Characterization of trauma patients treated in a pre-hospital care service

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Amanda de Ornelas Carvalho

2004-09-01

Full Text Available Objectives: To identify the characteristics of trauma patientstreated in a pre-hospital care service, to characterize the factorsrelated to the trauma event and quantify the severity of trauma,according to the Revised Trauma Score. Methods: This is adescriptive, exploratory, retrospective study carried out at thePre-Hospital Care Service of the Military Police - Rescue in thecity of São Paulo. Data comprised a randomized sample of 60nursing charts, distributed among the four advanced life supportunits in the city. Results: Of the occurrences dealt with, 65% arerelated to public streets, 20% are medical cases, 65% are maleindividuals, predominantly young adults. The predominantmechanisms of trauma are crash and run-over. Casa Verde wasthe care unit which obtained the highest Revised Trauma Scoreweighted mean. Conclusions: The results presented here are inconformity with the national statistics on trauma: young adults, ofworking age, involved in road accidents are most frequentlyaffected. Identifying this population is of utmost importance forthe development of preventive and educational measures.

Management and outcomes of acute ST-segment-elevation myocardial infarction at a tertiary-care hospital in Sri Lanka: an observational study

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Bandara, Ruwanthi; Medagama, Arjuna; Munasinghe, Ruwan; Dinamithra, Nandana; Subasinghe, Amila; Herath, Jayantha; Ratnayake, Mahesh; Imbulpitiya, Buddhini; Sulaiman, Ameena

2015-01-01

Background Sri Lanka is a developing country with a high rate of cardiovascular mortality. It is still largely dependent on thrombolysis for primary management of acute myocardial infarction. The aim of this study was to present current data on the presentation, management, and outcomes of acute ST-segment-elevation myocardial infarction (STEMI) at a tertiary-care hospital in Sri Lanka. Methods Eighty-one patients with acute STEMI presenting to a teaching hospital in Peradeniya, Sri Lanka, we...

Urban and rural implementation of pre-hospital diagnosis and direct referral for primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction

DEFF Research Database (Denmark)

Sørensen, Jacob Thorsted; Terkelsen, Christian Juhl; Nørgaard, Bjarne Linde

2011-01-01

Primary percutaneous coronary intervention (PCI) is the preferred treatment for ST-elevation myocardial infarction (STEMI). The distance to primary PCI centres and the inherent time delay in delivering primary PCI, however, limit widespread use of this treatment. This study aimed to evaluate...... the impact of pre-hospital diagnosis on time from emergency medical services contact to balloon inflation (system delay) in an unselected cohort of patients with STEMI recruited from a large geographical area comprising both urban and rural districts....

Hospital costs and revenue are similar for resuscitated out-of-hospital cardiac arrest and ST-segment acute myocardial infarction patients.

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Swor, Robert; Lucia, Victoria; McQueen, Kelly; Compton, Scott

2010-06-01

Care provided to patients who survive to hospital admission after out-of-hospital cardiac arrest (OOHCA) is sometimes viewed as expensive and a poor use of hospital resources. The objective was to describe financial parameters of care for patients resuscitated from OOHCA. This was a retrospective review of OOHCA patients admitted to one academic teaching hospital from January 2004 to October 2007. Demographic data, length of stay (LOS), and discharge disposition were obtained for all patients. Financial parameters of patient care including total cost, net revenue, and operating margin were calculated by hospital cost accounting and reported as median and interquartile range (IQR). Groups were dichotomized by survival to discharge for subgroup analysis. To provide a reference group for context, similar financial data were obtained for ST-segment elevation myocardial infarction (STEMI) patients admitted during the same time period, reported with medians and IQRs. During the study period, there were 72 admitted OOCHA patients and 404 STEMI patients. OOCHA and STEMI groups were similar for age, sex, and insurance type. Overall, 27 (38.6%) OOHCA patients survived to hospital discharge. Median LOS for OOHCA patients was 4 days (IQR = 1-8 days), with most of those hospitalized for Financial parameters for OOHCA patients are similar to those of STEMI patients. Financial issues should not be a negative incentive to providing care for these patients. (c) 2010 by the Society for Academic Emergency Medicine.

Mental Health and Job Burnout Among Pre-Hospital Emergency Care Personnel

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Mahsa Haji Mohammad Hoseini

2017-01-01

Full Text Available Background: Work environment dictates physical, social and mental tensions each of which affect the staff’s health. Likewise, pre-hospital emergency care staff, due to the special nature of their job, are exposed to the tensions of emergency situations which can affect their health. Therefore, this study was conducted to scrutinize the relationship between the job burnout and mental health in pre-hospital emergencies of Qom Province. Materials and Methods: In this descriptive sectional study, 150 employed personnel of Qom 115 Emergency Care entered the study using census method. Data were gathered using questionnaires of “Background and Clinical Information”, “Mental Health”, and “Job Burnout”, and then based on central indices, Pearson correlation test and multiple linear regression statistical tests were run through software SPSS13 and then analyzed. Results: The average age of the participants was 30.8±5.8. The averages of the values of burnout and mental health were 69.43±12.4 and 60±14.1, respectively. According to Pearson correlation test, the values of the burnout and mental health have a significant negative correlation (r=-0.8. The results of multiple linear regression test showed that the correlation of the burnout and mental health considering the confounding variables is significant. (P=0.05 Conclusion: Pre-hospital employed personnel have desirable mental health and [low] burnout. Furthermore, improved mental health results in decreasing job burnout. Therefore, it is advisable to consider necessary facilities for caring for oneself.

Barriers and facilitators to provide effective pre-hospital trauma care for road traffic injury victims in Iran: a grounded theory approach

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Hasselberg Marie

2010-11-01

Full Text Available Abstract Background Road traffic injuries are a major global public health problem. Improvements in pre-hospital trauma care can help minimize mortality and morbidity from road traffic injuries (RTIs worldwide, particularly in low- and middle-income countries (LMICs with a high rate of RTIs such as Iran. The current study aimed to explore pre-hospital trauma care process for RTI victims in Iran and to identify potential areas for improvements based on the experience and perception of pre-hospital trauma care professionals. Methods A qualitative study design using a grounded theory approach was selected. The data, collected via in-depth interviews with 15 pre-hospital trauma care professionals, were analyzed using the constant comparative method. Results Seven categories emerged to describe the factors that hinder or facilitate an effective pre-hospital trauma care process: (1 administration and organization, (2 staff qualifications and competences, (3 availability and distribution of resources, (4 communication and transportation, (5 involved organizations, (6 laypeople and (7 infrastructure. The core category that emerged from the other categories was defined as "interaction and common understanding". Moreover, a conceptual model was developed based on the categories. Conclusions Improving the interaction within the current pre-hospital trauma care system and building a common understanding of the role of the Emergency Medical Services (EMS emerged as key issues in the development of an effective pre-hospital trauma care process.

Medical Decision Algorithm for Pre-Hospital Trauma Care. Phase I.

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1996-09-01

Algorithm for Pre-Hospital Trauma Care PRINCIPAL INVESTIGATOR: Donald K. Wedding, P.E., Ph.D CONTRACTING ORGANIZATION : Photonics Systems, Incorporated... ORGANIZATION NAME(S) AND ADDRESS(ES) 8. PERFORMING ORGANIZATION REPORT NUMBER Photonics Systems, Incorporated Northwood, Ohio 43619 9. SPONSORING...three areas: 1) data acquisition, 2) neural network design, and 3) system architechture design. In the first area of this research, a triage database

Instrument for assessing the quality of mobile emergency pre-hospital care: content validation

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Rodrigo Assis Neves Dantas

2015-06-01

Full Text Available OBJECTIVES To validate an instrument to assess quality of mobile emergency pre-hospital care. METHOD A methodological study where 20 professionals gave their opinions on the items of the proposed instrument. The analysis was performed using Kappa test (K and Content Validity Index (CVI, considering K> 0.80 and CVI ≥ 0.80. RESULTS Three items were excluded from the instrument: Professional Compensation; Job Satisfaction and Services Performed. Items that obtained adequate K and CVI indexes and remained in the instrument were: ambulance conservation status; physical structure; comfort in the ambulance; availability of material resources; user/staff safety; continuous learning; safety demonstrated by the team; access; welcoming; humanization; response time; costumer privacy; guidelines on care; relationship between professionals and costumers; opportunity for costumers to make complaints and multiprofessional conjunction/actuation. CONCLUSION The instrument to assess quality of care has been validated and may contribute to the evaluation of pre-hospital care in mobile emergency services.

Evaluation of the Prevention and Reactivation Care Program (PReCaP for the hospitalized elderly: a prospective nonrandomized controlled trial

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Asmus-Szepesi KJ

2015-03-01

Full Text Available Kirsten J Asmus-Szepesi,1 Linda E Flinterman,1 Marc A Koopmanschap,2 Anna P Nieboer,2 Ton J Bakker,3 Johan P Mackenbach,1 Ewout W Steyerberg1 1Department of Public Health, Erasmus University Medical Center, 2Institute of Health Policy and Management, Erasmus University, 3Stichting Wetenschap Balans, Rotterdam, the Netherlands Background: The hospitalized elderly are at risk of functional decline. We evaluated the effects and care costs of a specialized geriatric rehabilitation program aimed at preventing functional decline among at-risk hospitalized elderly.Methods: The prospective nonrandomized controlled trial reported here was performed in three hospitals in the Netherlands. One hospital implemented the Prevention and Reactivation Care Program (PReCaP, while two other hospitals providing usual care served as control settings. Within the PReCaP hospital we compared patients pre-implementation with patients post-implementation of the PReCaP (“within-hospital analysis”, while our nonrandomized controlled trial compared patients of the PReCaP hospital post-implementation with patients from the two control hospitals providing usual care (“between-hospital analysis”. Hospitalized patients 65 years or older and at risk of functional decline were interviewed at baseline and at 3 and 12 months using validated questionnaires to score functioning, depression, and health-related quality of life (HRQoL. We estimated costs per unit of care from hospital information systems and national data sources. We used adjusted general linear mixed models to analyze functioning and HRQoL.Results: Between-hospital analysis showed no difference in activities of daily living (ADL or instrumental activities of daily living (IADL between PReCaP patients and control groups. PReCaP patients did have slightly better cognitive functioning (Mini Mental State Examination; 0.4 [95% confidence interval (CI 0.2–0.6], lower depression (Geriatric Depression Scale 15; -0

Smoking ban in public areas is associated with a reduced incidence of hospital admissions due to ST-elevation myocardial infarctions in non-smokers. Results from the Bremen STEMI Registry.

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Schmucker, J; Wienbergen, H; Seide, S; Fiehn, E; Fach, A; Würmann-Busch, B; Gohlke, H; Günther, K; Ahrens, W; Hambrecht, R

2014-09-01

Laws banning tobacco smoking from public areas have been passed in several countries, including the region of Bremen, Germany at the end of 2007. The present study analyses the incidence of hospital admissions due to ST-elevation myocardial infarctions (STEMIs) before and after such a smoking ban was implemented, focusing on differences between smokers and non-smokers. In this respect, data of the Bremen STEMI Registry (BSR) give a complete epidemiological overview of a region in northwest Germany with approximately 800,000 inhabitants since all STEMIs are admitted to one central heart centre. Between January 2006 and December 2010, data from the BSR was analysed focusing on date of admission, age, gender, and prior nicotine consumption. A total of 3545 patients with STEMI were admitted in the Bremen Heart Centre during this time period. Comparing 2006-2007 vs. 2008-2010, hence before and after the smoking ban, a 16% decrease of the number of STEMIs was observed: from a mean of 65 STEMI/month in 2006-2007 to 55/month in 2008-2010 (p smokers showed a constant number of STEMIs: 25/month in 2006-2007 to 26/month in 2008-2010 (+4%, p = 0.8). However, in non-smokers, a significant reduction of STEMIs over time was found: 39/month in 2006-2007 to 29/month in 2008-2010 (-26%, p non-smokers was consistently observed in all age groups and both sexes. Adjusting for potentially confounding factors like hypertension, obesity, and diabetes mellitus did not explain the observed decline. In the BSR, a significant decline of hospital admissions due to STEMIs in non-smokers was observed after the smoking ban in public areas came into force. No reduction of STEMI-related admissions was found in smokers. These results may be explained by the protection of non-smokers from passive smoking and the absence of such an effect in smokers by the dominant effect of active smoking. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

STEMI vs NSTEACS management trends in non-invasive hospital

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Abdulhalim Jamal Kinsara

2016-07-01

Conclusion: NSTEACS patients in western province of KSA present at an older age are mostly males and have higher prevalence of hypertension and hyperlipidemia compared with STEMI patients. It is therefore important to identify patients with high-risk profile and put implement measures to reduce these factors.

Smartphone ECG for evaluation of STEMI: results of the ST LEUIS Pilot Study.

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Muhlestein, Joseph Boone; Le, Viet; Albert, David; Moreno, Fidela Ll; Anderson, Jeffrey L; Yanowitz, Frank; Vranian, Robert B; Barsness, Gregory W; Bethea, Charles F; Severance, Harry W; Ramo, Barry; Pierce, John; Barbagelata, Alejandro; Muhlestein, Joseph Brent

2015-01-01

12-lead ECG is a critical component of initial evaluation of cardiac ischemia, but has traditionally been limited to large, dedicated equipment in medical care environments. Smartphones provide a potential alternative platform for the extension of ECG to new care settings and to improve timeliness of care. To gain experience with smartphone electrocardiography prior to designing a larger multicenter study evaluating standard 12-lead ECG compared to smartphone ECG. 6 patients for whom the hospital STEMI protocol was activated were evaluated with traditional 12-lead ECG followed immediately by a smartphone ECG using right (VnR) and left (VnL) limb leads for precordial grounding. The AliveCor™ Heart Monitor was utilized for this study. All tracings were taken prior to catheterization or immediately after revascularization while still in the catheterization laboratory. The smartphone ECG had excellent correlation with the gold standard 12-lead ECG in all patients. Four out of six tracings were judged to meet STEMI criteria on both modalities as determined by three experienced cardiologists, and in the remaining two, consensus indicated a non-STEMI ECG diagnosis. No significant difference was noted between VnR and VnL. Smartphone based electrocardiography is a promising, developing technology intended to increase availability and speed of electrocardiographic evaluation. This study confirmed the potential of a smartphone ECG for evaluation of acute ischemia and the feasibility of studying this technology further to define the diagnostic accuracy, limitations and appropriate use of this new technology. Copyright © 2015 Elsevier Inc. All rights reserved.

Pre-hospital care after a seizure: Evidence base and United Kingdom management guidelines.

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Osborne, Andrew; Taylor, Louise; Reuber, Markus; Grünewald, Richard A; Parkinson, Martin; Dickson, Jon M

2015-01-01

Seizures are a common presentation to pre-hospital emergency services and they generate significant healthcare costs. This article summarises the United Kingdom (UK) Ambulance Service guidelines for the management of seizures and explores the extent to which these guidelines are evidence-based. Summary of the Clinical Practice Guidelines of the UK Joint Royal Colleges Ambulance Liaison Committee relating to the management of seizures. Review of the literature relating to pre-hospital management of seizure emergencies. Much standard practice relating to the emergency out of hospital management of patients with seizures is drawn from generic Advanced Life Support (ALS) guidelines although many patients do not need ALS during or after a seizure and the benefit of many ALS interventions in seizure patients remains to be established. The majority of studies identified pertain to medical treatment of status epilepticus. These papers show that benzodiazepines are safe and effective but it is not possible to draw definitive conclusions about the best medication or the optimal route of administration. The evidence base for current pre-hospital guidelines for seizure emergencies is incomplete. A large proportion of patients are transported to hospital after a seizure but many of these may be suitable for home management. However, there is very little research into alternative care pathways or criteria that could be used to help paramedics avoid transport to hospital. More research is needed to improve care for people after a seizure and to improve the cost-effectiveness of the healthcare systems within which they are treated. Copyright © 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Standardised pre-hospital care of acute myocardial infarction patients: MISSION! guidelines applied in practice

NARCIS (Netherlands)

Atary, J. Z.; de Visser, M.; van den Dijk, R.; Bosch, J.; Liem, S. S.; Antoni, M. L.; Bootsma, M.; Viergever, E. P.; Kirchhof, C. J.; Padmos, I.; Sedney, M. I.; van Exel, H. J.; Verwey, H. F.; Atsma, D. E.; van der Wal, E. E.; Jukema, J. W.; Schalij, M. J.

2010-01-01

Background. To improve acute myocardial infarction (AMI) care in the region 'Hollands-Midden' (the Netherlands), a standardised guideline-based care program was developed (MISSION!). This study aimed to evaluate the outcome of the pre-hospital part of the MISSION! program and to study potential

Pre-Hospital ECG E-Transmission for Patients with Suspected Myocardial Infarction in the Highlands of Scotland

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Gordon F. Rushworth

2014-02-01

Full Text Available Patients with ST elevation myocardial infarction (STEMI require prompt treatment, best done by primary percutaneous coronary intervention (PPCI. However, for patients unable to receive PPCI, immediate pre-hospital thrombolysis (PHT is the best alternative. Evidence indicates that diagnostic and management support for staff increases the use of PHT. This study aimed to describe the patient demographics and management of patients, to determine any potential inter-area differences in referral rates to the ECG e-transmission service and to explore the views and experiences of key staff involved in ECG e-transmission within NHS Highland. Data from 2,025 patient episodes of ECG e-transmission identified a statistically significant geographical variation in ECG e-transmission and PHT delivery. Scottish Ambulance Service (SAS staff were more likely than GPs to deliver PHT overall, however, GPs were more likely to deliver in remote areas. Interviews with six Cardiac Care Unit (CCU nurses and six SAS staff highlighted their positive views of ECG e-transmission, citing perceived benefits to patients and interprofessional relationships. Poor access to network signal was noted to be a barrier to engaging in the system. This study has demonstrated that a specialist triage service based on e-transmission of ECGs in patients with suspected STEMI can be implemented in a diverse geographical setting. Work is needed to ensure equity of the service for all patients.

Short-term Cost-effectiveness of Reteplase versus Primary Percutaneous Coronary Intervention in Patients with Acute STEMI a Tertiary Hospital in Iran

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Khalil Alimohammadzadeh

2017-07-01

Full Text Available   Introduction: This study aimed to compare primary percutaneous coronary intervention (PPCI versus reteplase in terms of clinical and para-clinical outcomes; as well as cost-effectiveness in patients with ST-segment-elevation myocardial infarction (STEMI.Primary percutaneous coronary intervention is the method of choice in all patients especially those at higher risks. But an on-site professional team in a 24/7 facilitated system is a difficult goal to achieve in many areas and countries, therefore the cost-effectiveness of these two treatment strategies (PPCI and reteplase needs to be discussed.Methods: This prospective cohort study included 220 patients presented with STEMI who were admitted to a university hospital between January 2014 to July 2016. Patients were divided into two groups of 120, either receiving reteplase or PPCI. Clinical outcomes were considered duration of hospital stay and MACE (Major Advanced Cardiovascular Events including death, cerebrovascular accident, need for repeat revascularization, and major bleeding. LVEF (Left ventricular ejection fraction was considered as a para-clinical outcome. The outcomes and total hospital cost were compared between two treatment groups.Results: Demographic characteristics between two groups of PPCI or reteplase didn’t show any significant differences. But in para-clinical outcomes, patients in PPCI group showed higher LVEF, compared with reteplase group (45.9 ± 11.5% versus 42.0 ± 11.8%; P = 0.02. Complication rates were similar in both groups but repeat revascularization or coronary artery bypass surgery was more prevalent in those who received thrombolytic therapy (P < 0.05. Length of hospital stay in both groups was similar in two groups but total cost was higher in patients who have received PPCI. (147769406.9 ± 103929358.9 Tomans vs. 117116656.9 ± 67356122.6 Tomans; respectively, P = 0.01.Conclusions: In STEMI patients who present during off-hours, thrombolytic therapy

Pre-hospital National Early Warning Score (NEWS is associated with in-hospital mortality and critical care unit admission: A cohort study

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Tom E.F. Abbott

2018-03-01

Conclusion: Pre-hospital NEWS was associated with death or critical care unit escalation within 48 h of hospital admission. NEWS could be used by ambulance crews to assist in the early triage of patients requiring hospital treatment or rapid transport. Further cohort studies or trials in large samples are required before implementation.

Pre-Hospital Care Management of a Potential Spinal Cord Injured Patient: A Systematic Review of the Literature and Evidence-Based Guidelines

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Ahn, Henry; Singh, Jeffrey; Nathens, Avery; MacDonald, Russell D.; Travers, Andrew; Tallon, John; Fehlings, Michael G.

2011-01-01

Abstract An interdisciplinary expert panel of medical and surgical specialists involved in the management of patients with potential spinal cord injuries (SCI) was assembled. Four key questions were created that were of significant interest. These were: (1) what is the optimal type and duration of pre-hospital spinal immobilization in patients with acute SCI?; (2) during airway manipulation in the pre-hospital setting, what is the ideal method of spinal immobilization?; (3) what is the impact of pre-hospital transport time to definitive care on the outcomes of patients with acute spinal cord injury?; and (4) what is the role of pre-hospital care providers in cervical spine clearance and immobilization? A systematic review utilizing multiple databases was performed to determine the current evidence about the specific questions, and each article was independently reviewed and assessed by two reviewers based on inclusion and exclusion criteria. Guidelines were then created related to the questions by a national Canadian expert panel using the Delphi method for reviewing the evidence-based guidelines about each question. Recommendations about the key questions included: the pre-hospital immobilization of patients using a cervical collar, head immobilization, and a spinal board; utilization of padded boards or inflatable bean bag boards to reduce pressure; transfer of patients off of spine boards as soon as feasible, including transfer of patients off spinal boards while awaiting transfer from one hospital institution to another hospital center for definitive care; inclusion of manual in-line cervical spine traction for airway management in patients requiring intubation in the pre-hospital setting; transport of patients with acute traumatic SCI to the definitive hospital center for care within 24 h of injury; and training of emergency medical personnel in the pre-hospital setting to apply criteria to clear patients of cervical spinal injuries, and immobilize patients

Algorithm for the automatic computation of the modified Anderson-Wilkins acuteness score of ischemia from the pre-hospital ECG in ST-segment elevation myocardial infarction

DEFF Research Database (Denmark)

Fakhri, Yama; Sejersten-Ripa, Maria; Schoos, Mikkel Malby

2017-01-01

BACKGROUND: The acuteness score (based on the modified Anderson-Wilkins score) estimates the acuteness of ischemia based on ST-segment, Q-wave and T-wave measurements obtained from the electrocardiogram (ECG) in patients with ST Elevation Myocardial Infarction (STEMI). The score (range 1 (least...... the acuteness score. METHODS: We scored 50 pre-hospital ECGs from STEMI patients, manually and by the automated algorithm. We assessed the reliability test between the manual and automated algorithm by interclass correlation coefficient (ICC) and Bland-Altman plot. RESULTS: The ICC was 0.84 (95% CI 0.......72-0.91), PECGs, all within the upper (1.46) and lower (-1.12) limits...

ST-segment elevation myocardial infarction, systems of care. An urgent need for policies to co-ordinate care in order to decrease in-hospital mortality.

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Malik, Ali Osama; Abela, Oliver; Allenback, Gayle; Devabhaktuni, Subodh; Lui, Calvin; Singh, Aditi; Diep, Jimmy; Yamashita, Takashi; Yoo, Ji Won; Malhotra, Sanjay; Ahsan, Chowdhury

2017-08-01

Regional trends for ST-segment elevation myocardial infarction (STEMI) treatment is not known in the state of Nevada. Great disparity exists for treatment for STEMI in different geographical areas of Nevada. There is a great potential to improve treatment and outcomes of STEMI patients in the State of Nevada. Admissions to non-federal hospitals in the state of Nevada, using 2011 to 2013 discharge data from the Nevada State Inpatient Data Base (acquired from Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality), were analyzed. Outpatient-onset STEMI patients were identified. The state of Nevada was divided into three divisions based on population densities, defined as population per square mile. Division A included counties with population density of 200 per square mile. Trends in use of STEMI-related therapies and the impact on in-hospital mortality rates were compared. Almost 20% of the patients with outpatient-onset STEMI do not get any STEMI-related therapy and have significantly higher mortality rate. Patients from Division A do not have direct access to percutaneous coronary intervention (PCI) centers. These patients receive less STEMI-related therapies. Low-volume PCI centers had equivalent mortality rates for STEMI patients who got PCI, compared to high-volume PCI centers. Policies must be created and processes streamlined so all STEMI patients in Nevada receive appropriate treatment. Copyright © 2017. Published by Elsevier B.V.

Time-to-reperfusion in STEMI undergoing interhospital transfer using smartphone and WhatsApp messenger.

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Astarcioglu, Mehmet Ali; Sen, Taner; Kilit, Celal; Durmus, Halil Ibrahim; Gozubuyuk, Gokhan; Kalcik, Macit; Karakoyun, Suleyman; Yesin, Mahmut; Zencirkiran Agus, Hicaz; Amasyali, Basri

2015-10-01

The objective of this study is to assess the efficacy of WhatsApp application as a communication method among the emergency physician (EP) in a rural hospital without percutaneous coronary intervention (PCI) capability and the interventional cardiologist at a tertiary PCI center. Current guidelines recommend that patients with ST-segment elevation myocardial infarction (STEMI) receive primary PCI within 90 minutes. This door-to-balloon (D2B) time has been difficult to achieve in rural STEMI. We evaluated 108 patients with STEMI in a rural hospital with emergency department but without PCI capability to determine the impact of WhatsApp triage and activation of the cardiac catheterization laboratory on D2B time. The images were obtained from cases of suspected STEMI using the smartphones by the EP and were sent to the interventional cardiologist via the WhatsApp application (group 1, n=53). The control group included concurrently treated patients with STEMI during the same period but not receiving triage (group 2, n=55). The D2B time was significantly shorter in the intervention group (109±31 vs 130±46 minutes, PWhatsApp triage with activation of the cardiac catheterization laboratory was associated with shorter D2B time and results in a greater proportion of patients achieving guideline recommendations. The method is cheap, quick, and easy to operate. Copyright © 2015 Elsevier Inc. All rights reserved.

Spinal immobilisaton in pre-hospital and emergency care: A systematic review of the literature.

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Hood, Natalie; Considine, Julie

2015-08-01

Spinal immobilisation has been a mainstay of trauma care for decades and is based on the premise that immobilisation will prevent further neurological compromise in patients with a spinal column injury. The aim of this systematic review was to examine the evidence related to spinal immobilisation in pre-hospital and emergency care settings. In February 2015, we performed a systematic literature review of English language publications from 1966 to January 2015 indexed in MEDLINE and Cochrane library using the following search terms: 'spinal injuries' OR 'spinal cord injuries' AND 'emergency treatment' OR 'emergency care' OR 'first aid' AND immobilisation. EMBASE was searched for keywords 'spinal injury OR 'spinal cord injury' OR 'spine fracture AND 'emergency care' OR 'prehospital care'. There were 47 studies meeting inclusion criteria for further review. Ten studies were case series (level of evidence IV) and there were 37 studies from which data were extrapolated from healthy volunteers, cadavers or multiple trauma patients. There were 15 studies that were supportive, 13 studies that were neutral, and 19 studies opposing spinal immobilisation. There are no published high-level studies that assess the efficacy of spinal immobilisation in pre-hospital and emergency care settings. Almost all of the current evidence is related to spinal immobilisation is extrapolated data, mostly from healthy volunteers. Copyright © 2015 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.

Evaluation of the Prevention and Reactivation Care Program (PReCaP) for the hospitalized elderly: A prospective nonrandomized controlled trial

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Asmus-Szepesi, Kirsten; Flinterman, Linda; Koopmanschap, Marc; Nieboer, Anna; Bakker, Ton; Mackenbach, Johan; Steyerberg, Ewout

2015-01-01

textabstractBackground: The hospitalized elderly are at risk of functional decline. We evaluated the effects and care costs of a specialized geriatric rehabilitation program aimed at preventing functional decline among at-risk hospitalized elderly. Methods: The prospective nonrandomized controlled trial reported here was performed in three hospitals in the Netherlands. One hospital implemented the Prevention and Reactivation Care Program (PReCaP), while two other hospitals providing usual car...

Distribution of specialized care centers in the United States.

Science.gov (United States)

Wang, Henry E; Yealy, Donald M

2012-11-01

As a recommended strategy for optimally managing critical illness, regionalization of care involves matching the needs of the target population with available hospital resources. The national supply and characteristics of hospitals providing specialized critical care services is currently unknown. We seek to characterize the current distribution of specialized care centers in the United States. Using public data linked with the American Hospital Association directory and US Census, we identified US general acute hospitals providing specialized care for ST-segment elevation myocardial infarction (STEMI) (≥40 annual primary percutaneous coronary interventions reported in Medicare Hospital Compare), stroke (The Joint Commission certified stroke centers), trauma (American College of Surgeons or state-designated, adult or pediatric, level I or II), and pediatric critical care (presence of a pediatric ICU) services. We determined the characteristics and state-level distribution and density of specialized care centers (centers per state and centers per state population). Among 4,931 acute care hospitals in the United States, 1,325 (26.9%) provided one of the 4 defined specialized care services, including 574 STEMI, 763 stroke, 508 trauma, and 457 pediatric critical care centers. Approximately half of the 1,325 hospitals provided 2 or more specialized services, and one fifth provided 3 or 4 specialized services. There was variation in the number of each type of specialized care center in each state: STEMI median 7 interquartile range (IQR 2 to 14), stroke 8 (IQR 3 to 17), trauma 6 (IQR 3 to 11), pediatric specialized care 6 (IQR 3 to 11). Similarly, there was variation in the number of each type of specialized care center per population: STEMI median 1 center per 585,135 persons (IQR 418,729 to 696,143), stroke 1 center per 412,188 persons (IQR 321,604 to 572,387), trauma 1 center per 610,589 persons (IQR 406,192 to 917,588), and pediatric critical care 1 center per 665

Trends in Regionalization of Care for ST-Segment Elevation Myocardial Infarction

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Renee Y. Hsia

2017-09-01

Full Text Available Introduction: California has led successful regionalized efforts for several time-critical medical conditions, including ST-segment elevation myocardial infarction (STEMI, but no specific mandated protocols exist to define regionalization of care. We aimed to study the trends in regionalization of care for STEMI patients in the state of California and to examine the differences in patient demographic, hospital, and county trends. Methods: Using survey responses collected from all California emergency medical services (EMS agencies, we developed four categories – no, partial, substantial, and complete regionalization – to capture prehospital and inter-hospital components of regionalization in each EMS agency’s jurisdiction between 2005–2014. We linked the survey responses to 2006 California non-public hospital discharge data to study the patient distribution at baseline. Results: STEMI regionalization-of-care networks steadily developed across California. Only 14% of counties were regionalized in 2006, accounting for 42% of California’s STEMI patient population, but over half of these counties, representing 86% of California’s STEMI patient population, reached complete regionalization in 2014. We did not find any dramatic differences in underlying patient characteristics based on regionalization status; however, differences in hospital characteristics were relatively substantial. Conclusion: Potential barriers to achieving regionalization included competition, hospital ownership, population density, and financial challenges. Minimal differences in patient characteristics can establish that patient differences unlikely played any role in influencing earlier or later regionalization and can provide a framework for future analyses evaluating the impact of regionalization on patient outcomes.

Mortality and ST resolution in patients admitted with STEMI: the MOMI survey of emergency service experience in a complex urban area.

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Grieco, Niccolò; Sesana, Giovanni; Corrada, Elena; Ieva, Francesca; Paganoni, Annamaria; Marzegalli, Maurizio

2012-09-01

Since 2001, the urban area of Milan has been operating a network among 23 cardiac care units, the 118 dispatch centre (national free number for medical emergencies), and the county government health agency called Group for Prehospital Cardiac Emergency. In order to monitor the network activity, time to treatment, and clinical outcome, a periodic survey, called MOMI(2), was repeated two or three times a year. Each survey lasted 30 days and was repeated in comparable periods. Data were stratified for hospital admission mode. We collected data concerning 708 consecutive ST-elevation myocardial infarction (STEMI) patients (male 72.6%; mean age 64.4 years). In these six surveys, we observed a high rate of primary percutaneous coronary intervention (73.2%) and a mortality rate of 6.3%. Using advanced statistical models, we identified age, Killip class, and the symptom onset-to-balloon time as most relevant prognostic factors. Nonparametric test showed that the modality of hospital admittance was the most critical determinant of door-to-balloon time. 12-lead ECG tele-transmission and activation of a fast track directly to the catheterization laboratory are easy action to reduce time to treatment. The experience of the Milan network for cardiac emergency shows how a network coordinating the community, rescue units, and hospitals in a complex urban area and making use of medical technology contributes to the health care of patients with STEMI.

Pre-hospital and hospital delay in patients with non-ST elevation acute coronary syndromes in tertiary care

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G.S. Youssef

2017-09-01

Conclusion: Pre-hospital delay was mainly patient-related. Hospital delay was mainly related to healthcare resources. Governmental measures to promote ambulance emergency services may reduce the pre-hospital delay, while improving the utilization of healthcare resources may reduce hospital delay.

Impact of treatment delay on mortality in ST-segment elevation myocardial infarction (STEMI) patients presenting with and without haemodynamic instability: results from the German prospective, multicentre FITT-STEMI trial.

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Scholz, Karl Heinrich; Maier, Sebastian K G; Maier, Lars S; Lengenfelder, Björn; Jacobshagen, Claudius; Jung, Jens; Fleischmann, Claus; Werner, Gerald S; Olbrich, Hans G; Ott, Rainer; Mudra, Harald; Seidl, Karlheinz; Schulze, P Christian; Weiss, Christian; Haimerl, Josef; Friede, Tim; Meyer, Thomas

2018-04-01

The aim of this study was to investigate the effect of contact-to-balloon time on mortality in ST-segment elevation myocardial infarction (STEMI) patients with and without haemodynamic instability. Using data from the prospective, multicentre Feedback Intervention and Treatment Times in ST-Elevation Myocardial Infarction (FITT-STEMI) trial, we assessed the prognostic relevance of first medical contact-to-balloon time in n = 12 675 STEMI patients who used emergency medical service transportation and were treated with primary percutaneous coronary intervention (PCI). Patients were stratified by cardiogenic shock (CS) and out-of-hospital cardiac arrest (OHCA). For patients treated within 60 to 180 min from the first medical contact, we found a nearly linear relationship between contact-to-balloon times and mortality in all four STEMI groups. In CS patients with no OHCA, every 10-min treatment delay resulted in 3.31 additional deaths in 100 PCI-treated patients. This treatment delay-related increase in mortality was significantly higher as compared to the two groups of OHCA patients with shock (2.09) and without shock (1.34), as well as to haemodynamically stable patients (0.34, P < 0.0001). In patients with CS, the time elapsing from the first medical contact to primary PCI is a strong predictor of an adverse outcome. This patient group benefitted most from immediate PCI treatment, hence special efforts to shorten contact-to-balloon time should be applied in particular to these high-risk STEMI patients. NCT00794001.

(Non-)utilization of pre-hospital emergency care by migrants and non-migrants in Germany.

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Kietzmann, Diana; Knuth, Daniela; Schmidt, Silke

2017-01-01

This study was designed to explore the utilization and non-utilization of pre-hospital emergency care by migrants and non-migrants, and the factors that influence this behaviour. A cross-sectional representative German survey was conducted in a sample of 2.175 people, 295 of whom had a migration background. An additional sample of 50 people with Turkish migration background was conducted, partially in the Turkish language. Apart from socio-demographics, the utilization of emergency services and the reasons for non-utilization were assessed. Migrants had a higher utilization rate of pre-hospital emergency care (RR = 1.492) than non-migrants. Furthermore, migrants who were not born in Germany had a lower utilization rate (RR = 0.793) than migrants who were born in Germany. Regarding non-utilization, the most frequently stated reasons belonged to the categories initial misjudgment of the emergency situation and acting on one's own behalf, with the latter stated more frequently by migrants than by non-migrants. To prevent over-, under-, and lack of supply, it is necessary to transfer knowledge about the functioning of the medical emergency services, including first aid knowledge.

A consensus-based template for documenting and reporting in physician-staffed pre-hospital services

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Kruger, Andreas J; Lockey, David; Kurola, Jouni

2011-01-01

-staffed pre-hospital services in Europe. METHODS: Using predefined criteria, we recruited sixteen European experts in the field of pre-hospital care. These experts were guided through a four-step modified nominal group technique. The process was carried out using both e-mail-based communication and a plenary...... have established a core data set for documenting and reporting in physician-staffed pre-hospital services. We believe that this template could facilitate future studies within the field and facilitate standardised reporting and future shared research efforts in advanced pre-hospital care....

Diagnostic performance and system delay using telemedicine for prehospital diagnosis in triaging and teatment of STEMI

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Rasmussen, Martin Bøhme; Frost, Lars; Stengaard, Carsten

2014-01-01

diagnoses established by telemedicine confirmed on hospital arrival, and we determined system delay in patients diagnosed before hospital arrival and triaged directly to the catheterisation laboratory. Methods: Design: Population-based follow-up study. Setting: Central Denmark Region. Participants: 15 992...... patients diagnosed using telemedicine. Results: During the study period, a tentative diagnosis of STEMI was established in 1061 patients, of whom 919 were triaged directly to the PCI centre. In 771 (84%) patients, a diagnosis of STEMI was confirmed. Patients transported ... living telemedicine for prehospital diagnosis and triage of patients directly to the catheter laboratory is feasible and allows 89% of patients living up to 95 km from the invasive centre to be treated...

Evaluation of acute ischemia in pre-procedure ECG predicts myocardial salvage after primary PCI in STEMI patients with symptoms >12hours

DEFF Research Database (Denmark)

Fakhri, Yama; Busk, Martin; Schoos, Mikkel Malby

2016-01-01

-presenters). The Anderson-Wilkin's score (AW-score) estimates the acuteness of myocardial ischemia from the electrocardiogram (ECG) in STEMI patients. We hypothesized that the AW-score is superior to symptom duration in identifying substantial salvage potential in late-presenters. METHODS: The AW-score (range 1......-4) was obtained from the pre-pPCI ECG in 55 late-presenters and symptoms 12-72 hours. Myocardial perfusion imaging was performed to assess area at risk before pPCI and after 30days to assess myocardial salvage index (MSI). We correlated both the AW-score and pain-to-balloon with MSI and determined the salvage...

Are severely injured trauma victims in Norway offered advanced pre-hospital care? National, retrospective, observational cohort.

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Wisborg, T; Ellensen, E N; Svege, I; Dehli, T

2017-08-01

Studies of severely injured patients suggest that advanced pre-hospital care and/or rapid transportation provides a survival benefit. This benefit depends on the disposition of resources to patients with the greatest need. Norway has 19 Emergency Helicopters (HEMS) staffed by anaesthesiologists on duty 24/7/365. National regulations describe indications for their use, and the use of the national emergency medical dispatch guideline is recommended. We assessed whether severely injured patients had been treated or transported by advanced resources on a national scale. A national survey was conducted collecting data for 2013 from local trauma registries at all hospitals caring for severely injured patients. Patients were analysed according to hospital level; trauma centres or acute care hospitals with trauma functions. Patients with an Injury Severity Score (ISS) > 15 were considered severely injured. Three trauma centres (75%) and 17 acute care hospitals (53%) had data for trauma patients from 2013, a total of 3535 trauma registry entries (primary admissions only), including 604 victims with an ISS > 15. Of these 604 victims, advanced resources were treating and/or transporting 51%. Sixty percent of the severely injured admitted directly to trauma centres received advanced services, while only 37% of the severely injured admitted primarily to acute care hospitals received these services. A highly developed and widely distributed HEMS system reached only half of severely injured trauma victims in Norway in 2013. © 2017 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.

Pre-Hospital 12-Lead Electrocardiogram within 60 Minutes Differentiates Proximal versus Nonproximal Left Anterior Descending Artery Myocardial Infarction

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James J McCarthy

2011-05-01

Full Text Available Introduction: Acute anterior myocardial infarctions caused by proximal left anterior descending (LAD artery occlusions are associated with a higher morbidity and mortality. Early identification of high-risk patients via the 12-lead electrocardiogram (ECG could assist physicians and emergency response teams in providing early and aggressive care for patients with anterior ST-elevation myocardial infarctions (STEMI. Approximately 25% of US hospitals have primary percutaneous coronary intervention (PCI capability for the treatment of acute myocardial infarctions. Given the paucity of hospitals capable of PCI, early identification of more severe myocardial infarction may prompt emergency medical service routing of these patients to PCI-capable hospitals. We sought to determine if the 12 lead ECG is capable of predicting proximal LAD artery occlusions. Methods: In a retrospective, post-hoc analysis of the Pre-Hospital Administration of Thrombolytic Therapy with Urgent Culprit Artery Revascularization pilot trial, we compared the ECG findings of proximal and nonproximal LAD occlusions for patients who had undergone an ECG within 180 minutes of symptom onset. Results: In this study, 72 patients had anterior STEMIs, with ECGs performed within 180 minutes of symptom onset. In patients who had undergone ECGs within 60 minutes (n¼35, the mean sum of ST elevation (STE in leads V1 through V6 plus ST depression (STD in leads II, III, and aVF was 19.2 mm for proximal LAD occlusions and 11.7 mm for nonproximal LAD occlusions (P¼0.007. A sum STE in V1 through V6 plus STD in II, III, and aVF of at least 17.5 mm had a sensitivity of 52.3%, specificity of 92.9%, positive predictive value of 91.7%, and negative predictive value of 56.5% for proximal LAD occlusions. When the ECG was performed more than 60 minutes after symptom onset (n¼37, there was no significant difference in ST-segment deviation between the 2 groups. Conclusion: The sum STE (V1-V6 and STD (II

Pre-hospital ticagrelor in ST-segment elevation myocardial infarction in the French ATLANTIC population

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Cayla, Guillaume; Lapostolle, Frederic; Ecollan, Patrick

2017-01-01

BACKGROUND: ATLANTIC was a randomized study comparing pre- and in-hospital treatment with a ticagrelor loading dose (LD) in ongoing ST-segment elevation myocardial infarction (STEMI). We sought to compare patient characteristics and clinical outcomes in France with other countries participating...... in ATLANTIC. METHODS: The population comprised 1862 patients, 660 (35.4%) from France and 1202 from 12 other countries. The main endpoints were reperfusion (≥70% ST-segment elevation resolution) and TIMI flow grade 3 before (co-primary endpoints) and after percutaneous coronary intervention (PCI). Other...... endpoints included a composite ischaemic endpoint (death/myocardial infarction/stroke/urgent revascularization/definite stent thrombosis) and bleeding events at 30days. RESULTS: In France, median times from first LD to angiography and between first and second LDs were 49 and 35min, respectively, and were...

Management and outcomes of acute ST-segment-elevation myocardial infarction at a tertiary-care hospital in Sri Lanka: an observational study.

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Bandara, Ruwanthi; Medagama, Arjuna; Munasinghe, Ruwan; Dinamithra, Nandana; Subasinghe, Amila; Herath, Jayantha; Ratnayake, Mahesh; Imbulpitiya, Buddhini; Sulaiman, Ameena

2015-01-15

Sri Lanka is a developing country with a high rate of cardiovascular mortality. It is still largely dependent on thrombolysis for primary management of acute myocardial infarction. The aim of this study was to present current data on the presentation, management, and outcomes of acute ST-segment-elevation myocardial infarction (STEMI) at a tertiary-care hospital in Sri Lanka. Eighty-one patients with acute STEMI presenting to a teaching hospital in Peradeniya, Sri Lanka, were included in this observational study. Median interval between symptom onset and hospital presentation was 60 min (mean 212 min). Thrombolysis was performed in 73% of patients. The most common single reason for not performing thrombolysis was delayed presentation. Median door-to-needle time was 64 min (mean, 98 min). Only 16.9% of patients received thrombolysis within 30 min, and none underwent primary PCI. Over 98% of patients received aspirin, clopidogrel, and a statin on admission. Intravenous and oral beta blockers were rarely used. Follow-up data were available for 93.8% of patients at 1 year. One-year mortality rate was 12.3%. Coronary intervention was performed in only 7.3% of patients post infarction. Late presentation to hospital remains a critical factor in thrombolysis of STEMI patients in Sri Lanka. Thrombolysis was not performed within 30 min of admission in the majority of patients. First-contact physicians should receive further training on effective thrombolysis, and there is an urgent need to explore the ways in which PCI and post-infarction interventions can be incorporated into treatment protocols.

Nursing care system development for patients with cleft lip-palate and craniofacial deformities in Srinagarind Hospital: pre-post operation.

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Augsornwan, Darawan; Pattangtanang, Pantamanas; Pikhunthod, Kritsana

2011-12-01

Cleft lip and palate are the most common craniofacial anomalies. Srinagarind Hospital has 150-200 cases each year. The operating process of care requires continuity of care involving a multidisciplinary team. When the patients go to hospital to have operation, pain, limited activity and food are very different from normal life. During pre and post operative care nurses who work continuously and closely with the patients should have knowledge, experience and ability to take excellent care of their patients and families. This can prevent complications and help their decision process, decrease parents stress and encourage better co-operation. To develop a nursing care system for patients with cleft lip-palate undergoing operation. This is an action research divided into 3 phases. Phase 1, situation review: review of nursing care process by interview, focus group, observation and nursing documents. Phase 2, nursing system management: developing guidelines, composing nursing manual, handbook for parents, VCD for patients and family and story telling. Following that announcement and implementation. Phase 3: evaluation. The authors found that guidelines, nursing manual, handbook for parents, VCD for patients and family and story telling are appropriate and have good utilization, but the pictures in handbook for parents and storytelling were not clear, too small and not attractive. Nursing manual for giving information about pre-post operative care, handbook for parents, story telling and VCD about pre-post operative care provide optimal care for patients and family with cleft lip and palate, but need to evaluate further the nursing outcome after this nursing system development.

Achieving timely percutaneous reperfusion for rural ST-elevation myocardial infarction patients by direct transport to an urban PCI-hospital.

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Bennin, Charles-Lwanga K; Ibrahim, Saif; Al-Saffar, Farah; Box, Lyndon C; Strom, Joel A

2016-10-01

ST-elevation myocardial infarction (STEMI) guidelines recommend reperfusion by primary percutaneous coronary intervention (PCI) ≤ 90 min from time of first medical contact (FMC). This strategy is challenging in rural areas lacking a nearby PCI-capable hospital. Recommended reperfusion times can be achieved for STEMI patients presenting in rural areas without a nearby PCI-capable hospital by ground transportation to a central PCI-capable hospital by use of protocol-driven emergency medical service (EMS) STEMI field triage protocol. Sixty STEMI patients directly transported by EMS from three rural counties (Nassau, Camden and Charlton Counties) within a 50-mile radius of University of Florida Health-Jacksonville (UFHJ) from 01/01/2009 to 12/31/2013 were identified from its PCI registry. The STEMI field triage protocol incorporated three elements: (1) a cooperative agreement between each of the rural emergency medical service (EMS) agency and UFHJ; (2) performance of a pre-hospital ECG to facilitate STEMI identification and laboratory activation; and (3) direct transfer by ground transportation to the UFHJ cardiac catheterization laboratory. FMC-to-device (FMC2D), door-to-device (D2D), and transit times, the day of week, time of day, and EMS shift times were recorded, and odds ratio (OR) of achieving FMC2D times was calculated. FMC2D times were shorter for in-state STEMIs (81 ± 17 vs . 87 ± 19 min), but D2D times were similar (37 ± 18 vs . 39 ± 21 min). FMC2D ≤ 90 min were achieved in 82.7% in-state STEMIs compared to 52.2% for out-of-state STEMIs (OR = 4.4, 95% CI: 1.24-15.57; P = 0.018). FMC2D times were homogenous after adjusting for weekday vs . weekend, EMS shift times. Nine patients did not meet FMC2D ≤ 90 min. Six were within 10 min of target; all patient achieved FMC2D ≤ 120 min. Guideline-compliant FMC2D ≤ 90 min is achievable for rural STEMI patients within a 50 mile radius of a PCI-capable hospital by use of protocol-driven EMS ground

Pre-hospital treatment of acute poisonings in Oslo

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Heyerdahl, Fridtjof; Hovda, Knut E; Bjornaas, Mari A; Nore, Anne K; Figueiredo, Jose CP; Ekeberg, Oivind; Jacobsen, Dag

2008-01-01

Background Poisoned patients are often treated in and discharged from pre-hospital health care settings. Studies of poisonings should therefore not only include hospitalized patients. Aims: To describe the acutely poisoned patients treated by ambulance personnel and in an outpatient clinic; compare patients transferred to a higher treatment level with those discharged without transfer; and study the one-week mortality after pre-hospital discharge. Methods A one-year multi-centre study with prospective inclusion of all acutely poisoned patients ≥ 16 years of age treated in ambulances, an outpatient clinic, and hospitals in Oslo. Results A total of 3757 health service contacts from 2997 poisoning episodes were recorded: 1860 were treated in ambulances, of which 15 died and 750 (40%) were discharged without transfer; 956 were treated in outpatient clinic, of which 801 (84%) were discharged without transfer; and 941 episodes were treated in hospitals. Patients discharged alive after ambulance treatment were mainly poisoned by opiates (70%), were frequently comatose (35%), had respiratory depression (37%), and many received naloxone (49%). The majority of the patients discharged from the outpatient clinic were poisoned by ethanol (55%), fewer were comatose (10%), and they rarely had respiratory depression (4%). Among the hospitalized, pharmaceutical poisonings were most common (58%), 23% were comatose, and 7% had respiratory depression. Male patients comprised 69% of the pre-hospital discharges, but only 46% of the hospitalized patients. Except for one patient, who died of a new heroin overdose two days following discharge from an ambulance, there were no deaths during the first week after the poisonings in the 90% of the pre-hospital discharged patients with known identity. Conclusion More than half of the poisoned patients treated in pre-hospital treatment settings were discharged without transfer to higher levels. These poisonings were more often caused by drug and

Pre-hospital treatment of acute poisonings in Oslo

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Nore Anne K

2008-11-01

Full Text Available Abstract Background Poisoned patients are often treated in and discharged from pre-hospital health care settings. Studies of poisonings should therefore not only include hospitalized patients. Aims: To describe the acutely poisoned patients treated by ambulance personnel and in an outpatient clinic; compare patients transferred to a higher treatment level with those discharged without transfer; and study the one-week mortality after pre-hospital discharge. Methods A one-year multi-centre study with prospective inclusion of all acutely poisoned patients ≥ 16 years of age treated in ambulances, an outpatient clinic, and hospitals in Oslo. Results A total of 3757 health service contacts from 2997 poisoning episodes were recorded: 1860 were treated in ambulances, of which 15 died and 750 (40% were discharged without transfer; 956 were treated in outpatient clinic, of which 801 (84% were discharged without transfer; and 941 episodes were treated in hospitals. Patients discharged alive after ambulance treatment were mainly poisoned by opiates (70%, were frequently comatose (35%, had respiratory depression (37%, and many received naloxone (49%. The majority of the patients discharged from the outpatient clinic were poisoned by ethanol (55%, fewer were comatose (10%, and they rarely had respiratory depression (4%. Among the hospitalized, pharmaceutical poisonings were most common (58%, 23% were comatose, and 7% had respiratory depression. Male patients comprised 69% of the pre-hospital discharges, but only 46% of the hospitalized patients. Except for one patient, who died of a new heroin overdose two days following discharge from an ambulance, there were no deaths during the first week after the poisonings in the 90% of the pre-hospital discharged patients with known identity. Conclusion More than half of the poisoned patients treated in pre-hospital treatment settings were discharged without transfer to higher levels. These poisonings were more often

Statin Eligibility and Outpatient Care Prior to ST-Segment Elevation Myocardial Infarction.

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Miedema, Michael D; Garberich, Ross F; Schnaidt, Lucas J; Peterson, Erin; Strauss, Craig; Sharkey, Scott; Knickelbine, Thomas; Newell, Marc C; Henry, Timothy D

2017-04-12

The impact of the 2013 American College of Cardiology/American Heart Association cholesterol guidelines on statin eligibility in individuals otherwise destined to experience cardiovascular disease (CVD) events is unclear. We analyzed a prospective cohort of consecutive ST-segment elevation myocardial infarction (STEMI) patients from a regional STEMI system with data on patient demographics, low-density lipoprotein cholesterol levels, CVD risk factors, medication use, and outpatient visits over the 2 years prior to STEMI. We determined pre-STEMI eligibility according to American College of Cardiology/American Heart Association guidelines and the prior Third Report of the Adult Treatment Panel guidelines. Our sample included 1062 patients with a mean age of 63.7 (13.0) years (72.5% male), and 761 (71.7%) did not have known CVD prior to STEMI. Only 62.5% and 19.3% of individuals with and without prior CVD were taking a statin before STEMI, respectively. In individuals not taking a statin, median (interquartile range) low-density lipoprotein cholesterol levels in those with and without known CVD were low (108 [83, 138]  mg/dL and 110 [87, 133] mg/dL). For individuals not taking a statin, only 38.7% were statin eligible by ATP III guidelines. Conversely, 79.0% would have been statin eligible according to American College of Cardiology/American Heart Association guidelines. Less than half of individuals with (49.2%) and without (41.1%) prior CVD had seen a primary care provider during the 2 years prior to STEMI. In a large cohort of STEMI patients, application of American College of Cardiology/American Heart Association guidelines more than doubled pre-STEMI statin eligibility compared with Third Report of the Adult Treatment Panel guidelines. However, access to and utilization of health care, a necessity for guideline implementation, was suboptimal prior to STEMI. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Area at risk and collateral circulation in a first acute myocardial infarction with occluded culprit artery. STEMI vs non-STEMI patients.

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Figueras, Jaume; Otaegui, Imanol; Marti, Gerard; Domingo, Enric; Bañeras, Jordi; Barrabés, José A; Del Blanco, Bruno Garcia; Garcia-Dorado, David

2018-05-15

It is unclear why among patients with first acute myocardial infarction and an occluded culprit artery only some present ST segment elevation. In fact, there is no study that compares the angiographic area at risk and the collateral circulation in first NSTEMI vs STEMI patients. 205 patients admitted for myocardial infarction with occluded culprit artery were included, 132 STEMI and 73 NSTEMI. Demographic data, the area at risk determined by the BARI score and collateral supply by the Rentrop score from the 2 groups were compared. NSTEMI patients showed lower peak Tn I than STEMI in the overall group but also in the 3 subsets with different culprit arteries (p collaterals (Rentrop score ≥ 2, 1.82 vs 0.41, p collateral blood supply than STEMI patients in each of the 3 main culprit arteries. Copyright © 2018 Elsevier B.V. All rights reserved.

[Emergency care in the autonomous regions of Spain. Improvement in pre-hospital emergency care and welfare coordination. SESPAS Report 2012].

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Miguel García, Félix; Fernández Quintana, Ana Isabel; Díaz Prats, Amadeo

2012-03-01

The present article describes the general organization of pre-hospital emergency care in the autonomous regions and provides data on activity corresponding to 2010, drawn from the information available in the Primary Care Information System of the Ministry of Health, Social Policy and Equality. Emergency care is provided through various organizational structures covering 24-hour periods. Family medicine attended 17.8 million emergency consultations and nursing attended 10.2 million (year 2010, 14 autonomous communities, 79.7% of the National Health System population). Emergency department utilization ranged between 0.11 and 0.83 urgent family physician consultations per inhabitant/year and between 0.05 and 0.57 nursing consultations per inhabitant/year. Any reform in the management of pre-hospital emergency care will involve organizational changes and aims to produce measurable improvements in healthcare coordination. In the new organizational designs, most of the responsibility lies with human resources in order to achieve the new goals for the future aims to be presented in an operational teamwork structure. Undoubtedly, the main challenge is to achieve optimal coordination with other welfare levels, including the police, social services, nursing homes, etc. If optimal care of the population needs to count on the efforts of all these groups, mobility, individual differences, consistent achievement of high standards, and -most of all- the use of these services by citizens will determine the final result. The results can be quantified in various ways, but evaluation should concentrate on the resources used, the degree of satisfaction among all the parties involved and optimal management of demand, which will help to disseminate the need for a rational resource use. Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.

[Burnout syndrome in pre-hospital and hospital emergency. Cognitive study in two cohorts of nurses].

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Cicchitti, Chiara; Cannizzaro, Giorgia; Rosi, Fabrizio; Maccaroni, Roberto; Menditto, Vincenzo G

2014-01-01

Burnout syndrome (BOS) associated with stress has been documented in health care professionals in many specialties. The emergency department and the pre-hospital healthcare services are highly stressful environments. Little is known about the BOS in critical care nursing staff. The objective of the study is to compare the incidence of BOS and its three domains, namely, emotional exhaustion, depersonalization and reduced professional accomplishment, in two cohorts of critical care nurses: a pre-hospital and a hospital emergency service. A survey using a questionnaire (the Maslach Burnout Inventory-General Survey, MBI-GS), among nurses of two Italian emergency services has been performed: a hospital emergency service (HES, Emergency Department or "Pronto Soccorso") and a pre-hospital emergency service (PHES, territorial healthcare service or "Centrale Operativa 118"). All 60 nurses surveyed (82% female) filled the questionnaires. BOS-related symptoms have been identified in at least 50% of the nurses in the HES: 50% suffered a medium-high emotional exhaustion, 75% had a medium-high depersonalization and 92.5% had a medium-high reduced professional accomplishment. Among the PEHS nurses, BOS-related symptoms have been identified in at least 60% of the respondents: 60% had a medium-high emotional exhaustion, 70% had a medium-high depersonalization and 95% had a medium-high reduced professional accomplishment. Moreover, the likelihood that a nurse has a severe BOS, that is at least one degree of high burnout or ≥2 degrees of medium burnout, is significantly higher in the group of the PHES than in the HES (90% vs 60%, p nursing staff had a severe BOS. The incidence of BOS appeared to be similar among PHES and HES nurses with a higher trend for the former. Further interventional studies are needed to investigate the determinants of BOS among critical care nurses and the potentially preventive strategies.

Emergency management of patients with ST-segment elevation myocardial infarction in Eastern Austria: a descriptive quality control study.

Science.gov (United States)

Trimmel, Helmut; Bayer, Thomas; Schreiber, Wolfgang; Voelckel, Wolfgang G; Fiedler, Lukas

2018-05-09

Myocardial infarction is a time-critical condition and its outcome is determined by appropriate emergency care. Thus we assessed the efficacy of a supra-regional ST-segment elevation myocardial infarction (STEMI) network in Easternern Austria. The Eastern Austrian STEMI network serves a population of approx. 766.000 inhabitants within a region of 4186 km 2 . Established in 2007, it now comprises 20 pre-hospital emergency medical service (EMS) units (10 of these physician-staffed), 4 hospitals and 3 cardiac intervention centres. Treatment guidelines were updated in 2012 and documentation within a web-based STEMI registry became mandatory. For this retrospective qualitative control study, data from February 2012-April 2015 was assessed. A total of 416 STEMI cases were documented, and 99% were identified by EMS within 6 (4.0-8.0) minutes after arrival. Median time loss between onset of pain and EMS call was 54 (20-135) minutes; response, pre-hospital and door-to-balloon times were 14 (10-20), 46 (37-59) and 45 (32-66) minutes, respectively. When general practitioners were involved, time between onset of pain and balloon inflation significantly increased from 180 (135-254) to 218 (155-348) minutes (p < .001). A pre-hospital time < 30 min was achieved in 25.8% of all patients during the day vs. 11.6% during the night (p < .001). Three hundred forty-five patients (83%) were subjected to primary percutaneous coronary intervention (PPCI), and 6.5% were thrombolysed by EMS. Pre-hospital complication rate was 18% (witnessed cardiac arrest 7%, threatening arrhythmias 6%, cardiogenic shock 5%). Twenty-four hours and hospital mortality rate were 1.2 and 2.8%, respectively. Optimal patient care and subsequently outcome of STEMI is strongly determined by a short patient-decision time to call EMS and by the first medical contact to balloon time (FMCBT). Supra-regional networks are key in order to increase the efficacy and efficiency of health care. The goal of 120�

PRE-HOSPITAL EMERGENCY CARE IN SWEDEN

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Ulf BJÖRNSTIG

2004-01-01

In Sweden (9 million inhabitants, a sparsely populated country with sometimes long transportation distances to the nearest trauma hospital, 800 ambulances, 7 ambulance helicopters and 3–5 fixed wing ambulance aircraft are the available transport resources. In case of a mass casualty or disaster situation, inside or outside the country, a governmental project (Swedish National Medevac aims to convert a passenger aircraft from Scandinavian Airlines System (SAS to a qualified medical resource for long distance transport, with capacity to nurse six intensive care patients and an additional 6–20 lieing or seated patients during transport.

Trauma-informed care for children in the ambulance : international survey among pre-hospital providers

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Alisic, Eva; Tyler, Mark P; Giummarra, Melita J; Kassam-Adams, Rahim; Gouweloos, Juul; Landolt, Markus A; Kassam-Adams, Nancy

2017-01-01

Background: Pre-hospital providers, such as paramedics and emergency medical technicians, are in a position to provide key emotional support to injured children and their families. Objective: Our goal was to examine (a) pre-hospital providers' knowledge of traumatic stress in children, attitudes

Impact of pre-hospital antibiotic use on community-acquired pneumonia.

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Simonetti, A F; Viasus, D; Garcia-Vidal, C; Grillo, S; Molero, L; Dorca, J; Carratalà, J

2014-09-01

Information on the influence of pre-hospital antibiotic treatment on the causative organisms, clinical features and outcomes of patients with community-acquired pneumonia (CAP) remains scarce. We performed an observational study of a prospective cohort of non-immunosuppressed adults hospitalized with CAP between 2003 and 2012. Patients were divided into two groups: those who had received pre-hospital antibiotic treatment for the same episode of CAP and those who had not. A propensity score was used to match patients. Of 2179 consecutive episodes of CAP, 376 (17.3%) occurred in patients who had received pre-hospital antibiotic treatment. After propensity score matching, Legionella pneumophila was more frequently identified in patients with pre-hospital antibiotic treatment, while Streptococcus pneumoniae was less common (p sensitivity and specificity of the pneumococcal urinary antigen test for diagnosing pneumococcal pneumonia were similar in the two groups. Patients with pre-hospital antibiotic treatment were less likely to present fever (p 0.02) or leucocytosis (p 0.001). Conversely, chest X-ray cavitation was more frequent in these patients (p 0.04). No significant differences were found in the frequency of patients classified into high-risk Pneumonia Severity Index classes, in intensive care unit admission, or in 30-day mortality between the groups. In conclusion, L. pneumophila occurrence was nearly three times higher in patients who received pre-hospital antibiotics. After a propensity-adjusted analysis, no significant differences were found in prognosis between study groups. Pre-hospital antibiotic use should be considered when choosing aetiological diagnostic tests and empirical antibiotic therapy in patients with CAP. © 2013 The Authors Clinical Microbiology and Infection © 2013 European Society of Clinical Microbiology and Infectious Diseases.

Verbal abuse and mobbing in pre-hospital care services in Chile.

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Campo, Varinia Rodríguez; Klijn, Tatiana Paravic

2018-01-08

to determine the perception of verbal abuse and mobbing and the associated factors of paramedic technicians (nursing assistants) and professionals (nurses, midwives, kinesiologists) in the pre-hospital care areas of three regions in the south of Chile. descriptive and correlational study was performed within the professional community and a two-stage sample of the paramedic technician population in three regions. The questionnaire "workplace violence in the health sector" (spanish version) was applied after signing the informed consent. 51.4% of professionals and 46.6% of paramedic technicians consider they have been verbally abused during last year. 17.6% of paramedic technicians and 13.5% of professionals perceived mobbing. A low percentage of these events are reported. In only one case of mobbing, the aggressor was legally penalized. No significant differences were found between the job categories and the studied regions. A high percentage of participants in each group perceived verbal abuse and non-minor percentage perceived mobbing, but most of these events are not reported.

Disparities in Revascularization After ST Elevation Myocardial Infarction (STEMI) Before and After the 2002 IOM Report.

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Bolorunduro, Oluwaseyi B; Kiladejo, Adekunle V; Animashaun, Islamiyat Babs; Akinboboye, Olakunle O

2016-05-01

To examine nationwide trends for racial disparities in Percutaneous Coronary Intervention after ST elevated Myocardial Infarction (STEMI). The Institute of Medicine (IOM) report published in 2002 showed that African Americans were less likely to receive coronary revascularization such as CABG and stents even after controlling for socioeconomics. It recommended increased awareness of these disparities among health professionals to reduce this. We hypothesized that increased awareness of disparities since this report would have translated to reduction in racial disparities in percutaneous coronary intervention. A retrospective analysis was conducted using data from the Agency of Healthcare Research and Quality's (AHRQ) National Inpatient Sample (NIS) 1998-2007. All patients with STEMI during this period were identified. The proportion that received Percutaneous Coronary Intervention (PCI) during the incident admission was compared by different ethnicities over the time period. Multivariable regression for each year was conducted using Poisson regression with robust variances. The analysis controlled for gender, insurance status, co-morbidities, hospital bed size, location and teaching status. Based on the database, about 2.04 million patients were managed for acute Myocardial Infarction from 1998 to 2007, of these 938,176 had STEMI. The primary PCI rate after STEMI among Caucasians was 29.1%, African Americans-23.3% and Hispanics-28.3% [P IOM report. Copyright © 2016 National Medical Association. Published by Elsevier Inc. All rights reserved.

Systems of care for ST-segment-elevation myocardial infarction: a report From the American Heart Association's Mission: Lifeline.

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Jollis, James G; Granger, Christopher B; Henry, Timothy D; Antman, Elliott M; Berger, Peter B; Moyer, Peter H; Pratt, Franklin D; Rokos, Ivan C; Acuña, Anna R; Roettig, Mayme Lou; Jacobs, Alice K

2012-07-01

organizational characteristics of collaborative efforts by hospitals and emergency medical services to provide timely reperfusion in the United States. These findings serve as a benchmark for existing systems and should help guide healthcare teams in the process of organizing care for patients with STEMI.

Access to care for patients with time-sensitive conditions in Pennsylvania.

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Salhi, Rama A; Edwards, J Matthew; Gaieski, David F; Band, Roger A; Abella, Benjamin S; Carr, Brendan G

2014-05-01

Collective knowledge and coordination of vital interventions for time-sensitive conditions (ST-segment elevation myocardial infarction [STEMI], stroke, cardiac arrest, and septic shock) could contribute to a comprehensive statewide emergency care system, but little is known about population access to the resources required. We seek to describe existing clinical management strategies for time-sensitive conditions in Pennsylvania hospitals. All Pennsylvania emergency departments (EDs) open in 2009 were surveyed about resource availability and practice patterns for time-sensitive conditions. The frequency with which EDs provided essential clinical bundles for each condition was assessed. Penalized maximum likelihood regressions were used to evaluate associations between ED characteristics and the presence of the 4 clinical bundles of care. We used geographic information science to calculate 60-minute ambulance access to the nearest facility with these clinical bundles. The percentage of EDs providing each of the 4 clinical bundles in 2009 ranged from 20% to 57% (stroke 20%, STEMI 32%, cardiac arrest 34%, sepsis 57%). For STEMI and stroke, presence of a board-certified/board-eligible emergency physician was significantly associated with presence of a clinical bundle. Only 8% of hospitals provided all 4 care bundles. However, 53% of the population was able to reach this minority of hospitals within 60 minutes. Reliably matching patient needs to ED resources in time-dependent illness is a critical component of a coordinated emergency care system. Population access to critical interventions for the time-dependent diseases discussed here is limited. A population-based planning approach and improved coordination of care could improve access to interventions for patients with time-sensitive conditions. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Improving sexual health for HIV patients by providing a combination of integrated public health and hospital care services; a one-group pre- and post test intervention comparison

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Dukers-Muijrers Nicole HTM

2012-12-01

Full Text Available Abstract Background Hospital HIV care and public sexual health care (a Sexual Health Care Centre services were integrated to provide sexual health counselling and sexually transmitted infections (STIs testing and treatment (sexual health care to larger numbers of HIV patients. Services, need and usage were assessed using a patient perspective, which is a key factor for the success of service integration. Methods The study design was a one-group pre-test and post-test comparison of 447 HIV-infected heterosexual individuals and men who have sex with men (MSM attending a hospital-based HIV centre serving the southern region of the Netherlands. The intervention offered comprehensive sexual health care using an integrated care approach. The main outcomes were intervention uptake, patients’ pre-test care needs (n=254, and quality rating. Results Pre intervention, 43% of the patients wanted to discuss sexual health (51% MSM; 30% heterosexuals. Of these patients, 12% to 35% reported regular coverage, and up to 25% never discussed sexual health topics at their HIV care visits. Of the patients, 24% used our intervention. Usage was higher among patients who previously expressed a need to discuss sexual health. Most patients who used the integrated services were new users of public health services. STIs were detected in 13% of MSM and in none of the heterosexuals. The quality of care was rated good. Conclusions The HIV patients in our study generally considered sexual health important, but the regular counselling and testing at the HIV care visit was insufficient. The integration of public health and hospital services benefited both care sectors and their patients by addressing sexual health questions, detecting STIs, and conducting partner notification. Successful sexual health care uptake requires increased awareness among patients about their care options as well as a cultural shift among care providers.

PHARMACOTHERAPY ANALYSIS OF ACUTE ST-ELEVATION MYOCARDIAL INFARCTION IN HOSPITALS OF VARIOUS TYPES

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R. M. Magdeev

2011-01-01

Full Text Available Aim. To evaluate pharmacotherapy of ST-elevation myocardial infarction (STEMI in cardiology departments of Saratov hospitals of various types. Material and methods. The retrospective pharmacoepidemiological study was carried out with involved of 424 hospital charts of STEMI patients, discharged during the year from the cardiology department of Saratov municipal hospital (MH; n=216 and emergency cardiology department of Saratov clinical hospital (CH; n=208. Results. The real practice in the audited hospitals are not fully consistent with current guidelines for the STEMI patients management. The relationship between guidelines compliance and hospital type is clearly seen. Doctors in MH in comparison with them in CH more often prescribed respiratory analeptics (13.4% vs 5.3% , respectively, metabolic drugs (63.4% vs 37.5%, respectively and rarer used beta-blockers (50% vs 88.9%, respectively and thrombolytic therapy (3.7% vs 51%, respectively. In MH dipyridamole was used in 9.6% of patients as an alternative to the acetylsalicylic acid, and clopidogrel was not prescribed. At the same hospital clotting time was determined for monitoring of heparin therapy. Statins were rare used in both hospitals (26% in MH vs 40% in CH. Conclusion. The real clinical practice of STEMI patients management in Saratov hospitals are not completely consistent with current clinical guidelines. There are differences in STEMI patients therapy depending on hospital type.

Comprehensive electrocardiogram-to-device time for primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: A report from the American Heart Association mission: Lifeline program.

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Shavadia, Jay S; French, William; Hellkamp, Anne S; Thomas, Laine; Bates, Eric R; Manoukian, Steven V; Kontos, Michael C; Suter, Robert; Henry, Timothy D; Dauerman, Harold L; Roe, Matthew T

2018-03-01

Assessing hospital-related network-level primary percutaneous coronary intervention (PCI) performance for ST-segment elevation myocardial infarction (STEMI) is challenging due to differential time-to-treatment metrics based on location of diagnostic electrocardiogram (ECG) for STEMI. STEMI patients undergoing primary PCI at 588 PCI-capable hospitals in AHA Mission: Lifeline (2008-2013) were categorized by initial STEMI identification location: PCI-capable hospitals (Group 1); pre-hospital setting (Group 2); and non-PCI-capable hospitals (Group 3). Patient-specific time-to-treatment categories were converted to minutes ahead of or behind their group-specific mean; average time-to-treatment difference for all patients at a given hospital was termed comprehensive ECG-to-device time. Hospitals were then stratified into tertiles based on their comprehensive ECG-to-device times with negative values below the mean representing shorter (faster) time intervals. Of 117,857 patients, the proportion in Groups 1, 2, and 3 were 42%, 33%, and 25%, respectively. Lower rates of heart failure and cardiac arrest at presentation are noted within patients presenting to high-performing hospitals. Median comprehensive ECG-to-device time was shortest at -9 minutes (25th, 75th percentiles: -13, -6) for the high-performing hospital tertile, 1 minute (-1, 3) for middle-performing, and 11 minutes (7, 16) for low-performing. Unadjusted rates of in-hospital mortality were 2.3%, 2.6%, and 2.7%, respectively, but the adjusted risk of in-hospital mortality was similar across tertiles. Comprehensive ECG-to-device time provides an integrated hospital-related network-level assessment of reperfusion timing metrics for primary PCI, regardless of the location for STEMI identification; further validation will delineate how this metric can be used to facilitate STEMI care improvements. Copyright © 2017 Elsevier Inc. All rights reserved.

Mothers of Pre-Term Infants in Neonate Intensive Care

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MacDonald, Margaret

2007-01-01

In this study, eight mothers of pre-term infants under the care of nursing staff and neonatologists in the Neonatal Intensive Care Unit (NICU) of Children's Hospital in Vancouver, British Columbia, were observed and interviewed about their birth experience and their images of themselves as mothers during their stay. Patterns and themes in the…

Effect of intracoronary injection of tirofiban combined with anisodamine on myocardial perfusion in patients with STEMI after PCI

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Xiao-Gang Zhu

2016-10-01

Full Text Available Objective: To analyze the effect of intracoronary injection of tirofiban combined with anisodamine on myocardial perfusion in patients with STEMI after PCI. Methods: A total of 78 patients with acute ST segment elevation myocardial infarction (STEMI who received PCI therapy in our hospital were randomly divided into control group and observation group, control group accepted routine PCI treatment, observation group received intracoronary injection of tirofiban and anisodamine in PCI, and myocardial perfusion of two groups was compared. Results: QRS duration values of observation group the instant after PCI and 4h after PCI were less than those of control group (P<0.05; 99mTc-MIBI and 18F-FDG intake of observation group after PCI were more than those of control group (P<0.05; serum MCP-1, sFas, Copeptin, OPN and vWF levels of observation group 4 h after PCI were lower than those of control group (P<0.05. Conclusions: Intracoronary injection of tirofiban combined with anisodamine can optimize myocardial perfusion in patients with STEMI after PCI, and has positive clinical significance.

Pre-hospital transport times and survival for Hypotensive patients with penetrating thoracic trauma

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Mamta Swaroop

2013-01-01

Full Text Available Background: Achieving definitive care within the "Golden Hour" by minimizing response times is a consistent goal of regional trauma systems . This study hypothesizes that in urban Level I Trauma Centers, shorter pre-hospital times would predict outcomes in penetrating thoracic injuries. Materials and Methods: A retrospective cohort study was performed using a statewide trauma registry for the years 1999-2003 . Total pre-hospital times were measured for urban victims of penetrating thoracic trauma. Crude and adjusted mortality rates were compared by pre-hospital time using STATA statistical software. Results: During the study period, 908 patients presented to the hospital after penetrating thoracic trauma, with 79% surviving . Patients with higher injury severity scores (ISS were transported more quickly. Injury severity scores (ISS ≥16 and emergency department (ED hypotension (systolic blood pressure, SBP <90 strongly predicted mortality (P < 0.05 for each . In a logistic regression model including age, race, and ISS, longer transport times for hypotensive patients were associated with higher mortality rates (all P values <0.05. This was seen most significantly when comparing patient transport times 0-15 min and 46-60 min (P < 0.001. Conclusion: In victims of penetrating thoracic trauma, more severely injured patients arrive at urban trauma centers sooner . Mortality is strongly predicted by injury severity, although shorter pre-hospital times are associated with improved survival . These results suggest that careful planning to optimize transport time-encompassing hospital capacity and existing resources, traffic patterns, and trauma incident densities may be beneficial in areas with a high burden of penetrating trauma.

[Experience in the treatment of patients with STEMI in the frame of urgent PCI Project in Medimurje County].

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Hranilović, Rudolf

2009-02-01

In 2004, the mortality rate of cardiovascular disease in Medimurje County was 53%, with coronary heart disease accounting for 18.2% of cases. The need of organizing a County team for health was recognized. Five health priorities were acknowledged with coronary heart disease on the top of the list. In 2005, Medimurje County was among the first regions outside Zagreb that had launched the Project of urgent percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) patients. Internal medicine physicians from the County Hospital received thorough education and printed materials on the issue were distributed to primary care physicians. A media campaign for the general population of the Medimurje County was also prepared. During the first 2 years of the project, the average pain-to-needle time in our patients was less than 4 hours. From the beginning of the project till July 2007, more than 100 patients with STEMI were treated with emergency PCI. There still are issues that have remained unsolved (how to reduce the pain-to-door and door-to-needle time, managing patients in cardiogenic shock, NSTEMI-patients, and presentation of patients with multivessel disease to cardiac surgeons). It is important to carry on with the intensive media campaign as well as with further education of patients, physicians and other health personnel.

ST Elevations and Elevated Cardiac Enzymes Not Always a STEMI: Two Case Reports.

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Fernández Fernández, Juan; Deliz-Guzmán, Claudia; Andino-Colón, César; Claudio-Hernández, Héctor; Lugo-Amador, Nannette

2016-01-01

Chest pain is a common complaint in the emergency department (ED). Besides a careful history and physical exam; electrocardiogram, laboratory tests and imaging studies are widely available diagnostic tests that are used for patient assessment. When ST elevation and elevated cardiac enzymes are present the most likely diagnosis are ST elevation myocardial infarction (STEMI) or myocarditis. In this case report we present two low risk patients for major adverse cardiac event with ST elevation and elevated cardiac enzymes and how a careful risk assessment and detailed electrocardiogram evaluation could help differentiating between these two diagnoses.

Impact of ECG findings and process-of-care characteristics on the likelihood of not receiving reperfusion therapy in patients with ST-elevation myocardial infarction: results of a field evaluation.

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Kevin A Brown

Full Text Available BACKGROUND: Many patients with ST-elevation myocardial infarction (STEMI do not receive reperfusion therapy and are known to have poorer outcomes. We aimed to perform the first population-level, integrated analysis of clinical, ECG and hospital characteristics associated with non-receipt of reperfusion therapy in patients with STEMI. METHODS AND RESULTS: This systematic evaluation of STEMI care in 82 hospitals in Quebec included all patients with a discharge diagnosis of myocardial infarction, presenting with characteristic symptoms and an ECG showing STEMI as attested by at least one of two study cardiologists or left bundle branch block (LBBB. Excluding LBBB, an ECG was considered a definite STEMI diagnosis if both cardiologists scored 'certain STEMI' and ambiguous if one scored 'uncertain' or 'not STEMI'. Centers were classified according to accessibility to primary percutaneous coronary intervention (PPCI: 1 on-site PPCI; 2 routine transfer for PPCI; 3 varying mix of PPCI transfer and on-site fibrinolysis; and 4 routine on-site fibrinolysis. Of 3730 STEMI/LBBB patients, 812 (21.8% did not receive reperfusion therapy. In multivariate analysis, likelihood of no reperfusion therapy was a function of PPCI accessibility (odds ratio [OR] for fibrinolysis versus PPCI centers = 3.1; 95% CI: 2.2-4.4, presence of LBBB (OR = 24.1; 95% CI: 17.8-32.9 and an ECG ambiguous for STEMI (OR = 4.1; 95% CI: 3.3-5.1. When the ECG was ambiguous, likelihood of no reperfusion therapy was highest in hospitals most distant from PPCI centers. CONCLUSIONS: ECG diagnostic ambiguity, LBBB and PPCI accessibility are important predictors of not receiving reperfusion therapy, suggesting opportunities for improving outcomes.

Improving Door-to-balloon Time by Decreasing Door-to-ECG time for Walk-in STEMI Patients

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Coyne, Christopher J.

2014-12-01

Full Text Available Introduction: The American Heart Association/American College of Cardiology guidelines recommend rapid door-to-electrocardiography (ECG times for patients with ST-segment elevation myocardial infarction (STEMI. Previous quality improvement research at our institution revealed that we were not meeting this benchmark for walk-in STEMI patients. The objective is to investigate whether simple, directed changes in the emergency department (ED triage process for potential cardiac patients could decrease door-to-ECG times and secondarily door-to-balloon times. Methods: We conducted an interventional study at a large, urban, public teaching hospital from April 2010 to June 2012. All patients who walked into the ED with a confirmed STEMI were enrolled in the study. The primary intervention involved creating a chief complaint-based “cardiac triage” designation that streamlined the evaluation of potential cardiac patients. A secondary intervention involved moving our ECG technician and ECG station to our initial triage area. The primary outcome measure was door-to-ECG time and the secondary outcome measure was door-to-balloon time. Results: We enrolled 91 walk-in STEMI patients prior to the intervention period and 141 patients after the invention. We observed statistically significant reductions in door-to-ECG time (43±93 to 30±72 minutes, median 23 to 14 minutes p<0.01, ECG-to-activation time (87±134 to 52±82 minutes, median 43 to 31 minutes p<0.01, and door-to-balloon time (134±146 to 84±40 minutes, median 85 -75 minutes p=0.03. Conclusion: By creating a chief complaint-based cardiac triage protocol and by streamlining ECG completion, walk-in STEMI patients are systematically processed through the ED. This is not only associated with a decrease in door-to-balloon time, but also a decrease in the variability of the time sensitive intervals of door-to-ECG and ECG-to-balloon time. [West J Emerg Med. 2015;16(1:184–189.

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

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Menahem, Sasson; Roitgarz, Ina; Shvartzman, Pesach

2011-04-01

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

Plasma glucose and not hemoglobin or renal function predicts mortality in patients with STEMI complicated with cardiogenic shock

NARCIS (Netherlands)

Vis, Marije M.; Engström, Annemarie E.; Sjauw, Krischan D.; Tjong, Fleur Vy; Baan, Jan; Koch, Karel T.; de Vries, Hans J.; Tijssen, Jan Gp; de Winter, Robbert J.; Piek, Jan J.; Henriques, José Ps

2010-01-01

Objective To assess the predictive value of three biomarkers for mortality in ST-segment elevation myocardial infarction (STEMI) with cardiogenic shock. Background STEMI complicated by cardiogenic shock accounts for the majority of STEMI related deaths. Patients with STEMI and hyperglycemia, anemia

Pre-hospital management of patients with chest pain and/or dyspnoea of cardiac origin. A position paper of the Acute Cardiovascular Care Association (ACCA) of the ESC.

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Beygui, Farzin; Castren, Maaret; Brunetti, Natale Daniele; Rosell-Ortiz, Fernando; Christ, Michael; Zeymer, Uwe; Huber, Kurt; Folke, Fredrik; Svensson, Leif; Bueno, Hector; Van't Hof, Arnoud; Nikolaou, Nikolaos; Nibbe, Lutz; Charpentier, Sandrine; Swahn, Eva; Tubaro, Marco; Goldstein, Patrick

2015-08-27

Chest pain and acute dyspnoea are frequent causes of emergency medical services activation. The pre-hospital management of these conditions is heterogeneous across different regions of the world and Europe, as a consequence of the variety of emergency medical services and absence of specific practical guidelines. This position paper focuses on the practical aspects of the pre-hospital treatment on board and transfer of patients taken in charge by emergency medical services for chest pain and dyspnoea of suspected cardiac aetiology after the initial assessment and diagnostic work-up. The objective of the paper is to provide guidance, based on evidence, where available, or on experts' opinions, for all emergency medical services' health providers involved in the pre-hospital management of acute cardiovascular care. © The European Society of Cardiology 2015.

Continuous quality improvement process pin-points delays, speeds STEMI patients to life-saving treatment.

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2011-11-01

Using a multidisciplinary team approach, the University of California, San Diego, Health System has been able to significantly reduce average door-to-balloon angioplasty times for patients with the most severe form of heart attacks, beating national recommendations by more than a third. The multidisciplinary team meets monthly to review all cases involving patients with ST-segment-elevation myocardial infarctions (STEMI) to see where process improvements can be made. Using this continuous quality improvement (CQI) process, the health system has reduced average door-to-balloon times from 120 minutes to less than 60 minutes, and administrators are now aiming for further progress. Among the improvements instituted by the multidisciplinary team are the implementation of a "greeter" with enough clinical expertise to quickly pick up on potential STEMI heart attacks as soon as patients walk into the ED, and the purchase of an electrocardiogram (EKG) machine so that evaluations can be done in the triage area. ED staff have prepared "STEMI" packets, including items such as special IV tubing and disposable leads, so that patients headed for the catheterization laboratory are prepared to undergo the procedure soon after arrival. All the clocks and devices used in the ED are synchronized so that analysts can later review how long it took to complete each step of the care process. Points of delay can then be targeted for improvement.

Impact of diagnostic ECG to wire delay in STEMI patients treated with primary PCI - a DANAMI-3 substudy

DEFF Research Database (Denmark)

Nepper-Christensen, Lars; Lønborg, Jacob; Høfsten, Dan Eik

2018-01-01

AIMS: We evaluated the impact of delay from diagnostic pre-hospital electrocardiogram (ECG) to wiring of the infarct related vessel (ECG-to-wire) >120 minutes on cardiovascular magnetic resonance (CMR) markers of reperfusion success and clinical outcome in patients with ST-segment elevation...... myocardial infarction (STEMI). METHODS AND RESULTS: We included 1492 patients in the analyses of clinical outcome. CMR was performed in 748 patients to evaluate infarct size and myocardial salvage. In total, 304 patients (20%) had ECG-to-wire >120 minutes, which was associated with larger acute infarct size...... (18% [interquartile range (IQR), 10-28] vs. 15% [8-24]; p=0.022) and smaller myocardial salvage (0.42 [IQR 0.28-0.57] vs. 0.50 [IQR 0.34-0.70]; p=0.002). However, 33% of the patients with ECG-to-wire >120 minutes still had a substantial myocardial salvage of more than 0.50. In a multivariable analysis...

System delay and mortality among patients with STEMI treated with primary percutaneous coronary intervention

DEFF Research Database (Denmark)

Terkelsen, Christian Juhl; Sørensen, Jacob Thorsted; Maeng, Michael

2010-01-01

Timely reperfusion therapy is recommended for patients with ST-segment elevation myocardial infarction (STEMI), and door-to-balloon delay has been proposed as a performance measure in triaging patients for primary percutaneous coronary intervention (PCI). However, focusing on the time from first...... contact with the health care system to the initiation of reperfusion therapy (system delay) may be more relevant, because it constitutes the total time to reperfusion modifiable by the health care system. No previous studies have focused on the association between system delay and outcome in patients...

Knowledge of thromboprophylaxis guidelines pre- and post-didactic lectures during a venous thromboembolism awareness day at a tertiary-care hospital.

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Al-Dorzi, Hasan M; Cherfan, Antoine; Al-Harbi, Shmylan; Al-Askar, Ahmad; Al-Azzam, Saleh; Hroub, Ahmad; Olivier, Joan; Al-Hameed, Fahad; Al-Moamary, Mohamed; Abdelaal, Mohamed; Poff, Gregory A; Arabi, Yaseen M

2013-07-01

Didactic lectures are frequently used to improve compliance with practice guidelines. This study assessed the knowledge of health-care providers (HCPs) at a tertiary-care hospital of its evidence-based thromboprophylaxis guidelines and the impact of didactic lectures on their knowledge. The hospital launched a multifaceted approach to improve thromboprophylaxis practices, which included posters, a pocket-size guidelines summary and didactic lectures during the annual thromboprophylaxis awareness days. A self-administered questionnaire was distributed to HCPs before and after lectures on thromboprophylaxis guidelines (June 2010). The questionnaire, formulated and validated by two physicians, two nurses and a clinical pharmacist, covered various subjects such as risk stratification, anticoagulant dosing and the choice of anticoagulants in specific clinical situations. Seventy-two and 63 HCPs submitted the pre- and post-test, respectively (62% physicians, 28% nurses, from different clinical disciplines). The mean scores were 7.8 ± 2.1 (median = 8.0, range = 2-12, maximum possible score = 15) for the pre-test and 8.4 ± 1.8 for the post-test, P = 0.053. There was no significant difference in the pre-test scores of nurses and physicians (7.9 ± 1.7 and 8.2 ± 2.4, respectively, P = 0.67). For the 35 HCPs who completed the pre- and post-tests, their scores were 7.7 ± 1.7 and 8.8 ± 1.6, respectively, P = 0.003. Knowledge of appropriate anticoagulant administration in specific clinical situations was frequently inadequate, with approximately two-thirds of participants failing to adjust low-molecular-weight heparin doses in patients with renal failure. Education via didactic lectures resulted in a modest improvement of HCPs' knowledge of thromboprophylaxis guidelines. This supports the need for a multifaceted approach to improve the awareness and implementation of thromboprophylaxis guidelines.

Pre-hospital care time intervals among victims of road traffic injuries in Iran. A cross-sectional study.

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Bigdeli, Maryam; Khorasani-Zavareh, Davoud; Mohammadi, Reza

2010-07-09

Road traffic injuries (RTIs) are a major public health problem, requiring concerted efforts both for their prevention and a reduction of their consequences. Timely arrival of the Emergency Medical Service (EMS) at the crash scene followed by speedy victim transportation by trained personnel may reduce the RTIs' consequences. The first 60 minutes after injury occurrence--referred to as the "golden hour"--are vital for the saving of lives. The present study was designed to estimate the average of various time intervals occurring during the pre-hospital care process and to examine the differences between these time intervals as regards RTIs on urban and interurban roads. A retrospective cross-sectional study was designed and various time intervals in relation to pre-hospital care of RTIs identified in the ambulance dispatch centre in Urmia, Iran from 20 March 2005 to 20 March 2007. All cases which resulted in ambulance dispatches were reviewed and those that had complete data on time intervals were analyzed. In total, the cases of 2027 RTI victims were analysed. Of these, 61.5% of the subjects were injured in city areas. The mean response time for city locations was 5.0 minutes, compared with 10.6 minutes for interurban road locations. The mean on-scene time on the interurban roads was longer than on city roads (9.2 vs. 6.1 minutes, p transport times from the scene to the hospital were also significantly longer for interurban incidents (17.1 vs. 6.3 minutes, p transport and total time intervals among EMS responding to RTI incidents were longer for interurban roads, compared to the city areas. More research should take place on needs-to and access-for EMS on city and interurban roads. The notification interval seems to be a hidden part of the post-crash events and indirectly affects the "golden hour" for victim management and it needs to be measured through the establishment of the surveillance systems.

Pharmaceutical care in Kuwait: hospital pharmacists' perspectives.

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Katoue, Maram G; Awad, Abdelmoneim I; Schwinghammer, Terry L; Kombian, Samuel B

2014-12-01

Pharmaceutical care practice has been championed as the primary mission of the pharmacy profession, but its implementation has been suboptimal in many developing countries including Kuwait. Pharmacists must have sufficient knowledge, skills, and positive attitudes to practise pharmaceutical care, and barriers in the pharmacy practice model must be overcome before pharmaceutical care can be broadly implemented in a given healthcare system. To investigate hospital pharmacists' attitudes towards pharmaceutical care, perceptions of their preparedness to provide pharmaceutical care, and the barriers to its implementation in Kuwait. Six general hospitals, eight specialized hospitals and seven specialized health centers in Kuwait. A descriptive, cross-sectional survey was distributed to all pharmacists working in the governmental hospitals in Kuwait (385 pharmacists). Data were collected via a pre-tested self-administered questionnaire. Descriptive statistics including percentages, medians and means Likert scale rating (standard deviations) were calculated and compared using statistical package for social sciences, version 20. Statistical significance was accepted at a p value of Kuwait. Completed surveys were received from 250 (64.9%) of the 385 pharmacists. Pharmacists expressed overall positive attitudes towards pharmaceutical care. They felt well prepared to implement the various aspects of pharmaceutical care, with the least preparedness in the administrative/management aspects. Pharmacists with more practice experience expressed significantly more positive attitudes towards pharmaceutical care (p = 0.001) and they felt better prepared to provide pharmaceutical care competencies (p Kuwait advocate implementation of pharmaceutical care while also appreciating the organizational, technical and professional barriers to its widespread adoption. Collaborative efforts between health authorities and educational institutions, and the integration of innovative approaches in

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

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O. V. Reshetko

2016-01-01

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

Comparative care and outcomes for acute coronary syndromes in Central and Eastern European Transitional countries: A review of the literature.

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Smith, Fraser G D; Brogan, Richard A; Alabas, Oras; Laut, Kristina G; Quinn, Tom; Bugiardini, Raffaele; Gale, Chris P

2015-12-01

The purpose of this review was to compare quality of care and outcomes following acute coronary syndrome (ACS) in Central and Eastern European Transitional (CEET) countries. This was a review of original ACS articles in CEET countries from PubMed, ISI Web of Science, Medline and Embase databases published in English from November 2003 to February 2014. Seventeen manuscripts fulfilled the search criteria. Of 19 CEET countries studied, there were no published ACS management or outcome data for four countries. In-hospital mortality for patients with acute myocardial infarction (AMI) ranged from 6.3% in the Czech Republic to 15.3% in Latvia. In-hospital mortality for ST-elevation myocardial infarction (STEMI) ranged from 3.0% in Poland to 20.7% in Romania. For STEMI, primary percutaneous coronary intervention (PCI) ranged from 1.0% to over 92.0%, fibrinolytic therapy from 0.0% to 49.6%, and no reperfusion therapy from 7.0% to 63.0%. Many CEET countries do not have published ACS care and outcomes data. Of those that do, there is evidence for substantial geographical variation in early mortality. Wide variation in emergency reperfusion strategies for STEMI suggests that acute cardiac care is likely to be modifiable and if addressed could reduce mortality from ACS in CEET countries. The collection of ACS care and outcomes data across Europe must be prioritised. © The European Society of Cardiology 2014.

Influence of pre-infarction angina, collateral flow, and pre-procedural TIMI flow on myocardial salvage index by cardiac magnetic resonance in patients with ST-segment elevation myocardial infarction.

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Lønborg, Jacob; Kelbæk, Henning; Vejlstrup, Niels; Bøtker, Hans Erik; Kim, Won Yong; Holmvang, Lene; Jørgensen, Erik; Helqvist, Steffen; Saunamäki, Kari; Thuesen, Leif; Krusell, Lars Romer; Clemmensen, Peter; Engstrøm, Thomas

2012-05-01

In patients with ST-segment elevation myocardial infarction (STEMI) pre-infarction angina, pre-procedural TIMI flow and collateral flow to the myocardium supplied by the infarct related artery are suggested to be cardioprotective. We evaluated the effect of these factors on myocardial salvage index (MSI) and infarct size adjusting for area at risk in patients with STEMI treated with primary percutaneous coronary intervention. Cardiac magnetic resonance (CMR) was used to measure myocardial area at risk within 1-7 days and final infarct size 90 ± 21 days after the STEMI in 200 patients. MSI was calculated as (area-at-risk infarct size) / area-at-risk. Patients with pre-infarction angina had a median MSI of 0.80 (IQR 0.67 to 0.86) versus 0.72 (0.61 to 0.80) in those without pre-infarction angina, P = 0.004). In a regression analysis of the infarct size plotted against the area-at-risk there was a strong trend that the line for the pre-infarction angina group was below the one for the non-angina group (P = 0.05). Patients with pre-procedural TIMI flow 0/1, 2 and 3 had a median MSI of (0.69 (IQR 0.59 to 0.76), 0.78 (0.68 to 0.86) and 0.85 (0.77 to 0.91), respectively (PCollateral flow did not change MSI (P = 0.45) nor area-at-risk (P = 0.40) and no significant difference in infarct size adjusted for area at risk (P = 0.25) was observed. Pre-infarction angina increases MSI in patients with STEMI supporting the theory that pre-infarction angina leads to ischemic preconditioning. As opposed to the presence of angiographically visible collateral flow to the infarct area pre-procedural TIMI flow is strongly associated with MSI.

EkSTEMiT Learning Module and Inculcation of Inventive Thinking

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Norhaslinda Abdul Samad

2017-10-01

Full Text Available The young generation of today must be prepared with the knowledge and skills necessary to be able to compete globally thus boosting economic growth and prosperity. Therefore, students should not only be equipped with knowledge but they are in need of the “21st century skills”, which is the top priority and one of the main education agenda goals today. As one of the domains in the 21st century skills, inventive thinking includes elements of flexibility, self-regulation, curiosity, creativity, risk taking, higher order thinking and reasoning. In order to inculcate inventive thinking for students, the EkSTEMiT Learning Module was developed for the topic Electrochemistry; one of the most difficult topics to learn among students. EkSTEMiT Learning Module was developed based on the STEM (Science, Technology, Engineering and Mathematics integrated model. Thus, this paper will discuss the conceptual framework underlying the development of EkSTEMiT Learning Module with descriptions of learning activities designed for Electrochemistry.

Costs of war: excess health care burdens during the wars in Afghanistan and Iraq (relative to the health care experience pre-war).

Science.gov (United States)

2012-11-01

This report estimates the health care burden related to the wars in Iraq and Afghanistan by calculating the difference between the total health care delivered to U.S. military members during wartime (October 2001 to June 2012) and that which would have been delivered if pre-war (January 1998 to August 2001) rates of ambulatory visits, hospitalizations, and hospital bed days of active component members of the U.S. Armed Forces had persisted during the war. Overall, there were estimated excesses of 17,023,491 ambulatory visits, 66,768 hospitalizations, and 634,720 hospital bed days during the war period relative to that expected based on pre-war experience. Army and Marine Corps members and service members older than 30 accounted for the majority of excess medical care during the war period. The illness/injury-specific category of mental disorders was the single largest contributor to the total estimated excesses of ambulatory visits, hospitalizations, and bed days. The total health care burdens associated with the wars in Afghanistan and Iraq are undoubtedly greater than those enumerated in this report because this analysis did not address care delivered in deployment locations or at sea, care rendered by civilian providers to reserve component members in their home communities, care of veterans by the Departments of Defense and Veterans Affairs, preventive care for the sake of force health protection, and future health care associated with wartime injuries and illnesses.

Pre-hospital care time intervals among victims of road traffic injuries in Iran. A cross-sectional study

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Bigdeli Maryam

2010-07-01

Full Text Available Abstract Background Road traffic injuries (RTIs are a major public health problem, requiring concerted efforts both for their prevention and a reduction of their consequences. Timely arrival of the Emergency Medical Service (EMS at the crash scene followed by speedy victim transportation by trained personnel may reduce the RTIs' consequences. The first 60 minutes after injury occurrence - referred to as the "golden hour"- are vital for the saving of lives. The present study was designed to estimate the average of various time intervals occurring during the pre-hospital care process and to examine the differences between these time intervals as regards RTIs on urban and interurban roads. Method A retrospective cross-sectional study was designed and various time intervals in relation to pre-hospital care of RTIs identified in the ambulance dispatch centre in Urmia, Iran from 20 March 2005 to 20 March 2007. All cases which resulted in ambulance dispatches were reviewed and those that had complete data on time intervals were analyzed. Results In total, the cases of 2027 RTI victims were analysed. Of these, 61.5 % of the subjects were injured in city areas. The mean response time for city locations was 5.0 minutes, compared with 10.6 minutes for interurban road locations. The mean on-scene time on the interurban roads was longer than on city roads (9.2 vs. 6.1 minutes, p Conclusion The response, transport and total time intervals among EMS responding to RTI incidents were longer for interurban roads, compared to the city areas. More research should take place on needs-to and access-for EMS on city and interurban roads. The notification interval seems to be a hidden part of the post-crash events and indirectly affects the "golden hour" for victim management and it needs to be measured through the establishment of the surveillance systems.

Community-based home-care program for the management of pre-eclampsia: an alternative.

OpenAIRE

Helewa, M; Heaman, M; Robinson, M A; Thompson, L

1993-01-01

OBJECTIVE: To evaluate the safety, acceptability and cost of a community-based home-care program for the management of mild pre-eclampsia. DESIGN: A descriptive study of outcomes between Apr. 1, 1985, and Dec. 31, 1989. SETTING: St. Boniface General Hospital, Winnipeg. PATIENTS: Urban Winnipeg residents between 27 and 40 weeks' gestation with mild pre-eclampsia who demonstrated acceptance and compliance with home-care management; 321 patients of 1330 were enrolled in the program. INTERVENTION...

Hospital process intervals, not EMS time intervals, are the most important predictors of rapid reperfusion in EMS Patients with ST-segment elevation myocardial infarction.

Science.gov (United States)

Clark, Carol Lynn; Berman, Aaron D; McHugh, Ann; Roe, Edward Jedd; Boura, Judith; Swor, Robert A

2012-01-01

minutes. In our study, hospital process intervals (EMS activation, door to page, page to laboratory, and laboratory to reperfusion) are key covariates of rapid reperfusion for EMS STEMI patients and should be used when assessing STEMI care.

Ticagrelor versus clopidogrel in real-world patients with ST elevation myocardial infarction: 1-year results by propensity score analysis.

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Vercellino, Matteo; Sànchez, Federico Ariel; Boasi, Valentina; Perri, Dino; Tacchi, Chiara; Secco, Gioel Gabrio; Cattunar, Stefano; Pistis, Gianfranco; Mascelli, Giovanni

2017-04-05

European guidelines recommend the use of ticagrelor versus clopidogrel in patients with ST elevation myocardial infarction (STEMI). This recommendation is based on inconclusive results and subanalyses from clinical trials. Few data are available on the effects of ticagrelor in a real-world population. To compare the effects of ticagrelor and clopidogrel in a real-world STEMI population, we conducted a pre-post case-control study examining all patients with STEMI included in the Cardio-STEMI Sanremo registry between February 2011 and June 2013. Cases and controls were defined according to P2Y 12 inhibitors, correcting the bias due to lack of randomization by propensity score analysis. Ticagrelor was introduced in 2012 in both in-hospital and pre-hospital settings independently of this study. Of the 416 patients enrolled in the Cardio-STEMI registry, 401 with a definite diagnosis of STEMI were included in this study. One hundred forty-two patients received ticagrelor and 259 received clopidogrel. Regarding clinical presentation and procedural data, those in the ticagrelor group had lower CRUSADE scores (23 [14-36] vs 27 [18-38]; p = 0.015] but a higher proportion of radial access (33% vs 14%; p word propensity score analysis, ticagrelor did not affect the risk of MACE during the hospital phase, or the incidence of hospital bleeding in patients with STEMI. However, in this mono-centric experience, ticagrelor resulted in improved 1-year survival, even after correction by propensity score.

The pre-hospital administration of tranexamic acid to patients with multiple injuries and its effects on rotational thrombelastometry: a prospective observational study in pre-hospital emergency medicine.

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Kunze-Szikszay, Nils; Krack, Lennart A; Wildenauer, Pauline; Wand, Saskia; Heyne, Tim; Walliser, Karoline; Spering, Christopher; Bauer, Martin; Quintel, Michael; Roessler, Markus

2016-10-10

Hyperfibrinolysis (HF) is a major contributor to coagulopathy and mortality in trauma patients. This study investigated (i) the rate of HF during the pre-hospital management of patients with multiple injuries and (ii) the effects of pre-hospital tranexamic acid (TxA) administration on the coagulation system. From 27 trauma patients with pre-hospital an estimated injury severity score (ISS) ≥16 points blood was obtained at the scene and on admission to the emergency department (ED). All patients received 1 g of TxA after the first blood sample was taken. Rotational thrombelastometry (ROTEM) was performed for both blood samples, and the results were compared. HF was defined as a maximum lysis (ML) >15 % in EXTEM. The median (min-max) ISS was 17 points (4-50 points). Four patients (15 %) had HF diagnosed via ROTEM at the scene, and 2 patients (7.5 %) had HF diagnosed via ROTEM on admission to the ED. The median ML before TxA administration was 11 % (3-99 %) vs. 10 % after TxA administration (4-18 %; p > 0.05). TxA was administered 37 min (10-85 min) before ED arrival. The ROTEM results before and after TxA administration did not significantly differ. No adverse drug reactions were observed after TxA administration. HF can be present in severely injured patients during pre-hospital care. Antifibrinolytic therapy administered at the scene is a significant time saver. Even in milder trauma fibrinogen can be decreased to critically low levels. Early administration of TxA cannot reverse or entirely stop this decrease. The pre-hospital use of TxA should be considered for severely injured patients to prevent the worsening of trauma-induced coagulopathy and unnecessarily high fibrinogen consumption. ClinicalTrials.gov ID NCT01938768 (Registered 5 September 2013).

System dynamics modeling in the evaluation of delays of care in ST-segment elevation myocardial infarction patients within a tiered health system.

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Luciano de Andrade

Full Text Available Mortality rates amongst ST segment elevation myocardial infarction (STEMI patients remain high, especially in developing countries. The aim of this study was to evaluate the factors related with delays in the treatment of STEMI patients to support a strategic plan toward structural and personnel modifications in a primary hospital aligning its process with international guidelines.The study was conducted in a primary hospital localized in Foz do Iguaçu, Brazil. We utilized a qualitative and quantitative integrated analysis including on-site observations, interviews, medical records analysis, Qualitative Comparative Analysis (QCA and System Dynamics Modeling (SD. Main cause of delays were categorized into three themes: a professional, b equipment and c transportation logistics. QCA analysis confirmed four main stages of delay to STEMI patient's care in relation to the 'Door-in-Door-out' time at the primary hospital. These stages and their average delays in minutes were: a First Medical Contact (From Door-In to the first contact with the nurse and/or physician: 7 minutes; b Electrocardiogram acquisition and review by a physician: 28 minutes; c ECG transmission and Percutaneous Coronary Intervention Center team feedback time: 76 minutes; and d Patient's Transfer Waiting Time: 78 minutes. SD baseline model confirmed the system's behavior with all occurring delays and the need of improvements. Moreover, after model validation and sensitivity analysis, results suggested that an overall improvement of 40% to 50% in each of these identified stages would reduce the delay.This evaluation suggests that investment in health personnel training, diminution of bureaucracy, and management of guidelines might lead to important improvements decreasing the delay of STEMI patients' care. In addition, this work provides evidence that SD modeling may highlight areas where health system managers can implement and evaluate the necessary changes in order to improve the

Heart rate at admission is a predictor of in-hospital mortality in patients with acute coronary syndromes: Results from 58 European hospitals: The European Hospital Benchmarking by Outcomes in acute coronary syndrome Processes study.

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Jensen, Magnus T; Pereira, Marta; Araujo, Carla; Malmivaara, Anti; Ferrieres, Jean; Degano, Irene R; Kirchberger, Inge; Farmakis, Dimitrios; Garel, Pascal; Torre, Marina; Marrugat, Jaume; Azevedo, Ana

2018-03-01

The purpose of this study was to investigate the relationship between heart rate at admission and in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Consecutive ACS patients admitted in 2008-2010 across 58 hospitals in six participant countries of the European Hospital Benchmarking by Outcomes in ACS Processes (EURHOBOP) project (Finland, France, Germany, Greece, Portugal and Spain). Cardiogenic shock patients were excluded. Associations between heart rate at admission in categories of 10 beats per min (bpm) and in-hospital mortality were estimated by logistic regression in crude models and adjusting for age, sex, obesity, smoking, hypertension, diabetes, known heart failure, renal failure, previous stroke and ischaemic heart disease. In total 10,374 patients were included. In both STEMI and NSTE-ACS patients, a U-shaped relationship between admission heart rate and in-hospital mortality was found. The lowest risk was observed for heart rates between 70-79 bpm in STEMI and 60-69 bpm in NSTE-ACS; risk of mortality progressively increased with lower or higher heart rates. In multivariable models, the relationship persisted but was significant only for heart rates >80 bpm. A similar relationship was present in both patients with or without diabetes, above or below age 75 years, and irrespective of the presence of atrial fibrillation or use of beta-blockers. Heart rate at admission is significantly associated with in-hospital mortality in patients with both STEMI and NSTE-ACS. ACS patients with admission heart rate above 80 bpm are at highest risk of in-hospital mortality.

Superbugs causing ventilator associated pneumonia in a tertiary care hospital and the return of pre-antibiotic era!

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S Qureshi

2015-01-01

Full Text Available The rise in super bugs causing Ventilator-Associated Pneumonia (VAP is a major cause of mortality and morbidity despite recent advances in management owing to the looming ′antibiotic apocalypse′. The aetiology and susceptibility pattern of the VAP isolates varies with patient population, type of intensive care unit (ICU and is an urgent diagnostic challenge. The present study carried out for a period of one year in a tertiary care hospital, enrolled patients on mechanical ventilation (MV for ≥48 hrs. Endotracheal aspirates (ETA from suspected VAP patients were processed by semi quantitative method. Staphylococus aureus, members of Enterobacteriaceae were more common in early onset VAP (EOVAP, while Nonfermenting Gram negative bacilli (NFGNB were significantly associated with late onset VAP (LOVAP. Most of the isolates were multi drug resistant (MDR super bugs. With limited treatment options left for this crisis situation like the pre-antibiotic era; it is an alarm for rational antibiotic therapy usage and intensive education programs.

Bridging a divide: architecture for a joint hospital-primary care data warehouse.

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An, Jeff; Keshavjee, Karim; Mirza, Kashif; Vassanji, Karim; Greiver, Michelle

2015-01-01

Healthcare costs are driven by a surprisingly small number of patients. Predicting who is likely to require care in the near future could help reduce costs by pre-empting use of expensive health care resources such as emergency departments and hospitals. We describe the design of an architecture for a joint hospital-primary care data warehouse (JDW) that can monitor the effectiveness of in-hospital interventions in reducing readmissions and predict which patients are most likely to be admitted to hospital in the near future. The design identifies the key governance elements, the architectural principles, the business case, the privacy architecture, future work flows, the IT infrastructure, the data analytics and the high level implementation plan for realization of the JDW. This architecture fills a gap in bridging data from two separate hospital and primary care organizations, not a single managed care entity with multiple locations. The JDW architecture design was well received by the stakeholders engaged and by senior leadership at the hospital and the primary care organization. Future plans include creating a demonstration system and conducting a pilot study.

Frequency of color blindness in pre-employment screening in a tertiary health care center in Pakistan.

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Chhipa, Shaukat Ali; Hashmi, Farzeen K; Ali, Shehreen; Kamal, Mustafa; Ahmad, Khabir

2017-01-01

To describe the frequency of color vision deficiency among Pakistani adults presenting for pre-employment health screening in a tertiary care hospital. The cross-sectional study was carried out at the Aga Khan University Hospital, Karachi, and the data was collected for color vision deficiency, age, gender, and job applied for from pre-employment examination during 2013-2014. IBM SPSS 20 was used for statistical analysis. Three thousand four hundred and thirty seven persons underwent pre-employment screening during 2013 and 2014; 1837 (53.44%) were males and 1600 (46.65%) females. The mean age was 29.01 (±6.53) years. A total of 0.9% (32/3437) persons had color vision deficiency with male being 1.4% and female 0.4%. Color vision deficiency was observed in 0.9% of candidates screened for pre-employment health check up in a tertiary care hospital. The color vision deficiency was predominantly present in male individuals.

[Evidence-based management of ST-segment elevation myocardial infarction (STEMI). Latest guidelines of the European Society of Cardiology (ESC) 2010].

Science.gov (United States)

Silber, S

2010-12-01

coronary intervention) availability. The key question for further decisions is whether a primary PCI can be performed within 120 min after FMC. If so, the primary PCI should definitively be preferred. In patients infarction within 2 h after onset of symptoms, this time interval should not exceed 90 min. For primary PCI an often used measure of quality is the "door-to-balloon" time, which should of course be as short as possible. Therefore, patients with STEMI should be admitted directly to the catheterization laboratory bypassing the emergency room or intensive care unit. In Germany, the average time interval between FMC and start of primary PCI is approximately 120 min just at the upper limit of the guideline recommendations. Some other European countries report a significantly shorter corresponding time delay.If primary PCI is not possible within 120 min (or 90 min) after FMC, thrombolysis must be initiated within 30 min after FMC, either in the EMS ambulance or in a nearby non-PCI hospital. A thrombolytic therapy, however, even if "successful", is not the final therapy: within 24 h (but not before 3 h) cardiac catheterization has to be performed with PCI, if applicable. Analyzing the overall revascularization rates in Germany, 81% receive primary PCI, 7% thrombolysis and 12% no reperfusion therapy. Regarding any reperfusion in STEMI, Germany holds the third place after the Czech Republic and Belgium.Patients presenting at 12-24 h after onset of symptoms or later may possibly benefit from a PCI, even if already asymptomatic, if signs of ischemia/viability in the infarct artery-related area are demonstrable. If this cannot be shown, PCI in these patients is not indicated.The first-line medication aims at dual antiplatelet therapy (DAPT) and anticoagulation. For DAPT, the combination of ASA with a thienopyridine is mandatory. If primary PCI is feasible, DAPT with prasugrel (loading dose of 60 mg, independent of age and weight) is preferred due to its faster onset of action

Criteria-based audit of quality of care to women with severe pre-eclampsia and eclampsia in a referral hospital in Accra, Ghana.

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Joyce L Browne

Full Text Available Severe pre-eclampsia and eclampsia are one of the major causes of maternal mortality globally. Reducing maternal morbidity and mortality demands optimizing quality of care. Criteria-based audits are a tool to define, assess and improve quality of care. The aim of this study was to determine applicability of a criteria-based audit to assess quality of care delivered to women with severe hypertensive disorders in pregnancy, and to assess adherence to protocols and quality of care provided at a regional hospital in Accra, Ghana.Checklists for management of severe preeclampsia, hypertensive emergency and eclampsia were developed in an audit cycle based on nine existing key clinical care protocols. Fifty cases were audited to assess quality of care, defined as adherence to protocols. Analysis was stratified for complicated cases, defined as (imminent eclampsia, perinatal mortality and/or one or more WHO maternal near miss C-criteria.Mean adherence to the nine protocols ranged from 15-85%. Protocols for 'plan for delivery' and 'magnesium sulphate administration' were best adhered to (85%, followed by adherence to protocols for 'eclampsia' (64%, 'severe pre-eclampsia at admission' (60%, 'severe pre-eclampsia ward follow-up' (53% and 'hypertensive emergency' (53%. Protocols for monitoring were least adhered to (15%. No difference was observed for severe disease. Increased awareness, protocol-based training of staff, and clear task assignment were identified as contributors to better adherence.A criteria-based audit is an effective tool to determine quality of care, identify gaps in standard of care, and allow for monitoring and evaluation in a health facility, ultimately resulting in improved quality of care provided and reduced maternal morbidity and mortality. In our audit, good adherence was observed for plan for delivery and treatment with magnesium sulphate. Substandard adherence to a number of protocols was identified, and points towards

Association between use of pre-hospital ECG and 30-day mortality: A large cohort study of patients experiencing chest pain.

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Rawshani, Nina; Rawshani, Araz; Gelang, Carita; Herlitz, Johan; Bång, Angela; Andersson, Jan-Otto; Gellerstedt, Martin

2017-12-01

In the assessment of patients with chest pain, there is support for the use of pre-hospital ECG in the literature and in the care guidelines. Using propensity score methods, we aim to examine whether the mere acquisition of a pre-hospital ECG among patients with chest pain affects the outcome (30-day mortality). The association between pre-hospital ECG and 30-day mortality was studied in the overall cohort (n=13151), as well as in the one-to-one matched cohort with 2524 patients not examined with pre-hospital ECG and 2524 patients examined with pre-hospital ECG. In the overall cohort, 21% (n=2809) did not undergo an ECG tracing in the pre-hospital setting. Among those who had pain during transport, 14% (n=1159) did not undergo a pre-hospital ECG while 32% (n=1135) of those who did not have pain underwent an ECG tracing. In the overall cohort, the OR for 30-day mortality in patients who had a pre-hospital ECG, as compared with those who did not, was 0.63 (95% CI 0.05-0.79; pECG was used. The PH-ECG is underused among patients with chest discomfort and the mere acquisition of a pre-hospital ECG may reduce mortality. Copyright © 2017 Elsevier B.V. All rights reserved.

Paramedics' experiences of financial medicine practices in the pre-hospital environment. A pilot study

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Craig Vincent-Lambert

2016-10-01

Objectives: This qualitative pilot study explored and described the experiences of South African Paramedics with regard to the practicing of financial medicine in the local pre-hospital emergency care environment. Method: A sample of South African Paramedics were interviewed either face-to-face or telephonically. The interviews were audio recorded and transcripts produced. Content analysis was conducted to explore, document and describe the participants' experiences with regard to financial medicine practices in the local pre-hospital environment. Results: It emerged that all of the participants had experienced a number of financial medicine practices and associated unethical conduct. Examples included Over-servicing, Selective Patient Treatment, Fraudulent Billing Practices, Eliciting of kickbacks, incentives or benefits and Deliberate Time Wasting. Conclusion: The results of this study are concerning as the actions of service providers described by the participants constitute gross violations of the ethical and professional guidelines for health care professionals. The authors recommend additional studies be conducted to further explore these findings and to establish the reasons for, and ways of, limiting financial medicine practices in the South African emergency care environment.

Survival after hospital discharge for ST-segment elevation and non-ST-segment elevation acute myocardial infarction: a population-based study

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Darling CE

2013-07-01

Full Text Available Chad E Darling,1 Kimberly A Fisher,2 David D McManus,3,4 Andrew H Coles,5 Frederick A Spencer,5,6 Joel M Gore,3,4 Robert J Goldberg31Department of Emergency Medicine, 2Division of Pulmonary Critical Care, 3Department of Quantitative Health Sciences, 4Department of Medicine, 5Program for Gene Function and Expression, University of Massachusetts Medical School, Worcester, MA, USA; 6Department of Medicine, McMaster University, Hamilton, Ontario, CanadaBackground: Limited recent data are available describing differences in long-term survival, and factors affecting prognosis, after ST-segment elevation myocardial infarction (STEMI and non-ST-segment elevation myocardial infarction (NSTEMI, especially from the more generalizable perspective of a population-based investigation. The objectives of this study were to examine differences in post-discharge prognosis after hospitalization for STEMI and NSTEMI, with a particular focus on factors associated with reduced long-term survival.Methods: We reviewed the medical records of residents of the Worcester, MA, USA metropolitan area hospitalized at eleven central Massachusetts medical centers for acute myocardial infarction (AMI during 2001, 2003, 2005, and 2007.Results: A total of 3762 persons were hospitalized with confirmed AMI; of these, 2539 patients (67.5% were diagnosed with NSTEMI. The average age of study patients was 70.3 years and 42.9% were women. Patients with NSTEMI experienced higher post-discharge death rates with 3-month, 1-year, and 2-year death rates of 12.6%, 23.5%, and 33.2%, respectively, compared to 6.1%, 11.5%, and 16.4% for patients with STEMI. After multivariable adjustment, patients with NSTEMI were significantly more likely to have died after hospital discharge (adjusted hazards ratio 1.28; 95% confidence interval 1.14–1.44. Several demographic (eg, older age and clinical (eg, history of stroke factors were associated with reduced long-term survival in patients with NSTEMI and

Pre-hospital Emergency Care

African Journals Online (AJOL)

20 Apr 1974 ... lance services, training programmes that are not geared to the needs of these personnel and, not least, a lack of interest on the part of the medical profession, with a few notable exceptions, in the whole question of emergency care. There is a re- luctance on the part of many doctors to assist in the training of ...

[Prehospital thrombolysis: A national perspective. Pharmaco-invasive strategy for early reperfusion of STEMI in Mexico].

Science.gov (United States)

Arriaga-Nava, Roberto; Valencia-Sánchez, Jesús-Salvador; Rosas-Peralta, Martin; Garrido-Garduño, Martin; Calderón-Abbo, Moisés

2015-01-01

To review the existing evidence on the role of prehospital thrombolysis in patients with ST-segment elevation acute myocardial infarction (STEMI) as part of a strategy of cutting edge to reduce the time of coronary reperfusion and as a consequence improves both the survival and function. We used the technique of exploration-reduction-evaluation-analysis and synthesis of related studies, with an overview of current recommendations, data from controlled clinical trials and from the national and international registries about the different strategies for STEMI reperfusion. In total, we examined 186 references on prehospital thrombolysis, 130 references in times door-treatment, 139 references in STEMI management and national and international registries as well as 135 references on rescue and primary percutaneous coronary intervention for STEMI. Finally the 48 references that were more relevant and informative were retained. The «time» factor is crucial in the success of early reperfusion in STEMI especially if thrombolysis is applied correctly during the prehospital time. The primary percutaneous coronary intervention is contingent upon its feasibility before 120 min from the onset of symptoms. In our midst to internationally, thrombolysis continues to be a strategy with great impact on their expectations of life and function of patients. Telecommunication systems should be incorporate in real time to the priority needs of catastrophic diseases such as STEMI where life is depending on time. Copyright © 2014 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

Facilitators and obstacles in pre-hospital medical response to earthquakes: a qualitative study

Science.gov (United States)

2011-01-01

Background Earthquakes are renowned as being amongst the most dangerous and destructive types of natural disasters. Iran, a developing country in Asia, is prone to earthquakes and is ranked as one of the most vulnerable countries in the world in this respect. The medical response in disasters is accompanied by managerial, logistic, technical, and medical challenges being also the case in the Bam earthquake in Iran. Our objective was to explore the medical response to the Bam earthquake with specific emphasis on pre-hospital medical management during the first days. Methods The study was performed in 2008; an interview based qualitative study using content analysis. We conducted nineteen interviews with experts and managers responsible for responding to the Bam earthquake, including pre-hospital emergency medical services, the Red Crescent, and Universities of Medical Sciences. The selection of participants was determined by using a purposeful sampling method. Sample size was given by data saturation. Results The pre-hospital medical service was divided into three categories; triage, emergency medical care and transportation, each category in turn was identified into facilitators and obstacles. The obstacles identified were absence of a structured disaster plan, absence of standardized medical teams, and shortage of resources. The army and skilled medical volunteers were identified as facilitators. Conclusions The most compelling, and at the same time amenable obstacle, was the lack of a disaster management plan. It was evident that implementing a comprehensive plan would not only save lives but decrease suffering and enable an effective praxis of the available resources at pre-hospital and hospital levels. PMID:21575233

Facilitators and obstacles in pre-hospital medical response to earthquakes: a qualitative study.

Science.gov (United States)

Djalali, Ahmadreza; Khankeh, Hamidreza; Öhlén, Gunnar; Castrén, Maaret; Kurland, Lisa

2011-05-16

Earthquakes are renowned as being amongst the most dangerous and destructive types of natural disasters. Iran, a developing country in Asia, is prone to earthquakes and is ranked as one of the most vulnerable countries in the world in this respect. The medical response in disasters is accompanied by managerial, logistic, technical, and medical challenges being also the case in the Bam earthquake in Iran. Our objective was to explore the medical response to the Bam earthquake with specific emphasis on pre-hospital medical management during the first days. The study was performed in 2008; an interview based qualitative study using content analysis. We conducted nineteen interviews with experts and managers responsible for responding to the Bam earthquake, including pre-hospital emergency medical services, the Red Crescent, and Universities of Medical Sciences. The selection of participants was determined by using a purposeful sampling method. Sample size was given by data saturation. The pre-hospital medical service was divided into three categories; triage, emergency medical care and transportation, each category in turn was identified into facilitators and obstacles. The obstacles identified were absence of a structured disaster plan, absence of standardized medical teams, and shortage of resources. The army and skilled medical volunteers were identified as facilitators. The most compelling, and at the same time amenable obstacle, was the lack of a disaster management plan. It was evident that implementing a comprehensive plan would not only save lives but decrease suffering and enable an effective praxis of the available resources at pre-hospital and hospital levels.

Prevalence of Pre-Pregnancy Risk Factors and its Relationship with Preconception Care in Isfahan- Iran

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Parisa Shadab

2017-08-01

Full Text Available Background Preconception care means interventions required for maternal and fetal health care and detection of pre-pregnancy risk factors. Some risk factors that have a significant effect on the outcome of pregnancy can be detected and controlled before pregnancy. The present study aimed to determine the prevalence of pre-pregnancy risk factors, and its relationship with preconception care in Isfahan-Iran. Materials and Methods This descriptive study was a cross-sectional research which was conducted with multi-stage sampling (stratified and cluster from April to May 2016 on 702 women giving birth in hospitals in Isfahan (Iran. Data collection tool was a researcher made questionnaire and data were analyzed using SPSS software, descriptive statistics and chi-square test. Results The results showed that, the interval between current pregnancy with a previous pregnancy less than 4 years 22.8%, abnormal weight (13%, sexually transmitted infections (11.3%, thyroid disorders (11 % , and history of hospitalization of infants in the intensive care unit (11.1%, were the highest pre-pregnancy risk factors reported. There was a significant positive correlation between thyroid disorder and polycystic ovary (P

EMS Adherence to a Pre-hospital Cervical Spine Clearance Protocol

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Johnson, David

2001-10-01

Full Text Available Purpose: To determine the degree of adherence to a cervical spine (c-spine clearance protocol by pre-hospital Emergency Medical Services (EMS personnel by both self-assessment and receiving hospital assessment, to describe deviations from the protocol, and to determine if the rate of compliance by paramedic self-assessment differed from receiving hospital assessment. Methods: A retrospective sample of pre-hospital (consecutive series and receiving hospital (convenience sample assessments of the compliance with and appropriateness of c-spine immobilization. The c-spine clearance protocol was implemented for Orange County EMS just prior to the April-November 1999 data collection period. Results: We collected 396 pre-hospital and 162 receiving hospital data forms. From the pre-hospital data sheet. the percentage deviation from the protocol was 4.096 (16/396. Only one out of 16 cases that did not comply with the protocol was due to over immobilization (0.2%. The remaining 15 cases were under immobilized, according to protocol. Nine of the under immobilized cases (66% that should have been placed in c-spine precautions met physical assessment criteria in the protocol, while the other five cases met mechanism of injury criteria. The rate of deviations from protocol did not differ over time. The receiving hospital identified 8.0% (13/162; 6/16 over immobilized, 7/16 under immobilized of patients with deviations from the protocol; none was determined to have actual c-spine injury. Conclusion: The implementation of a pre-hospital c-spine clearance protocol in Orange County was associated with a moderate overall adherence rate (96% from the pre-hospital perspective, and 92% from the hospital perspective, p=.08 for the two evaluation methods. Most patients who deviated from protocol were under immobilized, but no c-spine injuries were missed. The rate of over immobilization was better than previously reported, implying a saving of resources.

Association between QRS duration on prehospital ECG and mortality in patients with suspected STEMI

DEFF Research Database (Denmark)

Hansen, Rikke; Frydland, Martin; Møller-Helgestad, Ole Kristian

2017-01-01

BACKGROUND: QRS duration has previously shown association with mortality in patients with acute myocardial infarction treated with thrombolytics, less is known in patients with suspected ST segment elevation myocardial infarction (STEMI) when assessing QRS duration on prehospital ECG. Thus......, the objective was to investigate the prognostic effect of QRS duration on prehospital ECG and presence of classic left and right bundle branch block (LBBB/RBBB) for all-cause mortality in patients with suspected STEMI. METHOD: In total 2105 consecutive patients (mean age 64±13years, 72% men) with suspected...... STEMI were prospectively included. QRS duration was registered from automated QRS measurement on prehospital ECG and patients were divided according to quartiles of QRS duration (111ms). Primary endpoint was all-cause 30-day mortality. Predictors of all-cause mortality were...

A validation of ground ambulance pre-hospital times modeled using geographic information systems.

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Patel, Alka B; Waters, Nigel M; Blanchard, Ian E; Doig, Christopher J; Ghali, William A

2012-10-03

Evaluating geographic access to health services often requires determining the patient travel time to a specified service. For urgent care, many research studies have modeled patient pre-hospital time by ground emergency medical services (EMS) using geographic information systems (GIS). The purpose of this study was to determine if the modeling assumptions proposed through prior United States (US) studies are valid in a non-US context, and to use the resulting information to provide revised recommendations for modeling travel time using GIS in the absence of actual EMS trip data. The study sample contained all emergency adult patient trips within the Calgary area for 2006. Each record included four components of pre-hospital time (activation, response, on-scene and transport interval). The actual activation and on-scene intervals were compared with those used in published models. The transport interval was calculated within GIS using the Network Analyst extension of Esri ArcGIS 10.0 and the response interval was derived using previously established methods. These GIS derived transport and response intervals were compared with the actual times using descriptive methods. We used the information acquired through the analysis of the EMS trip data to create an updated model that could be used to estimate travel time in the absence of actual EMS trip records. There were 29,765 complete EMS records for scene locations inside the city and 529 outside. The actual median on-scene intervals were longer than the average previously reported by 7-8 minutes. Actual EMS pre-hospital times across our study area were significantly higher than the estimated times modeled using GIS and the original travel time assumptions. Our updated model, although still underestimating the total pre-hospital time, more accurately represents the true pre-hospital time in our study area. The widespread use of generalized EMS pre-hospital time assumptions based on US data may not be appropriate in a

Cost-effectiveness of improving pediatric hospital care in Nicaragua.

Science.gov (United States)

Broughton, Edward I; Gomez, Ivonne; Nuñez, Oscar; Wong, Yudy

2011-11-01

To determine the costs and cost-effectiveness of an intervention to improve quality of care for children with diarrhea or pneumonia in 14 hospitals in Nicaragua, based on expenditure data and impact measures. Hospital length of stay (LOS) and deaths were abstracted from a random sample of 1294 clinical records completed at seven of the 14 participating hospitals before the intervention (2003) and 1505 records completed after two years of intervention implementation ("post-intervention"; 2006). Disability-adjusted life years (DALYs) were derived from outcome data. Hospitalization costs were calculated based on hospital and Ministry of Health records and private sector data. Intervention costs came from project accounting records. Decision-tree analysis was used to calculate incremental cost-effectiveness. Average LOS decreased from 3.87 and 4.23 days pre-intervention to 3.55 and 3.94 days post-intervention for diarrhea (P = 0.078) and pneumonia (P = 0.055), respectively. Case fatalities decreased from 45/10 000 and 34/10 000 pre-intervention to 30/10 000 and 27/10 000 post-intervention for diarrhea (P = 0.062) and pneumonia (P = 0.37), respectively. Average total hospitalization and antibiotic costs for both diagnoses were US$ 451 (95% credibility interval [CI]: US$ 419-US$ 482) pre-intervention and US$ 437 (95% CI: US$ 402-US$ 464) post-intervention. The intervention was cost-saving in terms of DALYs (95% CI: -US$ 522- US$ 32 per DALY averted) and cost US$ 21 per hospital day averted (95% CI: -US$ 45- US$ 204). After two years of intervention implementation, LOS and deaths for diarrhea decreased, along with LOS for pneumonia, with no increase in hospitalization costs. If these changes were entirely attributable to the intervention, it would be cost-saving.

Multicentre randomised study of the effect and experience of an early inhome programme (PreHomeCare) for preterm infants using video consultation and smartphone applications compared with inhospital consultations: protocol of the PreHomeCare study.

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Hägi-Pedersen, Mai-Britt; Norlyk, Annelise; Dessau, Ram; Stanchev, Hristo; Kronborg, Hanne

2017-03-09

Although premature infants and their parents are discharged earlier to inhomecare programmes, how to optimally support parents during this transition remains unknown. The aim of this study is to compare the effects of early inhomecare (PreHomeCare) including video consultations and mobile applications with those of inhospital consultations regarding breast feeding, parental confidence and parent-infant interactions. A randomised controlled intervention study will be conducted in four neonatal departments offering PreHomeCare (ie, premature infant inhomecare) in Denmark. Parents of hospitalised premature infants who fulfil the inclusion criteria for PreHomeCare will be randomised during hospitalisation to either the intervention (n=80) or control group (n=80) using 1:1 block randomisation. During PreHomeCare, the intervention group will receive a smartphone application with a video system and an infant scale, and the control group will receive usual care (ie, hospital consultations). Additionally, both groups will have planned nurse consultations two to three times a week: the intervention group through video consultations and the control group through inhospital consultations. Data collection will occur at inclusion/baseline, at the end of PreHomeCare and 1 month after discharge using questionnaires and hospital records. The primary outcome is the proportion of exclusively breastfed infants 1 month after discharge/end of PreHomeCare, the secondary outcomes are parent-infant interactions measured by the Mother and baby interaction scale and family confidence in caring for infants measured by the Karitane Parenting Confidence Scale. The process evaluation will consist of two qualitative studies: a field study and an interview study. Data collection will initially involve field observations of three scheduled video consultations with six families from the intervention group. These families will also be interviewed 1 month after PreHomeCare has ended. The project

Influence of pre-infarction angina, collateral flow, and pre-procedural TIMI flow on myocardial salvage index by cardiac magnetic resonance in patients with ST-segment elevation myocardial infarction

DEFF Research Database (Denmark)

Lønborg, Jacob Thomsen; Kelbæk, Henning Skov; Vejlstrup, Niels Grove

2012-01-01

BACKGROUND: In patients with ST-segment elevation myocardial infarction (STEMI) pre-infarction angina, pre-procedural TIMI flow and collateral flow to the myocardium supplied by the infarct related artery are suggested to be cardioprotective. We evaluated the effect of these factors on myocardial...

MBR technology: a promising approach for the (pre-)treatment of hospital wastewater.

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Beier, S; Cramer, C; Mauer, C; Köster, S; Schröder, H Fr; Pinnekamp, J

2012-01-01

Membrane bioreactor (MBR) technology is a very reliable and extensively tested solution for biological wastewater treatment. Nowadays, separate treatment of highly polluted wastewater streams especially from hospitals and other health care facilities is currently under investigation worldwide. In this context, the MBR technology will play a decisive role because an effluent widely cleaned up from solids and nutrients is absolutely mandatory for a subsequent further elimination of organic trace pollutants. Taking hospital wastewater as an example, the aim of this study was to investigate to what extent MBR technology is an adequate 'pre-treatment' solution for further elimination of trace pollutants. Therefore, we investigated - within a 2-year period - the performance of a full-scale hospital wastewater treatment plant (WWTP) equipped with a MBR by referring to conventional chemical and microbiological standard parameters. Furthermore, we measured the energy consumption and tested different operating conditions. According to our findings the MBR treatment of the hospital wastewater was highly efficient in terms of the removal of solids and nutrients. Finally, we did not observe any major adverse effects on the operation and performance of the MBR system which potentially could derive from the composition of the hospital wastewater. In total, the present study proved that MBR technology is a very efficient and reliable treatment approach for the treatment of highly polluted wastewater from hospitals and can be recommended as a suitable pre-treatment solution for further trace pollutant removal.

[Reduction of in-hospital mortality and improved secondary prevention after acute myocardial infarction. First results from the registry of secondary prevention after acute myocardial infarction (SAMI)].

Science.gov (United States)

Tebbe, U; Messer, C; Stammwitz, E; The, G S; Dietl, J; Bischoff, K-O; Schulten-Baumer, U; Tebbenjohanns, J; Gohlke, H; Bramlage, P

2007-07-30

In hospital mortality of acute myocardial infarction (AMI) has been reduced due to the availability of better therapeutic strategies. But there is still a gap between mortality rates in randomised trials and daily clinical practice. Thus, it was aim of the present registry to document the course and outcome of patients with AMI and to improve patient care by implementing recent guidelines. In a nationwide registry study in hospitals in Germany with a cardiology unit or an internal medicine department data on consecutive patients were recorded for six to twelve months at admission, discharge and during a follow-up of one year. From 02/2003 until 10/2004 a total of 5,353 patients with acute myocardial infarction (65.7 % male, mean age of 67.6 +/- 17.7 years; 55.1 % of them with ST elevation myocardial infarction (STEMI) were included in the registry. Of the patients with STEMI, 76.6 % underwent acute intervention, 37.1 % had thrombolysis, 69.7 % percutaneous transluminal coronary angioplasty (PTCA). 40.0 % of those with non-Stemi (NSTEMI) had an acute intervention, 6.6 % thrombolysis, 73.5 % PTCA. Recommended secondary prevention consisted of ASS (93.2 %), beta-blockers (93.0 %), CSE-inhibitors (83.5 %), ACE-inhibitors (80.9 %) and clopidogrel (74.0 %). In-hospital mortality was 10.5 % (STEMI) and 7.4 % (NSTEMI). The 9 % mortality among patients with acute myocardial infarction treated in the hospitals participating in the SAMI registry is low compared to that in similar collectives. The high number of patients who had thrombofibrinolysis and coronary interventions as well as the early initiation of drug therapy contributed to these results. Medical treatment in the prehospital phase of these patients remains still insufficient and to a substantial extent contributes to the mortality of acute myocardial infarction.

Short- and Long-Term Cause of Death in Patients Treated With Primary PCI for STEMI

DEFF Research Database (Denmark)

Pedersen, Frants; Butrymovich, Vitalij; Kelbæk, Henning

2014-01-01

BACKGROUND: Short-term mortality has been studied thoroughly in patients undergoing primary percutaneous coronary intervention (PCI), whereas long-term cause of death in patients with ST-segment elevation myocardial infarction (STEMI) remains unknown. OBJECTIVES: The goal of this study was to des......BACKGROUND: Short-term mortality has been studied thoroughly in patients undergoing primary percutaneous coronary intervention (PCI), whereas long-term cause of death in patients with ST-segment elevation myocardial infarction (STEMI) remains unknown. OBJECTIVES: The goal of this study...... was to describe the association between time and cause of death in patients with STEMI undergoing primary PCI. METHODS: A centralized civil registration system, patient files, and public disease and death cause registries with an accurate record linkage were used to trace time and cause of death in 2......,804 consecutive patients with STEMI (age 63 ± 13 years, 72% males) treated with primary PCI. RESULTS: Patients were followed up for a median of 4.7 years. During a total of 13,447 patient-years, 717 patients died. Main causes of death within the first 30 days were cardiogenic shock and anoxic brain injury after...

An artificial neural network to safely reduce the number of ambulance ECGs transmitted for physician assessment in a system with prehospital detection of ST elevation myocardial infarction

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Forberg Jakob L

2012-02-01

Full Text Available Abstract Background Pre-hospital electrocardiogram (ECG transmission to an expert for interpretation and triage reduces time to acute percutaneous coronary intervention (PCI in patients with ST elevation Myocardial Infarction (STEMI. In order to detect all STEMI patients, the ECG should be transmitted in all cases of suspected acute cardiac ischemia. The aim of this study was to examine the ability of an artificial neural network (ANN to safely reduce the number of ECGs transmitted by identifying patients without STEMI and patients not needing acute PCI. Methods Five hundred and sixty ambulance ECGs transmitted to the coronary care unit (CCU in routine care were prospectively collected. The ECG interpretation by the ANN was compared with the diagnosis (STEMI or not and the need for an acute PCI (or not as determined from the Swedish coronary angiography and angioplasty register. The CCU physician's real time ECG interpretation (STEMI or not and triage decision (acute PCI or not were registered for comparison. Results The ANN sensitivity, specificity, positive and negative predictive values for STEMI was 95%, 68%, 18% and 99%, respectively, and for a need of acute PCI it was 97%, 68%, 17% and 100%. The area under the ANN's receiver operating characteristics curve for STEMI detection was 0.93 (95% CI 0.89-0.96 and for predicting the need of acute PCI 0.94 (95% CI 0.90-0.97. If ECGs where the ANN did not identify a STEMI or a need of acute PCI were theoretically to be withheld from transmission, the number of ECGs sent to the CCU could have been reduced by 64% without missing any case with STEMI or a need of immediate PCI. Conclusions Our ANN had an excellent ability to predict STEMI and the need of acute PCI in ambulance ECGs, and has a potential to safely reduce the number of ECG transmitted to the CCU by almost two thirds.

Antiplatelet therapy in STEMI undergoing primary PCI, when, which one and how long.

Science.gov (United States)

Baralis, Giorgio; Rossini, Roberta; Musumeci, Giuseppe

2018-02-19

Reperfusion therapy for patients presenting with an acute ST-segment elevation myocardial infarction (STEMI) involves primary percutaneous coronary intervention (PPCI) and concomitant dual antiplatelet therapy (DAPT) with combination of a P2Y12 inhibitor and acetylsalicylic acid (ASA). Decision regarding DAPT can be challenging clinically in the modern era with the evolution of newer stents, more potent antiplatelet agents and novel anticoagulant drugs in addition to an older patient population with multiple comorbidities. This review outlines the currently available antiplatelet treatments, and their place within the therapeutic timeline of a patient presenting with STEMI.

Præhospital ultralyd

DEFF Research Database (Denmark)

Rognås, Leif Kåre; Christensen, Erika Frischknecht; Sloth, Erik

2009-01-01

Danish anaesthesiologists use ultrasound (US) to examine and treat acutely ill or traumatized patients in the emergency room, operating theatre and intensive care unit. They are also involved in pre-hospital care where US may theoretically be beneficial for both diagnostic and therapeutic purpose....... The literature concerning the potential use of emergency US in the pre-hospital setting is evaluated. Evidence from both Europe and the USA indicates that pre-hospital US improves diagnosis and visitation of acutely ill or traumatized patients. Udgivelsesdato: 2009-Aug-31...

Association of admission serum calcium levels and in-hospital mortality in patients with acute ST-elevated myocardial infarction: an eight-year, single-center study in China.

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Xin Lu

Full Text Available OBJECTIVE: The relationship between admission serum calcium levels and in-hospital mortality in patients with acute ST-segment elevation myocardial infarction (STEMI has not been well definitively explored. The objective was to assess the predictive value of serum calcium levels on in-hospital mortality in STEMI patients. METHODS: From 2003 to 2010, 1431 consecutive STEMI patients admitted to the First Affiliated Hospital of Nanjing Medical University were enrolled in the present study. Patients were stratified according to quartiles of serum calcium from the blood samples collected in the emergency room after admission. Between the aforementioned groups,the baseline characteristics, in-hospital management, and in-hospital mortality were analyzed. The association of serum calcium level with in-hospital mortality was calculated by a multivariable Cox regression analysis. RESULTS: Among 1431 included patients, 79% were male and the median age was 65 years (range, 55-74. Patients in the lower quartiles of serum calcium, as compared to the upper quartiles of serum calcium, were older, had more cardiovascular risk factors, lower rate of emergency revascularization,and higher in-hospital mortality. According to univariate Cox proportional analysis, patients with lower serum calcium level (hazard ratio 0.267, 95% confidence interval 0.164-0.433, p<0.001 was associated with higher in-hospital mortality. The result of multivariable Cox proportional hazard regression analyses showed that the Killip's class≥3 (HR = 2.192, p = 0.026, aspartate aminotransferase (HR = 1.001, p<0.001, neutrophil count (HR = 1.123, p<0.001, serum calcium level (HR = 0.255, p = 0.001, and emergency revascularization (HR = 0.122, p<0.001 were significantly and independently associated with in-hospital mortality in STEMI patients. CONCLUSIONS: Serum calcium was an independent predictor for in-hospital mortality in patients with STEMI. This widely

Cross-sectional study on factors hampering implementation of measles pre- and postexposure measures in Dutch hospitals during the 2013-2014 measles outbreak.

NARCIS (Netherlands)

Fievez, L C R; Wong, A; Ruijs, W L M; Meerstadt-Rombach, F S; Timen, A

2017-01-01

This study examined adherence to national recommendations on measles pre- and postexposure measures, including immunization of health care workers (HCWs) in Dutch hospitals, during a national outbreak of measles in The Netherlands. This study also investigated which hospital characteristics and

Seasonal Influenza Vaccination in Health Care Workers. A Pre-Post Intervention Study in an Italian Paediatric Hospital

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Francesco Gilardi

2018-04-01

Full Text Available Despite relevant recommendations and evidences on the efficacy of influenza vaccination in health care workers (HCWs, vaccination coverage rates in Europe and Italy currently do not exceed 25%. Aim of the study is to measure the variations in vaccination coverage rates in an Italian pediatric hospital after a promotion campaign performed in the period October–December 2017. The design is a pre-post intervention study. The intervention is based on a wide communication campaign and an expanded offer of easy vaccination on site. The study was carried out at Bambino Gesù Children’s hospital in Rome, Italy, on the whole population of HCWs. Univariate and multivariate statistical analyses were performed. Vaccination coverage rate increased in 2017/18 campaign compared with the 2016/17 one (+95 HCWs vaccinated; +4.4%. The highest increases were detected in males (+45.7%, youngest employees (+142.9%, mean age of employment (+175%, other HCWs (+209.1%, Emergency Area (+151.6% and Imaging Diagnostic Department (+200.0%. At multivariate logistic regression, working in some departments and being nurses represents a higher risk of being unvaccinated. Although the vaccination coverage rate remained low, a continuous increase of the coverage rate and development of a different consciousness in HCWs was highlighted. The study significantly identified the target for future campaigns.

Pre-hospital aspiration is associated with increased pulmonary complications.

Science.gov (United States)

Fawcett, Vanessa J; Warner, Keir J; Cuschieri, Joseph; Copass, Michael; Grabinsky, Andreas; Kwok, Heemun; Rea, Thomas; Evans, Heather L

2015-04-01

Rates of ventilator-associated pneumonia (VAP) are highest among patients intubated on an emergency basis following trauma. We reported previously a retrospective analysis demonstrating an association between subjective aspiration and VAP after pre-hospital intubation. We hypothesize that by directing paramedics to note features of aspiration at intubation, we will confirm prospectively the association between pre-hospital aspiration and subsequent pneumonia in trauma patients. Paramedics collected data regarding aspiration at the time of intubation. All intubated patients admitted to a level 1 trauma center intensive care unit (ICU) were included. Data comprised a clinical impression of pre-hospital aspiration, as well as the presence and timing of blood and emesis in the airway. Injury severity, co-morbidities, and outcomes were collected from the trauma registry. Healthcare-associated pneumonia (HAP) was identified by medical record review of both bronchoalveolar lavage culture results and discharge diagnosis. Descriptive statistics and univariate analysis of outcomes by aspiration status, as well as covariable adjustment using propensity scores, were performed. Of the 228 patients, 89 (39%) were determined by paramedics to have aspirated. The majority of those who aspirated (84 [94%]) did so prior to intubation. Patients who aspirated had higher Injury Severity Scores than those who did not aspirate (25.0 ± 1.7 vs. 21.9 ± 1.5 points; p=0.04) and lower preintubation Glasgow Coma Scale scores (8.2 ± 0.50 vs. 9.6 ± 0.40; p=0.02). Of the 89 patients who aspirated around the time of intubation, 14 (16%) developed HAP vs. five (3.6%) of those who did not aspirate (paspiration (deaths: 21 [23.6%] vs. 23 [16.6%]; p=0.19; ICU LOS: 5.3 ± 0.9 vs. 4.1 ± 0.5 days; p=0.13; duration of mechanical ventilation: 5.3 ± 1.2 vs. 3.2 ± 0.5 days; p=0.10). Aspiration prior to intubation was reported commonly by paramedics and was associated with a higher risk of HAP.

Do HMO penetration and hospital competition impact quality of hospital care?

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Rivers, P A; Fottler, M D

2004-11-01

This study examines the impact of HMO penetration and competition on hospital markets. A modified structure-conduct-performance paradigm was applied to the health care industry in order to investigate the impact of HMO penetration and competition on risk-adjusted hospital mortality rates (i.e. quality of hospital care). Secondary data for 1957 acute care hospitals in the USA from the 1991 American Hospital Association's Annual Survey of Hospitals were used. The outcome variables were risk-adjusted mortality rates in 1991. Predictor variables were market characteristics (i.e. managed care penetration and hospital competition). Control variables were environmental, patient, and institutional characteristics. Associations between predictor and outcome variables were investigated using statistical regression techniques. Hospital competition had a negative relationship with risk-adjusted mortality rates (a negative indicator of quality of care). HMO penetration, hospital competition, and an interaction effect of HMO penetration and competition were not found to have significant effects on risk-adjusted mortality rates. These findings suggest that when faced with intense competition, hospitals may respond in ways associated with reducing their mortality rates.

Predicting health-promoting self-care behaviors in people with pre-diabetes by applying Bandura social learning theory.

Science.gov (United States)

Chen, Mei-Fang; Wang, Ruey-Hsia; Hung, Shu-Ling

2015-11-01

The aim of this study was to apply Bandura social learning theory in a model for identifying personal and environmental factors that predict health-promoting self-care behaviors in people with pre-diabetes. The theoretical basis of health-promoting self-care behaviors must be examined to obtain evidence-based knowledge that can help improve the effectiveness of pre-diabetes care. However, such behaviors are rarely studied in people with pre-diabetes. This quantitative, cross-sectional survey study was performed in a convenience sample of two hospitals in southern Taiwan. Two hundred people diagnosed with pre-diabetes at a single health examination center were recruited. A questionnaire survey was performed to collect data regarding personal factors (i.e., participant characteristics, pre-diabetes knowledge, and self-efficacy) and data regarding environmental factors (i.e., social support and perceptions of empowerment process) that may have associations with health-promoting self-care behaviors in people with pre-diabetes. Multiple linear regression showed that the factors that had the largest influence on the practice of health-promoting self-care behaviors were self-efficacy, diabetes history, perceptions of empowerment process, and pre-diabetes knowledge. These factors explained 59.3% of the variance in health-promoting self-care behaviors. To prevent the development of diabetes in people with pre-diabetes, healthcare professionals should consider both the personal and the environmental factors identified in this study when assessing health promoting self-care behaviors in patients with pre-diabetes and when selecting the appropriate interventions. Copyright © 2015 Elsevier Inc. All rights reserved.

Rural emergency medical technician pre-hospital electrocardiogram transmission.

Science.gov (United States)

Powell, A M; Halon, J M; Nelson, J

2014-01-01

Emergent care of the acute heart attack patient continues to be at the forefront of quality and cost reduction strategies throughout the healthcare industry. Although the average cardiac door-to-balloon (D2B) times have decreased substantially over the past few years, there are still vast disparities found in D2B times in populations that reside in rural areas. Such disparities are mostly related to prolonged travel time and subsequent delays in cardiac catherization lab team activation. Urban ambulance companies that are routinely staffed with paramedic level providers have been successful in the implementation of pre-hospital 12-lead electrocardiogram (ECG) protocols as a strategy to reduce D2B times. The authors sought to evaluate the evidence related to the risk and benefits associated with the replication of an ECG transmission protocol in a small rural emergency medical service. The latter is staffed with emergency medical technician-basics (EMT-B), emergency medical technician-advanced (EMT-A), and emergency medical technician-intermediate (EMT-I) level. The evidence reviewed was limited to studies with relevant data regarding the challenges and complexities of the ECG transmission process, the difficulties associated with ECG transmission in rural settings, and ECG transmission outcomes by provider level. The evidence supports additional research to further evaluate the feasibility of ECG transmission at the non-paramedic level. Multiple variables must be investigated including equipment cost, utilization, and rural transmission capabilities. Clearly, pre-hospital ECG transmission and early activation of the cardiac catheterization laboratory are critical components to successfully decreasing D2B times.

STRATEGIES FOR ADVANCE IN DEVELOPMENT OF A HEALTH CARE INSTITUTION FOR SPECIALIZED PRE-HOSPITAL MEDICAL AID

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Desislava Todorova

2017-12-01

Full Text Available which brings about a competitive environment for an increase of the quality of services offered. The aim of the study is making evident the recommendatory strategies of a health care institution for specialized pre-hospital medical aid in Sofia City for activity performed in the period from the year 2016 to 2018. The task assigned is an analysis of the opportunities for the widening of the activity, products, and markets of "DCC XXIVth-Sofia" EOOD. The chosen healthcare institution is active in a competitive environment in Sofia City, and in the district that it serves. Data from the health care institution, data from the institutions of National Statistics, and scientific literature on the topic were used in connection with the analysis. Some essential approaches of management were applied - analysis of the market share, and SWOT analysis, for determination of strategy. The conclusions of the analysis performed showed four possible strategies of advance in development and opportunities for activity in each of them. The administration of "DCC XXIVth-Sofia" EOOD had opportunities to all practical purposes for minimization of the negative effects, induced by the weaknesses and threats, and to successfully develop the activity - during the period from the year 2016 to 2018. Both the activity of the healthcare institution and the public health services of the population in the corresponding village/town/city depend on the choice of the administration and on its execution by the personnel.

Pre-Hospital Emergency Medical Services: An Epidemiological Survey in Mashhad, Iran

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Mohsen Seyyednozadi

2017-07-01

Full Text Available Introduction: Providing appropriate care, in the right place and at the right time, is the main goal of emergency medical services (EMS to save lives. The present study aimed to assess the pre-hospital EMS in Mashhad, the second largest metropolis in Iran. Materials and Methods: In this research, data were extracted from the pre-hospital emergency mission forms, which were collected from the EMS stations in Mashhad and suburbs through systematic random sampling. In addition, supplementary information was obtained from the ambulance dispatch cards and emergency communication center forms. Results:Automobile accidents (33.7% and cardiovascular events (17.8% were the most common causes of contacts to the EMS. In the city and road stations, the mean response time was 2.6 and 1.6 minutes, while the mean time of arrival at the scene was 13.2 and 11.4 minutes, and the mean evacuation time was 13.2 and 11.4 minutes, respectively. Individuals aged 20-29 (25.2% and more than 60 years (23.9% constituted the majority of the cases receiving EMS. Conclusion: According to the results, the ‘golden time’ for emergency care was of great importance in the patients injured in car accidents or affected by cardiovascular events. Furthermore, a significant difference was observed in the time indices of EMS in Mashhad city with the EMS standards due to the lack of human resources or EMS facilities. Some contacts to the EMS were unnecessary, and no expert team aid was needed in some cases. It is recommended that citizens be trained on solving the problems associated with road traffic by implementing mobile emergency, while transfer units must be established for the better provision of emergency care by the EMS in Mashhad.

Hyperkalemia masked by pseudo-stemi infarct pattern and cardiac arrest.

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Peerbhai, Shareez; Masha, Luke; DaSilva-DeAbreu, Adrian; Dhoble, Abhijeet

2017-12-01

Hyperkalemia is a common electrolyte abnormality and has well-recognized early electrocardiographic manifestations including PR prolongation and symmetric T wave peaking. With severe increase in serum potassium, dysrhythmias and atrioventricular and bundle branch blocks can be seen on electrocardiogram. Although cardiac arrest is a worrisome consequence of untreated hyperkalemia, rarely does hyperkalemia electrocardiographically manifest as acute ischemia. We present a case of acute renal failure complicated by malignant hyperkalemia and eventual ventricular fibrillation cardiac arrest. Recognition of this disorder was delayed secondary to an initial ECG pattern suggesting an acute ST segment elevation myocardial infarction (STEMI). Emergent coronary angiography performed showed no evidence of coronary artery disease. Pseudo-STEMI patterns are rarely seen in association with acute hyperkalemia and are most commonly described with patient without acute cardiac symptomatology. This is the first such case presenting concurrently with cardiac arrest. A brief review of this rare pseudo-infarct pattern is also given.

Outcome of everolimus eluting bioabsorbable vascular scaffold (BVS) compared to non BVS drug eluting stent in the management of ST-segment elevation myocardial infarction (STEMI) — A comparative study

International Nuclear Information System (INIS)

Chakraborty, Rabin; Patra, Soumya; Banerjee, Suvro; Pande, Arindam; Khan, Aftab; Mandol, Prakash Chandra; Ghosh, Debashish; De, Swapan Kumar; Das, Sankha Subhro; Nag, Raja

2016-01-01

Background: The safety and efficacy of everolimus eluting bioabsorbable vascular scaffold (BVS) in the management of “ST” segment elevation myocardial infarction (STEMI) are yet to be established. Aims: To evaluate immediate and short term safety and efficacy of the everolimus-eluting ABSORB BVS compared with non BVS drug eluting stent (DES) in patients with STEMI. Methods: From December 2013 to December 2014, 220 patients with STEMI were included in this study. Among them, 35 patients treated with BVS were compared with a control group composed of 180 patients who underwent non BVS DES implantation in the same time period. The incidence of major adverse cardiac events (MACE: stent thrombosis: death, non-fatal myocardial infarction, or target vessel/lesion revascularization) before discharge and up to six months was evaluated. Results: 1 vessel disease was more frequent whereas, 2 and 3 vessel disease was less frequent in BVS group. Procedural characteristics were also similar between groups, except for the use of post dilation (p = 0.04). Procedural success, in-hospital, and up to six-month MACE rates were similar between both groups. Definite or probable stent thrombosis did not occur (according to the ARC criteria) in BVS patients, though two patients during the index admission and another two patients in the first month after DES implantation had stent thrombosis. Conclusion: The use of the ABSORB BVS for STEMI is feasible and associated with good procedural safety, and angiographic success rate.

Outcome of everolimus eluting bioabsorbable vascular scaffold (BVS) compared to non BVS drug eluting stent in the management of ST-segment elevation myocardial infarction (STEMI) — A comparative study

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Chakraborty, Rabin; Patra, Soumya, E-mail: dr_soumyapatra@rediffmail.com; Banerjee, Suvro; Pande, Arindam; Khan, Aftab; Mandol, Prakash Chandra; Ghosh, Debashish; De, Swapan Kumar; Das, Sankha Subhro; Nag, Raja

2016-04-15

Background: The safety and efficacy of everolimus eluting bioabsorbable vascular scaffold (BVS) in the management of “ST” segment elevation myocardial infarction (STEMI) are yet to be established. Aims: To evaluate immediate and short term safety and efficacy of the everolimus-eluting ABSORB BVS compared with non BVS drug eluting stent (DES) in patients with STEMI. Methods: From December 2013 to December 2014, 220 patients with STEMI were included in this study. Among them, 35 patients treated with BVS were compared with a control group composed of 180 patients who underwent non BVS DES implantation in the same time period. The incidence of major adverse cardiac events (MACE: stent thrombosis: death, non-fatal myocardial infarction, or target vessel/lesion revascularization) before discharge and up to six months was evaluated. Results: 1 vessel disease was more frequent whereas, 2 and 3 vessel disease was less frequent in BVS group. Procedural characteristics were also similar between groups, except for the use of post dilation (p = 0.04). Procedural success, in-hospital, and up to six-month MACE rates were similar between both groups. Definite or probable stent thrombosis did not occur (according to the ARC criteria) in BVS patients, though two patients during the index admission and another two patients in the first month after DES implantation had stent thrombosis. Conclusion: The use of the ABSORB BVS for STEMI is feasible and associated with good procedural safety, and angiographic success rate.

Frailty in Older Adults Using Pre-hospital Care and the Emergency Department: A Narrative Review.

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Goldstein, Judah P; Andrew, Melissa K; Travers, Andrew

2012-03-01

Older adults use more health-care services per capita than younger age groups and the older adult population varies greatly in its needs. Evidence suggests that there is a critical distinction between relative frailty and fitness in older adults. Here, we review how frailty is described in the pre-hospital literature and in the broader emergency medicine literature. PubMed was used as the primary database, but was augmented by searches of CINAHL and EMBASE. Articles were included if they focused on patients 60 years and older and implemented a definition of frailty or risk screening tool in the Emergency Medical Services (EMS) or Emergency Department setting. IN THE BROAD CLINICAL LITERATURE, THREE TYPES OF MEASURES CAN BE IDENTIFIED: frailty index measures, frailty scales, and a phenotypic definition. Each offers advantages and disadvantages for the EMS stakeholder. We identified no EMS literature on frailty conceptualization or management, although some risk measures from emergency medicine use terms that overlap with the frailty literature. There is a paucity of research on frailty in the Emergency Medical Services literature. No research was identified that specifically addressed frailty conceptualization or management in EMS patients. There is a compelling need for further research in this area.

Transitions from hospital to community care: the role of patient-provider language concordance.

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Rayan, Nosaiba; Admi, Hanna; Shadmi, Efrat

2014-01-01

Cultural and language discordance between patients and providers constitutes a significant challenge to provision of quality healthcare. This study aims to evaluate minority patients' discharge from hospital to community care, specifically examining the relationship between patient-provider language concordance and the quality of transitional care. This was a multi-method prospective study of care transitions of 92 patients: native Hebrew, Russian or Arabic speakers, with a pre-discharge questionnaire and structured observations examining discharge preparation from a large Israeli teaching hospital. Two weeks post-discharge patients were surveyed by phone, on the transition from hospital to community care (the Care Transition Measure (CTM-15, 0-100 scale)) and on the primary-care post-discharge visit. Overall, ratings on the CTM indicated fair quality of the transition process (scores of 51.8 to 58.8). Patient-provider language concordance was present in 49% of minority patients' discharge briefings. Language concordance was associated with higher CTM scores among minority groups (64.1 in language-concordant versus 49.8 in non-language-concordant discharges, P Language-concordant care, coupled with extensive discharge briefings and post-discharge explanations for ongoing care, are important contributors to the quality of care transitions of ethnic minority patients.

Nutritional practices in full-day-care pre-schools.

LENUS (Irish Health Repository)

Jennings, A

2011-06-01

Full-day-care pre-schools contribute significantly to the nutritional intake and acquisition of dietary habits of the pre-school child. The present study investigated nutritional practices in full-day-care pre-schools in Dublin, Ireland, aiming to determine the nutritional support that pre-school managers deem necessary, thereby facilitating the amelioration of existing pre-school nutritional training and practices.

Occupational Therapy Predischarge Home Visits in Acute Hospital Care: A Randomized Trial.

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Clemson, Lindy; Lannin, Natasha A; Wales, Kylie; Salkeld, Glenn; Rubenstein, Laurence; Gitlin, Laura; Barris, Sarah; Mackenzie, Lynette; Cameron, Ian D

2016-10-01

To determine whether an enhanced occupational therapy discharge planning intervention that involved pre- and postdischarge home visits, goal setting, and follow-up (the HOME program) would be superior to a usual care intervention in which an occupational therapy in-hospital consultation for planning and supporting discharge to home is provided to individuals receiving acute care. Randomized controlled trial. Acute and medical wards. Individuals aged 70 and older (N = 400). Primary outcomes: activities daily living (ADLs; Nottingham Extended Activities of Daily Living) and participation in life roles and activities (Late Life Disability Index (LLDI)). Occupational therapist recommendations differed significantly between groups (P occupational therapy recommendations as the in-hospital only consultation, which had a greater emphasis on equipment provision, but HOME did not demonstrate greater benefit in global measures of ADLs or participation in life tasks than in-hospital consultation alone. It is not recommended that home visits be conducted routinely as part of discharge planning for acutely hospitalized medical patients. Further work should develop guidelines for quality in-hospital consultation. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Hospital-at-home Integrated Care Program for Older Patients With Orthopedic Processes: An Efficient Alternative to Usual Hospital-Based Care.

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Closa, Conxita; Mas, Miquel À; Santaeugènia, Sebastià J; Inzitari, Marco; Ribera, Aida; Gallofré, Miquel

2017-09-01

To compare outcomes and costs for patients with orthogeriatric conditions in a home-based integrated care program versus conventional hospital-based care. Quasi-experimental longitudinal study. An acute care hospital, an intermediate care hospital, and the community of an urban area in the North of Barcelona, in Southern Europe. In a 2-year period, we recruited 367 older patients attended at an orthopedic/traumatology unit in an acute hospital for fractures and/or arthroplasty. Patients were referred to a hospital-at-home integrated care unit or to standard hospital-based postacute orthogeriatric unit, based on their social support and availability of the resource. We compared home-based care versus hospital-based care for Relative Functional Gain (gain/loss of function measured by the Barthel Index), mean direct costs, and potential savings in terms of reduction of stay in the acute care hospital. No differences were found in Relative Functional Gain, median (Q25-Q75) = 0.92 (0.64-1.09) in the home-based group versus 0.93 (0.59-1) in the hospital-based group, P =.333. Total health service direct cost [mean (standard deviation)] was significantly lower for patients receiving home-based care: €7120 (3381) versus €12,149 (6322), P home-based care [10.1 (7)] than in patients discharged to the postacute orthogeriatric hospital-based unit [15.3 (12) days, P home integrated care program was suitable for managing older patients with orthopedic conditions who have good social support for home care. It provided clinical care comparable to the hospital-based model, and it seems to enable earlier acute hospital discharge and lower direct costs. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

[The development of a portable life support device for transporting pre-hospital critically ill patients].

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Song, Zhen-xing; Wu, Tai-hu; Meng, Xing-ju; Lu, Heng-zhi; Zheng, Jie-wen; Wang, Hai-tao

2012-06-01

To describe a portable life support device for transportation of pre-hospital patients with critical illness. The characteristics and requirements for urgent management during transportation of critically ill patients to a hospital were analyzed. With adoption of the original equipment, with the aid of staple of the art soft ware, the overall structure, its installation, fixation, freedom from interference, operational function were studied, and the whole system of life support and resuscitation was designed. The system was composed by different modules, including mechanical ventilation, transfusion, aspiration, critical care, oxygen supply and power supply parts. The system could be fastened quickly to a stretcher to form portable intensive care unit (ICU), and it could be carried by different size vehicles to provide nonstop treatment by using power supply of the vehicle, thus raising the efficiency of urgent care. With characteristics of its small size, lightweight and portable, the device is particularly suitable for narrow space and extreme environment.

Positive Coping: A Unique Characteristic to Pre-Hospital Emergency Personnel.

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Ebadi, Abbas; Froutan, Razieh

2017-01-01

It is important to gain a thorough understanding of positive coping methods adopted by medical emergency personnel to manage stressful situations associated with accidents and emergencies. Thus, the purpose of this study was to gain a better understanding of positive coping strategies used by emergency medical service providers. This study was conducted using a qualitative content analysis method. The study participants included 28 pre-hospital emergency personnel selected from emergency medical service providers in bases located in different regions of the city of Mashhad, Iran, from April to November 2016. The purposive sampling method also was used in this study, which was continued until data saturation was reached. To collect the data, semistructured open interviews, observations, and field notes were used. Four categories and 10 subcategories were extracted from the data on the experiences of pre-hospital emergency personnel related to positive coping strategies. The four categories included work engagement, smart capability, positive feedback, and crisis pioneering. All the obtained categories had their own subcategories, which were determined based on their distinctly integrated properties. The results of this study show that positive coping consists of several concepts used by medical emergency personnel, management of stressful situations, and ultimately quality of pre-hospital clinical services. Given the fact that efficient methods such as positive coping can prevent debilitating stress in an individual, pre-hospital emergency authorities should seek to build and strengthen "positive coping" characteristics in pre-hospital medical emergency personnel to deal with accidents, emergencies, and injuries through adopting regular and dynamic policies.

Pre-hospital physical activity status affects in-hospital course of elderly patients with acute myocardial infarction.

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Miyamoto, Takamichi; Obayashi, Tohru; Hattori, Eijirou; Yamauchi, Yasuteru; Niwa, Akihiro; Isobe, Mitsuaki

2010-03-01

The clinical course of elderly patients with acute myocardial infarction (AMI) can sometimes unexpectedly result in an adverse outcome even when therapy appears to be successful. We suspect that specific factors may characterize this worsening of status during hospitalization. This study examines whether the pre-hospital physical activity status of the elderly treated with percutaneous coronary intervention (PCI) for AMI affects their in-hospital course. We studied 110 consecutive patients, aged 80 or older, who had undergone emergent PCI for AMI. Patients were divided into two groups based on clinical presentation: Better Killip class (Killip classes I and II) and Worse Killip class (Killip classes III and IV). Patients were also divided into two groups based on pre-hospital physical activity status, determined retrospectively by review of medical records: Good physical activity (n=57) comprising those able to go out alone independently and Poor physical activity comprising those mainly confined to home (n=53). The overall in-hospital mortality rate was 9.1% for the study population. The Worse Killip class group had a higher in-hospital mortality rate than the Better Killip class group (27.8% vs 5.4%, respectively; p=0.0102). In addition, the Poor physical activity group had a higher in-hospital mortality rate than the Good physical activity group (15.1% vs. 3.5%, respectively; p=0.047). These data suggest that pre-hospital physical activity status in elderly patients with AMI may affect in-hospital mortality as well as Killip class.

"Flashes" de como as gestantes percebem a assistência pré-natal em um hospital universitário "Flashes" de cómo las embarazadas perciben la asistencia pre-natal en un hospital universitario Flashes of how pregnants perceive pre-natal care in a university hospital

Directory of Open Access Journals (Sweden)

Sonia Silva Marcon

1997-10-01

estudio es mejor que la recibida en otro locales, ella no atiende, segun las propias embarazadas, sus expectativas y necesidades reales. En general, las embarazadas desearían obtener más orientaciones y una asistencia menos impersonal. Los motivos por los cuales no les gusta mucho la asistencia estan relacionados, principalmente, con la rotatividad de los alumnos.This article was based on a research carried out to characterise the pre-natal care offered to pregnant women at the out patient unit of a university hospital. This qualitative study used Ethnography, more precisely Miniethnography. The methodological approach and data collection were done through Participating Observation. Results showed that pregnant in touch with health professionals are able to filter information and, at the same time, behave as non participating clients, since they do not question the care offered to them even if the care is not good. Although women think that the care offered at this hospital is better than the one offered elsewhere, they admit that it does not respond successfully to their real expectations and needs. Generally speaking, they would like to receive more orientation and more personal assistance. They do not like this care very much mainly because of student's rotativity.

Nursing care documentation practice: The unfinished task of nursing care in the University of Gondar Hospital.

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Kebede, Mihiretu; Endris, Yesuf; Zegeye, Desalegn Tegabu

2017-09-01

Even though nursing care documentation is an important part of nursing practice, it is commonly left undone. The objective of this study was to assess nursing care documentation practice and the associated factors among nurses who are working at the University of Gondar Hospital. An institution-based cross-sectional study was conducted among 220 nurses working at the University of Gondar Hospital inpatient wards from March 20 to April 30, 2014. Data were collected using a structured and pre-tested self-administered questionnaire. Data were entered into Epi Info version 7 and analyzed with SPSS version 20. Descriptive statistics, bivariate, and multivariate logistic regression analyses were carried out. Two hundred and six nurses returned the questionnaire. Good nursing care documentation practice among nurses was 37.4%. A low nurse-to-patient ratio AOR = 2.15 (95%CI [1.155, 4.020]), in-service training on standard nursing process AOR = 2.6 (95%CI[1.326, 5.052]), good knowledge AOR = 2.156(95% CI [1.092, 4.254]), and good attitude toward nursing care documentation AOR = 2.22 (95% CI [1.105, 4.471] were significantly associated with nursing care documentation practice. Most of the nursing care provided remains undocumented. Nurse-to-patient ratio, in-service training, knowledge, and attitude of nurses toward nursing care documentation were factors associated with nursing care documentation practice.

[Study of public and private hospital care on a population basis, 1986-1996].

Science.gov (United States)

Rocha, J S; Simões, B J

1999-02-01

The last decade saw the creation and implementation of the Brazilian National Health System (NHS)--public, universal and equalitarian--with the objective of offering wide coverage to meet the population's health needs. The objective of the study was the assessment of the evolution of public and private hospital care on a populational basis during the period of the implementation of the NHS. The 984,142 inpatients of the general hospitals of Ribeirão Preto, Brazil, during the period 1986 to 1996 were studied and those of them living in their own municipal district were selected. The inpatients are classified according to the financing system as private, pre-payment and NHS; the social situation of the patients and the profile of hospital morbidity are analysed. In the period studied a continuous growth in the number of hospitalizations is observed, both in absolute numbers and in coefficient per thousand inhabitants, increasing from 43,773 to 55,844 inpatients per year. Though when the categories of the hospitalizations are studied, it is seen that private inpatients present a reduction both in absolute numbers and as a coefficient from 3,181 (7.3%) to 2,215 (3.9%); the NHS inpatients decrease in absolute numbers and in a percentage by a third at the end of the period--falling from 33,254 (76.0%) to 29,373 (51.7%). On the other hand the pre-payment inpatient system triplicates in absolute numbers and duplicates by rate for inhabitant--from 7,338 (16.8%) to 25,256 (44.4%). The NHS hospital care attends mainly unskilled and semi-skilled manual workers; the professionals, technicians, non manual and skilled manual workers being assisted by the private services. The hospital morbidity of NHS inpatients is different from that of the private inpatient systems. The health policy in that period, limiting NHS financing, repressing demand and discouraging the private providers to work with NHS inpatients led to negative selectivity. The result was an increase in difference

Hidden psychiatric morbidity. Part II: Training health care workers in detection: a pre- and post-study at Karanda Mission Hospital.

Science.gov (United States)

Hall, A; Williams, H

1987-11-01

A simple 5-session training program covering basic mental health problems, and instruction in the use of the Harding Self Report Questionaire, was instituted at Karanda Mission Hospital to help medical students recognise hidden psychiatric morbidity in somatically presenting patients. The Harding Self Report Questionaire was used as both a detection and training instrument, together with a Health Staff Rating Scale. Medical Assistants were assessed pre- and post-training on 2 measures--specificity and sensitivity. The training program demonstrated that health care workers can be trained to more accurately detect and diagnose hidden psychiatric disorder in this group of patients. An additional benefit was that workers developed an increased interest in this difficult area of patient care. In a previous study, the prevalence of hidden psychiatric morbidity in a general medical outpatient population in Bindura Provincial was found to be in line with other developing countries (i.e., in excess of 10%) and detection rate by health care workers (4.25%) was low, although comparable to that found in other studies. One of the conclusions reached after the Bindura study was that a simple program was needed to alert workers to recognise underlying psychiatric disorder in somatically presenting patients. With this in mind, the training program was devised and given at Karanda Mission Hospital which is situated about 220 km from Harare, Zimbabwe. It has 120 beds and is staffed by 2 doctors, 3 locally trained SRNs, several American trained SRNs, and 3 locally trained medical assistants. It also runs a nursing school for medical assistants. The hospital serves a population drawn from both subsistence and purchase area farmers, but is less diverse that that of Bindura. The training program was shown to be effective, as demonstrated in the improved accuracy in detection and diagnosis by medical assistants. The improvement post-training is perhaps all the more remarkable when the

Acute coronary syndromes: is there a place for a real pre-hospital treatment for patients "en route" to the coronary intensive care unit?

Science.gov (United States)

Assez, Nathalie; Smith, Grégoire; Adriansen, Christophe; Aboukais, Wissam; Wiel, Eric; Goldstein, Patrick

2012-08-01

Acute initial management of patients with acute coronary syndrome (ACS) is based on a precise clinical and electrocardiographic diagnosis. Initial risk stratification in the pre-hospital phase is the key step. The last step, adequate patient routing, is decided based on emergency level and reperfusion strategies, considered right from the pre-hospital phase. The management of a patient with an ACS requires close collaboration between emergency physicians and cardiologists, according to simplified protocols for easier access to catheterisation. The next challenges for the pre-hospital management of ACS are based on: - precise knowledge of new antiplatelet and anticoagulant drugs by the emergency physicians, in order to adjust their prescriptions to the patient profile; - developing co-operation between hospitals, according to regional specificities (geographic considerations and distribution of PCI centres) in order to reduce access time to catheterisation rooms; - organising the healthcare network, where the SAMU has an essential role in coordinating the different medical actors; - regular analysis of the evolution of our professional practices, considering, e.g., the guidelines of the "HAS" (French official healthcare guidelines institute);- integrating pre-hospital medicine in health prevention programmes; - improving our understanding of the population's presentations of coronary artery disease, in order to encourage the patients and their families to call the EMS as soon as possible. The challenge of the emergency physician is to adapt the strategies to the patient's needs.

Insight into the number of pre-malignancies and malignancies of the skin in a hospital population in the Netherlands.

Science.gov (United States)

van Rijsingen, Margit; Seubring, Inge; Maessen-Visch, Birgitte; Lavrijsen, Sjan; van Bergen, Bert; Groenewoud, Johannes; Gerritsen, Marie-Jeanne

2015-01-01

Skin cancer incidence is rising, placing a burden on healthcare systems worldwide. This problem may even be more extensive than expected, since registration of (pre)malignancies of the skin is poor. To provide insight into the numbers of (pre)malignancies in patients with actinic keratosis (AK) or basal cell carcinoma (BCC) in 2 university and 2 general hospitals. The types and numbers of previous tumours and of tumours during a two-year follow-up were collected from 574 patients. Mean time between the first diagnosed (pre)malignancy and time of inclusion was 6.6 years. Overall, 60% had multiple types of (pre)malignancies. In BCC patients, 61% had multiple BCCs, in patients with squamous cell carcinoma (SCC), 40% had multiple SCCs. The combination 'BCC and SCC' occurred in 10%, 'BCC and AK' in 47%, 'SCC and AK' in 14%. High numbers of patients with multiple (pre)malignancies were found in this patient population in university and general hospitals, which may well reflect the Dutch hospital population. We conclude that skin cancer patients are more extensively affected than was expected up till now. Consequently, the management of skin cancer may be in need of adaptation in near future and the question arises whether dermatologists have the capacity for providing care for all these patients.

Inter-regional competition and quality in hospital care.

Science.gov (United States)

Aiura, Hiroshi

2013-06-01

This study analyzes the effect of episode-of-care payment and patient choice on waiting time and the comprehensive quality of hospital care. The study assumes that two hospitals are located in two cities with different population sizes and compete with each other. We find that the comprehensive quality of hospital care as well as waiting time of both hospitals improve with an increase in payment per episode of care. However, we also find that the extent of these improvements differs according to the population size of the cities where the hospitals are located. Under the realistic assumptions that hospitals involve significant labor-intensive work, we find the improvements in comprehensive quality and waiting time in a hospital located in a small city to be greater than those in a hospital located in a large city. The result implies that regional disparity in the quality of hospital care decreases with an increase in payment per episode of care.

Hospital at Home care for older patients with cognitive impairment: a protocol for a randomised controlled feasibility trial.

Science.gov (United States)

Pouw, Maaike A; Calf, Agneta H; van Munster, Barbara C; Ter Maaten, Jan C; Smidt, Nynke; de Rooij, Sophia E

2018-03-27

An acute hospital admission is a stressful life event for older people, particularly for those with cognitive impairment. The hospitalisation is often complicated by hospital-associated geriatric syndromes, including delirium and functional loss, leading to functional decline and nursing home admission. Hospital at Home care aims to avoid hospitalisation-associated adverse outcomes in older patients with cognitive impairment by providing hospital care in the patient's own environment. This randomised, non-blinded feasibility trial aims to assess the feasibility of conducting a randomised controlled trial in terms of the recruitment, use and acceptability of Hospital at Home care for older patients with cognitive impairment. The quality of care will be evaluated and the advantages and disadvantages of the Hospital at Home care programme compared with usual hospital care. Eligible patients will be randomised either to Hospital at Home care in their own environment or usual hospital care. The intervention consists of hospital level care provided at patients' homes, including visits from healthcare professionals, diagnostics (laboratory tests, blood cultures) and treatment. The control group will receive usual hospital care. Measurements will be conducted at baseline, during admission, at discharge and at 3 and 6 months after the baseline assessment. Institutional ethics approval has been granted. The findings will be disseminated through public lectures, professional and scientific conferences, as well as peer-reviewed journal articles. The study findings will contribute to knowledge on the implementation of Hospital at Home care for older patients with cognitive disorders. The results will be used to inform and support strategies to deliver eligible care to older patients with cognitive impairment. e020313; Pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is

National Hospital Ambulatory Medical Care Survey

Data.gov (United States)

U.S. Department of Health & Human Services — The National Hospital Ambulatory Medical Care Survey (NHAMCS) is designed to collect data on the utilization and provision of ambulatory care services in hospital...

Clinical characteristics, angiographic profile and in hospital mortality in acute coronary syndrome patients in south indian population

Directory of Open Access Journals (Sweden)

Rajni Sharma

2014-01-01

Full Text Available Aims: The aim was to study the clinical profile, risk factors prevalence, angiographic distribution, and severity of coronary artery stenosis in acute coronary syndrome (ACS patients of South Indian population. Materials and Methods: A total of 1562 patients of ACS were analyzed for various risk factors, angiographic pattern and severity of coronary heart disease, complications and in hospital mortality at Sri Jayadeva Institute of Cardiovascular Research and Sciences, Bengaluru, Karnataka, India. Results: Mean age of presentation was 54.71 ± 19.90 years. Majority were male 1242 (79.5% and rest were females. Most patients had ST elevation myocardial infarction (STEMI 995 (63.7% followed by unstable angina (UA 390 (25% and non-STEMI (NSTEMI 177 (11.3%. Risk factors; smoking was present in 770 (49.3%, hypertension in 628 (40.2%, diabetes in 578 (37%, and obesity in (29.64% patients. Angiography was done in 1443 (92.38% patients. left anterior descending was most commonly involved, left main (LM coronary artery was least common with near similar frequency of right coronary artery and left circumflex involvement among all three groups of ACS patients. Single-vessel disease was present in 168 (45.28% UA, 94 (56.29% NSTEMI and 468 (51.71% STEMI patients. Double-vessel disease was present in 67 (18.08% UA, 25 (14.97% NSTEMI and 172 (19.01% STEMI patients. Triple vessel disease was present in 28 (7.55% UA, 16 (9.58% NSTEMI, 72 (7.95% STEMI patients. LM disease was present in 12 (3.23% UA, 2 (1.19% NSTEMI and 9 (0.99% STEMI patients. Complications; ventricular septal rupture occurred in 3 (0.2%, free wall rupture in 2 (0.1%, cardiogenic shock in 45 (2.9%, severe mitral regurgitation in 3 (0.2%, complete heart block in 11 (0.7% patients. Total 124 (7.9% patients died in hospital after 2.1 ± 1.85 days of admission. Conclusion: STEMI was most common presentation. ACS occurred a decade earlier in comparison to Western population. Smoking was most prevalent

Is hospital 'community benefit' charity care?

Science.gov (United States)

Bakken, Erik; Kindig, David A

2012-10-01

The Affordable Care Act is drawing increased attention to the Internal Revenue Service (IRS) Community Benefit policy. To qualify for tax exemption, the IRS requires nonprofit hospitals to allocate a portion of their operating expenses to certain "charitable" activities, such as providing free or reduced care to the indigent. To determine the total amount of community benefit reported by Wisconsin hospitals using official IRS tax return forms (Form 990), and examine the level of allocation across allowable activities. Primary data collection from IRS 990 forms submitted by Wisconsin hospitals for 2009. Community benefit reported in absolute dollars and as percent of overall hospital expenditures, both overall and by activity category. For 2009, Wisconsin hospitals reported $1.064 billion in community benefits, or 7.52% of total hospital expenditures. Of this amount, 9.1% was for charity care, 50% for Medicaid subsidies, 11.4% for other subsidized services, and 4.4% for Community Health Improvement Services. Charity care is not the primary reported activity by Wisconsin hospitals under the IRS Community Benefit requirement. Opportunities may exist for devoting increasing amounts to broader community health improvement activities.

Pre-ART retention in care and prevalence of tuberculosis among HIV-infected children at a district hospital in southern Ethiopia.

Science.gov (United States)

Westerlund, Emil; Jerene, Degu; Mulissa, Zewdie; Hallström, Inger; Lindtjørn, Bernt

2014-10-04

The Ethiopian epidemic is currently on the wane. However, the situation for infected children is in some ways lagging behind due to low treatment coverage and deficient prevention of mother-to-child transmission. Too few studies have examined HIV infected children presenting to care in low-income countries in general. Considering the presence of local variations in the nature of the epidemic a study in Ethiopia could be of special value for the continuing fight against HIV. The aim of this study is to describe the main characteristics of children with HIV presenting to care at a district hospital in a resource-limited area in southern Ethiopia. The aim was also to analyse factors affecting pre-ART loss to follow-up, time to ART-initiation and disease stage upon presentation. This was a prospective cohort study. The data analysed were collected in 2009 for the period January 2003 through December 2008 at Arba Minch Hospital and additional data on the ART-need in the region were obtained from official reports. The pre-ART loss to follow-up rate was 29.7%. Older children (10-14 years) presented in a later stage of their disease than younger children (76.9% vs. 45.0% in 0-4 year olds, chi-square test, χ2 = 8.8, P = 0.01). Older girls presented later than boys (100.0% vs. 57.1%, Fisher's exact test, P = 0.02). Children aged 0-4 years were more likely to be lost to follow-up (40.0 vs. 21.8%, chi-square test, χ2 = 5.4, P = 0.02) and had a longer time to initiate ART (Cox regression analysis, HR: 0.50, 95% CI: 0.25-0.97, P = 0.04, controlling for sex, place of residence, enrollment phase and WHO clinical stage upon presentation). Neither sex was overrepresented in the sample. Tuberculosis prevalence upon presentation and previous history of tubercolosis were 14.5% and 8% respectively. The loss to follow-up is alarmingly high and children present too late. Further research is needed to explore specific causes and possible solutions.

Clopidogrel reloading for patients with acute myocardial infarction already on clopidogrel therapy.

Science.gov (United States)

Doll, Jacob A; Li, Shuang; Chiswell, Karen; Roe, Matthew T; Kosiborod, Mikhail; Scirica, Benjamin M; Wang, Tracy Y

2018-01-14

We sought to determine the association of clopidogrel reloading with in-hospital bleeding and mortality in contemporary practice. We examined clopidogrel reloading for ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) patients on pre-admission clopidogrel therapy in the ACTION Registry-GWTG from 2009 to 2014. We used inverse probability weighted propensity adjustment to compare in-hospital mortality and major bleeding risks between patients reloaded in the first 24 h with ≥300 mg of clopidogrel vs. those continued on a maintenance (therapy who were admitted with STEMI, 9369 (75.8%) received a loading dose. Of 39 158 patients with NSTEMI, 10 144 (25.9%) were reloaded. Reloaded patients were younger, had fewer comorbid conditions, and were more likely to be treated with primary PCI (STEMI) or an early invasive strategy (NSTEMI). Risks of major bleeding were not significantly different between patients with and without reloading, whether presenting with STEMI (OR 0.98, 95% CI 0.85-1.13) or NSTEMI (OR 1.00, 95% CI 0.90-1.11). Among STEMI patients, clopidogrel reloading was associated with lower risks of in-hospital mortality (OR 0.80, 95% CI 0.66-0.96), however no significant mortality difference was observed among NSTEMI patients (OR 1.13, 95% CI 0.93-1.37). Clopidogrel reloading occurs frequently among MI patients who are on pre-admission clopidogrel therapy, particularly among STEMI patients. We did not observe increased bleeding or mortality risk with clopidogrel reloading, and therefore reloading could be safe for most MI patients. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

Pre-fracture individual characteristics associated with high total health care costs after hip fracture.

Science.gov (United States)

Schousboe, J T; Paudel, M L; Taylor, B C; Kats, A M; Virnig, B A; Dowd, B E; Langsetmo, L; Ensrud, K E

2017-03-01

Older women with pre-fracture slow walk speed, high body mass index, and/or a high level of multimorbidity have significantly higher health care costs after hip fracture compared to those without those characteristics. Studies to investigate if targeted health care interventions for these individuals can reduce hip fracture costs are warranted. The aim of this study is to estimate the associations of individual pre-fracture characteristics with total health care costs after hip fracture, using Study of Osteoporotic Fractures (SOF) cohort data linked to Medicare claims. Our study population was 738 women age 70 and older enrolled in Medicare Fee for Service (FFS) who experienced an incident hip fracture between January 1, 1992 and December 31, 2009. We assessed pre-fracture individual characteristics at SOF study visits and estimated costs of hospitalizations, skilled nursing facility and inpatient rehabilitation stays, home health care visits, and outpatient utilization from Medicare FFS claims. We used generalized linear models to estimate the associations of predictor variables with total health care costs (2010 US dollars) after hip fracture. Median total health care costs for 1 year after hip fracture were $35,536 (inter-quartile range $24,830 to $50,903). Multivariable-adjusted total health care costs for 1 year after hip fracture were 14 % higher ($5256, 95 % CI $156 to $10,356) in those with walk speed total health care costs after hip fracture in older women. Studies to investigate if targeted health care interventions for these individuals can reduce the costs of hip fractures are warranted.

Pre-eclampsia: Factores de riesgo. Estudio en el Hospital Nacional Cayetano Heredia.

OpenAIRE

Salviz Salhuana, Manuel; Cordero Muñoz, Luis; Saona Ugarte, Pedro

1996-01-01

Objetivo: El objetivo fue evaluar los factores de riesgo asociados a pre-eclampsia en nuestro hospital. Material y métodos: Se realizó un estudio prospectivo, de tipo caso-control concurrente en 88 pacientes con pre-eclampsia e igual número de controles. El trabajo se llevó a cabo en el Servicio de Obstetricia del Hospital Nacional Cayetano Heredia entre los meses de marzo a agosto de 1993. Resultados: Los factores asociados a pre-eclampsia fueron el antecedente previo a pre-eclampsia (OR:17)...

Home-based intermediate care program vs hospitalization

Science.gov (United States)

Armstrong, Catherine Deri; Hogg, William E.; Lemelin, Jacques; Dahrouge, Simone; Martin, Carmel; Viner, Gary S.; Saginur, Raphael

2008-01-01

OBJECTIVE To explore whether a home-based intermediate care program in a large Canadian city lowers the cost of care and to look at whether such home-based programs could be a solution to the increasing demands on Canadian hospitals. DESIGN Single-arm study with historical controls. SETTING Department of Family Medicine at the Ottawa Hospital (Civic campus) in Ontario. PARTICIPANTS Patients requiring hospitalization for acute care. Participants were matched with historical controls based on case-mix, most responsible diagnosis, and level of complexity. INTERVENTIONS Placement in the home-based intermediate care program. Daily home visits from the nurse practitioner and 24-hour access to care by telephone. MAIN OUTCOME MEASURES Multivariate regression models were used to estimate the effect of the program on 5 outcomes: length of stay in hospital, cost of care substituted for hospitalization (Canadian dollars), readmission for a related diagnosis, readmission for any diagnosis, and costs incurred by community home-care services for patients following discharge from hospital. RESULTS The outcomes of 43 hospital admissions were matched with those of 363 controls. Patients enrolled in the program stayed longer in hospital (coefficient 3.3 days, P costs of home-based care were not significantly different from the costs of hospitalization (coefficient -$501, P = .11). CONCLUSION While estimated cost savings were not statistically significant, the limitations of our study suggest that we underestimated these savings. In particular, the economic inefficiencies of a small immature program and the inability to control for certain factors when selecting historical controls affected our results. Further research is needed to determine the economic effect of mature home-based programs. PMID:18208958

Pre-resuscitation factors associated with mortality in 49,130 cases of in-hospital cardiac arrest: a report from the National Registry for Cardiopulmonary Resuscitation.

Science.gov (United States)

Larkin, Gregory Luke; Copes, Wayne S; Nathanson, Brian H; Kaye, William

2010-03-01

To evaluate key pre-arrest factors and their collective ability to predict post-cardiopulmonary arrest mortality. CPR is often initiated indiscriminately after in-hospital cardiopulmonary arrest. Improved understanding of pre-arrest factors associated with mortality may inform advance care planning. A cohort of 49,130 adults who experienced pulseless cardiopulmonary arrest from January 2000 to September 2004 was obtained from 366 US hospitals participating in the National Registry for Cardiopulmonary Resuscitation (NRCPR). Logistic regression with bootstrapping was used to model in-hospital mortality, which included those discharged in unfavorable and severely worsened neurologic state (Cerebral Performance Category >/=3). Overall in-hospital mortality was 84.1%. Advanced age, black race, non-cardiac, non-surgical illness category, pre-existing malignancy, acute stroke, trauma, septicemia, hepatic insufficiency, general floor or Emergency Department location, and pre-arrest use of vasopressors or assisted/mechanical ventilation were independently predictive of in-hospital mortality. Retained peri-arrest factors including cardiac monitoring, and shockable initial pulseless rhythms, were strongly associated with survival. The validation model's AUROC curve (0.77) revealed fair performance. Predictive pre-resuscitation factors may supplement patient-specific information available at bedside to assist in revising resuscitation plans during the patient's hospitalization. Copyright 2009. Published by Elsevier Ireland Ltd.

Assessing the effect of increased managed care on hospitals.

Science.gov (United States)

Mowll, C A

1998-01-01

This study uses a new relative risk methodology developed by the author to assess and compare certain performance indicators to determine a hospital's relative degree of financial vulnerability, based on its location, to the effects of increased managed care market penetration. The study also compares nine financial measures to determine whether hospital in states with a high degree of managed-care market penetration experience lower levels of profitability, liquidity, debt service, and overall viability than hospitals in low managed care states. A Managed Care Relative Financial Risk Assessment methodology composed of nine measures of hospital financial and utilization performance is used to develop a high managed care state Composite Index and to determine the Relative Financial Risk and the Overall Risk Ratio for hospitals in a particular state. Additionally, financial performance of hospitals in the five highest managed care states is compared to hospitals in the five lowest states. While data from Colorado and Massachusetts indicates that hospital profitability diminishes as the level of managed care market penetration increases, the overall study results indicate that hospitals in high managed care states demonstrate a better cash position and higher profitability than hospitals in low managed care states. Hospitals in high managed care states are, however, more heavily indebted in relation to equity and have a weaker debt service coverage capacity. Moreover, the overall financial health and viability of hospitals in high managed care states is superior to that of hospitals in low managed care states.

Elderly patients with STEMI are suboptimally treated with reperfusion therapy

Czech Academy of Sciences Publication Activity Database

Monhart, Z.; Faltus, Václav; Grünfeldová, Hana; Janský, P.

2008-01-01

Roč. 117, č. 19 (2008), s. 79-79 ISSN 0009-7322. [The 2008 World Congress on Cardiology . 18.05.2008-21.05.2008, Buenos Aires] R&D Projects: GA MŠk(CZ) 1M06014 Institutional research plan: CEZ:AV0Z10300504 Keywords : acute myocardial infarction * primary reprefusion therapy * STEMI Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery

Beyond the clinic: redefining hospital ambulatory care.

Science.gov (United States)

Rogut, L

1997-07-01

Responding to changes in health care financing, government policy, technology, and clinical judgment, and the rise of managed care, hospitals are shifting services from inpatient to outpatient settings and moving them into the community. Institutions are evolving into integrated delivery systems, developing the capacity to provide a continuum of coordinated services in an array of settings and to share financial risk with physicians and managed care organizations. Over the past several years, hospitals in New York City have shifted considerable resources into ambulatory care. In their drive to expand and enhance services, however, they face serious challenges, including a well-established focus on hospitals as inpatient centers of tertiary care and medical education, a heavy reliance upon residents as providers of medical care, limited access to capital, and often inadequate physical plants. In 1995, the United Hospital Fund awarded $600,000 through its Ambulatory Care Services Initiative to support hospitals' efforts to meet the challenges of reorganizing services, compete in a managed care environment, and provide high-quality ambulatory care in more efficient ways. Through the initiative, 12 New York City hospitals started projects to reorganize service delivery and build an infrastructure of systems, technology, and personnel. Among the projects undertaken by the hospitals were:--broad-based reorganization efforts employing primary care models to improve and expand existing ambulatory care services, integrate services, and better coordinate care;--projects to improve information management, planning and testing new systems for scheduling appointments, registering patients, and tracking ambulatory care and its outcomes;--training programs to increase the supply of primary care providers (both nurse practitioners and primary care physicians), train clinical and support staff in the skills needed to deliver more efficient and better ambulatory care, prepare staff

78 FR 15882 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Science.gov (United States)

2013-03-13

... Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and... Register entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals...

Hospital medicine (Part 2): what would improve acute hospital care?

LENUS (Irish Health Repository)

Kellett, John

2009-09-01

There are so many obvious delays and inefficiencies in our traditional system of acute hospital care; it is clear that if outcomes are to be improved prompt accurate assessment immediately followed by competent and efficient treatment is essential. Early warning scores (EWS) help detect acutely ill patients who are seriously ill and likely to deteriorate. However, it is not known if any EWS has universal applicability to all patient populations. The benefit of Rapid Response Systems (RRS) such as Medical Emergency Teams has yet to be proven, possibly because doctors and nurses are reluctant to call the RRS for help. Reconfiguration of care delivery in an Acute Medical Assessment Unit has been suggested as a "proactive" alternative to the "reactive" approach of RRS. This method ensures every patient is in an appropriate and safe environment from the moment of first contact with the hospital. Further research is needed into what interventions are most effective in preventing the deterioration and\\/or resuscitating seriously ill patients. Although physicians expert in hospital care decrease the cost and length of hospitalization without compromising outcomes hospital care will continue to be both expensive and potentially dangerous.

An Intervention to Reduce the Time Interval Between Hospital Entry and Emergency Coronary Angiography in Patients with ST-Elevation Myocardial Infarction.

Science.gov (United States)

Karkabi, Basheer; Jaffe, Ronen; Halon, David A; Merdler, Amnon; Khader, Nader; Rubinshtein, Ronen; Goldstein, Jacob; Zafrir, Barak; Zissman, Keren; Ben-Dov, Nissan; Gabrielly, Michael; Fuks, Alex; Shiran, Avinoam; Adawi, Salim; Hellman, Yaron; Shahla, Johny; Halabi, Salim; Flugelman, Moshe Y; Cohen, Shai; Bergman, Irina; Kassem, Sameer; Shapira, Chen

2017-09-01

Outcomes of patients with acute ST-elevation myocardial infarction (STEMI) are strongly correlated to the time interval from hospital entry to primary percutaneous coronary intervention (PPCI). Current guidelines recommend a door to balloon time of < 90 minutes. To reduce the time from hospital admission to PPCI and to increase the proportion of patients treated within 90 minutes. In March 2013 the authors launched a seven-component intervention program:  Direct patient evacuation by out-of-hospital emergency medical services to the coronary intensive care unit or catheterization laboratory Education program for the emergency department staff Dissemination of information regarding the urgency of the PPCI decision Activation of the catheterization team by a single phone call Reimbursement for transportation costs to on-call staff who use their own cars Improvement in the quality of medical records Investigation of failed cases and feedback. During the 14 months prior to the intervention, initiation of catheterization occurred within 90 minutes of hospital arrival in 88/133 patients(65%); during the 18 months following the start of the intervention, the rate was 181/200 (90%) (P < 0.01). The respective mean/median times to treatment were 126/67 minutes and 52/47 minutes (P < 0.01). Intervention also resulted in shortening of the time interval from hospital entry to PPCI on nights and weekends. Following implementation of a comprehensive intervention, the time from hospital admission to PPCI of STEMI patients shortened significantly, as did the proportion of patients treated within 90 minutes of hospital arrival.

Risk assessment of pre-hospital trauma airway management by anaesthesiologists using the predictive Bayesian approach

Directory of Open Access Journals (Sweden)

Nakstad Anders R

2010-04-01

Full Text Available Abstract Introduction Endotracheal intubation (ETI has been considered an essential part of pre-hospital advanced life support. Pre-hospital ETI, however, is a complex intervention also for airway specialist like anaesthesiologists working as pre-hospital emergency physicians. We therefore wanted to investigate the quality of pre-hospital airway management by anaesthesiologists in severely traumatised patients and identify possible areas for improvement. Method We performed a risk assessment according to the predictive Bayesian approach, in a typical anaesthesiologist-manned Norwegian helicopter emergency medical service (HEMS. The main focus of the risk assessment was the event where a patient arrives in the emergency department without ETI despite a pre-hospital indication for it. Results In the risk assessment, we assigned a high probability (29% for the event assessed, that a patient arrives without ETI despite a pre-hospital indication. However, several uncertainty factors in the risk assessment were identified related to data quality, indications for use of ETI, patient outcome and need for special training of ETI providers. Conclusion Our risk assessment indicated a high probability for trauma patients with an indication for pre-hospital ETI not receiving it in the studied HEMS. The uncertainty factors identified in the assessment should be further investigated to better understand the problem assessed and consequences for the patients. Better quality of pre-hospital airway management data could contribute to a reduction of these uncertainties.

Gauging food and nutritional care quality in hospitals

Directory of Open Access Journals (Sweden)

Diez-Garcia Rosa

2012-09-01

Full Text Available Abstract Background Food and nutritional care quality must be assessed and scored, so as to improve health institution efficacy. This study aimed to detect and compare actions related to food and nutritional care quality in public and private hospitals. Methods Investigation of the Hospital Food and Nutrition Service (HFNS of 37 hospitals by means of structured interviews assessing two quality control corpora, namely nutritional care quality (NCQ and hospital food service quality (FSQ. HFNS was also evaluated with respect to human resources per hospital bed and per produced meal. Results Comparison between public and private institutions revealed that there was a statistically significant difference between the number of hospital beds per HFNS staff member (p = 0.02 and per dietitian (p  Conclusions Food and nutritional care in hospital is still incipient, and actions concerning both nutritional care and food service take place on an irregular basis. It is clear that the design of food and nutritional care in hospital indicators is mandatory, and that guidelines for the development of actions as well as qualification and assessment of nutritional care are urgent.

Management, characteristics and outcomes of patients with acute coronary syndrome in Sri Lanka.

Science.gov (United States)

Galappatthy, Priyadarshani; Bataduwaarachchi, Vipula R; Ranasinghe, Priyanga; Galappatthy, Gamini K S; Wijayabandara, Maheshi; Warapitiya, Dinuka S; Sivapathasundaram, Mythily; Wickramarathna, Thilini; Senarath, Upul; Sridharan, Sathasivam; Wijeyaratne, Chandrika N; Ekanayaka, Ruvan

2018-02-16

Ischaemic heart disease is the leading cause of in-hospital mortality in Sri Lanka. Acute Coronary Syndrome Sri Lanka Audit Project (ACSSLAP) is the first national clinical-audit project that evaluated patient characteristics, clinical outcomes and care provided by state-sector hospitals. ACSSLAP prospectively evaluated acute care, in-hospital care and discharge plans provided by all state-sector hospitals managing patients with ACS. Data were collected from 30 consecutive patients from each hospital during 2-4 weeks window. Local and international recommendations were used as audit standards. Data from 87/98 (88.7%) hospitals recruited 2177 patients, with 2116 confirmed as having ACS. Mean age was 61.4±11.8 years (range 20-95) and 58.7% (n=1242) were males. There were 813 (38.4%) patients with unstable angina, 695 (32.8%) with non-ST-elevation myocardial infarction (NSTEMI) and 608 (28.7%) with ST-elevation myocardial infarction (STEMI). Both STEMI (69.9%) and NSTEMI (61.4%) were more in males (Pacute setting and on discharge. In STEMI, 407 (66.9%) were reperfused; 384 (63.2%) were given fibrinolytics and only 23 (3.8%) underwent primary percutaneous coronary intervention (PCI). Only 42.3 % had thrombolysis in coronary interventions planned. In patients with ACS, aspirin, clopidogrel and statin use met audit standards in acute setting and on discharge. Vast majority of patients with STEMI underwent fibrinolyisis than PCI, due to limited resources. Primary PCI, planned coronary interventions and timely thrombolysis need improvement in Sri Lanka. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

75 FR 34614 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and...

Science.gov (United States)

2010-06-17

... Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and Fiscal Year 2010 Rates and to the Long- Term Care Hospital Prospective Payment System and Rate Year 2010 Rates... Prospective Payment Systems for Acute Care Hospitals and Fiscal Year 2010 Rates and to the Long-Term Care...

[Pre-pregnancy nutritional status, maternal weight gain, prenatal care, and adverse perinatal outcomes among adolescent mothers].

Science.gov (United States)

Santos, Marta Maria Antonieta de Souza; Baião, Mirian Ribeiro; de Barros, Denise Cavalcante; Pinto, Alessandra de Almeida; Pedrosa, Priscila La Marca; Saunders, Claudia

2012-03-01

To identify the association between pre-gestational nutritional status, maternal weight gain, and prenatal care with low birth weight (LBW) and prematurity outcomes in infants of adolescent mothers. Cross-sectional study with 542 pairs of adolescent mothers and their children attending a public maternity hospital in Rio de Janeiro. Data were collected from medical records. To determine the association between independent variables and the outcomes studied, odds ratio (OR) and a 95% confidence interval (CI) were estimated With respect to pre-pregnancy nutritional status of adolescents, 87% had normal weight, 1% were underweight, 10% were overweight, and 2% obese. Inadequate total gestational weight gain (72%) exceeded adequacy (28%). Birth weight was favored with greater gestational weight gain, and reduced with late onset of prenatal care. The comparison between the low birth weight and normal birth weight groups revealed significant differences between variable means: interval between the past pregnancy and current pregnancy (p = 0.022), pre-gestational weight (p = 0.018); pre-gestational body mass index (p pregnancy weight and body mass index before pregnancy. The minimum frequency of six prenatal care visits was a protective factor against LBW and prematurity.

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

Science.gov (United States)

2010-10-01

...; RIN 0938-AP33 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Changes and FY 2011 Rates; Provider... Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective...

77 FR 4908 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Science.gov (United States)

2012-02-01

... Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal... the final rule entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates...

77 FR 65495 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Science.gov (United States)

2012-10-29

... Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and... Federal Register entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates...

Health Economic Evaluation of Home and Hospital-Based Care in T2D Patients on Insulin Therapy.

Science.gov (United States)

Janati, Ali; Sarabchian, Mohamad Ali; Mohaghegh, Bahram; Aghmohamadzadeh, Naser; Seyedin, Hesam; Gholizadeh, Masumeh; Hasanpoor, Edris

2017-11-01

Type 2 Diabetes is a main concern of public health in contemporary world with remarkable mortality, delayed complications and health costs. Governments are obliged to improve the quality of health care and consider appropriate strategies to reduce the costs. An alternative strategy for hospital services is care at home. Therefore, this study was aimed to evaluate the cost-effectiveness of home-based and hospital-based diabetes care. A quasi-experimental, pre-test and post-test design was conducted in Northwest Iran. Sixty subjects who were eligible insulin-treatment type 2 diabetes mellitus were randomly assigned into two equal groups to receive home-based or conventional hospital-based care. Data on glycosylated hemoglobin (HbA1c), hypoglycemia episodes, time needed to achieve glycemic control level, diabetes treatment satisfaction, diabetes knowledge and costs during three months were collected. The cost of home-based care in insulin therapy diabetes was 61% less compared with the hospital-based methods. The former strategy was cost-effective in terms of reduction in HbA1C and the time needed to achieve glycemic control. The patients in home care group were more satisfied and knowledgeable. The care at home approach for type 2 diabetic patients can be introduced and supported as a cost-effective care method in the country.

[Hospitality as an expression of nursing care].

Science.gov (United States)

Barra, Daniela Couto Carvalho; Waterkemper, Roberta; Kempfer, Silvana Silveira; Carraro, Telma Elisa; Radünz, Vera

2010-01-01

Qualitative research whose purpose was to reflect and argue about the relationship between hospitality, care and nursing according to experiences of PhD students. The research was developed from theoretic and practical meeting carried through by disciplines "the care in Nursing and Health" of PhD nursing Program at Santa Catarina Federal University. Its chosen theoretical frame of Hospitality perspective while nursing care. Data were collected applying a semi-structured questionnaire at ten doctoral students. The analysis of the data was carried through under the perspective of the content analysis according to Bardin. Hospitality it is imperative for the individuals adaptation in the hospital context or any area where it is looking for health care.

The impact of managed care penetration and hospital quality on efficiency in hospital staffing.

Science.gov (United States)

Mobley, Lee R; Magnussen, Jon

2002-01-01

The state of California has recently mandated minimum nurse-staffing ratios, raising concerns about possible affects on hospital efficiency. In this study, we examine how market factors and quality were related to staffing levels in California hospitals in 1995 (prior to implementation of the new law). We are particularly interested in the affect of managed care penetration on this aspect of hospital efficiency because the call to legislative action was predicated on fears that hospitals were reducing staffing below optimal levels in response to managed care pressures. We derive a unique measure of excess staffing in hospitals based on a data envelopment analysis (DEA) production function model, which explicitly includes ancillary care among the inputs and outputs. This careful specification of production is important because ancillary care use has risen relative to daily hospital services, with the spread of managed care and advances in medical technology. We find that market share (adjusted for size) and market concentration are the major determinants of excess staffing while managed care penetration is insignificant. We also find that poor quality (outcomes worse than expected) is associated with less efficient staffing. These findings suggest that the larger, more efficient urban hospitals will be penalized more heavily under binding staffing ratios than smaller, less-urban hospitals.

Collaboration between physicians and a hospital-based palliative care team in a general acute-care hospital in Japan

Directory of Open Access Journals (Sweden)

Nishikitani Mariko

2010-06-01

Full Text Available Abstract Background Continual collaboration between physicians and hospital-based palliative care teams represents a very important contributor to focusing on patients' symptoms and maintaining their quality of life during all stages of their illness. However, the traditionally late introduction of palliative care has caused misconceptions about hospital-based palliative care teams (PCTs among patients and general physicians in Japan. The objective of this study is to identify the factors related to physicians' attitudes toward continual collaboration with hospital-based PCTs. Methods This cross-sectional anonymous questionnaire-based survey was conducted to clarify physicians' attitudes toward continual collaboration with PCTs and to describe the factors that contribute to such attitudes. We surveyed 339 full-time physicians, including interns, employed in a general acute-care hospital in an urban area in Japan; the response rate was 53% (N = 155. We assessed the basic characteristics, experience, knowledge, and education of respondents. Multiple logistic regression analysis was used to determine the main factors affecting the physicians' attitudes toward PCTs. Results We found that the physicians who were aware of the World Health Organization (WHO analgesic ladder were 6.7 times (OR = 6.7, 95% CI = 1.98-25.79 more likely to want to treat and care for their patients in collaboration with the hospital-based PCTs than were those physicians without such awareness. Conclusion Basic knowledge of palliative care is important in promoting physicians' positive attitudes toward collaboration with hospital-based PCTs.

Impact of pre-infarction angina on angiographic and echocardiographic outcomes in patients with acute ante

Directory of Open Access Journals (Sweden)

Ahmed El Missiri

2016-09-01

Conclusions: For patients suffering from a first attack of acute anterior wall STEMI, pre-infarction angina is associated with a better Killip class at presentation, better TIMI flow grade after PPCI, less incidence of TMP 0 flow grade.

Managed care, vertical integration strategies and hospital performance.

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Wang, B B; Wan, T T; Clement, J; Begun, J

2001-09-01

The purpose of this study is to examine the association of managed care with hospital vertical integration strategies, as well as to observe the relationships of different types of vertical integration with hospital efficiency and financial performance. The sample consists of 363 California short-term acute care hospitals in 1994. Linear structure equation modeling is used to test six hypotheses derived from the strategic adaptation model. Several organizational and market factors are controlled statistically. Results suggest that managed care is a driving force for hospital vertical integration. In terms of performance, hospitals that are integrated with physician groups and provide outpatient services (backward integration) have better operating margins, returns on assets, and net cash flows (p < 0.01). These hospitals are not, however, likely to show greater productivity. Forward integration with a long-term-care facility, on the other hand, is positively and significantly related to hospital productivity (p < 0.001). Forward integration is negatively related to financial performance (p < 0.05), however, opposite to the direction hypothesized. Health executives should be responsive to the growth of managed care in their local market and should probably consider providing more backward integrated services rather than forward integrated services in order to improve the hospital's financial performance in today's competitive health care market.

Optimal pharmacological therapy in ST-elevation myocardial infarction-a review : A review of antithrombotic therapies in STEMI.

Science.gov (United States)

Hermanides, R S; Kilic, S; van 't Hof, A W J

2018-04-23

Antithrombotic therapy is an essential component in the optimisation of clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. There are currently several intravenous anticoagulant drugs available for primary percutaneous coronary intervention. Dual antiplatelet therapy comprising aspirin and P2Y12 inhibitor represents the cornerstone treatment for STEMI. However, these effective treatment strategies may be associated with bleeding complications. Compared with clopidogrel, prasugrel and ticagrelor are more potent and predictable, which translates into better clinical outcomes. Therefore, these agents are the first-line treatment in primary percutaneous coronary intervention. However, patients can still experience adverse ischaemic events, which might be in part attributed to alternative pathways triggering thrombosis. In this review, we provide a critical and updated review of currently available antithrombotic therapies used in patients with STEMI undergoing primary PCI. Finding a balance that minimises both thrombotic and bleeding risk is difficult, but crucial. Further randomised trials for this optimal balance are needed.

Costs of terminal patients who receive palliative care or usual care in different hospital wards.

Science.gov (United States)

Simoens, Steven; Kutten, Betty; Keirse, Emmanuel; Berghe, Paul Vanden; Beguin, Claire; Desmedt, Marianne; Deveugele, Myriam; Léonard, Christian; Paulus, Dominique; Menten, Johan

2010-11-01

In addition to the effectiveness of hospital care models for terminal patients, policy makers and health care payers are concerned about their costs. This study aims to measure the hospital costs of treating terminal patients in Belgium from the health care payer perspective. Also, this study compares the costs of palliative and usual care in different types of hospital wards. A multicenter, retrospective cohort study compared costs of palliative care with usual care in acute hospital wards and with care in palliative care units. The study enrolled terminal patients from a representative sample of hospitals. Health care costs included fixed hospital costs and charges relating to medical fees, pharmacy and other charges. Data sources consisted of hospital accountancy data and invoice data. Six hospitals participated in the study, generating a total of 146 patients. The findings showed that palliative care in a palliative care unit was more expensive than palliative care in an acute ward due to higher staffing levels in palliative care units. Palliative care in an acute ward is cheaper than usual care in an acute ward. This study suggests that palliative care models in acute wards need to be supported because such care models appear to be less expensive than usual care and because such care models are likely to better reflect the needs of terminal patients. This finding emphasizes the importance of the timely recognition of the need for palliative care in terminal patients treated in acute wards.

78 FR 38679 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Science.gov (United States)

2013-06-27

... Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Proposed... Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and... regarding MS-DRG classifications and new technology add-on payments. Eva Fung (410) 786-7539, for...

Providing quality nutrition care in acute care hospitals: perspectives of nutrition care personnel.

Science.gov (United States)

Keller, H H; Vesnaver, E; Davidson, B; Allard, J; Laporte, M; Bernier, P; Payette, H; Jeejeebhoy, K; Duerksen, D; Gramlich, L

2014-04-01

Malnutrition is common in acute care hospitals worldwide and nutritional status can deteriorate during hospitalisation. The aim of the present qualitative study was to identify enablers and challenges and, specifically, the activities, processes and resources, from the perspective of nutrition care personnel, required to provide quality nutrition care. Eight hospitals participating in the Nutrition Care in Canadian Hospitals study provided focus group data (n = 8 focus groups; 91 participants; dietitians, dietetic interns, diet technicians and menu clerks), which were analysed thematically. Five themes emerged from the data: (i) developing a nutrition culture, where nutrition practice is considered important to recovery of patients and teams work together to achieve nutrition goals; (ii) using effective tools, such as screening, evidence-based protocols, quality, timely and accurate patient information, and appropriate and quality food; (iii) creating effective systems to support delivery of care, such as communications, food production and delivery; (iv) being responsive to care needs, via flexible food systems, appropriate menus and meal supplements, up to date clinical care and including patient and family in the care processes; and (v) uniting the right person with the right task, by delineating roles, training staff, providing sufficient time to undertake these important tasks and holding staff accountable for their care. The findings of the present study are consistent with other work and provide guidance towards improving the nutrition culture in hospitals. Further empirical work on how to support successful implementation of nutrition care processes is needed. © 2013 The British Dietetic Association Ltd.

Evaluation of the Prevention and Reactivation Care Program (PReCaP) for the hospitalized elderly: A prospective nonrandomized controlled trial

NARCIS (Netherlands)

K.J.E. Asmus-Szepesi (Kirsten); L.E. Flinterman (Linda); M.A. Koopmanschap (Marc); A.P. Nieboer (Anna); T.J.E.M. Bakker (Ton); J.P. Mackenbach (Johan); E.W. Steyerberg (Ewout)

2015-01-01

textabstractBackground: The hospitalized elderly are at risk of functional decline. We evaluated the effects and care costs of a specialized geriatric rehabilitation program aimed at preventing functional decline among at-risk hospitalized elderly. Methods: The prospective nonrandomized controlled

Pre-hospital transfusion of plasma in hemorrhaging trauma patients independently improves hemostatic competence and acidosis

DEFF Research Database (Denmark)

Henriksen, Hanne Herborg; Rahbar, Elaheh; Baer, Lisa A

2016-01-01

hypothesized that pre-hospital plasma would improve hemostatic function as evaluated by rapid thrombelastography (rTEG). METHODS: We conducted a prospective observational study recruiting 257 trauma patients admitted to a Level I trauma center having received either blood products pre-hospital or in......BACKGROUND: The early use of blood products has been associated with improved patient outcomes following severe hemorrhage or traumatic injury. We aimed to investigate the influence of pre-hospital blood products (i.e. plasma and/or RBCs) on admission hemostatic properties and patient outcomes. We......-hospital within 6 hours of admission. Clinical data on patient demographics, blood biochemistry, injury severity score and mortality were collected. Admission rTEG was conducted to characterize the coagulation profile and hemostatic function. RESULTS: 75 patients received pre-hospital plasma and/or RBCs (PH group...

In-hospital mortality after pre-treatment with antiplatelet agents or oral anticoagulants and hematoma evacuation of intracerebral hematomas.

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Stein, Marco; Misselwitz, Björn; Hamann, Gerhard F; Kolodziej, Malgorzata; Reinges, Marcus H T; Uhl, Eberhard

2016-04-01

Pre-treatment with antiplatelet agents is described to be a risk factor for mortality after spontaneous intracerebral hemorrhage (ICH). However, the impact of antithrombotic agents on mortality in patients who undergo hematoma evacuation compared to conservatively treated patients with ICH remains controversial. This analysis is based on a prospective registry for quality assurance in stroke care in the State of Hesse, Germany. Patients' data were collected between January 2008 and December 2012. Only patients with the diagnosis of spontaneous ICH were included (International Classification of Diseases 10th Revision codes I61.0-I61.9). Predictors of in-hospital mortality were determined by univariate analysis. Predictors with Phematoma evacuation (odds ratio [OR]: 2.5; 95% confidence interval [CI]: 1.24-4.97; P=0.010) compared to patients without antiplatelet pre-treatment treatment (OR: 0.9; 95% CI: 0.79-1.09; P=0.376). In conclusion a higher rate of in-hospital mortality after pre-treatment with antiplatelet agents in combination with hematoma evacuation after spontaneous ICH was observed in the presented cohort. Copyright © 2015 Elsevier Ltd. All rights reserved.

Cardiovascular events and hospital resource utilization pre- and post-transcatheter mitral valve repair in high-surgical risk patients.

Science.gov (United States)

Vemulapalli, Sreekanth; Lippmann, Steven J; Krucoff, Mitchell; Hernandez, Adrian F; Curtis, Lesley H; Foster, Elyse; Qasim, Atif; Wang, Andrew; Glower, Donald D; Feldman, Ted; Hammill, Bradley G

2017-07-01

MitraClip is an approved therapy for mitral regurgitation (MR); however, health care resource utilization pre- and post-MitraClip remains understudied. Patients with functional and degenerative MR at high surgical risk in the EVEREST II High-Risk Registry and REALISM Continued-Access Study were linked to Medicare data. Pre- and post-MitraClip all-cause death, stroke, myocardial infarction, heart failure (HF), and bleeding hospitalizations were identified. Inpatient costs, adjusted to 2010 US dollars, were calculated, and event rate ratios and cost ratios were estimated with multivariable modeling. Among 403 linked patients, the mean age was 80 years, 60% were male, mean baseline left ventricular ejection fraction was 49.6%, 83.3% were New York Heart Association class III/IV, 78.2% were MR grade 3+/4+, and 63.3% had functional MR. All-cause hospitalization decreased from 1,854 to 1,435/1,000 person-years (Pproviders seeking to reduce HF hospitalizations and associated Medicare costs may consider MitraClip among appropriate patients likely to survive 1 year. Copyright © 2017 Elsevier Inc. All rights reserved.

Impact of care pathways for in-hospital management of COPD exacerbation: a systematic review.

Science.gov (United States)

Lodewijckx, C; Sermeus, W; Panella, M; Deneckere, S; Leigheb, F; Decramer, M; Vanhaecht, K

2011-11-01

In-hospital management of COPD exacerbation is suboptimal, and outcomes are poor. Care pathways are a possible strategy for optimizing care processes and outcomes. The aim of the literature review was to explore characteristics of existing care pathways for in-hospital management of COPD exacerbations and to address their impact on performance of care processes, clinical outcomes, and team functioning. A literature search was conducted for articles published between 1990 and 2010 in the electronic databases of Medline, CINAHL, EMBASE, and Cochrane Library. Main inclusion criteria were (I) patients hospitalized for a COPD exacerbation; (II) implementation and evaluation of a care pathway; (III) report of original research, including experimental and quasi experimental designs, variance analysis, and interviews of professionals and patients about their perception on pathway effectiveness. Four studies with a quasi experimental design were included. Three studies used a pre-post test design; the fourth study was a non randomized controlled trial comparing an experimental group where patients were treated according to a care pathway with a control group where usual care was provided. The four studied care pathways were multidisciplinary structured care plans, outlining time-specific clinical interventions and responsibilities by discipline. Statistic analyses were rarely performed, and the trials used very divergent indicators to evaluate the impact of the care pathways. The studies described positive effects on blood sampling, daily weight measurement, arterial blood gas measurement, referral to rehabilitation, feelings of anxiety, length of stay, readmission, and in-hospital mortality. Research on COPD care pathways is very limited. The studies described few positive effects of the care pathways on diagnostic processes and on clinical outcomes. Though due to limited statistical analysis and weak design of the studies, the internal validity of results is limited

Health care expenditure for hospital-based delivery care in Lao PDR

Directory of Open Access Journals (Sweden)

Douangvichit Daovieng

2012-01-01

Full Text Available Abstract Background Delivery by a skilled birth attendant (SBA in a hospital is advocated to improve maternal health; however, hospital expenses for delivery care services are a concern for women and their families, particularly for women who pay out-of-pocket. Although health insurance is now implemented in Lao PDR, it is not universal throughout the country. The objectives of this study are to estimate the total health care expenses for vaginal delivery and caesarean section, to determine the association between health insurance and family income with health care expenditure and assess the effect of health insurance from the perspectives of the women and the skilled birth attendants (SBAs in Lao PDR. Methods A cross-sectional study was carried out in two provincial hospitals in Lao PDR, from June to October 2010. Face to face interviews of 581 women who gave birth in hospital and 27 SBAs was carried out. Both medical and non-medical expenses were considered. A linear regression model was used to assess influencing factors on health care expenditure and trends of medical and non-medical expenditure by monthly family income stratified by mode of delivery were assessed. Results Of 581 women, 25% had health care insurance. Health care expenses for delivery care services were significantly higher for caesarean section (270 USD than for vaginal delivery (59 USD. After adjusting for the effect of hospital, family income was significantly associated with all types of expenditure in caesarean section, while it was associated with non-medical and total expenditures in vaginal delivery. Both delivering women and health providers thought that health insurance increased the utilisation of delivery care. Conclusions Substantially higher delivery care expenses were incurred for caesarean section compared to vaginal delivery. Three-fourths of the women who were not insured needed to be responsible for their own health care payment. Women who had higher family

Contemporary management of ST-segment elevation myocardial infarction.

Science.gov (United States)

Yadlapati, Ajay; Gajjar, Mark; Schimmel, Daniel R; Ricciardi, Mark J; Flaherty, James D

2016-12-01

ST-elevation myocardial infarction (STEMI), which constitutes nearly 25-40 % of current acute myocardial infarction (AMI) cases, is a medical emergency that requires prompt recognition and treatment. Since the 2013 STEMI practice guidelines, a wealth of additional data that may further advance optimal STEMI practices has emerged. These data highlight the importance of improving patient treatment and transport algorithms for STEMI from non-primary percutaneous coronary intervention (PCI) centers. In addition, a focus on the reduction of total pain-to-balloon (P2B) times rather than simply door-to-balloon (D2B) times may further improve outcomes after primary PCI for STEMI. The early administration of newer oral P2Y12 inhibitors, including crushed forms of these agents for faster absorption, represents another treatment advancement. Recent data also suggest avoiding concurrent morphine use due to interactions with P2Y12 inhibitors. Furthermore, new technological advancements and investigational therapies, including Bioresorbable Vascular Scaffolds and the use of pre-intervention intravenous microbubbles with transthoracic ultrasound, hold promise to play a useful role in future STEMI care. Despite these advancements, the prompt recognition of STEMI, at both the patient and health care system level, remains the cornerstone of optimal treatment.

Post–Acute Care Use and Hospital Readmission after Sepsis

Science.gov (United States)

Jones, Tiffanie K.; Fuchs, Barry D.; Small, Dylan S.; Halpern, Scott D.; Hanish, Asaf; Umscheid, Craig A.; Baillie, Charles A.; Kerlin, Meeta Prasad; Gaieski, David F.

2015-01-01

Rationale: The epidemiology of post–acute care use and hospital readmission after sepsis remains largely unknown. Objectives: To examine the rate of post–acute care use and hospital readmission after sepsis and to examine risk factors and outcomes for hospital readmissions after sepsis. Methods: In an observational cohort study conducted in an academic health care system (2010–2012), we compared post–acute care use at discharge and hospital readmission after 3,620 sepsis hospitalizations with 108,958 nonsepsis hospitalizations. We used three validated, claims-based approaches to identify sepsis and severe sepsis. Measurements and Main Results: Post–acute care use at discharge was more likely after sepsis, driven by skilled care facility placement (35.4% after sepsis vs. 15.8%; P Readmission rates at 7, 30, and 90 days were higher postsepsis (P readmission risk was present regardless of sepsis severity (27.3% after sepsis and 26.0–26.2% after severe sepsis). After controlling for presepsis characteristics, the readmission risk was found to be 1.51 times greater (95% CI, 1.38–1.66) than nonsepsis hospitalizations. Readmissions after sepsis were more likely to result in death or transition to hospice care (6.1% vs. 13.3% after sepsis; P readmissions after sepsis hospitalizations included age, malignancy diagnosis, hospitalizations in the year prior to the index hospitalization, nonelective index admission type, one or more procedures during the index hospitalization, and low hemoglobin and high red cell distribution width at discharge. Conclusions: Post–acute care use and hospital readmissions were common after sepsis. The increased readmission risk after sepsis was observed regardless of sepsis severity and was associated with adverse readmission outcomes. PMID:25751120

Hospital Medicine (Part 1): what is wrong with acute hospital care?

LENUS (Irish Health Repository)

Kellett, John

2009-09-01

Modern hospitals are facing several challenges and, over the last decade in particular, many of these institutions have become dysfunctional. Paradoxically as medicine has become more successful the demand for acute hospital care has increased, yet there is no consensus on what conditions or complaints require hospital admission and there is wide variation in the mortality rates, length of stay and possibly standards of care between different units. Most acutely ill patients are elderly and instead of one straightforward diagnosis are more likely to have a complex combination of multiple co-morbid conditions. Any elderly patient admitted to hospital is at considerable risk which must be balanced against the possible benefits. Although most of the patients in hospital die from only approximately ten diagnoses, obvious life saving treatment is often delayed by a junior doctor in-training first performing an exhaustive complete history and physical, and then ordering a number of investigations before consulting a senior colleague. Following this traditional hierarchy delays care with several "futile cycles" of clinical activity thoughtlessly directed at the patient without any benefit being delivered. If acute hospital medicine is to be improved changes in traditional assumptions, attitudes, beliefs and practices are needed.

Pre-hospital antibiotic treatment and mortality caused by invasive meningococcal disease, adjusting for indication bias

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Matute-Cruz Petra

2009-04-01

Full Text Available Abstract Background Mortality from invasive meningococcal disease (IMD has remained stable over the last thirty years and it is unclear whether pre-hospital antibiotherapy actually produces a decrease in this mortality. Our aim was to examine whether pre-hospital oral antibiotherapy reduces mortality from IMD, adjusting for indication bias. Methods A retrospective analysis was made of clinical reports of all patients (n = 848 diagnosed with IMD from 1995 to 2000 in Andalusia and the Canary Islands, Spain, and of the relationship between the use of pre-hospital oral antibiotherapy and mortality. Indication bias was controlled for by the propensity score technique, and a multivariate analysis was performed to determine the probability of each patient receiving antibiotics, according to the symptoms identified before admission. Data on in-hospital death, use of antibiotics and demographic variables were collected. A logistic regression analysis was then carried out, using death as the dependent variable, and pre-hospital antibiotic use, age, time from onset of symptoms to parenteral antibiotics and the propensity score as independent variables. Results Data were recorded on 848 patients, 49 (5.72% of whom died. Of the total number of patients, 226 had received oral antibiotics before admission, mainly betalactams during the previous 48 hours. After adjusting the association between the use of antibiotics and death for age, time between onset of symptoms and in-hospital antibiotic treatment, pre-hospital oral antibiotherapy remained a significant protective factor (Odds Ratio for death 0.37, 95% confidence interval 0.15–0.93. Conclusion Pre-hospital oral antibiotherapy appears to reduce IMD mortality.

Method for Assigning Priority Levels in Acute Care (MAPLe-AC predicts outcomes of acute hospital care of older persons - a cross-national validation

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Ljunggren Gunnar

2011-06-01

Full Text Available Abstract Background Although numerous risk factors for adverse outcomes for older persons after an acute hospital stay have been identified, a decision making tool combining all available information in a clinically meaningful way would be helpful for daily hospital practice. The purpose of this study was to evaluate the ability of the Method for Assigning Priority Levels for Acute Care (MAPLe-AC to predict adverse outcomes in acute care for older people and to assess its usability as a decision making tool for discharge planning. Methods Data from a prospective multicenter study in five Nordic acute care hospitals with information from admission to a one year follow-up of older acute care patients were compared with a prospective study of acute care patients from admission to discharge in eight hospitals in Canada. The interRAI Acute Care assessment instrument (v1.1 was used for data collection. Data were collected during the first 24 hours in hospital, including pre-morbid and admission information, and at day 7 or at discharge, whichever came first. Based on this information a crosswalk was developed from the original MAPLe algorithm for home care settings to acute care (MAPLe-AC. The sample included persons 75 years or older who were admitted to acute internal medical services in one hospital in each of the five Nordic countries (n = 763 or to acute hospital care either internal medical or combined medical-surgical services in eight hospitals in Ontario, Canada (n = 393. The outcome measures considered were discharge to home, discharge to institution or death. Outcomes in a 1-year follow-up in the Nordic hospitals were: living at home, living in an institution or death, and survival. Logistic regression with ROC curves and Cox regression analyses were used in the analyses. Results Low and mild priority levels of MAPLe-AC predicted discharge home and high and very high priority levels predicted adverse outcome at discharge both in the Nordic

First-Year Analysis of a New, Home-Based Palliative Care Program Offered Jointly by a Community Hospital and Local Visiting Nurse Service.

Science.gov (United States)

Pouliot, Katherine; Weisse, Carol S; Pratt, David S; DiSorbo, Philip

2017-03-01

There is a growing need for home-based palliative care services, especially for seriously ill individuals who want to avoid hospitalizations and remain with their regular outside care providers. To evaluate the effectiveness of Care Choices, a new in-home palliative care program provided by the Visiting Nurse Services of Northeastern New York and Ellis Medicine's community hospital serving New York's Capital District. This prospective cohort study assessed patient outcomes over the course of 1 year for 123 patients (49 men and 74 women) with serious illnesses who were new enrollees in the program. Quality of life was assessed at baseline and after 1 month on service. Satisfaction with care was measured after 1 and 3 months on service. The number of emergency department visits and inpatient hospitalizations pre- and postenrollment was measured for all enrollees. Patients were highly satisfied (72.7%-100%) with their initial care and reported greater satisfaction ( P care service. An in-home palliative care program offered jointly through a visiting nurse service and community hospital may be a successful model for providing quality care that satisfies chronically ill patients' desire to remain at home and avoid hospital admissions.

The epidemiology of Scottish trauma: A comparison of pre-hospital and in-hospital deaths, 2000 to 2011.

Science.gov (United States)

Morrison, Jonathan J; Yapp, Liam Z; Beattie, Anne; Devlin, Eimar; Samarage, Milan; McCaffer, Craig; Jansen, Jan O

2016-02-01

To characterise the temporal trends and urban-rural distribution of fatal injuries in Scotland through the analysis of mortality data collected by the National Records of Scotland. The prospectively collected NRS database was queried using ICD-10 codes for all Scottish trauma deaths during the period 2000 to 2011. Patients were divided into pre-hospital and in-hospital groups depending on the location of death. Incidence was plotted against time and linear regression was used to identify temporal trends. A total of 13,100 deaths were analysed. There were 4755 (36.3%) patients in the pre-hospital group with a median age (IQR) of 42 (28-58) years. The predominant cause of pre-hospital death related to vehicular injury (27.8%), which had a decreasing trend over the study period (p = 0.004). In-hospital, patients had a median age of 80 (58-88) years and the majority (67.0%) of deaths occurred following a fall on the level. This trend was shown to increase over the decade of study (p = 0.020). In addition, the incidence of urban incidents remained static, but the rate of rural fatal trauma decreased (p Scottish trauma patients die prior to hospital admission and the predominant mechanism of injury is due to road traffic accidents. This contrasts with in-hospital deaths, which are mainly observed in elderly patients following a fall from standing height. Further research is required to determine the preventability of fatal traumatic injury in Scotland. Copyright © 2015 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.

Processes of early stroke care and hospital costs.

Science.gov (United States)

Svendsen, Marie Louise; Ehlers, Lars H; Hundborg, Heidi H; Ingeman, Annette; Johnsen, Søren P

2014-08-01

The relationship between processes of early stroke care and hospital costs remains unclear. We therefore examined the association in a population based cohort study. We identified 5909 stroke patients who were admitted to stroke units in a Danish county between 2005 and 2010.The examined recommended processes of care included early admission to a stroke unit, early initiation of antiplatelet or anticoagulant therapy, early computed tomography/magnetic resonance imaging (CT/MRI) scan, early physiotherapy and occupational therapy, early assessment of nutritional risk, constipation risk and of swallowing function, early mobilization,early catheterization, and early thromboembolism prophylaxis.Hospital costs were assessed for each patient based on the number of days spent in different in-hospital facilities using local hospital charges. The mean costs of hospitalization were $23 352 (standard deviation 27 827). The relationship between receiving more relevant processes of early stroke care and lower hospital costs followed a dose–response relationship. The adjusted costs were $24 566 (95% confidence interval 19 364–29 769) lower for patients who received 75–100% of the relevant processes of care compared with patients receiving 0–24%. All processes of care were associated with potential cost savings, except for early catheterization and early thromboembolism prophylaxis. Early care in agreement with key guidelines recommendations for the management of patients with stroke may be associated with hospital savings.

Effect of Nonalcoholic Fatty Liver Disease on In-Hospital and Long-Term Outcomes in Patients With ST-Segment Elevation Myocardial Infarction.

Science.gov (United States)

Keskin, Muhammed; Hayıroğlu, Mert İlker; Uzun, Ahmet Okan; Güvenç, Tolga Sinan; Şahin, Sinan; Kozan, Ömer

2017-11-15

Nonalcoholic fatty liver disease (NAFLD) is a risk factor for coronary artery disease. We investigated the effect of NAFLD grade on in-hospital and long-term outcomes in patients with ST-segment elevation myocardial infarction (STEMI). The study group consisted of 360 patients with STEMI. The patients were classified according to the grade of the NAFLD using ultrasonography. Based on this classification, all patients were divided into 4 subgroups as grade 0 (no fatty liver disease), grade 1, grade 2, and grade 3. Hierarchical logistic regression and Cox proportional regression analysis were used to establish the relation between NAFLD grade and outcomes. In-hospital mortality for grade 0, 1, 2, and 3 NAFLDs were 4.7%, 8.3%, 11.3%, and 33.9%, respectively. Three-year mortality for grade 0, 1, 2, and 3 NAFLDs were 5.6%, 7.8%, 9.5%, and 33.3%, respectively. In the multivariable hierarchical logistic regression analysis, in-hospital mortality risks were higher for patients with grade 3 NAFLD (odds ratio 4.2). In a multivariable Cox proportional regression analysis, the mortality risk was higher for patients with grade 3 NAFLD (hazard ratio 4.0). In conclusion, in patients with STEMI, the presence of NAFLD is associated with unfavorable clinical outcomes. Among these patients, grade 3 NAFLD had the highest mortality rates. The present study supports NAFLD screening in patients with STEMI. Copyright © 2017 Elsevier Inc. All rights reserved.

Pending studies at hospital discharge: a pre-post analysis of an electronic medical record tool to improve communication at hospital discharge.

Science.gov (United States)

Kantor, Molly A; Evans, Kambria H; Shieh, Lisa

2015-03-01

Achieving safe transitions of care at hospital discharge requires accurate and timely communication. Both the presence of and follow-up plan for diagnostic studies that are pending at hospital discharge are expected to be accurately conveyed during these transitions, but this remains a challenge. To determine the prevalence, characteristics, and communication of studies pending at hospital discharge before and after the implementation of an electronic medical record (EMR) tool that automatically generates a list of pending studies. Pre-post analysis. 260 consecutive patients discharged from inpatient general medicine services from July to August 2013. Development of an EMR-based tool that automatically generates a list of studies pending at discharge. The main outcomes were prevalence and characteristics of pending studies and communication of studies pending at hospital discharge. We also surveyed internal medicine house staff on their attitudes about communication of pending studies. Pre-intervention, 70% of patients had at least one pending study at discharge, but only 18% of these were communicated in the discharge summary. Most studies were microbiology cultures (68%), laboratory studies (16%), or microbiology serologies (10%). The majority of study results were ultimately normal (83%), but 9% were newly abnormal. Post-intervention, communication of studies pending increased to 43% (p pending studies, but in usual practice, the presence of these studies has rarely been communicated to outpatient providers in the discharge summary. Communication significantly increased with the implementation of an EMR-based tool that automatically generated a list of pending studies from the EMR and allowed users to import this list into the discharge summary. This is the first study to our knowledge to introduce an automated EMR-based tool to communicate pending studies.

Improving Service Quality in Long-term Care Hospitals: National Evaluation on Long-term Care Hospitals and Employees Perception of Quality Dimensions

OpenAIRE

Kim, Jinkyung; Han, Woosok

2012-01-01

Objectives To investigate predictors for specific dimensions of service quality perceived by hospital employees in long-term care hospitals. Methods Data collected from a survey of 298 hospital employees in 18 long-term care hospitals were analysed. Multivariate ordinary least squares regression analysis with hospital fixed effects was used to determine the predictors of service quality using respondents? and organizational characteristics. Results The most significant predictors of employee-...

A Single Long-Term Acute Care Hospital Experience with a Pressure Ulcer Prevention Program.

Science.gov (United States)

Young, Daniel L; Borris-Hale, Cathy; Falconio-West, Margaret; Chakravarthy, Debashish

2015-01-01

The occurrence of pressure ulcers (PrUs) challenges care facilities. Few studies report PrU reduction efforts in long-term acute care (LTAC). This study described the PrU reduction efforts of a single, LTAC facility using the Medline Pressure Ulcer Prevention Program (mPUPP). This study was a quasi-experimental, quality improvement project, with pre- and postmeasurement design. Outcomes were tracked for 24 months. The mPUPP was implemented in month 11. Education for caregivers was provided through an interactive web-based suite. In addition, all Patient Care Technicians attended a 4-week 1-hour inservice. New skin care products were implemented. The facility also implemented an algorithm for treatment of wounds. There was a significant reduction in the mean monthly hospital-acquired PrU (nPrU) rate when preprogram is compared to postprogram. Sustainable nPrU reduction can be achieved with mPUPP. LTAC hospitals could expect to reduce nPrU with education and incentive of caregivers. © 2014 Association of Rehabilitation Nurses.

An overview of the construction of emergency and pre-hospital first aid platform

Directory of Open Access Journals (Sweden)

Song Chen

2018-01-01

Full Text Available To further improve the ability of pre-hospital and in-hospital collaborative treatment, strengthen emergency multidisciplinary cooperation and construct a scientific, rational and efficient emergency system, under the support of former chairman Yu Xue-zhong, Dr. Li Chun-sheng and numerous colleagues in the industry, the Emergency Medicine Society of the Chinese Medical Association appeal to us to draft Construction of Emergency and Pre-hospital Platform. Based on this background, the platform of emergency and pre-hospital first aid helps to build a “one horizontal and one Longitudinal” treatment model, using the horizontal and longitudinal patterns to integrate emergency medical resources to satisfy the automatic information integration and intelligent analysis sharing, realizing the emergency management visualization and medical information digitization, simplifying the medical process and establishing a perfect standard for the emergent diseases, thereby ultimately achieving efficient diagnosis and scientific treatment.

Hospital-based home care for children with cancer

DEFF Research Database (Denmark)

Hansson, Eva Helena; Kjaergaard, H; Schmiegelow, K

2012-01-01

, as it decreased the strain on the family and the ill child, maintained normality and an ordinary everyday life and fulfilled the need for safety and security. According to family members of children with cancer, hospital-based home care support enhanced their quality of life during the child's cancer trajectory......The study aims to describe the experiences of a hospital-based home care programme in the families of children with cancer. Fourteen parents, representing 10 families, were interviewed about their experiences of a hospital-based home care programme during a 4-month period in 2009 at a university...... hospital in Denmark. Five children participated in all or part of the interview. The interviews were transcribed verbatim and analysed using qualitative content analysis. The findings indicate that hospital-based home care enabled the families to remain intact throughout the course of treatment...

Prognostic Factors in Patients With Stemi Undergoing Primary PCI in the Clopidogrel Era: Role of Dual Antiplatelet Therapy at Admission and the Smoking Paradox on Long-Term Outcome.

Science.gov (United States)

Ciccarelli, Giovanni; Barbato, Emanuele; Golino, Marco; Cimmino, Giovanni; Bartunek, Jozef; Di Serafino, Luigi; Di Girolamo, Domenico; De Bruyne, Bernard; Wijns, William; Golino, Paolo

2017-02-01

Several clinical and laboratory variables have an impact on the prognosis of STEMI patients undergoing PPCI; however, little is known about the role of ongoing DAPT at the time of the event and the smoking status as prognostic factors affecting the outcome of these patients. Seven-hundred and thirteen consecutive STEMI patients undergoing PPCI, admitted to the S. Anna and S. Sebastiano Hospital (Caserta, Italy) and to the OLV Clinic (Aalst, Belgium), between March 2009 and December 2011, were retrospectively enrolled. Rescue PCI was the only exclusion criterion. Primary end-point was the combination of death for all causes, re-infarction, stroke, and target lesion revascularization (TLR). Patients already on DAPT at admission (26.4%) showed a significant increase in the event rate at univariate analysis (HR 2.34, CI 1.62-3.75, P 1 were more frequently present than in patients not on DAPT), Cox regression analysis confirmed that both DAPT (HR 1.74, 95%CI 1.20-2.53, P value. © 2016, Wiley Periodicals, Inc.

Severe maternal morbidity in Zanzibar's referral hospital: Measuring the impact of in-hospital care

NARCIS (Netherlands)

Herklots, T.; Acht, L. van; Meguid, T.; Franx, A.; Jacod, B.C.

2017-01-01

OBJECTIVE: to analyse the impact of in-hospital care on severe maternal morbidity using WHO's near-miss approach in the low-resource, high mortality setting of Zanzibar's referral hospital. SETTING: Mnazi Mmoja Hospital, a tertiary care facility, in Zanzibar, Tanzania. METHODS: We identified all

Transitional Home Care program utilizing the Integrated Practice Unit concept (THC-IPU: Effectiveness in improving acute hospital utilization

Directory of Open Access Journals (Sweden)

Lian Leng Low

2017-08-01

Full Text Available Background: Organizing care into integrated practice units (IPUs around conditions and patient segments has been proposed to increase value. We organized transitional care into an IPU (THC-IPU for a patient segment of functionally dependent patients with limited community ambulation. Methods: 1,166 eligible patients were approached for enrolment into THC-IPU. THC-IPU patients received a comprehensive assessment within two weeks of discharge; medication reconciliation; education using standardized action plans and a dedicated nurse case manager for up to 90 days after discharge. Patients who rejected enrolment into THC-IPU received usual post-discharge care planned by their attending hospital physician, and formed the control group. The primary outcome was the proportion of patients with at least one unscheduled readmission within 30 days after discharge. Results: We found a statistically significant reduction in 30-day readmissions and emergency department visits in patients on THC-IPU care compared to usual care, even after adjusting for confounders. Conclusion: Delivering transitional care to patients with functional dependence in the form of home visits and organized into an IPU reduced acute hospital utilization in this patient segment. Extending the program into the pre-hospital discharge phase to include discharge planning can have incremental effectiveness in reducing avoidable hospital readmissions.

Percutaneous Intervention for Concurrent Chronic Total Occlusions in Patients With STEMI: The EXPLORE Trial

NARCIS (Netherlands)

Henriques, J.P.; Hoebers, L.P.; Ramunddal, T.; Laanmets, P.; Eriksen, E.; Bax, M.; Ioanes, D.; Suttorp, M.J.; Strauss, B.H.; Barbato, E.; Nijveldt, R.; Rossum, A.C. van; Marques, K.M.; Elias, J.; Dongen, I.M. van; Claessen, B.E.; Tijssen, J.G.; Schaaf, R.J. van der; Boer, M.J. de; et al.,

2016-01-01

BACKGROUND: In 10% to 15% of patients with ST-segment elevation myocardial infarction (STEMI), concurrent coronary chronic total occlusion (CTO) in a non-infarct-related artery is present and is associated with increased morbidity and mortality. OBJECTIVES: The EXPLORE (Evaluating Xience and Left

Factors Impacting Mortality in the Pre-Hospital Period After Road Traffic Accidents in Urban India.

Science.gov (United States)

Chandrasekharan, Ananthnarayan; Nanavati, Aditya J; Prabhakar, Sandhya; Prabhakar, Subramaniam

2016-07-01

personal safety, and driving vehicles under adverse conditions are some of the leading causes of road traffic accidents. There should be an emphasis on emergency trauma care in the pre-hospital setting.

Mechanical ventilators in US acute care hospitals.

Science.gov (United States)

Rubinson, Lewis; Vaughn, Frances; Nelson, Steve; Giordano, Sam; Kallstrom, Tom; Buckley, Tim; Burney, Tabinda; Hupert, Nathaniel; Mutter, Ryan; Handrigan, Michael; Yeskey, Kevin; Lurie, Nicole; Branson, Richard

2010-10-01

The supply and distribution of mechanical ventilation capacity is of profound importance for planning for severe public health emergencies. However, the capability of US health systems to provide mechanical ventilation for children and adults remains poorly quantified. The objective of this study was to determine the quantity of adult and pediatric mechanical ventilators at US acute care hospitals. A total of 5,752 US acute care hospitals included in the 2007 American Hospital Association database were surveyed. We measured the quantities of mechanical ventilators and their features. Responding to the survey were 4305 (74.8%) hospitals, which accounted for 83.8% of US intensive care unit beds. Of the 52,118 full-feature mechanical ventilators owned by respondent hospitals, 24,204 (46.4%) are pediatric/neonatal capable. Accounting for nonrespondents, we estimate that there are 62,188 full-feature mechanical ventilators owned by US acute care hospitals. The median number of full-feature mechanical ventilators per 100,000 population for individual states is 19.7 (interquartile ratio 17.2-23.1), ranging from 11.9 to 77.6. The median number of pediatric-capable device full-feature mechanical ventilators per 100,000 population younger than 14 years old is 52.3 (interquartile ratio 43.1-63.9) and the range across states is 22.1 to 206.2. In addition, respondent hospitals reported owning 82,755 ventilators other than full-feature mechanical ventilators; we estimate that there are 98,738 devices other than full-feature ventilators at all of the US acute care hospitals. The number of mechanical ventilators per US population exceeds those reported by other developed countries, but there is wide variation across states in the population-adjusted supply. There are considerably more pediatric-capable ventilators than there are for adults only on a population-adjusted basis.

Moving Towards the Age-friendly Hospital: A Paradigm Shift for the Hospital-based Care of the Elderly.

Science.gov (United States)

Huang, Allen R; Larente, Nadine; Morais, Jose A

2011-12-01

Care of the older adult in the acute care hospital is becoming more challenging. Patients 65 years and older account for 35% of hospital discharges and 45% of hospital days. Up to one-third of the hospitalized frail elderly loses independent functioning in one or more activities of daily living as a result of the 'hostile environment' that is present in the acute hospitals. A critical deficit of health care workers with expertise and experience in the care of the elderly also jeopardizes successful care delivery in the acute hospital setting. We propose a paradigm shift in the culture and practice of event-driven acute hospital-based care of the elderly which we call the Age-friendly Hospital concept. Guiding principles include: a favourable physical environment; zero tolerance for ageism throughout the organization; an integrated process to develop comprehensive services using the geriatric approach; assistance with appropriateness decision-making and fostering links between the hospital and the community. Our current proposed strategy is to focus on delirium management as a hospital-wide condition that both requires and highlights the Geriatric Medicine specialist as an expert of content, for program development and of evaluation. The Age-friendly Hospital concept we propose may lead the way to enable hospitals in the fast-moving health care system to deliver high-quality care without jeopardizing risk-benefit, function, and quality of life balances for the frail elderly. Recruitment and retention of skilled health care professionals would benefit from this positive 'branding' of an institution. Convincing hospital management and managing change are significant challenges, especially with competing priorities in a fiscal environment with limited funding. The implementation of a hospital-wide delirium management program is an example of an intervention that embodies many of the principles in the Age-friendly Hospital concept. It is important to change the way

Quality assurance of pre-operative assessment--a review of quality assurance activities related to pre-operative assessment in nine hospitals in The Netherlands

NARCIS (Netherlands)

Klazinga, N. S.; Helsloot, R.

1989-01-01

Pre-operative assessment of patients for surgery is one of the most prevalent topics for quality assurance by peer-review in Dutch hospitals. This article describes the experiences with pre-operative assessment in nine hospitals. It is discussed why preoperative assessment is performed, what tests

Regulation and registration as drivers of continuous professional competence for Irish pre-hospital practitioners: a discussion paper.

Science.gov (United States)

Knox, S; Dunne, S S; Hughes, M; Cheeseman, S; Dunne, C P

2016-05-01

The regulatory body responsible for the registration of Irish pre-hospital practitioners, the Pre-Hospital Emergency Care Council (PHECC), identified the need to implement a continuing professional competence (CPC) framework. The first cycle of CPC (focused on emergency medical technicians) commenced in November 2013 creating for the first time a formal relationship between continuing competence and registration to practice. To review current literature and to describe benefits and challenges relevant to CPC, regulation, registration and their respective contributions to professionalism of pre-hospital practitioners: advanced paramedics, paramedics and emergency medical technicians. Online search of cumulative index to nursing and allied health literature (CINAHL Plus with Full Text), Allied and Complementary Medicine (AMED) and 'Pubmed' databases using: 'Continuous Professional Development'; 'Continuous Professional Development'; 'emergency medical technician'; 'paramedic'; 'registration'; 'regulation'; and "profession' for relevant articles published since 2004. Additional policy documents, discussion papers, and guidance documents were identified from bibliographies of papers found. Reports, governmental policies for other healthcare professions, and professional developments internationally for allied professions (e.g., nursing, physiotherapy and medicine) link maintenance of competence with requirements for registration to practice. We suggest that evolving professionalisation of Irish paramedics should be affirmed through behaviours and competencies that incorporate adherence to professional codes of conduct, reflective practice, and commitment to continuing professional development. While the need for ambulance practitioner CPD was identified in Ireland almost a decade ago, PHECC now has the opportunity to introduce a model of CPD for paramedics linking competence and professionalism to annual registration.

Hospital System Readmissions: A Care Cycle Approach

Directory of Open Access Journals (Sweden)

Cody Mullen

2012-01-01

Full Text Available Hospital readmission rates can be used as an indicator of the quality of health care services and can highlight high-priority research areas to ensure better health. A readmission is defined as when a patient is discharged from an acute care hospital and is admitted back to an acute care hospital in a set amount of days, with 30 days being the current national standard. On average, 19.6% of Medicare patients are readmitted to the hospital within 30 days of discharge and 56.1% within a year (Jencks, Williams, & Coleman, 2009. The hypothesis of this study was that the discharge location, or where a patient went immediately after discharge, would not have a significant effect on readmissions. A data set with all admission records was obtained from a major health provider. These data contain all hospital patients’ demographic and diagnosis information. General, women’s, and children’s hospitals were looked at from a system perspective to study the discharge location of patients as well as the effects of patient demographics on discharge location. By using a z-significance test in Microsoft Excel and SAS 9.2, it was discovered that patients discharged to home have a significantly lower likelihood of readmission. Generally, patients who are discharged to an extended care or intermediate care facility or patients with home health carerelated services had a significantly higher likelihood of being readmitted. The findings may indicate a possible need for an institution-to-institution intervention as well as institution-to-patient intervention. Future work will develop potential interventions in partnership with hospital staff.

The role of performing life support courses in rural areas in improving pre-hospital physiologic condition of patients with penetrating injuries

International Nuclear Information System (INIS)

Naffisi, N.; Mohebbi, H.A.; Moharamzadeh, Y.

2008-01-01

To evaluate the impact of animal model based medical training courses for village healthcare workers on prehospital physiologic condition and prognosis of patients with penetrating injuries. Seventy-six village healthcare workers were trained and equipped to deliver in-field medical first cares. First group (226 patients) consisted of those who received this cares by the trained group and second group (245 patients) were those who received no in-field cares and were transported directly to the trauma center in provincial capital, Ilam. Physiologic Severity Score (PSS) was calculated to determine the physiologic condition of patients in both groups. Results: The most prevalent cause of trauma in both groups was car accidents (61.6%). Controlling of hemorrhage was the most frequent provided initial medical care (40.6%). A significant improvement regarding the PSS score was observed in the first group of patients compared to the second group (7.505 vs. 6.799, 95% CI for difference: 0.3 to 0.9). The mortality rates of the first and second group of patients were 3% and 7.3%, respectively (p=0.051). Performing life support courses in rural areas of low-income countries where there is no pre-hospital triage and emergency medical system and provision of classic resuscitative measures are limited, has a significant impact on improvement of pre-hospital physiologic condition and prognosis of patients with penetrating injuries. (author)

Primary care referral management: a marketing strategy for hospitals.

Science.gov (United States)

Bender, A D; Geoghegan, S S; Lundquist, S H; Cantone, J M; Krasnick, C J

1990-06-01

With increasing competition among hospitals, primary care referral development and management programs offer an opportunity for hospitals to increase their admissions. Such programs require careful development, the commitment of the hospital staff to the strategy, an integration of hospital activities, and an understanding of medical practice management.

Spouses' conceptions of the pre-hospital phase when their partners suffered an acute myocardial infarction--a qualitative analysis.

Science.gov (United States)

Johansson, Ingela; Swahn, Eva; Strömberg, Anna

2008-09-01

Delay from onset of acute myocardial infarction symptoms to the delivery of medical care is a major determinant of prognosis. Although studies have explored patient reasons for delay, there are only limited data concerning experiences of the spouse. Was to describe spouses' conceptions of the pre-hospital phase when their partners suffered an acute myocardial infarction. A phenomenographic approach was applied. Fifteen spouses were interviewed rational, and consulting others. The category respecting independence contained: accepting the need for control, marital roles and experiences, restraining emotions, and seeking agreement. Our findings suggest that spouses have a strong influence on the course of events. When accepting the partner's need for control through following earlier marital roles and experiences, restraining own emotions and seeking agreement, this seemed to contribute to delay. However, when the spouse was resourceful by sharing the experience, having knowledge, understanding the severity, being rational and consulting others when needed, this seemed to have a positive influence on the pre-hospital time.

Record of hospitalizations for ambulatory care sensitive conditions: validation of the hospital information system.

Science.gov (United States)

Rehem, Tania Cristina Morais Santa Barbara; de Oliveira, Maria Regina Fernandes; Ciosak, Suely Itsuko; Egry, Emiko Yoshikawa

2013-01-01

To estimate the sensitivity, specificity and positive and negative predictive values of the Unified Health System's Hospital Information System for the appropriate recording of hospitalizations for ambulatory care-sensitive conditions. The hospital information system records for conditions which are sensitive to ambulatory care, and for those which are not, were considered for analysis, taking the medical records as the gold standard. Through simple random sampling, a sample of 816 medical records was defined and selected by means of a list of random numbers using the Statistical Package for Social Sciences. The sensitivity was 81.89%, specificity was 95.19%, the positive predictive value was 77.61% and the negative predictive value was 96.27%. In the study setting, the Hospital Information System (SIH) was more specific than sensitive, with nearly 20% of care sensitive conditions not detected. There are no validation studies in Brazil of the Hospital Information System records for the hospitalizations which are sensitive to primary health care. These results are relevant when one considers that this system is one of the bases for assessment of the effectiveness of primary health care.

Record of hospitalizations for ambulatory care sensitive conditions: validation of the hospital information system

Directory of Open Access Journals (Sweden)

Tania Cristina Morais Santa Barbara Rehem

2013-09-01

Full Text Available OBJECTIVE: to estimate the sensitivity, specificity and positive and negative predictive values of the Unified Health System's Hospital Information System for the appropriate recording of hospitalizations for ambulatory care-sensitive conditions. METHOD: the hospital information system records for conditions which are sensitive to ambulatory care, and for those which are not, were considered for analysis, taking the medical records as the gold standard. Through simple random sampling, a sample of 816 medical records was defined and selected by means of a list of random numbers using the Statistical Package for Social Sciences. RESULT: the sensitivity was 81.89%, specificity was 95.19%, the positive predictive value was 77.61% and the negative predictive value was 96.27%. In the study setting, the Hospital Information System (SIH was more specific than sensitive, with nearly 20% of care sensitive conditions not detected. CONCLUSION: there are no validation studies in Brazil of the Hospital Information System records for the hospitalizations which are sensitive to primary health care. These results are relevant when one considers that this system is one of the bases for assessment of the effectiveness of primary health care.

Pre-eclampsia: Factores de riesgo. Estudio en el Hospital Nacional Cayetano Heredia.

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Manuel Salviz Salhuana

1996-01-01

Full Text Available Objetivo: El objetivo fue evaluar los factores de riesgo asociados a pre-eclampsia en nuestro hospital. Material y métodos: Se realizó un estudio prospectivo, de tipo caso-control concurrente en 88 pacientes con pre-eclampsia e igual número de controles. El trabajo se llevó a cabo en el Servicio de Obstetricia del Hospital Nacional Cayetano Heredia entre los meses de marzo a agosto de 1993. Resultados: Los factores asociados a pre-eclampsia fueron el antecedente previo a pre-eclampsia (OR:17, el índice de masa corporal elevado (OR:9.6, la raza predominantemente blanca (OR:6.4, el antecedente familiar de hipertensión arterial (OR: 5.2, la falta de control pre-natal y la nuliparidad (OR: 2.5. La incidencia de pre-eclampsia fue 4.11%, y requirieron parto por cesárea el 69.3% de las pacientes. Presentaron complicaciones en el puerperio inmediato 28.4% de los casos, siendo más frecuentes las infecciones. (Rev Med Hered 1996; 7: 24-31.

Promoting accountability: hospital charity care in California, Washington state, and Texas.

Science.gov (United States)

Sutton, Janet P; Stensland, Jeffrey

2004-05-01

Debate as to whether private hospitals meet their charitable obligations is heated. This study examines how alternative state approaches for ensuring hospital accountability to the community affects charitable expenditures and potentially affects access to care for the uninsured. Descriptive and multivariate analyses were used to compare private California hospitals' charity care expenditures with those of hospitals in Texas and Washington state. The key finding from this study is that net of hospital characteristics, market characteristics and community need, Texas hospitals were estimated to provide over 3 times more charity care and Washington hospitals were estimated to provide 66% more charity care than California hospitals. This finding suggests that more prescriptive community benefit or charity care requirements may be necessary to ensure that private hospitals assume a larger role in the care of the uninsured.

Pre-hospital haemostatic dressings: a systematic review.

Science.gov (United States)

Granville-Chapman, J; Jacobs, N; Midwinter, M J

2011-05-01

Kingdom Armed Forces; retrospective clinical data supports their efficacy. However, in some recent animal models of lethal haemorrhage, WoundStat(mucoadhesive), Celox (mucoadhesive) and CombatGauze (procoagulant supplementor) have all outperformed both HemCon and QuikClot products. HemCon and QuikClot have augmented the haemostatic capabilities of the military first aid responder, but newer products demonstrate potential to be more effective and should be considered as replacements for current in service systems. These products could have utility for civilian pre-hospital care. 2010 Elsevier Ltd. All rights reserved.

Development and Evaluation of an Educational Initiative to Improve Hospital Personnel Preparedness to Care for Children with Autism Spectrum Disorder.

Science.gov (United States)

Lucarelli, Jennifer; Welchons, Leah; Sideridis, Georgios; Sullivan, Nancy R; Chan, Eugenia; Weissman, Laura

2018-06-01

To evaluate the effectiveness of a multimodal educational curriculum on increasing hospital personnel's awareness of successful strategies and comfort in caring for children with autism spectrum disorder (ASD). We developed a 3-part training for front-line staff (i.e., front desk, clinical assistants, and phlebotomists) in 8 outpatient hospital departments frequented by patients with ASD. Following a needs assessment, participants completed an online educational module and then attended an in-person seminar tailored to each department. To evaluate training effectiveness, we administered pre-, immediate post-, and 1 month post-training surveys assessing personnel attitudes, comfort, perceived knowledge, and behaviors around caring for patients with ASD. We trained 168 staff members from 8 departments. On the needs assessment, participants (N = 129) reported a mean 2.5 behavioral incidents involving patients with ASD over the previous 3 months; 92% believed that the training would be helpful for their work. Across pre-, immediate- and 1-month post-training surveys, scores improved on all questions related to personnel attitudes about the importance of ASD-friendly care, comfort interacting with patients with ASD, perceived knowledge about ASD, and self-reported frequency of behaviors intended to help children with ASD adjust to the hospital setting (p initiative led to improvement in attitudes, comfort level, perceived knowledge, and self-reported behaviors of hospital personnel working with patients with ASD, which was maintained over 1 month.

A subacute model of geriatric care for frail older persons: the Tan Tock Seng Hospital experience.

Science.gov (United States)

Chong, Mei Sian; Empensando, Esmiller F; Ding, Yew Yoong; Tan, Thai Lian

2012-08-01

The subacute care unit in Tan Tock Seng Hospital (TTSH) was set up in May 2009. We examined its impact on the transitions at the nexus between hospital and community sectors, patients' discharge destination and functional performance. We studied patients admitted during the initial 6-month period (May to October 2009). Differences in demographics, length of stay (LOS), comorbidity and severity of illness measures, functional outcomes (modified Barthel Index (MBI)) according to discharge destinations were obtained. We also studied the impact of LOS on the geriatric department and the bill size over the pre- and post-subacute implementation periods. Majority of the subacute patients' hospital stay was in subacute care. Of these patients, 44.9% were discharged home, 24.2% to a slow stream rehabilitation (SSR) setting and 29.2% to nursing homes. 16.9% consisted of a subgroup of dementia patients requiring further behavioural and functional interventions, of which 50% managed to be discharged home. Functional gains were seen during subacute stay; with greatest gains observed in the SSR group. There were no differences in overall LOS nor total bill size (DRG-adjusted) for the geriatric medicine department during the first 6 months of operating this new subacute model compared with the prior 4-month period. We propose this subacute model of geriatric care, which allows right-siting of care and improved functional outcomes. It fulfills the role easing transitions between acute hospital and community sectors. In particular, it provides specialised care to a subgroup of dementia patients with challenging behaviours and is fiscally sound from the wider hospital perspective.

Pre-hospitalization, hospitalization, and post-hospitalization costs of patients with neurocysticercosis treated at the Instituto Nacional de Neurologia y Neurocirugia (INNN in Mexico City, Mexico

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Rachana Bhattarai

2018-05-01

Full Text Available ABSTRACT The objective of this study was to estimate the direct costs associated with the diagnosis and treatment of neurocysticercosis (NCC during pre-hospitalization, hospitalization, and post-hospitalization periods for 108 NCC patients treated at the Instituto Nacional de Neurologia y Neurocirugia (INNN in Mexico City, Mexico. Information on clinical manifestations, diagnostic tests, hospitalizations, surgical procedures, prescription medication, and other treatments was collected via medical chart reviews. Uncertain values for costs and frequency of treatments were imputed using bootstrap techniques. The average per-patient pre-hospitalization and hospitalization costs were US$ 257 (95% CI: 185 – 329 and US$ 2,576 (95% CI: 2,244 – 2,908, respectively. Post-hospitalization costs tended to decrease over time, with estimates for the first five years post-hospitalization of US$ 475 (95% CI: 423 – 527, US$ 228 (95% CI: 167 – 288, US$ 157 (95% CI: 111 – 202, US$ 150 (95% CI: 106 – 204, and US$ 91 (95% CI: 27 – 154, respectively. NCC results in a significant economic burden for patients requiring hospitalization, with this burden continuing years post-hospitalization.

Long-term acute care hospitals and Georgia Medicaid: Utilization, outcomes, and cost

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Evan S. Cole

2016-09-01

Full Text Available Objectives: Because most research on long-term acute care hospitals has focused on Medicare, the objective of this research is to describe the Georgia Medicaid population who received care at a long-term acute care hospital, the type and volume of services provided by these long-term acute care hospitals, and the costs and outcomes of these services. For those with select respiratory conditions, we descriptively compare costs and outcomes to those of patients who received care for the same services in acute care hospitals. Methods: We describe Georgia Medicaid recipients admitted to a long-term acute care hospital between 2011 and 2012. We compare them to a population of Georgia Medicaid recipients admitted to an acute care hospital for one of five respiratory diagnosis-related groups. Measurements used include patient descriptive information, admissions, diagnosis-related groups, length of stay, place of discharge, 90-day episode costs, readmissions, and patient risk scores. Results: We found that long-term acute care hospital admissions for Medicaid patients were fairly low (470 90-day episodes and restricted to complex cases. We also found that the majority of long-term acute care hospital patients were blind or disabled (71.2%. Compared to patients who stayed at an acute care hospital, long-term acute care hospital patients had higher average risk scores (13.1 versus 9.0, lengths of stay (61 versus 38 days, costs (US$143,898 versus US$115,056, but fewer discharges to the community (28.4% versus 51.8%. Conclusion: We found that the Medicaid population seeking care at long-term acute care hospitals is markedly different than the Medicare populations described in other long-term acute care hospital studies. In addition, our study revealed that Medicaid patients receiving select respiratory care at a long-term acute care hospital were distinct from Medicaid patients receiving similar care at an acute care hospital. Our findings suggest that

Preventive PCI versus culprit lesion stenting during primary PCI in acute STEMI: a systematic review and meta-analysis

Science.gov (United States)

Pandit, Anil; Aryal, Madan Raj; Aryal Pandit, Aashrayata; Hakim, Fayaz Ahmad; Giri, Smith; Mainali, Naba Raj; Sharma, Prashant; Lee, Howard R; Fortuin, F David; Mookadam, Farouk

2014-01-01

Aim The benefit of preventive percutaneous coronary intervention (PCI) in ST elevation myocardial infarction (STEMI) has been shown in randomised trials. However, all the randomised trials are underpowered to detect benefit in cardiac death. We aim to systematically review evidence on the cardiac mortality benefit of preventive PCI in patients presenting with acute STEMI in randomised patient populations. Methods PubMed, Scopus, Cochrane and clinicaltrials.gov databases were searched for studies published until 30 September 2013. The studies were limited to randomised clinical trials. Independent observers abstracted the data on outcomes, characteristics and qualities of studies included. Fixed effect model was employed for meta-analysis. Heterogeneity of studies included was analysed using I2 statistics. Results In three randomised clinical trials published, involving 748 patients with acute STEMI and multivessel disease, 416 patients were randomised to preventive PCI and 332 to culprit-only PCI. Patients undergoing preventive PCI had significant lower risk of cardiovascular deaths (pooled OR 0.39, 95% CI 0.18 to 0.83, p=0.01, I2=0%), repeat revascularisation (pooled OR 0.28, 95% CI 0.18 to 0.44, p=0.00001, I2=0%) and non-fatal myocardial infarction (pooled OR 0.38, 95% CI 0.20 to 0.75, p=0.005, I2=0%) compared with culprit-only revascularisation. Conclusions In patients presenting with acute STEMI and significant multivessel coronary artery disease, based on our data, preventive PCI is associated with lower risk of cardiovascular mortality compared with primary PCI of only the culprit artery. This finding needs to be confirmed in larger adequately powered randomised clinical trials. PMID:25332779

Maternal and foetal outcome in hellp syndrome at tertiary care hospital

International Nuclear Information System (INIS)

Sadaf, N.; Haq, G.; Din, S.S.U.

2013-01-01

Objective: To determine maternal and foetal outcome in patients of Haemolysis, Elevated Liver enzyme and Low Platelet Cont syndrome. Methods: The descriptive case series was conducted at the Gynae Unit II of Civil Hospital, Karachi, over a period of 12 months in two episodes; first from December 28, 2006, to February 28, 2007, and then from September 1, 2007, to June 30, 2008. It comprised 40 consecutive women with pre-ecampsia and eclampsia along with altered platelet count who met the syndrome criteria. A pre-designed proforma was administered for data collection. Maternal and foetal outcomes were noted. SPSS 10 was used for statistical analysis. Result: Among the 40 mothers, cesarean section was the most common outcome (n=24; 60%). Pulmonary oedema was found in 2 (5%) cases, acute renal failure in 10 (25%), disseminated intravascular coagulation in 6 (15%), and abruptio placenta in 5 (12.5%). Intrauterine growth restriction as a foetal outcome was observed in 18 (45%) cases. Pre-term birth was the result in 20 (50%) cases, and perinatal mortality was high (n=23; 57.5%). Conclusion: Management and delivery of HELLP syndrome patients should be performed at tertiary care centres, where highly trained obstetrician, neonatal intensive care unit personnel and Multi-disciplinary facilities are available. Correct diagnosis and timely intervention can decrease the risk of maternal and perinatal mortality. (author)

Patients' level of satisfaction on quality of health care at Mwananyamala hospital in Dar es Salaam, Tanzania.

Science.gov (United States)

Khamis, Kudra; Njau, Bernard

2014-09-18

Enhancing quality of health care delivered in public health facilities in developing countries is a key prerequisite to increase utilization and sustainability of health care services in the population. The aim of the study was to determine patients' level of satisfaction on the quality of health care delivered at the out-patient department (OPD) in Mwananyamala hospital in Dar es Salaam, Tanzania. A cross-sectional study design was conducted from April to May, 2012. A systematic sampling method was employed to select 422 study subjects. A pre-tested SERVQUAL questionnaire was used to collect data and one-sample t-test was employed to identify patients' level of satisfaction and principal component analysis to identify key items that measure quality of care. Patients' level of satisfaction mean gap score was (-2.88 ± 3.1) indicating overall dissatisfaction with the quality of care. The level of dissatisfaction in the five service dimensions were as follows: assurance (-0.47), reliability (-0.49), tangible (-0.52), empathy (-0.55), and responsiveness (-0.72). Patients attending OPD at Mwananyamala hospital demonstrates an overall dissatisfaction on quality of care. Hospital management should focus on: improvement on communication skills among OPD staff in showing compassion, politeness and active listening, ensure availability of essential drugs, and improvement on clinicians' prescription skills.

Home hospitalization in the spectrum of community geriatric care.

Science.gov (United States)

Stessman, J; Hammerman-Rozenberg, R; Cohen, A

1997-04-01

The Home Hospitalization Programme was initiated in Jerusalem in 1991 to provide intensive medical care at home in order to prevent or shorten hospitalizations. The programme was based upon regular home visits by physicians, and nursing assessment to determine the need for regular nursing care. Primary-care physicians and nurses were renumerated by a global monthly fee, and were on 24-h call in addition to their periodic visits. Patients were recruited by senior geriatric physicians from acute hospital wards, as well as from the community, at the family doctor's request. Ancillary services available to the home hospitalization team included laboratory and electrocardiographic testing, specialty consultations, physical occupational or speech therapy, social work and home help up to 3 h daily. Monthly visits by a senior physician provided oversight and further consultation. Home hospitalization grew out of the continuing care division of the Clalit Sick Fund, a health maintenance organization providing umbrella medical insurance and ambulatory care. The programme grew synergistically with the other facilities of continuing care to encompass a network of comprehensive services to acute, subacute and chronic patients both at home and in institutional settings. In 4 years this network succeeded in establishing the focus of subacute intensive care in the community, achieving high levels of patient and family satisfaction, as well as striking economic advantages. In its first 2 years of operation home hospitalization saved S4 million due to reduced hospital utilization, and preliminary data for the subsequent 2 years indicated that this trend continued. Home hospitalization became the hub of a far-reaching system of supportive, intensive and humane care in the community.

Generic care pathway for elderly patients in need of home care services after discharge from hospital: a cluster randomised controlled trial.

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Røsstad, Tove; Salvesen, Øyvind; Steinsbekk, Aslak; Grimsmo, Anders; Sletvold, Olav; Garåsen, Helge

2017-04-17

, number of readmissions after hospital discharge, and health care utilisation except for more consultations with the GPs. A targeted exploration of prerequisites for implementation is recommended in the pre-trial phase of complex intervention studies. Clinical Trials.gov NCT01107119 , retrospectively registered 2010.04.18.

The Impact of Medicaid Disproportionate Share Hospital Payment on Provision of Hospital Uncompensated Care

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Hsieh, Hui-Min; Bazzoli, Gloria J.

2012-01-01

This study examines the association between hospital uncompensated care (UC) and reductions in Medicaid Disproportionate Share Hospital (DSH) payments resulting from the 1997 Balanced Budget Act. Data on California hospitals from 1996 to 2003 were examined using two-stage least squares with a first-differencing model to control for potential feedback effects. Our findings suggest that not-for-profit hospitals did reduce UC provision in response to reductions in Medicaid DSH, but the response was inelastic in value. Policy makers need to continue to monitor how UC changes as sources of support for indigent care change with the Patient Protection and Affordable Care Act (PPACA). PMID:23230705

Non-O blood groups can be a prognostic marker of in-hospital and long-term major adverse cardiovascular events in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention.

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Cetin, Mehmet Serkan; Ozcan Cetin, Elif Hande; Aras, Dursun; Topaloglu, Serkan; Temizhan, Ahmet; Kisacik, Halil Lutfi; Aydogdu, Sinan

2015-09-01

Recent studies have suggested ABO blood type locus as an inherited predictor of thrombosis, cardiovascular risk factors, myocardial infarction. However, data is scarce about the impact of non-O blood groups on prognosis in patients with ST-elevation myocardial infarction (STEMI). Therefore, we aimed to evaluate the prognostic importance of non-O blood groups in patients with STEMI undergoing primary percutaneous coronary intervention (pPCI) METHODS: 1835 consecutive patients who were admitted with acute STEMI between 2010 and 2015 were included and followed-up for a median of 35.6months. The prevalence of hyperlipidemia, total cholesterol, LDL, peak CKMB and no-reflow as well as hospitalization duration were higher in patients with non-O blood groups. Gensini score did not differ between groups. During the in-hospital and long-term follow-up period, MACE, the prevalence of stent thrombosis, non-fatal MI, and mortality were higher in non-O blood groups. In multivariate logistic regression analysis, non-0 blood groups were demonstrated to be independent predictors of in-hospital (OR:2.085 %CI: 1.328-3.274 p=0.001) and long term MACE (OR:2.257 %CI: 1.325-3.759 pblood group compared with O blood group (pblood groups were determined to be significant prognostic indicators of short- and long-term cardiovascular adverse events and mortality in patients with STEMI undergoing pPCI. In conjunction with other prognostic factors, evaluation of this parameter may improve the risk categorization and tailoring the individual therapy and follow-up in STEMI patient population. Copyright © 2015 Elsevier Ltd. All rights reserved.

Patient perception of pain care in hospitals in the United States

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Anita Gupta

2009-11-01

Full Text Available Anita Gupta1, Sarah Daigle2, Jeffrey Mojica3, Robert W Hurley41Pain Management Division, Department of Anesthesiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA; 2Department of Anesthesiology and Critical Care, 3Department of Anesthesiology and Critical Care, Division of Pain Medicine, University of Pennsylvania, Philadelphia, PA, USA; 4Medical Director of the Johns Hopkins Pain Treatment Center, Division of Pain Medicine, Deparment of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USAStudy objective: Assessment of patients’ perception of pain control in hospitals in the United States.Background: Limited data are available regarding the quality of pain care in the hospitalized patient. This is particularly valid for data that allow for comparison of pain outcomes from one hospital to another. Such data are critical for numerous reasons, including allowing patients and policy-makers to make data-driven decisions, and to guide hospitals in their efforts to improve pain care. The Hospital Quality Alliance was recently created by federal policy makers and private organizations in conjunction with the Centers for Medicare and Medicare Services to conduct patient surveys to evaluate their experience including pain control during their hospitalization.Methods: In March 2008, the results of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS survey was released for review for health care providers and researchers. This survey includes a battery of questions for patients upon discharge from the hospital including pain-related questions and patient satisfaction that provide valuable data regarding pain care nationwide. This study will review the results from the pain questions from this available data set and evaluate the performance of these hospitals in pain care in relationship to patient satisfaction. Furthermore, this analysis will be providing valuable

77 FR 63751 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

Science.gov (United States)

2012-10-17

... [CMS-1588-F2] RIN 0938-AR12 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates..., 2012 Federal Register entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for...

Hospital employees' theoretical knowledge on what to do in an in-hospital cardiac arrest

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Herlitz Johan

2010-08-01

Full Text Available Abstract Background Guidelines recommend that all health care professionals should be able to perform cardiopulmonary resuscitation (CPR, including the use of an automated external defibrillator. Theoretical knowledge of CPR is then necessary. The aim of this study was to investigate how much theoretical knowledge in CPR would increase among all categories of health care professionals lacking training in CPR, in an intervention hospital, after a systematic standardised training. Their results were compared with the staff at a control hospital with an ongoing annual CPR training programme. Methods Health care professionals at two hospitals, with a total of 3144 employees, answered a multiple-choice questionnaire before and after training in CPR. Bootstrapped chi-square tests and Fisher's exact test were used for the statistical analyses. Results In the intervention hospital, physicians had the highest knowledge pre-test, but other health care professionals including nurses and assistant nurses reached a relatively high level post-test. Improvement was inversely related to the level of previous knowledge and was thus most marked among other health care professionals and least marked among physicians. The staff at the control hospital had a significantly higher level of knowledge pre-test than the intervention hospital, whereas the opposite was found post-test. Conclusions Overall theoretical knowledge increased after systematic standardised training in CPR. The increase was more pronounced for those without previous training and for those staff categories with the least medical education.

Hospital administrator's perspectives regarding the health care industry.

Science.gov (United States)

McDermott, D R; Little, M W

1988-01-01

Based on responses from 52 hospital administrators, four areas of managerial concern have been addressed, including: (1) decision-making factors; (2) hospital service offerings: current and future; (3) marketing strategy and service priorities; and (4) health care industry challenges. Of the total respondents, 35 percent indicate a Director of Marketing has primary responsibility for making marketing-related decisions in their hospital, and 19 percent, a Vice-President of Marketing, thus demonstrating the increased priority of the marketing function. The continued importance of the physician being the primary market target is highlighted by 70 percent of the administrators feeling physician referrals will be more important regarding future admissions than in the past, compared to only two percent feeling the physicians' role will be less important. Of primary importance to patients selecting a hospital, as perceived by the administrators, are the physician's referral, the patient's previous experience, the hospital's reputation, and the courtesy of the staff. The clear majority of the conventional-care hospitals surveyed offer out-patient surgery, a hospital pharmacy, obstetrics/maternity care, and diabetic services. The future emphasis on expanding services is evidenced by some 50 percent of the hospital administrators indicating they either possibly or definitely plan to offer long-term nursing care, out-patient substance abuse programs, and cancer clinics by 1990. In addition, some one-third of the respondents are likely to expand their offerings to include wellness/fitness centers, in-patient substance abuse programs, remote or satellite primary care clinics, and diabetic services. Other areas having priority for future offerings include services geared specifically toward women and the elderly. Perceived as highest in priority by the administrators regarding how their hospital can achieve its goals in the next three years are market development strategies

Severe maternal morbidity in Zanzibar’s referral hospital : Measuring the impact of in-hospital care

NARCIS (Netherlands)

Herklots, Tanneke; Van Acht, Lieke; Meguid, Tarek; Franx, Arie; Jacod, Benoit

2017-01-01

Objective: to analyse the impact of in-hospital care on severe maternal morbidity using WHO’s near-miss approach in the low-resource, high mortality setting of Zanzibar’s referral hospital. Setting: Mnazi Mmoja Hospital, a tertiary care facility, in Zanzibar, Tanzania. Methods: We identified all

Processes of early stroke care and hospital costs

DEFF Research Database (Denmark)

Svendsen, Marie Louise; Ehlers, Lars H; Hundborg, Heidi H

2014-01-01

Background: The relationship between processes of early stroke care and hospital costs remains unclear. Aims: We therefore examined the association in a population-based cohort study. Methods: We identified 5909 stroke patients who were admitted to stroke units in a Danish county between 2005...... of hospitalization were $23352 (standard deviation 27827). The relationship between receiving more relevant processes of early stroke care and lower hospital costs followed a dose-response relationship. The adjusted costs were $24566 (95% confidence interval 19364-29769) lower for patients who received 75......-100% of the relevant processes of care compared with patients receiving 0-24%. All processes of care were associated with potential cost savings, except for early catheterization and early thromboembolism prophylaxis. Conclusions: Early care in agreement with key guidelines recommendations for the management...

How to Manage Hospital-Based Palliative Care Teams Without Full-Time Palliative Care Physicians in Designated Cancer Care Hospitals: A Qualitative Study.

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Sakashita, Akihiro; Kishino, Megumi; Nakazawa, Yoko; Yotani, Nobuyuki; Yamaguchi, Takashi; Kizawa, Yoshiyuki

2016-07-01

To clarify how highly active hospital palliative care teams can provide efficient and effective care regardless of the lack of full-time palliative care physicians. Semistructured focus group interviews were conducted, and content analysis was performed. A total of 7 physicians and 6 nurses participated. We extracted 209 codes from the transcripts and organized them into 3 themes and 21 categories, which were classified as follows: (1) tips for managing palliative care teams efficiently and effectively (7 categories); (2) ways of acquiring specialist palliative care expertise (9 categories); and (3) ways of treating symptoms that are difficult to alleviate (5 categories). The findings of this study can be used as a nautical chart of hospital-based palliative care team (HPCT) without full-time PC physician. Full-time nurses who have high management and coordination abilities play a central role in resource-limited HPCTs. © The Author(s) 2015.

SCI Hospital in Home Program: Bringing Hospital Care Home for Veterans With Spinal Cord Injury.

Science.gov (United States)

Madaris, Linda L; Onyebueke, Mirian; Liebman, Janet; Martin, Allyson

2016-01-01

The complex nature of spinal cord injury (SCI) and the level of care required for health maintenance frequently result in repeated hospital admissions for recurrent medical complications. Prolonged hospitalizations of persons with SCI have been linked to the increased risk of hospital-acquired infections and development or worsening pressure ulcers. An evidence-based alternative for providing hospital-level care to patients with specific diagnoses who are willing to receive that level of care in the comfort of their home is being implemented in a Department of Veterans Affairs SCI Home Care Program. The SCI Hospital in Home (HiH) model is similar to a patient-centered interdisciplinary care model that was first introduced in Europe and later tested as part of a National Demonstration and Evaluation Study through Johns Hopkins School of Medicine and School of Public Health. This was funded by the John A. Hartford Foundation and the Department of Veterans Affairs. The objectives of the program are to support veterans' choice and access to patient-centered care, reduce the reliance on inpatient medical care, allow for early discharge, and decrease medical costs. Veterans with SCI who are admitted to the HiH program receive daily oversight by a physician, daily visits by a registered nurse, access to laboratory services, oxygen, intravenous medications, and nursing care in the home setting. In this model, patients may typically access HiH services either as an "early discharge" from the hospital or as a direct admit to the program from the emergency department or SCI clinic. Similar programs providing acute hospital-equivalent care in the home have been previously implemented and are successfully demonstrating decreased length of stay, improved patient access, and increased patient satisfaction.

Cardiovascular risk factor assessment after pre-eclampsia in primary care

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Numans Mattijs E

2009-12-01

Full Text Available Abstract Background Pre-eclampsia is associated with an increased risk of development of cardiovascular disease later in life. It is not known how general practitioners in the Netherlands care for these women after delivery with respect to cardiovascular risk factor management. Methods Review of medical records of 1196 women in four primary health care centres, who were registered from January 2000 until July 2007 with an International Classification of Primary Care (ICPC code indicating pregnancy. Records were searched for indicators of pre-eclampsia. Of those who experienced pre-eclampsia and of a random sample of 150 women who did not, the following information on cardiovascular risk factor management after pregnancy was extracted from the records: frequency and timing of blood pressure, cholesterol and glucose measurements - and vascular diagnoses. Additionally the sensitivity and specificity of ICPC coding for pre-eclampsia were determined. Results 35 women experienced pre-eclampsia. Blood pressure was more often checked after pregnancy in these women than in controls (57.1% vs. 12.0%, p Conclusion Despite the evidence of increased risk of future cardiovascular disease in women with a history of pre-eclampsia, follow-up of these women is insufficient and undeveloped in primary care in the Netherlands.

Determinants of magnesium sulphate use in women hospitalized at <29 weeks with severe or non-severe pre-eclampsia.

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Dane A De Silva

Full Text Available Magnesium sulphate is recommended by international guidelines to prevent eclampsia among women with pre-eclampsia, especially when it is severe, but fewer than 70% of such women receive magnesium sulphate. We aimed to identify variables that prompt Canadian physicians to administer magnesium sulphate to women with pre-eclampsia.Data were used from the Canadian Perinatal Network (2005-11 of women hospitalized at <29 weeks' who were thought to be at high risk of delivery due to pre-eclampsia (using broad Canadian definition. Unadjusted analyses of relative risks were estimated directly and population attributable risk percent (PAR% calculated to identify variables associated with magnesium sulphate use. A multivariable model was created and a generalized estimating equation was used to estimate the adjusted RR that explained magnesium sulphate use in pre-eclampsia. The adjusted PAR% was estimated by bootstrapping.Of 631 women with pre-eclampsia, 174 (30.1% had severe pre-eclampsia, of whom 131 (75.3% received magnesium sulphate. 457 (69.9% women had non-severe pre-eclamspia, of whom 291 (63.7% received magnesium sulphate. Use of magnesium sulphate among women with pre-eclampsia could be attributed to the following clinical factors (PAR%: delivery for 'adverse conditions' (48.7%, severe hypertension (21.9%, receipt of antenatal corticosteroids (20.0%, maternal transport prior to delivery (9.9%, heavy proteinuria (7.8%, and interventionist care (3.4%.Clinicians are more likely to administer magnesium sulphate for eclampsia prophylaxis in the presence of more severe maternal clinical features, in addition to concomitant antenatal corticosteroid administration, and shorter admission to delivery periods related to transport from another institution or plans for interventionist care.

THE EFFECT OF STORYTELLING IN A PLAY THERAPY ON ANXIETY LEVEL IN PRE-SCHOOL CHILDREN DURING HOSPITALIZATION IN THE GENERAL HOSPITAL OF BUTON

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Mimi Yati

2017-09-01

Full Text Available Background: Anxiety is one of the psychical stresses experienced by children during hospitalization. A storytelling in a play therapy is considered effective in reducing anxiety. Objective: This study aims to determine the effect of storytelling in a play therapy on anxiety level in pre-school children during hospitalization in the general hospital of Buton. Methods: This was a quasy-experimental study with pretest-posttest control group design. There were 30 pre-school children selected in this study using accidental sampling, with 15 assigned in each group. The Pre School - Spence Children’s Anxiety Scale (SCAS was used to measure anxiety in pre-school children. Wilcoxon matched paired test was used to analyze the data. Results: Findings showed that the mean of anxiety level in the intervention group in pretest was 42 and in posttest was 31.53. Wilcoxon matched paired test showed p-value 0.003 (<0.05, which indicated that there was a statistically significant effect of storytelling on the level of anxiety in pre-school children. Conclusions: There is a significant influence of storytelling in a play therapy on anxiety levels in pre school children during hospitalization. It is suggested that this intervention could be applied as a nursing intervention to reduce anxiety in children.

The impact of HMOs on hospital-based uncompensated care.

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Thorpe, K E; Seiber, E E; Florence, C S

2001-06-01

Managed care in general and HMOs in particular have become the vehicle of choice for controlling health care spending in the private sector. By several accounts, managed care has achieved its cost-containment objectives. At the same time, the percentage of Americans without health insurance coverage continues to rise. For-profit and not-for-profit hospitals have traditionally financed care for the uninsured from profits derived from patients with insurance. Thus the relationship between growth in managed care and HMOs, hospital "profits," and care for the uninsured represent an important policy question. Using national data over an eight-year period, we find that a ten-percentage point increase in managed care penetration is associated with a two-percentage point reduction in hospital total profit margin and a 0.6 percentage point decrease in uncompensated care.

Shifting hospital care to primary care: An evaluation of cardiology care in a primary care setting in the Netherlands.

Science.gov (United States)

Quanjel, Tessa C C; Struijs, Jeroen N; Spreeuwenberg, Marieke D; Baan, Caroline A; Ruwaard, Dirk

2018-05-09

In an attempt to deal with the pressures on the healthcare system and to guarantee sustainability, changes are needed. This study is focused on a cardiology Primary Care Plus intervention in which cardiologists provide consultations with patients in a primary care setting in order to prevent unnecessary referrals to the hospital. This study explores which patients with non-acute and low-complexity cardiology-related health complaints should be excluded from Primary Care Plus and referred directly to specialist care in the hospital. This is a retrospective observational study based on quantitative data. Data collected between January 1 and December 31, 2015 were extracted from the electronic medical record system. Logistic regression analyses were used to select patient groups that should be excluded from referral to Primary Care Plus. In total, 1525 patients were included in the analyses. Results showed that male patients, older patients, those with the referral indication 'Stable Angina Pectoris' or 'Dyspnoea' and patients whose reason for referral was 'To confirm disease' or 'Screening of unclear pathology' had a significantly higher probability of being referred to hospital care after Primary Care Plus. To achieve efficiency one should exclude patient groups with a significantly higher probability of being referred to hospital care after Primary Care Plus. NTR6629 (Data registered: 25-08-2017) (registered retrospectively).

Kenya Hospices and Palliative Care Association: integrating palliative care in public hospitals in Kenya.

Science.gov (United States)

Ali, Zipporah

2016-01-01

In Kenya, cancers as a disease group rank third as a cause of death after infectious and cardiovascular diseases. It is estimated that the annual incidence of cancer is about 37,000 new cases with an annual mortality of 28,000 cases (Kenya National Cancer Control Strategy 2010). The incidence of non-communicable diseases accounts for more than 50% of total hospital admissions and over 55% of hospital deaths (Kenya National Strategy for the Prevention and Control of Non Communicable Diseases 2015-2020). The prevalence of HIV is 6.8 (KIAS 2014). Most of these patients will benefit from palliative care services, hence the need to integrate palliative care services in the public healthcare system. The process of integrating palliative care in public hospitals involved advocacy both at the national level and at the institutional level, training of healthcare professionals, and setting up services within the hospitals that we worked with. Technical support was provided to each individual institution as needed. Eleven provincial hospitals across the country have now integrated palliative care services (Palliative Care Units) and are now centres of excellence. Over 220 healthcare providers have been trained, and approximately, over 30,000 patients have benefited from these services. Oral morphine is now available in the hospital palliative care units. As a success of the pilot project, Kenya Hospices and Palliative Care Association (KEHPCA) is now working with the Ministry of Health Kenya to integrate palliative care services in 30 other county hospitals across the country, thus ensuring more availability and access to more patients. Other developing countries can learn from Kenya's successful experience.

Post-Hospital Medical Respite Care and Hospital Readmission of Homeless Persons

Science.gov (United States)

Kertesz, Stefan G.; Posner, Michael A.; O’Connell, James J.; Swain, Stacy; Mullins, Ashley N.; Michael, Shwartz; Ash, Arlene S.

2009-01-01

Medical respite programs offer medical, nursing, and other care as well as accommodation for homeless persons discharged from acute hospital stays. They represent a community-based adaptation of urban health systems to the specific needs of homeless persons. This paper examines whether post-hospital discharge to a homeless medical respite program was associated with a reduced chance of 90-day readmission compared to other disposition options. Adjusting for imbalances in patient characteristics using propensity scores, Respite patients were the only group that was significantly less likely to be readmitted within 90 days compared to those released to Own Care. Respite programs merit attention as a potentially efficacious service for homeless persons leaving the hospital. PMID:19363773

Pre-Employment Laboratory Education. Child Care Guidebook.

Science.gov (United States)

Texas Tech Univ., Lubbock. Home Economics Instructional Materials Center.

This guidebook is designed for use in teaching students enrolled in secondary pre-employment laboratory education (PELE) child care programs. The first of two major sections includes an overview for teachers in planning, conducting, and evaluating a child care program. Specific topics discussed in section 1 include (1) the school-operated center,…

A Study of Platelet Inhibition, Using a 'Point of Care' Platelet Function Test, following Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction [PINPOINT-PPCI].

Science.gov (United States)

Johnson, Thomas W; Mumford, Andrew D; Scott, Lauren J; Mundell, Stuart; Butler, Mark; Strange, Julian W; Rogers, Chris A; Reeves, Barnaby C; Baumbach, Andreas

2015-01-01

Rapid coronary recanalization following ST-elevation myocardial infarction (STEMI) requires effective anti-platelet and anti-thrombotic therapies. This study tested the impact of door to end of procedure ('door-to-end') time and baseline platelet activity on platelet inhibition within 24hours post-STEMI. 108 patients, treated with prasugrel and procedural bivalirudin, underwent Multiplate® platelet function testing at baseline, 0, 1, 2 and 24hours post-procedure. Major adverse cardiac events (MACE), bleeding and stent thrombosis (ST) were recorded. Baseline ADP activity was high (88.3U [71.8-109.0]), procedural time and consequently bivalirudin infusion duration were short (median door-to-end time 55minutes [40-70] and infusion duration 30minutes [20-42]). Baseline ADP was observed to influence all subsequent measurements of ADP activity, whereas door-to-end time only influenced ADP immediately post-procedure. High residual platelet reactivity (HRPR ADP>46.8U) was observed in 75% of patients immediately post-procedure and persisted in 24% of patients at 2hours. Five patients suffered in-hospital MACE (4.6%). Acute ST occurred in 4 patients, all were <120mins post-procedure and had HRPR. No significant bleeding was observed. In a post-hoc analysis, pre-procedural morphine use was associated with significantly higher ADP activity following intervention. Baseline platelet function, time to STEMI treatment and opiate use all significantly influence immediate post-procedural platelet activity.

Long-term clinical outcome in STEMI patients treated with primary PCI and drug-eluting or bare-metal stents: insights from a high-volume single-center registry

DEFF Research Database (Denmark)

Pedersen, Sune; Galatius, Soren; Mogelvang, Rasmus

2011-01-01

Use of drug-eluting stents (DES) in patients with ST-elevation myocardial infarction (STEMI) during routine primary percutaneous coronary intervention (pPCI) is controversial.......Use of drug-eluting stents (DES) in patients with ST-elevation myocardial infarction (STEMI) during routine primary percutaneous coronary intervention (pPCI) is controversial....

Effects of Implementing STEM-I Project-Based Learning Activities for Female High School Students

Science.gov (United States)

Lou, Shi-Jer; Tsai, Huei-Yin; Tseng, Kuo-Hung; Shih, Ru-Chu

2014-01-01

This study aims to explore the application of STEM-I (STEM-Imagination) project-based learning activities and its effects on the effectiveness, processes, and characteristics of STEM integrative knowledge learning and imagination development for female high school students. A total of 72 female high school students were divided into 18 teams.…

Health care waste management practice in a hospital.

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Paudel, R; Pradhan, B

2010-10-01

Health-care waste is a by-product of health care. Its poor management exposes health-care workers, waste handlers and the community to infections, toxic effects and injuries including damage of the environment. It also creates opportunities for the collection of disposable medical equipment, its re-sale and potential re-use without sterilization, which causes an important burden of disease worldwide. The purpose of this study was to find out health care waste management practice in hospital. A cross-sectional study was conducted in Narayani Sub-Regional Hospital, Birgunj from May to October 2006 using both qualitative and quantitative methods. Study population was four different departments of the hospital (Medical/Paediatric, Surgical/Ortho, Gynae/Obstetric and Emergency), Medical Superintendent, In-charges of four different departments and all sweepers. Data was collected using interview, group discussion, observation and measurement by weight and volume. Total health-care waste generated was 128.4 kg per day while 0.8 kg per patient per day. The composition of health care waste was found to be 96.8 kg (75.4%) general waste, 24.1 kg (8.8%) hazardous waste and 7.5 kg (5.8%) sharps per day by weight. Health staffs and sweepers were not practicing the waste segregation. Occupational health and safety was not given due attention. Majority of the sweepers were unaware of waste management and need of safety measures to protect their own health. Health care waste management practice in the hospital was unsatisfactory because of the lack of waste management plan and carelessness of patients, visitors and staffs. Therefore the hospital should develop the waste management plan and strictly follow the National Health Care Waste Management Guideline.

Does an in-house internist at a GP practice result in reduced referrals to hospital-based specialist care?

Science.gov (United States)

Quanjel, Tessa C C; Winkens, Anne; Spreeuwenberg, Marieke D; Struijs, Jeroen N; Winkens, Ron A G; Baan, Caroline A; Ruwaard, Dirk

2018-03-01

Consistent evidence on the effects of specialist services in the primary care setting is lacking. Therefore, this study evaluated the effects of an in-house internist at a GP practice on the number of referrals to specialist care in the hospital setting. Additionally, the involved GPs and internist were asked to share their experiences with the intervention. A retrospective interrupted times series study. Two multidisciplinary general practitioner (GP) practices. An internist provided in-house patient consultations in two GP practices and participated in the multidisciplinary meetings. The referral data extracted from the electronic medical record system of the GP practices, including all referral letters from the GPs to specialist care in the hospital setting. The number of referrals to internal medicine in the hospital setting. This study used an autoregressive integrated moving average model to estimate the effect of the intervention taking account of a time trend and autocorrelation among the observations, comparing the pre-intervention period with the intervention period. It was found that the referrals to internal medicine did not statistically significant decrease during the intervention period. This small explorative study did not find any clues to support that an in-house internist at a primary care setting results in a decrease of referrals to internal medicine in the hospital setting. Key Points An in-house internist at a primary care setting did not result in a significant decrease of referrals to specialist care in the hospital setting. The GPs and internist experience a learning-effect, i.e. an increase of knowledge about internal medicine issues.

Participation of informal caregivers in the hospital care of elderly patients and their evaluations of the care given: pilot study in three different hospitals.

Science.gov (United States)

Laitinen, P

1992-10-01

This action research is an ongoing study which will last from 1991 to 1993. The main purpose of the study is to increase the participation of informal caregivers in the hospital care of elderly patients without decreasing the quality of care. The data reported here are from a pilot study. This study had three aims: (a) to test reliability and validity of the measure used, (b) to investigate the current participation of informal caregivers in the hospital care of elderly patients (aged over 75), and (c) to evaluate and compare the quality of care from both the patients' and the informal caregivers' point of view in three different hospitals. The measure of quality of care was developed on the basis of need theories, mainly those of Maslow and Alderfer. Patients and caregivers were also asked to rate the participation of the caregivers in the hospital care of elderly patients. Participation consisted of 18 activities of daily living. The pilot test with 18 elderly hospital patients and seven family members or significant others showed differences between the two groups in perception of care received. Statistically significant differences (P needs, psychic and spiritual needs and totals. The results supported earlier findings that elderly patients are satisfied with and do not criticize their care. The younger generation (i.e. their children) is more demanding and has precise perceptions about the care given. Relatives could be used more in planning, evaluation and even implementation of care; however, their current participation in patient hospital care is minimal.

Managed Care, Distance Traveled, and Hospital Market Definition

OpenAIRE

Frech, Ted E

1998-01-01

Most scholars and antitrust cases have defined hospital service markets as primarily local. But, two recent decisions have greatly expanded geographic markets, incorporating hospitals as far as 100 miles apart. Managed care plans, now important in most markets, were believed to shift patients to distant hospitals to capture lower prices. We examine distance traveled and its connection to managed care penetration. In contrast to earlier literature, we examine both direct and indirect effects. ...

Residential aged care residents and components of end of life care in an Australian hospital.

Science.gov (United States)

Leong, Laurence Jee Peng; Crawford, Gregory Brian

2018-06-09

With ageing of Australians, the numbers of residential aged care (RAC) residents is rising. This places a spotlight on decisions about appropriate care for this population, including hospitalisation and end-of-life (EOL) care. The aim was to study a sample of RAC residents who attended and died in hospital, to quantify measurable components of EOL care so as to describe the extent of palliative care required. A retrospective case-note review of hospital records was conducted in Adelaide, Australia. Participants were 109 RAC residents who attended from July 2013 to June 2014 and died in hospital. Measurements were advance care planning, health care input from the RAC facilities to hospital and components of EOL care. Residents with and without advanced dementia were compared. Advance care directives (ACDs) were present from 11 to 50%, and advance care plans (ACPs) at 60%. There were more ACPs, resuscitation orders (for/against) and do-not-hospitalise orders in residents with advanced dementia than those without. General practitioner (GP) and extended care paramedic (ECP) input on decisions for hospital transfer were 30% and 1 %. Mean hospital stay to death was 5.2 days. For residents admitted under non-palliative care teams, specialist palliative care (SPC) was needed for phone advice in 5%, consultation in 45%, transfer to palliative care unit in 37%, and takeover by SPC team in 19%. Mean number of documented goals-of-care discussions with family/caregiver was 1.7. In the last 3 days of life, the mean daily number of doses of EOL medications was 4.2. Continuous subcutaneous infusion was commenced in 35%. Staff in RAC need to be adequately resourced to make complex decisions about whether to transfer to hospital. RAC nurses are mainly making these decisions as GP and ECP input were suboptimal. Ways to support nurses and optimise decision-making are needed. Advance care planning can be improved, especially documentation of EOL wishes and hospitalisation orders. By

Effect of a comprehensive health education program on pre-hospital delay intentions in high-risk stroke population and caregivers.

Science.gov (United States)

Yang, Li; Zhao, Qiuli; Zhu, Xuemei; Shen, Xiaoying; Zhu, Yulan; Yang, Liu; Gao, Wei; Li, Minghui

2017-08-01

Many factors influence pre-hospital delays in the event of stroke. This study aimed to develop and evaluate a comprehensive educational program for decreasing pre-hospital delays in high-risk stroke population. We enrolled 220 high-risk stroke population and caregivers from six urban communities in Harbin from May 2013 to May 2015, and randomly divided them into intervention and control groups. We implemented a comprehensive educational program (intervention group), comprising public lectures, instructional brochures, case videos, simulations, and role-playing from May 2013 to May 2015. We delivered conventional oral education in the control group. We compared stroke pre-hospital delay behavioral intention (SPDBI), pre-hospital stroke symptom coping test (PSSCT), and stroke pre-symptoms alert test (SPSAT) results between the groups before and 6, 12, and 18 months after health intervention. There were significant differences between before and after intervention (P educational program was significantly effective in decreasing SPDBI, improving knowledge, enhancing stroke pre-symptoms alert, and reducing the possibility of pre-hospital delays.

B-type Natriuretic Peptide and RISK-PCI Score in the Risk Assessment in Patients with STEMI Treated by Primary Percutaneous Coronary Intervention.

Science.gov (United States)

Asanin, Milika; Mrdovic, Igor; Savic, Lidija; Matic, Dragan; Krljanac, Gordana; Vukcevic, Vladan; Orlic, Dejan; Stankovic, Goran; Marinkovic, Jelena; Stankovic, Sanja

2016-01-01

RISK-PCI score is a novel score for risk stratification of patients with ST elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (pPCI). The aim of this study was to evaluate the role of B-type natriuretic peptide (BNP) and the RISK-PCI score for early risk assessment in patients with STEMI treated by pPCI. In 120 patients with STEMI treated by pPCI, BNP was measured on admission before pPCI. The primary end point was 30-day mortality. The ROC curve analysis revealed that the most powerful predictive factors of 30-day mortality were the plasma level of BNP ≥ 206.6 pg/mL with the sensitivity of 75% and specificity of 87.5% and the RISK-PCI score ≥ 5.25 with the sensitivity of 75% and specificity of 85.7%. Thirty-day mortality was 6.7%. After multivariate adjustment, admission BNP (≥ 206.6 pg/mL) (OR 2.952, 95% CI 1.072 - 8.133, p = 0.036) and the RISK-PCI score (≥ 5.25) (OR 2.284, 95% CI 1.140-4.578, p = 0.020) were independent predictors of 30-day mortality. The area under the ROC curve using the RISK-PCI score and BNP to detect mortality was 0.828 (p = 0.002) and 0.903 (p PCI score increased the area under the ROC to 0.949 (p PCI score for 30-day mortality. BNP on admission and the RISK-PCI score were the independent predictors of 30-day mortality in patients with the STEMI treated by pPCI. BNP in combination with the RISK-PCI score showed the way to more accurate risk assessment in patients with STEMI treated by pPCI.

Using In-Hospital Mortality as an Indicator of Quality Care and Hospital Performance

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Badia BISBIS

2016-06-01

Full Text Available The in-hospital mortality (MIH is used as a performance indicator and quality healthcare in hospital. However, the majority of deaths resulted from an inevitable disease process (severity of cases and / or co-morbidity, and not medical errors or changes in the quality of care. This work aims to make a distribution of deaths in the Regional Hospital of Eastern, Al Farabi hospital and to highlight that more studies on the MIH are required consistently with detailed clinical data at the admission. The MIH showed its limitation as a health care  indicator. The overall rate of in-hospital deaths within the Al Farabi hospital has averaged 2.4%, with 8.4% in the emergency unit, 28% in intensive care unit, 22% Neonatology unit, 1.6% in pediatric unit. The MIH may depend, firstly, on the condition of patients before hospitalization and secondly, on the conditions of their transfer from one institution to another that supports them as a last resort. Al Farabi hospital supports patients transferred from the provinces of the eastern region. Thus, 6% of patients who died in 2014 come from Berkane, 2% from  Nador, 2% from Bouarfa, 4% from  Taourirt and 2% from Jerrada. One might question about  the procedures and the conditions of such transfers. In conclusion, the overall MIH measured from routine data do not allow proper comparison between hospitals or the assessment of the quality of care and patient safety in the hospital. To do so, we should ideally have detailed clinical data on admission (e.g. type of admission, age of patient, sex, comorbidity, .... The MIH is however an important indicator to consider as a tool to detect potential  problems related to admission procedures and to suspect an area of "non-quality" in healthcare . The MIH is interesting for the patient and for the hospital because it serves the improvement of quality healthcare.

The Maternity Care Nurse Workforce in Rural U.S. Hospitals.

Science.gov (United States)

Henning-Smith, Carrie; Almanza, Jennifer; Kozhimannil, Katy B

To describe the maternity care nurse staffing in rural U.S. hospitals and identify key challenges and opportunities in maintaining an adequate nursing workforce. Cross-sectional survey study. Maternity care units within rural hospitals in nine U.S. states. Maternity care unit managers. We calculated descriptive statistics to characterize the rural maternity care nursing workforce by hospital birth volume and nursing staff model. We used simple content analysis to analyze responses to open-ended questions and identified themes related to challenges and opportunities for maternity care nursing in rural hospitals. Of the 263 hospitals, 51% were low volume (maternity care nurses. They did, however, identify significant challenges related to recruiting nurses, maintaining adequate staffing during times of census variability, orienting and training nurses, and retaining experienced nurses. Rural maternity care unit managers recognize the importance of nursing and have varied staffing needs. Policy implementation and programmatic support to ameliorate challenges may help ensure that an adequate nursing staff can be maintained, even in small-volume rural hospitals. Copyright © 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

Pre-hospital Management of the Fractured Femur Using the ...

African Journals Online (AJOL)

Two aspects of the early management of the fractured femur are discussed: firstly the immediate treatment in the pre-hospital phase and secondly the transportation of this injury case over a long distance where necessary. In both instances there is considerable room for improvement, and this is discussed, particularly with ...

Hospital heterogeneity: what drives the quality of health care.

Science.gov (United States)

Ali, Manhal; Salehnejad, Reza; Mansur, Mohaimen

2018-04-01

A major feature of health care systems is substantial variation in health care quality across hospitals. The quality of stroke care widely varies across NHS hospitals. We investigate factors that may explain variations in health care quality using measures of quality of stroke care. We combine NHS trust data from the National Sentinel Stroke Audit with other data sets from the Office for National Statistics, NHS and census data to capture hospitals' human and physical assets and organisational characteristics. We employ a class of non-parametric methods to explore the complex structure of the data and a set of correlated random effects models to identify key determinants of the quality of stroke care. The organisational quality of the process of stroke care appears as a fundamental driver of clinical quality of stroke care. There are rich complementarities amongst drivers of quality of stroke care. The findings strengthen previous research on managerial and organisational determinants of health care quality.

Home care, hospitalizations and doctor visits

OpenAIRE

Gonçalves Judite; Weaver France

2014-01-01

This study estimates the effects of formal home care on hospitalizations and doctor visits. We compare the effects of medically- and non-medically-related home care and investigate heterogeneous effects by age group and informal care availability. Two-part models are estimated, using data from Switzerland. In this federal country, home care policy is decentralized into cantons (i.e. states). The endogeneity of home care is addressed by using instrumental variables, canton and time fixed effec...

Criteria-based audit of quality of care to women with severe pre-eclampsia and eclampsia in a referral hospital in Accra, Ghana

NARCIS (Netherlands)

Browne, Joyce L.; Van Nievelt, Sabine W.; Srofenyoh, Emmanuel K.; Grobbee, Diederick E.; Klipstein-Grobusch, Kerstin

2015-01-01

Objectives Severe pre-eclampsia and eclampsia are one of the major causes of maternal mortality globally. Reducing maternal morbidity and mortality demands optimizing quality of care. Criteria-based audits are a tool to define, assess and improve quality of care. The aim of this study was to

Primary PCI as the preferred reperfusion therapy in STEMI: it is a matter of time

DEFF Research Database (Denmark)

Terkelsen, C J; Christiansen, E H; Sørensen, J T

2009-01-01

There is a continuing controversy about the acceptable time-window for primary percutaneous coronary intervention (PPCI) in patients with ST-elevation myocardial infarction (STEMI). Recent American and European guidelines recommend PPCI if the delay in performing PPCI instead of administering...... directly to catheterisation laboratories running 24/7....

Predictors of in-hospital mortality for patients admitted with ST-elevation myocardial infarction: a real-world study using the Myocardial Infarction National Audit Project (MINAP) database.

Science.gov (United States)

Gale, C P; Manda, S O M; Batin, P D; Weston, C F; Birkhead, J S; Hall, A S

2008-11-01

Although early thrombolysis reduces the risk of death in STEMI patients, mortality remains high. We evaluated factors predicting inpatient mortality for patients with STEMI in a "real-world" population. Analysis of the Myocardial Infarction National Audit Project (MINAP) database using multivariate logistic regression and area under the receiver operating curve analysis. All acute hospitals in England and Wales. 34 722 patients with STEMI from 1 January 2003 to 31 March 2005. Inpatient mortality was 10.6%. The highest odds ratios for inpatient survival were aspirin therapy given acutely and out-of-hospital thrombolysis, independently associated with a mortality risk reduction of over half. A 10-year increase in age doubled inpatient mortality risk, whereas cerebrovascular disease increased it by 1.7. The risk model comprised 14 predictors of mortality, C index = 0.82 (95% CI 0.82 to 0.83, pmodel comprising age, systolic blood pressure (SBP) and heart rate (HR) offered a C index of 0.80 (0.79 to 0.80, pmodels have focused on age, SBP and HR We have confirmed the importance of these predictors in the discrimination of death after STEMI, but also demonstrated that other potentially modifiable variables impact upon the prediction of short-term mortality.

Variability in the quality of rectal cancer care in public hospitals in Catalonia (Spain): clinical audit as a basis for action.

Science.gov (United States)

Manchon-Walsh, P; Borras, J M; Espinas, J A; Aliste, L

2011-04-01

Clinical practice guidelines in cancer are a relevant component of Catalonian Cancer Strategy aimed at promoting equity of access to therapy and quality of cancer care. The colorectal cancer (CRC) guideline was first published in 2003 and subsequently updated in 2008. This study examined the quality of therapy administered to patients with rectal cancer in public hospitals in Catalonia (Spain) in 2005 and 2007, according to CRC guideline recommendations. We conducted a multicentre retrospective cohort study of patients who underwent curative-intent surgery for primary rectal cancer at Catalonian public hospitals in 2005 and 2007. Data were drawn from clinical records. The study covered 1831 patients with rectal cancer. Performance of total mesorectal excision (TME) was poorly reported by surgeons (46.4%) and pathologists (36.2%). Pre-operative radiotherapy was performed on 52% of stage-II and -III patients. Compared to high-caseload hospitals, those with a low caseload (≤11 cases/year) registered more Hartman's procedures, worse TME quality, a higher rate of post-operative complications and lower adherence to recommended pre-operative radio-chemotherapy. Reporting quality of care is essential for ascertaining current performance status and opportunities for improvement. In our case, there is a need for the quality of the information included in clinical records to be improved, and variability in adherence to guideline recommendations to be reduced. In view of the fact that heterogeneity in the quality of the health care process was linked to hospital caseload, the health authorities have decided to reorganise the provision of rectal cancer care. Copyright © 2011 Elsevier Ltd. All rights reserved.

Atendimento pré-hospitalar: caracterização das ocorrências de acidente de trânsito Atención prehospitalaria: caracterización de las ocurrencias de accidentes de tránsito Pre-hospital care: characteristics of traffic accidents

Directory of Open Access Journals (Sweden)

Waleska Antunes da Porciúncula Pereira

2006-09-01

destacan el involucramiento del equipo de soporte básico en la atención prehospitalaria e indican la necesidad de prevención de esos daños y de calificación de los trabajadores para la estructuración del trabajo basado en la interdisciplinaridad.OBJECTIVES: to identify types of occurrence registered by a pre-hospital care unit and to characterize occurrences from traffic accidents. METHODS: a descriptive cross-sectional study was used to analyze 6,430 pre-hospital calls from July to September, 2003. RESULTS: the occurrences were classified as trauma (35.2 %, or traffic accidents (57.9%. Most occurrences took place in the afternoon and were common in all days of the week. The basic pre-hospital care team, consisting of a licensed practical nurse or associate degree nurse and an ambulance driver, was the team that answered most emergency calls (84.5%. A professional nurse participated in only 11.2% of the occurrences, and great part of these occurrences (4.27% was answered by the advanced pre-hospital care team. A physician participated in only 8.3% of occurrences. CONCLUSION: the basic pre-hospital care team was involved in the majority of emergency calls. This suggests a need of new strategies for preventing victim's complications and better ways to qualify pre-hospital care team members for a quality interdisciplinary-based work.

From acute care to home care: the evolution of hospital responsibility and rationale for increased vertical integration.

Science.gov (United States)

Dilwali, Prashant K

2013-01-01

The responsibility of hospitals is changing. Those activities that were once confined within the walls of the medical facility have largely shifted outside them, yet the requirements for hospitals have only grown in scope. With the passage of the Patient Protection and Affordable Care Act (ACA) and the development of accountable care organizations, financial incentives are focused on care coordination, and a hospital's responsibility now includes postdischarge outcomes. As a result, hospitals need to adjust their business model to accommodate their increased need to impact post-acute care settings. A home care service line can fulfill this role for hospitals, serving as an effective conduit to the postdischarge realm-serving as both a potential profit center and a risk mitigation offering. An alliance between home care agencies and hospitals can help improve clinical outcomes, provide the necessary care for communities, and establish a potentially profitable product line.

Demand-driven care and hospital choice. Dutch health policy toward demand-driven care: results from a survey into hospital choice.

Science.gov (United States)

Lako, Christiaan J; Rosenau, Pauline

2009-03-01

In the Netherlands, current policy opinion emphasizes demand-driven health care. Central to this model is the view, advocated by some Dutch health policy makers, that patients should be encouraged to be aware of and make use of health quality and health outcomes information in making personal health care provider choices. The success of the new health care system in the Netherlands is premised on this being the case. After a literature review and description of the new Dutch health care system, the adequacy of this demand-driven health policy is tested. The data from a July 2005, self-administered questionnaire survey of 409 patients (response rate of 94%) as to how they choose a hospital are presented. Results indicate that most patients did not choose by actively employing available quality and outcome information. They were, rather, referred by their general practitioner. Hospital choice is highly related to the importance a patient attaches to his or her physician's opinion about a hospital. Some patients indicated that their hospital choice was affected by the reputation of the hospital, by the distance they lived from the hospital, etc. but physician's advice was, by far, the most important factor. Policy consequences are important; the assumptions underlying the demand-driven model of patient health provider choice are inadequate to explain the pattern of observed responses. An alternative, more adequate model is required, one that takes into account the patient's confidence in physician referral and advice.

Impacts of market and organizational characteristics on hospital efficiency and uncompensated care.

Science.gov (United States)

Hsieh, Hui-Min; Clement, Dolores G; Bazzoli, Gloria J

2010-01-01

Hospitals have confronted a difficult financial environment given many factors, including expansion of managed care, changes in public policy, growing market competition for certain services, and growth in the number of uninsured. Policy makers have expressed concern that hospitals may forgo providing care to the indigent as a means to reduce costs and become more efficient when faced with financial pressures. This article examined the effects of environmental pressures on two dimensions of hospital performance: hospital efficiency and uncompensated care provision. Longitudinal data for the Commonwealth of Virginia from 1998 to 2004 were analyzed. Data Envelopment Analysis and bivariate probit were used to examine the factors associated with efficiency and uncompensated care. The results indicated that a positive relationship between hospital efficiency and uncompensated care provision exists. That is, hospitals that are categorized as efficient are likely to provide more uncompensated care. We also found that hospitals tended to provide more uncompensated care when increased demand for these services occurred in a market. Increases in Medicare or Medicaid patient share reduced the provision of uncompensated care. In relation to hospital efficiency, the results indicated that HMO penetration and Medicaid patient share reduced hospital efficiency. This study found that efficient hospitals tend to provide more uncompensated care over time. The findings also suggest that hospitals alter their efficiency and provision of uncompensated care in response to a number of environmental pressures, but it may depend on the type of pressures or uncertainties encountered.

Nurse led, primary care based antiretroviral treatment versus hospital care: a controlled prospective study in Swaziland

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Bailey Kerry A

2010-08-01

Full Text Available Abstract Background Antiretroviral treatment services delivered in hospital settings in Africa increasingly lack capacity to meet demand and are difficult to access by patients. We evaluate the effectiveness of nurse led primary care based antiretroviral treatment by comparison with usual hospital care in a typical rural sub Saharan African setting. Methods We undertook a prospective, controlled evaluation of planned service change in Lubombo, Swaziland. Clinically stable adults with a CD4 count > 100 and on antiretroviral treatment for at least four weeks at the district hospital were assigned to either nurse led primary care based antiretroviral treatment care or usual hospital care. Assignment depended on the location of the nearest primary care clinic. The main outcome measures were clinic attendance and patient experience. Results Those receiving primary care based treatment were less likely to miss an appointment compared with those continuing to receive hospital care (RR 0·37, p p = 0·001. Those receiving primary care based, nurse led care were more likely to be satisfied in the ability of staff to manage their condition (RR 1·23, p = 0·003. There was no significant difference in loss to follow-up or other health related outcomes in modified intention to treat analysis. Multilevel, multivariable regression identified little inter-cluster variation. Conclusions Clinic attendance and patient experience are better with nurse led primary care based antiretroviral treatment care than with hospital care; health related outcomes appear equally good. This evidence supports efforts of the WHO to scale-up universal access to antiretroviral treatment in sub Saharan Africa.

Introducing Namaste Care to the hospital environment: a pilot study.

Science.gov (United States)

St John, Kimberley; Koffman, Jonathan

2017-10-01

The rising prevalence of dementia is impacting on acute hospitals and placing increased expectations on health and social care professionals to improve the support and services they are delivering. It has been recommended that good practice in dementia care relies on adopting a palliative approach to care and meeting people's physical, psychological, social and spiritual needs. Increased dementia training for staff that includes initiatives that promote dignity; enhancing communication skills and recognizing that a person with dementia may be approaching the end of their lives are needed. Our study aim was to explore whether Namaste Care is an acceptable and effective service for people with advanced dementia being cared for on an acute hospital ward. This was an exploratory qualitative interview, pilot study. Individual, semi-structured, face-to-face interviews were conducted with hospital healthcare staff working in an area of the hospital where Namaste Care had been implemented. Data were analysed using the framework approach. Eight interviews were completed with members of the multidisciplinary ward team. Two themes were identified: (I) difficulties establishing relationships with people with dementia in hospital (subthemes: lack of time and resources, lack of confidence leading to fear and anxiety); (II) the benefits of a Namaste Care service in an acute hospital setting (subthemes: a reduction in agitated behavior; connecting and communicating with patients with dementia using the senses; a way of showing people with dementia they are cared for and valued). This small-scale study indicates that Namaste Case has the potential to improve the quality of life of people with advanced dementia being cared for in an acute hospital setting. However, further research is required to explore more specifically its benefits in terms of improved symptom management and wellbeing of people with dementia on acute hospitals wards.

Osteoprotegerin Levels Change During STEMI and Reflect Cardiac Function

DEFF Research Database (Denmark)

Lindberg, Søren; Jensen, Jan S; Hoffmann, Søren

2014-01-01

% confidence interval) before PCI, after PCI, and on day 1 and day 2 of 2650 ng/L (2315-3036 ng/L), 2778 ng/L (2442-3363 ng/L), 2024 ng/L (1775-230 6 ng/L), and 1808 ng/L (1551-2106 ng/L), respectively (P ...-reactive protein. Patients with reduced LVEF (P = 0.009). Adjustment for age, sex, body mass index, and cardiovascular risk factors did not significantly affect...... the association between reduced LVEF and increased OPG response (mean increase 33% (4%-70%; F = 5.784; P = 0.023). CONCLUSIONS: Circulating OPG levels are altered during STEMI treated with primary PCI. A high OPG level is independently associated with impaired LVEF....

Safety and feasibility of performing staged non-culprit vessel percutaneous coronary intervention within the index hospitalization in patients with ST-segment elevation myocardial infarction and multivessel disease

International Nuclear Information System (INIS)

Loh, Joshua P.; Kitabata, Hironori; Torguson, Rebecca; Satler, Lowell F.; Kent, Kenneth M.; Suddath, William O.; Pichard, Augusto D.; Lindsay, Joseph; Waksman, Ron

2013-01-01

Objectives: To determine whether staged percutaneous coronary intervention (PCI) within the same hospitalization as primary PCI is safe. Background: In ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease undergoing primary PCI, staged non-culprit vessel PCI at a separate session is recommended. Methods: We conducted a retrospective analysis of 282 consecutive STEMI patients with multivessel disease who underwent primary PCI followed by staged PCI of the non-culprit vessel. Patients were categorized into staged PCI in the same hospitalization (n = 184) and staged PCI at a separate hospitalization within 8 weeks of primary PCI (n = 98). Results: Baseline characteristics, presentation of STEMI, and procedural characteristics were similar in both groups. Contrast amount was higher in the separate hospitalization group for both index (175 vs. 153 ml, p = 0.011) and staged (144 vs. 120 ml, p = 0.004) procedures. More staged left main PCI was performed in the separate hospitalization group (3.9 vs. 0.3%, p = 0.008). Angiographic success of staged PCI was similar in both groups, with similar rates of vascular complications and major bleeding. Following staged PCI, in-hospital major adverse cardiac events (3.3 vs. 1.0%, p = 0.43) and mortality (2.7 vs. 0%, p = 0.17) were similar in both groups. Conclusions: Our study supports the safety and feasibility of staged PCI within the same hospitalization as primary PCI, achieving similar procedural success and in-hospital outcomes as staged PCI at a separate hospitalization. Higher contrast amount used during primary PCI and presence of left main lesion in non-culprit vessels may influence the decision to stage the PCI at a separate hospitalization

Manager traits and quality-of-care performance in hospitals.

Science.gov (United States)

Aij, Kjeld Harald; Aernoudts, René L M C; Joosten, Gepke

2015-07-06

This paper aims to assess the impact of the leadership traits of chief executive officers (CEOs) on hospital performance in the USA. The effectiveness and efficiency of the CEO is of critical importance to the performance of any organization, including hospitals. Management systems and manager behaviours (traits) are of crucial importance to any organization because of their connection with organizational performance. To identify key factors associated with the quality of care delivered by hospitals, the authors gathered perceptions of manager traits from chief executive officers (CEOs) and followers in three groups of US hospitals delivering different levels of quality of care performance. Three high- and three low-performing hospitals were selected from the top and bottom 20th percentiles, respectively, using a national hospital ranking system based on standard quality of care performance measures. Three lean hospitals delivering intermediate performance were also selected. A survey was used to gather perceptions of manager traits (providing a modern or lean management system inclination) from CEOs and their followers in the three groups, which were compared. Four traits were found to be significantly different (alpha management inclination. No differences were found between lean (intermediate-) and high-performing hospitals, or between high- and low-performing hospitals. These findings support a need for hospital managers to acquire appropriate traits to achieve lean transformation, support a benefit of measuring manager traits to assess progress towards lean transformation and lend weight to improved quality of care that can be delivered by hospitals adopting a lean system of management.

No Exit: Identifying Avoidable Terminal Oncology Intensive Care Unit Hospitalizations

Science.gov (United States)

Hantel, Andrew; Wroblewski, Kristen; Balachandran, Jay S.; Chow, Selina; DeBoer, Rebecca; Fleming, Gini F.; Hahn, Olwen M.; Kline, Justin; Liu, Hongtao; Patel, Bhakti K.; Verma, Anshu; Witt, Leah J.; Fukui, Mayumi; Kumar, Aditi; Howell, Michael D.; Polite, Blase N.

2016-01-01

Purpose: Terminal oncology intensive care unit (ICU) hospitalizations are associated with high costs and inferior quality of care. This study identifies and characterizes potentially avoidable terminal admissions of oncology patients to ICUs. Methods: This was a retrospective case series of patients cared for in an academic medical center’s ambulatory oncology practice who died in an ICU during July 1, 2012 to June 30, 2013. An oncologist, intensivist, and hospitalist reviewed each patient’s electronic health record from 3 months preceding terminal hospitalization until death. The primary outcome was the proportion of terminal ICU hospitalizations identified as potentially avoidable by two or more reviewers. Univariate and multivariate analysis were performed to identify characteristics associated with avoidable terminal ICU hospitalizations. Results: Seventy-two patients met inclusion criteria. The majority had solid tumor malignancies (71%), poor performance status (51%), and multiple encounters with the health care system. Despite high-intensity health care utilization, only 25% had documented advance directives. During a 4-day median ICU length of stay, 81% were intubated and 39% had cardiopulmonary resuscitation. Forty-seven percent of these hospitalizations were identified as potentially avoidable. Avoidable hospitalizations were associated with factors including: worse performance status before admission (median 2 v 1; P = .01), worse Charlson comorbidity score (median 8.5 v 7.0, P = .04), reason for hospitalization (P = .006), and number of prior hospitalizations (median 2 v 1; P = .05). Conclusion: Given the high frequency of avoidable terminal ICU hospitalizations, health care leaders should develop strategies to prospectively identify patients at high risk and formulate interventions to improve end-of-life care. PMID:27601514

Sex differences in hospital mortality following acute myocardial infarction in China: findings from a study of 45 852 patients in the COMMIT/CCS-2 study.

Science.gov (United States)

Chen, Yiping; Jiang, Lixin; Smith, Margaret; Pan, Hongchao; Collins, Rory; Peto, Richard; Chen, Zhengming

2011-01-01

To assess the sex difference in hospital mortality following ST elevation myocardial infarction (STEMI) in China. Observational study of patients enrolled into a large trial, adjusting for age, presenting characteristics and hospital treatments using logistic regression. 1250 hospitals in China during 1999-2005. 42 683 STEMI patients, including 31 309 men and 11 374 women. In the original trial, all patients received 162 mg of aspirin plus 75 mg of clopidogrel daily or matching placebo and metoprolol (15 mg intravenous then 200 mg oral daily) or matching placebo. All other aspects of patients' treatments were at the discretion of responsible doctors. Hospital mortality from any cause during the scheduled trial treatment period (ie, up to 4 weeks in hospital). Overall, 8% of the patients died in hospital, with the crude hospital mortality being twice as high in women as in men (12.6% vs 6.3%). After adjusting for age, the sex difference in hospital mortality attenuated but remained highly significant (OR 1.54; 95% CI 1.43 to 1.66). Further adjustment for other baseline characteristics and for the treatments given in hospital had little effect on the sex difference in hospital mortality (OR 1.50, 95% CI 1.38 to 1.62). The difference in hospital mortality was greater at a younger age, with the adjusted ORs being 2.14, 1.70, 1.48 and 1.18, respectively, for ages <55, 55-64, 65-74 and ≥75 years (p=0.0001 for trend). Compared with men of the same age, women had approximately a 50% higher mortality following hospital admission for STEMI, with a particularly higher excess risk at age <55 years.

Causes of Neonatal Mortality in the Neonatal Intensive Care Unit of Taleghani Hospital

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Ali Hossein Zeinalzadeh

2017-09-01

Full Text Available Background: Neonatal survival is one of the most important challenges today. Over 99% of neonatal mortalities occur in the developing countries, and epidemiologic studies emphasize on this issue in the developed countries, as well. In this study, we attempted to investigate the causes of neonatal mortality in Taleghani Hospital, Tabriz, Iran.Methods: In this cross-sectional study, we studied causes of neonatal mortality in neonatal intensive care unit (NICU of Taleghani Hospital, Tabriz, Iran, during 2013-2014. Data collection was performed by the head nurse and treating physician using a pre-designed questionnaire. Most of the data were extracted from the neonatal records. Information regarding maternal underlying diseases and health care during pregnancy was extracted from mothers' records.Results: A total of 891 neonates were admitted to NICU of Taleghani Hospital of Tabriz, Iran, during 2013-2014, 68 (7.5% of whom died. Among these cases, 37 (%54.4 were male, 29 (29.4% were extremely low birth weight, and 16 (23.5% weighed more than 2.5 kg. The main causes of mortality were congenital anomalies (35.3%, prematurity (26.5%, and sepsis (10.3%, respectively.Conclusion: Congenital anomaly is the most common cause of mortality, and the pattern of death is changing from preventable diseases to unavoidable mortalities

Variations in the Quality of Care at Large Public Hospitals in Beijing, China: A Condition-Based Outcome Approach.

Science.gov (United States)

Xu, Ye; Liu, Yuanli; Shu, Ting; Yang, Wei; Liang, Minghui

2015-01-01

Public hospitals deliver over ninety percent of all outpatient and inpatient services in China. Their quality is graded into three levels (A, B, and C) largely based on structural resources, but empirical evidence on the quality of process and outcome of care is extremely scarce. As expectations for quality care rise with higher living standards and cost of care, such evidence is urgently needed and vital to improve care and to inform future health reforms. We compiled and analyzed a multicenter database of over 4 million inpatient discharge summary records to provide a comprehensive assessment of the level and variations in clinical outcomes of hospitalization at 39 tertiary hospitals in Beijing. We assessed six outcome measures of clinical quality: in-hospital mortality rates (RSMR) for AMI, stroke, pneumonia and CABG, post-procedural complication rate (RS-CR), and failure-to-rescue rate (RS-FTR). The measures were adjusted for pre-admission patient case-mix using indirect standardization method with hierarchical linear mixed models. We found good overall quality with large variations by hospital and condition (mean/range, in %): RSMR-AMI: 6.23 (2.37-14.48), RSMR-stroke: 4.18 (3.58-4.44), RSMR-pneumonia: 7.78 (7.20-8.59), RSMR-CABG: 1.93 (1.55-2.23), RS-CR: 11.38 (9.9-12.88), and RS-FTR: 6.41 (5.17-7.58). Hospital grade was not significantly associated with any risk-adjusted outcome measures. Going to a higher grade public hospital does not always lead to better patient outcome because hospital grade only contains information about hospital structural resources. A hospital report card with some outcome measures of quality would provide valuable information to patients in choosing providers, and for regulators to identify gaps in health care quality. Reducing the variations in clinical practice and patient outcome should be a focus for policy makers in the next round of health sector reforms in China.

Healthcare associated infections in Paediatric Intensive Care Unit of a tertiary care hospital in India: Hospital stay & extra costs.

Science.gov (United States)

Sodhi, Jitender; Satpathy, Sidhartha; Sharma, D K; Lodha, Rakesh; Kapil, Arti; Wadhwa, Nitya; Gupta, Shakti Kumar

2016-04-01

Healthcare associated infections (HAIs) increase the length of stay in the hospital and consequently costs as reported from studies done in developed countries. The current study was undertaken to evaluate the impact of HAIs on length of stay and costs of health care in children admitted to Paediatric Intensive Care Unit (PICU) of a tertiary care hospital in north India. This prospective study was done in the seven bedded PICU of a large multi-specialty tertiary care hospital in New Delhi, India. A total of 20 children with HAI (cases) and 35 children without HAI (controls), admitted to the PICU during the study period (January 2012 to June 2012), were matched for gender, age, and average severity of illness score. Each patient's length of stay was obtained prospectively. Costs of healthcare were estimated according to traditional and time driven activity based costing methods approach. The median extra length of PICU stay for children with HAI (cases), compared with children with no HAI (controls), was seven days (IQR 3-16). The mean total costs of patients with and without HAI were ' 2,04,787 (US$ 3,413) and ' 56,587 (US$ 943), respectively and the mean difference in the total cost between cases and controls was ' 1,48,200 (95% CI 55,716 to 2,40,685, pcosts for PICU patients, especially costs due to prolongation of hospital stay, and suggests the need to develop effective strategies for prevention of HAI to reduce costs of health care.

Health care provider knowledge and routine management of pre-eclampsia in Pakistan.

Science.gov (United States)

Sheikh, Sana; Qureshi, Rahat Najam; Khowaja, Asif Raza; Salam, Rehana; Vidler, Marianne; Sawchuck, Diane; von Dadelszen, Peter; Zaidi, Shujat; Bhutta, Zulfiqar

2016-09-30

Maternal mortality ratio is 276 per 100,000 live births in Pakistan. Eclampsia is responsible for one in every ten maternal deaths despite the fact that management of this disease is inexpensive and has been available for decades. Many studies have shown that health care providers in low and middle-income countries have limited training to manage patients with eclampsia. Hence, we aimed to explore the knowledge of different cadres of health care providers regarding aetiology, diagnosis and treatment of pre-eclampsia and eclampsia and current management practices. We conducted a mixed method study in the districts of Hyderabad and Matiari in Sindh province, Pakistan. Focus group discussions and interviews were conducted with community health care providers, which included Lady Health Workers and their supervisors; traditional birth attendants and facility care providers. In total seven focus groups and 26 interviews were conducted. NVivo 10 was used for analysis and emerging themes and sub-themes were drawn. All participants were providing care for pregnant women for more than a decade except one traditional birth attendant and two doctors. The most common cause of pre-eclampsia mentioned by community health care providers was stress of daily life: the burden of care giving, physical workload, short birth spacing and financial constraints. All health care provider groups except traditional birth attendants correctly identified the signs, symptoms, and complications of pre-eclampsia and eclampsia and were referring such women to tertiary health facilities. Only doctors were aware that magnesium sulphate is recommended for eclampsia management and prevention; however, they expressed fears regarding its use at first and secondary level health facilities. This study found several gaps in knowledge regarding aetiology, diagnosis and treatment of pre-eclampsia among health care providers in Sindh. Findings suggest that lesser knowledge regarding management of pre

Improving stroke care for patients at Cavan hospital [poster

LENUS (Irish Health Repository)

Murugasu, G Dr.

2013-07-01

Under the Quality and Continuing Care Directorate (QCCD) in stroke care Cavan General Hospital was identified as a hospital that received a large number of stroke and TIA patients. A programme was established to improve services to this population.

The role of performing life support courses in rural areas in improving pre-hospital physiologic conditions of patients with penetrating injuries.

Science.gov (United States)

Nia, Masoud Saghafi; Naffisi, Nahid; Mohebbi, Hassan Ali; Moharamzadeh, Yashar

2008-09-01

To evaluate the impact of animal model based medical training courses for village healthcare workers on prehospital physiologic condition and prognosis of patients with penetrating injuries. Experimental study. This study was carried out in Mehran city and its neighbouring rural districts in western part of Iran from 2002 to 2004. Seventy-six village healthcare workers were trained and equipped to deliver in-field medical first cares. First group (226 patients) consisted of those who received this cares by the trained group and second group (245 patients) were those who received no in-field cares and were transported directly to the trauma center in provincial capital, Ilam. Physiologic Severity Score (PSS) was calculated to determine the physiologic condition of patients in both groups. The most prevalent cause of trauma in both groups was car accidents (61.6%). Controlling of hemorrhage was the most frequent provided initial medical care (40.6%). A significant improvement regarding the PSS score was observed in the first group of patients compared to the second group (7.505 vs. 6.799, 95% CI for difference: 0.3 to 0.9). The mortality rates of the first and second group of patients were 3% and 7.3%, respectively (p=0.051). Performing life support courses in rural areas of low-income countries where there is no pre-hospital triage and emergency medical system and provision of classic resuscitative measures are limited, has a significant impact on improvement of pre-hospital physiologic condition and prognosis of patients with penetrating injuries.

Effect of a real-time tele-transmission system of 12-lead electrocardiogram on the first-aid for athletes with ST-elevation myocardial infarction.

Science.gov (United States)

Zhang, Huan; Song, Donghan; An, Lina

2016-05-01

To study the effect of a real-time tele-transmission system of 12-lead electrocardiogram on door-to-balloon time in athletes with ST-elevation myocardial infarction. A total of 60 athletes with chest pain diagnosed as ST-elevation myocardial infarction (STEMI) from our hospital were randomly divided into group A (n=35) and group B (n=25), the patients in group A transmitted the real-time tele-transmission system of 12-lead electrocardiogram to the chest pain center before arriving in hospital, however, the patients in group B not. The median door-to-balloon time was significant shorter in-group A than group B (38min vs 94 min, p0.05). The median length of stay was significant reduced in-group A (5 days vs 7 days, pelectrocardiogram is beneficial to the pre-hospital diagnosis of STEMI.

Pre-admission statin use and in-hospital severity of 2009 pandemic influenza A(H1N1 disease.

Directory of Open Access Journals (Sweden)

Stephen J Brett

2011-04-01

Full Text Available Statins are drugs that are used to lower plasma cholesterol levels. Recently, contradictory claims have been made about possible additional effects of statins on progression of a variety of inflammatory disorders, including infections. We therefore examined the clinical course of patients admitted to hospital with 2009 pandemic influenza A(H1N1, who were or weren't taking statins at time of admission.A retrospective case-control study was performed using the United Kingdom Influenza Clinical Information Network (FLU-CIN database, containing detailed information on 1,520 patients admitted to participating hospitals with confirmed 2009 pandemic influenza A(H1N1 infection between April 2009 and January 2010. We confined our analysis to those aged over 34 years. Univariate analysis was used to calculate unadjusted odds ratios (OR and 95 percent confidence intervals (95%CI for factors affecting progression to severe outcome (high dependency or intensive care unit level support or death (cases; two multivariable logistic regression models were then established for age and sex, and for age, sex, obesity and "indication for statin" (e.g., heart disease or hypercholesterolaemia.We found no statistically significant association between pre-admission statin use and severity of outcome after adjustment for age and sex [adjusted OR: 0.81 (95% CI: 0.46-1.38; n = 571]. After adjustment for age, sex, obesity and indication for statin, the association between pre-admission statin use and severe outcome was not statistically significant; point estimates are compatible with a small but clinically significant protective effect of statin use [adjusted OR: 0.72 (95% CI: 0.38-1.33].In this group of patients hospitalized with pandemic influenza, a significant beneficial effect of pre-admission statin use on the in-hospital course of illness was not identified. Although the database from which these observations are derived represents the largest available suitable

STANDARD PRECAUTIONS: AN ASSESSMENT OF AWARENESS AMONG HEALTH CARE PERSONNEL IN A TEACHING HOSPITAL, SOUTH INDIA.

Directory of Open Access Journals (Sweden)

Sangeetha

2015-02-01

Full Text Available BACKGROUND : Standard precautions ar e crucial in the prevention and transmission of Healthcare associated infections ( HAI and transmission of blood - borne pathogens like Hepatitis B, Human Immunodeficiency Virus & Hepatitis C. They are not well u nderstood or implemented by health care practitioners. Hence this study was taken up to determine and compare knowledge, attitude of standard precautions among health care personnel at a teaching hospital, Bangalore. OBJECTIVE : To assess knowledge, attitud e, practices and compliance of Standard precautions among health care workers at a teaching hospital. METHODOLOGY : One hundred and fifty seven health care personnel participated in this study. A pretest and post test was administered to the study group. A pre - structured questionnaire on standard precautions was prepared which included knowledge, attitude and practices. RESULTS : 116 ( 73.88% nurses had knowledge about hand hygiene, but only 82 ( 52.2% nurses practiced hand hygiene before and after patient care. Knowledge about PPE measures like gloves, face mask & goggles, gowns were known to 101(64.33%, 56 ( 35.66% & 69 ( 43.94% nurses respectively. 117 ( 74.52% nurses discarded needles & sharps in correct puncture proof containers, but their correct knowled ge regarding colour coding of hospital waste segregation was comparatively less i.e. 104 ( 66.24%. 119 ( 75.79% of the nurses had practice of recapping the needles after use. CONCLUSION : There was significant improvement in the knowledge and practice of stan dard precautions in the present study after incorporating good training practices

Maternity Care Services Provided by Family Physicians in Rural Hospitals.

Science.gov (United States)

Young, Richard A

The purpose of this study was to describe how many rural family physicians (FPs) and other types of providers currently provide maternity care services, and the requirements to obtain privileges. Chief executive officers of rural hospitals were purposively sampled in 15 geographically diverse states with significant rural areas in 2013 to 2014. Questions were asked about the provision of maternity care services, the physicians who perform them, and qualifications required to obtain maternity care privileges. Analysis used descriptive statistics, with comparisons between the states, community rurality, and hospital size. The overall response rate was 51.2% (437/854). Among all identified hospitals, 44.9% provided maternity care services, which varied considerably by state (range, 17-83%; P maternity care, a mean of 271 babies were delivered per year, 27% by cesarean delivery. A mean of 7.0 FPs had privileges in these hospitals, of which 2.8 provided maternity care and 1.8 performed cesarean deliveries. The percentage of FPs who provide maternity care (mean, 48%; range, 10-69%; P maternity care who are FPs (mean, 63%; range, 10-88%; P maternity care services in US rural hospitals, including cesarean deliveries. Some family medicine residencies should continue to train their residents to provide these services to keep replenishing this valuable workforce. © Copyright 2017 by the American Board of Family Medicine.

Defining a caring hospital by using currently implemented survey tools.

Science.gov (United States)

Jennings, Nancy

2010-09-01

Health care organizations are constantly striving to provide a more cost-effective and higher quality treatment within a caring environment. However, balancing the demands of regulatory agencies with the holistic needs of the patient is challenging. Further challenging is how to define those hospitals that provide an exceptional caring environment for their patients. By using survey tools that are already being administered in hospital settings, the opportunity exists to analyze the results obtained from these tools to define a hospital as a caring organization without the added burden of separate data collection.

Pre-hospital management and risk factors in children with acute ...

African Journals Online (AJOL)

Background. Diarrhoea remains a major cause of childhood morbidity and mortality in the developing world. Implementation of World Health Organization Integrated Management of Childhood Illness (IMCI) guidelines and pre-hospital use of oral rehydration therapy (ORT) in the Western Cape Province of South Africa are ...

Decreased Time from 9-1-1 Call to PCI among Patients Experiencing STEMI Results in a Decreased One Year Mortality.

Science.gov (United States)

Studnek, Jonathan R; Infinger, Allison; Wilson, Hadley; Niess, Gary; Jackson, Patrick; Swanson, Doug

2018-03-29

The impact on mortality due to prompt recognition of ST-segment Elevation Myocardial Infarction (STEMI) patients by EMS has not been well described. The objective of this study was to describe the association between the time interval, 9-1-1 call to percutaneous intervention (PCI), and mortality at one year. This retrospective analysis included patients that were transported by EMS as a "code STEMI" and underwent PCI.  Total time from 9-1-1 call to PCI was calculated for each patient and was the independent variable of interest. Each patient's mortality status at one year was the outcome variable, collected by querying medical records and the national death index. Confounding variables were abstracted from hospital records. Logistic regression was conducted to determine the likelihood of survival given differences in time to PCI. A total of 550 patients were included in the analyses of which 68% were male with an average age 59.8 (SD 12.8). Mean reperfusion time was 81.8 min (SD 20.0) and was significantly lower in patients alive at one year (80.8 min, SD 19.7) vs. deceased at one year (93.9 min, SD 19.6), respectively. Odds of survival at one year decreased by 3% (OR 0.97; 95% CI 0.96-0.99) for every one minute increase in time to PCI. This relationship practically represents a 30% increase in mortality for every 10 minute delay from 9-1-1 call to PCI. The model produced suggests that a linear relationship exists between time to PCI and mortality in the prehospital environment with the probability of survival decreasing significantly as time to PCI increases.

Identification of myocardial infarction type from electronic hospital data in England and Australia: a comparative data linkage study

Science.gov (United States)

Nedkoff, Lee; Lopez, Derrick; Goldacre, Michael; Hobbs, Michael; Wright, F Lucy

2017-01-01

Objective To determine the utility of International Classification of Diseases (ICD) codes in investigating trends in ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) using person-linked electronic hospitalisation data in England and Western Australia (WA). Methods All hospital admissions with myocardial infarction (MI) as the principal diagnosis were identified from 2000 to 2013 from both jurisdictions. Fourth-digit ICD-10 codes were used to delineate all MI types—STEMI, NSTEMI, unspecified and subsequent MI. The annual frequency of each MI type was calculated as a proportion of all MI admissions. For all MI and each MI type, age-standardised rates were calculated and age-adjusted Poisson regression models used to estimate annual percentage changes in rates. Results In 2000, STEMI accounted for 49% of all MI admissions in England and 59% in WA, decreasing to 35% and 25% respectively by 2013. Less than 10% of admissions were recorded as NSTEMI in England throughout the study period, whereas by 2013, 70% of admissions were NSTEMI in WA. Unspecified MI comprised 60% of all MI admissions in England by 2013, compared with standards in each country. This has important implications for using electronic hospital data for monitoring MI and identifying MI types for outcome studies. PMID:29133337

38 CFR 17.35 - Hospital care and medical services in foreign countries.

Science.gov (United States)

2010-07-01

... VETERANS AFFAIRS MEDICAL Hospital Or Nursing Home Care and Medical Services in Foreign Countries § 17.35 Hospital care and medical services in foreign countries. The Secretary may furnish hospital care and... associated with and held to be aggravating a service-connected disability; (b) If the care is furnished to a...

Responding to financial pressures. The effect of managed care on hospitals' provision of charity care.

Science.gov (United States)

Mas, Núria

2013-06-01

Healthcare financing and insurance is changing everywhere. We want to understand the impact that financial pressures can have for the uninsured in advanced economies. To do so we focus on analyzing the effect of the introduction in the US of managed care and the big rise in financial pressures that it implied. Traditionally, in the US safety net hospitals have financed their provision of unfunded care through a complex system of cross-subsidies. Our hypothesis is that financial pressures undermine the ability of a hospital to cross-subsidize and challenges their survival. We focus on the impact of price pressures and cost-controlling mechanisms imposed by managed care. We find that financial pressures imposed by managed care disproportionately affect the closure of safety net hospitals. Moreover, amongst those hospitals that remain open, in areas where managed care penetration increases the most, they react by closing the health services most commonly used by the uninsured.

Cost variation in diabetes care delivered in English hospitals

DEFF Research Database (Denmark)

Kristensen, Troels

2009-01-01

the hospital fixed effect and adjust for hospital characteristics such as number of patients treated, factor prices and number of specialties involved in diabetes care. We rank hospitals by their adjusted fixed effect, which measures the extent to which their costs vary from the average after controlling......Background: Many diabetic patients are admitted to hospital, where care is costly and where there may be scope to improve efficiency. Aims: We analyse the costs and characteristics of diabetic patients admitted to English hospitals and aim to assess what proportions of cost variation are explained...... by patient and hospital characteristics. Methods: We apply a multilevel approach recognising that patients are clustered in hospitals. We first analyse the relationship between patient costs and their characteristics, such as HRG, age, gender, diagnostic markers and socio-economic status. We derive...

A Study of Platelet Inhibition, Using a 'Point of Care' Platelet Function Test, following Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction [PINPOINT-PPCI].

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Thomas W Johnson

Full Text Available Rapid coronary recanalization following ST-elevation myocardial infarction (STEMI requires effective anti-platelet and anti-thrombotic therapies. This study tested the impact of door to end of procedure ('door-to-end' time and baseline platelet activity on platelet inhibition within 24hours post-STEMI.108 patients, treated with prasugrel and procedural bivalirudin, underwent Multiplate® platelet function testing at baseline, 0, 1, 2 and 24hours post-procedure. Major adverse cardiac events (MACE, bleeding and stent thrombosis (ST were recorded. Baseline ADP activity was high (88.3U [71.8-109.0], procedural time and consequently bivalirudin infusion duration were short (median door-to-end time 55minutes [40-70] and infusion duration 30minutes [20-42]. Baseline ADP was observed to influence all subsequent measurements of ADP activity, whereas door-to-end time only influenced ADP immediately post-procedure. High residual platelet reactivity (HRPR ADP>46.8U was observed in 75% of patients immediately post-procedure and persisted in 24% of patients at 2hours. Five patients suffered in-hospital MACE (4.6%. Acute ST occurred in 4 patients, all were <120mins post-procedure and had HRPR. No significant bleeding was observed. In a post-hoc analysis, pre-procedural morphine use was associated with significantly higher ADP activity following intervention.Baseline platelet function, time to STEMI treatment and opiate use all significantly influence immediate post-procedural platelet activity.

Pre-hospital management and outcome of acute poisonings by ambulances in Yekaterinburg, Russia.

Science.gov (United States)

Krayeva, Yulia V; Brusin, Konstantin M; Bushuev, Alexander V; Kondrashov, Dmitriy L; Sentsov, Valentin G; Hovda, Knut Erik

2013-01-01

Large, prospective pre-hospital studies of acute poisonings are scarce. We present the epidemiology of the pre-hospital poisonings, the treatment given, the complications of the poisoning itself and the treatment, predictors for hospitalization, and the safety of the present approach in a large industrial Russian city. Data were collected from March 2009 to March 2010. All adult (≥ 16 years) acute poisonings in the city of Yekaterinburg, Russia were included. The prospective cohort inclusion of data included age, gender, simple clinical features (including consciousness, respiratory status, circulatory status, convulsions, etc.), main toxic agent, reason why poisoning was suspected, treatment given, and outcome. Multivariate logistic regression analysis was used to identify the factors associated with hospitalization of the patients. In total, 1795/2536 patients (71%) were brought to hospitals, 736/2536 (29%) were discharged by the ambulance, and 5/2536 (0.2%) died on scene. The most frequent main agents were opioids (25%), ethanol (9%), benzodiazepines (8%), corrosive substances (7%), carbon monoxide (5%), and neuroleptics (5%). Pre-hospital treatment was given to 73% of patients; 3% were intubated, and antidotes were given in 27% (naloxone 24%, atropine 2%, and flumazenil 0.2%). Gastric lavage was performed in 34%, but only 20% within the first hour after ingestion; 49% had a Glasgow Coma Scale (GCS)treatment practice in most places, especially concerning the use of gastric lavage. Whether the current practice led to an increased morbidity and mortality is uncertain, but it justifies the need for thorough evaluation of clinical practice. These findings highlight the importance of studies like the present to improve diagnostics, triage, and treatment in acute poisonings.

Multiple triangulation and collaborative research using qualitative methods to explore decision making in pre-hospital emergency care

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Maxine Johnson

2017-01-01

Full Text Available Abstract Background Paramedics make important and increasingly complex decisions at scene about patient care. Patient safety implications of influences on decision making in the pre-hospital setting were previously under-researched. Cutting edge perspectives advocate exploring the whole system rather than individual influences on patient safety. Ethnography (the study of people and cultures has been acknowledged as a suitable method for identifying health care issues as they occur within the natural context. In this paper we compare multiple methods used in a multi-site, qualitative study that aimed to identify system influences on decision making. Methods The study was conducted in three NHS Ambulance Trusts in England and involved researchers from each Trust working alongside academic researchers. Exploratory interviews with key informants e.g. managers (n = 16 and document review provided contextual information. Between October 2012 and July 2013 researchers observed 34 paramedic shifts and ten paramedics provided additional accounts via audio-recorded ‘digital diaries’ (155 events. Three staff focus groups (total n = 21 and three service user focus groups (total n = 23 explored a range of experiences and perceptions. Data collection and analysis was carried out by academic and ambulance service researchers as well as service users. Workshops were held at each site to elicit feedback on the findings and facilitate prioritisation of issues identified. Results The use of a multi-method qualitative approach allowed cross-validation of important issues for ambulance service staff and service users. A key factor in successful implementation of the study was establishing good working relationships with academic and ambulance service teams. Enrolling at least one research lead at each site facilitated the recruitment process as well as study progress. Active involvement with the study allowed ambulance service researchers and service

Multiple triangulation and collaborative research using qualitative methods to explore decision making in pre-hospital emergency care.

Science.gov (United States)

Johnson, Maxine; O'Hara, Rachel; Hirst, Enid; Weyman, Andrew; Turner, Janette; Mason, Suzanne; Quinn, Tom; Shewan, Jane; Siriwardena, A Niroshan

2017-01-24

Paramedics make important and increasingly complex decisions at scene about patient care. Patient safety implications of influences on decision making in the pre-hospital setting were previously under-researched. Cutting edge perspectives advocate exploring the whole system rather than individual influences on patient safety. Ethnography (the study of people and cultures) has been acknowledged as a suitable method for identifying health care issues as they occur within the natural context. In this paper we compare multiple methods used in a multi-site, qualitative study that aimed to identify system influences on decision making. The study was conducted in three NHS Ambulance Trusts in England and involved researchers from each Trust working alongside academic researchers. Exploratory interviews with key informants e.g. managers (n = 16) and document review provided contextual information. Between October 2012 and July 2013 researchers observed 34 paramedic shifts and ten paramedics provided additional accounts via audio-recorded 'digital diaries' (155 events). Three staff focus groups (total n = 21) and three service user focus groups (total n = 23) explored a range of experiences and perceptions. Data collection and analysis was carried out by academic and ambulance service researchers as well as service users. Workshops were held at each site to elicit feedback on the findings and facilitate prioritisation of issues identified. The use of a multi-method qualitative approach allowed cross-validation of important issues for ambulance service staff and service users. A key factor in successful implementation of the study was establishing good working relationships with academic and ambulance service teams. Enrolling at least one research lead at each site facilitated the recruitment process as well as study progress. Active involvement with the study allowed ambulance service researchers and service users to gain a better understanding of the research

Pre-Hospital and Hospital Management Practices and Circumstances behind Venomous Snakebite in Northwestern Part of Bangladesh

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Ratindra Mondal

2012-12-01

Full Text Available Background: Snakebite is the most important cause of envenomation in South Asia particularly in Bangladesh, though there is lack of data from the rural part of the country. About 82 species of snakes (28 venomous exist in Bangladesh. In this study, demographic characteristics of the victim, circumstances behind the bite along with pre-hospital and hospital managements and outcomes were evaluated. Methods: It was a cross-sectional study during January 2010 to June 2012 at Rangpur Medical College Hospital. Only venomous snakebite cases were included and diagnosis was made on clinical syndrome. Descriptive statistics were presented using percentage and proportion. Results: Out of 28 patients (mean age: 31.7 years, 20 (71.4% were males with a significant male-female ratio (2.5:1. Majority were farmers (46.4% and most (50% of the bites happened during household activities. Lag period between bite and hospitalization was ≤5 hours in 50% patients; 6 to 10 hours in 39.2% and >10 hours in 10.7% cases. 82.1% patients received ligature as pre-hospital first aid. Total 21 patients received anti-snake venom (ASV in different dose regimens. 15 (53.5% patients recovered while 13 (46.4% died. Among 13 patients who died, 53.8% died within 2 hours, 15.3% within 3-24 hours and 30.7% after 24 hours post-bite. Conclusion: Snakebite has a significant impact on human health and economy through treatment-related expenditures and loss of productivity. Policy makers of Bangladesh should prioritize the issue to reduce future mortality and morbidity. Keywords: Poisoning, Snakebite, Bangladesh, Envenomation, Management        

Current Trends for ST-segment Elevation Myocardial Infarction during the Past 5 Years in Rural Areas of China's Liaoning Province: A Multicenter Study

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Guang-Xiao Li

2017-01-01

Conclusions: Despite the great progress that has been made in guideline-recommended therapies, in-hospital outcomes among rural STEMI patients have not significantly improved. Therefore, there is still substantial room for improvement in the quality of care.

Ventricular arrhythmia burst is an independent indicator of larger infarct size even in optimal reperfusion in STEMI

NARCIS (Netherlands)

van der Weg, Kirian; Majidi, Mohamed; Haeck, Joost D. E.; Tijssen, Jan G. P.; Green, Cynthia L.; Koch, Karel T.; Kuijt, Wichert J.; Krucoff, Mitchell W.; Gorgels, Anton P. M.; de Winter, Robbert J.

2016-01-01

We hypothesized that ventricular arrhythmia (VA) bursts during reperfusion phase are a marker of larger infarct size despite optimal epicardial and microvascular perfusion. 126 STEMI patients were studied with 24h continuous, 12-lead Holter monitoring. Myocardial blush grade (MBG) was determined and

Organisation and Evaluation of General Palliative Care in a Danish Hospital

DEFF Research Database (Denmark)

Bergenholtz, Heidi; Hølge-Hazelton, Bibi; Jarlbæk, Lene

2015-01-01

and evaluation of generalist palliative care in hospitals. Therefore the aim of the study was to investigate the organization and evaluation of generalist palliative care in a large regional hospital by comparing results from existing evaluations. Methods: Results from three different data sets, all aiming...... of palliative care in order to identify concordances and/or discrepancies. Results: The triangulation indicated poor validity of the results from existing methods used to evaluate palliativecare in hospitals. When the datasets were compared, several discrepancies occurred with regard to the organizationand...... the performance of generalist palliative care. Five types of discrepancies were found in 35 out of 56 sections inthe fulfilment of the national accreditation standard for palliative care. Responses from the hospital management and the department managements indicated that generalist palliative care was organized...

Evaluation of Quality Indicators of Integrated Care in a Regional Psychiatry Budget – A Pre-Post Comparison by Secondary Data Analysis

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Anne Berghöfer

2016-12-01

Full Text Available The Regional Psychiatry Budget (RPB, as a special arrangement within the German Federal Hospital Refund Regulation, is based on the capitation principle. A lump sum is allocated to a major inpatient care provider in a large region on a yearly basis. Under this model, the provider is free to offer all forms of treatment and to construct individual models of integrated care that specifically suit the region and the needs of community members. The present study aimed to evaluate selected aspects that represent a change in the psychiatric health status of patients in the covered region under the conditions of the RPB. We performed a secondary data analysis of administrative data of 19,913 cases generated by the hospital in a pre-post comparison of the periods before and under RPB conditions.  The average length of an inpatient stay was reduced by approximately 22 % and could be partially replaced by day care. Selected indicators suggest equal or higher quality of care with stable cost in the population in need of psychiatric care in the district.

Outcomes of Nulliparous Women with Spontaneous Labor Onset Admitted to Hospitals in Pre-active versus Active Labor

Science.gov (United States)

NEAL, Jeremy L.; LAMP, Jane M.; BUCK, Jacalyn S.; LOWE, Nancy K.; GILLESPIE, Shannon L.; RYAN, Sharon L.

2014-01-01

Introduction The timing of when a woman is admitted to the hospital for labor care following spontaneous contraction onset may be among the most important decisions that labor attendants make as it can influence care patterns and birth outcomes. The aims of this study were to estimate the percentage of low-risk, nulliparous women at term who are admitted to labor units prior to active labor and to evaluate the effects of the timing of admission (i.e., pre-active versus active labor) on labor interventions and mode of birth. Methods Obstetrics data from low-risk, nulliparous women with spontaneous labor onset at term gestation (N = 216) were merged from two prospective studies conducted at three large, Midwestern hospitals. Baseline characteristics, labor interventions, and outcomes were compared between groups using Fisher’s exact and Mann-Whitney U tests, as appropriate. Likelihoods for oxytocin augmentation, amniotomy, and cesarean delivery were assessed by logistic regression. Results Of the sample of 216 low-risk nulliparous women, 114 (52.8%) were admitted in pre-active labor and 102 (47.2%) were admitted in active labor. Women admitted in pre-active labor were more likely to undergo oxytocin augmentation (84.2% and 45.1%, respectively; odds ratio (OR) 6.5, 95% confidence interval (CI) 3.43–12.27) but not amniotomy (55.3% and 61.8%, respectively; OR 0.8, 95% CI 0.44–1.32) when compared to women admitted in active labor. The likelihood of cesarean delivery was higher for women admitted before active labor onset (15.8% and 6.9%, respectively; OR 2.6, 95% CI 1.02–6.37). Discussion Many low-risk nulliparous women with regular, spontaneous uterine contractions are admitted to labor units before active labor onset, which increases their likelihood of receiving oxytocin and being delivered via cesarean section. An evidence-based, standardized approach for labor admission decision-making is recommended to decrease inadvertent admissions of women in pre

In-hospital outcome of acute myocardial infarction in correlation with 'thrombolysis in myocardial infarction' risk score

International Nuclear Information System (INIS)

Masood, A.; Naqvi, M.A.; Jafar, S.S.

2009-01-01

Effective risk stratification is integral to management of acute coronary syndromes (ACS). The Thrombolysis in Myocardial Infarction (TIMI) risk score for ST-segment elevation myocardial infarction (STEMI) is a simple integer score based on 8 high-risk parameters that can be used at the bedside for risk stratification of patients at presentation with STEMI. To evaluate the prognostic significance of TIMI risk score in a local population group of acute STEMI. The study included 160 cases of STEMI eligible for thrombolysis. TIMI risk score was calculated for each case at the time of presentation and were then followed during their hospital stay for the occurrence of electrical and mechanical complications as well as mortality. The patients were divided into three risk groups, namely 'low risk', 'moderate-risk' and 'high-risk' based on their TIMI scores (0-4 low-risk, 5-8 moderate-risk, 9-14 high risk). The frequencies of complications and deaths were compared among the three risk groups. Post MI arrhythmias were noted in 2.2%, 16% and 50%; cardiogenic shock in 6.7%, 16% and 60%; pulmonary edema in 6.7%, 20% and 80%; mechanical complications of MI in 0%, 8% and 30%; death in 4.4%, 8%, and 60% of patients belonging to low-risk, moderate-risk and high-risk groups respectively. Frequency of complications and death correlated well with TIMI risk score (p=0.001). TIMI risk score correlates well with the frequency of electrical or mechanical complications and death after STEMI. (author)

Home Health Nursing Care and Hospital Use for Medically Complex Children.

Science.gov (United States)

Gay, James C; Thurm, Cary W; Hall, Matthew; Fassino, Michael J; Fowler, Lisa; Palusci, John V; Berry, Jay G

2016-11-01

Home health nursing care (HH) may be a valuable approach to long-term optimization of health for children, particularly those with medical complexity who are prone to frequent and lengthy hospitalizations. We sought to assess the relationship between HH services and hospital use in children. Retrospective, matched cohort study of 2783 hospitalized children receiving postdischarge HH services by BAYADA Home Health Care across 19 states and 7361 matched controls not discharged to HH services from the Children's Hospital Association Case Mix database between January 2004 and September 2012. Subsequent hospitalizations, hospital days, readmissions, and costs of hospital care were assessed over the 12-month period after the initial hospitalization. Nonparametric Wilcoxon signed rank tests were used for comparisons between HH and non-HH users. Although HH cases had a higher percentage of complex chronic conditions (68.5% vs 65.4%), technology assistance (40.5% vs 35.7%), and neurologic impairment (40.7% vs 37.3%) than matched controls (P ≤ .003 for all), 30-day readmission rates were lower in HH patients (18.3% vs 21.5%, P = .001). At 12 months after the index admission, HH patients averaged fewer admissions (0.8 vs 1.0, P < .001), fewer days in the hospital (6.4 vs 6.6, P < .001), and lower hospital costs ($22 511 vs $24 194, P < .001) compared with matched controls. Children discharged to HH care experienced less hospital use than children with similar characteristics who did not use HH care. Further investigation is needed to understand how HH care affects the health and health services of children. Copyright © 2016 by the American Academy of Pediatrics.

Survey of advanced radiation technologies used at designated cancer care hospitals in Japan

International Nuclear Information System (INIS)

Shikama, Naoto; Tsujino, Kayoko; Nakamura, Katsumasa; Ishikura, Satoshi

2014-01-01

Our survey assessed the use of advanced radiotherapy technologies at the designated cancer care hospitals in Japan, and we identified several issues to be addressed. We collected the data of 397 designated cancer care hospitals, including information on staffing in the department of radiation oncology (e.g. radiation oncologists, medical physicists and radiation therapists), the number of linear accelerators and the implementation of advanced radiotherapy technologies from the Center for Cancer Control and Information Services of the National Cancer Center, Japan. Only 53% prefectural designated cancer care hospitals and 16% regional designated cancer care hospitals have implemented intensity-modulated radiotherapy for head and neck cancers, and 62% prefectural designated cancer care hospitals and 23% regional designated cancer care hospitals use intensity-modulated radiotherapy for prostate cancer. Seventy-four percent prefectural designated cancer care hospitals and 40% regional designated cancer care hospitals employ stereotactic body radiotherapy for lung cancer. Our multivariate analysis of prefectural designated cancer care hospitals which satisfy the institute's qualifications for advanced technologies revealed the number of radiation oncologists (P=0.01) and that of radiation therapists (P=0.003) were significantly correlated with the implementation of intensity-modulated radiotherapy for prostate cancer, and the number of radiation oncologists (P=0.02) was correlated with the implementation of stereotactic body radiotherapy. There was a trend to correlate the number of medical physicists with the implementation of stereotactic body radiotherapy (P=0.07). Only 175 (51%) regional designated cancer care hospitals satisfy the institute's qualification of stereotactic body radiotherapy and 76 (22%) satisfy that of intensity-modulated radiotherapy. Seventeen percent prefectural designated cancer care hospitals and 13% regional designated cancer care hospitals

Electronic health record use, intensity of hospital care, and patient outcomes.

Science.gov (United States)

Blecker, Saul; Goldfeld, Keith; Park, Naeun; Shine, Daniel; Austrian, Jonathan S; Braithwaite, R Scott; Radford, Martha J; Gourevitch, Marc N

2014-03-01

Previous studies have suggested that weekend hospital care is inferior to weekday care and that this difference may be related to diminished care intensity. The purpose of this study was to determine whether a metric for measuring intensity of hospital care based on use of the electronic health record was associated with patient-level outcomes. We performed a cohort study of hospitalizations at an academic medical center. Intensity of care was defined as the hourly number of provider accessions of the electronic health record, termed "electronic health record interactions." Hospitalizations were categorized on the basis of the mean difference in electronic health record interactions between the first Friday and the first Saturday of hospitalization. We used regression models to determine the association of these categories with patient outcomes after adjusting for covariates. Electronic health record interactions decreased from Friday to Saturday in 77% of the 9051 hospitalizations included in the study. Compared with hospitalizations with no change in Friday to Saturday electronic health record interactions, the relative lengths of stay for hospitalizations with a small, moderate, and large decrease in electronic health record interactions were 1.05 (95% confidence interval [CI], 1.00-1.10), 1.11 (95% CI, 1.05-1.17), and 1.25 (95% CI, 1.15-1.35), respectively. Although a large decrease in electronic health record interactions was associated with in-hospital mortality, these findings were not significant after risk adjustment (odds ratio 1.74, 95% CI, 0.93-3.25). Intensity of inpatient care, measured by electronic health record interactions, significantly diminished from Friday to Saturday, and this decrease was associated with length of stay. Hospitals should consider monitoring and correcting temporal fluctuations in care intensity. Copyright © 2014 Elsevier Inc. All rights reserved.

Feeling Heard & Understood in the Hospital Environment: Benchmarking Communication Quality Among Patients with Advanced Cancer Before and After Palliative Care Consultation.

Science.gov (United States)

Ingersoll, Luke T; Saeed, Fahad; Ladwig, Susan; Norton, Sally A; Anderson, Wendy; Alexander, Stewart C; Gramling, Robert

2018-05-02

Maximizing value in palliative care requires continued development and standardization of communication quality indicators. To describe the basic epidemiology of a newly-adopted patient-centered communication quality indicator for hospitalized palliative care patie9nts with advanced cancer. Cross-sectional analysis of 207 advanced cancer patients who received palliative care consultation at two medical centers in the United States. Participants completed the Heard & Understood quality indicator immediately before and the day following the initial palliative care consultation: "Over the past two days ["24 hours" for the post-consultation version], how much have you felt heard and understood by the doctors, nurses and hospital staff? Completely/Quite a Bit/Moderately/Slightly/Not at All". We categorized "Completely" as indicating ideal quality. Approximately one-third indicated ideal Heard & Understood quality before palliative care consultation. Age, financial security, emotional distress, preferences for comfort-longevity tradeoffs at end-of-life, and prognosis expectations were associated with pre-consultation quality. Among those with less-than-ideal quality at baseline, 56% rated feeling more Heard & Understood the day following palliative care consultation. The greatest pre-post improvement was among people who had unformed end-of-life treatment preferences or who reported having "no idea" about their prognosis at baseline. Most patients felt incompletely heard and understood at the time of referral to palliative care consultation and more than half improved following consultation. Feeling heard and understood is an important quality indicator sensitive to interventions to improve care and key variations in the patient experience. Copyright © 2018. Published by Elsevier Inc.

ValuedCare program: a population health model for the delivery of evidence-based care across care continuum for hip fracture patients in Eastern Singapore.

Science.gov (United States)

Mittal, Chikul; Lee, Hsien Chieh Daniel; Goh, Kiat Sern; Lau, Cheng Kiang Adrian; Tay, Leeanna; Siau, Chuin; Loh, Yik Hin; Goh, Teck Kheng Edward; Sandi, Chit Lwin; Lee, Chien Earn

2018-05-30

To test a population health program which could, through the application of process redesign, implement multiple evidence-based practices across the continuum of care in a functionally integrated health delivery system and deliver highly reliable and consistent evidence-based surgical care for patients with fragility hip fractures in an acute tertiary general hospital. The ValuedCare (VC) program was developed in three distinct phases as an ongoing collaboration between the Geisinger Health System (GHS), USA, and Changi General Hospital (CGH), Singapore, modelled after the GHS ProvenCare® Fragile Hip Fracture Program. Clinical outcome data on consecutive hip fracture patients seen in 12 months pre-intervention were then compared with the post-intervention group. Both pre- and post-intervention groups were followed up across the continuum of care for a period of 12 months. VC patients showed significant improvement in median time to surgery (97 to 50.5 h), as well as proportion of patients operated within 48 h from hospital admission (48% from 18.8%) as compared to baseline pre-intervention data. These patients also had significant reduction (p value based care for hip fracture patients at Changi General Hospital. This has also reflected successful change management and interdisciplinary collaboration within the organization through the program. There is potential for testing this methodology as a quality improvement framework replicable to other disease groups in a functionally integrated healthcare system.

Becoming Food Aware in Hospital: A Narrative Review to Advance the Culture of Nutrition Care in Hospitals.

Science.gov (United States)

Laur, Celia; McCullough, James; Davidson, Bridget; Keller, Heather

2015-06-01

The Nutrition Care in Canadian Hospitals (2010-2013) study identified the prevalence of malnutrition on admission to medical and surgical wards as 45%. Nutrition practices in the eighteen hospitals, including diagnosis, treatment and monitoring of malnourished patients, were ad hoc. This lack of a systematic approach has demonstrated the need for the development of improved processes and knowledge translation of practices aimed to advance the culture of nutrition care in hospitals. A narrative review was conducted to identify literature that focused on improved care processes and strategies to promote the nutrition care culture. The key finding was that a multi-level approach is needed to address this complex issue. The organization, staff, patients and their families need to be part of the solution to hospital malnutrition. A variety of strategies to promote the change in nutrition culture have been proposed in the literature, and these are summarized as examples for others to consider. Examples of strategies at the organizational level include developing policies to support change, use of a screening tool, protecting mealtimes, investing in food and additional personnel (healthcare aides, practical nurses and/or diet technicians) to assist patients at mealtimes. Training for hospital staff raises awareness of the issue, but also helps them to identify their role and how it can be modified to improve nutrition care. Patients and families need to be aware of the importance of food to their recovery and how they can advocate for their needs while in hospital, as well as post-hospitalization. It is anticipated that a multi-level approach that promotes being "food aware" for all involved will help hospitals to achieve patient-centred care with respect to nutrition.

Pre-hospital electrocardiographic severity and acuteness scores predict left ventricular function in patients with ST elevation myocardial infarction

DEFF Research Database (Denmark)

Fakhri, Yama; Ersbøll, Mads; Køber, Lars

2016-01-01

OBJECTIVES: System delay (time from first medical contact to primary percutaneous coronary intervention) is associated with heart failure and mortality in patients with ST segment elevation myocardial infarction (STEMI). We evaluated the impact of system delay on left ventricular function (LVF...

[Trends in hospital care].

Science.gov (United States)

Vecina Neto, Gonzalo; Malik, Ana Maria

2007-01-01

This paper analyses trends in the delivery of hospital services in Brazil, considering the setting, the current situation and its challenges, examining what still remains to be done. The variables studied for the analysis of the setting are: demography, epidemiological profile, human resources, technology, medicalization, costs, review of the role of the citizen, legislation, equity, hospital-centricity and regionalization, care fractioning and bed availability. The Brazilian setting was studied through the supplementary healthcare model, financing and the healthcare area production chain. The observations of the current situation present external evaluation models, outsourcing, public-private relationships, de-hospitalization and financing. The analysis of the challenges examines the need for long range planning, the quest for new legal models for the 'business', the use of information and information systems, cost controls and the need for enhanced efficiency and compliance with legal directives, guaranteed universal access to full healthcare facilities, the inclusion of primary prevention in healthcare procedures, integrating the public and private sectors and engaging physicians in solving problems.

Implementation of the Tobacco Tactics intervention versus usual care in Trinity Health community hospitals

Directory of Open Access Journals (Sweden)

Sonia A. Duffy

2016-11-01

Full Text Available Abstract Background Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM implementation framework, a National Institutes of Health-sponsored study compared the nurse-administered Tobacco Tactics intervention to usual care. A prior paper describes the effectiveness of the Tobacco Tactics intervention. This subsequent paper provides data describing the remaining constructs of the RE-AIM framework. Methods This pragmatic study used a mixed methods, quasi-experimental design in five Michigan community hospitals of which three received the nurse-administered Tobacco Tactics intervention and two received usual care. Nurses and patients were surveyed pre- and post-intervention. Measures included reach (patient participation rates, characteristics, and receipt of services, adoption (nurse participation rates and characteristics, implementation (pre-to post-training changes in nurses' attitudes, delivery of services, barriers to implementation, opinions about training, documentation of services, and numbers of volunteer follow-up phone calls, and maintenance (continuation of the intervention once the study ended. Results Reach: Patient participation rates were 71.5 %. Compared to no change in the control sites, there were significant pre- to post-intervention increases in self-reported receipt of print materials in the intervention hospitals (n = 1370, p < 0.001. Adoption: In the intervention hospitals, all targeted units and several non-targeted units participated; 76.0 % (n = 1028 of targeted nurses and 317 additional staff participated in the training, and 92.4 % were extremely or somewhat satisfied with the training. Implementation: Nurses in the intervention hospitals reported increases in providing advice to quit, counseling, medications, handouts, and DVD (all p < 0.05 and reported decreased barriers to implementing smoking cessation services (p < 0.001. Qualitative comments were very

[Dementia friendly care services in general hospitals : Representative results of the general hospital study (GHoSt)].

Science.gov (United States)

Hendlmeier, Ingrid; Bickel, Horst; Hessler, Johannes Baltasar; Weber, Joshua; Junge, Magdalena Nora; Leonhardt, Sarah; Schäufele, Martina

2017-11-06

Mostly model projects report on special care services and procedures for general hospital patients with cognitive impairment. The objective of this study was to determine the frequency of special care services and procedures in general hospitals on the basis of a representative cross-sectional study. From a list of all general hospitals in southern Germany we randomly selected a specified number of hospitals und somatic wards. The hospitals were visited and all older patients on the selected wards on that day were included in the study. Information about care services and their utilization was collected with standardized instruments. A total of 33 general hospitals and 172 wards participated in the study. The patient sample included 1469 persons over 65 (mean age 78.6 years) and 40% of the patients showed cognitive impairments. The staff reported that the most frequent measures for patients with cognitive impairments concerned patients with wandering behavior (63.1%), efforts to involve the patients' relatives to help with their daily care (60.1%), conducting nonintrusive interviews to identify cognitive impairments (59.9%), allocation to other rooms (58%) and visual aids for place orientation of patients (50.6%). In accordance with earlier studies our results show that other dementia friendly services implemented in pilot projects were rare. The existing special services for patients with cognitive impairment were rarely used by the patients or their relatives. The results demonstrate the urgent need to improve special care services and routines for identification of elderly patients with cognitive impairment and risk of delirium in general hospitals.

Prevalence and Risk Factors Associated with Low Back Pain Among Health Care Providers in a District Hospital

Directory of Open Access Journals (Sweden)

TS Wong

2010-07-01

Full Text Available STUDY DESIGN: A cross-sectional study among health care providers working at one hospital. OBJECTIVE: To investigate the prevalence, the consequences and the risk factors associated with low back pain (LBP among hospital staff. MATERIALS AND METHODS: The study sample consisted of 931 health care providers who answered a pre-established questionnaire including 30 items in two languages. RESULTS: The cumulative life-prevalence of LBP was 72.5% and the yearly prevalence was 56.9%. Chronic LBP prevalence was noted 5.1% of the cases. Treatment was sought in 34.1% of LBP sufferers and 7.3% required sick leave or absence from work due to LBP. Risk factors associated with LBP were professional categories, bad body posture, lifting objects or patients and the increased levels of lifting, levels of job satisfaction and stressful job demands. CONCLUSION: There was a high prevalence of LBP among hospital staff, resulting in significant medical and socio-professional consequences. Many risk factors were identified that would necessitate multidisciplinary involvement to reduce the LBP incidence and related costs.

Neurologic continuum of care: Evidence-based model of a post-hospital system of care.

Science.gov (United States)

Lewis, Frank D; Horn, Gordon J

2015-01-01

There is increasing need for a well-organized continuum of post-hospital rehabilitative care to reduce long term disability resulting from acquired brain injury. This study examined the effectiveness of four levels of post-hospital care (active neurorehabilitation, neurobehavioral intensive, day treatment, and supported living) and the functional variables most important to their success. Participants were 1276 adults with acquired brain injury who were being treated in one of the four program levels. A Repeated Measures MANOVA was used to evaluate change from admission to discharge on the Mayo Portland Adaptability Inventory-4 T-scores. Regression analyses were used to identify predictors of outcome. Statistical improvement on the MPAI-4 was observed at each program level. Self-care and Initiation were the strongest predictors of outcome. The results support the effectiveness of a continuum of care for acquired brain injury individuals beyond hospitalization and acute in-hospital rehabilitation. It is particularly noteworthy that reduction in disability was achieved for all levels of programming even with participants whose onset to admission exceeded 7 years post-injury.

Qualifying instrument for evaluation of food and nutritional care in hospital.

Science.gov (United States)

Díez García, R W; Souza, A A; Proença, R P C

2012-01-01

Establishing criteria for hospital nutrition care ensures that quality care is delivered to patients. The responsibility of the Hospital Food and Nutrition Service (HFNS) is not always well defined, despite efforts to establish guidelines for patient clinical nutrition practice. This study describes the elaboration of an Instrument for Evaluation of Food and Nutritional Care (IEFNC) aimed at directing the actions of the Hospital Food and Nutrition Service. This instrument was qualified by means of a comparative analysis of the categories related to hospital food and nutritional care, published in the literature. Elaboration of the IEFNC comprised the following stages: (a) a survey of databases and documents for selection of the categories to be used in nutrition care evaluation, (b) a study of the institutional procedures for nutrition practice at two Brazilian hospitals, in order to provide a description of the sequence of actions that should be taken by the HFNS as well as other services participating in nutrition care, (c) design of the IEFNC based on the categories published in the literature, adapted to the sequence of actions observed in the routines of the hospitals under study, (d) application of the questionnaire at two different hospitals that was mentioned in the item (b), in order to assess the time spent on its application, the difficulties in phrasing the questions, and the coverage of the instrument, and (e) finalization of the instrument. The IEFNC consists of 50 open and closed questions on two areas of food and nutritional care in hospital: inpatient nutritional care and food service quality. It deals with the characterization and structure of hospitals and their HFNS, the actions concerning the patients' nutritional evaluation and monitoring, the meal production system, and the hospital diets. "This questionnaire is a tool that can be seen as a portrait of the structure and characteristics of the HFNS and its performance in clinical and meal

Follow-up analysis of federal process of care data reported from three acute care hospitals in rural Appalachia

Directory of Open Access Journals (Sweden)

Sills ES

2013-03-01

Full Text Available E Scott Sills,1,2 Liubomir Chiriac,3 Denis Vaughan,4 Christopher A Jones,5 Shala A Salem11Division of Reproductive Endocrinology, Pacific Reproductive Center, Irvine, CA, USA; 2Graduate School of Life Sciences, University of Westminster, London, UK; 3Department of Mathematics, California Institute of Technology, Pasadena, CA, USA; 4Department of Obstetrics and Gynaecology, School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland; 5Global Health Economics Unit and Department of Surgery, Center for Clinical and Translational Science, University of Vermont College of Medicine, Burlington, VT, USABackground: This investigation evaluated standardized process of care data collected on selected hospitals serving a remote rural section of westernmost North Carolina.Methods: Centers for Medicare and Medicaid Services data were analyzed retrospectively for multiple clinical parameters at Fannin Regional Hospital, Murphy Medical Center, and Union General Hospital. Data were analyzed by paired t-test for individual comparisons among the three study hospitals to compare the three facilities with each other, as well as with state and national average for each parameter.Results: Centers for Medicare and Medicaid Services “Hospital Compare” data from 2011 showed Fannin Regional Hospital to have significantly higher composite scores on standardized clinical process of care measures relative to the national average, compared with Murphy Medical Center (P = 0.01 and Union General Hospital (P = 0.01. This difference was noted to persist when Fannin Regional Hospital was compared with Union General Hospital using common state reference data (P = 0.02. When compared with national averages, mean process of care scores reported from Murphy Medical Center and Union General Hospital were both lower but not significantly different (−3.44 versus −6.07, respectively, P = 0.54.Conclusion: The range of process of care scores submitted by acute care

Estimating Uncompensated Care Charges at Rural Hospital Emergency Departments

Science.gov (United States)

Bennett, Kevin J.; Moore, Charity G.; Probst, Janice C.

2007-01-01

Context: Rural hospitals face multiple financial burdens. Due to federal law, emergency departments (ED) provide a gateway for uninsured and self-pay patients to gain access to treatment. It is unknown how much uncompensated care in rural hospitals is due to ED visits. Purpose: To develop a national estimate of uncompensated care from patients…

Patients with worsening chronic heart failure who present to a hospital emergency department require hospital care

Directory of Open Access Journals (Sweden)

Shafazand Masoud

2012-03-01

Full Text Available Abstract Background Chronic heart failure (CHF is a major public health problem characterised by progressive deterioration with disabling symptoms and frequent hospital admissions. To influence hospitalisation rates it is crucial to identify precipitating factors. To characterise patients with CHF who seek an emergency department (ED because of worsening symptoms and signs and to explore the reasons why they are admitted to hospital. Method Patients (n = 2,648 seeking care for dyspnoea were identified at the ED, Sahlgrenska University Hospital/Östra. Out of 2,648 patients, 1,127 had a previous diagnosis of CHF, and of these, 786 were included in the present study with at least one sign and one symptom of worsening CHF. Results Although several of the patients wanted to go home after acute treatment in the ED, only 2% could be sent home. These patients were enrolled in an interventional study, which evaluated the acute care at home compared to the conventional, in hospital care. The remaining patients were admitted to hospital because of serious condition, including pneumonia/respiratory disease, myocardial infarction, pulmonary oedema, anaemia, the need to monitor cardiac rhythm, pathological blood chemistry and difficulties to communicate. Conclusion The vast majority of patients with worsening CHF seeking the ED required hospital care, predominantly because of co-morbidities. Patients with CHF with symptomatic deterioration may be admitted to hospital without additional emergency room investigations.

Hospital-based home care for children with cancer

DEFF Research Database (Denmark)

Hansson, Eva Helena; Kjaergaard, Hanne; Johansen, Christoffer

2013-01-01

BACKGROUND: To assess the feasibility and psychosocial impact of a hospital-based home care (HBHC) program for children with cancer. PROCEDURE: A HBHC program was carried out with 51 children (0-18 years) with cancer to assess its feasibility in terms of satisfaction, care preferences, safety...... children and 43 parents in the home care group, and 47 children and 66 parents receiving standard hospital care. RESULTS: All parents in the HBHC program were satisfied and preferred home care. There were no serious adverse events associated with HBHC, and costs did not increase. When adjusting for age......, gender, diagnosis and time since diagnosis, we found significant higher HRQOL scores in parent-reported physical health (P = 0.04; 95% confidence interval (CI): -0.2-19.5) and worry (P = 0.04; 95% CI: -0.4-20.6) in the home-care group indicating better physical health and less worry for children...

A statewide review of postnatal care in private hospitals in Victoria, Australia

Directory of Open Access Journals (Sweden)

Forster Della A

2010-05-01

Full Text Available Abstract Background Concerns have been raised in Australia and internationally regarding the quality and effectiveness of hospital postnatal care, although Australian women receiving postnatal care in the private maternity sector rate their satisfaction with care more highly than women receiving public maternity care. In Victoria, Australia, two-thirds of women receive their maternity care in the public sector and the remainder in private health care sector. A statewide review of public hospital postnatal care in Victoria from the perspective of care providers found many barriers to care provision including the busyness of postnatal wards, inadequate staffing and priority being given to other episodes of care; however the study did not include private hospitals. The aim of this study was replicate the review in the private sector, to explore the structure and organisation of postnatal care in private hospitals and identify those aspects of care potentially impacting on women's experiences and maternal and infant care. This provides a more complete overview of the organisational structures and processes in postnatal care in all Victorian hospitals from the perspective of care providers. Methods A mixed method design was used. A structured postal survey was sent to all Victorian private hospitals (n = 19 and key informant interviews were undertaken with selected clinical midwives, maternity unit managers and obstetricians (n = 11. Survey data were analysed using descriptive statistics and interview data analysed thematically. Results Private hospital care providers report that postnatal care is provided in very busy environments, and that meeting the aims of postnatal care (breastfeeding support, education of parents and facilitating rest and recovery for women following birth was difficult in the context of increased acuity of postnatal care; prioritising of other areas over postnatal care; high midwife-to-woman ratios; and the number and

Transitional care management in the outpatient setting.

Science.gov (United States)

Baldonado, Analiza; Hawk, Ofelia; Ormiston, Thomas; Nelson, Danielle

2017-01-01

Patients who are high risk high cost (HRHC), those with severe or multiple medical issues, and the chronically ill elderly are major drivers of rising health care costs.1 The HRHC patients with complex health conditions and functional limitations may likely go to emergency rooms and hospitals, need more supportive services, and use long-term care facilities.2 As a result, these patient populations are vulnerable to fragmented care and "falling through the cracks".2 A large county health and hospital system in California, USA introduced evidence-based interventions in accordance with the Triple AIM3 focused on patient-centered health care, prevention, health maintenance, and safe transitions across the care continuum. The pilot program embedded a Transitional Care Manager (TCM) within an outpatient Family Medicine clinic to proactively assist HRHC patients with outreach assistance, problem-solving and facilitating smooth transitions of care. This initiative is supported by a collaborative team that included physicians, nurses, specialists, health educator, and pharmacist. The initial 50 patients showed a decrease in Emergency Department (ED) encounters (pre-vs post intervention: 33 vs 17) and hospital admissions (pre-vs post intervention: 32 vs 11), improved patient outcomes, and cost saving. As an example, one patient had 1 ED visit and 5 hospital admission with total charges of $217,355.75 in the 6 months' pre-intervention with no recurrence of ED or hospital admissions in the 6 months of TCM enrollment. The preliminary findings showed improvement of patient-centered outcomes, quality of care, and resource utilization however more data is required.

Development and Validation of the Geriatric In-Hospital Nursing Care Questionnaire

NARCIS (Netherlands)

Persoon, Anke; Bakker, Franka C.; van der Wal-Huisman, Hanneke; Rikkert, Marcel G. M. Olde

ObjectivesTo develop a questionnaire, the Geriatric In-hospital Nursing Care Questionnaire (GerINCQ), to measure, in an integrated way, the care that older adults receive in the hospital and nurses' attitudes toward and perceptions about caring for older adults. DesignQuestionnaire development.

Patients' Care Needs: Documentation Analysis in General Hospitals.

Science.gov (United States)

Paans, Wolter; Müller-Staub, Maria

2015-10-01

The purpose of the study is (a) to describe care needs derived from records of patients in Dutch hospitals, and (b) to evaluate whether nurses employed the NANDA-I classification to formulate patients' care needs. A stratified cross-sectional random-sampling nursing documentation audit was conducted employing the D-Catch instrument in 10 hospitals comprising 37 wards. The most prevalent nursing diagnoses were acute pain, nausea, fatigue, and risk for impaired skin integrity. Most care needs were determined in physiological health patterns and few in psychosocial patterns. To perform effective interventions leading to high-quality nursing-sensitive outcomes, nurses should also diagnose patients' care needs in the health management, value-belief, and coping stress patterns. © 2014 NANDA International, Inc.

Quality indicators for colorectal cancer surgery and care according to patient-, tumor-, and hospital-related factors

International Nuclear Information System (INIS)

Mathoulin-Pélissier, Simone; Bécouarn, Yves; Belleannée, Geneviève; Pinon, Elodie; Jaffré, Anne; Coureau, Gaëlle; Auby, Dominique; Renaud-Salis, Jean-Louis; Rullier, Eric

2012-01-01

Colorectal cancer (CRC) care has improved considerably, particularly since the implementation of a quality of care program centered on national evidence-based guidelines. Formal quality assessment is however still needed. The aim of this research was to identify factors associated with practice variation in CRC patient care. CRC patients identified from all cancer centers in South-West France were included. We investigated variations in practices (from diagnosis to surgery), and compliance with recommended guidelines for colon and rectal cancer. We identified factors associated with three colon cancer practice variations potentially linked to better survival: examination of ≥12 lymph nodes (LN), non-use and use of adjuvant chemotherapy for stage II and stage III patients, respectively. We included 1,206 patients, 825 (68%) with colon and 381 (32%) with rectal cancer, from 53 hospitals. Compliance was high for resection, pathology report, LN examination, and chemotherapy use for stage III patients. In colon cancer, 26% of stage II patients received adjuvant chemotherapy and 71% of stage III patients. 84% of stage US T3T4 rectal cancer patients received pre-operative radiotherapy. In colon cancer, factors associated with examination of ≥12 LNs were: lower ECOG score, advanced stage and larger hospital volume; factors negatively associated were: left sided tumor location and one hospital district. Use of chemotherapy in stage II patients was associated with younger age, advanced stage, emergency setting and care structure (private and location); whereas under-use in stage III patients was associated with advanced age, presence of comorbidities and private hospitals. Although some changes in practices may have occurred since this observational study, these findings represent the most recent report on practices in CRC in this region, and offer a useful methodological approach for assessing quality of care. Guideline compliance was high, although some organizational

Quantifying the demand for hospital care services: a time and motion study.

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van Oostveen, Catharina J; Gouma, Dirk J; Bakker, Piet J; Ubbink, Dirk T

2015-01-22

The actual amount of care hospitalised patients need is unclear. A model to quantify the demand for hospital care services among various clinical specialties would avail healthcare professionals and managers to anticipate the demand and costs for clinical care. Three medical specialties in a Dutch university hospital participated in this prospective time and motion study. To include a representative sample of patients admitted to clinical wards, the most common admission diagnoses were selected from the most recent update of the national medical registry (LMR) of ICD-10 admission diagnoses. The investigators recorded the time spent by physicians and nurses on patient care. Also the costs involved in medical and nursing care, (surgical) interventions, and diagnostic procedures as an estimate of the demand for hospital care services per hospitalised patient were calculated and cumulated. Linear regression analysis was applied to determine significant factors including patient and healthcare outcome characteristics. Fifty patients on the Surgery (19), Pediatrics (17), and Obstetrics & Gynecology (14) wards were monitored during their hospitalization. Characteristics significantly associated with the demand for healthcare were: polypharmacy during hospitalization, complication severity level, and whether a surgical intervention was performed. A set of predictors of the demand for hospital care services was found applicable to different clinical specialties. These factors can all be identified during hospitalization and be used as a managerial tool to monitor the patients' demand for hospital care services and to detect trends in time.

A comparative study of occupancy and patient care quality in four different types of intensive care units in a children's hospital.

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Smith, Thomas J

2012-01-01

This paper reports a comparative study of occupancy and patient care quality in four types of intensive care units in a children's hospital,: an Infant Care Center (ICC), a Medical/Surgical (Med/Surg) unit, a Neonatal Intensive Care Unit (NICU), and a Pediatric Intensive Care Unit (PICU), each featuring a mix of multi-bed and private room (PR) patient care environments. The project is prompted by interest by the project sponsor in a pre-occupancy analysis, before the units are upgraded to exclusive PR designs. Methods comprised, for each unit: (1) observations of ergonomic design features; (2) task activity analyses of job performance of selected staff; and (3) use of a survey to collect perceptions by unit nursing and house staff (HS) of indicators of occupancy and patient care quality. (1) the five most common task activities are interaction with patients, charting, and interaction with equipment, co-workers and family members; (2) job satisfaction, patient care, work environment, job, patient care team interaction, and general occupancy quality rankings by ICC and/or NICU respondents are significantly higher than those by other staff respondents; and (3) ergonomic design shortcomings noted are excess noise, problems with equipment, and work environment, job-related health, and patient care quality issues.

Planned home versus hospital care for preterm prelabour rupture of the membranes (PPROM) prior to 37 weeks' gestation.

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Abou El Senoun, Ghada; Dowswell, Therese; Mousa, Hatem A

2014-04-14

Preterm prelabour rupture of membranes (PPROM) is associated with increased risk of maternal and neonatal morbidity and mortality. Women with PPROM have been predominantly managed in hospital. It is possible that selected women could be managed at home after a period of observation. The safety, cost and women's views about home management have not been established. To assess the safety, cost and women's views about planned home versus hospital care for women with PPROM. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2013) and the reference lists of all the identified articles. Randomised and quasi-randomised trials comparing planned home versus hospital management for women with PPROM before 37 weeks' gestation. Two review authors independently assessed clinical trials for eligibility for inclusion, risk of bias, and carried out data extraction. We included two trials (116 women) comparing planned home versus hospital management for PPROM. Overall, the number of included women in each trial was too small to allow adequate assessment of pre-specified outcomes. Investigators used strict inclusion criteria and in both studies relatively few of the women presenting with PPROM were eligible for inclusion. Women were monitored for 48 to 72 hours before randomisation. Perinatal mortality was reported in one trial and there was insufficient evidence to determine whether it differed between the two groups (risk ratio (RR) 1.93, 95% confidence interval (CI) 0.19 to 20.05).  There was no evidence of differences between groups for serious neonatal morbidity, chorioamnionitis, gestational age at delivery, birthweight and admission to neonatal intensive care.There was no information on serious maternal morbidity or mortality. There was some evidence that women managed in hospital were more likely to be delivered by caesarean section (RR (random-effects) 0.28, 95% CI 0.07 to 1.15). However, results should be interpreted cautiously as there is

Hospital care for mental health and substance abuse conditions in Parkinson's disease.

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Willis, Allison W; Thibault, Dylan P; Schmidt, Peter N; Dorsey, E Ray; Weintraub, Daniel

2016-12-01

The objective of this study was to examine mental health conditions among hospitalized individuals with Parkinson's disease in the United States. This was a serial cross-sectional study of hospitalizations of individuals aged ≥60 identified in the Nationwide Inpatient Sample dataset from 2000 to 2010. We identified all hospitalizations with a diagnosis of PD, alcohol abuse, anxiety, bipolar disorder, depression, impulse control disorders, mania, psychosis, substance abuse, and attempted suicide/suicidal ideation. National estimates of each mental health condition were compared between hospitalized individuals with and without PD. Hierarchical logistic regression models determined which inpatient mental health diagnoses were associated with PD, adjusting for demographic, payer, geographic, and hospital characteristics. We identified 3,918,703 mental health and substance abuse hospitalizations. Of these, 2.8% (n = 104, 437) involved a person also diagnosed with PD. The majority of mental health and substance abuse patients were white (86.9% of PD vs 83.3% of non-PD). Women were more common than men in both groups (male:female prevalence ratio, PD: 0.78, 0.78-0.79, non-PD: 0.58, 0.57-0.58). Depression (adjusted odds ratio 1.32, 1.31-1.34), psychosis (adjusted odds ratio 1.25, 1.15-1.33), bipolar disorder (adjusted odds ratio 2.74, 2.69-2.79), impulse control disorders (adjusted odds ratio 1.51, 1.31-1.75), and mania (adjusted odds ratio 1.43, 1.18-1.74) were more likely among PD patients, alcohol abuse was less likely (adjusted odds ratio 0.26, 0.25-0.27). We found no PD-associated difference in suicide-related care. PD patients have unique patterns of acute care for mental health and substance abuse. Research is needed to guide PD treatment in individuals with pre-existing psychiatric illnesses, determine cross provider reliability of psychiatric diagnoses in PD patients, and inform efforts to improve psychiatric outcomes. © 2016 International Parkinson and

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

Science.gov (United States)

2013-08-19

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

Pre-Transplant Aerobic Capacity and Prolonged Hospitalization After Liver Transplantation

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Eliane Viana Mancuzo

2015-05-01

Conclusions: In LT candidates, a reduced pre-VO2peak may predict a higher risk of greater pos-LT length of hospitalization. The length of ICU stay and postoperative mortality were not associated with variables studied. This finding should be evaluated in other studies before making specific recommendations about a routine use of CPET in LT candidates.

Becoming Food Aware in Hospital: A Narrative Review to Advance the Culture of Nutrition Care in Hospitals

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Celia Laur

2015-06-01

Full Text Available The Nutrition Care in Canadian Hospitals (2010–2013 study identified the prevalence of malnutrition on admission to medical and surgical wards as 45%. Nutrition practices in the eighteen hospitals, including diagnosis, treatment and monitoring of malnourished patients, were ad hoc. This lack of a systematic approach has demonstrated the need for the development of improved processes and knowledge translation of practices aimed to advance the culture of nutrition care in hospitals. A narrative review was conducted to identify literature that focused on improved care processes and strategies to promote the nutrition care culture. The key finding was that a multi-level approach is needed to address this complex issue. The organization, staff, patients and their families need to be part of the solution to hospital malnutrition. A variety of strategies to promote the change in nutrition culture have been proposed in the literature, and these are summarized as examples for others to consider. Examples of strategies at the organizational level include developing policies to support change, use of a screening tool, protecting mealtimes, investing in food and additional personnel (healthcare aides, practical nurses and/or diet technicians to assist patients at mealtimes. Training for hospital staff raises awareness of the issue, but also helps them to identify their role and how it can be modified to improve nutrition care. Patients and families need to be aware of the importance of food to their recovery and how they can advocate for their needs while in hospital, as well as post-hospitalization. It is anticipated that a multi-level approach that promotes being “food aware” for all involved will help hospitals to achieve patient-centred care with respect to nutrition.

Caring for the new uninsured: Hospital charity care for older people without coverage.

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DeLia, Derek

2006-12-01

Despite near-universal coverage through Medicare, a number of elderly residents in the United States do not have health insurance coverage. To the author's knowledge, this study is the first to document trends in the use of hospital charity care by uninsured older people. Data from the New Jersey Charity Care Program, which subsidizes hospitals for services provided to low-income uninsured people, were used to analyze trends in charity care utilization by older people from 1999 to 2004. Charity care charges are standardized to uniform Medicaid reimbursement rates and inflation adjusted using the Medical Care Consumer Price Index. From 1999 to 2004, use of charity care by older people grew much faster than it did for younger patients. As a result, older people now account for a greater share of hospital charity care in New Jersey than children. Elderly users of charity care generated higher costs per patient than their younger counterparts. Cost differences were especially salient at the upper end of the distribution, where high-cost elderly patients used significantly more resources than high-cost patients in other age groups. These results highlight an emerging source of strain on the healthcare safety net and point to a growing population of uninsured residents who have costly and complex medical needs. Similar experiences are likely to be found in other states, especially those that have growing populations of elderly immigrants who are likely to lack health insurance.

In California, not-for-profit hospitals spent more operating expenses on charity care than for-profit hospitals spent.

Science.gov (United States)

Valdovinos, Erica; Le, Sidney; Hsia, Renee Y

2015-08-01

In exchange for sizable tax exemptions, not-for-profit hospitals must engage in activities that meet the Internal Revenue Service's community benefit standard. The provision of charity care-free care to those unable to pay-can help meet that standard. Bad debt, the other form of uncompensated care, cannot be used to meet the standard, although Medicaid shortfalls can. However, the ACA lacks guidelines for providing charity care, and federal law sets no minimum requirements for community benefit activities. Using data from California, we examined whether the levels of charity and uncompensated care provided differed across general acute care hospitals by profit status and other characteristics during 2011-13. The mean proportion of total operating expenses spent on charity care differed significantly between not-for-profit (1.9 percent) and for-profit hospitals (1.4 percent), in contrast to the mean proportion spent on uncompensated care. Both types of spending varied widely across hospitals. Policy makers should consider measures that remove disincentives to meeting the persistent considerable need for charity care-for example, increasing supports to offset rising Medicaid shortfalls resulting from program expansion-and facilitate the tracking of ACA impacts on the distribution of charity care and uncompensated care delivery. Project HOPE—The People-to-People Health Foundation, Inc.

Effectiveness of palliative home-care services in reducing hospital admissions and determinants of hospitalization for terminally ill patients followed up by a palliative home-care team: a retrospective cohort study.

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Riolfi, Mirko; Buja, Alessandra; Zanardo, Chiara; Marangon, Chiara Francesca; Manno, Pietro; Baldo, Vincenzo

2014-05-01

It has been demonstrated that most patients in the terminal stages of cancer would benefit from palliative home-care services. The aim of this study was to assess the effectiveness of appropriate palliative home-care services in reducing hospital admissions, and to identify factors predicting the likelihood of patients treated at home being hospitalized. Retrospective cohort study. We enrolled all 402 patients listed by the Local Health Authority No. 5, Veneto Region (North-East Italy), as dying of cancer in 2011. Of the cohort considered, 39.9% patients had been taken into care by a palliative home-care team. Irrespective of age, gender, and type of tumor, patients taken into care by the palliative home-care team were more likely to die at home, less likely to be hospitalized, and spent fewer days in hospital in the last 2 months of their life. Among the patients taken into care by the palliative home-care team, those with hematological cancers and hepatocellular carcinoma were more likely to be hospitalized, and certain symptoms (such as dyspnea and delirium) were predictive of hospitalization. Our study confirms the effectiveness of palliative home care in enabling patients to spend the final period of their lives at home. The services of a palliative home-care team reduced the consumption of hospital resources. This study also provided evidence of some types of cancer (e.g. hematological cancers and hepatocellular carcinoma) being more likely to require hospitalization, suggesting the need to reconsider the pathways of care for these diseases.

Subgroup differences and determinants of patient-reported mental and physical health at hospital discharge among patients with ischemic heart disease

DEFF Research Database (Denmark)

Rasmussen, T. B.; Herning, M.; Johansen, P. P.

2017-01-01

Purpose: (i) To describe patient-reported outcomes (PROs) at hospital-discharge across three diagnostic IHD sub-groups; chronic ischemic heart disease/stable angina (IHD/AP), non-ST-elevation myocardial infarction/unstable angina (NSTEMI/UAP) and ST-elevation myocardial infarction (STEMI), and (i......) to examine determinants among demographic-, clinical- and self-report health behavior characteristics for PROs at hospital discharge in patients with IHD....

Prevalence of use of advance directives, health care proxy, legal guardian, and living will in 512 patients hospitalized in a cardiac care unit/intensive care unit in 2 community hospitals.

Science.gov (United States)

Kumar, Anil; Aronow, Wilbert S; Alexa, Margelusa; Gothwal, Ritu; Jesmajian, Stephen; Bhushan, Bharat; Gaba, Praveen; Catevenis, James

2010-04-30

The prevalence of use of any advance directives was 26% in 112 patients hospitalized in a cardiac care unit (CCU)/intensive care unit (ICU) in an academic medical center. We investigated in 2 community hospitals the prevalence of use of advance directives (AD), health care proxy (HCP), legal guardian (LG), and living will (LW) in 512 patients hospitalized in a CCU/ ICU approached for AD and HCP. The use of AD was 22%, of HCP was 19%, of LG was 16%, and of LW was 5%. The use of AD was 22%, of HCP was 19%, of LG was 16%, and of LW was 5% in patients hospitalized in a CCU/ICU. Educational programs on use of AD and of HCP need to be part of cardiovascular training programs and of cardiovascular continuing medical education.

Distribution of variable vs fixed costs of hospital care.

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Roberts, R R; Frutos, P W; Ciavarella, G G; Gussow, L M; Mensah, E K; Kampe, L M; Straus, H E; Joseph, G; Rydman, R J

1999-02-17

Most strategies proposed to control the rising cost of health care are aimed at reducing medical resource consumption rates. These approaches may be limited in effectiveness because of the relatively low variable cost of medical care. Variable costs (for medication and supplies) are saved if a facility does not provide a service while fixed costs (for salaried labor, buildings, and equipment) are not saved over the short term when a health care facility reduces service. To determine the relative variable and fixed costs of inpatient and outpatient care for a large urban public teaching hospital. Cost analysis. A large urban public teaching hospital. All expenditures for the institution during 1993 and for each service were categorized as either variable or fixed. Fixed costs included capital expenditures, employee salaries and benefits, building maintenance, and utilities. Variable costs included health care worker supplies, patient care supplies, diagnostic and therapeutic supplies, and medications. In 1993, the hospital had nearly 114000 emergency department visits, 40000 hospital admissions, 240000 inpatient days, and more than 500000 outpatient clinic visits. The total budget for 1993 was $429.2 million, of which $360.3 million (84%) was fixed and $68.8 million (16%) was variable. Overall, 31.5% of total costs were for support expenses such as utilities, employee benefits, and housekeeping salaries, and 52.4% included direct costs of salary for service center personnel who provide services to individual patients. The majority of cost in providing hospital service is related to buildings, equipment, salaried labor, and overhead, which are fixed over the short term. The high fixed costs emphasize the importance of adjusting fixed costs to patient consumption to maintain efficiency.

Evaluation of a Specialized Yoga Program for Persons Admitted to a Complex Continuing Care Hospital: A Pilot Study

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Kathryn Curtis

2016-01-01

Full Text Available Introduction. The purpose of this study was to evaluate a specialized yoga intervention for inpatients in a rehabilitation and complex continuing care hospital. Design. Single-cohort repeated measures design. Methods. Participants (N=10 admitted to a rehabilitation and complex continuing care hospital were recruited to participate in a 50–60 min Hatha Yoga class (modified for wheelchair users/seated position once a week for eight weeks, with assigned homework practice. Questionnaires on pain (pain, pain interference, and pain catastrophizing, psychological variables (depression, anxiety, and experiences with injustice, mindfulness, self-compassion, and spiritual well-being were collected at three intervals: pre-, mid-, and post-intervention. Results. Repeated measures ANOVAs revealed a significant main effect of time indicating improvements over the course of the yoga program on the (1 anxiety subscale of the Hospital Anxiety and Depression Scale, F(2,18 = 4.74, p<.05, and ηp2 = .35, (2 Self-Compassion Scale-Short Form, F(2,18 = 3.71, p<.05, and ηp2 = .29, and (3 Magnification subscale of the Pain Catastrophizing Scale, F(2,18 = 3. 66, p<.05, and ηp2 = .29. Discussion. The results suggest that an 8-week Hatha Yoga program improves pain-related factors and psychological experiences in individuals admitted to a rehabilitation and complex continuing care hospital.

Implementation of national palliative care guidelines in Swedish acute care hospitals: A qualitative content analysis of stakeholders' perceptions.

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Lind, S; Wallin, L; Brytting, T; Fürst, C J; Sandberg, J

2017-11-01

In high-income countries a large proportion of all deaths occur in hospitals. A common way to translate knowledge into clinical practice is developing guidelines for different levels of health care organisations. During 2012, national clinical guidelines for palliative care were published in Sweden. Later, guidance for palliative care was issued by the National Board of Health and Welfare. The aim of this study was two-fold: to investigate perceptions regarding these guidelines and identify obstacles and opportunities for implementation of them in acute care hospitals. Interviews were conducted with local politicians, chief medical officers and health professionals at acute care hospitals. The Consolidated Framework for Implementation Research was used in a directed content analysis approach. The results showed little knowledge of the two documents at all levels of the health care organisation. Palliative care was primarily described as end of life care and only few of the participants talked about the opportunity to integrate palliative care early in a disease trajectory. The environment and culture at hospitals, characterised by quick decisions and actions, were perceived as obstacles to implementation. Health professionals' expressed need for palliative care training is an opportunity for implementation of clinical guidelines. There is a need for further implementation of palliative care in hospitals. One option for further research is to evaluate implementation strategies tailored to acute care. Copyright © 2017 Elsevier B.V. All rights reserved.

Improving immediate newborn care practices in Philippine hospitals: impact of a national quality of care initiative 2008-2015.

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Silvestre, Maria Asuncion A; Mannava, Priya; Corsino, Marie Ann; Capili, Donna S; Calibo, Anthony P; Tan, Cynthia Fernandez; Murray, John C S; Kitong, Jacqueline; Sobel, Howard L

2018-03-31

To determine whether intrapartum and newborn care practices improved in 11 large hospitals between 2008 and 2015. Secondary data analysis of observational assessments conducted in 11 hospitals in 2008 and 2015. Eleven large government hospitals from five regions in the Philippines. One hundred and seven randomly sampled postpartum mother-baby pairs in 2008 and 106 randomly sampled postpartum mothers prior to discharge from hospitals after delivery. A national initiative to improve quality of newborn care starting in 2009 through development of a standard package of intrapartum and newborn care services, practice-based training, formation of multidisciplinary hospital working groups, and regular assessments and meetings in hospitals to identify actions to improve practices, policies and environments. Quality improvement was supported by policy development, health financing packages, health facility standards, capacity building and health communication. Sixteen intrapartum and newborn care practices. Between 2008 and 2015, initiation of drying within 5 s of birth, delayed cord clamping, dry cord care, uninterrupted skin-to-skin contact, timing and duration of the initial breastfeed, and bathing deferred until 6 h after birth all vastly improved (P<0.001). The proportion of newborns receiving hygienic cord handling and the hepatitis B birth dose decreased by 11-12%. Except for reduced induction of labor, inappropriate maternal care practices persisted. Newborn care practices have vastly improved through an approach focused on improving hospital policies, environments and health worker practices. Maternal care practices remain outdated largely due to the ineffective didactic training approaches adopted for maternal care.

Investing in Post-Acute Care Transitions: Electronic Information Exchange Between Hospitals and Long-Term Care Facilities.

Science.gov (United States)

Cross, Dori A; Adler-Milstein, Julia

2017-01-01

Electronic health information exchange (HIE) is expected to help improve care transitions from hospitals to long-term care (LTC) facilities. We know little about the prevalence of hospital LTC HIE in the United States and what contextual factors may motivate or constrain this activity. Cross-sectional analysis of U.S. acute-care hospitals responding to the 2014 AHA IT Supplement survey and with available readmissions data (n = 1,991). We conducted multivariate logistic regression to explore the relationship between hospital LTC HIE and selected IT and policy characteristics. Over half of the hospitals in our study (57.2%) reported engaging in some form of HIE with LTC providers: 33.9% send-only, 0.5% receive-only, and 22.8% send and receive. Hospitals that engaged in some form of LTC HIE were more likely than those that did not engage to have attested to meaningful use (odds ratio [OR], 1.87; P = .01 for stage 1 and OR, 2.05; P investing in electronic information exchange with LTCs as part of a general strategy to adopt EHRs and engage in HIE, but also potentially to strengthen ties to LTC providers and to reduce readmissions. To achieve widespread connectivity, continued focus on adoption of related health IT infrastructure and greater emphasis on aligning incentives for hospital-LTC care transitions would be valuable. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Hospital marketing orientation and managed care processes: are they coordinated?

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White, K R; Thompson, J M; Patel, U B

2001-01-01

The hospital marketing function has been widely adopted as a way to learn about markets, attract sufficient resources, develop appropriate services, and communicate the availability of such goods to those who may be able to purchase such services. The structure, tasks, and effectiveness of the marketing function have been the subject of increased inquiry by researchers and practitioners alike. A specific understanding of hospital marketing in a growing managed care environment and the relationship between marketing and managed care processes in hospitals is a growing concern. Using Kotler and Clarke's framework for assessing marketing orientation, we examined the marketing orientation of hospitals in a single state at two points in time--1993 and 1999. Study findings show that the overall marketing orientation score decreased from 1993 to 1999 for the respondent hospitals. The five elements of the Kotler and Clarke definition of marketing orientation remained relatively stable, with slightly lower scores related to customer philosophy. In addition, we evaluated the degree to which selected managed care activities are carried out as part of its marketing function. A significant (p marketing function was evident from 1993 to 1999. With increasing numbers of managed care plan enrollees, hospitals are likely focusing on organizational buyers as important customers. In order to appeal to organizational buyers, hospital executives may be focusing more on clinical quality and cost efficiency in the production of services, which will improve a hospital's position with organizational buyers.

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

Science.gov (United States)

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

2018-04-16

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

To provide care and be cared for in a multiple-bed hospital room.

Science.gov (United States)

Persson, Eva; Määttä, Sylvia

2012-12-01

To illuminate patients' experiences of being cared for and nurses' experiences of caring for patients in a multiple-bed hospital room. Many patients and healthcare personnel seem to prefer single-bed hospital rooms. However, certain advantages of multiple-bed hospital rooms (MBRs) have also been described. Eight men and eight women being cared for in a multiple-bedroom were interviewed, and two focus-group interviews (FGI) with 12 nurses were performed. A qualitative content analysis was used. One theme--Creating a sphere of privacy--and three categories were identified based on the patient interviews. The categories were: Being considerate, Having company and The patients' area. In the FGI, one theme--Integrating individual care with care for all--and two categories emerged: Experiencing a friendly atmosphere and Providing exigent care. Both patients and nurses described the advantages and disadvantages of multiple-bed rooms. The patient culture of taking care of one another and enjoying the company of room-mates were considered positive and gave a sense of security of both patients and nurses. The advantages were slight and could easily become disadvantages if, for example, room-mates were very ill or confused. The patients tried to maintain their privacy and dignity and claimed that there were small problems with room-mates listening to conversations. In contrast, the nurses stressed patient integrity as a main disadvantage and worked to protect the integrity of individual patients. Providing care for all patients simultaneously had the advantage of saving time. The insights gained in the present study could assist nurses in reducing the disadvantages and taking advantage of the positive elements of providing care in MBRs. Health professionals need to be aware of how attitudes towards male and female patients, respectively, could affect care provision. © 2012 The Authors. Scandinavian Journal of Caring Sciences © 2012 Nordic College of Caring Science.

An intervention to improve care and reduce costs for high-risk patients with frequent hospital admissions: a pilot study

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Kostrowski Shannon

2011-10-01

Full Text Available Abstract Background A small percentage of high-risk patients accounts for a large proportion of Medicaid spending in the United States, which has become an urgent policy issue. Our objective was to pilot a novel patient-centered intervention for high-risk patients with frequent hospital admissions to determine its potential to improve care and reduce costs. Methods Community and hospital-based care management and coordination intervention with pre-post analysis of health care utilization. We enrolled Medicaid fee-for-service patients aged 18-64 who were admitted to an urban public hospital and identified as being at high risk for hospital readmission by a validated predictive algorithm. Enrolled patients were evaluated using qualitative and quantitative interview techniques to identify needs such as transportation to/advocacy during medical appointments, mental health/substance use treatment, and home visits. A community housing partner initiated housing applications in-hospital for homeless patients. Care managers facilitated appropriate discharge plans then worked closely with patients in the community using a harm reduction approach. Results Nineteen patients were enrolled; all were male, 18/19 were substance users, and 17/19 were homeless. Patients had a total of 64 inpatient admissions in the 12 months before the intervention, versus 40 in the following 12 months, a 37.5% reduction. Most patients (73.3% had fewer inpatient admissions in the year after the intervention compared to the prior year. Overall ED visits also decreased after study enrollment, while outpatient clinic visits increased. Yearly study hospital Medicaid reimbursements fell an average of $16,383 per patient. Conclusions A pilot intervention for high-cost patients shows promising results for health services usage. We are currently expanding our model to serve more patients at additional hospitals to see if the pilot's success can be replicated. Trial registration

Tetanus immunization: perception of residents in a tertiary care teaching hospital in Western India

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Dhande Priti P, Beri Shirish G, Patel Hardik R

2013-04-01

Full Text Available Background: Prevention of tetanus is far easier than its treatment where mortality is very high. Most cases of tetanus occur due to lack of proper vaccination against the disease and incomplete immunization on exposure. Residents in a tertiary care teaching hospital constitute the first contact physicians for patients. Aim: To assess the perception about Tetanus immunization among residents in a tertiary care teaching hospital of Pune city. Methodology: A pre tested questionnaire was used to assess the knowledge & recommendations about tetanus immunization among randomly selected 157 residents. Results: 73.25% residents were not aware of the number of doses of tetanus vaccine recommended for children under the age of 16 years. Around 50% residents were not aware of the recommended number of doses of tetanus vaccine for adults over the age of 16 years and during pregnancy. Nearly 60% of the residents considered the wound after every injury to be tetanus prone. 75.8% of residents thought burn injuries to be prone to the development of tetanus while 13.4% and 36.9% of the residents did not consider animal bite and human bite to be tetanus prone respectively. 99.4% residents considered tetanus toxoid administration in wound with rusted iron. The knowledge regarding tetanus immunization in relation to the wound categories depending on the immunization status of the patients was very poor amongst the residents. Conclusion: Better awareness and adherence of tetanus prophylaxis recommendations is needed in residents who are the first tier of health care providers in teaching hospitals.

Enhancing early postnatal care: findings from a major reform of maternity care in three Australian hospitals.

Science.gov (United States)

Yelland, Jane; Krastev, Ann; Brown, Stephanie

2009-08-01

four hospitals comprising a health network in Melbourne, Australia, implemented a range of initiatives aimed at enhancing women's experiences of postnatal maternity care. to compare women's views and experiences of early postnatal care before and after implementation of maternity enhancement initiatives. 'before and after' study design incorporating two postal surveys of recent mothers (baseline and post-implementation). four hospitals in Melbourne, Australia. Analysis of postnatal outcomes was confined to three hospitals where the initiatives were fully operational. 1256 women participated in the baseline survey in 1999 (before implementing the initiative) and 1050 women responded to the post-implementation survey in 2001. the response to the 1999 baseline survey was 65.3% (1256/1922) and to the 2001 post-implementation survey 57.4% (1050/1829). Comparative analysis revealed a statistically significant improvement in overall ratings of hospital postnatal care; the level of advice and support received in relation to discharge and going home; the sensitivity of caregivers; and the proportion of women receiving domiciliary care after discharge. There was little change in the time women spent in hospital after birth between the two survey time-points. Over 90% of women reported one or more health problems in the first 3 months postpartum. The proportion of women reporting physical or emotional health problems between the two surveys did not change. mainstream maternity care can be restructured to improve women's experiences of early postnatal care. maternity service providers should consider a multi-faceted approach to reorienting postnatal services and improving women's experiences of care. Approaches worthy of consideration include attempts to ensure consistency and continuity of care through staffing arrangements, guidelines and protocols; an emphasis on planning for postnatal care during pregnancy; the use of evidence to inform both consumer information and advice

PREVALENCE OF ANEMIA AND ITS SOCIO - DEMOGRAPHIC DETERMINANTS IN PREGNANT WOMEN AT A TERTIARY CARE HOSPITAL IN JAIPUR, RAJASTHAN

OpenAIRE

Prabhjot Singh; Swati; Rajat; Urvahi; Karnika; Isha; Navsangeet; Arihant

2015-01-01

AIM: Prevalence of anemia and its socio - demographic determinants in pregnant women at a tertiary care hospital in Jaipur, Rajasthan . MATERIALS AND METHODS: All the pregnant women aged 25 to 35 years , registered at antenatal clinic at Department of Obstetrics an d Gynaecology , Mahatma Gandhi Medical College , Jaipur were included. A predesigned and pre tested questionnaire was used to elicit the information. Various possible causes of anaemi...

The Affordable Care Act and hospital chaplaincy: re-visioning spiritual care, re-valuing institutional wholeness.

Science.gov (United States)

Frierdich, Matthew D

2015-01-01

This article focuses on the institutional dimensions of spiritual care within hospital settings in the context of the Patient Protection and Affordable Care Act of 2010 (ACA), applying policy information and systems theory to re-imagine the value and function of chaplaincy to hospital communities. This article argues that chaplaincy research and practice must look beyond only individual interventions and embrace chaplain competencies of presence, ritual, and communication as foundational tools for institutional spiritual care.

Self-Care Posters Serve as a Low-Cost Option for Physical Activity Promotion of Hospital Nurses.

Science.gov (United States)

Raney, Marcella; Van Zanten, Erin

2018-03-01

Hospital nurses play an important role in the nation's short- and long-term patient care. At the same time, nurses often experience high levels of occupational stress and participate in low levels of physical activity (PA). The purpose of this study was to examine the impact of self-monitoring and a poster campaign on the PA behaviors of hospital nurses. Motivational and instructional exercise posters were hung in break rooms of experimental units and replaced biweekly for 8 weeks. A total of 26 nurses (control: n = 13; experimental: n = 13) wore accelerometers for 3 workdays pre-, mid-, and postintervention. Participants were provided a step counter at baseline and a PA report at each stage. Moderate to vigorous PA (MVPA) and step count (SC) increased pre- to midintervention for control (MVPA: 14.8 ± 7.6%; SC: 19.1 ± 7.8%) and experimental (MVPA: 26.7 ± 18.5%, SC: 17.6 ± 8.3%) participants. Physical activity levels returned to baseline postintervention for control ( p > .05) and increased mid- to postintervention for experimental (MVPA: 16.2 ± 5.2%, SC: 10.7 ± 4.7%, p poster campaign may increase PA levels of hospital nurses when combined with personalized PA feedback.

Pediatric Surgical Care in a Dutch Military Hospital in Afghanistan.

Science.gov (United States)

Idenburg, Floris J; van Dongen, Thijs T C F; Tan, Edward C T H; Hamming, Jaap H; Leenen, Luke P H; Hoencamp, Rigo

2015-10-01

From August 2006-August 2010, as part of the ISAF mission, the Armed Forces of the Netherlands deployed a role 2 enhanced Medical Treatment Facility (R2E-MTF) to Uruzgan province, Afghanistan. Although from the principle doctrine not considered a primary task, care was delivered to civilians, including many children. Humanitarian aid accounted for a substantial part of the workload, necessitating medical, infrastructural, and logistical adaptations. Particularly pediatric care demanded specific expertise and equipment. In our pre-deployment preparations this aspect had been undervalued. Because these experiences could be influential in future mission planning, we analyzed our data and compared them with international reports. This is a retrospective, descriptive study. Using the hospital's electronic database, all pediatric cases, defined as patients Afghanistan were analyzed. Of the 2736 admissions, 415 (15.2 %) were pediatric. The majority (80.9 %, 336/415) of these admissions were for surgical, often trauma-related, pathology and required 610 surgical procedures, being 26 % of all procedures. Mean length of stay was 3.1 days. The male to female ratio was 70:30. Girls were significantly younger of age than boys. In-hospital mortality was 5.3 %. Pediatric patients made up a considerable part of the workload at the Dutch R2E-MTF in Uruzgan, Afghanistan. This is in line with other reports from the recent conflicts in Iraq and Afghanistan, but used definitions in reported series are inconsistent, making comparisons difficult. Our findings stress the need for a comprehensive, prospective, and coalition-wide patient registry with uniformly applied criteria. Civilian disaster and military operational planners should incorporate reported patient statistics in manning documents, future courses, training manuals, logistic planning, and doctrines, because pediatric care is a reality that cannot be ignored.

An application of the MEMbrain training module: Pre-hospital rescue operation

DEFF Research Database (Denmark)

Andersen, V.

1998-01-01

A system for training in pre-hospital emergency management is being developed and the first version of a prototype has been completed. The training system fulfils the demands from the domain of hospital emergency planning centres and medical attendants concerning increased efficiency of rescue...... efforts. This includes enhanced first aid on site and improved overall co-ordination amongst the organisations involved in coping with emergency situations. The training system is based on the Multi-User System for Training Emergency Response (MUSTER) concept which is used for the training module...

Cost and Predictors of Hospitalizations for Ambulatory Care - Sensitive Conditions Among Medicaid Enrollees in Comprehensive Managed Care Plans