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Sample records for planned hospital birth

  1. Planned hospital birth versus planned home birth

    DEFF Research Database (Denmark)

    Olsen, O.; Clausen, J.A.

    2012-01-01

    Observational studies of increasingly better quality and in different settings suggest that planned home birth in many places can be as safe as planned hospital birth and with less intervention and fewer complications. This is an update of a Cochrane review first published in 1998....

  2. Transfer to hospital in planned home births

    DEFF Research Database (Denmark)

    Blix, Ellen; Kumle, Merethe; Kjærgaard, Hanne

    2014-01-01

    BACKGROUND: There is concern about the safety of homebirths, especially in women transferred to hospital during or after labour. The scope of transfer in planned home births has not been assessed in a systematic review. This review aimed to describe the proportions and indications for transfer from...... home to hospital during or after labour in planned home births. METHODS: The databases Pubmed, Embase, Cinahl, Svemed+, and the Cochrane Library were searched using the MeSH term "home childbirth". Inclusion criteria were as follows: the study population was women who chose planned home birth...... at the onset of labour; the studies were from Western countries; the birth attendant was an authorised midwife or medical doctor; the studies were published in 1985 or later, with data not older than from 1980; and data on transfer from home to hospital were described. Of the 3366 titles identified, 83 full...

  3. Transfers to hospital in planned home birth in four Nordic countries

    DEFF Research Database (Denmark)

    Blix, Ellen; Kumle, Merethe H; Ingversen, Karen

    2016-01-01

    INTRODUCTION: Women planning a home birth are transferred to hospital in case of complications or elevated risk for adverse outcomes. The aim of the present study was to describe the indications for transfer to hospital in planned home births, and the proportion of cases in which this occurs. MAT...

  4. Comparing the odds of postpartum haemorrhage in planned home birth against planned hospital birth: results of an observational study of over 500,000 maternities in the UK

    Directory of Open Access Journals (Sweden)

    Nove Andrea

    2012-11-01

    Full Text Available Abstract Background The aim of this study is to compare the odds of postpartum haemorrhage among women who opt for home birth against the odds of postpartum haemorrhage for those who plan a hospital birth. It is an observational study involving secondary analysis of maternity records, using binary logistic regression modelling. The data relate to pregnancies that received maternity care from one of fifteen hospitals in the former North West Thames Regional Health Authority Area in England, and which resulted in a live or stillbirth in the years 1988–2000 inclusive, excluding ‘high-risk’ pregnancies, unplanned home births, pre-term births, elective Caesareans and medical inductions. Results Even after adjustment for known confounders such as parity, the odds of postpartum haemorrhage (≥1000ml of blood lost are significantly higher if a hospital birth is intended than if a home birth is intended (odds ratio 2.5, 95% confidence interval 1.7 to 3.8. The ‘home birth’ group included women who were transferred to hospital during labour or shortly after birth. Conclusions Women and their partners should be advised that the risk of PPH is higher among births planned to take place in hospital compared to births planned to take place at home, but that further research is needed to understand (a whether the same pattern applies to the more life-threatening categories of PPH, and (b why hospital birth is associated with increased odds of PPH. If it is due to the way in which labour is managed in hospital, changes should be made to practices which compromise the safety of labouring women.

  5. [Planned non-hospital births in industrialized countries: bureaucratic dream vs. professional responsibility].

    Science.gov (United States)

    Arabin, B; Chervenak, F A; McCullough, L B

    2013-02-01

    This article addresses in how far planned non-hospital births should be an alternative to planned hospital births. Advocates of planned non-hospital deliveries have emphasised patient safety, patient satisfaction, cost effectiveness, and respect for women's rights. We provide a critical evaluation of each of these claims and have doubts that the information available for the pregnant women and the public is in accord with professional responsibility. We understand that the increasing rates of interventions and operative deliveries in hospital births demand an answer, but we doubt that planned home birth is the appropriate professional solution. Complications during non-hospital births inevitably demand a transport of mother and child to a perinatal centre. The time delay by itself is an unnecessary risk for both and this cannot be abolished by bureaucratic quality criteria as introduced for non-hospital births in Germany. Evidence-based studies have shown that modern knowledge of the course of delivery including ultrasound as well as intensive care during the delivery all reduce the rate of operative deliveries. Unfortunately, this is not well-known and only rarely considered during any delivery. All these facts, however, are the best arguments to find a cooperative model within perinatal centres to combine the art of midwifery with modern science, reduction of pain and perinatal care of the pregnant women before, during and after birth. We therefore call on obstetricians, midwifes and health-care providers as well as health politicians to carefully analyse the studies from Western countries showing increasing risks if the model of intention-to-treat is considered and accoordingly not to support planned non-hospital births nor to include these models into prospective trials. Alternatively, we recommend the introduction of a home-like climate within hospitals and perinatal centres, to avoid unnecessary invasive measures and to really care for the pregnant mother

  6. Transfers to hospital in planned home birth in four Nordic countries - a prospective cohort study.

    Science.gov (United States)

    Blix, Ellen; Kumle, Merethe H; Ingversen, Karen; Huitfeldt, Anette S; Hegaard, Hanne K; Ólafsdóttir, Ólöf Á; Øian, Pål; Lindgren, Helena

    2016-04-01

    Women planning a home birth are transferred to hospital in case of complications or elevated risk for adverse outcomes. The aim of the present study was to describe the indications for transfer to hospital in planned home births, and the proportion of cases in which this occurs. Women in Norway, Sweden, Denmark and Iceland who had opted for, and were accepted for, home birth at the onset of labor, were included in the study. Data from 3068 women, 572 nulliparas and 2446 multiparas, were analyzed for proportion of transfers during labor and within 72 h after birth, indications for transfer, how long before or after birth the transfer started, time from birth to start of transfer, duration and mode of transfer, and whether the transfer was classified as potentially urgent. Analyses were stratified for nulliparity and multiparity. One-third (186/572) of the nulliparas were transferred to hospital, 137 (24.0%) during labor and 49 (8.6%) after the birth. Of the multiparas, 195/2446 (8.0%) were transferred, 118 (4.8%) during labor and 77 (3.2%) after birth. The most common indication for transfers during labor was slow progress. In transfers after birth, postpartum hemorrhage, tears and neonatal respiratory problems were the most common indications. A total of 116 of the 3068 women had transfers classified as potentially urgent. One-third of all nulliparous and 8.0% of multiparous women were transferred during labor or within 72 h of the birth. The proportion of potentially urgent transfers was 3.8%. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

  7. Birth Plans

    Science.gov (United States)

    ... your child will happen — labor involves so many variables, you can't predict exactly what will happen. ... bottle feed ? Would you like the baby to sleep next to you or in the nursery? Hospitals ...

  8. Planned place of birth

    DEFF Research Database (Denmark)

    Overgaard, Charlotte; Coxon, Kirstie; Stewart, Mary

    Title Planned place of birth: issues of choice, access and equity. Outline In Northern European countries, giving birth is generally safe for healthy women with uncomplicated pregnancies, and their babies. However, place of birth can affect women’s outcomes and experiences of birth. Whilst tertiary...... centres provide appropriate medical supervision to women with complex pregnancies, the likelihood of receiving interventions including surgical birth is increased for low risk women in these settings. In this symposium, we consider issues of choice, access and equitable care for women in the context...... in Denmark Coxon K et al: Planned place of birth in England: perceptions of accessing obstetric units, midwife led units and home birth amongst women and their partners. How these papers interrelate These papers draw upon recent research in maternity care, undertaken in Denmark and in England. In both...

  9. Planned home birth: the professional responsibility response.

    Science.gov (United States)

    Chervenak, Frank A; McCullough, Laurence B; Brent, Robert L; Levene, Malcolm I; Arabin, Birgit

    2013-01-01

    This article addresses the recrudescence of and new support for midwife-supervised planned home birth in the United States and the other developed countries in the context of professional responsibility. Advocates of planned home birth have emphasized patient safety, patient satisfaction, cost effectiveness, and respect for women's rights. We provide a critical evaluation of each of these claims and identify professionally appropriate responses of obstetricians and other concerned physicians to planned home birth. We start with patient safety and show that planned home birth has unnecessary, preventable, irremediable increased risk of harm for pregnant, fetal, and neonatal patients. We document that the persistently high rates of emergency transport undermines patient safety and satisfaction, the raison d'etre of planned home birth, and that a comprehensive analysis undermines claims about the cost-effectiveness of planned home birth. We then argue that obstetricians and other concerned physicians should understand, identify, and correct the root causes of the recrudescence of planned home birth; respond to expressions of interest in planned home birth by women with evidence-based recommendations against it; refuse to participate in planned home birth; but still provide excellent and compassionate emergency obstetric care to women transported from planned home birth. We explain why obstetricians should not participate in or refer to randomized clinical trials of planned home vs planned hospital birth. We call on obstetricians, other concerned physicians, midwives and other obstetric providers, and their professional associations not to support planned home birth when there are safe and compassionate hospital-based alternatives and to advocate for a safe home-birth-like experience in the hospital. Copyright © 2013 Mosby, Inc. All rights reserved.

  10. Planned place of birth

    DEFF Research Database (Denmark)

    Overgaard, Charlotte; Coxon, Kirstie; Stewart, Mary

    of recent research on this topic. Individual papers/studies Stewart, M et al: The Birthplace in England Study – maternal outcomes and issues of choice and equity Overgaard, C et al: Freestanding midwifery units versus obstetric units – outcomes, care perceptions, equity and access in maternity care...... in Denmark Coxon K et al: Planned place of birth in England: perceptions of accessing obstetric units, midwife led units and home birth amongst women and their partners. How these papers interrelate These papers draw upon recent research in maternity care, undertaken in Denmark and in England. In both...... countries, maternity care is provided free to women, through public financing of health care; universal access to care is therefore secured. Nevertheless, different models of care exist, and debates about the appropriateness of providing maternity care in different settings take place in both countries...

  11. Confronting Rhetorical Disability: A Critical Analysis of Women's Birth Plans

    Science.gov (United States)

    Owens, Kim Hensley

    2009-01-01

    Through its analysis of birth plans, documents some women create to guide their birth attendants' actions during hospital births, this article reveals the rhetorical complexity of childbirth and analyzes women's attempts to harness birth plans as tools of resistance and self-education. Asserting that technologies can both silence and give voice,…

  12. Confronting Rhetorical Disability: A Critical Analysis of Women's Birth Plans

    Science.gov (United States)

    Owens, Kim Hensley

    2009-01-01

    Through its analysis of birth plans, documents some women create to guide their birth attendants' actions during hospital births, this article reveals the rhetorical complexity of childbirth and analyzes women's attempts to harness birth plans as tools of resistance and self-education. Asserting that technologies can both silence and give voice,…

  13. Birth control and family planning

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/001946.htm Birth control and family planning To use the sharing features ... please enable JavaScript. Your choice of a birth control method depends on a number of factors, including ...

  14. Planned Home Births in Iceland: Premise, Outcome, and Influential Factors

    OpenAIRE

    Berglind Hálfdánsdóttir 1973

    2016-01-01

    Background: Hospitalization of childbirth in Iceland in the 20th century reduced home birth rates to less than 0.1% in 1990. Icelandic home birth rates have risen rapidly in the new millennium and were 2.2% in 2014. Recent studies in other Western countries have consistently shown lower rates of interventions and maternal morbidity in planned home births than in planned hospital births, while neonatal outcomes are dissimilar in different countries. These study results have been met with scept...

  15. A critical review of the birth plan use in Catalonia.

    Science.gov (United States)

    Biescas, Herminia; Benet, Marta; Pueyo, Maria J; Rubio, Anna; Pla, Margarita; Pérez-Botella, Mercedes; Escuriet, Ramón

    2017-10-01

    The birth plan allows the woman to express her expectations and needs with regards to the childbearing continuum but its use has been debated in the clinical context and in published literature. The birth plan was first introduced in the Spanish Health Service in 2008 through the Strategy for the Care in Normal Childbirth. In Catalonia, the Normal Childbirth Care Programme has promoted the use of birth plans in hospitals participating in this Programme. This works describes and analyses the birth plans produced by the participating hospitals in order to gather knowledge about the options available to women. Qualitative study in which the content of birth plans is systematically and quantitatively described in order to evaluate options available to women. The final sample includes all the birth plans provided by 30 Catalonian public hospitals. Following an initial assessment, it was decided to devise a grading scale which allowed to code and assign a value to each of the items contained in the birth plans. Three different types of birth plan are identified: a) those which present a list of items with no (or very little) associated explanations, b) list of items with some explanations and c) plans without items which only explain normal working practices in the hospital and/or protocols. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. [Out-of-hospital births].

    Science.gov (United States)

    Fernández Domínguez, N; Leal Gómez, E; García Lavandeira, S; Vázquez Rodríguez, M

    2016-01-01

    Childbirth is a physiological process and, as such, there should be limited assistance for the woman to ensure that it follows its natural process, avoiding any possible complication and, if they do appear, attempting to resolve them. Health personnel should try to achieve a balance between safety and the least possible outside assistance. The out-of-hospital delivery is considered an emergency as it happens unexpectedly, that is, without being previously planned. Given that it has to be treated outside the ideal conditions of a maternity ward, it is considered as an emergency. Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Ethics and professional responsibility: Essential dimensions of planned home birth.

    Science.gov (United States)

    McCullough, Laurence B; Grünebaum, Amos; Arabin, Birgit; Brent, Robert L; Levene, Malcolm I; Chervenak, Frank A

    2016-06-01

    Planned home birth is a paradigmatic case study of the importance of ethics and professionalism in contemporary perinatology. In this article we provide a summary of recent analyses of the Centers for Disease Control database on attendants and birth outcomes in the United States. This summary documents the increased risks of neonatal mortality and morbidity of planned home birth as well as bias in Apgar scoring. We then describe the professional responsibility model of obstetric ethics, which is based on the professional medical ethics of two major figures in the history of medical ethics, Drs. John Gregory of Scotland and Thomas Percival of England. This model emphasizes the identification and careful balancing of the perinatologist's ethical obligations to pregnant, fetal, and neonatal patients. This model stands in sharp contrast to one-dimensional maternal-rights-based reductionist model of obstetric ethics, which is based solely on the pregnant woman's rights. We then identify the implications of the professional responsibility model for the perinatologist's role in directive counseling of women who express an interest in or ask about planned home birth. Perinatologists should explain the evidence of the increased, preventable perinatal risks of planned home birth, recommend against it, and recommend planned hospital birth. Perinatologists have the professional responsibility to create and sustain a strong culture of safety committed to a home-birth-like experience in the hospital. By routinely fulfilling these professional responsibilities perinatologists can help to prevent the documented, increased risks planned home birth. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. [The birth of the hospital].

    Science.gov (United States)

    Le Coz, R

    1998-01-01

    Hospitals were founded as early as the forth century, by the Church in the Byzantine Empire. However, it was not before the sixth century, with the Reform of Justinian, that the hospital got its definitive organization. In Bagdad, as soon as the eight century, the christian-nestorian doctors organized the first hospitals in the Arab-Muslim world.

  19. Birth Satisfaction Scale/Birth Satisfaction Scale-Revised (BSS/BSS-R): A large scale United States planned home birth and birth centre survey.

    Science.gov (United States)

    Fleming, Susan E; Donovan-Batson, Colleen; Burduli, Ekaterina; Barbosa-Leiker, Celestina; Hollins Martin, Caroline J; Martin, Colin R

    2016-10-01

    to explore the prevalence of birth satisfaction for childbearing women planning to birth in their home or birth centers in the United States. Examining differences in birth satisfaction of the home and birth centers; and those who birthed in a hospital using the 30-item Birth Satisfaction Scale (BSS) and the 10-item Birth Satisfaction Scale-Revised (BSS-R). a quantitative survey using the BSS and BSS-R were employed. Additional demographic data were collected using electronic linkages (Qualtrics(™)). a convenience sample of childbearing women (n=2229) who had planned to birth in their home or birth center from the US (United States) participated. Participants were recruited via professional and personal contacts, primarily their midwives. the total 30-item BSS score mean was 128.98 (SD 16.92) and the 10-item BSS-R mean score was 31.94 (SD 6.75). Sub-scale mean scores quantified the quality of care provision, women's personal attributes, and stress experienced during labour. Satisfaction was higher for women with vaginal births compared with caesareans deliveries. In addition, satisfaction was higher for women who had both planned to deliver in a home or a birth centre, and who had actually delivered in a home or a birth center. total and subscale birth satisfaction scores were positive and high for the overall sample IMPLICATIONS FOR PRACTICE: the BSS and the BSS-R provide a robust tool to quantify women's experiences of childbirth between variables such as birth types, birth settings and providers. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Birth Control and Family Planning in China

    Institute of Scientific and Technical Information of China (English)

    1996-01-01

    THIS year, Women of China asked two 30-year-old women from the Yimeng mountain area in Shandong Province about their chosen methods of birth control. Both women reported using intrauterine devices (IUDs), which they had placed by local gynecologists at the hospital 40 days after giving birth. Are these women aware of other contraceptive methods? Some rural women tell us they know of other methods such as oral contraception, contraceptive implants and tubal ligation.

  1. Out-of-hospital births in the United States 2009-2014.

    Science.gov (United States)

    Grunebaum, Amos; Chervenak, Frank A

    2016-10-01

    To evaluate recent trends of out-of-hospital births in the US from 2009 to 2014. We accessed data for all live births occurring in the US from the National Vital Statistics System, Natality Data Files for 2009-2014 through the interactive data tool, VitalStats. Out-of-hospital (OOH) births in the US increased from 2009 to 2014 by 80.2% from 32,596 to 58,743 (0.79%-1.47% of all live births). Home births (HB) increased by 77.3% and births in freestanding birthing centers (FBC) increased by 79.6%. In 2014, 63.8% of OOH births were HB, 30.7% were in FBC, and 5.5% were in other places, physicians offices, or clinics. The majority of women who had an OOH birth in 2014 were non-Hispanic White (82.3%). About in one in 47 non-Hispanic White women had an OOH in 2014, up from 1 in 87 in 2009. Women with a HB were older compared to hospital births (age ≥35: 21.5% vs. 15.4%), had a higher live birth order(≥5: 18.9% vs. 4.9%), 3.48% had infants birthing centers has significantly increased in the US making it the country with the most out of hospital births among all developed countries. The root cause of the increase in planned OOH births should be identified and addressed by the medical community.

  2. The Birth of a Plan

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    The formulation of the12th Five-Year Plan shows the operation of China’s public policy-making mechanism In March 2008,the National Development and Reform Committee (NDRC)began to evaluate the progress of the 11th Five-Year Plan for National Economic and Social Development

  3. Experiences of women who planned birth in a birth centre compared to alternative planned places of birth. Results of the Dutch Birth Centre Study.

    NARCIS (Netherlands)

    Hitzert, M.; Hermus, M.; Scheerhagen, M.; Boesveld, I.C.; Wiegers, T.; Akker-van Marle, M.E. van den; Dommelen, P. van; Pal-de Bruin, K.M. van der; Graal, J. P. de

    2016-01-01

    Objective: to assess the experiences with maternity care of women who planned birth in a birth centre and to compare them to alternative planned places of birth, by using the responsiveness concept of the World Health Organization. Design: this study is a cross-sectional study using the ReproQ

  4. Supporting patients' birth plans: theories, strategies & implications for nurses.

    Science.gov (United States)

    Anderson, Cynthia Jane; Kilpatrick, Caitlin

    2012-01-01

    Pregnant women often create birth plans to specify their preferences for their labor and delivery. When nurses implement and advocate for women's birth plans, it increases women's autonomy and decision-making in the birth process and can lead to greater patient satisfaction. This article describes strategies for how nurses can help implement patients' birth plans, and discusses two psychological theories as a base for understanding nurses' roles in advocating for birth plans to improve patients' experiences. © 2012 AWHONN.

  5. Intrapartum and Postpartum Transfers to a Tertiary Care Hospital from Out-of-Hospital Birth Settings: A Retrospective Case Series.

    Science.gov (United States)

    Lundeen, Tiffany

    2016-01-01

    This study describes the reasons for and outcomes of maternal transfers from private homes and freestanding birthing suites to a large academic hospital in order to better understand and meet the needs of transferring women and their families. The convenience sample included all adult women admitted to the labor and birth unit or emergency room within a 5-year period who: 1) had planned to give birth out-of-hospital but developed complications at term before the onset of labor and were admitted to the hospital for labor induction; 2) had planned to give birth at home or in a birthing suite but transferred to the hospital during labor; or 3) arrived at the hospital for care within 24 hours after a planned birth at home or in a birthing suite. Descriptive data for each transfer were obtained from the medical record. Fifty-one transfers were identified: 11 prior to labor, 38 during labor, and 2 postpartum. Only 4 transfers were considered urgent by the referring provider. The most common reasons for intrapartum transfer were prolonged labor (n = 19) and desire for epidural analgesia (n = 10). Only 25% of the medical records had documentation that the referring provider accompanied the woman to the hospital during the care transition or was involved in her hospital course; however, the prenatal and/or intrapartum records had been delivered by the referring provider, were referenced in the hospital admission note, and had become part of the permanent hospital medical record for 85% of the women. On average, one transfer per year was complicated by neonatal morbidity, and one transfer per year involved significant disagreement between hospital providers and the women presenting for care. Collecting and reviewing data about a facility's perinatal transfer events can help the local multi-stakeholder group appraise current practice and plan for quality improvement. © 2016 by the American College of Nurse-Midwives.

  6. Age, relationship status, and the planning status of births

    Directory of Open Access Journals (Sweden)

    Sarah Hayford

    2010-08-01

    Full Text Available In the United States historically, births to older mothers have been more likely to be planned than births to younger mothers, and births to unmarried women have been less likely to be planned than births to married women. As the average age of mothers has increased and more births have occurred outside of marriage in the United States, the intersection of these trends may have weakened the traditional linkage between age and birth planning status. In this article, we examine differences by maternal age in planning status of births using The 2002 National Survey of Family Growth. We find that age is strongly associated with planning status, but the association is reduced in magnitude when controlling for relationship status and is stronger for first and second births than for higher-parity births. Further, the association between union status and the planning status of births varies by race-ethnicity.

  7. BCG vaccination at birth and early childhood hospitalization

    DEFF Research Database (Denmark)

    Stensballe, Lone Graff; Sørup, Signe; Aaby, Peter

    2017-01-01

    BACKGROUND: The BCG vaccine is administered to protect against tuberculosis, but studies suggest there may also be non-specific beneficial effects upon the infant immune system, reducing early non-targeted infections and atopic diseases. The present randomised trial tested the hypothesis that BCG...... vaccination at birth would reduce early childhood hospitalisation in Denmark, a high-income setting. METHODS: Pregnant women planning to give birth at three Danish hospitals were invited to participate. After parental consent, newborn children were allocated to BCG or no intervention within 7 days of age......-protocol analyses. RESULTS: 4184 pregnant women were randomised and their 4262 children allocated to BCG or no intervention. There was no difference in risk of hospitalisation up to 15 months of age; 2129 children randomised to BCG experienced 1047 hospitalisations with a mean of 0.49 hospitalisation per child...

  8. INVESTIGATION OF BIRTHS DELIVERED IN A UNIVERSITY HOSPITAL

    Directory of Open Access Journals (Sweden)

    Atilla Senih MAYDA

    2006-12-01

    Full Text Available The aim of this study is to investigate the records of the births delivered in the Hospital of Duzce Medical School to determine the frequency of low birth weight, stillbirth, sezerian ratio; the relation between these variables and age of mother, number of pregnancy, birth weight, sex of the baby, way of the delivery. Data of this descriptive study was obtained from all the records of births delivered in this hospital from February 2001 to 2005 October. Number of total births according to the records was 2562. According to 2495 (97.4% birth records in which data if the baby was stillbirth or not had been written the number of stillbirth was 112 (4.5%. According to 2491 (97.25 birth records data about birth weight had been written the number of babies with low birth weight (less than 2500 gr was 564 (22.6%. Stillbirth was found related with low birth weight (x2=193.186, p<0.001; and low birth weight with female sex of the baby (x2 = 16.16, p<0.001, and less than 19 years of mothers’ ages. Of 2521 births, 1190 (47.2% was cesarean section. The results of this study showed that birth record of this hospital hasn’t included the data which must be at birth records. [TAF Prev Med Bull 2006; 5(6.000: 408-415

  9. Strategic market planning for hospitals.

    Science.gov (United States)

    Zallocco, R L; Joseph, W B; Doremus, H

    1984-01-01

    The application of strategic market planning to hospital management is discussed, along with features of the strategic marketing management process. A portfolio analysis tool, the McKinsey/G.E. Business Screen, is presented and, using a large urban hospital as an example, discussed in detail relative to hospital administration. Finally, strategic implications of the portfolio analysis are examined.

  10. Neonatal Mortality of Planned Home Birth in the United States in Relation to Professional Certification of Birth Attendants.

    Directory of Open Access Journals (Sweden)

    Amos Grünebaum

    Full Text Available Over the last decade, planned home births in the United States (US have increased, and have been associated with increased neonatal mortality and other morbidities. In a previous study we reported that neonatal mortality is increased in planned home births but we did not perform an analysis for the presence of professional certification status.The objective of this study therefore was to undertake an analysis to determine whether the professional certification status of midwives or the home birth setting are more closely associated with the increased neonatal mortality of planned midwife-attended home births in the United States.This study is a secondary analysis of our prior study. The 2006-2009 period linked birth/infant deaths data set was analyzed to examine total neonatal deaths (deaths less than 28 days of life in term singleton births (37+ weeks and newborn weight ≥ 2,500 grams without documented congenital malformations by certification status of the midwife: certified nurse midwives (CNM, nurse midwives certified by the American Midwifery Certification Board, and "other" or uncertified midwives who are not certified by the American Midwifery Certification Board.Neonatal mortality rates in hospital births attended by certified midwives were significantly lower (3.2/10,000, RR 0.33 95% CI 0.21-0.53 than home births attended by certified midwives (NNM: 10.0/10,000; RR 1 and uncertified midwives (13.7/10,000; RR 1.41 [95% CI, 0.83-2.38]. The difference in neonatal mortality between certified and uncertified midwives at home births did not reach statistical levels (10.0/10,000 births versus 13.7/10,000 births p = 0.2.This study confirms that when compared to midwife-attended hospital births, neonatal mortality rates at home births are significantly increased. While NNM was increased in planned homebirths attended by uncertified midwives when compared to certified midwives, this difference was not statistically significant. Neonatal

  11. Birthing Centers and Hospital Maternity Services

    Science.gov (United States)

    ... necessary to treat sick babies and moms. A birth center can provide natural pain control and pain control with mild narcotic medications, ... be an option. Women who want a natural birth with minimal medical intervention or pain control may feel more comfortable in a birth ...

  12. Birth environment facilitation by midwives assisting in non-hospital births: a qualitative interview study.

    Science.gov (United States)

    Igarashi, Toshiko; Wakita, Mariko; Miyazaki, Kikuko; Nakayama, Takeo

    2014-07-01

    midwifery homes (similar to birth centres) are rich in midwifery wisdom and skills that differ from those in hospital obstetrical departments, and a certain percentage of pregnant women prefer birth in these settings. This study aimed to understand the organisation of the perinatal environment considered important by independent midwives in non-hospital settings and to clarify the processes involved. semi-structured qualitative interview study and constant comparative analysis. 14 independent midwives assisting at births in midwifery homes in Japan, and six independent midwives assisting at home births. Osaka, Kyoto, Nara, and Shiga, Japan. midwives assisting at non-hospital births organised the birth environment based on the following four categories: 'an environment where the mother and family are autonomous'; 'a physical environment that facilitates birth'; 'an environment that facilitates the movement of the mother for birth'; and 'scrupulous safety preparation'. These, along with their sub-categories, are presented in this paper. independent midwives considered it important to create a candid relationship between the midwife and the woman/family from the period of pregnancy to facilitate birth in which the woman and her family were autonomous. They also organised a distinctive environment for non-hospital birth, with preparations to guarantee safety. Experiential knowledge and skills played a major part in creating an environment to facilitate birth, and the effectiveness of this needs to be investigated objectively in future research. Copyright © 2014 Elsevier Ltd. All rights reserved.

  13. Hospital mutual aid evacuation plan.

    Science.gov (United States)

    Phillips, R

    1997-02-01

    Health care facilities need to be prepared for disasters such as floods, tornadoes and earthquakes. Rochester, NY, and its surrounding communities devised a hospital mutual aid evacuation plan in the event a disaster occurs and also to comply with the Joint Commission. This document discusses the plan's development process and also provides the end result.

  14. Home birth or short-stay hospital birth in a low risk population in The Netherlands.

    NARCIS (Netherlands)

    Wiegers, T.A.; Zee, J. van der; Kerssens, J.J.; Keirse, M.J.N.C.

    1998-01-01

    In the Netherlands women with low risk pregnancies can choose whether they want to give birth at home or in hospital, under the care of their own primary caregiver. The majority of these women prefer to give birth at home, but over the last few decades an increasing number of low risk women have

  15. Home birth or short-stay hospital birth in a low risk population in The Netherlands.

    NARCIS (Netherlands)

    Wiegers, T.A.; Zee, J. van der; Kerssens, J.J.; Keirse, M.J.N.C.

    1998-01-01

    In the Netherlands women with low risk pregnancies can choose whether they want to give birth at home or in hospital, under the care of their own primary caregiver. The majority of these women prefer to give birth at home, but over the last few decades an increasing number of low risk women have cho

  16. Birthing Centers and Hospital Maternity Services

    Science.gov (United States)

    ... What are the hospital's statistics for cesarean sections, episiotomies, and mortality? (Keep in mind, though, that these ... What are the center's statistics for hospital transfers, episiotomies, and mortality? What procedures are followed after your ...

  17. HOSPITAL BIRTHS OF LOW BIRTH WEIGHT IN THE CITY OF CUIABÁ THE PERIOD 2000 TO 2008.

    Directory of Open Access Journals (Sweden)

    Carolina Sampaio Oliveira

    2011-01-01

    Full Text Available The ocurrence of low birth weight infants varies among contries, and even a general inidcator of health status of a population to be highly associated with socieconomic conditions(3. Newborns with low birth weight are more vulnerable to problems that increase the risk of morbidity and mortality(9. Several factors may be associated with low newborn weight among mothers with less than 20 years or over 35 years(16,17. Objectives: To describe the low-weight births in hospitals in the city of Cuiaba in the period 2000 to 2008 using the variables of the birth certificate (race, sex of infant and maternal age Method: a quantitative study, cross-sectional, restrospective and described with the use of secundary sources of data obtained from the Information System on Live Births (SINASC. The study population was constituted by the set of all vital statistics records of hospital deliveries of low birth weight infants n= 6.523, in the municipality of Cuiabá – MT in the period 2000 to 2008. Included only information from births and hospital births only, and with body weight equal to or less than 2,500g, this criterion is basead on the WHO classification. Results/Conclusion: The low birth weight hospital in the city of Cuiabá – MT in the period 2000 to 2008, has a prevalence of 6,6%, ocurred among newborns with GA between 37 and 41 weeks (43,3% n= 2827. The low weight births in the state of MT, evolve with the growing reduction of body weight, the highest prevalence being concentrated in the range of 1500 to 2499g weight. The low birth weight are more prevalent in females (53,7%, n=3506 and mullattos (70.4% n= 4595. 49% of mother of lbw infants are those who are aged 21 to 35 years of age (49,7%, n= 3240.

  18. The role of birthing centers in hospital marketing.

    Science.gov (United States)

    Kohler, D L; Bellenger, D N; Whyte, G E

    1990-01-01

    The research reported here investigated the repeat purchase intentions, key decision-making roles, and decision criteria related to hospital birthing centers. The results suggest that a marketing program with an emphasis on quality of care and high comfort standards directed to expectant mothers offers a realistic opportunity for hospital marketers.

  19. Report: hospitals need more sophisticated planning efforts.

    Science.gov (United States)

    Anderson, H J

    1990-09-20

    Sophisticated planning efforts are increasing among hospitals. However, hospital planners and marketers still have far to go before they can match their counterparts in industry. This is according to a report on hospital planning recently released by the Society for Healthcare Planning and Marketing of the American Hospital Association, Chicago.

  20. Home versus hospital birth--process and outcome.

    Science.gov (United States)

    Wax, Joseph R; Pinette, Michael G; Cartin, Angelina

    2010-02-01

    A constant small, but clinically important, number of American women choose to deliver at home. Contradictory professional and public policies reflect the polarization and politicization of the controversy surrounding this birth option. Women opting for home birth seek and often attain their goals of a nonmedicalized experience in comfortable, familiar surroundings wherein they maintain situational control. However, home deliveries in developed Western nations are often associated with excess perinatal and neonatal mortality, particularly among nonanomalous term infants. On the other hand, current home birth practices are, especially when birth attendants are highly trained and fully integrated into comprehensive health care delivery systems, associated with fewer cesareans, operative vaginal deliveries, episiotomies, infections, and third and fourth degree lacerations. Newborn benefits include less meconium staining, assisted ventilation, low birth weight, prematurity, and intensive care admissions. Existing data suggest areas of future research regarding the safety of home birth in the United States. Obstetricians & Gynecologists, Family Physicians. After completion of this educational activity, the participant should be better able to assess perinatal outcomes described in the reported literature associated with home births in developed countries, list potential advantages and disadvantages of planned home births, and identify confounders in current literature that impact our thorough knowledge of home birth outcomes.

  1. Use and influence of Delivery and Birth Plans in the humanizing delivery process

    Directory of Open Access Journals (Sweden)

    María Suárez-Cortés

    2015-06-01

    Full Text Available OBJECTIVES: get to know, analyze and describe the current situation of the Delivery and Birth Plans in our context, comparing the delivery and birth process between women who presented a Delivery and Birth Plan and those who did not.METHOD: quantitative and cross-sectional, observational, descriptive and comparative cohort study, carried out over two years. All women who gave birth during the study period were selected, including 9303 women in the study.RESULTS: 132 Delivery and Birth Plans were presented during the first year of study and 108 during the second. Among the variables analyzed, a significant difference was found in "skin to skin contact", "choice of dilation and delivery posture", "use of enema", "intake of foods or fluids", "eutocic deliveries", "late clamping of the umbilical cord" and "perineal shaving".CONCLUSIONS: the Delivery and Birth Plans positively influence the delivery process and its outcome. Health policies are needed to increase the number of Delivery and Birth Plans in our hospitals.

  2. Management strategies in hospitals: scenario planning

    National Research Council Canada - National Science Library

    Ghanem, Mohamed; Schnoor, Jörg; Heyde, Christoph-Eckhard; Kuwatsch, Sandra; Bohn, Marco; Josten, Christoph

    2015-01-01

    .... This work highlights the importance of scenario planning in hospitals, proposes an elaborated definition of the stakeholders of a hospital and defines the influence factors to which hospitals are exposed to. Methodology...

  3. Management strategies in hospitals: scenario planning

    National Research Council Canada - National Science Library

    Ghanem, Mohamed; Schnoor, Jörg; Heyde, Christoph-Eckhard; Kuwatsch, Sandra; Bohn, Marco; Josten, Christoph

    2015-01-01

    .... This work highlights the importance of scenario planning in hospitals, proposes an elaborated definition of the stakeholders of a hospital and defines the influence factors to which hospitals are exposed...

  4. Risk Factors for premature birth in a hospital

    Directory of Open Access Journals (Sweden)

    Margarita E. Ahumada-Barrios

    Full Text Available Abstract Objective: to determine the risk factors for premature birth. Methods: retrospective case-control study of 600 pregnant women assisted in a hospital, with 298 pregnant women in the case group (who gave birth prematurely <37 weeks and 302 pregnant women who gave birth to a full-term newborn in the control group. Stata software version 12.2 was used. The Chi-square test was used in bivariate analysis and logistic regression was used in multivariate analysis, from which Odds Ratios (OR and Confidence Intervals (CI of 95% were derived. Results: risk factors associated with premature birth were current twin pregnancy (adjusted OR= 2.4; p= 0.02, inadequate prenatal care (< 6 controls (adjusted OR= 3.2; p <0.001, absent prenatal care (adjusted OR= 3.0; p <0.001, history of premature birth (adjusted OR= 3.7; p <0.001 and preeclampsia (adjusted OR= 1.9; p= 0.005. Conclusion: history of premature birth, preeclampsia, not receiving prenatal care and receiving inadequate prenatal care were risk factors for premature birth.

  5. Perspectives on Promoting Hospital Primary Vaginal Birth: A Qualitative Study.

    Science.gov (United States)

    Kennedy, Holly P; Doig, Eleanor; Tillman, Stephanie; Strauss, Amanda; Williams, Beth; Pettker, Christian; Illuzzi, Jessica

    2016-12-01

    One in three women will deliver by cesarean, a procedure that can be life saving, but which also carries short- and long-term risks. There is growing interest in preventing primary cesarean deliveries, while optimizing the health of the mother and infant. The primary aim of this study was to use participatory action strategies and ethnographic interview data collected from diverse stakeholders in birth (caregivers, women, policymakers) about facilitators and barriers to the achievement of primary vaginal birth in first-time mothers in hospital settings. The secondary aim was to use the findings to identify strategies to promote primary vaginal birth and future areas of research. Individual and small group interviews were conducted with caregivers and policymakers (N = 79) and first-time mothers (N = 24) at a northeastern hospital. All interviews were audio-recorded, transcribed, and analyzed using Atlas.ti. Four broad themes were identified: 1) preparation for childbirth, 2) early labor management, 3) caregiver knowledge and practice style, and 4) birth environment (physical, cultural/emotional). The first two were closely linked from caregivers' perspectives. If the woman was not prepared for childbirth, it was perceived she would be more likely to present to the hospital in early labor. Once there, it was hard to prevent admission and interventions. A woman's knowledge and confidence were perceived as powerful mediators for vaginal birth. Caregivers and first-time mothers identified early labor management and childbirth preparation as important factors to promote primary vaginal birth in hospital settings. Both deserve further inquiry as potential strategies to decrease rising cesarean delivery rates. © 2016 Wiley Periodicals, Inc.

  6. Consumer involvement in the South Australian state policy for planned home birth.

    Science.gov (United States)

    Newman, Lareen; Hood, Jo

    2009-03-01

    Two consumer representatives were participants in the development of their state government's Policy for Planned Birth At Home in South Australia. It was released in November 2007 to guide staff in public hospital and community midwifery programs, and the first hospital-based home birth service is commencing in February 2009. Consumer experiences of policy development and perceived benefits of consumer involvement for policy and transparency processes are described. Inclusion of consumers widely and actively during development and reform of maternity care is essential if real consumer participation is to occur and contribute to care that is truly woman-centered.

  7. Leaving the hospital - your discharge plan

    Science.gov (United States)

    ... medlineplus.gov/ency/patientinstructions/000867.htm Leaving the hospital - your discharge plan To use the sharing features ... please enable JavaScript. After an illness, leaving the hospital is your next step toward recovery. Depending on ...

  8. Hospital evacuation; planning, assessment, performance and evaluation

    Institute of Scientific and Technical Information of China (English)

    Wabo Nero C; Örtenwall P; Khorram-Manesh A

    2012-01-01

    Objective: Malfunction in hospitals´ complex internal systems, or extern threats, may result in a hospital evacuation. Factors contributing to such evacuation must be identified, analyzed and action plans should be prepared. Our aims in this study were 1) to evaluate the use of risk and vulnerability analysis as a basis for hospital evacuation plan, 2) to identify risks/hazards triggering an evacuation and evaluate the respond needed and 3) to propose a template with main key points for planning, performance and evaluation of such evacuation. Methods: A risk and vulnerability analysis at two county hospitals along with a systematic online literature search based on the following keywords; “evacuation/closure”, “hospitals/medical facilities” and“disaster/hazards” alone or with “planning”, was conducted. Results: We found that although all hospitals have a disaster plan, there is a lack of knowledge and appropriate instruments to plan, perform and evaluate a hospital evacuation. Risk and vulnerability analysis can be used to reveal threats leading to an evacuation (e.g. on-going climate changes and terror actions). These key points can later be used to plan, perform and evaluate such evacuation. Conclusion: There is a need for an elaborated evacuation planning for hospitals. An evacuation plan should continuously be drilled based on a risk and vulnerability analysis. A general guide can be used as foundation to plan, perform and evaluate such plan.

  9. Strategic planning processes and hospital financial performance.

    Science.gov (United States)

    Kaissi, Amer A; Begun, James W

    2008-01-01

    Many common management practices in healthcare organizations, including the practice of strategic planning, have not been subject to widespread assessment through empirical research. If management practice is to be evidence-based, evaluations of such common practices need to be undertaken. The purpose of this research is to provide evidence on the extent of strategic planning practices and the association between hospital strategic planning processes and financial performance. In 2006, we surveyed a sample of 138 chief executive officers (CEOs) of hospitals in the state of Texas about strategic planning in their organizations and collected financial information on the hospitals for 2003. Among the sample hospitals, 87 percent reported having a strategic plan, and most reported that they followed a variety of common practices recommended for strategic planning-having a comprehensive plan, involving physicians, involving the board, and implementing the plan. About one-half of the hospitals assigned responsibility for the plan to the CEO. We tested the association between these planning characteristics in 2006 and two measures of financial performance for 2003. Three dimensions of the strategic planning process--having a strategic plan, assigning the CEO responsibility for the plan, and involving the board--are positively associated with earlier financial performance. Further longitudinal studies are needed to evaluate the cause-and-effect relationship between planning and performance.

  10. Trends of preterm birth and low birth weight in Japan: a one hospital-based study

    Directory of Open Access Journals (Sweden)

    Yorifuji Takashi

    2012-12-01

    Full Text Available Abstract Background The proportions of preterm birth (PTB, ie., delivered before 37 gestational weeks and low birth weight (LBW, ie., birth weight less than 2500 g at delivery have been rising in developed countries. We sought to examine the factors contributing to the rise in Japan, with particular focus on the effects of obstetric interventions. Methods We used a database maintained by one large regional hospital in Shizuoka, Japan. We restricted the analysis to mothers who delivered live singleton births from 1997 to 2010 (n = 19,221. We assessed the temporal trends in PTB and LBW, then divided the study period into four intervals and compared the proportions of PTB and LBW. We also compared the newborns’ outcomes between the intervals. Results PTB, in particular medically indicated PTB, increased considerably. The increase was largely explained by changes in caesarean sections. The neonatal outcomes did not worsen, and instead the Apgar scores and proportions requiring neonatal intensive care unit (NICU admission improved. In particular, the risks of NICU admission in the interval from 2007 to 2010 were decreased among all births [odds ratio (OR: 0.84; 95% confidence interval (CI: 0.75, 0.95] and medically indicated births (OR: 0.44; 95% CI: 0.29, 0.68 compared with the interval from 1997 to 2000. Conclusions Despite the increases in PTB as well as LBW, the present study suggests benefits of obstetric interventions. Rather than simple categorization of PTB or LBW, indicators such as perinatal mortality or other outcomes may be more appropriate for evaluation of perinatal health in developed countries.

  11. Maternal goals for childbirth associated with planned vaginal and planned cesarean birth.

    Science.gov (United States)

    Quiroz, Lieschen H; Blomquist, Joan L; Macmillan, Deborah; McCullough, Alexis; Handa, Victoria L

    2011-10-01

    We describe maternal childbirth goals among women planning either cesarean or vaginal birth. Women in the third trimester planning cesarean or vaginal birth were asked to report up to five childbirth goals. Goal achievement was assessed postpartum. Based on free-text responses, discrete goal categories were identified. Goals and goal achievement were compared between the two groups. Satisfaction was rated on a visual analogue scale and was compared with goal achievement. The sample included 163 women planning vaginal birth and 69 women planning cesarean. Twelve goal categories were identified. Only women planning vaginal birth reported a desire to achieve fulfillment related to childbirth. Women planning cesarean were less likely to express a desire to maintain control over their own responses during childbirth and more likely to report a desire to avoid complications. The 72 women who achieved all stated goals reported significantly higher mean satisfaction scores than the 94 women reporting that at least one goal was not achieved (P  =  0.001). Goal achievement was higher among women planning cesarean than among those planning vaginal birth (52.2% versus 23.1%, P  <  0.001). This research furthers our understanding of women's attitudes regarding cesarean childbirth and definitions of a successful birth experience. © Thieme Medical Publishers.

  12. Gross congenital malformation at birth in a government hospital

    Directory of Open Access Journals (Sweden)

    Sandeep Sachdeva

    2014-01-01

    Full Text Available A hospital-based cross-sectional study was undertaken to determine proportion of gross congenital malformation (GCMF occurring at intramural births. Rate of GCMF was found to be 16.4/1000 consecutive singleton births (>28 weeks with three leading malformation as anencephaly (44.68%, talipes equinovarus (17.02% and meningomyelocele (10.63%. Higher risk of malformed births were noticed amongst un-booked (2.07% in-comparison to booked (1.01% mothers; women with low level of education (up to 8 years [2.14%] vs. at least 9 years of schooling [0.82%]; gravida status of at least 3 (2.69% followed by 1 (1.43% and 2 (1.0% respectively; pre-term (5.13% vs. term (0.66%; cesarean section (4.36% versus vaginal delivery (0.62%. Mortality was significantly higher among congenitally malformed (17.35% than normal (0.34% newborns. With-in study limitation, emergence of neural tube defect as the single largest category of congenital malformation indicates maternal malnutrition (especially folic acid that needs appropriate attention and management.

  13. Birth Tourism and Neonatal Intensive Care: A Children's Hospital Experience.

    Science.gov (United States)

    Mikhael, Michel; Cleary, John P; Dhar, Vijay; Chen, Yanjun; Nguyen, Danh V; Chang, Anthony C

    2016-12-01

    Objective The aim of this article is to examine characteristics of birth tourism (BT) neonates admitted to a neonatal intensive care unit (NICU). Methods This was a retrospective review over 3 years; BT cases were identified, and relevant perinatal, medical, social, and financial data were collected and compared with 100 randomly selected non-birth tourism neonates. Results A total of 46 BT neonates were identified. They were more likely to be born to older women (34 vs. 29 years; p < 0.001), via cesarean delivery (72 vs. 48%; p = 0.007), and at a referral facility (80 vs. 32%; p < 0.001). BT group had longer hospital stay (15 vs. 7 days; p = 0.02), more surgical intervention (50 vs. 21%; p < 0.001), and higher hospital charges (median $287,501 vs. $103,105; p = 0.003). One-third of BT neonates were enrolled in public health insurance program and four BT neonates (10%) were placed for adoption. Conclusion Families of BT neonates admitted to the NICU face significant challenges. Larger studies are needed to better define impacts on families, health care system, and society.

  14. Determinants of survival in very low birth weight neonates in a public sector hospital in Johannesburg

    Directory of Open Access Journals (Sweden)

    Cooper Peter A

    2010-05-01

    Full Text Available Abstract Background Audit of disease and mortality patterns provides essential information for health budgeting and planning, as well as a benchmark for comparison. Neonatal mortality accounts for about 1/3 of deaths Methods This was a retrospective chart review of 474 VLBW infants admitted within 24 hours of birth, between 1 July 2006 and 30 June 2007, to the neonatal unit of Charlotte Maxeke Johannesburg Academic Hospital (CMJAH in Johannesburg, South Africa. Binary outcome logistic regression on individual variables and multiple logistic regression was done to identify those factors determining survival. Results Overall survival was 70.5%. Survival of infants below 1001 grams birth weight was 34.9% compared to 85.8% for those between 1001 and 1500 grams at birth. The main determinant of survival was birth weight with an adjusted survival odds ratio of 23.44 (95% CI: 11.22 - 49.00 for babies weighing between 1001 and 1500 grams compared to those weighing below 1001 grams. Other predictors of survival were gender (OR 3. 21; 95% CI 1.6 - 6.3, birth before arrival at the hospital (BBA (OR 0.23; 95% CI: 0.08 - 0.69, necrotising enterocolitis (NEC (OR 0.06; 95% CI: 0.02 - 0.20, hypotension (OR 0.05; 95% CI 0.01 - 0.21 and nasal continuous positive airways pressure (NCPAP (OR 4.58; 95% CI 1.58 - 13.31. Conclusions Survival rates compare favourably with other developing countries, but can be improved; especially in infants

  15. Effect of hospital nutrition support on growth velocity and nutritional status of low birth weight infants

    Directory of Open Access Journals (Sweden)

    Firas S. Azzeh

    Full Text Available Introduction: Infants with low birth weights are provided with hospital nutrition support to enhance their survivability and body weights. However, different hospitals have different nutrition support formulas. Therefore, the effectiveness of these nutrition support formulas should be investigated. Objective: To assess the effect of hospital nutrition support on growth velocity and nutritional status of low birth weight infants at Al-Noor hospital, Saudi Arabia. Methods: A cross-sectional study was conducted between October, 2010 and December, 2012. Three hundred newborns were recruited from Al-Noor Hospital in Makkah city, Saudi Arabia. Infants were selected according to their birth weights and were divided equally into three groups; (i Low Birth Weight (LBW infants (15012500 g birth weight, (ii Very Low Birth Weight (VLBW infants (1001-1500 g birth weight and (iii Extremely Low Birth Weight (ELBW infants ( 0.05 were observed among groups. Serum calcium, phosphorus and potassium levels at discharge were higher (p < 0.05 than that at birth for ELBW and VLBW groups; while sodium level decreased in ELBW group to be within normal ranges. Albumin level was improved (p < 0.05 in ELBW group. Conclusion: Health care management for low birth weight infants in Al-Noor Hospital was not sufficient to achieve normal growth rate for low birth weight infants, while biochemical indicators were remarkably improved in all groups.

  16. Plans, preferences or going with the flow: An online exploration of women's views and experiences of birth plans.

    Science.gov (United States)

    Divall, Bernie; Spiby, Helen; Nolan, Mary; Slade, Pauline

    2017-11-01

    To explore women's views of birth plans, and experiences of their completion and use. A qualitative, descriptive study, using Internet-mediated research methods. The discussion boards of two well-known, UK-based, online parenting forums, where a series of questions relating to birth plans were posted. Members of the selected parenting forums who had written and used, or who had chosen not to write or use, a birth plan. Women responded with a range of views and experiences relating to the completion and use of birth plans. The benefits of birth plans were described in terms of communication with healthcare professionals, potentially enhancing awareness of available options, and maintaining a sense of control during labour and birth. However, many respondents believed the idea of 'planning' birth was problematic, and described a reluctance to write a formal plan. The support of healthcare professionals, particularly midwives, was considered essential to the success of both writing and using birth plans. Our findings show a continued debate among women on the benefits and challenges involved in writing and using birth plans, suggesting problems for a 'one size fits all' approach often seen in the use of birth plan templates. In the context of maternity policy supporting women's choice and personalised care, and as a way of acknowledging perceived problems of 'planning' for birth, a flexible approach to birth plans is required, including the consideration of employing alternative nomenclature. Birth plans remain a point of contention in care contexts around the world. Midwives and other healthcare providers play a central role in supporting women to discuss available options, whether or not they decide to complete a formal birth plan. Copyright © 2017 Elsevier Ltd. All rights reserved.

  17. Management strategies in hospitals: scenario planning

    Directory of Open Access Journals (Sweden)

    Ghanem, Mohamed

    2015-06-01

    Full Text Available Background: Instead of waiting for challenges to confront hospital management, doctors and managers should act in advance to optimize and sustain value-based health. This work highlights the importance of scenario planning in hospitals, proposes an elaborated definition of the stakeholders of a hospital and defines the influence factors to which hospitals are exposed to. Methodology: Based on literature analysis as well as on personal interviews with stakeholders we propose an elaborated definition of stakeholders and designed a questionnaire that integrated the following influence factors, which have relevant impact on hospital management: political/legal, economic, social, technological and environmental forces. These influence factors are examined to develop the so-called critical uncertainties. Thorough identification of uncertainties was based on a “Stakeholder Feedback”. Results: Two key uncertainties were identified and considered in this study: According to the developed scenarios, complementary education of the medical staff as well as of non-medical top executives and managers of hospitals was the recommended core strategy. Complementary scenario-specific strategic options should be considered whenever needed to optimize dealing with a specific future development of the health care environment. Conclusion: Strategic planning in hospitals is essential to ensure sustainable success. It considers multiple situations and integrates internal and external insights and perspectives in addition to identifying weak signals and “blind spots”. This flows into a sound planning for multiple strategic options. It is a state of the art tool that allows dealing with the increasing challenges facing hospital management.

  18. Developing a strategic marketing plan for hospitals.

    Science.gov (United States)

    Dychtwald, K; Zitter, M

    1988-09-01

    The initial stages of developing a strategic marketing plan for hospitals are explored in this excerpt from the book, The Role of the Hospital in an Aging Society: A Blueprint for Action. The elderly have unique perceptual, cognitive, social, and psychological needs and preferences, and a marketing strategy for eldercare services must reflect these factors, as well as the financial role of third-party payers and the decision-making influence of families and physicians. Among the elements the hospital must address when developing a marketing strategy are market selection and segmentation, targeting markets with specific services, pricing, and positioning the hospital for a maximum share of the eldercare market.

  19. Are women birthing in New South Wales hospitals satisfied with their care?

    OpenAIRE

    Ford, Jane B.; Hindmarsh, Diane M; Browne, Kim M; Todd, Angela L.

    2015-01-01

    Background Surveys of satisfaction with maternity care have been conducted using overnight inpatient surveys and dedicated maternity surveys in a number of Australian settings, however none have been used to report on satisfaction with maternity care among women in New South Wales. The aims of this study were to investigate the association between: 1) parity (first and subsequent births) and patient experience of hospital care at birth, and 2) other patient, birth and hospital characteristics...

  20. Socioeconomic inequalities in hospital births in China between 1988 and 2008.

    Science.gov (United States)

    Feng, Xing Lin; Xu, Ling; Guo, Yan; Ronsmans, Carine

    2011-06-01

    To assess trends in hospital births in China during 1988-2008 in an effort to determine if efforts to overcome financial barriers to giving birth in hospital have reduced the access gap between the rich and the poor. Cross-sectional data obtained from four National Health Service Surveys were used to determine trends in hospital births during 1988-2008. Crude and adjusted annual rates were calculated by means of Poisson regression and were used to define trends across socioeconomic regions and households in different income quintiles. In 2008 women throughout China were giving birth in hospital almost universally except in region IV, the most remote rural region, where the percentage of hospital births was only 60.8. Hospital births in this region had increased steadily before 2002, but after that year the upward trend slowed down. During 1988-2001 the average yearly increase had been 21%, but in 2002-2008 it dropped to 10% (P = 0.0031). Inequalities between socioeconomic regions were greater than among individual households belonging to different income strata. By 2008 the difference between low- and high-income households in the proportion of hospital births had become very small (96.1% and 87.7% of high- and low-income households, respectively, gave birth in hospital that year). Most Chinese women now give birth in hospital, but the poorest rural region is still lagging behind. A more active and comprehensive approach will be needed to increase hospital births in these remote, hard-to-reach populations.

  1. Barriers to increasing hospital birth rates in rural Shanxi Province, China.

    Science.gov (United States)

    Gao, Yu; Barclay, Lesley; Kildea, Sue; Hao, Min; Belton, Suzanne

    2010-11-01

    This study investigated the reasons for continued high rates of home births in rural Shanxi Province, northern China, despite a national programme designed to encourage hospital deliveries. We conducted semi-structured interviews with 30 home-birthing women in five rural counties and drew on hospital audit data, observations and interviews with local health workers from a larger study. Multiple barriers were identified, including economic and geographic factors and poor quality of maternity care. Women's main reasons for not having institutional births were financial difficulties (n=26); poor quality of antenatal care (n=13); transport problems (n=11); dissatisfaction with hospital care expressed as fear of being in hospital (n=10); convenience of being at home and continuity of care provided by traditional birth attendants (TBAs) (n=10); and belief that the birth would be normal (n=6). These barriers must all be overcome to improve access to and acceptability of hospital birth. To ensure that the national policy of improving the hospital birth rate is implemented effectively, the government needs to improve the quality of antenatal and delivery care, increase financial subsidies to reduce out-of-pocket payments, remove transport barriers, and where hospital birth is not available in remote areas, consider allowing skilled attendance at home on an outreach basis and integrate TBAs into the health system.

  2. Management strategies in hospitals: scenario planning.

    Science.gov (United States)

    Ghanem, Mohamed; Schnoor, Jörg; Heyde, Christoph-Eckhard; Kuwatsch, Sandra; Bohn, Marco; Josten, Christoph

    2015-01-01

    Instead of waiting for challenges to confront hospital management, doctors and managers should act in advance to optimize and sustain value-based health. This work highlights the importance of scenario planning in hospitals, proposes an elaborated definition of the stakeholders of a hospital and defines the influence factors to which hospitals are exposed to. Based on literature analysis as well as on personal interviews with stakeholders we propose an elaborated definition of stakeholders and designed a questionnaire that integrated the following influence factors, which have relevant impact on hospital management: political/legal, economic, social, technological and environmental forces. These influence factors are examined to develop the so-called critical uncertainties. Thorough identification of uncertainties was based on a "Stakeholder Feedback". Two key uncertainties were identified and considered in this study: the development of workload for the medical staff the profit oriented performance of the medical staff. According to the developed scenarios, complementary education of the medical staff as well as of non-medical top executives and managers of hospitals was the recommended core strategy. Complementary scenario-specific strategic options should be considered whenever needed to optimize dealing with a specific future development of the health care environment. Strategic planning in hospitals is essential to ensure sustainable success. It considers multiple situations and integrates internal and external insights and perspectives in addition to identifying weak signals and "blind spots". This flows into a sound planning for multiple strategic options. It is a state of the art tool that allows dealing with the increasing challenges facing hospital management.

  3. Management strategies in hospitals: scenario planning

    Science.gov (United States)

    Ghanem, Mohamed; Schnoor, Jörg; Heyde, Christoph-Eckhard; Kuwatsch, Sandra; Bohn, Marco; Josten, Christoph

    2015-01-01

    Background: Instead of waiting for challenges to confront hospital management, doctors and managers should act in advance to optimize and sustain value-based health. This work highlights the importance of scenario planning in hospitals, proposes an elaborated definition of the stakeholders of a hospital and defines the influence factors to which hospitals are exposed to. Methodology: Based on literature analysis as well as on personal interviews with stakeholders we propose an elaborated definition of stakeholders and designed a questionnaire that integrated the following influence factors, which have relevant impact on hospital management: political/legal, economic, social, technological and environmental forces. These influence factors are examined to develop the so-called critical uncertainties. Thorough identification of uncertainties was based on a “Stakeholder Feedback”. Results: Two key uncertainties were identified and considered in this study: the development of workload for the medical staff the profit oriented performance of the medical staff. According to the developed scenarios, complementary education of the medical staff as well as of non-medical top executives and managers of hospitals was the recommended core strategy. Complementary scenario-specific strategic options should be considered whenever needed to optimize dealing with a specific future development of the health care environment. Conclusion: Strategic planning in hospitals is essential to ensure sustainable success. It considers multiple situations and integrates internal and external insights and perspectives in addition to identifying weak signals and “blind spots”. This flows into a sound planning for multiple strategic options. It is a state of the art tool that allows dealing with the increasing challenges facing hospital management. PMID:26504735

  4. COLOR PLANNING FOR HOSPITALS AND SCHOOLS.

    Science.gov (United States)

    Mobil Finishes Co., Inc., Chicago, IL.

    THE AIM OF THIS MANUAL PREPARED FOR ARCHITECTS AND BUILDERS IS TO PROVIDE FOR COLOR PLANNING IN HOSPITALS AND SCHOOLS AND ALTHOUGH APPROPRIATE FOR THE SELECTION OF ALL INTERIOR SURFACE MATERIALS IN NEW CONSTRUCTION. IN SCHOOL, AND INDIVIDUAL'S EXPOSURE TO DECORATION IS REPEATED DAILY FOR BOTH STUDENTS AND STAFF ATTEND AT LEAST FOR THE SCHOOL…

  5. [Put the planned birth propaganda and education in number 1 place: a summary of a conference].

    Science.gov (United States)

    Zhuang, F

    1981-04-01

    The Planned Birth Office of the Chinese State Council convened a National Planned Birth Propaganda Symposium in Beijing from January 10 to 14, 1981. There were over 50 representatives from various provincial, municipal, autonomous regional planned birth offices, Shanghai, Beijing, and Chengdu's Planned Birth Propaganda and Education Centers, the Central Cultural, Education and Public Health Ministries, and various population research centers, and journalists. The Vice-premier of the Chinese State Council, Chen Muhua made the following points in an address to the delegates: planned birth is a longterm project; the 2-fold character of production, i.e., material production and human reproduction, must be properly understood; the goal of limiting China's population to 1,200,000,000 is difficult, so everyone must plan for their families by understanding the work of birth planning early, carefully, and securely, and further that late marriage, late births, few births, and superior births must be advocated the attitude that families without sons will have no heirs must be abolished because girls are heirs too; the fear that China will become an aged society must be ameliorated because China's age structure is a young one. Wang Renchong, Chairman of the Central Propaganda Ministry, also addressed the Symposium. He remarked that with a population approaching 1 billion, 80% of whom are peasants, population control is crucial to the nation's health and survival and is an important part of the Four Modernizations. Birth planning propaganda and education must be given top priority, especially in rural areas. The chairman of the Planned Birth Office of the Chinese State Council closed the meetings by saying that birth planning work must rely on the Party and governmental policies, and especially on propaganda.

  6. Trends in Out-of-Hospital Births in the United States, 1990-2012

    Science.gov (United States)

    ... influenced by differences in state laws pertaining to midwifery practice or out-of-hospital births ( 10–11 ), ... in the United States choose home birth. J Midwifery Womens Health 54(2):119–26. 2009. Health ...

  7. Validity of Health Plan and Birth Certificate Data for Pregnancy Research

    Science.gov (United States)

    Andrade, Susan E.; Scott, Pamela E.; Davis, Robert L.; Li, De-Kun; Getahun, Darios; Cheetham, T. Craig; Raebel, Marsha A.; Toh, Sengwee; Dublin, Sascha; Pawloski, Pamala A.; Hammad, Tarek A.; Beaton, Sarah J.; Smith, David H.; Dashevsky, Inna; Haffenreffer, Katherine; Cooper, William O.

    2012-01-01

    Purpose To evaluate the validity of health plan and birth certificate data for pregnancy research. Methods A retrospective study was conducted using administrative and claims data from 11 U.S. health plans, and corresponding birth certificate data from state health departments. Diagnoses, drug dispensings, and procedure codes were used to identify infant outcomes (cardiac defects, anencephaly, preterm birth, and neonatal intensive care unit [NICU] admission) and maternal diagnoses (asthma and systemic lupus erythematosus [SLE]) recorded in the health plan data for live born deliveries between January 2001 and December 2007. A random sample of medical charts (n = 802) was abstracted for infants and mothers identified with the specified outcomes. Information on newborn, maternal, and paternal characteristics (gestational age at birth, birth weight, previous pregnancies and live births, race/ethnicity) was also abstracted and compared to birth certificate data. Positive predictive values (PPVs) were calculated with documentation in the medical chart serving as the gold standard. Results PPVs were 71% for cardiac defects, 37% for anencephaly, 87% for preterm birth, and 92% for NICU admission. PPVs for algorithms to identify maternal diagnoses of asthma and SLE were ≥ 93%. Our findings indicated considerable agreement (PPVs > 90%) between birth certificate and medical record data for measures related to birth weight, gestational age, prior obstetrical history, and race/ethnicity. Conclusions Health plan and birth certificate data can be useful to accurately identify some infant outcomes, maternal diagnoses, and newborn, maternal, and paternal characteristics. Other outcomes and variables may require medical record review for validation. PMID:22753079

  8. Do hospitals practice strategic planning? An empirical study.

    Science.gov (United States)

    Zallocco, R; Joseph, B; Furey, N

    1984-02-01

    A survey was conducted to determine the extent of strategic planning management and specific planning techniques used in hospitals today. Results indicate that approximately one-half of all hospitals use some sort of formalized strategic planning, although many of these are in the early stages of development. Data is also provided on other strategic planning issues such as budget allocations to planning, planning process participants, and aspects of planning needing improvement. A general discussion of the value of strategic planning to hospital management is offered.

  9. Poor birth weight recovery among low birth weight/preterm infants following hospital discharge in Kampala, Uganda

    Directory of Open Access Journals (Sweden)

    Namiiro Flavia B

    2012-01-01

    Full Text Available Abstract Background Healthy infants typically regain their birth weight by 21 days of age; however, failure to do so may be due to medical, nutritional or environmental factors. Globally, the incidence of low birth weight deliveries is high, but few studies have assessed the postnatal weight changes in this category of infants, especially in Africa. The aim was to determine what proportion of LBW infants had not regained their birth weight by 21 days of age after discharge from the Special Care Unit of Mulago hospital, Kampala. Methods A cross sectional study was conducted assessing weight recovery of 235 LBW infants attending the Kangaroo Clinic in the Special Care Unit of Mulago Hospital between January and April 2010. Infants aged 21 days with a documented birth weight and whose mothers gave consent to participate were included in the study. Baseline information was collected on demographic characteristics, history on pregnancy, delivery and postnatal outcome through interviews. Pertinent infant information like gestation age, diagnosis and management was obtained from the medical records and summarized in the case report forms. Results Of the 235 LBW infants, 113 (48.1% had not regained their birth weight by 21 days. Duration of hospitalization for more than 7 days (AOR: 4.2; 95% CI: 2.3 - 7.6; p value Conclusion Failure to regain birth weight among LBW infants by 21 days of age is a common problem in Mulago Hospital occurring in almost half of the neonates attending the Kangaroo clinic. Currently, the burden of morbidity in this group of high-risk infants is undetected and unaddressed in many developing countries. Measures for consideration to improve care of these infants would include; discharge after regaining birth weight and use of total parenteral nutrition. However, due to the pressure of space, keeping the baby and mother is not feasible at the moment hence the need for a strong community system to boost care of the infant. Close

  10. An overview of distribution of births in United States hospitals in 2008 with implications for small volume perinatal units in rural hospitals.

    Science.gov (United States)

    Simpson, Kathleen Rice

    2011-01-01

    To evaluate the distribution of births among United States (U.S.) hospitals in 2008 as part of the background for the Association of Women's Health, Obstetric and Neonatal Nurses' Guidelines for Professional Registered Nurse Staffing for Perinatal Units. Descriptive analysis of birth volumes in U.S. hospitals using American Hospital Association Annual Survey: 2008. U.S. hospitals providing obstetric (OB) services were identified based on information in any of three fields: OB services, OB beds, or number of births. Data were verified via telephone and/or website for the top 100 hospitals based on volume, hospitals with "Healthcare System" as part of their names, hospitals reporting births but no OB service, and hospitals reporting births. Hospitals with births were queried regarding nurse staffing. Descriptive statistics were used to analyze data. Approximately 3,265 U.S. hospitals offered OB services in 2008. The top 500 hospitals based on volume (15.3%) accounted for almost one half (47.4%) of births, the top 1,000 for 69.2%, and the remaining 2,265 for 30.8%. Fourteen percent of hospitals with births in 2008 reported discontinuing OB services in 2010, in part due to lack of physician coverage and costs. Most hospitals (n=159, 72.3%) with births routinely maintained two OB-skilled nurses in-house in 2010. U.S. births are unevenly distributed among hospitals; 15% have a disproportionate share of nearly one half of all births. Most hospitals (69.4%) are operating medium- to small-volume OB units. Most hospitals (72.3%) with births annually reported currently meeting minimum staffing guidelines. © 2011 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

  11. Birth weight pattern in the only referral teaching hospital in Manipur.

    Science.gov (United States)

    Akoijam, B S; Thangjam, N D; Singh, K T; Devi, S R; Devi, R K P

    2006-01-01

    Birth weight is an important determinant for child development and survival. Birth weight has been reported to be increasing with the passing years. There is no such accurate documentation from the state of Manipur. This cross sectional study has been attempted to see the birth weight pattern in the largest referral hospital in Manipur. Birth weights of four reference years in the last 15 years have been extracted from the records and analysed. There were 19478 singleton deliveries in the four reference years. The mean birth weight showed a gradual increase in these years. There was a gain of 88.9 g in 2000 since 1986 in term deliveries. There were significant differences in the mean birth weights among the four years, even after stratifying for gestation. However, there was no significant decrease in the percentage of low birth weight babies in these years. Low birth weight showed significant association with parity, age of the mother, booking status, haemoglobin level, and literacy of the mother. Since there was no significant decrease in low birth weight babies in spite of increasing birth weight, there is a need for continued and committed effort to realize the goals of RCH.

  12. Birthing support and breastfeeding initiation in Somaliland: experiences at the Edna Adan Maternity Hospital in Hargeisa, Somaliland.

    Science.gov (United States)

    Holder, Kelly

    2011-03-01

    Research has identified a relationship between birthing practices and breastfeeding initiation Continuous support during labor and delivery is a key component to increasing breastfeeding initiation. The purpose of this project was to assess the impact of labor support on breastfeeding initiation in a setting in which women receive traditional birthing support from female family members. Research was conducted at the Edna Adan Maternity Hospital in Hargeisa, Somaliland using the grounded theory method of qualitative research. Semi-structured interviews, direct observations and participant observations were conducted. A purposeful, non-statistical sample was chosen: ten women, five family members, six health care providers and five birth observations were included. The CDC EZ-Text, a software program developed by the Center for Disease Control and Prevention for use in qualitative research, was used in managing and analyzing the data. Data analysis and interpretation was conducted using micro-analysis, open, axial and selective coding procedures. The results indicated that due to cultural influences, contradictory beliefs and practices, lack of critical thinking and lack of long term planning, traditional birthing support was not always indicative of immediate breastfeeding initiation. The presence of a labor companion is a low-cost, preventative intervention that is consistent with the cultural practices of Somaliland. Breastfeeding education and support should, therefore, include a tertiary approach which includes pregnant and birthing women, labor support persons or family members and health care providers.

  13. 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.

  14. Obstetric and birth outcomes in pregnant women with epilepsy: A hospital-based study

    Directory of Open Access Journals (Sweden)

    Noor Haslina Othman

    2013-01-01

    Full Text Available Introduction : In addition to changes in seizure frequency, pregnant women with epilepsy (WWE are at increased risk of complications during pregnancy or delivery. In the absence of a nationwide WWE registry, hospital-based studies may provide important information regarding current management and outcomes in these patients. Objectives: The aims of this study were to determine changes in seizure frequency, and pregnancy and birth outcomes among pregnant WWE. Materials and Methods: We conducted a retrospective review of medical records of pregnant patients with epilepsy, who obtained medical care (from 2006 to 2011 at one of the general hospitals in the North-Eastern State of Malaysia. Data were collected for seizure frequency before and during the pregnancy, concurrent medications, pregnancy complications, and neonatal outcomes. Results: We reviewed records of 25 patients with a total of 33 different pregnancies. All patients were treated with antiepileptic medications during their pregnancies, with 42% monotherapy and 58% polytherapy. Seizure frequency decreased in 5 (15.2%, increased in 18 (54.5% and unchanged in 10 (30.3% cases of pregnancies. Pregnancy complications were anemia, gestational diabetes mellitus, gestational hypertension, intrauterine growth retardation, premature rupture of membrane, and vaginal bleeding. Preterm deliveries were recorded in 11 (33.3% infants. Conclusion: In our setting, many patients were being on polytherapy during their pregnancies. This underscores the need for planned pregnancies so that antiepileptic medications can be optimized prior to pregnancy.

  15. Hospital bioterrorism planning and burn surge.

    Science.gov (United States)

    Kearns, Randy D; Myers, Brent; Cairns, Charles B; Rich, Preston B; Hultman, C Scott; Charles, Anthony G; Jones, Samuel W; Schmits, Grace L; Skarote, Mary Beth; Holmes, James H; Cairns, Bruce A

    2014-01-01

    On the morning of June 9, 2009, an explosion occurred at a manufacturing plant in Garner, North Carolina. By the end of the day, 68 injured patients had been evaluated at the 3 Level I trauma centers and 3 community hospitals in the Raleigh/Durham metro area (3 people who were buried in the structural collapse died at the scene). Approximately 300 employees were present at the time of the explosion, when natural gas being vented during the repair of a hot water heater ignited. The concussion from the explosion led to structural failure in multiple locations and breached additional natural gas, electrical, and ammonia lines that ran overhead in the 1-story concrete industrial plant. Intent is the major difference between this type of accident and a terrorist using an incendiary device to terrorize a targeted population. But while this disaster lacked intent, the response, rescue, and outcomes were improved as a result of bioterrorism preparedness. This article discusses how bioterrorism hospital preparedness planning, with an all-hazards approach, became the basis for coordinated burn surge disaster preparedness. This real-world disaster challenged a variety of systems, hospitals, and healthcare providers to work efficiently and effectively to manage multiple survivors. Burn-injured patients served as a focus for this work. We describe the response, rescue, and resuscitation provided by first responders and first receivers as well as efforts made to develop burn care capabilities and surge capacity.

  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. Changes in Perinatal Care and Predictors of In-Hospital Mortality for Very Low Birth Weight Preterm Infants

    Directory of Open Access Journals (Sweden)

    Ying Dong

    2012-09-01

    Full Text Available Objective: Mortality of very low birth weight premature infants is of great public health concern. To better guide local intervention program, it is essential that current and reliable statistics be collected to understand the factors associated with mortality of these infants.Methods: Data of very low birth weight premature infants admitted to a neonatal unit during 2002-2009 was retrospectively collected. Changes in perinatal care between two halves of the study period (2002-2005 and 2006-2009 were identified. Factors associated with in-hospital mortality were found by logistic regression and a predictive score model was established.Findings: A total of 475 cases were enrolled. In-hospital mortality decreased from 29.8% in 2002-2005 to 28.1% in 2006-2009 (P>0.05. More infants born<28 gestational weeks survived to discharge in the latter epoch (38.1% vs 8.3%, P<0.05. Persistent pulmonary hypertension of newborn, pulmonary hemorrhage,birth weight <000 grams, gestational age <33 weeks, feeding before 3 postnatal days and enteral feeding were found predictors of in-hospital mortality by logistic regression. The discriminating ability of the predictivemodel was 82.4% and the cutoff point was -0.56.Conclusion: Survival of very low birth weight premature neonates was not significantly improved in 2006-2009 than 2002-2005. Infants with a score higher than -0.56 were assessed to be at high risk of in-hospital mortality. Multi-center studies of planned follow-up are needed to develop a comprehensive and applicable score system.

  18. Exercise during pregnancy and risk of late preterm birth, cesarean delivery, and hospitalizations

    Science.gov (United States)

    Tinloy, Jennifer; Zhu, Junjia; Pauli, Jaimey; Kraschnewski, Jennifer L.; Kjerulff, Kristen H.

    2013-01-01

    Background Federal physical activity guidelines recommend at least 150 minutes of moderate-intensity exercise per week during pregnancy. We studied whether regular exercise during pregnancy is associated with preterm birth, cesarean delivery, and hospitalization during pregnancy. Methods Self-reported weekly exercise was ascertained in 3,006 women during the 3rd trimester of pregnancy. Using multivariable logistic regression, we report the relationship between regular exercise (at least 150 minutes per week) and late preterm birth, cesarean delivery, and hospitalization during pregnancy, controlling for age, race, marital status, education, poverty status, pre-pregnancy BMI weight category, gestational weight gain, and prepregnancy diabetes or hypertension. Results Nearly one-third of women reported meeting current federal physical activity recommendations during pregnancy. Five percent had late preterm birth, 29% had cesarean deliveries, and 20% reported hospitalization during pregnancy. In multivariable analysis, regular exercise during pregnancy was not associated with late preterm birth or hospitalization during pregnancy. Physical activity of 150 or more minutes/week was associated with reduced odds of cesarean delivery compared with less than 60 minutes/week, but the finding was not statistically significant (adjusted OR 0.86, 95% CI 0.69 – 1.07). Conclusion In the First Baby Study, physical activity was not associated with late preterm birth or hospitalizations, and may be associated with decreased odds of cesarean delivery. PMID:24439953

  19. [Family planning programs and birth control in the third world].

    Science.gov (United States)

    Wohlschlagl, H

    1991-01-01

    The population explosion has been abating since the 2nd half of the 1960s. The birth rate of the 3rd World dropped from 45/1000 during 1950-55 to 31/1000 during 1985-90. From the 1st half of the 1960s to the 1st half of the 1980s the total fertility of such countries dropped from 6.1 to 4.2 children/woman. In Taiwan, Singapore, Hong Kong, South Korea, and Malaysia living standards improved as a result of industrialization, and fertility decreased significantly. In Sri Lanka, China, North Vietnam, and Thailand the drop of fertility is explained by cultural and religious factors. In 1982 about 78% of the population of developing countries lived in 39 states that followed an official policy aimed at reducing the population. Another 16% lived in countries supporting the concept of a desired family size. However, World Bank data showed that in the mid-1980s in 27 developing countries no state family planning (FP) programs existed. India adopted an official FP program in 1952, Pakistan followed suit in 1960, South Korea in 1961, and China in 1962. In Latin America a split policy manifested itself: in Brazil birth control was rejected, only Colombia had a FP policy. In 1986 the governments of 68 of 131 developing countries representing 3.1 billion people considered the number of children per woman too high. 31 of these countries followed concrete population control policies. On the other hand, in 1986 24 countries of Africa with 40% of the continent's population took no measures to influence population growth. In Latin America and the Caribbean 18 of 33 countries were idle, except for Mexico that had a massive state FP program. These programs also improve maternal and child health with birth spacing of at least 2 years, and the prevention of pregnancies of too young women or those over 40. The evaluation of rapidly spreading FP programs in the 1970s was carried out by the World Fertility Survey in 41 countries. The impact of FP programs was more substantial than

  20. Hospital Discharge Planning: A Guide for Families and Caregivers

    Science.gov (United States)

    ... FCA - A A + A You are here Home Hospital Discharge Planning: A Guide for Families and Caregivers ... publication Printer-friendly version A trip to the hospital can be an intimidating event for patients and ...

  1. Effect of Implementing a Birth Plan on Womens' Childbirth Experiences and Maternal & Neonatal Outcomes

    Science.gov (United States)

    Farahat, Amal Hussain; Mohamed, Hanan El Sayed; Elkader, Shadia Abd; El-Nemer, Amina

    2015-01-01

    Childbirth satisfaction represents a sense of feeling good about one's birth. It is thought to result from having a sense of control, having expectations met, feeling empowered, confident and supported. The aim of this study was to implement a birth plan and evaluate its effect on women's childbirth experiences and maternal, neonatal outcomes. A…

  2. Access to the Birth Control Pill and the Career Plans of Young Men and Women

    DEFF Research Database (Denmark)

    Steingrimsdottir, Herdis

    The paper explores the effect of unrestricted access to the birth control pill on young people’s career plans, using annual surveys of college freshmen from 1968 to 1980. In particular it addresses the question of who was affected by the introduction of the birth control pill by looking at career...

  3. Congenital malformations at birth in Central India: A rural medical college hospital based data.

    Science.gov (United States)

    Taksande, Amar; Vilhekar, Krishna; Chaturvedi, Pushpa; Jain, Manish

    2010-09-01

    To study the incidence of congenital anomalies and the associated risk factors in Department of Pediatrics at Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, a rural medical college hospital in central Maharashtra. All the intramural deliveries between 1 January 2005 and 31 July 2007 comprised 9386 births and their 9324 mothers (62 mothers gave birth to twin babies). The newborns were examined and assessed systematically for the presence of congenital anomalies, system wise distribution of anomalies and risk factors attributable. Out of the total 9386 deliveries, 9194 were live births and 192 were stillbirths. The total number of babies with congenital malformations was 179 (1.91%). Out of the 9262 singleton births, 177 (1.05%) were malformed, whereas 2 of the 62 pairs of twins had birth defects. Nine of the 179 malformed babies (5.02%) were still born. Prematurity, increased maternal age, increasing birth order and low birth weight were found to have a higher risk of congenital anomalies. Cardiovascular malformations were most common in live births, followed by musculoskeletal and genitourinary anomalies. Congenital anomalies are a major cause of stillbirths and infant mortality. Evaluation of cardiovascular system to rule out congenital heart disease in high-risk mothers' babies is the important factor to be considered.

  4. Ohio hospital PR pros collaborate on crisis communications plan.

    Science.gov (United States)

    Rees, Tom

    2002-01-01

    Two member hospitals of the Akron Regional Hospital Association (ARHA), Ohio, experienced crisis situations which severely strained their public relations resources. These events were the genesis for the development of a comprehensive plan for sharing public relations resources among 11 member hospitals. The plan details procedures for sharing help in the event of a crisis or specific hospital media event. It identifies three potential situations in which it can be implemented: internal disaster, external disaster, or a specific incident unique to one of the hospitals. No occasion has yet arisen to implement the plan.

  5. Serious adverse neonatal outcomes such as 5-minute Apgar score of zero and seizures or severe neurologic dysfunction are increased in planned home births after cesarean delivery.

    Science.gov (United States)

    Grünebaum, Amos; McCullough, Laurence B; Arabin, Birgit; Chervenak, Frank A

    2017-01-01

    The United States is with 37,451 home births in 2014 the country with the largest absolute number of home births among all developed countries. The purpose of this study was to examine the occurrence and risks of a 5-minute Apgar score of zero and neonatal seizures or serious neurologic dysfunction in women with a history of prior cesarean delivery for planned home vaginal birth after cesarean (VBAC), compared to hospital VBAC and hospital birth cesarean deliveries for term normal weight infants in the United States from 2007-2014. We report in this study outcomes of women who had one or more prior cesarean deliveries and included women who had a successful vaginal birth after a trial of labor after cesarean (TOLAC) at home and in the hospital, and a repeat cesarean delivery in the hospital. We excluded preterm births (Apgar score of 0 of 1 in 890 (11.24/10,000, relative risk 9.04, 95% confidence interval 4-20.39, p<.0001) and an incidence of neonatal seizures or severe neurologic dysfunction of 1 in 814 (Incidence: 12.27/10,000, relative risk 11.19, 95% confidence interval 5.13-24.29, p<.0001). Because of the significantly increased neonatal risks, obstetric providers should therefore not offer or perform planned home TOLACs and for those desiring a VBAC should strongly recommend a planned TOLAC in the appropriate hospital setting. We emphasize that this stance should be accompanied by effective efforts to make TOLAC available in the appropriate hospital setting.

  6. Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study.

    Science.gov (United States)

    Brocklehurst, Peter; Hardy, Pollyanna; Hollowell, Jennifer; Linsell, Louise; Macfarlane, Alison; McCourt, Christine; Marlow, Neil; Miller, Alison; Newburn, Mary; Petrou, Stavros; Puddicombe, David; Redshaw, Maggie; Rowe, Rachel; Sandall, Jane; Silverton, Louise; Stewart, Mary

    2011-11-23

    To compare perinatal outcomes, maternal outcomes, and interventions in labour by planned place of birth at the start of care in labour for women with low risk pregnancies. Prospective cohort study. England: all NHS trusts providing intrapartum care at home, all freestanding midwifery units, all alongside midwifery units (midwife led units on a hospital site with an obstetric unit), and a stratified random sample of obstetric units. 64,538 eligible women with a singleton, term (≥37 weeks gestation), and "booked" pregnancy who gave birth between April 2008 and April 2010. Planned caesarean sections and caesarean sections before the onset of labour and unplanned home births were excluded. A composite primary outcome of perinatal mortality and intrapartum related neonatal morbidities (stillbirth after start of care in labour, early neonatal death, neonatal encephalopathy, meconium aspiration syndrome, brachial plexus injury, fractured humerus, or fractured clavicle) was used to compare outcomes by planned place of birth at the start of care in labour (at home, freestanding midwifery units, alongside midwifery units, and obstetric units). There were 250 primary outcome events and an overall weighted incidence of 4.3 per 1000 births (95% CI 3.3 to 5.5). Overall, there were no significant differences in the adjusted odds of the primary outcome for any of the non-obstetric unit settings compared with obstetric units. For nulliparous women, the odds of the primary outcome were higher for planned home births (adjusted odds ratio 1.75, 95% CI 1.07 to 2.86) but not for either midwifery unit setting. For multiparous women, there were no significant differences in the incidence of the primary outcome by planned place of birth. Interventions during labour were substantially lower in all non-obstetric unit settings. Transfers from non-obstetric unit settings were more frequent for nulliparous women (36% to 45%) than for multiparous women (9% to 13%). The results support a policy

  7. Case mix planning in hospitals: a review and future agenda.

    Science.gov (United States)

    Hof, Sebastian; Fügener, Andreas; Schoenfelder, Jan; Brunner, Jens O

    2017-06-01

    The case mix planning problem deals with choosing the ideal composition and volume of patients in a hospital. With many countries having recently changed to systems where hospitals are reimbursed for patients according to their diagnosis, case mix planning has become an important tool in strategic and tactical hospital planning. Selecting patients in such a payment system can have a significant impact on a hospital's revenue. The contribution of this article is to provide the first literature review focusing on the case mix planning problem. We describe the problem, distinguish it from similar planning problems, and evaluate the existing literature with regard to problem structure and managerial impact. Further, we identify gaps in the literature. We hope to foster research in the field of case mix planning, which only lately has received growing attention despite its fundamental economic impact on hospitals.

  8. DETECTION OF LOW BIRTH WEIGHT BABIES BY AN ANTHROPOMETRIC SURROGATE MEASURE: A HOSPITAL BASED STUDY

    Directory of Open Access Journals (Sweden)

    Anjali

    2014-05-01

    Full Text Available INTRODUCTION: Birth weight is an indicator of both neonatal morbidity and mortality, maternal health, nutrition and quality of antenatal services. OBJECTIVE: To find out important anthropometric parameter(s in the newborn as related to birth weight so that newborns with low birth weight can be identified. MATERIAL AND METHODS: A prospective cross sectional, analytical, hospital based study was conducted at Amritsar on 200 term low birth weight newborn babies(<2.5 kg born during a period of 10 months and their various anthropometric measurements (HC, CC, MAC, TC, CFC were taken according to standard techniques. RESULTS: The study showed a strong correlation (p <0.001 between mid-arm circumference (r=0.834 and birth weight, followed by head circumference (r=0.816 and birth weight. Other parameters were also strongly correlated (p < 0.001. A value of <9.2 cm and <7.6 cm for mid-arm circumference showed highest validity for picking up newborns weighing <2500 gm and <2000 gm respectively. CONCLUSION: Measurement of arm circumference is easier, convenient and statistically superior to other anthropometrical parameters in detection of low birth weight newborn babies. The researchers recommend designing of a simple 'Tri-colored tape' for early detection of 'At Risk' LBW newborns in rural communities for their timely management.

  9. Home or hospital birth: a prospective study of midwifery care in the Netherlands.

    NARCIS (Netherlands)

    Wiegers, T.A.

    1997-01-01

    A large scale study on maternity care in the Netherlands, describing many facets of midwifery care in relation to the preferred place of birth (at home or in hospital), the obstetric result, and the experiences of childbirth. In the Netherlands only women with low risk pregnancies are free to cho

  10. Preparedness planning for pandemic influenza among large US maternity hospitals

    Directory of Open Access Journals (Sweden)

    A Akers

    2009-01-01

    Full Text Available The objective of this investigation was to determine the state of pandemic influenza preparedness and to delineate commonly reported challenges among a sample of larger US national maternity hospitals. This was done given the recent emphasis on hospital disaster planning and the disproportionate morbidity and mortality that pregnant women have suffered in previous influenza pandemics. An internet-based survey was sent to all 12 members of the Council of Women's and Infants' Specialty Hospitals. Questions addressed hospital demographics and overall pandemic preparedness planning, including presence of a pandemic planning committee and the existence of written plans addressing communications, surge capacity, degradation of services, and advance supply planning. Nine of 12 (75% hospitals responded. All had active pandemic planning committees with identified leadership. The majority (78% had written formal plans regarding back-up communications, surge/overflow capacity, and degradation of services. However, fewer (44% reported having written plans in place regarding supply-line/stockpiling of resources. The most common challenges noted were staff and supply coordination, ethical distribution of limited medical resources, and coordination with government agencies. In conclusion, the majority of the Council of Women's and Infants' Specialty Hospitals maternity hospitals have preliminary infrastructure for pandemic influenza planning, but many challenges exist to optimize maternal and fetal outcomes during the next influenza pandemic.

  11. Modeling to Optimize Hospital Evacuation Planning in EMS Systems.

    Science.gov (United States)

    Bish, Douglas R; Tarhini, Hussein; Amara, Roel; Zoraster, Richard; Bosson, Nichole; Gausche-Hill, Marianne

    2017-01-01

    To develop optimal hospital evacuation plans within a large urban EMS system using a novel evacuation planning model and a realistic hospital evacuation scenario, and to illustrate the ways in which a decision support model may be useful in evacuation planning. An optimization model was used to produce detailed evacuation plans given the number and type of patients in the evacuating hospital, resource levels (teams to move patients, vehicles, and beds at other hospitals), and evacuation rules. Optimal evacuation plans under various resource levels and rules were developed and high-level metrics were calculated, including evacuation duration and the utilization of resources. Using this model we were able to determine the limiting resources and demonstrate how strategically augmenting the resource levels can improve the performance of the evacuation plan. The model allowed the planner to test various evacuation conditions and resource levels to demonstrate the effect on performance of the evacuation plan. We present a hospital evacuation planning analysis for a hospital in a large urban EMS system using an optimization model. This model can be used by EMS administrators and medical directors to guide planning decisions and provide a better understanding of various resource allocation decisions and rules that govern a hospital evacuation.

  12. Home or hospital? Midwife or physician? Preferences for maternity care provider and place of birth among Western Australian students.

    Science.gov (United States)

    Stoll, Kathrin H; Hauck, Yvonne L; Hall, Wendy A

    2016-02-01

    Australian caesarean birth rates have exceeded 30% in most states and are approaching 45%, on average, in private hospitals. Australian midwifery practice occurs almost exclusively in hospitals; less than 3% of women deliver at home or in birthing centres. It is unclear whether the trend towards hospital-based, high interventionist birth reflects preferences of the next generation of maternity care consumers. We conducted a descriptive cross-sectional online survey of 760 Western Australian (WA) university students in 2014, to examine their preferences for place of birth, type of maternity care, mode of birth and attitudes towards birth. More students who preferred midwives (35.8%) had vaginal birth intentions, contested statements that birth is unpredictable and risky, and valued patient-provider relationships. More students who preferred obstetricians (21.8%) expressed concerns about childbirth safety, feared birth, held favourable views towards obstetric technology, and expressed concerns about the impact of pregnancy and birth on the female body. One in 8 students preferred out-of-hospital birth settings, supporting consumer demand for midwife-attended births at home and in birthing centres. Stories and experiences of friends and family shaped students' care provider preferences, rather than the media or information learned at school. Students who express preferences for midwives have significantly different views about birth compared to students who prefer obstetricians. Increasing access to midwifery care in all settings (hospital, birthing centre and home) is a cost effective strategy to decrease obstetric interventions for low risk women and a desirable option for the next generation. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  13. Broadcasting Birth Control: mass media and family planning

    NARCIS (Netherlands)

    Parry, M.

    2013-01-01

    This book explores the use of media by American birth control movement since the early twentieth century, as they built support for fertility control and the availability of contraception. Though these public efforts in advertising and education were undertaken initially by leading advocates,

  14. Broadcasting Birth Control: mass media and family planning

    NARCIS (Netherlands)

    Parry, M.

    2013-01-01

    This book explores the use of media by American birth control movement since the early twentieth century, as they built support for fertility control and the availability of contraception. Though these public efforts in advertising and education were undertaken initially by leading advocates, includ

  15. Strategic planning processes and financial performance among hospitals in Lebanon.

    Science.gov (United States)

    Saleh, Shadi; Kaissi, Amer; Semaan, Adele; Natafgi, Nabil Maher

    2013-01-01

    Strategic planning has been presented as a valuable management tool. However, evidence of its deployment in healthcare and its effect on organizational performance is limited in low-income and middle-income countries (LMICs). The study aimed to explore the use of strategic planning processes in Lebanese hospitals and to investigate its association with financial performance. The study comprised 79 hospitals and assessed occupancy rate (OR) and revenue-per-bed (RPB) as performance measures. The strategic planning process included six domains: having a plan, plan development, plan implementation, responsibility of planning activities, governing board involvement, and physicians' involvement. Approximately 90% of hospitals have strategic plans that are moderately developed (mean score of 4.9 on a 1-7 scale) and implemented (score of 4.8). In 46% of the hospitals, the CEO has the responsibility for the plan. The level of governing board involvement in the process is moderate to high (score of 5.1), whereas physician involvement is lower (score of 4.1). The OR and RPB amounted to respectively 70% and 59 304 among hospitals with a strategic plan as compared with 62% and 33 564 for those lacking such a plan. No statistical association between having a strategic plan and either of the two measures was detected. However, the findings revealed that among hospitals that had a strategic plan, higher implementation levels were associated with lower OR (p plans allow organizations to better cope with environmental turbulence. Copyright © 2012 John Wiley & Sons, Ltd.

  16. The reproductive life plan as a strategy to decrease poor birth outcomes.

    Science.gov (United States)

    Malnory, Margaret E; Johnson, Teresa S

    2011-01-01

    The purpose of this article is to discuss the importance of implementing a life course perspective model that includes a reproductive life plan to improve health outcomes, especially in populations at risk for adverse outcomes. A reproductive life plan is a comprehensive strategy that can be incorporated into nursing practice at all levels to improve birth outcomes. Health care providers, especially nurses, should incorporate reproductive life planning into their daily encounters with patients.

  17. Evidence-informed obstetric practice during normal birth in China: trends and influences in four hospitals

    Directory of Open Access Journals (Sweden)

    Liang Ji

    2006-03-01

    Full Text Available Abstract Background A variety of international organizations, professional groups and individuals are promoting evidence-informed obstetric care in China. We measured change in obstetric practice during vaginal delivery that could be attributed to the diffusion of evidence-based messages, and explored influences on practice change. Methods Sample surveys of women at postnatal discharge in three government hospitals in Shanghai and one in neighbouring Jiangsu province carried out in 1999, repeated in 2003, and compared. Main outcome measures were changes in obstetric practice and influences on provider behaviour. "Routine practice" was defined as more than 65% of vaginal births. Semi-structured interviews with doctors explored influences on practice. Results In 1999, episiotomy was routine at all four hospitals; pubic shaving, rectal examination (to monitor labour and electronic fetal heart monitoring were routine at three hospitals; and enema on admission was common at one hospital. In 2003, episiotomy rates remained high at all hospitals, and actually significantly increased at one; pubic shaving was less common at one hospital; one hospital stopped rectal examination for monitoring labour, and the one hospital where enemas were common stopped this practice. Mobility during labour increased in three hospitals. Continuous support was variable between hospitals at baseline and showed no change with the 2003 survey. Provider behaviour was mainly influenced by international best practice standards promoted by hospital directors, and national legislation about clinical practice. Conclusion Obstetric practice became more evidence-informed in this selected group of hospitals in China. Change was not directly related to the promotion of evidence-based practice in the region. Hospital directors and national legislation seem to be particularly important influences on provider behaviour at the hospital level.

  18. The Delivery Methods and the Factors Affecting Among Giving Birth in Hospitals in Yozgat, Turkey

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    Mahmut Kiliç

    2012-01-01

    Full Text Available Background: The most of pregnant women can have normal vaginal birth. Recently, caesarean section rates are graduallyincreasing both worldwide, and in my country.Objectives: The aim of this study was to establish the delivery preferences among women giving birth in hospitals, and thefactors affecting this preference.Methodology: This cross-sectional study was performed in state (n=674 and private (n=148 hospitals. Data were gatheredby a questionnaire applied by an interviewer. 822 women who had given live birth and gave verbal consent to participate,were included into the study. The data were analyzed by binary logistic regression analysis.Results: Two-thirds of the live births were by caesarean section. According to the binary logistic regression analysis, thepossibility of undergoing caesarean section increased when; mothers’ age increased, they were short, they gave birth in aprivate hospital, they had social security, they were primigravida, they had a previous miscarriage/ curettage/ stillbirth, andthe major factor was found to be, having had a previous delivery by caesarean section. Variables such as; pregnancy week,babies’ weight, mothers’ educational and occupational status, fathers’ educational status, family type, residential area,economical status were found to be insignificant.Conclusion: The facts that 2/3 rds. of the deliveries were by caesarean section, and that all of those who had undergone aprevious caesarean delivery had a consequent caesarean delivery, and that most of the primigravida (60.5% that gave birthby caesarean section were due to doctor’s medical indication, make us think that doctors prefer caesarean delivery.

  19. Impact of family planning programs in reducing high-risk births due to younger and older maternal age, short birth intervals, and high parity.

    Science.gov (United States)

    Brown, Win; Ahmed, Saifuddin; Roche, Neil; Sonneveldt, Emily; Darmstadt, Gary L

    2015-08-01

    Several studies show that maternal and neonatal/infant mortality risks increase with younger and older maternal age (34 years), high parity (birth order >3), and short birth intervals (Oaxaca decomposition technique, we then examine the contributions of family planning program, economic development (GDP per capita), and educational improvement (secondary school completion rate) on the progress of MCPR in order to link the net contribution of family planning program to the reduction of high-risk births mediated through contraceptive use. Countries that had the fastest progress in improving MCPR experienced the greatest declines in high-risk births due to short birth intervals (3), and older maternal age (>35 years). Births among younger women <18 years, however, did not decline significantly during this period. The decomposition analysis suggests that 63% of the increase in MCPR was due to family planning program efforts, 21% due to economic development, and 17% due to social advancement through women's education. Improvement in MCPR, predominately due to family planning programs, is a major driver of the decline in the burden of high-risk births due to high parity, shorter birth intervals, and older maternal age in developing countries. The lack of progress in the decline of births in younger women <18 years of age underscores the need for more attention to ensure that quality contraceptive methods are available to adolescent women in order to delay first births. This study substantiates the significance of family planning programming as a major health intervention for preventing high-risk births and associated maternal and child mortality, but it highlights the need for concerted efforts to strengthen service provision for adolescents.

  20. Risk factors for preterm birth in five Maternal and Child Health hospitals in Beijing.

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    Yun-Ping Zhang

    Full Text Available BACKGROUND: Preterm birth, the birth of an infant prior to 37 completed weeks of gestation, is the leading cause of perinatal morbidity and mortality. Preterm infants are at greater risk of respiratory, gastrointestinal and neurological diseases. Despite significant research in developed countries, little is known about the causes of preterm birth in many developing countries, especially China. This study investigates the association between sciodemographic data, obstetric risk factor, and preterm birth in five Maternal and Child Health hospitals in Beijing, China. METHODS AND FINDINGS: A case-control study was conducted on 1391 women with preterm birth (case group and 1391 women with term delivery (control group, who were interviewed within 48 hours of delivery. Sixteen potential factors were investigated and statistical analysis was performed by univariate analysis and logistic regression analysis. Univariate analysis showed that 14 of the 16 factors were associated with preterm birth. Inter-pregnancy interval and inherited diseases were not risk factors. Logistic regression analysis showed that obesity (odds ratio (OR = 3.030, 95% confidence interval (CI 1.166-7.869, stressful life events (OR = 5.535, 95%CI 2.315-13.231, sexual activity (OR = 1.674, 95%CI 1.279-2.191, placenta previa (OR 13.577, 95%CI 2.563-71.912, gestational diabetes mellitus (OR = 3.441, 95%CI1.694-6.991, hypertensive disorder complicating pregnancy (OR = 6.034, 95%CI = 3.401-10.704, history of preterm birth (OR = 20.888, 95%CI 2.519-173.218 and reproductive abnormalities (OR = 3.049, 95%CI 1.010-9.206 were independent risk factors. Women who lived in towns and cities (OR = 0.603, 95%CI 0.430-0.846, had a balanced diet (OR = 0.533, 95%CI 0.421-0.675 and had a record of prenatal care (OR = 0.261, 95%CI 0.134-0.510 were less likely to have preterm birth. CONCLUSIONS: Obesity, stressful life events, sexual activity, placenta previa

  1. Succession planning: perspectives of chief executive officers in US hospitals.

    Science.gov (United States)

    Collins, Sandra K

    2009-01-01

    A study was conducted to explore the perceptions of chief executive officers in US hospitals regarding the origins of leadership and how they felt about internally developed successors versus externally recruited successors. Furthermore, the study examined how this group of executives utilizes the succession planning process, what factors impact successor identification, what positions are applicable for succession planning activities, and who is ultimately held responsible for leadership continuity within the hospital industry.

  2. [Influence of prenatal hospitalization on parental stressful experience in the case of a premature birth].

    Science.gov (United States)

    Morisod-Harari, M; Borghini, A; Hohlfeld, P; Forcada-Guex, M; Muller-Nix, C

    2013-02-01

    To investigate the influence of prenatal hospitalization before a premature birth, on the parental stressful experience, parental symptoms of post-traumatic stress and quality of parent-infant interaction during the hospitalization in neonatology. 51 preterm infants born and 25 full term infants control. Four groups: controls, premature without prenatal hospitalization, premature with a short (premature with a long (≥ 8 days) prenatal hospitalization. the Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU, Miles et al., 1993 [14]) and the Perinatal PTSD Questionnaire (PPQ, Quinnell and Hynan, 1999 [16]). When prenatal hospitalization of the mother occurred, parents acknowledged increased stress induced by the environmental factors during the infant's hospitalization. Furthermore, mothers from the group with a short prenatal hospitalization presented significantly more symptoms of post-traumatic stress. Parents presenting more symptoms of post-traumatic stress describe a significantly more difficult interaction with their infant in neonatology. This study highlights the necessity to deliver special care to women hospitalized shortly (premature baby. This group is at high risk of presenting post-traumatic stress symptoms, which could have a negative impact on the quality of parent-infant interactions. Copyright © 2012. Published by Elsevier Masson SAS.

  3. Evaluation of the effects of a birth plan on Taiwanese women's childbirth experiences, control and expectations fulfilment: a randomised controlled trial.

    Science.gov (United States)

    Kuo, Su-Chen; Lin, Kuan-Chia; Hsu, Chi-Ho; Yang, Cherng-Chia; Chang, Min-Yu; Tsao, Chien-Ming; Lin, Lie-Chu

    2010-07-01

    In many western countries, pregnant women often prepare birth plans, outlining how they would like their childbirth experiences to proceed. However there have been no experimental studies to evaluate the effect of birth plans. The objective of this research was to evaluate the effects of birth plans on women's fulfilment of their childbirth expectations, their control over the birth process, and overall experiences. A randomised, single-blind controlled trial study design was used. This study involved seven hospitals and 10 obstetricians in Taiwan. Participants included primiparous women, each under the care of one of seven Taiwanese medical facilities, and who had been pregnant for at least 32 weeks. They were also at least 18 years old, and had no pregnancy complications. An exclusion criterion was elective caesarean as a mode of delivery. A total of 296 women in hospital clinics who met the study criteria were allocated by block randomisation to experimental (n=155) or control (n=141) groups. The women completed their basic personal information and a childbirth expectations questionnaire when they were recruited. One day after delivery, all the participants completed a questionnaire about the childbirth experience, control and fulfilment of their childbirth expectations. The experimental group had a statistically higher degree of positive childbirth experiences than that of the control group (t=2.48, p=0.01). The experimental group also showed a higher degree of childbirth control (t=9.60, pcontrol groups in prenatal birth expectations, but a significant difference (t=2.63, p=0.01) in the degree of fulfilment of their childbirth expectations after delivery. On a subscale measuring the fulfilment of childbirth expectations, there was a statistically higher degree of mastery and participation (t=3.74, pcontrol group. The results justify the clinical implementation of birth plans. Providing birth plans in medical facilities is an effective means of fulfilling

  4. The role of traditional birth attendants in family planning programs in Southeast Asia.

    Science.gov (United States)

    Peng, J Y

    1979-01-01

    The training and utilization of traditional birth attendants (TBAs) in maternal and child health and family planning programs in Indonesia, the Philippines, Thailand and Malaysia are discussed. Special efforts to organize and train TBAs for family planning in Malaysia are examined in detail. Import factors for successful utilization of TBAs include: (a) definite assignment of functions and tasks, (b) organization of good operational steps and (c) implementation of good supervisory activities.

  5. Late-preterm birth in a level III hospital: incidence and associated morbidity

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    Carla Garcez

    2016-03-01

    Full Text Available Introduction: Late-preterm infants are physiologically and metabolically immature and have important risk of morbidity and mortality.Aim: To analyze the incidence of late prematurity and its associated morbidity and mortality at a level III hospital between 2011 and 2013.Methods: This was a descriptive and retrospective study of infants born between 34 + 0/7 and 36 + 6/7 weeks’ gestation and its associated morbidity and mortality. Medical records were reviewed.Results: In a 3-year period there were 8,458 births of witch 513 (6.1% were late-preterm infants. Of these, 99/513 (19.3% had 34 weeks’ gestation, 145/513 (28.3% had 35 weeks’ gestation and 269/513 (52.4% had 36 weeks’ gestation. Late-preterm birth rate was 5.7% in 2011, 6.9% in 2012 and 5.6% in 2013 (p = 0.08. In relation to birth weight, 269 (52.4% of late-preterm infants had low birth weight. There was an association between gestational age and birth weight (p = 0.002.Of the 513 late-preterm infants, 177 (34.5% were admitted to the Neonatal Intensive Care Unit (NICU and more often at 34 weeks’ gestation (69/99, 69.7% than at 35 (57/145, 39.3% and 36 (51/269, 19.0% weeks’ gestation (p < 0.001. Most frequent clinical diagnoses were hyperbilirubinemia (112/177, 63.3%, feeding difficulties (111/177, 62.7%, transient tachypnea of the newborn (71/177, 40.1%, hypoglycemia (38/177, 21.5%, intrauterine growth restriction (33/177, 18.6%. Average length of hospitalization was 12 days. Newborns of 34 weeks’ gestation were longer admitted than newborns of 35 and 36 weeks’ gestation (15.3 vs 9.8 vs 10.8 days; p = 0.002. There was one death due to sepsis after surgical correction of gastroschisis.Conclusion: The incidence of late-preterm birth remained stable between 2011 and 2013. Late-preterm hospitalization rate in the NICU was 34.5%. Hyperbilirubinemia, feeding difficulties and respiratory disease were the main diagnosis. Late-preterm of 34 weeks’ gestation were admitted more

  6. The Florida Investigation of Primary Late Preterm and Cesarean Delivery: the accuracy of the birth certificate and hospital discharge records.

    Science.gov (United States)

    Clayton, Heather B; Sappenfield, William M; Gulitz, Elizabeth; Mahan, Charles S; Petersen, Donna J; Stanley, Kara M; Salihu, Hamisu M

    2013-07-01

    (1) Assess the accuracy of public health data sources used to investigate primary late preterm cesarean delivery (PLPCD) and (2) compare differences in data accuracy by hospital PLPCD rate classification. This analysis uses data from the Florida Investigation of Late Preterm and Cesarean Delivery (FILPCD), an investigation of singleton, PLPCD's that occurred from 2006 to 2007 in hospitals classified with either a low or high PLPCD rate (high rate 39.4-58.3 %, low rate 11.9-25.1 %). Three data sources were validated with maternal medical records: birth certificates, hospital discharge data, and combined birth certificate and hospital discharge data. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and kappa values were calculated. A summary measure of kappa values was compared by hospital PLPCD rate classification using the paired sample Wilcoxon signed rank test. Large variations in accuracy of data elements were found by hospital PLPCD rate classification, with low PLPCD rate hospitals demonstrating higher overall data accuracy. The summary measure of agreement was significantly higher for low PLPCD rate hospitals compared to high PLPCD rate hospitals (0.60 vs. 0.50, p late preterm birth are vital for public health practitioners and policy makers who seek to address the growing concern over recent increases in CD and late preterm birth. Understanding the potential for systematic differences in reporting accuracy by hospital PLPCD rate is important to data quality improvement efforts.

  7. Planned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more).

    Science.gov (United States)

    Middleton, Philippa; Shepherd, Emily; Flenady, Vicki; McBain, Rosemary D; Crowther, Caroline A

    2017-01-04

    Prelabour rupture of membranes (PROM) at term is managed expectantly or by planned early birth. It is not clear if waiting for birth to occur spontaneously is better than intervening, e.g. by inducing labour. The objective of this review is to assess the effects of planned early birth (immediate intervention or intervention within 24 hours) when compared with expectant management (no planned intervention within 24 hours) for women with term PROM on maternal, fetal and neonatal outcomes. We searched Cochrane Pregnancy and Childbirth's Trials Register (9 September 2016) and reference lists of retrieved studies. Randomised or quasi-randomised controlled trials of planned early birth compared with expectant management (either in hospital or at home) in women with PROM at 37 weeks' gestation or later. Two review authors independently assessed trials for inclusion, extracted the data, and assessed risk of bias of the included studies. Data were checked for accuracy. Twenty-three trials involving 8615 women and their babies were included in the update of this review. Ten trials assessed intravenous oxytocin; 12 trials assessed prostaglandins (six trials in the form of vaginal prostaglandin E2 and six as oral, sublingual or vaginal misoprostol); and one trial each assessed Caulophyllum and acupuncture. Overall, three trials were judged to be at low risk of bias, while the other 20 were at unclear or high risk of bias.Primary outcomes: women who had planned early birth were at a reduced risk of maternal infectious morbidity (chorioamnionitis and/or endometritis) than women who had expectant management following term prelabour rupture of membranes (average risk ratio (RR) 0.49; 95% confidence interval (CI) 0.33 to 0.72; eight trials, 6864 women; Tau² = 0.19; I² = 72%; low-quality evidence), and their neonates were less likely to have definite or probable early-onset neonatal sepsis (RR 0.73; 95% CI 0.58 to 0.92; 16 trials, 7314 infants;low-quality evidence). No clear

  8. Ethics and the architecture of choice for home and hospital birth.

    Science.gov (United States)

    Bogdan-Lovis, Elizabeth; de Vries, Raymond G

    2013-01-01

    In this issue of The Journal of Clinical Ethics, we offer a variety of perspectives on the moral and medical responsibilities of professionals with regard to a woman's choice of where she will birth her baby. The articles in this special issue focus on place of birth, but they have larger resonance for clinicians whose decisions about providing the best possible care require them to sort through evidence, consider their own possible biases and the limitations of their training, and balance the wishes of their patients with the demands of colleagues, hospitals, and insurers. The articles published in this special issue of The Journal of Clinical Ethics will help those who wrestle with such dilemmas in everyday clinical decision making.

  9. Incorporating the USAF Flight Center's TQM plan in a hospital.

    Science.gov (United States)

    Bridges, R D; Mathews, K A

    1993-01-01

    A total quality management (TQM) plan has been instituted by the United States Air Force Flight Test Center at Edwards Air Force Base. To determine the feasibility of implementing the same basic TQM plan in a district hospital, a joint industry-government team was established. Five areas of concentration were selected for review: infrastructure, methodology, training, strategic plan, and a "Quality Bill of Rights." The TQM "infrastructure" is intended to match and complement the existing organizational structure and chain of command, not to supplant it. As the overall plan seemed well-adapted for implementation in a hospital setting, a three-phase implementation approach was identified that included conceptual planning, initial training and goal setting, and full-scale implementation. Each phase is described in terms of objectives, staffing, and timing requirements.

  10. IT strategic planning in hospitals: from theory to practice.

    Science.gov (United States)

    Jaana, Mirou; Teitelbaum, Mari; Roffey, Tyson

    2014-07-01

    To date, IT strategic planning has been mostly theory-based with limited information on "best practices" in this area. This study presents the process and outcomes of IT strategic planning undertaken at a pediatric hospital (PH) in Canada. A five-stage sequential and incremental process was adopted. Various tools / approaches were used including review of existing documentation, internal survey (n = 111), fifteen interviews, and twelve workshops. IT strategic planning was informed by 230 individuals (12 percent of hospital community) and revealed consistency in the themes and concerns raised by participants (e.g., slow IT projects delivery rate, lack of understanding of IT priorities, strained communication with IT staff). Mobile and remote access to patients' information, and an integrated EMR were identified as top priorities. The methodology and used approach revealed effective, improved internal relationships, and ensured commitment to the final IT strategic plan. Several lessons were learned including: maintaining a dynamic approach capable of adapting to the fast technology evolution; involving stakeholders and ensuring continuous communication; using effective research tools to support strategic planning; and grounding the process and final product in existing models. This study contributes to the development of "best practices" in IT strategic planning, and illustrates "how" to apply the theoretical principles in this area. This is especially important as IT leaders are encouraged to integrate evidence-based management into their decision making and practices. The methodology and lessons learned may inform practitioners in other hospitals planning to engage in IT strategic planning in the future.

  11. Study of cases of still births at tertiary maternity care hospital (ReCoDe

    Directory of Open Access Journals (Sweden)

    Ami Yagnik

    2016-06-01

    Full Text Available To study the characteristics of pregnancies which end in antepartum still births using the classification systemReCoDe (Relevant Condition at Death and to suggest measures to reduce incidence of still births in our study population. The study is a retrospective study of cases of stillbirths. In the present study 100 cases with still births admitted to Deptt. Of Obs & Gynecology Govt Medical College, Sir.T.Hospital, Bhavnagar fulfilling the inclusion criteria was included. All these cases were subjected to routine investigations and the placenta with cord was sent for HPE in all the cases and followed up to one week in the postpartum period. All the cases were classified according to relevant condition at death classification of still births (ReCoDe. On classifying the aetiology of stillbirths in all cases according to the ReCoDe classification we were able to classify 90% of cases and only 10% remain unclassified. In the present study 28% stillbirths were attributed IUGR as a cause, 22% cases mother had hypertensive disorder, 21% with antepartum haemorrhage as a cause and 15% with congenital fetal anomaly. Of 100 cases 53 had a positive correlation in placental and cord on histopathological examination. The present study helped to classify and study the aetiology of stillbirths in study population in simplified way on condition relevant at death. This study lets us know that most of the causes can be taken care of by instituting appropriate measures at right time. The importance of antenatal care, nutrition, counseling early detection and medical help, timely referral to tertiary care hospital,

  12. No evidence of purported lunar effect on hospital admission rates or birth rates.

    Science.gov (United States)

    Margot, Jean-Luc

    2015-01-01

    Studies indicate that a fraction of nursing professionals believe in a "lunar effect"-a purported correlation between the phases of the Earth's moon and human affairs, such as birth rates, blood loss, or fertility. This article addresses some of the methodological errors and cognitive biases that can explain the human tendency of perceiving a lunar effect where there is none. This article reviews basic standards of evidence and, using an example from the published literature, illustrates how disregarding these standards can lead to erroneous conclusions. Román, Soriano, Fuentes, Gálvez, and Fernández (2004) suggested that the number of hospital admissions related to gastrointestinal bleeding was somehow influenced by the phases of the Earth's moon. Specifically, the authors claimed that the rate of hospital admissions to their bleeding unit is higher during the full moon than at other times. Their report contains a number of methodological and statistical flaws that invalidate their conclusions. Reanalysis of their data with proper procedures shows no evidence that the full moon influences the rate of hospital admissions, a result that is consistent with numerous peer-reviewed studies and meta-analyses. A review of the literature shows that birth rates are also uncorrelated to lunar phases. Data collection and analysis shortcomings, as well as powerful cognitive biases, can lead to erroneous conclusions about the purported lunar effect on human affairs. Adherence to basic standards of evidence can help assess the validity of questionable beliefs.

  13. Hospital planning in France and the Federal Republic of Germany.

    Science.gov (United States)

    Altenstetter, C

    1980-01-01

    This article on hospital planning programs in France and North-Rhine Westfalia (a state in the Federal Republic of Germany), assembles information on the formal building blocks of inter-organizational relations in the formulation and implementation process. Because these planning programs are embedded in past social policy developments and institution-building, it is necessary to first compare the two countries' compulsory health insurance schemes. This is followed by a general profile of each health care system. A third section examines the formulation and implementation of the countries' hospital planning programs and participation patterns. Based on this comparison, inferences are drawn that are relevant to policy and research. The analysis yields three major conclusions. First, despite abundant legal and administrative controls at the disposal of central health bureaucracies, the capability of the national leadership to influence the hospital system through innovative planning is limited by jurisdictional, institutional, functional and territorial fragmentation, and differentiation of control and public responsibility in health. However, the diverse goal orientations of participants may provide the necessary tension to allow for some change in otherwise highly structured political and administrative systems. Second, despite differences in historical, political and administrative developments, the decision making systems for health care policies in France and the Federal Republic, with the exception of health insurance, are strikingly similar to the fragmented decision making system in the United States. Third, the effect of government-mandated participation is empirically uncertain. Opening up the circle of participants seems to have reinforced alliances between public bureaucracies and corporate vested interests. Hospital planning continues to be carried out for rather than with the consumer and citizen. Hospital planning which is a mixture of goal and process

  14. Risk Factors for Preterm Birth and Low Birth Weight Among Pregnant Indian Women: A Hospital-based Prospective Study

    Science.gov (United States)

    Bhat, Parvati; Acharya, Shashidhar; Kamath, Asha; Bhat, Shashikala; Rao, Chythra; Nayak, Sathisha; Mukhopadhyay, Chiranjay

    2016-01-01

    Objectives: The present study was undertaken to study the maternal risk factors for preterm birth (PTB) and low birth weight (LBW) with a special emphasis on assessing the proportions of maternal genitourinary and periodontal infections among Indian women and their association with adverse pregnancy outcomes. Methods: A hospital-based prospective study comprising 790 pregnant women visiting the obstetrics clinic for a routine antenatal check-up was undertaken. Once recruited, all study participants underwent clinical and microbiological investigations for genitourinary infections followed by a dental check-up for the presence of periodontitis. The study participants were followed up until their delivery to record the pregnancy outcomes. Infectious and non-infectious risk factors for PTB and LBW were assessed using univariate and multivariate Cox regression analysis. Independent risk factors for PTB and LBW were reported in terms of adjusted relative risk (ARR) with the 95% confidence interval (CI). Results: Rates of PTB and LBW in the study population were 7.6% and 11.4%, respectively. Previous preterm delivery (ARR, 5.37; 95% CI, 1.5 to 19.1), periodontitis (ARR, 2.39; 95% CI, 1.1 to 4.9), Oligohydramnios (ARR, 5.23; 95% CI, 2.4 to 11.5), presence of Nugent’s intermediate vaginal flora (ARR, 2.75; 95% CI, 1.4 to 5.1), gestational diabetes mellitus (ARR, 2.91; 95% CI, 1.0 to 8.3), and maternal height <1.50 m (ARR, 2.21; 95% CI, 1.1 to 4.1) were risk factors for PTB, while periodontitis (ARR, 3.38; 95% CI, 1.6 to 6.9), gestational hypertension (ARR, 3.70; 95% CI, 1.3 to 10.8), maternal height <1.50 m (ARR, 2.66; 95% CI, 1.3 to 5.1) and genital infection during later stages of pregnancy (ARR, 2.79; 95% CI, 1.2 to 6.1) were independent risk factors for LBW. Conclusions: Our study findings underscore the need to consider screening for potential genitourinary and periodontal infections during routine antenatal care in developing countries. PMID:27255075

  15. Risk Factors for Preterm Birth and Low Birth Weight Among Pregnant Indian Women: A Hospital-based Prospective Study.

    Science.gov (United States)

    Tellapragada, Chaitanya; Eshwara, Vandana Kalwaje; Bhat, Parvati; Acharya, Shashidhar; Kamath, Asha; Bhat, Shashikala; Rao, Chythra; Nayak, Sathisha; Mukhopadhyay, Chiranjay

    2016-05-01

    The present study was undertaken to study the maternal risk factors for preterm birth (PTB) and low birth weight (LBW) with a special emphasis on assessing the proportions of maternal genitourinary and periodontal infections among Indian women and their association with adverse pregnancy outcomes. A hospital-based prospective study comprising 790 pregnant women visiting the obstetrics clinic for a routine antenatal check-up was undertaken. Once recruited, all study participants underwent clinical and microbiological investigations for genitourinary infections followed by a dental check-up for the presence of periodontitis. The study participants were followed up until their delivery to record the pregnancy outcomes. Infectious and non-infectious risk factors for PTB and LBW were assessed using univariate and multivariate Cox regression analysis. Independent risk factors for PTB and LBW were reported in terms of adjusted relative risk (ARR) with the 95% confidence interval (CI). Rates of PTB and LBW in the study population were 7.6% and 11.4%, respectively. Previous preterm delivery (ARR, 5.37; 95% CI, 1.5 to 19.1), periodontitis (ARR, 2.39; 95% CI, 1.1 to 4.9), Oligohydramnios (ARR, 5.23; 95% CI, 2.4 to 11.5), presence of Nugent's intermediate vaginal flora (ARR, 2.75; 95% CI, 1.4 to 5.1), gestational diabetes mellitus (ARR, 2.91; 95% CI, 1.0 to 8.3), and maternal height <1.50 m (ARR, 2.21; 95% CI, 1.1 to 4.1) were risk factors for PTB, while periodontitis (ARR, 3.38; 95% CI, 1.6 to 6.9), gestational hypertension (ARR, 3.70; 95% CI, 1.3 to 10.8), maternal height <1.50 m (ARR, 2.66; 95% CI, 1.3 to 5.1) and genital infection during later stages of pregnancy (ARR, 2.79; 95% CI, 1.2 to 6.1) were independent risk factors for LBW. Our study findings underscore the need to consider screening for potential genitourinary and periodontal infections during routine antenatal care in developing countries.

  16. Socioeconomic and nutritional determinants of low birth weight babies: A hospital based study

    Directory of Open Access Journals (Sweden)

    Smiti Narain

    2014-12-01

    Full Text Available According to the World Health Organization (WHO definition, infants with birth weights of less than 2,500 grams are classified as low birth weight (LBW. LBW is a sensitive indicator for predicting the chances of both infant survival and healthy childhood growth and development, and it also reflects the present and past health status of the mother. LBW constitutes an important factor affecting neonatal mortality and morbidity.Objective: To find the incidence of low birth weight babies and its determinants Materials and methods: Present study was a cross sectional type. All mothers delivering live born singleton neonate in study place (Postnatal ward of Rohilkhand Medical College and hospital were interviewed with pretested, predesigned schedule. Statistical analysis was done using SPSS version 21software and chi square test, OR etc.Results: Overall incidence of LBW was 20% and mean birth weight was 2776.85 + 383.6 gm LBW was found to be more common in the rural population and poor educational status. A higher incidence of LBW was seen in mothers with inadequate diet and those who were anaemic. Conclusion: Low birth weight still poses a fair problem in our perspective, and when we cannot control ethnic factors like height, or do a drastic socio-economic upliftment, some basic factors, like good ANC care, correcting anemia, and above all motivating the mother to follow some habits in the ANC period like adequate consumption of food and adequate rest, institutional deliveries shall take a long way forward in addressing the problem.

  17. Neurodevelopment of very low birth weight infants in the first two years of life in a Havana tertiary care hospital.

    Science.gov (United States)

    Cejas, Gianny; Gómez, Yahima; Roca, María del Carmen; Domínguez, Fernando

    2015-01-01

    Improved survival rates of neonates with very low birth weight (Havana tertiary care hospital. A case-series study was conducted to assess neurodevelopment outcomes of very low birth weight infants over their first two years of life. The study population comprised 116 surviving neonates with very low birth weight (Havana, Cuba, 2006-2010. A longitudinal, multidisciplinary and interdisciplinary follow up of all infants' neurodevelopment was performed, from hospital discharge to age two years, corrected for gestational age at birth. Data on each infant's perinatal variables were collected: birth weight in grams, gestational age at birth, and 1-minute and 5-minute Apgar scores. Patients were classified as having normal neurodevelopment, mild abnormalities and moderate-to-severe abnormalities. Pearson's chi-square test was used to determine possible relationships between perinatal variables studied and neurodevelopment, with exact sampling distribution and 95% confidence level. Normal neurodevelopment was observed in 69% of very low birth weight infants, 25.9% had mild abnormalities, and 5.2% displayed moderate-to-severe abnormalities. The results demonstrate a statistically significant relationship between gestational age and neurodevelopmental outcomes; more neurodevelopmental abnormalities were found in infants born at earlier gestational age (<30 weeks). Surviving very low birth weight neonates with lower gestational age at birth face a higher risk of neurodevelopmental abnormalities.

  18. Hospital Bioterrorism Planning and Burn Surge

    OpenAIRE

    Kearns, Randy D.; Myers, Brent; Cairns, Charles B.; Rich, Preston B.; Hultman, C. Scott; Charles, Anthony G.; Jones, Samuel W.; Schmits, Grace L.; Skarote, Mary Beth; Holmes, James H.; Cairns, Bruce A.

    2014-01-01

    On the morning of June 9, 2009, an explosion occurred at a manufacturing plant in Garner, North Carolina. By the end of the day, 68 injured patients had been evaluated at the 3 Level I trauma centers and 3 community hospitals in the Raleigh/Durham metro area (3 people who were buried in the structural collapse died at the scene). Approximately 300 employees were present at the time of the explosion, when natural gas being vented during the repair of a hot water heater ignited. The concussion ...

  19. Resource Requirements Planning for Hospitals Treating Serious Infectious Disease Cases

    Energy Technology Data Exchange (ETDEWEB)

    Vugrin, Eric D. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Verzi, Stephen Joseph [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Finley, Patrick D. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States); Turnquist, Mark A. [Cornell Univ., Ithaca, NY (United States); Wyte-Lake, Tamar [Veterans Emergency Management Evaluation Center; Griffin, Ann R. [Veterans Emergency Management Evaluation Center; Ricci, Karen J. [Veterans Emergency Management Evaluation Center; Plotinsky, Rachel [Providence Health and Services, Renton, WA (United States)

    2015-02-01

    This report presents a mathematical model of the way in which a hospital uses a variety of resources, utilities and consumables to provide care to a set of in-patients, and how that hospital might adapt to provide treatment to a few patients with a serious infectious disease, like the Ebola virus. The intended purpose of the model is to support requirements planning studies, so that hospitals may be better prepared for situations that are likely to strain their available resources. The current model is a prototype designed to present the basic structural elements of a requirements planning analysis. Some simple illustrati ve experiments establish the mo del's general capabilities. With additional inve stment in model enhancement a nd calibration, this prototype could be developed into a useful planning tool for ho spital administrators and health care policy makers.

  20. Resource Requirements Planning for Hospitals Treating Serious Infectious Disease Cases.

    Energy Technology Data Exchange (ETDEWEB)

    Vugrin, Eric D.; Verzi, Stephen Joseph; Finley, Patrick D.; Turnquist, Mark A.; Wyte-Lake, Tamar; Griffin, Ann R.; Ricci, Karen J.; Plotinsky, Rachel

    2015-02-01

    This report presents a mathematical model of the way in which a hospital uses a variety of resources, utilities and consumables to provide care to a set of in-patients, and how that hospital might adapt to provide treatment to a few patients with a serious infectious disease, like the Ebola virus. The intended purpose of the model is to support requirements planning studies, so that hospitals may be better prepared for situations that are likely to strain their available resources. The current model is a prototype designed to present the basic structural elements of a requirements planning analysis. Some simple illustrati ve experiments establish the mo del's general capabilities. With additional inve stment in model enhancement a nd calibration, this prototype could be developed into a useful planning tool for ho spital administrators and health care policy makers.

  1. Aligning business and information technology domains: strategic planning in hospitals.

    Science.gov (United States)

    Henderson, J C; Thomas, J B

    1992-01-01

    This article develops a framework for strategic information technology (IT) management in hospitals, termed the Strategic Alignment Model. This model is defined in terms of four domains--business strategy, IT strategy, organizational infrastructure, and IT infrastructure--each with its constituent components. The concept of strategic alignment is developed using two fundamental dimensions--strategic fit and integration. Different perspectives that hospitals use for aligning the various domains are discussed, and a prescriptive model of strategic IT planning is proposed.

  2. Medicare Advantage Plans Pay Hospitals Less Than Traditional Medicare Pays.

    Science.gov (United States)

    Baker, Laurence C; Bundorf, M Kate; Devlin, Aileen M; Kessler, Daniel P

    2016-08-01

    There is ongoing debate about how prices paid to providers by Medicare Advantage plans compare to prices paid by fee-for-service Medicare. We used data from Medicare and the Health Care Cost Institute to identify the prices paid for hospital services by fee-for-service (FFS) Medicare, Medicare Advantage plans, and commercial insurers in 2009 and 2012. We calculated the average price per admission, and its trend over time, in each of the three types of insurance for fixed baskets of hospital admissions across metropolitan areas. After accounting for differences in hospital networks, geographic areas, and case-mix between Medicare Advantage and FFS Medicare, we found that Medicare Advantage plans paid 5.6 percent less for hospital services than FFS Medicare did. Without taking into account the narrower networks of Medicare Advantage, the program paid 8.0 percent less than FFS Medicare. We also found that the rates paid by commercial plans were much higher than those of either Medicare Advantage or FFS Medicare, and growing. At least some of this difference comes from the much higher prices that commercial plans pay for profitable service lines.

  3. Hospital capacity planning: from measuring stocks to modelling flows.

    Science.gov (United States)

    Rechel, Bernd; Wright, Stephen; Barlow, James; McKee, Martin

    2010-08-01

    The metric of "bed numbers" is commonly used in hospital planning, but it fails to capture key aspects of how hospital services are delivered. Drawing on a study of innovative hospital projects in Europe, we argue that hospital capacity planning should not be based on beds, but rather on the ability to deliver processes. We propose using approaches that are based on manufacturing theory such as "lean thinking" that focuses on the value that different processes add for the primary customer, i.e. the patient. We argue that it is beneficial to look at the hospital, not from the perspective of beds or specialties, but rather from the path taken by the patients who are treated in them, the respective processes delivered by health professionals and the facilities appropriate to those processes. Systematized care pathways seem to offer one avenue for achieving these goals. However, they need to be underpinned by a better understanding of the flows of patients, work and goods within a hospital, the bottlenecks that occur, and translation of this understanding into new capacity planning tools.

  4. Hospital transfers and patterns of mortality in very low birth weight neonates with surgical necrotizing enterocolitis.

    Science.gov (United States)

    Fullerton, Brenna S; Sparks, Eric A; Morrow, Kate A; Edwards, Erika M; Soll, Roger F; Jaksic, Tom; Horbar, Jeffrey D; Modi, Biren P

    2016-06-01

    The objectives of this study were to evaluate mortality rates in very low birth weight (VLBW) infants with surgical necrotizing enterocolitis (NEC) by level of available surgical resources and to determine the effect of hospital transfer on mortality. Mortality among 4328 VLBW neonates with surgical NEC born 2009-2013 was assessed using the Vermont Oxford Network database. NICUs were classified by availability of resources as a marker of overall center capability: type A (restrictions on ventilation or do not routinely perform major neonatal surgery), type B (perform major neonatal surgery but not cardiac bypass), and type C (perform major surgery, including cardiac bypass in infants). Mortality was higher among those who had surgery at type B centers versus type C centers (44.3% vs 36.4%, adjusted prevalence ratio 1.20 (95% CI: 1.08, 1.33)). Neonates who were not transferred between birth and surgery had a higher mortality compared to those transferred (44.6% vs 31.6%, adjusted prevalence ratio 1.39 (95% CI: 1.25, 1.55)). Transfer between birth and surgery and a higher level of surgical resources at the operative center were associated with lower mortality. Early transfer of high risk neonates to centers with higher levels of surgical resources may be warranted. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Geographic Distribution of Maternal Group B Streptococcus Colonization and Infant Death During Birth Hospitalization: Eastern Wisconsin

    Directory of Open Access Journals (Sweden)

    Jessica J. F. Kram

    2016-04-01

    Full Text Available Purpose: Maternal group B Streptococcus (GBS can be transmitted from a colonized mother to newborn during vaginal delivery and may or may not contribute to infant death. This study aimed to explore the geographic distribution and risk factors of maternal GBS colonization and infant death during birth hospitalization. Methods: We retrospectively studied mothers with live birth(s in a large eastern Wisconsin hospital system from 2007 through 2013. Associations between maternal and neonatal variables, GBS colonization and infant death were examined using chi-squared, Mann-Whitney U and t-tests. Multivariable logistic regression models also were developed. Results: Study population (N = 99,305 had a mean age of 28.1 years and prepregnancy body mass index (BMI of 26.7 kg/m2; 64.0% were white, 59.2% married, 39.3% nulliparous and 25.7% cesarean delivery. Mean gestational age was 39.0 weeks. Rate of maternal GBS colonization (22.3% overall was greater in blacks (34.1% vs. 20.1% in whites, P < 0.0001, unmarried women (25.5% vs. 20.0% married, P < 0.0001, women with sexually transmitted or other genital infections (P < 0.0001 and residents of ZIP code group 532XX (P < 0.0001, and was associated with increasing BMI (P < 0.0001. All predictors of colonization were significant on multivariable analysis. Rate of infant death was 5.7 deaths/1,000 live births (n = 558 excluding lethal anomalies and stillbirths and was negatively associated with maternal GBS colonization (P < 0.0001. On multivariable analysis, 532XX ZIP code group, lower gestational age, preterm labor, hyaline membrane disease, normal spontaneous vaginal delivery, hydramnios, oligohydramnios and absence of maternal GBS were associated with infant death. Conclusions: Geographic characteristics were associated with infant death and maternal GBS colonization. Further research is needed to determine if increased surveillance or treatment of mothers colonized with GBS decreases the risk of infant

  6. Anthropometric surrogates to identify low birth weight Nepalese newborns: a hospital-based study

    Directory of Open Access Journals (Sweden)

    Singh Dela

    2008-04-01

    Full Text Available Abstract Background In Nepal, more than 90% of the deliveries take place at home where birth weight is often not recorded. In developing countries, low birth weight (LBW, Methods A cross-sectional study was carried out in Western Regional Hospital, Pokhara between April and June, 2006. All consecutive full-term, singleton, live born babies were included. To ensure reliability and avoid inter-observer bias one of the investigators weighed all the newborns and carried out anthropometric measurements within 24 hours after birth. Circumferences of head, chest, mid-upper arm, thigh and calf were measured according to standard techniques. Non-parametric receiver operating characteristic (ROC curve analyses were carried out using bootstrap to calculate 95% confidence intervals of areas under the curve (AUC. The cut-points with lowest total misclassification rate were chosen to identify LBW babies. Results Out of 400 newborns studied, 204 (51% were males and 196 (49% were females. The mean birth weight was 3029 ± 438 grams and 34 (8.5% newborns were LBW. By ROC-AUC analyses, head circumference (AUC = 0.89, 95% CI 0.85 to 0.93 and chest circumference (AUC = 0.86, 95% CI 0.80 to 0.91 were identified as the optimal surrogate indicators of LBW babies. The optimal cut-points for head circumference and chest circumference to identify LBW newborns were ≥ 33.5 cm and ≥ 30.8 cm respectively. Conclusion Head and chest circumferences were the best anthropometric surrogates of LBW among Nepalese newborns. Further studies are needed in the field to cross-validate our results.

  7. 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 (high 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.

  8. Improving resource capacity planning in hospitals with business approaches

    NARCIS (Netherlands)

    Lent, van Wineke Agnes Marieke

    2011-01-01

    This dissertation contributed to the knowledge on the translation of approaches from businesses and services to improve the resource capacity planning on tactical and operational level in (oncologic) hospital care. The following studies were presented: * Chapter 2 surveyed the business approache

  9. No Evidence of Purported Lunar Effect on Hospital Admission Rates or Birth Rates

    Science.gov (United States)

    Margot, Jean-Luc

    2015-01-01

    Background Studies indicate that a fraction of nursing professionals believe in a “lunar effect”—a purported correlation between the phases of the Earth’s moon and human affairs, such as birth rates, blood loss, or fertility. Purpose This article addresses some of the methodological errors and cognitive biases that can explain the human tendency of perceiving a lunar effect where there is none. Approach This article reviews basic standards of evidence and, using an example from the published literature, illustrates how disregarding these standards can lead to erroneous conclusions. Findings Román, Soriano, Fuentes, Gálvez, and Fernández (2004) suggested that the number of hospital admissions related to gastrointestinal bleeding was somehow influenced by the phases of the Earth’s moon. Specifically, the authors claimed that the rate of hospital admissions to their bleeding unit is higher during the full moon than at other times. Their report contains a number of methodological and statistical flaws that invalidate their conclusions. Reanalysis of their data with proper procedures shows no evidence that the full moon influences the rate of hospital admissions, a result that is consistent with numerous peer-reviewed studies and meta-analyses. A review of the literature shows that birth rates are also uncorrelated to lunar phases. Conclusions Data collection and analysis shortcomings, as well as powerful cognitive biases, can lead to erroneous conclusions about the purported lunar effect on human affairs. Adherence to basic standards of evidence can help assess the validity of questionable beliefs. PMID:25756232

  10. A midwifery-led in-hospital birth center within an academic medical center: successes and challenges.

    Science.gov (United States)

    Perdion, Karen; Lesser, Rebecca; Hirsch, Jennifer; Barger, Mary; Kelly, Thomas F; Moore, Thomas R; Lacoursiere, D Yvette

    2013-01-01

    The University of California San Diego Community Women's Health Program (CWHP) has emerged as a successful and sustainable coexistence model of women's healthcare. The cornerstone of this midwifery practice is California's only in-hospital birth center. Located within the medical center, this unique and physically separate birth center has been the site for more than 4000 births. With 10% cesarean delivery and 98% breast-feeding rates, it is an exceptional example of low-intervention care. Integrating this previously freestanding birth center into an academic center has brought trials of mistrust and ineffectual communication. Education, consistent leadership, and development of multidisciplinary guidelines aided in overcoming these challenges. This collaborative model provides a structure in which residents learn to be respectful consultants and appreciate differences in medical practice. The CWHP and its Birth Center illustrates that through persistence and flexibility a collaborative model of maternity services can flourish and not only positively influence new families but also future generations of providers.

  11. Birth Plans

    Science.gov (United States)

    ... These range from how you hope to handle pain relief to fetal monitoring. Think about the environment in ... how often you have internal exams during labor. Pain management. This is important for most women and is ...

  12. Water immersion during labor and birth: is there an extra cost for hospitals?

    Science.gov (United States)

    Poder, Thomas G

    2017-06-01

    Water immersion during labor and birth is growing in popularity, and many hospitals are now considering offering this service to laboring women. Some advantages of water immersion are demonstrated, but others remain uncertain, and particularly, few studies have examined the financial impact of such a device on hospitals. This study simulated what could be the extra cost of water immersion for hospitals. Clinical outcomes were drawn from the results of systematic reviews already published, and cost units were those used in the Quebec health network. A decision tree was used with microsimulations of representative laboring women. Sensitivity analyses were performed as regards analgesic use and labor duration. Microsimulations indicated an extra cost between $166.41 and $274.76 (2014 Canadian dollars) for each laboring woman as regards the scenario considered. The average extra cost was $221.12 (95% confidence interval, 219.97-222.28). While water immersion allows better clinical outcomes, implementation and other costs are higher than the savings generated, which leads to a small extra cost to allow women to potentially have more relaxation and less pain. © 2016 John Wiley & Sons, Ltd.

  13. The relationship between the weight of the placenta and birth weight of the neonate in a Nigerian Hospital

    Directory of Open Access Journals (Sweden)

    Abubakar A Panti

    2012-01-01

    Full Text Available Background: There have been several publications from different countries on the relationship between the placental weight and birth weight of the neonate. However, such reports from Nigeria are lacking in literature. The objective of this study was to determine the relationship between the placental weight and birth weight of the neonate at term pregnancy in a Nigerian hospital. Materials and Methods: It was a cross-sectional study conducted at Usmanu Danfodiyo University Teaching Hospital Sokoto between 1 st October 2008 and 31 st March 2009. Data gestational age at delivery (in weeks, parity, mode of delivery, fetal birth weight, placental weight, fetal gender, presence or absence of maternal medical diseases were obtained from 1009 singleton term deliveries who met the inclusion criteria for the study. The data was processed using EPI-INFO version 2005 and statistical analysis performed using one-way analysis of variance. A probability of 0.05 was set for statistical significance. Results: The placental birth weight ranged from 300 to 890 g with a mean of 590±82 g while the birth weight of the neonate ranged from 2030 to 5020 g with an average of 3275±469 g. The mean gestational age at delivery was 38.8±1.1 weeks while the mean placental birth weight ratio was 18.2±2.4 Increase in birth weight of the neonate was associated with corresponding increase in placental weight. However, as the gestational age at term advances the proportion of increase in the former was greater than that of the latter. Conclusions: There is a positive correlation between placental weight and birth weight of the neonate. However, the ratio of the placental and neonatal birth weights at term decreases with advancing gestational age. Thus, prolongation of pregnancy at term may adversely affect the fetus.

  14. Low birth weight at term and its determinants in a tertiary hospital of Nepal: a case-control study.

    Directory of Open Access Journals (Sweden)

    Sudesh Raj Sharma

    Full Text Available Birth weight of a child is an important indicator of its vulnerability for childhood illness and chances of survival. A large number of infant deaths can be averted by appropriate management of low birth weight babies and prevention of factors associated with low birth weight. The prevalence of low birth weight babies in Nepal is estimated to be about 12-32%.Our study aimed at identifying major determinants of low birth weight among term babies in Nepal. A hospital-based retrospective case control study was conducted in maternity ward of Tribhuvan University Teaching Hospital from February to July 2011. A total of 155 LBW babies and 310 controls were included in the study. Mothers admitted to maternity ward during the study period were interviewed, medical records were assessed and anthropometric measurements were done. Risk factors, broadly classified into proximal and distal factors, were assessed for any association with birth of low-birth weight babies. Regression analysis revealed that a history of premature delivery (adjusted odds ratio; aOR5.24, CI 1.05-26.28, hard physical work during pregnancy (aOR1.48, CI 0.97-2.26, younger age of mother (aOR1.98, CI 1.15-3.41, mothers with haemoglobin level less than 11gm/dl (aOR0.51, CI0.24-1.07 and lack of consumption of nutritious food during pregnancy (aOR1.99, CI 1.28-3.10 were significantly associated with the birth of LBW babies. These factors should be addressed with appropriate measures so as to decrease the prevalence of low birth weight among term babies in Nepal.

  15. Planning an outing from hospital for ventilator-dependent children.

    Science.gov (United States)

    Gilgoff, I S; Helgren, J

    1992-10-01

    Returning ventilator-dependent children to the home environment has become a well-accepted occurrence. The success of a home program depends on careful pre-discharge planning in order to ensure the child's medical safety, and adequate preparation to ensure the child's and family's adjustment to an active community life after discharge. To achieve this, involvement in community activities must begin while the child is still in hospital. As part of a complete rehabilitation program, nine ventilator-dependent children were taken on an inpatient outing to Disneyland. The planning and goals of the outing are described.

  16. Screening, testing, and reporting for drug and alcohol use on labor and delivery: a survey of Maryland birthing hospitals.

    Science.gov (United States)

    Miller, Catherine; Lanham, Amy; Welsh, Christopher; Ramanadhan, Shaalini; Terplan, Mishka

    2014-01-01

    Recent amendments to the Child Abuse Prevention and Treatment Act tie the receipt of federal block grants to mandatory reporting of substance-exposed newborns. To determine rates of screening, testing, and reporting of drug and alcohol use at the time of delivery, we administered a telephone survey of nursing managers and perinatal social workers at Maryland birthing hospitals. Of the 34 hospitals, 31 responded (response rate 91%). Although 97% of hospitals reported universal screening, only 6% used a validated instrument. Testing was reported by 94% with 45% reporting universal maternal testing and 7% universal newborn testing. Only 32% reported obtaining maternal consent prior to testing. There is significant heterogeneity in screening and testing for substance use in birthing hospitals. Given federal reporting mandates, state-level practices need to be standardized.

  17. The definition of life: a survey of obstetricians and neonatologists in New York City hospitals regarding extremely premature births.

    Science.gov (United States)

    Ramsay, Sharon M; Santella, Regina M

    2011-05-01

    Among obstetricians and neonatologists in administrative roles in New York City hospitals, a survey was initiated to compare the physicians' definitions of live birth and fetal death, the gestational age at which they consider infants viable, and the resuscitation practices of the neonatologists. The target survey population was 34 neonatologists, and 39 obstetricians representing 41 of the City's 43 maternity hospitals. A telephone survey was used to gather qualitative data from the physicians regarding their definitions of live birth, fetal death, and viability, and their practices regarding extremely premature births. Surveys were completed for 58 physicians, a response rate of 79% (94% for neonatologists and 67% for obstetricians). Physicians' definitions of live birth and fetal death varied, with almost a third (29%) of physicians including gestational age as part of their live birth criteria. Most of the physicians (90%) consider infants born at ≥23 weeks gestation viable. Most neonatologists (97%) said they always resuscitate infants born at ≥23 weeks gestation, and most (94%) said they would never resuscitate infants born at death. Whereas reporting requirements are based on definitions of live birth and fetal death, physicians make resuscitation and other clinical decisions regarding extremely premature infants based on definitions of viability.

  18. Health transformation plan: Goals achievement in Nemazee hospital

    Directory of Open Access Journals (Sweden)

    Ali Akbar Ahmadi

    2016-01-01

    Full Text Available Introduction: The main purpose of this study was to assess fulfillment of goals about “Health Transformation Plan (HTP of Ministry of Health, Treatment and Medical Education” from the perspective of managers, which is as one of the most important management challenges in the Health System Reform Plan. These goals included six packages determined by the Ministry of Health, Treatment and Medical Education, the fulfillment of each of which one was evaluated separately as sub-goals in the current study. Finally, the rank of each package in comparison to other packages was determined and presented, using means rank test (Friedman test. Method: This study was conducted using a questionnaire in which comments of the senior and middle managers of Nemazee hospital were collected as the research data. Due to the fact that about one year has passed since the beginning of implementation of HTP and since there were no documented methods or questionnaires, the researcher designed a self-made questionnaire. The basis of designing the questionnaire was the set of guidelines developed for Health System Reform Plan. These guidelines include goals that a hospital should achieve during implementation of Health System Reform Plan. After sharing these goals with senior and middle managers of Nemazee hospital (as the place of research, they were converted to a questionnaire including 20 questions. The questionnaire included the goals that must be achieved in Nemazee hospital of Shiraz during the implementation of the plan. After designing the questionnaire, a preliminary test was taken to assess the reliability. Results: Cronbach’s alpha coefficient (0.88 showed a high rate of reliability in the above questionnaire. After the final data collection, the questionnaire was tested in a sample of 100 senior and middle managers; the results showed that about six packages were specified by the Ministry of Health, Treatment and Medical Education. The majority of

  19. CHARACTERISTICS AND THE OUTCOME OF VERY LOW BIRTH WEIGHT INFANT BORN IN SANGLAH HOSPITAL DENPASAR

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    Yoga Putra

    2013-04-01

    Full Text Available Very low birth weight (VLBW infants is one of the most important medical problem especially in developing countries. This issue is due to its high morbidity and mortality rate. On the other hand, the long term impact of VLBW infants are poor growth and development including physical, emotional, intelectual (IQ, and disabilities, therefore it could decrease the quality of human resources and become a burden to their family. The objective of this study was to describe the characteristics and outcome among VLBW infants born in the Sanglah Hospital. This was a retrospective study. Data were collected from medical record of all infants with VLBW delivered in Sanglah Hospital from January to Desember 2009. Uncompleted infants and mother medical records were excluded from this study. Of 64 VLBW infants enrolled into the study of which 54.7%  of this subjects was male, median of weight was 1300 g, mean gestational of age was 30.9 (SD 2.28 weeks, and mean lenght of stay was 30.9 (SD 19.7 days. The survival of VLBW infants in this study was 62.5%,  mortality in the early neonatal period was 70,8%. The percentage of VLBW infants who survive was still low and the major causes mortality were HMD (50% and sepsis (41.6%. The mortality of VLBW happened mostly in early neonatal periode.

  20. Prenatal and childhood growth, and hospitalization for alcohol use disorders in adulthood: the Helsinki birth cohort study.

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    Jari Lahti

    Full Text Available BACKGROUND: Small birth size - an indicator of a sub-optimal prenatal environment - and variation in growth after birth have been associated with non-communicable diseases in later life. We tested whether birth size or growth in childhood associated with the risk of hospital admission for alcohol use disorders (AUDs from early to late adulthood. METHODS: The sample comprised 6544 men and 6050 women born between 1934 and 1944 in Helsinki, Finland. Data on anthropometric measures were extracted from medical records and diagnoses of AUD from the Finnish Hospital Discharge Register and Causes of Death Register covering a 40-year period from 1969 to 2008. RESULTS: Altogether 171 women (2.8% and 657 men (10.0% were diagnosed at a hospital with AUD. After adjusting for major confounders, shorter length at birth, shorter height up to two years of age, and lower weight at two years associated with hospitalization for AUD in women. In men, slower growth in height, particularly from 2 to 7 years, and slower weight gain from 7 to 11 years as well as shorter height and lower weight at 7 and 11 years associated with a diagnosis of AUD in men. CONCLUSIONS: Pre- and postnatal growth associates with the risk for AUD later in life differently in women than in men: the fetal period and infancy seem to be the sensitive periods for women, whereas those for men the occur from toddlerhood onwards.

  1. [Palliative care birth plan: a field of perinatal medicine to build].

    Science.gov (United States)

    Tosello, B; Le Coz, P; Payot, A; Gire, C; Einaudi, M-A

    2013-04-01

    Some couples may choose to continue the pregnancy unable to decide for termination of pregnancy. Such situations recently occurred in neonatology units and may lead to neonatal palliative care. Faced with all uncertainties inherent to medicine and the future of the baby, medical teams must inform parents of different possible outcome step by step. Consistency in the reflection and intentionality of the care is essential among all different stakeholders within the same health team to facilitate support of parents up to a possible fatal outcome. This issue in perinatal medicine seems to be to explore how caregivers can contribute in the construction of parenthood in a context of a palliative care birth plan.

  2. Maternal Chlamydia trachomatis Infections and Preterm Births in a University Hospital in Vitoria, Brazil

    Science.gov (United States)

    Schmidt, Renylena; Muniz, Renan Rosetti; Cola, Elizandra; Stauffert, Dulce; Silveira, Mariangela Freitas; Miranda, Angelica E.

    2015-01-01

    Background Preterm birth (PTB) is a major determinant of neonatal morbimortality with adverse consequences for health. The causes are multifactorial, with intrauterine infection probably explaining most of these outcomes. It is believed that infection with Chlamydia trachomatis (CT) is also involved in PTB and premature rupture of membranes. Objetives To evaluate the prevalence of and associated factors for CT among cases of PTB attended at a University Hospital in Vitoria, Brazil. Methods A cross-sectional study performed among parturient who had preterm birth from June 2012 to August 2013 in Vitoria, Brazil. Participants answered a questionnaire including demographic, behavioral, and clinical data. A sample of urine was collected and screened for CT using polymerase chain reaction. Chi-square tests were used for proportion differences and Student’s-t tests and variance analysis were used for testing differences between mean values. Odds ratio was used as a measure of association with a 95% confidence interval. Results The prevalence of PTB during the period of the study was 26% and the prevalence of CT among them was 13.9%. A total of 31.6% pregnant women were younger than 25 years old and women infected by CT were even younger than women not infected by CT (p = 0.022). Most of them (76.2%) were married or had a living partner, and CT infection was more frequent among the single ones (p = 0.018); 16.7% of women reported their first sexual intercourse under 14 years old. The causes of prematurity were maternal-fetal in 40.9%; rupture of the membranes in 29.7% and premature labor in 29.4%. In multivariate analysis, being married was a protective factor for infection [OR = 0.48 (95%CI:0.24–0.97)]. None of the other characteristics were associated with CT infection. Conclusions This study shows a high prevalence of CT infection among parturient who have preterm birth. This high prevalence highlight the need for defining screening strategies focused on young

  3. A financial planning model for estimating hospital debt capacity.

    Science.gov (United States)

    Hopkins, D S; Heath, D; Levin, P J

    1982-01-01

    A computer-based financial planning model was formulated to measure the impact of a major capital improvement project on the fiscal health of Stanford University Hospital. The model had to be responsive to many variables and easy to use, so as to allow for the testing of numerous alternatives. Special efforts were made to identify the key variables that needed to be presented in the model and to include all known links between capital investment, debt, and hospital operating expenses. Growth in the number of patient days of care was singled out as a major source of uncertainty that would have profound effects on the hospital's finances. Therefore this variable was subjected to special scrutiny in terms of efforts to gauge expected demographic trends and market forces. In addition, alternative base runs of the model were made under three distinct patient-demand assumptions. Use of the model enabled planners at the Stanford University Hospital (a) to determine that a proposed modernization plan was financially feasible under a reasonable (that is, not unduly optimistic) set of assumptions and (b) to examine the major sources of risk. Other than patient demand, these sources were found to be gross revenues per patient, operating costs, and future limitations on government reimbursement programs. When the likely financial consequences of these risks were estimated, both separately and in combination, it was determined that even if two or more assumptions took a somewhat more negative turn than was expected, the hospital would be able to offset adverse consequences by a relatively minor reduction in operating costs. PMID:7111658

  4. A financial planning model for estimating hospital debt capacity.

    Science.gov (United States)

    Hopkins, D S; Heath, D; Levin, P J

    1982-01-01

    A computer-based financial planning model was formulated to measure the impact of a major capital improvement project on the fiscal health of Stanford University Hospital. The model had to be responsive to many variables and easy to use, so as to allow for the testing of numerous alternatives. Special efforts were made to identify the key variables that needed to be presented in the model and to include all known links between capital investment, debt, and hospital operating expenses. Growth in the number of patient days of care was singled out as a major source of uncertainty that would have profound effects on the hospital's finances. Therefore this variable was subjected to special scrutiny in terms of efforts to gauge expected demographic trends and market forces. In addition, alternative base runs of the model were made under three distinct patient-demand assumptions. Use of the model enabled planners at the Stanford University Hospital (a) to determine that a proposed modernization plan was financially feasible under a reasonable (that is, not unduly optimistic) set of assumptions and (b) to examine the major sources of risk. Other than patient demand, these sources were found to be gross revenues per patient, operating costs, and future limitations on government reimbursement programs. When the likely financial consequences of these risks were estimated, both separately and in combination, it was determined that even if two or more assumptions took a somewhat more negative turn than was expected, the hospital would be able to offset adverse consequences by a relatively minor reduction in operating costs.

  5. [Evaluation of a functional plan for caregivers in hospital].

    Science.gov (United States)

    Quiñoz-Gallardo, M Dolores; Vellido-González, Concepción; Rivas-Campos, Antonio; Martín-Berrido, Mercedes; González-Guerrero, Leticia; Vellido-González, Dolores; Nieto-Poyato, Rosa María; Corral-Rubio, M Carmen

    2013-01-01

    The care of dependent persons has increased, as such that healthcare reforms are taking caregivers into account. A functional plan in hospitalization was developed for caregivers, and his study aims to investigate its implementation, identifying the strengths and weaknesses that promote changes between the formal and informal system. A qualitative study was designed, using nursing professionals and caregivers identified in the hospital as subjects. A focus group technique was used with 8 people selected for each segment. Two scripts were developed with questions on the evaluation criteria included in the plan: identification/recruitment, reception, rest, diet, health care, information/health education, management and implementation of the plan and other proposals. The data were collected during May 2011. Difficulties were encountered in identifying caregivers, as an initial evaluation was not made. As regards the reception, in some cases the information brochure was not given. Rest was not possible as the caregivers did not want to move away from the patient. Diet was the main cause of the conflict, highlighting the lack of health education to continue in home care. Circuits of preferential care in emergency were positively valuated. Nurses consider the plan as an extra task. The strengths and weaknesses identified should enable improvements to be made in the implementation of the plan, in order to achieve changes in specific aspects such as information/education, health, rest and diet of the caregivers. We emphasize the need to enhance the model change. Copyright © 2013 Elsevier España, S.L. All rights reserved.

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

    Science.gov (United States)

    Coffey, Diane

    2014-08-01

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

  7. Relationship of Characteristics of Baby’s Mother with the Low Birth Weight in Regional General Hospital in Sorong

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    Agustina Naa

    2016-02-01

    Full Text Available The mortality rate of low birth weight is part of a reflection of the public health status. Low birth weight babies are born with birth weight less than 2,500 grams regardless of pregnancy. The aim of research to determine the relationship characteristic of mothers of infants with LBW. This type of research is observational analytic with cross sectional design. Collecting data through observation sheet on record medic mothers who gave birth in hospitals 2014, in Sorong, West Papua Province in July-August 2015. The results reveal no relationship nutritional status of mothers with LBW (p = 0.000 and 9.54 RP. No relationship of anemia in mothers with LBW (p = 0.000 and 9.20 RP, no relationship of pregnancy range with LBW births (p = 0.000 and 5.01 RP, no maternal employment status relationship with the incidence of low birth weight (p = 0.001 and RP 3.22, there is a relationship with the mother's education level LBW (p = 0.005 and 2.82 RP, no correlation between age mothers with LBW (p = 0.011 and 2.51 RP and the biggest risk factors based on the RP is factor of maternal nutritional status (p = 0.000 and 9.54 RP.

  8. Infant mortality in a very low birth weight cohort from a public hospital in Rio de Janeiro, RJ, Brazil

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    Regina Coeli Azeredo Cardoso

    2013-09-01

    Full Text Available OBJECTIVES: to evaluate infant mortality in very low birth weight newborns from a public hospital in Rio de Janeiro, Brazil (2002-2006. METHODS: a retrospective cohort study was performed using the probabilistic linkage method to identify infant mortality. Mortality proportions were calculated according to birth weight intervals and period of death. The Kaplan-Meier method was used to estimate overall cumulative survival probability. The association between maternal schooling and survival of very low birth weight infants was evaluated by means of Cox proportional hazard models adjusted for: prenatal care, birth weight, and gestational age. RESULTS: the study included 782 very low birth weight newborns. Of these, (28.6% died before one year of age. Neonatal mortality was 19.5%, and earlyneonatal mortality was 14.9%. Mortality was highest in the lowest weight group (71.6%. Newborns whose mothers had less than four years of schooling had 2.5 times higher risk of death than those whose mothers had eight years of schooling or more, even after adjusting for intermediate factors. CONCLUSIONS: the results showed higher mortality among very low birth weight infants. Low schooling was an independent predictor of infant death in this low-income population sample.

  9. [Strategic planning: an important economic action for German hospitals].

    Science.gov (United States)

    Wiese, Christoph H R; Zink, Wolfgang; Russo, Sebastian G

    2011-11-01

    In medical systems, economic issues and means of action are in the course of dwindling human (physicians and nurses) and financial resources are more important. For this reason, physicians must understand basic economic principles. Only in this way, there may be medical autonomy from social systems and hospital administrators. The current work is an approach to present a model for strategic planning of an anesthesia department. For this, a "strengths", "weaknesses", "opportunities", and "threats" (SWOT) analysis is used. This display is an example of an exemplary anaesthetic department.

  10. Home births in the United States, 1990-2009.

    Science.gov (United States)

    MacDorman, Marian F; Mathews, T J; Declercq, Eugene

    2012-01-01

    After 14 years of decline, the percentage of home births rose by 29% from 2004 to 2009, to the point where it is at the highest level since data on this item began to be collected in 1989. The overall increase in home births was driven mostly by a 36% increase for non-Hispanic white women. About 1 out of every 90 births to non-Hispanic white women are now home births. The percentage of home births for non-Hispanic white women was three to five times higher than for any other racial or ethnic group. Home births have a lower risk profile than hospital births, with fewer births to teenagers or unmarried women, and with fewer preterm, low birthweight, and multiple births. The lower risk profile of home compared with hospital births suggests that home birth attendants are selecting low-risk women as candidates for home birth. The increase in the percentage of home births from 2004 to 2009 was widespread and involved selected states from every region of the country. The large variations in the percentage of home births by state may be influenced by differences among states in laws pertaining to births are more prevalent among non-Hispanic white women (7). midwifery practice or out-of-hospital birth (8,9), as well as by differences in the racial and ethnic composition of state populations, as home Studies have suggested that most home births are intentional or planned home births, whereas others are unintentional or unplanned, because of an emergency situation (i.e., precipitous labor, labor complications, or unable to get to the hospital in time) (3,6). Although not representative of all U.S. births (see "Data source and methods"), 87% of home births in a 26-state reporting area (comprising 50% of U.S. births) were planned in 2009. For non-Hispanic white women, 93% of home births were planned (10). Women may prefer a home birth over a hospital birth for a variety of reasons, including a desire for a low-intervention birth in a familiar environment surrounded by family

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

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    Koukoufilippou J

    2015-01-01

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

  12. Hospital churn and casemix instability: implications for planning and educating the nursing workforce.

    Science.gov (United States)

    Chiarella, Mary; Roydhouse, Jessica K

    2011-02-01

    Health workforce planning is a priority for Australian governments at both state and federal levels. Nursing shortages are a significant problem and addressing these shortages is likely to be a component of any workforce plan. This paper looks at the case of hospital nursing and argues that casemix, workforce and management instability inhibit workforce planning for hospital nursing. These issues are related and any efforts to objectively plan the hospital nursing workforce must seek to address them in order to succeed.

  13. The increasing trend in preterm birth in public hospitals in northern Argentina.

    Science.gov (United States)

    Weaver, Emily H; Gibbons, Luz; Belizán, José M; Althabe, Fernando

    2015-08-01

    To identify factors associated with the increasing incidence of preterm birth in northern Argentina. In an observational study, data were reviewed from a prospective, population-based registry of pregnancy outcomes in six cities in 2009-2012. The primary outcome was preterm birth (at 20-37 weeks). Bivariate tests and generalized estimating equations were used within a conceptual hierarchical framework to estimate the cluster-corrected annual trend in odds of preterm birth. The study reviewed data from 11 433 live births. There were 484 (4.2%) preterm births. The incidence of preterm births increased by 38% between 2009 and 2012, from 37.5 to 51.7 per 1000 live births. Unadjusted risk factors for preterm birth included young or advanced maternal age, normal body mass index, nulliparity, no prenatal care, no vitamins or supplements during pregnancy, multiple gestation, and maternal hypertension or prepartum hemorrhage. The prevalence of many risk factors increased over the study period, but variations in these factors explained less than 1% of the increasing trend in preterm birth. The incidence of preterm births in six small cities in northern Argentina increased greatly between 2009 and 2012. This trend was unexplained by the risk factors measured. Other factors should be assessed in future studies. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  14. 'Stress, anger, fear and injustice': An international qualitative survey of women's experiences planning a vaginal breech birth.

    Science.gov (United States)

    Petrovska, Karolina; Watts, Nicole P; Catling, Christine; Bisits, Andrew; Homer, Caroline Se

    2017-01-01

    the outcomes of the Term Breech Trial had a profound impact on women's options for breech birth, with caesarean section now seen as the default method for managing breech birth by many clinicians. Despite this, the demand for planned vaginal breech birth from women does exist. This study aimed to examine the experiences of women who sought a vaginal breech birth to increase understanding as to how to care for women seeking this birth option. an electronic survey was distributed to women online via social media. The survey consisted of qualitative and quantitative questions, with the qualitative data being the focus of this paper. Open ended questions sought information on the ways in which woman sourced a clinician skilled in vaginal breech birth and the level of support and quality of information provided from clinicians regarding vaginal breech birth. Thematic analysis was used to analyse and code the qualitative data into major themes. in total, 204 women from over seven countries responded to the survey. Written responses to the open ended questions were categorised into seven themes: Seeking the chance to try for a VBB; Encountering coercion and fear; Putting the birth before the baby?; Dealing with emotional wounds; Searching for information and support; Traveling across boundaries; Overcoming obstacles in the system. for women seeking vaginal breech birth, limited system and clinical support can impede access to balanced information and options for care. Recognition of existing evidence on the safety of vaginal breech birth, as well as the presence of clinical guidelines that support it, may assist in promoting vaginal breech birth as a legitimate option that should be available to women. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Bio-social Predictors of Low Birth Weight- A Prospective study at a Tertiary care Hospital of North Karnataka, India

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    DP Paneru

    2013-12-01

    Full Text Available BACKGROUND: Low Birth Weight is a multi-factorial problem of health and social concern Worldwide. India accounts for 40 percent of Low birth weight (LBW babies of the developing World and more than half of those in Asia. Despite the multitude of services rendered to improve maternal health care, LBW remains a public health problem in India. Objective: To determine bio-social predictors of low birth weight amongst the institutional births in North Karnataka, India. METHODS: A prospective hospital based study was conducted in Belgaum district of north Karnataka during July 2012-March 2013. A total of 426 pregnant women registered within 20 weeks of gestation during July–September 2013; eventually delivered in the same hospital were included in the study. Birth weight was measured by a digital weighing scale of 100 gram accuracy. Data were collected through individual interviews using pretested questionnaire. Data were analyzed by SPSS (16.0 Version. Descriptive statistics and multivariate regression were applied. P value < 0.05 considered significant. RESULTS: Mean age of subjects was 23.2254±3.09 years. About 96.7% were literates. Mean age at first pregnancy was 21.37±2.70 years. Low birth weight was observed amongst 22.5% new born (Mean weight: 2089.58±268.31gm. Almost 10.0% were preterm births. Paternal education and occupation, socio-economic status, religion, maternal blood group and gestation age at delivery were found to be the independent and significant bio-social factors predicting the low birth weight. About 68.0% variations in the birth weight were explained by these predictors. CONCLUSIONS: Low paternal education and occupation (farmers/laborers, low socio-economic status, maternal blood group (A is protective and prematurity were found to be independent bio-social predicators of LBW. Programme targeting paternal education may be useful and study of biological plausibility associated with the maternal blood group is recommended.

  16. IMPLEMENTATION BIRTH PLANNING AND COMPLICATIONS PREVENTIONS PROGRAM (P4K ON COASTAL COMMUNITIES IN MAMUJU

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    Ashriady Ashriady

    2017-01-01

    Full Text Available The results of the 97 countries, there is a significant correlation between aid delivery with maternal mortality (Depkes, 2011. Proportion of birth in Indonesia showed 76.1% in Healthcare Facilities and 23.7% in home and another (Kemenkes RI, 2014. In the coastal community primary choices deliveries take place at home, assisted by shamans because mothers feel safe from evil spirits, and convenient for the family attended (Yunarti, 2013. Scope of delivery assistance by health workers in 2006 - 2011 in West Sulawesi has not reached the target of minimum service standards in 2015 by 90%, obstetric complications handled in 2011 in Mamuju 35.1%. The aim of research to analyze the implementation of Birth Planning and Complications Preventions Program (P4K based on the knowledge and attitude of Mother on Coastal Communities in Mamuju. This type of research is survey with cross sectional study design. In the study period in August-October 2016. The population is all Mother toddler who visited IHC 330, 149 of the samples obtained by using the formula, taken by accidental sampling method. The results showed 68 (81.9% of respondents have sufficient knowledge of the implementation of the less well P4K, 113 (79.6% positive attitude to the implementation mother P4K less good, there is no statistical relationship between knowledge and attitude of mothers with implementation P4K. Midwives need intensive assistance in filling and installation sticker P4K at home mom.

  17. Social Work Discharge Planning in Acute Care Hospitals in Israel: Clients' Evaluation of the Discharge Planning Process and Adequacy

    Science.gov (United States)

    Soskolne, Varda; Kaplan, Giora; Ben-Shahar, Ilana; Stanger, Varda; Auslander, Gail. K.

    2010-01-01

    Objective: To examine the associations of patients' characteristics, hospitalization factors, and the patients' or family assessment of the discharge planning process, with their evaluation of adequacy of the discharge plan. Method: A prospective study. Social workers from 11 acute care hospitals in Israel provided data on 1426 discharged…

  18. Social Work Discharge Planning in Acute Care Hospitals in Israel: Clients' Evaluation of the Discharge Planning Process and Adequacy

    Science.gov (United States)

    Soskolne, Varda; Kaplan, Giora; Ben-Shahar, Ilana; Stanger, Varda; Auslander, Gail. K.

    2010-01-01

    Objective: To examine the associations of patients' characteristics, hospitalization factors, and the patients' or family assessment of the discharge planning process, with their evaluation of adequacy of the discharge plan. Method: A prospective study. Social workers from 11 acute care hospitals in Israel provided data on 1426 discharged…

  19. Population attributable risks of patient, child and organizational risk factors for perinatal mortality in hospital births.

    Science.gov (United States)

    Poeran, Jashvant; Borsboom, Gerard J J M; de Graaf, Johanna P; Birnie, Erwin; Steegers, Eric A P; Bonsel, Gouke J

    2015-04-01

    The main objective of this study was to estimate the contributing role of maternal, child, and organizational risk factors in perinatal mortality by calculating their population attributable risks (PAR). The primary dataset comprised 1,020,749 singleton hospital births from ≥22 weeks' gestation (The Netherlands Perinatal Registry 2000-2008). PARs for single and grouped risk factors were estimated in four stages: (1) creating a duplicate dataset for each PAR analysis in which risk factors of interest were set to the most favorable value (e.g., all women assigned 'Western' for PAR calculation of ethnicity); (2) in the primary dataset an elaborate multilevel logistic regression model was fitted from which (3) the obtained coefficients were used to predict perinatal mortality in each duplicate dataset; (4) PARs were then estimated as the proportional change of predicted- compared to observed perinatal mortality. Additionally, PARs for grouped risk factors were estimated by using sequential values in two orders: after PAR estimation of grouped maternal risk factors, the resulting PARs for grouped child, and grouped organizational factors were estimated, and vice versa. The combined PAR of maternal, child and organizational factors is 94.4 %, i.e., when all factors are set to the most favorable value perinatal mortality is expected to be reduced with 94.4 %. Depending on the order of analysis, the PAR of maternal risk factors varies from 1.4 to 13.1 %, and for child- and organizational factors 58.7-74.0 and 7.3-34.3 %, respectively. In conclusion, the PAR of maternal-, child- and organizational factors combined is 94.4 %. Optimization of organizational factors may achieve a 34.3 % decrease in perinatal mortality.

  20. Poverty and cumulative hospitalization in infancy and early childhood in the Quebec birth cohort: a puzzling pattern of association.

    Science.gov (United States)

    Nikièma, Béatrice; Zunzunegui, Maria Victoria; Séguin, Louise; Gauvin, Lise; Potvin, Louise

    2008-07-01

    We anticipate a negative gradient between income and hospitalization, since income is positively associated with good health. In a previous cross-sectional study, we reported an unexpected pattern of association between poverty and hospitalization for 5-month-old infants in Quebec. This study re-examines the poverty-hospitalization relationship within a longitudinal population study of the same birth cohort aged 3.5 years. Life table analysis, multivariable proportional hazard regression, and multivariable logistic regression were performed on data from the first four waves of the Quebec Longitudinal Study of Child Development (QLSCD). Probabilities of hospitalization were estimated by poverty status. The hazard ratios (HR) (Cox-regression) for duration of poverty (frequency of insufficient income) and severity of poverty (combining frequency and level of income insufficiency) were estimated, controlling for predisposing, enabling, and need determinants of hospitalization. At 3.5 years, 31% of children had been hospitalized at least once. Compared with children whose families had constantly sufficient income, children with intermittent poverty exhibited higher hospitalization risks (HR = 1.30; 95%CI = 1.04-1.64) while chronically poor children exhibited comparable hospitalization hazards (HR = 0.97; 95%CI = 0.73-1.27). Hospitalization risks for children in the severest poverty group resembled that of the non-poor group (HR = 0.99; 95%CI = 0.66-1.49), while children in less severely poor families were more likely to be hospitalized (HR = 1.26; 95%CI = 0.99-1.60). Results suggest hospitalization barriers for children living in chronic and severe poverty. If these barriers exist in a universal health care system, they may originate with primary care service organization or hospital care referral procedures.

  1. Cervical ripening with low-dose prostaglandins in planned vaginal birth after cesarean.

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    Thomas Schmitz

    Full Text Available OBJECTIVES: To compare uterine rupture, maternal and perinatal morbidity rates in women with one single previous cesarean after spontaneous onset of labor or low-dose prostaglandin-induced cervical ripening for unfavourable cervix. STUDY DESIGN: This was a retrospective cohort study of 4,137 women with one single previous cesarean over a 22-year period. Inpatient prostaglandin administration consisted in single daily local applications. RESULTS: Vaginal delivery was planned for 3,544 (85.7% patients, 2,704 (76.3% of whom delivered vaginally (vaginal birth after Cesarean (VBAC rate = 65.4%. Among women receiving prostaglandins (n=515, 323 (62.7% delivered vaginally. Uterine rupture (0.7% compared with 0.8%, OR 1.1, 95% CI 0.4-3.4, p=0.88, maternal (0.9% compared with 1.2%, OR 1.3, 95% CI 0.5-3.2, p=0.63 and perinatal (0.3% compared with 0.8%, OR 2.4, 95% CI 0.7-8.5, p=0.18 morbidity rates did not differ significantly between patients with spontaneous onset of labor and those receiving prostaglandins, nor did these rates differ according to the planned mode of delivery. CONCLUSION: In comparison with patients with spontaneous labor, inducing cervical ripening with low-dose prostaglandins in case of unfavourable cervix is not associated with appreciable increase in uterine rupture, maternal or perinatal morbidity.

  2. Changes in breastfeeding initiation at hospital discharge between first and second births in Nova Scotia: a population-based cohort study

    Science.gov (United States)

    Nix, Kimberley; Dodds, Linda

    2017-01-01

    Background: Breastfeeding has well-recognized health benefits for infants and mothers. However, little research has been conducted to investigate changes in breastfeeding from one pregnancy to another. This study was conducted to describe rates of breastfeeding initiation at hospital discharge for women's first and second births and to identify factors associated with changes in initiation at the second birth. Methods: We conducted a longitudinal, population-based cohort study involving women residing in Nova Scotia who delivered a first and second live-born singleton between 2007 and 2013. Separate analyses were conducted among women who breastfed their first infant and among women who did not breastfeed their first infant. Results: Of the 9643 (82.6%) mothers who initiated breastfeeding in the first birth, 973 (10.3%) did not initiate breastfeeding in the second birth. Of first-birth noninitiators, 526 (26.3%) initiated breastfeeding in the second birth. With the exception of smoking and cesarean births, factors that were associated with breastfeeding initiation in the second birth depended on breastfeeding initiation status in the first birth. These factors were associated with increased odds of not breastfeeding in the second birth among the subset of mothers who breastfed in the first birth, and decreased odds of breastfeeding in the second birth among the subset of mothers who did not breastfeed in the first birth. Interpretation: Most women continue the same method of infant feeding after their first and second births. Identifying factors associated with change in breastfeeding status between the first and second births may help to inform interventions for optimal breastfeeding initiation in the second birth.

  3. The impact of health system reform plan on the hospital\\'s performance indicators of Lorestan University of Medical Sciences

    Directory of Open Access Journals (Sweden)

    Reza Dadgar

    2017-10-01

    Conclusion: The health system  reform plan has been positive changes in indicators of hospital performance. Therefore, while considering the current trend of continuous improvement, the continuity of the project was advised based on the results of this study.

  4. Incidence of maternal near miss in hospital childbirth and postpartum: data from the Birth in Brazil study.

    Science.gov (United States)

    Dias, Marcos Augusto Bastos; Domingues, Rosa Maria Soares Madeira; Schilithz, Arthur Orlando Corrêa; Nakamura-Pereira, Marcos; Diniz, Carmen Simone Grilo; Brum, Ione Rodrigues; Martins, Alaerte Leandro; Theme Filha, Mariza Miranda; Gama, Silvana Granado Nogueira da; Carmo Leal, Maria do

    2014-08-01

    This study evaluated data on the incidence of maternal near miss identified on World Health Organization (WHO) criteria from the Birth in Brazil survey. The study was conducted between February 2011 and October 2012. The results presented are estimates for the study population (2,337,476 births), based on a sample of 23,894 women interviewed. The results showed an incidence of maternal near miss of 10.21 per 1,000 live births and a near-miss-to-mortality ratio of 30.8 maternal near miss to every maternal death. Maternal near miss was identified most prevalently by clinical criteria, at incidence of 5.2 per 1,000 live births. Maternal near miss was associated with maternal age 35 or more years (RR=1.6; 95%CI: 1.1-2.5), a history of previous cesarean delivery (RR=1.9; 95%CI: 1.1-3.4) and high-risk pregnancy (RR=4.5; 95%CI: 2.8-7.0). incidence of maternal near miss was also higher at hospitals in capital cities (RR=2.2; 95%CI: 1.3-3.8) and those belonging to Brazil's national health service, the Brazilian Unified National Health System (SUS) (RR=3.2; 95%CI: 1.6-6.6). Improved quality of childbirth care services can help reduce maternal mortality in Brazil.

  5. Natural Family Planning

    Science.gov (United States)

    ... Sex and Birth Control Birth Control Natural Family Planning Natural Family Planning Birth ControlPrevention and WellnessSex and Birth Control Share Natural Family Planning Natural Family PlanningWhat is natural family planning?Natural ...

  6. Hospital work and pregnancy outcomes: a study in the Danish National Birth Cohort

    DEFF Research Database (Denmark)

    Suárez-Varela, María M Morales; Kaerlev, Linda; Zhu, Jin Liang;

    2009-01-01

    In hospitals, women of reproductive age do a range of work tasks, some of which are known to carry potential risks. Tasks such as working with radiation, chemicals, and infectious agents, as well as performing heavy lifting or tasks requiring erratic sleep patterns have been reported to increase...... the risk of reproductive failures. Our aim was to study pregnancy outcomes in female hospital workers in Denmark. We performed a cohort study of 5976 female hospital workers and used as a reference group 60,890 women employed outside of hospitals. The reproductive health of hospital workers working during...... pregnancy is comparable to those of non-hospital workers for the majority of reproductive failures studied. However, an increased prevalence of congenital abnormalities was noted in some subgroups of hospital workers, which may indicate that some hospital work still entails fetotoxic hazards....

  7. Hospital work and pregnancy outcomes: a study in the Danish National Birth Cohort.

    Science.gov (United States)

    Suárez-Varela, María M Morales; Kaerlev, Linda; Zhu, Jin Liang; Bonde, Jens Peter; Nøhr, Ellen-Aagaard; Llopis-González, Agustín; Olsen, Jørn

    2009-01-01

    In hospitals, women of reproductive age do a range of work tasks, some of which are known to carry potential risks. Tasks such as working with radiation, chemicals, and infectious agents, as well as performing heavy lifting or tasks requiring erratic sleep patterns have been reported to increase the risk of reproductive failures. Our aim was to study pregnancy outcomes in female hospital workers in Denmark. We performed a cohort study of 5976 female hospital workers and used as a reference group 60,890 women employed outside of hospitals. The reproductive health of hospital workers working during pregnancy is comparable to those of non-hospital workers for the majority of reproductive failures studied. However, an increased prevalence of congenital abnormalities was noted in some subgroups of hospital workers, which may indicate that some hospital work still entails fetotoxic hazards.

  8. HCA Richmond Hospitals' new marketing strategy a winning plan.

    Science.gov (United States)

    Rees, Tom

    2003-01-01

    HCA Richmond Hospitals, a five-hospital system in Richmond, Va., is positioning itself as a winner in a highly competitive, healthcare-saturated market since overhauling is marketing strategy a little over a year ago. The marketing strategy enables individual hospital to target their own unique constituencies. "Understanding the intricate marketing dynamics of hospital systems is today of critical importance and equal complexity," said Tony Bejamin, principal of Oxygen Advertising Inc., New York, the agency that remodeled HCA Richmond Hospitals' marketing strategy.

  9. How a new 'public plan' could affect hospitals' finances and private insurance premiums.

    Science.gov (United States)

    Dobson, Allen; DaVanzo, Joan E; El-Gamil, Audrey M; Berger, Gregory

    2009-01-01

    Two key health reform bills in the House of Representatives and Senate include the option of a "public plan" as an additional source of health coverage. At least initially, the plan would primarily be structured to cover many of the uninsured and those who now have individual coverage. Because it is possible, and perhaps even likely, that this new public payer would pay less than private payers for the same services, such a plan could negatively affect hospital margins. Hospitals may attempt to recoup losses by shifting costs to private payers. We outline the financial pressures that hospitals and private payers could experience under various assumptions. High uninsured enrollment in a public plan would bolster hospital margins; however, this effect is reversed if the privately insured enter a public plan in large proportions, potentially stressing the hospital industry and increasing private insurance premiums.

  10. Profile of maternal and foetal complications during labour and delivery among women giving birth in hospitals in Matlab and Chandpur, Bangladesh.

    Science.gov (United States)

    Huda, Fauzia Akhter; Ahmed, Anisuddin; Dasgupta, Sushil Kanta; Jahan, Musharrat; Ferdous, Jannatul; Koblinsky, Marge; Ronsmans, Carine; Chowdhury, Mahbub Elahi

    2012-06-01

    Worldwide, for an estimated 358,000 women, pregnancy and childbirth end in death and mourning, and beyond these maternal deaths, 9-10% of pregnant women or about 14 million women per year suffer from acute maternal complications. This paper documents the types and severity of maternal and foetal complications among women who gave birth in hospitals in Matlab and Chandpur, Bangladesh, during 2007-2008. The Community Health Research Workers (CHRWs) of the icddr,b service area in Matlab prospectively collected data for the study from 4,817 women on their places of delivery and pregnancy outcomes. Of them, 3,010 (62.5%) gave birth in different hospitals in Matlab and/or Chandpur and beyond. Review of hospital-records was attempted for 2,102 women who gave birth only in the Matlab Hospital of icddr,b and in other public and private hospitals in the Matlab and Chandpur area. Among those, 1,927 (91.7%) records were found and reviewed by a physician. By reviewing the hospital-records, 7.3% of the women (n=1,927) who gave birth in the local hospitals were diagnosed with a severe maternal complication, and 16.1% with a less-severe maternal complication. Abortion cases--either spontaneous or induced--were excluded from the analysis. Over 12% of all births were delivered by caesarean section (CS). For a substantial proportion (12.5%) of CS, no clear medical indication was recorded in the hospital-register. Twelve maternal deaths occurred during the study period; most (83%) of them had been in contact with a hospital before death. Recommendations include standardization of the hospital record-keeping system, proper monitoring of indications of CS, and introduction of maternal death audit for further improvement of the quality of care in public and private hospitals in rural Bangladesh.

  11. Incidence and correlates of low birth weight at a referral hospital in ...

    African Journals Online (AJOL)

    abp

    2012-05-04

    May 4, 2012 ... mean birth weight and an increasing trend of LBW from 1970`s to 1990`s and ... Nearly half (46.2%) of women said they were given dietary counseling ... incidence ranging between 9.0% and 11.8% like Iran, Turkey, Pakistan, ...

  12. Low birth weight among adolescents at Cape Coast Metropolitan Hospital of Ghana

    Directory of Open Access Journals (Sweden)

    James Afriyie

    2016-12-01

    Conclusions: Adolescents are at a higher risk of giving birth to babies of LBW than adults. Factors predicting LBW may not be different for adolescent and adult mothers. Interventions for prevention of negative sexual health outcomes should focus on adolescents. [Int J Reprod Contracept Obstet Gynecol 2016; 5(12.000: 4242-4247

  13. Strategic planning, implementation, and evaluation processes in hospital systems: a survey from Iran.

    Science.gov (United States)

    Sadeghifar, Jamil; Jafari, Mehdi; Tofighi, Shahram; Ravaghi, Hamid; Maleki, Mohammad Reza

    2014-09-28

    Strategic planning has been presented as an important management practice. However, evidence of its deployment in healthcare systems in low-income and middle-income countries (LMICs) is limited. This study investigated the strategic management process in Iranian hospitals. The present study was accomplished in 24 teaching hospitals in Tehran, Iran from September 2012 to March 2013. The data collection instrument was a questionnaire including 130 items. This questionnaire measured the situation of formulation, implementation, and evaluation of strategic plan as well as the requirements, facilitators, and its benefits in the studied hospitals. All the investigated hospitals had a strategic plan. The obtained percentages for the items "the rate of the compliance to requirements" and "the quantity of planning facilitators" (68.75%), attention to the stakeholder participation in the planning (55.74%), attention to the planning components (62.22%), the status of evaluating strategic plan (59.94%) and the benefits of strategic planning for hospitals (65.15%) were in the medium limit. However, the status of implementation of the strategic plan (53.71%) was found to be weak. Significant statistical correlations were observed between the incentive for developing strategic plan and status of evaluating phase (P=0.04), and between status of implementation phase and having a documented strategic plan (P=0.03). According to the results, it seems that absence of appropriate internal incentive for formulating and implementing strategies led more hospitals to start formulation strategic planning in accordance with the legal requirements of Ministry of Health. Consequently, even though all the investigated hospital had the documented strategic plan, the plan has not been implemented efficiently and valid evaluation of results is yet to be achieved.

  14. Strategic Planning, Implementation, and Evaluation Processes in Hospital Systems: A Survey From Iran

    Science.gov (United States)

    Sadeghifar, Jamil; Jafari, Mehdi; Tofighi, Shahram; Ravaghi, Hamid; Maleki, Mohammad Reza

    2015-01-01

    Aim & Background: Strategic planning has been presented as an important management practice. However, evidence of its deployment in healthcare systems in low-income and middle-income countries (LMICs) is limited. This study investigated the strategic management process in Iranian hospitals. Methods: The present study was accomplished in 24 teaching hospitals in Tehran, Iran from September 2012 to March 2013. The data collection instrument was a questionnaire including 130 items. This questionnaire measured the situation of formulation, implementation, and evaluation of strategic plan as well as the requirements, facilitators, and its benefits in the studied hospitals. Results: All the investigated hospitals had a strategic plan. The obtained percentages for the items “the rate of the compliance to requirements” and “the quantity of planning facilitators” (68.75%), attention to the stakeholder participation in the planning (55.74%), attention to the planning components (62.22%), the status of evaluating strategic plan (59.94%) and the benefits of strategic planning for hospitals (65.15%) were in the medium limit. However, the status of implementation of the strategic plan (53.71%) was found to be weak. Significant statistical correlations were observed between the incentive for developing strategic plan and status of evaluating phase (P=0.04), and between status of implementation phase and having a documented strategic plan (P=0.03). Conclusion: According to the results, it seems that absence of appropriate internal incentive for formulating and implementing strategies led more hospitals to start formulation strategic planning in accordance with the legal requirements of Ministry of Health. Consequently, even though all the investigated hospital had the documented strategic plan, the plan has not been implemented efficiently and valid evaluation of results is yet to be achieved. PMID:25716385

  15. Comparative Effect of Massage Therapy versus Kangaroo Mother Care on Body Weight and Length of Hospital Stay in Low Birth Weight Preterm Infants.

    Science.gov (United States)

    Rangey, Priya Singh; Sheth, Megha

    2014-01-01

    Background. Massage therapy (MT) and kangaroo mother care (KMC) are both effective in increasing the weight and reducing length of hospital stay in low birth weight preterm infants but they have not been compared. Aim. Comparison of effectiveness of MT and KMC on body weight and length of hospital stay in low birth weight preterm (LBWPT) infants. Method. 30 LBWPT infants using convenience sampling from Neonatal Intensive Care Unit, V.S. hospital, were randomly divided into 2 equal groups. Group 1 received MT and Group 2 received KMC for 15 minutes, thrice daily for 5 days. Medically stable babies with gestational age Limitation. Long term follow-up was not taken.

  16. Risk factors for premature births: a cross-sectional analysis of hospital records in a Cameroonian health facility.

    Science.gov (United States)

    Chiabi, Andreas; Mah, Evelyn M; Mvondo, Nicole; Nguefack, Seraphin; Mbuagbaw, Lawrence; Kamga, Karen K; Zhang, Shiyuan; Mboudou, Emile; Tchokoteu, Pierre F; Mbond, Elie

    2013-12-01

    The aim of this study was to investigate the risk factors for preterm births in the Yaounde Gynaeco-Obstetric and Pediatric Hospital in Cameroon, and to describe their outcomes. We conducted a cross-sectional analytical study of hospital records over eight years. The incidence of prematurity was 26.5 % of admissions over a period of 7 years 7 months. After controlling for confounding factors, we identified attending antenatal care visits in a health centre (Odds ratio [OR] 6.19; 95% Confidence interval [CI] 1.15 - 33.22; p = 0.033), having a urinary tract infection (OR 39.04; 95% CI 17.19 - 88.62; p causes of death were neonatal infections (27.6%), neonatal asphyxia (11.9%) and congenital malformations (10.3%). We recommend enhanced prenatal care and management of pathologies which arise during pregnancy.

  17. Exclusive Breastfeeding among Preterm Low Birth Weight Infants at One Month Follow-up after Hospital Discharge

    Directory of Open Access Journals (Sweden)

    Ishrat Jahan

    2011-01-01

    Full Text Available Background: Establishment and maintenance of breastfeeding in preterm low birth weight (PT LBW neonates after discharge from hospital is challenging and may be affected by multiple factors. We designed this study to find out the association of these factors with breastfeeding in our population. Objectives: To observe the rate of exclusive breasrfeeding (EBF among the PT LBW neonates at one month follow up and to identify the factors that are related with the maintenance of EBF. Materials and Methods: This observational study was conducted during the period from July 2009 to October 2011 in Enam Medical College Hospital (EMCH. Preterm infants ≤ 34 wks gestation, stayed in the NICU for >3 days and discharged home were eligible. Mothers were interviewed at one month follow-up after discharge. Infants who were given only breast milk up to 4 weeks were termed as “Exclusively breastfed (EBF” and who were given formula milk in addition were labeled as “Nonexclusively breastfed (NEBF”. Baseline information regarding maternal demography, delivery of the baby, feeding during discharge was taken from database of neonatal ward. Results: Among 89 infants, 37 (42% were female and 52 (58% were male, including 5 twins. Gestational age ranged from 29 to 34 weeks (mean 32±2, and birth weight ranged from 1100 to 2200 grams (mean 1763±20 g. At one month follow up visit 19% (17/89 were found to be NEBF and 81% were EBF. Factors significantly associated with EBF were shorter duration of hospital stay (p=0.001, method of feeding at discharge (p=0.001, mode of delivery (p=0.004, below average socio-economic status (p=0.03, maternal education (p=0.02, number of antenatal visits (p=0.02 and larger birth weight (p=0.038. Conclusion: A variety of factors may affect EBF in PT LBW babies. Extensive counseling of the mothers during antenatal visits, counseling of the family members regarding the advantages of exclusive breastfeeding is necessary. Support should be

  18. A facility birth can be the time to start family planning: postpartum intrauterine device experiences from six countries.

    Science.gov (United States)

    Pfitzer, Anne; Mackenzie, Devon; Blanchard, Holly; Hyjazi, Yolande; Kumar, Somesh; Lisanework Kassa, Serawit; Marinduque, Bernabe; Mateo, Marie Grace; Mukarugwiro, Beata; Ngabo, Fidele; Zaeem, Shabana; Zafar, Zonobia; Smith, Jeffrey Michael

    2015-06-01

    Initiation of family planning at the time of birth is opportune, since few women in low-resource settings who give birth in a facility return for further care. Postpartum family planning (PPFP) and postpartum intrauterine device (PPIUD) services were integrated into maternal care in six low- and middle-income countries, applying an insertion technique developed in Paraguay. Facilities with high delivery volume were selected to integrate PPFP/PPIUD services into routine care. Effective PPFP/PPIUD integration requires training and mentoring those providers assisting women at the time of birth. Ongoing monitoring generated data for advocacy. The percentages of PPIUD acceptors ranged from 2.3% of women counseled in Pakistan to 5.8% in the Philippines. Rates of complications among women returning for follow-up were low. Expulsion rates were 3.7% in Pakistan, 3.6% in Ethiopia, and 1.7% in Guinea and the Philippines. Infection rates did not exceed 1.3%, and three countries recorded no cases. Offering PPFP/PPIUD at birth improves access to contraception.

  19. Risk Factors for Hospital Admission with RSV Bronchiolitis in England: A Population-Based Birth Cohort Study

    Science.gov (United States)

    Murray, Joanna; Bottle, Alex; Sharland, Mike; Modi, Neena; Aylin, Paul; Majeed, Azeem; Saxena, Sonia

    2014-01-01

    Objective To examine the timing and duration of RSV bronchiolitis hospital admission among term and preterm infants in England and to identify risk factors for bronchiolitis admission. Design A population-based birth cohort with follow-up to age 1 year, using the Hospital Episode Statistics database. Setting 71 hospitals across England. Participants We identified 296618 individual birth records from 2007/08 and linked to subsequent hospital admission records during the first year of life. Results In our cohort there were 7189 hospital admissions with a diagnosis of bronchiolitis, 24.2 admissions per 1000 infants under 1 year (95%CI 23.7–24.8), of which 15% (1050/7189) were born preterm (47.3 bronchiolitis admissions per 1000 preterm infants (95% CI 44.4–50.2)). The peak age group for bronchiolitis admissions was infants aged 1 month and the median was age 120 days (IQR = 61–209 days). The median length of stay was 1 day (IQR = 0–3). The relative risk (RR) of a bronchiolitis admission was higher among infants with known risk factors for severe RSV infection, including those born preterm (RR = 1.9, 95% CI 1.8–2.0) compared with infants born at term. Other conditions also significantly increased risk of bronchiolitis admission, including Down's syndrome (RR = 2.5, 95% CI 1.7–3.7) and cerebral palsy (RR = 2.4, 95% CI 1.5–4.0). Conclusions Most (85%) of the infants who are admitted to hospital with bronchiolitis in England are born at term, with no known predisposing risk factors for severe RSV infection, although risk of admission is higher in known risk groups. The early age of bronchiolitis admissions has important implications for the potential impact and timing of future active and passive immunisations. More research is needed to explain why babies born with Down's syndrome and cerebral palsy are also at higher risk of hospital admission with RSV bronchiolitis. PMID:24586581

  20. Risk factors for hospital admission with RSV bronchiolitis in England: a population-based birth cohort study.

    Directory of Open Access Journals (Sweden)

    Joanna Murray

    Full Text Available OBJECTIVE: To examine the timing and duration of RSV bronchiolitis hospital admission among term and preterm infants in England and to identify risk factors for bronchiolitis admission. DESIGN: A population-based birth cohort with follow-up to age 1 year, using the Hospital Episode Statistics database. SETTING: 71 hospitals across England. PARTICIPANTS: We identified 296618 individual birth records from 2007/08 and linked to subsequent hospital admission records during the first year of life. RESULTS: In our cohort there were 7189 hospital admissions with a diagnosis of bronchiolitis, 24.2 admissions per 1000 infants under 1 year (95%CI 23.7-24.8, of which 15% (1050/7189 were born preterm (47.3 bronchiolitis admissions per 1000 preterm infants (95% CI 44.4-50.2. The peak age group for bronchiolitis admissions was infants aged 1 month and the median was age 120 days (IQR = 61-209 days. The median length of stay was 1 day (IQR = 0-3. The relative risk (RR of a bronchiolitis admission was higher among infants with known risk factors for severe RSV infection, including those born preterm (RR = 1.9, 95% CI 1.8-2.0 compared with infants born at term. Other conditions also significantly increased risk of bronchiolitis admission, including Down's syndrome (RR = 2.5, 95% CI 1.7-3.7 and cerebral palsy (RR = 2.4, 95% CI 1.5-4.0. CONCLUSIONS: Most (85% of the infants who are admitted to hospital with bronchiolitis in England are born at term, with no known predisposing risk factors for severe RSV infection, although risk of admission is higher in known risk groups. The early age of bronchiolitis admissions has important implications for the potential impact and timing of future active and passive immunisations. More research is needed to explain why babies born with Down's syndrome and cerebral palsy are also at higher risk of hospital admission with RSV bronchiolitis.

  1. Hospital to Home: Plan for a Smooth Transition

    Science.gov (United States)

    ... hospital to home or to a shortterm rehabilitation program in a nursing home. This section focuses on important considerations when you are heading home from the hospital or a rehab program. Make sure you or your family caregiver talks ...

  2. [Parliament and the demographic question: a study of the debate over birth control and family planning in the National Congress].

    Science.gov (United States)

    Da Rocha, M I

    1987-12-01

    The author explores the involvement of Brazil's Chamber of Deputies and Federal Senate in issues of population policy, family planning, and birth control. The focus is on the period 1960-1985, with special attention to actions taken by the Parliamentary Inquiry Commission. The debate within the National Congress on these issues is described, and the opinions of members of Parliament are outlined. Data are from official and other published sources. (SUMMARY IN ENG)

  3. Caesarean section among referred and self-referred birthing women: a cohort study from a tertiary hospital, northeastern Tanzania

    Directory of Open Access Journals (Sweden)

    Oneko Olola

    2011-07-01

    Full Text Available Abstract Background The inequity in emergency obstetric care access in Tanzania is unsatisfactory. Despite an existing national obstetric referral system, many birthing women bypass referring facilities and go directly to higher-level care centres. We wanted to compare Caesarean section (CS rates among women formally referred to a tertiary care centre versus self-referred women, and to assess the effect of referral status on adverse outcomes after CS. Methods We used data from 21,011 deliveries, drawn from the birth registry of a tertiary hospital in northeastern Tanzania, during 2000-07. Referral status was categorized as self-referred if the woman had bypassed or not accessed referral, or formally-referred if referred by a health worker. Because CS indications were insufficiently registered, we applied the Ten-Group Classification System to determine the CS rate by obstetric group and referral status. Associations between referral status and adverse outcomes after CS delivery were analysed using multiple regression models. Outcome measures were CS, maternal death, obstetric haemorrhage ≥ 750 mL, postpartum stay > 9 days, neonatal death, Apgar score Results Referral status contributed substantially to the CS rate, which was 55.0% in formally-referred and 26.9% in self-referred birthing women. In both groups, term nulliparous singleton cephalic pregnancies and women with previous scar(s constituted two thirds of CS deliveries. Low Apgar score (adjusted OR 1.42, 95% CI 1.09-1.86 and neonatal ward transfer (adjusted OR 1.18, 95% CI 1.04-1.35 were significantly associated with formal referral. Early neonatal death rates after CS were 1.6% in babies of formally-referred versus 1.2% in babies of self-referred birthing women, a non-significant difference after adjusting for confounding factors (adjusted OR 1.37, 95% CI 0.87-2.16. Absolute neonatal death rates were > 2% after CS in breech, multiple gestation and preterm deliveries in both referral

  4. Prevalence of hospitalized live births affected by alcohol and drugs and parturient women diagnosed with substance abuse at liveborn delivery: United States, 1999-2008.

    Science.gov (United States)

    Pan, I-Jen; Yi, Hsiao-ye

    2013-05-01

    To describe prevalence trends in hospitalized live births affected by placental transmission of alcohol and drugs, as well as prevalence trends among parturient women hospitalized for liveborn delivery and diagnosed with substance abuse problems in the United States from 1999 to 2008. Comparison of the two sets of trends helps determine whether the observed changes in neonatal problems over time were caused by shifts in maternal substance abuse problems. This study independently identified hospitalized live births and maternal live born deliveries from discharge records in the Nationwide Inpatient Sample, one of the largest hospital administrative databases. Substance-related diagnosis codes on the records were used to identify live births affected by alcohol and drugs and parturient women with substance abuse problems. The analysis calculated prevalence differences and percentage changes over the 10 years, with Loess curves fitted to 10-year prevalence estimates to depict trend patterns. Linear and quadratic trends in prevalence were simultaneously tested using logistic regression analyses. The study also examined data on costs, primary expected payer, and length of hospital stays. From 1999 to 2008, prevalence increased for narcotic- and hallucinogen-affected live births and neonatal drug withdrawal syndrome but decreased for alcohol- and cocaine-affected live births. Maternal substance abuse at delivery showed similar trends, but prevalence of alcohol abuse remained relatively stable. Substance-affected live births required longer hospital stays and higher medical expenses, mostly billable to Medicaid. The findings highlight the urgent need for behavioral intervention and early treatment for substance-abusing pregnant women to reduce the number of substance-affected live births.

  5. The Effect of Mother’s Hypertension and Weight and Parent’s Smoking Habit on Low Birth Weight Deliveries in Hospital, Kuala Lumpur, Malaysia

    Directory of Open Access Journals (Sweden)

    Latiffah A Latiff

    2010-06-01

    Full Text Available Objective: Maternal factors such as age, health, diet, and environment are significantly associated with low birth weight. The objectives of this study were to determine the incidence, distribution and major risk factors of low birth weight in Hospital Kuala Lumpur.Materials and methods: A hospital based case–control study was done in Obstetric Ward of Maternity Hospital in Hospital Kuala Lumpur. Data was obtained using questionnaire and Performa. Out of 1021 deliveries, 330 were selected randomly as respondents that comprises of 110 cases and 220 controls. The outcome measure was low birth weight (<2500 grams.Results: The incidence of low birth weight was 10.8%. Among races, the highest occurrence of low birth weight was in Malay, while the highest age group was between 21 years old to 34 years old with majority of the respondent were married. Among the maternal socio-demographic factors, maternal height of less than 150 cm has a significant relationship with low birth weight. In addition, maternal weight of 45 kg and less and maternal weight gain during pregnancy of less than 10 kg were also found to be risk factors. However, none of the socio-demographic factors were significantly associated with low birth weight deliveries. Similarly, signs of premature delivery, maternal vaginal bleeding and fetal growth retardation (IUGR had a significant association.Conclusion: The mothers that have experienced any of the risks that were identified should be monitored and effective prevention should be taken to decrease the chances of low birth weight but not forgetting to promote a health lifestyle to the mother and father as well.

  6. Hospital-Based First Responder Mass Prophylaxis Plan

    Science.gov (United States)

    2005-03-01

    only: Date of last menstrual period: __________ Are you pregnant: Yes No mm/dd/yy Are you breastfeeding : Yes No Do you use birth...Recommendations The artificialities of a full-scale exercise allowed for the large number of first responders to be prophylaxed but did not exhibit

  7. Basic study on architectural planning of psychiatric hospital

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    This paper considers the main problems of the current mental health facilities in China from the standpoint of architects on the background that mental disorder has become a serious threat to human health. In order to effectively learn from the developed countries, this paper reviews the brief history of the world’s mental health and the main phases of the evolution of psychiatric hospitals, analyzes the actual situation of mental health facilities abroad based on a large amount of data, compares the roles of public and private psychiatric hospitals from the viewpoint of government supervision, and investigates the functions and positions of psychiatric hospitals and the psychiatry divisions of general hospitals in the medical system. At last, this paper discusses the necessity of the systemization of mental health facilities, the role of psychiatric hospitals in this facility system and the developing approaches of psychiatric hospitals in China.

  8. Planning, Designing, Building, and Moving a Large Volume Maternity Service to a New Labor and Birth Unit.

    Science.gov (United States)

    Thompson, Heather; Legorreta, Kimberly; Maher, Mary Ann; Lavin, Melanie M

    Our health system recognized the need to update facility space and associated technology for the labor and birth unit within our large volume perinatal service to improve the patient experience, and enhance safety, quality of care, and staff satisfaction. When an organization decides to invest $30 million dollars in a construction project such as a new labor and birth unit, many factors and considerations are involved. Financial support, planning, design, and construction phases of building a new unit are complex and therefore require strong interdisciplinary collaboration, leadership, and project management. The new labor and birth unit required nearly 3 years of planning, designing, and construction. Patient and family preferences were elicited through consumer focus groups. Multiple meetings with the administrative and nursing leadership teams, staff nurses, nurse midwives, and physicians were held to generate ideas for improvement in the new space. Involving frontline clinicians and childbearing women in the process was critical to success. The labor and birth unit moved to a new patient tower in a space that was doubled in square footage and geographically now on three separate floors. In the 6 months prior to the move, many efforts were made in our community to share our new space. The marketing strategy was very detailed and creative with ongoing input from the nursing leadership team. The nursing staff was involved in every step along the way. It was critical to have champions as workflow teams emerged. We hosted simulation drills and tested scenarios with new workflows. Move day was rehearsed with representatives of all members of the perinatal team participating. These efforts ultimately resulted in a move time of ~5 hours. Birth volumes increased 7% within the first 6 months. After 3 years in our new space, our birth volumes have risen nearly 15% and are still growing. Key processes and roles responsible for a successful build, efficient and safe move

  9. Birthing experiences of Ghanaian women in 37th Military Hospital, Accra, Ghana

    Directory of Open Access Journals (Sweden)

    R.S. Mensah

    2014-01-01

    Full Text Available The purpose of the study was to explore the expectations of women relating to their labor and delivery needs at the 37th Military Hospital, in Ghana. Using a generic or non-categorical qualitative research design women who delivered at the 37th Military Hospital were interviewed. Data was collected by using semi-structured individual interviews. Emerging themes from the data were: the importance of environmental serenity in childbirth, the need to confirm true labor, being in control during labor, the importance of midwives, and childbirth as a sacred and euphoric journey. The findings revealed that not only were the environment serene and devoid of noise but the nurse-midwives were friendly and supportive for the women and were competent in diagnosing the progression of labor. The competencies and attributes that the nurse-midwives possessed at this hospital offered the women with an element of ownership regarding their laboring processes.

  10. Planning among nurse managers in district hospitals in Ghana.

    Science.gov (United States)

    Asamani, James Avoka; Kwafo, Esther Oforiwaa; Ansah-Ofei, Adelaide Maria

    2013-12-01

    This article reports the results of a study that explored the planning practices of nurse managers at ward level, their knowledge of planning process and the factors that influence effective planning. Although the practice of planning was almost universal, half the participants had no knowledge of the process, and this knowledge gap was traced to a lack of educational preparation before their appointment. In-service training, support from management and staff, and funding were identified as major factors influencing effective planning at ward level. The authors recommend that prospective nurse managers have educational preparation before they take up these positions and nurse managers already in post have capacity-building training in planning.

  11. Positive Effect of Human Milk Feeding during NICU Hospitalization on 24 Month Neurodevelopment of Very Low Birth Weight Infants: An Italian Cohort Study

    OpenAIRE

    Dino Gibertoni; Luigi Corvaglia; Silvia Vandini; Paola Rucci; Silvia Savini; Rosina Alessandroni; Alessandra Sansavini; Maria Pia Fantini; Giacomo Faldella

    2015-01-01

    The aim of this study was to determine the effect of human milk feeding during NICU hospitalization on neurodevelopment at 24 months of corrected age in very low birth weight infants. A cohort of 316 very low birth weight newborns (weight ≤ 1500 g) was prospectively enrolled in a follow-up program on admission to the Neonatal Intensive Care Unit of S. Orsola Hospital, Bologna, Italy, from January 2005 to June 2011. Neurodevelopment was evaluated at 24 months corrected age using the Griffiths ...

  12. "Hospital Master Plan'ist" haiglavõrgu arengukavani / Tarmo Bakler

    Index Scriptorium Estoniae

    Bakler, Tarmo, 1970-

    2003-01-01

    Ülevaade, kuidas Hospital Master Planìs toodud põhimõtteid on kasutatud praeguseni elluviidud muutuste tegemisel ja kuidas on HMPd täiendatud Eesti Tervishoiuprojekt 2015 koostatud haiglavõrgu arengukavas 2002. Kaart. Tabelid

  13. "Hospital Master Plan'ist" haiglavõrgu arengukavani / Tarmo Bakler

    Index Scriptorium Estoniae

    Bakler, Tarmo, 1970-

    2003-01-01

    Ülevaade, kuidas Hospital Master Planìs toodud põhimõtteid on kasutatud praeguseni elluviidud muutuste tegemisel ja kuidas on HMPd täiendatud Eesti Tervishoiuprojekt 2015 koostatud haiglavõrgu arengukavas 2002. Kaart. Tabelid

  14. A Retrospective Perinatal Data Analysis of Immigrant and German Women from Representative Birth Cohorts at the Virchow Hospital, Berlin.

    Science.gov (United States)

    Armbrust, R; von Rennenberg, R; David, M

    2016-11-01

    Introduction: The aim of this study was to define and characterise differences in the level of obstetric care provided to immigrant and German women. Materials and Methods: An analysis of the Virchow Hospital's birth registers was conducted for the years 1974, 1984 and 1994. The study population of 5445 patients was grouped according to ancestry/family origin on the basis of a name analysis, and subsequently also according to parity (primiparous or multiparous). On name analysis 2741 women were defined as German, 1598 were grouped as women of Turkish origin and 810 as immigrants of other origin. χ(2) tests and Fisher's exact test were used for significance testing (significance level p German primipara and multipara from 1984 onwards. Discussion: This retrospective analysis of three historical birth cohorts showed significant differences in perinatal care between German and immigrant women, presumably reflecting deficits in care. It seems remarkable that this trend has not changed over a time span of three decades despite a continuous increase in immigration and acculturation. A "research paradox", however, remains: Despite these increasing rates, there are no current or older, prospective or systematic studies of obstetric care in immigrants.

  15. Hospital specialization: product-line planning during the market reformation.

    Science.gov (United States)

    Eastaugh, Steven R

    2011-01-01

    Rational expectations theory dictates that firms respond to shifts in the demand function as a result of substantial reforms in the insurance marketplace. Federal health reform has enhanced the benefits of specialization. Hospital product-line specialization trends are studied using multiple regression analysis for the period 2001-2010. The observed 32.8 percent rise in specialization was associated with a 9.8 percent decline in unit cost per admission. The number of specialized hospitals has grown by 174 percent in the past decade. Other hospitals are getting more specialized by reducing their product lines. Specialization has been highest in competitive West Coast markets and lowest in the rate-regulated states (New York and Massachusetts). Hospitals have less incentive to contain costs by decreasing the array of services offered in stringent rate-setting states. The term "underspecialization" is advanced to capture the inability of some hospitals to selectively prune out product lines in order to specialize. Such hospitals spread resources so thinly that many good departments suffer. Unit cost per case (DRG-adjusted) is higher in the less specialized hospitals.

  16. Hospital work and pregnancy outcomes: a study in the Danish National Birth Cohort

    DEFF Research Database (Denmark)

    Suárez-Varela, María M Morales; Kaerlev, Linda; Zhu, Jin Liang

    2009-01-01

    In hospitals, women of reproductive age do a range of work tasks, some of which are known to carry potential risks. Tasks such as working with radiation, chemicals, and infectious agents, as well as performing heavy lifting or tasks requiring erratic sleep patterns have been reported to increase ...

  17. Perinatal and maternal outcomes in planned home and obstetric unit births in women at 'higher risk' of complications: secondary analysis of the Birthplace national prospective cohort study.

    Science.gov (United States)

    Li, Y; Townend, J; Rowe, R; Brocklehurst, P; Knight, M; Linsell, L; Macfarlane, A; McCourt, C; Newburn, M; Marlow, N; Pasupathy, D; Redshaw, M; Sandall, J; Silverton, L; Hollowell, J

    2015-04-01

    To explore and compare perinatal and maternal outcomes in women at 'higher risk' of complications planning home versus obstetric unit (OU) birth. Prospective cohort study. OUs and planned home births in England. 8180 'higher risk' women in the Birthplace cohort. We used Poisson regression to calculate relative risks adjusted for maternal characteristics. Sensitivity analyses explored possible effects of differences in risk between groups and alternative outcome measures. Composite perinatal outcome measure encompassing 'intrapartum related mortality and morbidity' (intrapartum stillbirth, early neonatal death, neonatal encephalopathy, meconium aspiration syndrome, brachial plexus injury, fractured humerus or clavicle) and neonatal admission within 48 hours for more than 48 hours. Two composite maternal outcome measures capturing intrapartum interventions/adverse maternal outcomes and straightforward birth. The risk of 'intrapartum related mortality and morbidity' or neonatal admission for more than 48 hours was lower in planned home births than planned OU births [adjusted relative risks (RR) 0.50, 95% CI 0.31-0.81]. Adjustment for clinical risk factors did not materially affect this finding. The direction of effect was reversed for the more restricted outcome measure 'intrapartum related mortality and morbidity' (RR adjusted for parity 1.92, 95% CI 0.97-3.80). Maternal interventions were lower in planned home births. The babies of 'higher risk' women who plan birth in an OU appear more likely to be admitted to neonatal care than those whose mothers plan birth at home, but it is unclear if this reflects a real difference in morbidity. Rates of intrapartum related morbidity and mortality did not differ statistically significantly between settings at the 5% level but a larger study would be required to rule out a clinically important difference between the groups. © 2015 The Authors. BJOG An International Journal of Obstetrics and Gynaecology published by John

  18. Association between birth order and emergency room visits and acute hospital admissions following pediatric vaccination: a self-controlled study.

    Directory of Open Access Journals (Sweden)

    Steven Hawken

    Full Text Available OBJECTIVE: We investigated the association between a child's birth order and emergency room (ER visits and hospital admissions following 2-,4-,6- and 12-month pediatric vaccinations. METHODS: We included all children born in Ontario between April 1(st, 2006 and March 31(st, 2009 who received a qualifying vaccination. We identified vaccinations, ER visits and admissions using health administrative data housed at the Institute for Clinical Evaluative Sciences. We used the self-controlled case series design to compare the relative incidence (RI of events among 1(st-born and later-born children using relative incidence ratios (RIR. RESULTS: For the 2-month vaccination, the RIR for 1(st-borns versus later-born children was 1.37 (95% CI: 1.19-1.57, which translates to 112 additional events/100,000 vaccinated. For the 4-month vaccination, the RIR for 1(st-borns vs. later-borns was 1.70 (95% CI: 1.45-1.99, representing 157 additional events/100,000 vaccinated. At 6 months, the RIR for 1(st vs. later-borns was 1.27 (95% CI: 1.09-1.48, or 77 excess events/100,000 vaccinated. At the 12-month vaccination, the RIR was 1.11 (95% CI: 1.02-1.21, or 249 excess events/100,000 vaccinated. CONCLUSIONS: Birth order is associated with increased incidence of ER visits and hospitalizations following vaccination in infancy. 1(st-born children had significantly higher relative incidence of events compared to later-born children.

  19. Optimization-based decision support to assist in logistics planning for hospital evacuations.

    Science.gov (United States)

    Glick, Roger; Bish, Douglas R; Agca, Esra

    2013-01-01

    The evacuation of the hospital is a very complex process and evacuation planning is an important part of a hospital's emergency management plan. There are numerous factors that affect the evacuation plan including the nature of threat, availability of resources and staff the characteristics of the evacuee population, and risk to patients and staff. The safety and health of patients is of fundamental importance, but safely moving patients to alternative care facilities while under threat is a very challenging task. This article describes the logistical issues and complexities involved in planning and execution of hospital evacuations. Furthermore, this article provides examples of how optimization-based decision support tools can help evacuation planners to better plan for complex evacuations by providing real-world solutions to various evacuation scenarios.

  20. COMPARISON OF TWO METHODS OF OPERATING THEATRE PLANNING: APPLICATION IN BELGIAN HOSPITAL

    Institute of Scientific and Technical Information of China (English)

    Sondes CHAABANE; Nadine MESKENS; Alain GUINET; Marius LAURENT

    2008-01-01

    Operating Theatre is the centre of the hospital management's efforts. It constitutes the most expensive sector with more than 10% of the intended operating budget of the hospital. To reduce the costs while maintaining a good quality of care, one of the solutions is to improve the existent planning and scheduling methods by improving the services and surgical specialty coordination or finding the best estimation of surgical case durations. The other solution is to construct an effective surgical case plan and schedule. The operating theatre planning and scheduling is the two important steps, which aim to make a surgical case programming with an objective of obtaining a realizable and efficient surgical case schedule. This paper focuses on the first step, the operating theatre planning problem. Two planning methods are introduced and compared. Real data of a Belgian university hospital "Tivoli" are used for the experiments.

  1. Strategic plan modelling by hospital senior administration to integrate diversity management.

    Science.gov (United States)

    Newhouse, John J

    2010-11-01

    Limited research suggests that some hospital senior administrators and chief executive officers (CEOs) have employed a strategic planning function to achieve diversity management practices. As the hospital industry struggles with how to integrate diversity practices to improve patient satisfaction, increase the quality of care and enhance clinical outcomes for minority populations, understanding the planning process involved in this endeavour becomes significant for senior hospital administrators. What is not well understood is what this strategic planning process represents and how it is applied to integrate diversity management. Scant research exists about the type of strategic models that hospital CEOs employ when they wish to reposition their organizations through diversity management. This study examines the strategic planning models used by senior administrators to integrate diversity management for an institutional-wide agenda. A qualitative survey process was used for CEOs in the states of New York, Pennsylvania, New Jersey and Delaware. The key research questions dealt with what type of strategic plan approach senior administrators used for integrating diversity management and what rationale they used to pursue this. Significant differences were reported between three types of strategic plan modelling used by CEOs. Also, when comparing past and current practices over time, such differences existed. The need to integrate diversity management is underscored by this study. How senior hospital administrators apply strategic plan models and what impact these approaches have represent the major implications that this study offers.

  2. Succession planning in hospitals and the association with organizational performance.

    Science.gov (United States)

    Kim, Tae Hyun

    2012-01-01

    Effective succession planning is the heart of leadership development and an essential business strategy because it enhances the ability to achieve orderly transitions and maintain productivity levels. The results of this study are consistent with previous studies that exhibit a positive association of previous years' performance with internal succession planning. The key to successful succession planning lies in building a solid foundation of profitability. Having successors ready to fill key vacancies helps improve operational condition and the bottom line, and thus, gives a competitive edge in the market. Preparing successors for leadership may determine which organizations simply survive and which thrive and lead their markets down the road.

  3. The facilitating factors and barriers encountered in the adoption of a humanized birth care approach in a highly specialized university affiliated hospital

    Directory of Open Access Journals (Sweden)

    Behruzi Roxana

    2011-11-01

    Full Text Available Abstract Background Considering the fact that a significant proportion of high-risk pregnancies are currently referred to tertiary level hospitals; and that a large proportion of low obstetric risk women still seek care in these hospitals, it is important to explore the factors that influence the childbirth experience in these hospitals, particularly, the concept of humanized birth care. The aim of this study was to explore the organizational and cultural factors, which act as barriers or facilitators in the provision of humanized obstetrical care in a highly specialized, university-affiliated hospital in Quebec province, in Canada. Methods A single case study design was chosen. The study sample included 17 professionals and administrators from different disciplines, and 157 women who gave birth in the hospital during the study. The data was collected through semi-structured interviews, field notes, participant observations, a self-administered questionnaire, documents, and archives. Both descriptive and qualitative deductive content analyses were performed and ethical considerations were respected. Results Both external and internal dimensions of a highly specialized hospital can facilitate or be a barrier to the humanization of birth care practices in such institutions, whether independently, or altogether. The greatest facilitating factors found were: caring and family- centered model of care, professionals' and administrators' ambient for the provision of humanized birth care besides the medical interventional care which is tailored to improve safety, assurance, and comfort for women and their children, facilities to provide a pain-free birth, companionship and visiting rules, dealing with the patients' spiritual and religious beliefs. The most cited barriers were: the shortage of health care professionals, the lack of sufficient communication among the professionals, the stakeholders' desire for specialization rather than humanization, over

  4. The facilitating factors and barriers encountered in the adoption of a humanized birth care approach in a highly specialized university affiliated hospital.

    Science.gov (United States)

    Behruzi, Roxana; Hatem, Marie; Goulet, Lise; Fraser, William

    2011-11-25

    Considering the fact that a significant proportion of high-risk pregnancies are currently referred to tertiary level hospitals; and that a large proportion of low obstetric risk women still seek care in these hospitals, it is important to explore the factors that influence the childbirth experience in these hospitals, particularly, the concept of humanized birth care.The aim of this study was to explore the organizational and cultural factors, which act as barriers or facilitators in the provision of humanized obstetrical care in a highly specialized, university-affiliated hospital in Quebec province, in Canada. A single case study design was chosen. The study sample included 17 professionals and administrators from different disciplines, and 157 women who gave birth in the hospital during the study. The data was collected through semi-structured interviews, field notes, participant observations, a self-administered questionnaire, documents, and archives. Both descriptive and qualitative deductive content analyses were performed and ethical considerations were respected. Both external and internal dimensions of a highly specialized hospital can facilitate or be a barrier to the humanization of birth care practices in such institutions, whether independently, or altogether. The greatest facilitating factors found were: caring and family- centered model of care, professionals' and administrators' ambient for the provision of humanized birth care besides the medical interventional care which is tailored to improve safety, assurance, and comfort for women and their children, facilities to provide a pain-free birth, companionship and visiting rules, dealing with the patients' spiritual and religious beliefs. The most cited barriers were: the shortage of health care professionals, the lack of sufficient communication among the professionals, the stakeholders' desire for specialization rather than humanization, over estimation of medical performance, finally the training

  5. Positive effect of human milk feeding during NICU hospitalization on 24 month neurodevelopment of very low birth weight infants: an Italian cohort study.

    Science.gov (United States)

    Gibertoni, Dino; Corvaglia, Luigi; Vandini, Silvia; Rucci, Paola; Savini, Silvia; Alessandroni, Rosina; Sansavini, Alessandra; Fantini, Maria Pia; Faldella, Giacomo

    2015-01-01

    The aim of this study was to determine the effect of human milk feeding during NICU hospitalization on neurodevelopment at 24 months of corrected age in very low birth weight infants. A cohort of 316 very low birth weight newborns (weight ≤ 1500 g) was prospectively enrolled in a follow-up program on admission to the Neonatal Intensive Care Unit of S. Orsola Hospital, Bologna, Italy, from January 2005 to June 2011. Neurodevelopment was evaluated at 24 months corrected age using the Griffiths Mental Development Scale. The effect of human milk nutrition on neurodevelopment was first investigated using a multiple linear regression model, to adjust for the effects of gestational age, small for gestational age, complications at birth and during hospitalization, growth restriction at discharge and socio-economic status. Path analysis was then used to refine the multiple regression model, taking into account the relationships among predictors and their temporal sequence. Human milk feeding during NICU hospitalization and higher socio-economic status were associated with better neurodevelopment at 24 months in both models. In the path analysis model intraventricular hemorrhage-periventricular leukomalacia and growth restriction at discharge proved to be directly and independently associated with poorer neurodevelopment. Gestational age and growth restriction at birth had indirect significant effects on neurodevelopment, which were mediated by complications that occurred at birth and during hospitalization, growth restriction at discharge and type of feeding. In conclusion, our findings suggest that mother's human milk feeding during hospitalization can be encouraged because it may improve neurodevelopment at 24 months corrected age.

  6. Positive effect of human milk feeding during NICU hospitalization on 24 month neurodevelopment of very low birth weight infants: an Italian cohort study.

    Directory of Open Access Journals (Sweden)

    Dino Gibertoni

    Full Text Available The aim of this study was to determine the effect of human milk feeding during NICU hospitalization on neurodevelopment at 24 months of corrected age in very low birth weight infants. A cohort of 316 very low birth weight newborns (weight ≤ 1500 g was prospectively enrolled in a follow-up program on admission to the Neonatal Intensive Care Unit of S. Orsola Hospital, Bologna, Italy, from January 2005 to June 2011. Neurodevelopment was evaluated at 24 months corrected age using the Griffiths Mental Development Scale. The effect of human milk nutrition on neurodevelopment was first investigated using a multiple linear regression model, to adjust for the effects of gestational age, small for gestational age, complications at birth and during hospitalization, growth restriction at discharge and socio-economic status. Path analysis was then used to refine the multiple regression model, taking into account the relationships among predictors and their temporal sequence. Human milk feeding during NICU hospitalization and higher socio-economic status were associated with better neurodevelopment at 24 months in both models. In the path analysis model intraventricular hemorrhage-periventricular leukomalacia and growth restriction at discharge proved to be directly and independently associated with poorer neurodevelopment. Gestational age and growth restriction at birth had indirect significant effects on neurodevelopment, which were mediated by complications that occurred at birth and during hospitalization, growth restriction at discharge and type of feeding. In conclusion, our findings suggest that mother's human milk feeding during hospitalization can be encouraged because it may improve neurodevelopment at 24 months corrected age.

  7. Comparative Effect of Massage Therapy versus Kangaroo Mother Care on Body Weight and Length of Hospital Stay in Low Birth Weight Preterm Infants

    Directory of Open Access Journals (Sweden)

    Priya Singh Rangey

    2014-01-01

    Full Text Available Background. Massage therapy (MT and kangaroo mother care (KMC are both effective in increasing the weight and reducing length of hospital stay in low birth weight preterm infants but they have not been compared. Aim. Comparison of effectiveness of MT and KMC on body weight and length of hospital stay in low birth weight preterm (LBWPT infants. Method. 30 LBWPT infants using convenience sampling from Neonatal Intensive Care Unit, V.S. hospital, were randomly divided into 2 equal groups. Group 1 received MT and Group 2 received KMC for 15 minutes, thrice daily for 5 days. Medically stable babies with gestational age < 37 weeks and birth weight < 2500 g were included. Those on ventilators and with congenital, orthopedic, or genetic abnormality were excluded. Outcome measures, body weight and length of hospital stay, were taken before intervention day 1 and after intervention day 5. Level of significance was 5%. Result. Data was analyzed using SPSS16. Both MT and KMC were found to be effective in improving body weight (P = 0.001, P = 0.001. Both were found to be equally effective for improving body weight (P = 0.328 and reducing length of hospital stay (P = 0.868. Conclusion. MT and KMC were found to be equally effective in improving body weight and reducing length of hospital stay. Limitation. Long term follow-up was not taken.

  8. Effect of hospital nutrition support on growth velocity and nutritional status of low birth weight infants.

    Science.gov (United States)

    Azzeh, Firas S; Alazzeh, Awfa Y; Dabbour, Ibrahim R; Jazar, Abdelelah S; Obeidat, Ahmed A

    2014-10-01

    Introducción: Los bebés con bajo peso al nacer reciben asistencia nutricional hospitalaria para reforzar su supervivencia y peso corporal. Sin embargo, cada hospital tiene su propia fórmula de asistencia nutricional. Por lo tanto, la efectividad de esta asistencia nutricional debería ser investigada. Objetivo: Evaluar el efecto de la asistencia nutricional hospitalaria sobre la velocidad del crecimiento velocidad del crecimiento y el estado nutricional de bebés con bajo peso al nacer en el hospital Al-Noor, Arabia Saudita. Métodos: Se llevó a cabo un estudio interseccional entre octubre de 2010 y diciembre de 2012. Se seleccionó a trescientos recién nacidos del hospital Al-Noor de la ciudad de Makkah, Arabia Saudita. Los bebés fueron seleccionados según su peso al nacer y fueron separados en tres grupos iguales: (i) Bajo peso al nacer (BPN) (peso de nacimiento 1501- 2500 g), (ii) Muy Bajo peso al nacer (MBPN) (peso de nacimiento 1001-1500 g) y (iii) Peso extremadamente bajo al nacer (PEBN) (peso de nacimiento 0.05) observadas entre grupos. Los niveles de suero, calcio, fósforo y potasio en el momento del alta fueron superiores (p < 0.05) que los del momento del nacimiento para los grupos de EBPN y VBPN, mientras que los niveles de sodio descendieron en el grupo de EBPN hasta un rango normal. El nivel de albúmina mejoró (p < 0.05) en el grupo de EBPN. Conclusión: La gestión de la atención sanitaria para bebés con bajo peso al nacer en el hospital Al-Noor no fue suficiente para alcanzar un índice normal de crecimiento para bebés con bajo peso al nacer, mientras que los indicadores bioquímicos mejoraron notablemente en todos los grupos.

  9. [Participatory planning in health organizations: the case of the Bonsucesso General Hospital, Rio de Janeiro, Brazil].

    Science.gov (United States)

    Lima, Juliano de Carvalho; Faveret, Ana Cecília; Grabois, Victor

    2006-03-01

    This article presents the experience with participatory planning in the Bonsucesso General Hospital in Rio de Janeiro, Brazil, from 2003 to 2004. The participatory and communicative characteristics and the resulting institutional format are identified for guaranteeing the implementation of collective decisions from the planning workshops. The limits of implementation in participatory planning and management proposals are argued from the perspective of change and power relations in these institutions. The results support the notion that projects involving changes in hospitals and failing to take into account the different internal rationalities and power relations end up having reduced potential for implementation.

  10. A Stress Coping App for Hospitalized Pregnant Women at Risk for Preterm Birth.

    Science.gov (United States)

    Jallo, Nancy; Thacker, Leroy R; Menzies, Victoria; Stojanovic, Predrag; Svikis, Dace S

    Pregnant women hospitalized with preterm labor (PTL) complications experience increased stress. Prior researchers have attempted to provide stress management strategies with use of various media players to deliver stress coping interventions. The purpose of this study was to examine the efficacy of a mobile device delivered stress coping app designed to reduce stress in a sample of high-risk pregnant women hospitalized with complications of PTL. A descriptive study using a prospective mixed methods one-group pre/posttest design. Fifteen pregnant women used the mobile device app for 8 consecutive days. The app included study measures, educational overview of concepts, four guided imagery audio files to be listened to daily, and a stress self-assessment scale to be used before and after each use. Measures included: Perceived Stress Scale (PSS), Visual Analog Stress Scale (VASS), Coping Self-Efficacy Scale (CSES), and semistructured interviews. There was a significant drop in VASS scores when comparing scores before and after listening to the app (p app and provided suggestions for improvement. The intervention reduced immediate stress and provided a respite from the stress response in this population. Maternal child nurses may consider incorporating stress coping interventions as standard care practice.

  11. The roles of socioeconomic status and Aboriginality in birth outcomes at an urban hospital.

    Science.gov (United States)

    Titmuss, Angela T; Harris, Elizabeth; Comino, Elizabeth J

    2008-11-03

    To explore the role of socioeconomic status and Aboriginality on birthweight at an urban hospital. Extraction of data on the demographic characteristics (socioeconomic status, mothers' single-parent status, age and smoking status) and infants' birthweight from a clinical record system. Infants delivered at an outer urban hospital to mothers residing in the local government area during 2002 were included. Infants were identified and results interpreted in consultation with Indigenous health workers. Infant birthweight. Indigenous infants had a lower mean birthweight than non-Indigenous infants (difference, 127 g), and were more likely to weigh socioeconomic status for Indigenous and non-Indigenous infants. Indigenous infants in the most socioeconomically disadvantaged quintile in this study were at higher risk and had a mean birthweight 204 g less than non-Indigenous infants in the same quintile. In multivariate analysis, differences in birthweight were associated with socioeconomic status and smoking during pregnancy. For both Indigenous and non-Indigenous infants, birthweights were associated with socioeconomic status. Differences between Indigenous and non-Indigenous infants were largely explained by low socioeconomic status and smoking during pregnancy.

  12. Developing a master plan for hospital solid waste management: a case study.

    Science.gov (United States)

    Karamouz, Mohammad; Zahraie, Banafsheh; Kerachian, Reza; Jaafarzadeh, Nemat; Mahjouri, Najmeh

    2007-01-01

    Disposal of about 1750tons of solid wastes per day is the result of a rapid population growth in the province of Khuzestan in the south west of Iran. Most of these wastes, especially hospital solid wastes which have contributed to the pollution of the environment in the study area, are not properly managed considering environmental standards and regulations. In this paper, the framework of a master plan for managing hospital solid wastes is proposed considering different criteria which are usually used for evaluating the pollution of hospital solid waste loads. The effectiveness of the management schemes is also evaluated. In order to rank the hospitals and determine the share of each hospital in the total hospital solid waste pollution load, a multiple criteria decision making technique, namely analytical hierarchy process (AHP), is used. A set of projects are proposed for solid waste pollution control and reduction in the proposed framework. It is partially applied for hospital solid waste management in the province of Khuzestan, Iran. The results have shown that the hospitals located near the capital city of the province, Ahvaz, produce more than 43% of the total hospital solid waste pollution load of the province. The results have also shown the importance of improving management techniques rather than building new facilities. The proposed methodology is used to formulate a master plan for hospital solid waste management.

  13. Impact of short-term temperature variability on emergency hospital admissions for schizophrenia stratified by season of birth

    Science.gov (United States)

    Zhao, Desheng; Zhang, Xulai; Xu, Zhiwei; Cheng, Jian; Xie, Mingyu; Zhang, Heng; Wang, Shusi; Li, Kesheng; Yang, Huihui; Wen, Liying; Wang, Xu; Su, Hong

    2016-08-01

    Diurnal temperature range (DTR) and temperature change between neighboring days (TCN) are important meteorological indicators closely associated with global climate change. However, up to date, there have been no studies addressing the impacts of both DTR and TCN on emergency hospital admissions for schizophrenia. We conducted a time-series analysis to assess the relationship between temperature variability and daily schizophrenia onset in Hefei, an inland city in southeast China. Daily meteorological data and emergency hospital admissions for schizophrenia from 2005 to 2014 in Hefei were collected. After stratifying by season of birth, Poisson generalized linear regression combined with distributed lag nonlinear model (DLNM) was used to examine the relationship between temperature variability and schizophrenia, adjusting for long-term trend and seasonality, mean temperature, and relative humidity. Our analysis revealed that extreme temperature variability may increase the risk for schizophrenia onset among patients born in spring, while no such association was found in patients born in summer and autumn. In patients born in spring, the relative risks of extremely high DTR comparing the 95th and 99th percentiles with the reference (50th, 10 °C) at 3-day lag were 1.078 (95 % confidence interval (CI) 1.025-1.135) and 1.159 (95 % CI 1.050-1.279), respectively. For TCN effects, only comparing 99th percentile with reference (50th, 0.7 °C) was significantly associated with emergency hospital admissions for schizophrenia (relative risk (RR) 1.111, 95 % CI 1.002-1.231). This study suggested that exposure to extreme temperature variability in short-term may trigger later days of schizophrenia onset for patients born in spring, which may have important implications for developing intervention strategies to prevent large temperature variability exposure.

  14. Impact of short-term temperature variability on emergency hospital admissions for schizophrenia stratified by season of birth

    Science.gov (United States)

    Zhao, Desheng; Zhang, Xulai; Xu, Zhiwei; Cheng, Jian; Xie, Mingyu; Zhang, Heng; Wang, Shusi; Li, Kesheng; Yang, Huihui; Wen, Liying; Wang, Xu; Su, Hong

    2017-04-01

    Diurnal temperature range (DTR) and temperature change between neighboring days (TCN) are important meteorological indicators closely associated with global climate change. However, up to date, there have been no studies addressing the impacts of both DTR and TCN on emergency hospital admissions for schizophrenia. We conducted a time-series analysis to assess the relationship between temperature variability and daily schizophrenia onset in Hefei, an inland city in southeast China. Daily meteorological data and emergency hospital admissions for schizophrenia from 2005 to 2014 in Hefei were collected. After stratifying by season of birth, Poisson generalized linear regression combined with distributed lag nonlinear model (DLNM) was used to examine the relationship between temperature variability and schizophrenia, adjusting for long-term trend and seasonality, mean temperature, and relative humidity. Our analysis revealed that extreme temperature variability may increase the risk for schizophrenia onset among patients born in spring, while no such association was found in patients born in summer and autumn. In patients born in spring, the relative risks of extremely high DTR comparing the 95th and 99th percentiles with the reference (50th, 10 °C) at 3-day lag were 1.078 (95 % confidence interval (CI) 1.025-1.135) and 1.159 (95 % CI 1.050-1.279), respectively. For TCN effects, only comparing 99th percentile with reference (50th, 0.7 °C) was significantly associated with emergency hospital admissions for schizophrenia (relative risk (RR) 1.111, 95 % CI 1.002-1.231). This study suggested that exposure to extreme temperature variability in short-term may trigger later days of schizophrenia onset for patients born in spring, which may have important implications for developing intervention strategies to prevent large temperature variability exposure.

  15. An Approach for Hospital Planning with Multi-Agent Organizations

    DEFF Research Database (Denmark)

    Larsen, John; Villadsen, Jørgen

    2017-01-01

    The background for this paper is a development that the Danish hospitals are undertaking which requires the establishment of a common emergency department. It is uncertain exactly what and how many resources the department needs and so resources are assigned dynamically as seen necessary by the s...

  16. Hospital admissions in children with down syndrome: experience of a population-based cohort followed from birth.

    Directory of Open Access Journals (Sweden)

    Patrick Fitzgerald

    Full Text Available OBJECTIVE: Children with Down syndrome, the most common genetic cause of intellectual disability, are prone to multiple and varied health-related problems. This study describes patterns of hospitalisations for children and young people with Down syndrome in Western Australia. METHODS: Birth records were linked to the Western Australian population-based Intellectual Disability database to identify all children born with Down syndrome in Western Australia between 1 January, 1983 and 31 December, 1999. These records were linked to the Hospital Morbidity Data System to provide information on all hospitalisations up to 31 December, 2004. Hospitalisation data, coded using ICD-9CM or ICD-10 (v0.5 were grouped into clinically relevant categories using the primary diagnosis. Rates of hospital admission for all and specific diagnoses were expressed in 1000-person-years at-risk and median age at first admission and length of stay were calculated. RESULTS: Of the 405 children, 395 had one or more hospital admissions, totalling 3786 admissions for all children and an estimated 39.5 person-years in hospital. On average, children were admitted 9.7 times, with an estimated rate of 757.2 admissions per 1000pyr (95% CI: 680, 843. A quarter of all admissions occurred in the first year of life. The average hospital length of stay was 3.8 days (95% CI: 3.7, 4.1. Upper respiratory tract conditions affected the most children (58.5% and accounted for 12.1% of all admissions. Other disorders which affected a high percentage of children were ear/hearing conditions (50.6%, disorders of the oral cavity (38.0% and lower respiratory tract conditions (37.5%. Overall, children with Down syndrome were hospitalised at a rate five times (95% CI = 4.3-6.2 that of the general population. CONCLUSION: Children with Down syndrome are at increased risk of morbidity for varied causes underlining the importance of comprehensive and targeted primary care for this group.

  17. A Retrospective Perinatal Data Analysis of Immigrant and German Women from Representative Birth Cohorts at the Virchow Hospital, Berlin

    Science.gov (United States)

    Armbrust, R.; von Rennenberg, R.; David, M.

    2016-01-01

    Introduction: The aim of this study was to define and characterise differences in the level of obstetric care provided to immigrant and German women. Materials and Methods: An analysis of the Virchow Hospitalʼs birth registers was conducted for the years 1974, 1984 and 1994. The study population of 5445 patients was grouped according to ancestry/family origin on the basis of a name analysis, and subsequently also according to parity (primiparous or multiparous). On name analysis 2741 women were defined as German, 1598 were grouped as women of Turkish origin and 810 as immigrants of other origin. χ2 tests and Fisherʼs exact test were used for significance testing (significance level p episiotomy, higher grade perineal tears and severe postpartum haemorrhage did not differ between the groups. There were however significant differences in the use of uterine stimulants, analgesics in labour and both local and regional anaesthesia, with women of Turkish origin and other immigrants receiving anaesthesia less, but oxytocin more often. Rooming-in was more common among German primipara and multipara from 1984 onwards. Discussion: This retrospective analysis of three historical birth cohorts showed significant differences in perinatal care between German and immigrant women, presumably reflecting deficits in care. It seems remarkable that this trend has not changed over a time span of three decades despite a continuous increase in immigration and acculturation. A “research paradox”, however, remains: Despite these increasing rates, there are no current or older, prospective or systematic studies of obstetric care in immigrants. PMID:27904165

  18. Home Birth: Know the Pros and Cons

    Science.gov (United States)

    ... in a tub? Will you breast-feed your baby immediately after delivery? Discuss your birthing plan with your health care ... life-threatening problems can occur during labor and delivery without warning. In those cases, the need to transfer you and your baby to a hospital could delay care, which could ...

  19. Evaluation of Progesterone Utilization and Birth Outcomes in a State Medicaid Plan.

    Science.gov (United States)

    Hydery, Tasmina; Price, Mylissa K; Greenwood, Bonnie C; Takeshita, Mito; Kunte, Parag S; Mauro, Rose P; Lenz, Kimberly; Jeffrey, Paul L

    2017-08-22

    Progesterone (hydroxyprogesterone caproate injection and vaginal progesterone) has been shown to reduce preterm birth (PTB) rates by one-third among pregnant women at high risk. The purpose of this analysis is to report birth outcomes and medication adherence among Massachusetts Medicaid (MassHealth) members receiving progesterone, evaluate the association between member characteristics and birth outcomes and medication adherence, and compare cost of care to a prior preterm pregnancy. This retrospective cohort study used medical claims, pharmacy claims, and prior authorization (PA) request data for MassHealth members who had a PA submitted for progesterone between January 1, 2011 and March 31, 2015. Members were excluded due to breaks in coverage, progesterone was not indicated for prevention of PTB, and if current gestational week or date of delivery was unavailable. A total of 418 members were screened for inclusion of which 190 met criteria and 169 filled progesterone. Mean age was 29.2 years (SD = 5.23) and clinical comorbidities were identified in 90.5% of members. Consistent with clinical trials on progesterone effectiveness, 62.1% of members had a term delivery (≥ 37 weeks). Among members with prior gestational age at delivery available, the average difference in gestational age between pregnancies was 8.25 weeks (SD = 6.11). Additionally, 66.3% of members were adherent to progesterone based on proportion of days covered (PDC) ≥ 0.8. The overall mean PDC was 0.79 (SD = 0.26). Despite similar birth outcomes in clinical trials and national trends, medication adherence is low in this state Medicaid program. Therefore, members may benefit from adherence support. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  20. Birth Injuries and Related Risk Factors in Neonates Born in Emam Sajjad Hospital in Yasuj in 2005 to 2006

    Directory of Open Access Journals (Sweden)

    M Rezaie

    2009-04-01

    Risk factors were included NVD (difficult vaginal delivery, high gestation age, and low Apgar score at first minute of life, shoulder dystocia, vacuum and birth at night. Conclusion: The present study revealed that the incidence of birth injuries in this area is high. Considering the serious complications of birth injuries and hypoxic-ischemic encephalopathy with no treatment for some cases, it seems that using the preventing methods to reduce the prevalence of birth injuries is nessesary

  1. Obstetric Risk factors for Low Birth Weight amongst Full Term Babies Born at a Tertiary Care Hospital of Belgaum District, South India

    Directory of Open Access Journals (Sweden)

    Damaru Prasad Paneru, Vijaya A Naik, B R Nilgar, Mahesh D Mallapur

    2014-01-01

    Full Text Available Introduction: Low Birth Weight is a multifaceted socio- medical and public health problem, especially in developing countries where Intrauterine Growth Retardation remains major manifestation. This study was carried out to identify obstetric risk factors for Low Birth Weight amongst full term babies born at a tertiary care hospital. Methodology: This was the retrospective record-based study, carried out at the Dr P.K Charitable Hospital of Belgaum district, South India. Records of all consecutive full term (?37 weeks of gestation singleton live births occurring during the period from 1st April–September 31, 2012 was examined to obtain relevant information. Results: A total of 1299 women delivered singleton live births at full term during the stipulated time period. Mean maternal age was 23.28±3.39 years, 53% were primi-gravida and 48.8% were high risk pregnancy. Low birth weight (LBW was prevalent amongst 19.3% new born. Among the independent significant factors associated with the LBW, primigravida, hypertensive mothers, non cephalic presentation, female baby had 1.31, 1.96, 2.89 and 1.33 times higher odds of delivering/having LBW as against multigravida, normotensive mothers, cephalic presentation and male baby respectively. Conclusions: Primigravida, hypertensive disorders during pregnancy, fetal presentation at delivery and sex of the new born were significantly associated with the LBW. Early identification, monitoring and management of hypertensive disorders during pregnancy eventually reduce the LBWs attributable to hypertension.

  2. A study on mode of delivery and conduct of labour in women with vaginal birth after caesarean section in Dhulikhel Hospital.

    Science.gov (United States)

    Tamrakar, S R; Chawla, C D

    2010-06-01

    Vaginal birth after caesarean section is the delivery of a baby through the vagina after a previous cesarean delivery. For this to be conducted safely and responsibly emergency obstetric care must be available. To study the different modes of delivery in Dhulikhel Hospital (DH), evaluate the frequency of attempted and successful vaginal birth after caesarean section and, in the VBAC group, to identify those factors that may influence outcome and safety. The study was a retrospective study of all women who were delivered via different routes and the subgroup who underwent attempted vaginal birth after caesarean section in DH from January 2007 to December 2009. In this study factors associated with the successful VBAC were also analyzed. During the study period a total of 4215 deliveries conducted in DH and a total of 890 lower segment caesarean sections (21.1% of all deliveries) were performed. Of the 890 caesareans performed, 743 were primary and 147 were repeat (69 were repeat elective and 78 were repeat emergency). In this period an additional 33 women with previous lower segment caesarean sections had a successful vaginal delivery. Hence 18.3% (33/180) vaginal birth after caesarean sections was conducted successfully among women with previous caesarean). The results of this study indicate that vaginal birth after caesarean section is a clear feature of obstetric practice in DH. This is possible because of the vigilance in managing these women and the availability in this hospital setting of resources for immediate cesarean section.

  3. Financing and planning of public and private not-for-profit hospitals in the European Union.

    Science.gov (United States)

    Thompson, Ceri R; McKee, Martin

    2004-03-01

    While much has been written about health care financing in Europe in recent years, discussion has almost entirely focused on revenue. In contrast, there has been remarkably little written on financing of capital investment in European health care systems. Yet major changes are underway in several countries, in particular involving new forms of public-private partnerships (PPP). At the same time, there is growing recognition of the way in which the inherited structure of the health care delivery system constrains the system's ability to adapt to changing circumstances. This paper reports the results of a survey undertaken among key informants in the member states of the European Union to begin to ascertain existing practices and future plans in relation to hospital planning and financing amongst public and private not-for-profit hospitals. The locus of hospital planning decisions reflect the constitutional framework of the country involved, and thus the emphasis on national or local plans. There has been an expansion of private sector involvement, with four basic models identified: private loans direct to the hospital; private loans to a regional health body; a PPP where the private sector's role is to build, design and operate the non-clinical functions of the hospital; and, finally, a PPP, where the private sector's involvement also includes management of the clinical functions of the hospital. It is too early to say whether these approaches will be more successful than the models they are replacing.

  4. A Menu Planning Guide for Large Army Hospitals.

    Science.gov (United States)

    1970-01-01

    support of this statement, Kapfer (1968) emphasized that in commercial or private institutions the customer generally is able to choose the type of food...consideration is the capability of the menu planner. Kapfer (1968) emphasized that the academic knowl- edge of the basic requirements for menu planning should...productivity rather than patient satisfaction. According to Kapfer (1968), sound management of manpower, money, resources, and material can not be emphasized

  5. Risk perception and choice of place of birth in women with high risk pregnancies: A qualitative study.

    Science.gov (United States)

    Lee, Suzanne; Ayers, Susan; Holden, Des

    2016-07-01

    Objective To examine the perception of risk among a group of women with high risk pregnancies who were either planning to give birth in hospital, or at home despite medical advice to the contrary. The intention was to consider differences and similarities between the groups to examine how perception of risk relates to choice of place of birth. Design Qualitative study using semi-structured interviews. Setting Maternity department in a hospital in South East England. Participants Twenty-six women with high risk pregnancies, at least 32 weeks pregnant. Half were planning hospital births and half homebirths. Measurements and findings Semi-structured interviews to investigate women's understanding and assessment of risk. Results were analysed using thematic analysis. Five themes emerged: understanding of situation; judgement of risk; reassuring factors; impact of risk; and coping with risk. Women from both groups had some understanding of the implications of their medical/obstetric conditions. They displayed concerns about their babies' wellbeing. Women planning homebirths assessed their risks as lower and expressed less concerns than women planning hospital births. Women planning hospital births more frequently described following professional advice. Key conclusions Risk perception is individual and subjective. Women with high risk pregnancies who plan to give birth at home perceive risk differently to women who plan hospital births. Implications for practice Healthcare professionals working with women with high risk pregnancies should be aware of the potential for differences in definitions and perceptions of risk within this group.

  6. The baby-friendly hospital initiative and breastfeeding at birth in Brazil: a cross sectional study

    Directory of Open Access Journals (Sweden)

    Márcia Lazaro de Carvalho

    2016-10-01

    Full Text Available Resumo Introdução A amamentação na primeira hora de vida é importante para o sucesso do aleitamento materno e para a redução da mortalidade neonatal. Políticas governamentais vêm atuando neste sentido, destacando-se o credenciamento dos hospitais na Iniciativa Hospital Amigo da Criança (IHAC. O objetivo deste estudo é conhecer a associação entre o nascimento em Hospitais Amigos da Criança (HAC - exposição principal e o início oportuno da amamentação (desfecho, comparado com maternidades não HAC. Métodos Os dados vem do inquérito “Nascer no Brasil”, uma amostra de base hospitalar e abrangência nacional, sob a coordenação da Fundação Oswaldo Cruz. Foram estudados uma amostra de 22.035 mães/bebês através de um modelo teórico hierarquizado em três níveis e todas as análises consideraram o desenho complexo da amostra. As razões de chance foram obtidas por regressão logística, com IC 99 %. Resultados Entre o total de nascimentos, 40 % ocorreram em hospitais credenciados ou em processo de credenciamento pela IHAC e 52 % das mulheres foram submetidas à cesariana. No modelo final, no nível distal, as mães com menos de 35 anos, e as que residiam na Região Norte, apresentaram uma chance maior de início oportuno da amamentação. No nível intermediário, a realização de pré-natal no setor público e a orientação sobre amamentação tiveram associação direta com o desfecho. No nível proximal, ter nascido em Hospital Amigo da Criança e via de parto normal aumentaram a chance do início oportuno da amamentação, enquanto ser bebê prematuro e apresentar baixo peso ao nascer reduziram a chance do desfecho. Conclusões A chance de uma criança ser amamentada na primeira hora de vida nos hospitais amigos da criança foi duas vezes maior do que nos hospitais não credenciados, o que mostra a importância dessa iniciativa para o início oportuno da amamentação.

  7. Regional variation in obstetrical intervention for hospital birth in the Republic of Ireland, 2005–2009

    Directory of Open Access Journals (Sweden)

    Lutomski Jennifer E

    2012-11-01

    Full Text Available Abstract Background Obstetrical interventions during childbirth vary widely across European and North American countries. Regional differences in intrapartum care may reflect an inpatient-based, clinician-oriented, interventional practice style. Methods Using nationally representative hospital discharge data, a retrospective cohort study was conducted to explore regional variation in obstetric intervention across four major regions (Dublin Mid Leinster; Dublin Northeast; South; West within the Republic of Ireland. Specific focus was given to rates of induction of labour, caesarean delivery, epidural anaesthesia, blood transfusion, hysterectomy and episiotomy. Logistic regression analyses were performed to assess the association between geographical region and interventions while adjusting for patient case-mix. Results 323,588 deliveries were examined. The incidence of interventions varied significantly across regions; the greatest disparities were observed for rates of induction of labour and caesarean delivery. Women in the South had nearly two-fold odds of having prostaglandins (adjusted OR: 1.75, 95% CI 1.68-1.82, whereas women in the West had 1.85 odds (95% CI 1.77-1.93 of artificial rupture of membrane. Women delivering in the Dublin Northeast, South and West regions had more than two-fold increased odds of elective caesarean delivery relative to women delivering in the Dublin Mid Leinster region. The Dublin Northeast region had the highest odds of emergency caesarean delivery (adjusted OR: 1.36; 95% CI: 1.31-1.40. Conclusions Substantial regional variation in intrapartum care was observed within this small, relatively homogeneous population. The association of intervention use with region illustrates the need to encourage uptake of scientific based practice guidelines to better inform clinical judgment.

  8. [Terrorists' target World Cup 2006: disaster medicine on the sidelines?! Aspects of hospital disaster planning].

    Science.gov (United States)

    Weidringer, J W; Ansorg, J; Ulrich, B C; Polonius, M-J; Domres, B D

    2004-09-01

    Focussing on possible mass casualty situations during events such as the soccer world championship in 2006, the Professional Board of Surgeons in Germany and the German Society for Surgery canvassed surgeons-in-chief in the last quarter of 2003 concerning disaster plans for hospitals. The rate of returned questionnaires amounted to 26% covering the following areas of interest: plans-ready to use, known by the employees as well as by the rescue coordination center, performance of exercises, and concepts on decontamination and detoxification. Based on past numbers of casualties during soccer disasters, an excursus into details also includes a description of an approach to reduce the danger of bottleneck effects at doors. A preliminary concept based on the upcoming system for funding hospitals in Germany and including new partnerships is outlined, succeeded by some hopefully helpful hints for a web-based hospital disaster plan.

  9. Patient with stroke: hospital discharge planning, functionality and quality of life

    Directory of Open Access Journals (Sweden)

    Henrique José Mendes Nunes

    Full Text Available ABSTRACT Stroke still causes high levels of human inability and suffering, and it is one of the main causes of death in developed countries, including Portugal. Objective: analyze the strategies of hospital discharge planning for these patients, increasing the knowledge related to hospitalhome transition, discharge planning processes and the main impact on the quality of life and functionality. Method: integrative literature review using the PICOD criteria, with database research. Results: 19 articles were obtained, using several approaches and contexts. For quality of life, the factors related to the patient satisfaction with care and the psychoemotional aspects linked with functionality are the most significant. Conclusion: during the hospitalization period, a careful hospital discharge planning and comprehensive care to patients and caregivers - in particular the functional and psychoemotional aspects - tend to have an impact on the quality of life of patients.

  10. Pooled credit plans offer financing alternatives to independent hospitals.

    Science.gov (United States)

    Ziglar, J W

    1983-06-01

    Using the collective financial strength of a group of not-for-profit health care institutions to finance capital needs has become an increasingly popular concept. This article discusses the significant advantages and disadvantages of the concept, provides an overview of the development of multi-institutional financing arrangements, and describes the generic forms of credit poolings. It also outlines three broad areas of inquiry to be explored by potential participants before entering a pooled credit arrangement: the relationships among participants, the availability of assets to support debt, and corporate planning and strategy.

  11. The need for strategic tax planning among nonprofit hospitals.

    Science.gov (United States)

    Smith, Pamela C

    2005-01-01

    Strategic tax planning issues are important to the nonprofit health care sector, despite its philanthropic mission. The consolidation of the industry has led management to fight for resources and develop alternative strategies for raising money. When management evaluates alternative collaborative structures to increase efficiency, the impact on governance structures must also be considered. The increased governmental scrutiny of joint ventures within the health care sector warrants management's attention as well. The financial incentives must be considered, along with the various tax policy implications of cross-sector collaborations.

  12. OCLC for the hospital library: the justification plan for hospital administration.

    Science.gov (United States)

    Allen, C W; Branson, J R

    1982-07-01

    This paper delineates the necessary steps to provide hospital administrators with the information needed to evaluate an automated system, OCLC, for addition to the medical library. Based on experience at the Norton-Children's Hospitals, included are: (1) cost analyses of present technical processing systems and cost comparisons with OCLC; (2) delineation of start-up costs for installing OCLC; (3) budgetary requirements for 1981; (4) the impact of automation on library systems, personnel, and services; (5) potential as a shared service; and (6) preparation of the proposal for administrative review.

  13. Prenatal care, pregnancy outcomes, and postpartum birth control plans among pregnant women with opiate addictions.

    Science.gov (United States)

    Parlier, Anna Beth; Fagan, Blake; Ramage, Melinda; Galvin, Shelley

    2014-11-01

    To describe how effectively we provided adequate prenatal care and postpartum contraception to prevent repeat, unintended pregnancies to women using opiates or medication maintenance therapy (MMT) during pregnancy. We conducted a retrospective chart review of 94 women using opiates or MMT during 96 pregnancies while receiving prenatal care in the regional high-risk maternity care clinic between July 2010 and June 2012. We examined prenatal care usage, birth outcomes, and postpartum contraception using χ(2), Kruskal-Wallis, and binary logistic regression modeling. Patients were predominately white (93.6%), multiparous (75.5%), and in their 20s; 71 (74%) used MMT and 25 (26%) used prescribed or illicit opiates. Fewer than half (44% [46.2%]) received any documented prenatal counseling about postpartum contraception. Sixteen (17%) babies were premature. Sixty-four (66.7%) infants were diagnosed as having neonatal abstinence syndrome (NAS). Only 42 (43.8%) women attended their postpartum visits. Overall, 60 (62.5%) women received postpartum contraception. The only significant predictors of postpartum contraception use were preterm birth and postpartum appointment attendance. Alternative strategies for providing postpartum care should be explored because women using opiates or MMT during pregnancy are significantly more likely to use postpartum contraception if they attend their postpartum appointments.

  14. Strategic planning in healthcare: the experience of the University of Wisconsin Hospital and Clinics.

    Science.gov (United States)

    Sollenberger, Donna K

    2006-01-01

    In 1999, after 25 years of stable leadership from a single CEO, the University of Wisconsin Hospital and Clinics (UWHC) Authority Board named a new CEO. The 471-bed academic medical center had recently experienced significant change and challenges. In 1996, it had emerged as a public authority, a statutory designation by the state of Wisconsin that moved the hospital and clinics from the University of Wisconsin and the state of Wisconsin, and created it as a quasi-public entity with its own board. In 1999, when the new CEO was named, the hospital was experiencing a loss of revenue and market share, operating deficits, a 22 percent nurse vacancy rate, and patient satisfaction scores below the 40th percentile. The first task assigned to the new CEO by the board was the development of a new strategic plan that would reverse these trends and position UWHC as a premier academic hospital. The CEO began a strategic planning process that involved leaders, physicians, and staff from throughout the hospital and clinics, its affiliated medical school, and the physician practice plan. This article describes the collaborative, integrative, and communicative strategic planning process UWHC used; details the organization of the process; describes the results achieved by UWHC; and lists the lessons learned along the way.

  15. Succession planning: trends regarding the perspectives of Chief Executive Officers in US hospitals.

    Science.gov (United States)

    Collins, Sandra K; McKinnies, Richard C; Matthews, Eric; Collins, Kevin S

    2013-01-01

    A study was conducted to revisit the perceptions of chief executive officers in US hospitals regarding the origin of leadership and how they felt about internally developed successors versus externally recruited successors. Furthermore, the study sought to develop understanding of how this group of executives utilizes the succession planning process, what factors impact successor identification, what positions are applicable for succession planning activities, and who is ultimately held responsible for leadership continuity within the hospital industry. The results of this 2012 study were compared with a previous study conducted in 2007 to determine if the perceptions had changed over time.

  16. Development of a nurse case management service: a proposed business plan for rural hospitals.

    Science.gov (United States)

    Adams, Marsha Howell; Crow, Carolyn S

    2005-01-01

    The nurse case management service (NCMS) for rural hospitals is an entrepreneurial endeavor designed to provide rural patients with quality, cost-effective healthcare. This article describes the development of an NCMS. A detailed marketing and financial plan, a review of industry trends, and the legal structure and risks associated with the development of the venture are presented. The financial plan projects a minimum savings of 223,200 dollars for rural institutions annually. To improve quality and reduce cost for rural hospitals, the authors recommend implementation of an NCMS.

  17. High ANC coverage and low skilled attendance in a rural Tanzanian district: a case for implementing a birth plan intervention

    Directory of Open Access Journals (Sweden)

    Cousens Simon

    2010-03-01

    Full Text Available Abstract Background In Tanzania, more than 90% of all pregnant women attend antenatal care at least once and approximately 62% four times or more, yet less than five in ten receive skilled delivery care at available health units. We conducted a qualitative study in Ngorongoro district, Northern Tanzania, in order to gain an understanding of the health systems and socio-cultural factors underlying this divergent pattern of high use of antenatal services and low use of skilled delivery care. Specifically, the study examined beliefs and behaviors related to antenatal, labor, delivery and postnatal care among the Maasai and Watemi ethnic groups. The perspectives of health care providers and traditional birth attendants on childbirth and the factors determining where women deliver were also investigated. Methods Twelve key informant interviews and fifteen focus group discussions were held with Maasai and Watemi women, traditional birth attendants, health care providers, and community members. Principles of the grounded theory approach were used to elicit and assess the various perspectives of each group of participants interviewed. Results The Maasai and Watemi women's preferences for a home birth and lack of planning for delivery are reinforced by the failure of health care providers to consistently communicate the importance of skilled delivery and immediate post-partum care for all women during routine antenatal visits. Husbands typically serve as gatekeepers of women's reproductive health in the two groups - including decisions about where they will deliver- yet they are rarely encouraged to attend antenatal sessions. While husbands are encouraged to participate in programs to prevent maternal-to-child transmission of HIV, messages about the importance of skilled delivery care for all women are not given emphasis. Conclusions Increasing coverage of skilled delivery care and achieving the full implementation of Tanzania's Focused Antenatal Care

  18. Maternal oral health status and preterm low birth weight at Muhimbili National Hospital, Tanzania: a case-control study

    Directory of Open Access Journals (Sweden)

    Manji Karim P

    2007-06-01

    Full Text Available Abstract Background The study examined the relationship between oral health status (periodontal disease and carious pulpal exposure (CPE and preterm low-birth-weight (PTLBW infant deliveries among Tanzanian-African mothers at Muhimbili National Hospital (MNH, Tanzania. Methods A retrospective case-control study was conducted, involving 373 postpartum mothers aged 14–44 years (PTLBW – 150 cases and at term normal-birth-weight (TNBW – 223 controls, using structured questionnaire and full-mouth examination for periodontal and dentition status. Results The mean number of sites with gingival bleeding was higher in PTLBW than in TNBW (P = 0.026. No significant differences were observed for sites with plaque, calculus, teeth with decay, missing, filling (DMFT between PTLBW and TNBW. Controlling for known risk factors in all post-partum (n = 373, and primiparaous (n = 206 mothers, no significant differences were found regarding periodontal disease diagnosis threshold (PDT (four sites or more that had probing periodontal pocket depth 4+mm and gingival bleeding ≥ 30% sites, and CPE between cases and controls. Significant risk factors for PTLBW among primi- and multiparous mothers together were age ≤ 19 years (adjusted Odds Ratio (aOR = 2.09, 95% Confidence interval (95% CI: 1.18 – 3.67, P = 0.011, hypertension (aOR = 2.44, (95% CI: 1.20 – 4.93, P = 0.013 and being un-married (aOR = 1.59, (95% CI: 1.00 – 2.53, P = 0.049. For primiparous mothers significant risk factors for PTLBW were age ≤ 19 years (aOR = 2.07, 95% CI: 1.13 – 3.81, P = 0.019, and being un-married (aOR = 2.58, 95% CI: 1.42 – 4.67, P = 0.002. Conclusions These clinical findings show no evidence for periodontal disease or carious pulpal exposure being significant risk factors in PTLBW infant delivery among Tanzanian-Africans mothers at MNH, except for young age, hypertension, and being unmarried. Further research incorporating periodontal pathogens is recommended.

  19. Planning an open and IHE-compliant architecture for a filmless and paperless hospital

    Science.gov (United States)

    Ratib, Osman M.; McCoy, J. Michael; Kho, Hwa T.; Yu, Reba

    2001-08-01

    UCLA is in the process of building a new acute-care hospital due to open in 2005 with the intent to operate fully digitally. The strategic planning for this hospital is based on a set of new paradigms: wider and more efficient access to all information sources, enterprise-wide data repository, usage of thin-client technology and wide usage generic information-appliances and wireless devices allowing access to information from anywhere in the hospital. These new paradigms required significant changes from traditional information technology architecture in particular in workflow management of large quantities of imaging data.

  20. Modeling an integrated hospital management planning problem using integer optimization approach

    Science.gov (United States)

    Sitepu, Suryati; Mawengkang, Herman; Irvan

    2017-09-01

    Hospital is a very important institution to provide health care for people. It is not surprising that nowadays the people’s demands for hospital is increasing. However, due to the rising cost of healthcare services, hospitals need to consider efficiencies in order to overcome these two problems. This paper deals with an integrated strategy of staff capacity management and bed allocation planning to tackle these problems. Mathematically, the strategy can be modeled as an integer linear programming problem. We solve the model using a direct neighborhood search approach, based on the notion of superbasic variables.

  1. Saving lives at birth

    DEFF Research Database (Denmark)

    Daysal, N. Meltem; Trandafir, Mircea; van Ewijk, Reyn

    2015-01-01

    Many developed countries have recently experienced sharp increases in home birth rates. This paper investigates the impact of home births on the health of low-risk newborns using data from the Netherlands, the only developed country where home births are widespread. To account for endogeneity...... in location of birth, we exploit the exogenous variation in distance from a mother’s residence to the closest hospital. We find that giving birth in a hospital leads to substantial reductions in newborn mortality. We provide suggestive evidence that proximity to medical technologies may be an important...

  2. Perspectives of expectant women and health care providers on birth plans.

    Science.gov (United States)

    Aragon, Melissa; Chhoa, Erica; Dayan, Riki; Kluftinger, Amy; Lohn, Zoe; Buhler, Karen

    2013-11-01

    Objective : Un plan d’accouchement est un document détaillant les préférences et les attentes d’une femme à l’égard du travail et de l’accouchement. Les recherches empiriques explorant la valeur des plans d’accouchement ont obtenu des résultats contradictoires quant à la question de savoir si ces derniers exercent un effet positif ou négatif sur le travail et l’accouchement, ce qui semble souligner la nécessité de procéder à d’autres études sur le sujet. Cette étude avait pour but de comprendre les points de vue des femmes, des fournisseurs de soins et des accompagnateurs à l’égard de l’utilisation de plans d’accouchement. Méthodes : Un questionnaire transversal a été distribué à un échantillon de commodité de femmes enceintes ou ayant accouché, de fournisseurs de soins et d’accompagnateurs entre janvier 2012 et mars 2012 en Colombie-Britannique. Résultats : En tout, 122 femmes et 110 fournisseurs de soins de santé et accompagnateurs ont rempli le questionnaire. Tant les femmes que leurs fournisseurs de soins et de soutien estimaient que le plan d’accouchement était utile à titre d’outil de communication et d’éducation. Toutefois, les répondants ont souligné que les femmes pourraient être déçues ou mécontentes dans les cas où la mise en œuvre du plan d’accouchement s’avère impossible. Parmi les plus importants éléments du plan d’accouchement qui ont été identifiés, on trouvait la maîtrise de la douleur, les mesures visant le confort (p. ex. mobilité pendant le travail), les préférences postpartum (p. ex. allaitement), l’atmosphère (p. ex. intimité) et les croyances quant à l’accouchement (p. ex. aspects culturels). Conclusion : Il s’agit de la première étude à identifier les avantages et les désavantages de l’utilisation d’un plan d’accouchement, ainsi que les aspects les plus importants d’un tel plan, et ce, tant du point de vue des femmes que de celui de

  3. Morbidity and mortality of low birth weight infants in the new born unit of Kenyatta National Hospital, Nairobi.

    Science.gov (United States)

    Simiyu, D E

    2004-07-01

    Morbidity and mortality of low birth weight (LBW) infants at Kenyatta National Hospital (KNH) has previously been found to be high. Other centres have shown that even with lack of neonatal intensive care facilities, selective interventions can be implemented that improve neonatal survival rates. It is important to identify those factors at KNH that when selectively modified, will improve the quality of care hence survival rates. To quantify the morbidity and mortality of LBW infants in KNH. To audit the quality of care and identify factors that can be selectively modified to improve the quality of care and improve the currently low survival rates. Retrospective study utilising case notes. New born unit, Kenyatta National Hospital, Nairobi. All LBW infants admitted to the NBU at KNH from January to December 2000. Out of an expected 694 files, 533 (77%) were studied. The male to female ratio and LBW to VLBW ratio was 1:1 respectively. Small for gestational age (SGA) accounted for 11.6%. Overall mortality was 57.4% (574/1000 admissions) while mortality for SGA was 37%. Infants born out of KNH had significantly higher mortality (p=0.0047). Compared to Caeserian delivery, infants born via spontaneous vertex delivery had higher mortality (p=0.0087). The leading diagnoses on admission or death were respiratory distress(69%), apnoeic attacks (42%) suspected sepsis and jaundice (37% each), hypothermia(27%) and anaemia(17%). By time of death or discharge, 43% had no laboratory investigations done. While 37% had suspected sepsis, only 14% had blood culture done. Antibiotics were started in 460 (86%) of infants yet only 37% had diagnosis of suspected sepsis. Change of antibiotics was guided by culture and sensitivity reports in only 62(13.5%). Apnoeic spells were managed with rectal aminophyline in 156(29%) infants of whom 19(12%) survived. The terminal events for the dead infants included recurrent apnoeic spells. The only mode of nutrition was enteric feeding in 59% with

  4. Optimal administrative scale for planning public services: a social cost model applied to Flemish hospital care.

    Science.gov (United States)

    Blank, Jos L T; van Hulst, Bart

    2015-01-01

    In choosing the scale of public services, such as hospitals, both economic and public administrative considerations play important roles. The scale and the corresponding spatial distribution of public institutions have consequences for social costs, defined as the institutions' operating costs and the users' travel costs (which include the money and time costs). Insight into the relationship between scale and spatial distribution and social costs provides a practical guide for the best possible administrative planning level. This article presents a purely economic model that is suitable for deriving the optimal scale for public services. The model also reveals the corresponding optimal administrative planning level from an economic perspective. We applied this model to hospital care in Flanders for three different types of care. For its application, we examined the social costs of hospital services at different levels of administrative planning. The outcomes show that the social costs of rehabilitation in Flanders with planning at the urban level (38 areas) are 11% higher than those at the provincial level (five provinces). At the regional level (18 areas), the social costs of rehabilitation are virtually equal to those at the provincial level. For radiotherapy, there is a difference of 88% in the social costs between the urban and the provincial level. For general care, there are hardly any cost differences between the three administrative levels. Thus, purely from the perspective of social costs, rehabilitation should preferably be planned at the regional level, general services at the urban level and radiotherapy at the provincial level.

  5. [Building Process and Architectural Planning Characteristics of Daehan Hospital Main Building].

    Science.gov (United States)

    Lee, Geauchul

    2016-04-01

    This paper explores the introduction process of Daehan Hospital from Japan as the modern medical facility in Korea, and the architectural planning characteristics as a medical facility through the detailed building process of Daehan Hospital main building. The most noticeable characteristic of Daehan Hospital is that it was designed and constructed not by Korean engineers but by Japanese engineers. Therefore, Daehan Hospital was influenced by Japanese early modern medical facility, and Japanese engineers modeled Daehan Hospital main building on Tokyo Medical School main building which was constructed in 1876 as the first national medical school and hospital. The architectural type of Tokyo Medical School main building was a typical school architecture in early Japanese modern period which had a middle corridor and a pseudo Western-style tower, but Tokyo Medical School main building became the model of a medical facility as the symbol of the medical department in Tokyo Imperial University. This was the introduction and transplantation process of Japanese modern 'model' like as other modern systems and technologies during the Korean modern transition period. However, unlike Tokyo Medical School main building, Daehan Hospital main building was constructed not as a wooden building but as a masonry building. Comparing with the function of Daehan Hospital main building, its architectural form and construction costs was excessive scale, which was because Japanese Resident-General of Korea had the intention of ostentation that Japanese modernity was superior to Korean Empire.

  6. Economic evaluation of birth care in low-risk women. A comparison between a midwife-led birth unit and a standard obstetric unit within the same hospital in Norway. A randomised controlled trial.

    Science.gov (United States)

    Bernitz, Stine; Aas, Eline; Øian, Pål

    2012-10-01

    to investigate the cost-effectiveness in birth care for low-risk women, in an alongside midwife-led unit (MU) compared to a standard obstetric unit (SCU) within the same hospital. economic evaluation based on the findings of a randomised trial, randomising participants either into the MU or SCU. The hospital's activity-based costing system CPP was used to estimate costs, as no data on complete resource use exists. the Department of Obstetrics and Gynaecology, Østfold Hospital Trust, Norway. the study population consists of 1,110 consenting healthy women, assessed to be at low-risk at spontaneous onset of labour. effect measures; avoided caesarean sections, instrumental vaginal deliveries, complications requiring treatment in the operating room, epidural analgesia and oxytocin augmentation. Costs (€) were calculated by costs per day multiplied with length of stay, added costs for procedures performed outside the units. The results are expressed in incremental cost-effectiveness ratios (ICER) with SCU as comparator. total costs per stay were significantly lower for women at the MU (€1,672) compared to the SCU (€1,950, pcosts and reduction in clinical procedures) for all effect measures. Based on the sensitivity analysis, allocating low-risk women to MU significantly reduced costs, but was not a dominant strategy for all outcomes. the MU is more cost-effective than the SCU for low-risk women without prelabour preference for level of birth care provided equal capacity at the units. it is cost-effective to organise birth care for low-risk women in a separate midwife-led unit. Copyright © 2012 Elsevier Ltd. All rights reserved.

  7. Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study.

    NARCIS (Netherlands)

    Brocklehurst, P.; Kwee, A.; Birthplace in England Collaborative Group

    2011-01-01

    Objective: To compare perinatal outcomes, maternal outcomes, and interventions in labour by planned place of birth at the start of care in labour for women with low risk pregnancies. Design: Prospective cohort study. Setting: England: all NHS trusts providing intrapartum care at home, all freestandi

  8. Birth setting, transfer and maternal sense of control: results from the DELIVER study

    NARCIS (Netherlands)

    Geerts, C.C.; Klomp, T.; Lagro-Janssen, A.L.M.; Twisk, J.W.R.; Dillen, J. van; Jonge, A. de

    2014-01-01

    BACKGROUND: In the Netherlands, low risk women receive midwife-led care and can choose to give birth at home or in hospital. There is concern that transfer of care during labour from midwife-led care to an obstetrician-led unit leads to negative birth experiences, in particular among those with plan

  9. Variation in home-birth rates between midwifery practices in the Netherlands.

    NARCIS (Netherlands)

    Wiegers, T.A.; Zee, J. van der; Kerssens, J.J.; Keirse, M.J.N.C.

    2000-01-01

    Objective: to examine the reasons for the variation in home-birth rates between midwifery practices. method: multi-level analysis of client and midwife associated, case-specific and structural factors in relation to 4420 planned and actual home or hospital births in 42 midwifery practices. Findings:

  10. Knowledge attitude and practices of family planning methods among postnatal mothers-A hospital based study

    Directory of Open Access Journals (Sweden)

    Rekha Udgiri

    2016-04-01

    Full Text Available Background: All the couple have the basic rights to decide freely and responsibly on the number and spacing of their children and to have the information, education and means to do so. In developing countries, especially in India where deep rooted belief, customs and superstition regarding pregnancy, child birth, are still widely prevalent and women with poor socioeconomic background are more vulnerable to the health risks associated with child bearing in quick succession. Hence the present study provides excellent opportunities to educate the mother in postnatal ward regarding family planning method and help them to adopt birth spacing in the face of changing circumstances. Objectives: a To assess the knowledge, attitude & practices regarding family planning methods among postnatal mothers. b To educate them to use one of the family planning method. Material and Methods: Cross-sectional study was carried out for a period of one month. A total of 162 postnatal mother who were admitted in postnatal general ward of OBG Dept., Shri.BM.Patil medical college constitutes the sample size. After obtaining ethical clearance from the institute, the mothers were interviewed after taking verbal consent. The data was collected using semi-structured questionnaires. Statistical test like percentage, chi-square test was applied to know the association. Result: In the present study 65.4% of mothers knew about family planning methods. Significant association was found in relation to education (p= 0.000, religion (p= 0.055 and parity (p= 0.01. Conclusion: The literacy level will definitely help to gain the information regarding family planning.

  11. Can a simulation-based training program impact the use of evidence based routine practices at birth? Results of a hospital-based cluster randomized trial in Mexico

    Science.gov (United States)

    Fritz, Jimena; Walker, Dilys M.; Cohen, Susanna; Angeles, Gustavo; Lamadrid-Figueroa, Hector

    2017-01-01

    Background In Mexico, although the majority of births are attended in hospitals, reports have emerged of obstetric violence, use of unsafe practices, and failure to employ evidence-based practices (EBP). Recent attention has refocused global efforts towards provision of quality care that is both patient-centered and evidence-based. Scaling up of local interventions should rely on strong evidence of effectiveness. Objective To perform a secondary analysis to evaluate the impact of a simulation and team-training program (PRONTO) on the performance of EBP in normal births. Methods A pair-matched cluster randomized controlled trial of the intervention was designed to measure the impact of the program (PRONTO intervention) on a sample of 24 hospitals (12 hospitals received the PRONTO training and 12 served as controls) in the states of Chiapas, Guerrero, and Mexico. We estimated the impact of receiving the intervention on the probability of birth practices performance in a sample of 641 observed births of which 318 occurred in the treated hospitals and 323 occurred in control hospitals. Data was collected at 4 time points (baseline, 4th, 8th and 12th months after the training). Women were blinded to treatment allocation but observers and providers were not. Estimates were obtained by fitting difference-in-differences logistic regression models considering confounding variables. The trial is registered at clinicaltrials.gov: # NCT01477554. Results Significant changes were found following the intervention. At 4 months post-intervention an increase of 20 percentage points (p.p.) for complete Active Management of Third Stage of Labor (AMTSL) (p = 0.044), and 16 p.p. increase for Skin-to-Skin Contact (p = 0.067); at 12 months a 25 p.p. increase of the 1st step of AMTSL (p = 0.026) and a 42 p.p. increase of Delayed Cord Clamping (p = 0.004); at 4 months a 30 (p = 0.001) and at 8 months a 22 (p = 0.010) p.p. decrease for Uterine Sweeping. Conclusions The intervention has an

  12. Readmission rates after a planned hospital stay of 2 versus 3 days in fast-track colonic surgery

    DEFF Research Database (Denmark)

    Andersen, Jens; Hjort-Jakobsen, Dorthe; Christiansen, P. S.;

    2007-01-01

    with a planned hospital stay of 2 versus 3 days. METHODS: The study included 541 consecutive colonic resections from one surgical department with a structured care programme, including well defined discharge criteria, between April 1997 and December 2005. The planned hospital stay was increased from 2 to 3 days......BACKGROUND: Initial programmes of fast-track open colonic surgery with a planned 2-day postoperative hospital stay have had a high readmission rate (about 20 per cent). The aim of this large, consecutive series was to compare readmission rates after a fast-track open colonic surgery programme...... from August 2004. All patients were examined 8 and 30 days after surgery. RESULTS: Readmission rates fell from 20.1 per cent in 408 patients with a planned 2-day hospital stay (period 1) to 11.3 per cent in 133 patients with a planned 3-day hospital stay (period 2) (P

  13. Inadequate birth spacing is perceived as riskier than all family planning methods, except sterilization and abortion, in a qualitative study among urban Nigerians.

    Science.gov (United States)

    Schwandt, Hilary M; Skinner, Joanna; Hebert, Luciana Estelle; Cobb, Lisa; Saad, Abdulmumin; Odeku, Mojisola

    2017-09-11

    Fertility is high in Nigeria and contraceptive use is low. Little is known about how urban Nigerians perceive the risk of contraceptive use in relation to pregnancy and birth. This study examines and compares the risk perception of family planning methods and pregnancy related scenarios among urban Nigerians. A total of 26 focus group discussions with 243 participants were conducted in September and October 2010 in Ibadan and Kaduna. The groups were stratified by sex, age, family planning use, and city. Study participants were asked to identify the risk associated with six different family planning methods and four pregnancy related risks. The data were coded in ATLAS.ti 6 and analyzed using the thematic content analysis approach. The ten family planning and pregnancy related items ranked as follows from most to least risky: sterilization, abortion, getting pregnant soon after having a baby (no birth spacing), pill, IUD, injectable, having a birth under 18 years of age (teenage motherhood), condom use, having six children, and fertility awareness methods. Risk of family planning methods was often categorized in terms of side effects and complications. Positive perceptions of teenage motherhood and having many children influenced the low ranking of these items. Inadequate birth spacing was rated as more risky than all contraceptive methods and pregnancy related events except for sterilization and abortion. Some of the participants' risk perceptions of contraceptives and pregnancy related scenarios does not correspond to actual risk of methods and practices. Instead, the items' perceived riskiness largely correspond with prevailing social norms. However, there was a high level of understanding of the risks of inadequate birth spacing. This study is not a randomized control trial so the study has not been registered as such.

  14. Wealthy Flou Birth Control

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    China’s family planning policies have come under criticism for failing to con birth rates among wealthy families A ccording to the family planning policies, Hong Youfu, a restaurant owner in Fangcun District of

  15. Home birth and barriers to referring women with obstetric complications to hospitals: a mixed-methods study in Zahedan, southeastern Iran.

    Science.gov (United States)

    Ghazi Tabatabaie, Mahmoud; Moudi, Zahra; Vedadhir, AbouAli

    2012-03-20

    One factor that contributes to high maternal mortality in developing countries is the delayed use of Emergency Obstetric-Care (EmOC) facilities. The objective of this study was to determine the factors that hinder midwives and parturient women from using hospitals when complications occur during home birth in Sistan and Baluchestan province, Iran, where 23% of all deliveries take place in non- hospital settings. In the study and data management, a mixed-methods approach was used. In the quantitative phase, we compared the existing health-sector data with World Health Organization (WHO) standards for the availability and use of EmOC services. The qualitative phase included collection and analysis of interviews with midwives and traditional birth attendants and twenty-one in-depth interviews with mothers. The data collected in this phase were managed according to the principles of qualitative data analysis. The findings demonstrate that three distinct factors lead to indecisiveness and delay in the use of EmOC by the midwives and mothers studied. Socio-cultural and familial reasons compel some women to choose to give birth at home and to hesitate seeking professional emergency care for delivery complications. Apprehension about being insulted by physicians, the necessity of protecting their professional integrity in front of patients and an inability to persuade their patients lead to an over-insistence by midwives on completing deliveries at the mothers' homes and a reluctance to refer their patients to hospitals. The low quality and expense of EmOC and the mothers' lack of health insurance also contribute to delays in referral. Women who choose to give birth at home accept the risk that complications may arise. Training midwives and persuading mothers and significant others who make decisions about the value of referring women to hospitals at the onset of life-threatening complications are central factors to increasing the use of available hospitals. The hospitals

  16. Home birth and barriers to referring women with obstetric complications to hospitals: a mixed-methods study in Zahedan, southeastern Iran

    Directory of Open Access Journals (Sweden)

    Ghazi Tabatabaie Mahmoud

    2012-03-01

    Full Text Available Abstract Background One factor that contributes to high maternal mortality in developing countries is the delayed use of Emergency Obstetric-Care (EmOC facilities. The objective of this study was to determine the factors that hinder midwives and parturient women from using hospitals when complications occur during home birth in Sistan and Baluchestan province, Iran, where 23% of all deliveries take place in non- hospital settings. Methods In the study and data management, a mixed-methods approach was used. In the quantitative phase, we compared the existing health-sector data with World Health Organization (WHO standards for the availability and use of EmOC services. The qualitative phase included collection and analysis of interviews with midwives and traditional birth attendants and twenty-one in-depth interviews with mothers. The data collected in this phase were managed according to the principles of qualitative data analysis. Results The findings demonstrate that three distinct factors lead to indecisiveness and delay in the use of EmOC by the midwives and mothers studied. Socio-cultural and familial reasons compel some women to choose to give birth at home and to hesitate seeking professional emergency care for delivery complications. Apprehension about being insulted by physicians, the necessity of protecting their professional integrity in front of patients and an inability to persuade their patients lead to an over-insistence by midwives on completing deliveries at the mothers' homes and a reluctance to refer their patients to hospitals. The low quality and expense of EmOC and the mothers' lack of health insurance also contribute to delays in referral. Conclusions Women who choose to give birth at home accept the risk that complications may arise. Training midwives and persuading mothers and significant others who make decisions about the value of referring women to hospitals at the onset of life-threatening complications are central

  17. [Hospital nurses' knowledge of the patient care plan for immediate life threatening situations].

    Science.gov (United States)

    Rodríguez-Borrajo, Sara; Martínez de Lahidalga-Martínez, Olga; Gutiérrez-García de Cortazar, Aitziber; Arriaran-Mendialdua, Izaskun; Latorre-García, Kepa

    2008-01-01

    To evaluate knowledge of nurses in adult hospital units in Txagorritxu Hospital (Vitoria) on care plans for immediate life-threatening (ILT) situations and to determine their self-evaluation of knowledge of cardiopulmonary resuscitation and the main sociodemographic characteristics that could influence the need for better training in this field. We performed a cross-sectional, analytical, observational study through a survey of 207 nurses in adult hospital units. Data were collected using a self-administered 20-item questionnaire. Five of these items measured knowledge of the care plan for ILT situations. The response rate was 74.39%. Of the five questions measuring knowledge, 32.4% of the nurses answered four or more questions correctly. Of the total, 38.3% knew when to activate the ILT plan; 12.99% did not know how to remove or lower the bed head when the patient was experiencing an ILT situation, and 24.03% did so with difficulty. No significant differences were found in nurses' experience, age, or the percentage of correct responses. Training courses should be organized to enable nurses to act in an ILT situation, including when to activate the care plan, how to perform the measures, and how to handle the center's materials/equipment.

  18. Training hospital managers for strategic planning and management: a prospective study.

    Science.gov (United States)

    Terzic-Supic, Zorica; Bjegovic-Mikanovic, Vesna; Vukovic, Dejana; Santric-Milicevic, Milena; Marinkovic, Jelena; Vasic, Vladimir; Laaser, Ulrich

    2015-02-26

    Training is the systematic acquisition of skills, rules, concepts, or attitudes and is one of the most important components in any organization's strategy. There is increasing demand for formal and informal training programs especially for physicians in leadership positions. This study determined the learning outcomes after a specific training program for hospital management teams. The study was conducted during 2006 and 2007 at the Centre School of Public Health and Management, Faculty of Medicine, University of Belgrade and included 107 participants involved in the management in 20 Serbian general hospitals. The management teams were multidisciplinary, consisting of five members on average: the director of the general hospital, the deputy directors, the head nurse, and the chiefs of support services. The managers attended a training program, which comprised four modules addressing specific topics. Three reviewers independently evaluated the level of management skills at the beginning and 12 months after the training program. Principal component analysis and subsequent stepwise multiple linear regression analysis were performed to determine predictors of learning outcomes. The quality of the SWOT (strengths, weaknesses, opportunities and threats) analyses performed by the trainees improved with differences between 0.35 and 0.49 on a Likert scale (p analysis explained 81% of the variance affecting their quality of strategic planning. Following the training program, the external environment, strategic positioning, and quality of care were predictors of learning outcomes. The four regression models used showed that the training program had positive effects (p < 0.001) on the ability to formulate a Strategic Plan comprising the hospital mission, vision, strategic objectives, and action plan. This study provided evidence that training for strategic planning and management enhanced the strategic decision-making of hospital management teams, which is a requirement

  19. Incidence of intracranial haemorrhage in low-birth weight infants and its outcome: a hospital based prospective study

    Directory of Open Access Journals (Sweden)

    Rajesh Debbarma

    2016-10-01

    Conclusions: Low gestational age, specially <34 weeks, very low birth weight, male gender, difficult vaginal delivery, birth asphyxia, and hypothermia are risk factors for intracranial hemorrhage, specially intra-ventricular hemorrhage. For better evaluation of risk factors for ICH and its outcome, multicentric study should be performed with large number of simple and longer time period of follow up with the help of newer modalities of investigation. [Int J Res Med Sci 2016; 4(10.000: 4279-4285

  20. A management information system to plan and monitor the delivery of health-care services in government hospitals in India.

    Science.gov (United States)

    Ramani, K V

    2004-01-01

    Governments all over the world are getting increasingly concerned about their ability to meet their social obligations in the health sector. In this paper, we discuss the design and development of a management information system (MIS) to plan and monitor the delivery of healthcare services in government hospitals in India. Our MIS design is based on an understanding of the working of several municipal, district, and state government hospitals. In order to understand the magnitude and complexity of various issues faced by the government hospitals, we analyze the working of three large tertiary care hospitals administered by the Ahmedabad Municipal Corporation. The hospital managers are very concerned about the lack of hospital infrastructure and resources to provide a satisfactory level of service. Equally concerned are the government administrators who have limited financial resources to offer healthcare services at subsidized rates. A comprehensive hospital MIS is thus necessary to plan and monitor the delivery of hospital services efficiently and effectively.

  1. A Study on Strategic Planning and Procurement of Medicals in Uganda's Regional Referral Hospitals.

    Science.gov (United States)

    Masembe, Ishak Kamaradi

    2016-12-31

    This study was an analysis of the effect of strategic planning on procurement of medicals in Uganda's regional referral hospitals (RRH's). Medicals were defined as essential medicines, medical devices and medical equipment. The Ministry of Health (MOH) has been carrying out strategic planning for the last 15 years via the Health Sector Strategic Plans. Their assumption was that strategic planning would translate to strategic procurement and consequently, availability of medicals in the RRH's. However, despite the existence of these plans, there have been many complaints about expired drugs and shortages in RRH's. For this purpose, a third variable was important because it served the role of mediation. A questionnaire was used to obtain information on perceptions of 206 respondents who were selected using simple random sampling. 8 key informant interviews were held, 2 in each RRH. 4 Focus Group Discussions were held, 1 for each RRH, and between 5 and 8 staff took part as discussants for approximately three hours. The findings suggested that strategic planning was affected by funding to approximately 34% while the relationship between funding and procurement was 35%. The direct relationship between strategic planning and procurement was 18%. However when the total causal effect was computed it turned out that strategic planning and the related variable of funding contributed 77% to procurement of medicals under the current hierarchical model where MOH is charged with development of strategic plans for the entire health sector. Since even with this contribution there were complaints, the study proposed a new model called CALF which according to a simulation, if adopted by MOH, strategic planning would contribute 87% to effectiveness in procurement of medicals.

  2. Pediatric hospital medicine: a strategic planning roundtable to chart the future.

    Science.gov (United States)

    Rauch, Daniel A; Lye, Patricia S; Carlson, Douglas; Daru, Jennifer A; Narang, Steve; Srivastava, Rajendu; Melzer, Sanford; Conway, Patrick H

    2012-04-01

    Given the growing field of Pediatric Hospital Medicine (PHM) and the need to define strategic direction, the Society of Hospital Medicine, the American Academy of Pediatrics, and the Academic Pediatric Association sponsored a roundtable to discuss the future of the field. Twenty-one leaders were invited plus a facilitator utilizing established health care strategic planning methods. A "vision statement" was developed. Specific initiatives in 4 domains (clinical practice, quality of care, research, and workforce) were identified that would advance PHM with a plan to complete each initiative. Review of the current issues demonstrated gaps between the current state of affairs and the full vision of the potential impact of PHM. Clinical initiatives were to develop an educational plan supporting the PHM Core Competencies and a clinical practice monitoring dashboard template. Quality initiatives included an environmental assessment of PHM participation on key committees, societies, and agencies to ensure appropriate PHM representation. Three QI collaboratives are underway. A Research Leadership Task Force was created and the Pediatric Research in Inpatient Settings (PRIS) network was refocused, defining a strategic framework for PRIS, and developing a funding strategy. Workforce initiatives were to develop a descriptive statement that can be used by any PHM physician, a communications tool describing "value added" of PHM; and a tool to assess career satisfaction among PHM physicians. We believe the Roundtable was successful in describing the current state of PHM and laying a course for the near future. Copyright © 2011 Society of Hospital Medicine.

  3. Strategic competition: the application of business planning techniques to the hospital marketplace.

    Science.gov (United States)

    Morris, D E; Rau, S E

    1985-01-01

    Survival in the increasingly turbulent and uncertain health care environment should raise the application of business planning and corporate strategy to the highest levels of institutional consciousness. With hospital mergers and networking arrangements expected to account for over 60% of the hospital beds in the nation by 1990, and with government and business cost containment efforts squeezing hospital margins, the survivors are going to be those institutions able to develop and maintain a sustainable economic advantage over the competition in the programs and services that comprise the major portion of their business. The successful players will be those that allow the institution to identify and exploit new opportunities and concentrate management and financial resources in those segments of the market where competitive advantages are real and attainable.

  4. Customer satisfaction planning and industrial engineering move hospital towards in-house stockless program.

    Science.gov (United States)

    Burton, R; Mauk, D

    1993-03-01

    By integrating customer satisfaction planning and industrial engineering techniques when examining internal costs and efficiencies, materiel managers are able to better realize what concepts will best meet their customers' needs. Defining your customer(s), applying industrial engineering techniques, completing work sampling studies, itemizing recommendations and benefits to each alternative, performing feasibility and cost-analysis matrixes and utilizing resources through productivity monitoring will get you on the right path toward selecting concepts to use. This article reviews the above procedures as they applied to one hospital's decision-making process to determine whether to incorporate a stockless inventory program. Through an analysis of customer demand, the hospital realized that stockless was the way to go, but not by outsourcing the function--the hospital incorporated an in-house stockless inventory program.

  5. 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.

  6. Adverse obstetrical and perinatal outcome in adolescent mothers associated with first birth: a hospital-based case-control study in a tertiary care hospital in North-East India

    Directory of Open Access Journals (Sweden)

    Medhi R

    2016-04-01

    Full Text Available Robin Medhi, Banani Das, Arpana Das, Mansur Ahmed, Sonika Bawri, Suditi Rai Department of Obstetrics and Gynaecology, Silchar Medical College and Hospital, Silchar, Assam, India Purpose: To analyze the adverse obstetrical and perinatal outcome of adolescent mothers associated with first birth. Patients and methods: This prospective case-control study was conducted in a tertiary care teaching hospital of North-East India between January 2014 and December 2014. All adolescent primigravidae completing 28 weeks of gestation with singleton pregnancy and delivered at our institution were included in the study group. Primigravidae aged between 20 and 25 years were taken as a control group. Mothers having pregnancy complicated with diabetes mellitus, renal disorder, thyroid disorders, and cardiac diseases were excluded from the study. Demographic data, maternal complications like severe anemia, pre-eclampsia, eclampsia, gestational age at delivery, mode of delivery, and postpartum complications were compared. Among fetal complications, low-birth weight, preterm birth, neonatal intensive care unit admission, still birth, and early neonatal death were compared. All the patients were interviewed regarding contraceptive knowledge and its use preceding the pregnancy. Results: Quality antenatal care was received by 80.6% of adolescent mothers. The adolescent mothers had a higher incidence of pre-eclampsia (odds ratio [OR] 2.017 95% confidence interval [CI]: 1.045–3.894, P=0.03, preterm deliveries (OR: 1.655, 95% CI: 1.039–2.636, P=0.03. Among fetal outcomes, the low- birth weight babies (OR: 1.59, 95% CI: 1.016–2.478, low mean birth weight (2,544.4±622.09 g versus 2,701.6±582.51 g, and higher admission to neonatal intensive care unit (OR: 1.957, 95% CI: 1.120–3.417 were significantly associated with adolescent mothers. There was no significant difference found regarding the mode of delivery, still birth, and early neonatal death. Moreover

  7. Parto vertical em hospital universitário: série histórica, 1996 a 2005 Vertical-position births at a University Hospital: a time-series study, 1996 to 2005

    Directory of Open Access Journals (Sweden)

    Odaléa Maria Brüggemann

    2009-06-01

    Full Text Available OBJETIVOS: descrever a evolução do número de partos horizontais e verticais na maternidade do Hospital da Universidade Federal de Santa Catarina, Brasil, e avaliar a associação dos mesmos com a taxa de cesárea, de internações dos recém-nascidos em unidade de tratamento intensivo e semi-intensivo e as transfusões sanguíneas maternas. MÉTODOS: estudo descritivo -série histórica. Foram incluídos todos os partos, as internações dos recémnascidos na Unidade de Terapia Intensiva e as transfusões sanguíneas maternas ocorridas de 1996 até 2005. Para testar as tendências, utilizou-se o método de Prais-Winsten para regressão linear generalizada. RESULTADOS: em 1996 a porcentagem de partos verticais era 5,4% e em 2005 foi 52,3%. A variação média anual dos partos verticais foi de +20,8% (p=0,007 e dos partos horizontais de -15,2% (pOBJECTIVES: to describe the evolution of the number of horizontal and vertical births in the maternity ward of the University Hospital of the Federal University of Santa Catarina, Brazil and to evaluate their correlation with the rates for caesarian, for transfer of newborns to intensive and semi-intensive care units, and maternal blood transfusions. METHODS: a time-series study. All births resulting in newborns being transferred to the Intensive Care Unit, and the maternal blood transfusions obstetrics ward between 1996 and 2005 were included in this study. In order to test the tendencies, the Prais-Winsten generalized linear regression method was used. RESULTS: in 1996 the percentage for vertical births was 5.4% and in 2005 52.3%. The average annual variance for vertical births was +20.8% (p=0.007, and for horizontal births -15.2% (p<0.001. Caesarian births showed a tendency to stabilize (p=0.243. There was a decrease of in the number of newborns transferred to the neonatal intensive care unit, 6.1% per year (p=0.001 and in the need of maternal blood transfusions (5.2% -p<0.01. CONCLUSIONS: the

  8. Trial gain of weight and hospital length stay of the low birth weight preterm infant in assistance for kangaroo mother care

    OpenAIRE

    Márcia Aparecida Giacomini Rodrigues; Maria Aparecida Tedeschi Cano

    2006-01-01

    The aim of this study was to evaluate if the Kangaroo Mother Care (KMC) interferes in the gain of weight and in the hospital length stay of the low birth weight preterm newborn (LWBPTN). For this, it was realized an analytic retrospective study, through the evaluation of the medical records of 60 LWBPTN with born weight less than 2000 g that received assistance by KMC, for a period of 2 hours per day and, 60 LWBPTN that received assistance by the Traditional Method of Care (TMC), admitted in ...

  9. Evaluating the impact of the community-based health planning and services initiative on uptake of skilled birth care in Ghana.

    Directory of Open Access Journals (Sweden)

    Fiifi Amoako Johnson

    Full Text Available The Community-based Health Planning and Services (CHPS initiative is a major government policy to improve maternal and child health and accelerate progress in the reduction of maternal mortality in Ghana. However, strategic intelligence on the impact of the initiative is lacking, given the persistant problems of patchy geographical access to care for rural women. This study investigates the impact of proximity to CHPS on facilitating uptake of skilled birth care in rural areas.Data from the 2003 and 2008 Demographic and Health Survey, on 4,349 births from 463 rural communities were linked to georeferenced data on health facilities, CHPS and topographic data on national road-networks. Distance to nearest health facility and CHPS was computed using the closest facility functionality in ArcGIS 10.1. Multilevel logistic regression was used to examine the effect of proximity to health facilities and CHPS on use of skilled care at birth, adjusting for relevant predictors and clustering within communities. The results show that a substantial proportion of births continue to occur in communities more than 8 km from both health facilities and CHPS. Increases in uptake of skilled birth care are more pronounced where both health facilities and CHPS compounds are within 8 km, but not in communities within 8 km of CHPS but lack access to health facilities. Where both health facilities and CHPS are within 8 km, the odds of skilled birth care is 16% higher than where there is only a health facility within 8km.Where CHPS compounds are set up near health facilities, there is improved access to care, demonstrating the facilitatory role of CHPS in stimulating access to better care at birth, in areas where health facilities are accessible.

  10. Frequency and risk factors for the birth of small-for-gestational-age newborns in a public maternity hospital.

    Science.gov (United States)

    Teixeira, Marina Parca Cavelagna; Queiroga, Tatiana Peloso Reis; Mesquita, Maria Dos Anjos

    2016-01-01

    To determine the frequency and risk factors of small-for-gestational-age newborns in a high-risk maternity. This is an observational, cross-sectional, and case-control study, conducted in a public tertiary care maternity hospital. Data from 998 newborns and their mothers were collected through interviews and review of medical records and prenatal care cards. Some placentas underwent histopathological analysis. The variables of small-for-gestational-age and non-small-for-gestational-age newborns and of their mothers were statistically compared by means of Student's t test, Fisher's exact test, and odds ratio. The significance level used was 0.050. There was a 17.9% frequency of small-for-gestational-age newborns. The statistically significant factors associated with the birth of these babies were female sex (p=0.012); positive history of another small-for-gestational-age child (p=0.006); inadequate prenatal care (p=0.019); smoking (p=0.003); hypertensive disorders of pregnancy (p=0.007); placental bleeding (p=0.009) and infarction (p=0.001). In the population studied, the frequency of small-for-gestational-age newborns was high and associated with sex, inappropriate prenatal care, presence of maternal diseases and addictions, and placental abnormalities. Determinar a frequência e os fatores de risco de recém-nascidos pequenos para idade gestacional em uma maternidade de alto risco. Trata-se de um estudo observacional, transversal e caso-controle, realizado em maternidade pública de nível terciário. Foram levantados dados de 998 recém-nascidos e de suas respectivas mães por meio de entrevista e análise de prontuários e de cartões do pré-natal. Algumas placentas foram submetidas à análise anatomopatológica. As variáveis dos recém-nascidos pequenos e não pequenos para idade gestacional e de suas respectivas mães foram comparadas estatisticamente pelo teste paramétrico t de Student, pelo teste exato de Fisher e por odds ratio. O nível de signific

  11. [Dementia-friendly hospital wards : Expert recommendations for planning and design].

    Science.gov (United States)

    Büter, K; Motzek, T; Dietz, B; Hofrichter, L; Junge, M; Kopf, D; von Lützau-Hohlbein, H; Traxler, S; Zieschang, T; Marquardt, G

    2017-01-01

    Hospitals face great challenges in the necessity of providing care for the rising number of elderly patients with dementia. The adaptation of the spatial environment represents an important component to improve the care situation of patients with dementia. For more than 30 years research results from long-term care have provided evidence on the therapeutic effect of numerous architectural features on people with dementia. Due to specific medical and organizational requirements in hospitals, the transferability of these findings is, however, limited. An interdisciplinary workshop with experts from the fields of medicine, nursing, gerontology, self-help and architecture was conducted in July 2015. Based on existing research findings and experiences from pilot projects, the spatial requirements for dementia-friendly hospital wards were collated, suggested solutions were discussed from different perspectives and finally design recommendations were derived. The article gives a first comprehensive overview of architectural measures that are required for the design of dementia-friendly hospital wards. The recommendations provided range from architectural criteria, such as the size and spatial structure of hospital wards, to interior design elements, including orientation and navigation aids and the use of light and colors. Furthermore, information about the planning process are given.

  12. Evaluation of adjustment methods used to determine prevalence of low birth-weight babies at a rural hospital in Andhra Pradesh, India

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    C Rekha

    2013-01-01

    Full Text Available Accurate reporting of prevalence of low birth weight (LBW is important for monitoring health of a population. LBW is often underestimated in developing countries due to heaping of the data at 2.5 kg. UNICEF uses an average adjustment factor of 25% to re-classify babies listed as exactly 2.5 kg into the LBW category. From October 2009 to February 2010, we weighed 859 consecutive live births at a rural hospital in Andhra Pradesh, India, using analog and digital scales to evaluate the relative validity of the adjustment factor. Significantly more babies weighed exactly 2.5 kg on analog (13.4% versus digital (2.2% scales, showing heaping. Percentage of LBW by digital method (29.5% was significantly higher compared to the analog method (23% and with adjustment factors (26.4%. Conventional methods of adjusting birth-weight data underestimate the prevalence of LBW. Sensitive digital weighing machines or better adjustment methods are needed to monitor LBW in developing countries.

  13. Planning, Designing, Building, and Moving a Large Volume Maternity Service to a New Labor and Birth Unit: Commentary and Experiences of Experts.

    Science.gov (United States)

    VonBehren, Diane; Killion, Molly M; Burke, Carol; Finkelmeier, Betsy; Zamora, Brigit

    Three teams of perinatal expert nurses participated in planning and designing a new maternity unit, operationalizing the move to the new space, and evaluating care processes and workflows after the move. The hospitals involved were University of California, San Francisco Benioff Children's Hospital, Prentice Women's Hospital of Northwestern Memorial Healthcare in Chicago, IL, and Florida Hospital Orlando, Florida Hospital for Women. Although each team discussed specific details and lessons learned, there is remarkable consistency among the experiences of these teams and with the discussion of the process by the team at Mercy Hospital St. Louis published in this issue of MCN The American Journal of Maternal Child Nursing. Extensive planning, flexibility, involving key stakeholders, evaluating and simulating workflows, and adequate staffing and patient safety on move-day were reported to be essential to success. Reevaluation after settling in to the new unit and making changes as needed were discussed. Being part of the leadership team involved in planning and moving to a new maternity unit in what was likely a once-in-a-lifetime experience was viewed as a career highlight. Their commentary adds to what is known about planning and designing new maternity units, moving into the new space, and adjusting unit operations and care after making the new unit home.

  14. Prenatal care and subsequent birth intervals.

    Science.gov (United States)

    Teitler, Julien O; Das, Dhiman; Kruse, Lakota; Reichman, Nancy E

    2012-03-01

    Prenatal care generally includes contraceptive and health education that may help women to control their subsequent fertility. However, research has not examined whether receipt of prenatal care is associated with subsequent birthspacing. Longitudinally linked birth records from 113,662 New Jersey women who had had a first birth in 1996-2000 were used to examine associations between the timing and adequacy of prenatal care prior to a woman's first birth and the timing of her second birth. Multinomial logistic regression analyses adjusted for social and demographic characteristics, hospital and year of birth. Most women (85%) had initiated prenatal care during the first trimester. Women who had not obtained prenatal care until the second or third trimester, or at all, were more likely than those who had had first-trimester care to have a second child within 18 months, rather than in 18-59 months (odds ratios, 1.2-1.6). Similarly, women whose care had been inadequate were more likely than those who had had adequate care to have a short subsequent birth interval (1.2). The associations were robust to alternative measures of prenatal care and birth intervals, and were strongest for mothers with less than 16 years of education. Providers should capitalize on their limited encounters with mothers who initiate prenatal care late or use it sporadically to ensure that these women receive information about family planning. Copyright © 2012 by the Guttmacher Institute.

  15. Birth and Emergency Planning

    African Journals Online (AJOL)

    AJRH Managing Editor

    “major contributors to death and disability among women” 5. Inadequacy .... postnatal clinic based on the inclusion criteria and ... following: labour for > 12 hours, waters broke but no labour ... and Protocol Review Committee of the University.

  16. Two trisomy 22 live births in one hospital in 15 months: is it as rare as we thought?

    Science.gov (United States)

    Naicker, Thirona; Aldous, Colleen

    2014-02-01

    We report two cases of complete non-mosaic trisomy 22 who were born within 15 months of each other in KwaZulu Natal, South Africa. In an effort to consolidate diagnostic criteria to suspect trisomy 22 prior to chromosomal testing, we compare the clinical features of these infants with those of 23 other trisomy 22 live borns presented in the literature. We further compare the clinical phenotype of trisomy 22 with those of trisomies 13 and 18 to delineate a clinical picture to presume possible trisomy 22 soon after birth. Dysmorphic features which distinguish trisomy 22 from trisomy 13 and 18 include hypertelorism, long philtrum, long and thin upper lip, webbing of the neck, low set, wide spread nipples and an abnormal anus. Given the poor prognosis of this disorder and early mortality of most confirmed cases, non-aggressive versus aggressive treatment measures should be weighed up as soon after birth as possible.

  17. Technical and organisational aspects in enterprise resource planning systems implementation: lessons from a Spanish public hospital

    Science.gov (United States)

    Escobar-Rodriguez, Tomas; Escobar-Pérez, Bernabe; Monge-Lozano, Pedro

    2014-09-01

    Public resources should always be managed efficiently, more so in times of crisis. Due to the specific characteristics of the healthcare sector, there is a need for special attention, especially in regards to hospitals. Administrators need useful tools to be able to efficiently manage available resources, such as enterprise resource planning (ERP) systems. Therefore, an analysis of the effects of their implementation and use in hospitals is valuable. This study has two purposes. One is to analyse the role ERP systems play in aiding the integration of hospital data, with focus on user satisfaction as well as possible resistance to change. The other purpose is to analyse the effects of implanting and using ERP systems in the hospital environment and identifying how certain variables influence the process, especially the existence of different organisational cultures. Results indicate that clinical information has become notably more integrated, despite the lack of flow in the economic-financial area. The heterogeneous nature of the different groups, clinical (Medical, Nursing) and non-clinical (Economic-Financial, Accounting), had a negative influence on the implementation process, and limited the integration of information as well as the system's performance.

  18. Designing HIGH-COST medicine: hospital surveys, health planning, and the paradox of progressive reform.

    Science.gov (United States)

    Perkins, Barbara Bridgman

    2010-02-01

    Inspired by social medicine, some progressive US health reforms have paradoxically reinforced a business model of high-cost medical delivery that does not match social needs. In analyzing the financial status of their areas' hospitals, for example, city-wide hospital surveys of the 1910s through 1930s sought to direct capital investments and, in so doing, control competition and markets. The 2 national health planning programs that ran from the mid-1960s to the mid-1980s continued similar strategies of economic organization and management, as did the so-called market reforms that followed. Consequently, these reforms promoted large, extremely specialized, capital-intensive institutions and systems at the expense of less complex (and less costly) primary and chronic care. The current capital crisis may expose the lack of sustainability of such a model and open up new ideas and new ways to build health care designed to meet people's health needs.

  19. 77 FR 24403 - Direct Final Approval of Hospital/Medical/Infectious Waste Incinerators State Plan for Designated...

    Science.gov (United States)

    2012-04-24

    ... AGENCY 40 CFR Part 62 Direct Final Approval of Hospital/Medical/Infectious Waste Incinerators State Plan...). ACTION: Direct final rule. SUMMARY: EPA is approving Illinois' revised State Plan to control air pollutants from ``Hazardous/Medical/Infectious Waste Incinerators'' (HMIWI). The Illinois Environmental...

  20. 77 FR 24451 - Direct Final Approval of Hospital/Medical/Infectious Waste Incinerators State Plan for Designated...

    Science.gov (United States)

    2012-04-24

    ... AGENCY 40 CFR Part 62 Direct Final Approval of Hospital/Medical/Infectious Waste Incinerators State Plan...). ACTION: Proposed rule. SUMMARY: EPA is proposing to approve, through direct final rulemaking, Illinois' revised State Plan to control air pollutants from Hazardous/ Medical/Infectious Waste Incinerators (HMIWI...

  1. 77 FR 24405 - Direct Final Approval of Hospital/Medical/Infectious Waste Incinerators State Plan for Designated...

    Science.gov (United States)

    2012-04-24

    ... AGENCY 40 CFR Part 62 Direct Final Approval of Hospital/Medical/Infectious Waste Incinerators State Plan...). ACTION: Direct final rule. SUMMARY: EPA is approving Indiana's revised State Plan to control air pollutants from ``Hazardous/Medical/Infectious Waste Incinerators'' (HMIWI). The Indiana Department of...

  2. Time to subsequent live birth according to mode of delivery in the first birth.

    Science.gov (United States)

    O'Neill, S M; Khashan, A S; Kenny, L C; Kearney, P M; Mortensen, P B; Greene, R A; Agerbo, E; Uldbjerg, N; Henriksen, T B

    2015-08-01

    To estimate the rate and time to next live birth by mode of delivery. Hospital-based cohort. Aarhus University Hospital (AUH), Denmark. All pregnant women attending AUH were invited to enroll in the Aarhus Birth Cohort (ABC) study between 1989 and 2010 (n = 91,625). Women were followed from their first live birth until the subsequent live birth or until censoring due to study end using Cox regression models. Rate and time to subsequent live birth according to mode of delivery. 46,162 index live births were identified, of which 22,462 (49%) had a subsequent live birth. Women with any type of caesarean had a 6% reduction in the rate of subsequent live birth (HR 0.94, 95% CI 0.89, 0.98), which remained unchanged in the analysis by type (emergency, HR 0.95, 95% CI 0.89, 1.02; elective, HR 0.91, 95% CI 0.85, 0.98) compared with women who had a spontaneous vaginal delivery (SVD). Operative vaginal delivery was associated with an 8% reduction in subsequent live birth rates (HR 0.92, 95% CI 0.86, 0.98) and vaginal delivery complicated by shoulder dystocia with a 19% reduction compared with SVD. Median time to next birth in days was shortest in women with a first caesarean (994 days, 95% CI 973, 1026) and longest in women with a vaginal delivery complicated by shoulder dystocia (1065 days, 95% CI 994, 1191). In women with planned pregnancies, the shortest median time to second birth was in women with breech vaginal deliveries (859 days, 95% CI 737, 1089) and the longest in women with vaginal deliveries complicated by shoulder dystocia (1193 days, 95% CI 1028, 1430). The impact of mode of delivery on subsequent rate and time to next birth was minimal in this study. The greatest reduction was among women with assisted vaginal delivery complicated by shoulder dystocia. This study is strengthened by data on pregnancy planning as well as information on complications of pregnancy, delivery and neonatal morbidities, all of which may influence a woman's decision on subsequent birth

  3. Trial gain of weight and hospital length stay of the low birth weight preterm infant in assistance for kangaroo mother care

    Directory of Open Access Journals (Sweden)

    Márcia Aparecida Giacomini Rodrigues

    2006-08-01

    Full Text Available The aim of this study was to evaluate if the Kangaroo Mother Care (KMC interferes in the gain of weight and in the hospital length stay of the low birth weight preterm newborn (LWBPTN. For this, it was realized an analytic retrospective study, through the evaluation of the medical records of 60 LWBPTN with born weight less than 2000 g that received assistance by KMC, for a period of 2 hours per day and, 60 LWBPTN that received assistance by the Traditional Method of Care (TMC, admitted in the unity of neonatal intensive care and unity of premature of a private maternity in the city of Ribeirão Preto-SP, Brazil, comparing the gain of weight and the hospital length stay. We did not find differences statistically significant in relation to the gain of weight of the LWBPTN assisted by KMC, in relation to LWBPTN assisted by the TMC, 15,8 and 14,9 g/per day, respectively. In relation to the time of admission, we also did not find differences statistically significant, 27,3 and 26,2 days, for the LWBPTN in the KMC and TMC, respectively, although in the stratification of the sample, the LBWPTN with pregnancy age < 30 weeks or birth weight < 1500 g left the hospital 3 days earlier in the KMC. It was concluded that the KMC, in the conditions of this study, it seems not to interfere significatively in the gain of weight and in the time of admission of LWBPTN. We emphasize that the utilization of KMC in the assistance to the LWBPTN of low weight is a viable model, even for the private health institution.

  4. [Effect of a Discharge Planning Educational Program in a University Hospital].

    Science.gov (United States)

    Sakai, Shima; Ohori, Yoko; Tanaka, Yuko; Sato, Yukiko; Watanabe, Ami; Fujii, Junko

    2015-12-01

    The purpose of this study was to investigate the effect of a discharge planning educational program on multidisciplinary team staff in a community. We provided training to nurses of a university hospital. The training covered an introduction to discharge planning, decision-making support, home care medicine and home nursing care, the medical social welfare system, and case review meetings. It was conducted every year from September through February between 2012 and 2015. Before and after the training, the awareness of nurses was evaluated by using self-administered questionnaires and the Discharge Planning scale for Ward Nurses(DPWN), and discharge planning satisfaction was measured using a visual analogue scale (VAS). The study process was reviewed and approved by the Ethics Committee of Tokyo Women's Medical University. The questionnaires were distributed to 96 nurses; of these, responses of 72 nurses(pre- and post-training)were analyzed(response rate: 75.0%). The average number of years of nursing experience was 8.5± 7.7. The total score of the DPWN and its subscales, as well as the VAS, with regard to satisfaction level significantly increased after the training(pplanning practices.

  5. A Trend Analysis of Succession Planning in Health Care as Perceived by Chief Executive Officers in US Hospitals.

    Science.gov (United States)

    Collins, Sandra K; McKinnies, Richard; Lieneck, Cristian; Watts, Sandra

    A study was conducted to analyze the perceptions of chief executive officers in US hospitals regarding leadership development and succession planning. Results of the study were compared to identical surveys delivered in previous years for the purposes of identifying possible trends and changing perspectives related to how executives use succession planning in their facilities, what factors influence the identification of successors, what positions are the more likely to use succession planning efforts, and who specifically should be responsible for building the leadership pipeline.

  6. [Evaluation of the vital emergency action plan at the Navarre Hospital (Spain)].

    Science.gov (United States)

    Tirapu, Belén; Rodrigo, Isabel; Gost, Javier; Aranguren, María Isabel; Ezcurra, Paz

    2010-07-01

    Healthcare organizations are placing great emphasis on the care of patients with cardiopulmonary arrest (CPA) since interventions based on the scientific evidence can decrease both the mortality rate and sequelae. Nevertheless, there are limited comprehensive assessments covering all the resources and interventions required when a vital emergency arises. To evaluate the effectiveness of the vital emergency action plan at the Navarre Hospital by analyzing a panel of 70 indicators. Structure and process indicators were assessed in 25 clinical units at the Navarre Hospital from April to June 2008. The structure and review process of CPR carts were analyzed, defibrillators were tested and 40 simulations involving 144 professionals were evaluated. Nonconformities were found in 86% of the indicators evaluated. The percentages of compliance in the indicators of structure ranged from 39.6% to 100%. In the evaluation of process, conformity ranged from 2.5% to 100%. The percentages of simulations meeting time standards varied between 17.5% and 45%. In 37.5% of the simulations, at least 50% of trained staff were present in the unit. In 32.3% of the simulations, the standard for the number of people in the unit who participated in the simulations was achieved. This study identified problems in the structure and process of a vital emergency action plan without, at this stage, evaluating patient outcomes. Copyright © 2010 Elsevier España S.L. All rights reserved.

  7. Identifying Factors Influencing the Establishment of a Health System Reform Plan in Iran's Public Hospitals

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    Rasul Fani khiavi

    2016-09-01

    Full Text Available In today's world, health views have found a wider perspective in which non-medical expectations are particularly catered to. The health system reform plan seeks to improve society's health, decrease treatment costs, and increase patient satisfaction. This study investigated factors affecting the successful establishment of a health system reform plan. A mixed qualitative – quantitative approach was applied to conduct to explore influential factors associated with the establishment of a health system reform plan in Iran's public hospitals. The health systems and approaches to improving them in other countries have been studied. A Likert-based five-point questionnaire was the measurement instrument, and its content validity based on content validity ratio (CVR was 0.87. The construct validity, calculated using the factorial analysis and Kaiser Mayer Olkin (KMO techniques, was 0.964, which is a high level and suggests a correlation between the scale items. To complete the questionnaire, 185 experts, specialists, and executives of Iran’s health reform plan were selected using the Purposive Stratified Non Random Sampling and snowball methods. The data was then analyzed using exploratory factorial analysis and SPSS and LISREL software applications. The results of this research imply the existence of a pattern with a significant and direct relationship between the identified independent variables and the dependent variable of the establishment of a health system reform plan. The most important indices of establishing a health system reform plan, in the order of priority, were political support; suitable proportion and coverage of services presented in the society; management of resources; existence of necessary infrastructures; commitment of senior managers; constant planning, monitoring, and evaluation; and presentation of feedback to the plan's executives, intrasector/extrasector cooperation, and the plan’s guiding committee. Considering the

  8. Analysis of prenatal care that is provided to pregnant women in the province of Heredia who give birth in the San Vicente de Paul Hospital

    Directory of Open Access Journals (Sweden)

    Nathalie Alfaro Vargas

    2014-04-01

    Full Text Available This article presents the main results of a quantitative research design with a non- experimental descriptive cross, which aimed to analyze prenatal care that is provided to pregnant women in the province of Heredia who gave birth at St. Vincent Hospital de Paul in 2012. The population consisted of pregnant women who delivered at the hospital between the months of December 2011 to November 2012 and by medical professionals and nurses whowork for the health areas of Heredia and San Vicente de Paul Hospital, which provide prenatal control. To collect information three instruments considered infrastructure, equipment and procedures to carry out prenatal care, in addition, the level of satisfaction of pregnant women and the professionals were used. The investigation determined that the infrastructure to provide the prenatal control of health areas in the province of Heredia is in good condition, however, requires maintenance and suitability to be accessible to the entire population. Furthermore, the Costa Rican Social Security has a low coverage of antenatal care with compliance with quality criteria and otherwise report the information obtained during the prenatal control in the Perinatal Carnet is incomplete and incorrect. Finally there is little or almost no participation of professionals and Gynecological Nursing, Obstetric and Perinatal, in the process of prenatal care , although national legislation and recognize that these studies and these professionals have the necessary skills to provide adequate control

  9. Perinatal and maternal outcomes in planned home and obstetric unit births in women at ‘higher risk’ of complications: secondary analysis of the Birthplace national prospective cohort study

    Science.gov (United States)

    Li, Y; Townend, J; Rowe, R; Brocklehurst, P; Knight, M; Linsell, L; Macfarlane, A; McCourt, C; Newburn, M; Marlow, N; Pasupathy, D; Redshaw, M; Sandall, J; Silverton, L; Hollowell, J

    2015-01-01

    Objective To explore and compare perinatal and maternal outcomes in women at ‘higher risk’ of complications planning home versus obstetric unit (OU) birth. Design Prospective cohort study. Setting OUs and planned home births in England. Population 8180 ‘higher risk’ women in the Birthplace cohort. Methods We used Poisson regression to calculate relative risks adjusted for maternal characteristics. Sensitivity analyses explored possible effects of differences in risk between groups and alternative outcome measures. Main outcome measures Composite perinatal outcome measure encompassing ‘intrapartum related mortality and morbidity’ (intrapartum stillbirth, early neonatal death, neonatal encephalopathy, meconium aspiration syndrome, brachial plexus injury, fractured humerus or clavicle) and neonatal admission within 48 hours for more than 48 hours. Two composite maternal outcome measures capturing intrapartum interventions/adverse maternal outcomes and straightforward birth. Results The risk of ‘intrapartum related mortality and morbidity’ or neonatal admission for more than 48 hours was lower in planned home births than planned OU births [adjusted relative risks (RR) 0.50, 95% CI 0.31–0.81]. Adjustment for clinical risk factors did not materially affect this finding. The direction of effect was reversed for the more restricted outcome measure ‘intrapartum related mortality and morbidity’ (RR adjusted for parity 1.92, 95% CI 0.97–3.80). Maternal interventions were lower in planned home births. Conclusions The babies of ‘higher risk’ women who plan birth in an OU appear more likely to be admitted to neonatal care than those whose mothers plan birth at home, but it is unclear if this reflects a real difference in morbidity. Rates of intrapartum related morbidity and mortality did not differ statistically significantly between settings at the 5% level but a larger study would be required to rule out a clinically important difference between

  10. Brazilian multicentre study on preterm birth (EMIP: prevalence and factors associated with spontaneous preterm birth.

    Directory of Open Access Journals (Sweden)

    Renato Passini

    Full Text Available BACKGROUND: Preterm birth rate is increasing and is currently a worldwide concern. The purpose of this study was to estimate the prevalence of preterm birth in a sample of health facilities in Brazil and to identify the main risk factors associated with spontaneous preterm births. METHODS AND FINDINGS: This was a multicentre cross sectional study on preterm births in 20 referral obstetric hospitals with a case-control component to identify factors associated with spontaneous preterm birth. Surveillance was implemented at all centres to identify preterm births. For eligible consenting women, data were collected through a post-delivery questionnaire completed with information from all mother-newborn medical records until death or discharge or at a maximum of 60 days post-delivery, whichever came first. The risk of spontaneous preterm birth was estimated with OR and 95%CI for several predictors. A non-conditional logistic regression analysis was then performed to identify independently associated factors. The overall prevalence of preterm birth was 12.3%. Among them, 64.6% were spontaneous and 35.4% therapeutic. In the case-control component, 2,682 spontaneous preterm births were compared to a sample of 1,146 term births. Multivariate analyses identified the following as risk factors for spontaneous preterm birth among women with at least one previous birth: a previous preterm birth (ORadj = 3.19, 2.30-4.43, multiple pregnancy (ORadj = 29.06, 8.43-100.2, cervical insufficiency (ORadj = 2.93, 1.07-8.05, foetal malformation (ORadj = 2.63, 1.43-4.85, polyhydramnios (ORadj = 2.30, 1.17-4.54, vaginal bleeding (ORadj = 2.16, 1.50-3.11, and previous abortion (ORadj = 1.39, 1.08-1.78. High BMI (ORadj = 0.94, 0.91-0.97 and weight gain during gestation (ORadj = 0.92, 0.89-0.95 were found to be protective factors. CONCLUSIONS: The preterm birth rate in these health facilities in Brazil is high and spontaneous preterm births

  11. Duration and urgency of transfer in births planned at home and in freestanding midwifery units in England: secondary analysis of the birthplace national prospective cohort study.

    Science.gov (United States)

    Rowe, Rachel E; Townend, John; Brocklehurst, Peter; Knight, Marian; Macfarlane, Alison; McCourt, Christine; Newburn, Mary; Redshaw, Maggie; Sandall, Jane; Silverton, Louise; Hollowell, Jennifer

    2013-12-05

    In England, there is a policy of offering healthy women with straightforward pregnancies a choice of birth setting. Options may include home or a freestanding midwifery unit (FMU). Transfer rates from these settings are around 20%, and higher for nulliparous women. The duration of transfer is of interest because of the potential for delay in access to specialist care and is also of concern to women. We aimed to estimate the duration of transfer in births planned at home and in FMUs and explore the effects of distance and urgency on duration. This was a secondary analysis of data collected in a national prospective cohort study including 27,842 'low risk' women with singleton, term, 'booked' pregnancies, planning birth in FMUs or at home in England from April 2008 to April 2010. We described transfer duration using the median and interquartile range, for all transfers and those for reasons defined as potentially urgent or non-urgent, and used cumulative distribution curves to compare transfer duration by urgency. We explored the effect of distance for transfers from FMUs and described outcomes in women giving birth within 60 minutes of transfer. The median overall transfer time, from decision to transfer to first OU assessment, was shorter in transfers from home compared with transfers from FMUs (49 vs 60 minutes; p < 0.001). The median duration of transfers before birth for potentially urgent reasons (home 42 minutes, FMU 50 minutes) was 8-10 minutes shorter compared with transfers for non-urgent reasons. In transfers for potentially urgent reasons, the median overall transfer time from FMUs within 20 km of an OU was 47 minutes, increasing to 55 minutes from FMUs 20-40 km away and 61 minutes in more remote FMUs. In women who gave birth within 60 minutes after transfer, adverse neonatal outcomes occurred in 1-2% of transfers. Transfers from home or FMU commonly take up to 60 minutes from decision to transfer, to first assessment in an OU, even for

  12. Birthweight by gestational age and its effect on perinatal mortality in white and in Punjabi births: experience at a district general hospital in West London 1967-1975.

    Science.gov (United States)

    Dawson, I; Golder, R Y; Jonas, E G

    1982-11-01

    At Hillingdon Hospital in West London two main ethnic groups: 'UK' (i.e. white European) and 'Indian' (i.e. Punjabi) account for the bulk of obstetric work load. Birthweight by gestational age graphs were calculated for some 6000 Indian and 18000 UK infants born between 1967 and 1975 inclusive. A mean weight difference at term favoured UK male babies by 240 g and UK female babies by 230 g. Though the crude perinatal results in the two populations were not significantly different, the perinatal mortality of infants less than 2500 g in birthweight was lower in the Indian than the UK population, particularly in the 1500-2400 g group. This is attributed to a levelling off in intrauterine growth from 36 to 37 weeks gestation onwards in Indian compared with UK pregnancies, so that they were more mature than UK births of the same weight. However light-for-dates births, defined as birthweights below the 10th centile of weight-for-gestational age on their own ethnic and sex specific standards pose problems, irrespective of ethnic background.

  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. A Fortified Donor Milk Policy is Associated With Improved In-Hospital Head Growth and Weight Gain in Very Low-Birth-Weight Infants.

    Science.gov (United States)

    Ginovart, Gemma; Gich, Ignasi; Gutiérrez, Antonio; Verd, Sergio

    2017-08-01

    Previous research has reported that infants fed donor milk grow slower than those fed formula. However, most of the trials used unfortified donor milk, which limits the ability to generalize the results to current clinical practice. To evaluate the impact of early human milk feeding (donor milk and/or mother's own milk) with standard fortification on in-hospital growth of very low-birth-weight infants. This pre-/postretrospective study included selected newborn infants less than 1500 g admitted to a level IV neonatal intensive care unit before and after the introduction of a policy providing donor milk when mother's own milk was not available in sufficient quantity to meet her infant's need. When enteral feeds reached 80 mL/kg per day, all human milk was fortified. Seventy-two "before" (any formula-fed) and 114 "after" (human milk-fed) infants were enrolled in this study. Infant characteristics and neonatal morbidity were similar in both groups. Outcomes revealed that an initial human milk diet with standard fortification was associated with significantly higher early extrauterine weight gain and head growth in very low-birth-weight infants than a formula-fed diet. Very early initiation of fortified breast and/or donor milk feeding can help promote in-hospital head growth and weight gain of preterm infants. Formula may not be appropriate for early use among preterm infants. Further large-scale clinical trials are needed to determine the best initiation and composition of enteral feeding for preterm infants.

  15. Post discharge formula fortification of maternal human milk of very low birth weight preterm infants: an introduction of a feeding protocol in a University Hospital

    Directory of Open Access Journals (Sweden)

    Abeer El Sakka

    2016-10-01

    Full Text Available The objective of this study is to determine the growth parameters and nutritional biochemical markers and complications of fortification of human milk by post discharge formula of preterm very low birth weight newborns (VLBW. Fifty preterm infants less than 37 weeks with weight less than 1500 g were enrolled in the study. They received parental nutrition and feeding according to our protocol. When enteral feeding reached 100 cc/kg/day, infants were randomized into two groups: group I, Cases, n=25, where post discharge formula (PDF was used for fortification, group II, Controls, n=25 with no fortification. Infants of both groups were given 50% of required enteral feeding as premature formula. This protocol was used until infants’ weight reached 1800 g. Daily weight, weekly length and head circumference were recorded. Hemoglobin, albumin (Alb, electrolytes, blood urea nitrogen (BUN and clinical complications were documented. Human milk fortification with PDF resulted in better growth with increase in weight 16.8 and 13.78 g/kg/day (P=0.0430, length 0.76 and 0.58 cm/week (P=0.0027, and head circumference of 0.59 and 0.5 cm/week (P=0.0217 in cases and controls respectively. Duration of hospital stay was less in cases (22.76 versus 28.52 days in Controls, P=0.02. No significant changes were found in serum electrolytes, BUN, or Alb between both groups. Hemoglobin was significantly higher in Cases, P=0.04. There were no significant clinical complications. Our feeding protocol of fortification of human milk with PDF in preterm very low birth weight newborns resulted in better growth and decrease in length of hospital stay. The use of PDF could be an alternative option for fortification of mothers’ milk for preterm VLBW infants in developing countries with low resources.

  16. Post Discharge Formula Fortification of Maternal Human Milk of Very Low Birth Weight Preterm Infants: An Introduction of a Feeding Protocol in a University Hospital

    Science.gov (United States)

    El Sakka, Abeer; El Shimi, Mohamed Sami; Salama, Kareem; Fayez, Hend

    2016-01-01

    The objective of this study is to determine the growth parameters and nutritional biochemical markers and complications of fortification of human milk by post discharge formula of preterm very low birth weight newborns (VLBW). Fifty preterm infants less than 37 weeks with weight less than 1500 g were enrolled in the study. They received parental nutrition and feeding according to our protocol. When enteral feeding reached 100 cc/kg/day, infants were randomized into two groups: group I, Cases, n=25, where post discharge formula (PDF) was used for fortification, group II, Controls, n=25 with no fortification. Infants of both groups were given 50% of required enteral feeding as premature formula. This protocol was used until infants’ weight reached 1800 g. Daily weight, weekly length and head circumference were recorded. Hemoglobin, albumin (Alb), electrolytes, blood urea nitrogen (BUN) and clinical complications were documented. Human milk fortification with PDF resulted in better growth with increase in weight 16.8 and 13.78 g/kg/day (P=0.0430), length 0.76 and 0.58 cm/week (P=0.0027), and head circumference of 0.59 and 0.5 cm/week (P=0.0217) in cases and controls respectively. Duration of hospital stay was less in cases (22.76 versus 28.52 days in Controls), P=0.02. No significant changes were found in serum electrolytes, BUN, or Alb between both groups. Hemoglobin was significantly higher in Cases, P=0.04. There were no significant clinical complications. Our feeding protocol of fortification of human milk with PDF in preterm very low birth weight newborns resulted in better growth and decrease in length of hospital stay. The use of PDF could be an alternative option for fortification of mothers’ milk for preterm VLBW infants in developing countries with low resources. PMID:27777705

  17. Improvement of efficiency and safety in hospitals starts in the beginning of the planning phase and influences patient safety, staff, hygiene as well as logistics, and efficiency within the entire hospital.

    Science.gov (United States)

    Matern, Ulrich

    2011-01-01

    To increase patient safety and hospital efficiency a new stepwise planning methodology including an early peer review of the future design is shown in the article as well as innovative training concepts for hospital staff.

  18. A nationwide hospital survey on patient safety culture in Belgian hospitals: setting priorities at the launch of a 5-year patient safety plan.

    Science.gov (United States)

    Vlayen, Annemie; Hellings, Johan; Claes, Neree; Peleman, Hilde; Schrooten, Ward

    2012-09-01

    To measure patient safety culture in Belgian hospitals and to examine the homogeneous grouping of underlying safety culture dimensions. The Hospital Survey on Patient Safety Culture was distributed organisation-wide in 180 Belgian hospitals participating in the federal program on quality and safety between 2007 and 2009. Participating hospitals were invited to submit their data to a comparative database. Homogeneous groups of underlying safety culture dimensions were sought by hierarchical cluster analysis. 90 acute, 42 psychiatric and 11 long-term care hospitals submitted their data for comparison to other hospitals. The benchmark database included 55 225 completed questionnaires (53.7% response rate). Overall dimensional scores were low, although scores were found to be higher for psychiatric and long-term care hospitals than for acute hospitals. The overall perception of patient safety was lower in French-speaking hospitals. Hierarchical clustering of dimensions resulted in two distinct clusters. Cluster I grouped supervisor/manager expectations and actions promoting safety, organisational learning-continuous improvement, teamwork within units and communication openness, while Cluster II included feedback and communication about error, overall perceptions of patient safety, non-punitive response to error, frequency of events reported, teamwork across units, handoffs and transitions, staffing and management support for patient safety. The nationwide safety culture assessment confirms the need for a long-term national initiative to improve patient safety culture and provides each hospital with a baseline patient safety culture profile to direct an intervention plan. The identification of clusters of safety culture dimensions indicates the need for a different approach and context towards the implementation of interventions aimed at improving the safety culture. Certain clusters require unit level improvements, whereas others demand a hospital-wide policy.

  19. Adapting the "managing by walking around" methodology as a leadership strategy to communicate a hospital-wide strategic plan.

    Science.gov (United States)

    Rubin, Marcie Sara; Stone, Richard K

    2010-01-01

    Metropolitan Hospital Center (MHC) in East Harlem, New York, has undergone significant leadership changes within the past few years, and the current leadership team developed a long-term strategic plan for the organization that it wanted to effectively communicate to all hospital staff. The spread of information is a challenge at MHC, as it is in many hospitals, because of the large number of staff working various shifts, and the inability of staff to leave their units at the same time to attend general staff meetings. Because of the recent success of the hospital's Executive WalkRounds Program and Breakthough Program, which embody principles of the leadership strategy Managing By Walking Around (MBWA), the senior leadership team decided to roll out their new strategic plan in a 2-week series of rounds to each unit/department throughout the hospital during each shift. Utilizing this method, 69 percent of MHC staff attended the rounds, and 88.9 percent of management level staff and 64.5 percent of unionized/labor who participated in the hospital's Employee Satisfaction Survey stated that they understood the hospital's new strategic plan. MHC's successful strategy is easily applicable within other similar settings.

  20. The Traditional Birth Attendant in Maternal and Child Health and Family Planning: A Guide to Her Training and Utilization.

    Science.gov (United States)

    Verderese, Maria de Lourdes; Turnbull, Lily M.

    The publication provides guidelines for assisting developing countries in determining strategies for the utilization and training of traditional birth attendants (TBAs). TBA's are persons (usually women in rural areas) who assist the mother at childbirth and who initially acquired their skills through experience rather than formal training. After…

  1. Birth Control

    Science.gov (United States)

    Birth control, also known as contraception, is designed to prevent pregnancy. Birth control methods may work in a number of different ... eggs that could be fertilized. Types include birth control pills, patches, shots, vaginal rings, and emergency contraceptive ...

  2. [Analysis of the educational requirements and planning in a large public hospital].

    Science.gov (United States)

    Degan, Mario; Bragato, Laura; Duminuco, Leonardo; Bagno, Carla; Genova, Valeria; Sansoni, Julita

    2007-01-01

    The educational needs in a large hospital in the Venice region were analysed in order to plan continuing education programs for 2005-2006. The reference model was the analysis of the educational waiting lists in both operative and managerial professions. Two identical questionnaires were used: the first was distributed to all the professional staff of the hospital with university qualifications and asked them to give their opinion regarding educational priorities. The second was given to staff with managerial roles, asking them to indicate the educational priorities for the staff under their direction. Analysis of the data collected focused on : the priority given to the various areas and topics of education; differences of opinion identified between the various working environments between professional groups and between staff/managers; influence of social and personal factors on the opinions expressed. The fact that the fields of interest indicated varied according to the role and working activities of staff involved, indicate the need to offer educational procedures tailored to the requirements of each group.

  3. Factors associated with success of vaginal birth after one caesarean section (VBAC at three teaching hospitals in Addis Ababa, Ethiopia: a case control study

    Directory of Open Access Journals (Sweden)

    Birara Malede

    2013-02-01

    Full Text Available Abstract Background Vaginal delivery after previous one cesarean section for a non recurring indication has been described by several authors as safe and having a success rate of 60–80%. Hence many centers are offering VBAC for candidates leaving the century old dictum of once cesarean always cesarean. But predicting success of VBAC after trial of labor (TOL is still a difficult task due to the lack of a validated prediction tool. Studies on predictors of success are few and most of them conducted in developed countries and difficult to generalize. Therefore assessing factors associated with successful VBAC is very important to for counseling mothers while offering VBAC. The aim of this study was to assess factors associated with successful VBAC in three teaching Hospitals in Addis Ababa Ethiopia. Methods A case control study was conducted to compare the factors associated with successful VBAC in teaching hospitals in Addis Ababa in one year period. The cases were those successfully delivered vaginally and the controls were those with failed VBAC and delivered by caesarean section. The sample size of the cases was 101vaginal deliveries and the controls were 103 failed VBAC patients which made the case to control ratio of 1:1. Result In this study independent factors determining successful VBAC were, history of successful VBAC in the past, rupture of membrane at admission, and cervical dilatation of more than 3cm at admission. Presence of meconium, malposition and history of stillbirth were associated with failed VBAC. Factors like maternal age, past caesarean indications, inter delivery interval, and birth weight were not found to be significant determinants of success. The most common reason for repeat cesarean section for after trial of labor was labour dysfunction because of absence of a policy for augmentation on a scarred uterus in these hospitals. Conclusion It is possible to prepare a decision tool on the success of VBAC by taking

  4. Analysis of the Monitoring Results of Birth Defect in Hospitals Between 2001 and 2010 in Changsha%长沙市2001~2010年医院出生缺陷监测结果分析

    Institute of Scientific and Technical Information of China (English)

    祖月娥; 朱琳; 周红女; 周燕飞; 李杏秀; 王卫东; 徐扬; 林蓓蓓

    2013-01-01

    [Objective]To analyze the monitoring results of birth defect in hospital between 2001 and 2010 in Changsha in order to provide the basis for formulating the policy to reduce the birth defect rate of hospitals by health administrative department .[Methods] The statistical data from 13 birth defect monitoring hospitals of Changsha were analyzed .All the 13 hospital were accorded with birth defect definition and diagnostic standard in Chinese birth defect monitoring program and Chinese birth defect monitoring manual .All birth defect children were examined and registered by the trained physicians .The classification and statistical analysis were taken .[Results] In the past 10 years ,there were 173527 perinatal children born in 13 birth defect surveillance hospitals . Among them ,3856 children were birth defects .The total incidence rate was 222 .16/10000 .The incidence rate of birth defect during 10 years was increased obviously .The top 5 birth defects were congenital heart disease ,outer ear and other malformations ,cleft lip complicated with cleft palate ,multi-finger(toe) and congenital hydroceph-alus .Except the constituent ratio of congenital heart disease was increased ,the constituent ratio of 4 other birth defects had the declining trend .[Conclusion] The strategical change of the prevention mode of birth defect should be implemented so as to reduce the birth defect .%[目的]通过分析长沙市2001~2010年医院出生缺陷监测结果数据,为上级医疗行政部门制定降低医院出生缺陷率的政策提供依据。[方法]参照长沙市13所出生缺陷监测医院的统计数据。13所医院均按照《中国出生缺陷监测方案》及《中国出生缺陷监测手册》中有关出生缺陷的定义特征和诊断标准,经专职医生临床体检和相关检查确诊并分类统计。[结果]10年中13所出生缺陷监测医院总出生围生儿为173527例,出生缺陷3856例,总发生率为222.16/万,10年间出生缺

  5. Vaginal birth after cesarean section (VBAC versus emergency repeat cesarean section at teaching hospitals in India: an ICMR task force study

    Directory of Open Access Journals (Sweden)

    B. S. Dhillon

    2014-06-01

    Results: A total of 155863 deliveries occurred during the study duration, there were 28.1% (n=43824 cesarean section and (10.1% (n=15664 were the number of previous cesarean section. In 84% (n=13151 had repeat cesarean delivery and 2513 (16% delivered vaginally. A trial of labor was planned in 4035 (25.8% women. The success rate of VBAC was 62.3% with 2513 women had successful vaginal delivery and 1522 (37.7% delivered by emergency repeat cesarean section. Major indication of emergency cesarean section was CPD (52.9%, foetal distress (25.8%, severe PIH/eclampsia (5.0%, previous 2 CS (0.7%, APH (1.4% and others (2.7%. In majority, surgical technique was conventional and in 3.7% the Misgav-Ladach technique was used. Scar dehiscence and surgical complications were observed in 5.4% and 4.0% of cases respectively. Blood transfusion was given in 7.0% and post-operative complications were seen in 6.8%. Perinatal and maternal mortality was 18.0/1000 and 257/100000 deliveries respectively. Conclusions: Safety in childbirth for women with prior cesarean is a major public health concern. Repeat caesarean section and planned vaginal birth after cesarean section are both associated with benefits and harms and correct management represents one of the most significant and challenging issues in obstetric practice. [Int J Reprod Contracept Obstet Gynecol 2014; 3(3.000: 592-597

  6. Birth Defects

    Science.gov (United States)

    A birth defect is a problem that happens while a baby is developing in the mother's body. Most birth defects happen during the first 3 months of ... in the United States is born with a birth defect. A birth defect may affect how the ...

  7. Pre-implementation studies of a workforce planning tool for nurse staffing and human resource management in university hospitals.

    Science.gov (United States)

    van Oostveen, Catharina J; Ubbink, Dirk T; Mens, Marian A; Pompe, Edwin A; Vermeulen, Hester

    2016-03-01

    To investigate the reliability, validity and feasibility of the RAFAELA workforce planning system (including the Oulu patient classification system - OPCq), before deciding on implementation in Dutch hospitals. The complexity of care, budgetary restraints and demand for high-quality patient care have ignited the need for transparent hospital workforce planning. Nurses from 12 wards of two university hospitals were trained to test the reliability of the OPCq by investigating the absolute agreement of nursing care intensity (NCI) measurements among nurses. Validity was tested by assessing whether optimal NCI/nurse ratio, as calculated by a regression analysis in RAFAELA, was realistic. System feasibility was investigated through a questionnaire among all nurses involved. Almost 67 000 NCI measurements were performed between December 2013 and June 2014. Agreement using the OPCq varied between 38% and 91%. For only 1 in 12 wards was the optimal NCI area calculated judged as valid. Although the majority of respondents was positive about the applicability and user-friendliness, RAFAELA was not accepted as useful workforce planning system. Nurses' performance using the RAFAELA system did not warrant its implementation. Hospital managers should first focus on enlarging the readiness of nurses regarding the implementation of a workforce planning system. © 2015 John Wiley & Sons Ltd.

  8. Psychometric properties of the Dutch version of the hospital-level consumer assessment of health plans survey (R) instrument

    NARCIS (Netherlands)

    O.A. Arah; A.H.A. ten Asbroek; D.M.J. Delnoij; J.S. de Koning; P.J.A. Stam; A.H. Poll; B. Vriens; P.F. Schmidt; N.S. Klazinga

    2006-01-01

    Objectives. To assess the reliability and validity of a translated version of the American Hospital-level Consumer Assessment of Health Plans Survey (R) (H-CAHPS) instrument for use in Dutch health care. Data Sources/Study Setting. Primary survey data from adults aged 18 years or more who were recen

  9. Framing in policy processes: a case study from hospital planning in the National Health Service in England.

    Science.gov (United States)

    Jones, Lorelei; Exworthy, Mark

    2015-01-01

    This paper reports from an ethnographic study of hospital planning in England undertaken between 2006 and 2009. We explored how a policy to centralise hospital services was espoused in national policy documents, how this shifted over time and how it was translated in practice. We found that policy texts defined hospital planning as a clinical issue and framed decisions to close hospitals or hospital departments as based on the evidence and necessary to ensure safety. We interpreted this framing as a rhetorical strategy for implementing organisational change in the context of community resistance to service closure and a concomitant policy emphasising the importance of public and patient involvement in planning. Although the persuasive power of the framing was limited, a more insidious form of power was identified in the way the framing disguised the political nature of the issue by defining it as a clinical problem. We conclude by discussing how the clinical rationale constrains public participation in decisions about the delivery and organisation of healthcare and restricts the extent to which alternative courses of action can be considered. Copyright © 2014 Elsevier Ltd. All rights reserved.

  10. Qualidade da atenção ao parto em maternidades do Rio de Janeiro Quality of birth care in maternity hospitals of Rio de Janeiro, Brazil

    Directory of Open Access Journals (Sweden)

    Eleonora d'Orsi

    2005-08-01

    -control study was carried out in a public and a private maternity hospitals contracted by the Brazilian Health System in the city of Rio de Janeiro, Brazil, from October 1998 to March 1999. The sample comprised 461 women in the public maternity hospital (230 vaginal deliveries and 231 Cesarean sections and 448 women in the private one (224 vaginal deliveries and 224 Cesarean sections. Data was collected through interviews with puerperal women and review of medical records. A summarization score of quality of delivery care was constructed. RESULTS: There was low frequency of practices that should be encouraged, such as having an accompanying person (1% in the private hospital for both vaginal delivery and C-sections, freedom of movements throughout labor (9.6% of C-sections in the public hospital and 9.9% of vaginal deliveries in the private hospital and breastfeeding in the delivery room (6.9% of C-sections in the public hospital and 8.0% of C-sections in the private hospital. There was a high frequency of known harmful practices such as enema administration (38.4%; routine pubic shaving; routine intravenous infusion (88.8%; routine use of oxytocin (64.4%, strict bed rest throughout labor (90.1% and routine supine position in labor (98.7% in vaginal deliveries. The best summarizing scores were seen in the public maternity hospital. CONCLUSIONS: The two maternity hospitals have a high frequency of interventions during birth care. In spite of providing care to higher risk pregnant women, the public maternity hospital has a less interventionist profile than the private one. Procedures carried out on a routine basis should be pondered based on evidence of their benefits.

  11. Number of Surgical Procedures for Patients With Cleft lip and Palate From Birth to 21 Years Old at a Single Children's Hospital.

    Science.gov (United States)

    McIntyre, Joyce K; Sethi, Harleen; Schönbrunner, Anna; Proudfoot, James; Jones, Marilyn; Gosman, Amanda

    2016-05-01

    that contributed to the number of surgeries and anesthesia events that children with a cleft underwent from birth to adulthood at a single children's hospital. We found that "heralding" events, such as palatal fistula and multiple nasal or lip revisions, can put children at risk for an increasing--and perhaps deleterious--number of surgery and anesthesia events.

  12. hospital

    African Journals Online (AJOL)

    Pattern of congenital orthopaedic malformations in an African teaching hospital ... malformation in this environment while congenital hip dislocation (CDH) is rare when .... malformations of radial dysplasia and other congenital malformations.

  13. Avaliação da atenção ao parto por adolescentes em um hospital universitário Evaluation of birthing care provided to adolescents in a university hospital

    Directory of Open Access Journals (Sweden)

    Cleci de Fátima Enderle

    2012-12-01

    Full Text Available OBJETIVOS: avaliar a atenção ao parto na ótica de adolescentes assistidas em um hospital universitário. MÉTODOS: estudo quantitativo, descritivo, desenvolvido em um hospital universitário do Sul do Brasil. A amostra foi 269 adolescentes, entre 10 e 19 anos, de julho de 2008 a outubro de 2009. A coleta de dados foi com entrevista acerca das práticas de parto normal. Para análise estatística, foi utilizado o Teste Exato de Fisher. Os achados foram comparados com as práticas recomendadas à atenção perinatal preconizados pelo Ministério da Saúde (MS. RESULTADOS: a posição litotômica adotada em 99% dos casos; a episiotomia foi realizada em 89,6% das parturientes; os toques vaginais foram realizados por mais de um examinador em 69,4% dos partos; a cateterização venosa profilática de rotina foi instalada em 91,8% das adolescentes e a restrição hídrica e alimentação esteve presente em 87,4 %. Estes achados não condizem com as orientações preconizadas pelo MS acerca da atenção ao parto. CONCLUSÕES: muitas condutas recomendadas pelo MS para o parto são desconsideradas na instituição em estudo, precisando ser revistas de modo a contemplar as diretrizes do MS.OBJECTIVES: evaluate birthing care from the perspective of adolescents seen at a university hospital. METHODS: a quantitative descriptive study deve-loped at a university hospital in the south of Brazil. The research sample was comprised of 269 adolescents, between 10 and 19 years of age, from July 2008 to October 2009. The data was collected through interviews about the practices of vaginal childbirth. Statistical analysis was performed using Fisher's Exact Test. The fin-dings were then compared with the recommended practices for perinatal care recommended by the Ministry of Health (MH. RESULTS: the lithotomic position was adopted in 99% of cases; an episiotomy was performed on 89.6% of delivering women; digital vaginal examinations were conducted by more than one

  14. Leading quality through the development of a multi-year corporate quality plan: sharing The Ottawa Hospital experience.

    Science.gov (United States)

    Hunter, Linda; Myles, Joanne; Worthington, James R; Lebrun, Monique

    2011-01-01

    This article discusses the background and process for developing a multi-year corporate quality plan. The Ottawa Hospital's goal is to be a top 10% performer in quality and patient safety in North America. In order to create long-term measurable and sustainable changes in the quality of patient care, The Ottawa Hospital embarked on the development of a three-year strategic corporate quality plan. This was accomplished by engaging the organization at all levels and defining quality frameworks, aligning with internal and external expectations, prioritizing strategic goals, articulating performance measurements and reporting to stakeholders while maintaining a transparent communication process. The plan was developed through an iterative process that engaged a broad base of health professionals, physicians, support staff, administration and senior management. A literature review of quality frameworks was undertaken, a Quality Plan Working Group was established, 25 key stakeholder interviews were conducted and 48 clinical and support staff consultations were held. The intent was to gather information on current quality initiatives and challenges encountered and to prioritize corporate goals and then create the quality plan. Goals were created and then prioritized through an affinity exercise. Action plans were developed for each goal and included objectives, tasks and activities, performance measures (structure, process and outcome), accountabilities and timelines. This collaborative methodology resulted in the development of a three-year quality plan. Six corporate goals were outlined by the tenets of the quality framework for The Ottawa Hospital: access to care, appropriate care (effective and efficient), safe care and satisfaction with care. Each of the six corporate goals identified objectives and supporting action plans with accountabilities outlining what would be accomplished in years one, two and three. The three-year quality plan was approved by senior

  15. Planning and development of the Better Bites program: a pricing manipulation strategy to improve healthy eating in a hospital cafeteria.

    Science.gov (United States)

    Liebert, Mina L; Patsch, Amy J; Smith, Jennifer Howard; Behrens, Timothy K; Charles, Tami; Bailey, Taryn R

    2013-07-01

    The Better Bites program, a hospital cafeteria nutrition intervention strategy, was developed by combining evidence-based practices with hospital-specific formative research, including key informant interviews, the Nutrition Environment Measures Study in Restaurants, hospital employee surveys, and nutrition services staff surveys. The primary program components are pricing manipulation and marketing to promote delicious, affordable, and healthy foods to hospital employees and other cafeteria patrons. The pricing manipulation component includes decreasing the price of the healthy items and increasing the price of the unhealthy items using a 35% price differential. Point-of-purchase marketing highlights taste, cost, and health benefits of the healthy items. The program aims to increase purchases of healthy foods and decrease purchases of unhealthy foods, while maintaining revenue neutrality. This article addresses the formative research, planning, and development that informed the Better Bites program.

  16. Disaster planning: the past, present, and future concepts and principles of managing a surge of burn injured patients for those involved in hospital facility planning and preparedness.

    Science.gov (United States)

    Kearns, Randy D; Holmes, James H; Alson, Roy L; Cairns, Bruce A

    2014-01-01

    The 9/11 attacks reframed the narrative regarding disaster medicine. Bypass strategies have been replaced with absorption strategies and are more specifically described as "surge capacity." In the succeeding years, a consensus has coalesced around stratifying the surge capacity into three distinct tiers: conventional, contingency, and crisis surge capacities. For the purpose of this work, these three distinct tiers were adapted specifically to burn surge for disaster planning activities at hospitals where burn centers are not located. A review was conducted involving published plans, other related academic works, and findings from actual disasters as well as modeling. The aim was to create burn-specific definitions for surge capacity for hospitals where a burn center is not located. The three-tier consensus description of surge capacity is delineated in their respective stratifications by what will hereinafter be referred to as the three "S's"; staff, space, and supplies (also referred to as supplies, pharmaceuticals, and equipment). This effort also included the creation of a checklist for nonburn center hospitals to assist in their development of a burn surge plan. Patients with serious burn injuries should always be moved to and managed at burn centers, but during a medical disaster with significant numbers of burn injured patients, there may be impediments to meeting this goal. It may be necessary for burn injured patients to remain for hours in an outlying hospital until being moved to a burn center. This work was aimed at aiding local and regional hospitals in developing an extemporizing measure until their burn injured patients can be moved to and managed at a burn center(s).

  17. How to plan workflow changes: a practical quality improvement tool used in an outpatient hospital pharmacy.

    Science.gov (United States)

    Aguilar, Christine; Chau, Connie; Giridharan, Neha; Huh, Youchin; Cooley, Janet; Warholak, Terri L

    2013-06-01

    A quality improvement tool is provided to improve pharmacy workflow with the goal of minimizing errors caused by workflow issues. This study involved workflow evaluation and reorganization, and staff opinions of these proposed changes. The study pharmacy was an outpatient pharmacy in the Tucson area. However, the quality improvement tool may be applied in all pharmacy settings, including but not limited to community, hospital, and independent pharmacies. This tool can help the user to identify potential workflow problem spots, such as high-traffic areas through the creation of current and proposed workflow diagrams. Creating a visual representation can help the user to identify problem spots and to propose changes to optimize workflow. It may also be helpful to assess employees' opinions of these changes. The workflow improvement tool can be used to assess where improvements are needed in a pharmacy's floor plan and workflow. Suggestions for improvements in the study pharmacy included increasing the number of verification points and decreasing high traffic areas in the workflow. The employees of the study pharmacy felt that the proposed changes displayed greater continuity, sufficiency, accessibility, and space within the pharmacy.

  18. Intentions of hospital nurses to work with computers: based on the theory of planned behavior.

    Science.gov (United States)

    Shoham, Snunith; Gonen, Ayala

    2008-01-01

    The purpose of this study was to determine registered nurses' attitudes related to intent to use computers in the hospital setting as a predictor of their future behavior. The study was further aimed at identifying the relationship between these attitudes and selected sociological, professional, and personal factors and to describe a research model integrating these various factors. The study was based on the theory of planned behavior. A random sample of 411 registered nurses was selected from a single large medical center in Israel. The study tool was a Likert-style questionnaire. Nine different indices were used: (1) behavioral intention toward computer use; (2) general attitudes toward computer use; (3) nursing attitudes toward computer use; (4) threat involved in computer use; (5) challenge involved in computer use; (6) organizational climate; (7) departmental climate; (8) attraction to technological innovations/innovativeness; (9) self-efficacy, ability to control behavior. Strong significant positive correlations were found between the nurses' attitudes (general attitudes and nursing attitudes), self-efficacy, innovativeness, and intentions to use computers. Higher correlations were found between departmental climate and attitudes than between organizational climate and attitudes. The threat and challenge that are involved in computer use were shown as important mediating variables to the understanding of the process of predicting attitudes and intentions toward using computers.

  19. Improving quality and outcomes of stroke care in hospitals: Protocol and statistical analysis plan for the Stroke123 implementation study.

    Science.gov (United States)

    Cadilhac, Dominique A; Andrew, Nadine E; Kilkenny, Monique F; Hill, Kelvin; Grabsch, Brenda; Lannin, Natasha A; Thrift, Amanda G; Anderson, Craig S; Donnan, Geoffrey A; Middleton, Sandy; Grimley, Rohan

    2017-01-01

    Rationale The effectiveness of clinician-focused interventions to improve stroke care is uncertain. Aims To determine whether an organizational intervention can improve the quality of stroke care over usual care. Sample size estimates To detect an absolute 10% difference in overall performance (composite outcome), a minimum of 21 hospitals and 843 patients per group was determined. Methods and design Before and after controlled design in hospitals in Queensland, Australia. Intervention Externally facilitated program (StrokeLink) using outreach workshops incorporating clinical performance feedback, patient outcomes (survival, quality of life at 90-180 days), local barrier assessments to best practice care, action planning, and ongoing support. Descriptive and multivariable analyses adjusted for patient correlations by hospital (intention-to-treat method). Context Concurrent implementation of financial incentives to increase stroke unit access and use of the Australian Stroke Clinical Registry for performance monitoring. Study outcome(s) Primary outcome: net change in composite score (i.e. total number of process indicators achieved divided by the sum of eligible indicators for each cohort). change in individual indicators, change in composite score comparing hospitals that did or did not develop action plans (per-protocol analysis), impact on 90-180-day health outcomes. Sensitivity analyses: hospital self-rated status, alternate cross-sectional audit data (Stroke Foundation). To account for temporal effects, comparison of Queensland hospital performance relative to other Australian hospitals will also be undertaken. Discussion Twenty-one hospitals were recruited; however, one was unable to participate within the study time frame. Workshops were held between 11 March 2014 and 7 November 2014. Data are ready for analysis.

  20. Dystocia, stillbirth, gestation length, and birth weight in Holstein, Jersey, and reciprocal crosses from a planned experiment.

    Science.gov (United States)

    Olson, K M; Cassell, B G; McAllister, A J; Washburn, S P

    2009-12-01

    Holstein and Jersey cows were mated to 4 Holstein (H) bulls and 4 Jersey (J) bulls to create HH, HJ, JH, and JJ genetic groups (sire breed listed first) in a diallele crossbreeding scheme. Calvings (n = 756) occurred in research herds in Virginia, Kentucky, and North Carolina with 243, 166, 194, and 153 calvings in the HH, HJ, JH, and JJ groups, respectively. Birth weights (BW), dystocia scores (0 for unassisted and 1 for assisted), and stillbirth (0 for alive or 1 for dead within 48 h) were recorded at calving. Gestation lengths (GL) were determined from breeding dates. An animal model was used to analyze BW and GL, and an animal model with logistic regression was used for dystocia and stillbirth. Fixed effects considered for model inclusion were genetic group, herd-year-season, sex, parity (primiparous or multiparous), twin status, and gestation length. Genetic group and effects significant in the model building process were kept in the final model for each trait. Heifer calves had lower BW, shorter GL, and had a lower odds ratio (0.53) for dystocia than bull calves. Twins had lower BW, shorter GL, were 3.86 times more likely to experience dystocia, and 7.80 times more likely to be stillborn than single births. Primiparous cows had calves with lower BW, shorter GL, were 2.50 times more likely to require assistance at birth, and were 2.35 times more likely to produce stillborns than calves from multiparous cows. Genetic group did not affect GL. Least squares means (kg) for BW were 37.7 +/- 1.1, 29.1 +/- 1.1, 30.3 +/- 1.0, and 22.5 +/- 1.3 for HH, HJ, JH, and JJ, respectively. Animals in HH weighed more than animals of other genetic groups; the JJ group had the smallest BW, with no differences for BW between HJ and JH. Probability of dystocia in JJ and JH were 5.73% and 18.98% of HH. Calves in HJ and HH were not different for dystocia. Calves in HJ were 3.38 times more likely to be stillborn than calves in JH, but no other genetic group differences were significant

  1. Preterm Birth

    Science.gov (United States)

    ... is born too early, before 37 weeks of pregnancy have been completed. In 2015, preterm birth affected about 1 of every 10 infants born in the United States. Preterm birth rates decreased from 2007 to 2014, and CDC research shows ...

  2. Birth Injury

    Science.gov (United States)

    ... Are Up to Date Additional Content Medical News Birth Injury By Arthur E. Kopelman, MD, Professor of ... Problems in Newborns Overview of Problems in Newborns Birth Injury Prematurity Postmaturity Small for Gestational Age (SGA) ...

  3. Breech birth

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000623.htm Breech birth To use the sharing features on this page, ... safer for your baby to pass through the birth canal. In the last weeks of pregnancy, your ...

  4. The Birth of a Plan The formulation of the 12th Five-Year Plan shows the operation of China's public policy-making mechanism

    Institute of Scientific and Technical Information of China (English)

    JIN MINQING

    2011-01-01

    In March 2008,the National Development and Reform Committee ( NDRC) began to evaluate the progress of the 11th Five-Year Plan for National Economic and Social Development (2006-10),in an effort to push forward its implementation and prepare for the formulation of the next big blueprint.At the end of that year,the NDRC published 39 major subjects under eight categories for the formulation of the 12th Five-Year Plan (2011-15),and invited bids to carry out relevant studies.Thousands of experts and researchers focused on hundreds of topics,which finally yielded research reports of millions of words.Based on these reports,the NDRC set out to draft the basic lines of the 12th Five-Year Plan and reported to the Central Committee of the Communist Party of China (CPC) and the State Council.

  5. From institutionalized birth to home birth

    Directory of Open Access Journals (Sweden)

    Clara Fróes de Oliveira Sanfelice

    2014-06-01

    Full Text Available The study aimed to describe the experiences of a group of nurse-midwives from the city of Campinas, SP, Brasil, regarding the transition process from attending institutionalized births to attending home births, in the period 2011 – 2013. The study is of the experience report type; the reflections, perceptions and challenges experienced in this process were collected using the technique of brainstorming. Content analysis, as proposed by Bardin, was used, which yielded four thematic categories: a the hospital experience; b living with obstetric violence; c returning home and d the challenges of home care. It is concluded that attending home births offers greater satisfaction to the nurses, even in the face of various obstacles, as it is possible to offer a care to the woman and new-born which covers both the concept of comprehensiveness and the current scientific recommendations.

  6. [The functional planning of a enteral nutrition unit for home care at a hospital in Brazil].

    Science.gov (United States)

    Ribeiro Salomon, Ana Lúcia; Carvalho Garbi Novaes, Maria Rita

    2013-11-01

    Introducción: Con el objeto de garantizar la calidad del producto ofrecido a los clientes en sus domicilios, las unidades hospitalarias necesitan adecuar sus áreas físicas para poder desarrollar todas las actividades especializadas que conlleva la nutrición enteral. Objetivo: Proporcionar una planificación funcional y las herramientas para la reorganización del espacio físico de una unidad de nutrición enteral, describiendo el proceso de preparación, la descripción de sus características y funciones laborales. Métodos. Estudio descriptivo, retrospectivo y documental, proporcionando las herramientas para la planificación funcional y de gestión de calidad en una unidad de preparación de la nutrición enteral en un hospital público del Distrito Federal, Brasil. Los datos fueron recolectados en el período comprendido entre los años 2000 y 2010. Resultados. A través de la creación de un programa de nutrición enteral en el Departamento de Salud Pública del Distrito Federal y según lo dispuesto por la legislación nacional, se efectuó un plan de alta complejidad respecto de la nutrición enteral en atención al perfil demográfico y epidemiológico de la población. Este trabajo consiste en una propuesta de implementación de terapia nutricional dentro de un plan de alta complejidad, y de acuerdo a lo prescrito por la legislación del Ministerio de Salud Brasileño. El número de pacientes atendidos por esta modalidad terapéutica se ha ido incrementando, por consiguiente se hace necesario garantizar la calidad del servicio, por medio de la organización de los espacios funcionales. Conclusión. Por medio de la planificación funcional de un Laboratorio de Nutrición Enteral, se puede garantizar la asistencia nutricional especializada y de calidad, a la población hospitalaria o domiciliaria, tomando las precauciones necesarias en la manipulación de las fórmulas enterales.

  7. [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.

  8. 2001-2010年住院出生缺陷476例临床分析%Clinical analysis of birth defects in 476 cases of hospitalized children from 2001 to 2010.

    Institute of Scientific and Technical Information of China (English)

    祝轲; 任榕娜

    2011-01-01

    Objective To compile the prevalence and factors of birth defects on hospitalized children of Pediatrics in our hospital from 2001 to 2010 and provide some examples for reducing birth defects. Methods Data of birth defects of all hospitalized children from January 1, 2001 to December 31,2010 were reviewed. Types of birth defects and prenatal exposure to risk factors were retrospectively analyzed. Results The prevalence rate of birth defects on hospitalized children over the past 10 years was 16.41 per 1000.The risk factors influencing the incidence of birth defects were the age of parturient under 20 and over 35 , preterm birth (birth less than 37 weeks after conception) ,sick in early pregnancy .taking medicine in early pregnancy, spontaneous abortion, current family history of congenital defect, but the prevalence rates were no significance between urban and suburb and between male and female.Congenital heart diseases were the most common types of birth defects. Conclusion The surveillance and intervention program of birth defects and tertiary preventions shall be performed to decrease preference of birth defects on perinatal fetuses.%目的 统计住院患儿出生缺陷的发生情况及影响因素,为有效预防出生缺陷提供借鉴.方法 收集2001-01-01-2010-12-31南京军区福州总医院儿科住院患儿29015例中发生出生缺陷的病例资料,对患儿出生缺陷构成状况、孕妇多种相关暴露因素进行回顾性分析.结果 10年间南京军区福州总医院儿科住院患儿出生缺陷发生率为16.41‰(476/29015).近4年(2007-2010年)与前6年(2001-2006年)出生缺陷发生率相比(25.24‰对8.83‰),呈明显增高且呈逐年增加趋势,差异有统计学意义(x2=26.30,P<0.05).产妇年龄<20岁和> 35岁、早产(胎龄<37周)、孕早期患病、孕早期用药、有自然流产史、有家族史为出生缺陷发生的危险因素,而城乡、不同性别间出生缺陷发生

  9. Assessing the planning and implementation strategies for the ICD-10-CM/PCS coding transition in Alabama hospitals.

    Science.gov (United States)

    Houser, Shannon H; Morgan, Darius; Clements, Kay; Hart-Hester, Susan

    2013-01-01

    Health information management (HIM) professionals play a significant role in transitioning from ICD-9-CM to ICD-10-CM/PCS. ICD-10-CM/PCS coding will impact many operational aspects of healthcare facilities, such as physicians' documentation in health records, coders' process for review of clinical information, the billing process, and the payers' reimbursement to the healthcare facilities. This article examines the level of readiness and planning for ICD-10-CM/PCS implementation among hospitals in Alabama, identifies training methods/approaches to be used by the hospitals, and discusses the challenges to the ICD-10-CM/PCS coding transition. A 16-question survey was distributed to 116 Alabama hospital HIM directors in December 2011 with follow-up through February 2012. Fifty-three percent of respondent hospitals began the planning process in 2011, and most facilities were halfway or less than halfway to completion of specific implementation tasks. Hospital coders will be or are being trained using in-house training, through seminars/webinars, or by consultants. The impact of ICD-10-CM/PCS implementation can be minimized by training coders in advance, hiring new coders, and adjusting coders' productivity measures. Three major challenges to the transition were identified: the need to interact with physicians and other providers more often to obtain information needed to code in ICD-10-CM/PCS systems, education and training of coders and other ICD-10-CM/PCS users, and dependence on vendors for major technology upgrades for ICD-10-CM/PCS systems. Survey results provide beneficial information for HIM professionals and other users of coded data to assist in establishing sound practice standards for ICD-10-CM/PCS coding implementation. Adequate planning and preparation will be essential to the successful implementation of ICD-10-CM/PCS.

  10. Missing girls in India: infanticide, feticide and made-to-order pregnancies? Insights from hospital-based sex-ratio-at-birth over the last century.

    Directory of Open Access Journals (Sweden)

    Mohit Sahni

    Full Text Available BACKGROUND: There are 44 million missing women in India. Gender bias; neglect of girls, infanticides and feticides are responsible. The sex ratio at birth can be used to examine the influence of antenatal sex selection on the sex ratio. MATERIALS AND METHODS: Records from 321,991 deliveries at one hospital over 11 decades were utilized. The middle year in each decade was taken as representative of the decade. Data from 33,524 deliveries were then analyzed. Data for each decade was combined with that of previous decades and compared to the data of subsequent decades to look for any change in the trend. Sex ratio in the second children against sex of the first child was studied separately. RESULTS: The mean sex ratio for the 110 years examined was 910 girls to 1000 boys (95% CI; 891 to 930. The sex ratio dropped significantly from 935 (CI: 905 to 967 before 1979, to 892 (CI: 868 to 918 after 1980 (P = 0.04. The sex ratio in the second child was significantly lower if the first child was a girl [716 (CI: 672 to 762] (P<0.001. On the other hand, there was an excess of girls born to mothers whose first child was boy [1140 girls per 1000 boys (CI: 1072 to 1212 P<0.001]. CONCLUSIONS: The sex ratio fell significantly after 1980 when ultra sound machines for antenatal sex determination became available. The sex ratio in second children if the first was a girl was even lower. Sex selective abortions after antenatal sex determination are thus implicated. However data on second children especially the excess of girls born to mothers who have a previous boy seen in the decade before the advent of antenatal ultra sound machines, suggests that other means of sex selection are also used.

  11. Career plan and human resources plan of hospital logistic service staff%医院后勤人员职业规划与人力资源规划

    Institute of Scientific and Technical Information of China (English)

    孙麟; 王军; 谢磊; 张伟

    2013-01-01

    With the development of health system reform and the changing of hospital operation mode, hospital logistics support and management plays more important role for hospital development. The concept of integrated human resources plan and career plan is presented to solve the problems of short of staff, poor adaptive capacity, creation and professional on logistics department and to give reference on logistics professional team and management team building.%随着医疗体制改革不断深入,医院经营管理模式不断转变,医院发展对医院后勤支持保障管理提出了更高的要求。本文提出将医院后勤职工职业生涯发展与人力资源规划相结合的管理思路,探讨以后勤职工职业发展规划为基础,科学开展人力资源规划,解决目前医院后勤管理中人才短缺,适应力、创造力、专业性缺乏和技术落后的问题,为后勤专业技术队伍和管理团队的建设提供可借鉴的经验。

  12. Specific Association of Teratogen and Toxicant Metals in Hair of Newborns with Congenital Birth Defects or Developmentally Premature Birth in a Cohort of Couples with Documented Parental Exposure to Military Attacks: Observational Study at Al Shifa Hospital, Gaza, Palestine

    Directory of Open Access Journals (Sweden)

    Paola Manduca

    2014-05-01

    Full Text Available This study was undertaken in Gaza, Palestine, in a cohort of babies born in 2011. Hair samples of newborns were analyzed for metal load by DRC-ICP-MS. We report specific level of contamination by teratogen/toxicants metals of newborn babies, environmentally unexposed, according to their phenotypes at birth: normal full term babies, birth defects or developmentally premature. The occurrence of birth defects was previously shown to be correlated in this cohort to documented exposure of parents to weapons containing metal contaminants, during attacks in 2009. We detect, in significantly higher amounts than in normal babies, different specific teratogen or toxicant elements, known weapons’ components, characteristic for each of birth defect or premature babies. This is the first attempt to our knowledge to directly link a phenotype at birth with the in utero presence of specific teratogen and/or toxicant metals in a cohort with known episodes of acute exposure of parents to environmental contamination by these same metals, in this case delivered by weaponry The babies were conceived 20–25 months after the major known parental exposure; the specific link of newborn phenotypes to war-remnant metal contaminants, suggests that mothers’ contamination persists in time, and that the exposure may have a long term effect.

  13. Vaginal birth after cesarean: neonatal outcomes and United States birth setting.

    Science.gov (United States)

    Tilden, Ellen L; Cheyney, Melissa; Guise, Jeanne-Marie; Emeis, Cathy; Lapidus, Jodi; Biel, Frances M; Wiedrick, Jack; Snowden, Jonathan M

    2017-04-01

    Women who seek vaginal birth after cesarean delivery may find limited in-hospital options. Increasing numbers of women in the United States are delivering by vaginal birth after cesarean delivery out-of-hospital. Little is known about neonatal outcomes among those who deliver by vaginal birth after cesarean delivery in- vs out-of-hospital. The purpose of this study was to compare neonatal outcomes between women who deliver via vaginal birth after cesarean delivery in-hospital vs out-of-hospital (home and freestanding birth center). We conducted a retrospective cohort study using 2007-2010 linked United States birth and death records to compare singleton, term, vertex, nonanomolous, and liveborn neonates who delivered by vaginal birth after cesarean delivery in- or out-of-hospital. Descriptive statistics and multivariate regression analyses were conducted to estimate unadjusted, absolute, and relative birth-setting risk differences. Analyses were stratified by parity and history of vaginal birth. Sensitivity analyses that involved 3 transfer status scenarios were conducted. Of women in the United States with a history of cesarean delivery (n=1,138,813), only a small proportion delivered by vaginal birth after cesarean delivery with the subsequent pregnancy (n=109,970; 9.65%). The proportion of home vaginal birth after cesarean delivery births increased from 1.78-2.45%. A pattern of increased neonatal morbidity was noted in unadjusted analysis (neonatal seizures, Apgar score cesarean delivery in out-of-hospital settings had higher odds of neonatal morbidity and death compared with women of higher parity. Women who had not birthed vaginally prior to out-of-hospital vaginal birth after cesarean delivery had higher odds of neonatal morbidity and mortality compared with women who had birthed vaginally prior to out-of-hospital vaginal birth after cesarean delivery. Sensitivity analyses generated distributions of plausible alternative estimates by outcome. Fewer than 1 in

  14. The birth rate of full-term low birth weight infants in recent 5 years at obstetric department in our hospital and an analysis of its related factors%我院产科近5年足月低体重儿的出生率及其相关因素分析

    Institute of Scientific and Technical Information of China (English)

    郑再娟; 卢雪珍

    2012-01-01

    目的 探讨足月低体重儿的出生率,并分析其高危因素.方法 对我院分娩的14062例新生儿进行回顾性研究,分析足月低体重儿的出生率及高危因素.结果 足月低体重儿的出生率为2.52%,其高危因素有:妊娠期肝内胆汁淤积症、妊娠期高血压疾病、贫血、子宫发育畸形、多次人工流产、产检次数少、多胎妊娠、胎儿畸形、羊水过少、脐带异常、胎盘位置异常、形态异常和重量异常.结论 足月低体重儿的出生率较高,其高危因素多样,是各种因素综合作用的结果.%Objective To investigate the birth rate of full-term low birth weight infants,and to analyze its risk factors.Methods 14062 newborns who were born in our hospital were studied retrospectively.The birth rate of low birth weight infants and its related risk factors.Results The birth rate of low birth weight infants was 2.52%.The risk factors for low birth weight were intrahepatic cholestasis of pregnancy, pregnancy-induced hypertension, anemia, uterine malformation, multiple induced abortion, fewer prenatal examinations, multiple pregnancy, fetal malformation,oligohydramnios,umbilical cord abnormalities,and abnormal placental location,shape,and weight.Conclusions The birth rate is higher in low birth weight infants.The risk factors for low birth weight are various and the result of action of different factors.

  15. Quality assessment of home births in Denmark

    DEFF Research Database (Denmark)

    Jensen, Sabrina; Colmorn, Lotte B.; Schroll, Anne-Mette

    2017-01-01

    INTRODUCTION: The safety of home births has been widely debated. Observational studies examining maternal and neonatal outcomes of home births have become more frequent, and the quality of these studies has improved. The aim of the present study was to describe neonatal outcomes of home births...... compared with hospital births and to discuss which data are needed to evaluate the safety of home births. METHODS: This was a register-based cohort study. Data on all births in Denmark (2003-2013) were collected from the Danish Medical Birth Registry (DMBR). The cohort included healthy women...... with uncomplicated pregnancies and no medical interventions during delivery. A total of 6,395 home births and 266,604 hospital births were eligible for analysis. Comparative analyses were performed separately in nulliparous and multiparous women. The outcome measures were neonatal mortality and morbidity. RESULTS...

  16. What's the Plan? Needing Assistance with Plan of Care Is Associated with In-Hospital Death for ICU Patients Referred for Palliative Care Consultation.

    Science.gov (United States)

    Kiyota, Ayano; Bell, Christina L; Masaki, Kamal; Fischberg, Daniel J

    2016-08-01

    To inform earlier identification of intensive care unit (ICU) patients needing palliative care, we examined factors associated with in-hospital death among ICU patients (N=260) receiving palliative care consultations at a 542-bed tertiary care hospital (2005-2009). High pre-consultation length of stay (LOS, ≥7 days) (adjusted odds ratio (aOR)=5.0, 95% confidence interval (95% CI)=2.5-9.9, Pplan of care (aOR=11.6, 95% CI=5.6-23.9, Pplan of care and high pre-consult LOS had the highest odds of in-hospital death (aOR=36.3, 95% CI=14.9-88.5, Pplan of care and shorter pre-consult LOS (aOR=9.8, 95% CI=4.3-22.1, Pplan of care (aOR=4.7, 95% CI=1.8-12.4, P=.002). Our findings suggest that ICU patients who require assistance with plan of care need to be identified early to optimize end-of-life care and avoid in-hospital death.

  17. Availability of tuberculosis infection control plans at rural hospitals of Vhembe district, Limpopo Province of South Africa

    Directory of Open Access Journals (Sweden)

    Takalani G. Tshitangano

    2013-01-01

    Full Text Available Background: In Limpopo province the rate of new tuberculosis (TB cases increase daily.The Infection Control (IC plan is one of the essential actions for TB IC. This study aimed to establish the availability of these plans at health care facilities.Objectives: The objectives were to explore and describe the awareness and knowledge of health care workers (HCWs of the availability and content of TB IC plan; and to identity the role of infection control committees from the perspective of HCWs.Method: A qualitative approach using a cross-sectional descriptive design was adopted. The target population was all HCWs from the seven hospitals of Vhembe district. A purposive sampling approach was used to select 57 participants. The approval to conduct this study was obtained from the relevant authorities and participants. Data was collected through seven focus group discussions comprising five to 10 members. An unstructured discussion guide was used to collect data, and an open-coding method was used to analyse the data. Lincoln and Guba’s criteria ensured trustworthiness of the study findings.Results: Findings revealed that HCWs were not aware of the availability and the information contained in the TB IC plans. No person was designated as TB IC officer at hospital level. There was lack of a TB IC Committee and teams as well as ineffective utilisation of those that did exist.Conclusions: It was concluded that if the TB IC plans are not available at health care facilities,then the TB IC practices implemented by HCWs vary, resulting in TB nosocomial infection transmission. It was recommended that the World Health Organisation’s TB IC plans be adopted and implemented in Vhembe district.

  18. Availability of tuberculosis infection control plans at rural hospitals of Vhembe district, Limpopo Province of South Africa

    Directory of Open Access Journals (Sweden)

    Takalani G. Tshitangano

    2013-01-01

    Full Text Available Background: In Limpopo province the rate of new tuberculosis (TB cases increase daily.The Infection Control (IC plan is one of the essential actions for TB IC. This study aimed to establish the availability of these plans at health care facilities.Objectives: The objectives were to explore and describe the awareness and knowledge of health care workers (HCWs of the availability and content of TB IC plan; and to identity the role of infection control committees from the perspective of HCWs.Method: A qualitative approach using a cross-sectional descriptive design was adopted. The target population was all HCWs from the seven hospitals of Vhembe district. A purposive sampling approach was used to select 57 participants. The approval to conduct this study was obtained from the relevant authorities and participants. Data was collected through seven focus group discussions comprising five to 10 members. An unstructured discussion guide was used to collect data, and an open-coding method was used to analyse the data. Lincoln and Guba’s criteria ensured trustworthiness of the study findings.Results: Findings revealed that HCWs were not aware of the availability and the information contained in the TB IC plans. No person was designated as TB IC officer at hospital level. There was lack of a TB IC Committee and teams as well as ineffective utilisation of those that did exist.Conclusions: It was concluded that if the TB IC plans are not available at health care facilities,then the TB IC practices implemented by HCWs vary, resulting in TB nosocomial infection transmission. It was recommended that the World Health Organisation’s TB IC plans be adopted and implemented in Vhembe district.

  19. [The relationship between hospitals and health plans organizations in the scope of ANS Health Insurance Qualification Program].

    Science.gov (United States)

    Escrivão Junior, Alvaro; Koyama, Marcos Fumio

    2007-01-01

    In Brazilian health insurance sector, the fee-for-service model still remains the major payment method for health services, and predominates in the relationship between hospitals and private health insurance companies. After the creation of Health Insurance Qualification Program (HIQP), which focuses on the quality of the assistance given to consumers, the health insurance companies will be evaluated by health care performance indicators, established by this program. The present study discusses the impact of this pattern on the relationship between health insurance companies and hospitals, by analyzing data from interviews carried through with 18 health insurance managers, regarding the use - in hospital management - of performance indicators compatible to those adopted by HIQP. According to the managers perception, only three hospitals use this sort of indicators, two of them which are hospitals managed by the health insurance companies. The alignment of interests between health plans organizations and health care providers, at the HIQP proposed template, will imply changes in payment models between these market players, towards the inclusion of performance and quality of assistance given to users by providers, as components of wage determination.

  20. Examining the attitudes of hospital pharmacists to reporting medication safety incidents using the theory of planned behaviour.

    Science.gov (United States)

    Williams, Steven David; Phipps, Denham L; Ashcroft, Darren

    2015-08-01

    To assess the effect of factors within hospital pharmacists' practice on the likelihood of their reporting a medication safety incident. Theory of planned behaviour (TPB) survey. Twenty-one general and teaching hospitals in the North West of England. Two hundred and seventy hospital pharmacists (response rate = 45%). Hospital pharmacists were invited to complete a TPB survey, based on a prescribing error scenario that had resulted in serious patient harm. Multiple regression was used to determine the relative influence of different TPB variables, and participant demographics, on the pharmacists' self-reported intention to report the medication safety incident. The TPB variables predicting intention to report: attitude towards behaviour, subjective norm, perceived behavioural control and descriptive norm. Overall, the hospital pharmacists held strong intentions to report the error, with senior pharmacists being more likely to report. Perceived behavioural control (ease or difficulty of reporting), Descriptive Norms (belief that other pharmacists would report) and Attitudes towards Behaviour (expected benefits of reporting) showed good correlation with, and were statistically significant predictors of, intention to report the error [R = 0.568, R(2) = 0.323, adjusted R(2) = 0.293, P behavioural and control beliefs about the reporting process. This should include instilling greater confidence about the benefits of reporting and not harming professional relationships with doctors, greater clarity about what/not to report and a simpler reporting system. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  1. Effeetive planning of Hospital Financial Managemet%浅谈医院财务管理的有效筹划

    Institute of Scientific and Technical Information of China (English)

    王亚辉

    2015-01-01

    With the establishment of China's market economy system and the deepening of social security system reform, both internal and external environment of health economy have undergone tremendous changes, hospital ifnancial management has entered into every aspect of hospital area. Therefore, it has been important to strength ifnancial management of hospital, increase economic efifciency of hospital, promote healthy development of hospital, and advance hospital competitiveness under the condition of market economy. Financial work should make effective planning in the area of comprehensive cost management, budget management, ifnancial performance evaluation and economic behavior supervision, in order to guarantee the safety and efifcient operation of hospital economic activity.%随着我国市场经济体制的确立和社会保障制度改革的深化,卫生经济事业的内、外部环境都发生了巨大变化,医院的财务管理工作已经渗透到医院的各个领域、各个环节之中。所以,加强医院财务管理,提高医院经济效益,促进医院健康发展,提高医院在市场经济条件下的竞争力,已经成为现代医院管理中的一项重要内容。财务工作应从全面成本管理、预算管理、财务绩效评价、经济监督等方面进行有效筹划,确保医院经济活动安全、高效运行。

  2. College-age twins: university admission policies / twin research: birth weight and neuromotor performance; transfusion syndrome markers; vanishing twins and fetal sex determination; mz twin discordance for wilson's disease / media: big at birth; planned separation of conjoined twins; x factor twins; Cinema: the identical.

    Science.gov (United States)

    Segal, Nancy L

    2014-12-01

    There is a lack of research findings addressing the unique college admissions issues faced by twins and other multiples. The advantages and disadvantage twins face, as reported by college administrators, twins and families are reviewed. Next, recent research addressing twins' birth weight and neuromotor performance, transfusion syndrome markers, the vanishing twin syndrome and monozygotic (MZ) twin discordance for Wilson's disease is described. News items concerning the birth of unusually large twins, the planned separation of conjoined twins, twin participants in the X Factor games and a film, The Identical, are also summarized.

  3. Birth Order and Psychopathology

    Directory of Open Access Journals (Sweden)

    Ajay Risal

    2012-01-01

    Full Text Available Context: Ordinal position the child holds within the sibling ranking of a family is related to intellectual functioning, personality, behavior, and development of psychopathology. Aim: To study the association between birth order and development of psychopathology in patients attending psychiatry services in a teaching hospital. Settings and Design: Hospital-based cross-sectional study. Materials and Methods: Retrospective file review of three groups of patients was carried out. Patient-related variables like age of onset, birth order, family type, and family history of mental illness were compared with psychiatry diagnosis (ICD-10 generated. Statistical Analysis: SPSS 13; descriptive statistics and one-way analysis of variance (ANOVA were used. Results: Mean age of onset of mental illness among the adult general psychiatry patients (group I, n = 527 was found to be 33.01 ± 15.073, while it was 11.68 ± 4.764 among the child cases (group II, n = 47 and 26.74 ± 7.529 among substance abuse cases (group III, n = 110. Among group I patients, commonest diagnosis was depression followed by anxiety and somatoform disorders irrespective of birth order. Dissociative disorders were most prevalent in the first born child (36.7% among group II patients. Among group III patients, alcohol dependence was maximum diagnosis in all birth orders. Conclusions: Depression and alcohol dependence was the commonest diagnosis in adult group irrespective of birth order.

  4. Role of micronized progesterone in prevention of preterm labour in women with previous history of one or more preterm births: a research study at a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Rashmi Ahuja

    2015-08-01

    Conclusions: The study concluded that progesterone use was associated with 64.2% reduction in the incidence of preterm delivery (p=0.029.Antenatal administration of progesterone reduces the risk of preterm birth before 37 weeks and 34 weeks as well as the risk of a newborn being born with a birth weight of less than 2500 gms. [Int J Reprod Contracept Obstet Gynecol 2015; 4(4.000: 1176-1180

  5. Sleep Disorder Diagnosis During Pregnancy and Risk of Preterm Birth.

    Science.gov (United States)

    Felder, Jennifer N; Baer, Rebecca J; Rand, Larry; Jelliffe-Pawlowski, Laura L; Prather, Aric A

    2017-09-01

    To test the hypothesis that sleep disorder diagnosis would be associated with increased risk of preterm birth and to examine risk by gestational age, preterm birth type, and specific sleep disorder (insomnia, sleep apnea, movement disorder, and other). In this observational study, participants were from a cohort of nearly 3 million women in California between 2007 and 2012. Inclusion criteria were women with singleton neonates liveborn between 20 and 44 weeks of gestation without chromosomal abnormalities or major structural birth defects linked to a hospital discharge database maintained by the California Office of Statewide Health Planning and Development and without mental illness during pregnancy. Sleep disorder was defined based on International Classification of Diseases, 9th Revision, Clinical Modification diagnostic code (n=2,265). Propensity score matching was used to select a referent population at a one-to-one ratio. Odds of preterm birth were examined by gestational age (less than 34 weeks, 34-36 weeks, and less than 37 weeks of gestation) and type (spontaneous, indicated). Prevalence of preterm birth (before 37 weeks of gestation) was 10.9% in the referent group compared with 14.6% among women with a recorded sleep disorder diagnosis. Compared with the referent group, odds (95% CI, P value, percentage) of preterm birth were 1.3 (1.0-1.7, P=.023, 14.1%) for insomnia and 1.5 (1.2-1.8, Ppreterm birth type. Odds of preterm birth were not significantly increased for sleep-related movement disorders or other sleep disorders. Insomnia and sleep apnea were associated with significantly increased risk of preterm birth. Considering the high prevalence of sleep disorders during pregnancy and availability of evidence-based nonpharmacologic interventions, current findings suggest that screening for severe presentations would be prudent.

  6. Implementation of nutrition care service development plan at Banning Memorial Hospital: a case study.

    Science.gov (United States)

    Ben Oumlil, A; Rao, C P

    1992-01-01

    Health care service markets in general and hospital care service markets in particular are characterized by many competitive developments. Hence, hospital marketing managers are forced to respond to these emerging competitive pressures. However, in formulating appropriate marketing management strategies, hospital managers need to have detailed knowledge about consumers and their behaviors in the marketplace. This paper focuses on the Nutrition Care division of the Department of Nutrition Service at a hospital and its venture into new service development. This case study is intended to emphasize the significance of acquiring adequate knowledge of customers in the health care services industry. It particularly emphasizes the critical role that this type of information concerning customer behavior plays in the development and implementation of an appropriate business expansion strategy. Furthermore, the aim of this case study is to help the reader to relate the acquired marketing information to the problem at hand, and make the appropriate marketing management decision.

  7. Foot Length, Chest Circumference, and Mid Upper Arm Circumference Are Good Predictors of Low Birth Weight and Prematurity in Ethnic Minority Newborns in Vietnam: A Hospital-Based Observational Study.

    Directory of Open Access Journals (Sweden)

    Hai Nguyen Thi

    Full Text Available The evaluation of tools to accurately identify low birth weight (LBW and/or premature newborns in resource-limited countries is a research priority. We explored the use of foot length, chest circumference, and mid-upper arm circumference (MUAC measured within 24 h as diagnostic tools for identifying newborns who are LBW, premature, or both; and compared measurements taken at birth with those taken at five days of age.An observational study was undertaken in Hoa Binh Province General Hospital, Vietnam, in ethnic minority newborns. Birth weight, foot length, chest circumference, and MUAC were measured within 24 h of birth and in a subset of 200, were repeated on day five of life. Gestational age was estimated using the New Ballard Score. Receiver Operating Characteristic curves and optimal cut-points (the point with the highest sensitivity and specificity where the sensitivity was at least 0.8 were calculated, for predicting prematurity, LBW, and both. Measurements within 24 h and at five days of life were compared.485 newborns were recruited. Chest circumference and MUAC measured within 24 h of birth were found to be highly predictive of LBW (both yielding area under the curve [AUC] of 0.98, 95% confidence interval [CI] 0.96-0.99, and performed marginally better than foot length (AUC 0.94, 95%CI 0.92-0.96. The optimal cut-points for measurements within 24 h of birth were ≤ 7.4 cm for foot length; ≤ 30.4 cm for chest circumference; and ≤ 9.0 cm for MUAC. There was statistical evidence that anthropometric measurements taken within 24 h of birth were higher than measurements on day five (p<0.02 for all anthropometric measurements but the magnitude of these differences was small (at most 2mm.All measurements taken within 24 h of birth were good predictors of LBW, prematurity and both. Differences in measurements taken within 24 h and on day five were not clinically relevant. Further research will ensure that the application of these measures is

  8. Birth Weight

    Science.gov (United States)

    ... baby, taken just after he or she is born. A low birth weight is less than 5.5 pounds. A high ... weight is more than 8.8 pounds. A low birth weight baby can be born too small, too early (premature), or both. This ...

  9. Birthing Classes

    Science.gov (United States)

    ... first birth and hope to have a vaginal delivery this time, there is a class for that, too. Choose ... t covered in your birthing class, it’s a good idea to take an individual class on it, especially if you are a first-time mother. The health benefits of breastfeeding your baby ...

  10. More than clinical waste? Placenta rituals among Australian home-birthing women.

    Science.gov (United States)

    Burns, Emily

    2014-01-01

    The discursive construction of the human placenta varies greatly between hospital and home-birthing contexts. The former, driven by medicolegal discourse, defines the placenta as clinical waste. Within this framework, the placenta is as much of an afterthought as it is considered the "afterbirth." In home-birth practices, the placenta is constructed as a "special" and meaningful element of the childbirth experience. I demonstrate this using 51 in-depth interviews with women who were pregnant and planning home births in Australia or had recently had home births in Australia. Analysis of these interviews indicates that the discursive shift taking place in home-birth practices from the medicalized model translates into a richer understanding and appreciation of the placenta as a spiritual component of the childbirth experience. The practices discussed in this article include the burial of the placenta beneath a specifically chosen plant, consuming the placenta, and having a lotus birth, which refers to not cutting the umbilical cord after the birth of the child but allowing it to dry naturally and break of its own accord. By shifting focus away from the medicalized frames of reference in relation to the third stage of labor, the home-birthing women in this study have used the placenta in various rituals and ceremonies to spiritualize an aspect of birth that is usually overlooked.

  11. Unsanctioned births in China.

    Science.gov (United States)

    Li, L; Ballweg, J A

    1995-05-01

    This study hypothesizes that "unsanctioned" births (beyond the limit authorized by the government) in China are more likely among couples who have strong traditional fertility norms and less likely among couples who adopt new family planning norms. The theoretical framework is based on cultural conflict theory as developed by Sellin. Data are obtained from 6654 ever married women aged under 49 years from the 1987 In-Depth Fertility Survey for Guangdong province. Over 30% of the sample were married before 20 years of age. 20% had 1 child, 26.7% had 2 children, about 23% had 3 children, 13.9% had 4 children, and under 10% had 5 or more children. The average number of living children was 2.5. Findings reveal that socioeconomic status was significantly related to unsanctioned births; they were more common in less developed areas and among women of lower socioeconomic status (SES). Persons living in areas with a high monetary contribution per person in family planning efforts at the county level were less likely to have unsanctioned births. Women who lived in urban areas, worked in state enterprises, and had parents with high educational status were less likely to have unsanctioned births. They were more likely among women who married at an early age, lived with parents after the marriage, had female living children, and had failed pregnancies. They were also more likely among women who had arranged marriages, a traditional desire for large family sizes, an early marriage ideal, and a preference for sons. Knowledge of family planning and greater use of abortion were related to a lower incidence of unsanctioned births. Women who talked with their husbands about their family size desires were less likely to have unsanctioned births. Parental educational attainment only had an influence among rural women. Variables impacted on fertility differently in urban and rural areas.

  12. The effects of music on the selected stress behaviors, weight, caloric and formula intake, and length of hospital stay of premature and low birth weight neonates in a newborn intensive care unit.

    Science.gov (United States)

    Caine, J

    1991-01-01

    The purpose of this study was to examine the effects of music on selected stress behaviors, weight, caloric and formula intake, and length of hospital stay. Subjects were 52 preterm and low birth weight newborns in a newborn intensive care unit (NBICU) who were in stable condition and restricted to isolettes. Subjects in the experimental and control groups were matched for equivalency based on sex, birth weight, and diagnostic criticality. Eleven males and 15 females were assigned to the control group and received routine auditory stimulation. The experimental group of 11 males and 15 females received music stimulation, which consisted of approximately 60 minutes of tape recorded vocal music, including lullabies and children's music, and routine auditory stimulation. Thirty-minute segments of the recording were played alternatively with 30 minutes of routine auditory stimulation three times daily. Exposure to music stimulation occurred only during the infants' stay in the NBICU. Results suggest music stimulation may have significantly reduced initial weight loss, increased daily average weight, increased formula and caloric intake, significantly reduced length of the NBICU and total hospital stays, and significantly reduced the daily group mean of stress behaviors for the experimental group. Data analyses suggest the length of hospital stay may be correlated with the amount of stress experienced by the neonate and not with weight gains. Theoretical and practical aspects of these results are discussed.

  13. [Problems in career planning for novice medical technologists in Japanese national hospitals].

    Science.gov (United States)

    Ogasawara, Shu; Tsutaya, Shoji; Akimoto, Hiroyuki; Kojima, Keiya; Yabaka, Hiroyuki

    2012-12-01

    Skills and knowledge regarding many different types of test are required for medical technologists (MTs) to provide accurate information to help doctors and other medical specialists. In order to become an efficient MT, specialized training programs are required. Certification in specialized areas of clinical laboratory sciences or a doctoral degree in medical sciences may help MTs to realize career advancement, a higher earning potential, and expand the options in their career. However, most young MTs in national university hospitals are employed as part-time workers on a three-year contract, which is too short to obtain certifications or a doctoral degree. We have to leave the hospital without expanding our future. We need to take control of our own development in order to enhance our employability within the period. As teaching and training hospitals, national university hospitals in Japan are facing a difficult dilemma in nurturing MTs. I hope, as a novice medical technologist, that at least university hospitals in Japan create an appropriate workplace environment for novice MTs.

  14. Postpartum Care Services and Birth Features of The Women Who Gave Birth in Burdur in 2009

    Directory of Open Access Journals (Sweden)

    Binali Catak

    2011-10-01

    Full Text Available AIM: In the study, it is aimed to evaluate postpartum care services and the delivery characteristics of the women who gave birth in Burdur in 2009. MATERIAL AND METHODS: In the study, the data is used about \\\\\\"Birth and Postpartum Care\\\\\\" of the research \\\\\\" Birth, Postpartum Care Services, and Nutritional Status of Children of the women who are giving birth in Burdur in 2009 \\\\\\". The population of the planned cross-sectional study are women who gave birth in Burdur in 2009. For the determination of the population, a list of women who gave birth in 2009 were used which was requested from family physicians. The reported number of women was 2318. The sample size representing the population to be reached was calculated as 1179. The data were collected using face-to-face interviews and were analyzed using SPSS package program. RESULTS: The mean age of the women was 27.1 (± 5.5 with an average size of households 4.3 (± 1.2. 22.1% of the women live with large families and 64.4% live in the village. 8.0% of the women were relatives with their husbands, 52.8% have arranged marriage and 1.3% have no official marriage. 1 in every 4 women is housewive, 1.8% have no formal education, 76.4% have no available social and 7.1% have no available health insurance. The average number of pregnancies of women is 2.1 (± 1.2 and number of children is 1.8 (± 0.8. Spontaneous abortion, induced abortion, stillbirth and death rate of children under 5 years of age are respectively 16.4%, 6.6%, 2.7%, 3.4%. 99.8% of the women have given birth in hospital, % 67.3 had medical supervision, 62.8% had cesarean birth. The average days of hospital stay after birth is 1.9 (± 3.1. 4.8% of the women after being discharged from the hospital have not received Postpartum Care (DSB. Of the women who have received DSB service, 2.2% had taken this service at home by family physician / family health stuff, 33.9% by obstetrician in practice. 92.2% of the women 1 time, 15

  15. Assessing multiple hospitalizations for health-plan-managed Medicaid diabetic members.

    Science.gov (United States)

    Cramer, Samuel; Chapa, Griselda; Kotsos, Thomas; Jenich, Herman

    2010-01-01

    This study is a retrospective analysis of medical claims of individuals with diabetes enrolled in managed Medicaid as well as a diabetes management program. The sample consists of 695 individuals who had at least two hospitalizations in one calendar year. This study had two related aims. The first was to examine factors associated with an increased risk of repeat hospitalizations. The second was to determine an appropriate alternative to rehospitalization. Using negative binominal regression, we find that members most likely to be rehospitalized have congestive heart failure or psychosis. We suggest that rehospitalizations in this population may be mitigated by providing home healthcare.

  16. Ketogenic Diet for Children with Epilepsy: A Practical Meal Plan in a Hospital

    Science.gov (United States)

    2016-01-01

    A ketogenic diet (KD) is a dietary approach to treat intractable epilepsy. The KD begins with hospitalization and the child and their parents can adapt to the KD for 1-2 weeks. Recently, various type of dietary intervention such as the modified Atkins diet (MAD) and the low glycemic index treatment (LGIT) have been performed. Since 2010, we carried out the KD, MAD, and LGIT for total of 802 patients; 489 patients (61%) for the KD, 147 patients (18.3%) with the MAD, and 166 patients (20.7%) for the LGIT. In this report, application of these dietary practices in Severance Hospital is shared. PMID:26839878

  17. Participatory Design and Development of a Patient-centered Toolkit to Engage Hospitalized Patients and Care Partners in their Plan of Care.

    Science.gov (United States)

    Dykes, Patricia C; Stade, Diana; Chang, Frank; Dalal, Anuj; Getty, George; Kandala, Ravali; Lee, Jaeho; Lehman, Lisa; Leone, Kathleen; Massaro, Anthony F; Milone, Marsha; McNally, Kelly; Ohashi, Kumiko; Robbins, Katherine; Bates, David W; Collins, Sarah

    2014-01-01

    Patient engagement has been identified as a key strategy for improving patient outcomes. In this paper, we describe the development and pilot testing of a web-based patient centered toolkit (PCTK) prototype to improve access to health information and to engage hospitalized patients and caregivers in the plan of care. Individual and group interviews were used to identify plan of care functional and workflow requirements and user interface design enhancements. Qualitative methods within a participatory design approach supported the development of a PCTK prototype that will be implemented on intensive care and oncology units to engage patients and professional care team members developing their plan of care during an acute hospitalization.

  18. Birth defects in Yantai Yuhuangding Hospital during 2006 -2010%2006年-2010年烟台毓璜顶医院围产儿出生缺陷分析

    Institute of Scientific and Technical Information of China (English)

    曲鑫; 刘志芬; 李蕾; 徐爱群; 柳红杰

    2012-01-01

    Objective: To explore the situation, influencing factors, diagnosis of the birth defects in our hospital, so as to provide evidences for periconceptional care. Methods; 301 birth defects in a total of 22211 births were monitored from 2006 to 2010, the birth defect rate was 13. 55% (301/22211). The top 5 common birth defects were Cadiovascular disease, total cleft in lip and palate , synpolydactyly, anephrogenesis or Polycystic kidney and Genital malformation. There was significant difference in birth defect rate between puerperal at city and countryside (x2 = 24. 34, P < 0. 01). There was no significant difference in birth defect rate between puerperal at different age, with different educational status, or different gender of fetus, But, the birth defect rate were higher in the age below 25 and exceed 35 groups than the other group, and the birth defect rate decrease when the educational status of puerperal increase. 48. 17% (145/301 ) cases were confirmed in prenatal diagnosis, and the main method was Ultrasonic Diagnosis. Conclusions: The key to reduce the birth defect rate is the primary prevention. We should improve the quality of antenatal examination and prenatal diagnosis technology, reduce birth defects, and improve the population quality of newborn.%目的 探讨我院围产儿出生缺陷发生状况、影响因素及确诊手段,为探索开展围孕期保健提供依据.方法 对2006年- 2010年5年间在我院住院分娩出生围产儿的监测资料进行回顾性分析.结果 2006年- 2010年我院共出生22211例围产儿,出生缺陷共301例,出生缺陷发生率为13.55‰(301/22211).出生缺陷率位居前五位的分别为先天性心血管疾病、唇腭裂、多指与并指(趾)、单肾缺如及多囊肾、生殖器畸形.产妇城乡间出生缺陷发生率比较差异有统计学意义(x2=24.34,P<0.01).不同年龄、文化程度及胎儿性别比较,差异无统计学意义,但年龄<25岁及≥35岁的产妇其出生缺陷率

  19. Fulfilling the potential of traditional birth attendants.

    Science.gov (United States)

    Okubagzhi, G S

    1988-01-01

    In the Gondar region of Ethiopia, a study was conducted which examined the role of traditional birth attendants in the health care of mother and child, as opposed to modern medical practitioners, and the effects of training on the success of these attendants. 855 women who gave birth in the year before training of the attendants and 861 women who gave birth in the year after training were compared. Differences seen after training included the amount of women receiving antenatal care (48.6% before; 61.2% after), the proportion of women immunized during pregnancy (29.1% before; 65.5% after), a reduction in unsafe practices, utilization of UNICEF kits to cut the umbilical cord after training, a decrease in the amount of newborns requiring resuscitation (11% before; 7% after), an increase in the knowledge of family planning (13.85 of women before training; 43.4% after), and a slight decrease in infant mortality (rate fell from 103 to 99.4/1000). Those practices remaining unchanged included place of delivery (71.1% at home; 28.9% in the hospital), infant feeding, and the performance of uvulectomies. The traditional birth attendants were trained to give the mother care before and after birth. Unless these attendants are compensated by the community in the future, it may be difficult for them to continue their services since their workload is very heavy. The trained attendants complained of basic equipment shortages which may be relieved by community cooperation with the Revolutionary Ethiopia Women's Association. Traditional attendants remain the preferred human resource for pregnant women in Ethiopia, so it is important for trainers to understand local practices before training. Trained attendants should be supervised by health care personnel and should be trained to recognize and refer high risk cases to doctors. The importance of training should be discussed with community leaders and compensation for the attendants should be provided.

  20. Not just bricks and mortar: planning hospital cancer services for Aboriginal people

    Directory of Open Access Journals (Sweden)

    Durey Angela

    2011-03-01

    Full Text Available Abstract Background Aboriginal people in Australia experience higher mortality from cancer compared with non-Aboriginal Australians, despite an overall lower incidence. A notable contributor to this disparity is that many Aboriginal people do not take up or continue with cancer treatment which almost always occurs within major hospitals. Thirty in-depth interviews with urban, rural and remote Aboriginal people affected by cancer were conducted between March 2006 and September 2007. Interviews explored participants' beliefs about cancer and experiences of cancer care and were audio-recorded, transcribed verbatim and coded independently by two researchers. NVivo7 software was used to assist data management and analysis. Information from interviews relevant to hospital services including and building design was extracted. Findings Relationships and respect emerged as crucial considerations of participants although many aspects of the hospital environment were seen as influencing the delivery of care. Five themes describing concerns about the hospital environment emerged: (i being alone and lost in a big, alien and inflexible system; (ii failure of open communication, delays and inefficiency in the system; (iii practicalities: costs, transportation, community and family responsibilities; (iv the need for Aboriginal support persons; and (v connection to the community. Conclusions Design considerations and were identified but more important than the building itself was the critical need to build trust in health services. Promotion of cultural safety, support for Aboriginal family structures and respecting the importance of place and community to Aboriginal patients are crucial in improving cancer outcomes.

  1. Critical Analysis to Framework Quality to HR Plan in Bankstown Hospital by SWOT

    Science.gov (United States)

    Khudeir, Hamzeh; Khudeir, DUA'A

    2017-01-01

    This article has recognised the need for fundamental improvements in the HRM department of the Bankstown Hospital. Through the critical analysis and evaluation of internal systems and processes we were able to identify a number of issues as areas where improvement must be facilitated, each with varying degrees of seriousness. The key problem areas…

  2. Preferência pela via de parto nas parturientes atendidas em hospital público na cidade de Porto Velho, Rondônia Delivery preferences among women giving birth at a public hospital in the city of Porto Velho, in the Brazilian State of Rondônia

    Directory of Open Access Journals (Sweden)

    José Ferrari

    2010-12-01

    Full Text Available As parturientes que procuram o Centro Obstétrico do Hospital de Base de Porto Velho, Rondônia, para terem seus filhos são mulheres provenientes das camadas sociais desfavorecidas, ao contrário das mulheres com níveis de renda diferenciados que procuram os médicos em seus consultórios particulares e parem seus filhos por meio de cesarianas com dia e hora previamente marcados. O artigo aborda a questão do aumento da crescente incidência de cesarianas verificado em vários países latinos e também no mundo desenvolvido onde tem motivado necessárias e inadiáveis discussões no campo da Bioética e procura conhecer a opinião das parturientes quanto à via de parto que foram atendidas no Centro Obstétrico do Hospital de Base nos anos de 2006 e 2007.Women who come to give birth at the Obstetrics Center of the Hospital de Base in Porto Velho, in the Brazilian State of Rondônia are from underprivileged social groups. Wealthier women attend private clinics and give birth by way of caesarian section at a pre-scheduled date and time. This article addresses the question of the increase in the incidence of caesarian birth in Latin countries and also in the developed world, where this has provoked necessary and urgent bioethical discussion. It also investigates the opinions of women giving birth at the Obstetrics Center of the Hospital de Base in 2006 and 2007.

  3. An objective method for bed capacity planning in a hospital department - a comparison with target ratio methods.

    Science.gov (United States)

    Nguyen, J M; Six, P; Chaussalet, T; Antonioli, D; Lombrail, P; Le Beux, P

    2007-01-01

    To propose an objective approach in order to determine the number of beds required for a hospital department by considering how recruitment fluctuates over time. To compare this approach with classical bed capacity planning techniques. A simulated data-based evaluation of the impact that the variability in hospital department activity produces upon the performance of methods used for determining the number of beds required. The evaluation criteria included productive efficiency measured by the bed occupancy rate, accessibility measured by the transfer rate of patients due to lack of available beds and a proxy of clinical effectiveness, by the proportion of days during which there is no possibility for unscheduled admission. When the variability of the number of daily patients increases, the Target Occupancy Rate favors productive efficiency at the expense of accessibility and proxy clinical effectiveness. On the contrary, when the variability of the department activity is marginal, the Target Activity Rate penalizes the proxy of clinical effectiveness, and the Target Occupancy Rate underoptimizes productive efficiency. The method we propose led to a superior performance in terms of accessibility and proxy of clinical effectiveness at the expense of productive efficiency. Such a situation is suitable for intensive care units. In the case of other departments, a weighting procedure should be used to improve productive efficiency. This approach could be considered as the first step of a family of methods for quantitative healthcare planning.

  4. Could elective cesarean sections influence the birth weight of full-term infants?

    Directory of Open Access Journals (Sweden)

    Eddie Fernando Candido Murta

    Full Text Available CONTEXT AND OBJECTIVE: There are no studies on birth weights among full-term infants born by means of elective cesarean section. We aimed to study this in private and public hospitals. DESIGN AND SETTING: Retrospective study at Universidade Federal do Triângulo Mineiro, Uberaba, Brazil. METHODS: Data were collected from the municipal medical birth register of Uberaba from January to December 2000. The data obtained (maternal age, type of delivery, number of prenatal care visits and birth weight, from full-term pregnancy from the university hospital (UH, which is a tertiary hospital that only attends patients within the National Health System (SUS, were compared with data from four private hospitals (PHs that attend health insurance plans and private patients. Student's t test, chi2 test and multiple logistic regression were used for statistical analysis, with the significance level set at p < 0.05. RESULTS: In the PHs, 1,100 out of 1,354 births (81.2% were by cesarean section and in the UH, 373 out of 1,332 (28%. Birth weight increased significantly in association with increasing numbers of prenatal care visits, except for cesarean section cases in PHs. Birth weights among vaginal delivery cases in PHs were greater than in the UH (p < 0.05, but this was not observed among cesarean section cases. Multiple logistic regression showed that there was greater risk of low birth weight in PHs (odds ratio: 2.33; 95% confidence interval: 1.19 to 4.55. CONCLUSION: Elective cesarean section performed in PHs may be associated with low birth weight among full-term infants.

  5. Hospital to home: a geriatric educational program on effective discharge planning.

    Science.gov (United States)

    DeCaporale-Ryan, Lauren N; Cornell, Ann; McCann, Robert M; McCormick, Kevin; Speice, Jenny

    2014-01-01

    There has been increased attention on the needs of the burgeoning older adult population, with focus on the limited education and training experiences available in geriatric care. Older adults transitioning between levels of care often require increased attention, and the American Geriatrics Society (AGS) Task Force on the Future of Geriatric Medicine has encouraged greater training opportunities be provided to better understand the needs of this population. The Hospital to Home Program is one model of geriatric training emphasizing many of the AGS recommendations. Through qualitative analyses of 51 internal medicine residents' reflections, the authors report how this educational program is meeting the above need and share how Hospital to Home is enhancing residents' skills in creating a safe discharge for geriatric patients and their families.

  6. Analysis of birth defects supervision in obstetrical hospitals in Beijing Haidian District%北京市海淀区产科医院出生缺陷监测分析

    Institute of Scientific and Technical Information of China (English)

    钟赋真; 张雪峰; 周钰

    2012-01-01

    Objective To understand the incidence of birth defects in hospitals in Haidian District during recent years so as to provide management clue for supervision in the future. Methods From October 1 of 2006 to September 30 of 2010, fetus and newborns between 13 gestational weeks and 7d after delivery were supervised for birth defects in hospitals of Haidian district, and the supervision results were analyzed in terms of rate and cis position. Results There were 3 776 defected cases including 2 861 cases in perinatal period ( the incidence rate of birth defects in perinatal period was 17. 98‰ ) and 906 cases induced to abortion in second trimester. In floating population the incidence rate of birth defects showed a rising trend in perinatal period during these years( x2 =52. 250, P = 0. 000 ). The first five highest rates of birth defects were congenital heart disease, deformity of external ear, multi finger ( toe ), merged finger ( toe ) and hypospadias in order. The trend of neural tube defects rate was stable and the incidence of cleft lip dropped obviously. But the incidence of Trisomy 21 rose gradually, and there was no significant difference (x2 =6. 906, P =0. 075 ). Conclusion The incidence rate of birth defects is 17. 98‰ in hospitals of Haidian district, and the trend of birth defects rate is rising during 2006-2010 year especially in floating population. The primary prevention of folic acid supplement should be strengthened.%目的 了解近年来北京市海淀区医院出生缺陷的发生情况,为今后监测工作的管理重点提供依据.方法 对2006年10月1日至2010年9月30日期间北京市海淀区产科医院孕13周~产后7天的胎儿及新生儿进行出生缺陷监测,并对监测结果进行率及顺位等分析.结果 ①监测到出生缺陷儿3 776例,其中围产期2 861例(围产期出生缺陷儿发生率为17.98‰),中孕引产906例;②2006至2010年,外地户籍围产期出生缺陷发生率呈逐年上升的趋势(χ2

  7. Birth Control Methods

    Science.gov (United States)

    ... Home A-Z Health Topics Birth control methods Birth control methods > A-Z Health Topics Birth control methods ... To receive Publications email updates Enter email Submit Birth control methods Birth control (contraception) is any method, medicine, ...

  8. A dream birth? Try hypnobirthing!

    Science.gov (United States)

    Graves, Katharine

    2013-09-01

    Hypnobirthing is often regarded as a method of pain relief without drugs. This is to miss the point, as it presupposes that pain is there in the first place. When a woman learns to release the preconceptions, fears and worries about birth that are endemic in our society, her experience of giving birth to her baby can be the most wonderful and empowering experience of her life. Mind and body working together can be a powerful and efficient combination. This is how birth is designed to be, as midwives and hospitals are beginning to discover. Thus hypnobirthing can provide a service that women want as well as save scarce NHS funds.

  9. Implementation of a risk management plan in a hospital operating room

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    Li Guo

    2015-12-01

    Full Text Available A risk management program based on AS–NZS4360 risk management standards was developed and implemented in the operating room of Peking University Third Hospital. To accomplish this task, we developed a risk quantification matrix and a risk register form to identify potential risks in the operating room, and then implemented operating room policies designed to reduce or eliminate those risks. We also established a consultation mechanism and risk monitoring system designed to minimize risks to operation room nurses. Finally, we continuously seek to improve our operating room risk management capabilities, so we can continue to improve the quality of service provided and guarantee the safety of surgical patients.

  10. Plan de humanización para el Hospital Naval Guayaquil (HOSNAG).

    OpenAIRE

    Espinel Pactong, Victoria

    2014-01-01

    La actual constitución garantiza la asistencia en salud a todos los ciudadanos y en este empeño se encuentra la autoridad sanitaria nacional dando grandes avances en cuanto a la cobertura para lo cual a más de los hospitales públicos se ha engranado en la asistencia de salud a todos los prestadores de salud mediante la creación de la red pública integral de salud y red complementaria. El Hospital General HOSNAG actualmente forma parte de la red pública integral de salud y está em...

  11. Correlates of Low Birth Weight

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    Ankur Barua MD, PhD

    2014-12-01

    Full Text Available Background. Low birth weight is the single most important factor that determines the chances of child survival. A recent annual estimation indicated that nearly 8 million infants are born with low birth weight in India. The infant mortality rate is about 20 times greater for all low birth weight babies. Methods. A matched case–control study was conducted on 130 low birth weight babies and 130 controls for 12 months (from August 1, 2007, to July 31, 2008 at the Central Referral Hospital, Tadong, East District of Sikkim, India. Data were analyzed using the Statistical Package for Social Sciences, version 10.0 for Windows. Chi-square test and multiple logistic regression were applied. A P value less than .05 was considered as significant. Results. In the first phase of this study, 711 newborn babies, borne by 680 mothers, were screened at the Central Referral Hospital of Sikkim during the 1-year study period, and the proportion of low birth weight babies was determined to be 130 (18.3%. Conclusion. Multiple logistic regression analysis, conducted in the second phase, revealed that low or middle socioeconomic status, maternal underweight, twin pregnancy, previous history of delivery of low birth weight babies, smoking and consumption of alcohol during pregnancy, and congenital anomalies had independent significant association with low birth weight in this study population.

  12. Satisfaction with caregivers during labour among low risk women in the Netherlands: the association with planned place of birth and transfer of care during labour

    National Research Council Canada - National Science Library

    Caroline C Geerts; Jeroen van Dillen; Trudy Klomp; Antoine L M Lagro-Janssen; Ank de Jonge

    2017-01-01

    Background The caregiver has an important influence on women’s birth experiences. When transfer of care during labour is necessary, care is handed over from one caregiver to the other, and this might influence satisfaction with care...

  13. Playing the role of preventing and curing birth defects in the second grade general hospitals%发挥二级综合医院在防治出生缺陷中的作用

    Institute of Scientific and Technical Information of China (English)

    张园园; 蔡慧兰; 吴晨

    2013-01-01

    目的 通过对6个县市二级综合医院产前筛查等情况进行调查研究,探讨预防出生缺陷的新途径.方法 采取定性定量相结合的办法、访谈法、问卷调查法等.结果 二级综合医院开展遗传咨询、产前筛查、产前诊断、新生儿疾病筛查等方面工作做得不够,婚检和婚前保健工作存在薄弱环节.结论 我国出生缺陷总发生率呈上升趋势,加强二级综合医院妇产科建设,充分发挥其产前筛查、遗传咨询、产前诊断职能,有利于帮助解决出生缺陷这一突出的公共卫生问题.%Objective To investigate and study the conditions of prenatal screening and other items in the second grade general hospitals of six counties and cities, and to explore a new way to prevent birth defects. Methods A combination of qualitative and quantitative ways, interviews, questionnaires and other approaches were taken. Results Carrying out genetic counseling, prenatal screening & diagnosis, neonatal disease screening and other items were not good enough in the second grade general hospitals. Meanwhile, the antemarital physical examination and premarital health service had weaknesses. Conclusion The total incidence rate of birth defects in China increases in the ascendant trend. Therefore, it is vital to strengthen the construction of the department of obstetrics and gynecology in the second grade general hospitals, and the hospitals should fully display its functional role in prenatal screening, genetic counseling, prenatal diagnosis which can help resolve the prominent public health problem of birth defects.

  14. [The implementation of the Quebec Mental Health Action Plan: hands-on experience at the Maisonneuve-Rosemont hospital in Montreal].

    Science.gov (United States)

    Bernazzani, Odette; Rondeau, Alain

    2013-01-01

    The Mental Health Action Plan maps out the reorganization of mental health services in the province of Quebec. Accordingly, this paper presents the transformation process of the mental health program at the Maisonneuve-Rosemont hospital in Montreal. The authors discuss, on the one hand, the challenges that were met and, on the other hand, the model of care and organisational choices that were adopted. This article is divided in three parts. The first part describes the two main guiding principles underlying the Mental Health Action Plan. The second part examines the context surrounding the arrival of the Action Plan at the Maisonneuve-Rosemont Hospital. The third part describes the hospital transformation process that evolved in relation with: 1- the new centralized access points for mental health services; 2- the support for first line (or primary care) services; 3- the second line services for the specialized treatment of complex mental health problems.

  15. The Application of Water Birth at the Grassroots Level Hospital%水中分娩在基层医院的应用思考

    Institute of Scientific and Technical Information of China (English)

    雷金菊

    2014-01-01

    目的:探讨水中分娩对分娩过程中疼痛程度、产程时间、产后出血量及新生儿情况,评估其临床应用的价值。方法:抽取水中分娩的产妇120例为水中分娩组,抽取同期经阴道自然分娩的产妇140例为对照组,比较两组产妇的疼痛程度、产程时间、产后24 h出血量及新生儿窒息情况。结果:水中分娩组产妇疼痛程度及产程时间显著少于对照组(P0.05)。结论:水中分娩可以减轻疼痛、缩短产程,而产后出血量及新生儿窒息并无增加。%Objective: To explore the advantages of water birth during childbirth pain, duration of labor, postpartum hemorrhage and neonatal conditions, assess its value in clinical applications.Method: 120 cases birth mothers were extracted as water delivery group,140 cases of women who natural vaginal delivery in the same period were extracted as the control group. The maternal pain levels, labor time, 24 hours postpartum hemorrhage and newborn asphyxia were compared between the two groups.Result: The maternal pain levels and labor time in the water birth group were significantly less than the control group(P<0.05). While there were no significant difference of postpartum hemorrhage after 24 hours and newborn asphyxia between the water birth group and the control group.Conclusion: The water birth can reduce pain, shorten labor, postpartum hemorrhage and newborn asphyxia does not increase.

  16. Un modelo de programación por metas para el plan de producción de un hospital del servicio vasco de salud

    Directory of Open Access Journals (Sweden)

    Mariano Jiménez

    2005-01-01

    Full Text Available Este artículo propone un modelo de programación por metas para la asignación de recursos en un hospital de Osakidetza (Servicio Vasco de Salud, basado en su Plan Anual de Gestión. El estudio se realiza tomando como base los GRD (Grupos Relacionados por el Diagnóstico tratados por los diferentes servicios médicos de un hospital, teniendo en cuenta, entre otros aspectos: los recursos financieros, los indicadores sanitarios, el Plan de Producción (el case-mix y los objetivos estratégicos del hospital. El artículo finaliza con una breve presentación de los resultados obtenidos al aplicar nuestro modelo a un hospital de tamaño medio (114 camas de Osakidetza.

  17. Comprehensive computerized medical imaging at Victoria General Hospital: final implementation plan

    Science.gov (United States)

    Fisher, Paul D.; Brauer, Gerhard W.; Nosil, Josip; Scobie, Duncan L.; Clark, R. P.; Ritchie, Gordon W.; Weigl, Wilhelm J.

    1990-08-01

    A plan for the installation and implementation of a comprehensive computer-based system for the management and communication of digital radiographic images and diagnostic information is described. The paper is based on the authors' experience with, and evaluation of, prototype equipment and systems over the past 5 years. The final configuration will be realized in 1992 at the completion of a 3-phase installation plan. The system will address the clinical, data management, and administrative needs of the different types of users within the department, as well as the requirement to distribute radiographic information and images to locations outside of the department. In order to be considered successful, the system described herein will need to bring about a 90% reduction in both paper- and film-based communication of images and information. The British Columbia Ministry of Health is funding this phase of the project in order to obtain information on which to base decisions regarding installation of similar systems at other sites within the Province and predict with some confidence the cost effectiveness of such decisions.

  18. Women's perceptions of caesarean birth: a Roy international study.

    Science.gov (United States)

    Fawcett, Jacqueline; Aber, Cynthia; Haussler, Susan; Weiss, Marianne; Myers, Sheila Taylor; Hall, Jaye L; Waters, V Lynn; King, Charlette; Tarkka, Marja-Terttu; Rantanen, Anja; Astedt-Kurki, Paivi; Newton, Jennifer; Silva, Virginia

    2011-10-01

    The purpose of this Roy adaptation model-based multi-site international mixed method study was to examine the relations of type of caesarean birth (unplanned/planned), number of caesarean births (primary/repeat), and preparation for caesarean birth to women's perceptions of and responses to caesarean birth. The sample included 488 women from the United States (n = 253), Finland (n = 213), and Australia (n = 22). Path analysis revealed direct effects for type of and preparation for caesarean birth on responses to caesarean birth, and an indirect effect for preparation on responses to caesarean birth through perception of birth the experience.

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

    Science.gov (United States)

    Kash, Bita A; Deshmukh, A A

    2013-01-01

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

  20. RETROSPECTIVE STUDY OF RELAPAROTOMY IN DEPARTMENT OF OBSTRETRICS, GYNAECOLOGY AND FAMILY PLANNING IN, RURAL TERTIARY CARE HOSPITAL, ANDHRA PRADESH, INDIA

    Directory of Open Access Journals (Sweden)

    Uma Thombarapu, Prabha Devi Kodey, GangadharaRao Koneru

    2015-07-01

    Full Text Available Introduction: Relaparotomy is biggest dilemma to the surgeon and critical to the patient to undergo second surgery within short span of time .It is challenging both physically and mentally to the patient. Aim: Aim of the study was to determine incidence of relaparotomy and its indication, management and outcome in the department of Obstetrics, Gynaecology and Family Planning (OBGYN & FP in NRI Medical College & General Hospital at Guntur District. Materials and Methods: It is a retrospective observational study for the duration of 3 and ½ years. Total number of surgeries -7, 718. Total number of relaparotomy- 27 which include referral cases. Results: Incidence for relaparotomy was 0.34%. Most important cause for relaparotomy was haemorrhagic causes (44.4%, followed by burst abdomen (33.3%. Relaparotomy can increase morbidity, mortality (14.8% of patients with increased hospital stay on an average of 27 days including Intensive Care Unit, further increasing the financial burden to the patient. Conclusion: Emergency relaparotomy is a life saving procedure. Good expertise in selection of primary surgery and right surgical technique, intra operative hemostasis, control of post operative infection can avoid relaparatomy

  1. Community-Engaged Public Health Research to Inform Hospital Campus Planning in a Low Socioeconomic Status Urban Neighborhood.

    Science.gov (United States)

    Brittin, Jeri; Elijah-Barnwell, Sheila; Nam, Yunwoo; Araz, Ozgur; Friedow, Bethany; Jameton, Andrew; Drummond, Wayne; Huang, Terry T-K

    2015-01-01

    To compare sociodemographic and motivational factors for healthcare use and identify desirable health-promoting resources among groups in a low socioeconomic status (SES) community in Chicago, IL. Disparities in health services and outcomes are well established in low SES urban neighborhoods in the United States and many factors beyond service availability and quality impact community health. Yet there is no clear process for engaging communities in building resources to improve population-level health in such locales. A hospital building project led to a partnership of public health researchers, architects, and planners who conducted community-engaged research. We collected resident data and compared factors for healthcare use and choice and likelihood of engaging new health-promoting services. Neighborhood areas were strongly associated with ethnic groupings, and there were differences between groups in healthcare choice and service needs, such as, proximity to home was more important to Latinos than African Americans in choice of healthcare facility ( p adj = .001). Latinos expressed higher likelihood to use a fitness facility ( p adj = .001). Despite differences in vehicle ownership, >75% of all respondents indicated that nearby public transportation was important in choosing healthcare. Knowledge of community needs and heterogeneity is essential to decision makers of facility and community development plans. Partnerships between public health, urban planning, architecture, and local constituents should be cultivated toward focus on reducing health disparities. Further work to integrate community perspectives through the planning and design process and to evaluate the long-term impact of such efforts is needed. © The Author(s) 2015.

  2. KNOWLEDGE AND ATTITUDE OF PUERPERAL WOMEN TOWARDS FAMILY PLANNING PRACTICES IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Atmaja Nair

    2017-01-01

    Full Text Available BACKGROUND India is the second most populous country in the world after China. In an effort to stabilize the population, National Family Welfare Program was launched in 1951. There has been an increase in contraceptive prevalence and a reduction in total fertility rate since then. For better results, contraceptive use should start right from the post partum period. This also significantly reduces maternal and infant mortality rates. AIM To assess the knowledge and attitude about contraception in post-partum women in a tertiary care teaching hospital in North Kerala. MATERIALS AND METHODS This cross sectional study was conducted in the Department of Obstetrics and Gynaecology, IMCH, Govt. Medical College, Kozhikode, Kerala, between January 2016 and March 2016, using a prestructured questionnaire, in postpartum women. Their knowledge and attitude about contraception was assessed. RESULTS A total of 1500 postpartum women were included in the study. 80% were aware of some method of contraception. This knowledge increased with increasing education, parity and better socioeconomic class. Major source of information was health worker (46.67%. But only 18.33% had practiced any method of contraception before and 44% only showed willingness to use any contraception. The major reason for non-acceptance of contraception was the need for more children. CONCLUSION Low prevalence seen in the use of contraception can be overcome by promoting spacing methods like PPIUCD, injectables and pills. The couple should be counselled together to alleviate the anxiety in the husband.

  3. Planning, expectation, and image evaluation for PACS at the University of Iowa Hospitals and Clinics

    Science.gov (United States)

    Franken, E. A., Jr.; Smith, Wilbur L.; Berbaum, Kevin S.; Owen, David A.; Hilsenrath, Peter

    1990-08-01

    Our strategy in studying PACS is to evaluate its clinical implementation working with equipment supplied by an established manufacturer. Fiscal and personnel resources required to design and integrate the hardware components and operational software to develop a functional PACS precluded a bottom up development approach at our institution. Imaging equipment vendors possess more abundant design development resources for this task and therefore can support a more rapid development of the initial components of PACS. For this reason we have chosen to serve as a beta test site to study the viability of the basic PACS components in a clinical setting. Our efforts primarily focus on: (1) image quality; (2) cost effectiveness; (3) PACS/HIS/RIS integration; (4) equipment and software reliability; and (5) overall system performance. The results of our studies are shared with the vendor for future PACS development and refi nement. To attain our investigational goals we have formed an interdisciplinary team of Radiologists, Perceptual Psychologist, Economist, Electrical and Industrial Engineers, Hospital Information System personnel and key departmental administrative staff. For several reasons Pediatric Radiology was targeted as the initial area for our PACS study: a small area representative of the overall operation,tight operational controls and willingness of physicians. We used a step-wise approach, the first step being the installation of PACS exclusively within the physical confines of Pediatric Radiology.

  4. Trends in differences between births and surviving infants reported for immunization program planning and external data sources in Eastern and Southern Africa 2000-2013.

    Science.gov (United States)

    Kaiser, Reinhard; Chakauya, Jethro M; Shibeshi, Messeret E

    2016-02-24

    To inform our WHO team's support for immunization programs in Member States in Eastern and Southern Africa, we compared annual trends from 2000 to 2013 in target populations reported by Member States through the WHO-UNICEF joint reporting form with United Nations (UN) population projections and modeled infant mortality estimates from the UN Inter-agency Group for Child Mortality Estimation. Our findings indicated a tendency of underestimating births and surviving infants used by Member States as denominators for administrative immunization coverage rates, resulting in or contributing to overestimation of coverage. The difference with UN estimates appeared to be more pronounced for surviving infants than births. Measures of central tendency for individual country differences indicated that those differences decreased over time. Comparing trends of births and surviving infants with external sources can help monitoring progress in efforts to provide accurate and reliable target population estimates and sampling frames.

  5. Understanding Recent Home-Birth Research: An Interview With Drs. Melissa Cheyney and Jonathan Snowden.

    Science.gov (United States)

    Cheyney, Melissa

    2016-01-01

    In the past month, two new studies have been released-one in The New England Journal of Medicine (NEJM; Snowden et al., 2015) and the other in the Canadian Medical Association Journal (Hutton et al., 2015)-comparing out-of-hospital birth outcomes to hospital birth outcomes. These studies join a growing body of literature that consistently shows high rates of obstetric intervention in hospitals and also show low risk to neonates regardless of setting. However, the recent NEJM study found a small but statistically significant increase in risk for perinatal mortality for babies born out of hospital. Jeanette McCulloch of BirthSwell (http://www.birthswell.com) interviews Melissa Cheyney, PhD, CPM, LDM, medical anthropologist, chair of the Midwives Alliance Division of Research, and lead author on the largest study of outcomes for planned home births in the United States to date (Cheyney et al., 2014a), and Jonathan Snowden, PhD, epidemiologist and assistant professor in the Department of Obstetrics and Gynecology and School of Public Health at Oregon Health and Science University. Snowden is also the lead author of the recent NEJM study.

  6. Preparing for Multiple Births

    Science.gov (United States)

    ... Video Games, and the Internet Preparing for Multiple Births KidsHealth > For Parents > Preparing for Multiple Births Print ... a combination of both. The Risks of Multiple Births The most common risk involved with multiple births ...

  7. Impact of change in maternal age composition on the incidence of Caesarean section and low birth weight: analysis of delivery records at a tertiary hospital in Tanzania, 1999–2005

    Directory of Open Access Journals (Sweden)

    Kidanto Hussein L

    2009-07-01

    Full Text Available Abstract Background Previous studies on change in maternal age composition in Tanzania do not indicate its impact on adverse pregnancy outcomes. We sought to establish temporal changes in maternal age composition and their impact on annual Caesarean section (CS and low birth weight deliveries (LBWT at Muhimbili National Hospital in Tanzania. Methods We conducted data analysis of 91,699 singleton deliveries that took place in the hospital between 1999 and 2005. The data were extracted from the obstetric data base. Annual proportions of individual age groups were calculated and their trends over the years studied. Multiple logistic analyses were conducted to ascertain trends in the risks of CS and LBWT. The impact of age composition changes on CS and LBWT was estimated by calculating annual numbers of these outcomes with and without the major changes in age composition, all others remaining equal. In all statistics, a p value Results The proportion of teenage mothers (12–19 years progressively decreased over time while that of 30–34 years age group increased. From 1999, the risk of Caesarean delivery increased steadily to a maximum in 2005 [adjusted OR = 1.7; 95%CI (1.6–1.8] whereas that of LBWT declined to a minimum in 2005 (adjusted OR = 0.76; 95% CI (0.71–0.82. The current major changes in age trend were responsible for shifts in the number of CS of up to206 cases per year. Likewise, the shift in LBWT was up to 158 cases per year, but the 30–34 years age group had no impact on this. Conclusion The population of mothers giving birth at MNH is progressively becoming older with substantial impact on the incidence of CS and LBWT. Further research is needed to estimate the health cost implications of this change.

  8. Reduced Hospital Mortality With Surgical Ligation of Patent Ductus Arteriosus in Premature, Extremely Low Birth Weight Infants: A Propensity Score-matched Outcome Study.

    Science.gov (United States)

    Tashiro, Jun; Perez, Eduardo A; Sola, Juan E

    2016-03-01

    To evaluate outcomes after surgical ligation (SL) of patent ductus arteriosus (PDA) in premature, extremely low birth weight (ELBW) infants. Optimal management of PDA in this specialized population remains undefined. Currently, surgical therapy is largely reserved for infants failing medical management. To date, a large-scale, risk-matched population-based study has not been performed to evaluate differences in mortality and resource utilization. Data on identified premature (Propensity score-matched analysis of 1620 SL versus 1584 non-SL found reduced mortality (15% vs 26%) and more routine disposition (48% vs 41%) for SL (P Propensity score-matched analysis demonstrates reduced mortality in premature/ELBW infants with SL for PDA. NEC and sepsis are predictors of mortality and resource utilization.

  9. RETINOPATHY OF PREMATURITY IN INFANTS WITH BIRTH ...

    African Journals Online (AJOL)

    hi-tech

    2000-10-10

    Oct 10, 2000 ... Setting: Neonatal unit at Maternity Hospital, Kuwait city, Kuwait. Methods: All low birth ... surfactant therapy (Survanta®); presence of anaemia or hypotension at .... breath), following pregnancy or labour complications. To such ...

  10. THE INFLUENCE OF LEADERSHIP IN THE CONDUCT OF THE IMPLEMENTATION PROCESS OF STRATEGIC PLANNING: A CASE STUDY AT THE UNIVERSITY HOSPITAL OF THE UNIVERSITY OF ST CATHERINE

    Directory of Open Access Journals (Sweden)

    Giselly Rizzatti

    2012-09-01

    Full Text Available Teaching hospitals are undergoing profound and fast changes, especially resulting from the implementation of new policies for health. To achieve their goals and remain competitive, these organizations have been forced to adopt more effective management tools, among which are the elaboration of a strategic plan. The goal of this study is to analyze the influence of leadership in driving the implementation process of strategic planning in a teaching hospital. The study was conducted in the university hospital Prof. Polydoro Ernani de São Thiago from Federal University of Santa Catarina - HU / UFSC, where a semi-structured interview was conducted with the coordinator of the Strategic Planning Team HU / UFSC. Authors Hersey et al (1986, Northouse (2004, Schein (1997 Senge (1999, among others, were grounded theoretically in the theme of leadership. The theory of strategic planning was primarily based on works by authors Ansoff (l991, Hrebiniak (2006 and Pereira (2010. With the research results, we can conclude the great influence that leadership plays in driving the implementation process of strategic planning.

  11. Translating a National Laboratory Strategic Plan into action through SLMTA in a district hospital laboratory in Botswana

    Directory of Open Access Journals (Sweden)

    Keoratile Ntshambiwa

    2014-09-01

    Full Text Available Background: The Ministry of Health (MOH of Botswana adopted Strengthening Laboratory Management Toward Accreditation (SLMTA, a structured quality improvement programme, as a key tool for the implementation of quality management systems in its public health laboratories. Coupled with focused mentorship, this programme aimed to help MOH achieve the goals of the National Laboratory Strategic Plan to provide quality and timely clinical diagnosis.Objectives: This article describes the impact of implementing SLMTA in Sekgoma Memorial Hospital Laboratory (SMHL in Serowe, Botswana.Methods: SLMTA implementation in SMHL included trainings, improvement projects, site visits and focused mentorship. To measure progress, audits using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA checklist were conducted at baseline and exit of the programme, with scores corresponding to a zero- to five-star scale.Turnaround times and customer satisfaction were tracked.Results: The laboratory scored 53% (zero stars at the baseline audit and 80% (three stars at exit. Nearly three years later, the laboratory scored 85% (four stars in an official audit conducted by the African Society for Laboratory Medicine. Turnaround times became shorter after SLMTA implementation, with reductions ranging 19% to 52%; overall patient satisfaction increased from 56% to 73%; and clinician satisfaction increased from 41% to 72%. Improvements in inventory management led to decreases in discarded reagents, reducinglosses from US $18 000 in 2011 to $40 in 2013.Conclusion: The SLMTA programme contributed to enhanced performance of the laboratory,which in turn yielded potential positive impacts for patient care at the hospital.

  12. Role of Surgical Services in Profitability of Hospitals in California: An Analysis of Office of Statewide Health Planning and Development Annual Financial Data.

    Science.gov (United States)

    Moazzez, Ashkan; de Virgilio, Christian

    2016-10-01

    With constant changes in health-care laws and payment methods, profitability, and financial sustainability of hospitals are of utmost importance. The purpose of this study is to determine the relationship between surgical services and hospital profitability. The Office of Statewide Health Planning and Development annual financial databases for the years 2009 to 2011 were used for this study. The hospitals' characteristics and income statement elements were extracted for statistical analysis using bivariate and multivariate linear regression. A total of 989 financial records of 339 hospitals were included. On bivariate analysis, the number of inpatient and ambulatory operating rooms (ORs), the number of cases done both as inpatient and outpatient in each OR, and the average minutes used in inpatient ORs were significantly related with the net income of the hospital. On multivariate regression analysis, when controlling for hospitals' payer mix and the study year, only the number of inpatient cases done in the inpatient ORs (β = 832, P = 0.037), and the number of ambulatory ORs (β = 1,485, 466, P = 0.001) were significantly related with the net income of the hospital. These findings suggest that hospitals can maximize their profitability by diverting and allocating outpatient surgeries to ambulatory ORs, to allow for more inpatient surgeries.

  13. Resultado de partos domiciliares atendidos por enfermeiras de 2005 a 2009 em Florianópolis, SC Resultado de partos domiciliares atendidos por enfermeras de 2005 a 2009 en Florianópolis, Sur de Brasil Outcomes of planned home birth assisted by nurses, from 2005 to 2009, in Florianópolis, Brazil

    Directory of Open Access Journals (Sweden)

    Joyce Green Koettker

    2012-08-01

    Full Text Available Estudo transversal sobre resultados obstétricos e neonatais dos partos domiciliares planejados assistidos por enfermeiras obstétricas em Florianópolis, SC. Dados coletados nos prontuários de 100 parturientes assistidas de 2005 a 2009 apontam 11 transferências hospitalares, sendo nove submetidas a cesariana. A maioria das que pariram no domicílio apresentou batimentos cardíacos fetais (94,0% e evolução no partograma normais (61,0%, adotou posição vertical na água, no período expulsivo (71,9%, e os recém-nascidos receberam Apgar do 5° minuto > 7 (98,9%. A frequência de episiotomia foi 1,0%, 49,4% não necessitaram sutura perineal. Os resultados indicam que o parto domiciliar é seguro.Estudio transversal sobre resultados obstétricos y neonatales de los partos domiciliares planificados asistidos por enfermeras obstétricas en Florianópolis, Sur de Brasil. Datos colectados en los prontuarios de 100 parturientas asistidas de 2005 a 2009, señalan 11 transferencias hospitalarias, siendo nueve sometidas a cesárea. La mayoría de las que parieron en el domicilio presentó pulsaciones cardíacas fetales (94,0% y evolución en el partograma normales (61,0%, adoptó posición vertical en el agua, en el período expulsivo (71,9%, y los recién nacidos recibieron Apgar al 5° minuto >7 (98,9%. La frecuencia de episiotomía fue 1,0%, 49,4% no necesitaron sutura perineal. Los resultados indican que el parto domiciliar es seguro.A cross-sectional study was performed to analyze obstetric and neonatal results of planned home births assisted by obstetric nurses in the city of Florianópolis, Southern Brazil. Data collected from the medical records of 100 parturient women cared for between 2005 and 2009 indicated 11 hospital transfers, nine of which underwent a Cesarean section. The majority of women who had a home birth showed normal fetal heart beat (94.0% and progress on the partogram (61.0%, vertical water delivery was the position most

  14. A STUDY ON PREVAL E NCE OF BIRTH DEFECTS AND ITS ASSOCIATION WITH RISK FACTORS IN FAKHRUDHIN ALI AH MED MEDICAL COLLEGE AND HOSPITAL

    Directory of Open Access Journals (Sweden)

    Alpana

    2015-07-01

    Full Text Available OBJECTIVE: Congenital anomalies or Birth Defects are a global problem. It is the most common cause of disability in developed and developing countries. This study aims to evaluate the overall prevalence of clinically detectable congenital anomalies in newborns along with the different forms of congenital anomalies and associated risk factors if any over a period of one year. MATERIALS AND METHOD S: I t’s an observational analytical cross sectional type of study. Seven thousand seven hundred and ninety eight babies born during the period from 1 st Nov, 2013 to 31 st Oct, 2014 were analyzed. Details of cases were recorded after parent’s interviews, clinical, radiological and laboratory evaluations. RESULTS: In our study, we have found that out of the total no. of 7798 babies born during the said period, the total number of congenital anomalies found were 53 0.7%. Cleft lip and palate was the most common anomaly followed by clubfoot. System wise, congenital anomaly of the musculoskeletal system was the highest (45.3%. A male preponderance is seen with M:F = 4:3. Maximum number of anomalies was found in the 20 - 25 y rs of age group. Moreover, anomalies were found more in primi gravida. Various risk factors were associated in 9 numbers of cases out of 53. CONCLUSIONS: Prevalence of congenital anomaly was found to be 0.7% and therefore awareness about preventable risk f actors should be created and early prenatal diagnosis and management of anomalies is recommended.

  15. O registro de nascimento e sua importância em planejamento materno-infantil Live-birth register and its importance to maternal and child care planning

    Directory of Open Access Journals (Sweden)

    Maria Stella Levy

    1971-06-01

    Full Text Available Foi estimada a proporção de nascimentos registrados conforme o artigo 63 do decreto n.° 4.857 de 9 de novembro de 1939 - Lei dos Registros Públicos que obirga o registro de nascimento "no cartório do lugar em que tiver ocorrido o parto, no prazo de 15 dias após o nascimento", ou "na falta ou impedimento do pai", até 60 dias após o nascimento. No distrito de São Paulo, por "lugar onde ocorreu o parto", entende-se cada um dos 48 subdistritos em que o mesmo se subdivide. Com base em amostras colhidas em maternidades, foram estimadas essas proporções, no ano base de 1969.With basic on a probabilistic sample of live births collected in maternities, an estimative of the proportion of live births registered was made. According to the Brazilian law, the register has to be done in an especific date and place, depending on the local area where the birth occurred. The year-base for this study was 1969.

  16. Birth in Brazil: national survey into labour and birth

    Directory of Open Access Journals (Sweden)

    do Carmo Leal Maria

    2012-08-01

    Full Text Available Abstract Background Caesarean section rates in Brazil have been steadily increasing. In 2009, for the first time, the number of children born by this type of procedure was greater than the number of vaginal births. Caesarean section is associated with a series of adverse effects on the women and newborn, and recent evidence suggests that the increasing rates of prematurity and low birth weight in Brazil are associated to the increasing rates of Caesarean section and labour induction. Methods Nationwide hospital-based cohort study of postnatal women and their offspring with follow-up at 45 to 60 days after birth. The sample was stratified by geographic macro-region, type of the municipality and by type of hospital governance. The number of postnatal women sampled was 23,940, distributed in 191 municipalities throughout Brazil. Two electronic questionnaires were applied to the postnatal women, one baseline face-to-face and one follow-up telephone interview. Two other questionnaires were filled with information on patients’ medical records and to assess hospital facilities. The primary outcome was the percentage of Caesarean sections (total, elective and according to Robson’s groups. Secondary outcomes were: post-partum pain; breastfeeding initiation; severe/near miss maternal morbidity; reasons for maternal mortality; prematurity; low birth weight; use of oxygen use after birth and mechanical ventilation; admission to neonatal ICU; stillbirths; neonatal mortality; readmission in hospital; use of surfactant; asphyxia; severe/near miss neonatal morbidity. The association between variables were investigated using bivariate, stratified and multivariate model analyses. Statistical tests were applied according to data distribution and homogeneity of variances of groups to be compared. All analyses were taken into consideration for the complex sample design. Discussion This study, for the first time, depicts a national panorama of labour and birth

  17. European birth cohorts for environmental health research

    DEFF Research Database (Denmark)

    Vrijheid, Martine; Casas, Maribel; Bergström, Anna;

    2012-01-01

    Many pregnancy and birth cohort studies investigate the health effects of early-life environmental contaminant exposure. An overview of existing studies and their data is needed to improve collaboration, harmonization, and future project planning....

  18. Strategic information for hospital service planning: a linked data study to inform an urban Aboriginal Health Liaison Officer program in Western Australia.

    Science.gov (United States)

    Katzenellenbogen, Judith M; Miller, Laura J; Somerford, Peter; McEvoy, Suzanne; Bessarab, Dawn

    2015-09-01

    The aim of the present study was to provide descriptive planning data for a hospital-based Aboriginal Health Liaison Officer (AHLO) program, specifically quantifying episodes of care and outcomes within 28 days after discharge. A follow-up study of Aboriginal in-patient hospital episodes was undertaken using person-based linked administrative data from four South Metropolitan hospitals in Perth, Western Australia (2006-11). Outcomes included 28-day deaths, emergency department (ED) presentations and in-patient re-admissions. There were 8041 eligible index admissions among 5113 individuals, with episode volumes increasing by 31% over the study period. Among patients 25 years and older, the highest ranking comorbidities included injury (47%), drug and alcohol disorders (41%), heart disease (40%), infection (40%), mental illness (31%) and diabetes (31%). Most events (96%) ended in a regular discharge. Within 28 days, 24% of events resulted in ED presentations and 20% resulted in hospital readmissions. Emergency readmissions (13%) were twice as likely as booked re-admissions (7%). Stratified analyses showed poorer outcomes for older people, and for emergency and tertiary hospital admissions. Future planning must address the greater service volumes anticipated. The high prevalence of comorbidities requires intensive case management to address case complexity. These data will inform the refinement of the AHLO program to improve in-patient experiences and outcomes.

  19. Critical Path Method application to strategic planning project at Teaching Paediatrics Hospital “José Martí” in Sancti Spíritus province.

    Directory of Open Access Journals (Sweden)

    Manuel Hung Varela

    2010-09-01

    Full Text Available Present work was making at Teaching Paediatrics Hospital “José Martí” in Sancti Spíritus province, Sancti Spíritus city. Its main purpose is apply a control and planning system to a strategic planning project at mentioned entity, getting by this way to contribute to efficacy and efficient of planning process, through Critical Path Method. To it, was use tools like classic strategic planning procedure and software like WINQSB. As result, is obtaining the project estimate duration, the necessary information for its control and execution, including critical path, and resources assignment mainly. The project is finishing and has been useful the used method for its execution.

  20. Zinc supplementation reduces morbidity and mortality in very-low-birth-weight preterm neonates: a hospital-based randomized, placebo-controlled trial in an industrialized country.

    Science.gov (United States)

    Terrin, Gianluca; Berni Canani, Roberto; Passariello, Annalisa; Messina, Francesco; Conti, Maria Giulia; Caoci, Stefano; Smaldore, Antonella; Bertino, Enrico; De Curtis, Mario

    2013-12-01

    Zinc plays a pivotal role in the pathogenesis of many diseases and in body growth. Preterm neonates have high zinc requirements. The objective of the study was to investigate the efficacy of zinc supplementation in reducing morbidity and mortality in preterm neonates and to promote growth. This was a prospective, double-blind, randomized controlled study of very-low-birth-weight preterm neonates randomly allocated on the seventh day of life to receive (zinc group) or not receive (control group) oral zinc supplementation. Total prescribed zinc intake ranged from 9.7 to 10.7 mg/d in the zinc group and from 1.3 to 1.4 mg/d in the placebo control group. The main endpoint was the rate of neonates with ≥ 1 of the following morbidities: late-onset sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia, periventricular leucomalacia, and retinopathy of prematurity. Secondary outcomes were mortality and body growth. We enrolled 97 neonates in the zinc group and 96 in the control group. Morbidities were significantly lower in the zinc group (26.8% compared with 41.7%; P = 0.030). The occurrence of necrotizing enterocolitis was significantly higher in the control group (6.3% compared with 0%; P = 0.014). Mortality risk was higher in the placebo control group (RR: 2.37; 95% CI: 1.08, 5.18; P = 0.006). Daily weight gain was similar in the zinc (18.2 ± 5.6 g · kg⁻¹ · d⁻¹) and control (17.0 ± 8.7 g · kg⁻¹ · d⁻¹) groups (P = 0.478). Oral zinc supplementation given at high doses reduces morbidities and mortality in preterm neonates. This trial was registered in the Australian New Zealand Clinical Trial Register as ACTRN12612000823875.

  1. A Study Of Risk Factors For Low Birth Weight

    Directory of Open Access Journals (Sweden)

    Deswal B S

    1999-01-01

    Full Text Available Research question: What is the extent of low weight babies born in hospitals and its association with some maternal factors? Objectives: 1. To find an overall prevalence of low birth weight babies amongst hospital births in Meerut city. 2. To identify and quantify the effects of some risk factors for low birth weight. Setting: District women Hospital of Meerut city of western U.P. Study Design: Hospital based matched case-control study. Sample size: 491 low birth weight babies as ‘cases’ and an equal number of babies of normal birth weight in ‘control’ group matched for maternal age, sex of baby, birth order and institution of delivery. Study variables: Socio-economic Status: maternal biological factors including obstetric history: antenatal factors: nutritional factors: history of abortion: toxaemia of pregnancy etc. Results: Overall proportion of low birth weight babies was found to be 21.8% amongst hospital live births and 30.9% born to mothers aged below 30 years of age. Low maternal weight, under nutrition, lack of antenatal care, short inter-pregnancy interval, toxacmia of pregnancy were independent factors increasing the risk of low birth weight significantly. Conclusions: The study suggested that a substantial proportion of low birth weight babies can be averted by improving maternal nutritional status including anemic condition, birth spacing and proper antenatal care.

  2. Birth cohorts

    DEFF Research Database (Denmark)

    Andersen, Anne-Marie Nybo; Madsen, Mia

    2009-01-01

    ; provides practical guidance on how to set-up and maintain birth cohorts for completing family-based studies in life course epidemiology; describes how to undertake appropriate statistical analyses of family-based studies and correctly interpret results from these analyses; and provides examples...... that illustrate the ways in which family-based studies can enhance our understanding of life course epidemiology. In addition, there is discussion of difficulties specific to setting up such studies in low- and middle-income countries, and issues relating to proxy informants, where parents provide information...... on children and vice versa, or siblings provide information about each other. Examples of how family-based studies have been used in understanding the life course epidemiology of cardiovascular disease, mental health, and reproductive health illustrate the applicability of the research to these areas...

  3. Exploratory spatial data analysis for the identification of risk factors to birth defects

    Directory of Open Access Journals (Sweden)

    Song Xinming

    2004-06-01

    Full Text Available Abstract Background Birth defects, which are the major cause of infant mortality and a leading cause of disability, refer to "Any anomaly, functional or structural, that presents in infancy or later in life and is caused by events preceding birth, whether inherited, or acquired (ICBDMS". However, the risk factors associated with heredity and/or environment are very difficult to filter out accurately. This study selected an area with the highest ratio of neural-tube birth defect (NTBD occurrences worldwide to identify the scale of environmental risk factors for birth defects using exploratory spatial data analysis methods. Methods By birth defect registers based on hospital records and investigation in villages, the number of birth defects cases within a four-year period was acquired and classified by organ system. The neural-tube birth defect ratio was calculated according to the number of births planned for each village in the study area, as the family planning policy is strictly adhered to in China. The Bayesian modeling method was used to estimate the ratio in order to remove the dependence of variance caused by different populations in each village. A recently developed statistical spatial method for detecting hotspots, Getis's 7, was used to detect the high-risk regions for neural-tube birth defects in the study area. Results After the Bayesian modeling method was used to calculate the ratio of neural-tube birth defects occurrences, Getis's statistics method was used in different distance scales. Two typical clustering phenomena were present in the study area. One was related to socioeconomic activities, and the other was related to soil type distributions. Conclusion The fact that there were two typical hotspot clustering phenomena provides evidence that the risk for neural-tube birth defect exists on two different scales (a socioeconomic scale at 6.84 km and a soil type scale at 22.8 km for the area studied. Although our study has limited

  4. A study of birth weight of full term neonates and its′ determinants

    Directory of Open Access Journals (Sweden)

    Yugantara R Kadam

    2014-01-01

    Full Text Available Background: Low birth weight (LBW is highly prevalent in India and has a multifactorial causation. There is a need to study and identify the modifiable and non-modifiable risk factors determining birth weight. This will help in planning ante natal care more effectively. Materials and Methods : Study-type-cross-sectional study-setting: Hospital based. Study-subject: Mothers and their new borns. Sample size: All the births taken place during the study period. Study period: July 2010-June 2011. Study tools : (0 i Questionnaire. (ii pediatric weighing machine. Inclusion criteria : m0 others attending ante natal care (ANC clinic from 1 st trimester with minimum three antenatal visits, non-anemic at the end of 2 nd trimester, had full-term and singleton delivery. Exclusion criteria : H/O pregnancy induced hypertension (PIH, diabetes mellieutus (DM, tuberculosis (TB, urinary tract infection (UTI, delivered preterm and tobacco chewers or mishri users. Statistical Analysis : Percentages, mean and SD of birth weight, χ2 test, ANOVA, Z-test, and Binary logistic. Results: By using birth weight as a continuous data it was observed that birth-weight was significantly associated with maternal age (F = 3.360, df = 2, P = 0.035, education (F = 4.401, df = 4, P = 0.002 and breakfast (z = 3.970, P = 0.00. Proportion of LBW was 42.4%. For analysis, groups of newborns on the basis of birth weight showed significant association between LBW and maternal education (χ2 = 12.734, df = 4, P = 0.013, breakfast (χ2 = 13.241, df = 1, P = 0.00 and evening snacks (χ2 = 4.275, df = 1, P = 0.013. According to the binary logistic regression, breakfast and education were significant and best predictors for birth weight. Conclusion: Education and breakfast are strong determinants of birth-weight. Less educated women need more intense health education.

  5. [How to make regional medicine revive from the medical crisis or collapse due to the severe paucity of medical doctors: a plan with "the magnet hospital"].

    Science.gov (United States)

    Itoh, Tsunetoshi

    2009-01-01

    In 2002-2003, the practice of doctors lending their names to appear as "staff" of hospitals became known. Problems regarding funds from public hospitals were also revealed. Tohoku University asked regional societies how to improve the medical situation, and redefined its responsibilities. The Educational Development Center for Local Medicine and Department of Local Medical Service System were set up (2005-2008). A severe shortage of medical doctors prevails in Japan: the number of doctors per population is at the 4th lowest among OECD countries, and the number per hospital bed is the lowest. We have no nursing homes whose beds are not counted as hospital beds. The number of faculty staff in Japanese medical schools is 1/3 to those of Western countries. The reported number of doctors working in hospitals and offices surpasses that by census for medical doctors by >40,000. Japanese doctors work for >60 hours per week. I propose essential plans to improve Japanese situation for medical service: 1. Immediately increase the number of doctors by at least 50%. Based on our calculation, we need 450,000 doctors. 2. When the shortage of doctors is severe, establish a magnet hospital with c.a. 500 beds for every 200,000 population, capable of treating highly emergency patients and attracting doctors who need medical training. Hospitals should not belong to each city or town. 3. Establish a comprehensive organization to nurture doctors on a long-term basis. It should consist of a medical school, hospitals, and the prefectural government. It should help doctors to move between hospitals, and be responsible both for designing doctors' career paths and for allocating them appropriately.

  6. Congenital malformations in Ecuadorian children: urgent need to create a National Registry of Birth Defects

    Directory of Open Access Journals (Sweden)

    Fabricio González-Andrade

    2010-04-01

    females 30.40.Conclusion: This report documents the prevalence estimates for birth defects reported in the hospital discharge data. These estimates are important to 1 plan for health-care and education needs of the Ecuadorian population, 2 identify increased occurrences of birth defects in specific geographic regions, 3 serve as a reference point for assessment of provincial surveillance systems, 4 evaluate national public health interventions, 5 compare Ecuador prevalence estimates with those of other countries, and 6 help determine the appropriate allocation of resources for basic and public health research. There is an urgent need to establish a National Registry of Birth Defects involving different sources of information such as prenatal medical records, birth records and medical records during the first year of life at an early stage, and surveys on cytogenetic prenatal diagnostic surveys and cytogenetics of therapeutic abortions.Keywords: Ecuador, genetics, birth defects surveillance, database, prevalence, epidemiology, congenital malformations

  7. TO ASSESS EFFECTIVENESS OF PLAN TEACHING PROGRAMME ON NATIONAL ACCREDITATION BOARD FOR HOSPITALS AND HEALTH CARE PROVIDERS (NABH GUIDELINES AMONG NEWLY RECRUITED STAFF NURSES AT KRISHNA HOSPITAL, KARAD

    Directory of Open Access Journals (Sweden)

    Kavita Sanjay

    2015-12-01

    Full Text Available The continual improvement of service quality in healthcare units has become a prime consideration to ensure patient satisfaction across the world in the modern economic scenario. In India, health sector is one of the largest and fastest growing sector in which both the private and government care providers and hospitals put much emphasis on quality improvement and patient satisfaction. National Accreditation Board of Hospitals and Healthcare Providers (NABH along with Quality Council of India provided the criteria based on which quality standard of hospitals is determined. The study was conducted on 51 newly recruited staff nurses at Krishna Hospital, Karad. An evaluator survey approach was considered. Study design was used one group pre-test, post-test design. Purposive sampling technique was used. RESULTS The study was conducted on 51 newly recruited staff nurses at Krishna Hospital, Karad. An evaluator survey approach was considered. Study design was used one group pre-test, post-test design. Purposive sampling technique was used. CONCLUSION Study concludes majority of newly recruited nursing staff having 19.38% average knowledge and 17.85% having average practice towards NABH guidelines. Knowledge and practice score of newly recruited nursing staff between the pre-test and post-test was highly significant. OBJECTIVES 1 To assess newly recruited staff nurses knowledge and practice towards NABH guidelines. 2 To find an association of knowledge and practice between pre-test and post-test of PTP programme on NABH guidelines.

  8. [Scale Mosaic: definition and testing of a tool for assessing the risk of falling and the care planning during hospitalization].

    Science.gov (United States)

    Suprani, Riccarda; Taglioni, Mauro

    2014-01-01

    in year 2008 the Ausl of Ravenna had a small number of patients at risk among the patients fallen, and among the patients evaluated with risk for fall. This could be due to the rating scale used (Conley) that does not recognize the risk factors "drug therapy" and "conditions clinical care". to experiment a rating scale (Mosaic), to evaluate the performance indicators compared to the scales Conley, Fall Risk Assessment Scoring System (FRASS), Stratity; evaluate the effectiveness of actions taken to manage the risk; Operators remain vigilant about the risk falls. using the scale Mosaic for patients admitted in 16 Hospital Units for two-months. Performance indicators: sensitivity, specificity, positive predictive value and negative. Studies considered for comparison: Hospital (AO) Bologna for Conley, AO Bologna and AO Niguarda Cà Granda Milan for Stratify, AO Bergamo for FRASS. were analyzed 1474 tabs. Males are 848 (57.5%) and females 626 (43.5%), the average age is 70.8 years. Of these 42 patients have fallen (2.8%), including 25 males and 17 females and the average age is 72.2. Are not at risk 426 (29%) patients and at risk 1048 (71%) patients. In other assessments the patients at risk was 31% in AUSL Ravenna, 59% (Conley) and 13% (Stratify) in AO Bologna and 41.5% (FRASS) in AO Bergamo. The scale Mosaic has a sensitivity of 0.98 (Conley, Stratify and FRASS amounted to 0.69, to 0.20, to 0.50), a specificity of 0.30 (Conley, Stratify and FRASS amounted to 0.41, 0.87, 0.59.) The patients fallen are at risk in 41 cases (97%) and of these 24 low-risk. The most frequent risk factors are: "mobility and gait" (1209 items), "drug therapy" (850 items) , "conditions clinical care" (841 items). Planned actions have an average of 2.2 in patients fallen, of 3.5 in low-risk patients and of 4.48 in patients at high risk. Compared with the previous year shows a decrease of 14 falls and an increase in the level of outcome "no one" (from 61% to 73.5%). the greater number of falls

  9. HOSPITAL IN NIGERIA.

    African Journals Online (AJOL)

    reduce the incidence of prematurity and low birth weight babies must be instituted. Key words: Neonatal mortality. risk factors. tertiary hospital. INTRODUCTION .... Classification of Diseases WHO Geneva 1975: 700. 52 Nigerian Journal v_f(.

  10. Teaching Hospital, Sagamu

    African Journals Online (AJOL)

    birth asphyxia. It is recommended that greater effort be made through health education to encourage ... subjects, eight (34.8 percent) were born in private. Kehinde hospitals, six ..... plexus injiuries in Malaysian neonates. ] Trap Pedkztr. 1991 ...

  11. Impact of dose rate on accuracy of intensity modulated radiation therapy plan delivery using the pretreatment portal dosimetry quality assurance and setting up the workflow at hospital levels

    OpenAIRE

    Karunakaran Kaviarasu; N Arunai Nambi Raj; K Krishna Murthy; A Ananda Giri Babu; Bhaskar Laxman Durga Prasad

    2015-01-01

    The aim of this study was to examine the impact of dose rate on accuracy of intensity modulated radiation therapy (IMRT) plan delivery by comparing the gamma agreement between the calculated and measured portal doses by pretreatment quality assurance (QA) using electronic portal imaging device dosimetry and creating a workflow for the pretreatment IMRT QA at hospital levels. As the improvement in gamma agreement leads to increase in the quality of IMRT treatment delivery, gamma evaluation was...

  12. Alarming Rise In Birth Defects

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    A rapid rise in birth defects has prompted China to look for causes and solutionsEvery 60 seconds two children are born in China with a handicap.It’s an alarming fact,but one that young adults across the country who hope to have children face every day. At a conference on the prevention of birth defects in Chengdu of Sichuan Province in September,Vice Minister of the National Population and Family Planning Commission Jiang Fan revealed this inconvenient truth, supported by shocking statistics.

  13. Birth Control Explorer

    Science.gov (United States)

    ... STIs Media Facebook Twitter Tumblr Shares · 467 Birth Control Explorer Sort by all methods most effective methods ... You are here Home » Birth Control Explorer Birth Control Explorer If you’re having sex —or if ...

  14. Birth control pills - combination

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000655.htm Birth control pills - combination To use the sharing features on ... both progestin and estrogen. What Are Combination Birth Control Pills? Birth control pills help keep you from ...

  15. Essure Permanent Birth Control

    Science.gov (United States)

    ... Prosthetics Essure Permanent Birth Control Essure Permanent Birth Control Share Tweet Linkedin Pin it More sharing options ... System Essure is a a permanently implanted birth control device for women (female sterilization). Implantation of Essure ...

  16. CDC WONDER: Births

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Births (Natality) online databases in CDC WONDER report birth rates, fertility rates and counts of live births occurring within the United States to U.S....

  17. Facts about Birth Defects

    Science.gov (United States)

    ... Button Information For… Media Policy Makers Facts about Birth Defects Language: English (US) Español (Spanish) Recommend ... having a baby born without a birth defect. Birth Defects Are Common Every 4 ½ minutes, a ...

  18. CDC WONDER: Births

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Births (Natality) online databases in CDC WONDER report birth rates, fertility rates and counts of live births occurring within the United States to U.S....

  19. Birth Defects: Cerebral Palsy

    Science.gov (United States)

    ... defects, premature birth and infant mortality. Solving premature birth Featured articles Accomplishments and lessons learned since the ... and pregnancy Folic acid Medicine safety and pregnancy Birth defects prevention Learn how to help reduce your ...

  20. Warning Signs After Birth

    Science.gov (United States)

    ... defects, premature birth and infant mortality. Solving premature birth Featured articles Accomplishments and lessons learned since the ... and pregnancy Folic acid Medicine safety and pregnancy Birth defects prevention Learn how to help reduce your ...

  1. Extremely Preterm Birth

    Science.gov (United States)

    ... Events Advocacy For Patients About ACOG Extremely Preterm Birth Home For Patients Search FAQs Extremely Preterm Birth ... Spanish FAQ173, June 2016 PDF Format Extremely Preterm Birth Pregnancy When is a baby considered “preterm” or “ ...

  2. The Rankin Inlet Birthing Centre: community midwifery in the Inuit context.

    Science.gov (United States)

    Douglas, Vasiliki Kravariotis

    2011-04-01

    To trace the historical development of the Rankin Inlet Birthing Centre since its inception in 1993 in the context of plans to make it the nucleus of a system of community birthing centres throughout Nunavut. This is an analytical historical study using a combination of oral history interviews, government documents and existing literature. Oral history interviews with current and former employees of the Birthing Centre, founding organizers and women who gave birth there were combined with a review of the literature using MEDLINE, Anthropology PLUS, CINAHL and Historical Abstracts, as well as a search of the records of the Nunavut Government and the debates of the Nunavut Legislature and its predecessor, the NWT Legislature. Results. The Rankin Inlet Birthing Centre has been successful, but only marginally so. The majority of births for residents of this region still occur in southern hospitals, either in Churchill or Winnipeg. Although the long-term plan for the Centre is to train and employ Inuit midwives, thus far only two maternity care workers are employed at the Centre. All the midwives are from southern Canada and rotate through the Centre and the community on fixed terms. The Centre has been very successful at gaining and retaining support at the political level, with a strong official commitment to it from the Nunavut Legislature, and active support from the medical communities in the Kivalliq and in Manitoba through the Northern Health Unit at the University of Manitoba. Community support within Rankin Inlet is less apparent and has been halting. Plans to extend the model of the Centre to other communities are long-standing, but have been slow to come to fruition. The Rankin Inlet Birthing Centre has remained an important, but peripheral, institution in Rankin Inlet. It is in many ways a southern institution located in the Arctic; for this reason, and due to the social networks present in Rankin Inlet itself, it has suffered from a lack of enthusiastic

  3. On strategic planning and management of hospitals in Shanghai%上海市医院战略规划管理的实践探索

    Institute of Scientific and Technical Information of China (English)

    宋国明; 高解春; 郭永瑾

    2011-01-01

    The paper described the significance of strategic planning and management for hospitals and analyzed the presence practice of such strategic planning and management in the country. It focused on the practices of 23 tertiary hospitals in Shanghai in making and implementing their development plan for the "12th Five-year Plan"; summarized their three characteristics in public benefic guidance, better operability and better services. In addition, it introduced the initial achievements made in enhancing service quality and patient satisfaction, tapping resource potentials, enhancing operation efficiency and sustainable development.%文章在阐述医院实施战略规划管理的意义和分析国内医院实施战略规划管理现状的基础上,着重介绍了上海市23家三级医院制定"十一五"发展规划、实施战略规划管理的主要做法;归纳总结了引导公益性、提高可操作性和强调服务3方面的特点;以及在提高服务质量和患者满意度、发挥资源优势、提高运行效率、增强可持续发展能力等方面所取得的初步成效.

  4. Reasons Why Women Choose Home Birth

    Directory of Open Access Journals (Sweden)

    Mary Angelie P. Andrino

    2016-11-01

    Full Text Available Maternal deaths in the Philippines remain high. These deaths are mostly due to the large proportion of home births, complications of pregnancy and delivery, and lack of access to facilities and competently trained staff. Utilizing a descriptive, one-shot survey design, the study aimed to determine the reasons why women in a municipality in Iloilo prefer home birth. The respondents were interviewed using a validated questionnaire. Descriptive statistics were used to analyze and interpret the findings. The study revealed that the proportion of home births progressively declined from 2012 to 2014. Birth being imminent or inevitable is the number one reason that supports home birth. Autonomy, safety, affordability, readily available birthing equipment and supplies, accessibility of birth attendant, remote access by going to the birthing center, lack of transportation, and bad weather conditions also led women to give birth at home. Women from the rural areas of the municipality utilized available resources in the community which prompted the predominance of home deliveries assisted by traditional birth attendants (TBAs and even midwives, who were readily available nearby. This study recommends continuous improvement in existing maternal health interventions and strategies through engagement of women in policy planning, improvement of health service delivery, infrastructural enhancement, better care practices and continuous health education.

  5. What influences birth place preferences, choices and decision-making amongst healthy women with straightforward pregnancies in the UK? A qualitative evidence synthesis using a 'best fit' framework approach.

    Science.gov (United States)

    Coxon, Kirstie; Chisholm, Alison; Malouf, Reem; Rowe, Rachel; Hollowell, Jennifer

    2017-03-31

    English maternity care policy has supported offering women choice of birth setting for over twenty years, but only 13% of women in England currently give birth in settings other than obstetric units (OUs). It is unclear why uptake of non-OU settings for birth remains relatively low. This paper presents a synthesis of qualitative evidence which explores influences on women's experiences of birth place choice, preference and decision-making from the perspectives of women using maternity services. Qualitative evidence synthesis of UK research published January 1992-March 2015, using a 'best-fit' framework approach. Searches were run in seven electronic data bases applying a comprehensive search strategy. Thematic framework analysis was used to synthesise extracted data from included studies. Twenty-four papers drawing on twenty studies met the inclusion criteria. The synthesis identified support for the key framework themes. Women's experiences of choosing or deciding where to give birth were influenced by whether they received information about available options and about the right to choose, women's preferences for different services and their attributes, previous birth experiences, views of family, friends and health care professionals and women's beliefs about risk and safety. The synthesis additionally identified that women's access to choice of place of birth during the antenatal period varied. Planning to give birth in OU was straightforward, but although women considering birth in a setting other than hospital OU were sometimes well-supported, they also encountered obstacles and described needing to 'counter the negativity' surrounding home birth or birth in midwife-led settings. Over the period covered by the review, it was straightforward for low risk women to opt for hospital birth in the UK. Accessing home birth was more complex and contested. The evidence on freestanding midwifery units (FMUs) is more limited, but suggests that women wanting to opt for an

  6. Delivery type not associated with global methylation at birth

    Directory of Open Access Journals (Sweden)

    Virani Shama

    2012-06-01

    Full Text Available Abstract Background Birth by cesarean delivery (CD as opposed to vaginal delivery (VD is associated with altered health outcomes later in life, including respiratory disorders, allergies and risk of developing type I diabetes. Epigenetic gene regulation is a proposed mechanism by which early life exposures affect later health outcomes. Previously, type of delivery has been found to be associated with differences in global methylation levels, but the sample sizes have been small. We measured global methylation in a large birth cohort to identify whether type of delivery is associated with epigenetic changes. Methods DNA was isolated from cord blood collected from the University of Michigan Women’s & Children Hospital and bisulfite-converted. The Luminometric Methylation Assay (LUMA and LINE-1 methylation assay were run on all samples in duplicate. Results Global methylation data at CCGG sites throughout the genome, as measured by LUMA, were available from 392 births (52% male; 65% CD, and quantitative methylation levels at LINE-1 repetitive elements were available for 407 births (52% male; 64% CD. LUMA and LINE-1 methylation measurements were negatively correlated in this population (Spearman’s r = −0.13, p =0.01. LUMA measurements were significantly lower for total CD and planned CD, but not emergency CD when compared to VD (median VD = 74.8, median total CD = 74.4, p = 0.03; median planned CD = 74.2, p = 0.02; median emergency CD = 75.3, p = 0.39. However, this association did not persist when adjusting for maternal age, maternal smoking and infant gender. Furthermore, total CD deliveries, planned CD and emergency CD deliveries were not associated with LINE-1 measurements as compared to VD (median VD = 82.2, median total CD = 81.9, p = 0.19; median planned CD = 81.9, p = 0.19; median emergency CD = 82.1, p = 0.52. This lack of association held when adjusting for maternal age

  7. Birth in prison: pregnancy and birth behind bars in Brazil.

    Science.gov (United States)

    Leal, Maria do Carmo; Ayres, Barbara Vasques da Silva; Esteves-Pereira, Ana Paula; Sánchez, Alexandra Roma; Larouzé, Bernard

    2016-06-01

    The high vulnerability of incarcerated women is worsened when they are pregnant and give birth during imprisonment. This article traces the profile of incarcerated women living with their children in female prison units of the capitals and metropolitan regions of Brazil and describes pregnancy and childbirth conditions and healthcare practices while in incarceration. This study is an analysis of a series of cases resultant from a national census conducted between August 2012 and January 2014. This analysis included 241 mothers. Of these, 45% were younger than 25 years old, 57% were dark skinned, 53% had studied less than eight years and 83% were multiparous. At the time of incarceration, 89% were already pregnant and two thirds did not want the current pregnancy. Access to prenatal care was inadequate for 36% of the women. During their hospital stay, 15% referred to having suffered some type of violence (verbal, psychological, or physical). Only 15% of the mothers rated the care received during their hospital stay as excellent. They had low social/familial support and more than one third reported the use of handcuffs during their hospital stay. Incarcerated mothers received poorer healthcare during pregnancy and birth when compared with non-incarcerated users of the public sector. This study also found violations of human rights, especially during birth.

  8. Urinary System anomalies at birth

    Directory of Open Access Journals (Sweden)

    Sharada B. Menasinkai

    2015-06-01

    Full Text Available Background: Congenital anomalies of urinary system are common and are found in 3-4% of population, and lethal urinary anomalies account for 10% of termination of pregnancy. Methods: A study was done to know the incidence of congenital anomalies at birth for the period of 4 months from May 99 - Sept 99 at Cheluvamba hospital attached to Mysore medical college. Congenital anomalies in the still births, live births and aborted fetuses >20 weeks were studied along with the case history and ultrasound reports. Aborted fetuses and still born babies were collected for autopsy after the consent of parents. These babies were fixed in 10% formalin and autopsy was done after fixing, and anomalies were noted. Results: Total births during study period were 3000. There were 61 babies with congenital anomalies and 6 babies had anomalies of urinary system. Among the urinary system anomalies 1 baby had bilateral renal agenesis, 1 baby had unilateral renal agenesis with anophthalmia (Fraser syndrome, 2 babies had Multicystic dysplastic kidney disease (MCDK and 1 live baby had hydronephrosis due to obstruction at pelvi ureteric junction, and 1 live female baby had polycystic kidneys. Conclusion: Incidence of urinary system anomalies in the present study was 2 per 1000 births. U/S detection of urinary anomalies varies with period of gestation, amniotic fluid volume and visualisation of urinary bladder. Autopsy helps to detect renal agenesis. [Int J Res Med Sci 2015; 3(3.000: 743-748

  9. Examination of psychosocial predictors of Chinese hospital pharmacists' intention to provide clinical pharmacy services using the theory of planned behaviour: a cross-sectional questionnaire study

    Science.gov (United States)

    He, Yuan; Yang, Fan; Mu, Dongqin; Xing, Yuan; Li, Xin

    2016-01-01

    Objectives Main study aim was as follows: (1) to explore the usefulness of the theory of planned behaviour (TPB) model in predicting Chinese hospital pharmacists' intention to provide clinical pharmacy services (CPSs), including auxiliary CPSs and core CPSs; (2) to identify the main factors affecting the Chinese hospital pharmacists' intention to provide core CPSs based on TPB quantitatively. Design Cross-sectional questionnaire study. Setting The study was conducted in 22 general hospitals in seven cities located in the eastern and western part of China. Participants 416 hospital pharmacists (292 (70.2%) female) entered and completed the study. Primary and secondary outcome measures Quantitative responses with hospital pharmacists' intention, attitude, subjective norms (SNs) and perceived behavioural control (PBC) over provision of CPSs and their past behaviour (PB)-related CPSs. Results The structural equation model analysis found that attitude (p=0.0079, β=0.12), SN (p=0.038, β=0.10) and the pharmacists' intention to provide auxiliary CPSs (p=0.0001, β=0.63) significantly predicted of their intention to provide core CPSs, accounting for 54.0% of its variance. Attitude (p=0.0001, β=0.35), PBC (p=0.0182, β=0.12) and PB (p=0.0009, β=0.15) are significant predictors of pharmacists' intention, accounting for 21% of the variance in pharmacists' intention to provide auxiliary CPSs. Conclusions The TPB with the addition of PB is a useful framework for predicting pharmacists' intention to provide CPSs in Chinese hospital care context. Strategies to improve hospital pharmacists' intention to provide CPSs should focus on helping the individuals related medical care see the value of CPSs, altering their perception of social pressure towards core CPSs and the removal of obstacles that impede the translation of intentions into behaviour. PMID:27707835

  10. Examination of psychosocial predictors of Chinese hospital pharmacists' intention to provide clinical pharmacy services using the theory of planned behaviour: a cross-sectional questionnaire study.

    Science.gov (United States)

    He, Yuan; Yang, Fan; Mu, Dongqin; Xing, Yuan; Li, Xin

    2016-10-05

    Main study aim was as follows: (1) to explore the usefulness of the theory of planned behaviour (TPB) model in predicting Chinese hospital pharmacists' intention to provide clinical pharmacy services (CPSs), including auxiliary CPSs and core CPSs; (2) to identify the main factors affecting the Chinese hospital pharmacists' intention to provide core CPSs based on TPB quantitatively. Cross-sectional questionnaire study. The study was conducted in 22 general hospitals in seven cities located in the eastern and western part of China. 416 hospital pharmacists (292 (70.2%) female) entered and completed the study. Quantitative responses with hospital pharmacists' intention, attitude, subjective norms (SNs) and perceived behavioural control (PBC) over provision of CPSs and their past behaviour (PB)-related CPSs. The structural equation model analysis found that attitude (p=0.0079, β=0.12), SN (p=0.038, β=0.10) and the pharmacists' intention to provide auxiliary CPSs (p=0.0001, β=0.63) significantly predicted of their intention to provide core CPSs, accounting for 54.0% of its variance. Attitude (p=0.0001, β=0.35), PBC (p=0.0182, β=0.12) and PB (p=0.0009, β=0.15) are significant predictors of pharmacists' intention, accounting for 21% of the variance in pharmacists' intention to provide auxiliary CPSs. The TPB with the addition of PB is a useful framework for predicting pharmacists' intention to provide CPSs in Chinese hospital care context. Strategies to improve hospital pharmacists' intention to provide CPSs should focus on helping the individuals related medical care see the value of CPSs, altering their perception of social pressure towards core CPSs and the removal of obstacles that impede the translation of intentions into behaviour. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  11. Pregnancy planning among women at postpartum period in a public and a private hospital - doi:10.5020/18061230.2008.p269

    Directory of Open Access Journals (Sweden)

    Lucila Coca Leventhal

    2012-01-01

    Full Text Available Purpose: To compare the attitudes of women at postpartum period, from a public (PuH and a private hospital (PrH, regarding their pregnancy planning and to identify contraceptive methods that failed on use, in order to better direct the assistance at contraception. Methods: It was a descriptive study, held on two hospitals from the city of São Paulo. The data collection occurred in August, 2004, by means of a questionnaire applied to all women at postpartum period of each hospital (83 from PuH and 88 from PrU, comprising 171 interviewed. Statistical analysis was done by absolute frequencies and percentages. Results: Most of the interviewed women from PuH (69.9%; n=58 did not plan their pregnancy, while 83.0% (n=73 of those from PrH did so. The contraceptive methods that mostly caused failure were the pill (27.6%; n=16 and the condom (12.1%; n=7 at PuH; and the Ogino- Knaus method [rhythm method of contraception] (26.6%; n=4 and the pill (13.3%; n=2 at PrH. Conclusions: Pregnancy planning was done by most of the women from PrH; the same not occurring for women from PuH. The contraceptive pill and the condom, at PuH, and the rhythm method and the pill, at PrH, were the contraceptive methods that mostly failed. The accomplishment and disclosure of family planning programs for more deprived people is needed, as well as to favor them easy access to contraceptive methods.

  12. The birth and routinization of IVF in China

    DEFF Research Database (Denmark)

    Wahlberg, Ayo

    2016-01-01

    comprehensive family planning programmes aimed at preventing birth was being rolled out. IVF was not merely imported into China, rather it was experimentally developed within China into a form suitable for its restrictive family planning regulations. As a result, IVF and other assisted reproductive technologies...... (ARTs) have settled alongside contraception, sterilization and abortion as yet another technology of birth control....

  13. A Pleasing Birth

    NARCIS (Netherlands)

    Vries, De Raymond

    2005-01-01

    Women have long searched for a pleasing birth-a birth with a minimum of fear and pain, in the company of supportive family, friends, and caregivers, a birth that ends with a healthy mother and baby gazing into each other's eyes. For women in the Netherlands, such a birth is defined as one at home un

  14. Insights Into French Emergency Planning, Response, and Resilience Procedures From a Hospital Managerial Perspective Following the Paris Terrorist Attacks of Friday, November 13, 2015.

    Science.gov (United States)

    Ghanchi, Ali

    2016-10-01

    On Friday, November 13, 2015, Paris was subjected to a multiple terrorist attack that caused widespread carnage. Although French emergency planning, response, and resilience procedures (Plan Blanc) anticipated crisis management of a major incident, these had to be adapted to the local context of Pitié-Salpêtrière University Teaching Hospital. Health care workers had undergone Plan Blanc training and exercises and it was fortunate that such a drill had occurred on the morning of the attack. The procedures were observed to work well because this type of eventuality had been fully anticipated, and staff performance exceeded expectations owing to prior in-depth training and preparations. Staff performance was also facilitated by overwhelming staff solidarity and professionalism, ensuring the smooth running of crisis management and improving victim survival rates. Although lessons learned are ongoing, an initial debriefing of managers found organizational improvements to be made. These included improvements to the activation of Plan Blanc and how staff were alerted, bed management, emergency morgue facilities, and public relations. In conclusion, our preparations for an eventual terrorist attack on this unprecedented scale ensured a successful medical response. Even though anticipating the unthinkable is difficult, contingency plans are being made to face other possible terrorist threats including chemical or biological agents. (Disaster Med Public Health Preparedness. 2016;page 1 of 6).

  15. Environmental impacts of waste management in the hospitality industry: Creating a waste management plan for Bergvik Kartano

    OpenAIRE

    Adigwe, Christopher

    2014-01-01

    Many hospitality industries find it difficult to control or manage solid wastes, such as food, containers, paper, cardboard and scrap metals, which are waste generated on a daily basis depending on the industry. Most hospitality industries tend to lag behind when it comes to the collection of waste. Only a fraction of the¬¬ waste collected receives proper disposal. When waste is not collected sufficiently and the disposal is inappropriate the waste can accumulate and cause water, land and air...

  16. A Research on the Second Childbirth Expectation and the Birth Plan for the Fertility Age Population of Chinese%中国育龄人群二孩生育意愿与生育计划研究

    Institute of Scientific and Technical Information of China (English)

    张丽萍; 王广州

    2015-01-01

    首先提出构建队列终身二孩生育意愿方法,并以2012-2014年中国家庭幸福感热点问题调查数据为基础,对我国育龄人群生育意愿与生育计划进行测量。研究发现,育龄人群意愿生育水平较低且保持稳定,全部育龄人群的二孩终身生育意愿稳定在55%左右,而单独的生育意愿更低,明确打算生育二孩的单独育龄夫妇不到30%,而明确不打算生育二孩的单独育龄妇女超过40%。根据目前的调查结果,考虑到三孩及以上意愿生育人群比例的下降,取消生育限制与实行全面二孩政策的差别不大。即使二孩生育意愿与生育计划之间不存在差距,以往把理想子女数和有偏差的二孩生育意愿作为实际的生育水平来进行判断也是有误的。%Based on the construction of the cohort second childbirth expectation and taking the 2012, 2013 and 2014 data of Happiness of Chinese Family as example, this paper has measured the second childbirth expectation and the birth plan of the fertility age population of Chinese. We found the fertility age population of Chinese has relative low and stable second childbirth expectation. It is about 55% of the fertility age population expected to have the second child. Comparing with the all fertility age population, the couples with one spouse being an only child has much lower fertility expectation. Only 30% of the couples with one spouse being an only child have the clearly expectation to have the second child and more than 40% of them do not want the second child. Considering on the probability of the third child and above is very low, the differences between no family planning policy and the second child policy are not very big. Even if there is no difference between the second birth expectation and the real birth plan, it will make wrong conclusion for some researches taking the ideal number of children or fertility expectation as fertility plan.

  17. The Danish National Quality Database for Births

    DEFF Research Database (Denmark)

    Andersson, Charlotte Brix; Flems, Christina; Kesmodel, Ulrik Schiøler

    2016-01-01

    AIM OF THE DATABASE: The aim of the Danish National Quality Database for Births (DNQDB) is to measure the quality of the care provided during birth through specific indicators. STUDY POPULATION: The database includes all hospital births in Denmark. MAIN VARIABLES: Anesthesia/pain relief, continuous...... support for women in the delivery room, lacerations (third and fourth degree), cesarean section, postpartum hemorrhage, establishment of skin-to-skin contact between the mother and the newborn infant, severe fetal hypoxia (proportion of live-born children with neonatal hypoxia), delivery of a healthy...

  18. Birth statistics of high birth weight infants (macrosomia in Korea

    Directory of Open Access Journals (Sweden)

    Byung-Ho Kang

    2012-08-01

    Full Text Available &lt;B&gt;Purpose:&lt;/B&gt; The authors analyzed the trend from the birth-related statistics of high birth weight infants (HBWIs over 50 years in Korea from 1960 to 2010. &lt;B&gt;Methods:&lt;/B&gt; We used 2 data sources, namely, the hospital units (1960’s to 1990’s and Statistics Korea (1993 to 2010. The analyses include the incidence of HBWIs, birth weight distribution, sex ratio, and the relationship of HBWI to maternal age. &lt;B&gt;Results:&lt;/B&gt; The hospital unit data indicated the incidence of HBWI as 3 to 7% in the 1960’s and 1970’s and 4 to 7% in the 1980’s and 1990’s. Data from Statistics Korea indicated the percentages of HBWIs among total live births decreased over the years: 6.7% (1993, 6.3% (1995, 5.1 % (2000, 4.5% (2000, and 3.5% (2010. In HBWIs, the birth weight rages and percentage of incidence in infants’ were 4.0 to 4.4 kg (90.3%, 4.5 to 4.9 kg (8.8%, 5.0 to 5.4 kg (0.8%, 5.5 to 5.9 kg (0.1%, and &gt;6.0 kg (0.0% in 2000 but were 92.2%, 7.2%, 0.6%, 0.0%, and 0.0% in 2009. The male to female ratio of HBWIs was 1.89 in 1993 and 1.84 in 2010. In 2010, the mother's age distribution correlated with low (4.9%, normal (91.0%, and high birth weights (3.6%: an increase in mother's age resulted in an increase in the frequency of low birth weight infants (LBWIs and HBWIs. &lt;B&gt;Conclusion:&lt;/B&gt; The incidence of HBWIs for the past 50 years has been dropping in Korea. The older the mother, the higher was the risk of a HBWI and LBWI. We hope that these findings would be utilized as basic data that will aid those managing HBWIs.

  19. Using a theory of planned behaviour framework to explore hand hygiene beliefs at the '5 critical moments' among Australian hospital-based nurses.

    Science.gov (United States)

    White, Katherine M; Jimmieson, Nerina L; Obst, Patricia L; Graves, Nicholas; Barnett, Adrian; Cockshaw, Wendell; Gee, Phillip; Haneman, Lara; Page, Katie; Campbell, Megan; Martin, Elizabeth; Paterson, David

    2015-02-13

    Improving hand hygiene among health care workers (HCWs) is the single most effective intervention to reduce health care associated infections in hospitals. Understanding the cognitive determinants of hand hygiene decisions for HCWs with the greatest patient contact (nurses) is essential to improve compliance. The aim of this study was to explore hospital-based nurses' beliefs associated with performing hand hygiene guided by the World Health Organization's (WHO) 5 critical moments. Using the belief-base framework of the Theory of Planned Behaviour, we examined attitudinal, normative, and control beliefs underpinning nurses' decisions to perform hand hygiene according to the recently implemented national guidelines. Thematic content analysis of qualitative data from focus group discussions with hospital-based registered nurses from 5 wards across 3 hospitals in Queensland, Australia. Important advantages (protection of patient and self), disadvantages (time, hand damage), referents (supportive: patients, colleagues; unsupportive: some doctors), barriers (being too busy, emergency situations), and facilitators (accessibility of sinks/products, training, reminders) were identified. There was some equivocation regarding the relative importance of hand washing following contact with patient surroundings. The belief base of the theory of planned behaviour provided a useful framework to explore systematically the underlying beliefs of nurses' hand hygiene decisions according to the 5 critical moments, allowing comparisons with previous belief studies. A commitment to improve nurses' hand hygiene practice across the 5 moments should focus on individual strategies to combat distraction from other duties, peer-based initiatives to foster a sense of shared responsibility, and management-driven solutions to tackle staffing and resource issues. Hand hygiene following touching a patient's surroundings continues to be reported as the most neglected opportunity for compliance.

  20. Analysis of incidence and risk factors of preterm birth in 15 urban hospitals in China%15家城市医疗机构早产发生情况及影响因素分析

    Institute of Scientific and Technical Information of China (English)

    张小松; 赵更力; 杨慧霞; 时春艳; 周敏; 郝波

    2016-01-01

    (1 603/8 185),x2=13.573,P=0.000]、孕期遭遇负性生活事件[27.6%(264/958)与22.0%(1 802/8 185),x2=15.213,P=0.000]、孕前及孕期单纯服用叶酸[孕前:39.1%(375/958)与49.0% (4 007/8 185);孕期:61.2%(586/958)与67.0% (5 485/8 185),x2=31.842、11.667,P=0.000、0.001]、孕期服用多种维生素[43.4% (416/958)与48.1% (3 937/8 185),x2=7.393,P=0.007]、孕期并发症或合并症(包括贫血、胎膜早破、宫内感染、妊娠合并心脏病、羊水过少、胎盘早剥、前置胎盘、胎儿窘迫、多胎等)[59.9% (574/958)与38.9% (3 184/8 185),x2=156.471,P=0.000].经多因素分析发现与早产有关的危险因素为:产前检查次数<5次(OR=1.916,95%CI:1.060~3.462),重度子痫前期(OR=11.220,95%CI:1.041~2.149),前置胎盘(OR=6.607,95%CI:2.919~14.801),宫内感染(OR=5.441,95%CI:1.723~17.176),胎膜早破(OR=3.188,95%CI:1.916~5.305). 结论 影响早产发生的因素是多方面的,城市医疗机构应进一步提高孕期保健质量,及时发现和处理孕期并发症/合并症.%Objective To investigate the incidence and major risk factors of preterm birth in urban hospitals in China so as to provide evidence for effective interventions to reduce preterm birth.Methods Postpartum women delivered between 22 and 37 weeks of gestation were selected from 15 urban hospitals in Beijing,and Guangdong,Hu'nan,Hubei,Sichuan and Shaan'xi Province.Between April 2012 and March 2013,data of 10 days were collected every 3 months.Questionnaire was obtained under informed consent from 9 143 cases,including 958 cases of preterm birth and 8 185 cases of term birth.Demographics,history of pregnancy,prenatal care,and incidences of complication and/or comorbidities,lifestyle and dietary habit during pregnancy were included in the questionnaire.Chi-square test for univariate analysis and logistic regression multivariate analysis were used for statistics.Results The incidence ofpreterm birth was 9.9%(10 986

  1. Exploring spatial planning and functional program impact on microbial diversity and distribution in two South African hospital microbiomes

    CSIR Research Space (South Africa)

    Nice, Jaco A

    2015-07-01

    Full Text Available syntactical methods; and 3) static environmental monitoring using data loggers and weather stations. Ethical approval is under way and the initial results are planned for publication in late 2015. The study anticipates conclusive baseline data towards...

  2. Partos domiciliares planejados assistidos por enfermeiras obstétricas: transferências maternas e neonatais Partos domiciliarios planificados atendidos por enfermeras obstétricas: traslados maternales y neonatales Planned home births assisted by nurse midwives: maternal and neonatal transfers

    Directory of Open Access Journals (Sweden)

    Joyce Green Koettker

    2013-02-01

    intensiva neonatal. Según el estudio, el parto domiciliario planificado atendido por enfermeras obstétricas según protocolo de atención, exhibió buenos resultados maternales y neonatales, inclusive cuando fue necesario efectuar traslados hospitalarios.The objective of this explorative and descriptive study was to describe the rates and reasons for intrapartum transfers from home to hospital among women assisted by nurse midwives, and the outcomes of those deliveries. The sample consisted of eleven women giving birth and their newborns, from January 2005 to December 2009. Data was collected from the maternal and neonatal records and was analyzed using descriptive statistics. The transfer rate was 11%, most of the women were nulliparous (63.6%, and all of them were transferred during the first stage of labor. The most common reasons for transfer were arrested cervical dilation, arrested progress of the fetal head and cephalopelvic disproportion. Apgar scores were >7 for 81.8% of the newborns; and there were no admissions to the neonatal intensive care unit. The results show that planned home births assisted by nurse midwives following a clinical protocol, had good outcomes even when a transfer to the hospital was needed.

  3. Bed Capacity Planning Using Stochastic Simulation Approach in Cardiac-surgery Department of Teaching Hospitals, Tehran, Iran.

    Science.gov (United States)

    Torabipour, Amin; Zeraati, Hojjat; Arab, Mohammad; Rashidian, Arash; Akbari Sari, Ali; Sarzaiem, Mahmuod Reza

    2016-09-01

    To determine the hospital required beds using stochastic simulation approach in cardiac surgery departments. This study was performed from Mar 2011 to Jul 2012 in three phases: First, collection data from 649 patients in cardiac surgery departments of two large teaching hospitals (in Tehran, Iran). Second, statistical analysis and formulate a multivariate linier regression model to determine factors that affect patient's length of stay. Third, develop a stochastic simulation system (from admission to discharge) based on key parameters to estimate required bed capacity. Current cardiac surgery department with 33 beds can only admit patients in 90.7% of days. (4535 d) and will be required to over the 33 beds only in 9.3% of days (efficient cut off point). According to simulation method, studied cardiac surgery department will requires 41-52 beds for admission of all patients in the 12 next years. Finally, one-day reduction of length of stay lead to decrease need for two hospital beds annually. Variation of length of stay and its affecting factors can affect required beds. Statistic and stochastic simulation model are applied and useful methods to estimate and manage hospital beds based on key hospital parameters.

  4. Measuring and managing radiologist workload: application of lean and constraint theories and production planning principles to planning radiology services in a major tertiary hospital.

    Science.gov (United States)

    MacDonald, Sharyn L S; Cowan, Ian A; Floyd, Richard; Mackintosh, Stuart; Graham, Rob; Jenkins, Emma; Hamilton, Richard

    2013-10-01

    We describe how techniques traditionally used in the manufacturing industry (lean management, the theory of constraints and production planning) can be applied to planning radiology services to reduce the impact of constraints such as limited radiologist hours, and to subsequently reduce delays in accessing imaging and in report turnaround. Targets for imaging and reporting were set aligned with clinical needs. Capacity was quantified for each modality and for radiologists and recorded in activity lists. Demand was quantified and forecasting commenced based on historical referral rates. To try and mitigate the impact of radiologists as a constraint, lean management processes were applied to radiologist workflows. A production planning process was implemented. Outpatient waiting times to access imaging steadily decreased. Report turnaround times improved with the percentage of overnight/on-call reports completed by a 1030 target time increased from approximately 30% to 80 to 90%. The percentage of emergency and inpatient reports completed within one hour increased from approximately 15% to approximately 50% with 80 to 90% available within 4 hours. The number of unreported cases on the radiologist work-list at the end of the working day reduced. The average weekly accuracy for demand forecasts for emergency and inpatient CT, MRI and plain film imaging was 91%, 83% and 92% respectively. For outpatient CT, MRI and plain film imaging the accuracy was 60%, 55% and 77% respectively. Reliable routine weekly and medium to longer term service planning is now possible. Tools from industry can be successfully applied to diagnostic imaging services to improve performance. They allow an accurate understanding of the demands on a service, capacity, and can reliably predict the impact of changes in demand or capacity on service delivery. © 2013 The Royal Australian and New Zealand College of Radiologists.

  5. Center Variation in the Delivery of Indicated Late Preterm Births.

    Science.gov (United States)

    Aliaga, Sofia; Zhang, Jun; Long, D Leann; Herring, Amy H; Laughon, Matthew; Boggess, Kim; Reddy, Uma M; Grantz, Katherine Laughon

    2016-08-01

    Objective Evidence for optimal timing of delivery for some pregnancy complications at late preterm gestation is limited. The purpose of this study was to identify center variation of indicated late preterm births. Study design We performed an analysis of singleton late preterm and term births from a large U.S. retrospective obstetrical cohort. Births associated with spontaneous preterm labor, major congenital anomalies, chorioamnionitis, and emergency cesarean were excluded. We used modified Poisson fixed effects logistic regression with interaction terms to assess center variation of indicated late preterm births associated with four medical/obstetric comorbidities after adjusting for socio-demographics, comorbidities, and hospital/provider characteristics. Results We identified 150,055 births from 16 hospitals; 9,218 were indicated late preterm births. We found wide variation of indicated late preterm births across hospitals. The extent of center variation was greater for births associated with preterm premature rupture of membranes (risk ratio [RR] across sites: 0.45-3.05), hypertensive disorders of pregnancy (RR across sites: 0.36-1.27), and placenta previa/abruption (RR across sites: 0.48-1.82). We found less center variation for births associated with diabetes (RR across sites: 0.65-1.39). Conclusion Practice variation in the management of indicated late preterm deliveries might be a source of preventable late preterm birth.

  6. The Danish National Quality Database for Births

    Directory of Open Access Journals (Sweden)

    Andersson CB

    2016-10-01

    Full Text Available Charlotte Brix Andersson,1 Christina Flems,2 Ulrik Schiøler Kesmodel3 1Department of Obstetrics and Gynecology, Aalborg University Hospital, Aalborg, Denmark; 2Department of Obstetrics and Gynecology, Hvidovre Hospital, Copenhagen, Denmark; 3Department of Obstetrics and Gynecology, Herlev University Hospital, University of Copenhagen, Copenhagen, Denmark Aim of the database: The aim of the Danish National Quality Database for Births (DNQDB is to measure the quality of the care provided during birth through specific indicators. Study population: The database includes all hospital births in Denmark. Main variables: Anesthesia/pain relief, continuous support for women in the delivery room, lacerations (third and fourth degree, cesarean section, postpartum hemorrhage, establishment of skin-to-skin contact between the mother and the newborn infant, severe fetal hypoxia (proportion of live-born children with neonatal hypoxia, delivery of a healthy child after an uncomplicated birth, and anesthesia in case of cesarean section. Descriptive data: Data have been collected since 2010. As of August 2015, data on women and children representing 269,597 births and 274,153 children have been collected. All data for the DNQDB is collected from the Danish Medical Birth Registry. Registration to the Danish Medical Birth Registry is mandatory for all maternity units in Denmark. During the 5 years, performance has improved in the areas covered by the process indicators and for some of the outcome indicators. Conclusion: Measuring quality of care during childbirth has inspired and enabled staff to attend to the quality of the care they provide and has led to improvements in most of the areas covered. Keywords: DNQDB, Denmark, childbirth, anesthesia

  7. El Cuadro de Mando Integral en la ejecución del Plan Estratégico de un hospital general

    Directory of Open Access Journals (Sweden)

    Rocio Martínez

    2010-07-01

    Full Text Available Este estudio se centra en el proceso de aplicación del Cuadro de Mando Integral (CMI, como instrumento de gestión que alinea y comunica los objetivos estratégicos de la organización. Objetivo: Evaluar la utilidad del Cuadro de Mando Integral en la ejecución del Plan Estratégico de un hospital general. Material y métodos: Estudio descriptivo, observacional y retrospectivo realizado en el Hospital Nacional Cayetano Heredia (HNCH desde enero 2008 a junio de 2009. Resultados: Reducción de los rechazos por prestaciones valorizadas al Seguro Integral de Salud de 13,64% a 8,93%, disminución de las operaciones suspendidas de 13,04% a 9,83%, optimización de la utilización de camas de 79,23% a 91,15%, el desempeño de los planes operativos de las unidades orgánicas que alcanzaron nivel óptimo fue de 33,33% y las unidades orgánicas que expusieron las mejores presentaciones se incrementó de 8% a 40%. Conclusiones: La aplicación del CMI fue útil como instrumento de seguimiento y control de la ejecución del Plan Estratégico Institucional.(Rev Med Hered 2010;21:153-159

  8. 基层医院医疗骨干人才职业规划指导%Career Planning Guidance of Medical Talents in Basic Level Hospital

    Institute of Scientific and Technical Information of China (English)

    高燕玉; 卢红建

    2015-01-01

    Competition in medical market is the talent competition.The hospital should focus on the reali-zation of the ideal of medical talents when developing.The article mainly analyzed the influencing factors of employees'career planning, made career planning guidance to medical talents, constructed effective platform for the core talents to achieve career goals, made the selection, training, employment, incentive policies and measures to achieve a dual win of hospital comprehensive benefits and employee career development.%医疗市场的竞争就是人才的竞争,医院在注重发展的同时,要关注医疗骨干人才职业理想的实现。本文分析影响医疗骨干人才职业规划的因素,对医疗骨干人才进行职业规划指导,构建核心人才实现职业目标的有效平台,制定人才选拔、培养、任用、激励的政策措施,实现医院综合效益和员工职业发展的共赢。

  9. Safety and quality assurance of chemotherapeutic preparations in a hospital production unit: acceptance sampling plan and economic impact.

    Science.gov (United States)

    Paci, A; Borget, I; Mercier, L; Azar, Y; Desmaris, R P; Bourget, P

    2012-06-01

    The opportunity to apply a sampling plan was evaluated. Costs were computed by a microcosting study. In 2003, a sampling plan was defined to reduce the number of chemotherapy quality controls while preserving the same level of quality. Recent qualitative and quantitative changes led us to define a second sampling plan supplemented by an economic evaluation to determine the cost and cost-savings of quality control. The study considers preparation produced during four semesters classified into three groups. The first one includes drugs produced below 200 batches a semester. Group 2, those for which the lot of preparation lots would have been rejected twice among these four semesters. Group 3, those would have been accepted (≥3 'acceptable lot'). A single sampling plan by attributes was applied to this group with an acceptance quality level of 1.65% and a lot tolerance percent defective below 5%. A micro-costing study was conducted on quality control, from the sampling to the validation of the results. Among 39 cytotoxic drugs, 11 were sampled which enabled to avoid a mean of 17,512 control assays per year. Each batch of the 28 non-sampled drugs was however analyzed. Costs were estimated at 2.98€ and 5.25€ for control assays depending of the analytical method. The savings from the application of the sampling plans was 153,207€ in 6 years. The sampling plan allowed maintaining constancy in number of controls and the level of quality with significant costsavings, despite a substantial increase in drugs to assay and in the number of preparations produced.

  10. Birth control pill - slideshow

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/presentations/100108.htm Birth control pill - series—Normal female anatomy To use the ... produce a successful pregnancy. To prevent pregnancy, birth control pills affect how these organs normally function. Review ...

  11. Vaginal birth - slideshow

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/presentations/100198.htm Vaginal birth - series—Normal anatomy To use the sharing features ... vaginal delivery. Please keep in mind that every birth is unique, and your labor and delivery may ...

  12. Preterm Labor and Birth

    Science.gov (United States)

    ... Scientific Name Preterm labor Preterm birth Preterm infant Late-preterm birth ... first-time pregnancies No benefit in treating mildly low thyroid function in pregnancy, NIH Network study finds ...

  13. The Plan and Design of Hospital Information Security System%医院信息安全体系规划与设计

    Institute of Scientific and Technical Information of China (English)

    胡芳; 沈绍武

    2012-01-01

    通过对医院信息安全内涵的深入研究,结合医院实际建设情况,分析医院信息安全存在的主要问题.将医院安全体系划分为物理层安全、网络层安全、系统层安全、应用层安全和安全管理等五个不同的层次,对各个不同层次进行安全需求分析.并在此基础上,从安全防护、安全监测、安全恢复三个层面对医院信息安全体系进行整体规划与设计.重点介绍几种安全技术在医院中的具体应用,包括:安全网闸技术在医院内网和外网上隔离的处理方式,数字签名技术在电子病历中的应用,时间戳技术在保障医疗信息时效性,安全性方面的应用等.%In this paper, through the in-depth study of the hospital information system, and combined with the actual construction of'the hospital, we are going to analyze the main problems existing in hospital information system. We will divide the hospital security system into five different layers, including security of the physical layer, security of network layer, security of system layer, security of application layer and security of management, and we will analyze the security requirements of these layers. On this basis, we will plan and design the hospital information system from the three aspects of security protection, security monitoring, and security restoration. This article focuses on the specific application of several security technology in hospital, including method of isolating the hospital intranet and extranet by security gateway technology, application of digital signature in electronic medical records, and application of timestamp technology in the protection of medical information timeliness and security, etc.

  14. Traditional birth attendants in Malawi

    Directory of Open Access Journals (Sweden)

    J. J. M. Smit

    1994-05-01

    Full Text Available Traditional Birth Attendants (TBAs and traditional healers form an important link in the chain of health personnel providing primary health care in Malawi. In spite of the establishment of hospitals and health centres, it is to these traditional healers and TBAs that the majority of people turn in times of sickness and child-birth. Approximately 60 percent of all deliveries in Malawi occur in the villages. It is therefore important that due regard be paid to the activities of these traditional practitioners in order to ensure the achievement of the goal - "Health for all by the year 2000". The training of TBAs is seen as part of the Maternal and Child Health Services in the country.

  15. The Planning and Construction of Hospital Emergency Network System%医院应急网络系统的规划与建设

    Institute of Scientific and Technical Information of China (English)

    沈崑

    2012-01-01

    建设一个独立于有线业务网络的应急网络系统,对于医院信息系统的安全是十分重要的.无线网络系统易于覆盖广大区域,便于维护,是构建医院应急网络的不错选择.本文探讨了基于无线网络架构的医院应急网络系统的规划与建设.%It is very important to construct an emergency network system which is separated from the cable business network for the security of Hospital Information System. Because WLAN system is easy to cover large area and convenient for maintenance, it is a good choice on constructing hospital emergency network system. In this article, the planning and construction of hospital emergency network system based on WLAN system are discussed.

  16. Detailed statistical analysis plan for the target temperature management after out-of-hospital cardiac arrest trial

    DEFF Research Database (Denmark)

    Nielsen, Niklas; Winkel, Per; Cronberg, Tobias

    2013-01-01

    , and did not treat hyperthermia in the control groups. The optimal target temperature management (TTM) strategy is not known. To prevent outcome reporting bias, selective reporting and data-driven results, we present the a priori defined detailed statistical analysis plan as an update to the previously...

  17. Birth Control Pill

    Science.gov (United States)

    ... Surgery? A Week of Healthy Breakfasts Shyness Birth Control Pill KidsHealth > For Teens > Birth Control Pill Print A A A What's in this ... La píldora anticonceptiva What Is It? The birth control pill (also called "the Pill") is a daily ...

  18. Birth Control Patch

    Science.gov (United States)

    ... Surgery? A Week of Healthy Breakfasts Shyness Birth Control Patch KidsHealth > For Teens > Birth Control Patch Print A A A What's in this ... Does It Cost? What Is It? The birth control patch is a thin, beige, 1¾-inch (4½- ...

  19. Birth Control Shot

    Science.gov (United States)

    ... Surgery? A Week of Healthy Breakfasts Shyness Birth Control Shot KidsHealth > For Teens > Birth Control Shot Print A A A What's in this ... La inyección anticonceptiva What Is It? The birth control shot is a long-acting form of progesterone, ...

  20. Contraception and Birth Control

    Science.gov (United States)

    ... to the NICHD Staff Directory Skip sharing on social media links Rollup Image Home > Health & Research > A-Z Topics > Contraception and Birth Control > About Page Content ​About Contraception and Birth Control Contraception is the prevention of pregnancy. Contraception, or birth control, also allows couples to ...

  1. Encyclopedia of Birth Control.

    Science.gov (United States)

    Rengel, Marian

    This encyclopedia brings together in more than 200 entries, arranged in A-to-Z format, a portrait of the complex modern issue that birth control has become with advances in medicine and biochemistry during the 20th century. It is aimed at both the student and the consumer of birth control. Entries cover the following topics: birth control…

  2. Birth Control Ring

    Science.gov (United States)

    ... Right Sport for You Healthy School Lunch Planner Birth Control Ring KidsHealth > For Teens > Birth Control Ring Print A A A What's in ... español Anillo vaginal anticonceptivo What Is It? The birth control ring is a soft, flexible, doughnut-shaped ...

  3. Encyclopedia of Birth Control.

    Science.gov (United States)

    Rengel, Marian

    This encyclopedia brings together in more than 200 entries, arranged in A-to-Z format, a portrait of the complex modern issue that birth control has become with advances in medicine and biochemistry during the 20th century. It is aimed at both the student and the consumer of birth control. Entries cover the following topics: birth control…

  4. Birth Control Patch

    Science.gov (United States)

    ... Loss Surgery? A Week of Healthy Breakfasts Shyness Birth Control Patch KidsHealth > For Teens > Birth Control Patch A A A What's in this article? ... Much Does It Cost? What Is It? The birth control patch is a thin, beige, 1¾-inch (4½- ...

  5. Birth Control Pill

    Science.gov (United States)

    ... Loss Surgery? A Week of Healthy Breakfasts Shyness Birth Control Pill KidsHealth > For Teens > Birth Control Pill A A A What's in this article? ... español La píldora anticonceptiva What Is It? The birth control pill (also called "the Pill") is a daily ...

  6. Birth Control Ring

    Science.gov (United States)

    ... Loss Surgery? A Week of Healthy Breakfasts Shyness Birth Control Ring KidsHealth > For Teens > Birth Control Ring A A A What's in this article? ... español Anillo vaginal anticonceptivo What Is It? The birth control ring is a soft, flexible, doughnut-shaped ring ...

  7. Birth Control Shot

    Science.gov (United States)

    ... Loss Surgery? A Week of Healthy Breakfasts Shyness Birth Control Shot KidsHealth > For Teens > Birth Control Shot A A A What's in this article? ... español La inyección anticonceptiva What Is It? The birth control shot is a long-acting form of progesterone, ...

  8. Birth Defects (For Parents)

    Science.gov (United States)

    ... this virus during pregnancy, her child may have low birth weight, intellectual disability (mental retardation) or learning disabilities, ... and central nervous system problems. A child with late congenital syphilis may have abnormalities of the ... Diagnosing Birth Defects Many birth defects are diagnosed even before ...

  9. Methodological aspects of the 1993 Pelotas (Brazil) Birth Cohort Study

    Science.gov (United States)

    Victora, Cesar Gomes; Araújo, Cora Luiza Pavin; Menezes, Ana Maria Batista; Hallal, Pedro Curi; Vieira, Maria de Fátima; Neutzling, Marilda Borges; Gonçalves, Helen; Valle, Neiva Cristina; Lima, Rosangela Costa; Anselmi, Luciana; Behague, Dominique; Gigante, Denise Petrucci; Barros, Fernando Celso

    2010-01-01

    This paper describes the main methodological aspects of a cohort study, with emphasis on its recent phases, which may be relevant to investigators planning to carry out similar studies. In 1993, a population based study was launched in Pelotas, Southern Brazil. All 5,249 newborns delivered in the city’s hospitals were enrolled, and sub-samples were visited at the ages of one, three and six months and of one and four years. In 2004-5 it was possible to trace 87.5% of the cohort at the age of 10-12 years. Sub-studies are addressing issues related to oral health, psychological development and mental health, body composition, and ethnography. Birth cohort studies are essential for investigating the early determinants of adult disease and nutritional status, yet few such studies are available from low and middle-income countries where these determinants may differ from those documented in more developed settings. PMID:16410981

  10. The Rankin Inlet Birthing Centre: community midwifery in the Inuit context

    National Research Council Canada - National Science Library

    Douglas, Vasiliki Kravariotis

    2011-01-01

    To trace the historical development of the Rankin Inlet Birthing Centre since its inception in 1993 in the context of plans to make it the nucleus of a system of community birthing centres throughout Nunavut...

  11. The Rankin Inlet Birthing Centre: community midwifery in the Inuit context

    National Research Council Canada - National Science Library

    Vasiliki Kravariotis Douglas

    2011-01-01

      To trace the historical development of the Rankin Inlet Birthing Centre since its inception in 1993 in the context of plans to make it the nucleus of a system of community birthing centres throughout Nunavut...

  12. Using the Theory of Planned Behavior to explore hospital-based nurses' intention to use peripherally inserted central catheter (PICC): a survey study.

    Science.gov (United States)

    Bertani, Laura; Carone, Maria; Caricati, Luca; Demaria, Serena; Fantuzzi, Silvia; Guarasci, Alessandro; Pirazzoli, Luca

    2016-11-22

    The peripherally inserted central catheters (PICC) have become an alternative to the traditional CVC. PICCs are usually inserted by trained nurses who decided to attend and complete a special training on PICC insertion and management. The present work aimed to investigate the intention of using PICC in a sample of hospital-based nurses using the theory of planned behavior as theoretical framework. A cross-sectional design was used in which a questionnaire was delivered to 199 nurses. According to the theory of planned behavior, the attitude toward the use of PICC, subjective norms and perceived self-efficacy predicted the intention to use PICC. Contrary to the expectations, the effect of subjective norms on intention to use PICC was mediated by attitude and self-efficacy. Finally, age of participants was negatively related to the intention to use the PICC. The theory of planned behavior offers a useful framework to explain nurses' intention to use PICC. Shared norms favoring the use of PICC seem to increase both nurse's positive attitudes and self-efficacy whit respect to the use of these devices. Thus, it appears that to train professionals individually does not necessarily results in an increased use of PICC.

  13. Development of the breastfeeding quality improvement in hospitals learning collaborative in New York state.

    Science.gov (United States)

    Fitzpatrick, Eileen; Dennison, Barbara A; Welge, Sara Bonam; Hisgen, Stephanie; Boyce, Patricia Simino; Waniewski, Patricia A

    2013-06-01

    Exclusive breastfeeding is a public health priority. A strong body of evidence links maternity care practices, based on the Ten Steps to Successful Breastfeeding, to increased breastfeeding initiation, duration and exclusivity. Despite having written breastfeeding policies, New York (NY) hospitals vary widely in reported maternity care practices and in prevalence rates of breastfeeding, especially exclusive breastfeeding, during the birth hospitalization. To improve hospital maternity care practices, breastfeeding support, and the percentage of infants exclusively breastfeeding, the NY State Department of Health developed the Breastfeeding Quality Improvement in Hospitals (BQIH) Learning Collaborative. The BQIH Learning Collaborative was the first to use the Institute for Health Care Improvement's Breakthrough Series methodology to specifically focus on increasing hospital breastfeeding support. The evidence-based maternity care practices from the Ten Steps to Successful Breastfeeding provided the basis for the Change Package and Data Measurement Plan. The present article describes the development of the BQIH Learning Collaborative. The engagement of breastfeeding experts, partners, and stakeholders in refining the Learning Collaborative design and content, in defining the strategies and interventions (Change Package) that drive hospital systems change, and in developing the Data Measurement Plan to assess progress in meeting the Learning Collaborative goals and hospital aims is illustrated. The BQIH Learning Collaborative is a model program that was implemented in a group of NY hospitals with plans to spread to additional hospitals in NY and across the country.

  14. Out-of-Pocket and Informal Payment Before and After the Health Transformation Plan in Iran: Evidence from Hospitals Located in Kurdistan, Iran.

    Science.gov (United States)

    Piroozi, Bakhtiar; Rashidian, Arash; Moradi, Ghobad; Takian, Amirhossein; Ghasri, Hooman; Ghadimi, Tayyeb

    2017-02-11

    One of the objectives of the health transformation plan (HTP) in Iran is to reduce out-of-pocket (OOP) payments for inpatient services and eradicate informal payments. The HTP has three phases: the first phase (launched in May 5, 2014) is focused on reducing OOP payments for inpatient services; the second phase (launched in May 22, 2014) is focused on primary healthcare (PHC) and the third phase utilizes an updated relative value units for health services (launched in September 29, 2014) and is focused on the elimination of informal payments. This aim of this study was to determine the OOP payments and the frequency of informal cash payments to physicians for inpatient services before and after the HTP in Kurdistan province, Iran. This quasi-experimental study used multistage sampling method to select and evaluate 265 patients discharged from hospitals in Kurdistan province. The study covered 3 phases (before the HTP, after the first, and third phases of the HTP). Part of the data was collected using a hospital information system form and the rest were collected using a questionnaire. Data were analyzed using Fisher exact test, logistic regression, and independent samples t test. The mean OOP payments before the HTP and after the first and third phases, respectively, were US$59.4, US$17.6, and US$14.3 in hospital affiliated to the Ministry of Health and Medical Education (MoHME), US$39.6, US$33.7, and US$13.7 in hospitals affiliated to Social Security Organization (SSO), and US$153.3, US$188.7, and US$66.4 in private hospitals. In hospitals affiliated to SSO and MoHME there was a significant difference between the mean OOP payments before the HTP and after the third phase (PHTP, and 0.0%, 7.1%, and 10.0% after the first phase. Contrary to the time before the HTP, no informal payment was reported after the third phase. It seems that the implementation of the HTP has reduced the OOP payments for inpatient services and eradicated informal payments to physician in

  15. Doula birth support for incarcerated pregnant women.

    Science.gov (United States)

    Schroeder, Carole; Bell, Janice

    2005-01-01

    The objective of this study was to provide trained labor support (doulas) to pregnant women in jail. A multiagency intervention project provided doula birth services to pregnant women in urban jails. Program evaluation included interviews with women and written satisfaction surveys of providers and correctional officers. A convenience sample of 18 incarcerated women received doula services. A doula visited each woman in jail antepartum to review expectations for labor and birth; during hospitalization, the doula provided continuous support throughout labor and birth. Doulas visited women postpartum to review birth events. Surveys administered to providers and officers demonstrated high satisfaction with the program. Qualitative interviews with 14 women indicated unanimous support for the services and documented women's major concerns. Findings support offering doula services to all pregnant women in custody and expanding doula services to include early and comprehensive intervention coordinated by nurses.

  16. Maternal and neonatal outcomes after implementation of a hospital policy to limit low-risk planned caesarean deliveries before 39 weeks of gestation: an interrupted time-series analysis.

    Science.gov (United States)

    Hutcheon, J A; Strumpf, E C; Harper, S; Giesbrecht, E

    2015-08-01

    To evaluate the extent to which implementing a hospital policy to limit planned caesarean deliveries before 39 weeks of gestation improved neonatal health, maternal health, and healthcare costs. Retrospective cohort study. British Columbia Women's Hospital, Vancouver, Canada, in the period 2005-2012. Women with a low-risk planned repeat caesarean delivery. An interrupted time series design was used to evaluate the policy to limit planned caesarean deliveries before 39 weeks of gestation, introduced on 1 April 2008. Composite adverse neonatal health outcome (respiratory morbidity, 5-minute Apgar score of policy, the proportion of planned caesareans dropped by 20 percentage points (adjusted risk difference of 20 fewer cases per 100 deliveries; 95% CI -25.8, -14.3) to 41% (1033/2518). The policy had no detectable impact on adverse neonatal outcomes (2.2 excess cases per 100; 95% CI -0.4, 4.8), maternal complications, or healthcare costs, but increased the risk of out-of-hours delivery from 16.2 to 21.1% (adjusted risk difference 6.3 per 100; 95% CI 1.6, 10.9). We found little evidence that a hospital policy to limit planned caesareans before 39 weeks of gestation reduced adverse neonatal outcomes. Hospital administrators intending to introduce such policies should anticipate, and plan for, modest increases in out-of-hours and emergency-timing. © 2015 Royal College of Obstetricians and Gynaecologists.

  17. Doula, Sister, Aunt, Storyteller: A Midwife's Retelling of Birth.

    Science.gov (United States)

    Niles, Mimi

    2015-01-01

    As a midwife, delivering hundreds of babies a year in a busy city hospital, I rarely have the opportunity to reconnect with what made me pursue the path of midwifery. This is the story of the birth of my niece.

  18. Driving hospital transformation with SLMTA in a regional hospital in Cameroon

    Directory of Open Access Journals (Sweden)

    Laura T. Eno

    2014-09-01

    Full Text Available Background: Inspired by the transformation of the Regional Hospital Buea laboratory through implementation of the Strengthening Laboratory Management Toward Accreditation (SLMTA programme, hospital management adapted the SLMTA toolkit to drive hospital wide quality improvement.Objective: This paper describes changes in the hospital following the quality improvement activities in hygiene and sanitation, the outpatient waiting area and the surgical and maternity wards.Methods: In March 2011, hospital management established a quality improvement task force and created a hospital-wide quality improvement roadmap, following the SLMTA model. The roadmap comprised improvement projects, accountability plans, patient feedback forms and log books to track quality indicators including patient wait time, satisfaction level, infectionrates, birth outcomes and hospital revenue.Results: There was steady improvement in service delivery during the 11 months after the introduction of the quality improvement initiatives: patient wait time at the reception was reduced from three hours to less than 30 minutes and patient satisfaction increased from 15% to 60%. Treatment protocols were developed and documented for various units, infrastructure and workflow processes were improved and there was increased staff awareness of the importance of providing quality services. Maternal infection rates dropped from 3% to 0.5% and stillbirths from 5% to < 1%. The number of clients increased as a result of improvedservices, leading to a 25% increase in hospital revenue.Conclusion: The SLMTA approach was adapted successfully to meet the needs of the entire hospital. Such a programme has the potential to impact positively on hospital quality systems; consideration should be made for development of a formal SLMTA-like programmefor hospital quality improvement.

  19. A vision of long-term care. To care for tomorrow's elderly, hospitals must plan now, not react later.

    Science.gov (United States)

    Kodner, D L

    1989-12-01

    In the next two decades, rapid, fundamental changes will take place in the way we finance, organize, and provide long-term care services. Because the elderly make up such a large portion of the patient population, America's hospitals should be concerned--and involved. There are six keys to the future of long-term care: a sharp increase in elderly population, a new generation of elderly, restrained government role, intergenerational strains, growing corporate concern, and the rise of "gerotechnology." These trends and countertrends will result in a new look in the long-term care landscape. By the year 2010, changes will include a true public-private financing system, provider reimbursement on the basis of capitation and prospective payment, coordinated access to services, dominant alternative delivery systems, a different breed of nursing homes, fewer staffing problems, patient-centered care, a new importance in housing, and an emphasis on prevention. For hospitals, this future vision of long-term care means that significant opportunities will open up to meet the needs of the elderly-at-risk and to achieve a competitive position in the burgeoning elderly care industry.

  20. Perfil epidemiológico de adolescentes atendidas no pré-natal de um hospital universitário Perfil epidemiólogico de adolescentes atendidas en el prenatal de un hospital universitario Epidemiologist profile of teenagers at consultation in the pre-birth department of an university hospital

    Directory of Open Access Journals (Sweden)

    Thelma Spindola

    2009-03-01

    ólo el 49,1% de las jóvenes usaban métodos anticonceptivos, 88,3% nunca habían hecho un aborto. No hubo registro de intercurrencias obstétricas en 72 historias clínicas, evidenciando que la mayoría de las jóvenes evolucionó con un embarazo fisiológico, aunque la gestación en la adolescencia sea considerada de riesgo. Se concluye que la insuficiencia de adhesión a los métodos anticonceptivos contribuye para la alta incidencia de gestación no planificada en esta población.This exploratory and descriptive study with quantitative approach aimed at identifying socio-demographic characteristics of pregnant teenagers by sketching its epidemiological profile. It was carried out at an University Hospital in Rio de Janeiro, where 112 medical records from 2004 to 2006 were analyzed. The results make evident that the majority of adolescents were among 15 and 17 years old (68.7%; had elementary school education (69.5%; were students (64.3%, had a family income of 1 to 3 minimum salaries (66.9%. They had first sexual intercourse 1 to 3 years after the menarche (55.3%; carried their first pregnancy (79.4% and, (75% did not plan to get pregnancy, but it was well accepted by (58.9%. Although only (49.1% of the teenagers have used contraceptive methods, (88.3% have never had an abortion. There were no records of obstetric intercurrent events in the 72 medical records, showing that the majority of teenagers have had normal course of pregnancy, although pregnancy during adolescence is considered a risk factor. We concluded that the non-adherence of contraceptive methods among teenagers leads to a high incidence of unplanned pregnancy within this population.

  1. Implementación del cuadro de mando integral como herramienta de gestión complementaria al plan estratégico en un hospital

    Directory of Open Access Journals (Sweden)

    Rocío Martínez Malqui

    2010-08-01

    Full Text Available Uno de los grandes problemas que afronta un gobierno es la asistencia sanitaria accesible y de calidad a la población, siendo alta la exigencia en los resultados de las instituciones de salud. Este estudio se centra en el proceso de aplicación del Cuadro de Mando Integral (CMI, como instrumento de gestión que alinea y comunica los objetivos estratégicos a la organización. El objetivo fue valorar la implementación del CMI como herramienta complementaria al Plan Estratégico Institucional (PEI en un hospital peruano de salud pública de alta complejidad. La metodología se basó en un diseño de tipo descriptivo, observacional y retrospectivo. Nuestros resultados mostraron que la aplicación del CMI, permitió mejorar el control de la gestión institucional en todas las áreas, logrando alto impacto en el incremento de los ingresos por prestaciones del Seguro Integral de Salud, reducción de las intervenciones quirúrgicas suspendidas y optimización de la utilización de camas, además de alinear el Plan Operativo con el PEI y generar una cultura de gestión por resultados; este estudio contribuye a demostrar que en un hospital público de alta complejidad la implementación del CMI genera impactos favorables y motiva al desarrollo de nuevas investigaciones en instituciones similares.

  2. SWOT analysis: The analytical method in the process of planning and its application in the development of orthopaedic hospital department

    Directory of Open Access Journals (Sweden)

    Terzić Zorica

    2010-01-01

    Full Text Available Introduction. SWOT analysis is a managerial tool used to evaluate internal and external environment through strengths and weaknesses, opportunities and threats. Objective. The aim was to demonstrate the application of the SWOT analysis on the example of the Department for Paediatric Orthopaedics and Traumatology at the Institute of Orthopaedic Surgery 'Banjica' in Belgrade. Methods. Qualitative research was conducted during December 2008 at the Department for Paediatric Orthopaedics and Traumatology of the Institute of Orthopaedic Surgery 'Banjica' by applying the focus group technique. Participants were members of the medical staff and patients. In the first phase of the focus group brainstorming was applied to collect the factors of internal and external environment, and to identify strengths and weaknesses, opportunities and threats, respectively. In the second phase the nominal group technique was applied in order to reduce the list of factors. The factors were assessed according to their influence on the Department. Factors ranked by the three point Likert scale from 3 (highest impact to 1 (lowest impact. Results. The most important strengths of the Department are competent and skilled staff, high quality of services, average hospital bed utilization, the Department providing the educational basis of the School of Medicine, satisfied patients, pleasant setting, and additional working hours. The weaknesses are: poor spatial organization, personnel unmotivated to refresh knowledge, lack of specifically trained personnel, inadequate sanitary facilities, and uncovered services by the Insurance Fund, long average hospital stay, and low economic status of patients. The opportunities are: legislative regulations, formed paediatric traumatology service at the City level, good regional position of the Institute, and extension of referral areas. The threats are: absent Department autonomy in the personnel policy of the Institute, competitions within

  3. [SWOT analysis: the analytical method in the process of planning and its application in the development of orthopaedic hospital department].

    Science.gov (United States)

    Terzić, Zorica; Vukasinović, Zoran; Bjegović-Mikanović, Vesna; Jovanović, Vesna; Janicić, Radmila

    2010-01-01

    SWOT analysis is a managerial tool used to evaluate internal and external environment through strengths and weaknesses, opportunities and threats. The aim was to demonstrate the application of the SWOT analysis on the example of the Department for Paediatric Orthopaedics and Traumatology at the Institute of Orthopaedic Surgery "Banjica" in Belgrade. Qualitative research was conducted during December 2008 at the Department for Paediatric Orthopaedics and Traumatology of the Institute of Orthopaedic Surgery "Banjica" by applying the focus group technique. Participants were members of the medical staff and patients. In the first phase of the focus group brainstorming was applied to collect the factors of internal and external environment, and to identify strengths and weaknesses, opportunities and threats, respectively. In the second phase the nominal group technique was applied in order to reduce the list of factors. The factors were assessed according to their influence on the Department. Factors ranked by the three point Likert scale from 3 (highest impact) to 1 (lowest impact). The most important strengths of the Department are competent and skilled staff, high quality of services, average hospital bed utilization, the Department providing the educational basis of the School of Medicine, satisfied patients, pleasant setting, and additional working hours. The weaknesses are: poor spatial organization, personnel unmotivated to refresh knowledge, lack of specifically trained personnel, inadequate sanitary facilities, and uncovered services by the Insurance Fund, long average hospital stay, and low economic status of patients. The opportunities are: legislative regulations, formed paediatric traumatology service at the City level, good regional position of the Institute, and extension of referral areas. The threats are: absent Department autonomy in the personnel policy of the Institute, competitions within the Institute, impossibility to increase the Department

  4. Social marketing: the family planning experience.

    Science.gov (United States)

    El-ansary, A I; Kramer Oe, J

    1973-07-01

    The authors explore social marketing applications in the Louisiana model of statewide program for family planning. The marketing concept has 4 major elements: 1) consumer orientation; 2) social process; 3) integrated effort; 4) profitable operation. Success of program and continued growth are the results of defining services needed by consumer; determining market target; taking services to customer; and emphasizing concept of selling family planning rather than giving free birth control method. Another important facet is the recognition of many participants--community agencies, the church, the American Medical Association, funding sources, and hospitals. This project used anyaltical marketing tools and defined services as human services rather than the narrow family planning services. It also extended activities to multinational environment and adapted the product offering to meet these needs.

  5. at birth, at a birth, by birth, from birth, of... birth与give birth to

    Institute of Scientific and Technical Information of China (English)

    昝亚娟

    2000-01-01

    birth是中学英语教材中的一个常用词,也常见于birthday(生日)、birthplace(出生地)、birthrate(出生率)和birth control(计划生育)等一些复合名词或短语之中。从字面看,这些复合词和短语的意义容易理解,但下面一些含birth的介词短语和动词短语对于中学生来说就不那么容易理解了。

  6. Growth Assessment with Z Score of Weight for Very Low Birth Weight Infant During Hospital Stay%胎龄别体重Z评分法评价早产极低出生体重儿生后早期营养状况的分析

    Institute of Scientific and Technical Information of China (English)

    李乔红; 邹永蓉; 谭学蓉; 唐文秀; 高月; 陈伟; 王一

    2014-01-01

    Objective To evaluate the nutrition status in very low birth weight at reture birth weight and discharge with Z score of weight for correct age( CA) . Methods 141 appropriate for gestational age( GA) premature infants with hospital stay ex-ceeding 2 weeks but no major congenital diseases were included. Z scores of weight for age were calculated at birth and reture birth weight and discharge. Their clinical data were retrospectively analyzed. Results At all the subgroups( categorized by GA at birth or by nutrition support method or by nutrition status at discharge) ,The Z scores at reture birth weight and discharge were positively related with Z scores at birth(P<0. 001);Different nutrition support method were significantly related with Z score at reture birth weight and discharge(P<0. 001). The lower Z scores at birth, the time of reture birth weight and discharge were longer. Conclu-sion Very low birth weight infants occurred growth retardation during admission. Nutritional support strategy is helpful for nutri-tion condition in premature infants.%目的:采用纠正胎龄别体重Z评分法评估极低出生体重儿入院时、恢复出生体重时与出院时营养状况,探讨其与出生时营养状况、生后营养支持方式、恢复出生体重时间及住院时间之间的关系。方法选择出生胎龄28~33+6周,出生体重<1500g,生后24h内入院,住院时间≥2周新生儿,分别按出生胎龄和营养支持方式、出院时营养状况分组,比较每组出生时、恢复出生体重时和出院时的Z评分,以及恢复出生体重所需时间和住院时间的关系。结果每组患儿出院时Z评分均低于入院时;小出生胎龄组恢复出生体重时和出院时Z评分均高于大胎龄组;营养支持滞后组,恢复出生体重时及出院时Z评分均较积极组更低,滞后组恢复出生体重所需时间和住院时间也均更长;出生时Z评分越低,恢复出生体重时Z评分和出院时Z评分越低,恢复出

  7. Family planning services in a tertiary hospital in a semi-urban area of south-western Nigeria: Uptake and determinants of contraceptive use.

    Science.gov (United States)

    Adebayo, Ayodeji Matthew; Ojo, Temitope Olumuyiwa; Omotoso, Bridget Ama; Ayodeji, Oladele Olufemi

    2016-10-01

    An audit of 954 family planning clinic attendees, who received counselling from 2006 to 2010, was conducted at the only federal government owned tertiary hospital in Ondo state, Nigeria. Of these, 637 (66.8%) accepted a family planning method: 47.6% chose injectables, 23.2% intrauterine device, 19.5% oral contraceptive pills, 4.4% barrier methods, 3.3% implants and 2% tubal ligation. Clients who had some primary education [OR: 2.79; (95% CI: 1.14-6.84; p < 0.05] had statistically significant higher odds of accepting any contraceptive method while those with elevated blood pressure at first visit [OR: 0.23; 95% CI: 0.12-0.45; p < 0.001] and those with previous episode(s) of induced abortion OR: 0.57; 95% CI: 0.43-0.76; p < 0.001] had statistically significant lower odds of using any method. Concerted efforts at increasing uptake is advocated to bridge the gap between client counselling and uptake.

  8. Human births and the phase of the moon.

    Science.gov (United States)

    Abell, G O; Greenspan, B

    1979-01-11

    Published studies on the frequency of births as related to the lunar cycle are inconsistent with each other. The distribution of all births during 51 lunar cycles, from March 17, 1974, to April 30, 1978, was analyzed by the authors at the University of California, Los Angeles, Hospital. There were 11.691 live births, of which 8142 were natural, 141 multiple, and 168 stillbirths. In none of the 4 samples was the mean number of births occurring on the date of the full moon above average, showing that the birthrate during the period surveyed did not in any way correlate with the cycle of lunar phases.

  9. 云南省在医院出生新生儿乙型肝炎疫苗首剂及时接种影响因素研究%Study on the Influencing Factors of Hepatitis B Vaccine Timely Birth Dose for Infants Born at Hospitals in Yunnan Province

    Institute of Scientific and Technical Information of China (English)

    文洪梅; 丁峥嵘; 庞颜坤; 罗梅; 李凯; 昌思思; 胡筱莛; 陆林

    2012-01-01

    目的 了解云南省在医院出生新生儿乙型肝炎疫苗(Hepatitis B Vaccine,HepB)首剂(HepB1)及时接种状况和未及时接种原因,探讨提高新生儿HepB1及时接种率的对策.方法 采用现场查阅资料和问卷调查相结合的方法,抽样调查云南省2010年在医院出生的新生儿HepB1及时接种情况.结果 云南省在医院出生的新生儿HepB1及时接种率为92.78%.在乡卫生院出生新生儿的HepB1及时接种率(93.24%)略高于在县级医院出生的新生儿(92.65%).在医院出生新生儿未及时接种HepB1的原因以低体重、新生儿窒息、早产儿和发热为主.结论 正确把握接种禁忌证,是提高在医院出生新生儿HepB1及时接种率的关键.%Objective To understand the coverage of timely birth dose of hepatitis B vaccine (HepB1) and reasons contributed to the non-timely of HepB1 for the infants delivered in the hospital in Yunnan province, and to bring forword the special strategies to improve the coverage of HepB1 of infants born at hospitals. Methods The HepB] coverage of infants born at hospitals in 2010 was investigated by field survey and questionnaire. Results The average coverage of HepB1 of infants born at the hospitals in Yunnan province was 92.78%, and