled...

  20. [Enrichment of the functions of the psychiatric department in a general hospital and collaboration within the area].

    Science.gov (United States)

    Koishikawa, Hiraki; Ookami, Toshihiko

    2014-01-01

    Psychiatric disease has been included in the five main diseases, and a medical care plan is required. In it, there are many problems, for example, physical complications and which general hospital should chiefly deal with it. Here, we present a way to cope with these problems on the basis of achievements in the psychiatric department of Kameda General Hospital. Specifically, we would like to assert that creating a consultation-liaison team and enriching the section of clinical psychiatry are very important and effective. The activities of the consultation-liaison team, created to address various issues after establishing a psychiatric ward, have led to the possibility of a psychiatric department in a general hospital. Experience to date indicates that, in the context of a general hospital with a psychiatric inpatient unit, the existence of a multidisciplinary liaison team working across departmental boundaries is crucial to determining and managing the treatment of patients with psychiatric emergencies, as well as patients with psychiatric issues and physical complications. Additionally, in order to increase the effectiveness of the hospital liaison team, it is critical to realize seamless, prompt collaboration with facilities outside the hospital. In this respect, the role of a patient care coordinator is expected to become increasingly important. Additionally, enriching and guarding activities of clinical psychologists have contributed to the growth of psychiatric departments in general hospitals and proved to be effective in combination with activities of the consultation-liaison team.

  1. Comparison of Corporate Image a nd Patient Loyalty Perceptions of Outpatients and Inpatients: Example of a Training and Research Hospital in Ankara

    Directory of Open Access Journals (Sweden)

    Ömer Rıfkı Önder

    2014-12-01

    Full Text Available The purpose of this study is to determine the level of corporate image and patient loyalty of outpatients and inpatients who get services from a hospital and to evaluate the relationship between corporate images’ factors and patient loyalty. Totally 600 patients from a training and research hospitals in Ankara, formed the study sample. As a result, outpatients’ loyalty and image perceptions found medium level; while inpatients’ level found high. In addition, the effect of corporate image factors on patient loyalty was determined that there is a statistically significant , strong and positive correlation and 83% of patient loyalty is explained by corporate image factors. Based on the research findings, making improvements especially in quality and also physical, communication, social responsibility factors can obtain loyal patients. It is suggested to adopt different strategies to outpatients and inpatients while implementing these improvements.

  2. Adding Laboratory Data to Hospital Claims Data to Improve Risk Adjustment of Inpatient/30-Day Postdischarge Outcomes.

    Science.gov (United States)

    Pine, Michael; Fry, Donald E; Hannan, Edward L; Naessens, James M; Whitman, Kay; Reband, Agnes; Qian, Feng; Schindler, Joseph; Sonneborn, Mark; Roland, Jaclyn; Hyde, Linda; Dennison, Barbara A

    Numerical laboratory data at admission have been proposed for enhancement of inpatient predictive modeling from administrative claims. In this study, predictive models for inpatient/30-day postdischarge mortality and for risk-adjusted prolonged length of stay, as a surrogate for severe inpatient complications of care, were designed with administrative data only and with administrative data plus numerical laboratory variables. A comparison of resulting inpatient models for acute myocardial infarction, congestive heart failure, coronary artery bypass grafting, and percutaneous cardiac interventions demonstrated improved discrimination and calibration with administrative data plus laboratory values compared to administrative data only for both mortality and prolonged length of stay. Improved goodness of fit was most apparent in acute myocardial infarction and percutaneous cardiac intervention. The emergence of electronic medical records should make the addition of laboratory variables to administrative data an efficient and practical method to clinically enhance predictive modeling of inpatient outcomes of care.

  3. Proportion of rectal carriage of extended-spectrum β-lactamase-producing Enterobacteriaceae in the inpatients of a pediatric tertiary care hospital in Japan.

    Science.gov (United States)

    Minami, Kisei; Shoji, Yasuhiro; Kasai, Masashi; Ogiso, Yoshifumi; Nakamura, Tomohiko; Kawakami, Yoshiyuki; Saito, Yoshinobu; Kuzumoto, Kei; Kubota, Noriko; Yumoto, Kayoko; Ishii, Kinuko

    2012-01-01

    Extended-spectrum β-lactamase (ESBL)-producing-Enterobacteriaceae strains were detected in 12% (6 out of 50) of fecal samples collected from the inpatients of a Japanese pediatric hospital. All the ESBLs belonged to the CTX-M-1 group. The proportion of carriage of ESBL producers was higher among patients who had received antibiotics within the past 3 months and among those who had cardiologic diseases.

  4. Sudden Cardiac Death in Young Adults With Previous Hospital-Based Psychiatric Inpatient and Outpatient Treatment

    DEFF Research Database (Denmark)

    Risgaard, Bjarke; Waagstein, Kristine; Winkel, Bo Gregers

    2015-01-01

    Introduction: Psychiatric patients have premature mortality compared to the general population. The incidence of sudden cardiac death (SCD) in psychiatric patients is unknown in a nationwide setting. The aim of this study was to compare nationwide SCD incidence rates in young individuals with and......Introduction: Psychiatric patients have premature mortality compared to the general population. The incidence of sudden cardiac death (SCD) in psychiatric patients is unknown in a nationwide setting. The aim of this study was to compare nationwide SCD incidence rates in young individuals...... = 3.9; 95% CI, 3.0–5.0; P schizophrenia-spectrum disorders (38.9; 95% CI, 26.4–55.2) and substance-related disorders (31.6; 95% CI, 19.3–48.8). SCDs in psychiatric patients compared to nonpsychiatric patients were more...

  5. Pseudomembranous colitis and toxic megacolon due to C. difficile in an inpatient hospitalized for home accident

    Directory of Open Access Journals (Sweden)

    Piergiorgio Chiriacò

    2015-05-01

    Full Text Available Clostridium difficile infection (CDI is the main cause of hospital-acquired diarrhea. It can result in symptoms ranging from moderate diarrhea to pseudomembranous colitis. Among the risk factors, there is antibiotic therapy, responsible for intestinal flora disruption.A 72-year-old man presented to the Emergency Room for a home accident, a fall, that resulted in a cranio-facial trauma and tibio-tarsal fracture. He was administered cefazolin. Then he underwent surgery and the antibiotic therapy was switched to teicoplanin + levofloxacin; three days after, he started having diarrhea and mild fever. Rifaximin was added. A further exacerbation prompted the replacement of antibiotic therapy with tazobactam-piperacillin and metronidazole. Owing to the detection in fecal examination of CDI signs, tazobactam-piperacillin were replaced with vancomicin. Due to the persistence of symptoms, the worsening of physical conditions and the onset of pseudomembranous colitis and toxic megacolon, fidaxomicin therapy was started, with symptom resolution in few days. A patient’s follow-up at five months post-treatment showed no CDI recurrence.http://dx.doi.org/10.7175/cmi.v9i1s.1158

  6. Using Isovist Application to Explore Visibility Area of Hospital Inpatient Ward

    Science.gov (United States)

    Sengke, M. M. C.; Atmodiwirjo, P.

    2017-03-01

    This paper reports an on-going project that explores the use of digital application to study human field of view. The focus of discussion is to study the patients’ visual experience, in relation to the arrangement of interior elements in patients’ ward. The physical qualities of the environment can influence the healing process of the patient. Typical layout of interior elements often fails to provide visual stimulus that could support the healing process of the. This study explores the experience of seeing by simulating the hospital ward setting into 3D model using isovist analysis. Isovist is used to represent the experience of seeing by the patient from particular point of view and also to represent the object and surfaces that are being seen. Isovist has a function to show us the boundary of the visible areas, which can reveal which elements can and cannot seen by the patient. Isovist provides a way to understand the experience of seeing and being seen by visualizing the visibility area through three dimensional modelling. This study suggests the possibility to study human field of view to support the design of architecture for health.

  7. A clinical study of competency to consent to hospitalization and treatment in geriatric inpatients.

    Science.gov (United States)

    Billick, Stephen B; Perez, Dolores R; Garakani, Amir

    2009-07-01

    This study used a Competency Questionnaire modified for medical surgical patients (CQ-Med). Twenty-nine patients (ages 65-94 years) admitted to a geriatric medicine unit were studied. Along with the CQ-Med, patients were administered several WAIS-R subtests, the Blessed Dementia Scale (BDS), and Mini Mental State Exam (MMSE). Additionally, a blind forensic evaluation for competency to consent to hospitalization and treatment was performed for the purpose of validation of the CQ-Med. Results of the study found that, as expected, increased age was correlated with decreasing performance on the CQ-Med and decreased findings of competence by clinical exam. However, there was great variability within each age group, demonstrating individual differences in the progress of declining competency. CQ-Med scores also correlated well with the WAIS-R subtest raw and scaled scores. Scores on the MMSE and BDS were less well correlated. The CQ-Med may be a useful adjunct in assessing declining competency in geriatric patients.

  8. A prospective study of acute inpatient gout diagnoses and management in a tertiary hospital: the determinants and outcome of a rheumatology consultation.

    Science.gov (United States)

    Teichtahl, A J; Clemens, L; Nikpour, M; Romas, E

    2014-11-01

    Despite acute gout frequently complicating hospital admissions, diagnosis and management are variable. Rheumatology input may improve patient outcomes. To examine acute episodes of inpatient gout in a tertiary hospital to determine (i) factors that may lead to rheumatology input being sought and (ii) the differences in outcomes when rheumatology input occurs. Data collection occurred between February and October 2012 for inpatients in a tertiary Australian hospital. Data were prospectively collected for all rheumatology consultations with a diagnosis of gout. Subjects who had an inpatient admission complicated by acute gout and who did not have rheumatology input were identified through health information coding from discharge summaries. Fifty-eight patients (41% with rheumatology input) were included in the study. Rheumatology input was significantly more likely when the patient was younger (68.9 years vs 78.4 years; P = 0.04) with knee joint involvement (41.7% vs 3.0%; P rheumatology input occurred, subjects were more likely to have had a serum urate measured (83% vs 50%; P = 0.009), joint aspiration performed (54.2% vs 0%; P rheumatology input was more likely to be sought in younger patients with knee joint disease. When rheumatology input occurred, patients were more likely to have a synovial fluid confirmed diagnosis of gout with appropriate acute management and a follow-up plan. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

  9. Proton-pump inhibitor therapy and vitamin B12 status in an inpatient hospital setting.

    Science.gov (United States)

    Hartman, Brenda; Donnelly-VanderLoo, Mary; Watson, Tiffany; O'Connor, Colleen; Madill, Janet

    2016-06-23

    The risk for impaired vitamin B12 status increases with age, as does the use of proton pump inhibitors (PPI). Long-term use of PPIs is associated with several nutritional deficiencies including B12. Currently, there are no recommendations for B12 screening among patients taking PPIs. Data were abstracted on B12 concentrations, B12-containing supplement use, medications, and select hematological values from a retrospective chart review of 658 adults, 391 with serum B12 concentrations, admitted to 6 different medical units at 2 regional hospitals in Southwestern Ontario between 2010 and 2012. We found no difference between PPI users and nonusers and serum B12 concentrations (404 ± 224 vs 369 ± 213 pmol/L; P = 0.0690). This may be due to use of B12 containing multivitamins in 41% of PPI users. Regression modelling found that aging increases the odds of having an impaired B12 status (B12 supplements are almost 4 times more likely to have an impaired status. Mean corpuscular volume was not related to B12 status. In this population, older PPI users are more likely to be using multivitamins, which may delay nutritional deficiencies. However, the lower B12 concentrations of PPI users taking only B12 supplements is a concern and requires further research. Finally, physicians need to be aware that mean corpuscular volume is no longer recommended as an effective biomarker for B12 screening and updated screening protocols need to be used to reduce the possibility of adverse neurological effects from impaired B12 status.

  10. Asthma and myocardial infarction inpatient hospitalization and emergency room visit counts and rates by county, year and month of admission, age group, race/ethnicity and gender of California residents, 2000-2009.

    Data.gov (United States)

    California Environmental Health Tracking Program — This dataset contains case counts, rates, and confidence intervals of asthma (ICD9-CM 493.0-493.9) and myocardial infarction (ICD9-CM 410) inpatient hospitalizations...

  11. Accuracy of a Wrist-Worn Wearable Device for Monitoring Heart Rates in Hospital Inpatients: A Prospective Observational Study

    Science.gov (United States)

    Kroll, Ryan R; Boyd, J Gordon

    2016-01-01

    Background As the sensing capabilities of wearable devices improve, there is increasing interest in their application in medical settings. Capabilities such as heart rate monitoring may be useful in hospitalized patients as a means of enhancing routine monitoring or as part of an early warning system to detect clinical deterioration. Objective To evaluate the accuracy of heart rate monitoring by a personal fitness tracker (PFT) among hospital inpatients. Methods We conducted a prospective observational study of 50 stable patients in the intensive care unit who each completed 24 hours of heart rate monitoring using a wrist-worn PFT. Accuracy of heart rate recordings was compared with gold standard measurements derived from continuous electrocardiographic (cECG) monitoring. The accuracy of heart rates measured by pulse oximetry (Spo2.R) was also measured as a positive control. Results On a per-patient basis, PFT-derived heart rate values were slightly lower than those derived from cECG monitoring (average bias of −1.14 beats per minute [bpm], with limits of agreement of 24 bpm). By comparison, Spo2.R recordings produced more accurate values (average bias of +0.15 bpm, limits of agreement of 13 bpm, P<.001 as compared with PFT). Personal fitness tracker device performance was significantly better in patients in sinus rhythm than in those who were not (average bias −0.99 bpm vs −5.02 bpm, P=.02). Conclusions Personal fitness tracker–derived heart rates were slightly lower than those derived from cECG monitoring in real-world testing and not as accurate as Spo2.R-derived heart rates. Performance was worse among patients who were not in sinus rhythm. Further clinical evaluation is indicated to see if PFTs can augment early warning systems in hospitals. Trial Registration ClinicalTrials.gov NCT02527408; https://clinicaltrials.gov/ct2/show/NCT02527408 (Archived by WebCite at  http://www.webcitation.org/6kOFez3on) PMID:27651304

  12. Diagnosis and treatment of schizophrenia in a general hospital ...

    African Journals Online (AJOL)

    Diagnosis and treatment of schizophrenia in a general hospital based acute ... Conclusion: The study contributed by identifying these predictive indicators for the acute ... Key words: Acute management; Schizophrenia; Diagnosis; Treatment; ...

  13. Surgical management of pneumothorax: significance of effective admission or communication strategies between the district general hospitals and specialized unit.

    Science.gov (United States)

    Aslam, Muhammad I; Martin-Ucar, Antonio E; Nakas, Apostolos; Waller, David A

    2011-11-01

    A preoperative delay in emergency surgery for spontaneous pneumothorax is associated with a poor outcome after surgery and a prolonged hospital stay. To reduce preoperative delays, all tertiary referrals from district general hospitals to our thoracic surgery unit were processed through a 'clinical decisions unit' (CDU). Prior to the establishment of the CDU, these patients were added to a waiting list for a surgical bed. This study has reviewed the effect of this change in admission policy on the efficiency of treatment for non-elective spontaneous pneumothorax. An intergroup comparison (pre-CDU group vs. post-CDU group) was made of the following parameters: referral to transfer time, transfer to surgery time and length of inpatient stay in the referring and tertiary hospitals. There were no significant differences in gender, diagnosis, treatment in the referring hospitals, postoperative clinical outcome, or indications for or type of surgery. The total length of inpatient stay in the referring and tertiary hospitals was significantly reduced for the post-CDU group (12 vs. 15 days; P<0.001), which was attributed to the earlier transfer of patients (18 vs. 78 hours; P<0.001) hours. Allowing surgical access to a traditional medical admission unit is therefore, cost-effective and significantly improves the efficiency of non-elective pneumothorax surgery.

  14. LIGASURE (PRECISION HAEMORROIDECTOMY AT GOVT. GENERAL HOSPITAL

    Directory of Open Access Journals (Sweden)

    Anand

    2015-09-01

    Full Text Available BACKGROUND : Haemorrhoids is a common problem throughout the world. Many procedures are available for management of grade II and grade III hemorrhoids. The main postoperative complications associated with any of these procedures are pain and bleeding per rectum and pro longed healing time. Liga Surel TM haemorroidectomy was evaluated in this study for post - operative complications and symptomatic relief. METHODS: We analyzed 50 patients of hemorrhoids of grade II, III and IV who underwent Ligasure Precise haemorroidectomy by a classical Milligan - Morgan technique. The outcome factors analyzed were total operative time, blood loss, post - operative pain on visual analogue scale, any other complication and days of hospital stay. RESULTS: Of all the 50 patients, the operative ti me was less than 10 minutes in 27 patients (54% and the blood loss, as was measured by number of soaked gauze pieces only one gauze piece was soaked in 31 patients (62%. The Average Post - operative pain score measured on Visual Analogue Scale (VAS at 12, 24 & 48 hours were 6.54, 4.52 and 3.12 respectively. In all patients postoperative period and follow up was uneventful except for one patient who developed transient flatus incontinence. With physiotherapy and dietary management this problem resolved ther eafter. CONCLUSIONS: Liga Sure Hemarrhoidectomy is a safe, Technically easy and fast modality of treatment for 2 nd , 3 rd & 4 th degree of hemorrhoids whether single or multiple, requiring very less operating ti me, with no major post - operative complications an d early return to day to day activities

  15. Distribution of Ankle-Brachial Index among Inpatients with Cardiovascular Disease: Analysis Using the Kumamoto University Hospital Medical Database

    Science.gov (United States)

    Soejima, Hirofumi; Kojima, Sunao; Kaikita, Koichi; Yamamuro, Megumi; Izumiya, Yasuhiro; Tsujita, Kenichi; Yamamoto, Eiichiro; Tanaka, Tomoko; Sugamura, Koichi; Arima, Yuichiro; Sakamoto, Kenji; Akasaka, Tomonori; Tabata, Noriaki; Sueta, Daisuke; Miyoshi, Izuru; Usami, Makiko; Ogawa, Hisao

    2016-01-01

    Objective: To describe the distribution of ankle-brachial index (ABI) among Japanese cardiovascular inpatients and to explore risk factors of peripheral arterial disease (PAD) associated with ABI ≤0.9. Materials and Methods: This study was a retrospective analysis using clinical record databases of patients with cardiovascular disease admitted to the Department of Cardiovascular Medicine, Kumamoto University Hospital between 2007 and 2014. Results: Of 3639 patients included in the analysis, male patients accounted for 62.1% and the mean age of patients was 66.1 years. Ischemic heart disease (IHD) was observed in 49.1%. ABI ≤0.9 was observed in 11.3% of all patients, 14.1% in the IHD group and 8.5% in the non-IHD group. Age of ≥65 years (odds ratio [OR]: 2.93, 95% confidence interval [CI]: 2.22–3.86), current smoking (OR: 2.28, 95%CI:1.71–3.04), diabetes (OR: 2.15, 95%CI:1.71–2.71), hypertension (OR: 1.42, 95%CI:1.12–1.81) and chronic kidney disease (OR: 2.52, 95%CI:1.82–3.48) were significantly associated factors with ABI ≤0.9. Conclusions: This study suggests that PAD is prevalent even in patients without IHD. Active management of risk factors, early detection of PAD based on ABI, and therapeutic intervention could be effective in preventing future cardiovascular events or death. PMID:27087869

  16. Syndrome of inappropriate antidiuretic hormone secretion in hospital inpatients: a descriptive study in a tertiary care centre in South India

    Directory of Open Access Journals (Sweden)

    Mansoor C. Abdulla

    2015-03-01

    Full Text Available Background: Hyponatremia is the most common electrolyte abnormality among the patients in medical wards as well as in the intensive care unit contributing to substantial morbidity and mortality. The most common cause of hyponatraemia in hospital inpatients is Syndrome of Inappropriate Anti Diuretic Hormone secretion (SIADH. This prospective observational study was designed to assess the clinical profile of SIADH. Aim: To assess the clinical profile of SIADH in medically ill patients. Methods: This was an observational study for 24 months conducted in a tertiary care hospital. Patients were assessed clinically to study the volume status, effects of hyponatremia on nervous system and find out various etiologies for SIADH. All patients underwent routine hemogram, blood biochemistry, serum electrolytes, thyroid function tests, morning serum cortisol estimation, plasma and urinary osmolality determination as well as urinary sodium estimation. Patients were diagnosed to have Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH if they satisfied the Bartter and Schwartz criteria. Results: Among the eighty patients with euvolemic, hypoosmolal hyponatremia who were screened for SIADH, seven patients were excluded due to various reasons (hypothyroidism, Sheehan's syndrome, Addison's disease. The mean age of the patients was 64 +/- 13 years. Among 73 patients included there were 33 (45.2% male patients and 40 (54.8% female patients. Severe hyponatremia (Na <110 meq/l was detected in 33 patients (45%. Pulmonary causes were the most common cause of SIADH in this study seen in 25 (34.2%. The other causes were idiopathic in 20 (27.4%, neurological in 17 (23.3%, drug induced in 2 (2.7%, positive pressure ventilation in 5 (6.8% and other infections in 4 (5.5%.The average rate of correction was 5 meq +/- 1.5 in the first 24 hours. The overall mortality was found to be 7%. Conclusion: Hyponatremia due to SIADH is common among elderly patients with

  17. Anterior cervical discectomy and fusion in the outpatient ambulatory surgery setting compared with the inpatient hospital setting: analysis of 1000 consecutive cases.

    Science.gov (United States)

    Adamson, Tim; Godil, Saniya S; Mehrlich, Melissa; Mendenhall, Stephen; Asher, Anthony L; McGirt, Matthew J

    2016-06-01

    OBJECTIVE In an era of escalating health care costs and pressure to improve efficiency and cost of care, ambulatory surgery centers (ASCs) have emerged as lower-cost options for many surgical therapies. Anterior cervical discectomy and fusion (ACDF) is one of the most prevalent spine surgeries performed, and the frequency of its performance is rapidly increasing as the aging population grows. Although ASCs offer significant cost advantages over hospital-based surgical centers, concern over the safety of outpatient ACDF has slowed its adoption. The authors intended to 1) determine the safety of the first 1000 consecutive ACDF surgeries performed in their outpatient ASC, and 2) compare the safety of these outpatient ACDFs with that of consecutive ACDFs performed during the same time period in the hospital setting. METHODS A total of 1000 consecutive patients who underwent ACDF in an ACS (outpatient ACDF) and 484 consecutive patients who underwent ACDF at Vanderbilt University Hospital (inpatient ACDF) from 2006 to 2013 were included in this retrospective study of patients' medical records. Data were collected on patient demographics, comorbidities, operative details, and perioperative and 90-day morbidity. Perioperative morbidity and hospital readmission were compared between the outpatient and inpatient ACDF groups. RESULTS Of the first 1000 outpatient ACDF cases performed in the authors' ASC, 629 (62.9%) were 1-level and 365 (36.5%) were 2-level ACDFs. Mean patient age was 49.5 ± 8.6, and 484 (48.4%) were males. All patients were observed postoperatively at the ASC postanesthesia care unit (PACU) for 4 hours before being discharged home. Eight patients (0.8%) were transferred from the surgery center to the hospital postoperatively (for pain control [n = 3], chest pain and electrocardiogram changes [n = 2], intraoperative CSF leak [n = 1], postoperative hematoma [n = 1], and profound postoperative weakness and surgical reexploration [n = 1]). No perioperative

  18. ROLE OF STREPTOCOCCUS PNEUMONIAE IN THE STRUCTURE OF BACTERIAL INFECTIONS IN THE CHILDREN HOSPITALIZED TO INPATIENT HOSPITALS IN MOSCOW IN 2011–2012

    Directory of Open Access Journals (Sweden)

    A. A. Baranov

    2013-01-01

    Full Text Available Data on the spread of Streptococcus pneumoniae serotypes in the RF are extremely limited. 3 pneumococcal conjugated vaccines are approved inRussia; however, neither has yet been employed in the framework of the national population immunization program. At the same time, it is the dataon the serotype range of pneumococcal infections that may be considered the prognostic efficacy criterion for the national vaccination programs.The objective of this research is identification of the circulating S. pneumoniae serotypes and spread of pneumococcal etiology infections in the structure of bacterial infections in the infants hospitalized to 5 inpatient hospital of Moscow in 2011–2012. The trial involved 864 patients in tote. Vast majority of patients (86% had acute purulent otitis media and sinusitis. Community-acquired pneumonia was diagnosed in 9% of patients, sepsis and bacteremia — in 3.6%; purulent meningitis — 1.2% of patients. It has been revealed that S. pneumoniae is the primary pathogen in the structure of nasopharyngeal carriage in the children under 5 years of age hospitalized with acute bacterial infections, and the primary bacterial causative agent of acute otitis media at this age. Nasopharyngeal pneumococcal carriage analysis revealed the prevalent serotypes — 19F, 14, 23F, 3, 6A and B; they were present in 3/4 of all cases; 19F was the most frequent (> 20%. Diversity of the S. pneumoniae serotypes detected in middle ear liquid was less significant — 17 serotypes (in comparison with 24 serotypes in nasopharynx. The 5 prevalent serotypes were 19F, 3, 14, 23F, 6B and 19A (> 75% in tote. Detection rate of serotypes 3 and 19A in middle ear liquid significantly exceeded the detection rate of these serotypes in case of nasopharyngeal carriage. The study of invasive infections revealed serotypes 14, 23F, 3 and 15C. These data may be used as a benchmark for future monitoring and evaluation of effect of PCV vaccines on epidemiology of

  19. Eventos adversos a antibióticos em pacientes internados em um hospital universitário Adverse events to antibiotics in inpatients of a university hospital

    Directory of Open Access Journals (Sweden)

    Estela Louro

    2007-12-01

    Full Text Available OBJETIVO: Antibióticos são os medicamentos que mais causam eventos adversos, gerando problemas aos pacientes e custos adicionais ao sistema de saúde. Assim, objetivou-se analisar a ocorrência de eventos adversos a antibióticos em pacientes internados em um hospital. MÉTODOS: Realizou-se monitoramento intensivo do uso de antibióticos em pacientes adultos internados no município de Maringá, Paraná, de setembro de 2002 a fevereiro de 2003. Foram pesquisadas variáveis relativas aos medicamentos em uso, em particular aos antibióticos e aos eventos adversos. Com base em critérios para a avaliação do uso correto dos antibióticos, os eventos observados foram classificados como reações adversas, erros de medicação e "quase erros". Para relação de causalidade entre a administração do fármaco e o surgimento dos eventos utilizou-se o algoritmo de Naranjo. RESULTADOS: Foram acompanhados 87 pacientes e identificados 91 eventos adversos, sendo três deles (3,3% reações adversas a medicamentos, sete (7,7% erros de medicação, e 81 (89,0% "quase erros". As reações a medicamentos ocorreram devido ao uso de quinolonas e foram consideradas "prováveis" utilizando-se o algoritmo de Naranjo. Os sete erros de medicação ocorreram devido a quatro prescrições incorretas de dose e três interações medicamentosas. CONCLUSÕES: Os resultados sugerem que a falta de conhecimento do medicamento ou a falta de informação sobre o paciente no momento da prescrição tenham sido os principais fatores envolvidos na ocorrência das reações a medicamentos.OBJECTIVE: Antibiotics are the most common drugs causing adverse events and they lead to problems to patients and additional costs of the health system. The aim of the study was to evaluate the occurrence of adverse events to antibiotics in inpatients of a hospital. METHODS: An extensive drug monitoring was conducted in adult inpatients taking antibiotics in the city of Maringá, Southern

  20. 42 CFR 409.61 - General limitations on amount of benefits.

    Science.gov (United States)

    2010-10-01

    ...) Posthospital SNF care furnished by a SNF, or by a hospital or a CAH with a swing-bed approval. Up to 100 days... SERVICES MEDICARE PROGRAM HOSPITAL INSURANCE BENEFITS Scope of Hospital Insurance Benefits § 409.61 General limitations on amount of benefits. (a) Inpatient hospital or inpatient CAH services—(1) Regular benefit days...

  1. General surgery at rural Tennessee hospitals: a survey of rural Tennessee hospital administrators.

    Science.gov (United States)

    Cofer, Joseph B; Petros, Tommy J; Burkholder, Hans C; Clarke, P Chris

    2011-07-01

    Rural communities face an impending surgical workforce crisis. The purpose of this study is to describe perceptions of rural Tennessee hospital administrators regarding the importance of surgical services to their hospitals. In collaboration with the Tennessee Hospital Association, we developed and administered a 13-item survey based on a recently published national survey to 80 rural Tennessee hospitals in August 2008. A total of 29 responses were received for an overall 36.3 per cent response rate. Over 44 per cent of rural surgeons were older than 50 years of age, and 27.6 per cent of hospitals reported they would lose at least one surgeon in the next 2 years. The responding hospitals reported losing 10.4 per cent of their surgical workforce in the preceding 2 years. Over 53 per cent were actively recruiting a general surgeon with an average time to recruit a surgeon of 11.8 months. Ninety-seven per cent stated that having a surgical program was very important to their financial viability with the mean and median reported revenue generated by a single general surgeon being $1.8 million and $1.4 million, respectively. Almost 11 per cent of the hospitals stated they would have to close if they lost surgical services. Although rural Tennessee hospitals face similar difficulties to national rural hospitals with regard to retaining and hiring surgeons, slightly more Tennessee hospitals (54 vs 36%) were actively attempting to recruit a general surgeon. The shortage of general surgeons is a threat to the accessibility of comprehensive hospital-based care for rural Tennesseans.

  2. Planning Development for a Family Planning Centre in Nursing Unit of the General Hospital of Argolida

    Directory of Open Access Journals (Sweden)

    Koukoufilippou J

    2015-01-01

    Full Text Available Introduction: The family planning centres must be upgraded to a cornerstone of primary health care, and prevent, advise and protect the citizen's health while reducing hospitalization costs for hospitals. Aim: The purpose of this literature review is the family planning centre development in general hospital of Argolida that has a similar clinic. Material and Methods: Literature review was conducted of published English and Greek Articles from bibliographic databases Medline, Google Scholar and Scopus for the period 2001-2014, using keywords like: "Family Planning», «SWOT analysis", "functional design" "prevention", "health promotion", "economic cost". The option of creating inpatient center was made after analysis SWOT, by defining objectives, performance indicators and existing alternatives. Also the timing of implementation and functional design, provide the springboard effort for effective operation. Conclusions: The development of family planning centres in the country and abroad is designed to address very important problems in the bud, in order to improve the quality of citizens' health, then reduce the financial burden on the health system as a result of prevention, and contribute indirectly to the mental balance of citizens.

  3. Comparison of Routine Health Management Information System Versus Enhanced Inpatient Malaria Surveillance for Estimating the Burden of Malaria Among Children Admitted to Four Hospitals in Uganda

    Science.gov (United States)

    Mpimbaza, Arthur; Miles, Melody; Sserwanga, Asadu; Kigozi, Ruth; Wanzira, Humphrey; Rubahika, Denis; Nasr, Sussann; Kapella, Bryan K.; Yoon, Steven S.; Chang, Michelle; Yeka, Adoke; Staedke, Sarah G.; Kamya, Moses R.; Dorsey, Grant

    2015-01-01

    The primary source of malaria surveillance data in Uganda is the Health Management Information System (HMIS), which does not require laboratory confirmation of reported malaria cases. To improve data quality, an enhanced inpatient malaria surveillance system (EIMSS) was implemented with emphasis on malaria testing of all children admitted in select hospitals. Data were compared between the HMIS and the EIMSS at four hospitals over a period of 12 months. After the implementation of the EIMSS, over 96% of admitted children under 5 years of age underwent laboratory testing for malaria. The HMIS significantly overreported the proportion of children under 5 years of age admitted with malaria (average absolute difference = 19%, range = 8–27% across the four hospitals) compared with the EIMSS. To improve the quality of the HMIS data for malaria surveillance, the National Malaria Control Program should, in addition to increasing malaria testing rates, focus on linking laboratory test results to reported malaria cases. PMID:25422396

  4. REFINE (REducing Falls in In-patieNt Elderly) using bed and bedside chair pressure sensors linked to radio-pagers in acute hospital care: a randomised controlled trial.

    Science.gov (United States)

    Sahota, Opinder; Drummond, Avril; Kendrick, Denise; Grainge, Matthew J; Vass, Catherine; Sach, Tracey; Gladman, John; Avis, Mark

    2014-03-01

    falls in hospitals are a major problem and contribute to substantial healthcare burden. Advances in sensor technology afford innovative approaches to reducing falls in acute hospital care. However, whether these are clinically effective and cost effective in the UK setting has not been evaluated. pragmatic, parallel-arm, individual randomised controlled trial of bed and bedside chair pressure sensors using radio-pagers (intervention group) compared with standard care (control group) in elderly patients admitted to acute, general medical wards, in a large UK teaching hospital. Primary outcome measure number of in-patient bedside falls per 1,000 bed days. 1,839 participants were randomised (918 to the intervention group and 921 to the control group). There were 85 bedside falls (65 fallers) in the intervention group, falls rate 8.71 per 1,000 bed days compared with 83 bedside falls (64 fallers) in the control group, falls rate 9.84 per 1,000 bed days (adjusted incidence rate ratio, 0.90; 95% confidence interval [CI], 0.66-1.22; P = 0.51). There was no significant difference between the two groups with respect to time to first bedside fall (adjusted hazard ratio (HR), 0.95; 95% CI: 0.67-1.34; P= 0.12). The mean cost per patient in the intervention group was £7199 compared with £6400 in the control group, mean difference in QALYs per patient, 0.0001 (95% CI: -0.0006-0.0004, P= 0.67). bed and bedside chair pressure sensors as a single intervention strategy do not reduce in-patient bedside falls, time to first bedside fall and are not cost-effective in elderly patients in acute, general medical wards in the UK. isrctn.org identifier: ISRCTN44972300.

  5. An Update on Inpatient Hypertension Management.

    Science.gov (United States)

    Axon, R Neal; Turner, Mason; Buckley, Ryan

    2015-11-01

    Hypertension is highly prevalent affecting nearly one third of the US adult population. Though generally approached as an outpatient disorder, elevated blood pressure is observed in a majority of hospitalized patients. The spectrum of hypertensive disease ranges from patients with hypertensive emergency including markedly elevated blood pressure and associated end-organ damage to asymptomatic patients with minimally elevated pressures of unclear significance. It is important to note that current evidence-based hypertension guidelines do not specifically address inpatient hypertension. This narrative review focuses primarily on best practices for diagnosing and managing nonemergent hypertension in the inpatient setting. We describe examples of common hypertensive syndromes, provide suggestions for optimal post-acute management, and point to evidence-based or consensus guidelines where available. In addition, we describe a practical approach to managing asymptomatic elevated blood pressure observed in the inpatient setting. Finally, arranging effective care transitions to ensure optimal ongoing hypertension management is appropriate in all cases.

  6. Candida auris sp. nov., a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a Japanese hospital.

    Science.gov (United States)

    Satoh, Kazuo; Makimura, Koichi; Hasumi, Yayoi; Nishiyama, Yayoi; Uchida, Katsuhisa; Yamaguchi, Hideyo

    2009-01-01

    A single strain of a novel ascomycetous yeast species belonging to the genus Candida was isolated from the external ear canal of an inpatient in a Japanese hospital. Analyses of the 26S rDNA D1/D2 domain, nuclear ribosomal DNA ITS region sequences, and chemotaxonomic studies indicated that this strain represents a new species with a close phylogenetic relationship to Candida ruelliae and Candida haemulonii in the Metschnikowiaceae clade. This strain grew well at 40 degrees C, but showed slow and weak growth at 42 degrees C. The taxonomic description of Candida auris sp. nov. is proposed (type strain JCM15448T= CBS10913T= DSM21092T).

  7. 3 Certain Shell Hospital Inpatient Antibiotic Uses are Analysed%某三甲医院住院病人抗生素利用分析

    Institute of Scientific and Technical Information of China (English)

    刘伟卿

    2002-01-01

    Objective We appraise the application condition of 3 certain shell hospital antibiotics. Methods According to medicine, we use research method. As the 280 certain courtyard regular inpatients of May 2001 use the condition of antibiotic,investigate. With the survey that DDD studies as medicine use, we worth. Is judgement doctor with DUI reasonable use the standard of medicine? Results 185 examples are used antibiotic, take 66.07%. With penicillins, Quinolones and Aminoglycosides use count frequently highest. Before locating in, 5 antibiotics are in proper order. Penicillin G, Clindamycin,Amikacin, Sodium Cefotaxime, and Ciprofloxacin. Conclusions The most antibiotic DUI ≤ 1, whole, the application ofantibiotic is reasonable.

  8. 42 CFR 447.280 - Hospital providers of NF services (swing-bed hospitals).

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Hospital providers of NF services (swing-bed... Inpatient Hospital and Long-Term Care Facility Services Swing-Bed Hospitals § 447.280 Hospital providers of NF services (swing-bed hospitals). (a) General rule. If the State plan provides for NF services...

  9. Discharge against medical advice at a general hospital in Catalonia.

    Science.gov (United States)

    Duñó, Rosó; Pousa, Esther; Sans, Jordi; Tolosa, Carles; Ruiz, Ada

    2003-01-01

    Some studies on discharge against medical advice (AMA) in general hospitals report a prevalence between 0.7-7% with 11-42% of this population identified as psychiatric patients. To study the sociodemographic and psychopathological features of patients who leave AMA, we performed a retrospective case-control comparison study of length of hospitalization and presence of psychiatric disturbances on patients who left AMA from the University General Hospital in Catalan Spain over a two-year period. An analysis of the hospital epidemiological discharge register and retrospective chart review for presence of psychiatric disturbances found that AMA prevalence was 0.34%, the total discharge number in the 2-year period being 41,648. AMA rates by medical department were 0.44% for the internal medicine department; 0.24% for surgery; 0.26% for orthopedic surgery, 0.32% for obstetrics-gynecology and 0.93% for rehabilitation. The mean age for AMA patients was 38.63 years, with a higher number of men (59.9%). A total of 45.8% AMA discharges were from the internal medicine department. No significant differences were found in the average length of hospitalization between the AMA and control groups. The presence of psychiatric pathology was significantly higher among the AMA group (Phistory of psychiatric pathology, mainly narcotic dependence.

  10. Patient experience and satisfaction with inpatient service: development of short form survey instrument measuring the core aspect of inpatient experience.

    Directory of Open Access Journals (Sweden)

    Eliza L Y Wong

    Full Text Available Patient experience reflects quality of care from the patients' perspective; therefore, patients' experiences are important data in the evaluation of the quality of health services. The development of an abbreviated, reliable and valid instrument for measuring inpatients' experience would reflect the key aspect of inpatient care from patients' perspective as well as facilitate quality improvement by cultivating patient engagement and allow the trends in patient satisfaction and experience to be measured regularly. The study developed a short-form inpatient instrument and tested its ability to capture a core set of inpatients' experiences. The Hong Kong Inpatient Experience Questionnaire (HKIEQ was established in 2010; it is an adaptation of the General Inpatient Questionnaire of the Care Quality Commission created by the Picker Institute in United Kingdom. This study used a consensus conference and a cross-sectional validation survey to create and validate a short-form of the Hong Kong Inpatient Experience Questionnaire (SF-HKIEQ. The short-form, the SF-HKIEQ, consisted of 18 items derived from the HKIEQ. The 18 items mainly covered relational aspects of care under four dimensions of the patient's journey: hospital staff, patient care and treatment, information on leaving the hospital, and overall impression. The SF-HKIEQ had a high degree of face validity, construct validity and internal reliability. The validated SF-HKIEQ reflects the relevant core aspects of inpatients' experience in a hospital setting. It provides a quick reference tool for quality improvement purposes and a platform that allows both healthcare staff and patients to monitor the quality of hospital care over time.

  11. Alcohol screening for older adults in an acute general hospital: FAST v. MAST-G assessments

    OpenAIRE

    Knightly, Rachel; Tadros , George; Sharma, Juhi; Duffield, Peter; Carnall, Emma; Fisher, Jacqui; Salman, Shaza

    2016-01-01

    Aims and method Documented prevalence of alcohol misuse among older adult patients at Birmingham Heartlands Hospital is significantly lower than the national prevalence. We aimed to evaluate our alcohol misuse screening protocol for older adults to identify possible shortcomings. Hospital protocol is to screen all adults for alcohol misuse in the accident and emergency (A&E) department using the Fast Alcohol Screening Test (FAST). One hundred consecutive consenting in-patients aged 65-94 admi...

  12. Perfil del embarazo prolongado en pacientes de un hospital general

    OpenAIRE

    Chavarry Valencia, Flor de Maria; Cabrera Epiquen, Ronald Alfredo; Diaz Herrera, Jorge Antonio

    2012-01-01

    Objetivo: Determinar las características maternas y perinatales de las pacientes con diagnóstico de embarazo prolongado (EP) en un hospital general. Material y métodos: Estudio retrospectivo tipo serie de casos, realizado en el Hospital Nacional Cayetano Heredia del 1° de enero de 2000 al 31 de diciembre de 2004. Se incluyeron 341 pacientes con diagnóstico de EP (>42 semanas) basado en la fecha de último periodo menstrual o ecografía del primer trimestre. Resultados: El 76% de pacientes te...

  13. Martin Luther King, Jr., General Hospital and community involvement.

    Science.gov (United States)

    Humphrey, M M

    1973-07-01

    Community involvement is not just one facet of the new Martin Luther King, Jr., General Hospital's existence. It is the mainstream from which all other activities flow. In addition to meeting the conventional needs of a conventional hospital staff with the core collection of texts and journals, this library goes one step further. It acts as a resource for its community health workers, dietitians, and nurses in their various outreach programs. It serves as a stimulus for the high school or community college student who may be curious about a health career. It also finds time to provide reading material for its patients.

  14. Paraphilias in adult psychiatric inpatients.

    Science.gov (United States)

    Marsh, Patrick J; Odlaug, Brian L; Thomarios, Nick; Davis, Andrew A; Buchanan, Stephanie N; Meyer, Craig S; Grant, Jon E

    2010-05-01

    The goal of the present study was to examine the prevalence of paraphilias in an adult inpatient psychiatric population. One hundred twelve consecutive, voluntarily admitted, adult male psychiatric inpatients were administered the Structured Clinical Interview for DSM-IV, Sexual Disorders Module, Male Version, to assess the rates of DSM-IV paraphilias. Fifteen patients (13.4%) reported symptoms consistent with at least one lifetime DSM-IV paraphilia. The most common paraphilias were voyeurism (n = 9 [8.0%]), exhibitionism (n = 6 [5.4%]), and sexual masochism (n = 3 [2.7%]). Patients who screened positive for a paraphilia had significantly more psychiatric hospitalizations (P = .006) and, on a trend level, were more likely to have attempted suicide. In addition, patients with paraphilias were significantly more likely to report having been sexually abused than patients without a paraphilia (P = paraphilia. Paraphilias appear to be more common in adult male psychiatric inpatients than previously estimated. The study also demonstrated that these disorders were not screened for by the treating physician and thus may go untreated. Further, larger-scale studies are necessary in order to further examine the rates of these disorders in the general population.

  15. Lower respiratory tract infection hospitalizations among American Indian/Alaska Native children and the general United States child population

    Directory of Open Access Journals (Sweden)

    Eric M. Foote

    2015-11-01

    Full Text Available Background: The lower respiratory tract infection (LRTI-associated hospitalization rate in American Indian and Alaska Native (AI/AN children aged <5 years declined during 1998–2008, yet remained 1.6 times higher than the general US child population in 2006–2008. Purpose: Describe the change in LRTI-associated hospitalization rates for AI/AN children and for the general US child population aged <5 years. Methods: A retrospective analysis of hospitalizations with discharge ICD-9-CM codes for LRTI for AI/AN children and for the general US child population <5 years during 2009–2011 was conducted using Indian Health Service direct and contract care inpatient data and the Nationwide Inpatient Sample, respectively. We calculated hospitalization rates and made comparisons to previously published 1998–1999 rates prior to pneumococcal conjugate vaccine introduction. Results: The average annual LRTI-associated hospitalization rate declined from 1998–1999 to 2009–2011 in AI/AN (35%, p<0.01 and the general US child population (19%, SE: 4.5%, p<0.01. The 2009–2011 AI/AN child average annual LRTI-associated hospitalization rate was 20.7 per 1,000, 1.5 times higher than the US child rate (13.7 95% CI: 12.6–14.8. The Alaska (38.9 and Southwest regions (27.3 had the highest rates. The disparity was greatest for infant (<1 year pneumonia-associated and 2009–2010 H1N1 influenza-associated hospitalizations. Conclusions: Although the LRTI-associated hospitalization rate declined, the 2009–2011 AI/AN child rate remained higher than the US child rate, especially in the Alaska and Southwest regions. The residual disparity is likely multi-factorial and partly related to household crowding, indoor smoke exposure, lack of piped water and poverty. Implementation of interventions proven to reduce LRTI is needed among AI/AN children.

  16. Ideal timing to transfer from an acute care hospital to an interdisciplinary inpatient rehabilitation program following a stroke: an exploratory study

    Directory of Open Access Journals (Sweden)

    Nadeau Sylvie

    2006-11-01

    Full Text Available Abstract Background Timely accessibility to organized inpatient stroke rehabilitation services may become compromised since the demand for rehabilitation services following stroke is rapidly growing with no promise of additional resources. This often leads to prolonged lengths of stays in acute care facilities for individuals surviving a stroke. It is believed that this delay spent in acute care facilities may inhibit the crucial motor recovery process taking place shortly after a stroke. It is important to document the ideal timing to initiate intensive inpatient stroke rehabilitation after the neurological event. Therefore, the objective of this study was to examine the specific influence of short, moderate and long onset-admission intervals (OAI on rehabilitation outcomes across homogeneous subgroups of patients who were admitted to a standardized interdisciplinary inpatient stroke rehabilitation program. Methods A total of 418 patients discharged from the inpatient neurological rehabilitation program at the Montreal Rehabilitation Hospital Network after a first stroke (79% of all cases reviewed were included in this retrospective study. After conducting a matching procedure across these patients based on the degree of disability, gender, and age, a total of 40 homogeneous triads (n = 120 were formed according to the three OAI subgroups: short (less than 20 days, moderate (between 20 and 40 days or long (over 40 days; maximum of 70 days OAI subgroups. The rehabilitation outcomes (admission and discharge Functional Independence Measure scores (FIM, absolute and relative FIM gain scores, rehabilitation length of stay, efficiency scores were evaluated to test for differences between the three OAI subgroups. Results Analysis revealed that the three OAI subgroups were comparable for all rehabilitation outcomes studied. No statistical difference was found for admission (P = 0.305–0.972 and discharge (P = 0.083–0.367 FIM scores, absolute (P = 0

  17. Utilization of a consultation liaison psychiatry service in a general hospital.

    Science.gov (United States)

    Gobar, A H; Collins, J L; Mathura, C B

    1987-05-01

    This retrospective study was conducted in response to a need to evaluate the overall utilization rates of the psychiatric consultation liaison service by nonpsychiatric units within Howard University Hospital, which deals almost exclusively with a black, inner-city population. The study covers a three-year period (July 1982 to July 1985). During this time only 815 patients (2 percent) were referred for psychiatric evaluation out of the total number of hospital admissions (40,000 patients).Patient characteristics and general attitudes appear to have had a major role in this low ratio of referrals, particularly a lack of awareness and bias against psychiatry. This latter finding is in disparity with other published reports. Diagnostically, depression, organic mental disorders (acute), and substance abuse (mainly PCP) constituted the greater bulk of the patients seen by the consultation liaison psychiatry service. The review of a random sample of psychiatric inpatients (n = 100) revealed that in 50 percent of the cases there was a coexisting physical illness or abnormality.The role of mental health education and the liaison function needs to be emphasized. It is suggested that efforts should be directed toward a wider acceptance and utilization of consultation liaison psychiatry by primary care physicians in general hospitals. The factors listed by physicians and patients that may account for the observed underutilization of consultation liaison services are discussed. The results of 20 interviews and the reasons given by referring physicians as to whether or not they will seek consultation from the consultation liaison services are also reviewed.

  18. Neonatal outbreak of salmonella worthington in a general hospital

    Directory of Open Access Journals (Sweden)

    Muley V

    2004-01-01

    Full Text Available This is a report of an outbreak of Salmonella worthington in neonates at Sassoon General Hospitals, Pune, which occurred during August and September 2000. A total of 148 blood, 4 CSF and 6 stool specimens were received from neonates admitted to the hospital. Salmonella worthington could be isolated from 17 clinical specimens [15 blood (10.8%, 1 CSF (25% and 1 stool (16.6% sample]. Environmental swabs were also processed. An attempt was made to detect carriers in health care personnel. However, no source or carrier of Salmonella worthington in the hospital environment could be identified. Intensive cleaning measures and fumigation were undertaken. All these measures succeeded in aborting the outbreak.

  19. In-hospital mortality among patients with type 2 diabetes mellitus and acute myocardial infarction: results from the national inpatient sample, 2000-2010.

    Science.gov (United States)

    Ahmed, Bina; Davis, Herbert T; Laskey, Warren K

    2014-08-26

    Case-fatality rates in acute myocardial infarction (AMI) have significantly decreased; however, the prevalence of diabetes mellitus (DM), a risk factor for AMI, has increased. The purposes of the present study were to assess the prevalence and clinical impact of DM among patients hospitalized with AMI and to estimate the impact of important clinical characteristics associated with in-hospital mortality in patients with AMI and DM. We used the National Inpatient Sample to estimate trends in DM prevalence and in-hospital mortality among 1.5 million patients with AMI from 2000 to 2010, using survey data-analysis methods. Clinical characteristics associated with in-hospital mortality were identified using multivariable logistic regression. There was a significant increase in DM prevalence among AMI patients (year 2000, 22.2%; year 2010, 29.6%, Ptrendage-standardized mortality decreased significantly from 2000 (8.48%) to 2010 (4.95%) (Ptrenddeath risk over time was greatest among women and elderly patients. Among younger patients of both sexes, there was a leveling off of this decrease in more recent years. Despite increasing DM prevalence and disease burden among AMI patients, in-hospital mortality declined significantly from 2000 to 2010. The adverse impact of DM on mortality remained unchanged overall over time but was age and sex dependent. © 2014 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  20. Examination of the Comorbidity of Mental Illness and Somatic Conditions in Hospitalized Children in the United States Using the Kids' Inpatient Database, 2009.

    Science.gov (United States)

    Sztein, Dina M; Lane, Wendy G

    2016-03-01

    To examine the associations between mental and physical illness in hospitalized children. The data for this analysis came from the 2009 Kids' Inpatient Database (KID). Any child with an International Classification of Diseases, Ninth Revision code indicative of depressive, anxiety, or bipolar disorders or a diagnosis of sickle cell disease, diabetes mellitus type 1 or 2, asthma, or attention-deficit/hyperactivity disorder (ADHD) were included. Using SAS software, we performed χ(2) tests and multivariable logistic regression to determine degrees of association. Children discharged with sickle cell disease, asthma, diabetes mellitus type 1, diabetes mellitus type 2, and ADHD were 0.94, 2.76, 3.50, 6.37, and 38.39 times more likely to have a comorbid anxiety, depression, or bipolar disorder diagnosis than other hospitalized children, respectively. Children with several chronic physical illnesses (asthma, diabetes mellitus type 1, diabetes mellitus type 2) and mental illnesses (ADHD) have higher odds of being discharged from the hospital with a comorbid mood or anxiety disorder compared with other children discharged from the hospital. It is therefore important to screen children hospitalized with chronic medical conditions for comorbid mental illness to ensure optimal clinical care, to improve overall health and long-term outcomes for these children. Copyright © 2016 by the American Academy of Pediatrics.

  1. 29 CFR 825.114 - Inpatient care.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 3 2010-07-01 2010-07-01 false Inpatient care. 825.114 Section 825.114 Labor Regulations... LEAVE ACT OF 1993 Coverage Under the Family and Medical Leave Act § 825.114 Inpatient care. Inpatient care means an overnight stay in a hospital, hospice, or residential medical care facility,...

  2. Medicare program: changes to the hospital inpatient prospective payment systems and fiscal year 2009 rates; payments for graduate medical education in certain emergency situations; changes to disclosure of physician ownership in hospitals and physician self-referral rules; updates to the long-term care prospective payment system; updates to certain IPPS-excluded hospitals; and collection of information regarding financial relationships between hospitals. Final rules.

    Science.gov (United States)

    2008-08-19

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital related costs to implement changes arising from our continuing experience with these systems, and to implement certain provisions made by the Deficit Reduction Act of 2005, the Medicare Improvements and Extension Act, Division B, Title I of the Tax Relief and Health Care Act of 2006, the TMA, Abstinence Education, and QI Programs Extension Act of 2007, and the Medicare Improvements for Patients and Providers Act of 2008. In addition, in the Addendum to this final rule, we describe the changes to the amounts and factors used to determine the rates for Medicare hospital inpatient services for operating costs and capital-related costs. These changes are generally applicable to discharges occurring on or after October 1, 2008. We also are setting forth the update to the rate-of-increase limits for certain hospitals and hospital units excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits are effective for cost reporting periods beginning on or after October 1, 2008. In addition to the changes for hospitals paid under the IPPS, this document contains revisions to the patient classifications and relative weights used under the long-term care hospital prospective payment system (LTCH PPS). This document also contains policy changes relating to the requirements for furnishing hospital emergency services under the Emergency Medical Treatment and Labor Act of 1986 (EMTALA). In this document, we are responding to public comments and finalizing the policies contained in two interim final rules relating to payments for Medicare graduate medical education to affiliated teaching hospitals in certain emergency situations. We are revising the regulatory requirements relating to disclosure to patients of physician ownership or investment interests in hospitals and responding to public comments on a

  3. Hypnotics and the Occurrence of Bone Fractures in Hospitalized Dementia Patients: A Matched Case-Control Study Using a National Inpatient Database.

    Directory of Open Access Journals (Sweden)

    Hiroyuki Tamiya

    Full Text Available Preventing falls and bone fractures in hospital care is an important issue in geriatric medicine. Use of hypnotics is a potential risk factor for falls and bone fractures in older patients. However, data are lacking on the association between use of hypnotics and the occurrence of bone fracture.We used a national inpatient database including 1,057 hospitals in Japan and included dementia patients aged 50 years or older who were hospitalized during a period of 12 months between April 2012 and March 2013. The primary outcome was the occurrence of bone fracture during hospitalization. Use of hypnotics was compared between patients with and without bone fracture in this matched case-control study.Of 140,494 patients, 830 patients suffered from in-hospital fracture. A 1:4 matching with age, sex and hospital created 817 cases with fracture and 3,158 matched patients without fracture. With adjustment for the Charlson comorbidity index, emergent admission, activities of daily living, and scores for level walking, a higher occurrence of fractures were seen with short-acting benzodiazepine hypnotics (odds ratio, 1.43; 95% confidence interval, 1.19-1.73; P<0.001, ultrashort-acting non-benzodiazepine hypnotics (1.66; 1.37-2.01; P<0.001, hydroxyzine (1.45; 1.15-1.82, P=0.001, risperidone and perospirone (1.37; 1.08-1.73; P=0.010. Other drug groups were not significantly associated with the occurrence of in-hospital fracture.Short-acting benzodiazepine hypnotics and ultrashort-acting non-benzodiazepine hypnotics may increase risk of bone fracture in hospitalized dementia patients.

  4. [The practice of the mental health in the general hospital].

    Science.gov (United States)

    Kuroki, Nobuo

    2012-01-01

    On December 2, 2011 a new reform bill concerning the Labor Safety and Hygiene law was presented to parliament. The bill states that all companies and businesses regardless of size are obliged to have all employees take a stress test once a year in addition to the regular health check. In September 2010 the employees fo Toho University Sakura Hospital were given this new stress. The test included categories for occupation and the various departments in the hospital. There were 40 employees found to test high for stress and to have depressive tendencies. We interviewed about 16 of these employees. One employee started to receive medicine to help reduce the stress and 4 employees received counseling only. The other 11 employees did not need to receive counseling or medicine. From April 2005 to September 2011, we conducted another study. The subjects this time were 92 employees of the hospital who have received treatment at other facilities for mental problems from occupational physicians. We categorized the subjects by sex, age occupation, length of time employed at the hospital, department and period of time from the onset of symptoms to the time they sought treatment. In this paper I will present my findings and suggestions for improving mental health care for employees of general hospital throughout Japan.

  5. Exploring the Rate and Causes of Deductions Imposed on Social Security and Health Insurance`s Bills Related to Inpatients in Two Hospitals Affiliated with Tabriz University of Medical Sciences

    OpenAIRE

    Hossein Rezvanjou; Mobin Sokhanvar; Leila Doshmangir

    2017-01-01

    Background and Objectives: Annually, a large amount of fees that are paid by hospitals, will not be reimbursed as deductions by health insurance which imposes irreparable financial losses on hospitals. The purpose of this study was to determine the amount of deductions imposed on social security and health insurance`s bills and its causes related to inpatients in two hospitals affiliated with Tabriz University of Medical Sciences. Material and Methods: This was a cross-sectional study con...

  6. The Factors Affecting Performance of Nurse at Paniai General Hospital

    Directory of Open Access Journals (Sweden)

    Elias Tatogo

    2017-02-01

    Full Text Available General hospital of Paniai regency health service institution under Local Government Paniai Regency with amount of nurse resource counted 69 one who have duty to remain to can improve more certifiable service and reached by society, so to be form degree of health which at the farthest, so that nurse performance of vital importance in giving of health service. The goal of research: To knowing of factors affecting performance of nurse at Paniai general hospital. Method: Type research is causal associative by using quantitative approach. Sample is all of nurse as much 69 nurse with date implemented in October 2016. Data obtained used questioner and analyzed by chi square test. Result of research is obtained that factor’s affecting of nurse performance in Paniai General Hospital is motivation (p-value = 0,001; RP = 3,000; CI95%= 1,607 - 5,601, [job/activity] discipline (p-value = 0,043; RP = 2,068; CI95%= 1,150 - 3,719, reward (p- value = 0,001; RP = 5,008; CI95%= 1,656 - 15,142, punishment (p- value = 0,000 ; RP= 16,839; CI95%= ( 4,310 - 65,784 and style leadership [of] director (p- value = 0,000; RP = 3,333; CI95%= 1,742 - 6,380. The factor’s not related of nurse performance at Paniai general hospital is age (p- value = 1,000 ; RP = 0,908; CI95%= 0,456 - 1,806, long working (p- value = 1,000; RP = 0,908; CI95%= 0,456 - 1,806 and job rotation (p- value = 0,843; RP = 1,190; CI95%= 0,603 – 2,348.

  7. A strategy for enhancing financial performance: a study of general acute care hospitals in South Korea.

    Science.gov (United States)

    Choi, Mankyu; Lee, Keon-Hyung

    2008-01-01

    In this study, the determinants of hospital profitability were evaluated using a sample of 142 hospitals that had undergone hospital standardization inspections by the South Korea Hospital Association over the 4-year period from 1998 to 2001. The measures of profitability used as dependent variables in this study were pretax return on assets, after-tax return on assets, basic earning power, pretax operating margin, and after-tax operating margin. Among those determinants, it was found that ownership type, teaching status, inventory turnover, and the average charge per adjusted inpatient day positively and statistically significantly affected all 5 of these profitability measures. However, the labor expenses per adjusted inpatient day and administrative expenses per adjusted inpatient day negatively and statistically significantly affected all 5 profitability measures. The debt ratio negatively and statistically significantly affected all 5 profitability measures, with the exception of basic earning power. None of the market factors assessed were shown to significantly affect profitability. In conclusion, the results of this study suggest that the profitability of hospitals can be improved despite deteriorating external environmental conditions by facilitating the formation of sound financial structures with optimal capital supplies, optimizing the management of total assets with special emphasis placed on inventory management, and introducing efficient control of fixed costs including labor and administrative expenses.

  8. [Use of antibiotics in a general hospital (author's transl)].

    Science.gov (United States)

    Escolar, A; Gómez, J; Andreo, J; García-Estany, J; Espi, F; Amorós, T

    1980-10-25

    The utilization of antibiotics at a general hospital has been assessed by retrospectively studying the clinical histories of all patients admitted during the month of April 1978 to the Residencia General de la Ciudad Sanitaria Virgen de la Arrixaca (Murcia, Spain). Medical records were reviewed according to a preestablished protocol. Out of 1.057 patients admitted antibiotics were used in 419 (46%), of whom 189 belonged to the medical services and 302 to the surgical ones. Overall, the surgical services utilized more antibiotics and had less bacteriologic data on their patients. Antibiotics more utilized were ampicillin, which use was generally correct, followed by gentamicin, the G-penicillins, and trimethoprim-sulfamethoxazol. Undesirable side-effects of antibiotic treatment were found in 13 cases (2,6%). Infectious disease of bacterial origin was correctly diagnosed in 40% of the cases, while the diagnosis was doubtful or incorrect in the remaining 60% of cases treated with antibiotics. Appropriate bacteriological data were obtained only in 164 cases (33,4%), with positive results in 75 (49,9%). Independent antibiotics were given in association in 157 cases (31,9%). From this study it can be concluded that the more frequent causes of improper antibiotic utilization were the incorrect clinical diagnosis of bacterial infectious disease, the prophylactic use of antibiotics and the scarcity of bacteriological data. It is therefore suggested that systems of supervision of in-hospital antibiotic prescription be updated and continuous education programs for hospital staff be instituted.

  9. Predicting the risk for hospital-onset Clostridium difficile infection (HO-CDI) at the time of inpatient admission: HO-CDI risk score.

    Science.gov (United States)

    Tabak, Ying P; Johannes, Richard S; Sun, Xiaowu; Nunez, Carlos M; McDonald, L Clifford

    2015-06-01

    To predict the likelihood of hospital-onset Clostridium difficile infection (HO-CDI) based on patient clinical presentations at admission Retrospective data analysis Six US acute care hospitals Adult inpatients We used clinical data collected at the time of admission in electronic health record (EHR) systems to develop and validate a HO-CDI predictive model. The outcome measure was HO-CDI cases identified by a nonduplicate positive C. difficile toxin assay result with stool specimens collected >48 hours after inpatient admission. We fit a logistic regression model to predict the risk of HO-CDI. We validated the model using 1,000 bootstrap simulations. Among 78,080 adult admissions, 323 HO-CDI cases were identified (ie, a rate of 4.1 per 1,000 admissions). The logistic regression model yielded 14 independent predictors, including hospital community onset CDI pressure, patient age ≥65, previous healthcare exposures, CDI in previous admission, admission to the intensive care unit, albumin ≤3 g/dL, creatinine >2.0 mg/dL, bands >32%, platelets ≤150 or >420 109/L, and white blood cell count >11,000 mm3. The model had a c-statistic of 0.78 (95% confidence interval [CI], 0.76-0.81) with good calibration. Among 79% of patients with risk scores of 0-7, 19 HO-CDIs occurred per 10,000 admissions; for patients with risk scores >20, 623 HO-CDIs occurred per 10,000 admissions (Prisk identification tool for HO-CDI preventive interventions and outcome comparisons.

  10. Outcomes of an inpatient refeeding protocol in youth with anorexia nervosa: Rady Children's Hospital San Diego/University of California, San Diego.

    Science.gov (United States)

    Maginot, Tamara R; Kumar, Maya M; Shiels, Jacqueline; Kaye, Walter; Rhee, Kyung E

    2017-01-01

    Current guidelines for nutritional rehabilitation in hospitalized restrictive eating disorder patients recommend a cautious approach to refeeding. Several studies suggest that higher calorie diets may be safe and effective, but have traditionally excluded severely malnourished patients. The goal of this study was to evaluate the safety of a higher calorie nutritional rehabilitation protocol (NRP) in a broad sample of inpatients with restrictive eating disorders, including those who were severely malnourished. A retrospective chart review was conducted among eating disorder inpatients between January 2015 and March 2016. Patients were started on a lower calorie diet (≤1500 kcals/day) or higher calorie diet (≥1500 kcals/day). Calorie prescription on admission was based on physician clinical judgement. The sample included patients aged 8-20 years with any DSM-5 restrictive eating disorder. Those who were severely malnourished (<75% expected body weight [EBW]) or required tube feeding during admission were included. Multivariable regression models were used to determine whether level of nutritional rehabilitation was associated with hypophosphatemia, hypomagnesemia, or hypokalemia. The sample included 87 patients; mean age was 14.4 years (S.D. 32.7); 29% were <75% EBW. The majority (75.8%) was started on higher calorie diets (mean 1781 kcal/day). Controlling for rate of calorie change, initial %EBW, age, race/ethnicity, insurance, diagnosis, and NG/NJ tube placement, higher calorie diets were not associated with hypophosphatemia, hypomagnesemia, or hypokalemia on admission or within the first 72 h. Increased risk of hypophosphatemia on admission was associated with lower baseline %EBW. A higher calorie NRP was tolerated in this broad population of inpatients with restrictive eating disorders. Lower %EBW on admission was a more important predictor of hypophosphatemia than initial calorie level. Larger studies are required to demonstrate the safety of higher

  11. High-Dose, Extended-Interval Gentamicin and Tobramycin for Pediatric Inpatients: A Survey of Canadian Hospital Pharmacists.

    Science.gov (United States)

    Roy, Caitlin; Gray, Carolyn; Ruda, Lisa; Bell, Ali; Bolt, Jennifer

    2016-01-01

    The use of high-dose, extended-interval aminoglycosides, a common practice in adult populations, is less well established for pediatric patients. In younger populations, these drugs are often administered according to a multiple daily dosing method. To characterize prescribing practices for aminoglycosides in pediatric inpatients across Canada, with a focus on high-dose, extended-interval regimens. This study was based on an electronic survey of pharmacists representing Canadian health care delivery organizations that provided pediatric inpatient services, which was distributed in March 2015. Questions focused on demographic characteristics; indications for high-dose, extended-interval tobramycin or gentamicin; use of these regimens in patients with particular comorbidities; empiric dosing; monitoring parameters; and the extent of pharmacists' authority to independently prescribe doses and order monitoring parameters for aminoglycosides at their respective institutions. Forty-five (48%) of the 94 prospective participants responded to the survey. Of these 45 respondents, 35 (78%) indicated that their respective health regions used high-dose, extended-interval tobramycin or gentamicin in pediatric inpatients. The patient characteristics for use of such regimens were varied. The median reported doses were 10 mg/kg for pulmonary exacerbation in cystic fibrosis, 7 mg/kg for urinary tract infection, and 8 mg/kg for febrile neutropenia. Thirty-one (89%) of the 35 respondents using these regimens reported that they monitored serum levels, and 27 (77%) reported monitoring for nephrotoxicity. With regard to prescriptive authority, 7 (16%) of the 45 respondents indicated that pharmacists were authorized to independently adjust dosing at their institutions, and pharmacists at 14 (31%) of 45 sites were authorized to order monitoring parameters. High-dose, extended-interval aminoglycoside therapy was frequently used for pediatric patients across Canada, although the dosages and

  12. Terapia ocupacional en un hospital general de pacientes agudos = Occupational therapy in a general hospital for acute pacients

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    Ocello, M. G

    2006-09-01

    Full Text Available RESUMEN Desde su creación, el Hospital Provincial “Dr. José María Cullen” posee la característica de ser un hospital de emergencias, sostenido por la Sociedad de Beneficencia y la Hermanas de la Caridad.Su funcionamiento responde a un Modelo Clínico-Asistencial, lo cual influye en la inserción de Terapia Ocupacional debiendo adaptar sus funciones a las características de la Institución.Los marcos de referencia teóricos y programas que se implementandeber ser acordes con las necesidades surgidas de un Hospital General de Agudos y de emergencias.En el Sector de Terapia Ocupacional se desarrolla la actividad docente cumpliendo con los requisitos reglamentados por el Ministerio de Salud de la Provincia de Santa Fe.ABSTRACT Ever since its start the Provincial Hospital “Dr. José María Cullen” is characterised for being an emergency hospital under the guidance of the Benfit Society of Hermanas de la Caridad.Its function responds to a Clinical Assistential Model, which influences the insertion of Occupational Therapy, adapting its functiones to the characteristics of the Institution as and when called for.The theoretical points of reference and programmes that are used must be in accordance with tehe necessities that appear in an Acute and Emergency General Hospital.In the Occupational Therapy Sector the teaching activity is developed as required by rules and regulations of the Ministry of Health for the Province of Santa Fe.

  13. [Neuropaediatric care in the Hospital General Universitario de Guadalajara].

    Science.gov (United States)

    Peña-Segura, J L; López-Pisón, J; Marco-Olloqui, M; Mateos-Hernández, J; Adrados-Razola, I; Jiménez-Bustos, J M

    Influenced by medical, scientific and social advances, the changes that have taken place in the needs of the population have given rise to a growing demand for health care in neuropaediatric pathology. The aim of this study was to determine the neuropaediatric health care requirements at the Hospital General Universitario de Guadalajara, a secondary care hospital that is a reference centre for the province of Guadalajara. We studied the children up to the age of 10 years with a neurological pathology attended at the Hospital General Universitario de Guadalajara over an 8-year period, since the Neuropaediatric unit was opened on 1 July 1992. In all 1,236 children were evaluated, which represents 8.45% of all the children below the age of 10 in the province of Guadalajara, with an average of 154.5 new patients per year. There was a predominance of males, 56.4%, and a high percentage of very young children: 26.05% under the age of 1 year and 50.56% under the age of 3. There has been a progressive increase in the number of Neuropaediatric outpatients, which in the year 2000 accounted for 20% of first visits and 16% of the total number (first and successive) of Paediatric outpatients. 12.94% of the patients in our series had also been examined in different tertiary care hospitals. There is a very high demand for neuropaediatric care in Guadalajara and it is growing in a significant and progressive manner. We suggest it would be advisable to have a tertiary reference hospital available to help cope with this situation.

  14. Exploration of the comorbidity of alcohol use disorders and mental health disorders among inpatients presenting to all hospitals in New South Wales, Australia.

    Science.gov (United States)

    Lai, Harry Man Xiong; Sitharthan, Thiagarajan; Huang, Qi Rong

    2012-01-01

    Alcohol is one of the most commonly used legal psychoactive substances, and its use often coexists with mental health disorders. This study explores the relationships between alcohol use and some common mental health disorders. Admissions to all New South Wales (NSW) hospitals were analyzed. The data were extracted from the NSW Department of Health Inpatient Statistics Data Collection for the period 1 July 2006 to 30 June 2007. Readmissions within 28 days were excluded. Data extraction and analyses were performed by using the SAS program. Chi-square tests and odds ratio were used to measure the association. Of the 1.8 million admissions, associations between alcohol use disorders and mental health disorders were strong (odds ratio 7.8 to 10.7, P alcohol had at least 1 identifiable mental disorder. Higher comorbidity rates were observed for females (39.6%) and for those aged between 30 and 49 years. The most common mental disorders were anxiety disorders, bipolar affective disorders, major depressive disorders, personality disorders, schizophrenia, and severe stress disorders. Comorbidity with one of these mental disorders ranged from 1% to 17.6%, with significant associations (odds ratio 5.6 to 14.1). The average length of stay (ALOS) for alcohol use disorders were 6.4 days and the ALOS for the most common mental health admissions was 11.2 days. This study provides detailed information about the association between alcohol use and mental health disorders and extends our understanding of comorbidity presentations in inpatient admissions.

  15. Investigation of Hepatitis C Virus Infection Rate of Patients in a General Hospital

    Institute of Scientific and Technical Information of China (English)

    2013-01-01

    Objective To investigate the infection rate of hepatitis C virus among the ambulatory patients and in-patients of a tertiary teaching hospital, and study the demographic factors related to the prevalence of hepatitis C virus infection. Methods All patients tested for hepatitis C virus antibody from July 2008 to July 2009 in Peking Union Medical College Hospital were enrolled in this cross-sectional analysis. The prevalence of hepatitis C virus infection was compared according to age, gender, and departments, respectively. Among patients with positive serology hepatitis C virus marker, the positivity of hepatitis C virus RNA was analysed. Results Among 29 896 subjects included, the hepatitis C virus antibody of 494 patients were positive (1.7%). When patients were divided into 9 age groups, the age speciifc prevalence of hepatitis C virus antibody were 0.2%, 1.7%, 1.2%, 1.1%, 1.5%, 1.9%,2.6%, 2.4%and 2%, respectively. The prevalence of hepatitis C virus antibody in non-surgical department and surgical department was 3%and 1%, respectively. The prevalence of hepatitis C virus antibody of males was higher than that of the females. Total of 194 patients with positive hepatitis C virus antibody were tested for hepatitis C virus RNA, the RNA level of 113 patients (58.2%) were higher than the low detection limit. Conclusions The prevalence of hepatitis C virus antibody was relatively high among patients of general tertiary hospital. Age group of 60-69, males and patients in non-surgical departments were factors associated with high rate of hepatitis C virus infection.

  16. Evaluation of pathologic and clinical findings of 366 outpatients and inpatients of Razi Hospital for 8.5 tears

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    Naraghie ZS

    1997-04-01

    Full Text Available Mycosis fungoides is virtually a kind of cutaneous T cell lymphoma. The wide spectrum of clinical, and histopathologial features of MF accessitated performing an exact study on it. During a retrospective survey, clinical findings of 115 in-patients and histopathological finding of 366 ontpatients and inpatients of MF in an 8½ years period were studies with special attention to the pathological Aspects: Males were affected more than females. Their ages ranges from 11-88 years. The most common symptom and sign were pruritus and scaling, respectively. The first involved areas in male were the limbs and females was the trunk. The role of environmental and occupational factors in pathogenesis deserves greater contemplation. There were four distinct histopathological pattern in the epidermis: 1 without significant changes, 2 hyperplasia, 3 poikilodermatosus and 4 pagetoid patten. Epidrmotropism with or without associated pauntrier's microabscesses and halo cells was noted in the majority of cases (233 patients. The inflammatory infiltrate with predominence of atypical lymphocytes and also fibrosis, edema and occasional grenz-zone were the prominent finding of papillary dermis. The major finding of hypodermis was septal panniculitis. In conclusion integrated correlation between clinical and wide spectrum pathologic features of M.F could be a gnide to early diagnosis and appropriate mangement.

  17. Statistical analysis of the main diseases among atomic bomb survivors. Study of inpatients in Hiroshima Atomic Bomb Hospital, 1981 - 1986

    Energy Technology Data Exchange (ETDEWEB)

    Hamada, Tadao; Kuramoto, Kiyoshi; Nambu, Shigeru

    1988-03-01

    Diseases found in 2,104 consequetive inpatients between April 1981 and March 1986 were statistically analyzed. The incidence of disease increased in the following order: diabetes mellitus > heart disease > cerebrovascular disorder > malignancy > hypertensive disease > arteriosclerosis > osteoarthritis. Malignancy is the most common cause of death or the highest mortality rate, followed by heart disease, cerebrovascular disorder, and liver cirrhosis. For the number of autopsy, the order of diseases was: malignancy, cardiovascular disease, gastrointestinal disease, respiratory tract disease, endocrine disease, and hematopoietic disease; for the incidence of autopsy, the order was: liver cirrhosis, diabetes mellitus, cerebrovascular disorder, malignancy, and heart disease. Malignancy accounted for 23 % of the inpatients. The incidence of malignancy increased in the following organs: stomach > liver > colon > lung > breast > biliary tract > esophagus. The incidence of leukemia was low. There was no definitive correlation between the incidence of malignancy and exposure distance, although the incidence of breast cancer tended to be high in the group exposed at less than or equal to2,000 m from the hypocenter. According to age class, gastric cancer was frequent in patients less than 40 years and more than 60 years. Liver cancer was the most common in the sixtieth decade of life of men. The incidence of lung cancer increased with advancing age; the incidence of breast cancer was higher in younger patients. (Namekawa, K.).

  18. Factors associated with nursing home placement of all patients admitted for inpatient rehabilitation in Singapore community hospitals from 1996 to 2005: a disease stratified analysis.

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    Cynthia Chen

    Full Text Available OBJECTIVES: To (1 identify social and rehabilitation predictors of nursing home placement, (2 investigate the association between effectiveness and efficiency in rehabilitation and nursing home placement of patients admitted for inpatient rehabilitation from 1996 to 2005 by disease in Singapore. DESIGN: National data were retrospectively extracted from medical records of community hospital. DATA SOURCES: There were 12,506 first admissions for rehabilitation in four community hospitals. Of which, 8,594 (90.3% patients were discharged home and 924 (9.7% patients were discharged to a nursing home. Other discharge destinations such as sheltered home (n = 37, other community hospital (n = 31, death in community hospital (n = 12, acute hospital (n = 1,182 and discharge against doctor's advice (n = 24 were excluded. OUTCOME MEASURE: Nursing home placement. RESULTS: Those who were discharged to nursing home had 33% lower median rehabilitation effectiveness and 29% lower median rehabilitation efficiency compared to those who were discharged to nursing homes. Patients discharged to nursing homes were significantly older (mean age: 77 vs. 73 years, had lower mean Bathel Index scores (40 vs. 48, a longer median length of stay (40 vs. 33 days and a longer time to rehabilitation (19 vs. 15 days, had a higher proportion without a caregiver (28 vs. 7%, being single (21 vs. 7% and had dementia (23 vs. 10%. Patients admitted for lower limb amputation or falls had an increased odds of being discharged to a nursing home by 175% (p<0.001 and 65% (p = 0.043 respectively compared to stroke patients. CONCLUSIONS: In our study, the odds of nursing home placement was found to be increased in Chinese, males, single or widowed or separated/divorced, patients in high subsidy wards for hospital care, patients with dementia, without caregivers, lower functional scores at admission, lower rehabilitation effectiveness or efficiency at discharge and primary diagnosis groups such

  19. Herniated Nucleus Pulposus in Dr. Hasan Sadikin General Hospital Bandung Indonesia

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    Annisa Ikhsanawati

    2015-06-01

    Full Text Available Background: Herniated nucleus pulposus (HNP is one of the most common diseases of the spine. For an optimal management and prevention, there’s a need for data on factors related to the onset of complaints because this disease lowers the quality of life and increases morbidity. This study is aimed to see the scale and pattern of the HNP in Dr. Hasan Sadikin General Hospital, Bandung. Methods: This is a descriptive study with the design of case series, data was obtained from medical records of patients with the diagnosis of HNP in the inpatient care of Dr. Hasan Sadikin General Hospital in the period of 2007–2011. Results: According to the study on 79 patients, with 43 men and 36 women, the highest incidence was at the age group of 51–60 years old (31.6% and most common occupation was civil servant (11.4%. The most common clinical symptoms were sciatica (51.9% and low back pain (51.9%. Most frequent location was in the lumbar vertebrae at the level of L5–S1 (58.2%. Trauma was found to be the highest relatable history in the patients (39.2%. Therapy of choice was primarily conservative (58.2% and most patients went home after the progression (84.8%. The year 2007 showed the highest prevalence of HNP at 25.3%. The most common clinical symptoms were sciatica (51.9% and low back pain (51.9% Conclusions: The most common clinical symptoms were sciatica and low back pain. Most frequent location was in the lumbar vertebrae at the level L5–S1.

  20. Neuroticism and clinical course of weight restoration in a meal-based, rapid-weight gain, inpatient-partial hospitalization program for eating disorders.

    Science.gov (United States)

    Fischer, Laura K; Schreyer, Colleen C; Coughlin, Janelle W; Redgrave, Graham W; Guarda, Angela S

    2017-01-01

    We evaluated the impact of personality on weight restoration in 211 underweight (BMI ≤ 19 kg/m(2)) females admitted to an inpatient-partial hospitalization program for eating disorders. Symptomatology and personality were assessed by questionnaires, and clinical and demographic variables were assessed by chart review. Neuroticism, a personality trait associated with reactivity to stress, was correlated with higher symptomatology, chronicity, length of stay, and income source. Contrary to our hypothesis, neuroticism was positively associated with weight restoration. Length of stay mediated this relationship such that longer length of stay in patients with high neuroticism explained their higher likelihood of weight restoration prior to program discharge. Higher neuroticism is therefore associated with better weight restoration outcomes but may also indicate greater difficulty transitioning out of intensive treatment.

  1. Dispositivos clínicos em hospital geral Clinical dispositives in the general hospital

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    Ana Cleide Guedes Moreira

    2006-01-01

    Full Text Available Este trabalho participa de investigação sobre a inserção da Psicanálise no campo institucional e hospitalar de saúde, objetivando formular contribuições, a partir da clínica da melancolia e dos estados depressivos, para a construção de dispositivos clínicos em hospital geral do Sistema Único de Saúde.This paper is a part of a research project that investigates the insertion of Psychoanalysis into the health institutional field and hospitals; the objective is to formulate contributions from the clinic of melancholic and depressive states to the construction of clinical dispositives in general hospital of the "Sistema Único de Saúde (Unified Health System.

  2. Optimising neuroimaging effectiveness in a district general hospital.

    Science.gov (United States)

    McCarron, M O; Wade, C; McCarron, P

    2014-01-01

    Diagnostic accuracy in neurology frequently depends on clinical assessment and neuroimaging interpretation. We assessed neuroimaging discrepancy rates in reported findings between general radiologists and neuroradiologists among patients from a district general hospital (DGH). A neuroradiologist's report was sought on selected DGH patients over 28 months. Pre-planned outcomes included comparisons of primary findings (main diagnosis or abnormality), secondary findings (differential diagnoses and incidental findings) and advice from neuroradiologists for further investigations. A total of 233 patients (119 men and 114 women), mean age 47.2 (SD 17.8) years were studied: 43 had a computed tomography (CT) brain scan only, 37 had CT and magnetic resonance imaging (MRI) scans and 153 had only MRI scans. Discrepancies in the primary diagnosis/abnormality were identified in 33 patients (14.2%). This included 7 of 43 patients (16.3%) who had a CT brain scan as their only neuroimaging. Secondary outcomes differed in 50 patients (21.5%). Neuroradiologists recommended further neuroimaging for 29 patients (12.4%). The most common discrepancies in the primary diagnosis/abnormality were misinterpreting normal for hippocampal sclerosis and missed posterior fossa lesions. There was no evidence of temporal changes in discrepancy rates. Selecting CT and MR neuroimaging studies from general hospitals for reviewing by neuroradiologists is an important and effective way of optimising management of neurological patients.

  3. Training needs and role constraints of nurses and assistant nurses working in acute inpatients units of psychiatric hospitals

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    Nikolaos Gonis

    2010-07-01

    Full Text Available Aim: The aim of the research was to record the main clinical problems that mental health nurses and assistant nurses encounter in everyday practice.Material-Method: Data collection based on semi-structured interviews and nurses’ quotes who work in psychiatric acute inpatient wards. Content analysis was carried out and data was categorized into main themes. The total sample consisted of 82 mental health nurses and assistant nurses.Results: Analysis of data revealed that: The constraints of nursing role include the lack of autonomy, the accountability, the medication administration and nursing interventions. Training and clinical needs concern the managing of crisis, the collaboration inside the therapeutic team, the lack of nursing staff that means less time spent with the patient, the security in the work place and the psychological support for nurses.Conclusions: The findings indicated that mental health nurses are called to undertake a demanding role in every day clinical practice with inadequate preparation and training.

  4. How do hospital-specialty characteristics influence health system responsiveness? An empirical evaluation of in-patient care in the Italian region of Emilia-Romagna.

    Science.gov (United States)

    Fiorentini, Gianluca; Robone, Silvana; Verzulli, Rossella

    2017-06-29

    Studies of health system responsiveness mostly focus on the demand side by investigating the association between sociodemographic characteristics of patients and their reported level of responsiveness. However, little is known about the influence of supply-side factors. This paper addresses that research gap by analysing the role of hospital-specialty characteristics in explaining variations in patients' evaluation of responsiveness from a sample of about 38,700 in-patients treated in public hospitals within the Italian Region of Emilia-Romagna. The analysis is carried out by adopting a 2-step procedure. First, we use patients' self-reported data to derive 5 measures of responsiveness at the hospital-specialty level. By estimating a generalised ordered probit model, we are able to correct for variations in individual reporting behaviour due to the health status of patients and their experience of being in pain. Second, we run cross-sectional regressions to investigate the association between patients' responsiveness and potential supply-side drivers, including waiting times, staff workload, the level of spending on non-clinical facilities, the level of spending on staff education and training, and the proportion of staff expenditure between nursing and administrative staff. Results suggest that responsiveness is to some extent influenced by the supply-side drivers considered. Copyright © 2017 John Wiley & Sons, Ltd.

  5. Major depressive disorder in the general hospital: adaptation of clinical practice guidelines.

    Science.gov (United States)

    Voellinger, Rachel; Berney, Alexandre; Baumann, Pierre; Annoni, Jean Marie; Bryois, Christian; Buclin, Thierry; Büla, Christophe; Camus, Vincent; Christin, Laurent; Cornuz, Jacques; de Goumoëns, Pierre; Lamy, Olivier; Strnad, Jindrich; Burnand, Bernard; Stiefel, Frederic

    2003-01-01

    Major Depressive Disorder is particularly frequent among physically ill inpatients. Despite the considerable human burden and financial costs, Major Depressive Disorder remains under-detected and under-treated. To improve this situation, clinical practice guidelines for the management of Major Depressive Disorder were developed for patients in the general hospital. They were adapted from existing good quality guidelines. A literature search has been conducted to identify guidelines and systematic reviews about the management of Major Depressive Disorder. The quality of the existing guidelines was evaluated by means of the AGREE instrument (Appraisal of Guidelines for Research and Evaluation). Complementary literature searches were necessary to answer questions such as "depression and physical illness" or "antidepressants and somatic medication". The guidelines were discussed by a multidisciplinary internal panel. The final version was reviewed by an external panel. This paper presents the development process and a summary of these guidelines for the management of Major Depressive Disorder. The adaptation of good quality guidelines to local needs requires much time, effort and skills. Easier ways for the adaptation and use of high quality guidelines at the local level may result from better coordination, organization and updating of guidelines at a national or supranational level.

  6. A multicomponent approach to identify predictors of hospital outcomes in older in-patients: a multicentre, observational study.

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    Stefanie L De Buyser

    Full Text Available BACKGROUND: The identification of older patients at risk of poor hospital outcomes (e.g. longer hospital stay, in-hospital mortality, and institutionalisation is important to provide an effective healthcare service. OBJECTIVE: To identify factors related to older patients' clinical, nutritional, functional and socio-demographic profiles at admission to an acute care ward that can predict poor hospital outcomes. DESIGN AND SETTING: The CRiteria to assess appropriate Medication use among Elderly complex patients project was a multicentre, observational study performed in geriatric and internal medicine acute care wards of seven Italian hospitals. SUBJECTS: One thousand one hundred twenty-three consecutively admitted patients aged 65 years or older. METHODS: Hospital outcomes were length of stay, in-hospital mortality, and institutionalisation. RESULTS: Mean age of participants was 81 years, 56% were women. Median length of stay was 10 (7-14 days, 41 patients died during hospital stay and 37 were newly institutionalised. Number of drugs before admission, metastasized cancer, renal failure or dialysis, infection, falls at home during the last year, pain, and walking speed were independent predictors of LoS. Total dependency in activities of daily living and inability to perform grip strength test were independent predictors of in-hospital mortality. Malnutrition and total dependency in activities of daily living were independent predictors of institutionalisation. CONCLUSIONS: Our results confirm that not only diseases, but also multifaceted aspects of ageing such as physical function and malnutrition are strong predictors of hospital outcomes and suggest that these variables should be systematically recorded.

  7. [Treatment with tuberculostatic drugs: compliance at a general hospital].

    Science.gov (United States)

    Polo Friz, H; Kremer, L; Acosta, H; Abdala, O; Canova, S; Rojo, S; Roca, G; Daín, A

    1997-01-01

    The purpose of this study was to assess the compliance with tuberculostatic drugs treatment in a public hospital from Córdoba City and to establish the causes of noncompliance. All the patients to which treatment with tuberculostatic drugs was indicated from January 1991 up to December 1994 were included. 45 patients were included: 18 females (40%) and 29 males. Sixteen (35.6%) did not complete the time of treatment indicated. Nine (56.3%) abandoned the treatment 2 months after having initiated it. In the group that did not complete the treatment there was a higher percentage of female patients (62.5%) than in the group that did complete it (27.6%), p = 0.02. There were not statistically significant differences in age, percentages of pulmonar and extrapulmonar tuberculosis and months of treatment indicated between both groups. Thirty-six percent of the patients who abandoned the treatment referred having interrupted it due to their own negligency, knowing the risk of such behavior; 36% suffered side effects and did not come back to hospital; 21% referred having consulted another physician who indicated to interrupt the treatment without performing other tests; and 7% misunderstood the indications. It is concluded that in a general hospital from Córdoba City, the percentage of patients who abandoned tuberculostatic treatment is high. In most cases the cause was related to failures in the conduct of patients, physicians or both.

  8. Medicare Provider Utilization and Payment Data - Inpatient

    Data.gov (United States)

    U.S. Department of Health & Human Services — The data provided here include hospital-specific charges for the more than 3,000 U.S. hospitals that receive Medicare Inpatient Prospective Payment System (IPPS)...

  9. Quantifying the Relationship Among Hospital Design, Satisfaction, and Psychosocial Functioning in a Pediatric Hematology-Oncology Inpatient Unit

    Science.gov (United States)

    Sherman-Bien, Sandra A.; Malcarne, Vanessa L.; Roesch, Scott; Varni, James W.; Katz, Ernest R.

    2013-01-01

    Increasingly, empirical support demonstrates that the built environment may affect the physical and psychosocial well-being of patients, their families, and hospital staff (Beauchemin & Hays, 1996; Rubin, Owens, & Golden, 1998; Sherman, Varni, Ulrich, & Malcarne, 2005; Ulrich, 1991; Varni et al., 2004; Whitehouse et al., 2001). Investigators posit two mechanisms through which the built environment can impact patients: indirectly, by enhancing the quality of care and helping a patient feel more relaxed; and/or directly, by altering the physiological recovery process (Malcolm, 1992). Several literature reviews have been published on the relationship between the hospital built environment and patient outcomes (Joseph, Keller, & Kronick, 2008; Rubin et al., 1998; Sherman, Shepley, & Varni, 2005; Ulrich, Quan, Zimring, Joseph, & Choudhary, 2004). In their 1998 review, Rubin et al. found studies linking environment with a number of health and satisfaction outcomes but little research that had been conducted in a scientifically valid manner. Ulrich et al.'s 2004 review of the role of the physical environment in hospital design identified a number of more rigorously conducted studies, focusing mainly on adult environments and on issues of medical safety and hospital-acquired infection rates. Their conclusions linked environmental features such as noise to an increase in perceived stress and physiological arousal; exposure to natural light to reductions in depression, length of hospital stay, and pain medications and to improved sleep; and hospital gardens to improved physical and psychosocial functioning (Ulrich et al., 2004). PMID:21960191

  10. Recurrence of inguinal hernias repaired in a large hernia surgical specialty hospital and general hospitals in Ontario, Canada.

    Science.gov (United States)

    Malik, Atiqa; Bell, Chaim M; Stukel, Thérèse A; Urbach, David R

    2016-02-01

    The effect of hospital specialization on the risk of hernia recurrence after inguinal hernia repair is not well described. We studied Ontario residents who had primary elective inguinal hernia repair at an Ontario hospital between 1993 and 2007 using population-based, administrative health data. We compared patients from a large hernia specialty hospital (Shouldice Hospital) with those from general hospitals to determine the risk of recurrence. We studied 235 192 patients, 27.7% of whom had surgery at Shouldice hospital. The age-standardized proportion of patients who had a recurrence ranged from 5.21% (95% confidence interval [CI] 4.94%-5.49%) among patients who had surgery at the lowest volume general hospitals to 4.79% (95% CI 4.54%-5.04%) who had surgery at the highest volume general hospitals. In contrast, patients who had surgery at the Shouldice Hospital had an age-standardized recurrence risk of 1.15% (95% CI 1.05%-1.25%). Compared with patients who had surgery at the lowest volume hospitals, hernia recurrence among those treated at the Shouldice Hospital was significantly lower after adjustment for the effects of age, sex, comorbidity and income level (adjusted hazard ratio 0.21, 95% CI 0.19-0.23, p hernia repair at Shouldice Hospital was associated with a significantly lower risk of subsequent surgery for recurrence than repair at a general hospital. While specialty hospitals may have better outcomes for treatment of common surgical conditions than general hospitals, these benefits must be weighed against potential negative impacts on clinical care and the financial sustainability of general hospitals.

  11. Comparison Patients and Staffs Satisfaction in General Versus Special Wards of Hospitals of Jahrom.

    Science.gov (United States)

    Taheri, Leila; Kargar Jahromi, Marzieh; Hojat, Mohsen

    2015-04-02

    Patient satisfaction is the most important indicator of high-quality health care and is used for the assessment and planning of health care. Also, Job satisfaction is an important factor on prediction and perception of organizational manner. The aim of this study is to identify and compare patient and staff satisfaction in general versus special wards. In order to identify the various indicators of satisfaction and dissatisfaction, a descriptive study (cross sectional) was done to assess patients' satisfaction with in-patient care at Jahrom University of Medical Science hospitals. The sample size was 600 patients that selected by sequential random sampling technique and are close to their discharge from the hospital. Patients were asked to indicate the scale point which best reflected their level of satisfaction with the treatment or service. Also we assess the staff satisfaction (sample size was 408 staffs) in general ward using a researcher made questionnaire. It should be noted that the participants were anonymous and there was no obligation to participation. We tried to set a secure and comfortable environment for filling out the questionnaire. Among 600 patients, 239 (n=38.67%) were men and 368 (61.33%) were female. Number of nurses was 408, of which 135 (33.08%) were men and 273 (66.92%) female. There was a significant correlation between working experience and professional factors of personnel. The mean total patient satisfaction in general and special wards is (2.75±.35, 3.03±.53) respectively. Differences of patient satisfaction in domains such respect, care and confidence in general wards versus special ward were statistically significant, but there was no difference in expect time of patients in these wards. Differences Between the mean patient and staff satisfaction in the general wards versus special wards were statistically significant using independent t-tests (p=.018, p=.029). Spearman test showed a statistically significant correlation between

  12. Interconsulta psicológica: demanda e assistência em hospital geral Interconsulta psicológica: demanda y asistencia en hospital general Consultation-liaison psychology: demand and assistance in general hospital

    Directory of Open Access Journals (Sweden)

    Nátali Castro Antunes Santos

    2011-06-01

    adaptación del paciente a la hospitalización (41%. El modelo adoptado referencia psicológica era apropiado en el contexto estudiado, con la participación del equipo multidisciplinario en la efectividad de la práctica.The consultation-liaison psychology in general hospitals represents a modality of clinical and a methodological tool used by psychologists in inpatient care, upon the request of other health professionals. The study aimed to characterize the psychological demands of the liaison in a general hospital, from the analysis of attendance records request. One hundred and seven patients were treated between January and June 2010, in which 53% of the participants were male and 57% of adults over 45 years. Most requests were performed by physicians (44% and nurses (38%, formally (59%, and previous contact between interconsultor and the applicant (85%. The main reasons given for the request liaison were: psychological symptoms related to illness (43% and identification of impairment in the patient's adaptation to hospitalization (41%. The psychological liaison model adopted was appropriate to the studied context, with engagement of the multidisciplinary team in the effectiveness of practice.

  13. PREVALENCE AND QUALITY OF LIFE OF PEMPHIGUS PATIENTS AT SANGLAH GENERAL HOSPITAL BALI-INDONESIA

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    M Wardhana

    2013-01-01

    Full Text Available Objectives: Pemphigus vulgaris (PV is an autoimmune-blistering disease of the skin and mucous membranes caused by auto-antibodies against desmoglein-3 (Dsg-3 on the keratinocyte cell surface of squamous stratified epithelia. Pemphigus is a life-threatening autoimmune bullous disease resulting in the widespread denudation of skin and mucous membrane and severe impact of quality of life. Thepurpose of this study was to evaluate retrospectively the prevalence of pemphigus and to elucidate the clinical variants, clinical course, prognosis and quality of life (QOL of pemphigus patients after discharge from hospitalized.Method: Observational non analytical retrospective study was conducted by observation of the medical records of all the newly registered patients with pemphigus at SanglahGeneral Hospital in Bali-Indonesia during the period of January 1995 and December 2002, and analyzed with regard to personal statistic, history of the diseases including onset, site of affected, symptoms, clinical diagnosis, severity, associated illness, therapy, and quality of life based on theFinlay’s methods.Results: During the 8-year periods studies, 33 pemphigus patients were admitted, represented 5.8 % of all patients admitted in our in-patient ward during the periods. Our patients consist of female 20 patients (60.6 % and male 13 patients (39.4 %. The most common of clinicaltype was pemphigus vulgaris 26 patients (78.78 %, followed by pemphigus foleaceous and pemphigus vegetans. Six patients (18.18 % of 16 severe patients with severe condition at the clinical course of the diseases was death during the course of hospitalized. A number of 2 patients, in thisstudy were observed with severe impact of quality of life.Conclusion: Our finding showed that pemphigus vulgaris is common type of our cases has a relatively high prevalence our hospital (5.8 %, and relatively high death rate (18.18 %. In our study, systemic corticosteroid was still applied

  14. Inpatient satisfaction and job satisfaction/stress of medical workers in a hospital with the 7:1 nursing care system (in which 1 nurse cares for 7 patients at a time).

    Science.gov (United States)

    Fujimura, Yuko; Tanii, Hideji; Saijoh, Kiyofumi

    2011-03-01

    Inpatient satisfaction, job satisfaction/stress of medical workers, and hospital profitability under the 7:1 nursing care system (in which 1 nurse cares for 7 patients at a time) were compared with those under the 10:1 system at a hospital with the diagnosis procedure combination (DPC) payment system. A total of 202 inpatients discharged from the Departments of Cardiology and Metabolism completed an inpatient satisfaction questionnaire. A total of 108 medical workers were recruited to survey their job satisfaction/stress and to estimate the effects of the DPC. The profits for 10 cardiac and metabolic diseases in 2008 were compared with those in 2007. Mean inpatient satisfaction scores were around 4 ("somewhat satisfied") under both the 10:1 and 7:1 systems, and increased significantly to 4.14-4.38 under the 7:1 system. Excluding workload of physicians, the other stresses of physicians/nurses remained unaltered, as did their low job satisfaction. They estimated their understanding of the DPC as insufficient but felt that introducing the DPC neither shortened length of stay nor improved "the quality of medical/nursing care," regardless of the system. Total percentage profit in 2008 was almost the same as that in 2007, whereas diseases with deficits increased from 3 to 4. [corrected] The 7:1 system was somewhat beneficial for inpatients but not always for medical worker quality of life (QOL) or for hospital income, which are important to maintain high quality of medical/nursing care. It is important to further explore factors increasing QOL of medical workers and hospital income.

  15. The Contribution of Children's Temperamental Fear and Effortful Control to Restraint and Seclusion during Inpatient Treatment in a Psychiatric Hospital

    Science.gov (United States)

    Bridgett, David J.; Valentino, Kristin; Hayden, Lisa C.

    2012-01-01

    The current study examined temperament characteristics as risk factors for restraint and seclusion (R/S) events in psychiatrically hospitalized youth, extending work that has sought to identify R/S risk factors and research examining temperament-behavior problem associations that has largely relied upon community samples. It was anticipated that…

  16. Low rate of obesity among psychiatric inpatients in Indonesia.

    Science.gov (United States)

    Marthoenis, M; Aichberger, Marion; Puteh, Ibrahim; Schouler-Ocak, Meryam

    2014-01-01

    A vast majority of psychiatric medication causes weight gain, however the rate of obesity in psychiatric patients has yet to be thoroughly studied in Indonesia. The present study aims to assess the prevalence of obesity among psychiatric inpatients in Indonesia. This cross sectional study was conducted in Banda Aceh Psychiatric Hospital, Indonesia from December 2012 to January 2013. The Body Mass Index (BMI) and blood pressure of a total 242 inpatients was measured, and data on their demographic information and medication were collected from the patient's chart. The prevalence rate of obesity among psychiatric inpatients was 5% (95% CI = 2.6-8.5%), and overweight was 8% (95% CI = 5.1-12.4). The mean BMI was 21.44 kg/m² (SD: 3.43). Stage I hypertension and stage II hypertension was found among 7% (95% CI = 4.1-11), and 2% (95% CI = 0.9-5.3%) inpatients, respectively. The findings suggest that the rate of overweight, obesity and hypertension in the present study population was relatively low compared to rates of the general population. The inpatients have limited access to food and only eat meals that are provided to them by the hospital.

  17. Estudio de utilización de analgésicos opiáceos en un hospital general universitario Study of opioid analgesic use in a general university hospital

    Directory of Open Access Journals (Sweden)

    P. Gómez Salcedo

    2009-10-01

    el metamizol los analgésicos más ampliamente utilizados. Conclusiones: Los datos de nuestro estudio reflejan una tendencia al incremento del consumo de opiáceos en el hospital, lo que consideramos una mejora en el tratamiento del dolor, tanto agudo como crónico, pues en este incremento se ven involucrados todos los principios activos opiáceos. En un hospital con elevada actividad y complejidad asistencial como el Hospital La Paz, este tipo de estudios constituyen una herramienta que nos permite conocer y comparar el uso de opiáceos en los distintos hospitales y servicios clínicos. Nos permiten conocer la evolución del consumo así como detectar posibles desviaciones e implementar acciones de mejora en los diferentes servicios clínicos implicados en el tratamiento del dolor.Objective: The aim of this study was to analyze opioid analgesic use in the La Paz University Hospital in 2008 in order to identify patterns of use and consumption. To that end, data from inpatients were analyzed overall, as well as by hospitals and departments. We analyzed data on consumption in the previous 5 years and quantified the use of the remaining active principles administered as analgesics in our hospital. Materials and methods: Following the Wold Health Organization's guidelines for studieson medication use in hospitals, data are shown as defined daily dose (DDD per 100 hospital stays. Data on drug use were obtained from the drug management program, Farma Tools (Dominion®, which is used by the Pharmacy Service at La Paz Hospital. Results: The overall value of opioid utilization in 2008 was 8.1 DDD per 100 hospital stays. The most widely used active principles were parenteral morphine and transdermal fentanyl. Together, these drugs represented 83% of total opioid consumption. Analysis by hospital revealed that the General and Traumatology Hospitals showed the highest opioid drug consumption and followed the same utilization pattern as overall use. The services most

  18. RN assessments of excellent quality of care and patient safety are associated with significantly lower odds of 30-day inpatient mortality: A national cross-sectional study of acute-care hospitals.

    Science.gov (United States)

    Smeds-Alenius, Lisa; Tishelman, Carol; Lindqvist, Rikard; Runesdotter, Sara; McHugh, Matthew D

    2016-09-01

    Quality and safety in health care has been increasingly in focus during the past 10-15 years. Stakeholders actively discuss ways to measure safety and quality of care to improve the health care system as a whole. Defining and measuring quality and safety, however, is complicated. One underutilized resource worthy of further exploration is the use of registered nurses (RNs) as informants of overall quality of care and patient safety. However, research is still scarce or lacking regarding RN assessments of patient safety and quality of care and their relationship to objective patient outcomes. To investigate relationships between RN assessed quality of care and patient safety and 30-day inpatient mortality post-surgery in acute-care hospitals. This is a national cross-sectional study. A survey (n=>10,000 RNs); hospital organizational data (n=67); hospital discharge registry data (n>200,000 surgical patients). RN data derives from a national sample of RNs working directly with inpatient care in surgical/medical wards in acute-care hospitals in Sweden in 2010. Patient data are from the same hospitals in 2009-2010. Adjusted multivariate logistic regression models were used to estimate relationships between RN assessments and 30-day inpatient mortality. Patients cared for in hospitals where a high proportion of RNs reported excellent quality of care (the highest third of hospitals) had 23% lower odds of 30-day inpatient mortality compared to patients cared for in hospitals in the lowest third (OR 0.77, CI 0.65-0.91). Similarly, patients in hospitals where a high proportion of RNs reported excellent patient safety (highest third) had is 26% lower odds of death (OR 0.74, CI 0.60-0.91). RN assessed excellent patient safety and quality of care are related to significant reductions in odds of 30-day inpatient mortality, suggesting that positive RN reports of quality and safety can be valid indicators of these key variables. Copyright © 2016 The Author(s). Published by

  19. The logistics of an inpatient dermatology service.

    Science.gov (United States)

    Rosenbach, Misha

    2017-03-01

    Inpatient dermatology represents a unique challenge as caring for hospitalized patients with skin conditions is different from most dermatologists' daily outpatient practice. Declining rates of inpatient dermatology participation are often attributed to a number of factors, including challenges navigating the administrative burdens of hospital credentialing, acclimating to different hospital systems involving potential alternate electronic medical records systems, medical-legal concerns, and reimbursement concerns. This article aims to provide basic guidelines to help dermatologists establish a presence as a consulting physician in the inpatient hospital-based setting. The emphasis is on identifying potential pitfalls, problematic areas, and laying out strategies for tackling some of the challenges of inpatient dermatology including balancing financial concerns and optimizing reimbursements, tracking data and developing a plan for academic productivity, optimizing workflow, and identifying metrics to document the impact of an inpatient dermatology consult service. ©2017 Frontline Medical Communications.

  20. HCUP State Inpatient Databases (SID) - Restricted Access File

    Data.gov (United States)

    U.S. Department of Health & Human Services — The State Inpatient Databases (SID) contain the universe of hospital inpatient discharge abstracts in States participating in HCUP that release their data through...

  1. A Way to Understand Inpatients Based on the Electronic Medical Records in the Big Data Environment

    Science.gov (United States)

    2017-01-01

    In recent decades, information technology in healthcare, such as Electronic Medical Record (EMR) system, is potential to improve service quality and cost efficiency of the hospital. The continuous use of EMR systems has generated a great amount of data. However, hospitals tend to use these data to report their operational efficiency rather than to understand their patients. Base on a dataset of inpatients' medical records from a Chinese general public hospital, this study applies a configuration analysis from a managerial perspective and explains inpatients management in a different way. Four inpatient configurations (valued patients, managed patients, normal patients, and potential patients) are identified by the measure of the length of stay and the total hospital cost. The implications of the finding are discussed. PMID:28280506

  2. General Characteristics of HIV/AIDS Patients in Ditan Hospital

    Institute of Scientific and Technical Information of China (English)

    刘彦春; 徐克沂; 张福杰; 赵红心; 李兴旺; 李秀兰; 闫会文

    2004-01-01

    Objective: To elucidate general characteristics of HIV/AIDS patients seeking care at Ditan Hospital in an attempt to guide early diagnosis in routine medical care. Materials and methods: A retrospective analysis of 185 HIV/AIDS cases from January 1990 to June 2002 was completed using SPSS statistical analysis. Results: Male to female ratio was 1.8:1. Subjects ranged in age from 1 year old to 64 years old. 16 cases were younger than 20 years old with the median age among the younger subset at 7.7 years. 169 cases were older than 20 years old with a median age of 36 years old. 29% of the subjects were peasants. The remaining 71%, were of other unspecifiedoccupations. 90.8% of individuals were of Han descent while 3.7% of individuals were of a minority heritage. 50.3% of subjects were married; 23.8% have never married; 8.1% were divorced; and the remaining 17.8% were of unknown marital status. Of those represented in this study, 36.8% came from the Henan province; 17.8% were from Beijing; 8.6% were from Shanxi; 31.4% from the other 20 provinces of China; and 5.4% from outside of China. Mode of transmission: 40.0% (74/185) contracted HIV through unprotected sexual contact; 29.2% (54/185) through receiving blood or plasma transfusions; 21.1%(39/185) through donating plasma; 7 cases were intravenous drug users; 7 cases were vertically transmitted. Mode of transmission was unknown in 4 cases. Clinical categories: An included 45 cases; B included 85 cases: C consisted of 76 cases. 12 cases were deceased. Initial presentation: 39 cases presented with_fever ,cough and diarrhea. 37 cases had fever and cough only-38 cases presented with chronic diarrhea. 16 cases were discovered incidentally at time of operation. 8 cases presented with fungal infection of the oral cavity or in esophagus. The common HIV associated symptoms and opportunistic infections were: weight loss and diarrhea, respiratory diseases, dermatologic diseases, anemia, neutropenia. Diseases of other organ

  3. Pattern of use of antibiotics in hospitalized patients in the medicine department of a tertiary care hospital

    OpenAIRE

    2015-01-01

    Background: (1) To assess pattern of antibiotic use among in-patients of medicine unit in a tertiary care hospital, (2) to determine the frequency of adverse drug reactions (ADR) among the inpatients receiving antibiotics in medicine unit. Methods: The study was prospective and based on the daily review of patient records for 2 months (June, July) of study period, including all the inpatients of medicine unit 1 receiving antimicrobials. The general information of the patients, infection, a...

  4. Steps Toward Creating A Therapeutic Community for Inpatients Suffering from Chronic Ulcers: Lessons from Allada Buruli Ulcer Treatment Hospital in Benin

    Science.gov (United States)

    Amoussouhoui, Arnaud Setondji; Johnson, Roch Christian; Sopoh, Ghislain Emmanuel; Agbo, Ines Elvire; Aoulou, Paulin; Houezo, Jean-Gabin; Tingbe-Azalou, Albert; Boyer, Micah; Nichter, Mark

    2016-01-01

    Background Reducing social distance between hospital staff and patients and establishing clear lines of communication is a major challenge when providing in-patient care for people afflicted by Buruli ulcer (BU) and chronic ulcers. Research on hospitals as therapeutic communities is virtually non-existent in Africa and is currently being called for by medical anthropologists working in the field of health service and policy planning. This paper describes a pioneering attempt to establish a therapeutic community for patients suffering from BU and other chronic ulcers requiring long term hospital care in Benin. Methods A six-month pilot project was undertaken with the objectives of establishing a therapeutic community and evaluating its impact on practitioner and patient relations. The project was designed and implemented by a team of social scientists working in concert with the current and previous director of a hospital serving patients suffering from advanced stage BU and other chronic ulcers. Qualitative research initially investigated patients’ understanding of their illness and its treatment, identified questions patients had about their hospitalization, and ascertained their level of social support. Newly designed question–answer health education sessions were developed. Following these hospital wide education sessions, open forums were held each week to provide an opportunity for patients and hospital staff to express concerns and render sources of discontent transparent. Patient group representatives then met with hospital staff to problem solve issues in a non-confrontational manner. Psychosocial support for individual patients was provided in a second intervention which took the form of drop-in counseling sessions with social scientists trained to serve as therapy facilitators and culture brokers. Results Interviews with patients revealed that most patients had very little information about the identity of their illness and the duration of their

  5. Determinants of patient satisfaction: a study among 39 hospitals in an in-patient setting in Germany.

    Science.gov (United States)

    Schoenfelder, Tonio; Klewer, Joerg; Kugler, Joachim

    2011-10-01

    To identify key determinants of patient satisfaction. Data used were obtained through a self-administered, post-visit questionnaire by random sampling during the period of January 2009 to September 2009. Thirty-nine hospitals in Germany. A total of 8,428 patients. Global patient satisfaction was measured by a single item question. Attributes of medical aspects of care were measured using 12 items, performance of service using 3 items and different dimensions of patient expectations using 12 items. Medical aspects of care and performance of service items were entered into logistic regression analysis to identify determinants of patient satisfaction. The results of the analysis showed that there are 10 determinants of global patient satisfaction. The outcome of treatment was overall, the most salient predictor followed by nursing kindness as the second most important component. Items reflecting information receiving about the undergoing treatment do not have a major influence on patient satisfaction. The analysis identified key determinants that should be altered first in order to improve global patient satisfaction. The results also indicate that some aspects of the hospital stay are not seen as relevant by patients and therefore are unrelated to satisfaction ratings. The findings suggest that variables measuring patients' perceptions of care are more important determinants of global patient satisfaction in comparison to demographics and visit characteristics. Results of the present study have implications for health providers aiming at improving the service quality and quality of care.

  6. WHAT PATIENTS WANT TO KNOW ABOUT THEIR MEDICATION? : A SURVEY OF INPATIENTS AND OUTPATIENTS AT GONDAR UNIVERSITY HOSPITAL

    Directory of Open Access Journals (Sweden)

    Alemayehu Berhane*, Abiey Getahun, Asfaw Azanaw and Sherefedin Hamza

    2013-01-01

    Full Text Available Patients want and are seeking more information about drug and nondrug treatment options. While a great deal of patient information about medications, treatments, and diseases exists, much of it contains conflicting, inaccurate, poorly written, or non–evidence-based information. The objective of the study was thus, to assess what patients want to know about their medications at Gondar University Hospital. The study was conducted in Gondar University Hospital over 1 month period from March 1- 30, 2012. Data was collected using convenience sampling technique from 384 respondents using structured questionnaire which consists of 40 items. All data collected were then analyzed using the Statistical Package for Social Sciences (SPSS, v19 software. In the study 238 (68% male and 146(32% female patients were included. From the total questions forwarded for the total population 165(43% responded drug information as very relevant, 156(40.6% responded drug information as relevant, 40(10.4% responded drug information as somewhat relevant and 23(6% answered drug information as not relevant. Concerning drug information source the result showed that 49%, 49% and 2% of the patients got drug information from pharmacists, doctors and nurses respectively. Physicians, pharmacists and other health professionals should provide both written and oral information with their medication in order to meet the need what patients want to know about their medication.

  7. Off-Label Medicine Use in Pediatric Inpatients: A Prospective Observational Study at a Tertiary Care Hospital in India

    Directory of Open Access Journals (Sweden)

    Mohd Masnoon Saiyed

    2014-01-01

    Full Text Available Background. In the absence of standard pediatric prescribing information, clinicians often use medicines in an off-label way. Many studies have been published across the globe reporting different rates of off-label use. There is currently no study based on Indian drug formulary. Methods. The prospective observational study included pediatric patients in ages between 0 and 12 years admitted in a tertiary care hospital. Off-label use was assessed using the National Formulary of India (NFI. Predictors of off-label use were determined by logistic regression. Results. Of the 1645 medications prescribed, 1152 (70% were off-label based on 14 possible off-label categories. Off-label medicines were mainly due to dose difference and use in restricted age limits as indicated in NFI. Respiratory medicines (82%, anti-infectives (73%, and nervous system medicines (53% had higher off-label use. Important predictors of off-label prescribing were pediatric patients in age of 0 to 2 years (OR 1.68, 95% CI; P<0.001 and hospital stay of six to 10 days (OR 1.91, 95% CI; P<0.001. Conclusion. Off-label prescribing is common among pediatric patients. There is need to generate more quality data on the safety and efficacy of off-label medicines to rationalize pediatric pharmacotherapy.

  8. Validity of the CAGE questionnaire for screening alcohol-dependent inpatients on hospital wards Validade do questionário CAGE para rastrear pacientes com dependência ao álcool internados em enfermarias clínicas

    Directory of Open Access Journals (Sweden)

    Maria Alicia Castells

    2005-03-01

    Full Text Available OBJECTIVE: To verify the validity of the CAGE questionnaire in screening inpatients with alcohol dependence. METHODS: In a transversal study, 747 medical inpatients hospitalized on general medical wards in the Federal University of Santa Catarina University Hospital were evaluated. Sociodemographic and clinical data were collected and the following instruments were used: the CAGE questionnaire and the Mini International Neuropsychiatry Interview (MINI, the latter being a semi-structured interview used as the gold standard for diagnosing alcohol dependence (according to DSM-IV criteria. Validity indices (sensitivity and specificity were assessed for the different possible CAGE cut-off points. The ROC curve was used to determine the best cut-off point. RESULTS: The sample was composed of 747 patients. Most were men (66%, white (85% and married (61%. Mean age was 50 ± 17 years, and mean level of education was 6 ± 4 years. According to the MINI, 48 patients (6.6% were diagnosed as having alcohol dependence. The CAGE questionnaire presented its highest sensitivity (93.8% when the cut-off point of 0/1 (one or more "positive" responses indicating a positive test was used. The specificity for this cut-off point was 85.5%. CONCLUSION: Using the 0/1 cut-off point, the CAGE questionnaire presented good sensitivity (93.8% and specificity (85.5% for use in general hospital ward patients. Since it is an easily applied, rapidly executed and inexpensive instrument, it could be useful in screening such patients for alcohol dependence.OBJETIVO: Verificar a validade do questionário CAGE para rastrear pacientes com dependência ao álcool internados em enfermarias de clínica médica. MÉTODOS: Trata-se de um estudo transversal, no qual foram selecionados 747 pacientes internados na clínica médica do Hospital Universitário da Universidade Federal de Santa Catarina. Foram colhidos dados sociodemográficos e clínicos e aplicados os seguintes instrumentos: o

  9. 医保患者和自费患者住院费用及其影响因素%Contrast of hospitalization expense and analysis of its affecting factors between insured and uninsured inpatients

    Institute of Scientific and Technical Information of China (English)

    张丽华

    2014-01-01

    目的:对医保患者和自费患者住院费用差异性做出分析,找出其中的关键可控因素,从而在一定程度上控制医保医疗费用的过快增长。方法对从湖北某三甲医院HIS系统收集的2010~2012年医保出院患者和自费出院患者住院数据进行比较,并对两者的各项费用进行差异性分析。结果医保患者人均费用增长率高于自费患者人均费用增长率;医保患者人均药品费占人均住院费用比高于自费患者人均药品费占比。结论为医院医保管理找出医保费用增长的原因,并提出医院合理控制医疗费用的建议。%Objective Make the comparative analysis on hospitalization expenses between insured and uninsured inpatients and find out the key factors so as to control excessive growth of the medical insurance expense .Methods Compare and analyze the hos-pitalized data of the 2010 ~2012 insured and uninsured inpatients from a hospital'HIS system in Hubei.Results The insured inpatients'growth rate of per capita cost is higher than the uninsured inpatients';The per capita proportion of drug fees in the hospi-talization expenses of the insured inpatients is higher than that of the uninsured inpatients .Conclusion Find out the reasons of the growth of the medical insurance expense and propose the reasonable recommendations for controlling hospital 's medical expenses.

  10. Knowledge gaps about smoking cessation in hospitalized patients and their doctors.

    OpenAIRE

    Raupach, Tobias; Merker, Jacqueline; Hasenfuß, Gerd; Andreas, Stefan; Pipe, Andrew

    2011-01-01

    BACKGROUND: Hospitalization is an opportune time for smoking cessation support; cessation interventions delivered by hospital physicians are effective. While general practitioners' and outpatients' knowledge and attitudes towards smoking cessation have been studied in great detail, in-patient cessation programmes have received less attention. DESIGN: Questionnaire-based survey of a convenience sample of hospital physicians and in-patients at Göttingen University Hospital, Germany. M...

  11. 某院19起住院患者自杀事件特征分析%Analysison 19 Suicide Cases of Inpatient in Certain Hospital

    Institute of Scientific and Technical Information of China (English)

    卢昌懿; 谢红珍

    2014-01-01

    目的:分析综合医院住院患者发生自杀事件的特点规律,为防范住院患者自杀提供依据。方法回顾性分析某三甲医院2008年4月至2012年10月发生的19起住院患者自杀事件的特点、自杀的时间、方式等。结果住院患者自杀涉及全院内、外、专、老年病科等12个科室;肿瘤患者7例、占36.8%,肾病终末期患者5例、占26.3%;跳楼16例、占84.2%;自杀时间是午后至夜间,其中晚夜间15例,占78.9%;结论自杀事件可发生在综合医院的任何科室、任何年龄、性别的成人患者中;肿瘤、肾病终末期和抑郁症等精神障碍患者是住院患者自杀的高危人群;晚夜间,特别是凌晨是患者自杀的高危时段;跳楼是医院住院患者自杀采取的主要方式。安全警示:应加强医护人员识别和处置意识和能力;规范管理,关注自杀高危人群的,完善病区环境安全设施。%Objective To analyze features of suicides of inpatients in comprehensive hospital , to provide evidence for suicide prevention .Method A retrospective analysis of 19 suicide incidents from April 2008 to Octo-ber 2012 in certain hospital was conducted .The characteristics , time and methods of suicide were analyzed .Re-sults Suicidal inpatients come from 12 departments , including departments of internal medicine , surgery and geri-atrics.There are 7 patients of tumor, accounts for 36.8%.There are 5 patients of nephropathy at terminal stage , accounting for 26 .3%.As for their methods , there are 16 patients jumping to death , accounting for 84 .2%.The time of committing suicides ranges from afternoon to night .There are 15 patients committing suicide at midnight , accounting for 78 .9%.Conclusion Suicides can occur in any adult patients at any age of any sex from any de-partments .Patients of tumor , nephropathy at terminal stage , depression and other mental disorder are at high risk of committing

  12. Profilaxia para tromboembolia venosa em um hospital geral Venous thromboembolism prophylaxis in a general hospital

    Directory of Open Access Journals (Sweden)

    Fernanda Fuzinatto

    2011-04-01

    Full Text Available OBJETIVO: Avaliar a prática de profilaxia para tromboembolia venosa (TEV em pacientes em um hospital geral. MÉTODOS: Estudo de coorte transversal conduzido no Hospital Nossa Senhora da Conceição, localizado na cidade de Porto Alegre (RS, com uma amostra constituída de pacientes internados selecionados randomicamente entre outubro de 2008 e fevereiro de 2009. Foram incluídos pacientes maiores de 18 anos e internados por mais de 48 h. Os critérios de exclusão foram pacientes em uso de anticoagulantes, história de doença tromboembólica, gestação e puerpério. A adequação da profilaxia foi avaliada seguindo as recomendações de um protocolo criado pela instituição e tendo como base principal a diretriz da American College of Chest Physician, oitava edição. RESULTADOS: Foram incluídos 262 pacientes com média de idade de 59,1 ± 16,6 anos. Os fatores de risco mais comuns foram imobilização (70,6%, infecção (44,3%, câncer (27,5%, obesidade (23,3% e cirurgia maior (14,1%. Na avaliação do nível de risco para TEV, 143 (54,6% e 117 pacientes (44,7%, respectivamente, foram classificados como de risco alto e moderado. No geral, 46,2% dos pacientes tiveram profilaxia adequada, assim como 25% dos pacientes com três ou mais fatores de risco e 18% dos pacientes com câncer, e houve diferenças estatisticamente significativas entre esses grupos quando comparados àqueles com menos de três fatores de risco e sem câncer (p OBJECTIVE: To evaluate the use of venous thromboembolism (VTE prophylaxis in a general hospital. METHODS: A cross-sectional cohort study at the Hospital Nossa Senhora da Conceição, located in the city of Porto Alegre, Brazil, involving a random sample of patients admitted between October of 2008 and February of 2009. We included patients over 18 years of age and hospitalized for more than 48 h. The exclusion criteria were anticoagulant use, pregnancy, puerperium, and a history of thromboembolic disease. The

  13. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2018 Rates; Quality Reporting Requirements for Specific Providers; Medicare and Medicaid Electronic Health Record (EHR) Incentive Program Requirements for Eligible Hospitals, Critical Access Hospitals, and Eligible Professionals; Provider-Based Status of Indian Health Service and Tribal Facilities and Organizations; Costs Reporting and Provider Requirements; Agreement Termination Notices. Final rule.

    Science.gov (United States)

    2017-08-14

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2018. Some of these changes implement certain statutory provisions contained in the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, the 21st Century Cures Act, and other legislation. We also are making changes relating to the provider-based status of Indian Health Service (IHS) and Tribal facilities and organizations and to the low-volume hospital payment adjustment for hospitals operated by the IHS or a Tribe. In addition, we are providing the market basket update that will apply to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2018. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2018. In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific Medicare providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities). We also are establishing new requirements or revising existing requirements for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) participating in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program. We also are making changes relating to transparency of accrediting organization survey

  14. An analysis of acute admissions to a general hospital psychiatric unit

    African Journals Online (AJOL)

    QuickSilver

    Statistics for 1999 showed that Helen Joseph Hospital admits on the average 53 new .... Lund C & Flisher AJ. South African Mental Health Process Indicators. .... paper) will fall well on the ears of general hospital management. Moosa and ...

  15. Prevalence and etiologic agents of female reproductive tract infection among in-patients and out-patients of a tertiary hospital in Benin city, Nigeria

    Directory of Open Access Journals (Sweden)

    Christopher Aye Egbe

    2010-10-01

    Full Text Available Background: Reproductive tract infections are public health problems in women of reproductive age and can result in serious consequences if not treated. Aims: To determine the prevalence and causes of reproductive tract infections among in-patients and out-patients attending a tertiary health institution in Benin City. The antimicrobial susceptibility profiles of bacterial agents will also be determined. Patients and Methods: High vaginal swabs or endocervical swabs and blood were collected from 957 patients consisting of 755 out-patients and 202 in-patients. The swabs were processed and microbial isolates identified using standard technique. Disc susceptibility tests were also performed on microbial isolates. The blood samples were used for serological diagnosis of syphilis. Results: There was no significant difference in the prevalence of female reproductive tract infections between in-patients (52.48% and out-patients (47.02%, although in-patients showed a significantly higher risk of developing mixed infections (in-patients vs. out-patients; 34.91% vs. 22.25%, OR = 1.873 95% CI = 1.169, 3.001; P = 0.01. Candida albicans was the most prevalent etiologic agent among out-patients studied while Staphylococcus aureus was the most prevalent etiologic agent among in-patients. Trichomonas vaginalis was observed only among out-patients. Ceftriaxone, ciprofloxacin and ofloxacin were the most active antibacterial agents. Syphilis was not detected in any patient. Conclusion: An overall prevalence of 48.17% of female reproductive tract infection was observed among the study population. Although there was no significant difference between in-patients and out-patients, in-patients appeared to have 1-3-fold increase risk of developing mixed infections. The most prevalent etiologic agent differs between in-patients and out-patients. Despite the high activity of ceftriaxone, ciprofloxacin and ofloxacin against bacterial isolates from both in-patients and out

  16. Prevalence and etiologic agents of female reproductive tract infection among in-patients and out-patients of a tertiary hospital in Benin city, Nigeria

    Directory of Open Access Journals (Sweden)

    Richard Omoregie

    2010-01-01

    Full Text Available Background: Reproductive tract infections are public health problems in women of reproductive age and can result in serious consequences if not treated. Aims: To determine the prevalence and causes of reproductive tract infections among in-patients and out-patients attending a tertiary health institution in Benin City. The antimicrobial susceptibility profiles of bacterial agents will also be determined. Patients and methods: High vaginal swabs or endocervical swabs and blood were collected from 957 patients consisting of 755 out-patients and 202 in-patients. The swabs were processed and microbial isolates identified using standard technique. Disc susceptibility tests were also performed on microbial isolates. The blood samples were used for serological diagnosis of syphilis. Results: There was no significant difference in the prevalence of female reproductive tract infections between in-patients (52.48% and out-patients (47.02%, although in-patients showed a significantly higher risk of developing mixed infections (in-patients vs. out-patients; 34.91% vs. 22.25%, OR = 1.873 95% CI = 1.169, 3.001; P = 0.01. Candida albicans was the most prevalent etiologic agent among out-patients studied while Staphylococcus aureus was the most prevalent etiologic agent among in-patients. Trichomonas vaginalis was observed only among out-patients. Ceftriaxone, ciprofloxacin and ofloxacin were the most active antibacterial agents. Syphilis was not detected in any patient. Conclusion: An overall prevalence of 48.17% of female reproductive tract infection was observed among the study population. Although there was no significant difference between in-patients and out-patients, in-patients appeared to have 1-3-fold increase risk of developing mixed infections. The most prevalent etiologic agent differs between in-patients and out-patients. Despite the high activity of ceftriaxone, ciprofloxacin and ofloxacin against bacterial isolates from both in-patients and out

  17. Perfil del embarazo prolongado en pacientes de un hospital general

    Directory of Open Access Journals (Sweden)

    Flor de Maria Chavarry Valencia

    2009-10-01

    Full Text Available Objetivo: Determinar las características maternas y perinatales de las pacientes con diagnóstico de embarazo prolongado (EP en un hospital general. Material y métodos: Estudio retrospectivo tipo serie de casos, realizado en el Hospital Nacional Cayetano Heredia del 1° de enero de 2000 al 31 de diciembre de 2004. Se incluyeron 341 pacientes con diagnóstico de EP (>42 semanas basado en la fecha de último periodo menstrual o ecografía del primer trimestre. Resultados: El 76% de pacientes tenían una edad entre 20 a 35 años con una media de 25,8 ± 6,1 años. El 47,5% eran nulíparas. El 71,3% había ya iniciado una labor de parto espontánea; 16,4% fueron inducidas y 12,3% tuvieron indicación de cesárea al ingreso. Del grupo con inicio de trabajo de parto espontáneo el 71,6% terminó en parto vaginal; 19,3% cesárea, y 9,1% parto vaginal instrumentado. De las inducciones, el 71,4% tuvo parto vaginal espontáneo, 23,2% cesárea y 5,4% instrumentado. El 62% terminó en parto vaginal espontáneo, 29,9% en cesárea y 7,4% instrumentado. El 85,9% fue adecuado para EG, 11,1% grande para la EG, y 3% pequeño para la EG. El 53,4% de RN tuvo de 37 a 41 semanas por Capurro; 45,7% fueron >42 semanas y 0,9% tuvo < 37 semanas. El Apgar a los 5 minutos fue de 7 a 10 en 333 casos, < 7 en 4 RN. Ocurrieron 4 óbitos fetales (1,1%. Conclusión: El EP se encontró en mayor frecuencia en pacientes adultas y nulíparas, el inicio del trabajo de parto espontáneo fue el más frecuente y la vía de parto vaginal la más frecuente. Las complicaciones fueron bajas en los RN vivos, sin embargo la tasa de mortalidad fetal fue elevada de 11 por mil. La indicación más frecuente de cesárea fue DCP y sufrimiento fetal agudo. (Rev Med Hered 2009;20:200-205.

  18. Nutritional assessment associated with length of inpatients' hospital stay Evaluación nutricional asociada con la estancia hospitalaria

    Directory of Open Access Journals (Sweden)

    H. G. Valente da Silva

    2012-04-01

    Full Text Available Objective: To evaluate the nutritional status of patients on hospital admission, identify the length of hospital stay and identify the parameters of nutritional assessment that are most closely related with the length of stay (LOS. Methods: A cross-sectional study of 278 hospitalized patients evaluated patients´ nutritional status in the 48 hours after admission and their LOS after discharge. Anthropometric and biochemical parameters, related to nutrition status were analyzed, such as: weight, height, arm circumference (AC, waist circumference (WC, triceps skinfold thickness (TST, mild arm muscle circumference (MAMC, albumin (Alb and hemoglobin (HB. Body mass index (BMI was used to classify the nutritional status. All the nutritional factors except type of disease, gender and age were associated with LOS. The chi-square, Student-t, Mann-Whitney, Kruskal-Wallis and binary logistic multivariate tests were used in the statistical analyses. Results: The majority of patients was male (53%, elderly (56% and had neoplasm (19.4%. Undernutrition was higher in the elderly (p Objetivo: Evaluar el estado nutricional de los pacientes ingresados en el hospital, identificar la duración de la estancia hospitalaria e identificar los parámetros de la evaluación nutricional que se relacionen más estrechamente con la duración de la estancia (DE. Métodos: Se evaluó en un estudio transversal con 278 pacientes hospitalizados el estado nutricional en las 48 horas siguientes al ingreso y su DE tras el alta. Se analizaron los parámetros antropométricos y bioquímicos en relación con el estado nutricional, tales como: peso, talla, circunferencia del brazo (CB, circunferencia de la cintura (CC, el grosor del pliegue cutáneo tricipital (GPT, la circunferencia de la musculatura del brazo (CMB, la albúmina (Alb y la hemoglobina (HB. Se empleó el índice de masa corporal (IMC para clasificar el estado nutricional. Todos los factores nutricionales salvo el tipo de

  19. Point prevalence study of pediatric inpatients who are unable to communicate effectively about pain.

    Science.gov (United States)

    Hill, Douglas L; Carroll, Karen W; Dougherty, Susan; Vega, Cassandra; Feudtner, Chris

    2014-11-01

    Pediatric inpatients may be at risk for inadequate pain management if they are unable to communicate effectively because of age, physical or cognitive impairment, or medical procedures. We conducted a point prevalence study to estimate the proportion of inpatients at a children's hospital who have difficulty communicating to hospital staff. We obtained nurse reports of ability to communicate for all inpatients aged ≥12 months in a pediatric hospital. Demographic information was obtained from the medical record. Questionnaires were completed for 254 inpatients. Forty percent of inpatients had some difficulty communicating, and 69% had experienced pain during the hospitalization. Patient ability to communicate was not related to experiencing pain (χ(2) test, P = .30) or effectiveness of pain management (χ(2) test, P = .80) but was associated with difficulty communicating about pain and nurses needing help from the caretaker to communicate with the patient (χ(2) tests, Ps communicating effectively and experienced pain during hospitalization. These communication difficulties were not associated with nurse reports of the effectiveness of pain management. However, patients who had difficulties communicating in general were also more likely to have difficulty communicating about pain specifically, and nurses were more likely to need help from the caregiver to understand these patients. Future directions include identifying which conditions, procedures, and medications are associated with inability to communicate. Copyright © 2014 by the American Academy of Pediatrics.

  20. Nursing clinical handover improvement practices among acute inpatients in a tertiary hospital in Sydney: a best practice implementation project.

    Science.gov (United States)

    Wainwright, Craig; Wright, Kylie M

    2016-10-01

    The nursing handover normally occurs at the beginning of a nurse's shift and is considered essential for continuity of care. Nursing handovers have the potential to communicate accurate information about a patient's condition, treatment and anticipated needs but also to be ineffective or even harmful if information is incomplete or omitted. The Australian Commission on Safety and Quality in Health Care has recognized clinical handover as a National Standard, thus reinforcing its importance. This project aimed to conduct an audit of nursing clinical handover practices to implement evidence-based best practice recommendations to assess the effectiveness of these strategies to maximize the effectiveness of clinical handover across 11 units in a large tertiary hospital. The project used the Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research into Practice audit tool for promoting change in healthcare practice. A baseline audit of 330 observations of nursing clinical handover was conducted and measured against seven best practice recommendations, followed by the implementation of targeted strategies and a follow-up audit. The baseline audit revealed significant deficits between current practice and best practice in all but one criterion. Barriers for implementation of nursing clinical handover best practice criteria were identified by the project team, and a bundled education strategy was implemented. There were significantly improved outcomes across all best practice criteria in the follow-up audit. The findings showed how audits may be used to promote best practice in healthcare and that focused education and provision of relevant resources can have an immediate and positive impact on clinical practice. Some of the measured criteria improved to a moderate degree, leaving room for improvement; however, by the end of the project attitudes toward nursing clinical handover had been "transformed" from a passive routine "must do

  1. Hospitable archean climates simulated by a general circulation model.

    Science.gov (United States)

    Wolf, E T; Toon, O B

    2013-07-01

    Evidence from ancient sediments indicates that liquid water and primitive life were present during the Archean despite the faint young Sun. To date, studies of Archean climate typically utilize simplified one-dimensional models that ignore clouds and ice. Here, we use an atmospheric general circulation model coupled to a mixed-layer ocean model to simulate the climate circa 2.8 billion years ago when the Sun was 20% dimmer than it is today. Surface properties are assumed to be equal to those of the present day, while ocean heat transport varies as a function of sea ice extent. Present climate is duplicated with 0.06 bar of CO2 or alternatively with 0.02 bar of CO2 and 0.001 bar of CH4. Hot Archean climates, as implied by some isotopic reconstructions of ancient marine cherts, are unattainable even in our warmest simulation having 0.2 bar of CO2 and 0.001 bar of CH4. However, cooler climates with significant polar ice, but still dominated by open ocean, can be maintained with modest greenhouse gas amounts, posing no contradiction with CO2 constraints deduced from paleosols or with practical limitations on CH4 due to the formation of optically thick organic hazes. Our results indicate that a weak version of the faint young Sun paradox, requiring only that some portion of the planet's surface maintain liquid water, may be resolved with moderate greenhouse gas inventories. Thus, hospitable late Archean climates are easily obtained in our climate model.

  2. Phenotypic and molecular detection of the bla KPC gene in clinical isolates from inpatients at hospitals in São Luis, MA, Brazil.

    Science.gov (United States)

    Ribeiro, Patricia Cristina Saldanha; Monteiro, Andrea Souza; Marques, Sirlei Garcia; Monteiro, Sílvio Gomes; Monteiro-Neto, Valério; Coqueiro, Martina Márcia Melo; Marques, Ana Cláudia Garcia; de Jesus Gomes Turri, Rosimary; Santos, Simone Gonçalves; Bomfim, Maria Rosa Quaresma

    2016-12-07

    Bacteria that produce Klebsiella pneumoniae carbapenemases (KPCs) are resistant to broad-spectrum β-lactam antibiotics. The objective of this study was to phenotypically and genotypically characterize the antibiotic susceptibility to carbapenems of 297 isolates recovered from clinical samples obtained from inpatients at 16 hospitals in São Luis (Maranhão, Brazil). The study was conducted using phenotypic tests and molecular methods, including polymerase chain reaction (PCR), sequencing and enterobacterial repetitive intergenic consensus (ERIC)-PCR. The nonparametric chi-square test of independence was used to evaluate the associations between the bacterial bla KPC gene and the modified Hodge test, and the chi-square adherence test was used to assess the frequency of carbapenemases and their association with the bla KPC gene. The most frequently isolated species were Acinetobacter baumannii (n = 128; 43.0%), K. pneumoniae (n = 75; 25.2%), and Pseudomonas aeruginosa (n = 42; 14.1%). Susceptibility assays showed that polymixin B was active against 89.3% of the bacterial isolates. The Acinetobacter spp. and K. pneumoniae strains were susceptible to amikacin and tigecycline, and Pseudomonas spp. were sensitive to gentamicin and amikacin. Among the 297 isolates, 100 (33.7%) were positive for the bla KPC gene, including non-fermentative bacteria (A. baumannii) and Enterobacteriaceae species. Among the isolates positive for the bla KPC gene, K. pneumoniae isolates had the highest positivity rate of 60.0%. The bla KPC gene variants detected included KPC-2, which was found in all isolates belonging to species of the Enterobacteriaceae family. KPC-2 and KPC-3 were observed in A. baumannii isolates. Importantly, the bla KPC gene was also detected in three Raoultella isolates and one isolate of the Pantoea genus. ERIC-PCR patterns showed a high level of genetic diversity among the bacterial isolates; it was capable of distinguishing 34 clones among 100 strains

  3. An observational study in psychiatric acute patients admitted to General Hospital Psychiatric Wards in Italy

    Directory of Open Access Journals (Sweden)

    Margari Francesco

    2007-01-01

    Full Text Available Abstract Objectives this Italian observational study was aimed at collecting data of psychiatric patients with acute episodes entering General Hospital Psychiatric Wards (GHPWs. Information was focused on diagnosis (DSM-IV, reasons of hospitalisation, prescribed treatment, outcome of aggressive episodes, evolution of the acute episode. Methods assessments were performed at admission and discharge. Used psychometric scales were the Brief Psychiatric Rating Scale (BPRS, the Modified Overt Aggression Scale (MOAS and the Nurses' Observation Scale for Inpatient Evaluation (NOSIE-30. Results 864 adult patients were enrolled in 15 GHPWs: 728 (320 M; mean age 43.6 yrs completed both admission and discharge visits. A severe psychotic episode with (19.1% or without (47.7% aggressive behaviour was the main reason of admission. Schizophrenia (42.8% at admission and 40.1% at discharge and depression (12.9% at admission and 14.7% at discharge were the predominant diagnoses. The mean hospital stay was 12 days. The mean (± SD total score of MOAS at admission, day 7 and discharge was, respectively, 2.53 ± 5.1, 0.38 ± 2.2, and 0.21 ± 1.5. Forty-four (6.0% patients had episodes of aggressiveness at admission and 8 (1.7% at day 7. A progressive improvement in each domain/item vs. admission was observed for MOAS and BPRS, while NOSIE-30 did not change from day 4 onwards. The number of patients with al least one psychotic drug taken at admission, in the first 7 days of hospitalisation, and prescribed at discharge, was, respectively: 472 (64.8%, 686 (94.2% and 676 (92.9%. The respective most frequently psychotic drugs were: BDZs (60.6%, 85.7%, 69.5%, typical anti-psychotics (48.3%, 57.0%, 49.6%, atypical anti-psychotics (35.6%, 41.8%, 39.8% and antidepressants (40.9%, 48.8%, 43.2%. Rates of patients with one, two or > 2 psychotic drugs taken at admission and day 7, and prescribed at discharge, were, respectively: 24.8%, 8.2% and 13.5% in mono-therapy; 22.0%, 20

  4. Epidemia de influenza A(H1N1 en la Argentina: Experiencia del Hospital Nacional Profesor Alejandro Posadas Influenza A(H1N1 epidemic in Argentina: Experience in a National General Hospital (Hospital Nacional Profesor Alejandro Posadas

    Directory of Open Access Journals (Sweden)

    2009-10-01

    Full Text Available Se describe la preparación y la atención médica durante la epidemia de influenza A(H1N1 (junio 2009 en un hospital general de agudos, público, de alta complejidad; con diagnóstico de laboratorio, internación general y cuidados intensivos (UCI. Se elaboró un plan para aumentar la capacidad asistencial, reasignar recursos y garantizar la bioseguridad. La consulta fue 7.1 ± 3.8 veces mayor que en 2006-2008. La detección de casos de A(H1N1 fue confirmada por PCR-RT en 186/486 (38.3% pacientes internados y en 56/176 (31.8% ambulatorios. Internados: mediana de edad 20 años; 75% menores de 45 y 32.3% menores de 15. Mortalidad global: 6.8%; 9.1% en los positivos. Adultos: recepción en un área de atención ambulatoria, internación (aislamiento y ventilación mecánica. Sala general: ingresaron 110 pacientes (5 veces más que 1999-2006 con saturación de oxígeno The preparation and medical care during the influenza A(H1N1 outbreak (June 2009 in a high complexity level, public, general hospital with laboratory diagnosis, general and intensive care (ICU hospitalization is described. A plan was designed to increase the hospital's surge capacity, reallocate resources and guarantee bio-safety. The number of consultations was 7.1 ± 3.8 times higher than during June 2006-2008. Detection of A(H1N1 cases were confirmed by PCR-RT in 186/486 (38.3% in-patients and 56/176 (31.8% out-patients. Median age among in-patients was 20 years; 75% < 45 and 32.3% < 15. Global mortality: 6.8%; 9.1% among confirmed cases. Adults were directed to a reception area of out-patient care, hospitalization (isolation and mechanical ventilation. General ward: 110 patients with oxygen saturation < 96% and/or risk factors (65.5% had asthma, chronic obstructive pulmonary disease, obesity, pregnancy or other were admitted (5 times more than in 1999-2006. Chest X-ray showed lung infiltrates and/or lung consolidation in 97.3%. Severe hypoxemia: 43.5%. There were no significant

  5. Attitudes of Malaysian general hospital staff towards patients with mental illness and diabetes

    OpenAIRE

    Minas, H.; Zamzam, R; Midin, M; Cohen, A

    2011-01-01

    Abstract Background The context of the study is the increased assessment and treatment of persons with mental illness in general hospital settings by general health staff, as the move away from mental hospitals gathers pace in low and middle income countries. The purpose of the study was to examine whether general attitudes of hospital staff towards persons with mental illness, and extent of mental health training and clinical experience, are associated with different attitudes and behaviours...

  6. Behavior Assessment in Children Following Hospital-Based General Anesthesia versus Office-Based General Anesthesia

    Directory of Open Access Journals (Sweden)

    LaQuia A. Vinson

    2016-08-01

    Full Text Available The purpose of this study was to determine if differences in behavior exist following dental treatment under hospital-based general anesthesia (HBGA or office-based general anesthesia (OBGA in the percentage of patients exhibiting positive behavior and in the mean Frankl scores at recall visits. This retrospective study examined records of a pediatric dental office over a 4 year period. Patients presenting before 48 months of age for an initial exam who were diagnosed with early childhood caries were included in the study. Following an initial exam, patients were treated under HBGA or OBGA. Patients were followed to determine their behavior at 6-, 12- and 18-month recall appointments. Fifty-four patients received treatment under HBGA and 26 were treated under OBGA. OBGA patients were significantly more likely to exhibit positive behavior at the 6- and 12-month recall visits p = 0.038 & p = 0.029. Clinicians should consider future behavior when determining general anesthesia treatment modalities in children with early childhood caries presenting to their office.

  7. 某医院住院患者乙肝患病率调查%Hepatitis B infection rate of inpatients at Shuyang People's Hospital

    Institute of Scientific and Technical Information of China (English)

    张国明; 陆东阁

    2014-01-01

    Objective To understand the situation and detection results of hepatitis B infection of the inpatients at Shuyang People's Hospital.Methods Inpatients checked quantitative HBV from July 2011 to July 2013 at Shuyang People's Hospital were retrospectively analyzed.Five hepatitis B indicators were tested by time-resolved fluorescence immunoassay.If0.2 ng/ml < HBsAg < 10 ng/ml and both HBsAg and HBsAb were positive,the hepatitis B test results were rechecked.Results 11 826 cases were detected.768 cases were positive in HBsAg,with a positive rate of 6.5%.HBsAg test results were 0.2-1.0 ng/ml,1.1-10.0 ng/ml,10.1-100.0 ng/ml,100.1-225.0 ng/ml,and > 225 ng / ml,with 10 cases,27 cases,86 cases,119 cases,and 526 cases,respectively; the positive rates were 1.3%,3.5%,11.2%,15.5%,and 68.6%.1.3% (10/768) were positive in HBsAg and HBsAb,15.5% (199/768) in HBsAg,HBeAg,and HBcAb,and 62.8% (482/768) in HBsAg,HBeAb,and HBcAb.Conclusions The investigation showed that the infection rate was high.Early preventive vaccination basing on the infection mode can improve the health level of the people at Shuyang.%目的 了解沭阳县人民医院住院患者乙肝感染情况及检验结果模式.方法 回顾性分析201 1年7月至2013年7月我院住院患者中所有检查乙肝定量患者,用时间分辨荧光免疫测定乙肝五项,0.2 ng/ml<HBsAg<10 ng/ml及HBsAg和HBsAb同时阳性的检测结果用上海科华乙肝定性试剂复核.结果 共检测11 826例,HBsAg阳性者768人,阳性率6.5%; HBsAg检测结果为0.2~1.0 ng/ml、1.1~10.0 ng/ml、10.1~100.0 ng/ml、100.1~225.0 ng/ml、>225.0 ng/ml的人数分别为10人、27人、86人、119人、526人,阳性比率分别为1.3%、3.5%、11.2%、15.5%、68.6%; HBsAg和HBsAb同时阳性者占1.3%(10/768);HBsAg、HBeAg和HBcAb同时阳性者占15.5%(199/768),HBsAg、HBeAb和HBcAb同时阳性者占62.8%(482/768).结论 本次被调查者的患病率比较高,应依据感染模

  8. The effect of a whole-system approach in an antimicrobial stewardship programme at the Singapore General Hospital.

    Science.gov (United States)

    Teo, J; Kwa, A L H; Loh, J; Chlebicki, M P; Lee, W

    2012-06-01

    Inappropriate antibiotic use contributes to antimicrobial resistance. Multi-faceted antimicrobial stewardship programmes (ASPs) are recommended for sustainable changes in prescribing practices. A multi-disciplinary ASP was established in October 2008 and piloted in the Departments of General Surgery, Renal Medicine and Endocrinology sequentially. To improve the quality of patient care via optimising the (1) choice, (2) dose, (3) route and (4) duration of antibiotics, a "whole-system" approach incorporating prospective review with immediate concurrent feedback (ICF), prescriber education (public or individualised), de-escalation of therapy, dose optimisation and parenteral-to-oral conversion, while recognising the autonomy of primary prescribers, was adopted. The audited department received a quarterly outcomes report and any common unaccepted practices would be addressed. Outcomes were analysed for 12 months post-ASP implementation. A total of 1,535 antibiotic prescriptions were reviewed. Antimicrobial use in 376 (24.5%) prescriptions was inappropriate. Of 596 interventions made, 70.2% were accepted. A reduction in audited antibiotics consumption resulted in acquisition cost savings of S$198,575 for the hospital. Patients' cost-savings attributable to ASP-initiated interventions were $91,194. The overall all-cause mortality rate and median monthly inpatient-days pre- and post-intervention remained stable. A "whole-system" ASP was effective in optimising antibiotic use in our hospital, without compromising clinical outcomes.

  9. Cuidado ecológico: o significado para profissionais de um hospital geral Cuidado ecológico: el significado para profesionales de un hospital general Ecological care: meaning for health care professionals from a general hospital

    Directory of Open Access Journals (Sweden)

    Marli Terezinha Stein Backes

    2009-01-01

    ón general, todavía incipiente, respecto a la problemática ambiental. La preocupación principal está relacionada a la separación, reciclaje y destino adecuado de la basura, aunque algunos profesionales hayan destacado la importancia de medidas preventivas como el lavado de las manos, utilización de productos biodegradables, entre otros.OBJECTIVE: To understand the meaning of ecological care in view of complex thinking and how ecological care had been associated with the clinical practice of health care professionals from a general hospital. METHODS: This was a qualitative descriptive study among 15 health care professionals working in the laundry, nutrition, or inpatient unit. A semi-structured questionnaire was used to collect the data. Bardin's recommendations guided the content analysis. RESULTS: The following categories emerged: Meaning of ecological care, significance of ecological care for clinical practice, and preventive measures associated with ecological care. CONCLUSIONS: Although incipient, the findings suggest that there is a general concern regarding environmental issues. Even though some health care professionals stated the significance of hand washing and use of biodegradable products as preventive measures, the main concern was related to the separation, recycling, and disposal of trash.

  10. Facilitators and Barriers to Safe Medication Administration to Hospital Inpatients: A Mixed Methods Study of Nurses' Medication Administration Processes and Systems (the MAPS Study.

    Directory of Open Access Journals (Sweden)

    Monsey McLeod

    Full Text Available Research has documented the problem of medication administration errors and their causes. However, little is known about how nurses administer medications safely or how existing systems facilitate or hinder medication administration; this represents a missed opportunity for implementation of practical, effective, and low-cost strategies to increase safety.To identify system factors that facilitate and/or hinder successful medication administration focused on three inter-related areas: nurse practices and workarounds, workflow, and interruptions and distractions.We used a mixed-methods ethnographic approach involving observational fieldwork, field notes, participant narratives, photographs, and spaghetti diagrams to identify system factors that facilitate and/or hinder successful medication administration in three inpatient wards, each from a different English NHS trust. We supplemented this with quantitative data on interruptions and distractions among other established medication safety measures.Overall, 43 nurses on 56 drug rounds were observed. We identified a median of 5.5 interruptions and 9.6 distractions per hour. We identified three interlinked themes that facilitated successful medication administration in some situations but which also acted as barriers in others: (1 system configurations and features, (2 behaviour types among nurses, and (3 patient interactions. Some system configurations and features acted as a physical constraint for parts of the drug round, however some system effects were partly dependent on nurses' inherent behaviour; we grouped these behaviours into 'task focused', and 'patient-interaction focused'. The former contributed to a more streamlined workflow with fewer interruptions while the latter seemed to empower patients to act as a defence barrier against medication errors by being: (1 an active resource of information, (2 a passive information resource, and/or (3 a 'double-checker'.We have identified practical

  11. [Pain therapy in in-patients with cancer. Effects of a manual-based approach as guideline for pain-consulting service at a university hospital].

    Science.gov (United States)

    Brinkers, M; Pfau, Gernot; Lux, A; Pfau, Giselher; Schneemilch, C; Meyer, F; Grond, S

    2016-03-01

    Appropriate medication is an important and substantial part in the therapy of tumor-induced pain. The objective of this study was to investigate the efficiency of anaesthesiology-based consultant service characterizing the quality of this type of treatment in daily clinical practice of a university hospital, i. e., in the patient profile of a tertiary center (study design: systematic clinical, unicenter observational study reflecting clinical practice and study-based control of therapeutic care quality). In the course of consulting function with regard to pain care on the single wards a considerable portion of cancer patients are recieving drugs. For most patients such care comprises several consultations and subsequently initiated treatment modifications. The consulting function ends if the patients feel free of pain or report a substantial improvement. From 1/1/2010 to 12/31/2012 detailed information on the drug therapy applied prior to, during and after the consultation was prospectively documented.This data was retrospectively evaluated as "pre-vs.-post" comparison (Chi-squared test, Fisher's exact test and McNemar's test), in particular, focussing on the quality of pain medication using the WHO index as well as pain intensity obtained by means of the visual analogue scale (VAS). In total, 375 in-patients were treated. The modified pain medication by the anesthesiological consultant service led to a significant increase (p < 0.001; Wilcoxon's test) in the mean WHO index from 6.37 (SD, 1.83) to 8.43 (SD, 1.47). Furthermore, a reduction of VAS from 5.00 (SD, 2.39) to 2.64 (SD, 1.64) was noted (p < 0.001; Wilcoxon's test). The consequent application of established guidelines (according to WHO scheme) and the WHO index leads to a qualitative and measurable improvement of drug therapy for cancer-related pain. © Georg Thieme Verlag KG Stuttgart · New York.

  12. Bacterial Isolates and Their Antimicrobial Susceptibility Patterns of Wound Infections among Inpatients and Outpatients Attending the University of Gondar Referral Hospital, Northwest Ethiopia

    Directory of Open Access Journals (Sweden)

    Aynalem Mohammed

    2017-01-01

    Full Text Available Background. The widespread uses of antibiotics, together with the length of time over which they have been available, have led to the emergence of resistant bacterial pathogens contributing to morbidity and mortality. This study was aimed to assess bacterial isolates and their drug susceptibility patterns from inpatients and outpatients with pus and/or wound discharge. Methods. A cross-sectional study was conducted at the University of Gondar Referral Hospital from March to May, 2014. Wound swab samples were collected from each study participant and inoculated into appropriate media. The bacterial pathogens were identified using standard microbiological methods. Antimicrobial susceptibility tests were performed using disk diffusion technique following Kirby-Bauer method. Results. A total of 137 study subjects were included in the study with bacterial isolation rate of 115 (83.9%. Of all, 81 (59.1% were males. Seventy-seven (57% of the isolates were Gram-negative and 59 (43% were Gram-positive. From the total isolates, Staphylococcus aureus was the most predominant isolate 39/115 (34% followed by Klebsiella species (13%, coagulase negative staphylococci spp. (12% and Pseudomonas aeruginosa. Gram-positive isolates were resistant to ampicillin (86.4%, amoxicillin (83%, penicillin (81.3%, oxacillin (74.6%, and tetracycline (59.4%, while Gram-negative isolates were resistant to amoxicillin (97.4%, ampicillin (94.8%, tetracycline (72.7%, trimethoprim/sulfamethoxazole (66%, and chloramphenicol (54.5%. Conclusion. High prevalence of bacterial isolates was found, Staphylococcus aureus being the most dominant. High rates of multiple drug resistance pathogens to the commonly used antimicrobial agents were isolated. Therefore, concerned bodies should properly monitor the choice of antibiotics to be used as prophylaxis and empiric treatment in the study area.

  13. Inpatient Financial Burden of Atopic Dermatitis in the United States

    DEFF Research Database (Denmark)

    Narla, Shanthi; Hsu, Derek Y; Thyssen, Jacob P

    2017-01-01

    Little is known about the inpatient burden of atopic dermatitis (AD). We sought to determine the risk factors and financial burden of hospitalizations for AD in the United States. Data were analyzed from the 2002-2012 National Inpatient Sample, including a 20% representative sample of all......, there is a substantial inpatient financial burden of AD in the United States....

  14. End-of-life hospital transfers in out-of-hours general practice.

    NARCIS (Netherlands)

    Korte-Verhoef, M.C. de; Pasman, H.R.W.; Schweitzer, B.P.M.; Francke, A.L.; Onwuteaka-Philipsen, B.D.; Deliens, L.

    2012-01-01

    Background: During the end of life, many patients experience transfers from home to hospital, and the majority of them die in a hospital. Aim: To explore the reasons for hospital transfers of palliative care patients in out-of-hours general practices. Methods: A retrospective descriptive chart study

  15. A comparison of antibiotic point prevalence survey data from four Irish regional/general hospitals.

    LENUS (Irish Health Repository)

    Naughton, C

    2011-06-01

    Point prevalence surveys (PPS) are increasingly used to examining and compare hospital antibiotic consumption. The aim of this study was to identify the (1) point prevalence of antibiotic use in one regional hospital and (2) compare PPS data from similar regional\\/general hospitals.

  16. Historical Overview of Inpatient Care of Mental Patients Who Are Deaf.

    Science.gov (United States)

    Vernon, McCay; Daigle-King, Beth

    1999-01-01

    Analysis of published studies of deaf mentally ill inpatients indicates a greater overall prevalence of mental illness in the deaf population than in the general population. Characteristic symptoms leading to hospitalization of deaf people tend to be different from those of hearing patients. For both hearing and deaf patients, dual diagnosis…

  17. 精神专科医院外科住院患者精神病共病现状分析%Status analysis on psychiatric comorbidity of inpatients from surgery department of psychiatric hospitals

    Institute of Scientific and Technical Information of China (English)

    沈萍; 沈仲夏; 徐美英; 陈海勤; 金莉; 陈海支

    2012-01-01

    目的 分析精神专科医院外科住院患者精神病共病的流行病学情况及特征.方法外科住院患者791例,对其中共患精神病者进行统计学分析.结果 791例患者中共患精神病59例,精神病前3位分别为精神分裂症、抑郁症、神经症;外科疾病前3位分别为骨折、脑外伤、肠梗阻.结论 精神专科医院外科住院患者精神病共病比例高,共患疾病有相关性.%Objective To study the cpidcmiological status and characteristics on psychiatric comorbidity of inpatients from surgery department of psychiatric hospitals. Method Take statistic analysis on patients with psychiatric comorbidity from 791 inpatients from surgery department. Result There arc 59 psychiatric comorbidity patients from 791 patients. The first three of psychosis arc schizophrenia, depression and neurosis and the first three surgical diseases arc fracture, brain injury and intestinal obstruction. Conclusion There is a high level of psychiatric comorbidity among inpatients from surgery department of psychiatric hospitals. There is correlation between comorbidity diseases.

  18. Evaluation of Outpatient Antibiotic Use in Beijing General Hospitals in 2015

    Directory of Open Access Journals (Sweden)

    Chuan Yang

    2017-01-01

    Conclusions: Antibiotic use in Beijing general hospitals is generally low; however, inappropriate antibiotic use still exists. Inappropriately used antibiotics should be subject to rigorous control and management, and public policy initiatives are required to promote the judicious use of antibiotics.

  19. Inpatient cognitive behaviour therapy for adolescents with anorexia nervosa: immediate and longer-term effects

    Directory of Open Access Journals (Sweden)

    Riccardo eDalle Grave

    2014-02-01

    Full Text Available Introduction: Inpatient treatment for anorexia nervosa is often successful in restoring body weight, but a high percentage of patients relapse following discharge. The aim of the present study was to establish the immediate and longer-term effects of a novel inpatient program for adolescents that was designed to produce enduring change. Method: Twenty-seven consecutive patients with severe anorexia nervosa were admitted to a 20-week inpatient treatment program based upon enhanced cognitive behaviour therapy (CBT-E. The patients were assessed before and after hospitalization, and six and 12 months later. Results: Twenty-six patients (96% completed the program. In these patients there was a substantial improvement in weight, eating disorder features and general psychopathology that was well maintained at 12-month follow-up. Conclusions: These findings suggest that inpatient CBT-E is a promising approach to the treatment of adolescents with severe anorexia nervosa.

  20. Smoothing inpatient discharges decreases emergency department congestion: a system dynamics simulation model.

    Science.gov (United States)

    Wong, Hannah J; Wu, Robert C; Caesar, Michael; Abrams, Howard; Morra, Dante

    2010-08-01

    Timely access to emergency patient care is an important quality and efficiency issue. Reduced discharges of inpatients at weekends are a reality to many hospitals and may reduce hospital efficiency and contribute to emergency department (ED) congestion. To evaluate the daily number of ED beds occupied by inpatients after evenly distributing inpatient discharges over the course of the week using a computer simulation model. Simulation modelling study from an academic care hospital in Toronto, Canada. Daily historical data from the general internal medicine (GIM) department between 15 January and 15 December for two years, 2005 and 2006, were used for model building and validation, respectively. There was good agreement between model simulations and historical data for both ED and ward censuses and their respective lengths of stay (LOS), with the greatest difference being +7.8% for GIM ward LOS (model: 9.3 days vs historical: 8.7 days). When discharges were smoothed across the 7 days, the number of ED beds occupied by GIM patients decreased by approximately 27-57% while ED LOS decreased 7-14 hours. The model also demonstrated that patients occupying hospital beds who no longer require acute care have a considerable impact on ED and ward beds. Smoothing out inpatient discharges over the course of a week had a positive effect on decreasing the number of ED beds occupied by inpatients. Despite the particular challenges associated with weekend discharges, simulation experiments suggest that discharges evenly spread across the week may significantly reduce bed requirements and ED LOS.

  1. Time point survey of drug use inpatients of psychiatric hospital%某精神病院住院患者药物使用时点调查

    Institute of Scientific and Technical Information of China (English)

    朱颖; 王川

    2016-01-01

    目的:了解某精神病院住院患者药物使用状况,提高医院临床合理用药水平。方法利用天津市安宁医院 HIS系统对全部住院患者采用一日法进行用药时点调查。结果当日共调查616例患者,其中单用一种抗精神病药有499例(81.0%),联用两种59例(9.6%),联用三种1例(0.2%)。抗精神病药总用药例次为635,其中利培酮使用频度居首位317例(49.9%),其次为氯氮平163例(25.7%),喹硫平40例(6.3%)。共54例(8.8%)患者使用心境稳定剂,使用频率居前三位的分别为丙戊酸镁26例(48.1%),丙戊酸钠19例(35.2%),卡马西平9例(16.7%)。共222例(36.0%)患者使用抗焦虑和镇静催眠药物,其中苯二氮艹卓类药物中使用氯硝西泮74例(33.3%),其次为阿普唑仑61例(27.5%)、艾司唑仑30例(13.5%)。在躯体疾病辅助用药中,心脑血管疾病药、降糖药、保肝药物使用例数分别为468例(76.0%)、123例(20.0%)、73例(11.9%)。结论精神病院住院患者中非典型抗精神病药的使用占主导地位,且符合单一用药原则,药物使用剂量合理,但应控制苯二氮艹卓类药物的使用。%Objective To learn the status of drug use of inpatients in psychiatric hospitals,and to improve the level of hospital clinical rational drug use. Methods All hospitalized patients were investigated with a day of drug use point of time survey by the HIS system of Tianjin Anning Hospital. Results A total of 616 patients were investigated at that day. There were 499 cases(81. 0% )of single use of antipsychotic drugs,59 cases(9. 6% )with two kinds of drugs,1 case(0. 2% )with three kinds of drugs. The total cases of antipsychotic drug use were 635. The frequency of use in the first place was risperidone(317 cases,49. 9 % ),the second was 163 cases with clozapine(25. 7 % ),the third was 40 cases with quetiapine(6. 3 % ). A total of 54(8. 8

  2. Transferable and non-transferable drug resistance in enteric bacteria from hospital and from general practice

    DEFF Research Database (Denmark)

    Møller, JK; Bak, AL; Bülow, P

    1976-01-01

    Drug resistance to 8 different antibiotics in Enterobacteriaceae isolated from different hospitals and two groups of general practitioners was studied. Escherichia coli dominated among the 632 strains investigated. Drug resistance was found in 62% of the 512 hospital strains and in 38% of the 120...... strains from general practice. Multiple resistance was common especially in strains from hospital. R factors was found in 23% of the 317 drug-resistant strains from hospital and in 11% of the 46 drug-resistant strains from general practice. Resistance to streptomycin, sulphonamide and tetracycline either...

  3. Mortality during first hospital admission in a population that begins chronic dialysis in a general hospital

    OpenAIRE

    Herrera Añazco, Percy; Médico Asistente, Servicio de Nefrología, Hospital Nacional 2 de Mayo, Lima, Perú; Docente de la Facultad de Medicina, Universidad Científica del Sur, Lima, Perú; Docente de la Facultad de Medicina, Universidad Nacional de Piura, Piura, Perú.; Palacios Guillén, Melissa; Médico Asistente, Servicio de Nefrología, Hospital Daniel Alcides Carrión, Lima, Perú; Docente, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú.; Chipayo Gonzales, David; Médico Residente, Servicio de Nefrología, Hospital Nacional 2 de Mayo, Lima, Perú.; Silveira Chau, Manuela; Médico Asistente, Unidad Médica Empresarial, Clínica Internacional, Lima, Perú.

    2013-01-01

    The Health Ministry attends Peruvian population without social security and without a national dialysis program. Attention is limited to a few hospitals with dialysis centers. objectives: To determine mortality in the first hospitalization for dialysis in a population without social security. design: Descriptive study. Setting: Hospital Nacional Dos de Mayo, Lima, Peru. Patients: Patients with chronic renal disease. Interventions: We studied patients who started dialysis from January to Decem...

  4. Autonomy of long-stay psychiatric inpatients Autonomia de pacientes em internação prolongada em hospital psiquiátrico

    Directory of Open Access Journals (Sweden)

    Luciane Carniel Wagner

    2006-08-01

    Full Text Available OBJECTIVE: To assess personal autonomy of long-stay psychiatric inpatients, to identify those patients who could be discharged and to evaluate the impact of sociodemographic variables, social functioning, and physical disabilities on their autonomy was also assessed. METHODS: A total of 584 long-stay individuals of a psychiatric hospital (96% of the hospital population in Southern Brazil was assessed between July and August 2002. The following instruments, adapted to the Brazilian reality, were used: independent living skills survey, social behavioral schedule, and questionnaire for assessing physical disability. RESULTS: Patients showed severe impairment of their personal autonomy, especially concerning money management, work-related skills and leisure, food preparation, and use of transportation. Autonomy deterioration was associated with length of stay (OR=1.02, greater physical disability (OR=1.54; p=0.01, and male gender (OR=3.11; pOBJETIVO: Avaliar a autonomia de uma população de pacientes com internação prolongada em um hospital psiquiátrico, identificar indivíduos com possibilidades de desinternação e avaliar o impacto de variáveis sociodemográficas, do funcionamento social e de incapacitações físicas sobre a autonomia. MÉTODOS: Foi avaliado o total de 584 indivíduos de um hospital psiquiátrico de Porto Alegre, RS, com internação prolongada (96% dois pacientes, entre julho e agosto de 2002. Foram utilizados os instrumentos, adaptados para a realidade brasileira: independent living skills survey (inventário de habilidades de vida independente, social behavioral schedule (escala de avaliação do comportamento social e questionário de avaliação do grau de invalidez física. RESULTADOS: Os pacientes apresentaram grande comprometimento de sua autonomia, principalmente com relação à administração de dinheiro, ocupação, lazer, preparo de alimentos e transporte. A deterioração da autonomia esteve associada com o

  5. Access to health insurance and the use of inpatient medical care: evidence from the Affordable Care Act young adult mandate.

    Science.gov (United States)

    Akosa Antwi, Yaa; Moriya, Asako S; Simon, Kosali I

    2015-01-01

    The Affordable Care Act of 2010 expanded coverage to young adults by allowing them to remain on their parent's private health insurance until they turn 26 years old. While there is evidence on insurance effects, we know very little about use of general or specific forms of medical care. We study the implications of the expansion on inpatient hospitalizations. Given the prevalence of mental health needs for young adults, we also specifically study mental health related inpatient care. We find evidence that compared to those aged 27-29 years, treated young adults aged 19-25 years increased their inpatient visits by 3.5 percent while mental illness visits increased 9.0 percent. The prevalence of uninsurance among hospitalized young adults decreased by 12.5 percent; however, it does not appear that the intensity of inpatient treatment changed despite the change in reimbursement composition of patients.

  6. Microbiological etiology of bacterial prostatitis in general hospital and primary care clinic in Korea

    Directory of Open Access Journals (Sweden)

    Yong Sun Choi

    2013-09-01

    Conclusions: The total portion of chronic bacterial prostatitis was 59.3% (174/293. Culture-positive patients in the PCC were significantly higher than in the general hospital, but the number of PCR positive patients in the PCC was the same as in the general hospital.

  7. Effect of Hospital Ownership on Outcomes of Heart Failure Hospitalization.

    Science.gov (United States)

    Akintoye, Emmanuel; Briasoulis, Alexandros; Egbe, Alexander; Orhurhu, Vwaire; Ibrahim, Walid; Kumar, Kartik; Alliu, Samson; Nas, Hala; Levine, Diane; Weinberger, Jarrett

    2017-09-01

    ownerships. Outcomes were generally better in for-profit hospitals than other tiers of hospital and, notably, there was a significant difference in inpatient mortality for female patients (but not for male patients). Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Policy Changes and Fiscal Year 2016 Rates; Revisions of Quality Reporting Requirements for Specific Providers, Including Changes Related to the Electronic Health Record Incentive Program; Extensions of the Medicare-Dependent, Small Rural Hospital Program and the Low-Volume Payment Adjustment for Hospitals. Final rule; interim final rule with comment period.

    Science.gov (United States)

    2015-08-17

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2016. Some of these changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act), the Pathway for Sustainable Growth Reform(SGR) Act of 2013, the Protecting Access to Medicare Act of 2014, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, and other legislation. We also are addressing the update of the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2016.As an interim final rule with comment period, we are implementing the statutory extensions of the Medicare dependent,small rural hospital (MDH)Program and changes to the payment adjustment for low-volume hospitals under the IPPS.We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2016 and implementing certain statutory changes to the LTCH PPS under the Affordable Care Act and the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013 and the Protecting Access to Medicare Act of 2014.In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific providers (acute care hospitals,PPS-exempt cancer hospitals, and LTCHs) that are participating in Medicare, including related provisions for eligible hospitals and critical access hospitals participating in the Medicare Electronic Health Record (EHR)Incentive Program. We also are updating policies relating to the

  9. The knowledge of parents of children with diarrhea on oralit at the department of child health, Dr. Pirngadi General Hospital Medan.

    Science.gov (United States)

    Saragih, M; Ramayati, R; Karo-Karo, M; Harahap, E; Sutanto, A H; Siregar, H

    1983-01-01

    Over the October 1-December 30, 1981 period, the parents of all inpatients and outpatients at the Department of Child Health, Dr. Pirngadi General Hospital Medan (Indonesia) were interviewed to assess their knowledge or oralit, an oral rehydration treatment. The interviewer asked the educational level of the parents, knowledge and use of oralit, source of information, where oralit was obtained, and whether or not oralit is kept at home. 285 parents were interviewed. 227 had knowledge of oralit, but only 153 had used it; 58 had never heard of it. The primary information source was doctors (63.9%); newspapers and magazines (1.8%) had a minor role. Dispensaries (86.9%) were the places where people obtained oralit easily. Only 74 (48.3%) of the users kept oralit at home; 41 sometimes had it available; and 38 (24.9%) never had it. The main reason (44.3%) why the parents of children with diarrhea never kept it at home was the easy availability of oralit. Of 128 patients who sought treatment from medical staff (doctors and nurses) before they came to the hospital to be treated as inpatients or outpatients, 49% of the doctors and 50% of the nurses did not give oralit beforehand. The promotion of oralit would be more successful if village leaders, teachers, youths, and women's organizations participated in the program.

  10. PREVALENCE OF ANTI- Toxocara ANTIBODIES IN A RANDOM SAMPLE OF INPATIENTS AT A CHILDREN'S HOSPITAL IN VITÓRIA, ESPÍRITO SANTO, BRAZIL

    Directory of Open Access Journals (Sweden)

    Sandra F. MOREIRA-SILVA

    1998-07-01

    Full Text Available In the streets of Vitória, in the State of Espírito Santo, Brazil, are large number of stray dogs, many of which are infected with Toxocara canis, suggesting a high risk for human infection. In order to investigate the prevalence of Toxocara infection in children in Espírito Santo we studied the prevalence of anti-Toxocara antibodies in 100 random inpatients over one year of age, at the Children's Hospital N.S. da Glória, the reference children's hospital for the State.All the sera were collected during the period between October 1996 and January 1997. The mean age was 6.6±4.1 yrs. (1 to 14 yrs., median 6yrs. and there were patients from all of the different wards of the hospital. Sixty-eigth patients came from the metropolitan area of Vitória and the other 32 from 17 other municipalities. The anti-Toxocara antibodies were investigated by ELISA-IgG using a secretory-excretory antigen obtained from second stage larvae. All sera were adsorbed with Ascaris suum antigen before the test. Thirty-nine sera (39% were positive, predominantly from boys, but the gender difference was not statistically significant (boys:25/56 or 44.6%; girls:14/44 or 31.8%; p=0.311. The prevalence of positive sera was higher, but not statistically significant, in children from the urban periphery of metropolitan Vitória (formed by the cities of Vitória, Cariacica, Vila Velha, Serra and Viana than in children from 17 other municipalities (44.1% and 28.1% respectively, p=0.190. Although the samples studied do not represent all children living in the State of Espírito Santo, since the Children's Hospital N.S. da Glória admits only patients from the state health system, it is probable that these results indicate a high frequency of Toxocara infection in children living in Espírito Santo. Further studies of population samples are necessary to ascertain the prevalence of Toxocara infection in our country.Em Vitória é grande o número de cães soltos nas ruas, muitos

  11. Specialized consultant in radiological safety to the Ciudad del Carmen general hospital, PEMEX; Asesoria especializada en seguridad radiologica al hospital general Ciudad del Carmen, PEMEX

    Energy Technology Data Exchange (ETDEWEB)

    Angeles C, A.; Hernandez C, J. E.; Rodriguez A, F.; Garcia A, J

    2003-02-15

    The Ciudad del Carmen general hospital, dependent of PEMEX, It request consultant of the ININ to be able to maintain their sanitary license for the use of X-ray equipment for the radiologic diagnostic.The proposal of the ININ was to be a program of technical attendance, schedule monthly to be able to solve the observations that are presented in the use of those equipment, and that the hospital can conserve its respective sanitary license.(Author)

  12. Implementation of a Prototype Generalized Network Technology for Hospitals *

    OpenAIRE

    Tolchin, S. G.; Stewart, R. L.; Kahn, S. A.; Bergan, E. S.; Gafke, G. P.; Simborg, D.W.; Whiting-O'Keefe, Q. E.; Chadwick, M. G.; McCue, G. E.

    1981-01-01

    A demonstration implementation of a distributed data processing hospital information system using an intelligent local area communications network (LACN) technology is described. This system is operational at the UCSF Medical Center and integrates four heterogeneous, stand-alone minicomputers. The applications systems are PID/Registration, Outpatient Pharmacy, Clinical Laboratory and Radiology/Medical Records. Functional autonomy of these systems has been maintained, and no operating system c...

  13. Quality Metrics in Inpatient Neurology.

    Science.gov (United States)

    Dhand, Amar

    2015-12-01

    Quality of care in the context of inpatient neurology is the standard of performance by neurologists and the hospital system as measured against ideal models of care. There are growing regulatory pressures to define health care value through concrete quantifiable metrics linked to reimbursement. Theoretical models of quality acknowledge its multimodal character with quantitative and qualitative dimensions. For example, the Donabedian model distils quality as a phenomenon of three interconnected domains, structure-process-outcome, with each domain mutually influential. The actual measurement of quality may be implicit, as in peer review in morbidity and mortality rounds, or explicit, in which criteria are prespecified and systemized before assessment. As a practical contribution, in this article a set of candidate quality indicators for inpatient neurology based on an updated review of treatment guidelines is proposed. These quality indicators may serve as an initial blueprint for explicit quality metrics long overdue for inpatient neurology.

  14. Admission of foreign citizens to the general teaching hospital of bologna, northeastern Italy: An epidemiological and clinical survey

    Directory of Open Access Journals (Sweden)

    Sergio Sabbatani

    2006-04-01

    Full Text Available BACKGROUND: The emergency regarding recent immigration waves into Italy makes continued healthcare monitoring of these populations necessary. METHODS: Through a survey of hospital admissions carried out during the last five years at the S. Orsola-Malpighi General Hospital of Bologna (Italy, all causes of admission of these subjects were evaluated, together with their correlates. Subsequently, we focused on admissions due to infectious diseases. All available data regarding foreign citizens admitted as inpatients or in Day-Hospital settings of our teaching hospital from January 1, 1999, to March 31, 2004, were assessed. Diagnosis-related group (DRG features, and single discharge diagnoses, were also evaluated, and a further assessment of infectious diseases was subsequently made. RESULTS: Within a comprehensive pool of 339,051 hospitalized patients, foreign citizen discharges numbered 7,312 (2.15%, including 2,542 males (34.8% and 4,769 females (65.2%. Males had a mean age of 36.8±14.7 years, while females were aged 30.8±12.2 years. In the assessment of the areas of origin, 34.6% of hospitalizations were attributed to patients coming from Eastern Europe, 15.3% from Northern Africa, 7.3% (comprehensively from Western Europe and United States, 6.9% from the Indian subcontinent, 5.9% from sub-Saharan Africa, 5.7% from Latin America, 4.1% from China, 2.5% from the Philippines, and 1.1% from the Middle East. Among women, most hospitalizations (58.8% were due to obstetrical-gynecological procedures or diseases, including assistance with delivery (27.1%, and pregnancy complications (18.7%, followed by psycho-social disturbances (5.9%, malignancies (5.1%, gastrointestinal diseases (4.7%, and voluntary pregnancy interruption (4.4%. Among men, the most frequent causes of admissions were related to trauma (15.9%, followed by gastroenteric disorders (12%, heart-vascular diseases (8.9%, psycho-social disorders (8.4%, respiratory (7.1%, kidney (6.1%, liver

  15. Admission of foreign citizens to the general teaching hospital of bologna, northeastern Italy: An epidemiological and clinical survey

    Directory of Open Access Journals (Sweden)

    Sergio Sabbatani

    Full Text Available BACKGROUND: The emergency regarding recent immigration waves into Italy makes continued healthcare monitoring of these populations necessary. METHODS: Through a survey of hospital admissions carried out during the last five years at the S. Orsola-Malpighi General Hospital of Bologna (Italy, all causes of admission of these subjects were evaluated, together with their correlates. Subsequently, we focused on admissions due to infectious diseases. All available data regarding foreign citizens admitted as inpatients or in Day-Hospital settings of our teaching hospital from January 1, 1999, to March 31, 2004, were assessed. Diagnosis-related group (DRG features, and single discharge diagnoses, were also evaluated, and a further assessment of infectious diseases was subsequently made. RESULTS: Within a comprehensive pool of 339,051 hospitalized patients, foreign citizen discharges numbered 7,312 (2.15%, including 2,542 males (34.8% and 4,769 females (65.2%. Males had a mean age of 36.8±14.7 years, while females were aged 30.8±12.2 years. In the assessment of the areas of origin, 34.6% of hospitalizations were attributed to patients coming from Eastern Europe, 15.3% from Northern Africa, 7.3% (comprehensively from Western Europe and United States, 6.9% from the Indian subcontinent, 5.9% from sub-Saharan Africa, 5.7% from Latin America, 4.1% from China, 2.5% from the Philippines, and 1.1% from the Middle East. Among women, most hospitalizations (58.8% were due to obstetrical-gynecological procedures or diseases, including assistance with delivery (27.1%, and pregnancy complications (18.7%, followed by psycho-social disturbances (5.9%, malignancies (5.1%, gastrointestinal diseases (4.7%, and voluntary pregnancy interruption (4.4%. Among men, the most frequent causes of admissions were related to trauma (15.9%, followed by gastroenteric disorders (12%, heart-vascular diseases (8.9%, psycho-social disorders (8.4%, respiratory (7.1%, kidney (6.1%, liver

  16. The responses of nursing system to the outbreak of SARS in a general hospital

    Institute of Scientific and Technical Information of China (English)

    张黎明; 王建荣; 冯志英; 杨晓秋; 刘钰; 袁彬

    2003-01-01

    Severe Acute Respiratory Syndrome (SARS), referred to as "contagious atypical pneumonia" is the fastest spreading communicable disease known in recent history. This disease is different from other kinds of respiratory contagion due to the following aspects: the syndrome happens quickly and the infectivity is high. New problems encountered by the nursing management staff are the precipitate, pestiferous, and large numbers of in-patients and the understanding of appropriate responses, within large complex hospitals, to ensure patient care is actively supported and infectivity is prevented. To deal with these problems, we implemented the following strategies: reinforcement of the management system; optimization of the nursing flow; amendments to related hospital policies;collection of relevant information; adherence to stringent disinfection protocols; isolation of areas; reallocation of hospital resources and more efficient utilization of resources. The above strategies have reinforced the nursing management system's active response, guaranteed daily operation of the hospital'snursing activities, including the quality of care provided by the nurses, and ensured the health of patients, nurses and doctors.

  17. Factors affecting the technical efficiency of general hospitals in Iran: data envelopment analysis.

    Science.gov (United States)

    Kalhor, Rohollah; Amini, Saeed; Sokhanvar, Mobin; Lotfi, Farhad; Sharifi, Marziye; Kakemam, Edris

    2016-03-01

    Restrictions on resource accessibility and its optimal application is the main challenge in organizations nowadays. The aim of this research was to study the technical efficiency and its related factors in Tehran general hospitals. This descriptive analytical study was conducted retrospectively in 2014. Fifty-four hospitals with private, university, and social security ownerships from the total 110 general hospitals were randomly selected for inclusion into this study on the basis of the share of ownership. Data were collected using a checklist with three sections, including background variables, inputs, and outputs. Seventeen (31.48%) hospitals had an efficiency score of 1 (highest efficiency score). The highest average efficiency score was in social security hospitals (84.32). Private and university hospitals ranked next with an average of 84.29 and 79.64, respectively. Analytical results showed that there was a significant relationship between hospital ownership, hospital type in terms of duty and specialization, educational field of the chief executive officer, and technical efficiency. There was no significant relationship between education level of hospital manager and technical efficiency. Most of the studied hospitals were operating at low efficiency. Therefore, policymakers should plan to improve the hospital operations and promote hospitals to an optimal level of efficiency.

  18. Adverse events in hospitalised cancer patients: a comparison to a general hospital population

    DEFF Research Database (Denmark)

    Haukland, Ellinor; von Plessen, Christian; Nieder, Carsten

    2017-01-01

    ) compared to a general hospital population. Material and methods: A total of 6720 patient records were retrospectively reviewed comparing AEs in hospitalised cancer patients to a general hospital population in Norway, using the IHI Global Trigger Tool method. Results: 24.2 percent of admissions for cancer...... risk. The rate of AEs increases by 1.05 times for each day spent in hospital. For every year increase in age, the risk for AEs increases by 1.3%. Cancer patients more often have hospital-acquired infections, other surgical complications and AEs related to medications. Conclusions: Because of higher age...

  19. Can the use of Electronic Health Records in General Practice reduce hospitalizations for diabetes patients?

    DEFF Research Database (Denmark)

    Kongstad, Line Planck; Mellace, Giovanni; Rose Olsen, Kim

    on Electronic Health Records (EHR) on diabetes patients total hospitalizations, diabetes related hospitalizations and hospitalizations with diabetes and cardiovascular related Ambulatory Care Sentive Conditions (ACSC). We use a rich nationwide panel dataset (2004-2013) with information of stepwise enrolment......Disease management programmes (DMP) in the general practice sector are increasingly used to improve health of chronically ill patients, reduce hospitalizations and thereby costs. The aim of this paper is to estimate the causal effects of the enrolment of general practices (GP) in a DMP based...

  20. Practice and Exploration of Drug Counseling Training Mode for Inpatient Pharmacists in Our Hospital%我院住院药师药物咨询培训的实践与探索

    Institute of Scientific and Technical Information of China (English)

    王海莲

    2015-01-01

    OBJECTIVE:To cultivate the inpatient pharmacists with drug counseling capacity. METHODS:Drug counseling training was conducted for the inpatient pharmacists in our hospital,including drugs counseling workflow,common query tools for drugs counseling,communication skills,professional skills practical ability,emergency treatment capability and literature retrieval method,etc. RESULTS & CONCLUSIONS:The inpatient pharmacists trained with drug counseling teaching have basically owned professional practice of drugs counseling and achieved the combination of theoretical and clinical pharmacy practice.%目的:建立住院药师药物咨询培训体系,培养具备药物咨询能力的住院药师。方法:对我院住院药师进行药物咨询培训,培训内容包括药物咨询工作流程、药物咨询常用查询工具、沟通技巧、专业技能实践、突发事件的处理和文献检索方法等。结果与结论:经过药物咨询教学培训的住院药师已基本具备药物咨询的专业实践能力,实现了药学基础理论与临床实践的结合。

  1. The effect of an active on-ward participation of hospital pharmacists in Internal Medicine teams on preventable Adverse Drug Events in elderly inpatients: protocol of the WINGS study (Ward-oriented pharmacy in newly admitted geriatric seniors

    Directory of Open Access Journals (Sweden)

    Dijkgraaf Marcel G

    2011-05-01

    Full Text Available Abstract Background The potential of clinical interventions, aiming at reduction of preventable Adverse Drug Events (preventable ADEs during hospital stay, have been studied extensively. Clinical Pharmacy is a well-established and effective service, usually consisting of full-time on-ward participation of clinical pharmacists in medical teams. Within the current Hospital Pharmacy organisation in the Netherlands, such on-ward service is less feasible and therefore not yet established. However, given the substantial incidence of preventable ADEs in Dutch hospitals found in recent studies, appears warranted. Therefore, "Ward-Oriented Pharmacy", an on-ward service tailored to the Dutch hospital setting, will be developed. This service will consist of multifaceted interventions implemented in the Internal Medicine wards by hospital pharmacists. The effect of this service on preventable ADEs in elderly inpatients will be measured. Elderly patients are at high risk for ADEs due to multi-morbidity, concomitant disabilities and polypharmacy. Most studies on the incidence and preventability of ADEs in elderly patients have been conducted in the outpatient setting or on admission to a hospital, and fewer in the inpatient setting. Moreover, recognition of ADEs by the treating physicians is challenging in elderly patients because their disease presentation is often atypical and complex. Detailed information about the performance of the treating physicians in ADE recognition is scarce. Methods/Design The design is a multi-centre, interrupted time series study. Patients of 65 years or older, consecutively admitted to Internal Medicine wards will be included. After a pre-measurement, a Ward-Oriented Pharmacy service will be introduced and the effect of this service will be assessed during a post-measurement. The primary outcome measures are the ADE prevalence on admission and ADE incidence during hospital stay. These outcomes will be assessed using structured

  2. Collaboration between physicians and a hospital-based palliative care team in a general acute-care hospital in Japan

    Directory of Open Access Journals (Sweden)

    Nishikitani Mariko

    2010-06-01

    Full Text Available Abstract Background Continual collaboration between physicians and hospital-based palliative care teams represents a very important contributor to focusing on patients' symptoms and maintaining their quality of life during all stages of their illness. However, the traditionally late introduction of palliative care has caused misconceptions about hospital-based palliative care teams (PCTs among patients and general physicians in Japan. The objective of this study is to identify the factors related to physicians' attitudes toward continual collaboration with hospital-based PCTs. Methods This cross-sectional anonymous questionnaire-based survey was conducted to clarify physicians' attitudes toward continual collaboration with PCTs and to describe the factors that contribute to such attitudes. We surveyed 339 full-time physicians, including interns, employed in a general acute-care hospital in an urban area in Japan; the response rate was 53% (N = 155. We assessed the basic characteristics, experience, knowledge, and education of respondents. Multiple logistic regression analysis was used to determine the main factors affecting the physicians' attitudes toward PCTs. Results We found that the physicians who were aware of the World Health Organization (WHO analgesic ladder were 6.7 times (OR = 6.7, 95% CI = 1.98-25.79 more likely to want to treat and care for their patients in collaboration with the hospital-based PCTs than were those physicians without such awareness. Conclusion Basic knowledge of palliative care is important in promoting physicians' positive attitudes toward collaboration with hospital-based PCTs.

  3. Exploring the Rate and Causes of Deductions Imposed on Social Security and Health Insurance`s Bills Related to Inpatients in Two Hospitals Affiliated with Tabriz University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    Hossein Rezvanjou

    2017-02-01

    Full Text Available Background and Objectives: Annually, a large amount of fees that are paid by hospitals, will not be reimbursed as deductions by health insurance which imposes irreparable financial losses on hospitals. The purpose of this study was to determine the amount of deductions imposed on social security and health insurance`s bills and its causes related to inpatients in two hospitals affiliated with Tabriz University of Medical Sciences. Material and Methods: This was a cross-sectional study conducted in Alavi and Madani hospitals affiliated with Tabriz University of Medical Sciences by using 2015 data.  Researcher-designed checklist was used for data collecting. According to population size, census method and random sampling were used in Alavi and Madani hospitals, respectively. Gathered data were analyzed through descriptive statistics assisted by Excel v.13 software. Results: In the studied hospitals, most of the deductions in the Alavi and Madani hospitals were related to charge of surgeon and angioplasty, respectively. Also, in Alavi Hospital among deductions factors, the most repeated one was extra application in contrary to determined tariffs. In both hospitals, the role of the human factor in cases of error cannot be denied. Extra applications, inaccuracy in registration costs and lack of knowledge of the approved insurance tariffs are the main important factors influential on the deduction. Conclusion: Due to high rates of preventable deductions in both hospitals and being given the multiplicity and variety of services offered at the health centers, establishing income monitoring unit in hospitals and use of experienced staff is inevitable.

  4. Analysis of Disease Spectrum from In-patient Dermatologic Consultation in A Complex Hospital%综合医院皮肤科院内会诊疾病谱分析

    Institute of Scientific and Technical Information of China (English)

    朱铁山; 闫言; 赵娜; 乔菊; 张涛; 李峰; 王涛; 曾跃平

    2015-01-01

    Objective To study the disease spectrum of in-patient dermatologic consultation in a com-plex hospital.Methods 1138 cases of in-patient dermatologic consultation from January 2009 to December 2010 in Peking Union Medical College Hospital were retrospectively analyzed .Results Allergy dermatologic disease 38.05%(433/1138), infectious dermatologic disease 19.68% (224/1138) and autoimmunity der-matologic disease 9.58% (109/1138) were the most common in all in-patient dermatologic disease cases. In allergy dermatologic disease, drug eruption was more frequent than urticaria.In infectious dermatologic disease, fungi infectious dermatologic disease account for the highest percentage 50.45%(113/224). Conclusion Dermatologic consultation for in-patient is an important component of dermatologic work .The disease spectrum of in-patient dermatologic consultation appeared unique rules different from out-patient der-matologic consultation.Drug eruption was more common than urticaria; autoimmunity dermatologic disease accounted for higher percentage.%目的:研究综合医院皮肤科会诊疾病的疾病谱。方法采用回顾性分析的方法对2009年1月至2010年12月北京协和医院1138例皮肤科会诊病例进行分析。结果在皮肤科会诊疾病中,过敏性皮肤病38.05%(433/1138)、感染性皮肤病19.68%(224/1138)和自身免疫性皮肤病9.58%(109/1138)分别占前3位。在过敏性皮肤病中,药疹病例多于荨麻疹。在感染性皮肤病中,真菌感染性皮肤病占的比例最大,为50.45%(113/224)。结论皮肤科会诊是皮肤科工作的重要部分,皮肤科会诊疾病谱具有区别于皮肤科门诊的独特的规律,主要体现在药疹数量多于荨麻疹;自身免疫性皮肤病占疾病谱的比例高。

  5. Use of a Hospital-Wide Screening Program for Early Detection of Sepsis in General Surgery Patients.

    Science.gov (United States)

    MacQueen, Ian T; Dawes, Aaron J; Hadnott, Tracy; Strength, Kristen; Moran, Gregory J; Holschneider, Christine; Russell, Marcia M; Maggard-Gibbons, Melinda

    2015-10-01

    Sepsis remains a significant source of mortality among hospitalized patients. This study examines the usage of a vital sign-based screening protocol in identifying postoperative patients at risk for sepsis at an academic-affiliated medical center. We identified all general surgery inpatients undergoing abdominopelvic surgery from January to June 2014, and compared those with positive screening tests to a sample of screen-negative controls. Multivariate logistic regression was used to identify predictors of positive screening tests and progression to severe sepsis. In total, 478 patients underwent abdominopelvic operations, 59 had positive screening tests, 33 qualified for sepsis, and six progressed to severe sepsis. Predictors of a positive screening test were presence of cancer [odds ratio (OR) 30.7, 95% confidence interval (CI) 2.2-420], emergency operation (OR 6.5, 95% CI 1.7-24), longer operative time (OR 2.2/h, 95% CI 1.2-4.1), and presence of postoperative infection (OR 6.4, 95% CI 1.5-27). The screening protocol had sensitivity 100 per cent and specificity 88 per cent for severe sepsis. We identified no predictors of severe sepsis. In conclusion, vital sign-based screening provides value by drawing early attention to patients with potential to develop sepsis, but escalation of care for these patients should be based on clinical judgment.

  6. Parasuicide among youth in a general hospital in South Africa

    Directory of Open Access Journals (Sweden)

    T Mhlongo

    1999-09-01

    Full Text Available Parasuicide cases among youth (15-24 years referred to the clinical psychology section of a regional hospital from 1995 to 1998 were reviewed. In all 100 cases (37 males and 63 females were identified being about 10% of the caseload. As part of the clinical psychological assessment sociodemographic, clinical characteristics, trigger factors, employed methods and suicide intentions were analysed. Most patients were students (79% or unemployed (16%. The major method employed to attempt suicide was ingestion of harmful substances (like paraffin, pesticides or battery acid(73%. Acute social conflicts (38%, socio-economic deprivation (17%, AIDS phobia (17%, academic failure (14%, teenage pregnancy (10% and mental illness (5% triggered suicide attempts. Fifty-eight percent of the attempts were categorised as demonstrative and 27% as genuine. The psychodynamics of parasuicides are discussed in case studies and with reference to other studies.

  7. Evaluation of thromboprophylaxis in medium-sized general hospital

    Directory of Open Access Journals (Sweden)

    Cesar Roberto Busato

    2014-03-01

    Full Text Available CONTEXT: Deep vein thrombosis (DVT is a serious, common disease whose complications include pulmonary thromboembolism (PTE and postthrombotic syndrome. The importance and benefits of correct and effective pharmacological prophylaxis for DVT are well documented. OBJECTIVES: The aims of this study were to evaluate adequacy of prophylaxis for DVT and PTE at the Santa Casa de Misericórdia de Ponta Grossa (SCMPG, Paraná, Brazil, and determine risk stratification for patients hospitalized in this institution. METHODS: A cohort study was conducted to assess DVT prophylaxis of patients hospitalized on May 15th, 2009. The study population consisted of a sample of 104 patients, subdivided into clinical and surgical groups and stratified into different specialties. Correct use of DVT prophylaxis was evaluated according to recommendations published by The Brazilian Society for Angiology and Vascular Surgery and took into account prophylactic methods specified explicitly in information found in each patient's medical chart. RESULTS: Of the 104 patients interviewed, 51 (49.04% were clinical patients and 53 (50.96% surgical. Based on risk stratification, 17 (16.35% were classified as low risk, 37 (35.58% as moderate risk, 46 (44.23% as high risk and 4 (3.85% as extremely high risk for DVT/PTE. A total of 68 patients (65.38% received prophylaxis, but of these only 56 (53.85% received the correct prophylaxis, and 36 (34.62% did not receive any prophylaxis. CONCLUSION: The rates of prophylaxis use for DVT and PTE in this service are higher than rates published in the literature.

  8. Epidemiology of carbapenemase producing Enterobacteriaceae in a general hospital

    Directory of Open Access Journals (Sweden)

    Amina Kandeel

    2015-06-01

    Full Text Available Objective: Detect the presence of carbapenemases producing Enterobacteriaceae (CPE and associated epidemiologi­cal, microbiological, and clinical characteristics of patients in our hospital Methods: During 15 months period, all non duplicate Enterobacteriaceae isolates with reduced susceptibility to car­bapenem detected by MicroScan WalkAway system and confirmed by E test were collected. These suspected isolates were further screened by modified Hodge test and carbapenemase inhibition discs to identify CPE. Results: Out of 54 suspected Enterobacteriaceae isolates, 44 (88.5% isolates were either extended spectrum beta-lac­tamases (ESBLs or AmpC producers with porin loss whereas 10 isolates (18.5% were confirmed to produce carbapen­emase representing (0.74% of the total Enterobacteriaceae. Among these 10 isolates, 6 were OXA 48 producers and 2 isolates were class B and class A each. Six out of the 10 CPE were detected in ICU and specimen source was tracheal aspirate in 5 CPE isolates. All CPE isolates were sensitive to colistin and all but one to tigecycline. All patients had history of previous antibiotic exposure and hospital stays for more than 5 days. Conclusion: Although CPE is not the main cause of carbapenem resistance in Enterobacteriaceae in our setting, its emergence there represents a serious infection control and therapeutic challenge. This mandates its early detection using MHT and carbapenemase inhibition tests together with strict infection control measures to limit its spread. J Mi­crobiol Infect Dis 2015;5(2: 57-62

  9. Care complexity in the general hospital - Results from a European study

    NARCIS (Netherlands)

    de Jonge, P; Huyse, FJ; Slaets, JPJ; Herzog, T; Lobo, A; Lyons, JS; Opmeer, BC; Stein, B; Arolt, [No Value; Balogh, N; Cardoso, G; Fink, P; Rigatelli, M; van Dijck, R; Mellenbergh, GJ

    2001-01-01

    There is increasing pressure to effectively treat patients with complex care needs from the moment of admission to the general hospital. In this study, the authors developed a measurement strategy for hospital-based care complexity. The authors' four-factor model describes the interrelations between

  10. A cost study of a general practitioner hospital in the Netherlands.

    NARCIS (Netherlands)

    Hakkart-van Roijen, L.; Moll van Charante, E.P.; Bindels, P.J.E.; Yzermans, C.J.; Rutten, F.F.H.

    2004-01-01

    To perform a cost study of the first general practitioner (GP) hospital in the Netherlands. We conducted a cost study in a GP hospital in the Netherlands. Data on healthcare utilisation from 218 patients were collected for a period of one year. The costs of admission to the GP hosptial were compared

  11. Comparison of In-Hospital Mortality, Length of Stay, Postprocedural Complications, and Cost of Single-Vessel Versus Multivessel Percutaneous Coronary Intervention in Hemodynamically Stable Patients With ST-Segment Elevation Myocardial Infarction (from Nationwide Inpatient Sample [2006 to 2012]).

    Science.gov (United States)

    Panaich, Sidakpal S; Arora, Shilpkumar; Patel, Nilay; Schreiber, Theodore; Patel, Nileshkumar J; Pandya, Bhavi; Gupta, Vishal; Grines, Cindy L; Deshmukh, Abhishek; Badheka, Apurva O

    2016-10-01

    The primary objective of our study was to evaluate the in-hospital outcomes in terms of mortality, procedural complications, hospitalization costs, and length of stay (LOS) after multivessel percutaneous coronary intervention (MVPCI) in hemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI). The study cohort was derived from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database, years 2006 to 2012. Percutaneous coronary interventions (PCI) performed during STEMI were identified using appropriate International Classification of Diseases, Ninth Revision, diagnostic and procedural codes. Patients in cardiogenic shock were excluded. Hierarchical mixed-effects logistic regression models were used for categorical dependent variables such as in-hospital mortality and composite of in-hospital mortality and complications, and hierarchical mixed-effects linear regression models were used for continuous dependent variables such as cost of hospitalization and LOS. We identified 106,317 (weighted n = 525,161) single-vessel PCI and 15,282 (weighted n = 74,543) MVPCIs. MVPCI (odds ratio, 95% confidence interval [CI], p value) was not associated with significant increase in in-hospital mortality (0.99, 0.85 to 1.15, 0.863) but predicted a higher composite end point of in-hospital mortality and postprocedural complications (1.09, 1.02 to 1.17, 0.013) compared to single-vessel PCI. MVPCI was also predictive of longer LOS (LOS +0.19 days, 95% CI +0.14 to +0.23 days, p <0.001) and higher hospitalization costs (cost +$4,445, 95% CI +$4,128 to +$4,762, p <0.001). MVPCI performed during STEMI in hemodynamically stable patients is associated with no increase in in-hospital mortality but a higher rate of postprocedural complications and longer LOS and greater hospitalization costs compared to single-vessel PCI.

  12. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2015 rates; quality reporting requirements for specific providers; reasonable compensation equivalents for physician services in excluded hospitals and certain teaching hospitals; provider administrative appeals and judicial review; enforcement provisions for organ transplant centers; and electronic health record (EHR) incentive program. Final rule.

    Science.gov (United States)

    2014-08-22

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of these changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act), the Protecting Access to Medicare Act of 2014, and other legislation. These changes are applicable to discharges occurring on or after October 1, 2014, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits are effective for cost reporting periods beginning on or after October 1, 2014. We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes to the LTCH PPS under the Affordable Care Act and the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013 and the Protecting Access to Medicare Act of 2014. In addition, we discuss our proposals on the interruption of stay policy for LTCHs and on retiring the "5 percent" payment adjustment for collocated LTCHs. While many of the statutory mandates of the Pathway for SGR Reform Act apply to discharges occurring on or after October 1, 2014, others will not begin to apply until 2016 and beyond. In addition, we are making a number of changes relating to direct graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or revising requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, and LTCHs) that

  13. Una década de altas médicas no efectivizadas en un hospital de Lima, Perú A decade of no effective inpatient medical discharges, experience from a hospital in Lima, Peru

    Directory of Open Access Journals (Sweden)

    Félix García

    2012-06-01

    Full Text Available El objetivo del estudio fue describir los cambios financieros de los días de alta no efectiva desde el año 2001 al 2010, en un hospital general de Lima Metropolitana. Para ello, se obtuvieron los montos totales pagados y exonerados de las cuentas de los pacientes con alta médica no efectivizada, por falta de pago del hospital general. Encontramos que el número de pacientes con alta médica no efectivizada por falta de pago disminuyó del 2001 al 2010 en 77%, los días desde el alta médica hasta que el paciente abandonó el hospital disminuyeron en 80%; las cuentas totales, pagadas y exoneradas, se redujeron en 63, 53 y 68% respectivamente. Asimismo, el porcentaje promedio exonerado a cada paciente con alta médica no efectivizada por falta de pago, en la década estudiada, fue 61,7%. En conclusión, el alta no efectiva incrementa los costos al paciente, teniendo que ser asumido por el hospital al exonerar la cuenta, aunque este gasto disminuyó en el periodo estudiado, esto podría deberse a la implementación de políticas de aseguramiento en salud.Our aim is to describe the financial implications of no effective in patient discharges from 2001-2010 from a general hospital in lima city. For this purpose we analyzed the total amounts, cancellations and exonarations from the patient accounts with a non effective medical discharge because of hospital "debts". We found that the number of patients with a non effective medical discharge decreased 70% from 2001 to 2010, the number of days between the medical discharge until the day the patient left the hospital decreased 80%. The total amounts, cancellations and exonarations decreased 63%, 53% and 68%, respectively. The average amount of exoneration was 61,7%. In conclusion, the non effective medical discharges increase patient debts, which are partially exonerated and assumed by the hospital. Even though it has decreased in the last decade, this could be explained by the implementation of the

  14. Researches regarding the Morton ether inhaler at Massachusetts General Hospital, Boston.

    Science.gov (United States)

    Haridas, Rajesh P; Mifflin, Jeffrey A

    2013-11-01

    The Morton ether inhaler in the possession of Massachusetts General Hospital, Boston, MA, was traced back to 1906 when the earliest known photograph of it was published. The authors believe that the inhaler was given by William T. G. Morton, MD, to J. Mason Warren, MD, in January 1847. The inhaler was acquired by the Warren Anatomical Museum at an unknown date, loaned to Massachusetts General Hospital in October 1946, and placed on permanent loan to Massachusetts General Hospital in April 1948. Many documents relating to the inhaler have disappeared, and it was only identified in 2009 as the inhaler that probably belonged to J. Mason Warren, MD. The inhaler is not believed to be the one that Morton used on October 16, 1846, at Massachusetts General Hospital. It is the only known example of a Morton ether inhaler with valves (excluding replicas or reproduction inhalers) and is probably of similar design to the inhaler that Morton used on October 16, 1846.

  15. Analysis of inpatient specialist capacity of a hospital using DRGs method%运用DRGs方法对医院各专科住院医疗能力的分析

    Institute of Scientific and Technical Information of China (English)

    李小莹; 王力红; 仇叶龙; 郭默宁; 刘婉如; 冀冰心

    2015-01-01

    目的 对北京地区某医院2013~2014年各专科住院医疗能力进行分析,结合当地相关专科的发展情况,为医院专科发展提供建议.方法 以北京版DRG(BJ-DRG)分组方式,运用病例组合指数(CMI)、DRG组数对各专科(MDC)住院医疗能力进行分析,通过2014年MDC住院医疗能力现状与发展情况将研究医院各MDC分为类型1至类型4共四种类型.结果 19个MDC中,"神经系统疾病"等2个MDC属于类型1,"头颈、耳、鼻、口、咽疾病及功能障碍"等6个MDC属于类型2,"女性生殖系统疾病及功能障碍"等5个MDC属于类型3,"妊娠、分娩及产褥期"等6个MDC属于类型4.结论 研究医院各MDC住院医疗能力大多处于北京地区前列,可采取不同措施提高不同类型MDC的住院医疗能力.%Objective To analyze the inpatient specialist capacity of a hospital during 2013-2014 in Beijing for its specialists development, based on relevant local specialist development.Methods Analyzing the inpatient specialist capacity using case mix index (CMI) and DRG numbers according to BJ-DRG grouping method.Each MDC of the hospital is divided into four types according to the status and development of inpatient specialist capacity.Results Of the 19 MDCs, 2 (such as nervous system disease) fall into type 1, 6 MDCs (such as neck, ears, nose, mouth, pharynx disease and dysfunction) into type 2, while 5 MDCs (such as female reproductive system diseases and dysfunction) into type 3, and 6 MDCs (such as pregnancy, childbirth and postpartum) into type 4.Condusion Most of the MDC inpatient specialist capacities of the hospital in question are at ranking high in Beijing, and such capacities for various MDC can be improved by all means.

  16. Injectional anthrax at a Scottish district general hospital.

    Science.gov (United States)

    Inverarity, D J; Forrester, V M; Cumming, J G R; Paterson, P J; Campbell, R J; Brooks, T J G; Carson, G L; Ruddy, J P

    2015-04-01

    This retrospective, descriptive case-series reviews the clinical presentations and significant laboratory findings of patients diagnosed with and treated for injectional anthrax (IA) since December 2009 at Monklands Hospital in Central Scotland and represents the largest series of IA cases to be described from a single location. Twenty-one patients who fulfilled National Anthrax Control Team standardized case definitions of confirmed, probable or possible IA are reported. All cases survived and none required limb amputation in contrast to an overall mortality of 28% being experienced for this condition in Scotland. We document the spectrum of presentations of soft tissue infection ranging from mild cases which were managed predominantly with oral antibiotics to severe cases with significant oedema, organ failure and coagulopathy. We describe the surgical management, intensive care management and antibiotic management including the first description of daptomycin being used to treat human anthrax. It is noted that some people who had injected heroin infected with Bacillus anthracis did not develop evidence of IA. Also highlighted are biochemical and haematological parameters which proved useful in identifying deteriorating patients who required greater levels of support and surgical debridement.

  17. General hospital costs in England of medical and psychiatric care for patients who self-harm: a retrospective analysis.

    Science.gov (United States)

    Tsiachristas, Apostolos; McDaid, David; Casey, Deborah; Brand, Fiona; Leal, Jose; Park, A-La; Geulayov, Galit; Hawton, Keith

    2017-09-07

    Self-harm is an extremely common reason for hospital presentation. However, few estimates have been made of the hospital costs of assessing and treating self-harm. Such information is essential for planning services and to help strengthen the case for investment in actions to reduce the frequency and effects of self-harm. In this study, we aimed to calculate the costs of hospital medical care associated with a self-harm episode and the costs of psychosocial assessment, together with identification of the key drivers of these costs. In a retrospective analysis, we estimated hospital resource use and care costs for all presentations for self-harm to the John Radcliffe Hospital (Oxford, UK), between April 1, 2013, and March 31, 2014. Episode-related data were provided by the Oxford Monitoring System for Self-harm and we linked these with financial hospital records to quantify costs. We assessed time and resources allocated to psychosocial assessments through discussion with clinical and managerial staff. We then used generalised linear models to investigate the associations between hospital costs and methods of self-harm. Between April 1, 2013, and March 31, 2014, 1647 self-harm presentations by 1153 patients were recorded. Of these, 1623 (99%) presentations by 1140 patients could be linked with hospital finance records. 179 (16%) patients were younger than 18 years. 1150 (70%) presentations were for self-poisoning alone, 367 (22%) for self-injury alone, and 130 (8%) for a combination of methods. Psychosocial assessments were made in 75% (1234) of all episodes. The overall mean hospital cost per episode of self-harm was £809. Costs differed significantly between different types of self-harm: self-injury alone £753 (SD 2061), self-poisoning alone £806 (SD 1568), self-poisoning and self-injury £987 (SD 1823; pCosts were mainly associated with the type of health-care service contact such as inpatient stay, intensive care, and psychosocial assessment. Mean costs of

  18. [Mental Health in the General Hospital: Results of the Patient Health Questionnaire (PHQ) in Four Hospital Services].

    Science.gov (United States)

    Castro-Camacho, Leonidas; Escobar, Juan Manuel; Sáenz-Moncaleano, Camilo; Delgado-Barrera, Lucía; Aparicio-Turbay, Soraya; Molano, Juan Carlos; Noguera, Efraín

    2012-03-01

    Few individuals have access to mental health services due in part to underdetection. As it is more likely to consult for medical conditions, primary care may be a useful gateway for early detection of mental health problems. Detection of the frequency of mental health problems in four hospital services at the Fundación Santa Fe de Bogotá: Outpatient unit, hospitalization, emergency department, and primary care through a brief detection questionnaire, the Patient Health Questionnaire (PHQ). Cross-sectional study of patients seen at the four services who answered a Demographic Data Questionnaire and the PHQ together with information gathered about current medical diagnosis, history of visits, and hospitalizations during the last year. 1094 patients seen at the four hospital services between September 2010 and May 2011 were selected at random. A mental health problem was detected in 36.7% of the total sample. Major depressive disorder (7.3%), alcohol abuse (14.4%), and any anxiety disorder (7.7%) showed the highest prevalence with the emergency department showing the highest frequency of detection. The usefulness of a brief detection questionnaire such as the PHQ in hospital settings is demonstrated and implications in the design of mental health programs in the general hospital are discussed. The need to replicate this study in other settings and to undertake further research is outlined. Copyright © 2012 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  19. A 5-year audit of outcome of apicectomies carried out in a district general hospital.

    OpenAIRE

    Lyons, A. J.; Hughes, C E; Dixon, E. J.

    1995-01-01

    Success rates of up to 90% have been claimed for apicectomy. However, the conditions that this procedure is carried out under at district general hospitals may be at variance with such studies. A 5-year audit of outcome was therefore carried out within a district general hospital. It was found that 89% of apicected teeth still remained at 5 years. Outcome was not influenced by any of the factors examined, and could not be predicted radiographically. Most failures occurred after the average po...

  20. Psychiatric wards in general hospitals - the opinions of psychiatrists employed there

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    Janusz Chojnowski

    2016-04-01

    The psychiatrists employed in the psychiatric wards in general hospitals in Poland evaluate this organisational model positively. However, the destabilisation of economic foundations of these wards reported in the world literature was also reflected in the results of a survey conducted in Poland. There is a need to develop standards for the organisation and financing departments of psychiatry in general hospitals providing them stable status in the healthcare system in Poland.

  1. A Way to Understand Inpatients Based on the Electronic Medical Records in the Big Data Environment

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    Hongyi Mao

    2017-01-01

    Full Text Available In recent decades, information technology in healthcare, such as Electronic Medical Record (EMR system, is potential to improve service quality and cost efficiency of the hospital. The continuous use of EMR systems has generated a great amount of data. However, hospitals tend to use these data to report their operational efficiency rather than to understand their patients. Base on a dataset of inpatients’ medical records from a Chinese general public hospital, this study applies a configuration analysis from a managerial perspective and explains inpatients management in a different way. Four inpatient configurations (valued patients, managed patients, normal patients, and potential patients are identified by the measure of the length of stay and the total hospital cost. The implications of the finding are discussed.

  2. Well-Differentiated Thyroid Cancer: The Philippine General Hospital Experience

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    Tom Edward N. Lo

    2016-03-01

    Full Text Available BackgroundWell-differentiated thyroid cancer (WDTC is the most common form of thyroid malignancy. While it is typically associated with good prognosis, it may exhibit higher recurrence and mortality rates in selected groups, particularly Filipinos. This paper aims to describe the experience of a Philippine Hospital in managing patients with differentiated thyroid cancer.MethodsWe performed a retrospective cohort study of 723 patients with WDTC (649 papillary and 79 follicular, evaluating the clinicopathologic profiles, ultrasound features, management received, tumor recurrence, and eventual outcome over a mean follow-up period of 5 years.ResultsThe mean age at diagnosis was 44±13 years (range, 18 to 82, with a majority of cases occurring in the younger age group (<45 years. Most tumors were between 2 and 4 cm in size. The majority of papillary thyroid cancers (PTCs, 63.2% and follicular thyroid cancers (FTCs, 54.4% initially presented as stage 1, with a greater proportion of FTC cases (12.7% vs. 3.7% presenting with distant metastases. Nodal metastases at presentation were more frequent among patients with PTC (29.9% vs. 7.6%. A majority of cases were treated by complete thyroidectomy, followed by radioactive iodine therapy and thyroid stimulating hormone suppression, resulting in a disease-free state. Excluding patients with distant metastases at presentation, the recurrence rates for papillary and FTC were 30.1% and 18.8%, respectively.ConclusionOverall, PTC among Filipinos was associated with a more aggressive and recurrent behavior. FTC among Filipinos appeared to behave similarly with other racial groups.

  3. Etiological study of generalized lymphadenopathy in a tertiary care hospital

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    Subrata Halder

    2016-08-01

    Results: Among 116 patients of generalized lymphadenopathy 59.5% were non-malignant causes where 40.5% diagnosed as malignant causes. Among them tuberculosis consist of 39 (33.6%, NHL 18 (15.5%, reactive lymphadenopathy 16 (13.8%, CLL and HD 8 (6.9% each, ALL 7 (6%, SLE 5(4.3%, Kikuchi's disease 4 (3.4%, AML and RA 3 (2.6% each and castleman's disease, phenytoin lymphadenopathy, metastatic lung and breast carcinoma 1 (0.9% each. Cervical groups of lymph nodes were most commonly involved 86 patients (74.1% followed by axillary groups 73 patients (62.9%. Lymph nodes size 1.5cm were due to malignant and non-malignant granulomatous cases. FNAC give definite diagnosis 80.9% malignant cases where 76.8% in non-malignant cases. HPE shown definite diagnosis in 100% cases both malignant and non-malignant diseases. Conclusions: Tuberculosis is most common cause of generalized lymphadenopathy followed by lymphoma. And reactive lymphadenitis is also an important consideration. [Int J Res Med Sci 2016; 4(8.000: 3542-3548

  4. A review of governance of maternity services at South Tipperary general hospital

    LENUS (Irish Health Repository)

    Flory, David

    2015-09-01

    This review of the governance of maternity services at South Tipperary General Hospital has focussed on the systems and processes for assurance of service quality, risk management and patient safety primarily inside the hospital but also in the Hospital Group structure within which it operates. The effectiveness of the governance arrangements is largely determined by the quality of the leadership and management – both clinical and general – which designs, implements, and oversees those systems and processes and is ultimately responsible and accountable.\\r\

  5. DRUG MANAGEMENT REVIEWS IN DISTRICT DRUG MANAGEMENT UNIT AND GENERAL HOSPITAL

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    Max Joseph Herman

    2009-12-01

    Full Text Available Drug is one of the essential elements in healthcare that should be effectively and efficiently managed. Following thedecentralization in 2001 in Indonesia, drug management has changed in district drug management units and also in District General Hospitals. Certainly this condition influences the sustainability of drug access in primary health care such as in Community Health Center and District General Hospital, especially in drug financing policy. A cross sectional descriptive study to obtain information on drug management in public healthcare in district had been carried out between July and December 2006 in 10 District Public Drug Management Units from 10 district health offices and 9 district general hospitals as samples. Data were collected by interviewing heads of Drug Section in District Health Offices and heads of Hospital Pharmacies using structured questionnaires and observing drug storage in District Drug Management Units, Community Health Centers, and Hospital Pharmacies. Results of the study show that drug planning in District Health Offices and General Hospitals did not meet the basic real need in some districts nor District Hospitals. The minimum health service standards had no been achieved yet. Furthermore, drug procurement, storage and recording as well as reporting was not good enough either, such as shown by the existence of expired drugs. Lead time for drug delivery to community health centers in some districts was longer than the average of lead time in the past 3 years.

  6. 北京市改革试点公立医院住院患者满意度调查%Survey on satisfaction of inpatients in pilot public hospital of reform in Beijing

    Institute of Scientific and Technical Information of China (English)

    袁素维; 高星; 刘雯薇; 杨小冉; 陶婧婧; 李志建; 曹剑涛; 张哲; 陆琳

    2013-01-01

    Objective To evaluate the effectiveness of reform on public hospital in Beijing by inpatients.Methods Two hundred inpatients were selected from one pilot hospital of reform (with global budget and diagnosis related groups payment reform) and non-pilot hospital (without payment reform) respectively,and the satisfaction of inpatients with reform measures was surveyed with questionnaires.Results There was no significant difference in demographic characteristics between two hospitals (P > 0.05).The total score of satisfaction of pilot hospital (4.64 ± 0.24) was significantly higher than that of nonpilot hospital (4.40 ± 0.28) (P < 0.01).Among 5 first-level indicators,the scores of hospital environment,health service providing and medical auxiliary service in polit hospital were significantly higher than those in non-pilot hospital (P < 0.01).There was no significant difference in the satisfaction rate between pilot hospital (93.18%) and non-pilot hospital (90.98%)(P > 0.05).The satisfaction rate of health service providing was the lowest among 5 indicators in these two hospitals,and were 84.00% and 79.58% respectively (P > 0.05).The satisfaction rate of medical auxiliary service in pilot hospital (97.04%) was significantly higher than that in non-pilot hospital (87.83%)(P < 0.01).Among 20 second-level indicators,except for the indicators of waiting time for admission,admission procedures,explanation of admission reason by doctor,attitude of medical technician and doctor's response to the demand of patients,the scores of satisfaction of the other 15 indicators in pilot hospital were significantly higher than those in non-pilot hospital (P < 0.01).Moreover,inpatients were most satisfied with the service attitude of nurses,and were most dissatisfied with the health care cost.Convenience of bill query,satisfaction of hospital environment and food quality of hospital were second-level indicators that significantly correlated with the total

  7. HOSPITAL PATIENT DATABASE MANAGEMENT SYSTEM ‘A Case Study of General Hospital NORTH-BANK Makurdi- Nigeria’

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    Oye Nathaniel David

    2014-03-01

    Full Text Available Health care in Nigeria as in many other countries is confronted with growing demand for medical treatment and services. The medical records must appropriately have all of the patients’ medical history. Physicians must maintain flawless records, because this document serves a number of purposes. This study on hospital patient datable management system was design to transform the manual way of searching, sorting, keeping and accessing patient medical information (files into electronic medical record (EMR in order to solve the problem associate with manual method. The existing system (manual has been studied and hence a computer based application was provided to replace this manual method. These computer based systems generate the patient report as the patient register in and out of the hospital. This paper generally looks for a more accurate, reliable and efficient method of computer to facilitate patient record’s keeping in General Hospitals to ensure efficient outcome that will lessen time consuming. The study proposed that the design of hospital patient database record will be a solution to the problem being experienced by the current manual method of keeping patient medical record.

  8. The study of self-evaluated health level in inpatients with depression in general hosptial%综合医院住院抑郁障碍患者自测健康状况的研究

    Institute of Scientific and Technical Information of China (English)

    陈晓东; 苏敬华; 农秋葵

    2014-01-01

    Objective To explore the self-evaluated health level and it’s associated factors in inpatients with depression in general hospital. Method A total number of 600 inpatients were enrol ed from three general hosptial in Guangzhou city. Al of these patients were asked to complete a self-designed questionaire about demorgraphic features, and complete self-rating health measurement scale(SRHMS) to evaluate health level. Diagnostic and statistic manual about mental disorder, fourth edition(DSM-IV) was used to diagnose depression. We compared the differences between the depression group and control, and probed the associated factors of self-evaluated health level in depression group. Result The total score of SRHMS in patients with depression in general hosptial was 222.85±65.53, the scores of physical health, mental health and social health were 92.39±31.97, 75.06±24.97 and 55.09±23.10 respectively, which were al significantly lower than that in controls. The scores of physical health and mental health were higher in patients who were below 55 years old compare with those older. The educational level was associated with social health level. Multiple linear regression analysis showed that the fol owing factors were associated with higher total score of SRHMS, married, higher family monthly income, first admission and inpatient time range from 8 to 14 days. Conclusion The self-evaluated health levels were low in patients with depression in general hospital. Age, marrital status, educational level, family monthly income, admission frequency and time may be the important factors associated with health level.%目的:探讨综合医院住院患者中抑郁障碍者自测健康状况及其影响因素。方法采用自编一般情况问卷、自测健康状况评定量表(SRHMS)、美国《精神障碍诊断与统计手册第四版》DSM-Ⅳ轴Ⅰ障碍定式临床检查病人版(SCID)对广州市3家综合医院≥16岁的600名住院患者进行调查。以SCID为精

  9. Psychiatric inpatient expenditures and public health insurance programmes: analysis of a national database covering the entire South Korean population

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    Chung Woojin

    2010-09-01

    Full Text Available Abstract Background Medical spending on psychiatric hospitalization has been reported to impose a tremendous socio-economic burden on many developed countries with public health insurance programmes. However, there has been no in-depth study of the factors affecting psychiatric inpatient medical expenditures and differentiated these factors across different types of public health insurance programmes. In view of this, this study attempted to explore factors affecting medical expenditures for psychiatric inpatients between two public health insurance programmes covering the entire South Korean population: National Health Insurance (NHI and National Medical Care Aid (AID. Methods This retrospective, cross-sectional study used a nationwide, population-based reimbursement claims dataset consisting of 1,131,346 claims of all 160,465 citizens institutionalized due to psychiatric diagnosis between January 2005 and June 2006 in South Korea. To adjust for possible correlation of patients characteristics within the same medical institution and a non-linearity structure, a Box-Cox transformed, multilevel regression analysis was performed. Results Compared with inpatients 19 years old or younger, the medical expenditures of inpatients between 50 and 64 years old were 10% higher among NHI beneficiaries but 40% higher among AID beneficiaries. Males showed higher medical expenditures than did females. Expenditures on inpatients with schizophrenia as compared to expenditures on those with neurotic disorders were 120% higher among NHI beneficiaries but 83% higher among AID beneficiaries. Expenditures on inpatients of psychiatric hospitals were greater on average than expenditures on inpatients of general hospitals. Among AID beneficiaries, institutions owned by private groups treated inpatients with 32% higher costs than did government institutions. Among NHI beneficiaries, inpatients medical expenditures were positively associated with the proportion of

  10. Internal and External Perspectives on Quality of Healthcare Services at Sanglah General Hospital Denpasar

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    Made Nopy Diah Sundari

    2015-04-01

    Full Text Available Background and purpose: Customer satisfaction is a primary indicator of the quality of public healthcare services. This study investigated internal (hospital staff and external (hospital clients perspectives in order to gain insight into the quality of care at Sanglah General Hospital.Methods: The study used both qualitative and quantitative methodologies with 11 informants and 106 respondents. Qualitative data obtained through in-depth interviews with hospital staff were analyzed thematically. Quantitative data obtained through self-administered questionnaire were analyzed using univariate analysis.Results: Informants from the qualitative data collection stated that Sanglah General Hospital has a relatively high level of service and that existing structures to mitigate issues are in place, which act as reinforcing factors. Data from the quantitative survey indicated that clients were satisfied with the quality of service (ServQual, with an overall percentage of 83.82%.Conclusion: Further efforts could be made in order to improve healthcare provision at Sanglah Hospital, particularly from the perspective of hospital facilities, staff support and increased implementation of clinical governance.Keywords: quality of service, internal perspectives, external perspectives, Sanglah Hospital

  11. Psychiatric morbidity among medical in-patients: a standardized assessment (GHQ-12 and CIS-R) using 'lay' interviewers in a Brazilian hospital.

    Science.gov (United States)

    Botega, N J; Pereira, W A; Bio, M R; Garcia Júnior, C; Zomignani, M A

    1995-05-01

    The 12-item General Health Questionnaire (GHQ-12) and the revised Clinical Interview Schedule (CIS-R) were used to estimate the prevalence of psychiatric morbidity among 78 consecutive admissions to a general medical ward in a Brazilian university hospital (43 males and 35 females; mean age = 43.2 years). The CIS-R was administered by three 5th-year medical students after a brief training. A prevalence rate of 36% was found for psychiatric disorders. The most frequent symptoms were sleep disorders (48.7%), worry (35.9%), depression (28.2%) and anxiety (26.9%). The sensitivity and specificity of the GHQ-12 were 71% and 76%, respectively. The CIS-R was simple to administer and acceptable both to patients and interviewers. Misunderstanding was most likely to occur with the poorly educated (20% were illiterate) in questions involving time calculation. Alternative options might be used to specify the length of time in future studies. The findings support the feasibility of the CIS-R and the use of 'lay' interviewers to produce epidemiological information on psychiatric disorders in developing countries at lower costs.

  12. [Pharmaceutical Service after the Fukushima Disaster: A Case Report of Soma General Hospital].

    Science.gov (United States)

    Fukunaga, Hisanori; Momonoi, Toshiyuki; Kumakawa, Hiromi

    2016-01-01

      Despite being damaged by the 2011 Tohoku earthquake, tsunami, and nuclear disaster, Soma General Hospital, located approximately 40 km north of Fukushima Daiichi nuclear power plant, was able to fulfill its role as a key regional hospital in northeast Fukushima. To elucidate the pharmaceutical service in response to the disaster, we investigated the hospital's operations in 2011 according to the medical records and prescriptions. One of the difficulties that the department of pharmaceutical service faced at that time was the increase in emergency healthcare requests by evacuated patients from other hospitals and clinics. Herein, we propose the following countermeasures to be considered in future disaster preparations: (1) establishing a medical and pharmaceutical service coordinator for disaster relief; (2) sharing all local patients' medical information in emergencies (at least contraindicated drugs or allergy history); and (3) reviewing disaster stockpiles, especially pharmaceuticals (both at the hospital and in nearby locations).

  13. MANAGEMENT OF DIABETES IN ACUTE MYOCARDIAL INFARCTION IN CELJE GENERAL HOSPITAL IN 1999

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    Gregor Veninšek

    2001-12-01

    Full Text Available Background. DIGAMI study showed that intrahospital mortality and mortality at one year after myocardial infarction can be significantly reduced in diabetics treated in acute phase of myocardial infarction by GI infusion and afterwards for at least three months with intensive insulin treatment. Mortality can be reduced for more than 50% in a subgroup of patients younger than 70 years, without congestive heart failure, with first myocardial infarction, not treated with insulin or digitalis. In this perspective we reviewed treatment of diabetics with acute myocardial infarction in 1999 in Celje General Hospital.Methods. We reviewed documentation of treatment of all diabetics with acute myocardial infarction treated in Celje General Hospital in 1999. We collected data on number of newly discovered diabetes, on previous treatment of diabetes, on treatment of diabetes during hospitalization and at discharge, on drugs used for treatment of diabetes and on mortality during hospitalization.Results. Diabetics presented 20% of all patients with acute myocardial infarction treated in Celje General Hospital in 1999. None of patients received GI infusion, none had intensively managed blood sugar. 24% of patients were treated with sulfonylureas in acute phase of myocardial infarction. 33% of patients were discharged from hospital with insulin therapy. Intrahospital mortality was 9%, comparable with patients without diabetes.Conclusions. In 1999 was intrahospital treatment of diabetics with acute myocardial infarction in Celje General Hospital successful as their intrahospital mortality equaled non-diabetics. Treatment of diabetes itself, during hospitalization and after discharge, on the other hand, in 1999 had not been up to date according to results of recent studies. In our opinion, it is mandatory for diabetologist to make part of the team that treats diabetic with acute myocardial infarction

  14. Analysis of Disease Composition and Tendency about Inpatients of a Hospital in Liaoning Province from 2003 to 2014%2003~2014年辽宁某院住院病人疾病谱及变化趋势分析

    Institute of Scientific and Technical Information of China (English)

    石锋; 王飞

    2015-01-01

    Objective To know the main pattern about inpatients of a hospital in Liaoning province, and to provide a scientific basis for targeted arrangements of the relevant departments.Methods The constituent ratio and the Cochran-Armitage trend test were used to analyze the medical record about inpatients of a hospital in Liaoning province from 2003 to 2014, to get the disease composition and variation tendency of inpatients.Results Tumor is the first of the disease composition. Respiratory system disease, pregnancy and childbirth puerperium, tumor and circulatory problems are respectively the first of the disease compositions in different age groups.Conclusion Diagnosis and treatment of tumor, respiratory system diseases on children, circulatory system disease on the elderly, and health care of the child-bearing age women and children are the focus of health planning in this hospital in Liaoning province at present stage.%目的:了解辽宁某院住院病人的主要患病模式,为有关部门针对性的部署提供科学依据。方法利用2003~2014年辽宁某院住院病人病案首页资料,采用构成比和Cochran-Armitage趋势检验分析住院病人疾病构成及变化趋势特征。结果肿瘤居疾病构成首位,居各年龄段疾病构成首位的分别是呼吸系统疾病、妊娠分娩产褥期、肿瘤和循环系统疾病。结论现阶段肿瘤、儿童呼吸系统疾病和老年人循环系统疾病的诊治以及育龄妇幼卫生保健是该院诊疗工作规划的重点。

  15. The 30 degree tilt position vs the 90 degree lateral and supine positions in reducing the incidence of non-blanching erythema in a hospital inpatient population: a randomised controlled trial.

    Science.gov (United States)

    Young, Trudie

    2004-07-01

    Manual repositioning of patients by nursing staff is a recognised technique for preventing pressure ulcer formation. The 30 degree tilt is a method of positioning patients that, in the laboratory setting, reduced the contact pressure between the patient and the support surface. A randomised controlled trial was used to examine the effects of the 30 degree tilt position in reducing the incidence of non-blanching erythema (i.e. established pressure damage) in a hospital inpatient population (n=23) when compared to the use of the 90 degree lateral and supine position (n=23). The primary outcome of the trial was the incidence of pressure damage, defined as non-blanching erythema. In this study no subject developed pressure damage that presented with visible breaks in the epidermis, but all damage was restricted to areas of non-blanching erythema (five of the 39 subjects who completed the study exhibited such injury). The main findings of this study were that patient positioning using the 30 degree tilt method did not reduce the incidence of pressure damage compared with either the 90 degree lateral or supine positions. This study also investigated the feasibility of using the 30 degree tilt position with medical inpatients; it found that 78% of subjects experienced difficulty in adopting and maintaining the position. This finding seriously questions the practicality of using the 30 degree tilt method with a predominantly ill population.

  16. Mortality experience, 30-days and 365-days after admission, for the 20 most frequent DRG groups among Medicare inpatients aged 65 or older in Connecticut hospitals, fiscal years 1991, 1992, and 1993.

    Science.gov (United States)

    Hennen, J; Krumholz, H M; Radford, M J

    1995-03-01

    This report presents mortality rates following inpatient admissions for the 20 most frequent DRG categories among Medicare inpatients aged > or = 65 years at Connecticut acute-care hospitals during the three-year period from fiscal year 1991 to fiscal year 1993. We provide frequency distributions of the 30-day and 365-day mortality rates among these 20 DRG categories. Among the 199,680 discharges of elderly Medicare beneficiaries within the 20 most frequent DRG categories in the three-year study period, the crude 30-day mortality rate was 9.51%; the crude 365-day mortality rate was 28.40%. By gender, the crude 30-day mortality rate for women was 8.78%; the corresponding rate for men was 10.48%. This gender mortality differential occurred despite a significant age differential; on average, the females were 2.5 years older than the males. By age group, the crude mortality rates were: age 65-74 years, 6.66%; age 75-84 years, 9.80%; age > or = 85 years, 15.25%. The crude mortality rates for the DRG categories were found to be stable over the three-year study period.

  17. A 5-year audit of outcome of apicectomies carried out in a district general hospital.

    Science.gov (United States)

    Lyons, A. J.; Hughes, C. E.; Dixon, E. J.

    1995-01-01

    Success rates of up to 90% have been claimed for apicectomy. However, the conditions that this procedure is carried out under at district general hospitals may be at variance with such studies. A 5-year audit of outcome was therefore carried out within a district general hospital. It was found that 89% of apicected teeth still remained at 5 years. Outcome was not influenced by any of the factors examined, and could not be predicted radiographically. Most failures occurred after the average postoperative review period of 10.5 months. Patient satisfaction with the procedure was high at over 90%. Based on these results it was concluded that apicectomy was an effective procedure when carried out by staff of all grades within the district general hospital, and that repeated follow-up appointments with radiographs over the first postoperative year were not useful. PMID:7574319

  18. The Stroke Assessment of Fall Risk (SAFR): predictive validity in inpatient stroke rehabilitation.

    Science.gov (United States)

    Breisinger, Terry P; Skidmore, Elizabeth R; Niyonkuru, Christian; Terhorst, Lauren; Campbell, Grace B

    2014-12-01

    To evaluate relative accuracy of a newly developed Stroke Assessment of Fall Risk (SAFR) for classifying fallers and non-fallers, compared with a health system fall risk screening tool, the Fall Harm Risk Screen. Prospective quality improvement study conducted at an inpatient stroke rehabilitation unit at a large urban university hospital. Patients admitted for inpatient stroke rehabilitation (N = 419) with imaging or clinical evidence of ischemic or hemorrhagic stroke, between 1 August 2009 and 31 July 2010. Not applicable. Sensitivity, specificity, and area under the curve for Receiver Operating Characteristic Curves of both scales' classifications, based on fall risk score completed upon admission to inpatient stroke rehabilitation. A total of 68 (16%) participants fell at least once. The SAFR was significantly more accurate than the Fall Harm Risk Screen (p stroke rehabilitation patients. While the SAFR improves upon the accuracy of a general assessment tool, additional refinement may be warranted. © The Author(s) 2014.

  19. Attitudes of Malaysian general hospital staff towards patients with mental illness and diabetes

    Directory of Open Access Journals (Sweden)

    Midin Marhani

    2011-05-01

    Full Text Available Abstract Background The context of the study is the increased assessment and treatment of persons with mental illness in general hospital settings by general health staff, as the move away from mental hospitals gathers pace in low and middle income countries. The purpose of the study was to examine whether general attitudes of hospital staff towards persons with mental illness, and extent of mental health training and clinical experience, are associated with different attitudes and behaviours towards a patient with mental illness than towards a patients with a general health problem - diabetes. Methods General hospital health professionals in Malaysia were randomly allocated one of two vignettes, one describing a patient with mental illness and the other a patient with diabetes, and invited to complete a questionnaire examining attitudes and health care practices in relation to the case. The questionnaires completed by respondents included questions on demographics, training in mental health, exposure in clinical practice to people with mental illness, attitudes and expected health care behaviour towards the patient in the vignette, and a general questionnaire exploring negative attitudes towards people with mental illness. Questionnaires with complete responses were received from 654 study participants. Results Stigmatising attitudes towards persons with mental illness were common. Those responding to the mental illness vignette (N = 356 gave significantly lower ratings on care and support and higher ratings on avoidance and negative stereotype expectations compared with those responding the diabetes vignette (N = 298. Conclusions Results support the view that, in the Malaysian setting, patients with mental illness may receive differential care from general hospital staff and that general stigmatising attitudes among professionals may influence their care practices. More direct measurement of clinician behaviours than able to be implemented

  20. A comparative analysis of exposure doses between the radiation workers in dental and general hospital

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Nam Hee; Chung, Woon Kwan; Dong, Kyung Rae; Ju, Yong Jin; Song, Ha Jin [Dept. of Nuclear Engineering, Chosun University, Gwangju (Korea, Republic of); Choi, Eun Jin [Dept. of Public Health and Medicine, Dongshin University, Naju (Korea, Republic of)

    2015-02-15

    Research and investigation is required for the exposure dose of radiation workers to work in the dental hospital as increasing interest in exposure dose of the dental hospital recently accordingly, study aim to minimize radiation exposure by making a follow-up study of individual exposure doses of radiation workers, analyzing the status on individual radiation exposure management, prediction the radiation disability risk levels by radiation, and alerting the workers to the danger of radiation exposure. Especially given the changes in the dental hospital radiation safety awareness conducted the study in order to minimize radiation exposure. This study performed analyses by a comparison between general and dental hospital, comparing each occupation, with the 116,220 exposure dose data by quarter and year of 5,811 subjects at general and dental hospital across South Korea from January 1, 2008 through December 31, 2012. The following are the results obtained by analyzing average values year and quarter. In term of hospital, average doses were significantly higher in general hospitals than detal ones. In terms of job, average doses were higher in radiological technologists the other workers. Especially, they showed statistically significant differences between radiological technologists than dentists. The above-mentioned results indicate that radiation workers were exposed to radiation for the past 5 years to the extent not exceeding the dose limit (maximum 50 mSv y{sup -1}). The limitation of this study is that radiation workers before 2008 were excluded from the study. Objective evaluation standards did not apply to the work circumstance or condition of each hospital. Therefore, it is deemed necessary to work out analysis criteria that will be used as objective evaluation standard. It will be necessary to study radiation exposure in more precise ways on the basis of objective analysis standard in the future. Should try to minimize the radiation individual dose of

  1. Review of paediatric cardiology services in district general hospitals in the United Kingdom.

    Science.gov (United States)

    Andrews, Hannah; Singh, Yogen

    2016-03-01

    Following the Safe and Sustainable review of Paediatric Services in 2012/2013, National Health Service England recommended that local paediatric cardiology services should be provided by specially trained paediatricians with expertise in cardiology in all non-specialist hospitals. To understand the variation in local paediatric cardiology services provided across district general hospitals in the United Kingdom. An internet-based questionnaire was sent out via the Paediatrician with Expertise in Cardiology Special Interest Group and the Neonatologists with Interest in Cardiology and Haemodynamics contact databases and the National Health Service directory. Non-responders were followed-up via telephone. The response rate was 80% (141 of 177 hospitals), and paediatricians with expertise in cardiology were available in 68% of those. Local cardiology clinics led by paediatricians with expertise in cardiology were provided in 96 hospitals (68%), whereas specialist outreach clinics were held in 123 centres (87%). A total of 11 hospitals provided neither specialist outreach clinics nor any local cardiology clinics led by paediatricians with expertise in cardiology. Paediatric echocardiography services were provided in 83% of the hospitals, 12-lead electrocardiogram in 96%, Holter electrocardiogram in 91%, and exercise testing in only 47% of the responding hospitals. Telemedicine facilities were established in only 52% of the centres, where sharing echocardiogram images via picture archiving and communication system was used most commonly. There has been a substantial increase in the availability of paediatricians with expertise in cardiology since 2008. Most of the hospitals are well-supported by specialist cardiology centres via outreach clinics; however, there remains significant variation in the local paediatric cardiology services provided across district general hospitals in the United Kingdom.

  2. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2017 Rates; Quality Reporting Requirements for Specific Providers; Graduate Medical Education; Hospital Notification Procedures Applicable to Beneficiaries Receiving Observation Services; Technical Changes Relating to Costs to Organizations and Medicare Cost Reports; Finalization of Interim Final Rules With Comment Period on LTCH PPS Payments for Severe Wounds, Modifications of Limitations on Redesignation by the Medicare Geographic Classification Review Board, and Extensions of Payments to MDHs and Low-Volume Hospitals. Final rule.

    Science.gov (United States)

    2016-08-22

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2017. Some of these changes will implement certain statutory provisions contained in the Pathway for Sustainable Growth Reform Act of 2013, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Notice of Observation Treatment and Implications for Care Eligibility Act of 2015, and other legislation. We also are providing the estimated market basket update to apply to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2017. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2017. In addition, we are making changes relating to direct graduate medical education (GME) and indirect medical education payments; establishing new requirements or revising existing requirements for quality reporting by specific Medicare providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities), including related provisions for eligible hospitals and critical access hospitals (CAHs) participating in the Electronic Health Record Incentive Program; updating policies relating to the Hospital Value-Based Purchasing Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition Reduction Program; implementing statutory provisions that require hospitals and CAHs to furnish notification to Medicare beneficiaries, including Medicare Advantage enrollees, when the beneficiaries receive outpatient observation services for more than 24 hours; announcing the implementation of the Frontier Community Health Integration Project Demonstration; and

  3. Healing at home: Comparing cohorts of children with medium-sized burns treated as outpatients with in-hospital applied Acticoat to those children treated as inpatients with silver sulfadiazine.

    Science.gov (United States)

    Peters, Daniel A; Verchere, Cynthia

    2006-01-01

    Using Acticoat (Smith & Nephew, London, UK), a dressing that requires changing only twice per week, we are able to discharge children with medium-sized burns for the majority of their acute care. In sizeable wounds, early burn care is often too painful to do at home and, therefore, sedative analgesia or anesthesia can be provided by the burn unity as necessary. In the interval between dressings, the patients remain at home. A cohort of 30 patients treated in this fashion between 2000 and 2002 were compared with 73 matched historical controls kept as inpatients and treated with silver sulfadiazine. Children treated with Acticoat spent, on average, 0.83 days admitted in hospital whereas those treated with silver sulfadiazine averaged 13.85 days (P burn care.

  4. Psychological impact of the pandemic (H1N1) 2009 on general hospital workers in Kobe.

    Science.gov (United States)

    Matsuishi, Kunitaka; Kawazoe, Ayako; Imai, Hissei; Ito, Atsushi; Mouri, Kentaro; Kitamura, Noboru; Miyake, Keiko; Mino, Koichi; Isobe, Masanori; Takamiya, Shizuo; Hitokoto, Hidefumi; Mita, Tatsuo

    2012-06-01

    In order for hospitals to work efficiently in a pandemic, it is important to know how a pandemic affects the hospital staff. The aim of the present study was to investigate the psychological impact of the pandemic (H1N1) 2009 on hospital workers and how it was affected by the characteristics of the hospital, gender, age, job and work environment. In late June 2009, soon after the pandemic had ended in Kobe city, Japan, a questionnaire was distributed consisting of questions on sociodemographic characteristics, 19 stress-related questions and the Impact of Event Scale (IES) to all 3635 employees at three core general hospitals in Kobe. Exploratory factor analysis was applied to the 19 stress-related questions, and this produced four factors for evaluation (anxiety about infection, exhaustion, workload, and feeling of being protected). Multiple regression models were used to evaluate the association of personal characteristics with each score of the four factors and the IES. Valid answers were received from 1625 employees. Workers at a hospital with intense liaison psychiatric services felt less psychological impact. Workers at a hospital that provided staff with information about the pandemic less frequently, felt unprotected. Workers in work environments that had a high risk of infection felt more anxious and more exhausted. The total IES score was higher in workers in high-risk work environments. It is important for hospitals to protect hospital workers during a pandemic and to rapidly share information about the pandemic. Liaison psychiatric services can help to reduce the impact of the pandemic on hospital workers. © 2012 The Authors. Psychiatry and Clinical Neurosciences © 2012 Japanese Society of Psychiatry and Neurology.

  5. The use of the truth and deception in dementia care amongst general hospital staff.

    Science.gov (United States)

    Turner, Alex; Eccles, Fiona; Keady, John; Simpson, Jane; Elvish, Ruth

    2017-08-01

    Deceptive practice has been shown to be endemic in long-term care settings. However, little is known about the use of deception in dementia care within general hospitals and staff attitudes towards this practice. This study aimed to develop understanding of the experiences of general hospital staff and explore their decision-making processes when choosing whether to tell the truth or deceive a patient with dementia. This qualitative study drew upon a constructivist grounded theory approach to analyse data gathered from semi-structured interviews with a range of hospital staff. A model, grounded in participant experiences, was developed to describe their decision-making processes. Participants identified particular triggers that set in motion the need for a response. Various mediating factors influenced how staff chose to respond to these triggers. Overall, hospital staff were reluctant to either tell the truth or to lie to patients. Instead, 'distracting' or 'passing the buck' to another member of staff were preferred strategies. The issue of how truth and deception are defined was identified. The study adds to the growing research regarding the use of lies in dementia care by considering the decision-making processes for staff in general hospitals. Various factors influence how staff choose to respond to patients with dementia and whether deception is used. Similarities and differences with long-term dementia care settings are discussed. Clinical and research implications include: opening up the topic for further debate, implementing staff training about communication and evaluating the impact of these processes.

  6. Care for patients with cerebrovascular disease in a general hospital. 2 years experience

    Directory of Open Access Journals (Sweden)

    Joan Omar Rojas Fuentes

    2010-08-01

    Full Text Available Background: The care of patients with cerebrovascular disease requires an organized system from pre-hospital care until discharge of the patient, to ensure the continuity of rehabilitation. In order to provide differentiated services to patients with this condition was created in the General Hospital Universitario "Dr. Gustavo Lima Aldereguía "a specialized room for attention to these diseases and the rehabilitation of patients. Objective: To determine the benefits obtained with differentiated services to patients with cerebrovascular disease in a general hospital. Methods: Descriptive case series that included 1038 patients admitted to the specialized chamber for cerebrovascular disease. We analyzed the following variables: stay, type of cerebrovascular disease, clinical classification, the Barthel index and discharge status. Results: 972 patients suffered from cerebrovascular disease, hospital stay was reduced by two days, the attention of specialized equipment increased from 51.75% to 79.2% patients were discharged with a mild degree of functional dependence. Conclusions: The differentiated services to cerebrovascular disease in general hospitals shows benefits for patients.

  7. Care of severe head injury patients in the Sarawak General Hospital: intensive care unit versus general ward.

    Science.gov (United States)

    Sim, S K; Lim, S L; Lee, H K; Liew, D; Wong, A

    2011-06-01

    Intensive care for severe head injury patients is very important in the prevention and treatment of secondary brain injury. However, in a resources constraint environment and limited availability of Intensive Care Unit (ICU) beds in the hospitals, not all severe head injury patients will receive ICU care. This prospective study is aimed to evaluate the outcome of severe head injured patients who received ICU and general ward care in Sarawak General Hospital (SGH) over a 6-month period. A total of thirty five severe head injury patients were admitted. Twenty three patients (65.7%) were ventilated in general ward whereas twelve patients (34.3%) were ventilated in ICU. Overall one month mortality in this study was 25.7%. Patients who received ICU care had a lower one month mortality than those who received general ward care (16.7% vs 30.4%), although it was not statistically different. Multivariate analysis revealed only GCS on admission (OR 0.731; 95% CI 0.460 to 0.877; P=0.042) as the independent predictive factor for one month mortality in this study.

  8. Short and medium-term outcomes for general surgery in nonagenarian patients in a district general hospital.

    Science.gov (United States)

    Hayes, A J; Davda, A; El-Hadi, M; Murphy, P; Papettas, T

    2016-07-01

    Introduction Surgeons are increasingly performing surgery on older patients. There are currently no tools specifically for risk prediction in this group. The aim of this study was to review general surgical operations carried out on patients aged over 90 years and their outcome, before comparing these with predictors of morbidity and mortality. Methods A retrospective review was carried out at our district general hospital of all general surgery patients aged over 90 years who underwent a general surgical operation over a period of 14 years. Information collected included demographics, details of procedures, P-POSSUM (Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity), complications and outcomes. Results A total of 119 procedures were carried out, 72 involving entry into the peritoneal cavity. Overall, 14 patients (12%) died within 30 days and 34 (29%) died within one year. Postoperative complications included infection (56%), renal failure (24%), need for transfusion (17%) and readmission within 30 days (11%). Logistical regression analysis showed that the P-POSSUM correlated well with observed mortality and infection was a significant predictor of in-hospital mortality (p=0.003). Conclusions The P-POSSUM correlates significantly with outcome and should be used when planning major elective or emergency surgery in patients over 90 years of age. Infective complications appear to be a significant predictor of postoperative mortality. This study supports operative intervention as an option in this extreme age group but we emphasise the importance of appropriate patient selection and judicious clinical care.

  9. Recovery rate and associated factors of children age 6 to 59 months admitted with severe acute malnutrition at inpatient unit of Bahir Dar Felege Hiwot Referral hospital therapeutic feeding unite, northwest Ethiopia

    Science.gov (United States)

    Desyibelew, Hanna Demelash; Fekadu, Abel; Woldie, Haile

    2017-01-01

    Background Despite numerous advances made in improving child health and the clinical management protocols for treating severe acute malnutrition at treatment centers, evidences concerning the treatment outcomes are scarce. Therefore, this study was conducted to assess the recovery rate and associated factors of severely acute malnourished children of age 6 to 59 months admitted to inpatient therapeutic feeding unit at Felege Hiwot Referral Hospital. Methods We conducted a hospital-based cross-sectional study including 401 severely malnourished children who were admitted from September 2012 to January 2016. Bivariable and a Multivariable logistic regression model were fitted to identify factors associated with recovery rate. Adjusted Odds ratio with its 95% CI was reported and P-value less than 0.05 was considered as significant. Results Fifty eight percent (58.4%) (95%CI: 53.1–64.1) of admitted children were recovered with a mean recovery time of 18 (±6.3) days. Being female, children who were fully and partially vaccinated, who had better MUAC measurement, who stayed longer in the hospital, and children who took routine vitamin-A supplementation had better recovery rate. However, children who had co-morbidity at admission, had human immune virus (HIV) and Tuberculosis (TB) infection, and who had edema were less likely to recover. Interpretation Recovery rate was low as compared to international SPHERE cutoff points (> 75% recovery rate). Interventions that could address the outlined factors would be helpful to improve treatment recovery rate of admitted children. PMID:28166247

  10. Profiles and factors associated with poor glycemic control among inpatients with diabetes mellitus type 2 as a primary diagnosis in a teaching hospital

    Directory of Open Access Journals (Sweden)

    Aniza Ismail

    2016-01-01

    Full Text Available Context: Diabetes mellitus is a growing health problem in most countries. In Malaysia, there was an increase in prevalence over the years. This makes diabetes also a growing concern in Malaysia, which warrants strengthening of the prevention and control programme. Aims: This paper aims to describe the profiles of diabetes mellitus type 2 in tertiary setting and to identify the risk factors for high level of HbA1c among the study population. The findings will give a glimpse on current status of diabetes in our country and may reflect the achievement of the country in combating this disease. Settings and Design: A cross-sectional study was conducted in UKM Medical Centre. Methods and Material: Medical records of patient with E11 ICD-10 code were collected using Case Report Form. Statistical Analysis Used: Descriptive analysis done of mean and median while test of association were done using Spearman correlation and logistic regression. Results: The results showed that majority of inpatients of DMT2 showed mean age of 58.8 + 12.6 years and most were males (56.7% with secondary level of education (41.7%. Median duration of disease was 12.0 + 11.0 years with median HbA1c level of 8.9 ± 4.4%. Only small proportion of patients achieved the desired level of HbA1c <6.5% (21.3% and significant association was found with tertiary level of education [AOR=0.10, 95%CI=0.01-0.96] and with type of anti-diabetic therapy [AOR=15.90, 95%CI=2.03-124.30]. Conclusions: In conclusion, diabetes mellitus type 2 inpatients still showed unsatisfactory glycemic control and holistic approach using health education should be advocated continuously in the future in view of education being one of the predictors for the good HbA1c outcome.

  11. A Comparative Study of United States Service Members With and Without a History of Inpatient Psychiatric Hospitalization on Post Deployment Trauma, Depression, and Hazardous Alcohol Use Symptoms

    Science.gov (United States)

    2014-01-01

    34! Post-Deployment Health Reassessment (PDHRA) ....................................... 36! Human Subjects Protection...this thesis. The Methods section outlines the research design, sample, measures, procedures, human subjects protection, and data analytic approach...disorder hospitalization rates were greater than the hospitalization rates reported for diagnostic categories associated with pregnancy and childbirth (4

  12. Addressing Inpatient Glycaemic Control with an Inpatient Glucometry Alert System

    Directory of Open Access Journals (Sweden)

    J. N. Seheult

    2015-01-01

    Full Text Available Background. Poor inpatient glycaemic control has a prevalence exceeding 30% and results in increased length of stay and higher rates of hospital complications and inpatient mortality. The aim of this study was to improve inpatient glycaemic control by developing an alert system to process point-of-care blood glucose (POC-BG results. Methods. Microsoft Excel Macros were developed for the processing of daily glucometry data downloaded from the Cobas IT database. Alerts were generated according to ward location for any value less than 4 mmol/L (hypoglycaemia or greater than 15 mmol/L (moderate-severe hyperglycaemia. The Diabetes Team provided a weekday consult service for patients flagged on the daily reports. This system was implemented for a 60-day period. Results. There was a statistically significant 20% reduction in the percentage of hyperglycaemic patient-day weighted values >15 mmol/L compared to the preimplementation period without a significant change in the percentage of hypoglycaemic values. The time-to-next-reading after a dysglycaemic POC-BG result was reduced by 14% and the time-to-normalization of a dysglycaemic result was reduced from 10.2 hours to 8.4 hours. Conclusion. The alert system reduced the percentage of hyperglycaemic patient-day weighted glucose values and the time-to-normalization of blood glucose.

  13. Addressing Inpatient Glycaemic Control with an Inpatient Glucometry Alert System.

    Science.gov (United States)

    Seheult, J N; Pazderska, A; Gaffney, P; Fogarty, J; Sherlock, M; Gibney, J; Boran, G

    2015-01-01

    Background. Poor inpatient glycaemic control has a prevalence exceeding 30% and results in increased length of stay and higher rates of hospital complications and inpatient mortality. The aim of this study was to improve inpatient glycaemic control by developing an alert system to process point-of-care blood glucose (POC-BG) results. Methods. Microsoft Excel Macros were developed for the processing of daily glucometry data downloaded from the Cobas IT database. Alerts were generated according to ward location for any value less than 4 mmol/L (hypoglycaemia) or greater than 15 mmol/L (moderate-severe hyperglycaemia). The Diabetes Team provided a weekday consult service for patients flagged on the daily reports. This system was implemented for a 60-day period. Results. There was a statistically significant 20% reduction in the percentage of hyperglycaemic patient-day weighted values >15 mmol/L compared to the preimplementation period without a significant change in the percentage of hypoglycaemic values. The time-to-next-reading after a dysglycaemic POC-BG result was reduced by 14% and the time-to-normalization of a dysglycaemic result was reduced from 10.2 hours to 8.4 hours. Conclusion. The alert system reduced the percentage of hyperglycaemic patient-day weighted glucose values and the time-to-normalization of blood glucose.

  14. 42 CFR 413.114 - Payment for posthospital SNF care furnished by a swing-bed hospital.

    Science.gov (United States)

    2010-10-01

    ...) The hospital must not seek payment for posthospital SNF care after the end of the 5 day period... provides for payment for posthospital SNF care furnished by rural hospitals and CAHs having a swing-bed... SNF care furnished in general routine inpatient beds in rural hospitals and CAHs is paid in...

  15. The satisfaction levels of the patients admitted to a university hospital

    Directory of Open Access Journals (Sweden)

    Abdurrahim Emhan

    2010-09-01

    Full Text Available Objectives: The aim of this study was to determine various aspects of satisfaction levels and related socio-demographical variables of both inpatients and outpatients admitted to a university hospital.Material and Method: Two different questionnaires were prepared to evaluate the satisfaction levels of both inpa-tients and outpatients. Face to face interview was conducted with a total of 820 patients; 379 (%46.2 inpatients and 441 (%53.8 outpatients, to fill out the prepared questionnaires.Results: Among the inpatients 79.5% reported that they were generally satisfied at the level of or above their expec-tations, whereas it was the case for 76.2% of outpatients in the study. When the satisfaction levels of the inpatients and outpatients were compared; inpatients were more satisfied with the care provided by their doctors, the radiology services and patient security than the outpatients. In terms of general hospital hygiene outpatients reported a greater satisfaction than the inpatients. Among inpatients, the patients with advanced age were found to be more satisfied in terms of meal quality and hygiene of the clinic than the younger patients. Literate patients reported higher degrees of satisfaction of general hygiene and intent to re-prefer the hospital than high school graduates. Almost half of the pa-tients in the study (48% were from lower socioeconomical status and in some dimensions they reported less satis-faction than the patients from higher socioeconomical status.Conclusion: Low socioeconomical status is associated with decreased patient satisfaction. Although general satis-faction levels of inpatients and outpatients are similar, the care provided by doctors, the radiology services, patient security and general hospital hygiene may show some differences between these two groups.

  16. Upper urinary tract stone disease: the changing management in a district general hospital.

    OpenAIRE

    Goble, N M; Hammonds, J C; Wells, I P

    1987-01-01

    The advent of percutaneous nephrolithotomy (PCN) and ureteroscopy, in combination with stone disruption techniques, has dramatically altered the management of upper urinary tract stone disease. These advances are not necessarily confined to the teaching centres. The problems encountered introducing these techniques in a District General Hospital and their impact on the surgical management of upper urinary tract stones is presented.

  17. Critical care research in a district general hospital: the first year.

    Science.gov (United States)

    Camsooksai, Julie; Barnes, Helena; Reschreiter, Henrik

    2013-09-01

    Until recently, research in critical care units has usually taken place in university teaching hospitals. The 'general' critical care unit patient population is broader than this and the research needs to reflect this. As a general critical care unit in a district general hospital we wanted to set-up research within our own department, as part of the critical care team and part of our culture. With extensive background communication, drive and hard work, the support of the hospital Research and Development department was gained and Comprehensive Local Research Network funding successfully applied for. A research team was established and a model for the Research Nurse role was developed and implemented. This model is described. Participation in national trials commenced and the research portfolio is growing. Networking with other teams also proved valuable. Research has been established as part of the 'culture' of the day-to-day work and the staff have embraced this. Dedicated Research Nurse posts and education of the whole team have ensured successful implementation and recruitment of the studies. Experiences of the first year are shared and discussed here. Sharing experience of developing research within a critical care unit in a district general hospital, and a suggested model for a new Research Nurse role, may benefit other similar units in their efforts to establish research.

  18. Two decades of external peer review of cancer care in general hospitals; the Dutch experience

    NARCIS (Netherlands)

    Kilsdonk, M.J.; Siesling, S.; Otter, R.; Harten, van W.H.

    2015-01-01

    External peer review was introduced in general hospitals in the Netherlands in 1994 to assess and improve the multidisciplinary team approach in cancer care. This paper aims to explore the value, perceived impact, and (future) role of external peer review in cancer care. Semistructured interviews we

  19. TRANSPORT OF PATIENTS FOR PRIMARY PTCA FROM GENERAL HOSPITAL NOVO MESTO TO LJUBLJANA IN 2002

    Directory of Open Access Journals (Sweden)

    Renata Okrajšek

    2004-12-01

    Full Text Available Background. The treatment of acute coronary syndrome (ACS with ST-segment elevation with primary percutaneous transluminal coronary angioplasty (PTCA is the best way to treat these patients. Primary PTCA is also practicable with patients who are admitted into institution without catheter laboratory. The transport of patients into the tertiary institution is safe, but it is important to keep the time of ischemia as short as possible and to reach the time interval of door-balloon as recommended by the guidelines. The ACS patients with ST-segment elevation that were directed into General Hospital Novo mesto after examination at the internistic emergency department have been redirected to KC Ljubljana for realization of PTCA since October 2001.Methods. A prospective analysis of patients with ACS with STsegment elevation, who had been transferred from General Hospital Novo mesto to KC Ljubljana in the period from January 1, 2002 to December 31, 2002 to have a primary PTCA, was performed. The analysis comprised the following: the time interval of handling the patients at Internistic department of General Hospital Novo mesto, the time of transport of patients to Ljubljana and total time interval from the arrival of patients to General Hospital Novo mesto to the first inflation of balloon in Ljubljana. We monitored the complications that occurred during the treatment of the patients.Results. In the above mentioned period 29 patients (24 males and 5 females were transported from the General Hospital Novo mesto to the KC Ljubljana to have a primary PTCA performed. The total time interval measured between the patients’ arrival to General Hospital Novo mesto to the first inflation of balloon in Ljubljana in the year 2002 was 145 minutes, which is 17 minutes better than in the previous period. The time interval recommended by the guidelines was achieved with four patients.Conclusions. By recognizing the problems that had encountered with directing the

  20. Children in Foster Care: Before, during, and after Psychiatric Hospitalization

    Science.gov (United States)

    Persi, Joe; Sisson, Megan

    2008-01-01

    Although it is generally accepted that foster children are at greater risk for mental health problems than are children in the general population, very little is known about the smaller group of foster children admitted to psychiatric hospitals. The present study sought to determine whether foster children admitted to inpatient care are a distinct…

  1. Study of Patients Absconding Behavior in a General Hospital at Southern Region of Iran

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    Mohammad Khammarnia

    2015-03-01

    Full Text Available Background Patients’ escape from hospital imposes a significant cost to patients as well as the health system. Besides, for these patients, exposure to adverse events (such as suicide, self-harm, violence and harm to hospital reputation are more likely to occur compared to others. The present study aimed to determine the characteristics of the absconding patients in a general hospital through a case-control design in Shiraz, Iran. Methods This case-control study was conducted on 413 absconded patients as case and 413 patients as control in a large general hospital in Shiraz, southern Iran. In this study, data on the case and control patients was collected from the medical records using a standard checklist in the period of 2011–3. Then, the data were analyzed using descriptive and analytical statistics, through SPSS 16. Results The finding showed that 413 patients absconded (0.50% and mean of age in case group was 40.98 ± 16.31 years. In univariate analysis, variables of gender [Odds Ratio (OR= 2], ward (OR= 1.22, insurance status (OR= 0.41, job status (OR= 0.34 and residence expenditure were significant. However, in multivariate analysis significant variables were age (ORadj= 0.13, gender (ORadj= 2.15, self-employment/unemployed (ORadj= 0.47, emergency/admission (ORadj= 2.14, internal/admission (ORadj= 3.16, insurance status (ORadj= 4.49 and residence expenditure (ORadj= 1.15. Conclusion Characteristics such as middle age, male gender, no insurance coverage, inability to afford hospital expenditures and admission in emergency department make patients more likely abscond from the hospital. Therefore, it may be necessary to focus efforts on high-risk groups and increase insurance coverage in the country to prevent absconding from hospital.

  2. Comparing salivary cotinine concentration in non-smokers from the general population and hospitality workers in Spain.

    Science.gov (United States)

    Martínez-Sánchez, Jose M; Fu, Marcela; Pérez-Ríos, Mónica; López, María J; Moncada, Albert; Fernández, Esteve

    2009-12-01

    The objective was to compare the pattern of exposure to second-hand smoke (SHS) among non-smokers in the general population and in hospitality workers. We used the adult (16-64 years) non-smokers of two independent studies (general population and hospitality workers) in Spain. We assessed the exposure to SHS by means of questionnaire and salivary cotinine concentration. The salivary cotinine concentration by sex, age, educational level, day of week of saliva collection, and exposure to SHS were always higher in hospitality workers than in the general population. Our results indicated that non-smoker hospitality workers have higher levels of exposure to SHS than general population.

  3. 内科病房老年病人医院感染调查%Investigation of nosocomial infection of medical elderly inpatients in our hospital

    Institute of Scientific and Technical Information of China (English)

    郭子云

    2001-01-01

    目的 了解我院老年病人医院感染情况,为预防老 年人医院感染提供客观依据。 方法 对1996年1月~1998年12月我院内 科601例住院老年病人采取前瞻性与回顾性调查相结合的方法进行目标性监测。结 果 本组老年病人医院感染率为8.32%,明显高于我院这3年的平均医院感染率(1.4 8%)。感染部位以下呼吸道发生最多,占医院感染的52%。以内分泌、循环、消化、泌尿、呼 吸系统疾病等医院感染发生率较高。检出的医院感染病原菌以条件致病菌——真菌为主,占 85%。结论 老年人免疫功能低下,抗生素的大量应用等是引起医院感染的 主要因素。%Objective To find out nosocomial infection of elde rly patients in our nosocomial and to provide theoretical evidence for preventing nosocomial infection of elderly patients. Methods 601 elderly p ati ents of internal medicine in our hospital were investigated with prospective and retrospective methods from January 1996 to December 1998. Results Nosocomial infectious rate in this age was 8.32%, and it was higher than mean nosocomial infectious rate in our nosocomial during the last three years( 1.48%). Infectious sites was mostly the lower respiratory tract, and it's infe ctious r ate was 52%. Basic diseases such as endocrine system, circulatory system, dige stive system, genitourinary system, respiratory system diseases were higher in nosocomial infection. Opportunitive pathogens were the main cause of the nosocomial infectious pathogens, and fungi took 85% of the opportunitive pa thogens. Conclusions Nosocomial infectious factors are mainly that immune function is lower in the aged and antibiotic is used generally.

  4. Perfil clínico del adulto mayor atendido ambulatoriamente en un hospital general.

    OpenAIRE

    Casas, Paola; Médico Geriatra, Hospital Nacional Cayetano Heredia. Lima.; Varela, Luis; Médico Internista-Geriatra, Hospital Nacional Cayetano Heredia. Instituto de Gerontología, Universidad Peruana Cayetano Heredia. Lima.; Tello, Tania; Médico Geriatra, Hospital Nacional Cayetano Heredia. Instituto de Gerontología, Universidad Peruana Cayetano Heredia. Lima.; Ortiz, Pedro; Médico Internista, Hospital Nacional Arzobispo Loayza. Instituto de Gerontología, Universidad Peruana Cayetano Heredia. Lima.; Chávez, Helver; Médico Internista-Geriatra, Hospital Nacional Cayetano Heredia. Instituto de Gerontología, Universidad Peruana Cayetano Heredia. Lima.

    2012-01-01

    Objetivo: Describir el perfil clínico del adulto mayor atendido ambulatoriamente en un hospital general. Material y métodos: Estudio descriptivo, transversal, realizado a través de encuestas aplicadas a pacientes en la consulta ambulatoria de geriatría del Hospital Nacional Cayetano Heredia (HNCH), entre agosto de 2011 y enero 2012. Resultados: Se evaluaron 290 pacientes, el 69,3% fueron mujeres; el 65,5% tenía entre 60 y 79 años. La hipertensión arterial fue el diagnóstico más frecuente (55,...

  5. [Participatory planning in health organizations: the case of the Bonsucesso General Hospital, Rio de Janeiro, Brazil].

    Science.gov (United States)

    Lima, Juliano de Carvalho; Faveret, Ana Cecília; Grabois, Victor

    2006-03-01

    This article presents the experience with participatory planning in the Bonsucesso General Hospital in Rio de Janeiro, Brazil, from 2003 to 2004. The participatory and communicative characteristics and the resulting institutional format are identified for guaranteeing the implementation of collective decisions from the planning workshops. The limits of implementation in participatory planning and management proposals are argued from the perspective of change and power relations in these institutions. The results support the notion that projects involving changes in hospitals and failing to take into account the different internal rationalities and power relations end up having reduced potential for implementation.

  6. Awareness and utilization of peer support programs in Singapore public general hospitals.

    Science.gov (United States)

    Chan, Angelina O M; Kee, Jass P C; Chan, Yiong Huak

    2012-01-01

    To address the effects of acute, chronic and cumulative stress in the healthcare environment in Singapore, the Ministry of Health provided funding to develop a comprehensive crisis response management system (peer support programs/PSPs) that increases mental health awareness, provides emotional support to affected staff during work-related critical incidents and assists hospital management to better understand the emotional needs of the employees. This paper reports the awareness and utilization of PSPs in Singapore public general hospitals about one year after they were set up.

  7. Perfil clínico del adulto mayor atendido ambulatoriamente en un hospital general.

    OpenAIRE

    Paola Casas; Luis Varela; Tania Tello; Pedro Ortiz; Helver Chávez

    2012-01-01

    Objetivo: Describir el perfil clínico del adulto mayor atendido ambulatoriamente en un hospital general. Material y métodos: Estudio descriptivo, transversal, realizado a través de encuestas aplicadas a pacientes en la consulta ambulatoria de geriatría del Hospital Nacional Cayetano Heredia (HNCH), entre agosto de 2011 y enero 2012. Resultados: Se evaluaron 290 pacientes, el 69,3% fueron mujeres; el 65,5% tenía entre 60 y 79 años. La hipertensión arterial fue el diagnóstico más frecuente (55,...

  8. Analysis of Antibiotic Use Density in the Inpatients of a Secondary Hospital from 2011 to 2013%2011-2013年某二级医院住院患者抗菌药物使用强度分析

    Institute of Scientific and Technical Information of China (English)

    黄娟; 曾明辉

    2014-01-01

    目的:分析某二级医院2011—2013年住院患者抗菌药物的使用强度( AUD),为临床合理使用抗菌药物提供参考。方法:回顾性分析该医院2011—2013年抗菌药物使用记录,以限定日剂量(DDD)为单位,计算抗菌药物的使用频度(DDDs)和AUD。结果:该医院2011—2013年住院患者抗菌药物的AUD分别是65.30、55.76、54.33 DDDs/(100人· d),呈逐年下降趋势。其中,青霉素类、青霉素+β-内酰胺酶抑制剂、第1代头孢菌素类的AUD逐年下降,而第3代头孢、头孢菌素类+β-内酰胺酶抑制剂、氟喹诺酮类、咪唑衍生物呈上升趋势。结论:该医院抗菌药物应用仍存在一些问题,住院患者的AUD较高,第3代头孢菌素和氟喹诺酮类抗菌药物的AUD增长过快,医院管理部门需进一步加强抗菌药物管理,促进临床合理用药。%OBJECTIVE:To analyze the antibiotic use density ( AUD ) in the inpatients from a secondary hospital during 2011-2013 period for clinical reference of rational use of antibiotics.METHODS:The utilization data of antibiotics in our hospital during 2011-2013 period was analyzed retrospectively with DDDs and AUD analyzed taking defined daily dose (DDD) as unit.RESULTS:The AUD of antibiotics in the inpatients from 2011 to 2013 stood at 65.30, 55.76 and 54.33 DDDs/100 persons/day respectively, assuming downward trend.The AUD of penicillin, penicillin +enzyme inhibitors and first-generation cephalosporin showed a downward trend, however, the DDD of three generation cephalosporin, cephalosporins +enzyme inhibitors, quinolones and imidazole derivatives showed an upward trend. CONCLUSIONS:The problems encountered in the use of antibiotics in the inpatients of this hospital included high AUD, excessively rapid increase in the AUD of third generation cephalosporin and quinolones; it is urgent for hospital management department to tighten monitoring on the use of antibiotics to

  9. 妇幼保健院住院患者抗菌药物横断面调查%Cross Section Investigation on Antibiotics Usage in Inpatients in Maternity and Child Health Care Hospital

    Institute of Scientific and Technical Information of China (English)

    刘辽; 王华飞; 徐文芳; 熊婷婷; 蒋丹; 贾萍

    2012-01-01

    目的 了解妇幼保健院住院患者抗菌药物应用情况.方法 采用横断面调查法,对2012年2月份患者的抗菌药物使用情况进行调查.结果 抗菌药物横断面使用率为71.14%,其中单用率为79.27%,二联使用率为20.73%;住院患者使用频率排行前10位的抗菌药物中应用最多的是头孢硫脒;儿科抗菌药物使用率最高为93.27%;产科抗菌药物使用频率强度最高为77.37,妇科为67.19;所有患者临床微生物检验样本送检率仅为39.3%.结论 抗菌药物使用率及抗菌药物使用强度不符合相关规定,需要加强其抗菌药物临床应用的管理.%Objective To investigate the clinical application of antibiotics for inpatients in maternity and child health care hospital. Methods A cross section investigation method was used to survey the clinical application of antibiotics for inpatients in maternity and child health care hospital within February 2012. Results The usage rate of antibiotics was 71.14 %, of which, single drug application consisted 79.27 %, and double-drug application consisted 20.73%. In the ten antibiotics of the highest usage frequency, cefathiamidinc was on the top. The usage rate of antibiotics in Department of Pediatrics was the maximum (93.27%). Department with top consumption intensity of antibiotics was Obstetrics (77.37). Among all patients, the rate of microbiological examination was 39.3%. Conclusions The usage rate of antibiotics and consumption of antibiotics do not comply with the relative regulations. It is necessary for hospitals to strengthen the management of clinical antibiotics.

  10. Results of psychodynamically oriented trauma-focused inpatient treatment for women with complex posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD).

    Science.gov (United States)

    Sachsse, Ulrich; Vogel, Christina; Leichsenring, Falk

    2006-01-01

    In a naturalistic outcome study, the authors evaluated the results of a specific psychodynamically oriented trauma-focused inpatient treatment for women with complex posttraumatic stress disorder and concomitant borderline personality disorder, self-mutilating behavior, and depression. At admission, the frequency of self-mutilating behavior and the amount of inpatient treatment (an average of 68 days annually) of the sample was high, characterizing this patient group as "previously therapy resistant." Treatment outcome was assessed both at the end of treatment and in a 1-year follow-up. In comparison with a treatment-as-usual control group, the treatment program brought about significant and stable improvements both in trauma-specific symptoms (e.g. dissociation, intrusion, avoidance) and in general psychiatric symptoms (e.g., general symptom distress, frequency of self-mutilating behavior, number of hospitalizations). The frequency of inpatient treatments (hospitalizations) decreased dramatically (< 10 days annually; effect size: d = 2.88).

  11. HCUP National (Nationwide) Inpatient Sample (NIS) - Restricted Access File

    Data.gov (United States)

    U.S. Department of Health & Human Services — The NIS is the largest publicly available all-payer inpatient care database in the United States. It contains data from approximately 8 million hospital stays each...

  12. 加强军队医院住院收费管理的有效尝试%Reinforcing the Management of In-patient's Charge in Military Hospital

    Institute of Scientific and Technical Information of China (English)

    李俊霞; 姚红

    2001-01-01

    To ensure the fulfilling hospital's medical income, it is necessary to reinforce the management of in-patients' charge. To raise both economic and social benefits of hospitals , many measures need to be considered: management through net-works; raising the quality of the staff of shroff; establish rules and regulations; set up 3-level auditing system; consummate the management course of the patients' charge; make up of various possible leaks; reduce the patients' arrearage.%为了确保医院医疗收入及时完整的实现,必须加强住院病人的收费管理。通过微机网络化管理,提高收费员的整体素质,建章立规,实行三级审核制度,完善在院病人费用的环节管理,堵塞各种漏洞,减少出院病人欠款,使医院社会效益和经济效益同步上升。

  13. Tasa de empadronamiento real de los pacientes hospitalizados en el Hospital de Poniente almeriense Current census rates in inpatients hospitalized in the Hospital de Poniente in Almería [Spain

    Directory of Open Access Journals (Sweden)

    J. Salas

    2003-07-01

    Full Text Available Objetivo: Estudiar la tasa de empadronamiento actualizada de los pacientes ingresados en el servicio de medicina interna. Métodos: Estudiamos a todos los pacientes que ingresaron en medicina interna desde el 1 de enero al 31 de agosto del año 2000, con domicilio en 4 ayuntamientos de nuestra área hospitalaria. Se realizó una búsqueda exhaustiva sobre su inclusión en el padrón en el mes de septiembre de 2000. Resultados: Se analizaron 1.095 ingresos de un total de 1.759, que se realizaron hasta el 31 de agosto de 2000. El 24% correspondió a pacientes no empadronados. El 58% era mayor de 70 años. El 27% de los pacientes menores de 40 años tampoco estaba empadronado, y en su mayoría eran inmigrantes. Conclusiones: El 24% de los ingresos estudiados en el servicio de medicina interna no está empadronado en su ayuntamiento. Una explicación a este hecho sería la elevada tasa de población inmigrante y la falta de empadronamiento de la población anciana.Objective: To study the current census rate of patients admitted to an internal medicine service. Method: We studied all patients admitted to the internal medicine service from January 1 to August 31, 2000 whose addresses were registered in four local authorities of our hospital district. We made exhaustive searches to ascertain whether these patients were included in the register in September 2000. Results: We analyzed 1,095 admissions from a total of 1,759 up to August 31, 2000. Twenty-four percent corresponded to patients who were not registered. Fifty-eight percent of those not registered were aged more than 70 years. Twenty-seven percent of patients aged less than 40 years, most of whom were immigrants, were also unregistered. Conclusions: Twenty-four percent of the admissions to the internal medicine service that were studied corresponded to patients who were not registered with their respective local authorities. A possible explanation is the large immigrant popularion and the lack

  14. Troponin T: role in altering patient management and enabling earlier discharge from a district general hospital.

    Science.gov (United States)

    Owen, A; Khan, W; Griffiths, K D

    2001-03-01

    The use of troponin T to facilitate early patient discharge was investigated in a prospective study in a district general hospital. Troponin T was measured in 91 patients admitted over a period of 6 months with chest pain but without evidence of myocardial infarction. The main outcome measure was length of hospital stay. A negative troponin T was found in 70 patients. Fifty of these were discharged within 24 h of the troponin result being available and they had a significantly shorter hospital stay than a case control group and a historical control group from the previous 6 months. Troponin T measurement has a role in altering patient management by enabling early discharge, resulting in significant cost savings and increasing bed availability.

  15. [How are Pediatric Hospitals in North-Rhine Westfalia Prepared to Overcome Language Barriers? A Pilot Study Exploring The Structural Quality of Inpatient Care].

    Science.gov (United States)

    Langer, T; Zapf, T; Wirth, S; Meyer, B; Wiegand, A; Timmen, H; Gupta, S J; Schuster, S; Geraedts, M

    2017-07-01

    Background In Germany, 35% of all children are considered to have a "migration background", and in the state of North-Rhine-Westfalia 43%. Frequently, one or both parents of a patient with a migration background have limited German language proficiency. Communication barriers due to a language difference can have a negative impact on quality of care, patient safety and costs of care. In this study, we investigate how children's hospitals are prepared to meet the challenges associated with language barriers. Methods We surveyed all children's hospitals in the state of North-Rhine-Westfalia, Germany. The questionnaire was based on the "Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (CLAS)" and was adapted to circumstances in Germany. Results Thirty-eight hospitals participated (51%) in this survey. Language barriers occurred frequently (75% of respondents mentioned language difficulties in more than 10% of the patient population). 82% of respondents rated their hospital to be "less than well prepared" to overcome language barriers. In the majority of hospitals (62%), the need for an interpreter was determined on a case-to-case basis and not according to any set protocol. In most cases bilingual staff was used for interpreting. However, only 38% of respondents found a list of available bilingual staff to be a sufficient resource. 42% of respondents did not know the monthly costs for professional interpreting services. In the remaining cases, costs were less than € 500/month. Conclusion To overcome language barriers, hospitals rely on local resources. The majority of respondents did not find them to be appropriate and sufficient. The development of quality standards and the provision of financial resources are necessary to mobilize this potential for improvement. Therefore, other disciplines and sectors of healthcare need to be analyzed in order to provide the evidence for a constructive discussion with decision makers in

  16. Factors Affecting The Adoption Of Mhealth In Maternal Health Care In Nakuru Provincial General Hospital

    Directory of Open Access Journals (Sweden)

    Simon Munyua

    2015-08-01

    Full Text Available Abstract Access to timely and quality maternal health care remains to be a major development challenge in many developing economies particularly in Kenya. The countrys system of providing maternal health care also continue to be anchored on conventional methods of physical presence of the patient and the doctor in a hospital setup. The countrys ICT and health policies also place very little emphasis on the use of these platforms. This study therefore sought to establish the factors affecting the adoption of mHealth by focusing on maternal health in Nakuru Provincial General Hospital. Objectives of the study were to determine the extent to knowledge and awareness affects the adoption of mHealth in maternal health care at Nakuru PGH to identify the government policies affecting the adoption of mHealth in maternal health care at Nakuru PGH to assess how access to technology affects the adoption of mHealth in maternal healthcare to establish the effects of ICT infrastructure on the adoption of mHealth in maternal health care and to identify the cost aspects affecting the adoption of mHealth in maternal health care at Nakuru Provincial General Hospital. It is envisaged that the study could provide useful information on the adoption of mHealth in managing maternal health care in Nakuru Provincial General Hospital. Descriptive survey research design will be used where all the medical staff and patients of Nakuru Provincial General Hospital was surveyed. The study population therefore was made up of 24 medical staff and 3460 mothers visiting the antenatal clinic selected using clustered random sampling technique. The main instrument for primary data collection was the questionnaire. Data analysis was then done using both descriptive and inferential statistics. Descriptive statistics to be used include frequency counts percentages and measures of central tendency. Inferential statistics on the other hand include t-test analysis and spearman correlation

  17. Factors associated with readmission to a general hospital in Brazil Fatores associados às readmissões hospitalares em um hospital geral brasileiro

    OpenAIRE

    Mônica Silva Monteiro de Castro; Marilia Sá Carvalho; Cláudia Travassos

    2005-01-01

    The objective of this study was to compare different modeling strategies to identify individual and admissions characteristics associated with readmission to a general hospital. Routine data recorded in the Hospital Information System on all admissions to the Regional Public Hospital of Betim, Minas Gerais State, Brazil, from July 1996 to June 2000 were analyzed. Cox proportional hazards model and variants designed to deal with multiple-events data, like Andersen-Gill (AG), Prentice, Williams...

  18. Benefits and limitations of Bowen therapy with psychiatric inpatients.

    Science.gov (United States)

    Zerbe, K J; Fabacher, J E

    1989-11-01

    The authors discuss the benefits and limitations of Bowen family systems therapy for psychiatric inpatients. Although this method may enable some patients to deal more effectively with crucial problems in their families of origins, its application for psychiatric inpatients has met with varying results. The authors discuss why hospitalized patients may have particular difficulties using Bowen therapy. The assumptions of Bowen theory are reviewed and critiqued in the context of the special problems encountered when working in a psychiatric hospital system.

  19. [General information system through whole hospital and electronic medical record system].

    Science.gov (United States)

    Goto, Takaaki

    2006-02-01

    A new system has been introduced and implemented at the Nagoya City University Hospital since January 2004 in order to improve services for patients and general operation for man