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Sample records for hospital blood center

  1. An examination of blood center structure and hospital customer satisfaction: what can centralized and decentralized blood centers learn from each other?

    Science.gov (United States)

    Carden, Robert; DelliFraine, Jami L

    2005-01-01

    The cost of blood and blood products has increased rapidly over the last several years while the supply of available blood donors has simultaneously decreased. Higher blood costs and donor shortages have put a strain on the relationship between blood suppliers and their hospital customers. This study examines the association between blood center centralization or decentralization and several aspects of hospital satisfaction. Centralized and decentralized blood centers have significant differences in various aspects of hospital customer satisfaction. Advantages and disadvantages of the two structures are discussed, as well as areas for future research.

  2. Patient-centered blood management.

    Science.gov (United States)

    Hohmuth, Benjamin; Ozawa, Sherri; Ashton, Maria; Melseth, Richard L

    2014-01-01

    Transfusions are common in hospitalized patients but carry significant risk, with associated morbidity and mortality that increases with each unit of blood received. Clinical trials consistently support a conservative over a liberal approach to transfusion. Yet there remains wide variation in practice, and more than half of red cell transfusions may be inappropriate. Adopting a more comprehensive approach to the bleeding, coagulopathic, or anemic patient has the potential to improve patient care. We present a patient-centered blood management (PBM) paradigm. The 4 guiding principles of effective PBM that we present include anemia management, coagulation optimization, blood conservation, and patient-centered decision making. PBM has the potential to decrease transfusion rates, decrease practice variation, and improve patient outcomes. PBM's value proposition is highly aligned with that of hospital medicine. Hospitalists' dual role as front-line care providers and quality improvement leaders make them the ideal candidates to develop, implement, and practice PBM. © 2013 Society of Hospital Medicine.

  3. An examination of hospital satisfaction with blood suppliers.

    Science.gov (United States)

    Carden, Robert; DelliFraine, Jami L

    2004-11-01

    The purpose of this study was to identify factors that predict overall hospital satisfaction with blood suppliers. The data for this study came from a 2001 satisfaction survey of hospital blood bank managers conducted by the National Blood Data Resource Center. A total of 1325 blood-utilizing hospitals were included in the final study database. The measurement of hospital satisfaction with its blood supplier encompasses the five composites of the SERVQUAL model. The five composites are 1) tangibles, 2) reliability, 3) responsiveness, 4) assurance, and 5) empathy. Linear regression was performed with overall hospital satisfaction as the dependent variable and the five composites of the SERVQUAL model and control variables as predictors of overall hospital satisfaction with blood suppliers. Significant predictors of hospital satisfaction with blood suppliers are satisfaction with medical and clinical support provided by the blood center, satisfaction with the routine delivery schedule, and price (service fee) of red cells. Prior studies have demonstrated the importance of customer satisfaction to organizations. As organizations, blood centers can benefit from improved satisfaction from their hospital customers. Blood center strategies that focus on improving these three predictors of overall hospital satisfaction with primary blood suppliers will be the most likely to improve and/or maintain hospital customer satisfaction with primary blood suppliers.

  4. Transfusion safety: is this the business of blood centers?

    Science.gov (United States)

    Slapak, Colleen; Fredrich, Nanci; Wagner, Jeffrey

    2011-12-01

    ATSO is in a unique position to break down organizational silos between hospitals and blood centers through the development of a collaborative relationship between the two entities. Use of the TSO as blood center staff centralizes the role into a consultative position thereby retaining the independence of the hospitals. The TSO position then becomes a value-added service offered by the blood center designed to supplement processes within the hospital.Whether the TSO is based in the hospital or the blood center, improvements are gained through appropriate utilization of blood components, reductions in hospital costs, ongoing education of hospital staff involved in transfusion practice, and increased availability of blood products within the community. Implementation and standardization of best practice processes for ordering and administration of blood products developed by TSOs leads to improved patient outcomes. As a liaison between hospitals and blood centers, the TSO integrates the mutual goal of transfusion safety: the provision of the safest blood product to the right patient at the right time for the right reason.

  5. Secular trends of blood isolates in patients from a rural area population hospitalized in a tertiary center in a small city in Greece

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    Holevas Pierros V

    2006-05-01

    Full Text Available Abstract Background Most of the studies evaluating the secular trends of blood isolates come from tertiary hospitals in urban areas. We sought to study the trends of the antimicrobial resistance of blood isolates in patients from a rural population hospitalized in a tertiary hospital in a small city in Greece. Methods We retrospectively collected and analysed data for the first positive blood culture obtained for each admission for each patient hospitalized in General Hospital of Tripolis, Tripolis, Peloponnesus, Greece during a 5 year period (16/05/2000 – 15/05/2005. Results Sixty-seven thousand and seventy patients were hospitalized during the study period from whom 3,206 blood cultures were obtained. A higher increase of the number of obtained blood cultures than the number of admissions was noted during the study period (p Escherichia coli (29%, and Staphylococcus aureus (18.2% were the most commonly isolated pathogens. Among the Staphylococcus aureus isolates, the proportion of methicillin-resistant Staphylococcus aureus (MRSA was 17.2% (5/29. The proportion of Escherichia coli resistant to trimethoprim and sulfamethoxazole, ampicillin and cefuroxime was 29.6% (32/108, 25.0% (27/108, and 8.3% (9/108 respectively. Imipenem-resistance was noted in 3.4% (1/29 of Pseudomonas aeruginosa isolates. There were only 6 (1.6% Acinetobacter baummanii blood isolates during the study period. Conclusion The antimicrobial resistance of isolates from patients receiving care at the studied tertiary hospital in a small city in Greece is considerably less compared to that noted in tertiary hospitals in larger cities of the country.

  6. Hospital billing for blood processing and transfusion for inpatient stays.

    Science.gov (United States)

    McCue, Michael J; Nayar, Preethy

    2009-07-01

    Medicare, an important payer for hospitals, reimburses hospitals for inpatient stays using Diagnosis Related Groups (DRGs). Many private insurers also use the DRG methodology to reimburse hospitals for their services. Therefore, those blood service organizations that bill Medicare directly require an understanding of the DRG system of payment to enable them to bill Medicare correctly, and in order to be certain they are adequately reimbursed. Blood centers that do not bill Medicare directly need to understand how hospitals are reimbursed for blood and blood components as this affects a hospital's ability to pay service fees related to these products. This review presents a detailed explanation of how hospitals are reimbursed by the Centers for Medicare and Medicaid Services (CMS) for Medicare inpatient services, including blood services.

  7. Birthing Centers and Hospital Maternity Services

    Science.gov (United States)

    ... Educators Search English Español Birthing Centers and Hospital Maternity Services KidsHealth / For Parents / Birthing Centers and Hospital Maternity Services What's in this article? Giving Birth at ...

  8. National Rehabilitation Hospital Assistive Technology Research Center

    Science.gov (United States)

    1995-10-01

    Shoulder-Arm Orthoses Several years ago, the Rehabilitation Engineering Research Center (RERC) on Rehabilitation Robotics in Delaware1 identified a... exoskeletal applications for persons with disabilities. 2. Create a center of expertise in rehabilitation technology transfer that benefits persons with...AD COOPERATIVE AGREEMENT NUMBER: DAMD17-94-V-4036 TITLE: National Rehabilitation Hospital Assistive Technology- Research Center PRINCIPAL

  9. Transfusion of blood and blood component therapy for postpartum haemorrhage at a tertiary referral center

    International Nuclear Information System (INIS)

    Hussain, N.; Shah, T.; Shah, N.; Khan, N.H.

    2011-01-01

    Objective: To determine the practice of transfusion of blood and blood products in cases of postpartum haemorrhage, at a tertiary referral center. Methods: A retrospective study was conducted where medical records were reviewed for women, who either delivered or were admitted in labour suite with diagnosis of postpartum haemorrhage. The study period extended from Jan 2008 to Oct 2009. During a period of 22 months, records were reviewed for transfusion of blood and blood products in above group of women. Data were analyzed for descriptive statistics. Results: During the study period, a total of 4744 patients were admitted in the labour suite. A total of 113 (2.36%) women were diagnosed with Post partum haemorrhage. Uterine atony was the commonest cause of PPH, followed by genital tract trauma. A total of 81(71%) women received transfusion of blood and blood components (1.6%). The mean blood loss was 1088 ml (+- 584ml). Transfusion of blood and blood component therapy was significantly more in women who underwent caesarean section, compared to those women who delivered vaginally. There was one case of acute tubular necrosis due to PPH, and seven maternal deaths. The mean hospital stay was of +- 3 days. Conclusion: In this hospital based study, the prevalence of PPH was 2.36 +- %, and the rate of transfusion of blood and blood products was 1.6%.

  10. Blood inventory management: hospital best practice.

    Science.gov (United States)

    Stanger, Sebastian H W; Yates, Nicola; Wilding, Richard; Cotton, Sue

    2012-04-01

    Blood is a perishable product, and hence good management of inventories is crucial. Blood inventory management is a trade-off between shortage and wastage. The challenge is to keep enough stock to ensure a 100% supply of blood while keeping time expiry losses at a minimum. This article focuses on inventory management of red blood cells in hospital transfusion laboratories to derive principles of best practice and makes recommendations that will ensure losses due to time expiry are kept to a minimum. The literature was reviewed to identify available models for perishable inventory management. Historical data from the UK blood supply chain was analyzed to identify hospitals with good inventory management practice and low wastage levels. Transfusion laboratory managers in the selected hospitals were interviewed in 7 case studies with the aim of identifying drivers for low wastage and good inventory management practice. The findings from the case studies were compared with the literature. The extant literature asserts that the drivers for good inventory performance are the use of complex inventory models and algorithms. This study has found this not to be the case. Instead, good performance is driven by the quality of transfusion laboratory staff, who must be skilled, regularly trained, and experienced. Electronic crossmatching, transparency of the inventory, and simple management procedures also facilitate good performance. Copyright © 2012 Elsevier Inc. All rights reserved.

  11. Utilization of blood cultures in Danish hospitals

    DEFF Research Database (Denmark)

    Gubbels, S; Nielsen, J; Voldstedlund, M

    2015-01-01

    This national population-based study was conducted as part of the development of a national automated surveillance system for hospital-acquired bacteraemia and ascertains the utilization of blood cultures (BCs). A primary objective was to understand how local differences may affect interpretation......, Streptococcus pneumoniae, Enterococcus faecium, Enterococcus faecalis, Pseudomonas aeruginosa, Candida albicans, Enterobacter cloacae and Klebsiella oxytoca, accounted for 74.7% of agents for this purpose classified as pathogenic. An increase in BCs and positive BCs was observed over time, particularly among...

  12. Out for blood. The newly overhauled American Red Cross is thirsty for a bigger share of the $2 billion business of supplying blood to hospitals.

    Science.gov (United States)

    Hensley, S

    1998-06-22

    The newly overhauled American Red Cross, led by President Elizabeth Dole (left), has launched an ambitious campaign to increase its piece of the more than $2 billion business of supplying blood to hospitals. Its quest for market share has sparked what some call a "blood war" with its main competitors: independent, community-governed blood banks affiliated with America's Blood Centers.

  13. Determination of Rate and Causes of Wastage of Blood and Blood Products in Iranian Hospitals

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    Rafat Mohebbi Far

    2014-06-01

    Full Text Available OBJECTIVE: The purpose of this study was to determine the rate and causes of wastage of blood and blood products (packed red cells, plasma, platelets, and cryoprecipitate in Qazvin hospitals. METHODS: The study was conducted in all hospitals in Qazvin, including 5 teaching hospitals, 2 social welfare hospitals, 3 private hospitals, 1 charity hospital, and 1 military hospital. This descriptive study was based on available data from hospital blood banks in the province of Qazvin. The research instrument was a 2-part questionnaire. The first part was related to demographic characteristics of hospitals and the second part elicited information about blood and blood component wastage. The collected data were then analyzed using descriptive statistic methods and SPSS 11.5. RESULTS: Blood wastage may occur for a number of reasons, including time expiry, wasted imports, blood medically or surgically ordered but not used, stock time expired, hemolysis, or miscellaneous reasons. Data indicated that approximately 77.9% of wasted pack cell units were wasted for the reason of time expiry. Pack cell wastage in hospitals is reported to range from 1.93% to 30.7%. Wastage at all hospitals averaged 9.8% among 30.913 issued blood products. Overall blood and blood product (packed red cells, plasma, platelets, and cryoprecipitate wastage was 3048 units and average total wastage per participant hospital for all blood groups was 254 units per year. CONCLUSION: Blood transfusion is an essential part of patient care. The blood transfusion system has made significant advancements in areas such as donor management, storage of blood, cross-matching, rational use of blood, and distribution. In order to improve the standards of blood banks and the blood transfusion services in Iran, comprehensive standards have been formulated to ensure better quality control in collection, storage, testing, and distribution of blood and its components for the identified major factors

  14. A Survey of Blood Request Versus Blood Utilization at a University Hospital in Iran

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    Arash Peivandi Yazdi

    2016-01-01

    Full Text Available Background: Reservation of blood leads to blood wastage if the blood is not transfused. Therefore, in some centers only blood type and screen are evaluated. In this study, the efficacy of a blood crossmatch-to-transfusion ratio was measured and then compared with the standard levels. Methods: This prospective study was conducted during one year in a university hospital. During this period, 398 patients for whom blood had been requested were studied. In these patients, at the first surgical type, the laboratory tests (hematocrit, hemoglobin, platelet count, and prothrombin time and the number of preoperative crossmatched and intraoperative transfused blood units were recorded. Then the crossmatch-to-transfusion ratio, transfusion probability, transfusion index, and correlation between related factors, and the transfusion ratio were evaluated. Results: In this cross-sectional study, blood was requested for 398 patients. According to available blood unit deficiency, from 961 blood unit requisitions, only 456 units were crossmatched and 123 units were transfused. The crossmatch-to-transfusion ratio, transfusion probability, and transfusion index were 3.71 (7.81 if all requisitions were crossmatched, 16.83%, and 0.31, respectively. The most unfavorable indexes were observed in patients who had ear, nose, and throat surgeries (0 transfused from 19 crossmatched blood units and obstetric and gynecologic surgery (crossmatch-to-transfusion ratio was 18.6. The best indexes were related to thoracic surgery and neurosurgery (crossmatch-to-transfusion ratio was 1.53 and 1.54, respectively. There were no significant correlations between hemoglobin, hematocrit, platelet count, and prothrombin time with the number of transfused blood units (P = 0.2, 0.14, 0.26, and 0.06, respectively. Conclusion: The data for the crossmatch-to-transfusion ratio, transfusion probability, and transfusion index were suboptimal at this center, especially for ear, nose, and throat

  15. Poor procedures and quality control among nonaffiliated blood centers in Burkina Faso: an argument for expanding the reach of the national blood transfusion center.

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    Nébié, Koumpingnin; Ouattara, Siaka; Sanou, Mahamoudou; Kientega, Youssouphe; Dahourou, Honorine; Ky, Lassina; Kienou, Kisito; Diallo, Samba; Bigirimana, Françoise; Fretz, Catherine; Murphy, Edward L; Lefrère, Jean-Jacques

    2011-07-01

    The World Health Organization (WHO) recommends the creation of national blood transfusion services. Burkina Faso has a CNTS (Centre National de Transfusion Sanguine-National Blood Transfusion Center) but it currently covers only 53% of the national blood supply versus 47% produced by independent hospital blood banks. To evaluate blood collection, testing, preparation, and prescription practices in the regions of Burkina Faso that are not covered by the CNTS, a cross-sectional survey was conducted. Data were collected by trained professionals from May to June 2009 at 42 autonomous blood centers not covered by the CNTS. Blood collection was supervised in all sites by laboratory technicians without specific training. There was no marketing of community blood donation nor mobile collection. Donation was restricted to replacement (family) donors in 21.4% of sites. Predonation screening of donors was performed in 63.4% of sites, but some did not use written questionnaires. Testing for HIV, hepatitis B virus, and syphilis was universal, although some sites did not screen for hepatitis C virus. In 83.3% of the sites, blood typing was performed without reverse ABO typing. In 97.6% of the sites, nurses acted alone or in conjunction with a physician to order blood transfusions. Shortcomings in non-CNTS blood centers argue for the development of a truly national CNTS. Such a national center should coordinate and supervise all blood transfusion activities, and is the essential first step for improving and institutionalizing blood transfusion safety and efficacy in a developing country. © 2011 American Association of Blood Banks.

  16. Target marketing for the hospital-based wellness center.

    Science.gov (United States)

    Cangelosi, J D

    1997-01-01

    The American population is aging, medical technology is advancing, and life expectancies are on the rise. At the same time hospitals are looking for additional sources of income due to the pressures of government regulations and managed care. One of the options for hospitals looking for additional sources of income is the hospital-based but free-standing comprehensive wellness and fitness center. Such centers go beyond the facilities, programs and services offered by traditional health and fitness centers. In addition to physical fitness programs, hospital-based wellness centers offer programs in CPR, nutrition, weight control and many other programs of interest to an aging but active American populace. This research documents the hospital industry, wellness industry and the prospects of success or failure for he hospital attempting such a venture. The focus of the research is the experience of a particular hospital with regard to the programs, facilities and services deemed most important by its target market.

  17. Cardiovascular Topics Blood pressure control at a hospital day clinic ...

    African Journals Online (AJOL)

    1999-02-01

    Feb 1, 1999 ... control in a hospital day clinic population receiving cal- cium channel ... we had showed poor control of blood pressure in this hospital-based population .... Assessment of com- .... Program are obering: 19 almost half of newly treated hyper- tensives will di ... blood pressure control and quality of life. There is ...

  18. Poor procedures and quality control among non-affiliated blood centers in Burkina Faso: an argument for expanding the reach of the national blood transfusion center

    Science.gov (United States)

    Nébié, Koumpingnin; Ouattara, Siaka; Sanou, Mahamoudou; Kientega, Youssouphe; Dahourou, Honorine; Ky, Lassina; Kienou, Kisito; Diallo, Samba; Bigirimana, Françoise; Fretz, Catherine; Murphy, Edward L.; Lefrère, Jean-Jacques

    2011-01-01

    Introduction The World Health Organization (WHO) recommends the creation of national blood transfusion services. Burkina Faso has a CNTS (Centre national de transfusion sanguine - National Blood Transfusion Center) but it currently covers only 53% of the national blood supply versus 47% produced by independent hospital blood banks. Study design To evaluate blood collection, testing, preparation and prescription practices in the regions of Burkina Faso that are not covered by the CNTS, we conducted a cross-sectional survey. Methodology Data were collected by trained professionals from May to June 2009, at 42 autonomous blood centers not covered by the CNTS. Results Blood collection was supervised in all sites by laboratory technicians without specific training. There was no marketing of community blood donation nor mobile collection. Donation was restricted to replacement (family) donors in 21.4% of sites. Pre-donation screening of donors was performed in 63.4% of sites, but some did not use written questionnaires. Testing for HIV, hepatitis B virus and syphilis was universal, although some sites did not screen for hepatitis C virus. In 83.3% of the sites blood typing was performed without reverse ABO typing. In 97.6% of the sites, nurses acted alone or in conjunction with a physician to order blood transfusions. Conclusion Shortcomings in non-CNTS blood centers argue for the development of a truly national CNTS. Such a national center should coordinate and supervise all blood transfusion activities, and is the essential first step for improving and institutionalizing blood transfusion safety and efficacy in a developing country. PMID:21736582

  19. "Hospes": The Wabash Center as a Site of Transformative Hospitality

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    Jones, Carolyn M.

    2007-01-01

    The Wabash Center for Teaching and Learning in Theology and Religion is a place of hospitality and its staff the epitome of the "good host." This essay explores the meaning of hospitality, including its problematic dimensions, drawing on a number of voices and texts: Jacques Derrida's "Of Hospitality"; Henri M. Nouwen's "Reaching Out: The Three…

  20. Blood Transfusion Delay and Outcome in County Hospitals in Kenya.

    Science.gov (United States)

    Thomas, Julius; Ayieko, Philip; Ogero, Morris; Gachau, Susan; Makone, Boniface; Nyachiro, Wycliffe; Mbevi, George; Chepkirui, Mercy; Malla, Lucas; Oliwa, Jacquie; Irimu, Grace; English, Mike

    2017-02-08

    Severe anemia is a leading indication for blood transfusion and a major cause of hospital admission and mortality in African children. Failure to initiate blood transfusion rapidly enough contributes to anemia deaths in sub-Saharan Africa. This article examines delays in accessing blood and outcomes in transfused children in Kenyan hospitals. Children admitted with nonsurgical conditions in 10 Kenyan county hospitals participating in the Clinical Information Network who had blood transfusion ordered from September 2013 to March 2016 were studied. The delay in blood transfusion was calculated from the date when blood transfusion was prescribed to date of actual transfusion. Five percent (2,875/53,174) of admissions had blood transfusion ordered. Approximately half (45%, 1,295/2,875) of children who had blood transfusion ordered at admission had a documented hemoglobin transfusions, 82% were administered and documented in clinical records, and three-quarters of these (75%, 1,760/2,352) were given on the same day as ordered but these proportions varied from 71% to 100% across the 10 hospitals. Children who had a transfusion ordered but did not receive the prescribed transfusion had a mortality of 20%, compared with 12% among those transfused. Malaria-associated anemia remains the leading indication for blood transfusion in acute childhood illness admissions. Delays in transfusion are common and associated with poor outcomes. Variance in delay across hospitals may be a useful indicator of health system performance. © The American Society of Tropical Medicine and Hygiene.

  1. Lucinda Huffaker and the Hospitality of the Wabash Center

    Science.gov (United States)

    Placher, William C.

    2007-01-01

    As associate director and then director of the Wabash Center for Teaching and Learning in Theology and Religion, Lucinda Huffaker has been a key factor in the Center's reputation for hospitality. The Center's work presupposes that reflection on teaching improves teaching and learning, and good reflection on one's teaching requires taking risks and…

  2. New Orleans Charity Hospital--your trauma center at work.

    Science.gov (United States)

    Stockinger, Zsolt T; Holloway, Vicki L; McSwain, Norman E; Thomas, Dwayne; Fontenot, Cathi; Hunt, John P; Mederos, Eileen; Hewitt, Robert L

    2004-01-01

    The Medical Center of Louisiana at New Orleans-Charity Hospital stands with pride as one of only two level I trauma centers in the state and one of the largest trauma centers in the United States, seeing over 4,000 trauma patients per year. Despite perennial funding issues, Charity Hospital's Emergency Department treated almost 200,000 patients in 2003. This brief report gives an overview of the emergency- and trauma-related services provided by Charity Hospital and underscores its value as a critical asset to healthcare in the Louisiana.

  3. Tendencia del perfil de sensibilidad antimicrobiana de los aislamientos de sangre en un hospital oncológico (1998-2003 Trend of antimicrobial drug-susceptibility of blood isolates at an oncological center (1998-2003

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    Patricia Cornejo-Juárez

    2005-07-01

    Full Text Available OBJETIVO: Describir la frecuencia de la resistencia en microrganismos aislados en cultivos de sangre en pacientes de un hospital oncológico de tercer nivel. MATERIAL Y MÉTODOS: De enero de 1998 a diciembre de 2003, en el Instituto Nacional de Cancerología se desarrolló un estudio retrospectivo en el cual se obtuvieron cepas de cultivos de sangre que fueron incluidas y procesadas por sistema Bactec y Microscan, para determinar identificación y sensibilidad antimicrobiana. Se determinó la tendencia anual de la resistencia de cada organismo especificado a los diferentes antibióticos. Se obtuvo la diferencia porcentual (incremento o decremento comparando la frecuencia de resistencia al inicio y al final del estudio. RESULTADOS: Se detectaron 2 071 cultivos positivos. Se recuperaron Gram negativos en 59.7% de las muestras, Gram positivos en 35.7% y levaduras en 4.6%. Escherichia coli fue el principal germen identificado (18.6%, seguido de S. epidermidis (12.7% y Klebsiella spp (9%. Durante el periodo de estudio la sensibilidad se mantuvo estable y por arriba de 88% (excepto para Pseudomonas aeruginosa. La sensibilidad de ciprofloxacina para E. coli se encontró alrededor de 50%. Amikacina presentó mayor sensibilidad que gentamicina. Staphylococcus aureus presentó una sensibilidad a oxacilina de 96% y a vancomicina de 100%. S.epidermidis de 14% a oxacilina y de 98.6% a vancomicina. No se encontraron cepas de enterococo resistente a vancomicina. Todas las cepas de S. pneumoniae fueron sensibles a penicilina. CONCLUSIONES: Se considera que los patrones de resistencia encontrados en este hospital son el resultado del control en el uso de antimicrobianos, del programa de vigilancia de infecciones nosocomiales y de la utilización de terapia combinada en todos los pacientes con bacteremia.OBJECTIVE: To describe the patterns of antimicrobial resistance organisms isolated in blood cultures from patients detected in a tertiary level of care, teaching

  4. Expanding role of a blood center

    Directory of Open Access Journals (Sweden)

    Jaisy Mathai

    2012-01-01

    Full Text Available Materials and Methods: The study was performed on prospective donors who reported to the Department of Transfusion Medicine. Individuals deferred due to hypertension contributed the study population. They were compared with age and sex matched donor controls. Demographic details were recorded in a proforma. On identification of a hypertensive individual, consequent two comparable donors were taken as controls with a total of 50 hypertensive subjects. Hypertensive status of the subjects were assessed based on the criteria formulated by the WHO-ISH and US Seventh Joint National Committee report on prevention, detection, evaluation and treatment of high blood pressure. Results: About 0.95% of healthy blood donors had undetected hypertension. Mean age at detection of hypertension in the study group was 35.44 ± 7.69 years. Higher BMI was observed in the hypertensive group compared to normotensive control group with P value significant at 0.0001. Conclusion: About 1% of healthy individuals were found to have undetected hypertension. Though the study was not designed to determine the prevalence of hypertension in the region, it is a rough estimate of the proportion of undetected hypertension in the local population as donors are considered as representative of healthy population.

  5. [Blood Test Patterns for Blood Donors after Nucleic Acid Detection in the Blood Center].

    Science.gov (United States)

    Men, Shou-Shan; Lv, Lian-Zhi; Chen, Yuan-Feng; Han, Chun-Hua; Liu, Hong-Yu; Yan, Yan

    2017-12-01

    To investigate the blood test patterns for blood donors after nucleic acid detection in blood center. The collected blood samples after voluntary blood donors first were detected by conventional ELISA, then 31981 negative samples were detected via HBV/HCV/HIV combined nucleic acid test of 6 mixed samples(22716 cases) or single samples(9265 cases) by means of Roche cobas s201 instrument. The combined detection method as follows: the blood samples were assayed by conventional nucleic acid test of 6 mixed samples, at same time, 6 mixed samples were treated with polyethylene glycol precipitation method to concentrate the virus, then the nucleic acid test of blood samples was performed; the single detection method as follows: firstly the conventional nucleic acid test of single sample was performed, then the positive reactive samples after re-examination were 6-fold diluted to simulate the nucleic acid test of 6-mixed samples. The positive rate of positive samples detected by combined nucleic acid test, positive samples detected by nucleic acid test of mixed virus concentration and positive samples detected by single nucleic acid test was statistically analyzed. In addition, for HBV + persons the serological test yet should be performed. In 22 716 samples detected by nucleic acid test of 6 mixed samples (MP-6-NAT) , 9 cases were HBV + (0.40‰, 9/22716); at same time, the detection of same samples by nucleic acid test of mixed sample virus concentration showed 29 cases of HBV + (1.28‰, 29/22716). In 9265 samples detected by single nucleic acid test(ID-NAT) 12 cases showed HBV + (1.30‰, 12/9265), meanwhile the detection of these 12 samples with HBV + by 6-fold dilution for virus concentration found only 4 samples with HBV + . In serological qualified samples, ID-NAT unqualified rate was 1.28‰, which was higher than that of MP-6-NAT(0.4‰) (χ 2 =8.11, P0.05). In 41 samples with HBsAg - HBV DNA + detected by ELISA, 36 samples were confirmed to be occult HBV

  6. Risk factors for inappropriate blood requisition among hospitals in Tanzania.

    Science.gov (United States)

    Mauka, Wilhellmuss I; Mtuy, Tara B; Mahande, Michael J; Msuya, Sia E; Mboya, Innocent B; Juma, Abdul; Philemon, Rune N

    2018-01-01

    Blood is a critical aspect of treatment in life saving situations, increasing demand. Blood requisition practices greatly effect sufficient supply in blood banks. This study aimed to determine the risk factors for inappropriate blood requisition in Tanzania. This was a cross sectional study using secondary data of 14,460 patients' blood requests from 42 transfusion hospitals. Primary data were obtained by using cluster-sampling design. Data were analysed using a two-level mixed-effects Poisson regression to determine fixed-effects of individual-level factors and hospital level factors associated with inappropriate blood requests. P-value Factors significantly associated with inappropriate requisition were; reporting pulse rate and capillary refill decrease the risk (RR 0.74; 95% CI 0.64, 0.84) and (RR 0.73; 95% CI 0.63, 0.85) respectively and the following increased the risk; having surgery during hospital stay (RR 1.22; 95% CI 1.06, 1.4); being in general surgical ward (RR 3.3; 95% CI 2.7, 4.2), paediatric ward (RR 1.8; 95% CI 1.2, 2.7), obstetric ward (RR 2.5; 95% CI 2.0, 3.1), gynaecological ward (RR 2.1; 95% CI 1.5, 2.9), orthopaedics ward (RR 3.8; 95% CI 2.2, 6.7). Age of the patient, pallor and confirmation of pre-transfusion haemoglobin level were also significantly associated with inappropriate requisition. Majority of appropriate requisitions within the wards were marked in internal medicine (91.7%) and gynaecological wards (77.8%). The proportion of inappropriate blood requests was high. Blood requisition was determined by clinical and laboratory findings and the ward patients were admitted to. Adherence to transfusion guidelines is recommended to assure the best use of limited blood supply.

  7. Occupational Blood Exposure among Health Care Personnel and Hospital Trainees

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    M Hajjaji Darouiche

    2014-01-01

    Full Text Available Blood and body fluid Exposure is a major occupational safety problems for health care workers. Therefore, we conducted a descriptive and retrospective study to identify the characteristics of blood exposure accidents in health care settings which lasted five years (2005-2009 at the two university hospitals of Sfax. We have 593 blood exposure accidents in health care settings 152 (25.6% health personnel and 441 (74.4% trainees' doctors, nurses and health technicians. The mechanism of blood and body fluid exposure was accidental needle-stick injury in 78.9% of health staff, and 81% of trainees, accidental cut in 14.7% of health workers and 10.2% of trainees. The increasing severity of blood exposure accidents is linked to the lack of safe behavior against this risk.

  8. Is there a need to phase out replacement blood donors by voluntary blood donors in hospital based blood transfusion services?

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    Praneeta Jaswant Singh

    2017-01-01

    Conclusion: Data highlight that RD contributed major source of blood supply in hospital-based blood transfusion services and the prevalence of TTI was higher among them in comparison to first-time voluntary donors. Thus, efforts should be made to increase the number of VBD.

  9. Orthopedic specialty hospitals: centers of excellence or greed machines?

    Science.gov (United States)

    Badlani, Neil; Boden, Scott; Phillips, Frank

    2012-03-07

    Orthopedic specialty hospitals have recently been the subject of debate. They are patient-centered, physician-friendly health care alternatives that take advantage of the economic efficiencies of specialization. Medically, they provide a higher quality of care and increase patient and physician satisfaction. Economically, they are more efficient and profitable than general hospitals. They also positively affect society through the taxes they pay and the beneficial aspects of the competition they provide to general hospitals. Their ability to provide a disruptive innovation to the existing hospital industry will lead to lower costs and greater access to health care. However, critics say that physician ownership presents potential conflicts of interest and leads to overuse of medical care. Some general hospitals are suffering as a result of unfair specialty hospital practices, and a few drastic medical complications have occurred at specialty hospitals. Specialty hospitals have been scrutinized for increasing the inequality of health care and continue to be a target of government regulations. In this article, the pros and cons are examined, and the Emory Orthopaedics and Spine Hospital is analyzed as an example. Orthopedic specialty hospitals provide excellent care and are great assets to society. Competition between specialty and general hospitals has provided added value to patients and taxpayers. However, physicians must take more responsibility in their appropriate and ethical leadership. It is critical to recognize financial conflicts of interest, disclose ownership, and act ethically. Patient care cannot be compromised. With thoughtful and efficient leadership, specialty hospitals can be an integral part of improving health care in the long term. Copyright 2012, SLACK Incorporated.

  10. Impact of the May 12, 2008, Earthquake on blood donations across five Chinese blood centers.

    Science.gov (United States)

    Liu, Jing; Huang, Yi; Wang, Jingxing; Bi, Xinhong; Li, Julin; Lu, Yunlai; Wen, Xiuqiong; Yao, Fuzhu; Dong, Xiangdong; He, Weilan; Huang, Mei; Ma, Hongli; Mei, Heili; King, Melissa; Wright, David J; Ness, Paul M; Shan, Hua

    2010-09-01

    On May 12, 2008, a severe earthquake struck China's Sichuan Province. The nationwide outpouring of charity resulted in a surge of subsequent blood donations. The quantity and quality of these donations were examined in comparison with routine donations. Whole blood and apheresis donations from five geographically different blood centers collected within 1 week postearthquake were compared with those collected during the rest of the year. Regional differences, demographic characteristics, first-time and repeat donor status, and infectious disease screening markers associated with these donations were compared by earthquake status using chi-square statistics. Poisson regression analysis examined the number of daily donations by earthquake status after adjusting for center, day of week, and seasonal variations. The number of daily donations across five blood centers increased from 685 on a typical day to 1151 in the postearthquake week. The surge was observed in both sexes and across different education levels, age, and ethnicity groups and three blood centers and was significant after adjusting for confounding covariates. The influx of first-time donors (89.5%) was higher than that of repeat donors (34%). There was a significant change in the overall screening reactive marker rates excluding alanine aminotransferase (2.06% vs. 1.72%% vs. 4.96%). However, when the individual screening test was analyzed separately, no significant differences were found. Timely donations in response to a disaster are crucial to ensure emergency blood transfusion. The dramatically increased postearthquake donations suggest that Chinese blood centers are capable of handling emergency blood needs. Measures to maintain blood safety should be taken in times of emergency. © 2010 American Association of Blood Banks.

  11. [Development and application of hospital customer service center platform].

    Science.gov (United States)

    Chen, Minya; Zheng, Konglin; Xia, Yong

    2012-01-01

    This paper introduces the construction and application of the platform of client service center in the general hospital and discusses how to provide patients with an entire service including service before clinic, on clinic and after clinic. It can also provide references for a new service mode for clinic service.

  12. Temporal distribution of blood donations in three Brazilian blood centers and its repercussion on the blood supply.

    Science.gov (United States)

    Oliveira, Claudia Di Lorenzo; de Almeida-Neto, Cesar; Liu, Emily Jing; Sabino, Ester Cerdeira; Leão, Silvana Carneiro; Loureiro, Paula; Wright, David; Custer, Brian; Gonçalez, Thelma Therezinha; Capuani, Ligia; Busch, Michael; Proietti, Anna Bárbara de Freitas Carneiro

    2013-01-01

    Seasonal distribution of blood donation hinders efforts to provide a safe and adequate blood supply leading to chronic and persistent shortages. This study examined whether holidays, geographical area and donation type (community versus replacement) has any impact on the fluctuation of donations. The numbers of blood donations from 2007 through 2010 in three Brazilian Retrovirus Epidemiological Donor Study II (REDS-II) participating centers were analyzed according to the week of donation. The weeks were classified as holiday or non-holiday. To compare donations performed during holiday versus non-holiday weeks, tabulations and descriptive statistics for weekly donations by blood center were examined and time series analysis was conducted. The average weekly number of donations varied according to the blood center and type of week. The average number of donations decreased significantly during Carnival and Christmas and increased during the Brazilian National Donor Week. The fluctuation was more pronounced in Recife and Belo Horizonte when compared to São Paulo and higher among community donors. National bank holidays affect the blood supply by reducing available blood donations. Blood banks should take into account these oscillations in order to plan local campaigns, aiming at maintaining the blood supply at acceptable levels.

  13. Experts: hospitals can improve care, save health care dollars by cracking down on unnecessary blood transfusions.

    Science.gov (United States)

    2013-01-01

    Leading health care quality organizations say that blood transfusions are among the most overused treatments. The problem wastes a precious resource as well as health care dollars, continues to stretch what is known to be in short supply in some parts of the country. Part of the problem is continued adherence to an outdated medical practice that calls for transfusions when they are not medically necessary. Also, experts say many guidelines are vague regarding hemoglobin triggers. However, education coupled with IT-driven interventions can help hospitals make dramatic improvements in their blood usage, potentially preserving blood products for patients who really need them. The American Red Cross says that blood use rose by 40% in the United States between 1994 and 2008. Studies show there is wide variation regarding when blood transfusions are called for by practitioners. The latest research suggests hemoglobin thresholds of 7 or 8 grams per deciliter are acceptable, although practitioners often call for transfusions when hemoglobin is at 10 grams per deciliter. Of particular importance to EDs, the lower hemoglobin triggers don't always apply to actively bleeding patients. Through a comprehensive blood conservation program, Eastern Maine Medical Center in Bangor, ME, has been able to nearly halve the number of patients who now receive transfusions without negatively impacting patient care. Also, the program has saved the hospital more than $5 million in blood costs.

  14. Evaluation of Collection and Disposal of Hospital Waste in Hospitals and Healthcare Centers

    Directory of Open Access Journals (Sweden)

    Saeid Nazemi

    2012-08-01

    Full Text Available Currently, one of the environmental issues is waste of hospitals and healthcare facilities which due to hazardous, toxic, and disease-causing agents such as pharmaceutical, chemical and infectious disease, is of particular sensitivity. According to a 2002 survey by WHO, it was determined that 22 million people worldwide suffer from infectious diseases annually, because of contacting hospital wastes. Also based on a research conducted in 22 countries, 18 to 64 percent of hospitals wastes are not disposed properly [1]. The purpose f the study is to appraise collection and disposal of hospital wastes in hospitals and healthcare centers of Shahroud.In this sectional study, 3 university hospitals (580 beds and 10 healthcare facilities were investigated for six months (mehr-azar 89 at Shahroud. In order to determine the amount of waste, produced waste of an entire day was weighted in hospitals and health centers. In this research, proposed questionnaires of WHO for developing countries was used to evaluate collection and disposal system of hospitals waste. Collected data was coded and analyzed by SPSS ver.15.

  15. TRANSFUSION OF BLOOD AND BLOOD COMPONENTS IN POLYTRAUMATISED PATIENTS AT CELJE HOSPITAL (1998–2001

    Directory of Open Access Journals (Sweden)

    Slavomir Milovanović

    2003-12-01

    Full Text Available Background. The replacement of fluids after severe injuries is always a complex issue, either in medical doctrine or in clinical practice. Regardless of the fact, daily work with patients requires the clearest possible guidelines and their regular monitoring.Methods. We made a chart showing the number of patients and the quantity of blood or blood components used in the Celje General Hospital in the past four years.Results. The analyses have shown that indications for the use of blood or blood components have narrowed. At the same time, it is quite evident that it is difficult and also risky to decide on a transfusion only on the given laboratory values. Only a careful analysis of the therapy has shown that the decision on a transfusion is based on both, the clinical picture and its development, the evaluation of visible and invisible loss of blood, and on regular and extensive laboratory monitoring.Conclusions. Despite improved surgical techniques and introduction of new transfusion strategies loss of blood and need for transfusion during and after polytrauma surgeries is still rather high. In the analysed four year period, the maintained level of haemoglobin in patients that had a major surgery has slightly declined. It is therefore essential to cooperate with the respective hospital transfusion committee and prepare as well as follow up some clear guidelines for the rationalisation, not only restriction of transfusion of blood and blood components.

  16. Operative time, blood loss, hemoglobin drop, blood transfusion, and hospital stay in orthognathic surgery.

    Science.gov (United States)

    Salma, Ra'ed Ghaleb; Al-Shammari, Fahad Mohammed; Al-Garni, Bishi Abdullah; Al-Qarzaee, Mohammed Abdullah

    2017-06-01

    This study was conducted to evaluate the operative time, blood loss, hemoglobin drop, blood transfusion, and length of hospital stay in orthognathic surgery. A 10-year retrospective analysis was performed on patients who underwent bilateral sagittal split osteotomy (with or without genioplasty), Le Fort I osteotomy (with or without genioplasty), or any combination of these procedures. A total of 271 patients were included. The age range was 17 to 49 years, with a mean age of 24.13 ± 4.51 years. Approximately 62% of patients underwent double-jaw surgery. The most common procedure was bilateral sagittal split with Le Fort I (37%). The average operative time was 3.96 ± 1.25 h. The mean estimated blood loss was 345.2 ± 149.74 mL. Approximately 9% of patients received intraoperative blood transfusion. The mean hemoglobin drop in the non-transfusion cases was 2.38 ± 0.89 g/dL. The mean postoperative hospital stay was 1.85 ± 0.83 days. Only one patient was admitted to the ICU for one night. In orthognathic surgery, blood loss is relatively minor, blood transfusion is frequent, and ICU admission is unlikely. Operative time, blood loss, blood transfusion, and the complexity of the surgical procedure can significantly increase the length of hospital stay. Males may bleed more than females in orthognathic surgery. Hemoglobin drop can be overestimated due to hemodilution in orthognathic surgery, which may influence the decision to use blood transfusion.

  17. Blood transfusion in burn patients: Triggers of transfusion in a referral burn center in Iran.

    Science.gov (United States)

    Tavousi, S H; Ahmadabadi, A; Sedaghat, A; Khadem-Rezaiyan, M; Yaghoubi Moghaddam, Z; Behrouzian, M J; Nemati, S; Saghafi, H

    2018-02-01

    Blood and its derivatives are one of the most lifesaving products in the modern medicine practice. However, it is not an absolutely safe prescription. Many adverse effects such as infection, transfusion-related acute lung injury, immunosuppression, multi-organ dysfunction, acute respiratory syndrome, transfusion errors, transmission of infectious agents such as HIV, HBV, HCV are attributable to blood transfusion. The aim of this study was to describe how and when blood products were transfused in a referral burn center. This cross-sectional study was performed on medical records of all admitted patients in the Department of Burns and Reconstructive Surgery of Imam Reza Hospital, Mashhad, Iran during September 2014 up to August 2015. Transfusion measures such as Hb, Hct and demographic data were extracted from patient records. SPSS version 11.5 was used for data analysis. During the study period, 701 acute burnt patients were admitted with the mean age of 25.5±20.5 years. Sixty-four percent were male and burnt percentage of total body surface area (TBSA) was 30.9±24.3%. About one third (240) of patients received at least one blood product. Mean of the transfused packed red blood cell was 274.1±674.6mL per patient and 8.85mL per 1% of burnt TBSA. Anemia was the most common transfusion trigger. Mortality in burnt patients who received blood products was two folds more than patients who did not receive any blood products. We prescribed less blood products compared with other reviewed burn centers. However, following a written blood transfusion protocol by all clinicians may reduce blood transfusion in unnecessary situations even more significantly. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  18. Vasovagal reactions in whole blood donors at three REDS-II blood centers in Brazil.

    OpenAIRE

    Gonçalez, TT; Sabino, EC; Schlumpf, KS; Wright, DJ; Leao, S; Sampaio, D; Takecian, PL; Proietti, AB; Murphy, E; Busch, M; Custer, B; NHLBI Retrovirus Epidemiology Donor Study-II REDS-II, International Component,

    2012-01-01

    In Brazil little is known about adverse reactions during donation and the donor characteristics that may be associated with such events. Donors are offered snacks and fluids before donating and are required to consume a light meal after donation. For these reasons the frequency of reactions may be different than those observed in other countries.A cross-sectional study was conducted of eligible whole blood donors at three large blood centers located in Brazil between July 2007 and December 20...

  19. The prevalence of HIV among blood donors at Juba Teaching Hospital Blood Bank, South Sudan

    Directory of Open Access Journals (Sweden)

    Kenneth L L Sube

    2014-11-01

    Full Text Available Objectives The aim of this study is to determine the prevalence of HIV among blood donors in Juba Teaching Hospital Blood Bank, South Sudan in 2013. Method and Materials This is a retrospective study that involved the abstraction of data from registers at the blood bank. Data were collected onto data sheets and entered into a computer database. Statistical analysis was performed using SPSS Version 20 Software. A p value of <0.05 was considered statistically significant. Results Out of 1095 blood donors, 1074 (98.1% were males and 21 (1.9% were females. The mean age and the range for the whole group was 29+7.16 (15-69 yrs. The prevalence of HIV was higher among males than females 85 (7.9% vs 1 (4.8% respectively but this was not statistical significant (p=0.6. The 20 to 29 year age group had the highest prevalence of 49 (57% with no statistical significance (p=0.3.The prevalence of HIV was 7.0 % (86 and there were co-infections between HIV and HBV, HCV and syphilis of 14 (50%, 5 (18%, 9 (32% with p=0.7, p=0.1, p=0.8 respectively. Blood group O positive had the highest percentage 58.1 % (n=50 and was the commonest group. Conclusion In this study, HIV prevalence is very high among blood donors at the Juba Teaching Hospital blood bank.

  20. [Drug information management through the intranet of a hospital center].

    Science.gov (United States)

    Juárez Giménez, J C; Mendarte Barrenechea, L; Gil Luján, G; Sala Piñol, F; Lalueza Broto, P; Girona Brumós, L; Monterde Junyent, J

    2006-01-01

    This paper describes the methodology used for the implementation and validation of a network resource incorporated to the intranet of the Hospital, in order to retain and disseminate information from the Drug Information Center (DIC) of a pharmacy service in a hospital center. A working group designed the structure, contents, memory needs, priority of access for users and a quality assessment questionnaire. The resource developed by the working group had a capacity of 70 Gb and its structure was based on HTML documents, including files with different format and 12 theme areas. Two levels of priority of access were established depending on the user and two persons were in charge of the resource. The questionnaire was delivered after three months of use. Sixty nine per cent of the users regarded the resource as very useful and 31%, as useful. The final structure, according to the results of the survey, had 11 theme areas. The use of the hospital Intranet in order to include and organize DIC information can be very simple and economic. Furthermore, the involvement of all the users in its design and structure can facilitate the practical use of this tool and improve its quality.

  1. Analysis of inventory strategies for blood components in a regional blood center using process simulation.

    Science.gov (United States)

    Baesler, Felipe; Nemeth, Matías; Martínez, Cristina; Bastías, Alfonso

    2014-02-01

    The storage of blood components is an important concern in the blood supply chain. Because these are perishable products, the definition of good inventory policies is crucial to reduce shortages and spills. To analyze and propose inventory policies in a regional blood center, a discrete event simulation model was created using simulation software (Arena 12.0, Rockwell Software). The model replicates the activities that are performed along the supply chain including donation arrivals, testing, production, inventory management, and dispatching. Twelve different scenarios were analyzed, with each one representing different inventory policies composed of a combination of an optimal inventory, a reorder point, and a level of extra donations. The best scenario demonstrates that it is possible to decrease unsatisfied demand and wastage of red blood cell units by 2.5 and 3%, respectively, when compared to current practices. This study shows that simulation is an alternative that can be used to model inventory components in blood centers. A responsible selection of inventory variables can improve the capability of the system to respond to the final patient requirements. © 2013 American Association of Blood Banks.

  2. [Investigation on nutritional intakes for hospitalized children with blood disease].

    Science.gov (United States)

    Xu, Zi-Liang; Wu, Yun-Tang; Sun, Zhong; Zhu, Xiao-Fan; Li, Rui; Li, Hong-Qiang; Qi, Yu-Mei; Song, Ji-Chang; Han, Zhong-Chao

    2008-08-01

    To investigate the diet and nutritional status of hospitalized children with blood disease in order to provide nutritional guidelines. The patients' daily dietary intakes, including breakfast, lunch, dinner and additional meals, were recorded in detail for seven consecutive days. The intake amount of various nutrients was calculated using the dietary database. The majority of children with blood disease showed inadequate intakes of calories [mean 1825.81 kCal/d, 73.62% of the recommended intake (RNI)] and protein (mean 67.68 g/d, 81.34% of RNI). Intakes of vitamin E and riboflavin were adequate, but intakes of vitamin A, thiamine and vitamin C (66.67%, 77.78% and 69.89% of RNI, respectively) were inadequate. Iron and selenium intakes were adequate, but calcium and zinc intakes (41.11% and 56.21% of RNI, respectively) were grossly inadequate. Hospitalized children with blood disease had decreased dietary intakes of calories, protein, vitamin A, vitamin C, thiamin, calcium and zinc. The dietary pattern and nutritional intake need to be improved.

  3. YaAn earthquake increases blood pressure among hospitalized patients.

    Science.gov (United States)

    Li, Chuanwei; Luo, Xiaoli; Zhang, Wen; Zhou, Liang; Wang, Hongyong; Zeng, Chunyu

    YaAn, a city in Sichuan province, China, was struck by a major earthquake measuring 7.0 on the Richter scale on April 20, 2013. This study sought to investigate the impact of YaAn earthquake on the blood pressure (BP) among hospitalized patients in the department of cardiology. We enrolled 52 hospitalized patients who were admitted to our hospital at least three days before the day of earthquake in 2013 (disaster group) as compared with 52 patients during April 20, 2014 (nondisaster group). BP was measured three times per day and the prescription of antihypertensive medicine was recorded. The earthquake induced a 3.3 mm Hg significant increase in the mean postdisaster systolic blood pressure (SBP) in the disaster group as compared with the nondisaster group. SBP at admission was positively associated with the elevated SBP in the logistic regression model (odds ratio (OR) = 1.09, 95% confidence interval (CI):1.016-1.168, p = 0.015), but not other potential influencing factors, including antihypertensive medicine, sex, age, and body weight, excluding β-blockers. Patients with β-blockers prescription at the time of earthquake showed a blunt response to earthquake-induced SBP elevation than those who were taking other antihypertensive drugs (OR = 0.128, 95% CI: 0.019-0.876, p = 0.036). The YaAn earthquake induced significant increase in SBP even at a distance from the epicenter among hospitalized patients. The findings demonstrate that pure psychological components seem to be a cause of the pressor response and β-blockers might be better in controlling disaster-induced hypertension.

  4. Hospital image and the positioning of service centers: an application in market analysis and strategy development.

    Science.gov (United States)

    Smith, S M; Clark, M

    1990-09-01

    The research confirms the coexistence of different images for hospitals, service centers within the same hospitals, and service programs offered by each of the service centers. The images of individual service centers are found not to be tied to the image of the host facility. Further, service centers and host facilities have differential rankings on the same service decision attributes. Managerial recommendations are offered for "image differentiation" between a hospital and its care centers.

  5. Patient-centered approach to ensuring appropriateness of care through blood management.

    Science.gov (United States)

    King, Rita; Michelman, Mark; Curran, Vivian; Bean, Jo; Rowden, Paul; Lindsey, Jeffrey

    2013-06-01

    Concerns have been raised about the safety and efficacy of blood transfusions. Blood products are in demand and a decreasing supply is projected, with resource conservation a global concern. A consultant group determined that the transfusion rate at Mease Countryside Hospital was higher than an average baseline. A process-improvement project was initiated using a multidisciplinary team approach to improve blood utilization and ensure appropriateness in transfusion practice. The foundation of this project was to create new guidelines for transfusion; provide detailed education, communication, reporting, and feedback; and develop criteria to ensure compliance. The mean monthly usage of red blood cell units per 1000 inpatient discharges between April 2010 and October 2011 was 321.4 compared with 212.0 for the 5 months after implementation. The mean monthly number of patients transfused per 1000 inpatient discharges from April 2010 to October 2011 was 135.2 compared with 90.2 after implementation. In both cases, this reduction was found to be statistically significant at a 95% confidence level (P = 0.000 in both respects). The success of this project was the result of careful planning and execution, administrative support, physician leadership, and teamwork. Blood management includes strategies to avoid inappropriate transfusions and proactively treat anemia. Anemia management should be based on the patient's symptoms, laboratory values, and clinical assessment. Treatment of anemia should encompass a patient-centered approach, with the aim of promoting patient safety and minimizing the risk from exposure to blood products.

  6. Complications associated with blood donations in a blood bank at an Indian tertiary care hospital.

    Science.gov (United States)

    Meena, Monika; Jindal, Tarun

    2014-09-01

    Blood donation, though safe, has a few potentially avoidable complications associated with it. They are important reasons for the failure of the donors to return for repeat donations. The aim of this study was to assess the frequency and identify the possible factors associated with increased risk of blood donation related complications so that they can be minimized. A prospective study was done over a period of four months in the blood bank of an Indian tertiary care hospital to record the donation related complications. Out of 7450 blood donations, total donation associated complications were 74, of which majority were vasovagal reactions (VVRs) (n=48), followed by venous hematomas (n=24) and arterial punctures (n=2). The incidence of VVRs was more, though not statistically significant, in females, replacement/repeat donors, donors between 21-30 y of age and who had a body-mass-index (BMI) of 18.5-24.9. VVRs were more common in April (p=0.002) and in those who donated 450ml of blood (pdonated 350ml of blood, statistically significant association was seen only in repeat donors (pdonation in our country has a complication rate of nearly 1%.

  7. Adverse reactions to blood donation: A descriptive study of 3520 blood donors in a Nigerian tertiary hospital

    OpenAIRE

    C Aneke John; U Ezeh Theodora; A Nwosu Gloria; E Anumba Chika

    2017-01-01

    Background: The occurrence of adverse reactions to blood donation significantly hampers donor retention and negatively impacts on the universal availability of adequate numbers of blood donor units. Objective: To analyze the spectrum and prevalence of adverse reactions in blood donors in a tertiary hospital-based blood bank in Nigeria. Subjects and Methods: The details of 3520 blood donors who presented for donation over a 12 months period were retrieved from the departmental archives for ana...

  8. Blood culture contamination in hospitalized pediatric patients: a single institution experience

    Science.gov (United States)

    Min, Hyewon; Park, Cheong Soo; Kim, Dong Soo

    2014-01-01

    Purpose Blood culture is the most important tool for detecting bacteremia in children with fever. However, blood culture contamination rates range from 0.6% to 6.0% in adults; rates for young children have been considered higher than these, although data are limited, especially in Korea. This study determined the contamination rate and risk factors in pediatric patients visiting the emergency room (ER) or being admitted to the ward. Methods We conducted a retrospective chart review of blood cultures obtained from children who visited Yonsei Severance Hospital, Korea between 2006 and 2010. Positive blood cultures were labeled as true bacteremia or contamination according to Centers for Disease Control and Prevention/National Healthcare Safety Network definitions for laboratory-confirmed bloodstream infection, after exclusion of cultures drawn from preexisting central lines only. Results Among 40,542 blood cultures, 610 were positive, of which 479 were contaminations and 131 were true bacteremia (overall contamination rate, 1.18%). The contamination rate in the ER was significantly higher than in the ward (1.32% vs. 0.66%, P6 years, respectively). Conclusion Overall, contamination rates were higher in younger children than in older children, given the difficulty of performing blood sampling in younger children. The contamination rates from the ER were higher than those from the ward, not accounted for only by overcrowding and lack of experience among personnel collecting samples. Further study to investigate other factors affecting contamination should be required. PMID:24868215

  9. Managing Hyperglycemia (High Blood Sugar) in the Hospital: a Patient's Guide

    Science.gov (United States)

    Managing Hyperglycemia (High Blood Sugar) in the Hospital A Patient’s Guide Hyperglycemia is the medical term for blood glucose (sugar) ... org/guidelines/index.cfm). www.hormone.org Managing Hyperglycemia (High Blood Sugar) in the Hospital Patient Guide ...

  10. The effect of text messaging on hospital visits and blood pressure ...

    African Journals Online (AJOL)

    Background: Non-attendance to hospital appointment and non-adherence to blood pressure lowering medication are major factors in sub-optimal control of high blood pressure. The aim of the study was to assess the effect of text messaging on improving hospital visits and blood pressure control in adult hypertensives in ...

  11. Ambulatory Surgery Centers and Prices in Hospital Outpatient Departments.

    Science.gov (United States)

    Carey, Kathleen

    2017-04-01

    Specialty providers claim to offer a new competitive benchmark for efficient delivery of health care. This article explores this view by examining evidence for price competition between ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs). I studied the impact of ASC market presence on actual prices paid to HOPDs during 2007-2010 for four common surgical procedures that were performed in both provider types. For the procedures examined, HOPDs received payments from commercial insurers in the range of 3.25% to 5.15% lower for each additional ASC per 100,000 persons in a market. HOPDs may have less negotiating leverage with commercial insurers on price in markets with high ASC market penetration, resulting in relatively lower prices.

  12. [Hypertensive emergencies at the University Hospital Center in Brazzaville, Congo].

    Science.gov (United States)

    Ellenga, Mbolla B F; Gombet, T R; Mahoungou, Guimbi K C; Otiobanda, G F; Ossou, Nguiet P M; Ikama, M S; Kimbally-Kaky, G; Etitiele, F

    2011-02-01

    The purpose of this retrospective study conducted in the emergency department of the University Hospital Center in Brazzaville, Congo was to determine the prevalence and clinical characteristics of hypertensive emergencies. With a total of 76 patients admitted during the study period, the prevalence of hypertensive emergency was 4%. The sex ratio was 1 and mean patient age was 57.3 years (range, 30 to 80 years). Risk factors included obesity in 62 cases (81.6%), history of hypertension in 65 (85.5%) and low socioeconomic level in 58 (76.3%). Mean delay for consultation was 50 hours (range, 1 to 240 hours). The disease underlying the hypertensive emergency was stroke with 38 cases (50%), heart failure in 20 (26.3%), hypertensive encephalopathy in 11 (14.4%), malignant hypertension in 9 (11.8%), and renal failure in 10 (13.1%). The mean length of emergency treatment was 14.7 hours (range, 5 to 48 hours). Eight deaths (10.5%) occurred during hospitalization in the emergency department.

  13. Motivation and social capital among prospective blood donors in three large blood centers in Brazil.

    Science.gov (United States)

    Gonçalez, Thelma T; Di Lorenzo Oliveira, Claudia; Carneiro-Proietti, Anna Barbara F; Moreno, Elizabeth C; Miranda, Carolina; Larsen, Nina; Wright, David; Leão, Silvana; Loureiro, Paula; de Almeida-Neto, Cesar; Lopes, Maria-Inês; Proietti, Fernando A; Custer, Brian; Sabino, Ester

    2013-06-01

    Studies analyzing motivation factors that lead to blood donation have found altruism to be the primary motivation factor; however, social capital has not been analyzed in this context. Our study examines the association between motivation factors (altruism, self-interest, and response to direct appeal) and social capital (cognitive and structural) across three large blood centers in Brazil. We conducted a cross-sectional survey of 7635 donor candidates from October 15 through November 20, 2009. Participants completed self-administered questionnaires on demographics, previous blood donation, human immunodeficiency virus testing and knowledge, social capital, and donor motivations. Enrollment was determined before the donor screening process. Among participants, 43.5 and 41.7% expressed high levels of altruism and response to direct appeal, respectively, while only 26.9% expressed high levels of self-interest. More high self-interest was observed at Hemope-Recife (41.7%). Of participants, 37.4% expressed high levels of cognitive social capital while 19.2% expressed high levels of structural social capital. More high cognitive and structural social capital was observed at Hemope-Recife (47.3 and 21.3%, respectively). High cognitive social capital was associated with high levels of altruism, self-interest, and response to direct appeal. Philanthropic and high social altruism were associated with high levels of altruism and response to direct appeal. Cognitive and structural social capital and social altruism are associated with altruism and response to direct appeal, while only cognitive social capital is associated with self-interest. Designing marketing campaigns with these aspects in mind may help blood banks attract potential blood donors more efficiently. © 2012 American Association of Blood Banks.

  14. Respiratory syncytial virus neutralizing antibodies in cord blood, respiratory syncytial virus hospitalization, and recurrent wheeze

    DEFF Research Database (Denmark)

    Stensballe, Lone Graff; Ravn, Henrik; Kristensen, Kim

    2008-01-01

    BACKGROUND: Respiratory syncytial virus (RSV) hospitalization is associated with wheeze. OBJECTIVE: To examine the influence of maternally derived RSV neutralizing antibodies in cord blood on RSV hospitalization and recurrent wheeze in infancy. METHODS: Among children from the Danish National Birth...

  15. Vasovagal reactions in whole blood donors at 3 REDS-II blood centers in Brazil

    Science.gov (United States)

    Goncalez, T. T.; Sabino, E. C.; Schlumpf, K.S.; Wright, D.J.; Leao, S.; Sampaio, D.; Takecian, P. L.; Carneiro-Proietti, AB; Murphy, E.; Busch, M.; Custer, B.

    2013-01-01

    Background In Brazil little is known about adverse reactions during donation and the donor characteristics that may be associated with such events. Donors are offered snacks and fluids prior to donating and are required to consume a light meal after donation. For these reasons the frequency of reactions may be different than those observed in other countries. Methods A cross-sectional study was conducted of eligible whole blood donors at three large blood centers located in Brazil between July 2007 and December 2009. Vasovagal reactions (VVRs) along with donor demographic and biometric data were collected. Reactions were defined as any presyncopal or syncopal event during the donation process. Multivariable logistic regression was performed to identify predictors of VVRs. Results Of 724,861 donor presentations, 16,129 (2.2%) VVRs were recorded. Rates varied substantially between the three centers: 53, 290 and 381 per 10,000 donations in Recife, São Paulo and Belo Horizonte, respectively. Although the reaction rates varied, the donor characteristics associated with VVRs were similar [younger age (18–29), replacement donors, first time donors, low estimated blood volume (EBV)]. In multivariable analysis controlling for differences between the donor populations in each city younger age, first-time donor status and lower EBV were the factors most associated with reactions. Conclusion Factors associated with VVRs in other locations are also evident in Brazil. The difference in VVR rates between the three centers might be due to different procedures for identifying and reporting the reactions. Potential interventions to reduce the risk of reactions in Brazil should be considered. PMID:22073941

  16. Motivation and Social Capital among prospective blood donors in three large blood centers in Brazil

    Science.gov (United States)

    Gonçalez, Thelma T.; Di Lorenzo Oliveira, Claudia; Carneiro-Proietti, Anna Barbara F.; Moreno, Elizabeth C.; Miranda, Carolina; Larsen, Nina; Wright, David; Leão, Silvana; Loureiro, Paula; de Almeida-Neto, Cesar; Lopes, Maria-Inês; Proietti, Fernando A.; Custer, Brian; Sabino, Ester

    2012-01-01

    Background Studies analyzing motivation factors that lead to blood donation have found altruism to be the primary motivation factor; however social capital has not been analyzed in this context. Our study examines the association between motivation factors (altruism, self-interest and response to direct appeal) and social capital (cognitive and structural) across three large blood centers in Brazil. Study Design and Methods We conducted a cross-sectional survey of 7,635 donor candidates from October 15 through November 20, 2009. Participants completed self-administered questionnaires on demographics, previous blood donation, HIV testing and knowledge, social capital and donor motivations. Enrollment was determined prior to the donor screening process. Results Among participants, 43.5% and 41.7% expressed high levels of altruism and response to direct appeal respectively, while only 26.9% expressed high levels of self-interest. More high self-interest was observed at Hemope-Recife (41.7%). Of participants, 37.4% expressed high levels of cognitive social capital while 19.2% expressed high levels of structural social capital. More high cognitive and structural social capital was observed at Hemope-Recife (47.3% and 21.3%, respectively). High cognitive social capital was associated with high levels of altruism, self-interest and response to direct appeal. Philanthropic and high social altruism was associated with high levels of altruism and response to direct appeal. Conclusion Cognitive and structural social capital and social altruism are associated with altruism and response to direct appeal, while only cognitive social capital is associated with self-interest. Designing marketing campaigns with these aspects in mind may help blood banks attract potential blood donors more efficiently. PMID:22998740

  17. Patient Blood Management in Europe: surveys on top indications for red blood cell use and Patient Blood Management organization and activities in seven European university hospitals.

    Science.gov (United States)

    Bruun, M T; Pendry, K; Georgsen, J; Manzini, P; Lorenzi, M; Wikman, A; Borg-Aquilina, D; van Pampus, E; van Kraaij, M; Fischer, D; Meybohm, P; Zacharowski, K; Geisen, C; Seifried, E; Liumbruno, G M; Folléa, G; Grant-Casey, J; Babra, P; Murphy, M F

    2016-11-01

    Patient Blood Management (PBM) in Europe is a working group of the European Blood Alliance with the initial objective to identify the starting position of the participating hospitals regarding PBM for benchmarking purposes, and to derive good practices in PBM from the experience and expertise in the participating teams with the further aim of implementing and strengthening these practices in the participating hospitals. We conducted two surveys in seven university hospitals in Europe: Survey on top indications for red blood cell use regarding usage of red blood cells during 1 week and Survey on PBM organization and activities. A total of 3320 units of red blood cells were transfused in 1 week at the seven hospitals. Overall, 61% of red cell units were transfused to medical patients and 36% to surgical patients, although there was much variation between hospitals. The organization and activities of PBM in the seven hospitals were variable, but there was a common focus on optimizing the treatment of bleeding patients, monitoring the use of blood components and treatment of preoperative anaemia. Although the seven hospitals provide a similar range of clinical services, there was variation in transfusion rates between them. Further, there was variable implementation of PBM activities and monitoring of transfusion practice. These findings provide a baseline to develop joint action plans to further implement and strengthen PBM across a number of hospitals in Europe. © 2016 International Society of Blood Transfusion.

  18. Code development of the national hemovigilance system and expansion strategies for hospital blood banks

    Directory of Open Access Journals (Sweden)

    Kim Jeongeun

    2012-01-01

    Full Text Available Objectives : The aims of this study were to develop reportable event codes that are applicable to the national hemovigilance systems for hospital blood banks, and to present expansion strategies for the blood banks. Materials and Methods : The data were obtained from a literature review and expert consultation, followed by adding to and revising the established hemovigilance code system and guidelines to develop reportable event codes for hospital blood banks. The Medical Error Reporting System-Transfusion Medicine developed in the US and other codes of reportable events were added to the Korean version of the Biologic Products Deviation Report (BPDR developed by the Korean Red Cross Blood Safety Administration, then using these codes, mapping work was conducted. We deduced outcomes suitable for practice, referred to the results of the advisory councils, and conducted a survey with experts and blood banks practitioners. Results : We developed reportable event codes that were applicable to hospital blood banks and could cover blood safety - from blood product safety to blood transfusion safety - and also presented expansion strategies for hospital blood banks. Conclusion : It was necessary to add 10 major categories to the blood transfusion safety stage and 97 reportable event codes to the blood safety stage. Contextualized solutions were presented on 9 categories of expansion strategies of hemovigilance system for the hospital blood banks.

  19. Hypopharyngeal carcinoma: King Faisal Specialist Hospital and Research Center experience

    International Nuclear Information System (INIS)

    Mahasin, Z.; Khan, B.

    1996-01-01

    From 1975 to 1985, 202 patients with hypopharyngeal cancer were seen at King Faisal Specialist Hospital and Research Center (KFSHRC). The endoscopic investigation showed that 28.3% of these patients had postcricoid carcinoma; 19.85% had pyriform fossa carcinoma and 52.9% had involvement of both sites. The pathological diagnosis of all cases was squamous cell carcinoma type. The majority of the patients (62.98%) had T4 lesions, which showed a late presentation to KFSHRC. Information related to survival was available for a smaller number of patients to many lost-to-follow-up cases. The overall median survival time was 8.5 months (1-110 months). The survival rate for each site was calculated, as well as the staging of the disease and treatment modality used. It appeared that pyriform fossa (median 21 months) had the best survival rate. In addition the earlier the lesion was detected and the more aggressive the treatment applied, the better the survival rate. Fifty percent of the patients receiving radiation therapy and surgery had a five year survival arte. Factors other than smoking and/on drinking should be looked for in our community as predisposing to this disease in our population. (author)

  20. Trends in the profile of blood donors at a large blood center in the city of São Paulo, Brazil

    Directory of Open Access Journals (Sweden)

    Gonçalez Thelma

    2003-01-01

    Full Text Available OBJECTIVE: To describe the trends in the profile of blood donors from 1995 through 2001 at a large blood center in the city of São Paulo, Brazil, particularly following the initiation in 1998 of marketing strategies aimed at substituting replacement donors with altruistic repeat donors. METHODS: Using an information system that had been established at the Pro-Blood Foundation/Blood Center of São Paulo (Fundação Pró-Sangue/Hemocentro de São Paulo in 1994, we collected information on sex, age, and type of donation for the years 1995-2001. We classified blood donors as either replacement blood donors (if they stated that the reason for donating was that they had a friend or relative in the hospital or as altruistic donors. First-time blood donors were those who had not donated in our institution since the establishment of the information system. RESULTS: The percentage of repeat altruistic blood donors increased over time as first-time replacement donors declined for both genders. The proportion of altruistic donors climbed from 20% of all blood donors in 1995 to 57% in 2001. In 2001, first-time blood donors represented only 52% of all donors, as contrasted to 88% in 1995. Female donors increased from 20% to 37% of the donors over the period studied. CONCLUSIONS: Our data provide evidence that the São Paulo population has responded well to the marketing strategies that have been introduced in our institution. We believe that similar promotional efforts elsewhere in Brazil would produce comparable, positive results.

  1. Prevalence of HIV among blood donors at Juba Teaching Hospital ...

    African Journals Online (AJOL)

    Male. 85. (99%). 193. (99%). 34. (100%). 102. (97%). 414. Female. 1(1%). 2(1%). 0. 3(3%). 6. Total. 86. 195. 34. 105. 420. Figure 1. Distribution (percent) of HIV, HBV, HCV and syphilis among blood donors. Table 3. Distribution of blood groups among blood donors. Blood group. Frequency. Percentage (%). A+ve. 270. 24.7.

  2. The Breast Health Center at Women & Infants Hospital: origin, philosophy, and features.

    Science.gov (United States)

    Falkenberry, S S; Chung, M; Legare, R; Strenger, R; Wallace, D; Phillips, G; Morry, S; Marchant, D J; Cady, B

    2000-04-01

    The Breast Health Center, a component of the program in Women's Oncology at Women & Infants Hospital, is a multidisciplinary center devoted to the treatment and study of benign and malignant breast diseases. The philosophy, structure, and function of The Breast Health Center are described along with its specific components. The Breast Health Center's three fundamental missions of patient care, education, and research are discussed.

  3. Day hospital and psychosocial care center: Expanding the discussion of partial hospitalization in mental health

    Directory of Open Access Journals (Sweden)

    César Augusto Trinta Weber

    Full Text Available Summary Introduction: Since the second half of the twentieth century the discussions about mental patient care reveal ongoing debate between two health care paradigms: the biomedical/biopsychosocial paradigm and the psychosocial paradigm. The struggle for hegemony over the forms of care, on how to deal optimally with the experience of becoming ill is underpinned by an intentionality of reorganizing knowledge about the health/disease dichotomy, which is reflected in the models proposed for the implementation of actions and services for the promotion, prevention, care and rehabilitation of human health. Objective: To discuss the guidelines of care in mental health day hospitals (MHDH in contrast to type III psychosocial care centers (CAPS III. Method: Review of mental health legislation from 1990 to 2014. Results: A definition of therapeutic project could not be found, as well as which activities and techniques should be employed by these health services. Conclusion: The MHDH and PCC III are services that replace psychiatric hospital admission and are characterized by their complementarity in the care to the mentally ill. Due to their varied and distinctive intervention methods, which operate synergistically, the contributions from both models of care are optimized. Discussions on the best mental health care model reveal polarization between the biomedical/biopsychosocial and psychosocial paradigms. This reflects the supremacy of the latter over the former in the political-ideological discourse that circumscribes the reform of psychiatric care, which may hinder a better clinical outcome for patients and their families.

  4. Blood lactate as a predictor for in-hospital mortality in patients admitted acutely to hospital: A systematic review

    DEFF Research Database (Denmark)

    Kruse, Ole; Grunnet, Niels; Barfod, Charlotte

    2011-01-01

    to the hospital, or serial lactate measurements. Furthermore there is no consensus whether the sample should be drawn from arterial, peripheral venous, or capillary blood. The aim of this review was: 1) To examine whether blood lactate levels are predictive for in-hospital mortality in patients in the acute...... setting, i.e. patients assessed pre-hospitally, in the trauma centre, emergency department, or intensive care unit. 2) To examine the agreement between arterial, peripheral venous, and capillary blood lactate levels in patients in the acute setting. METHODS: We performed a systematic search using Pub......Med, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and CINAHL up to April 2011. 66 articles were considered potentially relevant and evaluated in full text, of these ultimately 33 articles were selected. RESULTS AND CONCLUSION: The literature reviewed supported blood...

  5. No transmission of blood-borne viruses among hospital staff despite frequent blood exposure

    DEFF Research Database (Denmark)

    Eskandarani, Hassan Ali; Kehrer, Michala; Christensen, Peer Brehm

    2014-01-01

    to provide an updated evaluation of the annual frequency of registered exposures during the 2003-2012 period, the prevalence and incidence of transmission of HIV, HBV and HCV among HCWs, the prevalence of HIV, HBV and HCV among source patients, the follow-up by HBV vaccination and blood sampling in exposed...... HCWs and, finally, reporting habits. MATERIAL AND METHODS: All registered first-time cases of BBF exposure at Odense University Hospital during the 2003-2012 period were included. The exposed HCW and source patient were linked to a laboratory database to obtain the test results for HIV, HBV, HCV...... among HCWs was zero. The prevalence of anti-HIV among source patients was 0.9%, HBsAg 1.2% and anti-HCV/HCV-RNA 3.8%. In 2003-2012, 31.3% of the tested HCWs had an anti-HBs ≥ 10 IU/l at baseline and this increased to 76.1% after vaccination. In 2012, 95% of the HCWs had blood samples at the time...

  6. Hospitalization in Parkinson disease: a survey of National Parkinson Foundation Centers

    NARCIS (Netherlands)

    Chou, K.L.; Zamudio, J.; Schmidt, P.; Price, C.C.; Parashos, S.A.; Bloem, B.R.; Lyons, K.E.; Christine, C.W.; Pahwa, R.; Bodis-Wollner, I.; Oertel, W.H.; Suchowersky, O.; Aminoff, M.J.; Malaty, I.A.; Friedman, J.H.; Okun, M.S.

    2011-01-01

    OBJECTIVES: To explore current practices and opinions regarding hospital management of Parkinson disease (PD) patients in specialized PD Centers. METHODS: Fifty-one out of 54 National Parkinson Foundation (NPF) Centers worldwide completed an online survey regarding hospitalization of PD patients.

  7. An international investigation into O red blood cell unit administration in hospitals

    DEFF Research Database (Denmark)

    Zeller, Michelle P; Barty, Rebecca; Aandahl, Astrid

    2017-01-01

    BACKGROUND: Transfusion of group O blood to non-O recipients, or transfusion of D- blood to D+ recipients, can result in shortages of group O or D- blood, respectively. This study investigated RBC utilization patterns at hospitals around the world and explored the context and policies that guide ...

  8. Maternal and neonatal outcomes in birth centers versus hospitals among women with low-risk pregnancies in Japan: A retrospective cohort study.

    Science.gov (United States)

    Kataoka, Yaeko; Masuzawa, Yuko; Kato, Chiho; Eto, Hiromi

    2018-01-01

    In order for low-risk pregnant women to base birth decisions on the risks and benefits, they need evidence of birth outcomes from birth centers. The purpose of this study was to describe and compare the maternal and neonatal outcomes of low-risk women who gave birth in birth centers and hospitals in Japan. The participants were 9588 women who had a singleton vaginal birth at 19 birth centers and two hospitals in Tokyo. The data were collected from their medical records, including their age, parity, mode of delivery, maternal position at delivery, duration of labor, intrapartum blood loss, perineal trauma, gestational weeks at birth, birth weight, Apgar score, and stillbirths. For the comparison of birth centers with hospitals, adjusted odds ratios for the birth outcomes were estimated by using a logistic regression analysis. The number of women who had a total blood loss of >1 L was higher in the midwife-led birth centers than in the hospitals but the incidence of perineal lacerations was lower. There were fewer infants who were born at the midwife-led birth centers with Apgar scores of birth centers and hospitals. Additional research, using matched baseline characteristics, could clarify the comparisons for maternal and neonatal outcomes. © 2017 Japan Academy of Nursing Science.

  9. Outcomes of antiretroviral treatment: a comparison between hospitals and health centers in Ethiopia.

    Science.gov (United States)

    Balcha, Taye T; Jeppsson, Anders

    2010-01-01

    the objective of this study was to compare the outcomes of antiretroviral therapy (ART) between hospital and health center levels in Ethiopia. medical records of 1709 ART patients followed for 24 months at 2 hospitals and 3 health centers in the Oromia region of Ethiopia were reviewed. Noted outcomes of ART were currently alive and on treatment; lost to follow-up (LTFU); transferred out (TO); and died (D). of 1709 HIV-positive patients started on ART between September 2006 and February 2007, 1044 (61%) remained alive and were on treatment after 24-month follow-up. In all, 835 (57%) of ART patients at hospitals and 209 (83%) at health centers were retained in the program. Of those who were alive and receiving ART, 79% of patients at health centers and 72% at hospitals were clinically or immunologically improving. In addition, 331 (23%) patients at hospitals were LFTU as compared to 24 (10%) of patients at health centers (relative risk [RR] at 95% confidence interval [CI]: .358 [.231-.555]). While 11% was the mortality rate at hospitals, 5% of patients at health centers also died (RR at 95% CI: .360 [.192-.673]). antiretroviral therapy at health centers was associated with more favorable outcomes than at hospitals.

  10. Institutional blood glucose monitoring system for hospitalized patients: an integral component of the inpatient glucose control program.

    Science.gov (United States)

    Boaz, Mona; Landau, Zohar; Matas, Zipora; Wainstein, Julio

    2009-09-01

    The ability to measure patient blood glucose levels at bedside in hospitalized patients and to transmit those values to a central database enables and facilitates glucose control and follow-up and is an integral component in the care of the hospitalized diabetic patient. The goal of this study was to evaluate the performance of an institutional glucometer employed in the framework of the Program for the Treatment of the Hospitalized Diabetic Patient (PTHDP) at E. Wolfson Medical Center, Holon, Israel. As part of the program to facilitate glucose control in hospitalized diabetic patients, an institutional glucometer was employed that permits uploading of data from stands located in each inpatient department and downloading of that data to a central hospital-wide database. Blood glucose values from hospitalized diabetic patients were collected from August 2007 to October 2008. The inpatient glucose control program was introduced gradually beginning January 2008. During the follow-up period, more than 150,000 blood glucose measures were taken. Mean glucose was 195.7 +/- 99.12 mg/dl during the follow-up period. Blood glucose values declined from 206 +/- 105 prior to PTHDP (August 2007-December 2007) to 186 +/- 92 after its inception (January 2008-October 2008). The decline was associated significantly with time (r = 0.11, p < 0.0001). The prevalence of blood glucose values lower than 60 mg/dl was 1.48% [95% confidence interval (CI) 0.36%] prior to vs 1.55% (95% CI 0.37%) following implementation of the PTHDP. Concomitantly, a significant increase in the proportion of blood glucose values between 80 and 200 mg/dl was observed, from 55.5% prior to program initiation vs 61.6% after program initiation (p < 0.0001). The present study was designed to observe changes in institution-wide glucose values following implementation of the PTHDP. Information was extracted from the glucometer system itself. Because the aforementioned study was not a clinical trial, we cannot rule out

  11. Hospital blood bank information systems accurately reflect patient transfusion: results of a validation study.

    Science.gov (United States)

    McQuilten, Zoe K; Schembri, Nikita; Polizzotto, Mark N; Akers, Christine; Wills, Melissa; Cole-Sinclair, Merrole F; Whitehead, Susan; Wood, Erica M; Phillips, Louise E

    2011-05-01

    Hospital transfusion laboratories collect information regarding blood transfusion and some registries gather clinical outcomes data without transfusion information, providing an opportunity to integrate these two sources to explore effects of transfusion on clinical outcomes. However, the use of laboratory information system (LIS) data for this purpose has not been validated previously. Validation of LIS data against individual patient records was undertaken at two major centers. Data regarding all transfusion episodes were analyzed over seven 24-hour periods. Data regarding 596 units were captured including 399 red blood cell (RBC), 95 platelet (PLT), 72 plasma, and 30 cryoprecipitate units. They were issued to: inpatient 221 (37.1%), intensive care 109 (18.3%), outpatient 95 (15.9%), operating theater 45 (7.6%), emergency department 27 (4.5%), and unrecorded 99 (16.6%). All products recorded by LIS as issued were documented as transfused to intended patients. Median time from issue to transfusion initiation could be calculated for 535 (89.8%) components: RBCs 16 minutes (95% confidence interval [CI], 15-18 min; interquartile range [IQR], 7-30 min), PLTs 20 minutes (95% CI, 15-22 min; IQR, 10-37 min), fresh-frozen plasma 33 minutes (95% CI, 14-83 min; IQR, 11-134 min), and cryoprecipitate 3 minutes (95% CI, -10 to 42 min; IQR, -15 to 116 min). Across a range of blood component types and destinations comparison of LIS data with clinical records demonstrated concordance. The difference between LIS timing data and patient clinical records reflects expected time to transport, check, and prepare transfusion but does not affect the validity of linkage for most research purposes. Linkage of clinical registries with LIS data can therefore provide robust information regarding individual patient transfusion. This enables analysis of joint data sets to determine the impact of transfusion on clinical outcomes. © 2010 American Association of Blood Banks.

  12. Cord blood banking activities at a university hospital in northeast Mexico: an 8-year experience.

    Science.gov (United States)

    Jaime-Perez, Jose C; Monreal-Robles, Roberto; Colunga-Pedraza, Julia; Mancías-Guerra, Consuelo; Rodríguez-Romo, Laura; Gómez-Almaguer, David

    2012-12-01

    Umbilical cord blood (UCB) represents an alternative source of stem cells for transplantation for the treatment of hematologic malignancies and genetic disorders. There is scarce information detailing cord blood bank (CBB) collection and transplantation activities from developing countries. We documented our experience at a public university hospital in northeast Mexico. We carried out a retrospective and descriptive analysis of our CBB activity during an 8-year period from May 2002 to September 2010. Collection, processing, and cryopreservation of CB were carried out following standard operating procedures. The minimum volume and total nucleated cell (TNC) content for cryopreservation were 80 mL and 8.0 × 10(8) , respectively. A total of 1256 UCB units were collected; 428 (34%) were banked and 828 (66%) were discarded. The main reason for exclusion was biologic: low volume and/or low number of TNC accounted for 84% of the total discarded units. Cryopreserved cord blood units (CBUs) had a median volume of 113.8 mL (range, 80-213.2 mL) and 13.0 × 10(8) (range, 8 × 10(8) -36.6 × 10(8) ) TNCs. Cell viability was 99.3% (88-100%). The median CD34+ cell content was 4.0 × 10(6) (0.46 × 10(6) -19.38 × 10(6) ). Sixteen units have been released for transplantation, leading to a utilization rate of 3.7%. CBB demands considerable human and financial resources; it is then essential for centers at developing countries to share their experience, results, and databases to increase the probability of finding matching units for their patients. Efforts to create and maintain CBBs allow to offer this therapeutic option at an affordable cost. © 2012 American Association of Blood Banks.

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

    Science.gov (United States)

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

    2012-10-01

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

  14. Factors affecting the labor efficiency of hospital-based blood bank laboratories.

    Science.gov (United States)

    Lam, H C; Kominski, G F; Petz, L D; Sofaer, S

    1994-09-01

    A variety of financing mechanisms and managerial innovations have been developed in the past decade to control hospital costs. Some evidence suggests that those changes have not produced substantial improvements in labor efficiency among employees in the hospital's technical level, such as in the blood bank laboratories. This study measured labor efficiency in 40 hospital-based blood bank laboratories in Southern California during the year from July 1989 to June 1990 and explored the impact of financial, managerial, and operational factors on labor efficiency. With standardized output measures used in all blood bank laboratories, a wide variation of labor efficiency was found. Multivariate analyses indicate that the labor efficiency of blood bank employees was not influenced by organizational financial incentives, but was affected by the managerial styles of blood bank managers. Interpretation of the findings suggests that labor efficiency is affected by operational designs intended to improve responses to variable workloads and reduce slack time.

  15. Quality indicators for discarding blood in the National Blood Center, Kuala Lumpur

    Directory of Open Access Journals (Sweden)

    Mohammed Morish

    2012-01-01

    Full Text Available Background and Objective: The implementation of quality system and continuous evaluation of all activities of the Blood Transfusion Services (BTS can help to achieve the maximum quantity and quality of safe blood. Optimizing blood collection and processing would reduce the rate of discard and improve the efficiency of the BTS. The objective of this study is to determine the rate of discard of blood and blood component and identify its reasons at the National Blood Centre (NBC, Kuala Lumpur, during the year of 2007 in order to introduce appropriate intervention. Study Designs and Methods: Data on the number of discarded whole blood units and its components, reasons for discard, and the number of blood components processed as well as the number of collected blood units were obtained from the Blood Bank Information System - NBC database. These were analyzed. Results: The total number of blood units collected in 2007 was 171169 from which 390636 units of components were prepared. The total number of discarded whole blood units and its components was 8968 (2.3%. Platelet concentrate recorded the highest of discard at 6% (3909 followed by whole blood at 3.7% (647, fresh frozen plasma (FFP at 2.5% (2839, and cryoprecipitate at 2% (620. The rate of discarded packed red blood cells RBCs, plasma aphaeresis, and PLT aphaeresis was less than 1% at 0.6% (902, 0.6% (37, and 0.29% (14, respectively. RBC contamination of PLT and plasma were the major cause of discard at 40% (3558. Other causes include leakage (26% - 2306, lipemia (25% - 2208, and underweight (4% - 353. Conclusion: Good donor selection, training and evaluation of the staff, as well as implementation of automation will help to improve processes and output of BTS. This would reduce discard of blood components and wastage caused by non conformance.

  16. Patient blood management knowledge and practice among clinicians from seven European university hospitals

    DEFF Research Database (Denmark)

    Manzini, P. M.; Dall'Omo, A. M.; D'Antico, S.

    2018-01-01

    Background and Objectives: The aim of this survey was to evaluate the knowledge about Patient Blood Management (PBM) principles and practices amongst clinicians working in seven European hospitals participating in a European Blood Alliance (EBA) project. Materials and Methods: A web...

  17. Blood Transfusion During Total Ankle Arthroplasty Is Associated With Increased In-Hospital Complications and Costs.

    Science.gov (United States)

    Ewing, Michael A; Huntley, Samuel R; Baker, Dustin K; Smith, Kenneth S; Hudson, Parke W; McGwin, Gerald; Ponce, Brent A; Johnson, Michael D

    2018-04-01

    Total ankle arthroplasty (TAA) is an increasingly used, effective treatment for end-stage ankle arthritis. Although numerous studies have associated blood transfusion with complications following hip and knee arthroplasty, its effects following TAA are largely unknown. This study uses data from a large, nationally representative database to estimate the association between blood transfusion and inpatient complications and hospital costs following TAA. Using the Nationwide Inpatient Sample (NIS) database from 2004 to 2014, 25 412 patients who underwent TAA were identified, with 286 (1.1%) receiving a blood transfusion. Univariate analysis assessed patient and hospital factors associated with blood transfusion following TAA. Patients requiring blood transfusion were more likely to be female, African American, Medicare recipients, and treated in nonteaching hospitals. Average length of stay for patients following transfusion was 3.0 days longer, while average inpatient cost was increased by approximately 50%. Patients who received blood transfusion were significantly more likely to suffer from congestive heart failure, peripheral vascular disease, hypothyroidism, coagulation disorder, or anemia. Acute renal failure was significantly more common among patients receiving blood transfusion ( P < .001). Blood transfusions following TAA are infrequent and are associated with multiple medical comorbidities, increased complications, longer hospital stays, and increased overall cost. Level III: Retrospective, comparative study.

  18. Bedside practice of blood transfusion in a large teaching hospital in Uganda : an observational study

    NARCIS (Netherlands)

    de Graaf, J D; Kajja, I; Bimenya, G S; Postma, Maarten; Smit Sibinga, C.Th.

    BACKGROUND: Adverse transfusion reactions can cause morbidity and death to patients who receive a blood transfusion. Blood transfusion practice in Mulago Hospital, Kampala, Uganda is analyzed to see if and when these practices play a role in the morbidity and mortality of patients. MATERIALS AND

  19. Frequency and antibiotic resistance patterns of isolated bacteria from positive blood culture of hospitalized patients

    Directory of Open Access Journals (Sweden)

    Azadeh Vahedi

    2018-03-01

    Conclusion: The most prevalent bacterial isolate among the blood cultures of patients was Pseudomonas. The patients more than 50 years were more susceptible to blood stream infections. The most bacteria were isolated from the internal medicine department of hospital. The antibiotic resistance was also increasing especially in Acinetobacter, Staphylococcus coagulase negative, Escherichia coil and Klebsiella

  20. Adverse reactions to blood donation: A descriptive study of 3520 blood donors in a Nigerian tertiary hospital

    Directory of Open Access Journals (Sweden)

    C Aneke John

    2017-01-01

    Full Text Available Background: The occurrence of adverse reactions to blood donation significantly hampers donor retention and negatively impacts on the universal availability of adequate numbers of blood donor units. Objective: To analyze the spectrum and prevalence of adverse reactions in blood donors in a tertiary hospital-based blood bank in Nigeria. Subjects and Methods: The details of 3520 blood donors who presented for donation over a 12 months period were retrieved from the departmental archives for analysis. These included sociodemographic information, type of donor, type and frequency of adverse reactions to blood donation. Data were analyzed using the Statistical Package for Social Sciences version 20.0 (SPSS Inc., Chicago, IL, USA computer software. Descriptive and inferential statistics were employed to represent the distribution of donor characteristics (as percentages and compare reaction rates by gender and severity, respectively. Results: The prevalence of adverse reactions to blood donation was (56/3520 1.60%; this occurred more frequently in male and family replacement donors (55.35% and 100.0%, respectively. The spectrum of donor adverse reactions included anxiety 25 (44.64%, generalized body weakness 11 (19.64%, hematoma 10 (17.86%, fainting 5 (8.93%, and vomiting 5 (8.93%. Vasovagal reactions were the most frequent adverse reaction encountered among the donors (46/56; 82.14%. Conclusion: Vasovagal reactions are common adverse phenomena in our blood donor set; this has implications on transfusion safety and blood donor retention.

  1. Perioperative allogenic blood transfusion is a poor prognostic factor after hepatocellular carcinoma surgery: a multi-center analysis.

    Science.gov (United States)

    Wada, Hiroshi; Eguchi, Hidetoshi; Nagano, Hiroaki; Kubo, Shoji; Nakai, Takuya; Kaibori, Masaki; Hayashi, Michihiro; Takemura, Shigekazu; Tanaka, Shogo; Nakata, Yasuyuki; Matsui, Kosuke; Ishizaki, Morihiko; Hirokawa, Fumitoshi; Komeda, Koji; Uchiyama, Kazuhisa; Kon, Masanori; Doki, Yuichiro; Mori, Masaki

    2018-01-01

    The influence of allogenic blood transfusion on the postoperative outcomes of hepatocellular carcinoma (HCC) surgery remains controversial. This study aims to clarify the clinical impacts of perioperative allogenic blood transfusion on liver resection outcome in HCC patients. We analyzed data collected over 5 years for 642 patients who underwent hepatectomy for HCC at one of the five university hospitals. We investigated the impact of allogenic blood transfusion on postoperative outcome after surgery in all patients and in 74 matched pairs, using a propensity score. Of the 642 patients, 198 (30.8%) received perioperative allogenic blood transfusion (AT group) and 444 (69.2%) did not (non-AT group). Overall survival was lower in the AT group than in the non-AT group in univariate (P blood transfusion was found to be a poor prognostic factor for HCC patients. In this multi-center study, perioperative blood transfusion was an independent factor for poor prognosis after curative surgery for primary HCC in the patient group and in pairs matched by propensity scores.

  2. Ethico-legal aspects of hospital-based blood transfusion practice; implications of professional negligence to medical practitioners: a review

    OpenAIRE

    Orkuma J.A; Ayia O.N.

    2014-01-01

    Background: Blood transfusion is predominantly a hospital-based practice in many resourceconstrained economies like Nigeria, wherein the sourcing, storage, processing and clinical use of blood and blood products resides in the often financial and manpower constrained hospitals. Aim: To identify the ethical and legal issues related to hospital-based blood transfusion practice for medical practitioner. Methods: Relevant articles retrieved via PubMed/MEDLINE and Google scholar search...

  3. Ambulatory surgery center and general hospital competition: entry decisions and strategic choices.

    Science.gov (United States)

    Al-Amin, Mona; Housman, Michael

    2012-01-01

    General hospitals are consistently under pressure to control cost and improve quality. In addition to mounting payers' demands, hospitals operate under evolving market conditions that might threaten their survival. While hospitals traditionally were concerned mainly with competition from other hospitals, today's reimbursement schemes and entrepreneurial activities encouraged the proliferation of outpatient facilities such as ambulatory surgery centers (ASCs) that can jeopardize hospitals' survival. The purpose of this article was to examine the relationship between ASCs and general hospitals. More specifically, we apply the niche overlap theory to study the impact that competition between ASCs and general hospitals has on the survival chances of both of these organizational populations. Our analysis examined interpopulation competition in models of organizational mortality and market demand. We utilized Cox proportional hazard models to evaluate the impact of competition from each on ASC and hospital exit while controlling for market factors. We relied on two data sets collected and developed by Florida's Agency for Health Care Administration: outpatient facility licensure data and inpatient and outpatient surgical procedure data. Although ASCs do tend to exit markets in which there are high levels of ASC competition, we found no evidence to suggest that ASC exit rates are affected by hospital density. On the other hand, hospitals not only tend to exit markets with high levels of hospital competition but also experience high exit rates in markets with high ASC density. The implications from our study differ for ASCs and hospitals. When making decisions about market entry, ASCs should choose their markets according to the following: demand for outpatient surgery, number of physicians who would practice in the surgery center, and the number of surgery centers that already exist in the market. Hospitals, on the other hand, should account for competition from ASCs

  4. Comparison of poisonings managed at military and Veterans Administration hospitals reported to Texas poison centers.

    Science.gov (United States)

    Forrester, M B

    2017-01-01

    There is little information on poisonings managed at military and Veterans Administration (VA) hospitals. This investigation described and compared poisonings reported to Texas poison centers that were managed at military and VA hospitals. Retrospective analysis of poison centre data. Cases were poisonings among patients aged 18 years or more reported to Texas poison centers during 2000-2015 where management occurred at a military or VA hospital. The distribution of exposures for various demographic and clinical factors was determined for military and veterans hospitals and comparisons were made between the two groups. There were 4353 and 1676 poisonings managed at military and VA hospitals, resepctively. Males accounted for 50.5% of the military hospital patients and 84.9% of the VA hospital patients. The mean age for military hospital patients was 31 years and for VA hospital patients was 50 years. The proportion of poisonings managed at military hospitals and VA hospitals, respectively, were intentional (70.0% vs 64.1%), particularly suspected attempted suicide (57.3% vs 47.7%), and unintentional (25.0% vs 30.5%). More than one substance was reported in 37.7% of military and 33.2% of VA hospital poisonings. The most commonly reported substance categories for poisonings managed at military and VA hospitals, respectively, were analgesics (28.4% vs 19.7%), sedatives/hypnotics/antipsychotics (24.7% vs 23.4%), antidepressants (18.7% vs 19.7%) and alcohol (11.3% vs 10.6%). A number of differences were observed between poisonings managed at military and VA hospitals. These differing patterns of poisonings may need to be taken into account in the education, prevention and treatment of poisonings at these hospitals and among the populations they serve. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  5. [Investigation on current situation of malaria blood examinations in township-level hospitals of Nantong City].

    Science.gov (United States)

    Gui-Sheng, Ding; Cai-Qun, Cao; Ping, Miao; Mei-Fang, Gu; Xiao-Bin, Cao

    2016-11-18

    To understand the quality of malaria blood examinations in township-level hospitals, so as to provide the evidence for continuing the malaria blood examinations in the stage of post-malaria elimination. A total of 64 township hospitals were investigated and 640 negative malaria blood slides were scored individually according to 10 indicators in "Malaria Elimination Technical Scheme" in 2013 and 2014. The single and multiple indicators were calculated, and the work of blood examinations and situation of technicians were investigated. The data of malaria blood examinations and patient discovery in township hospitals of Nantong City were collected and analyzed during the period of 2011-2014. For the single indicator, 29.5% of the thick blood films did not reach the standard, and 35.8% of thin blood films did not reach the standard. For the multiple indicators, blood slides with more than 4 indicators below the standard (poor quality) accounted for 32.5%. From malaria blood examinations and malaria situation, the number of slides was 194 635 during the period of 2011-2014, and there were no local vivax malaria casesin 4 consecutive years from 2011 to 2014, and local malaria has been effectively controlled in Nantong City. For health facilities where malaria patients initially presented, the township and village level accounted for 16.3%, and county and higher level accounted for 83.7%. The quality of malaria blood examinations in township level hospitals of Nantong City is not high and the microscopic examination has a relatively low efficiency in the discovery of malaria cases. A new model for malaria blood examinations needs to be further explored.

  6. Hospital CIO Explains Blockchain Potential: An Interview with Beth Israel Deaconess Medical Center's John Halamka.

    Science.gov (United States)

    Mertz, Leslie

    2018-01-01

    Work is already underway to bring blockchain technology to the healthcare industry, and hospital administrators are trying to figure out what it can do for them, their clinicians, and their patients. That includes administrators at Beth Israel Deaconess Medical Center, a leading academic medical center located in Boston.

  7. Conception of a computer for the nuclear medical department of the Augsburg hospital center

    International Nuclear Information System (INIS)

    Graf, G.; Heidenreich, P.

    1984-01-01

    A computer system based on the Siemens R30 process computer has been employed at the Institute of Nuclear Medicine of the Augsburg Hospital Center since early 1981. This system, including the development and testing of organ-specific evaluation programs, was used as a basis for the conception of the new computer system for the department of nuclear medicine of the Augsburg Hospital Center. The computer system was extended and installed according to this conception when the new 1400-bed hospital was opened in the 3rd phase of construction in autumn 1982. (orig.) [de

  8. Hospital Blood Transfusion Patterns During Major Noncardiac Surgery and Surgical Mortality.

    Science.gov (United States)

    Chen, Alicia; Trivedi, Amal N; Jiang, Lan; Vezeridis, Michael; Henderson, William G; Wu, Wen-Chih

    2015-08-01

    We retrospectively examined intraoperative blood transfusion patterns at US veteran's hospitals through description of national patterns of intraoperative blood transfusion by indication for transfusion in the elderly; assessment of temporal trends in the use of intraoperative blood transfusion; and relationship of institutional use of intraoperative blood transfusion to hospital 30-day risk-adjusted postoperative mortality rates.Limited data exist on the pattern of intraoperative blood transfusion by indication for transfusion at the hospital level, and the relationship between intraoperative transfusion rates and institutional surgical outcomes.Using the Department of Veterans Affairs Surgical Quality Improvement Program database, we assigned 424,015 major noncardiac operations among elderly patients (≥65 years) in 117 veteran's hospitals, from 1997 to 2009, into groups based on indication for intraoperative blood transfusion according to literature and clinical guidelines. We then examined institutional variations and temporal trends in surgical blood use based on these indications, and the relationship between these institutional patterns of transfusion and 30-day postoperative mortality.Intraoperative transfusion occurred in 38,056/424,015 operations (9.0%). Among the 64,390 operations with an indication for transfusion, there was wide variation (median: 49.9%, range: 8.7%-76.2%) in hospital transfusion rates, a yearly decline in transfusion rates (average 1.0%/y), and an inverse relationship between hospital intraoperative transfusion rates and hospital 30-day risk-adjusted mortality (adjusted mortality of 9.8 ± 2.8% vs 8.3 ± 2.1% for lowest and highest tertiles of hospital transfusion rates, respectively, P = 0.02). In contrast, for the 225,782 operations with no indication for transfusion, there was little variation in hospital transfusion rates (median 0.7%, range: 0%-3.4%), no meaningful temporal change in transfusion (average 0.0%/y), and

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

    DEFF Research Database (Denmark)

    Mosha, Dominic; Poulsen, Anja; Reyburn, Hugh

    2009-01-01

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

  10. Bedside practice of blood transfusion in a large teaching hospital in Uganda: An observational study

    Directory of Open Access Journals (Sweden)

    de Graaf J

    2009-01-01

    Full Text Available Background: Adverse transfusion reactions can cause morbidity and death to patients who receive a blood transfusion. Blood transfusion practice in Mulago Hospital, Kampala, Uganda is analyzed to see if and when these practices play a role in the morbidity and mortality of patients. Materials and Methods: An observational study on three wards of Mulago Hospital. Physicians, paramedics, nurses, medical students and nurse students were observed using two questionnaires. For comparison, a limited observational study was performed in the University Medical Centre Groningen (UMCG in Groningen, The Netherlands. Results: In Mulago Hospital guidelines for blood transfusion practice were not easily available. Medical staff members work on individual professional levels. Students perform poorly due to inconsistency in their supervision. Documentation of blood transfusion in patient files is scarce. There is no immediate bedside observation, so transfusion reactions and obstructions in the blood transfusion flow are not observed. Conclusion: The poor blood transfusion practice is likely to play a role in the morbidity and mortality of patients who receive a blood transfusion. There is a need for a blood transfusion policy and current practical guidelines.

  11. Geriatric resources in acute care hospitals and trauma centers: a scarce commodity.

    Science.gov (United States)

    Maxwell, Cathy A; Mion, Lorraine C; Minnick, Ann

    2013-12-01

    The number of older adults admitted to acute care hospitals with traumatic injury is rising. The purpose of this study was to examine the location of five prominent geriatric resource programs in U.S. acute care hospitals and trauma centers (N = 4,865). As of 2010, 5.8% of all U.S. hospitals had at least one of these programs. Only 8.8% of trauma centers were served by at least one program; the majorities were in level I trauma centers. Slow adoption of geriatric resource programs in hospitals may be due to lack of champions who will advocate for these programs, lack of evidence of their impact on outcomes, or lack of a business plan to support adoption. Future studies should focus on the benefits of geriatric resource programs from patients' perspectives, as well as from business case and outcomes perspectives. Copyright 2013, SLACK Incorporated.

  12. Activity-based costs of blood transfusions in surgical patients at four hospitals.

    Science.gov (United States)

    Shander, Aryeh; Hofmann, Axel; Ozawa, Sherri; Theusinger, Oliver M; Gombotz, Hans; Spahn, Donat R

    2010-04-01

    Blood utilization has long been suspected to consume more health care resources than previously reported. Incomplete accounting for blood costs has the potential to misdirect programmatic decision making by health care systems. Determining the cost of supplying patients with blood transfusions requires an in-depth examination of the complex array of activities surrounding the decision to transfuse. To accurately determine the cost of blood in a surgical population from a health system perspective, an activity-based costing (ABC) model was constructed. Tasks and resource consumption (materials, labor, third-party services, capital) related to blood administration were identified prospectively at two US and two European hospitals. Process frequency (i.e., usage) data were captured retrospectively from each hospital and used to populate the ABC model. All major process steps, staff, and consumables to provide red blood cell (RBC) transfusions to surgical patients, including usage frequencies, and direct and indirect overhead costs contributed to per-RBC-unit costs between $522 and $1183 (mean, $761 +/- $294). These exceed previously reported estimates and were 3.2- to 4.8-fold higher than blood product acquisition costs. Annual expenditures on blood and transfusion-related activities, limited to surgical patients, ranged from $1.62 to $6.03 million per hospital and were largely related to the transfusion rate. Applicable to various hospital practices, the ABC model confirms that blood costs have been underestimated and that they are geographically variable and identifies opportunities for cost containment. Studies to determine whether more stringent control of blood utilization improves health care utilization and quality, and further reduces costs, are warranted.

  13. Improving hospital weekend handover: a user-centered, standardised approach.

    Science.gov (United States)

    Mehra, Avi; Henein, Christin

    2014-01-01

    Clinical Handover remains one of the most perilous procedures in medicine (1). Weekend handover has emerged as a key area of concern with high variability in handover processes across hospitals (1,2,4, 5-10). Studying weekend handover processes within medicine at an acute teaching hospital revealed huge variability in documented content and structure. A total of 12 different pro formas were in use by the medical day-team to handover to the weekend team on-call. A Likert-survey of doctors revealed 93% felt the current handover system needed improvement with 71% stating that it did not ensure patient safety (Chi-squared, p-value RCP) guidelines (2), with direct end-user input. Results following implementation revealed a considerable improvement in documented ceiling of care, urgency of task and team member assignment with 100% uptake of the new proforma at both 4-week and 6-month post-implementation analyses. 88% of doctors surveyed perceived that the new proforma improved patient safety (p<0.01, n=25), with 62% highlighting that it allowed doctors to work more efficiently. Results also revealed that 44% felt further improvements were needed and highlighted electronic solutions and handover training as main priorities. Handover briefing was subsequently incorporated into junior doctor induction and education modules delivered, with good feedback. Following collaboration with key stakeholders and with end-user input, integrated electronic handover software was designed and funding secured. The software is currently under final development. Introducing a standardized handover proforma can be an effective initial step in improving weekend handover. Handover education and end-user involvement are key in improving the process. Electronic handover solutions have been shown to significantly increase the quality of handover and are worth considering (9, 10).

  14. Quality of Care of Hospitalized Infective Endocarditis Patients: Report from a Tertiary Medical Center.

    Science.gov (United States)

    Kashef, Mohammad Amin; Friderici, Jennifer; Hernandez-Montfort, Jaime; Atreya, Auras R; Lindenauer, Peter; Lagu, Tara

    2017-06-01

    There have been no recent studies describing the management and outcomes of patients with infective endocarditis (IE). We conducted a retrospective cohort study of adult patients admitted to a tertiary medical center from 2007 to 2011 with a Duke criteria consistent discharge diagnosis of IE. We examined concordance with guideline recommendations. Outcomes included embolic events, inhospital and 1-year mortality, length of stay (LOS) and cardiac surgery. We used descriptive statistics to describe the cohort and Fisher exact and unpaired t tests to compare native valve endocarditis (NVE) with prosthetic valve endocarditis (PVE). Of 170 patients, definite IE was present in 135 (79.4%) and possible IE in 35 (20.6%); 74.7% had NVE, and 25.3% had PVE. Mean ± standard deviation age was 60.0 ± 17.9 years. Comparing PVE to NVE, patients with PVE were less likely to have embolic events (14.0% vs. 32.3%; P = 0.03), had shorter LOS (median 12.0 days vs. 14.0 days; P = 0.047), but they did not show a statistically significant difference in inhospital mortality (20.9% vs. 12.6%; P = 0.21). Of 170, patients 27.6% (n = 47) underwent valve surgery. Most patients received timely blood cultures and antibiotics. Guideline-recommended consults were underused, with 86.5%, 54.1%, and 47.1% of patients receiving infectious disease, cardiac surgery, and cardiology consultation, respectively. As the number of consultations increased (from 0 to 3), we observed a nonsignificant trend toward reduction in 6-month readmission and 12-month mortality. IE remains a disease with significant morbidity and mortality. There are gaps in the care of IE patients, most notably underuse of specialty consultation. Journal of Hospital Medicine 2017;12:414-420. © 2017 Society of Hospital Medicine

  15. Transfusion transmissible infections among healthy blood donors at blood bank from children's hospital and institute of child health lahore

    International Nuclear Information System (INIS)

    Zameer, M.; Shahzad, F.; Khan, F.S.; Farooq, M.; Ali, H.; Saeed, U.

    2017-01-01

    Objective: To determine the frequency of HIV, HBV, HCV, syphilis and malaria in blood donors at Children Hospital and Institute of Child Health (ICH), Lahore and compare with other local and international published data. Study Design: Descriptive study. Place and Duration of Study: This was conducted at the blood bank of Children's Hospital and ICH, Lahore from October 2015 to February 2016. Patient and Methods: All adult male blood donors who had donated blood during above mentioned period, between 18 to 55 years of age were included in this study. Each and every donor was subjected to a predetermined, prepared questionnaire to find out their eligibility for donation. All blood donors' serum samples were screened for HBsAg, Anti-HCV, syphilis, HIV and malaria by immuno chromatography technique according to manufacturer instruction. Results: Statistical analysis showed that out of 10,048 blood donors, 7.94 percent (n=798) were infected with any one of the above mentioned diseases and 92.05 percent (n=9,250) had no infection. The overall frequency of HBsAg, HCV, HIV, syphilis and malaria were found to be 1.59 percent, 3.75 percent, 0.11 percent, 2.08 percent and 0.39 percent respectively. The co-infections of HCV + Syphilis, HBsAg + HCV, HBsAg + Syphilis, HCV + malarial parasite (M.P) and HBsAg + HIV + syphilis was 0.12 percent, 0.11 percent, 0.01 percent and 0.0099 percent respectively. Conclusion: There is a decreasing trend of HBsAg, HCV infections but increasing trend of HIV and syphilis infections in blood donors that is an alarming situation. (author)

  16. Risks Associated with Fresh Whole Blood and Red Blood Cell Transfusions in a Combat Support Hospital

    National Research Council Canada - National Science Library

    Spinella, Philip C; Perkins, Jeremy G; Grathwohl, Kurt W; Repine, Thomas; Beekley, Alec C; Sebesta, James; Jenkins, Donald; Azarow, Kenneth; Holcomb, John B

    2007-01-01

    .... Between April 2004 and December 2004, FWB was prescreened only at one combat support hospital for human immunodeficiency virus, hepatitis C virus, and hepatitis B surface antigen before transfusion...

  17. Internal quality control of blood products: An experience from a tertiary care hospital blood bank from Southern Pakistan.

    Science.gov (United States)

    Sultan, Sadia; Zaheer, Hasan Abbas; Waheed, Usman; Baig, Mohammad Amjad; Rehan, Asma; Irfan, Syed Mohammed

    2018-01-01

    Internal quality control (IQC) is the backbone of quality assurance program. In blood banking, the quality control of blood products ensures the timely availability of a blood component of high quality with maximum efficacy and minimal risk to potential recipients. The main objective of this study is to analyze the IQC of blood products as an indicator of our blood bank performance. An observational cross-sectional study was conducted at the blood bank of Liaquat National Hospital and Medical College, from January 2014 to December 2015. A total of 100 units of each blood components were arbitrarily chosen during the study. Packed red cell units were evaluated for hematocrit (HCT); random platelet concentrates were evaluated for pH, yield, and culture; fresh frozen plasma (FFP) and cryoprecipitate (CP) were evaluated for unit volume, factor VIII, and fibrinogen concentrations. A total of 400 units were tested for IQC. The mean HCT of packed red cells was 69.5 ± 7.24, and in 98% units, it met the standard (<80% of HCT). The mean platelet yield was 8.8 ± 3.40 × 10 9 /L and pH was ≥6.2 in 98% bags; cultures were negative in 97% of units tested. Mean factor VIII and fibrinogen levels were found to be 84.24 ± 15.01 and 247.17 ± 49.69 for FFP, respectively. For CP, mean factor VIII and fibrinogen level were found to be 178.75 ± 86.30 and 420.7 ± 75.32, respectively. The IQC of blood products at our blood bank is in overall compliance and met recommended international standards. Implementation of standard operating procedures, accomplishment of standard guidelines, proper documentation with regular audit, and staff competencies can improve the quality performance of the transfusion services.

  18. Investing in CenteringPregnancy™ Group Prenatal Care Reduces Newborn Hospitalization Costs.

    Science.gov (United States)

    Crockett, Amy; Heberlein, Emily C; Glasscock, Leah; Covington-Kolb, Sarah; Shea, Karen; Khan, Imtiaz A

    CenteringPregnancy™ group prenatal care is an innovative model with promising evidence of reducing preterm birth. The outpatient costs of offering CenteringPregnancy pose barriers to model adoption. Enhanced provider reimbursement for group prenatal care may improve birth outcomes and generate newborn hospitalization cost savings for insurers. To investigate potential cost savings for investment in CenteringPregnancy, we evaluated the impact on newborn hospital admission costs of a pilot incentive project, where BlueChoice Health Plan South Carolina Medicaid managed care organization paid an obstetric practice offering CenteringPregnancy $175 for each patient who participated in at least five group prenatal care sessions. Using a one to many case-control matching without replacement, each CenteringPregnancy participant was matched retrospectively on propensity score, age, race, and clinical risk factors with five individual care participants. We estimated the odds of newborn hospital admission type (neonatal intensive care unit [NICU] or well-baby admission) for matched CenteringPregnancy and individual care cohorts with four or more visits using multivariate logistic regression. Cost savings were calculated using mean costs per admission type at the delivery hospital. Of the CenteringPregnancy newborns, 3.5% had a NICU admission compared with 12.0% of individual care newborns (p Investing in CenteringPregnancy for 85 patients ($14,875) led to an estimated net savings for the managed care organization of $67,293 in NICU costs. CenteringPregnancy may reduce costs through fewer NICU admissions. Enhanced reimbursement from payers to obstetric practices supporting CenteringPregnancy sustainability may improve birth outcomes and reduce associated NICU costs. Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  19. The prevalence of malaria parasitaemia in blood donors in a Nigerian teaching hospital.

    Science.gov (United States)

    Okocha, E C; Ibeh, C C; Ele, P U; Ibeh, N C

    2005-03-01

    The present study was undertaken to assess the prevalence of malaria parasitaemia among blood donors and to determine the possible risk of transmission of malaria parasite to recipients of blood in Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State. Four hundred and forty-four subjects were selected randomly and EDTA added blood was collected for screening malaria parasites using Giemsa stain. The data were subjected to chi2 analysis. Prevalence of malaria was 30.2% among blood donors and showed bimodal distribution with significant variation in different months. Due to high prevalence of asymptomatic malaria parasitaemia in this region, all blood samples should be screened for malaria parasites (post-donor screening) and administered with a curative dose of antimalarials prophylactically to all patients transfused with malaria parasite positive blood.

  20. Comparison of microbial pattern in early and late onset neonatal sepsis in referral center Haji Adam Malik hospital Medan Indonesia

    Science.gov (United States)

    Hasibuan, B. S.

    2018-03-01

    Neonatal sepsis contributes a significant rate of infants mortality and morbidity. The pathogens are diverse from region to another and change time to time even in the same place. To analyze the microbial pattern in early and late onset neonatal sepsis andthe pattern of antibiotic resistance of the causative microbes at one of referral center hospital in Indonesia, Haji Adam Malik Hospital, a cross-sectional descriptive study was conducted on neonates with sepsis diagnosis proven with positive blood culture within one year period (2015-2016). Among 626 neonates admitted to perinatology unit, the total of 154 neonates was proven to have neonatal sepsis with positive blood culture with the incidence rate 24.6%. Seventy-nine (51.3%) neonates were diagnosed with early onset sepsis while 75 (48,7%) neonates had late-onset sepsis. Klebsiella pneumonia was the most commonly isolated organism in both early and late onset sepsis, encompassing 19.5% of cases. Periodic surveillance of the causative agents of neonatal sepsis is needed to implement the rational, empirical choice of antibiotic prescription while waiting for blood culture result to come out.

  1. Correlation of routine haematological parameters between normal maternal blood and the cord blood of healthy newborns in selected hospitals of karachi

    International Nuclear Information System (INIS)

    Qaiser, D.H.; Ghori, G.M.; Sandila, M.P.; Omair, A.

    2013-01-01

    Objective: To determine any significant correlation between the routine haematological parameters of maternal blood and umbilical cord blood of their respective newborns. Study Design: Cross sectional study. Place and Duration of Study: The study was conducted at four public and private hospitals of Karachi including Sindh Government Qatar Hospital, Sindh Government Hospital, Liaquatabad, Ziauddin University Hospital and Chinniot Maternity and Child Hospital, respectively from July 2006 to April 2008. Methodology: Three milliliters venous blood was collected in EDTA containing tube for complete blood count of mothers before delivery. Five milliliters cord blood was collected from the umbilical cord of the babies immediately after delivery by clamping and cutting the babies' end of the cord. For haematological parameters a standard coultergram was done including haemoglobin, RBCs count, haematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC), white blood cell count, differential leukocyte count and platelet count. Pearson's correlation co-efficient was used to determine an association between the maternal and cord blood parameters. Results: A total of 404 maternal and umbilical cord blood samples were analyzed. All the blood parameters including haemoglobin, RBCs count, HCT, MCV, MCH, white blood cell count, differential leukocyte count and platelet count were found to be high in cord blood as compared to the maternal blood, but they showed a very weak to negligible correlation. Mean Corpuscular Haemoglobin Concentration (MCHC), showed a moderate correlation. Conclusion: Routine haematological parameters of newborns are independent of maternal routine haematological parameters. (author)

  2. Statistical Machines for Trauma Hospital Outcomes Research: Application to the PRospective, Observational, Multi-Center Major Trauma Transfusion (PROMMTT Study.

    Directory of Open Access Journals (Sweden)

    Sara E Moore

    Full Text Available Improving the treatment of trauma, a leading cause of death worldwide, is of great clinical and public health interest. This analysis introduces flexible statistical methods for estimating center-level effects on individual outcomes in the context of highly variable patient populations, such as those of the PRospective, Observational, Multi-center Major Trauma Transfusion study. Ten US level I trauma centers enrolled a total of 1,245 trauma patients who survived at least 30 minutes after admission and received at least one unit of red blood cells. Outcomes included death, multiple organ failure, substantial bleeding, and transfusion of blood products. The centers involved were classified as either large or small-volume based on the number of massive transfusion patients enrolled during the study period. We focused on estimation of parameters inspired by causal inference, specifically estimated impacts on patient outcomes related to the volume of the trauma hospital that treated them. We defined this association as the change in mean outcomes of interest that would be observed if, contrary to fact, subjects from large-volume sites were treated at small-volume sites (the effect of treatment among the treated. We estimated this parameter using three different methods, some of which use data-adaptive machine learning tools to derive the outcome models, minimizing residual confounding by reducing model misspecification. Differences between unadjusted and adjusted estimators sometimes differed dramatically, demonstrating the need to account for differences in patient characteristics in clinic comparisons. In addition, the estimators based on robust adjustment methods showed potential impacts of hospital volume. For instance, we estimated a survival benefit for patients who were treated at large-volume sites, which was not apparent in simpler, unadjusted comparisons. By removing arbitrary modeling decisions from the estimation process and concentrating

  3. Factors Influencing Adoption of Hospital-Acquired Pressure Ulcer Prevention Programs in US Academic Medical Centers.

    Science.gov (United States)

    Padula, William V; Valuck, Robert J; Makic, Mary Beth F; Wald, Heidi L

    2015-01-01

    Recent data show a decrease in hospital-acquired pressure ulcers (PUs) throughout US hospitals; these changes may be associated with increased success in implementing evidence-based practices for PU prevention. The purpose of this study was to identify wound care nurse perceptions of the primary factors that influenced the overall reduction of PUs. Cross-sectional descriptive survey. Surveys were sent to wound care nurses at 98 University HealthSystem Consortium (UHC) hospitals. The UHC consists of more than 120 academic medical centers and affiliated facilities across the United States. Responses solicited from this survey represented a geographically diverse set of hospitals from less than 200 beds to more than 1000 beds. The survey questionnaire used a framework of 7 internal and 5 external influential factors for implementing evidence-based practices for PU prevention. Internal influential factors queried included availability of nurse specialists, high nursing job turnover, high PU rates, and prevention campaigns. External influential factors included data sharing, Medicare nonpayment policy, and applications for Magnet recognition. Hospital-acquired PU prevention experts at UHC hospitals were contacted through the Wound, Ostomy and Continence Nurses Society membership directory to complete the questionnaire. Consenting participants were e-mailed a disclosure and online questionnaire; they were also sent monthly reminders until they either responded to the survey or declined participation. Fifty-five respondents (59% response rate) indicated several internal factors that influenced evidence-based practice: hospital prevention campaigns; the availability of nursing specialists; and the level of preventive knowledge among hospital staff. External influential factors included financial concerns; application for Magnet recognition; data sharing among peer institutions; and regulatory issues. These findings suggest that the Centers for Medicare & Medicaid Services

  4. Estimation of center line and diameter of brain blood vessel using three-dimensional blood vessel matching method with head three-dimensional CTA image

    International Nuclear Information System (INIS)

    Maekawa, Masashi; Shinohara, Toshihiro; Nakayama, Masato; Nakasako, Noboru

    2010-01-01

    To support and automate the brain blood vessel disease diagnosis, a novel method to obtain the center line and the diameter of a blood vessel is proposed with a three-dimensional head computed tomographic angiography (CTA) image. Although the line thinning processing with distance transform or gray information is generally used to obtain the blood vessel center line, this method is not essentially one to obtain the center line and tends to yield extra lines depending on CTA images. In this study, the center line of the blood vessel is obtained by tracing the vessel. The blood vessel is traced by sequentially estimating the center point and direction of the blood vessel. The center point and direction of the blood vessel are estimated by taking the correlation between the blood vessel and a solid model of the blood vessel that is designed by considering noise influence. In addition, the vessel diameter is also estimated by correlating the blood vessel and the blood vessel model of which the diameter is variable. The validity of the proposed method is confirmed by experimentally applied the proposed method to an actual three-dimensional head CTA image. (author)

  5. The Blood Stocks Management Scheme, a partnership venture between the National Blood Service of England and North Wales and participating hospitals for maximizing blood supply chain management.

    Science.gov (United States)

    Chapman, J F; Cook, R

    2002-10-01

    The Blood Stocks Management Scheme (BSMS) has been established as a joint venture between the National Blood Service (NBS) in England and North Wales and participating hospitals to monitor the blood supply chain. Stock and wastage data are submitted to a web-based data-management system, facilitating continuous and complete red cell data collection and 'real time' data extraction. The data-management system enables peer review of performance in respect of stock holding levels and red cell wastage. The BSMS has developed an innovative web-based data-management system that enables data collection and benchmarking of practice, which should drive changes in stock management practice, therefore optimizing the use of donated blood.

  6. Core elements of hospital antibiotic stewardship programs from the Centers for Disease Control and Prevention.

    Science.gov (United States)

    Pollack, Loria A; Srinivasan, Arjun

    2014-10-15

    The proven benefits of antibiotic stewardship programs (ASPs) for optimizing antibiotic use and minimizing adverse events, such as Clostridium difficile and antibiotic resistance, have prompted the Centers for Disease Control and Prevention (CDC) to recommend that all hospitals have an ASP. This article summarizes Core Elements of Hospital Antibiotic Stewardship Programs, a recently released CDC document focused on defining the infrastructure and practices of coordinated multidisciplinary programs to improve antibiotic use and patient care in US hospitals. Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.

  7. Guidelines on product liability for the hospital blood bank. The British Committee for Standards in Haematology.

    Science.gov (United States)

    1990-01-01

    This report aims to clarify the position of the hospital blood bank in the light of product liability legislation contained in the Consumer Protection Act of 1987. Blood has been defined a 'product' under this Act. The potential for the blood bank to be seen in the role of 'supplier', 'keeper' or even 'producer' in the chain of product supply to the patient is explained and advice given on the resulting implications for blood bank practice. It will be necessary to define, adopt and implement standard operating procedures (SOP) for all blood bank activities. Guidance is given on the format, preparation and content of SOPs and specimen examples offered. The fundamental importance of quality assurance is emphasized.

  8. Social Welfare Centers Protect Outpatients with Mood Disorders from Risk of Hospital Admission.

    Directory of Open Access Journals (Sweden)

    Kyu-Tae Han

    Full Text Available South Korea faces difficulties in the management of mental disorders, and those difficulties are expected to gradually worsen. Therefore, we analyzed the relationship between social welfare centers and hospital admission after outpatient treatment for mood disorders.We used data from the National Health Insurance Service National Sample Cohort 2002-2013, which included all medical claims filed for the 50,160 patients who were newly diagnosed with a mood disorder among the 1,025,340 individuals in a nationally representative sample. We performed a logistic regression analysis using generalized estimating equation (GEE models to examine the relationship between social welfare centers and hospital admission after outpatient treatment for mood disorders (ICD-10: F3.There was a 3.9% admission rate among a total of 99,533 person-years. Outpatients who lived in regions with more social welfare centers were less likely to be admitted to a hospital (per increase of five social welfare centers per 100,000 people; OR: 0.958; 95% CI: 0.919-0.999. Social welfare centers had an especially strong protective effect on patients with relatively mild mood disorders and those who were vulnerable to medical expenditures.Considering the protective role of social welfare centers in managing patients with mood disorders, health-policy makers need to consider strategies for activating mental healthcare.

  9. Comparison of tissue plasminogen activator administration management between Telestroke Network hospitals and academic stroke centers: the Telemedical Pilot Project for Integrative Stroke Care in Bavaria/Germany.

    Science.gov (United States)

    Audebert, Heinrich J; Kukla, Christian; Vatankhah, Bijan; Gotzler, Berthold; Schenkel, Johannes; Hofer, Stephan; Fürst, Andrea; Haberl, Roman L

    2006-07-01

    Systemic thrombolysis is the only therapy proven to be effective for ischemic stroke. Telemedicine may help to extend its use. However, concerns remain whether management and safety of tissue plasminogen activator (tPA) administration after telemedical consultation are equivalent in less experienced hospitals compared with tPA administration in academic stroke centers. During the second year of the ongoing Telemedical Pilot Project for Integrative Stroke Care, all systemic thrombolyses in stroke patients of the 12 regional clinics and the 2 stroke centers were recorded prospectively. Patients' demographics, stroke severity (National Institutes of Health Stroke Scale), frequency of administration, time management, protocol violations, and safety were included in the analysis. In 2004, 115 of 4727 stroke or transient ischemic attack patients (2.4%) in the community hospitals and 110 of 1889 patients in the stroke centers (5.8%) received systemic thrombolysis. Prehospital latencies were shorter in the regional hospitals despite longer distances. Door to needle times were shorter in the stroke centers. Although blood pressure was controlled more strictly in community hospitals, symptomatic intracerebral hemorrhage rate (7.8%) was higher (P=0.14) than in stroke centers (2.7%) but still within the range of the National Institute of Neurological Disorders and Stroke trial. In-hospital mortality rate was low in community hospitals (3.5%) and in stroke centers (4.5%). Although with a lower rate of systemic thrombolysis, there was no evidence of lower treatment quality in the remote hospitals. With increasing numbers of tPA administration and growing training effects, the telestroke concept promises better coverage of systemic thrombolysis in nonurban areas.

  10. [Safe and family-centered maternity hospitals: organizational culture of maternity hospitals in the province of Buenos Aires].

    Science.gov (United States)

    Ramos, Silvina; Romero, Mariana; Ortiz, Zulma; Brizuela, Vanessa

    2015-12-01

    In 2010, the Safe and Family-Centered Maternity Hospitals initiative was launched in order to transform large public maternity centers into settings where safe practices are implemented and the rights of women, newborn infants and families are warranted. As a result, the paradigm of perinatal care was modified. This article reports on the findings of organizational culture as a component for the implementation of the initiative. The sample was selected in a non-probabilistic way and was made up of 29 public hospitals located in the province of Buenos Aires that participated in the initiative. During 2011 and 2012, an anonymous, self-administered survey was completed by members of the Department of Neonatology and the Department of Obstetrics. The survey collected information on three dimensions of the organizational culture: organizational environment, safe practices, and facilitation of change. A total of 1828 surveys were collected; 51% of survey respondents stated that there is a need to improve communication by having more meetings, while 60% made a positive assessment of various aspects of leadership. Work overload was described as the main cause of conflicts by 60%. Approximately 25% agreed and showed commitment with the initiative of transforming maternity centers. Adherence to practices was dissimilar depending on the practice, but half of survey respondents reported that there were genuine reasons for change. The assessment of the organizational culture showed that commitment to the Safe and Family-Centered Maternity Hospitals initiative is yet to be consolidated, and the evaluation of leadership is not comprehensive. Work overload and communication failures are the main reasons for conflict.

  11. Pediatric blood transfusion practices at a regional referral hospital in Kenya

    Science.gov (United States)

    Fegan, Greg; Shavadia, Jay; Denje, Douglas; Mandaliya, Kishor; Bates, Imelda; Maitland, Kathryn; Hassall, Oliver W.

    2016-01-01

    BACKGROUND Severe anemia in children is a major public health problem in sub‐Saharan Africa. In this study we describe clinical and operational aspects of blood transfusion in children admitted to Coast Provincial General Hospital, Kenya. STUDY DESIGN AND METHODS This was an observational study where over a 2‐year period, demographic and laboratory data were collected on all children for whom the hospital blood bank received a transfusion request. Clinical data were obtained by retrospective review of case notes over the first year. RESULTS There were 2789 requests for blood for children (median age, 1.8 years; interquartile range [IQR], 0.6‐6.6 years); 70% (1950) of the samples were crossmatched with 85% (1663/1950) issued. Ninety percent (1505/1663) were presumed transfused. Median time from laboratory receipt of request to collection of blood was 3.6 hours (IQR, 1.4‐12.8 hr). Case notes of 590 children were reviewed and median pretransfusion hemoglobin level was 6.0 g/dL (IQR, 4.2‐9.1 g/dL). Ninety‐four percent (186) were transfused “appropriately” while 52% (120) were transfused “inappropriately.” There was significant disagreement between the clinical and laboratory diagnosis of severe anemia (exact McNemar's test; p blood transfusions but only 41% (106) of these had a positive blood film. CONCLUSION In this setting, clinicians often order blood based on the clinical impression of “severe anemia.” This has implications for laboratory workload and the blood supply itself. However, the majority of children with severe anemia were appropriately transfused. The use of antimalarials with blood transfusions irrespective of blood film results is common practice. PMID:27611471

  12. Pediatric blood transfusion practices at a regional referral hospital in Kenya.

    Science.gov (United States)

    Nabwera, Helen M; Fegan, Greg; Shavadia, Jay; Denje, Douglas; Mandaliya, Kishor; Bates, Imelda; Maitland, Kathryn; Hassall, Oliver W

    2016-11-01

    Severe anemia in children is a major public health problem in sub-Saharan Africa. In this study we describe clinical and operational aspects of blood transfusion in children admitted to Coast Provincial General Hospital, Kenya. This was an observational study where over a 2-year period, demographic and laboratory data were collected on all children for whom the hospital blood bank received a transfusion request. Clinical data were obtained by retrospective review of case notes over the first year. There were 2789 requests for blood for children (median age, 1.8 years; interquartile range [IQR], 0.6-6.6 years); 70% (1950) of the samples were crossmatched with 85% (1663/1950) issued. Ninety percent (1505/1663) were presumed transfused. Median time from laboratory receipt of request to collection of blood was 3.6 hours (IQR, 1.4-12.8 hr). Case notes of 590 children were reviewed and median pretransfusion hemoglobin level was 6.0 g/dL (IQR, 4.2-9.1 g/dL). Ninety-four percent (186) were transfused "appropriately" while 52% (120) were transfused "inappropriately." There was significant disagreement between the clinical and laboratory diagnosis of severe anemia (exact McNemar's test; p blood transfusions but only 41% (106) of these had a positive blood film. In this setting, clinicians often order blood based on the clinical impression of "severe anemia." This has implications for laboratory workload and the blood supply itself. However, the majority of children with severe anemia were appropriately transfused. The use of antimalarials with blood transfusions irrespective of blood film results is common practice. © 2016 The Authors. Transfusion published by Wiley Periodicals, Inc. on behalf of AABB.

  13. Hospitalizations for asthma among adults exposed to the September 11, 2001 World Trade Center terrorist attack.

    Science.gov (United States)

    Miller-Archie, Sara A; Jordan, Hannah T; Alper, Howard; Wisnivesky, Juan P; Cone, James E; Friedman, Stephen M; Brackbill, Robert M

    2018-04-01

    We described the patterns of asthma hospitalization among persons exposed to the 2001 World Trade Center (WTC) attacks, and assessed whether 9/11-related exposures or comorbidities, including posttraumatic stress disorder (PTSD) and gastroesophageal reflux symptoms (GERS), were associated with an increased rate of hospitalization. Data for adult enrollees in the WTC Health Registry, a prospective cohort study, with self-reported physician-diagnosed asthma who resided in New York State on 9/11 were linked to administrative hospitalization data to identify asthma hospitalizations during September 11, 2001-December 31, 2010. Multivariable zero-inflated Poisson regression was used to examine associations among 9/11 exposures, comorbid conditions, and asthma hospitalizations. Of 11 471 enrollees with asthma, 406 (3.5%) had ≥1 asthma hospitalization during the study period (721 total hospitalizations). Among enrollees diagnosed before 9/11 (n = 6319), those with PTSD or GERS had over twice the rate of hospitalization (adjusted rate ratio (ARR) = 2.5, 95% CI = 1.4-4.1; ARR = 2.1, 95% CI = 1.3-3.2, respectively) compared to those without. This association was not statistically significant in enrollees diagnosed after 9/11. Compared to higher educational attainment, completing less than college was associated with an increased hospitalization rate among participants with both pre-9/11- and post-9/11-onset asthma (ARR = 1.9, 95% CI = 1.2-2.9; ARR = 2.6, 95% CI = 1.6-4.1, respectively). Sinus symptoms, exposure to the dust cloud, and having been a WTC responder were not associated with asthma hospitalization. Among enrollees with pre-9/11 asthma, comorbid PTSD and GERS were associated with an increase in asthma hospitalizations. Management of these comorbidities may be an important factor in preventing hospitalization.

  14. COMPARISON OF DIFFERENT HELIPORT SOLUTIONS FOR THE CLINICAL HOSPITAL CENTER IN OSIJEK

    Directory of Open Access Journals (Sweden)

    Tatjana Timko

    2017-01-01

    Full Text Available Complexity in takeoff and landing operations of helicopters require careful planning and designing of heliport infrastructure. The world's biggest aviation organization, namely Federal Aviation Administration and International Civil Aviation Organization, published their standards and designing recommendations for heliport designers to implement that are analyzed and compared in this paper. In the Republic of Croatia, helicopters are designed according to the recommendations of National heliport regulations which are based on recommendations of International Civil Aviation Organization (Annex 14. The practical part of the paper deals with the implementation of national heliport standard recommendations in two variants of heliport designs for emergency medical service for the clinical hospital center in Osijek. As a potential location of the new heliport for emergency medical transportation a transit port is analyzed because it is close to the clinical hospital center in Osijek and is well connected with the existing road infrastructure, and it is also possible to make a direct access to the hospital complex from the north side. Two solutions were analyzed and compared upon the criteria of accessibility, security of operations and possibility for instrument flight conditions, size of heliport and necessary areas, costs of building and maintenance and helicopter noise. There is an intention that regional capital cities that have clinical hospital centers need to have infrastructure for emergency helicopter transportation near the hospital.

  15. Positioning academic medical centers and teaching hospitals to thrive in the next decade.

    Science.gov (United States)

    Morris, D E

    1985-06-01

    Market share for academic medical centers and teaching hospitals will decline over the next five years necessitating new strategies to ensure growth and profitability. These types of institutions are, however, in a strong position to compete and gain market share locally by building a defensible competitive advantage. This article offers three avenues for increasing market share: networking, brand name product differentiation, and business diversification.

  16. [ISO 9002 at the Center of Pediatric Intensive Care at the Albert Einstein Israeli Hospital].

    Science.gov (United States)

    Gé Lacerda, D P; Rocha, M L; Santos, R P

    2000-01-01

    This study shows the process of implementation of a quality program in Pediatric Intensive Therapy Center of "Hospital Israelita Albert Einstein" which resulted in the certification of this service for the Standards ISO 9002/94. It points out the nurse's role as a leader in this process.

  17. [Management of Grave's disease in the tropics (experience at Bouffard Army Hospital Center in Djibouti].

    Science.gov (United States)

    Coulet, O; Kraemer, P; Leyral, G; Cloatre, G

    2004-01-01

    Based on their experience in managing Grave's disease at the Bouffard Army Hospital Center within the local health care context in Djibouti, the authors advocate surgery as the first line treatment. Medical and economical factors supporting this preference are discussed so that readers can adapt them to his own local context.

  18. Evaluating organizational change in health care: the patient-centered hospital model.

    Science.gov (United States)

    Fiorio, Carlo V; Gorli, Mara; Verzillo, Stefano

    2018-02-08

    An increasing number of hospitals react to recent demographic, epidemiological and managerial challenges moving from a traditional organizational model to a Patient-Centered (PC) hospital model. Although the theoretical managerial literature on the PC hospital model is vast, quantitative evaluations of the performance of hospitals that moved from the traditional to the PC organizational structure is scarce. However, quantitative analysis of effects of managerial changes is important and can provide additional argument in support of innovation. We take advantage of a quasi-experimental setting and of a unique administrative data set on the population of hospital discharge charts (HDCs) over a period of 9 years of Lombardy, the richest and one of the most populated region of Italy. During this period three important hospitals switched to the PC model in 2010, whereas all the others remained with the functional organizational model. This allowed us to develop a difference-in-difference analysis of some selected measures of efficiency and effectiveness for PC hospitals focusing on the "between-variability" of the 25 major diagnostic categories (MDCs) in each hospital and estimating a difference-in-difference model. We contribute to the literature that addresses the evaluation of healthcare and hospital change by providing a quantitative estimation of efficiency and effectiveness changes following to the implementation of the PC hospital model. Results show that both efficiency and effectiveness have significantly increased in the average MDC of PC hospitals, thus confirming the need for policy makers to invest in new organizational models close to the principles of PC hospital structures. Although an organizational change towards the PC model can be a costly process, implying a rebalancing of responsibilities and power among hospital personnel (e.g. medical and nursing staff), our results suggest that changing towards a PC model can be worthwhile in terms of both

  19. Comparison of CDE data in phacoemulsification between an open hospital-based ambulatory surgical center and a free-standing ambulatory surgical center.

    Science.gov (United States)

    Chen, Ming; Chen, Mindy

    2010-11-12

    Mean CDE (cumulative dissipated energy) values were compared for an open hospital- based surgical center and a free-standing surgical center. The same model of phacoemulsifier (Alcon Infiniti Ozil) was used. Mean CDE values showed that surgeons (individual private practice) at the free-standing surgical center were more efficient than surgeons (individual private practice) at the open hospital-based surgical center (mean CDE at the hospital-based surgical center 18.96 seconds [SD = 12.51]; mean CDE at the free-standing surgical center 13.2 seconds [SD = 9.5]). CDE can be used to monitor the efficiency of a cataract surgeon and surgical center in phacoemulsification. The CDE value may be used by institutions as one of the indicators for quality control and audit in phacoemulsification.

  20. [Optimization of inventory levels in the blood transfusion centers in Morocco].

    Science.gov (United States)

    Bellabdaoui, A; Bennis, I; Saadi, J; Benajiba, M

    2014-03-01

    Improve the flow of quantities of blood products between the different centers to restore the ideal quantities at low cost. The problem addressed in this work concerns the balancing inventory levels between blood transfusion centers in Morocco. This problem is characterized by a number of constraints to be taken into account: safety stock, stock ideal proportional balancing of stocks, etc. An integer linear model has been proposed to determine the optimal allocation between different centers. Two variants are examined; the first which aims to minimize the level of inventory loss, the second is to balance the different levels of stock, so that all centers have a level of surplus stock and/or loss proportional to the ideal stock. Two variants of an integer linear model that determine the optimal allocation between different centers has been proposed and their performance was evaluated by experimental results obtained using a solver commercial. The results of this study allow us to meet the goal of PSL availability of sufficient and subsequently the quality of service required blood transfusion. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  1. Happy crisis tests hospitals' PR plan. Septuplets' arrival swamps Iowa hospitals with national, international media. Blank Children's Hospital, Iowa Methodist Medical Center, Des Moines.

    Science.gov (United States)

    1998-01-01

    The public relations staff believed the birth of healthy septuplets would become a human interest story for local media. But the staff was stunned at the outpouring of international and national media knocking at their front doors. The staff of both Iowa Methodist Medical Center and Blank Children's Hospital in Des Moines, Iowa, organized a communications plan for 14 official press conferences, constant updates to the media and a website to handle ongoing inquiries from the public. As a result, the story of the McCaughey septuplets was shown in more than 10,000 television stories around the world. The hospitals received more than 36,000 magazine and newspaper articles. The public relations staff not only fielded more than 2,000 phone calls in the days following the Nov. 19 birth, but more than 15 major networks parked their vehicles and satellite dishes in front of the hospital.

  2. Trends in Red Blood Cell Transfusion and 30-Day Mortality among Hospitalized Patients

    Science.gov (United States)

    Roubinian, Nareg H; Escobar, Gabriel J; Liu, Vincent; Swain, Bix E; Gardner, Marla N; Kipnis, Patricia; Triulzi, Darrell J; Gottschall, Jerome L; Wu, Yan; Carson, Jeffrey L; Kleinman, Steven H; Murphy, Edward L

    2014-01-01

    Background Blood conservation strategies have been shown to be effective in decreasing red blood cell (RBC) utilization in specific patient groups. However, few data exist describing the extent of RBC transfusion reduction or their impact on transfusion practice and mortality in a diverse inpatient population. Methods We conducted a retrospective cohort study using comprehensive electronic medical record data from 21 medical facilities in Kaiser Permanente Northern California (KPNC). We examined unadjusted and risk-adjusted RBC transfusion and 30-day mortality coincident with implementation of RBC conservation strategies. Findings The inpatient study cohort included 391,958 patients who experienced 685,753 hospitalizations. From 2009 to 2013, the incidence of RBC transfusion decreased from 14.0% to 10.8% of hospitalizations; this change coincided with a decline in pre-transfusion hemoglobin levels from 8.1 to 7.6 g/dL. Decreased RBC utilization affected broad groups of admission diagnoses and was most pronounced in patients with a nadir hemoglobin level between 8 and 9 g/dL (n=73,057; 50.8% to 19.3%). During the study period, the standard deviation of risk adjusted RBC transfusion incidence across hospitals decreased by 44% (p blood conservation strategies, RBC transfusion incidence and pre-transfusion hemoglobin levels decreased broadly across medical and surgical patients. Variation in RBC transfusion incidence across hospitals decreased from 2010 to 2013. Consistent with clinical trial data, more restrictive transfusion practice did not appear to impact 30-day mortality. PMID:25135770

  3. Pattern of Blood Stream Infections within Neonatal Intensive Care Unit, Suez Canal University Hospital, Ismailia, Egypt.

    Science.gov (United States)

    Kishk, Rania Mohammed; Mandour, Mohamed Fouad; Farghaly, Rasha Mohamed; Ibrahim, Ahmed; Nemr, Nader Attia

    2014-01-01

    Introduction. Blood stream infection (BSI) is a common problem of newborn in neonatal intensive care units (NICUs). Monitoring neonatal infections is increasingly regarded as an important contributor to safe and high-quality healthcare. It results in high mortality rate and serious complications. So, our aim was to determine the incidence and the pattern of BSIs in the NICU of Suez Canal University Hospital, Egypt, and to determine its impact on hospitalization, mortality, and morbidity. Methods. This study was a prospective one in which all neonates admitted to the NICUs in Suez Canal University hospital between January, 2013 and June 2013 were enrolled. Blood stream infections were monitored prospectively. The health care associated infection rate, mortality rate, causative organism, and risk factors were studied. Results. A total of 317 neonates were admitted to the NICU with a mortality rate of 36.0%. During this study period, 115/317 (36.3%) developed clinical signs of sepsis and were confirmed as BSIs by blood culture in only 90 neonates with 97 isolates. The total mean length of stay was significantly longer among infected than noninfected neonates (34.5 ± 18.3 and 10.8 ± 9.9 days, resp., P value Suez Canal University Hospital was relatively high with high mortality rate (36.0%).

  4. Changing trends in blood transfusion: an analysis of 244,013 hospitalizations.

    Science.gov (United States)

    Shehata, Nadine; Forster, Alan; Lawrence, Nadine; Rothwell, Deanna M; Fergusson, Dean; Tinmouth, Alan; Wilson, Kumanan

    2014-10-01

    Identifying recipients of blood transfusion and the trends in transfusion are needed to properly identify and target clinical services in need of patient blood management strategies. We determined the proportion of admissions to each clinical service that received blood, the mean number of units utilized, and the 5-year trends in utilization. We used a large administrative database, a repository for three campuses of one university-affiliated hospital, and included all adults that were hospitalized from November 1, 2006, to June 2012. The data were analyzed as the proportion of admissions transfused and the mean number units transfused per admission. Of 244,013 hospitalizations, 38,265 received at least one transfusion (29,165 for red blood cells [RBCs], 6760 for plasma, and 5795 for platelets [PLTs]). Although there has been a gradual decrease in the mean number of RBCs transfused (percent change, -9.8%; p = 0.002), an increase in the proportion of admissions receiving RBCs (17.2% increase, p conservation strategies. © 2014 AABB.

  5. Caesarean delivery-related blood transfusion: correlates in a tertiary hospital in Southwest Nigeria.

    Science.gov (United States)

    Akinlusi, Fatimat M; Rabiu, Kabiru A; Durojaiye, Idayat A; Adewunmi, Adeniyi A; Ottun, Tawaqualit A; Oshodi, Yusuf A

    2018-01-10

    Caesarean delivery carries a risk of major intra-operative blood loss and its performance is often delayed by non-availability of blood and blood products. Unnecessary cross-matching and reservation of blood lead to apparent scarcity in centres with limited supply. This study set out to identify the risk factors for blood transfusion in women who underwent caesarean delivery at a tertiary obstetric unit with a view to ensuring efficient blood utilization. A prospective cohort analysis of 906 women who had caesarean deliveries at the Lagos State University Teaching Hospital, Nigeria between January and December, 2011. A comparison was made between 188 women who underwent blood transfusion and 718 who did not. Data were obtained on a daily basis by investigators from patients, clinical notes and referral letters using structured pre-tested data collecting form. Socio-demographic characteristics; antenatal, perioperative and intraoperative details; blood loss; transfusion; and puerperal observations were recorded. EPI-Info statistical software version 3.5.3 was used for multivariable analysis to determine independent risk factors for blood transfusion. Of the 2134 deliveries during the study period, 906 (42.5%) had caesarean deliveries and of which 188 (20.8%) were transfused. The modal unit of blood transfused was 3 pints (41.3%). The most common indication for caesarean section was cephalo-pelvic disproportion (25.7%).The independent risk factors for blood transfusion at caesarean section were second stage Caesarean Section (aOR = 76.14, 95% CI = 1.25-4622.06, p = 0.04), placenta previa (aOR = 32.57, 95% CI = 2.22-476.26, p = 0.01), placental abruption (aOR = 25.35, 95% CI = 3.06-211.02, p blood transfusion (aOR = 0.24, 95% CI = 0.09-0.61, p = 0.0024). The overall risk of blood transfusion in cesarean delivery is high. Paturients with the second stage Caesarean section, placenta previa, abruptio placentae and

  6. Determinants and time to blood transfusion among thermal burn patients admitted to Mulago Hospital.

    Science.gov (United States)

    Kilyewala, C; Alenyo, R; Ssentongo, R

    2017-07-06

    Blood transfusion, a practice under re-evaluation in general, remains common among thermal burn patients due to the hematological alterations associated with burns that manifest as anemia. Today advocacy is for restrictive blood transfusion taking into account individual patient characteristics. We went out to identify the parameters that may determine transfusion requirement and the time to blood transfusion for thermal burn patients in Mulago Hospital in order to build statistics and a basis to standardize future practice and Hospital protocol. 112 patients with thermal burns were enrolled into a prospective cohort study conducted in the Surgical Unit of the Accidents and Emergency Department and Burns Unit of Mulago Hospital. Relevant data on pre-injury, injury and post-injury factors was collected including relevant laboratory investigations and treatment modalities like surgical intervention. Patients were clinically followed up for a maximum period of 28 days and we identified those that were transfused. 22.3% of patients were transfused. The median time to transfusion was 17 days from time of injury and varied with different patient characteristics. The median pre-transfusion hemoglobin (Hb) level was 8.2 g/dL. Transfusion was significantly related to; admission to the intensive care unit (p = 0.001), a body mass index (BMI) burn surface area (TBSA) >20 (p = 0.049), pre-existing illness (p = 0.046), and white blood cell (WBC) count 12,000/μL (p = 0.05). Pre-existing illnesses, a low BMI, TBSA of >20%, admission to the intensive care unit and abnormalities in the WBC count are useful predictors of blood transfusion among thermal burns patients admitted to Mulago Hospital. The precise time to transfusion from time of burns injury cannot be generalized. With close monitoring of each individual patient lies the appropriateness and timeliness of their management.

  7. Temperature and time stability of whole blood lactate: implications for feasibility of pre-hospital measurement

    Directory of Open Access Journals (Sweden)

    Watkins Timothy R

    2011-05-01

    Full Text Available Abstract Background To determine the time and temperature stability of whole blood lactate using experimental conditions applicable to the out-of-hospital environment. Findings We performed a prospective, clinical laboratory-based study at an academic hospital. Whole blood lactate was obtained by venipuncture from five post-prandial, resting subjects. Blood was stored in lithium heparinized vacutainers in three temperature conditions: 1 room temperature (20°C, 2 wrapped in a portable, instant ice pack (0°C, or 3 wet ice (0°C. Lactate concentrations (mmol/L were measured at 0, 5, 10, 20, and 30 minutes after sampling, and compared using repeated measures analysis of variance. Mean baseline lactate among resting subjects (N = 5 was 1.24 mmol/L (95%CI: 0.49,1.98 mmol/L. After 30 minutes, lactate concentration increased, on average, by 0.08 mmol/L (95%CI: 0.02,0.13 mmol/L, 0.18 mmol/L (95%CI: 0.07,0.28 mmol/L, and 0.36 mmol/L (95%CI: 0.24,0.47 mmol/L when stored in wet ice, ice pack, and room temperature, respectively. The increase in lactate was similar in samples wrapped in portable ice pack or stored in wet ice at all time points (p > 0.05, and met criteria for equivalence at 30 minutes. However, lactate measurements from whole blood stored at room temperature were significantly greater, on average, than wet ice or portable ice pack within five and ten minutes, respectively (p Conclusions Whole blood lactate measurements using samples stored in a portable ice pack are similar to wet ice for up to 30 minutes. These conditions are applicable to the out-of-hospital environment, and should inform future studies of pre-hospital measurement of lactate.

  8. A management plan for hospitals and medical centers facing radiation incidents

    Directory of Open Access Journals (Sweden)

    Fereshteh Davari

    2015-01-01

    Full Text Available Background: Nowadays, application of nuclear technology in different industries has largely expanded worldwide. Proportionately, the risk of nuclear incidents and the resulting injuries have, therefore, increased in recent years. Preparedness is an important part of the crisis management cycle; therefore efficient preplanning seems crucial to any crisis management plan. Equipped with facilities and experienced personnel, hospitals naturally engage with the response to disasters. The main purpose of our study was to present a practical management pattern for hospitals and medical centers in case they encounter a nuclear emergency. Materials and Methods: In this descriptive qualitative study, data were collected through experimental observations, sources like Safety manuals released by the International Atomic Energy Agency and interviews with experts to gather their ideas along with Delphi method for polling, and brainstorming. In addition, the 45 experts were interviewed on three targeted using brainstorming and Delphi method. Results: We finally proposed a management plan along with a set of practicality standards for hospitals and medical centers to optimally respond to nuclear medical emergencies when a radiation incident happens nearby. Conclusion: With respect to the great importance of preparedness against nuclear incidents adoption and regular practice of nuclear crisis management codes for hospitals and medical centers seems quite necessary.

  9. A management plan for hospitals and medical centers facing radiation incidents.

    Science.gov (United States)

    Davari, Fereshteh; Zahed, Arash

    2015-09-01

    Nowadays, application of nuclear technology in different industries has largely expanded worldwide. Proportionately, the risk of nuclear incidents and the resulting injuries have, therefore, increased in recent years. Preparedness is an important part of the crisis management cycle; therefore efficient preplanning seems crucial to any crisis management plan. Equipped with facilities and experienced personnel, hospitals naturally engage with the response to disasters. The main purpose of our study was to present a practical management pattern for hospitals and medical centers in case they encounter a nuclear emergency. In this descriptive qualitative study, data were collected through experimental observations, sources like Safety manuals released by the International Atomic Energy Agency and interviews with experts to gather their ideas along with Delphi method for polling, and brainstorming. In addition, the 45 experts were interviewed on three targeted using brainstorming and Delphi method. We finally proposed a management plan along with a set of practicality standards for hospitals and medical centers to optimally respond to nuclear medical emergencies when a radiation incident happens nearby. With respect to the great importance of preparedness against nuclear incidents adoption and regular practice of nuclear crisis management codes for hospitals and medical centers seems quite necessary.

  10. PACS and its hospital-wide implementation: A case study at the Madigan Army Medical Center

    International Nuclear Information System (INIS)

    Choi, Hyung Sik; Kim, Yong Min; Smith, Donald V.; Bender, Gregory N.

    1993-01-01

    PACS represents the future of radiology in modern hospitals. Workstations and databases can be developed to substantially increase clinician's productivity, improve diagnostic accuracy, and make a large amount of knowledge and patient information available on-line to the physician. Currently, there are several hospitals in the process of implementing a total PACS system. They include Madigan Army Medical Center (Tacoma, Washington), VA Hospital in Baltimore, and Hammersmith Hospital in London (1). In order to provide the radiologist, the clinicians, and other health personnel in Korea with the general concept of PACS and its up-to-date status report, we describe the MDIS system being implemented in MAMC (Madigan Army Medical Center) which is the first hospital-wide large-scale PACS in the world. The major PACS components in MAMC have been installed since March 1992 and the full system implementation will be completed by summer 1993. The goal of the MDIS system in MAMC is to increase to more than 90% filmless by the end of 1993. In this paper, we discuss the introduction and background of PACS and its potential benefits, the current status of PACS installation in MAMC and the future plan, and the flow of image data and text information in MAMC

  11. Clinicians' satisfaction with a hospital blood transfusion service: a marketing analysis of a monopoly supplier.

    Science.gov (United States)

    Pennington, S J; McClelland, D B; Murphy, W G

    1993-12-01

    One of the objectives of the NHS reforms is to improve customer focus within the health service. In a study to assess the quality of customer service provided by the Edinburgh and South East Scotland Blood Transfusion Service a 19 item questionnaire survey of the main clinical users of the service was performed to ascertain their satisfaction, measured on a 5 point anchored scale, with important aspects of the service, including medical consultation, diagnostic services, blood and blood components or products and their delivery, and general satisfaction with the service. Of 122 clinicians in medical and surgical disciplines in five hospitals in Edinburgh, 72 (59%) replied. Fourteen (22%) indicated dissatisfaction with any aspect of the medical consultation service, owing to inadequate follow up of clinical contacts and unsatisfactory routing of incoming calls. Diagnostic services were criticised for the presentation, communication, and interpretation of results. The restricted availability of whole blood, the necessity to order platelets and plasma through the duty blood transfusion service doctor, and the use of a group and screen policy, attracted criticism from a small number of clinicians. Ten of 68 respondents expressed dissatisfaction with delivery of blood and components to the wards and theatres. The findings indicate that the clinicians served by this blood transfusion service are largely satisfied with the service. Changes are being implemented to improve reporting of laboratory results and measures taken to improve liaison with clinicians.

  12. How do I provide leukapheresis products? Blood center experience and evidence for process improvement.

    Science.gov (United States)

    Ginzburg, Yelena; Kessler, Debra; Narici, Manlio; Caltabiano, Melinda; Rebosa, Mark; Strauss, Donna; Shaz, Beth

    2013-10-01

    The past few decades have seen a resurgence of interest in leukapheresis products to improve the survival of infected patients with neutropenia. These products have a short shelf life and require donor stimulation with dexamethasone before collection. Additionally, a system with good communications and logistical support is essential. A recent survey of blood centers in North America revealed that the majority of centers collecting leukapheresis products use steroid-stimulated donors. The survey results suggested that an analysis of the process and potential process improvement would be of interest to the transfusion medicine community. Data from 2008 to 2011 regarding donor selection, donor dexamethasone stimulation, leukapheresis collection, and correlations between potentially pertinent variables for process improvement were analyzed. Results from an analysis of cost are also included. We evaluate 432 leukapheresis donations and demonstrate correlations between 1) pre- and poststimulation white blood cell (WBC) count (pproduct granulocyte yield (pimprovement in granulocyte quality and yield can be accomplished in dexamethasone-stimulated donors, by selecting eligible donors with relatively high normal prestimulation WBC counts and/or previously good responses to dexamethasone, increasing the duration between dexamethasone stimulation and granulocyte collection, and maintaining optimal hematocrit (5%-10%) in granulocyte collections. Because the majority of surveyed blood centers collecting stimulated granulocytes use steroids alone, modifications presented here may prove useful. Further assessment of correlation between granulocyte yield and clinical outcome will await results of additional studies. © 2012 American Association of Blood Banks.

  13. Hospitalization in daily home hemodialysis and matched thrice-weekly in-center hemodialysis patients.

    Science.gov (United States)

    Weinhandl, Eric D; Nieman, Kimberly M; Gilbertson, David T; Collins, Allan J

    2015-01-01

    Cardiovascular disease is a common cause of hospitalization in dialysis patients. Daily hemodialysis improves some parameters of cardiovascular function, but whether it associates with lower hospitalization risk is unclear. Observational cohort study using US Renal Data System data. Medicare-enrolled daily (5 or 6 sessions weekly) home hemodialysis (HHD) patients initiating NxStage System One use from January 1, 2006, through December 31, 2009, and contemporary thrice-weekly in-center hemodialysis patients, matched 5 to 1. Daily HHD or thrice-weekly in-center hemodialysis. All-cause and cause-specific hospital admissions, hospital readmissions, and hospital days assessed from Medicare Part A claims. For 3,480 daily HHD and 17,400 thrice-weekly in-center hemodialysis patients in intention-to-treat analysis, the HR of all-cause admission for daily HHD versus in-center hemodialysis was 1.01 (95%CI, 0.98-1.03). Cause-specific admission HRs were 0.89 (95%CI, 0.86-0.93) for cardiovascular disease, 1.18 (95%CI, 1.13-1.23) for infection, 1.01 (95%CI, 0.93-1.09) for vascular access dysfunction, and 1.02 (95%CI, 0.99-1.06) for other morbidity. Regarding cardiovascular disease, first admission and readmission HRs for daily HHD versus in-center hemodialysis were 0.91 and 0.87, respectively. Regarding infection, first admission and readmission HRs were 1.35 and 1.03, respectively. Protective associations of daily HHD with heart failure and hypertensive disease were most pronounced, as were adverse associations of daily HHD with bacteremia/sepsis, cardiac infection, osteomyelitis, and vascular access infection. Results may be confounded by unmeasured factors, including vascular access type; information about dialysis frequency, duration, and dose was lacking; causes of admission may be misclassified; results may not apply to patients without Medicare coverage. All-cause hospitalization risk was similar in daily HHD and thrice-weekly in-center hemodialysis patients. However

  14. Development of a Hospital-based Massage Therapy Course at an Academic Medical Center.

    Science.gov (United States)

    Dion, Liza J; Cutshall, Susanne M; Rodgers, Nancy J; Hauschulz, Jennifer L; Dreyer, Nikol E; Thomley, Barbara S; Bauer, Brent

    2015-03-01

    Massage therapy is offered increasingly in US medical facilities. Although the United States has many massage schools, their education differs, along with licensure and standards. As massage therapy in hospitals expands and proves its value, massage therapists need increased training and skills in working with patients who have various complex medical concerns, to provide safe and effective treatment. These services for hospitalized patients can impact patient experience substantially and provide additional treatment options for pain and anxiety, among other symptoms. The present article summarizes the initial development and description of a hospital-based massage therapy course at a Midwest medical center. A hospital-based massage therapy course was developed on the basis of clinical experience and knowledge from massage therapists working in the complex medical environment. This massage therapy course had three components in its educational experience: online learning, classroom study, and a 25-hr shadowing experience. The in-classroom study portion included an entire day in the simulation center. The hospital-based massage therapy course addressed the educational needs of therapists transitioning to work with interdisciplinary medical teams and with patients who have complicated medical conditions. Feedback from students in the course indicated key learning opportunities and additional content that are needed to address the knowledge and skills necessary when providing massage therapy in a complex medical environment. The complexity of care in medical settings is increasing while the length of hospital stay is decreasing. For this reason, massage provided in the hospital requires more specialized training to work in these environments. This course provides an example initial step in how to address some of the educational needs of therapists who are transitioning to working in the complex medical environment.

  15. Quantitative evaluation of plasma after methylene blue and white light treatment in four Chinese blood centers.

    Science.gov (United States)

    Chunhui, Yang; Guohui, Bian; Hong, Yang; Xiaopu, Xiao; Zherong, Bai; Mingyuan, Wang; Xinsheng, Zhang; Juanjuan, Wang; Changqing, Li; Wuping, Li

    2013-12-01

    Pathogen reduction technology is an important process in the blood safety system, including solvent/detergent treatment, filtration and methylene blue-photochemical technology (MB-PCT). To investigate the quality of MB-PCT-treated plasma, plasma samples from four Chinese blood centers were analyzed over 12 months of storage to determine the recovery of activities and levels of various plasma proteins. Ten plasma units each from the Suzhou, Yancheng, Chongqing and Shandong blood centers were divided into two aliquots. One was subjected to treatment with one of two methylene blue-photochemical technology instruments and the other was used as control. The treated and untreated sample pairs were stored at -30°C. The recovery rates of coagulation factors, inhibitor proteins, total protein, immunoglobulins, and complement proteins were measured at different time points after storage. The mean recovery of most proteins exceeded 80% after MB treatment. The exceptions were factor XI and fibrinogen, of which only 71.3-74% and 69.0-92.3% were retained during storage. The two equipment types differed in terms of residual MB concentration in the plasma samples (0.18 μM and 0.29 μM, respectively). They had similar protein recovery rates at 0.5 month but differed at later time points. The four blood centers differed significantly with regard to factor II, V, VIII and fibrinogen activities. Only the samples from the Shandong blood center met the methylene blue treated fresh frozen plasma requirement. The major factor that influenced the quality of the MB-FFP samples was the time taken between blood collection and storage. Methylene blue treated plasma showed reduced coagulation factor (CF) activity and protein levels. The MB treatment-induced damage to the proteins was acceptable at the four Chinese blood centers, but the quality of the MB-treated plasma in general was not satisfactory. The main factor affecting plasma quality may be the duration of the collection and

  16. Cesarean Outcomes in US Birth Centers and Collaborating Hospitals: A Cohort Comparison.

    Science.gov (United States)

    Thornton, Patrick; McFarlin, Barbara L; Park, Chang; Rankin, Kristin; Schorn, Mavis; Finnegan, Lorna; Stapleton, Susan

    2017-01-01

    High rates of cesarean birth are a significant health care quality issue, and birth centers have shown potential to reduce rates of cesarean birth. Measuring this potential is complicated by lack of randomized trials and limited observational comparisons. Cesarean rates vary by provider type, setting, and clinical and nonclinical characteristics of women, but our understanding of these dynamics is incomplete. We sought to isolate labor setting from other risk factors in order to assess the effect of birth centers on the odds of cesarean birth. We generated low-risk cohorts admitted in labor to hospitals (n = 2527) and birth centers (n = 8776) using secondary data obtained from the American Association of Birth Centers (AABC). All women received prenatal care in the birth center and midwifery care in labor, but some chose hospital admission for labor. Analysis was intent to treat according to site of admission in spontaneous labor. We used propensity score adjustment and multivariable logistic regression to control for cohort differences and measured effect sizes associated with setting. There was a 37% (adjusted odds ratio [OR], 0.63; 95% confidence interval [CI], 0.50-0.79) to 38% (adjusted OR, 0.62; 95% CI, 0.49-0.79) decreased odds of cesarean in the birth center cohort and a remarkably low overall cesarean rate of less than 5% in both cohorts. These findings suggest that low rates of cesarean in birth centers are not attributable to labor setting alone. The entire birth center care model, including prenatal preparation and relationship-based midwifery care, should be studied, promoted, and implemented by policy makers interested in achieving appropriate cesarean rates in the United States. © 2016 by the American College of Nurse-Midwives.

  17. In-hospital mortality following acute myocardial infarction in Kosovo: Asingle center study

    International Nuclear Information System (INIS)

    Bajraktari, G.; Gjoka, S.; Rexhepaj, N.; Daullxhiu, I.; Thaqi, K.; Pacolli, S.; Sylejmani, X.; Elezi, S.

    2008-01-01

    Randomized trials have demonstrated that primary angioplasty is moreeffective than intravenous thrombolysis in reducing mortality and morbidityin patients with acute myocardial infarction (AMI). The aim of this study wasto assess the in-hospital mortality of patients with AMI admitted to the onlytertiary care center in Kosovo, where coronary percutaneous interventionprocedures are unavailable. We also assessed the impact of age and gender onin-hospital mortality. Consecutive patients with the diagnosis of AMI,admitted in our institution between 1999 and 2007, were included in thisretrospective study. Of 2848 patients (mean age 61+- 1.3 years, 73.4% males)admitted with AMI, 292 (10.25%) died during in-hospital stay. The overallin-hospital mortality was 12.3% for women and 9.5% for men (P<05). Women weresignificantly older than men (64.2+-11 years vs. 59.7+-11.8 years, P<.05).Mean length of stay was 12.0+-94 for women and 10.7+-7.6 for men. From 1999break was detected by the application of thepatients with Ami but themortality rate remained stable. Compared to developed countries, patientswith AMI in Kososvo present at an early age but have a higher mortality rate.Women with AMI had a significantly higher in-hospital mortality rate thanmen. The lack of percutaneous coronary intervention procedures in AMIpatients may have contributed to the high in-hospital mortality in ourpopulation. (auhor)

  18. Inter-arm blood pressure difference in hospitalized elderly patients--is it consistent?

    Science.gov (United States)

    Grossman, Alon; Weiss, Avraham; Beloosesky, Yichayaou; Morag-Koren, Nira; Green, Hefziba; Grossman, Ehud

    2014-07-01

    Inter-arm blood pressure difference (IAD) is recognized as a risk factor for cardiovascular mortality. Its reproducibility in the elderly is unknown. The authors determined the prevalence and reproducibility of IAD in hospitalized elderly patients. Blood pressure was measured simultaneously in both arms on two different days in elderly individuals hospitalized in a geriatric ward. The study included 364 elderly patients (mean age, 85±5 years). Eighty-four patients (23%) had systolic IAD >10 and 62 patients (17%) had diastolic IAD >10 mm Hg. A total of 319 patients had two blood pressure measurements. Systolic and diastolic IAD remained in the same category in 203 (64%) and 231 (72%) patients, respectively. Correlations of systolic and diastolic IAD between the two measurements were poor. Consistency was not affected by age, body mass index, comorbidities, or treatment. IAD is extremely common in hospitalized elderly patients, but, because of poor consistency, its clinical significance in this population is uncertain. ©2014 Wiley Periodicals, Inc.

  19. THE PORTION OF AUTOLOGOUS BLOOD IN ORTHOPEDIC DEPARTMENT OF GENERAL HOSPITAL NOVA GORICA IN FIVE YEARS PERIOD (1996–2000

    Directory of Open Access Journals (Sweden)

    Janka Černe-Zavadlav

    2002-04-01

    Full Text Available Background. The presentation of autologous blood donation with analysis of used blood and the percentage of autologous blood on Orthopedic Department in the years 1996–2000.Methods. From card-index of autologous blood donors we analysed 363 preoperative autologous blood donations.We followed the number of doses in one patient and type of operating procedure.We analysed the usage of blood from transfusion issue protocols and the usage of postoperative autotransfusion from patient protocols.Results. 91% of all preoperative blood donations in our hospital in five years period were from Orthopedic Department. There were 280 operating procedures (hip and knee arthroplasty that needed blood transfusion. 196 of these (70% were included in preoperative blood donation programme. We collected 330 doses: 1 dose in 61 cases, 2 doses in 100, 3 doses in 34 and 4 doses in 1 case or 1.68 doses per patient. The relationship between used autologous and allogenic blood were 46 : 54 (doses or 38 : 62 (mL. Autologous blood represented 38% of all used blood on Orthopedic Department, only 11% of autologous blood were discarded.Conclusions. The program of preoperative blood donation is well organized on The Orthopedic Department of our Hospital. To our experience we make the most of profit of autotransfusion (to avoid risks of allogenic blood, optimal patient colaboration, low percentage of discarded blood with two predonated doses in combination with postoperative autotransfusion. Regard to The Law of Blood supply (may 2000 we are going to introduce this protocol of preoperative blood donation for all programed operating procedures in our Hospital, which need blood transfusion.

  20. The prevalence of toxoplasmosis in Imam Reza Hospital blood bank samples, Tehran, Iran.

    Science.gov (United States)

    Shaddel, M; Mirzaii Dizgah, I; Sharif, F

    2014-10-01

    The prevalence of toxoplasma gondii (T.g) infection in blood donors has been poorly studied. The aim of this study was to assess the prevalence of acute and chronic toxoplasmosis in blood products. A total of 223 blood products (101 fresh frozen plasma (FFP) and 122 packed cells (PC)) in Imam Reza hospital blood bank, Tehran, Iran were tested for specific T.g antibodies (IgG and IgM) by ELISA method. Positive IgG anti-T.g samples were further tested for IgM anti-T.g. A positive IgG test with the negative and positive IgM test was interpreted as a chronic and acute toxoplasmosis respectively. Of 223 samples 38.6% and 0.45% were positive for IgG anti-T.g and IgM anti-T.g levels respectively. Therefore, one and 85 samples were involved acute and chronic toxoplasmosis respectively. Twenty-six of fresh frozen plasma samples were positive for IgG anti-T.g and one of them was positive for IgM anti-T.g. Sixty packed cell samples were positive for IgG anti-T.g. Our study showed that there were chronic and acute toxoplasmosis in blood products and the prevalence of toxoplasmosis especially chronic form was high. Therefore screening of blood for T.g antibodies may be considered. Copyright © 2014 Elsevier Ltd. All rights reserved.

  1. Blood transfusion in patients having caesarean section: a prospective multicentre observational study of practice in three Pakistan hospitals.

    Science.gov (United States)

    Ismail, S; Siddiqui, S; Shafiq, F; Ishaq, M; Khan, S

    2014-08-01

    Increasing awareness of the risks of blood transfusion has prompted examination of red cell transfusion practice in obstetrics. A six-month prospective observational study was performed to examine blood transfusion practices in patients undergoing caesarean delivery at three hospitals in Pakistan. In the three hospitals (two private, one public) 3438 caesarean deliveries were performed in the study period. Data were collected on patient demographics, indications for transfusion, ordering physicians, consent, associations with obstetric factors, estimated allowable blood loss, calculated blood loss, pre- and post-transfusion haemoglobin and discharge haemoglobin. A total number of 397 (11.5%) patients who underwent caesarean section received a blood transfusion. The highest transfusion rate of 16% was recorded in the public tertiary care hospital compared to 5% in the two private hospitals. Emergency caesarean delivery and multiparity were associated with blood transfusion (Ptransfusion in 98% of cases. In 343 (86%) patients, blood transfusion was given even when the haemoglobin was >7g/dL. The method for documenting the indication or consent for transfusion was not found in any of the three hospitals. Blood transfusion was prescribed more readily in the public hospital. Identification of a transfusion trigger and the development of institutional guidelines to reduce unnecessary transfusion are required. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. On the practice of ignoring center-patient interactions in evaluating hospital performance.

    Science.gov (United States)

    Varewyck, Machteld; Vansteelandt, Stijn; Eriksson, Marie; Goetghebeur, Els

    2016-01-30

    We evaluate the performance of medical centers based on a continuous or binary patient outcome (e.g., 30-day mortality). Common practice adjusts for differences in patient mix through outcome regression models, which include patient-specific baseline covariates (e.g., age and disease stage) besides center effects. Because a large number of centers may need to be evaluated, the typical model postulates that the effect of a center on outcome is constant over patient characteristics. This may be violated, for example, when some centers are specialized in children or geriatric patients. Including interactions between certain patient characteristics and the many fixed center effects in the model increases the risk for overfitting, however, and could imply a loss of power for detecting centers with deviating mortality. Therefore, we assess how the common practice of ignoring such interactions impacts the bias and precision of directly and indirectly standardized risks. The reassuring conclusion is that the common practice of working with the main effects of a center has minor impact on hospital evaluation, unless some centers actually perform substantially better on a specific group of patients and there is strong confounding through the corresponding patient characteristic. The bias is then driven by an interplay of the relative center size, the overlap between covariate distributions, and the magnitude of the interaction effect. Interestingly, the bias on indirectly standardized risks is smaller than on directly standardized risks. We illustrate our findings by simulation and in an analysis of 30-day mortality on Riksstroke. © 2015 The Authors. Statistics in Medicine published by John Wiley & Sons Ltd.

  3. Levels of blood lead in Griffon vultures from a Wildlife Rehabilitation Center in Spain.

    Science.gov (United States)

    González, Fernando; López, Irene; Suarez, Laura; Moraleda, Virginia; Rodríguez, Casilda

    2017-09-01

    Lead is considered a highly toxic contaminant with important impacts to bird wildlife. Griffon vultures (Gyps fulvus) are a sensitive indicator of the level of environmental contamination due to their position at the top of the food chain and their dependence on human activities. The aim of this study was to assess susceptibility to lead intoxication in Griffon vultures admitted to Wildlife Rehabilitation Centers (WRC), measuring blood lead levels and determining if blood lead concentrations are related to clinical signs, hematological, biochemical or radiographic findings. Also, the influence of age, gender, body condition, season and primary cause of admission were evaluated. This study was realized in all Griffon vultures admitted during a period of one year in the Rehabilitation Center GREFA. Blood lead levels are measured by using anodic stripping voltammetry. In Griffon vultures, we observed that 26% of the analyzed birds presented lead levels above 20µg/dL with 74% below 20µg/dL ([Pb] lead according to sex, season of admission to the center and body condition. A negative correlation was found between levels of metal and hematocrit. No association was found between clinical signs and blood lead levels in Griffon vultures, except for digestive signs as stasis and weight loss. On numerous occasions, the intoxication in this specie is related to ingestion of lead ammunition; however, we have not detected radiographic lead in our vultures. Compared with other studies, we generally found low levels of lead in blood of Griffon vultures but the blood of all birds admitted to WRC presented detectable lead concentrations. This species apparently presents a higher sensibility to the toxic effects of this metal than that described by other authors. It have been observed that there is some evidence that suggests that subclinical levels of lead could be related with a predisposition to injury or diseases, even though these birds might be admitted for other causes. The

  4. Comparison of CDE data in phacoemulsification between an open hospital-based ambulatory surgical center and a free-standing ambulatory surgical center

    Directory of Open Access Journals (Sweden)

    Ming Chen

    2010-11-01

    Full Text Available Ming Chen1, Mindy Chen21University of Hawaii, Honolulu, HI, USA; 2University of California, Irvine, CA, USAAbstract: Mean CDE (cumulative dissipated energy values were compared for an open hospital-based surgical center and a free-standing surgical center. The same model of phacoemulsifier (Alcon Infiniti Ozil was used. Mean CDE values showed that surgeons (individual private practice at the free-standing surgical center were more efficient than surgeons (individual private practice at the open hospital-based surgical center (mean CDE at the hospital-based surgical center 18.96 seconds [SD = 12.51]; mean CDE at the free-standing surgical center 13.2 seconds [SD = 9.5]. CDE can be used to monitor the efficiency of a cataract surgeon and surgical center in phacoemulsification. The CDE value may be used by institutions as one of the indicators for quality control and audit in phacoemulsification.Keywords: CDE (cumulative dissipated energy, open hospital-based ambulatory surgical center, free-standing surgical center, phacoemulsification 

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

    Science.gov (United States)

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

    2014-12-01

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

  6. Causes of prolonged hospitalization among general internal medicine patients of a tertiary care center.

    Science.gov (United States)

    Ruangkriengsin, Darat; Phisalprapa, Pochamana

    2014-03-01

    Unnecessary days of prolonged hospitalization may lead to the increase in hospital-related complications and costs, especially in tertiary care center Currently, there have not been many studies about the causes of prolonged hospitalization. Some identified causes could, however, be prevented and improved. To identify the prevalence, causes, predictive factors, prognosis, and economic burden of prolonged hospitalization in patients who had been in general internal medicine wards of the tertiary care center for 7 days or more. Retrospective chart review study was conducted among all patients who were admitted for 7 days or more in general internal medicine wards of Siriraj Hospital, the largest tertiary care center in Thailand. The period of this study was from 1 August 2012 to 30 September 2012. Demographic data, principle diagnosis, comorbid diseases, complications, discharge status, total costs of admission and percentage of reimbursement were collected. The causes of prolonged hospitalization at day 7, 14, 30, and 90 were assessed. Five hundred and sixty-two charts were reviewed. The average length of stay was 25.9 days. The two most common causes of prolonged admission at day 7 were treatment of main diagnosed disease with stable condition (27.6%) and waiting for completion of intravenous antibiotics administration with stable condition (19.5%). The causes of prolonged hospitalization at day 14 were unstable condition from complications (22.6%) and those waiting for completion of intravenous antibiotics administration with stable condition (15.8%). The causes of prolonged admission at day 30 were unstable conditions from complications (25.6%), difficulty weaning or ventilator dependence (17.6%), and caregiver problems (15.2%). The causes of prolonged hospitalization at day 90 were unstable condition from complications (30.0%), caregiver problems (30.0%), and palliative care (25.0%). Poor outcomes were shown in the patients admitted more than 90 days. Percentage

  7. Blood and Blood Product Conservation: Results of Strategies to Improve Clinical Outcomes in Open Heart Surgery Patients at a Tertiary Hospital.

    Science.gov (United States)

    Khan, Junaid H; Green, Emily A; Chang, Jimmin; Ayala, Alexandria M; Barkin, Marilyn S; Reinys, Emily E; Stanton, Jeffrey; Stanten, Russell D

    2017-12-01

    Blood product usage is a quality outcome for patients undergoing cardiac surgery. To address an increase in blood product usage since the discontinuation of aprotinin, blood conservation strategies were initiated at a tertiary hospital in Oakland, CA. Improving transfusion rates for open heart surgery patients requiring Cardiopulmonary bypass (CPB) involved multiple departments in coordination. Specific changes to conserve blood product usage included advanced CPB technology upgrades, and precise individualized heparin dose response titration assay for heparin and protamine management. Retrospective analysis of blood product usage pre-implementation, post-CPB changes and post-Hemostasis Management System (HMS) implementation was done to determine the effectiveness of the blood conservation strategies. Statistically significant decrease in packed red blood cells, fresh frozen plasma, cryoprecipitate, and platelet usage over the stepped implementation of both technologies was observed. New oxygenator and centrifugal pump technologies reduced active circuitry volume and caused less damage to blood cells. Individualizing heparin and protamine dosing to a patient using the HMS led to transfusion reductions as well. Overall trends toward reductions in hospital length of stay and intensive care unit stay, and as a result, blood product cost and total hospitalization cost are positive over the period of implementation of both CPB circuit changes and HMS implementation. Although they are multifactorial in nature, these trends provide positive enforcement to the changes implemented.

  8. Fox Chase Network: Fox Chase Cancer Center's community hospital affiliation program.

    Science.gov (United States)

    Higman, S A; McKay, F J; Engstrom, P F; O'Grady, M A; Young, R C

    2000-01-01

    Fox Chase Cancer Center developed a format for affiliation with community providers in 1986. Fox Chase Network was formed to establish hospital-based community cancer centers to increase access to patients involved in clinical research. Under this program, the Fox Chase Network now contributes 500 patients per year to prevention and clinical research studies. As relationships with community providers form, patient referrals have increased at Fox Chase Cancer Center and for each Fox Chase Network member. A dedicated staff is required to operate the central office on a day-to-day basis as well as at each affiliate. We have found this to be a critical element in each program's success. New challenges in the cancer business-increasing volumes with declining revenue-have caused us to reconfigure the services offered to affiliates, while maintaining true to our mission: to reduce the burden of human cancer.

  9. Pattern of Blood Stream Infections within Neonatal Intensive Care Unit, Suez Canal University Hospital, Ismailia, Egypt

    Directory of Open Access Journals (Sweden)

    Rania Mohammed Kishk

    2014-01-01

    Full Text Available Introduction. Blood stream infection (BSI is a common problem of newborn in neonatal intensive care units (NICUs. Monitoring neonatal infections is increasingly regarded as an important contributor to safe and high-quality healthcare. It results in high mortality rate and serious complications. So, our aim was to determine the incidence and the pattern of BSIs in the NICU of Suez Canal University Hospital, Egypt, and to determine its impact on hospitalization, mortality, and morbidity. Methods. This study was a prospective one in which all neonates admitted to the NICUs in Suez Canal University hospital between January, 2013 and June 2013 were enrolled. Blood stream infections were monitored prospectively. The health care associated infection rate, mortality rate, causative organism, and risk factors were studied. Results. A total of 317 neonates were admitted to the NICU with a mortality rate of 36.0%. During this study period, 115/317 (36.3% developed clinical signs of sepsis and were confirmed as BSIs by blood culture in only 90 neonates with 97 isolates. The total mean length of stay was significantly longer among infected than noninfected neonates (34.5 ± 18.3 and 10.8 ± 9.9 days, resp., P value < 0.001. The overall mortality rates among infected and noninfected neonates were 38.9% and 34.8%, respectively, with a significant difference. Klebsiella spp. were the most common pathogen (27.8% followed by Pseudomonas (21.6% and Staphylococcus aureus (15.4%. Conclusion. The rate of BSIs in NICU at Suez Canal University Hospital was relatively high with high mortality rate (36.0%.

  10. Which is more useful in predicting hospital mortality--dichotomised blood test results or actual test values? A retrospective study in two hospitals.

    Science.gov (United States)

    Mohammed, Mohammed A; Rudge, Gavin; Wood, Gordon; Smith, Gary; Nangalia, Vishal; Prytherch, David; Holder, Roger; Briggs, Jim

    2012-01-01

    Routine blood tests are an integral part of clinical medicine and in interpreting blood test results clinicians have two broad options. (1) Dichotomise the blood tests into normal/abnormal or (2) use the actual values and overlook the reference values. We refer to these as the "binary" and the "non-binary" strategy respectively. We investigate which strategy is better at predicting the risk of death in hospital based on seven routinely undertaken blood tests (albumin, creatinine, haemoglobin, potassium, sodium, urea, and white blood cell count) using tree models to implement the two strategies. A retrospective database study of emergency admissions to an acute hospital during April 2009 to March 2010, involving 10,050 emergency admissions with routine blood tests undertaken within 24 hours of admission. We compared the area under the Receiver Operating Characteristics (ROC) curve for predicting in-hospital mortality using the binary and non-binary strategy. The mortality rate was 6.98% (701/10050). The mean predicted risk of death in those who died was significantly (p-value non-binary strategy (risk = 0.222 95%CI: 0.194 to 0.251), representing a risk difference of 28.74 deaths in the deceased patients (n = 701). The binary strategy had a significantly (p-value non-binary strategy (0.853 95% CI: 0.840 to 0.867). Similar results were obtained using data from another hospital. Dichotomising routine blood test results is less accurate in predicting in-hospital mortality than using actual test values because it underestimates the risk of death in patients who died. Further research into the use of actual blood test values in clinical decision making is required especially as the infrastructure to implement this potentially promising strategy already exists in most hospitals.

  11. Which Is More Useful in Predicting Hospital Mortality -Dichotomised Blood Test Results or Actual Test Values? A Retrospective Study in Two Hospitals

    Science.gov (United States)

    Mohammed, Mohammed A.; Rudge, Gavin; Wood, Gordon; Smith, Gary; Nangalia, Vishal; Prytherch, David; Holder, Roger; Briggs, Jim

    2012-01-01

    Background Routine blood tests are an integral part of clinical medicine and in interpreting blood test results clinicians have two broad options. (1) Dichotomise the blood tests into normal/abnormal or (2) use the actual values and overlook the reference values. We refer to these as the “binary” and the “non-binary” strategy respectively. We investigate which strategy is better at predicting the risk of death in hospital based on seven routinely undertaken blood tests (albumin, creatinine, haemoglobin, potassium, sodium, urea, and white blood cell count) using tree models to implement the two strategies. Methodology A retrospective database study of emergency admissions to an acute hospital during April 2009 to March 2010, involving 10,050 emergency admissions with routine blood tests undertaken within 24 hours of admission. We compared the area under the Receiver Operating Characteristics (ROC) curve for predicting in-hospital mortality using the binary and non-binary strategy. Results The mortality rate was 6.98% (701/10050). The mean predicted risk of death in those who died was significantly (p-value non-binary strategy (risk = 0.222 95%CI: 0.194 to 0.251), representing a risk difference of 28.74 deaths in the deceased patients (n = 701). The binary strategy had a significantly (p-value non-binary strategy (0.853 95% CI: 0.840 to 0.867). Similar results were obtained using data from another hospital. Conclusions Dichotomising routine blood test results is less accurate in predicting in-hospital mortality than using actual test values because it underestimates the risk of death in patients who died. Further research into the use of actual blood test values in clinical decision making is required especially as the infrastructure to implement this potentially promising strategy already exists in most hospitals. PMID:23077528

  12. Severe obesity and high blood pressure among children, Philadelphia health centers, 2010.

    Science.gov (United States)

    Nguyen, John V; Robbins, Jessica M; Houck, Kevin L; Nobis, Elizabeth A; Inman, Katelyn A; Khan, Khudsiya S; Robbins, Susan W

    2014-04-01

    Child obesity is a major health problem particularly affecting disadvantaged population groups. Severe obesity carries additional health risks for children. In the context of the childhood obesity epidemic, high blood pressure among children is of increasing concern. Chart reviews were carried out to examine the prevalence of severe obesity and its association with high blood pressure measurements among randomly selected patients aged 3 to 17 years who had well-child care visits at 8 public community health centers during 2010. A majority of the 691 patients reviewed were African American (58%); an additional 16% were Hispanic. The prevalence of severe obesity was 7.7% (95% confidence interval = 5.8% to 9.9%) and the prevalence of high blood pressure measurements was 17.5% (95% confidence interval = 14.8% to 20.6%). Patients who were severely obese were more than twice as likely as other children to have high blood pressure values. Severe obesity is associated with substantially increased frequency of high blood pressure measurements in children, and should be investigated further as a potential marker for hypertension in children. Primary care providers should be prepared to diagnose and treat hypertension in severely obese children.

  13. Whole blood donor deferral analysis at a center in Western India

    Directory of Open Access Journals (Sweden)

    Agnihotri Naveen

    2010-01-01

    Full Text Available Introduction: Deferrals lead to loss of precious whole blood donors (WBD and blood units available for transfusion purposes. Knowledge of rate and causes of donor deferral can guide the recruitment strategy for WBD. Aim: To find the incidence and causes of deferral in Indian WBD and apply relevant findings to modify recruitment strategy for blood donors. Materials and Methods: Data for WBD presenting for donation in a blood center and outdoor camps over one and half year were analyzed retrospectively. National guidelines were used for selection and deferral of WBD. Result: 736 (11.6% WBD were deferred out of 6357 presenting for donation during the study period. Most (69.8% of the donors were deferred on physical examination and hemoglobin (Hb testing. Most common reasons for deferral were low Hb (55.8%, abnormal blood pressure (11.1%, medication (6.9% and underweight donors (2.9%. Significantly more volunteers were deferred than relative donors (13.97% vs 5.80%; P<0.000. Females were found to have higher deferral rate than males (53.5% vs 6.9%; P=0.000 and higher odds ratio for deferral (15.4. Donors older than 40 years of age had significantly higher chance of being deferred (P<0.05. Discussion and Conclusion: It is important to determine the rate and causes of WBD deferral to guide the recruitment and retention efforts at local, regional, and national level.

  14. [Results of Training for Personnel Involved in Blood-Transfusion Testing Outside of Regular Work Hours at Saga University Hospital].

    Science.gov (United States)

    Yamada, Marie; Yamada, Naotomo; Higashitani, Takanori; Ohta, Shoichiro; Sueoka, Eisaburo

    2015-11-01

    Laboratory testing prior to blood transfusion outside of regular hours in many hospitals and clinics is frequently conducted by technicians without sufficient experience in such testing work. To obtain consistent test results regardless of the degree of laboratory experience with blood transfusion testing, the number of facilities introducing automated equipment for testing prior to blood transfusion is increasing. Our hospital's blood transfusion department introduced fully automated test equipment in October of 2010 for use when blood transfusions are conducted outside of regular hours. However, excessive dependence on automated testing can lead to an inability to do manual blood typing or cross-match testing when necessitated by breakdowns in the automated test equipment, in the case of abnormal specimen reactions, or other such case. In addition, even outside of normal working hours there are more than a few instances in which transfusion must take place based on urgent communications from clinical staff, with the need for prompt and flexible timing of blood transfusion test and delivery of blood products. To address this situation, in 2010 we began training after-hours laboratory personnel in blood transfusion testing to provide practice using test tubes manually and to achieve greater understanding of blood transfusion test work (especially in cases of critical blood loss). Results of the training and difficulties in its implementation for such after-hours laboratory personnel at our hospital are presented and discussed in this paper. [Original

  15. Effciency of HIV-infected patients detection in neurological hospitals of large industrial center

    Directory of Open Access Journals (Sweden)

    Shmelev V.V.

    2012-06-01

    Full Text Available

    Aim of the study: to evaluate the effciency of detection for HIV-infection in patients of neurological departments of Saratov. Materials and methods. We retrospectively analyzed 25 250 medical histories of patients hospitalized into neurological departments of Saratov hospitals between January 2007 and April 2012. Results. Blood samples of 2010 patients (7,96 % were tested for the presence of HIV-antibodies. 37 patients were HIV-positive (1,84 % of examined patients and 0,15 % of the total number of patients. Conclusion. Increasing popularity and variety of clinical manifestations of HIV-infection requires the expansion of neurological patients whom serum test for antibodies against HIV is needed.

  16. The Ratio of Blood Products Transfused Affects Mortality in Patients Receiving Massive Transfusions at a Combat Support Hospital

    National Research Council Canada - National Science Library

    Borgman, Matthew A; Spinella, Philip C; Perkins, Jeremy G; Grathwohl, Kurt W; Repine, Thomas; Beekley, Alec C; Sebesta, James; Jenkins, Donald; Wade, Charles E; Holcomb, John B

    2007-01-01

    ...:1 ratio of plasma to red blood cell (RBC) units. Methods: We performed a retrospective chart review of 246 patients at a US Army combat support hospital, each of who received a massive transfusion...

  17. The Epidemiological And Susceptibility Study Of Inpatient Blood Cultures In Amir Alam Hospital 1998 - 2000

    Directory of Open Access Journals (Sweden)

    Karimi Shahidi M

    2002-07-01

    Full Text Available Sepsis is one of the most critical medical emergency situations. Treatment with anti microbial drugs should be initiated as soon as samples of blood and other relevant sites have been cultured. Available information about patterns of anti microbial Susceptibility among bacterial isolates from the community, the hospital, and the patient should be taken in to account. It is important, pending culture results, to initiate empirical anti microbial therapy."nMaterials and methods: In a descriptive study during 3 years (1377-1379, microbial and anti microbial susceptibility patterns evaluated in Amir alam clinical laboratory on 2000 specimen of blood culture received from 765 hospitalized patients at Amir Alam hospital wards."nResults: 113 specimens from 77 patient (10 percent were positive for microbial growth. Enterobacter, S. aureus, S.epidermidis, Pneumococci, Ecoli, and Pseudomonas were the most common isolated etiologic agents(80 percent . The most common organism was Entenobacter in 1377, S.aureus in 1378 and pseudomonas in 1379 There were significant change in patlern of organisms, increase resistance to some important available antibiotics and change in antibiotic susceptibility pattern during three years (disc diffusion method."nConclusions: According to Results of this study due to change in pattern of organism and their antibiotic susceptibility, dynamic microbiological study provide important data for Ordering empirical and culture oriented treatment of patients with bacteremia, Sepsis, anti microbial Chemotherapy, anti microbial susceptibility empirical anti microbial therapy, microbial pattern.

  18. Practices for rational use of blood components in a universitary hospital.

    Science.gov (United States)

    Leão, Sydney Correia; Gomes, Mariana Araújo Bezerra; Aragão, Mila Cintra de Azevedo; Lobo, Iza Maria Fraga

    2015-08-01

    to produce improvements in transfusion practices through the implementation of an educational program for health professionals in a university hospital. this is an interventional and prospective study, with pre- and postanalysis of an educational intervention. The research was developed at the University Hospital of the Universidade Federal de Sergipe, involving participation of health professionals in the stage of training, during the month of February 2011, in addition to the monitoring of blood transfusions performed in the pre- and post-intervention periods. Transfusion practices were investigated upon request for transfusion or devolution of unused blood components. Knowledge of health professionals was assessed based on the responses to a questionnaire about transfusion practices. during the educative campaign, 63 professionals were trained, including 33 nurses or nursing technicians and 30 physicians. Among the doctors, there was a statistically significant gain of 20.1% in theoretical knowledge (p=0.037). Gain in the nursing group was even higher: 30.4% (p=0.016). The comparative analysis of transfusion request forms showed a non-significant decrease from 26.7 to 19.5% (p=0.31) in all forms with incomplete information. We also observed a statistically significant improvement in relation to the filling of four items of transfusion request. there was a significant improvement of the entire process related to blood transfusions after interventional project conducted in February 2011.

  19. Practices for rational use of blood components in a universitary hospital

    Directory of Open Access Journals (Sweden)

    Sydney Correia Leão

    2015-08-01

    Full Text Available SummaryObjective:to produce improvements in transfusion practices through the implementation of an educational program for health professionals in a university hospital.Methods:this is an interventional and prospective study, with pre- and postanalysis of an educational intervention. The research was developed at the University Hospital of the Universidade Federal de Sergipe, involving participation of health professionals in the stage of training, during the month of February 2011, in addition to the monitoring of blood transfusions performed in the preand post-intervention periods. Transfusion practices were investigated upon request for transfusion or devolution of unused blood components. Knowledge of health professionals was assessed based on the responses to a questionnaire about transfusion practices.Results:during the educative campaign, 63 professionals were trained, including 33 nurses or nursing technicians and 30 physicians. Among the doctors, there was a statistically significant gain of 20.1% in theoretical knowledge (p=0.037. Gain in the nursing group was even higher: 30.4% (p=0.016. The comparative analysis of transfusion request forms showed a non-significant decrease from 26.7 to 19.5% (p=0.31 in all forms with incomplete information. We also observed a statistically significant improvement in relation to the filling of four items of transfusion request.Conclusion:there was a significant improvement of the entire process related to blood transfusions after interventional project conducted in February 2011.

  20. ABO Blood Group and Endometrial Carcinoma: A Preliminary Single-Center Experience from Saudi Arabia.

    Science.gov (United States)

    Abu-Zaid, Ahmed; Alsabban, Mohannad; Abuzaid, Mohammed; Alomar, Osama; Al-Badawi, Ismail A; Salem, Hany

    2017-12-18

    Inherited ABO blood groups have been shown to play possible contributions in the pathogenesis of various gynecologic and non-gynecologic carcinomas. With regard to gynecologic carcinomas, there is a confined number of studies that explored the relationship between ABO blood group and endometrial carcinoma (EC) in the PubMed-indexed literature. To the best of our knowledge, no such study has ever been conducted in Saudi Arabia. Our study has two objectives: (I) to determine the prevalence of ABO blood groups among Saudi patients with EC, and (II) to explore the relationship between ABO blood group and several clinico-pathological prognostic parameters (namely: menopausal status [age], body mass index [BMI], tumor grade, FIGO [Fédération Internationale de Gynécologie et d'Obstétrique] stage and recurrence) in Saudi patients with EC. A retrospective cross-sectional study from 01-January-2010 to 31-July-2014 was conducted at King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia - a referral tertiary healthcare institute. One-hundred and fourteen patients (n=114) were included in the study. Clinico-pathological data were extrapolated from medical records, and their association with ABO blood groups were evaluated. Categorical data were presented as number of cases (n) and percentages (%). Two-tailed Chi-square test was used for univariate analysis. For all purposes, p values 28 kg/m 2 (84.2%), diagnosed with early FIGO stage I-II (76.3%) and developed no recurrence (86.8%). The frequencies of ABO blood group types A, B, AB, and O were 28.1%, 12.3%, 3.5% and 56.1%, respectively. When ABO blood groups were analyzed as four different types (A, B, AB and O), O-type was the most common ABO blood group in pre- and post-menopausal EC patients (43.8% and 58.2%, respectively; p=0.14). There were no statistically significant correlations between ABO blood groups and all the examined clinico-pathological factors. Moreover, when ABO blood groups were

  1. The epidemiological profile of Pediatric Intensive Care Center at Hospital Israelita Albert Einstein.

    Science.gov (United States)

    Lanetzki, Camila Sanches; de Oliveira, Carlos Augusto Cardim; Bass, Lital Moro; Abramovici, Sulim; Troster, Eduardo Juan

    2012-01-01

    This study outlined the epidemiological profiles of patients who were admitted to the Pediatric Intensive Care Center at Albert Einstein Israelite Hospital during 2009. Data were retrospectively collected for all patients admitted to the PICC during 2009. A total of 433 medical charts were reviewed, and these data were extracted using the DATAMARTS System and analyzed using the statistical software package STATA, version 11.0. There were no statistically significant differences in regards to patient gender, and the predominant age group consisted of patients between the ages of 1 to 4 years. The average occupancy rate was 69.3% per year, and there was a greater number of admissions during April, August, and October. The average length of stay at the hospital ranged from 9.7 to 19.1 days. Respiratory diseases were the main cause for admission to the Pediatric Intensive Care Center, and the mortality rate of the patients admitted was 1.85%. Respiratory diseases were the most common ailment among patients admitted to the Pediatric Intensive Care Center, and the highest mortality rates were associated with neoplastic diseases.

  2. In-hospital mortality following acute myocardial infarction in Kosovo : A single center study

    International Nuclear Information System (INIS)

    Gani Bajraktari

    2010-01-01

    Randomized trials have demonstrated that primary angioplasty is more effective than intravenous thrombolysis in reducing mortality and morbidity in patients with acute myocardial infarction (AMI). The aim of this study was to assess the in-hospital mortality of patients with AMI admitted to the only tertiary care center in Kosovo, where coronary percutaneous intervention procedures are unavailable. We also assessed the impact of age and gender on in-hospital mortality. Patients and Consecutive patients with the diagnosis of AMI, admitted in our institution between 1999 and 2007, were included in this retrospective study. Of 2848 patients (mean age 61±11.3 years, 73.4% males) admitted with AMI, 292 (10.25%) patients died during in-hospital stay. The overall in-hospital mortality was 12.3% for women and 9.5% for men (P<.05). Women were significantly older than men (64.2±11 years vs 59.7±11.8 years, P<.05). Mean length of stay was 12.0±94 for women and 10.7±7.6 for men. From 1999 to 2007 there was an increase in the age of patients with AMI but the mortality rate remained stable.Compared to developed countries, patients with AMI in Kosovo present at an earlier age but have a higher mortality rate. Women with AMI had a significantly higher in-hospital mortality rate than men. The lack of percutaneous coronary intervention procedures in AMI patients may have contributed to the high in-hospital mortality in our population (Author).

  3. The Survey of Contamination of Platelet Product with Aerobic Bacteria in Isfahan Blood Transfusion Center

    Directory of Open Access Journals (Sweden)

    F Baghban

    2016-09-01

    Full Text Available Introduction: Although nowadays the risk of transmission of bacterial pathogens through blood transfusion has been decreased, but there is the possibility of transmission of these factors by injection of these kind of products. The purpose of this survey was determination of contamination of platelet products with aerobic bacteria in Isfahan Blood Transfusion Center. Methods: In the spring and summer of 2014, 2000 platelet product samples were examined randomly in 5 months for aerobic bacterial contamination. First, samples were cultured in fluid thioglycollate medium. The bacteria that were grown in this medium were identified by Gram staining and biochemical tests. Then, DNA was extracted from isolated bacteria and PCR was done for 16S rRNA gene. After that the PCR products were sequenced and the bacteria were recognized at the level of species. Results: At this research, 4 contaminated samples were identified. Isolated bacteria were including: Klebsiella pneumoniae 1 case, Staphylococcus aureus 1 case, Staphylococcus epidermidis 1 case and Staphylococcus haemolyticus 1 case.    After sequencing of 16S rRNA gene, the homology was observed 97%, 83%, 99%, and 90% at theses bacteria, respectively. Discussion: According to the results of this research, platelet products may be contaminated with aerobic bacteria. Therefore, providing appropriate conditions in transfusion centers and other therapeutic centers for doing screening tests on platelet products to identifying bacterial contaminations before using of these products seems to be necessary.

  4. Work ability among nursing personnel in public hospitals and health centers in Campinas--Brazil.

    Science.gov (United States)

    Monteiro, Inês; Chillida, Manuela de Santana Pi; Moreno, Luciana Contrera

    2012-01-01

    Nursing personnel is essential in hospital, health centers and enterprises and is the large work force in health system. A cross-sectional study was conducted in a large city in two public hospitals and five health centre with the objective of to evaluate the work ability and health aspects of nursing staff. The sample was composed by 570 workers. The Work Ability Index - WAI and a questionnaire with socio-demographic, health and life style data was applied. The majority of workers was women (83%), married (50.4%), and was working in night shift work (65.6%); 61.4% was auxiliary nursing, 22.3% was registered nurses (RN). The average age was 38.9 years (SD 7.8) and the Body Mass Index mean was 25.8 (SD 5.3). Only 17.2% referred to practice at least 150 minutes of physical exercise five times per week or more. 26.8% had a second job. The work ability mean was 39.3 (SD 5.3) points. Age had a negative correlation with WAI (p=0.0052). Public hospital and health centre workers had poor work ability score when compared with workers from another branches. Public policies related to workplace health promotion need to be implemented in public hospital and health centre to improve the work ability.

  5. Utilization of arterial blood gas measurements in a large tertiary care hospital.

    Science.gov (United States)

    Melanson, Stacy E F; Szymanski, Trevor; Rogers, Selwyn O; Jarolim, Petr; Frendl, Gyorgy; Rawn, James D; Cooper, Zara; Ferrigno, Massimo

    2007-04-01

    We describe the patterns of utilization of arterial blood gas (ABG) tests in a large tertiary care hospital. To our knowledge, no hospital-wide analysis of ABG test utilization has been published. We analyzed 491 ABG tests performed during 24 two-hour intervals, representative of different staff shifts throughout the 7-day week. The clinician ordering each ABG test was asked to fill out a utilization survey. The most common reasons for requesting an ABG test were changes in ventilator settings (27.6%), respiratory events (26.4%), and routine (25.7%). Of the results, approximately 79% were expected, and a change in patient management (eg, a change in ventilator settings) occurred in 42% of cases. Many ABG tests were ordered as part of a clinical routine or to monitor parameters that can be assessed clinically or through less invasive testing. Implementation of practice guidelines may prove useful in controlling test utilization and in decreasing costs.

  6. Prevalence and prevalence trends of transfusion transmissible infections among blood donors at four chinese regional blood centers between 2000 and 2010

    Directory of Open Access Journals (Sweden)

    Li Changqing

    2012-08-01

    Full Text Available Abstract Background In China, high prevalence of HBV and HCV parallels with the growing epidemic of syphilis and HIV in the general population poses a great threat to blood safety. This study investigated the prevalence of serologic markers for transfusion transmissible infections (TTIs among four Chinese blood centers. Methods We examined whole blood donations collected from January 2000 through December 2010 at four Chinese blood centers. Post-donation testing of TTIs (HIV, HBV, HCV and syphilis were conducted using two different enzyme-linked immunosorbent assay kits for each seromarker. The prevalence of serologic markers for TTIs (% was calculated and additional analysis was conducted to examine donor characteristics associated with positive TTIs serology. Results Of the 4,366,283 donations, 60% were from first-time donors and 40% were from repeated donors. The overall prevalence of HIV, HBsAg, HCV and syphilis was 0.08%, 0.86%, 0.51% and 0.47%, respectively. The prevalence profile of TTIs varied among different blood centers and appeared at relatively high levels. Overall, the prevalence of HBsAg and HCV demonstrated a decline trend among four blood centers, while the prevalence of HIV and syphilis displayed three different trends: constantly steady, continually increasing and declining among different centers. Conclusions This study reflects the risk of TTIs has been greatly reduced in China, but blood transfusion remains an ongoing risk factor for the spread of blood-borne infections, and further work and improvements are needed to strengthen both safety and availability of blood in China.

  7. Manual to radioactive waste management produced in hospitals, research and education centers

    International Nuclear Information System (INIS)

    Villasenor N, L.F.; Mejia L, M.

    1996-01-01

    This manual collects the experience on the disposal and management of the wastes produced in the preparation and application of radioactive material. Although the content is not so extensive, the authors have tried to provide the necessary guidelines and adequate information for the management of the wastes produced in hospitals and research and education centers. The objective of this work is to describe the basis and principles for the establishment of a minimization program, a segregation program and a provisional waste storage, in order to reduce the generation of wastes, personal exposure and the environmental impact. (authors). 5 refs

  8. 77 FR 9665 - Submission for OMB Emergency Review; Comment Request: A Multi-Center International Hospital-Based...

    Science.gov (United States)

    2012-02-17

    ... Review; Comment Request: A Multi- Center International Hospital-Based Case-Control Study of Lymphoma in... the Office of Management and Budget (OMB) a request for emergency review and processing this... Hospital- Based Case-Control Study of Lymphoma in Asia (AsiaLymph) (NCI). Type of Information Collection...

  9. Transfusion transmittable infections - Seroprevalence among blood donors in a tertiary care hospital of Delhi

    Directory of Open Access Journals (Sweden)

    Sangeeta Pathak

    2013-01-01

    Full Text Available Context: Transfusion transmittable infections (TTI continue to be a major threat to safe transfusion practices. Blood is one of the major sources of transmission of infectious diseases viz. human immunodeficiency virus (HIV, hepatitis B virus (HBV, hepatitis C virus (HCV, syphilis, malaria, and many other infections in India. Screening assays for the infectious diseases with excellent sensitivity and specificity helps to enhance the safety of the blood transfusions reducing the diagnostic window period as much as possible. Aims: The present study was designed to determine the seroprevalence of TTIs viz., HIV, HCV, and HBV, among the blood donors in Max Super Specialty Hospital, New Delhi, India based on dual testing strategy using high sensitive screening assays such as enhanced chemiluminescence assay and nucleic acid testing (NAT. Materials and Methods: A total of 41207 blood units collected from the donors (both voluntary and replacement donors were screened for the TTI s, viz., anti HIV 1 and 2 antibody, anti HCV antibody, anti HBcore antibody, and HBsAg by enhanced chemiluminescence assay on VITROS ® ECiQ immunodiagnostics system. NAT was performed using Roche Cobas ® TaqScreen MPX assay, which can detect simultaneously HIV 1 (groups M and O, HIV-2, HCV, and HBV on Roche Cobas ® s201 system. Results: The seroprevalence of HIV, HBsAg, anti HBcore antibody, and HCV based on enhanced chemiluminescence assay was found to be 0.25, 0.2, 7.06, and 0.7%, respectively. A total number of 6587 samples from July 2010 to December 2010 were tested on NAT, of which 3 samples were reactive for HBV in NAT; this was missed by enhanced chemiluminescence assay. Conclusions: Based on the seroprevalence study of infectious diseases viz., HIV, HBV, and HCV, we conclude that screening of blood and blood components by dual testing strategy using high sensitivity serological assay like enhanced chemiluminescence technology and NAT helps in detecting the

  10. Neonatal blood stream infections in tertiary referral hospitals in Kurdistan, Iran.

    Science.gov (United States)

    Nikkhoo, Bahram; Lahurpur, Fariba; Delpisheh, Ali; Rasouli, Mohammad Aziz; Afkhamzadeh, Abdorrahim

    2015-06-09

    Bloodstream infection (BSI) is one of the most common causes of nosocomial infection in neonatal intensive care units (NICU). The aim of the present study was to determine bacterial agents and their susceptibility patterns to antibiotics and to investigate the risk factors associated with BSI. This was a nested case-control study carried out from September 2009 to June 2010 in the NICU wards in Sanandaj hospitals western Iran. Cases were patients with BSI and controls were other patients who had negative blood culture. Bacteriologic diagnosis and antibiotic susceptibility pattern was performed based on the Edward & Ewings and the National Committee of Clinical Laboratory (NCCL) Standards. Of 472 patients who hospitalized in NICU, 6.4% had BSI (n = 30) including 17girls (56.7%) and 13 boys (43.3%). Enterobacter SPP was the predominant isolated bacteria from blood culture (36.7%). The maximum antibiotic resistance and sensitivity were observed by Tetracycline and Ciprofloxacin respectively. Risk factors associated with BSI were age ≤ 7 days (p = 0.001), previous antibiotic consumption (p = 0.013), and low birth weight (LBW), (p = 0.001). Gram negative bacteria and Entrobacter in particular are the most common pathogens. Improving prenatal health care, standards of infection control and choosing accurate antibiotics are recommended to avoid BSI in neonatal intensive care units.

  11. Inter-Arm Blood Pressure Difference in Hospitalized Elderly Patients Is Not Associated With Excess Mortality.

    Science.gov (United States)

    Weiss, Avraham; Grossman, Alon; Beloosesky, Yichayaou; Koren-Morag, Nira; Green, Hefziba; Grossman, Ehud

    2015-10-01

    Inter-arm blood pressure difference (IAD) has been found to be associated with cardiovascular mortality. Its clinical significance and association with mortality in the elderly is not well defined. This study evaluated the association of IAD with mortality in a cohort of hospitalized elderly individuals. Blood pressure (BP) was measured simultaneously in both arms in elderly individuals (older than 65 years) hospitalized in a geriatric ward from October 2012 to July 2014. During the study period, 445 patients, mostly women (54.8%) with a mean age of 85±5 years, were recruited. Systolic and diastolic IAD were >10 mm Hg in 102 (22.9%) and 76 (17.1%) patients, respectively. Patients were followed for an average of 342±201 days. During follow-up, 102 patients (22.9%) died. Mortality was not associated with systolic or diastolic IAD. It is therefore questionable whether BP should be routinely measured in both arms in the elderly. © 2015 Wiley Periodicals, Inc.

  12. Blood pressure change does not associate with Center of Pressure movement after postural transition in geriatric outpatients

    NARCIS (Netherlands)

    Timmermans, Sjoerd T.; Reijnierse, Esmee M.; Pasma, J.H.; Trappenburg, Marijke C.; Blauw, Gerard J.; Maier, Andrea B.; Meskers, Carel G M

    2018-01-01

    Background: Orthostatic hypotension (OH), a blood pressure drop after postural change, is associated with impaired standing balance and falls in older adults. This study aimed to assess the association between blood pressure (BP) and a measure of quality of standing balance, i.e. Center of

  13. Analysis of the Service Quality of Medical Centers Using Servqual Model (Case:Shaheed Rahnemoon Hospital

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    H Zare Ahmadabadi

    2007-07-01

    Full Text Available Introduction: Many organizations, especially service oriented ones, relative to their goals and mission, have a special view towards quality phenomena and its management. Methods: This paper analyzes medical service quality in one case; The internal section of Shaheed Rahnemoon Hospital Based on the basis of gap analysis model and Servqual technique. A questionnaire was designed and applied to measure expectations and perceptions of patients and personnel of the hospital. Results: On application of non-parametric statistical tests, we propose certain recommendations. These tests drive on five conceptual dimensions of service quality including intangibility, responsiveness, reliability, assurance and empathy. Results show that patients in this section were satisfied from the service provider’s responsiveness, but there are significant differences between expectations and perceptions in other dimensions. Conclusion: The service quality analysis models are useful for managers of medical centers to distinguish gaps between the two sides of service representation; patients and medical centers personnel. Ultimately, they can reinforce strengths and control weaknesses.

  14. The real world of blood glucose point-of-care testing (POCT) system running in China teaching hospital.

    Science.gov (United States)

    Li, Feng-Fei; Xie, Yun; Shi, Bing-Yin; Niu, Min; Guo, Hui; Cao, Yan; Liu, Bing-Li; Yan, Reng-Na; Su, Xiao-Fei; Wu, Jin-Dan; Zhang, Dan-Feng; Chen, Li-Ming; Ma, Jian-Hua

    2018-06-01

     The blood glucose point-of-care testing (POCT) system is important in the decision-making process involving patients suspected of having hypoglycemia. To investigate the real world of the POCT system being used in teaching hospitals in China. The survey was conducted by Hisend Research Group from May 2015 to July 2015 in four teaching hospitals in China. The survey questions were referred to the ISO 15197:2013 standard requirements for the use of the POCT system in a hospital setting. A total of 170 subjects were included from 4 hospitals, which included nursing staff, nurse unit managers, employees from the department of medical instruments, and staff members employed by the clinical laboratories in the Tianjin Metabolism Hospital, Nanjing First Hospital, First Affiliated Hospital of Dalian Medical University, and the First hospital affiliated with the Xi'an Transportation University. The average score for the four hospitals surveyed in this study was 66.6, which varied from 46.1 to 79.7. The main factors influencing the scores were the multiple choices of blood-glucose meters, and the quality control assessment. Our data indicates that the real world use of the POCT system in hospital settings in China needs more closer adherence to a quality management framework.

  15. Usefullness of routine use of fecal occult blood test in a hospital setting

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    Simona Ravnik

    2006-12-01

    Full Text Available Background: Fecal occult blood test, hematest, is a well excepted non-invasive method used for detecting different diseases of the gastrointestinal tract. It was proven in different randomized studies that usage of this simple method may facilitate further diagnostic and therapeutic treatment.Patients and methods: The retrospective analysis includes patients, which were admitted to the gastroenterological and endoscopy department of the General hospital Maribor in the last quarter of the year 2005. In all patients fecal occult blood test was performed.Results: We examined 200 patients, 104 women and 96 men, average age 63.9 years, SD±16.9, ranging from 21 to 97 years. Positive hematest was discovered in 76 patients (38 %. The source of hemorrhage from the upper digestive tract was confirmed in 37 patients (48.6 % of all positive tests and from the lower digestive tract in 34 patients (46 % of all positive tests. The most frequent causes of hemorrhage from the lower digestive tract were chronic inflammatory bowel disease (13.1 % of all positive tests, colorectal cancer (10.5 % and polyps (6.6 %. The source of hemorrhage was not located in five patients (6.6 % of all positive tests despite the accurate diagnostic procedure.Conclusions: By performing a fecal occult blood screening in non-symptomatic patients, we can make an essential step towards discovering different gastrointestinal diseases, even colorectal cancer in its early, limited form, when the effect of treatment is greatest.

  16. Frequency of Blood Culture Isolates and their Antibiogram in a Teaching Hospital

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    Subha Shrestha

    2014-03-01

    Full Text Available Introduction: Bloodstream infections are associated with significant patient morbidity and mortality. Antimicrobial susceptibility patterns should guide the choice of empiric antimicrobial regimens for patients with bacteremia. Methods: Blood sample received from the patient attending Nepal Medical College and Teaching Hospital from March 2013 – August, 2013 were subjected to for culture. Isolate identification and antimicrobial susceptibility testing was done by standard microbiological method Results: Out of the total 2,766 blood samples, 13.3% showed bacterial growth. The percentage of neonatal septicemia was 13.3%. Staphylococcus aureus (28% was the most common isolates followed by Salmonella enterica Serotype Typhi (22%, Coagulase negative Staphylococci (9.5%, Salmonella enterica Serotype Paratyphi ((7.6% and Klebsiella pneumoniae (7.6%. 26.3% of the isolates of Staphylococcus aureus were oxacillin resistant. Most of the gram positive organisms were susceptible to amikacin and vancomycin and showed high level resistance to cefuroxime and cotrimoxazole. Out of 109 isolates of typhoid bacilli, 95.3% were resistant to nalidixic acid ,79% to ciprofloxacin and 60.5% to ofloxacin. More than 50% of the isolates of Klebsiella pneumoniae and Escherichia coli showed resistance to cephalosporins and cotrimoxazole. Acinetobacter spp showed high resistance (more than 60% to ceftriaxone and ofloxacin. More than 20% of the isolates of Pseudomonas aeruginosa were resistant to ciprofloxacin and amikacin. Conclusions: Ongoing surveillance for antimicrobial susceptibility remains essential, and will enhance efforts to identify resistance and attempt to limit its spread. Keywords: antibiotic; bacteria; blood stream infections.

  17. The preanalytical optimization of blood cultures: a review and the clinical importance of benchmarking in 5 Belgian hospitals.

    Science.gov (United States)

    Willems, Elise; Smismans, Annick; Cartuyvels, Reinoud; Coppens, Guy; Van Vaerenbergh, Kristien; Van den Abeele, Anne-Marie; Frans, Johan

    2012-05-01

    Bloodstream infections remain a major challenge in medicine. Optimal detection of pathogens is only possible if the quality of preanalytical factors is thoroughly controlled. Since the laboratory is responsible for this preanalytical phase, the quality control of critical factors should be integrated in its quality control program. The numerous recommendations regarding blood culture collection contain controversies. Only an unambiguous guideline permits standardization and interlaboratory quality control. We present an evidence-based concise guideline of critical preanalytical determinants for blood culture collection and summarize key performance indicators with their concomitant target values. In an attempt to benchmark, we compared the true-positive rate, contamination rate, and collected blood volume of blood culture bottles in 5 Belgian hospital laboratories. The true-positive blood culture rate fell within previously defined acceptation criteria by Baron et al. (2005) in all 5 hospitals, whereas the contamination rate exceeded the target value in 4 locations. Most unexpected, in each of the 5 laboratories, more than one third of the blood culture bottles were incorrectly filled, irrespective of the manufacturer of the blood culture vials. As a consequence of this shortcoming, one manufacturer recently developed an automatic blood volume monitoring system. In conclusion, clear recommendations for standardized blood culture collection combined with quality control of critical factors of the preanalytical phase are essential for diagnostic blood culture improvement. Copyright © 2012 Elsevier Inc. All rights reserved.

  18. The ethical leadership challenge: creating a culture of patient- and family-centered care in the hospital setting.

    Science.gov (United States)

    Piper, Llewellyn E

    2011-01-01

    The growing number of medical errors and resulting preventable deaths in hospitals presents an ethical dilemma that must be addressed by health care leaders and managers. These medical errors and deaths raise questions about safety and quality issues resulting in rising public mistrust and patient dissatisfaction. Many of these medical errors and deaths could have been avoided by including the patient and family in the care. The ethical challenge for leadership is creating a culture of patient- and family-centered care as a means to improve quality, safety, patient satisfaction, and public trust. This article addresses ways to improve safety, quality, patient satisfaction, and cost and thereby reduce medical errors and deaths by implementing a patient- and family-centered care culture. The first critical step for improvement is for hospital leaders and managers to answer the ethical call to create a culture centered on patient- and family-centered care in the hospital setting.

  19. Factors interfering with the accuracy of five blood glucose meters used in Chinese hospitals.

    Science.gov (United States)

    Lv, Hong; Zhang, Guo-jun; Kang, Xi-xiong; Yuan, Hui; Lv, Yan-wei; Wang, Wen-wen; Randall, Rollins

    2013-09-01

    The prevalence of diabetes is increasing in China. Glucose control is very important in diabetic patients. The aim of this study was to compare the accuracy of five glucose meters used in Chinese hospitals with a reference method, in the absence and presence of various factors that may interfere with the meters. Within-run precision of the meters was evaluated include Roche Accu-Chek Inform®, Abbott Precision PCx FreeStyle®, Bayer Contour®, J&J LifeScan SureStep Flexx®, and Nova Biomedical StatStrip®. The interference of hematocrit level, maltose, ascorbic acid, acetaminophen, galactose, dopamine, and uric acid were tested in three levels of blood glucose, namely low, medium, and high concentrations. Accuracy (bias) of the meters and analytical interference by various factors were evaluated by comparing results obtained in whole blood specimens with those in plasma samples of the whole blood specimens run on the reference method. Impact of oxygen tension on above five blood glucose meters was detected. Precision was acceptable and slightly different between meters. There were no significant differences in the measurements between the meters and the reference method. The hematocrit level significantly interfered with all meters, except StatStrip. Measurements were affected to varying degrees by different substances at different glucose levels, e.g. acetaminophen and ascorbic acid (Freestyle), maltose and galactose (FreeStyle, Accu-Chek), uric acid (FreeStyle, Bayer Contour), and dopamine (Bayer Contour). The measurements with the five meters showed a good correlation with the plasma hexokinase reference method, but most were affected by the hematocrit level. Some meters also showed marked interference by other substances. © 2013 Wiley Periodicals, Inc.

  20. Blood sample collection and patient identification demand improvement: a questionnaire study of preanalytical practices in hospital wards and laboratories.

    Science.gov (United States)

    Wallin, Olof; Söderberg, Johan; Van Guelpen, Bethany; Stenlund, Hans; Grankvist, Kjell; Brulin, Christine

    2010-09-01

    Scand J Caring Sci; 2010; 24; 581-591 
 Blood sample collection and patient identification demand improvement: a questionnaire study of preanalytical practices in hospital wards and laboratories   Most errors in venous blood testing result from human mistakes occurring before the sample reach the laboratory.   To survey venous blood sampling (VBS) practices in hospital wards and to compare practices with hospital laboratories.   Staff in two hospitals (all wards) and two hospital laboratories (314 respondents, response rate 94%), completed a questionnaire addressing issues relevant to the collection of venous blood samples for clinical chemistry testing.   The findings suggest that instructions for patient identification and the collection of venous blood samples were not always followed. For example, 79% of the respondents reported the undesirable practice (UDP) of not always using wristbands for patient identification. Similarly, 87% of the respondents noted the UDP of removing venous stasis after the sampling is finished. Compared with the ward staff, a significantly higher proportion of the laboratory staff reported desirable practices regarding the collection of venous blood samples. Neither education nor the existence of established sampling routines was clearly associated with VBS practices among the ward staff.   The results of this study, the first of its kind, suggest that a clinically important risk of error is associated with VBS in the surveyed wards. Most important is the risk of misidentification of patients. Quality improvement of blood sample collection is clearly needed, particularly in hospital wards. © 2009 The Authors. Journal compilation © 2009 Nordic College of Caring Science.

  1. Estimating the unit costs of public hospitals and primary healthcare centers.

    Science.gov (United States)

    Younis, Mustafa Z; Jaber, Samer; Mawson, Anthony R; Hartmann, Michael

    2013-01-01

    Many factors have affected the rise of health expenditures, such as high-cost medical technologies, changes in disease patterns and increasing demand for health services. All countries allocate a significant portion of resources to the health sector. In 2008, the gross domestic product of Palestine was estimated to be at $6.108bn (current price) or about $1697 per capita. Health expenditures are estimated at 15.6% of the gross domestic product, almost as much as those of Germany, Japan and other developed countries. The numbers of hospitals, hospital beds and primary healthcare centers in the country have all increased. The Ministry of Health (MOH) currently operates 27 of 76 hospitals, with a total of 3074 beds, which represent 61% of total beds of all hospitals in the Palestinian Authorities area. Also, the MOH is operating 453 of 706 Primary Health Care facilities. By 2007, about 40 000 people were employed in different sectors of the health system, with 33% employed by the MOH. This purpose of this study was to develop a financing strategy to help cover some or all of the costs involved in operating such institutions and to estimate the unit cost of primary and secondary programs and departments. A retrospective study was carried out on data from government hospitals and primary healthcare centers to identify and analyze the costs and output (patient-related services) and to estimate the unit cost of health services provided by hospitals and PHCs during the year 2008. All operating costs are assigned and allocated to the departments at MOH hospitals and primary health care centers (PPHCs) and are identified as overhead departments, intermediate-service and final-service departments. Intermediate-service departments provide procedures and services to patients in the final-service departments. The costs of the overhead departments are distributed to the intermediate-service and final-service departments through a step-down method, according to allocation

  2. A retrospective study: ABO and Rh phenotype blood group distribution among blood donors in H.N.B. Base Hospital, Srinagar, Uttarakhand, India

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    Satish Kumar

    2018-01-01

    Full Text Available Objective: To determine the prevalence of ABO and Rh blood groups based on the antigenic presence on the surface of red blood cells with respect to gender and calculate allele frequency of the blood groups. Globally, approximately 700 type red cell antigens have been identified till now. ABO and Rh blood groups play an important role in the process of blood transfusion, resolving certain medicolegal issues, parental testing, and various genetic studies. Methods: This study was conducted in H.N.B. Base Hospital, Srinagar, Uttarakhand, from January 2012 to December 2016. Relevant data of blood donors were collected from blood bank department of the hospital. Blood grouping was conducted using commercially available standard monoclonal antisera applying test tube and column agglutination techniques. Results: Out of 9883 individuals, 9333 (92.4% were males and 750 (7.6% were female individuals. The most common blood group found was B (31.68% and least common being AB (11.70%. The prevalence of Rhesus positive and negative distribution in the present studied population was found as 93.51% and 6.49%, respectively. Overall, male ABO group pattern found was shown by formula B > A > O > AB which was similar among Rh-positive male individuals while Rh-negative males' pattern was found as A > B = O > AB. In females, ABO group pattern was B > O > A > AB which was similar to Rh-positive female pattern while differs in Rh negative. The estimated allele frequencies were found as 0.2403, 0.2475, and 0.5122 for IA (p, IB (q, and IO (r, respectively. Conclusion: The most common blood group found among the Gharwali donors was B positive while the least common was AB negative, which plays an important contribution for making government policies to develop National Health Program.

  3. Factors Associated with a Prolonged Length of Hospital Stay in Patients with Diabetic Foot: A Single-Center Retrospective Study.

    Science.gov (United States)

    Choi, Sang Kyu; Kim, Cheol Keun; Jo, Dong In; Lee, Myung Chul; Kim, Jee Nam; Choi, Hyun Gon; Shin, Dong Hyeok; Kim, Soon Heum

    2017-11-01

    We conducted this study to identify factors that may prolong the length of the hospital stay (LHS) in patients with diabetic foot (DF) in a single-institution setting. In this single-center retrospective study, we evaluated a total of 164 patients with DF, and conducted an intergroup comparison of their baseline demographic and clinical characteristics, including sex, age, duration of diabetes, smoking status, body mass index, underlying comorbidities (e.g., hypertension or diabetic nephropathy), wound characteristics,type of surgery, the total medical cost, white blood cell (WBC) count, C-reactive protein (CRP) levels, erythrocyte sedimentation rate, and albumin, protein, glycated hemoglobin, and 7-day mean blood glucose (BG) levels. Pearson correlation analysis showed that an LHS of >5 weeks had a significant positive correlation with the severity of the wound (r=0.647), WBC count (r=0.571), CRP levels (r=0.390), DN (r=0.020), and 7-day mean BG levels (r=0.120) (PLHS of >5 weeks had a significant positive correlation with the severity of the wound (odds ratio [OR]=3.297; 95% confidence interval [CI], 1.324-10.483; P=0.020), WBC count (OR=1.423; 95% CI, 0.046-0.356; P=0.000), CRP levels (OR=1.079; 95% CI, 1.015-1.147; P=0.014), albumin levels (OR=0.263; 95% CI, 0.113-3.673; P=0.007), and 7-day mean BG levels (OR=1.018; 95% CI, 1.001-1.035; P=0.020). Surgeons should consider the factors associated with a prolonged LHS in the early management of patients with DF. Moreover, this should also be accompanied by a multidisciplinary approach to reducing the LHS.

  4. Factors Associated with a Prolonged Length of Hospital Stay in Patients with Diabetic Foot: A Single-Center Retrospective Study

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    Sang Kyu Choi

    2017-11-01

    Full Text Available Background We conducted this study to identify factors that may prolong the length of the hospital stay (LHS in patients with diabetic foot (DF in a single-institution setting. Methods In this single-center retrospective study, we evaluated a total of 164 patients with DF, and conducted an intergroup comparison of their baseline demographic and clinical characteristics, including sex, age, duration of diabetes, smoking status, body mass index, underlying comorbidities (e.g., hypertension or diabetic nephropathy, wound characteristics,type of surgery, the total medical cost, white blood cell (WBC count, C-reactive protein (CRP levels, erythrocyte sedimentation rate, and albumin, protein, glycated hemoglobin, and 7-day mean blood glucose (BG levels. Results Pearson correlation analysis showed that an LHS of >5 weeks had a significant positive correlation with the severity of the wound (r=0.647, WBC count (r=0.571, CRP levels (r=0.390, DN (r=0.020, and 7-day mean BG levels (r=0.120 (P5 weeks had a significant positive correlation with the severity of the wound (odds ratio [OR]=3.297; 95% confidence interval [CI], 1.324–10.483; P=0.020, WBC count (OR=1.423; 95% CI, 0.046–0.356; P=0.000, CRP levels (OR=1.079; 95% CI, 1.015–1.147; P=0.014, albumin levels (OR=0.263; 95% CI, 0.113–3.673; P=0.007, and 7-day mean BG levels (OR=1.018; 95% CI, 1.001–1.035; P=0.020. Conclusions Surgeons should consider the factors associated with a prolonged LHS in the early management of patients with DF. Moreover, this should also be accompanied by a multidisciplinary approach to reducing the LHS.

  5. Electronic remote blood issue: a combination of remote blood issue with a system for end-to-end electronic control of transfusion to provide a "total solution" for a safe and timely hospital blood transfusion service.

    Science.gov (United States)

    Staves, Julie; Davies, Amanda; Kay, Jonathan; Pearson, Oliver; Johnson, Tony; Murphy, Michael F

    2008-03-01

    The rapid provision of red cell (RBC) units to patients needing blood urgently is an issue of major importance in transfusion medicine. The development of electronic issue (sometimes termed "electronic crossmatch") has facilitated rapid provision of RBC units by avoidance of the serologic crossmatch in eligible patients. A further development is the issue of blood under electronic control at blood refrigerator remote from the blood bank. This study evaluated a system for electronic remote blood issue (ERBI) developed as an enhancement of a system for end-to-end electronic control of hospital transfusion. Practice was evaluated before and after its introduction in cardiac surgery. Before the implementation of ERBI, the median time to deliver urgently required RBC units to the patient was 24 minutes. After its implementation, RBC units were obtained from the nearby blood refrigerator in a median time of 59 seconds (range, 30 sec to 2 min). The study also found that unused requests were reduced significantly from 42 to 20 percent, the number of RBC units issued reduced by 52 percent, the number of issued units that were transfused increased from 40 to 62 percent, and there was a significant reduction in the workload of both blood bank and clinical staff. This study evaluated a combination of remote blood issue with an end-to-end electronically controlled hospital transfusion process, ERBI. ERBI reduced the time to make blood available for surgical patients and improved the efficiency of hospital transfusion.

  6. Prospective change control analysis of transfer of platelet concentrate production from a specialized stem cell transplantation unit to a blood transfusion center.

    Science.gov (United States)

    Sigle, Joerg-Peter; Medinger, Michael; Stern, Martin; Infanti, Laura; Heim, Dominik; Halter, Joerg; Gratwohl, Alois; Buser, Andreas

    2012-01-01

    Specialized centers claim a need for blood component production independent from the general blood transfusion services. We performed a prospective change control analysis of the transfer of platelet (PLT) production for hematological patients at the University Hospital Basel from the Department of Hematology to the Blood Transfusion Centre, Swiss Red Cross, Basel in February 2006. We wanted to demonstrate that neither quality nor transfusion outcome was affected. Production quantity and efficiency, product quality and transfusion outcome were systematically recorded. A 2-year pretransfer period was compared to a 2 year post-transfer period. After transfer production quantity at the Blood Transfusion Centre increased from 4,483 to 6,190 PLT concentrates. Production efficiency increased with a significant decrease in the rate of expired products (18% vs. 8%; P 5 × 10(11); P 5 vs. 10.7; P = 0.3) and the rate of patients with inadequate post-transfusion increment (31.5% vs. 32.1%; P = 0.6) did not differ. Supply and quality of PLT products was maintained after the transfer of PLT production to the Blood Transfusion Centre. An optimization of the supply chain process with markedly decreased expiration rates was achieved. These results argue against the need of specialized PLT production sites for selected patient groups. Copyright © 2012 Wiley Periodicals, Inc.

  7. CASE REPORT OF PATIENTS WITH LEPTOSPIROSIS HOSPITALIZED IN THE DEPARTMENT OF INFECTIOUS DISEASES AT GENERAL HOSPITAL MURSKA SOBOTA IN THE YEAR 2002 – THE SIGNIFICANCE OF BLOOD CULTURE

    Directory of Open Access Journals (Sweden)

    Emil Pal

    2003-05-01

    Full Text Available Background. Leptospirosis is a zoonosis with worldwide distribution. In Slovenia, Pomurje is an endemic area. Manifestations of leptospirosis may be observed as different types of disease. The range from a short-lived febrile state to a severe disease with renal failure, liver impairment, hemorrhage and fulminant course.Patients and methods. Until year 2001 in the Department of infectious diseases at General Hospital Murska Sobota, only serological methods in diagnosis of leptospirosis had been used. Only in 2002 isolation of leptospires from blood was used. Four cases of confirmed leptospirosis hospitalized in our Department in 2002 were presented with broad spectrum of clinical courses and the significance of cultivation of leptospires from blood in the diagnosis.Conclusions. Because of the protean manifestations of leptospirosis, microbiological tests are essential for confirmatory diagnosis. In case of epidemiological data, clinical course and laboratory markers suggesting the diagnosis of leptospirosis, it is advisible to obtain blood cultures.

  8. Beam stability of cyclotron accelerator for therapy at National Cancer Center Hospital East

    International Nuclear Information System (INIS)

    Nishio, T.; Ogino, T.; Shinbo, M.; Ikeda, H.; Tachikawa, T.; Kumata, Y.

    2000-01-01

    In 1997, the proton-treatment facility that has the therapeutic AVF cyclotron accelerator (C235), is constructed at National Cancer Center Hospital East. The facility has 3-irradiation ports (rooms) that are 2-rotationg gantry ports and 1-horizontal fixed port. The C235 can accelerate proton to 235 MeV with the beam intensity of 300 nA. The external diameter is a very compact with about 4 m. The radio frequency is 106 MHz, the accelerating voltage is about 60 kV, and the harmonic number is 4. A beam stability of the C235 has an important relation with the uniformity of an irradiation field and is a very difficulty. The measured result indicated that the incident beam position must be into the 0.5-mmφ circle. (author)

  9. Prevalance of ABO and Rhesus Blood Groups in Blood Donors: A Study from a Tertiary Care Teaching Hospital of Kumaon Region of Uttarakhand.

    Science.gov (United States)

    Garg, Parul; Upadhyay, Saloni; Chufal, Sanjay Singh; Hasan, Yuman; Tayal, Ishwer

    2014-12-01

    Backround: ABO and Rhesus (Rh) blood group antigens are hereditary characters and are useful in population genetic studies, in resolving medico-legal issues and more importantly for the immunologic safety of blood during transfusion. This study is aimed to determine the distribution pattern of the ABO and Rh blood groups among blood donors in Kumaon region of Uttarakhand and compare it with other data from similar studies within the India and all over the world. It is a retrospective study carried out at blood bank of Shushila Tewari Hospital of Government Medical College, Haldwani from January 2012 to December 2013. The study was conducted on 12,701 blood donors. ABO and Rh typing was done using slide agglutination method with antisera ABO and Rh (Tulip diagnostics ltd). Doubtful cases were confirmed by tube agglutination method and reverse grouping using known pooled A and B cells. The age group and sex of donors, frequency of ABO and Rh blood groups were reported in simple percentages. The predominant donors belonged to age group between 18-35years (84.28%). Male donors were more than female donors, ratio being 352:1. Replacement donors (99.71%) were much more than voluntary donors (0.91%). The most common blood group was B (32.07%) and least common being AB (10.53%). Blood group 'O' and 'A' had same frequency. The prevalence of Rhesus positive and negative distribution in the studied population was 94.49% and 5.51% respectively. Blood group frequency with respect to ABO and Rhesus positive was found to be shown by formula B> O>A >AB. The frequency for ABO and Rhesus negative was given by the formula B>A>O>AB. Knowledge of frequencies of the different blood groups is very important for blood banks and transfusion service policies that could contribute significantly to the National Health System.

  10. Pseudoexfoliation Glaucoma in the National Eye Center, Cicendo Eye Hospital, January–October 2012

    Directory of Open Access Journals (Sweden)

    Rizki Fasa Ramdhani

    2015-03-01

    Full Text Available Background: Pseudoexfoliation syndrome is characterized by the deposition of a distinctive fibrillar material in the anterior segment of the eye. This condition is a major risk factor for development of glaucoma, termed pseudoexfoliation glaucoma (PEXG. The aim of this study was to describe the characteristic and management of PEXG in the National Eye Center Cicendo Eye Hospital. Methods: A descriptive retrospective study was conducted in October–November 2012 using medical records of PEXG patients in the National Eye Center Cicendo Eye Hospital during January–October 2012. Results: There were 32 patients (43 eyes diagnosed as PEXG, most of them were male (78.1%, age 70–74 years old (34.4% and followed by those in the range of age 65–69 years old (21.9%. Most of the cases were unilateral (65.6% decrease of visual acuity less than 3/60 (76.7%, increase of intraocular pressure (IOP with majority in the range of 31–40 mmHg (32.6% and 41–50 mmHg (32.6%, Cup/Disc Ratio 0.9–1.0 (46.51% and followed by those classified as majority which were hard to assess because of the presence of opaque media (34.89%. The type of glaucoma was open angle glaucoma (88.4%. The treatment received was a combination of two types of antiglaucoma medication and surgery IOP Conclusion: PEXG is mostly found in elderly patients. While most of the patients come with high IOP and late stage of the disease IOP

  11. Strategic response by providers to specialty hospitals, ambulatory surgery centers, and retail clinics.

    Science.gov (United States)

    Burns, Lawton R; David, Guy; Helmchen, Lorens A

    2011-04-01

    Radical innovation and disruptive technologies are frequently heralded as a solution to delivering higher quality, lower cost health care. According to the literature on disruption, local hospitals and physicians (incumbent providers) may be unable to competitively respond to such "creative destruction" and alter their business models for a host of reasons, thus threatening their future survival. However, strategic management theory and research suggest that, under certain conditions, incumbent providers may be able to weather the discontinuities posed by the disrupters. This article analyzes 3 disruptive innovations in service delivery: single-specialty hospitals, ambulatory surgical centers, and retail clinics. We first discuss the features of these innovations to assess how disruptive they are. We then draw on the literature on strategic adaptation to suggest how incumbents develop competitive responses to these disruptive innovations that assure their continued survival. These arguments are then evaluated in a field study of several urban markets based on interviews with both incumbents and entrants. The interviews indicate that entrants have failed to disrupt incumbent providers primarily as a result of strategies pursued by the incumbents. The findings cast doubt on the prospects for these disruptive innovations to transform health care.

  12. Outcome of Accidental Exposure Prone to Blood Borne Viral Infections in an Educational Hospital

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    Shahnaz Sali

    2016-04-01

    Full Text Available Background: The risk for transmission of blood-borne viruses (BBVs such as Human immunodeficiency virus (HIV, hepatitis B virus (HBV and hepatitis C virus (HCV due to occupational exposure is a major concern in the health care setting.Materials and Methods: This study among 337 health care workers (HCWs accidentally exposed to BBVs was carried out from January 2009 to March 2015. The data were reviewed in labbafinejhad hospital, Tehran, Iran.Results: 4 HCWs had exposure to HBS Ag positive, which HBS antibody titer of them was higher than 10 mlu/ml, 6 HCWs were exposed to HCV seropositive patients underwent laboratory investigations for  HCV-antibody on 4,12, 24 weeks that results were negative. 3 cases had exposure to HIV seropositive patients which received standard antiretroviral post exposure prophylaxis.Conclusion: Timely performance for PEP (Post Exposure Prophylaxis reducing BBVs transmission among HCWs.prophylaxis. Conclusions: Timely performance for  PEP(Post Exposure Prophylaxis reducing BBVs transmission among HCWs.Key words: Outcome; Accidental Exposure; Blood Borne Viral Infections

  13. [Effectiveness of a nutritional education program in lowering blood cholesterol levels in a public health center].

    Science.gov (United States)

    Seki, M; Yamaguchi, T

    1993-06-01

    An educational program for persons found to have high blood cholesterol during health examinations at the Nerima Public Health Center was begun in April, 1989. This program was differed from the usual program in two areas. First, new educational material was developed consisting of a check list of 30 items to assess eating patterns. By checking these items, participants could gain an understanding of what they should change in their eating behavior. Secondly, the table of restricted foods was not used. Participants were advised to achieve healthy eating patterns and followed up with a nutritional consultation that was held after three months, at which time they were interviewed regarding compliance and had their blood cholesterol levels measured. The effectiveness of the new educational program and the relationship between achievement of healthy eating patterns and reduction in blood cholesterol levels were analyzed. The main results were as follows: 1) In subjects (n = 79) who received the new education program in 1989-1990, serum cholesterol levels showed significant reduction, as compared with controls (n = 38) who received the usual education program in 1988-1989. 2) Subjects were divided into three groups according to their changes in serum cholesterol levels,--normalized, improved and unimproved--and the number of items complied with were counted for analysis. The mean score of compliance was highest in the normalized group with significant difference between the normalized and the unimproved groups. 3) The items of the high compliance score in the normalized group were in order of high score "to decrease high-fat meats", "to decrease cakes", "to choose lean meats and poultry without skin" and "to eat vegetables at every meal".

  14. [Satisfaction survey in general hospital personnel involved in blood transfusion: implementation of the ISO 9001: 2000 standard].

    Science.gov (United States)

    Chord-Auger, S; de Bouchony, E Tron; Moll, M-C; Boudart, D; Folléa, G

    2004-07-01

    As part of its policy of constant quality improvement, Etablissement Français du Sang (EFS) des Pays de la Loire (Pays de la Loire Regional blood transfusion institution) carried out a satisfaction survey among the hospital personnel involved in prescribing and using immuno-hematological tests and labile blood products. The polling tool selected by agreement between the hospital management and quality assurance department was a questionnaire that permitted item rating and free commentary. It addressed the personnel's perception of the quality of erythrocyte immuno-hematological (EIH) testing and of the products administered, as well as their perception of the quality of communications with the local EFS. The questionnaire was sent to 26 physicians and 32 senior nurses in 15 hospital departments. The reply rate was 60% and expressed a 85% overall satisfaction level. Dissatisfaction causes were more specifically analysed, the main one involving labile blood product distribution in emergency situations. A joint undertaking by the EFS and the hospital led to the implementation of corrective measures, including the writing and implementation of a common standard operating procedure for emergency transfusion management. The results obtained demonstrated the feasibility of this type of survey and the interest, to a blood transfusion centre and the hospital personnel involved in transfusion, of assessing their very own perception of service quality.

  15. A comprehensive palliative care center implementation in S.B. Ulus State Hospital

    Directory of Open Access Journals (Sweden)

    Ayla Kabalak

    2012-06-01

    Every people wants to best care and to die painless in their end-stage of life. This is a human right. Therefore, end-of-life care is considered an indicator of health quality all over the world. The ultimate goal of palliative care is to relieve the suffering of patients and their families by the comprehensive assessment and treatment of physical, psychosocial, and spiritual symptoms experienced by patients. After the patient\\s death, palliative care focuses primarily on bereavement of the family. T.C. Ministry of Health to find a solution of this important issue as a first step, the preparations for the establishment of palliative care centers and units, training of health personnel started. S.B. Ulus State Hospital as a team we have set out to open a comprehensive palliative care center. Our goal is to contribute on take place of palliative care organization in health system and to the spread across the country. [J Contemp Med 2012; 2(2.000: 122-126

  16. Environmental dose level survey of radiotherapy center in large cancer hospital

    International Nuclear Information System (INIS)

    Wan Bin; Zhong Hailuo; Wu Dake; Li Jian; Wang Pei; Qi Guohai; Huang Renbing; Lang Jinyi

    2009-01-01

    Objective: To investigate and analyze the radiation dosage around the working environment in radiotherapy centre affiliated to Sichuan cancer hospital in the western China. Methods: In 60 days, we have continuously monitored the accumulated dose that absorbed by doctors, nurses, technicians, physicists and engineers, and investigated the working environment ( 60 Co unit, accelerator, after loading unit, X-ray simulator, CT simulator, gamma knife, MRI and doctor's office) and external environment by using TLD, and compared our results to those released by relevant departments. Results: The average dosage in the working environment is 1.96 μC ·kg -1 ·month -1 , 1.61 μC ·kg -1 ·month -1 in external environment. Conclusion: In the past 25 years, the radiotherapy center constructed strictly by the criterions of environment and protection departments required, so the radiation dosage in or outside the radiotherapy center has reached the national standard, which is safe for the staff and patients. Its instatement that the radiotherapy sites constructed by the related laws well accorded with the safety standards regulated. (authors)

  17. Progression of Blood Pressure and Cardiovascular Outcomes in Hypertensive Patients in a Reference Center

    International Nuclear Information System (INIS)

    Guimarães Filho, Gilberto Campos; Sousa, Ana Luiza Lima; Jardim, Thiago de Souza Veiga; Souza, Weimar Sebba Barroso; Jardim, Paulo César Brandão Veiga

    2015-01-01

    Hypertension is a public health problem, considering its high prevalence, low control rate and cardiovascular complications. Evaluate the control of blood pressure (BP) and cardiovascular outcomes in patients enrolled at the Reference Center for Hypertension and Diabetes, located in a medium-sized city in the Midwest Region of Brazil. Population-based study comparing patients enrolled in the service at the time of their admission and after an average follow-up of five years. Participants were aged ≥18 years and were regularly monitored at the Center up to 6 months before data collection. We assessed demographic variables, BP, body mass index, risk factors, and cardiovascular outcomes. We studied 1,298 individuals, predominantly women (60.9%), and with mean age of 56.7±13.1 years. Over time, there was a significant increase in physical inactivity, alcohol consumption, diabetes, dyslipidemia, and excessive weight. As for cardiovascular outcomes, we observed an increase in stroke and myocardial revascularization, and a lower frequency of chronic renal failure. During follow-up, there was significant improvement in the rate of BP control (from 29.6% to 39.6%; p = 0.001) and 72 deaths, 91.7% of which were due to cardiovascular diseases. Despite considerable improvements in the rate of BP control during follow-up, risk factors worsened and cardiovascular outcomes increased

  18. Progression of Blood Pressure and Cardiovascular Outcomes in Hypertensive Patients in a Reference Center

    Energy Technology Data Exchange (ETDEWEB)

    Guimarães Filho, Gilberto Campos, E-mail: camposguimaraes@yahoo.com.br; Sousa, Ana Luiza Lima; Jardim, Thiago de Souza Veiga; Souza, Weimar Sebba Barroso; Jardim, Paulo César Brandão Veiga [Liga de Hipertensão da Faculdade de Medicina da Universidade Federal de Goiânia, Goiás, GO (Brazil)

    2015-04-15

    Hypertension is a public health problem, considering its high prevalence, low control rate and cardiovascular complications. Evaluate the control of blood pressure (BP) and cardiovascular outcomes in patients enrolled at the Reference Center for Hypertension and Diabetes, located in a medium-sized city in the Midwest Region of Brazil. Population-based study comparing patients enrolled in the service at the time of their admission and after an average follow-up of five years. Participants were aged ≥18 years and were regularly monitored at the Center up to 6 months before data collection. We assessed demographic variables, BP, body mass index, risk factors, and cardiovascular outcomes. We studied 1,298 individuals, predominantly women (60.9%), and with mean age of 56.7±13.1 years. Over time, there was a significant increase in physical inactivity, alcohol consumption, diabetes, dyslipidemia, and excessive weight. As for cardiovascular outcomes, we observed an increase in stroke and myocardial revascularization, and a lower frequency of chronic renal failure. During follow-up, there was significant improvement in the rate of BP control (from 29.6% to 39.6%; p = 0.001) and 72 deaths, 91.7% of which were due to cardiovascular diseases. Despite considerable improvements in the rate of BP control during follow-up, risk factors worsened and cardiovascular outcomes increased.

  19. [Traceability of labile blood products in Morocco: experience of the Ibn-Sina hospital of Rabat between 1999 and 2010].

    Science.gov (United States)

    Ouadghiri, S; Atouf, O; Brick, C; Benseffaj, N; Essakalli, M

    2012-02-01

    The blood transfusion and haemovigilance service of the Ibn-Sina hospital in Rabat (Morocco) was created 1997. This unit manages the pretransfusional tests, distribution of blood products, traceability and haemovigilance. The objective of this study was to analyze, over a period of 12years, the traceability of blood products delivered in our hospital and the measures used to improve feedback information. This is a retrospective study conducted between 1999 and 2010. Traceability rate was calculated from the feedback of traceability forms supplied with blood products (number of blood products noted on traceability forms on the total number of delivered product). To improve traceability rate, several actions were undertaken: one-time training, awareness campaigns and call phones asking for feedback information. Between 1999 and 2010, the service has delivered 173,858 blood products. The average rate of traceability during this period was 13.4 %. Traceability rate varies widely over time (5.2 % in 1999, 15.5 % in 2010) and shows a maximum value of 27.2 % in 2005. Feedback information is lower in emergency departments than in medical and surgical services. Feedback information about traceability in Ibn-Sina hospital remains very poor despite the measures used. Other actions, such as continuous education courses, low enforcement and informatisation should be considered. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  20. Designated Stroke Center Status and Hospital Characteristics as Predictors of In-Hospital Mortality among Hemorrhagic Stroke Patients in New York, 2008-2012.

    Science.gov (United States)

    Gatollari, Hajere J; Colello, Anna; Eisenberg, Bonnie; Brissette, Ian; Luna, Jorge; Elkind, Mitchell S V; Willey, Joshua Z

    2017-01-01

    Although designated stroke centers (DSCs) improve the quality of care and clinical outcomes for ischemic stroke patients, less is known about the benefits of DSCs for patients with intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH). Compared to non-DSCs, hospitals with the DSC status have lower in-hospital mortality rates for hemorrhagic stroke patients. We believed these effects would sustain over a period of time after adjusting for hospital-level characteristics, including hospital size, urban location, and teaching status. We evaluated ICH (International Classification of Diseases, Ninth Revision; ICD-9: 431) and SAH (ICD-9: 430) hospitalizations documented in the 2008-2012 New York State Department of Health Statewide Planning and Research Cooperative System inpatient sample database. Generalized estimating equation logistic regression was used to evaluate the association between DSC status and in-hospital mortality. We calculated ORs and 95% CIs adjusted for clustering of patients within facilities, other hospital characteristics, and individual level characteristics. Planned secondary analyses explored other hospital characteristics associated with in-hospital mortality. In 6,352 ICH and 3,369 SAH patients in the study sample, in-hospital mortality was higher among those with ICH compared to SAH (23.7 vs. 18.5%). Unadjusted analyses revealed that DSC status was related with reduced mortality for both ICH (OR 0.7, 95% CI 0.5-0.8) and SAH patients (OR 0.4, 95% CI 0.3-0.7). DSC remained a significant predictor of lower in-hospital mortality for SAH patients (OR 0.6, 95% CI 0.3-0.9) but not for ICH patients (OR 0.8, 95% CI 0.6-1.0) after adjusting for patient demographic characteristics, comorbidities, hospital size, teaching status and location. Admission to a DSC was independently associated with reduced in-hospital mortality for SAH patients but not for those with ICH. Other patient and hospital characteristics may explain the benefits of DSC

  1. Integration of the clinical engineering specialist at a high complexity children's hospital. Our professional experience at a surgical center

    International Nuclear Information System (INIS)

    Vargas Enriquez, M J; Chazarreta, B; Emilio, D G; Fernandez Sarda, E

    2007-01-01

    This document aims to find relating points between the current and future Clinical Engineer professional in order to discuss about the hospital environment, its characteristics and its realities which lead to our professional development. The main aim is to depict our experience through a retrospective analysis based on the underwriting experience and consequently to arrive at conclusions that will support the inclusion and active interaction of the Clinic Engineer Specialist as part of a Hospital's Surgical Center

  2. [Epidemiological, clinical, cytologic and immunophenotypic aspects of acute leukemia in children: the experience at the hematology laboratory of IBN SINA University Hospital Center].

    Science.gov (United States)

    Doumbia, Mariam; Uwingabiye, Jean; Bissan, Aboubacar; Rachid, Razine; Benkirane, Souad; Masrar, Azlarab

    2016-01-01

    The aim of this study was to describe epidemiological, cytologic and immunophenotypic aspects of acute leukemias (AL) in children diagnosed at IBN SINA University Hospital Center and to determine the concordance between cytology and immunophenotyping results. This is a cross-sectional study conducted in the hematology laboratory of IBN SINA University Hospital Center between June 2012 and May 2014. Among the 104 cases with diagnosed AL, 52% were boys with a sex-ratio H/F= 1.32, the average age was 5.7 years. The distribution of different types of AL was: lymphoid AL (LAL) (74%), myeloid (AML) (20.2%), biphenotypic AL (BAL) (65.8%). Among the LALs, 78% were classified as B LAL and 22% as T LAL. Clinical signs were mainly presented with tumor syndrome (73.1%), fever (61%) and hemorrhagic syndrome (50%). The most common blood count abnormalities were: thrombopenia (89.4%), anemia (86.5%), hyperleukocytosis (79.8%). The rate of peripheral and bone marrow blasts was statistically higher for LAL than for AML and BAL (p <0.001). The rate of relapse and mortality was 21.2% and 16. 3% respectively. Concordance rate between the results of cytology and of immunophenotyping was 92.7% for LAL and 82.6% for AML. Diagnosis of AL is always based primarily on cytology. Immunophenotyping allowed us to make a better distinction between acute leukemias. The management of paediatric AL is a major health problem which requires specialized care centers.

  3. Analysis of bias in measurements of potassium, sodium and hemoglobin by an emergency department-based blood gas analyzer relative to hospital laboratory autoanalyzer results.

    Directory of Open Access Journals (Sweden)

    Jian Bo Zhang

    Full Text Available The emergency departments (EDs of Chinese hospitals are gradually being equipped with blood gas machines. These machines, along with the measurement of biochemical markers by the hospital laboratory, facilitate the care of patients with severe conditions who present to the ED. However, discrepancies have been noted between the Arterial Blood Gas (ABG analyzers in the ED and the hospital laboratory autoanalyzer in relation to electrolyte and hemoglobin measurements. The present study was performed to determine whether the ABG and laboratory measurements of potassium, sodium, and hemoglobin levels are equivalent, and whether ABG analyzer results can be used to guide clinical care before the laboratory results become available.Study power analyses revealed that 200 consecutive patients who presented to our ED would allow this prospective single-center cohort study to detect significant differences between ABG- and laboratory-measured potassium, sodium, and hemoglobin levels. Paired arterial and venous blood samples were collected within 30 minutes. Arterial blood samples were measured in the ED by an ABL 90 FLEX blood gas analyzer. The biochemistry and blood cell counts of the venous samples were measured in the hospital laboratory. The potassium, sodium, and hemoglobin concentrations obtained by both methods were compared by using paired Student's t-test, Spearman's correlation, Bland-Altman plots, and Deming regression.The mean ABG and laboratory potassium values were 3.77±0.44 and 4.2±0.55, respectively (P<0.0001. The mean ABG and laboratory sodium values were 137.89±5.44 and 140.93±5.50, respectively (P<0.0001. The mean ABG and laboratory Hemoglobin values were 12.28±2.62 and 12.35±2.60, respectively (P = 0.24.Although there are the statistical difference and acceptable biases between ABG- and laboratory-measured potassium and sodium, the biases do not exceed USCLIA-determined limits. In parallel, there are no statistical differences and

  4. Internal quality control of blood products: An experience from a tertiary care hospital blood bank from Southern Pakistan

    Directory of Open Access Journals (Sweden)

    Sadia Sultan

    2018-01-01

    CONCLUSION: The IQC of blood products at our blood bank is in overall compliance and met recommended international standards. Implementation of standard operating procedures, accomplishment of standard guidelines, proper documentation with regular audit, and staff competencies can improve the quality performance of the transfusion services.

  5. The development of a national surveillance system for monitoring blood use and inventory levels at sentinel hospitals in South Korea.

    Science.gov (United States)

    Lim, Y A; Kim, H H; Joung, U S; Kim, C Y; Shin, Y H; Lee, S W; Kim, H J

    2010-04-01

    We developed a web-based program for a national surveillance system to determine baseline data regarding the supply and demand of blood products at sentinel hospitals in South Korea. Sentinel hospitals were invited to participate in a 1-month pilot-test. The data for receipts and exports of blood from each hospital information system were converted into comma-separated value files according to a specific conversion rule. The daily data from the sites could be transferred to the web-based program server using a semi-automated submission procedure: pressing a key allowed the program to automatically compute the blood inventory level as well as other indices including the minimal inventory ratio (MIR), ideal inventory ratio (IIR), supply index (SI) and utilisation index (UI). The national surveillance system was referred to as the Korean Blood Inventory Monitoring System (KBIMS) and the web-based program for KBIMS was referred to as the Blood Inventory Monitoring System (BMS). A total of 30 256 red blood cell (RBC) units were submitted as receipt data, however, only 83% of the receipt data were submitted to the BMS server as export data (25 093 RBC units). Median values were 2.67 for MIR, 1.08 for IIR, 1.00 for SI, 0.88 for UI and 5.33 for the ideal inventory day. The BMS program was easy to use and is expected to provide a useful tool for monitoring hospital inventory levels. This information will provide baseline data regarding the supply and demand of blood products in South Korea.

  6. A single center 14 years study of infectious complications leading to hospitalization of patients with primary antibody deficiencies

    Directory of Open Access Journals (Sweden)

    Setareh Mamishi

    Full Text Available Primary antibody deficiencies (PADs are a heterogeneous group of disorders, characterized by hypogammaglobulinemia and increased susceptibility to bacterial infections, leading to hospitalizations. This study was performed to determine the main infectious causes of hospital admissions in selective Iranian patients with PADs. Forty patients with PADs, who were admitted to the Infectious Ward of Children's Medical Center Hospital during a 14-year period, were reviewed in this study. There were 115 documented episodes of hospital admission during a 14-year period. The average length of hospital stay was 33.30 ± 25.72 days. Pneumonia was the most prominent infection leading to hospitalization among these patients (n = 48, followed by gastroenteritis (n = 23. Other less frequent causes of hospitalization were fever and neutropenia, septic arthritis, encephalitis, orbital cellulitis, sepsis, urinary tract infection, meningitis, oral ulcer, and lung abscess. The most common causative organisms of diarrhea were: Giardia lamblia, followed by Candida albicans, and Salmonella sp. Many patients with PADs suffer from repeated infections leading to hospitalization, in spite of immunoglobulin replacement therapy. Respiratory tract infections were the prominent cause of hospitalization among studied patients, followed by gastrointestinal infections.

  7. Moral dilemmas faced by hospitals in time of war: the Rambam Medical Center during the second Lebanon war.

    Science.gov (United States)

    Bar-El, Yaron; Reisner, Shimon; Beyar, Rafael

    2014-02-01

    Rambam Medical Center, the only tertiary care center and largest hospital in northern Israel, was subjected to continuous rocket attacks in 2006. This extreme situation posed serious and unprecedented ethical dilemmas to the hospital management. An ambiguous situation arose that required routine patient care in a tertiary modern hospital together with implementation of emergency measures while under direct fire. The physicians responsible for hospital management at that time share some of the moral dilemmas faced, the policy they chose to follow, and offer a retrospective critical reflection in this paper. The hospital's first priority was defined as delivery of emergency surgical and medical services to the wounded from the battlefields and home front, while concomitantly providing the civilian population with all elective medical and surgical services. The need for acute medical service was even more apparent as the situation of conflict led to closure of many ambulatory clinics, while urgent or planned medical care such as open heart surgery and chemotherapy continued. The hospital management took actions to minimize risks to patients, staff, and visitors during the ongoing attacks. Wards were relocated to unused underground spaces and corridors. However due to the shortage of shielded spaces, not all wards and patients could be relocated to safer areas. Modern warfare will most likely continue to involve civilian populations and institutes, blurring the division between peaceful high-tech medicine and the rough battlefront. Hospitals in high war-risk areas must be prepared to function and deliver treatment while under fire or facing similar threats.

  8. Satisfaction survey in general hospital personnel involved in blood transfusion: implementation of the ISO 9001: 2000 standard.

    Science.gov (United States)

    Chord-Auger, S; Tron de Bouchony, E; Moll, M C; Boudart, D; Folléa, G

    2004-10-01

    As part of its policy of constant quality improvement, Etablissement francais du sang (EFS) des pays de la Loire (Pays de la Loire Regional Blood Transfusion Centre) carried out a satisfaction survey among the hospital personnel involved in prescribing and using immunohaematological tests and labile blood products (LBP). The polling tool selected by agreement between the Saint Nazaire's hospital management and Quality Assurance (QA) Department was a questionnaire that permitted item rating and free commentary. It addressed the personnel's perception of the quality of erythrocyte immunohaematological (EIH) testing and of the products administered, as well as their perception of the quality of communications with the local EFS. The questionnaire was sent to 26 physicians and 32 senior nurses in 15 hospital departments. The reply rate was 60% and expressed an 85% overall satisfaction level. Dissatisfaction causes were more specifically analysed, the main one involving LBP distribution in emergency situations. A joint undertaking by the EFS and the hospital led to the implementation of corrective measures, including the writing and implementation of a common standard operating procedure for emergency transfusion management. The results obtained demonstrated the feasibility of this type of survey and the interest, to a blood transfusion centre and the hospital personnel involved in transfusion, of assessing their very own perception of service quality.

  9. An Analysis of Blood Utilization for Stem Cell Transplant Patients in a Tertiary Care Hospital.

    Science.gov (United States)

    Ali, Natasha

    2017-05-30

    Haematopoietic stem cell transplant is a potentially curative treatment option in various benign and malignant haematological diseases. Patients undergoing stem cell transplant procedure require blood transfusion on a daily basis. Currently, there is paucity of data from developing countries on transfusion practices. This audit was undertaken to determine the consumption of packed red blood cells (PRBCs) transfusion in the bone marrow transplant unit of the Aga Khan University Hospital. A retrospective audit was conducted for packed red cell transfusion ordering practice over a period from June 2014∼June 2015. All consecutive patients, admitted for stem cell transplant procedure for various underlying diseases were included. Outcome measures used in this study were (i) cross match to transfusion (C: T) ratio and (ii) transfusion trigger. During the study period, n=25 patients underwent haematopoietic stem cell transplant. There were n=19 males and n=6 females. One patient was less than 15 years of age while rests were adults. Median age±SD was 26.5±14.5 years (12∼54 years). The underlying diagnosis included Aplastic anemia (n=8), Thalassemia major (n=3), Multiple Myeloma (n=4), Acute leukemia (n=5), Hodgkin's lymphoma (n=4), PRCA (n=1). Grand total consumption of PRBCs during the study period was 204 while 258 products were crossmatch. The C:T ratio was 1.26. The transfusion trigger was Hb level of less than 8 gms/dl. The results of our BMT unit indicate that the C:T ratio and transfusion trigger is comparable to the international benchmark.

  10. Post-9/11 drug- and alcohol- related hospitalizations among World Trade Center Health Registry enrollees, 2003-2010.

    Science.gov (United States)

    Hirst, Andrew; Miller-Archie, Sara A; Welch, Alice E; Li, Jiehui; Brackbill, Robert M

    2018-06-01

    To describe patterns of drug- and alcohol-related hospitalizations among persons exposed to the 2001 World Trade Center (WTC) terrorist attacks and to assess whether 9/11-related exposures or post-9/11 post-traumatic stress disorder (PTSD) were associated with increased odds of hospitalization. Data for adult enrollees in the WTC Health Registry, a prospective cohort study, were linked to New York State (NYS) administrative hospitalization data to identify alcohol- and drug-related hospitalizations from enrollment to December 31, 2010. Logistic regression was used to analyze the associations between substance use-related hospitalization, 9/11-related exposure and PTSD. Of 41,176 NYS resident enrollees, we identified 626 (1.5%) who had at least one alcohol- or drug-related hospitalization; 53.4% (n = 591) of these hospitalizations were for alcohol only diagnoses and 46.6% (n = 515) were drug-related. Witnessing ≥3 traumatic events on 9/11 was significantly associated with having a drug-related hospitalization (AOR 1.4, 95% CI = [1.1, 1.9]). PTSD was significantly associated with both having a drug-related hospitalization as well as an alcohol only-related hospitalization. (AOR 2.6, 95% CI = [2.0, 3.3], AOR 1.8, 95% CI = [1.4, 2.3], respectively). Witnessing traumatic events and having PTSD were independently associated with substance use-related hospitalizations. Targeting people who witnessed traumatic events on 9/11 and/or who have PTSD for substance use- treatment could reduce alcohol and drug-related hospitalizations connected to 9/11. Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

  11. Blood blister-like aneurysms: Single center experience and systematic literature review

    International Nuclear Information System (INIS)

    Gonzalez, Ana Marcos; Narata, Ana Paula; Yilmaz, Hasan; Bijlenga, Philippe; Radovanovic, Ivan; Schaller, Karl; Lovblad, Karl-Olof; Pereira, Vitor Mendes

    2014-01-01

    Blood blister-like aneurysms (BBAs) are a controversial entity. They arise from non-branching sites on the supraclinoid internal carotid artery (ICA) and are suspected to originate from a dissection. Our aim is to describe the BBA cases seen in our center and to present a systematic review of the literature on BBAs. We analyzed the eleven cases of BBA admitted to our center from 2003 to 2012. We assessed the medical history, treatment modality (endovascular and/or surgery), complications and clinical outcome. The cohort included 8 women and 4 men with a mean age of 53.16 years. Treatment of the BBA consisted of stenting and coiling in 5 patients, stenting only in 4 patients, coiling and clipping in 1 patient, clipping only in 1 patient, and conservative treatment in 1 patient. A good outcome was found in 10 patients, as defined by a modified Rankin Scale (mRS) less than or equal to two at three months. A systematic review of the literature was performed, and 314 reported patients were found: 221 patients were treated with a primarily surgical approach, and 87 patients were treated with a primarily endovascular approach. A rescue or second treatment was required in 46 patients (21%). The overall estimated treatment morbidity rate was 17%, and the mortality rate was 15%. BBAs exhibit more aggressive behavior compared to saccular aneurysms, and more intra-operative complications occur with BBAs, independent of the treatment type offered. They are also significantly more likely to relapse and rebleed after treatment. Endovascular treatment offers a lower morbidity–mortality compared with surgical approaches. Multilayer flow-diverting stents appear to be a promising strategy

  12. Blood transfusion practices in a tertiary care center in Northern India

    OpenAIRE

    Kumari, Sonam

    2017-01-01

    Background: Blood transfusion plays vital roles in the medical and surgical practice. To achieve optimum use of blood, transfusion has to be appropriate and judicious consuming minimal resources and manpower. Objective: To evaluate the pattern of blood transfusion requests and utilization with the aim of determining transfusion practice. Materials and Methods: Blood request forms and cross-match worksheets at the blood bank were analyzed over a 6-month period. Numbers of requisitions, b...

  13. Willingness to pay and willingness to accept in a patient-centered blood pressure control study.

    Science.gov (United States)

    Gleason-Comstock, Julie; Streater, Alicia; Goodman, Allen; Janisse, James; Brody, Aaron; Mango, LynnMarie; Dawood, Rachelle; Levy, Phillip

    2017-08-07

    Elevated blood pressure is a major risk factor for cardiovascular disease and stroke but patients often discount recommended behavioral changes and prescribed medications. While effective interventions to promote adherence have been developed, cost-effectiveness from the patient's perspective, has not been well studied. The valuation of patient time and out of pocket expenses should be included while performing cost effectiveness evaluation. The Achieve BP study uses the contingent valuation method to assess willingness to accept (WTA) and willingness to pay (WTP) among patients with a history of uncontrolled blood pressure discharged from an urban emergency department and enrolled in a larger randomized controlled trial. WTA and WTP were assessed by asking patients a series of questions about time and travel costs and time value related to their study participation. A survey was conducted during the final study visit with patients to investigate the effectiveness of a kiosk-based educational intervention on blood pressure control. All study patients, regardless of study arm, received the same clinical protocol of commonly prescribed antihypertensive medication and met with research clinicians four times as part of the study procedures. Thirty-eight patients were offered the opportunity to participate in the cost-effectiveness study and all completed the survey. Statistical comparisons revealed these 38 patients were similar in representation to the entire RCT study population. All 38 (100.0%) were African-American, with an average age of 49.1 years; 55.3% were male, 21.1% were married, 78.9% had a high school or higher education, and 44.7% were working. 55.9% did not have a primary care provider and 50.0% did not have health insurance. Time price linear regression analysis was performed to estimate predictors of WTA and WTP. WTP and WTA may generate different results, and the elasticities were proportional to the estimated coefficients, with WTP about twice as

  14. An international investigation into O red blood cell unit administration in hospitals: the GRoup O Utilization Patterns (GROUP) study.

    Science.gov (United States)

    Zeller, Michelle P; Barty, Rebecca; Aandahl, Astrid; Apelseth, Torunn O; Callum, Jeannie; Dunbar, Nancy M; Elahie, Allahna; Garritsen, Henk; Hancock, Helen; Kutner, José Mauro; Manukian, Belinda; Mizuta, Shuichi; Okuda, Makoto; Pagano, Monica B; Pogłód, Ryszard; Rushford, Kylie; Selleng, Kathleen; Sørensen, Claess Henning; Sprogøe, Ulrik; Staves, Julie; Weiland, Thorsten; Wendel, Silvano; Wood, Erica M; van de Watering, Leo; van Wordragen-Vlaswinkel, Maria; Ziman, Alyssa; Jan Zwaginga, Jaap; Murphy, Michael F; Heddle, Nancy M; Yazer, Mark H

    2017-10-01

    Transfusion of group O blood to non-O recipients, or transfusion of D- blood to D+ recipients, can result in shortages of group O or D- blood, respectively. This study investigated RBC utilization patterns at hospitals around the world and explored the context and policies that guide ABO blood group and D type selection practices. This was a retrospective study on transfusion data from the 2013 calendar year. This study included a survey component that asked about hospital RBC selection and transfusion practices and a data collection component where participants submitted information on RBC unit disposition including blood group and D type of unit and recipient. Units administered to recipients of unknown ABO or D group were excluded. Thirty-eight hospitals in 11 countries responded to the survey, 30 of which provided specific RBC unit disposition data. Overall, 11.1% (21,235/191,397) of group O units were transfused to non-O recipients; 22.6% (8777/38,911) of group O D- RBC units were transfused to O D+ recipients, and 43.2% (16,800/38,911) of group O D- RBC units were transfused to recipients that were not group O D-. Disposition of units and hospital transfusion policy varied within and across hospitals of different sizes, with transfusion of group O D- units to non-group O D- patients ranging from 0% to 33%. A significant proportion of group O and D- RBC units were transfused to compatible, nonidentical recipients, although the frequency of this practice varied across sites. © 2017 AABB.

  15. Patient-centered care, nurse work environment and implicit rationing of nursing care in Swiss acute care hospitals: A cross-sectional multi-center study.

    Science.gov (United States)

    Bachnick, Stefanie; Ausserhofer, Dietmar; Baernholdt, Marianne; Simon, Michael

    2018-05-01

    Patient-centered care is a key element of high-quality healthcare and determined by individual, structural and process factors. Patient-centered care is associated with improved patient-reported, clinical and economic outcomes. However, while hospital-level characteristics influence patient-centered care, little evidence is available on the association of patient-centered care with characteristic such as the nurse work environment or implicit rationing of nursing care. The aim of this study was to describe patient-centered care in Swiss acute care hospitals and to explore the associations with nurse work environment factors and implicit rationing of nursing care. This is a sub-study of the cross-sectional multi-center "Matching Registered Nurse Services with Changing Care Demands" study. We included 123 units in 23 acute care hospitals from all three of Switzerland's language regions. The sample consisted of 2073 patients, hospitalized for at least 24 h and ≥18 years of age. From the same hospital units, 1810 registered nurses working in direct patient care were also included. Patients' perceptions of patient-centered care were assessed using four items from the Generic Short Patient Experiences Questionnaire. Nurses completed questionnaires assessing perceived staffing and resource adequacy, adjusted staffing, leadership ability and level of implicit rationing of nursing care. We applied a Generalized Linear Mixed Models for analysis including individual-level patient and nurse data aggregated to the unit level. Patients reported high levels of patient-centered care: 90% easily understood nurses, 91% felt the treatment and care were adapted for their situation, 82% received sufficient information, and 70% felt involved in treatment and care decisions. Higher staffing and resource adequacy was associated with higher levels of patient-centered care, e.g., sufficient information (β 0.638 [95%-CI: 0.30-0.98]). Higher leadership ratings were associated with

  16. How to market an affiliation. St. Elizabeth Hospital and Mercy Medical Center affiliate to create Affinity Health System.

    Science.gov (United States)

    1996-01-01

    When Wisconsin's St. Elizabeth Hospital and Mercy Medical Center affiliated to create Affinity Health System, Inc., strategic planning and a solid marketing plan carefully executed were instrumental in its success. A corporate identity campaign and product line identification were follow-up phases to the merger approval.

  17. A 2-year retrospective study of pediatric dental emergency visits at a hospital emergency center in Taiwan

    Directory of Open Access Journals (Sweden)

    Chia-Pei Jung

    2016-06-01

    Conclusions: For children, trauma and toothache constituted the most common reasons for dental emergency visits at a hospital emergency center in Taiwan. While dental emergencies are sometimes unforeseeable or unavoidable, developing community awareness about proper at-home care as well as regular dental preventive measures can potentially reduce the number of emergency visits.

  18. Family centered care of hospitalized children: A hybrid concept analysis in Iran

    Directory of Open Access Journals (Sweden)

    Mahboobeh Khajeh

    2017-09-01

    Full Text Available Background: Family centered care of hospitalized children (FCCHC is a multidimensional concept, which is directly associated with the context and healthcare system. This study was conducted to analyze the concept of FCCHC in Iran.Methods: This concept analysis was conducted with the use of hybrid model in 3 phases: a literature review in the theoretical phase, semi-structured interviews and descriptive observations in the fieldwork phase, and combination of the results of 2 previous phases in the final analytical phase.Results: The 4 main themes extracted in theoretical phase included "family and healthcare professional participation", "information sharing with families", "family and healthcare professional relationship based on dignity and respect" and "individualized care of family".Moreover, 4 themes were emerged in the fieldwork phase, including "family as a nonparticipant visitor", "one-way education", "non-supportive interactions" and "non-specific care of family". In third phase with combination of the results of 2 phases, the final definition of the concept was presented.Conclusion: FCCHC is a comprehensive care that is affected by human and organizational factors and requires full participation of staff and family, effective interaction with family, education and information sharing with them, and individualized care of each family. By knowing the dimensions of the FCCHC, we will be able to run our activities to provide facilities and features for its optimal implementation in Iran.

  19. Cardiovascular disease hospitalizations in relation to exposure to the September 11, 2001 World Trade Center disaster and posttraumatic stress disorder.

    Science.gov (United States)

    Jordan, Hannah T; Stellman, Steven D; Morabia, Alfredo; Miller-Archie, Sara A; Alper, Howard; Laskaris, Zoey; Brackbill, Robert M; Cone, James E

    2013-10-24

    A cohort study found that 9/11-related environmental exposures and posttraumatic stress disorder increased self-reported cardiovascular disease risk. We attempted to replicate these findings using objectively defined cardiovascular disease hospitalizations in the same cohort. Data for adult World Trade Center Health Registry enrollees residing in New York State on enrollment and no cardiovascular disease history (n = 46,346) were linked to a New York State hospital discharge-reporting system. Follow-up began at Registry enrollment (2003-2004) and ended at the first cerebrovascular or heart disease (HD) hospitalization, death, or December 31, 2010, whichever was earliest. We used proportional hazards models to estimate adjusted hazard ratios (AHRs) for HD (n = 1151) and cerebrovascular disease (n = 284) hospitalization during 302,742 person-years of observation (mean follow-up, 6.5 years per person), accounting for other factors including age, race/ethnicity, smoking, and diabetes. An elevated risk of HD hospitalization was observed among women (AHR 1.32, 95% CI 1.01 to 1.71) but not men (AHR 1.16, 95% CI 0.97 to 1.40) with posttraumatic stress disorder at enrollment. A high overall level of World Trade Center rescue and recovery-related exposure was associated with an elevated HD hospitalization risk in men (AHR 1.82, 95% CI 1.06 to 3.13; P for trend = 0.05), but findings in women were inconclusive (AHR 3.29, 95% CI 0.85 to 12.69; P for trend = 0.09). Similar associations were observed specifically with coronary artery disease hospitalization. Posttraumatic stress disorder increased the cerebrovascular disease hospitalization risk in men but not in women. 9/11-related exposures and posttraumatic stress disorder appeared to increase the risk of subsequent hospitalization for HD and cerebrovascular disease. This is consistent with findings based on self-reported outcomes.

  20. Patient blood management knowledge and practice among clinicians from seven European university hospitals: a multicentre survey.

    Science.gov (United States)

    Manzini, P M; Dall'Omo, A M; D'Antico, S; Valfrè, A; Pendry, K; Wikman, A; Fischer, D; Borg-Aquilina, D; Laspina, S; van Pampus, E C M; van Kraaij, M; Bruun, M T; Georgsen, J; Grant-Casey, J; Babra, P S; Murphy, M F; Folléa, G; Aranko, K

    2018-01-01

    The aim of this survey was to evaluate the knowledge about Patient Blood Management (PBM) principles and practices amongst clinicians working in seven European hospitals participating in a European Blood Alliance (EBA) project. A web-based questionnaire was sent to 4952 clinicians working in medical, surgery and anaesthesiology disciplines. The responses were analysed, and the overall results as well as a comparison between hospitals are presented. A total of 788 responses (16%) were obtained. About 24% of respondents were not aware of a correlation between preoperative anaemia (POA) and perioperative morbidity and mortality. For 22%, treatment of POA was unlikely to favourably influence morbidity and mortality even before surgery with expected blood loss. More than half of clinicians did not routinely treat POA. 29%, when asked which is the best way to treat deficiency anaemia preoperatively, answered that they did not have sufficient knowledge and 5% chose to 'do nothing'. Amongst those who treated POA, 38% proposed red cell transfusion prior to surgery as treatment. Restrictive haemoglobin triggers for red blood cell transfusion, single unit policy and reduction of number and volumes of blood samples for diagnostic purposes were only marginally implemented. Overall, the responses indicated poor knowledge about PBM. Processes to diagnose and treat POA were not generally and homogeneously implemented. This survey should provide further impetus to implement programmes to improve knowledge and practice of PBM. © 2017 International Society of Blood Transfusion.

  1. Colonization with hospital flora and its associated risk factors in neonates hospitalized in neonatal ward of a teaching center in Isfahan, Iran.

    Science.gov (United States)

    Shirani, Kiana; Mostafavizadeh, Kamyar; Ataei, Behrouz; Akhani, Khatere

    2018-01-01

    Due to the high incidence and prevalence of infection in neonatal ward, especially Neonatal Intensive Care Units (NICUs) reported by different studies and the important role of colonization with hospital germs in the development of nosocomial infections, we intended to evaluate the risk of colonization with hospital germs in neonates and its associated risk factors. This cross-sectional, descriptive-analytical study was conducted in 2016 in a Teaching Center in Iran. In total, 51 neonates were selected based on the inclusion criteria, and after recording their information in a checklist, samples were taken by swab from outer ear, axilla, and groin for culture. Neonates with negative culture from mentioned regions were enrolled in the study. The swab samples again were taken and sent for culture from mentioned regions in at least 3 days after hospitalization. Culture results from first and second sampling were collected and analyzed statistically. This study was conducted on 51 neonates. The mean gestational age among the neonates ranged from 35.25 (Week) ± 2.98. 22 girls (43.1%) and 29 boys (56.9%), most of them were born by cesarean. Based on the results of logistic regression, a significant association was found between the occurrence of colonization of hospital flora and the place hospitalization of the newborns (odds ratio (OR): 4.750; 95% confidence interval (CI): 1.26-17.85). This study revealed that the only risk factors of colonization with hospital flora in neonates are the type of delivery and place of hospitalization. Based on findings of the study, it is recommended to focus on efforts in increasing the rate of natural birth as well as improving conditions of infection control in NICUs to reduce the number of incidences of colonization with hospital flora in neonates.

  2. Clinical Correlates of Ambulatory Blood Pressure Phenotypes at a Tertiary Care Hospital in Turkey

    Directory of Open Access Journals (Sweden)

    Siyar Erdogmus

    2018-05-01

    Full Text Available Background/Aims: Hypertension and its complications are major public health issues worldwide due to their association with high cardiovascular morbidity and mortality. Despite significant progress in health, the prevalence of hypertension is increasing. Ambulatory blood pressure monitoring (ABPM is becoming increasingly important for the management of hypertension. In this study, we aimed to investigate the clinical and laboratory correlates of ambulatory blood pressure (ABP phenotypes at a tertiary care hospital in Turkey. Methods: The characteristics of 1053 patients were retrospectively obtained from the hospital database. Hypertension was defined as patients with office blood pressure (BP ≥140/90 mmHg and/or previously diagnosed hypertension and/or the use of antihypertensive medication. According to the office BP and ABPM results patients were identified namely: (1 sustained normotensive (SNT patients (both office BP and ABPM were normal, (2 sustained hypertensive (SHT patients (both office BP and ABPM were high, (3 masked hypertensive (MHT patients (office BP were normal, but ABPM were high, (4 white coat hypertensive (WCHT patients (office BP were above limits, but ABPM were normal. Results: A total of 1053 patients were included to the study (female/male: 608/445 and mean age 55 ± 15 years. The mean age of patients with hypertension was significantly higher than without hypertension (p< 0.0001. Hypertension was more frequent in females (p=0.009. The rates of history of diabetes mellitus (DM, hyperlipidemia (HL, and chronic kidney disease (CKD were higher in patients with hypertension (p< 0.0001. Among patients with hypertension (n=853, 81%, ABPM results showed that 388 (45% of patients had SHT, 92 (11% had MHT, and 144 (17% had WCHT, whereas 229 (27% had SNT. Patients with MHT were significantly older than patients with SNT (p=0.025. The prevalence of SHT was higher in men than in women, whereas the prevalence of WCHT was higher in

  3. A survey of blood conservation methods in clinical practice in some urban south-eastern government hospitals in Nigeria.

    Science.gov (United States)

    Amucheazi, A O; Ajuzeiogu, V O; Ezike, H A; Odiakosa, M C; Nwoke, O M; Onyia, E

    2011-01-01

    GENERAL OBJECTIVE: To assess the practice of blood conservation. To determine the methods of blood conservation in use, to assess the lower limit for hemoglobin for elective procedures, to determine transfusion trigger point in practice, to find out limitations in practice and ways to improve clinical practice. This was conducted in February 2009. Self-administered questionnaires were distributed among the surgeons and anesthetists in practice at the University of Nigeria Teaching Hospital, Enugu State University Teaching Hospital, Ebonyi State University Teaching Hospital and National Orthopaedic Hospital, Enugu. The data gathered was analyzed using the SPSS software. : Of participants who agreed to fill the questionnaires, more than 50% were males. The most prevalent specialty was general surgery (24.2%), followed by orthopedics (22.6%), obstetrics and gynecology (20.7%), and anesthesia (17.7%). The lowest hemoglobin limit before the patient was allowed into the theatre for elective procedures was 10 g/dl while individual transfusion trigger points ranged from hemoglobin of 6 to 10 g/dl. Majority of the doctors would avoid homologous blood transfusion in order to avoid transfusion-related diseases and reaction. Regarding knowledge of blood conservation methods and means of avoiding homologous blood, the use of diathermy was highest (12.33%), followed by preoperative blood donation (11.87%), use of hematinics (10.96%), and tourniquet 10.5%. Also, in practice, diathermy was the most frequently used (18.69%), followed by preoperative blood donation (16.16%), use of tourniquet (15.15%), while the Ovadje cell saver was least with 0.01%. Suggestions from respondents on the ways of limiting transfusion-related problems included optimization of patients (24.5%), improvement of standard of living (17.7%), and personnel training (13.3%). There is an agreement with the global trend geared toward minimizing the use of homologous blood by doctors in these hospitals. However

  4. A survey of blood conservation methods in clinical practice in some urban south-eastern government hospitals in Nigeria

    Directory of Open Access Journals (Sweden)

    Amucheazi A

    2011-01-01

    Full Text Available General Objective: To assess the practice of blood conservation. Specific Objectives: To determine the methods of blood conservation in use, to assess the lower limit for hemoglobin for elective procedures, to determine transfusion trigger point in practice, to find out limitations in practice and ways to improve clinical practice. Materials and Methods: This was conducted in February 2009. Self-administered questionnaires were distributed among the surgeons and anesthetists in practice at the University of Nigeria Teaching Hospital, Enugu State University Teaching Hospital, Ebonyi State University Teaching Hospital and National Orthopaedic Hospital, Enugu. The data gathered was analyzed using the SPSS software. Results : Of participants who agreed to fill the questionnaires, more than 50% were males. The most prevalent specialty was general surgery (24.2%, followed by orthopedics (22.6%, obstetrics and gynecology (20.7%, and anesthesia (17.7%. The lowest hemoglobin limit before the patient was allowed into the theatre for elective procedures was 10 g/dl while individual transfusion trigger points ranged from hemoglobin of 6 to 10 g/dl. Majority of the doctors would avoid homologous blood transfusion in order to avoid transfusion-related diseases and reaction. Regarding knowledge of blood conservation methods and means of avoiding homologous blood, the use of diathermy was highest (12.33%, followed by preoperative blood donation (11.87%, use of hematinics (10.96%, and tourniquet 10.5%. Also, in practice, diathermy was the most frequently used (18.69%, followed by preoperative blood donation (16.16%, use of tourniquet (15.15%, while the Ovadje cell saver was least with 0.01%. Suggestions from respondents on the ways of limiting transfusion-related problems included optimization of patients (24.5%, improvement of standard of living (17.7%, and personnel training (13.3%. Conclusion: There is an agreement with the global trend geared toward

  5. Center for Fetal Monkey Gene Transfer for Heart, Lung, and Blood Diseases: An NHLBI Resource for the Gene Therapy Community

    Science.gov (United States)

    Skarlatos, Sonia I.

    2012-01-01

    Abstract The goals of the National Heart, Lung, and Blood Institute (NHLBI) Center for Fetal Monkey Gene Transfer for Heart, Lung, and Blood Diseases are to conduct gene transfer studies in monkeys to evaluate safety and efficiency; and to provide NHLBI-supported investigators with expertise, resources, and services to actively pursue gene transfer approaches in monkeys in their research programs. NHLBI-supported projects span investigators throughout the United States and have addressed novel approaches to gene delivery; “proof-of-principle”; assessed whether findings in small-animal models could be demonstrated in a primate species; or were conducted to enable new grant or IND submissions. The Center for Fetal Monkey Gene Transfer for Heart, Lung, and Blood Diseases successfully aids the gene therapy community in addressing regulatory barriers, and serves as an effective vehicle for advancing the field. PMID:22974119

  6. Reducing risks of Transfusion-transmitted infections in a resource-limited hospital-based blood bank: the case of the Yaoundé University Teaching Hospital, Cameroon

    Science.gov (United States)

    Tagny, C. T.; Ndoumba, A.; Laperche, S.; Murphy, E.; Mbanya, D.

    2016-01-01

    Background and Objectives Although interest in assessing risk of TTIs, very few trends in blood safety epidemiological data from resource-limited blood services are reported in the literature. This analysis aims at reporting trends in seroprevalences of TTIs in blood donations in the Yaoundé University Teaching Hospital (UTH) from 2011 to 2015 and to describe reasons for these changes. Materials and Methods All donations of 2015 were tested for HIV 1&2 antibodies and the P24 antigen, HBsAg, HCV antibody and the Treponema pallidum antibody. Screening for HIV uses a national algorithm based on the systematic use of two assays of different principles: a rapid determination testing assay and an EIA HIV 1 & 2 Ab-Ag. The tests used for HBsAg and HCVAb screening were all based on EIA techniques. Treponema pallidum antibody screening was based on Treponema Pallidum hemagglutination assay (TPHA) and rapid immunochromatographic test (RIT). Screening techniques and results from 2015 were compared to retrospective data from 2011, 2012, 2013 and 2014. Results In 2015, 13·4% (n = 214) of 1,596 blood donations were seropositive for at least one screened TTIs. The most frequent serological marker was HBsAg with 123 (7·7%) blood units contaminated. Nineteen (1·2%) and 18 (1·1%) blood units was positive for HIV and syphilis, respectively. There was a significant decrease in the total number of blood donations (P < 10−4) and HIV, HBsAg and syphilis seroprevalences and an increase in the proportion of voluntary non-remunerated blood donor (P < 0·05). HCVAb seroprevalence was 3·8% in 2015 and has not decreased significantly over the years (P = 0·09). Conclusion Significant progress is noted in reduction in seroprevalences of HIV, HBV, HCV and syphilis since the beginning of a regular registration of data in 1990. PMID:28484511

  7. A study on abdomen ultrasonography classified by particular disease practiced in health promotion center of a university hospital

    International Nuclear Information System (INIS)

    Kim, Nam Hee; Choi, Jong Hak

    2001-01-01

    This study is to get preliminary data for an effectiveness evaluation of abdominal examination and improvement of it. Abnormal cases of abdominal ultrasonography are classified by sex, frequency, diagnosis and age, 4.924 examinees were included at a university hospital of health promotion center from January to December in 1999. The results are as follow. According to the distribution of sex, there are more male patients(55.0%) than females patients (48.0%). for men, 40's showed the highest percentage among examinees. For women, 50's were the highest. The reason that 'they visited the health promotion center was that they wanted to check their health status'. This answers were reported the highest (59.3%). Patients that had abnormal cases of abdominal ultrasonography were 48.3%. Liver, kidney, gallbladder showed the highest percentage of abnormal cases in order of organs. Additionally, abnormal cases were discovered in liver cases. According to the frequency of abnormal cases among examinees, the slight fatty liver were the highest regardless of sex. Men had the slight fatty liver, kidney simple cyst, liver calcification and liver simple cyst in order of abnormal cases. Women showed the slight fatty liver kidney simple cyst, kidney calcification, liver simple cyst, and blood vessel tumor in order of abnormal cases. For the abnormal cases of live by sex and age, the 50's reported the highest number of abnormal cases in men (299 patients). In addition, 60's had the highest of disease rata 47.8%. For women, 50's reported the highest number of abnormal cases (361 patients).. Over 70's patients had the highest of disease rata 52.6%. For kidney, men and women showed the highest number of abnormal cases -62 vs 44 respectively. Over 70's patients had the highest percentage of disease rata -23.2% vs 14.0% respectively. For gallbladder, the number of abnormal cases were the most in men's 60's (31 patients) and in women's in the same age group (32 patients). According to

  8. [Prevalence of smoking among doctors and paramedical staff in Hospital University Center Mohammed VI, Marrakech].

    Science.gov (United States)

    Badri, Farid; Sajiai, Hafsa; Amro, Lamyae

    2017-01-01

    Smoking is a major public health problem. Doctors and paramedical staff are not excluded from this plague. Smoking ban in hospitals originated from government effort to reduce passive smoking. The objectives were to evaluate smoking habits among doctors and paramedical staff in order to implement tobacco control strategy in this study population and to refer them to the smoking-cessation counselling. We conducted a descriptive cross-sectional study of the entire staff of the Hospital University Center Mohammed VI, Marrakech based on the distribution of anonymous questionnaires. A total of 530 questionnaires were distributed, and 380 were returned, a response rate of 71.7%. The study population consisted of 58.2% women (n=221) and 41.8% men (n=159). Doctors (n=220) were the most represented occupational category (57.9%) followed by nurses (31.8%). Smokers (n=62) accounted for 16.3% of our study population; the ex-smokers (n=31) accounted for 8.1% and the non-smokers (n=287) 75.5%. The average age of smokers was 31.1 years, ranging from 22 to 56 years. The prevalence of smoking was 16.3% (n=62) of study population, of whom 32.7% (n=52) among men compared to 4.5% (n=10) among women. The average age of smoking onset was 19 years with a range from 11 to 29 years and with a mean consumption of 9 cigarettes/day. 13% (n=50) of people even smoked narguilé, 9% (n=34) consumed alcohol, and 3% (n=21) cannabis. 67.7% of smokers (n=42) were planning to quit, of whom 30.9% (n=13) in the next 3 months, 52.4% (n=22) in the next 6 months and 16, 7% (n=16) were planning to quit in the year. Several activities encouraged smoking, including night shift, coffee breaks and meals in 90.3% (n=56), 64.3% (n=40) and 61.3% (n=38) of cases respectively. This survey highlights the need to carry out awareness-raising actions to strengthen people motivation to quit smoking and help them during their withdrawal.

  9. Evaluation of blood stream infections by Candida in three tertiary hospitals in Salvador, Brazil: a case-control study

    Directory of Open Access Journals (Sweden)

    Maria Goreth Barberino

    Full Text Available Invasive infections caused by Candida spp. are an important problem in immunocompromised patients. There is scarce data on the epidemiology of blood stream candidiasis in Salvador, Brazil. This study evaluates the risk factors associated with candidemia, among patients admitted to three tertiary, private hospitals, in Salvador, Brazil. We conducted a case-control, retrospective study to compare patients with diagnosis of candidemia in three different tertiary hospitals in Salvador, Brazil. Patients were matched for nosocomial, acquired infections, according to the causal agent: cases were defined by positive blood cultures for Candida species. Controls were those patients who had a diagnosis of systemic bacterial infection, with a positive blood culture to any bacteria, within the same time period (± 30 days of case identification. The groups were compared for the main known risk factors for candidemia and for mortality rates. A hundred thirty-eight patients were identified. Among the 69 cases, only 14 were diagnosed as infected by Candida albicans. Candida species were defined in only eight cultures: C. tropicalis (4 cases, C. glabrata, C. parapsilosis, C. guillermondi, C. formata (1 case each. The main risk factors, identified in a univariate analysis, were: presence of a central venous catheter (CVC, use of parenteral nutrition support (PNS, previous exposure to antibiotics, and chronic renal failure (CRF. No association was detected with surgical procedures, diabetes mellitus, neutropenia or malignancies. Patients were more likely to die during the hospitalization period, but the rates of death caused by the infections were similar for cases and controls. The length of hospitalization was similar for both groups, as well as the time for a positive blood culture. Blood stream infection by Candida spp. is associated with CVC, PNS, previous use of antibiotics, and CRF. The higher mortality rate for cases probably better reflects the severity

  10. Neer Award 2016: Outpatient total shoulder arthroplasty in an ambulatory surgery center is a safe alternative to inpatient total shoulder arthroplasty in a hospital: a matched cohort study.

    Science.gov (United States)

    Brolin, Tyler J; Mulligan, Ryan P; Azar, Frederick M; Throckmorton, Thomas W

    2017-02-01

    Recent emphasis on safe and efficient delivery of high-quality health care has increased interest in outpatient total joint arthroplasty. The purpose of this study was to evaluate the safety of outpatient total shoulder arthroplasty (TSA) by comparing episode-of-care complications in matched cohorts of patients with anatomic TSA as an outpatient or inpatient procedure. Thirty patients with outpatient TSA at a freestanding ambulatory surgery center (ASC) were compared with an age- and comorbidities-matched cohort of 30 patients with traditional inpatient TSA to evaluate 90-day episode-of-care complications, including hospital admissions or readmissions and reoperations. Two-tailed t-tests were used to evaluate differences, and differences of P surgery and disrupted his subscapularis repair. Three minor complications in the hospital cohort were mild asymptomatic anterior subluxation, blood transfusion, and superficial venous thrombosis. The complication rates (13% vs. 10%) were not significantly different. Outpatient TSA is a safe alternative to hospital admission in appropriately selected patients. Further investigation is warranted to evaluate the longer term outcomes and cost-effectiveness of outpatient TSA. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  11. Are Evidence-based Practices Associated With Effective Prevention of Hospital-acquired Pressure Ulcers in US Academic Medical Centers?

    Science.gov (United States)

    Padula, William V; Gibbons, Robert D; Valuck, Robert J; Makic, Mary B F; Mishra, Manish K; Pronovost, Peter J; Meltzer, David O

    2016-05-01

    In 2008, the Centers for Medicare and Medicaid Services (CMS) established nonpayment policies resulting from costliness of hospital-acquired pressure ulcers (HAPUs) to hospitals. This prompted hospitals to adopt quality improvement (QI) interventions that increase use of evidence-based practices (EBPs) for HAPU prevention. To evaluate the longitudinal impact of CMS policy and QI adoption on HAPU rates. We characterized longitudinal adoption of 25 QI interventions that support EBPs through hospital leadership, staff, information technology, and performance and improvement. Quarterly counts of HAPU incidence and inpatient characteristics were collected from 55 University HealthSystem Consortium hospitals between 2007 and 2012. Mixed-effects regression models tested the longitudinal association of CMS policy, HAPU coding, and QI on HAPU rates. The models assumed level-2 random intercepts and random effects for CMS policy and EBP implementation to account for between-hospital variability in HAPU incidence. Controlling for all 25 QI interventions, specific updates to EBPs for HAPU prevention had a significant, though modest reduction on HAPU rates (-1.86 cases/quarter; P=0.002) and the effect of CMS nonpayment policy on HAPU prevention was much greater (-11.32 cases/quarter; P<0.001). HAPU rates were significantly lower after changes in CMS reimbursement. Reductions are associated with hospital-wide implementation of EBPs for HAPU prevention. Given that administrative data were used, it remains unknown whether these improvements were due to changes in coding or improved quality of care.

  12. Comparision between bed side testing of blood glucose by glucometer vs centralized testing in a tertiary care hospital.

    Science.gov (United States)

    Baig, Ayaz; Siddiqui, Imran; Jabbar, Abdul; Azam, Syed Iqbal; Sabir, Salman; Alam, Shahryar; Ghani, Farooq

    2007-01-01

    To determine the accuracy, turnaround time and cost effectiveness of bedside monitoring of blood glucose levels by non-laboratory health care workers and centralized testing of blood glucose by automated analyzer in a tertiary care hospital. The study was conducted in Section of Chemical Pathology, Department of Pathology and Microbiology and Section of Endocrinology Department of Medicine, Aga Khan University and Hospital Karachi, from April 2005 to March 2006. One hundred and ten patients were included in the study. The blood glucose levels were analyzed on glucometer (Precision Abbott) by finger stick, using Biosensor Technology. At the same time venous blood was obtained to analyze glucose in clinical laboratory on automated analyzer (SYNCHRON CX7) by glucose oxidase method. We observed good correlation between bed side glucometer and laboratory automated analyzer for glucose values between 3.3 mmol/L (60 mg/dl) and 16.7 (300 mg/dl). A significant difference was observed for glucose values less than 3.3 mmol/L (p = 0.002) and glucose values more than 16.67 mmol/l (p = 0.049). Mean Turnaround time for glucometer and automated analyzer were 0.08 hours and 2.49 hours respectively. The cost of glucose testing with glucometer was 48.8% lower than centralized lab based testing. Bedside glucometer testing, though less expensive does not have good accuracy in acutely ill patient with either very high or very low blood glucose levels.

  13. Hospitals

    Data.gov (United States)

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

  14. Variations in survival after cardiac arrest among academic medical center-affiliated hospitals.

    Directory of Open Access Journals (Sweden)

    Michael Christopher Kurz

    Full Text Available Variation exists in cardiac arrest (CA survival among institutions. We sought to determine institutional-level characteristics of academic medical centers (AMCs associated with CA survival.We examined discharge data from AMCs participating with Vizient clinical database-resource manager. We identified cases using ICD-9 diagnosis code 427.5 (CA or procedure code 99.60 (CPR. We estimated hospital-specific risk-standardized survival rates (RSSRs using mixed effects logistic regression, adjusting for individual mortality risk. Institutional and community characteristics of AMCs with higher than average survival were compared with those with lower survival.We analyzed data on 3,686,296 discharges in 2012, of which 33,700 (0.91% included a CA diagnosis. Overall survival was 42.3% (95% CI 41.8-42.9 with median institutional RSSR of 42.6% (IQR 35.7-51.0; Min-Max 19.4-101.6. We identified 28 AMCs with above average survival (median RSSR 61.8% and 20 AMCs with below average survival (median RSSR 26.8%. Compared to AMCs with below average survival, those with high CA survival had higher CA volume (median 262 vs.119 discharges, p = 0.002, total beds (722 vs. 452, p = 0.02, and annual surgical volume (24,939 vs. 13,109, p<0.001, more likely to offer cardiac catheterization (100% vs. 72%, p = 0.007 or cardiac surgery (93% vs. 61%, p = 0.02 and cared for catchment areas with higher household income ($61,922 vs. $49,104, p = 0.004 and lower poverty rates (14.6% vs. 17.3%, p = 0.03.Using discharge data from Vizient, we showed AMCs with higher CA and surgical case volume, cardiac catheterization and cardiac surgery facilities, and catchment areas with higher socioeconomic status had higher risk-standardized CA survival.

  15. FREQUENCY AND DISTRIBUTION OF ABO & RH BLOOD GROUP IN BILASPUR DISTRICT OF CHHATTISGARH STATE : A STUDY FROM MEDICAL COLLEGE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Bhanu Pratap

    2015-07-01

    Full Text Available BACKGROUND : Approximate 30 blood group systems have discovered and more than 400 erythrocytes antigens are identified. Blood group ABO and Rh are most important among all other blood group systems in transfusion service practices. The frequency of four major blood gr oup s namely A, B, O, AB with Rh Positive and Negative varies in different population of the world and differ also in region and race wise. MATERIAL AND METHOD : This 5 years retrospective study was conducted at Blood Bank of a Medical college Hospital of Bi laspur in Northern Chhattisgarh, catering the 1/3 population of state. Data were collected from the Blood Bank Grouping record from the period of January 2010 to December 2014. Blood group of blood donors and patients were determined by Monoclonal Anti Ser a by slide agglutinations tests. Rare case and difficult case were examined by test tube agglutination method and Matrix Gel System of Tulip. RESULT AND CONCLUSIO N: 31973 subjects were examined for blood group during observation period, Out of these 31092( 97.25% were male and 881 (2.75% were female. The frequency of blood group B in these populations was 11007 (34.42% (33.36% Rh Positive and 1.06% Rh Negative Followed by O were 10864 (33.97% (33.33% Rh Positive and 0.64% Rh Negative, A was 9113 (28.50 % (27.99 % Rh Positive and 0.51% Rh Negative and AB was 989 (3.11% (3.01% Rh Positive and 0.1% Rh Negative. Rhesus group Rh Positive were 31242 (97.7 % and Rh Negative were 731 (2.3 %.

  16. Retrospective analysis of forward and reverse ABO typing discrepancies among patients and blood donors in a tertiary care hospital.

    Science.gov (United States)

    Makroo, R N; Kakkar, B; Agrawal, S; Chowdhry, M; Prakash, B; Karna, P

    2018-01-12

    The aim of our study was to determine the incidence and causes of ABO typing discrepancies among patients and blood donors at our centre. An accurate interpretation of the ABO blood group of an individual is of utmost importance to ensure patient safety and good transfusion practices. A retrospective observational study was carried out in the Department of Transfusion Medicine in our hospital from March 2013 to December 2015. Records of all patient and blood donor samples were retrieved and analysed for ABO typing discrepancies. In total, 135 853 patient and 62 080 donor samples were analysed for ABO typing discrepancies. The incidence among patients and blood donors was found to be 0·1% (138/135853) and 0·02% (14/62080), respectively. The mean age for patients and blood donors was 48·4 and 29·2 years, respectively. The most common cause of ABO typing discrepancies was due to cold autoantibodies among the patients (50·7%) and blood donors (57%) causing discrepant results in reverse typing. The various other causes of reverse typing discrepancies among patients were weak/missing antibody (25·4%), cold-reacting alloantibody (4·3%), warm autoantibody (2·2%), anti-A1 antibody (2·2%), Bombay phenotype (1·5%), transplantation (0·7%) and rouleaux (0·7%), whereas in blood donors, the causes were cold-reacting antibody (7%) and weak antibody (7%). The major cause of forward typing discrepancies among patients (12·3%) and blood donors (29%) was ABO subgroups. The resolution of ABO typing discrepancy is essential to minimise the chance of transfusion of ABO-incompatible blood. © 2018 British Blood Transfusion Society.

  17. Study of the outcome of suicide attempts: characteristics of hospitalization in a psychiatric ward group, critical care center group, and non-hospitalized group

    Directory of Open Access Journals (Sweden)

    Kemuyama Nobuo

    2010-01-01

    Full Text Available Abstract Background The allocation of outcome of suicide attempters is extremely important in emergency situations. Following categorization of suicidal attempters who visited the emergency room by outcome, we aimed to identify the characteristics and potential needs of each group. Methods The outcomes of 1348 individuals who attempted suicide and visited the critical care center or the psychiatry emergency department of the hospital were categorized into 3 groups, "hospitalization in the critical care center (HICCC", "hospitalization in the psychiatry ward (HIPW", or "non-hospitalization (NH", and the physical, mental, and social characteristics of these groups were compared. In addition, multiple logistic analysis was used to extract factors related to outcome. Results The male-to-female ratio was 1:2. The hospitalized groups, particularly the HICCC group, were found to have biopsychosocially serious findings with regard to disturbance of consciousness (JCS, general health performance (GAS, psychiatric symptoms (BPRS, and life events (LCU, while most subjects in the NH group were women who tended to repeat suicide-related behaviors induced by relatively light stress. The HIPW group had the highest number of cases, and their symptoms were psychologically serious but physically mild. On multiple logistic analysis, outcome was found to be closely correlated with physical severity, risk factor of suicide, assessment of emergent medical intervention, and overall care. Conclusion There are different potential needs for each group. The HICCC group needs psychiatrists on a full-time basis and also social workers and clinical psychotherapists to immediately initiate comprehensive care by a medical team composed of multiple professionals. The HIPW group needs psychological education to prevent repetition of suicide attempts, and high-quality physical treatment and management skill of the staff in the psychiatric ward. The NH group subjects need a

  18. Ethico-legal aspects of hospital-based blood transfusion practice ...

    African Journals Online (AJOL)

    McRoy

    2014-12-31

    Dec 31, 2014 ... Results: This review found that, medical practitioners are directly or vicariously liable in ... transfusion or fail to obtain an informed consent for blood ...... and physical impairments, emotional torture, ..... The rational use of blood.

  19. Role of water quality assessments in hospital infection control: Experience from a new oncology center in eastern India

    Directory of Open Access Journals (Sweden)

    Ramkrishna Bhalchandra

    2014-01-01

    Full Text Available Water quality assessment and timely intervention are essential for health. Microbiology, total dissolved solids (TDS and free residual chlorine were measured for water quality maintenance in an oncology center in India. Impact of these interventions over a period of 22 months has been demonstrated with four cardinal events. Pseudomonas in hospital water was controlled by adequate chlorination, whereas high TDS in the central sterile supply department water was corrected by the installation of electro-deionization plant. Contaminated bottled water was replaced using quality controlled hospital supply. Timely detection and correction of water-related issues, including reverse osmosis plant was possible through multi-faceted approach to water quality.

  20. Candida species distribution and fluconazole susceptibility of blood isolates at a regional hospital in Passo Fundo, RS, Brazil

    Directory of Open Access Journals (Sweden)

    Maira Giseli C. Silva

    2015-06-01

    Full Text Available ABSTRACT Introduction: Candidemia is a bloodstream infection produced by Candida genus yeasts. Objective: The purpose of this study was to characterize the epidemiology and the fluconazole susceptibility in Candida species isolated from patients at a regional hospital in Passo Fundo, RS. Methods: Records from the laboratory were used to identify patients with positive blood cultures for Candida between 2010 and 2011. The in vitro activity of fluconazole was determined using the disk diffusion method. Results: Were analyzed 24 positive blood cultures for Candida and found a 54.16% mortality rate. C. albicans was the most prevalent species, followed by C. parapsilosis and C. krusei. For susceptibility to fluconazole, C. albicans, C. parapsilosis and C. tropicalis showed 100% sensitivity. However, C. krusei was 100% resistant; and C. glabrata, 50% resistant. Conclusion: The high mortality and fluconazole resistance rates emphasize the importance of the diagnosis of candidemia in a hospital environment.

  1. Building a patient-centered hospital web site: best practices in china.

    Science.gov (United States)

    Huang, Edgar

    2015-01-01

    In this case study, based on six criteria, four Chinese hospitals were chosen from a national sample to showcase, through content analysis and in-depth interviews, the best practices of serving patients online. The extensive findings have addressed the following three questions: what these hospitals have in common in their Web development, what problems and challenges they are facing, and how they have excelled in serving their patients online. The study concludes that, like larger hospitals, smaller hospitals can also excel in creating an outstanding Web site to serve their patients so long as they truly care about their patients, have a clear vision and strong expertise in IT development. The study also concludes that Chinese private hospitals can learn from these state-owned hospitals in establishing a good reputation through professional and responsible interaction with patients. The four hospitals studied may shed light on the Web development in many other Chinese hospitals that are going through the same healthcare new media adoption. The findings from this study can also help Chinese hospitals form their visions in serving patients online.

  2. Blood-conservation techniques for coronary-artery bypass surgery at a private hospital.

    Science.gov (United States)

    Davies, M J; Picken, J; Buxton, B F; Fuller, J A

    1988-11-21

    The utilization of homologous blood and blood products was recorded in 100 consecutive patients who underwent primary coronary-artery bypass surgery. Nine patients underwent saphenous-vein grafts only, 55 patients underwent a single internal-mammary-artery graft that was supplemented by vein grafts and 36 patients underwent bilateral internal-mammary-artery grafts and vein grafts. All patients underwent normovolaemic haemodilution, and autologous blood was collected before bypass surgery. Residual blood was collected from the cardiopulmonary bypass machine and was washed and concentrated in a cell processor, and blood also was scavenged postoperatively from the mediastinal drainage tubes as methods to conserve blood. The mean (+/- SD) utilization of homologous blood was 1.3 +/- 1.5 units with 0.2 +/- 0.7 units of fresh-frozen plasma being used, and 0.8 +/- 2.1 units of platelets being used. The utilization of homologous blood was not different among the three different methods of coronary-artery bypass surgery, but patients who underwent bilateral internal-mammary-artery grafts suffered a greater postoperative loss of blood than did those patients who underwent saphenous-vein grafts or single internal-mammary-artery grafts. A comparison of patients who were taking aspirin or a non-steroidal anti-inflammatory drug preoperatively with those patients who were not showed no difference in the utilization of homologous blood but a statistically-significant difference was found in the loss of blood postoperatively.

  3. The value of arterial blood gas parameters for prediction of mortality in survivors of out-of-hospital cardiac arrest

    Directory of Open Access Journals (Sweden)

    Katharina Isabel von Auenmueller

    2017-01-01

    Full Text Available Context: Sudden cardiac death is one of the leading causes of death in Europe, and early prognostication remains challenging. There is a lack of valid parameters for the prediction of survival after cardiac arrest. Aims: This study aims to investigate if arterial blood gas parameters correlate with mortality of patients after out-of-hospital cardiac arrest. Materials and Methods: All patients who were admitted to our hospital after resuscitation following out-of-hospital cardiac arrest between January 1, 2008, and December 31, 2013, were included in this retrospective study. The patient's survival 5 days after resuscitation defined the study end-point. For the statistical analysis, the mean, standard deviation, Student's t-test, Chi-square test, and logistic regression analyses were used (level of significance P< 0.05. Results: Arterial blood gas samples were taken from 170 patients. In particular, pH < 7.0 (odds ratio [OR]: 7.20; 95% confidence interval [CI]: 3.11–16.69; P< 0.001 and lactate ≥ 5.0 mmol/L (OR: 6.79; 95% CI: 2.77–16.66; P< 0.001 showed strong and independent correlations with mortality within the first 5 days after hospital admission. Conclusion: Our study results indicate that several arterial blood gas parameters correlate with mortality of patients after out-of-hospital resuscitation. The most relevant parameters are pH and lactate because they are strongly and independently associated with mortality within the first 5 days after resuscitation. Despite this correlation, none of these parameters by oneself is strong enough to allow an early prognostication. Still, these parameters can contribute as part of a multimodal approach to assessing the patients' prognosis.

  4. THE ROLE OF REGIONAL CENTERS AND UNIVERSITY CHILDREN’S HOSPITAL IN DEVELOPMENT OF HOME MECHANICAL VENTILATION NETWORK

    Directory of Open Access Journals (Sweden)

    Rsovac Snezana

    2017-08-01

    Full Text Available Application of home mechanical ventilators represents the future in the treatment of children with chronic respiratory insufficiency. In this way patients are treated in the home environment, they have full support from their families, they are protected against nosocomial infections and their condition is monitored by medical staff. The role of regional centers is very important in the future development of the home mechanical ventilation network. Doctors in these centers under the full support of the University Children's Hospital physicians can assist and monitor the treatment of children on the household respirators.

  5. Clinical significance of detection of serum markers of several viral infections in hospitalized patients before blood exposure

    International Nuclear Information System (INIS)

    Hong Kai; Chen Linxing; Chen Yichang; Ding Yingshu

    2005-01-01

    Objective: To explore the desirability of setting a routine of test for detection of the serum markers of several viral infections hospitalized patients before anticipated blood exposure. Methods: Serum levels of five HBV markers, anti-HCV, anti-HIV (with ELISA) and ALT were determined in 214 hospitalized patients before forthcoming blood exposure as well as in 2468 controls. Results: The positive rate of each of the above-mentioned markers in the patients was: HBsAg 15.2% (397/2614), HBcAb- IgG 72.5% (1895/2614), anti-HCV 3.91% (102/2614), anti- HIV 0.08% (2/2614) and ALT level was above 40 u in 8.7% of the patients (227/2614). Each of the positive rate was significantly higher than that in the controls. Conclusion: There is a substantial portion of subjects harboring viral infections in the hospitalized patients. It is imperative to have these patients identified before blood exposure so that proper cautions can be taken and preventive measures implemented to minimize possible nosocomial as well as patients-to-staff infections. Moreover, any potential legal problems can also be appropriately dealt with. (authors)

  6. Comparative evaluation of paired blood culture (aerobic/aerobic) and single blood culture, along with clinical importance in catheter versus peripheral line at a tertiary care hospital.

    Science.gov (United States)

    Tarai, B; Das, P; Kumar, D; Budhiraja, S

    2012-01-01

    Paired blood culture (PBC) is uncommon practice in hospitals in India, leading to delayed and inadequate diagnosis. Also contamination remains a critical determinant in hampering the definitive diagnosis. To establish the need of PBC over single blood culture (SBC) along with the degree of contamination, this comparative retrospective study was initiated. We processed 2553 PBC and 4350 SBC in BacT/ALERT 3D (bioMerieux) between October 2010 and June 2011. The positive cultures were identified in VITEK 2 Compact (bioMerieux). True positivity and contaminants were also analyzed in 486 samples received from catheter and peripheral line. Out of 2553 PBC samples, positivity was seen in 350 (13.70%). In 4350 SBC samples, positivity was seen in 200 samples (4.59%). In PBC true pathogens were 267 (10.45%) and contaminants were 83 (3.25%), whereas in SBC 153 (3.51%) were true positives and contaminants were 47 (1.08%). Most of the blood cultures (99.27 %) grew within 72 h and 95.8% were isolated within 48 h. In 486 PBCs received from catheter/periphery (one each), catheter positivity was found in 85 (true positives were 48, false positives 37). In peripheral samples true positives were 50 and false positives were 8. Significantly higher positive rates were seen in PBCs compared with SBCs. Automated blood culture and identification methods significantly reduced the time required for processing of samples and also facilitated yield of diverse/rare organisms. Blood culture from catheter line had higher false positives than peripheral blood culture. Thus every positive result from a catheter must be correlated with clinical findings and requires further confirmation.

  7. Emergency blood transfusion practices among anaemic children presenting to an urban emergency department of a tertiary hospital in Tanzania.

    Science.gov (United States)

    Shari, Catherine R; Sawe, Hendry R; Murray, Brittany L; Mwafongo, Victor G; Mfinanga, Juma A; Runyon, Michael S

    2017-01-01

    Severe anaemia contributes significantly to mortality, especially in children under 5 years of age. Timely blood transfusion is known to improve outcomes. We investigated the magnitude of anaemia and emergency blood transfusion practices amongst children under 5 years presenting to the Emergency Department (ED) of Muhimbili National Hospital (MNH) in Tanzania. This prospective observational study enrolled children under 5 years old with anaemia, over a 7-week period in August and September of 2015. Anaemia was defined as haemoglobin of MNH. Less than a quarter of children with indications for transfusion receive it in the EMD, the median time to transfusion is nearly 8 h, and those not transfused have nearly a 3-fold higher mortality. Future quality improvement and research efforts should focus on eliminating barriers to timely blood transfusion.

  8. Does procedure profitability impact whether an outpatient surgery is performed at an ambulatory surgery center or hospital?

    Science.gov (United States)

    Plotzke, Michael Robert; Courtemanche, Charles

    2011-07-01

    Ambulatory surgery centers (ASCs) are small (typically physician owned) healthcare facilities that specialize in performing outpatient surgeries and therefore compete against hospitals for patients. Physicians who own ASCs could treat their most profitable patients at their ASCs and less profitable patients at hospitals. This paper asks if the profitability of an outpatient surgery impacts where a physician performs the surgery. Using a sample of Medicare patients from the National Survey of Ambulatory Surgery, we find that higher profit surgeries do have a higher probability of being performed at an ASC compared to a hospital. After controlling for surgery type, a 10% increase in a surgery's profitability is associated with a 1.2 to 1.4 percentage point increase in the probability the surgery is performed at an ASC. Copyright © 2010 John Wiley & Sons, Ltd.

  9. Diversity and Adaptation of Human Respiratory Syncytial Virus Genotypes Circulating in Two Distinct Communities: Public Hospital and Day Care Center

    Directory of Open Access Journals (Sweden)

    Gustavo Rocha Garcia

    2012-10-01

    Full Text Available HRSV is one of the most important pathogens causing acute respiratory tract diseases as bronchiolitis and pneumonia among infants. HRSV was isolated from two distinct communities, a public day care center and a public hospital in São José do Rio Preto – SP, Brazil. We obtained partial sequences from G gene that were used on phylogenetic and selection pressure analysis. HRSV accounted for 29% of respiratory infections in hospitalized children and 7.7% in day care center children. On phylogenetic analysis of 60 HRSV strains, 48 (80% clustered within or adjacent to the GA1 genotype; GA5, NA1, NA2, BA-IV and SAB1 were also observed. SJRP GA1 strains presented variations among deduced amino acids composition and lost the potential O-glycosilation site at amino acid position 295, nevertheless this resulted in an insertion of two potential O-glycosilation sites at positions 296 and 297. Furthermore, a potential O-glycosilation site insertion, at position 293, was only observed for hospital strains. Using SLAC and MEME methods, only amino acid 274 was identified to be under positive selection. This is the first report on HRSV circulation and genotypes classification derived from a day care center community in Brazil.

  10. "Center punch" and "whole spot" bioanalysis of apixaban in human dried blood spot samples by UHPLC-MS/MS.

    Science.gov (United States)

    Zheng, Naiyu; Yuan, Long; Ji, Qin C; Mangus, Heidi; Song, Yan; Frost, Charles; Zeng, Jianing; Aubry, Anne-Françoise; Arnold, Mark E

    2015-04-15

    Apixaban (Eliquis™) was developed by Bristol-Myers Squibb (BMS) and Pfizer to use as an antithrombotic/anticoagulant agent and has been recently approved for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. A clinical study of apixaban, sponsored by BMS and Pfizer, included a pilot exploratory portion to evaluate the potential for future drug concentration monitoring using dried blood spot (DBS) sample collection. For DBS sample collection, a fixed blood volume was dispensed onto a DBS card by either regular volumetric pipette (venous blood collection) or capillary dispenser (finger prick blood collection). A 96-well semi-automated liquid-liquid extraction sample preparation procedure was developed to provide clean extracts for UHPLC-MS/MS quantitation. Assays using both partial-spot center punch and whole spot punch were developed and validated. The linear dynamic ranges for all the analyses were from 0.5 to 500 ng/mL. The coefficient of determination (r(2)) values was >0.9944 for all the validation runs. For the center punch approach, the intra-assay precision (%CV) was within 4.4% and inter-assay precision was within 2.6%. The assay accuracy, expressed as %Dev., was within ± 5.4% of the nominal concentrations. One accuracy and precision run was performed using the whole spot approach, the intra-assay precision (%CV) was within 7.1% and the accuracy was within ± 8.0% of the nominal concentrations. In contrast to the center punch approach, the whole spot approach eliminated the effect of hematocrit and high lipids on the analysis of apixaban in human DBS when an accurate sample blood volume was collected on DBS cards. Copyright © 2015 Elsevier B.V. All rights reserved.

  11. The Effect of Family-centered Care on Management of Blood Glucose Levels in Adolescents with Diabetes.

    Science.gov (United States)

    Cheraghi, Fatemeh; Shamsaei, Farshid; Mortazavi, Sayyedeh Zohreh; Moghimbeigi, Abbas

    2015-07-01

    Responsibility for diabetes management tasks must shift from caregivers to adolescents as adolescents grow older. Also, family-centered care is a way to provide efficient care for them at home. This study aimed to identify the effect of family-centered care on management of blood glucose levels in adolescents with type 1 diabetes mellitus (T1DM). This is a Pre-experimental study with a pre- and post-test design. The participants consisted of forty adolescents with T1DM, aged between 10-14 years, with their caregivers who were selected through simple random sampling from Hamadan Diabetes Research Center in Iran in 2013. The sample was divided into four similar groups. Educational sessions were conducted for each group for 30 to 40 minutes. Data collection tools were "Supervisory Behaviors of Caregiver" (SBC), "Management Behaviors of adolescents" (MBA) questionnaires, and the "Blood Glucose Levels Record Sheet". Data were analyzed using SPSS 19 and based on descriptive statistics, Kolmogorov-Smirnov, paired t-test and Pearson coefficient. There was a significant difference between the subjects' MBA and SBC mean scores before (110.17±26.6) and after (134.6±1.28) intervention in four domains: "blood glucose testing", "insulin therapy", "meal plan" and "physical activity" (PPearson coefficient showed a positive relationship between the supervisory behaviors of caregivers with management behaviors of adolescents before and after the intervention (Pmanagement of blood glucose levels and reduce their HbA1Clevels. Therefore, Family-centered care could provide for better regime adherence at home.

  12. A novel strategy for screening blood donors for syphilis at Komfo Anokye Teaching Hospital, Ghana

    DEFF Research Database (Denmark)

    Sarkodie, F; Ullum, H; Owusu-Dabo, E

    2016-01-01

    OBJECTIVE: To implement and describe a novel syphilis screening strategy for blood donors. BACKGROUND: The seroprevalence of syphilis in blood donors is often high in low- and middle-income countries (LMIC) although the proportion of infectious donations is probably low. Syphilis screening may...... not happen at all; or the use of non-specific screening tests, which have high false positive rates, results in many donations being discarded unnecessarily. This can have a critical effect on already inadequate blood supplies. MATERIALS AND METHODS: Blood donors were screened at the time of donation...... negative were released to stock and test-positive units discarded. RESULTS: Of the 2213 blood donors, 182 (8·2%; 182/2213) screened positive by RDT. In addition, 38 out of these 182 (20·9%) were RPR positive on post-donation testing. Over 2 months there was a 79% reduction in blood units discarded due...

  13. Knowledge of appropriate blood product use in perioperative patients among clinicians at a tertiary hospital

    Directory of Open Access Journals (Sweden)

    Bradley Yudelowitz

    2016-12-01

    Conclusion: Clinician's knowledge of risks, resources, costs and ordering of blood products for perioperative patients is poor. Transfusion triggers and administration protocols had an acceptable correct response rate.

  14. [Concrete pain prevention measures regarding hospital internal transport in a cancer center].

    Science.gov (United States)

    Nebbak, Jean-Marie; Vignozzi, Annick; Bussy, Catherine; Charleux, Diane; Laplanche, Agnès; Mathivon, Delphine; Di Palma, Mario

    2013-01-01

    Iatrogenic pain is a common problem for cancer patients, including those due to hospital internal transport. An original prospective study conducted in 2006 allowed risk factor identification, and from 2007, a pluri-annual progress plan was implemented. Its actions were systematically evaluated and all phases of transportation reconsidered: preparation, patient transport to and care in medicotechnical units. Measures applied to anticipate these pains help improve the quality of hospital care. All professionals involved in the patient transportation system need to be made aware of this and not only hospital porters.

  15. Impact of bleeding-related complications and/or blood product transfusions on hospital costs in inpatient surgical patients

    Directory of Open Access Journals (Sweden)

    Reynolds Matthew W

    2011-05-01

    Full Text Available Abstract Background Inadequate surgical hemostasis may lead to transfusion and/or other bleeding-related complications. This study examines the incidence and costs of bleeding-related complications and/or blood product transfusions occurring as a consequence of surgery in various inpatient surgical cohorts. Methods A retrospective analysis was conducted using Premier's Perspective™ hospital database. Patients who had an inpatient procedure within a specialty of interest (cardiac, vascular, non-cardiac thoracic, solid organ, general, reproductive organ, knee/hip replacement, or spinal surgery during 2006-2007 were identified. For each specialty, the rate of bleeding-related complications (including bleeding event, intervention to control for bleeding, and blood product transfusions was examined, and hospital costs and length of stay (LOS were compared between surgeries with and without bleeding-related complications. Incremental costs and ratios of average total hospital costs for patients with bleeding-related complications vs. those without complications were estimated using ordinary least squares (OLS regression, adjusting for demographics, hospital characteristics, and other baseline characteristics. Models using generalized estimating equations (GEE were also used to measure the impact of bleeding-related complications on costs while accounting for the effects related to the clustering of patients receiving care from the same hospitals. Results A total of 103,829 cardiac, 216,199 vascular, 142,562 non-cardiac thoracic, 45,687 solid organ, 362,512 general, 384,132 reproductive organ, 246,815 knee/hip replacement, and 107,187 spinal surgeries were identified. Overall, the rate of bleeding-related complications was 29.9% and ranged from 7.5% to 47.4% for reproductive organ and cardiac, respectively. Overall, incremental LOS associated with bleeding-related complications or transfusions (unadjusted for covariates was 6.0 days and ranged from 1

  16. A 2-year retrospective study of pediatric dental emergency visits at a hospital emergency center in Taiwan.

    Science.gov (United States)

    Jung, Chia-Pei; Tsai, Aileen I; Chen, Ching-Ming

    2016-06-01

    There is a paucity of information regarding pediatric dental emergencies in Taiwan. This study investigates the prevalence and characteristics of the pediatric dental emergency services provided at a medical center. This study included a retrospective chart review of patients under 18 years of age with dental complaints who visited the Emergency Department (ED) of Linkou Medical Center of Chang Gung Memorial Hospital from January 2012 to December 2013. Information regarding age, gender, time/day/month of presentation, diagnosis, treatment, and follow-up was collected and analyzed. Statistical analysis included descriptive statistics and Pearson's Chi-square test with the significance level set as p dental emergencies in the medical center ED were predominantly related to orodental trauma (47.1%) and pulpal pain (29.9%). Most patients were male (p management for dental emergencies was prescribing medication for pulp-related problems and orodental trauma. The follow-up rate of orodental trauma was the highest (p dental emergency visits at a hospital emergency center in Taiwan. While dental emergencies are sometimes unforeseeable or unavoidable, developing community awareness about proper at-home care as well as regular dental preventive measures can potentially reduce the number of emergency visits. Copyright © 2016 Chang Gung University. Published by Elsevier B.V. All rights reserved.

  17. [Automated management of the Center of Transfusion Blood Bank equipped with Autogrouper 16 C].

    Science.gov (United States)

    Girard, M; Connes, Y; Picot, P

    1981-11-01

    We describe in this paper a first processing of direct connection and data management from the Autogrouper 16 C. It bas been used since November 1980 in the Centre Départemental de Tranfusion Sanguine des Hauts-de-Seine. The automation of validation procedures, updating blood donors' file and labelling blood units allows the suppression of clerical errors that are the major cause of Trannsfusion accidents. The progressive development of programming lets a good adaptation of working methods and makes the setting of the system much easier in the Blood Bank.

  18. Depletion of blood supply and cost due to indeterminate donations at the Guillermo Almenara Irigoyen National Hospital

    Directory of Open Access Journals (Sweden)

    Jeel Moya-Salazar

    2017-06-01

    Full Text Available Objective: To evaluate the depletion of blood supply and the cost due to indeterminate donations at Hospital Nacional Guillermo Almenara Irigoyen during 2014. Materials and methods: A retrospective cross-sectional study and a cost-utility analysis were conducted in donations showing results in the gray zone (sample value/cutoff value between >0.85 and <1 after a serological screening of seven infectious markers (HIV, HBsAg, HBcAb, HCV, HTLV-1/2, syphilis and Chagas disease and the simultaneous determination of the HIV Ag/Ab combo by means of a fourth generation ELISA. Data was encoded and tabulated using the e-Delphyn® system. The cost-utility analysis was performed considering the current exchange rate. Results: Out of 9,560 donations, 20.7% (1977 donations showed results in the gray zone which caused a loss of 863.9 liters of blood and USD 92,640. The highest and lowest rate of seroprevalence were observed in HBcAb with 10.18% (973 indeterminate test results and anti-HIV with 0.39% (47 indeterminate test results, respectively (p<0.05. No significant differences were found between the anti-HIV y HIV Ag/Ab combo screening methods (p=0.776. Conclusions: It was demonstrated that more than 800 liters of discarded blood generated a more than USD 90,000 cost due to indeterminate donations causing economic damages to the hospital budget and a depletion of blood supply available for patients at Hospital Nacional Guillermo Almenara Irigoyen.

  19. Central radiological department of the Jahn Ferenc hospital and medical center

    Energy Technology Data Exchange (ETDEWEB)

    Erdelyi, M Jr [Jahn Ferenc Korhaz-Rendeloeintezet, Budapest (Hungary). Koezponti Radiologia

    1982-01-01

    The design, organisation and functioning of the central X-ray diagnostical unit of the new hospital, inaugurated in December 1980 are reviewed. The experiences of the shortcomings of the planning are summerized, too.

  20. Hospitality industry veteran and Hampton Roads Center team up to present workshop on ensuring success

    OpenAIRE

    Felker, Susan B.

    2008-01-01

    Hospitality industry veteran Howard Feiertag is hosting a workshop aimed at novice and experienced hotel sales managers, directors and general managers looking for ways to reinvigorate their team's efforts and ensuring success during economic shifts.

  1. The role of university hospitals as centers of excellence for shared health-care-delivery of in- and outpatients

    International Nuclear Information System (INIS)

    Adelhard, K.; Matzko, M.; Bruening, R.; Holzknecht, N.; Stark, V.; Reiser, M.

    2002-01-01

    Problem. Health care delivery in Germany has to face severe challenges that will lead to a closer integration of services for in- and out-patients. University hospitals play an important role due to their activities in research, education and health care delivery. They are requested to promote and evaluate new means and ways for health care delivery. Methods. The Institute of Clinical Radiology at the University Hospital of the Ludwig-Maximilians-University started teleradiological services for hospitals and general practices in January 1999 in the framework of the ''Imaging services - teleradiological center of excellence''. Legal, technical and organizational prerequisites were analyzed. Results. Networks between university hospitals and general practices are not likely to solve all future problems. They will, however, increase the availability of the knowledge of experts even in rural areas and contribute to a quality ensured health care at the patients home. Future developments may lead to international co-operations and such services may be available to patients abroad. Conclusion. Legal, technical and organizational obstacles have to be overcome to create a framework for high quality telemedical applications. University hospitals will play an important role in promoting and evaluating teleradiological services. (orig.) [de

  2. Influence of Internet dissemination on hospital selection for benign surgical disease: A single center retrospective study.

    Science.gov (United States)

    Lee, Sung Ryul; Koo, Bum Hwan; Byun, Geon Young; Lee, Seung Geun; Kim, Myoung Jin; Hong, Soo Kyung; Kim, Su Yeon; Lee, Yu Jin

    2018-05-17

    The Internet is used worldwide, but its effect on hospital selection of minor surgical disease has not hitherto been thoroughly studied. To investigate the effect of the Internet dissemination on hospital selection of minor surgical disease and information affecting selection, we conducted a survey of patients who underwent laparoscopic surgery from January 2016 to April 2017. We analyzed the questionnaire responses of 1916 patients. Over 80% of patients in all groups selected the hospital based on Internet information. Among patients aged over 60 years, 65.1% selected the hospital based on Internet information. With regard to hospital selection factors, the highest number of responses was for sophisticated surgical treatment (93.1%). The second highest was for a simplified medical care system (33.0%); third was a comprehensive nursing care system (18.1%). Among responses about surgical treatment, the most were obtained for short operation time and fewer hospitalization days (81.5%). Copyright © 2018 John Wiley & Sons, Ltd.

  3. Custodiol versus blood cardioplegia in pediatric cardiac surgery, two-center study

    Directory of Open Access Journals (Sweden)

    Ebtehal A. Qulisy

    2016-05-01

    Conclusions: Custodial cardioplegia is associated with less optimal myocardial protection and higher adverse outcomes compared to cold blood cardioplegia in children undergoing cardiac surgery. A randomized comparison is warranted.

  4. [Prospects in blood transfusion].

    Science.gov (United States)

    Rouger, P

    2003-04-01

    What will be the evolution of blood transfusion in the next 10 years? What are the scientific and medical arguments to help the decision makers to propose the developments? Many scientific and clinical studies show that blood substitutes are not ready for use in man. So, for a long time, blood collection in man will still be a necessity to prepare cell concentrates (red blood cells and platelets) and fresh frozen plasma. During this period, blood safety will be based on development of testing technics and preparation processes of blood products. Another major point will be a better clinical use of blood derivates. Cellular therapy will be probably only a way of diversification in blood transfusion centers in partnership with hospitals.

  5. [SHTLV-I/II seroprevalence in blood donors of Hospital Pablo Tobón Uribe Blood Bank during the period 2014-2015].

    Science.gov (United States)

    Muñoz, Manuela; Carvalho, Santiago; Donado, Jorge Hernando; Barco, Gloria Eugenia; Jaramillo, Sergio

    2018-03-15

    The human-T cell lymphotropic virus is a retrovirus with various types known so far. HTLV-I and HTLV-II are of clinically importance as they cause different diseases such as adult T-cell leukemia/lymphoma, tropical spastic paraparesis, and human T-lymphotropic virus type I-associated myelopathy (HAM). To estimate the prevalence of presumptive and confirmatory reactivity to HTLV-I/II in blood donors of Hospital Pablo Tobón Uribe Blood Bank between 2014 and 2015. The information was obtained from the Hospital Pablo Tobón Uribe Blood Bank database. We analyzed age, sex, place of origin, and place of residence of donors, and the reactivity using the screening test (ELISA) as well as the confirmatory test (immunoblot). The donor population studied included 6,275 men and 8,148 women, for a total of 14,423 donors recruited between March 1, 2014, and June 30, 2015. Of all tested donors, 25 were positive for HTLV-I/II by the screening test (ELISA). After performing the confirmatory test (immunoblot), only nine patients were positive for HTLV-I/II (36%), of whom eight were reactive to HTLV-I (32%) and one to HTLV-II (4%), for a global seroprevalence of 0.06% (CI 95%: 0.10-0.25). Our findings were consistent with those found in similar studies in non-endemic areas of the country and with those from studies at international level reported in the literature.

  6. [Effect of maximum blood pressure fluctuation on prognosis of patients with acute ischemic stroke within 24 hours after hospital admission].

    Science.gov (United States)

    Wang, H; Tang, Y; Zhang, Y; Xu, K; Zhao, J B

    2018-05-10

    Objective: To investigate the relationship between the maximum blood pressure fluctuation within 24 hours after admission and the prognosis at discharge. Methods: The patients with ischemic stroke admitted in Department of Neurology of the First Affiliated Hospital of Harbin Medical University within 24 hours after onset were consecutively selected from April 2016 to March 2017. The patients were grouped according to the diagnostic criteria of hypertension. Ambulatory blood pressure of the patients within 24 hours after admission were measured with bedside monitors and baseline data were collected. The patients were scored by NIHSS at discharge. The relationships between the maximum values of systolic blood pressure (SBP) or diastolic blood pressure (DBP) and the prognosis at discharge were analyzed. Results: A total of 521 patients with acute ischemic stroke were enrolled. They were divided into normal blood pressure group (82 cases) and hypertension group(439 cases). In normal blood pressure group, the maximum values of SBP and DBP were all in normal distribution ( P >0.05). The maximum value of SBP fluctuation was set at 146.6 mmHg. After adjustment for potential confounders, the OR for poor prognosis at discharge in patients with SBP fluctuation ≥146.6 mmHg was 2.669 (95 %CI : 0.594-11.992) compared with those with SBP fluctuation blood pressure at admission, the maximum values of SBP and DBP within 24 hours after admission had no relationship with prognosis at discharge. In acute ischemic stroke patients with hypertension at admission, the maximum values of SBP and DBP within 24 hours after admission were associated with poor prognosis at discharge.

  7. Prevalence of human T-cell lymphotropic virus types 1 and 2 in blood donors of the Caruaru Blood Center (Hemope

    Directory of Open Access Journals (Sweden)

    Waleska Mayara Gomes de Lima

    2013-01-01

    Full Text Available BACKGROUND: There is difficulty in gathering data on the prevalence of human T-cell lymphotropic virus in blood donors as confirmatory testing is not mandatory in Brazil. This suggests there may be an underreporting of the prevalence. OBJECTIVE: To estimate the prevalence of human T-cell lymphotropic virus types 1 and 2 in donors of a blood bank in Caruaru, Brazil. METHODS: This was an observational, epidemiological, descriptive, longitudinal and retrospective study with information about the serology of donors of the Caruaru Blood Center, Fundação de Hematologia e Hemoterapia de Pernambuco (Hemope from May 2006 to December 2010. The data were analyzed using the Excel 2010 computer program (Microsoft Office(r. RESULTS: Of 61,881 donors, 60 (0.096% individuals were identified as potential carriers of human T-cell lymphotropic virus types 1 and 2. Of these, 28 (0.045% were positive and 32 (0.051% had inconclusive results in the serological screening. Forty-five (0.072% were retested; 17 were positive (0.027% and 3 inconclusive (0.005%. After confirmatory tests, 8 were positive (0.013%. Six (75% of the confirmed cases were women. CONCLUSION: Epidemiological surveys like this are very important in order to create campaigns to attract donors and reduce the costs of laboratory tests.

  8. A personalized mobile patient guide system for a patient-centered smart hospital: Lessons learned from a usability test and satisfaction survey in a tertiary university hospital.

    Science.gov (United States)

    Yoo, Sooyoung; Jung, Se Young; Kim, Seok; Kim, Eunhye; Lee, Kee-Hyuck; Chung, Eunja; Hwang, Hee

    2016-07-01

    The present study focused on the design, implementation, and evaluation of a personalized mobile patient guide system that utilizes smart phones, indoor navigation technology and a hospital information system (HIS) to address the difficulties that outpatients face in finding hospital facilities, recognizing their daily treatment schedule, and accessing personalized medical and administrative information. The present study was conducted in a fully digitized tertiary university hospital in South Korea. We developed a real-time location-based outpatient guide system that consists of Bluetooth access points (APs) for indoor navigation, an Android-based guide application, a guide server, and interfaces with the HIS. A total of 33 subjects and 43 outpatients participated in the usability test (UT) and the satisfaction survey, respectively. We confirmed that the indoor navigation feature can be applied to outpatient departments with precision using a position error test. The participants in the UT completed each scenario with an average success rate of 67.4%. According to the results, we addressed the problems and made improvements to the user interface by providing users with context-based guidance information. The satisfaction rating of the system was high, with an average score of 4.0 out of 5.0, showing its utility as a patient-centered hospital service. The innovative mobile patient guide system for outpatients is feasible and can be successfully implemented to provide personalized information with high satisfaction. Additionally, the issues identified and lessons learned from our experiences regarding task scheduling, indoor navigation, and usability should be considered when developing the system. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  9. Hospital specific factors affect quality of blood pressure treatment in chronic kidney disease

    NARCIS (Netherlands)

    Zuilen, A.D. van; Blankestijn, P.J.; Buren, M. van; Dam, M.A. ten; Kaasjager, K.A.; Ligtenberg, G.; Sijpkens, Y.W.; Sluiter, H.E.; Ven, P.J. van der; Vervoort, G.M.M.; Vleming, L.; Bots, M.L.; Wetzels, J.F.M.

    2011-01-01

    BACKGROUND: Blood pressure (BP) is the most important modifiable risk factor for cardiovascular (CV) disease and progression of kidney dysfunction in patients with chronic kidney disease. Despite extensive antihypertensive treatment possibilities, adequate control is notoriously hard to achieve.

  10. Effectiveness of protocols for preventing occupational exposure to blood and body fluids in Dutch hospitals

    NARCIS (Netherlands)

    van Gemert-Pijnen, Julia E.W.C.; Hendrix, M.G.R.; van der Palen, Jacobus Adrianus Maria; Schellens, P.J.

    2006-01-01

    Compliance of different healthcare workers (HCWs) (nurses, physicians, laboratory technicians and cleaners) with protocols to prevent exposure to blood and body fluids (BBF) was studied. Questionnaires were used to assess perception of risks, familiarity with protocols, motivation and actual

  11. Epidemiological profile of seropositive blood donors at a tertiary care hospital in North India

    Directory of Open Access Journals (Sweden)

    Jency Maria Koshy

    2014-01-01

    Full Text Available Background: Transfusion-transmissible infections HIV, HBV, and HCV are among the greatest threats to blood safety for transfusion recipients. Seroprevalence among blood donors is a useful source of information on their prevalence in the community. The present study was undertaken to determine the profile of the seropositive blood donors attending the blood bank at Christian Medical College, Ludhiana, Punjab. Materials and Methods: This was a 3-year cross-sectional study, (1 st January 2008 till 31 st December 2010 whereby the data of the blood donors screened during this time were analyzed. We further studied the epidemiological profile of the seropositive donors. Results: There were a total of 32,829 donations. Seroprevalence of HIV, HBV, and HCV were 0.27%, 1.11% and 1.53%, respectively. Most of them were males (96.76% and were in the age group of 18-30 years. Replacement donors constituted 95.75%. Occupation of seropositive donors included business, various services, and agriculture. There were 89 students who were seropositive. Conclusions: Seroprevalence among blood donors has shown a significant (P value for HIV 0.05, HBV < 0.001, HCV 0.004 decreasing trend over the 3 years. The professional distribution reveals the shift in seroprevalence from the high-risk group to the general population. Introducing pre test and post test counselling in blood banks will identify patients at an earlier stage where treatment would be more effective. The need to shift the burden to voluntary blood donation cannot be overemphasised.

  12. Clinical characteristics of dental emergencies and prevalence of dental trauma at a university hospital emergency center in Korea.

    Science.gov (United States)

    Bae, Ji-Hyun; Kim, Young-Kyun; Choi, Yong-Hoon

    2011-10-01

    The aim of this study was to examine the clinical characteristics of dental emergency patients who visited a university hospital emergency center and to evaluate the incidence of dental trauma. A retrospective chart review of patients with dental complaints and who visited the Seoul National University Bundang Hospital (SNUBH) emergency center in Gyeonggi-do, Korea, from January 2009 to December 2009 was conducted. Information regarding age, gender, the time, day, and month of presentation, diagnosis, treatment, and follow up was collected and analyzed. One thousand four hundred twenty-five patients with dental problems visited the SNUBH emergency center. Dental patients accounted for 1.47% of the total 96,708 patients at the emergency center. The male-to-female ratio was 1.68:1, with a considerably larger number of male patients (62.7%). The age distribution peak was at 0-9 years (27.5%), followed by patients in their forties (14.1%). The number of patients visiting the dental emergency center peaked in May (14.2%), on Sundays (22.4%), and between 2100 and 2400 h (20.8%). The patients' chief complaints were as follows: dental trauma, dental infection, oral bleeding, and temporomandibular joint disorder (TMD). The prevalence of dental trauma was 66%. The reasons for dental emergency visits included the following: dental trauma, dental infection, oral bleeding, and TMD, with 66% of the patients requiring management of dental trauma. It is important that dentists make a prompt, accurate diagnosis and initiate effective treatment in case of dental emergencies, especially dental trauma. © 2011 John Wiley & Sons A/S.

  13. Studies on the chronological alterations of blood counts on the radiological technicians at health centers in Japan (1957 - 1975)

    International Nuclear Information System (INIS)

    Endo, Kouichi; Ishizaka, Masatsuna

    1977-01-01

    From the nine health surveys made on clinical radiation technicians working at health centers during the 18 years from 1957 to 1975, 679 technicians on whom blood examinations were made for not less than ten consecutive years were sampled to investigate for chronological alterations in their blood parameters. The radiation protective means at the health centers have made rapid progress ever since the atomic bomb experiment in 1954, and the dose of exposure to radiation then began to decrease. On the other hand, it was in about 1960 that the measurement of individual exposure doses began to be made on 60% of all the technicians. Chronological alterations in the average blood counts of these technicians under the abovementioned situation were such that RBC and hemoglobin level continued to increase from 1963 until about 1967, but then began to decrease, and that WBC was as low as 5,883/mm 3 in 1957, but tended to increase though slightly at each of the subsequent surveys, and was increased to 6,570/mm 3 in 1975, that is, WBC has been approaching the normal count of 6,774/mm 3 in the Japanese, with a significant difference at a not more than 1% level of significance in each survey year. For the purpose of preventing radiation hazard, further efforts should be made to protect the technicians from exposure to radiation and to control their health. (auth.)

  14. A research on the enhancement of research management efficiency for the division of research, Korea cancer center hospital

    International Nuclear Information System (INIS)

    Lee, S. W.; Ma, K. H.; Kim, J. R.; Lee, D. C.; Lee, J. H.

    1999-06-01

    The research activities of Korea Cancer Center Hospital have increased for the past a few years just in proportion to the increase of research budget, but the assisting manpower of the office of research management has never been increased and the indications are that the internal and external circumstances will not allow the recruitment for a fairly long time. It has, therefore, become inevitable to enhance the work efficiency of the office by analyzing the administrative research assistance system, finding out problems and inefficiency factors, and suggesting possible answers to them. The office of research management and international cooperation has conducted this research to suggest possible ways to facilitate the administrative support for the research activities of Korea Cancer Center Hospital By analyzing the change of research budget, organization of the division of research and administrative support, manpower, and the administrative research supporting system of other institutes, we suggested possible ways to enhance the work efficiency for administrative research support and developed a relative database program. The research report will serve as a data for the organization of research support division when the Radiation Medicine Research Center is established. The database program has already been used for research budget management

  15. Effect of Pre-Hospital Red Blood Cell Transfusion on Mortality and Time of Death in Civilian Trauma Patients.

    Science.gov (United States)

    Rehn, Marius; Weaver, Anne; Brohi, Karim; Eshelby, Sarah; Green, Laura; Røislien, Jo; Lockey, David J

    2018-04-16

    Current management principles of haemorrhagic shock after trauma emphasize earlier transfusion therapy to prevent dilution of clotting factors and correct coagulopathy. London's air ambulance (LAA) was the first UK civilian pre-hospital service to routinely offer pre-hospital red blood cell (RBC) transfusion (phRTx). We investigated the effect of phRTx on mortality. Retrospective trauma database study comparing mortality before-implementation with after-implementation of phRTx in exsanguinating trauma patients. Univariate logistic regression was performed for the unadjusted association between phRTx and mortality was performed, and multiple logistic regression adjusting for potential confounders. We identified 623 subjects with suspected major haemorrhage. We excluded 84 (13.5%) patients due to missing data on survival status. Overall 187 (62.3%) patients died in the before phRTx period and 143 (59.8%) died in the after phRTx group. There was no significant improvement in overall survival after the introduction of phRTx (p = 0.554). Examination of pre-hospital mortality demonstrated 126 deaths in the pre-phRTx group (42.2%) and 66 deaths in the RBC administered group (27.6%) There was a significant reduction in pre-hospital mortality in the group who received RBC (p < 0.001). phRTx was associated with increased survival to hospital, but not overall survival. The "delay death" effect of phRTx carries an impetus to further develop in-hospital strategies to improve survival in severely bleeding patients.

  16. EVALUATION OF THE BLOOD PRESSURE MEASURING KNOWLEDGE OF THE NURSES WHO ARE WORKING IN A MEDICAL FACULTY HOSPITAL

    Directory of Open Access Journals (Sweden)

    Tahir Kemal SAHIN

    2006-02-01

    Full Text Available Objective: The aim of this study is to determine the right knowledge of blood pressure measurement of the nurses who working in clinics. Materials and Method: 103 nurses who are working in Meram Medical Faculty Hospital were included to this descriptive study. Sampling method was stratified proportional random sampling method, with strata for the number of nurses at clinics. A questionnaire, which was formed of some questions about standard measuring methods of blood pressure, was applied to the nurses. Results: It was determined that 55.3% to 98.1% of the nurses answered the most of the questions correctly. But, they gave different answers to the questions about choosing the arm for measurement, inflation level of the cuff, deflation speed and how many measurements should be done for true result. It was found that the female nurses had much more knowledge about the tension of wrapping the cuff around the arm and the correct positioning of the stethescope than the male ones. Oppositely, the male nurses had higher correct answer rate about deflation of the cuff than the female nurses. Conclusion: It was concluded that the knowledge of blood pressure measurement of the nurses was partly insufficient. Periodical educational studies should be done for the nurses to complete the blood pressure measurement knowledge of them. [TAF Prev Med Bull 2006; 5(1.000: 8-18

  17. Health and Prevention Enhancement (H-PEACE): a retrospective, population-based cohort study conducted at the Seoul National University Hospital Gangnam Center, Korea.

    Science.gov (United States)

    Lee, Changhyun; Choe, Eun Kyung; Choi, Ji Min; Hwang, Yunji; Lee, Young; Park, Boram; Chung, Su Jin; Kwak, Min-Sun; Lee, Jong-Eun; Kim, Joo Sung; Park, Sue Kyung; Cho, Sang-Heon

    2018-04-19

    The Health and Prevention Enhancement (H-PEACE) study was designed to investigate the association of diagnostic imaging results, biomarkers and the predisease stage of non-communicable diseases (NCDs), such as malignancies and metabolic diseases, in an average-risk population in Korea. This study enrolled a large-scale retrospective cohort at the Healthcare System Gangnam Center, Seoul National University Hospital, from October 2003 to December 2014. The baseline and follow-up information collected in the predisease stage of NCDs allows for evaluation of an individual's potential NCD risk, which is necessary for establishing personalised prevention strategies. A total of 91 336 health examinees were included in the cohort, and we repeatedly measured and collected information for 50.9% (n=46 484) of the cohort members. All participants completed structured questionnaires (lifestyle, medical history, mini-dietary assessment index, sex-specific variables and psychiatric assessment), doctors' physical examinations, laboratory blood and urine tests and digital chest X-ray imaging. For participants with available data, we also obtained information on specific diagnostic variables using advanced diagnostic tests, including coronary CT for coronary calcium scores, colonoscopy and brain MRI. Furthermore, 17 455 of the participants who provided informed consent and donated blood samples were enrolled into the Gene-environmental interaction and phenotype study, a subcohort of the H-PEACE, from October 2013, and we analysed genome-wide single-nucleotide polymorphism array data for 6579 of these blood samples. The data obtained from this cohort will be used to facilitate advanced and accurate diagnostic techniques related to NCDs while considering various phenotypes. Potential collaborators can access the dataset after receiving approval from our institutional review board. Applications can be submitted on the study homepage (http://en-healthcare.snuh.org/HPEACEstudy).

  18. Organizational culture and the implementation of person centered care: results from a change process in Swedish hospital care.

    Science.gov (United States)

    Alharbi, Tariq Saleem J; Ekman, Inger; Olsson, Lars-Eric; Dudas, Kerstin; Carlström, Eric

    2012-12-01

    Sweden has one of the oldest, most coherent and stable healthcare systems in the world. The culture has been described as conservative, mechanistic and increasingly standardized. In order to provide a care adjusted to the patient, person centered care (PCC) has been developed and implemented into some parts of the health care industry. The model has proven to decrease patient uncertainty. However, the impact of PCC has been limited in some clinics and hospital wards. An assumption is that organizational culture has an impact on desired outcomes of PCC, such as patient uncertainty. Therefore, in this study we identify the impact of organizational culture on patient uncertainty in five hospital wards during the implementation of PCC. Data from 220 hospitalized patients who completed the uncertainty cardiovascular population scale (UCPS) and 117 nurses who completed the organizational values questionnaire (OVQ) were investigated with regression analysis. The results seemed to indicate that in hospitals where the culture promotes stability, control and goal setting, patient uncertainty is reduced. In contrast to previous studies suggesting that a culture of flexibility, cohesion and trust is positive, a culture of stability can better sustain a desired outcome of reform or implementation of new care models such as person centered care. It is essential for health managers to be aware of what characterizes their organizational culture before attempting to implement any sort of new healthcare model. The organizational values questionnaire has the potential to be used as a tool to aid health managers in reaching that understanding. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  19. Restructuring within an academic health center to support quality and safety: the development of the Center for Quality and Safety at the Massachusetts General Hospital.

    Science.gov (United States)

    Bohmer, Richard M J; Bloom, Jonathan D; Mort, Elizabeth A; Demehin, Akinluwa A; Meyer, Gregg S

    2009-12-01

    Recent focus on the need to improve the quality and safety of health care has created new challenges for academic health centers (AHCs). Whereas previously quality was largely assumed, today it is increasingly quantifiable and requires organized systems for improvement. Traditional structures and cultures within AHCs, although well suited to the tripartite missions of teaching, research, and clinical care, are not easily adaptable to the tasks of measuring, reporting, and improving quality. Here, the authors use a case study of Massachusetts General Hospital's efforts to restructure quality and safety to illustrate the value of beginning with a focus on organizational culture, using a systematic process of engaging clinical leadership, developing an organizational framework dependent on proven business principles, leveraging focus events, and maintaining executive dedication to execution of the initiative. The case provides a generalizable example for AHCs of how applying explicit management design can foster robust organizational change with relatively modest incremental financial resources.

  20. Factors affecting autologous peripheral blood hematopoietic stem cell collections by large-volume leukapheresis: a single center experience

    Directory of Open Access Journals (Sweden)

    Araci Massami Sakashita

    2011-06-01

    Full Text Available Objective: To evaluate factors affecting peripheral bloodhematopoietic stem cell yield in patients undergoing large-volumeleukapheresis for autologous peripheral blood stem cell collection.Methods: Data from 304 consecutive autologous peripheral bloodstem cell donors mobilized with hematopoietic growth factor (usually G-CSF, associated or not with chemotherapy, at Hospital Israelita Albert Einstein between February 1999 and June 2010 were retrospectively analyzed. The objective was to obtain at least 2 x 106CD34+ cells/kg of body weight. Pre-mobilization factors analyzedincluded patient’s age, gender and diagnosis. Post mobilizationparameters evaluated were pre-apheresis peripheral white bloodcell count, immature circulating cell count, mononuclear cell count,peripheral blood CD34+ cell count, platelet count, and hemoglobinlevel. The effect of pre and post-mobilization factors on hematopoietic stem cell collection yield was investigated using logistic regression analysis (univariate and multivariate approaches. Results: Premobilization factors correlating to poor CD34+ cell yield in univariate analysis were acute myeloid leukemia (p = 0.017 and other hematological diseases (p = 0.023. Significant post-mobilization factors included peripheral blood immature circulating cells (p = 0.001, granulocytes (p = 0.002, hemoglobin level (p = 0.016, and CD34+ cell concentration (p < 0.001 in the first harvesting day. However, according to multivariate analysis, peripheral blood CD34+ cell content (p < 0.001 was the only independent factor that significantly correlated to poor hematopoietic stem cell yield. Conclusion: In this study, peripheral blood CD34+ cell concentration was the only factor significantly correlated to yield in patients submitted to for autologous collection.

  1. Hospitals

    DEFF Research Database (Denmark)

    Mullins, Michael

    2013-01-01

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

  2. Management of Low-Level Radioactive Waste from Research, Hospitals and Nuclear Medical Centers in Egypt - 13469

    Energy Technology Data Exchange (ETDEWEB)

    Hasan, M.A.; Selim, Y.T.; Lasheen, Y.F. [Hot Labs and Waste Management Center, Atomic Energy Authority, 3 Ahmed El-Zomor St., El-Zohour District, Naser City, 11787, Cairo (Egypt)

    2013-07-01

    The application of radioisotopes and radiation sources in medical diagnosis and therapy is an important issue. Physicians can use radioisotopes to diagnose and treat diseases. Methods of treatment, conditioning and management of low level radioactive wastes from the use of radiation sources and radioisotopes in hospitals and nuclear medicine application, are described. Solid Radioactive waste with low-level activity after accumulation, minimization, segregation and measurement, are burned or compressed in a compactor according to the international standards. Conditioned drums are transported to the interim storage site at the Egyptian Atomic Energy Authority (EAEA) represented in Hot Labs and Waste Management Center (HLWMC) for storage and monitoring. (authors)

  3. [Predictors of mean blood glucose control and its variability in diabetic hospitalized patients].

    Science.gov (United States)

    Sáenz-Abad, Daniel; Gimeno-Orna, José Antonio; Sierra-Bergua, Beatriz; Pérez-Calvo, Juan Ignacio

    2015-01-01

    This study was intended to assess the effectiveness and predictors factors of inpatient blood glucose control in diabetic patients admitted to medical departments. A retrospective, analytical cohort study was conducted on patients discharged from internal medicine with a diagnosis related to diabetes. Variables collected included demographic characteristics, clinical data and laboratory parameters related to blood glucose control (HbA1c, basal plasma glucose, point-of-care capillary glucose). The cumulative probability of receiving scheduled insulin regimens was evaluated using Kaplan-Meier analysis. Multivariate regression models were used to select predictors of mean inpatient glucose (MHG) and glucose variability (standard deviation [GV]). The study sample consisted of 228 patients (mean age 78.4 (SD 10.1) years, 51% women). Of these, 96 patients (42.1%) were treated with sliding-scale regular insulin only. Median time to start of scheduled insulin therapy was 4 (95% CI, 2-6) days. Blood glucose control measures were: MIG 181.4 (SD 41.7) mg/dL, GV 56.3 (SD 22.6). The best model to predict MIG (R(2): .376; P<.0001) included HbA1c (b=4.96; P=.011), baseline plasma glucose (b=.056; P=.084), mean capillary blood glucose in the first 24hours (b=.154; P<.0001), home treatment (versus oral agents) with basal insulin only (b=13.1; P=.016) or more complex (pre-mixed insulin or basal-bolus) regimens (b=19.1; P=.004), corticoid therapy (b=14.9; P=.002), and fasting on admission (b=10.4; P=.098). Predictors of inpatient blood glucose control which should be considered in the design of DM management protocols include home treatment, HbA1c, basal plasma glucose, mean blood glucose in the first 24hours, fasting, and corticoid therapy. Copyright © 2014 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

  4. Efficacy of Implementation of a Chest Pain Center at a Community Hospital.

    Science.gov (United States)

    Davis, Alexandra; Chiu, Jason; Lau, Stanley K; Kok, Yih Jen; Wu, Jonathan Y H

    2017-12-01

    Chest pain is the second leading cause for emergency department (ED) visits in the United States; however, Asian-based community hospital in the United States. Additionally, this assessment sought to evaluate the effectiveness and safety of a HEART protocol in the first 4 months after its adoption. The facility implemented the CPC, an observation unit, in October 2016. ED physicians risk stratified patients using the HEART score. The guidelines allow ED physicians to stratify patients into 3 categories: to discharge low-risk patients, observe moderate-risk patients in the CPC, and admit high-risk patients. Patients in the CPC received additional diagnostic work-up under the care of ED physicians and cardiologists for less than 24 hours. In addition, CPC patients were followed-up 2 and 30 days after discharge. A total of 172 patients presented at the ED with a chief complaint of chest pain. The majority of the patients were classified into the moderate-risk group (n = 101). Low-risk patients spent significantly less hours in the hospital than the moderate- and high-risk groups, and the high-risk group spent more time in the hospital than the moderate-risk group. The staff followed-up with 74 CPC patients through telephone calls to assess if patients were still experiencing chest pain and if they had followed-up with a cardiologist or primary care physician. The 2- and 30-day survival rates were 100% and 97%, respectively. The data showed a significant reduction in total length of stay for all chest pain patients. This retrospective program evaluation demonstrated some evidence in using HEART score to safely risk stratify chest pain patients to the appropriate level of care. As healthcare moves from a fee-for-service environment to value-based purchasing, hospitals need to devise and implement innovative strategies to provide efficient, beneficial, and safe care for the patients.

  5. The proton therapy system for Massachusetts General Hospital's Northeast Proton Therapy Center

    International Nuclear Information System (INIS)

    Jongen, Y.

    1996-01-01

    In 1989, two companies, Ion Beam Applications in Belgium (IBA) and Sumitomo Heavy Industries in Japan (SHI) started to design proton therapy equipments based on cyclotrons. In 1991, SHI and IBA decided to join their development efforts in this field. In 1993, the Massachusetts General Hospital (MGH), pioneer in the field of proton therapy, launched an international request for proposals for the procurement of an in-hospital proton therapy facility. The 18 may 1994, the contract was signed with a team of industries led by IBA, including also SHI and General Atomics (GA) of California. The proposed system is based on a fixed energy, isochronous cyclotron, followed by an energy degrader and an energy selection system. The variable energy beam can be rapidly switched in any one of three treatment rooms. Two rooms are equipped with large isocentric gantries and robotic patient positioners allowing to direct the proton beam within the patient from any direction. The third room is equipped with fixed horizontal beam. The complete system is computer controlled by a distributed network of computers, programmable logic controllers and workstations. This computer control allows to change the energy in one treatment room is less than two second, a performance matching or exceeding the flexibility offered by synchrotrons. The system is now built and undergoing factory tests. The beam has been accelerated to full energy in the cyclotron, and beam extraction tests are underway. Installation in the hospital building will take place in 1997. (author)

  6. A Multi-Center Assessment of Nutrient Levels and Foods Provided by Hospital Patient Menus

    Directory of Open Access Journals (Sweden)

    Susan Trang

    2015-11-01

    Full Text Available Diets of high nutritional quality can aid in the prevention and management of malnutrition in hospitalized patients. This study evaluated the nutritional quality of hospital patient menus. At three large acute care hospitals in Ontario, Canada, 84 standard menus were evaluated, which included regular and carbohydrate-controlled diets and 3000 mg and 2000 mg sodium diets. Mean levels of calories, macronutrients and vitamins and minerals provided were calculated. Comparisons were made with the Dietary Reference Intakes (DRI and Canada’s Food Guide (CFG recommendations. Calorie levels ranged from 1281 to 3007 kcal, with 45% of menus below 1600 kcal. Protein ranged from 49 to 159 g (0.9–1.1 g/kg/day. Energy and protein levels were highest in carbohydrate-controlled menus. All regular and carbohydrate-controlled menus provided macronutrients within the Acceptable Macronutrient Distribution Ranges. The proportion of regular diet menus meeting the DRIs: 0% for fiber; 7% for calcium; 57% for vitamin C; and 100% for iron. Compared to CFG recommended servings, 35% met vegetables and fruit and milk and alternatives, 11% met grain products and 8% met meat and alternatives. These data support the need for frequent monitoring and evaluation of menus, food procurement and menu planning policies and for sufficient resources to ensure menu quality.

  7. A Multi-Center Assessment of Nutrient Levels and Foods Provided by Hospital Patient Menus.

    Science.gov (United States)

    Trang, Susan; Fraser, Jackie; Wilkinson, Lori; Steckham, Katherine; Oliphant, Heather; Fletcher, Heather; Tzianetas, Roula; Arcand, JoAnne

    2015-11-11

    Diets of high nutritional quality can aid in the prevention and management of malnutrition in hospitalized patients. This study evaluated the nutritional quality of hospital patient menus. At three large acute care hospitals in Ontario, Canada, 84 standard menus were evaluated, which included regular and carbohydrate-controlled diets and 3000 mg and 2000 mg sodium diets. Mean levels of calories, macronutrients and vitamins and minerals provided were calculated. Comparisons were made with the Dietary Reference Intakes (DRI) and Canada's Food Guide (CFG) recommendations. Calorie levels ranged from 1281 to 3007 kcal, with 45% of menus below 1600 kcal. Protein ranged from 49 to 159 g (0.9-1.1 g/kg/day). Energy and protein levels were highest in carbohydrate-controlled menus. All regular and carbohydrate-controlled menus provided macronutrients within the Acceptable Macronutrient Distribution Ranges. The proportion of regular diet menus meeting the DRIs: 0% for fiber; 7% for calcium; 57% for vitamin C; and 100% for iron. Compared to CFG recommended servings, 35% met vegetables and fruit and milk and alternatives, 11% met grain products and 8% met meat and alternatives. These data support the need for frequent monitoring and evaluation of menus, food procurement and menu planning policies and for sufficient resources to ensure menu quality.

  8. Strategic planning for clinical services: St. Joseph Hospital and Health Care Center.

    Science.gov (United States)

    Linggi, A; Pelham, L D

    1986-09-01

    A pharmacy department at a 340-bed community hospital based its strategic plan for developing patient-oriented services on a sound drug distribution system, a credible work-measurement program, and fiscal responsibility. In 1982 the department of pharmacy and i.v. therapy implemented a strategic plan for improving pharmaceutical services. The plan involved developing goals and objectives for the department; marketing the department's services and fiscal management to hospital administrators, medical staff, and nursing staff; building teamwork among the pharmacy staff; and improving the drug distribution system before instituting clinical services. Hiring of additional pharmacy staff was justified on the basis of work-measurement data. By adjusting staffing levels every two weeks based on work-measurement data, the department increased the efficiency of drug distribution activities; the pharmacy also implemented cost-saving programs like selection of therapeutic alternates and formulary restrictions. The savings were then reinvested in labor-intensive patient-oriented pharmaceutical services. A staff development program using staff pharmacists as preceptors expanded the breadth and depth of pharmacists' clinical skills. The planning efforts were successful because the needs of hospital administrators, the pharmacy department, and staff members were addressed.

  9. Method validation of a set of 12 GEM® Premier™ 4000 blood gas analyzers for point-of-care testing in a university teaching hospital

    Directory of Open Access Journals (Sweden)

    Charlotte Oris

    2018-03-01

    Conclusion: Our results met standard requirements and the 12 analyzers were assessed as suitable for point-of-care testing in services of academic medical centers, as exemplified at Clermont-Ferrand hospital.

  10. Blood

    Science.gov (United States)

    ... a reduced production of red blood cells, including: Iron deficiency anemia. Iron deficiency anemia is the most common type of anemia and ... inflammatory bowel disease are especially likely to have iron deficiency anemia. Anemia due to chronic disease. People with chronic ...

  11. Informed consent in blood transfusion : Knowledge and administrative issues in Uganda hospitals

    NARCIS (Netherlands)

    Kajja, Isaac; Bimenya, Gabriel S.; Smit Sibinga, Cees Th.

    Blood as a transplant is not free of risks. Clinicians and patients ought to know the parameters of a transfusion informed consent. A mixed methodology to explore patients' and clinicians' knowledge and opinions of administration and strategies to improve the transfusion informed consent process was

  12. Inappropriate use of the faecal occult blood test in a university hospital in the Netherlands

    NARCIS (Netherlands)

    van Rijn, Anne F.; Stroobants, An K.; Deutekom, Marije; Lauppe, Corinne; Sturk, Auguste; Bossuyt, Patrick M. M.; Fockens, Paul; Dekker, Evelien

    2012-01-01

    Objectives Although all international guidelines state that there is no indication to perform a faecal occult blood test (FOBT) in symptomatic patients, we believe the test is frequently used as a diagnostic test. The objective of this study was to investigate whether the current guidelines for FOBT

  13. Prevalence of extended-spectrum beta-lactamases among Enterobacteriaceae isolated from blood culture in a tertiary care hospital

    International Nuclear Information System (INIS)

    El-Khizzi, Noura A.; Bakheshwain, S. M.

    2006-01-01

    To determine the prevalence of extended spectrum beta-lactamase among Enterobacteriaceae isolated from blood culture in a tertiary care hospital. We carried out this study at the Armed Forces Hospital, Riyadh, Kingdom of Saudi Arabia during the period between January 2003 - December 2004. We tested a total of 601 isolates of the family Enterobacteriaceae from blood culture for the prevalence of extended spectrum beta-lactamase (ESBL) production by the standardized disc diffusion method and confirmed by the ESBL E test strips. Ninety-five (15.8%) of the isolates were ESBL producers. Among these, 48.4% were Klebsiella pneumoniae (K. pneumoniae) followed by15.8% of both Escherichia coli (E. coli) and Enterobacter cloacae (Ent. cloacae). Other isolates produced ESBL in low numbers. Klebsiella pneumoniae produced ESBL in significant numbers. Extended spectrum beta-lactamase gram-negative bacilli present significant diagnostic and therapeutic challenges to the management of infections due to these organisms. Microbiology laboratories should start reporting ESBL producing Enterobacteriaceae organism due to their importance in respect to antibiotic therapy and infection control aspects. (author)

  14. The first private-hospital based proton therapy center in Korea; Status of the proton therapy center at Samsung Medical Center

    International Nuclear Information System (INIS)

    Chung, Kwang Zoo; Han, Young Yih; Kim, Jin Sung

    2015-01-01

    The purpose of this report is to describe the proton therapy system at Samsung Medical Center (SMC-PTS) including the proton beam generator, irradiation system, patient positioning system, patient position verification system, respiratory gating system, and operating and safety control system, and review the current status of the SMC-PTS. The SMC-PTS has a cyclotron (230 MeV) and two treatment rooms: one treatment room is equipped with a multi-purpose nozzle and the other treatment room is equipped with a dedicated pencil beam scanning nozzle. The proton beam generator including the cyclotron and the energy selection system can lower the energy of protons down to 70 MeV from the maximum 230 MeV. The multi-purpose nozzle can deliver both wobbling proton beam and active scanning proton beam, and a multi-leaf collimator has been installed in the downstream of the nozzle. The dedicated scanning nozzle can deliver active scanning proton beam with a helium gas filled pipe minimizing unnecessary interactions with the air in the beam path. The equipment was provided by Sumitomo Heavy Industries Ltd., RayStation from RaySearch Laboratories AB is the selected treatment planning system, and data management will be handled by the MOSAIQ system from Elekta AB. The SMC-PTS located in Seoul, Korea, is scheduled to begin treating cancer patients in 2015

  15. The first private-hospital based proton therapy center in Korea; status of the Proton Therapy Center at Samsung Medical Center.

    Science.gov (United States)

    Chung, Kwangzoo; Han, Youngyih; Kim, Jinsung; Ahn, Sung Hwan; Ju, Sang Gyu; Jung, Sang Hoon; Chung, Yoonsun; Cho, Sungkoo; Jo, Kwanghyun; Shin, Eun Hyuk; Hong, Chae-Seon; Shin, Jung Suk; Park, Seyjoon; Kim, Dae-Hyun; Kim, Hye Young; Lee, Boram; Shibagaki, Gantaro; Nonaka, Hideki; Sasai, Kenzo; Koyabu, Yukio; Choi, Changhoon; Huh, Seung Jae; Ahn, Yong Chan; Pyo, Hong Ryull; Lim, Do Hoon; Park, Hee Chul; Park, Won; Oh, Dong Ryul; Noh, Jae Myung; Yu, Jeong Il; Song, Sanghyuk; Lee, Ji Eun; Lee, Bomi; Choi, Doo Ho

    2015-12-01

    The purpose of this report is to describe the proton therapy system at Samsung Medical Center (SMC-PTS) including the proton beam generator, irradiation system, patient positioning system, patient position verification system, respiratory gating system, and operating and safety control system, and review the current status of the SMC-PTS. The SMC-PTS has a cyclotron (230 MeV) and two treatment rooms: one treatment room is equipped with a multi-purpose nozzle and the other treatment room is equipped with a dedicated pencil beam scanning nozzle. The proton beam generator including the cyclotron and the energy selection system can lower the energy of protons down to 70 MeV from the maximum 230 MeV. The multi-purpose nozzle can deliver both wobbling proton beam and active scanning proton beam, and a multi-leaf collimator has been installed in the downstream of the nozzle. The dedicated scanning nozzle can deliver active scanning proton beam with a helium gas filled pipe minimizing unnecessary interactions with the air in the beam path. The equipment was provided by Sumitomo Heavy Industries Ltd., RayStation from RaySearch Laboratories AB is the selected treatment planning system, and data management will be handled by the MOSAIQ system from Elekta AB. The SMC-PTS located in Seoul, Korea, is scheduled to begin treating cancer patients in 2015.

  16. Ten-year patterns in blood product utilization during cardiothoracic surgery with cardiopulmonary bypass in a tertiary hospital.

    Science.gov (United States)

    Vonk, Alexander B A; Meesters, Michael I; van Dijk, Wouter B; Eijsman, Leon; Romijn, Johannes W A; Jansen, Evert K; Loer, Stephan A; Boer, Christa

    2014-10-01

    This retrospective analysis describes blood conservation strategies and overall consumption of red blood cells (RBCs), fresh-frozen plasma (FFP), and platelet (PLT) concentrates during nonaortic cardiac surgery with cardiopulmonary bypass (CPB) in a tertiary hospital over a 10-year period. Study variables of 6026 patients that underwent cardiac surgery between 2002 and 2011 were incorporated in the database and included hemoglobin (Hb), lowest temperature, CPB duration, 24-hour blood loss, fluid balance, and overall transfusion requirements. Between 2002 and 2011, the lowest intraoperative Hb levels and temperature increased from 8.5 ± 1.2 to 10.4 ± 1.4 g/dL and from 32 ± 2 to 34 ± 1°C, respectively. In addition to the steep decrease in the postoperative fluid balance over time, a reduction in 24-hour blood loss from 815 ± 588 mL (2002) to 590 ± 438 mL (2011) was observed. These changes were paralleled by a 28% reduction in overall RBC transfusion from 1443 units in 2002 to 1038 in 2011. While RBC transfusion decreased over time, there was no significant change in the use of FFP or PLT concentrate transfusion. The probability to receive RBC transfusion increased after cessation of aprotinin, but reduced after routine cell salvage in all operations. This institutional report shows a large reduction in blood loss and transfusion requirements in cardiac surgery over a 10-year period. This reduction is most probably attributed to structural cell salvage, reduced intraoperative fluid volumes, and the increase in the lowest intraoperative body temperature. © 2013 AABB.

  17. Length of stay and medical stability for spinal cord-injured patients on admission to an inpatient rehabilitation hospital: a comparison between a model SCI trauma center and non-SCI trauma center.

    Science.gov (United States)

    Ploumis, A; Kolli, S; Patrick, M; Owens, M; Beris, A; Marino, R J

    2011-03-01

    Retrospective database review. To compare lengths of stay (LOS), pressure ulcers and readmissions to the acute care hospital of patients admitted to the inpatient rehabilitation facility (IRF) from a model spinal cord injury (SCI) trauma center or from a non-SCI acute hospital. Only sparse data exist comparing the status of patients admitted to IRF from a model SCI trauma center or from a non-SCI acute hospital. Acute care, IRF and total LOS were compared between patients transferred to IRF from the SCI center (n=78) and from non-SCI centers (n=131). The percentages of pressure ulcers on admission to IRF and transfer back to acute care were also compared. Patients admitted to IRF from the SCI trauma center (SCI TC) had significantly shorter (P=0.01) acute care LOS and total LOS compared with patients admitted from non-SCI TCs. By neurological category, acute-care LOS was less for all groups admitted from the SCI center, but statistically significant only for tetraplegia. There was no significant difference in the incidence of readmissions to acute care from IRF. More patients from non-SCI centers (34%) than SCI centers (12%) had pressure ulcers (PSCI TCs before transfer to IRF can significantly lower acute-care LOS or total LOS and incidence of pressure ulcers compared with non-SCI TCs. Patients admitted to IRF from SCI TCs are no more likely to be sent back to an acute hospital than those from non-SCI TCs.

  18. Road map to a patient-centered research agenda at the intersection of hospital medicine and geriatric medicine.

    Science.gov (United States)

    Wald, Heidi L; Leykum, Luci K; Mattison, Melissa L P; Vasilevskis, Eduard E; Meltzer, David O

    2014-06-01

    As the United States ages, the patient population in acute care hospitals is increasingly older and more medically complex. Despite evidence of a high burden of disease, high costs, and often poor outcomes of care, there is limited understanding of the presentation, diagnostic strategies, and management of acute illness in older adults. In this paper, we present a strategy for the development of a research agenda at the intersection of hospital and geriatric medicine. This approach is informed by the Patient-Centered Outcomes Research Institute (PCORI) framework for identification and prioritization of research areas, emphasizing input from patients and caregivers. The framework's four components are: 1) Topic generation, 2) Gap Analysis in Systematic Review, 3) Value of information (VOI) analysis, and 4) Peer Review. An inclusive process for topic generation requiring the systematic engagement of multiple stakeholders, especially patients, is emphasized. In subsequent steps, researchers and stakeholders prioritize research topics in order to identify areas that optimize patient-centeredness, population impact, impact on clinical decision making, ease of implementation, and durability. Finally, next steps for dissemination of the research agenda and evaluation of the impact of the patient-centered research prioritization process are described.

  19. White Coat Hypertension and Masked Hypertension Among Omani Patients Attending a Tertiary Hospital for Ambulatory Blood Pressure Monitoring

    Directory of Open Access Journals (Sweden)

    Khamis Al-Hashmi

    2015-03-01

    Full Text Available Objectives: Our study aimed to estimate the rate of white coat hypertension (WCH and effect, and masked hypertension in patients attending a tertiary care hospital for 24 hour ambulatory blood pressure monitoring (24-h ABPM. Methods: A total of 231 adult patients were referred to the Department of Clinical Physiology at Sultan Qaboos University Hospital, Muscat, for ABPM, between January 2010 and June 2012. The following data were gathered and analyzed: demographic data, clinic blood pressure (BP measurements, and 24-h BP profile from ABPM. Thirty-two patients were excluded and the final analysis included 199 patients. Results: There were 105 (52.8% women and 94 (47.2% men studied. The mean age of patients was 46±15 years and most patients were overweight with a mean BMI of 29.6±5kg/m2. Around half of patients (53.8% were on one or more antihypertensive medications. WCH was found in 10.6% and white coat effect was found in 16% of patients. The majority of patients (57% with WCH were aged 40 years or above. Masked hypertension was present in 6% of patients and masked uncontrolled hypertension in 8.5% of patients. Conclusions: Our study showed that WCH and effect, and masked hypertension are common in hypertensive patients. Identifying these patients will have an impact on their management. However, the results of the study should be interpreted within the context of its limitations. Prospective randomized community and hospital-based studies should be conducted to estimate the true prevalence in the general population as well as in hypertensive patients.

  20. Sensitometric Control of Automatic Processors in a Hospital Center : Retrospective Study

    International Nuclear Information System (INIS)

    Lobato Busto, R.; Pombar Camean, M.

    1992-01-01

    This paper analyses the results obtained between February (1990) and July (1991) of the sensitometric control of the seven automatic processors which are in Hospital General de Galicia-Clinico Universitario (Santiago de Compostela). The deviations with regard to the reference values of each processor, permitting the precocious detection of disturbances before being revealed by the image, were analysed. In this analysis, it was achieved that the days in which the automatic processors were out of standing only varied between 2.3% and 5% from the checked days. (author)

  1. Comparison of Genotypes and Enterotoxin Genes Between Staphylococcus aureus Isolates from Blood and Nasal Colonizers in a Korean Hospital

    Science.gov (United States)

    Peck, Kyong Ran; Baek, Jin Yang; Song, Jae-Hoon

    2009-01-01

    In this study, we investigated the genetic background of 70 Staphylococcus aureus isolates (36 methicillin-resistant S. aureus [MRSA] and 34 methicillin-susceptible S. aureus [MSSA]) obtained from blood at a Korean tertiary-care hospital, using spa typing, multilocus sequence typing, and SCCmec typing. In addition, the prevalence of enterotoxin (sea, seb, sec, sed, see, seg, seh, sei, and sek), tst, and pvl genes among the samples was assessed via polymerase chain reaction, and the results were compared with those of 95 isolates of S. aureus obtained from nasal swabs. All MRSA isolates from blood, except one, belonged to three major clones: sequence type (ST)5-MRSA-II, ST72-MRSA-II (or IVA), and ST239-MRSA-III, among which ST5-MRSA-II was the predominant clone. The prevalence of enterotoxin genes in the S. aureus isolates obtained from blood differed significantly from those from the nasal swabs for the sea, seb, sec, and seh gene. In particular, the seb and sec genes were detected exclusively in the MRSA isolates of ST5 or spa-CC002, thereby suggesting the co-adaptation of virulence genes with the genetic background and their contribution to biological fitness. PMID:19654937

  2. Bacteriologic profile and antibiogram of blood culture isolates from a children's hospital in Kabul.

    Science.gov (United States)

    Tariq, Tariq Mahmud

    2014-06-01

    To identify the bacterial pathogens causing paediatric septicaemia in Kabul and to determine their antibiogram to improve empirical antibiotic therapy. Cross-sectional study. Microbiology Laboratory of FMIC, Kabul, Afghanistan, from January 2010 to June 2012. Blood cultures from suspected cases of sepsis were processed in BD (Becton Dickinson, USA) for culture BACTEC™ 9240 Blood Culture System. Positive growths were examined and isolates were identified by conventional biochemical tests. Bacteria were identified to the species level using various Analytical Profile Index (API) identification strips. Antibiotic susceptibility testing was performed by modified Kirby-Bauer disk diffusion method. Drug resistant strains were studied for extended spectrum beta lactamase (ESBL) production by combination disk method and for methicillin resistant Staphylococcus aureus (MRSA) by Cefoxitin disk diffusion method. Out of a total 3360 blood cultures received from in-patients, 410 yielded monomicrobial growth; hence the frequency of positive blood culture was 12.2%. Out of a total 410 isolates, 212 (51.71%) were gram-negative bacilli and 184 (44.88%) were gram-positive cocci. In addition, 14 (3.41%) Candida species were also isolated. The frequently isolated species of gram-negative bacteria belonged to Enterobacteriaceae and included 66 Klebsiella (16.1%), 42 Enterobacter (10.2%), 35 Escherichia (E.) coli (8.5%) and 16 Serratia (3.9%) species. In addition, 21 (5.12%) Pseudomonas species were also isolated. Correspondingly, amongst gram-positive cocci, the most frequently isolated species were 108 coagulase-negative Staphylococci (26.34%) followed by 49 Staphylococcus aureus (11.95%) and 21 Streptococcus species (5.12%). Among gram-negative isolates, those that produced ESBL i.e., 110 out of 212 (51.9%) were found to be multidrug-resistant and showed high resistance to commonly used antibiotics namely Ampicillin, Gentamicin, 3rd generation Cephalosporins, Fluoroquinolones and

  3. Motorcycle-related hospitalization of adolescents in a Level I trauma center in southern Taiwan: a cross-sectional study.

    Science.gov (United States)

    Liang, Chi-Cheng; Liu, Hang-Tsung; Rau, Cheng-Shyuan; Hsu, Shiun-Yuan; Hsieh, Hsiao-Yun; Hsieh, Ching-Hua

    2015-08-28

    The aim of this study was to investigate and compare the injury pattern, mechanisms, severity, and mortality of adolescents and adults hospitalized for treatment of trauma following motorcycle accidents in a Level I trauma center. Detailed data regarding patients aged 13-19 years (adolescents) and aged 30-50 years (adults) who had sustained trauma due to a motorcycle accident were retrieved from the Trauma Registry System between January 1, 2009 and December 31, 2012. The Pearson's chi-squared test, Fisher's exact test, or the independent Student's t-test were performed to compare the adolescent and adult motorcyclists and to compare the motorcycle drivers and motorcycle pillion. Analysis of Abbreviated Injury Scale (AIS) scores revealed that the adolescent patients had sustained higher rates of facial, abdominal, and hepatic injury and of cranial, mandibular, and femoral fracture but lower rates of thorax and extremity injury; hemothorax; and rib, scapular, clavicle, and humeral fracture compared to the adults. No significant differences were found between the adolescents and adults regarding Injury Severity Score (ISS), New Injury Severity Score (NISS), Trauma-Injury Severity Score (TRISS), mortality, length of hospital stay, or intensive care unit (ICU) admission rate. A significantly greater percentage of adolescents compared to adults were found not to have worn a helmet. Motorcycle riders who had not worn a helmet were found to have a significantly lower first Glasgow Coma Scale (GCS) score, and a significantly higher percentage was found to present with unconscious status, head and neck injury, and cranial fracture compared to those who had worn a helmet. Adolescent motorcycle riders comprise a major population of patients hospitalized for treatment of trauma. This population tends to present with a higher injury severity compared to other hospitalized trauma patients and a bodily injury pattern differing from that of adult motorcycle riders, indicating the

  4. Clinical Characteristic of the HIV/AIDS Patients with Cryptosporidiosis Referring to Behavioral Diseases Consultation Center, Imam Khomeini Hospital, Tehran in 2013.

    Science.gov (United States)

    Gholami, Rashid; Gholami, Shirzad; Emadi-Kouchak, Hamid; Abdollahi, Alireza; Shahriari, Mona

    2016-01-01

    Cryptosporidium is known as an opportunist disease-causing agent in man in recent decades. It causes diarrhea and intestinal disorders in the immune deficit and immune competent individuals. This study was aimed to investigate the clinical characteristics of HIV/AIDS patients with cryptosporidiosis infection. This cross-sectional descriptive study was performed on 53 HIV/AIDS patients referred to the Behavior Disease Consultation Center of Imam Khomeini Hospital in Tehran, Iran in 2013. First, the patients were studied clinically and the context data were recorded in a questionnaire for parasitological examination and referred to the laboratory for eosinophil count, and CD4 count per ml of blood. Cryptosporidiosis was observed in 4 (7.6%) of the total 53 HIV/AIDS patients. The highest prevalence of infection was observed in the age range of 30-39 yr. It was observed in different sexes as 5.7% of male and 1.9% of female, but statistically was insignificant (P=0.163).75% of patients had no intestinal symptom, 11.4% with acute diarrhea and 3.8% with chronic diarrhea. Cryptosporidiosis cases were observed in 5.7% of patients without intestinal symptom. Practitioners in the clinical examination for the detection of the opportunistic intestinal protozoan infection should use clinical and paraclinical characteristics of the HIV/AIDS patients for the diagnostic of Cryptosporidium and other opportunistic parasitic diseases.

  5. Bacteriologic Profile and Antibiogram of Blood Culture Isolates from a Children's Hospital in Kabul

    International Nuclear Information System (INIS)

    Tariq, O. M.

    2014-01-01

    Objective: To identify the bacterial pathogens causing paediatric septicaemia in Kabul and to determine their antibiogram to improve empirical antibiotic therapy. Study Design: Cross-sectional study. Place and Duration of Study: Microbiology Laboratory of FMIC, Kabul, Afghanistan, from January 2010 to June 2012. Methodology: Blood cultures from suspected cases of sepsis were processed in BD (Becton Dickinson, USA) for culture BACTEC 9240 Blood Culture System. Positive growths were examined and isolates were identified by conventional biochemical tests. Bacteria were identified to the species level using various Analytical Profile Index (API) identification strips. Antibiotic susceptibility testing was performed by modified Kirby-Bauer disk diffusion method. Drug resistant strains were studied for extended spectrum beta lactamase (ESBL) production by combination disk method and for methicillin resistant Staphylococcus aureus (MRSA) by Cefoxitin disk diffusion method. Results: Out of a total 3360 blood cultures received from in-patients, 410 yielded monomicrobial growth; hence the frequency of positive blood culture was 12.2%. Out of a total 410 isolates, 212 (51.71%) were gram-negative bacilli and 184 (44.88%) were gram-positive cocci. In addition, 14 (3.41%) Candida species were also isolated. The frequently isolated species of gram-negative bacteria belonged to Enterobacteriaceae and included 66 Klebsiella (16.1%), 42 Enterobacter (10.2%), 35 Escherichia (E.) coli (8.5%) and 16 Serratia (3.9%) species. In addition, 21 (5.12%) Pseudomonas species were also isolated. Correspondingly, amongst gram-positive cocci, the most frequently isolated species were 108 coagulase-negative Staphylococci (26.34%) followed by 49 Staphylococcus aureus (11.95%) and 21 Streptococcus species (5.12%). Among gram-negative isolates, those that produced ESBL i.e., 110 out of 212 (51.9%) were found to be multidrug-resistant and showed high resistance to commonly used antibiotics namely

  6. Service utilization in community health centers in China: a comparison analysis with local hospitals

    Directory of Open Access Journals (Sweden)

    Wang Xiaohang

    2006-08-01

    Full Text Available Abstract Background Being an important part of China's Urban Health Care Reform System, Community Health Centers (CHCs have been established throughout the entire country and are presently undergoing substantial reconstruction. However, the services being delivered by the CHCs are far from reaching their performance targets. In order to assess the role of the CHCs, we examined their performance in six cities located in regions of South-East China. The purpose of this investigation was to identify the utilization and the efficiency of community health resources that are able to provide basic medical and public health services. Methods The study was approved by Peking University Health Science Center Institutional Reviewing Board (NO: IRB00001052-T1. Data were collected from all the local health bureaux and processed using SPSS software. Methods of analysis mainly included: descriptive analysis, paired T-test and one-way ANOVA. Results The six main functions of the CHCs were not fully exploited and the surveys that were collected on their efficiency and utilization of resources indicate that they have a low level of performance and lack the trust of local communities. Furthermore, the CHCs seriously lack funding support and operate under difficult circumstances, and residents have less positive attitudes towards them. Conclusion The community health service must be adjusted according to the requirements of urban medical and health reform, taking into account communities' health needs. More research is required on the living standards and health needs of residents living within the CHC's range, taking into consideration the users' needs in expanding the newly implemented service, and at the same time revising the old service system so as to make the development of CHCs realistic and capable of providing a better service to patients. Several suggestions are put forward for an attainable scheme for developing a community health service.

  7. A Growing Opportunity: Community Gardens Affiliated with US Hospitals and Academic Health Centers.

    Science.gov (United States)

    George, Daniel R; Rovniak, Liza S; Kraschnewski, Jennifer L; Hanson, Ryan; Sciamanna, Christopher N

    Community gardens can reduce public health disparities through promoting physical activity and healthy eating, growing food for underserved populations, and accelerating healing from injury or disease. Despite their potential to contribute to comprehensive patient care, no prior studies have investigated the prevalence of community gardens affiliated with US healthcare institutions, and the demographic characteristics of communities served by these gardens. In 2013, national community garden databases, scientific abstracts, and public search engines (e.g., Google Scholar) were used to identify gardens. Outcomes included the prevalence of hospital-based community gardens by US regions, and demographic characteristics (age, race/ethnicity, education, household income, and obesity rates) of communities served by gardens. There were 110 healthcare-based gardens, with 39 in the Midwest, 25 in the South, 24 in the Northeast, and 22 in the West. Compared to US population averages, communities served by healthcare-based gardens had similar demographic characteristics, but significantly lower rates of obesity (27% versus 34%, p gardens are located in regions that are demographically representative of the US population, and are associated with lower rates of obesity in communities they serve.

  8. Six years analysis of cleft palate in a university hospital center

    Directory of Open Access Journals (Sweden)

    Farahvash M

    1999-08-01

    Full Text Available Cleft palate is a congenital condition that occurs with the incidence rate of one out of 2000 births. This anomaly produces intraoral pressure changes (increase or decrease, can cause speech, sucking and feeding problems of involved patient. On the other hand, if cleft palate is associated with cleft of the lip or alveolar area, growth and alignment of teeth may change the appearance of the patient and affect the psychologic and occupational future of the patient. Eustatian tube malfunction in involved neonates increase. Many procedures are used to repair the cleft palate and correction of palatal muscles which are: 1 Von Langenbeck (18.5%. 2 Veau-Wardil-Kilner (72.5%. 3 Double opposing Z-Plasty (9%. In this research the demographic criteria of patients including age of the patient at operation rime (mean age 30.14 months, city of residence, family history of cleft palate (12.4%, familial relation of parents (15.2%, associated anomalies, complete or incomplete lesion, weight of patients at the time of surgery (mean 11.28 Kg, hemoglobin (11.3 mg/dl, complications, otitis media and the side of cleft palate are studied in 178 admitted patients to Imam General Hospital between 1989 and 1995.

  9. Blood donor notification and counseling: Our experience from a tertiary care hospital in India

    Directory of Open Access Journals (Sweden)

    Urvershi Kotwal

    2015-01-01

    Full Text Available Aims: To evaluate the response rate of transfusion-transmissible infection (TTI-reactive donors after notification of their abnormal test results for the year 2012. Materials and Methods: This study is an observational descriptive study performed in our department over a period of 1 year. We evaluated the response rate of TTI-reactive donors after notification of their abnormal test results over 1 year as per the existing strategy (three telephonic and two postal communications. Results: During the study period, among the annual donation of 15,322 units, 464 blood donors were found to be seroreactive. Of these 464 seroreactive cases, 47 were HIV positive, 284 were reactive for Hepatitis B surface antigen (HBsAg, 49 were Hepatitis C (HCV positive and 84 were VDRL reactive. The TTI-reactive donors (464 for various markers were contacted: 229 (49.4% telephonically and the remaining 235 (50.6% not contacted on phone were informed by post. Of the 229 contacted donors, the response rate was 98.2% as only 225 donors reported (221 on the first, three on second and one on the third call for one to one counseling. The remaining four non-responders were - one HIV and three HBsAg reactive. The remaining 235 (50.6% reactive donors did not respond to any communication. Conclusion: Donor notification and post-donation counseling are an essential aspect of the blood bank that entails provision of information on serological status, assess the impact of test results on the donor and finally referral for medical care. As in our data only 49.4% of the blood donors could be contacted successfully, incomplete demographic details was the major limiting factor in communicating with rest. Of the 229 contacted donors, the response rate was 98.2%. A large majority (94.75% of the notified donors in our study contacted their health care provider when given clear instructions to do so. These results are encouraging because they indicate that a major element of the

  10. [Diagnostic strategies in the Tuberculosis Clinic of the Hospital General La Raza National Medical Center].

    Science.gov (United States)

    Flores-Ibarra, Alberto Alejandro; Ochoa-Vázquez, María Dolores; Sánchez-Tec, Georgina Alejandra

    2016-01-01

    In order to diagnose TB infection, tuberculin skin test and interferon gamma release assay are available. The tuberculin test has a sensitivity of 99 % and a specificity of 95 %. For the detection of interferon gamma in blood there are currently two tests available: TBGold QuantiFERON-In-Tube (with a sensitivity of 0.70 and a specificity of 0.90), and T-SPOT-TB (sensitivity 0.90 and specificity 0.93). To diagnose the disease, a microscopy of direct smears for acid-fast bacilli is used if the physician is facing an extensive cavitary lung disease due to M. tuberculosis (this test has a high sensitivity: 80-90 %). The most common staining techniques used are Ziehl-Neelsen and Kinyoun, and the fluorescent technique, auramine-rhodamine. The culture is the gold standard and it has a sensitivity of 80 % and a specificity over 90 %, but the results take weeks. The nucleic acid amplification test has an overall sensitivity and specificity of 0.85 and 0.97, respectively. In the presence of a pleural effusion is necessary to perform a pleural biopsy for culture with a sensitivity of 85 % if it is percutaneous and 98 % if it was taken by thoracoscopy. The adenosine deaminase can be determined in pleural fluid with a sensitivity and specificity of 95 %.

  11. A MULTI-CENTER CLUSTER-RANDOMIZED TRIAL OF A MULTI-FACTORIAL INTERVENTION TO IMPROVE ANTIHYPERTENSIVE MEDICATION ADHERENCE AND BLOOD PRESSURE CONTROL AMONG PATIENTS AT HIGH CARDIOVASCULAR RISK (The COM99 study)*

    Science.gov (United States)

    Pladevall, Manel; Brotons, Carlos; Gabriel, Rafael; Arnau, Anna; Suarez, Carmen; de la Figuera, Mariano; Marquez, Emilio; Coca, Antonio; Sobrino, Javier; Divine, George; Heisler, Michele; Williams, L Keoki

    2010-01-01

    Background Medication non-adherence is common and results in preventable disease complications. This study assesses the effectiveness of a multifactorial intervention to improve both medication adherence and blood pressure control and to reduce cardiovascular events. Methods and Results In this multi-center, cluster-randomized trial, physicians from hospital-based hypertension clinics and primary care centers across Spain were randomized to receive and provide the intervention to their high-risk patients. Eligible patients were ≥50 years of age, had uncontrolled hypertension, and had an estimated 10-year cardiovascular risk greater than 30%. Physicians randomized to the intervention group counted patients’ pills, designated a family member to support adherence behavior, and provided educational information to patients. The primary outcome was blood pressure control at 6 months. Secondary outcomes included both medication adherence and a composite end-point of all cause mortality and cardiovascular-related hospitalizations. Seventy-nine physicians and 877 patients participated in the trial. The mean duration of follow-up was 39 months. Intervention patients were less likely to have an uncontrolled systolic blood pressure (odds ratio 0.62; 95% confidence interval [CI] 0.50–0.78) and were more likely to be adherent (OR 1.91; 95% CI 1.19–3.05) when compared with control group patients at 6 months. After five years 16% of the patients in the intervention group and 19% in the control group met the composite end-point (hazard ratio 0.97; 95% CI 0.67–1.39). Conclusions A multifactorial intervention to improve adherence to antihypertensive medication was effective in improving both adherence and blood pressure control, but it did not appear to improve long-term cardiovascular events. PMID:20823391

  12. Studies on retrospective analysis of leading primary cancers and improvement of cancer treatment method in Korea cancer center hospital

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    Lee, Jong In; Lee, Kang Hyun; Choi, Soo Yong; Kim, Ki Wha; Kang, Sung Mok

    2000-12-01

    a. Retrospective studies included cancers of the stomach, breast, bladder, salivary gland, thyroid, esophagus, endometrium and ovary. (1) Study cancers were analyzed about clinical characteristics, prognostic factors influenced on survival time, survival rate, etc. (2) Among 5,305 study patients, 1,405(26.5%) were identified with death, 3,485(65.7%) were alive and 415(7.8%) were not identified. b. Prospective studies included 10 subjects such as bladder cancer, retinoblastoma, malignant patients, gastric cancer, uterine cervix cancer and ovary cancer. We are continuing registering eligible study patients. c. Results for 11 papers were published at the journal. d. We established follow-up system in order to identify the survival for study subjects through National Statistical Office, Government Provincial Office and Cancer Registration System at Korea Cancer Center Hospital. e. At present, we are establishing computerized registration system about case report form for study cancers.

  13. Studies on retrospective analysis of leading primary cancers and improvement of cancer treatment method in Korea cancer center hospital

    International Nuclear Information System (INIS)

    Lee, Jong In; Lee, Kang Hyun; Choi, Soo Yong; Kim, Ki Wha; Kang, Sung Mok

    2000-12-01

    a. Retrospective studies included cancers of the stomach, breast, bladder, salivary gland, thyroid, esophagus, endometrium and ovary. (1) Study cancers were analyzed about clinical characteristics, prognostic factors influenced on survival time, survival rate, etc. (2) Among 5,305 study patients, 1,405(26.5%) were identified with death, 3,485(65.7%) were alive and 415(7.8%) were not identified. b. Prospective studies included 10 subjects such as bladder cancer, retinoblastoma, malignant patients, gastric cancer, uterine cervix cancer and ovary cancer. We are continuing registering eligible study patients. c. Results for 11 papers were published at the journal. d. We established follow-up system in order to identify the survival for study subjects through National Statistical Office, Government Provincial Office and Cancer Registration System at Korea Cancer Center Hospital. e. At present, we are establishing computerized registration system about case report form for study cancers

  14. [Blood transfusion assessment to 112 homozygous sickle-cell disease patients in university hospital of Brazzaville].

    Science.gov (United States)

    Dokekias, A Elira; Ossini, L Ngolet; Tsiba, F O Atipo; Malanda, F; Koko, I; De Montalembert, M

    2009-01-01

    Homozygous, sickle-cell disease (SCD) is responsible for acute complication, especially anaemic crisis and special situation such as acute chest syndrome, stroke and acute priapism. Pregnancy sickle-cell disease presents high risk for the mother and the fetus. In these indications, blood transfusion is the main therapy aiming to reduce anaemia in order to restore hemoglobin's rate or to increase normal Hb proportion. This study aims to assess the short-term efficiency of the red cell transfusion in SCD homozygous form. One hundred and twelve homozygous sickle-cell patients were enrolled in this prospective study: 59 females and 53 males, median age is 21,8 years (extremes: 2 and 45 years). These patients are mostly with very low income. Two groups of patients are included in this study. In the first group, patients present acute anemia crisis caused by infections disease (malaria, bacterial infections). In the second group (20 cases), SCD patients have particularly situations: pregnancy (10 cases); stroke (six cases); cardiac failure (two cases) and priapism (two cases). Transfusion treatment in first group is simple regimen. Transfusion of EC increased median Hb level at 2,9 g/dl (extremes: 1,1 and 4,7). In the second group of patients, 16 cases were transfused by manual partial exchange (1-3) and four patients received simple regimen of transfusion. Median Hb level was 3,1g/dl (extremes: 2,4-4,9 g/dl). HbS percentage reduction was after PTE between -30 and -66,8% (median: -52,6%). According to our diagnostic possibilities (blood serologic test), we have not found any contamination by HIV, HBV and HCV (virus).

  15. Establishing and evaluating bar-code technology in blood sampling system: a model based on human centered human-centered design method.

    Science.gov (United States)

    Chou, Shin-Shang; Yan, Hsiu-Fang; Huang, Hsiu-Ya; Tseng, Kuan-Jui; Kuo, Shu-Chen

    2012-01-01

    This study intended to use a human-centered design study method to develop a bar-code technology in blood sampling process. By using the multilevel analysis to gather the information, the bar-code technology has been constructed to identify the patient's identification, simplify the work process, and prevent medical error rates. A Technology Acceptance Model questionnaire was developed to assess the effectiveness of system and the data of patient's identification and sample errors were collected daily. The average scores of 8 items users' perceived ease of use was 25.21(3.72), 9 items users' perceived usefulness was 28.53(5.00), and 14 items task-technology fit was 52.24(7.09), the rate of patient identification error and samples with order cancelled were down to zero, however, new errors were generated after the new system deployed; which were the position of barcode stickers on the sample tubes. Overall, more than half of nurses (62.5%) were willing to use the new system.

  16. Relationship between blood parameters and Clonorchis sinensis infection: A retrospective single center study.

    Science.gov (United States)

    Chen, Huaping; Chen, Siyuan; Huang, Zhili; Kong, Lingxi; Hu, Zuojian; Qin, Shanzi; Qin, Xue; Li, Shan

    2018-06-01

    Our study aims to retrospectively investigate neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and eosinophil-to-lymphocyte ratio (ELR) in patients infected with Clonorchis sinensis. This study analyzes a total of 151 patients with C. sinensis infections and 53 healthy control patients from our hospital. We found close relationships between the three candidate markers and the stages of C. sinensis infection-related biliary obstruction. The NLRs, PLRs and ELRs of patients with C. sinensis infections were significantly higher than those of healthy individuals; of those, ELRs showed the most superior diagnostic accuracy (sensitivity = 62.9%, specificity = 92.5%). Further, we constituted a logistic regression prediction model; applying two variables (age and NLR) with a sensitivity of 88.89% and a specificity of 83.78% in differentiating C. sinensis-related cholelithiasis from C. sinensis-untreated patients. Cancer antigen 19-9 (CA19-9) is a commonly used marker in the diagnosis of cholangiocarcinoma. Significant correlation was observed between NLR and CA19-9 in patients with C. sinensis-related cholangiocarcinoma (r = 0.590, P = 0.000). In the receiver operating characteristic analysis for separating C. sinensis-related cholelithiasis and cholangiocarcinoma, the cutoff value of PLR was 145.14 with a sensitivity of 65.62% and a specificity of 68.89%; the sensitivity of CA19-9 was 75.00% with a specificity of 77.78%. PLR showed acceptable efficiency to separate C. sinensis-related cholelithiasis from cholangiocarcinoma. In conclusion, all of the candidate markers (PLRs, NLRs and ELRs) may act as the valuable supplement in detecting C. sinensis infections and diseases. Copyright © 2018. Published by Elsevier B.V.

  17. Drug abuse in hospitalized trauma patients in a university trauma care center: an explorative study

    Directory of Open Access Journals (Sweden)

    A.R. Soroush

    2006-08-01

    Full Text Available Background: Drug abuse has been known as a growing contributing factor to all types of trauma in the world. The goal of this article is to provide insight into demographic and substance use factors associated with trauma and to determine the prevalence of drug abuse in trauma patients. Methods: Evidence of substance abuse was assessed in trauma patients presenting to Sina trauma hospital over a 3-month period. They were interviewed and provided urine samples to detect the presence of drug/metabolites of opium, morphine, cannabis and heroin by “Morphine Check” kits. Demographic data, mechanisms of injury, history of smoking and drug abuse were recorded. Results: A total of 358 patients with a mean age of 28.4 years were studied. The Patients were predominantly male (94.7%. There was a history of smoking in 136 cases (38%. 58 cases (16.2% reported to abuse drugs (91.5% opium. The commonest route of administration was smoke inhalation (37.2%. Screening by Morphine Check test revealed 95 samples to be positive (26.5%. The preponderance of test-positive cases was among young people (of 20-30 years of age with a history of smoking. Victims of violence and those with penetrating injuries also showed a higher percentage of positive screens (P=0.038 and P<0.001, respectively. Conclusion: These results suggest that drug abuse is a contributing factor to trauma especially in violent injuries and among the young. Regarding the considerable prevalence of drug abuse among trauma patients, it’s highly recommended that all trauma patients be screened for illicit drugs

  18. SUSCEPTIBILITY OF RESPIRATORY ISOLATES OF STREPTOCOCCUS PNEUMONIAE ISOLATED FROM CHILDREN HOSPITALIZED IN THE CLINICAL CENTER NIS.

    Science.gov (United States)

    Dinić, Marina M; Mladenović Antić, Snezana; Kocić, Branislava; Stanković Dordević, Dobrila; Vrbić, Miodrag; Bogdanović, Milena

    2016-01-01

    Streptococcus pneumoniae is one of the most common causes of respiratory infections. The aim was to study the susceptibility to antimicrobial agents of respiratory isolates ofStreptococcus pneumoniae obtained from hospitalized children. A total of 190 respiratory pneumococcal isolates obtained from children aged from 0 to 14 years were isolated and identified by using standard microbiological methods. Susceptibility to oxacillin, erythromycin, clindamycin, tetracycline, cotrimoxazole, ofloxacin and rifampicin was tested by disc diffusion method. Minimal inhibitory concentrations for amoxicillin and ceftriaxone were determined by means of E test. The macrolide-resistant phenotype was detected by double disc diffusion test. All tested isolates were susceptible to amoxicillin and ceftriaxone. The minimal amoxicillin concentration inhibiting the growth of 50% of isolates and of 90% of isolates was 0.50 microg/ml and 1.0 microg/ml, respectively and the minimal ceftriaxone concentration inhibiting the growth of 50% of isolates and of 90% of isolates was 0.25 microg/ml and 0.50 microg/ml, respectively. Susceptibility to erythromycin and clindamycin was observed in 21.6% and 29.47% of isolates, respectively. The resistence to macrolides-M phenotype was detected in 10.07% of isolates and constitutive macrolide-lincosamide-streptogramin phenotype (constitutive MLS phenotype) was found in 89.93% of isolates. All tested isolates were susceptible to ofloxacin and rifampicin. Amoxicillin could be the therapy of choice in pediatric practice. The macrolides should not be recommended for the empirical therapy of pneumococcal respiratory tract infection in our local area.

  19. The patient experience of patient-centered communication with nurses in the hospital setting: a qualitative systematic review protocol.

    Science.gov (United States)

    Newell, Stephanie; Jordan, Zoe

    2015-01-01

    care. However, current methods used to collect and use information from patients about their care is often retrospective, provides inadequate real time data and is not effective in creating action to produce change at the individual patient level. Methods which focus on including the patient and their information in real-time are considered by many to be crucial to the advancement of improved health outcomes and the reduced costs that are required of health care to be sustainable. One such method is patient-centered communication.The nurse-patient interaction is a core component of nursing science and high quality nursing care. Fleisher et al. contend that 'the main intention of communication and interaction, in the health setting, is to influence the patient's health status or state of well-being'. As a profession, nursing predominately requires communicating with, and relating to, patients at the individual level. In the hospital setting nurses undertake many of their patient related duties in a face-to-face manner with the patient at the bedside and these moments can facilitate effective interaction to occur between the nurse and the patient, which is patient-centered. McCabe et al. state that patient-centered communication as "defined by Langewitz et al. as 'communication that invites and encourages the patient to participate and negotiate in decision-making regarding their own care'.''However, qualitative studies by McCabe and Wellard et al, highlighted that nurses interact with patients only when performing administrative or functional activities and nursing 'practice was predominately task-orientated'. The outcome of these studies are supported by Maurer et al. in their report on the tools and strategies available to support patient and family engagement in the hospital setting. Maurer et al. identified that current strategies 'are not attuned to patient and family member experiences of hospitalization' and that most tools and strategies were 'more reflective of

  20. Bacteriological profile of burn wound isolates in a burns center of a tertiary hospital

    Directory of Open Access Journals (Sweden)

    Amankwa Richcane

    2017-01-01

    Full Text Available Objective: To determine the bacteriological profile and antimicrobial susceptibility patterns of burn wound isolates.Methods: Swabs were taken from burn wound of patients admitted to Ward D2C and Burns Intensive Care Unit (BICU from December 2014 to November 2015. Samples were processed at the Microbiology Laboratory for identification and sensitivity. Bacteria isolated were identified using their morphological characteristics, Gram staining reaction and biochemical tests. The antimicrobial susceptibility testing was done using Kirby-Bauer disc diffusion method. Questionnaires were also administered to study participants to obtain information on demography, kind of first aid received, antibiotics received prior to culture and sensitivity.Results: A total of 86 patients comprising 45 patients from Ward D2C and 41 from BICU participated in the study. Males were 51(59.3% and females 35 (40.7%. Age of participants ranged from 0–56+ years. Pseudomonas aeruginosa was the commonest pathogen isolated 26(30.2%, followed by Pseudomonas spp. 21(24.4%, Escherichia coli 17(19.8%, Klebsiella spp. 12(14.0%. Coagulase negative Staphylococcus accounted for 2(2.3%. Overall prevalence of infection in the study was 90.7%.Conclusions: Burn wound infection continues to be a major challenge in burn centers. Regular surveillance of commonly identified pathogens in the ward and their antimicrobial susceptibility will guide proper empiric selection of antibiotics for management of burn wounds.

  1. Adherence to blood pressure and glucose recommendations in chronic kidney disease hospital inpatients: Clinical inertia and patient adherence.

    Science.gov (United States)

    Gardiner, Fergus William; Nwose, Ezekiel Uba; Bwititi, Phillip Taderera; Crockett, Judith; Wang, Lexin

    2018-05-01

    To determine the extent to which targets for blood pressure (BP) (inertia affects BP and glucose control in CKD and diabetes mellitus (DM). Data was collected from the 1st January 2015 until 31st December 2015 on key patient pathology, admission reason, final discharge diagnosis, and information concerning clinical guideline adherence. Eighty-seven (n = 87) CKD patients were included. The average hospital BP for all CKD patients was 134.3/73.4 mmHg, adhering to recommendations of 7.0% >53 mmol/mol). There were 21 cases of clinical inertia, affecting 18 out of 87 patients (20.7%), with significant adverse hospital discharge differences (p = inertia and non- clinical inertia patient systolic BP (144.2 vs. 132.8 mmHg), deranged BGL (66.7% vs. 35.3%), and reduction in kidney function (83.3% vs. 30.9%). Adherence appears to be related to inpatient clinical inertia and outpatient patient health literacy and empowerment. Copyright © 2017 Diabetes India. Published by Elsevier Ltd. All rights reserved.

  2. [BACTERIA WITHOUT BORDERS: A HIGH CARRIAGE RATE OF ANTIBIOTIC-RESISTANT BACTERIA AMONG SYRIAN CHILDREN HOSPITALIZED IN GALILEE MEDICAL CENTER].

    Science.gov (United States)

    Faour Kassem, Diana; Shahar, Naama; Ocampo, Smadar; Bader, Tarif; Zonis, Zeev; Glikman, Daniel

    2017-05-01

    As the civil war in Syria enters its fifth year, the Israeli government continues to provide humanitarian aid to Syrian civilians in Israeli hospitals. Many wounded Syrian children are treated at the Galilee Medical Center (GMC). Due to the patients' incomplete medical history and increasing infection rates in Syria, contact isolation and screening cultures for multi-drug resistant bacteria (MDR's) are conducted upon admission for all Syrian children. To describe the rate of MDR carriage in Syrian children and compare it to hospitalized Israeli children. Prospective collection of screening culture data of Syrian patients admitted to GMC between 6/2013-11/2014 and comparison with Israeli children admitted between 1-3/2014. Extended-spectrum beta- lactamase-producing Enterobateriaceae (ESBL), Vancomycin-resistant Enterococcus (VRE), Carbapenem-resistant Enterobacteriaceae (CRE), and Methicillin-resistant Staphylococcus aureus (MRSA) were considered MDR's. Of 47 pediatric Syrian patients, 41 were severely wounded. MDR's were found in 37 (79%) children; most of the isolates were ESBL+ Escherichia coli. Over half of the ESBL's were resistant to additional antibiotics such as sulfa and quinolones; no resistance to amikacin was found. In comparison, in 6 of 40 (15%) Israeli children, MDR's (all ESBL's) were found (p<0.001). In hospitalized Syrian children, contact isolation and screening cultures for MDR's have an important role in the prevention of nosocomial transmission and establishment of empiric antimicrobial protocols. In suspected infections in Syrian children, amikacin and carbapenems are the antimicrobials of choice. MDR's are carried to a lesser extent in Israeli children but due to their importance, further largescale research is needed.

  3. Assessment of preventive measures for accidental blood exposure in operating theaters: a survey of 20 hospitals in Northern France.

    Science.gov (United States)

    Tarantola, Arnaud; Golliot, Franck; L'Heriteau, François; Lebascle, Karin; Ha, Catherine; Farret, Danièle; Bignon, Sylvie; Smaïl, Amar; Doutrellot-Philippon, Catherine; Astagneau, Pascal; Bouvet, Elisabeth

    2006-08-01

    Accidental exposures to blood of body fluids (ABE) expose health care workers (HCW) to the risk of occupational infection. Our aim was to assess the prevention equipment available in the operating theater (OT) with reference to guidelines or recommendations and its use by the staff in that OT on that day and past history of ABE. Correspondents of the Centre de Coordination de la Lutte contre les Infections Nosocomiales (CCLIN) Paris-Nord ABE Surveillance Taskforce carried out an observational multicenter survey in 20 volunteer French hospitals. In total, 260 operating staff (including 151 surgeons) were investigated. Forty-nine of the 260 (18.8%) staff said they double-gloved for all patients and procedures, changing gloves hourly. Blunt-tipped suture needles were available in 49.1% of OT; 42 of 76 (55.3%) of the surgeons in these OT said they never used them. Overall, 60% and 64% of surgeons had never self-tested for HIV and hepatitis C virus (HCV), respectively. Fifty-five surgeons said they had sustained a total of 96 needlestick injuries during the month preceding the survey. Ten of these surgeons had notified of 1 needlestick injury each to the occupational health department of their hospital (notification rate, 10.4%). The occurrence of needlestick injury remained high in operating personnel in France in 2000. Although hospitals may improve access to protective devices, operating staff mindful of safety in the OT should increase their use of available devices, their knowledge of their own serostatus, and their ABE notification rate to guide well-targeted prevention efforts.

  4. Associations between blood glucose level and outcomes of adult in-hospital cardiac arrest: a retrospective cohort study.

    Science.gov (United States)

    Wang, Chih-Hung; Huang, Chien-Hua; Chang, Wei-Tien; Tsai, Min-Shan; Yu, Ping-Hsun; Wu, Yen-Wen; Chen, Wen-Jone

    2016-08-24

    We intended to analyse the associations between blood glucose (BG) level and clinical outcomes of in-hospital cardiac arrest (IHCA). We conducted a retrospective observational study in a single medical centre and evaluated patients who experienced IHCA between 2006 and 2014. We used multivariable logistic regression analysis to study associations between independent variables and outcomes. We calculated the mean BG level for each patient by averaging the maximum and minimum BG levels in the first 24 h after arrest, and we used mean BG level for our final analysis. We included a total of 402 patients. Of these, 157 patients (39.1 %) had diabetes mellitus (DM). The average mean BG level was 209.9 mg/dL (11.7 mmol/L). For DM patients, a mean BG level between 183 and 307 mg/dL (10.2-17.1 mmol/L) was significantly associated with favourable neurological outcome (odds ratio [OR] 2.71, 95 % confidence interval [CI] 1.18-6.20; p value = 0.02); a mean BG level between 147 and 317 mg/dL (8.2-17.6 mmol/L) was significantly associated with survival to hospital discharge (OR 2.38, 95 % CI 1.26-4.53; p value = 0.008). For non-DM patients, a mean BG level between 143 and 268 mg/dL (7.9-14.9 mmol/L) was significantly associated with survival to hospital discharge (OR 2.93, 95 % CI 1.62-5.40; p value level in the first 24 h after cardiac arrest was associated with neurological outcome for IHCA patients with DM. For neurological and survival outcomes, the optimal BG range may be higher for patients with DM than for patients without DM.

  5. Retrospective Analysis of Blood Stream Infections and Antibiotic Susceptibility Pattern of Gram Negative Bacteria in a Tertiary Care Cancer Hospital

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    Radha Rani D

    2017-12-01

    Full Text Available Background: Bacterial bloodstream infections are important causes of morbidity and mortality globally. The aim of the present study was to determine the bacterial profile of bloodstream infections and their antibiotic susceptibility pattern among the clinically diagnosed cases of sepsis in cancer patients. Methods: In the present study, etiological and antimicrobial susceptibility profile of blood cultures over a period of 1 year at a tertiary cancer care hospital was done. Blood culture positive isolates were identified using standard microbiological methods and by Fully automated BD Phoenix 100. The antibiotic susceptibility pattern of the organisms was performed by Kirby-Bauer disc diffusion method and MIC (Minimum inhibitory concentration was done by Fully automated BD Phoenix 100. Results: There were 1178 blood culture samples, of which 327 (27.7% were identified to be culture positive. Out of 327 positive cultures, 299 (91.4% showed bacterial growth, Gram negative were 161 (53.8% and Gram positive were 138 (46.1%. Candida species were isolated from 13 (3.97% of positive samples and 15 samples showed contamination. The most common Gram-negative isolate was. Escherichia coli (37.80% and Gram-positive isolate was coagulasenegative staphylococci (52.80%. Escherichia coli showed highest sensitivity to amikacin (83.60% and sensitivity to piperacillin+ tazobactum and cefaperazone+sulbactam was 54.09% and 52.45% respectively. High degree of resistance was found to cephalosporins and levofloxacin. Conclusion: The results indicate high level of antimicrobial resistance among Gram negative bacilli in septicemic patients. The results warrant continuous monitoring of antimicrobial pattern so as to build geographical epidemiological data.

  6. Evaluation of the relationship between physiological FDG uptake in the heart and age, blood glucose level, fasting period, and hospitalization

    International Nuclear Information System (INIS)

    Kaneta, Tomohiro; Hakamatsuka, Takashi; Takanami, Kentaro

    2006-01-01

    Positron emission tomography (PET) with fluorodeoxyglucose (FDG) is widely used for evaluation of cancer and ischemic heart disease. Recently, increased myocardial FDG uptake has been reported to be related to some types of heart disease, such as sarcoidosis. However, the physiological increased FDG uptake in the heart often mimics the abnormal high uptake in these cases. In this study, we investigated the relationships between myocardial uptake and age, blood glucose level, fasting period, and hospitalization status (inpatient vs. outpatient). A total of 159 non-diabetic patients were enrolled in the present study. Patients were imaged on a PET/CT scanner, and a three-dimensional region of interest (ROI) was drawn on the fused PET/CT image to measure the maximum standardized uptake value (SUV max ) of the whole left ventricle. No significant relationships were observed between myocardial uptake and age or fasting period. Blood glucose level showed a significant relationship (p=0.025) with myocardial uptake, but the R-square was extremely small (r 2 =0.03). With an SUV max threshold of 3.0, there was no significant difference between inpatients and outpatients. However, outpatients showed a significantly higher frequency of myocardial uptake over SUV max of 5.0 (x 2 test: p=0.046). It is difficult to predict the degree of physiological uptake in the heart from data regarding age, fasting period, or blood glucose level. Outpatients tend to show higher myocardial uptake than inpatients, which may make it difficult to detect abnormally increased uptake in the heart. A long fasting period, such as overnight fasting, is an inadequate means to reduce the physiological uptake of FDG in the heart. (author)

  7. Primary antibody deficiencies at Queen Rania Children Hospital in Jordan: single center experience.

    Science.gov (United States)

    Habahbeh, Zeyad M; Abu-Shukair, Mohammad E; Almutereen, Mohammad A; Alzyoud, Raed M; Wahadneh, Adel M

    2014-03-01

    Primary antibody deficiency, the most common primary immunodeficiency disorder, represents a heterogeneous spectrum of conditions caused by a defect in any critical stage of B cell development and is characterized by impaired production of normal amounts of antigen-specific antibodies. This retrospective study aimed at description and analysis of demographic, clinical, immunological features and complications of subjects diagnosed with primary antibody deficiency at a referral center in Jordan. The medical records of pediatric patients who were diagnosed as primary antibody deficiency (PAD) during the period from January 2006 to June 2013 were reviewed. Patients were diagnosed as PADs based on the Pan-American Group for Immunodeficiency (PAGID) and the European Society for Immunodeficiency (ESID) diagnostic criteria. A total number of 53 patients with PAD were identified; 37(70%) males and 16(30%) females, 16(30%) patients with congenital agammaglobulinemia, 16(30%) patients with common variable immunodeficiency, 4(7.5%) patients with IgG subclass deficiency, 10(19%) cases with transient hypogammaglobulinemia of infancy and 7(13.5%) patients as undefined PAD. The most common infection among patients was pneumonia (62%); followed by suppurative otitis media in 49% of patients. Cytopenia was the most noted autoimmune association and was found at prevalence of 22 %, other autoimmune associations (17%) including inflammatory arthritis, discoid lupus, inflammatory bowel disease, vasculitis and celiac disease. The prevalence of long-term complications was 58%, the most frequent ones were; stunted growth in 13%, bronchiectasis and lymphoproliferation in 11% for each. Our results indicated that congenital agammaglobulinemia and common variable immunodeficiency are the most frequent primary antibody deficiency in our patients. The awareness of families, general population as well as primary health physicians is crucial in the establishment of early diagnosis and prompt

  8. At crossroads between laboratory disciplines and medical advancements-The Center for Molecular Medicine at the Karolinska University Hospital.

    Science.gov (United States)

    Terenius, Lars

    2009-04-01

    The Center for Molecular Medicine (CMM) was conceived and built to respond to the challenges presented by the still common chronic diseases such as atherosclerosis, rheumatoid arthritis, diabetes, allergy, and alcoholism. The Karolinska University Hospital has a proud history of research with developments such as the pacemaker and the gamma-knife. The nearby Karolinska Institutet has a strong presence internationally on the basic sciences. However, the challenges of the "new biology" and the access to the complete human genome, transcriptome, and proteome raised the need for a new research institute that could meet the experimental requirements for translational research. A Foundation was established in 1994 with the goal to build and govern the new enterprise. After an intense fundraising campaign, building could start and CMM (Fig. 1) was inaugurated in 1997. Through more than 10 years of existence, it has evolved into a multidisciplinary research institute with research in four programs, Cardiovascular and Metabolic Diseases, Infection and Immunity, Neuropsychiatric Diseases, and Medical Genetics. Performance parameters have been introduced and scientific impact and relevance are followed annually. Transparency and collaboration between groups (now 28 groups with an approximate total of 400 people engaged in research) and leadership training for junior faculty are means to stimulate "centerness".

  9. An investigative case study at local hospital into the current reliability of blood pressure sphygmomanometers

    Directory of Open Access Journals (Sweden)

    Vinícius Naves Rezende Faria

    2017-04-01

    Full Text Available Abstract Introduction Arterial Blood Pressure is a significant indicator of the current health condition of an individual. The correct detection of hypertension is essential, where this health problem is considered as one of the greatest health risks factors that affect the heart and circulatory system. This paper presents the importance of the application of metrological criteria for the diagnosis of hypertension using a sphygmomanometer aneroid. Methods 72 mechanical aneroid sphygmomanometers were calibrated using a standard manometer and the indication error, hysteresis, air leakage and rapid exhaust were determined; readings of these sphygmomanometers were compared to a properly calibrated and adjusted aneroid sphygmomanometer to carry out pressure measurements as those made during the hypertension diagnosis; the uncertainty of measurement associated with the sphygmomanometers calibration, and pressure values was assessed according to the recommendations of the Guide to the Expression of Uncertainty in Measurement, defined by the Joint Committee for Guides in Metrology. Results The results obtained have shown that about 61% of the evaluated aneroid sphygmomanometers did not meet the specifications. The variable that most contributed to the final calibration uncertainty was the hysteresis of the standard manometer, with 53% of contribution, followed by the sphygmomanometer resolution with 27%. Conclusion The periodic verifications are essential to evaluate the performance of these devices. It was shown that uncertainty of measurement influences the final diagnosis of hypertension and the application of metrological criteria can increase the reliability of the final diagnosis.

  10. Do We Need a Patient-Centered Target for Systolic Blood Pressure in Hypertensive Patients With Type 2 Diabetes Mellitus?

    Science.gov (United States)

    Wan, Eric Yuk Fai; Yu, Esther Yee Tak; Fung, Colman Siu Cheung; Chin, Weng Yee; Fong, Daniel Yee Tak; Chan, Anca Ka Chun; Lam, Cindy Lo Kuen

    2017-12-01

    The current trend on diabetes mellitus management advocates replacing the paradigm from a uniform to an individualized patient-centered systolic blood pressure (SBP), but there is no consensus on the achieved treatment goals of SBP level. The study aimed at evaluating the association between SBP and the risk of cardiovascular diseases (CVD) and all-cause mortality for diabetic patients to identify patient-centered treatment targets. A retrospective study was conducted on 95 086 Chinese adult primary care patients with type 2 diabetes mellitus and hypertension. Using the average of the annual SBP records (updated SBP) over a median follow-up of 5.9 years, the risks of overall CVD, all-cause mortality, and their composite associated with SBP were evaluated using Cox proportional hazards regression. Subgroup analysis was performed on the incidence of CVD by stratifying patient's baseline characteristics. The SBP range for the lowest risk of CVD and all-cause mortality was 130 to 134 mm Hg among type 2 diabetes mellitus population. A J-shaped curvilinear relationship was identified between SBP and risk of CVD and all-cause mortality, irrespective of patients' characteristics. The findings showed that all patients with SBP diabetic management. © 2017 American Heart Association, Inc.

  11. Development of a center for light ion therapy and accurate tumor diagnostics at karolinska institutet and hospital

    Science.gov (United States)

    Brahme, Anders; Lind, Bengt K.

    2002-04-01

    Radiation therapy is today in a state of very rapid development with new intensity modulated treatment techniques continuously being developed. This has made intensity modulated electron and photon beams almost as powerful as conventional uniform beam proton therapy. To be able to cure also the most advanced hypoxic and radiation resistant tumors of complex local spread, intensity modulated light ion beams are really the ultimate tool and only slightly more expensive than proton therapy. The aim of the new center for ion therapy and tumor diagnostics in Stockholm is to develop radiobiologically optimized 3-dimensional pencil beam scanning techniques. Beside the "classical" approaches using low ionization density hydrogen ions (protons, but also deuterons and tritium nuclei) and high ionization density carbon ions, two new approaches will be developed. In the first one lithium or beryllium ions, that induce the least detrimental biological effect to normal tissues for a given biological effect in a small volume of the tumor, will be key particles. In the second approach, referred patients will be given a high-dose high-precision "boost" treatment with carbon or oxygen ions during one week preceding the final treatment with conventional radiations in the referring hospital. The rationale behind these approaches is to reduce the high ionization density dose to the normal tissue stroma inside the tumor and to ensure a microscopically uniform dose delivery. The principal idea of the center is to closely integrate ion therapy into the clinical routine and research of a large radiotherapy department. The light ion therapy center will therefore be combined with advanced tumor diagnostics including MR and PET-CT imaging to facilitate efficient high-precision high-dose boost treatment of remitted patients. The possibility to do 3D tumor diagnostics and 3D dose delivery verification with the same PET camera will be the ultimate step in high quality adaptive radiation therapy

  12. Maternal Asthma, Diabetes, and High Blood Pressure are Associated with Low Birth Weight and Increased Hospital Birth and Delivery Charges; Hawai‘i Hospital Discharge Data 2003–2008

    Science.gov (United States)

    Feigal, David W; Smith, Ruben A; Fuddy, Loretta J

    2014-01-01

    Asthma, diabetes, and high blood pressure are common maternal conditions that can impact birth outcomes. Data from hospital discharges in Hawai‘i were analyzed for 107,034 singleton births from 2003–2008. Categories were determined using the International Statistical Classification of Diseases, ninth revision (ICD-9) from linked delivery records of mother and infant. Prevalence estimates of asthma (ICD-9: 493), diabetes (ICD-9: 250,648.0, 648.8), high blood pressure (ICD-9: 401–405,642) as coded on the delivery record, low birth weight (4500 grams), Cesarean delivery, and median hospital charges were calculated. Median regression analysis assessed total hospital charges adjusting for maternal age, maternal race, insurance, and Cesarean delivery. Maternal asthma was present in 4.3% (95% confidence interval=4.1–4.4%), maternal diabetes was present in 7.7% (95% CI=7.6–7.9%), and maternal high blood pressure was present in 9.2% (95% CI=9.0–9.3%) of births. In the adjusted median regression analysis, mothers with asthma had $999 (95% CI: $886 to $1,112) higher hospital charges compared to those without; mothers with diabetes had $743 (95% CI: $636 to $850) higher charges compared to those without; and mothers with high blood pressure had $2,314 (95% CI: $2,194 to $2,434) higher charges compared to those without. Asthma, diabetes, and high blood pressure are associated with higher hospital delivery charges and low birth weight. Diabetes and high blood pressure were also associated with Cesarean delivery. An increased awareness of the impact of these conditions on both adverse birth outcomes and the development of chronic disease is needed. PMID:24567868

  13. Maternal asthma, diabetes, and high blood pressure are associated with low birth weight and increased hospital birth and delivery charges; Hawai'i hospital discharge data 2003-2008.

    Science.gov (United States)

    Hayes, Donald K; Feigal, David W; Smith, Ruben A; Fuddy, Loretta J

    2014-02-01

    Asthma, diabetes, and high blood pressure are common maternal conditions that can impact birth outcomes. Data from hospital discharges in Hawai'i were analyzed for 107,034 singleton births from 2003-2008. Categories were determined using the International Statistical Classification of Diseases, ninth revision (ICD-9) from linked delivery records of mother and infant. Prevalence estimates of asthma (ICD-9: 493), diabetes (ICD-9: 250,648.0, 648.8), high blood pressure (ICD-9: 401-405,642) as coded on the delivery record, low birth weight (4500 grams), Cesarean delivery, and median hospital charges were calculated. Median regression analysis assessed total hospital charges adjusting for maternal age, maternal race, insurance, and Cesarean delivery. Maternal asthma was present in 4.3% (95% confidence interval=4.1-4.4%), maternal diabetes was present in 7.7% (95% CI=7.6-7.9%), and maternal high blood pressure was present in 9.2% (95% CI=9.0-9.3%) of births. In the adjusted median regression analysis, mothers with asthma had $999 (95% CI: $886 to $1,112) higher hospital charges compared to those without; mothers with diabetes had $743 (95% CI: $636 to $850) higher charges compared to those without; and mothers with high blood pressure had $2,314 (95% CI: $2,194 to $2,434) higher charges compared to those without. Asthma, diabetes, and high blood pressure are associated with higher hospital delivery charges and low birth weight. Diabetes and high blood pressure were also associated with Cesarean delivery. An increased awareness of the impact of these conditions on both adverse birth outcomes and the development of chronic disease is needed.

  14. Barrett's esophagus: Ten years of experience at a tertiary care hospital center in Mexico.

    Science.gov (United States)

    Valdovinos-Andraca, F; Bernal-Méndez, A R; Barreto-Zúñiga, R; Briseño-García, D; Martínez-Lozano, J A; Romano-Munive, A F; Elizondo-Rivera, J; Téllez-Ávila, F I

    The prevalence of Barrett's esophagus has been calculated at between 1.3 and 1.6%. There is little information with respect to this in Mexico. To determine the frequency and characteristics of Barrett's esophagus in patients that underwent endoscopy at a national referral center, within a 10-year time frame. The databases of the pathology and gastrointestinal endoscopy departments of the Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" were analyzed, covering the period of January 2002 to December 2012. Patients with a histologic diagnosis of Barrett's esophagus were included. The variables of age, sex, the presence of dysplasia/esophageal adenocarcinoma, Barrett's esophagus length, and follow-up were analyzed. Of 43,639 upper gastrointestinal endoscopies performed, 420 revealed Barrett's esophagus, corresponding to a frequency of 9.6 patients for every 1,000 endoscopies. Of those patients, 66.9% (n=281) were men, mean patient age±SD was 57.2±15.3 years, 223 patients (53%) presented with long-segment Barrett's esophagus, and 197 (47%) with short-segment Barrett's esophagus. Dysplasia was not present in 339 patients (80.7%). Eighty-one (19.3%) patients had some grade of dysplasia or cancer: 48/420 (11.42%) presented with low-grade dysplasia, 20/420 (4.76%) with high-grade dysplasia, and 13/420 (3.1%) were diagnosed with esophageal cancer arising from Barrett's esophagus. Mean follow-up time was 5.6 years. The frequency of Barrett's esophagus was 9.6 cases for every 1,000 upper gastrointestinal endoscopies performed. Dysplasia was not documented in the majority of the patients with Barrett's esophagus and they had no histopathologic changes during follow-up. A total of 19.3% of the patients presented with dysplasia or cancer. Copyright © 2017 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.

  15. Integration of the clinical engineering specialist at a high complexity children's hospital. Our professional experience at a surgical center

    Energy Technology Data Exchange (ETDEWEB)

    Vargas Enriquez, M J; Chazarreta, B; Emilio, D G; Fernandez Sarda, E [Surgical Center-Neurophysiology Division of Medical Tecnology Department, Garrahan Children' s Hospital, Combate de los Pozos 1881, Buenos Aires (Argentina)

    2007-11-15

    This document aims to find relating points between the current and future Clinical Engineer professional in order to discuss about the hospital environment, its characteristics and its realities which lead to our professional development. The main aim is to depict our experience through a retrospective analysis based on the underwriting experience and consequently to arrive at conclusions that will support the inclusion and active interaction of the Clinic Engineer Specialist as part of a Hospital's Surgical Center.

  16. Proposed maximum surgical blood ordering schedule for common orthopedic surgeries in a Tertiary Health - Care Center in Northern India

    Directory of Open Access Journals (Sweden)

    Sonam Kumari

    2017-01-01

    CONCLUSIONS: MSBOS based on the past blood utilization records for different surgeries and keeping patients variables in consideration wherever required would provide an efficient way of blood utilization and appropriate management of blood bank resources.

  17. Ratio of systolic blood pressure to left ventricular end-diastolic pressure at the time of primary percutaneous coronary intervention predicts in-hospital mortality in patients with ST-elevation myocardial infarction.

    Science.gov (United States)

    Sola, Michael; Venkatesh, Kiran; Caughey, Melissa; Rayson, Robert; Dai, Xuming; Stouffer, George A; Yeung, Michael

    2017-09-01

    To determine the ability of simple hemodynamic parameters obtained at the time of cardiac catheterization to predict in-hospital mortality following ST-elevation myocardial infarction (STEMI). Hemodynamic parameters measured at the time of primary percutaneous coronary intervention (PPCI) could potentially identify high-risk patients who would benefit from aggressive hemodynamic support in the Cardiac Catheterization laboratory. This is a retrospective single-center study of 219 consecutive patients with STEMI. Left ventricular end-diastolic pressure (LVEDP), systolic blood pressure (SBP), and aortic diastolic blood pressure were obtained after successful revascularization. The prognostic ability of LVEDP, pulse pressure, and SBP/LVEDP ratio were compared to major mortality risk scores. Patients had a mean age of 60 ±14 years, were predominantly white (73%), male (64%), with anterior wall infarcts in 39%. Comorbidities included diabetes mellitus (27%), heart failure (9%), and chronic kidney disease (7%). In-hospital mortality was 9%. Patients with SBP/LVEDP ≤ 4 had increased risk of in-hospital death (32% vs. 5.3%, P  4. The area under curve (AUC) for SBP/LVEDP ratio for in-hospital mortality (0.69) was more predictive than LVEDP (0.61, P = 0.04) or pulse pressure (0.55, P = 0.02) but similar to Shock Index (ratio of heart rate to SBP) and Modified Shock Index (ratio of HR to mean arterial pressure). An SBP/LVEDP ratio ≤ 4 identified a group of STEMI patients at high risk of in-hospital death. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  18. Impact of positive chest X-ray findings and blood cultures on adverse outcomes following hospitalized pneumococcal lower respiratory tract infection

    DEFF Research Database (Denmark)

    Skovgaard, Marlene; Schønheyder, Henrik Carl; Benfield, Thomas

    2013-01-01

    Little is known about the clinical presentation and outcome of pneumococcal lower respiratory tract infection (LRTI) without positive chest X-ray findings and blood cultures. We investigated the prognostic impact of a pulmonary infiltrate and bacteraemia on the clinical course of hospitalized...

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

    Science.gov (United States)

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

    2017-10-01

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

  20. Coagulase-negative staphylococci causing blood stream infection at an Indian tertiary care hospital: Prevalence, antimicrobial resistance and molecular characterisation.

    Science.gov (United States)

    Singh, S; Dhawan, B; Kapil, A; Kabra, S K; Suri, A; Sreenivas, V; Das, B K

    2016-01-01

    Recent years have seen a rise of coagulase-negative staphylococci (CoNS) from common contaminants to agents of nosocomial blood stream infections (BSI's). Molecular typing and establishing a correlation with antibiotic resistance is essential particularly in countries like India where genotyping studies for drug-resistant CoNS are sparse. A prospective study was done over 18 months, wherein 42,693 blood samples were received, and 59 patients with BSI due to CoNS were evaluated. The isolates recovered were identified by a biochemical test panel and matrix-assisted laser desorption ionization - time of flight mass spectrometry followed by antimicrobial susceptibility testing by Kirby-Baur disc diffusion method and E-test strips. Staphylococcal chromosomal cassette mec (SCCmec) element was characterised by multiplex polymerase chain reaction for all methicillin-resistant (MR) isolates. The majority of CoNS isolated were constituted by Staphylococcus haemolyticus (47.5%) followed by Staphylococcus epidermidis (33.9%), Staphylococcus hominis (11.86%), Staphylococcus cohnii (5.08%) and Staphylococcus warneri (1.69%). Among all isolates 57.6% were MR with statistically significant higher resistance versus methicillin sensitive-CoNS. This difference was significant for erythromycin (76% vs. 44%, P = 0.011), rifampicin (50% vs. 12%,P= 0.002) and amikacin (26.5% vs. 4%, P = 0.023), ciprofloxacin (64.7% vs. 20%, P = 0.001) and cotrimoxazole (55.9% vs. 20%, P = 0.006). SCCmec type I was predominant (61.8%, P = 0.028) and exhibited multidrug resistance (76.2%). Coexistence of SCCmec type I and III was seen in 8.82% MR isolates. CoNS exhibit high antimicrobial resistance thereby limiting treatment options. The presence of new variants of SCCmec type in hospital-acquired CoNS may predict the antibiotic resistance pattern. This is the first evaluation of the molecular epidemiology of CoNS causing BSI from India and can serve as a guide in the formulation of hospital infection

  1. Coagulase-negative staphylococci causing blood stream infection at an Indian tertiary care hospital: Prevalence, antimicrobial resistance and molecular characterisation

    Directory of Open Access Journals (Sweden)

    S Singh

    2016-01-01

    Full Text Available Introduction: Recent years have seen a rise of coagulase-negative staphylococci (CoNS from common contaminants to agents of nosocomial blood stream infections (BSI's. Molecular typing and establishing a correlation with antibiotic resistance is essential particularly in countries like India where genotyping studies for drug-resistant CoNS are sparse. Methods: A prospective study was done over 18 months, wherein 42,693 blood samples were received, and 59 patients with BSI due to CoNS were evaluated. The isolates recovered were identified by a biochemical test panel and matrix-assisted laser desorption ionization – time of flight mass spectrometry followed by antimicrobial susceptibility testing by Kirby–Baur disc diffusion method and E-test strips. Staphylococcal chromosomal cassette mec (SCCmec element was characterised by multiplex polymerase chain reaction for all methicillin-resistant (MR isolates. Results: The majority of CoNS isolated were constituted by Staphylococcus haemolyticus (47.5% followed by Staphylococcus epidermidis (33.9%, Staphylococcus hominis (11.86%, Staphylococcus cohnii (5.08% and Staphylococcus warneri (1.69%. Among all isolates 57.6% were MR with statistically significant higher resistance versus methicillin sensitive-CoNS. This difference was significant for erythromycin (76% vs. 44%, P = 0.011, rifampicin (50% vs. 12%,P= 0.002 and amikacin (26.5% vs. 4%, P = 0.023, ciprofloxacin (64.7% vs. 20%, P = 0.001 and cotrimoxazole (55.9% vs. 20%, P = 0.006. SCCmec type I was predominant (61.8%, P = 0.028 and exhibited multidrug resistance (76.2%. Coexistence of SCCmec type I and III was seen in 8.82% MR isolates. Conclusion: CoNS exhibit high antimicrobial resistance thereby limiting treatment options. The presence of new variants of SCCmec type in hospital-acquired CoNS may predict the antibiotic resistance pattern. This is the first evaluation of the molecular epidemiology of CoNS causing BSI from India and can serve as a

  2. Treatment and Outcome of Carbapenem-Resistant Gram-Negative Bacilli Blood-Stream Infections in a Tertiary Care Hospital.

    Science.gov (United States)

    Shah, Pooja G; Shah, Sweta R

    2015-07-01

    Infections caused by carbapenem-resistant bacteria constitute a major challenge for current medical practice. To describe treatment and outcome of carbapenem-resistant Gram-negative bacilli (GNB) blood-stream infection (BSI) caused by these organisms at a tertiary care hospital in Mumbai. Carbapenem-resistant isolates from blood cultures were collected from January 2013 to April 2013. Identification and antimicrobial susceptibility testing were performed using Vitek 2 analyzer (Biomerieux Ltd.). Carbapenemase production was detected by modified Hodge's test (MHT). Patient's medical history, treatment and co-morbid conditions were noted. Outcomes of BSIs were evaluated. Forty-two isolates of carbapenem-resistant GNB isolated from BSIs were Enterobacteriaceae spp. (19), Acinetobacter baumannii (15), and Pseudomonas aeruginosa (8). Colistin had maximum in vitro activity with 97% against Enterobacteriaceae, 100% against Acinetobacter, and 100% activity against Pseudomonas aeruginosa isolates. Positivity of MHT was 92.9%. Outcome of colistin mono and combination therapy was comparable with 83% and 79%, respectively. Outcome of colistin and carbapenem combination therapy was found to be 100 percent. High incidences of bacteremia by carbapenem-resistant GNB including Enterobacteriaceae is a worrisome trend. Treatment options are compromised and only available option is colistin which has its own limitation. Colistin monotherapy may be non-inferior compared to combination therapy for treating BSIs caused by isolates with minimum inhibitory concentration (MIC) for colistin as ≤0.5 mg/l. Combined use of the colistin and carbapenem may provide good therapeutic options for BSI caused by carbapenem-resistant GNB and warrants further investigations.

  3. High blood lead levels are associated with lead concentrations in households and day care centers attended by Brazilian preschool children.

    Science.gov (United States)

    da Rocha Silva, Júlia Prestes; Salles, Fernanda Junqueira; Leroux, Isabelle Nogueira; da Silva Ferreira, Ana Paula Sacone; da Silva, Agnes Soares; Assunção, Nilson Antonio; Nardocci, Adelaide Cassia; Sayuri Sato, Ana Paula; Barbosa, Fernando; Cardoso, Maria Regina Alves; Olympio, Kelly Polido Kaneshiro

    2018-08-01

    A previous study observed high blood lead levels (BLL) in preschool children attending 50 day care centers (DCC) in São Paulo, Brazil. To identify whether lead levels found in both homes and DCC environments are associated with high blood lead levels. Children attending 4 DCCs, quoted here as NR, VA, PS and PF, were divided into two groups according to BLL: high exposure (HE: ≥13.9 μg/dL; 97.5 percentile of the 2013 year sample) and low exposure (LE: 600 μg/g, whereas such levels were observed in 77.1% of NR playground measurements. In VA DCC, 22% and 23% of the measurements in the building and in the playgrounds had levels higher than 600 μg/g, respectively. The percentage of high lead levels in the children's houses of the LE group was 5.9% (95% CI: 4.3-7.6%) and 13.2 (95% CI: 8.3-18.0%) in the HE group. Moreover, a significant association was found between high BLLs and lead levels found both in households and DCCs (p < 0.001). Most of the high lead measurements were found in tiles and playground equipment. Lead exposure estimated from the DCCs, where children spend about 10 h/day, can be as relevant as their household exposure. Therefore, public authorities should render efforts to provide a rigorous surveillance for lead-free painting supplies and for all objects offered to children. Copyright © 2018 Elsevier Ltd. All rights reserved.

  4. Safety and efficacy of allogeneic umbilical cord red blood cell transfusion for children with severe anaemia in a Kenyan hospital: an open-label single-arm trial

    Science.gov (United States)

    Hassall, Oliver W; Thitiri, Johnstone; Fegan, Greg; Hamid, Fauzat; Mwarumba, Salim; Denje, Douglas; Wambua, Kongo; Mandaliya, Kishor; Maitland, Kathryn; Bates, Imelda

    2015-01-01

    Summary Background In sub-Saharan Africa, children are frequently admitted with severe anaemia needing an urgent blood transfusion, but blood is often unavailable. When conventional blood supplies are inadequate, allogeneic umbilical cord blood could be a feasible alternative. The aim of this study was to assess the safety and efficacy of cord blood transfusion in children with severe anaemia. Methods Between June 26, 2007, and May 20, 2008, 413 children needing an urgent blood transfusion were admitted to Kilifi District Hospital in Kenya. Of these, 87 children were eligible for our study—ie, younger than 12 years, no signs of critical illness, and haemoglobin 100 g/L or lower (if aged 3 months or younger) or 40 g/L or lower (if older than 3 months). Cord blood was donated at Coast Provincial General Hospital, Mombasa, and screened for transfusion-transmitted infections and bacterial contamination. Red blood cells were stored vertically at 2–6°C to enable sedimentation. After transfusion, children were monitored closely for adverse events and followed up for 28 days. The primary outcome measure was the frequency and nature of adverse reactions associated with the transfusion. Secondary outcomes were the changes in haemoglobin concentrations 24 h and 28 days after transfusion, compared with pretransfusion levels. This trial is registered on ISRCTN.com, number ISRCTN66687527. Findings Of the 87 children eligible for the study, cord blood was unavailable for 24, six caregivers declined consent, and two children were withdrawn before transfusion. Therefore, 55 children received umbilical cord red blood cells from 74 donations. Ten (18%) children had ten serious adverse events and 43 (78%) had 94 adverse events; the most frequent adverse events were anaemia (n=14), weight loss (n=12), and vomiting (n=10). An independent expert panel judged none of these adverse events to be probably or certainly caused by the cord blood transfusion (one-sided 97·5% CI 0–6·5

  5. Safety and efficacy of allogeneic umbilical cord red blood cell transfusion for children with severe anaemia in a Kenyan hospital: an open-label single-arm trial.

    Science.gov (United States)

    Hassall, Oliver W; Thitiri, Johnstone; Fegan, Greg; Hamid, Fauzat; Mwarumba, Salim; Denje, Douglas; Wambua, Kongo; Mandaliya, Kishor; Maitland, Kathryn; Bates, Imelda

    2015-03-01

    In sub-Saharan Africa, children are frequently admitted with severe anaemia needing an urgent blood transfusion, but blood is often unavailable. When conventional blood supplies are inadequate, allogeneic umbilical cord blood could be a feasible alternative. The aim of this study was to assess the safety and efficacy of cord blood transfusion in children with severe anaemia. Between June 26, 2007, and May 20, 2008, 413 children needing an urgent blood transfusion were admitted to Kilifi District Hospital in Kenya. Of these, 87 children were eligible for our study--ie, younger than 12 years, no signs of critical illness, and haemoglobin 100 g/L or lower (if aged 3 months or younger) or 40 g/L or lower (if older than 3 months). Cord blood was donated at Coast Provincial General Hospital, Mombasa, and screened for transfusion-transmitted infections and bacterial contamination. Red blood cells were stored vertically at 2-6°C to enable sedimentation. After transfusion, children were monitored closely for adverse events and followed up for 28 days. The primary outcome measure was the frequency and nature of adverse reactions associated with the transfusion. Secondary outcomes were the changes in haemoglobin concentrations 24 h and 28 days after transfusion, compared with pretransfusion levels. This trial is registered on ISRCTN.com, number ISRCTN66687527. Of the 87 children eligible for the study, cord blood was unavailable for 24, six caregivers declined consent, and two children were withdrawn before transfusion. Therefore, 55 children received umbilical cord red blood cells from 74 donations. Ten (18%) children had ten serious adverse events and 43 (78%) had 94 adverse events; the most frequent adverse events were anaemia (n=14), weight loss (n=12), and vomiting (n=10). An independent expert panel judged none of these adverse events to be probably or certainly caused by the cord blood transfusion (one-sided 97·5% CI 0-6·5). Haemoglobin increased by a median of 26 g

  6. The impact of ED nurse manager leadership style on staff nurse turnover and patient satisfaction in academic health center hospitals.

    Science.gov (United States)

    Raup, Glenn H

    2008-10-01

    Nurse managers with effective leadership skills are an essential component to the solution for ending the nursing shortage. Empirical studies of existing ED nurse manager leadership styles and their impact on key nurse management outcomes such as staff nurse turnover and patient satisfaction have not been performed. The specific aims of this study were to determine what types of leadership styles were used by ED nurse managers in academic health center hospitals and examine their influence on staff nurse turnover and patient satisfaction. ED nurse managers were asked to complete the Multifactor Leadership Questionnaire and a 10-item researcher defined nurse manager role and practice demographics survey. Completed surveys (15 managers and 30 staff nurses) representing 15 out of 98 possible U.S. academic health centers were obtained. Fisher's exact test with 95% confidence intervals were used to analyze the data. The sample percentage of managers who exhibited Transformational leadership styles and demographic findings of nurse manager age, total years experience and length of time in current position matched current reports in the literature. A trend of lower staff nurse turnover with Transformational leadership style compared to non-Trasformational leadership styles was identified. However, the type of leadership style did not appear to have an effect on patient satisfaction. The ED is an ever-changing, highly regulated, critical-care environment. Effective ED nurse manager leadership strategies are vital to maintaining the standards of professional emergency nursing practice to create an environment that can produce management outcomes of decreased staff nurse turnover, thereby enhancing staff nurse retention and potentially impacting patient satisfaction.

  7. An epidemiologic survey on the causes of infertility in patients referred to infertility center in Fatemieh Hospital in Hamadan

    Directory of Open Access Journals (Sweden)

    Seyedeh Zahra Masoumi

    2015-08-01

    Full Text Available Background: Infertility is considered as a major health care problem of different communities. The high prevalence of this issue doubled its importance. A significant proportion of infertility have been related to environmental conditions and also acquired risk factors. Different environmental conditions emphasized the need to study the different causes of infertility in each area. Objective: The aim of this study was to determine the frequency causes of infertility in infertile couples. Materials and Methods: In this cross sectional descriptive study 1200 infertile men and women that were referred to infertility clinic of Fatemieh Hospital during 2010 to 2011, were examined. This center is the only governmental center for infertility in Hamadan. Sampling was based on census method. Information about the patients was obtained from medical examinations and laboratory findings. To analyze the data, descriptive statistics such as frequencies and the mean were used. Results: The prevalence of primary and secondary infertility was 69.5% and 30.5% respectively. Among the various causes of infertility women factors (88.6% had the highest regard. In the causes of female infertility, menstrual disorders, diseases (obesity, thyroid diseases, and diabetes, ovulation dysfunction, uterine factor, fallopian tubes and cervical factor had the highest prevalence respectively. The causes of male infertility based on their frequency included semen fluid abnormalities, genetic factors, vascular abnormalities, and anti-spermatogenesis factors, respectively. Conclusion: Etiology pattern of infertility in our study is similar with the many other patterns that have been reported by the World Health Organization. However, frequency of menstrual disorders is much higher than other studies that require further consideration.

  8. Primary care program improves reimbursement. The Federally Qualified Health Center program helps hospitals improve services to the medically indigent.

    Science.gov (United States)

    Fahey, T M; Gallitano, D G

    1993-03-01

    Under a program created by Congress in 1989, certain primary care treatment centers serving the medically and economically indigent can become Federally Qualified Health Centers (FQHCs). Recently enacted rules and regulations allow participants in the FQHC program to receive 100 percent reasonable cost reimbursement for Medicaid services and 80 percent for Medicare services. An all-inclusive annual cost report is the basis for determining reimbursement rates. The report factors in such expenses as physician and other healthcare and professional salaries and benefits, medical supplies, certain equipment depreciation, and overhead for facility and administrative costs. Both Medicaid and Medicare reimbursement is based on an encounter rate, and states employ various methodologies to determine the reimbursement level. In Illinois, for example, typical reimbursement for a qualified encounter ranges from $70 to $88. To obtain FQHC status, an organization must demonstrate community need, deliver the appropriate range of healthcare services, satisfy management and finance requirements, and function under a community-based governing board. In addition, an FQHC must provide primary healthcare by physicians and (where appropriate) midlevel practitioners; it must also offer its community diagnostic laboratory and x-ray services, preventive healthcare and dental care, case management, pharmacy services, and arrangements for emergency services. Because FQHCs must be freestanding facilities, establishing them can trigger a number of ancillary legal issues, such as those involved in forming a new corporation, complying with not-for-profit corporation regulations, applying for tax-exempt status, and applying for various property and sales tax exemptions. Hospitals that establish FQHCs must also be prepared to relinquish direct control over the delivery of primary care services.

  9. Red Blood Cell Transfusion Need for Elective Primary Posterior Lumbar Fusion in A High-Volume Center for Spine Surgery

    Science.gov (United States)

    Ristagno, Giuseppe; Beluffi, Simonetta; Tanzi, Dario; Belloli, Federica; Carmagnini, Paola; Croci, Massimo; D’Aviri, Giuseppe; Menasce, Guido; Pastore, Juan C.; Pellanda, Armando; Pollini, Alberto; Savoia, Giorgio

    2018-01-01

    (1) Background: This study evaluated the perioperative red blood cell (RBC) transfusion need and determined predictors for transfusion in patients undergoing elective primary lumbar posterior spine fusion in a high-volume center for spine surgery. (2) Methods: Data from all patients undergoing spine surgery between 1 January 2014 and 31 December 2016 were reviewed. Patients’ demographics and comorbidities, perioperative laboratory results, and operative time were analyzed in relation to RBC transfusion. Multivariate logistic regression analysis was performed to identify the predictors of transfusion. (3) Results: A total of 874 elective surgeries for primary spine fusion were performed over the three years. Only 54 cases (6%) required RBC transfusion. Compared to the non-transfused patients, transfused patients were mainly female (p = 0.0008), significantly older, with a higher ASA grade (p = 0.0002), and with lower pre-surgery hemoglobin (HB) level and hematocrit (p < 0.0001). In the multivariate logistic regression, a lower pre-surgery HB (OR (95% CI) 2.84 (2.11–3.82)), a higher ASA class (1.77 (1.03–3.05)) and a longer operative time (1.02 (1.01–1.02)) were independently associated with RBC transfusion. (4) Conclusions: In the instance of elective surgery for primary posterior lumbar fusion in a high-volume center for spine surgery, the need for RBC transfusion is low. Factors anticipating transfusion should be taken into consideration in the patient’s pre-surgery preparation. PMID:29385760

  10. Red Blood Cell Transfusion Need for Elective Primary Posterior Lumbar Fusion in A High-Volume Center for Spine Surgery

    Directory of Open Access Journals (Sweden)

    Giuseppe Ristagno

    2018-01-01

    Full Text Available (1 Background: This study evaluated the perioperative red blood cell (RBC transfusion need and determined predictors for transfusion in patients undergoing elective primary lumbar posterior spine fusion in a high-volume center for spine surgery. (2 Methods: Data from all patients undergoing spine surgery between 1 January 2014 and 31 December 2016 were reviewed. Patients’ demographics and comorbidities, perioperative laboratory results, and operative time were analyzed in relation to RBC transfusion. Multivariate logistic regression analysis was performed to identify the predictors of transfusion. (3 Results: A total of 874 elective surgeries for primary spine fusion were performed over the three years. Only 54 cases (6% required RBC transfusion. Compared to the non-transfused patients, transfused patients were mainly female (p = 0.0008, significantly older, with a higher ASA grade (p = 0.0002, and with lower pre-surgery hemoglobin (HB level and hematocrit (p < 0.0001. In the multivariate logistic regression, a lower pre-surgery HB (OR (95% CI 2.84 (2.11–3.82, a higher ASA class (1.77 (1.03–3.05 and a longer operative time (1.02 (1.01–1.02 were independently associated with RBC transfusion. (4 Conclusions: In the instance of elective surgery for primary posterior lumbar fusion in a high-volume center for spine surgery, the need for RBC transfusion is low. Factors anticipating transfusion should be taken into consideration in the patient’s pre-surgery preparation.

  11. Evaluation of serum anti-nuclear antibody among women with PCOS: a hospital based single center cross sectional study.

    Science.gov (United States)

    Rashid, Aafia; Bhat, Javaid Ahmad; Ganie, Mohd Ashraf; Wani, Imtiyaz Ahmad; Bhat, Moomin Hussain; Shah, Zaffar Amin; Masoodi, Shariq R; Marwaha, R K

    2018-05-07

    Polycystic ovary syndrome (PCOS), a major endocrinopathy is associated with barrage of metabolic aberrations. Reports in literature on association of PCOS and autoimmunity are conflicting. We aim to evaluate serum levels of anti-nuclear antibody (ANA) among Indian women with PCOS. In this hospital-based single center cross-sectional study, women qualifying a diagnosis of PCOS by Rotterdam criteria 2003 were recruited. Eighty-nine eligible women who consented were enrolled. All these women along with 87 age-matched, healthy controls underwent, clinical (menstrual history, anthropometry, hirsutism scoring), biochemical, hormonal assessment and serum ANA estimation. OGTT after overnight (8-12 h) fast with 75 g oral glucose load was done for 1 h, 2 h glucose and insulin measurements. The mean age of cases and controls was comparable (22.67 ± 5.53 vs. 22.84 ± 3.64 years). The prevalence of ANA positivity was significantly higher among women with PCOS (18.4% vs. 2.29%; p PCOS, being a marker of autoimmunity, suggests a possible role of autoimmunity in causation of PCOS and needs further elucidation.

  12. Radiotherapy and Nuclear Medicine Project for an Integral Oncology Center at the Oaxaca High Specialization Regional Hospital

    International Nuclear Information System (INIS)

    De Jesus, M.; Trujillo-Zamudio, F. E.

    2010-01-01

    A building project of Radiotherapy and Nuclear Medicine services (diagnostic and therapy), within an Integral Oncology Center (IOC), requires interdisciplinary participation of architects, biomedical engineers, radiation oncologists and medical physicists. This report focus on the medical physicist role in designing, building and commissioning stages, for the final clinical use of an IOC at the Oaxaca High Specialization Regional Hospital (HRAEO). As a first step, during design stage, the medical physicist participates in discussions about radiation safety and regulatory requirements for the National Regulatory Agency (called CNSNS in Mexico). Medical physicists propose solutions to clinical needs and take decisions about installing medical equipment, in order to fulfill technical and medical requirements. As a second step, during the construction stage, medical physicists keep an eye on building materials and structural specifications. Meanwhile, regulatory documentation must be sent to CNSNS. This documentation compiles information about medical equipment, radioactivity facility, radiation workers and nuclear material data, in order to obtain the license for the linear accelerator, brachytherapy and nuclear medicine facilities. As a final step, after equipment installation, the commissioning stage takes place. As the conclusion, we show that medical physicists are essentials in order to fulfill with Mexican regulatory requirements in medical facilities.

  13. Computer-Based Training in Eating and Nutrition Facilitates Person-Centered Hospital Care: A Group Concept Mapping Study.

    Science.gov (United States)

    Westergren, Albert; Edfors, Ellinor; Norberg, Erika; Stubbendorff, Anna; Hedin, Gita; Wetterstrand, Martin; Rosas, Scott R; Hagell, Peter

    2018-04-01

    Studies have shown that computer-based training in eating and nutrition for hospital nursing staff increased the likelihood that patients at risk of undernutrition would receive nutritional interventions. This article seeks to provide understanding from the perspective of nursing staff of conceptually important areas for computer-based nutritional training, and their relative importance to nutritional care, following completion of the training. Group concept mapping, an integrated qualitative and quantitative methodology, was used to conceptualize important factors relating to the training experiences through four focus groups (n = 43), statement sorting (n = 38), and importance rating (n = 32), followed by multidimensional scaling and cluster analysis. Sorting of 38 statements yielded four clusters. These clusters (number of statements) were as follows: personal competence and development (10), practice close care development (10), patient safety (9), and awareness about the nutrition care process (9). First and second clusters represented "the learning organization," and third and fourth represented "quality improvement." These findings provide a conceptual basis for understanding the importance of training in eating and nutrition, which contributes to a learning organization and quality improvement, and can be linked to and facilitates person-centered nutritional care and patient safety.

  14. Profiles of Attendees in Voluntary Counseling and Testing Centers of a Medical College Hospital in Coastal Karnataka

    Science.gov (United States)

    Jayarama, S; Shenoy, Shaliny; Unnikrishnan, B; Ramapuram, John; Rao, Manjula

    2008-01-01

    Research Question: What are the socio-demographic profile and risk behavior pattern of seropositive attendees in the voluntary counseling and testing center (VCTC)? Study Design: Retrospective study. Setting: VCTC in the outpatient complex of Kasturba Medical College Hospital, Mangalore, Karnataka. Subjects: Records pertaining to all the 539 and 330 seropositive attendees during the years 2005 and 2006, respectively, were included in the study besides data from 2001 onwards in order to assess the time trend of human immunodeficiency virus (HIV). Study Variables: Age, sex, marital status, religion, educational status, occupation, place of residence and pattern of risk behavior in relation to HIV/AIDS. Statistical Analysis: Analysis was done with SPSS version 11. Statistical test and Chi-square was done, and P profile, about 17-27% were housewives, 19-21% were laborers/hotel workers and 7% were entrepreneurs. About 45% were from urban area and nearly one-third hailing from other districts in the border of Karnataka. About 25% were exposed to commercial sex workers; another 21-23% were involved in premarital sex and nearly 38% were indulging in heterosexual activities. PMID:19966996

  15. Association of smoking with blood lipids in coronary heart disease patients admitted in Taiping Hospital, Perak, Malaysia

    Directory of Open Access Journals (Sweden)

    A.T.M. Emdadul Haque

    2016-01-01

    Full Text Available Introduction: Cigarette smoking is one of the predisposing factors for cardiovascular diseases as it may increase low-density lipoproteins (LDLs levels and decrease high-density lipoproteins (HDLs. Objective: To measure the blood level of LDL and HDL and compare the result between smokers and nonsmokers who suffered from coronary heart diseases (CHDs. Materials and Methods: This is a cross-sectional study. The information was collected by using a checklist from the records of CHD patients, admitted to Taiping General Hospital, Perak, Malaysia. Data collected were interpreted to find any significant association between smoking, level of total cholesterol, triglycerides, HDL, and LDL. Results: Among the 196 patients included in this study, 85 were active smokers (43.4%, 54 ex-smokers (27.6%, and 57 nonsmokers (29%. Out of 171 patients with decreased level of HDL, 90.6% were smokers, 88.9% ex-smokers, and 80.7% of nonsmokers. It was found that significant changes occurred among the groups with decreased level of HDL (P < 0.05. Conclusion: HDL level is more reduced among the smokers compared to the ex-smokers and nonsmokers especially in the female.

  16. Evaluating laboratory request forms submitted to haematology and blood transfusion departments at a hospital in Northwest Nigeria

    Directory of Open Access Journals (Sweden)

    Feyisayo Jegede

    2016-05-01

    Objective: We assessed routinely-submitted LRFs to determine the degree of correctness, completeness and consistency. Methods: LRFs submitted to the Department of Haematology (DH and Blood Transfusion Services (BTS of Aminu Kano Teaching Hospital in Kano, Nigeria, between October 2014 and December 2014, were evaluated for completion of all items on the forms. Performance in four quality indicator domains, including patient identifiers, test request details, laboratory details and physician details, was derived as a composite percentage. Results: Of the 2084 LRFs evaluated, 999 were from DH and 1085 from BTS. Overall, LRF completeness was 89.5% for DH and 81.2% for BTS. Information on patient name, patient location and laboratory number were 100% complete for DH, whereas only patient name was 100% complete for BTS. Incomplete information was mostly encountered on BTS forms for physician’s signature (60.8% and signature of laboratory receiver (63.5%. None of the DH and only 9.4% of BTS LRFs met all quality indicator indices. Conclusion: The level of completion of LRFs from these two departments was suboptimal. This underscores the need to review and redesign the LRF, improve on training and communication between laboratory and clinical staff and review specimen rejection practices.

  17. Blood transfusion in the surgical treatment of adolescent idiopathic scoliosis-a single-center experience of patient blood management in 210 cases.

    Science.gov (United States)

    Ohrt-Nissen, Søren; Bukhari, Naeem; Dragsted, Casper; Gehrchen, Martin; Johansson, Pär I; Dirks, Jesper; Stensballe, Jakob; Dahl, Benny

    2017-07-01

    The surgical treatment of adolescent idiopathic scoliosis can be associated with substantial blood loss, requiring allogeneic red blood cell (RBC) transfusion. This study describes the use of RBC and the effect of a standardized perioperative patient blood management program. Patients treated with posterior instrumented fusion were consecutively enrolled over a 6-year period. Patient blood management strategies were implemented in 2011, including prophylactic tranexamic acid, intraoperative permissive hypotension, restrictive fluid therapy (including avoidance of synthetic colloids), restrictive RBC trigger according to institutional standardized protocol, the use of cell savage, and goal-directed therapy according to thrombelastography. In total, 210 patients were included. 64 patients (31%) received RBC transfusions. A decline in the intraoperative rate of RBC transfusion was observed, from 77% in 2011 to 13% in 2016 (p transfusion group had a significantly larger major curve, lower preoperative hemoglobin, higher estimated blood loss, and an increased use of crystalloid volume resuscitation. Multiple logistic regression showed that significant predictors for RBC transfusion were preoperative hemoglobin level (odds ratio [OR], 0.40; 95% confidence interval [CI], 0.27-0.57), estimated blood loss (OR, 1.26; 95% CI, 1.15-1.42), and year of surgery (indicating the effect of patient blood management) (OR per year, 0.76; 95% CI, 0.58-0.99). A perioperative patient blood management program substantially reduced the need for RBC transfusion. A preoperative evaluation of anemia is essential to further minimize transfusion rates. © 2017 AABB.

  18. Hospital-acquired symptomatic urinary tract infection in patients admitted to an academic stroke center affects discharge disposition.

    Science.gov (United States)

    Ifejika-Jones, Nneka L; Peng, Hui; Noser, Elizabeth A; Francisco, Gerard E; Grotta, James C

    2013-01-01

    To test the role of hospital-acquired symptomatic urinary tract infection (SUTI) as an independent predictor of discharge disposition in the acute stroke patient. A retrospective study of data collected from a stroke registry service. The registry is maintained by the Specialized Programs of Translational Research in Acute Stroke Data Core. The Specialized Programs of Translational Research in Acute Stroke is a national network of 8 centers that perform early phase clinical projects, share data, and promote new approaches to therapy for acute stroke. A single university-based hospital. We performed a data query of the fields of interest from our university-based stroke registry, a collection of 200 variables collected prospectively for each patient admitted to the stroke service between July 2004 and October 2009, with discharge disposition of home, inpatient rehabilitation, skilled nursing facility, or long-term acute care. Baseline demographics, including age, gender, ethnicity, and National Institutes of Health Stroke Scale (NIHSS) score, were collected. Cerebrovascular disease risk factors were used for independent risk assessment. Interaction terms were created between SUTI and known covariates, such as age, NIHSS, serum creatinine level, history of stroke, and urinary incontinence. Because patients who share discharge disposition tend to have similar length of hospitalization, we analyzed the effect of SUTI on the median length of stay for a correlation. Days in the intensive care unit and death were used to evaluate morbidity and mortality. By using multivariate logistic regression, the data were analyzed for differences in poststroke disposition among patients with SUTI. Of 4971 patients admitted to the University of Texas at Houston Stroke Service, 2089 were discharged to home, 1029 to inpatient rehabilitation, 659 to a skilled nursing facility, and 226 to a long-term acute care facility. Patients with an SUTI were 57% less likely to be discharged home

  19. Blood Donation Process

    Science.gov (United States)

    ... Drive Biomedical Services Hospital Partners Blood Products Blood Banking Resources Order Blood Products Invoice Central Case Reports ... Speed up your donation by completing a RapidPass® online or on the Blood Donor app on the ...

  20. Concentration and Distribution Characteristics of Airborne Fungi in the Ambient Air of Milad Hospital, Blood Transfusion Organization and Tehran’s Shahrake Ghods Wastewater Treatment Plant

    Directory of Open Access Journals (Sweden)

    2015-12-01

    Full Text Available Background and aims: Recently contact with bioaerosols has been presented as an important problem which endangers human being’s health. The aim of this investigation is to compare potential of separation of fungal aerosols in the air around Tehran’s Milad hospital, blood transfusion organization and waste water treatment plant of Tehran’s Shahrake Ghods. methods: this cross-sectional investigation was done in Milad hospital, blood transfusion organization and Tehran’s Shahrake Ghods waste water treatment plant within for 4 months. The sampling was done passively for 1 hour and once in 6 days. The culture medium was Sabouraud dextrose agar. Results: comparing selected sampling stations the most fungal density was for 100 meters after the last unit of waste water treatment plant (67 CFU and the least density was for Milad hospital (30 CFU. Dominant genera of fungal in waste water treatment plant and blood transfusion organization was related to Cladosporium (in order of 49% and 84% and in air around Milad hospital was related to Alternaria (47%. Conclusion: according to the results processing and operating sections in waste water treatment plant can be effective in fungal density and separation of bioaerosols. Therefore it seems to be vital that the responsible organizations should do necessary actions to develop guidelines and standards related to bioaerosols. Also appropriate administration of environmental health in waste water treatment plant can be an important factor in reduction of aerosol separation.

  1. Subanesthetic ketamine for pain management in hospitalized children, adolescents, and young adults: a single-center cohort study

    Directory of Open Access Journals (Sweden)

    Sheehy KA

    2017-04-01

    Full Text Available Kathy A Sheehy,1,* Caroline Lippold,1,* Amy L Rice,1 Raissa Nobrega,1 Julia C Finkel,1 Zenaide MN Quezado1,2 1Division of Anesthesiology, Pain, and Perioperative Medicine, The Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s Research Institute, Children’s National Health System, George Washington University School of Medicine and Health Sciences, 2Center for Neuroscience Research, Children’s Research Institute, Children’s National Health System, Washington, DC, USA *These authors contributed equally to this work Background: Subanesthetic doses of ketamine, an N-methyl-D-aspartate receptor antagonist used as an adjuvant to opioid for the treatment of pain in adults with acute and chronic pain, have been shown, in some instances, to improve pain intensity and to decrease opioid intake. However, less is known about the role of ketamine in pain management in children, adolescents, and young adults. Purpose: We examined the effects of subanesthetic ketamine on pain intensity and opioid intake in children, adolescents, and young adults with acute and chronic pain syndromes treated in an inpatient setting. Methods: This is a longitudinal cohort study of patients treated with subanesthetic ketamine infusions in regular patient care units in a tertiary pediatric hospital. Primary outcomes included changes in pain scores and morphine-equivalent intake. Results: The study cohort included 230 different patients who during 360 separate hospital admissions received subanesthetic ketamine infusions for pain management. Overall, ketamine infusions were associated with significant reductions in mean pain scores from baseline (mean pain scores 6.64 [95% CI: 6.38–6.90] to those recorded on the day after discontinuation of ketamine (mean pain scores 4.38 [95% CI: 4.06–4.69], p<0.001. Importantly, the effect of ketamine on pain scores varied according to clinical diagnosis (p=0.011, infusion duration (p=0.004, and pain location (p=0

  2. Blood transfusion in the surgical treatment of adolescent idiopathic scoliosis-a single-center experience of patient blood management in 210 cases

    DEFF Research Database (Denmark)

    Ohrt-Nissen, Søren; Bukhari, Naeem; Dragsted, Casper

    2017-01-01

    DESIGN AND METHODS: Patients treated with posterior instrumented fusion were consecutively enrolled over a 6-year period. Patient blood management strategies were implemented in 2011, including prophylactic tranexamic acid, intraoperative permissive hypotension, restrictive fluid therapy (including...

  3. 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

  4. The Relation between Anxiety, Depression and Sexual Dysfunction and the Level of Blood Glucose Control in Patients with Type 2 Diabetes Attending Endocrine Clinic of Taleghani Hospital

    Directory of Open Access Journals (Sweden)

    Afarin Ahmadian

    2018-02-01

    Full Text Available Diabetes, as a common disease, is one of the major health problems in countries all over the world. There has been evidence of an increase in the prevalence rate of psychological disorders such as anxiety and depression and sexual dysfunction in people with diabetes compared to other people. The study aimed to investigate the relation between blood glucose control and anxiety, depression and sexual dysfunction. For this purpose, 141 patients with type 2 diabetes attending to Endocrine clinic of Taleghani Hospital in Tehran were randomly selected. In order to assess the prevalence rate of anxiety and depression, the HADS questionnaire was applied, and ARIZONA questionnaire was used to assess prevalence rate of sexual dysfunction. The status of blood glucose control was assessed based on the HbA1c scale as well. According to the results of the present research, 93.9% of the subjects in the uncontrolled blood glucose group suffered from either anxiety or depression, or both of them, and 6.1% in the control blood glucose group. 77.2% of patients in uncontrolled blood glucose group had severe sexual disorder; while, 22.8% of patients in controlled blood glucose group had this problem. Based on the obtained results of data analysis, there is a significant relationship between the status of blood glucose control based on the HbA1c scale and the prevalence rate of anxiety, depression and sexual dysfunction.

  5. Congenital Heart Disease in Children's hospital medical center A Cross-Sectional study 2000 - 2001

    Directory of Open Access Journals (Sweden)

    Zeinaloo. A. A Tadbir. M

    2002-07-01

    Full Text Available The most common congenital diseases in children is congenital heart disease. Factors such as environment, genetic, old maternal age during pregnancy, maternal disease and using medicine in pregnancy, prematuritiy, and specific seasons are significant in the prevalence of disease."nMaterials and Methods: A cross sectional study was conducted to investigate the status of children with congenital heart diseases, among 665 child that refereed to Children's hospital medical center, Tehran University of Medical Sciences and Health Services, during 1 year (2000 tO 2001. The researchers due to the lack of existing appropriate tools developed the instrument for the study. The questionnaire was 15 items, nominal, ordinal and interval scale. All items were verified using major authoritative pediatric cardiologists references and were subjected to face and content validation by three experts. Convenient sampling was utilized for collecting data. All subjects were examined in cardiology department and echocardiography was done for them."nResults: From a total of 665 children with congenital heart defects, 56.2 percent were male and 43.8 percent were female. 32.6 percent were born in autumn. Septal defects were predominant lesions, which account for 36.1 percent of lesions. 89.8 percent of children have never extracardiac defects. Children of mothers age 20-35 years had a percentage of 86.2 percent of developing congenital heart disease, Percentage of children who their birth weight less than 2500 gram was quite small, at 24.1 per cent overall. There was no significant relationship between selected variables and congenital heart diseases."nConclusion: With regard to the prevalence of disease and preventing therapeutic costs, parents and teachers education have an important role in preventing congenital heart disease. Therefore, the formation of a learning curriculum model for a life free of congenital heart disease and congenital heart diseases

  6. Multiple perpetrator rape among girls evaluated at a hospital-based child advocacy center: seven years of reviewed cases.

    Science.gov (United States)

    Edinburgh, Laurel; Pape-Blabolil, Julie; Harpin, Scott B; Saewyc, Elizabeth

    2014-09-01

    The aim of this study was to describe contextual events, abuse experiences, and disclosure processes of adolescents who presented to a hospital-based Child Advocacy Center for medical evaluation and evidentiary collection as indicated after experiencing multiple perpetrator rape during a single event (n=32) and to compare these findings to a group of single perpetrator sexual assaults (n=534). This study used a retrospective mixed-methods design with in-depth, forensic interviews and complete physical examinations of gang-raped adolescents. Patients ranged from 12 to 17 years (M=14 years). Girls who experienced multiple perpetrator rape during a single event were more likely to have run away, to have drunk alcohol in the past month, and to have participated in binge drinking in the past 2 weeks. Acute presentation of these victims were rare but 30% had hymenal transections and 38% had sexually transmitted infections (STIs). Forensic interviews revealed alcohol was a common weapon used by offenders, and its use resulted in victims experiencing difficulty in remembering and reporting details for police investigation or physical and mental health care. Most victims were raped at parties they attended with people they thought they could trust, and they felt let down by witnesses who could have helped but did not intervene. Although relatively rare, multiple perpetrator rape during a single event is a type of severe sexual assault experience and has significant risks for deleterious health outcomes. These victims require health care by trained providers to diagnose physical findings, treat STIs, screen for trauma, and support victims. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  7. [Parasitological study of 78 cases of human cystic echinococcosis collected between 2005 to 2012 in Mustapha hospital center of Algiers].

    Science.gov (United States)

    Zait, H; Boulahbel, M; Normand, A C; Zait, F; Achir, I; Guerchani, M K; Chaouche, H; Ladjadj, Y; Hamrioui, B

    2014-12-01

    The aim of this work is to know the fertility rate of the metacestodes resulting from patients suffering from hydatidosis, the one of protoscoleces's viability and by comparing the results obtained with those found elsewhere. It reports, also, the epidemiological, clinical and diagnostically aspects of the studied patients. This study has carried on 78 hydatics samples resulting from 78 patients collected between 2005 and 2012 at the laboratory of parasitology of the Mustapha hospital center of Algiers. A questionnaire on the epidemiological context (contact with an animal-host of the cycle, place of residence, presence of family cases reached of hydatidosis and knowledge on the hydatic disease) concerned 69 patients. For each sample, a direct microscopic examination is made with or without vital staining. The presence of protoscoleces made qualified the fertile cyst. Those visualized moving or resistant to eosin at 0.2% are considered viables. Indirect diagnosis is based on the techniques: passive hemagglutination, electrophoresis, Elisa IgG Echinococcus granulosus and immunoblotting IgG "Echinococcus". Molecular analysis is based on PCR and sequencing the partials fragments of two mitochondrial genes with the primers COX1 and ND1. The results obtained show that the surgical frequency of hydatidosis is significant at the young adult and at the child. The epidemiological context associated at the disease is the conjointly presence of a dog and herbivores. The fertility rate of human hydatid cysts is 88.4% and the ones of viability of the protoscoleces is 74.5%. In this series, the serology shows global positivity at 70%. The molecular characterization of five samples identify the species: E. granulosus ss. Finally, the viability and fertility rates found here are raised. Sometimes viables protoscoleses are found after use of scolicidal solution. In front of these results, the parasitical treatment is more than necessary in order to minimize the risk of occurred of

  8. Hospital-Acquired Pressure Ulcers at Academic Medical Centers in the United States, 2008-2012: Tracking Changes Since the CMS Nonpayment Policy.

    Science.gov (United States)

    Padula, William V; Makic, Mary Beth F; Wald, Heidi L; Campbell, Jonathan D; Nair, Kavita V; Mishra, Manish K; Valuck, Robert J

    2015-06-01

    In 2007, the Centers for Medicare & Medicaid Services (CMS) announced its intention to no longer reimburse hospitals for costs associated with hospital-acquired pressure ulcers (HAPUs) and a list of other hospital-acquired conditions (HACs), which was followed by enactment of the nonpayment policy in October 2008. This study was conducted to define changes in HAPU incidence and variance since 2008. In a retrospective observational study, HAPU cases were identified at 210 University HealthSystem Consortium (UHC) academic medical centers in the United States. HAPU incidence rates were calculated as a ratio of HAPU cases to the total number of UHC inpatients between the first quarter of 2008 and the second quarter of 2012. HAPU cases were defined by multiple criteria: not present on admission (POA); coded for stage III or IV pressure ulcers; and a length of stay greater than four days. Among the UHC hospitals between 2008 and June 2012, 10,386 HAPU cases were identified among 4.08 million inpatients. The HAPU incidence rate decreased significantly from 11.8 cases per 1,000 inpatients in 2008 to 0.8 cases per 1,000 in 2012 (p CMS non-payment policy as a significant covariate of changing trends in HAPU incidence rates. HAPU incidence rates decreased significantly among 210 UHC AMCs after the enactment of the CMS nonpayment policy. The hospitals appeared to be reacting efficiently to economic policy incentives by improving prevention efforts.

  9. [STRATEGY OF USE AND MAINTENANCE OF CLINICAL HOSPITAL CENTER RIJEKA IN ACCORDANCE WITH KEY PERFORMANCE INDICATORS FOR STRATEGIC HEALTHCARE FACILITIES MAINTENANCE].

    Science.gov (United States)

    Sjekavica, Mariela; Haller, Herman; Cerić, Anita

    2015-01-01

    Building usage is the phase in the building life cycle that is most time-consuming, most functional, most significant due to building purpose and often systematically ignored. Maintenance is the set of activities that ensure the planned duration of facility exploitation phase in accordance with the requirements for quality maintenance of a large number of important building features as well as other elements immanent to the nature of facilities' life. The aim of the study is to show the analysis of the current state of organized, planned and comprehensive managerial approach in hospital utilization and maintenance in the Republic of Croatia, given on the case study of Clinical hospital center in Rijeka. The methodology used consists of relevant literature section of theory of facility utilization, maintenance and management in general, hospital buildings especially, display of practice on case study, and comparison of key performance indicators values obtained through interview with those that author Igal M. Shohet defined in his study by field surveys and statistical analyses. Despite many positive indicators of Clinical hospital center Rijeka maintenance, an additional research is needed in order to define a more complete national hospital maintenance strategy.

  10. Determination of prevalence and causes of hyponatremia in patient's admitted in pediatric intensive care unit of the Children's Hospital Medical Center

    Directory of Open Access Journals (Sweden)

    Kadivar M

    1999-06-01

    Full Text Available Among the 708 patients who were admitted in the pediatric intensive care unit (PICU of the children's hospital medical center, there were 100 patients with hyponatermia (Na<130 mEq/L. 62% of these patients had hyponatermia at the beginning of admission and 38% during hospitalization in PICU. According to the classification of hyponatermia in comparison to body fluid, this study revealed 7% pseudohyponatermia, 40% euvolemic hyponatermia, 34% hypovolemic hyponatermia and 10% hypovolemic hyponatermia. In conclusion, the most perevalent causes of hyponatermia in this study were syndrome of inappropriate antidiuretic hormone secretion (SIADH (27%, water intoxication (22% and extrarenal losses (20%

  11. 30-Day Mortality and Readmission after Hemorrhagic Stroke among Medicare Beneficiaries in Joint Commission Primary Stroke Center Certified and Non-Certified Hospitals

    Science.gov (United States)

    Lichtman, Judith H.; Jones, Sara B.; Leifheit-Limson, Erica C.; Wang, Yun; Goldstein, Larry B.

    2012-01-01

    Background and Purpose Ischemic stroke patients treated at Joint Commission Primary Stroke Center (JC-PSC) certified hospitals have better outcomes. Data reflecting the impact of JC-PSC status on outcomes after hemorrhagic stroke are limited. We determined whether 30-day mortality and readmission rates after hemorrhagic stroke differed for patients treated at JC-PSC certified versus non-certified hospitals. Methods The study included all fee-for-service Medicare beneficiaries ≥65 years old with a primary discharge diagnosis of subarachnoid hemorrhage (SAH) or intracerebral hemorrhage (ICH) in 2006. Covariate-adjusted logistic and Cox proportional hazards regression assessed the effect of care at a JC-PSC certified hospital on 30-day mortality and readmission. Results There were 2,305 SAH and 8,708 ICH discharges from JC-PSC certified hospitals and 3,892 SAH and 22,564 ICH discharges from non-certified hospitals. Unadjusted in-hospital mortality (SAH: 27.5% vs. 33.2%, pmortality (SAH: 35.1% vs. 44.0%, pmortality was 34% lower (OR 0.66, 95% CI 0.58–0.76) after SAH and 14% lower (OR 0.86, 95% CI 0.80–0.92) after ICH for patients discharged from JC-PSC certified hospitals. There was no difference in 30-day risk-adjusted readmission rates for SAH or ICH based on JC-PSC status. Conclusions Patients treated at JC-PSC certified hospitals had lower risk-adjusted mortality rates for both SAH and ICH but similar 30-day readmission rates as compared with non-certified hospitals. PMID:22033986

  12. 30-day mortality and readmission after hemorrhagic stroke among Medicare beneficiaries in Joint Commission primary stroke center-certified and noncertified hospitals.

    Science.gov (United States)

    Lichtman, Judith H; Jones, Sara B; Leifheit-Limson, Erica C; Wang, Yun; Goldstein, Larry B

    2011-12-01

    Ischemic stroke patients treated at Joint Commission Primary Stroke Center (JC-PSC)-certified hospitals have better outcomes. Data reflecting the impact of JC-PSC status on outcomes after hemorrhagic stroke are limited. We determined whether 30-day mortality and readmission rates after hemorrhagic stroke differed for patients treated at JC-PSC-certified versus noncertified hospitals. The study included all fee-for-service Medicare beneficiaries aged 65 years or older with a primary discharge diagnosis of subarachnoid hemorrhage (SAH) or intracerebral hemorrhage (ICH) in 2006. Covariate-adjusted logistic and Cox proportional hazards regression assessed the effect of care at a JC-PSC-certified hospital on 30-day mortality and readmission. There were 2305 SAH and 8708 ICH discharges from JC-PSC-certified hospitals and 3892 SAH and 22 564 ICH discharges from noncertified hospitals. Unadjusted in-hospital mortality (SAH: 27.5% versus 33.2%, Pmortality (SAH: 35.1% versus 44.0%, Pmortality was 34% lower (odds ratio, 0.66; 95% confidence interval, 0.58-0.76) after SAH and 14% lower (odds ratio, 0.86; 95% confidence interval, 0.80-0.92) after ICH for patients discharged from JC-PSC-certified hospitals. There was no difference in 30-day risk-adjusted readmission rates for SAH or ICH based on JC-PSC status. Patients treated at JC-PSC-certified hospitals had lower risk-adjusted mortality rates for both SAH and ICH but similar 30-day readmission rates as compared with noncertified hospitals.

  13. New-Onset Depression Following Hip Fracture Is Associated With Increased Length of Stay in Hospital and Rehabilitation Centers

    Directory of Open Access Journals (Sweden)

    Anna C. Phillips

    2015-05-01

    Full Text Available This article examines the coincident effects of new-onset depression post hip fracture on length of hospital stay, readmission rates, and incidence of infections in older adults. Participants were 101 hip fracture patients aged 60+ years; 38 developed depressive symptoms following their fracture. Infection rates, readmissions to hospital and rehabilitation units, and length of hospital stay were assessed over the 6 months post hip fracture from hospital and general practitioner notes. Patients who developed depression by Week 6 post fracture were likely to spend more time in hospital/rehabilitation wards (p = .02 and more likely to be discharged to a rehabilitation unit (p < .05. There were no group differences in readmissions or infection rates. New-onset depression coincident with hip fracture in older adults is associated with longer hospital ward stays and greater need for rehabilitation.

  14. Immediate Symptom Relief After a First Session of Massage Therapy or Reiki in Hospitalized Patients: A 5-year Clinical Experience from a Rural Academic Medical Center.

    Science.gov (United States)

    Vergo, Maxwell T; Pinkson, Briane M; Broglio, Kathleen; Li, Zhongze; Tosteson, Tor D

    2018-04-05

    There is an increasing demand for and use of alternative and complementary therapies, such as reiki and massage therapy, in hospital-based settings. Most controlled studies and practice-based reports include oncology and surgical patient populations; thus the effect in a more heterogeneous hospitalized patient population is hard to estimate. We examined the immediate symptom relief from a single reiki or massage session in a hospitalized population at a rural academic medical center. Retrospective analysis of prospectively collected data on demographic, clinical, process, and quality of life for hospitalized patients receiving massage therapy or reiki. A 396-bed rural academic and tertiary medical center in the United States. Hospitalized patients requesting or referred to the healing arts team who received either a massage or reiki session and completed both a pre- and post-therapy symptom questionnaire. First session of routine reiki or massage therapy during a hospital stay. Differences between pre- and postsession patient-reported scores in pain, nausea, fatigue, anxiety, depression, and overall well-being using an 11-point Likert scale. Patients reported symptom relief with both reiki and massage therapy. Analysis of the reported data showed reiki improved fatigue (-2.06 vs. -1.55 p massage therapy and did not vary based on age, gender, length of session, and baseline symptoms. Reiki and massage clinically provide similar improvements in pain, nausea, fatigue, anxiety, depression, and overall well-being while reiki improved fatigue and anxiety more than massage therapy in a heterogeneous hospitalized patient population. Controlled trials should be considered to validate the data.

  15. Comparison of the outcomes for laparoscopic gastrectomy performed by the same surgeon between a low-volume hospital and a high-volume center.

    Science.gov (United States)

    Kim, Min Gyu; Kwon, Sung Joon

    2014-05-01

    The volume-outcome relationship in laparoscopic surgery is controversial. This study was designed to identify differences in laparoscopic gastrectomy outcomes between a low-volume hospital and a high-volume center and to provide guidelines for overcoming the problems associated with a low-volume hospital. From April 2009 to November 2012, one surgeon performed 134 totally laparoscopic distal gastrectomies (TLDGs) at a high-volume center (HVC; ASAN Medical Center) and at a low-volume hospital (LVH; Hanyang University Guri Hospital). All laparoscopically assisted gastrectomies were excluded from this study. During the early period of laparoscopic gastrectomy at the low-volume hospital, TLDG with Roux-en-Y gastrojejunostomy (RYGJ) was performed according to the surgeon's choice. The reconstruction method was classified as gastroduodenostomy (GD) or RYGJ. Early surgical outcomes achieved at the LVH were investigated and compared with those obtained at the HVC. The early surgical outcomes differed significantly between the two hospitals. In particular, the postoperative complication rate for the patients who underwent TLDG RYGJ at the LVH was higher than at the HVC (LVH 15.4 % vs. HVC 0 %; p = 0.037). Furthermore, significant differences were observed in the mean operation time (TLDG GD: LVH 141.0 min vs. HVC 117.4 min, p = 0.001; TLDG RYGJ: LVH 186.3 min vs. HVC 134.6 min, p = 0.009) and length of hospital stay (TLDG GD: LVH 8.1 days vs. HVC 7.2 days, p = 0.044; TLDG RYGJ: LVH 11.5 day vs. HVC 6.8 day, p = 0.009). Although all the operations were performed by one experienced surgeon, the early surgical outcomes differed significantly between the low- and high-volume hospitals. Low-volume hospitals often lack well-trained surgical professionals such as first assistants and scrub nurses. Therefore, the authors recommend that a surgeon who works at an LVH should assess potential personnel shortages and find a solution before operating.

  16. Hematopoietic Stem Cell Transplantation Activity in Pediatric Cancer between 2008 and 2014 in the United States: A Center for International Blood and Marrow Transplant Research Report.

    Science.gov (United States)

    Khandelwal, Pooja; Millard, Heather R; Thiel, Elizabeth; Abdel-Azim, Hisham; Abraham, Allistair A; Auletta, Jeffery J; Boulad, Farid; Brown, Valerie I; Camitta, Bruce M; Chan, Ka Wah; Chaudhury, Sonali; Cowan, Morton J; Angel-Diaz, Miguel; Gadalla, Shahinaz M; Gale, Robert Peter; Hale, Gregory; Kasow, Kimberly A; Keating, Amy K; Kitko, Carrie L; MacMillan, Margaret L; Olsson, Richard F; Page, Kristin M; Seber, Adriana; Smith, Angela R; Warwick, Anne B; Wirk, Baldeep; Mehta, Parinda A

    2017-08-01

    This Center for International Blood and Marrow Transplant Research report describes the use of hematopoietic stem cell transplantation (HSCT) in pediatric patients with cancer, 4408 undergoing allogeneic (allo) and3076 undergoing autologous (auto) HSCT in the United States between 2008 and 2014. In both settings, there was a greater proportion of boys (n = 4327; 57%), children reports of transplant practices in the United States. Copyright © 2017 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

  17. Hospital cultural competency as a systematic organizational intervention: Key findings from the national center for healthcare leadership diversity demonstration project.

    Science.gov (United States)

    Weech-Maldonado, Robert; Dreachslin, Janice L; Epané, Josué Patien; Gail, Judith; Gupta, Shivani; Wainio, Joyce Anne

    Cultural competency or the ongoing capacity of health care systems to provide for high-quality care to diverse patient populations (National Quality Forum, 2008) has been proposed as an organizational strategy to address disparities in quality of care, patient experience, and workforce representation. But far too many health care organizations still do not treat cultural competency as a business imperative and driver of strategy. The aim of the study was to examine the impact of a systematic, multifaceted, and organizational level cultural competency initiative on hospital performance metrics at the organizational and individual levels. This demonstration project employs a pre-post control group design. Two hospital systems participated in the study. Within each system, two hospitals were selected to serve as the intervention and control hospitals. Executive leadership (C-suite) and all staff at one general medical/surgical nursing unit at the intervention hospitals experienced a systematic, planned cultural competency intervention. Assessments and interventions focused on three organizational level competencies of cultural competency (diversity leadership, strategic human resource management, and patient cultural competency) and three individual level competencies (diversity attitudes, implicit bias, and racial/ethnic identity status). In addition, we evaluated the impact of the intervention on diversity climate and workforce diversity. Overall performance improvement was greater in each of the two intervention hospitals than in the control hospital within the same health care system. Both intervention hospitals experienced improvements in the organizational level competencies of diversity leadership and strategic human resource management. Similarly, improvements were observed in the individual level competencies for diversity attitudes and implicit bias for Blacks among the intervention hospitals. Furthermore, intervention hospitals outperformed their respective

  18. Seroprevalence of human immunodeficiency virus, hepatitis B and C viruses and syphilis infections among blood donors at the Muhimbili National Hospital in Dar Es Salaam, Tanzania

    Directory of Open Access Journals (Sweden)

    Lyamuya Eligius F

    2006-01-01

    Full Text Available Abstract Background According to the latest Tanzanian National AIDS Control Programme (NACP report a total of 147,271 individuals donated blood during the year 2002. However, blood safety remains an issue of major concern in transfusion medicine in Tanzania where national blood transfusion services and policies, appropriate infrastructure, trained personnel and financial resources are inadequate. Most of the donated blood is screened for HIV alone. Methods We determined among blood donors at Muhimbili National Hospital (MNH, the seroprevalence of human immunodeficiency virus (HIV, hepatitis C virus (HCV, hepatitis B surface antigen (HBsAg and syphilis by donor type, sex and age and to determine association, if any, in the occurrence of the pathogens. The sample included 1599 consecutive donors, 1424(89.1% males and 175 (10.9% females, who donated blood between April 2004 and May, 2005. Most of them 1125 (70.4% were replacement donors and a few 474 (29.6% voluntary donors. Their age (in years ranged from 16 to 69, and most (72.2% were between 20–39 years. Results Two hundred and fifty four (15.9% of the donated blood had serological evidence of infection with at least one pathogen and 28 (1.8% had multiple infections. The current seroprevalence of HIV, HBsAg, HCV and syphilis among blood donors at MNH in Dar es Salaam was found to be 3.8%, 8.8%, 1.5% and 4.7%, respectively. Respective seroprevalences among HIV seronegative blood donors were 8.7% for HBV, 1.6% for HCV and 4.6% for syphilis. The differences in the prevalence of HIV and syphilis infections between replacement and voluntary donors were statistically significant (P 2 = 58.5 df = 5, P Conclusion The high (15.9% seroprevalence of blood-borne infections in blood donated at MNH calls for routine screening of blood donors for HBV, HCV, HIV and syphilis and for strict selection criteria of donors, with emphasis on getting young voluntary donors and for establishment of strict guidelines

  19. Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Short Inpatient Hospital Stays; Transition for Certain Medicare-Dependent, Small Rural Hospitals Under the Hospital Inpatient Prospective Payment System; Provider Administrative Appeals and Judicial Review. Final rule with comment period; final rule.

    Science.gov (United States)

    2015-11-13

    This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2016 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program. Further, this document includes certain finalized policies relating to the hospital inpatient prospective payment system: Changes to the 2-midnight rule under the short inpatient hospital stay policy; and a payment transition for hospitals that lost their status as a Medicare-dependent, small rural hospital (MDH) because they are no longer in a rural area due to the implementation of the new Office of Management and Budget delineations in FY 2015 and have not reclassified from urban to rural before January 1, 2016. In addition, this document contains a final rule that finalizes certain 2015 proposals, and addresses public comments received, relating to the changes in the Medicare regulations governing provider administrative appeals and judicial review relating to appropriate claims in provider cost reports.

  20. The Glucagon-Like Peptide-1 Analog Exenatide Increases Blood Glucose Clearance, Lactate Clearance, and Heart Rate in Comatose Patients After Out-of-Hospital Cardiac Arrest

    DEFF Research Database (Denmark)

    Wiberg, Sebastian; Kjaergaard, Jesper; Schmidt, Henrik

    2018-01-01

    the first 6 hours from study drug initiation: lactate level, blood glucose level, heart rate, mean arterial pressure, and combined dosage of norepinephrine and dopamine. MEASUREMENTS AND MAIN RESULTS: The population consisted of 106 patients receiving either exenatide or placebo. During the first 6 hours...... from study drug initiation, the levels of blood glucose and lactate decreased 17% (95% CI, 8.9-25%; p = 0.0004) and 21% (95% CI, 6.0-33%; p = 0.02) faster in patients receiving exenatide versus placebo, respectively. Exenatide increased heart rate by approximately 10 beats per minute compared......OBJECTIVES: To investigate the effects of the glucagon-like peptide-1 analog exenatide on blood glucose, lactate clearance, and hemodynamic variables in comatose, resuscitated out-of-hospital cardiac arrest patients. DESIGN: Predefined post hoc analyzes from a double-blind, randomized clinical...

  1. Prognostic role of ABO blood type in patients with extranodal natural killer/T cell lymphoma, nasal type: a triple-center study.

    Science.gov (United States)

    Li, Ya-Jun; Yi, Ping-Yong; Li, Ji-Wei; Liu, Xian-Ling; Tang, Tian; Zhang, Pei-Ying; Jiang, Wen-Qi

    2017-07-31

    The prognostic significance of ABO blood type for lymphoma is largely unknown. We evaluated the prognostic role of ABO blood type in patients with extranodal natural killer (NK)/T-cell lymphoma (ENKTL). We retrospectively analyzed clinical data of 697 patients with newly diagnosed ENKTL from three cancer centers. The prognostic value of ABO blood type was evaluated using Kaplan-Meier curves and Cox proportional hazard models. The prognostic values of the International Prognostic Index (IPI) and the Korean Prognostic Index (KPI) were also evaluated. Compared with patients with blood type O, those with blood type non-O tended to display elevated baseline serum C-reactive protein levels (P = 0.038), lower rate of complete remission (P = 0.005), shorter progression-free survival (PFS, P 60 years (P KPI in distinguishing between the intermediate-to-low- and high-to-intermediate-risk groups. ABO blood type was an independent predictor of clinical outcome for patients with ENKTL.

  2. Pattern of Frequent But Nontargeted Pharmacologic Thromboprophylaxis for Hospitalized Patients With Cancer at Academic Medical Centers: A Prospective, Cross-Sectional, Multicenter Study

    Science.gov (United States)

    Zwicker, Jeffrey I.; Rojan, Adam; Campigotto, Federico; Rehman, Nadia; Funches, Renee; Connolly, Gregory; Webster, Jonathan; Aggarwal, Anita; Mobarek, Dalia; Faselis, Charles; Neuberg, Donna; Rickles, Frederick R.; Wun, Ted; Streiff, Michael B.; Khorana, Alok A.

    2014-01-01

    Purpose Hospitalized patients with cancer are considered to be at high risk for venous thromboembolism (VTE). Despite strong recommendations in numerous clinical practice guidelines, retrospective studies have shown that pharmacologic thromboprophylaxis is underutilized in hospitalized patients with cancer. Patients and Methods We conducted a prospective, cross-sectional study of hospitalized patients with cancer at five academic hospitals to determine prescription rates of thromboprophylaxis and factors influencing its use during hospitalization. Results A total of 775 patients with cancer were enrolled across five academic medical centers. Two hundred forty-seven patients (31.9%) had relative contraindications to pharmacologic prophylaxis. Accounting for contraindications to anticoagulation, the overall rate of pharmacologic thromboprophylaxis was 74.2% (95% CI, 70.4% to 78.0%; 392 of 528 patients). Among the patients with cancer without contraindications for anticoagulation, individuals hospitalized with nonhematologic malignancies were significantly more likely to receive pharmacologic thromboprophylaxis than those with hematologic malignancies (odds ratio [OR], 2.34; 95% CI, 1.43 to 3.82; P = .007). Patients with cancer admitted for cancer therapy were significantly less likely to receive pharmacologic thromboprophylaxis than those admitted for other reasons (OR, 0.37; 95% CI, 0.22 to 0.61; P < .001). Sixty-three percent of patients with cancer classified as low risk, as determined by the Padua Scoring System, received anticoagulant thromboprophylaxis. Among the 136 patients who did not receive anticoagulation, 58.8% were considered to be high risk by the Padua Scoring System. Conclusion We conclude that pharmacologic thromboprophylaxis is frequently administered to hospitalized patients with cancer but that nearly one third of patients are considered to have relative contraindications for prophylactic anticoagulation. Pharmacologic thromboprophylaxis in

  3. Do blood tests cause anemia in hospitalized patients? The effect of diagnostic phlebotomy on hemoglobin and hematocrit levels.

    Science.gov (United States)

    Thavendiranathan, Paaladinesh; Bagai, Akshay; Ebidia, Albert; Detsky, Allan S; Choudhry, Niteesh K

    2005-06-01

    To determine whether phlebotomy contributes to changes in hemoglobin and hematocrit levels in hospitalized general internal medicine patients. Retrospective cohort study. General internal medicine inpatient service at a tertiary care hospital. All adult patients discharged from the Toronto General Hospital's internal medicine service between January 1 and June 30, 2001. A total of 989 hospitalizations were reviewed and 404 hospitalizations were included in our analysis. Mean (SD) hemoglobin and hematocrit changes during hospitalization were 7.9 (12.6) g/L (Phemoglobin and hematocrit were predicted by the volume of phlebotomy, length of hospital stay, admission hemoglobin/hematocrit value, age, Charlson comorbidity index, and admission intravascular volume status. The volume of phlebotomy remained a strong predictor of drop in hemoglobin and hematocrit after adjusting for other predictors using multivariate analysis (Phemoglobin and hematocrit of 7.0 g/L and 1.9%, respectively. Phlebotomy is highly associated with changes in hemoglobin and hematocrit levels for patients admitted to an internal medicine service and can contribute to anemia. This anemia, in turn, may have significant consequences, especially for patients with cardiorespiratory diseases. Knowing the expected changes in hemoglobin and hematocrit due to diagnostic phlebotomy will help guide when to investigate anemia in hospitalized patients.

  4. Predicting mortality among older adults hospitalized for community-acquired pneumonia: an enhanced confusion, urea, respiratory rate and blood pressure score compared with pneumonia severity index.

    Science.gov (United States)

    Abisheganaden, John; Ding, Yew Yoong; Chong, Wai-Fung; Heng, Bee-Hoon; Lim, Tow Keang

    2012-08-01

    Pneumonia Severity Index (PSI) predicts mortality better than Confusion, Urea >7 mmol/L, Respiratory rate >30/min, low Blood pressure: diastolic blood pressure blood pressure 65 years (CURB-65) for community-acquired pneumonia (CAP) but is more cumbersome. The objective was to determine whether CURB enhanced with a small number of additional variables can predict mortality with at least the same accuracy as PSI. Retrospective review of medical records and administrative data of adults aged 55 years or older hospitalized for CAP over 1 year from three hospitals. For 1052 hospital admissions of unique patients, 30-day mortality was 17.2%. PSI class and CURB-65 predicted 30-day mortality with area under curve (AUC) of 0.77 (95% confidence interval (CI): 0.73-0.80) and 0.70 (95% CI: 0.66-0.74) respectively. When age and three co-morbid conditions (metastatic cancer, solid tumours without metastases and stroke) were added to CURB, the AUC improved to 0.80 (95% CI: 0.77-0.83). Bootstrap validation obtained an AUC estimate of 0.78, indicating negligible overfitting of the model. Based on this model, a clinical score (enhanced CURB score) was developed that had possible values from 5 to 25. Its AUC was 0.79 (95% CI: 0.76-0.83) and remained similar to that of PSI class. An enhanced CURB score predicted 30-day mortality with at least the same accuracy as PSI class did among older adults hospitalized for CAP. External validation of this score in other populations is the next step to determine whether it can be used more widely. © 2012 The Authors. Respirology © 2012 Asian Pacific Society of Respirology.

  5. The development of the nursing care system for patients with cleft lip-palate and craniofacial deformities at Tawanchai Cleft Center, Srinagarind Hospital, Khon Kaen, Thailand.

    Science.gov (United States)

    Pradubwong, Suteera; Pongpagatip, Sumalee; Volrathongchai, Kanittha; Chowchuen, Bowornsilp

    2012-11-01

    The highest incidence of cleft lip-palate and craniofacial deformities in Thailand occur in the Northeastern Region. There is the necessity for an interdisciplinary care team as well as the specialized care center with systematic coordinated care, thus "Tawanchai Cleft Center" is becoming a superior medical center for patients with cleft lip-palate and craniofacial deformities. Therefore, the development of the nursing care system for patients with cleft lip-palate and craniofacial deformities at Tawanchai Cleft Center, Srinagarind Hospital is extremely important and necessary. To develop the nursing care system appropriate for a super tertiary hospital (Tawanchai Cleft Center). It is a participation study which has 3 steps as follows, 1) Analyzing the situations and collecting the opinions of the 22 Out-patient Surgery Department staff and Tawanchai Cleft Center staff by using 6 questions, 2) Summarizing of the situation analysis from the meetings and the questionnaires, then using such summary as the guidelines for developing the nursing care system from January 2011 onwards, 3) evaluating the satisfaction after the 4 month development period (May-August 2011) with 106 caregivers by using 8 questions and being analyzed by the average value, percentage and standard deviation. 1) The nursing care system consisted of psychosocial care, breast feeding, counseling and other assistance as required. This various assistance responded to the patient/family problems by following the treatment guideline of the multidisciplinary team which uses the continuous evaluation processes for the holistic patient/family care. 2) The patients with complete cleft lip-palate were the most common type, found in 44 cases or 41.53 percent. The highest number of caregivers were mothers which were 68 percent; the average age of those mothers was 36 years old. The highest number of them finished elementary school at 43 percent and 40 percent were farmers. The satisfaction for the services of

  6. [Care for elderly patients in Africa: Analysis of the financial implications of the SESAME plan on the budget of the regional hospital center in Thies, Senegal].

    Science.gov (United States)

    Faye, A; Diousse, P; Seck, I; Diongue, M; Ndiaye, P; Diagne-Camara, M; Tal-Dia, A; Dia, La

    2010-04-01

    The SESAME plan has been implemented at the Thies Regional Hospital Center (TRHC) for one year. The purpose of this study was to analyze the financial implications of the plan on the hospital budget for the sustainability of care for persons aged 60 and over. This descriptive study included analysis of budget data from October 2006 to September 2007 plus information obtained by interviewing the accountant and head of SESAME plan. The number of patients managed, sources of CHRT funding, grants from various SESAME plan partners, and expenditures for each partner were determined. The weight of the SESAME plan in the CHRT operating budget was determined by calculating the ratio of the overall cost of care for elderly persons in relation to the hospital's revenues and SESAME grants. During the study period, the CHRT received a total of 17375 elderly persons including 89% with no pension or social security. The institute pension scheme (IPRES) covered 21% of the plan as compared to 79% for the state. Utilization plan grants in relation to funding source was 41% for IPRES and 124% for the State. The total cost of services provided to beneficiaries of the SESAME plan exceeded the aggregate amount by 26 083 847 CFA francs. The weight of the SESAME plan in the operating cost of the CHRT was 17%. Prefinancing a plan to cover elderly care in hospitals should be sufficient to prevent deficits from impacting negatively on the operating budget of the hospital.

  7. Healthcare Costs for Acute Hospitalized and Chronic Heart Failure in South Korea: A Multi-Center Retrospective Cohort Study.

    Science.gov (United States)

    Ku, Hyemin; Chung, Wook Jin; Lee, Hae Young; Yoo, Byung Soo; Choi, Jin Oh; Han, Seoung Woo; Jang, Jieun; Lee, Eui Kyung; Kang, Seok Min

    2017-09-01

    Although heart failure (HF) is recognized as a leading contributor to healthcare costs and a significant economic burden worldwide, studies of HF-related costs in South Korea are limited. This study aimed to estimate HF-related costs per Korean patient per year and per visit. This retrospective cohort study analyzed data obtained from six hospitals in South Korea. Patients with HF who experienced ≥one hospitalization or ≥two outpatient visits between January 1, 2013 and December 31, 2013 were included. Patients were followed up for 1 year [in Korean won (KRW)]. Among a total of 500 patients (mean age, 66.1 years; male sex, 54.4%), the mean 1-year HF-related cost per patient was KRW 2,607,173, which included both, outpatient care (KRW 952,863) and inpatient care (KRW 1,654,309). During the post-index period, 22.2% of patients had at least one hospitalization, and their 1-year costs per patient (KRW 8,530,290) were higher than those of patients who had only visited a hospital over a 12-month period (77.8%; KRW 917,029). Among 111 hospitalized patients, the 1-year costs were 1.7-fold greater in patients (n=52) who were admitted to the hospital via the emergency department (ED) than in those (n=59) who were not (KRW 11,040,453 vs. KRW 6,317,942; pSouth Korea was related to hospitalization, especially admissions via the ED. Appropriate treatment strategies including modification of risk factors to prevent or decrease hospitalization are needed to reduce the economic burden on HF patients. © Copyright: Yonsei University College of Medicine 2017

  8. Commercialization as a recommended approach to hospital restructuring. Case study of Łańcut Medical Center

    Directory of Open Access Journals (Sweden)

    Wiktor Patena

    2015-10-01

    Full Text Available Our society is on the brink of health care system reorganization and implementation of new medical technology. Hospitals have to be a core component of the medical revolution so they have to be prepared for the upcoming leap in their development. If Poland wants to be a pioneer in providing new medical solutions, the current ineffective system has to be changed. The necessary action should be taken to deal with the financial problems Polish hospitals have faced for over 20 years. The current structure of hospitals - SPZOZ, is old-fashioned and cannot adapt to a turbulent social and economic environment. The hospitals should be commercialized and restructured. Being capitalized companies will give incentives and new tools to deal with financial problems. The article presents an example of the commercialized hospital in Łańcut. We make the observations that commercialization increases: a hospital’s profitability, its employment productivity, its capital investment spending and leverage. The case proves that the transformation of hospitals to capital companies proposed by the Ministry of Health may be an appropriate approach and it does work once a reasonable management board is in charge. However, the legal structure alteration should be treated as the first step in the overall restructuring process. The article highlights the problem of managers of Polish hospitals who do not only struggle with financial shortages, but barely know which business model they should follow after commercialization to successfully run the restructuring process. Having examined the LMC the authors are crafting a prelude to the overall research on already commercialized hospitals to find an appropriate business model.

  9. Prevalence of hepatitis B virus and hepatitis C virus among blood donors at a tertiary care hospital in India: a five-year study.

    Science.gov (United States)

    Meena, Monika; Jindal, Tarun; Hazarika, Anjali

    2011-01-01

    Hepatitis B virus (HBV) and hepatitis C virus (HCV) are important transfusion-transmissible infections. This study was performed to assess the prevalence of HBV and HCV seropositivity among blood donors at a tertiary care hospital-based blood bank in India. The blood donation records over 5 years (2005-2009) were reviewed, retrospectively, for the prevalence and yearly trends of HBV and HCV seropositivity. A total of 94,716 donations were received. The overall number of HBV-seropositive donations was 1353 and that for HCV was 537, with the prevalence rates of 1.43% for hepatitis B surface antigen (HBsAg) and 0.57% for HCV. The seropositivity rate was higher in the replacement donors compared to the voluntary donors. The annual rates showed decreasing trends in case of HBsAg, but in case of HCV, there was a linear increase. Our study raises serious concerns regarding the HBV and HCV prevalence in our country. Although HBV showed decreasing trends, it cannot be relied upon because the donors were screened only for HBsAg. HCV is clearly on the rise. Stringent measures need to be taken on urgent basis including dissemination of information, strict screening of blood, inclusion of antibody to hepatitis B core antigen and other sensitive markers to the screening protocol, and better donor recruitment. © 2010 American Association of Blood Banks.

  10. The development and evaluation of options for improving future U.K. blood component labelling--outcome of the 2013 U.K. hospital survey.

    Science.gov (United States)

    Nightingale, M J; Brazier, A M; McArthur, K; Jones, J; Cardigan, R; Lodge, L; Maclennan, S

    2014-04-01

    U.K. blood component labels have evolved to accommodate a plethora of information. Concern has, however, been expressed that current U.K. labelling is too 'cluttered', detracting from the clarity of critical information. This prompted a holistic review of labelling and available information technology (IT) with the aim of improving the situation. A survey was circulated requiring U.K. hospital participants to rank each item of information on the label according to its 'criticality' and assess three novel 'future' and one 'transition' prototype labels. Prototypes were based on applicable regulatory standards, best practice guidance, international benchmark data and U.K. expert input. The prototypes support steps towards 'full face' label printing and utilise 2D and quick response (QR) barcodes. Two-hundred eleven completed surveys were received identifying 110 contributing hospitals with 41% from clinical staff, 37% from transfusion laboratory staff and 22% from transfusion practitioners. There was excellent agreement between the three groups on the critical information, i.e., blood group, expiry date, blood component name, unique donation identification number (DIN) and blood component volume but far less on the other information, especially the various warning messages. Of the 'future' labels, option 3 (closest to the current 'quadrant model') was most popular. Option 1, with its additional inverted section replicating critical information was least popular and prompted significant safety concerns. The prototype labels correctly identified the critical items of information and extensive comments confirmed that this was more prominently and clearly displayed. Laboratory staff commented that the transition label was essential to enable IT systems to be adapted. © 2014 The Authors. Transfusion Medicine © 2014 British Blood Transfusion Society.

  11. Evaluation of the i-STAT Portable Clinical Analyzer for point-of-care blood testing in the intensive care units of a university children's hospital.

    Science.gov (United States)

    Papadea, Christine; Foster, Joyce; Grant, Sharon; Ballard, Sandra A; Cate, John C; Southgate, W Michael; Purohit, Dilip M

    2002-01-01

    We evaluated the analytical performance of the i-STAT Portable Clinical Analyzer (PCA), a point-of-care testing system consisting of a hand-held analyzer and single-use cartridges that measure different panels of electrolytes, metabolites, blood gases, and hematocrit in 65-100 microl of blood. Our objective was to determine whether PCA measurements at the bedside of patients in the neonatal and pediatric intensive care units of the MUSC Children's Hospital would be as reliable as those performed by the clinical laboratory's primary methods (Radiometer ABL 725 blood gas analyzer; Vitros 750 chemistry analyzer; and Coulter STKS hematology analyzer). Four cartridge types: (a) EC8+ (sodium; potassium; chloride; urea; glucose; pH; blood gases [PO2; pCO2]), (b) EC6+ (sodium; potassium; ionized calcium; glucose; hematocrit; pH), (c) G3+ (pH; PO2; pCO2), and (d) creatinine, were assessed for reproducibility, linearity, and method comparisons using aqueous samples, blood samples supplemented with several analytes, and -225 blood samples from patients. Reproducibility (CV) was good ( or < 3 mo) showed that agreement between the PCA and the primary methods was clinically acceptable. After the PCA was implemented for clinical testing, the observation of discrepant results of creatinine concentrations in neonatal blood samples that would have affected clinical management led to a second creatinine comparison study (59 additional samples) and to our eventual discontinuation of the PCA creatinine assay. This problem notwithstanding, the successful implementation of the PCA is attributed to careful analytical evaluations and ongoing communication with the clinical staff.

  12. Adoption of new HIV treatment guidelines and drug substitutions within first-line as a measure of quality of care in rural Lesotho: health centers and hospitals compared.

    Science.gov (United States)

    Labhardt, Niklaus D; Sello, Motlalepula; Lejone, Thabo; Ehmer, Jochen; Mokhantso, Mohlaba; Lynen, Lutgarde; Pfeiffer, Karolin

    2012-10-01

    In 2007, Lesotho launched new national antiretroviral treatment (ART) guidelines, prioritising tenofovir and zidovudine over stavudine as a backbone together with lamivudine. We compared the rate of adoption of these new guidelines and substitution of first-line drugs by health centers (HC) and hospitals in two catchment areas in rural Lesotho. Retrospective cohort analysis. Patients aged ≥16 years were stratified into a HC- and a hospital-group. Type of backbone at ART-initiation (i), substitutions within first line (ii) and type of backbone among patients retained by December 2010 (iii). A multiple logistic regression model including HC vs. hospital, patient characteristics (sex, age, WHO-stage, baseline CD4-count, concurrent pregnancy, concurrent tuberculosis treatment) and year of ART-start, was used. Of 3936 adult patients initiated on ART between 2007 and 2010, 1971 started at hospitals and 1965 at HCs. Hospitals were more likely to follow the new guidelines as measured by prescription of backbones without stavudine (Odds-ratio 1.55; 95%CI: 1.32-1.81) and had a higher rate of drug substitutions while on first-line ART (2.39; 1.83-3.13). By December 2010, patients followed at health centres were more likely to still receive stavudine (2.28; 1.83-2.84). Health centers took longer to adopt the new guidelines and substituted drugs less frequently. Decentralised ART-programmes need close support, supervision and mentoring to absorb new guidelines and to adhere to them. © 2012 Blackwell Publishing Ltd.

  13. Non-Escherichia coli versus Escherichia coli community-acquired urinary tract infections in children hospitalized in a tertiary center: relative frequency, risk factors, antimicrobial resistance and outcome.

    Science.gov (United States)

    Marcus, Nir; Ashkenazi, Shai; Yaari, Arnon; Samra, Zmira; Livni, Gilat

    2005-07-01

    Currently hospitalization for children with urinary tract infections (UTIs) is reserved for severe or complicated cases. Changes may have taken place in the characteristics and causative uropathogens of hospital-treated community-acquired UTI. To study children hospitalized in a tertiary center with community-acquired UTI, compare Escherichia coli and non-E. coli UTI, define predictors for non-E. coli UTI and elucidate the appropriate therapeutic approach. A prospective clinical and laboratory study from 2001 through 2002 in a tertiary pediatric medical center. Patients were divided by results of the urine culture into E. coli and non-E. coli UTI groups, which were compared. Of 175 episodes of culture-proved UTI, 70 (40%) were caused by non-E. coli pathogens. Non-E. coli UTI was more commonly found in children who were male (P = 0.005), who had underlying renal abnormalities (P = 0.0085) and who had received antibiotic therapy in the prior month (P = 0.0009). Non-E. coli uropathogens were often resistant to antibiotics usually recommended for initial therapy for UTI, including cephalosporins and aminoglycosides; 19% were initially treated with inappropriate empiric intravenous antibiotics (compared with 2% for E. coli UTI, P = 0.0001), with a longer hospitalization. Current treatment routines are often inappropriate for hospitalized children with non-E. coli UTI, which is relatively common in this population. The defined risk factors associated with non-E. coli UTIs and its antimicrobial resistance patterns should be considered to improve empiric antibiotic therapy for these infections.

  14. Prognostic Implications of Level-of-Care at Tertiary Heart Centers Compared With Other Hospitals After Resuscitation From Out-of-Hospital Cardiac Arrest

    DEFF Research Database (Denmark)

    Søholm, Helle; Kjaergaard, Jesper; Bro-Jeppesen, John

    2015-01-01

    (OR, 10 [5.3-22] and 3.8 [2.5-5.7]), neurophysiological examination (OR, 1.8 [1.3-2.6]), and brain computed tomography (OR, 1.9 [1.4-2.6]), whereas no difference in therapeutic hypothermia was noted. Patients at tertiary centers were more often consulted by a cardiologist (OR, 8.6 [5.0-15]), had...

  15. The impact of e-mail in acquiring and retaining whole-blood donors: a comparative analysis of the Puget Sound Blood Center donor e-mail communication program.

    Science.gov (United States)

    Geyer, Maria Elena

    2005-12-01

    With the emergence of e-mail as a common form of communication, it is important to understand the role and impact e-mail can have on acquiring and retaining whole-blood donors. Whole-blood donors who opted in to receive e-mail communications (n = 43,232) from the Puget Sound Blood Center (PSBC) and as a result participated in one or more of five e-mail marketing campaigns between July 2002 and March 2003 were studied. New donors with e-mail addresses grew by 74 percent over the measurement period compared with 2 percent growth of those without e-mail addresses. Nearly 15,000 prospective donors were reached as a result of donors passing along e-mails they received from PSBC to friends and family. Nearly 5 percent of PSBC e-mail campaign recipients registered to donate online. PSBC e-mail campaigns have outperformed e-mail marketing industry mean open rates by 44 percent and click-through rates by 36 percent. E-mail is now a mainstream communication medium. It has proven to be an effective method of reaching new donors and generating new donation registrations. Donors respond more favorably to e-mail communications from PSBC compared with e-mail they receive from other organizations. Deeper understanding of how different segments of blood donors use e-mail may help blood centers adjust their donor acquisition and retention programs. New recruitment methods are needed to grow the overall donor base, and e-mail appears to have the potential to make a significant contribution to meeting this objective.

  16. Use of alternative and complementary therapies in labor and delivery care: a cross-sectional study of midwives' training in Catalan hospitals accredited as centers for normal birth.

    Science.gov (United States)

    Muñoz-Sellés, Ester; Vallès-Segalés, Antoni; Goberna-Tricas, Josefina

    2013-11-15

    The use of complementary and alternative medicine (CAM) and complementary and alternative therapies (CAT) during pregnancy is increasing. Scientific evidence for CAM and CAT in the field of obstetrics mainly covers pain relief in labor. Midwives are responsible for labor and delivery care: hence, their knowledge of CAM and CAT is important. The aims of this study are to describe the professional profile of midwives who provide care for natural childbirth in Catalan hospitals accredited as centers for normal birth, to assess midwives' level of training in CAT and their use of these therapies, and to identify specific resources for CAT in labor wards. A descriptive, cross-sectional, quantitative method was used to assess the level of training and use of CAT by midwives working at 28 hospitals in Catalonia, Spain, accredited as public normal birth centers. Just under a third of midwives (30.4%) trained in CAT after completion of basic training. They trained in an average of 5.97 therapies (SD 3.56). The number of CAT in which the midwives were trained correlated negatively with age (r = - 0.284; p trained in CAT considered that the following therapies were useful or very useful for pain relief during labor and delivery: relaxation techniques (64.3%), hydrotherapy (84.8%) and the application of compresses to the perineum (75.9%). The availability of resources for providing CAT during normal birth care varied widely from center to center. Age may influence attitudes towards training. It is important to increase the number of midwives trained in CAM for pain relief during childbirth, in order to promote the use of CAT and ensure efficiency and safety. CAT resources at accredited hospitals providing normal childbirth care should also be standardized.

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

    Science.gov (United States)

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

    2015-10-01

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

  18. Change in MS-DRG assignment and hospital reimbursement as a result of Centers for Medicare & Medicaid changes in payment for hospital-acquired conditions: is it coding or quality?

    Science.gov (United States)

    McNutt, Robert; Johnson, Tricia J; Odwazny, Richard; Remmich, Zachary; Skarupski, Kimberly; Meurer, Steven; Hohmann, Samuel; Harting, Brian

    2010-01-01

    In October 2008, the Centers for Medicare & Medicaid Services reduced payments to hospitals for a group of hospital-acquired conditions (HACs) not documented as present on admission (POA). It is unknown what proportion of Medicare severity diagnosis related group (MS-DRG) assignments will change when the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis code for the HAC is not taken into account even before considering the POA status. The primary objectives were to estimate the proportion of cases that change MS-DRG assignment when HACs are removed from the calculation, the subsequent changes in reimbursement to hospitals, and the attenuation in changes in MS-DRG assignment after factoring in those that may be POA. Last, we explored the effect of the numbers of ICD-9-CM diagnosis codes on MS-DRG assignment. We obtained 2 years of discharge data from academic medical centers that were members of the University Health System Consortium and identified all cases with 1 of 7 HACs coded through ICD-9-CM diagnosis codes. We calculated the MS-DRG for each case with and without the HAC and, hence, the proportion where MS-DRG assignment changed. Next, we used a bootstrap method to calculate the range in the proportion of cases changing assignment to account for POA status. Changes in reimbursement were estimated by using the 2008 MS-DRG weights payment formula. Of 184,932 cases with at least 1 HAC, 27.6% (n = 52,272) would experience a change in MS-DRG assignment without the HAC factored into the assignment. After taking into account those conditions that were potentially POA, 7.5% (n = 14,176) of the original cases would change MS-DRG assignment, with an average loss in reimbursement per case ranging from $1548 with a catheter-associated urinary tract infection to $7310 for a surgical site infection. These reductions would translate into a total reimbursement loss of $50 261,692 (range: $38 330,747-$62 344,360) for the 86

  19. Weekend versus weekday hospital deaths: analysis of in-patient data in a Nigerian tertiary healthcare center.

    Science.gov (United States)

    Nwosu, B O; Eke, N O; Obi-Nwosu, A; Osakwe, O J; Eke, C O; Obi, N P

    2013-01-01

    This study aims at comparing weekday deaths to weekend deaths of in-patients of a tertiary hospital in Nigeria. This is a 10-year retrospective survey conducted at the Nnamdi Azikiwe University Teaching Hospital in which the death records of the hospital were accessed from the various wards and health records department to extract relevant data pertaining to the time of hospital death. Tests of statistical significance were done using Chi-square test at 95% confidence intervals. A total of 3934 deaths were recorded during the period of study. The ages ranged from a few hours to 94 years with a mean age of 38.5 years. The male to female ratio was 1.2:1. An average of 547 weekend deaths and 568 weekday deaths were recorded, giving a ratio of 0.96:1. A ratio of weekend to weekday death rate of 0.99:1 and 0.93:1 for the males and females, respectively was noted. The labor ward, followed by the intensive care unit (ICU) had the highest weekend to weekday death ratio of 1.72:1 ( P = 0.0461) and 1.41:1 ( P = 0.1440), respectively. Weekend deaths were less in the other wards, with the gynaecological ward having the least ratio of 0.63:1 ( P = 0.7360). The rate of hospital deaths was generally found not to vary significantly over the weekends and weekdays in the hospital except for the labor ward which had significantly higher weekend to weekday death rates of 1.72:1. There is therefore need for confidential enquiry into the causes of hospital deaths, especially in the labor ward, in order to identify and prevent avoidable deaths.

  20. Very poor agreement between routine outpatient clinic office and ambulatory blood pressure: time to improve an old hospital outpatient clinic routine?

    Science.gov (United States)

    Reinhard, Mark; Poulsen, Per L; Christensen, Kent L

    2016-12-01

    We investigated the agreement between elevated outpatient clinic office blood pressure (OC-OBP) as measured in the daily routine in our University Hospital Cardiology Outpatient Clinic and subsequent awake ambulatory blood pressure (AABP). In all patients referred for ambulatory blood pressure monitoring from our Cardiology Outpatient Clinic, we identified OC-OBP and changes in medication in the period from 1 January 2014 to 15 September 2015. The AABP was used as a reference measurement for the OC-OBP. A total of 183 patients were included in the study. Their mean age was 62.1±14.0 years and 49% were women. The mean systolic OC-OBP was 166.8±17.9 mmHg and the difference between the mean systolic OC-OBP and AABP was 28.0±19.5 mmHg (Pclinic agrees poorly with AABP and may lead to unnecessary treatment and pharmacologically induced symptomatic hypotension, particularly in elderly patients. The results of this study urgently call for alternative solutions to routine OC-OBP in hospital outpatient clinics.

  1. Blood and Diversity

    Science.gov (United States)

    ... Drive Biomedical Services Hospital Partners Blood Products Blood Banking Resources Order Blood Products Invoice Central Case Reports ... app (over 1 million downloads and counting!) and online scheduler make it quick to set up your ...

  2. Gender, age, and educational level attribute to blood alcohol concentration in hospitalized intoxicated adolescents: A cohort study

    NARCIS (Netherlands)

    van Zanten, Eva; van der Ploeg, Tjeerd; van Hoof, Joris Jasper; van der Lely, Nicolaas

    2013-01-01

    Background The prevalence of adolescents hospitalized with acute alcohol intoxication, mainly because of severe reduced consciousness, is increasing. However, the characteristics of these adolescents are mainly unidentified. In this clinical research, we aimed to identify factors that attribute to

  3. Hospital Organization and Importance of an Interventional Radiology Inpatient Admitting Service: Italian Single-Center 3-Year Experience

    International Nuclear Information System (INIS)

    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

    2009-01-01

    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 < 0.05). The results of the 3-year activity show that the activation of a COUIR with an inpatient admitting service, and the better 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 Euro 1,009,095.35. 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.

  4. Effect of antifibrinolytic drugs on transfusion requirement and blood loss during orthotopic liver transplantation: Results from a single center

    Directory of Open Access Journals (Sweden)

    Devi A

    2008-01-01

    Full Text Available Background: During orthotopic liver transplantation (OLT, activation of the fibrinolytic system can contribute significantly to perioperative bleeding. Prophylactic administration of antifibrinolytic agents has been shown to reduce blood loss and the need for allogenic transfusion. Objective: To study the effect of antifibrinolytics on requirement of blood components, blood loss and operative time during OLT in patients with end stage liver disease, reporting to a single centre. Materials and Methods: Consecutive patients who underwent OLT at this centre during the period February 2003-October 2007 were the subjects of this study. Based on the individual anesthesiologist′s preference, patients were assigned to receive either two million units of aprotinin (AP as a bolus followed by 5,00,000 units/hour or 10 mg/kg tranexamic acid (TAas a bolus followed by 10 mg/kg every six to eight hours, administered from the induction till the end of the surgery. Transfusion policy was standardized in all patients. Intraoperative red cell salvage was done wherever possible. The effect of these two antifibrinolytic drugs on transfusion requirement was evaluated as a whole and in a sub group of patients from each treatment group and compared with a concurrent control group that did not receive antifibrinolytic drugs. Results: Fifty patients (40 M / 10 F, 44 adults, 6 pediatric patients underwent OLT in the study period. Fourteen patients were given AP, 25 patients were given TA and 11 patients did not receive any of the agents(control group. The median volume of total blood components transfused in antifibrinolytic group (n=39 was 4540 ml(0-19,200ml, blood loss 5 l(0.7-35l and operative time 9h (4.5-17h and that of control group(n=11 was 5700 ml(0-15,500ml, 10 l(0.6-25 l and 9h (6.4-15.8h respectively. The median volume of blood transfusions, blood loss and operative time was lesser in AP group(n=14 than that of TA group(n=25. Conclusion: There is definite

  5. Evaluation of the BioFire® FilmArray® Blood Culture Identification Panel on positive blood cultures in a regional hospital laboratory in KwaZulu-Natal

    Directory of Open Access Journals (Sweden)

    Mokshanand Fhooblall

    2016-09-01

    Full Text Available Background: There are presently many non-culture-based methods commercially available to identify organisms and antimicrobial susceptibility from blood culture bottles. Each platform has its benefits and limitations. However, there is a need for an improved system with minimal hands-on requirements and short run times. Objectives: In this study, the performance characteristics of the FilmArray® BCID Panel kit were evaluated to assess the efficiency of the kit against an existing system used for identification and antimicrobial susceptibility of organisms from blood cultures. Methods: Positive blood cultures that had initially been received from hospitalised patients of a large quaternary referral hospital in Durban, South Africa were processed as per routine protocol at its Medical Microbiology Laboratory. Positive blood cultures were processed on the FilmArray BCID Panel kit in parallel with the routine sample processing. Inferences were then drawn from results obtained. Results: Organism detection by the FilmArray BCID panel was accurate at 92.6% when organisms that were on the repertoire of the kit were considered, compared to the combination methods (reference method used in the study laboratory. Detection of the antimicrobial resistance markers provided by the panel and reference method demonstrated 100% consistency. Blood cultures with a single organism were accurately identified at 93.8% by FilmArray, while blood cultures with more than one organism were identified at 85.7%. Conclusion: The FilmArray BCID Panel kit is valuable for detection of organisms and markers of antibiotic resistance for an extensive range of organisms.

  6. NIH Clinical Center: There’s No Other Hospital Like It | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... scientists. The innovative curriculum includes courses in pharmacology, principles and practice of clinical research, and bioethics. Recently, the NIH Clinical Center launched the Sabbatical in Clinical Research Management program for clinical investigators, healthcare managers and administrators, ...

  7. When children with profound multiple disabilities are hospitalized: A cross-sectional survey of parental burden of care, quality of life of parents and their hospitalized children, and satisfaction with family-centered care.

    Science.gov (United States)

    Seliner, Brigitte; Latal, Bea; Spirig, Rebecca

    2016-07-01

    We aimed to assess parental burden of care, satisfaction with family-centered care, and quality of life (HRQoL) of parents and their hospitalized children with profound intellectual and multiple disabilities (PIMD), and determine the relationship among these factors. A cross-sectional study using printed questionnaires and qualitative questions was undertaken at a Swiss University Children's Hospital. The 117 parents (98 mothers, 19 fathers) studied indicated a substantial impact on burden of care and parental health-related quality of life. Significant correlations with the hospitalized children's well-being were rs = .408 for burden of care and rs -.368 for quality of life. Qualitative results showed parents struggling to safeguard their children and worrying most about the children's well-being. Health professionals need to be aware of parental burden and that the perception of the children's well-being and the parents' efforts determine their support needs. Easing parents' burden and fostering confidence in the hospitalized children's well-being requires coordination of care provided by advanced nurse specialists, with an institutional framework that clarifies parental collaboration. © 2016, Wiley Periodicals, Inc.

  8. Risk factors associated with in-hospital mortality in elderly patients admitted to a regional trauma center after sustaining a fall.

    Science.gov (United States)

    Cartagena, L J; Kang, A; Munnangi, S; Jordan, A; Nweze, I C; Sasthakonar, V; Boutin, A; George Angus, L D

    2017-06-01

    Falls are a significant cause of mortality in the elderly patients. Despite this, the literature on in-hospital mortality related to elderly falls remains sparse. Our study aims to determine the risk factors associated with in-hospital mortality in elderly patients admitted to a regional trauma center after sustaining a fall. All elderly case records with fall-related injuries between 2003 and 2013 were retrospectively analyzed for demographic characteristics, injury severities, comorbidity factors and clinical outcomes. Logistic regression analysis was used to examine the risk factors associated with in-hospital mortality. In total, 1026 elderly patients with fall-related injuries were included in the study. The average age of patients was 80.94 ± 8.16 years. Seventy seven percent of the patients had at least one comorbid condition. Majority of the falls occurred at home. More than half of the patients fell from ground level. Overall, the in-hospital mortality rate was 16 %. Head injury constituted the most common injury sustained in patients who died (77 %). In addition to age, ISS, GCS, ICU admission and anemia were significantly (P fall patients. Ground-level falls in the elderly can be devastating and carry a significant mortality rate. Elderly patients with anemia were two times more likely to die in the hospital after sustaining a fall in our study population. Increased focus on anemia which is often underappreciated in elderly fall patients can be beneficial in improving outcomes and reducing in-hospital mortality.

  9. Lasting effect of an oral hygiene care program for patients with stroke during in-hospital rehabilitation: a randomized single-center clinical trial.

    Science.gov (United States)

    Kim, Eun-Kyong; Park, Eun Young; Sa Gong, Jung-Whan; Jang, Sung-Ho; Choi, Youn-Hee; Lee, Hee-Kyung

    2017-11-01

    Because the oral hygiene is poorly prioritized in the immediate post-stroke period, we implemented an oral hygiene care program (OHCP) for stroke in-patients and evaluated its persistence after discharge. In all, 62 patients with stroke who were admitted to the rehabilitation ward were randomly assigned to two groups: 33 patients to the intervention group and 29 to the control group. The OHCP, including tooth brushing education and professional tooth cleaning, was administered to the intervention group twice a week six times during in-hospital rehabilitation. Oral health status was examined both at baseline and three months after discharge from the hospital. Oral hygiene status was examined at three- to four-day intervals five times during the hospitalization period. After OHCP, oral hygiene status including the plaque index, calculus index, and O'Leary plaque index improved significantly in the intervention group, compared to the control group (p < 0.05). In the intervention group, after administration of the OHCP for the fourth time, the O'Leary index improved significantly, and remained high when checked three months after discharge (p < 0.001). An OHCP conducted during in-hospital rehabilitation was effective in improving oral health and plaque control performance among patients with stroke, with effects still seen three months after discharge from the hospital. Implications for Rehabilitation Initial oral hygiene status and plaque control performance were poor in stroke patients who were in rehabilitation center. An oral hygiene care program during in-hospital rehabilitation was effective in improving oral hygiene status and plaque control performance among stroke patients at three months after discharge. Repeated tooth brushing education and professional tooth cleaning were necessary to improve plaque control performance of stroke patients.

  10. Readmission after treatment of Grade 3 and 4 renal injuries at a Level I trauma center: Statewide assessment using the Comprehensive Hospital Abstract Reporting System.

    Science.gov (United States)

    Winters, Brian; Wessells, Hunter; Voelzke, Bryan B

    2016-03-01

    One criticism of the existing renal trauma research is the limited outpatient follow-up after index hospitalization. We assessed readmission rates following treatment for American Association for the Surgery of Trauma (AAST) Grade 3 and 4 renal injury using the Comprehensive Hospital Abstract Reporting System (CHARS). We evaluated all patients with AAST Grade 3 and 4 renal injuries admitted to Harborview Medical Center (HMC) between 1998 and 2010, the only Level 1 trauma center in Washington state. Grade 4 renal injuries were stratified by collecting system laceration (CSL) or segmental vascular injury. Data were abstracted from the CHARS database for readmissions to any Washington state hospital within 6 months of renal injury. Clinical variables, diagnoses, and procedures were queried based on DRG International Classification of Diseases-9th Rev. codes. A total of 477 Grade 3 and 159 Grade 4 renal injuries were initially treated at HMC. On admission, 111 patients required intervention: 75 (16%) of 477 Grade 3 and 36 (23%) of 159 Grade 4 injuries. Within 6 months of index hospitalization, 86 (18%) of 477 Grade 3 and 38 (24%) of 159 Grade 4 patients were readmitted to any Washington state hospital. Eighty percent of Grade 3 injuries and 66% of Grade 4 injuries returned to HMC compared with secondary hospitals (p = 0.08). At readmission, 19 (22%) of 86 Grade 3 and 16 (42%) of 38 Grade 4 injuries had a urologic diagnosis. Subsequent procedural intervention was required on readmission in 6 (7%) of 86 Grade 3 and 5 (13%) of 38 Grade 4 renal injuries (all CSL injuries). A subset of patients treated for Grade 3 and 4 renal trauma will be readmitted for further management. While urologic diagnoses and additional procedures may be low overall, readmission to outside hospitals may preclude accurate determination of renal trauma outcomes. Based on these data, patients with Grade 4 CSL injuries seem to be at the highest risk for readmission and to require a subsequent

  11. 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

    for patient-centered services. Further research should be directed at developing sophisticated patient-centered services as a communication tool between the hospital and the patient. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  12. Urinary protein as a marker for systolic blood pressure reduction in patients with type 2 diabetes mellitus participating in an in-hospital diabetes education program.

    Science.gov (United States)

    Okada, Kenta; Miyamoto, Michiaki; Kotani, Kazuhiko; Yagyu, Hiroaki; Osuga, Junichi; Nagasaka, Shoichiro; Ishibashi, Shun

    2011-10-01

    Increased blood pressure (BP) and urinary protein (UP)/microalbuminuria are risk factors for cardiovascular disease in patients with diabetes. Although the management of BP in patients with diabetes should involve a multidisciplinary therapy, there are no reports in which modulators have been identified in an in-hospital diabetes education program. The aim of the present study was to investigate the change in BP levels in patients with type 2 diabetes mellitus (T2DM) during a short-term (2-week) in-hospital education program on lifestyle modifications. A total of 167 patients with T2DM (101 men, 66 women; mean age, 61.1 years; glycated hemoglobin, 9.2%) were divided into 2 groups on the basis of their urinary albumin levels: 1 group without UP (urinary albumin level patients with T2DM.

  13. [The composition and antimicrobial resistance of isolates from lower respiratory tract and blood in hospitalized patients in respiratory ward: a multicenter national study in China].

    Science.gov (United States)

    Tang, X; Zhuo, C; Xu, Y C; Zhong, N S

    2018-04-12

    Objective: To investigate the species and antimicrobial resistance of bacterial pathogens isolated from hospitalized patients in respiratory ward in China. Methods: This was a multicenter retrospective study based on a national epidemiological network called China Antimicrobial Resistance Surveillance System (CARSS). The non-repetitive strains isolated from lower respiratory tract and blood samples in 91 hospitals from seven geographic regions of CARSS were reviewed. The distribution of specimen type, hospital level (secondary and tertiary hospital), patient age group [geriatric (>65 years old), adult (15 to 65 years old), pediatric (28 days to 14 years old ) and newborn group (≤28 days)] and ward type (respiratory intensive care unit and general respiratory ward) were analyzed for MRSA, PRSP, CREC, CRKP, CRPA, CRAB, ESBL-EC and ESBL-KP. The categorical variables were analyzed by chi-square test using SPSS 16.0 statistical software. P respiratory tract (LRT), 2 649 isolates from blood and 5 017 isolates from other samples (urine and secretions)] from 48 752 inpatients (without illness type information) were enrolled in the study. 90.2% (45 491/50 417) isolates were obtained from 63 tertiary hospitals. According to patients' age, all cases were divided into 4 groups, i. e. geriatric(46.0%, 23 177/50 417), adult(29.9%, 15 092/50 417), pediatric(24.0%, 12 112/50 417) and newborn group(0.0%, 36/50 417). All isolates were obtained from respiratory intensive care unit (6.2%, 3 129/50 417) or general respiratory wards (93.8%, 47 288/50 417). The majority of bacterial pathogens were isolated from lower respiratory and blood culture samples, which accounted for 90.0% of all the samples (45 400/50 417). Sputum accounted for 81.6% (41 131/50 417) of samples, and the leading 4 isolates were K . pneumonia (18.9%, 7 784/41 131), P . aeruginosa (13.6%, 5 580/41 131), A . baumanni (11.3%, 4 644/41 131) and S . pneumonia (11.1%, 4 564/41 131). Blood samples accounted for 5.3% (2

  14. Blood pressure control status and relationship between salt intake and lifestyle including diet in hypertensive outpatients treated at a general hospital.

    Science.gov (United States)

    Ohta, Yuko; Kimura, Yorio; Kitaoka, Chie; Sakata, Tomoko; Abe, Isao; Kawano, Yuhei

    2017-01-01

    The purpose of the present study was to investigate blood pressure (BP) control and salt intake in hypertensive outpatients treated at a general hospital and to examine the relationship between their lifestyles and amount of salt intake. Subjects comprised 429 hypertensive patients (206 males, 223 females, and average age of 71 ± 11 years). We estimated 24-hour salt excretion using spot urine samples and assessed lifestyle using a self-description questionnaire. Average clinic BP and the number of antihypertensive drugs were 132 ± 11/73 ± 8 mmHg and 1.8 ± 0.9, respectively. In all subjects, average estimated salt intake was 9.2 ± 2.8 g/day and the rate of achievement of the estimated salt intake of hospital. It may be important to provide data on actual salt intake and guide salt restriction in the individual management of hypertension.

  15. 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 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.

  16. Creating a "culture of research" in a community hospital: Strategies and tools from the National Cancer Institute Community Cancer Centers Program.

    Science.gov (United States)

    Dimond, Eileen P; St Germain, Diane; Nacpil, Lianne M; Zaren, Howard A; Swanson, Sandra M; Minnick, Christopher; Carrigan, Angela; Denicoff, Andrea M; Igo, Kathleen E; Acoba, Jared D; Gonzalez, Maria M; McCaskill-Stevens, Worta

    2015-06-01

    The value of community-based cancer research has long been recognized. In addition to the National Cancer Institute's Community Clinical and Minority-Based Oncology Programs established in 1983, and 1991 respectively, the National Cancer Institute established the National Cancer Institute Community Cancer Centers Program in 2007 with an aim of enhancing access to high-quality cancer care and clinical research in the community setting where most cancer patients receive their treatment. This article discusses strategies utilized by the National Cancer Institute Community Cancer Centers Program to build research capacity and create a more entrenched culture of research at the community hospitals participating in the program over a 7-year period. To facilitate development of a research culture at the community hospitals, the National Cancer Institute Community Cancer Centers Program required leadership or chief executive officer engagement; utilized a collaborative learning structure where best practices, successes, and challenges could be shared; promoted site-to-site mentoring to foster faster learning within and between sites; required research program assessments that spanned clinical trial portfolio, accrual barriers, and outreach; increased identification and use of metrics; and, finally, encouraged research team engagement across hospital departments (navigation, multidisciplinary care, pathology, and disparities) to replace the traditionally siloed approach to clinical trials. The health-care environment is rapidly changing while complexity in research increases. Successful research efforts are impacted by numerous factors (e.g. institutional review board reviews, physician interest, and trial availability). The National Cancer Institute Community Cancer Centers Program sites, as program participants, had access to the required resources and support to develop and implement the strategies described. Metrics are an important component yet often challenging to

  17. Using Lean-Six Sigma to reduce hemolysis in the emergency care center in a collaborative quality improvement project with the hospital laboratory.

    Science.gov (United States)

    Damato, Charlotte; Rickard, Dana

    2015-03-01

    As part of a strategic quality improvement plan, laboratory management at Sarasota Memorial Health Care System (SMHCS) focused its efforts on improving preanalytical work flow and blood collection processes-both negatively affected by hemolyzed specimens. When hemolysis is detected in a blood specimen, blood may need to be re-collected, resulting in bottlenecks and rework all along the value stream. From July through December 2009, hemolysis averaged 9.8% in the Emergency Care Center (ECC) and 3.4% housewide. The goal was set to reduce hemolysis to 2%. The project team identified hemolysis as one of seven factors contributing to non-value-added activities and bottlenecks in blood collection and preanalytical processes. Observations and interviews helped to identify error-prone practices and process variation. To verify the root causes of hemolysis, the findings were compared against best practices. The team developed a housewide protocol, standardized collection processes, created competency-based training, and enhanced ECC hiring practices. During December 2010-March 2011, following initial housewide interventions and ECC self-sustaining solutions, ECC hemolysis decreased by 91%-from 9.8% (423 hemolyzed/4,295 collected) to 0.88% (58 hemolyzed/6,560 collected). Housewide hemolysis decreased by 59%-from 3.4% (2,046 hemolyzed/60,307 collected) to 1.39% (619 hemolyzed/44,528 collected). Since the project, hemolysis has continued to trend downward; the mean percentage has consistently been Lean-Six Sigma tools helped to pinpoint hemolysis as a key inefficiency in blood collection and preanalytical work flow. Although focused on the ECC, the project team standardized blood collection practices and instituted quality devices to achieve hemolysis reductions housewide.

  18. Blood donation

    CERN Multimedia

    GS Department

    2009-01-01

    A blood donation is organised by the Cantonal Hospital of Geneva On Thursday 19 March 2009 from 9 a.m. to 5 p.m. CERN RESTAURANT 2 Number of donations during the last blood donations :135 donors in July 2008 122 donors in November 2008 Let’s do better in 2009 !!! Give 30 minutes of your time to save lives...

  19. Antibody-linked drug destroys tumor cells and tumor blood vessels in many types of cancer | Center for Cancer Research

    Science.gov (United States)

    A team led by Brad St. Croix, Ph.D., Senior Associate Scientist, Mouse Cancer Genetics Program, has developed an antibody-drug conjugate (ADC) that destroys both tumor cells and the blood vessels that nourish them. The drug significantly shrank breast tumors, colon tumors and several other types of cancer and prolonged survival. Learn more...  

  20. Using Videoconferencing Technology to Provide Breastfeeding Support to Low-Income Women: Connecting Hospital-Based Lactation Consultants with Clients Receiving Care at a Community Health Center.

    Science.gov (United States)

    Friesen, Carol A; Hormuth, Laura J; Petersen, Devan; Babbitt, Tina

    2015-11-01

    The Tele-Lactation Pilot Project (TLPP), 1 of 13 community-based breastfeeding projects implemented in Indiana in 2013 using Centers for Disease Control and Prevention grant funds, explored the feasibility of using videoconferencing technology to provide breastfeeding education and support to low-income women by a centrally located International Board Certified Lactation Consultant (IBCLC). The IBCLC was housed at the Breastfeeding Center at the hospital where the women would deliver; the women receiving the education and support were located at an inner-city community health center (CHC) where they received their primary care. The videoconferencing sessions were juxtaposed with the women's regularly scheduled prenatal and postnatal visits at the CHC. After delivery, the lactation consultant visited the mother and infant in person at the hospital to offer additional support. Overall, 35 mothers were served by the TLPP during the 9-month project period. A total of 134 visits (30-45 minutes each) were conducted (3.8 sessions per woman). At the conclusion of the project, interviews with key participants indicated that the tele-lactation videoconferencing sessions were easy to implement, allowed the IBCLC to reach a wider client base, and allowed the women to receive expert support that they might not have otherwise received. Comments indicated that, in addition to providing education and increasing the women's confidence, the tele-lactation sessions appeared to have decreased the mothers' anxiety about the birthing process and the hospital experience. The TLPP demonstrated that incorporating videoconferencing technology into routine care can help foster collaboration among health care providers and provide mothers with continuous, easily accessible breastfeeding education and support. © The Author(s) 2015.

  1. Determination of lead content in blood from the female transit police who belong to the Center and South units of Metropolitan Lima

    International Nuclear Information System (INIS)

    Arosquipa Aguilar, Graciela; Villegas Silva, Elvito

    2013-01-01

    The average content of lead in blood from the female police who belong to the center and south units from Metropolitan Lima in 2005 and 2008 have been below the threshold level (20 μg Pb/dL) for both workers in the street and in offices. Nevertheless, there is the possibility of occupational risk for the toxicity of lead in any concentration in a human being. For p < 0,05 there are no significant differences between the average contents of lead in blood for the workers in the streets but in different units; and there was similar situation for the workers in offices, in both years 2005 and 2008. (author)

  2. Independent Predictive Factors of Hospitalization in a North-West Burn Center of Iran; an Epidemiologic Study

    Directory of Open Access Journals (Sweden)

    Samad Shams Vahdati

    2015-01-01

    Full Text Available Introduction: A high grade burn is one of the most devastating injuries with several medical, social, economic, and psychological effects. These injuries are the most common cause of accidental deaths after traffic injuries in both the developed and developing countries. Therefore this research was aimed to determine demographic characteristics of patients with burn injury admitted to the emergency department and identify predictive factors of hospitalization. Methods: This is a cross sectional descriptive study, which is done in 20 March up to 20 September 2011 in emergency department of Sina Hospital, Tabriz, Iran. Patients’ information including demographic characteristic, cause of burn, place of accident, anatomical areas burned, grading and percent of burning and disposition were gathered and analyzed using SPSS version 18.0 statistical software. Stepwise multivariate regression analysis was used for recognition of independent predictive factors of hospitalization in burned patients. Results: One hundred and sixty patients were enrolled (54.4% female. The average age of those was 20.47±13.5 years. The prevalence of burn was significantly higher in ages under 20 years (p<0.001. Lower limb (37.5%, head and neck (21.25% and upper limb (17.5% were three frequent site of burn. The most common cause of burns was boiling water scalding (34.4%. Home related burn was significantly higher than other place (p<0.001. The most frequent percent of burn was <5% (46.25%. Finally 50 (31.25% cases hospitalized. Univariate analysis demonstrated that age under 20 years old (p=0.02 female gender (p=0.02, burning site (p=0.002, cause (p=0.005, place (p<0.001, grade (p<0.001, and percent (p<0.001 was related to disposition of patients. Stepwise multiple logistic regression showed female gender (OR=3.52; 95% CI: 1.57-7.88; p=0.002, work related burning (OR=1.78; 95% CI: 1.26-2.52; p=0.001, and burning over 5 percent (OR=2.15; 95% CI: 1.35-3.41; p=0.001 as

  3. Analysis of the main activities of the city center of Alexander's psychosomatic hospital of St. Petersburg, focused on the choice of priorities in perfection of treatment and prophylaxis

    Directory of Open Access Journals (Sweden)

    N. P. Vanchakova

    2014-01-01

    Full Text Available The authors have analyzed the results of the City Psychosomatic Centre (CPSC activity in 2009-2011 ys in order to find out the most important trends in the clinical work that may be helpful in planning of management and prophylaxis. The methods applied were statistical and clinico-statistical analyses of the results of of the Center work in 2009-2011 ys. There were changes in the structure by increasing the incidence of diseases associated with stress and organic damage brain with mental disorders, showed an increase in the flow of male patients. Found that the average length of stay in bed in the center of psychosomatic inpatient unit was 9.2-9.7 days, which creates barriers to good practice the use of antidepressants. Overcoming of these challenges can be achieved through the formation of new forms of continuity between the departments of the psychosomatic center, the health center and the offices of St. Petersburg SHCI «Alexander's Hospital,» and other medical institutions of the city.

  4. C235-V3 cyclotron for a proton therapy center to be installed in the hospital complex of radiation medicine (Dimitrovgrad)

    Science.gov (United States)

    Galkin, R. V.; Gurskii, S. V.; Jongen, Y.; Karamysheva, G. A.; Kazarinov, M. Yu.; Korovkin, S. A.; Kostromin, S. A.; Calderan, J.-M.; Cahay, P.; Mokrenko, S. P.; Morozov, N. A.; Nkongolo, H.; Ol'shevskii, A. G.; Paradis, Y.; Petrov, D. S.; Romanov, V. M.; Samsonov, E. V.; Syresin, E. M.; Shakun, A. N.; Shakun, N. G.; Shirkov, G. D.; Shirkov, S. G.

    2014-06-01

    Proton therapy is an effective method of treating oncologic diseases. In Russia, construction of several centers for proton and ion therapy is slated for the years to come. A proton therapy center in Dimitrovgrad will be the first. The Joint Institute for Nuclear Research (Russia) in collaboration with Ion Beam Application (IBA) (Belgium) has designed an C235-V3 medical proton cyclotron for this center. It outperforms previous versions of commercial IBA cyclotrons, which have already been installed in 11 oncologic hospital centers in different countries. Experimental and calculation data for the beam dynamics in the C235-V3 medical cyclotron are presented. Reasons for beam losses during acceleration are considered, the influence of the magnetic field radial component in the midplane of the accelerator and main resonances is studied, and a beam extraction system is designed. In 2011-2012 in Dubna, the cyclotron was mounted, its magnetic field was properly configured, acceleration conditions were optimized, and beam extraction tests were carried out after which it was supplied to Dimitrovgrad. In the C235-V3 cyclotron, an acceleration efficiency of 72% and an extraction efficiency of 62% have been achieved without diaphragming to form a vertical profile of the beam.

  5. Prognostic value of blood pressure measured during hospitalization after acute myocardial infarction: an insight from survival trials

    DEFF Research Database (Denmark)

    Yap, Yee Guan; Duong, Trinh; Bland, J Martin

    2007-01-01

    , CAMIAT, SWORD, TRACE and DIAMOND-MI studies with left ventricular ejection fraction less than 40% or asymptomatic ventricular arrhythmia surviving more than 45 days after MI were pooled. Systolic and diastolic blood pressures and pulse pressures were measured soon after MI (median 6 days, range 0-53 days...

  6. PTSD: National Center for PTSD

    Medline Plus

    Full Text Available ... TEE) Tournament Wheelchair Games Winter Sports Clinic Locations Hospitals & Clinics Vet Centers Regional Benefits Offices Regional Loan Centers ... Prevention / Wellness Public Health Weight Management (MOVE!) Locations Hospitals & Clinics Vet Centers Veterans Canteen Service (VCS) Research Research ...

  7. Implementation of a simple electronic transfusion alert system decreases inappropriate ordering of packed red blood cells and plasma in a multi-hospital health care system.

    Science.gov (United States)

    Smith, Matthew; Triulzi, Darrell J; Yazer, Mark H; Rollins-Raval, Marian A; Waters, Jonathan H; Raval, Jay S

    2014-12-01

    Prescriber adherence to institutional blood component ordering guidelines can be low. The goal of this study was to decrease red blood cell (RBC) and plasma orders that did not meet institutional transfusion guidelines by using data within the laboratory information system to trigger alerts in the computerized order entry (CPOE) system at the time of order entry. At 10 hospitals within a regional health care system, discernment rules were created for RBC and plasma orders utilizing transfusion triggers of hemoglobin 1.6, respectively, with subsequent alert generation that appears within the CPOE system when a prescriber attempts to order RBCs or plasma on a patient whose antecedent laboratory values do not suggest that a transfusion is indicated. Orders and subsequent alerts were tracked for RBCs and plasma over evaluation periods of 15 and 10 months, respectively, along with the hospital credentials of the ordering health care providers (physician or nurse). Alerts triggered which were heeded remained steady and averaged 11.3% for RBCs and 19.6% for plasma over the evaluation periods. Overall, nurses and physicians canceled statistically identical percentages of alerted RBC (10.9% vs. 11.5%; p = 0.78) and plasma (21.3% vs. 18.7%; p = 0.22) orders. Implementing a simple evidence-based transfusion alert system at the time of order entry decreased non-evidence based transfusion orders by both nurse and physician providers. Copyright © 2014 Elsevier Ltd. All rights reserved.

  8. Predictors of positive blood culture and deaths among neonates with suspected neonatal sepsis in a tertiary hospital, Mwanza- Tanzania

    Directory of Open Access Journals (Sweden)

    Jeremiah Seni

    2010-06-01

    Full Text Available Abstract Background Neonatal sepsis is a significant cause of morbidity and mortality in neonates. Appropriate clinical diagnosis and empirical treatment in a given setting is crucial as pathogens of bacterial sepsis and antibiotic sensitivity pattern can considerably vary in different settings. This study was conducted at Bugando Medical Centre (BMC, Tanzania to determine the prevalence of neonatal sepsis, predictors of positive blood culture, deaths and antimicrobial susceptibility, thus providing essential information to formulate a policy for management of neonatal sepsis. Methods This was a prospective cross sectional study involving 300 neonates admitted at BMC neonatal unit between March and November 2009. Standard data collection form was used to collect all demographic data and clinical characteristics of neonates. Blood culture was done on Brain Heart Infusion broth followed by identification of isolates using conventional methods and testing for their susceptibility to antimicrobial agents using the disc diffusion method. Results Among 770 neonates admitted during the study period; 300 (38.9% neonates were diagnosed to have neonatal sepsis by WHO criteria. Of 300 neonates with clinical neonatal sepsis 121(40% and 179(60% had early and late onset sepsis respectively. Positive blood culture was found in 57 (47.1% and 92 (51.4% among neonates with early and late onset neonatal sepsis respectively (p = 0.466. Predictors of positive blood culture in both early and late onset neonatal sepsis were inability to feed, lethargy, cyanosis, meconium stained liquor, premature rupture of the membrane and convulsion. About 49% of gram negatives isolates were resistant to third generation cephalosporins and 28% of Staphylococcus aureus were found to be Methicillin resistant Staphylococcus aureus (MRSA. Deaths occurred in 57 (19% of neonates. Factors that predicted deaths were positive blood culture (p = 0.0001, gram negative sepsis (p = 0.0001 and

  9. Variation in Red Blood Cell Transfusion Practices During Cardiac Operations Among Centers in Maryland: Results From a State Quality-Improvement Collaborative.

    Science.gov (United States)

    Magruder, J Trent; Blasco-Colmenares, Elena; Crawford, Todd; Alejo, Diane; Conte, John V; Salenger, Rawn; Fonner, Clifford E; Kwon, Christopher C; Bobbitt, Jennifer; Brown, James M; Nelson, Mark G; Horvath, Keith A; Whitman, Glenn R

    2017-01-01

    Variation in red blood cell (RBC) transfusion practices exists at cardiac surgery centers across the nation. We tested the hypothesis that significant variation in RBC transfusion practices between centers in our state's cardiac surgery quality collaborative remains even after risk adjustment. Using a multiinstitutional statewide database created by the Maryland Cardiac Surgery Quality Initiative (MCSQI), we included patient-level data from 8,141 patients undergoing isolated coronary artery bypass (CAB) or aortic valve replacement at 1 of 10 centers. Risk-adjusted multivariable logistic regression models were constructed to predict the need for any intraoperative RBC transfusion, as well as for any postoperative RBC transfusion, with anonymized center number included as a factor variable. Unadjusted intraoperative RBC transfusion probabilities at the 10 centers ranged from 13% to 60%; postoperative RBC transfusion probabilities ranged from 16% to 41%. After risk adjustment with demographic, comorbidity, and operative data, significant intercenter variability was documented (intraoperative probability range, 4% -59%; postoperative probability range, 13%-39%). When stratifying patients by preoperative hematocrit quartiles, significant variability in intraoperative transfusion probability was seen among all quartiles (lowest quartile: mean hematocrit value, 30.5% ± 4.1%, probability range, 17%-89%; highest quartile: mean hematocrit value, 44.8% ± 2.5%; probability range, 1%-35%). Significant variation in intercenter RBC transfusion practices exists for both intraoperative and postoperative transfusions, even after risk adjustment, among our state's centers. Variability in intraoperative RBC transfusion persisted across quartiles of preoperative hematocrit values. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  10. Understanding the relationship between the Centers for Medicare and Medicaid Services' Hospital Compare star rating, surgical case volume, and short-term outcomes after major cancer surgery.

    Science.gov (United States)

    Kaye, Deborah R; Norton, Edward C; Ellimoottil, Chad; Ye, Zaojun; Dupree, James M; Herrel, Lindsey A; Miller, David C

    2017-11-01

    Both the Centers for Medicare and Medicaid Services' (CMS) Hospital Compare star rating and surgical case volume have been publicized as metrics that can help patients to identify high-quality hospitals for complex care such as cancer surgery. The current study evaluates the relationship between the CMS' star rating, surgical volume, and short-term outcomes after major cancer surgery. National Medicare data were used to evaluate the relationship between hospital star ratings and cancer surgery volume quintiles. Then, multilevel logistic regression models were fit to examine the association between cancer surgery outcomes and both star rankings and surgical volumes. Lastly, a graphical approach was used to compare how well star ratings and surgical volume predicted cancer surgery outcomes. This study identified 365,752 patients undergoing major cancer surgery for 1 of 9 cancer types at 2,550 hospitals. Star rating was not associated with surgical volume (P cancer surgery outcomes (mortality, complication rate, readmissions, and prolonged length of stay). The adjusted predicted probabilities for 5- and 1-star hospitals were 2.3% and 4.5% for mortality, 39% and 48% for complications, 10% and 15% for readmissions, and 8% and 16% for a prolonged length of stay, respectively. The adjusted predicted probabilities for hospitals with the highest and lowest quintile cancer surgery volumes were 2.7% and 5.8% for mortality, 41% and 55% for complications, 12.2% and 11.6% for readmissions, and 9.4% and 13% for a prolonged length of stay, respectively. Furthermore, surgical volume and the star rating were similarly associated with mortality and complications, whereas the star rating was more highly associated with readmissions and prolonged length of stay. In the absence of other information, these findings suggest that the star rating may be useful to patients when they are selecting a hospital for major cancer surgery. However, more research is needed before these ratings can

  11. Procedural Portfolio Planning in Plastic Surgery, Part 2: Collaboration Between Surgeons and Hospital Administrators to Develop a Funds Flow Model for Procedures Performed at an Academic Medical Center.

    Science.gov (United States)

    Hultman, Charles Scott

    2016-06-01

    Although plastic surgeons make important contributions to the clinical, educational, and research missions of academic medical centers (AMCs), determining the financial value of a plastic surgery service can be difficult, due to complex cost accounting systems. We analyzed the financial impact of plastic surgery on an AMC, by examining the contribution margins and operating income of surgical procedures. We collaborated with hospital administrators to implement 3 types of strategic changes: (1) growth of areas with high contribution margin, (2) curtailment of high-risk procedures with negative contribution margin, (3) improved efficiency of mission-critical services with high resource consumption. Outcome measures included: facility charges, hospital collections, contribution margin, operating margin, and operating room times. We also studied the top 50 Current Procedural Terminology codes (total case number × charge/case), ranking procedures for profitability, as determined by operating margin. During the 2-year study period, we had no turnover in faculty; did not pursue any formal marketing; did not change our surgical fees, billing system, or payer mix; and maintained our commitment to indigent care. After rebalancing our case mix, through procedural portfolio planning, average hospital operating income/procedure increased from $-79 to $+816. Volume and diversity of cases increased, with no change in payer mix. Although charges/case decreased, both contribution margin and operating margin increased, due to improved throughput and decreased operating room times. The 5 most profitable procedures for the hospital were hernia repair, mandibular osteotomy, hand skin graft, free fibula flap, and head and neck flap, whereas the 5 least profitable were latissimus breast reconstruction, craniosynostosis repair, free-flap breast reconstruction, trunk skin graft, and cutaneous free flap. Total operating income for the hospital, from plastic surgery procedures, increased

  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

    are participating in Medicare. 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. In addition, we are making technical corrections to the regulations governing provider administrative appeals and judicial review; updating the reasonable compensation equivalent (RCE) limits, and revising the methodology for determining such limits, for services furnished by physicians to certain teaching hospitals and hospitals excluded from the IPPS; making regulatory revisions to broaden the specified uses of Medicare Advantage (MA) risk adjustment data and to specify the conditions for release of such risk adjustment data to entities outside of CMS; and making changes to the enforcement procedures for organ transplant centers. We are aligning the reporting and submission timelines for clinical quality measures for the Medicare HER Incentive Program for eligible hospitals and critical access hospitals (CAHs) with the reporting and submission timelines for the Hospital IQR Program. In addition, we provide guidance and clarification of certain policies for eligible hospitals and CAHs such as our policy for reporting zero denominators on clinical quality measures and our policy for case threshold exemptions. In this document, we are finalizing two interim final rules with comment period relating to criteria for disproportionate share hospital uncompensated care payments and extensions of temporary changes to the payment adjustment for low-volume hospitals and of the Medicare-Dependent, Small Rural Hospital (MDH) Program.

  13. Effects of a humor-centered activity on disruptive behavior in patients in a general hospital psychiatric ward

    OpenAIRE

    Antonio Higueras; Hugo Carretero-Dios; José P. Muñoz; Esther Idini; Ana Ortiz; Francisco Rincón; David Prieto-Merino; María M. Rodríguez del Águila

    2006-01-01

    El objetivo de este estudio cuasi-experimental es analizar lo efectos de una actividad centrada en el humor sobre las conductas disruptivas de pacientes hospitalizados en un servicio de Psiquiatría. Se han comparado, teniendo en cuenta dos grupos homogéneos de pacientes hospitalizados en un servicio de Psiquiatría de hospital general (unidad de agudos), dos periodos temporales de 83 días cada uno, siendo el período 1 el de línea base, y el período 2, el de intervención. Para am...

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

    Science.gov (United States)

    Badreldin, Hisham

    2018-07-01

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

  15. Applying User-Centered Design Methods to the Development of an mHealth Application for Use in the Hospital Setting by Patients and Care Partners.

    Science.gov (United States)

    Couture, Brittany; Lilley, Elizabeth; Chang, Frank; DeBord Smith, Ann; Cleveland, Jessica; Ergai, Awatef; Katsulis, Zachary; Benneyan, James; Gershanik, Esteban; Bates, David W; Collins, Sarah A

    2018-04-01

     Developing an optimized and user-friendly mHealth application for patients and family members in the hospital environment presents unique challenges given the diverse patient population and patients' various states of well-being.  This article describes user-centered design methods and results for developing the patient and family facing user interface and functionality of MySafeCare, a safety reporting tool for hospitalized patients and their family members.  Individual and group usability sessions were conducted with specific testing scenarios for participants to follow to test the usability and functionality of the tool. Participants included patients, family members, and Patient and Family Advisory Council (PFAC) members. Engagement rounds were also conducted on study units and lessons learned provided additional information to the usability work. Usability results were aligned with Nielsen's Usability Heuristics.  Eleven patients and family members and 25 PFAC members participated in usability testing and over 250 patients and family members were engaged during research team rounding. Specific themes resulting from the usability testing sessions influenced the changes made to the user interface design, workflow functionality, and terminology.  User-centered design should focus on workflow functionality, terminology, and user interface issues for mHealth applications. These themes illustrated issues aligned with four of Nielsen's Usability Heuristics: match between system and the real world, consistency and standards, flexibility and efficiency of use, and aesthetic and minimalist design. We identified workflow and terminology issues that may be specific to the use of an mHealth application focused on safety and used by hospitalized patients and their families. Schattauer GmbH Stuttgart.

  16. The Ratio of Blood Products Transfused Affects Mortality in Patients Receiving Massive Transfusions at a Combat Support Hospital

    Science.gov (United States)

    2007-10-01

    therapy resuscitation, and exacer- bated by hemorrhagic shock, metabolic acidosis, hypother- mia, hyperfibrinolysis, hypocalcemia , and anemia.11,14–19...outcome studies examining the effect of blood product transfusion ratios for trauma patients requiring massive transfusion. Most deaths (80% to 85%) that...calculation of apheresis platelet units transfused, though FWB has previously been shown to be as effective as 10 units of platelet concentrate.33 The

  17. Increased preoperative collection of autologous blood with recombinant human erythropoietin therapy in tertiary care hospitals of Jammu

    Directory of Open Access Journals (Sweden)

    Kumkum Sharma

    2013-01-01

    Full Text Available Introduction: To study whether the administration of recombinant human erythropoietin increases the amount of autologous blood that can be collected before orthopaedic surgery. Materials and Methods: We conducted a randomized controlled trial of recombinant human erythropoietin in 68 adults scheduled for elective orthopedic procedures. The patients received either erythropoietin 600 units/kg of body weight or placebo intravenously every 5 th day prior to each phlebotomy for 21 days during which time up to 5 units of blood was collected. Patients were excluded from donation when their hematocrit values were less than 33%. All patients received iron sulphate 325mg orally 3 times daily. The mean number of units collected per patient was 4.33 ± 0.4 for erythropoietin group and 3.05± 0.71 for the placebo group. Results: The mean packed red cell volume donated by patients who received erythropoietin was 32% greater than that donated by patients who received placebo (196.3 vs. 169.4 ml, p<0.05. 68% in the placebo group and 9% of patients treated with erythropoietin were unable to donate ≥4 units. No adverse effects were attributed to erythropoietin. While participating in the study, complications developed in 2 patients one in each group necessitating their removal from the study. Conclusion: We conclude that recombinant human erythropoietin increases the ability of the patients about to undergo elective surgery to donate autologous blood units.

  18. Increasing patient mobility through an individualized goal-centered hospital mobility program: A quasi-experimental quality improvement project.

    Science.gov (United States)

    Klein, Lisa M; Young, Daniel; Feng, Du; Lavezza, Annette; Hiser, Stephanie; Daley, Kelly N; Hoyer, Erik H

    2018-02-27

    Hospital-acquired functional decline due to decreased mobility has negative impacts on patient outcomes. Current nurse-directed mobility programs lack a standardized approach to set achievable mobility goals. We aimed to describe implementation and outcomes from a nurse-directed patient mobility program. The quality improvement mobility program on the project unit was compared to a similar control unit providing usual care. The Johns Hopkins Mobility Goal Calculator was created to guide a daily patient mobility goal based on the level of mobility impairment. On the project unit, patient mobility increased from 5.2 to 5.8 on the Johns Hopkins Highest Level of Mobility score, mobility goal attainment went from 54.2% to 64.2%, and patients exceeding the goal went from 23.3% to 33.5%. All results were significantly higher than the control unit. An individualized, nurse-directed, patient mobility program using daily mobility goals is a successful strategy to improve daily patient mobility in the hospital. Copyright © 2018 Elsevier Inc. All rights reserved.

  19. Evaluation of surrogate markers for human immunodeficiency virus infection among blood donors at the blood bank of "Hospital Universitário Regional Norte do Paraná", Londrina, PR, Brazil

    Directory of Open Access Journals (Sweden)

    Reiche Edna Maria Vissoci

    2003-01-01

    Full Text Available This study evaluated the usefulness of the anti-HBc, hepatitis C virus antibodies (anti-HCV, human T cell lymphotropic virus I and II antibodies (anti-HTLV I/II, serologic tests for syphilis, and surface antigen of hepatitis B virus (HBsAg as surrogate markers for the risk for HIV infection in 80,284 serum samples from blood donors from the Blood Bank of "Hospital Universitário Regional Norte do Paraná", Londrina, Paraná State, Brazil, analyzed from July 1994 to April 2001. Among 39 blood donors with positive serology for HIV, 12 (30.8% were anti-HBc positive, 10 (25.6% for anti-HCV, 1 (2.6% for anti-HTLV I/I, 1 (2.6% was positive for syphilis, and 1 (2.6% for HBsAg. Among the donors with negative serology for HIV, these markers were detected in 8,407 (10.5%, 441 (0.5%, 189 (0.2%, 464 (0.6%, and 473 (0.6% samples, respectively. The difference was statistically significant (p < 0.001 for anti-HBc and anti-HCV. Although the predictive positive value for these surrogate markers were low for HIV infection, the results confirmed the anti-HBc and anti-HCV as useful surrogate markers for HIV infection thus reinforcing the maintenance of them in the screening for blood donors contributing to the prevention of the small number of cases in which HIV is still transmitted by transfusion.

  20. Thirty-Day Hospital Readmission After Restorative Proctocolectomy and Ileal Pouch Anal Anastomosis for Chronic Ulcerative Colitis at a High-Volume Center.

    Science.gov (United States)

    McKenna, Nicholas P; Mathis, Kellie L; Khasawneh, Mohammad; Shariq, Omair; Dozois, Eric J; Larson, David W; Lightner, Amy L

    2017-11-01

    Ileal pouch anal anastomosis (IPAA) is associated with a high 30-day hospital readmission rate. Risk factors and etiology of readmission remain poorly defined. We sought to determine the 30-day hospital readmission rate following IPAA at a high-volume center and identify any modifiable perioperative factors. A retrospective review of all patients undergoing two- or three-stage IPAA for chronic ulcerative colitis at our institution between 2002 and 2013 was performed. Analysis was performed on rate of readmission, readmission diagnosis, intervention performed upon readmission, and risk factors for readmission. Thirty-day primary and secondary readmission rates after IPAA were 20.3% (n = 185) and 2.1% (n = 19), respectively. The leading etiologies for readmission included partial small bowel obstruction/ileus (n = 52, 21.9%), pelvic sepsis (n = 43, 18.1%), dehydration (n = 42, 17.7%), and venous thromboembolism (n = 31, 13.1%). While the majority of readmissions were managed medically (n = 119, 65.4%), 19.2% (n = 35) required radiologic intervention and 15.3% (n = 28) required a return to the operating room. On univariate analysis, younger age (p = 0.03) and female sex (p = 0.04) had a significantly increased risk of readmission. On multivariable analysis, BMI ≥ 30 (OR 0.51; 95% CI, 0.25-0.97, p = 0.04) was protective of readmission. Thirty-day hospital readmission following IPAA remains a common problem. Preventable etiologies of readmission include dehydration and venous thromboembolism (VTE). Future quality improvement efforts should focus on education regarding stoma output and extended VTE prophylaxis to decrease hospital readmission rates following IPAA.

  1. De-hospitalization of the pediatric day surgery by means of a freestanding surgery center: pilot study in the lazio region

    Directory of Open Access Journals (Sweden)

    Mangia Giovanni

    2012-02-01

    Full Text Available Abstract Background Day surgery should take place in appropriate organizational settings. In the presence of high volumes, the organizational models of the Lazio Region are represented by either Day Surgery Units within continuous-cycle hospitals or day-cycle Day Surgery Centers. This pilot study presents the regional volumes provided in 2010 and the additional volumes that could be provided based on the best performance criterion with a view to suggesting the setting up of a regional Freestanding Center of Pediatric Day Surgery. Methods This is an observational retrospective study. The activity volumes have been assessed by means of a DRG (Diagnosis Related Group-specific indicator that measures the ratio of outpatients to the total number of treated patients (freestanding indicator, FI. The included DRGs had an FI exceeding the 3rd quartile present in at least a health-care facility and a volume exceeding 0.5% of the total patients of the pediatric surgery and urology facilities of the Lazio Region. The relevant data have been provided by the Public Health Agency and relate to 2010. The best performance FI has been used to calculate the theoretical volume of transferability of the remaining facilities into freestanding surgery centers. Patients under six months of age and DRGs common to other disciplines have been excluded. The Chi Square test has been used to compare the FI of the health-care facilities and the FI of the places of origin of the patients. Results The DRG provided in 2010 amounted to a total of 5768 belonging to 121 types of procedures. The application of the criteria of inclusion have led to the selection of seven final DRG categories of minor surgery amounting to 3522 cases. Out of this total number, there were 2828 outpatients and 694 inpatients. The recourse of the best performance determines a potential transfer of 497 cases. The total outpatient volume is 57%. The Chi Square test has pointed to a statistically significant

  2. The accident of stereotaxic radiosurgery at the University hospital center of Toulouse. Expert report n.2. Dosimetric and clinical evaluation. Risk analysis

    International Nuclear Information System (INIS)

    2008-01-01

    The regional center of stereotaxic radiosurgery (C.R.R.S.) of the University hospital center (C.H.U.) of Toulouse is equipped since april 2006 with a Novalis accelerator (Brainlab) devoted to radiosurgery and intra skull stereotaxic radiotherapy.In april 2007, during an intercomparison of dosimetry files coming from various sites, the Brainlab society detects an anomaly. The analysis made by the society concludes to the use of an unsuited detector for the measurement of a dosimetry parameter during the accelerator initial calibration. Following this error, 145 patients (on 172 patients treated since the center opening) suffer of an overdose whom importance is variable. On the 26. june 2007 the Authority of nuclear safety (Asn) requires an expertise on the following points: checking of the experimental protocols of micro-beams calibration before and after correction of the dysfunction; analysis at the theoretical level of the neurological complications risk at long term for the exposed patients. The second point of this request is the subject of this report. It gives the synthesis of the whole of information, at the clinical and dosimetric level and outlines successively: the expertise methodology; the cohort of patients treated at the C.R.R.S.; the parameters of the risk analysis of neurological complications; the different risk analysis according the pathologies treated at the C.R.R.S.; the recommendations. (N.C.)

  3. Prophylactic use of Saccharomyces boulardii probiotics in preventing antibiotic-associated diarrhea: a single center hospital-based case-control study in Serbia

    Directory of Open Access Journals (Sweden)

    Nikola Panic

    2015-12-01

    Full Text Available Background. Antibiotic-associated diarrhea (AAD develops through the loss of normal bacterial intestinal flora. We have conducted a case-control study in order to assess whether prophylactic administration of Saccharomyces boulardii (S. boulardii prevents occurrence of AAD among adult hospitalized patients. Methods. Single-center hospital based case-control study was conducted in University Clinic “Dr Dragisa Misovic-Dedinje”, Belgrade, Serbia. Hospital records were screened in order to identify all the patients developing AAD in period January 1. 2010 – August 31. 2015. For every case, one age and gender matched control was randomly selected among patients hospitalized at the same time at the same department who were administered with antibiotics and did not develop AAD. For both cases and controls data were extracted on demographics, medical history, indication for use of antibiotics, antibiotics used, and prophylactic use of S.boulardii probiotics. The relationship between occurrence of AAD and putative risk factors were measured using the odds ratios (ORs and their 95% confidence interval (CI derived from logistic regression analysis. Results. Number of 59 cases and 59 controls were included in the study. Most of AAD cases were associated with old age (mean age of 78.05, and almost half (49.15% were hospitalized on geriatrics department. Most prescribed class of antibiotics among cases was III generation cephalosporins (50.85%, followed by fluoroquinolones (28.81% and trimethoprim-sulfamethoxazole (20.34%. Significantly more cases than controls were treated with carbapenems (16.95% vs. 5.08% respectively, p=0.04. Significantly less cases were administered with prophylactic S. boulardii probiotics (18.64% vs. 42.37% p=0.005. We identified prophylactic use of S. boulardii to act protectively against development of AAD from both univariate (OR: 0.31, 95% CI: 0.14-0.72 and multivariate analysis (OR:0.36, 95% CI: 0.14-0.80. Use of