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Sample records for satakunta hospital district

  1. Cesarean Myomectomy Outcome in a Nigerian District Hospital

    African Journals Online (AJOL)

    Mubeen

    myomectomy done under the supervision of a Sabbatical obstetrician and gynaecologist at a district hospital in Nigeria. ... the fear of the operation itself may have prevented their ... Room Nurse from the suction bottle, weight differentials.

  2. Structure and geological evolution of the bedrock at southern Satakunta, SW Finland

    Energy Technology Data Exchange (ETDEWEB)

    Paulamaeki, S.; Paananen, M.; Elo, S. [Geological Survey of Finland (Finland)

    2002-02-01

    The southern Satakunta area lies on the west coast of Finland, mainly covering the mainland (with main towns Pori and Rauma), but also including the coastal archipelago and part of the Bothnian Sea. Near the centre of the area lies the island of Olkiluoto, on which Finland's site for a deep repository for spent nuclear fuel is located. The purpose of the present report is to compile and interpret all available geological and geophysical data relevant to understanding the regional geological setting of the Olkiluoto site. The area described is covered by four 1:100 000 scale geological map sheets, published by the Geological Survey of Finland, which, together with low-altitude aeromagnetic maps, provide the basis for a new 1:250 000 geological map compilation. This shows that the bedrock of southern Satakunta can be subdivided into three main zones: a pelitic migmatite belt in the southwest, a central, NW-SE trending area of sandstone, and a psammitic migmatite belt in the northeast. The migmatite belts formed during the Svecofennian orogeny, 1900-1800 Ma ago (Palaeoproterozoic). The sandstone area is the remnant of an alluvial basin, preserved now in a NW-SE trending graben, bounded on both sides by normal fault zones. The sandstones are thought to be at least 1400-1300 Ma old (Mesoproterozoic), and they are cut by Postjotnian olivine diabase dykes, 1270-1250 Ma in age. The Svecofennian migmatite belts show a complex history of formation, with various phases of anatexis/metamorphism, deformation and intrusion. In the pelitic migmatite belt, in which the Olkiluoto site is situated, four phases of ductile deformation (D-D4) and two phases of regional highT/lowP metamorphism and migmatite formation can be recognised, together with synorogenic (tonalite, granodiotite) and late orogenic ( potassium granite) intrusions. Subsequently, this very heterogeneous complex was intruded by anorogenic rapakivi granites, with ages 1580-1550 Ma. One pluton, the Eurajoki stock

  3. Structure and geological evolution of the bedrock at southern Satakunta, SW Finland

    Energy Technology Data Exchange (ETDEWEB)

    Paulamaeki, S.; Paananen, M.; Elo, S. [Geological Survey of Finland (Finland)

    2002-02-01

    The southern Satakunta area lies on the west coast of Finland, mainly covering the mainland (with main towns Pori and Rauma), but also including the coastal archipelago and part of the Bothnian Sea. Near the centre of the area lies the island of Olkiluoto, on which Finland's site for a deep repository for spent nuclear fuel is located. The purpose of the present report is to compile and interpret all available geological and geophysical data relevant to understanding the regional geological setting of the Olkiluoto site. The area described is covered by four 1:100 000 scale geological map sheets, published by the Geological Survey of Finland, which, together with low-altitude aeromagnetic maps, provide the basis for a new 1:250 000 geological map compilation. This shows that the bedrock of southern Satakunta can be subdivided into three main zones: a pelitic migmatite belt in the southwest, a central, NW-SE trending area of sandstone, and a psammitic migmatite belt in the northeast. The migmatite belts formed during the Svecofennian orogeny, 1900-1800 Ma ago (Palaeoproterozoic). The sandstone area is the remnant of an alluvial basin, preserved now in a NW-SE trending graben, bounded on both sides by normal fault zones. The sandstones are thought to be at least 1400-1300 Ma old (Mesoproterozoic), and they are cut by Postjotnian olivine diabase dykes, 1270-1250 Ma in age. The Svecofennian migmatite belts show a complex history of formation, with various phases of anatexis/metamorphism, deformation and intrusion. In the pelitic migmatite belt, in which the Olkiluoto site is situated, four phases of ductile deformation (D-D4) and two phases of regional highT/lowP metamorphism and migmatite formation can be recognised, together with synorogenic (tonalite, granodiotite) and late orogenic ( potassium granite) intrusions. Subsequently, this very heterogeneous complex was intruded by anorogenic rapakivi granites, with ages 1580-1550 Ma. One pluton, the Eurajoki stock

  4. Pediatric Human Immunodeficiency Virus Screening in an African District Hospital

    OpenAIRE

    De Baets, A. J.; Edidi, B. S.; Kasali, M. J.; Beelaert, G.; Schrooten, W.; Litzroth, A; Kolsteren, P; Denolf, D.; Fransen, K

    2005-01-01

    In order to evaluate alternative tests and strategies to simplify pediatric human immunodeficiency virus (HIV) screening at the district hospital level, a cross-sectional exploratory study was organized in the Democratic Republic of the Congo. Venous and capillary phlebotomies were performed on 941 Congolese children, aged 1 month to 12 years (153 children under 18 months and 788 children more than 18 months old). The HIV prevalence rate was 4.7%. An algorithm for children more than 18 months...

  5. DRUG MANAGEMENT REVIEWS IN DISTRICT DRUG MANAGEMENT UNIT AND GENERAL HOSPITAL

    Directory of Open Access Journals (Sweden)

    Max Joseph Herman

    2009-12-01

    Full Text Available Drug is one of the essential elements in healthcare that should be effectively and efficiently managed. Following thedecentralization in 2001 in Indonesia, drug management has changed in district drug management units and also in District General Hospitals. Certainly this condition influences the sustainability of drug access in primary health care such as in Community Health Center and District General Hospital, especially in drug financing policy. A cross sectional descriptive study to obtain information on drug management in public healthcare in district had been carried out between July and December 2006 in 10 District Public Drug Management Units from 10 district health offices and 9 district general hospitals as samples. Data were collected by interviewing heads of Drug Section in District Health Offices and heads of Hospital Pharmacies using structured questionnaires and observing drug storage in District Drug Management Units, Community Health Centers, and Hospital Pharmacies. Results of the study show that drug planning in District Health Offices and General Hospitals did not meet the basic real need in some districts nor District Hospitals. The minimum health service standards had no been achieved yet. Furthermore, drug procurement, storage and recording as well as reporting was not good enough either, such as shown by the existence of expired drugs. Lead time for drug delivery to community health centers in some districts was longer than the average of lead time in the past 3 years.

  6. Obstetric anaesthesia at district and regional hospitals in KwaZulu ...

    African Journals Online (AJOL)

    ... in KwaZulu-Natal: human resources, caseloads and the experience of doctors. ... Only 3% of responding doctors working in rural hospitals had a Diploma in ... in obstetric anaesthesia and documents workload patterns at district hospitals.

  7. [Increased epidemic incidence of hepatitis B in a district hospital].

    Science.gov (United States)

    Jakob, A; Mönch, E

    1978-01-15

    It is reported on an epidemic of hepatitis B of 29 patients in a district hospital. Due to diagnostic errors in importation and a more frequent appearance of diseases of hepatitis B in the surgical department and the 2nd medical department, in which above all diabetics are treated, took place. The average age of the patients was 55 years. In all patients the clinical course was to be regarded as severe. 4 of 29 patients died. In all patients the hepatitis B disease showed a pronounced jaundice with high transaminases, particularly the SGOT and LAP were clearly increased. Also the duration of the presence was longer than in hepatitis A as well as the transition into chronic hepatitis was more frequent. By diagnostic information of the physicians and the other medical staff as well as improved measures of desinfection the epidemic could be restricted.

  8. Barriers to quality patient care in rural district hospitals

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    Johanna E. Eygelaar

    2012-05-01

    Full Text Available Currently barriers exist in delivering quality health care. This study aimed to investigate such barriers in the eight rural district hospitals of the West Coast Winelands Region, three type A and five type B hospitals. A quantitative descriptive design was applied which included the total population of nursing staff (n = 340 working at the time of data collection. A self-administered questionnaire was distributed with a response rate of 82%.Reliability of the instrument was verified using the Cronbach alpha coefficient and a pilot study. The validity, specifically construct and content validity, were assured by means of an extensive literature review, pilot study and use of experts. Ethics approval was obtained from the relevant stakeholders.Results showed that 272 participants (97% disagreed that provision of staff was adequate, with staff above 40 years of age more likely to disagree (p = <0.01. A statistically significant association was shown between availability of doctors and staff not being able to cope with emergencies (p = <0.01. Most participants (n =212; 76% indicated that they were not receiving continuing education, with the registered nurses more likely to disagree (χ² test, p = 0.02. Participants in both hospital types A (n = 131; 82% and B (n = 108; 91% also disagreed that provision of equipment and consumables was adequate.The research showed that inadequacies relating to human resources, professional development, consumables and equipment influenced the quality of patient care. Urgent attention should be given to the problems identified to ensure quality of patient care in rural hospitals.

  9. Optimising neuroimaging effectiveness in a district general hospital.

    Science.gov (United States)

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

    2014-01-01

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

  10. Laparoscopic assisted appendicectomy in District Hospital, Joypurhat, Bangladesh.

    Science.gov (United States)

    Bashar, M K; Alam, M Z; Aziz, M M; Nur-E-Elahi, M; Taher, M A; Jahan, I

    2014-01-01

    "Laparoscopic assisted appendicectomy" refers to visualization of abdominal cavity, identification of appendix, drawing the appendix out through the port wound and appendicectomy. The objective of this study is to evaluate the outcome of the procedure of laparoscopic assisted appendicectomy. In this prospective study patients with appendicitis were randomly selected for laparoscopic assisted appendicectomy from August 2007 to February 2009 in the Department of Surgery, Modernized District Hospital, Joypurhat, Bangladesh. Out of 73 patients Laparoscopic assisted appendicectomy was performed successfully in 95.89% cases and conversion rate was 4.11%. Male to female ratio was almost 1:2 with mean±SD age 18.62±9.16 years. The wound infection rate was 8.2% and urinary retention 2.7%. Early postoperative feeding was started within 24 hours in 86.3% cases and mean duration of hospital stay was 2 days in 76.71% patients. More than 82% returned to their home and started social activities within 5 days. Duration of surgery was almost similar in emergency and interval appendicectomy group (19.35±10.13 vs. 23.66±9.43) minutes. Postoperative morbidity in emergency appendicectomy group showed significantly higher morbidity than interval appendicectomy group (p=0.003). This study indicates that the laparoscopic assisted appendicectomy is feasible for the majority of the patients with appendicitis in both emergency and interval settings. It reduces the operative time, shortens hospital stay and helps in early resumption of normal activities with good cosmetic outcome and patients' satisfaction.

  11. A 5-year audit of outcome of apicectomies carried out in a district general hospital.

    OpenAIRE

    Lyons, A. J.; Hughes, C E; Dixon, E. J.

    1995-01-01

    Success rates of up to 90% have been claimed for apicectomy. However, the conditions that this procedure is carried out under at district general hospitals may be at variance with such studies. A 5-year audit of outcome was therefore carried out within a district general hospital. It was found that 89% of apicected teeth still remained at 5 years. Outcome was not influenced by any of the factors examined, and could not be predicted radiographically. Most failures occurred after the average po...

  12. Neonatal seizures in a rural Kenyan District Hospital: aetiology, Incidence and outcome of hospitalization

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    Newton Charles RJC

    2010-03-01

    Full Text Available Abstract Background Acute seizures are common among children admitted to hospitals in resource poor countries. However, there is little data on the burden, causes and outcome of neonatal seizures in sub-Saharan Africa. We determined the minimum incidence, aetiology and immediate outcome of seizures among neonates admitted to a rural district hospital in Kenya. Methods From 1st January 2003 to 31st December 2007, we assessed for seizures all neonates (age 0-28 days admitted to the Kilifi District Hospital, who were resident in a defined, regularly enumerated study area. The population denominator, the number of live births in the community on 1 July 2005 (the study midpoint was modelled from the census data. Results Seizures were reported in 142/1572 (9.0% of neonatal admissions. The incidence was 39.5 [95% confidence interval (CI 26.4-56.7] per 1000 live-births and incidence increased with birth weight. The main diagnoses in neonates with seizures were sepsis in 85 (60%, neonatal encephalopathy in 30 (21% and meningitis in 21 (15%, but only neonatal encephalopathy and bacterial meningitis were independently associated with seizures. Neonates with seizures had a longer hospitalization [median period 7 days - interquartile range (IQR 4 to10] -compared to 5 days [IQR 3 to 8] for those without seizures, P = 0.02. Overall, there was no difference in inpatient case fatality between neonates with and without seizures but, when this outcome was stratified by birth weight, it was significantly higher in neonates ≥ 2.5 kg compared to low birth weight neonates [odds ratio 1.59 (95%CI 1.02 to 2.46, P = 0.037]. Up to 13% of the surviving newborn with seizures had neurological abnormalities at discharge. Conclusion There is a high incidence of neonatal seizures in this area of Kenya and the most important causes are neonatal encephalopathy and meningitis. The high incidence of neonatal seizures may be a reflection of the quality of the perinatal and

  13. Convergence of PPTCT with RCH Services in a District Hospital, Haryana

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    Puneet Bhagat

    2014-03-01

    Full Text Available Background: The integration of PPTCT and RCH activities is an important strategy for universal screening of ANC mothers through available government health infrastructure in a district. The objective of this study was to understand process and analyzing outcome of convergence of PPTCT & RCH services in a District Hospital. Methods: The study was a descriptive study conducted in district hospital, Gurgaon. Results: In the district hospital Gurgaon percentage of women counseled at ICTC has increased from 77% to 89.4% and percentage of women tested has increased from 75% to 87.8% during 2010 and 2011. However, not all women tested positive delivered at hospital. Only 6.7% women were knowing about transmission of HIV from mother to baby. About 60% ANC registration are delayed primarily due to lack of family support (71%. Majority of ANC women got HIV screening at district hospital due to non-availability of facility at CHC/PHC levels. About 58% of Institutional deliveries in the State are in private hospitals, but they still need to be involved in PPTCT. Conclusion: Currently, convergence of PPTCT and RCH services seems to be fragmented and at initial stage. Convergence need to be taken up at policy, planning, implementation, capacity building, resource mobilization and monitoring for success of the initiative in the state.

  14. Technical efficiency of public district hospitals in Madhya Pradesh, India: a data envelopment analysis

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    Tej Ram Jat

    2013-09-01

    Full Text Available Background: Scarcity of resources for healthcare is a well-acknowledged problem. In this context, efficient utilization of existing financial and human resources becomes crucial for strengthening the healthcare delivery. The assessment of efficiency of health facilities can guide decision makers in ensuring the optimum utilization of available resources. Objective: The objective of this study was to evaluate the technical efficiency (TE of the public district hospitals in Madhya Pradesh, India, with special emphasis on maternal healthcare services, using data envelopment analysis (DEA. Methods: Data from 40 district hospitals from January to December 2010 were collected from the health management information system and other records of the department of health and family welfare of the state. DEA was performed with input orientation and variable returns to scale assumption. Results: TE and scale efficiency scores of the district hospitals were 0.90 (SD = 0.14 and 0.88 (SD = 0.15, respectively. Of the total district hospitals in the study, 20 (50% were technically efficient constituting the ‘best practice frontier’. The other half were technically inefficient, with an average TE score of 0.79 (SD = 0.12 meaning that these hospitals could produce the same outputs by using 21% less inputs from current input levels. Twenty-six (65% district hospitals were found to be scale inefficient, manifesting a mean score of 0.81 (SD = 0.16. Conclusions: Half of the district hospitals in the study were operating inefficiently. Decision makers and administrators in the state should identify the causes of the observed inefficiencies and take appropriate measures to increase efficiency of these hospitals.

  15. [Hospitalizations due to ambulatory care-sensitive conditions in the Federal District, Brazil, 2008].

    Science.gov (United States)

    Junqueira, Rozania Maria Pereira; Duarte, Elisabeth Carmen

    2012-10-01

    To analyze hospitalization rates due to ambulatory care-sensitive conditions. The study used data from the Hospital Database of the Brazilian National Health System corresponding to the Federal District in the year of 2008. The main diagnosis for hospitalization was analyzed based on the International Classification of Diseases, and absolute frequency, proportion and coefficient were calculated according to causes, age groups and sex. The ambulatory care-sensitive conditions (ACSC) represented approximately 20% of the hospital admissions in the National Health System. The most frequent conditions were: gastroenteritis (2.4%), heart failure (2.3%), and kidney and urinary tract infection (2.1%). The following aspects were verified: significant hospitalization rates due to ACSC in the infant group (< 1 year of age), an important reduction in the following age groups (1 to 29 years), and a gradual increase until the more advanced ages. Compared to men, hospitalization rates were slightly higher among young women (20 to 29 years) and lower among women older than 49 years. Hospitalizations due to ACSC represented 19.5% of all hospital admissions in the Federal District (2008), and the main causes of hospitalizations were gastroenteritis, heart failure and kidney and urinary tract infection. The effectiveness of primary health care in preventing these events in the Federal District is discussed.

  16. Analysis the Development of Mother and Infant Health in Sampang District Hospital

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    Rukmini Rukmini

    2016-01-01

    Full Text Available Background: The hospital have a strategic role in efforts to reduce maternal and infant mortality. This study aimed to determine the development of maternal and infant health services carried out in Sampang District hospital between 2010 and May 2012. Methods: The quantitative study with ecology design carried out in Sampang District hospital east Java Province Indonesia in 2012. The collection of secondary data such as coverage of maternal and infant health care in the period of 2010 to May 2012, as well as qualitative data collection with in depth interview to the Head of Service, Obstetrics and Gynecology Specialist Doctors and midwives. Data were analyzed descriptively. Result: In Sampang District hospital in period 2010 – May 2012 showed, an increase in maternal and child health services, where an increase in the handling of complications of pregnancy, normal delivery or Sectio Caesar and management of newborn complications and maternal and neonatal deaths are relatively increased . The coverage of family planning services was still low and the vast majority was IUD. Conclusion: The maternal and child health services in Sampang District hospital in period of 2010 – May 2012, showed an increase in the quantity of service coverage. The majority cases of delivery in hospitals were referral cases and complications. Howefer, the number of Sectio Caesar, maternal and neonatal mortality were still high. Recommendation: Sampang District Health Offi ce and Sampang District Hospital should create a policis and programs to reduce neonatal mortality in an integrated, continuous with proper implementation of standard procedures at every level of service, supported by well trained human resources, infrastructure and adequate fi nancing.

  17. A 5-year audit of outcome of apicectomies carried out in a district general hospital.

    Science.gov (United States)

    Lyons, A. J.; Hughes, C. E.; Dixon, E. J.

    1995-01-01

    Success rates of up to 90% have been claimed for apicectomy. However, the conditions that this procedure is carried out under at district general hospitals may be at variance with such studies. A 5-year audit of outcome was therefore carried out within a district general hospital. It was found that 89% of apicected teeth still remained at 5 years. Outcome was not influenced by any of the factors examined, and could not be predicted radiographically. Most failures occurred after the average postoperative review period of 10.5 months. Patient satisfaction with the procedure was high at over 90%. Based on these results it was concluded that apicectomy was an effective procedure when carried out by staff of all grades within the district general hospital, and that repeated follow-up appointments with radiographs over the first postoperative year were not useful. PMID:7574319

  18. Quality Improvement: Appropriate episiotomies in a district hospital

    African Journals Online (AJOL)

    Abstract. Work satisfaction, enthusiasm and better patient care at times come from the simplest things. ... A multidisciplinary team did a quality improvement project to reduce the number of episiotomies. .... successful in the hospital and in the.

  19. [Use of fresh frozen plasma in a Swiss hospital district].

    Science.gov (United States)

    Schlesinger, P; Frey-Wettstein, M

    1983-11-01

    The causes of a unexpected rise in the consumption of fresh frozen plasma (FFP) in the years 1977-1980 are analyzed. FFP appears to be used increasingly in the department of surgery, and more specifically cardiac surgery, in the University Hospital. No basic changes are registered regarding the type of operations performed or the indications for prescribing FFP. At the same time, consumption of FFP in nonspecialized regional hospitals has increased to only a minor extent. It is pointed out that FFP is collected from blood donations and, as a product of human origin, should be used with moderation.

  20. The management of sexual assault victims at Odi District Hospital in ...

    African Journals Online (AJOL)

    Division of Family Medicine and Primary Care, Faculty of Health Sciences, Stellenbosch University ... Setting: Odi District Hospital in the North-West Province, South Africa. ..... The lack of equipment was also frustrating to the examining doctors. If .... Sexual assault: the physician's role in prevention and treatment. J Miss.

  1. Evaluation of the work of hospital districts' research ethics committees in Finland.

    Science.gov (United States)

    Halila, Ritva

    2014-12-01

    The main task of research ethics committees (RECs) is to assess research studies before their start. In this study, 24 RECs that evaluate medical research were sent questionnaires about their structure and functions. The RECs were divided into two separate groups: those working in university hospital districts (uRECs) and those in central hospital districts (non-uRECs). The two groups were different in many respects: the uRECs were bigger in size, covered a wider range of disciplines (both medical and non-medical), had better resources and more frequent and regular meetings. After the survey was performed and analysed, the Medical Research Act was amended so that only hospital districts with a medical faculty in their region had a duty to establish ethics committees. After the amendment, the number of RECs evaluating medical research in Finland decreased from 25 to 9. The ethics committees that remained had wider expertise and were better equipped already by the time of this survey. Only one non-uREC was continuing its work, and this was being done under the governance of a university hospital district. Simple measures were used for qualitative analysis of the work of RECs that evaluate medical research. These showed differences between RECs. This may be helpful in establishing an ethics committee network in a research field or administrational area. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  2. Upper urinary tract stone disease: the changing management in a district general hospital.

    OpenAIRE

    Goble, N M; Hammonds, J C; Wells, I P

    1987-01-01

    The advent of percutaneous nephrolithotomy (PCN) and ureteroscopy, in combination with stone disruption techniques, has dramatically altered the management of upper urinary tract stone disease. These advances are not necessarily confined to the teaching centres. The problems encountered introducing these techniques in a District General Hospital and their impact on the surgical management of upper urinary tract stones is presented.

  3. Students’ perceptions of the instructional quality of district hospital-based training

    Science.gov (United States)

    Memon, Shehla Jabbar; Louw, Jakobus Murray; Hugo, Jannie; Rauf, Waqar-un Nisa; Sandars, John Edward

    2016-01-01

    Background An innovative, three-year training programme, the Bachelor of Clinical Medical Practice (BCMP), for mid-level medical healthcare workers was started in 2009 by the Department of Family Medicine, University of Pretoria. Aim To measure the students’ perceptions of the instructional quality of district hospital-based training. Setting Training of students took place at clinical learning centres in rural district hospitals in the Mpumalanga and Gauteng provinces. Methods A survey using the MedEd IQ questionnaire was performed in 2010 and 2011 to measure BCMP second- and third-year students’ perceptions of instructional quality of district hospital-based training. The MedEd IQ questionnaire is composed of four subscales: preceptor activities, learning opportunities, learner involvement and the learning environment. Composite scores of instructional quality were used to present results. Results The preceptor activities, learning opportunities and the learning environment were considered by second- and third-year BCMP students to be of consistently high instructional quality. In the area of learner involvement, instructional quality increased significantly from second to third year. Conclusion Overall, instructional quality of district hospital-based training was high for both second- and third-year BCMP students, and the instructional quality of learner involvement being significantly higher in third year students. The MedEd IQ tool was a useful tool for measuring instructional quality and to inform programme quality improvement. PMID:27543282

  4. out-patient prescribing practices at mbagathi district hospital-nairobi ...

    African Journals Online (AJOL)

    2013-12-01

    Dec 1, 2013 ... Request for reprints to: G. Muyu, Mbagathi District Hospital, Nairobi, Kenya ... society at large. ... public health problems. ... medicine use in outpatient health facilities and has .... Analysis of percentage constitution of selected prescribing variables with respect to total number of ..... United Arab Emirates. LJM ...

  5. Healthcare-associated infection in Burkina Faso: an assessment in a district hospital

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    Hervé Hien

    2012-12-01

    Full Text Available In developing countries, few data are available on healthcare-associated infections. In Burkina Faso, there has been a failure to take into account risk management and patient safety in the quality assurance program. The main objective of our study was to carry out an assessment of healthcare-associated infection in a first level hospital. We conducted a crosssectional study in June 2011 in the care units of Ziniaré District Hospital (Ziniaré, Burkina Faso. The hospital has been divided in three components: i hospital population (care providers, in-patients and patients’ guardians; ii healthcare and services organization; iii hospital environment. We included: care providers of the clinical services, hospital inpatients and patients’ guardians, hospitalization infrastructure and nursing units, and all the documents relating to standards and protocols. Data collection has been done by direct observation, interviews and biological samples taken at different settings. In hospital population, care providers and patients’ guardians represented a high source of infection: adherence to hygiene practice on the part of care providers was low (12/19, and no patients’ guardian experienced good conditions of staying in the hospital. In healthcare and services organization, healthcare waste management represented a high-risk source of infection. In hospital environment, hygiene level of the infrastructure in the hospital rooms was low (6.67%. Prevalence of isolated bacteria was 71.8%. Urinary-tract catheters infections were the most significant in our sample, followed by surgical-site infections. In total, 56.26% (9/19 of germs were -Lactamase producers (ESBL. They were represented by Escherichia coli and Klebsiella pneumoniae. Our analysis identified clearly healthcare-associated infection as a problem in Ziniaré district hospital. Hence, a national program of quality assurance in the hospitals should now integrate the risk infectious management

  6. Temporary emergency pacing-an orphan in district hospitals

    DEFF Research Database (Denmark)

    Gjesdal, Knut; Johansen, Jens Brock; Gadler, Fredrik

    2012-01-01

    . The procedure times were long and complications were frequent. The organization of emergency pacing is discussed, and we suggest that unless qualified physicians can establish transvenous pacing, the patients who need that should be transferred with transcutaneous pacing as back-up during transport...... to a hospital with more available competence. Ideally, those who need pacing immediately, including those who need permanent pacing, should be offered permanent implantation on a 24 hours/7 days per week base....

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

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    Maxwell M. Lodenyo

    2016-03-01

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

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

    Directory of Open Access Journals (Sweden)

    Maxwell M. Lodenyo

    2016-03-01

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

  9. Healthcare-associated infection in Burkina Faso: an assessment in a district hospital

    OpenAIRE

    Hervé Hien; Koiné Maxime Darbo; Laurent Ouédraogo; Salifou Konfé; Sylvain Zeba; Lassana Sangaré; Sidzabda C. Compaoré; Jean Bosco Ouédraogo; Ouendo, Edgard M.; Michel Makoutodé; Nicolas Meda

    2012-01-01

    In developing countries, few data are available on healthcare-associated infections. In Burkina Faso, there has been a failure to take into account risk management and patient safety in the quality assurance program. The main objective of our study was to carry out an assessment of healthcare-associated infection in a first level hospital. We conducted a crosssectional study in June 2011 in the care units of Ziniaré District Hospital (Ziniaré, Burkina Faso). The hospital has been divided in t...

  10. Hospitalisation due to infectious and parasitic diseases in District Civil Hospital, Belgaum, Karnataka.

    Science.gov (United States)

    Naik, A C; Bhat, S; Kholkute, S D

    2008-01-01

    To assess the burden of infectious and parasitic diseases on hospital services at District Civil Hospital (DCH) Belgaum, a retrospective study was carried out using discharge records concerning 8506 inpatients due to infectious and parasitic diseases among 95,655 patients admitted for all causes during the reference period 2000-2003. Out of the 21 causes of infectious and parasitic diseases, only 5 contributed maximally towards hospital admission. The most frequent cause was intestinal infections (44.0%) followed by tuberculosis (35.4%). 57.5% of these admissions were from the productive age group of 20-54 years. Tuberculosis is the most important disease in terms of hospital bed days (59.7%). Tuberculosis and intestinal infectious diseases represent more than three-fourth of the overall burden in terms of hospital bed days.

  11. Specialisation of spinal services: consequences for cervical trauma management in the district hospital

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    Cordell-Smith James

    2007-11-01

    Full Text Available Abstract Background Specialisation in spinal services has lead to a low threshold for referral of cervical spine injuries from district general hospitals. We aim to assess the capability of a district general hospital in providing the halo vest device and the expertise available in applying the device for unstable cervical spine injuries prior to transfer to a referral centre. Methods The study was a postal questionnaire survey of trauma consultants at district general hospitals without on-site spinal units in the United Kingdom. Seventy institutions were selected randomly from an electronic NHS directory. We posed seven questions on the local availability, expertise and training with halo vest application, and transferral policies in patients with spinal trauma. Results The response rate was 51/70 (73%. Nineteen of the hospitals (37% did not stock the halo vest device. Also, one third of the participants (18/51, 35%, 95% confidence interval 22 – 50% were not confident in application of the halo vest device and resorted to transfer of patients to referral centres without halo immobilization. Conclusion The lack of equipment and expertise to apply the halo vest device for unstable cervical spine injuries is highlighted in this study. Training of all trauma surgeons in the application of the halo device would overcome this deficiency.

  12. Turning around an ailing district hospital: a realist evaluation of strategic changes at Ho Municipal Hospital (Ghana)

    Science.gov (United States)

    2010-01-01

    Background There is a growing consensus that linear approaches to improving the performance of health workers and health care organisations may only obtain short-term results. An alternative approach premised on the principle of human resource management described as a form of 'High commitment management', builds upon a bundles of balanced practices. This has been shown to contribute to better organisational performance. This paper illustrates an intervention and outcome of high commitment management (HiCom) at an urban hospital in Ghana. Few studies have shown how HiCom management might contribute to better performance of health services and in particular of hospitals in low and middle-income settings. Methods A realist case study design was used to analyse how specific management practices might contribute to improving the performance of an urban district hospital in Ho, Volta Region, in Ghana. Mixed methods were used to collect data, including document review, in-depth interviews, group discussions, observations and a review of routine health information. Results At Ho Municipal Hospital, the management team dealt with the crisis engulfing the ailing urban district hospital by building an alliance between hospital staff to generate a sense of ownership with a focus around participative problem analysis. The creation of an alliance led to improving staff morale and attitude, and contributed also to improvements in the infrastructure and equipment. This in turn had a positive impact on the revenue generating capacity of the hospital. The quick turn around in the state of this hospital showed that change was indeed possible, a factor that greatly motivated the staff. In a second step, the management team initiated the development of a strategic plan for the hospital to maintain the dynamics of change. This was undertaken through participative methods and sustained earlier staff involvement, empowerment and feelings of reciprocity. We found that these factors acted

  13. An assessment of the quality of care for children in eighteen randomly selected district and sub-district hospitals in Bangladesh

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    Hoque Dewan ME

    2012-12-01

    Full Text Available Abstract Background Quality hospital care is important in ensuring that the needs of severely ill children are met to avert child mortality. However, the quality of hospital care for children in developing countries has often been found poor. As the first step of a country road map for improving hospital care for children, we assessed the baseline situation with respect to the quality of care provided to children under-five years age in district and sub-district level hospitals in Bangladesh. Methods Using adapted World Health Organization (WHO hospital assessment tools and standards, an assessment of 18 randomly selected district (n=6 and sub-district (n=12 hospitals was undertaken. Teams of trained assessors used direct case observation, record review, interviews, and Management Information System (MIS data to assess the quality of clinical case management and monitoring; infrastructure, processes and hospital administration; essential hospital and laboratory supports, drugs and equipment. Results Findings demonstrate that the overall quality of care provided in these hospitals was poor. No hospital had a functioning triage system to prioritise those children most in need of immediate care. Laboratory supports and essential equipment were deficient. Only one hospital had all of the essential drugs for paediatric care. Less than a third of hospitals had a back-up power supply, and just under half had functioning arrangements for safe-drinking water. Clinical case management was found to be sub-optimal for prevalent illnesses, as was the quality of neonatal care. Conclusion Action is needed to improve the quality of paediatric care in hospital settings in Bangladesh, with a particular need to invest in improving newborn care.

  14. HIV/AIDS related deaths from three district hospitals of West Bengal:An observation

    Institute of Scientific and Technical Information of China (English)

    MK Bhattacharya; MK Saha; PS Chakraborty; A Sinha; A Bhattacharya; KK Dutta

    2014-01-01

    Data onHIV/AIDS incidence or deaths are limited in poor-resource country likeIndia and non-existent in state ofWestBengal.These data are essential for formulating policies forHIV intervention strategies to curbHIV epidemic.In present study, a descriptive analysis of all registered cases from three district hospitals(Maldah,North24Parganas andDarjeeling) during July2006-December2007was conducted.HIV/AIDS related deaths were found to be higher in Darjeeling district compare to other two districts.A comprehensive and well-coordinated survey is needed to explore furtherHIV/AIDS mortality data inIndia for providing necessary information in developingHIV prevention programs.

  15. HIV/AIDS related deaths from three district hospitals of West Bengal: An observation

    Directory of Open Access Journals (Sweden)

    MK Bhattacharya

    2014-01-01

    Full Text Available Data on HIV/AIDS incidence or deaths are limited in poor-resource country like India and non-existent in state of West Bengal. These data are essential for formulating policies for HIV intervention strategies to curb HIV epidemic. In present study, a descriptive analysis of all registered cases from three district hospitals (Maldah, North 24 Parganas and Darjeeling during July 2006-December 2007 was conducted. HIV/AIDS related deaths were found to be higher in Darjeeling district compare to other two districts. A comprehensive and well-coordinated survey is needed to explore further HIV/AIDS mortality data in India for providing necessary information in developing HIV prevention programs.

  16. Injectional anthrax at a Scottish district general hospital.

    Science.gov (United States)

    Inverarity, D J; Forrester, V M; Cumming, J G R; Paterson, P J; Campbell, R J; Brooks, T J G; Carson, G L; Ruddy, J P

    2015-04-01

    This retrospective, descriptive case-series reviews the clinical presentations and significant laboratory findings of patients diagnosed with and treated for injectional anthrax (IA) since December 2009 at Monklands Hospital in Central Scotland and represents the largest series of IA cases to be described from a single location. Twenty-one patients who fulfilled National Anthrax Control Team standardized case definitions of confirmed, probable or possible IA are reported. All cases survived and none required limb amputation in contrast to an overall mortality of 28% being experienced for this condition in Scotland. We document the spectrum of presentations of soft tissue infection ranging from mild cases which were managed predominantly with oral antibiotics to severe cases with significant oedema, organ failure and coagulopathy. We describe the surgical management, intensive care management and antibiotic management including the first description of daptomycin being used to treat human anthrax. It is noted that some people who had injected heroin infected with Bacillus anthracis did not develop evidence of IA. Also highlighted are biochemical and haematological parameters which proved useful in identifying deteriorating patients who required greater levels of support and surgical debridement.

  17. Review of paediatric cardiology services in district general hospitals in the United Kingdom.

    Science.gov (United States)

    Andrews, Hannah; Singh, Yogen

    2016-03-01

    Following the Safe and Sustainable review of Paediatric Services in 2012/2013, National Health Service England recommended that local paediatric cardiology services should be provided by specially trained paediatricians with expertise in cardiology in all non-specialist hospitals. To understand the variation in local paediatric cardiology services provided across district general hospitals in the United Kingdom. An internet-based questionnaire was sent out via the Paediatrician with Expertise in Cardiology Special Interest Group and the Neonatologists with Interest in Cardiology and Haemodynamics contact databases and the National Health Service directory. Non-responders were followed-up via telephone. The response rate was 80% (141 of 177 hospitals), and paediatricians with expertise in cardiology were available in 68% of those. Local cardiology clinics led by paediatricians with expertise in cardiology were provided in 96 hospitals (68%), whereas specialist outreach clinics were held in 123 centres (87%). A total of 11 hospitals provided neither specialist outreach clinics nor any local cardiology clinics led by paediatricians with expertise in cardiology. Paediatric echocardiography services were provided in 83% of the hospitals, 12-lead electrocardiogram in 96%, Holter electrocardiogram in 91%, and exercise testing in only 47% of the responding hospitals. Telemedicine facilities were established in only 52% of the centres, where sharing echocardiogram images via picture archiving and communication system was used most commonly. There has been a substantial increase in the availability of paediatricians with expertise in cardiology since 2008. Most of the hospitals are well-supported by specialist cardiology centres via outreach clinics; however, there remains significant variation in the local paediatric cardiology services provided across district general hospitals in the United Kingdom.

  18. Outcome of phacoemulsification and extracapsular cataract extraction: A study in a district hospital in Malaysia.

    Science.gov (United States)

    Thevi, T; Reddy, S C; Shantakumar, C

    2014-01-01

    The aim of the study was to compare the outcomes of phacoemulsification (Phaco) and extracapsular cataract extraction (ECCE) in a district hospital setting. A retrospective analysis was done from the medical records of the patients who underwent Phaco and ECCE in Temerloh District Hospital, Pahang state between October 2009 and September 2010. The age, gender and ethnicity of the patients, intraoperative and postoperative complications, and the best corrected visual acuity at the last follow-up visit were noted. Statistical analysis was done using Stata Software Version 11.0. The results of the two procedures were compared. Out of the 179 cataract surgeries performed, 146 cases were Phaco and 33 were ECCE. In our study, 82 were men and 97 were women. The age of patients ranged from 39 to 82 years; majority of the patients (71.3%) were more than 60 years of age. There was a significant association between type of surgery and outcome of visual acuity (p = 0.001). There was no significant association between intraoperative complication and type of surgery (p = 0.166). Postoperative complications of the surgeries were not significantly different. Good visual outcome was noted in 80.1% of eyes operated by Phaco compared to 48.5% of eyes operated by ECCE procedure. Since the visual outcome was significantly better in Phaco compared to ECCE procedure (p = 0.001), we recommend that Phaco equipments should be supplied in the district hospitals with adequate facilities for performing intraocular surgery.

  19. Improvement of district hospital service system to increase treatment adherence among tuberculosis patients in Pakistan.

    Science.gov (United States)

    Khan, Muhammad Shafiq; Suwannapong, Nawarat; Howteerakul, Nopporn; Pacheun, Oranut; Rajatanun, Titipat

    2011-05-01

    Adherence to medication regimen is essential for tuberculosis (TB) treatment success. We carried out quasi-experimental, single group intervention study at Rawalpindi District Hospital to improve TB patient treatment adherence using a Chronic Care Model (CCM). Ninety-nine newly diagnosed TB patients at the TB Clinic, Rawalpindi District Hospital, during February-March 2009, were included in the study. A set of four quality indicators were determined based on current scientific evidence: quality of service system, patient satisfaction, treatment adherence and cure rate. Care quality changes over time were analyzed by paired t-test. Significant improvements in service quality were seen post-intervention. Overall, the hospital service system quality improved to "good" (from 1.0% to 28.3%), and patient satisfaction increased to "good" (10.2% to 54.1%). Treatment adherence increased (from 23.2% to 56.1%). The quarterly cure rate increased notably (5.3% to 17.2%). The overall mean scores for hospital service system quality, patient satisfaction, and TB patient treatment adherence, improved significantly 6 month post-intervention (p<0.001).

  20. Critical care research in a district general hospital: the first year.

    Science.gov (United States)

    Camsooksai, Julie; Barnes, Helena; Reschreiter, Henrik

    2013-09-01

    Until recently, research in critical care units has usually taken place in university teaching hospitals. The 'general' critical care unit patient population is broader than this and the research needs to reflect this. As a general critical care unit in a district general hospital we wanted to set-up research within our own department, as part of the critical care team and part of our culture. With extensive background communication, drive and hard work, the support of the hospital Research and Development department was gained and Comprehensive Local Research Network funding successfully applied for. A research team was established and a model for the Research Nurse role was developed and implemented. This model is described. Participation in national trials commenced and the research portfolio is growing. Networking with other teams also proved valuable. Research has been established as part of the 'culture' of the day-to-day work and the staff have embraced this. Dedicated Research Nurse posts and education of the whole team have ensured successful implementation and recruitment of the studies. Experiences of the first year are shared and discussed here. Sharing experience of developing research within a critical care unit in a district general hospital, and a suggested model for a new Research Nurse role, may benefit other similar units in their efforts to establish research.

  1. Patient safety culture in a district hospital in South Africa: An issue of quality.

    Science.gov (United States)

    Mayeng, Lorraine M; Wolvaardt, Jacqueline E

    2015-11-05

    The Nursing Act 33 of 2005 holds nurse practitioners responsible for all acts and omissions in the delivery of quality patient care. But quality patient care is influenced by a number of factors beyond the control of nurse practitioners. Patient safety culture is one such factor and is seldom explored in hospitals in developing countries. This article describes the patient safety culture of a district hospital in South Africa. The study identified and analysed the factors that influence the patient safety culture by using the Manchester Patient Safety Framework at the National District Hospital, Bloemfontein, Free State Province. A descriptive cross-sectional study was conducted and included the total population of permanent staff; community service health professionals; temporarily employed health professionals and volunteers. The standard Manchester Patient Safety Framework questionnaire was distributed with a response rate of 61%. Less than half of the respondents (42.4%; n = 61) graded their units as acceptable. Several quality dimensions were statistically significant for the employment profile: overall commitment to quality (p = 0.001); investigating patient incidents (p = 0.031); organisational learning following incidents (p < 0.001); communication around safety issues (p = 0.001); and team working around safety issues (p = 0.005). These same quality dimensions were also statistically significant for the professional profiles. Medical doctors had negative perceptions of all the safety dimensions. The research measured and described patient safety culture (PSC) amongst the staff at the National District Hospital (NDH). This research has identified the perceived inadequacies with PSC and gives nurse managers a clear mandate to implement change to ensure a PSC that fosters quality patient care.

  2. Patient safety culture in a district hospital in South Africa: An issue of quality

    Directory of Open Access Journals (Sweden)

    Lorraine M. Mayeng

    2015-02-01

    Full Text Available Background: The Nursing Act 33 of 2005 holds nurse practitioners responsible for all acts and omissions in the delivery of quality patient care. But quality patient care is influenced by a number of factors beyond the control of nurse practitioners. Patient safety culture is one such factor and is seldom explored in hospitals in developing countries. This article describes the patient safety culture of a district hospital in South Africa.Objectives: The study identified and analysed the factors that influence the patient safety culture by using the Manchester Patient Safety Framework at the National District Hospital, Bloemfontein, Free State Province.Method: A descriptive cross-sectional study was conducted and included the total population of permanent staff; community service health professionals; temporarily employed health professionals and volunteers. The standard Manchester Patient Safety Framework questionnaire was distributed with a response rate of 61%.Results: Less than half of the respondents (42.4%; n = 61 graded their units as acceptable. Several quality dimensions were statistically significant for the employment profile: overall commitment to quality (p = 0.001; investigating patient incidents (p = 0.031; organisational learning following incidents (p < 0.001; communication around safety issues (p = 0.001; and team working around safety issues (p = 0.005. These same quality dimensions were also statistically significant for the professional profiles. Medical doctors had negative perceptions of all the safety dimensions.Conclusion: The research measured and described patient safety culture (PSC amongst the staff at the National District Hospital (NDH. This research has identified the perceived inadequacies with PSC and gives nurse managers a clear mandate to implement change to ensure a PSC that fosters quality patient care.

  3. Troponin T: role in altering patient management and enabling earlier discharge from a district general hospital.

    Science.gov (United States)

    Owen, A; Khan, W; Griffiths, K D

    2001-03-01

    The use of troponin T to facilitate early patient discharge was investigated in a prospective study in a district general hospital. Troponin T was measured in 91 patients admitted over a period of 6 months with chest pain but without evidence of myocardial infarction. The main outcome measure was length of hospital stay. A negative troponin T was found in 70 patients. Fifty of these were discharged within 24 h of the troponin result being available and they had a significantly shorter hospital stay than a case control group and a historical control group from the previous 6 months. Troponin T measurement has a role in altering patient management by enabling early discharge, resulting in significant cost savings and increasing bed availability.

  4. Road traffic accidents before and after seatbelt legislation--study in a district general hospital.

    Science.gov (United States)

    Thomas, J

    1990-01-01

    Injuries among samples of car accident cases attending the Accident & Emergency (A & E) department of a District General Hospital (DGH) in the year before and after the introduction of seat belt legislation were classified applying the Abbreviated Injury Scale using information recorded in the patient case notes. Those who died or did not attend an A & E department were not included in the sampling frame. The number of those who escaped injury increased by 40% and those with mild and moderate injuries decreased by 35% after seatbelt legislation. There was a significant reduction in soft tissue injuries to the head. Only whiplash injuries to the neck showed a significant increase. PMID:2319551

  5. A study on bed utilization in the gynaecological ward of a district hospital in West Bengal.

    Science.gov (United States)

    Dutta, S; Biswas, R; Lahiri, A

    2005-01-01

    A study was conducted in a non-paying gynaecological ward of the district hospital, South 24 Parganas, West Bengal to assess different bed efficiency indicators. Total 331 patients were admitted in 23 study beds (12 OPD beds and 11 emergency beds) during an observation period of six months. Overall average number of admissions were 14.4 and average length of stay 14.7days. Bed turnover rate was 13.8 and was higher for emergency beds (22.1) compared to OPD beds (9). Bed occupancy rate was 61.3% with significant difference between OPD beds (57.5%) and emergency beds (65.4%).

  6. Management of cryptococcal meningitis in a district hospital in KwaZulu-Natal: A clinical audit

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    Benjamin O. Adeyemi

    2014-01-01

    Full Text Available Background: Despite the development of context-specific guidelines, cryptococcal meningitis (CCM remains a leading cause of death amongst HIV-infected patients. Results from clinical audits in routine practice have shown critical gaps in clinicians’ adherence to recommendations regarding the management of CCM.Aim: The aim of this study was to review the acute management of CCM at an urban district hospital in KwaZulu-Natal, South Africa with a view to making recommendations for improving care.Setting: An urban district hospital in KwaZulu-Natal, South Africa.Methods: A retrospective audit was performed on clinical records of all patients (age > 13 years admitted to the hospital with a diagnosis of CCM between June 2011 and December 2012.Results: Measurement of cerebrospinal fluid opening pressure at initial lumbar puncture (LP was done rarely and only 23.4% of patients had therapeutic LPs. The majority of patients (117/127; 92.1% received amphotericin B, however, only 19 of the 117 patients (16.2% completed the 14-day treatment target. Amphotericin B-toxicity monitoring and prevention was suboptimal; however, in-patient referral for HIV counselling and testing was excellent.Conclusions: The quality of care of CCM based on selected process criteria showed gaps in routine care at the hospital despite the availability of context-specific guidelines. An action plan for improving care was developed based on stakeholders’ feedback. A repeat audit should be conducted in the future in order to evaluate the impact of this plan and to ensure that improvements are sustained.

  7. Cost-effectiveness of anti-retroviral therapy at a district hospital in southern Ethiopia

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    Robberstad Bjarne

    2009-07-01

    Full Text Available Abstract Background As the resource implications of expanding anti-retroviral therapy (ART are likely to be large, there is a need to explore its cost-effectiveness. So far, there is no such information available from Ethiopia. Objective To assess the cost-effectiveness of ART for routine clinical practice in a district hospital setting in Ethiopia. Methods We estimated the unit cost of HIV-related care from the 2004/5 fiscal year expenditure of Arba Minch Hospital in southern Ethiopia. We estimated outpatient and inpatient service use from HIV-infected patients who received care and treatment at the hospital between January 2003 and March 2006. We measured the health effect as life years gained (LYG for patients receiving ART compared with those not receiving such treatment. The study adopted a health care provider perspective and included both direct and overhead costs. We used Markov model to estimate the lifetime costs, health benefits and cost-effectiveness of ART. Findings ART yielded an undiscounted 9.4 years expected survival, and resulted in 7.1 extra LYG compared to patients not receiving ART. The lifetime incremental cost is US$2,215 and the undiscounted incremental cost per LYG is US$314. When discounted at 3%, the additional LYG decreases to 5.5 years and the incremental cost per LYG increases to US$325. Conclusion The undiscounted and discounted incremental costs per LYG from introducing ART were less than the per capita GDP threshold at the base year. Thus, ART could be regarded as cost-effective in a district hospital setting in Ethiopia.

  8. The effects of a language barrier in a South African district hospital.

    Science.gov (United States)

    Schlemmer, A; Mash, B

    2006-10-01

    Communication between health workers and patients at Hottentots Holland Hospital (HHH) is hindered by staff and patients not speaking the same language. HHH is a district hospital in the Cape Town Metropolitan District of the Western Cape where staff mainly speak Afrikaans or English and a large number of patients mainly Xhosa. The study aimed to explore the effects of this language barrier on health workers and patients at HHH. Three focus group interviews were held with 21 members of staff and 5 in-depth patient interviews were conducted. The language barrier was found to interfere with working efficiently, create uncertainty about the accuracy of interpretation, be enhanced by a lack of education or training, cause significant ethical dilemmas, negatively influence the attitudes of patients and staff towards each other, decrease the quality of and satisfaction with care, and cause cross-cultural misunderstandings. The effects of the language barrier were considerable and persistent despite an official language policy in the province. The training and employment of professional interpreters as well as teaching of basic Xhosa to staff are recommended.

  9. Liver biopsy in a district general hospital: Changes over two decades

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To study liver biopsy practice over two decades in a district general hospital in the United Kingdom. METHODS: We identified all patients who had at least one liver biopsy between 1986 and 2006 from the databases of the radiology and gastroenterology departments. Subjects with incomplete clinical data were excluded from the study. RESULTS: A total of 103 liver biopsies were performed. Clinical data was available for 88 patients, with 95 biopsies. Between 1986 and 1996, 18 (95%) out of the 19 liver biopsies performed were blind and 6 (33%) were for primary biliary cirrhosis. Between 1996 and 2006, 14 (18%) out of 76 biopsies were blind; and the indications were abnormal liver tests (33%), hepatitis C (12%) and targeted-biopsies (11%). Liver biopsies were unhelpful in 5 (5%) subjects. Pain was the most common complication of liver biopsy (5%). No biopsy-related mortality was reported. There was a trend towards more technical failures and complications with the blind biopsy technique. CONCLUSION: Liver biopsies performed in small district hospitals are safe and useful for diagnostic and staging purposes. Abnormal liver tests, non-alcoholic fatty liver disease and targeted biopsies are increasingly common indications. Ultrasound-guided liver biopsies are now the preferred method and are associated with fewer complications.

  10. Technical efficiency of public district hospitals and health centres in Ghana: a pilot study

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    Kirigia Joses M

    2005-09-01

    Full Text Available Abstract Background The Government of Ghana has been implementing various health sector reforms (e.g. user fees in public health facilities, decentralization, sector-wide approaches to donor coordination in a bid to improve efficiency in health care. However, to date, except for the pilot study reported in this paper, no attempt has been made to make an estimate of the efficiency of hospitals and/or health centres in Ghana. The objectives of this study, based on data collected in 2000, were: (i to estimate the relative technical efficiency (TE and scale efficiency (SE of a sample of public hospitals and health centres in Ghana; and (ii to demonstrate policy implications for health sector policy-makers. Methods The Data Envelopment Analysis (DEA approach was used to estimate the efficiency of 17 district hospitals and 17 health centres. This was an exploratory study. Results Eight (47% hospitals were technically inefficient, with an average TE score of 61% and a standard deviation (STD of 12%. Ten (59% hospitals were scale inefficient, manifesting an average SE of 81% (STD = 25%. Out of the 17 health centres, 3 (18% were technically inefficient, with a mean TE score of 49% (STD = 27%. Eight health centres (47% were scale inefficient, with an average SE score of 84% (STD = 16%. Conclusion This pilot study demonstrated to policy-makers the versatility of DEA in measuring inefficiencies among individual facilities and inputs. There is a need for the Planning and Budgeting Unit of the Ghana Health Services to continually monitor the productivity growth, allocative efficiency and technical efficiency of all its health facilities (hospitals and health centres in the course of the implementation of health sector reforms.

  11. Cost analysis for efficient management: diabetes treatment at a public district hospital in Thailand.

    Science.gov (United States)

    Riewpaiboon, Arthorn; Chatterjee, Susmita; Piyauthakit, Piyanuch

    2011-10-01

    OBJECTIVE  The study estimated cost of illness from the provider's perspective for diabetic patients who received treatment during the fiscal year 2008 at Waritchaphum Hospital, a 30-bed public district hospital in Sakhon Nakhon province in northeastern Thailand. METHODS  This retrospective, prevalence-based cost-of-illness study looked at 475 randomly selected diabetic patients, identified by the World Health Organization's International Classification of Diseases, 10th revision, codes E10-E14. Data were collected from the hospital financial records and medical records of each participant and were analysed with a stepwise multiple regression. KEY FINDINGS  The study found that the average public treatment cost per patient per year was US$94.71 at 2008 prices. Drug cost was the highest cost component (25% of total cost), followed by inpatient cost (24%) and outpatient visit cost (17%). A cost forecasting model showed that length of stay, hospitalization, visits to the provincial hospital, duration of disease and presence of diabetic complications (e.g. diabetic foot complications and nephropathy) were the significant predictor variables (adjusted R(2) = 0.689). CONCLUSIONS  According to the fitted model, avoiding nephropathy and foot complications would save US$19 386 and US$39 134 respectively per year. However, these savings are missed savings for the study year and the study hospital only and not projected savings, as that would depend on the number of diabetic patients managed in the year, the ratio of complicated to non-complicated cases and effectiveness of the prevention programmes. Nonetheless, given the high avoidable cost associated with complications of diabetes, healthcare providers in Thailand should focus on initiatives that delay the progression of complications in diabetic patients.

  12. Low hospital referral rates of school scoliosis screening positives in an urban district of mainland China.

    Science.gov (United States)

    Guo, Yawen; Jiang, Qingwu; Tanimoto, Tetsuya; Kami, Masahiro; Luo, Chunyan; Leppold, Claire; Nishimura, Koichi; He, Yongpin; Kato, Shigeaki; Ding, Xiaocang

    2017-04-01

    Significant prevalence rates of adolescent scoliosis in China were suggested in previous studies. However, school screenings for adolescent scoliosis have been suspended due to low rates of positive detection under the past screening system in China. The present study was undertaken to screen for adolescent scoliosis in middle school students under a modern assessment system in a district of Shanghai. We performed a population-based, cross-sectional study of a middle school scoliosis screening program in the Jingan district. In 2015, schoolchildren were initially screened by visual inspection of clinical signs and the forward-bending test. Suspected cases were referred for radiography in hospital for scoliosis diagnosis. A total of 5327 middle school students (grades 6-8) were screened with 520 (9.76%) positives (the positive rates of girls and boys at 15.28% and 4.59%, respectively) and no statistically significant difference among grades. Only 301 positives (57.9%) followed the referral for hospital radiography. There were 102 cases (33.9%) that were diagnosed with scoliosis by radiography criteria (Cobb angle ≥10°) including mild scoliosis (Cobb 10-25) for 94 cases and moderate scoliosis (Cobb 25-40) for 8 cases, and false-positives (Cobb 0) for 39 cases. The putative prevalence rate was estimated as 1.9% from the referred students. Under an accurate and modern assessment system, school screenings can detect scoliosis at a significant rate, but awareness of scoliosis risks is needed for residents in China to take up referrals for hospital diagnosis after school screenings.

  13. Patient's perceptions about the service quality of public hospitals located at District Kohat.

    Science.gov (United States)

    Aman, Bakhtiar; Abbas, Faisal

    2016-01-01

    To determine patients' perception regarding service and quality of healthcare at public-sector institutions. The descriptive quantitative study was conducted in Kohat district, Pakistan, between July and December 2014, and focussed on 30 variables to assess the participants' perceptions of the actual healthcare service quality delivered. SERVQUAL instrument was used to measure the reliability and cronbach alpha was calculated to measure the reliability and validity of the instrument. A total of 200 questionnaires were distributed and 157(78.5%) were received back fully filled. Of them, 105(67%) were men and 52(33%) were women.The mean value of Assurance parameter was 3.05±0.88, indicating trust in public hospitals was high as they had experienced and capable doctors. On the other hand, the lowest mean value of 2.61±0.84 was for Empathy, highlighting the fact that public hospitals lacked the ability to handle patients' problem properly, services were not offered in time and they were short of staff. Public hospitals were largely seen as failing to deliver quality service.

  14. Measuring the Capacity Utilization of Public District Hospitals in Tunisia: Using Dual Data Envelopment Analysis Approach

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    Chokri Arfa

    2017-01-01

    Full Text Available Background Public district hospitals (PDHs in Tunisia are not operating at full plant capacity and underutilize their operating budget. Methods Individual PDHs capacity utilization (CU is measured for 2000 and 2010 using dual data envelopment analysis (DEA approach with shadow prices input and output restrictions. The CU is estimated for 101 of 105 PDH in 2000 and 94 of 105 PDH in 2010. Results In average, unused capacity is estimated at 18% in 2010 vs. 13% in 2000. Of PDHs 26% underutilize their operating budget in 2010 vs. 21% in 2000. Conclusion Inadequate supply, health quality and the lack of operating budget should be tackled to reduce unmet user’s needs and the bypassing of the PDHs and, thus to increase their CU. Social health insurance should be turned into a direct purchaser of curative and preventive care for the PDHs.

  15. Patient profile and outcome of pilomatrixoma in district general hospital in United Kingdom

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    Mahmoud AbdelDayem

    2013-01-01

    Full Text Available Introduction: A pilomatrixoma is a benign appendage tumour related to hair cells matrix. Most of the literature review about pilomatrixoma is in the form of case reports with fewer cohort studies. The objective of this cohort is to study the variable demographic characteristics, presentation and histopathology of this condition among a larger group of patients. Materials and Methods: We conducted a retrospective study of patients who had excision of pilomatrixoma between February 1998 and August 2011 in a District General Hospital in UK. Results: The study included 67 patients with histopathologically diagnosed pilomatrixoma. The mean age was 32 years. Male to Female ratio was 35:32. The average diameter of the lesion at presentation was 13 mm (range: 2-30 mm. 66 of 67 (98.5% patients presented with solitary lesion, while 1 patient (1.5% had two lesions. Conclusion: Pilomatrixoma is not an uncommon benign lesion. It is more common in the maxillofacial area.

  16. Facility type and primary care performance in sub-district health promotion hospitals in Northern Thailand.

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    Kitreerawutiwong, Nithra; Jordan, Sue; Hughes, David

    2017-01-01

    Poor and middle-income Thai people rely heavily on primary care health services. These are staffed by a range of professionals. However, it is unknown whether the performance of primary care varies according to the staffing and organization of local service delivery units. Tambon (sub-district) health promotion hospitals (THPHs) were introduced in 2009 to upgrade the services offered by the previous health centres, but were faced with continuing shortages of doctors and nurses. The Ministry of Public Health (MoPH) designated three categories of THPH, defined according to whether they were regularly staffed by a medical practitioner, a qualified nurse or non-clinical public health officers. This study aimed to compare the performance of primary care offered by the three different types of primary care facilities in one public health region of Northern Thailand (Public Health Region 2). A cross-sectional survey was undertaken in 2013. Data were collected on accessibility, continuity, comprehensiveness, co-ordination and community orientation of care from 825 patients attending 23 primary care facilities. These were selected to include the three officially-designated types of Tambon (sub-district) health promotion hospitals (THPHs) led by medical, nursing or public health personnel. Survey scores were compared in unadjusted and adjusted analyses. THPHs staffed only by public health officers achieved the highest performance score (Mean = 85.14, SD. = 7.30), followed by THPHs staffed by qualified nurses (Mean = 82.86, SD. = 7.06). THPHs staffed by a doctor on rotation returned the lowest scores (Mean = 81.63, SD. = 7.22). Differences in overall scores resulted mainly from differences in reported accessibility, continuity, and comprehensiveness of care, rather than staff skill-mix per se. Policy on quality improvement should therefore focus on improving performance in these areas.

  17. Facility type and primary care performance in sub-district health promotion hospitals in Northern Thailand

    Science.gov (United States)

    Kitreerawutiwong, Nithra; Jordan, Sue; Hughes, David

    2017-01-01

    Background Poor and middle-income Thai people rely heavily on primary care health services. These are staffed by a range of professionals. However, it is unknown whether the performance of primary care varies according to the staffing and organization of local service delivery units. Tambon (sub-district) health promotion hospitals (THPHs) were introduced in 2009 to upgrade the services offered by the previous health centres, but were faced with continuing shortages of doctors and nurses. The Ministry of Public Health (MoPH) designated three categories of THPH, defined according to whether they were regularly staffed by a medical practitioner, a qualified nurse or non-clinical public health officers. This study aimed to compare the performance of primary care offered by the three different types of primary care facilities in one public health region of Northern Thailand (Public Health Region 2). Methods A cross-sectional survey was undertaken in 2013. Data were collected on accessibility, continuity, comprehensiveness, co-ordination and community orientation of care from 825 patients attending 23 primary care facilities. These were selected to include the three officially-designated types of Tambon (sub-district) health promotion hospitals (THPHs) led by medical, nursing or public health personnel. Survey scores were compared in unadjusted and adjusted analyses. Results THPHs staffed only by public health officers achieved the highest performance score (Mean = 85.14, SD. = 7.30), followed by THPHs staffed by qualified nurses (Mean = 82.86, SD. = 7.06). THPHs staffed by a doctor on rotation returned the lowest scores (Mean = 81.63, SD. = 7.22). Conclusions Differences in overall scores resulted mainly from differences in reported accessibility, continuity, and comprehensiveness of care, rather than staff skill-mix per se. Policy on quality improvement should therefore focus on improving performance in these areas. PMID:28339494

  18. Prevalence of inflammatory bowel disease in two districts of Sri Lanka: a hospital based survey

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    Satharasinghe Raveendra L

    2010-03-01

    Full Text Available Abstract Background Inflammatory bowel disease (IBD is being increasingly diagnosed in Asia. However there are few epidemiological data from the region. Methods To determine prevalence and clinical characteristics of IBD, a hospital-based survey was performed in the Colombo and Gampaha districts (combined population 4.5 million in Sri Lanka. Patients with established ulcerative colitis (UC and Crohn's disease (CD, who were permanent residents of these adjoining districts, were recruited from hospital registries and out-patient clinics. Clinical information was obtained from medical records and patient interviews. Results There were 295 cases of IBD (UC = 240, CD = 55, of which 34 (UC = 30, CD = 4 were newly diagnosed during the study year. The prevalence rate for UC was 5.3/100,000 (95% CI 5.0-5.6/100,000, and CD was 1.2/100,000 (95% CI 1.0-1.4/100,000. The incidence rates were 0.69/100,000 (95% CI 0.44-0.94/100,000 for UC and 0.09/100,000 (95% CI 0.002-0.18/100,000 for CD. Female:male ratios were 1.5 for UC and 1.0 for CD. Mean age at diagnosis was (males and females 36.6 and 38.1y for UC and 33.4 and 36.2y for CD. Among UC patients, 51.1% had proctitis and at presentation 58.4% had mild disease. 80% of CD patients had only large bowel involvement. Few patients had undergone surgery. Conclusions The prevalence of IBD in this population was low compared to Western populations, but similar to some in Asia. There was a female preponderance for UC. UC was mainly mild, distal or left-sided, while CD mainly involved the large bowel.

  19. Contextual influences on health worker motivation in district hospitals in Kenya

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    Blaauw Duane

    2009-07-01

    Full Text Available Abstract Background Organizational factors are considered to be an important influence on health workers' uptake of interventions that improve their practices. These are additionally influenced by factors operating at individual and broader health system levels. We sought to explore contextual influences on worker motivation, a factor that may modify the effect of an intervention aimed at changing clinical practices in Kenyan hospitals. Methods Franco LM, et al's (Health sector reform and public sector health worker motivation: a conceptual framework. Soc Sci Med. 2002, 54: 1255–66 model of motivational influences was used to frame the study Qualitative methods including individual in-depth interviews, small-group interviews and focus group discussions were used to gather data from 185 health workers during one-week visits to each of eight district hospitals. Data were collected prior to a planned intervention aiming to implement new practice guidelines and improve quality of care. Additionally, on-site observations of routine health worker behaviour in the study sites were used to inform analyses. Results Study settings are likely to have important influences on worker motivation. Effective management at hospital level may create an enabling working environment modifying the impact of resource shortfalls. Supportive leadership may foster good working relationships between cadres, improve motivation through provision of local incentives and appropriately handle workers' expectations in terms of promotions, performance appraisal processes, and good communication. Such organisational attributes may counteract de-motivating factors at a national level, such as poor schemes of service, and enhance personally motivating factors such as the desire to maintain professional standards. Conclusion Motivation is likely to influence powerfully any attempts to change or improve health worker and hospital practices. Some factors influencing motivation may

  20. Employees’ Commitment to the Organization of a Public District Hospital: a Case Study

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    Eyaggelia Tsolaki

    2013-01-01

    Full Text Available Background: The employees' satisfaction from their job and their commitment to the organization appears to be one of the most determinants factors of organizational effectiveness.Aim: The aim of this study was the research of commitment to the organization of employees' working at Sparta General Hospital, as well as the correlation between job satisfaction and social, economic, demographic or other factors.Methodology: The research’s sample included 121 employees from all departments of a public district hospital. For research purposes, the Organizational Commitment Questionnaire was used. Data specially designed for the research’s purposes.Results: The largest sample’s proportion, declared moderate to very satisfy by their job at that Hospital. The particular job demands, exhausting timetables, stress and organizational weaknesses of the Greek Health System seem to have been key components of the problem. Also, for a large sample proportion, the job demands affect negatively the time and energy that Sparta General Hospital employees’ dedicate to themselves and to their families. Almost half of the participants replied that they are not at all satisfied with their payroll. Regarding the rates of emotional, standing and exemplary commitment, showed that gender, education level, marital status, age and total years of professional seniority correlated with the level of emotional commitment. To higher affective commitment is positively correlated with age of employees and years of service.Conclusions: The research of commitment to the organization can contribute substantially in improving the hospital’s and health system’s effectiveness, the increment of job’s satisfaction, the employees’ efficiency.

  1. Prescription pattern in the department of surgery in a tribal district hospital of andhra pradesh, India.

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    Khade, A; Bashir, Msm; Sheethal, A

    2013-07-01

    Usually, surgical management cannot be completed without the use of antimicrobial and analgesic drugs. Irrational prescription may lead to severe postoperative complications. The objective of this study was to evaluate the prescription trend in the surgery department of a tribal district hospital so as to determine the extent of rational use of medicines. It was a retrospective study in which 50 cases were selected randomly. Case records were analyzed for prescription trend. Data was analyzed using Microsoft Office Excel 2007 and values were presented descriptively. Most of the cases were between the age group of 21 and 40 years, 18 cases (36%). Commonest cause of hospitalization was renal calculi (10 (20%)) followed by acute abdomen and abscess (6, (12%)). Total of 255 numbers of drugs were used with an average of 5.1 drugs per patient. Most preferred route was intravenous route (174 drugs, 68.2%). Antimicrobial was the most common (97 (38.0%)) group of drugs followed by analgesic/antipyretics (50 (19.6%)). Among antimicrobials, ciprofloxacin (22 (22.7%)) was the most common drug followed by metronidazole (21 (18.5%)). All the cases were managed by empirical treatment. Two different antimicrobials were prescribed to 20 (40%) of cases. Dosage of 83 (32.6%) drugs was inappropriate while frequency was inappropriate in 26 (10.2%) cases. Urgent steps like specific guidelines, training, and monitoring of drugs use are needed to correct some irrational approaches.

  2. Bare Below the Elbows: A comparative study of a tertiary and district general hospital.

    Science.gov (United States)

    Collins, A M; Connaughton, J; Ridgway, P F

    2013-10-01

    A 'Bare Below the Elbows' (BBTE) dress code policy has been introduced by the majority of NHS trusts in the UK. The aim of this Irish study was to evaluate the impact of an educational intervention on perception of medical attire. The study was carried out in two centres: a tertiary referral centre (Beaumont Hospital) and a district hospital (MRH, Portlaoise). Two questionnaires, incorporating photographic evaluation of appropriate attire for consultants and junior doctors, were completed pre and post BBTE education. One hundred and five patients participated. Analysis pre BBTE education indicated patients considered formal attire and white coats most appropriate for consultants and junior doctors respectively. Post-intervention analysis revealed a significant reduction in the popularity of both (p <0.001), with scrubs and smart casual attire gaining significant support in both cohorts (p <0.001). Our findings demonstrated that patient opinion on medical attire is malleable. The support of such a policy may be achieved if patients are informed that the aim is to reduce the spread of healthcare-associated infections.

  3. Anthropometric measurements of term neonates in tertiary care hospital of Wardha district

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    Amar M. Taksande

    2015-04-01

    Full Text Available Objective: The present study was undertaken to find the anthropometric parameter like birth weight (BW, length, occipitofrontal circumference(OFC, midarm circumference(MAC, chest circumference (CC, midthigh circumference(MTC and maximum calf circumference (MCC of normal healthy neonates at birth which can be used to draw growth chart. Study design: Hospital based cross-sectional study. This study was done in the pediatric department of AVBRH hospital, Sawangi (Meghe, Wardha from April 2012 to August 2012. Materials and methods: 211 full terms, normal, singleton newborn babies were included BW, length, OFC, MAC, CC, MTC and MCC were taken within 72 hours of birth. Results: Of the 211 neonates 115 (54.5% were male and 96 (45.5% female. The mean BW, length, OFC, MAC, CC, MTC and MCC were 2.815(0.28 kg, 51.15(3.31 cm, 33.52(1.92 cm, 10.12(1.30 cm 28.66(2.52 cm, 14.33(1.74 cm and 10.58(1.20 cm respectively. No statistically significant difference was present in the anthropometric parameter of boys and girls. Conclusions: This study establishes local normal values for anthropometric measurements for healthy, full term newborn in wardha district. To develop our population data, community based studies should be conducted regularly.

  4. Developing a tool to measure health worker motivation in district hospitals in Kenya

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    Gilson Lucy

    2009-05-01

    Full Text Available Abstract Background We wanted to try to account for worker motivation as a key factor that might affect the success of an intervention to improve implementation of health worker practices in eight district hospitals in Kenya. In the absence of available tools, we therefore aimed to develop a tool that could enable a rapid measurement of motivation at baseline and at subsequent points during the 18-month intervention study. Methods After a literature review, a self-administered questionnaire was developed to assess the outcomes and determinants of motivation of Kenyan government hospital staff. The initial questionnaire included 23 questions (from seven underlying constructs related to motivational outcomes that were then used to construct a simpler tool to measure motivation. Parallel qualitative work was undertaken to assess the relevance of the questions chosen and the face validity of the tool. Results Six hundred eighty-four health workers completed the questionnaires at baseline. Reliability analysis and factor analysis were used to produce the simplified motivational index, which consisted of 10 equally-weighted items from three underlying factors. Scores on the 10-item index were closely correlated with scores for the 23-item index, indicating that in future rapid assessments might be based on the 10 questions alone. The 10-item motivation index was also able to identify statistically significant differences in mean health worker motivation scores between the study hospitals (p Conclusion The 10-item score developed may be useful to monitor changes in motivation over time within our study or be used for more extensive rapid assessments of health worker motivation in Kenya.

  5. A study of the emotional intelligence of employees at a District Hospital of Greece

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    Sofia Zyga

    2012-01-01

    Full Text Available Background: The role of emotional intelligence is one of the main issues in modern management. Contemporary terms withsemiotic meaning that target emotions, such as ‘leading with the heart’, ‘the art of influence’, ‘team mind’ and ‘teamintelligence quotient’, are now quite frequent in Greek and International literature.The objective of this study was the investigation of the level of emotional intelligence in three professional groups ofemployees in a district hospital.Methods: The population of the study consisted of 132 employees of a General Regional Hospital (doctors, nurses,administrative employees. The “Emotional Competence Inventory (ECI”, which was developed in 1999 by Goleman,Boyatzis and Rhee and is applied in organizational environments after relevant permission, was used for data collection.Chi-square test and Takey test (ANOVA / POST –HOC were used in the statistical analysis of the data, which wasperformed with SPSS and Microsoft Office Excel.Results: Chi-square test was used to investigate the relationship between the answers of every professional group, therelationship between males and females of the population of the study, as well as the relationship between the educationlevel of the study’s population. Important differences were found. The values of the answers were summed up (Likert-scale– additive model and were converted to z-scores. According to the study’s model, nurses of the hospital in question are firstin self-awareness, social awareness and cognitive thought; whereas self-management was found in doctors and relationshipmanagement was found in administrative employees.Conclusions: The analysis of the results indicates differences between the professional groups and distinctively points outthe qualitative characteristic elements of each profession which relate with the subfactors that investigate emotionalintelligence. The difference between professionals in how they manage their tasks with

  6. Factors Affecting Anemia among Pregnant Women in Manokwari District Hospital 2016

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    Merlin Soripet

    2016-12-01

    Full Text Available Anemia is an indicator of poor nutrition and poor health. Anaemia in pregnant women is associated with mortality and morbidity in the mother and baby, including risk of miscarriage, stillbirth, prematurity and low birth weight. The incidence of anemia in Manokwari Hospital is still a problem in pregnant women. This research aimed to determine the factors that affect anemia in pregnant women in Manokwari District General Hospital in 2016. Method: This research is analytic survey with cross sectional approach .. The study was conducted in October 2016 in Manokwari Hospital. Population is the expectant mother as much as 208 people. The data were obtained using a questionnaire and analyzed using chi square. results indicated that there was an effect of knowledge of anemia in pregnant women (p-value 0.001; RP = 12.479; CI95% = 1.462 to 4.203. No effect of malaria on anemia in pregnant women. (P-value 0.001; RP = 3.599; CI95% = 2.322 to 5.579. No effect of worm infection to anemia in pregnant women (p-value 0.000; RP = 4.118; CI95% (2.764 to 6.133. There was an effect of compliance consumption of iron tablet of anemia in pregnant women (p-value 0.000; RP = 2,449; CI95% = 1.498 to 4.005. There is the influence of cigarette smoke exposure on anemia in pregnant women (p-value 0.000; RP = 4.678; CI95% = 2.828 to 7.738.

  7. Improving paediatric and neonatal care in rural district hospitals in the highlands of Papua New Guinea: a quality improvement approach.

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    Sa'avu, Martin; Duke, Trevor; Matai, Sens

    2014-05-01

    In developing countries such as Papua New Guinea (PNG), district hospitals play a vital role in clinical care, training health-care workers, implementing immunization and other public health programmes and providing necessary data on disease burdens and outcomes. Pneumonia and neonatal conditions are a major cause of child admission and death in hospitals throughout PNG. Oxygen therapy is an essential component of the management of pneumonia and neonatal conditions, but facilities for oxygen and care of the sick newborn are often inadequate, especially in district hospitals. Improving this area may be a vehicle for improving overall quality of care. A qualitative study of five rural district hospitals in the highlands provinces of Papua New Guinea was undertaken. A structured survey instrument was used by a paediatrician and a biomedical technician to assess the quality of paediatric care, the case-mix and outcomes, resources for delivery of good-quality care for children with pneumonia and neonatal illnesses, existing oxygen systems and equipment, drugs and consumables, infection-control facilities and the reliability of the electricity supply to each hospital. A floor plan was drawn up for the installation of the oxygen concentrators and a plan for improving care of sick neonates, and a process of addressing other priorities was begun. In remote parts of PNG, many district hospitals are run by under-resourced non-government organizations. Most hospitals had general wards in which both adults and children were managed together. Paediatric case-loads ranged between 232 and 840 patients per year with overall case-fatality rates (CFR) of 3-6% and up to 15% among sick neonates. Pneumonia accounts for 28-37% of admissions with a CFR of up to 8%. There were no supervisory visits by paediatricians, and little or no continuing professional development of staff. Essential drugs were mostly available, but basic equipment for the care of sick neonates was often absent or

  8. Geothermal district heating systems

    Science.gov (United States)

    Budney, G. S.; Childs, F.

    1982-06-01

    Ten district heating demonstration projects and their present status are described. The projects are Klamath County YMCA, Susanville District Heating, Klamath Falls District Heating, Reno Salem Plaza Condominium, El Centro Community Center Heating/Cooling, Haakon School and Business District Heating, St. Mary's Hospital, Diamond Ring Ranch, Pagosa Springs District Heating, and Boise District Heating.

  9. HIV counseling and testing in a tertiary care hospital in Ganjam district, Odisha, India

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    M Dash

    2013-01-01

    Full Text Available Background: Human immunodeficiency virus (HIV counseling and testing (HCT conducted at integrated counseling and testing centers (ICTCs is an entry point, cost-effective intervention in preventing transmission of HIV. Objectives: To study the prevalence of HIV among ICTC attendees, sociodemographic characteristics, and risk behaviors of HIV-seropositive clients. Materials and Methods: It was hospital record-based cross-sectional study of 26,518 registered ICTC clients at a tertiary care hospital in Ganjam district, Odisha, India over a 4-year period from January 2009 to September 2012. Results: A total of 1732 (7.5% out of 22,897 who were tested for HIV were seropositive. Among HIV-seropositives, 1138 (65.7% were males, while 594 (34.3% were females. Majority (88.3% of seropositives were between the age group of 15-49 years. Client-initiated HIV testing (12.1% was more seropositive compared to provider-initiated (2.9%. Among discordant couples, majority (95.5% were male partner/husband positive and female partner/wife negative. Positives were more amongst married, less educated, low socioeconomic status, and outmigrants (P<0.0001. Risk factors included heterosexual promiscuous (89.3%, parent-to-child transmission 5.8%, unknown 3.1%, infected blood transfusion 0.8%, homosexual 0.5%, and infected needles (0.5%. Conclusions: There is need to encourage activities that promote HCT in all health facilities. This will increase the diagnosis of new HIV cases. The data generated in ICTC provide an important clue to understand the epidemiology in a particular geographic region and local planning for care and treatment of those infected with HIV and preventive strategies for those at risk especially married, young adults, and outmigrants to reduce new infections.

  10. Undiagnosed tuberculosis in patients with HIV infection who present with severe anaemia at a district hospital

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    Mbulelo Mntonintshi

    2017-01-01

    Full Text Available Background: Tuberculosis (TB is a major cause of severe anaemia in patients with human immunodeficiency virus (HIV infection in South Africa. However, TB can be difficult to diagnose as it may be extra pulmonary and paucibacillary.Aim: The aim of this study was to investigate undiagnosed TB in patients with HIV infection and severe anaemia and to identify the optimal investigations for diagnosing TB.Setting: Mthatha General Hospital, a district hospital.Methods: The study was a case series.Results: Haemoglobin levels ranged from 3.6 g/dL to 7.9 g/dL, the mean CD4 count was 176 cells/μL and 80% of patients had a positive TB symptom screen. Forty-three (86% patients had either clinical or bacteriologically proven TB of whom 33 had pulmonary TB, 34 had extra pulmonary TB and 24 had both types. The diagnostic yield for TB was: chest X-ray (CXR 91%; ultrasound (US abdomen pericardium and lower chest 62%; sputum Xpert MTB/RIF 35%; TB blood culture 21% and TB urine culture 15%. Blood and urine cultures did not identify any additional cases over those identified by CXR and US. The laboratory turnaround times were as follows: sputum Xpert, 1.6 days; blood culture, 20 days and urine culture, 28 days. CXR and US were done within one day of initial patient assessment.Conclusions: The majority of HIV patients with severe anaemia had TB disease, and extra pulmonary TB was as prevalent as pulmonary TB. CXR, US and sputum Xpert were the optimum tests for rapid diagnosis of TB. South African national TB/HIV guidelines should incorporate these specific tests to diagnose TB in patients with HIV and severe anaemia.

  11. A way for reducing drug supply chain cost for a hospital district: A case study

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    Postacchini, L.; Ciarapica, F.E.; Bevilacqua, M.; Mazzuto, G.; Paciarotti, C.

    2016-07-01

    This work aims at providing insights to optimise healthcare logistic of the drug management, in order to deal with the healthcare expenditure cut. In this paper the effects of different drug supply chain configurations, on the resulting average stock, service level and Bullwhip effect, of the studied supply chain, is quantitatively assessed. A case study of an Italian district has been studied, taking into account three echelons: suppliers, central stock, and hospitals. A model of the various supply chain configurations has been created with the use of the simulation. Specifically, 24 supply chain configurations have been examined, stemming from the combination of several supply chain design parameters, namely: transshipment policies (Emergency Lateral Transshipment or Total Inventory Equalization); re-order and inventory management policies (Economic Order Quantity or Economic Order Interval); required service levels (90% or 95%); the number of available vans (one or two). For each configuration, hospital average stock, service level and a “Bullwhip effect” analysis are computed. To know which input variables are statistically significant, a DoE (Design of Experiments) analysis has been executed. The output of this paper provides useful insights and suggestions to optimize the healthcare logistic and drug supply chain. According to the developed DoE analysis, it can be stated that the introduction of transshipment policies provides important improvement in terms of service and stock levels. To reduce the Bullwhip effect, which results in a service level decreasing, and in a managing stock costs increasing, it is worth to adopt an EOQ re-order policy. This research gives practical recommendations to the studied system, in order to reduce costs and maintain a very satisfactory service level. This paper fulfils an identified need to study which combination of transshipment policies, re-order/inventory management policies and required service levels, can be the

  12. Registry of kidney biopsy in a single center in Puerto Rico: university district hospital.

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    Báez Bonilla, Rafael; Parrilla, Francisco; Kidd, Ortiz; Cangiano, José L

    2011-01-01

    Glomerular diseases continue to be the leading cause of end-stage renal disease globally. Renal biopsy plays a fundamental role in the evaluation of glomerular diseases not only to establish an accurate diagnosis but also help deciding on appropriate treatment and assessing prognosis. The prevalence of glomerular disease and the clinical indications for kidney biopsies are poorly delineated in Puerto Rico. We undertook a retrospective analysis of the indications, clinical presentation and pathologic reports in renal biopsies performed at the University District Hospital in San Juan, Puerto Rico from the year 1995 to 2008. A total of 208 kidney biopsies showed a predominance of membranous nephropathy representing 20% of the studied population. Women were more frequently biopsied than men (57.2% vs. 42.7%). Lupus nephritis, a condition affecting mostly women was identified in 16.9% of the patients. Minimal change disease was reported in 13.6% of the patients, a condition that affects mostly children and adolescents. In contrast to other geographical areas IgAN was reported only in 6.3% and FSG in 0.9% of patients. In our biopsied patient population, membranous nephropathy is the most common primary glomerular disease and lupus erythematosus the most frequent secondary glomerular disease.

  13. Physicians' nutritional counselling practices: A study in district hospitals of Chhattisgarh

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    Ashish Sharma

    2013-04-01

    Full Text Available Introduction: Nutrition counseling is an important tool for fostering healthy nutrition behavior among individuals. Physicians play a strategic role in imparting nutrition advice to their patient during daily encounters in healthcare settings. Present study explored nutritional counseling practices and attitudes of physicians working at district hospitals in Chhattisgarh state in India. Materials and Methods: A cross-sectional study was conducted to explore present scenario of nutritional counseling practices by Physicians from 1 st April to 30 th June 2011. Questionnaires and observation guides were framed based on previous studies. Both 3-point and 5-point Likert scale were used to explore the knowledge, satisfaction, and attitude related statements. Results: Majority of the respondents (76% were strongly in favor of training in nutrition counseling and 35% believed that they should spend more time exploring dietary habit of patients in routine practice. Fifty-four percent of practitioners were of the opinion that counseling is futile and 62% considered counseling as time-consuming process. Majority of physician expressed their willingness to undergo additional training in nutrition. Discussion: In view of emerging burden of chronic disease related to nutrition and life style, it is imperative that physician should be trained adequately so as to advice their patients appropriately, pertaining to nutrition.

  14. Pediatric emergency care capacity in a low-resource setting: An assessment of district hospitals in Rwanda

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    Shoveller, Jean; Tuyisenge, Lisine; Kenyon, Cynthia; Cechetto, David F.; Lynd, Larry D.

    2017-01-01

    Background Health system strengthening is crucial to improving infant and child health outcomes in low-resource countries. While the knowledge related to improving newborn and child survival has advanced remarkably over the past few decades, many healthcare systems in such settings remain unable to effectively deliver pediatric advance life support management. With the introduction of the Emergency Triage, Assessment and Treatment plus Admission care (ETAT+)–a locally adapted pediatric advanced life support management program–in Rwandan district hospitals, we undertook this study to assess the extent to which these hospitals are prepared to provide this pediatric advanced life support management. The results of the study will shed light on the resources and support that are currently available to implement ETAT+, which aims to improve care for severely ill infants and children. Methods A cross-sectional survey was undertaken in eight district hospitals across Rwanda focusing on the availability of physical and human resources, as well as hospital services organizations to provide emergency triage, assessment and treatment plus admission care for severely ill infants and children. Results Many of essential resources deemed necessary for the provision of emergency care for severely ill infants and children were readily available (e.g. drugs and laboratory services). However, only 4/8 hospitals had BVM for newborns; while nebulizer and MDI were not available in 2/8 hospitals. Only 3/8 hospitals had F-75 and ReSoMal. Moreover, there was no adequate triage system across any of the hospitals evaluated. Further, guidelines for neonatal resuscitation and management of malaria were available in 5/8 and in 7/8 hospitals, respectively; while those for child resuscitation and management of sepsis, pneumonia, dehydration and severe malnutrition were available in less than half of the hospitals evaluated. Conclusions Our assessment provides evidence to inform new strategies

  15. Assessment and Availability of Trauma Care Services in a District Hospital of South India; A Field Observational Study

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    Pallavi Sarji Uthkarsh

    2016-04-01

    Full Text Available Objective: To assess the availability of trauma care services in a district referral hospital of Southern India. Methods: This was a cross-sectional study being performed during 2013 in a tertiary healthcare centre in Southern Indian. A detailed assessment of trauma care services was done in a 400 bed speciality hospital which is an apex referral hospital in the public health system using a check list based on WHO guidelines for evaluation of essential trauma care services, along with in-depth interviews of hospital stake holders and key informants. Results: The hospital had physical infrastructure in terms of emergency room, inpatient wards, operation theatres, intensive care unit and blood bank facilities. The recently constructed designated building for trauma care services was not operational and existing facilities were used beyond capacity. A designated trauma team was lacking and speciality services for managing polytrauma were deficient and thus, existing personnel were performing multiple tasks. Neurosurgeons and rehabilitative nursing staff were unavailable, and a radiographer was not available on a 24/7 basis. Existing nursing personnel had not received any formal training in trauma care and standard operating protocols were not available for trauma care. Resources for acute resuscitation were partially adequate. The hospital lacked adequate resources to manage head, abdomen, chest and spine injuries, and most of the polytrauma cases were referred to nearby city hospitals. Conclusion: District hospital, the only referral hospital in public health system for trauma victims of that region, had inadequate resources to manage trauma victims, which was probably responsible for delay in trauma care, improper referrals, high cost of care and poor outcomes.

  16. Language Disorder In Schizophrenia Patient: A Case Study Of Five Schizophrenia Paranoid Patients In Simeulue District Hospital

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    Kurnia, Beby Febri

    2015-01-01

    Language disorder in schizophrenia patients is an acquired language disorder due to thought disorder. This analysis analyzed language disorder in schizophrenia paranoid patients in Simeulue District Hospital. The objective of this analysis were: (1) to find out the types of schizophrenic speech found in schizophrenia paranoid patients, (2) to find out the most dominant type of schizophrenia speech found in schizophrenia paranoid patients, and (3) to find out which patient has most severe lang...

  17. Challenges of Asthma Management for School Nurses in Districts with High Asthma Hospitalization Rates

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    Liberatos, Penny; Leone, Jennifer; Craig, Ann Marie; Frei, Elizabeth Mary; Fuentes, Natalie; Harris, India Marie

    2013-01-01

    Background: School nurses play a central role in assisting elementary school children in managing their asthma, especially those in higher-risk school districts that are at increased risk of uncontrolled asthma. Study purposes are to (1) identify barriers to asthma management by school nurses in higher-risk school districts; and (2) assess the…

  18. Effectiveness of a clinical pathway for acute stroke care in a district general hospital: an audit

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    Siegert Richard J

    2006-02-01

    Full Text Available Abstract Background Organised stroke care saves lives and reduces disability. A clinical pathway might be a form of organised stroke care, but the evidence for the effectiveness of this model of care is limited. Methods This study was a retrospective audit study of consecutive stroke admissions in the setting of an acute general medical unit in a district general hospital. The case-notes of patients admitted with stroke for a 6-month period before and after introduction of the pathway, were reviewed to determine data on length of stay, outcome, functional status, (Barthel Index, BI and Modified Rankin Scale, MRS, Oxfordshire Community Stroke Project (OCSP sub-type, use of investigations, specific management issues and secondary prevention strategies. Logistic regression was used to adjust for differences in case-mix. Results N = 77 (prior to the pathway and 76 (following the pathway. The median (interquartile range, IQR age was 78 years (67.75–84.25, 88% were European NZ and 37% were male. The median (IQR BI at admission for the pre-pathway group was less than the post-pathway group: 6 (0–13.5 vs. 10 (4–15.5, p = 0.018 but other baseline variables were statistically similar. There were no significant differences between any of the outcome or process of care variables, except that echocardiograms were done less frequently after the pathway was introduced. A good outcome (MRS Conclusion A clinical pathway for acute stroke management appeared to have no benefit for the outcome or processes of care and may even have been associated with worse outcomes. These data support the conclusions of a recent Cochrane review.

  19. Dengue and Chikungunya fever among viral diseases in outpatient febrile children in Kilosa district hospital, Tanzania.

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    Chipwaza, Beatrice; Mugasa, Joseph P; Selemani, Majige; Amuri, Mbaraka; Mosha, Fausta; Ngatunga, Steve D; Gwakisa, Paul S

    2014-11-01

    Viral etiologies of fever, including dengue, Chikungunya, influenza, rota and adeno viruses, cause major disease burden in tropical and subtropical countries. The lack of diagnostic facilities in developing countries leads to failure to estimate the true burden of such illnesses, and generally the diseases are underreported. These diseases may have similar symptoms with other causes of acute febrile illnesses including malaria and hence clinical diagnosis without laboratory tests can be difficult. This study aimed to identify viral etiologies as a cause of fever in children and their co-infections with malaria. A cross sectional study was conducted for 6 months at Kilosa district hospital, Tanzania. The participants were febrile children aged 2-13 years presented at the outpatient department. Diagnostic tests such as IgM and IgG ELISA, and PCR were used. A total of 364 patients were enrolled, of these 83(22.8%) had malaria parasites, 76 (20.9%) had presumptive acute dengue infection and among those, 29(38.2%) were confirmed cases. Dengue was more likely to occur in children ≥ 5 years than in dengue infection or malaria. Co-infections between malaria and Chikungunya, malaria and dengue fever as well as Chikungunya and dengue were detected. Most patients with Chikungunya and dengue infections were treated with antibacterials. Furthermore, our results revealed that 5(5.2%) of patients had influenza virus while 5(12.8%) had rotavirus and 2(5.1%) had adenovirus. Our results suggest that even though viral diseases are a major public health concern, they are not given due recognition as a cause of fever in febrile patients. Emphasis on laboratory diagnostic tests for proper diagnosis and management of febrile patients is recommended.

  20. A PROSPECTIVE STUDY OF MECONIUM ASPIRATION SYNDROME IN NEWBORNS IN A DISTRICT HOSPITAL IN SOUTHERN INDIA

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    Vijayalakshmi

    2015-06-01

    Full Text Available AIM OF THE STUDY: 1. To study the incidence and risk factors of MAS in neonates, 2. To study the outcome of using appropriate respiratory support (CPAP and mechanical ventilation in neonates with MAS and 3. To find the MAS related mortality rates. MATERIALS AND METHODS: T he present study was a single centre, descriptive, prospective and observational cross sectional study, done over a period of one year from 1 st of May 2014 to 30 th of April 2015. Only inborn cases with history of birth through MSAF were included. Gestation al age, birth weight, type of meconium, Apgar score at 1min and 5 min, duration of requirement of O2, CPAP, SIMV and number of deaths were recorded and analysed further. RESULTS: The study was performed over a period of 12 months from May 2014 to April 2015. During the study period, total number of deliveries in the district hospital was 9934. Total number of live births and still births were 9697 and 237 respectively. Total NICU a dmissions were 2237. Total MSAF cases were 563(5.67% of total deliveries. Total MAS cases were 220(2.21% of total deliveries and 39.08% of total MSAF cases. Percentage of MAS cases on ventilatory support was 35.45% (78/220, 0.19% of total number of deliv eries. Total MAS related deaths were 19(8.64% of total MAS cases. CONCLUSION: The incidence of MAS was 2.21% of total deliveries. Post maturity, low Apgar scores and thick MSAF were the risk factors associated with severe MAS and high mortality rate. Usi ng appropriate respiratory support in severe MAS cases had shown low mortality rate. The Mortality rate of MAS was 8.64%.

  1. A way for reducing drug supply chain cost for a hospital district: A case study

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    Leonardo Postacchini

    2016-03-01

    Full Text Available Purpose: This work aims at providing insights to optimise healthcare logistic of the drug management, in order to deal with the healthcare expenditure cut. In this paper the effects of different drug supply chain configurations, on the resulting average stock, service level and Bullwhip effect, of the studied supply chain, is quantitatively assessed. Design/methodology/approach: A case study of an Italian district has been studied, taking into account three echelons: suppliers, central stock, and hospitals. A model of the various supply chain configurations has been created with the use of the simulation. Specifically, 24 supply chain configurations have been examined, stemming from the combination of several supply chain design parameters, namely: transshipment policies (Emergency Lateral Transshipment or Total Inventory Equalization; re-order and inventory management policies (Economic Order Quantity or Economic Order Interval; required service levels (90% or 95%; the number of available vans (one or two. For each configuration, hospital average stock, service level and a “Bullwhip effect” analysis are computed. To know which input variables are statistically significant, a DoE (Design of Experiments analysis has been executed. Findings: The output of this paper provides useful insights and suggestions to optimize the healthcare logistic and drug supply chain. According to the developed DoE analysis, it can be stated that the introduction of transshipment policies provides important improvement in terms of service and stock levels. To reduce the Bullwhip effect, which results in a service level decreasing, and in a managing stock costs increasing, it is worth to adopt an EOQ re-order policy. Practical implications: This research gives practical recommendations to the studied system, in order to reduce costs and maintain a very satisfactory service level. Originality/value: This paper fulfils an identified need to study which combination of

  2. Prevalence and assessment of malnutrition among children attending the Reproductive and Child Health clinic at Bagamoyo District Hospital, Tanzania.

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    Juma, Omar Ali; Enumah, Zachary Obinna; Wheatley, Hannah; Rafiq, Mohamed Yunus; Shekalaghe, Seif; Ali, Ali; Mgonia, Shishira; Abdulla, Salim

    2016-10-19

    Malnutrition has long been associated with poverty, poor diet and inadequate access to health care, and it remains a key global health issue that both stems from and contributes to ill-health, with 50 % of childhood deaths due to underlying undernutrition. The purpose of this study was to determine the prevalence of malnutrition among children under-five seen at Bagamoyo District Hospital (BDH) and three rural health facilities ranging between 25 and 55 km from Bagamoyo: Kiwangwa, Fukayosi, and Yombo. A total of 63,237 children under-five presenting to Bagamoyo District Hospital and the three rural health facilities participated in the study. Anthropometric measures of age, height/length and weight and measurements of mid-upper arm circumference were obtained and compared with reference anthropometric indices to assess nutritional status for patients presenting to the hospital and health facilities. Overall proportion of stunting, underweight and wasting was 8.37, 5.74 and 1.41 % respectively. Boys were significantly more stunted, under weight and wasted than girls (p-value malnutrition remains a problem within Tanzania; however our data suggests that the population presenting to BDH and rural health facilities presented with decreased rates of malnutrition compared to the general population. Hospital and facility attending populations of under-five children in and around Bagamoyo suffer moderately high rates of malnutrition. Current nutrition programs focus on education for at risk children and referral to regional hospitals for malnourished children. Even though the general population has even greater malnutrition than the population presenting at the hospital, in areas of high malnutrition, hospital-based interventions should also be considered as centralized locations for reaching thousands of malnourished children under-five.

  3. Epidemiology of measles in the Central Region of Ghana: a five-year case review in three district hospitals.

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    Bosu, W K; Odoom, S; Deiter, P; Essel-Ahun, M

    2003-06-01

    As part of a national accelerated campaign to eliminate measles, we conducted a study, to define the epidemiology of measles in the Central Region. A descriptive survey was carried out on retrospective cases of measles. Patients were drawn from the three district hospitals (Assin, Asikuma and Winneba Hospitals) with the highest number of reported cases in the region. Records of outpatient and inpatient measles patients attending the selected health facilities between 1996 and 2000. Data on reported measles cases in all health facilities in the three study, districts were also analysed. The distribution of measles cases in person (age and sex), time (weekly, or monthly, trends) and place (residence), the relative frequency, of cases, and the outcome of treatment. There was an overall decline in reported cases of measles between 1996 and 2000 both in absolute terms and relative to other diseases. Females constituted 48%-52% of the reported 1508 cases in the hospitals. The median age of patients was 36 months. Eleven percent of cases were aged under nine months; 66% under five years and 96% under 15 years. With some minor variations between districts, the highest and lowest transmission occurred in March and September respectively. Within hospitals, there were sporadic outbreaks with up to 34 weekly cases. In Ghana, children aged nine months to 14 years could be appropriately targeted for supplementary, measles immunization campaigns. The best period for the campaigns is during the low transmission months of August to October. Retrospective surveillance can expediently inform decisions about the timing and target age groups for such campaigns.

  4. A multifaceted intervention to implement guidelines and improve admission paediatric care in Kenyan district hospitals: a cluster randomised trial.

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    Philip Ayieko

    2011-04-01

    Full Text Available BACKGROUND: In developing countries referral of severely ill children from primary care to district hospitals is common, but hospital care is often of poor quality. However, strategies to change multiple paediatric care practices in rural hospitals have rarely been evaluated. METHODS AND FINDINGS: This cluster randomized trial was conducted in eight rural Kenyan district hospitals, four of which were randomly assigned to a full intervention aimed at improving quality of clinical care (evidence-based guidelines, training, job aides, local facilitation, supervision, and face-to-face feedback; n  =  4 and the remaining four to control intervention (guidelines, didactic training, job aides, and written feedback; n  =  4. Prespecified structure, process, and outcome indicators were measured at baseline and during three and five 6-monthly surveys in control and intervention hospitals, respectively. Primary outcomes were process of care measures, assessed at 18 months postbaseline. In both groups performance improved from baseline. Completion of admission assessment tasks was higher in intervention sites at 18 months (mean  =  0.94 versus 0.65, adjusted difference 0.54 [95% confidence interval 0.05-0.29]. Uptake of guideline recommended therapeutic practices was also higher within intervention hospitals: adoption of once daily gentamicin (89.2% versus 74.4%; 17.1% [8.04%-26.1%]; loading dose quinine (91.9% versus 66.7%, 26.3% [-3.66% to 56.3%]; and adequate prescriptions of intravenous fluids for severe dehydration (67.2% versus 40.6%; 29.9% [10.9%-48.9%]. The proportion of children receiving inappropriate doses of drugs in intervention hospitals was lower (quinine dose >40 mg/kg/day; 1.0% versus 7.5%; -6.5% [-12.9% to 0.20%], and inadequate gentamicin dose (2.2% versus 9.0%; -6.8% [-11.9% to -1.6%]. CONCLUSIONS: Specific efforts are needed to improve hospital care in developing countries. A full, multifaceted intervention was associated

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

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

    2011-11-01

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

  6. Impact of Lean on patient cycle and waiting times at a rural district hospital in KwaZulu-Natal

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    Logandran Naidoo

    2016-03-01

    Full Text Available Background: Prolonged waiting time is a source of patient dissatisfaction with health care and is negatively associated with patient satisfaction. Prolonged waiting times in many district hospitals result in many dissatisfied patients, overworked and frustrated staff, and poor quality of care because of the perceived increased workload.Aim: The aim of the study was to determine the impact of Lean principles techniques, and tools on the operational efficiency in the outpatient department (OPD of a rural district hospital.Setting: The study was conducted at the Catherine Booth Hospital (CBH – a rural district hospital in KwaZulu-Natal, South Africa.Methods: This was an action research study with pre-, intermediate-, and post-implementation assessments. Cycle and waiting times were measured by direct observation on two occasions before, approximately two-weekly during, and on two occasions after Lean implementation. A standardised data collection tool was completed by the researcher at each of the six key service nodes in the OPD to capture the waiting times and cycle times.Results: All six service nodes showed a reduction in cycle times and waiting times between the baseline assessment and post-Lean implementation measurement. Significant reduction was achieved in cycle times (27%; p < 0.05 and waiting times (from 11.93 to 10 min; p = 0.03 at the Investigations node. Although the target reduction was not achieved for the Consulting Room node, there was a significant reduction in waiting times from 80.95 to 74.43 min, (p < 0.001. The average efficiency increased from 16.35% (baseline to 20.13% (post-intervention.Conclusion: The application of Lean principles, tools and techniques provides hospital managers with an evidence-based management approach to resolving problems and improving quality indicators.

  7. Antibiotic prophylaxis compliance for clean-contaminated wounds in a district hospital in Jakarta

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    Syachroni Syachroni

    2016-01-01

    Full Text Available AbstrakLatar belakang: Insidens infeksi luka operasi (ILO masih menjadi masalah namun kejadiannya dapatdikurangi dengan tindakan pencegahan yaitu antara lain dengan pemberian antibiotik profilaksis.Penelitian ini bertujuan untuk menilai kesesuaian penggunaan antibiotik profilaksis pada pasien bedahbersih-terkontaminasi.Metode: Penelitian potong lintang di sebuah rumah sakit umum daerah (RSUD di Jakarta pada periode1 Januari sampai 31 Desember 2013. Data berasal dari rekam medik pasien dewasa yang menjalanipembedahan dengan kriteria kelas luka bedah bersih-terkontaminasi kecuali bedah sesar. Analisis datadilakukan secara deskriptif. Sebagai standar penggunaan antibiotika digunakan Permenkes RI No.2406/2011 tentang pedoman antibiotik nasional dan pedoman standar internasional untuk profilaksis bedah.Hasil: Sebanyak 626 subjek diikutsertakan dalam penelitian dengan bedah ginekologi (49,5% dangenitourinari (32,6% merupakan tindakan bedah terbanyak dan lebih dari 80% bedah elektif. Jenisantibiotik yang paling umum digunakan baik preoperatif maupun postoperatif adalah seftriakson (49,8%,ampisilin/sulbaktam (11,7% dan sefuroksim (8,3%. Keseluruhan ketepatan antibiotik profilaksis diketahui96,8% tepat indikasi prosedur bedah, 21,5% tepat obat dan hanya 2,3% tepat waktu pemberiannya 60menit sebelum operasi.Kesimpulan: Kepatuhan antibiotik profilaksis untuk bedah bersih-terkontaminasi di suatu RSUD Jakartabelum sesuai dengan pedoman nasional dan standar internasional. (Health Science Journal of Indonesia2015;6:57-62Kata kunci: antibiotik, bedah, bersih-terkontaminasi, kepatuhan, profilaksis. AbstractBackground: The incidence of surgical site infection (SSI is still a problem, but its occurrence can bereduced by preventive action such as the provision of antibiotic prophylaxis in surgery. This study aimedto describe the compliance of antibiotic prophylaxis in clean-contaminated wounds.Methods: This cross-sectional study design was conducted in a district

  8. Determinants of pre-eclampsia: A case-control study in a district hospital in South India

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    Kumar S

    2010-01-01

    Full Text Available Objective: The objective was to study the determinants of pre-eclampsia among pregnant women admitted for delivery in a district hospital. Materials and Methods: A case-control study was conducted at District Lady Goschen Hospital, Dakshina Kannada district, Karnataka, South India. The group of pregnant women with pre-eclampsia comprised those with hypertension after the 20th week of gestation with associated proteinuria, and controls were pregnant women not diagnosed with pre-eclampsia. A total of 100 cases and 100 controls were selected for the year 2006. Study variables included mother′s age, parity, body mass index, history of chronic hypertension, history of diabetes, history of renal disease, family history of hypertension, and history of pre-eclampsia in earlier pregnancy. Statistical Analysis: Chi-square test, and crude and adjusted odds ratio with 95% confidence intervals were used for statistical analysis. Results: Significant risk factors identified in univariate analysis included prepregnancy body mass index (BMI > 25 (OR = 11.27, history of chronic hypertension (OR = 8.65, history of diabetes (OR = 11.0, history of renal disease (OR = 7.98, family history of hypertension (OR = 5.4, history of pre-eclampsia in earlier pregnancy (OR = 9.63, and multiple pregnancy (OR = 4.85. Multiple logistic regression analysis revealed that the prepregnancy BMI of >25 (OR = 7.56, history of chronic hypertension (OR = 6.69, history of diabetes (OR = 8.66, history of renal disease (OR = 5.6, family history of hypertension (OR = 5.48, and multiple pregnancy (OR = 5.73 are the significant risk factors of pre-eclampsia. Conclusion: Pregnant women at risk of pre-eclampsia should be identified and high-quality antenatal care should be given in order to minimize the complications of pre-eclampsia both for the mother and the fetus.

  9. Impact of toxigenic Clostridium difficile colonization and infection among hospitalized adults at a district hospital in southern Taiwan.

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    Yuan-Pin Hung

    Full Text Available BACKGROUND: The impact of toxigenic Clostridium difficile colonization (tCDC in hospitalized patients is not clear. AIM: To study the significance of tCDC in hospitalized patients. METHODS: A prospective study in the medical wards of a regional hospital was performed from January to June 2011. Fecal samples collected from patients at the time of admission were tested for tcdB by real-time polymerase chain reaction (PCR and cultured for C. difficile. The patients were followed up weekly or when they developed diarrhea during hospitalization. If C. difficile was isolated, tcdA and tcdB would be tested by multiplex PCR. The primary outcome was the development of C. difficile-associated diarrhea (CDAD. FINDINGS: Of 168 patients enrolled, females predominated (87, 51.8%, and the mean patient age was 75.4 years old. Approximately 70% of the patients were nursing home residents, and one third had a recent hospitalization within the prior three months. Twenty-eight (16.7% patients had tCDC, including 16 (9.5% patients with tCDC at the time of admission and 12 (7.2% with tCDC during the follow-up period. With regard to the medications taken during hospitalization, the patients were more likely to have tCDC if they had received more than one class of antibiotics than if they had received monotherapy (odds ratio [OR] 6.67, 95% confidence interval [CI] 1.41-31.56, P = 0.01, particularly if they received a glycopeptide in combination with a cephalosporin or penicillin or a cephalosporin and a carbapenem. More patients with tCDC developed CDAD than those without tCDC (17.9%, 5/28 vs. 1.4%, 2/140, P = 0.002. Overall 7 (4.2% of the 168 patients developed CDAD, and crude mortality rate of those with and without tCDC was similar (21.4%, 6/28 vs. 19.4%, 27/140, P = 0.79. CONCLUSION: Recent use of glycopeptides and β-lactam antibiotics is associated with toxigenic C. difficile colonization, which is a risk factor for developing C. difficile-associated diarrhea.

  10. Impact of HIV comprehensive care and treatment on serostatus disclosure among Cameroonian patients in rural district hospitals.

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    Marie Suzan-Monti

    Full Text Available This work aimed to analyze the rate of disclosure to relatives and friends over time and to identify factors affecting disclosure among seropositive adults initiating antiretroviral therapy (ART in rural district hospitals in the context of decentralized, integrated HIV care and task-shifting to nurses in Cameroon. Stratall was a 24-month, randomized, open-label trial comparing the effectiveness of clinical monitoring alone with laboratory plus clinical monitoring on treatment outcomes. It enrolled 459 HIV-infected ART-naive adults in 9 rural district hospitals in Cameroon. Participants in both groups were sometimes visited by nurses instead of physicians. Patients with complete data both at enrolment (M0 and at least at one follow-up visit were included in the present analysis. A mixed Poisson regression was used to estimate predictors of the evolution of disclosure index over 24 months (M24.The study population included 385 patients, accounting for 1733 face-to-face interviews at follow-up visits from M0 to M24. The median [IQR] number of categories of relatives and friends to whom patients had disclosed was 2 [1]-[3] and 3 [2]-[5] at M0 and M24 (p-trend<0.001, respectively. After multiple adjustments, factors associated with disclosure to a higher number of categories of relatives and friends were as follows: having revealed one's status to one's main partner, time on ART, HIV diagnosis during hospitalization, knowledge on ART and positive ratio of follow-up nurse-led to physician-led visits measuring task-shifting. ART delivered in the context of decentralized, integrated HIV care including task-shifting was associated with increased HIV serological status disclosure.

  11. Out of Pocket Expenditure for Hospitalization among Below Poverty Line Households in District Solan, Himachal Pradesh, India, 2013.

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    Anadi Gupt

    Full Text Available Health insurance schemes, like Rashtriya Swasthya Bima Yojana (RSBY, should provide financial protection against catastrophic health costs by reducing out of pocket expenditure (OOPE for hospitalizations. We estimated and compared the proportion and extent of OOPE among below poverty line (BPL families beneficiaries and not beneficiaries by RSBY during hospitalizations in district Solan, H.P., India, 2013.We conducted a cross sectional survey among hospitalized BPL families in the beneficiaries and non-beneficiaries groups. We compared proportion incurring OOPE and its extent during hospitalization, pre/post-hospitalization periods in different domains.Overall, proportion of non-beneficiaries who incurred OOPE was higher than the beneficiaries but it was not statistically significant (87.2% vs. 80.9%. The median overall OOPE was $39 (Rs 2567 in the non-beneficiaries group as compared to $11 (Rs 713 in the beneficiaries group (p<0.01. Median expenditure on in house and out house drugs and consumables was $23 (Rs 1500 in the non beneficiaries group as compared to nil in the beneficiaries group (p<0.01. Non-beneficiary status was significantly associated [OR: 2.4 (1.3-4.3] with OOPE above median independently and also after adjusting for various covariates.RSBY has decreased the extent of OOPE among the beneficiaries; however OOPE was incurred mainly due to purchase of drugs from outside the health facility. The treatment seeking behaviour in beneficiaries group has improved among comparatively older group with chronic conditions. RSBY has enabled beneficiaries to get more facilities such as drugs, consumables and diagnostics from the health facility.

  12. Junior doctor dementia champions in a district general hospital (innovative practice).

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    Wilkinson, Iain; Coates, Anna; Merrick, Sophie; Lee, Chooi

    2016-03-01

    Dementia is a common condition in the UK with around 25% of patients in acute hospitals having dementia. In the UK, there is national guidance on the assessment of cognitive impairment in acute hospitals. This article is a qualitative study of junior doctors' experiences as part of a dementia and delirium team involved in changing the care of patients with dementia in a hospital in the UK. It draws on data from a focus group and follow-up questionnaire in two hospital trusts. We examine what drives doctors to become involved in such projects and the effects of this experience upon them. We suggest a typology for getting junior doctors involved in projects generating change when working with patients with dementia. Being more actively involved in caring for and developing services for patients with dementia may represent the crossing of an educational threshold for these junior doctors.

  13. A study on risk factors of breast cancer among patients attending the tertiary care hospital, in Udupi district

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    Ramchandra Kamath

    2013-01-01

    Full Text Available Background: Cancer has become one of the ten leading causes of death in India. Breast cancer is the most common diagnosed malignancy in India, it ranks second to cervical cancer. An increasing trend in incidence is reported from various registries of national cancer registry project and now India is a country with largest estimated number of breast cancer deaths worldwide. Aim: To study the factors associated with breast cancer. Objectives: To study the association between breast cancer and selected exposure variables and to identify risk factors for breast cancer. Materials and Methods: A hospital based Case control study was conducted at Shirdi Sai Baba Cancer Hospital and Research Center, Manipal, Udupi District. Results: Total 188 participants were included in the study, 94 cases and 94 controls. All the study participants were between 25 to 69 years of age group. The cases and controls were matched by ± 2 years age range. Non vegetarian diet was one of the important risk factors (OR 2.80, CI 1.15-6.81. More than 7 to 12 years of education (OR 4.84 CI 1.51-15.46 had 4.84 times risk of breast cancer as compared with illiterate women. Conclusion: The study suggests that non vegetarian diet is the important risk factor for Breast Cancer and the risk of Breast Cancer is more in educated women as compared with the illiterate women. Limitation: This is a Hospital based study so generalisability of the findings could be limited.

  14. Impact of a Baby-Friendly hospital on breastfeeding indicators in Shaqlawa district in Erbil governorate, Kurdistan region of Iraq.

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    Shaker, N Z; Hasan, S S; Ismail, Z A

    2016-03-15

    This study aimed to assess the impact of the Baby-Friendly Hospital Initiative on WHO-defined breastfeeding indicators in Shaqlawa district in Kurdistan region of Iraq. A household survey was carried out on a purposive non-probability sample of 200 mothers with a child aged < 30 months. Mothers were interviewed using a structured form to determine demographic data and feeding practices of the most recent child. The rate of early initiation of breastfeeding was 38.1%, exclusive breastfeeding was 15.4% and continued breastfeeding was 61.0% and 39.5% at 1 and 2 years of age respectively. A significant relationship was found between delivery at the Baby- Friendly accredited hospital and early initiation of breastfeeding but not with exclusive or continued breastfeeding. While continued breastfeeding at 1 year and 2 year was good, early initiation and exclusive breastfeeding indicators were not at an acceptable level, which indicates an ineffective role for the Baby-Friendly Hospital Initiative.

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

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    Coffey, Diane

    2014-08-01

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

  16. Study on the Indications for and Factors Related to Cesarean Section at Three District Hospitals in Shanghai

    Institute of Scientific and Technical Information of China (English)

    Hong LIANG; Li-feng ZHOU; Bing-shun WANG; Ye ZHONG

    2006-01-01

    Objective To understand the indications for and factors related to cesarean section(CS).Methods Pregnant women who attended health examination at three selected district hospitals were investigated from May 2001 to February 2003.Results Among 933 puerperas, the CS rate was 37. 62%. The top four indications for CS were fetal distress (36.5%), social factors (35.9%), relative cephalopelvic disproportion (18.5%) and pregnancy complications (6.3%) respectively. The result of regression analysis showed that puerperas who were overweight before pregnancy,had no confidence in vaginal delivery and had macrosomia were more likely to have CS.Conclusion At present, the CS rate in Shanghai was rather high. The main indications for CS were fetal distress and social factors. The high CS rate was associated with the psychological factor and some demographic factors such as birth weight and puerperas' weight before pregnancy.

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

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    Takalani G. Tshitangano

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Takalani G. Tshitangano

    2013-01-01

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

  19. An intervention to improve paediatric and newborn care in Kenyan district hospitals: Understanding the context

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    Opondo Charles

    2009-07-01

    Full Text Available Abstract Background It is increasingly appreciated that the interpretation of health systems research studies is greatly facilitated by detailed descriptions of study context and the process of intervention. We have undertaken an 18-month hospital-based intervention study in Kenya aiming to improve care for admitted children and newborn infants. Here we describe the baseline characteristics of the eight hospitals as environments receiving the intervention, as well as the general and local health system context and its evolution over the 18 months. Methods Hospital characteristics were assessed using previously developed tools assessing the broad structure, process, and outcome of health service provision for children and newborns. Major health system or policy developments over the period of the intervention at a national level were documented prospectively by monitoring government policy announcements, the media, and through informal contacts with policy makers. At the hospital level, a structured, open questionnaire was used in face-to-face meetings with senior hospital staff every six months to identify major local developments that might influence implementation. These data provide an essential background for those seeking to understand the generalisability of reports describing the intervention's effects, and whether the intervention plausibly resulted in these effects. Results Hospitals had only modest capacity, in terms of infrastructure, equipment, supplies, and human resources available to provide high-quality care at baseline. For example, hospitals were lacking between 30 to 56% of items considered necessary for the provision of care to the seriously ill child or newborn. An increase in spending on hospital renovations, attempts to introduce performance contracts for health workers, and post-election violence were recorded as examples of national level factors that might influence implementation success generally. Examples of factors

  20. Perception of staff nurses regarding quality audit process in hospitals of Mangalore District, Karnataka.

    Science.gov (United States)

    Rao, Radhika K; Alva, Janet; Sudhakar, Christopher; Lhamo, Nyima; Jose, Dona Mary; Mathew, Jestymol; Paul, Dinsa; Netto, Nimil; Sunny, Geethu Ann

    2012-01-01

    As in other fields, auditing in clinical nursing can go a long way in enhancing the productivity of nurses. Nursing audit is helpful in ascertaining the extent to which the organisation complies with the relevant quality norms and can involve in procedural or assessment criteria. Purposive sampling technique was used in this study which involved 255 staff nurses from two hospitals of Karnataka. The study tools included demographic proforma and audit scale (arbitrarily classified as unfavourable and favourable perception) to evaluate the impact of hospital and community-based clinical audit programme. It was shown that in selected hospitals, staff nurses had positive perception about the audit process; they also reported improvement in their levels of knowledge, skill and patient care though frequent audit hindered them in discharge of their duties.

  1. Characteristics of patients who are admitted with or acquire Pressure Ulcers in a District General Hospital; a 3 year retrospective analysis

    OpenAIRE

    Worsley, Peter R.; Smith, Glenn; Schoonhoven, Lisette; Bader, Dan L.

    2016-01-01

    Abstract Aim The study aimed to characterize demographic and clinical practice factors associated with community (CAPU) and hospital acquired pressure ulcers (HAPU). Design A comparative retrospective evaluation of pressure ulcer data, collected from a district general hospital. Methods Demographic and pressure ulcer related data were collected from patients at risk of developing a pressure ulcer, collated by a single observer using a standardized tool. Comparisons were made within and betwee...

  2. Repeat HIV testing during pregnancy and delivery: missed opportunities in a rural district hospital in Zambia.

    Science.gov (United States)

    Heemelaar, Steffie; Habets, Nicole; Makukula, Ziche; van Roosmalen, Jos; van den Akker, Thomas

    2015-03-01

    To assess coverage of repeat HIV testing among women who delivered in a Zambian hospital. HIV testing of pregnant women and repeat testing every 3 months during pregnancy and breastfeeding is the recommended policy in areas of high HIV prevalence. A prospective implementation study in a second-level hospital in rural Zambia. Included were all pregnant women who delivered in hospital during May and June 2012. Data regarding antenatal visits and HIV testing were collected by two investigators using a standardised form. Of 401 women who delivered in hospital, sufficient antenatal data could be retrieved for 322 (80.3%) women. Of these 322 women, 301 (93.5%) had attended antenatal care (ANC) at least once. At the time of discharge after delivery in hospital, 171 (53.1%) had an unclear HIV status because their negative test result was more than 3 months ago or of an unknown date, or because they had not been tested at all during pregnancy or delivery. An updated HIV status was present for 151 (46.9%) women: 25 (7.8%) were HIV positive and 126 (39.1%) had tested negative within the last 3 months. In this last group, 79 (24.5%) had been tested twice or more during pregnancy. During the study period, none of the women was tested during admission for delivery. Despite high ANC coverage, opportunities for repeat HIV testing were missed in almost half of all women who delivered in this hospital in a high-prevalence HIV setting. © 2014 John Wiley & Sons Ltd.

  3. The problem of illegally induced abortion: results from a hospital-based study conducted at district level in Dar es Salaam

    DEFF Research Database (Denmark)

    Rasch, V; Muhammad, H; Urassa, E;

    2000-01-01

    to describe the circumstances which characterized the abortion. The population of this cross-sectional questionnaire study comprised patients from Temeke District Hospital, Dar es Salaam, Tanzania. After an in-depth confidential interview, 603 women with incomplete abortion were divided into two groups: 362...

  4. Postgraduate training for family medicine in a rural district hospital in South Africa: Appropriateness and sufficiency of theatre procedures as a sentinel indicator

    Directory of Open Access Journals (Sweden)

    Dawie Du Plessis

    2016-03-01

    Full Text Available Background: Since 2007, the postgraduate training of family physicians for South African district hospitals has been formalised. This training differs from European and North American programmes as up to 30% of the skills needed rely on district hospital surgical, obstetrics and anaesthetics procedures, particularly in rural areas, as outlined in the national unit standards. The aim of this study was to evaluate the appropriateness and sufficiency of learning opportunities for these skills in a rural district hospital.Methods: A descriptive, cross-sectional study was undertaken of the number and type of procedures performed in theatre for a 1-year period and compared with the required procedural skills stipulated in the national unit standards. Descriptive statistical analyses were used to analyse categorical data.Results: Three thousand seven hundred and forty-one procedures were performed during the study period. Anaesthesia was the most common procedure, followed by Caesarean section. There were adequate opportunities for teaching most core skills.Conclusions: Sufficient and appropriate learning opportunities exist for postgraduate family medicine training in all the core skills performed in a theatre according to the national unit standards.Keywords: Post Graduate Training, Family Medicine, Procedural Skills, Rural, District hospitals

  5. Occupational Safety Precautions among Nurses at Four Hospitals, Nablus District, Palestine

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    IA Al-Khatib

    2015-10-01

    Full Text Available Occupational hazards, exposure to blood and body fluids (BBF accidents and safety precautions constitute an important public health issue. We assessed the prevalence and determinants of exposure to occupational hazards among nurses, and their knowledge of occupational safety precautions. In a cross-sectional study, we surveyed 332 nurses working in 4 hospitals, Nablus, West Bank, Palestine, by a questionnaire. Bivariate analysis tested the associations between ever exposure and the high likelihood of BBF exposure and the independent socio-demographic and occupational variables. Binary logistic regression analysis was used to assess the associations between the same two exposures and selected independent variables (those significant in the bivariate analysis. Prevalence of ever exposure to BBF was 51.7%, and was associated with working in private and charitable hospitals (OR 2.62, 2.68, respectively, having 4–6 family members (OR 0.52 and “nursing” being as one's top career choice at university (OR 0.48. The prevalence of high likelihood of BBF exposure was 62.2%, and was associated with working in charitable and private hospitals (OR 7.81, 2.43, respectively and “nursing” being as one's top career choice (OR 0.57. Regarding knowledge, most respondents believed it is necessary to enact laws and regulations regarding occupational safety precautions, reported the use of sharps containers, immediate disinfection after an accident, reporting an accident, and using personal protective equipment. Nurses had adequate knowledge of the risks of their hospital work. Nevertheless, they exhibited high prevalence of exposure to BBF accidents. Future studies are needed to re-evaluate existing occupational safety guidelines in hospitals, establish monitoring and evaluation protocols for health care workers' adherence to the guidelines, and institute well-defined policies for reporting occupational injury incidents so these can be handled appropriately.

  6. Occupational Safety Precautions among Nurses at Four Hospitals, Nablus District, Palestine.

    Science.gov (United States)

    Al-Khatib, I A; El Ansari, W; Areqat, T A; Darkhawaja, R A; Mansour, S H; Tucktuck, M A; Khatib, J I

    2015-10-01

    Occupational hazards, exposure to blood and body fluids (BBF) accidents and safety precautions constitute an important public health issue. We assessed the prevalence and determinants of exposure to occupational hazards among nurses, and their knowledge of occupational safety precautions. In a cross-sectional study, we surveyed 332 nurses working in 4 hospitals, Nablus, West Bank, Palestine, by a questionnaire. Bivariate analysis tested the associations between ever exposure and the high likelihood of BBF exposure and the independent socio-demographic and occupational variables. Binary logistic regression analysis was used to assess the associations between the same two exposures and selected independent variables (those significant in the bivariate analysis). Prevalence of ever exposure to BBF was 51.7%, and was associated with working in private and charitable hospitals (OR 2.62, 2.68, respectively), having 4-6 family members (OR 0.52) and "nursing" being as one's top career choice at university (OR 0.48). The prevalence of high likelihood of BBF exposure was 62.2%, and was associated with working in charitable and private hospitals (OR 7.81, 2.43, respectively) and "nursing" being as one's top career choice (OR 0.57). Regarding knowledge, most respondents believed it is necessary to enact laws and regulations regarding occupational safety precautions, reported the use of sharps containers, immediate disinfection after an accident, reporting an accident, and using personal protective equipment. Nurses had adequate knowledge of the risks of their hospital work. Nevertheless, they exhibited high prevalence of exposure to BBF accidents. Future studies are needed to re-evaluate existing occupational safety guidelines in hospitals, establish monitoring and evaluation protocols for health care workers' adherence to the guidelines, and institute well-defined policies for reporting occupational injury incidents so these can be handled appropriately.

  7. Short and medium-term outcomes for general surgery in nonagenarian patients in a district general hospital.

    Science.gov (United States)

    Hayes, A J; Davda, A; El-Hadi, M; Murphy, P; Papettas, T

    2016-07-01

    Introduction Surgeons are increasingly performing surgery on older patients. There are currently no tools specifically for risk prediction in this group. The aim of this study was to review general surgical operations carried out on patients aged over 90 years and their outcome, before comparing these with predictors of morbidity and mortality. Methods A retrospective review was carried out at our district general hospital of all general surgery patients aged over 90 years who underwent a general surgical operation over a period of 14 years. Information collected included demographics, details of procedures, P-POSSUM (Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity), complications and outcomes. Results A total of 119 procedures were carried out, 72 involving entry into the peritoneal cavity. Overall, 14 patients (12%) died within 30 days and 34 (29%) died within one year. Postoperative complications included infection (56%), renal failure (24%), need for transfusion (17%) and readmission within 30 days (11%). Logistical regression analysis showed that the P-POSSUM correlated well with observed mortality and infection was a significant predictor of in-hospital mortality (p=0.003). Conclusions The P-POSSUM correlates significantly with outcome and should be used when planning major elective or emergency surgery in patients over 90 years of age. Infective complications appear to be a significant predictor of postoperative mortality. This study supports operative intervention as an option in this extreme age group but we emphasise the importance of appropriate patient selection and judicious clinical care.

  8. The incidence, aetiology and outcome of acute seizures in children admitted to a rural Kenyan district hospital

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    Maitland Kathryn

    2008-02-01

    Full Text Available Abstract Background Acute seizures are a common cause of paediatric admissions to hospitals in resource poor countries and a risk factor for neurological and cognitive impairment and epilepsy. We determined the incidence, aetiological factors and the immediate outcome of seizures in a rural malaria endemic area in coastal Kenya. Methods We recruited all children with and without seizures, aged 0–13 years and admitted to Kilifi District hospital over 2 years from 1st December 2004 to 30th November 2006. Only incident admissions from a defined area were included. Patients with epilepsy were excluded. The population denominator, the number of children in the community on 30th November 2005 (study midpoint, was modelled from a census data. Results Seizures were reported in 900/4,921(18.3% incident admissions and at least 98 had status epilepticus. The incidence of acute seizures in children 0–13 years was 425 (95%CI 386, 466 per 100,000/year and was 879 (95%CI 795, 968 per 100,000/year in children Conclusion There is a high incidence of acute seizures in children living in this malaria endemic area of Kenya. The most important causes are diseases that are preventable with available public health programs.

  9. Longer travel time to district hospital worsens neonatal outcomes: a retrospective cross-sectional study of the effect of delays in receiving emergency cesarean section in Rwanda.

    Science.gov (United States)

    Niyitegeka, Joseph; Nshimirimana, Georges; Silverstein, Allison; Odhiambo, Jackline; Lin, Yihan; Nkurunziza, Theoneste; Riviello, Robert; Rulisa, Stephen; Banguti, Paulin; Magge, Hema; Macharia, Martin; Habimana, Regis; Hedt-Gauthier, Bethany

    2017-07-25

    In low-resource settings, access to emergency cesarean section is associated with various delays leading to poor neonatal outcomes. In this study, we described the delays a mother faces when needing emergency cesarean delivery and assessed the effect of these delays on neonatal outcomes in Rwanda. This retrospective study included 441 neonates and their mothers who underwent emergency cesarean section in 2015 at three district hospitals in Rwanda. Four delays were measured: duration of labor prior to hospital admission, travel time from health center to district hospital, time from admission to surgical incision, and time from decision for emergency cesarean section to surgical incision. Neonatal outcomes were categorized as unfavorable (APGAR cesarean sections started within 5 h after hospital admission and 85.2% (288 of 338) started more than 30 min after the decision for cesarean section was made. Neonatal outcomes were significantly worse among mothers with more than 90 min of travel time from the health center to the district hospital compared to mothers referred from health centers located on the same compound as the hospital (aOR = 5.12, p = 0.02). Neonates with cesarean deliveries starting more than 30 min after decision for cesarean section had better outcomes than those starting immediately (aOR = 0.32, p = 0.04). Longer travel time between health center and district hospital was associated with poor neonatal outcomes, highlighting a need to decrease barriers to accessing emergency maternal services. However, longer decision to incision interval posed less risk for adverse neonatal outcome. While this could indicate thorough pre-operative interventions including triage and resuscitation, this relationship should be studied prospectively in the future.

  10. Patterns of Delivery and Perinatal Outcomes Among Women Delivered at District Hospital of Rural Nepal

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    Amatya YR

    2014-10-01

    Full Text Available Studies have shown increased rate of labour induction and cesarean section (CS with several health consequences for neonates and mothers. Still there is limited data especially in developing countries. A hospital based retrospective cross sectional study was done where all hospital deliveries occurring during the period of 6 months were recorded to assess the patterns of deliveries and their associated perinatal outcomes. Cesarean rate was 18.5%, with meconium- stained liquor being the commonest reason, and 12.5% of deliveries were medically induced. Post dated pregnancies were more likely to have either elective CS or medical induction. Medically induced cases were less likely to have meconium stained liquor however, these cases are at higher odds of emergency CS. Induction of labour is not always without risk as cases lead to more emergency cesarean section. However, this paper highlights that medical induction of labor improve neonatal outcomes which might be attributed to timely intervention in such cases.

  11. Antibiotic use in a district hospital in Kabul, Afghanistan: are we overprescribing?

    Science.gov (United States)

    Bajis, S; Van den Bergh, R; De Bruycker, M; Mahama, G; Van Overloop, C; Satyanarayana, S; Bernardo, R S; Esmati, S; Reid, A J

    2014-12-21

    Contexte : Un hôpital de district à Kaboul, Afghanistan, soutenu par Médecins Sans Frontières (MSF).Objectifs : Evaluer les pratiques en matière de prescription d'antibiotiques en consultation externe en été (août 2013) et en hiver (janvier 2014).Schema : Etude transversale basée sur les données hospitalières recueillies en routine et la méthode de dose thérapeutique quotidienne (DDD) de l'Organisation Mondiale de la Santé (OMS).Resultats : L'analyse de 4857 prescriptions (été) et de 4821 prescriptions (hiver) a montré que respectivement 62% et 50% de tous les consultants externes se voyaient prescrire au moins un antibiotique. Les prescriptions non accompagnées d'un diagnostic établi représentaient une proportion importante de l'ensemble des antibiotiques prescrits. En ce qui concerne les infections respiratoires hautes (URTI), les problèmes dentaires, les infections urinaires (UTI) et la diarrhée, on notait une bonne adhésion aux doses recommandées dans les directives standard de traitement de MSF quand on les mesurait en fonction des DDD. Cependant, certains médicaments, ne figurant pas dans les directives, étaient néanmoins prescrits comme par exemple l'amoxicilline et la métronidazole dans les UTI et l'azithromycine dans les URTI.Conclusion : Les taux de prescriptions d'antibiotiques en consultation externe dans un hôpital de district d'Afghanistan étaient très élevés, atteignant le double des recommandations de l'OMS de 30%. Même s'il n'a pas été observé de non adhésion aux doses recommandées, il semble y avoir eu des prescriptions inappropriées pour certaines pathologies. Cette étude suggère que la connaissance des déterminants de la prescription d'antibiotiques en fonction du contexte est une première étape dans la rationalisation des pratiques de prescription dans ce type de situation.

  12. [Neurological health care activity in a recently created district hospital: model of high efficiency].

    Science.gov (United States)

    Jiménez-Jiménez, Félix J; Plaza-Nieto, José F; Navacerrada, Francisco; Alonso-Navarro, Hortensia; Pilo-de-la-Fuente, Belén; Arroyo-Solera, Margarita; Guillán, Marta; Calleja, Marisol; Moreno-Puertas, Dolores

    2015-03-01

    Objetivo. Analizar la actividad asistencial de un hospital comarcal de reciente creacion, con especial enfasis en los indicadores asistenciales en consultas externas y en actos medicos de pacientes ingresados. Pacientes y metodos. Describimos la actividad asistencial realizada por nuestra seccion de neurologia durante los años 2008-2013. Se comparan nuestros indicadores asistenciales de los años 2012 y 2013 (quinto y sexto año de actividad), tanto en consultas externas como en pacientes ingresados, con los de otros dos hospitales de caracteristicas similares, otros tres de nivel secundario y otros cuatro de nivel terciario. Resultados. La seccion de neurologia de nuestro hospital fue la que realizo mayor numero de primeras consultas por facultativo, tuvo el mejor indice de consultas sucesivas/primeras y el mayor porcentaje de consultas de alta resolucion, tuvo la menor estancia media en los dos grupos relacionados por el diagnostico (GRD) mas frecuentes en nuestra especialidad, y fue la segunda en ingresos por facultativo del GRD 'ictus con infarto' y la tercera en ingresos por facultativo del GRD 'otros trastornos del sistema nervioso'. Conclusiones. Los indicadores asistenciales de la seccion de neurologia de nuestro hospital muestran un modelo de muy alta eficiencia, al cual solo se aproximan los de otros dos de caracteristicas y desarrollo similares al nuestro. La implantacion gradual de modelos similares al de estos tres hospitales en los niveles secundario y terciario podria ser de utilidad en la mejora de su eficiencia asistencial.

  13. Perfil das doenças glomerulares em um hospital público do Distrito Federal Profile of glomerular diseases in a public hospital of Federal District, Brazil

    Directory of Open Access Journals (Sweden)

    Fabio Humberto Ribeiro Paes Ferraz

    2010-09-01

    Full Text Available INTRODUÇÃO: As doenças glomerulares são uma causa frequente de doença renal crônica, sobretudo nos países em desenvolvimento. OBJETIVO: O objetivo deste estudo foi determinar o perfil destas glomerulopatias em um hospital público da cidade de Brasília, Distrito Federal. MÉTODOS: Foram realizadas 121 biopsias renais pela equipe de nefrologia do Hospital Regional da Asa Norte (HRAN entre agosto de 2005 e maio de 2009. Foram excluídas oito biopsias realizadas em pacientes transplantados renais e analisados os prontuários dos 113 pacientes restantes. Dados analisados: sexo, idade, exames laboratoriais, síndrome glomerular, diagnóstico clínico, grau de fibrose intersticial, uso de imunossupressores, necessidade de diálise e desfecho clínico. RESULTADOS: A média de idade foi 34,9 ± 16,2 anos, com predomínio masculino (51,3%. As principais síndromes glomerulares foram: síndrome nefrótica (41,6% e glomerulonefrite rapidamente progressiva (35,4%. Entre as glomerulopatias primárias, houve predomínio da glomeruloesclerose segmentar e focal (26,9% e da nefropatia por IgA (25% e entre as secundárias a nefrite lúpica (50% e a glomerulonefrite proliferativa exsudativa difusa (34,2%. A maioria dos pacientes fez uso de imunossupressores (68,1% e quase um terço deles (29,2% necessitou de diálise durante a internação. Evoluíram para terapia dialítica crônica 13,3% dos pacientes e 10,6% evoluíram a óbito. CONCLUSÃO: Este estudo poderá contribuir para melhor entendimento epidemiológico das doenças glomerulares no Distrito Federal, orientando na adoção de políticas públicas visando permitir rápido diagnóstico e manejo clínico das mesmas.INTRODUCTION: Glomerular diseases are a frequent etiology of chronic kidney disease, especially in the developing countries. OBJECTIVE: To determine the profile of such glomerulopathies in a public hospital located in the city of Brasilia, Federal District. METHODS: 121 renal biopsies in

  14. FACTORS RELATED TO KNOWLEDGE ON NEWBORN DANGER SIGNS AMONG THE RECENTLY DELIVERED WOMEN IN SUB-DISTRICT HOSPITALS OF BANGLADESH

    Directory of Open Access Journals (Sweden)

    Sojib Bin Zaman

    2017-06-01

    Full Text Available Background: Bangladesh continues to be one of the top ten countries with the highest burden of neonatal mortality. While, most of the neonatal deaths are preventable; health system delays, delayed identification of newborn danger signs, late diagnosis and initiation of treatment are claimed to be the main challenges. Objective: 1 to determine the level of knowledge among the recently delivered women (RDW about newborn danger signs and 2 to distinguish the factors associated with ability of identifying the danger signs. Methods: A facility based cross-sectional study was conducted in three sub-district hospitals of Bangladesh among 135 RDW between 1 January 2015 and 30 April 2015. Seven key danger signs were identified, and responses were categorized accordingly. Bivariable logistic regression was conducted to determine the likelihood of the association of factors with danger signs identification. Results: About 51% of RDW could identify one key danger sign. Knowledge on “fever’’ was the most commonly known danger sign (65%. Middle age (OR 1.67, 95% CI: 1.09 - 2.18, high education (OR 2.37, 95% CI: 1.46 - 2.77, increased parity (OR 1.91, 95% CI: 1.17 - 2.89, and previous hospital delivery (OR 1.79, 95% CI: 1.14 - 2.68 were found associated with the knowl¬edge of the danger signs. Conclusion: The findings indicate the immediate need to enhance health education among the RDW about newborn danger signs before their hospital discharge. Community based health education programs can be a cost effective intervention to increase awareness and early recognition of neonatal danger signs.

  15. Candidiasis in HIV and AIDS Patients Attending the Nylon Health District Hospital in Douala, Cameroon

    Directory of Open Access Journals (Sweden)

    Anna Longdoh Njunda

    2011-12-01

    Full Text Available AIM: Candidiasis is the leading opportunistic mycosis in HIV and AIDS patients. METHOD: In order to determine its prevalence in patients with different CD4+ T cell categories in the Nylon Health District in Douala, a cross-sectional study was carried out whereby 304 HIV positive individuals were recruited between March and August, 2007. They were divided into two groups; those on highly active antiretroviral therapy (HAART and those not on HAART. Three samples constituting mouth, vaginal/urethral swabs and urine were collected from each subject. RESULTS: A total of 204 (67.1% [95% confidence interval (CI: 0.618-0.724] of these patients had more than one predisposing condition to candidiasis, with those on antibiotic therapy having the highest prevalence (63.7% followed by pregnant patients (7.3% (P < 0.05. Candidiasis was more common in patients with low CD4+ T cell count (<200 [66%] than patients with higher CD4+ T cell count (17.9% (P<0.05. One hundred and sixty one (53% of the patients had candidiasis whereby those not on HAART were more frequently infected (69.6% than those on HAART (30.1% (P< 0.05. CONCLUSION: We conclude that candidiasis is a major opportunistic infection in HIV patients and should be checked especially in patients not yet on antiretroviral therapy. [TAF Prev Med Bull 2011; 10(6.000: 701-706

  16. Compliance of district hospitals in the Center Region of Cameroon with WHO/IATSIC guidelines for the care of the injured: a cross-sectional analysis.

    Science.gov (United States)

    Chichom-Mefire, Alain; Mbarga-Essim, Nicole Therese; Monono, Martin Ekeke; Ngowe, Marcelin Ngowe

    2014-10-01

    Injuries are a major cause of death and disability worldwide. Low-income countries, particularly in Africa, are disproportionately affected. The burden of injuries can be alleviated by preventive measures and appropriate management of injury cases. African countries generally lack trauma care systems based on reliable and affordable guidelines. The aim of this study was to assess the compliance of some district hospitals in Cameroon with World Health Organization/International Association for Trauma and Intensive Care (WHO/IATSIC) guidelines for care of the injured. This cross-sectional descriptive survey used items from the WHO/IATSIC "Guidelines for Essential Trauma Care" to develop a checklist for inspection of physical equipment and a questionnaire assessing human resources and organizational capabilities in 25 district hospitals of the Center Region of Cameroon. All hospitals surveyed had at least one doctor available. Each reported treating a mean of 338 ± 214 injury cases every year. Most hospitals (n = 22) were globally either not compliant or partly compliant with the guidelines. Staff generally had received the appropriate basic training but had no additional training specifically directed toward trauma management. Skills for managing specific injuries (e.g., chest injuries) were poor. Availability and utilization of equipment was globally inadequate, and organizational capabilities were almost nonexistent. District hospitals of the Center Region of Cameroon still lack compliance with the WHO/IATSIC guidelines for essential trauma care but have significant potential for improvement. It seems possible to optimize the utilization of existing facilities.

  17. Glass injuries seen in the emergency department of a South African district hospital.

    Science.gov (United States)

    Nzaumvila, Doudou; Govender, Indiran; Kramer, Efraim B

    2015-01-01

    The emergency department of Embhuleni Hospital frequently manages patients with glass-related injuries. This study assessed these injuries and the glass that caused them in more detail. The objectives of our study included determining the type of glass causing these injuries and describing the circumstances associated with different types of glass injuries. The emergency department of Embhuleni Hospital in Elukwatini, Mpumalanga province, South Africa. This was a cross-sectional study with a sample size of 104 patients. Descriptive statistics were used to assess the characteristics of the glass injuries. Five different types of glass were reported to have caused the injuries, namely car glass (7.69%), glass ampoules (3.85%), glass bottles (82.69%), glass windows (3.85%) and street glass shards (1.92%). Glass bottle injuries were mainly caused by assaults (90.47%) and most victims were mostly young males (80.23%). The assaults occurred at alcohol-licensed premises in 65.11% of cases. These injuries occurred mostly over weekends (83.72%), between 18:00 and 04:00. The face (34.23%) and the scalp (26.84%) were the sites that were injured most often. Assault is the most common cause of glass injuries, usually involving young men at alcohol-licensed premises. Glass injuries generally resulted in minor lacerations, with few complications (2.68%).

  18. Barriers to Encourage Motivation in Relation to Work Performance of Nurses in Buleleng District Hospital

    Directory of Open Access Journals (Sweden)

    Budiastri .

    2014-08-01

    Full Text Available Background and purpose: Nurses at hospitals regularly receives criticism from the general public, negativelycommenting on their lack of patient care, lack of professionalism and diminished quality of service. Survey findings onpatient satisifaction at Buleleng Public Hospital from 2011 indicate that 2.03% of patients remained unsatisfied withstaff workplace attitudes and 6.39% felt that nursing service overall was unsatisifactory. Preliminary interviews withward nurses on 24 November 2012 exposed a number of issues: a lack of career support and development for nurses,including opportunities to expand their skills, and a lack of workplace satisifaction from patient supplementary income.Weakness regarding technical support and motivation from ward supervisors evidently also has an impact on nursesworkplace motivation and therefore quality of service. This research investigates the influence of supervision, careerdevelopment, supplementary income support, and administrational records on the workplace attitude of nursing staff.Methods: Research was formulated using qualitative and phenomenology methods. Informants were purposivelyselected. Data was collected through in-depth interviews and administration documentation study and analysed usingthematic analysis.Results and conclusion: Findings indicated that little monitoring and evaluation of nurse workplace attitudes, alack of support and motivational direction from supervisors, administrational documentation issues, minimunsupplementary income support, as well as career development had a large impact on nurse quality of care. Mostdominant variables included supervision, career development and supplementary income support.Keywords: motivation, nurse’s performance, nursing care

  19. Characteristics and mortality of elderly patients admitted to the Intensive Care Unit of a district hospital

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    José Carlos Llamas Reyes

    2016-01-01

    Full Text Available Aim: To study all the elderly patients (≥75 years who were admitted in an Intensive Care Unit (ICU of a Spanish hospital and identify factors associated with mortality. Patients and Methods: A retrospective, observational data collected prospectively in patients ≥75 years recruited from the ICU in the period of January 2004 to December 2010. Results: During the study period, 1661 patients were admitted to our unit, of whom 553 (33.3% were older than 75 years. The mean age was 79.9 years, 317 (57.3% were male, and the overall in-hospital mortality was 94 patients (17% confidence interval 14-20.3%. When comparing patients who survived to those who died, we found significant differences in mean age (P = 0.001, Acute Physiologic Assessment and Chronic Health Evaluation II and Simplified Acute Physiology Scoring II (SAPS II on admission (P 75 years was not significant (P = 0.1390. Conclusions: The percentage of elderly patients in our unit is high, with low mortality rates. The age itself is not the sole determinant for admission to the ICU and other factors should be taken into account.

  20. The interface between the national tuberculosis control programme and district hospitals in Cameroon: missed opportunities for strengthening the local health system -a multiple case study.

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    Keugoung, Basile; Macq, Jean; Buve, Anne; Meli, Jean; Criel, Bart

    2013-03-22

    Tuberculosis remains a major public health problem in sub-Saharan Africa. District hospitals (DHs) play a central role in district-based health systems, and their relation with vertical programmes is very important. Studies on the impact of vertical programmes on DHs are rare. This study aims to fill this gap. Its purpose is to analyse the interaction between the National Tuberculosis Control Programme (NTCP) and DHs in Cameroon, especially its effects on the human resources, routine health information system (HIS) and technical capacity at the hospital level. We used a multiple case study methodology. From the Adamaoua Region, we selected two DHs, one public and one faith-based. We collected qualitative and quantitative data through document reviews, semi-structured interviews with district and regional staff, and observations in the two DHs. The NTCP trained and supervised staff, designed and provided tuberculosis data collection and reporting tools, and provided anti-tuberculosis drugs, reagents and microscopes to DHs. However, these interventions were limited to the hospital units designated as Tuberculosis Diagnostic and Treatment Centres and to staff dedicated to tuberculosis control activities. The NTCP installed a parallel HIS that bypassed the District Health Services. The DH that performs well in terms of general hospital care and that is well managed was successful in tuberculosis control. Based on the available resources, the two hospitals adapt the organisation of tuberculosis control to their settings. The management teams in charge of the District Health Services are not involved in tuberculosis control. In our study, we identified several opportunities to strengthen the local health system that have been missed by the NTCP and the health system managers. Well-managed DHs perform better in terms of tuberculosis control than DHs that are not well managed. The analysis of the effects of the NTCP on the human resources, HIS and technical capacity of DHs

  1. Perception and practice regarding infection control measures amongst healthcare workers in district government hospitals of Mangalore, India

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    Yamini

    2012-01-01

    Full Text Available Introduction: Healthcare workers must know the various measures for their own protection. They should improve organization of work, implement standard precautions and dispose biomedical waste properly to prevent occupational exposure. This study aimed at assessing the perception and practice of infection control measures amongst the healthcare workers in Mangalore. Materials and Methods: This cross-sectional study was conducted by using a pretested semi-structured proforma, by interview cum observational technique. One hundred and twenty healthcare workers (70 hospital staff including nurses and technicians at the two Government District Hospitals and 50 final-year MBBS students were selected using convenient sampling and their perception and practice regarding infection control measures were studied. Results: Of the 120 participants, the majority (85.8% was aware of disposing used needles and syringes in puncture-resistant containers but only 55.7% were actually practicing it. Three-fourths (75.8% of the participants were aware about not recapping the needles after use but on observation, only 35.4% were practicing this. All healthcare workers were aware about the indication for using masks and gloves while handling patients, while only 77.1% were using them. We also found that only 61.8% washed their hands after attending every patient, 94.3% cleaned the area with a sterile swab before giving injections and only 35.7% of the labs/ wards/ operation theatres had three colored bags. Few (11.7% of the workers have already been exposed to infectious blood samples and some (19.2% are still not immunized against Hepatitis B. Conclusion: There is a need for improvement in the perception and practice of infection control measures among healthcare workers for both self and patient′s protection. They should also get themselves immunized against Hepatitis B and report accidental exposure to infectious samples to the infection control committee.

  2. Creating a sustainable culture of quality through the SLMTA programme in a district hospital laboratory in Kenya

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    Phidelis M. Maruti

    2014-09-01

    Full Text Available Background: Bungoma District Hospital Laboratory (BDHL, which supports a 200-bed referral facility, began its Strengthening Laboratory Management Toward Accreditation (SLMTA journey in 2011 together with eight other laboratories in the second round of SLMTA rollout in Kenya.Objectives: To describe how the SLMTA programme and enhanced quality interventions changed the culture and management style at BDHL and instilled a quality system designed to sustain progress for years to come.Methods: SLMTA implementation followed the standard three-workshop series, mentorship site visits and audits. In order to build sustainability of progress, BDHL integrated quality improvement processes into its daily operations. The lab undertook a process of changing its internal culture to align all hospital stakeholders – including upper management, clinicians, laboratory staff and maintenance staff – to the mission of sustainable quality practices at BDHL.Results: After 16 months in the SLMTA programme, BDHL improved from zero stars (38% to four stars (89%. Over a period of two to three years, external quality assessment results improved from 47% to 87%; staff punctuality increased from 49% to 82%; clinician complaints decreased from 83% to 16; rejection rates decreased from 12% to 3%; and annual equipment repairs decreased from 40 to 15. Twelve months later the laboratory scored three stars (81% in an external surveillance audit conducted by Kenya Accreditation Service (KENAS.Conclusion: Management buy-in, staff participation, use of progress-monitoring tools and feedback systems, as well as incorporation of improvement processes into routine daily activities, were vital in developing and sustaining a culture of quality improvement.

  3. A study on work stress, stress coping strategies and health promoting lifestyle among district hospital nurses in Taiwan.

    Science.gov (United States)

    Lee, Wei-Lun; Tsai, Shieunt-Han; Tsai, Chao-Wen; Lee, Chia-Ying

    2011-01-01

    To determine work stress, and stress-coping strategies, and to analyze their the relationships in order to improve health-promoting lifestyle of nurses in Taiwan. Three hundred eighty-five nurses who had work experience for more than 6 mo, were selected from four district hospitals in Kaohsiung and Ping Tung. We used a stratified cluster random sampling method for the selection. The nurses answered a self-report questionnaire, which was categorized into four sections: personal background data, work stress, stress-coping strategies, and health-promoting lifestyle. The findings indicate work stress and the health promoting lifestyle of nurses are at a higher level, with stress-coping strategies being at a medium level. Work stress and stress-coping strategies were significantly and positively correlated. Professional relationships, managerial role, personal responsibility, and recognition of work stress and the responsibilities of a health-promoting lifestyle were negatively correlated. Managerial role, personal responsibility, and organizational atmosphere of work stress as well as realization, an item of health-promoting lifestyle, were negatively correlated. Recognition of work stress and stress management, items of health-promoting lifestyle, were negatively correlated. Health responsibility, and self-actualization, items of health-promoting lifestyle, as well as stress-coping strategies were negatively correlated. Nutrition, an item of health-promoting lifestyle, and the support stress-coping strategy was negatively correlated. Nurses have greater work pressure and better work stress-coping strategies, but worse health responsibility and realization of a health-promoting lifestyle. We suggest hospitals build good relationships and appropriately increase employment of nurses through a good work atmosphere to achieve nurses' realization of a health-promoting lifestyle.

  4. Dietary habits among health professionals working in a district hospital in KwaZulu-Natal, South Africa.

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    Kunene, Siyabonga H; Taukobong, Nomathemba P

    2017-06-28

    The burden of diseases associated with unhealthy lifestyle behaviours continues to increase in the low- and middle-income countries including South Africa. Among the affected population are the health professionals who are assumed to be knowledgeable about healthy eating. This study aimed to determine the dietary habits of health professionals in a public district hospital in KwaZulu-Natal, South Africa. A cross-sectional survey was conducted in 2012 among 109 randomly selected health professionals. Each received a questionnaire consisting of mostly closed and few open-ended questions. Its main focus was the dietary and eating habits of the professionals. An ethical clearance was granted by the Medunsa Research and Ethics committee at the University of Limpopo. Permission to conduct the study was sought and obtained from participants as well. Descriptive statistics and frequencies were used to analyse data. A 100% (109) response rate was achieved. The majority skipped meals especially breakfast with a significant positive correlation between breakfast intake per week and age (r = 0.98, p = 0.048). The majority consumed a lot of unhealthy foods and carbonated beverages with sugar. Consumption of fruits, vegetables, high fibre and whole grain foods was less common. The study showed poor eating habits among participants. Urgent health interventions are therefore indicated to highlight the importance of healthy eating habits among the entire population.

  5. Assessing Nutrient Intake and Nutrient Status of HIV Seropositive Patients Attending Clinic at Chulaimbo Sub-District Hospital, Kenya

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    Agatha Christine Onyango

    2012-01-01

    Full Text Available Background. Nutritional status is an important determinant of HIV outcomes. Objective. To assess the nutrient intake and nutrient status of HIV seropositive patients attending an AIDS outpatient clinic, to improve the nutritional management of HIV-infected patients. Design. Prospective cohort study. Setting. Comprehensive care clinic in Chulaimbo Sub-District Hospital, Kenya. Subjects. 497 HIV sero-positive adults attending the clinic. Main Outcome Measures. Evaluation of nutrient intake using 24-hour recall, food frequency checklist, and nutrient status using biochemical assessment indicators (haemoglobin, creatinine, serum glutamate pyruvate (SGPT and mean corpuscular volume (MCV. Results. Among the 497 patients recruited (M : F sex ratio: 1.4, mean age: 39 years ± 10.5 y, Generally there was inadequate nutrient intake reported among the HIV patients, except iron (10.49 ± 3.49 mg. All the biochemical assessment indicators were within normal range except for haemoglobin 11.2 g/dL (11.4 ± 2.60 male and 11.2 ± 4.25 female. Conclusions. Given its high frequency, malnutrition should be prevented, detected, monitored, and treated from the early stages of HIV infection among patients attending AIDS clinics in order to improve survival and quality of life.

  6. Dietary habits among health professionals working in a district hospital in KwaZulu-Natal, South Africa

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    Siyabonga H. Kunene

    2017-01-01

    Full Text Available Introduction: The burden of diseases associated with unhealthy lifestyle behaviours continues to increase in the low- and middle-income countries including South Africa. Among the affected population are the health professionals who are assumed to be knowledgeable about healthy eating.Aim: This study aimed to determine the dietary habits of health professionals in a public district hospital in KwaZulu-Natal, South Africa.Methods: A cross-sectional survey was conducted in 2012 among 109 randomly selected health professionals. Each received a questionnaire consisting of mostly closed and few open-ended questions. Its main focus was the dietary and eating habits of the professionals. An ethical clearance was granted by the Medunsa Research and Ethics committee at the University of Limpopo. Permission to conduct the study was sought and obtained from participants as well. Descriptive statistics and frequencies were used to analyse data.Results: A 100% (109 response rate was achieved. The majority skipped meals especially breakfast with a significant positive correlation between breakfast intake per week and age (r = 0.98, p = 0.048. The majority consumed a lot of unhealthy foods and carbonated beverages with sugar. Consumption of fruits, vegetables, high fibre and whole grain foods was less common.Conclusion: The study showed poor eating habits among participants. Urgent health interventions are therefore indicated to highlight the importance of healthy eating habits among the entire population.

  7. Hip resurfacing in a district general hospital: 6-year clinical results using the ReCap hip resurfacing system

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    van der Weegen Walter

    2012-12-01

    Full Text Available Abstract Background The purpose of our study was to prospectively report the clinical results of 280 consecutive hips (240 patients who received a ReCap Hip Resurfacing System implant (Biomet Inc., Warsaw, USA in a single district general hospital. Literature reports a large variation in clinical results between different resurfacing designs and published results using this particular design are scarce. Methods Mean follow up was 3.3 years (1.0 to 6.3 and four patients were lost to follow-up. All patients were diagnosed with end-stage hip osteoarthritis, their mean age was 54 years and 76.4% of all patients were male. Results There were 16 revisions and four patients reported a Harris Hip Score Conclusions This independent series confirms that hip resurfacing is a demanding procedure, and that implant survival of the ReCap hip resurfacing system is on a critical level in our series. In non-revised patients, reported outcomes are generally excellent. Trial registration ClinicalTrials.gov Identifier: NCT00603395

  8. Adopting and sustaining a Virtual Fracture Clinic model in the District Hospital setting – a quality improvement approach

    Science.gov (United States)

    Logishetty, Kartik

    2017-01-01

    Virtual Fracture Clinics (VFCs) are an alternative to the conventional fracture clinics, to manage certain musculoskeletal injuries. This has recently been reported as a safe, cost-effective and efficient care model. As demonstrated at vanguard sites in the United Kingdom, VFCs can enhance patient care by standardising treatment and reducing outpatient appointments. This project demonstrates how a Quality Improvement approach was applied to introduce VFCs in the District General Hospital setting. We demonstrate how undertaking Process Mapping, Driver Diagrams, and Stakeholder Analysis can assist implementation. We discuss Whole Systems Measures applicable to VFCs, to consider how robust and specific data collection can progress this care model. Three Plan-Do-Study-Act cycles led to a change in practice over a 21-month period. Our target for uptake of new patients seen in VFCs within 6 months of starting was set at 50%. It increased from 0% to 56.1% soon after introduction, and plateaued at an average of 56.4% in the six-months before the end of the study period. Careful planning, frequent monitoring, and gathering feedback from a multidisciplinary team of varying seniority, were the important factors in transitioning to, and sustaining, a successful VFC model.

  9. Assessment of self-reported adherence among patients with type 2 diabetes in Matlala District Hospital, Limpopo Province

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    Sadeen A. Adegbola

    2016-03-01

    Full Text Available Introduction: Complications associated with Diabetes Mellitus are a burden to health services, especially in resource poor settings. These complications are associated with substandard care and poor adherence to treatment plans. The aim of the study was to assess the self-reported adherence to treatment amongst patients with type 2 diabetes in Matlala District Hospital, Limpopo Province. Methods: This cross-sectional study used convenience sampling with a standardised, validated questionnaire. Data were collected over 4 months, and Microsoft Excel was used for data capturing. Results: We found that 137 (70% of the participants considered themselves adherent to their diabetes medication. Younger age (p = 0.028, current employment (p = 0.018 and keeping appointment were factors significantly associated with adherence. Reasons given for poor adherence were that the clinic did not have their pills (29%, they had forgotten to take their medication (16% and gone travelling without taking enough pills (14%. Reasons given for poor adherences to a healthy lifestyle were being too old (29%, 22% had no specific reason, 13% struggled to motivate themselves and 10% simply forgot what to do. Sixty-eight percent of the adhered participants recommended the use of medication at meal times, 14% set a reminder, and 8% used the assistance of a treatment supporter. Conclusions and recommendations: The study revealed a higher than expected reported level of adherence to diabetes treatment. Further research is needed to assess whether self-reported adherence corresponds to the metabolic control of the patients and to improve services.

  10. The impact of audit in a district general hospital on post-operative nausea and vomiting after major gynaecological surgery.

    Science.gov (United States)

    Hadji, F; Eastwood, D; Fear, S; Corfield, H J

    1998-09-01

    An audit of post-operative nausea and vomiting (PONV) was undertaken in 935 female patients who used morphine patient-controlled analgesia (PCA) for pain relief after major gynaecological operations in a district general hospital. We investigated retrospectively five different antiemetic policies and a reference group without policy from January 1993 to July 1995. The department's computerized audit system was used to analyse the observations. At the beginning of the audit, the incidence of nausea and vomiting was as high as 71.5%. But as a consequence of this audit, a departmental policy was adopted 3 years later, which had an incidence of PONV of only 51.7%. During this time the compliance with antiemetic protocols increased from 41% to 76%. There was significantly less PONV if an antiemetic protocol was followed (P = 0.002). This emphasizes the importance of corporate involvement in the development, formulation and evaluation of departmental protocols if compliance is to be high. We conclude that audit as a corporate effort improves the acceptance of departmental protocols. This reduces PONV significantly irrespective of the type of antiemetic drug used.

  11. The association between psychological stress and low back pain among district hospital employees in Gauteng, South Africa

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    B. Olivier

    2010-02-01

    Full Text Available The presence of low back pain (LBP can be influenced by psychosocial  stress experienced  at  work.  The  aim  of  this  study  was  to  determine the point prevalence for LBP and the psychological stress expe-rienced at work as a factor associated with the presence of LBP amongst staff  employed  at  district  hospital  in  Pretoria,  Gauteng,  South  Africa.  A  self-administered questionnaire was  completed  by  all  participants. Results indicated that the point prevalence for LBP was 47.46%. Sixty five point five seven percent of employees who experienced stress at work all the time, suffered from LBP (p=0.001. Stress experienced at work all the time increased the risk of LBP (OR 3.47 CI 1.46 ; 8.23.  A clinical recommendation resulting from this study is that healthcare providers need to include the provision of education, support and appropriate  referral for patients who perceive themselves to have high levels of stress.

  12. Contribution of the outpatient surgery unit ITO the general surgery department of a district hospital.

    Science.gov (United States)

    Carrasco; Flores; Aguayo; de Andres B; Moreno Egea A; Cartagena; De Vicente JP; Martin

    2000-07-01

    Introduction: The creation of Outpatient Surgery (OPS) units to combine the quality of medical attention and rationalize costs allows for greater efficiency in the use of resources. Aim: To report our series of patients undergoing surgery at the OPS units integrated into our Hospital (Type II): Patients and method: Between May 1994 and March 1998, 832 outpatients, of a total of 5230, underwent surgery at our General Surgery Unit. The criteria for exclusion from the programme depended on the patient and the enviroment or resulted from the operation itself. Results: Mean patient age was 47.5 years; there were 420 males and 412 females. Surgery was performed for 229 inguinofemoral hernias, 47 umbilical-epigastric hernias, nine incisional hernias, 193 pilonidal sinuses, 156 mammary nodules, 65 varicose veins, 64 arteriovenous fistulae and 69 proctology operations. The most common anesthesia techniques performed were rachianesthesia and local anesthesia. Eight point seven percent of the patients required admission (OPS failure), the most frequent causes being excessive pain, orthostatic-syncopal hypotension, nausea and vomiting and urine retention. There was no morbidity or mortality. Conclusion: OPS is a highly efficient procedure for resolving the most common pathologies in General Surgery. The anesthesia technique was an important factor in the rate of failure.

  13. Intestinal Helminth Infections in Pregnant Women Attending Antenatal Clinic at Kitale District Hospital, Kenya

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    A. W. Wekesa

    2014-01-01

    Full Text Available Intestinal helminth infections during pregnancy are associated with adverse outcomes including low birth weight and prenatal mortality. The infections are a major public health problem in developing countries. A hospital based survey was undertaken for six months to determine the infection prevalence, intensity, and risk factors. The study involved expectant women attending antenatal clinic. Stool samples were screened microscopically for helminth ova using Kato Katz technique. Information on risk factors was collected using semistructured questionnaire and analyzed using SPSS. Epidemiological data was analysed using descriptive statistics and multivariate analysis. The overall prevalence of infection was 21 (13.8%. Ascariasis was the most prevalent 10 (6.5%, hookworm infection was 6 (3.9%, and trichuriasis was 2 (1.3%. Pregnant women aged below 29 years (OR = 3.63, CI = 0.87–11.75 and those with primary level of education (OR = 3.21, CI = 0.88–11.75 were at a higher risk of infection compared to those aged ≥ 29 years with secondary level of education. Hand washing was significantly associated with reduced likelihood of infection (OR = 0.18, 95% CI = 0.06–0.57. It was concluded that intestinal helminth infections were prevalent among pregnant women. We recommended that all expectant women visiting antenatal clinics be screened for intestinal helminth infections and positive cases be advised to seek treatment.

  14. Implementing the Emergency Triage, Assessment and Treatment plus admission care (ETAT+) clinical practice guidelines to improve quality of hospital care in Rwandan district hospitals: healthcare workers' perspectives on relevance and challenges.

    Science.gov (United States)

    Hategeka, Celestin; Mwai, Leah; Tuyisenge, Lisine

    2017-04-07

    An emergency triage, assessment and treatment plus admission care (ETAT+) intervention was implemented in Rwandan district hospitals to improve hospital care for severely ill infants and children. Many interventions are rarely implemented with perfect fidelity under real-world conditions. Thus, evaluations of the real-world experiences of implementing ETAT+ are important in terms of identifying potential barriers to successful implementation. This study explored the perspectives of Rwandan healthcare workers (HCWs) on the relevance of ETAT+ and documented potential barriers to its successful implementation. HCWs enrolled in the ETAT+ training were asked, immediately after the training, their perspective regarding (i) relevance of the ETAT+ training to Rwandan district hospitals; (ii) if attending the training would bring about change in their work; and (iii) challenges that they encountered during the training, as well as those they anticipated to hamper their ability to translate the knowledge and skills learned in the ETAT+ training into practice in order to improve care for severely ill infants and children in their hospitals. They wrote their perspectives in French, Kinyarwanda, or English and sometimes a mixture of all these languages that are official in the post-genocide Rwanda. Their notes were translated to (if not already in) English and transcribed, and transcripts were analyzed using thematic content analysis. One hundred seventy-one HCWs were included in our analysis. Nearly all these HCWs stated that the training was highly relevant to the district hospitals and that it aligned with their work expectation. However, some midwives believed that the "neonatal resuscitation and feeding" components of the training were more relevant to them than other components. Many HCWs anticipated to change practice by initiating a triage system in their hospital and by using job aids including guidelines for prescription and feeding. Most of the challenges stemmed

  15. Influenza and pneumococcal vaccinations in dialysis patients in a London district general hospital.

    Science.gov (United States)

    Wilmore, Stephanie M S; Philip, Keir E; Cambiano, Valentina; Bretherton, Christopher P; Harborne, Josephine E; Sharma, Aditi; Jayasena, Shyama D

    2014-02-01

    Patients on dialysis mount reduced immune responses compared with the general population. The Department of Health advises that these patients receive influenza and pneumococcal vaccinations at regular intervals-once yearly and every five years, respectively. This article investigates the uptake of these vaccinations in this patient population and seeks to examine factors that may influence vaccination status such as patient's language and presence of a general practitioner (GP) electronic vaccination reminder system. It also explores preferred site of vaccination for patients and GPs as these are primary care vaccinations yet patients have more frequent contact with their dialysis unit than their GP, blurring the boundaries between primary and specialized care. This is a retrospective study of all patients registered as dialysing at the North Middlesex University Hospital NHS Trust (NMUH) in September 2011. Information was obtained through GP letters, GP and patient questionnaires. Of 154 patients, 133 were included in the data analysis. Nineteen per cent were up-to-date with both vaccinations and 67% with their influenza vaccination. Fifty per cent had received the influenza vaccination in the last two consecutive years. Thirty per cent were not up-to-date with either vaccination. There was no evidence of a difference in uptake in 2009 (P = 0.7564) and in 2010 (P = 0.7435) among those who could and could not speak English. Twenty-five per cent of GPs and 58.6% of patients preferred vaccination to occur in the dialysis unit. Unfortunately a high number of GPs did not provide information on whether they used an electronic vaccination reminder but the analysis from the information provided by the few respondents did not reveal any correlation between the presence of an electronic reminder and vaccination status. Most dialysis patients were not up-to-date with both vaccinations. They were, however, more up-to-date with their influenza than their pneumococcal

  16. Midazolam sedation to produce complete amnesia for bronchoscopy: 2 years' experience at a district general hospital.

    Science.gov (United States)

    Williams, T J; Bowie, P E

    1999-05-01

    Patients may find bronchoscopy without sedation unpleasant. There is some evidence that patient satisfaction correlates with amnesia for the procedure. For several years we have used doses of midazolam sufficient to put patients lightly asleep hoping to produce complete amnesia. We looked at practical aspects of this technique over a 2-year period. We studied 337 consecutive patients. They were 219 men and 118 women of mean age 63 +/- 12.4 (SD). Sixty-seven patients were aged 75 years or over and the eldest was 86. Sixty-three patients were already hospital inpatients but the remainder were seen as day cases. Midazolam was given by slow i.v. injection over several minutes until the patient was judged to be lightly asleep. Patients were given supplemental oxygen (3 l min-1) and monitored by ECG and pulse oximetry. A note was made of the time at which they awakened, defined as when nursing staff felt the patients were awake enough to have a cup of tea and toast. Patients were asked if they had any memory of the procedure both on awakening and when seen a few days later to discuss the results. The procedures were carried out in a well-staffed Day Case Unit with a recovery area. The mean dose of midazolam used was 10.8 mg (mean +/- SD = 0.16 +/- 0.095 mg kg-1). The midazolam was given over a median of 4 min (range 1-15 min). Patients took 59 +/- 45 min (mean +/- SD) to wake up. Twenty-eight patients were given flumazanil to reverse the sedation (11 for concern over bleeding following biopsies, three for desaturation during and three after procedure, four as they were frail, two as they were restless, two as they were hypotensive after procedure and three for miscellaneous reasons). Only nine patients could remember any part of the procedure. Incremental doses of midazolam given slowly until patients are lightly asleep almost invariably produce complete amnesia for bronchoscopy. This is a safe technique but patients need careful monitoring and may require reversal of

  17. Infertility: an approach to management in a district hospital in Ghana.

    Science.gov (United States)

    Fiander, A

    1990-07-01

    Up to 1/3 of women of child bearing age are infertile in certain African areas. Over 1000 patients registered at Bawku Hospital, Upper East Region, Ghana during an 18-month period, where a scheme for the investigation and treatment of infertile patients was established. The 5 main causes of infertility are: 1) tubal damage; 2) male factor; 3) anovulation; 4) uterine factor; and 5) unexplained. Special clinics are set up for infertility; outpatient staff are recruited. A preprinted questionnaire should be used for a uniform approach. The one used in Bawku is shown in the appendix. Health talks should be given. They should use the local language be at the right level, and use visual aids. In large clinics, numbers should be used to insure a 1st come, 1st served basis. A treatment protocol is important. When the patient 1st walks in, the infertility form is completed; appropriate investigations are done--hemoglobin, VDRL, seminal analysis, and cervical or high vagina swabs, and others--and the results are reviewed. The patient is encouraged to keep a menstrual calendar for 3 months. At the 2nd visit, the menstrual calendar is reviewed. A pelvic examination and a tubal patency test (TPT) are done. At the 3rd visit, abdominal and pelvic examinations are done and a TPT. Then patients can be diagnosed and counselled accordingly. At the last visit, further explanation is given, further TPTs are done if necessary, and anovulation is treated with clomiphene. The visits are spread out over 6 months. In unexplained fertility cases, the couple is told there is nothing wrong, they should keep trying. The idea that the man may be causing the infertility is foreign to many communities. This needs changing. 20% of infertility is due to male factor in Bawku. Male infertility is hard to cure. Cultural considerations prevent the clinician from telling the patient that her partner is infertile. They will tell her that there is nothing wrong with her. Approximately 15% become pregnant

  18. Cost-analysis of the WHO Essential Medicines List in A Resource-Limited Setting: Experience from A District Hospital in India.

    Science.gov (United States)

    Alvarez-Uria, Gerardo; Thomas, Dixon; Zachariah, Seeba; Byram, Rajarajeshwari; Kannan, Shanmugamari

    2014-05-01

    The World Health Organization (WHO) has been publishing the essential medicines list (EML) since 1977. The EML includes the most efficacious, safe and cost-effective drugs for the most relevant public health conditions worldwide. The WHO performs a cost-effectiveness analysis within each therapeutic group, but very little is known about which therapeutic groups are costliest for hospitals that adopt the WHO EML concept. In this study, we have described the annual consumption of medicines in a district hospital in India, that limited the list of available drugs according to the WHO EML concept. Only 21 drugs constituted 50% of the hospital spending. Anti-infective medicines accounted for 41% of drug spending, especially antiretrovirals which were used to treat HIV infection. Among other therapeutic groups, insulin had the highest impact on the hospital budget. We identified medicines used in perinatal care, which included anti-D immunoglobulin and lung surfactants, that were used rarely, but bore a relatively high cost burden. The results of this study indicate that, in district that adopt the WHO EML, antiretrovirals and antibiotics were the top therapeutic groups for the drug hospital budgets.

  19. Food production and wastage in relation to nutritional intake in a general district hospital - wastage is not reduced by training the staff

    DEFF Research Database (Denmark)

    Almdal, T.; Viggers, L.; Beck, Anne Marie

    2003-01-01

    Background and Aims: To assess the amount of food produced in a hospital kitchen and the amount wasted. To assess the amount of food eaten by patients in relation to their energy needs. To assess whether the food production and wastage could be reduced by training members of the staff. Methods......: The study was carried out in a general district hospital in Denmark. The amount of food produced in the hospital kitchen and returned uneaten (wasted) was determined. In a representative sample of patients, the energy expenditure was calculated and in the same patients, the energy and protein intake....... Following training of the hospital staff, a new investigation showed no significant changes in the amount of food ordered and wasted. Conclusion: Despite a supply of food, which was much higher than the patients' needs, the patients have only approx. 60% of their energy need covered. We suggest...

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

    Science.gov (United States)

    Jordan, Mark; Caesar, Jenny

    2015-01-01

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

  1. The effectiveness of the South African Triage Toll use in Mahalapye District Hospital – Emergency Department, Botswana

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    Stephane T. Tshitenge

    2016-03-01

    Full Text Available Background: The study aimed to determine the proportion of each priority level of patients, time of performance in each priority level, and the reliability of the South African Triage Scale (SATS tool at the Mahalapye District Hospital - Emergency Department (MDH-ED, a setting where the majority of the nurses were not formally trained on the use of the SATS.Methods: This was a cross-sectional study using case records in MDH-ED from 1 January 2014 to 31 December 2014. A panel of experts from the Mahalapye site of the Family Medicine Department, University of Botswana, reviewed and scored each selected case record that was compared with the scores previously attributed to the nurse triage.Results: From the 315 case records, both the nurse triage and the panel of expert triage assigned the majority of cases in the routine category (green, 146 (46% and 125 (40%, respectively, or in the urgent category (yellow, they assigned 140 (44% and 111 (35% cases, respectively.Overall, there was an adequate agreement between the nurse triage and the panel of expert triage (k = 0.4, 95% confidence interval: 0.3–0.5, although the level of agreement was satisfactory.Conclusion: Findings of the study reported that the profile of the priority-level categories in MDH-ED was made in the majority of routine and urgent patients, only the routine and the emergency patients were seen within the targeted time and they had a satisfactory level of reliability (between 0.4 and 0.6.

  2. Profile of clients tested HIV positive in a voluntary counseling and testing center of a district hospital, Udupi

    Directory of Open Access Journals (Sweden)

    Gupta Megha

    2009-01-01

    Full Text Available Background: The growing menace created by the HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome has alarmed not only the public health officials but also the general community. The Voluntary Counseling and Testing Centre (VCTC services have begun as a cost-effective intervention in reversing this epidemic. Objectives: 1 To study the sociodemographic characteristics of HIV-positive clients and their risk behaviors. 2 To elucidate the reasons for their visit to the VCTC and know the problems anticipated by the clients after revealing their HIV-positive status. Study Design: A cross-sectional record-based study. Materials and Methods: The study was conducted in August 2007 among clients who tested positive for HIV in the VCTC of a district hospital in Karnataka from January to July 2007. Results: Study included 249 individuals of whom 161 were males and rest 88 females. A high percentage of nonresponse regarding the pattern of risk behavior was noted among the subjects (males: 42.8% and females: 90.9%. Of the individuals who responded, 91 males (98.9% and 6 females (75.0% had multiple heterosexual sex partners, while 1 male had homosexual partner. The figures in females show that two (25% of them had a history of blood transfusion. The reason for visiting the VCTC were cited as some form of illness (33.3%, confirmation of test results (32.9%, family members diagnosed as HIV positive (12.9% and 11.6% were referred from Directly Observed Treatment Scheme (DOTS center. More than one-thirds of the sample population anticipated discrimination at the time of medical treatment. Conclusion: People have begun using VCTC services, which reflects a change in their attitude toward HIV. The study provides us a clue to formulate an effective approach to educate people as well as the health personnel who are thought of as one of the important sources of discrimination.

  3. Lower extremity reconstruction: epidemiology, management and outcomes of patients of the Federal District North Wing Regional Hospital

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    JEFFERSON LESSA SOARES MACEDO

    Full Text Available ABSTRACT Objective: to evaluate the management of lower limbs complex traumatic injuries by analyzing their characteristics, types, conduct and evolution, with emphasis on surgical treatment. Methods: we conducted a prospective study of patients treated by Plastic Surgery at a regional hospital of the Federal District during a one-year period. We collected data through serial evaluations and telephone contact records. Results: we studied 40 patients, with a mean age of 25.6 years, predominantly male (62.5%. The most frequent wounds were of the distal third of the lower limb (37.5%. Bone or tendon exposures occurred in 55% had and there was a 35% rate of exposed lower limb fractures. The treatments employed were skin grafting (57.5%, local fasciocutaneous flap (15%, muscle flap (12.5%, cross-leg fasciocutaneous flap, reverse sural flap (12.5% and microsurgical flap (2.5%. Short-term evaluation showed that 35 patients had excellent or good results (87.5%, four had a regular result (10%, and one had an unsatisfactory result (2.5%. In the long term, of the 18 patients who answered the questionnaire, ten resumed walking, even with support, in the first three months after surgery (55.6%. Conclusion: young men involved in motorcycle accidents during leisure time represented the profile of patients with lower limb trauma requiring surgical reconstruction; the distal third of the leg was the most affected region. Grafting was the most used technique for reconstruction and postoperative functional evaluation showed that, despite complex lesions, most patients evolved with a favorable healing process and successful functional evolution.

  4. A study on sexually transmitted diseases in patients in a STD clinic in a district hospital in North India

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    Neerja Puri

    2014-07-01

    Full Text Available Introduction: The Sexually transmitted diseases (STDs are a global health problem of great magnitude. The pattern of STDs differs from country to country and from region to region. The increased risk of the transmission of HIV is known to be associated with the presence of sexually transmitted diseases (STDs and despite the presence of the National STD Control Program in India the number of people with STDs remains high. Aim: The aim of our study was to study the profile of patients in a STD clinic in North India and to study various sexually transmitted infections in both male and female patients. Material and Methods: A prospective study of the patients attending STD clinic in a district hospital in North India from December 2009 to December 2012 was done. A total of 2700 patients attending the STDclinic in three years from December 2009 to December 2012 were taken up for the study. Results: The commonest sexually transmitted infection in males was herpes genitalis (30% followed by 20% cases of genital warts. 10% patients had gonorrhoea, genital molluscum contagiosum, syphilis and genital scabies each and 5% patients had nongonococcal urethritis. Only 5% of the total patients had chancroid, donovanosis and LGV. The commonest sexually transmitted infection in females was vaginal discharge seen in 40% patients, lower abdominal pain in 20% patients, herpes genitalis in 15% patients followed by 20% cases of genital warts and syphilis each. Genital molluscum contagiosum was seen in 5% patients only. Conclusions: The treatment of STD’s is important as both non-ulcerative and ulcerative STDs increase the susceptibility to or transmissibility of HIV infection and as such, an increase in STD prevalence as revealed by clinic attendance in this study was bound to facilitate the spread of HIV/AIDS. Perhaps it is high time health planners adopted a more aggressive and result oriented HIV/AIDS/STD awareness campaign strategy.

  5. Evaluation of the status of the pre-hospital trauma care in road trafifc accidents in Kancheepuram district of Tamil Nadu

    Institute of Scientific and Technical Information of China (English)

    Prateek Saurabh Shrivastava; Jegadeesh Ramasamy

    2015-01-01

    Objective:To evaluate the status of the pre-hospital trauma care in a road traffic accidents in a rural area of Kancheepuram district. Methods: A cross-sectional study of two months duration (June and July 2014) was conducted in the tertiary care hospital of a medical college, and its affiliated urban/rural health centers. Universal sampling was used and all road accident victims were enrolled as study participants. The required information was obtained with the help of a semi-structured questionnaire. Ethical clearance was obtained before the start of the study.SPSS version 18 was used for data entry and statistical analysis. Descriptive statistics were calculated for all the variables. Results:A total of 80 (77.7%) study subjects were from the productive age group (15–45 years). Most of the accidents were reported at night time [43 (41.7%)], on weekends [59 (56.5%)], and involved two-wheelers [81 (78.6%)]. In addition, 69 cases (67%) of the victims were not aware of the existence of emergency ambulance services, while only 6 (5.8%) of the victims were brought to the hospital in an emergency ambulance. Conclusions: The study findings clearly suggest that the quality of the pre-hospital trauma care for road traffic accidentvictims in a rural area of Kancheepuram district lacks on multiple dimensions and there is an immense need to improve and strengthen the range of services to save the lives of the victims.

  6. Evaluation of the status of the pre-hospital trauma care in road traffic accidents in Kancheepuram district of Tamil Nadu

    Directory of Open Access Journals (Sweden)

    Saurabh RamBihariLal Shrivastava

    2015-12-01

    Full Text Available Objective: To evaluate the status of the pre-hospital trauma care in a road traffic accidents in a rural area of Kancheepuram district. Methods: A cross-sectional study of two months duration (June and July 2014 was conducted in the tertiary care hospital of a medical college, and its affiliated urban/rural health centers. Universal sampling was used and all road accident victims were enrolled as study participants. The required information was obtained with the help of a semi-structured questionnaire. Ethical clearance was obtained before the start of the study. SPSS version 18 was used for data entry and statistical analysis. Descriptive statistics were calculated for all the variables. Results: A total of 80 (77.7% study subjects were from the productive age group (15–45 years. Most of the accidents were reported at night time [43 (41.7%], on weekends [59 (56.5%], and involved two-wheelers [81 (78.6%]. In addition, 69 cases (67% of the victims were not aware of the existence of emergency ambulance services, while only 6 (5.8% of the victims were brought to the hospital in an emergency ambulance. Conclusions: The study findings clearly suggest that the quality of the pre-hospital trauma care for road traffic accident victims in a rural area of Kancheepuram district lacks on multiple dimensions and there is an immense need to improve and strengthen the range of services to save the lives of the victims.

  7. Hospital Staff Shortage after the 2011 Triple Disaster in Fukushima, Japan-An Earthquake, Tsunamis, and Nuclear Power Plant Accident: A Case of the Soso District

    Science.gov (United States)

    Ochi, Sae; Tsubokura, Masaharu; Kato, Shigeaki; Iwamoto, Shuichi; Ogata, Shinichi; Morita, Tomohiro; Hori, Arinobu; Oikawa, Tomoyoshi; Kikuchi, Antoku; Watanabe, Zenjiro; Kanazawa, Yukio; Kumakawa, Hiromi; Kuma, Yoshinobu; Kumakura, Tetsuo; Inomata, Yoshimitsu; Kami, Masahiro; Shineha, Ryuzaburo; Saito, Yasutoshi

    2016-01-01

    Introduction In 2011, Fukushima was struck by a triple disaster: an earthquake, tsunamis, and a nuclear accident. In the aftermath, there was much fear among hospital staff members about radiation exposure and many staff members failed to report to work. Objectives One objective is to measure this shortage in hospital staff and another is to compare the difference in recovery by hospital types and by categories of hospital staff. Design The monthly records of the number of staff members from May 2011 to September 2012 were extracted anonymously from the records of 7 local hospitals in the Soso district in Fukushima. Change in the number of staff was analyzed. Results Staff shortages at hospitals reached a maximum within one month after the disaster (47% reported to work). The shortage of clerks was the most severe (38% reported to work), followed by nurses (48% reported to work). The shortages remained even 18 months after the disaster. Conclusion After a disaster in which the damage to hospital functions surpasses the structural damage, massive support of human resources in the acute phase and a smaller volume of support in the mid-term phase appear to be required, particularly for non-medical staff. PMID:27788170

  8. Profile of clients tested HIV positive in a voluntary counseling and testing center of a district hospital, Udupi, South Kannada

    Directory of Open Access Journals (Sweden)

    Kumar A

    2008-01-01

    Full Text Available Background: The growing menace created by the HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome has alarmed not only the public health officials but also the general community. The Voluntary Counseling and Testing Centre (VCTC services have begun as a cost-effective intervention in reversing this epidemic. Objectives: 1. To study the sociodemographic characteristics of HIV-positive clients and their risk behaviors. 2. To elucidate the reasons for their visit to the VCTC and know the problems anticipated by the clients after revealing their HIV-positive status. Study Design: A cross-sectional record-based study. Materials and Methods: The study was conducted in August 2007 among clients who tested positive for HIV in the VCTC of a district hospital in Karnataka from January to July 2007. Results: Study included 249 individuals, of whom 64.7% were males, 88.7% (age, 15-49 years, married (72.7% males and 84.0% females and literate (females 71.5% and males 85.7%. A high percentage of nonresponse regarding the pattern of risk behavior was noted among the subjects (males: 42.8% and females: 90.9%. Of the individuals who responded, 91 males (98.9% and 6 females (75.0% had multiple heterosexual sex partners, while 1 male had homosexual partner. The figures in females show that two (25% of them had a history of blood transfusion. The reason for visiting the VCTC were cited as some form of illness (33.3%, confirmation of test results (32.9%, family members diagnosed as HIV positive (12.9% and 11.6% were referred from Directly Observed Treatment Scheme (DOTS center. More than three quarter of the sample population anticipated discrimination at the time of medical treatment. Conclusion: People have begun using VCTC services, which reflects a change in their attitude toward HIV. The study provides us a clue to formulate an effective approach to educate people as well as the health personnel who are thought of as one of the important

  9. Lower extremity reconstruction: epidemiology, management and outcomes of patients of the Federal District North Wing Regional Hospital.

    Science.gov (United States)

    Macedo, Jefferson Lessa Soares; Rosa, Simone Corrêa; Botelho, Daniel Lobo; Santos, Clendes Pereira Dos; Queiroz, Murilo Neves DE; Gomes, Tabatha Gonçalves Andrade Castelo Branco

    2017-01-01

    to evaluate the management of lower limbs complex traumatic injuries by analyzing their characteristics, types, conduct and evolution, with emphasis on surgical treatment. we conducted a prospective study of patients treated by Plastic Surgery at a regional hospital of the Federal District during a one-year period. We collected data through serial evaluations and telephone contact records. we studied 40 patients, with a mean age of 25.6 years, predominantly male (62.5%). The most frequent wounds were of the distal third of the lower limb (37.5%). Bone or tendon exposures occurred in 55% had and there was a 35% rate of exposed lower limb fractures. The treatments employed were skin grafting (57.5%), local fasciocutaneous flap (15%), muscle flap (12.5%), cross-leg fasciocutaneous flap, reverse sural flap (12.5%) and microsurgical flap (2.5%). Short-term evaluation showed that 35 patients had excellent or good results (87.5%), four had a regular result (10%), and one had an unsatisfactory result (2.5%). In the long term, of the 18 patients who answered the questionnaire, ten resumed walking, even with support, in the first three months after surgery (55.6%). young men involved in motorcycle accidents during leisure time represented the profile of patients with lower limb trauma requiring surgical reconstruction; the distal third of the leg was the most affected region. Grafting was the most used technique for reconstruction and postoperative functional evaluation showed that, despite complex lesions, most patients evolved with a favorable healing process and successful functional evolution. avaliar o tratamento de feridas traumáticas complexas de membros inferiores analisando suas características, tipos, condutas e evolução, com ênfase no tratamento cirúrgico. estudo prospectivo de pacientes tratados pela Cirurgia Plástica em um hospital regional do Distrito Federal no período de um ano. Os dados foram coletados através de avaliações seriadas e registro de

  10. Molar apicectomy with amalgam root-end filling: results of a prospective study in two district general hospitals.

    Science.gov (United States)

    Wesson, C M; Gale, T M

    2003-12-20

    To determine the five-year success rates, site or sites of failure, prognostic indicators and lower lip morbidity associated with molar apicectomy using amalgam root-end filling. Multicentre, prospective study. The departments of oral and maxillo-facial surgery in two district general hospitals. One thousand and seven molar apicectomy procedures, combined with amalgam root-end filling were expedited during the period 1974-1995. A five-year review of each operated tooth was carried out or attempted between 1979-2000. Of the 790 (78%) operated molars successfully reviewed at 5 years or later 451 (57%) exhibited 'complete healing' and 39 (5%) 'uncertain healing'. Three hundred (38%) were classified as 'unsatisfactory healing' (failures), and these included 12 which were assumed to be of periodontal origin. Whilst longitudinal root fracture, perforation and/or infection in the furcation, periodontal disease or a non-restorable crown accounted for treatment failure and often the need to remove teeth subsequently, the study probably pointed to the apical ends of the roots rather than the furcation as being the major sites at which 'unsatisfactory healing' occurred. Mandibular first molars attracted the highest 'complete healing' rate (60%) and mandibular second molars the lowest (46%). 'Good' root canal treatment (RCT) at the outset improved the prognosis of a root-end filling (REF) whilst the absence of RCT compromised it. Cystic change pointed to a better prognosis than apical granulomatous change as did a deep compared with a shallow 'bone cuff'. Disease at the furcation suggested a worse prognosis. Teeth which showed 'complete healing' at 1 year had a 75% probability of maintaining this outcome at 5 years. Sensory disturbance of variable duration occurred in the lower lip following 20-21% of mandibular molar procedures. In the majority of cases (79-80%) this had remitted within 3 months. A permanent deficit occurred in 8 patients (1%) where the apicectomy could

  11. Diabetic patients’ awareness regarding diabetes mellitus and its ocular complications at the National District Hospital in Bloemfontein, Free State, South Africa

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    Elzana Kempen

    2017-01-01

    Full Text Available Introduction: Globally, the prevalence of diabetes mellitus (DM and obesity is rapidly increasing. DM and, consequently, diabetic retinopathy (DR are serious issues that all countries around the world are facing. This study originated from a need to assess whether diabetic patients at the Outpatient Department at the National District Hospital in Bloemfontein have knowledge about their disease and are aware of the possible ocular complications.Methods: A descriptive study on a single group of participants was conducted at the Outpatient Department at National District Hospital in Bloemfontein. Non-random judgemental sampling was used to select participants who were diagnosed with diabetes. All participants were above the age of 18 and gave signed consent after reading through the information document provided.Results: The participants (n = 70 were mainly women (72% and elderly (> 40 years. Age groups represented were 40 years (7.1%, 40–49 years (12.9%, 50–59 years (32.9%, 60–69 years (28.6% and ≥ 70 years (18.56%. Almost 82% of the participants were aware that DM can cause blindness and 85.7% were aware of cataracts as a possible complication of DM. Almost half (47.1% were not aware that DM can cause DR and more than half (52.9% were unaware that DM can cause increased intraocular pressure (IOP.Conclusion: These results highlight the need for further education of diabetic patients regarding the relationship between DM and the ocular complications.

  12. Heart attack pervasiveness along with associated risk factors in District Headquarter Hospital in Karak, Khyber Pakhtunkhwa, Pakistan

    OpenAIRE

    Zareen Shehzad; Ur Rehman Hameed; Zareen Hira; Ghaffar Sadia; Khattak Nayab; Shafi Saira; Noreen Sadia; Subhan Mutahira; Azra Bibi; Fatima Faiza; Saeed Rifat; Waqar Ahmad; Raqeebullah

    2016-01-01

    Objective: To investigate the possible risk factors among heart patients of Karak District. Methods: Different questions were asked from the respondents regarding their educational level, stress taking, smoking, mode of medication and diabetic history. A total of 72 heart patients were included in this study with the confirmed medical history of myocardial disorder/ heart attack either once or twice. Results: It was revealed in this study that a high prevalence of heart attack ...

  13. Hospitals

    Data.gov (United States)

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

  14. A multifaceted intervention to improve the quality of care of children in district hospitals in Kenya: a cost-effectiveness analysis.

    Directory of Open Access Journals (Sweden)

    Edwine W Barasa

    Full Text Available To improve care for children in district hospitals in Kenya, a multifaceted approach employing guidelines, training, supervision, feedback, and facilitation was developed, for brevity called the Emergency Triage and Treatment Plus (ETAT+ strategy. We assessed the cost effectiveness of the ETAT+ strategy, in Kenyan hospitals. Further, we estimate the costs of scaling up the intervention to Kenya nationally and potential cost effectiveness at scale.Our cost-effectiveness analysis from the provider's perspective used data from a previously reported cluster randomized trial comparing the full ETAT+ strategy (n = 4 hospitals with a partial intervention (n = 4 hospitals. Effectiveness was measured using 14 process measures that capture improvements in quality of care; their average was used as a summary measure of quality. Economic costs of the development and implementation of the intervention were determined (2009 US$. Incremental cost-effectiveness ratios were defined as the incremental cost per percentage improvement in (average quality of care. Probabilistic sensitivity analysis was used to assess uncertainty. The cost per child admission was US$50.74 (95% CI 49.26-67.06 in intervention hospitals compared to US$31.1 (95% CI 30.67-47.18 in control hospitals. Each percentage improvement in average quality of care cost an additional US$0.79 (95% CI 0.19-2.31 per admitted child. The estimated annual cost of nationally scaling up the full intervention was US$3.6 million, approximately 0.6% of the annual child health budget in Kenya. A "what-if" analysis assuming conservative reductions in mortality suggests the incremental cost per disability adjusted life year (DALY averted by scaling up would vary between US$39.8 and US$398.3.Improving quality of care at scale nationally with the full ETAT+ strategy may be affordable for low income countries such as Kenya. Resultant plausible reductions in hospital mortality suggest the intervention could be

  15. A Multifaceted Intervention to Improve the Quality of Care of Children in District Hospitals in Kenya: A Cost-Effectiveness Analysis

    Science.gov (United States)

    Barasa, Edwine W.; Ayieko, Philip; Cleary, Susan; English, Mike

    2012-01-01

    Background To improve care for children in district hospitals in Kenya, a multifaceted approach employing guidelines, training, supervision, feedback, and facilitation was developed, for brevity called the Emergency Triage and Treatment Plus (ETAT+) strategy. We assessed the cost effectiveness of the ETAT+ strategy, in Kenyan hospitals. Further, we estimate the costs of scaling up the intervention to Kenya nationally and potential cost effectiveness at scale. Methods and Findings Our cost-effectiveness analysis from the provider's perspective used data from a previously reported cluster randomized trial comparing the full ETAT+ strategy (n = 4 hospitals) with a partial intervention (n = 4 hospitals). Effectiveness was measured using 14 process measures that capture improvements in quality of care; their average was used as a summary measure of quality. Economic costs of the development and implementation of the intervention were determined (2009 US$). Incremental cost-effectiveness ratios were defined as the incremental cost per percentage improvement in (average) quality of care. Probabilistic sensitivity analysis was used to assess uncertainty. The cost per child admission was US$50.74 (95% CI 49.26–67.06) in intervention hospitals compared to US$31.1 (95% CI 30.67–47.18) in control hospitals. Each percentage improvement in average quality of care cost an additional US$0.79 (95% CI 0.19–2.31) per admitted child. The estimated annual cost of nationally scaling up the full intervention was US$3.6 million, approximately 0.6% of the annual child health budget in Kenya. A “what-if” analysis assuming conservative reductions in mortality suggests the incremental cost per disability adjusted life year (DALY) averted by scaling up would vary between US$39.8 and US$398.3. Conclusion Improving quality of care at scale nationally with the full ETAT+ strategy may be affordable for low income countries such as Kenya. Resultant plausible reductions in hospital

  16. Investigating Patients with Recent Onset of Chest Pain Against NICE Guidelines in a District General Hospital Setting in the United Kingdom

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    Azeem S Sheikh

    2012-09-01

    Full Text Available Background: Chest pain is a very common symptom leading to a significant number of patients visiting the primary care trusts, emergency departments and a huge number of emergency hospital admissions.Objective: The objective of our audit was to investigate whether patients with recent onset of chest pain referred to the Rapid Access Chest Pain Clinic were being investigated in accordance with the recommendations by the National Institute for Health and Clinical Excellence (NICE, in a busy District General Hospital setting.Design: Retrospective collection of dataSetting: Southend University Hospital NHS Foundation TrustPatients: We collected data over a period of three months for all the patients who underwent invasive coronary angiogram after being referred via Rapid Access Chest Pain Clinic (RACPC or General Cardiology Clinic presenting with recent onset of chest pain. A total of 157 patients were enrolled in the study. The patients were then categorised into four groups based upon their description of symptoms, age and risk factors, as defined by NICE.Results: We found that 86% (135/157 patients had estimated likelihood of CAD >60% and 51% of these had unnecessary non-invasive investigations contrary to what NICE recommends. This shows that adhering to the NICE guidelines would have saved a substantial amount of hospital resources and time of the healthcare team and the patients.Conclusions: The development of strategies for cost-conscious quality care must begin with the history, risk factors for coronary artery disease and patients’ investigations should be based on their risk stratification.

  17. Alarmingly High Incidence of Eosinophilia in Barabanki and Neighboring Districts of Eastern Uttar Pradesh: A Prospective Hospital-Based Study.

    Science.gov (United States)

    Thakur, Neha; Rai, Narendra

    2016-12-01

    Eosinophilia is very common among rural poulation in Barabanki and neighbouring districts with no access to hygienic mode of stool disposition. Significant proportions of these children are suffering from anemia, undernutrition, anorexia, pain abdomen, cough and hence long term morbidity. This adds to the DALY of a developing country like India. All these chronic problems are preventable and treatable with simple corrective steps of which the most important ones are access to safe drinking water and toilet. The present study was conducted to study clinical and laboratory profile of patients with eosinophilia and to identify possible causes. © The Author [2016]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  18. Asthma Hospitalization Rates among Children, and School Building Conditions, by New York State School Districts, 1991-2001

    Science.gov (United States)

    Belanger, Erin; Kielb, Christine; Lin, Shao

    2006-01-01

    School-age children spend a significant portion of their day at school where they can be exposed to asthma triggers, but little information exists regarding potential relationships between childhood asthma and school environmental factors. This study examined patterns of asthma hospitalization and possible factors contributing to asthma…

  19. Legislative Districts - House Districts

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This layer represents the Arkansas State House of Representatives district boundaries adopted by the Arkansas Board of Apportionment on July 29, 2011. The Board of...

  20. Legislative Districts - Senate Districts

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This layer represents the Arkansas State Senate district boundaries adopted by the Arkansas Board of Apportionment on July 29, 2011. The Board of Apportionment,...

  1. Clinical deterioration during antitubercular treatment at a district hospital in South Africa: the importance of drug resistance and AIDS defining illnesses.

    Directory of Open Access Journals (Sweden)

    Dominique J Pepper

    Full Text Available BACKGROUND: Clinical deterioration on drug therapy for tuberculosis is a common cause of hospital admission in Africa. Potential causes for clinical deterioration in settings of high HIV-1 prevalence include drug resistant Mycobacterium tuberculosis (M.tb, co-morbid illnesses, poor adherence to therapy, tuberculosis associated-immune reconstitution inflammatory syndrome (TB-IRIS and subtherapeutic antitubercular drug levels. It is important to derive a rapid diagnostic work-up to determine the cause of clinical deterioration as well as specific management to prevent further clinical deterioration and death. We undertook this study among tuberculosis (TB patients referred to an adult district level hospital situated in a high HIV-1 prevalence setting to determine the frequency, reasons and outcome for such clinical deterioration. METHOD: A prospective observational study conducted during the first quarter of 2007. We defined clinical deterioration as clinical worsening or failure to stabilise after 14 or more days of antitubercular treatment, resulting in hospital referral. We collected data on tuberculosis diagnosis and treatment, HIV-1 status and antiretroviral treatment, and investigated reasons for clinical deterioration as well as outcome. RESULTS: During this period, 352 TB patients met inclusion criteria; 296 were admitted to hospital accounting for 17% of total medical admissions (n = 1755. Eighty three percent of TB patients (291/352 were known to be HIV-1 co-infected with a median CD4 count of 89cells/mm(3 (IQR 38-157. Mortality among TB patients admitted to hospital was 16% (n = 48. The median duration of hospital admission was 9.5 days (IQR 4-18, longer than routine in this setting (4 days. Among patients in whom HIV-1 status was known (n = 324, 72% of TB patients (n = 232 had an additional illness to tuberculosis; new AIDS defining illnesses (n = 80 were the most frequent additional illnesses (n = 208 in HIV-1 co-infected patients (n

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

    Directory of Open Access Journals (Sweden)

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

    2014-01-01

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

  3. Implementation experience during an eighteen month intervention to improve paediatric and newborn care in Kenyan district hospitals

    Directory of Open Access Journals (Sweden)

    Wamae Annah

    2009-07-01

    Full Text Available Abstract Background We have conducted an intervention study aiming to improve hospital care for children and newborns in Kenya. In judging whether an intervention achieves its aims, an understanding of how it is delivered is essential. Here, we describe how the implementation team delivered the intervention over 18 months and provide some insight into how health workers, the primary targets of the intervention, received it. Methods We used two approaches. First, a description of the intervention is based on an analysis of records of training, supervisory and feedback visits to hospitals, and brief logs of key topics discussed during telephone calls with local hospital facilitators. Record keeping was established at the start of the study for this purpose with analyses conducted at the end of the intervention period. Second, we planned a qualitative study nested within the intervention project and used in-depth interviews and small group discussions to explore health worker and facilitators' perceptions of implementation. After thematic analysis of all interview data, findings were presented, discussed, and revised with the help of hospital facilitators. Results Four hospitals received the full intervention including guidelines, training and two to three monthly support supervision and six monthly performance feedback visits. Supervisor visits, as well as providing an opportunity for interaction with administrators, health workers, and facilitators, were often used for impromptu, limited refresher training or orientation of new staff. The personal links that evolved with senior staff seemed to encourage local commitment to the aims of the intervention. Feedback seemed best provided as open meetings and discussions with administrators and staff. Supervision, although sometimes perceived as fault finding, helped local facilitators become the focal point of much activity including key roles in liaison, local monitoring and feedback, problem solving

  4. Understanding predictors of postdischarge deaths: a prospective evaluation of children 5 years and younger discharged from Philippine district hospitals.

    Science.gov (United States)

    Panelo, Carlo Irwin A; Shimkhada, Riti; Solon, Orville C; Quimbo, Stella A; Florentino, Jhiedon F; Peabody, John W

    2011-04-01

    Factors that increase likelihood of readmission or mortality postdischarge from diarrhea and pneumonia cases among children is less understood. This study investigated the deaths of 24 children from a cohort of 3275. Using logistic regression, the authors compared data from those who survived with those who died to estimate the determinants of mortality in the study population. The authors also analyzed the hospital charts and completed mortality interviews with families of the deceased children. Poor quality of care significantly increased the likelihood of mortality. Sicker children, those born to less-educated mothers, and those who had longer lengths of stay also had a higher likelihood of mortality. Hospital charts corroborated findings from clinical vignettes. The mortality interviews revealed delays in seeking care from onset of symptoms. Quality of care contributes to postdischarge mortality and that clinical vignettes are an effective means to identify where quality can be improved.

  5. Council Districts

    Data.gov (United States)

    Town of Cary, North Carolina — View the location of the Town of Cary’s four Town Council districts.Please note that one district, District A, is split into two geo-spatial areas. One area is in...

  6. Factors That Negatively Affect the Prognosis of Pediatric Community-Acquired Pneumonia in District Hospital in Tanzania

    Science.gov (United States)

    Caggiano, Serena; Ullmann, Nicola; De Vitis, Elisa; Trivelli, Marzia; Mariani, Chiara; Podagrosi, Maria; Ursitti, Fabiana; Bertolaso, Chiara; Putotto, Carolina; Unolt, Marta; Pietravalle, Andrea; Pansa, Paola; Mphayokulela, Kajoro; Lemmo, Maria Incoronata; Mkwambe, Michael; Kazaura, Joseph; Duse, Marzia; Nieddu, Francesco; Azzari, Chiara; Cutrera, Renato

    2017-01-01

    Community-acquired pneumonia (CAP) is still the most important cause of death in countries with scarce resources. All children (33 months ± 35 DS) discharged from the Pediatric Unit of Itigi Hospital, Tanzania, with a diagnosis of CAP from August 2014 to April 2015 were enrolled. Clinical data were gathered. Dried blood spot (DBS) samples for quantitative real-time polymerase chain reaction (PCR) for bacterial detection were collected in all 100 children included. Twenty-four percent of patients were identified with severe CAP and 11% died. Surprisingly, 54% of patients were admitted with a wrong diagnosis, which increased complications, the need for antibiotics and chest X-rays, and the length of hospitalization. Comorbidity, found in 32% of children, significantly increased severity, complications, deaths, need for chest X-rays, and oxygen therapy. Malnourished children (29%) required more antibiotics. Microbiologically, Streptococcus pneumonia (S. p.), Haemophilus influenza type b (Hib) and Staphylococcus aureus (S. a.) were the bacteria more frequently isolated. Seventy-five percent of patients had mono-infection. Etiology was not correlated with severity, complications, deaths, oxygen demand, or duration of hospitalization. Our study highlights that difficult diagnoses and comorbidities negatively affect clinical evolution. S. p. and Hib still play a large role; thus, implementation of current vaccine strategies is needed. DBS is a simple and efficient diagnostic method for bacterial identification in countries with scarce resources. PMID:28335406

  7. hospital

    African Journals Online (AJOL)

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

  8. STUDY OF THE MORBIDITY PATTERN IN THE SPECIAL NEW BORN CARE UNIT (SNCU AT A TERTIARY CARE TEACHING HOSPITAL IN KURNOOL DISTRICT , ANDHRA PRADESH, INDIA

    Directory of Open Access Journals (Sweden)

    Sardar Sulthana

    2015-06-01

    Full Text Available OBJECTIVE: To Study the Morbidity Pattern in NICU at a Tertiary Care teaching Hospital Kurnool medical college Kurnool. METHODS: Retrospective study of medical records during the period of July 2014 to Dec. 2014 of all neonates who were admitted to the SNCU were reviewed Data regarding the place of birth , gestational age , birth weight and diagnosis were recorded. SETTINGS: SNCU of Tertiary Care teaching Hospital located in Kurnool District of Andhra Pradesh. Study carried out over 6 months – during July 2014 to Dec. 2014. PARTICIPANTS: Study sampl e 1418 neonates . With some illness who were admitted to NICU. OUTCOME: Study of Pattern of Morbidity among neonates admitted in SNCU during 6 months period. RESULTS: A total of 1418 babies in SNCU were included for data analysis excluding babies who left t he hospital against medical advice. Ratio of inborn ( 28.91 % and out born ( 71.09% neonates was 0.41%. Majority of admissions constitute Term ( 54.8% followed by preterm 25.79% followed by IUGR 19.46%. Major causes of Morbidity were birth Asphyxia with HIE ( 32.07% , pre maturity 25.74%. IUGR ( 23.98% Sepsis ( 23.41% followed by , HMD in premature ( 11.92% . The most common cause of referral from outside were birth Asphyxia with HIE ( 29.76% Neonatal sepsis ( 25.5% , prematurity with RDS ( 11.51% , IUGR ( 7.74% . CONCLUSION: Study identified HIE prematurity ( 25.74% IUGR ( 23.98% Sepsis ( 23.41% as the major cause of morbidity. Adequate antenatal care to the at risk mothers and advances in the neonatal intensive care will improve the neonatal outcome .

  9. Heart attack pervasiveness along with associated risk factors in District Headquarter Hospital in Karak, Khyber Pakhtunkhwa, Pakistan

    Institute of Scientific and Technical Information of China (English)

    Zareen Shehzad; Fatima Faiza; Saeed Rifat; Waqar Ahmad; Raqeebullah; Ur Rehman Hameed; Zareen Hira; Ghaffar Sadia; Khattak Nayab; Shafi Saira; Noreen Sadia; Subhan Mutahira; Azra Bibi

    2016-01-01

    Objective: To investigate the possible risk factors among heart patients of Karak District. Methods: Different questions were asked from the respondents regarding their educational level, stress taking, smoking, mode of medication and diabetic history. A total of 72 heart patients were included in this study with the confirmed medical history of myocardial disorder/heart attack either once or twice. Results: It was revealed in this study that a high prevalence of heart attack was observed in respondents at secondary level of educationi.e. 73.33%. This was followed by the respondents at primary level of education having 63.64% heart patients and then respondents at postgraduate educational level having 61.11% heart patients. Least number of heartpatients were found at graduate groupi.e. 27.78% heart patients. This study revealed that stress takers were at a higher risk of heart attack, while nonstress takers were comparatively healthier than stress takers. About 83.33% stress taker respondents were heart patients, while 76.67% healthy respondents were nonstress takers. Current study also revealed that smoking was a leading cause of cardiovascular diseases as 88.10% heart patients were either occasional smokers or chain smokers, while 66.67% nonsmokers were healthy with no symptoms of heart disease. Self-medication was found an elevated cause of heart diseases as 76.19% heart patients had a history of self-medication. Conclusions: This practice was found low in healthy respondents where only 23.81% respondents had self-medication in their past history. Diabetes was found the associated disease with the heart patients.

  10. Do Malawian women critically assess the quality of care? A qualitative study on women’s perceptions of perinatal care at a district hospital in Malawi

    Directory of Open Access Journals (Sweden)

    Kumbani Lily C

    2012-11-01

    Full Text Available Abstract Background Malawi has a high perinatal mortality rate of 40 deaths per 1,000 births. To promote neonatal health, the Government of Malawi has identified essential health care packages for improving maternal and neonatal health in health care facilities. However, regardless of the availability of health services, women’s perceptions of the care is important as it influences whether the women will or will not use the services. In Malawi 95% of pregnant women receive antenatal care from skilled attendants, but the number is reduced to 71% deliveries being conducted by skilled attendants. The objective of this study was to describe women’s perceptions on perinatal care among the women delivered at a district hospital. Methods A descriptive study design with qualitative data collection and analysis methods. Data were collected through face-to-face in-depth interviews using semi-structured interview guides collecting information on women’s perceptions on perinatal care. A total of 14 in depth interviews were conducted with women delivering at Chiradzulu District Hospital from February to March 2011. The women were asked how they perceived the care they received from health workers during antepartum, intrapartum and postpartum. They were also asked about the information they received during provision of care. Data were manually analyzed using thematic analysis. Results Two themes from the study were good care and unsatisfactory care. Subthemes under good care were: respect, confidentiality, privacy and normal delivery. Providers’ attitude, delay in providing care, inadequate care, and unavailability of delivery attendants were subthemes under unsatisfactory care. Conclusions Although the results show that women wanted to be well received at health facilities, respected, treated with kindness, dignity and not shouted at, they were not critical of the care they received. The women did not know the quality of care to expect because they

  11. Service delivery in Kenyan district hospitals – what can we learn from literature on mid-level managers?

    Science.gov (United States)

    2013-01-01

    Background There is a growing emphasis on the need to tackle inadequate human resources for health (HRH) as an essential part of strengthening health systems; but the focus is mostly on macro-level issues, such as training, recruitment, skill mix and distribution. Few attempts have been made to understand the capability of health workers, their motivation and other structural and organizational aspects of systems that influence workforce performance. We have examined literature on the roles of mid-level managers to help us understand how they might influence service delivery quality in Kenyan hospitals. In the Kenyan hospital settings, these are roles that head of departments who are also clinical or nursing service providers might play. Methods A computerized search strategy was run in Pub Med, Cochrane Library, Directory of Open Access Journals Social Science Research Network, Eldis, Google Scholar and Human Resources for Health web site databases using both free-text and MeSH terms from 1980 to 2011. In addition, citation searching from excluded and included articles was used and relevant unpublished literature systematically identified. Results and discussion A total of 23 articles were finally included in the review from over 7000 titles and abstracts initially identified. The most widely documented roles of mid-level managers were decision-making or problem-solving, strategist or negotiator and communicator. Others included being a therapist or motivator, goal setting or articulation and mentoring or coaching. In addition to these roles, we identified important personal attributes of a good manager, which included interpersonal skills, delegation and accountability, and honesty. The majority of studies included in the review concerned the roles that mid-level managers are expected to play in times of organizational change. Conclusion This review highlights the possible significance of mid-level managers in achieving delivery of high-quality services in Kenyan

  12. Lean thinking: can it improve the outcome of fracture neck of femur patients in a district general hospital?

    Science.gov (United States)

    Yousri, T A; Khan, Z; Chakrabarti, D; Fernandes, R; Wahab, K

    2011-11-01

    We present our experience in the management of hip fracture patients after the application of a value-stream approach, the Lean framework, in our trust. This system uses available resources in an efficient manner whilst eliminating waste. A statistically significant reduction of 5% and 9.3% was noted in the 30-day and overall mortality, respectively, after implementing 'Lean thinking'. Further improvements were also noted in door-to-theatre time, use of trauma beds and early discharge from hospitals. To our knowledge, this is the largest study in the literature where the Lean framework has been successfully employed for the management of a very challenging health-care issue faced by the National Health Service. Future prospective studies are, however, needed to reconfirm these results and to evaluate the components that are most critical to the success of the implemented framework. Copyright © 2010 Elsevier Ltd. All rights reserved.

  13. Diagnosis and Management of Ureterovaginal Fistula in a Resource-Constrained Setting: Experience at a District Hospital in Northern Nigeria

    Directory of Open Access Journals (Sweden)

    Randawa AJ1, Khalid L2, Abbas A3

    2009-01-01

    Full Text Available During 2007 we were invited at different times to review and manage four women with ureterovaginalfistula following caesarean section performed in different rural hospitals. We describe our experienceof a simple technique of diagnosis and management of these indigent patients in a resourceconstrainedhospital. The condition was diagnosed by the three-swab test in all four patients, andabdominopelvic ultrasound was employed to help find the ureter involved. Transvesical ureteralimplantation with a stent was carried out. Stent was removed after 2 weeks. All four patients were dry.Amidst the complexity of and sophistication of modern health care, it is important to remind ourselvesof the common occurrence of this distressing condition following caesarean section and the use of awell known simple diagnostic technique and subsequent management in resource-poor communities.

  14. Translating a National Laboratory Strategic Plan into action through SLMTA in a district hospital laboratory in Botswana

    Directory of Open Access Journals (Sweden)

    Keoratile Ntshambiwa

    2014-09-01

    Full Text Available Background: The Ministry of Health (MOH of Botswana adopted Strengthening Laboratory Management Toward Accreditation (SLMTA, a structured quality improvement programme, as a key tool for the implementation of quality management systems in its public health laboratories. Coupled with focused mentorship, this programme aimed to help MOH achieve the goals of the National Laboratory Strategic Plan to provide quality and timely clinical diagnosis.Objectives: This article describes the impact of implementing SLMTA in Sekgoma Memorial Hospital Laboratory (SMHL in Serowe, Botswana.Methods: SLMTA implementation in SMHL included trainings, improvement projects, site visits and focused mentorship. To measure progress, audits using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA checklist were conducted at baseline and exit of the programme, with scores corresponding to a zero- to five-star scale.Turnaround times and customer satisfaction were tracked.Results: The laboratory scored 53% (zero stars at the baseline audit and 80% (three stars at exit. Nearly three years later, the laboratory scored 85% (four stars in an official audit conducted by the African Society for Laboratory Medicine. Turnaround times became shorter after SLMTA implementation, with reductions ranging 19% to 52%; overall patient satisfaction increased from 56% to 73%; and clinician satisfaction increased from 41% to 72%. Improvements in inventory management led to decreases in discarded reagents, reducinglosses from US $18 000 in 2011 to $40 in 2013.Conclusion: The SLMTA programme contributed to enhanced performance of the laboratory,which in turn yielded potential positive impacts for patient care at the hospital.

  15. Consentimento livre e esclarecido em odontologia nos hospitais públicos do Distrito Federal Informed consent for dentistry in public hospitals, Federal District, Brazil

    Directory of Open Access Journals (Sweden)

    Fabiano Maluf

    2007-12-01

    Full Text Available A individualidade e o poder de decisão dos indivíduos devem ser respeitados. A autonomia manifestada por meio do consentimento livre e esclarecido é a fonte de tal respeito. Este trabalho visou levantar dados sobre a realidade no uso do consentimento livre e esclarecido nos hospitais públicos do Distrito Federal. Um questionário foi encaminhado aos dentistas dos hospitais públicos para ser respondido. Os resultados obtidos demonstram que, no início do tratamento, é utilizado o consentimento livre e esclarecido, de forma verbal, na maioria dos hospitais. Observam-se, ainda, equívocos na utilização e conceituação do consentimento livre e esclarecido. Os documentos misturam autorização do uso de imagem, com consentimento livre e esclarecido. Os documentos apresentam poucas informações e não esclarecem aspectos importantes do tratamento. Portanto, os cirurgiões-dentistas atuantes na rede pública hospitalar necessitam de um aprofundamento nos fundamentos bioéticos com o intuito de congregarem, ao princípio da beneficência, já consolidado e normatizado, o princípio da autonomia.Personal powers of decision and individuality must be respected, grounded on autonomy expressed through informed consent. This paper examines data on the actual use of informed consent in public hospitals in Brazil's Federal District. A questionnaire was completed by dentists in public hospitals, and its findings show that verbal informed consent is obtained at the start of treatment in most of the hospitals. Errors were noted in the use and conceptualization of informed consent. Failing to distinguish between image rights authorization and informed consent, the documents provide little information and do not explain important aspects of the treatment. Dentists practicing in the public hospital network thus need more detailed knowledge of basic bio-ethics in order to merge the long-consolidated and regulated principle of welfare with the principle of

  16. Special Taxing Districts, Special taxing unit districts derived from the taxunit coverage, include a layer for Improvement, Drainage, Watershed, Cemetery, Hospital, Redevelopment, Sewer and Industrial Districts. Primary attributes include district name, Election Office code, and, Published in 2008, 1:1200 (1in=100ft) scale, Sedgwick County, Kansas.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Special Taxing Districts dataset, published at 1:1200 (1in=100ft) scale, was produced all or in part from Published Reports/Deeds information as of 2008. It is...

  17. The profile and frequency of known risk factors or comorbidities for deep vein thrombosis in an urban district hospital in KwaZulu-Natal

    Directory of Open Access Journals (Sweden)

    Damilola Awolesi

    2016-02-01

    Full Text Available Background: Although deep vein thrombosis (DVT is a preventable disease, it increases the morbidity and mortality in hospitalised, patients, resulting in considerable economic health impact. The identification and primary prevention of risk factors using risk assessment and stratification with subsequent anti-thrombotic prophylaxis in moderate- to severe-risk categories is the most rational means of reducing morbidity and mortality.Aim and setting: The aim of the study was to describe the profile and frequency of known risk factors or comorbidities of hospitalised medical patients with ultrasound-diagnosed DVT in an urban district hospital in KwaZulu-Natal.Methods: A retrospective review of clinical notes of all medical patients (age ≥ 13 years admitted to the hospital with ultrasound-diagnosed DVT between July and December 2013.Results: The median age was 40 years (interquartile range 32–60 years and female preponderance was 72.84%. HIV and tuberculosis emerged as the prevalent risk factors, accounting for 51.85% and 35.80%, respectively. Other risk factors observed were recent hospitalisation (34.57%, smoking (25.93%, previous DVT (19.75% and congestive cardiac failure (18.52%.Conclusion: DVT in our study occurred predominantly in young female patients unlike previous studies where patients were generally older. Furthermore, HIV and tuberculosis were the two most common known risk factors or comorbidities observed. Clinicians should have a heightened awareness of venous thromboembolism in patients with either condition or where both conditions occur together and appropriate thromboprophylaxis should be administered.Keywords: Deep Vein Thrombosis; risk factors; profile

  18. Factors influencing uptake of contraceptive implants in the immediate postpartum period among HIV infected and uninfected women at two Kenyan District Hospitals.

    Science.gov (United States)

    Shabiby, Mufida M; Karanja, Joseph G; Odawa, Francis; Kosgei, Rose; Kibore, Minnie W; Kiarie, James N; Kinuthia, John

    2015-08-19

    Family planning is a cost effective strategy for prevention of mother to child transmission of HIV and reduction of maternal/infant morbidity and mortality. Contraceptive implants are a safe, effective, long term and reversible family planning method whose use remains low in Kenya. We therefore set out to determine and compare the uptake, and factors influencing uptake of immediate postpartum contraceptive implants among HIV infected and uninfected women at two hospitals in Kenya. This cross sectional study targeted postpartum mothers at two Kenyan district hospitals (one urban and one rural). All participants received general family planning and method specific (Implant) counseling followed by immediate insertion of contraceptive implants to those who consented. The data was analyzed by descriptive analysis, T-test, Chi square tests and logistic regression. One hundred eighty-five participants were enrolled (91 HIV positive and 94 HIV negative) with a mean age of 26 years. HIV positive mothers were significantly older (27.5 years) than their HIV negative counterparts (24.5 years), P = 0.001. The two groups were comparable in education, employment, marital status and religious affiliation. Overall, the uptake of contraceptive implants in the immediate postpartum period was 50.3% and higher among HIV negative than HIV positive participants (57% vs. 43%, P = 0.046). Multivariate analysis revealed that a negative HIV status (P = 0.017) and prior knowledge of contraceptive implants (P = 0.001) were independently associated with increased uptake of contraceptive implants. There was a high uptake of immediate postpartum contraceptive implants among both HIV infected and un-infected women; efforts therefore need to be made in promoting this method of family planning in Kenya and providing this method to women in the immediate postpartum period so as to utilize this critical opportunity to increase uptake and reduce the high unmet need for family planning.

  19. Performance of health product risk management and surveillance conducted by health personnel at sub-district health promotion hospitals in the northeast region of Thailand

    Directory of Open Access Journals (Sweden)

    Kanjanarach T

    2014-10-01

    Full Text Available Tipaporn Kanjanarach,1,2 Raksaworn Jaisa-ard,1,2 Nantawan Poonaovarat3 1Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, Thailand; 2Center for Research and Development of Herbal Health Products, Khon Kaen University, Khon Kaen, Thailand; 3Health Consumer Protection, Chaiyapum Health Provincial Office, Chaiyapum, Thailand Background: Health personnel at sub-district health promotion hospitals (SD-HPHs are assigned to take responsibility for 15 activities related to health product risk management and surveillance (HP-RM&S. This cross-sectional survey aimed to identify factors that determined their job performance and to record their expressed needs to support HP-RM&S operation. In this study, job performance was defined as completion of all 15 activities. Methods: Self-administered postal questionnaires were used to collect data from 380 randomly selected health personnel who were in charge of HP-RM&S at SD-HPHs in the northeast of Thailand. Results: Thirty-six point one percent (n=137 of the respondents were able to perform all 15 of the HP-RM&S activities assigned to SD-HPHs. A logistic regression model identified three factors that statistically significantly determined the completion of all 15 HP-RM&S activities. These were: receiving a high or very high level of support from the community (adjusted odds ratio [OR]: 2.5; 95% confidence interval [CI]: 1.5, 4.1, the responsible persons for HP-RM&S did not hold an administrative position (adjusted OR: 1.7; 95% CI: 1.1, 2.7, and having at least one training session related to HP-RM&S per year (adjusted OR: 1.7; 95% CI 1.1, 2.6. There were 1,536 expressed needs which can be classified into four major categories, ie, training needs (41.6%, n=639, resource support (28.3%, n=435, mechanisms that facilitate HP-RM&S operation (24.1%, n=370 and adjusting of the scope of HP-RM&S (6.0%, n=92. The topics most frequently referred to in training needs were drug law, food law, and cosmetics

  20. Oral sildenafil (Viagra™ in male erectile dysfunction: use, efficacy and safety profile in an unselected cohort presenting to a British district general hospital.

    Directory of Open Access Journals (Sweden)

    Boustead Gregory

    2002-04-01

    Full Text Available Abstract Introduction Sildenafil (Viagra® is one of the drugs used in the first line therapy of male erectile dysfunction (MED. We have recorded outcomes, adverse events and acceptability of Sildenafil (Viagra therapy in an unselected group of men presenting with ED to a British district general hospital. Methods In this prospective observational study, 147 men with ED were seen since Oct 1999. Study patients were reviewed at 4, 12 and 52 weeks. All the patients filled the International Index of Erectile Function (IIEF questionnaire and were asked about their willingness to pay (WTP for treatment. Results All suitable men accepted Viagra as first line therapy. 91% of our patients found sildenafil treatment successful. 80% of these patients were willing to continue with sildenafil therapy. Side effect profile of sildenafil was different in this study with much higher incidence of headache, dyspepsia, flushing and abnormal vision. 92% of men with ED expect to be treated by the NHS. Of those men eligible for treatment in the NHS, 30% qualify under the clinical categories and 18% under the 'distress' category. Only 55% of those with cardiovascular risk factors qualify for NHS treatment. Conclusions Sildenafil is widely accepted as first line therapy among British men with ED and has a success rate of 91%. Nearly half of men with ED qualify for NHS treatment. Nearly half of those with vascular risk factors do not qualify for NHS treatment. Most men with ED could possibly be managed in primary care.

  1. Adopting Thai Diagnosis Related Group for Vietnam Universal Health Coverage: A Case of Ba Vi District Hospital

    Directory of Open Access Journals (Sweden)

    Pham Le Tuan, M.D., Ph.D.

    2015-09-01

    Full Text Available Objective: This studyaimedtoclassifyallhospitaldischargescoveredbyhealthinsurancesystem intodiagnosis relatedgroup (DRG to guideproviderpayment reforms of universalhealth coverage roadmap in Vietnam. Methods: Data from Ba Vi hospital from January to December 2012 were grouped into DRGs by Viet-DRG grouperversion1.0developedbasedon Thai-DRG version5methodologies. ThePearsoncorrelation(r wasused to assess the performance of Viet-DRG grouper as against Thai-DRG grouper. A 5-step trimming of individual inpatientdata to achieve thehighest correlations was performed. Results: Dataof12,220inpatientcases wereanalyzedbybothgroupers,84.4% of totalcases wereclassifiedinto 89 DRGs. Thefive mostcommon DRGs werevaginaldelivery withoutcomplicatingdiagnosis (14500; Respira- tory infection/inflammation, no complication and comorbidity (04520; Otitis media and URI, no complication andcomorbidity(03530; Viral illnessexceptdengue,child,nocomplicationandcomorbidity(18610; Bronchitis and asthma, no complication and comorbidity (04590. The performance of Viet-DRG grouper v1.0 compared with Thai-DRG grouper v5.0for 89 DRGs intermsof relative weights as of 0.4 andlength of stay as of 0.5. Conclusion: Validity of thefirst Viet-DRG was at moderate level compared to Thai-DRG due to the limitation ofdata availability andqualityat thehospital.

  2. Long-Term Survival and Outcome in Children Admitted to Kilifi District Hospital with Convulsive Status Epilepticus

    Directory of Open Access Journals (Sweden)

    Agnes Prins

    2014-01-01

    Full Text Available Objectives. The incidence of convulsive status epilepticus (CSE is high in Africa but the long-term outcome is unknown. We examined the neurocognitive outcome and survival of children treated for CSE in a Kenyan hospital 3 to 4 years after discharge. Methods. The frequency and nature of neurological deficits among this group of children were determined and compared to a control group. The children were screened with the Ten Questions Questionnaire for neurodevelopmental impairment if alive and those that screened positive were invited for further assessment to determine the pattern and extent of their impairment. A verbal autopsy was performed to determine the cause of death in those that died. Results. In the 119 cases followed-up, 9 (8% died after discharge, with the majority having seizures during their fatal illness. The 110 survivors (median age 5 years had significantly more neurological impairments on the screening compared to 282 controls (34/110 (30.9% versus 11/282 (3.9%, OR = 11.0, 95% CI 5.3–22.8. Fifteen percent of the cases had active epilepsy. Conclusions. This study demonstrates the considerable burden of CSE in African children. Strategies to manage children with CSE that are acceptable to the community need to be explored to improve the longer-term outcome.

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

    Directory of Open Access Journals (Sweden)

    Bhanu Pratap

    2015-07-01

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

  4. Determinants of unfavorable prognosis for out-of-hospital sudden cardiac arrest in Bielsko-Biala district

    Science.gov (United States)

    Nowak, Jolanta U.; Krzych, Łukasz J.

    2016-01-01

    Introduction The prognosis in out-of-hospital sudden cardiac arrest (OHCA) remains unfavorable and depends on a number of demographic and clinical variables, the reversibility of its causes and its mechanisms. Aim To investigate the risk factors of prehospital death in patients with OHCA in Bielsko County. Material and methods The study analyzed all dispatch cards of the National Emergency Medical Services (EMS) teams in Bielsko-Biala for the year 2013 (n = 23 400). Only the cards related to sudden cardiac arrest in adults were ultimately included in the study (n = 272; 190 men, 82 women; median age: 71 years). Results Sixty-seven victims (45 men, 22 women) were pronounced dead upon the arrival of the EMS team, and cardiopulmonary resuscitation (CPR) was not undertaken. In the remaining group of 205 subjects, CPR was commenced but was ineffective in 141 patients (97 male, 44 female). Although univariate analysis indicated 6 predictors of prehospital death, including OHCA without the presence of witnesses (odds ratio (OR) = 4.2), OHCA occurring in a public place (OR = 3.1), no bystander CPR (OR = 9.7), no bystander cardiac massage (OR = 13.1), initial diagnosis of non-shockable cardiac rhythm (OR = 7.0), and the amount of drugs used for CPR (OR = 0.4), logistic regression confirmed that only the lack of bystander cardiac massage (OR = 6.5) and non-shockable rhythm (OR = 4.6) were independent determinants of prehospital death (area under ROC curve = 0.801). Conclusions Non-shockable rhythm of cardiac arrest and lack of bystander cardiac massage are independent determinants of prehospital death in Bielsko-Biala inhabitants suffering from OHCA.

  5. Clinical manifestations and outcomes of severe malaria among children admitted at Rungwe and Kyela district hospitals in south-western Tanzania.

    Science.gov (United States)

    Kalinga, Akili; Mayige, Mary; Kagaruki, Gibson; Shao, Amani; Mwakyusa, Brighton; Jacob, Frank; Mwesiga, Charles

    2012-01-01

    Malaria remains as an important public health and a major cause of childhood death and paediatric hospital admission in sub-Saharan Africa. This prospective hospital based cross sectional study was conducted from April 2007 to April 2008. The main objective was to assess clinical manifestations and outcomes of severe malaria in children admitted to district hospital in Rungwe and Kyela in south-western Tanzania. A total of 1371 children were selected as screening group of which 409 (29.8%) were tested positive for malaria. Mean age of the children was 2.7 (95%CI= 2.5, 2.8) years and the majority (86%) were under five years of age. The proportion of children severe malaria in Rungwe was significantly higher than that of Kyela by 21.3% (P=0.002). The common symptoms of severe malaria during admission were convulsions (50.9%) compensated shock (30.6%), prostration (29.1%) and symptomatic severe anaemia (14.9%). The case fatality rate (CFR) was 4.6% and the cure rate (CR) was 95.4%. Children with suspected severe acidosis and symptomatic severe anemia were 4.8 (95%CI=1.6, 14.6) and 5.5 (95%CI 1.1, 28.2), respectively, more likely to die compared to those without these symptoms. The proportion of deaths among children presenting ≥5 symptoms was 32.1% higher than among those presenting one symptom (OR =0.50, 95%CI 0.125-2.000; P=0.000). Convulsions and compensated shock were the leading symptoms at admission. Suspected severe acidosis and symptomatic severe anemia were the predictors of mortality for children. In order to reduce mortality among admitted children with severe malaria there is a need for health providers to deploy strategic management of fatal prognostic factors. In conclusion, convulsion and compensated shock were the leading symptoms among children at admission and that suspected severe acidosis and symptomatic severe anemia were the predictors of mortality. It is therefore important to emphasis early diagnosis and prompt treatment of severe cases of

  6. Factors affecting mothers’ choice of breastfeeding vs. formula feeding in the lower Umfolozi district war memorial hospital, KwaZulu-Natal

    Directory of Open Access Journals (Sweden)

    Robin C. Dolman

    2010-03-01

    Full Text Available The aim of this study was to determine which factors influence choice of breast- versus the formulafeeding of infants. This may help to understand where the focus should lie in the promotion of breastfeeding. A structured questionnaire was completed by a 100 women and focus-group discussions were held with 22 women who delivered babies at the Lower Umfolozi District War Memorial Hospital (LUDWM in Kwazulu-Natal. Most of the mothers (72% chose breastfeeding and 58% intended to breastfeed for only 6 months. One-third (33% were influenced by health care professionals and 44% of the mothers made their own decisions in their feeding method. Only one participant stated that she chose formula-feeding due to her HIV-positive status, but in the focusgroup discussions, the fear of transmission of HIV through breast-milk was stated as an important reason why mothers chose replacement-feeding. Significantly more HIV-infected than uninfected mothers chose replacement-feeding as the feeding method and mothers who chose breastfeeding were significantly older than mothers who selected replacement-feeding. They made their infantfeeding decision earlier than those who chose replacement-feeding. Findings showed that the majority of women in this study did not have access to running water and flush toilets in their houses.In these areas where replacement-feeding will not be acceptable, feasible, affordable, sustainable and safe, due to lack of sanitation and poor socio-economic status, health professionals should promote exclusive breastfeeding for 6 months, even though there is a high prevalence of HIV infection.

    Opsomming

    Die doel van die studie was om te bepaal watter faktore vroue in hulle keuse van bors- of bottelvoeding beïnvloed. Dit sal help om te verstaan op watter faktore gesondheidswerkers moet fokus wanneer borsvoeding bevorder word. ’n Gestruktureerde vraelys is voltooi deur 100 vroue en fokusgroepbesprekings is met 22 vroue

  7. Treatment of Helicobacter pylori in surgical practice: A randomised trial of triple versus quadruple therapy in a rural district general hospital

    Institute of Scientific and Technical Information of China (English)

    Siok Siong Ching; Sivakumaran Sabanathan; Uoyd R Jenldnson

    2008-01-01

    AIM: To compare a lansoprazole-based triple versus quadruple therapy for Helicobacter pylori (H pylori)eradication with emphasis on side effect profile,patient compliance and eradication rate at a rural district general hospital in Wales,United Kingdom.METHODS= One hundred one patients with H pylori infection were included in the study.Patients were randomised to receive triple therapy comprising of lansoprazole 30 mg,amoxycillin 1 g,clarithromycin 500 mg,all b.d.(LAC),or quadruple therapy comprising of lansoprazole 30 mg b.d.,metronidazole 500 mg t.d.s.,bismuth subcitrate 240 mg b.d.,and tetracycline chloride 500 mg q.d.s.(LMBT).Cure was defined as a negative 13C urea breath test 2 mo after treatment.RESULTS: Seven patients were withdrawn after randomisation.Fifty patients were assigned to LAC group and 44 to LMBT group.The intention-to-treat cure rates were 92% and 91%,whereas the perprotocol cure rates were 92% and 97%,respectively.Side effects were common,with 56% experiencing moderate to severe symptoms in the LAC group and 59% in the LHBT group.Symptoms of vomiting,diarrhoea and black stools were significantly more common in the LMBT group.Patient compliance was 100% for triple therapy and 86% for quadruple therapy (P<0.01).One-third of patients in both groups were still taking acid-reducing medications at six-month follow-up.CONCLUSION: One-week triple and quadruple therapies have similar intention-to-treat eradication rates.Certain side effects are more common with quadruple therapy,which can compromise patient compliance.Patient education or modifications to the regimen are alternative options to improve compliance of the quadruple regimen.

  8. Profile and mortality outcome of patients admitted with cryptococcal meningitis to an urban district hospital in KwaZulu-Natal, South Africa

    Directory of Open Access Journals (Sweden)

    Benjamin Adeyemi

    2014-11-01

    Full Text Available Introduction: Cryptococcal meningitis (CCM is one of the leading causes of early mortality among HIV-infected patients. This study was a part of clinical audit (1 aimed at improving care for patients with CCM at an urban district hospital in South Africa. Methods: Clinical records of all patients (age>13 years admitted to the hospital with a diagnosis of CCM (based on a positive India ink, positive cryptococcal latex agglutination test (CLAT or a positive culture of Cryptococcus neoformans between June 2011 and December 2012 were retrospectively reviewed. Descriptive statistics and Chi-square analysis were generated with Epi Info 7.1.2.0. 95% confidence intervals were reported where appropriate. Results: Of the 127 patients admitted with CCM, only 97 (76.4% knew their HIV status. Only 44.8% (43/96 of those who knew they were HIV positive were on antiretroviral therapy (ART. Seventeen out of 25 patients (68% previously treated for CCM had defaulted fluconazole and only 60% (15/25 were on ART. Acute mortality (death within 14 days of CCM diagnosis was 55.9% (71/127. The median time to death from diagnosis was four days (IQR 2–9. The association between CSF WBC count<20cells/mL and increased risk of death within 14 days was statistically significant (OR 2.2; 95% CI 1.1–4.6, p=0.03. Patients with heavy cryptococcal burden (reported as numerous yeasts seen on microscopy at diagnosis were three times more likely to die within 14 days of diagnosis of CCM (OR 3.2; 95% CI 0.9–10.7, p=0.06. Even though a CD4 count<100cells/mm3 was associated with a 1.6 times increased acute mortality risk, the association was not statistically significant (OR 1.6; 95% CI 0.6–4.6, p=0.3. The role of elevated CSF opening pressure at diagnosis was not assessed because only two (1.6% patients had their baseline opening pressure measured. Conclusions: Acute CCM-related mortality remains high. The number of patients who do not know their HIV status, the number of HIV

  9. Indoor air quality due to secondhand smoke: Signals from selected hospitality locations in rural and urban areas of Bangalore and Dharwad districts in Karnataka, India.

    Science.gov (United States)

    Travers, Mark J; Nayak, Nayanatara S; Annigeri, Vinod B; Billava, N Narayan

    2015-01-01

    Tobacco smoke has compounds that are known as human carcinogens. With every breath of secondhand smoke we inhale thousands of chemicals. The Government of India in the interest of public health has enacted the Cigarette and Other Tobacco Products Act (COTPA), 2003, which bans smoking in all the public places including hotels and restaurants. The purpose of this study was to observe and record air pollution in smoke free and smoke observed locations and thereby find out whether the owners/managers of hotels, restaurants, and bars comply with rules of COTPA. The objectives of the study were to measure and compare the level of particulate air pollution from secondhand smoke (PM2.5) in smoking and nonsmoking venues. The study was conducted from September 2009 to March 2010 in Karnataka, India following a nonrandom sample of 79 locations, which included restaurants, bars, cafes, hotels, and tea stalls in two districts. The concentration of PM2.5 was measured using a TSI SidePak AM510 Personal Aerosol Monitor. In Karnataka out of the 79 hospitality locations, smoking was observed in 58% places and only 28% had displayed the required "No Smoking" signage. Places where indoor smoking was observed had high levels of air pollution with average 135 PM2.5, which were 3.1 times higher than the average 43 PM2.5 in smoke-free locations and 14 times higher than the World Health Organization (WHO) target air quality guideline for PM2.5. The average PM2.5 levels in different locations ranged from 11 to 417 μg/m(3) and was lower in the case of apparently compliant designated smoking area (DSR). The patrons and the workers in the hospitality sector continue to be exposed to secondhand smoke despite the enactment of COTPA, which bans smoking in public places. This situation demands stringent measures for effective implementation of the Smoke Free Act and negative response to smoking among civil society.

  10. Indoor air quality due to secondhand smoke: Signals from selected hospitality locations in rural and urban areas of Bangalore and Dharwad districts in Karnataka, India

    Directory of Open Access Journals (Sweden)

    Mark J Travers

    2015-01-01

    Full Text Available BACKGROUND: Tobacco smoke has compounds that are known as human carcinogens. With every breath of secondhand smoke we inhale thousands of chemicals. The Government of India in the interest of public health has enacted the Cigarette and Other Tobacco Products Act (COTPA, 2003, which bans smoking in all the public places including hotels and restaurants. The purpose of this study was to observe and record air pollution in smoke free and smoke observed locations and thereby find out whether the owners/managers of hotels, restaurants, and bars comply with rules of COTPA. OBJECTIVES: The objectives of the study were to measure and compare the level of particulate air pollution from secondhand smoke (PM2.5 in smoking and nonsmoking venues. MATERIALS AND METHODS: The study was conducted from September 2009 to March 2010 in Karnataka, India following a nonrandom sample of 79 locations, which included restaurants, bars, cafes, hotels, and tea stalls in two districts. The concentration of PM2.5was measured using a TSI SidePak AM510 Personal Aerosol Monitor. RESULTS: In Karnataka out of the 79 hospitality locations, smoking was observed in 58% places and only 28% had displayed the required “No Smoking” signage. Places where indoor smoking was observed had high levels of air pollution with average 135 PM2.5, which were 3.1 times higher than the average 43 PM2.5in smoke-free locations and 14 times higher than the World Health Organization (WHO target air quality guideline for PM2.5. The average PM2.5levels in different locations ranged from 11 to 417 μg/m3 and was lower in the case of apparently compliant designated smoking area (DSR. CONCLUSIONS: The patrons and the workers in the hospitality sector continue to be exposed to secondhand smoke despite the enactment of COTPA, which bans smoking in public places. This situation demands stringent measures for effective implementation of the Smoke Free Act and negative response to smoking among civil society.

  11. Analysis on 2077 Hospitalized Cases of Death in a Hospital of the West District in Inner Mongolia%内蒙古西部区某院2077例住院死亡病例分析

    Institute of Scientific and Technical Information of China (English)

    盖红卫; 赵莉; 盖自强

    2016-01-01

    目的 探讨内蒙西部区某三级乙等医院近8年内住院患者死亡病例的主要特点,为医院管理和相关部门制定针对性卫生策略和疾病预防措施提供科学依据.方法 按ICD-10疾病分类编码,通过HIS系统统计2007年-2014年期间307563例住院患者的基本信息,对于其中2077例死亡病例应用Excel 2003和SPSS19.0统计软件进行分析,以x2检验及秩和检验做组间数据对比.结果 男女死亡比例1.97:1,8年期间男性死亡率高于女性(x2=158.67,P<0.01).排名前五位死因为循环系统疾病、肿瘤、呼吸系统疾病、损伤中毒和外因的某些其他后果、消化系统疾病;蒙汉民族死因统计死亡率对比有差异(P<0.01);死亡高发年龄段为70岁~79岁年龄组,与全国人口普查预期人均寿命一致.结论 结合本地区死亡高危因素及不同民族死亡特点制定预防、诊断和治疗措施,以降低病死率.%Objectives To investigate the characters of hospitalized cases of death in a Third Grade Class B Hospital in the west district of Inner Mongolia, provide scientific basis for hospital management and relevant departments to make regional and targeted health strategies as well as preventive measures. Methods According to the diseases classification coding in ICD-10, to collect the basic information of 307563 of hospitalized cases from 2007 to 2014 through the HIS system, and conducted statistical analysis on the 2077 death cases with Excel 2003 and SPSS19.0.x2 test and rank-sum test were used to compare the data between groups, if P<0.01, the difference between the two groups was statistically significant. Results The death rate between male and female was 1.97:1, and male patients had higher death rate than female ones in the past 8 years(x2=158.67,P<0.01). The five leading causes of death were circulation system disease, tumor, respiratory diseases, damage poisoning or other results from external reasons and digestive system disease. The

  12. Prevalencia del síndrome del quemado y estudio de los factores asociados en los trabajadores de un hospital comarcal Burnout syndrome: prevalence and associated factors among workers in a district hospital

    Directory of Open Access Journals (Sweden)

    G. Pera

    2002-12-01

    Full Text Available Objetivo: El síndrome del quemado o de burnout es un tipo de estrés laboral que puede tener repercusiones psicosomáticas, conductuales, emocionales, familiares y sociales, y que puede ser motivo de absentismo laboral y de bajo rendimiento en el trabajo. El objetivo de este trabajo es conocer la prevalencia del síndrome del quemado entre los trabajadores de un hospital comarcal, así como conocer las características personales y laborales que se asocian a dicho síndrome. Métodos: Se diseñó un estudio observacional transversal en el que se seleccionó una muestra aleatoria, estratificada por categoría profesional, de 300 trabajadores a los que se les administró el Maslach Burnout Inventory para medir el grado de burnout. Este cuestionario consta de tres subescalas: el cansancio emocional, la despersonalización y la realización personal. Resultados: El 13,9% de los entrevistados presentó un grado elevado de burnout para el cansancio emocional, el 11,1% para la despersonalización y el 6,6% para la realización personal. Ninguno de los entrevistados obtuvo puntuaciones elevadas en las tres escalas a la vez, mientras que un 27% presentó un grado alto de burnout en al menos una de las tres escalas. En el análisis multivariante la categoría profesional y el sexo se asociaron de forma estadísticamente significativa con un alto grado de burnout. Conclusiones: La prevalencia de síndrome del quemado en el hospital de Mataró es relativamente baja y se asocia al género y la categoría profesional.Aim: Burnout syndrome refers to a kind of occupational stress that can have psychosomatic, behavioral, emotional, familial, and social repercussions; it can also cause absenteeism and loss of efficacy at work. The aim of this study was to determine the prevalence of burnout among staff in a district hospital, as well as the personal and working characteristics associated with the syndrome. Methods: A cross-sectional study was designed in which a

  13. 大型综合医院多院区总体发展建设规划探讨%THE OVERALL DEVELOPMENT AND CONSTRUCTION PLANNING OF LARGE GENERAL HOSPITAL MULTIPLE DISTRICTS

    Institute of Scientific and Technical Information of China (English)

    谭西平; 梁建岚; 陈海勇; 黄晓群; 曾勇

    2015-01-01

    The article explains the large general hospital multiple districts development planning principles, overal development and construction planning key points, based on the development direction and objectives, defines reasonable preposition, proper size and location of each district;combining fund raising capacity and medical business premises turnaround plan, makes rational phase implementation plan.%文章结合参加大型综合医院多院区总体发展建设规划的实践,系统阐述了大型综合医院多院区发展规划的原则、总体发展建设规划的编制要点。

  14. 上海市某区医院MRSA感染现状研究%STUDY ON THE CURRENT SITUATION OF NOSOCOMIAL MRSA INFECTION IN CERTAIN DISTRICT HOSPITAL OF SHANGHAI

    Institute of Scientific and Technical Information of China (English)

    舒明; 徐飚; 沈伟

    2012-01-01

    目的 了解上海市某区综合性医院院内耐甲氧西林金黄色葡萄球菌(MRSA)感染现状及分布特点,以便加强防控措施.方法 通过回顾性调查方式,对上海市某区4所综合性医院住院病人中MRSA感染现状进行调查与分析.结果 所调查的4所医院在2008年度共发现金黄色葡萄球菌感染患者248例,其中MRSA感染203例,占金黄色葡葡球菌感染的81.85%.全院住院病人中MRSA感染发病率为2.68‰,病人主要分布于ICU,占32.5%.医院MRSA感染患者预后不良,病死率高达27.59%.结论 该区4所综合性医院住院病人MRSA感染率为2.68%,MRSA在检出的金黄色葡葡球菌中占81.85%,需要加强ICU MRSA感染的防控措施.%Objective To investigate nosocomial MRSA infection situation and distribution in general hospitals in certain district of Shanghai, in order to strengthen the prevention and control measures. Methods The retrospective investigation was used to survey and analyze the situation of MRSA infection inpatients in 4 comprehensive hospitals in certain district of Shanghai. Results 248 patients infected with Staphylococcus aweus were found in 4 investigated hospitals in year 2008 and 203 cases infected with MRSA that accounted for 81. 85% of Staphylococcus aureus infection. The hospital inpatients of MRSA infection was 2. 68%? of all the inpatients of this hospital that was mainly in ICU, accounted for 32. 5% of all the infections. The prognosis of hospital MRSA infection patients was so bad and the case fatality rate was up to 27. 59%. Conclusion The inpatient MRSA infection rate is 2. 68‰ in the 4 general hospitals and the MRSA infections accounted for 81. 85% of Staphylococcus aureus infections, so the prevention and control measures in ICU should be strengthened.

  15. Congressional Districts

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This layer depicts the 114th Congressional Districts for the United States. Found within this layer is the listing of the 114th House of Representatives. Elected to...

  16. Wastewater Districts

    Data.gov (United States)

    Vermont Center for Geographic Information — The Wastewater districts layer is part of a larger dataset that contains administrative boundaries for Vermont's Agency of Natural Resources. The dataset includes...

  17. Wildlife Districts

    Data.gov (United States)

    Vermont Center for Geographic Information — The Wildlife Districts layer is part of a larger dataset contains administrative boundaries for Vermont's Agency of Natural Resources. The dataset includes feature...

  18. Warden Districts

    Data.gov (United States)

    Vermont Center for Geographic Information — This dataset is a representation overlay of warden (areas of responsibility). The Vermont Warden Districts layer is part of a dataset that contains administrative...

  19. Forestry Districts

    Data.gov (United States)

    Vermont Center for Geographic Information — The Forestry Districts layer is part of a dataset that contains administrative boundaries for Vermont's Agency of Natural Resources. This is a layer file which...

  20. Fisheries Districts

    Data.gov (United States)

    Vermont Center for Geographic Information — The Fisheries districts data layer is part of a larger dataset that contains administrative boundaries for Vermont's Agency of Natural Resources. The dataset...

  1. Park Districts

    Data.gov (United States)

    Vermont Center for Geographic Information — The Parks Districts layer is part of a dataset contains administrative boundaries for Vermont's Agency of Natural Resources. The dataset includes feature classes for...

  2. Monitoring the referral system through benchmarking in rural Niger: an evaluation of the functional relation between health centres and the district hospital

    Directory of Open Access Journals (Sweden)

    Miyé Hamidou

    2006-04-01

    Full Text Available Abstract Background The main objective of this study is to establish a benchmark for referral rates in rural Niger so as to allow interpretation of routine referral data to assess the performance of the referral system in Niger. Methods Strict and controlled application of existing clinical decision trees in a sample of rural health centres allowed the estimation of the corresponding need for and characteristics of curative referrals in rural Niger. Compliance of referral was monitored as well. Need was matched against actual referral in 11 rural districts. The referral patterns were registered so as to get an idea on the types of pathology referred. Results The referral rate benchmark was set at 2.5 % of patients consulting at the health centre for curative reasons. Niger's rural districts have a referral rate of less than half this benchmark. Acceptability of referrals is low for the population and is adding to the deficient referral system in Niger. Mortality because of under-referral is highest among young children. Conclusion Referral patterns show that the present programme approach to deliver health care leaves a large amount of unmet need for which only comprehensive first and second line health services can provide a proper answer. On the other hand, the benchmark suggests that well functioning health centres can take care of the vast majority of problems patients present with.

  3. A time series analysis of meteorological factors and hospital outpatient admissions for cardiovascular disease in the Northern district of Guizhou Province, China

    Energy Technology Data Exchange (ETDEWEB)

    Jie, Y.; Houjin, H. [School of Public Health, Zunyi Medical University, Zunyi, Guizhou (China); Mengxue, Y. [Department of Endocrinology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou (China); Wei, Q. [Department of Physiology, Zunyi Medical University, Zunyi, Guizhou (China); Jie, X. [School of Public Health, Zunyi Medical University, Zunyi, Guizhou (China)

    2014-07-08

    Findings on the effects of weather on health, especially the effects of ambient temperature on overall morbidity, remain inconsistent. We conducted a time series study to examine the acute effects of meteorological factors (mainly air temperature) on daily hospital outpatient admissions for cardiovascular disease (CVD) in Zunyi City, China, from January 1, 2007 to November 30, 2009. We used the generalized additive model with penalized splines to analyze hospital outpatient admissions, climatic parameters, and covariate data. Results show that, in Zunyi, air temperature was associated with hospital outpatient admission for CVD. When air temperature was less than 10°C, hospital outpatient admissions for CVD increased 1.07-fold with each increase of 1°C, and when air temperature was more than 10°C, an increase in air temperature by 1°C was associated with a 0.99-fold decrease in hospital outpatient admissions for CVD over the previous year. Our analyses provided statistically significant evidence that in China meteorological factors have adverse effects on the health of the general population. Further research with consistent methodology is needed to clarify the magnitude of these effects and to show which populations and individuals are vulnerable.

  4. A survey report on dermatitis patients in hospital in Baoan district of Shenzhen city from 1992 to 2006%深圳市某区1992至2006年皮炎住院病例的调查

    Institute of Scientific and Technical Information of China (English)

    朱志良; 叶伟国; 王绵珍; 张虹; 吴俊华

    2010-01-01

    目的 了解近年来深圳市某区皮炎住院患者的流行病学分布特点,为研究三氯乙烯(TCE)药疹样皮炎和预防提供依据.方法 对1992至2006年该区及其各街道医院的住院皮炎患者临床资料进行描述性分析.结果该区住院皮炎患者共645例,1998至2005年患者总人数呈上升趋势,主要年龄段为16~岁,其次为26~岁,工人占多数.过敏性皮炎(34.1%)、药物性皮炎(30.8%)、TCE药疹样皮炎(9.3%),依次为住院皮炎病例的前3位.60例TCE药疹样皮炎病例中有过敏史者2例(3.3%),与其他皮炎病例(144例,22.6%)比较,差异有统计学意义(P<0.05);TCE药疹样皮炎患者肝功能异常的比例(71.7%)较高,与其他皮炎(13.8%)比较,差异有统计学意义(P<0.05);患者主要分布于电子、五金、电镀行业.结论 TCE药疹样皮炎危害严重,加强工人的自我保护意识,重视重点行业、重点工种工人的工初观察和健康监护,减少职业接触机会,可以有效地减少TCE所致皮炎的发生.%Objective To analyze the epidemiological distribution of dermatitis patients in hospital and provide basis for studying the basic conditions and the prevention of dermatitis especially TCE-induced dermatitis in Baoan District of Shenzhen City.Methods All dermatitis patients in hospital in Baoan District from 1992 to 2006 were descriptively analyzed.Results There were 645 dermatitis patients in hospital in Baoan District.The total number of patients tended to rise in recent years,mainly in group of 16~ years old,followed by 26~ years old,with the majority of workers.The clinical diagnosis was allergic dermatitis (34.1%),drug-induced dermatitis and TCE-induced dermatitis (9.3%).Two among 60 patients with TCE-induced dermatitis had history of allergy (3.3%) with significat difference (P<0.05) compared with the patients with other dermatitis(144,22.6%).The risk of hepatic dysfunction in TCE-induced dermatitis(71.7%) was significantly greater

  5. Investigation on the satisfaction of discharged patients about public hospitals in Beijing Xicheng District%北京市西城区区属公立医院出院患者满意度调查研究

    Institute of Scientific and Technical Information of China (English)

    刘永东; 乔蓉; 焦占雅; 宋雯; 杨光; 刘贵宾

    2016-01-01

    目的:开展北京市西城区区属公立医院出院患者满意度调查研究,为主管部门提供决策依据。方法采用概率与规模等比例随机抽样方法确定样本量,采用计算机辅助电话调查方法开展调查。结果2015年度北京市西城区区属公立医院出院患者满意度得分以百分制计算为91.8分。得分较高的项目是办理入院手续、医生与护士服务态度、医生与护士技术水平等;得分较低的项目是随访、伙食、医院硬件、护工等。结论应注重医学人文建设,加强与患者的沟通与交流,重视患者随访,加强医院硬件建设,改善患者伙食,加强护工培训,以提升患者满意度水平。%Objective Investigation on the satisfaction of discharged patients about public hospitals in Beijing Xicheng District is carried out to provide decision-making basis for competent department.Method Sample size is determined by proportional random sampling method including probability and scale; computer aided telephone survey method is used to carry out investigation.Result Score of the satisfaction of discharged patients about public hospitals in Beijing Xicheng District in 2015 is 91.8 after calculated according to centesimal system. Items of higher scores include admission process, the attitude of doctors and nurses, doctors and nurses’ technical level; items of lower scores include follow-up, food, hardware of the hospitals, nursing workers, etc.Conclusion Attention shall be paid to construction of medical humanities, enhance communication with the patients, follow-up, enhance construction of the hospital’s hardware, improve food provided to the patients, enhance training of nursing workers and the satisfaction of patients.

  6. 基层医疗机构护士职业倦怠相关因素分析%Reason analysis of the job burnout for nurses in district or county grade hospital

    Institute of Scientific and Technical Information of China (English)

    刘淑芸; 吴悦

    2013-01-01

    目的 调查区县级医疗机构中护理人员的职业倦怠情况,为制定相应的对策提供依据.方法 采用便利抽样法,在会议期间用Maslach工作倦怠量表中文版((Maslach Burnout Inventory General Survey,简称MBI-GS)对我区县级医疗机构中的381名护士进行调查分析.结果 ①该地区县级医疗机构中护理人员的职业倦怠三个维度均值处于中度,职业倦怠比较严重;其中护龄6~10年与本科学历护士职业倦怠处于重度水平.②职称、职位倦怠水平呈负相关,工作负荷、夜班轮值频度、经济状况、社会地位、护患纠纷与倦怠水平呈显著负相关.③领导重视、组织支持、社会肯定、绩效呈正相关.结论 目前区县级医疗机构中护理人员的职业倦怠比较严重.政府干预,改善社会外部大环境,理解护士、尊重护士对缓解职业倦怠非常重要.领导重视、组织支持、增加编制,减轻工作负荷是缓解倦怠的必要条件.加强自我调节是消除倦怠的基础.%Objective To discuss the reason of the job burnout for nurses in district or county grade hospital. Methods 381 nurses working in district or county grade hospital were recruited with MBI-GS questionnaire. Results The total levels of job burnout were Middle-grade. The highest level of job burnout was observed in ( 6~10) year group and University degree. It was negative correlation that the levels of job burnout with professional title, position, Length of service and educational background. Marked negative correlation were heavily working load,frequently night shift, a few salary, lowly social status and dispute between nurses with patients. It was positive factor that leader makes a point, team and other people support and good performance. Conclusion Relatively high level of job burnout existed in nurses in district or county grade hospitals. It is very important to understand and respect nurses. Hospital managers should pay attention to

  7. Improving door-to-needle times for patients presenting with ST-elevation myocardial infarction at a rural district general hospital

    OpenAIRE

    Jordan, Mark; Caesar, Jenny

    2016-01-01

    Acute coronary syndrome is a common condition with a major global impact on healthcare resources and expenditure. International guidelines are clear in specifying that patients with acute ST-elevation myocardial infarction (STEMI) should receive urgent coronary reperfusion with either primary percutaneous coronary intervention (PCI) or thrombolysis. Although PCI is the gold standard in the treatment of STEMI, this is not always achievable in a rural hospital with no cardiac catheterization se...

  8. Nonadherence to antiretroviral therapy among people living with HIV/AIDS attending two tertiary care hospitals in district of northern India

    OpenAIRE

    Mukesh Shukla; Monika Agarwal,; Jai Vir Singh; Anil Kumar Tripathi; Anand Kumar Srivastava; Vijay Kumar Singh

    2016-01-01

    Introduction: Adherence to antiretroviral therapy is a principal predictor for the success of human immunodeficiency virus (HIV) treatment. It remains as a challenge to acquired immunodeficiency syndrome (AIDS) treatment and care with the widespread of the associated risks. Therefore, study aims to assess nonadherence level and factors associated with nonadherence to ART among people living with HIV/AIDS (PLHA). Materials and Methods: A hospital-based, cross-sectional study was conducted at t...

  9. In vitro antifungal susceptibility patterns of Candida albicans from HIV and AIDS patients attending the Nylon Health District Hospital in Douala, Cameroon

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    Anna L. Njunda

    2012-05-01

    Full Text Available HIV and AIDS are major public health problems in Cameroon where the HIV prevalence is 5.5%. Candidiasis is the leading opportunistic mycosis in HIV and AIDS patients. The objective of this study was to determine the in vitro antifungal susceptibility pattern of Candida albicans in HIV and AIDS patients to eight antifungal agents in the Nylon Health District of Douala in Cameroon. Three hundred and four HIV and AIDS patients were recruited between March and August 2007 to participate in a cross-sectional study. All subjects who fulfilled the inclusion criteria were enrolled. Informed consent was obtained from all subjects before samples were collected. Three samples comprising oral swabs, vagina/urethra swabs and a mid-stream urine were collected from each subject. Specimens were cultured on sabouraud dextrose agar and C. albicans isolates were identified using the germ tube technique. The disk diffusion method was used for antifungal susceptibility testing using eight antifungal agents. The prevalence of candidiasis in the study population was 67.8% (95% CI: 62.5-73.1% and that of C. albicans was 42.8% (95% CI: 37.2-48.4%. Oral swabs had the highest prevalence of C. albicans followed by vaginal/urethral samples (52.6% vs. 29.7% respectively. Forty (30.8% subjects had C. albicans infection at more than one collection site. There was a statistically significant difference in the infectivity of C. albicans with age, sex and site of infection (P<0.05. C. albicans isolates were most sensitive to ketoconazole (80% followed by econazole (64.6% while fluconazole and 5-flurocytosin recorded the poorest sensitivities (22.9% vs 24.6%, respectively. There was a statistically significant difference in the sensitivity pattern of antifungal agents with respect to the site of isolation of the organism (P<0.05. Ketoconazole is the drug of choice for the treatment of C. albicans infection in HIV and AIDS patients in the Nylon Health District of Douala, Cameroon.

  10. STUDY THE CAUSE OF DEATH & ITS SOME FACTORS AMONG HOSPITALIZED PAEDIATRIC CASES AT A TERTIARY CARE CENTRE OF RURAL DISTRICT OF MAHARASHTRA, INDIA.

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    Amol R

    2014-01-01

    Full Text Available BACKGROUND : Reaching the MDG on reducing child mortality will require universal coverage with key effective and affordable interventions. Records of vital events like death constitute an important component of publi c health information system. In - depth analysis of death of children provides valuable information. Aim of the study wa s to describe the causes of deaths among hospitalized pediatric patient and contributing factors associated with it. METHODS AND MATERIALS : This was a r etrospective re cord based study. Total pediatric deaths were identified & segregated through admission records from medical record section under PSM department of Government Medical College , during January 2010 to December 2010. Variables lik e age , sex , birth weight and cause of death were collected from death records. WHO Child Growth Standards (z score separate for boys & girls were used for comparing weight of child at the time of admission. Data was entered , cleaned and analyzed using MS excel. RESULTS : An overall 313 (13.1% death occurred among 2380 hospitalized pediatric cases.56.4% were male child and 43.8% female child. Maximum deaths (67.8% were among early neonates. 175(60% were severely underweight a t the time of admission. Time interval between admission and death i.e. hospital stay revealed that 134 (42.8% of deaths occurred within 24 h of ad mission. 180 (77% deaths were in low birth weight (less than 2.5 kg. Infection (35% was the leading cause of death among all pediatric age groups followed by birth asphyxia (29% , prematurity (22% nutritional (4% and congenital (6%.Viral encephalitis was found to be the most common cause of death in more than 5 yrs. age group. CONCLUSION : Monitoring the mo rtality pattern among hospitalized cases is important strategy to address public health issues at community level as well as to strengthen the hospital services. Strategies like antenatal care about nutrition to avoid LBW , timely treatment of

  11. Effect of a multi-faceted quality improvement intervention on inappropriate antibiotic use in children with non-bloody diarrhoea admitted to district hospitals in Kenya

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    Opondo Charles

    2011-11-01

    Full Text Available Abstract Background There are few reports of interventions to reduce the common but irrational use of antibiotics for acute non-bloody diarrhoea amongst hospitalised children in low-income settings. We undertook a secondary analysis of data from an intervention comprising training of health workers, facilitation, supervision and face-to-face feedback, to assess whether it reduced inappropriate use of antibiotics in children with non-bloody diarrhoea and no co-morbidities requiring antibiotics, compared to a partial intervention comprising didactic training and written feedback only. This outcome was not a pre-specified end-point of the main trial. Methods Repeated cross-sectional survey data from a cluster-randomised controlled trial of an intervention to improve management of common childhood illnesses in Kenya were used to describe the prevalence of inappropriate antibiotic use in a 7-day period in children aged 2-59 months with acute non-bloody diarrhoea. Logistic regression models with random effects for hospital were then used to identify patient and clinician level factors associated with inappropriate antibiotic use and to assess the effect of the intervention. Results 9, 459 admission records of children were reviewed for this outcome. Of these, 4, 232 (44.7% were diagnosed with diarrhoea, with 130 of these being bloody (dysentery therefore requiring antibiotics. 1, 160 children had non-bloody diarrhoea and no co-morbidities requiring antibiotics-these were the focus of the analysis. 750 (64.7% of them received antibiotics inappropriately, 313 of these being in the intervention hospitals vs. 437 in the controls. The adjusted logistic regression model showed the baseline-adjusted odds of inappropriate antibiotic prescription to children admitted to the intervention hospitals was 0.30 times that in the control hospitals (95%CI 0.09-1.02. Conclusion We found some evidence that the multi-faceted, sustained intervention described in this

  12. High-risk sexual behavior among people living with HIV/AIDS attending tertiary care hospitals in district of Northern India

    OpenAIRE

    Mukesh Shukla; Monica Agarwal; Jai Vir Singh; Anil Kumar Tripathi; Anand Kumar Srivastava; Vijay Kumar Singh

    2016-01-01

    Context: Prevention with a positive approach has been advocated as one of the main strategies to diminish the new instances of HIV and the target are those who are engaged in high-risk sexual behavior. Therefore, understanding the risky behaviors of the HIV-infected individual is important. Aims: This study aimed to assess the prevalence and the predictors of high-risk sexual behavior among people living with HIV/AIDS (PLHA). Settings and Design: A hospital-based cross-sectional study was con...

  13. Analysis of birth defects supervision in obstetrical hospitals in Beijing Haidian District%北京市海淀区产科医院出生缺陷监测分析

    Institute of Scientific and Technical Information of China (English)

    钟赋真; 张雪峰; 周钰

    2012-01-01

    Objective To understand the incidence of birth defects in hospitals in Haidian District during recent years so as to provide management clue for supervision in the future. Methods From October 1 of 2006 to September 30 of 2010, fetus and newborns between 13 gestational weeks and 7d after delivery were supervised for birth defects in hospitals of Haidian district, and the supervision results were analyzed in terms of rate and cis position. Results There were 3 776 defected cases including 2 861 cases in perinatal period ( the incidence rate of birth defects in perinatal period was 17. 98‰ ) and 906 cases induced to abortion in second trimester. In floating population the incidence rate of birth defects showed a rising trend in perinatal period during these years( x2 =52. 250, P = 0. 000 ). The first five highest rates of birth defects were congenital heart disease, deformity of external ear, multi finger ( toe ), merged finger ( toe ) and hypospadias in order. The trend of neural tube defects rate was stable and the incidence of cleft lip dropped obviously. But the incidence of Trisomy 21 rose gradually, and there was no significant difference (x2 =6. 906, P =0. 075 ). Conclusion The incidence rate of birth defects is 17. 98‰ in hospitals of Haidian district, and the trend of birth defects rate is rising during 2006-2010 year especially in floating population. The primary prevention of folic acid supplement should be strengthened.%目的 了解近年来北京市海淀区医院出生缺陷的发生情况,为今后监测工作的管理重点提供依据.方法 对2006年10月1日至2010年9月30日期间北京市海淀区产科医院孕13周~产后7天的胎儿及新生儿进行出生缺陷监测,并对监测结果进行率及顺位等分析.结果 ①监测到出生缺陷儿3 776例,其中围产期2 861例(围产期出生缺陷儿发生率为17.98‰),中孕引产906例;②2006至2010年,外地户籍围产期出生缺陷发生率呈逐年上升的趋势(χ2

  14. Broad spectrum β-lactam resistance in faecal Escherichia coli isolated from severely malnourished and nourished children attending Mbagathi district hospital, Nairobi: A case-control study

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    Samuel Mwangi Njoroge

    2014-01-01

    Full Text Available Context: Severely malnourished children have increased risk of being put on antibiotics due to co-morbidities. Aim: The study′s objective was to characterize the Escherichia coli β-lactamase mediated resistance to the broad spectrum β-lactam antimicrobials among this population and compare them with nourished children as controls. Settings and Design: In this case-control, hospital-based setup, 109 E. coli isolates were obtained from each group, one isolate per subject. Materials and Methods: Stool or anal swabs were collected, enriched in buffered peptone water and cultured on MacConkey and eosin methylene blue agars. Biochemical test were used to identify E. coli. antibiograms to determine phenotypic resistance were determined using a panel of 14 drugs. Only the isolates showing synergy between ampicillin-calvulanic acid and one or more third generation cephalosporins were picked as extended spectrum β-lactamase (ESBL producers. Statistical Analysis: Differences in ESBL rates and susceptibility percentages between cases and controls were evaluated for significance using 2-tailed Fisher′s exact test. Results: Prevalence of ESBL phenotype was higher in severely malnourished children (39% as compared to the controls (7%. The plasmid-encoded AmpC′s (pAmpC-like phenotype was observed in 11% isolates. Conclusions: Isolation of ESBL-E. coli among severely malnourished children is high. Surveillance of ESBL producers, both in the community and hospital settings needs to be stepped up in Kenya.

  15. 医疗风险最小化的县区级医院抢救策略%Medical rescue strategies to minimize medical risk of county or district hospital

    Institute of Scientific and Technical Information of China (English)

    梁启军; 邓斌; 邱友民; 郭忠民

    2014-01-01

    Objective To discuss the important points of rescue strategies in saving patients and related administration to minimize the medical risk of county or district hospitals. Methods The analytic method to minimize the medical risk of district and county hospitals was from clinical practice and via induction,summary and reorganization. Results and Conclusions The reasonable and effective clinical medical operative process includes,timely necessary emergency initial examinations,immediately organizing group consultation after mastering the emergency rescue procedures in various critical situations,following the newest modern treatment guidelines or professional expert consensus,treating patients with correct motivation to maximize the therapeutic effect,carrying out treatment while the diagnosis confirmed,properly communicating between doctor and patient,timely recording the medical record,improving the diagnosis and treatment capacity in cases with critical and difficult diseases step by step,correcting the errors and mistakes,immediately and effectively proceeding to crisis public relations in time.%目的:探讨县区级医院医疗风险最小化的抢救策略及相关管理要点。方法从临床实际出发,通过归纳、总结、整理方法,分析区县医院医疗风险最小化的方法。结果及结论合理有效的临床医疗运作流程,及时进行必要的紧急初始检查,掌握不同危急情况下的抢救程序,及时会诊,遵循最新治疗用药指南或专家共识,端正治疗动机、最大化治疗效果,边治边诊,医患沟通到位、医疗文书记录要及时,有步骤地提高危重和疑难疾病诊治能力,及时纠正错误和失误、及时有效进行危机公关等。

  16. 99mTechnetium-labelled red blood cell scintigraphy as an alternative to angiography in the investigation of gastrointestinal bleeding: clinical experience in a district general hospital.

    Science.gov (United States)

    Bearn, P.; Persad, R.; Wilson, N.; Flanagan, J.; Williams, T.

    1992-01-01

    99mTechnetium-labelled red blood cell scintigraphy (99mTc RBC scintigraphy) was used as the second-line investigation to localise bleeding in 23 patients (11 male, 12 female; mean age 67 years) presenting with active bleeding per rectum. Scintigraphy was available on a 24 h basis. A total of 18 patients had positive scans (78%). Surgery was performed urgently in 11 patients and the site of bleeding, as predicted by scintigraphy, was confirmed in 9 (82%). 99mTc RBC scintigraphy was less useful in patients who were not bleeding actively or who were being investigated for chronic anaemia. This study suggests that 99mTc RBC scintigraphy can play a useful role in the preoperative localisation of unexplained gastrointestinal bleeding in hospitals with nuclear medicine facilities, but confirms it has little place in the management of patients unless they are bleeding actively. PMID:1319696

  17. Nonadherence to Antiretroviral Therapy Among People Living with HIV/AIDS Attending Two Tertiary Care Hospitals in District of Northern India

    Science.gov (United States)

    Shukla, Mukesh; Agarwal, Monika; Singh, Jai Vir; Tripathi, Anil Kumar; Srivastava, Anand Kumar; Singh, Vijay Kumar

    2016-01-01

    Introduction: Adherence to antiretroviral therapy is a principal predictor for the success of human immunodeficiency virus (HIV) treatment. It remains as a challenge to acquired immunodeficiency syndrome (AIDS) treatment and care with the widespread of the associated risks. Therefore, study aims to assess nonadherence level and factors associated with nonadherence to ART among people living with HIV/AIDS (PLHA). Materials and Methods: A hospital-based, cross-sectional study was conducted at two tertiary care hospital of Lucknow. A total of 322 adult HIV-positive patients registered in the ART center were included. Systematic random sampling was used to recruit patients. Nonadherence was assessed on the basis of pill count method. Results: A total of 10.9% of patients were found to be nonadherent to ART. Principal causes cited were being busy with other work (40.0%), felt sick or ill (28.5%), not having money (14.2%), and being away from home (11.4). Multivariate logistic regression analysis revealed that nonadherence was significantly associated with nonbeneficial perceptions towards ART (odds ratio (OR) 18.5; 95% confidence interval (CI) 3.2-106.6; P = 0.001), being counseled for adherence for more than 3 months (OR 13.9; 95% CI 1.6-118.9; P = 0.01), presence of depression (OR 2.6; 95% CI 1.0-6.7; P = 0.04), and those who were not satisfied with healthcare facilities (OR 5.63; 95% CI 1.88-16.84; P = 0.00). Conclusion: Although adherence to ART varies between individuals and over time, the factors that affect nonadherence can be addressed with proper periodic counseling and motivation of patients and their family members. Adherence to highly active antiretroviral therapy (HAART) could delay the progression of this lethal disease and minimize the risk of developing drug resistance. PMID:26917875

  18. High-risk sexual behavior among people living with HIV/AIDS attending tertiary care hospitals in district of Northern India

    Directory of Open Access Journals (Sweden)

    Mukesh Shukla

    2016-01-01

    Full Text Available Context: Prevention with a positive approach has been advocated as one of the main strategies to diminish the new instances of HIV and the target are those who are engaged in high-risk sexual behavior. Therefore, understanding the risky behaviors of the HIV-infected individual is important. Aims: This study aimed to assess the prevalence and the predictors of high-risk sexual behavior among people living with HIV/AIDS (PLHA. Settings and Design: A hospital-based cross-sectional study was conducted at antiretroviral therapy centers of two tertiary care hospitals in Lucknow. Materials and Methods: A total of 322 HIV-positive patients were interviewed about their sexual behaviors during last 3 months using a pretested questionnaire. Statistical Analysis Used: Probability (p was calculated to test for statistical significance at 5% level of significance. Association between risk factors and high-risk sexual behavior was determined using bivariate analysis followed by multivariate logistic regression. Results: Prevalence of high-risk sexual behavior was 24.5%. Of these patients, multiple sexual partners were reported by 67.3% whereas about 46.9% were engaged in unprotected sex. Multivariate logistic regression analysis revealed that high-risk sexual behavior was significantly associated with nonsupporting attitude of spouse (odds ratio [OR]: 18; 95% confidence interval [CI]: 1.4–225.5; P = 0.02 and alcohol consumption (OR: 9.3; 95% CI: 2.4–35.4; P = 0.001. Conclusions: Specific intervention addressing alcohol consumption and encouragement of spouse and family support should be integrated in the routine HIV/AIDS care and treatment apart from HIV transmission and prevention knowledge.

  19. High-risk sexual behavior among people living with HIV/AIDS attending tertiary care hospitals in district of Northern India

    Science.gov (United States)

    Shukla, Mukesh; Agarwal, Monica; Singh, Jai Vir; Tripathi, Anil Kumar; Srivastava, Anand Kumar; Singh, Vijay Kumar

    2016-01-01

    Context: Prevention with a positive approach has been advocated as one of the main strategies to diminish the new instances of HIV and the target are those who are engaged in high-risk sexual behavior. Therefore, understanding the risky behaviors of the HIV-infected individual is important. Aims: This study aimed to assess the prevalence and the predictors of high-risk sexual behavior among people living with HIV/AIDS (PLHA). Settings and Design: A hospital-based cross-sectional study was conducted at antiretroviral therapy centers of two tertiary care hospitals in Lucknow. Materials and Methods: A total of 322 HIV-positive patients were interviewed about their sexual behaviors during last 3 months using a pretested questionnaire. Statistical Analysis Used: Probability (p) was calculated to test for statistical significance at 5% level of significance. Association between risk factors and high-risk sexual behavior was determined using bivariate analysis followed by multivariate logistic regression. Results: Prevalence of high-risk sexual behavior was 24.5%. Of these patients, multiple sexual partners were reported by 67.3% whereas about 46.9% were engaged in unprotected sex. Multivariate logistic regression analysis revealed that high-risk sexual behavior was significantly associated with nonsupporting attitude of spouse (odds ratio [OR]: 18; 95% confidence interval [CI]: 1.4–225.5; P = 0.02) and alcohol consumption (OR: 9.3; 95% CI: 2.4–35.4; P = 0.001). Conclusions: Specific intervention addressing alcohol consumption and encouragement of spouse and family support should be integrated in the routine HIV/AIDS care and treatment apart from HIV transmission and prevention knowledge. PMID:27190412

  20. Nonadherence to antiretroviral therapy among people living with HIV/AIDS attending two tertiary care hospitals in district of northern India

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    Mukesh Shukla

    2016-01-01

    Full Text Available Introduction: Adherence to antiretroviral therapy is a principal predictor for the success of human immunodeficiency virus (HIV treatment. It remains as a challenge to acquired immunodeficiency syndrome (AIDS treatment and care with the widespread of the associated risks. Therefore, study aims to assess nonadherence level and factors associated with nonadherence to ART among people living with HIV/AIDS (PLHA. Materials and Methods: A hospital-based, cross-sectional study was conducted at two tertiary care hospital of Lucknow. A total of 322 adult HIV-positive patients registered in the ART center were included. Systematic random sampling was used to recruit patients. Nonadherence was assessed on the basis of pill count method. Results: A total of 10.9% of patients were found to be nonadherent to ART. Principal causes cited were being busy with other work (40.0%, felt sick or ill (28.5%, not having money (14.2%, and being away from home (11.4. Multivariate logistic regression analysis revealed that nonadherence was significantly associated with nonbeneficial perceptions towards ART (odds ratio (OR 18.5; 95% confidence interval (CI 3.2-106.6; P = 0.001, being counseled for adherence for more than 3 months (OR 13.9; 95% CI 1.6-118.9; P = 0.01, presence of depression (OR 2.6; 95% CI 1.0-6.7; P = 0.04, and those who were not satisfied with healthcare facilities (OR 5.63; 95% CI 1.88-16.84; P = 0.00. Conclusion: Although adherence to ART varies between individuals and over time, the factors that affect nonadherence can be addressed with proper periodic counseling and motivation of patients and their family members. Adherence to highly active antiretroviral therapy (HAART could delay the progression of this lethal disease and minimize the risk of developing drug resistance.

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

    Science.gov (United States)

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

    1982-11-01

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

  2. School District Mergers: What One District Learned

    Science.gov (United States)

    Kingston, Kathleen

    2009-01-01

    Throughout the planning process for a school district merger in a northwestern Pennsylvania school district, effective communication proved to be a challenge. Formed in 1932, this school district of approximately 1400 students was part of a utopian community; one established by a transportation system's corporation that was a major industrial…

  3. Prevalence of undiagnosed diabetes and pre-diabetes among hypertensive patients attending Kiambu district Hospital, Kenya: a cross-sectional study.

    Science.gov (United States)

    Meme, Nkatha; Amwayi, Samuel; Nganga, Ziporrah; Buregyeya, Esther

    2015-01-01

    Hypertension (HTN) and diabetes mellitus (DM) are two common non-communicable diseases (NCDs) that are closely linked: one cannot be properly managed without attention to the other. The aim of this study was to determine the prevalence of undiagnosed diabetic and pre-diabetic states that is abnormal glucose regulation (AGR) and factors associated with it among hypertensive patients in Kiambu Hospital, Kenya. We conducted a cross-sectional study from February 2014 to April 2014. Hypertensive patients aged ≥ 18 attending the out-patient medical clinic were included in the study. Pregnant and known diabetic patients were excluded. Data was collected on socio-demographics, behavior, and anthropometrics. Diabetes status was based on a Glycated Haemoglobin (HbA1C) classification of ≥ 6.5% for diabetes, 6.0-6.4% for pre-diabetes and ≤ 6.0% for normal. AGR was the dependable variable and included two diabetic categories; diabetes and pre-diabetes. We enrolled 334 patients into the study: the mean age was 59 years (Standard deviation = 14.3). Of these patients 254 (76%) were women. Thirty two percent (107/334; 32%) were found to have AGR, with 14% (46) having un-diagnosed DM and 18%(61) with pre-diabetes. Factors associated with AGR were age ≥ 45 (OR = 3.23; 95% CI 1.37 ≥ 7.62), basal metabolic index (BMI) ≥ 25 Kg/m(2) (OR = 3.13; 95% CI 1.53 - 6.41), low formal education (primary/none)(OR= 2; 95%CI 1.08 - 3.56) and family history of DM (OR = 2.19; 95%CI 1.16 - 4.15). There was a high prevalence of undiagnosed AGR among hypertensive patients. This highlights the need to regularly screen for AGR among hypertensive patients as recommended by WHO.

  4. A study to assess the psychological impact of fetal loss among the postnatal mothers admitted in selected hospitals of district Faridkot, Punjab, India

    Directory of Open Access Journals (Sweden)

    Anmol Bhatia

    2016-05-01

    Full Text Available Background: Miscarriage, spontaneous abortion of a fetus and the loss of an infant through stillbirth, or neonatal death is recognized as a traumatic life event before the expected point of viability. Women's response ranges from relief to devastation. Predictors of development of complicated grief after prenatal loss include lack of social support, pre-existing relationship difficulties, or absence of surviving children, as well as ambivalent attitudes or heightened perception of the reality of the pregnancy. The study aimed to assess the psychological impact of fetal loss among the postnatal mothers. Methods: The research design selected for the study was non-experimental descriptive design. Study was conducted from Dec 2014 to Jan 2015 in obstetrics and gynaecology unit of G.G.S medical hospital, Faridkot, Punjab, India. 60 postnatal women were selected by convenience sampling. The perinatal grief scale (standardized tool was used to assess fetal loss. Results: The majority of women i.e. 76.7% had more psychological impact, 23.3% women had less psychological impact of fetal loss. The range of score varies from 62-129 with mean score 102.82 ,SD 15.21 ,standard error mean 1.963, and median 103.50 and a statistically significant relation was found between psychological impact of fetal loss and gravida, Number of fetal loss, Number of live births and period of gestation at p<0.05. Conclusion: Hence it can be concluded that majority of women had more psychological impact of fetal loss and association of psychological impact of fetal loss was found between number of previous loss, number of live births, gravida and period of gestation. [Int J Reprod Contracept Obstet Gynecol 2016; 5(5.000: 1607-1612

  5. 36 CFR 28.3 - Boundaries: The Community Development District; The Dune District; The Seashore District.

    Science.gov (United States)

    2010-07-01

    ... Development District; The Dune District; The Seashore District. 28.3 Section 28.3 Parks, Forests, and Public... General Provisions § 28.3 Boundaries: The Community Development District; The Dune District; The Seashore... Community Development District, the Seashore District, and the Dune District. (b) The Community...

  6. 衢州地区急性颅脑创伤患者院前及急诊救治现状分析%Analysis on pre-hospital care and emergency treatment of craniocerebral trauma patients in Quzhou district

    Institute of Scientific and Technical Information of China (English)

    黄强; 戴伟民; 揭园庆; 聂俊; 王小芳; 胡永亮; 余小明; 宋光太; 金涛

    2013-01-01

    Objective To study an epidemiological research and analysis on current status of craniocerebral trauma patients'pre-hospital care and emergency treatment.Methods In order to achieve the objective,factors,including age,sex,cause of injury,injury date and time,on-site emergency treatment,transport mode,time period from injury to specialist treatment,time period from injury to first-time head examine,emergency room treatment status,treatment outcomes,etc.,are analyzed based on statistics of craniocerebral trauma in-patients of Quzhou district in 2009.Results Young men are the high risk population of acute craniocerebral trauma.Traffic accident is the main cause of trauma,mines and factories are closely related places.The relative percentages of on-site professional emergency treatment and ambulance transportation are quite low.Township hospitals have the shortest time period from injury to hospital treatment,but also have the longest time period from injury to specialist treatment or first-time head CT examine.raniocerebral trauma are mainly closed injuries,while the most common emergency room treatments are debridement and suturing.Conclusion Craniocerebral trauma is a dangerous kind of traumatic diseases with high risk and incidence rate.The incidence rate of the trauma can be reduced by strengthening the enforcement of related laws and regulations as well as the popularization and education of related knowledge.The mortality rate and disability rate can be reduced by training the doctors and nurses as well as improving the medical equipment of hospitals,especially the primary hospitals.%目的 对颅脑创伤患者的院前急救和急诊室救治现状进行流行病学调查和研究.方法 以2009年衢州地区颅脑创伤住院病人为研究对象,对年龄、性别、致伤原因、致伤日期和时间、现场急救、伤员转运方式、受伤-急诊专科救治时间、受伤-首次头颅检查时间、急诊室急救现状和治疗结

  7. 北京市某区级医院护理人力资源分析与思考%Analysis and Reflection of Nursing Human Resources in a District Hospital in Beijing

    Institute of Scientific and Technical Information of China (English)

    管惠娟

    2012-01-01

    目的 了解北京市某区级医院护理人力资源现状,分析存在问题的原因,探讨切实可行的护理人力资源建设策略.方法 基于该医院人力资源管理系统,收集截至2011年底护理岗位工作人员信息并进行分析.结果 护理人员总数666人,在编护士与合同制护士之比约为2∶3;护士年龄以30岁以下为主,占61.86%;学历以本科和大专为主,占64.27%;职称以初级为主,占76.88%.结论 该医院护理人员队伍初具规模,高学历护理人员比例较小,人员素质尚待提高;合同制护士流动性较大;人员结构有待调整,需加强岗位针对性培训;稳定人员队伍,完善人员结构.%Objectives To understand the current status of nursing human resources in a district hospital in Beijing and to analyze reasons of the problems, then to explore practical development policy of nursing human resource. Methods Based on the human resource management system, collected and analyzed the information of staffs in nursing post by the end of 2011. Results In a total of 666 nursing staffs, the ratio of enrolled nurses and contract nurses was 2:3 approximately; the nurses aged under 30 accounted for 61. 86%; the nurses having a bachelor or college degree accounted for 64. 27% ; the nurses who had a primary title accounted for 76. 88%. Conclusions The hospital has a primary nursing team and a small proportion of highly educated nursing staffs. The personnel quality needs to be improved yet. The contract nurses have a large liquidity and the structure of staffs needs to be adjusted. The job-specific training also needs to be strengthened.

  8. TRANSMISSION OF HIV AT KITALE DISTRICT HOSPITAL '

    African Journals Online (AJOL)

    Women attending AN C for two times or less young women under 20 ... mothers who deliver in a health facility were more likely to access nevirapine both for themselves and .... Logistic regressions were also used to compare several variables.

  9. Analysis of Antibiotic Use in 224 Surgical Cases in Beijing Fangshan District First Hospital%北京市房山区第一医院224份手术病历抗菌药物应用分析

    Institute of Scientific and Technical Information of China (English)

    王秀云; 刘洋; 周秋峰

    2015-01-01

    目的:了解北京市房山区第一医院(以下简称“我院”)手术患者中抗菌药物的使用情况、使用特点及存在的问题,为临床合理应用抗菌药物提供参考。方法:随机抽取2013年我院224份手术病历,对患者情况、抗菌药物使用情况、手术情况、切口类别等进行统计分析。结果:224份病历中,Ⅰ类切口手术68例,占30.4%,抗菌药物使用率为29.4%,主要使用的抗菌药物为注射用头孢呋辛;Ⅱ类切口手术137例,占61.2%,主要使用的抗菌药物为注射用头孢呋辛、注射用头孢拉定、注射用头孢西丁、注射用奥硝唑、头孢呋辛酯片等。结论:我院手术患者抗菌药物的使用情况基本合理,但在抗菌药物使用剂量、频次、使用时间及联合用药等方面仍存在问题,需要继续加强抗菌药物合理使用的培训与宣传工作,促进临床合理用药。%OBJECTIVE:To investigate the status quo , characteristics and problems in the antibiotic use in surgical cases in Beijing Fangshan District First Hospital ( hereinafter referred to as “our hospital”) for reference of clinical rational use of antibiotics .METHODS:A total of 224 records of surgical cases in our hospital were randomly selected in 2013 for statistical analysis regarding patients'status, antibiotic use, surgery, incision type etc.RESULTS:Of the 224 cases, 68(30.4%) underwent type Ⅰincision surgery with 29.4%treated with antibiotics, predominantly cefuroxime for injection; 137 ( 61.2%) underwent type Ⅱ incision surgery , for whom the antibiotics including cefuroxime sodium for injection , cefradine for Injection , ornidazole for Injection and cefuroxime axetil tablets were used predominantly .CONCLUSIONS:The antibiotic use in surgical cases in our hospital was basically rational; however , there are still problems in dose , frequency and time of administration and combination therapy .It is important to

  10. Expectativa de mulheres à espera de reprodução assistida em hospital público do DF - estudo bioético Bioethical study on the expectations of women awaiting assisted reproduction in a public hospital in the Federal District, Brazil

    Directory of Open Access Journals (Sweden)

    Mônica Samrsla

    2007-02-01

    Full Text Available OBJETIVO: Investigar a expectativa de mulheres que aguardam tratamento de reprodução assistida (RA no hospital de referência da rede pública de saúde do Distrito Federal, Brasil, o Hospital Regional da Asa Sul (HRAS. MÉTODOS: Durante um mês, foram entrevistadas, por meio de questionário composto por dez perguntas objetivas, 51 das 56 mulheres que procuraram o HRAS em busca de tratamento para infertilidade. RESULTADOS: A amostra foi dividida em dois grupos. O primeiro, considerado grupo controle, constou de 27 pacientes recém-encaminhadas de postos de saúde ou de um hospital regional para o HRAS. O segundo, identificado como grupo de estudo, teve 24 mulheres já inscritas na fila de espera para fertilização in vitro, com diagnóstico anterior concluído pela equipe médica especializada do hospital. O longo tempo médio de espera pelo tratamento faz com que as mulheres avancem na idade e acabem ingressando no período de gravidez de risco sem terem conseguido tratamento. CONCLUSÃO: As mulheres sem condições de arcar com despesas de tratamento em clínicas privadas de infertilidade estão longe de se beneficiar da RA; o problema de saúde dessa população específica não passa por um processo de correção e muito menos de distribuição de recursos. A espera imposta pelo Estado potencializa a expectativa das pacientes à espera de tratamento. Não há um padrão de informação sobre o tempo da espera. A imprevisibilidade no repasse de medicamentos indispensáveis para a fertilização in vitro coloca o oferecimento futuro do serviço em dúvida.OBJECTIVE: To analyze the expectations of women who wait for Assisted Reproduction Treatment - RA in the public hospital chosen as the reference in the Public Health Network in the Federal District - HRAS, Brazil. METHODS: For thirty days, 51 women of the 56 who went to the Hras for infertility treatment were interviewed by a questionnaire including 10 objective questions related to the

  11. Private Water Districts

    Data.gov (United States)

    California Department of Resources — Private Water District boundaries are areas where private contracts provide water to the district in California. This database is designed as a regions polygon...

  12. California Political Districts

    Data.gov (United States)

    California Department of Resources — This is a series of district layers pertaining to California'spolitical districts, that are derived from the California State Senateand State Assembly information....

  13. R9 Air Districts

    Data.gov (United States)

    U.S. Environmental Protection Agency — The Region 9 Air Districts layer is a compilation of polygons representing the California Air Pollution Control and Air Quality Management Districts, Arizona Air...

  14. State Water Districts

    Data.gov (United States)

    California Department of Resources — State Water Project District boundaries are areas where state contracts provide water to the district in California. This database is designed as a regions polygon...

  15. National Register Historic Districts

    Data.gov (United States)

    Iowa State University GIS Support and Research Facility — The National Register Historic District layer is a shape file showing the boundaries of Historic Districts that are listed on the National Register of Historic Places.

  16. Legislative Districts - 1990

    Data.gov (United States)

    Kansas Data Access and Support Center — Each coverage contains a COVER-ID field that defines the House or Senate district number. Kansas House and Senate districts were created by the Legislative Research...

  17. Lieutenant Chief Warden Districts

    Data.gov (United States)

    Vermont Center for Geographic Information — This dataset is a representation overlay of Lieutenant Chief Warden Districts (areas of responsibility). The Vermont Lieutenant Chief Warden Districts layer is part...

  18. Managing Neonatal and Early Childhood Syndromic Sepsis in Sub-District Hospitals in Resource Poor Settings: Improvement in Quality of Care through Introduction of a Package of Interventions in Rural Bangladesh.

    Science.gov (United States)

    Rahman, Ahmed Ehsanur; Iqbal, Afrin; Hoque, D M Emdadul; Moinuddin, Md; Zaman, Sojib Bin; Rahman, Qazi Sadeq-Ur; Begum, Tahmina; Chowdhury, Atique Iqbal; Haider, Rafiqul; Arifeen, Shams El; Kissoon, Niranjan; Larson, Charles P

    2017-01-01

    Sepsis is dysregulated systemic inflammatory response which can lead to tissue damage, organ failure, and death. With an estimated 30 million cases per year, it is a global public health concern. Severe infections leading to sepsis account for more than half of all under five deaths and around one quarter of all neonatal deaths annually. Most of these deaths occur in low and middle income countries and could be averted by rapid assessment and appropriate treatment. Evidence suggests that service provision and quality of care pertaining to sepsis management in resource poor settings can be improved significantly with minimum resource allocation and investments. Cognizant of the stark realities, a project titled 'Interrupting Pathways to Sepsis Initiative' (IPSI) introduced a package of interventions for improving quality of care pertaining to sepsis management at 2 sub-district level public hospitals in rural Bangladesh. We present here the quality improvement process and achievements regarding some fundamental steps of sepsis management which include rapid identification and admission, followed by assessment for hypoxemia, hypoglycaemia and hypothermia, immediate resuscitation when required and early administration of parenteral broad spectrum antibiotics. Key components of the intervention package include identification of structural and functional gaps through a baseline environmental scan, capacity development on protocolized management through training and supportive supervision by onsite 'Program Coaches', facilitating triage and rapid transfer of patients through 'Welcoming Persons' and enabling rapid treatment through 'Task Shifting' from on-call physicians to on-duty paramedics in the emergency department and on-call physicians to on-duty nurses in the inpatient department. From August, 2013 to March, 2015, 1,262 under-5 children were identified as syndromic sepsis in the emergency departments; of which 82% were admitted. More neonates (30%) were referred

  19. Case-case study of factors associated to hMLH1, hMSH2, and hMSH6 protein expression among endometrial cancer patients of the University District Hospital of San Juan, Puerto Rico

    Science.gov (United States)

    González, Lorena; Ortiz, Ana P.; Suárez, Erick; Umpierre, Sharee; Marcos, Maria J.; Billoch, Jorge; Joy, Leilani; Charneco, Eileen; Lacourt, Mercedes Y.; Bernabe-Dones, Raúl D.; Cruz-Correa, Marcia

    2012-01-01

    Lynch syndrome (LS) is an autosomal dominant disorder caused by DNA mismatch repair (MMR) system deficiencies. Women affected by LS present a 40 to 60% lifetime risk of endometrial cancer (EC). Objective This case-case study aims to determine the frequency of the hMLH1, hMSH2, and hMSH6 MMR proteins and the factors (age, family history of cancer [FHC] related to LS, and body mass index [BMI]) associated to their absence in EC patients attending the University District Hospital of San Juan, Puerto Rico. Method/Materials Twenty cases were preliminary evaluated for the MMR protein expression by immunohistochemistry testing and classified as positive-cases (presence of protein) or negative-cases (absence of protein). The statistical analysis was based on the logistic regression model using the Maximum Likelihood estimation (MLE). The Bayesian approach was used to determine the posterior probability {posterior Pr[OR>1]}. Results Results showed absence for at least one MMR protein in 25% of the cases; 15% for hMLH1 and 10% for hMSH2. None of the cases showed an absence for hMSH6. The MLE demonstrated that women diagnosed with EC before the age of 50 (OR: 12.4; 95%CI = 0.5–322.7), having FHC related to LS (OR: 17.7; 95%CI = 0.6–534.6), and having lower BMI (OR: 2.38; 95%CI = 0.39–14.28) present higher odds than their counterparts of lacking an MMR protein, once adjusting for potential predictors (p > .05). The posterior probability that an excess risk of lacking an MMR protein occurs was ≥ 95% for each predictor. Conclusion Our study in this Hispanic population supports previous studies in that younger age, FHC, and lower BMI are associated with increased odds of having an absence of MMR protein expression. Further studies with larger sample sizes should be performed. PMID:22635031

  20. District nursing in Dominica

    NARCIS (Netherlands)

    Kolkman, PME; Luteijn, AJ; Nasiiro, RS; Bruney, [No Value; Smith, RJA; Meyboom-de Jong, B

    1998-01-01

    District nurses constitute the basis of the primary health care services in Dominica. All encounters of three district nurses were registered using the international classification of primary care. Information on other aspects of district nursing was collected by participating observation and the us

  1. District nurse training

    OpenAIRE

    Elliott, Arnold; Freeling, Paul; Owen, John

    1980-01-01

    Training for district nursing is being reviewed. By 1981 district nurses will have a new administrative structure, a new curriculum, and a new examination. Training for nursing, like that for general practice, is to become mandatory. The history of the development of district nurse training is briefly described.

  2. District nursing in Dominica

    NARCIS (Netherlands)

    Kolkman, PME; Luteijn, AJ; Nasiiro, RS; Bruney, [No Value; Smith, RJA; Meyboom-de Jong, B

    1998-01-01

    District nurses constitute the basis of the primary health care services in Dominica. All encounters of three district nurses were registered using the international classification of primary care. Information on other aspects of district nursing was collected by participating observation and the

  3. A Study of Mesoproterozoic Iron Cosmic Micro-spherules from 1.8 Ga and 1.6 Ga Old Strata in the Ming Tombs District, Beijing

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Numerous iron cosmic micro-spherules have been discovered from Mesoproterozoic strata including the Changzhougou Formation (1.8 Ga) and the Dahongyu Formation (1.6 Ga) of the Ming Tombs district, Beijing. There are 1 to 30 grains of cosmic spherules per 2 kg of a sandstone sample taken from the bottom of a coarse sandstone bed of the Changzhougou Formation and 56 grains per 3.69 kg of a rock sample from silicified carbonate rocks of the Dahongyu Formation. The surface textures of cosmic spherules analyzed by means of the secondary electron imagery are identical with those reported from references either domestic or abroad. So far the geo-ages of 1.8 Ga and 1.6 Ga of cosmic spherules from the Changzhougou and Dahongyu formations might be older than those reported in the world. Table 1 gives the electron probe analysis data of cosmic spherules for 30 spherule grains and 44 testing points as follows (%): FeO, 80-95; Cr2O3; 0-9.56; NiO, 0-0.78; CoO, 0-0.46;indicating that the Cr2O3 content is higher and FeO content lower in the Changzhougou Formation than in the Dahongyu Formation. The helium isotopic data of cosmic spherules as well as their host rocks vary greatly between the Changzhougou and the Dahongyu formations as shown in Table 2. The data of cosmic spherules of the Changzhougou Formation vs the Dahongyu Formation are 57.5/1.23 in 3He/4He (10-8); and 55.54/809.60 in 4He (10-6cm3STP/g); those of coarse sandstone of the Changzhougou Formation vs silicified carbonate of the Dahongyu Formation are 3.39/2.59 in 3He/4He (10-8) and 4.56/2.34 in 3He (10-6cm3STP/g). The ratio of analytic data of helium isotopes are different for cosmic spherules and their host rocks; for example, the 3He/4He (10-8) values are 16.96 and 0.48, and the 4He(10-6 cm3STP/g) are 12.18 and 345.98 for the Changzhougou and Dahongyu formations respectively. It was reported that the world's oldest micrometeorites had been found in the Meso-Proterozoie Satakunta Formation, Finland. However, the

  4. Managing Neonatal and Early Childhood Syndromic Sepsis in Sub-District Hospitals in Resource Poor Settings: Improvement in Quality of Care through Introduction of a Package of Interventions in Rural Bangladesh

    Science.gov (United States)

    Iqbal, Afrin; Hoque, D. M. Emdadul; Moinuddin, Md.; Zaman, Sojib Bin; Rahman, Qazi Sadeq-ur; Begum, Tahmina; Chowdhury, Atique Iqbal; Haider, Rafiqul; Arifeen, Shams El; Kissoon, Niranjan; Larson, Charles P.

    2017-01-01

    Introduction Sepsis is dysregulated systemic inflammatory response which can lead to tissue damage, organ failure, and death. With an estimated 30 million cases per year, it is a global public health concern. Severe infections leading to sepsis account for more than half of all under five deaths and around one quarter of all neonatal deaths annually. Most of these deaths occur in low and middle income countries and could be averted by rapid assessment and appropriate treatment. Evidence suggests that service provision and quality of care pertaining to sepsis management in resource poor settings can be improved significantly with minimum resource allocation and investments. Cognizant of the stark realities, a project titled ‘Interrupting Pathways to Sepsis Initiative’ (IPSI) introduced a package of interventions for improving quality of care pertaining to sepsis management at 2 sub-district level public hospitals in rural Bangladesh. We present here the quality improvement process and achievements regarding some fundamental steps of sepsis management which include rapid identification and admission, followed by assessment for hypoxemia, hypoglycaemia and hypothermia, immediate resuscitation when required and early administration of parenteral broad spectrum antibiotics. Materials and Method Key components of the intervention package include identification of structural and functional gaps through a baseline environmental scan, capacity development on protocolized management through training and supportive supervision by onsite ‘Program Coaches’, facilitating triage and rapid transfer of patients through ‘Welcoming Persons’ and enabling rapid treatment through ‘Task Shifting’ from on-call physicians to on-duty paramedics in the emergency department and on-call physicians to on-duty nurses in the inpatient department. Results From August, 2013 to March, 2015, 1,262 under-5 children were identified as syndromic sepsis in the emergency departments; of

  5. VT Maintenance District Boundaries

    Data.gov (United States)

    Vermont Center for Geographic Information — Vermont has eight transportation maintenance districts which are responsible for all maintenance activities on state highways, and for providing technical assistance...

  6. Suboptimal compliance with blood culture standards at a district ...

    African Journals Online (AJOL)

    The audit was conducted at a 282-bed district hospital in Cape. Town. The hospital is situated ..... In addition, the regular use of quality indicators (such as blood volume ... management of severe sepsis and septic shock: 2012. Crit Care Med ...

  7. 2010年广东省深圳市光明新区医院急诊伤害监测资料分析%Sentinel surveillance of injury in a district hospital in Shenzhen city, Guangdong province, 2010

    Institute of Scientific and Technical Information of China (English)

    陈小良; 邰昌松; 詹劲基; 苏展; 李伟梅

    2012-01-01

    Objective To understand the epidemiological characteristics of injuries in emergency department in the hospital in Guangming new district and provide evidence for injury prevention and control. Methods Descriptive epidemiological analysis was conducted on the surveillance data of injury in the hospital in 2010. Results A total of 22 784 injury cases were reported in 2010. The injuries were mainly caused by blunt force (40. 24% ), falling down (16. 46% ), animal bite (13. 28% ), knife/sharp instrument wound (11.43% ) and motor vehicle accident (10. 51% ). The injuries mainly occurred in industrial/construction sites (40. 80% ) and on street/road( 22. 65% ). Most cases were unintentional injuries (83. 97% ) and mild in severity (76. 30% ). The majority of serious injuries were caused by motor vehicle accident (55. 26% ). Most injuries occurred during 08:00 -22:00 in a day (85. 51% ). No obvious peak was found in overall time distribution of injury cases, but the differences on the time distribution in different populations were significant (x2 = 998, P = 0. 00). The injuries in pre school aged children mainly occurred during 17: 00 - 20:00 (37. 43% ), the injuries in students mainly occurred during 16:00 - 19:00 (36.91 % ) and self wounding/suicide mainly occurred during 00:00-01:00 (12. 85% ) ,20:00 - 21:00 (8.38%) and 21:00 - 22:00 (8.38%). Conclusion Targeted intervention should be focused on occupational injury, animal bite and traffic accident injury prevention and control in different population, places and times.%目的 了解广东省深圳市光明新区医院急诊伤害分布情况,为伤害事件预防与控制提供依据.方法 采用统一的调查表对在深圳市光明新区伤害监测哨点医院急诊科就诊的首诊伤害病例进行登记,运用描述流行病学方法进行分析.结果 2010年全年累计伤害病例22 784例,伤害发生的主要原因为钝器伤(40.24%)、跌倒/坠落(16.46%)、动物伤(13.28%)、刀/锐器伤(11

  8. Acute admissions to medical departments. A comparison between an urban and a rural district

    DEFF Research Database (Denmark)

    Hilsted, J C; Evald, T; Elbrønd, R;

    1995-01-01

    To compare hospitalization into medical departments, acute admissions into a city hospital and into a district hospital were compared prospectively over a two-week period. Patients referred to the city hospital were on average older, were more frequently living alone and they had a greater amount...

  9. Primary amenorrhoea: three cases from a semi-rural Namibian hospital.

    Science.gov (United States)

    van Dillen, Jeroen; van der Honing, Anouk

    2005-07-01

    We discuss the diagnostic process of three patients presenting with primary amenorrhoea in Onandjokwe Lutheran Hospital in Northern Namibia. This semirural district hospital also serves as a referral hospital and has both ultrasound and laparoscopy possibilities.

  10. A importância da brinquedoteca hospitalar e da Terapia Ocupacional sob a óptica da equipe de enfermagem de um hospital público do Distrito Federal/The importance of hospital playroom and Occupational Therapy from the perspective of the nursing team of a public hospital in the Federal District

    National Research Council Canada - National Science Library

    Caroline Jonas Rezaghi Ricomini Nunes; Hellen Delchova Rabelo; Denise Pinheiro Falcão; Marilucia Rocha de Almerida Picanço

    2013-01-01

    ... hospitalar e o modo como percebem o terapeuta ocupacional nesse contexto. Método: Aplicação de um questionário a profissionais da equipe de enfermagem da unidade de pediatria do terceiro maior hospital do Distrito Federal. Resultados: Percebeu-se a importância atribuída à brinquedoteca por parte da equipe de enfermagem, o reconhecimento do valo...

  11. Cultura de Segurança do Doente percecionada por enfermeiros em hospitais distritais portugueses Cultura de Seguridad del Enfermo percibida por enfermeros en hospitales distritales portugueses Patient Safety Culture as perceived by portuguese nurses in district hospitals

    Directory of Open Access Journals (Sweden)

    António Manuel Martins Lopes Fernandes

    2011-07-01

    incluidos, 55,1% tienen menos de 44 años. Cuatro de los doce factores de la CSD revelaron ser “críticos/problemáticos” y uno “fuerte”. De los 42 indicadores, cinco presentan un porcentaje muy bueno de respuestas positivas (>75% y catorce presentan ser “críticos/problemáticos”, con un porcentaje positivo inferior a 50%. Solamente el 46% de los enfermeros atribuye el grado de “muy bueno” o “excelente” a la Seguridad del Enfermo en su servicio. El grupo de los 23-43, años presenta un porcentaje positivo inferior en nueve factores y superior en uno. Conclusión: la CSD se presenta como siendo un factor crítico, de la Calidad de los Cuidados, al revelar apenas un factor fuerte. Estos profesionales revelaron ser escépticos, los más jóvenes menos positivos en su apreciación. La Cultura identificada se caracteriza por el paradigma de la punición y ocultación del error, ya que los enfermeros están convencidos de que, cuando notificado el error, son ellos mismos el centro de la atención y no el evento.Background: the Patient Safety Culture (PSC is a structural component of the Quality in Health. Nurses, with their beliefs, competencies and characteristics of their performance, have a decisive influence in it. Objectives: to characterize the Patient Safety Culture perceived by nurses in district hospitals. Methodology: quantitative, descriptive-analytical and crossectional study conducted using a questionnaire on PSC. Results: 55.1% of the sample of 136 professionals was under 44 years of age. Four out of twelve factors of the PSC were considered “critical/problematic” and one “strong”. Of the 42 indicators, five had a very good percentage of positive answers (>75% and fourteen were “critical/problematic”, with a positive percentage of 50%. Only 46% of the nurses considered patient safety in their services “very good” or “excellent”. Participants aged 23-43 had a lower positive percentagwe in nine factors and a higher percentage

  12. Groundwater Managment Districts

    Data.gov (United States)

    Kansas Data Access and Support Center — This dataset outlines the location of the five Groundwater Management Districts in Kansas. GMDs are locally formed and elected boards for regional groundwater...

  13. Municipal League Districts

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — This dataset contains boundaries for the Municipal League Districts in New Mexico. It is a vector digital data structure at a scale of 1:100,000.

  14. NM School District Boundaries

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — The dataset represents the boundaries of all public school districts in the state of New Mexico. The source for the data layer is the New Mexico Public Education...

  15. Allegheny County Council Districts

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This dataset portrays the boundaries of the County Council Districts in Allegheny County. The dataset is based on municipal boundaries and City of Pittsburgh ward...

  16. NM Property Tax Districts

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — This layer represents boundaries for New Mexico tax district "OUT" categories and incorporated/municipal "IN" categories as identified on the "Certificate of Tax...

  17. ACT250 Districts

    Data.gov (United States)

    Vermont Center for Geographic Information — The ACT 250 Districts layer is part of a larger dataset that contains administrative boundaries for Vermont's Agency of Natural Resources. The dataset includes...

  18. Solid Waste Management Districts

    Data.gov (United States)

    Vermont Center for Geographic Information — The Solid waste management districts layer is part of a dataset that contains administrative boundaries for Vermont's Agency of Natural Resources. This dataset...

  19. Allegheny County Council Districts

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This dataset portrays the boundaries of the County Council Districts in Allegheny County. The dataset is based on municipal boundaries and City of Pittsburgh ward...

  20. 远程医疗在三级医院多院区的应用探索%Application and Exploration of Telemedicine in Multi-district of the Third Grade Hospitals

    Institute of Scientific and Technical Information of China (English)

    聂海鑫

    2016-01-01

    Under normal circumstances, the tertiary hospitals have a large number of high-quality medical resources and expert resources. But with changes in tertiary hospital operation mode, how to make tertiary hospital limited high-quality medical resources and expert resources maximum improve work efficiency, a reasonable allocation of hospital quality medical resources, reduce the medical risk, becomes suspends in front of the medical units. Through teaching exploration and application in tertiary hospital remote consultation and emergency consultation, remote business training and communication, remote operation, improve the work efficiency of the hospital experts, solve the problem of insufficient hospital experts, which is convenient for the patient, strong operability. Of course, in the process of exploration and application of telemedicine, is also facing management system is not perfect, composite type personnel training should be strengthened, patients of telemedicine applications of cognitive needs further promotion, the hospital will continue in telemedicine enlarges the investment, a bold attempt in the future.%一般情况下,三级医院拥有大量的优质医疗资源和专家资源。但随着三级医院运营模式的变化,如何合理调配医院优质医疗资源,让其最大限度的提高工作效率,降低医疗风险,成为一大问题。通过在三级医院多院区的远程会诊和应急会诊、远程业务交流和培训、远程手术示教等远程医疗技术的应用与探索,提高了医院专家工作效率,解决了院内专家不足问题,方便了患者,可操作性强。在远程医疗应用探索过程中,也面临着管理制度尚不完善、复合型人才培养有待加强、患者对远程医疗应用的认知需进一步宣传推广等,医院未来将继续在远程医疗方面加大投入、大胆尝试。

  1. To see the sustainable development of hospice care in the regional medical institutions from the perspective of development process of Geriatric Hospital of Pudong New District%从浦东新区老年医院发展看地区机构临终关怀服务的可持续发展

    Institute of Scientific and Technical Information of China (English)

    王华萍

    2016-01-01

    目的:通过调查分析上海市浦东新区老年医院近30年的临终关怀服务发展历程,为机构临终关怀服务的可持续发展提供参考。方法:通过查阅资料、定性访谈和查阅文献的方法,调查浦东新区老年医院临终关怀开展情况。结果:浦东新区老年医院设置临终关怀科经历了3个发展阶段,目前有10张病床。2010—2015年医护人员数量增长缓慢,护工人数平均为68人;临终关怀科收治患者共146例,大于80岁的患者88例(60.27%),在院死亡124例(84.93%);146例临终关怀患者人均住院天数29 d;6年来医院临终关怀科业务总收入有所增加,但收支结果仍为负值。结论:临终关怀发展受多种因素影响,应加强临终关怀技术力量培养,完善医疗保险及运营政策保障,促进机构临终关怀可持续发展。%Objective:To investigate and analyze the development of hospice care in the Geriatric Hospital of Pudong New District in Shanghai in recent 30 years to provide the reference for the sustainable development of hospice care of the medical institutions.Methods: By means of consulting data, qualitative interview and literature review, the development of Hospice Care of Geriatric Hospital of Pudong New District has been investigated.Results: GeriatricHospital of Pudong New District has experienced three stages to set up the Department of Hospice Care, and now has 10 hospice beds. From 2010 to 2015, the medical personnel number increased slowly and the average number of nursing workers was 68. The Department of Hospice Care treated 146 patients totally. The patients over 80-year-old were 88(60.27%), and 124 patients(84.93%) died in the hospital. The per capita hospitalization days of the 146 patients were 29 days. The total business revenue of the Department of Hospice Care increased in 6 years, but the balance of payments remained negative results.Conclusion: The development of hospice

  2. Epidemiology of intracerebral haemorrhage in Livorno district

    Directory of Open Access Journals (Sweden)

    Luca Masotti

    2011-08-01

    Full Text Available BACKGROUND: Intracranial haemorrhage represents the most feared stroke subtype. AIM: To evaluate the burden of intracranial haemorrhage in Tuscany hospitals with special reference to Livorno district. MATERIALS AND METHODS: Data of patients discharged in 2009 from Tuscan and Livorno hospitals with codes ICD-9-CM related to any type of spontaneous intracranial haemorrhage were selected and analyzed. RESULTS: 3,472 patients were discharged from Tuscan hospitals with these diagnoses. Overall mortality was 24.3%. 50% of patients were admitted in Internal Medicine wards. Incidence of intracranial haemorrhage and intracerebral haemorrhage (ICH in population of Livorno district was 64 and 45/100,000 inhabitants/year with related mortality of 36.5% and 39.4%respectively. Intra-hospital mortality of patients admitted in Livorno hospitals for intracranial haemorrhage were 36.7%. 40% of deaths occurred in the first 48 hours. 69.6% of intracranial haemorrhage were ICHs, 16.8% subaracnoideal. Intra-hospital mortality, admissions for intracranial haemorrhage in respect of total admissions and mortality for intracranial haemorrhage in respect to total mortality increased in the last decade. 23% of patients with intracranial haemorrhage and 16% of patients with ICH underwent to surgical procedures. ICHs related to antithrombotic treatment significantly increased in the last years. Mortality in patients on antithrombotic drugs was three times over compared to that in patients not undergone these drugs (43.7% vs 12.8%, p < 0.01. CONCLUSION: There is an increasing trend in frequency, mortality and hospital burden of intracranial haemorrhage and ICH. Efforts aimed at reducing the burden and consequences of this devasting disease are warranted.

  3. Implementation of a 12-week disease management program improved clinical outcomes and quality of life in adults with asthma in a rural district hospital: pre- and post-intervention study.

    Science.gov (United States)

    Chamnan, Parinya; Boonlert, Kittipa; Pasi, Wanit; Yodsiri, Songkran; Pong-on, Sirinya; Khansa, Bhoonsab; Yongkulwanitchanan, Pichapat

    2010-03-01

    Despite the availability of effective medical treatment and disease management guidelines, asthma remains a poorly controlled disease in developing countries. There is little evidence of the effectiveness of disease management guidelines in rural clinical practice. The effect of disease management guidelines on clinical outcomes and quality of life in asthmatic patients in a rural community hospital was examined. Fifty-seven patients aged > or = 16 years with physician-diagnosed asthma from a hospital outpatient clinic in Ubon-ratchathani, Thailand, were recruited. Asthma diagnosis was confirmed by reviewing clinical records. We implemented a 12-week disease management program, including the use of written asthma treatment plan and asthma action plan tailored to individual patients. Using one-group pre- and post-intervention design, we compared the average number of emergency visits and hospitalizations from acute asthmatic attacks before and after the implementation of interventions using the Wilcoxon matched-pairs signed-rank test. We also compared patient's asthma quality of life (AQL) scores, measured using the 7-point scaled Mini Asthma Quality of Life Questionnaire. It was found that among the 57 patients, 38 (67%) were women, and the mean age (SD) of the patients was 47.6 (17.0) years. Sixteen patients (28%) had a family history of asthma. Emergency visits decreased from 0.48 (SD = 0.83) per patient before implementation of interventions to 0.11 (0.37) per patient after implementation of interventions (p = 0.003). Hospitalizations with acute asthma attacks reduced from 0.14 (0.35) per patient to 0.04 (0.27) per patient (p = 0.034). Overall AQL scores increased significantly from 3.7 to 5.4 (p management program could reduce emergency visits and hospitalizations, and improve patients' quality of life in a rural practice setting.

  4. Government Districts, Other - MDC_CommissionerDistrictOffice

    Data.gov (United States)

    NSGIC Local Govt | GIS Inventory — A point feature class of Commissioner District Offices. Only District offices were included in this feature class. Main offices at the Stephen P. Clark Center were...

  5. Election Districts and Precincts, Voter districts, Published in 2006, Freelance.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Election Districts and Precincts dataset, was produced all or in part from Hardcopy Maps information as of 2006. It is described as 'Voter districts'. Data by...

  6. Special Taxing Districts, TIF districts, Published in 2006, Freelance.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Special Taxing Districts dataset, was produced all or in part from Published Reports/Deeds information as of 2006. It is described as 'TIF districts'. Data by...

  7. School Districts, School districts-Elementary, Published in 2002, Freelance.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This School Districts dataset, was produced all or in part from Hardcopy Maps information as of 2002. It is described as 'School districts-Elementary'. Data by this...

  8. School Districts, School districts-Middle, Published in 2002, Freelance.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This School Districts dataset, was produced all or in part from Hardcopy Maps information as of 2002. It is described as 'School districts-Middle'. Data by this...

  9. FacilitiesHospitals_HOSPITAL

    Data.gov (United States)

    Vermont Center for Geographic Information — This data layer contains point locations of all major community, regional, comprehensive health, and healthcare provider hospitals in the state of Vermont. The...

  10. Hospitals; hospitals13

    Data.gov (United States)

    University of Rhode Island Geospatial Extension Program — Hospital Facilities information was compiled from several various sources. Main source was the RI Department of Health Facilities Regulation database, License 2000....

  11. Unified School Districts, Census 2000

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — The New Mexico 2000 Unified School Districts layer was derived from the TIGER Line files from the US Census Bureau. The districts are clipped to the state...

  12. State Highway District Boundaries - 2004

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — This data represents the NM Department of Transportation District boundaries as legislatively defined (i.e. these are not maintenance defined districts).

  13. Modelling district nurse expertise.

    Science.gov (United States)

    Burke, Michelle

    2014-12-01

    As changes in society and health provision mean that one in four people over the age of 75 will require nursing care at home, pre-registration adult nurse education increasingly prepares student nurses for a future career within the community. District nurses undertake complex, multidimensional health and social assessments and care in a non-clinical setting and work in partnership with patients and their significant others to promote practical and psychological coping mechanisms and self-care. The district nurse's first assessment visit is key to developing a therapeutic partnership and it is often during this visit that expertise in district nursing practice emerges. The holistic, contextual and dynamic aspects of nursing in the home setting can make district nursing expertise difficult to illustrate and demonstrate within the classroom setting. This article explores the ways in which an understanding of expertise development theory can enable the tacit expertise that occurs within the first assessment visit to be made visible to student nurses, using simulation and expert narrative as a pedagogical strategy.

  14. District-Level Downsizing

    Science.gov (United States)

    Schachter, Ron

    2011-01-01

    Draconian cuts have become the order of business for many school districts since the economic recession hit in 2008. But for the coming school year, "draconian" has taken on an even harsher meaning, as states from California and Texas to Illinois and New York wrestle with deficits in the tens of billions of dollars and make…

  15. Methods and effects of increasing patient satisfaction in transfusion districts of outpatient departments in children 's hospitals%提高儿童医院门急诊输液区患儿及家属满意度的方法与效果

    Institute of Scientific and Technical Information of China (English)

    龚梅; 丁俭; 孙静敏

    2011-01-01

    Objective To increase the satisfaction degree of children and their families in transfusion district of outpatient departments in children hospitals. Methods The measures included setting up the quality control team,developing the responsible holistic nursing,implementing responsible system for the infusion district and improving the training system and hardware conditions. Results 3 months after the stringent management, the overall satistifation of the outpatient and emergencys transfusion area and satisfaction rates to the environment of the transfusion area,timely response to patients'calling were significantly increased ( P < 0.01 ). Conclusion Setting up the quality control team, developing responsible holistic nursing and continuous quality improvement can effectively increase the satisfaction degree of the outpatients patients.%目的 探讨提高门急诊输液区患儿和家属满意度的方法与效果.方法 成立质量控制小组,开展责任制整体护理,实行输液床位分区负责制,加强培训和改善硬件条件.结果 实施强化管理3个月后,患儿及家属对输液区环境、人流状况、呼叫护士及时响应等满意度提高(P<0.01);门急诊输液区总体满意度提高(P<0.01).结论 成立质量控制小组,开展责任制整体护理和质量持续改进,能有效提高门急诊输液区患儿和家属的满意度.

  16. Investigation and Analysis of Pharmaceutical Affairs Management of 23 Hospitals in Hanyang District of Wu-han%武汉市汉阳区23家医院药事管理工作现状调查分析

    Institute of Scientific and Technical Information of China (English)

    付美霞; 吕中明

    2015-01-01

    目的:为推动基层医疗卫生机构药事管理工作标准化建设提供参考.方法:采用填报调研表结合实地考察的方式,对武汉市汉阳区23家医院的药事管理工作进行调研,并就调查结果进行汇总分析.结果:共发放23份调研表,回收有效调研表23份,有效回收率为100%.受访医院中,3家一级医院无药品调剂管理制度,所有一级医院均无临床药师管理制度,3家一级医院无药事管理与药物治疗学组制度,三级以下医院信息化管理系统无统计功能,5家一级医院没有规范的阴凉库;13家一级医院抗菌药物门诊使用率超过20%;21家有特殊管理药品的医院中18家三级以下医院未使用国家统一标识;4家一级医院未每年组织药学人员培训.结论:武汉市汉阳区医疗卫生机构特别是一级医院在药事管理组织机构建设、临床药学学科建设、设备设施配备及药学人员管理及培训等方面均存在一些问题.建议基层医疗卫生机构通过扩建药学工作人员队伍、注重基础建设和信息化建设、认真履行工作职责、重视培训及效果评价、着力发展临床药学学科建设等,以提升药事管理水平.%OBJECTIVE:To provide reference for promoting the standardization construction of pharmaceutical affairs manage-ment in primary medical institutions. METHODS:Completing the survey forms was combined with field trip to investigate the phar-maceutical affairs management in 23 hospitals in Hanyang district of Wuhan,and the results were summarized and analyzed. RE-SULTS:Totally 23 survey forms were sent out,and 23 were effectively received with effective recovery rate of 100%. In the sur-veyed hospitals,3 community hospitals had no adjust management system,all community hospitals had no clinical pharmacists management system,3 community hospitals had no pharmaceutical management and pharmacotherapeutics system,the information-ization management system in hospitals below

  17. District nurses deserve better support to ensure safe care.

    Science.gov (United States)

    2016-09-07

    Campaigns for safe nurse staffing levels have focused invariably on our hospitals, where the absence of sufficient suitably qualified nursing staff is often easy to identify. However, the problem is just as prevalent in the community, where patients and other service users are suffering because district nurses and those in similar roles are overstretched.

  18. 医联体内区级中医院医学复合型青年人才评价指标的研究%Evaluation indexes on comprehensive young talents among traditional Chinese medicine hospitals of district-level afifliated to health alliance

    Institute of Scientific and Technical Information of China (English)

    符竣杰; 吴宝苹; 何平; 马祥雪; 王洪

    2016-01-01

    目的:探究医联体内区级中医院医学复合型青年人才评价的要素。方法:采用德尔菲(Delphi)法,对15名专家进行2轮问卷咨询,根据咨询结果筛选评价核心指标,并对指标进行权重赋值。结果:初步建立医联体内区级中医院复合型青年人才评价指标体系,包括基本素质、临床业务、科研水平在内的3项一级指标及5项二级指标、18项三级指标,以及各指标权重,3项一级指标的权重分别为基本素质0.444、临床业务0.444、科研水平0.112,其中权重最大的2项三级指标分别为医德医风和创新思维。结论:基本素质、临床业务是区级中医院复合型青年人才的考核重点,科研水平仅作为辅翼,而其中医德医风以及协作能力是重中之重,说明个人修养相对于个人能力更是青年人才的重要衡量指标。本研究中所制订的指标体系,尚待实际测试应用以进一步调整和完善,以期为医联体内中医院人才建设提供思路。%Objective:To explore the evaluation elements on traditional Chinese medicine comprehensive young talents in the district hospitals affiliated to health alliance.Methods:The Delphi method was used. Two rounds of structured consultation were conducted and fifteen experts were interviewd,and the core indexes were screened based on consultation. Weight assignment on these indexes was also conducted.Results:Evaluation indexes on comprehensive young talents among traditional Chinese medicine hospitals of district-level affiliated to health alliance were preliminary developed. These indexes construted an indicator system containing three major elements covering basic quality,clinical business and level of scientific research,five secondary indexes,eighteen three-grade indicators and their weight. The weight of three major elements was 0.444 for basic quality,0.444 for clinical business and 0.112 for level of scientific research. The

  19. Comprehensive Conservation Plan: Huron Wetland Management District, Madison Wetland Management District, Sand Lake Wetland Management District

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This Comprehensive Conservation Plan (CCP) was written to guide management on Huron Wetland Management District, Madison Wetland Management District, and Sand Lake...

  20. 我院对外药房分区间小范围盘点的实施方案介绍%Implementation of Inter-district Small-scale Stocktaking in Outpatient Pharmacy of Our Hospital

    Institute of Scientific and Technical Information of China (English)

    李辉; 季波; 张晓琳

    2009-01-01

    OBJECTIVE: To strength pharmacy management, improve pharmacy stocktaking efficiency and lower the error rate of the stocktaking in outpatient pharmacy. METHODS: Based on "Army No. 1" inventory management system, the data were retrieved and adjusted using Excel spreadsheet, and the inter- district small- scale inventory table of the outpatient pharmacy was designed in which certain individuals should be responsible for certain drugs and the order of drugs in the inventory table were in line with the arrangement order of drugs. RESULTS: The new drug stocktaking model reduced the error rate of traditional monthly drug stocktaking by 3%. CONCLUSION: The established drug stocktaking method reduces human and material resources, facilitates a more flexible, convenient and rapid stocktaking, and greatly enhances the conformity rate between drugs and accounts.%目的:加强药房管理,提高药房盘点效率,降低药品盘点误差.方法:依托"军卫一号"库存管理系统,从中提取数据并应用Excel表格加以调整,设计对外药房分区间(按药柜划分)小范围盘点表,采用定人定药使库存盘点表药品排序与药品摆放顺序相符的方式进行盘点.结果:新方案实施误差率较传统的每月式盘点降低了3个百分点.结论:该盘点方法不仅减少了人力物力,而且使得盘点更为灵活、方便、快捷,账物相符率也有了明显的提高.

  1. Investigation of work status of intermediate professional title nursing staff in secondclass hospitals in a district of Beijing%北京市某区二级医院中级职称护理人员工作现状调查

    Institute of Scientific and Technical Information of China (English)

    梁红艳; 杨爱军

    2012-01-01

    Objective: To investigate the work status of intermediate professional title nursing staff in second-class hospitals in a district of Beijing. Methods: Totally 138 intermediate professional title nursing staff from five second-class hospitals in a district of Beijing were selected randomly for investigation. The working status and attitude were investigated using the self-designed questionnaire. Results: Among the 138 intermediate professional title nursing staff, 90 worked at the nursing position, while 48 were not at nursing position. For the nursing staff worked at nursing position, 62.2% of them wanted to move away from their nursing position; 84.4% of them considered to choose the position with little stress or without night shift. Conclusion: Intermediate professional title nursing staff had low satisfaction rate on their work status. Measures should be taken to stabilize the intermediate professional title nursing staff team to maintain the sustainable development of clinical nursing work.%目的:调查北京市某区二级医院中级职称护理人员的工作现状.方法:随机选取北京市某区5家二级医院的138名中级职称护理人员,采用自行设计的调查问卷对其工作现状进行调查.结果:138名中级职称护理人员中有90人在护理岗位工作,48人未在护理岗位工作:其中在护理岗位工作的中级职称护理人员目前想脱离护理工作岗位的占62.2%,考虑选择工作轻松压力小或不上夜班岗位的占84.4%.结论:中级职称护理人员工作现状堪优,应采取有效措施稳定中级职称护理人员队伍,发挥其中坚作用,使临床护理工作实现可持续发展.

  2. Analyzing and measures on the factors of turnover of nurse in the department of neurology of the third class A hospital in Xiangyang district%襄阳地区三甲医院神经内科护士流失原因分析及对策

    Institute of Scientific and Technical Information of China (English)

    齐志华; 梁俊华

    2012-01-01

    Objective: To investigate on factors of turnover of nurse in the department of neurology of the third class A hospital in Xiangyang district, and to develop appropriate countermeasures. Methods: Questionnaire survey and analysis were conducted to the losses nurses of neurology department in the third class A hospitals in Xiangyang district from 2008 to 2010. Results: Work overload, wide disparities between input and output of the nurses and work pressure were the main reasons for neurology nurse losses. 50% of the nurses that left were the cornerstone forces, who were 25 to 35 years old, and were of senior and tertiary qualifications. There was also increasing trend of nurse turnover rate. Conclusion: Managers should take effective measures to alleviate the pressure of neurology nurses and thus to maintain stability of nursing team and improve the quality of care. These measures may include increasing staffing, increasing nurses' pay, strengthening business training and humane management and so on.%目的:探讨襄阳地区三甲医院神经内科护士流失的原因,并制订相应的对策.方法:对2008~2010年襄阳地区三甲医院流失的神经内科护士的情况进行问卷调查分析.结果:工作负荷过重、收入与付出悬殊较大、工作压力大等原因是造成神经内科护士流失的主要原因.流失护士中有50%是起着中流砥柱作用的25~35岁者、护师及大专学历者.护士流失率有逐年增加的趋势.结论:管理者应采取有效措施缓解神经内科护士压力,促进护理队伍稳定及护理质量的提高.这些措施可包括增加人员配备、提高护士薪酬、加强业务培训、实行人性化管理等.

  3. Hospital Compare

    Data.gov (United States)

    U.S. Department of Health & Human Services — Hospital Compare has information about the quality of care at over 4,000 Medicare-certified hospitals across the country. You can use Hospital Compare to find...

  4. HCAHPS - Hospital

    Data.gov (United States)

    U.S. Department of Health & Human Services — A list of hospital ratings for the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). HCAHPS is a national, standardized survey of hospital...

  5. Surveys of violence towards nurses in Baoshan district general hospital,Shanghai%上海市宝山区综合性医院护理人员遭受暴力状况调查

    Institute of Scientific and Technical Information of China (English)

    施永斌; 赵宝龙; 王霞

    2016-01-01

    Objective To survey violence towards nurses and influencing factors in different departments of general hospital.Methods Violated events within 6 months were investigated and analyzed in 645 nur-ses of medical,surgical,obstetric and gynecologic,paediatrics and emergency department from 3 general hospitals.Results There were significant differences in the incidences of violated events within 6 months in nurses of different departments (χ2 =39.79,P <0.01).The incidence of violated events in nurses of de-partment of pediatrics was the highest (74.5%),then emergency department (59.5%);the incidence of suffering from psychological and physical violence at the same time was the highest in emergency depart-ment nurses (13.9%).Nurses’ages,honor,emotional tiredness and sense of achievement all had signifi-cant influences on violated events (P <0.05 or 0.01).Conclusion The incidences of violated events in hospital are higher,especially in paediatrics and emergency department nurses,and effective interventions should be adopted to structure harmonious doctor-patient relationship and ensure medical personnel job se-curity.%目的:了解综合性医院不同科别护理人员遭受暴力事件发生状况及其影响因素。方法对上海市宝山中心城区3所综合性医院的内科、外科、妇产科、儿科及急诊科645名护理人员6个月内遭受暴力事件状况进行调查分析。结果6个月内不同科别护理人员暴力事件发生率比较差异有极显著性(χ2=39.79,P <0.01)。儿科护理人员遭受心理暴力发生率最高(74.5%)、其次为急诊科(59.5%);同时遭受心理及身体暴力急诊科护理人员发生率最高(13.9%)。护理人员的年龄、是否得到过荣誉、情绪疲倦感、成就感等因素对是否遭受暴力均具有显著影响(P <0.05或0.01)。结论医院暴力事件发生率高,尤以儿科、急诊科护理人员最为显著,医疗及相关部门应采取有效干预措施,努力构造和谐医患

  6. Norovirus - hospital

    Science.gov (United States)

    Gastroenteritis - norovirus; Colitis - norovirus; Hospital acquired infection - norovirus ... fluids ( dehydration ). Anyone can become infected with norovirus. Hospital patients who are very old, very young, or ...

  7. Hospital campus design related with EeB challenges

    NARCIS (Netherlands)

    Hoogh, S. de; Giulio, R. di; Quentin, C.; Turillazzi, B.; Sebastian, R.

    2015-01-01

    Energy efficiency and reduction of carbon emission of Healthcare buildings and districts are a key factor for a sustainable community since their energy use and carbon emission are among the highest of all building types. A hospital - which is a part of a healthcare district - uses 2.5 times more en

  8. Hospital campus design related with EeB challenges

    NARCIS (Netherlands)

    Hoogh, S. de; Giulio, R. di; Quentin, C.; Turillazzi, B.; Sebastian, R.

    2015-01-01

    Energy efficiency and reduction of carbon emission of Healthcare buildings and districts are a key factor for a sustainable community since their energy use and carbon emission are among the highest of all building types. A hospital - which is a part of a healthcare district - uses 2.5 times more

  9. Unit cost of medical services at different hospitals in India.

    Directory of Open Access Journals (Sweden)

    Susmita Chatterjee

    Full Text Available Institutional care is a growing component of health care costs in low- and middle-income countries, but local health planners in these countries have inadequate knowledge of the costs of different medical services. In India, greater utilisation of hospital services is driven both by rising incomes and by government insurance programmes that cover the cost of inpatient services; however, there is still a paucity of unit cost information from Indian hospitals. In this study, we estimated operating costs and cost per outpatient visit, cost per inpatient stay, cost per emergency room visit, and cost per surgery for five hospitals of different types across India: a 57-bed charitable hospital, a 200-bed private hospital, a 400-bed government district hospital, a 655-bed private teaching hospital, and a 778-bed government tertiary care hospital for the financial year 2010-11. The major cost component varied among human resources, capital costs, and material costs, by hospital type. The outpatient visit cost ranged from Rs. 94 (district hospital to Rs. 2,213 (private hospital (USD 1 = INR 52. The inpatient stay cost was Rs. 345 in the private teaching hospital, Rs. 394 in the district hospital, Rs. 614 in the tertiary care hospital, Rs. 1,959 in the charitable hospital, and Rs. 6,996 in the private hospital. Our study results can help hospital administrators understand their cost structures and run their facilities more efficiently, and we identify areas where improvements in efficiency might significantly lower unit costs. The study also demonstrates that detailed costing of Indian hospital operations is both feasible and essential, given the significant variation in the country's hospital types. Because of the size and diversity of the country and variations across hospitals, a large-scale study should be undertaken to refine hospital costing for different types of hospitals so that the results can be used for policy purposes, such as revising

  10. Government Districts, Other - MDC_CommissionDistrict2001

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — Polygon feature class representing the Redistricting Commission Plan 11-15, adopted November 15, 2001. This Commission District Boundary layer becomes effective...

  11. A Finnish Concept for Academic Entrepreneurship: The Case of Satakunta University of Applied Sciences

    Science.gov (United States)

    Lain, Kari

    2008-01-01

    In a knowledge-driven economy there is a growing need for deeper and more productive interaction between higher education and industry. The full exploitation of knowledge requires strategies, incentives, appropriate systems and strong interaction between the transfer processes and the main processes in higher education. In a knowledge-based…

  12. Management of Rational Application of Antibiotics in Inpatient Department of People's Hospital of Panyu District%住院部抗菌药物合理应用管理成效

    Institute of Scientific and Technical Information of China (English)

    杨辉; 马海燕

    2009-01-01

    目的 考查检查与培训相结合对规范住院部抗菌药物合理应用成效.方法 分别抽取3个科室的临床主任、临床术科和非术科质控员与2名药师共同检查,讨论病历.结果 临床医师、药师在检查中抗菌药物合理应用知识有明显的提高,派医师参检科室不合理使用抗菌药物比例有下降趋势.结论 检查与培训相结合的方式更有利于从根源上规范临床抗菌药物使用.%Objective To test the effect of combination of inspection and training on the rational application of antibioticsin-patient department. Methods Three clinical directors were taken from 3 different sections of the hospital,clinical subjects and non-cultural quality control staff to check with two pharmacists common to discuss the medical records. Results The clinicians, pharmacists in the examination of knowledge rational use of antibiotics has increased significantly, to send Dr. Frederick Participation sections the proportion of irrational use of antibiotics there is a downward trend. Conclusion The combination of inspection and training is more conducive to the way up from the norms of the root causes of the clinical use of antibacterial drugs.

  13. A Study to Assess the Factors and Out of Pocket Expenditures in the Patients of Road Traffic Accidents Admitted in a Tertiary Care Hospital in a Central India District

    Directory of Open Access Journals (Sweden)

    Srivastava DK

    2014-12-01

    Full Text Available Background: Road traffic injuries are estimated to be the eighth leading cause of death globally, with an impact similar to that caused by many communicable diseases, such as malaria. road traffic injuries are estimated to cost low- and middle-income countries between 1–2 % of their Gross Domestic Product (GDP, an estimate of about US$ 100 billion a year. Objectives: To study the epidemiological profile of Road Traffic Injuries among the patients admitted in a tertiary care centre and too find out the various out of pocket expenditure in the patients of Road Traffic Accidents. Material and Method: The present study was a hospital based Descriptive Prospective Study. A list of all the patients admitted due to Road Traffic Accident in last one week was obtained from the ward sisters of Orthopedic Department. All the selected participants were interviewed on the two fixed days. A pre tested structured open ended questionnaire was used for data collection. Results: Of the 48 participants interviewed, 34male and 14 females. Most common age group affected was 21-25 years followed by 16-20 years. The rate of accidents was most common on the weekends. The rate of accidents was more in users of two wheelers. Majority of the expenditure in the First week of admission was on the purchase of medicines followed by diagnosis. Majority of the victims also suffered huge financial loss due to loss of salary, closure of shop, loss due to daily wages etc. Conclusion: The present study hereby concludes that there is an urgent need for creating awareness about Road Traffic Accident. The study also concludes that majority of the out of pocket expenditure in the first week of admission is on the medication.

  14. Effects of locality based community hospital care on independence in older people needing rehabilitation: randomised controlled trial

    Science.gov (United States)

    Green, John; Young, John; Forster, Anne; Mallinder, Karen; Bogle, Sue; Lowson, Karin; Small, Neil

    2005-01-01

    Objective To determine the effects on independence in older people needing rehabilitation in a locality based community hospital compared with care on a ward for elderly people in a district general hospital. Design Randomised controlled trial. Setting Care in a community hospital and district general hospital in Bradford, England. Participants 220 patients needing rehabilitation after an acute illness that required hospital admission. Interventions Patients were randomly allocated to a locality based community hospital or to remain within a department for the care of elderly people in a district general hospital. Main outcome measures Primary outcomes were Nottingham extended activities of daily living scale and general health questionnaire 28 (carer). Secondary outcomes were activities of daily living (Barthel index), Nottingham health profile, hospital anxiety and depression scale, mortality, destination after discharge, satisfaction with services, carer strain index, and carer's satisfaction with services. Results The median length of stay was 15 days for both the community hospital and the district general hospital groups (interquartile range: community hospital 9-25 days; district general hospital 9-24 days). Independence at six months was greater in the community hospital group (adjusted mean difference 5.30, 95% confidence interval 0.64 to 9.96). Results for the secondary outcome measures, including care satisfaction and measures of carer burden, were similar for both groups. Conclusions Care in a locality based community hospital is associated with greater independence for older people than care in wards for elderly people in a district general hospital. PMID:15994660

  15. Outpatient visit due to influenza like illness in sentinel hospitals in Xicheng district of Beijing, 2009-2012%2009-2012年北京市西城区流感哨点监测医院流感样病例门诊就诊负担分析

    Institute of Scientific and Technical Information of China (English)

    苗芳; 李达; 胡晓芬; 张晶波; 王永全; 卢立新

    2013-01-01

    Objective To understand the incidence of influenza like illness (ILI) and estimate the disease burden caused by ILI in Xi-cheng district of Beijing.Methods The data of the early warning system for infectious disease in medical institutions and the National Influenza Surveillance Network were used for the study.The surveillance data of ILI from 2009 to 2012 in two sentinel hospitals in Xicheng district were collected.Excel 2007 and SPSS 13.0 were used to analyzed the statistical data.Results A total of 72 414 ILI cases were reported by two sentinel hospitals from June 2009 to May 2012,the average proportion of ILI cases in outpatients was 1.85%.During the period of 2009-2010 influenza season,average proportion of ILI in outpatients was 2.38%,the RT-PCR positive rate of influenza virus nucleic acid detection was 39.70%,the estimated influenza infection rate was 38.63% and the influenza cases accounted for 9.19‰ of the outpatient visit in sentinel hospitals.During 2010-2011 influenza season,the average proportion of ILl in outpatients was 2.02%,the RT-PCR positive rate of influenza virus nucleic acid detection was 18.68%,the estimated influenza infection rate was 15.33% and the influenza cases accounted for 3.10‰ of the outpatient visit in two sentinel hospitals.During 2011-2010 influenza season,the average proportion of ILI in outpatients was 1.28%,the RT-PCR positive rate of influenza virus nucleic acid detection was 18.23%,the estimated influenza infection rate was 15.66% and the influenza cases accounted for 2.00‰ of the outpatient visit in two sentinel hospitals.ILI visits focused on child outpatients and fever clinics under the age of 15 years old.The peak of RT-PCR positive detection curve and the peak of outpatient visit due to ILI were consistent during three influenza seasons,which mainly occurred in winter and spring.Conclusions Outpatient visit due to ILI mainly occurred during winter-spring in Xicheng district.It is important to

  16. 南京市城郊结合部区级医院护士自主学习能力与评判性思维能力的相关性分析%Relationship between the self-learning ability and critical thinking ability of nurses in district hospitals in Nanjing suburban areas

    Institute of Scientific and Technical Information of China (English)

    陈贤; 王爱红; 夏大珍; 南兴建

    2015-01-01

    Objective To survey the current status of the self-learning ability and critical thinking ability of nurses in district hospitals in suburban areas and explore the relationship between them to supply grounds for nurse training programs. Methods By convenient sampling from April to June 2014, a total of 404 nurses from 4 district hospitals in suburban areas in Nanjing were investigated with the nurse self-learning ability rating scale and critical thinking disposition inventory in Chinese version (CTDI-CV). Results The total score of suburban nurse self-leaning ability was (122. 57 ± 18. 00) while that of critical thinking ability was (276. 03 ± 24. 43). The single factor analysis presented that nurses with different occupational title had different level of critical thinking with statistical significance (F=6. 788,P<0. 05). The influencing factors of nurse self-leaning ability and critical thinking ability included whether they involved research, whether they were nursing mainstay or manager. The self-leaning ability was positively correlated with the critical thinking ability by Pearson analysis ( r=0. 378,P<0. 01). Conclusions The self-leaning ability and critical thinking ability of nurses in the four hospitals in Nanjing are in the moderate level, and they have a positive interacted relationship. According to the influencing factors, nursing managers should take appropriate and effective measures to develop and improve nurses, both abilities.%目的:调查并分析南京市城郊结合部区级医院护士自主学习能力与评判性思维能力的现状以及两者之间的关系,为护理管理者培训提供参考依据。方法2014年4—7月采用便利抽样法选择南京市城郊结合部4所区级医院的404名护士,采用护理人员自主学习能力评价量表和中文版评判性思维能力测量表(CTDI-CV)进行问卷调查。结果城郊结合部区级医院护士自主学习能力总分为(122.57±18.00)分;评

  17. Características do processo de desmame da ventilação mecânica em hospitais do Distrito Federal Weaning from mechanical ventilation process at hospitals in Federal District

    Directory of Open Access Journals (Sweden)

    Juliana Quixabeira Gonçalves

    2007-03-01

    Therapists in weaning and also obtaining its parameters in Intensive Care Units (ICU. METHODS: A survey related to the weaning process was done with active ICU Respiratory Therapists from (FD in the year 2005. The survey consisted of 31 subjective and objective questions, some of them allowing multiple answers. RESULTS: Eighty surveys were carried out at twenty hospitals. 90% of participants were specialized staff with a mean of three year working experience in ICU. In 98.7% of the answers, doctors and respiratory therapists were responsible for operating the ventilators. In 61.3%, doctors and respiratory therapists were responsible for their use and, in 36.3%, the responsibility was solely on the respiratory therapist professionals. It was found that only twenty-four respiratory therapists (30% follow the weaning protocol. Among the most practiced parameters from the weaning process are: respiratory frequency (98%, tidal volume (97.5% and periferic oxygen saturation (92.5%. The least utilized are the maximum inspiratory pressure (18.8% and the vital capacity (13.8%. CONCLUSIONS: Great differences were observed in the weaning methods, choice of parameters and the way they were collected. These variations suggest that there is a lack of routine and the need to implement simple protocols.

  18. Legitimacy of hospital reconfiguration: the controversial downsizing of Kidderminster hospital.

    Science.gov (United States)

    Oborn, Eivor

    2008-04-01

    This paper examines the contested organizational legitimacy of hospital reconfiguration, which continues to be a central issue in health care management. A qualitative study which focuses on the controversial downsizing of Kidderminster Hospital, a highly publicized landmark case of district general hospital closure. Rhetorical strategies are analysed to examine how legitimacy was constructed by stakeholder groups and how these strategies were used to support or resist change. Stakeholders promoting change legitimized re-organization pragmatically and morally arguing the need for centralization as a rational necessity. Stakeholders resisting change argued for cognitive and moral legitimacy in current service arrangements, contrasting local versus regionalized aspects of safety and provision. Groups managed to talk past each other, failing to establish a dialogue, which led to significant conflict and political upheaval. Stakeholders value hospitals in different ways and argue for diverse accounts of legitimacy. Broader discourses of medical science and democratic participation were drawn into rhetorical texts concerning regionalization to render them more powerful.

  19. Clinical experiences of collaborative imaging diagnosis in Shanghai district healthcare services

    Science.gov (United States)

    Zhang, Kai; Ling, Tonghui; Yang, Yuanyuan; Sun, Jianyong; Wang, Mingqing; Zhang, Jianguo

    2016-03-01

    To improve healthcare service quality with balancing healthcare resources between large and small hospitals, as well as reducing costs, each district health administration in Shanghai with more than 24 million citizens has built image-enabled electronic healthcare records (iEHR) system to share patient medical records and encourage patients to visit small hospitals for initial evaluations and preliminary diagnoses first, then go to large hospitals to have better specialists' services. We implemented solution for iEHR systems, based on the IHE XDS-I integration profile and installed the systems in more than 100 hospitals cross three districts in Shanghai and one city in Jiangsu Province in last few years. Here, we give operational results of these systems in these four districts and evaluated the performance of the systems in servicing the regional collaborative imaging diagnosis.

  20. HIV counselling and care programmes at the district level in Ghana.

    Science.gov (United States)

    Brugha, R

    1994-01-01

    The district hospital is the focus for the presentation of HIV-related disease in rural sub-Saharan Africa. Patients require not only medical care, but often economic support and counselling for themselves and their families. Psychosocial support should be provided at the hospital and in the home, the latter often being the preferred option. A team approach to HIV disease care and counselling, with careful selection and support of staff, and appropriate training in counselling skills is essential. A primary health care approach at the district level, mobilizing community participation and intersectoral support is necessary. Community Health Outreach Departments, as integral parts of the district hospital, are recommended and could pilot low-cost HIV hospital and home-care programmes.

  1. PDCA循环管理法在重庆市南川区人民医院全科医生转岗培训中的应用%Application of PDCA loop for job-transfer training of general practition-ers in Chongqing Nanchuan District People's Hospital

    Institute of Scientific and Technical Information of China (English)

    杨娟; 张艳; 邬开凤; 郝瑜

    2015-01-01

    目的:探讨计划、实施、检查、处理(PDCA)循环管理法在重庆市南川区人民医院全科医生转岗培训中的应用效果。方法将重庆市南川区人民医院30名全科医生转岗培训学员分为实验组(2013年4月~2014年12月)和对照组(2011年4月~2012年12月),对照组采用常规培训,实验组采用PDCA循环管理法,建立毕业后医学教育委员会专门监管、完善制度并培训、教学指标落实到具体科室、制订相应的带教措施、利用信息化软件协助管理等系列措施。先调查现状、找出存在的问题,然后分析原因并制订对策,最后检查、落实,反馈培训效果。比较两组学员实施PDCA循环前后的培训效果及满意度情况。结果与对照组比较,实验组的学员理论考试合格率从72.7豫上升至94.7豫;操作技能合格率从63.6豫上升至94.7豫;病历书写合格率从72.7豫上升至100.0豫;医护患投诉率、职业暴露发生率均从18.2豫下降至5.3豫;学员对各项指标的综合满意度从72.7豫上升至94.7豫;两组各指标差异均有统计学意义(均P<0.05)。结论PDCA循环管理法用于重庆市南川区人民医院全科医生转岗培训中的管理成效显著,值得在其他医院培训领Ⅱ推广应用。%Objective To explore application effects of job-transfer training of general practitioners by using Plan, Do, Check, Action (PDCA) loop in Chongqing Nanchuan District People's Hospital. Methods 30 general practitioner train-ing job-transfer were randomly divided into the experimental group (from April 2013 to December 2014) and control group (from April 2011 to December 2012) in Chongqing Nanchuan District People's Hospital. Regular training was used in the control group and PDCA loop was used in the experimental group. The system was supervised, improved and trained, the training index was concretely allotted to each department and the teaching measures were developed, the

  2. Internal Auditing for School Districts.

    Science.gov (United States)

    Cuzzetto, Charles

    This book provides guidelines for conducting internal audits of school districts. The first five chapters provide an overview of internal auditing and describe techniques that can be used to improve or implement internal audits in school districts. They offer information on the definition and benefits of internal auditing, the role of internal…

  3. Internal Auditing for School Districts.

    Science.gov (United States)

    Cuzzetto, Charles

    This book provides guidelines for conducting internal audits of school districts. The first five chapters provide an overview of internal auditing and describe techniques that can be used to improve or implement internal audits in school districts. They offer information on the definition and benefits of internal auditing, the role of internal…

  4. Redesigning the District Operating System

    Science.gov (United States)

    Hodas, Steven

    2015-01-01

    In this paper, we look at the inner workings of a school district through the lens of the "district operating system (DOS)," a set of interlocking mutually-reinforcing modules that includes functions like procurement, contracting, data and IT policy, the general counsel's office, human resources, and the systems for employee and family…

  5. Etiological analysis of acute infectious diarrhea in adults of west district sentinel hospital of Shanghai in 2011-2013%2011-2013年上海西区哨点医院成人急性腹泻细菌感染的病原学分析

    Institute of Scientific and Technical Information of China (English)

    沈思兰; 李颖; 史慧晶; 刘岩红; 张万菊; 何静; 朱绍琴; 胡芸文; 钱方兴

    2016-01-01

    OBJECTIVE To understand the distribution of pathogens causing acute infectious diarrhea in adults of west district sentinel hospital of Shanghai and analyze the change trend so as to put forward targeted prevention and control measures of the acute diarrhea .METHODS A total of 2 091 patients with acute diarrhea who were not treated with antibiotics in diarrhea outpatient department of west district sentinel hospital of Shanghai from Jan 2011 to Dec 2013 were enrolled in the study ,then the stool specimens were collected to culture and isolate the common species of intestinal tract pathogenic bacteria (Vibrio parahaemolyticus ,Escherichia coli ,Salmonella , Campylobacter jejuni ,and Shigella) ,and the isolated positive strains were identified and preserved by center for disease control and prevention of Changning district .RESULTS The stool specimens were cultured positive in 671 patients ,with the positive rate 32 .1% .Totally 671 strains of pathogens were isolated;the V .parahaemolyticus , E .coli ,Salmonella ,and Shigella were dominant among the pathogens ,accounting for 33 .8% ,22 .1% ,21 .5% , and 10 .3% ,respectively ;the enterotoxigenic E .coli was dominant among the E .coli strains ,accounting for 74 . 3% (110/148);the Salmonella Enteritidis was the most common species of Salmonella ,accounting for 44 .4%(64/144);the Shigellasonnei was dominant among the Shigellaspp ,accounting for 84 .1% (58/69) .The isola‐tion rate of pathogens was highest (29 .5% ) in the patients aged from 21 to 30 years old (198/671);68 .70%(461/671) of the pathogens were isolated in July‐September .CONCLUSION The adults with acute diarrhea in the western district of Shanghai show remarkable seasonal character ,and the young patients are dominant .The inci‐dence of E .coli infection shows an upward trend .It is necessary to actively conduct the targeted prevention and control of the diarrhea in the key population .%目的:了解上海市西区哨点医院成人急性腹泻病

  6. 2007-2010年上海市松江区哨点医院首诊伤害流行趋势分析%Analysis of epidemiological trend of injury cases treated for the first time in sentinel hospitals in Songjiang District of Shanghai City, 2007-2010

    Institute of Scientific and Technical Information of China (English)

    黄丽; 周德定; 严卫军

    2012-01-01

    Objective To understand the epidemiological characteristics and its trend of injury in Songjiang District for providing the bases to prevent and control the occurrence of injury. Methods According to WHO standards, the medical history of injury cases treated in 3 hospitals and 14 community service centers for the first time in Songjiang District from January 1st, 2007 to December 31st, 2010 were collected, and then analyzed. Results Songjiang District injury case increased year after year. A total of 256 686 injury cases were analyzed, the male to female ratio was 1.92 : 1 and reduced year by year(P<0. 001). The largest proportion of injured people was 25-44 year in age (40. 19% ). The common occupation were transport equipment operators and related workers (26. 53% ) , business or servers personnel (19. 73% ) and professional and technical personnel (14.25% ). Each year the top three causes of injury were objects/appliance mechanical accident (including sharp injury, blunt injury and firearms hurt) (39.46% ) , falls(35.24% ) , and traffic accident (18. 33% ). The annual proportion of other provinces and cities injury was ever increasing from 2007 to 2010, and reached a high level in 2010 (61. 87% ). Most of them were unintentional hurt (92. 46% ) and ever increased, while assault and self-inflicted violence decreased from 2007 to 2010. Conclusions The top three causes of injury in Songjiang District were the objects/appliance mechanical accident, followed by falls and traffic accidents; the main occupation were transport equipment operators and related workers, business or servers personnel and professional and technical personnel; unintentional injury should be the priority list for preventing and controlling in Songjiang District.%目的 了解上海市松江区伤害流行特征及其变化趋势,为制定有效的综合干预措施提供科学依据.方法 收集2007年1月1日~2010年12月31日,到松江区3家综合性医院及14家社区卫生服务中

  7. hospital's perspective

    African Journals Online (AJOL)

    Cost effectiveness of autologous blood transfusion - A developing country hospital's ... 4Military Hospital, Lagos. Summary. An autologous blood donation program was set up at. National .... risk of infection for autologous patients was 5.06.

  8. 2013年重庆渝中区市属三甲医院重症医学科院感调查分析%Investigation of nosocomial infection in intensive care unit of municipal grade A hospital in Yuzhong district of Chongqingin2013

    Institute of Scientific and Technical Information of China (English)

    刘奕; 周发春; 张丹; 廖璞; 彦令

    2014-01-01

    目的:了解渝中区市属三甲医院重症医学科(ICU)医院感染的现状,分析常见病原菌及其易感原因,为降低医院感染的发生率提供指导。方法收集2013年重庆市渝中区5所医院ICU医院感染相关资料,研究其发病率、常见感染部位、常见病原菌,并分析其感染发生原因。结果2013年平均感染例次率6.58%,平均日感染发生率12.51‰;呼吸(58.91%)、泌尿(28.29%)及血液(8.91%)为常见感染系统;长时间留住ICU,疾病危重程度,高龄,使用“三管”是ICU医院感染的易感因素;对有创机械通气患者施行声门下吸引、床头抬高、早期开展肠内营养、气囊测压、洗必泰口腔护理可有效预防呼吸机相关性肺炎(VAP)的发生(P<0.05);铜绿假单胞菌(27.81%)、鲍曼不动杆菌(20.86%)及大场埃希菌(15.56%)为常见感染细菌,且耐药率高。结论渝中区三甲医院ICU院感率符合院感控制标准且低于全国平均水平;结合本地区特点,应重点做好VAP的预防工作,采取切断非发酵菌的传播途径、限制广谱抗菌药物的滥用等预防措施以控制ICU医院感染的发生。%Objective To investigate current situation of nosocomial infection in intensive care unit (ICU ) of municipal grade A hospital in Yuzhong district ,explore the common pathogentic bacterium and susceptible factors , and to provide advice for reducing the incidence of nosocomial infection .Methods Nosocomial infection related infor‐mation of ICU of 5 grade A hospital in Yuzhong district was collected ,and the incidence of nosocomial infection ,com‐mon sites of nosocomial infection ,common pathogentic bacterium and susceptible factors were analyzed .Results The incidence of nosocomial infections in 2013 was 6 .58% ,the incidence of nosocomial infection per patient day was 12 .51‰ .Respiratory system(58 .91% ) ,urinary

  9. Hospitality within hospital meals –

    DEFF Research Database (Denmark)

    Justesen, Lise; Gyimóthy, Szilvia; Mikkelsen, Bent Egberg

    2016-01-01

    Hospital meals and their role in nutritional care have been studied primarily from a life and natural science perspective. This article takes a different approach and explores the idea of hospitality inspired by Jacques Derrida’s work on the ontology of hospitality. By drawing on ethnographic...... fieldwork in a Danish hospital, hospitality practices were studied using a socio-material assemblage approach. The study showed that rethinking the meal event could change the wards into temporary “pop-up-restaurants,” transcending the hospital context and providing a scene for shifting host...... and management involved in hospital food service and in nutritional care to work more systematically with the environment for improved hospital meal experiences in the future...

  10. Government Districts, Other - MO 2014 Springfield Conditional Overlay Districts (SHP)

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — Conditional Overlay District polygons for the City of Springfield, inside city limits only. Created and maintained by the GIS Division of the Information Systems...

  11. Zoning Districts - MO 2011 Springfield Conditional Overlay Districts (SHP)

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — Conditional Overlay District polygons for the City of Springfield, inside city limits only. Created and maintained by the GIS Division of the Information Systems...

  12. 2006 Southwest Florida Water Management District (SWFWMD) Lidar: North District

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This data set is one component of a digital terrain model (DTM) for the Southwest Florida Water Management District's FY2006 Digital Orthophoto (B089) and LiDAR...

  13. 2006 Southwest Florida Water Management District (SWFWMD) Lidar: North District

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — This data set is one component of a digital terrain model (DTM) for the Southwest Florida Water Management District's FY2006 Digital Orthophoto (B089) and LiDAR...

  14. Government Districts, Other, National Register districts, Published in 2006, Freelance.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Government Districts, Other dataset, was produced all or in part from Published Reports/Deeds information as of 2006. It is described as 'National Register...

  15. Gorey District Hospital, Mc Curtin Street, Gorey, Wexford.

    LENUS (Irish Health Repository)

    Ryan, Ruth CM

    2011-10-24

    Abstract Background Dendritic cells (DCs) connect innate and adaptive immunity, and are necessary for an efficient CD4+ and CD8+ T cell response after infection with Mycobacterium tuberculosis (Mtb). We previously described the macrophage cell death response to Mtb infection. To investigate the effect of Mtb infection on human DC viability, we infected these phagocytes with different strains of Mtb and assessed viability, as well as DNA fragmentation and caspase activity. In parallel studies, we assessed the impact of infection on DC maturation, cytokine production and bacillary survival. Results Infection of DCs with live Mtb (H37Ra or H37Rv) led to cell death. This cell death proceeded in a caspase-independent manner, and without nuclear fragmentation. In fact, substrate assays demonstrated that Mtb H37Ra-induced cell death progressed without the activation of the executioner caspases, 3\\/7. Although the death pathway was triggered after infection, the DCs successfully underwent maturation and produced a host-protective cytokine profile. Finally, dying infected DCs were permissive for Mtb H37Ra growth. Conclusions Human DCs undergo cell death after infection with live Mtb, in a manner that does not involve executioner caspases, and results in no mycobactericidal effect. Nonetheless, the DC maturation and cytokine profile observed suggests that the infected cells can still contribute to TB immunity.

  16. Gorey District Hospital, Mc Curtin Street, Gorey, Wexford.

    LENUS (Irish Health Repository)

    Oglesby, Irene K

    2010-01-01

    MicroRNAs (miRNAs) have emerged as a class of regulatory RNAs with immense significance in numerous biological processes. When aberrantly expressed miRNAs have been shown to play a role in the pathogenesis of several disease states. Extensive research has explored miRNA involvement in the development and fate of immune cells and in both the innate and adaptive immune responses whereby strong evidence links miRNA expression to signalling pathways and receptors with critical roles in the inflammatory response such as NF-κB and the toll-like receptors, respectively. Recent studies have revealed that unique miRNA expression profiles exist in inflammatory lung diseases such as cystic fibrosis, chronic obstructive pulmonary disease, asthma, idiopathic pulmonary fibrosis and lung cancer. Evaluation of the global expression of miRNAs provides a unique opportunity to identify important target gene sets regulating susceptibility and response to infection and treatment, and control of inflammation in chronic airway disorders. Over 800 human miRNAs have been discovered to date, however the biological function of the majority remains to be uncovered. Understanding the role that miRNAs play in the modulation of gene expression leading to sustained chronic pulmonary inflammation is important for the development of new therapies which focus on prevention of disease progression rather than symptom relief. Here we discuss the current understanding of miRNA involvement in innate immunity, specifically in LPS\\/TLR4 signalling and in the progression of the chronic inflammatory lung diseases cystic fibrosis, COPD and asthma. miRNA in lung cancer and IPF are also reviewed.

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

    Science.gov (United States)

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

    2013-12-01

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

  18. Indications for Caesarean Section at a Nigerian District Hospital

    African Journals Online (AJOL)

    Alasia Datonye

    caeserean sections performed with obstructed labour being the highest indication. ... maternity ward register while other clinical records were retrieved from the ... December 2006 was recorded for analysis. The patients ... The routine laboratory ... rate of CS various Nigerian studies are 10.4% in Awka , 9.1%. 9. 10 in Ilorin ...

  19. HBV, HIV CO-INFECTION AT KISUMU DISTRICT HOSPITAL ...

    African Journals Online (AJOL)

    hi-tech

    2004-12-12

    Dec 12, 2004 ... Design: A prospective, cross-sectional, descriptive study of all consecutive patients included in ... of medicine, and was referred to by Hippocrates over ... subject (For <18 year olds, signed by parent/ guardian). .... is high among homosexuals, which was also associated ... HIV may modify the natural history.

  20. health in Wakiso District, Uganda

    African Journals Online (AJOL)

    In a qualitative study on the perceptions of domestic violence in Wakiso district, payment of bride price emerged as .... Bride price payment was found acceptable to many older women .... Issues in Mental Health Nursing 1989; 10: 209-227. 11.

  1. Boise geothermal district heating system

    Energy Technology Data Exchange (ETDEWEB)

    Hanson, P.J.

    1985-10-01

    This document describes the Boise geothermal district heating project from preliminary feasibility studies completed in 1979 to a fully operational system by 1983. The report includes information about the two local governments that participated in the project - the City of Boise, Idaho and the Boise Warm Springs Water District. It also discusses the federal funding sources; the financial studies; the feasibility studies conducted; the general system planning and design; design of detailed system components; the legal issues involved in production; geological analysis of the resource area; distribution and disposal; the program to market system services; and the methods of retrofitting buildings to use geothermal hot water for space heating. Technically this report describes the Boise City district heating system based on 170/sup 0/F water, a 4000 gpm production system, a 41,000 foot pipeline system, and system economies. Comparable data are also provided for the Boise Warm Springs Water District. 62 figs., 31 tabs.

  2. Allegheny County School District Boundaries

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This dataset demarcates the school district boundaries within Allegheny County If viewing this description on the Western Pennsylvania Regional Data Center’s open...

  3. Allegheny County School District Boundaries

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This dataset demarcates the school district boundaries within Allegheny County If viewing this description on the Western Pennsylvania Regional Data Center’s open...

  4. VT Senate Districts 1992 - lines

    Data.gov (United States)

    Vermont Center for Geographic Information — (Link to Metadata) The senatorial district designations for this layer were taken from a trace map of unknown origin. A visual compilation of the traced lines and...

  5. New Mexico Property Tax Districts

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — This layer represents boundaries for New Mexico tax district "OUT" categories and incorporated/municipal "IN" categories as identified on the "Certificate of Tax...

  6. Districts for 104th Congress

    Data.gov (United States)

    U.S. Geological Survey, Department of the Interior — This is a polygon coverage of 104th Congressional District boundaries obtained from the U.S. Bureau of the Census. The 103rd Congress was the first Congress that...

  7. Hospitality Industry

    Directory of Open Access Journals (Sweden)

    Marian Ionel

    2017-03-01

    Full Text Available Development of accommodation, as basic services offered to tourists, led to the creation of a genuine hospitality industry. Currently, the hospitality industry is no longer just the accommodation service itself but also requires an atmosphere that ensures leisure tourists in the hotel. Thus, hospitable unit manager offers its service in addition to accommodation and catering services, leisure services, treatment services, business services required.. The existence of factors such as revenue growth, increasing leisure time, the development of transport services, the emergence of new tourist attractions have caused increasing international flows of tourists, with consequent development of units hospitable, and therefore a strong hospitality industry. In Romania, after 1990, the tourism sector experienced a true expansion, both through the development of the hotel sector, but also by developing rural hospitality units.

  8. Application of Responsibility System Holistic Nursing Model in Tranfusion District Special Out-Patient Department of Children s Hospital%责任制整体护理模式在儿童医院特需留察输液区的应用

    Institute of Scientific and Technical Information of China (English)

    徐丽芳; 莫霖

    2016-01-01

    transfusion district special out-patient department in children’ s hospital effectively improved patient’ s satisfaction, reduced error rate of medical order implementation, helped to recognize changes in patient condition in time, and guaranteed the implementation of continuous, whole course nursing service.

  9. 76 FR 20971 - Turlock Irrigation District and Modesto Irrigation District; Notice of Intent To File License...

    Science.gov (United States)

    2011-04-14

    ... Energy Regulatory Commission Turlock Irrigation District and Modesto Irrigation District; Notice of..., 2011. d. Submitted By: Turlock Irrigation District and Modesto Irrigation District. e. Name of Project... Regulatory Affairs, Turlock Irrigation District, P.O. Box 949, Turlock, California 95381, 209-883-8241...

  10. District Governance and Student Learning in Indonesia

    OpenAIRE

    Pradhan, Menno; de Ree, Joppe

    2014-01-01

    We document the likely importance of district governance and teacher management policies in relation to student learning in Indonesian primary schools. As the responsibility to deliver primary education has been decentralized to district governments, we expect district specific variations in teacher management policies. Consequently, we also expect variations in learning trajectories across districts. We document substantial heterogeneity in learning gains across districts. Furthermore, we sh...

  11. Benefits of task-shifting HIV care to nurses in terms of health-related quality of life in patients initiating antiretroviral therapy in rural district hospitals in Cameroon [Stratall Agence Nationale de Recherche sur le SIDA (ANRS) 12110/Ensemble pour une Solidarité Thérapeutique Hospitalière en Réseau (ESTHER) substudy].

    Science.gov (United States)

    Suzan-Monti, M; Blanche, J; Boyer, S; Kouanfack, C; Delaporte, E; Bonono, R-C; Carrieri, P M; Protopopescu, C; Laurent, C; Spire, B

    2015-05-01

    The World Health Organization (WHO) recommends task-shifting HIV care to nurses in low-resource settings with limited numbers of physicians. However, the effect of such task-shifting on the health-related quality of life (HRQL) of people living with HIV (PLHIV) has seldom been evaluated. We aimed to investigate the effect of task-shifting HIV care to nurses on HRQL outcomes in PLHIV initiating antiretroviral therapy (ART) in rural district hospitals in Cameroon. Outcomes in PLHIV were longitudinally collected in the 2006-2010 Stratall trial. PLHIV were followed up for 24 months by nurses and/or physicians. Six HRQL dimensions were assessed during face-to-face interviews using the WHO Quality of Life (WHOQOL)-HIV BREF scale: physical health; psychological health; independence level; social relationships; environment; and spirituality/religion/personal beliefs. The degree of task-shifting was estimated using a consultant ratio (i.e. the ratio of nurse-led to physician-led visits). The effect of task-shifting and other potential correlates on HRQL dimensions was explored using a Heckman two-stage approach based on linear mixed models to adjust for the potential bias caused by missing data in the outcomes. Of 1424 visits in 440 PLHIV (70.5% female; median age 36 years; median CD4 count 188 cells/μL at enrolment), 423 (29.7%) were task-shifted to nurses. After multiple adjustment, task-shifting was associated with higher HRQL level for four dimensions: physical health [coefficient 0.7; 95% confidence interval (CI) 0.1-1.2; P = 0.01], psychological health (coefficient 0.5; 95% CI 0.0-1.0; P = 0.05), independence level (coefficient 0.6; 95% CI 0.1-1.1; P = 0.01) and environment (coefficient 0.6; 95% CI 0.1-1.0; P = 0.02). Task-shifting HIV care to nurses benefits the HRQL of PLHIV. Together with the previously demonstrated comparable clinical effectiveness of physician-based and nurse-based models of HIV care, our results support the WHO recommendation

  12. A new methodology for hospital design.

    Science.gov (United States)

    Mejia, Ana Maria Silva

    2013-08-01

    According to architect, Ana Maria Silva Mejia, 'a new era for the design of hospitals in Guatemala has arrived', with a considerable growth in interest around good healthcare facility design. Here, in a slightly adapted version of an article, 'A new methodology for design', first published in the IFHE (International Federation of Hospital Engineering) Digest 2012, she reports on the application of a new methodology designed to optimise efficient use of space, and clinical and other adjacencies, in a district hospital in the City of Zacapa. The system has subsequently been successfully applied to a number of other Guatemalan healthcare facilities.

  13. 78 FR 3892 - Turlock Irrigation District and Modesto Irrigation District; Notice Clarifying Party Status

    Science.gov (United States)

    2013-01-17

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF ENERGY Federal Energy Regulatory Commission Turlock Irrigation District and Modesto Irrigation District; Notice Clarifying Party Status On January 9, 2013, the Modesto Irrigation District (Modesto) filed a motion...

  14. A staff support programme for rural hospitals in Nepal

    OpenAIRE

    Zimmerman, Mark; Shah, Sharada; Shakya, Rabina; Sundar Chansi, Bal; Shah, Kashim; Munday, Daniel; Eyal, Nir; Hayes, Bruce

    2015-01-01

    Abstract Problem District hospitals in Nepal struggle to provide essential services such as caesarean sections. Approach Retention of health workers is critical to the delivery of long-term, quality health-care services. To promote retention and enhance performance in rural public hospitals, the Government of Nepal and the Nick Simons Institute progressively implemented a rural staff support programme in remote hospitals. After competitive selection for a compulsory-service scholarship and tr...

  15. Analysis of 7 kinds of sexually transmitted disease detection rate in People′s Hospital of Qijiang District in Chongqing from 2009 to 2012%重庆市綦江区人民医院2009~2012年7种性病检出率分析

    Institute of Scientific and Technical Information of China (English)

    曾广丽; 周世林

    2013-01-01

    Objective To understand detection rate of AIDS ,syphilis ,gonorrhea ,genital herpes ,genital warts lesions ,urea mycoplasma infection and chlamydia trachomatis infection ,and its change in Outpatient Service of Skin and Venereal Disease ,People′s Hospital of Qijiang District in nearly 4 years .Methods 4 764 patients with skin and venereal disease between April 2009 and September 2009 in the hospital were analyzed ,and 11 571 genitourinary tract secretions or blood were detected by pathogen biological cultivation ,antigen test and serum antibody test .Results Detection rates of the metioned venereal diseases were respectively :gonorrhea 14 .1% ,AIDS 0 .8% ,syphilis 31 .1% , genital herpes 23 .1% ,genital warts lesions 13 .4% ,chlamydia trachomatis infection 25 .8% ,ureaplasma mycoplasma infection 9 .9% in recent 4 years .Conclusion The detection rate of Syphilis up to 31 .1% in nearly four years ,the HIV detection rate is the lowest ,acounting for 0 .8% ;The total detection rate of sexually transmitted diseases is fall-ing ,which genital herpes′decline is most obvious and the syphilis detection rate is rising year by year .%  目的了解淋病、艾滋病、梅毒、生殖器疱疹、生殖器疣类病变、沙眼衣原体感染、解脲支原体感染等7种性病近4年在重庆市綦江区人民医院皮肤性病门诊的检出率及检出率的变化。方法统计和分析2009年4月至2012年9月在该院皮肤性病门诊部就诊的4764例皮肤性病患者,11571人次的泌尿生殖道分泌物或血液进行病原生物培养、抗原检测和血清抗体检测。结果近4年来,7种性病的检出率分别为:淋病14.1%,艾滋病0.8%,梅毒31.1%,生殖器疱疹23.1%,生殖器疣类病变13.4%,沙眼衣原体感染25.8%,解脲支原体感染9.9%。结论近4年来梅毒的检出率最高达31.1%,艾滋病的检出率最低为0.8%;性病的总检出率在下降,其中生殖器疱疹的

  16. Hospital Inspections

    Data.gov (United States)

    U.S. Department of Health & Human Services — Welcome to hospitalinspections.org, a website run by the Association of Health Care Journalists (AHCJ) that aims to make federal hospital inspection reports easier...

  17. Hospital Inspections

    Data.gov (United States)

    U.S. Department of Health & Human Services — Welcome to hospitalinspections.org, a website run by the Association of Health Care Journalists (AHCJ) that aims to make federal hospital inspection reports easier...

  18. Industrial District as a Corporation

    Directory of Open Access Journals (Sweden)

    Reza MOHAMMADY GARFAMY

    2011-03-01

    Full Text Available This paper provides a comparison study of industrial districts in two European countries, Spain and Sweden, using the conceptual framework of corporation. The relevance of this approach is based on the specific qualities that the industrial districts have, including the preexisting conditions, local traditions, products and production characteristics, marketing strategies, local policies and present challenges. The findings indicate the ways in which different patterns of inter-firm relationships, organization of production and dynamics of local alliances have shaped divergent regional responses to the industrial construction.

  19. Hospital marketing.

    Science.gov (United States)

    Carter, Tony

    2003-01-01

    This article looks at a prescribed academic framework for various criteria that serve as a checklist for marketing performance that can be applied to hospital marketing organizations. These guidelines are drawn from some of Dr. Noel Capon of Columbia University's book Marketing Management in the 21st Century and applied to actual practices of hospital marketing organizations. In many ways this checklist can act as a "marketing" balanced scorecard to verify performance effectiveness and develop opportunities for innovation.

  20. Future Services for District Heating Solutions in Residential Districts

    Directory of Open Access Journals (Sweden)

    Hannele Ahvenniemi

    2014-06-01

    Full Text Available The underlying assumption of this study is that in order to retain the competitiveness while reaching for the EU targets regarding low-energy construction, district heating companies need to develop new business and service models. How district heating companies could broaden their perspective and switch to a more service-oriented way of thinking is a key interest of our research. The used methods in our study are house builder interviews and a questionnaire. With the help of these methods we discussed the potential interest in heating related services acquiring a comprehensive understanding of the customer needs. The results indicate the importance of certain criteria when choosing the heating system in households: easiness, comfort and affordability seem to dominate the house builders’ preferences. Also environmental awareness seems to be for many an important factor when making a decision about the heating of the house. Altogether, based on the results of this study, we suggest that the prospects of district heating could benefit from highlighting certain aspects and strengths in the future. District heating companies need to increase flexibility, readiness to adopt new services, to invest in new marketing strategies and improving the communication skills.

  1. Government Districts, Other, Voting districts, fire districts, inspector districts, engineering districts, school zones, recreation leagues, Published in 2014, Not Applicable scale, GIS.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Government Districts, Other dataset, published at Not Applicable scale, was produced all or in part from Published Reports/Deeds information as of 2014. It is...

  2. Study on prevalence of ancylostomosis in dogs at Anand district, Gujarat, India

    Directory of Open Access Journals (Sweden)

    Nilima N. Brahmbhatt

    2015-12-01

    Full Text Available Aim: This study was undertaken to derive the prevalence rate of ancylostomosis in dogs by a collection of fecal samples from Anand district. Materials and Methods: The fecal samples were collected from the dogs brought to the Hospital of Veterinary College (Teaching Veterinary Clinical Service Complex and the surrounding areas of Anand district. On the day of collection, fecal samples were collected and brought to the Department of Veterinary Parasitology and processed for standard qualitative examination. The sedimentation technique was used to detect the presence of Ancylostoma spp. eggs in the samples. Result: The highest prevalence rate was observed in the month of May (36.66% fecal samples and the lowest in the month of December (13.79% fecal samples at Anand district. Conclusion: It can be concluded that heavy infection is present in Anand district especially in the season of summer followed by monsoon and the least in winter.

  3. Iowa Congressional Districts for 2013-2022

    Data.gov (United States)

    Iowa State University GIS Support and Research Facility — Congressional district boundaries, enacted April 19, 2011, effective beginning with the elections in 2012 for the 113th U.S. Congress. The districts will remain in...

  4. Location - Managed Facility - St. Paul District (MVP)

    Data.gov (United States)

    Army Corps of Engineers, Department of the Army, Department of Defense — St. Paul District - US Army Corps of Engineers Managed Facility locations. District headquarters, Natural Resource, Recreation, Lock and Dam, and Regulatory offices...

  5. Crosby Wetland Management District Narrative report: 1972

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This annual narrative report for Crosby Wetland Management District outlines District accomplishments during the 1972 calendar year. The report begins by summarizing...

  6. Upper Mississippi River National Wildlife and Fish Refuge : Winona District, La Crosse District, McGregor District, Savanna District : Annual Narrative Report : Calendar Year 1992

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This annual narrative report for Upper Mississippi River National Wildlife and Fish Refuge summarizes activities for Winona District, La Crosse District, McGregor...

  7. Upper Mississippi River National Wildlife and Fish Refuge : Winona District, La Crosse District, McGregor District, Savanna District : Annual Narrative Report : Calendar Year 1996

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This annual narrative report for Upper Mississippi River National Wildlife and Fish Refuge summarizes activities for Winona District, La Crosse District, McGregor...

  8. Upper Mississippi River National Wildlife and Fish Refuge : Winona District, La Crosse District, McGregor District, Savanna District : Annual Narrative Report : Calendar Year 1993

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This annual narrative report for Upper Mississippi River National Wildlife and Fish Refuge summarizes activities for Winona District, La Crosse District, McGregor...

  9. Upper Mississippi River National Wildlife and Fish Refuge : Winona District, La Crosse District, McGregor District, Savanna District : Annual Narrative Report : Calendar Year 1995

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This annual narrative report for Upper Mississippi River National Wildlife and Fish Refuge summarizes activities for Winona District, La Crosse District, McGregor...

  10. Small School Districts: Providing Personalized Education.

    Science.gov (United States)

    Hottmann, Monte

    1987-01-01

    The author discusses secondary vocational education and the small school districts of the future, which he believes can provide adequate vocational education opportunities by cooperating with other districts through their Cooperative Educational Service Agency. (Author/CH)

  11. Upper Mississippi River National Wildlife and Fish Refuge : Winona District, La Crosse District, McGregor District, Savanna District : Annual Narrative Report : Calendar Year 1994

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This annual narrative report for Upper Mississippi River National Wildlife and Fish Refuge summarizes activities for Winona District, La Crosse District, McGregor...

  12. District, north-east Tanzania

    African Journals Online (AJOL)

    The overall geometric mean parasite density (GMPD) was 77.4 parasites/ptl of blood and median parasite density was 200 ... world malaria incidence is estimated at 300 to 500 ... In holoendemic areas, including the coastal regions ... The district has a population of approximately .... off points for areas with different altitudes.

  13. 75 FR 43958 - Turlock Irrigation District and Modesto Irrigation District; Notice of Application for Amendment...

    Science.gov (United States)

    2010-07-27

    ... Energy Regulatory Commission Turlock Irrigation District and Modesto Irrigation District; Notice of...: May 24, 2010. d. Applicant: Turlock Irrigation District and Modesto Irrigation District. e. Name of.... g. Filed Pursuant to: Federal Power Act, 16 USC 791a-825r. h. Applicant Contact: Turlock...

  14. 75 FR 35778 - Modesto Irrigation District and Turlock Irrigation District; Notice of Preliminary Permit...

    Science.gov (United States)

    2010-06-23

    ... Energy Regulatory Commission Modesto Irrigation District and Turlock Irrigation District; Notice of... Competing Applications June 16, 2010. On February 1, 2010, Modesto Irrigation District and Turlock Irrigation District filed an application for a preliminary permit, pursuant to section 4(f) of the...

  15. 77 FR 16828 - Turlock Irrigation District, & Modesto Irrigation District; Notice of Dispute Resolution Process...

    Science.gov (United States)

    2012-03-22

    ... Energy Regulatory Commission Turlock Irrigation District, & Modesto Irrigation District; Notice of... and the Modesto Irrigation District (collectively, the Districts), are co-licensees for the Don Pedro... Steelhead Full Life-Cycle Population Models; and Request 9--Effects of the Project and Related Facilities on...

  16. The Philadelphia School District's Ongoing Financial Crisis

    Science.gov (United States)

    Caskey, John; Kuperberg, Mark

    2014-01-01

    This article describes the budget crisis that the School District of Philadelphia has faced for the past few years. Three specific events triggered the 2012 crisis: an abrupt reduction in federal and state funding, the inability of the district to cut many of its costs, and political pressures on the district to spend available revenues in a given…

  17. School District Cash Management. Program Audit.

    Science.gov (United States)

    New York State Legislative Commission on Expenditure Review, Albany.

    New York State law permits school districts to invest cash not immediately needed for district operation and also specifies the kinds of investments that may be made in order to ensure the safety and liquidity of public funds. This audit examines cash management and investment practices in New York state's financially independent school districts.…

  18. School District Cash Management. Program Audit.

    Science.gov (United States)

    New York State Legislative Commission on Expenditure Review, Albany.

    New York State law permits school districts to invest cash not immediately needed for district operation and also specifies the kinds of investments that may be made in order to ensure the safety and liquidity of public funds. This audit examines cash management and investment practices in New York state's financially independent school districts.…

  19. 7 CFR 946.31 - Districts.

    Science.gov (United States)

    2010-01-01

    ... Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements... included in either the Quincy or South Irrigation Districts which lies east of township vertical line R27E... Irrigation Districts which lies west of township line R28E. (c) District No. 3—The counties of Benton...

  20. Groundwater and geothermal: urban district heating applications

    Energy Technology Data Exchange (ETDEWEB)

    Mounts, R.; Frazier, A.; Wood, E.; Pyles, O.

    1982-01-01

    This report describes how several cities use groundwater and geothermal energy in district heating systems. It begins with groundwater, introducing the basic technology and techniques of development, and describing two case studies of cities with groundwater-based district heating systems. The second half of the report consists of three case studies of cities with district heating systems using higher temperature geothermal resources.

  1. Interoperable tools for designing energy-efficient buildings in healthcare districts

    NARCIS (Netherlands)

    Benner, J.; Häfele, K.H.; Bonsma, P.; Bourdeau, M.; Soubra, S.; Sleiman, H.; Robert, S.

    2015-01-01

    The EU funded collaborative research project STREAMER aims on Energy-efficient Buildings (EeB), focusing on mixed-use healthcare districts. Besides innovations in EeB technology, special emphasis is laid on improving methodologies and tools used in the design process of new or retrofitted hospital b

  2. Health care seeking behaviour and utilisation of health services in Kalabo District, Zambia

    NARCIS (Netherlands)

    Stekelenburg, J.

    2004-01-01

    Van 1997 tot 2001 werkte de auteur in het Zambiaanse gezondheidszorgsysteem en wel in het Kalabo District Hospital. In die tijd rezen bij hem vele vragen. Een aantal daarvan wordt in dit proefschrift behandeld en beantwoord. Het centrale thema is de tegenstelling tussen enerzijds de grote ziektelast

  3. 78 FR 58049 - Proposed Establishment of the Adelaida District, Creston District, El Pomar District, Paso Robles...

    Science.gov (United States)

    2013-09-20

    ... year defines climatic regions. Climatic region I has less than 2,500 GDDs per year; region II, 2,501 to... District.... Valley floor transitioning to mountain slopes; elevations between 1,160 to 2,086 feet... of 11.4 inches; Winkler III climate. Santa Margarita Ranch Valley floor and hillsides;...

  4. Inappropriate Hospital Utilization for Long-stay Patients in Southern Taiwan

    Directory of Open Access Journals (Sweden)

    Herng-Chia Chiu

    2003-05-01

    Full Text Available This study examined the inappropriate utilization of hospital services under the National Health Insurance (NHI program. The study population consisted of long-stay inpatients who stayed longer than 30 days in acute care hospitals located in southern Taiwan. The study hospitals included four medical centers, six regional hospitals, and 21 district general hospitals. The survey of patients was conducted in January and May of 1996 using the Acute Care Hospital Long-stay Questionnaire developed by the research team. Excluding subjects with missing values and abnormal length of stay, 536 long-stay patients were included in the analysis. Among these, 196 patients (36.6% were classified as having an inappropriate stay, while 340 patients (63.4% had an appropriate stay. Of the long-stay patients in medical centers, 32.2% were inappropriate stays; this figure was 45.4% for regional hospitals and 43.3% for district general hospitals. There were significantly higher proportions of inappropriate long-stay patients in regional and district general hospitals than in medical centers. In conclusion, this study confirms the existence of inappropriate hospital bed days, which may be due to patient characteristics, hospital factors, and NHI payment schemes. If the NHI program can provide incentives to long-stay patients who no longer need acute care to move, patients' utilization behaviors might change and hospital discharge plans could be modified for more efficient utilization of hospital beds.

  5. The Relationship between Student Achievement, School District Economies of Scale, School District Size, and Student Socioeconomic Status

    Science.gov (United States)

    Trani, Randy

    2009-01-01

    The relationships between student achievement, school district economies of scale, school district size and student socioeconomic status were measured for 131 school districts in the state of Oregon. Data for school districts ranging in size from districts with around 300 students to districts with more than 40,000 students were collected for…

  6. Academic Hospitality

    Science.gov (United States)

    Phipps, Alison; Barnett, Ronald

    2007-01-01

    Academic hospitality is a feature of academic life. It takes many forms. It takes material form in the hosting of academics giving papers. It takes epistemological form in the welcome of new ideas. It takes linguistic form in the translation of academic work into other languages, and it takes touristic form through the welcome and generosity with…

  7. Hospitality Management.

    Science.gov (United States)

    College of the Canyons, Valencia, CA.

    A project was conducted at College of the Canyons (Valencia, California) to initiate a new 2-year hospitality program with career options in hotel or restaurant management. A mail and telephone survey of area employers in the restaurant and hotel field demonstrated a need for, interest in, and willingness to provide internships for such a program.…

  8. Scheduling Coast Guard District Cutters

    Science.gov (United States)

    1992-09-01

    DESCRIPTION ..... ............ .. 14 D. COSTS, PENALTIES, AND MEASURES OF EFFECTIVENESS 15 iv IV . COMPUTATIONAL EXPERIENCE ............ 19 A. TEST PROBLEMS...used. Using the model of Chapter III, computational performance for a year’s worth of actual data from the First District is presented in Chapter IV ...2G, B-2NY, B-2SAR, C); t - week the cutter assumes the patrol status. COSTO - cost of scheduling cutter i to patrol k; (1 if ship i is available for

  9. Hospital de Morges – Suiza

    Directory of Open Access Journals (Sweden)

    Bosshabdt, E.

    1975-05-01

    Full Text Available This hospital basically serves the districts of Aubonne and Morges and partly those of Cossonay and Rolle. It comprises a block of six storeys, with the actual hospital, and another one of five storeys with a college for nurses and male nurses; both of them equipped with the latest inventions with regard to technique and comfort. Both centres mutually use the service installations and the rooms that the other building disposes of, for a more rational utilization of the investment made. The complex has a magnificent location in a natural environment. The construction is traditional, the structure being of reinforced concrete and the finishing of high quality.Este hospital atiende fundamentalmente a los distritos Aubonne y Morges y, parcialmente, a los de Cossonay y Rolle. Consta de un bloque de seis plantas, como hospital propiamente dicho, y otro de cinco plantas, para escuela de enfermeras y enfermeros asistentes; ambos dotados con los últimos adelantos de la técnica y el confort. Uno y otro centro utilizan, recíprocamente, los servicios y locales de que disponen, para un más racional aprovechamiento de la inversión realizada. El conjunto está magníficamente ambientado en el entorno natural que lo rodea. La construcción es tradicional, con estructura de hormigón armado y acabados de gran calidad.

  10. Criteria-based audit to improve a district referral system in Malawi: A pilot study

    Directory of Open Access Journals (Sweden)

    Mlava Grace

    2008-09-01

    Full Text Available Abstract Background To study the feasibility of using criteria-based audit to improve a district referral system. Methods A criteria-based audit was used to assess the Salima District referral system in Malawi. A retrospective review of 60 obstetric emergencies referred from 12 health centres was conducted and compared with prior established standards for optimal referral of emergencies. Recommendations were made and implemented. Three months later, a re-audit was conducted (62 cases. Results There were significant improvements in 4 out of 7 standards: adequate resuscitation before referral (33.3% vs 88.7%; p = 0.001; delay of less than 2 hours from the time the ambulance is called to when the ambulance brought the patient to the hospital (42.8% vs 88.3%; p = 0.014; clinician attends to patient within 30 minutes of arrival to hospital (30.8% vs 92.6%; p = 0.001 and feedback given to the referring health centres (1.7% vs 91.9%; p 95% in both the initial audit and the re-audit: referred patients accompanied by a referral form; ambulances are available at all times and the district hospital is informed through short-wave radio by the health centre when a patient is referred. Conclusion Criteria-based audit can improve the ability of a district referral system to handle obstetric emergencies in countries with limited resources.

  11. 上海市一区级医院老年患者尿路致病性大肠埃希菌分子分型和耐药性分析%Molecular characterization and antimicrobial resistance properties of uropathogenic Escherichia coli isolated from elderly patients in a district tertiary hospital in shanghai

    Institute of Scientific and Technical Information of China (English)

    李维正; 孙琳; 陈蓓; 严萍; 洪金玲; 张洁; 戴俊华; 陈嘉臻; 张文宏

    2016-01-01

    Objective To investigate the molecular epidemiology and antimicrobial resistance status of uropathogenic Escherichia coli (UPEC) in senior population in Putuo District ,Shanghai .Methods A total of 72 UPEC strains were isolated from elderly inpatients with urinary tract infections in Putuo Hospital ,Shanghai University of Traditional Chinese Medicine from January 2013 to March 2015 .The strains were characterized by multi‐locus sequence typing (MLST ) .The β‐lactamase gene and the plasmid mediated quinolone resistance (PMQR) gene were detected ,and the mutations of quinolone resistance‐determining regions (QRDR) in gyrA and parC genes were demonstrated .In vitro drug susceptibility test was performed .Continuous variables were compared using t test and categorical variables were compared using chi‐squared test or Fisher exact test .Results The UPEC strains showed different resistance rates to ciprofloxacin ,cefotaxime and trimethoprim‐sulfamethoxazole ,which were 76 .4% ,73 .6% and 65 .3% , respectively .UPEC still remained highly sensitive to imipenem ,meropenem ,amikacin and piperacillin‐tazobactam .Among 72 isolates ,55 (76 .4% ) of 49 (68 .1% ) extended‐spectrum β‐lactamase (ESBL )‐positive strains harbored blaCTX‐M genes .Among the 55 ciprofloxacin resistant strains ,51 (92 .7% ) had three or four mutations in QRDR of gyrA and parC genes .The “hot‐spot” mutations of QRDR were located at amino acid position 83 and 87 in gyrA gene and at positions 80 and 84 in parC gene .Forward analysis by MLST showed that the most frequent sequence types (ST ) were ST131 (18/72 ,25 .0% ) , ST1193(7/72 ,9 .7% ) ,ST405 (7/72 ,9 .7% ) ,ST38 (5/72 ,6 .9% ) and ST648 (3/72 ,4 .2% ) .ST131 isolates were predominant in ST which caused community‐onset urinary tract infections .Multiple drug‐resistance were detected in ST 131 ,ST405 ,ST38 and ST648 which were mainly producing blaCTX‐M ESBL .Conclusions Community‐acquired multiple drug

  12. District nurse clinics: accountability and practice.

    Science.gov (United States)

    Griffith, Richard; Tengnah, Cassam

    2013-02-01

    The numbers of district nurse clinics are continuing to grow in primary care and they provide timely and more cost effective intervention for patients. The clinics provide exciting opportunities for district nurses but also carry an increased risk of exposure to liability. This article discusses some of the key areas of accountability underpinning the duty of care of district nurses working in nurse-led clinics.

  13. Enhancing assertiveness in district nurse specialist practice

    OpenAIRE

    Green, J.

    2016-01-01

    District nurse (DN) care delivery has undergone substantial change in recent years due to changing demographics and service delivery demands that have called for a move of care delivery from secondary to primary care. The title District Nurse is recorded with the Nursing and Midwifery Council (NMC) on completion of the Specialist Practice Qualification in District Nursing (SPQ DN), which purports to be a 'transformational' course that prepares future caseload holders to manage their team and ...

  14. Election Districts and Precincts, VotingDistricts, Published in 2008, Millard County.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Election Districts and Precincts dataset, was produced all or in part from Other information as of 2008. It is described as 'VotingDistricts'. Data by this...

  15. Government Districts, Other, ConservancyDistricts, Published in 2000, Millard County.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Government Districts, Other dataset, was produced all or in part from Other information as of 2000. It is described as 'ConservancyDistricts'. Data by this...

  16. School Districts, Walworth County School Districts, Published in 2010, Not Applicable scale, Walworth County.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This School Districts dataset, published at Not Applicable scale as of 2010. It is described as 'Walworth County School Districts'. Data by this publisher are often...

  17. Election Districts and Precincts, City Council districts, Published in 2005, Freelance.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Election Districts and Precincts dataset, was produced all or in part from Hardcopy Maps information as of 2005. It is described as 'City Council districts'....

  18. Election Districts and Precincts, School Board districts, Published in 2006, Freelance.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Election Districts and Precincts dataset, was produced all or in part from Hardcopy Maps information as of 2006. It is described as 'School Board districts'....

  19. Election Districts and Precincts, County Council districts, Published in 2005, Freelance.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Election Districts and Precincts dataset, was produced all or in part from Hardcopy Maps information as of 2005. It is described as 'County Council districts'....

  20. School Districts, washoe county school district, Published in 2006, Washoe County.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This School Districts dataset, was produced all or in part from Published Reports/Deeds information as of 2006. It is described as 'washoe county school district'....

  1. 4th Generation District Heating (4GDH)

    DEFF Research Database (Denmark)

    Lund, Henrik; Werner, Sven; Wiltshire, Robin

    2014-01-01

    This paper defines the concept of 4th Generation District Heating (4GDH) including the relations to District Cooling and the concepts of smart energy and smart thermal grids. The motive is to identify the future challenges of reaching a future renewable non-fossil heat supply as part...... of the implementation of overall sustainable energy systems. The basic assumption is that district heating and cooling has an important role to play in future sustainable energy systems – including 100 percent renewable energy systems – but the present generation of district heating and cooling technologies will have...

  2. Cyclone hazard proneness of districts of India

    Indian Academy of Sciences (India)

    M Mohapatra

    2015-04-01

    Hazards associated with tropical cyclones (TCs) are long-duration rotatory high velocity winds, very heavy rain, and storm tide. India has a coastline of about 7516 km of which 5400 km is along the mainland. The entire coast is affected by cyclones with varying frequency and intensity. Thus classification of TC hazard proneness of the coastal districts is very essential for planning and preparedness aspects of management of TCs. So, an attempt has been made to classify TC hazard proneness of districts by adopting a hazard criteria based on frequency and intensity of cyclone, wind strength, probable maximum precipitation, and probable maximum storm surge. Ninety-six districts including 72 districts touching the coast and 24 districts not touching the coast, but lying within 100 km from the coast have been classified based on their proneness. Out of 96 districts, 12 are very highly prone, 41 are highly prone, 30 are moderately prone, and the remaining 13 districts are less prone. This classification of coastal districts based on hazard may be considered for all the required purposes including coastal zone management and planning. However, the vulnerability of the place has not been taken into consideration. Therefore, composite cyclone risk of a district, which is the product of hazard and vulnerability, needs to be assessed separately through a detailed study.

  3. District Fiscal Policy and Student Achievement

    Directory of Open Access Journals (Sweden)

    Gary G. Huang

    2002-09-01

    Full Text Available School restructuring raises questions about the role of school districts in improving student learning. Centralization by state governments and decentralization to individual schools as proposed in systemic reform leave districts' role unsettled. Empirical research on the district role in the context of ongoing reform is inadequate. This analysis of combined data from the NAEP and the Common Core of Data (CCD was intended to address the issue. We analyzed 1990, 1992, and 1996 NAEP 8th grade mathematics national assessment data in combination with CCD data of corresponding years to examine the extent to which student achievement was related to districts' control over instructional expenditure, adjusting for relevant key factors at both district and student levels. Upon sample modification, we used hierarchical linear modeling (HLM to estimate the relationships of student achievement to two district fiscal policy indictors, current expenditure per pupil (CEPP and districts' discretionary rates for instructional expenditure (DDR. Net of relevant district factors, DDR was found unrelated to districts' average 8th grade math performance. The null effect was consistent in the analysis of the combined NAEP-CCD data for 1990, 1992, and 1996. In contrast, CEPP was found related to higher math performance in a modest yet fairly consistent way. Future research may be productive to separately study individual states and integrate the findings onto the national level.

  4. Rehabilitation of district heating networks

    Energy Technology Data Exchange (ETDEWEB)

    Ottosson, Peter [AaF-Energikonsult Syd AB (Sweden)

    1996-11-01

    Often the choice is between reparation or exchange of a damaged section of the network. If the exchange is based on the wrong assumptions, large sections of undamaged pipelines could be removed. Most important for the district heating company is to decide which strategy to use for the future exchange of the pipelines. Whichever strategy used, it has to based on an assessment of the network and/or assumptions based on that assessment. The question if it is possible extend the life span of the pipelines arises. What is the most economical choice, the exchange or the renovation. (au)

  5. 78 FR 37538 - Idaho Irrigation District; New Sweden Irrigation District; Notice of Preliminary Permit...

    Science.gov (United States)

    2013-06-21

    ... Energy Regulatory Commission Idaho Irrigation District; New Sweden Irrigation District; Notice of... Competing Applications On April 19, 2013, the Idaho and New Sweden Irrigation Districts, filed a joint... Street, Idaho Falls, Idaho 83404; phone: (208) 522-2356. Mr. Louis Thiel, Chairman, New Sweden...

  6. Maternal mortality in Bijapur district

    Directory of Open Access Journals (Sweden)

    Vidya A. Thobbi

    2015-04-01

    Full Text Available Objectives: The objectives of this study is to evaluate the incidence of maternal deaths, causes responsible for maternal mortality, direct and indirect factors, and various preventable methods to reduce maternal mortality rate. Background: 95% of maternal deaths occur in Asia and Africa. The need for undertaking this study is to know the maternal mortality rate, analyze the causes and preventable factors of death occurring in the district of Bijapur, Karnataka, India. Methodology: It is a study of 2years from the Records of District Health Office and Institutions on maternal mortality from June 2011 to May 2013 in Bijapur. Results: In two years there were fifty eight maternal deaths and seventy nine thousand five hundred and sixty six live births, hence maternal mortality ratio was seventy three per lakh live births. Eighty two percent of maternal deaths occurred in families who belonged to Below Poverty Line. Prevalence of anemia in pregnancy was 79.3%. Severe anemia (Hemoglobin <7g% seen in 5.1% was the most common indirect cause of death. Forty three percent of the deaths occurred at private setups. Hemorrhage, Septicemia and Preeclampsia & Eclampsia were responsible for 44.82%, 15.51% and 6.89% respectively. Conclusion: Majority of the maternal deaths are preventable if these four delays are avoided: a Delay in identifying the problem. b Delay in seeking care. c Delay in reaching the referral institute. d Delay in getting treatment on reaching the referral institute.

  7. GIS Database and Google Map of the Population at Risk of Cholangiocarcinoma in Mueang Yang District, Nakhon Ratchasima Province of Thailand.

    Science.gov (United States)

    Kaewpitoon, Soraya J; Rujirakul, Ratana; Joosiri, Apinya; Jantakate, Sirinun; Sangkudloa, Amnat; Kaewthani, Sarochinee; Chimplee, Kanokporn; Khemplila, Kritsakorn; Kaewpitoon, Natthawut

    2016-01-01

    Cholangiocarcinoma (CCA) is a serious problem in Thailand, particularly in the northeastern and northern regions. Database of population at risk are need required for monitoring, surveillance, home health care, and home visit. Therefore, this study aimed to develop a geographic information system (GIS) database and Google map of the population at risk of CCA in Mueang Yang district, Nakhon Ratchasima province, northeastern Thailand during June to October 2015. Populations at risk were screened using the Korat CCA verbal screening test (KCVST). Software included Microsoft Excel, ArcGIS, and Google Maps. The secondary data included the point of villages, sub-district boundaries, district boundaries, point of hospital in Mueang Yang district, used for created the spatial databese. The populations at risk for CCA and opisthorchiasis were used to create an arttribute database. Data were tranfered to WGS84 UTM ZONE 48. After the conversion, all of the data were imported into Google Earth using online web pages www.earthpoint.us. Some 222 from a 4,800 population at risk for CCA constituted a high risk group. Geo-visual display available at following www.google.com/maps/d/u/0/ edit?mid=zPxtcHv_iDLo.kvPpxl5mAs90 and hl=th. Geo-visual display 5 layers including: layer 1, village location and number of the population at risk for CCA; layer 2, sub-district health promotion hospital in Mueang Yang district and number of opisthorchiasis; layer 3, sub-district district and the number of population at risk for CCA; layer 4, district hospital and the number of population at risk for CCA and number of opisthorchiasis; and layer 5, district and the number of population at risk for CCA and number of opisthorchiasis. This GIS database and Google map production process is suitable for further monitoring, surveillance, and home health care for CCA sufferers.

  8. Geothermal district heating and cooling of hotel/casinos in downtown Reno, Nevada

    Energy Technology Data Exchange (ETDEWEB)

    Cerci, Y.; Kanoglu, M.; Cengel, Y.A.; Turner, R.H. [Univ. of Nevada, Reno, NV (United States)

    1996-12-31

    In this paper, potential revenues from the proposed geothermal district heating/cooling system for the hotel/casino complexes in downtown Reno, Nevada are estimated by analyzing their actual electricity and natural gas bills during 1993 through 1994. The geothermal system appears to be feasible, and financially very attractive. The geothermal district system can meet the entire heating and cooling requirements of the hotel/casinos, generating total potential revenues of $3,486,000 per year. Also, other buildings around the downtown area such as Saint Mary`s Hospital, several motels, business complexes, Washoe County School District Building, and even the UNR campus will add extra potential revenues, if these buildings are connected to the geothermal grid. Since most buildings around the downtown use central heating and cooling system, the retrofit costs for the both system should be minimal.

  9. Poverty, philanthropy, and professionalism. The establishment of a district nursing service in Wellington, New Zealand, 1903.

    Science.gov (United States)

    Wood, Pamela; Arcus, Kerri

    2011-01-01

    The establishment in 1903 of a professional district nursing service in Wellington, New Zealand's capital city, was a philanthropic response to the need for skilled care for the sickpoor in their own homes, as hospital and charitable aid boards believed chronic patients drained their resources. This paper argues that it was the timely combination of the individual philanthropy of Sarah Ann Rhodes, the organisational philanthropy of the St John Ambulance Association and the new professional standing and availability of registered nurses such as Annie Holgate that ensured its successful foundation. It also argues that district nursing services blurred spatial, social, and public-private boundaries in new ways. Finally, it considers the district nurse's role as the philanthropist 's proxy, the means for realising the philanthropist's desire to help the sick poor.

  10. EPA Recognizes Charleston County School District for Reducing Food Waste

    Science.gov (United States)

    ATLANTA - Today, U.S. Environmental Protection Agency (EPA) recognized the Charleston County School District for the District's achievements in reducing food waste. The District cultivated one of the state's first student-driven commercial compostin

  11. Hastings Wetland Management District Annual narrative report: Calendar year 1977

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This narrative report for Hastings Wetland Management District outlines District accomplishments for the 1977 calendar year. The report begins by giving District...

  12. Hastings Wetland Management District Annual narrative report: Calendar year 1978

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This narrative report for Hastings Wetland Management District outlines District accomplishments for the 1978 calendar year. The report begins by giving District...

  13. Superintendent Leadership: Focusing on District Culture

    Science.gov (United States)

    Donnelly, Tanya A.; Adams, Jeffery S.; Smith, Dwayne E.

    2012-01-01

    This report describes a problem-based learning project focusing on superintendent leadership and stakeholder influence of school district culture. Current research findings suggest the importance of superintendent leadership in assessing, influencing, and enhancing school district culture. Multiple scholars wrote literature in the area of…

  14. Special Education Paraprofessionals in District Context

    Science.gov (United States)

    Howley, Craig; Howley, Aimee; Telfer, Deborah

    2017-01-01

    This survey research investigated the experience of Ohio districts using paraprofessionals assigned to special education students. This study provides a unique statewide description of district experience. Based on themes from the literature and preliminary conversations with educational practitioners in Ohio, the survey conceptualized district…

  15. 7 CFR 953.11 - District.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 8 2010-01-01 2010-01-01 false District. 953.11 Section 953.11 Agriculture Regulations of the Department of Agriculture (Continued) AGRICULTURAL MARKETING SERVICE (Marketing Agreements.... District No. 3. James City and Nansemond Counties and the cities of Chesapeake and Virginia Beach in...

  16. Superintendent Leadership: Focusing on District Culture

    Science.gov (United States)

    Donnelly, Tanya A.; Adams, Jeffery S.; Smith, Dwayne E.

    2012-01-01

    This report describes a problem-based learning project focusing on superintendent leadership and stakeholder influence of school district culture. Current research findings suggest the importance of superintendent leadership in assessing, influencing, and enhancing school district culture. Multiple scholars wrote literature in the area of…

  17. School District Reorganization: A Qualified Success.

    Science.gov (United States)

    Canter, Gary

    The circumstances preceding and following the 1984 merger of two small school districts in North Central New York State contained cooperation, controversy, and disharmony. The school districts had enough similarities--in their rural, agricultural base, in the pride and loyalty with which many residents viewed their schools, in the central role…

  18. The Soil Conservation District Movement in Tennessee.

    Science.gov (United States)

    Mathews, Thomas Cochran; And Others

    The development of soil conservation districts in Tennessee is the subject of this graduate study. Related literature, existing records, and personal interviews are used to record progress since Tennessee adopted Public Law 46 establishing soil conservation districts in 1939. In 1959 all 95 counties of Tennessee had organized soil conservation…

  19. District Leaders' Framing of Educator Evaluation Policy

    Science.gov (United States)

    Woulfin, Sarah L.; Donaldson, Morgaen L.; Gonzales, Richard

    2016-01-01

    Purpose: Educator evaluation systems have recently undergone scrutiny and reform, and district and school leaders play a key role in interpreting and enacting these systems. This article uses framing theory to understand district leaders' interpretation and advancement of a state's new educator evaluation policy. Research Methods: The article…

  20. Zhengdong New District: A Water City

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    ON April 12, 2002, at the Yuda World Trade Building, Zhengzhou City, Henan Province, a signing ceremony for the first group of developers to enter Zhengdong New District was in progress. Government officials announced, "In the years to come, Zhengdong New District will be a government focus.

  1. Ownership and technical efficiency of hospitals: evidence from Ghana using data envelopment analysis

    Science.gov (United States)

    2014-01-01

    Background In order to measure and analyse the technical efficiency of district hospitals in Ghana, the specific objectives of this study were to (a) estimate the relative technical and scale efficiency of government, mission, private and quasi-government district hospitals in Ghana in 2005; (b) estimate the magnitudes of output increases and/or input reductions that would have been required to make relatively inefficient hospitals more efficient; and (c) use Tobit regression analysis to estimate the impact of ownership on hospital efficiency. Methods In the first stage, we used data envelopment analysis (DEA) to estimate the efficiency of 128 hospitals comprising of 73 government hospitals, 42 mission hospitals, 7 quasi-government hospitals and 6 private hospitals. In the second stage, the estimated DEA efficiency scores are regressed against hospital ownership variable using a Tobit model. This was a retrospective study. Results In our DEA analysis, using the variable returns to scale model, out of 128 district hospitals, 31 (24.0%) were 100% efficient, 25 (19.5%) were very close to being efficient with efficiency scores ranging from 70% to 99.9% and 71 (56.2%) had efficiency scores below 50%. The lowest-performing hospitals had efficiency scores ranging from 21% to 30%. Quasi-government hospitals had the highest mean efficiency score (83.9%) followed by public hospitals (70.4%), mission hospitals (68.6%) and private hospitals (55.8%). However, public hospitals also got the lowest mean technical efficiency scores (27.4%), implying they have some of the most inefficient hospitals. Regarding regional performance, Northern region hospitals had the highest mean efficiency score (83.0%) and Volta Region hospitals had the lowest mean score (43.0%). From our Tobit regression, we found out that while quasi-government ownership is positively associated with hospital technical efficiency, private ownership negatively affects hospital efficiency. Conclusions It would be

  2. Ownership and technical efficiency of hospitals: evidence from Ghana using data envelopment analysis.

    Science.gov (United States)

    Jehu-Appiah, Caroline; Sekidde, Serufusa; Adjuik, Martin; Akazili, James; Almeida, Selassi D; Nyonator, Frank; Baltussen, Rob; Asbu, Eyob Zere; Kirigia, Joses Muthuri

    2014-04-08

    In order to measure and analyse the technical efficiency of district hospitals in Ghana, the specific objectives of this study were to (a) estimate the relative technical and scale efficiency of government, mission, private and quasi-government district hospitals in Ghana in 2005; (b) estimate the magnitudes of output increases and/or input reductions that would have been required to make relatively inefficient hospitals more efficient; and (c) use Tobit regression analysis to estimate the impact of ownership on hospital efficiency. In the first stage, we used data envelopment analysis (DEA) to estimate the efficiency of 128 hospitals comprising of 73 government hospitals, 42 mission hospitals, 7 quasi-government hospitals and 6 private hospitals. In the second stage, the estimated DEA efficiency scores are regressed against hospital ownership variable using a Tobit model. This was a retrospective study. In our DEA analysis, using the variable returns to scale model, out of 128 district hospitals, 31 (24.0%) were 100% efficient, 25 (19.5%) were very close to being efficient with efficiency scores ranging from 70% to 99.9% and 71 (56.2%) had efficiency scores below 50%. The lowest-performing hospitals had efficiency scores ranging from 21% to 30%.Quasi-government hospitals had the highest mean efficiency score (83.9%) followed by public hospitals (70.4%), mission hospitals (68.6%) and private hospitals (55.8%). However, public hospitals also got the lowest mean technical efficiency scores (27.4%), implying they have some of the most inefficient hospitals.Regarding regional performance, Northern region hospitals had the highest mean efficiency score (83.0%) and Volta Region hospitals had the lowest mean score (43.0%).From our Tobit regression, we found out that while quasi-government ownership is positively associated with hospital technical efficiency, private ownership negatively affects hospital efficiency. It would be prudent for policy-makers to examine the

  3. Persisting high hospital and community childhood mortality in an urban setting in Guinea-Bissau

    DEFF Research Database (Denmark)

    Veirum, Jens Erik; Biai, Sidu; Jakobsen, Marianne

    2007-01-01

    %. It was found that wet season, lack of maternal schooling and living in a specific district were significant risk factors for both community and in-hospital death, whereas higher hospitalization rates were associated with better-off families. CONCLUSION: In populations with high hospitalization rates, even...... minor improvements in acute case management of sick children attending the hospital would be expected to result in substantial reduction in overall childhood mortality. Persistently high acute in-hospital mortality reflects the need of immediate and appropriate care at the hospital. Treatment should...... been hospitalized, and 24% of all deaths in the community occurred in-hospital. Community infant and under-three mortality rates were 110 and 207 per 1,000 person-years, respectively. In-hospital mortality remained persistently high from 1991 to 1996 and the overall in-hospital mortality was 12...

  4. Energy Assessment of Automated Mobility Districts

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Yuche [National Renewable Energy Laboratory (NREL), Golden, CO (United States)

    2017-08-03

    Automated vehicles (AVs) are increasingly being discussed as the basis for on-demand mobility services, introducing a new paradigm in which a fleet of AVs displace private automobiles for day-to-day travel in dense activity districts. This project examines such a concept to displace privately owned automobiles within a region containing dense activity generators (jobs, retail, entertainment, etc.), referred to as an automated mobility district (AMDs). The project reviews several such districts including airport, college campuses, business parks, downtown urban cores, and military bases, with examples of previous attempts to meet the mobility needs apart from private automobiles, some with automated technology and others with more traditional transit based solutions. The issues and benefits of AMDs are framed within the perspective of intra-district, inter-district, and border issues, and the requirements for a modeling framework are identified to adequately reflect the breadth of mobility, energy, and emissions impact anticipated with AMDs.

  5. A cost effectiveness analysis within a randomised controlled trial of post-acute care of older people in a community hospital

    Science.gov (United States)

    O'Reilly, Jacqueline; Lowson, Karin; Young, John; Forster, Anne; Green, John; Small, Neil

    2006-01-01

    Objective To assess the cost effectiveness of post-acute care for older people in a locality based community hospital compared with a department for care of elderly people in a district general hospital, which admits patients aged over 76 years with acute medical conditions. Design Cost effectiveness analysis within a randomised controlled trial. Setting Community hospital and district general hospital in Yorkshire, England. Participants 220 patients needing rehabilitation after an acute illness for which they required admission to hospital. Interventions Multidisciplinary care in the district general hospital or prompt transfer to the community hospital. Main outcome measures EuroQol EQ-5D scores transformed into quality adjusted life years (QALYs), and health and social service costs over six months from randomisation. Results The mean QALY score for the community hospital group was marginally non-significantly higher than that for the district general hospital group (0.38 v 0.35) at six months after recruitment. The mean (standard deviation) costs per patient of the health and social services resources used were similar for both groups: community hospital group £7233 (euros 10 567; $13 341) (£5031), district general hospital group £7351 (£6229), and these findings were robust to several sensitivity analyses. The incremental cost effectiveness ratio for community hospital care dominated. A cost effectiveness acceptability curve, based on bootstrapped simulations, suggests that at a willingness to pay threshold of £10 000 per QALY, 51% of community hospital cases will be cost effective, which rises to 53% of cases when the threshold is £30 000 per QALY. Conclusion Post-acute care for older people in a locality based community hospital is of similar cost effectiveness to that of an elderly care department in a district general hospital. PMID:16861254

  6. Repetition of a sisterhood survey at district level in Malawi: the challenge to achieve MDG 5.

    Science.gov (United States)

    Beltman, Jogchum Jan; van den Akker, Thomas; Lam, Eva; Moens, Mieke; Kazima, Julie; Massaquoi, Moses; van Roosmalen, Jos

    2011-05-05

    Objective To evaluate progress made at district level in Malawi towards reaching the 5th Millennium Development Goal, the reduction of maternal mortality. Methods In 2006, community-based maternal mortality in Thyolo, Malawi was calculated by applying the 'sisterhood method', a survey that relies on participants responding to basic questions about maternal mortality in their families. Results were compared with a 1989 sisterhood study in the same district. Information on facility-based maternal mortality in 2005 was extracted from district hospital records. Results The community-based maternal mortality ratio (MMR) was calculated as 558 per 100 000 live births (95% CI 260 to 820). A comparison with the MMR from the 1989 survey (409 per 100 000 live births) shows that maternal mortality had not declined. The hospital-based MMR was 994 per 100 000 live births in 2005. Conclusion Maternal mortality in this district has not reduced and may actually have increased. The threat of failure to achieve Millennium Development Goal 5 increases the moral obligation to improve access to quality health care.

  7. An overview of tobacco related cancers in Patan district, Gujarat state

    Directory of Open Access Journals (Sweden)

    Jivarajani Parimal J

    2014-12-01

    Full Text Available ABSTRACT: Tobacco is the single most important cause of avoidable morbidity and early mortality in many countries. In India approximately 700,000-900,000 new cancers are diagnosed every year. Nearly half of all cancers in men and one fifth of cancers in women are tobacco related cancers. The present study was conducted to examine the proportion of tobacco related cancers, their age distribution and geographical variations in Patan district, Gujarat. All new cases of tobacco related cancers diagnosed during the year 2011 were included in the study. Apart from Gujarat Cancer & Research Institute, cancer data were also obtained from government hospitals, private hospitals& consultants, pathology laboratories and death registration units of Patan district and other districts. During the year 2011, a total of 472 new cases (Males: 310; Females: 162 were registered. Among them 214 cases were tobacco related cancers with a male preponderance (189 cases. Majority of the cases were in the age group of 35-64 years. Tongue Cancer was the commonest site in both sexes. Patan taluka had highest tobacco related cancers. This study implies an urgent need for tobacco control among the population of Patan district as tobacco is the most common risk factor of cancer occurrence.

  8. Comprehensive discharge follow-up in patients' homes by GPs and district nurses of elderly patients. A randomized controlled trial

    DEFF Research Database (Denmark)

    Rytter, L.; Jakobsen, Helle; Rønholt, Finn

    2010-01-01

    Many hospital admissions are due to inappropriate medical treatment, and discharge of fragile elderly patients involves a high risk of readmission. The present study aimed to assess whether a follow-up programme undertaken by GPs and district nurses could improve the quality of the medical...

  9. Assessment of WHO/INRUD core drug use indicators in two tertiary care hospitals of Bahawalpur, Punjab, Pakistan

    OpenAIRE

    Atif, Muhammad; Sarwar, Muhammad Rehan; Azeem, Muhammad; Umer, Danial; Rauf, Abdul; Rasool, Arslan; Ahsan, Muhammad; Scahill, Shane

    2016-01-01

    Background Medicines are a main therapeutic intervention provided within hospitals and their proper use in the outpatient setting is important for patients and the community. The objective of this study was to evaluate drug use patterns in the outpatient departments (OPDs) of two tertiary care hospitals (Bahawal Victoria Hospital and Civil Hospital) in the Bahawalpur district of the Punjab province of Pakistan by employing the standard World Health Organization/International Network of Ration...

  10. Louisiana State Senate Districts from LEGIS source data, Geographic NAD83, LOSCO (2004) [la_senate_districts_LEGIS_2003

    Data.gov (United States)

    Louisiana Geographic Information Center — Louisiana State Senate Districts. The district boundaries are the result of legislative acts and redistricting. Reapportionment (redistricting) occurs during the...

  11. Louisiana State House Districts from LEGIS source data, Geographic NAD83, LOSCO (2004) [la_house_districts_LEGIS_2004

    Data.gov (United States)

    Louisiana Geographic Information Center — Louisiana State House Districts. The district boundaries are the result of legislative acts and redistricting. Reapportionment (redistricting) occurs during the next...

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

    OpenAIRE

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

    2014-01-01

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

  13. Effective team management by district nurses.

    Science.gov (United States)

    Bliss, Julie

    2004-12-01

    This article considers the key role played by the district nurse in managing the district nursing team in order to provide high quality health care. It considers how the district nurse can use key managerial roles (interpersonal, informational and decision-making) in order to ensure unity within the team. The importance of shared goals and trust to achieve unity is explored and a strategy for managing conflict is discussed. Finally, the article suggests a set of ground rules which could be used to facilitate effective team working.

  14. Performance analysis of hybrid district heating system

    DEFF Research Database (Denmark)

    Mikulandric, Robert; Krajačić, Goran; Khavin, Gennadii

    2013-01-01

    as problems related to transportation, storage and environmental impacts of biomass and waste utilisation. Implementation of heat storages in district heating systems could contribute to integration of intermittent energy sources. Hybridisation of heat production facility combines two or more different energy...... that combines different energy sources for heat production will be used. The work has been carried out in scope of 4th Generation District Heating Technologies and Systems project.......District heating system could contribute to more efficient heat generation through cogeneration power plants or waste heat utilization facilities and to increase of renewable energy sources share in total energy consumption. In the most developed EU countries, renewable energy sources have been...

  15. Earthquake vulnerability evaluation Faizabad district of Kermanshah

    Directory of Open Access Journals (Sweden)

    Saba Naderi

    2014-07-01

    Full Text Available This paper as examplehas been studied Faizabad district of Kermanshah and to reach its main purpose, which is reducing the damagecaused by the earthquake on the Faizabad district is been providedand in subsidiary purposes part the research is tried identify factors influence in vulnerability earthquakes,pay to provide the factors required; All these factors havean impact on reducing earthquake vulnerability. This data using geological data, soil texture, getting satelliteimages and layering over Arc Gis software identified and for long term periods donepredict using relation kernel PSHA also. In determining the level ofenvironmental risk is to use software crisis. Finally, by recognizing the riskzone, solutions for Faizabad district offered.

  16. Hospital Outpatient PPS Partial Hospitalization Program LDS

    Data.gov (United States)

    U.S. Department of Health & Human Services — Hospital Outpatient Prospective Payment System (OPPS) Partial Hospitalization Program LDS This file contains select claim level data and is derived from 2010 claims...

  17. Hospital Outpatient PPS Partial Hospitalization Program LDS

    Data.gov (United States)

    U.S. Department of Health & Human Services — Hospital Outpatient Prospective Payment System (OPPS) Partial Hospitalization Program LDS This file contains select claim level data and is derived from 2010 claims...

  18. Environmental Assessment: Winnett School District Boiler Replacement Project

    Energy Technology Data Exchange (ETDEWEB)

    1994-07-01

    This environmental assessment analyzes the environmental impacts of replacing the Winnett School District complex`s existing oil-fired heating system with a new coal-fired heating system with funds provided from a grant under the Institutional Conservation Program. This Assessment has been prepared in accordance with the provisions of the National Environmental Policy Act (NEPA), the Council on Environmental Quality`s regulations; the Department`s Implementing Procedures and Guidelines Revocation; and the May 1993 ``Recommendations for the Preparation of Environmental Assessments and Environmental Impact Statements,`` by the Department`s Office of NEPA Oversight. Under the Institutional Conservation Programs, created by the National Energy Conservation Policy Act (PL 95--619), the Department is authorized to encourage energy conservation-by providing funding for up to 50 percent of the costs of installation of qualified energy conservation measures by entities such as schools, hospitals, and other buildings owned by local governments. This proposed action to fund partially the installation of a new coal-fired heating system for the Winnett School District is part of this energy conservation program.

  19. Snakebites in Two Rural Districts in Lao PDR: Community-Based Surveys Disclose High Incidence of an Invisible Public Health Problem.

    Directory of Open Access Journals (Sweden)

    Inthanomchanh Vongphoumy

    Full Text Available The Lao PDR (Laos is one of the least developed countries in Asia with an estimated 25% of the population living in poverty. It is the habitat of some highly venomous snakes and the majority of the population earns their living from agricultural activities. Under these circumstances the incidence of snakebites is expected to be high.Two cross-sectional, community-based surveys were performed in Champone and Phin district, Savannakhet province, Lao PDR to estimate snakebite incidence. Multistage random sampling was used. In the first stage approximately 40% of all villages in each district were randomly selected. In the second stage 33% of all households in each village were randomly chosen. Members of the selected households were interviewed about snakebites during the previous 12 months.Thirty-five of 9856 interviewees reported a snakebite in a 12 month period in Champone district and 79 of 7150 interviewees in Phin district. The estimated incidence is 355 snakebites per 100,000 persons per year and 1105 per 100,000 in Champone and Phin district respectively. All snakebite victims received treatment by traditional healers or self-treatment at home and nobody went to a hospital. Incidence of snakebites, calculated on the basis of hospital records of 14 district hospitals and Savannakhet provincial hospital, ranged from 3 to 14 cases per 100,000 persons per year between 2012 and 2014.Incidence of snakebites is high in rural communities in Laos with significant regional differences. Poverty most likely contributes significantly to the higher number of snakebites in Phin district. Hospital statistics profoundly underestimates snakebite incidence, because the majority of snakebite victims receive only treatment by traditional healers or self-treatment in their village. There is an urgent need to train medical staff and students in management of snakebite patients and make snake antivenom available to cope effectively with this important public

  20. Hospital-acquired pneumonia

    Science.gov (United States)

    ... tends to be more serious than other lung infections because: People in the hospital are often very sick and cannot fight off ... prevent pneumonia. Most hospitals have programs to prevent hospital-acquired infections.

  1. Structural Measures - Hospital

    Data.gov (United States)

    U.S. Department of Health & Human Services — A list of hospitals and the availability of structural measures at that hospital. A structural measure reflects the environment in which hospitals care for patients....

  2. Going to the Hospital

    Science.gov (United States)

    ... Too Short All About Puberty Going to the Hospital KidsHealth > For Kids > Going to the Hospital Print ... you flowers, balloons, or other treats! previous continue Hospital People You'll meet lots of people in ...

  3. Understanding your hospital bill

    Science.gov (United States)

    ... medlineplus.gov/ency/patientinstructions/000881.htm Understanding your hospital bill To use the sharing features on this ... help you save money. Charges Listed on Your Hospital Bill A hospital bill will list the major ...

  4. Research in Hospitality Management

    African Journals Online (AJOL)

    Research in Hospitality Management is a peer-reviewed journal publishing papers ... to the understanding of hospitality and hospitality management in a global context. ... financial management, marketing, strategic management, economics, ...

  5. Patient survey (HCAHPS) - Hospital

    Data.gov (United States)

    U.S. Department of Health & Human Services — A list of hospital ratings for the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). HCAHPS is a national, standardized survey of hospital...

  6. 20 CFR 702.272 - Informal recommendation by district director.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Informal recommendation by district director... Procedures Discrimination § 702.272 Informal recommendation by district director. (a) If the district... employee accept the district director's recommendation, it will be incorporated in an order and mailed...

  7. 7 CFR 982.31 - Grower districts.

    Science.gov (United States)

    2010-01-01

    ... and Orders; Fruits, Vegetables, Nuts), DEPARTMENT OF AGRICULTURE HAZELNUTS GROWN IN OREGON AND WASHINGTON Order Regulating Handling Hazelnut Control Board § 982.31 Grower districts. (a) For the purpose...

  8. New Mexico House Legislative District Boundaries - 2009

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — This dataset contains the New Mexico House District Boundaries as of July 2006. It is in a vector digital shapefile created to show the voting precinct coverage for...

  9. Litchfield Wetland Management District: Comprehensive Conservation Plan

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This Comprehensive Conservation Plan (CCP) was written to guide management on Litchfield Wetland Management District for the next 15 years. This plan outlines the...

  10. Narrative Report Fergus Falls Wetland Management District

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This annual narrative report for Minnesota Wetlands Complex outlines District accomplishments for FY 1974. The report begins by summarizing the weather conditions,...

  11. New Mexico Senate Legislative District Boundaries - 2009

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — This dataset contains the New Mexico Senate District Boundaries as of July 2006. It is in a vector digital shapefile created to show the voting precinct coverage for...

  12. Windom Wetland Management District : Calendar Year 2005

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This annual narrative report for Windom Wetland Management District summarizes activities during the 2005 calendar year. The report begins with an introduction to...

  13. Windom Wetland Management District : Calendar Year 2004

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This annual narrative report for Windom Wetland Management District summarizes activities during the 2004 calendar year. The report begins with an introduction to...

  14. Allegheny County Voting District (2015) Web Map

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This webmap demarcates municipal voting districts in Allegheny County. If viewing this description on the Western Pennsylvania Regional Data Center’s open data...

  15. NM Property Tax Districts November 2010

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — This layer represents boundaries for New Mexico tax district "OUT" categories and incorporated/municipal "IN" categories as identified on the "Certificate of Tax...

  16. NM Property Tax Districts December 2013

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — This layer represents boundaries for New Mexico tax district "OUT" categories and incorporated/municipal "IN" categories as identified on the "Certificate of Tax...

  17. Allegheny County Magisterial Districts Outlines (2015)

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This dataset shows the magisterial districts in Allegheny County. If viewing this description on the Western Pennsylvania Regional Data Center’s open data portal...

  18. US Forest Service Ranger District Boundaries

    Data.gov (United States)

    US Forest Service, Department of Agriculture — A map service on the www depicting the boundary that encompasses a Ranger District. This map service provides display, identification, and analysis tools for...

  19. Narrative report 1971 Lostwood Wetland Management District

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This annual narrative report for the Waterfowl Production Area District of the Lostwood National Wildlife Refuge outlines Refuge accomplishments during the 1971...

  20. Windom Wetland Management District : Calendar Year 2007

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This annual narrative report for Windom Wetland Management District summarizes activities during the 2007 calendar year. The report begins with an introduction to...

  1. Morris Wetland Management District Habitat Management Plan

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The Morris Wetland Management District Habitat Management Plan provides a long-term vision and specific guidance on managing habitats for the resources of concern at...

  2. VT Tax Increment Financing (TIF) Districts

    Data.gov (United States)

    Vermont Center for Geographic Information — Tax Increment Financing (TIF) Districts is established by a municipality around an area that requires public infrastructure to encourage public and private real...

  3. Allegheny County Pennsylvania Senate District Boundaries

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This dataset demarcates the Pennsylvania Senate district boundaries within Allegheny County. If viewing this description on the Western Pennsylvania Regional Data...

  4. Emotional intelligence: district nurses' lived experiences.

    Science.gov (United States)

    Davies, Sarah; Jenkins, Emrys; Mabbett, Gaynor

    2010-03-01

    Emotional Intelligence, recognizing and handling ones' own and others' emotions is beginning to figure in nursing literature, with potential to enhance care, teamwork and wellbeing. District nursing is laden with complex and emotional issues yet little research investigates the value of emotional intelligence in district nursing specifically. This qualitative study adopts interpretative phenomenological analysis with five district nurses, (of different grades), to illuminate perceptions and experiences of emotional intelligence. Findings show district nurses perceive emotional intelligence to be an essential part of their role, regardless of grade or position. Despite being a relatively new concept to nurses, each participant perceived relevant attributes as essential to quality care in the home, especially in relation to palliative care. Themes identified include: self awareness, control, assessment, experience, palliative care and leadership. Only some of these are consistent with existing literature and illustrate a need to investigate this interesting area further.

  5. Allegheny County Voting District Boundaries (2015)

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This dataset demarcates municipal voting districts in Allegheny County. If viewing this description on the Western Pennsylvania Regional Data Center’s open data...

  6. Minnesota Wild and Scenic River Districts

    Data.gov (United States)

    Minnesota Department of Natural Resources — District boundaries for wild, scenic, and recreational rivers designated under the Minnesota State Wild and Scenic Rivers Act. Includes portions of the Minnesota...

  7. Windom Wetland Management District : Calendar Year 2006

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This annual narrative report for Windom Wetland Management District summarizes activities during the 2006 calendar year. The report begins with an introduction to...

  8. Windom Wetland Management District : Fiscal Year 2003

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This annual narrative report for Windom Wetland Management District summarizes activities during the 2003 fiscal year. The report begins with an introduction to the...

  9. Windom Wetland Management District : Fiscal Year 2002

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This annual narrative report for Windom Wetland Management District summarizes activities during the 2002 fiscal year. The report begins with an introduction to the...

  10. Windom Wetland Management District : Calendar Year 2008

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This annual narrative report for Windom Wetland Management District summarizes activities during the 2008 calendar year. The report begins with an introduction to...

  11. Windom Wetland Management District : Fiscal Year 2001

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This annual narrative report for Windom Wetland Management District summarizes activities during the 2001 fiscal year. The report begins with an introduction to the...

  12. Lostwood Wetland Management District: Narrative report: 1972

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This annual narrative report for Lostwood WMD outlines District accomplishments during the 1972 calendar year. The report begins by summarizing the weather...

  13. Allegheny County Voting District (2015) Web Map

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This webmap demarcates municipal voting districts in Allegheny County. If viewing this description on the Western Pennsylvania Regional Data Center’s open data...

  14. Zoning Districts, Zoning, Published in 2002, Freelance.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Zoning Districts dataset, was produced all or in part from Hardcopy Maps information as of 2002. It is described as 'Zoning'. Data by this publisher are often...

  15. Allegheny County Voting District (2016) Web Map

    Data.gov (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — This webmap demarcates municipal voting districts in Allegheny County. If viewing this description on the Western Pennsylvania Regional Data Center’s open data...

  16. Windom Wetland Management District : Fiscal Year 2000

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This annual narrative report for Windom Wetland Management District summarizes activities during the 2000 fiscal year. The report begins with an introduction to the...

  17. School District Finance Survey, 2013-14

    Data.gov (United States)

    Department of Education — School District Finance Survey, 2013–14 (F-33 2013–14) is a study that is part of the Common Core of Data (CCD) program; program data is available since 1989–90 at ....

  18. Leopold Wetland Management District: Comprehensive Conservation Plan

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — This CCP articulates the management direction for the Leopold Wetland Management District for the next 15 years. Through goals, objectives, and strategies, this CCP...

  19. Optimising corrosion monitoring in district heating systems

    DEFF Research Database (Denmark)

    Hilbert, Lisbeth Rischel; Thorarinsdottir, R.I.; Andersen, A.

    2002-01-01

    A three-year project - financially supported by the Nordic Industrial Fund - on monitoring of corrosion in district heating systems has been initiated with participation of researchers and industrial partners in Denmark, Finland, Iceland, Norway and Sweden. The primary objective of the project...... is to improve the quality control in district heating systems by corrosion monitoring. In Danish systems electrochemical impedance spectroscopy (EIS), linear polarisation resistance (LPR), high-sensitive electrical resistance (ER) technology, crevice corrosion probes, as well as weight loss coupons...

  20. Sacramento District History (1929-2004)

    Science.gov (United States)

    2004-01-01

    canyons along the river and marveled Stanislaus River: at the natural formations and the spectacular arrays of stalactites and stalagmites. Word spread... formation that Congress hoped might result in the ramento areas spotlighted the need for an additional integrated development of North American water...operate as a body inde- so rapidly that the District found itself contracting pendent of the San Francisco District. The formation out for tasks such as

  1. INDUSTRIAL DISTRICTS AS LOCAL SYSTEMS OF INNOVATION

    OpenAIRE

    Giancarlo Cor�; Stefano Micelli

    2007-01-01

    This essay examines the situation and the lines of development of industrial districts from the point of view of local systems of innovation. First of all, this article points out to the modernity factors of the district model � which are ascribable to the supply chain economy, to entrepreneurial dynamics and to the importance of geography as a competitive resource � through the analysis of recent contributions of economic literature that examined the emerging organizational models in knowled...

  2. Expansion of antiretroviral treatment to rural health centre level by a mobile service in Mumbwa district, Zambia

    Science.gov (United States)

    Dube, Christopher; Hayakawa, Tadao; Kakimoto, Kazuhiro; Yamada, Norio; Simpungwe, James B

    2010-01-01

    Abstract Problem Despite the Government’s effort to expand services to district level, it is still hard for people living with HIV to access antiretroviral treatment (ART) in rural Zambia. Strong demands for expanding ART services at the rural health centre level face challenges of resource shortages. Approach The Mumbwa district health management team introduced mobile ART services using human resources and technical support from district hospitals, and community involvement at four rural health centres in the first quarter of 2007. This paper discusses the uptake of the mobile ART services in rural Mumbwa. Local setting Mumbwa is a rural district with an area of 23 000 km2 and a population of 167 000. Before the introduction of mobile services, ART services were provided only at Mumbwa District Hospital. Relevant changes The mobile services improved accessibility to ART, especially for clients in better functional status, i.e. still able to work. In addition, these mobile services may reduce the number of cases “lost to follow-up”. This might be due to the closer involvement of the community and the better support offered by these services to rural clients. Lessons learnt These mobile ART services helped expand services to rural health facilities where resources are limited, bringing them as close as possible to where clients live. PMID:20931065

  3. 上海市普陀区医院信息系统在传染病信息报告与管理中的利用现况%The Current Situation of the Use of Hospital Information System in the Report and Management of Infectious Diseases in Putuo District of Shanghai

    Institute of Scientific and Technical Information of China (English)

    崔燕; 王瑞; 周艳冰; 张宇艳

    2015-01-01

    目的:了解辖区医院信息系统在传染病信息报告与管理中的利用现况。方法分析2005~2013年国家疾病监测信息系统中法定报告的传染病网络直报数据;并对辖区18家公立医疗机构传染病报告专职人员和医院信息科负责人开展信息系统和网络直报利用现况的调查。结果辖区二、三级综合医院传染病报告卡数占87.58%;18家公办医疗机构均开发医院信息系统,但信息化程度不同,传染病报告仍需通过手工方式进行二次信息录入到国家传染病网络直报系统,医院信息系统信息不能满足传染病信息报告字段要求,各医疗机构逐步开始利用HIS系统开展传染病漏报自查。结论我区卫生信息化在传染病报告管理中初见成效,但仍不能开展有效的数据交换服务和实现传染病报告管理工作和信息化建设的有效衔接。%Objective To understand the use of hospital information system in the report and management of infectious diseases.MethodsTo analyze data of national disease surveilance information system from 2005 to 2013, and investigate the ful-time staff of infectious disease report and hospital information department’responsible person among 18 hospitals.Results The second and third class comprehensive hospital infectious disease report cards accounted for 87.58%. 18 public medical institutions were developing hospital information system, but levels of information were different. Reporting of infectious diseases still need to input secondary information to the national infectious disease network system by hand. The field setting of hospital information system can't meet the infectious diseases reporting information. All medical institutions gradually began to use hospital information system to carry out the infectious disease report self-examination.Conclusion We have achieved initial success in the management of infectious diseases report, but it still can not carry

  4. District heating substations - design and installation

    Energy Technology Data Exchange (ETDEWEB)

    2004-12-15

    These technical regulations for district heating substations are sector-wide regulations for the Swedish district heating sector, describing the design, installation, use and maintenance of substations. If a district heating substation is to operate in the best possible way, the building's space heating and domestic hot water systems must comply with the requirements in these regulations and with those issued by public authorities. These regulations also describe aspects that must be considered when substations need to be replaced. The use then of correct values for the building energy requirements ensures that the new substation will be properly matched to its duties. These regulations are intended for use by: - those responsible for contacts between the district heating supplier and the customer. - those who own, operate and/or administer a building or facility that is heated by district heating. - those who design, manufacture, purchase, test or install substations. It is recommended that enquiries should refer to the Swedish District Heating Association's technical regulations when specifying requirements. The procurement criteria described in these regulations should be applied when evaluating tenders

  5. A staff support programme for rural hospitals in Nepal.

    Science.gov (United States)

    Zimmerman, Mark; Shah, Sharada; Shakya, Rabina; Sundar Chansi, Bal; Shah, Kashim; Munday, Daniel; Eyal, Nir; Hayes, Bruce

    2016-01-01

    District hospitals in Nepal struggle to provide essential services such as caesarean sections. Retention of health workers is critical to the delivery of long-term, quality health-care services. To promote retention and enhance performance in rural public hospitals, the Government of Nepal and the Nick Simons Institute progressively implemented a rural staff support programme in remote hospitals. After competitive selection for a compulsory-service scholarship and training, family practice doctors who could do basic surgery, orthopaedics and obstetrics were hired under a binding three-year contract in each participating hospital. Comfortable living quarters and an Internet connection were provided for the resident doctors; in-service training for all staff and capacity development for each hospital's management committee were provided. Nepal's mountainous landscape, poverty and inequitable rural/urban distribution of health workers pose barriers to adequate health care. Between 2011 and 2015 family practice doctors were maintained in all seven programme hospitals. All hospitals became providers of comprehensive emergency obstetric care and served more patients. Compared with hospitals not within the programme, deliveries increased significantly (203% versus 71% increase, respectively; P = 0.002). The programme recently expanded to 14 hospitals. A package of human resource supports can improve the retention of doctors and the use of remote hospitals. Factors contributing to the success of this programme were compulsory-service scholarship, central personnel management, performance-based incentives and the provision of comfortable living quarters.

  6. A Research Report of Small/Rural School Districts in New Mexico Compared to School Districts of Similiar Size Nationwide.

    Science.gov (United States)

    Barker, Bruce O.; Muse, Ivan D.

    A 1982-83 survey produced data used to compare 17 small/rural K-12 New Mexico school districts (900 students or fewer) with 642 similar districts nationwide. Of New Mexico's 88 school districts, 43 were identified as qualifying (48.9%, enrolling 16,648 students), for comparison to 4,125 similar districts nationwide. A questionnaire mailed to…

  7. Towards improving hospital performance in Uganda and Zambia: reflections and opportunities for autonomy.

    Science.gov (United States)

    Hanson, Kara; Atuyambe, Lynn; Kamwanga, Jolly; McPake, Barbara; Mungule, Oswald; Ssengooba, Freddie

    2002-07-01

    Hospitals have been relatively neglected although their high resource consumption implies that gains from improving the services they deliver may be substantial. Nevertheless, the challenges posed by hospital reforms are great. Hospital autonomy usually consists of both decentralisation, and a greater measure of exposure to market forces. In Uganda and Zambia, more traditional 'decentralisation' of authority to district level authorities includes district hospitals; and some measure of 'autonomy' (known as 'self-accounting status' in Uganda) has been applied to some or all second and third level referral hospitals. The hospital policies pursued in both countries present opportunities to tackle their hospital sectors. In Zambia, purchasing of services means that new incentives and policy mechanisms can come into play. Little advantage has been taken of these opportunities to date. In Uganda, there is no financial link between districts and higher levels of the system, but decentralisation of control over personnel is more advanced. These two components--the alignment of incentives (to promote access and quality for those intended to be covered by the public budget) and the effective decentralisation of control over key resources--seem to us the key tools to address the stubborn problems of hospitals.

  8. Heriberto Duarte Sr. v. Chino Community Hospital.

    Science.gov (United States)

    1999-01-01

    Court Decision: 85 California Reporter, 2d Series 521: 1999 Jun 3 (date of decision). The California Court of Appeals for the Fourth District held that an accident victim's physician was immune under state statute for refusal to withdraw the patient from a respirator. The victim's family alleged negligence on the part of the doctors and the hospital for refusing to comply with the family's requests to terminate life support, specifically a respirator, or to transfer her to a hospital that would terminate life support. The court found that the patient had nothing in writing supporting her wish to be taken off life-sustaining treatment, neither a living will nor a medical power of attorney. Under those facts and state statutes, the court found no negligence where the life support was removed only after the patient was diagnosed as brain dead.

  9. Hospital marketing revisited.

    Science.gov (United States)

    Costello, M M

    1987-05-01

    With more hospitals embracing the marketing function in their organizational management over the past decade, hospital marketing can no longer be considered a fad. However, a review of hospital marketing efforts as reported in the professional literature indicates that hospitals must pay greater attention to the marketing mix elements of service, price and distribution channels as their programs mature.

  10. Economies of scale and scope in Vietnamese hospitals.

    Science.gov (United States)

    Weaver, Marcia; Deolalikar, Anil

    2004-07-01

    Hospitals consume a large share of health resources in developing countries, but little is known about the efficiency of their scale and scope. The Ministry of Health of Vietnam and World Bank collected data in 1996 from the largest sample ever surveyed in a developing country. The sample included 654 out of 815 public hospitals, six categories of hospitals and a broad range of sizes. These data were used to estimate total variable cost as a function of multiple products, such as admissions and outpatient visits. We report results for two specifications: (1) estimates with a single variable for beds and (2) estimates with interaction terms for beds and the category of hospital. The coefficient estimates were used to calculate marginal costs, short-run returns to the variable factor, economies of scale, and economies of scope for each category of hospital. There were important differences across categories of hospitals. The measure of economies of scale was 1.09 for central general and 1.05 for central specialty hospitals with a mean of 516 and 226 beds, respectively, indicating roughly constant returns to scale. The measure was well below one for both provincial general and specialty hospitals with a mean of 357 and 192 beds, respectively, indicating large diseconomies of scale. The measure was 1.16 for district hospitals and 0.89 other ministry hospitals indicating modest economies and diseconomies of scale, respectively. There were large economies of scope for central and provincial general hospitals. We conclude that in a system of public hospitals in a developing country that followed an administrative structure, the variable cost function differed significantly across categories of hospitals. Economies of scale and scope depended on the category of the hospital in addition to the number of beds and volume of output.

  11. What Do Effective District Leaders Do? Strategies for Evaluating District Leadership. Policy Snapshot

    Science.gov (United States)

    Hornung, Katie; Yoder, Nick

    2014-01-01

    In the wake of the Common Core State Standards and teacher evaluation reform, school leaders increasingly look to district leaders for support, coaching, and leadership. District leaders--superintendents, assistant or area superintendents, specialists, principal supervisors, and school business administrators--can hold varying and multiple roles…

  12. Virtual District, Real Improvement: A Retrospective Evaluation of the Chancellor's District, 1996-2003

    Science.gov (United States)

    Phenix, Deinya; Siegel, Dorothy; Zaltsman, Ariel; Fruchter, Norm

    2004-01-01

    This paper describes the origins, structure, and components of the Chancellor's District, and details the findings about its outcomes for elementary schools. The Chancellor's District initiative ended in July 2003, with the implementation of a system-wide restructuring policy that reorganized the entire New York City school system. The 32…

  13. Overcrowding in hospital wards as a predictor of antidepressant treatment among hospital staff.

    Science.gov (United States)

    Virtanen, Marianna; Pentti, Jaana; Vahtera, Jussi; Ferrie, Jane E; Stansfeld, Stephen A; Helenius, Hans; Elovainio, Marko; Honkonen, Teija; Terho, Kirsi; Oksanen, Tuula; Kivimäki, Mika

    2008-11-01

    This report assessed whether hospital ward overcrowding predicts antidepressant use among hospital staff. The extent of hospital ward overcrowding was determined using administrative records of monthly bed occupancy rates between 2000 and 2004 in 203 somatic illness wards in 16 Finnish hospitals providing specialized health care. Information on job contracts for personnel was obtained from the employers' registers. Comprehensive daily data on purchased antidepressant prescriptions (World Health Organization's Anatomical Therapeutic Chemical classification code N06A) for nurses (N=6,699) and physicians (N=641) was derived from national registers. Cox proportional hazards models were used to examine the association between bed occupancy rate and subsequent antidepressant treatment. Monthly bed occupancy rates were used as a time-dependent exposure that could change in value over the course of observation. Hazard ratios were adjusted for sex, age, occupation, type and length of employment contract, hospital district, specialty, and calendar year. Exposure over 6 months to an average bed occupancy rate over 10% in excess of the recommended limit was associated with new antidepressant treatment. This association followed a dose-response pattern, with increasing bed occupancy associated with an increasing likelihood of antidepressant use. There was no evidence of reverse causality; antidepressant treatment among employees did not predict subsequent excess bed occupancy. The increased risk of antidepressant use observed in this study suggests that overcrowding in hospital wards may have an adverse effect on the mental health of staff.

  14. District heating in Italy; Genesi ed evoluzione del district heating in Italia

    Energy Technology Data Exchange (ETDEWEB)

    Sacchi, E. [Milan Politecnico (Italy). Dip. di energetica

    1998-12-01

    The legislative act establishing the electric monopoly virtually shut out the district heating associated with electricity cogeneration, while other laws, issued to counteract the effects of oil shocks, allowed municipal utilities to do so. Thus, district heating has experienced some development, though well below its possibilities. The article analyses the reasons for this lagging, reports district heating data and projects its forecasts against the Kyoto Protocol objectives. [Italiano] La legge istitutiva del monopolio elettrico ha di fatto impedito il district heating associato alla cogenerazione di elettricita`, mentre le leggi tese a contrastare gli effetti delle crisi energetiche lo hanno reso possibile ad opera delle aziende municipali: un certo sviluppo si e` verificato, seppure ben al di sotto delle possibili potenzialita`. L`articolo analizza i motivi di questo rallentato sviluppo, riporta i dati del district heating e ne proietta le previsioni lungo gli obiettivi del Protocollo di Kyoto.

  15. Solar heat storages in district heating networks

    Energy Technology Data Exchange (ETDEWEB)

    Ellehauge, K. (Ellehauge og Kildemoes, AArhus (DK)); Engberg Pedersen, T. (COWI A/S, Kgs. Lyngby (DK))

    2007-07-15

    This report gives information on the work carried out and the results obtained in Denmark on storages for large solar heating plants in district heating networks. Especially in Denmark the share of district heating has increased to a large percentage. In 1981 around 33% of all dwellings in DK were connected to a district heating network, while the percentage in 2006 was about 60% (in total 1.5 mio. dwellings). In the report storage types for short term storage and long term storages are described. Short term storages are done as steel tanks and is well established technology widely used in district heating networks. Long term storages are experimental and used in connection with solar heating. A number of solar heating plants have been established with either short term or long term storages showing economy competitive with normal energy sources. Since, in the majority of the Danish district heating networks the heat is produced in co-generation plants, i.e. plants producing both electricity and heat for the network, special attention has been put on the use of solar energy in combination with co-generation. Part of this report describes that in the liberalized electricity market central solar heating plants can also be advantageous in combination with co-generation plants. (au)

  16. Characteristics of Postpartum Depression in Anand District, Gujarat, India.

    Science.gov (United States)

    Patel, Himadri L; Ganjiwale, Jaishree D; Nimbalkar, Archana S; Vani, Shashi N; Vasa, Rohitkumar; Nimbalkar, Somashekhar M

    2015-10-01

    Characteristics of postpartum depression (PPD) in Anand District, Gujarat, India. PPD affects 1 in 10 women in the developed world. It has been implicated as an independent factor with adverse effect on child health, and health care-seeking behavior of mothers. We sought to find the prevalence of PPD in our hospital by including mothers who registered and delivered live babies at our hospital. Basic demographic information related to pregnancy was acquired from mothers and Edinburgh Postnatal Depression Scale (EPDS), pre-translated and validated in Gujarati language, was administered. Current study observed prevalence of PPD as 48.5% using cutoff score of 10.5 for classifying depression in Gujarati women. Factors associated with depression after multivariable logistic regression were: age of mother, modified Kuppuswami category (MKC) score, family type, violence from husband, gravida, para and sex of infant. PPD has higher prevalence in our study vis-a-vis Western countries. This may be because of early administration of EPDS. © The Author [2015]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  17. EPIDEMIOLOGY OF THYROID LESIONS IN WARDHA DISTRICT OF CENTRAL INDIA

    Directory of Open Access Journals (Sweden)

    Samarth Shukla

    2015-02-01

    Full Text Available AIMS: To establish a significant predominance of thyroid lesions in and around Wardha district, and to establish specific etiological link for the predominance the thyroid lesions. MATERIALS AND METHOD S : This was a hospital based analytical prospective study, conducted in Acharya Vinobha Bhave Rural Hospital (A.V.B.R.H. involving 108 patients. The study was carried over a duration of 1 year January 2010 to December 2010. Patients attending endocrinological clinics and the newly detected cases of thyroid lesions, within set parameters of study, were the subjects of this study. OBSERVATION: Thyroid lesions which we came across in the course of the study were Thyrotoxicosis, Myxoedema, Thyroiditis, Diffuse goitre, Nodular Goitre and Carcinoma Thyroid . These were correlated with epidemiological factors like Age, Sex, Region, Diet and Iodine Intake. Significant relationship between thyroid function, age of patient, diet was seen in comparison to individual thyroid lesions. CONCLUSION : G oitre was the commest pathology encountered . Almost all of the thyroid lesions were of hypothyroid in their function with exception of thyrotoxicosis and carcinoma. Thyroid lesions were found predominantly in females, Age related lesion pathology was significant, and vegetarian and non - vegetarian diets along with low and high iodine salt uptake had obvious pathological effects on thyroid

  18. Comparison of infant malaria incidence in districts of Maputo province, Mozambique

    Directory of Open Access Journals (Sweden)

    Zacarias Orlando P

    2011-04-01

    Full Text Available Abstract Background Malaria is one of the principal health problems in Mozambique, representing 48% of total external consultations and 63% of paediatric hospital admissions in rural and general hospitals with 26.7% of total mortality. Plasmodium falciparum is responsible for 90% of all infections being also the species associated with most severe cases. The aim of this study was to identify zones of high malaria risk, showing their spatially and temporal pattern. Methods Space and time Poison model for the analysis of malaria data is proposed. This model allows for the inclusion of environmental factors: rainfall, temperature and humidity as predictor variables. Modelling and inference use the fully Bayesian approach via Markov Chain Monte Carlo (MCMC simulation techniques. The methodology is applied to analyse paediatric data arising from districts of Maputo province, Mozambique, between 2007 and 2008. Results Malaria incidence risk is greater for children in districts of Manhiça, Matola and Magude. Rainfall and humidity are significant predictors of malaria incidence. The risk increased with rainfall (relative risk - RR: .006761, 95% interval: .001874, .01304, and humidity (RR: .049, 95% interval: .03048, .06531. Malaria incidence was found to be independent of temperature. Conclusions The model revealed a spatial and temporal pattern of malaria incidence. These patterns were found to exhibit a stable malaria transmission in most non-coastal districts. The findings may be useful for malaria control, planning and management.

  19. Validity of referral hospitals for the toxicovigilance of acute poisoning in Sri Lanka.

    Science.gov (United States)

    Senarathna, L; Buckley, N A; Jayamanna, S F; Kelly, P J; Dibley, M J; Dawson, A H

    2012-06-01

    To identify the hospital admission data set that best captures the incidence of acute poisoning in rural Sri Lanka. Data were collected on all acute poisoning cases admitted to 34 primary and 1 referral hospital in Anuradhapura district from September 2008 to January 2010. Three admission data sets were compared with the "true" incidence of acute poisoning to determine the systematic bias inherent to each data set. "True" incidence was calculated by adding all direct admissions (not transfers) to primary hospitals and to the referral hospital. The three data sets were: (i) all admissions to primary hospitals only; (ii) all admissions to the referral hospital only (direct and referrals), and (iii) all admissions to both primary hospitals and the referral hospital ("all admissions"). The third is the government's routine statistical method but counts transfers twice, so for the study transferred patients were counted only once through data linkage. Of 3813 patients admitted for poisoning, 3111 first presented to a primary hospital and 2287 (73.5%) were later transferred to the referral hospital, where most deaths (161/177) occurred. All data sets were representative demographically and in poisoning type, but referral hospital data yielded a more accurate case-fatality rate than primary hospital data or "all admissions" data. Admissions to primary hospitals only or to the referral hospital only underestimated the incidence of acute poisoning by about 20%, and data on "all admissions" overestimated it by 60%. Admission data from referral hospitals are easily obtainable and accurately reflect the true poisoning incidence.

  20. Research Use by Leaders in Canadian School Districts

    Directory of Open Access Journals (Sweden)

    Amanda Cooper

    2013-12-01

    Full Text Available This paper, part of a larger study, investigates the ways research is used by leaders in Canadian schools and districts, an area in which there is relatively little empirical evidence. The paper analyzes survey results from 188 education leaders in 11 school districts across Canada about school and district practices related to the use of research. Results indicate a growing awareness in districts of the importance of research use, reported district capacity, and many kinds of support available for research-related activities; however, actual research use remains modest. Districts appear to have relatively weak processes and systems for finding, sharing, and using relevant research.

  1. Spatio-Temporal Variation and Prediction of Ischemic Heart Disease Hospitalizations in Shenzhen, China

    Directory of Open Access Journals (Sweden)

    Yanxia Wang

    2014-05-01

    Full Text Available Ischemic heart disease (IHD is a leading cause of death worldwide. Urban public health and medical management in Shenzhen, an international city in the developing country of China, is challenged by an increasing burden of IHD. This study analyzed the spatio-temporal variation of IHD hospital admissions from 2003 to 2012 utilizing spatial statistics, spatial analysis, and space-time scan statistics. The spatial statistics and spatial analysis measured the incidence rate (hospital admissions per 1,000 residents and the standardized rate (the observed cases standardized by the expected cases of IHD at the district level to determine the spatio-temporal distribution and identify patterns of change. The space-time scan statistics was used to identify spatio-temporal clusters of IHD hospital admissions at the district level. The other objective of this study was to forecast the IHD hospital admissions over the next three years (2013–2015 to predict the IHD incidence rates and the varying burdens of IHD-related medical services among the districts in Shenzhen. The results show that the highest hospital admissions, incidence rates, and standardized rates of IHD are in Futian. From 2003 to 2012, the IHD hospital admissions exhibited similar mean centers and directional distributions, with a slight increase in admissions toward the north in accordance with the movement of the total population. The incidence rates of IHD exhibited a gradual increase from 2003 to 2012 for all districts in Shenzhen, which may be the result of the rapid development of the economy and the increasing traffic pollution. In addition, some neighboring areas exhibited similar temporal change patterns, which were also detected by the spatio-temporal cluster analysis. Futian and Dapeng would have the highest and the lowest hospital admissions, respectively, although these districts have the highest incidence rates among all of the districts from 2013 to 2015 based on the prediction

  2. Spatio-Temporal Variation and Prediction of Ischemic Heart Disease Hospitalizations in Shenzhen, China

    Science.gov (United States)

    Wang, Yanxia; Du, Qingyun; Ren, Fu; Liang, Shi; Lin, De-nan; Tian, Qin; Chen, Yan; Li, Jia-jia

    2014-01-01

    Ischemic heart disease (IHD) is a leading cause of death worldwide. Urban public health and medical management in Shenzhen, an international city in the developing country of China, is challenged by an increasing burden of IHD. This study analyzed the spatio-temporal variation of IHD hospital admissions from 2003 to 2012 utilizing spatial statistics, spatial analysis, and space-time scan statistics. The spatial statistics and spatial analysis measured the incidence rate (hospital admissions per 1,000 residents) and the standardized rate (the observed cases standardized by the expected cases) of IHD at the district level to determine the spatio-temporal distribution and identify patterns of change. The space-time scan statistics was used to identify spatio-temporal clusters of IHD hospital admissions at the district level. The other objective of this study was to forecast the IHD hospital admissions over the next three years (2013–2015) to predict the IHD incidence rates and the varying burdens of IHD-related medical services among the districts in Shenzhen. The results show that the highest hospital admissions, incidence rates, and standardized rates of IHD are in Futian. From 2003 to 2012, the IHD hospital admissions exhibited similar mean centers and directional distributions, with a slight increase in admissions toward the north in accordance with the movement of the total population. The incidence rates of IHD exhibited a gradual increase from 2003 to 2012 for all districts in Shenzhen, which may be the result of the rapid development of the economy and the increasing traffic pollution. In addition, some neighboring areas exhibited similar temporal change patterns, which were also detected by the spatio-temporal cluster analysis. Futian and Dapeng would have the highest and the lowest hospital admissions, respectively, although these districts have the highest incidence rates among all of the districts from 2013 to 2015 based on the prediction using the GM (1

  3. Enhancing assertiveness in district nurse specialist practice.

    Science.gov (United States)

    Green, Julie

    2016-08-02

    District nurse (DN) care delivery has undergone substantial change in recent years due to changing demographics and service delivery demands that have called for a move of care delivery from secondary to primary care. The title District Nurse is recorded with the Nursing and Midwifery Council (NMC) on completion of the Specialist Practice Qualification in District Nursing (SPQ DN), which purports to be a 'transformational' course that prepares future caseload holders to manage their team and prioritise care delivery effectively. This article explores the need for assertiveness skills in this role in response to Australian research, and outlines the pedagogic interventions implemented during the SPQ DN course to enhance this skill. Assertiveness scores were monitored for the duration of the course and demonstrated a significant increase-a topic that is now the subject of a future, funded study.

  4. District nurses prescribing as nurse independent prescribers.

    Science.gov (United States)

    Downer, Frances; Shepherd, Chew Kim

    2010-07-01

    Nurse prescribing has been established in the UK since 1994, however, limited focus has been placed on the experiences of district nurses adopting this additional role. This phenomenological study explores the experiences of district nurses prescribing as nurse independent prescribers across the West of Scotland. A qualitative Heideggarian approach examined the every-day experiences of independent prescribing among district nurses. A purposive sample was used and data collected using audio taped one-to-one informal interviews. The data was analysed thematically using Colaizzi's seven procedural steps. Overall these nurses reported that nurse prescribing was a predominantly positive experience. Participants identified improvements in patient care, job satisfaction, level of autonomy and role development. However, some of the participants indicated that issues such as support, record keeping, confidence and ongoing education are all major influences on prescribing practices.

  5. Optimising corrosion monitoring in district heating systems

    DEFF Research Database (Denmark)

    Hilbert, Lisbeth Rischel; Thorarinsdottir, R.I.; Andersen, A.

    2002-01-01

    is to improve the quality control in district heating systems by corrosion monitoring. In Danish systems electrochemical impedance spectroscopy (EIS), linear polarisation resistance (LPR), high-sensitive electrical resistance (ER) technology, crevice corrosion probes, as well as weight loss coupons......A three-year project - financially supported by the Nordic Industrial Fund - on monitoring of corrosion in district heating systems has been initiated with participation of researchers and industrial partners in Denmark, Finland, Iceland, Norway and Sweden. The primary objective of the project...... will be tested. Laboratory studies as well as on-line measurements in district heating systems using probes in a specially designed sidestream unit are included in the practical part of the project....

  6. Modeling and Exergy Analysis of District Cooling

    DEFF Research Database (Denmark)

    Nguyen, Chan

    . As a principle example, the CO2 emission for each of the cooling and heating consumer is found. The conclusion is analogue to the exergy costing method, i.e. the exergoenvironmmental method can be used as motivation for reducing CO2 emission. One of the main obstacles with district cooling in a traditional water......In this thesis energy, exergy and exergoeconomic analysis has been carried out on a different number of co-generation energy systems involving cooling. The models and methods developed can be used as a frame work to improve the district heating and cooling system thermodynamically and...... in a district heating system based on combined heat and power plants (CHP). A theoretical comparison of trigeneration (cooling, heating and electricity) systems, a traditional system and a recovery system is carried out. The comparison is based on the systems overall exergy efficiency. The traditional system...

  7. Hospitable Classrooms: Biblical Hospitality and Inclusive Education

    Science.gov (United States)

    Anderson, David W.

    2011-01-01

    This paper contributes to a Christian hermeneutic of special education by suggesting the biblical concept of hospitality as a necessary characteristic of classroom and school environments in which students with disabilities and other marginalized students can be effectively incorporated into the body of the classroom. Christian hospitality, seen…

  8. Delirium and dementia in acute hospitals: assessing the impact of RMN input.

    Science.gov (United States)

    Law, Emma

    2008-11-01

    There is evidence that provision for the mental health needs of older people in acute hospitals is generally poor. This article describes a study undertaken over a nine-month period at Perth Royal Infirmary, a 317-bed district general hospital. The study sought to measure the impact of input from an RMN in an acute hospital setting and within a multidisciplinary liaison model. The article examines the implications, preparation, implementation and evaluation of RMN input, and the baseline knowledge and expectations of acute hospital staff when caring for patients with dementia and delirium.

  9. Performance analysis of hybrid district heating system

    DEFF Research Database (Denmark)

    Mikulandric, Robert; Krajačić, Goran; Khavin, Gennadii

    2013-01-01

    as problems related to transportation, storage and environmental impacts of biomass and waste utilisation. Implementation of heat storages in district heating systems could contribute to integration of intermittent energy sources. Hybridisation of heat production facility combines two or more different energy...... more extensively used in district heating systems either separately or as a supplement to traditional fossil fuels in order to achieve national energy policy objectives. However, they are still facing problems such as high intermittences, high energy production costs and low load factors as well...

  10. Geothermal district heating: basics to success

    Energy Technology Data Exchange (ETDEWEB)

    Lunis, B.C.

    1985-01-01

    A district heating system using geothermal energy is a viable and economic option in many locations. A successful system, however, is dependent upon a variety of factors, and it is the purpose of this presentation to accent those items that are proving to have significant impact upon the successful operation of geothermal district heating systems. (These lessons can also apply to other sources of energy.) The six major basics to success that are discussed in this paper are economic viability, an adequate geothermal resource, simplicity of design, a closed loop system, a local champion, and good public relations.

  11. Odonates of Coimbatore District, Tamil Nadu, India

    OpenAIRE

    M. Suhirtha Muhil; Pramod, P

    2017-01-01

    Odonates were surveyed in Coimbatore District from September 2012 to January 2016.  The survey sites covered three major rivers—the Noyyal, Bhavani and Aliyar.  Aquatic habitats such as forest streams, riverine sites, irrigational tanks and paddy fields were surveyed in the study.  A total of 70 species of odonates were recorded in the survey, which brings the list of odonates in Coimbatore to 87 species.  Eighteen species are first time records to the district.  In this paper, we catalogue o...

  12. Odonates of Coimbatore District, Tamil Nadu, India

    Directory of Open Access Journals (Sweden)

    M. Suhirtha Muhil

    2017-02-01

    Full Text Available Odonates were surveyed in Coimbatore District from September 2012 to January 2016.  The survey sites covered three major rivers—the Noyyal, Bhavani and Aliyar.  Aquatic habitats such as forest streams, riverine sites, irrigational tanks and paddy fields were surveyed in the study.  A total of 70 species of odonates were recorded in the survey, which brings the list of odonates in Coimbatore to 87 species.  Eighteen species are first time records to the district.  In this paper, we catalogue odonates and their distribution from the present survey and pre-existing records. 

  13. Corrosion Fatigue in District Heating Water Tanks

    DEFF Research Database (Denmark)

    Maahn, Ernst Emanuel

    1996-01-01

    Three candidate materials for construction of buffer tanks for district heating water have been tested for corrosion fatigue properties in a district heating water environment. The investigation included Slow Strain Rate Testing of plain tensile specimens, crack initiation testing by corrosion...... fatigue of plain tensile specimens and crack growth rate determination for Compact Tensile Specimens under corrosion fatigue conditions. The three materials are equal with respect to stress corrosion sensibility and crack initiation. Crack growth rate is increased with a factor of 4-6 relative to an inert...

  14. The application of hospitality elements in hospitals.

    Science.gov (United States)

    Wu, Ziqi; Robson, Stephani; Hollis, Brooke

    2013-01-01

    In the last decade, many hospital designs have taken inspiration from hotels, spurred by factors such as increased patient and family expectations and regulatory or financial incentives. Increasingly, research evidence suggests the value of enhancing the physical environment to foster healing and drive consumer decisions and perceptions of service quality. Although interest is increasing in the broader applicability of numerous hospitality concepts to the healthcare field, the focus of this article is design innovations, and the services that such innovations support, from the hospitality industry. To identify physical hotel design elements and associated operational features that have been used in the healthcare arena, a series of interviews with hospital and hotel design experts were conducted. Current examples and suggestions for future hospitality elements were also sought from the experts, academic journals, and news articles. Hospitality elements applied in existing hospitals that are addressed in this article include hotel-like rooms and decor; actual hotels incorporated into medical centers; hotel-quality food, room service, and dining facilities for families; welcoming lobbies and common spaces; hospitality-oriented customer service training; enhanced service offerings, including concierges; spas or therapy centers; hotel-style signage and way-finding tools; and entertainment features. Selected elements that have potential for future incorporation include executive lounges and/or communal lobbies with complimentary wireless Internet and refreshments, centralized controls for patients, and flexible furniture. Although the findings from this study underscore the need for more hospitality-like environments in hospitals, the investment decisions made by healthcare executives must be balanced with cost-effectiveness and the assurance that clinical excellence remains the top priority.

  15. National audit of acute severe asthma in adults admitted to hospital. Standards of Care Committee, British Thoracic Society.

    OpenAIRE

    1995-01-01

    OBJECTIVE--To ascertain the standard of care for hospital management of acute severe asthma in adults. DESIGN--Questionnaire based retrospective multicentre survey of case records. SETTING--36 hospitals (12 teaching and 24 district general hospitals) across England, Wales, and Scotland. PATIENTS--All patients admitted with acute severe asthma between 1 August and 30 September 1990 immediately before publication of national guidelines for asthma management. MAIN MEASURES--Main recommendations ...

  16. Barriers to emergency obstetric care services: accounts of survivors of life threatening obstetric complications in Malindi District, Kenya.

    Science.gov (United States)

    Echoka, Elizabeth; Makokha, Anselimo; Dubourg, Dominique; Kombe, Yeri; Nyandieka, Lillian; Byskov, Jens

    2014-01-01

    Pregnancy-related mortality and morbidity in most low and middle income countries can be reduced through early recognition of complications, prompt access to care and appropriate medical interventions following obstetric emergencies. We used the three delays framework to explore barriers to emergency obstetric care (EmOC) services by women who experienced life threatening obstetric complications in Malindi District, Kenya. A facility-based qualitative study was conducted between November and December 2010. In-depth interviews were conducted with 30 women who experienced obstetric "near miss" at the only public hospital with capacity to provide comprehensive EmOC services in the district. Findings indicate that pregnant women experienced delays in making decision to seek care and in reaching an appropriate care facility. The "first" delay was due to lack of birth preparedness, including failure to identify a health facility for delivery services regardless of antenatal care and to seek care promptly despite recognition of danger signs. The "second" delay was influenced by long distance and inconvenient transport to hospital. These two delays resulted in some women arriving at the hospital too late to save the life of the unborn baby. Delays in making the decision to seek care when obstetric complications occur, combined with delays in reaching the hospital, contribute to ineffective treatment upon arrival at the hospital. Interventions to reduce maternal mortality and morbidity must adequately consider the pre-hospital challenges faced by pregnant women in order to influence decision making towards addressing the three delays.

  17. Burden, pattern and outcomes of road traffic injuries in a rural district of India.

    Science.gov (United States)

    Gururaj, Gopalkrishna; Uthkarsh, Pallavi Sarji; Rao, Girish N; Jayaram, Ashok N; Panduranganath, Venkatesh

    2016-01-01

    Road traffic injuries (RTIs) are a leading public health problem and the understanding of RTIs in rural India is limited. The present report documents the burden, pattern, characteristics and outcomes of RTIs in a rural district of India using combined data sources: police and hospital. RTIs contributed for 38% of fatal and 39% of non-fatal injuries with an annual mortality rate of 18.1/100,000 population/year. Young males were affected most and two-wheeler users and pedestrians were involved in 45% and 20% of fatal crashes, respectively. Nearly half (51%) of fatal RTIs occurred on national highways of the district; 46% died immediately at the site. Among those hospitalised, 20% were under the influence of alcohol while use of helmets and seat belts was India with a focus on safe roads, safe vehicles and safe people along with trauma care.

  18. Twenty-five years of bicycle helmet promotion for children in Skaraborg District, Sweden.

    Science.gov (United States)

    Ekman, Diana Stark; Ekman, Robert

    2012-01-01

    The purpose of this study is to describe some of the results of a long-term bicycle helmet campaign for children in Skaraborg District, Sweden. The hospital discharge data for bicycle-related injuries occurring in children under the age of 15 were reviewed, to assess changes in patterns for head and other body injuries. The study shows that head injuries to children as a result of bicycle injuries were reduced between 94 and 99% in the study areas. The tremendous gains in safety for children who ride bicycles in Skaraborg District were the result of not only national policy changes that occurred in the latter half of this study period but also the result of local collaborations based on the Safe Communities model, which were organised during the first part of the study period.

  19. The Hospitable Meal Model

    DEFF Research Database (Denmark)

    Justesen, Lise; Overgaard, Svend Skafte

    2017-01-01

    This article presents an analytical model that aims to conceptualize how meal experiences are framed when taking into account a dynamic understanding of hospitality: the meal model is named The Hospitable Meal Model. The idea behind The Hospitable Meal Model is to present a conceptual model...... that can serve as a frame for developing hospitable meal competencies among professionals working within the area of institutional foodservices as well as a conceptual model for analysing meal experiences. The Hospitable Meal Model transcends and transforms existing meal models by presenting a more open......-ended approach towards meal experiences. The underlying purpose of The Hospitable Meal Model is to provide the basis for creating value for the individuals involved in institutional meal services. The Hospitable Meal Model was developed on the basis of an empirical study on hospital meal experiences explored...

  20. Staph infections - hospital

    Science.gov (United States)

    ... medlineplus.gov/ency/patientinstructions/000449.htm Staph infections - hospital To use the sharing features on this page, ... one person to another. Staph Infections in the Hospital Staph germs are mostly spread by skin-to- ...