WorldWideScience

Sample records for receiving hospital characteristics

  1. Characteristic patients with oral mucositis receiving 5-FU chemotherapy at Hasan Sadikin Hospital Bandung

    Directory of Open Access Journals (Sweden)

    Syarifah Fatimah

    2016-11-01

    Full Text Available Introduction: Oral mucositis is an inflammatory reaction of oral mucous membrane that often appears in cancer patients due to the chemotherapeutic agents, such as 5-fluorouracil (5-FU. The aim of this study was to describe the characteristic patients who receive 5-FU and had oral mucositis. Methods: This study was conducted on 41 patients with cancer receiving 5-FU chemotherapy at Dr Hasan Sadikin Hospital Bandung. The data was retrieved through interviews to find out patient’s characteristic; nutritional status examination by using body mass index measurement; and oral examination. Severity level was determined by using National Cancer Institute’s Common Toxicity Criteria scale, and the level of pain was measured by Numeric Pain Intensity Rating scale. Results: This research have shown 60,98% patient with cancer had received 5-FU chemotherapy treatment, and 44% with poor nutritional status (underweight. Oral mucositis was only found at non-keratinised mucous. The finding of this study was patients that receiving 5-FU chemotherapy treatment diagnosed with oral mucositis was on the 1st stadium (52% and the 2nd stadium (44% with the level of pain was on the mild level (48% and moderate level (32%.Conclusion: Oral mucositis was found on patients with cancer that received 5-FU chemotherapy with a variety of characteristics, nutritional statuses, locations, levels of severity and pain.

  2. Howard Feiertag receives hospitality industry award

    OpenAIRE

    Ho, Sookhan

    2004-01-01

    Howard Feiertag, of Blacksburg, an instructor in hospitality and tourism management at Virginia Tech's Pamplin College of Business, received the inaugural Excellence in Sales and Marketing Strategy Award at the Hospitality Sales and Marketing Association/New York University Strategy Conference in New York recently.

  3. Nonadherence Factors and Sociodemographic Characteristics of HIV-Infected Adults Receiving Antiretroviral Therapy in Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria

    OpenAIRE

    Okoronkwo, Ijeoma; Okeke, Uchenna; Chinweuba, Anthonia; Iheanacho, Peace

    2013-01-01

    Adherence to treatment instructions with antiretroviral therapy (ART) is very crucial for successful treatment outcome. However, sticking to treatment instructions pose-great challenges to HIV/AIDS patients. This cross-sectional study was on HIV infected adults attending ART clinic in Nigeria to explore nonadherence factors in relation to their socioeconomic characteristics. Validated structured questionnaire was administered to 221 participants. Results showed a high nonadherence rate of 85....

  4. Nonadherence Factors and Sociodemographic Characteristics of HIV-Infected Adults Receiving Antiretroviral Therapy in Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.

    Science.gov (United States)

    Okoronkwo, Ijeoma; Okeke, Uchenna; Chinweuba, Anthonia; Iheanacho, Peace

    2013-01-01

    Adherence to treatment instructions with antiretroviral therapy (ART) is very crucial for successful treatment outcome. However, sticking to treatment instructions pose-great challenges to HIV/AIDS patients. This cross-sectional study was on HIV infected adults attending ART clinic in Nigeria to explore nonadherence factors in relation to their socioeconomic characteristics. Validated structured questionnaire was administered to 221 participants. Results showed a high nonadherence rate of 85.1%. The commonest occurring factors of non-adherence were forgetfulness (53.8%), busy schedule (38.8%), side effects of drugs (31.9%), and stigma (31.9%). Males were more likely to complain from busy schedule, feeling healthy, fear of partner disclosure, long waiting period, and long term regimen. Patients with no formal education were more likely to attribute non-adherence to poor communication, side effects of drugs, and stigma. Employed patients seemed to miss their drugs more than the unemployed and artisans. The high non-adherence rate has serious implications for the control of HIV in infected individuals and management of HIV in general. Nurses should intensify efforts on patient education and counseling.

  5. Assessment of hospital-based adult triage at emergency receiving ...

    African Journals Online (AJOL)

    The study was conducted in 6 of the 7 hospitals in the region. ... gency department, the rest receive emergency patients/perform triage from .... gional Referral Hospital (government facility) with emer- ... sionals who were involved in daily initial management of ..... for receiving emergency cases can be complex especially.

  6. Receiver operator characteristic (ROC) analysis without truth

    International Nuclear Information System (INIS)

    Henkelman, R.M.; Kay, I.; Bronskill, M.J.

    1990-01-01

    Receiver operator characteristic (ROC) analysis, the preferred method of evaluating diagnostic imaging tests, requires an independent assessment of the true state of disease, which can be difficult to obtain and is often of questionable accuracy. A new method of analysis is described which does not require independent truth data and which can be used when several accurate tests are being compared. This method uses correlative information to estimate the underlying model of multivariate normal distributions of disease-positive and disease-negative patients. The method is shown to give results equivalent to conventional ROC analysis in a comparison of computed tomography, radionuclide scintigraphy, and magnetic resonance imaging for liver metastasis. When independent truth is available, the method can be extended to incorporate truth data or to evaluate the consistency of the truth data with the imaging data

  7. Financial reserve. Hospitals leery of credit lines, factoring receivables.

    Science.gov (United States)

    Edwards, D E; Hamilton, W C; Hauser, R

    1991-10-01

    Opening lines of credit and factoring (selling) accounts receivable are two ways to generate operating cash that non-healthcare industries have long used successfully. A recent survey of hospital officials across the nation, however, showed these techniques are used infrequently in health care. Among the 281 hospitals responding: Only 45 percent use lines of credit; Less than 5 percent pursue accounts receivable factoring; and Only 12 percent plan to begin factoring receivables in the future. As hospitals look for ways to offset depleted cash reserves, these percentages may increase.

  8. Better to receive than to give? Interorganizational service arrangements and hospital performance.

    Science.gov (United States)

    Trinh, Hanh Q; Begun, James W; Luke, Roice D

    2010-01-01

    The literature points to possible efficiencies in local-hospital-system performance, but little is known about the internal dynamics that might contribute to this. Study of the service arrangements that nearby same-system hospitals have with one another should provide clues into how system efficiencies might be attained. The purpose of this research was to better understand the financial and operational effects of service sharing and receiving arrangements among nearby hospitals belonging to the same systems. Data are compiled for the 1,227 U.S. urban acute care hospitals that belong to multihospital systems. A longitudinal structural equation model is employed-environmental pressures and organizational characteristics in 1997 are associated with service sharing and receiving arrangements in 2000; service sharing and receiving arrangements are then associated with performance in 2003. Service sharing and receiving are measured by counts of services focal hospitals report that are not duplicated by other-system hospitals within the same county. Linear Structural Relations (LISREL) is used to estimate the model. In general, market competition from managed care and hospitals influences hospitals to exchange services. For individual hospitals, service sharing has no effects on operational efficiency and financial performance. Service receiving, however, is related to greater efficiencies and higher profits. The findings underscore the asymmetrical relationships that exist among local-system hospitals. Individual hospitals benefit from service receiving arrangements but not from sharing arrangements-it is better to receive than to give. To the extent that individual hospitals independently determine service capacities, systems may not be able to effectively rationalize service offerings.

  9. Hearing Instrument using receivers with different performance characteristics

    DEFF Research Database (Denmark)

    2009-01-01

    The invention regards a signal processing device in a hearing aid, wherein the signal processing device is electrically coupled to a connection socket operable to detachably connect a receiver to the socket and whereby the signal processing device further comprise a detector operable to detect...... a characteristics of the receiver which is connected to the signal processing device through the connection socket....

  10. Rehospitalizations and Emergency Department Visits after Hospital Discharge in Patients Receiving Maintenance Hemodialysis.

    Science.gov (United States)

    Harel, Ziv; Wald, Ron; McArthur, Eric; Chertow, Glenn M; Harel, Shai; Gruneir, Andrea; Fischer, Hadas D; Garg, Amit X; Perl, Jeffrey; Nash, Danielle M; Silver, Samuel; Bell, Chaim M

    2015-12-01

    Clinical outcomes after a hospital discharge are poorly defined for patients receiving maintenance in-center (outpatient) hemodialysis. To describe the proportion and characteristics of these patients who are rehospitalized, visit an emergency department, or die within 30 days after discharge from an acute hospitalization, we conducted a population-based study of all adult patients receiving maintenance in-center hemodialysis who were discharged between January 1, 2003, and December 31, 2011, from 157 acute care hospitals in Ontario, Canada. For patients with more than one hospitalization, we randomly selected a single hospitalization as the index hospitalization. Of the 11,177 patients included in the final cohort, 1926 (17%) were rehospitalized, 2971 (27%) were treated in the emergency department, and 840 (7.5%) died within 30 days of discharge. Complications of type 2 diabetes mellitus were the most common reason for rehospitalization, whereas heart failure was the most common reason for an emergency department visit. In multivariable analysis using a cause-specific Cox proportional hazards model, the following characteristics were associated with 30-day rehospitalization: older age, the number of hospital admissions in the preceding 6 months, the number of emergency department visits in the preceding 6 months, higher Charlson comorbidity index score, and the receipt of mechanical ventilation during the index hospitalization. Thus, a large proportion of patients receiving maintenance in-center hemodialysis will be readmitted or visit an emergency room within 30 days of an acute hospitalization. A focus on improving care transitions from the inpatient setting to the outpatient dialysis unit may improve outcomes and reduce healthcare costs. Copyright © 2015 by the American Society of Nephrology.

  11. Smooth time-dependent receiver operating characteristic curve estimators.

    Science.gov (United States)

    Martínez-Camblor, Pablo; Pardo-Fernández, Juan Carlos

    2018-03-01

    The receiver operating characteristic curve is a popular graphical method often used to study the diagnostic capacity of continuous (bio)markers. When the considered outcome is a time-dependent variable, two main extensions have been proposed: the cumulative/dynamic receiver operating characteristic curve and the incident/dynamic receiver operating characteristic curve. In both cases, the main problem for developing appropriate estimators is the estimation of the joint distribution of the variables time-to-event and marker. As usual, different approximations lead to different estimators. In this article, the authors explore the use of a bivariate kernel density estimator which accounts for censored observations in the sample and produces smooth estimators of the time-dependent receiver operating characteristic curves. The performance of the resulting cumulative/dynamic and incident/dynamic receiver operating characteristic curves is studied by means of Monte Carlo simulations. Additionally, the influence of the choice of the required smoothing parameters is explored. Finally, two real-applications are considered. An R package is also provided as a complement to this article.

  12. Receiver Operating Characteristics (ROCs) in Recognition Memory: A Review

    Science.gov (United States)

    Yonelinas, Andrew P.; Parks, Colleen M.

    2007-01-01

    Receiver operating characteristic (ROC) analysis is being used increasingly to examine the memory processes underlying recognition memory. The authors discuss the methodological issues involved in conducting and analyzing ROC results, describe the various models that have been developed to account for these results, review the behavioral empirical…

  13. Thermal characteristics of tubular receivers of solar radiation line concentrators

    International Nuclear Information System (INIS)

    Klychev, Sh.I.; Zakhidov, R.A.; Khuzhanov, R. et al.

    2013-01-01

    A stationary thermal model of an LCS-HR system is considered, taking into account the basic parameters of the problem: availability of a transparent screen, selectivity of the receiver, characteristics of the heat carrier and average concentration on the surface of the tubular receiver C"". Based on this model, an algorithm and program of numerical research of the thermal characteristics of the HR-temperature of heating and local and average coefficients of efficiency are developed. For possible concentrations, the selectivity of the receiver and the transparency of the screen in linear concentrators, the potential stationary heating temperatures, and the coefficients of efficiency for main three types of heat carriers - air, water, and liquid metal coolant are studied. The time of achieving stationary values by the temperatures of the heat carrier is estimated. (author)

  14. Hospital of Diagnosis Influences the Probability of Receiving Curative Treatment for Esophageal Cancer.

    Science.gov (United States)

    van Putten, Margreet; Koëter, Marijn; van Laarhoven, Hanneke W M; Lemmens, Valery E P P; Siersema, Peter D; Hulshof, Maarten C C M; Verhoeven, Rob H A; Nieuwenhuijzen, Grard A P

    2018-02-01

    The aim of this article was to study the influence of hospital of diagnosis on the probability of receiving curative treatment and its impact on survival among patients with esophageal cancer (EC). Although EC surgery is centralized in the Netherlands, the disease is often diagnosed in hospitals that do not perform this procedure. Patients with potentially curable esophageal or gastroesophageal junction tumors diagnosed between 2005 and 2013 who were potentially curable (cT1-3,X, any N, M0,X) were selected from the Netherlands Cancer Registry. Multilevel logistic regression was performed to examine the probability to undergo curative treatment (resection with or without neoadjuvant treatment, definitive chemoradiotherapy, or local tumor excision) according to hospital of diagnosis. Effects of variation in probability of undergoing curative treatment among these hospitals on survival were investigated by Cox regression. All 13,017 patients with potentially curable EC, diagnosed in 91 hospitals, were included. The proportion of patients receiving curative treatment ranged from 37% to 83% and from 45% to 86% in the periods 2005-2009 and 2010-2013, respectively, depending on hospital of diagnosis. After adjustment for patient- and hospital-related characteristics these proportions ranged from 41% to 77% and from 50% to 82%, respectively (both P < 0.001). Multivariable survival analyses showed that patients diagnosed in hospitals with a low probability of undergoing curative treatment had a worse overall survival (hazard ratio = 1.13, 95% confidence interval 1.06-1.20; hazard ratio = 1.15, 95% confidence interval 1.07-1.24). The variation in probability of undergoing potentially curative treatment for EC between hospitals of diagnosis and its impact on survival indicates that treatment decision making in EC may be improved.

  15. [Management characteristics in charity hospitals in Brazil].

    Science.gov (United States)

    Lima, Sheyla Maria Lemos; Barbosa, Pedro Ribeiro; Portela, Margareth C; Ugá, Maria Alicia Dominguez; Vasconcellos, Miguel Murat; Gerschman, Silvia

    2004-01-01

    This paper presents the management characteristics of charity hospitals in Brazil, based on data from a national survey developed in 2001. The sample accounted for the random inclusion of 66 Brazilian Unified Health System (SUS) inpatient care providers with less than 599 beds and all 26 hospitals with at least 599 beds. It also included 10 institutions assumed as non-providers of services to the SUS. The analyses are descriptive, focusing on the classification of the hospitals according to their managerial development level, as well as selected issues regarding the utilization of specific managerial technologies, human resources, technical services, and services contracting. Distinct managerial levels were identified, but it is important to note that 83% of the SUS providers with less than 599 beds were classified as having incipient management. The authors discuss implications of the findings for inpatient care policies, considering the importance of charity hospitals for the Brazilian Health System.

  16. Board characteristics, governance objectives, and hospital performance

    DEFF Research Database (Denmark)

    Thiel, Andrea; Winter, Vera; Büchner, Vera Antonia

    2018-01-01

    membership relates to board characteristics and financial performance. METHODOLOGY: Using factor analysis, we identify latent classes of governance objectives and use hierarchical cluster analysis to detect distinct clusters with varying emphasis on the classes. We then use multinomial regression to explore...... the associations between cluster membership and board characteristics (size, gender diversity, and occupational diversity) and examine the associations between clusters and financial performance using OLS regression. RESULTS: Classes of objectives reflecting three governance theories-agency theory, stewardship...... and hospital financial performance, with two of three groups performing significantly better than the reference group. CONCLUSION: High performance in hospitals can be the result of governance logics, which, compared to simple board characteristics, are associated with better financial outcomes. PRACTICE...

  17. Cryogenic receiver front-end with sharp skirt characteristics

    Energy Technology Data Exchange (ETDEWEB)

    Narahashi, S [RF Technology Laboratory, Wireless Laboratories, NTT DoCoMo, Inc, Yokosuka, Kanagawa 239-8536 (Japan); Satoh, K [RF Technology Laboratory, Wireless Laboratories, NTT DoCoMo, Inc, Yokosuka, Kanagawa 239-8536 (Japan); Kawai, K [RF Technology Laboratory, Wireless Laboratories, NTT DoCoMo, Inc, Yokosuka, Kanagawa 239-8536 (Japan); Koizumi, D [RF Technology Laboratory, Wireless Laboratories, NTT DoCoMo, Inc, Yokosuka, Kanagawa 239-8536 (Japan); Nojima, T [Graduate School of Information Science and Technology, Hokkaido University, Sapporo, Hokkaido 060-0808 (Japan)

    2006-05-15

    This paper presents an experimental cryogenic receiver front-end (CRFE) with sharp skirt characteristics for mobile base stations. The CRFE comprises a high-temperature superconducting filter, a cryogenic low-noise amplifier, and a highly reliable cryostat that is very compact. The major characteristics of the proposed CRFE measured at 70 K are a centre frequency of 1.95 GHz, passband width of 20 MHz, sharp selectivity of 20 dB/100 kHz, 1.4 dB ripple, 31.3 dB average passband gain, and average passband equivalent noise temperature of 47.9 K. The CRFE weighs 19 kg and occupies 35 l. Random failure of the cryostat is also evaluated by a continuous operation test using four identical ones simultaneously. The cryostat used in the CRFE has a high reliability level of over five years of continuous maintenance-free operation.

  18. A Three-Dimensional Receiver Operator Characteristic Surface Diagnostic Metric

    Science.gov (United States)

    Simon, Donald L.

    2011-01-01

    Receiver Operator Characteristic (ROC) curves are commonly applied as metrics for quantifying the performance of binary fault detection systems. An ROC curve provides a visual representation of a detection system s True Positive Rate versus False Positive Rate sensitivity as the detection threshold is varied. The area under the curve provides a measure of fault detection performance independent of the applied detection threshold. While the standard ROC curve is well suited for quantifying binary fault detection performance, it is not suitable for quantifying the classification performance of multi-fault classification problems. Furthermore, it does not provide a measure of diagnostic latency. To address these shortcomings, a novel three-dimensional receiver operator characteristic (3D ROC) surface metric has been developed. This is done by generating and applying two separate curves: the standard ROC curve reflecting fault detection performance, and a second curve reflecting fault classification performance. A third dimension, diagnostic latency, is added giving rise to 3D ROC surfaces. Applying numerical integration techniques, the volumes under and between the surfaces are calculated to produce metrics of the diagnostic system s detection and classification performance. This paper will describe the 3D ROC surface metric in detail, and present an example of its application for quantifying the performance of aircraft engine gas path diagnostic methods. Metric limitations and potential enhancements are also discussed

  19. Receiver Operating Characteristic Analysis for Detecting Explosives-related Threats

    Energy Technology Data Exchange (ETDEWEB)

    Oxley, Mark E; Venzin, Alexander M

    2012-11-14

    The Department of Homeland Security (DHS) and the Transportation Security Administration (TSA) are interested in developing a standardized testing procedure for determining the performance of candidate detection systems. This document outlines a potential method for judging detection system performance as well as determining if combining the information from a legacy system with a new system can signicantly improve performance. In this document, performance corresponds to the Neyman-Pearson criterion applied to the Receiver Operating Characteristic (ROC) curves of the detection systems in question. A simulation was developed to investigate how the amount of data provided by the vendor in the form of the ROC curve eects the performance of the combined detection system. Furthermore, the simulation also takes into account the potential eects of correlation and how this information can also impact the performance of the combined system.

  20. Financial characteristics of hospitals purchased by investor-owned chains.

    Science.gov (United States)

    McCue, M J; Furst, R W

    1986-01-01

    This article focuses on the preacquisition financial condition of not-for-profit hospitals acquired by investor-owned hospital chains. Financial ratios are used to determine if not-for-profit hospitals acquired by investor-owned hospital systems have common financial characteristics which make them a likely target for a takeover. The results indicate that during the time period studied, investor-owned hospital systems did tend to purchase hospitals with common financial characteristics and that these characteristics provide a reasonable description of a financially distressed hospital. This finding has important consequences for our health care delivery system. PMID:3771232

  1. In-hospital stroke: characteristics and outcomes.

    LENUS (Irish Health Repository)

    Briggs, R

    2015-01-01

    In-hospital stroke (IS) made up 6.5% of strokes recorded in the Irish National Stroke Register in 2012. International research has demonstrated poorer outcomes post IS compared to out of hospital stroke (OS). We aimed to profile all IS and OS over a 22 month period and compare the two groups by gathering data from the HIPE portal stroke register. The study site is a primary stroke centre. IS represented 11% (50\\/458) of total strokes with over half (27\\/50, 54%) admitted initially with medical complaints. IS patients had a significantly longer length of stay (79.2 +\\/- 87.4 days vs. 21.9 +\\/- 45.9 days, p < 0.01) and higher mortality (13\\/50 vs. 39\\/408, p < 0.01). Patients in the IS group were also less likely to receive stroke unit care (1\\/50 vs. 136\\/408, p < 0.01). This study demonstrates the significant morbidity and mortality associated with IS and highlights the need for efforts to be made to optimize identification and management of acute stroke in this cohort.

  2. Receiver operating characteristic analysis improves diagnosis by radionuclide ventriculography

    International Nuclear Information System (INIS)

    Dickinson, C.Z.; Forman, M.B.; Vaugh, W.K.; Sandler, M.P.; Kronenberg, M.W.

    1985-01-01

    Receiver operating characteristic analysis (ROC) evaluates continuous variables to define diagnostic criteria for the optimal sensitivity (SENS) and specificity (SPEC) of a test. The authors studied exercise-induced chest pain (CP), ST-changes on electrocardiography (ECG) and rest-exercise gated radionuclide ventriculography (RVG) using ROC to clarify the optimal criteria for detecting myocardial ischemia due to coronary artherosclerosis (CAD). The data of 95 consecutive patients studied with coronary angiography, rest-exercise RVG and ECG were reviewed. 77 patients had ''significant'' CAD (≥50% lesions). Exercise-induced CP, ECG abnormalities (ST-T shifts) and RVG abnormalities (change in ejection fraction, 2-view regional wall motion change and relative end-systolic volume) were evaluated to define optimal SENS/SPEC of each and for the combined data. ROC curves were constructed by multiple logistic regression (MLR). By MLR, RVG alone was superior to ECG and CP. The combination of all three produced the best ROC curve for the entire group and for clinical subsets based on the number of diseased vessels and the presence or absence of prior myocardial infarction. When CP, ECG and RVG were combined, the optimal SENS/SPEC for detection of single vessel disease was 88/86. The SENS/SPEC for 3 vessel disease was 93/95. Thus, the application of RVG for the diagnosis of myocardial ischemia is improved with the inclusion of ECG and CP data by the use of a multiple logistic regression model. ROC analysis allows clinical application of multiple data for diagnosing CAD at desired SENS/SPEC rather than by arbitrary single-standard criteria

  3. Expecting excellence is key to receivable success in small and rural hospitals.

    Science.gov (United States)

    Boucher, D

    1990-06-01

    Although small and rural hospitals may have trouble hiring experienced billing and collection personnel, they can succeed in keeping down receivable levels and receivable days by adopting two principles for the business office: expect excellence and inspect for excellence. These principles include setting goals for business office staff as well as listening to and implementing their ideas for more effective operations.

  4. The effect of hospital organizational characteristics on postoperative complications.

    Science.gov (United States)

    Knight, Margaret

    2013-12-01

    To determine if there is a relationship between the risk of postoperative complications and the nonclinical hospital characteristics of bed size, ownership structure, relative urbanicity, regional location, teaching status, and area income status. This study involved a secondary analysis of 2006 administrative hospital data from a number of U.S. states. This data, gathered annually by the Agency for Healthcare Research and Quality (AHRQ) via the National Inpatient Sample (NIS) Healthcare Utilization Project (HCUP), was analyzed using probit regressions to measure the effects of several nonclinical hospital categories on seven diagnostic groupings. The study model included postoperative complications as well as additional potentially confounding variables. The results showed mixed outcomes for each of the hospital characteristic groupings. Subdividing these groupings to correspond with the HCUP data analysis allowed a greater understanding of how hospital characteristics' may affect postoperative outcomes. Nonclinical hospital characteristics do affect the various postoperative complications, but they do so inconsistently.

  5. Patients with schizophrenia or schizoaffective disorder who receive multiple electroconvulsive therapy sessions: characteristics, indications, and results.

    Science.gov (United States)

    Iancu, Iulian; Pick, Nimrod; Seener-Lorsh, Orit; Dannon, Pinhas

    2015-01-01

    While electroconvulsive therapy (ECT) has been used for many years, there is insufficient research regarding the indications for continuation/maintenance (C/M)-ECT, its safety and efficacy, and the characteristics of patients with schizophrenia or schizoaffective disorder who receive multiple ECT sessions. The aims of this study were to characterize a series of patients who received 30 ECT sessions or more, to describe treatment regimens in actual practice, and to examine the results of C/M-ECT in terms of safety and efficacy, especially the effect on aggression and functioning. We performed a retrospective chart review of 20 consecutive patients (mean age 64.6 years) with schizophrenia (n=16) or schizoaffective disorder (n=4) who received at least 30 ECT sessions at our ECT unit, and also interviewed the treating physician and filled out the Clinical Global Impression-Severity, Global Assessment of Functioning, and the Staff Observation Aggression Scale-Revised. Patients received a mean of 91.3 ECT sessions at a mean interval of 2.6 weeks. All had been hospitalized for most or all of the previous 3 years. There were no major adverse effects, and cognitive side effects were relatively minimal (cognitive deficit present for several hours after treatment). We found that ECT significantly reduced scores on the Staff Observation Aggression Scale-Revised subscales for verbal aggression and self-harm, and improved Global Assessment of Functioning scores. There were reductions in total aggression scores, subscale scores for harm to objects and to others, and Clinical Global Impression-Severity scores, these were not statistically significant. C/M-ECT is safe and effective for chronically hospitalized patients. It improves general functioning and reduces verbal aggression and self-harm. More research using other aggression tools is needed to determine its effects and to reproduce our findings in prospective and controlled studies.

  6. Wavelet and receiver operating characteristic analysis of heart rate variability

    Science.gov (United States)

    McCaffery, G.; Griffith, T. M.; Naka, K.; Frennaux, M. P.; Matthai, C. C.

    2002-02-01

    Multiresolution wavelet analysis has been used to study the heart rate variability in two classes of patients with different pathological conditions. The scale dependent measure of Thurner et al. was found to be statistically significant in discriminating patients suffering from hypercardiomyopathy from a control set of normal subjects. We have performed Receiver Operating Characteristc (ROC) analysis and found the ROC area to be a useful measure by which to label the significance of the discrimination, as well as to describe the severity of heart dysfunction.

  7. Data breach locations, types, and associated characteristics among US hospitals.

    Science.gov (United States)

    Gabriel, Meghan Hufstader; Noblin, Alice; Rutherford, Ashley; Walden, Amanda; Cortelyou-Ward, Kendall

    2018-02-01

    The objectives of this study were to describe the locations in hospitals where data are breached, the types of breaches that occur most often at hospitals, and hospital characteristics, including health information technology (IT) sophistication and biometric security capabilities, that may be predicting factors of large data breaches that affect 500 or more patients. The Office of Civil Rights breach data from healthcare providers regarding breaches that affected 500 or more individuals from 2009 to 2016 were linked with hospital characteristics from the Health Information Management Systems Society and the American Hospital Association Health IT Supplement databases. Descriptive statistics were used to characterize hospitals with and without breaches, data breach type, and location/mode of data breaches in hospitals. Multivariate logistic regression analysis explored hospital characteristics that were predicting factors of a data breach affecting at least 500 patients, including area characteristics, region, health system membership, size, type, biometric security use, health IT sophistication, and ownership. Of all types of healthcare providers, hospitals accounted for approximately one-third of all data breaches and hospital breaches affected the largest number of individuals. Paper and films were the most frequent location of breached data, occurring in 65 hospitals during the study period, whereas network servers were the least common location but their breaches affected the most patients overall. Adjusted multivariate results showed significant associations among data breach occurrences and some hospital characteristics, including type and size, but not others, including health IT sophistication or biometric use for security. Hospitals should conduct routine audits to allow them to see their vulnerabilities before a breach occurs. Additionally, information security systems should be implemented concurrently with health information technologies. Improving

  8. Clinical characteristics of pneumonia in bedridden patients receiving home care: a 3-year prospective observational study.

    Science.gov (United States)

    Ishida, Tadashi; Tachibana, Hiromasa; Ito, Akihiro; Ikeda, Satoshi; Furuta, Kenjiro; Nishiyama, Akihiro; Noyama, Maki; Tokioka, Fumiaki; Yoshioka, Hiroshige; Arita, Machiko

    2015-08-01

    The aim of the study was to describe the epidemiology, clinical features, antimicrobial treatment, and outcomes of bedridden pneumonia patients receiving home healthcare. A 3-year prospective observational study of poor performance status (PS) 3-4 patients receiving long-term home healthcare and hospitalized at a single center with pneumonia between October 2010 and September 2013 was conducted, and their clinical characteristics were compared with non-bedridden community-acquired pneumonia (CAP) patients. A total of 131 CAP patients with PS 3-4, and 400 CAP patients with PS 0-2 were evaluated. The PS 3-4 patients were older, and exhibited a higher frequency of underlying diseases. Aspiration was thought to be associated with pneumonia in 77.1% of the PS 3-4 patients. Streptococcus pneumoniae was the leading pathogen in both groups, whereas the frequency of streptococci and polymicrobial infections was higher in the PS 3-4 group. The incidence of multidrug-resistant pathogens such as methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa was lower than in previous healthcare-associated pneumonia reports. The in-hospital mortality and recurrence rates were significantly higher in the PS 3-4 group than in the good PS group (17.6% vs. 6.0%, p < 0.001 and 15.3% vs. 7.5%, p = 0.008, respectively). The clinical characteristics of pneumonia in poor PS patients were similar to healthcare-associated pneumonia (HCAP), except for the frequency of drug-resistant pathogens. Hence, it might be beneficial to categorize pneumonia in home residents with poor PS separately from pneumonia in CAP patients who were previously healthy or experienced mild comorbidities. Copyright © 2015 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  9. Nutritional status of patients with gastrointestinal cancer receiving care in a public hospital; 2010-2011.

    Science.gov (United States)

    Dias do Prado, Corina; Alvares Duarte Bonini Campos, Juliana

    2013-01-01

    To identify the nutritional status of patients with gastrointestinal cancer and verify its association with demographic and clinical characteristics. This was a cross-sectional study with a nonprobability sampling design. The participants were 143 adult patients with gastrointestinal cancer, receiving care in the Amaral Carvalho Hospital (Jaú-SP, Brazil) from November 2010 to October 2011. A survey was conducted to collect information for the purpose of demographic and clinical characterization. In order to identify nutritional status, the Scored Pati2) test were used. The prevalence ratio (PR) was estimated. The level of significance adopted was 5%. The mean age of patients was 57.45 (SD = 9.62) years, with Stages III and IV of the disease being the most prevalent (39.2% and 35.0%). There was 44.8% prevalence of malnutrition. The undernourished individual more frequently reported having problems with eating (pcent-Generated Subjective Global Assessment (Scored PG-SGA) was applied. Descriptive statistics and the Chi-square (cancer, with significant association with clinical symptoms directly related to the eating process. Copyright © AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.

  10. Hospital ownership, decisions on supervisory board characteristics, and financial performance.

    Science.gov (United States)

    Kuntz, Ludwig; Pulm, Jannis; Wittland, Michael

    2016-01-01

    Dynamic and complex transformations in the hospital market increase the relevance of good corporate governance. However, hospital performance and the characteristics of supervisory boards differ depending on ownership. The question therefore arises whether hospital owners can influence performance by addressing supervisory board characteristics. The objective of this study is to explain differences in the financial performance of hospitals with regard to ownership by studying the size and composition of supervisory boards. The AMADEUS database was used to collect information on hospital financial performance in 2009 and 2010. Business and quality reports, hospital websites, and data from health insurer were used to obtain information on hospital and board characteristics. The resulting sample consisted of 175 German hospital corporations. We utilized ANOVA and regression analysis to test a mediation hypothesis that investigated whether decisions regarding board size and composition were associated with financial performance and could explain performance differences. Financial performance and board size and composition depend on ownership. An increase in board size and greater politician participation were negatively associated with all five tested measures of financial performance. Furthermore, an increase in physician participation was positively associated with one dimension of financial performance, whereas one negative relationship was identified for nurse and economist participation. For clerics, no associations were found. Decisions concerning board size and composition are important as they relate to hospital financial performance. We contribute to existing research by showing that, in addition to board size and physician participation, the participation of other professionals can also influence financial performance.

  11. Patient Characteristics Predicting Readmission Among Individuals Hospitalized for Heart Failure

    Science.gov (United States)

    O'Connor, Melissa; Murtaugh, Christopher M.; Shah, Shivani; Barrón-Vaya, Yolanda; Bowles, Kathryn H.; Peng, Timothy R.; Zhu, Carolyn W.; Feldman, Penny H.

    2015-01-01

    Heart failure is difficult to manage and increasingly common with many individuals experiencing frequent hospitalizations. Little is known about patient factors consistently associated with hospital readmission. A literature review was conducted to identify heart failure patient characteristics, measured before discharge, that contribute to variation in hospital readmission rates. Database searches yielded 950 potential articles, of which 34 studies met inclusion criteria. Patient characteristics generally have a very modest effect on all-cause or heart failure–related readmission within 7 to 180 days of index hospital discharge. A range of cardiac diseases and other comorbidities only minimally increase readmission rates. No single patient characteristic stands out as a key contributor across multiple studies underscoring the challenge of developing successful interventions to reduce readmissions. Interventions may need to be general in design with the specific intervention depending on each patient's unique clinical profile. PMID:26180045

  12. Patient Characteristics Predicting Readmission Among Individuals Hospitalized for Heart Failure.

    Science.gov (United States)

    O'Connor, Melissa; Murtaugh, Christopher M; Shah, Shivani; Barrón-Vaya, Yolanda; Bowles, Kathryn H; Peng, Timothy R; Zhu, Carolyn W; Feldman, Penny H

    2016-02-01

    Heart failure is difficult to manage and increasingly common with many individuals experiencing frequent hospitalizations. Little is known about patient factors consistently associated with hospital readmission. A literature review was conducted to identify heart failure patient characteristics, measured before discharge, that contribute to variation in hospital readmission rates. Database searches yielded 950 potential articles, of which 34 studies met inclusion criteria. Patient characteristics generally have a very modest effect on all-cause or heart failure-related readmission within 7 to 180 days of index hospital discharge. A range of cardiac diseases and other comorbidities only minimally increase readmission rates. No single patient characteristic stands out as a key contributor across multiple studies underscoring the challenge of developing successful interventions to reduce readmissions. Interventions may need to be general in design with the specific intervention depending on each patient's unique clinical profile. © The Author(s) 2015.

  13. Basic clinical characteristics and hospital outcomes of acute ...

    African Journals Online (AJOL)

    Basic clinical characteristics and hospital outcomes of acute coronary syndrome patients - Sudan. A.M. Taha, H.O. Mirghani. Abstract. Background: There are Variation in the presentation of the acute coronary syndrome between countries. The present study aimed to investigate the basic clinical characteristics and ...

  14. Association between value-based purchasing score and hospital characteristics

    Directory of Open Access Journals (Sweden)

    Borah Bijan J

    2012-12-01

    Full Text Available Abstract Background Medicare hospital Value-based purchasing (VBP program that links Medicare payments to quality of care will become effective from 2013. It is unclear whether specific hospital characteristics are associated with a hospital’s VBP score, and consequently incentive payments. The objective of the study was to assess the association of hospital characteristics with (i the mean VBP score, and (ii specific percentiles of the VBP score distribution. The secondary objective was to quantify the associations of hospital characteristics with the VBP score components: clinical process of care (CPC score and patient satisfaction score. Methods Observational analysis that used data from three sources: Medicare Hospital Compare Database, American Hospital Association 2010 Annual Survey and Medicare Impact File. The final study sample included 2,491 U.S. acute care hospitals eligible for the VBP program. The association of hospital characteristics with the mean VBP score and specific VBP score percentiles were assessed by ordinary least square (OLS regression and quantile regression (QR, respectively. Results VBP score had substantial variations, with mean score of 30 and 60 in the first and fourth quartiles of the VBP score distribution. For-profit status (vs. non-profit, smaller bed size (vs. 100–199 beds, East South Central region (vs. New England region and the report of specific CPC measures (discharge instructions, timely provision of antibiotics and beta blockers, and serum glucose controls in cardiac surgery patients were positively associated with mean VBP scores (p Conclusions Although hospitals serving the poor and the elderly are more likely to score lower under the VBP program, the correlation appears small. Profit status, geographic regions, number and type of CPC measures reported explain the most variation among scores.

  15. Retrospective chart review of elderly patients receiving electroconvulsive therapy in a tertiary general hospital

    OpenAIRE

    Mosam Phirke; Harshal Sathe; Nilesh Shah; Sushma Sonavane; Anup Bharati; Avinash DeSousa

    2015-01-01

    Background: Electroconvulsive therapy (ECT) is the one of the oldest and effective treatments in psychiatry today. It has been used in a wide variety of psychiatric disorders in both young and old patients. Aims of the study: The present study is a retrospective chart review of geriatric patients receiving ECT as a treatment option in a tertiary care general hospital psychiatry setting. Methodology: The study evaluated ECT records over a 5-year period between the years 2010 and 2014...

  16. [Out of hospital deliveries: incidence, obstetrical characteristics and perinatal outcome].

    Science.gov (United States)

    Zur, M; Hadar, A; Sheiner, E; Mazor, M

    2003-01-01

    Traditionally, women used to deliver their babies at home. In 1927, in England and Wales, 85% of births took place at home. By 1970 the position was reversed. The move from home to institutional delivery has been accompanied by changes in the institutions themselves and in the type of care provider. There are two kinds of out-of-hospital deliveries: 1. Planned home deliveries--women who decide to deliver in their home with the assistance of midwives or other consultant obstetric facilities. Few cases from this group, however, end up in the hospital; 2. Unplanned home deliveries or delivery en-route to the hospital--when women enter the active phase of labor rapidly, resulting in accidental out-of-hospital deliveries. The study aims to review the available literature and to describe the incidence, obstetrical characteristics and perinatal outcome of out-of-hospital deliveries.

  17. [Characteristics of Hospitalizations of Homeless Persons in Seville, Spain].

    Science.gov (United States)

    Tornero Patricio, Sebastián; Fernández Ajuria, Alberto; Charris Castro, Liliana

    2016-02-10

    The aim was to determine the characteristics of hospital admissions of homeless persons in Seville, Spain. Observational study of 103,802 hospital admissions of 71,756 patients admitted in the Hospitals "Virgen del Rocío" and "Virgen Macarena" (Seville), in 2013 and 2014. Bivariate analysis were performed using χ2 and t-Student tests and multivariate analysis using binomial logistic regression model. 0.16% (n=163) of admissions were homeless persons and 99.84% (n=103,639) were not. The mean age at admission in homeless patients was 48 years and 76.5% of them were men. Hospital deaths of homeless patients occurred being 23 years younger. 92% of hospital admissions came from emergency departments and 10.0% of their discharges were against medical advice. The average length of stay was 4.8 days longer in homeless persons and the most frequent diagnoses on admission were mental (27.0%), infectious (19.6%) and respiratory diseases (18.4%). Mental disorders were present on 83.7% of homeless patients as secondary diagnose and 77.6% referred drugs consumption. Hospital admissions characteristics of homeless persons were particularly different. Homeless patients were hospitalized and died at a younger age than non-homeless patients. The morbidity and mortality of homeless persons reflect their vulnerable health condition.

  18. Out-of-hospital mortality among patients receiving methadone for noncancer pain.

    Science.gov (United States)

    Ray, Wayne A; Chung, Cecilia P; Murray, Katherine T; Cooper, William O; Hall, Kathi; Stein, C Michael

    2015-03-01

    Growing methadone use in pain management has raised concerns regarding its safety relative to other long-acting opioids. Methadone hydrochloride may increase the risk for lethal respiratory depression related to accidental overdose and life-threatening ventricular arrhythmias. To compare the risk of out-of-hospital death in patients receiving methadone for noncancer pain with that in comparable patients receiving sustained-release (SR) morphine sulfate. A retrospective cohort study was conducted using Tennessee Medicaid records from 1997 through 2009. The cohort included patients receiving morphine SR or methadone who were aged 30 to 74 years, did not have cancer or another life-threatening illness, and were not in a hospital or nursing home. At cohort entry, 32 742 and 6014 patients had filled a prescription for morphine SR or methadone, respectively. The patients' median age was 48 years, 57.9% were female, and comparable proportions had received cardiovascular, psychotropic, and other musculoskeletal medications. Nearly 90% of the patients received the opioid for back pain or other musculoskeletal pain. The median doses prescribed for morphine SR and methadone were 90 mg/d and 40 mg/d, respectively. The primary study end point was out-of-hospital mortality, given that opioid-related deaths typically occur outside the hospital. There were 477 deaths during 28 699 person-years of follow-up (ie, 166 deaths per 10 000 person-years). After control for study covariates, patients receiving methadone had a 46% increased risk of death during the follow-up period, with an adjusted hazard ratio (HR) of 1.46 (95% CI, 1.17-1.83; P Methadone doses of 20 mg/d or less, the lowest dose quartile, were associated with an increased risk of death (HR, 1.59; 95% CI, 1.01-2.51, P = .046) relative to a comparable dose of morphine SR (methadone in this retrospective cohort study, even for low doses, supports recommendations that it should not be a drug of first choice for

  19. Hospital variation in 30-day mortality after colorectal cancer surgery in denmark: the contribution of hospital volume and patient characteristics

    DEFF Research Database (Denmark)

    Osler, Merete; Iversen, Lene Hjerrild; Borglykke, Anders

    2011-01-01

    This study examines variation between hospitals in 30-day mortality after surgery for colorectal cancer (CRC) in Denmark and explores whether hospital volume and patient characteristics contribute to any variation between hospitals.......This study examines variation between hospitals in 30-day mortality after surgery for colorectal cancer (CRC) in Denmark and explores whether hospital volume and patient characteristics contribute to any variation between hospitals....

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

    LENUS (Irish Health Repository)

    Forde, Dónall

    2009-01-01

    BACKGROUND: Warfarin is an oral anticoagulant (OAT) that needs active management to ensure therapeutic range. Initial management is often carried out as an inpatient, though not requiring inpatient facilities. This mismatch results in financial costs which could be directed more efficaciously. The extent of this has previously been unknown. Here we aim to calculate the potential number of bed nights which may be saved among those being dose optimized as inpatients and examine associated factors. METHODS: A 6 week prospective audit of inpatients receiving OAT, at Cork University Hospital, was carried out. The study period was from 11th June 2007 to 20th July 2007. Data was collected from patient\\'s medications prescription charts, medical record files, and computerised haematology laboratory records. The indications for OAT, the patient laboratory coagulation results and therapeutic intervals along with patient demographics were analysed. The level of potentially avoidable inpatient nights in those receiving OAT in hospital was calculated and the potential cost savings quantified. Potential avoidable bed nights were defined as patients remaining in hospital for the purpose of optimizing OAT dosage, while receiving subtherapeutic or therapeutic OAT (being titred up to therapeutic levels) and co-administered covering low molecular weight heparin, and requiring no other active care. The average cost of euro638 was taken as the per night hospital stay cost for a non-Intensive Care bed. Ethical approval was granted from the Ethical Committee of the Cork Teaching Hospitals, Cork, Ireland. RESULTS: A total of 158 patients were included in the audit. There was 94 men (59.4%) and 64 women (40.6%). The mean age was 67.8 years, with a median age of 70 years.Atrial Fibrillation (43%, n = 70), followed by aortic valve replacement (15%, n = 23) and pulmonary emboli (11%, n = 18) were the commonest reasons for prescribing OAT. 54% had previously been prescribed OAT prior to

  1. Prescription Pattern of Analgesic Drugs for Patients Receiving Palliative Care in a Teaching Hospital in India.

    Science.gov (United States)

    Menezes, Vishma Hydie; Nair, Shoba N; Soumya, M S; Tarey, S D

    2016-01-01

    Drugs used in the palliative care unit for managing symptoms are major contributors toward the expenditure occurring in palliative care. This study was conducted to understand the prescription pattern of analgesic drugs in the patients who are receiving palliative care in a teaching hospital in India by a retrospective study of case records. Case record based, retrospective, descriptive study was conducted at the Pain and Palliative Care Department of St. John's Medical College Hospital, Bengaluru. Case record files of all patients referred to Pain and Palliative Care Department for the treatment of pain in the year of 2012 were studied. Patients' age, gender, diagnoses, numerical pain rating scale (0-10), drugs prescribed, dosage, frequency, route of administration were recorded. The difference in drug utilization between the genders was done using Chi-square test. Data were collected from 502 patients of which 280 (56%) were males and 222 (44%) were females. Twelve percent of patients had mild pain (1-3), 34% had moderate pain (4-6), and 54% had severe pain (7-10). The most commonly used analgesic drugs were opioids (47%), followed by nonsteroidal anti-inflammatory drugs (36%). The opioids used were tramadol (56%), and morphine (38%). Ninety percent of patients with numerical pain scale more than 6 received morphine. There was no difference in analgesic drug utilization with regards to gender. Prescription pattern differed depending on the severity of pain. Opioids were the most commonly used drugs for pain management. The study shows that prescription pattern in palliative care unit of this hospital was in accordance with WHO pain management guidelines. The study showed the current trend in prescription of analgesic drugs in the teaching hospital where the study was conducted.

  2. Alcohol in Primary Care. Differential characteristics between alcohol-dependent patients who are receiving or not receiving treatment.

    Science.gov (United States)

    Barrio, Pablo; Miquel, Laia; Moreno-España, Jose; Martínez, Alicia; Ortega, Lluisa; Teixidor, Lidia; Manthey, Jakob; Rehm, Jürgen; Gual, Antoni

    2016-03-02

    primary health care services for other reasons. The aim of the present study is to describe the differential characteristics of AD patients in primary care, distinguishing between those who receive treatment and those who do not, and their reasons for not seeking it. In a cross-sectional study patients were evaluated by their general practitioner (GP) and interviewed by a member of the research team. Sociodemographic, diagnostic and clinical data were collected. From 1,372 patients interviewed in Catalonia, 118 (8.6%) were diagnosed as AD. These patients showed a lower socioeconomic status (48.3% vs 33.3%, odds ratio 2.02), higher unemployment rates (32.2% vs 19.2 %, odds ratio 2.11), and greater psychological distress and disability. Patients with AD receiving treatment (16.9%), were older (44 vs 36 years of age), reported higher unemployment rates (66% vs 25.5%, odds ratio 6.32) and higher daily alcohol consumption (61.5 vs 23.7 grams), suggesting a more advanced disease. Patients with AD in general showed a higher degree of comorbidity compared to other patients, with patients in treatment showing the most elevated level. The main reasons given for not seeking treatment were shame, fear of giving up drinking and barriers to treatment. Taken together, the data suggest the need to implement earlier strategies for the detection and treatment of AD.

  3. SNR characteristics of 850-nm OEIC receiver with a silicon avalanche photodetector.

    Science.gov (United States)

    Youn, Jin-Sung; Lee, Myung-Jae; Park, Kang-Yeob; Rücker, Holger; Choi, Woo-Young

    2014-01-13

    We investigate signal-to-noise ratio (SNR) characteristics of an 850-nm optoelectronic integrated circuit (OEIC) receiver fabricated with standard 0.25-µm SiGe bipolar complementary metal-oxide-semiconductor (BiCMOS) technology. The OEIC receiver is composed of a Si avalanche photodetector (APD) and BiCMOS analog circuits including a transimpedance amplifier with DC-balanced buffer, a tunable equalizer, a limiting amplifier, and an output buffer with 50-Ω loads. We measure APD SNR characteristics dependence on the reverse bias voltage as well as BiCMOS circuit noise characteristics. From these, we determine the SNR characteristics of the entire OEIC receiver, and finally, the results are verified with bit-error rate measurement.

  4. Retrospective chart review of elderly patients receiving electroconvulsive therapy in a tertiary general hospital

    Directory of Open Access Journals (Sweden)

    Mosam Phirke

    2015-01-01

    Full Text Available Background: Electroconvulsive therapy (ECT is the one of the oldest and effective treatments in psychiatry today. It has been used in a wide variety of psychiatric disorders in both young and old patients. Aims of the study: The present study is a retrospective chart review of geriatric patients receiving ECT as a treatment option in a tertiary care general hospital psychiatry setting. Methodology: The study evaluated ECT records over a 5-year period between the years 2010 and 2014, and it was observed that 23 elderly patients (aged ≥60 years had received ECT. Results: The patients received modified bitemporal ECT using a brief pulse ECT machine and had no major complications. A total of 184 ECT treatments were administered at an average of 8 treatments per case. The major diagnoses of patients were schizophrenia and major depression. The main indications of ECT were intolerance to medication, suicidal behavior and aggression. Out of the 23 elderly patients, 18 (78.26% showed a good response to ECT. The only complication noted was memory loss and confusion in 3 cases. Patients with medical illnesses like hypertension, diabetes and both together received ECT without any complications. Conclusions: This study adds to the scarce database on the use of ECT in elderly patients in India and adds evidence to the fact that ECT is a safe and effective treatment in the elderly.

  5. Bootstrap-based procedures for inference in nonparametric receiver-operating characteristic curve regression analysis.

    Science.gov (United States)

    Rodríguez-Álvarez, María Xosé; Roca-Pardiñas, Javier; Cadarso-Suárez, Carmen; Tahoces, Pablo G

    2018-03-01

    Prior to using a diagnostic test in a routine clinical setting, the rigorous evaluation of its diagnostic accuracy is essential. The receiver-operating characteristic curve is the measure of accuracy most widely used for continuous diagnostic tests. However, the possible impact of extra information about the patient (or even the environment) on diagnostic accuracy also needs to be assessed. In this paper, we focus on an estimator for the covariate-specific receiver-operating characteristic curve based on direct regression modelling and nonparametric smoothing techniques. This approach defines the class of generalised additive models for the receiver-operating characteristic curve. The main aim of the paper is to offer new inferential procedures for testing the effect of covariates on the conditional receiver-operating characteristic curve within the above-mentioned class. Specifically, two different bootstrap-based tests are suggested to check (a) the possible effect of continuous covariates on the receiver-operating characteristic curve and (b) the presence of factor-by-curve interaction terms. The validity of the proposed bootstrap-based procedures is supported by simulations. To facilitate the application of these new procedures in practice, an R-package, known as npROCRegression, is provided and briefly described. Finally, data derived from a computer-aided diagnostic system for the automatic detection of tumour masses in breast cancer is analysed.

  6. Observational study identifies non-attendance characteristics in two hospital outpatient clinics

    DEFF Research Database (Denmark)

    Blæhr, Emely; Søgaard, Rikke; Kristensen, Thomas

    2016-01-01

    INTRODUCTION: Non-attended hospital appointments are receiving increasing attention in times when rapid access and efficient service delivery at public hospitals are on the agenda. The aim of this study was to investigate the extent of non-attendance in a Danish outpatient setting and its...... association with user-level and provider-level characteristics. METHODS: The study was based on appointments scheduled from June 2013 to March 2015 at an orthopaedic and a radiologic outpatient clinic. Data on outcomes of cancellation on the part of the user or the provider, and non-attendance without giving...

  7. Relocation and the characteristics of hospital and hostel regimes.

    Science.gov (United States)

    Booth, T; Simons, K; Booth, W

    1991-01-01

    Drawing on evidence from a research evaluation of a local community care programme, this paper explores whether relocation from a British National Health Service mental handicap hospital into local authority hostels (supervised residential facilities) brought about a qualitative change in the residential environment of movers towards less restrictive management practices and caring routines, more responsive attitudes towards their rights and needs as individuals, and greater control over their own lives. The conclusions point to the existence of a substantial measure of overlap in the fundamental characteristics of the hospital and hostel regimes.

  8. A review of hospital characteristics associated with improved performance.

    Science.gov (United States)

    Brand, Caroline A; Barker, Anna L; Morello, Renata T; Vitale, Michael R; Evans, Sue M; Scott, Ian A; Stoelwinder, Johannes U; Cameron, Peter A

    2012-10-01

    The objective of this review was to critically appraise the literature relating to associations between high-level structural and operational hospital characteristics and improved performance. The Cochrane Library, MEDLINE (Ovid), CINAHL, proQuest and PsychINFO were searched for articles published between January 1996 and May 2010. Reference lists of included articles were reviewed and key journals were hand searched for relevant articles. and data extraction Studies were included if they were systematic reviews or meta-analyses, randomized controlled trials, controlled before and after studies or observational studies (cohort and cross-sectional) that were multicentre, comparative performance studies. Two reviewers independently extracted data, assigned grades of evidence according to the Australian National Health and Medical Research Council guidelines and critically appraised the included articles. Data synthesis Fifty-seven studies were reported within 12 systematic reviews and 47 observational articles. There was heterogeneity in use and definition of performance outcomes. Hospital characteristics investigated were environment (incentives, market characteristics), structure (network membership, ownership, teaching status, geographical setting, service size) and operational design (innovativeness, leadership, organizational culture, public reporting and patient safety practices, information technology systems and decision support, service activity and planning, workforce design, staff training and education). The strongest evidence for an association with overall performance was identified for computerized physician order entry systems. Some evidence supported the associations with workforce design, use of financial incentives, nursing leadership and hospital volume. There is limited, mainly low-quality evidence, supporting the associations between hospital characteristics and healthcare performance. Further characteristic-specific systematic reviews are

  9. Predictive factors in patients with hepatocellular carcinoma receiving sorafenib therapy using time-dependent receiver operating characteristic analysis.

    Science.gov (United States)

    Nishikawa, Hiroki; Nishijima, Norihiro; Enomoto, Hirayuki; Sakamoto, Azusa; Nasu, Akihiro; Komekado, Hideyuki; Nishimura, Takashi; Kita, Ryuichi; Kimura, Toru; Iijima, Hiroko; Nishiguchi, Shuhei; Osaki, Yukio

    2017-01-01

    To investigate variables before sorafenib therapy on the clinical outcomes in hepatocellular carcinoma (HCC) patients receiving sorafenib and to further assess and compare the predictive performance of continuous parameters using time-dependent receiver operating characteristics (ROC) analysis. A total of 225 HCC patients were analyzed. We retrospectively examined factors related to overall survival (OS) and progression free survival (PFS) using univariate and multivariate analyses. Subsequently, we performed time-dependent ROC analysis of continuous parameters which were significant in the multivariate analysis in terms of OS and PFS. Total sum of area under the ROC in all time points (defined as TAAT score) in each case was calculated. Our cohort included 175 male and 50 female patients (median age, 72 years) and included 158 Child-Pugh A and 67 Child-Pugh B patients. The median OS time was 0.68 years, while the median PFS time was 0.24 years. On multivariate analysis, gender, body mass index (BMI), Child-Pugh classification, extrahepatic metastases, tumor burden, aspartate aminotransferase (AST) and alpha-fetoprotein (AFP) were identified as significant predictors of OS and ECOG-performance status, Child-Pugh classification and extrahepatic metastases were identified as significant predictors of PFS. Among three continuous variables (i.e., BMI, AST and AFP), AFP had the highest TAAT score for the entire cohort. In subgroup analyses, AFP had the highest TAAT score except for Child-Pugh B and female among three continuous variables. In continuous variables, AFP could have higher predictive accuracy for survival in HCC patients undergoing sorafenib therapy.

  10. Some psychological characteristics of adolescents hospitalized following a suicide attempt.

    Science.gov (United States)

    Maraš, J S; Kolundžija, K; Dukić, O; Marković, J; Okanović, P; Stokin, B; Mitrović, D; Ivanović-Kovačević, S

    2013-02-01

    In most countries, suicide is second or third leading cause of death in youth. Suicidal tendencies among youth have been the subject of extensive research. Reports of increased rate of suicide attempts in the past few decades indicate that this phenomenon has not been fully understood. The aim of this study was to better understand the phenomenon of adolescent suicide behavior by defining some specific psychological characteristics of adolescents who were hospitalized at the psychiatric ward because of the suicide attempt. 62 participants were assigned to two groups: clinical (adolescents who were hospitalized after a suicide attempt) and non-clinical (adolescents without psychiatric symptoms). They filled in a series of instruments: a questionnaire examining adolescents' demographic characteristics, Rosenberg's Self-Esteem Scale, Youth Self Report. Compared to the non-clinical populaton adolescents attempting suicide had significantly more frequent suicidal thoughts (χ2 = 18.627, df = 1, p self-esteem (t = 4.23, p suicide attempt.  

  11. Preliminary analysis of the operating characteristics of a generic repository receiving facility: Status report

    International Nuclear Information System (INIS)

    1985-10-01

    The operating characteristics of a repository receiving facility structured around current technology and practices have been reviewed. Cask turnaround times and operator doses were estimated. Large throughout and long-term receiving operations at a nuclear waste repository result in an unprecedented number of casks being handled. While the current generation of material-handling equipment is adequate to process the casks, personnel radiation exposures for the generic facility analyzed are unacceptably high. This emphasizes the need for development of occupational radiation exposure control concepts for application in repository receiving facilities. 3 refs., 22 figs., 6 tabs

  12. Clinical characteristics of rotavirus diarrhea in hospitalized Romanian infants.

    Science.gov (United States)

    Lesanu, Gabriela; Becheanu, Cristina Adriana; Vlad, Raluca Maria; Pacurar, Daniela; Tincu, Iulia Florentina; Smadeanu, Roxana Elena

    2013-01-01

    Clinical characteristics of rotavirus enteritis were evaluated by comparison with acute diarrhea of other etiologies. We reviewed the medical records of children (aged 0-12 months) admitted with acute diarrhea in our hospital between January and December 2011. Of the 839 patients, 49.3% had rotavirus diarrhea. The incidence of severe disease was significantly higher for rotavirus diarrhea (65.2%, P < 0.01) than for other types of diarrheal disease.

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

    National Research Council Canada - National Science Library

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

    2007-01-01

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

  14. Enhancing physical activity in older adults receiving hospital based rehabilitation: a phase II feasibility study

    Directory of Open Access Journals (Sweden)

    Said Catherine M

    2012-06-01

    Full Text Available Abstract Background Older adults receiving inpatient rehabilitation have low activity levels and poor mobility outcomes. Increased physical activity may improve mobility. The objective of this Phase II study was to evaluate the feasibility of a randomized controlled trial (RCT of enhanced physical activity in older adults receiving rehabilitation. Methods Patients admitted to aged care rehabilitation with reduced mobility were randomized to receive usual care or usual care plus additional physical activity, which was delivered by a physiotherapist or physiotherapy assistant. The feasibility and safety of the proposed RCT protocol was evaluated. The primary clinical outcome was mobility, which was assessed on hospital admission and discharge by an assessor blinded to group assignment. To determine the most appropriate measure of mobility, three measures were trialled; the Timed Up and Go, the Elderly Mobility Scale and the de Morton Mobility Index. Results The protocol was feasible. Thirty-four percent of people admitted to the ward were recruited, with 47 participants randomised to a control (n = 25 or intervention group (n = 22. The rates of adverse events (death, falls and readmission to an acute service did not differ between the groups. Usual care therapists remained blind to group allocation, with no change in usual practice. Physical activity targets were met on weekdays but not weekends and the intervention was acceptable to participants. The de Morton Mobility Index was the most appropriate measure of mobility. Conclusions The proposed RCT of enhanced physical activity in older adults receiving rehabilitation was feasible. A larger multi-centre RCT to establish whether this intervention is cost effective and improves mobility is warranted. Trial registration The trial was registered with the ANZTCR (ACTRN12608000427370.

  15. Robust Biometric Score Fusion by Naive Likelihood Ratio via Receiver Operating Characteristics

    NARCIS (Netherlands)

    Tao, Q.; Veldhuis, Raymond N.J.

    This paper presents a novel method of fusing multiple biometrics on the matching score level. We estimate the likelihood ratios of the fused biometric scores, via individual receiver operating characteristics (ROC) which construct the Naive Bayes classifier. Using a limited number of operation

  16. Receiver operating characteristics of perceptrons : Influence of sample size and prevalence

    NARCIS (Netherlands)

    Freking, Ansgar; Biehl, Michael; Braun, Christian; Kinzel, Wolfgang; Meesmann, Malte

    1999-01-01

    In many practical classification problems it is important to distinguish false positive from false negative results when evaluating the performance of the classifier. This is of particular importance for medical diagnostic tests. In this context, receiver operating characteristic (ROC) curves have

  17. Sexual Dysfunction among Females Receiving Psychotropic Medication: A Hospital-based Cross-sectional Study

    Science.gov (United States)

    Shetageri, Veda N.; Bhogale, Govind S.; Patil, N. M.; Nayak, R. B.; Chate, S. S.

    2016-01-01

    Background: Sexual dysfunction (SD) is a known adverse effect of psychotropic medications. Even though sexual difficulties are common among women; very few studies have been carried out in India. Objective: To study the prevalence and nature of SD among females receiving psychotropic medications and to compare the SD among female patients receiving antipsychotics and antidepressants. Materials and Methods: Female investigator conducted a hospital-based cross-sectional study on female patients visiting the psychiatry outpatient department. Patients meeting inclusion criteria were assessed for SD disorder as per Diagnostic and Statistical Manual of Mental Disorders 4th Edition Text Revision. SD severity was measured using Female Sexual Function Index (FSFI) scale. Results: The prevalence of SD in this study was 68.32%. There was more than one SD in 48 (47.52%). FSFI score was significantly low in patients with SD as compared to patients not having SD (P = 0.001). SD was more common in patients who were on combination of antidepressants and benzodiazepines than antidepressant alone or antipsychotic alone. Conclusion: SD was prevalent in more than 50% of female patients on psychotropic drugs. Number of patients on individual psychotropic drugs was so small that a definite conclusion could not be drawn. Study emphasizes the need to carry out similar study on larger number of patients to get better insight into this problem. PMID:27833229

  18. Characteristics of zero-absenteeism in hospital care.

    Science.gov (United States)

    Schreuder, J A H; Roelen, C A M; van der Klink, J J L; Groothoff, J W

    2013-06-01

    Literature on sickness presenteeism is emerging, but still little is known about employees who are never absent from work due to injuries or illness. Insight into the determinants and characteristics of such zero-absentees may provide clues for preventing sickness absence. To investigate the characteristics of zero-absentees, defined as employees without sickness absence over a period of 5 years. A mixed-method qualitative study comprising semi-structured interviews and focus groups for which Azjen and Fishbein's theory of planned behaviour was used as a framework. Zero-absentees working in hospital care were invited for semi-structured interviews until saturation was reached. The results of semi-structured interviews were validated in two focus groups. Of 1053 hospital employees, 47 were zero-absentees of whom 31 (66%) agreed to participate in the study. After 16 semi-structured interviews, no new insights or information were gathered from the interviews. The remaining 15 employees were invited to two (n = 8 and n = 7) focus groups. Personal attitudes and self-efficacy were more important in zero-absenteeism than social pressures of managers, colleagues or patients. Zero-absentees were found to be intrinsically motivated to try attending work when ill. In the present study population of hospital employees, we found indications that zero-absenteeism and sickness presenteeism might be different types of work attendance. Managers should realize that zero-absentees are driven by intrinsic motivation rather than social pressures to attend work.

  19. Hospital administrative characteristics and volunteer resource management practices.

    Science.gov (United States)

    Intindola, Melissa; Rogers, Sean; Flinchbaugh, Carol; Della Pietra, Doug

    2016-05-16

    Purpose - The purpose of this paper is to explore the links between various characteristics of hospital administration and the utilization of classes of volunteer resource management (VRM) practices. Design/methodology/approach - This paper uses original data collected via surveys of volunteer directors in 122 hospitals in five Northeastern and Southern US states. Findings - Structural equation modeling results suggest that number of paid volunteer management staff, scope of responsibility of the primary volunteer administrator, and hospital size are positively associated with increased usage of certain VRM practices. Research limitations/implications - First, the authors begin the exploration of VRM antecedents, and encourage others to continue this line of inquiry; and second, the authors assess dimensionality of practices, allowing future researchers to consider whether specific dimensions have a differential impact on key individual and organizational outcomes. Practical implications - Based on the findings of a relationship between administrative characteristics and the on-the-ground execution of VRM practice, a baseline audit comparing current practices to those VRM practices presented here might be useful in determining what next steps may be taken to focus investments in VRM that can ultimately drive practice utilization. Originality/value - The exploration of the dimensionality of volunteer management adds a novel perspective to both the academic study, and practice, of volunteer management. To the authors' knowledge, this is the first empirical categorization of VRM practices.

  20. Associations Between End-of-Life Discussion Characteristics and Care Received Near Death: A Prospective Cohort Study

    Science.gov (United States)

    Mack, Jennifer W.; Cronin, Angel; Keating, Nancy L.; Taback, Nathan; Huskamp, Haiden A.; Malin, Jennifer L.; Earle, Craig C.; Weeks, Jane C.

    2012-01-01

    Purpose National guidelines recommend that discussions about end-of-life (EOL) care planning happen early for patients with incurable cancer. We do not know whether earlier EOL discussions lead to less aggressive care near death. We sought to evaluate the extent to which EOL discussion characteristics, such as timing, involved providers, and location, are associated with the aggressiveness of care received near death. Patients and Methods We studied 1,231 patients with stage IV lung or colorectal cancer in the Cancer Care Outcomes Research and Surveillance Consortium, a population- and health system–based prospective cohort study, who died during the 15-month study period but survived at least 1 month. Our main outcome measure was the aggressiveness of EOL care received. Results Nearly half of patients received at least one marker of aggressive EOL care, including chemotherapy in the last 14 days of life (16%), intensive care unit care in the last 30 days of life (9%), and acute hospital-based care in the last 30 days of life (40%). Patients who had EOL discussions with their physicians before the last 30 days of life were less likely to receive aggressive measures at EOL, including chemotherapy (P = .003), acute care (P EOL discussions are prospectively associated with less aggressive care and greater use of hospice at EOL. PMID:23150700

  1. Hospital social workers in Saudi Arabia: characteristics and functions.

    Science.gov (United States)

    Albrithen, Abdulaziz; Yalli, Nadir

    2015-01-01

    Social work practitioners are important members of the health care team and the hospital sector has been a traditional employer of social workers. Social work practitioners have become increasingly involved in hospital work as a result of the growing recognition of the important link between the biophysical aspects of health and the surrounding psychosocial circumstances, which require multidisciplinary interventions and demand the involvement of specialized social work personnel to deal with such issues. The article has been carried out in order to contribute to the literature by exploring to see if the characteristics and functions of contemporary professional social workers (who practice in the health sector in western Saudi Arabia) are achieving best practice.

  2. Creatinine Versus Cystatin C: Differing Estimates of Renal Function in Hospitalized Veterans Receiving Anticoagulants.

    Science.gov (United States)

    Wang, Christina Hao; Rubinsky, Anna D; Minichiello, Tracy; Shlipak, Michael G; Price, Erika Leemann

    2018-05-31

    Current practice in anticoagulation dosing relies on kidney function estimated by serum creatinine using the Cockcroft-Gault equation. However, creatinine can be unreliable in patients with low or high muscle mass. Cystatin C provides an alternative estimation of glomerular filtration rate (eGFR) that is independent of muscle. We compared cystatin C-based eGFR (eGFR cys ) with multiple creatinine-based estimates of kidney function in hospitalized patients receiving anticoagulants, to assess for discordant results that could impact medication dosing. Retrospective chart review of hospitalized patients over 1 year who received non-vitamin K antagonist anticoagulation, and who had same-day measurements of cystatin C and creatinine. Seventy-five inpatient veterans (median age 68) at the San Francisco VA Medical Center (SFVAMC). We compared the median difference between eGFR by the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) study equation using cystatin C (eGFR cys ) and eGFRs using three creatinine-based equations: CKD-EPI (eGFR EPI ), Modified Diet in Renal Disease (eGFR MDRD ), and Cockcroft-Gault (eGFR CG ). We categorized patients into standard KDIGO kidney stages and into drug-dosing categories based on each creatinine equation and calculated proportions of patients reclassified across these categories based on cystatin C. Cystatin C predicted overall lower eGFR compared to creatinine-based equations, with a median difference of - 7.1 (IQR - 17.2, 2.6) mL/min/1.73 m 2 versus eGFR EPI , - 21.2 (IQR - 43.7, - 8.1) mL/min/1.73 m 2 versus eGFR MDRD , and - 25.9 (IQR - 46.8, - 8.7) mL/min/1.73 m 2 versus eGFR CG . Thirty-one to 52% of patients were reclassified into lower drug-dosing categories using cystatin C compared to creatinine-based estimates. We found substantial discordance in eGFR comparing cystatin C with creatinine in this group of anticoagulated inpatients. Our sample size was limited and included few women. Further

  3. Quality of previous diabetes care among patients receiving services at ophthalmology hospitals in Mexico.

    Science.gov (United States)

    Rodríguez-Saldana, Joel; Rosales-Campos, Andrea C; Rangel León, Carmen B; Vázquez-Rodríguez, Laura I; Martínez-Castro, Francisco; Piette, John D

    2010-12-01

    To survey a large sample of type 2 diabetes mellitus (T2DM) patients in Mexico City to determine if patient experience, access to basic services, treatment, and outcomes differed between those with social security coverage and those without. From 2001-2007 a total of 1 000 individuals with T2DM were surveyed in outpatient clinics of the three largest public ophthalmology hospitals in Mexico City. Patients reported information about their health status and receipt of basic diabetes services, such as laboratory glycemic monitoring and diabetes education. Rates were compared between those with (n = 461) and without (n = 539) social security. Almost half of the patients (46%) in these public facilities were social security patients that were unable to access other services and had to pay out-of-pocket for care. Half of respondents were originally identified as potentially diabetic based on symptom complaints (51%), including 11% with visual impairment. Most patients (87.9%) reported that their glycemic level was being monitored exclusively via fasting blood glucose testing or random capillary blood glucose tests; only 5.3% reported ever having a glycated hemoglobin test. While nearly all respondents reported an individual physician encounter ever, only 39% reported ever receiving nutrition counseling and only 21% reported attending one or more sessions of diabetes education in their lifetime. Processes of care and outcomes were no different in patients with and those without social security coverage. In Mexico, the quality of diabetes care is poor. Despite receiving social security, many patients still have to pay out-of-pocket to access needed care. Without policy changes that address these barriers to comprehensive diabetes management, scientific achievements in diagnosis and pharmacotherapy will have limited impact.

  4. Estimating flow characteristics of different weir types and optimum dimensions of downstream receiving pool

    OpenAIRE

    Emiroglu, M. Emin

    2010-01-01

    This paper presents the results of a laboratory study on the flow characteristics of sharp-crested weirs, broad-crested weirs, and labyrinth weirs. The variation of the maximum bubble penetration depth for different weir types is investigated depending on overfall jet expansion, discharge, and drop height. Moreover, most efficient depth, length and width of the downstream receiving pool in an open channel system are studied by considering the penetration depth, overfall jet expansion, jet tra...

  5. Sleep of Parents Living With a Child Receiving Hospital-Based Home Care: A Phenomenographical Study.

    Science.gov (United States)

    Angelhoff, Charlotte; Edéll-Gustafsson, Ulla; Mörelius, Evalotte

    2015-01-01

    Caring for an ill child at home gives the family the chance to be together in a familiar environment. However, this involves several nocturnal sleep disturbances, such as frequent awakenings and bad sleep quality, which may affect parents' ability to take care of the child and themselves. The aim of this study was to describe parents' perceptions of circumstances influencing their own sleep when living with a child enrolled in hospital-based home care (HBHC) services. This is a phenomenographical study with an inductive, exploratory design. Fifteen parents (11 mothers and 4 fathers) with children enrolled in HBHC services were interviewed. Data were analyzed to discover content-related categories describing differences in ways parents experienced sleep when caring for their children receiving HBHC. Four descriptive categories were detected: sleep influences mood and mood influences sleep; support influences safeness and safeness influences sleep; the child's needs influence routines and routines influence sleep; and "me time" influences sleep. Sleep does not affect only the parents' well-being but also the child's care. Symptoms of stress may limit the parents' capacity to meet the child's needs. Support, me time, and physical activity were perceived as essential sources for recovery and sleep. It is important for nurses to acknowledge parental sleep in the child's nursing care plan and help the parents perform self-care to promote sleep and maintain life, health, and well-being.

  6. Variation in guideline adherence in non-Hodgkin’s lymphoma care: impact of patient and hospital characteristics

    International Nuclear Information System (INIS)

    Stienen, Jozette J.C.; Hermens, Rosella P.M.G.; Wennekes, Lianne; Schans, Saskia A.M. van de; Maazen, Richard W.M. van der; Dekker, Helena M.; Liefers, Janine; Krieken, Johan H.J.M. van; Blijlevens, Nicole M.A.; Ottevanger, Petronella B.

    2015-01-01

    The objective of this observational study was to assess the influence of patient, tumor, professional and hospital related characteristics on hospital variation concerning guideline adherence in non-Hodgkin’s lymphoma (NHL) care. Validated, guideline-based quality indicators (QIs) were used as a tool to assess guideline adherence for NHL care. Multilevel logistic regression analyses were used to calculate variation between hospitals and to identify characteristics explaining this variation. Data for the QIs regarding diagnostics, therapy, follow-up and organization of care, together with patient, tumor and professional related characteristics were retrospectively collected from medical records; hospital characteristics were derived from questionnaires and publically available data. Data of 423 patients diagnosed with NHL between October 2010 and December 2011 were analyzed. Guideline adherence, as measured with the QIs, varied considerably between the 19 hospitals: >20 % variation was identified in all 20 QIs and high variation between the hospitals (>50 %) was seen in 12 QIs, most frequently in the treatment and follow-up domain. Hospital variation in NHL care was associated more than once with the characteristics age, extranodal involvement, multidisciplinary consultation, tumor type, tumor aggressiveness, LDH level, therapy used, hospital region and availability of a PET-scanner. Fifteen characteristics identified at the patient level and at the hospital level could partly explain hospital variation in guideline adherence for NHL care. Particularly age was an important determinant: elderly were less likely to receive care as measured in the QIs. The identification of determinants can be used to improve the quality of NHL care, for example, for standardizing multidisciplinary consultations in daily practice

  7. Characteristics of Symptomatic Intracranial Hemorrhage in Patients Receiving Non-Vitamin K Antagonist Oral Anticoagulant Therapy.

    Directory of Open Access Journals (Sweden)

    Hisanao Akiyama

    Full Text Available The first non-vitamin K antagonist oral anticoagulant (NOAC introduced to the market in Japan was dabigatran in March 2011, and three more NOACs, rivaroxaban, apixaban, and edoxaban, have since become available. Randomized controlled trials of NOACs have revealed that intracranial hemorrhage (ICH occurs less frequently with NOACs compared with warfarin. However, the absolute incidence of ICH associated with NOACs has increased with greater use of these anticoagulants, and we wanted to explore the incidence, clinical characteristics, and treatment course of patients with NOACs-associated ICH.We retrospectively analyzed the characteristics of symptomatic ICH patients receiving NOACs between March 2011 and September 2014.ICH occurred in 6 patients (5 men, 1 woman; mean ± SD age, 72.8 ± 3.2 years. Mean time to onset was 146.2 ± 111.5 days after starting NOACs. Five patients received rivaroxaban and 1 patient received apixaban. None received dabigatran or edoxaban. Notably, no hematoma expansion was observed within 24 h of onset in the absence of infusion of fresh frozen plasma, activated prothrombin complex concentrate, recombinant activated factor VIIa or hemodialysis. When NOAC therapy was initiated, mean HAS-BLED and PANWARDS scores were 1.5 ± 0.5 and 39.5 ± 7.7, respectively. Mean systolic blood pressure was 137.8 ± 15.9 mmHg within 1 month before spontaneous ICH onset.Six symptomatic ICHs occurred early in NOAC therapy but hematoma volume was small and did not expand in the absence of infusion of reversal agents or hemodialysis. The occurrence of ICH during NOAC therapy is possible even when there is acceptable mean systolic blood pressure control (137.8 ± 15.9 mmHg and HAS-BLED score ≤ 2. Even stricter blood pressure lowering and control within the acceptable range may be advisable to prevent ICH during NOAC therapy.

  8. Polarization Characteristics Inferred From the Radio Receiver Instrument on the Enhanced Polar Outflow Probe

    Science.gov (United States)

    Danskin, Donald W.; Hussey, Glenn C.; Gillies, Robert G.; James, H. Gordon; Fairbairn, David T.; Yau, Andrew W.

    2018-02-01

    The Radio Receiver Instrument (RRI) on the CAScade, Smallsat, and Ionospheric Polar Explorer/enhanced Polar Outflow Probe (CASSIOPE/e-POP) satellite was used to receive continuous wave and binary phase shift keyed transmissions from a high-frequency transmitter located in Ottawa, ON, Canada during April 2016 to investigate how the ionosphere affects the polarization characteristics of transionospheric high-frequency radio waves. The spacecraft orientation was continuously slewed to maintain the dipole orientation in a plane perpendicular to the direction toward the transmitter, enabling the first in situ planar polarization determination for continuous wave and binary phase shift keyed modulated radio waves from space at times when the wave frequency is at least 1.58 times the plasma frequency. The Stokes parameters and polarization characteristics were derived from the measured data and interpreted using an existing ray tracing model. For the southern part of the passes, the power was observed to oscillate between the two dipoles of RRI, which was attributed to Faraday rotation of the radio waves. For the first time, a reversal in the rate of change of orientation angle was observed where the minimum in modeled Faraday rotation occurred. The reversal point was poleward of the point of closest approach between the satellite and transmitter; this was explained by the variations of total electron content and component of magnetic field along the direction of propagation. The received signals show both quasi-longitudinal (QL) and quasi-transverse characteristics. South of the transmitter the QL regime is dominant. Around the reversal point, a combination of QL and quasi-transverse nature was observed.

  9. Multidisciplinary Treatments, Patient Characteristics, Context of Care, and Adverse Incidents in Older, Hospitalized Adults

    Directory of Open Access Journals (Sweden)

    Leah L. Shever

    2012-01-01

    Full Text Available The purpose of this study was to examine factors that contribute to adverse incidents by creating a model that included patient characteristics, clinical conditions, nursing unit context of care variables, medical treatments, pharmaceutical treatments, and nursing treatments. Data were abstracted from electronic, administrative, and clinical data repositories. The sample included older adults hospitalized during a four-year period at one, academic medical facility in the Midwestern United States who were at risk for falling. Relational databases were built and a multistep, statistical model building analytic process was used. Total registered nurse (RN hours per patient day (HPPD and HPPDs dropping below the nursing unit average were significant explanatory variables for experiencing an adverse incident. The number of medical and pharmaceutical treatments that a patient received during hospitalization as well as many specific nursing treatments (e.g., restraint use, neurological monitoring were also contributors to experiencing an adverse incident.

  10. Receiver operating characteristic analysis of chest radiographs with computed radiography and conventional analog films

    International Nuclear Information System (INIS)

    Morioka, C.; Brown, K.; Dalter, S.; Milos, M.J.; Huang, H.K.; Kangarloo, H.; Boechat, I.M.; Batra, P.

    1988-01-01

    Receiver operating characteristic is used to compare the image quality of films obtained digitally using computed radiography (CR) and conventionally using analog film following fluoroscopic examination. Twenty-four cases, some with a solitary noncalcified nodule and/or pneumothorax, were collected. Ten radiologists have been tested viewing analog and CR digital films separately. Preliminary results indicate that there is no significant difference in the ability to detect either a pneumothorax or a solitary noncalcified nodule when comparing CR digital film with conventional analog film. A comparison of the CR digital image displayed on a 2,048-line monitor against analog and CR digital film is in progress

  11. Characteristics of Transgender Women Living with HIV Receiving Medical Care in the United States.

    Science.gov (United States)

    Mizuno, Yuko; Frazier, Emma L; Huang, Ping; Skarbinski, Jacek

    2015-09-01

    Little has been reported from population-based surveys on the characteristics of transgender persons living with HIV. Using Medical Monitoring Project (MMP) data, we describe the characteristics of HIV-infected transgender women and examine their care and treatment needs. We used combined data from the 2009 to 2011 cycles of MMP, an HIV surveillance system designed to produce nationally representative estimates of the characteristics of HIV-infected adults receiving medical care in the United States, to compare demographic, behavioral, and clinical characteristics, and met and unmet needs for supportive services of transgender women with those of non-transgender persons using Rao-Scott chi-square tests. An estimated 1.3% of HIV-infected persons receiving care in the United States self-identified as transgender women. Transgender women were socioeconomically more marginalized than non-transgender men and women. We found no differences between transgender women and non-transgender men and women in the percentages prescribed antiretroviral therapy (ART). However, a significantly lower percentage of transgender women compared to non-transgender men had 100% ART dose adherence (78.4% vs. 87.4%) and durable viral suppression (50.8% vs. 61.4%). Higher percentages of transgender women needed supportive services. No differences were observed in receipt of most of supportive services, but transgender women had higher unmet needs than non-transgender men for basic services such as food and housing. We found little difference between transgender women and non-transgender persons in regards to receipt of care, treatment, and most of supportive services. However, the noted disparities in durable viral suppression and unmet needs for basic services should be explored further.

  12. 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.

  13. Absorbed doses received by patients submitted to chest radiographs in hospitals of the city of Sao Paulo, Brazil

    International Nuclear Information System (INIS)

    Freitas, Marcelo Baptista de

    2000-01-01

    Medical irradiation contributes with a significant amount to the dose received by the population. Here, this contribution was evaluated in a survey of absorbed doses received by patients submitted to chest radiological examinations (postero-anterior (PA) and lateral (LAT) projections) in hospitals of the city of Sao Paulo. Due to the variety of equipment and procedures used in radiological examinations, a selection of hospitals was made (12, totalizing 27 X-ray facilities), taking into account their representativeness as medical institutions in the city, in terms of characteristics and number of radiographs carried out. An anthropomorphic phantom, provided with thermoluminescent dosemeters (TLD-1 00), was irradiated simulating the patient, and the radiographic image quality was evaluated. Absorbed doses were determined to the thoracic region (entrance and exit skin and lung doses), and to some important organs from the radiation protection point of view (lens of the eye, thyroid and gonads). The great variation on the exposure parameters (kV, mA.s, beam size) leads to a large interval of entrance skin doses-ESD (coefficients of variation, CV, of 60% and 76%, for PA and LAT projections, respectively, were found) and of organ doses (CV of 60% and 46%. for thyroid and lung respectively). Mean values of ESD for LAT and PA projections were 0.22 and 0.98 mGy, respectively. The average absorbed doses per exam (PA and LAT) to thyroid and lung, 0.15 and 0.24 mGy respectively,showed that the thyroid was irradiated by the primary beam in many cases. Values of lens of the eye and gonad absorbed doses were below 30 μGy. Comparison of the lung doses obtained in this study with values in the literature, calculated by Monte Carlo simulation, showed good agreement. On the other hand, the comparison shows significant differences in the dose values to organs outside the chest region (thyroid, lens of eye and gonads). The effective dose calculated for a chest examination, PA and LAT

  14. Hospitalization for urinary tract infections and the quality of preventive health care received by people with spina bifida.

    Science.gov (United States)

    Armour, Brian S; Ouyang, Lijing; Thibadeau, Judy; Grosse, Scott D; Campbell, Vincent A; Joseph, David

    2009-07-01

    The preventive health care needs of people with disabilities often go unmet, resulting in medical complications that may require hospitalization. Such complications could be due, in part, to difficulty accessing care or the quality of ambulatory care services received. To use hospitalizations for urinary tract infections (UTIs) as a marker of the potential quality of ambulatory care services received by people affected by spina bifida. MarketScan inpatient and outpatient medical claims data for 2000 through 2003 were used to identify hospitalizations for UTI, which is an ambulatory care sensitive condition, for people affected by spina bifida and to calculate inpatient discharge rates, average lengths of stay, and average medical care expenditures for such hospitalizations. People affected by spina bifida averaged 0.5 hospitalizations per year, and there were 22.8 inpatient admissions with UTI per 1000 persons with spina bifida during the period 2000-2003, in comparison to an average of 0.44 admission with UTI per 1000 persons for those without spina bifida. If the number of UTI hospitalizations among people affected by spina bifida were reduced by 50%, expenditures could be reduced by $4.4 million per 1000 patients. Consensus on the evaluation and management of bacteriuria could enhance clinical care and reduce the disparity in UTI discharge rates among people affected by spina bifida compared to those without spina bifida. National evidence-based guidelines are needed.

  15. Characteristics of HIV-Positive Transgender Men Receiving Medical Care: United States, 2009-2014.

    Science.gov (United States)

    Lemons, Ansley; Beer, Linda; Finlayson, Teresa; McCree, Donna Hubbard; Lentine, Daniel; Shouse, R Luke

    2018-01-01

    To present the first national estimate of the sociodemographic, clinical, and behavioral characteristics of HIV-positive transgender men receiving medical care in the United States. This analysis included pooled interview and medical record data from the 2009 to 2014 cycles of the Medical Monitoring Project, which used a 3-stage, probability-proportional-to-size sampling methodology. Transgender men accounted for 0.16% of all adults and 11% of all transgender adults receiving HIV medical care in the United States from 2009 to 2014. Of these HIV-positive transgender men receiving medical care, approximately 47% lived in poverty, 69% had at least 1 unmet ancillary service need, 23% met criteria for depression, 69% were virally suppressed at their last test, and 60% had sustained viral suppression over the previous 12 months. Although they constitute a small proportion of all HIV-positive patients, more than 1 in 10 transgender HIV-positive patients were transgender men. Many experienced socioeconomic challenges, unmet needs for ancillary services, and suboptimal health outcomes. Attention to the challenges facing HIV-positive transgender men may be necessary to achieve the National HIV/AIDS Strategy goals of decreasing disparities and improving health outcomes among transgender persons.

  16. Patients with schizophrenia or schizoaffective disorder who receive multiple electroconvulsive therapy sessions: characteristics, indications, and results

    Directory of Open Access Journals (Sweden)

    Iancu I

    2015-03-01

    Full Text Available Iulian Iancu,* Nimrod Pick,* Orit Seener-Lorsh, Pinhas Dannon Be’er Ya’akov Mental Health Center, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel *These authors share first authorship of this paper Background: While electroconvulsive therapy (ECT has been used for many years, there is insufficient research regarding the indications for continuation/maintenance (C/M-ECT, its safety and efficacy, and the characteristics of patients with schizophrenia or schizoaffective disorder who receive multiple ECT sessions. The aims of this study were to characterize a series of patients who received 30 ECT sessions or more, to describe treatment regimens in actual practice, and to examine the results of C/M-ECT in terms of safety and efficacy, especially the effect on aggression and functioning.Methods: We performed a retrospective chart review of 20 consecutive patients (mean age 64.6 years with schizophrenia (n=16 or schizoaffective disorder (n=4 who received at least 30 ECT sessions at our ECT unit, and also interviewed the treating physician and filled out the Clinical Global Impression-Severity, Global Assessment of Functioning, and the Staff Observation Aggression Scale-Revised.Results: Patients received a mean of 91.3 ECT sessions at a mean interval of 2.6 weeks. All had been hospitalized for most or all of the previous 3 years. There were no major adverse effects, and cognitive side effects were relatively minimal (cognitive deficit present for several hours after treatment. We found that ECT significantly reduced scores on the Staff Observation Aggression Scale-Revised subscales for verbal aggression and self-harm, and improved Global Assessment of Functioning scores. There were reductions in total aggression scores, subscale scores for harm to objects and to others, and Clinical Global Impression-Severity scores, these were not statistically significant.Conclusion: C/M-ECT is safe and effective for

  17. Characteristics of patients with measles admitted to allied hospital rawalpindi

    International Nuclear Information System (INIS)

    Sultana, A.; Sabir, S.A.; Awan, A.

    2015-01-01

    Measles, a virus borne droplet infection, is one of the leading causes of death among young children worldwide despite presence of a safe and cost-effective vaccine. Objective of our study was to identify the characteristics of measles patients admitted to Allied Hospitals, Rawalpindi. Methods: This cross-sectional study was conducted amongst patients admitted with measles in paediatric units of Rawalpindi Medical College Allied Hospitals, Rawalpindi. A standard proforma was used to collect data from the respondents. Results: A total of 55 patients (mean age-29.36 months) with measles were included in the study. 65.5% children were vaccinated while 34.5% were not vaccinated. Among those vaccinated 14 were male. Out of the vaccinated children 52.6% were residents of middle class areas, 31.6% lower middle class area, 10.5% upper middle class areas and 5.3% rural areas. In 55.0% of patients who were vaccinated with at least one dose of measles at nine month of age the estimated calendar months of vaccination was March to April while in 30% the overall climatic period of vaccination was of summer (May to September). Twenty one study subjects were exposed to a case of measles in the family and thirty five out of all developed at least one known complication of the disease. Pneumonia was the most common complication reported in patients (63.6%) followed by diarrhoea (27.3%). Conclusion: Majority of the patients suffering from measles were not vaccinated and the most common reason for failure to immunize children was lack of awareness. Educated and well off fathers were more likely to get their children immunized. The vaccinated children who developed measles majority were vaccinated during months of March, April and May. (author)

  18. Basic characteristics of hospital stroke services in Eastern Hungary

    International Nuclear Information System (INIS)

    Mihalka, Laszlo; Fekete, Istvan; Csepany, Tuende; Csiba, Laszlo; Bereczki, Daniel

    1999-01-01

    Stroke mortality is extremely high in Central-Eastern European countries. We report basic characteristics of a stroke unit in Eastern Hungary, including age and sex distribution; the proportion of transient ischemic attacks (TIA), ischemic and hemorrhagic strokes; case fatality; application of diagnostic methods; and length of stay for all patients treated with acute cerebrovascular disease over a 12-month period. Records of all patients with acute cerebrovascular disease (n = 522) discharged in 1995 from a stroke unit with a well defined catchment area of 220,000 inhabitants in Eastern Hungary were retrospectively analyzed. Case fatality was 18.6% for all patients and 21.1% after excluding cases with TIA. Computer tomography, duplex carotid ultrasound, cerebrospinal fluid examination and electroencephalography were performed in 79%, 77%, 7% and 2% of the patients, respectively. The database of the university hospital with the same catchment area was electronically searched for patients who were discharged with the diagnosis of stroke from the three departments of internal medicine. Stroke mortality data of the catchment area based on death certificates was obtained from the Central Statistical Bureau. Two hundred twenty-eight stroke deaths were reported in the catchment area in 1995. In the same period 97 stroke deaths occurred at the stroke unit and 76 at the departments of internal medicine. If we aim to treat all patients with acute stroke at the stroke unit, with the present stroke incidence and duration of hospital stay the current capacity of the stroke unit (1 bed per 10.000 inhabitants) should be doubled

  19. Differences in resource utilization between patients with diabetes receiving glycemia-targeted specialized nutrition vs standard nutrition formulas in U.S. hospitals.

    Science.gov (United States)

    Hamdy, Osama; Ernst, Frank R; Baumer, Dorothy; Mustad, Vikkie; Partridge, Jamie; Hegazi, Refaat

    2014-11-01

    The purpose of the study was to compare patient outcomes and costs for patients with diabetes mellitus (DM) receiving glycemia-targeted specialized nutrition (GTSN) with similar patients receiving standard nutrition (STDN) formulas during acute care hospitalizations. The study was designed as a retrospective analysis over a 10-year period (2000-2009) of clinical and cost data from 125,000 hospital inpatient episodes in the Premier Research Database. Patients received either GTSN or STDN, by tube or orally, as a component of comprehensive care for hyperglycemia in patients with DM. To adjust for potential cohort imbalances, GTSN patients were matched with STDN patients on the basis of propensity scores, adjusting for many characteristics, including age, sex, race, All Patient Refined Diagnosis-Related Group (APR-DRG) illness severity, APR-DRG mortality risk, and comorbidities. Tube-fed patients with DM who were provided GTSN had a 0.88-day (95% confidence interval [CI], 0.73-1.02) shorter length of hospital stay (LOS) on average compared with those patients provided STDN. Orally fed patients with DM who were provided GTSN had a 0.17-day (95% CI, 0.14-0.21) shorter LOS than did those patients provided STDN. The shorter LOS associated with GTSN contributed to a cost savings of $2586 for tube-fed patients and $1356 for orally fed patients. The use of GTSN feeding formulas for patients with DM in acute care hospital settings was associated with reduced LOS and inpatient hospital episode cost in comparison to STDN. © 2014 Abbott Nutrition.

  20. Substantial shifts in ranking of California hospitals by hospital-associated methicillin-resistant Staphylococcus aureus infection following adjustment for hospital characteristics and case mix.

    Science.gov (United States)

    Tehrani, David M; Phelan, Michael J; Cao, Chenghua; Billimek, John; Datta, Rupak; Nguyen, Hoanglong; Kwark, Homin; Huang, Susan S

    2014-10-01

    States have established public reporting of hospital-associated (HA) infections-including those of methicillin-resistant Staphylococcus aureus (MRSA)-but do not account for hospital case mix or postdischarge events. Identify facility-level characteristics associated with HA-MRSA infection admissions and create adjusted hospital rankings. A retrospective cohort study of 2009-2010 California acute care hospitals. We defined HA-MRSA admissions as involving MRSA pneumonia or septicemia events arising during hospitalization or within 30 days after discharge. We used mandatory hospitalization and US Census data sets to generate hospital population characteristics by summarizing across admissions. Facility-level factors associated with hospitals' proportions of HA-MRSA infection admissions were identified using generalized linear models. Using state methodology, hospitals were categorized into 3 tiers of HA-MRSA infection prevention performance, using raw and adjusted values. Among 323 hospitals, a median of 16 HA-MRSA infections (range, 0-102) per 10,000 admissions was found. Hospitals serving a greater proportion of patients who had serious comorbidities, were from low-education zip codes, and were discharged to locations other than home were associated with higher HA-MRSA infection risk. Total concordance between all raw and adjusted hospital rankings was 0.45 (95% confidence interval, 0.40-0.51). Among 53 community hospitals in the poor-performance category, more than 20% moved into the average-performance category after adjustment. Similarly, among 71 hospitals in the superior-performance category, half moved into the average-performance category after adjustment. When adjusting for nonmodifiable facility characteristics and case mix, hospital rankings based on HA-MRSA infections substantially changed. Quality indicators for hospitals require adequate adjustment for patient population characteristics for valid interhospital performance comparisons.

  1. Impacts of patient characteristics on hospital care experience in 34,000 Swedish patients

    Directory of Open Access Journals (Sweden)

    Wolf Axel

    2012-06-01

    Full Text Available Abstract Background Standardized patient surveys are widely used for assessing quality of healthcare from the patient perspective. An important purpose of such surveys is to identify disparities in care among different patient groups. The purpose of this study was to 1. evaluate aspects of the validity of the adapted Swedish version of the Picker Patient Care Experience -15 (PPE-15 survey and 2. examine the explanatory value of various socio-demographic and health characteristics in predicting patients’ care experiences. Methods A retrospective cross-sectional study design was used. Patients discharged from internal medicine wards at regional and university hospitals in different parts of Sweden during 2010 were invited to participate in the regularly administered national care-experience survey for hospital care. The internal validity of the PPE-15 was assessed with Cronbach’s alpha and item-scale correlations. Pearson product–moment correlation coefficients were used to compare PPE-15 total scores with overall care satisfaction ratings and Spearman correlation coefficients were used to compare PPE-15 total scores with various patient characteristics. Multiple linear regression analysis was performed to examine the influence of various patient characteristics on PPE-15 scores. Results The response rate was 66% (n = 34 603. Cronbach’s alpha was 0.87. The correlation between the PPE-15 total score and overall care satisfaction was high (0.62, p  Conclusions Our results supported the internal validity of the Swedish adapted version of the PPE-15. The explanatory value of the examined patient socio-demographic and health characteristics was low, suggesting the need for exploring other patient-related determinants of care experiences. Our findings also suggest a care paradox: patients in greatest need of hospital care are least satisfied with the quality of the care they receive.

  2. [Physicopharmaceutical characteristics of ulinastatin vaginal suppositories prepared in a hospital].

    Science.gov (United States)

    Satake, Kiyoshi; Nakajima, Takanori; Iwata, Masanori; Fujikake, Yoshio; Kimura, Masayuki

    2011-01-01

    We studied a locally applied vaginal preparation (vaginal suppositories) of ulinastatin (urinary trypsin inhibitor, UTI), designed to threatened premature delivery and maintain pregnancy. Witepsol S55 was chosen as the basic component of the vaginal suppositories based on the physical pharmaceutical characteristics of three kinds of hard fats. The average particle size of the UTI aqueous injection was approximately 70% as compared with that of the UTI lyophilized product, used as the base material for the preparation of UTI vaginal suppositories. We compared the physical pharmaceutical properties of UTI vaginal suppositories with water contents of 2.5%, 5.0%, and 7.5%, respectively. Preparation strength negatively correlated with the water content. The coefficient of viscosity positively correlated with the water content of the preparation. UTI vaginal suppositories with a water content of 5.0% had the highest average drug release rate on moment analysis. A comprehensive evaluation of the properties of UTI vaginal suppositories, including high strength due to disintegration resistance, the coefficient of viscosity and its influence on local retention, and drug release and its influence on the duration of effect, indicated that a 5.0% UTI aqueous solution for injection combined with Witepsol S55 as the base was the optimal formulation for the hospital preparation of vaginal suppositories.

  3. The Impact of Hospital Closures and Hospital and Population Characteristics on Increasing Emergency Department Volume: A Geographic Analysis.

    Science.gov (United States)

    Lee, David C; Carr, Brendan G; Smith, Tony E; Tran, Van C; Polsky, Daniel; Branas, Charles C

    2015-12-01

    Emergency visits are rising nationally, whereas the number of emergency departments is shrinking. However, volume has not increased uniformly at all emergency departments. It is unclear what factors account for this variability in emergency volume growth rates. The objective of this study was to test the association of hospital and population characteristics and the effect of hospital closures with increases in emergency department volume. The study team analyzed emergency department volume at New York State hospitals from 2004 to 2010 using data from cost reports and administrative databases. Multivariate regression was used to evaluate characteristics associated with emergency volume growth. Spatial analytics and distances between hospitals were used in calculating the predicted impact of hospital closures on emergency department use. Among the 192 New York hospitals open from 2004 to 2010, the mean annual increase in emergency department visits was 2.7%, but the range was wide (-5.5% to 11.3%). Emergency volume increased nearly twice as fast at tertiary referral centers (4.8%) and nonurban hospitals (3.7% versus urban at 2.1%) after adjusting for other characteristics. The effect of hospital closures also strongly predicted variation in growth. Emergency volume is increasing faster at specific hospitals: tertiary referral centers, nonurban hospitals, and those near hospital closures. This study provides an understanding of how emergency volume varies among hospitals and predicts the effect of hospital closures in a statewide region. Understanding the impact of these factors on emergency department use is essential to ensure that these populations have access to critical emergency services.

  4. Characteristics of a Danish population of adults with acquired deafblindness receiving rehabilitation services

    DEFF Research Database (Denmark)

    Dammeyer, Jesper Herup

    2013-01-01

    The aim of this study is to report on the characteristics of a population of 916 individuals with acquired deafblindness receiving national Danish counselling and rehabilitation services. Age, gender, prevalence, social status, and communication mode are some of the data included in this study....... Results show that 70% of the population was older than 79 years, 15% was between 65 and 79 years, and 15% of the population was younger than 65 years. Oral speech was used by 86%, sign language by 10%, and tactile sign language by 4%. Among individuals younger than 65 years, less than 50% was employed...... or in education. Results are discussed with respect to the organization of the Danish counselling and rehabilitation service system....

  5. Receiver operating characteristic (ROC) curves: review of methods with applications in diagnostic medicine

    Science.gov (United States)

    Obuchowski, Nancy A.; Bullen, Jennifer A.

    2018-04-01

    Receiver operating characteristic (ROC) analysis is a tool used to describe the discrimination accuracy of a diagnostic test or prediction model. While sensitivity and specificity are the basic metrics of accuracy, they have many limitations when characterizing test accuracy, particularly when comparing the accuracies of competing tests. In this article we review the basic study design features of ROC studies, illustrate sample size calculations, present statistical methods for measuring and comparing accuracy, and highlight commonly used ROC software. We include descriptions of multi-reader ROC study design and analysis, address frequently seen problems of verification and location bias, discuss clustered data, and provide strategies for testing endpoints in ROC studies. The methods are illustrated with a study of transmission ultrasound for diagnosing breast lesions.

  6. Optimal algorithm for automatic detection of microaneurysms based on receiver operating characteristic curve

    Science.gov (United States)

    Xu, Lili; Luo, Shuqian

    2010-11-01

    Microaneurysms (MAs) are the first manifestations of the diabetic retinopathy (DR) as well as an indicator for its progression. Their automatic detection plays a key role for both mass screening and monitoring and is therefore in the core of any system for computer-assisted diagnosis of DR. The algorithm basically comprises the following stages: candidate detection aiming at extracting the patterns possibly corresponding to MAs based on mathematical morphological black top hat, feature extraction to characterize these candidates, and classification based on support vector machine (SVM), to validate MAs. Feature vector and kernel function of SVM selection is very important to the algorithm. We use the receiver operating characteristic (ROC) curve to evaluate the distinguishing performance of different feature vectors and different kernel functions of SVM. The ROC analysis indicates the quadratic polynomial SVM with a combination of features as the input shows the best discriminating performance.

  7. Receiver Operator Characteristic Tools Graphic User Interface Extension for R Commander

    Directory of Open Access Journals (Sweden)

    Daniel Corneliu LEUCUŢA

    2015-12-01

    Full Text Available Background: Receiver Operator Characteristic (ROC curve, is a graphical plot which presents the performance of a binary classifier when the discrimination cutoff is varied. The aim of this work was to create an extension for R Commander that offers a graphical user interface for Receiver Operator Characteristic tools provided by several existing command line accessible packages like pROC and ROCR. Material and Methods: The extension was built and tested with R version 3.2.0 and R Commander 2.1-7. Results: We built an extension called RcmdrPlugin.ROC that we uploaded on the CRAN servers. The extension adds a new menu called ROC, along with two submenus pROC and ROCR that broadly corresponds to commands available to access the functions of these packages. The pROC menu offers several commands: to plot a ROC curve for a dataset or for a logistic regression model, to compare paired and unpaired ROC curves, each providing the following tabs: General (to select the variables for the analysis, and options for switching cases with controls; Smoothing (allowing the user to select different types of smoothing – binominal, density, distributions like normal, lognormal, ...; AUC (to specify the partial area under the curve (AUC options, CI (to select the options of confidence intervals (CI – the level, computing method: DeLong, bootstrap, ...; Plot (for the plotting options. The ROCR dialogue window offers more options in choosing the performance measures for the plot. Conclusion: The RcmdrPlugin.ROC extension helps less advanced users of R accessing ROC tools in a friendly graphical user interface.

  8. Impact of signal scattering and parametric uncertainties on receiver operating characteristics

    Science.gov (United States)

    Wilson, D. Keith; Breton, Daniel J.; Hart, Carl R.; Pettit, Chris L.

    2017-05-01

    The receiver operating characteristic (ROC curve), which is a plot of the probability of detection as a function of the probability of false alarm, plays a key role in the classical analysis of detector performance. However, meaningful characterization of the ROC curve is challenging when practically important complications such as variations in source emissions, environmental impacts on the signal propagation, uncertainties in the sensor response, and multiple sources of interference are considered. In this paper, a relatively simple but realistic model for scattered signals is employed to explore how parametric uncertainties impact the ROC curve. In particular, we show that parametric uncertainties in the mean signal and noise power substantially raise the tails of the distributions; since receiver operation with a very low probability of false alarm and a high probability of detection is normally desired, these tails lead to severely degraded performance. Because full a priori knowledge of such parametric uncertainties is rarely available in practice, analyses must typically be based on a finite sample of environmental states, which only partially characterize the range of parameter variations. We show how this effect can lead to misleading assessments of system performance. For the cases considered, approximately 64 or more statistically independent samples of the uncertain parameters are needed to accurately predict the probabilities of detection and false alarm. A connection is also described between selection of suitable distributions for the uncertain parameters, and Bayesian adaptive methods for inferring the parameters.

  9. Characteristics of Hospitals Associated with Complete and Partial Implementation of Electronic Health Records.

    Science.gov (United States)

    Bhounsule, Prajakta; Peterson, Andrew M

    2016-01-01

    (1) To determine the proportion of hospitals with and without implementation of electronic health records (EHRs). (2) To examine characteristics of hospitals that report implementation of EHRs partially or completely versus those that report no implementation. (3) To identify hospital characteristics associated with nonimplementation to help devise future policy initiatives. This was a retrospective cross-sectional study using the 2012 American Hospital Association Annual Survey Database. The outcome variable was the implementation of EHRs completely or partially. Independent variables were hospital characteristics, such as staffing, organization structure, accreditations, ownership, and services and facilities provided at the hospitals. Descriptive frequencies were determined, and multinomial logistic regression was used to determine variables independently associated with complete or partial implementation of EHRs. In this study, 12.6 percent of hospitals reported no implementation of EHRs, while 43.9 percent of hospitals implemented EHRs partially and 43.5 percent implemented EHRs completely. Overall characteristics of hospitals with complete and partial implementation were similar. The multinomial regression model revealed a positive association between the number of licensed beds and complete implementation of EHRs. A positive association was found between children's general medical, surgical, and heart hospitals and complete implementation of EHRs. Conversely, psychiatric and rehabilitation hospitals, limited service hospitals, hospitals participating in a network, service hospitals, government nonfederal hospitals, and nongovernment not-for-profit hospitals showed less likelihood of complete implementation of EHRs. Study findings suggest a disparity of EHR implementation between larger, for-profit hospitals and smaller, not-for-profit hospitals. Low rates of implementation were observed with psychiatric and rehabilitation hospitals. EHR policy initiatives

  10. Coping strategies and socio-demographic characteristics among Jordanian caregivers of patients receiving hemodialysis

    Directory of Open Access Journals (Sweden)

    Eman Alnazly

    2016-01-01

    Full Text Available Individuals who care for family members receiving chronic hemodialysis (HD are likely to experience burdens that may adversely impact their patients. Effective coping strategies are shaped by various factors, including sociodemographic characteristics. To assess the relationship between caregivers and their patients, we studied 225 family-member caregivers of chronic HD patients through answering the Ways of Coping Questionnaire-Revised. Sociodemographic data, including caregiver age, gender, educational level, relationship to the patients, length of care time and weekly hours of caregiving were analyzed using the t-test, analysis of variance and least-significant difference post hoc test. Of the eight coping strategies investigated, seven were significantly related to at least one of the analyzed sociodemographic variables; these were confrontive coping, distancing, self-controlling, seeking social support, accepting responsibility, planful problem solving and positive reappraisal. The findings of the present study may be useful for administering dialysis by nurses for identifying coping strategies among caregivers and for establishing plans of care that would promote coping strategies in relation to the caregiver′s sociodemographic characteristics.

  11. Association of Kidney Disease Quality of Life (KDQOL-36) with mortality and hospitalization in older adults receiving hemodialysis.

    Science.gov (United States)

    Hall, Rasheeda K; Luciano, Alison; Pieper, Carl; Colón-Emeric, Cathleen S

    2018-01-15

    For older adults receiving dialysis, health-related quality of life is not often considered in prognostication of death or future hospitalizations. To determine if routine health-related quality of life measures may be useful for prognostication, the objective of this study is to determine the extent of association of Kidney Disease Quality of Life (KDQOL-36) subscales with adverse outcomes in older adults receiving dialysis. This is a longitudinal study of 3500 adults aged ≥75 years receiving dialysis in the United States in 2012 and 2013. We used Cox and Fine and Gray models to evaluate the association of KDQOL-36 subscales with risk of death and hospitalization. We adjusted for sociodemographic variables, hemodialysis access type, laboratory values, and Charlson index. Three thousand one hundred thirty-two hemodialysis patients completed the KDQOL-36. From KDQOL-36 completion date in 2012, 880 (28.1%) died and 2023 (64.6%) had at least one hospitalization over a median follow-up of 512 and 203 days, respectively. Cohort members with a SF-12 physical component summary (PCS) in the lowest quintile had an increased adjusted risk of death [hazard ratio (HR), 1.55, 95% confidence interval (CI) 1.19-2.03] and hospitalization (HR, 1.29, 95% CI 1.09-1.54) compared with those with scores in the highest quintile. Cohort members with a SF-12 mental component summary in the lowest quintile had an increased risk of hospitalization (HR, 1.39, 95% CI 1.17-1.65) compared with those in the highest quintile. In adjusted analyses, there was no association between the symptoms of kidney disease, effects of kidney disease, and burden of kidney disease subscales with time to death or first hospitalization. Competing risk models showed similar HRs. Among the KDQOL-36 subscales, the SF-12 PCS demonstrates the strongest association with both death and future hospitalizations in older adults receiving hemodialysis Further research is needed to assess the value this subscale may add

  12. Anxiety and depression related to the hospitalization experience of patients receiving radioiodine ablation

    International Nuclear Information System (INIS)

    Koc, Z.; Karaboc, A.; Balci, T.; Kepenek, F.; Atmaca, M.

    2015-01-01

    Full text of publication follows. Objective: the hospital rooms for radioiodine ablation of differentiated thyroid carcinoma are designed according to radiation safety lows where patients have to remain isolated. The aim of the present study is to investigate depression and anxiety levels of the patients associated with hospitalization experience for radioiodine ablation. Methods: 30 patients (8 M, 22 F; mean: 45±13 years old) with differentiated thyroid carcinoma were included into study. After withdrawal of thyroid hormone replacement at least for 3 weeks, the patients were subject of the ablation treatment. After routine psychiatric examination Hamilton Anxiety and Depression scales were administered to the patients before and after complement of hospitalization for 1-3 days. Results: according to the statistical analysis there was not any significant difference between Hamilton depression and anxiety scores and state and trait anxiety scores of the patients before and after treatment (P>0.05). However, 18 patients had depression, with major depression of six, and 21 had high anxiety levels, according to Hamilton Depression and Anxiety Scales. Conclusion: Although the patients with differentiated thyroid carcinoma do not experience anxiety or depression related to the hospitalization itself for radioiodine ablation they might frequently have depression or anxiety just before the treatment. (authors)

  13. Hospitality and tourism management professor receives Fulbright to teach in India

    OpenAIRE

    Ho, Sookhan

    2009-01-01

    Mahmood A. Khan, professor of hospitality and tourism management at Virginia Tech's Pamplin College of Business, has been awarded a Fulbright-Nehru Scholar grant to teach at the Indian Institute of Technology in New Delhi during the 2009-10 academic year.

  14. 75 FR 20511 - Respecting the Rights of Hospital Patients to Receive Visitors and to Designate Surrogate...

    Science.gov (United States)

    2010-04-20

    ... Surrogate Decision Makers for Medical Emergencies Memorandum for the Secretary of Health and Human Services... privileges on the basis of race, color, national origin, religion, sex, sexual orientation, gender identity... of Health and Human Services can take to address hospital visitation, medical decisionmaking, or...

  15. Cost-Effectiveness Analysis of Probiotic Use to Prevent Clostridium difficile Infection in Hospitalized Adults Receiving Antibiotics.

    Science.gov (United States)

    Shen, Nicole T; Leff, Jared A; Schneider, Yecheskel; Crawford, Carl V; Maw, Anna; Bosworth, Brian; Simon, Matthew S

    2017-01-01

    Systematic reviews with meta-analyses and meta-regression suggest that timely probiotic use can prevent Clostridium difficile infection (CDI) in hospitalized adults receiving antibiotics, but the cost effectiveness is unknown. We sought to evaluate the cost effectiveness of probiotic use for prevention of CDI versus no probiotic use in the United States. We programmed a decision analytic model using published literature and national databases with a 1-year time horizon. The base case was modeled as a hypothetical cohort of hospitalized adults (mean age 68) receiving antibiotics with and without concurrent probiotic administration. Projected outcomes included quality-adjusted life-years (QALYs), costs (2013 US dollars), incremental cost-effectiveness ratios (ICERs; $/QALY), and cost per infection avoided. One-way, two-way, and probabilistic sensitivity analyses were conducted, and scenarios of different age cohorts were considered. The ICERs less than $100000 per QALY were considered cost effective. Probiotic use dominated (more effective and less costly) no probiotic use. Results were sensitive to probiotic efficacy (relative risk 1.6%), the risk of probiotic-associated bactermia/fungemia (cost (65). In probabilistic sensitivity analysis, at a willingness-to-pay threshold of $100000/QALY, probiotics were the optimal strategy in 69.4% of simulations. Our findings suggest that probiotic use may be a cost-effective strategy to prevent CDI in hospitalized adults receiving antibiotics age 65 or older or when the baseline risk of CDI exceeds 1.6%.

  16. Cost-Effectiveness Analysis of Probiotic Use to Prevent Clostridium difficile Infection in Hospitalized Adults Receiving Antibiotics

    Science.gov (United States)

    Leff, Jared A; Schneider, Yecheskel; Crawford, Carl V; Maw, Anna; Bosworth, Brian; Simon, Matthew S

    2017-01-01

    Abstract Background Systematic reviews with meta-analyses and meta-regression suggest that timely probiotic use can prevent Clostridium difficile infection (CDI) in hospitalized adults receiving antibiotics, but the cost effectiveness is unknown. We sought to evaluate the cost effectiveness of probiotic use for prevention of CDI versus no probiotic use in the United States. Methods We programmed a decision analytic model using published literature and national databases with a 1-year time horizon. The base case was modeled as a hypothetical cohort of hospitalized adults (mean age 68) receiving antibiotics with and without concurrent probiotic administration. Projected outcomes included quality-adjusted life-years (QALYs), costs (2013 US dollars), incremental cost-effectiveness ratios (ICERs; $/QALY), and cost per infection avoided. One-way, two-way, and probabilistic sensitivity analyses were conducted, and scenarios of different age cohorts were considered. The ICERs less than $100000 per QALY were considered cost effective. Results Probiotic use dominated (more effective and less costly) no probiotic use. Results were sensitive to probiotic efficacy (relative risk CDI (>1.6%), the risk of probiotic-associated bactermia/fungemia (cost (65). In probabilistic sensitivity analysis, at a willingness-to-pay threshold of $100000/QALY, probiotics were the optimal strategy in 69.4% of simulations. Conclusions Our findings suggest that probiotic use may be a cost-effective strategy to prevent CDI in hospitalized adults receiving antibiotics age 65 or older or when the baseline risk of CDI exceeds 1.6%. PMID:29230429

  17. Relationship between Grooming Performance and Motor and Cognitive Functions in Stroke Patients with Receiver Operating Characteristic Analysis.

    Science.gov (United States)

    Fujita, Takaaki; Sato, Atsushi; Tsuchiya, Kenji; Ohashi, Takuro; Yamane, Kazuhiro; Yamamoto, Yuichi; Iokawa, Kazuaki; Ohira, Yoko; Otsuki, Koji; Tozato, Fusae

    2017-12-01

    This study aimed to elucidate the relationship between grooming performance of stroke patients and various motor and cognitive functions and to examine the cognitive and physical functional standards required for grooming independence. We retrospectively analyzed the data of 96 hospitalized patients with first stroke in a rehabilitation hospital ward. Logistic regression analysis and receiver operating characteristic curves were used to investigate the related cognitive and motor functions with grooming performance and to calculate the cutoff values for independence and supervision levels in grooming. For analysis between the independent and supervision-dependent groups, the only item with an area under the curve (AUC) of .9 or higher was the Berg Balance Scale, and the calculated cutoff value was 41/40 (sensitivity, 83.6%; specificity, 87.8%). For analysis between the independent-supervision and dependent groups, the items with an AUC of .9 or higher were the Simple Test for Evaluating Hand Function (STEF) on the nonaffected side, Vitality Index (VI), and FIM ® cognition. The cutoff values were 68/67 for the STEF (sensitivity, 100%; specificity, 72.2%), 9/8 points for the VI (sensitivity, 92.3%; specificity, 88.9%), and 23/22 points for FIM ® cognition (sensitivity, 91.0%; specificity, 88.9%). Our results suggest that upper-extremity functions on the nonaffected side, motivation, and cognitive functions are particularly important to achieve the supervision level and that balance is important to reach the independence level. The effective improvement of grooming performance is possible by performing therapeutic or compensatory intervention on functions that have not achieved these cutoff values. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  18. Emergency patients receiving anaesthesiologist-based pre-hospital treatment and subsequently released at the scene

    DEFF Research Database (Denmark)

    Højfeldt, S G; Sørensen, L P; Mikkelsen, Søren

    2014-01-01

    BACKGROUND: The Mobile Emergency Care Unit in Odense, Denmark consists of a rapid response car, manned with an anaesthesiologist and an emergency medical technician. Eleven per cent of the patients are released at the scene following treatment. The aim of the study was to investigate which...... investigated. In each patient, diagnosis as well as any renewed contact with the Mobile Emergency Care Unit or the hospital within 24 h was registered. RESULTS: ONE THOUSAND SIX HUNDRED NINE: patients were released at the scene. Diagnoses within the category 'examination and investigation' [International...... with the Mobile Emergency Care Unit within 24 h. Of the 143 victims of traffic accidents, 19 (13%) required renewed contact with the emergency department and one required admission to hospital (0.7%). Of all 1609 patients, four died within 24 h of contact (0.2%). CONCLUSION: Patients treated and released...

  19. Numerical research of dynamic characteristics in tower solar cavity receiver based on step-change radiation flux

    Science.gov (United States)

    Chen, Zhengwei; Wang, Yueshe; Hao, Yun; Wang, Qizhi

    2013-07-01

    The solar cavity receiver is an important light-energy to thermal-energy convector in the tower solar thermal power plant system. The heat flux in the inner surface of the cavity will show the characteristics of non-continuous step change especially in non-normal and transient weather conditions, which may result in a continuous dynamic variation of the characteristic parameters. Therefore, the research of dynamic characteristics of the receiver plays a very important role in the operation and the control safely in solar cavity receiver system. In this paper, based on the non-continuous step change of radiation flux, a non-linear dynamic model is put forward to obtain the effects of the non-continuous step change radiation flux and step change feed water flow on the receiver performance by sequential modular approach. The subject investigated in our study is a 1MW solar power station constructed in Yanqing County, Beijing. This study has obtained the dynamic responses of the characteristic parameters in the cavity receiver, such as drum pressure, drum water level, main steam flow and main steam enthalpy under step change radiation flux. And the influence law of step-change feed water flow to the dynamic characteristics in the receiver also has been analyzed. The results have a reference value for the safe operation and the control in solar cavity receiver system.

  20. Population characteristics of markets of safety-net and non-safety-net hospitals.

    Science.gov (United States)

    Gaskin, D J; Hadley, J

    1999-09-01

    To compare and contrast the markets of urban safety-net (USN) hospitals with the markets of other urban hospitals. To develop profiles of the actual inpatient markets of hospitals, we linked 1994 patient-level information from hospital discharge abstracts from nine states with 1990 data at the ZIP code level from the US Census Bureau. Each hospital's market was characterized by its racial and ethnic composition, median household income, poverty rate, and educational attainment. Measures of hospital competition were also calculated for each hospital. The analysis compared the market profiles of USN hospitals to those of other urban hospitals. We also compared the level of hospital competition and financial status of USN and other urban hospitals. The markets of USN hospitals had higher proportions of racial and ethnic minorities and non-English-speaking residents. Adults residing in markets of USN hospitals were less educated. Families living in markets of USN hospitals had lower incomes and were more likely to be living at or below the federal poverty level. USN hospitals and other urban hospitals faced similar levels of competition and had similar margins. However, USN hospitals were more dependent on Medicare disproportionate share payments and on state and local government subsidies to remain solvent. USN hospitals disproportionately serve vulnerable minority and low-income communities that otherwise face financial and cultural barriers to health care. USN hospitals are dependent on the public subsidies they receive from federal, state, and local governments. Public policies and market pressures that affect the viability of USN hospitals place the access to care by vulnerable populations at risk. Public policy that jeopardizes public subsidies places in peril the financial health of these institutions. As Medicare and Medicaid managed care grow, USN hospitals may lose these patient revenues and public subsidies based on their Medicaid and Medicare patient

  1. Pressure ulcers in four Indonesian hospitals: prevalence, patient characteristics, ulcer characteristics, prevention and treatment.

    Science.gov (United States)

    Amir, Yufitriana; Lohrmann, Christa; Halfens, Ruud Jg; Schols, Jos Mga

    2017-02-01

    The objective of this article was to study characteristics of pressure ulcer patients and their ulcers, pressure ulcer preventive and treatment measures in four Indonesian general hospitals. A multicentre cross-sectional design was applied to assess pressure ulcers and pressure ulcer care in adult patients in medical, surgical, specialised and intensive care units. Ninety-one of the 1132 patients had a total of 142 ulcers. Half (44·0%) already had pressure ulcers before admission. The overall prevalence of category I-IV pressure ulcers was 8·0% (95% CI 6·4-9·6), and the overall nosocomial pressure ulcer prevalence was 4·5% (95% CI 3·3-5·7). Most pressure ulcer patients had friction and shear problems, were bedfast, had diabetes and had more bedridden days. Most ulcers (42·3%) were category III and IV. One third of the patients had both pressure ulcers and moisture lesions (36·3%) and suffered from pain (45·1%). The most frequently used prevention measures were repositioning (61·5%), skin moisturising (47·3%), patient education (36·3%) and massage (35·2%). Most pressure ulcer dressings involved saline-impregnated or antimicrobial gauzes. This study shows the complexities of pressure ulcers in Indonesian general hospitals and reveals that the quality of pressure ulcer care (prevention and treatment) could be improved by implementing the recent evidence-based international guideline. © 2016 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  2. Receiver operating characteristic curve evaluation on computed radiography: an experimental study

    International Nuclear Information System (INIS)

    Yu Zixi; Wang Changyuan; Xu Yue; Xie Jindong; Zhang Menglong; Wang Jian

    2003-01-01

    Objective: To get the maximum information from computed radiography (CR) output images by changing post-processing parameters. Methods: Six experimental photos of polypropylene balls of 2.0 mm in diameter were taken by means of one time X-ray exposing on an imaging plate (IP) with different post-processing parameters including rotation amount (GA), gray gradation type (GT), rotation center (GC), shifting amount (GS), frequency rank (RN), frequency type (RT), and degree of enhancement (RE). 6 photos were viewed by three students and one radiologist on a 6000 lx illuminance viewbox. Receiver operating characteristic (ROC) curves were made by means of 5-value-differentiation method. Results: The largest mean area value (Az) below ROC curves of a low contrast experimental photo with post-processing parameters GA=1.0, GT=A, GC=1.6, GS=0.3, RN=4.0, RT=R and RE=3.0 was 0.96, and the maximum information was obtained. The smallest mean area value (Az) was 0.78 with changed post-processing parameters GA=0.8, GS=-0.2 and RE=0.5 while other parameters were not changed. The minimum information was obtained from this photo. Conclusion: In order to get the maximum information from a CR output image, the post-processing parameters should be suitably selected

  3. Measuring diagnostic and predictive accuracy in disease management: an introduction to receiver operating characteristic (ROC) analysis.

    Science.gov (United States)

    Linden, Ariel

    2006-04-01

    Diagnostic or predictive accuracy concerns are common in all phases of a disease management (DM) programme, and ultimately play an influential role in the assessment of programme effectiveness. Areas, such as the identification of diseased patients, predictive modelling of future health status and costs and risk stratification, are just a few of the domains in which assessment of accuracy is beneficial, if not critical. The most commonly used analytical model for this purpose is the standard 2 x 2 table method in which sensitivity and specificity are calculated. However, there are several limitations to this approach, including the reliance on a single defined criterion or cut-off for determining a true-positive result, use of non-standardized measurement instruments and sensitivity to outcome prevalence. This paper introduces the receiver operator characteristic (ROC) analysis as a more appropriate and useful technique for assessing diagnostic and predictive accuracy in DM. Its advantages include; testing accuracy across the entire range of scores and thereby not requiring a predetermined cut-off point, easily examined visual and statistical comparisons across tests or scores, and independence from outcome prevalence. Therefore the implementation of ROC as an evaluation tool should be strongly considered in the various phases of a DM programme.

  4. Design of a receiver operating characteristic (ROC) study of 10:1 lossy image compression

    Science.gov (United States)

    Collins, Cary A.; Lane, David; Frank, Mark S.; Hardy, Michael E.; Haynor, David R.; Smith, Donald V.; Parker, James E.; Bender, Gregory N.; Kim, Yongmin

    1994-04-01

    The digital archiving system at Madigan Army Medical Center (MAMC) uses a 10:1 lossy data compression algorithm for most forms of computed radiography. A systematic study on the potential effect of lossy image compression on patient care has been initiated with a series of studies focused on specific diagnostic tasks. The studies are based upon the receiver operating characteristic (ROC) method of analysis for diagnostic systems. The null hypothesis is that observer performance with approximately 10:1 compressed and decompressed images is not different from using original, uncompressed images for detecting subtle pathologic findings seen on computed radiographs of bone, chest, or abdomen, when viewed on a high-resolution monitor. Our design involves collecting cases from eight pathologic categories. Truth is determined by committee using confirmatory studies performed during routine clinical practice whenever possible. Software has been developed to aid in case collection and to allow reading of the cases for the study using stand-alone Siemens Litebox workstations. Data analysis uses two methods, ROC analysis and free-response ROC (FROC) methods. This study will be one of the largest ROC/FROC studies of its kind and could benefit clinical radiology practice using PACS technology. The study design and results from a pilot FROC study are presented.

  5. ROCView: prototype software for data collection in jackknife alternative free-response receiver operating characteristic analysis

    Science.gov (United States)

    Thompson, J; Hogg, P; Thompson, S; Manning, D; Szczepura, K

    2012-01-01

    ROCView has been developed as an image display and response capture (IDRC) solution to image display and consistent recording of reader responses in relation to the free-response receiver operating characteristic paradigm. A web-based solution to IDRC for observer response studies allows observations to be completed from any location, assuming that display performance and viewing conditions are consistent with the study being completed. The simplistic functionality of the software allows observations to be completed without supervision. ROCView can display images from multiple modalities, in a randomised order if required. Following registration, observers are prompted to begin their image evaluation. All data are recorded via mouse clicks, one to localise (mark) and one to score confidence (rate) using either an ordinal or continuous rating scale. Up to nine “mark-rating” pairs can be made per image. Unmarked images are given a default score of zero. Upon completion of the study, both true-positive and false-positive reports can be downloaded and adapted for analysis. ROCView has the potential to be a useful tool in the assessment of modality performance difference for a range of imaging methods. PMID:22573294

  6. Receiver operating characteristic analysis of age-related changes in lineup performance.

    Science.gov (United States)

    Humphries, Joyce E; Flowe, Heather D

    2015-04-01

    In the basic face memory literature, support has been found for the late maturation hypothesis, which holds that face recognition ability is not fully developed until at least adolescence. Support for the late maturation hypothesis in the criminal lineup identification literature, however, has been equivocal because of the analytic approach that has been used to examine age-related changes in identification performance. Recently, receiver operator characteristic (ROC) analysis was applied for the first time in the adult eyewitness memory literature to examine whether memory sensitivity differs across different types of lineup tests. ROC analysis allows for the separation of memory sensitivity from response bias in the analysis of recognition data. Here, we have made the first ROC-based comparison of adults' and children's (5- and 6-year-olds and 9- and 10-year-olds) memory performance on lineups by reanalyzing data from Humphries, Holliday, and Flowe (2012). In line with the late maturation hypothesis, memory sensitivity was significantly greater for adults compared with young children. Memory sensitivity for older children was similar to that for adults. The results indicate that the late maturation hypothesis can be generalized to account for age-related performance differences on an eyewitness memory task. The implications for developmental eyewitness memory research are discussed. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Receiver operating characteristic analysis of eyewitness memory: comparing the diagnostic accuracy of simultaneous versus sequential lineups.

    Science.gov (United States)

    Mickes, Laura; Flowe, Heather D; Wixted, John T

    2012-12-01

    A police lineup presents a real-world signal-detection problem because there are two possible states of the world (the suspect is either innocent or guilty), some degree of information about the true state of the world is available (the eyewitness has some degree of memory for the perpetrator), and a decision is made (identifying the suspect or not). A similar state of affairs applies to diagnostic tests in medicine because, in a patient, the disease is either present or absent, a diagnostic test yields some degree of information about the true state of affairs, and a decision is made about the presence or absence of the disease. In medicine, receiver operating characteristic (ROC) analysis is the standard method for assessing diagnostic accuracy. By contrast, in the eyewitness memory literature, this powerful technique has never been used. Instead, researchers have attempted to assess the diagnostic performance of different lineup procedures using methods that cannot identify the better procedure (e.g., by computing a diagnosticity ratio). Here, we describe the basics of ROC analysis, explaining why it is needed and showing how to use it to measure the performance of different lineup procedures. To illustrate the unique advantages of this technique, we also report 3 ROC experiments that were designed to investigate the diagnostic accuracy of simultaneous versus sequential lineups. According to our findings, the sequential procedure appears to be inferior to the simultaneous procedure in discriminating between the presence versus absence of a guilty suspect in a lineup.

  8. Recollection is a continuous process: Evidence from plurality memory receiver operating characteristics.

    Science.gov (United States)

    Slotnick, Scott D; Jeye, Brittany M; Dodson, Chad S

    2016-01-01

    Is recollection a continuous/graded process or a threshold/all-or-none process? Receiver operating characteristic (ROC) analysis can answer this question as the continuous model and the threshold model predict curved and linear recollection ROCs, respectively. As memory for plurality, an item's previous singular or plural form, is assumed to rely on recollection, the nature of recollection can be investigated by evaluating plurality memory ROCs. The present study consisted of four experiments. During encoding, words (singular or plural) or objects (single/singular or duplicate/plural) were presented. During retrieval, old items with the same plurality or different plurality were presented. For each item, participants made a confidence rating ranging from "very sure old", which was correct for same plurality items, to "very sure new", which was correct for different plurality items. Each plurality memory ROC was the proportion of same versus different plurality items classified as "old" (i.e., hits versus false alarms). Chi-squared analysis revealed that all of the plurality memory ROCs were adequately fit by the continuous unequal variance model, whereas none of the ROCs were adequately fit by the two-high threshold model. These plurality memory ROC results indicate recollection is a continuous process, which complements previous source memory and associative memory ROC findings.

  9. An extension of the receiver operating characteristic curve and AUC-optimal classification.

    Science.gov (United States)

    Takenouchi, Takashi; Komori, Osamu; Eguchi, Shinto

    2012-10-01

    While most proposed methods for solving classification problems focus on minimization of the classification error rate, we are interested in the receiver operating characteristic (ROC) curve, which provides more information about classification performance than the error rate does. The area under the ROC curve (AUC) is a natural measure for overall assessment of a classifier based on the ROC curve. We discuss a class of concave functions for AUC maximization in which a boosting-type algorithm including RankBoost is considered, and the Bayesian risk consistency and the lower bound of the optimum function are discussed. A procedure derived by maximizing a specific optimum function has high robustness, based on gross error sensitivity. Additionally, we focus on the partial AUC, which is the partial area under the ROC curve. For example, in medical screening, a high true-positive rate to the fixed lower false-positive rate is preferable and thus the partial AUC corresponding to lower false-positive rates is much more important than the remaining AUC. We extend the class of concave optimum functions for partial AUC optimality with the boosting algorithm. We investigated the validity of the proposed method through several experiments with data sets in the UCI repository.

  10. Identifying indicators of harmful and problem gambling in a Canadian sample through receiver operating characteristic analysis.

    Science.gov (United States)

    Quilty, Lena C; Avila Murati, Daniela; Bagby, R Michael

    2014-03-01

    Many gamblers would prefer to reduce gambling on their own rather than to adopt an abstinence approach within the context of a gambling treatment program. Yet responsible gambling guidelines lack quantifiable markers to guide gamblers in wagering safely. To address these issues, the current investigation implemented receiver operating characteristic (ROC) analysis to identify behavioral indicators of harmful and problem gambling. Gambling involvement was assessed in 503 participants (275 psychiatric outpatients and 228 community gamblers) with the Canadian Problem Gambling Index. Overall gambling frequency, duration, and expenditure were able to distinguish harmful and problematic gambling at a moderate level. Indicators of harmful gambling were generated for engagement in specific gambling activities: frequency of tickets and casino; duration of bingo, casino, and investments; and expenditures on bingo, casino, sports betting, games of skill, and investments. Indicators of problem gambling were similarly produced for frequency of tickets and casino, and expenditures on bingo, casino, games of skill, and investments. Logistic regression analyses revealed that overall gambling frequency uniquely predicted the presence of harmful and problem gambling. Furthermore, frequency indicators for tickets and casino uniquely predicted the presence of both harmful and problem gambling. Together, these findings contribute to the development of an empirically based method enabling the minimization of harmful or problem gambling through self-control rather than abstinence.

  11. Screening for depressive disorders using the MASQ anhedonic depression scale: A receiver-operator characteristic analysis

    Science.gov (United States)

    Bredemeier, Keith; Spielberg, Jeffrey M.; Silton, Rebecca Levin; Berenbaum, Howard; Heller, Wendy; Miller, Gregory A.

    2010-01-01

    The present study examined the utility of the anhedonic depression scale from the Mood and Anxiety Symptoms Questionnaire (MASQ-AD) as a way to screen for depressive disorders. Using receiver-operator characteristic analysis, the sensitivity and specificity of the full 22-item MASQ-AD scale, as well as the 8 and 14-item subscales, were examined in relation to both current and lifetime DSM-IV depressive disorder diagnoses in two nonpatient samples. As a means of comparison, the sensitivity and specificity of a measure of a relevant personality dimension, neuroticism, was also examined. Results from both samples support the clinical utility of the MASQ-AD scale as a means of screening for depressive disorders. Findings were strongest for the MASQ-AD 8-item subscale and when predicting current depression status. Furthermore, the MASQ-AD 8-item subscale outperformed the neuroticism measure under certain conditions. The overall usefulness of the MASQ-AD scale as a screening device is discussed, as well as possible cutoff scores for use in research. PMID:20822283

  12. Receiver Operating Characteristic (ROC to Determine Cut-Off Points of Biomarkers in Lung Cancer Patients

    Directory of Open Access Journals (Sweden)

    Heidi L. Weiss

    2004-01-01

    Full Text Available The role of biomarkers in disease prognosis continues to be an important investigation in many cancer studies. In order for these biomarkers to have practical application in clinical decision making regarding patient treatment and follow-up, it is common to dichotomize patients into those with low vs. high expression levels. In this study, receiver operating characteristic (ROC curves, area under the curve (AUC of the ROC, sensitivity, specificity, as well as likelihood ratios were calculated to determine levels of growth factor biomarkers that best differentiate lung cancer cases versus control subjects. Selected cut-off points for p185erbB-2 and EGFR membrane appear to have good discriminating power to differentiate control tissues versus uninvolved tissues from patients with lung cancer (AUC = 89% and 90%, respectively; while AUC increased to at least 90% for selected cut-off points for p185erbB-2 membrane, EGFR membrane, and FASE when comparing between control versus carcinoma tissues from lung cancer cases. Using data from control subjects compared to patients with lung cancer, we presented a simple and intuitive approach to determine dichotomized levels of biomarkers and validated the value of these biomarkers as surrogate endpoints for cancer outcome.

  13. Receiver operating characteristic analysis of regional cerebral blood flow in Alzheimer's disease

    International Nuclear Information System (INIS)

    Zemcov, A.; Barclay, L.L.; Sansone, J.; Metz, C.E.

    1985-01-01

    Receiver operating characteristic (ROC) curves were used to quantitatively assess the ability of individual detectors in a 32-detector 133 Xe inhalation system to discriminate between two populations over the range of regional cerebral blood flow (rCBF) values. These populations were clinically evaluated as normal (age 63.1 +/- 13.1, n = 23) and presumed Alzheimer's disease (age 72.7 +/- 7.0, n = 82). Summary statistics showed that for homologous detectors the average value of blood flow in the normal group was greater than the flow value in the group of subjects with Alzheimer's disease. Conclusions drawn from single values of flow or mean hemispheric flow can lead to erroneous conclusions about hemisphere asymmetries. However, the dynamic relationship between the correct identifications (true positives) compared with incorrect identifications (false positives) of Alzheimer's disease at each detector varies over the range of blood flow values, and quantitative characterization of this relationship in terms of an ROC curve provides more insight into the structure of the data. Detectors approximating the speech, auditory and association cortex were most effective in discriminating between groups. Frontal detectors were marginally useful diagnostically

  14. [Prevalence and characteristics of anemia and iron deficiency in patients hospitalized for gastrointestinal diseases in Spain].

    Science.gov (United States)

    Mearin, Fermín; Barreiro-de Acosta, Manuel; González-Galilea, Ángel; Gisbert, Javier P; Cucala, Mercedes; Ponce, Julio

    2013-10-01

    To determine the prevalence and characteristics of anemia and iron deficiency in patients hospitalized for gastrointestinal diseases. An epidemiological, multicenter, mixed design study (retrospective review of randomized clinical records and prospective visits) conducted between February 2010 and March 2011 in 22 Spanish gastroenterology departments. Severe anemia was defined as Hb iron deficiency as ferritin anemia at admission was 60% (95% CI 55 to 65), and anemia was severe (Hb iron deficiency was 54% of evaluable patients (95% CI 47 to 61). Gastrointestinal bleeding at admission was found in 39% of the patients, of whom 83% (121/146) were anemic. At discharge, the proportion of anemic patients was unchanged (from 60% at admission to 58% at discharge) (95% CI 53 to 63) and iron deficiency was found in 41% (95% CI 32 to 50): anemia was severe in 17% and mild/moderate in 41%. During follow-up, at 3-6 months after admission, 44% (95% CI 39 to 50) of evaluable patients continued to have iron deficiency and 28% (95% CI 23 to 32) were still anemic: 5% severe and 23% mild/moderate. The prevalence of iron deficiency was 44% (95% CI: 39-50). During admission, 50% of patients with anemia did not receive treatment. At discharge, 55% were untreated. The prevalence of anemia in patients hospitalized for gastroenterological diseases was very high. Anemia persisted in over a quarter of patients at the follow-up visit. Only half of hospitalized patients received treatment for anemia, even when the anemia was severe. Copyright © 2013 Elsevier España, S.L. y AEEH y AEG. All rights reserved.

  15. The information needs of patients receiving procedural sedation in a hospital emergency department.

    Science.gov (United States)

    Revell, Sue; Searle, Judy; Thompson, Shona

    2017-07-01

    This research investigated the information needs of patients receiving ED procedural sedation to determine the best format to consistently deliver key information in a way acceptable to all involved. Of particular interest was the question concerning patients' need for receiving written information. A descriptive exploratory study gathered qualitative data through face-to-face interviews and focus groups involving patients, nurses and medical staff. Individual interviews were conducted with eight adult patients following procedural sedation. They identified very few gaps in terms of specific information they needed pertaining to procedural sedation and rejected the need for receiving information in a written format. Their information needs related to a central concern for safety and trust. Focus groups, reflecting on the findings from patients, were conducted with five ED nurses and four emergency medicine consultants/registrars who regularly provided procedural sedation. Themes that emerged from the analysis of data from all three groups identified the issues concerning patient information needs as being: competence and efficiency of staff; explanations of procedures and progress; support person presence; and medico-legal issues. The research confirms that the quality of the patient's ED experience, specifically related to procedural sedation, is enhanced by ED staff, especially nurses, providing them with ongoing and repeated verbal information relevant to their circumstances. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. A Numerical Study on the Heat Transfer Characteristics of a Solar Thermal Receiver with High-temperature Heat Pipes

    International Nuclear Information System (INIS)

    Park, Young Hark; Jung, Eui Guk; Boo, Joon Hong

    2007-01-01

    A numerical analysis was conducted to predict the heat transfer characteristics of a solar receiver which is subject to very high heat fluxes and temperatures for solar thermal applications. The concentration ratio of the solar receiver ranges from 200 to 1000 and the concentrated heat is required to be transported to a certain distance for specific applications. The study deals with a solar receiver incorporating high-temperature sodium heat pipe as well as typical one that employs a molten-salt circulation loop. The isothermal characteristics in the receiver section is of major concern. The diameter of the solar thermal receiver was 120 mm and the length was 400 mm. For the molten-salt circulation type receiver, 48 axial channels of the same dimensions were attached to the outer wall of the receiver with even spacing in the circumferential direction. The molten salt fed through the channels by forced convection using a special pump. For the heat pipe receiver, the channels are changed to high-temperature sodium heat pipes. Commercial softwares were employed to deal with the radiative heat transfer inside the receiver cavity and the convection heat transfer along the channels. The numerical results are compared and analyzed from the view point of high-temperature solar receiver

  17. Association of emergency department and hospital characteristics with elopements and length of stay.

    Science.gov (United States)

    Handel, Daniel A; Fu, Rongwei; Vu, Eugene; Augustine, James J; Hsia, Renee Y; Shufflebarger, Charles M; Sun, Benjamin

    2014-06-01

    As the Centers for Medicare & Medicaid Services (CMS) core measures in 2013 compare Emergency Department (ED) treatment time intervals, it is important to identify ED and hospital characteristics associated with these metrics to facilitate accurate comparisons. The objective of this study is to assess differences in operational metrics by ED and hospital characteristics. ED-level characteristics included annual ED volume, percentage of patients admitted, percentage of patients presenting by ambulance, and percentage of pediatric patients. Hospital-level characteristics included teaching hospital status, trauma center status, hospital ownership (nonprofit or for-profit), inpatient bed capacity, critical access status, inpatient bed occupancy, and rural vs. urban location area. Data from the ED Benchmarking Alliance from 2004 to 2009 were merged with the American Hospital Association's Annual Survey Database to include hospital characteristics that may impact ED throughput. Overall median length of stay (LOS) and left before treatment is complete (LBTC) were the primary outcome variables, and a linear mixed model was used to assess the association between outcome variables and ED and hospital characteristics, while accounting for correlations among multiple observations within each hospital. All data were at the hospital level on a yearly basis. There were 445 EDs included in the analysis, from 2004 to 2009, with 850 observations over 6 years. Higher-volume EDs were associated with higher rates of LBTC and LOS. For-profit hospitals had lower LBTC and LOS. Higher inpatient bed occupancies were associated with a higher LOS. Increasing admission percentages were positively associated with overall LOS for EDs, but not with rates of LBTC. Higher-volume EDs are associated with higher LBTC and LOS, and for-profit hospitals appear more favorably in these metrics compared with their nonprofit counterparts. It is important to appreciate that hospitals have different baselines

  18. Contribution of case-mix classification to profiling hospital characteristics and productivity.

    Science.gov (United States)

    Kuwabara, Kazuaki; Matsuda, Shinya; Fushimi, Kiyohide; Ishikawa, Koichi B; Horiguchi, Hiromasa; Hayashida, Kenshi; Fujimori, Kenji

    2011-01-01

    Case-mix classification has made it possible to analyze acute care delivery case volumes and resources. Data arising from observed differences have a role in planning health policy. Aggregated length of hospital stay (LOS) and total charges (TC) as measures of resource use were calculated from 34 case-mix groups at 469 hospitals (1,721,274 eligible patients). The difference between mean resource use of all hospitals and the mean resource use of each hospital was subdivided into three components: amount of variation attributable to hospital practice behavior (efficiency); amount attributable to hospital case-mix (complexity); and amount attributable to the interaction. Hospital characteristics were teaching status (academic or community), ownership, disease coverage, patients, and hospital volume. Multivariate analysis was employed to determine the impact of hospital characteristics on efficiency. Mean LOS and TC were greater for academic than community hospitals. Academic hospitals were least associated with LOS and TC efficiency. Low disease coverage was a predictor of TC efficiency while low patient volume was a predictor of unnecessarily long hospital stays. There was an inverse correlation between complexity and efficiency for both LOS and TC. Policy makers should acknowledge that differentiation of hospital function needs careful consideration when measuring efficiency. Copyright © 2010 John Wiley & Sons, Ltd.

  19. Acute referral of patients from general practitioners: should the hospital doctor or a nurse receive the call?

    Directory of Open Access Journals (Sweden)

    Mortensen Anne Mette M

    2011-08-01

    Full Text Available Abstract Background Surprisingly little is known about the most efficient organization of admissions to an emergency hospital. It is important to know, who should be in front when the GP requests an acute admission. The aim of the study was to analyse how experienced ED nurses perform when assessing requests for admissions, compared with hospital physicians. Methods Before- and after ED nurse assessment study, in which two cohorts of patients were followed from the time of request for admission until one month later. The first cohort of patients was included by the physicians on duty in October 2008. The admitting physicians were employed in the one of the specialized departments and only received request for admission within their speciality. The second cohort of patients was included by the ED in May 2009. They received all request from the GPs for admission, independent of the speciality in question. Results A total of 944 requests for admission were recorded. There was a non-significant trend towards the nurses admitting a smaller fraction of patients than the physicians (68 versus 74%. While the nurses almost never rejected an admission, the physicians did this in 7% of the requests. The nurses redirected 8% of the patients to another hospital, significantly more than the physicians with only 1%. (p Conclusions We found no differences in the frequency of admitted patients or unnecessary admissions, but the nurses redirected significantly more patients to the right hospital according to the catchment area, and used only half the time for the assessment. We find, that nurses, trained for the assignment, are able to handle referrals for emergency admissions, but also advise the subject to be explored in further studies including other assessment models and GP satisfaction.

  20. Receiver operating characteristic analysis for the detection of simulated microcalcifications on mammograms using hardcopy images

    International Nuclear Information System (INIS)

    Lai, C J; Shaw, Chris C; Whitman, Gary J; Yang, Wei T; Dempsey, Peter J; Nguyen, Victoria; Ice, Mary F

    2006-01-01

    The aim of this study was to compare mammography systems based on three different detectors-a conventional screen-film (SF) combination, an a-Si/CsI flat-panel (FP)-based detector, and a charge-coupled device (CCD)-based x-ray phosphor-based detector-for their performance in detecting simulated microcalcifications (MCs). 112-150 μm calcium carbonate grains were used to simulate MCs and were overlapped with a slab phantom of simulated 50% adipose/50% glandular breast tissue-equivalent material referred to as the uniform background. For the tissue structure background, 200-250 μm calcium carbonate grains were used and overlapped with an anthropomorphic breast phantom. All MC phantom images were acquired with and without magnification (1.8X). The hardcopy images were reviewed by five mammographers. A five-point confidence level rating was used to score each detection task. Receiver operating characteristic (ROC) analysis was performed, and the areas under the ROC curves (A z s) were used to compare the performances of the three mammography systems under various conditions. The results showed that, with a uniform background and contact images, the FP-based system performed significantly better than the SF and the CCD-based systems. For magnified images with a uniform background, the SF and the FP-based systems performed equally well and significantly better than the CCD-based system. With tissue structure background and contact images, the SF system performed significantly better than the FP and the CCD-based systems. With magnified images and a tissue structure background, the SF and the CCD-based systems performed equally well and significantly better than the FP-based system. In the detection of MCs in the fibroglandular and the heterogeneously dense regions, no significant differences were found except that the SF system performed significantly better than the CCD-based system in the fibroglandular regions for the contact images

  1. The ROC Toolbox: A toolbox for analyzing receiver-operating characteristics derived from confidence ratings.

    Science.gov (United States)

    Koen, Joshua D; Barrett, Frederick S; Harlow, Iain M; Yonelinas, Andrew P

    2017-08-01

    Signal-detection theory, and the analysis of receiver-operating characteristics (ROCs), has played a critical role in the development of theories of episodic memory and perception. The purpose of the current paper is to present the ROC Toolbox. This toolbox is a set of functions written in the Matlab programming language that can be used to fit various common signal detection models to ROC data obtained from confidence rating experiments. The goals for developing the ROC Toolbox were to create a tool (1) that is easy to use and easy for researchers to implement with their own data, (2) that can flexibly define models based on varying study parameters, such as the number of response options (e.g., confidence ratings) and experimental conditions, and (3) that provides optimal routines (e.g., Maximum Likelihood estimation) to obtain parameter estimates and numerous goodness-of-fit measures.The ROC toolbox allows for various different confidence scales and currently includes the models commonly used in recognition memory and perception: (1) the unequal variance signal detection (UVSD) model, (2) the dual process signal detection (DPSD) model, and (3) the mixture signal detection (MSD) model. For each model fit to a given data set the ROC toolbox plots summary information about the best fitting model parameters and various goodness-of-fit measures. Here, we present an overview of the ROC Toolbox, illustrate how it can be used to input and analyse real data, and finish with a brief discussion on features that can be added to the toolbox.

  2. Bayesian receiver operating characteristic estimation of multiple tests for diagnosis of bovine tuberculosis in Chadian cattle.

    Directory of Open Access Journals (Sweden)

    Borna Müller

    Full Text Available BACKGROUND: Bovine tuberculosis (BTB today primarily affects developing countries. In Africa, the disease is present essentially on the whole continent; however, little accurate information on its distribution and prevalence is available. Also, attempts to evaluate diagnostic tests for BTB in naturally infected cattle are scarce and mostly complicated by the absence of knowledge of the true disease status of the tested animals. However, diagnostic test evaluation in a given setting is a prerequisite for the implementation of local surveillance schemes and control measures. METHODOLOGY/PRINCIPAL FINDINGS: We subjected a slaughterhouse population of 954 Chadian cattle to single intra-dermal comparative cervical tuberculin (SICCT testing and two recently developed fluorescence polarization assays (FPA. Using a Bayesian modeling approach we computed the receiver operating characteristic (ROC curve of each diagnostic test, the true disease prevalence in the sampled population and the disease status of all sampled animals in the absence of knowledge of the true disease status of the sampled animals. In our Chadian setting, SICCT performed better if the cut-off for positive test interpretation was lowered from >4 mm (OIE standard cut-off to >2 mm. Using this cut-off, SICCT showed a sensitivity and specificity of 66% and 89%, respectively. Both FPA tests showed sensitivities below 50% but specificities above 90%. The true disease prevalence was estimated at 8%. Altogether, 11% of the sampled animals showed gross visible tuberculous lesions. However, modeling of the BTB disease status of the sampled animals indicated that 72% of the suspected tuberculosis lesions detected during standard meat inspections were due to other pathogens than Mycobacterium bovis. CONCLUSIONS/SIGNIFICANCE: Our results have important implications for BTB diagnosis in a high incidence sub-Saharan African setting and demonstrate the practicability of our Bayesian approach for

  3. ROC-ing along: Evaluation and interpretation of receiver operating characteristic curves.

    Science.gov (United States)

    Carter, Jane V; Pan, Jianmin; Rai, Shesh N; Galandiuk, Susan

    2016-06-01

    It is vital for clinicians to understand and interpret correctly medical statistics as used in clinical studies. In this review, we address current issues and focus on delivering a simple, yet comprehensive, explanation of common research methodology involving receiver operating characteristic (ROC) curves. ROC curves are used most commonly in medicine as a means of evaluating diagnostic tests. Sample data from a plasma test for the diagnosis of colorectal cancer were used to generate a prediction model. These are actual, unpublished data that have been used to describe the calculation of sensitivity, specificity, positive predictive and negative predictive values, and accuracy. The ROC curves were generated to determine the accuracy of this plasma test. These curves are generated by plotting the sensitivity (true-positive rate) on the y axis and 1 - specificity (false-positive rate) on the x axis. Curves that approach closest to the coordinate (x = 0, y = 1) are more highly predictive, whereas ROC curves that lie close to the line of equality indicate that the result is no better than that obtained by chance. The optimum sensitivity and specificity can be determined from the graph as the point where the minimum distance line crosses the ROC curve. This point corresponds to the Youden index (J), a function of sensitivity and specificity used commonly to rate diagnostic tests. The area under the curve is used to quantify the overall ability of a test to discriminate between 2 outcomes. By following these simple guidelines, interpretation of ROC curves will be less difficult and they can then be interpreted more reliably when writing, reviewing, or analyzing scientific papers. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Radiations to received for patients in the Radiology Service of the Calderon Guardia Hospital

    International Nuclear Information System (INIS)

    Mora Rodriguez, P.

    1999-01-01

    Was collected a total of 1348 radiodiagnostic studies for the following analysis: thorax, cranium, abdomen, hip and pelvis, dorsal columns, lumbar columns and intravenous pielograms. The reading and analysis of dose of the crystals was carried out in the Laboratory of Nuclear Physics of the University of Costa Rica. Upon comparing the dose with the reference values of dose of the International of Atomic Energy Agency, is found that for all the studies exist figures by above the value recommended. To be able to explain to patient the quantity of radiation received in terms not scientific, is proposed to utilized a qualitative unit, the Bert (equivalent time to natural radiation). Due to the large variations in the dose, is recommended to implement quality control programs, where be guaranteed the diminution of the collective dose and be maintained or improve the quality of the radiologic image. (S. Grainger) [es

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

    Directory of Open Access Journals (Sweden)

    Louíse Viecili Hoffmeister

    2015-02-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

  7. Characteristics of Acute Poisoning at Two Referral Hospitals in ...

    African Journals Online (AJOL)

    Background: The epidemiology of acute poisoning in Botswana is not well established due to the limited availability of published data. In an attempt to fill this gap, this study aimed to characterise acute poisoning cases admitted to two urban hospitals in Francistown and Gaborone, Botswana. Methods: This study followed a ...

  8. A study on the annual equivalent doses received by cardiologists in a UK hospital

    International Nuclear Information System (INIS)

    Fong, R.Y.L.; Ryan, E.; Alonso-Arrizabalaga, S.

    2001-01-01

    A dose assessment study was carried out to determine the likely annual equivalent doses received by various parts of a cardiologist's body. High sensitivity GR-200 thermoluminescent dosemeters were attached to cardiologists' foreheads, little fingers, wrists, elbows, knees and ankles. Three common cardiology procedures were investigated, namely, percutaneous transluminal coronary angioplasty (PTCA), permanent pacemaker insertion (PPM) and left heart catheterisation (LHC). Dose monitoring was done on a case-by-case basis. Data on ten cases of each procedure were gathered. The projected annual equivalent doses were computed by averaging the ten doses measured at each site for each examination type and finding out from the cardiologists how many cases of PTCA, PPM and LHC they do in a year. Results in this study show that for the lens of the eye, the projected annual equivalent dose is below 10 mSv and for the other body parts, it is below 100 mSv per year. The study demonstrated that the methodology used can help to optimise radiation protection in diagnostic radiology. (author)

  9. Characteristics of patients presenting to the vascular emergency department of a tertiary care hospital: a 2-year study

    Directory of Open Access Journals (Sweden)

    Kotsikoris Ioannis

    2011-11-01

    Full Text Available Abstract Background The structure of health care in Greece is receiving increased attention to improve its cost-effectiveness. We sought to examine the epidemiological characteristics of patients presenting to the vascular emergency department of a Greek tertiary care hospital during a 2-year period. We studied all patients presenting to the emergency department of vascular surgery at Red Cross Hospital, Athens, Greece between 1st January 2009 and 31st December 2010. Results Overall, 2452 (49.4% out of 4961 patients suffered from pathologies that should have been treated in primary health care. Only 2509 (50.6% needed vascular surgical intervention. Conclusions The emergency department of vascular surgery in a Greek tertiary care hospital has to treat a remarkably high percentage of patients suitable for the primary health care level. These results suggest that an improvement in the structure of health care is needed in Greece.

  10. Virologic outcome among patients receiving antiretroviral therapy at five hospitals in Haiti.

    Directory of Open Access Journals (Sweden)

    Frantz Jean Louis

    Full Text Available Viral load (VL assessment is the preferred method for diagnosing and confirming virologic failure for patients on antiretroviral therapy (ART. We conducted a retrospective cross-sectional study to evaluate the virologic suppression rate among patients on ART for ≥6 months in five hospitals around Port-au-Prince, Haiti.Plasma VL was measured and patients with VL <1,000 copies/mL were defined as virologically suppressed. A second VL test was performed within at least six months of the first test. Factors associated with virologic suppression were analyzed using logistic regression models accounting for site-level clustering using complex survey procedures.Data were analyzed for 2,313 patients on ART for six months or longer between July 2013 and February 2015. Among them, 1,563 (67.6% achieved virologic suppression at the first VL test. A second VL test was performed within at least six months for 718 (31.0% of the patients. Of the 459 patients with an initial HIV-1 RNA <1,000 copies/mL who had a second VL performed, 394 (85.8% maintained virologic suppression. Virologic suppression was negatively associated with male gender (adjusted odds ratio [aOR]: 0.80, 95% CI: 0.74-0.0.86, 23 to 35 months on ART (aOR:0.72[0.54-0.96], baseline CD4 counts of 201-500 cells/mm3 and 200 cells/mm3 or lower (aORs: 0.77 [0.62-0.95] and 0.80 [0.66-0.98], respectively, poor adherence (aOR: 0.69 [0.59-0.81], and TB co-infection (aOR: 0.73 [0.55-0.97].This study showed that over two-thirds of the patients in this evaluation achieved virologic suppression after ≥ six months on ART and the majority of them remained suppressed. These results reinforce the importance of expanding access to HIV-1 viral load testing in Haiti for monitoring ART outcomes.

  11. Frequency of worsening liver function in severe dengue hepatitis patients receiving paracetamol: A retrospective analysis of hospital data

    International Nuclear Information System (INIS)

    Syed, A.A.; Aslam, F.; Hakeem, H.; Siddiqui, F.; Nasir, N.

    2017-01-01

    To determine the frequency of worsening liver function among hospital in-patients with severe dengue hepatitis receiving paracetamol. Methods: This retrospective study was conducted at the Department of Medicine, Aga Khan University Hospital, Karachi, and comprised records of dengue patients with severe hepatitis who received paracetamol for control of fever between June 2007 and December 2014. Alanine aminotransferase at baseline and following paracetamol administration was noted, as well as dosage and duration of paracetamol, along with participants' demographic details. Frequency of patients who developed worsening or improvement of alanine aminotransferase was also noted. SPSS 19 was used for data analysis. Results: Of the 113 subjects, 73(64.6%) were male and 40(35.4%) were female. Overall improvement was observed in subsequent alanine aminotransferase levels (491 units per litre, IQR 356.5 TO 775 vs 151 units per litre, IQR 49.5 to 299.5). Most commonly prescribed dose of paracetamol was 2g (IQR 1 to 5 grams), which was taken for a median duration of 1 day (IQR 1 to 3 days). Moreover, 100(88.5 %) patients showed improvement in alanine aminotransferase. Only 13(11.5 %) patients developed worsening of alanine aminotransferase. Of those with worsening liver function, 8(61.5 %) were discharged home with no clinical deterioration and 5(38.5 %) deaths were observed. However, causes of deaths were unrelated to liver dysfunction. Conclusion: The frequency of worsening liver function following paracetamol administration in patients with severe dengue hepatitis was relatively low. (author)

  12. [The characteristics of medical technologies in emergency medical care hospital].

    Science.gov (United States)

    Murakhovskiĭ, A G; Babenko, A I; Bravve, Iu I; Tataurova, E A

    2013-01-01

    The article analyzes the implementation of major 12 diagnostic and 17 treatment technologies applied during medical care of patients with 12 key nosology forms of diseases in departments of the emergency medical care hospital No 2 of Omsk. It is established that key groups of technologies in the implementation of diagnostic process are the laboratory clinical diagnostic analyses and common diagnostic activities at reception into hospital and corresponding departments. The percentage of this kind of activities is about 78.3% of all diagnostic technologies. During the realization of treatment process the priority technologies are common curative and rehabilitation activities, intensive therapy activities and clinical diagnostic monitoring activities. All of them consist 80.1% of all curative technologies.

  13. Characteristics of Hospitalized Children With a Diagnosis of Malnutrition: United States, 2010.

    Science.gov (United States)

    Abdelhadi, Ruba A; Bouma, Sandra; Bairdain, Sigrid; Wolff, Jodi; Legro, Amanda; Plogsted, Steve; Guenter, Peggi; Resnick, Helaine; Slaughter-Acey, Jaime C; Corkins, Mark R

    2016-07-01

    Malnutrition is common in hospitalized patients in the United States. In 2010, 80,710 of 6,280,710 hospitalized children malnutrition (CDM). This report summarizes nationally representative, person-level characteristics of hospitalized children with a CDM. Data are from the 2010 Healthcare Cost and Utilization Project, which contains patient-level data on hospital inpatient stays. When weighted appropriately, estimates from the project represent all U.S. hospitalizations. The data set contains up to 25 ICD-9-CM diagnostic codes for each patient. Children with a CDM listed during hospitalization were identified. In 2010, 1.3% of hospitalized patients malnutrition's true prevalence may be underrepresented. Length of stay among children with a CDM was almost 2.5 times longer than those without a CDM. Hospital costs for children with a CDM were >3 times higher than those without a CDM. Hospitalized children with a CDM were less likely to have routine discharge and almost 3.5 times more likely to require postdischarge home care. Children with a CDM were more likely to have multiple comorbidities. Hospitalized children with a CDM are associated with more comorbidities, longer hospital stay, and higher healthcare costs than those without this diagnosis. These undernourished children may utilize more healthcare resources in the hospital and community. Clinicians and policymakers should factor this into healthcare resource utilization planning. Recognizing and accurately coding malnutrition in hospitalized children may reveal the true prevalence of malnutrition. © 2016 American Society for Parenteral and Enteral Nutrition.

  14. Treatment received, satisfaction with health care services, and psychiatric symptoms 3 months after hospitalization for self-poisoning

    Directory of Open Access Journals (Sweden)

    Grimholt Tine K

    2012-04-01

    Full Text Available Abstract Background Patients who self-poison have high repetition and high mortality rates. Therefore, appropriate follow-up is important. The aims of the present work were to study treatment received, satisfaction with health care services, and psychiatric symptoms after hospitalization for self-poisoning. Methods A cohort of patients who self-poisoned (n = 867 over a period of 1 year received a questionnaire 3 months after discharge. The Beck Depression Inventory (BDI, Beck Hopelessness Scale (BHS, and Generalized Self-Efficacy Scale (GSE were used. The participation rate was 28% (n = 242; mean age, 41 years; 66% females. Results Although only 14% of patients were registered without follow-up referrals at discharge, 41% reported no such measures. Overall, satisfaction with treatment was fairly good, although 29% of patients waited more than 3 weeks for their first appointment. A total of 22% reported repeated self-poisoning and 17% cutting. The mean BDI and BHS scores were 23.3 and 10.1, respectively (both moderate to severe. The GSE score was 25.2. BDI score was 25.6 among patients with suicide attempts, 24.9 for appeals, and 20.1 for substance-use-related poisonings. Conclusions Despite plans for follow-up, many patients reported that they did not receive any. The reported frequency of psychiatric symptoms and self-harm behavior indicate that a more active follow-up is needed.

  15. Occurrence of antibiotics and antibiotic resistance genes in hospital and urban wastewaters and their impact on the receiving river.

    Science.gov (United States)

    Rodriguez-Mozaz, Sara; Chamorro, Sara; Marti, Elisabet; Huerta, Belinda; Gros, Meritxell; Sànchez-Melsió, Alexandre; Borrego, Carles M; Barceló, Damià; Balcázar, Jose Luis

    2015-02-01

    Antibiotic resistance has become a major health concern; thus, there is a growing interest in exploring the occurrence of antibiotic resistance genes (ARGs) in the environment as well as the factors that contribute to their emergence. Aquatic ecosystems provide an ideal setting for the acquisition and spread of ARGs due to the continuous pollution by antimicrobial compounds derived from anthropogenic activities. We investigated, therefore, the pollution level of a broad range of antibiotics and ARGs released from hospital and urban wastewaters, their removal through a wastewater treatment plant (WWTP) and their presence in the receiving river. Several antimicrobial compounds were detected in all water samples collected. Among antibiotic families, fluoroquinolones were detected at the highest concentration, especially in hospital effluent samples. Although good removal efficiency by treatment processes was observed for several antimicrobial compounds, most antibiotics were still present in WWTP effluents. The results also revealed that copy numbers of ARGs, such as blaTEM (resistance to β-lactams), qnrS (reduced susceptibility to fluoroquinolones), ermB (resistance to macrolides), sulI (resistance to sulfonamides) and tetW (resistance to tetracyclines), were detected at the highest concentrations in hospital effluent and WWTP influent samples. Although there was a significant reduction in copy numbers of these ARGs in WWTP effluent samples, this reduction was not uniform across analyzed ARGs. Relative concentration of ermB and tetW genes decreased as a result of wastewater treatment, whereas increased in the case of blaTEM, sulI and qnrS genes. The incomplete removal of antibiotics and ARGs in WWTP severely affected the receiving river, where both types of emerging pollutants were found at higher concentration in downstream waters than in samples collected upstream from the discharge point. Taken together, our findings demonstrate a widespread occurrence of

  16. Receiver-operating characteristic curves for somatic cell scores and California mastitis test in Valle del Be lice dairy sheep

    NARCIS (Netherlands)

    Riggio, V.; Pesce, L.L.; Morreale, S.; Portolano, B.

    2013-01-01

    Using receiver-operating characteristic (ROC) curve methodology this study was designed to assess the diagnostic effectiveness of somatic cell count (SCC) and the California mastitis test (CMT) in Valle del Belice sheep, and to propose and evaluate threshold values for those tests that would

  17. Screening for Depressive Disorders Using the Mood and Anxiety Symptoms Questionnaire Anhedonic Depression Scale: A Receiver-Operating Characteristic Analysis

    Science.gov (United States)

    Bredemeier, Keith; Spielberg, Jeffery M.; Silton, Rebecca Levin; Berenbaum, Howard; Heller, Wendy; Miller, Gregory A.

    2010-01-01

    The present study examined the utility of the anhedonic depression scale from the Mood and Anxiety Symptoms Questionnaire (MASQ-AD scale) as a way to screen for depressive disorders. Using receiver-operating characteristic analysis, we examined the sensitivity and specificity of the full 22-item MASQ-AD scale, as well as the 8- and 14-item…

  18. Costs, charges, and revenues for hospital diagnostic imaging procedures: differences by modality and hospital characteristics.

    Science.gov (United States)

    Sistrom, Christopher Lee; McKay, Niccie L

    2005-06-01

    This study examined financial data reported by Florida hospitals concerning costs, charges, and revenues related to imaging services. Financial reports to the Florida Hospital Uniform Reporting System by all licensed acute care facilities for fiscal year 2002 were used to calculate four financial indices on a per procedure basis. These included charge, net revenue, operating expense (variable cost), and contribution margin. Analysis, stratified by cost center (imaging modality), tested the effects of bed size, ownership, teaching status, and urban or rural status on the four indices. The mean operating expense and charge per procedure were as follows: computed tomography (CT): $51 and $1565; x-ray and ultrasound: $55 and $410; nuclear medicine (NM): $135 and $1138; and magnetic resonance imaging (MRI): $165 and $2048. With all four modalities, for-profit hospitals had higher charges than not-for-profit and public facilities. Excepting NM, however, the difference by ownership disappeared when considering net revenue. Operating expense did not differ by ownership type or bed size. Operating expense (variable cost) per procedure is considerably lower for CT than for MRI. Consequently, when diagnostically equivalent, CT is preferable to MRI in terms of costs for hospitals. If the cost structure of nonhospital imaging is at all similar to hospitals, the profit potential for performing CT and MRI seems to be substantial, which has relevance to the issue of imaging self-referral.

  19. Cost of management in epistaxis admission: Impact of patient and hospital characteristics.

    Science.gov (United States)

    Goljo, Erden; Dang, Rajan; Iloreta, Alfred M; Govindaraj, Satish

    2015-12-01

    To investigate patient and hospital characteristics associated with increased cost and length of stay in the inpatient management of epistaxis. Retrospective cross-sectional study of the 2008 to 2012 National (Nationwide) Inpatient Sample. Patient and hospital characteristics of epistaxis admissions were analyzed. Multiple linear regression analysis was used to ascertain variables associated with increased cost and length of hospital stay. Variables significantly associated with high cost were further analyzed to determine the contribution of operative intervention and total procedures to cost. A total of 16,828 patients with an admitting diagnosis of epistaxis were identified. The average age was 67.5; 52.3% of the patients were male; 73.3% of the patients were Caucasian; and 70.7% of the hospital stays were government funded. The average length of stay was 3.24 days, and average hospitalization cost was $6,925. Longer length of stay was associated with black race, alcohol abuse, sinonasal disease, renal disease, Medicaid, and care at a northeastern U.S. hospital. Increased hospitalization costs of > $1,000 were associated with Asian/Pacific Islander race; sinonasal disease; renal disease; top income quartile; and care at urban teaching, northeastern, and western hospitals in the United States. High costs were predicted by procedural intervention in patients with comorbid alcohol abuse, sinonasal disease, renal disease, patients with private insurance, and patients managed at large hospitals. Although hospitalization costs are complex and multifactorial, we were able to identify patient and hospital characteristics associated with high costs in the management of epistaxis. Early identification and intervention, combined with implementation of targeted hospital management protocols, may improve outcomes and reduce financial burden. 2C. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  20. Characteristics of Children with Autism Spectrum Disorders Who Received Services through Community Mental Health Centers

    Science.gov (United States)

    Bryson, Stephanie A.; Corrigan, Susan K.; McDonald, Thomas P.; Holmes, Cheryl

    2008-01-01

    Despite the presence of significant psychiatric comorbidity among children with autism spectrum disorders (ASDs), little research exists on those who receive community-based mental health services. This project examined one year (2004) of data from the database maintained by 26 community mental health centers (CMHCs) in the Midwestern US state of…

  1. Statistical characteristics of L1 carrier phase observations from four low-cost GPS receivers

    DEFF Research Database (Denmark)

    Cederholm, Jens Peter

    2010-01-01

    Statistical properties of L1 carrier phase observations from four low-cost GPS receivers are investigated through a case study. The observations are collected on a zero baseline with a frequency of 1 Hz and processed with a double difference model. The carrier phase residuals from an ambiguity...

  2. Characteristics of Hemorrhagic Peptic Ulcers in Patients Receiving Antithrombotic/Nonsteroidal Antiinflammatory Drug Therapy

    OpenAIRE

    Nakamura, Kazuhiko; Akahoshi, Kazuya; Ochiai, Toshiaki; Komori, Keishi; Haraguchi, Kazuhiro; Tanaka, Munehiro; Nakamura, Norimoto; Tanaka, Yoshimasa; Kakigao, Kana; Ogino, Haruei; Ihara, Eikichi; Akiho, Hirotada; Motomura, Yasuaki; Kabemura, Teppei; Harada, Naohiko

    2012-01-01

    Background/Aims Antithrombotic/nonsteroidal antiinflammatory drug (NSAID) therapies increase the incidence of upper gastrointestinal bleeding. The features of hemorrhagic peptic ulcer disease in patients receiving antithrombotic/NSAID therapies were investigated. Methods We investigated the medical records of 485 consecutive patients who underwent esophagogastroduodenoscopy and were diagnosed with hemorrhagic gastroduodenal ulcers. The patients treated with antithrombotic agents/NSAIDs were c...

  3. Occurrence of Antibiotic Resistance Genes and Bacterial Markers in a Tropical River Receiving Hospital and Urban Wastewaters.

    Directory of Open Access Journals (Sweden)

    Naresh Devarajan

    Full Text Available The occurrence of emerging biological contaminants including antibiotic resistance genes (ARGs and Faecal Indicator Bacteria (FIB is still little investigated in developing countries under tropical conditions. In this study, the total bacterial load, the abundance of FIB (E. coli and Enterococcus spp. (ENT, Pseudomonas spp. and ARGs (blaTEM, blaCTX-M, blaSHV, blaNDM and aadA were quantified using quantitative PCR in the total DNA extracted from the sediments recovered from hospital outlet pipes (HOP and the Cauvery River Basin (CRB, Tiruchirappalli, Tamil Nadu, India. The abundance of bacterial marker genes were 120, 104 and 89 fold higher for the E. coli, Enterococcus spp. and Pseudomonas spp., respectively at HOP when compared with CRB. The ARGs aadA and blaTEM were most frequently detected in higher concentration than other ARGs at all the sampling sites. The ARGs blaSHV and blaNDM were identified in CRB sediments contaminated by hospital and urban wastewaters. The ARGs abundance strongly correlated (r ≥ 0.36, p < 0.05, n = 45 with total bacterial load and E. coli in the sediments, indicating a common origin and extant source of contamination. Tropical aquatic ecosystems receiving wastewaters can act as reservoir of ARGs, which could potentially be transferred to susceptible bacterial pathogens at these sites.

  4. Radiation Dose to Family Member of Hospitalized Patient Receiving I-131 Therapy for Thyroid Cancer: Case Study

    International Nuclear Information System (INIS)

    Tuntawiroon, M; Chaudakshetrin, P; Sritongkul N; Thongprapal, T

    2009-07-01

    Full text: During high-dose I-131 therapy, hospitalized patient who is unable to walk to the bathroom is at risk of radiation burden to comforter from excreted urine. Foley catheter is usually placed in the patient before I-131 administration. The urine was collected and housed in lead shielding, emptied every 4 to 6 hours on the first day, and every 8 to 10 hours on subsequent days. After specific instructions with regard to radiation safety, family member designed as the caregiver of patient was provided an electronic personal dosimeter to directly measure radiation dose for three days in isolated hospitalization and two more weeks at home. The caregiver recorded time spent in contact with the patient and activities performed during these times. Total accumulative dose for 16 days was 650 μSv of which 44% (288 μSv) was from the first 24 hours and more than 70% (462 μSv) during the first 72 hours, and about 25% (162 μSv) from emptying urine bags. Most of the dose received (488 μSv) was from attending time spent in the vicinity of the patients. However, this was not exceeding the constraints of 1 mSv/y and well below the limit of 5 mSv in any one year for exposed caregiver and comforter

  5. Maternal characteristics and hospital policies as risk factors for nonreceipt of hepatitis B vaccine in the newborn nursery.

    Science.gov (United States)

    O'Leary, Sean T; Nelson, Christina; Duran, Julie

    2012-01-01

    A birth dose of hepatitis B vaccine (HBV) is a primary focus of the Advisory Committee on Immunization Practices' strategy to eliminate transmission of hepatitis B virus in the United States. We sought to assess the impact of maternal characteristics and hospital policy on the receipt of a birth dose of HBV. A retrospective cohort study was performed using data from the 2008 Colorado birth registry. Hospital policy was assessed by state health department personnel. Univariate and multivariate logistic regression analyses were used to examine the association of maternal characteristics and hospital policy with nonreceipt of HBV. A total of 64,425 infants were identified in the birth cohort, of whom 61.6% received a birth dose of HBV. Higher maternal education and income were associated with nonreceipt of HBV (master's degree vs. eighth grade or less: adjusted odds ratio [OR] = 1.66, 95% confidence interval [CI] = 1.49-1.85; >$75,000 vs. risk of perinatal hepatitis B transmission, hospitals should stipulate that all infants are offered HBV and ensure that these policies are implemented and followed.

  6. Hospital Value-Based Purchasing Performance: Do Organizational and Market Characteristics Matter?

    Science.gov (United States)

    Spaulding, Aaron; Edwardson, Nick; Zhao, Mei

    The hospital value-based purchasing (HVBP) program of the Centers for Medicare & Medicaid Services challenges hospitals to deliver high-quality care or face a reduction in Medicare payments. How do different organizational structures and market characteristics enable or inhibit successful transition to this new model of value-based care? To address that question, this study employs an institutional theory lens to test whether certain organizational structures and market characteristics mediate hospitals' ability to perform across HVBP domains.Data from the 2014 American Hospital Association Annual Survey Database, Area Health Resource File, the Medicare Hospital Compare Database, and the association between external environment and hospital performance are assessed through multiple regression analysis. Results indicate that hospitals that belong to a system are more likely than independent hospitals to score highly on the domains associated with the HVBP incentive arrangement. However, varying and sometimes counterintuitive market influences bring different dimensions to the HVBP program. A hospital's ability to score well in this new value arrangement may be heavily based on the organization's ability to learn from others, implement change, and apply the appropriate amount of control in various markets.

  7. CLINICAL CHARACTERISTICS OF GOUT: A HOSPITAL CASE SERIES

    Directory of Open Access Journals (Sweden)

    GUN SC

    2011-01-01

    Full Text Available Introduction: Gout is an increasingly common medical problem. The traditional risk factors of male sex and high red meat or alcohol consumption have been joined with newer risks such as increased life expectancy, and the metabolic syndrome (hypertension, diabetes, dyslipidaemia, truncal obesity. Methods: This was a retrospective study to determine the epidemiology, clinical features, associated conditions as well as renal related conditions in existing gout patients followed-up in Rheumatology outpatient clinic, Hospital Tuanku Ja’afar, Seremban. Results: Over a three month period, we identified 54 gouty patients on our follow-up, the majority being male, Malay ethnicity, withthe age of onset in the third and fourth decades of life. Commonly associated risk factors were hypertension, hyperlipidaemia and obesity. However, underlying history of diabetes mellitus, alcohol consumption, and family history were not commonly associated with gout in our group of patients. Half of our patients had at least two or more joints involvement. About half of the patients with tophaceous gout had renal impairment. Conclusion: Our series of gout patients highlight the high prevalence of cardiovascular risk factors. The high prevalence of tophi and renal impairment is a cause for concern.

  8. Part 5: Receiver Operating Characteristic Curve and Area under the Curve

    Directory of Open Access Journals (Sweden)

    Saeed Safari

    2016-04-01

    Full Text Available Multiple diagnostic tools are used by emergency physicians,every day. In addition, new tools are evaluated to obtainmore accurate methods and reduce time or cost of conventionalones. In the previous parts of this educationalseries, we described diagnostic performance characteristicsof diagnostic tests including sensitivity, specificity, positiveand negative predictive values, and likelihood ratios. Thereceiver operating characteristics (ROC curve is a graphicalpresentation of screening characteristics. ROC curve is usedto determine the best cutoff point and compare two or moretests or observers by measuring the area under the curve(AUC. In this part of our educational series, we explain ROCcurve and two methods to determine the best cutoff value.

  9. Determinants of hospital fall rate trajectory groups: a longitudinal assessment of nurse staffing and organizational characteristics.

    Science.gov (United States)

    Everhart, Damian; Schumacher, Jessica R; Duncan, R Paul; Hall, Allyson G; Neff, Donna F; Shorr, Ronald I

    2014-01-01

    Patient falls in acute care hospitals represent a significant patient safety concern. Although cross-sectional studies have shown that fall rates vary widely between acute care hospitals, it is not clear whether hospital fall rates remain consistent over time. The aim of this study was to determine whether hospitals can be categorized into fall rate trajectory groups over time and to identify nurse staffing and hospital characteristics associated with hospital fall rate trajectory groups. We conducted a 54-month (July 2006-December 2010) longitudinal study of U.S. acute care general hospitals participating in the National Database for Nursing Quality Indicators (2007). We used latent class growth modeling to categorize hospitals into groups based on their long-term fall rates. Nurse staffing and hospital characteristics associated with membership in the highest hospital fall rate group were identified using logistic regression. A sample of 1,529 hospitals (mean fall rate of 3.65 per 1,000 patient days) contributed data to the analysis. Latent class growth modeling findings classified hospital into three groups based on fall rate trajectories: consistently high (mean fall rate of 4.96 per 1,000 patient days), consistently medium (mean fall rate of 3.63 per 1,000 patient days), and consistently low (mean fall rate of 2.50 per 1,000 patient days). Hospitals with higher total nurse staffing (odds ratio [OR] = 0.92, 95% confidence interval [CI] [0.85, 0.99]), Magnet status (OR = 0.49, 95% CI [0.35, 0.70]), and bed size greater than 300 beds (OR = 0.70, 95% CI [0.51, 0.94]) were significantly less likely to be categorized in the "consistently high" fall rate group. Over this 54-month period, hospitals were categorized into three groups based on long-term fall rates. Hospital-level factors differed among these three groups. This suggests that there may be hospitals in which "best practices" for fall prevention might be identified. In addition, administrators may be able

  10. Elderly patients with suspected chronic digoxin toxicity: A comparison of clinical characteristics of patients receiving and not receiving digoxin-Fab.

    Science.gov (United States)

    Arbabian, Hooman; Lee, Hwee Min; Graudins, Andis

    2018-04-01

    The aim of the present study was to compare clinical features of patients with elevated serum digoxin concentrations who were treated with digoxin-Fab with those where the immunotherapy was not given by a tertiary hospital toxicology service. This was a retrospective series of patients with supratherapeutic serum digoxin concentrations referred to the toxicology service from August 2013 to October 2015. Data collected included demographics, presenting complaint, digoxin dose, other medications taken, serum digoxin, potassium and creatinine concentration on presentation and initial and post-digoxin-Fab heart rate. There were 47 referrals. Digoxin-Fab was administered in 21 cases. It was given more commonly when the heart rate was 5.0 mmol/L. Patients receiving digoxin-Fab were more likely to be on maintenance therapy with beta-blockers or calcium channel blockers (95% vs 61%; OR 13.1; 95% CI 1.5-113) and/or potassium-sparing medications (95% vs 54%; OR 17.1; 95% CI 2.0-147). They had elevated serum creatinine (76% vs 42%; OR 8.2; 95% CI 1.9-34), higher serum potassium (median: 5.1 mmol/L vs 4.2 mmol/L, P = 0.02), higher serum digoxin concentration (median: 3.5 nmol/L vs 2.3 nmol/L, P = 0.02) and pretreatment heart rate Fab. However, individual heart rate response to digoxin-Fab was variable. Digoxin-Fab was more commonly administered when heart rate was Fab was variable as patients were using other negative chronotropic medications. In symptomatic bradycardic patients on multiple heart failure medications, positive chronotropic and potassium-lowering therapies should be considered in concert with digoxin-Fab. © 2018 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  11. Building Process and Architectural Planning Characteristics of Daehan Hospital Main Building

    Directory of Open Access Journals (Sweden)

    Geauchul LEE

    2016-04-01

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

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

    Science.gov (United States)

    Lee, Geauchul

    2016-04-01

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

  13. Characteristics of Rotavirus Diarrhea in Hospitalized Children in Kosovo

    Science.gov (United States)

    Ismaili-Jaha, Vlora; Shala, Muje; Azemi, Mehmedali; Hoxha-Kamberi, Teuta; Avdiu, Muharrem; Spahiu, Shqipe; Jaha, Luan

    2014-01-01

    Background: Diarrhea is a leading cause of child mortality worldwide. Rotavirus is one of the most common causes of severe diarrhea and dehydration in children. Authors reviewed epidemiological and clinical data of the rotavirus diarrhea in Kosovo. Methods: This is a prospective study carried between January 1st and December 31st 2011. All data, comprising demographics, nutrition, clinical presentation, laboratory findings, management and outcome of the rotavirus diarrhea are collected on the specially designed form. Results: 116 children with rotavirus diarrhea are included in the study. The majority boys (74.4%) and children aged 0 – 12 months (82.75%). Mean age of children in the study was 16.38 months. Almost every third child in the study was hypotrophic (29.2%). More than half of the infants (55.2%) were on mixed food, somewhat more than every third was breast feeding (36.45%), and every twelfth (8.33%) was on artificial milk (animal or formula). Apart from diarrhea, present in all patients, vomiting (97.41%) and fever (43.96%) were characteristics of the clinical presentation of the diarrhea. Two thirds of the children had mild grade dehydration (70.7%). All patients recovered with no sequels. Conclusion: Rotavirus continues to be responsible for a significant portion of acute diarrhea in Kosovo. Clinical features, epidemiological data and the agglutination test are safe enough to establish the diagnosis. Treated correctly rotavirus diarrhea has a favorable outcome. PMID:25568634

  14. Growth, body characteristics and blood parameters of ostrich chickens receiving commercial probiotics

    Energy Technology Data Exchange (ETDEWEB)

    Karimi-Kivi, R.; Dadashbeiki, M.; Seidavi, A.

    2015-07-01

    This study was undertaken to determine the effect of four commercial probiotics on growth, body characteristics and haematological parameters of ostrich chicks. A total of 25 ostrich chicks (937±68.1 g) were individually allocated and fed the experimental diet for six weeks (n=5 per treatment). Experimental diets consisted of a corn/soybean meal-based diet unsupplemented (T1: Control), and four diets supplemented with probiotics according to the recommendations of the manufacturer (T2: 0.04% Bioplus 2B; T3: 0.09% Primalac; T4: 0.1% Thepax; and T5: 0.03% Protexin). Feed intake (FI), body weight (BW) and seven body characteristics (e.g. height) were measured every week. Blood samples and other body characteristics were also taken in the last week. There was an interaction effect between diet and time on all the growth variables and body characteristics (p<0.05). Both the BW and the BW gain of the ostrich chicks were, in general, higher for those fed the diet T2 than those fed the control diet (0.42, 1.07, 0.99, 1.09, 2.51, and 1.66 kg BW gain vs 0.28, 0.41, 0.83, 0.94, 1.15, and 1.15 kg BW gain at 7, 14, 21, 28, 35, and 42 days respectively), while for those fed the other diets containing probiotics differences were only observed at 42 days (p<0.05). Consuming probiotics over an extended period influenced several of the haematological parameters differently compared to those fed the control diet (p<0.05). T2 and T3 increased the concentration of total cholesterol (157 and 210 mg/dL respectively), when compared to those fed the control diet (119 mg/dL), while total cholesterol was slightly reduced (p>0.05) for those fed the diet containing Thepax (T4, 79 mg/dL). In conclusion, the effects of commercial probiotics on growth performance, body characteristics and haematological parameters varied among probiotics. (Author)

  15. Elemental composition and structural characteristics of as-received TriTaniumTM orthodontic archwire

    Science.gov (United States)

    Ilievska, I.; Petrov, V.; Mihailov, V.; Karatodorov, S.; Andreeva, L.; Zaleski, A.; Mikli, V.; Gueorgieva, M.; Petrova, V.; Stoyanova-Ivanova, A.

    2018-03-01

    Orthodontic archwires are among the most important devices of fixed orthodontic therapy. Many types of archwires are made available on the market by various manufacturers with different elemental composition and structural characteristics. Knowing this information is important when choosing a suitable archwire for a particular stage of orthodontic treatment. The aim of our study is to characterize a new type orthodontic archwires (TriTaniumTM, American Orthodontics) before their placement in the oral cavity. To achieve the aim, we used modern methods for determining their elemental composition and structural characteristics: laser-induced plasma spectroscopy (LIBS), X-ray diffraction analysis (XRD), scanning electronic microscopy (SEM), energy dispersive X-ray spectroscopy (EDX) and differential scanning calorimetry (DSC). The results obtained from the qualitative elemental analysis by LIBS and the quantitative elemental analysis by EDX showed that Ni and Ti are the main elements in the archwire studied. The room-temperature XRD patterns showed peaks typical for a Ni-Ti alloy with an austenite-type structure. Monitoring the phase transitions by means of DSC measurements in the temperature range from –50 °C to +50 °C, we showed that in TriTaniumTM archwires, besides the austenite to martensite transition, there exists a rhombohedral intermediate phase (R phase). This study will be useful in assisting orthodontists in applying appropriate nickel-titanium orthodontic archwires in the clinical practice.

  16. Structural characteristics of hospitals and nurse-reported care quality, work environment, burnout and leaving intentions.

    Science.gov (United States)

    Lindqvist, Rikard; Smeds Alenius, Lisa; Griffiths, Peter; Runesdotter, Sara; Tishelman, Carol

    2015-03-01

    To investigate whether hospital characteristics not readily susceptible to change (i.e. hospital size, university status, and geographic location) are associated with specific self-reported nurse outcomes. Research often focuses on factors within hospitals (e.g. work environment), which are susceptible to change, rather than on structural factors in their own right. However, numerous assumptions exist about the role of structural factors that may lead to a sense of pessimism and undermine efforts at constructive change. Data was derived from survey questions on assessments of work environment and satisfaction, intention to leave, quality of care and burnout (measured by the Maslach Burnout Inventory), from a population-based sample of 11 000 registered nurses in Sweden. Mixed model regressions were used for analysis. Registered nurses in small hospitals were slightly more likely to rank their working environment and quality of nursing care better than others. For example 23% of staff in small hospitals were very satisfied with the work environment compared with 20% in medium-sized hospitals and 21% in large hospitals. Registered nurses in urban areas, who intended to leave their job, were more likely to seek work in another hospital (38% vs. 32%). While some structural factors were related to nurse-reported outcomes in this large sample, the associations were small or of questionable importance. The influence of structural factors such as hospital size on nurse-reported outcomes is small and unlikely to negate efforts to improve work environment. © 2013 John Wiley & Sons Ltd.

  17. Hospitalized children drawing their pain: the contents and cognitive and emotional characteristics of pain drawings.

    Science.gov (United States)

    Kortesluoma, Riitta-Liisa; Punamäki, Raija-Leena; Nikkonen, Merja

    2008-12-01

    Describing pain is difficult. Children like to draw, and through their drawing they reveal worrying issues. This study aimed to examine how hospitalized children express pain through drawings, and was carried out by examining children's thematic drawings of pain. A comparison was made between hospitalized children and healthy control groups with respect to the thematic contents and cognitive and emotional characteristics of pain drawings. The drawings were sorted in categories on the basis of content, and cognitive competence and emotional disturbances by the Draw-a-Person procedure. The hospitalized children showed a lower level of cognitive capacity than their healthy controls. The control group children revealed a higher level of emotional disturbance than the hospitalized children. The groups differed in the contents of their drawings. The drawings of the hospitalized children frequently depicted medical procedures, whereas the drawings of the healthy controls depicted more consoling human and family relations.

  18. The characteristics of physical activity and gait in patients receiving radiotherapy in cancer induced bone pain

    International Nuclear Information System (INIS)

    Sande, Tonje A.; Scott, Angela C.; Laird, Barry J.A.; Wan, Hong I.; Fleetwood-Walker, Susan M.; Kaasa, Stein; Klepstad, Pål; Mitchell, Rory; Murray, Gordon D.; Colvin, Lesley A.; Fallon, Marie T.

    2014-01-01

    Background and purpose: An objective measure of pain relief may add important information to patients’ self assessment, particularly after a treatment. The study aims were to determine whether measures of physical activity and/or gait can be used in characterizing cancer-induced bone pain (CIBP) and whether these biomarkers are sensitive to treatment response, in patients receiving radiotherapy (XRT) for CIBP. Materials and methods: Patients were assessed before (baseline) and 6–8 weeks after XRT (follow up). The following assessments were done: Brief Pain Inventory (BPI), activPAL™ activity meter, and GAITRite® electronic walkway (measure of gait). Wilcoxon, Mann–Whitney and Pearson statistical analyses were done. Results: Sixty patients were assessed at baseline; median worst pain was 7 and walking interference was 5. At follow up 42 patients were assessed. BPI worst pain, average pain, walking interference and total functional interference all improved (p < 0.001). An improvement in functional interference correlated with aspects of physical activity (daily hours standing r = 0.469, p = 0.002) and gait (cadence r = 0.341, p = 0.03). The activPAL and GAITRite parameters did not change following XRT (p > 0.05). In responder analyses there were no differences in activPAL and GAITRite parameters (p > 0.05). Conclusion: Assessment of physical activity and gait allow a characterization of the functional aspects of CIBP, but not in the evaluation of XRT

  19. Characteristic Trend Analysis of Cancer Patients Hospitalized in Shanxi Tumor Hospital for the First Time during 2001 and 2010.

    Science.gov (United States)

    Zhang, Wen-Li; Wang, Yan; Han, Cun-Zhi

    2015-01-01

    To observe and analyze the characteristic trend of cancer patients hospitalized for the first time in Shanxi Tumor Hospital from 2001 to 2010, clinical data including case number, age, gender, and frequency of different tumor occurrences were collected and statistically analyzed. (i) From 2001 to 2010, the number of cancer patients hospitalized for the first time increased by 1.3-fold; (ii) The patient overall average age also increased from 51.8 to 54.4, for males from 55.5 to 58.7 and females from 48.4 to 51.1, respectively. (iii) Male patients accounted for 43-48% and females accounted for 52-57% of the total. The percentage of female patients was higher than that of male patients in every year and showed an upward trend over the years, while that of the males showed a downward trend (χ2 =7.031, p=0.008); (iv) Among the top 6 most common cancers, lung, cervical, esophageal, colorectal and breast cancers tended to increase over the years (ppatients hospitalized for the first time during the past 10 years increased year by year, and was higher for female than male; (ii) the average age of patients increased year after year and was greater for male than female; (iii) the number of patients with lung cancer, cervical cancer, esophageal cancer, colorectal cancer and breast cancer increased over years.

  20. [Stress syndrome in patients receiving outpatient treatment at the General Hospital, in Bangui, in a context of armed conflict].

    Science.gov (United States)

    Mpembi, Magloire Nkosi; Lukeba, Thierry; Mayemba, Damien; Massamba, Victoria Kubuta; Ma Nzuzi, Thierry Matonda; Gokara, Symphorien; Vermeiren, Etienne; Mananga Lelo, Gilbert; Ma Miezi, Samuel Mampunza

    2018-01-01

    in Africa's zones of conflict, recent studies report a high frequency of post-traumatic stress disorder (PTSD) particularly in community settings. This study aimed to contribute to a better management of patients experiencing violence subsequent to the Central African Republic socio-political conflict. We conducted a cross-sectional study of the medical records of patients receiving outpatient treatment in the Doctors Without Borders/Médecins Sans Frontières (France) Trauma Center, Bangui. 33.33% (n=35) of patients had PTSD, while 17.14% (n=18) of patients had acute stress syndrome. Stress syndrome (SS) was associated with female sex, rape, anxiety and depression. Rape multiplied the risk of SS occurrence by 8. The average age was 30 years (P25:22 years; P75:40 years). The majority of patients had mood disorder (63.81%; n=67). Insomnia was present in 62.83% (n=66) of patients. Hospital Anxiety and Depression Scale (HADS) was present in 44.76 % of patients. Depression was found in 40.95% (n=43) of patients. The obtained results show how the society, apart from militia members, is affected by conflict-related violence in the country. These results can enrich the reflections on health organisation and on the management of patients in Central African, by considering the impact of conflict-related acute stress syndome in the short, medium and long term.

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

    LENUS (Irish Health Repository)

    Bartels, C

    2012-01-06

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

  2. Comparison of clinical characteristics between healthcare-associated pneumonia and community-acquired pneumonia in patients admitted to secondary hospitals

    Directory of Open Access Journals (Sweden)

    Jong Hoo Lee

    Full Text Available BACKGROUND: Since healthcare-associated pneumonia (HCAP is heterogeneous, clinical characteristics and outcomes are different from region to region. There can also be differences between HCAP patients hospitalized in secondary or tertiary hospitals. This study aimed to evaluate the clinical characteristics of HCAP patients admitted into secondary community hospitals. METHODS: This was a retrospective study conducted in patients with HCAP or community-acquired pneumonia (CAP hospitalized in two secondary hospitals between March 2009 and January 2011. RESULTS: Of a total of 303 patients, 96 (31.7% had HCAP. 42 patients (43.7% resided in a nursing home or long-term care facility, 36 (37.5% were hospitalized in an acute care hospital for > 2 days within 90 days, ten received outpatient intravenous therapy, and eight attended a hospital clinic or dialysis center. HCAP patients were older. The rates of patients with CURB65 scores of 3 or more (22.9% vs. 9.1%; p = 0.001 and PSI class IV or more (82.2% vs. 34.7%; p < 0.001 were higher in the HCAP group. Drug-resistant pathogens were more frequently detected in the HCAP group (23.9% vs. 0.4%; p < 0.001. However, Streptococcus pneumoniae was the most common pathogen in both groups. The rates of antibiotic change, use of inappropriate antibiotics, and failure of initial antibiotic therapy in the HCAP group were significantly higher. Although the overall survival rate of the HCAP group was significantly lower (82.3% vs. 96.8%; p < 0.001, multivariate analyses failed to show that HCAP itself was a prognostic factor for mortality (p = 0.826. Only PSI class IV or more was associated with increased mortality (p = 0.005. CONCLUSIONS: HCAP should be distinguished from CAP because of the different clinical features. However, the current definition of HCAP does not appear to be a prognostic for death. In addition, the use of broad-spectrum antibiotics for HCAP should be reassessed because S. pneumoniae was most

  3. Psychological effects of relational job characteristics: validation of the scale for hospital nurses.

    Science.gov (United States)

    Santos, Alda; Castanheira, Filipa; Chambel, Maria José; Amarante, Michael Vieira; Costa, Carlos

    2017-07-01

    This study validates the Portuguese version of the psychological effects of the relational job characteristics scale among hospital nurses in Portugal and Brazil. Increasing attention has been given to the social dimension of work, following the transition to a service economy. Nevertheless, and despite the unquestionable relational characteristics of nursing work, scarce research has been developed among nurses under a relational job design framework. Moreover, it is important to develop instruments that study the effects of relational job characteristics among nurses. We followed Messick's framework for scale validation, comprising the steps regarding the response process and internal structure, as well as relationships with other variables (work engagement and burnout). Statistical analysis included exploratory factor analysis and confirmatory factor analysis. The psychological effects of the relational job characteristics scale provided evidence of good psychometric properties with Portuguese and Brazilian hospital nurses. Also, the psychological effects of the relational job characteristics are associated with nurses' work-related well-being: positively with work engagement and negatively concerning burnout. Hospitals that foster the relational characteristics of nursing work are contributing to their nurses' work-related well-being, which may be reflected in the quality of care and patient safety. © 2017 John Wiley & Sons Ltd.

  4. Risk management of QTc-prolongation in patients receiving haloperidol: an epidemiological study in a University hospital in Belgium.

    Science.gov (United States)

    Vandael, Eline; Vandenberk, Bert; Vandenberghe, Joris; Spriet, Isabel; Willems, Rik; Foulon, Veerle

    2016-04-01

    Many drugs, including haloperidol, are linked with a risk of QTc-prolongation, which can lead to Torsade de Pointes and sudden cardiac death. To investigate the prevalence of concomitant risk factors for QTc-prolongation in patients treated with haloperidol, and the use of safety measures to minimize this risk. University Hospitals of Leuven, Belgium. Methods A retrospective epidemiological study was performed. On 15 consecutive Mondays, all patients with a prescription for haloperidol were included. A risk score for QTc-prolongation, inspired by the pro-QTc score of Haugaa et al., was calculated based on gender, comorbidities, lab results and concomitant QTc-prolonging drugs (each factor counting for one point). Available electrocardiograms before and during the treatment of haloperidol were registered. Management of the risk of QTc-prolongation. Two hundred twenty-two patients were included (59.0 % men, median age 77 years) of whom 26.6 % had a risk score of ≥4 (known to significantly increase the mortality). Overall, 24.3 % received haloperidol in combination with other drugs with a known risk of Torsade de Pointes. Half of the patients had an electrocardiogram in the week before the start of haloperidol; only in one-third a follow-up electrocardiogram during haloperidol treatment was performed. Of the patients with a moderately (n = 41) or severely (n = 14) prolonged QTc-interval before haloperidol, 48.8 % and 42.9 % respectively had a follow-up electrocardiogram. In patients with a risk score ≥4, significantly more electrocardiograms were taken before starting haloperidol (p = 0.020). Although many patients had risk factors for QTc-prolongation (including the use of other QTc-prolonging drugs) or had a prolonged QTc on a baseline electrocardiogram, follow-up safety measures were limited. Persistent efforts should be taken to develop decision support systems to manage this risk.

  5. Evaluation of pharmaceuticals and personal care products with emphasis on anthelmintics in human sanitary waste, sewage, hospital wastewater, livestock wastewater and receiving water.

    Science.gov (United States)

    Sim, Won-Jin; Kim, Hee-Young; Choi, Sung-Deuk; Kwon, Jung-Hwan; Oh, Jeong-Eun

    2013-03-15

    We investigated 33 pharmaceuticals and personal care products (PPCPs) with emphasis on anthelmintics and their metabolites in human sanitary waste treatment plants (HTPs), sewage treatment plants (STPs), hospital wastewater treatment plants (HWTPs), livestock wastewater treatment plants (LWTPs), river water and seawater. PPCPs showed the characteristic specific occurrence patterns according to wastewater sources. The LWTPs and HTPs showed higher levels (maximum 3000 times in influents) of anthelmintics than other wastewater treatment plants, indicating that livestock wastewater and human sanitary waste are one of principal sources of anthelmintics. Among anthelmintics, fenbendazole and its metabolites are relatively high in the LWTPs, while human anthelmintics such as albendazole and flubendazole are most dominant in the HTPs, STPs and HWTPs. The occurrence pattern of fenbendazole's metabolites in water was different from pharmacokinetics studies, showing the possibility of transformation mechanism other than the metabolism in animal bodies by some processes unknown to us. The river water and seawater are generally affected by the point sources, but the distribution patterns in some receiving water are slightly different from the effluent, indicating the influence of non-point sources. Copyright © 2013 Elsevier B.V. All rights reserved.

  6. Five-Year Data of Clinical Characteristics and Laboratory Findings of Hospitalized Hemophilic Patients in Dr. Hasan Sadikin General Hospital

    Directory of Open Access Journals (Sweden)

    Dina Marlina

    2016-12-01

    Full Text Available Background: Hemophilia A has the highest incidence, more than 80% of 172.323 cases worldwide in 2012. It is stated that clinical characteristics of hemophilia A is worse than others, so it is required to prove and to know further about the clinical characteristics and severity likelihood in all hemophilic patients in order to prevent re-bleeding and re-injury and also for a better medical response. Methods: A retrospective cross-sectional study was carried out to 43 medical records of hospitalized hemophilic patients from 2009 to 2013 in Dr Hasan Sadikin General Hospital. The inclusion criteria were a complete patient identity (name, age, sex, written chief complaint, complete physical examination (bleeding, edema, hematoma, hemarthrosis, anemic symptoms and laboratory test results (factor level, hemoglobin, hematocrit, platelet and Activated Partial Thromboplastin Time. The data was collected from August‒October 2014, analyzed and presented using frequency distribution. Results: Most of the patients were 5-10 years old, male and had hemophilia A. The most common complaint was external bleeding, followed by edema. From 43 patients, 38 (88% cases were classified as severe factor deficiency, had mild to severe anemia, however the platelet count in most of the cases was in normal value. About 91% cases had prolonged Activated Partial Thromboplastin Time in moderate to severe level. Conclusions: Similar with other studies worldwide, most of the hospitalized hemophilic patients have hemophilia A. Most of the patents has moderate to severe bleeding with laboratory test result between moderate to severe level as well.

  7. Determinants of hospitalization in Chinese patients with type 2 diabetes receiving a peer support intervention and JADE integrated care: the PEARL randomised controlled trial.

    Science.gov (United States)

    Yeung, Roseanne O; Cai, Jing-Heng; Zhang, Yuying; Luk, Andrea O; Pan, Jun-Hao; Yin, Junmei; Ozaki, Risa; Kong, Alice P S; Ma, Ronald; So, Wing-Yee; Tsang, Chiu Chi; Lau, K P; Fisher, Edwin; Goggins, Williams; Oldenburg, Brian; Chan, Julianna

    2018-01-01

    In a randomized controlled trial of 628 Chinese patients with type 2 diabetes receiving multidisciplinary care in the Joint Asia Diabetes Evaluation (JADE) Progam, 372 were randomized to receive additional telephone-based peer support (Peer Empowerment And Remote communication Linked by information technology, PEARL) intervention. After 12 months, all-cause hospitalization was reduced by half in the PEARL group especially in those with high Depression Anxiety and Stress Scale (DASS) scores. We used stratified analyses, negative binomial regression, and structural equation modelling (SEM) to examine the inter-relationships between emotions, self-management, cardiometabolic risk factors, and hospitalization. Hospitalized patients were older, more likely to have heart or kidney disease, and negative emotions than those without hospitalization. Patients with high DASS score who did not receive peer support had the highest hospitalization rates. After adjustment for confounders, peer support reduced the frequency of hospitalizations by 48% with a relative risk of 0.52 (95% CI 0·35-0·79; p  = 0·0018). Using SEM, improvement of negative emotions reduced treatment nonadherence (Est = 0.240, p  = 0.034) and hospitalizations (Est=-0.218, p  = 0.001). The latter was also reduced by an interactive term of peer support and chronic kidney disease (Est = 0.833, p  = diabetes, improvement of negative emotions and peer support reduced hospitalizations, especially in those with comorbidities, in part mediated through improving treatment nonadherence. Integrating peer support is feasible and adds value to multidisciplinary care, augmented by information technology, especially in patients with comorbidities. NCT00950716 Registered July 31, 2009.

  8. Assessing the Organizational Characteristics Influencing Quality Improvement Implementation in Saudi Hospitals.

    Science.gov (United States)

    Shamsuddin Alaraki, Mohammad

    The health care system in Saudi Arabia has serious problems with quality and safety that can be reduced through systematic quality improvement (QI) activities. Despite the use of different QI models to improve health care in Saudi hospitals during the last 2 decades, consistent improvements have not yet been achieved and the results are still far below expectations. This may reflect a problem in introducing and implementing the QI models in the local contexts. The objective of this study is to assess the extent of QI implementation in Saudi hospitals and to identify the organizational characteristics that make Saudi hospitals particularly challenging for QI. Understanding these characteristics can inform efforts to improve them and may lead to more successful implementation. A mixed-methods approach was conducted using 2 data collection tools: questionnaires and interviews. The quantitative phase (questionnaires) aimed to uncover the current level of QI implementation in Saudi hospital as measured by 7 critical dimensions adapted from the literature. The qualitative phase (interviews) aimed to understand the organizational characteristics that impede or underpin QI in Saudi hospitals. The QI implementation was found to be significantly poor across the 7 dimensions with average score ranging between 22.80 ± 0.57 and 2.11 ± 0.69 on a 5-point Likert scale and with P value of less than .05. We also found that the current level of QI implementation helped Saudi hospitals neither to improve "customer satisfaction" nor to achieve measurable improvements in "quality results" scoring significantly low at 2.11 ± 0.69 with P value of .000 and 2.47 ± 0.57 with P value of .000, respectively. Our study confirms the presence of a multitude of organizational barriers that impede QI in Saudi hospitals. These are related to organizational culture, human resources management, processes and systems, and structure. These 4 were found to have the strongest impact on QI in Saudi

  9. Interrelationships Between Receiver/Relative Operating Characteristics Display, Binomial, Logit, and Bayes' Rule Probability of Detection Methodologies

    Science.gov (United States)

    Generazio, Edward R.

    2014-01-01

    Unknown risks are introduced into failure critical systems when probability of detection (POD) capabilities are accepted without a complete understanding of the statistical method applied and the interpretation of the statistical results. The presence of this risk in the nondestructive evaluation (NDE) community is revealed in common statements about POD. These statements are often interpreted in a variety of ways and therefore, the very existence of the statements identifies the need for a more comprehensive understanding of POD methodologies. Statistical methodologies have data requirements to be met, procedures to be followed, and requirements for validation or demonstration of adequacy of the POD estimates. Risks are further enhanced due to the wide range of statistical methodologies used for determining the POD capability. Receiver/Relative Operating Characteristics (ROC) Display, simple binomial, logistic regression, and Bayes' rule POD methodologies are widely used in determining POD capability. This work focuses on Hit-Miss data to reveal the framework of the interrelationships between Receiver/Relative Operating Characteristics Display, simple binomial, logistic regression, and Bayes' Rule methodologies as they are applied to POD. Knowledge of these interrelationships leads to an intuitive and global understanding of the statistical data, procedural and validation requirements for establishing credible POD estimates.

  10. Effects of untreated hospital effluents on the accumulation of toxic metals in sediments of receiving system under tropical conditions: case of South India and Democratic Republic of Congo.

    Science.gov (United States)

    Mubedi, Josué Ilunga; Devarajan, Naresh; Le Faucheur, Séverine; Mputu, John Kayembe; Atibu, Emmanuel K; Sivalingam, Periyasamy; Prabakar, Kandasamy; Mpiana, Pius T; Wildi, Walter; Poté, John

    2013-10-01

    Physicochemical and ecotoxicological analyses have been performed to assess the quality of sediments receiving untreated hospital effluents from Indian and Democratic Republic of Congo (DRC) hospitals. The sediments were collected monthly and characterized for grain size, organic matter, total organic carbon, total carbon, nitrogen, phosphorus, toxic metals and ecotoxicity. The results highlight the high concentration of toxic metals from the Indian hospital effluent receiving systems, especially for Cr, Cu, As, Zn and Hg. On the other hand, the metal concentrations in the sediment receiving system from DRC are low (e.g. maximum Hg and Zn concentration were 0.46 and 48.84 mg kg(-1) respectively). Ostracods exposed to sediment samples H2 (September month sample) and H3 (June and September month samples) were found dead after 6d of exposure whereas the higher mortality rate for Congo sediments was 23% but was accompanied with 33 ± 7% of growth inhibition. The results of this study show the variation of sediment composition on toxic metal levels as well as toxicity related to both, the type of hospitals and the sampling period. Additionally, hospital effluent disposal practices at the study sites can lead to the pollution of water resources and may generate risks for aquatic organisms and human health. Copyright © 2013 Elsevier Ltd. All rights reserved.

  11. Hospitalized hemorrhagic stroke patients with renal insufficiency: clinical characteristics, care patterns, and outcomes.

    Science.gov (United States)

    Ovbiagele, Bruce; Schwamm, Lee H; Smith, Eric E; Grau-Sepulveda, Maria V; Saver, Jeffrey L; Bhatt, Deepak L; Hernandez, Adrian F; Peterson, Eric D; Fonarow, Gregg C

    2014-10-01

    There is a paucity of information on clinical characteristics, care patterns, and clinical outcomes for hospitalized intracerebral hemorrhage (ICH) patients with chronic kidney disease (CKD). We assessed characteristics, care processes, and in-hospital outcome among ICH patients with CKD in the Get With the Guidelines-Stroke (GWTG-Stroke) program. We analyzed 113,059 ICH patients hospitalized at 1472 US centers participating in the GWTG-Stroke program between January 2009 and December 2012. In-hospital mortality and use of 2 predefined ICH performance measures were examined based on glomerular filtration rate. Renal dysfunction was categorized as a dichotomous (+CKD = estimated glomerular filtration rate mortality was also higher for those with CKD (adjusted odds ratio [OR], 1.47; 95% confidence interval [CI], 1.42-1.52), mild dysfunction (adjusted OR, 1.12; 95% CI, 1.08-1.16), moderate dysfunction (adjusted OR, 1.46; 95% CI, 1.39-1.53), severe dysfunction (adjusted OR, 1.96; 95% CI, 1.81-2.12), and kidney failure (adjusted OR, 2.22; 95% CI, 2.04-2.43) relative to those with normal renal function. Chronic kidney disease is present in nearly a third of patients hospitalized with ICH and is associated with slightly worse care and substantially higher mortality than those with normal renal function. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  12. Experimental Design and Data Analysis in Receiver Operating Characteristic Studies: Lessons Learned from Reports in Radiology from 1997 to 20061

    Science.gov (United States)

    Shiraishi, Junji; Pesce, Lorenzo L.; Metz, Charles E.; Doi, Kunio

    2009-01-01

    Purpose: To provide a broad perspective concerning the recent use of receiver operating characteristic (ROC) analysis in medical imaging by reviewing ROC studies published in Radiology between 1997 and 2006 for experimental design, imaging modality, medical condition, and ROC paradigm. Materials and Methods: Two hundred ninety-five studies were obtained by conducting a literature search with PubMed with two criteria: publication in Radiology between 1997 and 2006 and occurrence of the phrase “receiver operating characteristic.” Studies returned by the query that were not diagnostic imaging procedure performance evaluations were excluded. Characteristics of the remaining studies were tabulated. Results: Two hundred thirty-three (79.0%) of the 295 studies reported findings based on observers' diagnostic judgments or objective measurements. Forty-three (14.6%) did not include human observers, with most of these reporting an evaluation of a computer-aided diagnosis system or functional data obtained with computed tomography (CT) or magnetic resonance (MR) imaging. The remaining 19 (6.4%) studies were classified as reviews or meta-analyses and were excluded from our subsequent analysis. Among the various imaging modalities, MR imaging (46.0%) and CT (25.7%) were investigated most frequently. Approximately 60% (144 of 233) of ROC studies with human observers published in Radiology included three or fewer observers. Conclusion: ROC analysis is widely used in radiologic research, confirming its fundamental role in assessing diagnostic performance. However, the ROC studies reported in Radiology were not always adequate to support clear and clinically relevant conclusions. © RSNA, 2009 Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.2533081632/-/DC1 PMID:19864510

  13. Do coder characteristics influence validity of ICD-10 hospital discharge data?

    Directory of Open Access Journals (Sweden)

    Beck Cynthia A

    2010-04-01

    Full Text Available Abstract Background Administrative data are widely used to study health systems and make important health policy decisions. Yet little is known about the influence of coder characteristics on administrative data validity in these studies. Our goal was to describe the relationship between several measures of validity in coded hospital discharge data and 1 coders' volume of coding (≥13,000 vs. Methods This descriptive study examined 6 indicators of face validity in ICD-10 coded discharge records from 4 hospitals in Calgary, Canada between April 2002 and March 2007. Specifically, mean number of coded diagnoses, procedures, complications, Z-codes, and codes ending in 8 or 9 were compared by coding volume and employment status, as well as hospital type. The mean number of diagnoses was also compared across coder characteristics for 6 major conditions of varying complexity. Next, kappa statistics were computed to assess agreement between discharge data and linked chart data reabstracted by nursing chart reviewers. Kappas were compared across coder characteristics. Results 422,618 discharge records were coded by 59 coders during the study period. The mean number of diagnoses per record decreased from 5.2 in 2002/2003 to 3.9 in 2006/2007, while the number of records coded annually increased from 69,613 to 102,842. Coders at the tertiary hospital coded the most diagnoses (5.0 compared with 3.9 and 3.8 at other sites. There was no variation by coder or site characteristics for any other face validity indicator. The mean number of diagnoses increased from 1.5 to 7.9 with increasing complexity of the major diagnosis, but did not vary with coder characteristics. Agreement (kappa between coded data and chart review did not show any consistent pattern with respect to coder characteristics. Conclusions This large study suggests that coder characteristics do not influence the validity of hospital discharge data. Other jurisdictions might benefit from

  14. Patient, hospital, and local health system characteristics associated with the use of observation stays in veterans health administration hospitals, 2005 to 2012

    OpenAIRE

    Wright, Brad; O'Shea, Amy M.J.; Glasgow, Justin M.; Ayyagari, Padmaja; Vaughan-Sarrazin, Mary

    2016-01-01

    Abstract Recent studies have documented that a significant increase in the use of observation stays along with extensive variation in patterns of use across hospitals. The objective of this longitudinal observational study was to examine the extent to which patient, hospital, and local health system characteristics explain variation in observation stay rates across Veterans Health Administration (VHA) hospitals. Our data came from years 2005 to 2012 of the nationwide VHA Medical SAS inpatient...

  15. Do audiences receive diverse ideas from news media? Exposure to a variety of news media and personal characteristics as determinants of diversity as received

    NARCIS (Netherlands)

    van der Wurff, R.

    2011-01-01

    Media policies in Europe traditionally promote a diverse media supply. This article investigates for the first time under what conditions audience members actually receive diversity. It focuses on the reception of diverse ideas on European integration from mainstream news media in Ireland and the

  16. Evaluation of factors associated with the difficulty in finding receiving hospitals for traffic accident patients at the scene treated by emergency medical services: a population-based study in Osaka City, Japan.

    Science.gov (United States)

    Katayama, Yusuke; Kitamura, Tetsuhisa; Kiyohara, Kosuke; Iwami, Taku; Kawamura, Takashi; Hayashida, Sumito; Ogura, Hiroshi; Shimazu, Takeshi

    2017-10-01

    Although the prolongation of the time between injury and hospital arrival of traffic accident patients can influence their prognosis, factors associated with the difficulty in hospital acceptance of these patients have not been sufficiently evaluated in Japan. We retrospectively analyzed the population-based ambulance records of all traffic accident patients for whom the Osaka Municipal Fire Department (Osaka City, Japan) dispatched an ambulance in 2013. We defined "cases with difficulty in hospital acceptance" as cases that required ≥4 calls by emergency medical service personnel at the scene before receiving hospital acceptance. We included patient characteristics (age, sex, coma status, and trauma severity judged by emergency medical service personnel), time factors (day/night or weekday/holiday and weekends), and accident location for multivariable logistic regression analysis to assess factors associated with the difficulty in hospital acceptance. Among 13,427 traffic accident patients, 2,033 (15.1%) were cases with difficulty in hospital acceptance. Pediatric patients (adjusted odds ratio [OR], 1.265; 95% confidence interval [CI], 1.060-1.509), male sex (adjusted OR, 1.260; 95% CI, 1.135-1.398), moderate-grade trauma (adjusted OR, 2.241; 95% CI, 1.972-2.547), severe-grade trauma (adjusted OR, 2.057; 95% CI, 1.249-3.388), holidays and weekends (adjusted OR, 1.702; 95% CI, 1.539-1.882), and night-time (adjusted OR, 2.720; 95% CI, 2.443-3.027) were positively associated with difficulty in hospital acceptance. Using population-based ambulance records from a large urban community in Japan, we showed that the difficulty in hospital acceptance of patients at the scene of traffic accidents was positively associated with several prehospital factors.

  17. Patient, hospital, and local health system characteristics associated with the use of observation stays in veterans health administration hospitals, 2005 to 2012.

    Science.gov (United States)

    Wright, Brad; OʼShea, Amy M J; Glasgow, Justin M; Ayyagari, Padmaja; Vaughan-Sarrazin, Mary

    2016-09-01

    Recent studies have documented that a significant increase in the use of observation stays along with extensive variation in patterns of use across hospitals.The objective of this longitudinal observational study was to examine the extent to which patient, hospital, and local health system characteristics explain variation in observation stay rates across Veterans Health Administration (VHA) hospitals.Our data came from years 2005 to 2012 of the nationwide VHA Medical SAS inpatient and enrollment files, American Hospital Association Survey, and Area Health Resource File. We used these data to estimate linear regression models of hospitals' observation stay rates as a function of hospital, patient, and local health system characteristics, while controlling for time trends and Veterans Integrated Service Network level fixed effects.We found that observation stay rates are inversely related to hospital bed size and that hospitals with a greater proportion of younger or rural patients have higher observation stay rates. Observation stay rates were nearly 15 percentage points higher in 2012 than 2005.Although we identify several characteristics associated with variation in VHA hospital observation stay rates, many factors remain unmeasured.

  18. Friendliness, functionality and freedom: Design characteristics that support midwifery practice in the hospital setting.

    Science.gov (United States)

    Hammond, Athena; Homer, Caroline S E; Foureur, Maralyn

    2017-07-01

    to identify and describe the design characteristics of hospital birth rooms that support midwives and their practice. this study used a qualitative exploratory descriptive methodology underpinned by the theoretical approach of critical realism. Data was collected through 21 in-depth, face-to-face photo-elicitation interviews and a thematic analysis guided by study objectives and the aims of exploratory research was undertaken. the study was set at a recently renovated tertiary hospital in a large Australian city. participants were 16 registered midwives working in a tertiary hospital; seven in delivery suite and nine in birth centre settings. Experience as a midwife ranged from three to 39 years and the sample included midwives in diverse roles such as educator, student support and unit manager. three design characteristics were identified that supported midwifery practice. They were friendliness, functionality and freedom. Friendly rooms reduced stress and increased midwives' feelings of safety. Functional rooms enabled choice and provided options to better meet the needs of labouring women. And freedom allowed for flexible, spontaneous and responsive midwifery practice. hospital birth rooms that possess the characteristics of friendliness, functionality and freedom offer enhanced support for midwives and may therefore increase effective care provision. new and existing birth rooms can be designed or adapted to better support the wellbeing and effectiveness of midwives and may thereby enhance the quality of midwifery care delivered in the hospital. Quality midwifery care is associated with positive outcomes and experiences for labouring women. Further research is required to investigate the benefit that may be transmitted to women by implementing design intended to support and enhance midwifery practice. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

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

    2017-01-01

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

  20. Associations of Hospital and Patient Characteristics with Fluid Resuscitation Volumes in Patients with Severe Sepsis

    DEFF Research Database (Denmark)

    Hjortrup, Peter Buhl; Haase, Nicolai; Wetterslev, Jørn

    2016-01-01

    PURPOSE: Fluid resuscitation is a key intervention in patients with sepsis and circulatory impairment. The recommendations for continued fluid therapy in sepsis are vague, which may result in differences in clinical practice. We aimed to evaluate associations between hospital and patient characte....... The data indicate variations in clinical practice not explained by patient characteristics emphasizing the need for RCTs assessing fluid resuscitation volumes fluid in patients with sepsis.......PURPOSE: Fluid resuscitation is a key intervention in patients with sepsis and circulatory impairment. The recommendations for continued fluid therapy in sepsis are vague, which may result in differences in clinical practice. We aimed to evaluate associations between hospital and patient...... characteristics and fluid resuscitation volumes in ICU patients with severe sepsis. METHODS: We explored the 6S trial database of ICU patients with severe sepsis needing fluid resuscitation randomised to hydroxyethyl starch 130/0.42 vs. Ringer's acetate. Our primary outcome measure was fluid resuscitation volume...

  1. Receiver operating characteristic analysis and its potential role in evaluating the effect of head movement in PET of the brain

    International Nuclear Information System (INIS)

    Patterson, H.; Clarke, G.H.; Lombardo, P.; McKay, W.J.; Austin and Repatriation Medical Centre, Heidelberg, VIC

    1999-01-01

    Full text: We outline an example of receiver operating characteristic (ROC) analysis in the assessment of image quality. ROC analysis is a measure of image quality that accounts for the consequences of the decision and the role of the observer. Kim and Haynie (Nuclear Diagnostic Imaging: Practical Clinical Applications. Melbourne: Macmillan, 1987) describe ROC analysis as an 'objective approach to the evaluation of diagnostic decision making'. ROC analysis is an ideal technique for evaluating images of a Hoffman brain phantom obtained using positron emission tomography. Images have been acquired with the phantom in different positions. The position of the phantom and the time the phantom remained in each position was based on the measurements of head movement during simulated brain imaging (Patterson et al., Technologists Symposium, ANZSNM, 1998). This study was undertaken to explore the potential of ROC analysis in determining the effect of movement on the ability to detect lesions of various sizes

  2. A Primer on Receiver Operating Characteristic Analysis and Diagnostic Efficiency Statistics for Pediatric Psychology: We Are Ready to ROC

    Science.gov (United States)

    2014-01-01

    Objective To offer a practical demonstration of receiver operating characteristic (ROC) analyses, diagnostic efficiency statistics, and their application to clinical decision making using a popular parent checklist to assess for potential mood disorder. Method Secondary analyses of data from 589 families seeking outpatient mental health services, completing the Child Behavior Checklist and semi-structured diagnostic interviews. Results Internalizing Problems raw scores discriminated mood disorders significantly better than did age- and gender-normed T scores, or an Affective Problems score. Internalizing scores 30 had a diagnostic likelihood ratio of 7.4. Conclusions This study illustrates a series of steps in defining a clinical problem, operationalizing it, selecting a valid study design, and using ROC analyses to generate statistics that support clinical decisions. The ROC framework offers important advantages for clinical interpretation. Appendices include sample scripts using SPSS and R to check assumptions and conduct ROC analyses. PMID:23965298

  3. Verification of a model for the detection of intrauterine growth restriction (IUGR) by receiver operating characteristics (ROC)

    Science.gov (United States)

    Liu, Pengbo; Mongelli, Max; Mondry, Adrian

    2004-07-01

    The purpose of this study is to verify by Receiver Operating Characteristics (ROC) a mathematical model supporting the hypothesis that IUGR can be diagnosed by estimating growth velocity. The ROC compare computerized simulation results with clinical data from 325 pregnant British women. Each patient had 6 consecutive ultrasound examinations for fetal abdominal circumference (fac). Customized and un-customized fetal weights were calculated according to Hadlock"s formula. IUGR was diagnosed by the clinical standard, i.e. estimated weight below the tenth percentile. Growth velocity was estimated by calculating the changes of fac (Dzfac/dt) at various time intervals from 3 to 10 weeks. Finally, ROC was used to compare the methods. At 3~4 weeks scan interval, the area under the ROC curve is 0.68 for customized data and 0.66 for the uncustomized data with 95% confidence interval. Comparison between simulation data and real pregnancies verified that the model is clinically acceptable.

  4. Informing Leadership Models: Nursing and Organizational Characteristics of Neonatal Intensive Care Units in Freestanding Children's Hospitals.

    Science.gov (United States)

    Toole, Cheryl A; DeGrazia, Michele; Connor, Jean Anne; Gauvreau, Kimberlee; Kuzdeba, Hillary Bishop; Hickey, Patricia A

    Neonatal intensive care units (NICUs) located in freestanding children's hospitals may exhibit significant variation in nursing and organizational characteristics, which can serve as opportunities for collaboration to understand optimal staffing models and linkages to patient outcomes. Adopting methods used by Hickey et al in pediatric cardiovascular critical care, the purpose of this study was to provide a foundational description of the nursing and organizational characteristics for NICUs located in freestanding children's hospitals in the United States. Clinical nurse leaders in NICUs located in freestanding children's hospitals were invited to participate in an electronic cross-sectional survey. Descriptive analyses were used to summarize nursing and organizational characteristics. The response rate was 30% (13/43), with 69.2% of NICUs classified as level III/IV and 30.8% classified as level II/III. Licensed bed capacity varied significantly (range, 24-167), as did the proportion of full-time equivalent nurses (range, 71.78-252.3). Approximately three-quarters of staff nurses held baccalaureate degrees or higher. A quarter of nurses had 16 or more years (26.3%) of experience, and 36.9% of nurses had 11 or more years of nursing experience. Nearly one-third (29.2%) had 5 or less years of total nursing experience. Few nurses (10.6%) held neonatal specialty certification. All units had nurse educators, national and unit-based quality metrics, and procedural checklists. This study identified (1) variation in staffing models signaling an opportunity for collaboration, (2) the need to establish ongoing processes for sites to participate in future collaborative efforts, and (3) survey modifications necessary to ensure a more comprehensive understanding of nursing and organizational characteristics in freestanding children's hospital NICUs.

  5. Medication adherence and utilization in patients with schizophrenia or bipolar disorder receiving aripiprazole, quetiapine, or ziprasidone at hospital discharge: A retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Berger Ariel

    2012-08-01

    Full Text Available Abstract Background Schizophrenia and bipolar disorder are chronic debilitating disorders that are often treated with second-generation antipsychotic agents, such as aripiprazole, quetiapine, and ziprasidone. While patients who are hospitalized for schizophrenia and bipolar disorder often receive these agents at discharge, comparatively little information exists on subsequent patterns of pharmacotherapy. Methods Using a database linking hospital admission records to health insurance claims, we identified all patients hospitalized for schizophrenia (ICD-9-CM diagnosis code 295.XX or bipolar disorder (296.0, 296.1, 296.4-296.89 between January 1, 2001 and September 30, 2008 who received aripiprazole, quetiapine, or ziprasidone at discharge. Patients not continuously enrolled for 6 months before and after hospitalization (“pre-admission” and “follow-up”, respectively were excluded. We examined patterns of use of these agents during follow-up, including adherence with treatment (using medication possession ratios [MPRs] and cumulative medication gaps [CMGs] and therapy switching. Analyses were undertaken separately for patients with schizophrenia and bipolar disorder, respectively. Results We identified a total of 43 patients with schizophrenia, and 84 patients with bipolar disorder. During the 6-month period following hospitalization, patients with schizophrenia received an average of 101 therapy-days with the second-generation antipsychotic agent prescribed at discharge; for patients with bipolar disorder, the corresponding value was 68 therapy-days. Mean MPR at 6 months was 55.1% for schizophrenia patients, and 37.3% for those with bipolar disorder; approximately one-quarter of patients switched to another agent over this period. Conclusions Medication compliance is poor in patients with schizophrenia or bipolar disorder who initiate treatment with aripiprazole, quetiapine, or ziprasidone at hospital discharge.

  6. Research Article. Characteristics of Sleep Apnea Assessed Before Discharge in Patients Hospitalized with Acute Heart Failure

    Directory of Open Access Journals (Sweden)

    Kocsis Ildikó

    2017-03-01

    Full Text Available Objectives. Evaluation of the characteristics of sleep apnea (SA in patients hospitalized with acute heart failure, considering that undiagnosed SA could contribute to early rehospitalization. Methods. 56 consecutive patients (13 women, 43 men, mean age 63.12 years with acute heart failure, in stable condition, underwent nocturnal polygraphy before hospital discharge. The type and severity of SA was determined. Besides descriptive statistics, correlations between the severity of SA and clinical and paraclinical characteristics were also analyzed (t-test, chi-square test, significancy at alpha 30/h. The apnea was predominantly obstructive (32 cases vs. 12 with central SA. Comparing the patients with mild or no SA with those with severe SA, we did not find statistically significant correlations (p>0.05 between the severity of SA and the majority of main clinical and paraclinical characteristics - age, sex, BMI, cardiac substrates of heart failure, comorbidities. Paradoxically, arterial hypertension (p=0.028 and atrial fibrillation (p=0.041 were significantly more prevalent in the group with mild or no SA. Conclusions. Before discharge, in the majority of patients hospitalized with acute heart failure moderate and severe SA is present, and is not related to the majority of patient related factors. Finding of significant SA in this setting is important, because its therapy could play an important role in preventing readmissions and improving prognosis.

  7. Organizational characteristics associated with cultural and linguistic service provision within Alabama hospitals.

    Science.gov (United States)

    Davis, Jullet A; Whitman, Marilyn V

    2008-01-01

    Like several states in the Southeast, Alabama is in the nascent stages of an increase in the population of foreign-born individuals for whom English is a second language. These individuals are also culturally different from the traditional southern population. Given the impact of culture and language on a person's service utilization, the introduction of new cultures may pose significant challenges for Alabama's health care providers if they are not prepared. The purpose of this project is to examine the organizational characteristics associated with the provision of culturally and linguistically appropriate services by Alabama hospitals. The data for the project come from a survey of all medical/surgical hospitals (N = 101). Fifty-nine surveys were returned, giving us a 58% response rate. The data were analyzed using correlations, analysis of variance, and logistic regression. Approximately 47% of the sample hospitals reported having a staff interpreter. Furthermore, hospitals that had staff interpreters did seem to be more aware of their community, which was reflected in their mission statements. In addition, directors who viewed their role as fulfilling the strategic plan accepted the task of providing staff interpreters. Thus, several hospitals in Alabama seemed to be ready to meet the cultural and language needs of their markets.

  8. Hospital costs estimation and prediction as a function of patient and admission characteristics.

    Science.gov (United States)

    Ramiarina, Robert; Almeida, Renan Mvr; Pereira, Wagner Ca

    2008-01-01

    The present work analyzed the association between hospital costs and patient admission characteristics in a general public hospital in the city of Rio de Janeiro, Brazil. The unit costs method was used to estimate inpatient day costs associated to specific hospital clinics. With this aim, three "cost centers" were defined in order to group direct and indirect expenses pertaining to the clinics. After the costs were estimated, a standard linear regression model was developed for correlating cost units and their putative predictors (the patients gender and age, the admission type (urgency/elective), ICU admission (yes/no), blood transfusion (yes/no), the admission outcome (death/no death), the complexity of the medical procedures performed, and a risk-adjustment index). Data were collected for 3100 patients, January 2001-January 2003. Average inpatient costs across clinics ranged from (US$) 1135 [Orthopedics] to 3101 [Cardiology]. Costs increased according to increases in the risk-adjustment index in all clinics, and the index was statistically significant in all clinics except Urology, General surgery, and Clinical medicine. The occupation rate was inversely correlated to costs, and age had no association with costs. The (adjusted) per cent of explained variance varied between 36.3% [Clinical medicine] and 55.1% [Thoracic surgery clinic]. The estimates are an important step towards the standardization of hospital costs calculation, especially for countries that lack formal hospital accounting systems.

  9. Suicidal behaviour characteristics and factors associated with mortality in the hospital setting.

    Science.gov (United States)

    Sendra-Gutiérrez, Juan Manuel; Esteban-Vasallo, María; Domínguez-Berjón, M Felicitas

    2016-04-29

    Suicide is a major public health problem worldwide, and an approach is necessary due to its high potential for prevention. This paper examines the main characteristics of people admitted to hospitals in the Community of Madrid (Spain) with suicidal behaviour, and the factors associated with their hospital mortality. A study was conducted on patients with E950-E959 codes of suicide and self-inflicted injuries of the International Classification of Diseases, Ninth Revision, Clinical Modification, contained in any diagnostic field of the minimum basic data set at hospital discharge between 2003 and 2013. Sociodemographic, clinical and health care variables were assessed by uni- and multivariate logistic regression analysis in the evaluation of factors associated with hospital mortality. Hospital suicidal behaviour predominates in women (58.7%) and in middle-age. Hospital mortality is 2.2% (1.6% in women and 3.2% in men), increasing with age. Mental disorders are detected 3-4 times more in secondary diagnoses. The main primary diagnosis (>74%) is poisoning with substances, with lower mortality (∼1%) than injury by hanging and jumping from high places (≥12%), which have the highest numbers. Other factors associated with increased mortality include different medical comorbidities and severity of the injury, while length of stay and mental disorders are protective factors. Type of hospital, poisoning, and Charlson index are associated differently with mortality in men and women. Hospitalised suicidal acts show a low mortality, mainly related to comorbidities and the severity of injuries. Copyright © 2016 SEP y SEPB. Published by Elsevier España. All rights reserved.

  10. Reasons for not receiving thrombolytic therapy in patients with acute myocardial infarction admitted to Bu-Ali Sina Hospital in Qazvin (2013-14)

    OpenAIRE

    MM. Daei; M. Karimi Rad; M. Khalaja

    2017-01-01

    This hospital-based cross-sectional study was conducted in 2013-14 in Qazvin Bu-Ali Sina Hospital. 170 patients with acute myocardial infarction who not receiving thrombolytic therapy entered the study and were analyzed. Medical history, physical examination, twelve lead ECG and cardiac biomarkers were obtained. The mean age of the patients was 63.4±14.4 years (from 19 to 90 years). 110 (64.7%) of the patients were male and 48 (28.2%) were diabetic. 86 (50%) of patients due to late present...

  11. Prevalence of diabetes mellitus among pregnant women receiving health services at the Puerto Rico University Hospital, Puerto Rico, 1997-1998.

    Science.gov (United States)

    Acosta, I; Aponte, Z; de-Jesús, Z; de-León, A; González, M C; Hernández, J; Martínez, P; Santos, E R; Pérez-Perdomo, R

    2001-06-01

    To estimate the prevalence and to describe the clinical characteristics of gestational diabetes mellitus (GDM) in pregnant women receiving health care services at the Puerto Rico University Hospital from 1997 to 1998. The study design was cross-sectional. All medical records available of pregnant women diagnosed with GDM were retrospectively reviewed. Descriptive statistics such as frequency distributions and summary measures (mean and standard deviation) were used. Annual and 18-month period prevalences of GDM were calculated. Fisher's exact test was used to compare proportions. A total of 78 medical records were available during the 18-month study period (June 1997 to December 1998). The estimated prevalence of GDM was 2% for the total study period (18-month) as well as for the year 1998. The highest proportion (52.3%) of GDM cases was found in the 30 years or less age group. Forty-eight percent had a body mass index (BMI) > or = 30 m/kg2 (obese) before pregnancy; however, the weight gained during the last pregnancy was higher than 15 pounds (57%). Sixty-four percent of the cases had a family history of diabetes, meanwhile, 34.7% reported a history of GDM during previous pregnancies. During the first prenatal visit, 80.5% reflected glucose levels higher than 110 mg/ml. Preeclampsia (6.4%) and macrosomia (14%) were the most frequent complications for the mother and the fetus, respectively. More epidemiological studies about GMD in Puerto Rico need to be performed to better describe the prevalence of the condition in the island.

  12. Community-associated urinary infections requiring hospitalization: risk factors, microbiological characteristics and patterns of antibiotic resistance.

    Science.gov (United States)

    Medina-Polo, J; Guerrero-Ramos, F; Pérez-Cadavid, S; Arrébola-Pajares, A; Sopeña-Sutil, R; Benítez-Sala, R; Jiménez-Alcaide, E; García-González, L; Alonso-Isa, M; Lara-Isla, A; Passas-Martínez, J B; Tejido-Sánchez, Á

    2015-03-01

    Although patients with urinary tract infections (UTIs) are usually managed as outpatients, a percentage of them requires hospitalization. To review risk factors and microbiological characteristics of community-associated UTIs (CAUTIs) requiring hospitalization has been our objective. A prospective observational study was carried out from November 2011 to December 2013. Incidence, microbiological characteristics and antibiotic resistance patterns in patients with CAUTIs that required hospitalization were analyzed. Risk factors (including diabetes mellitus, urolithiasis, urinary catheterization) and resistance rates of each pathogen were also analyzed. Four hundred and fifty seven patients were hospitalized in our department with CAUTI. The mean age was 56.2±19.85 years. Of them, 52.1% patients were women, 19.7% had urinary indwelling catheter and 11.4% have had a previous UTI. The most frequently isolated pathogens were Escherichia coli (60.6%), followed by Klebsiella (9.2%), Enterococcus (8.4%) and Pseudomonas (7.2%). Enterobacteriaceae other than E.coli were more prevalent in male and older patients. On the other side the most frequently isolated pathogen in patients with a previous UTI and a urinary catheter was Entercoccus. The resistance rates E. coli against ampicillin/amoxicillin + β lactamase inhibitor was 23.5%, against third-generation cephalosporins 16.6%, against fluoroquinolones 31.3% and 16.7% against aminoglycosides. 11.4% E. coli strains were producers of extended-spectrum Beta-lactamases (ESBL). Finally, the resistance rates of Enterococcus and Pseudomonas against quinolones were of 50.0% and 61.5%, respectively. CAUTIs that require hospitalization are most frequent in older age, male gender, and presence of urinary catheter, with urolithiasis and with previous episodes of UTI. These factors are also related to isolation of pathogens other than E. coli and higher resistance rates. Copyright © 2014 AEU. Publicado por Elsevier España, S.L.U. All

  13. [Social demographic characteristics and the elderly care after hospital discharge in the family health system].

    Science.gov (United States)

    Marin, Maria José Sanches; Bazaglia, Fernanda Crizol; Massarico, Aline Ribeiro; Silva, Camila Batista Andrade; Campos, Rita Tiagor; Santos, Simone de Carvalho

    2010-12-01

    The objective of this study was o verify the sociodemographic profile of the elderly and the health care service they receive from the Family Health Strategy (FHS) after their discharge. This is a descriptive study, and data collection was performed with 67 aged individuals who were discharged in October, November and December, 2007, and lived in the area covered by the FHS of Marília (São Paulo state). Simple descriptive analysis was used for the presentation of data. The majority of the elderly are female, and their hospitalization occurred as a referral of the Emergency Room due to complication. More than two thirds report they were visited by FHS team professionals, mainly the Community Health Agent (CHA), but they suggested the team should follow up closer. In conclusion, it is necessary to develop a new health care model for the elderly after hospital discharge.

  14. Associations between teaching effectiveness scores and characteristics of presentations in hospital medicine continuing education.

    Science.gov (United States)

    Ratelle, John T; Wittich, Christopher M; Yu, Roger C; Newman, James S; Jenkins, Sarah M; Beckman, Thomas J

    2015-09-01

    There is little research regarding characteristics of effective continuing medical education (CME) presentations in hospital medicine (HM). Therefore, we sought to identify associations between validated CME teaching effectiveness scores and characteristics of CME presentations in the field of HM. This was a cross-sectional study of participants and didactic presentations from a national HM CME course in 2014. Participants provided CME teaching effectiveness (CMETE) ratings using an instrument with known validity evidence. Overall CMETE scores (5-point scale: 1 = strongly disagree; 5 = strongly agree) were averaged for each presentation, and associations between scores and presentation characteristics were determined using the Kruskal-Wallis test. The threshold for statistical significance was set at P teaching effectiveness scores and characteristics of effective CME presentations in HM. Our findings, which support previous research in other fields, indicate that CME presentations may be improved by increasing interactivity through the use of audience response systems and allowing longer presentations. © 2015 Society of Hospital Medicine.

  15. Family Caregiver Knowledge, Patient Illness Characteristics, and Unplanned Hospital Admissions in Older Adults With Cancer.

    Science.gov (United States)

    Geddie, Patricia I; Wochna Loerzel, Victoria; Norris, Anne E

    2016-07-01

    To explore factors related to unplanned hospital admissions and determine if one or more factors are predictive of unplanned hospital admissions for older adults with cancer.
. A prospective longitudinal design and a retrospective chart review.
. Adult oncology outpatient infusion centers and inpatient units at Orlando Regional Medical Center in Florida.
. A convenience sample of 129 dyads of older adults with cancer and their family caregivers. 
. Family caregiver demographic and side effect knowledge data were collected prospectively during interviews with family caregivers using a newly developed tool, the Nurse Assessment of Family Caregiver Knowledge and Action Tool. Patient demographic and clinical data were obtained through a retrospective chart review. Descriptive statistics and logistic regression analyses were used to evaluate data and examine relationships among variables.
. Patient illness characteristics; impaired function; side effects, such as infection, fever, vomiting, and diarrhea; family caregiver knowledge; and unplanned hospital admissions.
. Unplanned hospital admissions were more likely to occur when older adults had impaired function and side effects, such as infection, fever, vomiting, and diarrhea. Impaired function and family caregiver knowledge did not moderate the effects of these side effects on unplanned hospital admissions. 
. Findings suggest that the presence of impaired function and side effects, such as infection, fever, vomiting, and diarrhea, predict unplanned hospital admissions in older adults with cancer during the active treatment phase. Side effects may or may not be related to chemotherapy and may be related to preexisting comorbidities. 
. Nurses can conduct targeted assessments to identify older adults and their family caregivers who will need additional follow-up and support during the cancer treatment trajectory. Information gained from these assessments will assist nurses to provide practical and

  16. Evaluation of an impedance threshold device in patients receiving active compression-decompression cardiopulmonary resuscitation for out of hospital cardiac arrest.

    Science.gov (United States)

    Plaisance, Patrick; Lurie, Keith G; Vicaut, Eric; Martin, Dominique; Gueugniaud, Pierre-Yves; Petit, Jean-Luc; Payen, Didier

    2004-06-01

    The purpose of this multicentre clinical randomized controlled blinded prospective trial was to determine whether an inspiratory impedance threshold device (ITD), when used in combination with active compression-decompression (ACD) cardiopulmonary resuscitation (CPR), would improve survival rates in patients with out-of-hospital cardiac arrest. Patients were randomized to receive either a sham (n = 200) or an active impedance threshold device (n = 200) during advanced cardiac life support performed with active compression-decompression cardiopulmonary resuscitation. The primary endpoint of this study was 24 h survival. The 24 h survival rates were 44/200 (22%) with the sham valve and 64/200 (32%) with the active valve (P = 0.02). The number of patients who had a return of spontaneous circulation (ROSC), intensive care unit (ICU) admission, and hospital discharge rates was 77 (39%), 57 (29%), and 8 (4%) in the sham valve group versus 96 (48%) (P = 0.05), 79 (40%) (P = 0.02), and 10 (5%) (P = 0.6) in the active valve group. Six out of ten survivors in the active valve group and 1/8 survivors in the sham group had normal neurological function at hospital discharge (P = 0.1). The use of an impedance valve in patients receiving active compression-decompression cardiopulmonary resuscitation for out-of-hospital cardiac arrest significantly improved 24 h survival rates.

  17. Sociodemographic and Clinical Characteristics of Patients attending Psychotherapy in a Tertiary Care Hospital in Oman

    Directory of Open Access Journals (Sweden)

    Zena Al-Sharbati

    2012-02-01

    Full Text Available Objectives: There is significant evidence that psychotherapy is a pivotal treatment for persons diagnosed with Axis I clinical psychiatric conditions; however, a psychotherapy service has only recently been established in the Omani health care system. This study aimed to investigate the sociodemographic and clinical characteristics of attendees at a psychotherapy clinic at a tertiary care hospital. Methods: An analysis was carried out of 133 new referrals to the Psychotherapy Service at Sultan Qaboos University Hospital, a tertiary care hospital. Results: The majority of referrals were females (59%, aged 18–34 years, employed (38%, had ≤12 years of formal education (51%, and were single (54%. A total of 43% were treated for anxiety disorders (including obsessive compulsive disorder, while 22% were treated for depression. A total of 65% were prescribed psychotropic medications. The utilisation of the Psychotherapy Service and its user characteristics are discussed within the context of a culturally diverse Omani community which has unique personal belief systems such as in supernatural powers (Jinn, contemptuous envy (Hassad, evil eye (Ain and sorcery (Sihr which are often used to explain the aetiology of mental illness and influence personal decisions on utilising medical and psychological treatments. Conclusion: Despite the low number of referrals to the Psychotherapy Service, there is reason to believe that psychotherapy would be an essential tool to come to grips with the increasing number of mental disorders in Oman.

  18. Health literacy, numeracy, and other characteristics associated with hospitalized patients' preferences for involvement in decision making.

    Science.gov (United States)

    Goggins, Kathryn M; Wallston, Kenneth A; Nwosu, Samuel; Schildcrout, Jonathan S; Castel, Liana; Kripalani, Sunil

    2014-01-01

    Little research has examined the association of health literacy and numeracy with patients' preferred involvement in the problem-solving and decision-making process in the hospital. Using a sample of 1,249 patients hospitalized with cardiovascular disease from the Vanderbilt Inpatient Cohort Study (VICS), we assessed patients' preferred level of involvement using responses to two scenarios of differing symptom severity from the Problem-Solving Decision-Making Scale. Using multivariable modeling, we determined the relationship of health literacy, subjective numeracy, and other patient characteristics with preferences for involvement in decisions, and how this differed by scenario. The authors found that patients with higher levels of health literacy desired more participation in the problem-solving and decision-making process, as did patients with higher subjective numeracy skills, greater educational attainment, female gender, less perceived social support, or greater health care system distrust (pparticipate more in the decision-making process when the hypothetical symptom they were experiencing was less severe (i.e., they deferred more to their physician when the hypothetical symptom was more severe). These findings underscore the role that patient characteristics, especially health literacy and numeracy, play in decisional preferences among hospitalized patients.

  19. [Characteristics of cases hospitalized for severe pandemic (H1N1) 2009 in Catalonia].

    Science.gov (United States)

    Godoy, Pere; Rodés, Anna; Alvarez, Josep; Camps, Neus; Barrabeig, Irene; Sala, María Rosa; Minguell, Sofía; Lafuente, Sarah; Pumarola, Tomás; Domínguez, Angela; Plasència, Antoni

    2011-01-01

    Influenza pandemics may cause more severe cases. The objective was to determine the characteristics of hospitalized severe cases of pandemic influenza in Catalonia and to study risk factors for admission to intensive care unit (ICU). A prospective epidemiologic study of new cases of pandemic influenza hospitalized by their severity between June 2009 and May 2010. Hospitals were asked to declare laboratory confirmed pandemic influenza cases that met the case specific case definition for severe case. A standardized epidemiological survey was conducted to collect information on demographics, clinical characteristics, risk factors, treatment and outcome. Differences between the cases in ICU compared to other severe cases were studied with the odds ratio (OR), which were adjusted using a logistic regression model. We detected total of 773 pandemic influenza (H1N1) 2009 severe cases; 465 (60.2%) of them had at least one risk factor and the most prevalent were: pregnancy 19 (13%), asthma 87 (12%), chronic obstructive pulmonary disease 87 (11.4%) and heart disease 80 (10.5%). Required admission to ICU 293 patients (37.9%). Factors associated with ICU admission were obesity BMI>40 (adjusted OR = 2.5, 95% CI 1.4-4.5) and chronic liver disease (adjusted OR = 2.3, 95% CI 1.1-4.8). This study confirms the high prevalence of pregnancy, chronic respiratory diseases, diabetes and obesity among pandemic influenza severe cases. Obesity acts as a risk factor for ICU admission and should therefore be considered as an indicator for influenza vaccination.

  20. Characteristics of registration of medical records in a hospital in southern Peru

    Directory of Open Access Journals (Sweden)

    Cender Udai Quispe-Juli

    2016-04-01

    Full Text Available Objective: To determine the characteristics of registration of medical records of hospitalization in the Hospital III Yanahuara in Arequipa, Peru. Material and methods: The study was observational, cross-sectional and retrospective. 225 medical records of hospitalization were evaluated in November 2015. A tab consisting of 15 items was used; each item was assessed using a scale: "very bad", "bad", "acceptable", "good" and "very good". Adescriptive analysis was done by calculating frequency. Results: Items with a higher proportion of acceptable registration data were: clear therapeutic indication (84%, clinical evolution (74.7%, diagnosis (70.7%, complete and orderly therapeutic indication (54.2%, medical history taking (50.2% and physical examination (43.1%. The very well recorded items were: indication of tests and procedures (97.3%, medical identification (91.1% and allergies (67.1%. Very bad recorded items were: reason for admission (91.1%, life habits (72.9% and prior treatment (38.2%. Conclusions: Most medical records of hospitalization are characterized by an acceptable record of most evaluated items; however they have notable deficiencies in some items.

  1. Characteristics of equatorial plasma bubbles observed by TEC map based on ground-based GNSS receivers over South America

    Science.gov (United States)

    Barros, Diego; Takahashi, Hisao; Wrasse, Cristiano M.; Figueiredo, Cosme Alexandre O. B.

    2018-01-01

    A ground-based network of GNSS receivers has been used to monitor equatorial plasma bubbles (EPBs) by mapping the total electron content (TEC map). The large coverage of the TEC map allowed us to monitor several EPBs simultaneously and get characteristics of the dynamics, extension and longitudinal distributions of the EPBs from the onset time until their disappearance. These characteristics were obtained by using TEC map analysis and the keogram technique. TEC map databases analyzed were for the period between November 2012 and January 2016. The zonal drift velocities of the EPBs showed a clear latitudinal gradient varying from 123 m s-1 at the Equator to 65 m s-1 for 35° S latitude. Consequently, observed EPBs are inclined against the geomagnetic field lines. Both zonal drift velocity and the inclination of the EPBs were compared to the thermospheric neutral wind, which showed good agreement. Moreover, the large two-dimensional coverage of TEC maps allowed us to study periodic EPBs with a wide longitudinal distance. The averaged values observed for the inter-bubble distances also presented a clear latitudinal gradient varying from 920 km at the Equator to 640 km at 30° S. The latitudinal gradient in the inter-bubble distances seems to be related to the difference in the zonal drift velocity of the EPB from the Equator to middle latitudes and to the difference in the westward movement of the terminator. On several occasions, the distances reached more than 2000 km. Inter-bubble distances greater than 1000 km have not been reported in the literature.

  2. Characteristics of Latinas in Puerto Rico and the US mainland receiving teriparatide in the DANCE observational study.

    Science.gov (United States)

    Ruff, Valerie A; Acosta, Agaph; Soto-Raices, Oscar; Sierra-Zorita, Radamés; Toro-Torres, Ramón; Rodríguez-Ginorio, Henry; Comulada, Angel; Chiang, Alan Y; Krohn, Kelly; Taylor, Kathleen A

    2014-09-01

    The Direct Assessment of Nonvertebral Fractures in Community Experience (DANCE) study investigated the use of teriparatide in men and women with osteoporosis in the United States (US) and Puerto Rico (PR). In a sub-analysis, we evaluated whether the baseline characteristics of Latinas differed from those of white women in the study population and whether any patient attributes affected physicians' decisions to prescribe teriparatide. We assessed 3 patient cohorts treated with teriparatide 20 microg once daily for up to 24 months: 1) PR Latinas, 2) US Latinas, and 3) white women on the US mainland (white women). We analyzed differences related to ethnicity (Latina vs. white) and geography (PR vs. US mainland). Overall, 302 of the 3243 women (9%) enrolled in DANCE were Latina (205 of these 302 Latinas resided in PR). Significant differences were observed in 7 of 11 baseline characteristics. White women had more prior fragility fractures and family history of hip fracture than Latinas, while PR Latinas were generally older than US Latinas and had more comorbid conditions. A similar proportion of subjects in each cohort had received prior osteoporosis therapy. Physicians prescribed teriparatide more often for Latinas based on multiple risk factors for fracture and intolerance to previous osteoporosis therapy and to white women based on inadequate response to previous therapy or new (incident) fractures. Overall, Latinas were less persistent with teriparatide therapy than white women. We observed significant differences related to ethnicity and geography in the baseline demographics of Latinas enrolled in the DANCE study, criteria cited by physicians for initiating teriparatide therapy, and treatment persistence.

  3. Characteristics and mutation analysis of Ph-positive leukemia patients with T315I mutation receiving tyrosine kinase inhibitors

    Directory of Open Access Journals (Sweden)

    Xu PP

    2017-09-01

    Full Text Available Peipei Xu,1 Dan Guo,2 Xiaoyan Shao,1 Miaoxin Peng,1 Bing Chen2 1Department of Hematology, Drum Tower Hospital, School of Medicine, Nanjing University, 2Department of Hematology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, People’s Republic of China Background: TKIs are the first-line treatment for patients with Ph-positive (Ph+ leukemia. However, drug resistance is frequently observed, mainly due to mutations within the breakpoint cluster region-Abelson leukemia virus (BCR-ABL kinase domain. The T315I substitution confers complete resistance to TKIs. The aim of this study was to analyze the clinical characteristics of 17 patients with T315I mutation after TKI treatment and provide a basis for prognosis.Patients and methods: The clinical data of 17 TKI-resistant Ph+ leukemia patients who were found to have a ABL kinase domain mutation from September 2008 to January 2017 were collected. Karyotypes and BCR-ABL fusion gene were analyzed by R-banding and fluorescence in situ hybridization, respectively. Total RNA was extracted by TRIzol reagent, and the ABL kinase domain mutation was detected by direct sequencing.Results: A total of 17 patients reached effective remission including major molecular response and complete cytogenetic response. However, all the patients subsequently developed a T315I mutation after treatment with TKIs. The rate of the BCR-ABL fusion gene in most of the patients who developed the T315I mutation was significantly higher than that before the mutation. At initial diagnosis, patients average platelet count was 149.7×109/L, whereas the average platelet count was only 53.88×109/L after the T315I mutation (P<0.01. The results also showed that the survival time of patients with a high proportion of blast cells or a high number of white blood cells was obviously shortened.Conclusion: Patients platelet count decreased when detected with the T315I mutation compared with the initial

  4. Scene perception and memory revealed by eye movements and receiver-operating characteristic analyses: does a cultural difference truly exist?

    Science.gov (United States)

    Evans, Kris; Rotello, Caren M; Li, Xingshan; Rayner, Keith

    2009-02-01

    Cultural differences have been observed in scene perception and memory: Chinese participants purportedly attend to the background information more than did American participants. We investigated the influence of culture by recording eye movements during scene perception and while participants made recognition memory judgements. Real-world pictures with a focal object on a background were shown to both American and Chinese participants while their eye movements were recorded. Later, memory for the focal object in each scene was tested, and the relationship between the focal object (studied, new) and the background context (studied, new) was manipulated. Receiver-operating characteristic (ROC) curves show that both sensitivity and response bias were changed when objects were tested in new contexts. However, neither the decrease in accuracy nor the response bias shift differed with culture. The eye movement patterns were also similar across cultural groups. Both groups made longer and more fixations on the focal objects than on the contexts. The similarity of eye movement patterns and recognition memory behaviour suggests that both Americans and Chinese use the same strategies in scene perception and memory.

  5. Clinical diagnostic accuracy of acute colonic diverticulitis in patients admitted with acute abdominal pain, a receiver operating characteristic curve analysis.

    Science.gov (United States)

    Jamal Talabani, A; Endreseth, B H; Lydersen, S; Edna, T-H

    2017-01-01

    The study investigated the capability of clinical findings, temperature, C-reactive protein (CRP), and white blood cell (WBC) count to discern patients with acute colonic diverticulitis from all other patients admitted with acute abdominal pain. The probability of acute diverticulitis was assessed by the examining doctor, using a scale from 0 (zero probability) to 10 (100 % probability). Receiver operating characteristic (ROC) curves were used to assess the clinical diagnostic accuracy of acute colonic diverticulitis in patients admitted with acute abdominal pain. Of 833 patients admitted with acute abdominal pain, 95 had acute colonic diverticulitis. ROC curve analysis gave an area under the ROC curve (AUC) of 0.95 (CI 0.92 to 0.97) for ages patients. Separate analysis showed an AUC = 0.83 (CI 0.80 to 0.86) of CRP alone. White blood cell count and temperature were almost useless to discriminate acute colonic diverticulitis from other types of acute abdominal pain, AUC = 0.59 (CI 0.53 to 0.65) for white blood cell count and AUC = 0.57 (0.50 to 0.63) for temperature, respectively. This prospective study demonstrates that standard clinical evaluation by non-specialist doctors based on history, physical examination, and initial blood tests on admission provides a high degree of diagnostic precision in patients with acute colonic diverticulitis.

  6. ROC [Receiver Operating Characteristics] study of maximum likelihood estimator human brain image reconstructions in PET [Positron Emission Tomography] clinical practice

    International Nuclear Information System (INIS)

    Llacer, J.; Veklerov, E.; Nolan, D.; Grafton, S.T.; Mazziotta, J.C.; Hawkins, R.A.; Hoh, C.K.; Hoffman, E.J.

    1990-10-01

    This paper will report on the progress to date in carrying out Receiver Operating Characteristics (ROC) studies comparing Maximum Likelihood Estimator (MLE) and Filtered Backprojection (FBP) reconstructions of normal and abnormal human brain PET data in a clinical setting. A previous statistical study of reconstructions of the Hoffman brain phantom with real data indicated that the pixel-to-pixel standard deviation in feasible MLE images is approximately proportional to the square root of the number of counts in a region, as opposed to a standard deviation which is high and largely independent of the number of counts in FBP. A preliminary ROC study carried out with 10 non-medical observers performing a relatively simple detectability task indicates that, for the majority of observers, lower standard deviation translates itself into a statistically significant detectability advantage in MLE reconstructions. The initial results of ongoing tests with four experienced neurologists/nuclear medicine physicians are presented. Normal cases of 18 F -- fluorodeoxyglucose (FDG) cerebral metabolism studies and abnormal cases in which a variety of lesions have been introduced into normal data sets have been evaluated. We report on the results of reading the reconstructions of 90 data sets, each corresponding to a single brain slice. It has become apparent that the design of the study based on reading single brain slices is too insensitive and we propose a variation based on reading three consecutive slices at a time, rating only the center slice. 9 refs., 2 figs., 1 tab

  7. Differences in characteristics of raters who use the visual estimation method in hospitals based on their training experiences.

    Science.gov (United States)

    Kawasaki, Yui; Tamaura, Yuki; Akamatsu, Rie; Sakai, Masashi; Fujiwara, Keiko

    2018-02-07

    Despite a clinical need, only a few studies have provided information concerning visual estimation training for raters to improve the validity of their evaluations. This study aims to describe the differences in the characteristics of raters who evaluated patients' dietary intake in hospitals using the visual estimation method based on their training experiences. We collected data from three hospitals in Tokyo from August to September 2016. The participants were 199 nursing staff members, and they completed a self-administered questionnaire on demographic data; working career; training in the visual estimation method; knowledge, attitude, and practice associated with nutritional care; and self-evaluation of method validity of and skills of visual estimation. We classified participants into two groups, experienced and inexperienced, based on whether they had received training. Square test, Mann-Whitney U test, and univariable and multivariable logistic regression analysis were used to describe the differences between these two groups in terms of their characteristics; knowledge, attitude, and practice associated with nutritional care; and self-evaluation of method validity and tips used in the visual estimation method. Of the 158 staff members (79.4%) (118 nurses and 40 nursing assistants) who agreed to participate in the analysis, thirty-three participants (20.9%) were trained in the visual estimation method. Participants who had received training had better knowledge (2.70 ± 0.81, score range was 1-5) than those who had not received any training (2.34 ± 0.74, p = 0.03). Score of self-evaluation of method validity of the visual estimation method was higher in the experienced group (3.78 ± 0.61, score range was 1-5) than the inexperienced group (3.40 ± 0.66, p trained had adequate knowledge (OR: 2.78, 95% CI: 1.05-7.35) and frequently used tips in visual estimation (OR: 1.85, 95% CI: 1.26-2.73). Trained participants had more required knowledge and

  8. Patients characteristics and perception of quality of care in a teaching hospital in Anambra State, Nigeria.

    Science.gov (United States)

    Emelumadu, O F; Ndulue, C N

    2012-01-01

    Patients' assessment of quality of health care despite its importance in uptake of available services has not been closely examined in developing countries. The main objective of this study was to assess patient's perception of the quality of healthcare services as offered at the General Outpatients Department (GOPD) of a teaching hospital in order to obtain rational information for effective policy formulation on improved patient care in our hospitals. This was a four-week duration descriptive cross-sectional study involving three hundred and ninety (390) new adult patients seen at the General Out-Patients' Department of Nnamdi Azikiwe University Teaching Hospital, Nnewi. Using a self-administered pre-tested, semi-structured questionnaire in English language, relevant information was obtained from the participants. A total of 390 adult new patients with mean age 31.4 years participated in the study of which females 216 (55.5%) were slightly more than males 174 (45.5%). About 225 (57.7%) of the respondents received at most a primary school education. The major reasons for seeking care at the GOPD were expectations of being attended to by qualified doctors and nurses (38%); receiving efficient and quality service (36%) and obtaining cheaper and affordable drugs (14.5%). A quarter ofthe patients (25%) waited for up to one hour to register, while 38% spent more than an hour before being attended to by a doctor. Seventy percent (70%) of thepatients opined that the nurses were friendly, 94.5% of the patients rated the doctors as being friendly while 82.5% expressed satisfaction with the care received from the doctors. The conditions of the waiting hall were deemed very comfortable by 42%,and 42% felt hat it was uncomfortable. In all 79% of the patients felt at the quality of care was good and 82% were willing to return for consultations in future if need be. The waiting time for obtaining the patients card and doctors' consultation appeared to be acceptably long in this

  9. Influence of patient characteristics on care time in patients hospitalized with schizophrenia

    Directory of Open Access Journals (Sweden)

    Sugibayashi Y

    2014-08-01

    Full Text Available Yukiko Sugibayashi,1 Kimio Yoshimura,1 Keita Yamauchi,1,2 Ataru Inagaki,3 Naoki Ikegami1 1Department of Health Policy and Management, Keio University School of Medicine, Tokyo, 2Keio University Graduate School of Health Management, Kanagawa, 3Aoyama Gakuin University, School of International Politics, Economics and Communication, Tokyo, Japan Background: In the current Japanese payment system for the treatment of psychiatric inpatients, the length of hospital stay and nurse staffing levels are key determinants of the amount of payment. These factors do not fully reflect the costs of care for each patient. The objective of this study was to clarify the relationship between patient characteristics and their care costs as measured by “care time” for patients with schizophrenia.Methods: Patient characteristics and care time were investigated in 14,557 inpatients in 102 psychiatric hospitals in Japan. Of these 14,557 inpatients, data for 8,379 with schizophrenia were analyzed using a tree-based model.Results: The factor exerting the greatest influence on care time was ”length of stay”, so subjects were divided into 2 groups, a “short stay group” with length of stay ≦104 days, and “long stay group” ≧105 days. Each group was further subdivided according to dependence with regard to “activities of daily living”, “psychomotor agitation”, “verbal abuse”, and “frequent demands/repetitive complaints”, which were critical variables affecting care time. The mean care time was shorter in the long-stay group; however, in some long-stay patients, the mean care time was considerably longer than that in patients in the short-stay group.Conclusion: The results of this study suggest that it is necessary to construct a new payment system reflecting not only length of stay and nurse staffing levels, but also individual patient characteristics. Keywords: psychiatric hospital, schizophrenia, care time, case mix, tree-based model

  10. Characteristics of pregnancy with human immuno-deficiency virus (HIV) and perinatal transmission in Nakornping Hospital.

    Science.gov (United States)

    Gomutbutra, Vorapin

    2008-02-01

    The HIV infected pregnancy delivered at Nakornping Hospital was common. To reduce and prevent HIV infection in pregnancy and perinatal transmission, the understanding of characteristics of HIV pregnancy and neonatal infective outcome were needed for proper strategy and policy making. To study the characteristics of HIV pregnancy and neonatal infective outcome in a hospital in the northern part of Thailand. This retrospective descriptive study was conducted at the Department of Obstetrics and Gynecology Unit, Nakornping Hospital, Chiang Mai Province, Thailand. Medical records of HIV infected pregnancy from the labor unit during October 2002 and September 2005 was scrutinized. The relevant data of the characteristics of HIV infected mother, pregnancy and neonatal infective outcome were collected and analyzed. There were 172 HIV infected mothers among 7,872 parturients (2.2%). The mean age was 28.2 years (range 14-44 years). Most of the cases were between 25-29 years (40%). 45 pregnancies (26%) delivered before 37 weeks. About half (50.6%) delivered via cesarean section. 22% of their newborn weighted below 2,500 grams. With antiviral regimen of Navirapine and Zidovudine for both mothers and their neonate the overall perinatal transmission rate was 4%. In mothers having ANC group the transmission rate was 3.2% compared to 11.7% in no ANC group. (X2 = 1.092 p = 0.296 Cl 0.04-1.4) RR of ANC group = 0.274 compare to no ANC. Many of HIV infected mothers were in the young age group. High preterm labor rate was observed. The no ANC group had about 4 folds infective neonate compared to the ANC group. No antiviral drug during pregnancy in no ANC group may be a factor. This information was vital for strategic ANC planning to prevent and reduce this problem.

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

    Science.gov (United States)

    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.

  12. [Hospital emergencies arising from nursing homes in a region: evolution, characteristics and appropriateness].

    Science.gov (United States)

    Sánchez-Pérez, Inma; Comes Garcia, Nuri; Romero Piniella, Lola; Prats Martos, Gemma; Arnau Bataller, Gemma; Coderch, Jordi

    Hospital emergencies (HE) arising from nursing homes (NH) are on the rise. We analyse the evolution, characteristics and appropriateness of HE of NH residents in a region, as well as resulting hospital admissions. Retrospective descriptive study between 2010 and 2013 of institutionalised residents of 11 NH located in Baix Empordà (704 beds) and Palamós Hospital. Gender, age, morbidity and relative weight according to clinical risk groups (CRG), NH, length of stay, diagnosis of the emergency, appropriateness of HE according to Bermejo's criteria and the HE appropriateness protocol (HEAP), and appropriateness of hospitalisations according to the Appropriateness Evaluation Protocol (AEP). Sample to evaluate appropriateness: 159 HE and 91 hospitalisations. frequency, mean, standard deviation, percentiles, Fisher's exact test and ANOVA, with a confidence interval of 95% and using IBM SPSS Statistics 23. 1,474 people were enrolled, of which 73% were women. Group ≥85 years increased to 60.3% and the mean weight of morbidity was 3.2 to 4.0 (p <0.001). 1,805 HE were generated. The annual rate per 1,000 stays arising from NH increased from 1.64 to 2.05, of which 90.6% were appropriate according to Bermejo's criteria and 93.7% according to the HEAP. Of these, 502 involved hospitalisation. The annual rate per 10 emergencies fell from 2.96 to 2.64 and 98.9% were appropriate according to the AEP. Hospital emergencies and hospitalisations of NH residents are increasing and are appropriate. Increasing age and disease burden could explain this phenomenon. NH and hospitals should react appropriately, considering the specific needs of this population sector. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  13. Hospitals

    Data.gov (United States)

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

  14. Adherence to iron supplements among women receiving antenatal care at Mulago National Referral Hospital, Uganda-cross-sectional study.

    Science.gov (United States)

    Kiwanuka, Tusuubira S; Ononge, Sam; Kiondo, Paul; Namusoke, Fatuma

    2017-10-25

    Antenatal iron supplementation is a cost effective way of reducing iron deficiency anaemia among pregnant women in resource limited countries like Uganda. Poor adherence to iron supplements has limited its effectiveness in reducing maternal anaemia as evidenced by the high burden of iron deficiency anemia in Sub-saharan Africa. The aim of this study was to determine the level of and factors associated with adherence to iron supplementation among women attending antenatal clinic at Mulago National Referral Hospital, Kampala, Uganda. Three hundred and seventy pregnant women were recruited in a cross sectional survey in Mulago National Referral Hospital antenatal clinic after informed consent between February and April 2014. Levels of adherence to iron supplements were assessed using visual analogue scale and factors associated collected using an interviewer administered questionnaire. About 12% (11.6%) of the mothers attending the antenatal clinic adhered to iron supplements over 30 day period. Mothers who had had four or more antenatal visits prior to the survey [odds ratio (OR) = 1.49, 95% confidence interval (CI) 1.12-1.97], had more than 2 week supply of iron supplements in the previous visit (OR 2.81, 95% CI 1.02-1.09), prior health education (OR 1.56, 95% CI 1.07-2.29) were more likely to adhere to iron supplements. Inadequate drug supplies and fear for side effects were the main reasons why participants missed the iron supplements. There was low adherence to iron supplements among mothers attending antenatal clinic at Mulago National Referral  Hospital. We recommend a national evaluation of adherence to iron supplements and look at ways of increasing adherence.

  15. Using Videoconferencing Technology to Provide Breastfeeding Support to Low-Income Women: Connecting Hospital-Based Lactation Consultants with Clients Receiving Care at a Community Health Center.

    Science.gov (United States)

    Friesen, Carol A; Hormuth, Laura J; Petersen, Devan; Babbitt, Tina

    2015-11-01

    The Tele-Lactation Pilot Project (TLPP), 1 of 13 community-based breastfeeding projects implemented in Indiana in 2013 using Centers for Disease Control and Prevention grant funds, explored the feasibility of using videoconferencing technology to provide breastfeeding education and support to low-income women by a centrally located International Board Certified Lactation Consultant (IBCLC). The IBCLC was housed at the Breastfeeding Center at the hospital where the women would deliver; the women receiving the education and support were located at an inner-city community health center (CHC) where they received their primary care. The videoconferencing sessions were juxtaposed with the women's regularly scheduled prenatal and postnatal visits at the CHC. After delivery, the lactation consultant visited the mother and infant in person at the hospital to offer additional support. Overall, 35 mothers were served by the TLPP during the 9-month project period. A total of 134 visits (30-45 minutes each) were conducted (3.8 sessions per woman). At the conclusion of the project, interviews with key participants indicated that the tele-lactation videoconferencing sessions were easy to implement, allowed the IBCLC to reach a wider client base, and allowed the women to receive expert support that they might not have otherwise received. Comments indicated that, in addition to providing education and increasing the women's confidence, the tele-lactation sessions appeared to have decreased the mothers' anxiety about the birthing process and the hospital experience. The TLPP demonstrated that incorporating videoconferencing technology into routine care can help foster collaboration among health care providers and provide mothers with continuous, easily accessible breastfeeding education and support. © The Author(s) 2015.

  16. Characteristics of patients receiving midwife-led prenatal care in Canada: results from the Maternity Experiences Survey (MES).

    Science.gov (United States)

    Abdullah, Peri; Gallant, Sabrina; Saghi, Naseem; Macpherson, Alison; Tamim, Hala

    2017-06-02

    The aim of this study was to determine the characteristics of women in Canada who received care from a midwife during their prenatal period. The findings of this study were drawn from the Maternity Experiences Survey (MES), which was a cross-sectional survey that assessed the experiences of women who gave birth between November 2005 and May 2006. The main outcome variable for this study was the prenatal care provider (i.e. midwife versus other healthcare providers). Demographic, socioeconomic, as well as health and pregnancy factors were evaluated using bivariate and multivariate models of logistic regression. A total of 6421 participants were included in this analysis representing a weighted total of 76,508 women. The prevalence of midwife-led prenatal care was 6.1%. The highest prevalence of midwife-led prenatal care was in British Columbia (9.8%), while the lowest prevalence of midwife-led prenatal care was 0.3% representing the cumulative prevalence in Nova Scotia, Prince Edward Island, Newfoundland and Labrador, New Brunswick, Saskatchewan, and Yukon. Factors showing significant association with midwife-led prenatal care were: Aboriginal status (OR = 2.26, 95% CI: 1.41-3.64), higher education with bachelor and graduate degree attainment having higher ORs when compared to high-school or less (OR = 2.71, 95% CI: 1.71-4.31 and OR = 3.17, 95% CI: 1.81-5.55, respectively), and alcohol use (OR = 1.63, 95% CI: 1.17-2.26). Age, marital status, immigrant status, work during pregnancy, household income, previous pregnancies, perceived health, maternal Body Mass Index (BMI), and smoking during the last 3 months of pregnancy were not significantly associated with midwife care. In general, women who were more educated, have aboriginal status, and/or are alcohol drinkers were more likely to receive care from midwives. Since MES is the most recent resource that includes information about national midwifery utilization, future studies can provide more up

  17. [Family characteristics, organic risk factors, psychopathological picture and premorbid adjustment of hospitalized adolescent patients].

    Science.gov (United States)

    Małkiewicz-Borkowska, M; Namysłowska, I; Siewierska, A; Puzyńska, E; Sredniawa, H; Zechowski, C; Iwanek, A; Ruszkowska, E

    1996-01-01

    The relation of some family characteristics such as cohesion and adaptability with organic risk factors, developmental psychopathology, clinical picture and premorbid adjustment was assessed in the group of 100 hospitalized adolescent patients and families. We found correlation between: some of organic risk factors (pathology of neonatal period, pathology of early childhood), some of indicators of developmental psychopathology (eating disorders, conduct disorders), some of clinical signs (mannerism, grandiosity, hostility, suspciousness, disturbances of content of thinking), premorbid adjustment, and variables related to families, described before. We think that biological variables characterizing child (pathology of neonatal period, pathology of early childhood) have an influence on some family characteristics as independent variable. General system theory and circular thinking support these conclusions. In order to verify them, it is necessary to undertake further investigations, based on other methodology, using this results as preliminary findings.

  18. Impact of quality control radiation doses received by patients undergoing abdomen x-ray examination in ten hospitals

    International Nuclear Information System (INIS)

    Aghahadi, B.; Zhang, Z.; Zareh, S.; Sarkar, S.; Tayebi, P. S.

    2006-01-01

    The X-ray machines used for radiodiagnosis should meet certain quality assurance programmes. These are necessary to have good quality radiographs at reasonably low exposure to patients. Materials and Methods: Dose reduction methods in abdomen X-ray examination were carried out in 10 hospitals in Tehran. This paper presents the work, which was implemented on 200 patients and evaluated using the entrance skin dose in the Anterior-Posterior abdomen projection measured directly at the center of the X-ray field. In addition, the machine room, and dark room parameters, as well as work practices and repeat rates were studied. Results: The quality control parameters and the entrance skin dose were evaluated utilizing an anthropologic phantom to define the optimal exposure condition at all hospitals before and after quality control . Results show that after using the quality control parameters and optimization of the exposure conditions, the mean of mAs and entrance skin dose can be decreased by 62% and 65% respectively. Conclusion: The quality of the radiographs generally increased. The reported method is easily implemented in any clinical situation where optimization of abdomen radiography is necessary

  19. Critical thresholds of liver function parameters for ketosis prediction in dairy cows using receiver operating characteristic (ROC) analysis.

    Science.gov (United States)

    Sun, Yuhang; Wang, Bo; Shu, Shi; Zhang, Hongyou; Xu, Chuang; Wu, Ling; Xia, Cheng

    2015-01-01

    Fatty liver syndrome and ketosis are important metabolic disorders in high-producing cows during early lactation with fatty liver usually preceding ketosis. To date, parameters for early prediction of the risk of ketosis have not been investigated in China. To determine the predictive value of some parameters on the risk of ketosis in China. In a descriptive study, 48 control and 32 ketotic Holstein Friesian cows were randomly selected from one farm with a serum β-hydroxybutyrate (BHBA) concentration of 1.20 mmol/L as cutoff point. The risk prediction thresholds for ketosis were determined by receiver operating characteristic (ROC) analysis. In line with a high BHBA concentration, blood glucose concentration was significantly lower in ketotic cows compared to control animals (2.77 ± 0.24 versus 3.34 ± 0.03 mmol/L; P = 0.02). Thresholds were more than 0.76 mmol/L for nonesterified fatty acids (NEFA, with 65% sensitivity and 92% specificity), more than 104 U/L for aspartate aminotransferase (AST, 74% and 85%, respectively), less than 140 U/L for cholinesterase (CHE, 75% and 59%, respectively), and more than 3.3 µmol/L for total bilirubin (TBIL, 58% and 83%, respectively). There were significant correlations between BHBA and glucose (R = -4.74), or CHE (R = -0.262), BHBA and NEFA (R = 0.520), or AST (R = 0.525), or TBIL (R = 0.278), or direct bilirubin (DBIL, R = 0.348). AST, CHE, TBIL and NEFA may be useful parameters for risk prediction of ketosis. This study might be of value in addressing novel directions for future research on the connection between ketosis and liver dysfunction.

  20. Receiver-operating characteristic curves for somatic cell scores and California mastitis test in Valle del Belice dairy sheep.

    Science.gov (United States)

    Riggio, Valentina; Pesce, Lorenzo L; Morreale, Salvatore; Portolano, Baldassare

    2013-06-01

    Using receiver-operating characteristic (ROC) curve methodology this study was designed to assess the diagnostic effectiveness of somatic cell count (SCC) and the California mastitis test (CMT) in Valle del Belice sheep, and to propose and evaluate threshold values for those tests that would optimally discriminate between healthy and infected udders. Milk samples (n=1357) were collected from 684 sheep in four flocks. The prevalence of infection, as determined by positive bacterial culture was 0.36, 87.7% of which were minor and 12.3% major pathogens. Of the culture negative samples, 83.7% had an SCCculture negative vs. infected), minor pathogen status (culture negative vs. infected with minor pathogens), major pathogen status (culture negative vs. infected with major pathogens), and CMT results were evaluated, the estimated area under the ROC curve was greater for glands infected with major compared to minor pathogens (0.88 vs. 0.73), whereas the area under the curve considering all pathogens was similar to the one for minor pathogens (0.75). The estimated optimal thresholds were 3.00 (CMT), 2.81 (SCS for the whole sample), 2.81 (SCS for minor pathogens), and 3.33 (SCS for major pathogens). These correctly classified, respectively, 69.0%, 73.5%, 72.6% and 91.0% of infected udders in the samples. The CMT appeared only to discriminate udders infected with major pathogens. In this population, SCS appeared to be the best indirect test of the bacteriological status of the udder. Copyright © 2012 Elsevier Ltd. All rights reserved.

  1. Receiver Operating Characteristic Curve-Based Prediction Model for Periodontal Disease Updated With the Calibrated Community Periodontal Index.

    Science.gov (United States)

    Su, Chiu-Wen; Yen, Amy Ming-Fang; Lai, Hongmin; Chen, Hsiu-Hsi; Chen, Sam Li-Sheng

    2017-12-01

    The accuracy of a prediction model for periodontal disease using the community periodontal index (CPI) has been undertaken by using an area under a receiver operating characteristics (AUROC) curve. How the uncalibrated CPI, as measured by general dentists trained by periodontists in a large epidemiologic study, and affects the performance in a prediction model, has not been researched yet. A two-stage design was conducted by first proposing a validation study to calibrate CPI between a senior periodontal specialist and trained general dentists who measured CPIs in the main study of a nationwide survey. A Bayesian hierarchical logistic regression model was applied to estimate the non-updated and updated clinical weights used for building up risk scores. How the calibrated CPI affected performance of the updated prediction model was quantified by comparing AUROC curves between the original and updated models. Estimates regarding calibration of CPI obtained from the validation study were 66% and 85% for sensitivity and specificity, respectively. After updating, clinical weights of each predictor were inflated, and the risk score for the highest risk category was elevated from 434 to 630. Such an update improved the AUROC performance of the two corresponding prediction models from 62.6% (95% confidence interval [CI]: 61.7% to 63.6%) for the non-updated model to 68.9% (95% CI: 68.0% to 69.6%) for the updated one, reaching a statistically significant difference (P prediction model was demonstrated for periodontal disease as measured by the calibrated CPI derived from a large epidemiologic survey.

  2. Reasons for not receiving thrombolytic therapy in patients with acute myocardial infarction admitted to Bu-Ali Sina Hospital in Qazvin (2013-14

    Directory of Open Access Journals (Sweden)

    MM. Daei

    2017-04-01

    Full Text Available This hospital-based cross-sectional study was conducted in 2013-14 in Qazvin Bu-Ali Sina Hospital. 170 patients with acute myocardial infarction who not receiving thrombolytic therapy entered the study and were analyzed. Medical history, physical examination, twelve lead ECG and cardiac biomarkers were obtained. The mean age of the patients was 63.4±14.4 years (from 19 to 90 years. 110 (64.7% of the patients were male and 48 (28.2% were diabetic. 86 (50% of patients due to late presentation and 47 (28% due to lack of diagnosis and 29 (17% due to contraindication and 8 (5% due to autolysis or coronary spam were not received thrombolytic therapy. We could reduce failure of receiving thrombolytic therapy more than seventy five percent with increasing people's awareness about the symptoms of myocardial infarction and skills of health staff in relation to the proper and timely diagnosis of myocardial infarction.

  3. [Microbiological characteristics and patterns of resistance in prosthetic joint infections in a referral hospital].

    Science.gov (United States)

    Ortega-Peña, Silvestre; Colín-Castro, Claudia; Hernández-Duran, Melissa; López-Jácome, Esaú; Franco-Cendejas, Rafael

    2015-01-01

    The prosthetic joint infection is the most feared and catastrophic complication for cause severe physical damage to patients and, generates high economic costs. To describe the microbiological characteristics and to determine the resistance pattern in prosthetic joint infections in a reference hospital in Mexico. Patients whose prosthetic devices were withdrawn due to suspicion of septic and aseptic loosening were included. Cultures were performed to identify microorganisms and susceptibility analysis. Of the 111 patients included, 55% were diagnosed with prosthetic joint infection, with the most frequent prosthesis being of the hip (43%). Positive cultures were obtained in 97% of the infected cases, of which 75% were monomicrobial infections. The most frequent bacterial species isolated were: Staphylococcus epidermidis (31%), Enterococcus faecalis (16%), Staphylococcus aureus (13%), and Escherichia coli (8%). The resistance patterns for the Staphylococcus genus were: oxacillin (79%), erythromycin (45%) and ciprofloxacin (37%). Enterococcus faecalis showed a high percentage of resistance to erythromycin and clindamycin (86%), and fluoroquinolones (43%). The large majority (86%) of Escherichia coli were extended spectrum beta-lactamases positive, in addition to having high resistance to fluoroquinolones (86%), trimethoprim/sulfamethoxazole (86%) and gentamicin (72%). The microbiological characteristics found in prosthetic joint infections vary according to the hospitals. In this series, a high proportion of coagulase-negative Staphylococci and Enterococcus spp. were found, as well as a high bacterial resistance. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  4. Early Period Results and Clinical Characteristics of Upper Gastrointestinal Endoscopy in Sivrihisar State Hospital

    Directory of Open Access Journals (Sweden)

    Ozgur Turk

    2014-12-01

    Full Text Available Aim: Our aim was to identify the characteristics of the patient that performed upper gastrointestinal endoscopy in a new established endoscopy unit of a state hospital. We want to present the spectrum of gastrointestinal diseases in our hospitals region. Material and Method: We analyzed patients upper endoscopy results according to age, sex, complaints, clinical characteristics, type of anesthesia, and the necessity of biopsy. We reviewed 256 patients data between 2013 December-2014 July. All endoscopies were performed by same surgeon. Results: The highest complaint was epigastric pain (n=112, 43, 8%. Other complaints were followed as dyspepsia (n=84, 32.8%, heartburn (n=42, 16.4%, nausea (n=4, 1.6%, vomiting (n=2, 0.8%, dysphagia (n=6, 2.3%. We determined 218 gastritis (85.2%, 64 hiatal hernia (25%, 120 esophagitis (46.9%, 76 duodenitis (29.7%, 4 gastric ulcer (1.6%, 18 duodenal ulcers (7%, 20 bile reflux (7.8%, 26 Gastro esophageal reflux disease (GERD in patients (10.2%. 10 patients reported as normal (3.9%. Biopsy was performed in 186 of the patients. Discussion: Endoscopy can become an early diagnostic examination by increasing the availability of endoscopy. Also alarm symptoms should not be ignored and endoscopy should perform immediately in symptomatic patients. As an early result of upper gastrointestinal endoscopies that performed in this study; gastritis, esophagitis, duodenitis and hiatal hernia are common gastrointestinal diseases in our region.

  5. Reviewing information support during the Great East Japan Earthquake disaster : From the perspective of a hospital library that received support

    Science.gov (United States)

    Terasawa, Motoko

    The Great East Japan Earthquake of March 11, 2011 caused extensive damage over a widespread area. Our hospital library, which is located in the affected area, was no exception. A large collection of books was lost, and some web content was inaccessible due to damage to the network environment. This greatly hindered our efforts to continue providing post-disaster medical information services. Information support, such as free access to databases, journals, and other online content related to the disaster areas, helped us immensely during this time. We were fortunate to have the cooperation of various medical employees and library members via social networks, such as twitter, during the process of attaining this information support.

  6. Depression in climacteric women: analysis of a sample receiving care at a university hospital in Maranhão, Brazil

    OpenAIRE

    Silva, Mari-Nilva Maia da; Brito, Luciane Maria Oliveira; Chein, Maria Bethânia da Costa; Brito, Luiz Gustavo Oliveira; Navarro, Paula Andréa de Albuquerque Salles

    2008-01-01

    Introdução: O climatério, período de transição entre a fase reprodutiva e não-reprodutiva, ocasiona mudanças biopsicossociais nas mulheres que o vivenciam. A associação entre a maior prevalência de depressão nesse período é, no entanto, ainda controversa. O objetivo deste estudo foi avaliar a prevalência de depressão em mulheres climatéricas atendidas em um hospital universitário numa cidade da Região Nordeste do Brasil e identificar fatores associados. Método: Foi realizado um estudo prospec...

  7. Awareness, Knowledge and Attitudes Towards Cervical Cancer Amongst HIV-Positive Women Receiving Care in a Tertiary Hospital in Nigeria.

    Science.gov (United States)

    Adibe, Maxwell O; Aluh, Deborah O

    2017-05-05

    The incidence of cervical cancer (CC) in the sub-Saharan Africa region, where Nigeria is located, is amongst the highest in the world; it is estimated that 70,722 new cases of invasive cervical cancer occur annually in sub-Saharan Africa. Immunosuppression, especially due to human immunodeficiency virus (HIV) infection, is a predisposing factor for persistent infection with high-risk human papilloma virus (HR-HPV) and the development of squamous intraepithelial lesions. Four hundred and fifty women who attended the HIV clinic at the Nnamdi Azikiwe University Teaching Hospital, Nnewi, and who consented to participate in the study were randomly selected. They were given self-administered questionnaires which sought to determine their awareness and knowledge of cervical cancer and attitudes towards cervical cancer screening and prevention. The media 23% (n = 103) was the most common source of information amongst respondents who had heard about cervical cancer. For all the women surveyed, the average percentage knowledge was 9.95%. Having attitude scores greater than or equal to the mean attitude score of 55.16% was regarded as having a positive attitude while a score lower than that was regarded as negative attitude. About 43.5% (n = 195) respondents had a positive attitude towards cervical cancer screening and prevention. Cervical cancer awareness and knowledge amongst women attending the HIV clinic in the Nnamdi Azikiwe University Teaching Hospital, Nnewi, were very poor. Their attitude towards cervical cancer screening practices and prevention was also very poor.

  8. Etiology and characteristics of large symptomatic pericardial effusion in a community hospital in the contemporary era.

    Science.gov (United States)

    Abdallah, R; Atar, S

    2014-05-01

    The etiology and laboratory characteristics of large symptomatic pericardial effusion (LSPE) in the Western world have evolved over the years, and vary between regions, community and tertiary hospitals. We reviewed data of 86 consecutive patients who underwent pericardiocentesis or pericardial window due to LSPE in a community hospital from 2001 to 2010. The characteristics of the PE including chemistry, hematology, bacteriology, serology and cytology have been analyzed. We correlated the etiologies of PE with age, gender and clinical presentation. The most frequent etiology of LSPE was idiopathic [36% (77% with a clinical diagnosis of pericarditis)], followed by malignancy (31.4%), ischemic heart disease (16.3%), renal failure (4.6%), trauma (4.6%) and autoimmune disease (4.6%). The average age of all the etiological groups excluding trauma was over 50 years. Laboratory tests did not modify the pre-procedure diagnosis in any of the patients. The most frequent presenting symptom was dyspnea (76.6%). Chest pain was mostly common in patients with idiopathic etiology (58.06%). The most frequent medical condition associated with LSPE was the use of anticoagulant or antiplatelet drugs (31.40%), especially aspirin, and in those, the PE tended to be bloody (73%, P = 0.11). Most of the effusions were exudates (70.9%). PE due to renal failure was the largest (1467 ± 1387 ml). The spectrum of etiologies of LSPE in a community hospital in the Western world in the contemporary era is continuously evolving. The most frequent etiology is now idiopathic, followed by malignancy. Routine laboratory testing still rarely modifies the pre-procedure diagnosis.

  9. Prevalence and Molecular Characteristics of Carbapenemase-Producing Enterobacteriaceae From Five Hospitals in Korea.

    Science.gov (United States)

    Jeong, Seok Hoon; Kim, Han Sung; Kim, Jae Seok; Shin, Dong Hoon; Kim, Hyun Soo; Park, Min Jeong; Shin, Saeam; Hong, Jun Sung; Lee, Seung Soon; Song, Wonkeun

    2016-11-01

    The emergence of carbapenemase-producing Enterobacteriaceae (CPE) represents a major clinical problem because these bacteria are resistant to most antibiotics. CPE remain relatively uncommon in Korea. We report the prevalence, clinical characteristics, and molecular epidemiology of CPE isolates collected from five university hospitals in Korea. Between January and December 2015, 393 non-duplicated isolates that were nonsusceptible to ertapenem were analyzed. Production of carbapenemase, extended-spectrum β-lactamase, and AmpC β-lactamase was determined by genotypic tests. Antimicrobial susceptibility profiles were determined by using an Etest. Clonality of Klebsiella pneumoniae carbapenemase (KPC)-2-producing and oxacillinase (OXA)-232-producing Klebsiella pneumoniae isolates was determined by pulsed-field gel electrophoresis (PFGE). Of the 393 isolates tested, 79 (20.1%) were CPE. Of these 79 isolates, 47 (59.5%) harbored the bla(OXA-232) gene while the remaining isolates carried genes bla(KPC-2) (n=27), bla(IMP-1) (n=4), and bla(NDM-1) (n=1). Among the 24 KPC-2 K. pneumoniae isolates from hospital B, 100% were resistant to carbapenems, 8% to colistin, and 0% to tigecycline. Among the 45 OXA-232 K. pneumoniae at hospital C, 95% were resistant to ertapenem, 68% to imipenem, 95% to meropenem, 10% to colistin, and 24% to tigecycline. PFGE analysis revealed a unique pattern for KPC-2 K. pneumoniae and identified 30 isolates belonging to the dominant pulsotypes (PT)1 and PT2 among 41 OXA-232 K. pneumoniae isolates. CPE strains are present in Korea, with the majority of K. pneumoniae isolates producing OXA-232 and KPC-2. The prevalence and predominant genotypes of CPE show hospital-specific differences.

  10. Behavioral and clinical characteristics of people receiving medical care for HIV infection in an outpatient facility in Sicily, Italy

    Directory of Open Access Journals (Sweden)

    Di Carlo P

    2016-05-01

    Full Text Available Paola Di Carlo,1 Giuliana Guadagnino,1 Palmira Immordino,1 Giovanni Mazzola,2 Pietro Colletti,2 Ilenia Alongi,1 Lucia Adamoli,1 Francesco Vitale,1 Alessandra Casuccio1 1Department of Sciences for Health Promotion and Mother-Child Care “G D’Alessandro”, University of Palermo, 2Department of Medicinal Clinics and Emerging Diseases, “Paolo Giaccone” Polyclinic University Hospital, Palermo, Italy Aim: The authors examined a cohort of HIV-positive outpatients at the AIDS Center of Palermo University in Italy in order to identify factors related to the frequency of their visits to the outpatient facility for health care services.Methods: Two hundred and twenty-four HIV-infected subjects were enrolled in the study. Demographic and HIV disease characteristics were recorded and assessed with the number of days accessed to our outpatients unit in univariate and multivariate analyses. The potential relationship with immunological status was also analyzed stratifying the patients into groups according to their CD4+ T-cell counts (≥500 vs <500/mm3, and ≥200 vs <200/mm3.Results: Both univariate and multivariate analyses showed that duration of antiretroviral therapy <5 years and hypertension were significantly associated with a CD4+ T-cell count of <500/mm3, whereas geographic origin (Africa was associated with a CD4+ T-cell count of <200/mm3. Mean number of days the patients sought access to day-care services for laboratory tests was negatively associated with CD4+ T-cell count.Conclusion: Patients with low CD4+ T-cell counts showed higher use of health care services, demonstrating how early HIV diagnosis can help to reduce health care costs. The CD4+ T-cell cut-off of 200 cells emphasizes the importance of identifying and managing HIV infection among hard-to-reach groups like vulnerable migrants. In our sample, the illegal status of immigrants does not influence the management of their HIV/AIDS condition, but the lack of European health card

  11. Hospital and urban effluent waters as a source of accumulation of toxic metals in the sediment receiving system of the Cauvery River, Tiruchirappalli, Tamil Nadu, India.

    Science.gov (United States)

    Devarajan, Naresh; Laffite, Amandine; Ngelikoto, Patience; Elongo, Vicky; Prabakar, Kandasamy; Mubedi, Josué I; Piana, Pius T M; Wildi, Walter; Poté, John

    2015-09-01

    Hospital and urban effluents contain a variety of toxic and/or persistent substances in a wide range of concentrations, and most of these compounds belong to the group of emerging contaminants. The release of these substances into the aquatic ecosystem can lead to the pollution of water resources and may place aquatic organisms and human health at risk. Sediments receiving untreated and urban effluent waters from the city of Tiruchirappalli in the state of Tamil Nadu, India, are analyzed for potential environmental and human health risks. The sediment samples were collected from five hospital outlet pipes (HOP) and from the Cauvery River Basin (CRB) both of which receive untreated municipal effluent waters (Tiruchirappalli, Tamil Nadu, India). The samples were characterized for grain size, organic matter, toxic metals, and ecotoxicity. The results highlight the high concentration of toxic metals in HOP, reaching values (mg kg(-1)) of 1851 (Cr), 210 (Cu), 986 (Zn), 82 (Pb), and 17 (Hg). In contrast, the metal concentrations in sediments from CRB were lower than the values found in the HOP (except for Cu, Pb), with maximum values (mg kg(-1)) of 75 (Cr), 906 (Cu), 649 (Zn), 111 (Pb), and 0.99 (Hg). The metal concentrations in all sampling sites largely exceed the Sediment Quality Guidelines (SQGs) and the Probable Effect Concentration (PEC) for the Protection of Aquatic Life recommendation. The ecotoxicity test with ostracods exposed to the sediment samples presents a mortality rate ranging from 22 to 100 % (in sediments from HOP) and 18-87 % (in sediments from CRB). The results of this study show the variation of toxic metal levels as well as toxicity in sediment composition related to both the type of hospital and the sampling period. The method of elimination of hospital and urban effluents leads to the pollution of water resources and may place aquatic organisms and human health at risk.

  12. 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.

    Directory of Open Access Journals (Sweden)

    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.

  13. Delineating a Retesting Zone Using Receiver Operating Characteristic Analysis on Serial QuantiFERON Tuberculosis Test Results in US Healthcare Workers

    Directory of Open Access Journals (Sweden)

    Wendy Thanassi

    2012-01-01

    Full Text Available Objective. To find a statistically significant separation point for the QuantiFERON Gold In-Tube (QFT interferon gamma release assay that could define an optimal “retesting zone” for use in serially tested low-risk populations who have test “reversions” from initially positive to subsequently negative results. Method. Using receiver operating characteristic analysis (ROC to analyze retrospective data collected from 3 major hospitals, we searched for predictors of reversion until statistically significant separation points were revealed. A confirmatory regression analysis was performed on an additional sample. Results. In 575 initially positive US healthcare workers (HCWs, 300 (52.2% had reversions, while 275 (47.8% had two sequential positive tests. The most statistically significant (Kappa = 0.48, chi-square = 131.0, P<0.001 separation point identified by the ROC for predicting reversion was the tuberculosis antigen minus-nil (TBag-nil value at 1.11 International Units per milliliter (IU/mL. The second separation point was found at TBag-nil at 0.72 IU/mL (Kappa = 0.16, chi-square = 8.2, P<0.01. The model was validated by the regression analysis of 287 HCWs. Conclusion. Reversion likelihood increases as the TBag-nil approaches the manufacturer's cut-point of 0.35 IU/mL. The most statistically significant separation point between those who test repeatedly positive and those who revert is 1.11 IU/mL. Clinicians should retest low-risk individuals with initial QFT results < 1.11 IU/mL.

  14. Characteristics of High-Risk Pregnancy in Sanglah General Hospital 2011-2014

    Directory of Open Access Journals (Sweden)

    Ryan Saktika Mulyana

    2016-07-01

    Full Text Available Background: Pregnant women with a high-risk pregnancy are women with increased risk in pregnancy or childbirth. There is no readily available data available about the characteristics of the high-risk pregnancy in Bali. Objective: Our study aimed to provide a data, to be the base of Sanglah General Hospital resource planning to reduce maternal mortality and morbidity. Method: This was an observational study using medical records of high risk pregnancy patients at Sanglah General Hospital from 2011 to 2014. Inclusion criteria were the patients with complete medical record and exclusion criteria are patient whose medical report incomplete. There was no missing data in this study.Result Over the 4 year study period at Sanglah, there were 1027 high-risk deliveries in 2011, 1590 in 2012, 1590 in 2013, and 948 in 2014. In the 4 years, there were 748 with age ≥ 35 years. The majority were in the age group of 26-30 years. As many as 2932 were multiparous. Overall, 3082 were multigravida and only 197 were grandemultipara. There were 1406 preterm (<37 week. By onset and mode of delivery, 2027 (41.50% had a caesarean section, There were 9 (0.18% Breech deliveries and Neonatal outcomes were recorded, showing that 296 (6.29% had moderate asphyxia and 2189 (4.63% had severe asphyxia. The multiple pregnancy was 197 (3.82% twin pregnancies and 5 (0.1% cases of triplets. The largest group of obstetrics complications in Sanglah hospital was premature rupture of membrane 1652 cases (30.99%. The most common medical disorder of pregnant women at our hospital was anemia, 353 cases (45.43%. The most prevalent congenital anomalies were multiple congenital abnormalities, as many as 18 infants (20.22%.Conclusion: There were a significant number of high-risk pregnancies delivered at Sanglah, with nearly 46.85% being high risk deliveries. Characteristics of these high risk pregnancies can be used to plan appropriate care to reduce the maternal mortality rate.

  15. Situational leadership styles, staff nurse job characteristics related to job satisfaction and organizational commitment of head nurses working in hospitals under the jurisdiction of the Royal Thai Army.

    Science.gov (United States)

    Intaraprasong, Bhusita; Potjanasitt, Sureporn; Pattaraarchachai, Junya; Meennuch, Chavalit

    2012-06-01

    To analyze the relationships between the situational leadership styles, staff nurse job characteristic with job satisfaction and organizational commitment of head nurses working in hospitals under the jurisdiction of the Royal Thai Army The cross-sectional analytical study was conducted in 128 head nurses working in hospitals under the jurisdiction of the Royal Thai Army. Data were collected by mailed questionnaires. A total of 117 completed questionnaires (91.4%) were received for analysis. Statistical analysis was done using Pearson's Product Moment Correlation Coefficient. It was found that situational leadership styles were not correlated with job satisfaction and organizational commitment of head nurses. Staff nurse job characteristics had a low level of positive correlation with job satisfaction and organizational commitment of head nurses at 0.05 level of significance (r = 0.202 and 0.189 respectively). The hospital administrators should formulate policy to improve working system, human resource management and formulate policies and strategies based on situational leadership. In addition, they should improve the characteristics of staff nurse job by using surveys to obtain job satisfaction and organizational commitment.

  16. Low energy laser in prevention of oral mucositis in patients receiving radiotherapy and/or chemotherapy in Pernambuco Cancer Hospital

    International Nuclear Information System (INIS)

    Kelner, Natalie; Castro, Jurema Freire Lisboa de

    2007-01-01

    Oral mucositis induced by antineoplastic therapy causes wide-range pain and discomfort resulting in decreased quality of life. The present study evaluated the benefits of low intensity laser and 0.12% chlorhexidine gluconate in the prevention of oral mucositis induced by radiation, associated or not with chemotherapy, and considered degrees/severity, time of appearance of the lesions and functional loss. Eighty-four outpatients were considered and 49 were included in this study and divided into two groups: Group 1 received laser treatments in three stages, starting three days before treatment until the end of therapy. Group 2 was instructed to do daily mouth rinses with chlorhexidine gluconate. The prevalence of clinical mucositis was 49%, and of functional mucositis, 28.6%, when the two groups were considered together. This percentage was smaller in the laser group, 44% for the clinical mucositis group and 24% for the functional. The two protocols were well tolerated and showed benefits, mainly from the point of view of functionality, and delayed the onset and development of mucositis. (author)

  17. Low energy laser in prevention of oral mucositis in patients receiving radiotherapy and/or chemotherapy in Pernambuco Cancer Hospital

    Energy Technology Data Exchange (ETDEWEB)

    Kelner, Natalie; Castro, Jurema Freire Lisboa de [Federal University of Pernambuco, Recife (Brazil). Dept. of Clinics and Preventive Dentistry. Discipline of Oral Pathology]. E-mail: jlisboa72@hotmail.com

    2007-07-01

    Oral mucositis induced by antineoplastic therapy causes wide-range pain and discomfort resulting in decreased quality of life. The present study evaluated the benefits of low intensity laser and 0.12% chlorhexidine gluconate in the prevention of oral mucositis induced by radiation, associated or not with chemotherapy, and considered degrees/severity, time of appearance of the lesions and functional loss. Eighty-four outpatients were considered and 49 were included in this study and divided into two groups: Group 1 received laser treatments in three stages, starting three days before treatment until the end of therapy. Group 2 was instructed to do daily mouth rinses with chlorhexidine gluconate. The prevalence of clinical mucositis was 49%, and of functional mucositis, 28.6%, when the two groups were considered together. This percentage was smaller in the laser group, 44% for the clinical mucositis group and 24% for the functional. The two protocols were well tolerated and showed benefits, mainly from the point of view of functionality, and delayed the onset and development of mucositis. (author)

  18. Characteristics and visual outcomes of patients hospitalized for ocular trauma in central China:2006-2011

    Directory of Open Access Journals (Sweden)

    Ying Qi

    2015-05-01

    Full Text Available AIM: To complete the data of ocular trauma in central China, as a well-known tertiary referral center for ocular trauma, we documented the epidemiological characteristics and visual outcomes of patients hospitalized for ocular trauma in this region. METHODS: A retrospective study of patients hospitalized for ocular trauma in central China from 2006 to 2011 was performed. RESULTS: This study included 5964 eyes of 5799 patients. The average age was 35.5±21.8y with a male-to-female ratio of 2.8:1. The most common age was 45-59y age group. Most patients were farmers and workers (51.9%. The most common injuries were firework related (24.5%, road traffic related (24.2%, and work related (15.0%. Among the most common causative agents were firecrackers (24.5%, followed by metal/knife/scissors (21.4%. Most injuries occurred in January (14.2%, February (27.0%, and August (10.0%. There were 8.5% patients with ocular injuries combined with other injuries. The incidence of open ocular injuries (4585 eyes, 76.9% was higher than closed ocular injuries (939 eyes, 15.7%. The incidences of chemical and thermal ocular injuries were 1.2% and 0.6%. Ocular trauma score (OTS predicted final visual acuity at non light perception (NLP, 20/200-20/50 and 20/40 with a sensitivity of 100%, and light perception (LP/hand motion (HM and 1/200-19/200 with a specificity of 100%. CONCLUSIONS: This study provides recent epidemiological data of patients hospitalized for ocular trauma in central China. Some factors influencing the visual outcome include time interval between injury and visit to the clinic, wound location, open or closed globe injury, initial visual acuity, and OTS.

  19. Demographic and clinical characteristics of patients referred to psychiatric unit in a tertiary care hospital

    International Nuclear Information System (INIS)

    Yousafzai, A.W.; Kazim, M.; Jehangiri, A.U.R.

    2015-01-01

    Very few studies from Pakistan have examined the profile of patients seen by psychiatrists in general hospital. The aim of this research is to describe the clinical and demographic characteristics of patients referred to the psychiatric unit of a general hospital over a one year period. Methods: This cross-sectional study was conducted at the Ayub Teaching Hospital, Abbottabad, from January 1st to December 31st 2012. All patients being referred to psychiatry were included in the study over one year period. The information was recorded on a structured questionnaire and analysed the data using SPSS-19.0. Results: Out of the 105 patients referred to the psychiatric unit, 74 (72.3%) were females. A total of 69 (68.5%) patients were married. More than half were uneducated and only number 4 (3%) patients had university qualification. Housewives made up 64.4% of the patient population followed by students (11%). Majority 55 (53%) had less than Rs. 5000/ monthly income. About 30% patients were shifted to psychiatry ward while, nearly one tenth were discharged. In 35% cases the psychiatrist was asked to help in the management, while in 50% cases only opinion was sought. Aggressive and threatening behaviour was source of concern in majority of patients for the primary team while 34% exhibited suicidal behaviour. Depression was most frequent diagnosis in 45 43% patients, followed by conversion disorder 19 (17%) and delirium 16 (14%). Conclusion: The rate of psychiatric referrals is dismal with only one third of the patients being transferred to the psychiatric ward. The major psychiatric diagnosis was depression. Patients with aggressive and threatening behaviour were more frequently referred. (author)

  20. Medical emergencies in the imaging department of a university hospital: event and imaging characteristics.

    Science.gov (United States)

    van Tonder, F C; Sutherland, T; Smith, R J; Chock, J M E; Santamaria, J D

    2013-01-01

    We aimed to describe the characteristics of medical emergencies that occurred in the medical imaging department (MID) of a university hospital in Melbourne, Australia. A database of 'Respond Medical Emergency Team (MET)' and 'Respond Blue' calls was retrospectively examined for the period June 2003 to November 2010 in relation to events that occurred in the MID. The hospital medical imaging database was also examined in relation to these events and, where necessary, patients' notes were reviewed. Ethics approval was granted by the hospital ethics review board. There were 124 medical emergency calls in the MID during the study period, 28% Respond Blue and 72% Respond MET. Of these 124 calls, 26% occurred outside of usual work hours and 12% involved cardiac arrest. The most common reasons for the emergency calls were seizures (14%) and altered conscious state (13%). Contrast anaphylaxis precipitated the emergency in 4% of cases. In 83% of cases the emergency calls were for patients attending the MID for diagnostic imaging, the remainder being for a procedure. Of the scheduled imaging techniques, 45% were for computed tomography. The scheduled imaging was abandoned due to the emergency in 12% of cases. When performed, imaging informed patient management in 34% of cases in diagnostic imaging and in all cases in the context of image-guided procedures. Medical emergency calls in the MID often occurred outside usual work hours and were attributed to a range of medical problems. The emergencies occurred in relation to all imaging techniques and imaging informed patient management in many cases. Crown Copyright © 2012. Published by Elsevier Ireland Ltd. All rights reserved.

  1. Clinical characteristics of two probable cases of Angelman syndrome in the Hospital Nacional de Ninos

    International Nuclear Information System (INIS)

    Midence-Cerda, Marvin; Brian-Gago, Roberto

    2004-01-01

    Angelman Syndrome is a severe neurological disorder. No other case has been reported in our country until now. There are two children reported with the clinical suspicion of Angelman Syndrome. They were treated at the Departamento de Neurologia del Hospital Nacional de Ninos. The information was taken from their medical records. The two patients present the four cardinal clinical features, including severe developmental delay, profound speech impairment, ataxia and a happy, sociable disposition. In addition, the patients displayed other characteristics: seizures associated with a typical spike and slow wave activity on EEG an love for water. The clinical diagnosis is difficult because other disorders can mimic the features of Angelman Syndrome. Nonetheless, at an early age, the behavioral phenotype of happy disposition and hyperexcitability is the most important manifestation and appears to be decisive in the differential diagnosis of patients with psychomotor and language delay. (author) [es

  2. Population-based characteristics of fatal and hospital admissions for poisoning in Fiji: TRIP Project-11

    Science.gov (United States)

    Peiris-John, Roshini; Kafoa, Berlin; Wainiqolo, Iris; Reddy, Ravi Krishnan; McCaig, Eddie; Ameratunga, Shanthi N

    2013-01-01

    This study investigated the incidence and characteristics of poisoning fatalities and hospital admissions among indigenous Fijians and Indians in Viti Levu, Fiji. Individuals with a mechanism of injury classified as poisoning were identified using the Fiji injury surveillance in hospitals system, a population-based registry established for 12 months in Viti Levu, and analysed using population-based denominators. The mean annual rates of fatalities and hospitalisations were 2.3 and 26.0 per 100 000, respectively. Over two-thirds of poisonings occurred among people of Indian ethnicity. Most intentional poisoning admissions occurred among women (58.3%) and in 15–29-year-old individuals (73.8%). Unintentional poisoning admission rates were highest among Indian boys aged 0–14 years. While over 75% of events occurred at home, the substances involved were not systematically identified. The findings indicate the need for a strategy that addresses the differing contexts across age group, gender and ethnicity, and a lead agency responsible for implementing and monitoring its effectiveness. PMID:23353079

  3. Emergence of Stenotrophomonas maltophilia nosocomial isolates in a Saudi children's hospital. Risk factors and clinical characteristics.

    Science.gov (United States)

    Alqahtani, Jobran M

    2017-05-01

      To describe the clinical characteristics of pediatric patients colonized or infected by Stenotrophomonas maltophilia (S. maltophilia) at a Saudi children's hospital, to identify risk factors associated with infection, and to investigate the antimicrobial resistance patterns of this emerging pathogen.  Methods: In this cross-sectional observational study, 64 non-duplicating S. maltophilia strains were isolated  in Najran Maternity and Children's Hospital, Najran,  Saudi Arabia between January 2015 to February 2016. Antimicrobial susceptibility testing was performed using the reference broth microdilution method.  Results: In this study, 48 (75%) isolates were identified in true infections and 16 (25%) isolates were considered colonization. The main types of S. maltophilia infection were pneumonia in 22 (45.8%) patients and bloodstream infection in 14 (29.2%) patients. The significant risk factors included exposure to invasive procedure (p=0.02), and presence of acute leukemia as an underlying disease (p=0.02). The most active antimicrobials were trimethoprim/sulfamethoxazole (100% sensitivity) and tigecycline (93.7% sensitivity). Conclusions: Stenotrophomonas maltophilia is an emerging nosocomial pathogen among pediatric patients. Accurate identification and susceptibility testing of this emerging pathogen are crucial for the management of infected patients and prevention of spread of this nosocomial pathogen.

  4. Characteristics and management of Enterobacteriaceae harboring IMP-4 or IMP-8 carbapenemase in a tertiary hospital.

    Science.gov (United States)

    Pang, Feng; Jia, Xiu-Qin; Song, Zhen-Zhu; Li, Yan-Hua; Wang, Bin; Zhao, Qi-Gang; Wang, Chuan-Xin; Zhang, Yi; Wang, Le-Xin

    2016-03-01

    The emergence of Enterobacteriaceae harboring IMP-4 or IMP-8 carbapenemases is rare. We report an occurrence of Enterobacteriaceae harboring IMP-4 or IMP-8 carbapenemases in a Chinese tertiary care hospital from November 2010 to December 2012. The clinical characteristics of 30 patients were described. The genetic relationship of isolates was determined by pulsed-field gel electrophoresis (PFGE). Carbapenemases were detected by modified Hodge test (MHT) and polymerase chain reactions (PCRs). Amplicons were sequenced and blasted to determine the genotype. Most infected patients were from intensive care unit and had complex and serious underlying illnesses requiring mechanical ventilation. PFGE revealed that Klebsiella pneumoniae showed two major PFGE types. Two Klebsiella oxytoca had an indistinguishable PFGE pattern, while four Enterobacter cloacae were different strains. The sequencing studies showed Enterobacteriaceae harboring IMP-4 or IMP-8 carbapenemase in the 23 infected patients. The majority of patients had infections with the carbapenemase-producing Enterobacteriaceae (CPE) strain, most were successfully treated with a range of antibiotics and discharged. It is important to maintain a high index of suspicion to screen for carbapenemase-producing Enterobacteriaceae strains. Rapid identification of these strains and implementation of stringent procedures are the key to prevent major outbreaks in a hospital setting.

  5. Clinical characteristics of lung abscess in children: 15-year experience at two university hospitals.

    Science.gov (United States)

    Choi, Mi Suk; Chun, Ji Hye; Lee, Kyung Suk; Rha, Yeong Ho; Choi, Sun Hee

    2015-12-01

    Information on the clinical features of lung abscess, which is uncommon in children, at hospitalizationis helpful to anticipate the disease course and management. There is no report concerning lung abscess in Korean children. We aimed to identify the clinical characteristics of pediatric lung abscess and compare the difference between primary and secondary abscess groups. The medical records of 11 lung abscess patients (7 males and 4 females) from March 1998 to August 2011 at two university hospitals were retrospectively reviewed. The clinical characteristics, symptoms, underlying disease, laboratory and radiologic findings, microbiological results, and treatments were examined. Six patients had underlying structural-related problems (e.g., skeletal anomalies). No immunologic or hematologic problem was recorded. The mean ages of the primary and secondary groups were 2.4 and 5.3 years, respectively, but the difference was not statistically significant. The mean length of hospital stay was similar in both groups (22.8 days vs. 21.4 days). Immunologic studies were performed in 3 patients; the results were within the normal range. Most patients had prominent leukocytosis. Seven and 4 patients had right and left lung abscess, respectively. Staphylococcus aureus, Streptococcus pneumoniae, and antimycoplasma antibodies were detected in both groups. Two patients with primary lung abscess were administered antibiotics in the absence of other procedures, while 8 underwent interventional procedures, including 5 with secondary abscess. The most common symptoms were fever and cough. All patients in the primary group were younger than 3 years. Structural problems were dominant. Most patients required interventional procedures and antibiotics.

  6. Predictors of early mortality in a cohort of HIV-infected children receiving high active antiretroviral treatment in public hospitals in Ethiopia.

    Science.gov (United States)

    Ebissa, Getachew; Deyessa, Negusse; Biadgilign, Sibhatu

    2015-01-01

    Highly active antiretroviral therapy (HAART) is the breakthrough in care and treatment of people living with HIV, leading to a reduction in mortality and an improvement in the quality of life. Without antiretroviral treatment, most HIV-infected children die before their fifth birthday. So the objective of this study is to determine the mortality and associated factors in a cohort of HIV-infected children receiving ART in Ethiopia. A multicentre facility-based retrospective cohort study was done in selected pediatric ART units in hospitals found in Addis Ababa, Ethiopia. The probability of survival was estimated using the Kaplan-Meier method, and multivariate analysis by Cox proportional hazards regression models was conducted to determine the independent predictor of survival. A total of 556 children were included in this study. Of the total children, 10.4% were died in the overall cohort. More deaths (70%) occurred in the first 6 months of ART initiation, and the remaining others were still on follow-up at different hospitals. Underweight (moderate and severe; HR: 10.10; 95% CI: 2.08, 28.00; P = 0.004; and HR: 46.69; 95% CI: 9.26, 200.45; P ART adherence (HR: 11.72; 95% CI: 1.60, 48.44; P = 0.015), and hemoglobin level less than 7 g/dl (HR: 4.08: 95% CI: 1.33, 12.56; P = 0.014) were confirmed as significant independent predictors of death after controlling for other factors. Underweight, advanced disease stage, poor adherence to ART, and anemia appear to be independent predictor of survival in HIV-infected children receiving HAART at the pediatric units of public hospitals in Ethiopia. Nutritional supplementations, early initiation of HAART, close supervision, and monitoring of patients during the first 6 months, the follow up period is recommended.

  7. Special article: Creation of a guide for the transfer of care of the malignant hyperthermia patient from ambulatory surgery centers to receiving hospital facilities.

    Science.gov (United States)

    Larach, Marilyn Green; Dirksen, Sharon J Hirshey; Belani, Kumar G; Brandom, Barbara W; Metz, Keith M; Policastro, Michael A; Rosenberg, Henry; Valedon, Arnaldo; Watson, Charles B

    2012-01-01

    Volatile anesthetics and/or succinylcholine may trigger a potentially lethal malignant hyperthermia (MH) event requiring critical care crisis management. If the MH triggering anesthetic is given in an ambulatory surgical center (ASC), then the patient will need to be transferred to a receiving hospital. Before May 2010, there was no clinical guide regarding the development of a specific transfer plan for MH patients in an ASC. MECHANISM BY WHICH THE STATEMENT WAS GENERATED: A consensual process lasting 18 months among 13 representatives of the Malignant Hyperthermia Association of the United States, the Ambulatory Surgery Foundation, the Society for Ambulatory Anesthesia, the Society for Academic Emergency Medicine, and the National Association of Emergency Medical Technicians led to the creation of this guide. EVIDENCE FOR THE STATEMENT: Most of the guide is based on the clinical experience and scientific expertise of the 13 representatives. The list of representatives appears in Appendix 1. The recommendation that IV dantrolene should be initiated pending transfer is also supported by clinical research demonstrating that the likelihood of significant MH complications doubles for every 30-minute delay in dantrolene administration (Anesth Analg 2010;110:498-507). This guide includes a list of potential clinical problems and therapeutic interventions to assist each ASC in the development of its own unique MH transfer plan. Points to consider include receiving health care facility capabilities, indicators of patient stability and necessary report data, transport team considerations and capabilities, implementation of transfer decisions, and coordination of communication among the ASC, the receiving hospital, and the transport team. See Appendix 2 for the guide.

  8. A randomized controlled trial to determine the effects of music and relaxation interventions on perceived anxiety in hospitalized patients receiving orthopaedic or cancer treatment.

    Science.gov (United States)

    Eckhouse, Diane R; Hurd, Mary; Cotter-Schaufele, Susan; Sulo, Suela; Sokolowski, Malgorzata; Barbour, Laurel

    2014-01-01

    Nonpharmacological interventions, including combinations of music, education, coping skills, and relaxation techniques, have been found to have a positive effect on patients' perceived anxiety in many settings. However, few research studies have assessed and compared the effectiveness of music and relaxation interventions in reducing the anxiety levels of orthopaedic and oncology patients. We conducted a prospective, randomized, controlled study to examine the effectiveness of music and relaxation interventions on perceived anxiety during initial hospitalization for patients receiving orthopaedic or cancer care treatment at a Midwestern teaching hospital. This was a pre-test/post-test study design utilizing the State-Trait Anxiety Inventory. One hundred twelve patients were randomized into 3 study groups. Thirty-eight subjects (34%) were randomized in the music-focused relaxation group, 35 subjects (31%) in the music and video group, and 39 (35%) subjects in the control group. Fifty-seven (51%) were orthopaedic patients and 55 (49%) were oncology patients. Comparison of the 3 study groups showed no statistically significant differences with regard to patients' demographics. Although reduced anxiety levels were reported for all 3 groups postintervention, the differences were not statistically significant (p > .05). Also, there was no significant difference found between the perceived anxiety levels of patients admitted to the orthopaedic and oncology care units (p > .05). Finally, the results of the intragroup comparisons (regardless of the group assignment) showed a significant decrease in anxiety levels reported by all patients postintervention (p Music and relaxation interventions could be an additional tool in assisting patients to become less anxious during their hospital stay. Music focused relaxation and music and video are both valuable and cost-effective strategies that can assist the orthopaedic and oncology patient population. Identifying opportunities to

  9. From Humans to Rats and Back Again: Bridging the Divide between Human and Animal Studies of Recognition Memory with Receiver Operating Characteristics

    Science.gov (United States)

    Koen, Joshua D.; Yonelinas, Andrew P.

    2011-01-01

    Receiver operating characteristics (ROCs) have been used extensively to study the processes underlying human recognition memory, and this method has recently been applied in studies of rats. However, the extent to which the results from human and animal studies converge is neither entirely clear, nor is it known how the different methods used to…

  10. Summary receiver operating characteristic curves as a technique for meta-analysis of the diagnostic performance of duplex ultrasonography in peripheral arterial disease

    NARCIS (Netherlands)

    deVries, SO; Hunink, MGM; Polak, JF

    Rationale and Objectives. We summarized and compared the diagnostic performance of duplex and color-guided duplex ultrasonography in the evaluation of peripheral arterial disease. We present our research as an example of the use of summary receiver operating characteristic (ROC) curves in a

  11. Characteristics of smokers and their knowledge about smoking at a teaching hospital in Karachi

    International Nuclear Information System (INIS)

    Qidwai, W.; Zahid, N.

    2005-01-01

    Objective: To study the characteristics of smokers and their knowledge about smoking, among Family Practice Patients, at a teaching hospital in Karachi, Pakistan. Main outcome measures: Age at starting smoking, duration and number of cigarettes smoked, started smoking under influence of friends, colleagues, family members or self motivation, number of friends and colleagues who smoked, whether smoking is unhealthy, and actual chance of harm to an individual due to smoking is very rare or not. Results: One hundred patients who visited Family Practice Center were interviewed. Sixty one percent were young married men, well educated and either student, in private service, self employed or unemployed. Eighty-four (84%) smokers started smoking between 16-25 years of age, and smoked 6-20 cigarettes daily for two to twenty five years. Sixty-nine (69%) of them started smoking under the influence of friends and had 3-5 friends and colleagues who smoked. 91% of smokers believed that smoking is unhealthy and were aware that it causes lung cancer and heart disease. Majority of them (69%) believed that the actual harm of smoking to an individual is not very rare. Conclusion: We have documented the characteristics of smokers and their knowledge about smoking among Family Practice patients. Majority of the respondents started smoking at a young age under the influence of friends though they were aware of its harmful effects. Though the sample size is small but it does give an indication about the responsible factors to plan interventional preventive strategies. (author)

  12. Clinical characteristics of basal cell carcinoma in a tertiary hospital in Sarawak, Malaysia.

    Science.gov (United States)

    Yap, Felix Boon Bin

    2010-02-01

    Basal cell carcinoma (BCC) is the most common skin cancer among Orientals. Data on this malignancy is lacking in Malaysia, prompting a retrospective study to determine the clinical characteristics in the skin clinic, Sarawak General Hospital between 2000 and 2008. Demographic data and clinical features of 64 histopathologically proven BCC from 43 patients were retrieved. Statistical analysis was performed comparing the clinical characteristics based on the region of involvement and gender. The mean age of presentation was 60.9 years. Male to female ratio was 1.05. Majority of the patients were Chinese (44.2%) followed by Malays (32.6%), Bidayuhs (14.0%) and Ibans (6.9%). Nodular BCC accounted for 95.3% of cases while 4.7% were superficial BCC. All the nodular BCC were pigmented. Ulceration was noted in 18%. There were 82.8% of BCC on the head and neck region and 17.2% on the trunk and limb region. BCC on the latter region were larger (mean 35.0 cf. 14.4 mm, p Sarawak were similar to other Asian studies. Additionally, BCC on the trunk and limbs and in men were larger, ulcerative and long standing warranting better efforts for earlier detection.

  13. Hospitals

    DEFF Research Database (Denmark)

    Mullins, Michael

    2013-01-01

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

  14. [Sociodemographic characteristics of the pregnant adolescent in a high specialty hospital].

    Science.gov (United States)

    Blanquet-García, Jaime; Montoya-Cázarez, Aminta; Carranza-Lira, Sebastián

    2016-01-01

    The adolescents' pregnancy is a public health problem related to sociocultural and economic factors which compromise the mother-son binomial. The aim of this paper is to identify the socio-demographic characteristics of pregnant adolescents from the hospital. Retrospective, descriptive and observational study, in which all pregnant patients between 10 and 19 years from the Hospital, during June 2012 and January 2014, were studied. The following data were collected: age, scholarship, occupation, marital status, age at beginning of sexual relations, number of sexual partners, contraceptive use and type of contraceptive method, pregnancies, parturition, cesarean section and abortions. Statistical analysis: Descriptive statistic was used, consistent in central tendency and dispersion measures. 608 adolescent were studied, age was 16.7 ± 1.2 years, 50.2% were students, 35.1% unemployed, 29.5% were single and 25.2% married. In 79% was its first pregnancy. The age at beginning of sexual relations was at 15.0 ± 1.3 years; 39% didn't use contraceptive method and 24.5% hadn't addictions. The pregnancy wasn't planned nor wished in 78.1%. Gestational age was between 8 and 44 weeks, this latter due to no confident amenorrhea and 56.7% had associated pathology. The mean age of the couple was 20.6 ± 3.8 years, 84.1% worked and 64.2% hadn't addictions. The opportune detection of risk factors will allow the prevention and attention of the teenage pregnancy.

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

    Directory of Open Access Journals (Sweden)

    Arpita Sen

    2016-01-01

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

  16. Neuro-ophthalmic and clinical characteristics of brain tumours in a tertiary hospital in Ghana

    International Nuclear Information System (INIS)

    Tagoe, N. N.; Essuman, V. A.; Fordjuor, G.; Akpalu, J.; Bankah, P.; Ndanu, T.

    2015-01-01

    Anecdotally, increasing number of patients are seen at Korle Bu Teaching Hospital (KBTH) with brain tumour. Neuro-ophthalmic symptoms and signs may help in timely diagnosis and intervention. The objective of this study is to evaluate the neuro-ophthalmic and clinical characteristics of brain tumour in patients presenting at a tertiary hospital in Ghana. The study design involved a prospective case series involving 36 consecutive patients newly diagnosed with brain tumour from November 2010 to October 2011, at the Ophthalmology, Neurosurgery and Endocrine units of KBTH, Ghana. All patients had clinical diagnosis of brain tumour with confirmation by computerized tomography (CT) or magnetic resonance imaging (MRI). Thirteen patients had histological confirmation of diagnosis. The outcome measures of the study include presenting visual acuity, colour vision, visual fields and cranial nerve deficits. Data of 36 patients were analysed. The results of the study showed that ages ranged from 3 to 69 years, mean (SD) 42.56(±16.6 years). Twenty-six (72%) were females. Tumours included pituitary adenoma (20, 55.5%), meningioma (10, 27.8%), choroid plexus tumour (1, 2.8%), medulloblastom (1, 2.8%), craniopharyngioma (1, 2.8%), haemangioblastoma (1, 2.8%), thalamic tumour (1, 2.8%) and haemangioma (1, 2.8%). Histologically confirmed tumours included pituitary adenoma (9, 69.2%), meningioma (3, 23.1%), craniopharyngioma (1, 7.7%). One patient had both a pituitary adenoma and meningioma. Blurred vision (30, 83.3%), headache (28, 77.8%) and photophobia (13, 36.1%) were predominant symptoms. Commonest neuro-ophthalmic signs were impaired colour vision (62 eyes, 88.6%), optic atrophy (26, 74.3%), unilateral or bitemporal hemianopia (15, 41.5%) and relative afferent pupillary defect (12, 34.3%). Seven (19.4%) patients were visually impaired and nine (25%) blind. Thirty-three of 72(45.8%) eyes had monocular blindness. Common neuro-ophthalmic characteristics were blurred vision

  17. Potential radiation doses likely to be received by the radiologists and para medical staff in an hospital in Pakistan. (G. M. counter, survey meter measurements )

    International Nuclear Information System (INIS)

    Ali, A.; Zeb, J.; Iqbal, S.; Orfi, S.D.

    1999-01-01

    Potential radiation doses likely to received by the radiologists and paramedical staff in a typical hospital in Pakistan have been measured using a very sensitive radiation survey meter (FAG FH40F2) employing in Geiger Muller counter (FHZ 120] as a role which is extendable up to 4 meters in length. The measurements have been compared with internationally accepted Maximum Permissible Radiation Dos Level (MPDL). Radiation dose rates measured on the hands of two radiologist during fluoroscopy examination of the patient were of the order of 1 m Sv.h/sup -1/ and 540 u Sv. h/sup -1/ which were 400% to 21% higher than the MPDL (250 u Sv. h/sup -1/). Radiation dose rates measured on the chest of the nurses were 300 and 50 u Sv. h/sup -1/, which were 3000% to 500% higher than those of MPDL(10 u Sv. h/sup -1/). Such high dose rates present a serious situation from radiation damage point of view and deserve attention of the hospital management and of national regulatory authority so as to minimize the potential radiation doses to the radiologists and paramedical staff. As Low As Reasonably Achievable (ALARA) concept should be implemented in the health sector. (author)

  18. Potential radiation doses likely to be received by the radiologists and paramedical staff in typical hospital in Pakistan (GM counter, survey meter measurements) (abstract)

    International Nuclear Information System (INIS)

    Ali, A.; Zeb, J.; Iqbal, S.; Orfi, S.D.

    1998-01-01

    Potential radiation doses likely to be received by the radiologists and para medical staff in a typical hospital in Pakistan have been measured using a very sensitive radiation survey meter (FAG FH40F2) employing a Geiger Muller counter (FHZ120) as a probe which is a probe extend able up to 4 meters in length. These measurements have been compared with internationally accepted Maximum Permissible Radiation Dose Level (MPDL). Radiation dose rates measured on the hands of two radiologists during fluoroscopy examination of the patient were of the order of 1mSv.h/sup -1/ and 540 mu Sv.h/sup -1/ which were 400% to 216% times higher than the MPDL (250 mu Sv.h/sup -1/). Radiation dose rates measured on the chest and neck were 300 and 50 mu Sv.h/sup -1/, which were 3000% to 500% times higher than those of MPDL (10 mu Sv.h/sup -1/. Such high dose rates present a serious situation and deserve attention of the hospital management and of national regulatory authority so as to minimize the potential radiation doses to the radiologists and para medical staff. As Low As Reasonably Achievable (ALARA) concept should be implemented in the health sector. (author)

  19. Characteristics and outcome among patients suffering from out-of-hospital cardiac arrest: Factors associated with survival

    Directory of Open Access Journals (Sweden)

    Trpković S.

    2014-01-01

    Full Text Available The aim was to define factors associated with an improved outcome among patients suffering out-of-hospital cardiac arrest (OHCA using the Utstain style data collection. We examined 200 patients suffering from OHCA in a prospective study in a two years period. We determined survival from cardiac arrest (CA to discharge from hospital and the factors associated with survival. 78% of CA patients had a cardiac aetiology, 65% occurred at home, 3.7% received bystander CPR. 36% were found in VF/VT, 64% in asystole/PEA. 52% of patients were intubated in the field, survival to discharge from hospital was significantly higher among patients who were intubated in the field. The mean response time was 6.6 minutes. 66.7% of patients were given the shock after 4 minutes. 131 (65.5% were pronounced dead in the field, 69 patients were transported to the hospital. 53 (76.8% patients of them died during the transport or in the ED, 7 died after hospital admission and 9 survived to hospital discharge. Multivariate logistic regression analysis showed that variables significantly associated with survival to hospital discharge were: age, endotracheal intubation in the field and mean response time. The outcome of CPR was better in patients who were younger, who were intubated in the field and when the response time was shorter.

  20. Low-FODMAP formula improves diarrhea and nutritional status in hospitalized patients receiving enteral nutrition: a randomized, multicenter, double-blind clinical trial.

    Science.gov (United States)

    Yoon, So Ra; Lee, Jong Hwa; Lee, Jae Hyang; Na, Ga Yoon; Lee, Kyun-Hee; Lee, Yoon-Bok; Jung, Gu-Hun; Kim, Oh Yoen

    2015-11-03

    Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) are poorly absorbed, short-chain carbohydrates that play an important role in inducing functional gut symptoms. A low-FODMAP diet improves abdominal symptoms in patients with inflammatory bowel disease and irritable bowel syndrome. However, there were no study for the effect of FODMAP content on gastrointestinal intolerance and nutritional status in patients receiving enteral nutrition (EN). In this randomized, multicenter, double-blind, 14-day clinical trial, eligible hospitalized patients receiving EN (n = 100) were randomly assigned to three groups; 84 patients completed the trial (low-FODMAP EN, n = 30; moderate-FODMAP EN, n = 28; high-FODMAP EN, n = 26). Anthropometric and biochemical parameters were measured; stool assessment was performed using the King's Stool Chart and clinical definition. Baseline values were not significantly different among the three groups. After the 14-day intervention, diarrhea significantly improved in the low-FODMAP group than in the moderate- and high-FODMAP groups (P nutritional status and facilitating prompt recovery from illness.

  1. Clinical and electroencephalographic characteristics of benign occipital epilepsy of childhood in two tertiary Brazilian hospitals

    Directory of Open Access Journals (Sweden)

    Soniza Vieira Alves-Leon

    2011-08-01

    Full Text Available This study intended to investigate the clinical and electroencephalographic benign occipital epilepsy of childhood (BOEC characteristics in a population sample of patients from two tertiary Brazilian hospitals. We analyzed retrospectively 4912 electroencephalograms (EEGs records, and the included patients were submitted to a new clinical and EEG evaluation. Were included 12 (0.92% patients; 4 (33.3% with criteria for early BOEC; 6 (50% for late form and 2 (16.7% with superimposed early and late onset forms. After new investigation, 2 (16.7% had normal EEG; 4 (33.3% had paroxysms over the occipital region; 3 (25% over the temporal posterior regions and 3 (25% over the posterior regions. Sharp waves were the predominant change, occurring in 8 (66.6%; spike and slow wave complexes in 1 (8.3% and sharp and slow wave complexes in 1 (8.3%. Vomiting, headache and visual hallucinations were the most common ictal manifestations, presented in 100% of patients with superimposed forms. Vomiting were absent in the late form and headache was present in all forms of BOEC.

  2. Differential characteristics of bacteraemias according to age in a community hospital.

    Science.gov (United States)

    Toyas, C; Aspiroz, C; Martínez-Álvarez, R M; Ezpeleta, A I; Arazo, P; Ferrando, J C

    To describe the characteristics of bacteraemias, according to age, in a community hospital. A prospective study of bacteraemias was conducted in 2011. The patients were classified into 3 age groups: younger than 65 years, 65 to 79, and 80 or older. The study collected variables on the patients and episodes. The study analysed 233 bacteraemias in 227 patients (23.8% in those younger than 65 years; 38.3% in the 65 to 79 age group; and 37.9% in the 80 years or older group). The most common underlying disease in all the groups was diabetes mellitus. In the most elderly patients, the Charlson index was highest, there was a lower proportion of exogenous factors, and almost 25% were severely dependent (Barthel index<20). Escherichia coli was the most common germ, and the main focus was urological. The patients aged 80 years or older had predominantly healthcare-associated infections, less severe symptoms (sepsis) (66.3%) and higher mortality (29.1%) compared with the younger patients. The very elderly patients with bacteraemia presented fewer exogenous factors, greater comorbidity and a poorer functional situation. The most common focus was urological and the origin was healthcare related. Despite their less severe clinical presentation, these patients' mortality was greater, and their degree of dependence was a highly relevant independent risk factor. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  3. Health-related quality of life in epilepsy patients receiving anti-epileptic drugs at National Referral Hospitals in Uganda: a cross-sectional study.

    Science.gov (United States)

    Nabukenya, Anne M; Matovu, Joseph K B; Wabwire-Mangen, Fred; Wanyenze, Rhoda K; Makumbi, Fredrick

    2014-04-12

    Epilepsy is a devastating disorder that impacts on patients' quality of life, irrespective of use of anti epileptic drugs (AEDs). This study estimates the health-related quality of life (HRQOL) and its associated predictors among epilepsy patients receiving AEDs. A total of 175 epilepsy patients already receiving AED for at least 3 months were randomly selected and interviewed from mental clinics at Mulago and Butabika national referral hospitals in Uganda between May - July 2011. A HRQOL index, the primary outcome, was constructed using items from Quality Of Life in Epilepsy Inventory (QOLIE-31) and the Hospital Anxiety and Depression Scale (HADS) questionnaires. The internal consistency and adequacy of these items was also computed using Cronbach's alpha and Kaiser-Meyer-Olkin tests. Partial correlations were used to evaluate the contribution of the health dimensions (mental, psychological, social, physical functioning and emotional well being) and, multiple linear regressions to determine factors independently associated with HRQOL. Just about half of the respondents (54%) were males, and nearly two thirds (62%) had received AEDs for at least 12 months. The average age was 26.6 years (SD = 11.1). The overall HRQOL mean score was 58 (SD = 13) on a scale of 0-100. The average scores of different dimensions or subscales ranged from 41 (physical) to 65 (psychological). At least three quarters (75%) of all subscales had good internal consistency and adequacy. The largest variations in the overall HRQOL were explained by social and mental functioning; each accounting for about 30% of the difference in the HRQOL but seizure control features explained a little (6%) variation. Factors negatively associated with HRQOL were poly-therapy (-1.16, p = 0.01) and frequency of seizures (-2.29, p = 0.00). Other factors associated with overall HRQOL included drug side effects, sex, marital status and education. Duration on AEDs was not a significant predictor of HRQOL. The HRQOL

  4. 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.

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

    Directory of Open Access Journals (Sweden)

    Kemuyama Nobuo

    2010-01-01

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

  6. Organisational characteristics associated with the use of daily interruption of sedation in US hospitals: a national study.

    Science.gov (United States)

    Miller, Melissa A; Krein, Sarah L; Saint, Sanjay; Kahn, Jeremy M; Iwashyna, Theodore J

    2012-02-01

    Daily interruption of sedation (DIS) has multiple proven benefits, but implementation is erratic. Past research on sedative interruption utilisation focused on individual clinicians, ignoring the role of organisations in shaping practice. The authors test the hypothesis that specific hospital organisational characteristics are associated with routine use of DIS. National, mailed survey to a stratified random sample of US hospitals in 2009. Respondents were the lead infection control professionals at each institution. Survey items enquired about DIS use, institutional structure, and organisational culture. Multivariable analysis was used to evaluate the independent association of these factors with DIS use. A total of 386 hospitals formed our final analytic sample; the response rate was 69.4%. Hospitals ranged in size from 25 to 1359 beds. 26% of hospitals were associated with a medical school. Almost 80% reported regular use of DIS for ventilated patients. While 75.4% of hospitals reported having leadership focus on safety culture, only 42.7% reported that their staff were receptive to changes in practice. In a multivariable logistic regression model, structural characteristics such as size and academic affiliation were not associated with use of DIS. However, leadership emphasis on safety culture (p=0.04), staff receptivity to change (p=0.02) and involvement in an infection prevention collaborative (p=0.04) were significantly associated with regular DIS use. Several elements of hospital organisational culture were associated with regular use of DIS in US hospitals. These findings emphasise the importance of combining specific administrative approaches with strategies to encourage receptivity to change among bedside clinicians in order to successfully implement complex evidence-based practices in the intensive care setting.

  7. Patient characteristics, resource use and outcomes associated with general internal medicine hospital care: the General Medicine Inpatient Initiative (GEMINI) retrospective cohort study.

    Science.gov (United States)

    Verma, Amol A; Guo, Yishan; Kwan, Janice L; Lapointe-Shaw, Lauren; Rawal, Shail; Tang, Terence; Weinerman, Adina; Cram, Peter; Dhalla, Irfan A; Hwang, Stephen W; Laupacis, Andreas; Mamdani, Muhammad M; Shadowitz, Steven; Upshur, Ross; Reid, Robert J; Razak, Fahad

    2017-12-11

    The precise scope of hospital care delivered under general internal medicine services remains poorly quantified. The purpose of this study was to describe the demographic characteristics, medical conditions, health outcomes and resource use of patients admitted to general internal medicine at 7 hospital sites in the Greater Toronto Area. This was a retrospective cohort study involving all patients who were admitted to or discharged from general internal medicine at the study sites between Apr. 1, 2010, and Mar. 31, 2015. Clinical data from hospital electronic information systems were linked to administrative data from each hospital. We examined trends in resource use and patient characteristics over the study period. There were 136 208 admissions to general internal medicine involving 88 121 unique patients over the study period. General internal medicine admissions accounted for 38.8% of all admissions from the emergency department and 23.7% of all hospital bed-days. Over the study period, the number of admissions to general internal medicine increased by 32.4%; there was no meaningful change in the median length of stay or cost per hospital stay. The median patient age was 73 (interquartile range [IQR] 57-84) years, and the median number of coexisting conditions was 6 (IQR 3-9). The median acute length of stay was 4.6 (IQR 2.5-8.6) days, and the median total cost per hospital stay was $5850 (IQR $3915-$10 061). Patients received at least 1 computed tomography scan in 52.2% of admissions. The most common primary discharge diagnoses were pneumonia (5.0% of admissions), heart failure (4.7%), chronic obstructive pulmonary disease (4.1%), urinary tract infection (4.0%) and stroke (3.6%). Patients admitted to general internal medicine services represent a large, heterogeneous, resource-intensive and growing population. Understanding and improving general internal medicine care is essential to promote a high-quality, sustainable health care system. Copyright 2017

  8. Optimization of doses received by the hospital staff and the members of the family of patients undergoing In - 111 pentetreotide therapy

    International Nuclear Information System (INIS)

    Kontogeorgakos, D.; Limouris, G.S.; Papanikolos, G.; Vlahos, L.; Carinou, E.; Kamenopoulou, V.; Dimitriou, P.

    2005-01-01

    corresponding DCLs. Applying the protocol, the time frame of the labeling procedure was shortened by nearly 50 %, while the doses to the staff were reduced by 40 %. The ruler and the thumb finger proved to receive the greatest dose. Following the instructions, the dose received by the person accompanying the patient was kept below the DC value. Analysis of the dose rate / time curve at 1 m distance from the patient, showed that the physical decay of 111 In (2.83 days) can be used for calculations of doses to thirds following the release. Our results underline the need for the establishment of a firm radiation protection protocol to be followed during the 111 In therapeutic procedures. The use of electronic dosemeters for monitoring the doses received by the staff during the procedure, is recommended. The technologists should also be equipped with finger dosemeters. Detailed behavior instructions, based on dose calculations and the patient's life conditions are essential to be given to the patient in order to optimize doses to thirds alter the release from the hospital. (author)

  9. How to create a marketing strategy based on hospital characteristics that attract physicians.

    Science.gov (United States)

    Nordstrom, R D; Horton, D E; Hatcher, M E

    1987-03-01

    Through use of multivariate statistical and research techniques, the authors analyzed 30 hospital features that contribute to a physician's image of a hospital as being a good or a poor place for patient admission and in which to practice. Use of the data obtained in this study can enable a hospital administrator to monitor changes in physicians' attitudes, plan strategies to encourage quality physicians to admit their patients, improve aspects perceived to be weak or unresponsive, and capitalize on strengths.

  10. Low Virologic Failure and Drug Resistance among HIV-Infected Patients Receiving Hospital-Based ART While Care and Outreach through Community in Guangxi, China.

    Science.gov (United States)

    Liang, Shujia; Shen, Zhiyong; Yan, Jing; Liang, Fuxiong; Tang, Zhenzhu; Liu, Wei; Kan, Wei; Liao, Lingjie; Leng, Xuebing; Ruan, Yuhua; Xing, Hui; Shao, Yiming

    2015-01-01

    To investigate human immunodeficiency virus (HIV) virologic suppression and drug resistance among HIV-infected patients receiving first-line antiretroviral treatment (ART) in hospitals while community care and outreach through local health workers in Guangxi, China. This was a series of cross-sectional surveys from 2004 to 2012 in Guangxi, supported by the Chinese National HIVDR Surveillance and Monitoring Network Working Group. Guangxi, China. Demographic, ART, and laboratory data (CD4(+) cell count, viral load, and drug resistance) were analyzed. Factors associated with virologic suppression were identified by logistic regression analysis. A total of 780 patients were included in this study. The median treatment duration was 20.6 months (IQR 6.6-35.9). Of 780 study participants, 95.4% of patients (744/780) had HIV virologic suppression. Among these, of the 143 patients who were infected through drug injection, only 10 (7.0%) experienced virologic failure, and the overall prevalence of HIV drug resistance was 2.8% (22/789). Factors associated with virologic suppression in the final multivariate models included self-reported missing doses in the past month (compared to not missing doses in the past month, AOR = 0.2, 95% CI: 0.1-0.6) and initial ART regimen without 3TC (compared to initial ART regimen with 3TC, AOR = 0.2, 95% CI: 0.1-0.4). Moreover, the trend chi-square test showed that the proportion of virologic suppression increased over time from 2004 to 2012 (P = 0.002). This study first demonstrated that HIV patients infected through various transmission routes can achieve an excellent treatment outcome in hospitals at or above the county level for free first-line ART in Guangxi. It is an important of ART education and adherence to intervention for achieving better treatment outcomes.

  11. Epidemiology and clinical characteristics of patients hospitalized for ocular trauma in South-Central China.

    Science.gov (United States)

    Wang, Wanpeng; Zhou, Yalan; Zeng, Jun; Shi, Meng; Chen, Baihua

    2017-09-01

    Ocular trauma is a major cause of visual loss, but little is known about its epidemiology and clinical characteristics in China. The aim of this study was to determine the prevalence and clinical characteristics of ocular trauma and assess prognostic factors in Changsha, Hunan, located in South-Central China. A retrospective case series (ICD codes: S05) study of ocular trauma in patients was performed at the Second Xiangya Hospital, Central South University, from 1 January 2010 to 31 December 2014. Demographic information, injury causes, ocular trauma types and initial and final visual acuity (VA) were recorded and analysed. The ocular trauma score (OTS) was calculated to assess the extent of the eye injury, prognosis and factors associated with visual impairment. All patient data were collected from the medical records system. Of the 2009 patients presenting during this 5-year period, 1695 (84.4%) were males and 314 (15.6%) were females. The average age of all patients was 37.0 ± 19.3 years (range from 1 to 87 years). The age distribution showed a peak in the ocular trauma population in the 41- to 50-year age group (24%, n = 482), followed by the 51- to 60-year age group (16.9%, n = 339). Overall, open-globe injuries had a higher frequency (70.7%, n = 1420) than closed-globe injuries (28.6%, n = 575) and thermal/chemical injuries (0.7%, n = 14). Of the open-globe injuries, corneal penetration was the most common injury (32.2%, n = 646) followed by rupture (21.5%, n = 432) and an intraocular foreign body (16.2%, n = 325). Overall, the most frequent ocular trauma setting was the workplace (39.6%, n = 795), followed by the home (28.4%, n = 570), and the most frequent activity was ironwork. Firecracker- and firework-associated ocular trauma was significantly higher during the months of January and February than during other months (50.0%, n = 112, p firework-related ocular trauma occurred during the months adjacent to the Chinese New Year

  12. Prevalence and clinical characteristics of tori and jaw exostoses in a teaching hospital in Jordan.

    Science.gov (United States)

    Sawair, Faleh A; Shayyab, Mohammad H; Al-Rababah, Mohammad A; Saku, Takashi

    2009-12-01

    To determine the prevalence and clinical characteristics of oral bony outgrowths (OBOs); torus palatinus (TP), torus mandibularis (TM), and exostoses in Jordanian dental patients. This cross-sectional study was conducted between November 1 and December 31, 2008 at the University of Jordan Hospital, Amman, Jordan. Clinical examinations of 618 patients (354 men and 264 women), 10-82 years of age, were conducted to determine the presence of OBOs. There were 239 subjects (38.7%) who had OBOs. Nearly one-third (34.6%) had TP, TM, or both. The prevalence rates were 25.7% for TM, 15.4% for TP, and 14.4% for exostoses. The OBOs were mostly noted in patients in their fifth decade of life, with attrition, clenching, or bruxism. Women had more TP, but gender differences were not statistically significant in cases of TM and exostoses. Most TP were large in size (71.6%), spindle (41.1%), or flat (40%) in shape, and located at the premolar-molar region (45.3%). The TM were mostly medium to large in size (84.9%), bilateral (81.1%), composed of single node (69.2%), and located at the premolar region (65.4%). Of the studied subjects, 7.1% had mandibular buccal exostosis, 10% had maxillary buccal, and 2.4% had palatal exostoses. Statistically significant associations were noticed between the concurrent existence of OBOs. A relatively high prevalence of OBOs was noted, and this should be taken into consideration when planning periodontal surgery and prosthodontic treatment.

  13. [Characteristics of induced labors at Marqués de Valdecilla University Hospital].

    Science.gov (United States)

    González-Maestro, Marta; Laurrieta-Saiz, Izaskun; García-González, Casandra; López-Mirones, Marta; Terán-Muñoz, Oihane; Alonso-Salcines, Alicia

    2017-01-03

    Induction of labor (IOL) is a common obstetric practice which has increased in recent decades. The main objective of this study is to describe the characteristics of induced labor at Marqués de Valdecilla University Hospital. A descriptive, retrospective study was performed between January 1st and April 30t h of 2014, by reviewing medical histories. A standardised registration has been used to collect data. There were a total of 376 IOL, the incidence was 35.1%. The most frequent indications were premature rupture of membranes (33.9%) and gestational age of 41 completed weeks or more (16.7%). Oxytocin was used to start 66.8% of the IOL. Of all births, 61.4% were spontaneous vaginal births and 25.3% caesarean sections. An increase in the rate of caesarean sections was observed in the group of gestational age of 41 completed weeks or more (27.3%) and hypertensive disorders of pregnancy (29.8%). The main cause of dystocia was suspected fetal compromise (36.4%). Adaptation to extrauterine life was within the parameters of normality in 94% of the newborn infants. Comparing the IOL with spontaneous labor, a decrease in spontaneous vaginal births and an increase in caesarean sections and operative vaginal births was observed in the inductions. This study provides relevant information to the professionals in the fields of gynaecology and obstetrics, and opens the way for future research to obtain results transferable to the clinical practice. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

  14. Recent changes in sociodemographic characteristics, dietary behaviors and clinical parameters of adults receiving food assistance in France

    Directory of Open Access Journals (Sweden)

    Katia Castetbon

    2016-08-01

    Full Text Available Abstract Background In 2004–2005, a survey carried out on food recipients in France revealed an alarming nutritional situation. In 2011–2012, and using a protocol similar to that of 2004–2005, our objective was to update the description of sociodemographic characteristics, dietary behaviors and clinical parameters of food assistance recipients and to analyze changes since 2004–2005. Methods Both surveys included multistage random sampling of adults benefitting from structures that supply food pantries and charitable grocery stores. Data on sociodemographic characteristics and dietary behaviors were collected along with weight, height and blood pressure measurements. Comparisons between the 2004–2005 (n = 883 and 2011–2012 (n = 1,058 survey observations were made, adjusting for socio-demographic changes which had occurred in the meantime. Results Since 2004–2005, proportions of food recipients ≥55 years (13.1–19.1 %, born in France (29.2–36.8 % and employed (5.5–11.7 % have increased; food insufficiency has decreased (95–74 %. For over half of the recipients, canned (52.4 % and non-perishable (50.9 % foods were obtained only from food assistance. Frequency of consumption significantly increased even after adjustment for socio-demographic changes; this was the case for dairy products (for twice a day consumption, 30.2–36.4 %, fruits and vegetables (three times a day, 7.8–13.9 %, and meat, eggs and fish (twice a day, 9.4–19.2 %. In 2011–2012, 15.6 % of men and 36.0 % of women were obese, while 44.5 and 35.1 % had high blood pressure, respectively. Conclusions Between 2004–2005 and 2011–2012 in France, consumption of staple foods has been slightly improved in food assistance recipients. However, prevalence of cardiovascular risk factors remains high, which underlines the need for long-term efforts at better quality of foods delivered.

  15. [Gestational history and prenatal care characteristics of adolescent and adult mothers in a maternity hospital in the interior of Minas Gerais, Brazil].

    Science.gov (United States)

    Santos, Luciana Angélica Vieira; Lara, Maristela Oliveira; Lima, Renata Caroline Ribeiro; Rocha, André Freire; Rocha, Euza Mara; Glória, José Cristiano Ramos; Ribeiro, Gabriela de Cássia

    2018-02-01

    The scope of this research was to analyze the gestational history and prenatal care characteristics of adolescent and adult mothers in a maternity hospital located in a city in Minas Gerais, which is a hospital of reference in the macro-region of health of Jequitinhonha. It involved a descriptive cross-sectional study. A total of 327 mothers were interviewed between May 2013 and March 2014 using a semi-structured questionnaire. With a sample of 255, the number of adult women was predominant. With respect to prenatal care, 324 pregnant women had medical appointments. In terms of the location for prenatal care, 79.2% of adolescents were attended in the public health service, while that percentage was 60.4% among adult women. Regarding the type of birth, 54.7% of mothers had normal delivery and 45% had cesarean section. Among adolescents, there was a higher percentage of normal delivery compared to adult women and this data had a statistically significant relationship with the age of the pregnant women. With respect to gestational age at birth, 85.9% had full-term deliveries, 13.5% had preterm delivery and 0.6% had post-term delivery. It was revealed that adolescent mothers were at a disadvantage compared to the other mothers in terms of both socioeconomic characteristics and prenatal care received.

  16. Recovery characteristics of patients receiving either sugammadex or neostigmine and glycopyrrolate for reversal of neuromuscular block: a randomised controlled trial.

    Science.gov (United States)

    Paech, M J; Kaye, R; Baber, C; Nathan, E A

    2018-03-01

    Sugammadex more rapidly and reliably reverses rocuronium-induced neuromuscular block compared with neostigmine, but it is not known if subsequent patient outcomes, including nausea, vomiting and other aspects of recovery are modified. In this study, we compared the recovery characteristics of sugammadex and neostigmine/glycopyrrolate following reversal of neuromuscular block. This was a single-centre, randomised, blinded, parallel-group clinical trial in women undergoing elective day-surgical laparoscopic gynaecological surgery, with a standardised general anaesthesia regimen that included rocuronium. Neuromuscular block was reversed with either sugammadex 2 mg.kg -1 or neostigmine 40 μg.kg -1 and glycopyrrolate 400 μg. The primary outcome was the incidence of nausea and vomiting during the first six postoperative hours. Secondary outcomes included other measures of postoperative recovery such as patient symptoms and recovery scores. Three-hundred and four women were analysed by intention-to-treat (sugammadex n = 151, neostigmine n = 153), which included four major protocol violations. There was no significant difference between sugammadex and neostigmine groups in the incidence of early nausea and vomiting (49.0% vs. 51.0%, respectively; OR 0.92, 95%CI 0.59-1.45; p = 0.731). Double vision (11.5% vs. 20.0%; p = 0.044) and dry mouth (71.6% vs. 85.5%; p = 0.003) were less common after sugammadex. Sedation scores at 2 h were also lower after sugammadex (median (IQR [range]) 0 (0-3 [0-10]) vs. 2 (0-4.[0-10]); p = 0.021). Twenty-four-hour recovery scores were not significantly different between groups. Reversal with sugammadex in this patient population did not reduce postoperative nausea or vomiting compared with neostigmine/glycopyrrolate. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

  17. Reducing hospital-acquired pressure ulcers using bundle methodology in pediatric and neonatal patients receiving extracorporeal membrane oxygenation therapy: An integrative review and call to action.

    Science.gov (United States)

    Courtwright, Suzanne E; Mastro, Kari A; Preuster, Christa; Dardashti, Navid; McGill, Sandra; Madelon, Myrlene; Johnson, Donna

    2017-10-01

    This review focuses on identifying (1) evidence of the effectiveness of care bundle methodology to reduce hospital-acquired pressure ulcers (HAPUs) in pediatric and neonatal patients receiving extracorporeal membrane oxygenation (ECMO) therapy and (2) barriers to implementing HAPU care bundles in this at-risk population. An integrative review was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search of the scientific literature was performed. Studies included were published between January 2011 and February 2016. A total of seven articles met inclusion criteria. Data were extracted from each published article and analyzed to identify common themes, specifically bundle methodology and barriers to implementing HAPU bundles, in this population. There is limited research on effectiveness of care bundle methodology in reducing HAPUs in children, and no research specific to its effectiveness in pediatric or neonatal ECMO patients. No research was identified studying barriers to implementation of HAPU care bundles in this population. Nurses are well poised to test innovative strategies to prevent HAPUs. Nurses should consider implementing and testing bundle methodology to reduce HAPU in this at-risk population, and conduct research to identify any barriers to implementing this strategy. There is literature to support the use of nurses as unit-based skin care champions to facilitate teamwork and reliable use of the bundle, both critical components to the success of bundle methodology. © 2017 Wiley Periodicals, Inc.

  18. Characteristics and outcomes of older HIV-infected patients receiving antiretroviral therapy in Malawi: A retrospective observation cohort study.

    Directory of Open Access Journals (Sweden)

    Hannock Tweya

    Full Text Available To estimate patients enrolling on antiretroviral therapy (ART over time; describe trends in baseline characteristics; and compare immunological response, loss to follow-up (LTFU, and mortality by three age groups (25-39, 40-49 and ≥50 years.A retrospective observation cohort study.This study used routine ART data from two public clinics in Lilongwe, Malawi. All HIV-infected individuals, except pregnant or breastfeeding women, aged ≥ 25 years at ART initiation between 2006 and 2015 were included. Poisson regression models estimated risk of mortality, stratified by age groups.Of 37,378 ART patients, 3,406 were ≥ 50 years old. Patients aged ≥ 50 years initiated ART with more advanced WHO clinical stage and lower CD4 cell count than their younger counterparts. Older patients had a significantly slower immunological response to ART in the first 18 months on ART compared to patients aged 25-39 years (p = 0.04. Overall mortality rates were 2.3 (95% confidence Interval (CI 2.2-2.4, 2.9 (95% CI 2.7-3.2 and 4.6 (95% CI 4.2-5.1 per 100 person-years in patients aged 25-39 years, 40-49 years and 50 years and older, respectively. Overall LTFU rates were 6.3 (95% CI 6.1-6.5, 4.5 (95% CI 4.2-4.7, and 5.6 (95% CI 5.1-6.1 per 100 person years among increasing age cohorts. The proportion of patients aged ≥ 50 years and newly enrolling into ART care remained stable at 9% while the proportion of active ART patients aged ≥50 years increased from 10% in 2006 to 15% in 2015.Older people had slower immunological response and higher mortality. Malawi appears to be undergoing a demographic shift in people living with HIV. Increased consideration of long-term ART-related problems, drug-drug interactions and age-related non-communicable diseases is warranted.

  19. COPD exacerbation: anthropometric characteristics of patients and the frequency of hospital admissions

    Directory of Open Access Journals (Sweden)

    Gashynova K.Y.

    2014-11-01

    Full Text Available Exceptional importance of exacerbations for COPD course prognosing was reflected in the GOLD, 2011, where the number of exacerbations during the past year has been recognized as one of the main criteria of the future risks for patients. The aim of study was to determine the anthropometric indicators that increase the risk of re-hospitalization due to acute exacerbation of COPD. A retrospective analysis of medical records of inpatients who were hospitalized with COPD exacerbation to therapeutic department of CI "Dnipropetrovs’k sixth municipal clinical hospital" of Dnipropetrovsk regional council" during three years was done. It was established that neither sex, nor height, nor weight affect the rate of hospitalization due to COPD exacerbations. Older age is not a factor that increases the risk of hospitalization due to COPD exacerbation (despite the fact that the majority of hospitalized patients were elderly patients, 37% of them were persons of potentially working age. Severe exacerbation of COPD may occur in any patients with, even one year, experience of the disease. Among anthropometric indices, the most important predictor of re-hospitalization due to exacerbation of COPD is BMI<18.5, so its calculation is advisable in long-term observation of patients.

  20. Clinical Characteristics of Pulmonary Tuberculosis Patients from a Southern Taiwan Hospital-based Survey

    Directory of Open Access Journals (Sweden)

    Chuan-Sheng Wang

    2008-01-01

    Full Text Available This study aimed to identify the clinical characteristics of culture-positive pulmonary tuberculosis (TB patients from a southern Taiwan hospital-based survey between August 1, 2003 and July 31, 2006. Demographics, symptoms, susceptibility patterns, sputum acid-fast bacilli (AFB stain status and treatment outcomes were recorded. The medical records of 154 patients who presented to the Kaohsiung Municipal Hsiao-Kang Hospital were analyzed retrospectively. The mean age of patients was 59.5 years; 115 patients were male and 39 were female. Diabetes mellitus (48/154; 31.2% was the most frequent risk factor for pulmonary TB infection. Nearly all patients (139/154; 90.3% had a cough. Fever was only seen in 27.9% and hemoptysis in 14.9% of patients. The combined resistance rates of Mycobacterium tuberculosis to the tested first-line agents were as follows: isoniazid, 3.2%; rifampin, 7.8%; ethambutol, 5.8%; and streptomycin, 2.6%. The combined resistance rate to any one of four first-line drugs was 12.3%. The combined resistance rate to ofloxacin was 3.9%. The combined resistance rate of multidrug resistant-TB was 1.9%. Sputum AFB stains were positive in 68.2% of cases. Analysis of treatment outcomes showed overall treatment success at 76.6%. The proportions of patients who died, defaulted treatment or in whom treatment failed were 16.2%, 3.9% and 0.0%, respectively. In conclusion, our study showed: (1 a higher frequency of pulmonary TB in male subjects than in other areas of Taiwan; (2 a higher frequency of cough and lower frequency of fever and hemoptysis than previous studies; (3 that the combined resistance rates to isoniazid and streptomycin were lower than both average levels in Taiwan and the global combined drug resistance rate; and (4 a higher proportion of patients responding to treatment and lower proportions of patients suffering mortality, defaulting treatment or not responding to treatment compared with other areas of Taiwan. With regard

  1. Clinical and Epidemiological Characteristics of HIV Infection/AIDS in Hospitalized Patients.

    Science.gov (United States)

    Ahmetagic, Sead; Porobić-Jahic, Humera; Piljic, Dilista; Custovic, Amer; Sabitovic, Damir; Zepic, Denis

    2015-02-01

    More than three decades after recognition of acquired immunodeficiency syndrome (AIDS) in the United States, the pandemic of human immunodeficiency virus (HIV) infection has dramatically changed the global burden of disease. The main goal of this research is retrospective analysis of epidemiological and clinical characteristics of 28 HIV infected patients, who were diagnosed and treated at the Clinic for Infectious Diseases in University Clinical Center Tuzla in the period from 1996 until the end of 2013. Retrospective analysis was performed using the medical records of 28 HIV-infected persons. Two rapid tests were used for HIV testing: OraQuick Advance test, Vikia HIV1/2, Elisa combo test, HIV RNA test. AIDS disease was determined by using the criteria from WHO. Among a total of 28 HIV-infected persons, 23 (82.14%) were males and 5 (17.86%) were females, with the male: female ratio of 4,6:1. In terms of the transmission route, a large proportion of cases were infected through heterosexual contact 19 (67.86%). At the time of the first visit, 16 (57.15%) patients showed asymptomatic HIV infection, 4 (14.28%) HIV infection with symptoms other than the AIDS defining diseases, and 8 (28.57) had AIDS. At the time of first hospital visit, the CD4 + cells count ranged from 40 to 1795/µl (conducted in 19 patients), and mean value of CD4 + cells was 365,31/µl, and mean HIV RNA titer was 287 118 copies/ml³. Of 28 HIV-infected persons 39 cases of opportunistic diseases developed in 12 patients (42.9%). In terms of the frequency of opportunistic diseases, tuberculosis (12 cases, 42.9%). Among a total of 28 HIV-infected patients, 6 (21.4%) of them died. This study characterizes the epidemiological and clinical patterns of HIV-infected patients in Tuzla region of Bosnia and Herzegovina to accurately understand HIV infection/AIDS in our region, in the hope to contribute in the establishment of effective HIV guidelines in the Tuzla region of B&H in the future.

  2. The Characteristics of Personal Order Sets in a Computerized Physician Order Entry System at a Community Hospital

    OpenAIRE

    Thomas, Sean M.; Davis, Daniel C.

    2003-01-01

    Personal order sets (POS) have been touted as important for the success of a computerized physician order entry (CPOE) system1. However, POS may systematize practice variability and are difficult to centrally administer. Few studies have looked at the characteristics and use of POS in a community hospital. We examined how POS are used at the Queen’s Medical Center (QMC). POS are an important part of the success of the QMC CPOE, but have definite disadvantages.

  3. The incidence, risk factors and characteristics of pressure ulcers in hospitalized patients in China.

    Science.gov (United States)

    Jiang, Qixia; Li, Xiaohua; Qu, Xiaolong; Liu, Yun; Zhang, Liyan; Su, Chunyin; Guo, Xiujun; Chen, Yuejuan; Zhu, Yajun; Jia, Jing; Bo, Suping; Liu, Li; Zhang, Rui; Xu, Ling; Wu, Leyan; Wang, Hai; Wang, Jiandong

    2014-01-01

    Pressure ulcers are very common in hospital patients. Though many studies have been reported in many countries, the large-scale benchmarking prevalence of pressure ulcers in China is not available. The aim of this study is to quantify the prevalence of pressure ulcers and the incidence of hospital-acquired pressure ulcers and analyze risk factors in hospitalized patients in China. A multi-central cross-sectional survey was conducted in one university hospital and 11 general hospitals in China. The Minimum Data Set (MDS) recommended by European Pressure Ulcer Advisory Panel (EUPAP) was used to collect information of inpatients. All patients stayed in hospital more than 24 hours and older than 18 years signed consent form and were included. Data from 39952 out of 40415 (98.85%) inpatients were analyzed. Of the 39952 patients, 631 patients (including 1024 locations) had pressure ulcers. The prevalence rate of pressure ulcers in 12 hospitals was 1.58% (0.94-2.97%). The incidence of hospital-acquired pressure ulcers (HAPU) was 0.63% (0.20-1.20%). The most common locations developed pressure ulcers were sacrum, heels, and iliac crests. The common stages of pressure ulcers were stage I and II. Patients in Intensive Care Unit, Geriatric and Neurological Department were easier to develop pressure ulcers. The prevalence and incidence of pressure ulcers in China was lower than that reported in European and other countries. The stages of pressure ulcers in China were different than that reported in European countries. Our study provides with a baseline value for intensive research on pressure ulcer in China.

  4. Measuring dynamic social contacts in a rehabilitation hospital: effect of wards, patient and staff characteristics.

    Science.gov (United States)

    Duval, Audrey; Obadia, Thomas; Martinet, Lucie; Boëlle, Pierre-Yves; Fleury, Eric; Guillemot, Didier; Opatowski, Lulla; Temime, Laura

    2018-01-26

    Understanding transmission routes of hospital-acquired infections (HAI) is key to improve their control. In this context, describing and analyzing dynamic inter-individual contact patterns in hospitals is essential. In this study, we used wearable sensors to detect Close Proximity Interactions (CPIs) among patients and hospital staff in a 200-bed long-term care facility over 4 months. First, the dynamic CPI data was described in terms of contact frequency and duration per individual status or activity and per ward. Second, we investigated the individual factors associated with high contact frequency or duration using generalized linear mixed-effect models to account for inter-ward heterogeneity. Hospital porters and physicians had the highest daily number of distinct contacts, making them more likely to disseminate HAI among individuals. Conversely, contact duration was highest between patients, with potential implications in terms of HAI acquisition risk. Contact patterns differed among hospital wards, reflecting varying care patterns depending on reason for hospitalization, with more frequent contacts in neurologic wards and fewer, longer contacts in geriatric wards. This study is the first to report proximity-sensing data informing on inter-individual contacts in long-term care settings. Our results should help better understand HAI spread, parameterize future mathematical models, and propose efficient control strategies.

  5. Characteristics and in-hospital outcomes of patients with acute coronary syndromes and heart failure in the United Arab Emirates.

    Science.gov (United States)

    Shehab, Abdulla; Al-Dabbagh, Bayan; Almahmeed, Wael; Bustani, Nazar; Nagelkerke, Nicolaas; Yusufali, Afzal; Wassef, Adel; Ibrahim, Mohamed; Brek, Azan Bin

    2012-09-26

    Heart failure (HF) is a serious complication of acute coronary syndromes (ACS), and is associated with high in-hospital mortality and poor long-term survival. The aims of this study were to describe the clinical characteristics, management and in-hospital outcomes of coronary syndrome (ACS) patients with HF in the United Arab Emirates. The study was selected from the Gulf Registry of Acute Coronary Events (Gulf RACE), a prospective multi-national, multicenter registry of patients hospitalized with ACS in six Middle East countries. The present analysis was focused on participants admitted to various hospitals in the UAE with a diagnosis of ACS in 2007 and were analyzed in terms of HF (Killip class II/III and IV) on admission. Of 1691 patients (mean age: 52.6 ± 11.7 years; 210 Females, 1481 Males) with ACS, 356 (21%) had an admission diagnosis of HF (Killip class II/III and IV). HF patients were less frequently males (19.2% vs. 34.3%; P < 0.001). HF was more frequently associated with hypertension (64.3% vs. 43.9%; P < 0.001), hyperlipidemia (49.4% vs. 31.8%; P < 0.001) and diabetes mellitus (DM) (51.1% vs. 36.2%; P < 0.001). HF was significantly associated with in-hospital mortality (OR = 11.821; 95% CI: 5.385-25.948; P < 0.001). In multivariate logistic regression, age, hyperlipidemia, heart rate and DM were associated with higher in-hospital HF. HF is observed in about 1 in 5 patients with ACS in the UAE and is associated with a significant increase in in-hospital mortality and other adverse outcomes.

  6. Books Received

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education. Books Received. Articles in Resonance – Journal of Science Education. Volume 1 Issue 1 January 1996 pp 118-118 Books Received. Books Received · More Details Fulltext PDF. Volume 1 Issue 2 February 1996 pp 120-120 Books Received. Books Received.

  7. Characteristics and predictors of death among hospitalized HIV-infected patients in a low HIV prevalence country: Bangladesh.

    Directory of Open Access Journals (Sweden)

    Lubaba Shahrin

    Full Text Available Predictors of death in hospitalized HIV-infected patients have not been previously reported in Bangladesh.The primary aim of this study was to determine predictors of death among hospitalized HIV-infected patients at a large urban hospital in Bangladesh.A study was conducted in the HIV in-patient unit (Jagori Ward of icddr,b's Dhaka Hospital. Characteristics of patients who died during hospitalization were compared to those of patients discharged from the ward. Bivariate analysis was performed to determine associations between potential risk factors and death. Multivariable logistic regression was used to identify factors independently associated with death.Of 293 patients admitted to the Jagori Ward, 57 died during hospitalization. Most hospitalized patients (67% were male and the median age was 35 (interquartile range: 2-65 years. Overall, 153 (52% patients were diagnosed with HIV within 6 months of hospitalization. The most common presumptive opportunistic infections (OIs identified were tuberculosis (32%, oesophageal candidiasis (9%, Pneumocystis jirovecii pneumonia (PJP (8%, and histoplasmosis (7%. On multivariable analysis, independent predictors of mortality were CD4 count ≤200 cells/mm3 (adjusted odds ratio [aOR]: 16.6, 95% confidence interval [CI]: 3.7-74.4, PJP (aOR: 18.5, 95% CI: 4.68-73.3, oesophageal candidiasis (aOR: 27.5, 95% CI: 5.5-136.9, malignancy (aOR:15.2, 95% CI: 2.3-99.4, and bacteriuria (aOR:7.9, 95% CI: 1.2-50.5. Being on antiretroviral therapy prior to hospitalization (aOR: 0.2, 95% CI: 0.06-0.5 was associated with decreased mortality.This study showed that most patients who died during hospitalization on the Jagori Ward had HIV-related illnesses which could have been averted with earlier diagnosis of HIV and proper management of OIs. It is prudent to develop a national HIV screening programme to facilitate early identification of HIV.

  8. Quantitative and qualitative characteristics of hospital waste in the city of Behshahr-2016

    Directory of Open Access Journals (Sweden)

    Zabihollah Yousefi

    2017-03-01

    Full Text Available Background: Recently, the rapid increase in quantity and type of waste has resulted to environmental pollution and health hazards which serve as a major challenge to humans. The level of this waste can be so high that dangerous chemicals and biological contaminants can be found in ordinary household waste. Major sources of waste in every city are mostly from care/health centers. Hence, this study aims to investigate the quantitative and qualitative waste taken from hospitals in the city. Methods: In this cross-sectional study, four city hospitals were examined in the city. For this purpose, a questionnaire was designed for quantitative analysis method and weighing scales based on the Ministry of Health questionnaire. Data were analyzed using SPSS software and for statistical analyses, Excel and Graph Pad Prism 5 were used. Results: According to findings, the total amount of hospital waste comprising infectious waste, sharp and pharmaceutical chemicals were related to Imam Khomeini hospital with values of 44 220 012 and 10 kg per day respectively, with 220 kg per day of general waste related to same hospital. Hence, the total weight of waste produced per capita, for infectious waste, general waste, chemical waste, and sharp - machinery were 2.35 ± 0.25, 0.39 ± 0.075, 1.25 ± 0.66, 0.05 ± 0.028 and 0.021 ± 0.015 kg per day per bed respectively. Conclusion: The data should be more focused on waste management and frequent orientation to hospitalized patients. This evaluation indicates the poor management of hospital wastes in view of collection, separation, infectious waste care, temporary storage station and on-time transmission and health disposal.

  9. Clinical characteristics of triple negative breast cancer in Egyptian women: a hospital-based experience

    Directory of Open Access Journals (Sweden)

    Nivine Gado

    2016-06-01

    Full Text Available Purpose: Triple negative breast cancer (TNBC is an aggressive subtype of breast cancer with poor prognosis despite the high rates of response to chemotherapy. We aim to study the clinical features, factors influencing recurrence and survival outcomes of TNBC patients.Methods: We retrospectively studied the charts of patients with biopsy proven TNBC treated at The Clinical Oncology Department Ain-Shams University between 2009 and 2012.Results: One hundred and forty five patients fulfilled the eligibility criteria. The incidence of TNBC was 10.5% - 15% with a mean of 12% of all breast cancer patients. The follow-up duration ranged from six months to four years. The age range was 26 to 78 years. Infiltrating ductal carcinoma represented 93.1% of the pathologic types. 87% of patients were free of metastases (M0 at presentation. Clinical stages II and III represented 38 and 39.5% of the patients. 66% of patients had modified radical mastectomy. Following surgery, 77.5% of patients received adjuvant chemotherapy while 61% of the patients had adjuvant radiation therapy. Anthracyclines based chemotherapy was given to 52% of patients. Disease-free survival (DFS of the M0 patients at 20 and 30 months was 92% and 80% respectively. Relapse occurred in 23% of M0 patients. After a mean duration of DFS of 15.1 months, the most common sites of metastases for relapsed M0 patients were pulmonary (44.8%, bone (41.4%, and locoregional (13.8%. The median overall survival (ORS of patients was 18 months (1 - 45 months, whereas for the M1 group of patients the median ORS was 9 months (2 - 29 months.Conclusion: The incidence, pathological characteristics, and clinical behavior of TNBC were similar to what is mentioned in the literature. Adding taxanes to the chemotherapy protocols and using postoperative radiotherapy were both associated with a significant increase in the mean period of DFS, while did not significantly affect the ORS.

  10. Characteristics of diarrheagenic Escherichia coli among children under 5 years of age with acute diarrhea: a hospital based study.

    Science.gov (United States)

    Zhou, Yu; Zhu, Xuhui; Hou, Hongyan; Lu, Yanfang; Yu, Jing; Mao, Lie; Mao, Liyan; Sun, Ziyong

    2018-02-01

    Diarrhea is the leading infectious cause of childhood morbidity and mortality. Among bacterial agents, diarrheagenic Escherichia coli (DEC) is the major causal agent of childhood diarrhea in developing countries, particularly in children under the age of 5 years. Here, we performed a hospital-based prospective study to explore the pathotype distribution, epidemiological characteristics and antibiotic resistance patterns of DEC from coli (EPEC) isolates were identified simultaneously with serology. Furthermore, antimicrobial sensitivity tests and sequencing of antibiotic resistance-related genes were conducted. DEC strains were identified in 7.9% of the 684 stool samples. Among them, the most commonly detected pathotype was EPEC (50.0% of DEC), of which 77.8% were classified as atypical EPEC (aEPEC). Age and seasonal distribution revealed that DEC tended to infect younger children and to occur in summer/autumn periods. Multidrug-resistant DEC isolates were 66.7%; resistance rates to ampicillin, co-trimoxazole, cefazolin, cefuroxime, cefotaxime, and ciprofloxacin were ≥ 50%. Among 5 carbapenem-resistant DEC, 60.0% were positive for carbapenemase genes (2 blaNDM-1 and 1 blaKPC-2). Among 30 cephalosporin-resistant DEC, 93.3% were positive for extended-spectrum β-lactamase (ESBL) genes, with blaTEM-1 and blaCTX-M-55 being the most common types. However, no gyrA or gyrB genes were detected in 16 quinolone-resistant isolates. Notably, aEPEC, which has not received much attention before, also exhibited high rates of drug resistance (81.0%, 66.7%, and 14.3% for ampicillin, co-trimoxazole , and carbapenem resistance, respectively). EPEC was the most frequent DEC pathotype in acute diarrheal children, with aEPEC emerging as a dominant diarrheal agent in central China. Most DEC strains were multidrug-resistant, making even ciprofloxacin unsuitable for empiric treatment against DEC infection. Among carbapenem-resistant DEC strains, those harboring blaNDM-1 and blaKPC-2

  11. Improved diagnostic performance of exercise thallium-201 single photon emission computed tomography over planar imaging in the diagnosis of coronary artery disease: a receiver operating characteristic analysis

    International Nuclear Information System (INIS)

    Fintel, D.J.; Links, J.M.; Brinker, J.A.; Frank, T.L.; Parker, M.; Becker, L.C.

    1989-01-01

    Qualitative interpretation of tomographic and planar scintigrams, a five point rating scale and receiver operating characteristic analysis were utilized to compare single photon emission computed tomography and conventional planar imaging of myocardial thallium-201 uptake in the accuracy of the diagnosis of coronary artery disease and individual vessel involvement. One hundred twelve patients undergoing cardiac catheterization and 23 normal volunteers performed symptom-limited treadmill exercise, followed by stress and redistribution imaging by both tomographic and planar techniques, with the order determined randomly. Paired receiver operating characteristic curves revealed that single photon emission computed tomography was more accurate than planar imaging over the entire range of decision thresholds for the overall detection and exclusion of coronary artery disease and involvement of the left anterior descending and left circumflex coronary arteries. Tomography offered relatively greater advantages in male patients and in patients with milder forms of coronary artery disease, who had no prior myocardial infarction, only single vessel involvement or no lesion greater than or equal to 50 to 69%. Tomography did not appear to provide improved diagnosis in women or in detection of disease in the right coronary artery. Although overall detection of coronary artery disease was not improved in patients with prior myocardial infarction, tomography provided improved identification of normal and abnormal vascular regions. These results indicate that single photon emission computed tomography provides improved diagnostic performance compared with planar imaging in many clinical subgroups

  12. Characteristics of patients hospitalized at an intensive care unit due to drug abuse

    Directory of Open Access Journals (Sweden)

    Flávia Antunes

    2013-07-01

    Full Text Available Objective. To characterize the clinical and demographic profile of patients hospitalized due to drug intoxication at an intensive care unit (ICU of a teaching hospital between 2004 and 2010. Methodology. In this descriptive study, information was collected from the hospitalized patients, as informed by a Toxicology Care Center (CAT in Paraná (Brazil. The clinical files were checked and information was collected about age, gender, toxic agents and intoxication circumstances, comorbidities and clinical outcomes. Results. Sixty-two patients were included in the study, with a mean age of 58 years and 77% male. Alcohol was the substance related to most hospitalizations (77%, followed by psychoactive drugs (14% and marihuana and crack (5% each. The main comorbidities were bronchopneumonia due to aspiration (37%, alcohol-related liver cirrhosis (24% and traumatic brain injury (19%. The most frequent intoxication circumstances were chronic abuse (79%, attemptive suicide (19% and acute abuse (4.9%. Thirty-nine percent of the patients died during hospitalization. Conclusion. The results show a concerning reality, as most of the patients are men of economically active age, who were intoxicated by a legal substance like alcohol, with a relevant number of deaths. Nurses need to pay particular attention to this health problem, in the context of which they play a fundamental role as educators with a view to the encouragement of healthy lifestyles.

  13. Comparison of road traffic injury characteristics between local versus floating migrant patients in a tertiary hospital between 2007 and 2010.

    Directory of Open Access Journals (Sweden)

    Chungui Xu

    Full Text Available BACKGROUND: The aim of this study is to give a description of the road traffic injuries (RTIs characteristics of floating migrant population by comparing with those of local residents in a harbor city of China. METHODS: A population-based descriptive study was carried out between 2007 and 2010 with RTI patient records from the Fifth Center Hospital of Tianjin. Inpatient diagnoses of RTI patients were defined using the International Classification of Diseases, Tenth Revision (ICD-10 codes. We analyzed the demographics and general characteristics of RTI patients that were in the hospital during the four years. In order to compare the group differences between local resident patients and floating migrant patients, the distribution of their ages, diagnoses, severity of injuries, duration of inpatient stays, hospitalization cost were analyzed. RESULTS: People between the ages of 16 and 55 were the most likely to suffer RTIs. The floating migrant patients between the ages of 16 and 45 had a higher incidence of accidents, while local resident patients between 46 and 55 had a higher incidence of accidents. Compared to local resident patients, floating migrant patients were more vulnerable to open injuries and severe traffic injuries. With the severity of injuries ranked from mild to severe, floating migrant patients had lower duration of inpatient stay, but higher hospitalization costs compared to local resident patients. CONCLUSIONS: Floating migrant patients had a different age distribution, severity of injuries, diseases, inpatient duration and hospitalization cost compared with local resident patients. Compared to local resident patients, floating migrants had a higher risk to RTIs and were more vulnerable to severer traffic accidents at lower ages.

  14. Governance and performance: the performance of Dutch hospitals explained by governance characteristics.

    Science.gov (United States)

    Blank, Jos L T; van Hulst, Bart Laurents

    2011-10-01

    This paper describes the efficiency of Dutch hospitals using the Data Envelopment Analysis (DEA) method with bootstrapping. In particular, the analysis focuses on accounting for cost inefficiency measures on the part of hospital corporate governance. We use bootstrap techniques, as introduced by Simar and Wilson (J. Econom. 136(1):31-64, 2007), in order to obtain more efficient estimates of the effects of governance on the efficiency. The results show that part of the cost efficiency can be explained with governance. In particular we find that a higher remuneration of the board as well as a higher remuneration of the supervisory board does not implicate better performance.

  15. The anchor-based minimal important change, based on receiver operating characteristic analysis or predictive modeling, may need to be adjusted for the proportion of improved patients.

    Science.gov (United States)

    Terluin, Berend; Eekhout, Iris; Terwee, Caroline B

    2017-03-01

    Patients have their individual minimal important changes (iMICs) as their personal benchmarks to determine whether a perceived health-related quality of life (HRQOL) change constitutes a (minimally) important change for them. We denote the mean iMIC in a group of patients as the "genuine MIC" (gMIC). The aims of this paper are (1) to examine the relationship between the gMIC and the anchor-based minimal important change (MIC), determined by receiver operating characteristic analysis or by predictive modeling; (2) to examine the impact of the proportion of improved patients on these MICs; and (3) to explore the possibility to adjust the MIC for the influence of the proportion of improved patients. Multiple simulations of patient samples involved in anchor-based MIC studies with different characteristics of HRQOL (change) scores and distributions of iMICs. In addition, a real data set is analyzed for illustration. The receiver operating characteristic-based and predictive modeling MICs equal the gMIC when the proportion of improved patients equals 0.5. The MIC is estimated higher than the gMIC when the proportion improved is greater than 0.5, and the MIC is estimated lower than the gMIC when the proportion improved is less than 0.5. Using an equation including the predictive modeling MIC, the log-odds of improvement, the standard deviation of the HRQOL change score, and the correlation between the HRQOL change score and the anchor results in an adjusted MIC reflecting the gMIC irrespective of the proportion of improved patients. Adjusting the predictive modeling MIC for the proportion of improved patients assures that the adjusted MIC reflects the gMIC. We assumed normal distributions and global perceived change scores that were independent on the follow-up score. Additionally, floor and ceiling effects were not taken into account. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. The characteristics of hospital emergency department visits made by people with mental health conditions who had dental problems.

    Science.gov (United States)

    Nalliah, Romesh P; Da Silva, John D; Allareddy, Veerasathpurush

    2013-06-01

    There is a paucity of knowledge regarding nationally representative estimates of hospital-based emergency department (ED) visits for dental problems made by people with mental health conditions. The authors conducted a study to provide nationwide estimates of hospital-based ED visits attributed to dental caries, pulpal and periapical lesions, gingival and periodontal lesions and mouth cellulitis/abscess made by people with mental health conditions. The authors used the Nationwide Emergency Department Sample, which is a component of the Healthcare Cost and Utilization Project sponsored by the Agency for Healthcare Research and Quality. ED visits attributable to dental caries, pulpal and periapical lesions, gingival and periodontal lesions and mouth cellulitis/abscess were identified by the emergency care provider by using diagnostic codes in International Classification of Diseases, Ninth Revision, Clinical Modification. The authors examined outcomes, including hospital charges. They used simple descriptive statistics to summarize the data. In 2008, people with mental health conditions made 15,635,253 visits to hospital-based ED in the United States. A diagnosis of dental caries, pulpal and periapical lesions, gingival and periodontal lesions and mouth cellulitis/abscess represented 63,164 of these ED visits. The breakdown of the ED visits was 34,574 with dental caries, 25,352 with pulpal and periapical lesions, 9,657 with gingival and periodontal lesions, and 2,776 with mouth cellulitis/abscess. The total charge for ED visits in the United States was $55.46 million in 2008. In 2008, people with mental health conditions made 63,164 visits to hospital-based EDs and received a diagnosis of dental caries, pulpal and periapical lesions, gingival and periodontal lesions or mouth cellulitis/abscess. These ED visits incurred substantial hospital charges. Programs designed to reduce the number of ED visits made by this population for common dental problems could have a

  17. Characteristics of unit-level patient safety culture in hospitals in Japan: a cross-sectional study.

    Science.gov (United States)

    Fujita, Shigeru; Seto, Kanako; Kitazawa, Takefumi; Matsumoto, Kunichika; Hasegawa, Tomonori

    2014-10-22

    Patient safety culture (PSC) has an important role in determining safety and quality in healthcare. Currently, little is known about the status of unit-level PSC in hospitals in Japan. To develop appropriate strategies, characteristics of unit-level PSC should be investigated. Work units may be classified according to the characteristics of PSC, and common problems and appropriate strategies may be identified for each work unit category. This study aimed to clarify the characteristics of unit-level PSC in hospitals in Japan. In 2012, a cross-sectional study was conducted at 18 hospitals in Japan. The Hospital Survey on Patient Safety Culture questionnaire, developed by the United States Agency for Healthcare Research and Quality, was distributed to all healthcare workers (n =12,076). Percent positive scores for 12 PSC sub-dimensions were calculated for each unit, and cluster analysis was used to categorise the units according to the percent positive scores. A generalised linear mixed model (GLMM) was used to analyse the results of the cluster analysis, and odds ratios (ORs) for categorisation as high-PSC units were calculated for each unit type. A total of 9,124 respondents (75.6%) completed the questionnaire, and valid data from 8,700 respondents (72.0%) were analysed. There were 440 units in the 18 hospitals. According to the percent positive scores for the 12 sub-dimensions, the 440 units were classified into 2 clusters: high-PSC units (n =184) and low-PSC units (n =256). Percent positive scores for all PSC sub-dimensions for high-PSC units were significantly higher than those for low-PSC units. The GLMM revealed that the combined unit type of 'Obstetrics and gynaecology ward, perinatal ward or neonatal intensive care unit' was significantly more likely to be categorised as high-PSC units (OR =9.7), and 'Long-term care ward' (OR =0.2), 'Rehabilitation unit' (OR =0.2) and 'Administration unit' (OR =0.3) were significantly less likely to be categorised as high

  18. Characteristics of patients who stop falling after a risk-based multidisciplinary intervention initiated in a geriatric day hospital.

    Science.gov (United States)

    Flabeau, O; Laurendeau, G; Laksir, H; Castaings-Pelet, S; Harston, S; Bourdel-Marchasson, I

    2013-02-01

    Multidisciplinary interventions for fallers have provided conflicting results in part due to the diversity of fallers' profiles. to determine the characteristics of the subgroup of patients with a positive response to a multidisciplinary fall prevention program initiated in a geriatric day hospital. Prospective observational study in day hospital. Patients > 75 years referred for falls during the last 3 months benefited from a multidisciplinary assessment to record their characteristics at baseline and to tailor a risk-based multidisciplinary intervention for fall prevention. Patients free from falls at the 3rd or 6th month were compared to persistent fallers for baseline characteristics. Sixty-nine patients were assessed at baseline (mean age 85.2 y (SD=0.6)), 44 at the 3rd month and 21 at the 6th month. Baseline characteristics of the patients free from falls at the 3rd month were the lower number of previous non-serious falls (p=0.013), living in nursing home (p=0.045), a higher Berg balance score (p=0.02) and a better mental health-related quality of life (M HQol, p=0.045). On multivariate analysis restricted to home-dwelling patients, the positive predictive factors were less isolation at home (OR=0.028, 95%CI [0-0.813], p=0.037), a lower number of non-serious previous falls (OR= 0.526 [0.309- 0.894], p=0.018), a better M HQol (OR=1.205 [1.000-1.452], p=0.050) and a trend for younger age (OR= 0.662, [0.426-1.027], p=0.066). Being able to call upon a support person (familial or institutional) to apply advice and a less serious risk of falling may be preliminary conditions for success in a multidisciplinary intervention initiated in a day hospital.

  19. Characteristics of developmental dysplasia of the hip at a tertiary hospital in Riyadh, Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Omar A Al-Mohrej

    2017-01-01

    Conclusions: The awareness of DDH should be increased among paediatricians to decrease the incidence of late DDH diagnosis. A structured screening program has to be created and implemented in all hospitals of the country to detect DDH earlier and to provide treatment as early as possible.

  20. Perceptions of job and industry characteristics on career decisions in the hospitality industry

    NARCIS (Netherlands)

    Blomme, R.J.; Tromp, D.M.; Rheede, van A.

    2009-01-01

    This paper reports on the initial results of a case study on management-level turnover in the hospitality industry and on factors influencing the career decisions of highly educated employees to stay or leave the industry. This issue is considered using an interpretative paradigm and the conclusion

  1. Characteristics of fatal and hospital admissions for burns in Fiji: a population-based study (TRIP Project-2).

    Science.gov (United States)

    Taoi, Mable; Wainiqolo, Iris; Kafoa, Berlin; Kool, Bridget; Naisaki, Asilika; McCaig, Eddie; Ameratunga, Shanthi

    2012-08-01

    Over 95% of burn deaths are estimated to occur in low-and-middle-income countries. However, the epidemiology of burn-related injuries in Pacific Island Countries is unclear. This study investigated the incidence and demographic characteristics associated with fatal and hospitalised burns in Fiji. This cross-sectional study utilised the Fiji Injury Surveillance in Hospital database to estimate the population-based incidence and contextual characteristics associated with burns resulting in death or hospital admission (≥12h) during a 12-month period commencing 1st October 2005. 116 people were admitted to hospital or died as a result of burns during the study period accounting for an overall annual incidence of 17.8/100,000 population, and mortality rate of 3.4/100,000. Most (92.2%) burns occurred at home, and 85.3% were recorded as unintentional. Burns were disproportionately higher among Fijian children compared with Fijian-Indian children with the converse occurring in adulthood. In adults, Indian women were at particularly high risk of death from self-inflicted burns as a consequence of 'conflict situations'. Burns are a significant public health burden in Fiji requiring prevention and management strategies informed by important differences in the context of these injuries among the major ethic groups of the country. Copyright © 2011 Elsevier Ltd and ISBI. All rights reserved.

  2. Relationships between coping strategies, individual characteristics and job satisfaction in a sample of hospital nurses: cross-sectional questionnaire survey.

    Science.gov (United States)

    Golbasi, Zehra; Kelleci, Meral; Dogan, Selma

    2008-12-01

    This study aims to describe and compare the job satisfaction, coping strategies, personal and organizational characteristics among nurses working in a hospital in Turkey. In this cross-sectional survey design study, 186 nurses from Cumhuriyet University Hospital completed Personal Data Form, Minnesota Satisfaction Questionnaire and Ways of Coping Inventory. Response rate was 74.4%. In this study, it was found that job satisfaction score of nurses showed moderate (mean: 3.46+/-0.56) was found. While nurses mostly used to employ self-confident and optimistic approaches that had already being considered as positive coping strategies with stress, yielding and helpless approaches were employed less than that. While a statistically significant positive relation (pjob satisfaction and dimensions of Ways of Coping Inventory "self-confident approach" and "optimistic approach", negative relation (pjob satisfaction and dimensions of the "helpless approach". Organizational and individual nurse characteristics were not found to be associated with job satisfaction. But, job satisfaction of the nurses who is bounded by a contract was found higher than that of permanent staff nurses (pjob satisfaction of Turkish hospital nurses was at a moderate and that of the nurses who succeeded to coping with the stress was heightened. Higher levels of job satisfaction were associated with positive coping strategies. This study contributes to a growing body of evidence demonstrating the importance of coping strategies to nurses' job satisfaction.

  3. Early results of a prospective quality of life analysis using the lung cancer symptom scale (LCSS) in patients receiving radiation therapy (XRT) for lung cancer in the community hospital setting

    International Nuclear Information System (INIS)

    Lutz, Stephen T.; Norrell, Ruth; Johnson, Christopher R.; Kachnic, Lisa A.; Arthur, Douglas W.; Huang, David T.

    1997-01-01

    Purpose/Objective: To prospectively determine symptom response in patients receiving radiation therapy for primary lung cancer. Materials and Methods: Thirty-three consecutive lung cancer patients were evaluated between March 1996 and February 1997 at the Medical College of Virginia satellite facility which serves a local community hospital. The LCSS, a validated quality of life scale, was used prospectively during the consultation and upon subsequent follow-up. The scale allowed scoring of symptom improvement, worsening, or stability following therapy. One patient declined therapy, while another was not offered XRT. The 31 remaining patients received a median dose of 54 Gy. Eleven patients received radiotherapy with curative intent to doses between 60 and 70 Gy, 5 small cell lung carcinoma (SmCCa) patients received 54 Gy consolidative therapy, and 13 patients received 15 to 30 Gy with palliative intent. Eight patients received chemotherapy as part of their initial treatment course, including all of those diagnosed with SmCCa. Twenty-one patients completed the LCSS at least once in the three month interval after therapy, while 6 died prior to follow-up, 2 were under treatment at the time of this analysis, and 2 were lost to follow-up. Survival analysis was completed using the Kaplan-Meier method. Results: Median follow-up was 4 months (range = 1 to 14), with an estimated median survival of 5 months. Fourteen patients died of lung cancer, 12 are alive with disease, 6 are alive without disease, and 1 died without disease. Patient characteristics were median age of 69 years (range = 43 to 91), male to female ratio of 4.5 to 1, mean weight loss of 12 pounds (range = 0 to 27), and mean duration of symptoms of 3 months (range = 0 to 12). Stage was: I 9%, II = 0%, IIIA = 6%, IIIB = 43%, IV = 27%, and limited stage SmCCa = 15%. Histology was: squamous cell carcinoma = 21%, adenocarcinoma = 23%, large cell carcinoma = 23%, poorly differentiated carcinoma = 15%, mesothelioma

  4. Predictors of Suicide-Related Hospitalization among U.S. Veterans Receiving Treatment for Comorbid Depression and Substance Dependence: Who Is the Riskiest of the Risky?

    Science.gov (United States)

    Mrnak-Meyer, Jennifer; Tate, Susan R.; Tripp, Jessica C.; Worley, Matthew J.; Jajodia, Archana; Mcquaid, John R.

    2011-01-01

    This study examined whether widely accepted suicide risk factors are useful in predicting suicide-related hospitalization, beyond history of a suicide attempt, in high-risk treatment-seeking veterans with depression and substance dependence. Negative mood regulation expectancies were the only significant predictor of hospitalization during…

  5. Absorbed doses received by patients submitted to chest radiographs in hospitals of the city of Sao Paulo, Brazil; Doses absorvidas pelos pacientes submetidos a radiografias toracicas em hospitais do municipio de Sao Paulo

    Energy Technology Data Exchange (ETDEWEB)

    Freitas, Marcelo Baptista de

    2000-07-01

    Medical irradiation contributes with a significant amount to the dose received by the population. Here, this contribution was evaluated in a survey of absorbed doses received by patients submitted to chest radiological examinations (postero-anterior (PA) and lateral (LAT) projections) in hospitals of the city of Sao Paulo. Due to the variety of equipment and procedures used in radiological examinations, a selection of hospitals was made (12, totalizing 27 X-ray facilities), taking into account their representativeness as medical institutions in the city, in terms of characteristics and number of radiographs carried out. An anthropomorphic phantom, provided with thermoluminescent dosemeters (TLD-1 00), was irradiated simulating the patient, and the radiographic image quality was evaluated. Absorbed doses were determined to the thoracic region (entrance and exit skin and lung doses), and to some important organs from the radiation protection point of view (lens of the eye, thyroid and gonads). The great variation on the exposure parameters (kV, mA.s, beam size) leads to a large interval of entrance skin doses-ESD (coefficients of variation, CV, of 60% and 76%, for PA and LAT projections, respectively, were found) and of organ doses (CV of 60% and 46%. for thyroid and lung respectively). Mean values of ESD for LAT and PA projections were 0.22 and 0.98 mGy, respectively. The average absorbed doses per exam (PA and LAT) to thyroid and lung, 0.15 and 0.24 mGy respectively,showed that the thyroid was irradiated by the primary beam in many cases. Values of lens of the eye and gonad absorbed doses were below 30 {mu}Gy. Comparison of the lung doses obtained in this study with values in the literature, calculated by Monte Carlo simulation, showed good agreement. On the other hand, the comparison shows significant differences in the dose values to organs outside the chest region (thyroid, lens of eye and gonads). The effective dose calculated for a chest examination, PA and

  6. Injury characteristics and outcome of road traffic accident among victims at Adult Emergency Department of Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia: a prospective hospital based study.

    Science.gov (United States)

    Seid, Mohammed; Azazh, Aklilu; Enquselassie, Fikre; Yisma, Engida

    2015-05-20

    Road traffic injuries are the eighth leading cause of death globally, and the leading cause of death for young people. More than a million people die each year on the world's roads, and the risk of dying as a result of a road traffic injury is highest in Africa. A prospective hospital based study was undertaken to assess injury characteristics and outcome of road traffic accident among victims at Adult Emergency Department of Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia. A structured pre-tested questionnaire was used to gather the required data. The collected data were analyzed using SPSS version 20.0. Hierarchical multiple regression analysis was used to identify predictors of fatalities among the road traffic crash victims. A total of 230 road traffic accident victims were studied. The majority of the study subjects were men 165 (71.7%) and the male/female ratio was 2.6:1. The victims' ages ranged from 14 to 80 years with the mean and standard deviations of 32.15 and ± 14.38 years respectively. Daily laborers (95 (41.3%)) and students (28 (12.2%)) were the majority of road traffic accident victims. Head (50.4%) and musculoskeletal (extremities) (47.0%) were the most common body region injured. Fractures (78.0%) and open wounds (56.5%) were the most common type of injuries sustained. The overall length of hospital stay (LOS) ranged from 1 day to 61 days with mean (± standard deviation) of 7.12 ± 10.5 days and the mortality rate was 7.4%. Hierarchical multiple regression analysis showed that age of the victims (ß = 0.16, p road traffic accident is a major public health problem. Urgent road traffic accident preventive measures and prompt treatment of the victims are warranted in order to reduce morbidity and mortality among the victims.

  7. Chronic complications and quality of life of patients living with sickle cell disease and receiving care in three hospitals in Cameroon: a cross-sectional study.

    Science.gov (United States)

    Andong, Anne M; Ngouadjeu, Eveline D T; Bekolo, Cavin E; Verla, Vincent S; Nebongo, Daniel; Mboue-Djieka, Yannick; Choukem, Simeon-Pierre

    2017-01-01

    Sickle Cell Disease (SCD) is associated with chronic multisystem complications that significantly influence the quality of life (QOL) of patients early in their life. Although sub-Saharan Africa bears 75% of the global burden of SCD, there is a paucity of data on these complications and their effects on the QOL. We aimed to record these chronic complications, to estimate the QOL, and to identify the corresponding risk factors in patients with SCD receiving care in three hospitals in Cameroon. In this cross-sectional study, a questionnaire was used to collect data from consecutive consenting patients. Information recorded included data on the yearly frequency of painful crisis, the types of SCD, and the occurrence of chronic complications. A 36-Item Short Form (SF-36) standard questionnaire that examines the level of physical and mental well-being, was administered to all eligible participants. Data were analyzed with STATA® software. Of 175 participants included, 93 (53.1%) were female and 111 (aged ≥14 years) were eligible for QOL assessment. The median (interquartile range, IQR) age at diagnosis was 4.0 (2.0-8.0) years and the median (IQR) number of yearly painful crisis was 3.0 (1.0-7.0). The most frequent chronic complications reported were: nocturnal enuresis, chronic leg ulcers, osteomyelitis and priapism (30.9%, 24.6%, 19.4%, and 18.3% respectively). The prevalence of stroke and avascular necrosis of the hip were 8.0% and 13.1% respectively. The median (IQR) physical and mental scores were 47.3 (43.9-58.5) and 41.0 (38.8-44.6) respectively. Age and chronic complications such as stroke and avascular necrosis were independently associated with poor QOL. In this population of patients living with SCD, chronic complications are frequent and their QOL is consequently poor. Our results highlight the need for national guidelines for SCD control, which should include new-born screening programs and strategies to prevent chronic complications.

  8. Correlation between Tumor-Infiltrating Lymphocytes and Pathological Response in Locally Advanced Breast Cancer Patients Who Received Neoadjuvant Chemotherapy in H. Adam Malik General Hospital

    Directory of Open Access Journals (Sweden)

    Kamal Basri Siregar

    2017-08-01

    Full Text Available Background: Tumor-infiltrating lymphocytes (TILs are emerging as biomarkers mediating tumor response to treatments. Earlier studies have provided evidence that the level of TILs has prognostic value, particularly in triple-negative and human epidermal growth factor receptor-2-positive breast cancer. Moreover, the level of TILs has been associated with treatment outcome in patients undergoing neoadjuvant chemotherapy, and there is a strong correlation with pathologically complete response. In this study, we analyzed whether changes in TILs take place after neoadjuvant therapy and if they correlate with pathological response to treatment. Patients and Methods: We retrospectively analyzed the specimen slides from the Department of Anatomic Pathology of H. Adam Malik General Hospital during 2011–2015. We identified 51 patients fulfilling the inclusion criteria of this study. The histological sections had already been evaluated by hematoxylin and eosin slides. They were reassessed by our pathologist for the percentage of intratumoral and stromal TILs. The correlation with pathological response of the tumor after neoadjuvant therapy was also studied in these patients. Each case was also defined as high- or low-TIL breast cancer adopting previously validated cutoffs. Results: The mean age of the 51 patients was 49.22 years. The most frequent type of breast cancer histology was invasive ductal breast carcinoma in 49 (96% patients, and there were 2 (4% patients with lobular carcinoma. The histopathological grading for high TILs was grade 1 in 5 patients, grade 2 in 15 patients, and grade 3 in 3 patients. High TILs that had a pathologically complete response were found in 47.8% of patients, and low TILs were found in 28.8%. There was no significant correlation between TILs and pathological response in patients with neoadjuvant chemotherapy (p = 0.157. Conclusions: This research has not been able to demonstrate a significant correlation between TILs and

  9. Biopsychosocial characteristics of adolescent mothers assisted at a school hospital in a City of Minas Gerais, Brazil

    Directory of Open Access Journals (Sweden)

    Daniela Tavares Gontijo

    2010-01-01

    Full Text Available The adolescence is a human development time characterized by biopsychosocial changes, influenced by personal life experiences. In this context pregnancy along adolescence has been regarded as a relevant social issue due to the high prevalence in this age group. This study aims to describe biopsychosocial characteristics of adolescent mothers in a school hospital (SH of a public university in Minas Gerais, Brazil. This is a cross-sectional descriptive study with 40 adolescent mothers in this hospital. Data were collected through a form and analyzed using descriptive statistics. The data in this study were similar to findings in studies conducted in other urban centers especially as regards the participants’ average age and the precarious economic condition of their families and school performance. The data analysis has highlighted the need to understand teenage pregnancy as an experience with different factors as biological, psychological, economic and social development.

  10. BIOPSYCHOSOCIAL CHARACTERISTICS OF ADOLESCENT MOTHERS ASSISTED AT A SCHOOL HOSPITAL IN A CITY OF MINAS GERAIS, BRAZIL

    Directory of Open Access Journals (Sweden)

    Daniela Tavares Gontijo

    2010-10-01

    Full Text Available The adolescence is a human development time characterized by biopsychosocial changes, influenced by personal life experiences. In this context pregnancy along adolescence has been regarded as a relevant social issue due to the high prevalence in this age group. This study aims to describe biopsychosocial characteristics of adolescent mothers in a school hospital (SH of a public university in Minas Gerais, Brazil. This is a cross-sectional descriptive study with 40 adolescent mothers in this hospital. Data were collected through a form and analyzed using descriptive statistics. The data in this study were similar to findings in studies conducted in other urban centers especially as regards the participants’ average age and the precarious economic condition of their families and school performance. The data analysis has highlighted the need to Características de mães adolescentes understand teenage pregnancy as an experience with different factors as biological, psychological, economic and social development. teenage pregnancy, adolescent, reproduction

  11. Investigating Public Facility Characteristics from a Spatial Interaction Perspective: A Case Study of Beijing Hospitals Using Taxi Data

    Directory of Open Access Journals (Sweden)

    Xiaoqing Kong

    2017-02-01

    Full Text Available Services provided by public facilities are essential to people’s lives and are closely associated with human mobility. Traditionally, public facility access characteristics, such as accessibility, equity issues and service areas, are investigated mainly based on static data (census data, travel surveys and particular records, such as medical records. Currently, the advent of big data offers an unprecedented opportunity to obtain large-scale human mobility data, which can be used to study the characteristics of public facilities from the spatial interaction perspective. Intuitively, spatial interaction characteristics and service areas of different types and sizes of public facilities are different, but how different remains an open question, so we, in turn, examine this question. Based on spatial interaction, we classify public facilities and explore the differences in facilities. In the research, based on spatial interaction extracted from taxi data, we introduce an unsupervised classification method to classify 78 hospitals in 6 districts of Beijing, and the results better reflect the type of hospital. The findings are of great significance for optimizing the spatial configuration of medical facilities or other types of public facilities, allocating public resources reasonably and relieving traffic pressure.

  12. Acute pulmonary oedema: clinical characteristics, prognostic factors, and in-hospital management.

    Science.gov (United States)

    Parissis, John T; Nikolaou, Maria; Mebazaa, Alexandre; Ikonomidis, Ignatios; Delgado, Juan; Vilas-Boas, Fabio; Paraskevaidis, Ioannis; Mc Lean, Antony; Kremastinos, Dimitrios; Follath, Ferenc

    2010-11-01

    Acute pulmonary oedema (APE) is the second, after acutely decompensated chronic heart failure (ADHF), most frequent form of acute heart failure (AHF). This subanalysis examines the clinical profile, prognostic factors, and management of APE patients (n = 1820, 36.7%) included in the Acute Heart Failure Global Survey of Standard Treatment (ALARM-HF). ALARM-HF included a total of 4953 patients hospitalized for AHF in Europe, Latin America, and Australia. The final diagnosis was made at discharge, and patients were classified according to European Society of Cardiology guidelines. Patients with APE had higher in-hospital mortality (7.4 vs. 6.0%, P = 0.057) compared with ADHF patients (n = 1911, 38.5%), and APE patients exhibited higher systolic blood pressures (P chronic renal disease (P renal function, and history may identify high-risk APE patients.

  13. Receiver operating characteristics of diagnostic efficacy of resting left ventricular performance (evaluating with a non-imaging ECG gated scintillation detector - nuclear stethoscope)

    International Nuclear Information System (INIS)

    Kotlyarov, E.V.; Reba, R.C.; Lindsay, J.

    1983-01-01

    Receiver operating characteristic (ROC) analysis of left ventricular performance at rest was applied to evaluate diagnostic utility of non-imaging nuclear detector (''Nuclear Stethoscope''), for screening patients with coronary artery disease (CAD). Thirty-one patients without CAD and normal rest and stress radionuclide ventriculography (MUGA) were used as a control group. Another 62 patients with abnormal left ventricular reserve and segmental wall motion abnormalities at rest were also studied. All 93 patients were studied with the Nuclear Stethoscope (30 minutes after conventional MUGA testing) both in beat-to-beat and gated equilibrium modes. ROC analysis showed that along with ejection fraction, stroke and end-diastolic volumes, evaluation of the left ventricular filling phase has a great potential for the identification of patients with a segmental wall motion abnormality and, therefore, significant CAD

  14. Paired receiver operating characteristic curves and the effect of history on radiographic interpretation: CT of the head as a case study

    International Nuclear Information System (INIS)

    McNeil, B.J.; Hanley, J.A.; Funkenstein, H.H.; Wallman, J.

    1983-01-01

    The use of a statistical technique for paired comparisons using receiver operating characteristic (ROC) curves is illustrated by studying the extent to which clinical history altered the interpretation of computed tomographic (CT) examinations of the head. Eighty-nine CT examinations of the head were presented in random order to four readers, first with minimum history (age and sex) and then several weeks later with complete neutrological history as of the time the CT examination had been obtained. Using a paired ROC analysis, a small but significant (p < .05) improvement was detected for the interpretations in the presence of complete history; for readings without history the average area was 94.4% and for readings with history it was 97.7%

  15. Receiver-operating characteristic curves and likelihood ratios: improvements over traditional methods for the evaluation and application of veterinary clinical pathology tests

    DEFF Research Database (Denmark)

    Gardner, Ian A.; Greiner, Matthias

    2006-01-01

    Receiver-operating characteristic (ROC) curves provide a cutoff-independent method for the evaluation of continuous or ordinal tests used in clinical pathology laboratories. The area under the curve is a useful overall measure of test accuracy and can be used to compare different tests (or...... different equipment) used by the same tester, as well as the accuracy of different diagnosticians that use the same test material. To date, ROC analysis has not been widely used in veterinary clinical pathology studies, although it should be considered a useful complement to estimates of sensitivity...... and specificity in test evaluation studies. In addition, calculation of likelihood ratios can potentially improve the clinical utility of such studies because likelihood ratios provide an indication of how the post-test probability changes as a function of the magnitude of the test results. For ordinal test...

  16. Characteristics and outcomes of paracetamol poisoning cases at a general hospital in Northern Malaysia.

    Science.gov (United States)

    Mohd Zain, Z; Fathelrahman, A I; Ab Rahman, A F

    2006-02-01

    Paracetamol is available as an over-the-counter medication in many countries including Malaysia. This drug has been implicated in many poisoning cases admitted to hospitals throughout the country. We conducted a three-year retrospective review of 165 medical records of patients admitted to the Penang General Hospital for acute paracetamol poisoning. Cases were identified according to the discharge diagnosis documented in their medical records. Acute paracetamol poisoning occurred in all major ethnic groups. About 70 percent of our patients were female. There was minimal involvement of children. Admissions were more likely to be due to deliberate ingestions rather than accidental poisoning. In most cases, serum concentrations data plotted on the Rumack-Matthew nomogram predicted the majority of cases to be unlikely to be hepatotoxic, which were consistent with their mild clinical courses. Patients who acutely ingested more than 140 mg/kg or predicted to be hepatotoxic, based on their serum concentrations, had a significantly longer hospital stay. Although acute paracetamol poisoning was common, the outcome was generally good.

  17. Delirium after lung transplantation: Association with recipient characteristics, hospital resource utilization, and mortality.

    Science.gov (United States)

    Sher, Yelizaveta; Mooney, Joshua; Dhillon, Gundeep; Lee, Roy; Maldonado, José R

    2017-05-01

    Delirium is associated with increased morbidity and mortality. The factors associated with post-lung transplant delirium and its impact on outcomes are under characterized. The medical records of 163 consecutive adult lung transplant recipients were reviewed for delirium within 5 days (early-onset) and 30 hospital days (ever-onset) post-transplantation. A multivariable logistic regression model assessed factors associated with delirium. Multivariable negative binomial regression and Cox proportional hazards models assessed the association of delirium with ventilator duration, intensive care unit (ICU) length of stay (LOS), hospital LOS, and one-year mortality. Thirty-six percent of patients developed early-onset, and 44% developed ever-onset delirium. Obesity (OR 6.35, 95% CI 1.61-24.98) and bolused benzodiazepines within the first postoperative day (OR 2.28, 95% CI 1.07-4.89) were associated with early-onset delirium. Early-onset delirium was associated with longer adjusted mechanical ventilation duration (P=.001), ICU LOS (Pdelirium was associated with longer ICU (Pdelirium was not significantly associated with one-year mortality (early-onset HR 1.65, 95% CI 0.67-4.03; ever-onset HR 1.70, 95% CI 0.63-4.55). Delirium is common after lung transplant surgery and associated with increased hospital resources. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. C-reactive protein-to-albumin ratio is a predictor of hepatitis B virus related decompensated cirrhosis: time-dependent receiver operating characteristics and decision curve analysis.

    Science.gov (United States)

    Huang, Si-Si; Xie, Dong-Mei; Cai, Yi-Jing; Wu, Jian-Min; Chen, Rui-Chong; Wang, Xiao-Dong; Song, Mei; Zheng, Ming-Hua; Wang, Yu-Qun; Lin, Zhuo; Shi, Ke-Qing

    2017-04-01

    Hepatitis B virus (HBV) infection remains a major health problem and HBV-related-decompensated cirrhosis (HBV-DC) usually leads to a poor prognosis. Our aim was to determine the utility of inflammatory biomarkers in predicting mortality of HBV-DC. A total of 329 HBV-DC patients were enrolled. Survival estimates for the entire study population were generated using the Kaplan-Meier method. The prognostic values for model for end-stage liver disease (MELD) score, Child-Pugh score, and inflammatory biomarkers neutrophil/lymphocyte ratio, C-reactive protein-to-albumin ratio (CAR), and lymphocyte-to-monocyte ratio (LMR) for HBV-DC were compared using time-dependent receiver operating characteristic curves and time-dependent decision curves. The survival time was 23.1±15.8 months. Multivariate analysis identified age, CAR, LMR, and platelet count as prognostic independent risk factors. Kaplan-Meier analysis indicated that CAR of at least 1.0 (hazard ratio, 7.19; 95% confidence interval, 4.69-11.03), and LMR less than 1.9 (hazard ratio, 2.40; 95% confidence interval, 1.69-3.41) were independently associated with mortality of HBV-DC. The time-dependent receiver operating characteristic indicated that CAR showed the best performance in predicting mortality of HBV-DC compared with LMR, MELD score, and Child-Pugh score. The results were also confirmed by time-dependent decision curves. CAR and LMR were associated with the prognosis of HBV-DC. CAR was superior to LMR, MELD score, and Child-Pugh score in HBV-DC mortality prediction.

  19. Correlation of free-response and receiver-operating-characteristic area-under-the-curve estimates: Results from independently conducted FROC/ROC studies in mammography

    International Nuclear Information System (INIS)

    Zanca, Federica; Hillis, Stephen L.; Claus, Filip; Van Ongeval, Chantal; Celis, Valerie; Provoost, Veerle; Yoon, Hong-Jun; Bosmans, Hilde

    2012-01-01

    Purpose: From independently conducted free-response receiver operating characteristic (FROC) and receiver operating characteristic (ROC) experiments, to study fixed-reader associations between three estimators: the area under the alternative FROC (AFROC) curve computed from FROC data, the area under the ROC curve computed from FROC highest rating data, and the area under the ROC curve computed from confidence-of-disease ratings. Methods: Two hundred mammograms, 100 of which were abnormal, were processed by two image-processing algorithms and interpreted by four radiologists under the FROC paradigm. From the FROC data, inferred-ROC data were derived, using the highest rating assumption. Eighteen months afterwards, the images were interpreted by the same radiologists under the conventional ROC paradigm; conventional-ROC data (in contrast to inferred-ROC data) were obtained. FROC and ROC (inferred, conventional) data were analyzed using the nonparametric area-under-the-curve (AUC), (AFROC and ROC curve, respectively). Pearson correlation was used to quantify the degree of association between the modality-specific AUC indices and standard errors were computed using the bootstrap-after-bootstrap method. The magnitude of the correlations was assessed by comparison with computed Obuchowski-Rockette fixed reader correlations. Results: Average Pearson correlations (with 95% confidence intervals in square brackets) were: Corr(FROC, inferred ROC) = 0.76[0.64, 0.84] > Corr(inferred ROC, conventional ROC) = 0.40[0.18, 0.58] > Corr (FROC, conventional ROC) = 0.32[0.16, 0.46]. Conclusions: Correlation between FROC and inferred-ROC data AUC estimates was high. Correlation between inferred- and conventional-ROC AUC was similar to the correlation between two modalities for a single reader using one estimation method, suggesting that the highest rating assumption might be questionable.

  20. [Hysterectomies at the Conakry university hospitals: social, demographic, and clinical characteristics, types, indications, surgical approaches, and prognosis].

    Science.gov (United States)

    Baldé, I S; Sy, T; Diallo, B S; Diallo, Y; Mamy, M N; Diallo, M H; Bah, E M; Diallo, T S; Keita, N

    2014-01-01

    The objectives of this study were to calculate the frequency of hysterectomies at the Conakry university hospitals (Donka Hospital and Ignace Deen Hospital), describe the women's social, demographic, and clinical characteristics, and identify the key indications, the surgical techniques used, and the prognosis. This was a 2-year descriptive study, retrospective for the first year (May 2011-April 2012) and prospective for the second (May 2012-April 2013), of 333 consecutive hysterectomies performed in the obstetrics and gynecology departments of these two hospitals. Hysterectomy is one of the surgical procedures most commonly performed in these departments (following cesarean deliveries), with frequency of 4.4% interventions. The profile of the women undergoing this surgery was that of a woman aged younger than 49 years (61%), married (75.7%), multiparous (33%), of childbearing age (61%), and with no history of abdominal or pelvic surgery (79.6%). Nearly all hysterectomies were total (95%, compared with 5% subtotal; the approach was abdominal in 82.25% of procedures and vaginal in 17.75%. The most common indication for surgery was uterine fibroids (39.6%), followed by genital prolapse (22.2%), and obstetric emergencies (17.8%). The average duration of surgery was 96 minutes for abdominal and 55 minutes for vaginal hysterectomies. The principal intraoperative complication was hemorrhage (12.31%), and the main postoperative complication parietal suppuration (21.02%). The average length of hospital stay was 10.3 days for abdominal hysterectomies and 7.15 days for vaginal procedures. We recorded 14 deaths for a lethality rate of 4.2%; most of these deaths were associated with hemorrhagic shock during or after an obstetric hysterectomy (93%). Hysterectomy remains a common intervention in developing countries. Its indications are common during the pregnancy and postpartum period, with high morbidity and mortality rates. Improving obstetric coverage could reduce its

  1. Clinical and epidemiological characteristics in hospitalized young children with acute gastroenteritis in southern Taiwan: According to major pathogens

    Directory of Open Access Journals (Sweden)

    Ning Chung

    2017-12-01

    Full Text Available Background: Acute gastroenteritis (AGE can be caused by a wide array of pathogens, including bacteria, viruses, and parasites. A prospective study to investigate the epidemiology and clinical presentation in young children hospitalized with AGE was conducted in a medical center in southern Taiwan. Methods: Patients aged less than 5 years who was hospitalized due to AGE in National Cheng Kung University Hospital were enrolled from July 2014 to June 2016. The demographic information, clinical features and laboratory data were collected by chart reviews, and stool samples were sent to Centers of Disease Control, Taiwan (Taiwan CDC for a panel of pathogen identification consisting of two viruses, nine bacteria, and five parasites. Results: Totally 441 patients were enrolled in this study. Salmonella spp. was the leading cause of disease (21.8%, followed by norovirus (17.0%, Clostridium difficile (9.5%, and rotavirus (9.3%. Norovirus identification rate was the highest among patients less than 6 months of age, while Salmonella was highest among patients between 2 and 3 years old. Patients with Salmonella infection frequently presented with fever, lethargy, bloody stool, and elevated serum level of C-reactive protein (CRP; norovirus and rotavirus infection frequently presented with vomiting. Salmonella gastroenteritis also resulted in longer hospitalization and more frequent antibiotics administration. C. difficile could be isolated from both gastroenteritis patients and control children. Conclusion: Salmonella spp. was the most common pathogen of AGE in hospitalized children in southern Taiwan during 2014–2016, followed by norovirus and rotavirus. Further monitoring of epidemiology characteristics among cardinal pathogens of pediatric gastroenteritis is necessary. Keywords: Acute gastroenteritis, Children, Epidemiology, Taiwan

  2. Differences in Characteristics and Treatment Received among Depressed Adolescent Psychiatric Outpatients with and without Co-Occuring Alcohol Misuse: A 1-Year Follow-Up Study

    Directory of Open Access Journals (Sweden)

    Tiia Pirkola

    2011-01-01

    Full Text Available Objectives. We aimed at examining the differences between depressed psychiatric adolescent outpatients with and without cooccurring alcohol misuse in psychosocial background, clinical characteristics, and treatment received during one-year followup. Furthermore, we investigated factors related to nonattendance at treatment. Materials and Methods. Consecutive 156 adolescent (13–19 years psychiatric outpatients with a unipolar depressive disorder at baseline were interviewed using structured measures at baseline and at 12 months. Alcohol misuse was defined as having an AUDIT score of 8 or more points. The outpatients received “treatment as usual” of clinically defined duration. Results. Among depressive outpatients, poor parental support, parental alcohol use and decreased attendance at treatment associated with alcohol misuse. The severity of alcohol use as measured by AUDIT-score was the strongest factor independently predicting nonattendance at treatment in multivariate analysis. Conclusions. Alcohol misuse indicates family problems, has a deleterious effect on treatment attendance, and should be taken into account when managing treatment for depressive adolescent outpatients.

  3. Association between Characteristics of Cats and Satisfaction of Owners who Adopted Cats from an Animal Hospital in Japan

    Science.gov (United States)

    ONODERA, Nodoka; UCHIDA, Keiko; KAKUMA, Yoshie

    2014-01-01

    ABSTRACT A follow-up questionnaire survey was conducted with 29 cat owners who adopted cats from an animal hospital in Japan. Physical characteristics were found to be important factors for the owners when choosing a cat. There were significant differences between impression of the cat for the owners at present and images of their ideal cats, and the levels of aggression and activeness of the cats at present were rated higher than their ideal cats. A significant negative correlation was found between the degree of satisfaction with the cat and occurrence of house soiling; thus, some behavioral problems may deteriorate the relationship between the owner and the cat. PMID:24419973

  4. Demographic characteristics and clinical predictors of patients discharged from university hospital-affiliated pain clinic due to breach in narcotic use contract.

    Science.gov (United States)

    Chakrabortty, Shushovan; Gupta, Deepak; Rustom, David; Berry, Hussein; Rai, Ajit

    2014-01-01

    The current retrospective study was completed with the aim to identify demographic characteristics and clinical predictors (if any) of the patients discharged from our pain clinic due to breach in narcotic use contract (BNUC). Retrospective patient charts' review and data audit. University hospital-affiliated pain clinic in the United States. All patient charts in our pain clinic for a 2-year period (2011-2012). The patients with BNUC were delineated from the patients who had not been discharged from our pain clinic. Pain characteristics, pain management, and substance abuse status were compared in each patient with BNUC between the time of admission and the time of discharge. The patients with BNUC discharges showed significant variability for the discharging factors among the pain physicians within a single pain clinic model with this variability being dependent on their years of experience and their proactive interventional pain management. The patients with BNUC in our pain clinic setting were primarily middle-aged, obese, unmarried males with nondocumented stable occupational history who were receiving only noninterventional pain management. Substance abuse, doctor shopping, and potential diversion were the top three documented reasons for BNUC discharges. In 2011-2012, our pain clinic discharged 1-in-16 patients due to breach in narcotic use contract.

  5. The role of stenosis ratio as a predictor of surgical satisfaction in patients with lumbar spinal canal stenosis: a receiver-operator characteristic (ROC) curve analysis.

    Science.gov (United States)

    Mohammadi, Hassanreza R; Azimi, Parisa; Benzel, Edward C; Shahzadi, Sohrab; Azhari, Shirzad

    2016-09-01

    The aim of this study was to elucidate independent factors that predict surgical satisfaction in lumbar spinal canal stenosis (LSCS) patients. Patients who underwent surgery were grouped based on the age, gender, duration of symptoms, walking distance, Neurogenic Claudication Outcome Score (NCOS) and the stenosis ratio (SR) described by Lurencin. We recorded on 2-year patient satisfaction using standardized measure. The optimal cut-off points in SR, NCOS and walking distance for predicting surgical satisfaction were estimated from sensitivity and specificity calculations and receiver operator characteristic (ROC) curves. One hundred fifty consecutive patients (51 male, 99 female, mean age 62.4±10.9 years) were followed up for 34±13 months (range 24-49). One, two, three and four level stenosis was observed in 10.7%, 39.3%, 36.0 % and 14.0% of patients, respectively. Post-surgical satisfaction was 78.5% at the 2 years follow up. In ROC curve analysis, the asymptotic significance is less than 0.05 in SR and the optimal cut-off value of SR to predict worsening surgical satisfaction was measured as more than 0.52, with 85.4% sensitivity and 77.4% specificity (AUC 0.798, 95% CI 0.73-0.90; Ppatients with degenerative lumbar stenosis considered for surgical treatment. Using a ROC curve analysis, a radiological feature, the SR, demonstrated superiority in predicting patient satisfaction, compared to functional and clinical characteristics such as walking distance and NCOS.

  6. A Survey of Nursing Home Organizational Characteristics Associated with Potentially Avoidable Hospital Transfers and Care Quality in One Large British Columbia Health Region

    Science.gov (United States)

    McGregor, Margaret J.; Baumbusch, Jennifer; Abu-Laban, Riyad B.; McGrail, Kimberlyn M.; Andrusiek, Dug; Globerman, Judith; Berg, Shannon; Cox, Michelle B.; Salomons, Kia; Volker, Jan; Ronald, Lisa

    2011-01-01

    Hospitalization of nursing home residents can be futile as well as costly, and now evidence indicates that treating nursing home residents in place produces better outcomes for some conditions. We examined facility organizational characteristics that previous research showed are associated with potentially avoidable hospital transfers and with…

  7. Molecular and phenotypic characteristics of methicillin-resistant Staphylococcus aureus isolated from hospitalized patients.

    Science.gov (United States)

    de Oliveira, Caio Ferreira; Morey, Alexandre Tadachi; Santos, Jussevania Pereira; Gomes, Ludmila Vilela Pereira; Cardoso, Juscélio Donizete; Pinge-Filho, Phileno; Perugini, Márcia Regina Eches; Yamauchi, Lucy Megumi; Yamada-Ogatta, Sueli Fumie

    2015-07-30

    Methicillin-resistant Staphylococcus aureus (MRSA) is one of the leading causes of infections acquired in both community and hospital settings. In this study, MRSA isolated from different sources of hospitalized patients was characterized by molecular and phenotypic methods. A total of 123 S. aureus isolates were characterized according to their genetic relatedness by repetitive element sequence based-PCR (REP-PCR), in vitro antimicrobial susceptibility profile, SCCmec typing and presence of seven virulence factor-encoding genes. REP-PCR fingerprinting showed low relatedness between the isolates, and the predominance of one specific lineage or clonal group was not observed. All isolates were susceptible to teicoplanin and linezolide. All isolates were resistant to cefoxitin and penicillin, and the majority were also resistant to one or more other antimicrobials. Fifty isolates (41.7%) were intermediately resistant to vancomycin. Most isolates harbored SCCmec type II (53.7%), followed by type I (22.8%), type IV (8.1%) and type III (1.6%). All isolates harbored at least two virulence factor-encoding genes, and the prevalence was as follows: coa, 100%; icaA, 100%; hla, 13.0%; hlb, 91.1%, hld, 91.1%; lukS-PV and lukF-PV, 2.4%; and tst, 34.1%. A positive association with the presence of hla and SCCmec type II, and tst and SCCmec type I was observed. This study showed the high virulence potential of multidrug-resistant MRSA circulating in a teaching hospital. A high prevalence of MRSA showing intermediate vancomycin resistance was also observed, indicating the urgent need to improve strategies for controlling the use of antimicrobials for appropriate management of S. aureus infections.

  8. Characteristics of Infective Endocarditis in a Tertiary Hospital in East China

    Science.gov (United States)

    Xu, Huimin; Cai, Siyu

    2016-01-01

    The epidemiology, clinical presentation, and treatment of infective endocarditis (IE) has significantly changed over the past few years in developed countries. However, relevant data from developing countries are different and remain scarce. The objective of this study was to evaluate the clinical presentations, treatment and outcomes of IE patients in a tertiary hospital in East China over an 8-year period. This was a retrospective observational study of consecutive cases of definite or possible IE as per the modified Duke criteria between January 2008 and December 2015. A total of 135 definite and 39 probable IE cases were identified. The mean age was 47.8 ± 15.7 years, with a male preponderance (1.9: 1). Degenerative valve disease accounted for 30.5% cases of IE, followed by congenital heart disease (29.9%) and rheumatic heart disease (14.9%). Native cardiac valves were present in 93.7% of the IE patients. Echocardiography and blood culture were performed in all patients, of whom 55.2% were found to have large vegetations (≥10 mm) and the positive rate of blood culture was 60.3%. Streptococcus remained the chief causative agent that was identified in 61.9% of culture-positive patients. Glycopeptide antibacterials and cephalosporins were the most frequently used antimicrobial drugs for IE therapy. Seventy-six (43.7%) of the IE patients were surgically treated. The mortality rate during hospital stay was 10.9%. Our data reflected clinical and microbiological profile, and treatment of IE in a tertiary hospital located in the East China. PMID:27861628

  9. Characteristics of Infective Endocarditis in a Tertiary Hospital in East China.

    Science.gov (United States)

    Xu, Huimin; Cai, Siyu; Dai, Haibin

    2016-01-01

    The epidemiology, clinical presentation, and treatment of infective endocarditis (IE) has significantly changed over the past few years in developed countries. However, relevant data from developing countries are different and remain scarce. The objective of this study was to evaluate the clinical presentations, treatment and outcomes of IE patients in a tertiary hospital in East China over an 8-year period. This was a retrospective observational study of consecutive cases of definite or possible IE as per the modified Duke criteria between January 2008 and December 2015. A total of 135 definite and 39 probable IE cases were identified. The mean age was 47.8 ± 15.7 years, with a male preponderance (1.9: 1). Degenerative valve disease accounted for 30.5% cases of IE, followed by congenital heart disease (29.9%) and rheumatic heart disease (14.9%). Native cardiac valves were present in 93.7% of the IE patients. Echocardiography and blood culture were performed in all patients, of whom 55.2% were found to have large vegetations (≥10 mm) and the positive rate of blood culture was 60.3%. Streptococcus remained the chief causative agent that was identified in 61.9% of culture-positive patients. Glycopeptide antibacterials and cephalosporins were the most frequently used antimicrobial drugs for IE therapy. Seventy-six (43.7%) of the IE patients were surgically treated. The mortality rate during hospital stay was 10.9%. Our data reflected clinical and microbiological profile, and treatment of IE in a tertiary hospital located in the East China.

  10. Recipient characteristics and outcome of pediatric kidney transplantation at the King Fahad Specialist Hospital-Dammam.

    Science.gov (United States)

    Khan, Iftikhar A R; Al-Maghrabi, Mohammad; Kassim, Mohammad Salah; Tawfeeq, Mansour; Al-Saif, Faisal; Al-Oraifi, Ibrahim; Al-Qahtani, Mohammed; Alsaghier, Mohammad

    2014-07-01

    The success of a pediatric kidney transplantation program can only be judged by reviewing its results. We aim to audit our short-term outcome of pediatric kidney transplantation at the King Fahad Specialist Hospital-Dammam. A retrospective chart review was performed to collect data about recipient demographics, etiology of end-stage kidney disease, type of dialysis, type of donor and outcome. Between September 2008 and April 2012, 35 pediatric kidney trans-plantations (need to encourage preemptive transplantation and living donation in this population.

  11. CHARACTERISTICS OF RHEUMATIC PATHOLOGY IN THE REPUBLIC OF TAJIKISTAN AS DEFINED IN HOSPITAL

    Directory of Open Access Journals (Sweden)

    S. M. Shukurova

    2014-01-01

    Full Text Available The lack of reliable data on rheumatic diseases (RD incidence in the Republic of Tajikistan, discrepancy in statistical figures and growing rate of registered advanced cases became an impetus to analyzing hospital incidence of rheumatic diseases within the largest republican medical institution.Objective: to present the pattern, incidence and clinical picture of RD in patients who was undergoing hospital treatment in the Department of Rheumatology of National Medical Healthcare Center (NMHC of the Republic of Tajikistan (Dushanbe.Subjects and methods. The present article provides data of retrospective analysis of medical records of 4716 patients hospitalized to the Department of Rheumatology of NMHC during 2005–2010. All patients were divided into two groups on a provisional basis: patients with inflammatory RD (n=2872 and those with non-inflammatory or metabolic RD (n=1844.Results. Authors established that leading cases among inflammatory rheumatic diseases are rheumatoid (n=1481 and reactive (n=598 arthritis, whereas among non-inflammatory and metabolic RD – osteoarthritis (n=1243 and gout (n=157. Continuing growth of newly registered RD can be proven by the fact that over 5 years the number of callings increased from 729 to 1032 per year. At this, women were diagnosed with RD more often than men (66 and 34% of cases respectively. Mean age of RD patients was 41.05±11.79 years, what shows that the part of the country population which is characterized by the highest work productivity is affected. Patients with RD also had comorbid cardiovascular pathology, metabolic syndrome and gastropathies.Conclusion. Rheumatoid and reactive arthritis are the most frequent RD of inflammatory origin, whereas osteoarthritis is one of the most frequent reasons of hospitalization. RD affects the most productive part of population. Besides, RD is gender-selective as in all considered age groups women were most affected. The most

  12. Neighborhood characteristics, bystander automated external defibrillator use, and patient outcomes in public out-of-hospital cardiac arrest.

    Science.gov (United States)

    Andersen, Lars W; Holmberg, Mathias J; Granfeldt, Asger; Løfgren, Bo; Vellano, Kimberly; McNally, Bryan F; Siegerink, Bob; Kurth, Tobias; Donnino, Michael W

    2018-05-01

    Automated external defibrillators (AEDs) can be used by bystanders to provide rapid defibrillation for patients with out-of-hospital cardiac arrest (OHCA). Whether neighborhood characteristics are associated with AED use is unknown. Furthermore, the association between AED use and outcomes has not been well characterized for all (i.e. shockable and non-shockable) public OHCAs. We included public, non-911-responder witnessed OHCAs registered in the Cardiac Arrest Registry to Enhance Survival (CARES) between 2013 and 2016. The primary patient outcome was survival to hospital discharge with a favorable functional outcome. We first assessed the association between neighborhood characteristics and bystander AED use using logistic regression and then assessed the association between bystander AED use and patient outcomes in a propensity score matched cohort. 25,182 OHCAs were included. Several neighborhood characteristics, including the proportion of people living alone, the proportion of white people, and the proportion with a high-school degree or higher, were associated with bystander AED use. 5132 OHCAs were included in the propensity score-matched cohort. Bystander AED use was associated with an increased risk of a favorable functional outcome (35% vs. 25%, risk difference: 9.7% [95% confidence interval: 7.2%, 12.2%], risk ratio: 1.38 [95% confidence interval: 1.27, 1.50]). This was driven by increased favorable functional outcomes with AED use in patients with shockable rhythms (58% vs. 39%) but not in patients with non-shockable rhythms (10% vs. 10%). Specific neighborhood characteristics were associated with bystander AED use in OHCA. Bystander AED use was associated with an increase in favorable functional outcome. Copyright © 2018 Elsevier B.V. All rights reserved.

  13. Temporal characteristics of decisions in hospital encounters: a threshold for shared decision making? A qualitative study.

    Science.gov (United States)

    Ofstad, Eirik H; Frich, Jan C; Schei, Edvin; Frankel, Richard M; Gulbrandsen, Pål

    2014-11-01

    To identify and characterize physicians' statements that contained evidence of clinically relevant decisions in encounters with patients in different hospital settings. Qualitative analysis of 50 videotaped encounters from wards, the emergency room (ER) and outpatient clinics in a department of internal medicine at a Norwegian university hospital. Clinical decisions could be grouped in a temporal order: decisions which had already been made, and were brought into the encounter by the physician (preformed decisions), decisions made in the present (here-and-now decisions), and decisions prescribing future actions given a certain course of events (conditional decisions). Preformed decisions were a hallmark in the ward and conditional decisions a main feature of ER encounters. Clinical decisions related to a patient-physician encounter spanned a time frame exceeding the duration of the encounter. While a distribution of decisions over time and space fosters sharing and dilution of responsibility between providers, it makes the decision making process hard to access for patients. In order to plan when and how to involve patients in decisions, physicians need increased awareness of when clinical decisions are made, who usually makes them, and who should make them. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  14. A study of the characteristics and needs of people transferred from acute hospitals to nursing homes.

    Science.gov (United States)

    Lefroy, R B; Davey, M; Hyndman, J; Hobbs, M S

    1993-09-20

    To describe the categories of people being approved for admission to nursing homes; to consider whether any alternatives would have been more appropriate; and to outline the care needed for each category. Patients in acute-care facilities in metropolitan Perth for whom a request had been made for nursing home admission. Patients were interviewed (by R B L and M D) and records in the acute hospital were examined. A second interview of those patients still available was conducted after their transfer to the nursing home. Nursing care was considered necessary for 123 of the 201 people seen in the acute hospitals; domestic care in a standard hostel for 24 people; care in a special dementia unit (SDU) hostel for 26 people; and care in a psychiatric institution for 16 people. Twelve others had various specific needs. Several different categories were identified in the group needing nursing care. Applicants for nursing home admission do not form a homogeneous group; there are several categories with different needs. SDU hostels should be added to the available facilities. In addition to undertaking the assessment of nursing home applicants, personnel from geriatric services should be encouraged to become involved in their continuing care.

  15. Psychological, clinical and social characteristics of patients implementing different types of aggression in the hospital (gender aspect

    Directory of Open Access Journals (Sweden)

    Bulygina V.G.

    2015-11-01

    Full Text Available Results of the comparative analysis of clinical, social and psycho-pathological predictors of violations of the regime requirements, physical and verbal aggression among mentally ill women and men during the compulsory treatment are presented. It is revealed that the type of aggression in women sample significantly more frequently associated with clinical and social and pathopsychological characteristics: emotional unstable stew, learned in childhood and adolescence behavioral model of aggression and the severity of hostility and suspicion; the inertia of mental processes combined with low level of the cognitive functioning and a violation of insight in a broad sense. Among men – with the emotional and personal deformation, which were revealed before the beginning of illness, the decline in cognitive functioning and undeveloped links in the regulation of behavior, high level of aggressiveness in communication, internal conflict combined with the rigidity of self-concept. The authors concluded that assessment of risk factors from hospital-acquired aggression is an independent psycho-diagnostic work that needs to be provided with special tools, aimed whilst on the study of individual psychological characteristics of the regulation of behavior, strategies coping, communication installations and the treats of the aggression, as well as subjective ratings of social functioning in the hospital.

  16. Impact and characteristics of the non-Caucasian population in hospital admissions for diabetes onset during 2003-2010.

    Science.gov (United States)

    San José, Patricia; Guerrero, Mireia; García-Martín, Isabel; Caballero, Jordi; Pérez-Maraver, Manuel

    2016-01-01

    To assess the prevalence of non-Caucasian patients in hospital admissions for onset of symptomatic diabetes mellitus during the 2003-2010 period, and to analyze the characteristics differentiating them from the Caucasian population at diagnosis and 2 years later. A retrospective, observational study. Patients aged 18-40 years admitted for de novo symptomatic diabetes from January 2003 to October 2010. Prevalence of patients of non-Caucasian origin was analyzed, and clinical, biochemical, immunological, and beta-cell function of both populations were compared at diagnosis and 2 years later. Nineteen percent of patients admitted to hospital for de novo symptomatic diabetes were non-Caucasian, with a progressive increase in recent years. Non-Caucasian patients had milder decompensation (3.0% had ketoacidosis, as compared to 15.2% in the Caucasian group, P1%, P1) and higher stimulated C-peptide levels (0.70±0.56 vs. 0.42±0.39 nmol/l, P1 vs. 93.8%). Non-Caucasian patients had a lower prevalence of autoimmunity, better beta-cell function at diagnosis, particularly due to the subgroup with negative autoimmunity, and less need for intensive treatment 2 years after diagnosis, features which are more characteristic of type 2 diabetes mellitus. Copyright © 2016 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

  17. The Characteristics of Cervical Cancer Patients Who Underwent a Radical Hysterectomy at Sanglah Hospital Denpasar in 2015

    Directory of Open Access Journals (Sweden)

    I Nyoman Bayu Mahendra

    2016-05-01

    Full Text Available Background: Cervical cancer is the most common gynecologic cancer in women. It is the main cause of cancer-related death in women in developing countries. Cervical cancer in Indonesia is the second most cancer affecting Indonesian women and the prevalence is relatively stable in the last 30 years. Cervical cancer was closely related to the histologic type of itself. A squamous cell carcinoma has a specific route of local spreading and a lymphatic route. The sample of this study are cervical cancer patients who underwent a radical hysterectomy from January 1 to December 31, 2015 in Sanglah Hospital Denpasar, Bali. The aim of this study is to discover the characteristics of the patients by age, parity, education level, marital status, sexual activity, the first symptoms and the early screening done, and the clinical staging. Methods: This descriptive study involved 20 patients in Sanglah Hospital Denpasar who had a radical hysterectomy from January 1 until December 31, 2015. The characteristics are gathered from the patients’ medical record. Results: The most cases done radical hysterectomy between 41-45 years old which proportion was 40%, the most parity was parity 2 (60%, elementary school was the most education level (35%, all of the samples only married once and sexually active, the most first symptom was vaginal bleeding (55%, only 10% had pap smear as early detection, and the most clinical stage was stage IIB (50%.

  18. Treating Dehydration at Home Avoids Healthcare Costs Associated With Emergency Department Visits and Hospital Readmissions for Adult Patients Receiving Home Parenteral Support.

    Science.gov (United States)

    Konrad, Denise; Roberts, Scott; Corrigan, Mandy L; Hamilton, Cindy; Steiger, Ezra; Kirby, Donald F

    2017-06-01

    Administration of home parenteral support (HPS) has proven to be cost-effective over hospital care. Avoiding hospital readmissions became more of a focus for healthcare institutions in 2012 with the implementation of the Affordable Care Act. In 2010, our service developed a protocol to treat dehydration at home for HPS patients by ordering additional intravenous fluids to be kept on hand and to focus patient education on the symptoms of dehydration. A retrospective analysis was completed through a clinical management database to identify HPS patients with dehydration. The hospital finance department and homecare pharmacy were utilized to determine potential cost avoidance. In 2009, 64 episodes (77%) of dehydration were successfully treated at home versus 6 emergency department (ED) visits (7.5%) and 13 readmissions (15.5%). In 2010, we successfully treated 170 episodes (84.5%) at home, with 9 episodes (4.5%) requiring ED visits and 22 hospital readmissions (11%). The number of dehydration episodes per patient was significantly higher in 2010 ( P dehydration identified and treated at home in 2010 versus 2009. Our protocol helped educate and provide the resources required to resolve dehydration at home when early signs were recognized. By reducing ED visits and hospital readmissions, healthcare costs were avoided by a factor of 29 when home treatment was successful.

  19. Trends and Characteristics of United States Out-of-Hospital Births 2004-2014: New Information on Risk Status and Access to Care.

    Science.gov (United States)

    MacDorman, Marian F; Declercq, Eugene

    2016-06-01

    Out-of-hospital births are increasing in the United States. Our purpose was to examine trends in out-of-hospital births from 2004 to 2014, and to analyze newly available data on risk status and access to care. Newly available data from the revised birth certificate for 47 states and Washington, DC, were used to examine out-of-hospital births by characteristics and to compare them with hospital births. Trends from 2004 to 2014 were also examined. Out-of-hospital births increased by 72 percent, from 0.87 percent of United States births in 2004 to 1.50 percent in 2014. Compared with mothers who had hospital births, those with out-of-hospital births had lower prepregnancy obesity (12.5% vs 25.0%) and smoking (2.8% vs 8.5%) rates, and higher college graduation (39.3% vs 30.0%) and breastfeeding initiation (94.3% vs 80.8%) rates. Among planned home births, 67.1 percent were self-paid, compared with 31.9 percent of birth center and 3.4 percent of hospital births. Vaginal births after cesarean (VBACs) comprised 4.6 percent of planned home births and 1.6 percent of hospital and birth center births. Sociodemographic and medical risk status of out-of-hospital births improved substantially from 2004 to 2014. Improvements in risk status of out-of-hospital births from 2004 to 2014 suggest that appropriate selection of low-risk women is improving. High rates of self-pay for the costs of out-of-hospital birth suggest serious gaps in insurance coverage, whereas higher-than-average rates of VBAC could reflect lack of access to hospital VBACs. Mandating private insurance and Medicaid coverage could substantially improve access to out-of-hospital births. Improving access to hospital VBACs might reduce the number of out-of-hospital VBACs. © 2016 Wiley Periodicals, Inc.

  20. [Prevalence and clinical characteristics of coronavirus NL63 infection in children hospitalized for acute lower respiratory tract infections in Changsha].

    Science.gov (United States)

    Zhang, Fei; Zhang, Bing; Xie, Zhi-Ping; Gao, Han-Chun; Zhao, Xin; Zhong, Li-Li; Zhou, Qiong-Hua; Hou, Yun-De; Duan, Zhao-Jun

    2012-04-01

    The main objective of this study was to explore the prevalence and clinical characteristics of human coronavirus NL63 infection in hospitalized children with acute lower respiratory tract infection (ALRTI) in Changsha. Nasopharyngeal aspirates (NPA) samples were collected from 1185 hospitalized children with ALRTI at the People's Hospital of Hunan province, between September 2008 and October 2010. Reverse transcriptase polymerase chain reaction (RT-PCR) was employed to screen for coronavirus NL63, which is a 255 bp fragment of a part of N gene. All positive amplification products were confirmed by sequencing and compared with those in GenBank. The overall frequency of coronavirus NL63 infection was 0.8%, 6 (60%) out of the coronavirus NL63 positive patients were detected in summer, 2 in autumn, 1 in spring and winter, respectively. The patients were from 2 months to two and a half years old. The clinical diagnosis was bronchopneumonia (60%), bronchiolitis (30%), and acute laryngotracheal bronchitis (10%). Four of the 10 cases had critical illness, 4 cases had underlying diseases, and 7 cases had mixed infection with other viruses. The homogeneity of coronavirus NL63 with those published in the GenBank at nucleotide levels was 97%-100%. Coronavirus NL63 infection exists in hospitalized children with acute lower respiratory tract infection in Changsha. Coronavirus NL63 infections are common in children under 3 years of age. There is significant difference in the infection rate between the boys and the girls: the boys had higher rate than the girls. The peak of prevalence of the coronavirus NL63 was in summer. A single genetic lineage of coronavirus NL63 was revealed in human subjects in Changsha. Coronavirus NL63 may also be one of the lower respiratory pathogen in China.

  1. Trends and characteristics of home and other out-of-hospital births in the United States, 1990-2006.

    Science.gov (United States)

    MacDorman, Marian F; Menacker, Fay; Declercq, Eugene

    2010-03-03

    This report examines trends and characteristics of out-of-hospital and home births in the United States. Descriptive tabulations of data are presented and interpreted. In 2006, there were 38,568 out-of-hospital births in the United States, including 24,970 home births and 10,781 births occurring in a freestanding birthing center. After a gradual decline from 1990 to 2004, the percentage of out-of-hospital births increased by 3% from 0.87% in 2004 to 0.90% in 2005 and 2006. A similar pattern was found for home births. After a gradual decline from 1990 to 2004, the percentage of home births increased by 5% to 0.59% in 2005 and remained steady in 2006. Compared with the U.S. average, home birth rates were higher for non-Hispanic white women, married women, women aged 25 and over, and women with several previous children. Home births were less likely than hospital births to be preterm, low birthweight, or multiple deliveries. The percentage of home births was 74% higher in rural counties of less than 100,000 population than in counties with a population size of 100,000 or more. The percentage of home births also varied widely by state; in Vermont and Montana more than 2% of births in 2005-2006 were home births, compared with less than 0.2% in Louisiana and Nebraska. About 61% of home births were delivered by midwives. Among midwife-delivered home births, one-fourth (27%) were delivered by certified nurse midwives, and nearly three-fourths (73%) were delivered by other midwives. Women may choose home birth for a variety of reasons, including a desire for a low-intervention birth in a familiar environment surrounded by family and friends and cultural or religious concerns. Lack of transportation in rural areas and cost factors may also play a role.

  2. [Characteristics of bedridden elderly people living at home and in a hospital].

    Science.gov (United States)

    Nagura, E; Igata, A; Fujita, H; Inoue, T; Kanno, K; Matsuura, T; Tokuda, H; Hosokawa, T

    1997-07-01

    We compared bedridden elderly people living at home to others who were hospital inpatients. Questionnaires regarding medical status and care were returned by 85 of 116 people caring for a bedridden elderly person at home in Obu city, Aichi prefecture and by 62 of 64 nurses and family members caring for bedridden inpatients at Chubu National hospital. All subjects were at least 65 years old. The median age in both groups was 81 years, neither age distribution nor female sex predominance differed between both groups. The percentage of subjects with only one underlying disease was 62.5% among those living at home and 64.4% among inpatients. In both groups the most common disease was cerebrovascular disease (42.5% among those at home and 39.0% among inpatients), followed by dementia (31.3%), infirmity of old age (17.5%) and bone fracture (13.8%) among those at home, and by bone fracture (27.1%), dementia (20.3%) and infirmity of old age (16.9%) among inpatients. The median durations of bedridden status were 2 years and 3 months among those at home and 3 months among inpatients. The proportion of subjects bedridden for less than 6 months was greater among inpatients (p bedridden, and 17.7% were completely bedridden. The most common cause rending the patients bedridden was infection (usually pneumonia). The degree of disability did not differ between groups. Decubitus ulcers were present in 25.9% of those at home and 17.7% of inpatients.

  3. Are estimates of wind characteristics based on measurements with Pitot tubes and GNSS receivers mounted on consumer-grade unmanned aerial vehicles applicable in meteorological studies?

    Science.gov (United States)

    Niedzielski, Tomasz; Skjøth, Carsten; Werner, Małgorzata; Spallek, Waldemar; Witek, Matylda; Sawiński, Tymoteusz; Drzeniecka-Osiadacz, Anetta; Korzystka-Muskała, Magdalena; Muskała, Piotr; Modzel, Piotr; Guzikowski, Jakub; Kryza, Maciej

    2017-09-01

    The objective of this paper is to empirically show that estimates of wind speed and wind direction based on measurements carried out using the Pitot tubes and GNSS receivers, mounted on consumer-grade unmanned aerial vehicles (UAVs), may accurately approximate true wind parameters. The motivation for the study is that a growing number of commercial and scientific UAV operations may soon become a new source of data on wind speed and wind direction, with unprecedented spatial and temporal resolution. The feasibility study was carried out within an isolated mountain meadow of Polana Izerska located in the Izera Mountains (SW Poland) during an experiment which aimed to compare wind characteristics measured by several instruments: three UAVs (swinglet CAM, eBee, Maja) equipped with the Pitot tubes and GNSS receivers, wind speed and direction meters mounted at 2.5 and 10 m (mast), conventional weather station and vertical sodar. The three UAVs performed seven missions along spiral-like trajectories, most reaching 130 m above take-off location. The estimates of wind speed and wind direction were found to agree between UAVs. The time series of wind speed measured at 10 m were extrapolated to flight altitudes recorded at a given time so that a comparison was made feasible. It was found that the wind speed estimates provided by the UAVs on a basis of the Pitot tube/GNSS data are in agreement with measurements carried out using dedicated meteorological instruments. The discrepancies were recorded in the first and last phases of UAV flights.

  4. Epidemiologic and Clinical Characteristics of Migraine and Tension-Type Headaches among Hospitals Staffs of Shiraz (Iran

    Directory of Open Access Journals (Sweden)

    Ayatollahi Seyyed Mohammad Taghi

    2009-05-01

    Full Text Available Headache is a common symptom that constitutes a major health problem to all countries in the world. This study was conducted to estimate the prevalence of migraine and tension -type headaches(TTH, its associated occupational risk factors among Shiraz hospitals staffs, and to report on clinical characteristics of migraine and TTH with using the International Headache Society (IHS diagnosis criteria. A random sample of 1023 staffs constituting a 20% sample of the hospitals staff population was selected. Sampling method was categorical random sampling. Within each group sampling was carried out systematically. Data were collected by screening questionnaire followed by clinical interviews, general physical and neurological examination, and diagnostic criteria of IHS. Prevalence of migraine, TTH and coexisting migraine and TTH were estimated as 11.2% (115 cases, 19.5% (199 subjects and 3.2% (33 subjects respectively. In this study , clinical characteristics of headache including type, site, number , intensity ,concomitant symptom of headaches had been surveyed. TTH and migraine headaches were significantly associated with self reported abnormal sleep pattern and female gender (P < 0.001. Also TTH was negatively associated with total 24hr duration of sleep and history of involvement in second job significantly (P<0.026. The average of prevalence of migraine and TTH were lower than their counter parts in western countries but higher than previous studies conducted in other Asian countries. Clinical characteristics were almost parallel with IHS criteria, headache- related missed work rates were higher for subjects with migraine headache, and also TTH and migraine were separate disorders and were not as a part of a continuum of headache disorders. Headache disorders deserve more attention, especially concerning strategies leading to adequate primary prevention, diagnosis and treatment.

  5. Characteristics and management of patients with inflammatory bowel disease between a secondary and tertiary hospitals: a propensity score analysis

    Directory of Open Access Journals (Sweden)

    Ki Hwan Song

    2018-04-01

    Full Text Available Background/Aims : This study aimed to compare the clinical characteristics and management patterns of inflammatory bowel disease (IBD patients in a secondary hospital (SH with those in tertiary referral centers (TRC. Methods : Data from IBD patients in SH and 2 TRCs were retrospectively reviewed. The cumulative thiopurine use rate was compared between hospitals after controlling for different baseline characteristics using propensity score matching. Results : Among the total of 447 patients with IBD, 178 Crohn's disease (CD and 269 ulcerative colitis (UC patients were included. Regarding initial CD symptoms, patients from SH were more likely to show perianal symptoms, such as anal pain or discharge (56.6% vs. 34.3%, P=0.003, whereas those from TRCs more often had luminal symptoms, such as abdominal pain (54.9% vs. 17.1%, P<0.001, diarrhea (44.1% vs. 18.4%, P<0.001, and body weight loss (9.8% vs. 1.3%, P=0.025. Complicating behaviors, such as stricturing and penetrating, were significantly higher in TRCs, while perianal disease was more common in SH. Ileal location was more frequently observed in TRCs. For UC, SH had a more limited extent of disease (proctitis 58.8% vs. 21.2%, P<0.001. The cumulative azathioprine use rate in SH was significantly lower than that in TRCs in both CD and UC patients after controlling for disease behavior, location, and perianal disease of CD and extent of UC. Conclusions : The clinical characteristics and management of the IBD patients in SH were substantially different from those in TRCs. Thiopurine treatment was less commonly used for SH patients.

  6. Characteristic of low vision patients attending an eye hospital in eastern region of Nepal.

    Science.gov (United States)

    Labh, R K; Adhikari, P R; Karki, P; Singh, S K; Sitoula, R P

    2015-01-01

    Low vision is an important public health problem. To study the profile of low vision patients in a hospital of Nepal. Information related to the patients' profile, visual status, ocular disease and, low vision devices prescribed were obtained retrospectively from the records of 1,860 visually- impaired patients, regardless of the cause, presenting to the low vision department of the Biratnagar Eye Hospital, Biratnagar, Nepal, over a period of four years. These patients, after a comprehensive ocular examination, underwent low vision examination by an ophthalmologist and a low vision specialist. Of 1,860 patients, males comprised 1298 (70 %), while 562 (30 %) patients were female. Six hundred and one (32.3%) patients were of less than 20 years while 398(21.4%) were more than 60 years of age. Agriculture (500, 27 %), household work (341, 18 %) and students (308, 17 %) were the common occupations. Retinal diseases were the commonest cause of low vision. They were: macular disorders 408 (22 %), retinitis pigmentosa 226 (12.1 %) and other retinal causes 361 (19.4 %) (diabetic retinopathy, choroidal coloboma, post laser for retinal vasculitis and central retinal/branch retinal vein occlusion, healed macular chorioretinal scar secondary to retinochroiditis and choroiditis). Refractive error 215 (11.5 %), amblyopia 49 (2.6 %), optic atrophy 144 (7.8 %) and microphthalmos 105 (5.6 %) were the other causes. Uncorrected distance visual acuity was between 6/24 and 6/60 in 509 (27.4 %) and between 5/60 and PL in 1,327 (71.3 %) patients. Similarly, near visual acuity with vision better than 2.50 M (N 20) and worse than 2.50 M (N20) was present in 643(34.5%) and 1,217(65.5%) patients. About 67% and 54.5% of the patients had some improvement in their distance and near visual acuity with glasses and low vision aids. Distance spectacles 909 (49 %), near spectacles 106 (5.7 %), hand held magnifiers 78 (4 %) and telescopes 18 (1 %) were the optical devices prescribed. The prevalence of

  7. Clinical characteristics, etiology and antimicrobial susceptibility among overweight and obese individuals with diarrhea: observed at a large diarrheal disease hospital, Bangladesh.

    Directory of Open Access Journals (Sweden)

    Sumon Kumar Das

    Full Text Available BACKGROUND: The present study aimed to determine the clinical characteristics and etiology of overweight and obese (OO individuals with diarrhea attending an urban Dhaka Hospital, International Centre for Diarrheal Disease Research (icddr,b, Bangladesh. METHODS: Total of 508 under-5 children, 96 individuals of 5-19 years and 1331 of >19 years were identified as OO from the Diarrheal Disease Surveillance System (DDSS between 1993-2011. Two comparison groups such as well-nourished and malnourished individuals from respective age stratums were selected. RESULTS: Isolation rate of rotavirus was higher among OO under-5 children compared to malnourished group (46% vs. 28%. Rotavirus infection among OO individuals aged 5-19 years (9% vs. 3% (9% vs. 3% and >19 years (6% vs. 4% (6% vs. 3% was higher compared to well-nourished and malnourished children. Conversely, Vibrio cholerae was lower among all OO age groups compared to well-nourished and malnourished ones. Shigella (4% vs. 6% (4% vs. 8%, and Campylobacter (3% vs. 5% (3% vs. 5% were lower only among OO in >19 years individuals compared to their counterparts of the same age stratum. Salmonella was similarly isolated in all age strata and nutritional groups. In multinomial logistic regression among under-5 children, significant association was observed only with use of antimicrobials at home [OR-1.97] and duration of hospital stay [OR-0.68]. For individuals aged 5-19 years, use of antimicrobials at home (OR-1.83, some or severe dehydration (OR-3.12, having received intravenous saline (OR-0.46 and rotavirus diarrhea (OR-2.96 were found to be associated with OO respectively. Moreover, significant associations were also found for duration of diarrhea before coming to hospital (>24 hours (OR-1.24, Shigella (OR-0.46, and Campylobacter (OR-0.58 among >19 years OO individuals along with other associated co-variates in 5-19 years group (all p<0.05. CONCLUSION AND SIGNIFICANCE: Higher proportion of OO were

  8. Characteristics and Outcomes of Patients with Anterior Circulation Intracranial Aneurysm Managed with Clipping in Hospital Sungai Buloh.

    Science.gov (United States)

    Ab Ghani, Ailani; Nayan, Saiful Azli Mat; Kandasamy, Regunath; Rosman, Azmin Kas; Ghani, Abdul Rahman Izani

    2016-11-01

    The annual incidence of intracranial aneurysm in Malaysia is estimated to be 1.1-1.7 per 100,000 population based on a study done conducted in 1988. Since then, little epidemiological research has been conducted in Malaysia, and the real incidence is therefore probably unreported despite advancements in the diagnosis and treatment of this disorder. Intracranial aneurysm may be treated by microsurgical clipping or embolisation depending on its location and the surgeon's preference. This study aims to report the characteristics and outcomes of patients with a clipped anterior circulation aneurysm in Hospital Sungai Buloh. We retrospectively collected the data of patients with anterior circulation aneurysms who underwent clipping from 1 January 2013 until 30 June 2014 in Hospital Sungai Buloh. The mean age of the patients was 48.9 years old, and 56.7% of the study population were male and 63.3% were Malay. There were almost equal numbers of patients with (46.7%) and without (53.3%) co-morbidities such as hypertension and ischaemic heart disease. Half of the study population fell under Fisher grade 3 (50.0%), whereas 46.7% were Fisher grade 4. With respect to the Navarro score, 20% of patients scored 10, 16.7% scored 5 or 7, 13.3% scored 11, 10% scored 9, 6.7% scored 1 and 3.3% scored 2, 3 or 8. Most of the patients fell under grade I (33.3%) of the World Federation of Neurological Societies grading (WFNS), and the fewest number of patients were grade III (3.3%). Most (56.7%) patients had an intracranial aneurysm located at the anterior communicating artery (ACOM), followed by the anterior cerebral artery (ACA) and the middle cerebral artery (MCA) (16.7% each), the posterior communicating artery (PCOM) (6.7%) and, finally, the internal carotid artery (ICA) (3.3%). Neurological outcomes at three and six months were assessed using the Modified Rankin Scale (mRS). At three months follow-up, the majority of the participants (33.3%) scored 0 or 6, whereas at six months

  9. Diversity receiver

    NARCIS (Netherlands)

    2005-01-01

    The invention is directed to the reception of high rate radio signals (for example DVB-T signals) while the receiver is moving at a high speed (for example in or with a car). Two or more antennas (12, 16) are closely spaced and arranged behind each other in the direction of motion (v) for receiving

  10. Recipient characteristics and outcome of pediatric kidney transplantation at the king fahad specialist hospital-dammam

    Directory of Open Access Journals (Sweden)

    Iftikhar A. R. Khan

    2014-01-01

    Full Text Available The success of a pediatric kidney transplantation program can only be judged by reviewing its results. We aim to audit our short-term outcome of pediatric kidney transplantation at the King Fahad Specialist Hospital-Dammam. A retrospective chart review was performed to collect data about recipient demographics, etiology of end-stage kidney disease, type of dialysis, type of donor and outcome. Between September 2008 and April 2012, 35 pediatric kidney trans-plantations (<16 year were performed of a total of 246 kidney transplants (14.2%. The mean age was 8.1 years, with a mean weight of 23.3 kg, and there were 21 (60% boys in the study. Kidney dysplasia/hypoplasia was the most common etiology (51.4%. Pre-emptive kidney transplantation was performed in six (17% patients. Peritoneal dialysis was the most common mode of dialysis [24 (69% children]. Living donation was the source of kidney allografts in 13 (37% cases. During a mean follow-up of 1.5 years, one patient died and one graft was lost due to kidney vein thrombosis. The one year patient and graft survival rates were 97% and 94%, respectively. Efforts should now be focused on achieving optimal long-term results. There is also a need to encourage pre-emptive transplantation and living donation in this population.

  11. Evaluation of the optimal diagnostic criteria for regional lymph node metastases of lung cancer on MR imaging by receiver operating characteristic curve

    International Nuclear Information System (INIS)

    Iwai, Naomichi; Yamaguchi, Yutaka

    1991-01-01

    MRI was performed in 78 primary lung cancer cases to evaluate the optimal diagnostic criteria for regional lymph node metastases. Receiver operating characteristic (ROC) curve analysis for 262 lymph nodes of the hilar and mediastinal regions showed that the optimal size criterion is 10 mm in the mean axis of nodal diameter. Employing this criterion, the diagnostic rates for hilar and mediastinal lymph nodes had a sensitivity of 75%, a specificity of 82%, and an overall accuracy of 79%. However, the diagnostic rates for subaortic, paraaortic, and hilar lymph nodes using the same criterion showed lower specificities than those for other nodes. It was suggested that evaluation by coronal section made the diagnosis for subaortic lymph nodes more precise. In the ROC curve analysis for each histologic type, it was thought that the optimal criterion for adenocarcinoma was 10 mm in the mean axis, and that the criteria for squamous cell carcinoma were 11 mm in the mean axis and 10 mm in the sort axis. (author)

  12. Sex differences in the prediction of the effectiveness of paroxetine for patients with major depressive disorder identified using a receiver operating characteristic curve analysis for early response.

    Science.gov (United States)

    Tomita, Tetsu; Yasui-Furukori, Norio; Norio, Yasui-Furukori; Sato, Yasushi; Nakagami, Taku; Tsuchimine, Shoko; Kaneda, Ayako; Kaneko, Sunao

    2014-01-01

    We investigated cutoff values for the early response of patients with major depressive disorder to paroxetine and their sex differences by using a receiver operating characteristic (ROC) curve analysis to predict the effectiveness of paroxetine. In total, 120 patients with major depressive disorder were enrolled and treated with 10-40 mg/day paroxetine for 6 weeks; 89 patients completed the protocol. A clinical evaluation using the Montgomery-Asberg Depression Rating Scale (MADRS) was performed at weeks 0, 1, 2, 4, and 6. In male subjects, the cutoff values for MADRS improvement rating in week 1, week 2, and week 4 were 20.9%, 34.9%, and 33.3%, respectively. The sensitivities and the specificities were 83.3% and 80.0%, 83.3% and 80.0%, and 100% and 90%, respectively. The areas under the curve (AUC) were 0.908, 0.821, and 0.979, respectively. In female subjects, the cutoff values for the MADRS improvement rating in week 1, week 2, and week 4 were 21.4%, 35.7%, and 32.3%, respectively. The sensitivities and the specificities were 71.4% and 84.6%, 73.8% and 76.9%, and 90.5% and 76.9%, respectively. The AUCs were 0.781, 0.735, and 0.904, respectively. Early improvement with paroxetine may predict the long-term response. The accuracy of the prediction for the response is higher in male subjects.

  13. Disadvantages of using the area under the receiver operating characteristic curve to assess imaging tests: A discussion and proposal for an alternative approach

    International Nuclear Information System (INIS)

    Halligan, Steve; Altman, Douglas G.; Mallett, Susan

    2015-01-01

    The objectives are to describe the disadvantages of the area under the receiver operating characteristic curve (ROC AUC) to measure diagnostic test performance and to propose an alternative based on net benefit. We use a narrative review supplemented by data from a study of computer-assisted detection for CT colonography. We identified problems with ROC AUC. Confidence scoring by readers was highly non-normal, and score distribution was bimodal. Consequently, ROC curves were highly extrapolated with AUC mostly dependent on areas without patient data. AUC depended on the method used for curve fitting. ROC AUC does not account for prevalence or different misclassification costs arising from false-negative and false-positive diagnoses. Change in ROC AUC has little direct clinical meaning for clinicians. An alternative analysis based on net benefit is proposed, based on the change in sensitivity and specificity at clinically relevant thresholds. Net benefit incorporates estimates of prevalence and misclassification costs, and it is clinically interpretable since it reflects changes in correct and incorrect diagnoses when a new diagnostic test is introduced. ROC AUC is most useful in the early stages of test assessment whereas methods based on net benefit are more useful to assess radiological tests where the clinical context is known. Net benefit is more useful for assessing clinical impact. (orig.)

  14. Perspective Biological Markers for Autism Spectrum Disorders: Advantages of the Use of Receiver Operating Characteristic Curves in Evaluating Marker Sensitivity and Specificity

    Directory of Open Access Journals (Sweden)

    Provvidenza M. Abruzzo

    2015-01-01

    Full Text Available Autism Spectrum Disorders (ASD are a heterogeneous group of neurodevelopmental disorders. Recognized causes of ASD include genetic factors, metabolic diseases, toxic and environmental factors, and a combination of these. Available tests fail to recognize genetic abnormalities in about 70% of ASD children, where diagnosis is solely based on behavioral signs and symptoms, which are difficult to evaluate in very young children. Although it is advisable that specific psychotherapeutic and pedagogic interventions are initiated as early as possible, early diagnosis is hampered by the lack of nongenetic specific biological markers. In the past ten years, the scientific literature has reported dozens of neurophysiological and biochemical alterations in ASD children; however no real biomarker has emerged. Such literature is here reviewed in the light of Receiver Operating Characteristic (ROC analysis, a very valuable statistical tool, which evaluates the sensitivity and the specificity of biomarkers to be used in diagnostic decision making. We also apply ROC analysis to some of our previously published data and discuss the increased diagnostic value of combining more variables in one ROC curve analysis. We also discuss the use of biomarkers as a tool for advancing our understanding of nonsyndromic ASD.

  15. The relationship between some demographic characteristics and organizational commitment of nurses working in the Social Security Hospital of Khorramabad.

    Science.gov (United States)

    Sepahvand, Faribah; Atashzadeh-Shoorideh, Foorozan; Parvizy, Soroor; Tafreshi, Mansoureh Zagheri

    2017-06-01

    Reduction in organizational commitment of nurses results in deficiency of care services. Some demographic factors affect organizational commitment. The present study is intended to determine the organizational commitment of nurses and its relationship with demographic characteristics. This study was a descriptive correlation (cross-sectional) study in January and February of 2016 on 126 nurses who held Bachelor of Science (B.Sc.) or Master of Science (M.Sc.) and at least one year of work experience in the Social Security Hospital of Khorramabad, selected using the census method. Data collection tools included a demographic characteristics form and Allen and Meyer questionnaire. Data analysis was performed using SPSS 20. Independent-samples t-test and one-way ANOVA were used to determine the relationship between organizational commitment and demographic characteristics. The majority of nurses had moderate organizational commitment, the highest score belonging to the continuance commitment (22.33%), and the lowest score belonging to the normative commitment (19.16%). Also, there was a significant correlation between the continuance commitment and work experience (p=0.001), the staff posts (p=0.01) and shifts (p=0.04). Considering the moderate level of subjects' organizational commitment in the present study, managers should take necessary measures to increase the attachment and organizational commitment of nurses and provide the ground for improving nursing services.

  16. Hospital-acquired pneumonia after lung resection surgery is associated with characteristic cytokine gene expression.

    LENUS (Irish Health Repository)

    White, Mary

    2012-02-01

    BACKGROUND: Infection in humans has been linked with altered cytokine gene transcription. It is unclear whether this phenomenon is a consequence of an established disease process or precedes the infective process. The primary end point of this study was to determine whether hospital-acquired pneumonia (HAP) was associated with differential gene expression of interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha, and IL-23p19. The secondary end point was to identify whether alteration in gene expression preceded the clinical onset of infection. METHODS: Sixty consecutive patients undergoing elective thoracic surgery were recruited. HAP was diagnosed as per National Nosocomial Infection Surveillance guidelines. Messenger RNA (mRNA) and protein levels were analyzed preoperatively and 24 h and 5 days postoperatively. RESULTS: Forty-one patients had an uncomplicated recovery. Nineteen patients developed HAP. IL-6, IL-10, IL-12p35, IL-23p19, IL-27p28, TNF-alpha, and IFN-gamma mRNA and protein levels of IL-6, IL-23, and IFN-gamma in peripheral blood leukocytes were analyzed before surgery and 24 h and 5 days postsurgery. IL-23p19 mRNA levels were reduced in the pneumonia group (median, 4.19; 10th-90th centile range, 3.90-4.71) compared with the nonpneumonia group (4.50; 3.85-5.32) day 1 postsurgery (P=02). IFN-gamma mRNA levels were reduced in the pneumonia group (2.48; 1.20-3.20) compared with nonpneumonia group (2.81; 2.10-3.26) (P=03) day 5 postsurgery. Results are expressed as log to base 10 copy numbers of cytokine mRNA per 10 million beta-actin mRNA copy numbers. All values are given as median and 10th to 90th centile range. CONCLUSIONS: Cytokine gene expression is altered immediately following surgery in patients with postoperative HAP.

  17. Meningococcal meningitis: clinical and laboratorial characteristics, fatality rate and variables associated with in-hospital mortality

    Directory of Open Access Journals (Sweden)

    Vanessa L. Strelow

    Full Text Available ABSTRACT Meningococcal meningitis is a public health problem. The aim of this study was to describe the clinical characteristics of patients with meningococcal meningitis, and to identify associated factors with mortality. This was a retrospective study, between 2006 and 2011, at a referral center in São Paulo, Brazil. Logistic regression analysis was used to identify factors associated with mortality. We included 316 patients. The median age was 16 years (IQR: 7–27 and 60% were male. The clinical triad: fever, headache and neck stiffness was observed in 89% of the patients. The cerebrospinal triad: pleocytosis, elevated protein levels and low glucose levels was present in 79% of patients. Factors associated with mortality in the multivariate model were age above 50 years, seizures, tachycardia, hypotension and neck stiffness. The classic clinical and laboratory triads of meningococcal meningitis were variable. The fatality rate was low. Age, seizures and shock signs were independently associated with mortality.

  18. Characteristics and evidence of nursing scientific production for medication errors at the hospital environment

    Directory of Open Access Journals (Sweden)

    Lolita Dopico da Silva

    2012-06-01

    Full Text Available This study aimed to identify the characteristics of nurses’ publications about medication errors. It was used an Integrative methodology review covering January 2005 to October 2010 with "medication errors" and "nursing" descriptors and it was also collected data from electronic databases via “Capes Portal”. Results show four categories, the conduct of health professionals in medication errors, types and rates of errors, medication system weaknesses, and barriers to error. Discussion of the prevalent practice was not to notify the error. The prevalent error type was administration and error rates which ranged from 14.8 to 56.7%. Ilegible handwriting, communication failures among professionals, and lack of technical knowledge were weaknesses. Among the barriers, the civility from patient, nurses and technology were evident. Advances in researches for testing barriers were found and some gaps were apparent concerning lack of study that address pharmacodynamics or pharmacokinetic aspects of drugs involved in errors.

  19. Characteristics of Antimicrobial Stewardship Programs at Veterans Affairs Hospitals: Results of a Nationwide Survey.

    Science.gov (United States)

    Chou, Ann F; Graber, Christopher J; Jones, Makoto; Zhang, Yue; Goetz, Matthew Bidwell; Madaras-Kelly, Karl; Samore, Matthew; Kelly, Allison; Glassman, Peter A

    2016-06-01

    BACKGROUND Antimicrobial stewardship programs (ASPs) are variably implemented. OBJECTIVE To characterize variations of antimicrobial stewardship structure and practices across all inpatient Veterans Affairs facilities in 2012 and correlate key characteristics with antimicrobial usage. DESIGN A web-based survey regarding stewardship activities was administered to each facility's designated contact. Bivariate associations between facility characteristics and inpatient antimicrobial use during 2012 were determined. SETTING Total of 130 Veterans Affairs facilities with inpatient services. RESULTS Of 130 responding facilities, 29 (22%) had a formal policy establishing an ASP, and 12 (9%) had an approved ASP business plan. Antimicrobial stewardship teams were present in 49 facilities (38%); 34 teams included a clinical pharmacist with formal infectious diseases (ID) training. Stewardship activities varied across facilities, including development of yearly antibiograms (122 [94%]), formulary restrictions (120 [92%]), stop orders for antimicrobial duration (98 [75%]), and written clinical pathways for specific conditions (96 [74%]). Decreased antimicrobial usage was associated with having at least 1 full-time ID physician (P=.03), an ID fellowship program (P=.003), and a clinical pharmacist with formal ID training (P=.006) as well as frequency of systematic patient-level reviews of antimicrobial use (P=.01) and having a policy to address antimicrobial use in the context of Clostridium difficile infection (P=.01). Stop orders for antimicrobial duration were associated with increased use (P=.03). CONCLUSIONS ASP-related activities varied considerably. Decreased antibiotic use appeared related to ID presence and certain select practices. Further statistical assessments may help optimize antimicrobial practices. Infect Control Hosp Epidemiol 2016;37:647-654.

  20. An audit of the quality of referral letters received by the Department of Oral and Maxillofacial Surgery, Dublin Dental School and Hospital.

    LENUS (Irish Health Repository)

    Moloney, Justin

    2010-10-01

    One hundred consecutive referral letters, sent by dental practitioners to the Department of Oral and Maxillofacial Surgery, Dublin Dental School and Hospital, were audited in terms of quality. The audit was based on the Scottish Intercollegiate Guidelines Network (SIGN) recommendations of 1998. The audit demonstrated that in general referral letters required modification and did not give the clinician the required information. This paper sets out the results of the audit and suggests a template that should be used for future referrals.

  1. Factors influencing changes in levels of radiation doses received by patients during gastroduodenal series procedures in the Hospital Dr. Max Peralta de Cartago

    International Nuclear Information System (INIS)

    Guzman Campos, Jeremy; Vargas Navarro, Jonnathan

    2009-01-01

    A measurement was made of the number of radiation doses emitted by fluoroscopy equipment used in Hospital Dr. Max Peralta, specifically at the Centro de Deteccion de Cancer Gastrico. The analysis has included the factors could be influencing on increase of the total dose to the patient, by means of indicators that directly affect the unnecessary increase in dose, such as: the procedure, sequences of images, indicators of dosage levels, varying conditions of actual studies, variations dose levels and production process factors. [es

  2. An audit of the quality of referral letters received by the Department of Oral and Maxillofacial Surgery, Dublin Dental School and Hospital.

    LENUS (Irish Health Repository)

    Moloney, Justin

    2010-11-01

    One hundred consecutive referral letters, sent by dental practitioners to the Department of Oral and Maxillofacial Surgery, Dublin Dental School and Hospital, were audited in terms of quality. The audit was based on the Scottish Intercollegiate Guidelines Network (SIGN) recommendations of 1998. The audit demonstrated that in general referral letters required modification and did not give the clinician the required information. This paper sets out the results of the audit and suggests a template that should be used for future referrals.

  3. Making reasonable and achievable adjustments: the contributions of learning disability liaison nurses in 'Getting it right' for people with learning disabilities receiving general hospitals care.

    Science.gov (United States)

    MacArthur, Juliet; Brown, Michael; McKechanie, Andrew; Mack, Siobhan; Hayes, Matthew; Fletcher, Joan

    2015-07-01

    To examine the role of learning disability liaison nurses in facilitating reasonable and achievable adjustments to support access to general hospital services for people with learning disabilities. Mixed methods study involving four health boards in Scotland with established Learning Disability Liaison Nurses (LDLN) Services. Quantitative data of all liaison nursing referrals over 18 months and qualitative data collected from stakeholders with experience of using the liaison services within the previous 3-6 months. Six liaison nurses collected quantitative data of 323 referrals and activity between September 2008-March 2010. Interviews and focus groups were held with 85 participants included adults with learning disabilities (n = 5), carers (n = 16), primary care (n = 39), general hospital (n = 19) and liaison nurses (n = 6). Facilitating reasonable and achievable adjustments was an important element of the LDLNs' role and focussed on access to information; adjustments to care; appropriate environment of care; ensuring equitable care; identifying patient need; meeting patient needs; and specialist tools/resources. Ensuring that reasonable adjustments are made in the general hospital setting promotes person-centred care and equal health outcomes for people with a learning disability. This view accords with 'Getting it right' charter produced by the UK Charity Mencap which argues that healthcare professionals need support, encouragement and guidance to make reasonable adjustments for this group. LDLNs have an important and increasing role to play in advising on and establishing adjustments that are both reasonable and achievable. © 2015 John Wiley & Sons Ltd.

  4. A prospective cohort study of stroke characteristics, care, and mortality in a hospital stroke registry in Vietnam

    Directory of Open Access Journals (Sweden)

    Tirschwell David L

    2012-12-01

    Full Text Available Abstract Background As low and middle-income countries such as Vietnam experience the health transition from infectious to chronic diseases, the morbidity and mortality from stroke will rise. In line with the recommendation of the Institute of Medicine’s report on “Promoting Cardiovascular Health in the Developing World” to “improve local data”, we sought to investigate patient characteristics and clinical predictors of mortality among stroke inpatients at Da Nang Hospital in Vietnam. Methods A stroke registry was developed and implemented at Da Nang Hospital utilizing the World Health Organization’s Stroke STEPS instrument for data collection. Results 754 patients were hospitalized for stroke from March 2010 through February 2011 and admitted to either the intensive care unit or cardiology ward. Mean age was 65 years, and 39% were female. Nearly 50% of strokes were hemorrhagic. At 28-day follow-up, 51.0% of patients with hemorrhagic stroke died whereas 20.3% of patients with ischemic stroke died. A number of factors were independently associated with 28-day mortality; the two strongest independent predictors were depressed level of consciousness on presentation and hemorrhagic stroke type. While virtually all patients completed a CT during the admission, evidence-based processes of care such as anti-thrombotic therapy and carotid ultrasound for ischemic stroke patients were underutilized. Conclusions This cohort study highlights the high mortality due in part to the large proportion of hemorrhagic strokes in Vietnam. Lack of hypertension awareness and standards of care exacerbated clinical outcomes. Numerous opportunities for simple, inexpensive interventions to improve outcomes or reduce recurrent stroke have been identified.

  5. Characteristic of Gastric Perforation Type and The Histopathology at Haji Adam Malik General Hospital Medan-Indonesia

    Directory of Open Access Journals (Sweden)

    Kamsir Koto

    2016-10-01

    Full Text Available Background: According to BPPK of health department in 2008, gastric ulcers ranks 10 in cause of mortality on male with age group 45-54 at Indonesia. To date, there is no report of gastric perforation characteristic at Haji Adam Malik General Hospital Medan. Methods: This was a non-experimental study with descriptive retrospective design. Data retrieved from patients’ medical record with diagnosis of gastric perforation at Haji Adam Malik General Hospital Medan on January 2011-December 2014. Results: Majority of patients involved in this study was male with 44 subjects (78.6%, while female was 12 subjects (21.4%. The most frequent age group with gastric perforation was 47-53 and 61-67 years old and the least frequent age group was 40-46 years old and 75-81 years old. 28 subjects were patients with type 3 gastric perforation and no type 2 gastric perforation was found. Histopathology examination revealed that no malignancy was found. Majority of subjects both in male and female use NSAID. Conclusions: Majority of subjects was male. The most frequent age group with gastric perforation was 47-53 and 61-67 years old. The most frequent type of gastric perforation was type 3. Histopathology examination showed that all subjects were with chronic inflammation.

  6. Emergence of Stenotrophomonas maltophilia nosocomial isolates in a Saudi children’s hospital. Risk factors and clinical characteristics

    Directory of Open Access Journals (Sweden)

    Jobran M. Alqahtani

    2017-05-01

    Full Text Available Objectives: To describe the clinical characteristics of pediatric patients colonized or infected by Stenotrophomonas maltophilia (S. maltophilia at a Saudi children’s hospital, to identify risk factors associated with infection, and to investigate the antimicrobial resistance patterns of this emerging pathogen. Methods: In this cross-sectional observational study, 64 non-duplicating S. maltophilia strains were isolated in Najran Maternity and Children’s Hospital, Najran, Saudi Arabia between January 2015 to February 2016. Antimicrobial susceptibility testing was performed using the reference broth microdilution method. Results: In this study, 48 (75% isolates were identified in true infections and 16 (25% isolates were considered colonization. The main types of S. maltophilia infection were pneumonia in 22 (45.8% patients and bloodstream infection in 14 (29.2% patients. The significant risk factors included exposure to invasive procedure (p=0.02, and presence of acute leukemia as an underlying disease (p=0.02. The most active antimicrobials were trimethoprim/sulfamethoxazole (100% sensitivity and tigecycline (93.7% sensitivity. Conclusions: Stenotrophomonas maltophilia is an emerging nosocomial pathogen among pediatric patients. Accurate identification and susceptibility testing of this emerging pathogen are crucial for the management of infected patients and prevention of spread of this nosocomial pathogen.

  7. Clinical characteristics and antimicrobial susceptibilities of anaerobic bacteremia in an acute care hospital.

    Science.gov (United States)

    Tan, Thean Yen; Ng, Lily Siew Yong; Kwang, Lee Ling; Rao, Suma; Eng, Li Ching

    2017-02-01

    This study investigated the clinical features of anaerobic bacteraemia in an acute-care hospital, and evaluated the antimicrobial susceptibility of these isolates to commonly available antibiotics. Microbiological and epidemiological data from 2009 to 2011were extracted from the laboratory information system and electronic medical records. One hundred and eleven unique patient episodes consisting of 116 anaerobic isolates were selected for clinical review and antibiotic susceptibility testing. Susceptibilities to amoxicillin-clavulanate, clindamycin, imipenem, metronidazole, moxifloxacin, penicillin and piperacillin-tazobactam were performed using Etest strips with categorical interpretations according to current CLSI breakpoints. Metronidazole-resistant and carbapenem-resistant anaerobic Gram-negative bacilli were screened for the nim and cfiA genes. Clinical data was obtained retrospectively from electronic medical records. During the 3 year period, Bacteroides fragilis group (41%), Clostridium species (14%), Propionibacterium species (9%) and Fusobacterium species (6%) were the most commonly isolated anaerobes. Patients with anaerobic bacteraemia that were included in the study were predominantly above 60 years of age, with community-acquired infections. The most commonly used empiric antibiotic therapies were beta-lactam/beta-lactamase inhibitor combinations (44%) and metronidazole (10%). The crude mortality was 25%, and appropriate initial antibiotic therapy was not significantly associated with improved survival. Intra-abdominal infections (39%) and soft-tissue infections (33%) accounted for nearly three-quarters of all bacteraemia. Antibiotics with the best anaerobic activity were imipenem, piperacillin-tazobactam, amoxicillin-clavulanate and metronidazole, with in-vitro susceptibility rates of 95%, 95%, 94% and 92% respectively. Susceptibilities to penicillin (31%), clindamycin (60%) and moxifloxacin (84%) were more variable. Two multidrug

  8. The relation of depression, anxiety and stress with personal characteristics of nurses in hospitals of Tabriz, Iran

    Directory of Open Access Journals (Sweden)

    Esmail Khodadadi

    2016-05-01

    Full Text Available The current industrialized world and ever advancing technology has changed human life by a significant increase in the level of stress and anxiety. Nurses are among those professionals who experience an overwhelming level of stress, anxiety and depression due to work overload and subsequent burnout. The nature of nursing profession for a vulnerable human character increases the possibility of emotional setbacks. Hence, this study was designed to explore and identify the prevalence of anxiety, stress and depression among the Iranian nurses and investigate how these variables relate to personal characteristics and influence the quality of patient care. Using a correlational descriptive design and random cluster method, 242 nurses who worked at different hospital wards in Tabriz, Iran were assessed for anxiety, stress and depression, while their personal characteristics were identified. Data were collected by using a standard questionnaire for stress, anxiety and depression (DASS-21 and later analyzed by SPSS (ver.17.Results showed that Iranian nurses suffered from a moderate level of anxiety, stress and depression and gender influenced these variable rates (p<0.05. Hospital ward type had a relation with stress level (p<0.05, being interested in nursing had an inverse relation to anxiety, stress and depression (p<0.05, while the education level positively related to depression rate among nurses (p<0.05. Type of work at different shifts influenced stress (p<0.05 and marital status reduced depression among nurses (p<0.05. Prevalence of stress and anxiety among the Iranian nurses were at a significant level with susceptibility to experience psychological disorders and provide lower quality of patient care. Findings of this study can alarm the Iranian authorities in healthcare systems to adopt a new policy and improve the current state of health for nurses and patients.

  9. Visitor characteristics and alcohol-based hand sanitizer dispenser locations at the hospital entrance: Effect on visitor use rates.

    Science.gov (United States)

    Hobbs, Mary A; Robinson, Susan; Neyens, David M; Steed, Connie

    2016-03-01

    Hospital visitors' hand hygiene (HH) is an important aspect of preventing health care-associated infections, but little is known about visitors' use of alcohol-based hand sanitizers (AHS). The study aim was to examine if use of AHS is influenced by visitor characteristics and the location of AHS within the lobby of a large hospital. An observational study was conducted with AHS placed in 3 different locations. The data included visitor characteristics and if AHS were used. The results suggest that visitors are 5.28 times (95% confidence interval [CI], 3.68-7.82) more likely to use AHS when dispensers are located in the middle of the lobby with limited landmarks or barriers, 1.35 times more likely to use the AHS in the afternoon compared with the morning, or when they are younger visitors (adjusted odds ratio, 1.47; 95% CI, 1.09-1.97). Individuals in a group are more likely (adjusted odds ratio, 1.39; 95% CI, 1.06-1.84) to use AHS. In addition to location, time of day, and age, there is a group effect that results in visitors being more likely to use AHS when in a group. The increased use related to groups may serve as a mechanism to encourage visitor HH. The results suggest future research opportunities to investigate the effect of group dynamics and social pressure on visitor AHS use and to identify strategies for improving visitor HH. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  10. [Characteristics of Hospitalized Mentally ill Spanish Migrants in Germany - Results of a Statistical Reanalysis].

    Science.gov (United States)

    Valdés-Stauber, J; Valdés-Stauber, M A

    2015-10-01

    To draft a clinical profile of mentally ill first-generation Spanish immigrants in Germany treated in a special setting in their native language and to identify possible correlations between time of onset of a mental disorder and migration and also between degree of utilization and clinical as well as care variables. Statistical reanalysis of individual data (n = 100) of a previously published descriptive study with aggregated data corresponding to 15 variables. Correlations are calculated using chi-square as well as Fisher's exact test. Multivariate regression and logistic models were conducted. In addition to the explained variance of the models (R(2)), analyses of residuals as well as post-hoc power analyses (1-β) were performed. A quarter of the sample (26 %) was mentally ill before migration; most of the patients received treatment very late (about 10 years after onset) and became chronically ill. Half of the sample shows a relevant somatic comorbidity and large average lengths of inpatient stays (54 days). In 16 % of treated cases, repatriation had to be organized. The degree of chronicity correlates with mental illness prior to migration. Severe mood disorders and psychoses occur late after having migrated, addictions and neurotic disorders are equally distributed over time. Migration can not be set in a causal relationship with the development of mental disorders, although there is a positive correlation between affective disorders and the duration of the migration status. Chronicity is related to an outbreak of the disease before migration. The sample is relatively homogeneous (one nationality, first generation), but loses epidemiological representativeness (not related to a catchment area). © Georg Thieme Verlag KG Stuttgart · New York.

  11. Characteristics of small areas with high rates of hospital-treated self-harm: deprived, fragmented and urban or just close to hospital? A national registry study.

    LENUS (Irish Health Repository)

    O'Farrell, I B

    2014-10-15

    Previous research has shown an inconsistent relationship between the spatial distribution of hospital treated self-harm and area-level factors such as deprivation and social fragmentation. However, many of these studies have been confined to urban centres, with few focusing on rural settings and even fewer studies carried out at a national level. Furthermore, no previous research has investigated if travel time to hospital services can explain the area-level variation in the incidence of hospital treated self-harm.

  12. Characteristics of individuals receiving disability benefits in the Netherlands and predictors of leaving the disability benefit scheme: a retrospective cohort study with five-year follow-up.

    Science.gov (United States)

    Louwerse, Ilse; Huysmans, Maaike A; van Rijssen, H Jolanda; van der Beek, Allard J; Anema, Johannes R

    2018-01-18

    Today, work disability is one of the greatest social and labour market challenges for policy makers in most OECD countries, where on average, about 6% of the working-age population relies on disability benefits. Understanding of factors associated with long-term work disability may be helpful to identify groups of individuals at risk for disability benefit entitlement or continuing eligibility, and to develop effective interventions for these groups. The purpose of this study is to provide insight into the main diagnoses of workers who qualify for disability benefits and how these diagnoses differ in age, gender and education. Using a five-year follow-up, we examined the duration of disability benefits and how durations differ among individuals with various characteristics. We performed a cohort study of 31,733 individuals receiving disability benefits from the Dutch Social Security Institute (SSI) with a five-year follow-up. Data were collected from SSI databases. Information about disorders was assessed by an insurance physician upon benefit application. These data were used to test for significant relationships among socio-demographics, main diagnoses and comorbidity, and disability benefit entitlement and continuing eligibility. Mental disorders were the most frequent diagnosis for individuals claiming work disability. Diagnoses differed among age groups and education categories. Mental disorders were the main diagnosis for work disability for younger and more highly educated individuals, and physical disorders (generally musculoskeletal, cardiovascular and cancer) were the main diagnosis for older and less educated individuals. In 82% of the claims, the duration of disability benefit was five years or more after approval. Outflow was lowest for individuals with (multiple) mental disorders and those with comorbidity of mental and physical disorders, and highest for individuals with (multiple) physical disorders. The main diagnosis for persons entitled to

  13. Predicting need for orthognathic surgery in early permanent dentition patients with unilateral cleft lip and palate using receiver operating characteristic analysis.

    Science.gov (United States)

    Yun-Chia Ku, Michelle; Lo, Lun-Jou; Chen, Min-Chi; Wen-Ching Ko, Ellen

    2018-03-01

    The purpose of this study was to predict the need for orthognathic surgery in patients with unilateral cleft lip and palate (UCLP) in the early permanent dentition. In this retrospective cohort study, we included 61 patients with complete UCLP (36 male, 25 female; mean age, 18.47 years; range, 16.92-26.17 years). The subjects were grouped into an orthognathic surgery group and a nonsurgery group at the time of growth completion. Lateral cephalograms obtained at the age of 11 years were analyzed to compare the 2 groups. The receiver operating characteristic analysis was applied to predict the probability of the need for orthognathic surgery in early adulthood by using the measurements obtained at the age of 11 years. SNB, ANB, SN, overbite, overjet, maxillary length, mandibular body length, and L1-MP were found to be significantly different between the 2 groups. For a person with a score of 2 in the 3-variable-based criteria, the sensitivity and specificity for determining the need for surgical treatment were 90.0% and 83.9%, respectively (ANB, ≤-0.45°; overjet, ≤-2.00 mm; maxillary length, ≤47.25 mm). Three cephalometric variables, the minimum number of discriminators required to obtain the optimum discriminant effectiveness, predicted the future need for orthognathic surgery with an accuracy of 86.9% in patients with UCLP. Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

  14. DTI measures identify mild and moderate TBI cases among patients with complex health problems: A receiver operating characteristic analysis of U.S. veterans.

    Science.gov (United States)

    Main, Keith L; Soman, Salil; Pestilli, Franco; Furst, Ansgar; Noda, Art; Hernandez, Beatriz; Kong, Jennifer; Cheng, Jauhtai; Fairchild, Jennifer K; Taylor, Joy; Yesavage, Jerome; Wesson Ashford, J; Kraemer, Helena; Adamson, Maheen M

    2017-01-01

    Standard MRI methods are often inadequate for identifying mild traumatic brain injury (TBI). Advances in diffusion tensor imaging now provide potential biomarkers of TBI among white matter fascicles (tracts). However, it is still unclear which tracts are most pertinent to TBI diagnosis. This study ranked fiber tracts on their ability to discriminate patients with and without TBI. We acquired diffusion tensor imaging data from military veterans admitted to a polytrauma clinic (Overall n  = 109; Age: M  = 47.2, SD  = 11.3; Male: 88%; TBI: 67%). TBI diagnosis was based on self-report and neurological examination. Fiber tractography analysis produced 20 fiber tracts per patient. Each tract yielded four clinically relevant measures (fractional anisotropy, mean diffusivity, radial diffusivity, and axial diffusivity). We applied receiver operating characteristic (ROC) analyses to identify the most diagnostic tract for each measure. The analyses produced an optimal cutpoint for each tract. We then used kappa coefficients to rate the agreement of each cutpoint with the neurologist's diagnosis. The tract with the highest kappa was most diagnostic. As a check on the ROC results, we performed a stepwise logistic regression on each measure using all 20 tracts as predictors. We also bootstrapped the ROC analyses to compute the 95% confidence intervals for sensitivity, specificity, and the highest kappa coefficients. The ROC analyses identified two fiber tracts as most diagnostic of TBI: the left cingulum (LCG) and the left inferior fronto-occipital fasciculus (LIF). Like ROC, logistic regression identified LCG as most predictive for the FA measure but identified the right anterior thalamic tract (RAT) for the MD, RD, and AD measures. These findings are potentially relevant to the development of TBI biomarkers. Our methods also demonstrate how ROC analysis may be used to identify clinically relevant variables in the TBI population.

  15. Workplace violence against nurses--prevalence and association with hospital organizational characteristics and health-promotion efforts: Cross-sectional study.

    Science.gov (United States)

    Wei, Ching-Yao; Chiou, Shu-Ti; Chien, Li-Yin; Huang, Nicole

    2016-04-01

    To determine the prevalence of workplace violence and explore the role of hospital organizational characteristics and health promotion efforts in reducing hospital violence among nurses in Taiwan. Cross-sectional survey. One hundred hospitals across Taiwan. The final sample in our study comprised responses from 26,979 nurses. The data were obtained from a nationwide hospital survey, Physical and Mental Health and Safety Needs in Full-Time Health Care Staff, which was developed and conducted by the Bureau of Health Promotion, Taiwan, in 2011. The main dependent variable was whether nurses had experienced violence within the past year. Physical violence, threatened or intimidated personal safety, verbal violence or sexual harassment were all included. Of the 26,979 nurses, 13,392 nurses (49.6%) had experienced at least one episode of any type of violence in the past year; 5150 nurses (19.1%) had been exposed to physical violence, and 12,491 nurses (46.3%) had been exposed to non-physical violence. The prevalence of having experienced any violence varied widely and ranged from the highest (55.5%) in an emergency room or intensive care unit to the lowest (28.3%) among those aged 55-65 years. After adjusting for other characteristics, younger nurses were significantly more likely to be exposed to any violent threat. Nurses working in public hospitals had a significantly higher risk of workplace violence than those working in private hospitals. Significant variations were also observed among work units. Although nurses working in a certified health promoting hospital (HPH) did not have a lower risk of workplace violence, those working in an outstanding HPH had a significantly lower risk of workplace violence. A similar pattern was observed for non-physical violence. Workplace violence is a major challenge to workplace safety for nurses in hospitals. This large scale nurse survey identified individual, work and hospital characteristics associated with workplace violence

  16. Effect of Socio-Demographic and Clinical Characteristics on Physical Activity of Pregnant Women at Referral Hospital in Riyadh, KSA

    Directory of Open Access Journals (Sweden)

    Shaffi Ahamed Shaik

    2017-01-01

    Full Text Available Objective: The objective of this study was to investigate the effects of socio demographic and clinical characteristics of pregnant women on their physical activity. Methods: An observational quantitative cross sectional design was carried out in the delivery ward and paediatrics clinic of king Khalid University Hospital, Riyadh, Saudi Arabia. The study subjects included all women who had delivered in the last three months, during the study period between 2013- 2014. The sample size was 336. Data collection included socio-demographic variables, pregnancy related variables and the physical activity by using validated pregnancy physical activity questionnaire. Results: The mean (standard deviation total physical activity score of all the study subjects was 197.39(72.1. The physical activity scores are statistically significantly higher in younger women, graduation education level, and among those who were employed. The physical activity scores were statistically significantly higher in women who had normal delivery, did not have any illness and those who had followed the advice to perform physical activity. Conclusion: The levels of physical activity along with their socio demographic and clinical characteristic were assessed among the pregnant women. The study found low pursuance of physical activity during pregnancy. Any kind of illness suffered during pregnancy further reduced the physical activity levels. It was only the young and educated pregnant women who held onto regular physical activity as advised during their pregnancy.

  17. [Characteristics of infection prevention and coping behavior for seasonal influenza-like illnesses and its relationship to personal characteristics among hospital nurses].

    Science.gov (United States)

    Hattori, Saki; Takahashi, Mihoko

    2011-10-01

    To describe the infection prevention and coping behavior for seasonal influenza-like illnesses among hospital nurses. We conducted an anonymous questionnaire survey of 444 nurses in October 2007, who belonged to two hospitals in one city. We investigated their infection prevention behavior (handwashing, gargling, mask-use, influenza vaccination rate, humidification of the room, room ventilation, increased physical strength) and coping behavior (type of coping, elapsed time until taking appropriate action, absent days, recognition of infection source) in one season, and their characteristics (sex, age, division, family). 423 questionnaires were analyzed. Most nurses performed handwashing with soap or a disinfectant. However, only 71% and 53% of nurses regularly did this after blowing their nose or touching any hair. Many used only water. Only 58% of the nurses gargled at home. Except after handling linen, gargling was done by less than 10%. Regarding handwashing or gargling, nurses who performed these before the beginning of duties or any treatment was only in the range from 10-25% which was less than when they finished their duties or treatment. Handwashing before beginning duties was significantly associated with "living together with a family" (odds ratio [95% confidence interval] after adjusting for sex and age) (0.32[0.12-0.84]) and "living together with children who go to school" (0.49[0.24-0.995]), respectively. Gargling after any treatment and gargling at home, room humidification and ventilation were all significantly associated with "living together with babies and infants" (2.36[1.07-5.21], 1.87[1.07-3.27], 2.29[1.32-3.97] and 2.46[1.39-4.36]). Fifty-five% of the nurses regularly wore masks during work. The influenza vaccination rate was 82%. 67% of 51 nurses who had flu-like symptoms responded appropriately within 24 hours after onset. However, 25% of 51 nurses did not consult a doctor, but instead took over-the-counter medicine or rested at home. Some

  18. HIV Case Management Support Service Is Associated with Improved CD4 Counts of Patients Receiving Care at the Antiretroviral Clinic of Pantang Hospital, Ghana

    Directory of Open Access Journals (Sweden)

    Bismark Sarfo

    2017-01-01

    Full Text Available Background. Factors associated with individual patient-level management of HIV have received minimal attention in sub-Saharan Africa. This study determined the association between support services and cluster of differentiation 4 (CD4 counts among HIV patients attending ART clinic in Ghana. Methodology. This was a cross-sectional study involving adults with HIV recruited between 1 August 2014 and 31 January 2015. Data on support services were obtained through a closed-ended personal interview while the CD4 counts data were collected from their medical records. Data were entered into EpiData and analyzed using Stata software. Results. Of the 201 patients who participated in the study, 67% (129/191 received case management support service. Counseling about how to prevent the spread of HIV (crude odds ratio (cOR (95% confidence interval (CI (2.79 (1.17–6.68, mental health services (0.2 (0.04–1.00, and case management support service (2.80 (1.34–5.82 was associated with improved CD4 counts of 350 cells/mm3 or more. After adjusting for counseling about how to prevent the spread of HIV and mental health services, case management support service was significantly associated with CD4 counts of 350 cells/mm3 or more (aOR = 2.36 (CI = 1.01–5.49. Conclusion. Case management support service for HIV patients receiving ART improves their CD4 counts above 350 cells/mm3. Incorporating HIV case management services in ART regimen should be a priority in sub-Saharan Africa.

  19. Patient Preferences for Receiving Remote Communication Support for Lifestyle Physical Activity Behaviour Change: The Perspective of Patients with Musculoskeletal Disorders from Three Hospital Services

    Directory of Open Access Journals (Sweden)

    Steven M. McPhail

    2015-01-01

    Full Text Available This study examined patients’ preference ratings for receiving support via remote communication to increase their lifestyle physical activity. Methods. People with musculoskeletal disorders (n=221 of 296 eligible accessing one of three clinics provided preference ratings for “how much” they wanted to receive physical activity support via five potential communication modalities. The five ratings were generated on a horizontal analogue rating scale (0 represented “not at all”; 10 represented “very much”. Results. Most (n=155, 70% desired referral to a physical activity promoting intervention. “Print and post” communications had the highest median preference rating (7/10, followed by email and telephone (both 5/10, text messaging (1/10, and private Internet-based social network messages (0/10. Desire to be referred was associated with higher preference for printed materials (coefficient = 2.739, p<0.001, telephone calls (coefficient = 3.000, p<0.001, and email (coefficient = 2.059, p=0.02. Older age was associated with lower preference for email (coefficient = −0.100, p<0.001, texting (coefficient = −0.096, p<0.001, and social network messages (coefficient = −0.065, p<0.001. Conclusion. Patients desiring support to be physically active indicated preferences for interventions with communication via print, email, or telephone calls.

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

    Science.gov (United States)

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

    2011-10-01

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

  1. Using a qualitative approach for understanding hospital-affiliated integrated clinical and fitness facilities: characteristics and members' experiences.

    Science.gov (United States)

    Yang, Jingzhen; Kingsbury, Diana; Nichols, Matthew; Grimm, Kristin; Ding, Kele; Hallam, Jeffrey

    2015-06-19

    With health care shifting away from the traditional sick care model, many hospitals are integrating fitness facilities and programs into their clinical services in order to support health promotion and disease prevention at the community level. Through a series of focus groups, the present study assessed characteristics of hospital-affiliated integrated facilities located in Northeast Ohio, United States and members' experiences with respect to these facilities. Adult members were invited to participate in a focus group using a recruitment flyer. A total of 6 focus groups were conducted in 2013, each lasting one hour, ranging from 5 to 12 participants per group. The responses and discussions were recorded and transcribed verbatim, then analyzed independently by research team members. Major themes were identified after consensus was reached. The participants' average age was 57, with 56.8% currently under a doctor's care. Four major themes associated with integrated facilities and members' experiences emerged across the six focus groups: 1) facility/program, 2) social atmosphere, 3) provider, and 4) member. Within each theme, several sub-themes were also identified. A key feature of integrated facilities is the availability of clinical and fitness services "under one roof". Many participants remarked that they initially attended physical therapy, becoming members of the fitness facility afterwards, or vice versa. The participants had favorable views of and experiences with the superior physical environment and atmosphere, personal attention, tailored programs, and knowledgeable, friendly, and attentive staff. In particular, participants favored the emphasis on preventive care and the promotion of holistic health and wellness. These results support the integration of wellness promotion and programming with traditional medical care and call for the further evaluation of such a model with regard to participants' health outcomes.

  2. Tuberculosis among Healthcare Workers at Chiang Mai University Hospital, Thailand: Clinical and Microbiological Characteristics and Treatment Outcomes.

    Science.gov (United States)

    Inchai, Juthamas; Liwsrisakun, Chalerm; Bumroongkit, Chaiwat; Euathrongchit, Juntima; Tajarernmuang, Pattraporn; Pothirat, Chaicharn

    2018-05-24

    Tuberculosis (TB) among healthcare workers (HCWs) highly affects morbidity and TB transmission in hospitals. A retrospective cohort study of TB among HCWs (HCW-TB) was conducted using a registered database from 2003 to 2016 at Chiang Mai University Hospital to determine clinical and microbiological characteristics and treatment outcomes of HCW-TB. A total of 76 patients comprising 54 nurses (71.1%), 12 physicians (15.8%), and 10 paramedics (13.2%) were diagnosed with TB disease. The men to women ratio was 25:51, with a mean age of 37.0±11.6 years, a median work duration of 12.0 years (5-20) and a body mass index of 19.4±2.5 kg/m 2 . Within the HCW-TB group, 28 (36.8%) worked in the Medical Department, 12 (15.8%) worked in the Outpatient Department/Emergency Room, and 9 (11.8%) worked in the Surgical Department. Pulmonary TB (PTB) was the most common manifestation of HCW-TB (92.1%). Sputum acid-fast stains were positive among 28 (40.0%) HCWs with PTB. Mycobacterium tuberculosis cultures were positive in 26 (34.2%) patients. Drug susceptibility testing showed sensitivity to all first-line drugs (75.0%), resistance to any one first-line drug (20.8%), and multidrug-resistant TB comprised 4.2%. The end-of-treatment success rate was 100%. Therefore, TB control guidelines should be strictly implemented to prevent TB transmission in healthcare settings.

  3. Investigating the widely held belief that men and women with learning disabilities receive poor quality healthcare when admitted to hospital: a single-site study of 30-day readmission rates.

    Science.gov (United States)

    Kelly, C L; Thomson, K; Wagner, A P; Waters, J P; Thompson, A; Jones, S; Holland, A J; Redley, M

    2015-09-01

    This study aims to use 30-day readmission rates to investigate the presumption that men and women with learning disabilities (LDs, known internationally as intellectual disabilities) receive poorer quality hospital care than their non-disabled peers. A 12-month retrospective audit was conducted using Hospital Episode Statistics (HES) at a single acute hospital in the East of England. This identified all in-patient admissions; admissions where the person concerned was recognised as having a LD; and all emergency readmissions within 30 days of discharge. Additionally, the healthcare records of all patients identified as having a LD and readmitted within 30 days as a medical emergency were examined in order to determine whether or not these readmissions were potentially preventable. Over the study period, a total of 66 870 adults were admitted as in-patients, among whom 7408 were readmitted as medical emergencies within 30 days of discharge: a readmission rate of 11%. Of these 66 870 patients, 256 were identified as having a LD, with 32 of them experiencing at least one emergency readmission within 30 days: a readmission rate of 13%. When examined, the healthcare records pertaining to these 32 patients who had a total of 39 unique 30-day readmissions revealed that 69% (n = 26) of these readmissions were potentially preventable. Although overall readmission rates were similar for patients with LDs and those from the general population, patients with LDs had a much higher rate of potentially preventable readmissions when compared to a general population estimate from van Walraven et al. This suggests that there is still work to be done to ensure that this patient population receives hospital care that is both safe and of high quality. © 2015 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

  4. Incidence, risk factors, and phenomenological characteristics of postoperative delirium in patients receiving intravenous patient-controlled analgesia: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Lin YT

    2016-12-01

    Full Text Available Yao Tsung Lin,1 Kuo Mao Lan,1 Li-Kai Wang,1 Chin-Chen Chu,1 Su-Zhen Wu,1 Chia-Yu Chang,2 Jen-Yin Chen1,3 1Department of Anesthesiology, 2Department of Neurology, Chi Mei Medical Center, 3Department of the Senior Citizen Service Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan Background: Intravenous patient-controlled analgesia (IVPCA is a common method of relieving pain which is a risk factor of postoperative delirium (POD. However, research concerning POD in IVPCA patients is limited. Objective: We aimed to determine the incidence, risk factors, and phenomenological characteristics of POD in patients receiving IVPCA. Methods: A prospective, cohort study was conducted in post-general anesthesia IVPCA patients aged ≥60 years. POD was measured by the Nursing Delirium Screening Scale (NuDESC; 0–10. Delirium, pain severity at rest and/or on movement, and side effects of IVPCA during 3 postoperative days were examined twice-daily by the acute pain service team. Pain severity is measured by an 11-point verbal numerical rating scale (11-point VNRS (0–10. An 11-point VNRS >3 was considered inadequate pain relief. If POD (detected by NuDESC ≥1 is suspected, consulting a neurologist or a psychiatrist to confirm suspected POD is required. Results: In total, 1,608 patients were included. The incidence rate of POD was 2.2%. Age ≥70 years and American Society of Anesthesiologists physical status >III were the risk factors of POD in IVPCA patients. Approximately three-quarters of all POD cases occurred within the first 2 postoperative days. For pain at rest, patients with inadequate pain relief had significantly greater rates of POD than patients with adequate pain relief (day 1, 8.4% vs 1.5%, P<0.001; day 2, 9.6% vs 2.0%, P=0.028; day 3, 4.1% vs 2.1%, P=0.412. However, the incidence of POD was not associated with movement-evoked pain relief. Most (79.9% POD cases in IVPCA patients showed either one or two symptoms. The

  5. Characteristics of Older Georgians Receiving Older Americans Act Nutrition Program Services and Other Home- and Community-Based Services: Findings from the Georgia Aging Information Management System (GA AIMS).

    Science.gov (United States)

    Lee, Jung Sun; Shannon, Jerry; Brown, Arvine

    2015-01-01

    This descriptive study examined characteristics of older Georgians receiving Older Americans Act Nutrition Program Services and other home- and community-based services (HCBS) using state aging administrative data (N = 31,341, mean age: 76.6 ± 9.2 y, 71.2% female, 52.3% White). Home-delivered meals (HDM) was used most frequently. The characteristics of older Georgian HCBS participants varied by the type and number of HCBS received. Those receiving HDM and other in-home and caregiving services were more likely to show poorer sociodemographic, economic, and functional characteristics, and food insecurity. Those receiving multiple HCBS were most vulnerable, but showed lower level of food insecurity than those receiving single HCBS, suggesting potential combined benefits of receiving multiple programs. This study underscores the importance of documenting dynamic needs for HCBS, especially HDM, among vulnerable older adults as part of standard administrative process to identify those at high risk of institutionalization, optimize HCBS delivery and coordination, and maximize HCBS benefits.

  6. Percentage of pathological complete response in patients with rectal cancer that received neoadjuvant therapy with chemotherapy and radiotherapy at the Servicio de Radioterapia from Hospital Mexico, in the period from January 2009 to December 2013

    International Nuclear Information System (INIS)

    Lopez Mena, Stephanie

    2015-01-01

    Percentage of pathologic complete response is determined in patients with rectal cancer, treated with neoadjuvant chemotherapy and radiotherapy, in the Servicio de Radioterapia from Hospital Mexico, in the period between January 2009 and December 2013. Tumor histology is determined. The distance of the tumor is identified with respect to the anal margin. The correlation between the TNM staging and the response received in this type of neoadjuvant therapy is described. Radiotherapy dose used in each case is described. Different schemes of chemotherapy used are characterized. The acute side effects most common are determined in the study population [es

  7. The effect of daily sedation interruption protocol on early incidence of ventilator-associated pneumonia among patients hospitalized in critical care units receiving mechanical ventilation

    Directory of Open Access Journals (Sweden)

    Mehdi Shahabi

    2016-01-01

    Full Text Available Background: Ventilator-associated pneumonia (VAP is a common side effect in patients who receive intravenous sedation infusion. In routine care, after starting sedation infusion for patients who receive mechanical ventilation, interruption of sedation starts without protocol. This study aimed to evaluate the effect of daily sedation vacation protocol on the incidence of VAP in mechanically ventilated patients. Materials and Methods: In this clinical trial study, 80 patients with intravenous sedation infusion were selected and randomly allocated to intervention and control groups. In the intervention group, daily sedation vacation protocol and in the control group, routine sedation vacation was followed. Modified clinical pulmonary infection score questionnaire was completed before intervention and on the third, fourth, and fifth days after intervention. Data were analyzed by using repeated measures analysis of variance (ANOVA, Chi-square, and independent t-test. Results: The results of this study showed that the incidence rate of VAP in the intervention and control groups was 0% versus 15% on the third day of intervention, 12.5% versus 50% on the fourth day, and 27.5% versus 55.3% on the fifth day of intervention in the intervention and control groups, respectively. The incidence of VAP in the intervention group was significantly lower than in the control group (P < 0.05. Conclusions: The results of this study showed that in patients with intravenous sedation, infusion of a daily sedation vacation protocol may reduce the incidence of VAP. Therefore, in order to prevent VAP, nurses are recommended to use this daily sedation vacation protocol.

  8. Frequency and Clinical Characteristics of Tympanic Membrane Perforation Outpatients at Dr. Hasan Sadikin General Hospital in 2011–2013

    Directory of Open Access Journals (Sweden)

    Veronika Ratih

    2016-03-01

    Full Text Available Background: Tympanic membrane perforation is a hearing problem that has become a health problem in the society. In Indonesia, there are only a few studies regarding tympanic membrane perforation. This study was aimed to observe the frequency and clinical characteristics of tympanic membrane perforation patients. Methods: This was a descriptive study performed from August to September 2014. The data was taken retrospectively from medical records of tympanic membrane perforation patients at Dr. Hasan Sadikin General Hospital from January 2011 to December 2013. Results: Of 579 tympanic perforation patients, there were only 214 medical records met the inclusion criteria. The frequency of tympanic membrane perforation patients increased in 2011 it was 28%, in 2013 it was 37.6%. The number of male patients (53.3% was higher than female patients’. Most patients were in productive age (83.2%. Most patients came with the chief complaint of discharge from ear (36.4% and the most common etiology was infection (84.1%. Otological examination showed that most patients had unilateral perforation (73.8%. Based on the size of perforation, central perforation (52.3% was the most common otological finding. From audiogram, most patients had conductive hearing loss (41.5% with moderate degree of hearing loss (30.4%. Most patients were treated by medications (64.5%. Conclusions: The frequency of tympanic membrane steadily increases with clinical characteristic mostly in male patients in productive age admitted with chieft complain of discharge of ear. The most common etiology is infection. Majority of patients have unilateral central perforation that cause conductive hearing lost.

  9. Clinical and Epidemiological Characteristics of Scrub Typhus and Murine Typhus among Hospitalized Patients with Acute Undifferentiated Fever in Northern Vietnam

    Science.gov (United States)

    Hamaguchi, Sugihiro; Cuong, Ngo Chi; Tra, Doan Thu; Doan, Yen Hai; Shimizu, Kenta; Tuan, Nguyen Quang; Yoshida, Lay-Myint; Mai, Le Quynh; Duc-Anh, Dang; Ando, Shuji; Arikawa, Jiro; Parry, Christopher M.; Ariyoshi, Koya; Thuy, Pham Thanh

    2015-01-01

    A descriptive study on rickettsiosis was conducted at the largest referral hospital in Hanoi, Vietnam, to identify epidemiological and clinical characteristics of specific rickettsiosis. Between March 2001 and February 2003, we enrolled 579 patients with acute undifferentiated fever (AUF), excluding patients with malaria, dengue fever, and typhoid fever, and serologically tested for Orientia tsutsugamushi and Rickettsia typhi. Of the patients, 237 (40.9%) and 193 (33.3%) had scrub and murine typhus, respectively, and 149 (25.7%) had neither of them (non–scrub and murine typhus [non-ST/MT]). The proportion of murine typhus was highest among patients living in Hanoi whereas that of scrub typhus was highest in national or regional border areas. The presence of an eschar, dyspnea, hypotension, and lymphadenopathy was significantly associated with a diagnosis of scrub typhus (OR = 46.56, 10.90, 9.01, and 7.92, respectively). Patients with murine typhus were less likely to have these findings but more likely to have myalgia, rash, and relative bradycardia (OR = 1.60, 1.56, and 1.45, respectively). Scrub typhus and murine typhus were shown to be common causes of AUF in northern Vietnam although the occurrence of spotted fever group rickettsiae was not determined. Clinical and epidemiological information may help local clinicians make clinical diagnosis of specific rickettsioses in a resource-limited setting. PMID:25778504

  10. Identification and characteristics of imipenem-resistant Acinetobacter baumannii in surgical wards in a Chinese university hospital.

    Science.gov (United States)

    Wang, Dalin; Ma, Linlin; Wu, Zhenyu; Li, Mingcheng; Li, Xiaohan; Zhang, Wei; Chen, Kun

    2015-03-01

    The aim of this study was to investigate the prevalence and characteristics of imipenem-resistant Acinetobacter baumanni isolated from surgical wards in a university hospital, China. A total of 143 non-duplicate A. baumannii were isolated from 517 inpatients in surgery intensive care units (ICUs), burn wards, and general surgery wards. Of these, 102 isolates of A. baumannii (71.3%) were resistant to imipenem. Among imipenem-resistant isolates, all isolates were resistant to almost all antimicrobial agents except polymyxin E, all isolates were positive for blaOXA-23 and blaOXA-51 in addition to ISAba1, 52 (51%) were positive for blaOXA-58, 8 (7.8%) contained blaVIM-2, which co-harbored with blaOXA-58. Molecular typing revealed the presence of three clones among imipenem-resistant isolates. This study confirmed that A. baumannii strains harboring OXA or VIM type β-lactamases are widely distributed throughout the surgery wards. The data demonstrate that there was a high prevalence of imipenem-resistant A. baumannii infection in the region.

  11. Characteristics of health problems in returned overseas travelers at a tertiary teaching hospital in a suburban area in Japan.

    Science.gov (United States)

    Hirata, Kazuki; Ogawa, Taku; Fujikura, Hiroyuki; Ogawa, Yoshihiko; Hirai, Nobuyasu; Nakagawa-Onishi, Tomoko; Uno, Kenji; Takeyama, Masahiro; Kasahara, Kei; Nakamura-Uchiyama, Fukumi; Konishi, Mitsuru; Mikasa, Keiichi

    2018-03-01

    Few studies have analyzed the characteristics of patients who develop physical disorders after overseas travel. We retrospectively reviewed the medical records of 183 patients who visited Nara Medical University Hospital from 2008 to 2016 because of physical problems after traveling abroad. The main travel destinations were Southeast Asia (n = 100), Africa (n = 27), and South Asia (n = 23). The main reasons for the travel were leisure (n = 96), business (n = 51), and volunteer work (n = 19). The most common final diagnosis was gastrointestinal disease (n = 72), followed by febrile disease (n = 59) and respiratory disease (n = 19). There were eight malaria cases, including one patient who was infected after travel. Additionally, 61 of 71 cases of travelers' diarrhea and 15 of 21 cases of dengue fever occurred after travel. 26 cases of vaccine preventable diseases, such as hepatitis A, typhoid fever, and influenza, were observed. Consequently, healthcare providers should notify Japanese overseas travelers that there is a non-negligible health risk inherent to short-term travel, while stressing on the importance of pre-travel medical consultation. Copyright © 2018 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  12. Clinical characteristics of adult patients with inborn errors of metabolism in Spain: A review of 500 cases from university hospitals

    Directory of Open Access Journals (Sweden)

    J. Pérez-López

    2017-03-01

    Full Text Available Patients with inborn errors of metabolism (IEMs have become an emerging and challenging group in the adult healthcare system whose needs should be known in order to implement appropriate policies and to adapt adult clinical departments. We aimed to analyze the clinical characteristics of adult patients with IEMs who attend the most important Spanish hospitals caring for these conditions. A cohort study was conducted in 500 patients, categorized by metabolic subtype according to pathophysiological classification. The most prevalent group of IEMs was amino acid disorders, with 108 (21.6% patients diagnosed with phenylketonuria. Lysosomal storage disorders were the second group, in which 32 (6.4% and 25 (5% patients had Fabry disease and Gaucher disease respectively. The great clinical heterogeneity, the significant delay in diagnosis after symptom onset, the existence of some degree of physical dependence in a great number of patients, the need for a multidisciplinary and coordinated approach, and the lack of specific drug treatment are common features in this group of conditions.

  13. Associations between characteristics of the nurse work environment and five nurse-sensitive patient outcomes in hospitals : A systematic review of literature

    NARCIS (Netherlands)

    Stalpers, Dewi; de Brouwer, Brigitte J M; Kaljouw, Marian J.; Schuurmans, Marieke J.

    2015-01-01

    Objective: To systematically review the literature on relationships between characteristics of the nurse work environment and five nurse-sensitive patient outcomes in hospitals. Data sources: The search was performed in Medline (PubMed), Cochrane, Embase, and CINAHL. Review methods: Included were

  14. Associations between characteristics of the nurse work environment and five nurse-sensitive patient outcomes in hospitals: a systematic review of literature

    NARCIS (Netherlands)

    Stalpers, D.; Brouwer, B.J.M. de; Kaljouw, M.J.; Schuurmans, M.J.

    2015-01-01

    OBJECTIVE: To systematically review the literature on relationships between characteristics of the nurse work environment and five nurse-sensitive patient outcomes in hospitals. DATA SOURCES: The search was performed in Medline (PubMed), Cochrane, Embase, and CINAHL. REVIEW METHODS: Included were

  15. Heat and ultraviolet light treatment of colostrum and hospital milk: effects on colostrum and hospital milk characteristics and calf health and growth parameters.

    Science.gov (United States)

    Teixeira, A G V; Bicalho, M L S; Machado, V S; Oikonomou, G; Kacar, C; Foditsch, C; Young, R; Knauer, W A; Nydam, D V; Bicalho, R C

    2013-08-01

    The aim of this study was to evaluate the effects of different physical treatments of bovine colostrum and hospital milk on milk bacteriology, immunoglobulin G (IgG) and lactoferrin concentrations, calf serum IgG concentrations and calf health, growth and survivability. Pooled colostrum samples (n=297) were heat treated (HTC; 63°C for 60 min), exposed to ultraviolet light (UVC; 45 J/cm(2)) or untreated ('raw', RC). Hospital milk (n=712) was subjected to high temperature short time pasteurization (HTST; 72°C for 15s), ultraviolet light irradiation (UVH; 45 J/cm(2)) or was untreated. Neonatal Holstein heifer calves (n=875) were randomly enrolled (309 HTC, 285 UVC, 281 RC) and block randomized (by colostrum treatment) into hospital milk treatments HTST (n=449) or UVH (n=426). HTC was more effective than UVC and HTST was more effective than UVH in reducing bacterial counts. IgG and lactoferrin concentrations were significantly lower in HTC and UVC than in RC. Lactoferrin concentrations were significantly lower in HTST than in UVH or untreated hospital milk. There were no significant differences in serum IgG concentrations among calves fed HTC, UVC or RC. Colostrum and hospital milk treatments did not have any significant effect on calf body weight gain, survivability, or frequency of diarrhea or pneumonia. Copyright © 2013 Elsevier Ltd. All rights reserved.

  16. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2017 Rates; Quality Reporting Requirements for Specific Providers; Graduate Medical Education; Hospital Notification Procedures Applicable to Beneficiaries Receiving Observation Services; Technical Changes Relating to Costs to Organizations and Medicare Cost Reports; Finalization of Interim Final Rules With Comment Period on LTCH PPS Payments for Severe Wounds, Modifications of Limitations on Redesignation by the Medicare Geographic Classification Review Board, and Extensions of Payments to MDHs and Low-Volume Hospitals. Final rule.

    Science.gov (United States)

    2016-08-22

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2017. Some of these changes will implement certain statutory provisions contained in the Pathway for Sustainable Growth Reform Act of 2013, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Notice of Observation Treatment and Implications for Care Eligibility Act of 2015, and other legislation. We also are providing the estimated market basket update to apply to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2017. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2017. In addition, we are making changes relating to direct graduate medical education (GME) and indirect medical education payments; establishing new requirements or revising existing requirements for quality reporting by specific Medicare providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities), including related provisions for eligible hospitals and critical access hospitals (CAHs) participating in the Electronic Health Record Incentive Program; updating policies relating to the Hospital Value-Based Purchasing Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition Reduction Program; implementing statutory provisions that require hospitals and CAHs to furnish notification to Medicare beneficiaries, including Medicare Advantage enrollees, when the beneficiaries receive outpatient observation services for more than 24 hours; announcing the implementation of the Frontier Community Health Integration Project Demonstration; and

  17. Objective working hour characteristics and work-life conflict among hospital employees in the Finnish public sector study.

    Science.gov (United States)

    Karhula, Kati; Puttonen, Sampsa; Ropponen, Annina; Koskinen, Aki; Ojajärvi, Anneli; Kivimäki, Mika; Härmä, Mikko

    2017-01-01

    This epidemiological cohort study, based on Finnish public sector data, investigated the associations between objective working hour characteristics and work-life conflict in day and shift work. The comprehensive data of hospital workers (n = 8 931, 92% women, average age 45 years), consisted of survey responses from 2012, linked with the payroll data of working hour characteristics from 91 days preceding the survey. Logistic regression analysis was used to investigate the associations between working hour characteristics and experiencing work-life conflict often/very often. The analyses were adjusted for age (50 years), sex, level of education, marital status, number of small (0-6 years) and school-aged (7-18 years) children, and the overall stressfulness of the life situation. We also conducted stratified analyses of age and sex on the basis of significant interactions. Difficulties in combining work and life were more often associated with shift work without night shifts and shift work with night shifts than with day work (41% and 34 versus 27%; OR for shift work with night shifts 1.78, 95% CI 1.59-2.00, OR for shift work without night shifts 1.42, 95% CI 1.26-1.60). A high proportion (> 25%) of long (> 40h, (OR 1.26, 95% 1.14-1.39) and very long (> 48h, OR 1.31, 95% CI 1.15-1.49) weekly working hours were associated with work-life conflict, and in the stratified analysis, the latter was also true among women (OR 1.54, 95% CI 1.25-1.89). Of the unsocial working hour characteristics, a relatively large amount (> 10% of all shifts) of evening (OR 1.56, 95% CI 1.41-1.72) and night shifts (OR 1.46, 95%CI 1.32-1.61), a high proportion (> 25% of all shifts) of quick returns (work (OR 1.44, 95% CI 1.31-1.58) were associated with work-life conflict. A large amount of single days off (> 25% of all days off) was associated with work-life conflict among men (OR 1.90, 95% CI 1.11-3.25), but not in the whole sample. When the two types of shift work were analyzed separately

  18. Relationship between time to clinical response and outcomes among Pneumonia Outcomes Research Team (PORT) risk class III and IV hospitalized patients with community-acquired pneumonia who received ceftriaxone and azithromycin.

    Science.gov (United States)

    Zasowski, Evan; Butterfield, Jill M; McNutt, Louise-Ann; Cohen, Jason; Cosler, Leon; Pai, Manjunath P; Gottwald, Joseph; Chen, Wen Zhen; Lodise, Thomas P

    2014-07-01

    Recent Food and Drug Administration (FDA) guidance endorses the use of an early clinical response endpoint as the primary outcome for community-acquired bacterial pneumonia (CABP) trials. While antibiotics will now be approved for CABP, in practice they will primarily be used to treat patients with community-acquired pneumonia (CAP). More importantly, it is unclear how achievement of the new FDA CABP early response endpoint translates into clinically applicable real-world outcomes for patients with CAP. To address this, a retrospective cohort study was conducted among adult patients who received ceftriaxone and azithromycin for CAP of Pneumonia Outcomes Research Team (PORT) risk class III and IV at an academic medical center. The clinical response was defined as clinical stability for 24 h with improvement in at least one pneumonia symptom and with no symptom worsening. A classification and regression tree (CART) was used to determine the delay in response time, measured in days, associated with the greatest risk of a prolonged hospital length of stay (LOS) and adverse outcomes (in-hospital mortality or 30-day CAP-related readmission). A total of 250 patients were included. On average, patients were discharged 2 days following the achievement of a clinical response. In the CART analysis, adverse clinical outcomes were higher among day 5 nonresponders than those who responded by day 5 (22.4% versus 6.9%, P = 0.001). The findings from this study indicate that time to clinical response, as defined by the recent FDA guidance, is a reasonable prognostic indicator of real-world effectiveness outcomes among hospitalized PORT risk class III and IV patients with CAP who received ceftriaxone and azithromycin. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

  19. Clinical characteristics and causes of heart failure adherence to treatment guidelines and mortality of patients with acute heart failure: Experience at Groote Schuur Hospital Cape Town South Africa

    Directory of Open Access Journals (Sweden)

    P Szymanski

    2018-02-01

    Full Text Available Background. There is limited information on acute heart failure (AHF and its treatment in sub-Saharan Africa.Objective. To describe the clinical characteristics and causes of heart failure (HF, adherence to HF treatment guidelines, and mortality of patients with AHF presenting to Groote Schuur Hospital (GSH, Cape Town, South Africa.Methods. This sub-study of The Sub-Saharan Africa Survey of Heart Failure (THESUS-HF was a prospective and observational survey that focused on the enrolment and follow-up of additional patients with AHF presenting to GSH and entered into the existing registry after publication of the primary THESUS-HF article in 2012. The patients were classified into prevalent (existing or incident (new cases of HF.Results. Of the 119 patients included, 69 (58.0% were female and the mean (standard deviation age was 49.9 (16.3 years. The majority of prevalent cases were patients of mixed ancestry (63.3%, and prevalent cases had more hypertension (70.0%, diabetes mellitus (36.7%, hyperlipidaemia (33.3% and ischaemic heart disease (IHD (36.7% than incident cases. The top five causes of HF were cardiomyopathy (20.2%, IHD (19.3%, rheumatic valvular heart disease (RHD (18.5%, cor pulmonale (11.8% and hypertension (10.1%, with the remaining 20.1% consisting of miscellaneous causes including pericarditis, toxins and congenital heart disease. Most patients received renin-angiotensin system blockers and loop diuretics on discharge. There was a low rate of beta-blocker, aldosterone antagonist and digoxin use. Rehospitalisation within 180 days occurred in 25.2% of cases. In-hospital mortality was 8.4% and the case fatality rate at 6 months was 26.1%.Conclusion. In Cape Town, the main causes of AHF are cardiomyopathy, IHD and RHD. AHF affects a young population and is associated with a high rate of rehospitalisation and mortality. There is serious under-use of beta-blockers, aldosterone antagonists and digoxin. Emphasis on the rigorous

  20. Characteristics of plasmids in multi-drug-resistant Enterobacteriaceae isolated during prospective surveillance of a newly opened hospital in Iraq.

    Directory of Open Access Journals (Sweden)

    Xiao-Zhe Huang

    Full Text Available BACKGROUND: Gram-negative multidrug-resistant (MDR bacteria are major causes of nosocomial infections, and antibiotic resistance in these organisms is often plasmid mediated. Data are scarce pertaining to molecular mechanisms of antibiotic resistance in resource constrained areas such as Iraq. METHODOLOGY/PRINCIPAL FINDINGS: In this study, all MDR Enterobacteriaceae (n = 38 and randomly selected non-MDR counterparts (n = 41 isolated from patients, healthcare workers and environmental surfaces in a newly opened hospital in Iraq were investigated to characterize plasmids found in these isolates and determine their contribution to antibiotic resistance. Our results demonstrated that MDR E. coli and K. pneumoniae isolates harbored significantly more (≥ 3 plasmids compared to their non-MDR counterparts, which carried ≤ 2 plasmids (p<0.01. Various large plasmids (~52 to 100 kb from representative isolates were confirmed to contain multiple resistance genes by DNA microarray analysis. Aminoglycoside (acc, aadA, aph, strA/B, and ksgA, β-lactam (bla(TEM1, bla(AMPC, bla(CTX-M-15, bla(OXA-1, bla(VIM-2 and bla(SHV, sulfamethoxazole/trimethoprim (sul/dfr, tetracycline (tet and chloramphenicol (cat resistance genes were detected on these plasmids. Additionally, multiple plasmids carrying multiple antibiotic resistance genes were found in the same host strain. Genetic transfer-associated genes were identified on the plasmids from both MDR and non-MDR isolates. Seven plasmid replicon types (FII, FIA, FIB, B/O, K, I1 and N were detected in the isolates, while globally disseminated IncA/C and IncHI1 plasmids were not detected in these isolates. CONCLUSIONS/SIGNIFICANCE: This is the first report of the characteristics of the plasmids found in Enterobacteriaceae isolated following the opening of a new hospital in Iraq. The information provided here furthers our understanding of the mechanisms of drug resistance in this specific region and their evolutionary

  1. Diagnostic, therapeutic and evolutionary characteristics of cervical cancer in Department of Radiotherapy, Mohamed V Military Hospital - Rabat in Morocco.

    Science.gov (United States)

    Elmarjany, Mohammed; Maghous, Abdelhak; Razine, Rachid; Marnouche, Elamin; Andaloussi, Khalid; Bazine, Amine; Lalya, Issam; Zaghba, Noha; Hadadi, Khalid; Sifat, Hassan; Habib, Baba; Kouach, Jaouad; Mansouri, Hamid

    2015-01-01

    Cancer of uterine cervix is the second most common cause of cancer related deaths among women. The aim of this study is to report the experience of Military Hospital Mohamed V in the management of cervical cancer and their results. All cervical cancer managed at the radiotherapy department of Military Hospital Mohamed V between January 2005 and February 2010, were included for investigation of their demographic, histological, therapeutic and follow-up characteristics. Of the 162 cases managed, 151 (93.2 %) cases were treated in our department. In our study the median age was 51.5 years (33-82). The median duration of symptoms before diagnosis was four [3, 7] months. The major presenting complaints were abnormal vaginal bleeding (89.8 %). Squamous cell carcinoma cervix was seen in 86.2 % (n = 137), adenocarcinoma in 11.3 % (n = 18) and adenosquamous carcinoma in 2.4 % (n = 4). One hundred seventeen (84.8 %) cases were seen at late stage. An abdominal and pelvic computed tomography (CT) scan was performed in 34.6 % (n = 56) of cases, magnetic resonance imaging (MRI) in 62.9 % (n = 102). The pelvic lymph nodes were achieved in 16.6 % of cases. Over half of patients 58.3 % (n = 88) were treated with a combination of external beam radiation therapy (EBRT) and a concurrent cisplatin based chemotherapy (40 mg /m2 weekly). With a mean of 51.6 months (2 to 109), we recorded 19 (12.6 %) pelvic relapse and 15 (9.9 %) metastases. The median time to onset was 19.4 months (2-84 months). The local control rate was 63.6 % (n = 96) and 21 (13.9 %) patients were lost to follow-up. The overall survival (OS) at 3 years and 5 years was respectively 78.3 % and 73.6 % and the relapse-free survival (RFS) was respectively 80 % and 77.2 %. Most of cervical cancer patients in Morocco are seen at late stage necessitating referral for radiotherapy, chemotherapy or palliative care. This may reflect lack of cervical screening in order to early

  2. Demographic characteristics and visual status of patients undergoing cataract surgery at a tertiary hospital in Kano, Nigeria.

    Science.gov (United States)

    Kurawa, Musbahu Sani; Abdu, Lawan

    2017-01-01

    Objective/Purpose: To describe the demographic and baseline ocular characteristics, prevalence of blindness and visual impairment among patients undergoing extracapsular cataract extraction for age related cataract at the study hospital over a one year period. Materials/Patients: All consecutive patients aged 40 years and above identified with age related cataract in one or both eyes who voluntarily agree to participate were included. The study adhered to the tenets of the Helsinki declaration. Written informed consent was obtained from all eligible patients. All patients underwent basic eye examination by the ophthalmologist. Visual impairment was determined for each eye according to the standard WHO categorizations. Information obtained also included age, sex and history of previous cataract surgery. Data were recorded in manual tally sheets and on modified computer Cataract Surgery Record forms. Analyses were done using SPSS (version 16, SPSS Inc., Chicago, USA). The participation rate was 91.2%. There were 495 eyes of 487 consecutive patients. This include 212 males and 275 females (M:F, 1:1.3). The age range was 40 to 99 years with a mean age of 62.76 ± 10.49 years (61.35 ± 9.75 years in men and 63.85±10.9 years in females). Most of the patients (n = 451; 92.6%, 95% CI: 89.9-94.6%) were aged 50 years and above. Sixty patients (12.3%, 95% CI: 9.6-15.5%) had cataract in both eyes, 427 (87.7%, 95% CI: 84.5-90.3%) were in one eye. Among these, preoperatively 16 (3.3%, 95% CI: 2.0-5.3%) had aphakia, 21 (4.3%, 95% CI: 2.8-6.5%) had uniocular pseudophakia. About 63.2% (95% CI: 58.9-67.4%) of patients had normal vision in the better eye (presenting VA ≥6/18). Overall 9.5% (95% CI: 7.3-12.7%) were bilaterally blind. About 96.8% of eyes (95% CI: 94.5-98.0%) undergoing cataract surgery were blind (presenting VAConclusion: The study highlights preponderance of females and high incidence of blinding cataract. Education and early disease awareness may play an important

  3. Características clínicas e epidemiológicas da leishmaniose visceral em crianças internadas em um hospital universitário de referência no norte de Minas Gerais, Brasil Clinical and epidemiological characteristics of visceral leishmaniasis in children hospitalized at a reference university hospital in the north of Minas Gerais, Brazil

    Directory of Open Access Journals (Sweden)

    Ludmila Mourão Xavier-Gomes

    2009-12-01

    12 years admitted with a diagnosis of VL at the University Hospital Clemente de Faria, Montes Claros, MG. Records for the period between January 2006 and December 2007 were analyzed. RESULTS: We identified 51 children with VL, of which 51% were female, and 74.5% were under 5 years of age. Children came from Montes Claros (31%, 20 municipalities in the north of the state of Minas Gerais (69%, urban areas (72.5%, and rural areas (21.6%. The main clinical manifestation was fever (96.1% and major clinical findings at admission were splenomegaly (98% and hepatomegaly (94%. The treatment of choice was Glucantime (70.6%, Conventional Amphotericin B (13.7%, Liposomal Amphotericin B (2%, and Glucantime associated with Amphotericin B (15.7%. Infections developed during hospitalization in 35.4% of cases, and of those, 11.8% were skin infections. The average length of hospitalization was 19 days (SD = ± 5.4; 96.1% children received medical discharge and 3.9% progressed to death. CONCLUSIONS: From the clinical and epidemiological characteristics identified in the study, more effective monitoring by healthcare workers is recommended, aiming at early recognition and appropriate treatment of the disease and its complications.

  4. Perfil das parturientes e seus recém-nascidos atendidos em um hospital-escola do Noroeste do Estado do Paraná Perfil de las parturientas y sus recién nacidos atendidos en un hospital escuela del noroeste del Estado de Paraná Profile of parturients and their newborn babies receiving care in a university hospital in northwestern Paraná

    Directory of Open Access Journals (Sweden)

    Gisele Ferreira da Silva

    2009-03-01

    demostrar la posibilidad de utilizar el SINASC como uno de los instrumentos de evaluación de la salud en una unidad terciaria y proponer intervenciones capaces de prevenir la morbimortalidad materno-infantil.The study had the purpose to outline the profile of parturients and their newborn babies receiving care in a school hospital, based on the Live Birth Information System - Sistema de Informações sobre Nascidos Vivos - SINASC. For so, a descriptive, exploratory study was elaborated, identifying the characteristics of all the parturients and their newborns receiving care at Hospital Universitário de Maringá - HUM in 2006. It was observed that 27.1% of the parturients were adolescents, 68.4% had no partner, 59.3% lived outside Maringá, and 63.6% had seven or more pre-natal appointments. The ratio of cesarian sections was 50.4%. The newborns, mostly, had good vitality at birth, although 25.5% were preterms and 23.6% had low weight at birth. With the results, it was possible to outline the profile of the parturients and their newborns receiving care at the HUM, show the possibility of using the SINASC as an instrument of health evaluation in tertiary units and propose interventions capable of preventing maternal-child morbimortality.

  5. Clinical pathological characteristics of systemic lupus erythematosus patients presenting at a tertiary care hospital - a single centre study

    International Nuclear Information System (INIS)

    Shiram, S.A.; Ahmed, M.; Nisar, S.

    2018-01-01

    Objective: To determine the frequency of clinopathological characteristics of systemic lupus erythematosus (SLE) patients presenting to Military Hospital (MH) Rawalpindi. Study Design: Descriptive cross sectional study. Place and Duration of Study: The study was carried out at MH Rawalpindi, from Jan 2011 to Dec 2013. Material and Methods: All patients presenting to Rheumatology department, MH Rawalpindi with a diagnosis of SLE were included in this study. Presenting features, clinical profile and laboratory parameters of patients were recorded. Results: A total of 76 patients were included in this study, 70 (92.1%) were females and 6 (7.9%) male patients with female- male ratio of 11.6:1. Mean age at presentation was 33 ± 8.31 years. Seventy two patients (94.7%) were anti nuclear antibody (ANA) positive, 63 (83%) were positive for anti-double stranded deoxyribonucleic acid (anti-dsDNA) antibody and 6 (7.9%) were anti Smith positive. Seventy (92.1%) patients had musculoskeletal symptoms, 65 patients (85.5%) had fever, 36 (47.4%) patients had cutaneous symptoms, and 20 patients (26.3%) had oral ulcers. About 13 patients (17.1%) had alopecia and 15 patients (19.7%) had serositis. Forty two patients (55.3%) had nephritis, 20 patients (26.3%) had lupus cerebritis, 57 patients (75%) had hematological involvement, 9 patients (11.83%) had pulmonary involvement, 8 patients (10.5%) had rheumatoid arthritis (RA) factor positive and 7 patients (9.2%) had overlap syndrome. Conclusion: Renal and hematological involvement was more common in this study population while mucocutaneous features and neuropsychiatric features were comparable to many local studies with exception to that of Lahore based study that showed much higher percentage of these features. These results reflect the need to have a high index of suspicion for kidney and hematological involvement in SLE patients. (author)

  6. Assessment of time to clinical response, a proxy for discharge readiness, among hospitalized patients with community-acquired pneumonia who received either ceftaroline fosamil or ceftriaxone in two phase III FOCUS trials.

    Science.gov (United States)

    Lodise, Thomas P; Anzueto, Antonio R; Weber, David J; Shorr, Andrew F; Yang, Min; Smith, Alexander; Zhao, Qi; Huang, Xingyue; File, Thomas M

    2015-02-01

    The primary driver of health care costs for patients with community-acquired pneumonia (CAP) is the hospital length of stay (LOS). Unfortunately, hospital LOS comparisons are difficult to make from phase III CAP trials because of their structured designs and prespecified treatment durations. However, an opportunity still exists to draw inferences about potential LOS differences between treatments through the use of surrogates for hospital discharge. The intent of this study was to quantify the time to a clinical response, a proxy for the time to discharge readiness, among hospitalized CAP patients who received either ceftaroline or ceftriaxone in two phase III CAP FOCUS clinical trials. On the basis of the Infectious Diseases Society of America and American Thoracic Society CAP management guidelines and recent FDA guidance documents for community-acquired bacterial pneumonia, a post hoc adjudication algorithm was constructed a priori to compare the time to a clinical response, a proxy for the time to discharge readiness, between patients who received ceftaroline or ceftriaxone. Overall, 1,116 patients (ceftaroline, n=562; ceftriaxone, n=554) from the pooled FOCUS trials met the selection criteria for this analysis. Kaplan-Meier analyses showed that ceftaroline was associated with a shorter time, measured in days, to meeting the clinical response criteria (P=0.03). Of the patients on ceftaroline, 61.0, 76.1, and 83.6% achieved a clinical response by days 3, 4, and 5, compared to 54.3, 69.8, and 79.3% of the ceftriaxone-treated patients. In the Cox regression, ceftaroline was associated with a shorter time to a clinical response (HR, 1.16, P=0.02). The methodology employed here provides a framework to draw comparative effectiveness inferences from phase III CAP efficacy trials. (The FOCUS trials whose data were analyzed in this study have been registered at ClinicalTrials.gov under registration no. NCT00621504 and NCT00509106.). Copyright © 2015, American Society

  7. Characteristics of response of oral and pharyngeal mucosa in patients receiving chemo-IMRT for head and neck cancer using hypofractionated accelerated radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Bhide, Shreerang A., E-mail: sabhide@yahoo.co [Royal Marsden Hospital, Sutton, London (United Kingdom); Institute of Cancer Research, Sutton, London (United Kingdom); Gulliford, Sarah [Institute of Cancer Research, Sutton, London (United Kingdom); Fowler, Jack [Department of Human Oncology, University of Wisconsin, Madison (United States); Department of Medical Physics, University of Wisconsin, Madison (United States); Rosenfelder, Nicola; Newbold, Katie [Royal Marsden Hospital, Sutton, London (United Kingdom); Harrington, Kevin J; Nutting, Christopher M [Royal Marsden Hospital, Sutton, London (United Kingdom); Institute of Cancer Research, Sutton, London (United Kingdom)

    2010-10-15

    Purpose: This study describes the acute response of oral and pharyngeal mucosa to chemo-IMRT schedules using different doses per fraction. Materials and methods: Patients, treated in prospective trials of concomitant chemo-IMRT with 2.17 Gy, 2.25 Gy and 2.4 Gy per fraction and identical dose of cisplatin, were included in this study. Acute toxicity was recorded prospectively using the CTCAE v2.0. We describe the incidence and prevalence of grade 3 oral mucositis and dysphagia over time and report the influence of overall treatment time (OTT). The association between the lengths of pharyngeal mucosa receiving 50 Gy (L50) and 60 Gy (L60) and grade 3 dysphagia was tested. Results: The incidence and the peak prevalence of grade 3 dysphagia were significantly higher in patients receiving 2.4 Gy per fraction. The peak prevalence of grade 3 dysphagia was higher and the recovery was slower in patients with lower OTT (median 38 days vs. 42 days) treatment. There was a significant correlation between L50, L60 and grade 3 dysphagia. A L50 and L60 greater than 8 cm resulted in greater than 60% and 70% incidence of grade 3 dysphagia, respectively. Conclusion: The length of pharyngeal mucosa receiving doses close to the prescription dose correlates with grade 3 dysphagia. It was observed that incidence of grade 3 dysphagia was lower and recovery from it was quicker in patients with greater OTT.

  8. Characteristics of response of oral and pharyngeal mucosa in patients receiving chemo-IMRT for head and neck cancer using hypofractionated accelerated radiotherapy

    International Nuclear Information System (INIS)

    Bhide, Shreerang A.; Gulliford, Sarah; Fowler, Jack; Rosenfelder, Nicola; Newbold, Katie; Harrington, Kevin J.; Nutting, Christopher M.

    2010-01-01

    Purpose: This study describes the acute response of oral and pharyngeal mucosa to chemo-IMRT schedules using different doses per fraction. Materials and methods: Patients, treated in prospective trials of concomitant chemo-IMRT with 2.17 Gy, 2.25 Gy and 2.4 Gy per fraction and identical dose of cisplatin, were included in this study. Acute toxicity was recorded prospectively using the CTCAE v2.0. We describe the incidence and prevalence of grade 3 oral mucositis and dysphagia over time and report the influence of overall treatment time (OTT). The association between the lengths of pharyngeal mucosa receiving 50 Gy (L50) and 60 Gy (L60) and grade 3 dysphagia was tested. Results: The incidence and the peak prevalence of grade 3 dysphagia were significantly higher in patients receiving 2.4 Gy per fraction. The peak prevalence of grade 3 dysphagia was higher and the recovery was slower in patients with lower OTT (median 38 days vs. 42 days) treatment. There was a significant correlation between L50, L60 and grade 3 dysphagia. A L50 and L60 greater than 8 cm resulted in greater than 60% and 70% incidence of grade 3 dysphagia, respectively. Conclusion: The length of pharyngeal mucosa receiving doses close to the prescription dose correlates with grade 3 dysphagia. It was observed that incidence of grade 3 dysphagia was lower and recovery from it was quicker in patients with greater OTT.

  9. Cryogenic microwave channelized receiver

    International Nuclear Information System (INIS)

    Rauscher, C.; Pond, J.M.; Tait, G.B.

    1996-01-01

    The channelized receiver being presented demonstrates the use of high temperature superconductor technology in a microwave system setting where superconductor, microwave-monolithic-integrated-circuit, and hybrid-integrated-circuit components are united in one package and cooled to liquid-nitrogen temperatures. The receiver consists of a superconducting X-band four-channel demultiplexer with 100-MHz-wide channels, four commercial monolithically integrated mixers, and four custom-designed hybrid-circuit detectors containing heterostructure ramp diodes. The composite receiver unit has been integrated into the payload of the second-phase NRL high temperature superconductor space experiment (HTSSE-II). Prior to payload assembly, the response characteristics of the receiver were measured as functions of frequency, temperature, and drive levels. The article describes the circuitry, discusses the key issues related to design and implementation, and summarizes the experimental results

  10. Characteristics of Hospitalized Cases of Pertussis in Catalonia and Navarra, Two Regions in the North of Spain.

    Directory of Open Access Journals (Sweden)

    Inma Crespo

    Full Text Available Pertussis causes a large number of cases and hospitalizations in Catalonia and Navarra. We made a study of household cases of pertussis during 2012 and 2013 in order to identify risk factors for hospitalization in pertussis cases. Each primary case reported triggered the study of their contacts. Close contacts at home and people who were in contact for >2 hours during the transmission period of cases were included. The adjusted OR and 95% confidence intervals (CI was calculated using logistic regression. A total of 1124 pertussis cases were detected, of which 14.9% were hospitalized. Inspiratory whoop (aOR: 1.64; CI: 1.02-2.65, apnoea (aOR: 2.47; CI: 1.51-4.03 and cyanosis (aOR: 15.51; CI: 1.87-128.09 were more common in hospitalized than in outpatient cases. Hospitalization occurred in 8.7% of correctly-vaccinated cases, 41.1% of non-vaccinated cases and 9.4% of partially-vaccinated cases. In conclusion, inspiratory whoop, apnoea and cyanosis were associated factors to hospitalization while vaccination reduced hospitalizations due to pertussis.

  11. Characteristics of Hospitalized Cases of Pertussis in Catalonia and Navarra, Two Regions in the North of Spain.

    Science.gov (United States)

    Crespo, Inma; Toledo, Diana; Soldevila, Núria; Jordán, Iolanda; Solano, Rubén; Castilla, Jesús; Caylà, Joan A; Godoy, Pere; Muñoz-Almagro, Carmen; Domínguez, Ángela

    2015-01-01

    Pertussis causes a large number of cases and hospitalizations in Catalonia and Navarra. We made a study of household cases of pertussis during 2012 and 2013 in order to identify risk factors for hospitalization in pertussis cases. Each primary case reported triggered the study of their contacts. Close contacts at home and people who were in contact for >2 hours during the transmission period of cases were included. The adjusted OR and 95% confidence intervals (CI) was calculated using logistic regression. A total of 1124 pertussis cases were detected, of which 14.9% were hospitalized. Inspiratory whoop (aOR: 1.64; CI: 1.02-2.65), apnoea (aOR: 2.47; CI: 1.51-4.03) and cyanosis (aOR: 15.51; CI: 1.87-128.09) were more common in hospitalized than in outpatient cases. Hospitalization occurred in 8.7% of correctly-vaccinated cases, 41.1% of non-vaccinated cases and 9.4% of partially-vaccinated cases. In conclusion, inspiratory whoop, apnoea and cyanosis were associated factors to hospitalization while vaccination reduced hospitalizations due to pertussis.

  12. Molecular and phenotypic characteristics of healthcare- and community-associated methicillin-resistant Staphylococcus aureus at a rural hospital.

    Directory of Open Access Journals (Sweden)

    Amy E Peterson

    Full Text Available BACKGROUND: While methicillin-resistant Staphylococcus aureus (MRSA originally was associated with healthcare, distinct strains later emerged in patients with no prior hospital contact. The epidemiology of MRSA continues to evolve. METHODS: To characterize the current epidemiology of MRSA-colonized patients entering a hospital serving both rural and urban communities, we interviewed patients with MRSA-positive admission nasal swabs between August 2009 and March 2010. We applied hospitalization risk factor, antimicrobial resistance phenotype, and multi-locus sequence genotype (MLST classification schemes to 94 case-patients. RESULTS: By MLST analysis, we identified 15 strains with two dominant clonal complexes (CCs-CC5 (51 isolates, historically associated with hospitals, and CC8 (27 isolates, historically of community origin. Among patients with CC5 isolates, 43% reported no history of hospitalization within the past six months; for CC8, 67% reported the same. Classification by hospitalization risk factor did not correlate strongly with genotypic classification. Sensitivity of isolates to ciprofloxacin, clindamycin, or amikacin was associated with the CC8 genotype; however, among CC8 strains, 59% were resistant to ciprofloxacin, 15% to clindamycin, and 15% to amikacin. CONCLUSIONS: Hospitalization history was not a strong surrogate for the CC5 genotype. Conversely, patients with a history of hospitalization were identified with the CC8 genotype. Although ciprofloxacin, clindamycin, and amikacin susceptibility distinguished CC8 strains, the high prevalence of ciprofloxacin resistance limited its predictive value. As CC8 strains become established in healthcare settings and CC5 strains disseminate into the community, community-associated MRSA definitions based on case-patient hospitalization history may prove less valuable in tracking community MRSA strains.

  13. Are older women more likely to receive surgical treatment for stress urinary incontinence since the introduction of the mid-urethral sling? An examination of Hospital Episode Statistics data.

    Science.gov (United States)

    Gibson, W; Wagg, A

    2016-07-01

    To examine the trends in surgical treatment of stress urinary incontinence (SUI) in older women since the introduction of the mid-urethral sling. Analysis of data from Hospital Episode Statistics (HES) between 2000 and 2012. All surgical procedures for SUI in the National Health Service (NHS) in England. Retrospective cohort analysis of Hospital Episode Statistics for England from 2000 to 2012. Number of invasive, less invasive, and urethral bulking procedures performed in women in three age groups. There was a 90% fall in the number of invasive surgical treatments for SUI and a four-fold increase in the number of mid-urethral slings over this time. The total number of surgical procedures for SUI increased from 8458 to 13 219. However, the rise in the number of procedures in women aged over 75 was more modest-a three-fold increase from a low start of 187-and these women now make up a smaller proportion of all women receiving a mid-urethral sling (MUS). Despite the development and wide availability of a less invasive, safe and effective operation for stress urinary incontinence in older women, they do not appear to have benefitted. The reasons for this require prospective investigation. © 2015 Royal College of Obstetricians and Gynaecologists.

  14. Characteristics, quality of care, and in-hospital outcomes of Asian-American heart failure patients: Findings from the American Heart Association Get With The Guidelines-Heart Failure Program.

    Science.gov (United States)

    Qian, Feng; Fonarow, Gregg C; Krim, Selim R; Vivo, Rey P; Cox, Margueritte; Hannan, Edward L; Shaw, Benjamin A; Hernandez, Adrian F; Eapen, Zubin J; Yancy, Clyde W; Bhatt, Deepak L

    2015-01-01

    Because little was previously known about Asian-American patients with heart failure (HF), we compared clinical profiles, quality of care, and outcomes between Asian-American and non-Hispanic white HF patients using data from the American Heart Association Get With The Guidelines-Heart Failure (GWTG-HF) program. We analyzed 153,023 HF patients (149,249 whites, 97.5%; 3774 Asian-Americans, 2.5%) from 356 U.S. centers participating in the GWTG-HF program (2005-2012). Baseline characteristics, quality of care metrics, in-hospital mortality, discharge to home, and length of stay were examined. Relative to white patients, Asian-American HF patients were younger, more likely to be male, uninsured or covered by Medicaid, and recruited in the western region. They had higher prevalence of diabetes, hypertension, and renal insufficiency, but similar ejection fraction. Overall, Asian-American HF patients had comparable quality of care except that they were less likely to receive aldosterone antagonists at discharge (relative risk , 0.88; 95% confidence interval , 0.78-0.99), and anticoagulation for atrial fibrillation (RR, 0.91; 95% CI, 0.85-0.97) even after risk adjustment. Compared with white patients, Asian-American patients had comparable risk adjusted in-hospital mortality (RR, 1.11; 95% CI, 0.91-1.35), length of stay>4 days (RR, 1.01; 95% CI, 0.95-1.08), and were more likely to be discharged to home (RR, 1.08; 95% CI, 1.06-1.11). Despite some differences in clinical profiles, Asian-American patients hospitalized with HF receive very similar quality of care and have comparable health outcomes to their white counterparts. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  15. Receiver operating characteristic (ROC) curves and the definition of threshold levels to diagnose coronary artery disease on electrocardiographic stress testing. Part II: the use of ROC curves in the choice of electrocardiographic stress test markers of ischaemia.

    Science.gov (United States)

    Marazìa, Stefania; Barnabei, Luca; De Caterina, Raffaele

    2008-01-01

    A common problem in diagnostic medicine, when performing a diagnostic test, is to obtain an accurate discrimination between 'normal' cases and cases with disease, owing to the overlapping distributions of these populations. In clinical practice, it is exceedingly rare that a chosen cut point will achieve perfect discrimination between normal cases and those with disease, and one has to select the best compromise between sensitivity and specificity by comparing the diagnostic performance of different tests or diagnostic criteria available. Receiver operating characteristic (or receiver operator characteristic, ROC) curves allow systematic and intuitively appealing descriptions of the diagnostic performance of a test and a comparison of the performance of different tests or diagnostic criteria. This review will analyse the basic principles underlying ROC curves and their specific application to the choice of optimal parameters on exercise electrocardiographic stress testing. Part II will be devoted to the comparative analysis of various parameters derived from exercise stress testing for the diagnosis of underlying coronary artery disease.

  16. Health literacy, numeracy, and other characteristics associated with hospitalized patients' preferences for involvement in decision-making

    OpenAIRE

    Goggins, KM; Wallston, KA; Nwosu, S; Schildcrout, JS; Castel, L; Kripalani, S

    2014-01-01

    Little research has examined the association of health literacy and numeracy with patients' preferred involvement in the problem-solving and decision-making process in the hospital. Using a sample of 1,249 patients hospitalized with cardiovascular disease from the Vanderbilt Inpatient Cohort Study (VICS), we assessed patients' preferred level of involvement using responses to two scenarios of differing symptom severity from the Problem-Solving Decision-Making (PSDM) Scale. Using multivariable...

  17. Clinical Characteristics of Tuberculosis-Associated Immune Reconstitution Inflammatory Syndrome in North Indian Population of HIV/AIDS Patients Receiving HAART

    Directory of Open Access Journals (Sweden)

    Suman Karmakar

    2011-01-01

    Full Text Available Background & Objective. IRIS is an important complication that occurs during management of HIV-TB coinfection and it poses difficulty in diagnosis. Previous studies have reported variable incidence of IRIS. The present study was undertaken to describe the pattern of TB-associated IRIS using recently proposed consensus case-definitions for TB-IRIS for its use in resource-limited settings. Methods. A prospective analysis of ART-naïve adults started on HAART from November, 2008 to May, 2010 was done in a tertiary care hospital in north India. A total 224 patients divided into two groups, one with HIV-TB and the other with HIV alone, were followedup for a minimum period of 3 months. The diagnosis of TB was categorised as ‘‘definitive’’ and ‘‘probable’’. Results. Out of a total of 224 patients, 203 completed followup. Paradoxical TB-IRIS occurred in 5 of 123 (4% HIV-TB patients while 6 of 80 (7.5% HIV patients developed ART-associated TB. A reduction in plasma viral load was significantly (P=.016 associated with paradoxical TB-IRIS. No identifiable risk factors were associated with the development of ART-associated TB. Conclusion. The consensus case-definitions are useful tools in the diagnosis of TB-associated IRIS. High index of clinical suspicion is required for an early diagnosis.

  18. Patient characteristics related to metabolic disorders and chronic complications in type 2 diabetes mellitus patients hospitalized at the Qingdao Endocrine and Diabetes Hospital from 2006 to 2012 in China.

    Science.gov (United States)

    Dong, Yanhu; Gao, Weiguo; Zhang, Lei; Wei, Jia; Hammar, Niklas; Cabrera, Claudia S; Wu, Xiaoli; Qiao, Qing

    2017-01-01

    To study the clinical characteristics related to metabolic disorders and complications in type 2 diabetes mellitus patients hospitalized in the Qingdao Endocrine and Diabetes Hospital from 2006 to 2012 in Qingdao, China. Data from 14,289 (51% males) type 2 diabetes mellitus patients hospitalized between 2006 and 2012 were collected and analysed. Information on patients' demographic, anthropometric, laboratory and disease histories were extracted from electronic medical records. The mean age of the patients was 60.5 years, with median diabetes duration of 9.0 years. Mean haemoglobin A1c was 8.4%, where 1.9% had hypertriglyceridaemia. Retinopathy was diagnosed in 51.1% of patients, nephropathy in 21.6%, neuropathy in 50.4%, hypertension in 77.4%, coronary heart disease in 27.6% and peripheral vascular disease in 58.6%. Once hospitalized, 71.1% of patients underwent insulin injection treatments, either mono-therapy or combined with other anti-diabetic drugs. Metformin was prescribed to 36.9% of patients, followed by acarbose 29.9%, thiazolidinediones 18.1%, meglitinides 14.8% and sulfonylureas 10.7%. Inadequate control of hyperglycaemia, poor metabolic profiles and diabetic complications were common challenges for long-term diabetes management in Chinese patients with type 2 diabetes mellitus. © The Author(s) 2016.

  19. Characteristics of the Websites of the Community of Madrid Hospitals: Relationship between Web Quality and Corporate Social Responsibility

    Directory of Open Access Journals (Sweden)

    Herenia Gutiérrez-Ponce

    2018-02-01

    Full Text Available The aim of this research is to analyse the quality of websites of the public and private hospitals of the Community of Madrid; as well as to identify its relationship with the indicators of Corporate Social Responsibility (CSR. This study is in tune with the increasing demand of digital information about health institutions in follow-up of the Law of Transparency, Access to the Public Information and Good Government. The methodology used, supported by previous academic publications, consists on exploring the scores of hospitals by means of questionnaires and accessibility tools able to identify the quality of a web information, and its statistical relation with CSR indicators, especially in the case of public hospitals.

  20. Lifestyle, socioeconomic characteristics, and medical history of elderly persons who receive seasonal influenza vaccination in a tax-supported healthcare system

    DEFF Research Database (Denmark)

    Hellfritzsch, Maja; Thomsen, Reimar Wernich; Baggesen, Lisbeth Munksgård

    2017-01-01

    inactivity (aPR: 1.08, 95% CI 1.03–1.13). Levels of education and income were similar in the two groups. Vaccinated persons had a higher prevalence of major physical limitations (aPR: 1.40, 95% CI 1.17–1.66) and need for assistance with activities of daily living (aPR: 1.29, 95% CI 1.13–1.47). Conclusion......Background Observational studies on effectiveness of influenza vaccination in the elderly are thought to be biased by healthier lifestyles and higher socioeconomic status among vaccinated vs. unvaccinated persons. We examined this hypothesis in a uniform tax-supported health care system with free......-of-charge influenza vaccination to the elderly. Methods We conducted a cross-sectional study among Danes aged 65–79 years participating in a survey. We compared elderly persons with and without a recent (within six months) influenza vaccination in terms of (i) lifestyle and socioeconomic characteristics obtained from...

  1. Getting the first birth right: A retrospective study of outcomes for low-risk primiparous women receiving standard care versus midwifery model of care in the same tertiary hospital.

    Science.gov (United States)

    Wong, Nola; Browne, Jenny; Ferguson, Sally; Taylor, Jan; Davis, Deborah

    2015-12-01

    There is national and international concern for increasing obstetric intervention in childbirth and rising caesarean section rates. Repeat caesarean section is a major contributing factor, making primiparous women an important target for strategies to reduce unnecessary intervention and surgeries in childbirth. The aim was to compare outcomes for a cohort of low risk primiparous women who accessed a midwifery continuity model of care with those who received standard public care in the same tertiary hospital. A retrospective comparative cohort study design was implemented drawing on data from two databases held by a tertiary hospital for the period 1 January 2010 to 31 December 2011. Categorical data were analysed using the chi-squared statistic and Fisher's exact test. Continuous data were analysed using Student's t-test. Comparisons are presented using unadjusted and adjusted odds ratios, with 95% confidence intervals (CIs) and p-values with significance set at 0.05. Data for 426 women experiencing continuity of midwifery care and 1220 experiencing standard public care were compared. The study found increased rates of normal vaginal birth (57.7% vs. 48.9% p=0.002) and spontaneous vaginal birth (38% vs. 22.4% p=rates of instrumental birth (23.5% vs. 28.5% p=0.050) and caesarean sections (18.8% vs. 22.5% p=0.115) in the midwifery continuity cohort. There were also fewer interventions in this group. No differences were found in neonatal outcomes. Strategies for reducing caesarean section rates and interventions in childbirth should focus on primiparous women as a priority. This study demonstrates the effectiveness of continuity midwifery models, suggesting that this is an important strategy for improving outcomes in this population. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  2. Characteristics of plasmids in multi-drug-resistant enterobacteriaceae isolated during prospective surveillance of a newly opened hospital in Iraq

    Science.gov (United States)

    Multidrug-resistant (MDR) bacteria such as Escherichia coli and Klebsiella spp. are increasingly common causes of infections in hospitals worldwide and also in the U.S. military treatment facilities. Plasmids are thought to play an important role in the dissemination of antibiotic resistance in thes...

  3. Characteristics of out-of-hospital paediatric emergencies attended by ambulance- and helicopter-based emergency physicians

    NARCIS (Netherlands)

    Eich, Christoph; Russo, Sebastian G.; Heuer, Jan F.; Timmermann, Arnd; Gentkow, Uta; Quintel, Michael; Roessler, Markus

    Background: In Germany, as in many other countries, for the vast majority of cases, critical out-of-hospital (OOH) paediatric emergencies are attended by non-specialised emergency physicians (EPs). As it is assumed that this may lead to deficient service we aimed to gather robust data on the

  4. Clinical and Laboratory Characteristics of Patients with Nontuberculous Mycobacterium Bloodstream Infection in a Tertiary Referral Hospital in Beijing, China

    Directory of Open Access Journals (Sweden)

    Sai-Nan Bian

    2016-01-01

    Conclusions: We reported all cases in our hospital diagnosed with bloodstream NTM infection that was rarely reported. In this group of patients, patients usually had a high fever and could have multiple organ involvements. All patients with poor prognosis had underlying diseases.

  5. Clinical characteristics of synthetic cannabinoid-induced psychosis in relation to schizophrenia: a single-center cross-sectional analysis of concurrently hospitalized patients

    Directory of Open Access Journals (Sweden)

    Altintas M

    2016-08-01

    Full Text Available Merih Altintas,1 Leman Inanc,2 Gamze Akcay Oruc,1 Selim Arpacioglu,1 Huseyin Gulec1 1Department of Psychiatry, Erenköy Mental and Neurological Diseases Training and Research Hospital, Istanbul, 2Department of Psychiatry, Dr Cevdet Aykan Mental Health and Diseases Hospital, Tokat, Turkey Background: This study aimed to evaluate synthetic cannabinoid (SC-induced psychosis in terms of patient profile and clinical characteristics with reference to concurrently hospitalized schizophrenic patients. Methods: A total of 81 male patients diagnosed with psychotic disorder induced by the use of SCs (n=50; mean (standard deviation [SD] age: 25.9 (5.5 years or with schizophrenia (n=31, mean (SD age: 42.9 (11.6 years based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnosis criteria who were concurrently hospitalized at Erenköy Mental and Neurological Diseases Training and Research Hospital were included in this cross-sectional study. Data on sociodemographic characteristics, Brief Psychiatric Rating Scale (BPRS, Positive and Negative Syndrome Scale (PANSS, Frontal Assessment Battery (FAB, Hamilton Rating Scale for Depression (HRSD, and Hamilton Anxiety Rating Scale (HAM-A were recorded in all the patients. Results: Mean (SD age at disease onset in SC-induced psychosis patients was 22.3 (5.6 years; 26.0% had suicidal ideation and 58.4% were hospitalized involuntarily. Marijuana was the most common first used substance (72.0%, and solitary use of SC was noted in 38.0% of patients. SC-induced psychosis patients had similar PANSS positive, BPRS, HRSD, and FAB scores and significantly lower PANSS negative scores (18.0 [6.5] vs 22.3 [6.0], P=0.004 than patients with schizophrenia, while they had similar HAM-A scores (17.8 [10.3] vs 21.6 [5.5], P=0.085 as young schizophrenics. Age at onset for SC (r=0.364, P=0.05 or substance (r=0.395, P=0.01 use was correlated positively with total FAB scores.Conclusion: In conclusion, our

  6. Characteristics and determinants of adult patients with acute poisoning attending the accident and emergency department of a teaching hospital in Qatar.

    Science.gov (United States)

    Khudair, I F; Jassim, Z; Hanssens, Y; Alsaad, W A

    2013-09-01

    Data about etiologic and demographic characteristics of acute poisoning in adults in Qatar are lacking. This prospective observational study was undertaken to analyze characteristics and possible determinants of acute poisoning in adults in Qatar. During 2010, 18,073 patients attended the emergency department of Hamad General Hospital, a teaching hospital in Qatar. Out of them, 599 (3.3%) patients were diagnosed as "poisoning case" with either chemical or pharmaceutical substances. The prevalence rate of poisoning incidence was 35.3/100,000 population. Seven patients died, corresponding with a case-fatality rate of 0.39/1000. The majority were male (65%) and the mean age was 34 years. The poisons involved were mainly chemicals (61.6%) and pharmaceuticals (38.4%). Female, mainly single, suffered more intentional poisoning compared to male. Of the patients aged 60 years and above (7.2%), the majority (95.3%) suffered unintentional poisoning with pharmaceuticals; 56% with warfarin, 12% with digoxin and 7% with insulin. Multivariate analysis shows that female gender, single status, younger than 35 years of age, being poisoned by pharmaceutical products, and the need for hospitalization are significant determinants for acute intentional poisoning after adjusting all other possible covariates. The findings of this study can be used to establish awareness and prophylactic campaigns in Qatar.

  7. 'Chaos' in superregenerative receivers

    International Nuclear Information System (INIS)

    Commercon, Jean-Claude; Badard, Robert

    2005-01-01

    The superregenerative principle has been known since the early 1920s. The circuit is extremely simple and extremely sensitive. Today, superheterodyne receivers generally supplant superregenerative receivers in most applications because there are several undesirable characteristics: poor selectivity, reradiation, etc. Superregenerative receivers undergo a revival in recent papers for wireless systems, where low cost and very low power consumption are relevant: house/building meters (such as water, energy, gas counter), personal computer environment (keyboard, mouse), etc. Another drawback is the noise level which is higher than that of a well-designed superheterodyne receiver; without an antenna input signal, the output of the receiver hears in an earphone as a waterfall noise; this sound principally is the inherent input noise amplified and detected by the circuit; however, when the input noise is negligible with respect of an antenna input signal, we are faced to an other source of 'noise' self-generated by the superregenerative working. The main objective of this paper concerns this self-generated noise coming from an exponential growing followed by a re-injection process for which the final state is a function of the phase of the input signal

  8. Health-related characteristics and preferred methods of receiving health education according to dominant language among Latinos Aged 25 to 64 in a large Northern California health plan

    Directory of Open Access Journals (Sweden)

    Iribarren Carlos

    2008-09-01

    Full Text Available Abstract Background Latinos are a fast growing segment of the U.S. health care population. Acculturation factors, including English fluency, result in an ethnic group heterogeneous with regard to SES, health practices, and health education needs. This study examined how demographic and health-related characteristics of Spanish-dominant (SD, Bilingual (BIL, and English-dominant (ED Latino men and women aged 25–64 differed among members of a large Northern California health plan. Methods This observational study was based on data from cohorts of 171 SD (requiring an interpreter, 181 BIL, and 734 ED Latinos aged 25–64 who responded to random sample health plan member surveys conducted 2005–2006. Language groups were compared separately by gender on education, income, behavioral health risks (smoking, obesity, exercise frequency, dietary practices, health beliefs, health status (overall health and emotional health, diabetes, hypertension, high cholesterol, heartburn/acid reflux, back pain, depression, computer and Internet access, and health education modality preferences. Results Compared with ED Latinos, higher percentages of the SD and BIL groups had very low educational attainment and low income. While groups were similar in prevalence of diabetes, hypertension, and high cholesterol, SD were less likely than ED Latinos to rate overall health and emotional well-being as good, very good, or excellent and more likely to report heartburn and back pain (women only. The groups were similar with regard to smoking and obesity, but among women, SD were more likely to be physically inactive than ED, and BIL were less likely than SD and ED groups to eat Conclusion There are important differences among Latinos of different English language proficiency with regard to education, income, health status, health behaviors, IT access, and health education modality preferences that ought to be considered when planning and implementing health programs for this

  9. Clinical characteristics and outcomes among pediatric patients hospitalized with pandemic influenza A/H1N1 2009 infection

    Directory of Open Access Journals (Sweden)

    Eun Lee

    2011-08-01

    Full Text Available Purpose : The purpose of this article is to describe the clinical and epidemiologic features and outcomes among children hospitalized with pandemic influenza A/H1N1 2009 infection. Methods : We retrospectively reviewed the charts of hospitalized pediatric patients (&lt;18 years diagnosed with pandemic influenza A/H1N1 2009 infection by reverse-transcriptase polymerase chain reaction at a tertiary hospital in Seoul, Korea, between September 2009 and February 2010. Results : A total of 72 children were hospitalized with pandemic influenza A/H1N1 2009 infection (median age, 6.0 years; range, 2 months to 18 years. A total of 40% had at least 1 underlying medical condition, including asthma (17%, malignancies (19%, and heart diseases (17%. Of the 72 patients, 54 (76% children admitted with H1N1 infection showed radiographic alterations compatible with pneumonia. There was no significant difference in pre-existing conditions between pandemic influenza A/H1N1 infected patients with or without pneumonia. Children with pandemic influenza A/ H1N1 pneumonia were more likely to have a lower lymphocyte ratio (P=0.02, higher platelet count (P=0.02, and higher level of serum glucose (P=0.003, and more commonly presented with dyspnea than did those without pneumonia (P=0.04. Conclusion : No significant differences in age, sex, or presence of preexisting conditions were found between children hospitalized with pandemic influenza A/H1N1 H1N1 influenza infection with pneumonia and those without pneumonia. Higher leukocyte count, higher glucose level, and a lower lymphocyte ratio were associated with the development of pandemic A/H1N1 2009 influenza pneumonia.

  10. Clinical characteristics and outcomes of acute community acquired pneumonia in children at a reference public hospital in Pernambuco State, Brazil (2010-2011

    Directory of Open Access Journals (Sweden)

    Rita de Cássia Coelho Moraes de Brito

    Full Text Available Abstract Objectives: to describe the clinical characteristics and outcomes of acute community acquired pneumonia in children at a reference public hospital in Pernambuco State, Brazil (2010-2011 Methods: pneumonia case series of 80 children aged 28 days to 14 years old at Hospital da Restauração in Pernambuco, Brazil, from 2010 to 2011. Information was noted from medical files, and two comparison groups were created according to the severity of the disease, considering the presence of pleural effusion. Fisher or Mann-Whitney tests were used for comparative analyses. Results: severe pneumonia with pleural effusion was more frequent in children under five years of age (p=0,025, and was associated with longer period of fever (19 x 15 days and coughing (17 x 13 days, when compared to non-complicated pneumonia cases. Six children (7,5%, 6/80 died, 50% before the fourth day of hospitalization (p=0,001. All deaths were from the pleural effusion group in children from the countryside (p=0,026. Conclusions: the severity of pneumonia in children attended at this hospital is related to younger children, and those transferred from the health units in the countryside, so, early diagnosis and medical intervention are limited by infrastructure and available resources for the health.

  11. [Evaluation of the impact of a training program on vitamin K antagonists (VKA) implemented by pharmacy students aiming at improving the knowledge of patients receiving vitamin K antagonists during their hospital clinical training course].

    Science.gov (United States)

    Conort, O; Siguret, V; Bourdon, O; Nazaraly, S; Brignone, M; Pons-Kerjean, N; Houze, S; Laribe Cage, S; Berthet, F; Golmard, J-L; Brion, F; Tilleul, P

    2014-07-01

    We developed a training program for pharmacy students aiming at supporting patients receiving vitamin K antagonists (VKAs). The objective was to estimate how the program impacts VKA-treated patient knowledge acquisition and/or improvement on their anticoagulant treatment. Using dedicated tools, pharmacy students received education on VKA treatment. Once appointed to clinical wards of Assistance publique-Hôpitaux de Paris, they were in charge of evaluating patient's knowledge on VKA treatment before and after training. Evaluation was conducted using a face-to-face standardized interview (14-item questionnaire). A global score was calculated for each patient. An univariate and multivariate analysis was performed to identify potential variables influencing score result. One hundred and seventy VKA-treated patients were recruited in seven hospitals for evaluation of their knowledge on VKA treatment and on clinical at risk situations. Before intervention, patients obtained an average score of 12.3±3.2 (maximum: 18). Factors significantly associated with the score were possession of a VKA information booklet, VKA treatment duration, treatment initiation and age. Fifty-two patients with a low score were further trained by the pharmacy student. After intervention, their initial score was improved significantly, from 9.9±3.3 to 13.5±2.3 (P<0.0001). Increasing patient knowledge is a way to decrease the rate of adverse effects. This study demonstrates that patients with primary poor knowledge improved it significantly thanks to pharmacy students' intervention. This may contribute to lower the VKA-associated risk of adverse events and consequently to the improvement of patients quality of life and healthcare expenditures. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  12. Comparing clinical and demographic characteristics of people with mental illness in hospital- and community-based residential rehabilitation units in Queensland.

    Science.gov (United States)

    Meehan, Tom; Stedman, Terry; Parker, Stephen; Curtis, Bretine; Jones, Donna

    2017-05-01

    Objective The aim of the present study was to examine care pathways and characteristics of mental health consumers participating in both hospital- and community-based residential rehabilitation programs. Methods An audit of consumers (n=240) in all publicly funded residential rehabilitation units in Queensland was performed on the same day in 2013. Data collection focused on demographic characteristics, clinical information and measures of consumer functioning. Results Significant differences emerged for consumers in community- and hospital-based services with regard to age, length of stay, functioning, Mental Health Act status, guardianship status, family contact and risk of violence. Consumers in hospital-based programs have more severe and complex problems. Conclusions Consumers in residential rehabilitation units have high levels of disability, poor physical health and high levels of vulnerability. Nonetheless, it is likely that a sizeable proportion of consumers occupying rehabilitation beds in Queensland could be discharged if more 'step-down' options to move patients on were available. What is known about the topic? A small subgroup of people with severe and complex mental health problems is likely to require time in a residential rehabilitation program. This group is characterised by failure to respond to treatment, severe negative symptoms and some degree of cognitive impairment. What does this paper add? Patients currently occupying residential rehabilitation beds in Queensland have high levels of disability, poor physical health and high levels of vulnerability. Patients in hospital-based programs are more severely disabled than those in community-based programs. What are the implications for practitioners? It is likely that a sizeable proportion of patients occupying rehabilitation beds in Queensland could be discharged if more 'step-down' options were available. Future planning initiatives need to focus on developing a greater array of community

  13. Prevalence, characteristics and risk factors of pressure ulcers in public and private hospitals care units and nursing homes in France.

    Science.gov (United States)

    Barrois, Brigitte; Colin, Denis; Allaert, François-André

    2018-02-01

    The aim of this study conducted in 2014 was to describe the prevalence of pressure ulcers in different types of French hospital unit at the national level to compare them with data from the 1994 and 2004 study. This cross-sectional study was conducted over a single day. All care units were invited to participate by drawing lots stratified by region in successive waves until 1,200 agreements were obtained. Lots were drawn for towns with more than 10,000 inhabitants. All public- and private-sector hospital facilities in each town drawn by lot were invited to participate in the survey. 776 hospital services throughout France took part and accommodated 21,538 patients: 12,752 women (59.2%) and 8,786 men (40.8%). Of these patients, 1,753 (8.1%; IC95% = 7.7; 8.5) had pressure ulcers. The pressure-ulcer rate was 7.8% (IC95% = [7.3; 8.3] (n = 997)) for hospitalized women and 8.6% (IC95% = [8.0; 9.2] (n = 756)) for men (p = 0.0381). The 8.1% level reported in 2014 therefore points to a reduction in pressure-ulcer prevalence; 8.6% in 1994 and 8.9% in 2004. The actions performed daily by healthcare professionals to prevent pressure ulcers, supported by research and training programs, including those by PERSE, are having a real impact over time.

  14. Comparison of the characteristics of suicide attempters with major depressive disorder and those with no psychiatric diagnosis in emergency departments of general hospitals in China.

    Science.gov (United States)

    Wei, Shengnan; Li, Haiyan; Hou, Jinglin; Chen, Wei; Chen, Xu; Qin, Xiaoxia

    2017-01-01

    Major depressive disorder (MDD) is a known major risk factor for suicide due to the high suicide mortality. However, studies comparing the characteristics of suicide attempters with major depressive disorder and those with no psychiatric diagnosis in China are very limited. This study examined and compared the sociodemographic and psychological characteristics of suicide attempters with MDD and those with no psychiatric diagnosis in emergency departments of general hospitals to better understand the risk factors for suicide attempts in China. All subjects were enrolled in the study between June 2007 and January 2008. A total of 127 suicide attempters-54 with MDD and 73 with no psychiatric diagnosis-were enrolled. The sociodemographic and clinical characteristics were compared between two groups using the statistical analysis performed using frequency distribution, Student's t test, Chi-square test, and Fisher's exact test and a logistic regression model. Suicide attempters with MDD were more likely to be more depressive, older, divorced or separated, unemployed, and living alone, and more likely to write a suicide note, have suicide ideation, and be motivated by reducing pain and burden. Suicide attempters with no psychiatric diagnosis were more likely to be younger and more impulsive, have self-rescue, and be motivated by threatening or taking revenge on others. Multivariate logistic regression analysis identified the following independent predictors of suicide attempts in individuals with MDD: a lower score on the quality of life scale, more years of education, and suicide ideation. The present study found both similarities and differences in the sociodemographic and clinical characteristics of suicide attempters with MDD and those with no psychiatric diagnosis in the emergency departments of general hospitals in China. These findings will help us to recognize the characteristics of suicide attempters in both groups and develop specific interventions for the two

  15. Characteristics of Extended-Spectrum β-Lactamases-Producing Escherichia coli in Fecal Samples of Inpatients of Beijing Tongren Hospital.

    Science.gov (United States)

    Xu, Maoye; Fan, Yanyan; Wang, Mei; Lu, Xinxin

    2017-05-24

    We aimed to investigate the prevalence of extended-spectrum β-lactamases (ESBL)-producing Escherichia coli in Beijing Tongren hospital and to identify a possible relation between colonization and infection. The clinical data on 650 inpatients between March 2012 and July 2012 were retrospectively reviewed. The prevalence of ESBL-producing E. coli among the inpatients was 25.7% (167/650), with the highest level (50.0%) in the rheumatology ward and the lowest (10.0%) in intensive care units. Hospital stay more than 2 years prior to infection, the use of antibiotics within 3 months of infection, and the use of glucocorticoids or immunosuppressive drugs were found to be significantly associated with carriage of ESBL-producing E. coli (P coli was not high. The risk factors of carriage of ESBL-producing E. coli are hospitalization and use of antibiotics, glucocorticoids, or immunosuppressive drugs. ST38, ST10, ST131, and ST167 are the prominent genotypes, but almost 50.0% of STs were scarcely distributed.

  16. The roles of users personal characteristics and organisational support in the attitude towards using ERP systems in a Spanish public hospital.

    Science.gov (United States)

    Escobar-Rodriguez, Tomas; Bartual-Sopena, Lourdes

    Enterprise resources planning (ERP) systems enable central and integrative control over all processes throughout an organisation by ensuring one data entry point and the use of a common database. T his paper analyses the attitude of healthcare personnel towards the use of an ERP system in a Spanish public hospital, identifying influencing factors. This research is based on a regression analysis of latent variables using the optimisation technique of partial least squares. We propose a research model including possible relationships among different constructs using the technology acceptance model. Our results show that the personal characteristics of potential users are key factors in explaining attitude towards using ERP systems.

  17. The extent and characteristics of United Kingdom hospital pharmacists keeping, or not keeping, a professional development portfolio.

    Science.gov (United States)

    Kostrzewski, Andrzej J; Dhillon, Soraya; Goodsman, Danë; Taylor, Kevin M G; Weinman, John A

    2009-10-01

    The aim of this study was to examine the use of continuing professional development (CPD) portfolios by hospital pharmacists. The objectives were to assess the extent to which pharmacists use portfolios in CPD and to examine the attitudes/beliefs which differentiate those who do and do not keep a portfolio. Participants completed two questionnaires: (1) personality traits were examined using the Big-Five questionnaire and (2) a new Pharmacist Portfolio-Engaging Behaviour Questionnaire (PPEBQ) examined the attitudes and beliefs. What constitutes a portfolio was left to the interpretation of the participants, but it was specified that the survey was about participants' views of producing written records of their professional practice for CPD. The setting was hospital pharmacists based in the London area in December 2004. Overall, 134 pharmacists (78%) returned both questionnaires, and 80 stated that they kept a portfolio and 52 stated that they did not (two questionnaires were returned spoilt). There was no significant difference in the age or number of years qualified between those with and without a portfolio. Three personality traits were linked to keeping a portfolio (conscientiousness, agreeableness and emotional stability). Pharmacists with a portfolio scored highly on the perceived behavioural control and behavioural intention scales of the PPEBQ. The Big-Five personality questionnaire is a useful tool to investigate pharmacists' use of a portfolio. Results of the PPEBQ suggested that hospital pharmacists who had a portfolio were concerned with having control over its production. However, the PPEBQ requires further development to improve its reliability. These findings have implications for the educational support of CPD.

  18. Clinical and laboratory characteristics and associated risk factors of infants hospitalized in neonatal unit due to indirect hyperbilirubinemia

    Directory of Open Access Journals (Sweden)

    Sami Hatipoğlu

    2012-03-01

    Full Text Available Objectives: The aim of this study was to investigate characteristicsof neonates hospitalized to Neonatal Unit dueto indirect hyperbilirubinemia and to determine risk factorsfor indirect hyperbilirubinemia.Materials and methods: Totally 222 newborns, aged≥35 weeks of gestational age and hospitalized in neonatalunit with indirect hyperbilirubinemia, were investigated.Physical examination and laboratory studies of childrenwere performed. Decision of phototherapy and exchangetransfusion was done according to total serum bilirubin(TSB level that notified in the Guidelines of AmericanAcademy of Pediatrics.Results: Study group consisted of 131 (60% male and91 (30% female newborns. No significant difference wasfound in TSB values between male and female neonates.There was 71.2% term and 19.8% late preterm newbornbabies. Babies born with spontaneous vaginal deliveryhad borderline higher TSB values compared with cesareansection deliveries (p=0.051. ABO blood group incompatibilitywas found in 30.1% and Rh incompatibilityin 6.7%. Insufficient nutrition and inadequate caloric intakewere found in 49 (22.7% of neonates, urinary tractinfection in 19 (8.5%, hypernatremic dehydration in 9(4.5% and hypothyroidism in 4 (2.0%. Exchange transfusionwas performed in 10 newborns and kernicterus occurredin two. A significant negative correlation was foundbetween TSB values at hospitalization and baby’s birth(p<0.05 and a positive correlation between initial TSBvalue and percent of patient weight loss (p<0.05.Conclusions: According to our results, the most frequentetiological causes of jaundice in newborns were ABOblood group incompatibility, insufficient nutrition and beinglate preterm. J Clin Exp Invest 2012; 3(1: 38-43

  19. The effect of facility characteristics on patient safety, patient experience, and service availability for procedures in non-hospital-affiliated outpatient settings: A systematic review.

    Science.gov (United States)

    Berglas, Nancy F; Battistelli, Molly F; Nicholson, Wanda K; Sobota, Mindy; Urman, Richard D; Roberts, Sarah C M

    2018-01-01

    Over recent decades, numerous medical procedures have migrated out of hospitals and into freestanding ambulatory surgery centers (ASCs) and physician offices, with possible implications for patient outcomes. In response, states have passed regulations for office-based surgeries, private organizations have established standards for facility accreditation, and professional associations have developed clinical guidelines. While abortions have been performed in office setting for decades, states have also enacted laws requiring that facilities that perform abortions meet specific requirements. The extent to which facility requirements have an impact on patient outcomes-for any procedure-is unclear. We conducted a systematic review to examine the effect of outpatient facility type (ASC vs. office) and specific facility characteristics (e.g., facility accreditation, emergency response protocols, clinician qualifications, physical plant characteristics, other policies) on patient safety, patient experience and service availability in non-hospital-affiliated outpatient settings. To identify relevant research, we searched databases of the published academic literature (PubMed, EMBASE, Web of Science) and websites of governmental and non-governmental organizations. Two investigators reviewed 3049 abstracts and full-text articles against inclusion/exclusion criteria and assessed the quality of 22 identified articles. Most studies were hampered by methodological challenges, with 12 of 22 not meeting minimum quality criteria. Of 10 studies included in the review, most (6) examined the effect of facility type on patient safety. Existing research appears to indicate no difference in patient safety for outpatient procedures performed in ASCs vs. physician offices. Research about specific facility characteristics is insufficient to draw conclusions. More and higher quality research is needed to determine if there is a public health problem to be addressed through facility

  20. Receiver operating characteristic (ROC) curves and the definition of threshold levels to diagnose coronary artery disease on electrocardiographic stress testing. Part I: The use of ROC curves in diagnostic medicine and electrocardiographic markers of ischaemia.

    Science.gov (United States)

    Barnabei, Luca; Marazìa, Stefania; De Caterina, Raffaele

    2007-11-01

    A common problem in diagnostic medicine, when performing a diagnostic test, is to obtain an accurate discrimination between 'normal' cases and cases with disease, owing to the overlapping distributions of these populations. In clinical practice, it is exceedingly rare that a chosen cut point will achieve perfect discrimination between normal cases and those with disease, and one has to select the best compromise between sensitivity and specificity by comparing the diagnostic performance of different tests or diagnostic criteria available. Receiver operating characteristic (or receiver operator characteristic, ROC) curves allow systematic and intuitively appealing descriptions of the diagnostic performance of a test and a comparison of the performance of different tests or diagnostic criteria. This review will analyse the basic principles underlying ROC curves and their specific application to the choice of optimal parameters on exercise electrocardiographic (ECG) stress testing. Part I will focus on theoretical description and analysis along with reviewing the common problems related to the diagnosis of myocardial ischaemia by means of exercise ECG stress testing. Part II will be devoted to applying ROC curves to available diagnostic criteria through the analysis of ECG stress test parameters.

  1. Epidemiological characteristics of trauma patients maxillofacial surgery at the Hospital Geral de Blumenau SC from 2004 to 2009

    Directory of Open Access Journals (Sweden)

    Martins Junior, José Carlos

    2010-06-01

    Full Text Available Introduction: Accidents involving the face have increased incidence in the last four decades. The medical literature refers to the increase in motor vehicle collisions and urban violence as the major causes of injuries, especially in young individuals. Objective: Raise the epidemiological profile of 222 patients with facial fractures at the Hospital Santo Antonio from 2004 to 2009. Method: Case study with retrospective analysis of records of patients diagnosed with facial fractures. Several variables were considered: gender, age, occupation, education level, origin, location and number of bones involved, etiology, and mean hospital stay of patients. Results: The male sex predominated with 178 cases (80.1%, the average age was 29.6 years, 86 (38.73% had a steady job. Unmarried 178 cases (80.18%. Primary school predominated among the patients, 74 (33.34%, and most live in the city of Blumenau, 175 (78.82%. The assault was primarily responsible for the surgical indication in 79 cases (35.58%, involving a bone in 193 cases (86.9%. The main bone involved was the mandible in 90 cases (40.54%. The average length of stay was 2.5 days. Conclusions: The epidemiological profile of 222 patients is an individual male, aged 20-29 years old, unmarried, low education and employee. The most prevalent etiology was assault, involving a bone, the mandible being the most involved bone.

  2. Socio-demographic characteristics and psychosocial consequences of sickle cell disease: the case of patients in a public hospital in Ghana.

    Science.gov (United States)

    Adzika, Vincent A; Glozah, Franklin N; Ayim-Aboagye, Desmond; Ahorlu, Collins S K

    2017-01-31

    Sickle cell disease (SCD) is of major public health concern globally, with majority of patients living in Africa. Despite its relevance, there is a dearth of research to determine the socio-demographic distribution and psychosocial impact of SCD in Ghana. The objective of this study was to examine the socio-demographic distribution and psychosocial consequences of SCD among patients in Ghana and to assess their quality of life and coping mechanisms. A cross-sectional research design was used that involved the completion of questionnaires on socio-demographic characteristics, quality of life, coping mechanisms, anxiety and depression. Participants were 387 male and female patients attending a sickle cell clinic in a public hospital. Results showed that majority of the patients were single, female, less than 39 years old and had attained secondary school level of education or less. Also, patients were more satisfied by the presence of love, friends and relatives as well as home, comm